bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of achieved systolic blood pressure in newly treated hypertensive patients aged 60–79 years before and after Eighth Joint National Committee recommendations
Authors: Kelly Michael S. , Saseen Joseph J. , Marrs Joel C. 
Published: January 2017

Objective: To determine whether patients who were newly prescribed antihypertensive therapy after the Eighth Joint National Committee (JNC 8) update were treated to a relaxed systolic blood pressure (SBP) goal compared with patients treated before the update. Methods: A retrospective cohort study approved by the Colorado Multiple Institutional Review Board. Patients aged 60–79 years, without diabetes or chronic kidney disease (CKD), newly treated for hypertension at a University of Colorado primary care clinics were included. The mean first-achieved and last-stable SBPs of patients newly prescribed antihypertensive medications from 1 January 2012 to 31 December 31 2013 (before cohort) were compared with patients newly prescribed antihypertensive therapy from 1 January 2014 to 1 October 2015 (after cohort). The mean number of antihypertensive medications at first-achieved SBP, the time to first-achieved SBP, and the class of initial antihypertensive medications were also evaluated. Results: A total of 128 patients were included, 64 patients in each cohort. The coprimary outcome of first-achieved mean SBP did not differ between the groups (131.3 mmHg versus 130.2 mmHg; p = 0.65). Last-stable mean SBP values were also similar between the groups (130.2 mmHg versus 129.5 mmHg; p = 0.74). Angiotensin converting enzyme inhibitors (ACE-I) were the most frequently initiated antihypertensive agent in both cohorts (43.8% versus 48.4%; p = 0.72). Conclusions: Our findings suggest that the JNC 8 recommendations did not alter SBP goals among patients aged 60–79 years newly treated for hypertension at University of Colorado primary care clinics.
Quantification of the articular view of the elbow afforded by standard portals using 30° arthroscopy
Authors: Moverley Robert , Colaco Henry B. , Rudran Bran , Szarko Matthew , Arnander Magnus , Tennent Duncan 
Published: January 2017

Background The present study quantifies the field of view (FOV) from standard arthroscopy portals and aims to identify anatomical regions where the FOV is limited. Methods Eleven cadaveric elbows were examined through standard anteromedial, anterolateral and posterior portals. The FOV was marked with dye using a spinal needle. The articular surfaces were then exposed and the percentage FOV seen was calculated. FOV percentage areas were compared using a Student’s t-test (JMP, version 10, SAS Institute Inc., Cary, NC, USA). P < 0.05 was considered statistically significant. Results The mean (SD) FOV percentage area seen from the anteromedial portal and anterolateral portal was 91.69% (3.63%) and 92.03% (3.93%), respectively, for the anterior humerus articular surface. There was no significant difference in the mean FOV percentage area seen from the anteromedial and anterolateral portals ( p = 0.99). The mean (SD) FOV percentage area of the posterior humerus articular surface was 84.69% (2.28%). The mean (SD) FOV percentage area seen of the radial head and trochlear was 16.05% (2.66%) and 4.14% (1.76%), respectively. Conclusions The present study is the first to quantify the FOV of elbow arthroscopy. The majority of the anterior and posterior humerus articular surface can be seen through standard portals. The limitations in FOV are primarily confined to the radial head and trochlear notch.
Blood versus urine ketone monitoring in a pediatric cohort of patients with type 1 diabetes: a crossover study
Authors: Goffinet Line , Barrea Thierry , Beauloye Véronique , Lysy Philippe A. 
Published: January 2017

