bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors predicting admission to extended care facility after distal femoral fracture
Authors: Boin Michael A. , Narayanan Shankar , Duren Dana , Dorweiler Matthew , Lee Jessica , Froehle Andrew , Laughlin Richard 
Published: June 2017

Background:
Delayed identification of patients requiring admission to an extended care facility (ECF) after orthopaedic injuries is leading to delays in discharge. The aim of this study was to identify patient factors that predict the need for admission to an ECF after distal femoral fracture.

Methods:
A retrospective chart review was performed in 176 patients admitted with a distal femoral fracture at a level one trauma center. Patient characteristics, medical comorbidities, and fracture classification were among the variables analyzed. Discriminate function analysis was used to predict if a patient would need an ECF after their hospital stay.

Results:
Seventy-one patients were included in the final statistical analysis. Of these, 11 men (48%) and 40 women (83%) were discharged to an ECF. Analysis demonstrated that higher American Society of Anesthesiologist (ASA) score (P<0.001), higher body mass index (BMI) (P<0.02), diabetes (P<0.03), and periprosthetic fracture (P<0.04) for men, while a higher ASA score (P<0.001) and lower hemoglobin (P<0.05) for women were the key variables in predicting discharge to an ECF. Using these variables, we developed a predictive equation that correctly classified 95.7% of men and 81.3% of women as requiring an ECF.

Conclusions:
We were able to distinguish patient factors that predicted discharge to an ECF. Patient care providers can use these findings to proactively identify those who will need an ECF and potentially decrease nonmedical delays in discharge.
Stiffness after primary total knee arthroplasty: a radiographic analysis with a matched-control population
Authors: Moya-Angeler Joaquin , Bas Marcel A. , Cooper H. John , Hepinstall Matthew S. , Rodriguez Jose A. , Scuderi Giles R. 
Published: June 2017

Background:
The purposes of this study were (1) to evaluate standardized radiographic parameters in a population of patients who developed stiffness after primary total knee arthroplasty (TKA), and (2) to compare those to a matched control population.

Methods:
A retrospective review was performed to identify patients who required revision for stiffness after primary TKA. Patients with history of TKA revision or infection, as well as, those treated with isolated polyethylene exchange were excluded. Study patients were matched 1:1 with controls based on age, sex, body mass index (BMI). Radiographic measurements were performed by two blinded independent observers.

Results:
A total of 44 patients met the inclusion criteria. Thirty-one (70%) were females. Mean BMI was 33 kg/m2 (19-58). Univariate odds ratios showed significance for patella baja (5.776; 0.025), increased anterior condylar offset ratio (ACO) (15.265; 0.000), increased anterior implant-cortex gap (5.067; 0.038), and increased percentage of patellar displacement (PPD) (6.476; 0.016). Multivariate regression analysis showed significance for ACO (18.307; 0.001) and PPD (9.338; 0.024). No significance was observed with respect to component alignment in the coronal or sagittal planes, posterior condylar offset ratio, patellar tilt, presence of heterotopic ossification, or posterior osteophyte formation. Intraclass correlation coefficients (ICCs) ranged from good to excellent (>0.8) for all measurements performed.

Conclusions:
The restoration of the joint line and avoiding overstuffing the patellofemoral compartment are fundamental in preventing the development of postoperative stiffness. Poor mechanics of the patellofemoral compartment are significantly associated with the development of stiffness after primary TKA.
Second Place Award: Tranexamic acid and intrathecal morphine are synergistic in reducing transfusion requirements in pediatric posterior spinal fusion
Authors: Schur Mathew D. , Blumstein Gideon W. , Ross Patrick A. , Andras Lindsay M. , Skaggs David L. 
Published: June 2017

Background:
Previous studies demonstrated that the independent use of both tranexamic acid (TXA) and intrathecal morphine (ITM) reduced transfusion requirements in scoliosis patients undergoing posterior spinal fusion (PSF). This study examined the combined effects of TXA and ITM on transfusion requirements in pediatric patients undergoing PSF.

Methods:
A retrospective review of consecutive patients treated with PSF at a single institution was performed. Patients with a minimum of 10 vertebral levels of fusion and PSF with segmental instrumentation were included. Transfusion records were reviewed during surgery and 7 days postoperatively. Patients were divided into four treatment groups for comparison: 1. No TXA, No ITM; 2. Only TXA; 3. Only ITM and 4. TXA and ITM. Multivariate regression analysis, Student t-test, and chi-squared test were used to determine significance.

