bluuebunny/crossref_metadata_2025_split huggingface dataset:
Optic neuropathy in the context of leukemia or lymphoma: diagnostic approach to a neuro-oncologic emergency
Authors: Myers Kenneth A. , Nikolic Ana , Romanchuk Kenneth , Weis Ezekiel , Brundler Marie-Anne , Lafay-Cousin Lucie , Costello Fiona 
Published: July 2016

AbstractBackgroundOptic neuropathy in the context of leukemia or lymphoma has a broad differential diagnosis, including infiltration, infection, inflammation, compression, and medication effects. Confirming the underlying etiology in a timely manner is crucial as, while infiltration carries a poor prognosis, treatment modalities can have serious consequences themselves.MethodsA review of the literature was conducted for cases of isolated optic neuropathy in the context of leukemia or lymphoma, in which the underlying etiology remained unclear following initial clinical examination and neuroimaging. Clinical, radiological, and pathological characteristics of the cases are summarized.ResultsNinety-two cases meeting inclusion criteria were identified. Leukemic or lymphomatous infiltration was the presumed diagnosis in 72% of the reports, indicating this is the most likely etiology in such cases. The remaining reports were attributed to inflammation, infection, or drug toxicity. For illustrative purposes, the previously unpublished case of an 11-year-old girl with remitted T lymphoblastic lymphoma is presented. She suffered recurrence in the form of isolated left optic nerve infiltration that required transconjunctival biopsy to confirm diagnosis.ConclusionsOptic nerve infiltration by leukemia or lymphoma requires both diagnostic certainty and urgent management. Recommendations are made for a step-wise, yet rapid investigative approach that may ultimately require biopsy of the optic nerve.
Implementation of an Infectious Disease Fellow-Managed Penicillin Allergy Skin Testing Service
Authors: Heil Emily L. , Bork Jacqueline T. , Schmalzle Sarah A. , Kleinberg Michael , Kewalramani Anupama , Gilliam Bruce L. , Buchwald Ulrike K. 
Published: July 2016

Abstract
Background.  A large percentage of patients presenting to acute care facilities report penicillin allergies that are associated with suboptimal antibiotic therapy. Penicillin skin testing (PST) can clarify allergy histories but is often limited by access to testing. We aimed to implement an infectious diseases (ID) fellow-managed PST program and to assess the need for PST via national survey.
Methods.  We conducted a prospective observational study of the implementation of an ID fellow-managed penicillin allergy skin testing service. The primary outcome of the study was to assess the feasibility and acceptability of an ID fellow-managed PST service and its impact on the optimization of antibiotic selection. In addition, a survey of PST practices was sent out to all ID fellowship program directors in the United States.
Results.  In the first 11 months of the program, 90 patients were assessed for PST and 76 patients were tested. Of the valid tests, 96% were negative, and 84% with a negative test had antibiotic changes; 63% received a narrower spectrum antibiotic, 80% received more effective therapy, and 61% received more cost-effective therapy. The majority of survey of respondents (n = 50) indicated that overreporting of penicillin allergy is a problem in their practice that affects antibiotic selection but listed inadequate personnel and time as the main barriers to PST.
Conclusions.  Inpatient PST can be successfully managed by ID fellows, thereby promoting optimal antibiotic use in patients reporting penicillin allergies. This model can increase access to PST at institutions without adequate access to allergists while also providing an important educational experience to ID trainees.
Serum Fibrosis Markers for the Diagnosis of Liver Disease Among People With Chronic Hepatitis C in Chennai, India
Authors: Cepeda Javier A. , Solomon Sunil S. , Srikrishnan Aylur K. , Nandagopal Paneerselvam , Balakrishnan Pachamuthu , Kumar Muniratnam S. , Thomas David L. , Sulkowski Mark S. , Mehta Shruti H. 
Published: July 2016

