bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pleural lymphocyte-rich transudates in cats
Authors: Probo Monica , Valenti Valentina , Venco Luigi , Paltrinieri Saverio , Lavergne Emme , Trumel Catherine , Bertazzolo Walter 
Published: September 2017

Objectives Non-chylous lymphorrhagic pleural effusions are transudative effusions with a predominance of lymphocytes; however, they do not contain chylomicrons and therefore do not have the classical milky aspect of true chylous effusion. This type of effusion has been anecdotally associated with cardiac diseases in cats, but studies are lacking. The aim of this study was to investigate the association between this type of effusion and the primary disease. Methods In this study, feline non-chylous lymphorrhagic pleural effusions were retrospectively selected from the database of the authors’ institutions over a 3 year period. All cases underwent thoracic imaging, including echocardiography. Effusions classified as transudates with a predominance of lymphocytes on cytology were included. Results Thirty-three cases fulfilled the inclusion criteria: 23 (69.7%) had a concurrent cardiac disease, eight (24.2%) cases were associated with the presence of a mediastinal lymphoma or carcinoma or a thoracic mass, one case (3.0%) was a thymoma and one case (3.0%) was a sequela of a pyothorax. Conclusions and relevance Since a clear lymphatic origin of the fluid could not be demonstrated, lymphocyte-rich transudate might be considered a better designation for these kinds of effusions rather than non-chylous lymphorrhagic effusions. Although the number of cases in this preliminary study is low, the presence of a pleural lymphocyte-rich transudate in a cat should prompt the search for cardiac disease or intrathoracic neoplasia.
Recurrence of disease activity during pregnancy after cessation of fingolimod in multiple sclerosis
Authors: Meinl Ingrid , Havla Joachim , Hohlfeld Reinhard , Kümpfel Tania 
Published: September 2017

Background: Fingolimod is an effective treatment for active relapsing–remitting multiple sclerosis (MS). Discontinuation of therapy may be followed by recurrence of disease activity. Thus, female MS patients may be at risk of relapse during pregnancy after stopping fingolimod. Objectives and methods: To report the disease course during pregnancy of five women who interrupted therapy with fingolimod for pregnancy. Results: All patients experienced relapses during pregnancy and/or postpartum after stopping fingolimod. Conclusion: The risk of recurrence of disease activity during pregnancy after stopping fingolimod may be substantial. This should be considered and discussed with MS patients who are planning to become pregnant.
Prognostic usefulness of an age-adapted equation for renal function assessment in older patients with acute coronary syndrome
Authors: Rioboo Lestón Lucía , Abu-Assi Emad , Raposeiras-Roubin Sergio , Cobas-Paz Rafael , Caneiro-Queija Berenice , Rodríguez-Rodríguez Jose Manuel , Íñiguez-Romo Andres 
Published: September 2017

Background: Renal dysfunction negatively impacts survival in acute coronary syndrome patients. The Berlin Initiative Study creatinine-based (BIScrea) equation has recently been proposed for renal function assessment in older persons. However, up to now it is unknown if the superiority of the new BIScrea equation, with respect to the most recommended chronic kidney disease epidemiology collaboration creatinine-based (CKD-EPIcrea) formula, would translate into better risk prediction of adverse events in older patients with acute coronary syndrome. Objectives: To study the impact of using estimated glomerular filtration rate calculated according to the BIScrea and CKD-EPIcrea equations on mortality in acute coronary syndrome patients aged 70 years and over. Methods: Retrospectively, between 2011 and 2016, a total of 2008 patients with acute coronary syndrome (64% men; age 79±7 years) were studied. Follow-up was 18±10 months. Measures of performance were evaluated using continuous data and stratifying patients into three estimated glomerular filtration rate subgroups: ≥60, 59.9–30 and <30 mL/min/1.73 m2. Results: The two formulas afforded independent prognostic information over follow-up. However, risk prediction was most accurate using the BIScrea formula as evaluated by Cox proportional hazards models (hazard ratio (for each 10 mL/min/1.73 m2 decrease) 1.47 vs. 1.27 with the CKD-EPI equation; P<0.001 for comparison), c-statistic values (0.69 vs. 0.65, respectively; P=0.04 for comparison) and Bayesian information criterion. Net reclassification improvement based on the estimated glomerular filtration rate categories significantly favoured BIScrea +9 (95% confidence interval 2–16%; P=0.02). Conclusions: Our findings suggest that the BIScrea formula may improve death risk prediction more than the CKD-EPIcrea formula in older patients with acute coronary syndrome.
Effect of Topical Opioid Antagonist on Diabetic Wound Healing in Rat Model
Authors: Cain Jarrett , Titunick Michelle 
Published: September 2017

