bluuebunny/crossref_metadata_2025_split huggingface dataset:
Failures and Successes in Total HIP Replacement-Why Good Ideas May Not Work
Authors: Morscher E. W. 
Published: July 2017

The course of development of total hip replacement (THR) is neither harmonious nor linear. Progress and set-backs alternate. Progress in THR manifests itself through reductions in the number and the severity of complications (infection, aseptic loosening, prematurely worn components, etc.). Innovation is the motor of progress. However, today's innovation may well be tomorrow's revision! Progress has been achieved in part through new implant materials and designs that provide improvements in such things as stress distribution in surrounding bone, tissue compatibility and osseointegration, and resistance to both wear and cyclic fatigue. Of at least equal importance, however, are improvements achieved in operative procedures (e.g., cementing technique) and finally, in clinical quality control: more complete documentation of implant and patient variables, establishment of implant registers, and utilization of outcome studies to guide the course of further development. Causes of failure in THR are numerous. However, unexpected side effects of innovations are the most frequent cause. An innovation may solve one problem, but also creates new ones. Problems in innovation which can lead to failures include: over-generalization of expected patient responses, ignoring past experience or assigning wrong causes to encountered problems, and finally, ignoring the dynamic nature of the living system (which can be described as using “necro-” instead of biomechanical thinking). Quality control in both manufacturing and clinical practice has to be improved. The pioneer times have come to an end. Today's patients should have the right to be operated on by a well trained surgeon and to be provided with well tested, well-understood implant materials and devices. Progress in endoprosthetics has led to the present high level of clinical success. Paradoxically, however, success is the greatest obstacle to further progress. This is because the curve of progress as a result of effort expended has turned asymptotic in endoprosthetics, as it does in many endeavors. In such situations the more a product (e.g., surgical implant and procedure, automobile design, computer program) becomes successful, the more efforts (and finances) are needed for further progress. On the other hand, the “scissors” — Created by crossing what might be feasible with what resources are available — Open widely and can cut sharply. In fact, financial restrictions may force orthopaedic surgeons and the medical device and technology industry to turn to lower technologies in the future. However, whatever new developments in endoprosthetics may bring (be they sophistications or simplifications), we must remain open-minded and not assume things to be facts until there is evidence to support them.
Endovascular vs Open AAA Repair: Similar Effects on Renal Proximal Tubular Function
Authors: Aho P.-S. , Niemi T. , Lindgren L. , Lepäntalo M. 
Published: July 2017

Aim: To compare the effect of open and endovascular repair on renal function. Materials and methods: In a prospective, non-randomized study twenty-four abdominal aortic aneurysms (AAA) treatable with either method were repaired, 15 using endovascular device (ENDO group) and nine with open surgery with infrarenal aortic cross-clamping (OPEN group). All the patients had standardised general anaesthesia, intravascular fluid therapy and monitoring. Renal function tests and cardiovascular measurements were performed at predetermined intervals. Results: N-acetyl-β-D-glucosaminidase indexed to urinary creatinine (U-NAG/crea), sensitive marker of renal proximal tubular damage, increased similarly in both groups at the end of surgery (two-way ANOVA, p < 0.05). No patient developed clinical renal impairment, on the contrary, creatinine clearance was increased, serum cystatin C (a sensitive marker of renal glomerular filtration) and serum creatinine concentration decreased at 24 hours postoperatively (Wilcoxon paired test, p < 0.05). Intraoperative blood loss and the amount of administered crystalloids were higher in the OPEN than in the ENDO group (Mann-Whitney U-test, p < 0.05). The cardiovascular measurements were comparable between the groups. The mean (SD) amount of radio-contrast media given was 3.1 (1.1) ml/kg in the ENDO group. Conclusions: Our results indicate that endovascular AAA repair does not protect renal proximal tubular function. A temporary renal tubular dysfunction was found both in open and in endovascular AAA repair which did not lead to permanent changes in renal function.
The Effect of Fibrin Sealant Combined with Fibrinolysis Inhibitor on Reducing the Amount of Lymphatic Leakage after Axillary Evacuation in Breast Cancer
Authors: Mustonen P. K. , Härmä M. A. , Eskelinen M. J. 
Published: July 2017

