bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of a Single-Visit Approach to Breast Care in Zambia
Authors: Pinder Leeya F. , Shibemba Aaron , Kusweje Victor , Nzayisenga Jean-Baptiste , Chiboola Hector , Amuyunzu-Nyamongo Mary , Mwaba Catherine , Msadabwe Susan Citonje , Lermontov Pavlo , Chikontwe Edgar , Parham Groesbeck P. 
Published: April 2017

Abstract 11 Background: System-level barriers to care and low levels of awareness lead to late-stage presentation of breast disorders in resource-constrained environments. Simulating Zambia’s successful screen and treat approach to cervical cancer prevention, we designed and implemented an algorithm to improve breast care efficiency. Methods: In collaboration with the Zambian Ministry of Health and with support from the Susan G. Komen Breast Cancer Foundation, we initially expanded breast care capacity in Zambia through on-site training of mid- and high-level health care providers by international experts. By using this cadre of local experts, we then implemented a rural breast care camp of 1-week duration, during which breast self-awareness, psychosocial counseling, clinical breast examination, breast ultrasound, ultrasound-guided breast biopsy, histologic analysis of biopsy specimens, and treatment were offered to participants in a single-visit format. Results: Four hundred seventy-five women were evaluated during the camp. The mean age of participants was 34.5 (± 13.0) years. The majority of women were multiparous (81.9%), breast-fed (78.5%), and reported hormone use (54.1%). Abnormalities were detected on clinical breast examination in 33 women, 27 of which required ultrasound. Lesions were confirmed in 17 and evaluated by using ultrasound-guided core needle biopsy (12) or fine-needle aspiration (five). On-site imprint cytology was performed on all specimens and later confirmed by histology, with a concordance of 100%. Two cancers were detected. Three women with benign lesions underwent same-day surgery after histologic confirmation. Conclusion: Similar to the see-and-treat approach for cervical cancer prevention, the single-visit algorithm has the potential to vastly improve breast care efficiency in low-resource environments ( Fig 1 ). [Figure: see text] Funding: Susan G. Komen Breast Cancer Foundation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Leeya F. Pinder No relationship to disclose Aaron Shibemba No relationship to disclose Victor Kusweje No relationship to disclose Jean-Baptiste Nzayisenga No relationship to disclose Hector Chiboola No relationship to disclose Mary Amuyunzu-Nyamongo No relationship to disclose Catherine Mwaba Research Funding: Mylan (Inst) Travel, Accommodations, Expenses: Fresenius Susan Citonje Msadabwe Travel, Accommodations, Expenses: AstraZeneca Pavlo Lermontov No relationship to disclose Edgar Chikontwe No relationship to disclose Groesbeck P. Parham No relationship to disclose
Costs of Diagnosing Breast-Related Conditions at a Large, Public Hospital in a Middle-Income Country Without Population-Level Screening
Authors: Lince-Deroche Naomi , Van Rensburg Craig , Firnhaber Cindy , Benn Carol , Rubin Grace , Michelow Pam , Rayne Sarah 
Published: April 2017