Background: The aim of our study was to determine the influence of routine ketone monitoring on hyperglycemic events (HE) and ketosis in youngsters with type 1 diabetes (T1D). Methods: Our single-site, controlled and randomized study was conducted on children and adolescents with T1D outside of remission phase. During two crossover periods of 6 months, patients ( n = 22) experiencing HE tested ketones alternatively with a blood ketone meter or urine ketone test strips and gave their opinion on screening methods after completion of clinical trial. Moreover, we evaluated levels of awareness of ketone production in a series of 58 patients and sometimes parents via a multiple-choice questionnaire. Results: Based on self-monitoring data, patients experienced a mean of 4.8 HE/month (range 0–9.3). Patients performed accurate ketone tests more frequently during urine (46%) than during blood-testing (29%) periods ( p < 0.05); while globally, 50% of ketone tests were inaccurate (i.e. without HE). Ketosis occurred significantly more often during urine (46.4%) than during blood (14.8%) monitoring ( p = 0.01), although no episodes of diabetic ketoacidosis (DKA) were noticed. Duration of hyperglycemia was not different whether patients measured ketones or not, suggesting that ketone monitoring did not affect correction of glycemia. Patients evaluated blood monitoring more frequently as being practical, reliable, and useful compared with urine testing. Scores in the awareness questionnaire were globally low (36.8%) without difference between patients and their parents. Conclusions: Although our study shows differences in outcomes (e.g. accurate use, detection of ketosis) of urine versus blood ketone monitoring, these did not affect the occurrence of HE. Whereas ketone monitoring is part of standardized diabetes education, its implementation in daily routine remains difficult, partly because patient awareness about mechanisms of ketosis is lacking.
Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey
Authors: Koifman Edward , Beigel Roy , Iakobishvili Zaza , Shlomo Nir , Biton Yitschak , Sabbag Avi , Asher Elad , Atar Shaul , Gottlieb Shmuel , Alcalai Ronny , Zahger Doron , Segev Amit , Goldenberg Ilan , Strugo Rafael , Matetzky Shlomi 
Published: January 2017

Background: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Methods: Data from the Acute Coronary Survey in Israel registry 2000–2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. Results: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120–262) vs 195 (interquartile range 130–333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66–0.94), p=0.01). Conclusions: Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.
Are we cross-matching too much blood for elective open abdominal aortic aneurysm repair?
Authors: Lowe Emily , Quarmby John 
Published: January 2017

Objectives: This study aims to identify current blood transfusion requirements in elective open abdominal aortic aneurysm repair and to compare this to an existing maximum surgical blood order schedule. Methods: We retrospectively identified patients who underwent elective open abdominal aortic aneurysm repair over a 40-month period in our institution. Pre-operative number of units cross-matched and the number of units actually transfused were identified. The cross-match to transfusion ratio was then calculated. Results: Blood transfusion at any time post-operatively was required in 23 (48.9%) cases. Patients needing an intra-operative blood transfusion had a median of 2 units. Of the pre-operative cross-matched units (123), only 43 were used, giving a cross-match to transfusion ratio of 2.86. Conclusion: Our current maximum surgical blood order schedule is poorly followed and a cross-match to transfusion ratio of 2.86 indicates we are cross-matching too many units for elective open abdominal aortic aneurysm repair. A carefully considered individualised management of blood products, with the requirement of at least a valid group and save sample, may be more appropriate.
Antibiotic resistance and gyrA mutation affect the efficacy of 10‐day sitafloxacin‐metronidazole‐esomeprazole therapy for Helicobacter pylori in penicillin allergic patients
Authors: Mori Hideki , Suzuki Hidekazu , Matsuzaki Juntaro , Masaoka Tatsuhiro , Kanai Takanori 
Published: January 2017

