bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Cadaveric Model Evaluating the Influence of Bony Anatomy and the Effectiveness of Partial Scapulectomy on Decompression of the Scapulothoracic Space in Snapping Scapula Syndrome
Authors: Tahal Dimitri S. , Katthagen J. Christoph , Marchetti Daniel Cole , Mikula Jacob D. , Montgomery Scott R. , Brady Alex , Dornan Grant J. , Millett Peter J. 
Published: March 2017

Background:Snapping scapula syndrome (SSS) is caused by bony and/or soft tissue impingement in the scapulothoracic articulation. Surgical resection of the superomedial angle (SMA) plus bursectomy can provide relief in most cases; however, the amount needed to achieve adequate scapulothoracic space decompression (SSD) is unknown.Purpose:The aim of this study was to evaluate the effectiveness of partial scapulectomy and the influence of bony anatomy on SSD. It was hypothesized that the anterior offset and costomedial angle would correlate with the amount of bony resection needed to achieve adequate SSD.Study Design:Controlled laboratory study.Methods:Twenty pairs (n = 40) of shoulder specimens (mean age, 58 years [range, 41-64 years]; 10 male and 10 female specimens) were included. The scapula shape, medial scapula corpus angle (MSCA), anterior offset, and costomedial angle were obtained from computed tomography scans. Specimens were dissected, and each bare bony scapula was rigidly mounted. Points were collected using a 3-dimensional measuring arm. An SMA point and theoretical resection points (incremental 1-cm points up to 3 cm) proceeding laterally and medially were collected. The scapular plane was interpolated using points from the posterior scapular body. The horizontal distances of the anterior offset and each resection point to the scapular plane were calculated. The difference between the native anterior offset and the offset after resection represented the SSD. Adequate SSD was set at 5 mm. One-way analyses of variance and Pearson correlations were used with statistical significance set at P < .05.Results:The maximum SSD with 3-cm resection was significantly correlated with the anterior offset ( R = 0.83, P < .001) as well as the costomedial angle ( R = −0.43, P = .006) but not the MSCA ( R = −0.11, P = .495) or scapula shape ( F2,37= 0.39, P = .681). For the 5 scapulae with an anterior offset of less than 20 mm, a 5-mm SSD was not achieved. For 18 of 30 (60%) scapulae with an anterior offset between 20 mm and 35 mm, 3-cm resection provided at least a 5-mm SSD. For the 5 scapulae with an anterior offset of greater than 35 mm, 2-cm resection resulted in at least a 5-mm SSD in all cases.Conclusion:The anterior offset of the scapula appeared to be the most important bony parameter to consider during preoperative planning and the evaluation of SSD with partial scapulectomy.Clinical Relevance:The results of this study may help surgeons with preoperative planning of surgical decompression of the scapulothoracic space for patients with symptomatic SSS.
Effect of Pitching Consecutive Days in Youth Fast-Pitch Softball Tournaments on Objective Shoulder Strength and Subjective Shoulder Symptoms
Authors: Skillington S. Andrew , Brophy Robert H. , Wright Rick W. , Smith Matthew V. 
Published: March 2017