Results:
Five hundred and ninety-four patients met inclusion criteria; 63% (376/594) were female, average age: 14.6 yr (range 8.0-24.3 yr) and average 13 levels fused (10-18 levels). Fifty-three percent (316/594) received packed red blood cell (PRBC) transfusion. Patients receiving the TXA and ITM combination had 72% lower odds ratio of transfusion (P<0.001, OR 0.28, CI 0.14-0.56). Patients did not have lower odds ratio of transfusion when receiving TXA alone (P=0.32, OR 0.65, CI 0.28-1.53) or ITM alone (P=0.09, OR 0.55, CI 0.28-1.09). Similar results were seen when patients were analyzed separately by diagnosis (idiopathic vs. nonidiopathic).

Conclusions:
The combination of TXA and ITM was associated with 72% reduction in odds ratio of PRBC transfusion in pediatric patients undergoing PSF, an effect seen in both idiopathic and nonidiopathic scoliosis when analyzed separately.
Clinical outcomes of single-incision suture anchor repair of distal biceps tendon rupture
Authors: Dupaix John P. , Kuba Megan H.M. , Atkinson Robert E. , Singer Daniel I. , Chock Megan M. , Napier Erin 
Published: June 2017

Background:
Rupture of the distal biceps tendon remains an uncommon injury that is ideally treated by operative repair. Single-incision anterior approach with suture anchor repair is one such method. The purpose of this study was to describe the outcomes in patients who underwent repair of the distal biceps tendon with single anterior incision and suture anchor repair.

Methods:
One hundred and nineteen patients (120 repairs) with distal biceps tendon repairs between January 1, 2002 and December 31, 2012 were identified and their charts retrospectively reviewed. Twenty-five of these patients participated in additional collection of outcome data including range of motion, strength, pain, satisfaction, and clinical outcome.

Results:
In the retrospective analysis, the population was 93% male. Average age was 47.3 yr; however, females had a significantly higher mean age (62.5). Most of the patients (69.8%) returned to full or partial work. The additional data collection cohort reported high satisfaction, little-to-no pain on visual analog scale (VAS) and average Disability of the Arm Shoulder and Hand (DASH) scores. Patients with workers’ compensation claims reported significantly higher pain and worse DASH scores. There was small but significant loss of pronation, and a small loss of grip strength that approached significance.

Conclusions:
Single anterior incision with suture anchor repair may be utilized for repair of ruptures of the distal biceps tendon with good clinical and functional outcomes and minimal loss of range of motion and strength. Females tend to be older at presentation than males with this condition. As in other studies, workers’ compensation claims were associated with poorer clinical outcomes.

Level of Evidence:
Therapeutic, level IV, case series study.
Third Place Award: Posttraumatic elbow arthrofibrosis incidence and risk factors: a retrospective review
Authors: Marchand Lucas S. , Working Zachary M. , Williams John B. , Elliott Iain S. , Higgins Thomas F. , Rothberg David L. , Kubiak Erik N. 
Published: June 2017

Background:
Loss of elbow range of motion (ROM) can significantly decrease patient quality of life. Posttraumatic arthrofibrosis is a common cause of decreased elbow ROM, and it has been reported that loss of 50% of elbow motion can compromise 80% of extremity function. The aim of this study was to examine the incidence and risk factors of posttraumatic elbow arthrofibrosis.

Methods:
We performed a retrospective review of all patients with intraarticular elbow fracture treated with operative fixation over a 10-year period. Pearson’s Chi-squared, Student’s t-test, and a logistic multivariate regression model was used to predict arthrofibrosis risk factors.

Results:
A total of 390 consecutive patients with intra-articular elbow fractures were identified. A total of 105 (27%) patients developed arthrofibrosis with 72 surgical interventions performed to improve ROM. At final follow-up 88 (23%) patients had persistent arthrofibrosis. Using multivariate regression analysis, high-energy mechanism (odds ratio (OR) 3.61, 95% confidence interval (CI) 1.16-6.3, P<0.001), deep post operative infection (OR 2.3, 95% CI 1.26-4.37, P=0.038), elbow fracture-dislocations (OR 3.44, 95% CI 1.32-7.41, P=0.005), and distal humeral fractures (OR 1.9, 95% CI 1.1-3.19, P=0.027) were significantly associated with the development of arthrofibrosis. The effect of duration of immobilization was significant, with each extra day of immobilization increasing the odds of arthrofibrosis by 9% (OR 1.09, P=0.001).

