bluuebunny/crossref_metadata_2025_split huggingface dataset:
Suture anchor repair for ruptured deltoid ligament in pronation ankle fractures
Authors: Diab Hossam S. 
Published: August 2017

Background:
The deltoid ligament is the main medial stabilizer of the ankle joint. Rupture of this ligament is not uncommon in pronation ankle injuries and should be suspected in the absence of medial malleolar fractures. The purpose of this study was to evaluate the effectiveness of deltoid ligament reconstruction using suture anchor fixation to the medial malleolus for such conditions.

Methods:
Twenty-seven ankles with pronation ankle injuries were surgically treated and enrolled in this prospective study. Sixteen patients with pronation-external rotation injury (group 1) and 11 patients with pronation-abduction injury (group 2) were evaluated using the Foot and Ankle Outcome score (FAOS) and Ankle-Hindfoot scale. A composite questionnaire, including the Health-related Quality of Life Index (EQ-5D) and visual analog scales (VAS) for pain and satisfaction, was used to assess the surgical result.

Results:
All patients returned to their preinjury activity level at their final follow-up. The mean FAOS score for all patients included in the study was 94.44, and the mean Ankle-Hindfoot scale was 93.3, with no statistical difference between the two groups. Adequate range of motion was achieved in all patients. Twenty-five patients reported being fully satisfied, while two patients reported to be just satisfied, with an overall satisfaction scale of 8.85.

Conclusions:
Surgical reconstruction of a ruptured deltoid ligament in pronation ankle injury using suture anchors is an effective treatment modality with excellent functional outcome.
Biologics for idiopathic inflammatory myopathies
Authors: Moghadam-Kia Siamak , Aggarwal Rohit , Oddis Chester V. 
Published: August 2017

Purpose of review
As treatment of refractory cases of idiopathic inflammatory myopathies (IIMs) has been challenging, there is growing interest in assessing novel biologics that target various pathways implicated in the pathogenesis of IIM.

Recent findings
In the largest clinical trial in adult and juvenile IIM assessing the effectiveness of rituximab, the primary outcome was not met but 83% of this refractory group of IIM patients met a predefined definition of improvement and rituximab demonstrated a significant glucocorticoid-sparing effect. Antitumor necrosis factor utility in IIM is generally limited by uncertain efficacy data along with recent reports suggesting their potential for inducing systemic autoimmune disease including IIM.

Summary
Further research is required to evaluate the role of newer therapies such as tocilizumab (anti-interleukin-6), abatacept (inhibition of T-cell costimulation), sifalimumab (anti-interferonα) and ruxolitinib, (Janus kinase inhibitor) given their biological plausibility and encouraging recent small case series results. Future clinical trials should consider the targeting of biomarkers implicated in the etiopathogenesis of IIM, predictive factors of treatment response, recent revisions in IIM classification criteria, as well as newly developed data-driven response criteria which employ validated core set measures.
Adjacent Segment Disease After Cervical Spine Fusion
Authors: Alhashash Mohamed , Shousha Mootaz , Boehm Heinrich 
Published: August 2017

Study Design.
A retrospective study of 70 patients undergoing surgical treatment for adjacent segment disease (ASD) after anterior cervical decompression and fusion (ACDF).

Objective.
To analyze the risk factors for the development of ASD in patients who underwent ACDF.

Summary of Background Data.
ACDF has provided a high rate of clinical success for the cervical degenerative disc disease; nevertheless, adjacent segment degeneration has been reported as a complication at the adjacent level secondary to the rigid fixation.

Methods.
Between January 2005 and December 2012, 70 consecutive patients underwent surgery for ASD after ACDF in our institution. In all patients thorough clinical and radiological examination was performed preoperatively, postoperatively, and at the final follow-up. The clinical data included the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS). The radiological evaluation included x-rays and magnetic resonance imaging (MRI) for all patients. The duration of follow up after the adjacent segment operation ranged from 3 to 10 years.

