bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rotational Alignment of the Knee is Different in Osteological Specimens with and without a Large Cam Deformity of the Proximal Femur
Authors: Gebhart Jeremy J. , Streit Jonathan J. , Goodman Avi , Etscheidt Jordan , Weinberg Douglas S. , Bedi Asheesh , Nho Shane J. , Salata Michael J. 
Published: February 2017

Purpose We studied a large osteological collection for differences in knee rotation based upon the presence or absence of a large cam deformity of the proximal femur. Methods We obtained 357 matched tibiae and femora from the Hamann-Todd Osteological Collection and measured: femoral head-neck alpha angle, anteroposterior axis (or Whiteside's line) at the distal femur relative to the posterior condylar axis, and position of the tibial tubercle with respect to the posterior condylar axis of the proximal tibia. We then divided these specimens into two groups based upon alpha angle <45° (Group 1, n = 73) or alpha angle >60° (Group 2, n = 122) and performed an independent samples t-test to evaluate for differences in measured parameters between groups using this subset of specimens. Results The mean alpha angles in Group 1 and 2 were 40.9° ± 3.3° and 67.0° ± 5.6°, respectively. Whiteside's line was externally rotated with respect to the posterior femoral condylar axis by a mean of 1.8° ± 6.8° in Group 1, vs. 3.0° ± 3.7° in Group 2 (p = 0.03). The tibial tubercle was externally rotated by a mean of 19.4° ± 6.8° in Group 1, versus 16.6° ± 5.1° in Group 2 (p = 0.003). Conclusions Specimens with femoral head-neck alpha angle >60° demonstrated greater external rotation of the distal femur and a more internally-rotated tibial tubercle compared to specimens with an alpha angle <45°. Differences in anatomic characteristics of the knee may play a role in the development of patellofemoral pain in patients with a large cam deformity.
Correlation between Serum Metal Ion Levels and Adverse Local Tissue Reactions after Conserve® plus Hip Resurfacing Arthroplasty
Authors: Amstutz Harlan C. , Le Duff Michel J. 
Published: February 2017

Background Adverse local tissue reactions (ALTR) have been associated with the use of metal-on-metal (MoM) bearings and the monitoring of cobalt (Co) and chromium (Cr) ion levels in blood or serum may be the best way to evaluate in vivo the wear of these bearings. However, the relationship between Co and Cr ion concentrations and the formation of ALTR remains unclear. Methods We investigated the relationship between ALTR and serum Co and Cr ion levels and identified the clinical factors influencing the formation of ALTR in patients treated with MoM hip resurfacing arthroplasties. 228 patients with unilateral Conserve® Plus MoM hip resurfacing had serum metal ion studies performed more than 1 year after surgery. Metal artifact reduction sequence magnetic resonance imaging (MARS MRI) was performed on subjects at risk for ALTR as determined by a screening protocol. Results 12 patients had ALTR. Logistic regression showed a strong association of ALTR with elevated ion levels and with low (<10 mm) contact patch to rim distance. Conclusions MoM bearings require enough functional coverage of the socket by design and then precise implantation to maximise functional coverage of the femoral ball, enhance lubrication, and avoid edge-loading wear.
The Use of Polycarbonate-Urethane as an Acetabular Shell Bearing Surface: A 5-Year Prospective Study
Authors: Mai Sabine , Mai Burkhard , Siebert Werner E. 
Published: February 2017

Aim To evaluate the clinical performance of a polycarbonate-urethane liner as a bearing material inside a cobalt-chrome acetabular shell. Methods Between December 2007 and July 2011, this material combination was used in 27 total hip replacement patients, most of whom had an indication of osteoarthritis. This report focuses on the first 5-year results of the clinical use of this material combination in the TriboFit® Hip System. Results Mean Harris Hip Score showed significant improvement from 40 to 86 after 5 years, similar to studies in the literature. No adverse events - revisions or complications - or disadvantages that have been reported for other total hip materials were observed over the 5-year period. The radiographs showed no signs of wear, migration or loosening of the implants. Conclusions These early results indicate this new material combination offers promise as a safe and effective alternative bearing material for use in total hip systems. Further clinical trials are necessary to reconfirm these findings.
Chronological Changes in Functional Cup Position at 10 Years after Total Hip Arthroplasty
Authors: Okanoue Yusuke , Ikeuchi Masahiko , Takaya Shogo , Izumi Masashi , Aso Koji , Kawakami Teruhiko 
Published: February 2017

