bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-Term Results of a Ruptured Deltoid Ligament Repair During an Acute Ankle Fracture Fixation
Authors: Woo Seung Hun , Bae Su-Young , Chung Hyung-Jin 
Published: October 2017

Background: There is no consensus on the optimal treatment or preferred method of operation for the management of acute deltoid ligament injuries during an ankle fracture fixation. This study aimed to analyze the outcomes of repairing the deltoid ligament during the fixation of an ankle fracture compared to conservative management. Methods: We retrospectively evaluated 78 consecutive cases of a ruptured deltoid ligament with an associated ankle fracture between 2001 and 2016. All of the ankle fractures were treated with a plate and screw fixation. Patients in the conservative treatment for ruptured deltoid ligament underwent management from 2001 to 2008 (37 fractures, group 1), while the operative treatment for ruptured deltoid ligament was included from 2009 to 2016 (41 fractures, group 2). The outcome measures included radiographic findings, the American Orthopaedic Foot & Ankle Society ankle-hindfoot scores, visual analog scale scores, and the Foot Function Index. All patients were followed for an average of 17 months. Results: Radiologic findings in both groups were comparable, but the final follow-up of the medial clear space (MCS) was significantly smaller in the group 2 ( P < .01). Clinical outcomes were similar between the two groups ( P > .05). Comparing those who underwent syndesmotic fixation between both groups, group 2 showed a significantly smaller final follow-up MCS, and all clinical outcomes were better in group 2 ( P < .05). Linear regression analysis showed that the final follow-up MCS had a significant influence on clinical outcomes ( P < .05). Conclusion: Although the clinical outcomes were not significantly different between the 2 groups, we obtained a more favorable final follow-up MCS in the deltoid repair group. Particularly when accompanied by a syndesmotic injury, the final follow-up MCS and the clinical outcomes were better in the deltoid repair group. In the case of high-grade unstable fractures of the ankle with syndesmotic instability, a direct repair of the deltoid ligament was adequate for restoring medial stability. Level of Evidence: Level III, retrospective comparative case series.
Continuous Wound Infiltration After Hallux Valgus Surgery
Authors: Braito Matthias , Dammerer Dietmar , Schlager Andreas , Wansch Jürgen , Linhart Caroline , Biedermann Rainer 
Published: October 2017

Background: Hallux valgus surgery is associated with significant early postoperative pain. The aim of this study was to investigate the use of continuous wound infiltration (CWI) with ropivacaine for pain management after hallux valgus surgery. Methods: In this prospective, randomized, double-blind, and placebo-controlled single-center trial, 50 patients undergoing distal metatarsal osteotomy for idiopathic hallux valgus were allocated to CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h or placebo for 24 hours postoperatively. Average and peak pain levels on the verbal numeric rating scale (NRS; 1-10) during the first 48 hours after surgery were recorded as primary outcome parameters. Secondary outcome parameters included consumption of narcotics, clinical outcome, incidence of postoperative complications, and patient satisfaction. Results: No significant difference in mean ( P = .596) and peak ( P = .353) postoperative pain level was found for CWI with either ropivacaine (mean NRS 1.9 ± 0.8; peak NRS 3.5 ± 2.0) or placebo (mean NRS 2.0 ± 0.7; peak NRS 3.9 ± 1.7) during the early postoperative course. Furthermore, no significant difference between both groups was detected regarding narcotic consumption ( P = .354) and all other secondary outcome parameters. Two severe complications (local dysesthesia with CWI, catheter accidentally fixed by a suture) and 5 catheter dislocations were observed. Conclusion: CWI with ropivacaine 2 mg/mL at a rate of 2 mL/h for 24 hours after hallux valgus surgery did not reduce postoperative pain level in an inpatient setting. Level of Evidence: Level I, prospective randomized trial.
Radiographic Results of Nitinol Compression Staples for Hindfoot and Midfoot Arthrodeses
Authors: Schipper Oliver N. , Ford Samuel E. , Moody Patrick W. , Van Doren Bryce , Ellington J. Kent 
Published: October 2017

