bluuebunny/crossref_metadata_2025_split huggingface dataset:
Baseball Players With an Ulnar Collateral Ligament Tear Display Increased Nondominant Arm Humeral Torsion Compared With Healthy Baseball Players
Authors: Meyer Casey J. , Garrison J. Craig , Conway John E. 
Published: September 2016

Background: Previous work has suggested that an increase in the amount of developmentally acquired, dominant arm humeral retrotorsion (D HRT) in the thrower’s shoulder may be a potentially protective mechanism. Although the relationship between HRT and shoulder injuries has been reported, the relationship between HRT and ulnar collateral ligament (UCL) tears in baseball players is not known. Purpose: To determine whether D HRT and nondominant arm HRT (ND HRT) measurements in baseball players with a UCL tear differ statistically from a matched healthy cohort. Study Design: Case-control study; Level of evidence, 3. Methods: D HRT and ND HRT were measured in 112 male competitive high school and collegiate baseball players seen over an 18-month period from 2013 to 2015. A total of 56 participants with a clinical and magnetic resonance imaging–confirmed diagnosis of a throwing-arm UCL tear (UCLInj group) were compared with 56 healthy baseball players with no history of an elbow injury who were matched for age, experience, and position (NUCLInj group). The mean ages in the UCLInj and NUCLInj groups were 17.9 ± 2.2 and 17.6 ± 2.8 years, respectively. Using a previously validated ultrasound method, D HRT and ND HRT were measured in the supine position, and the HRT side-to-side difference (D HRT – ND HRT) was calculated. A 1-way multivariate analysis of variance was used to determine the mean statistical differences between groups ( P < .05). Results: Baseball players with a UCL tear displayed significantly more humeral torsion (ie, less retrotorsion) in their nondominant arm compared with healthy baseball players (UCLInj = 33.27° ± 10.27°, NUCLInj = 27.82° ± 10.88°; P = .007). Baseball players with a UCL tear did not display any differences in D HRT compared with healthy baseball players (UCLInj = 18.67° ± 9.41°, NUCLInj = 17.09° ± 9.92°; P = .391). Significant side-to-side differences in HRT existed between groups (UCLInj = −14.60° ± 6.72°, NUCLInj = −10.72° ± 6.88°; P = .003). Conclusion: There was a significant increase in mean nondominant arm humeral torsion (ie, less retrotorsion) in the UCL tear group, but there was no significant difference in the mean D HRT between the injured and uninjured groups. A greater HRT side-to-side difference was displayed in the UCL tear group. The extent to which a thrower has developmentally acquired both D HRT and ND HRT may affect elbow UCL tear risk. Furthermore, it is possible that the extent of genetically predisposed ND HRT may influence the throwing-related increase in D HRT.
The Cost-Effectiveness of Anterior Cruciate Ligament Reconstruction in Competitive Athletes
Authors: Stewart Bruce A. , Momaya Amit M. , Silverstein Marc D. , Lintner David 
Published: September 2016

Background: Competitive athletes value the ability to return to competitive play after the treatment of anterior cruciate ligament (ACL) injuries. ACL reconstruction has high success rates for return to play, but some studies indicate that patients may do well with nonoperative physical therapy treatment. Purpose: To evaluate the cost-effectiveness of the treatment of acute ACL tears with either initial surgical reconstruction or physical therapy in competitive athletes. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: The incremental cost, incremental effectiveness, and incremental cost-effectiveness ratio (ICER) of ACL reconstruction compared with physical therapy were calculated from a cost-effectiveness analysis of ACL reconstruction compared with physical therapy for the initial management of acute ACL injuries in competitive athletes. The ACL reconstruction strategy and the physical therapy strategy were represented as Markov models. Costs and quality-adjusted life-years (QALYs) were evaluated over a 6-year time horizon and were analyzed from a societal perspective. Quality of life and probabilities of clinical outcomes were obtained from the peer-reviewed literature, and costs were compiled from a large academic hospital in the United States. One-way, 2-way, and probabilistic sensitivity analyses were used to assess the effect of uncertainty in variables on the ICER of ACL reconstruction. Results: The ICER of ACL reconstruction compared with physical therapy was $22,702 per QALY gained. The ICER was most sensitive to the quality of life of returning to play or not returning to play, costs, and duration of follow-up but relatively insensitive to the rates and costs of complications, probabilities of return to play for both operative and nonoperative treatments, and discount rate. Conclusion: ACL reconstruction is a cost-effective strategy for competitive athletes with an ACL injury.
Description and Contribution of Brain Magnetic Resonance Imaging in Nontraumatic Critically Ill Children
Authors: Mortamet Guillaume , Kossorotoff Manoelle , Baptiste Amandine , Boddaert Nathalie , Castelle Martin , Hubert Philippe , Lesage Fabrice , Renolleau Sylvain , Oualha Mehdi 
Published: September 2016