Results.
Surgery for ASD was performed after a mean period of 32 months from the primary ACDF. ASD occurred after single level ACDF in 54% of cases, most commonly after C5/6 fusion (28%). Risk factors for ASD were found to be preexisting radiological signs of degeneration at the primary surgery (74%) and bad sagittal profile after the primary ACDF (90%).

Conclusion.
ASD occurred predominantly in the middle cervical region (C4–6); especially in patients with preexisting evidence of radiological degeneration in the adjacent segment at the time of primary cervical fusion, notably when this surgery failed to restore or maintain the cervical lordosis.

Level of Evidence: 4
Coronal Decompensation After Posterior-only Thoracolumbar Hemivertebra Resection and Short Fusion in Young Children With Congenital Scoliosis
Authors: Li Song , Chen Zhong-Hui , Qiu Yong , Xu Liang , Chen Xi , Du Chang-Zhi , Zhu Ze-Zhang , Sun Xu 
Published: August 2017

Study Design.
A retrospective study.

Objective.
To determine the incidence and risk factors of coronal decompensation after posterior-only thoracolumbar hemivertebra (HV) resection and short fusion in patients younger than 5-years old.

Summary of Background Data.
Postoperative coronal decompensation may occur in operated patients during the follow up. However, there is a paucity of valid data regarding this complication in very young patients with thoracolumbar HV.

Methods.
This study reviewed a consecutive series of patients (younger than 5 years) who had undergone posterior-only hemivertebrectomy and short fusion from January 2006 to December 2014. They had a minimum follow-up of 24 months. According to the coronal compensation behavior, they were divided into two groups: Group P (progressed, curve decompensated beyond twenty degrees) and Group NP (nonprogressed, curve well compensated).

Results.
There were 179 patients included in this study. Mean age at surgery was 38 ± 11 months. Mean follow-up was 41 ± 11 months. Postoperative coronal decompensation was identified in 18 patients (rate, 10.1%) who constituted Group P. The remaining 161 patients had a well-compensated pattern. In contrast to Group NP, the patients in Group P had greater preoperative lowest instrumented vertebra (LIV) translation (18.5 mm ± 6.4 mm vs. 10.5 mm ± 4.9 mm, P < 0.01), and higher postoperative LIV disc angle (7.0° ± 3.1° vs. 3.1° ± 3.3°, P < 0.01) after surgery. During the follow up, LIV translation and LIV disc experienced continuous aggravation until initiation of bracing. Preoperative LIV translation (≥15.1 mm) and postoperative LIV disc angle (≥5.5°) were identified as two independent risk factors of coronal decompensation after surgery.

Conclusion.
After thoracolumbar hemivertebrectomy in children younger than 5 years, the overall rate of coronal decompensation is approximately 10.1%. As two independent risk factors of postoperative coronal decompensation, preoperative LIV translation (≥15.1 mm) and postoperative LIV disc angle (≥5.5°) should on all accounts be the major causes for concern.

Level of Evidence: 4
Individualizing Thresholds of Cerebral Perfusion Pressure Using Estimated Limits of Autoregulation
Authors: Donnelly Joseph , Czosnyka Marek , Adams Hadie , Robba Chiara , Steiner Luzius A. , Cardim Danilo , Cabella Brenno , Liu Xiuyun , Ercole Ari , Hutchinson Peter John , Menon David Krishna , Aries Marcel J. H. , Smielewski Peter 
Published: August 2017

Objectives:
In severe traumatic brain injury, cerebral perfusion pressure management based on cerebrovascular pressure reactivity index has the potential to provide a personalized treatment target to improve patient outcomes. So far, the methods have focused on identifying “one” autoregulation-guided cerebral perfusion pressure target—called “cerebral perfusion pressure optimal”. We investigated whether a cerebral perfusion pressure autoregulation range—which uses a continuous estimation of the “lower” and “upper” cerebral perfusion pressure limits of cerebrovascular pressure autoregulation (assessed with pressure reactivity index)—has prognostic value.

Design:
Single-center retrospective analysis of prospectively collected data.

Setting:
The neurocritical care unit at a tertiary academic medical center.