Abstract 42 Background: Literature regarding the costs and cost-effectiveness of diagnosing breast disease globally, including cancer, has focused on mammographic screening in high-income settings. South Africa, a middle-income country, is currently crafting its first national breast cancer policy, and information on costs and best practices for national imaging services in low- and middle-income settings is required. We undertook this work to estimate the average cost per procedure and per patient for diagnosis of breast conditions by using a large, public outpatient clinic in Johannesburg as well as to explore potential cost savings through rationing mammography for diagnosis. Methods: Results of a retrospective clinical cohort study conducted at an outpatient clinic in 2013 and 2014 were used to establish a 12-month population of clinic patients and diagnostic service statistics. We used microcosting to estimate the average cost for each diagnostic procedure from the health service perspective. An Excel-based model and scenario analysis were used to explore changes in total and per patient costs when mammography use was incrementally reduced by shifting patients to ultrasound-based services. Results: We estimated that 3,867 individuals attended the clinic over 12 months. The average cost per patient for initial consultation and/or exam was $10.14 (2015 USD). Mammography was more costly than ultrasound at $59.96 and $21.11, respectively. Procedures for pathology were the most costly diagnostic (stereotactic core needle biopsy, $330.05; ultrasound-guided core needle biopsy, $279.42; fine needle aspiration, $101.00) because of substantial laboratory charges. The average cost per patient seen was $115.96. Hypothetically, replacing mammography with ultrasound resulted in minimal decreases in the average cost per patient as a result of the high cost of the mammogram machine. Cost savings at the facility level may be achieved when mammography use is eliminated entirely. Conclusion: Per patient mammography costs are largely dependent on economies of scale. Because ultrasound can be considered as an alternative for many women without compromising imaging in nonoccult disease, diagnostic mammography should be offered in centralized locations for maximum efficiency gains. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Naomi Lince-Deroche No relationship to disclose Craig Van Rensburg No relationship to disclose Cindy Firnhaber Research Funding: Merck (Inst) Carol Benn No relationship to disclose Grace Rubin No relationship to disclose Pam Michelow No relationship to disclose Sarah Rayne Travel, Accommodations, Expenses: Novartis
Results of Cancer Control Education for Primary Care Providers in Low- and Middle-Income Countries
Authors: Eaton Vanessa J. , Kremzier Megan K. , Pyle Doug 
Published: April 2017

Abstract 28 Background: The global burden of cancer is growing in low- and middle-income countries where availability of specialists to treat cancer is acutely low. To detect cancer earlier, patients must be educated about their risk for cancer and be screened when appropriate. In response to a growing need for cancer education in primary health care, ASCO International created the Cancer Control in Primary Care course, which was piloted in 2015. The purpose of the program is to increase the knowledge of primary health workers so as to recognize signs and symptoms of cancer, increase their ability to talk with patients about their risk, and to know how and when to refer patients for additional screening or diagnostic testing. Methods: ASCO collects data from participants in two stages: an on-site evaluation and a follow-up survey 12 months after the workshop. The survey instruments include questions about practice changes, learning objectives, and demographic information. Results: Follow-up surveys have been conducted for four courses. Ninety-three percent of respondents have reported that they made practice changes after the course. In addition, 90% reported that communication with patients about their risk for cancer had increased, 76% reported that they are screening patients for cancer more than before, and 74% reported that they have worked with specialists to plan treatment for their patients with cancer. Conclusion: Results of the Cancer Control in Primary Care course are positive, and ASCO will continue to collaborate with society and institutional partners to train primary health workers around the world to raise awareness of cancer. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.
Autotaxin Is Regulated by Glucose and Insulin in Adipocytes
Authors: D’Souza Kenneth , Kane Daniel A. , Touaibia Mohamed , Kershaw Erin E. , Pulinilkunnil Thomas , Kienesberger Petra C. 
Published: April 2017

Abstract
Autotaxin (ATX) is an adipokine that generates the bioactive lipid, lysophosphatidic acid. Despite recent studies implicating adipose-derived ATX in metabolic disorders including obesity and insulin resistance, the nutritional and hormonal regulation of ATX in adipocytes remains unclear. The current study examined the regulation of ATX in adipocytes by glucose and insulin and the role of ATX in adipocyte metabolism. Induction of insulin resistance in adipocytes with high glucose and insulin concentrations increased ATX secretion, whereas coincubation with the insulin sensitizer, rosiglitazone, prevented this response. Moreover, glucose independently increased ATX messenger RNA (mRNA), protein, and activity in a time- and concentration-dependent manner. Glucose also acutely upregulated secreted ATX activity in subcutaneous adipose tissue explants. Insulin elicited a biphasic response. Acute insulin stimulation increased ATX activity in a PI3Kinase-dependent and mTORC1-independent manner, whereas chronic insulin stimulation decreased ATX mRNA, protein, and activity. To examine the metabolic role of ATX in 3T3-L1 adipocytes, we incubated cells with the ATX inhibitor, PF-8380, for 24 hours. Whereas ATX inhibition increased the expression of peroxisome proliferator–activated receptor-γ and its downstream targets, insulin signaling and mitochondrial respiration were unaffected. However, ATX inhibition enhanced mitochondrial H2O2 production. Taken together, this study suggests that ATX secretion from adipocytes is differentially regulated by glucose and insulin. This study also suggests that inhibition of autocrine/paracrine ATX–lysophosphatidic acid signaling does not influence insulin signaling or mitochondrial respiration, but increases reactive oxygen species production in adipocytes.
Bisphosphonate Treatment and the Characteristics of Femoral Fractures in Children With Osteogenesis Imperfecta
Authors: Vuorimies Ilkka , Mäyränpää Mervi K. , Valta Helena , Kröger Heikki , Toiviainen-Salo Sanna , Mäkitie Outi 
Published: April 2017