Background: The authors aimed to collect all brain magnetic resonance imaging (MRI) performed in critically ill children in the authors’ medical pediatric intensive care unit over a 2-year period (2012-2013) to (1) describe the findings and (2) assess its contribution on practical patient care. Methods: This is a single-center and retrospective study. All children without traumatic brain injury who underwent a brain MRI during pediatric intensive care unit stays were included. To assess the exam’s contribution, the patient’s medical condition at the time of the MRI exam was blindly and separately exposed to a pediatric neurologist and a pediatric intensivist. Results: During the study period, 87 patients (7.5%) underwent a brain MRI. Median age was 4 months and 13 children (14.9%) died in pediatric intensive care unit. The most common final diagnosis was postanoxic encephalopathy. Brain MRI was abnormal in 68 patients (78.2%). No serious adverse event occurred during the transport. The neurologist and the intensivist considered brain MRI as indicated during pediatric intensive care unit stay in 65 (74.7%) and 68 patients (78.2%). They deemed that brain MRI had a diagnostic contribution in 76 (87.4%) and 60 (69.0%) patients, respectively. A therapeutic change consecutive to MRI findings occurred in 19 patients (21.8%) and MRI results were associated with a decision to withdraw life-sustaining treatment in 21 patients (24.1%). Conclusion: Brain MRI is one component of neuromonitoring, and this study suggests a substantial diagnostic contribution, although its therapeutic impact appears limited to specific diagnoses.
Methionine Metabolites in Patients With Sepsis
Authors: Wexler Orren , Gough Michael S. , Morgan Mary Anne M. , Mack Cynthia M. , Apostolakos Michael J. , Doolin Kathleen P. , Mooney Robert A. , Arning Erland , Bottiglieri Teodoro , Pietropaoli Anthony P. 
Published: September 2016

Objective: Sepsis is characterized by microvascular dysfunction and thrombophilia. Several methionine metabolites may be relevant to this sepsis pathophysiology. S-adenosylmethionine (SAM) serves as the methyl donor for trans-methylation reactions. S-adenosylhomocysteine (SAH) is the by-product of these reactions and serves as the precursor to homocysteine. Relationships between plasma total homocysteine concentrations (tHcy) and vascular disease and thrombosis are firmly established. We hypothesized that SAM, SAH, and tHcy levels are elevated in patients with sepsis and associated with mortality. Methods: This was a combined case–control and prospective cohort study consisting of 109 patients with sepsis and 50 control participants without acute illness. The study was conducted in the medical and surgical intensive care units of the University of Rochester Medical Center. Methionine, SAM, SAH, and tHcy concentrations were compared in patients with sepsis versus control participants and in sepsis survivors versus nonsurvivors. Results: Patients with sepsis had significantly higher plasma SAM and SAH concentrations than control participants (SAM: 164 [107-227] vs73 [59-87 nM], P < .001; SAH: 99 [60-165] vs 35 [28-45] nM, P < .001). In contrast, plasma tHcy concentrations were lower in sepsis patients compared to healthy control participants (4 [2-6]) vs 7 [5-9] μM; P = .04). In multivariable analysis, quartiles of SAM, SAH, and tHcy were independently associated with sepsis ( P = .006, P = .05, and P < .001, respectively). Sepsis nonsurvivors had significantly higher plasma SAM and SAH concentrations than survivors (SAM: 223 [125-260] vs 136 [96-187] nM; P = .01; SAH: 139 [81-197] vs 86 [55-130] nM, P = .006). Plasma tHcy levels were similar in survivors vs nonsurvivors. The associations between SAM or SAH and hospital mortality were no longer significant after adjusting for renal dysfunction. Conclusions: Methionine metabolite concentrations are abnormal in sepsis and linked with clinical outcomes. Further study is required to determine whether these abnormalities have pathophysiologic significance.
Strengthening Urban Health for Advancing Universal Health Coverage in India
Authors: Lahariya Chandrakant , Bhagwat Sadhana , Saksena Priyanka , Samuel Reuben 
Published: September 2016