Purpose This study aims to clarify the chronological changes in functional cup position at a minimum follow-up of 10 years after total hip arthroplasty (THA), and to identify the risk factors influencing a significant difference in functional cup position during the postoperative follow-up period. Methods We evaluated the chronological changes in functional cup position at a minimum follow-up of 10 years after THA in 58 patients with unilateral hip osteoarthritis. Radiographic cup position was measured on anteroposterior pelvic radiographs with the patient in the supine position, whereas functional cup position was recorded in the standing position. Radiographs were obtained before, 3 weeks after, and every 1 year after surgery. Results Functional cup anteversion (F-Ant) increased over time, and was found to have significantly increased at final follow-up compared to that at 3 weeks after surgery (p<0.01). The maximum postoperative change in F-Ant was 17.0° anteriorly; 12 cases (21%) showed a postoperative change in F-Ant by >10° anteriorly. Preoperative posterior pelvic tilt in the standing position and vertebral fractures after THA were significant predictors of increasing functional cup anteversion. Conclusions Although chronological changes in functional cup position do occur after THA, their magnitude is relatively low. However, posterior impingement is likely to occur, which may cause edge loading, wear of the polyethylene liner, and anterior dislocation of the hip. We believe that, for the combined anteversion technique, the safe zone should probably be 5°-10° narrower in patients predicted to show considerable changes in functional cup position compared with standard cases.
Concomitant Pulsatile and Continuous Flow VAD in Biventricular and Univentricular Physiology: A Comparison Study with a Numerical Model
Authors: Di Molfetta Arianna , Ferrari Gianfranco , Iacobelli Roberta , Filippelli Sergio , Guccione Paolo , Fresiello Libera , Perri Gianluigi , Amodeo Antonio 
Published: February 2017

Introduction To develop and test a lumped parameter model to simulate and compare the effects of the simultaneous use of continuous flow (CF) and pulsatile flow (PF) ventricular assist devices (VADs) to assist biventricular circulation vs. single ventricle circulation in pediatrics. Methods Baseline data of 5 patients with biventricular circulation eligible for LVAD and of 5 patients with Fontan physiology were retrospectively collected and used to simulate patient baselines. Then, for each patient the following simulations were performed: (a) CF VAD to assist the left ventricle (single ventricle) + a PF VAD to assist the right ventricle (cavo-pulmonary connection) (LCF + RPF); (b) PF VAD to assist the left ventricle (single ventricle) + a CF VAD to assist the right ventricle (cavo-pulmonary connection) (RCF + LPF) Results In biventricular circulation, the following results were found: cardiac output (17% RCF + LPF, 21% LCF + RPF), artero-ventricular coupling (-36% for the left ventricle and -21.6% for the right ventricle), pulsatility index (+6.4% RCF + LPF, p = 0.02; -8.5% LCF + RPF, p = 0.00009). Right (left) atrial pressure and right (left) ventricular volumes are decreased by the RCF + LPF (by RPF + LCF). Pulmonary arterial pressure decreases in the LCF + RPF configuration. In Fontan physiology: cardiac output (LCF + RPF 35% vs. 8% in RCF + LPF), ventricular preload (+4% RCF + LPF, -10% LCF + RPF), Fontan conduit pressure (-5% RCF + LPF, +7% LCF + RPF), artero-ventricular coupling (-14% RCF + LPF vs. -41% LCF + RPF) and pulsatility (+13% RCF + LPF, - 8% LCF + RPF). Conclusions A numerical model supports clinicians in defining and innovating the VAD implantation strategy to maximize the hemodynamic benefits. Results suggest that the hemodynamic benefits are maximized by the LCF + RPF configuration.
Effect of Topical Antiinflammatory Drugs on Mechanical Behavior of Rabbit Cornea
Authors: Lepore Domenico , De Santis Roberto , Pagliara Monica M. , Gloria Antonio , Oliviero Olimpia , Nucci Carlo , Improta Giovanni , Triassi Maria , Ambrosio Luigi 
Published: February 2017