Category: Basic Sciences/Biologics, Diabetes Introduction/Purpose: Approximately 50% of the 170 million people worldwide with diabetes experience complications associated with delayed cutaneous wound healing. The current widely used treatment for DFU is topical platelet-derived growth factor (PDGF); however, it has significant side-effects. Preclinical studies have shown that a small molecular weight opioid receptor antagonist, blocks the interactions between the growth inhibitory peptide Opioid Growth Factor (OGF) and its receptor OGFr and accelerates cell proliferation and enhances angiogenesis and wound closure. The hypothesis of this research is that the topical formulation of opioid receptor antagonist is an effective therapy for healing of cutaneous wounds in diabetic rats, with healing times comparable to the standard care and will promote enhanced cell replication and accelerated angiogenesis. Methods: Fourteen diabetic rats per group with four excisional cutaneous wounds were positioned dorsally on type 1 diabetic rats and randomly treated topically with an opioid receptor antagonist (0.03% Naltrexone), topical platelet derived growth factor (Regranex®), or placebo moisturizing cream alone. Wound closure, DNA synthesis (bromodeoxyuridine incorporation-BrdU labeling), and production of the cytokines PDGF and vascular endothelial growth factor (VEGF) were monitored. Results: Naltrexone and Regranex® treatment resulted in more than 65% closure on days 8 and 10 respectively. On day 12, only one Naltrexone- and two Regranex-treated wounds remained (~1%), whereas the control group had 50% visible wounds. DNA synthesis in Regranex® treated wounds was 21% in comparison to vehicle-treated wounds at 28%; Naltrexone-treated diabetic wounds had 42% BrdU labeling comparable to the normal vehicle treated wounds. Naltrexone treatment significantly increased cell replication in comparison to Regranex treatment and to vehicle-only treated wounds (p<0.001). Tissue immunostained at 1, 2, and 4 days after surgery with anti-PDGF antibodies indicated that both Regranex® and Naltrexone increase PDGF+ labeling at 1 day, with Naltrexone treatment (but not Regranex®) continuing to enhance PDGF production at 4 days Conclusion: Topical opioid receptor antagonist has been shown to enhance wound healing by increasing cell replication, accelerating angiogenesis, and matrix formation and targets an underlying pathophysiology of diabetes and enhances cell replication at all stages of wound remodeling. Topical opioid receptor antagonist is safe and effectively targets the disease-modifying pathways in this comparison study of topical platelet derived growth factor for wound closure in Type 1 diabetic rats.These data suggest that blockade of the OGF-OGFr axis, utilizing 0.03% Naltrexone is a safe and effective alternative for treatment for diabetic wounds by targeting several phases of wound repair.
HV Patients Show Greater Pronation of the First Metatarsal than Normals
Authors: Campbell Bradley , Conti Stephen 
Published: September 2017