Background: The purpose of this study was to determine the radiographic union rate after midfoot and hindfoot arthrodeses using a new generation of nitinol staples, and to compare outcomes between a nitinol staple construct and a nitinol staple and threaded compression screw construct. Methods: A retrospective chart review was performed to identify patients who underwent hindfoot or midfoot arthrodesis using a new generation of nitinol compression staples with or without a partially threaded cannulated screw with minimum 3-month radiographic follow-up. The primary outcome variable was radiographic evidence of arthrodesis on radiographs and, when available, computed tomographic scan in patients who underwent midfoot or hindfoot arthrodesis using nitinol staples. Ninety-six patients and 149 joints were eligible for analysis. Median radiographic follow-up was 5.7 months. Results: Radiographic union was seen in 93.8% (60/64) of patients and 95.1% (98/103) of joints using the nitinol staple construct. Radiographic union was seen in 90.6% (29/32) of patients and 95.7% (44/46) of joints using the nitinol combined staple and screw construct. There was no significant difference in radiographic union rate or revision surgery between the 2 groups. Seven patients developed nonunion, 4 in the nitinol staple construct group and 3 in the staple and screw group. Conclusions: New-generation nitinol staples were safe and effective for hindfoot and midfoot arthrodeses, with a high radiographic union rate. The use of a partially threaded screw for additional fixation was not found to either significantly increase or decrease radiographic fusion with nitinol staple fixation. Level of Evidence: Level III, comparative cohort study.
Whole-Body Biodistribution, Dosimetry, and Metabolite Correction of [11C]Palmitate: A PET Tracer for Imaging of Fatty Acid Metabolism
Authors: Christensen Nana L. , Jakobsen Steen , Schacht Anna C. , Munk Ole L. , Alstrup Aage K. O. , Tolbod Lars P. , Harms Hendrik J. , Nielsen Søren , Gormsen Lars C. 
Published: October 2017

Introduction: Despite the decades long use of [11C]palmitate positron emission tomography (PET)/computed tomography in basic metabolism studies, only personal communications regarding dosimetry and biodistribution data have been published. Methods: Dosimetry and biodistribution studies were performed in 2 pigs and 2 healthy volunteers by whole-body [11C]palmitate PET scans. Metabolite studies were performed in 40 participants (healthy and with type 2 diabetes) under basal and hyperinsulinemic conditions. Metabolites were estimated using 2 approaches and subsequently compared: Indirect [11C]CO2 release and parent [11C]palmitate measured by a solid-phase extraction (SPE) method. Finally, myocardial fatty acid uptake was calculated in a patient cohort using input functions derived from individual metabolite correction compared with population-based metabolite correction. Results: In humans, mean effective dose was 3.23 (0.02) µSv/MBq, with the liver and myocardium receiving the highest absorbed doses. Metabolite correction using only [11C]CO2 estimates underestimated the fraction of metabolites in studies lasting more than 20 minutes. Population-based metabolite correction showed excellent correlation with individual metabolite correction in the cardiac PET validation cohort. Conclusion: First, mean effective dose of [11C]palmitate is 3.23 (0.02) µSv/MBq in humans allowing multiple scans using ∼300 MBq [11C]palmitate, and secondly, population-based metabolite correction compares well with individual correction.
Poly-de-prescribing to treat polypharmacy: efficacy and safety
Authors: Garfinkel Doron 
Published: October 2017

Background: The aim of this study was to evaluate efficacy and safety of poly-de-prescribing (PDP) based on the Garfinkel method in older people with polypharmacy. Methods: A longitudinal, prospective, nonrandomized study in Israel was carried out between 2009 and 2016. Comprehensive geriatric assessments were performed at home in people age ⩾66 years consuming ⩾6 prescription drugs. Exclusion criteria were life expectancy <6 months and a seeming unwillingness to cooperate (poor compliance). PDP of ⩾3 prescription drugs was recommended. Follow up was at ⩾3 years. Between April 2015 and April 2016 Likert scale questionnaires were filled by all participants/families to evaluate overall satisfaction and clinical outcomes. The outcome measures were change in functional, mental and cognitive status, sleep quality, appetite, continence; major complication, hospitalizations, mortality, and family doctor’s cooperation. Results: Poly-de-prescribing of ⩾3 drugs was eventually achieved by 122 participants (PDP group); ⩽2 drugs stopped by 55 ‘nonresponders’ (NR group). The average age was 83.4 ± 5.3 in the PDP group, and 80.8 ± 6.3 in the NR group ( p = 0.0045). Follow up was 43.6 ± 14 months (PDP) and 39.5 ± 16.6 months (NR) ( p = 0.09). The prevalence of most diseases/symptoms was comparable except for a higher prevalence for dementia, incontinence and functional decline in the PDP group. The main barrier to de-prescribing was the family doctor’s unwillingness to adopt PDP recommendations ( p < 0.0001). The baseline median number of medications taken by both groups was 10 (IQR 8 to 12) ( p = 0.55). On the last follow up, the drug count was 11 (IQR 8 to 12) in the NR group and 4 (IQR 2 to 5) in the PDP group ( p =0.0001). The PDP group showed significantly less deterioration (sometimes improvement) in general satisfaction, functional, mental and cognitive status, sleep quality, appetite, sphincter control, and the number of major complications was significantly reduced ( p < 0.002 in all). The rate of hospitalizations and mortality was comparable. Health improvement occurred within 3 months after de-prescribing in 83%, and persisted for ⩾2 years in 68%. Conclusions: This self-selected sample longitudinal research strongly suggests that the negative, usually invisible effects of polypharmacy are reversible. PDP is well tolerated and associated with improved clinical outcomes, in comparison with outcomes of older people who adhere to all clinical guidelines and take all medications conventionally. Future double-blind studies will probably prove beneficial economic outcomes as well.
Sex Hormone Status in Women With Chronic Kidney Disease: Survey of Nephrologists’ and Renal Allied Health Care Providers’ Perceptions
Authors: Ramesh Sharanya , James Matthew T. , Holroyd-Leduc Jayna M. , Wilton Stephen B. , Seely Ellen W. , Wheeler David C. , Ahmed Sofia B. 
Published: October 2017