Abstract
Background.  Access to hepatitis C virus (HCV) treatment is limited in low- and middle-income countries (LMICs). Noninvasive biomarkers, such as fibrosis 4 (FIB-4) and aminotransferase to platelet ratio index (APRI), are low-cost alternatives to staging liver disease and identifying treatment need in people with chronic HCV infection, but their accuracy has not been evaluated in LMICs.
Methods.  We tested the accuracy of FIB-4 and APRI at validated cutoffs (FIB-4 &lt;1.45, &gt;3.25; APRI &lt;0.5, &gt;1.5) in predicting severe liver stiffness by elastography among 281 persons chronically infected with HCV. Multivariable logistic and Cox regression were used to identify markers of improved prediction and mortality, respectively.
Results.  Sensitivity and specificity of FIB-4 and APRI for predicting severe stiffness were 62% and 87% and 61% and 83%, respectively. Fibrosis 4 and APRI were less accurate in excluding significant stiffness; however, performance of models significantly improved with γ-glutamyl transpeptidase (GGT) and body mass index (BMI) (area under receiver operating characteristic curve, 0.81; 95% confidence interval, .76–.87). Severe liver stiffness predicted via FIB-4 &gt;3.25, APRI &gt;1.5, and a modified FIB-4 that included GGT and BMI were significantly associated with increased mortality.
Conclusions.  Fibrosis 4 and APRI may be useful in identifying individuals with severe stiffness who need treatment and continued monitoring in LMICs. Exclusion of significant stiffness may be improved by including GGT and BMI to FIB-4 models.
Court Enforcement, Bank Loans, and Firm Investment: Evidence from a Bankruptcy Reform in Brazil
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Authors: Ponticelli Jacopo , Alencar Leonardo S. 
Published: July 2016

Abstract
We exploit variation in the congestion of civil courts across Brazilian municipalities, together with a bankruptcy reform increasing secured creditors’ protection, to estimate the effect of enforcement on firm access to finance, investment, and size. We find that firms operating in municipalities with less congested courts experienced a larger increase in the use of secured loans, as well as a larger increase in investment and value of output in the years after the reform. To establish the direction of causality, we use an instrumental variable strategy that exploits Brazilian state laws on judicial organization, and focus on differences in court congestion across otherwise similar neighboring municipalities located across judicial district borders within the same state. The evidence indicates that differences in court enforcement affect the impact of financial reform on firm access to finance, investment, and size.
6. Outcome of Low-Intensity Pulsed Ultrasound (LIPUS) Treatment for Adult Phalanx Delayed Union
Authors: Ota Tsuyoshi 
Published: July 2016

Introduction:
In adult phalanx fractures with delayed union, we obtained good results from low-intensity pulsed ultrasound (LIPUS) fracture treatment.

Methods:
The subjects were 10 patients (7 male and 3 female) presenting with adult phalanx fracture with delayed union. The average age was 38.3-year-old. Eight cases presented with distal phalanx fracture and 2 with proximal phalanx fracture. Six cases involved a closed fracture and 4 cases an open fracture. The average LIPUS start time was 3.1 months, and the average treatment period was 5.1 months.

Results:
Bone union was obtained in 9 cases (90%). The single case in which bone union was not obtained involved nail deficient severe open fracture. The ratios of joint range of motion on the other side were 50%–100% (average 78.5%). Although a mild skin disorder was seen on the LIPUS treatment site in one case as a complication, it was effectively treated by medication.

Discussion:
LIPUS demonstrated significant effects in adult phalanx fractures when the maximum gap was small. We saw a bone union 90% of the cases without additional surgery, and confirmed the validity of LIPUS.
8. Low-Intensity Pulsed Ultrasound (LIPUS) Treatment for the Patient With Bone Reconstruction by the Masquelet Technique Using RIA
Authors: Niikura Takahiro , Yang Lee Sang , Iwakura Takashi , Kurosaka Masahiro 
Published: July 2016

Background:
The Masquelet technique is a relatively new option in the management of bone defects. It consists of 2-stage surgery. At first surgery, a cement spacer is placed to fill the bone defect. After a waiting period of 6–8 weeks, a pseudo-synovial membrane is formed around the cement. The induced membrane is rich in vascularity and osteogenic activity. At second surgery, the cement is replaced with an autologous bone graft and the graft is packed in the membrane. To harvest large quantities of bone graft, the reamer irrigator aspirator (RIA) is utilized. We report a case in which low-intensity pulsed ultrasound (LIPUS) was applied to bone reconstruction by the Masquelet technique using RIA.