Abstract

Context:
The short-term benefits of bisphosphonates (BPs) are evident in the treatment of children with osteogenesis imperfecta (OI), but some concerns related to long-term effects remain.

Objective:
To elucidate the effect of BPs on characteristics of femoral fractures in children with OI.

Design and Setting:
Retrospective cohort study at a university hospital.

Patients and Main Outcome Measure:
The study included 93 patients with OI. We recorded fracture histories and analyzed all femoral fractures for location and fracture type using radiographs obtained at fracture diagnosis. Effects of BPs were evaluated by comparing fracture characteristics in three groups: patients (1) naive to BPs, (2) receiving ongoing BP treatment, and (3) whose treatment was discontinued.

Results:
In total, 127 femoral fractures occurred in 24 patients. Of the fractures, 63 (50%) occurred in patients naive to BPs, 44 (35%) during BP treatment, and 20 (16%) after treatment discontinuation. Mid or distal shaft fractures were most common (41%), followed by subtrochanteric (33%) and distal (20%) fractures. Almost all fractures were transverse (65%) or oblique (28%). The pattern of femoral fractures was similar in all three BP treatment groups (P = 0.78 for location; P = 0.35 for fracture type) and was not related to cumulative BP dose. Instead, OI type correlated with fracture characteristics, and distal location and transverse configuration were more common in the more severe types III and IV compared with type I OI.

Conclusion:
Characteristics of femoral fractures in children with OI are affected by OI type but not by BP exposure.
Novel Dominant-Negative GH Receptor Mutations Expands the Spectrum of GHI and IGF-I Deficiency
Authors: Vairamani Kanimozhi , Merjaneh Lina , Casano-Sancho Paula , Sanli Merve Emecen , David Alessia , Metherell Louise A. , Savage Martin O. , Sánchez del Pozo Jaime , Backeljauw Philippe F. , Rosenfeld Ron G. , Aisenberg Javier , Dauber Andrew , Hwa Vivian 
Published: April 2017

Abstract

Context:
Autosomal-recessive mutations in the growth hormone receptor (GHR) are the most common causes for primary growth hormone insensitivity (GHI) syndrome with classical GHI phenotypically characterized by severe short stature and marked insulin-like growth factor (IGF)-I deficiency. We report three families with dominant-negative heterozygous mutations in the intracellular domain of the GHR causing a nonclassical GHI phenotype.

Objective:
To determine if the identified GHR heterozygous variants exert potential dominant-negative effects and are the cause for the GHI phenotype in our patients.

Results:
All three mutations (c.964dupG, c.920_921insTCTCAAAGATTACA, and c.945+2T&gt;C) are predicted to result in frameshift and early protein termination. In vitro functional analysis of variants c.964dupG and c.920_921insTCTCAAAGATTACA (c.920_921ins14) suggests that these variants are expressed as truncated proteins and, when coexpressed with wild-type GHR, mimicking the heterozygous state in our patients, exert dominant-negative effects. Additionally, we provide evidence that a combination therapy of recombinant human growth hormone (rhGH) and rhIGF-I improved linear growth to within normal range for one of our previously reported patients with a characterized, dominant-negative GHR (c.899dupC) mutation.