Conclusions:
Duration of immobilization, fracture pattern, presence of deep postoperative infection, and energy of injury were all predictive factors for the development of elbow arthrofibrosis after operative treatment of intraarticular elbow fractures.
ABNORMAL RETINAL REFLECTIVITY TO SHORT-WAVELENGTH LIGHT IN TYPE 2 IDIOPATHIC MACULAR TELANGIECTASIA
Authors: Sallo Ferenc B. , Leung Irene , Zeimer Meike , Clemons Traci E. , Dubis Adam M. , Fruttiger Marcus , Pauleikhoff Daniel , Chew Emily Y. , Egan Catherine , Peto Tunde , Bird Alan C. ,   the MacTel Study Group
Published: June 2017

Purpose:
Macular telangiectasia Type 2 (MacTel) is a bilateral, progressive, potentially blinding retinal disease characterized by vascular and neurodegenerative signs, including an increased parafoveal reflectivity to blue light. Our aim was to investigate the relationship of this sign with other signs of macular telangiectasia Type 2 in multiple imaging modalities.

Methods:
Participants were selected from the MacTel Type 2 study, based on a confirmed diagnosis and the availability of images. The extent of signs in blue-light reflectance, fluorescein angiographic, optical coherence tomographic, and single- and dual-wavelength autofluorescence images were analyzed.

Results:
A well-defined abnormality of the perifovea is demonstrated by dual-wavelength autofluorescence and blue-light reflectance in early disease. The agreement in area size of the abnormalities in dual-wavelength autofluorescence and in blue-light reflectance images was excellent: for right eyes: ρ = 0.917 (P < 0.0001, 95% confidence interval 0.855–0.954, n = 46) and for left eyes: ρ = 0.952 (P < 0.0001, 95% confidence interval 0.916–0.973, n = 49). Other changes are less extensive initially and expand later to occupy that area and do not extend beyond it.

Conclusion:
Our findings indicate that abnormal metabolic handling of luteal pigment and physical changes giving rise to increased reflectance are widespread in the macula throughout the natural history of the disease, precede other changes, and are relevant to early diagnosis.
CYP2E1 Gene Polymorphisms Related to the Formation of Coronary Artery Lesions in Kawasaki Disease
Authors: Chang Ling-Sai , Hsu Yu-Wen , Lu Chien-Chang , Lo Mao-Hung , Hsieh Kai-Sheng , Li Sung-Chou , Chang Wei-Chiao , Kuo Ho-Chang 
Published: June 2017

Background:
Kawasaki disease (KD) is an acute febrile systemic vasculitis that disturbs coronary arteries. Patients’ risks of adverse cardiovascular events and subclinical atherosclerosis have been found to significantly increase with polymorphisms of the human cytochrome P450. This current study aims to research the possible relationship between cytochrome P450, family 2, subfamily E and polypeptide 1 (CYP2E1) polymorphisms with KD.

Methods:
We selected 6 tag single-nucleotide polymorphisms (SNPs) of the CYP2E1 gene for TaqMan allelic discrimination assay in 340 KD patients and performed analysis on the clinical phenotypes and coronary artery lesions (CALs). CAL associations of tag SNPs were adjusted for age and gender in the logistic regression.

Results:
The KD patients with a CC genotype of rs915906 demonstrated a greater proportion of CAL formation (P = 0.009). Furthermore, the GG genotype frequencies of rs2070676 showed a significantly greater risk for CAL formation in KD patients (P = 0.007). However, the SNPs of the CYP2E1 gene did not influence CAL formation in the participating KD patients either with or without high-dose acetylsalicylic acid. Using the expression quantitative trait locus analyses, we found that the SNPs associated with CAL formation in KD also affected CYP2E1 expression in certain cell types.