Category: Basic Sciences/Biologics, Bunion, Midfoot/Forefoot Introduction/Purpose: The progression of the hallux valgus (HV) deformity demonstrates dorsiflexion and abduction; concomitant pronation has not received adequate documentation and the extent of pronation in the pathology is unknown even though correction of the deformity may need to address all three angles. To overcome the inability of standard radiographs to capture pronation, we have developed a means to assess the three dimensional deformity using CT scans. Our goal was to document the extent of pronation/supination both of the first phalanx with respect to the first metatarsal and of the first metatarsal with respect to the second metatarsal. Furthermore, we wanted to regress pronation against the intermetatarsal (IMA) angle of hallux valgus patients. Methods: Three-dimensional models were reconstructed from loaded and unloaded CT files of patients (10 HV, 10 normal). The orientations of specific bones, in anatomic directions, were determined by selecting landmarks on the surface of the phalanx and of the first and second metatarsals. The resulting calculations output a set of angles to determine the pronation/supination of the first metatarsal relative to the second and of the first phalanx relative to the first metatarsal. A regression analysis was conducted to extrapolate any relationship between adduction and pronation (known intermetatarsal and pronation). Results: The average pronation of the first metatarsal relative to the second metatarsal was 19.8 ± 7.1 and 28.3 ± 10.8 in the normal and HV groups respectively (p < 0.05). The influence of weightbearing demonstrated pronation angle differences that were greater in the normal group than in the HV group for both the IM pronation and the HV pronation (p < 0.05) (Figure 1). The differences in HV angles and IM angles between normal and HV patients were 22° and 7° respectively. The regression analysis of the pronation and intermetatarsal angle was not found to be significant, with a weak correlation (r2 = 0.26). Conclusion: The pronation of the first metatarsal relative to the second metatarsal between normal and HV patients is significantly different. While the first metatarsal had measurable pronation in patients with hallux valgus but that value was not predicted by the IMA. The findings of this study indicate pronation should be considered in any surgical technique that seeks to restore native configurations.
Comparative Outcomes for Treatment of Articular Cartilage Lesions in the Ankle with Particulated Juvenile Cartilage Allograft
Authors: Deal James , Turner Robert , Ryan Paul , Anderson Claude , Groth Adam 
Published: September 2017

Category: Ankle Introduction/Purpose: Treatment of osteochondral defects of the talus with particulated juvenile cartilage allograft is a relatively new procedure. Although other treatment options exist for large osteochondral defects of the talus, the potential advantage of particulated juvenile allograft is the ability to perform the procedure arthroscopically or through a minimal approach. No previous studies have looked at the results of an arthroscopic approach and no previous studies have compared an arthroscopic technique to an open approach. The purpose of this study was to compare the outcomes of an arthroscopic transfer technique to the previously published open technique. Methods: A total of 34 patients underwent treatment of talar cartilage lesions with juvenile particulated cartilage allograft. Twenty of these were done arthroscopically and 14 were done with an open arthrotomy. There was no statistically significant difference between the groups with respect to age, lesion width, lesion depth, lesion length, or operative time. Scores for 6 different validated outcome measures were recorded for patients in each group pre-operatively and subsequently at 6 months, 1 year, 18 months, and 2 years. Results: Comparing outcome measurements at each data point to baseline, there were no statistically significant post-operative differences found between open and arthroscopic approaches with regards to VAS Pain Scale, AOFAS Ankle-Hindfoot Scale, Foot and Ankle Ability Measure - Sport Scale, or SF12 Physical Health Scale. Conclusion: Treatment of talar articular cartilage lesions with particulated juvenile cartilage allograft is associated with improved outcomes at 2 years with regards to several validated outcome measures regardless of technique utilized. At 2 years follow up, there were no statistically significant differences in outcomes utilizing an arthroscopic technique versus open technique with the numbers given. This data supports the use of particulated juvenile cartilage allograft utilizing either arthroscopic or open techniques.
Primary vs Secondary Osteochondral Autograft Transplantation in Patients with Large Sized OLT
Authors: Park Kwang Hwan , Hwang Yeokgu , Park Yoo Jung , Shim Dong-Woo , Lee Jin Woo 
Published: September 2017