Background A variety of antiinflammatory therapies are employed to promote corneal wound healing. The effects of steroidal and nonsteroidal antiinflammatory drugs on the biomechanical properties of rabbit cornea were investigated over time using tensile tests. Methods Full-thickness incisions were made and used to analyze the effects of dexamethasone sodium phosphate 0.1% and diclofenac sodium 0.1% on corneal biomechanical properties during wound healing at 7, 14 and 21 days after surgery. Results The full-thickness incision deeply modified all of the mechanical properties. At 3 weeks after incision, regardless of the drug therapy, the tensile modulus was about 70% of the value for the intact cornea. Conclusions Topical treatment with dexamethasone was particularly effective during the first week after surgery; the second week after surgery, a similar result was observed in the corneas treated with diclofenac. Low doses of steroidal and nonsteroidal antiinflammatory drugs would seem to have the potential to improve biomechanical properties only during the early stage of the healing process of the cornea.
Laparoscopic Dissection of the Ureter in Deep-Infiltrating Endometriosis (DIE) of the Pelvis using Ultrasonically Activated Shears
Authors: Rampinelli Fabio , Donarini Paolo , Antonelli Alessandro , Visenzi Chiara , Ciravolo Giuseppe 
Published: February 2017

Objective The technique for freeing the ureter in the endoscopic treatment of deeply infiltrating endometriosis (DIE). Methods One hundred and forty-nine patients with complete obliteration of the cul-de-sac submitted to laparoscopic dissection of the ureter using ultrasonically activated shears, were retrospectively evaluated. Surgical technique, operative time and morbidity were analyzed. Results Two hundred and ninety-nine ureters were dissected in 149 patients affected by endometriosis of the posterior compartment. The average time to unroof the ureter on one side was 16 min. In three cases the ureter was damaged and promptly repaired without ureteronephrosis with a further 18-month radiographic control. Conclusions An important step in laparoscopic surgical treatment of DIE obliterating cul-de-sac, is dissection of the ureter at its crossing with the uterine artery, to avoid ureteral damage. In this paper, we describe a feasible and safe technique for ureteral dissection in DIE with the use of ultrasonic energy, even with rectal involvement. The use of ultrasonic energy reduces potential complications related to electrical energy.
Arteriovenous access does not perform as well for plasmapheresis
Authors: Wooster Mathew , Wilson Rachel , Shames Murray , Moudgill Neil 
Published: February 2017

Purpose Access surgeons are occasionally asked to create arteriovenous access for non-dialysis functions. Subjectively noting overall poor results, we seek to present our experience with arteriovenous access creation for apheresis. Methods Billing records were reviewed using Current Procedural Terminology (CPT) and International Classification of Diseases (ICD-9) codes to identify patients undergoing arteriovenous access creation for diseases other than renal failure from January 2007 to August 2014. Inpatient and outpatient records were reviewed to identify patient demographics, disease-specific medications/treatments, access-specific characteristics, patency data, and reinterventions required. Results A total of 16 access creation procedures were performed for 8 patients, accounting for just 1.6% of total access creations during the period. Treatment was for myasthenia gravis (n = 6), chronic inflammatory degenerative polyneuropathy (n = 9), and stiff man syndrome (n = 1). Access failure was by thrombosis (n = 7), non-maturation (n = 4), and infection/steal syndrome (n = 1), with four accesses still functional at conclusion of review. There was 50% autogenous access creation and overall maturation rate of 37.5%. Mean primary patency was 236 days (range 10-878), with secondary patency achieved in three patients adding a mean of 174 days (range 2-517). Cumulative 3-month and 1-year patency rates were 36.5% and 25%, respectively. Conclusions Arteriovenous access creation for plasmapheresis represents a minority of access procedures. Though it remains unclear why, patency and maturation rates are significantly lower than expected when compared to access for hemodialysis access. These high failure rates must be taken into account when considering replacement of temporary catheters with surgical access for non-hemodialysis needs.
A randomized study of training with large versus small vessel size on successful ultrasound-guided peripheral venous access
Authors: Davis Joshua , Faust Timothy , Tajani Azeem , Bates Amanda , Jarriel Jenna , Au Arthur , Fields Jason Matthew 
Published: February 2017