Background: The windmill pitching motion has been associated with risk for shoulder injury. Because there are no pitching limits on youth fast-pitch softball pitchers, these athletes often pitch multiple games across consecutive days. Strength changes, fatigue levels, and shoulder pain that develop among female fast-pitch pitchers over the course of consecutive days of pitching have not been investigated. Hypothesis: Over the course of 2- and 3-day fast-pitch softball tournaments, pitchers will develop progressive objective weakness and increased subjective shoulder fatigue and pain without complete recovery between days. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fourteen female fast-pitch softball pitchers between the ages of 14 and 18 years were evaluated for strength and fatigue changes across 2- and 3-day tournaments. At the beginning and end of each day of tournament play, pitchers were asked to quantify shoulder fatigue and shoulder pain levels of their dominant throwing arm using a 10-point visual analog scale (VAS). Shoulder abduction, flexion, external rotation, internal rotation, elbow flexion, and elbow extension strength measurements were gathered using a handheld dynamometer. Results: Over the course of an average single day of tournament participation, pitchers developed significant increases in VAS scores for shoulder fatigue (median, 2.0; 95% CI, 1.3-3.0) and pain (median, 1.3; 95% CI, 0.5-2.3) and significant strength loss in all tested motions. Pitchers also developed significant increases in VAS shoulder fatigue (median, 3.5; 95% CI, 1.5-5.5), VAS shoulder pain (median, 2.5; 95% CI, 1.0-4.5), and strength loss in all tested motions over the entire tournament. Shoulder pain, fatigue, and strength do not fully recover between days. The accumulation of subjective shoulder pain and fatigue over the course of tournament play were closely correlated. Conclusion: Among youth female fast-pitch softball pitchers, there is a progressive increase in shoulder fatigue, pain, and weakness over the course of 2- and 3-day tournaments without full recovery between consecutive days of pitching.
Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players
Authors: Larson Christopher M. , Ross James R. , Kuhn Andrew W. , Fuller Donnie , Rowley David M. , Giveans M. Russell , Stone Rebecca M. , Bedi Asheesh 
Published: March 2017

Background: Hip disorders in athletes have been increasingly recognized. Purpose: To characterize radiographic hip anatomy for National Hockey League (NHL) players and correlate it with hip range of motion and hip symptoms and/or surgery. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fifty-nine professional hockey players (118 hips) with 1 NHL organization (mean age, 24.2 years; range, 18-36) prospectively underwent history and physician examination by 2 independent orthopaedic surgeons. Current or previous groin and/or hip pain or surgery was noted. Anteroposterior (AP) pelvis and bilateral Dunn lateral radiographs were obtained for all players with assessment of hip morphology by 2 blinded independent orthopaedic surgeons. Results: Good to very good reliability of radiographic assessments was noted (intraclass correlation coefficients = 0.749-0.958). Sixty-four percent of athletes had a positive crossover sign, while 86% and 60% had a positive posterior wall sign and a prominent ischial spine sign, respectively. Twenty-one percent of hips demonstrated dysplastic acetabular features (lateral center edge angle <25°). Eighty-five percent and 89% of hips demonstrated cam-type morphology based on alpha angle (>50° Dunn lateral) and head-neck offset, respectively. Good to very good reliability was noted for ROM assessments (intraclass correlation coefficient >0.69). Mean hip flexion was 107.4º ± 6.7º, and mean hip internal rotation was 26.1º ± 6.6º. Thirty-one percent of hips had a history of hip-related pain and/or surgery. Higher AP, Dunn lateral, and maximal alpha angles correlated with decreased hip internal rotation ( P = .004). Greater AP alpha angle correlated with decreased hip extension/abduction ( P = .025), and greater Dunn lateral and maximal alpha angle correlated with decreased hip flexion/abduction ( P = .001). A positive posterior wall sign correlated with increased straight hip abduction, while other radiographic acetabular parameters were not predictive of range of motion. Only decreased hip external rotation and total arc of motion correlated with an increased risk for current or prior hip symptoms or surgery ( P < .001). Conclusion: Hip anatomy in NHL players is characterized by highly prevalent cam-type morphology (>85%) and acetabular retroversion (>60%). In addition, acetabular dysplasia (21%) was relatively common. Greater cam-type morphology correlated with decreased hip range of motion, and a positive crossover sign correlated with increased hip abduction. Decreased hip external rotation and total arc of motion were predictive of hip-related pain and/or surgery.
Promoting Stair Climbing in a Worksite and Public Setting: Are Footprints Enough?
Authors: Van Hoecke Ann-Sophie , Seghers Jan , Boen Filip 
Published: March 2017