Patients:
Data from 729 severe traumatic brain injury patients admitted between 1996 and 2016 were used. Treatment was guided by controlling intracranial pressure and cerebral perfusion pressure according to a local protocol.

Interventions:
None.

Methods and Main Results:
Cerebral perfusion pressure-pressure reactivity index curves were fitted automatically using a previously published curve-fitting heuristic from the relationship between pressure reactivity index and cerebral perfusion pressure. The cerebral perfusion pressure values at which this “U-shaped curve” crossed the fixed threshold from intact to impaired pressure reactivity (pressure reactivity index = 0.3) were denoted automatically the “lower” and “upper” cerebral perfusion pressure limits of reactivity, respectively. The percentage of time with cerebral perfusion pressure below (%cerebral perfusion pressure < lower limit of reactivity), above (%cerebral perfusion pressure > upper limit of reactivity), or within these reactivity limits (%cerebral perfusion pressure within limits of reactivity) was calculated for each patient and compared across dichotomized Glasgow Outcome Scores. After adjusting for age, initial Glasgow Coma Scale, and mean intracranial pressure, percentage of time with cerebral perfusion pressure less than lower limit of reactivity was associated with unfavorable outcome (odds ratio %cerebral perfusion pressure < lower limit of reactivity, 1.04; 95% CI, 1.02–1.06; p < 0.001) and mortality (odds ratio, 1.06; 95% CI, 1.04–1.08; p < 0.001).

Conclusions:
Individualized autoregulation-guided cerebral perfusion pressure management may be a plausible alternative to fixed cerebral perfusion pressure threshold management in severe traumatic brain injury patients. Prospective randomized research will help define which autoregulation-guided method is beneficial, safe, and most practical.
Necrotizing Infundibular Crystalline Folliculitis: An Unusual Clinical Presentation and Demonstration of the Presence of Calcium Palmitate
Authors: Beaufrère Aurélie , Garcia Valérie , Frochot Vincent , Molina Thierry , Daudon Michel , Fraitag Sylvie 
Published: August 2017

Abstract:
Necrotizing infundibular crystalline folliculitis (NICF) is a rare disorder, which was described for the first time by Lucke et al in 1999. NICF is characterized by multiple folliculocentric papules with a predilection for occurring in seborrheic areas in adults and corresponding dilated follicular ostia containing crystalline material. The precise pathogenesis and nature of this crystalline material are currently unknown. Here, we report an unusual case of NICF presented as an uncommon generalized skin rash in an adolescent. In addition, we present analysis using infrared microscopy for improved characterization of this crystalline material. Similar to previous cases, a biopsy revealed a dilated follicular ostium with the appearance of containing crystalline material associated with parakeratosis. Infrared microscopy analysis produced specific spectral features of calcium palmitate.
Eruptive Keratoacanthoma-Like Discoid Lupus Erythematosus
Authors: Georgesen Corey , Magro Cynthia 
Published: August 2017

Abstract:
Hypertrophic discoid lupus erythematosus can resemble keratoacanthoma histomorphologically. We describe a unique case of eruptive keratoacanthomatous scaly papules in a 56-year-old woman with discoid lupus erythematosus. We review the literature and conclude by discussing important histologic features and useful immunostains to consider when attempting to discern the underlying identity and pathogenicity of such lesions.
Elastic Staining in Differentiating Between Follicular Streamers and Follicular Scars in Horizontal Scalp Biopsy Sections
Authors: Tan Timothy , Guitart Joan , Gerami Pedram , Yazdan Pedram 
Published: August 2017

Background:
Accurate identification of follicular streamers versus follicular scars on horizontal scalp biopsy sections is important to differentiate between cicatricial and noncicatricial alopecias. However, distinguishing between them can be difficult especially in nonoptimal specimens. The utility of elastic Verhoeff–Van Gieson (EVG) stain in cicatricial alopecias has been described on vertical sections, but its evaluation on horizontal sections has not been performed.