Purpose Our objective was to investigate whether training on phantoms with smaller or larger vessels would improve success rate in novice medical students learning this skill. Methods Medical students who participated in a voluntary, extracurricular ultrasound training day were asked to participate in the study as part of their procedural training. They were given a standardized education and demonstration of how to use ultrasound to place a peripheral intravenous (IV) catheter. They were then randomized to practice three times on homemade phantom models with either a 5-mm or a 2.5-mm diameter simulated vessel. Afterwards, they were observed attempting to place an ultrasound-guided IV on a 5-mm diameter vessel. Successful cannulation rates was the primary outcome. Results Fifty-one students from five institutions were included in the analysis. No significant difference in success rate, time to cannulation, number of sticks, or number of redirects was seen between the group who trained on the phantoms with the smaller vessels versus those who trained on the phantoms with the larger vessel. A trend towards significance was seen for success rate and number of redirects, favoring the group trained on the smaller vessels, but this did not reach significance. Conclusion In our small sample, there was no difference in success rate of novice students trained in ultrasound-guided peripheral IV access using either a smaller or a larger vessel phantom. Future work should focus on elucidating other aspects of training in ultrasound-guided procedures and should attempt a similar study with a larger sample size.
The independent association of preoperative serum albumin on the functional maturation of radiocephalic arteriovenous fistulae
Authors: Kordzadeh Ali , Tokidis Evripidis , Askari Alan , Hoff Mekhola , Panayiotopoulos Yiannis 
Published: February 2017

Purpose The aim of this study is to test the null hypothesis that preoperative albumin along with other preoperative confounders have no impact on the functional maturation of radiocephalic arteriovenous fistulae (RCAVF). Methods A retrospective cohort study of n = 195 individuals undergoing RCAVF formation from July 2013 to December 2015 was conducted. The null hypothesis was assessed through chi squared test. Independent association of each variable was evaluated through univariate and multivariate logistic regression model. Pearson's correlation test was also performed between scale variables to establish their causal link. Results Preoperative hypoalbuminaemic group of individuals demonstrated significant failure of maturation (49.3% vs. 27.2%, p = 0.002). At multivariate analysis, hypoalbuminemia remained an independent marker of fistula failure (OR 0.40, 95% CI 0.21-0.76, p = 0.004) and demonstrated a weak but a positive correlation at the endpoint of maturation (R = 0.223, p = 0.002). Conclusions Preoperative hypoalbuminemia (<35 mg/dL) is independently associated with 40% reduction in the functional maturation of RCAVF. Stratification of this readily available biomarker prior to RCAVF formation may require consideration subjected to further research.
“Extended subcutaneous route” technique: a quick subcutaneous tunnelling technique for PICC insertion
Authors: Elli Stefano , Abbruzzese Chiara , Cannizzo Luigi , Vimercati Simona , Vanini Stefania , Lucchini Alberto 
Published: February 2017

Purpose To describe a quick tunnelling technique for peripherally inserted central catheter (PICC) insertion called the “extended subcutaneous route” technique. Methods The “extended subcutaneous route” technique is described step by step. Results In 18 consecutive PICCs, inserted with extended route technique in ASST Monza, no complications during insertion were registered. In 969 catheter days observed, we identified only one accidental dislodgement. No other mid-term complications were observed. Conclusions Extended subcutaneous route technique allows the creation of a subcutaneous tunnel <5 cm, without skin incision and additional manipulation. Extended subcutaneous route technique may be feasible and useful, particularly for patients with high risk of bleeding or infection.
Surgical reconstruction of central venous obstruction in salvaging upper extremity dialysis accesses
Authors: Babadjanov Jurabek , Bernstein Rick , Kirksey Lee 
Published: February 2017

