bluuebunny/crossref_metadata_2025_split huggingface dataset:
Complications After Pediatric ACL Reconstruction: A Meta-analysis
Authors: Wong Stephanie E. , Feeley Brian T. , Pandya Nirav K. 
Published: September 2017

Background:
The purpose of this meta-analysis is to review clinical outcomes and complications following pediatric anterior cruciate ligament (ACL) reconstruction.

Methods:
The PubMed and EMBASE databases were searched for studies on ACL ruptures in the skeletally immature from 1985 to 2016. Full-text studies in English and performed on humans were included (n=5718). Titles included discussed operative intervention on skeletally immature patients with ACL tears (n=160). Studies that reported rerupture and/or complications with ACL reconstruction specific to the pediatric population, specifically growth disturbance, were then included in a secondary analysis (n=45). Complications not specific to the pediatric population were excluded. Demographics, graft type, surgical technique, follow-up, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate.

Results:
In total, 45 studies were included with 1321 patients and 1392 knees. The average age was 13.0 years, 67% were male, and mean follow-up was 49.6 months. There were 115 (8.7%) reruptures in the initial 160 studies reviewed. In total, 94.6% of patients with rerupture required revision ACL surgery. There were 58 total growth disturbances (16 required corrective surgery, or 27.6%). Eighteen knees (3.7%) developed angular deformity, most commonly valgus. There were 37 patients (7.5%) had at least a 1 cm limb-length discrepancy. A total of 23 studies reported International Knee Documentation Committee scores (range, 81 to 100, 88% grade A or B). In total, 20 studies reported excellent Lysholm scores with mean scores of 94.6.

Conclusions:
Growth disturbance can occur with any of the reconstruction techniques. Proper surgical technique is likely more important than the specific reconstruction technique utilized. Patients with rerupture require surgery at much higher rates than those with growth disturbance. Although much attention has been focused on growth disturbance, we suggest that equal attention be given to the prevention of rerupture in this age group.

Level of Evidence:
Level III.
Should Proximal Femoral Implants be Removed Prophylactically or Reactively in Children With Cerebral Palsy?
Authors: Truong Walter H. , Novotny Susan A. , Novacheck Tom F. , Shin Eyun-Jung , Howard Andrew , Narayanan Unni G. 
Published: September 2017

Background:
Implants are commonly used to stabilize proximal femoral osteotomies in children with cerebral palsy (CP). Removal of implants is common practice and believed to avoid infection, fracture, or pain that might be associated with retained hardware. There is little evidence to support a prophylactic strategy over a reactive approach based on symptoms. The aim of this study was to compare the outcomes of prophylactic and reactive approaches to removal of proximal femoral implants in children with CP.

Methods:
An intention-to-treat model was used to compare 2 institutions that followed a prophylactic (within ∼1 y) and reactive (following complication/symptoms) approach to hardware removal, respectively. Patients with CP who had femoral implants placed at or before age 16, and had ≥2-year postsurgical follow-up were included. Demographics, surgical details, reasons for removal, and complications were recorded. χ2 and t tests were used.

Results:
Six hundred twenty-one patients (prophylactic=302, reactive=319) were followed for an average of 6 years (range, 2 to 17 y). Two hundred eighty-seven (95%) implants were removed in the prophylactic group at 1.2 years. In the reactive group, 64 (20%) implants were removed at an average of 4.2 years. Reasons for removal included pain; infection; fracture; or for repeat reconstruction. The rate of unplanned removals due to fracture or infection was higher in the reactive group (4.7% vs. 0.7%, P=0.002), but there was no difference in the rate of complications during/after removal between the 2 groups (1.7% vs. 3.1%; P=0.616). No specific risk factor associated with unplanned removal could be identified; but children under 8 years old seemed more likely to undergo later removal (odds ratio 1.98; 95% confidence interval, 0.99-3.99).

Conclusions:
Eighty percent of patients in the reactive removal strategy avoided surgery. This group did have a 4% higher rate of fracture or infection necessitating unplanned removal but these were successfully treated at time of removal with no difference in complication rates associated with removal between both groups. One would need to remove implants from 25 patients to avoid 1 additional complication, providing some support for a reactive approach to removal of proximal femoral implants in this population.