Category: Ankle, Arthroscopy, Sports Introduction/Purpose: Osteochondral autograft transplantation (OAT) for large sized osteochondral lesions of the talus (OLT) has presented promising clinical results in recent studies. However, there was no study which has compared clinical outcomes between primary OAT and secondary OAT in the large sized OLT. The purpose of this study is to compare clinical outcomes between patients receiving primary transplantation and patients receiving secondary transplantation after failure of previous marrow stimulation for large sized OLT and investigate prognostic factor affecting clinical failures. Methods: Between 2005 and 2014, 18 patients with large sized OLT (=150 mm2) underwent primary OAT as a primary surgery (primary group) and 28 patients with large sized OLT underwent secondary OAT after a failure of arthroscopic marrow stimulation (secondary group). After arthroscopic inspection and debridement for concomitant soft tissue pathologies, conventional OAT procedures were performed. Clinical outcomes were assessed using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) scores, Foot and Ankle Outcome Score (FAOS) and re-operation rate. Factors associated with clinical failure were evaluated using bivariate analysis and logistic regression analysis. Survival outcomes were compared using Kaplan-Meier analysis. Results: The mean follow-up time was 6.0 years (range 2.0-10.8) and the mean size of the lesion was 194.9 mm2 (range 151.7- 296.3). There was no significant difference in patients` demographics, and preoperative findings between primary and secondary groups. Postoperative VAS, AOFAS score, FAOS, and re-operation rate had no significant difference between primary and secondary groups at the last follow-up. According to bivariate analysis, significant factor associated with clinical failure was not prior marrow stimulation but more than 225 mm2 of lesion size in preoperative MRI. Logistic regression analysis revealed that preoperative AOFAS score was significant predictor of clinical failure after the OAT in this study. The survival probabilities were not significantly different between primary and secondary groups in Kaplan-Meier plots (P = .947). Conclusion: Outcomes of secondary OAT were comparable to those of primary OAT in the large sized OLT. Therefore, we suggested that symptomatic patients with large sized OLT could be initially treated by either arthroscopic marrow stimulation or OAT and if failed with marrow stimulation, secondary OAT could be considered.
Histological Analysis of Early Osteolysis in Total Ankle Arthroplasty
Authors: Schipper Oliver , Haddad Steven 
Published: September 2017

Category: Ankle Arthritis Introduction/Purpose: The purpose of this study was to perform a histological comparative analysis of tibiotalar joint samples taken from areas of osteolysis adjacent to total ankle arthroplasties vs control synovial specimens to determine the reaction to and presence of polyethylene (PE) particles. Methods: A total of 57 pathology samples were identified in the osteolysis group, while 11 were identified in the control group. For each sample, hematoxylin and eosin, Oil Red O (ORO), and macrophage marker CD163-stained slides were created. Polarized light and ORO stain were used to identify PE particles. The presence of metal particles and giant cell reaction to PE particles were also scored. Results: Macrophages, PE particles, metallosis, and foreign body giant cell reaction scores were significantly higher in the osteolysis group compared with the control group. In the osteolysis group, ORO staining was positive in 93% (53/57), birefringent material was present in 96.5% (55/57), and macrophage infiltrates were present in 96.5% (55/57). Foreign body giant cell reaction with giant cells surrounding PE particles was present in 49.1% (28/57) of osteolytic specimens. The presence of foreign body giant cell reaction was associated with significantly higher macrophage, ORO, and polarizable material scores. The average time to surgery for osteolysis from the index ankle replacement was 6.0 (range, 0-15) years for the 57 patients in the osteolysis group. Conclusion: This study is the largest ankle arthroplasty histological analysis to show that areas of osteolysis consist of abundant polyethylene wear particles, present both intracellularly and extracellularly. Furthermore, these areas were associated with a CD163+ macrophage infiltrate and frequently a foreign body reaction with giant cells engulfing PE particles. It is likely that implant wear particles play a significant role in osteolysis based on the histopathology.
Rates of Acute and Delayed Achilles Repair
Authors: Younger Alastair , Park Sam Si-Hyeong , Veljkovic Andrea , Penner Murray , Wing Kevin 
Published: September 2017