Background and Aims: One third of women undergoing mastectomy with axillary evacuation for primary breast cancer suffer from postoperative seromas leading to unnecessary costs and complications such as infections and new operations. Different methods to prevent seroma formation have been tried without permanent success. The aim of this prospective randomised study was to examine the effect of fibrin sealant with fibrinolysis inhibitor firstly on the reduction of the amount of lymphatic leakage after axillary evacuation and secondly on the reduction of days with drains and postoperative seroma punctures. Methods: 40 patients with primary breast cancer were prospectively randomised to the treatment group (n = 19) getting fibrin clue combined with fibrinolysis inhibitor (aprotinin) sprayed into the axillary fossa and to the control group (n = 21). Results: There were no differences in the incidence of postoperative seromas between the groups. However, the seromas were easier to treat if fibrin clue was used. Total quantity (mean ± SD) of lymphorrhea and total number of aspirations (mean ± SD) were almost twice as high in the patients of the control group compared to those having fibrin sealant. In the treatment group seromas resolved after one or occasionally after two aspirations in 71 % of patients, while in the control group 90 % of patients needed three or more aspirations. Conclusion: Potentially, fibrin sealant combined with fibrinolysis inhibitor might be used for the treatment of post-axillary evacuation lymphorrhea and seroma.
Hip Fractures in Finland — A Comparison of Patient Characteristics and Outcomes in Six Hospitals
Authors: Heikkinen T. , Willig R. , Hänninen A. , Koskinen K. , Mannismäki P. , Alavaikko A. , von und zu Fraunberg M. , Jalovaara P. 
Published: July 2017

Background and Aims: To compare six Finnish hospitals for the quality of treatment of hip fractures and to obtain information for the development of care. Material and Methods: Data of 1179 consecutive hip fracture patients (about 200 patients per hospital) was collected prospectively, using similar standardized forms and focusing on background factors and the four-month functional outcome. Results: There were significant differences between the hospitals in patient characteristics (age, place of residence, walking ability, use of walking aids, morbidity and type of fracture) and in the unadjusted outcome variables at four months' follow-up (place of residence, mobility, use of walking aids and pain in injured hip). After adjustment for baseline characteristics, there was a significant difference in the post-fracture walking ability between the centres but no significant differences in post-fracture place of residence. Unadjusted mortality did not vary between the centres, but adjustment resulted in significant differences. The most marked difference in surgical methods between the hospitals was seen in the use of either sliding hip screw or Gamma Nail for trochanteric fractures, but this difference was not reflected in the results of multivariate analysis. Conclusions: We found minor differences in mobility and mortality between the participating hospitals, and these might serve them as a stimulus for improving their standard of good practice. Continuous quality improvement by repeating the audit cycle is recommended in order to reach and then improve the prevalent standards in the care of hip fracture patients. Confounding factors should be adjusted when comparing the medical centres treating hip fractures, and the evaluation of the results should be multidimensional.
Treatment of Pancreatic Pseudocysts
Authors: Andrén-Sandberg Å. , Ansorge C. , Eiriksson K. , Glomsaker T. , Maleckas A. 
Published: July 2017

According to the Atlanta classification an acute pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of acute pancreatitis or pancreatic trauma, whereas a chronic pseudocyst is a collection of pancreatic juice enclosed by a wall of fibrous or granulation tissue, which arises as a consequence of chronic pancreatitis and lack an antecedent episode of acute pancreatitis. It is generally agreed that acute and chronic pseudocysts have a different natural history, though many reports do not differentiate between pseudocysts that complicate acute pancreatitis and those that complicate chronic disease. Observation — “conservative treatment” — of a patient with a pseudocyst is preponderantly based on the knowledge that spontaneous resolution can occur. It must, however, be admitted that there is substantial risk of complications or even death; first of all due to bleeding. There are no randomized studies for the management protocols for pancreatic pseudocysts. Therefore, today we have to rely on best clinical practice, but still certain advice may be given. First of all it is important to differentiate acute from chronic pseudocysts for management, but at the same time not miss cystic neoplasias. Conservative treatment should always be considered the first option (pseudocysts should not be treated just because they are there). However, if intervention is needed, a procedure that is well known should always be considered first. The results of percutaneous or endoscopic drainage are probably more dependent on the experience of the interventionist than the choice of procedure and if surgery is needed, an intern anastomosis can hold sutures not until several weeks (if possible 6 weeks).
Sandbox deployment model for services in modeling and simulation as a service
Authors: Martinez-Salio Jose-Ramon 
Published: July 2017