Level of Evidence:
Level III—therapeutic.
Quantitative Analysis of Face and Neck Skin Tightening by Microfocused Ultrasound With Visualization in Asians
Authors: Lu Pei-Hsuan , Yang Chih-Hsun , Chang Ya-Ching 
Published: September 2017

BACKGROUND
Previous studies of microfocused ultrasound with visualization (MFU-V) on facial and neck laxity were largely based on masked physician assessments, histological analysis, and safety profile. More quantitative studies are needed.

OBJECTIVE
To evaluate the 800 treatment lines of MFU-V on skin tightening effect of face and neck in Asians using 2 quantitative analysis systems at 0, 90, and 180 days after treatment.

MATERIALS AND METHODS
Total 25 subjects were recruited in this prospective study. Subjects were treated with MFU-V to the face and neck using 2 different transducers: 4 MHz, 4.5-mm focal depth and 7 MHz, 3.0-mm focal depth with total 800 lines. The subjects were evaluated by skin complexion analysis and 3-dimensional imaging system at 0, 90, and 180 days. Mean brow height lift and submental lift were calculated.

RESULTS
All 25 subjects completed treatment and received the follow-up examinations at 90 and 180 days. Two of the 25 subjects were male. Mean patient age was 53.3 years (range: 39.8–61.1 years). Wrinkles, texture, and pores were 3 variables relevant to analysis of skin laxity. Only mean wrinkles score reduction at 90 days was statistically significant (p = .0222). There was a mean 0.47 mm brow lift at 90 days (p = .0165), but there was a 0.12 mm decrease in brow height compared to baseline at 180 days (p = .6494). At 90 days, a mean 26.44 mm2 submental lift was noted (p = .0217). And at 180 days, a mean 13.76 mm2 submental lift was noted (p = .243).

CONCLUSION
This study showed that the most prominent change after the 800-line MFU-V treatments in Asians was the significant submental lift at 90 days. Other noninvasive or minimally invasive treatment modalities can be considered to combine with MFU-V for the optimal treatment response. Additional MFU-V treatments can be considered 3 months after the first treatment.
Clinical Benefits of Preoperative Conventional Fluorescence Diagnosis in Surgical Treatment of Extramammary Paget Disease
Authors: Wan Miaojian , Ma Han , Zhao Yue , Xie Lin , Chen Zhirui 
Published: September 2017

BACKGROUND
In extramammary Paget disease (EMPD), initial margins of surgical excision are difficult to determine preoperatively. Fluorescence diagnosis (FD) may have utility as a noninvasive method for delineating tumor boundaries.

OBJECTIVE
The relationship between FD-delineated borders and results of multiple scouting biopsies (MSBs) in EMPD was investigated, evaluating the potential clinical role of FD.

MATERIALS AND METHODS
A cohort of 21 patients was studied, looking for consistencies between FD and MSB results. Initial surgical margins were determined by FD or FD plus MSB. All margins were subjected to frozen section analysis.

RESULTS
Paget cells were identified in 88 of 117 (71.8%) biopsies obtained from FD borders. When used preoperatively with MSB in 9 patients, 96.4% of margins proved negative at initial resection stage. Using a 6-mm margin beyond FD borders in another 9 patients, 86.7% of margins were negative at initial stage. The maximum distance of excision beyond FD border was 12 mm.

CONCLUSION
Fluorescence diagnosis borders (identified visually) correlated well with MSB histopathology. Fluorescence diagnosis is a useful method to delineate initial margins for surgical resection of EMPD.
Successful Second Microsurgical Replantation for Amputated Penis
Authors: Fujiki Masahide , Ozaki Mine , Kai Akiko , Takushima Akihiko , Harii Kiyonori 
Published: September 2017

