bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recommendations for the medical management of chronic venous disease: The role of Micronized Purified Flavanoid Fraction (MPFF)
Authors: Bush Ronald , Comerota Anthony , Meissner Mark , Raffetto Joseph D. , Hahn Steven R. , Freeman Katherine 
Published: February 2017

Scope A systematic review of the clinical literature concerning medical management of chronic venous disease with the venoactive therapy Micronized Purified Flavonoid Fraction was conducted in addition to an investigation of the hemodynamics and mechanism of chronic venous disease. Methods The systematic review of the literature focused on the use of Micronized Purified Flavonoid Fraction (diosmin) which has recently become available in the US, in the management of chronic venous disease. The primary goal was to assess the level of evidence of the role of Micronized Purified Flavonoid Fraction in the healing of ulcers, and secondarily on the improvement of the symptoms of chronic venous disease such as edema. An initial search of Medline, Cochrane Database for Systematic Reviews and Google Scholar databases was conducted. The references of articles obtained in the primary search, including a Cochrane review of phlebotonics for venous insufficiency, were reviewed for additional studies. Studies were included if patients had a diagnosis of chronic venous disease documented with Doppler and Impedance Plethysmography. Studies excluded were those that had patients with arterial insufficiency (Ankle Brachial Index < .6), comorbidity of diabetes, obesity, rheumatological diseases, or if other causes of edema were present (congestive heart failure, renal, hepatic or lymphatic cause), or if the patient population had recent surgery or deep vein thrombosis, or had been using diuretics (in studies of edema). Other elements of the study design were to note specifically the type of compression therapy used in conjunction with Micronized Purified Flavonoid Fraction. Results The literature review yielded 250 abstracts, 65 of which met criteria for further review and 10 papers were selected for consideration in the systematic review. Conclusion In summary, the general level of evidence supports the recommendation that the use of medical therapy with Micronized Purified Flavonoid Fraction has beneficial outcomes without serious adverse events. In the United States, diosmiplex is the only available prescription formulation of Micronized Purified Flavonoid Fraction. It is derived from the rinds of oranges and is categorized as a medical food and not as a drug; and may be a particularly attractive therapy for many chronic venous disease patients because of its favorable safety profile. The Working Group for chronic venous disease concurs with previous guidance by the International European Society for Vascular Surgery in 2015 which recommended the use of Micronized Purified Flavonoid Fraction for the healing of venous ulcers, alone and adjunctive to compression therapy, and for the reduction in symptoms of chronic venous disease such as edema.
Hip and pelvic fracture patients with fear of falling: development and description of the “Step by Step” treatment protocol
Authors: Kampe Karin , Kohler Michaela , Albrecht Diana , Becker Clemens , Hautzinger Martin , Lindemann Ulrich , Pfeiffer Klaus 
Published: February 2017

Objective: Based on a theoretical framework and sound evidence, this article describes a rehabilitation programme for patients with fear of falling after hip and pelvic fracture. Rationale: Based on exercise science principles, current knowledge from fall prevention, emotion regulation, and the Health Action Process Approach we developed a theoretical framework, from which the components of the intervention were derived. Description of the intervention: The intervention consists of 6 components: (1) relaxation, (2) meaningful activities and mobility-based goals, (3) falls related cognitions and emotions, coping with high risk tasks and situations, (4) individual exercise programme, (5) planning and implementing exercises and activities, and (6) fall risks and hazards. The intervention comprises of 8 individual sessions during 3 to 5 weeks of inpatient rehabilitation and 4 telephone calls and 1 home visit over a 2-month post-discharge period. Each session or telephone call takes about 30-60 minutes. It is provided to geriatric hip and pelvic fracture patients with concerns about falling and no cognitive impairment. To ensure completeness of reporting, the Template for Intervention Description and Replication (TIDierR) is used. Results: Fifty-seven patients were assigned to the intervention group. All 46 completers met all pre-defined criteria for an intervention per protocol. Conclusion: The programme is feasible to administer. We have completed a randomised controlled trial, which will be submitted in due time (for trial protocol: www.isrctn.org ; ISRCTN79191813).
Neuropsychiatric Symptoms in Mild Cognitive Impairment
Authors: Gallagher Damien , Fischer Corinne E. , Iaboni Andrea 
Published: February 2017

Objective: Neuropsychiatric symptoms (NPS) may be the first manifestation of an underlying neurocognitive disorder. We undertook a review to provide an update on the epidemiology and etiological mechanisms of NPS that occur in mild cognitive impairment (MCI) and just before the onset of MCI. We discuss common clinical presentations and the implications for diagnosis and care. Method: The authors conducted a selective review of the literature regarding the emergence of NPS in late life, before and after the onset of MCI. We discuss recent publications that explore the epidemiology and etiological mechanisms of NPS in the earliest clinical stages of these disorders. Results: NPS have been reported in 35% to 85% of adults with MCI and also occur in advance of cognitive decline. The occurrence of NPS for the first time in later life should increase suspicion for an underlying neurocognitive disorder. The presenting symptom may provide a clue regarding the etiology of the underlying disorder, and the co-occurrence of NPS may herald a more accelerated cognitive decline. Conclusions: NPS are prevalent in the early clinical stages of neurocognitive disorders and can serve as both useful diagnostic and prognostic indicators. Recognition of NPS as early manifestations of neurocognitive disorders will become increasingly important as we move towards preventative strategies and disease-modifying treatments that may be most effective when deployed in the earliest stages of disease.
Cognitive impairment in patients with multiple sclerosis is associated with atrophy of the inner retinal layers
Authors: Coric Danko , Balk Lisanne J , Verrijp Merike , Eijlers Anand , Schoonheim Menno M , Killestein Joep , Uitdehaag Bernard MJ , Petzold Axel 
Published: February 2017