Background Central vein thrombosis or obstruction is a common complication associated with central venous catheters placed for intermittent hemodialysis. The reported outcomes of percutaneous catheter-based interventions reveal high rates of lesion recurrence with varying and frequently limited patency intervals. We present the case of open venous bypass in the treatment of catheter-associated chronic central vein occlusion. Methods We report a case of symptomatic arm swelling secondary to central vein stenosis and failed endovascular venous intervention treated by central vein bypass with prosthetic graft through median sternotomy. Results Patient had an open axillary to innominate venous bypass via median sternotomy incision, which resulted in resolution of patient's symptoms and uninterrupted patency of the pre-existing vascular access. Conclusions Open venous bypass is a reliable alternative to endovascular intervention in the symptomatic patient with extensive central vein occlusion as a primary intervention or in whom prior endovascular therapy has failed.
Chlorhexidine-impregnated transparent dressings decrease catheter-related infections in hemodialysis patients: a quality improvement project
Authors: Apata Ibironke W. , Hanfelt John , Bailey James L. , Niyyar Vandana Dua 
Published: February 2017

Purpose Central venous catheters (CVC) are associated with increased infection rates, morbidity and mortality compared to other hemodialysis vascular access. Chlorhexidine-impregnated transparent (CHG-transparent) dressings allow for continuous antimicrobial exposure and easy visibility of the CVC insertion site. We conducted a quality improvement project to compare catheter-related infection (CRI) rates in two dressing regimens – CHG-transparent dressings and adhesive dry gauze dressing in hemodialysis patients with tunneled CVCs. Methods The study was conducted in two phases. In phase 1, CHG-transparent dressing was introduced to EDC hemodialysis unit, while EDG and EDN hemodialysis units, served as the control sites and maintained adhesive dry gauze dressing. Phase 2 of the study involved replacing the adhesive dry gauze dressing with CHG-transparent dressing at EDG and EDN and maintaining CHG-transparent dressing at EDC. CRI rates at each hemodialysis unit during the 12-month intervention were compared to CRI rates for the 12-month pre-intervention period for each study phase. CRI rates were also compared between all three hemodialysis units. Results In phase 1, CRI rates (per 1000 days) in EDC (intervention site) decreased by 52% (1.69 vs. 0.82, p<0.05) and increased by 12% (1.80 vs. 2.02, p = 0.75) at EDG, and 35% (0.91 vs. 1.23, p = 0.40) at EDN. In phase 2, CRI rates at EDG and EDN (intervention sites) decreased by 86% (1.86 vs. 0.26 p<0.05), and 53% (1.89 vs. 0.88, p<0.05), respectively, and decreased by 20% at EDC (0.73 vs. 0.58, p = 0.65). Conclusions Replacing adhesive dry gauze dressing with CHG-transparent dressing for hemodialysis patients with tunneled CVC was associated with decreased CRI rates.
Mechanical recanalization for clot occlusion of venous access ports: experimental study using ports with clot occlusion
Authors: Song Myung Gyu , Seo Tae-Seok , Kim Baek-hui , Kim Jeong Ho 
Published: February 2017

Purpose To test the hypothesis that mechanical injection of saline is safe and effective in restoring patency of totally implantable venous access ports (TIVAPs) with clot occlusion. We devised an experimental port model for the evaluation of mechanical TIVAP recanalization prior to its clinical application. Materials and Methods The clot TIVAP occlusion model was constructed by filling the catheter with swine blood and incubating it at 37.5°C. The model was incubated for different lengths of time ranging from 1 day to 7 days. Each incubation time point included 20 ports. Total catheter occlusion of the TIVAPs was assessed with a 10-mL saline syringe equipped with a non-coring needle. Occlusion was defined as no passage of saline through the catheter when it was aspirated and infused gently with the 10-mL saline syringe. Pressure was evaluated during recanalization with an indeflator. Histological examination was performed on the clot obtained during recanalization. Results Among the 140 total experimental ports, 65 occlusions (46.4%) were detected. Of these 65 occlusions, 56 (86.1%) were recanalized by mechanical saline pressure via the indeflator. The indeflator pressure ranged from 29 pound per square-inch (psi) to 265 psi at mechanical catheter recanalization (mean: 110 psi). Histologically, all specimens from the model ports exhibited a similar appearance; specifically, erythrocytes, cells, and fibrin were evenly scattered throughout the clot. Conclusions Our data indicate that it is feasible to generate a TIVAP clot occlusion model with swine blood. Moreover, mechanical recanalization was suitable for resolving occluded catheters without thrombolytic agents.