In 2011, nearly 31 per cent of Indian population lived in urban areas and this proportion was rapidly growing. In parallel, the disease epidemiology in India, as a whole, was changing, with non-communicablediseases (NCDs) contributing to nearly two-thirds of total disease burden stressing the already overburdened health systems in Indian states. Contrary to common perceptions, the health outcomes of the urban poor in India are not any better and at times worse than those of the rural population. The challenges in urban health are well known—poor infrastructure, uncoordinated and fragmented health service delivery, suboptimal financing, insufficient coordination amongst multiple agencies, migrant population, shortage of human resources, high level of inequalities and inequities, etc. In recent years, with the recognition that replication of what is being done in rural areas may not be sufficient to address challenges in urban settings, unique solutions to urban health have been identified. This article summarizes the key health challenges and proposes a few solutions to address urban health challenges and improved health outcomes in urban agglomerations. The authors argue that progress towards universal health coverage in India would be partial unless sustained and harmonized initiatives are done to improve health situation in urban India.
Voltage-gated potassium channel antibody limbic encephalitis: a case illustrating the neuropsychiatric and PET/CT features with clinical and imaging follow-up
Authors: Celliers Liesl , Hung Te-jui , Al-ogaili Zeyad , Moschilla Girolamo , Knezevic Wally 
Published: September 2016

Objective: To illustrate the neuropsychiatric and imaging findings in a confirmed case of voltage-gated potassium channel antibody limbic encephalitis. Method: Case report and review of the literature. Results: A 64-year-old man presented with several months’ history of obsessive thoughts and compulsions associated with faciobrachial dystonic seizures. He had no significant past medical and psychiatric history. Physical examinations revealed only mildly increased tone in the left upper limb. Bedside cognitive testing was normal. Positron-emission tomography showed intense symmetrical uptake in the corpus striatum. No underlying malignancy was identified on whole body imaging. Magnetic resonance imaging, lumbar puncture and electroencephalogram were normal. Serum voltage-gated potassium channel antibodies were strongly positive. The patient had a favourable response to antiepileptic drugs, oral steroids and immunotherapy. Conclusions: Voltage-gated potassium channel limbic encephalitis characteristically presents with neuropsychiatric symptoms and temporal lobe seizures. Positron-emission tomography–computed tomography can be a useful adjunct to the clinical and biochemical work-up.
Zebras in the Forest: the experiences of Dual-Trained Child Psychiatrists and Paediatricians in Australia and New Zealand
Authors: Thabrew Hiran 
Published: September 2016

Objectives: The objectives of this study were to examine the experiences of dual-trained child psychiatrists and paediatricians in Australia and New Zealand and inform the review of the Dual Fellowship Training Programme by the Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians. Methods: All dual-trained child psychiatrists and paediatricians and current trainees were electronically surveyed in 2015. Results: Seven out of eight specialists (88%) and four out of six trainees (67%) responded. Six (55%) completed or were undertaking training as part of the Dual Fellowship Training Programme. Most respondents entered dual training without difficulty, found the transition from paediatrics to adult psychiatry challenging, and were reassured by their decision to undertake dual training on reaching advanced training in child psychiatry. Benefits and downsides of dual training were noted during and following training. A significant proportion of specialists (55%) were working in hospital-based environments, especially consult liaison services, suggesting that they added long-term value to both the fields of child psychiatry and paediatrics. Conclusions: The Dual Fellowship Training Programme remains a valuable vehicle for gaining skills in paediatrics and child psychiatry. There is support for its continuation by previous and current participants.
Metabolic monitoring and management among clozapine users
Authors: Tso Grace , Kumar Puja , Jayasooriya Thilini , Kisely Steve , Siskind Dan 
Published: September 2016