Background and aimHelicobacter pylori (H. pylori ) eradication regimen has not been standardized for patients with penicillin allergy. We investigated the association between the efficacy of a 10‐day sitafloxacin, metronidazole, and esomeprazole triple regimen and antibiotic resistance, in patients with penicillin allergy.MethodsPenicillin‐allergic patients infected with H. pylori were enrolled between March 2014 and November 2015. The minimum inhibitory concentrations (MICs) of sitafloxacin and metronidazole, and the gyrA mutation status of the H. pylori strains were determined before treatment. The cut‐off points for antimicrobial resistance were defined as 8.0 µg/ml for metronidazole and 0.12 µg/ml for sitafloxacin. The patients received the triple therapy (20 mg esomeprazole, bid; 250 mg metronidazole, bid; and 100 mg sitafloxacin, bid) for 10 days. Successful eradication was evaluated using the [13 C] urea breath test or the H. pylori stool antigen test.ResultsFifty‐seven patients were analyzed, and the overall eradication rate was 89.5%. The eradication rate in cases of double antibiotic resistance to metronidazole and sitafloxacin was 40.0%, whereas for other combinations of resistance, this was above 90.0%. Finally, the eradication rate of gyrA mutation‐negative strains was 96.2%, whereas for gyrA mutation‐positive strains, it was 83.9%. Adverse events were reported in 31.6% of cases, all of which were mild and tolerable.ConclusionTen days of sitafloxacin and metronidazole triple therapy was safe and highly effective in eradicating H. pylori in penicillin‐allergic patients. Double resistance to metronidazole and sitafloxacin was an important predicting factor for eradication failure. However, 10 days of the sitafloxacin and metronidazole triple therapy was highly effective if the strain was susceptible to either sitafloxacin or metronidazole.
The one-year experience of tape and mesh removal at a urological tertiary referral centre
Authors: Bekarma Holly , Granitsiotis Paraskeve 
Published: January 2017

Objective: There is increasing controversy surrounding the use of synthetic materials in transvaginal tape and vaginal mesh for stress incontinence and pelvic organ prolapse. The aim of this study was to review the case load and operative management of a tertiary referral urology centre dealing with surgical complications of these procedures within Scotland. Participants/patients (or materials) and methods: A retrospective review of patients undergoing removal of products and analysis of their symptom, operative findings and postoperative status was conducted. Results: Twenty-five patients were identified in a one-year period. Eighty per cent of initial procedures were performed by a gynaecologist. Patients presented with a variety of symptoms including pain, infections and haematuria. The most common device needing removal was a tension-free vaginal tape obturator (TVTO). Intraoperative findings were classified using an online calculator with the most common location for complications being within the urethra. Most patients underwent successful removal of all parts of the tape and a small number required combined abdominal and vaginal approach. Postoperatively there was significant symptom resolution for most women with recurrent urinary infections and pain. Over 50% of women were continent postoperatively. Conclusion: We have demonstrated the benefit of performing operative management of these patients in a tertiary referral centre in terms of outcomes regarding improvement of symptoms and continence rates.
Risk factors associated with complications following total hip arthroplasty using the two-incision technique
Authors: Nishiyama Daisuke , Matsuzaki Kosaku , Yamazaki Satoru , Takiguchi Noboru , Harada Teiji , Sando Shigeki 
Published: January 2017

Background: The frequency of the complications following total hip arthroplasty (THA) using the two-incision technique is well documented. However, few reports have analyzed the preoperative patient–related factors associated with the complications. The purpose of this study was to estimate the incidence of early complications following primary two-incision THA and to define the risk factors associated with perioperative complications. Materials and Methods: The subjects of this retrospective study were 1218 consecutive patients who underwent primary two-incision THA. The incidence of hip dislocation, stem subsidence, intraoperative femoral fracture, and nontraumatic postoperative femoral fracture was evaluated. The association between complications and preoperative patient–related factors, including gender, obesity, Crowe classification, age, body mass index (BMI), and morphological parameters of the proximal femoral medullary cavity, were investigated. Results: The incidences of complications were dislocation (1.1%), stem subsidence (0.9%), intraoperative femoral fracture (1.2%), and postoperative femoral fracture (0.7%). Obesity (BMI > 30) influenced the occurrences of stem subsidence and postoperative femoral fractures ( p = 0.0001, p = 0.019). Crowe classification significantly correlated with intraoperative femoral fractures (Grade II: odds ratio (OR) 4.63, 95% confidence interval (CI), 1.32–15.6; Grade III and IV: OR 8.96, 95% CI, 2.2–34.94). Additionally, the outer diameter of the femur 10 cm below the lesser trochanter tended to be small in patients who developed a femoral fracture. Conclusions: The early complication rate was comparable to other methods used in uncemented THA. It is necessary for patients with risk factors revealed in this study to pay careful attention or consider other surgical approaches to avoid complications. Further studies considering femur morphology are required.
Surgical anatomy of the pelvic vasculature, with particular reference to acetabular screw fixation in cementless total hip arthroplasty in Asian population
Authors: Ohashi Hironori , Kikuchi Shinichi , Aota Shigeo , Hakozaki Michiyuki , Konno Shinichi 
Published: January 2017