Conclusion:
This study is the first to find that the risk of CAL formation is related to CYP2E1 gene polymorphisms in KD patients.
Redistribution of Streptococcus pneumoniae Serotypes After Nationwide 13-valent Pneumococcal Conjugate Vaccine Program in Children in Northern Taiwan
Authors: Cho Ying-Chun , Chiu Nan-Chang , Lu Chun-Yi , Huang Daniel Tsung-Ning , Huang Fu-Yuan , Chang Luan-Yin , Huang Li-Min , Chi Hsin 
Published: June 2017

Background:
After the introduction of 13-valent pneumococcal conjugate vaccine (PCV13) against Streptococcus pneumoniae, public health officials in Taiwan monitored a decline in circulating vaccine serotypes and the emergence of nonvaccine serotypes in children with invasive pneumococcal disease. A gradually expanded PCV13 national immunization program was launched in 2013 in Taiwan. Here, we evaluate the changes in the distribution of pneumococcal serotypes and antimicrobial nonsusceptibility in children during the evolution of vaccination policy.

Methods:

S. pneumoniae isolates from children with pneumococcal disease were collected and serotyped from 2010 to 2015 in northern Taiwan. PCVs were administered at the recipients’ expense between 2010 and 2012, and then PCV13 was partially reimbursed by the government beginning in 2013. The distribution and diversity of serotypes were analyzed along with their antimicrobial susceptibilities.

Results:
Among a total of 498 isolates, the proportion of invasive pneumococcal disease isolates declined (47.1%–10.6%) during the study period, and serotype diversity increased after 2011. Between 2010 and 2012, the dominant serotypes were 19A, 19F, 3, 6B and 14, and serotype 19A rose from 44.1% to 57.5%. Serotypes 19A, 15A, 19F and 15B were more prevalent from 2013 to 2015, and serotype 19A decreased from 42.1% to 4.5%. Serotypes 19F and 15A became the most commonly detected serotypes in 2015. Overall, PCV13 additional serotypes were reduced by 80% (P < 0.0001) but nonvaccine serotypes increased from 8.8% to 51.5% (P < 0.0001).

Conclusions:
The step-by-step PCV13 national immunization program is effective against pneumococcal disease in Taiwanese children, mainly by reducing PCV13 additional serotypes.
Ivermectin 1% Cream
Authors: Rasmussen Annelise , Jacob Sharon E. 
Published: June 2017

ABSTRACT
A drug is defined as a substance that exerts a physiologic effect upon introduction to a biological system. These drugs may come in various forms including ingested pills, topical creams or ointments, and inhaled or injected substances. The purpose of this column is to bring attention to common drugs used in dermatology, their usage and purpose, their mechanisms, and available alternatives. This edition focuses on ivermectin and its usage in treatment of rosacea.
Comparison of Approaches for Notification and Authorization in Pragmatic Clinical Research Evaluating Commonly Used Medical Practices
Authors: Weinfurt Kevin P. , Bollinger Juli M. , Brelsford Kathleen M. , Bresciani Martina , Lampron Zachary , Lin Li , Topazian Rachel J. , Sugarman Jeremy 
Published: June 2017

Background:
For pragmatic clinical research comparing commonly used treatments, questions exist about if and how to notify participants about it and secure their authorization for participation.

Objective:
To determine how patients react when they seek clinical care and encounter one of several different pragmatic clinical research studies.

Research Design:
In an online survey using a between-subjects experimental design, respondents read and responded to 1 of 24 hypothetical research scenarios reflecting different types of studies and approaches to notification and authorization (eg, general notification, oral consent, written consent).

Subjects:
English-speaking US adults 18 years and older.

Measures:
Willingness to participate in the hypothetical study, acceptability of the notification and authorization approach, understanding of the study, perceptions of benefit/harm, trust, and perception of amount of study information received.

Results:
Willingness to participate did not differ by notification and authorization approach. Some (21%–36%) of the patients randomized to general notification with an explicit opt-out provision were not aware they would be enrolled by default. Acceptability was greatest for and similar among notification and authorization approaches that actively engaged the patient (eg, oral or written consent) and lower for approaches with less engagement (eg, general notification). Problems of understanding were found among 20%–55% of respondents, depending on the particular scenario. Most respondents (77%–94%) felt that participation in the hypothetical study posed no risks of harm to their health or privacy.