Modeling and simulation as a service (MSaaS) is based on the idea of simulation services deployed in any host device under demand. These services can be anything from a small plug-in to a full-scale system. The users and devices requesting the simulation can be placed anywhere. The whole MSaaS concept is based on modeling and simulation services that comply with simulation standards, are compliant with a certain level of security (multilevel security), and can interoperate and interact with other services or with the host device, in a seamless way. This article centers on the election of the deployment model of the services, already finished, inside the MSaaS model. That is, choosing the best way in which the services will be made available for the final user in a systemic and institutionalized way. The selection of the proper development model is one of the most critical activities in MSaaS that can determine the final success of the whole initiative. Starting from a finished model, the election of the best deployment model is discussed by considering how to control and guarantee the services in terms of quality of the software, security, and quality of the features.
Femoroacetabular Impingement in Athletes, Part II
Authors: Byrd J. W. Thomas 
Published: July 2017

Context: Femoroacetabular impingement (FAI) is a common cause of hip pathology and secondary dysfunction among athletes. Much information has been gained regarding the cause and pathomechanics of this disorder. Now, efforts are focusing on treatment to restore the joint and reduce the secondary damage that causes painful dysfunction. Evidence Acquisition: This article reviews the scientific literature in reference to treatment of FAI in athletes. Results: Several studies reported reasonably successful outcomes in the arthroscopic management of FAI in athletes, and 1 study reported on open surgical correction of this disorder. Few major complications have been described. Conclusions: When the diagnosis is given early, some athletes may benefit from a rehabilitation strategy that includes training modifications to protect the at-risk hip. When indicated, arthroscopic surgery can address the joint damage and correct the underlying impingement. Although the joint may not be normal, successful results with return to sports can often be expected.
A Descriptive Evaluation of a Self-Care Medication Program in Industry
Authors: Ondrejka Dennis 
Published: July 2017

A Self-Care Medication Program was developed in an industrial plant in an effort to decrease the nursing workload from non-occupational related visits. Minimal health education was provided by having self-help books available, but the reading of this material was not mandatory prior to an employee utilizing the program. Data were collected over a 33-month period and then evaluated using incident rates which allows for a comparison from one year to another. The incident rate (I.R.) for a specific type of visit was the number of visits (Incidence=I) for each 100 employees in a one-year time period, divided by the total number of hours worked. [Formula: see text] The Self-Care Medication Program had one complicated outcome in 23,250 visits. The self-care visits were inversely related to non-occupational visits and as the self-care visits increased, there was a reduction in the non-occupational visits by 65%. For each self-care visit there was a 16.5-minute savings. A self-care visit averaged 0.6 minutes while the one-to-one contact with the nurse and waiting time totaled 17.1 minutes. The average length of time for the one-to-one visit with the nurse totaled 10 minutes. This industrial setting, with only 2200 employees had an annualized savings of 2321 lost production time hours with an additional savings of 1406 nurse treatment hours. The Self-Care Medication Program appears to be a safe, cost avoidance manpower saver that has the capability of reducing healthcare provider headcount or freeing up the time for other purposes. It supports those theories which espouse that people can provide for themselves and do it safely when treating minor symptomatic health problems such as colds, stomach upset, headache and sore throats. It appears to be a viable alternative healthcare method capable of saving significant amounts of money in terms of time saved.
Occupational Health in Spain: The Worker's Perspective
Authors: Barber-Madden Rosemary , Glanz Karen 
Published: July 2017