Purpose: Pelvic vascular injury is a serious complication associated with acetabular component setting with screw fixation in cementless total hip arthroplasty (THA). In this study, we investigated the safety zone for acetabular component setting with screw fixation in cementless THA as a means to prevent pelvic vascular injury. Methods: Thirty left hip joints of Japanese cadavers (11 males and 19 females) were analyzed. We used a hemispherical measuring cup with 52 guide holes designed to allow vertical insertion of a Kirschner wire. After the measuring cup was placed on the acetabulum, the Kirschner wire was inserted from each guide hole to examine the anatomical relationship between the acetabulum and the pelvic vessels. We calculated the frequency of pelvic vessel punctures and measured the distance from the acetabular surface to the pelvic vessels at each guide hole. Results: Our findings revealed that pelvic vessels do not exist in certain parts of the posterior area of the acetabulum. Furthermore, in this area, intrapelvic vessels are either lacking or located at a distance ≥31 mm from the surface of the acetabulum. Conclusion: The posterior area of the acetabulum, excluding its central portion, appeared to be the safety zone for acetabular screw fixation in Japanese cadavers.
Pain Assessment After Anterior Cruciate Ligament Reconstruction
Authors: Okoroha Kelechi R. , Keller Robert A. , Jung Edward K. , Khalil Lafi , Marshall Nathan , Kolowich Patricia A. , Moutzouros Vasilios 
Published: January 2017

Background: Anterior cruciate ligament (ACL) reconstruction is a common outpatient procedure that is accompanied by significant postoperative pain. Purpose: To determine differences in acute pain levels between patients undergoing ACL reconstruction with bone–patellar tendon–bone (BTB) versus hamstring tendon (HS) autograft. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 70 patients who underwent primary ACL reconstruction using either BTB or HS autografts consented to participate. The primary outcome of the study was postoperative pain levels (visual analog scale), which were collected immediately after surgery and for 3 days postoperatively. Secondary outcome measures included opioid consumption (intravenous morphine equivalents), hours slept, patient satisfaction, reported breakthrough pain, and calls to the physician. Results: Patients treated with BTB had increased pain when compared with those treated with HS in the acute postoperative period (mean ± SD: day 0, 6.0 ± 1.7 vs 5.2 ± 2.0 [ P = .066]; day 1, 5.9 ± 1.7 vs 4.9 ±1.7 [ P = .024]; day 2, 5.2 ± 1.9 vs 4.1 ± 2.0 [ P = .032]; day 3, 4.8 ± 2.1 vs 3.9 ± 2.3 [ P = .151]). There were also significant increases in reported breakthrough pain (day 0, 76% vs 43% [ P = .009]; day 1, 64% vs 35% [ P = .003]) and calls to the physician due to pain (day 1, 19% vs 0% [ P = .041]) in the BTB group. There were no significant differences in narcotic requirements or sleep disturbances. Overall, the BTB group reported significantly less satisfaction with pain management on days 0 and 1 ( P = .024 and .027, respectively). Conclusion: A significant increase in acute postoperative pain was found when performing ACL reconstruction with BTB compared with HS. Patients treated with BTB were more likely to have breakthrough pain, decreased satisfaction with their pain management, and to contact their physician due to pain. These findings suggest a difference in early postoperative pain between the 2 most common graft options for ACL reconstruction. Patients should be informed of the differences in acute postoperative pain when deciding on graft choice with their physician.
Prevalence of Vitamin D Insufficiency in Professional Hockey Players
Authors: Mehran Nima , Schulz Brian M. , Neri Brian R. , Robertson William J. , Limpisvasti Orr 
Published: January 2017