Background: Chronic kidney disease (CKD) in reproductive-age women is accompanied by menstrual and fertility disorders and premature menopause. Objective: We sought to determine nephrologists’ and allied health care providers’ perceptions on management of sex hormone status in women with CKD. Methods: An anonymous, Internet-based survey was sent to nephrology society members from Canada, Australia, New Zealand, and the United Kingdom, and the Canadian Association of Nephrology Nurses and Technologists (February-November 2015). We assessed reported perceptions and management of sex hormone status in women with CKD. Results: One hundred seventy-five nephrologists (21% response rate) and 121 allied health care providers (30%; 116 nurses, 5 pharmacists) responded. Sixty-eight percent of nephrologists and 46% of allied providers were between the ages of 30 and 50 years, and 38% of nephrologists and 89% of allied workers were female. Ninety-five percent of nephrologists agreed that kidney function impacts sex hormone status, although only a minority of nephrologists reported often discussing fertility (35%, female vs male nephrologists, P = .06) and menstrual irregularities with their patients (15%, female vs male nephrologists, P = .02). Transplant nephrologists reported discussing fertility more often than did nontransplant nephrologists (53% vs 30%, P = .03). Physicians were more likely to report discussing fertility (33% vs 7.5%, P < .001) and menstrual irregularities (15% vs 9%, P = .04) with patients than allied health care providers. Forty-three percent of physicians reported uncertainty about the role for postmenopausal hormone therapy in women with CKD. Conclusion: Nephrologists and allied health care providers recognize an impact of CKD on sex hormones in women but report not frequently discussing sex hormone–related issues with patients. Our international survey highlights an important knowledge gap in nephrology.
Persistent pit viper envenomation in a cat
Authors: Yankin Igor , Schaer Michael , Johnson Matthew , Meland Tessa , Londoño Leonel A 
Published: October 2017

Case summary A 4-year-old female spayed, indoor/outdoor domestic mediumhair cat presented with multiple bleeding puncture wounds and hemorrhagic shock. The cat was diagnosed with suspected pit viper envenomation based on the location and appearance of the bite wounds, as well as the presence of severe coagulopathy with prolonged activated coagulation time (762 s), which responded to antivenom administration. The clinical course of the cat was unique owing to the prolonged clinical signs of envenomation that appeared as intermittent coagulopathy and hemorrhage over a 2 week period. Five vials of antivenom were administered and three units of packed red blood cells were transfused over a 7 day period. The cat made a complete recovery with cessation of hemorrhage and normalization of clotting times. Relevance and novel information This is the first report of persistent pit viper venom-induced coagulopathy in the feline veterinary literature.
Traffic-related air pollution exposure over a 5-year period is associated with increased risk of asthma and poor lung function in middle age
Authors: Bowatte Gayan , Erbas Bircan , Lodge Caroline J. , Knibbs Luke D. , Gurrin Lyle C. , Marks Guy B. , Thomas Paul S. , Johns David P. , Giles Graham G. , Hui Jennie , Dennekamp Martine , Perret Jennifer L. , Abramson Michael J. , Walters E. Haydn , Matheson Melanie C. , Dharmage Shyamali C. 
Published: October 2017