Purpose: To evaluate the impact of footprints on stair climbing in different settings. Design: Interrupted time-series design. Setting: A company (stair/elevator choice) and a mall (stair/escalator choice). Participants: Employees (n = 5676) and visitors of the mall (n = 12 623). Intervention: An intervention comprising 3 consecutive phases was implemented—(1) footprints leading to the stairs were stuck on the floor, (2) a health message referring to the footprints was introduced, and (3) passersby were congratulated for their increased stair use. Measures: Stair climbing was observed before (ie, baseline), during, and 6 to 13 weeks after (ie, follow-up) the intervention. Analysis: Proportions of stair climbers were compared using χ2 analyses. Results: The footprints resulted in a closely significant increase in stair climbing in the company (from 27.7% at baseline to 31.2% in phase 1). However, they did not produce any effect in the mall. Introducing a health message yielded an additional 12.4% increase in stair climbing in the company and a significant 11.4% increase in the mall (22.3% in phase 2). Congratulating people did not further increase stair climbing. At follow-up, the proportions of stair climbers dropped but still exceeded baseline. Conclusion: Footprints tend to increase stair climbing in a worksite setting with a stair/escalator choice but not in a public setting with a stair/elevator choice. Adding a meaningful message seems essential to obtain stronger and longer term effects.
Evaluation of a medication intensity screening tool used in malignant hematology and bone marrow transplant services to identify patients at risk for medication-related problems
Authors: Lucena Mariana , Bondarenka Carolyn , Luehrs-Hayes Genevieve , Perez Andy 
Published: March 2017

Background In 2014, a screening tool was implemented at Medical University of South Carolina (MUSC) Health to identify patients who are at risk for medication-related events. Patients are classified as high-risk if they meet one of the following criteria: receiving anticoagulation therapy, taking more than 10 scheduled medications upon admission, or readmission within the past 30 days. The goal of this study was to determine risk criteria specific to the malignant hematology (MH) and bone marrow transplant (BMT) patients. Methods A retrospective chart review of 114 patients admitted and discharged from the MH/BMT services between 1 September 2015 and 31 October 2015 was performed. A pharmacist-conducted medication history was completed and documented, and all interventions at admission and throughout hospitalization were categorized by severity and by value of service. The primary objective was to evaluate if patients in the MH/BMT services have more medication-related interventions documented upon admission compared with patients who are not screened as high risk. The secondary objectives were to evaluate the different types and severities of interventions made by pharmacists during the entire hospital stay, and to determine if there are certain characteristics that can help identify hematology/oncology high-risk patients. Results More interventions documented upon admission in the high-risk group as a whole when compared with the not high-risk group (73 vs. 31), but when normalized per patients in each group, there was an equal number of interventions (1.0). The most common interventions were to modify regimen (36%) and discontinue therapy (16%). The patient characteristics associated with high-risk included neutropenia, lower average platelet counts on admission, and longer length of stay. Conclusion The screening tool does not further differentiate an already complex MH/BMT patient population. Pharmacists may be more useful at capturing errors or changes during a patient’s hospital stay instead of upon admission. Thrombocytopenia, neutropenia, and active infections may correlate with higher-risk status.
Sodium–glucose co-transporter type 2 inhibitors reduce evening home blood pressure in type 2 diabetes with nephropathy
Authors: Takenaka Tsuneo , Kishimoto Miyako , Ohta Mari , Tomonaga Osamu , Suzuki Hiromichi 
Published: March 2017

Background: The effects of sodium–glucose co-transporter type 2 inhibitors on home blood pressure were examined in type 2 diabetes with nephropathy. Methods: The patients with diabetic nephropathy were screened from medical records in our hospitals. Among them, 52 patients who measured home blood pressure and started to take sodium–glucose co-transporter type 2 inhibitors were selected. Clinical parameters including estimated glomerular filtration rate, albuminuria and home blood pressure for 6 months were analysed. Results: Sodium–glucose co-transporter type 2 inhibitors (luseogliflozin 5 mg/day or canagliflozin 100 mg/day) reduced body weight, HbA1c, albuminuria, estimated glomerular filtration rate and office blood pressure. Although sodium–glucose co-transporter type 2 inhibitors did not alter morning blood pressure, it reduced evening systolic blood pressure. Regression analyses revealed that decreases in evening blood pressure predicted decrements in albuminuria. Conclusion: The present data suggest that sodium–glucose co-transporter type 2 inhibitors suppress sodium overload during daytime to reduce evening blood pressure and albuminuria.
Transfer of the musculocutaneous nerve branch to the brachialis muscle to the triceps for elbow extension: anatomical study and report of five cases
Authors: Bertelli J. A. , Soldado F. , Ghizoni M. F. , Rodríguez-Baeza A. 
Published: March 2017