Summary:
Penile amputation is a rare emergency, but the best method for its repair is required due to the organ’s functional and societal role. Since the first successful microsurgical replantation of the amputated penis, microsurgical techniques have matured and become the standard treatment for the penile replantation. However, the successful second microsurgical replantation for amputated penis has been rarely reported. We present the case of a 40-year-old man with schizophrenia who had a past history of penile self-mutilation and successful replantation at another hospital 2 years ago. After stopping oral medication for schizophrenia, he again cut his penis with a kitchen knife. We successfully replanted the amputated penis by anastomosing both circumflex arteries, the superficial dorsal vein, and the deep dorsal vein using microsurgical techniques. Postoperatively, the foreskin of the replanted penis gradually developed partial necrosis, requiring surgical debridement. The aesthetic and functional results were satisfactory and retrograde urethrography showed no evidence of leakage and stricture of the urethra. Although skin necrosis after penile replantation has been reported as an unavoidable process owing to the nature of injury, the rate would be higher after secondary replantation because of scar formation due to the previous operation. Therefore, our case of successful secondary replantation suggests that skin necrosis would be a predictable postoperative complication and the debridement timing of the devitalized foreskin should be closely monitored, and also secondary amputation is not a contraindication of replantation.
Analysis of Hypokalemia as a Side Effect of Liposomal Amphotericin in Pediatric Patients
Authors: Kobayashi Ryoji , Keino Dai , Hori Daiki , Sano Hirozumi , Suzuki Daisuke , Kishimoto Kenji , Kobayashi Kunihiko 
Published: September 2017

Background:
Liposomal amphotericin (L-AMB) is a widely used broad-spectrum antifungal drug. Although L-AMB demonstrates better safety compared with amphotericin, renal dysfunction and hypokalemia are well-known adverse effects of L-AMB.

Method:
We analyzed 56 episodes in 40 children and adolescents who received L-AMB therapy to determine risk factors of hypokalemia.

Results:
Hypokalemia (<3.0 mEq/L continuously for more than 2 episodes) was observed in 31 of 56 episodes (55.4%). The median onset of hypokalemia was at 10 days on L-AMB (range, 3–54 days), and the median cumulative dose of L-AMB at occurrence of hypokalemia was 25 mg/kg (range, 10–167.5 mg/kg). None of the patients with hypokalemia had solid tumors, and they had significantly higher estimated glomerular filtration rates than those with normokalemia (P = 0.013). Seven of 25 (28.0%) patients in the normokalemia group and 1 of 31 (3.2%) patients in the hypokalemia group had eGFRs of <90 mL/min/1.73 m2 (P = 0.017).

Conclusion:
Although the reason for the association between estimated glomerular filtration rates and hypokalemia is unclear, assessing the estimated glomerular filtration rates before L-AMB administration may predict the development of hypokalemia.
Resurgence of Pertussis and Emergence of the Ptxp3 Toxin Promoter Allele in South Italy
Authors: Loconsole Daniela , De Robertis Anna Lisa , Morea Anna , Metallo Angela , Lopalco Pier Luigi , Chironna Maria 
Published: September 2017

Background:
Despite universal immunization programs, pertussis remains a major public health concern. This study aimed to describe the pertussis epidemiology in the Puglia region in 2006–2015 and to identify recent polymorphisms in Bordetella pertussis virulence-associated genes.

Methods:
The pertussis cases in 2006–2015 were identified from the National Hospital Discharge Database and the Information System of Infectious Diseases. Samples of pertussis cases in 2014–2016 that were confirmed by the Regional Reference Laboratory were subjected to ptxA, ptxP and prn gene sequencing and, in 10 cases, multiple-locus variable-number tandem repeat analysis.

Results:
In Puglia in 2006–2015, the pertussis incidence rose from an average of 1.39/100,000 inhabitants in 2006–2013 to 2.56–2.54/100,000 in 2014–2015. In infants <1 year of age, the incidence rose from an average of 60.4/100,000 infants in 2006–2013 to 149.9/100,000 in 2015. Of the 661 cases recorded in 2006–2015, 80.3% required hospitalization; of these, 45.4% were <1 year of age. Of the 80 sequenced samples, the allelic profile ptxA1-ptxP3-prn2 was detected in 74. This variant was detected in both vaccinated and unvaccinated people. Six Bordetella pertussis samples were prn deficient. The multiple-locus variable-number tandem repeat analysis cases exhibited multiple-locus variable-number tandem repeat analysis-type 27.