Current evidence concerning the impact of exposure to traffic-related air pollution (TRAP) on adult respiratory morbidity mainly comes from cross-sectional studies. We sought to establish more robust measures of this association and potential gene–environment interactions using longitudinal data from an established cohort study.Associations between measures of TRAP (nitrogen dioxide (NO2) and distance to major roads) and wheeze, asthma prevalence and lung function were investigated in participants of the Tasmanian Longitudinal Health Study at 45- and 50-year follow-ups. Generalised estimating equations were used to quantify associations and the potential modifying effect of glutathioneS-transferase gene variants.Living <200 m from a major road was associated with increased prevalence of current asthma and wheeze, and lower lung function. The association between living <200 m from a major road and current asthma and wheeze was more marked for carriers of theGSTT1null andGSTP1 val/valorile/valgenotypes. Over the 5-year period, higher NO2exposures were associated with increased current asthma prevalence. Higher NO2exposure was associated with lower forced vital capacity for carriers of theGSTT1null genotype.TRAP exposures were associated with increased risk of asthma, wheeze and lower lung function in middle-aged adults. The interaction with theGSTT1genotype suggests that deficient antioxidant mechanisms may play a role in these adverse health effects.
Proteomics in asthma: the clinicians were right after all, were not they?
Authors: Sinha Anirban , Sterk Peter J. 
Published: October 2017

AbstractClinical disease phenotypes with underlying information of molecular and biological signatures for the same, is a prerequisite for improving medical care and developing more effective, stratified management strategies. This commentary reviews the research carried out by Cao et al. to unravel biological networks associated with different clinical categories of asthma. It finally comments on the utility of using data from multiple platforms aided by integrated systems approaches to effectively find out the obvious underlying physiological disease signatures related to clinical disease sub‐types.
A Prospective International Multicentre Cohort Study of Intraoperative Heart Rate and Systolic Blood Pressure and Myocardial Injury After Noncardiac Surgery: Results of the VISION Study
Authors: Abbott Tom E. F. , Pearse Rupert M. , Archbold R. Andrew , Ahmad Tahania , Niebrzegowska Edyta , Wragg Andrew , Rodseth Reitze N. , Devereaux Philip J. , Ackland Gareth L. 
Published: October 2017

BACKGROUND:
The association between intraoperative cardiovascular changes and perioperative myocardial injury has chiefly focused on hypotension during noncardiac surgery. However, the relative influence of blood pressure and heart rate (HR) remains unclear. We investigated both individual and codependent relationships among intraoperative HR, systolic blood pressure (SBP), and myocardial injury after noncardiac surgery (MINS).

METHODS:
Secondary analysis of the Vascular Events in Noncardiac Surgery Cohort Evaluation (VISION) study, a prospective international cohort study of noncardiac surgical patients. Multivariable logistic regression analysis tested for associations between intraoperative HR and/or SBP and MINS, defined by an elevated serum troponin T adjudicated as due to an ischemic etiology, within 30 days after surgery. Predefined thresholds for intraoperative HR and SBP were: maximum HR >100 beats or minimum HR <55 beats per minute (bpm); maximum SBP >160 mm Hg or minimum SBP <100 mm Hg. Secondary outcomes were myocardial infarction and mortality within 30 days after surgery.

RESULTS:
After excluding missing data, 1197 of 15,109 patients (7.9%) sustained MINS, 454 of 16,031 (2.8%) sustained myocardial infarction, and 315 of 16,061 patients (2.0%) died within 30 days after surgery. Maximum intraoperative HR >100 bpm was associated with MINS (odds ratio [OR], 1.27 [1.07–1.50]; P < .01), myocardial infarction (OR, 1.34 [1.05–1.70]; P = .02), and mortality (OR, 2.65 [2.06–3.41]; P < .01). Minimum SBP <100 mm Hg was associated with MINS (OR, 1.21 [1.05–1.39]; P = .01) and mortality (OR, 1.81 [1.39–2.37]; P < .01), but not myocardial infarction (OR, 1.21 [0.98–1.49]; P = .07). Maximum SBP >160 mm Hg was associated with MINS (OR, 1.16 [1.01–1.34]; P = .04) and myocardial infarction (OR, 1.34 [1.09–1.64]; P = .01) but, paradoxically, reduced mortality (OR, 0.76 [0.58–0.99]; P = .04). Minimum HR <55 bpm was associated with reduced MINS (OR, 0.70 [0.59–0.82]; P < .01), myocardial infarction (OR, 0.75 [0.58–0.97]; P = .03), and mortality (OR, 0.58 [0.41–0.81]; P < .01). Minimum SBP <100 mm Hg with maximum HR >100 bpm was more strongly associated with MINS (OR, 1.42 [1.15–1.76]; P < .01) compared with minimum SBP <100 mm Hg alone (OR, 1.20 [1.03–1.40]; P = .02).