Conclusion:
Dominant-negative GHR mutations are causal of the mild GHI with substantial growth failure observed in our patients. Heterozygous defects in the intracellular domain of GHR should, therefore, be considered in cases of idiopathic short stature and IGF-I deficiency. Combination therapy of rhGH and rhIGF-I improved growth in one of our patients.
Competing with Copycats When Customers Are Strategic
Authors: Pun Hubert , DeYong Gregory D. 
Published: April 2017

In this paper, we use a two-period game theoretical model to examine the decisions of a manufacturer and a copycat firm who are competing for strategic customers. The manufacturer decides on the amount of its market expansion advertising investment in the first period and on its pricing strategy in both periods. Advertising increases the “size of the pie,” but eventually the manufacturer may end up inadvertently sharing the benefits with the copycat. After the first period, the copycat makes a market-entry decision, and, if it opts to enter, it also decides on a pricing strategy. The customers are strategic, and they decide whether or not to buy, when to buy, and which product to buy. We find that, interestingly, lower quality levels of the manufacturer’s product may increase the manufacturer’s prices and profit. Moreover, the manufacturer may be worse off when customers are more likely to purchase its product immediately rather than wait for a price reduction or for the copycat’s product. Finally, the copycat may be worse off when customers withhold their purchases in the first period in anticipation of the possibility of copycat product becoming available in a later period.The online appendix is available at https://doi.org/10.1287/msom.2016.0613 .
The recognition and incidence of peroneal tendon dislocation associated with a fracture of the talus
Authors: Sadamasu A. , Yamaguchi S. , Nakagawa R. , Kimura S. , Endo J. , Akagi R. , Sasho T. 
Published: April 2017

Aims The purposes of this study were to clarify first, the incidence of peroneal tendon dislocation in patients with a fracture of the talus and second the factors associated with peroneal tendon dislocation. Patients and Methods We retrospectively examined 30 patients (30 ankles) with a mean age of 37.5 years, who had undergone internal fixation for a fracture of the talus. Independent examiners assessed for peroneal tendon dislocation using the pre-operative CT images. The medical records were also reviewed for the presence of peroneal tendon dislocation. The associations between the presence of dislocation with the patient characteristics or radiological findings, including age, mechanism of injury, severity of fracture, and fleck sign, were assessed using Fisher’s exact tests. Results The pre-operative CT images showed peroneal tendon dislocation in eight out of 30 patients. Dislocation was found later in one patient whose pre-operative CT image had not shown dislocation. The overall incidence of peroneal tendon dislocation was 30% (9/30). The presence of dislocation was associated with the presence of a fleck sign (p = 0.03). Conclusions Surprisingly, approximately one-third of the patients who underwent internal fixation for a fracture of the talus had peroneal tendon dislocation. This was associated with a fleck sign. Cite this article: Bone Joint J 2017;99-B:489–93.
Cemented versus cementless hemiarthroplasty for a displaced fracture of the femoral neck
Authors: Veldman H. D. , Heyligers I. C. , Grimm B. , Boymans T. A. E. J. 
Published: April 2017

Aims Our aim was to prepare a systematic review and meta-analysis to compare the outcomes of cemented and cementless hemiarthroplasty of the hip, in elderly patients with a fracture of the femoral neck, to investigate the mortality, complications, length of stay in hospital, blood loss, operating time and functional results. Materials and Methods A systematic review and meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on randomised controlled trials (RCTs), studying current generation designs of stem only. The synthesis of results was done of pooled data, with a fixed effects or random effects model, based on heterogeneity. Results A total of five RCTs including 950 patients (950 hips) were included. Cementless stems were found to be associated with more complications compared with cemented stems (odds ratio (OR) 1.61, 95% confidence interval (CI) 1.12 to 2.31, p = 0.01), especially implant-related complications (OR 3.15, 95% CI 1.55 to 6.41, p = 0.002). The operating time was shorter for cementless stems (weighted mean difference -9.96 mins, 95%CI -12.93 to -6.98, p < 0.001). The data on functional outcomes could not be pooled. There was no statistically significant difference for any other outcome between the two methods of fixation. Conclusion In hemiarthroplasty of the hip using current generation stems, cemented stems result in fewer implant-related complications and similar mortality compared with cementless stems. Cite this article: Bone Joint J 2017;99-B:421–31.
Unsatisfactory outcomes following unicompartmental knee arthroplasty in patients with partial thickness cartilage loss
Authors: Hamilton T. W. , Pandit H. G. , Inabathula A. , Ostlere S. J. , Jenkins C. , Mellon S. J. , Dodd C. A. F. , Murray D. W. 
Published: April 2017