Conclusions:
The pertussis incidence in Puglia has risen. The hypervirulent strain was also found in vaccinated people. This suggests bacterial adaptation to the vaccine and raises questions about acellular vaccine effectiveness. Prevention of infant pertussis cases is best achieved by immunizing the pregnant mother. Enhanced surveillance and systematic laboratory confirmation of pertussis should be improved in Italy.
Correlates of Nonimprovement to Pharmacotherapy for Chronic, Antidepressant-Resistant, Military Service–Related Posttraumatic Stress Disorder
Authors: Byrne Simon P. , Krystal John H. , Rosenheck Robert A. , Vessicchio Jennier , Pietrzak Robert H. 
Published: September 2017

Abstract

Background
Posttraumatic stress disorder (PTSD) is a chronic and often difficult-to-treat condition that is prevalent among military veterans. First-line pharmacotherapy for this population typically involves antidepressants; however, veterans who do not improve are sometimes prescribed antipsychotics such as risperidone. A 2011 randomized controlled trial of adjunctive risperidone versus placebo for veterans with chronic, antidepressant-resistant, military service–related PTSD revealed no difference between groups. Hence, there is a need to examine predictors of nonimprovement for chronic, treatment-resistant PTSD.

Methods
We examined correlates of nonimprovement and delayed improvement (ie, ≥12 weeks) using data from 267 veterans with chronic, antidepressant-resistant PTSD who were prescribed adjunctive risperidone or a placebo. Veterans received 1 to 4 mg adjunctive risperidone (n = 133; mean dose, 2.74 mg) or a placebo daily (n = 134) in addition to their original treatment regimen over the 24-week trial.

Results
Greater severity of PTSD symptoms at baseline, specifically reexperiencing (ie, nightmares) and emotional numbing (ie, sense of foreshortened future), was independently associated with nonimprovement. Of the 194 veterans (72.7%) who did improve, 95 (49.0%) showed delayed improvement, taking 12 weeks or longer to demonstrate a 10-point reduction in Clinician-Administered PTSD Scale scores. Emotional difficulties affecting role functioning, as assessed using the Veterans RAND 36-item Health Survey, independently predicted nonimprovement.

Conclusions
While results are indicative of nonspecific pharmacotherapeutic effects, they suggest that specific PTSD symptom clusters and impairment are associated with variable improvement in veterans with antidepressant-resistant PTSD. They underscore the importance of developing more effective and targeted pharmacotherapies for specific symptom clusters in this population.
Randomized Controlled Trial of Self-directed Versus In-Classroom Education of Narrow Band Imaging in Diagnosing Colorectal Polyps Using the NICE Criteria
Authors: Allen James E. , Vennalaganti Prashanth , Gupta Neil , Hornung Benjamin , Choudhary Abhishek , Titi Mohammad , Alsop Benjamin R. , Lim Diego , Sharma Prateek 
Published: September 2017

Background:
The optimal method for teaching NBI International Colorectal Endoscopic (NICE) criteria to medical trainees is unknown.

Methods:
Trainees (medical students, residents, and gastroenterology fellows) were randomized to 2 groups (in-classroom vs. self-directed training). Teaching phase: A standardized presentation was developed about narrow band imaging (NBI) and NICE criteria. The in-class teaching group attended a single live-teaching session (with NBI expert). The self-directed training group was provided with the same educational tool with recorded audio. Testing phase: All participants provided their predicted histology and their level of confidence. After completing initial 10 clips, the in-class teaching group received live feedback (NBI expert), whereas the self-teaching group received automated audio feedback. All participants then reviewed the next 30 NBI videos. The diagnostic performance of NBI in predicting histology was compared between the 2 groups.

Results:
Twenty medical trainees (8 students, 8 residents, and 4 gastroenterology fellows) participated in the study. The overall accuracy, sensitivity, specificity, and negative predictive value in using NBI to predict histology were: 79.0% [95% confidence interval (CI), 76.2-81.8], 69.5% (95% CI, 65.0-74.0), 88.5% (95% CI, 85.3-91.6), and 74.4% (95% CI, 70.4-78.3). There were no significant differences in the performance characteristics between the in-classroom and self-directed groups for all responses including those answered with high confidence.