Objective: To assess, among clozapine users, the rates of monitoring, presence and treatment of metabolic syndrome and its components. Methods: A chart review was conducted of all clozapine users who were followed up in community mental health clinics at two Metro South Health Hospitals over a 1-year period. Metabolic syndrome was diagnosed according to the International Diabetes Federation criteria. Results: We included 251 clozapine users. Only 43.4% (109/251) had data collected for all five metabolic syndrome parameters. Among these people, 45.0% (49/109) met criteria for metabolic syndrome, while 61.2% (30/49) of those with metabolic syndrome were offered appropriate treatments. Correspondence with primary care providers occurred in only 18.7% ( n = 47). Non-pharmacological interventions, such as motivational interviewing and education about healthy lifestyle alternatives, occurred in 49.8% ( n = 125). Conclusions: There is growing awareness of the importance of metabolic monitoring, however, there remain specific gaps in the collaborative work among mental health services, primary care providers and clozapine users, to ensure appropriate physical health interventions.
Comparison of futility monitoring guidelines using completed phase III oncology trials
Authors: Zhang Qiang , Freidlin Boris , Korn Edward L , Halabi Susan , Mandrekar Sumithra , Dignam James J. 
Published: September 2016

Background: Futility (inefficacy) interim monitoring is an important component in the conduct of phase III clinical trials, especially in life-threatening diseases. Desirable futility monitoring guidelines allow timely stopping if the new therapy is harmful or if it is unlikely to demonstrate to be sufficiently effective if the trial were to continue to its final analysis. There are a number of analytical approaches that are used to construct futility monitoring boundaries. The most common approaches are based on conditional power, sequential testing of the alternative hypothesis, or sequential confidence intervals. The resulting futility boundaries vary considerably with respect to the level of evidence required for recommending stopping the study. Purpose: We evaluate the performance of commonly used methods using event histories from completed phase III clinical trials of the Radiation Therapy Oncology Group, Cancer and Leukemia Group B, and North Central Cancer Treatment Group. Methods: We considered published superiority phase III trials with survival endpoints initiated after 1990. There are 52 studies available for this analysis from different disease sites. Total sample size and maximum number of events (statistical information) for each study were calculated using protocol-specified effect size, type I and type II error rates. In addition to the common futility approaches, we considered a recently proposed linear inefficacy boundary approach with an early harm look followed by several lack-of-efficacy analyses. For each futility approach, interim test statistics were generated for three schedules with different analysis frequency, and early stopping was recommended if the interim result crossed a futility stopping boundary. For trials not demonstrating superiority, the impact of each rule is summarized as savings on sample size, study duration, and information time scales. Results: For negative studies, our results show that the futility approaches based on testing the alternative hypothesis and repeated confidence interval rules yielded less savings (compared to the other two rules). These boundaries are too conservative, especially during the first half of the study (<50% of information). The conditional power rules are too aggressive during the second half of the study (>50% of information) and may stop a trial even when there is a clinically meaningful treatment effect. The linear inefficacy boundary with three or more interim analyses provided the best results. For positive studies, we demonstrated that none of the futility rules would have stopped the trials. Conclusion: The linear inefficacy boundary futility approach is attractive from statistical, clinical, and logistical standpoints in clinical trials evaluating new anti-cancer agents.
A SCN10A SNP biases human pain sensitivity
Authors: Duan Guangyou , Han Chongyang , Wang Qingli , Guo Shanna , Zhang Yuhao , Ying Ying , Huang Penghao , Zhang Li , Macala Lawrence , Shah Palak , Zhang Mi , Li Ningbo , Dib-Hajj Sulayman D , Waxman Stephen G , Zhang Xianwei 
Published: September 2016