Background: Vitamin D is a fat-soluble hormone that plays a role in bone health, muscle function, and athletic performance. Studies have shown that low levels of vitamin D can lead to slower muscle recovery and function, increased rates of stress fractures, and even poorer athletic performance. Insufficient vitamin D levels have been demonstrated in professional basketball and football players, however, there have been no studies to date reviewing vitamin D insufficiency in professional hockey players. Purpose/Hypothesis: The purpose of this study was to perform a cross-sectional review to determine the prevalence of vitamin D deficiency and insufficiency in professional hockey players. The hypothesis was that there would be a high percentage of players with vitamin D insufficiency. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The preseason serum 25-hydroxy (OH) vitamin D laboratory test results of 105 professional hockey players were retrospectively reviewed. All players on 3 National Hockey League (NHL) teams were included. Player parameters evaluated included age, height, weight, body mass index, and 25(OH) vitamin D level. Players were divided into 4 groups based on serum vitamin D levels: deficient (<20 ng/mL), insufficient (20-31.9 ng/mL), sufficient (≥32 ng/mL), and ideal (≥40 ng/mL). Descriptive statistics were performed, in addition to 2-group and 3-group comparisons. Results: The average 25(OH) vitamin D level of 105 players was 45.8 ± 13.7 ng/mL (range, 24-108 ng/mL). No players in the study were considered deficient. A total of 14 players (13.3%) were considered insufficient, while 91 players (86.7%) were considered sufficient. However, only 68 players (64.8%) were considered ideal. When comparing groups, athletes with sufficient vitamin D levels were older than athletes with insufficient vitamin D levels (25.9 vs 23.1 years; P = .018). All other player parameters demonstrated no significant difference between groups. Conclusion: Despite playing a winter sport and spending a great deal of time training indoors, professional hockey players have low levels of vitamin D insufficiency.
NSQIP as a Predictor of Length of Stay in Patients Undergoing Free Flap Reconstruction
Authors: Riley Charles A. , Barton Blair M. , Lawlor Claire M. , Cai David Z. , Riley Phoebe E. , McCoul Edward D. , Hasney Christian P. , Moore Brian A. 
Published: January 2017

ObjectiveThe National Surgical Quality Improvement Program (NSQIP) calculator was created to improve outcomes and guide cost‐effective care in surgery. Patients with head and neck cancer (HNC) undergo ablative and free flap reconstructive surgery with prolonged postoperative courses.MethodsA case series with chart review was performed on 50 consecutive patients with HNC undergoing ablative and reconstructive free flap surgery from October 2014 to March 2016 at a tertiary care center. Comorbidities and intraoperative and postoperative variables were collected. Predicted length of stay was tabulated with the NSQIP calculator.ResultsThirty‐five patients (70%) were male. The mean (SD) age was 67.2 (13.4) years. The mean (SD) length of stay (LOS) was 13.5 (10.3) days. The mean (SD) NSQIP‐predicted LOS was 10.3 (2.2) days (P =. 027).DiscussionThe NSQIP calculator may be an inadequate predictor for LOS in patients with HNC undergoing free flap surgery. Additional study is necessary to determine the accuracy of this tool in this patient population.Implications for Practice:Head and neck surgeons performing free flap reconstructive surgery following tumor ablation may find that the NSQIP risk calculator underestimates the LOS in this population.