Case:
The patient was a 44-year-old man. He suffered a tibia fracture involving the proximal part and the shaft. Open reduction and internal fixation was performed at the previous hospital. However, MRSE infection was found at 6 months postoperatively and surgery to eradicate the infection was performed. Two months after surgery, pseudoarthrosis surgery was performed; however no progression in bone union was observed for 5 months. Therefore, the patient was referred to our hospital. At the first surgery in our hospital, plates and screws were removed, and the avascular bone was debrided. Vancomycin-impregnated cement was placed to fill the bone defect and an Ilizarov external fixator was applied. Eight weeks later, the cement was replaced with the autologous bone graft and the graft was packed in the induced membrane. Bone graft was harvested from the ipsilateral femur using RIA. We applied LIPUS to the affected site postoperatively. Now, 4 months after the second surgery, bone union is progressing and the patient can walk without pain.

Discussion:
LIPUS may be used as an adjuvant therapy for a patient treated by the Masquelet technique using RIA.
12. Influence of Wound Dressing on the Fracture Healing Effect of Low-Intensity Pulsed Ultrasound (LIPUS)
Authors: Naruse Koji , Uchino Masataka , Hirakawa Noriko , Toyama Masahiro , Miyajima Genyo , Mukai Manabu , Urabe Ken , Uchida Kentaro , Itoman Moritoshi 
Published: July 2016

Objective:
We have conducted a basic study on the influences on ultrasonic properties when LIPUS is applied through wound dressing. According to the results of ex vivo experiments conducted to date, LIPUS showed ultrasonic properties such as transmittance, coefficient of transmission, and a non-uniformity ratio through film wound dressing better than other wound dressing, and it was considered that LIPUS's effect for fracture healing was not influenced by film wound dressing. Then, we discussed the influence on the effect of LIPUS through film wound dressing.

Methods:
Thirty male 8-week-old Sprague-Dawley rats were used for the trial. After creating close transverse femoral fractures on the right legs of these 30 rats, they were divided into 3 groups of 10; LIPUS through wound dressing (Group A), LIPUS without wound dressing (Group B), and No LIPUS treatment (Group C). OPSITE Wound, which was thought to have the least influence on ultrasound properties, was used for this trial. Group A and B received LIPUS for 20 minutes a day from the first day after the fractures. LIPUS was generated from Teijin Pharma's device for a basic experiment. When treating Group A, the wound dressing was pasted on the ultrasound terminal in order to apply LIPUS through the dressing. We assessed the time-oriented morphological change of each group in anesthetized condition using simple radiographs on the 8th, 16th, and 24th day after the fractures.

Results:
Six rats in Group A, 2 in Group B, and 1 in Group C died in anesthesia, and we discussed the remaining 4 rats in Group A, 8 in Group B, and 9 in Group C. We defined more than one teleost callus bridging as bone-union. We also counted a bone remodeling when we recognized the absorption of existing cortical bone and the transformation of new bone to cortical bone in simple radiographs. As a result, compared with Group C, we recognized that both bone union and remodeling accelerated remarkably in Group B, but not in Group A.

Discussion:
It suggested that LIPUS through wound dressing had negative influences on both period shorting of fracture healing and bone remodeling. When LIPUS was conducted through film wound dressing, transmittance and coefficient of transmission were unchanged; however, the non-uniformity ratio changed slightly. The non-uniformity ratio of the ultrasound transducer had a significant influence on the effect of LIPUS on fracture healing.
3. Can Combined Therapy With Teriparatide and Low-Intensity Pulsed Ultrasound (LIPUS) Accelerate Fracture Healing?
Authors: Nozaka Koji , Shimada Yoichi , Miyakoshi Naohisa , Yamada Shin , Hongo Michio , Nagasawa Hiroyuki , Kasukawa Yuji , Saito Hidetomo , Kijima Hiroaki , Tsuchie Hiroyuki 
Published: July 2016

Background:
It is an advantage for orthopaedic surgeons to remove an Ilizarov external fixator as early as possible after surgery. Although both teriparatide and low-intensity pulsed ultrasound (LIPUS) have been found to accelerate fracture-healing processes, the effect of the combination of teriparatide and LIPUS in clinical bone fracture management remains unclear.