Methods:
Sixty-four cicatricial alopecias (25 lichen planopilaris, 29 central centrifugal cicatricial alopecias, and 10 discoid lupus erythematosus) and 53 noncicatricial alopecias (34 androgenic alopecia, 8 telogen effluvium, and 11 alopecia areata) were identified, and EVG staining was performed on horizontal sections.

Results:
In follicular streamers, EVG highlighted an intact elastic network composed of delicate and thin elastic fibers circumferentially surrounding the angiofibrotic streamer without elastic network attenuation, loss, clumping, thickening, or recoil. In follicular scars, EVG demonstrated central attenuation and loss of the elastic network with peripheral clumping and recoil of elastic fibers.

Conclusions:
In cases where distinguishing between follicular streamers and scars is difficult, EVG may be a helpful adjunctive tool in this regard and aid in allowing better discrimination between cicatricial and noncicatricial alopecias.
Resilience in Adolescents with Cancer: Association of Coping with Positive and Negative Affect
Authors: Murphy Lexa K. , Bettis Alexandra H. , Gruhn Meredith A. , Gerhardt Cynthia A. , Vannatta Kathryn , Compas Bruce E. 
Published: August 2017

ABSTRACT:

Objective:
To examine the prospective association between adolescents' coping with cancer-related stress and observed positive and negative affect during a mother-adolescent interaction task involving discussion of cancer-related stressors.

Methods:
Adolescents (age 10–15 years) self-reported about their coping and affect approximately 2 months after cancer diagnosis. Approximately 3 months later, adolescents and mothers were video recorded having a discussion about cancer, and adolescents were coded for expression of positive affect (positive mood) and negative affect (sadness and anxiety).

Results:
Adolescents' use of secondary control coping (i.e., acceptance, cognitive reappraisal, and distraction) in response to cancer-related stress predicted higher levels of observed positive affect, but not negative affect, over time.

Conclusion:
Findings provide support for the importance of coping in the regulation of positive emotions. The potential role of coping in preventive interventions to enhance resilience in adolescents facing cancer-related stress is highlighted.
Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial
Authors: Fiks Alexander G. , Mayne Stephanie L. , Michel Jeremy J. , Miller Jeffrey , Abraham Manju , Suh Andrew , Jawad Abbas F. , Guevara James P. , Grundmeier Robert W. , Blum Nathan J. , Power Thomas J. 
Published: August 2017

ABSTRACT:

Objective:
To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales.

Methods:
Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record–linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review.

Results:
One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6–27.7) and 18.8 (95% CI, 1.9–35.7) percentage points, respectively.

Conclusion:
A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.
Physician Awareness of Developmental Screening and Referral in the State of Kuwait
Authors: Hix-Small Hollie , Alkherainej Khaled 
Published: August 2017

ABSTRACT:

Objective:
In the State of Kuwait, family physicians and pediatricians are responsible for identifying and referring children at risk of disability. The aims of this study were to better understand physician (1) use of developmental screening instruments, (2) referral practices for children at risk of developmental disability, (3) interpretation of screening results, and (4) anticipatory guidance topics prioritized over child screening.

Methods:
A nonprobability volunteer, self-selection sample of family physicians, general practitioners, and pediatricians (n = 398) completed a 60-item paper questionnaire. Items assessed included: (1) practitioner familiarity with, belief in, and use of screening instruments; (2) familiarity with early childhood intervention services; (3) perceived barriers to screening implementation; and (4) anticipatory topics prioritized over screening. Logistic regression was used to test a priori hypotheses.

Results:
In general, family doctors and pediatricians practicing in public hospitals and primary health care centers in the State of Kuwait do not use or know how to use a developmental screening instrument, while over half prioritized immunization counseling over child screening. Screening confidence and training on using screening instruments increased the likelihood of tool use. Staff shortages, time constraints, and a perceived lack of Arabic screening instruments were barriers to tool use.