This paper was written partially on the basis of an occupational health clinical study in Spain conducted by the authors in September 1982. The information discussed in this paper was obtained through site visits to factories and their medical services departments, to hospitals contracted by the social security system, and to a university school of nursing. In addition, we had the opportunity to observe contruction and agricultural workers. Our observations during the visit were limited to sites in central and southern Spain. A review of the literature provided background information on the Spanish labor force, work and living conditions of Spanish workers, political events influencing industrial relations and economic development, and some case examples of epidemiological studies in occupational health.
Crohn's Disease — More Than a Chronic Illness
Authors: Messner Roberta , Gardner Sylvia , Lewis Susan 
Published: July 2017

Crohn's disease is a chronic, inflammatory bowel disease which may occur in single or multiple areas of the entire GI tract from the mouth to the anus. This multifaceted disorder is manifested by various unpredictable health disturbances, affecting its victims' physical and psychosocial well-being. Individuals with Crohn's disease present a multitude of nursing challenges as they often lack the positive effects of proper nutrition, physical activity, emotional expression, interpersonal relationships, and family life. Nurses are the primary care providers who can comprehensively address the varied and complex health care needs of individuals with Crohn's disease. The core theme is the belief that it is essential for these individuals to maintain a sense of control in the midst of an altered lifestyle. Occupational health nurses can assist employees with Crohn's disease to develop a variety of physical and psychosocial strategies to cope with the unpleasant, even repugnant, aspects of a disease for which there is no known cure. The promotion of optimal health, based on the nursing process, is the objective toward which the unique efforts of nursing are directed.
Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM)
Authors: Hidalgo-Tenorio Carmen , Ramírez-Taboada Jessica , Gil-Anguita Concepción , Esquivias Javier , Omar-Mohamed-Balgahata Mohamed , SamPedro Antonio , Lopez-Ruz Miguel , Pasquau Juan 
Published: July 2017

AbstractBackgroundSafety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine were evaluated in HIV-positive Spanish MSM. The prevalence of High Squamous Intraepithelial Lesions (HSIL) and genotypes of high-risk human papillomavirus (HR-HPV) were also determined, as well as risk factors associated with the presence of HR-HPV in anal mucosa.MethodsThis is a randomised, double blind, placebo-controlled trial of the quadrivalent HPV (qHPV) vaccine. The study enrolled from May 2012 to May 2014. Vaccine and placebo were administered at 0, 2 and 6 months (V1, V2, V3 clinical visits). Vaccine antibody titres were evaluated at 7 months. Cytology (Thin Prep®Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope) were performed at V1.ResultsPatients (n = 162; mean age 37.9 years) were screened for inclusion; 14.2% had HSIL, 73.1% HR-HPV and 4.5% simultaneous infection with HPV16 and 18. Study participants (n = 129) were randomized to qHPV vaccine or placebo. The most common adverse event was injection-site pain predominating in the placebo group [the first dose (83.6% vs. 56.1%; p = 0.0001]; the second dose (87.8% vs. 98.4%; p = 0.0001); the third dose (67.7% vs. 91.9%; p = 0.0001). The vaccine did not influence either the viral load of HIV or the levels of CD4. Of those vaccinated, 76% had antibodies to HPV vs. 30.2% of those receiving placebo (p = 0.0001). In the multivariate analysis, Older age was associated with lower HR-HPV infection (RR 0.97; 95% CI 0.96–0.99), and risk factor were viral load of HIV >200 copies/µL (RR 1.42 95% CI 1.17–1.73) and early commencement of sexual activity (RR 1.35; 95% CI 1.001–1.811).ConclusionsThis trial showed significantly higher anti-HR-HPV antibody titres in vaccinated individuals than in unvaccinated controls. There were no serious adverse events attributable to the vaccine. In our cohort, 1 of every 7 patients had HSIL and the prevalence of combined infection by genotypes 16 and 18 was low. This suggests that patients could benefit from receiving qHPV vaccine. Older age was the main protective factor against HR-HPV infection, and non-suppressed HIV viremia was a risk factor.Clinical trial registration: ISRCTN14732216 (http://www.isrctn.com/ISRCTN14732216).
A small-molecule/cytokine combination enhances hematopoietic stem cell proliferation via inhibition of cell differentiation
Authors: Wang Lan , Guan Xin , Wang Huihui , Shen Bin , Zhang Yu , Ren Zhihua , Ma Yupo , Ding Xinxin , Jiang Yongping 
Published: July 2017

Abstract
Background
Accumulated evidence supports the potent stimulating effects of multiple small molecules on the expansion of hematopoietic stem cells (HSCs) which are important for the therapy of various hematological disorders. Here, we report a novel, optimized formula, named the SC cocktail, which contains a combination of three such small molecules and four cytokines.