Conclusions:
Current attitudes about notification and authorization approaches and difficulties understanding pragmatic clinical research pose significant challenges for pragmatic research. Data from this study provide a starting point to developing solutions to these surprisingly complex issues.
Thigh Ultrasound Monitoring Identifies Decreases in Quadriceps Femoris Thickness as a Frequent Observation in Critically Ill Children*
Authors: Valla Frederic V. , Young David K. , Rabilloud Muriel , Periasami Uvaraj , John Manoj , Baudin Florent , Vuillerot Carole , Portefaix Aurélie , White Deborah , Ridout Jenna A. , Meyer Rosan , Gaillard Le Roux Bénédicte , Javouhey Etienne , Pathan Nazima 
Published: June 2017

Objectives:
Significant muscle wasting develops in critically ill adults, with subsequent worse outcomes. In the pediatric setting, occurrence and effects of muscle wasting are undescribed; this is in part due to a lack of validated, objective methods for assessing muscle wasting. A single measurement of quadriceps femoris thickness has failed to show consistent reproducibility. We hypothesized that averaging repeated measurements could afford good reproducibility to allow for quadriceps femoris thickness decline detection and monitoring.

Design:
A prospective bedside observational study.

Setting:
Two PICUs.

Patients:
Mechanically ventilated critically ill children were 15 years and younger.

Interventions:
Transverse and longitudinal axis measurements of quadriceps femoris anterior thickness were undertaken using bedside ultrasound. The average of four measurement values was recorded. The location of measurement was marked for consistency within subsequent measurements by the same or another trained operator, to assess intra- and interoperator repeatability and reproducibility of the technique. Where feasible, serial measurements were undertaken until the time of extubation in a group of children with prolonged PICU stay (> 5 d).

Measurements and Main Results:
Seventy-three children were enrolled to assess intra- and interoperator ultrasound reliability. Their median (25–75 interquartile range) age and weight were 30 months (4.5–96) and 10 kg (5–23.5). In the intraoperator repeatability study, mean relative difference in quadriceps femoris muscle thickness was 0.36% ± 2.5% (lower and upper limits of agreement: −4.5/+5.2%). In the interoperator reproducibility study, intraclass correlation coefficient was 0.998. In the 17 children monitored over their PICU stay, quadriceps femoris thickness significantly decreased at day 5 by 9.8% (p = 0.006) and by 13.3% (< 0.001) at the last performed measurement.

Conclusions:
Quadriceps femoris thickness decrease, proposed as a surrogate for muscle mass, is an early, frequent, and intense phenomenon in PICU. Quadriceps femoris ultrasonography is a reliable technique to monitor this process and in future could help to guide rehabilitation and nutrition interventions.
Brief Report: High Need to Switch cART or Comedication With the Initiation of DAAs in Elderly HIV/HCV-Coinfected Patients
Authors: Smolders Elise J. , Smit Colette , T. M. M. de Kanter Clara , Dofferiiof Anton S. M. , Arends Joop E. , Brinkman Kees , Rijnders Bart , van der Valk Marc , Reiss Peter , Burger David M. ,   on behalf the ATHENA national HIV observational cohort
Published: June 2017

Background:
To describe the use of nonantiretroviral comedication and combination antiretroviral therapy (cART) in patients coinfected with HIV/hepatitis C virus (HCV) and to predict the potential for drug–drug interactions (DDIs) with direct-acting antivirals (DAAs) against HCV.

Methods:
This is a retrospective, cross-sectional study, using the Dutch, nationwide ATHENA observational HIV cohort database. All patients with a known HIV/HCV coinfection on January 1, 2015, were included. Comedication and cART registered in the database were listed. The potential for DDIs between DAAs and comedication/cART were predicted using http://hep-druginteractions.org. DDIs were categorized as: (1) no clinically relevant DDI; (2) possible DDI; (3) contraindication; or (4) no information available.

Results:
We included 777 patients of whom 488 (63%) used nonantiretroviral comedication. At risk for a category 2/3 DDI with nonantiretroviral comedications were 299 patients (38%). Most DDIs were predicted with paritaprevir/ritonavir, ombitasvir ± dasabuvir (47% of the drugs) and least with grazoprevir/elbasvir (11% of the drugs). Concerning cART, daclatasvir/sofosbuvir is the most favorable combination as no cART is contraindicated with this combination. In genotype 1/4 patients, grazoprevir/elbasvir is least favorable as 75% of the patients must alter their cART.

Conclusions:
This study showed that comedication use in the aging HIV/HCV population is frequent and diverse. There is a high potential for DDIs between DAAs and comedication/cART.