Conclusion:
Raising health care providers' awareness of standardized developmental screening instruments and establishment of an early identification system in the State of Kuwait are needed. Standardization and adaptation of technically sound Arabic-language screening tools for use in the State of Kuwait and physician training programs on screening are recommended.
Congenital Hypotonia in Toddlerhood
Authors: Steiner Naomi , Torres Alcy , Reddy Arathi , Augustyn Marilyn 
Published: August 2017

CASE: David is a 22-month-old boy who is new to your practice. He recently moved from a rural area in the Midwest. His father is in the United States Air Force, and his mother works as a full-time homemaker. Their household includes 5 older siblings. The family moves every year because of the father's Air Force placement.
David was born full-term in Virginia, with no reported pregnancy complications and no alcohol, tobacco, or drug exposure. He was delivered vaginally, with Apgar scores of 7 and 9, respectively and no respiratory issues. In the newborn nursery, his nurse noted that he was floppy, with generalized low muscle tone. Laboratory work performed included normal thyroid studies and a chromosomal microarray.
Because of persistent hypotonia, he was seen by a pediatric neurologist at 9 months of age. A magnetic resonance imaging was performed and was normal, with no structural deficits noted. He was referred to Early Intervention at 6 months, when he was not yet rolling over. He received physical therapy for a few months before the family moved again for his father's next placement.
David presents in your office as a sweet nondysmorphic toddler who maintains steady eye contact and smiles responsively. His height, head circumference, and weight are at the 50th percentile. His physical examination is notable for generalized hypotonia, with intact upper and lower deep tendon reflexes. He spontaneously says about 20 words. He turns his head when his name is called and can follow a simple command, such as “clap, clap.” He reaches his whole hand toward desired objects and will look at his parents if they are out of reach. He can grasp a block, bang, and transfer objects. He demonstrates an immature pincer grasp. He can roll over and sit independently and is just beginning to pull to a stand. His parents report he has recently restarted Early Intervention, where he is receiving physical, speech, and occupational therapy. His audiology examination is normal.
His parents' primary concern today is regarding feeding. David is a picky eater. He has difficulty with new foods and textures. The parents noticed a regression in his tolerance for new foods around the recent move. He eats baby puffs, stage 2 to 3 baby foods, and fruit and vegetable pouches. He does not like soft, sticky foods. He is also reported to have other sensory sensitivities. He does not tolerate loud noises and is bothered by tags in his clothing. You wonder, what further work-up would be helpful for David? How can his feeding issues be addressed?
Postmenopausal choriocarcinoma: a rare case report and review of the literature
Authors: Guo Na , Yin Rutie , Li Qingli , Song Liang , Wang Danqing 
Published: August 2017

Abstract

Objective:
Choriocarcinoma is rare in postmenopausal women, and an early diagnosis contributes to a potential cure.

Methods:
We report a rare case of a postmenopausal woman with choriocarcinoma. The 61-year-old patient presented with irregular vaginal bleeding, 11 years after menopause and 30 years after the birth of the last child.

Results:
Radiological investigation found a 3-cm mass on the lower left part of the vaginal wall, and also bilateral lung nodules. Gynecological examination found 3-4 cm blue and purple nodules in the lower left part of the vaginal wall. Her serum CA125 and serum β-hCG levels were 10.2 and 9273.9 mIU/mL, respectively. The early diagnosis was a choriocarcinoma, and combination chemotherapy (etoposide, kengshengmycin, methotrexate, leucovorin, vincristine, and cyclophosphamide [EMACO]) was administered. After the sixth chemotherapy session, her serum β-hCG level was <2 mIU/mL, and two additional consolidation chemotherapy sessions were performed. She achieved serological remission, but 4 months after completion of the chemotherapy, a rise in serum β-hCG level was observed. Therefore, she was subjected to a second treatment with EMACO and fluorouracil (5-Fu) local injection chemotherapy. After nine chemotherapy sessions and three local 5-Fu injections, she showed a normal β-hCG level, with negative radiological results, and negative pigmentation in the lower left part of the vaginal wall. After a 4-year follow-up period, no local recurrence or distant metastases was found.

Conclusions:
This patient has shown a mild response to chemotherapy when compared with patients in reproductive age, and the combination of standard chemotherapy with local injection chemotherapy may be helpful for treating similar clinical cases.