AimsWhile medial unicompartmental knee arthroplasty (UKA) is indicated for patients with full-thickness cartilage loss, it is occasionally used to treat those with partial-thickness loss. The aim of this study was to investigate the five-year outcomes in a consecutive series of UKAs used in patients with partial thickness cartilage loss in the medial compartment of the knee.Patients and MethodsBetween 2002 and 2014, 94 consecutive UKAs were undertaken in 90 patients with partial thickness cartilage loss and followed up independently for a mean of six years (1 to 13). These patients had partial thickness cartilage loss either on both femur and tibia (13 knees), or on either the femur or the tibia, with full thickness loss on the other surface of the joint (18 and 63 knees respectively). Using propensity score analysis, these patients were matched 1:2 based on age, gender and pre-operative Oxford Knee Score (OKS) with knees with full thickness loss on both the femur and tibia. The functional outcomes, implant survival and incidence of re-operations were assessed at one, two and five years post-operatively. A subgroup of 36 knees in 36 patients with partial thickness cartilage loss, who had pre-operative MRI scans, was assessed to identify whether there were any factors identified on MRI that predicted the outcome.ResultsKnees with partial thickness cartilage loss had significantly worse functional outcomes at one, two and five years post-operatively compared with those with full thickness loss. A quarter of knees with partial thickness loss had a fair or poor result and a fifth failed to achieve a clinically significant improvement in OKS from a baseline of four points or more; double that seen in knees with full thickness loss. Whilst there was no difference in implant survival between the groups, the rate of re-operation in knees with partial thickness loss was three times higher. Most of the re-operations (three-quarters), were arthroscopies for persistent pain. Compared with those achieving good or excellent outcomes, patients with partial thickness cartilage loss who achieved fair or poor outcomes were younger and had worse pre-operative functional scores. However, there were no other differences in the baseline demographics. MRI findings of full thickness cartilage loss, subchondral oedema, synovitis or effusion did not provide additional prognostic information.ConclusionMedial UKA should be reserved for patients with full thickness cartilage loss on both the femur and tibia. Whilst some patients with partial thickness loss achieve a good result we cannot currently identify which these will be and in this situation MRI is unhelpful and misleading. Cite this article: Bone Joint J 2017;99-B:475–82.
Imaging modalities in patients with slipped capital femoral epiphysis
Authors: Hesper T. , Zilkens C. , Bittersohl B. , Krauspe R. 
Published: April 2017

Background Slipped capital femoral epiphysis (SCFE) is a frequent disorder of the adolescent hip, which may lead to avascular necrosis (AVN) of the femoral head, chondrolysis and early osteoarthritis due to the post-slip deformity of the proximal femur. To warrant the best possible outcome for the affected (and contralateral) hip, early diagnosis and proper treatment are needed. Methods A review of the literature was undertaken to identify today's role of available imaging modalities in the management of SCFE. Summary This review outlines the relevancy of different imaging modalities such as radiography, ultrasound, CT, MRI and bone scintigraphy in the treatment of SCFE patients. While standard radiography is the first-choice imaging modality for patients with suspected SCFE, ultrasound and advanced imaging modalities may aid in surgical planning, diagnosis of complications such as AVN and treatment follow-up.
Pinning the slipped and contralateral hips in the treatment of slipped capital femoral epiphysis
Authors: Hägglund G. 
Published: April 2017

Purpose To describe and comment on the treatment of the slipped capital femoral epiphysis (SCFE) with pinning and to present the pros and cons of prophylactic pinning of the contralateral hip. Summary Pinning the SCFE aims to fix the epiphysis and prevent further slipping. Some devices allow for further growth and remodeling of the femoral neck post-operatively. This results in maintained femoral offset and probably reduced risk of femoroacetabular impingement. There are currently no long-term follow-up studies showing less complications or better function than after in situ fixation. The contralateral hip can be managed by prophylactic pinning or close follow-up with repeated radiographic examinations. Which of the methods is best is still controversial due to different opinions on the risk of bilateral SCFE, the consequences of a later contralateral slip and the risks of prophylactic pinning. Although research supports prophylactic pinning the child and the family's preference is crucial.