Methods
Small-molecule candidates were individually screened and then combined at their optimal concentration with the presence of cytokines to achieve maximum capacity for stimulating the human CD34+ cell expansion ex vivo. The extent of cell expansion and the immunophenotype of expanded cells were assessed through flow cytometry. The functional preservation of HSC stemness was confirmed by additional cell and molecular assays in vitro. Subsequently, the expanded cells were transplanted into sublethally irradiated NOD/SCID mice for the assessment of human cell viability and engraftment potential in vivo. Furthermore, the expression of several genes in the cell proliferation and differentiation pathways was analyzed through quantitative polymerase chain reaction (qPCR) during the process of CD34+ cell expansion.

Results
The SC cocktail supported the retention of the immunophenotype of hematopoietic stem/progenitor cells remarkably well, by yielding purities of 86.6 ± 11.2% for CD34+ cells and 76.2 ± 10.5% for CD34+CD38– cells, respectively, for a 7-day culture. On day 7, the enhancement of expansion of CD34+ cells and CD34+CD38– cells reached a maxima of 28.0 ± 5.5-fold and 27.9 ± 4.3-fold, respectively. The SC cocktail-expanded CD34+ cells preserved the characteristics of HSCs by effectively inhibiting their differentiation in vitro and retained the multilineage differentiation potential in primary and secondary in vivo murine xenotransplantation trials. Further gene expression analysis suggested that the small-molecule combination strengthened the ability of the cytokines to enhance the Notch pathway for the preservation of HSC stemness, and inhibited the ability of the cytokines to activate the Wnt pathway for HSC differentiation.

Conclusions
We developed an optimal small-molecule/cytokine combination for the enhancement of HSC expansion via inhibition of differentiation. This approach indicates promising application for preparation of both the HSCs and the mature, functional hematopoietic cells for clinical transplantation.
Opposing regulation and roles for PHD3 in lung dendritic cells and alveolar macrophages
Authors: Tavernier Simon J , Vanlangenakker Nele , Vetters Jessica , Carmeliet Peter , Janssens Sophie , Lambrecht Bart N 
Published: July 2017

Abstract
The prolyl hydroxylase domain-containing enzymes (PHDs) are important metabolic sensors of the cell and its environment, which might be employed to alert cells of the immune system. These enzymes regulate the expression of the hypoxia inducible factor (HIF) isoforms and NF-κB, crucial transcription factors controlling cellular metabolism and inflammation. PHD/HIF signaling is activated in the allergic lung and is proposed as a potential druggable pathway. Here, we investigated the regulation and role of the PHD isoforms in CD11c-expressing dendritic cells (DCs) and macrophages (Mϕ), sensors of the environment and crucial antigen-presenting cells in the pathogenesis of asthma. Although PHD2 and PHD3 were expressed in baseline, stimulation with house dust mite (HDM) allergen, hypoxia, and TLR4 ligands induced the expression of PHD3 in DCs. Conditional deletion or overexpression of PHD3 in CD11chi cells had minor effects on DCs and alveolar Mϕ biology in steady state. However, when put into competition with wild-type counterparts in mixed chimeric mice, alveolar Mϕ uniquely required PHD3 for optimal reconstitution of the alveolar space. Using genetic and chemical approaches, we were unable to find a clear role for PHD3 or the other PHD isoforms in DCs in asthma development. These data show cell-specific competitive advantage of PHD3 expression in antigen-presenting cells, but question whether therapeutic manipulation of PHDs in DCs would offer therapeutic benefit in asthma.