Subjects:
From among 721 patients with a lower limb fracture on admission to our department who underwent surgical treatment for a lower limb fracture with an Ilizarov external fixator, 38 patients over 60-year-old were investigated. Patients were either treated with an Ilizarov external fixator alone (IEF alone, n = 20) or an Ilizarov external fixator combined with teriparatide and LIPUS (IEF combination, n = 18). The patients' mean age was 64.1 years (range, 60–79 years) in the IEF alone group and 67.2 years (range, 60–83 years) in the IEF combination group. Teriparatide (20 μg subcutaneous injection daily or 56.5 μg subcutaneous injection once-weekly) and LIPUS (20 min/d) were started immediately after surgery for the IEF combination group in an attempt to accelerate healing of the lower limb fracture with the Ilizarov external fixator.

Results:
The mean time to union was 111.9 days (range, 94–175 days) for IEF alone and 72.1 days (range, 68–141 days) for the IEF combination; it was significantly shorter with the IEF combination. Bone density (relative to young adult mean, YAM) was 61.3% (range, 38%–82%) for IEF alone and 52.1% (range, 30%–79%) for the IEF combination. The mean AOFAS score was 86.2 (range, 72–100) for IEF alone and 91.2 (range, 82–100) for the IEF combination.

Discussion:
In elderly patients with lower limb fractures, combined therapy (teriparatide and LIPUS) showed a shorter mean duration of union than the Ilizarov external fixator alone. Combined therapy with teriparatide and LIPUS may become a useful option in the treatment of elderly patients with lower limb fractures.
Component-resolved diagnostics in vernal conjunctivitis
Authors: Armentia Alicia , Sanchís Eugenia , Montero Javier A. 
Published: July 2016

Purpose of review
Conventional diagnostic tests in allergy are insufficient to clarify the cause of vernal conjunctivitis. Component-resolved diagnostic (CRD) by microarray allergen assay may be useful in detecting allergens that might be involved in the inflammatory process.

Recent findings
In a recent trial in patients suffered from eosinophilic esophagitis, after 2 years of the CRD-guided exclusion diet and specific immunotherapy, significant clinical improvement was observed, and 68% of patients were discharged (cure based on negative biopsy, no symptoms, and no medication intake). Our new objective was to evaluate IgE-mediated hypersensitivity by CRD in tears and serum from patients with vernal conjunctivitis and treat patients with identified triggering allergens by specific immunotherapy. Twenty-five patients with vernal conjunctivitis were evaluated. The identified triggering allergens were n Lol p 1 (11 cases), n Cyn d 1 (eight cases), group 4 and 6 grasses (six cases) and group 5 of grasses (five cases). Prick test and pollen IgE were positive in one case. Clinical improvement was observed in 13/25 vernal conjunctivitis patients after 1-year specific immunotherapy.

Summary
CRD seems to be a more sensitive diagnostic tool compared with prick test and IgE detection. Specific CRD-led immunotherapy may achieve clinical improvements in vernal conjunctivitis patients.
Dental hygiene in maintaining a healthy joint replacement: a survey of Canadian total joint replacement patients
Authors: Wood Thomas J. , Petruccelli Danielle , Piccirillo Liz , Staibano Phillip , Winemaker Mitch , de Beer Justin 
Published: July 2016

Background:
Dental procedures and their role in prosthetic joint infections remain controversial. Recent literature shows that total joint replacement in patients with good oral hygiene are less like to develop an prosthetic joint infection. The purpose of this study was to assess dental hygiene practices and knowledge of its importance in maintaining joint health among patients who have had a total joint replacement, and to understand, based on patient report, the extent to which current clinical practice guidelines have been adopted into everyday practice.

Methods:
A cross-sectional survey study of dental hygiene practices was conducted on patients who have had total joint replacement presenting for their 6 wk postoperative follow-up. We hypothesized that patients would have good dental hygiene habits, but limited knowledge of oral hygiene and prosthetic joint infection risk. Responses were analyzed using descriptive statistics and benchmarked against population data from the Oral Health Module of the Canadian Health Measures Survey (CHMS).