We report the study of the anatomical feasibility of transferring the nerve to the brachialis muscle to the upper medial head motor branch that innervate the triceps, and outcomes of such transfers in restoring elbow extension in five patients with posterior cord lesion of the brachial plexus. The length of the branches to the brachialis muscle measured 7.6 cm and the triceps upper medial head motor branch was 5 cm in 10 adult cadavers. Five male patients were treated with this transfer 5 months after the injury (range 4 to 6 months) after posterior cord injury of the brachial plexus with a mean follow-up of 31 months (range 28 to 36 months). Elbow extension scored M4 in all cases. No complications occurred. These preliminary results suggest that transferring the nerve to the brachialis muscle is an effective technique for the reconstruction of elbow extension after posterior cord brachial plexus injuries. Level of evidence: IV
Choosing Wisely
Authors: Chan Emilie , Hemmelgarn Brenda , Klarenbach Scott , Manns Braden , Mustafa Reem , Nesrallah Gihad , McQuillan Rory 
Published: March 2017

Purpose of review: The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused. Sources of information: A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi process, and a comprehensive literature review to determine 10 candidate items representing potentially ineffective care in nephrology. An in-person vote by CSN members at their Annual General Meeting was used to rank each item based on their relevance to and potential impact on patients with kidney disease to derive the final 5 items on the list. Key messages: One hundred thirty-four of 609 (22%) CSN members responded to the survey, from which the CSN working group identified 10 candidate-misused items. Sixty-five CSN members voted on the ranking of these items. The top 5 recommendations selected for the final list were (1) do not initiate erythropoiesis-stimulating agents in patients with chronic kidney disease (CKD) with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia; (2) do not prescribe nonsteroidal anti-inflammatory drugs for individuals with hypertension or heart failure or CKD of all causes, including diabetes; (3) do not prescribe angiotensin-converting-enzyme inhibitors in combination with angiotensin II receptor blockers for the treatment of hypertension, diabetic nephropathy or heart failure; (4) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team; and (5) do not initiate dialysis in outpatients with CKD category G5-ND in the absence of clinical indications. Limitations: A low survey response rate of both community and academic nephrologists could contribute to sampling bias. However, the purpose of this report is to generate discussion, rather than study practice variation. Implications: These 5 evidence-based recommendations aim to improve outcomes and individualize care for patients with kidney disease, while reducing inefficiencies and preventing harm.
The effect of oral tranexamic acid administration on blood loss and hospital costs in patients undergoing total knee arthroplasty
Authors: Akman Budak , Aksu Burak Çağrı , Uluçay Çağatay , Kılınçoğlu Volkan , Özler Turhan , Altıntaş Faik 
Published: March 2017