Background: Nav1.8 sodium channels, encoded by SCN10A, are preferentially expressed in nociceptive neurons and play an important role in human pain. Although rare gain-of-function variants in SCN10A have been identified in individuals with painful peripheral neuropathies, whether more common variants in SCN10A can have an effect at the channel level and at the dorsal root ganglion, neuronal level leading to a pain disorder or an altered normal pain threshold has not been determined. Results: Candidate single nucleotide polymorphism association approach together with experimental pain testing in human subjects was used to explore possible common SCN10A missense variants that might affect human pain sensitivity. We demonstrated an association between rs6795970 (G > A; p.Ala1073Val) and higher thresholds for mechanical pain in a discovery cohort (496 subjects) and confirmed it in a larger replication cohort (1005 female subjects). Functional assessments showed that although the minor allele shifts channel activation by −4.3 mV, a proexcitatory attribute, it accelerates inactivation, an antiexcitatory attribute, with the net effect being reduced repetitive firing of dorsal root ganglion neurons, consistent with lower mechanical pain sensitivity. Conclusions: At the association and mechanistic levels, the SCN10A single nucleotide polymorphism rs6795970 biases human pain sensitivity.
Ganglioside GM3 synthase depletion reverses neuropathic pain and small fiber neuropathy in diet-induced diabetic mice
Authors: Menichella Daniela M , Jayaraj Nirupa D , Wilson Heather M , Ren Dongjun , Flood Kelsey , Wang Xiao-Qi , Shum Andrew , Miller Richard J , Paller Amy S 
Published: September 2016

Background Small fiber neuropathy is a well-recognized complication of type 2 diabetes and has been shown to be responsible for both neuropathic pain and impaired wound healing. In previous studies, we have demonstrated that ganglioside GM3 depletion by knockdown of GM3 synthase fully reverses impaired wound healing in diabetic mice. However, the role of GM3 in neuropathic pain and small fiber neuropathy in diabetes is unknown. Purpose Determine whether GM3 depletion is able to reverse neuropathic pain and small fibers neuropathy and the mechanism of the reversal. Results We demonstrate that GM3 synthase knockout and the resultant GM3 depletion rescues the denervation in mouse footpad skin and fully reverses the neuropathic pain in diet-induced obese diabetic mice. In cultured dorsal root ganglia from diet-induced diabetic mice, GM3 depletion protects against increased intracellular calcium influx in vitro. Conclusions These studies establish ganglioside GM3 as a new candidate responsible for neuropathic pain and small fiber neuropathy in diabetes. Moreover, these observations indicate that systemic or topically applied interventions aimed at depleting GM3 may improve both the painful neuropathy and the wound healing impairment in diabetes by protecting against nerve end terminal degeneration, providing a disease-modifying approach to this common, currently intractable medical issue.
Effects of a combined technique and agility program on youth soccer players’ skills
Authors: Zago Matteo , Giuriola Massimo , Sforza Chiarella 
Published: September 2016

High-intensity actions with high technical demands heavily influence soccer game outcomes. While performance factors have been traditionally trained separately, a program combining agility and technique training was proposed, structured on artificial constraints (tapes) creating spatiotemporal restrictions. This repeated-measures study involved an experimental and a control group: 20 Under-12 sub-elite male soccer players were tested before and after a 22-weeks differentiated training intervention or the traditional training schedule. The proposed program produced higher performance improvements, compared to traditional training, in the Shuttle Sprint Test (two-way analysis of variance, factors: Group and Time, significant Group × Time interaction, P < 0.05) and in the Loughborough Soccer Passing Test execution time (−4.8%, P < 0.05). Both groups improved Slalom Dribbling Test performance ( P < 0.001). We concluded that the proposed program could enhance performance in 180° change-of-direction and in the time to complete a controlling and passing dynamic task. The methodological implications of this study could be beneficial in improving youth soccer training effectiveness.