Results:
The study cohort included 453 patients (mean age 65.9±9.9 yr) with total joint replacements. Our findings demonstrated that although 86% had a cleaning within 12 mo, 5% did not visit a dentist. While 95% brush and 46% floss daily, 4% did not brush and 21% did not floss which is comparable to CHMS population data. Only 49% had been informed of dental hygiene in reducing prosthetic joint infection risk.

Conclusions:
Patients who have had total joint replacement practice good dental hygiene overall; however, communication regarding its importance in preventing prosthetic joint infection remains inconsistent. Healthcare practitioners must uniformly educate patients who have total joint replacement on the importance of good dental hygiene in maintaining joint health.
Retrospective comparative study of conventional arthrodesis versus clavicula pro humero for shoulder reconstruction after wide resection of malignant bone tumor of the proximal humerus
Authors: Rahman Mohamed Abdel , Mashhour Mohamed Ahmed , El Masry Ayman Mohammad , Azmy Sherif Ishak 
Published: July 2016

Background:
The proximal humerus represents one of the most common sites for primary malignant bone tumors. Limb salvage procedures have become the standard modality in treatment of these tumors. Several techniques can be used in shoulder reconstruction after wide resection of malignant bone tumors. The purpose of this study was to compare the functional outcome and complications for two important methods of shoulder joint reconstruction: conventional arthrodesis using fibular autogenous graft and clavicula pro humero.

Methods:
We retrospectively studied 30 patients with malignant tumors of the proximal humerus treated with limb salvage procedures with mean follow-up period of 67.16 mo. In 13 we used the clavicula pro humerus technique for reconstruction, and in 17 we performed conventional shoulder arthrodesis using nonvascularized fibular graft.

Results:
The mean Musculoskeletal Tumor Score (MSTS) for the conventional shoulder arthrodesis group was 69.6%. For the clavicula-pro-humero group the score was 67.5%. The Oxford Shoulder Score (OSS) for the conventional shoulder arthrodesis group was 34.6, while for the clavicula-pro-humero group it was 36.8. The median time to union was 8 wk for both groups.

Conclusions:
Both techniques represent reliable methods of shoulder reconstruction after wide resection of malignant tumors with comparable functional outcome and complications rates.
Multiple Procedures in the Initial Surgical Setting: When Do the Benefits Outweigh the Risks in Patients With Multiple System Trauma?
Authors: Childs Benjamin R. , Nahm Nickolas J. , Moore Timothy A. , Vallier Heather A. 
Published: July 2016

Objectives:
To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures.

Design:
Prospective, cohort.

Setting:
Level 1 trauma center.

Patients/Participants:
A total of 370 patients with high-energy fractures were treated after a standard protocol for resuscitation to lactate <4.0 mmol/L, pH ≥7.25, or base excess (BE) ≥−5.5 mmol/L. Fractures included femur (n = 167), pelvis (n = 74), acetabulum (n = 54), and spine (n = 107).

Main Outcome Measurements:
Complications, including pneumonia, acute respiratory distress syndrome, infections, deep venous thrombosis, pulmonary embolism, sepsis, multiple organ failure, and death, and length of stay.

Results:
Definitive fixation was performed concurrently with another procedure in 147 patients. They had greater ISS (29.4 vs. 24.6, P < 0.01), more transfusions (8.9 U vs. 3.6 U, P < 0.01), and longer surgery (4:22 vs. 2:41, P < 0.01) than patients with fracture fixation only, but no differences in complications. When patients who had definitive fixation in the same setting as another procedure were compared only with other patients who required more than 1 procedure performed in a staged manner on different days (n = 71), complications were fewer (33% vs. 54%, P = 0.004), and ventilation time (4.00 vs. 6.83 days), intensive care unit (ICU) stay (6.38 vs. 10.6 days), and length of stay (12.4 vs. 16.0 days) were shorter (all P ≤ 0.03) for the nonstaged patients.

Conclusions:
In resuscitated patients, definitive fixation in the same setting as another procedure did not increase the frequency of complications despite greater ISS, transfusions, and surgical duration in the multiple procedure group. Multiple procedures in the same setting may reduce complications and hospital stay versus additional surgeries on other days.

Level of Evidence:
Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.