Aim: Total knee arthroplasty is a kind of major orthopaedic operation that may go with serious amount of peroperative blood loss. Tranexamic acid administration (an antifibrinolytic agent) is one of the most common strategy among the various blood preserving strategies used in major surgeries associated with high volume blood loss. The aim of this study is to evaluate effectiveness of oral tranexamic acid in reducing blood loss and blood transfusion in total knee arthroplasty procedures. In addition hospital costs were also compared. Materials-Methods: Between 2013-2016, 256 total knee arthroplasty procedure performed by six different staff surgeons in our clinic. 125 patients appropriate for our study criteria were included in our study and retrospectively evaluated. 49 patients in study group were administered 15 mg/kg tranexamic intravenous infusion before relasing intraoperative tourniquet and continued as oral 500 mg tranexamic acid three times with 6 hours interval in the first postoperative 24 hours.76 patients were not administered tranexamic acid and compromised the control group. Information on pateints’s demographics, preoperative and postoperative 24th hour hemoglobin and hematocrit values, postoperative 24th hour drain volumes and blood transfusions were obtained from patient files retrospectively. Results: Postoperative 24th hour drain volumes were significiantly less in tranexamic acid administered group (283 130 cc) than that of control group (383 135 cc) (p<0,001). Decrease in hemoglobin and hematocrit values in the postoperative 24th hour were significiantly less in study group (1,73 g/dL-%6,13) than those of control group (2,92 g/dL -%8,63) (P<0,001). Both number of total erythrocyte suspensions (ES) transfused and number of patients transfused were higher in control group than those of study group. (52 ES and 45 patients versus 18 ES and 14 patients) Calculated average ES per patient were 0.37 in study group and 0.68 in control group. (P=0,009). As a result blood bank costs were reduced %50 in study group as compared to control group. Conclusions: Tranexamic acid administered as single intraoperative intravenous dose and sequentially continued as 500 mg oral dosage 3 times with six hours interval in the first postoperatve24 hours is a significiantly effective approach in preventing bloos loss and reducing hospital costs in total knee arthroplasty procedures. In addition easiness and convinience of oral administration of tranexamic acid makes the approach more advantageous.
The prevalance of femoroacetabular impingement findings on radiological survey of the emergeny service patients with trauma
Authors: Polat Gökhan , Şahin Koray , Arzu Ufuk , Aşık Mehmet 
Published: March 2017

Femoroacetabular impingemet (FAI) is a disease causing hip pain in young-adult population and can be diagnosed frequently on asymptomatic stage. The European studies on this subject show that 20-25% of the population actually has asymptomatic FAI. Actually, there is no study in Turkey on this topic. The purpose of our study is to determine the prevalance of FAI on the X-rays of the patients who applied to the emergency service with trauma. Materials-Methods: Patients applied between September 2015 and January 2016 aged 18-65 and who has pelvis AP and frog leg X-rays were included. Pelvic graphs on which both iliac crests and proximal femurs are seen, the X-ray tube is centralised to the symphysis pubis and the obturator foramens are symmetrical were included. The graphs with fractures or ligamentous injuries affecting the pelvic ring, fractures on long bones of the lower limbs, arthrosis on coxofemoral joint and findings of previous pelvic and hip surgery were excluded. Totally 3487 patients were evaluated and 528 of them were included. Alpha, lateral central edge (LCE), Tönnis and collodiaphyseal angle were measured. The morphological anomalies (FAI, dysplasia) were noted. The measured alpha angle value above 55° graphs were accepted as CAM type; Tönnis angle below 4° angle or LCE angle above 39° were accepted as Pincer type impingement. The graphs with LCE angle below 25° or with Tönnis angle above 10° were considered as dysplasia. Results: The average age of the 528 included patients was 43,38. 323 were female and 205 were male. We determined 15,5% CAM, 11,1% Pincer and 4,7% combined type FAI in these 528 patients.The ratios were noted in female group, 4,6% CAM, 13,3% Pincer and 1,5% combined type; in male group 32,7% CAM, 7,8% Pincer 9,8% combined type. Average alpha angle on pelvis AP graphs was 48,9° on right and 47,8° on left side. Average alpha angle on pelvis frog leg graphs was 51,7° on right, 49,8° on left side. Average LCE angle was 32,9° on right and 34,7° on left side. Average Tönnis angle was 6,7° for right and 5,8° for left side. SPSS.21 were used to analyse the data. Discussion: FAI can be seen in population asymptomatically with a seriously high rates. In our study, we evaluated the asypmtomatic patients with trauma applying to the emergency service and we found radiological FAI findings rate 19,5% in females and 50,2% in males.