Conclusions:
Using a standardized educational tool, the accuracy of distinguishing adenomatous versus hyperplastic colon polyps using NBI between the in-class teaching and self-directed learning were similar. This suggests that both training methods can be utilized for the education of medical trainees in the use of NICE criteria.
Trafficking and Trauma
Authors: Ravi Anita , Pfeiffer Megan R. , Rosner Zachary , Shea Judy A. 
Published: September 2017

Background:
Sex-trafficked persons experience significant trauma while exploited, resulting in complex health issues and barriers to health care. Incorporating survivor perspectives is critical in optimizing health care delivery for this population.

Objectives:
We interviewed sex-trafficking survivors regarding their experiences with trauma while being trafficked and elicited advice about health care delivery.

Research Design:
Qualitative interviews were conducted in New York City’s Rikers Island jail from July to September 2015.

Subjects:
In total, 21 English-speaking women who had experienced sex trafficking were the subjects of the study.

Measures:
Interview domains included: interpersonal violence, behavioral health, and health care delivery advice.

Results:
Interviewees described experiencing severe and chronic trauma perpetrated by traffickers and sex buyers. Substance use was the primary method of coping with trauma. With regard to mental health, interviewees noted diagnoses of depression, anxiety and posttraumatic stress disorder, low self-esteem, and challenges in intimate relationships. Health care delivery themes included approaches to discussing trafficking in health care settings, concerns regarding sexual assault examinations, and suggestions for improving direct-services and prevention programming.

Conclusions:
With this perspective into the complex intersection of trauma and behavioral health that sex-trafficked women can experience, health care providers can better understand the context and recommendations regarding trauma-informed care practices for this population. Our results also offer several avenues for future studies with regard to discussing trafficking in clinical settings and an opportunity for stakeholders to incorporate survivor-based input to improve health care for this population.
Implant Porosity and the Foreign Body Response
Authors: Jordan Sumanas W. , Fligor Jennifer E. , Janes Lindsay E. , Dumanian Gregory A. 
Published: September 2017

Summary:
The biocompatibility of prosthetic mesh is dependent on a number of physicochemical properties that ultimately incite an optimal foreign body response. The magnitude and character of the foreign body response directly affect the clinical success of the hernia repair, with too little scar resulting in bulge or hernia recurrence and too much scar causing mesh wrinkling and pain. Moreover, it is important to consider the effect of a sustained foreign body response and scar remodeling on the combined strength of the mesh-tissue construct over time. Understanding key elements that determine the foreign body response, such as implant porosity, surface area, and filament size, is critical to the performance of surgery. New absorbable materials introduce the additional variable of durability and persistence of the foreign body response after the foreign body itself has dissolved. In this review, we discuss the experimental and clinical literature relating the quality of the foreign body response to the physical attributes of implants in an effort to demystify prosthetic mesh selection.
Columellar Reconstruction following Nasal Continuous Positive Airway Pressure Injury
Authors: Chang Catherine S. , Swanson Jordan W. , Wilson Anthony , Low David W. , Bartlett Scott P. 
Published: September 2017

Summary:
Nasal continuous positive airway pressure is used increasingly to treat pulmonary immaturity in premature neonates. Nasal injury is common with nasal continuous positive airway pressure use, with full-thickness tissue loss at the columella among the most devastating complications. Columellar necrosis often imparts a full-thickness injury to the overlying columellar skin, the medial crura of the lower lateral nasal cartilages, the anteromedial inner nasal mucosal lining, and potentially the anterior septal cartilage. Consequently, the columella can become scarred and shortened. Although multiple techniques have been described to reconstruct the columella, no known technique has been specifically developed to treat the unique columellar defect common to severe nasal continuous positive airway pressure injury. Donor-site morbidity related to these techniques, and how growth of the reconstructed nose will proceed, are obvious concerns, especially in young children. The authors present a novel reconstruction technique that uses recreation of the defect with posteriorly based book flaps and auricular chondrocutaneous composite graft interposition. This technique has several advantages, including avoiding central facial scars, supplying well-matched skin color and texture, and facilitating robust tip support. The authors retrospectively review the use and outcomes of this technique from 1995 and 2016 on all patients with a history of nasal continuous positive airway pressure columellar necrosis at their center.