CONCLUSIONS:
Intraoperative tachycardia and hypotension are associated with MINS. Further interventional research targeting HR/blood pressure is needed to define the optimum strategy to reduce MINS.
Radioactive seed localization compared with wire-guided localization of non-palpable breast carcinoma in breast conservation surgery— the first experience in the United Kingdom
Authors: Milligan Robert , Pieri Andrew , Critchley Adam , Peace Richard , Lennard Tom , O'Donoghue J.M. , Howitt Rachel , Nicholson Stewart , Cain Henry , Petrides George , Sibal Nidhi 
Published: October 2017

Objective:
In the UK, guidewires have traditionally been used for localization of non-palpable breast lesions in patients undergoing breast conservation surgery (BCS). Radioactive seed localization (RSL) using Iodine-125 seeds is an alternative localization method and involves inserting a titanium capsule, containing radioactive Iodine-125, into the breast lesion. We aim to demonstrate feasibility of RSL compared with guidewire-localization (GWL) for BCS in the UK.

Methods:
Data were collected on 100 patients with non-palpable unifocal invasive carcinoma of the breast undergoing GWL WLE prior to the introduction of RSL and the first 100 patients treated with RSL WLE. Statistical comparisons were made using Χ2-squared analysis or unpaired two-sample t-test. Significance was determined to be at p ≤ 0.05.

Results:
Mean total tumour size was 19.44 mm (range: 5–55) in the GWL group and 18.61 mm (range: 3.8–59) in the RSL group (p = 0.548), while mean total specimen excision weight was significantly lower in the RSL group; 31.55 g (range: 4.5–112) vs 37.42 g (range: 7.8–157.1) (p = 0.018). Although 15 patients had inadequate surgical resection margins in the GWL group compared the 13 in the RSL group (15 vs 13%, respectively, p = 0.684), 10 of the patients in the GWL group had invasive carcinoma present resulting in at least one positive margin compared with only 3 patients in the RSL group (10 vs 3%, respectively, p = 0.045).

Conclusion:
In this study, RSL is shown to be non-inferior to the use of GWL for non-palpable carcinoma in patients undergoing BCS and we suggest that it could be introduced successfully in other breast units.

Advances in knowledge:
Here we have demonstrated the use of RSL localization results in significant lower weight resection specimens of breast carcinoma when compared with a matched group using GWL, without any significant differences in oncological outcome between the groups.
Cost-effectiveness of magnetic resonance carotid plaque imaging for primary stroke prevention in Canada
Authors: E Lechtman , I Balki , K Thomas , K Chen , AR Moody , PN Tyrrell 
Published: October 2017

Objective:
Magnetic resonance of the carotid arteries provides important insight into plaque composition and vulnerability in addition to the traditional measure of stenosis. The purpose of this study was to evaluate the cost-effectiveness of MR imaging as a first-line modality to assess carotid disease and guide management for high-risk patients with &lt;50% stenosis.

Methods:
Using TreeAge Pro, a cost-effectiveness simulation was conducted comparing two strategies: (a) standard of care first-line carotid duplex ultrasound (DUS) with regular follow-up, v s (b) first-line MR assessment of stenosis and intraplaque haemorrhage (MRIPH) in which patients with IPH received annual DUS surveillance and immediate carotid endarterectomy in case of plaque progression.

Results:
For patients aged 70 years old, using a first-line MRIPH strategy resulted in a 16.8% relative risk reduction in strokes compared to DUS (0.080 vs 0.097 strokes per patient per lifetime), and an increased quality-adjusted-life years (12.23 vs 12.20) at an increased cost of $897.33 over a patient’s lifetime ($5784.53 vs $4887.20 average total cost per patient per lifetime). The incremental cost-effectiveness ratio was $29,744 per quality-adjusted-life years. MRIPH remained cost-effective below a willingness-to-pay threshold of $50,000 for 91.8% of sensitivity analyses.

Conclusion:
MRIPH was found to be a cost-effective first-line tool to identify asymptomatic patients at high risk for stroke requiring annual surveillance and prompt management.

Advances in Knowledge:
Using MR imaging as a fist-line method to detect the presence of IPH provides clinically useful and cost-effective information that allows for enhanced risk evaluation and primary stroke prevention.