Category: Sports, Trauma Introduction/Purpose: The need for repair of the ruptured achilles tendon has been discussed extensively in recent literature. A landmark paper in 2010 (Willits JBJS) outlined that the re-rupture rates were similar in surgical and non surgically treated Achilles tendon ruptures. However concern has to be raised as to the strength of the muscle tendon complex if the tendon is too long, potentially increasing the rate of late repair. This paper analyses the rate of acute achilles tendon repair and delayed repair before and after the 2010 publication of the Willits paper. Methods: Using the published billings from the Province of British Columbia, the rates per year of surgical repair of achilles tendon and delayed repair were determined. The population of British Columbia has increased over the years from 3.9 million in 1997 to 4.7 million in 2016. The rates of acute and chronic surgery were plotted prior to 2010, and since 2010. The rates were fitted against time using a linear and binomial plot. The rates in the years before and after 2010 were compared with ANOVA and the change of rate in time compared with Pearson’s correlation. Results: The rate of acute repair increased from 271 repairs in 1997 to over 400 repairs per year in 2009. The rate of acute repair has since dropped to just over 300 repairs per year. This is reflected in the enclosed binomial plot. There was a significant increase until 2010 (p<0.001), and a significant decrease since 2010 p<0.05). An average of 374 repairs per year (95% CI 349 to 398) were performed before 2010, decreasing to 328 since (95% CI 294 to 360), p<0.05. The rate of late repair has increased from 48 per year (CI 40 to 56) to 80 (CI 70 to 91) since 2010. The rate of late repair increased both prior to (r2 prior to 2010 .5, p<0.01) and since 2010. Conclusion: The landmark 2010 paper has resulted in a reduction of acute repair. However the increase in late repair is concerning and indicates that the muscle tendon weakness observed in the 2010 paper on strength testing at 1 year review in the non surgical group may be causing an increased rate of late repair. Further evaluation and development of both surgical and non surgical technique is required if the need for late repair is going to be avoided that likely reflects poor patient outcomes.
Clinical outcomes of full thickness skin graft combined with negative pressure wound therapy in diabetes mellitus foot amputee after infection
Authors: Ahn Ji-Yong 
Published: September 2017

Category: Diabetes Introduction/Purpose: Infected diabetes mellitus (DM) foot has been controlled with amputation. After performing the amputation with preserving enough length of the foot due to functional and cosmetic advantages, remaining wounds have been covered with split thickness skin graft (STSG) despite of sacrifice of donor site with pain and scar. We hypothesized outcomes of full thickness skin graft (FTSG) combined with negative pressure wound therapy (NPWT) can be an alternative STSG. The aim of this study was to investigate clinical outcomes of FTSG combined with negative pressure wound therapy in DM foot infection. Methods: This study included 21 patients of infected DM foot (21 feet). There were 20 cases of midfoot and 1 case of hindfoot. We performed the amputation and combined NPWT at a mean age of 51.7 years (37 to 81) with the mean 12 months follow-up between June, 2014, and January, 2016. FTSG was performed after sufficient granulation healing of DM foot amputee. We measured multiple risk factors preoperatively and postoperatively. The wound healing after FTSG was evaluated during the followup. The relationship between outcomes of FTSG and multiple risk factors were evaluated. Results: 20 feet showed complete healing of wound. One foot showed failed wound healing. Mean NPWT number of times before the FTSG were 11. Mean C-reactive protein (CRP) values and Hemoglobin A1C (HbA1C) were 1.24 and 9.21 just before FTSG, respectively. There were no significant correlations between wound healing and risk factors (CRP, HbA1C) (p=0.223, p=0.175). Conclusion: Full thickness skin graft combined with negative pressure wound therapy (NPWT) can be the treatment of choice for the diabetes mellitus foot amputee as an alternative STSG.