Background: Inner retinal layer (IRL) atrophy is a potential biomarker for neurodegeneration in multiple sclerosis (MS). Objective: To investigate the relationship between cognitive impairment and IRL atrophy in MS. Methods: Cross-sectional study design, including 217 patients and 59 healthy controls. Subjects were investigated clinically, underwent retinal optical coherence tomography (OCT) and comprehensive cognitive assessments. The association between these modalities was evaluated by regression analyses. Results: Of the patients, 44.2% were cognitively impaired. In the absence of multiple sclerosis–associated optic neuritis (MSON), cognitively impaired patients had a significantly lower mean peripapillary retinal nerve fiber layer (pRNFL, Δ: 8.13 µm, p < 0.001) and mean macular ganglion cell–inner plexiform layer (mGCIPL, Δ: 11.50 µm, p < 0.001) thickness compared to cognitively preserved patients. There was a significant association between the presence of cognitive impairment and pRNFL (odds ratio (OR): 1.11, 95% confidence interval (CI): 1.04–1.18, p = 0.001) and mGCIPL (OR = 1.11, 95% CI = 1.05–1.18, p < 0.001) atrophy. This association was masked by the severe IRL atrophy seen following MSON. Conclusion: The strong relationship between cognitive impairment across multiple cognitive domains and atrophy of the pRNFL and mGCIPL in patients who never suffered from MSON suggests that OCT is useful in assessing central nervous system neurodegeneration in MS.
Some patients live after trauma: Re-examining the lethality of vertical deceleration injuries
Authors: Smith Michael R , Amberger Melissa A , Pavalonis Albert G , Onursal Elif M , Lee Sean , Phillips Patricia A , Edwards Joseph S 
Published: February 2017

Background Vertical deceleration injury is a unique urban phenomenon of blunt injury resulting in significant morbidity and mortality. Since evaluations began in the 1940s and more extensively in the 1980s through 2005, the fall height at which 50% of patients are expected to die (LD50) has been consistently estimated to be 40 ft (12.1 m) and historical reports suggest no patients were able to survive a fall greater than 50 ft (15.2 m). The aim of this study was to determine the current LD50 or survivable free fall height in comparison to historical reports. Study design The trauma database at an urban level one trauma center was reviewed for all falls from a significant height from January 2010 to December 2015. The data were stratified based upon the height of the fall. The height at which 50% of patients were expected to die was determined by logistic non-linear regression line plot. Results In total, 110 patients were identified, with 97 meeting criteria for inclusion into the study. Twelve patients fell from 60 ft (18.2 m) with six survivors. The calculated LD50 was 48 ft (14.8 m) when the heights of a story and floor were standardized to 10 ft (3 m); if the height was increased to 12 ft (3.7 m) per story, the LD50 would be 68 ft (20.1 m). Conclusions The survivable height, as well as the LD50 of vertical free falls, has increased as compared to previous studies. We assume that this is attributable to the advances in diagnostic imaging, interventional radiology therapies, critical care, and field management of these patients. A fall from 80 ft (24 m) exceeds the maximum threshold of force that the human body can withstand.
Revisions to the Common Rule: A proposal in search of evidence
Authors: Nicholls Stuart G 
Published: February 2017

Proposed changes to the Common Rule are proffered to save almost 7,000 reviews annually and consequently vast amounts of investigator and IRB-member time. However, the proposed changes have been subject to criticism. While some have lauded the changes as being imperfect, but nevertheless as improvements, others have contended that ‘neither the scientific community nor the public can be confident that improved practices will emerge from the regulatory changes mandated by the NPRM.’ In the present article, I discuss an important aspect that has been overlooked: the question of whether benefits will emerge is demonstrably empirical, yet data upon which to draw conclusions are conspicuous by their absence. This is thrown into sharp relief when we consider the current environment in which health research is increasingly focused on providing evidence of need or benefit, where there is greater emphasis on evidence-based practice, and when we have the nascent field of implementation science.
Assessment of cross-cultural adaptations of patient-reported shoulder outcome measures in Spanish: a systematic review
Authors: Gómez-Valero Sara , García-Pérez Fernando , Flórez-García Mariano Tomás , Miangolarra-Page Juan Carlos 
Published: February 2017

Background The present study aimed to conduct a systematic review of self-administered shoulder-disability functional assessment questionnaires adapted to Spanish, analyzing the quality of the transcultural adaptation and the clinimetric properties of the new version. Methods A search of the main biomedical databases was conducted to locate Spanish shoulder function assessment scales. The authors reviewed the papers and considered whether the process of adaptation of the questionnaire had followed international recommendations, and whether its psychometric properties had been appropriately assessed. Results The search identified nine shoulder function assessment scales adapted to Spanish: Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), Upper Limb Functional Index (ULFI), Simple Shoulder Test (SST), Shoulder Pain and Disability Index (SPADI), Oxford Shoulder Score (OSS), Shoulder Disability Questionnaire (SDQ), Western Ontario Rotator Cuff index (WORC), Western Ontario Shoulder Instability index (WOSI) and Wheelchair Users Shoulder Pain Index (WUSPI). The DASH was adapted on three occasions and the SPADI on two. The transcultural adaptation procedure was generally satisfactory, albeit somewhat less rigorous for the SDQ and WUSPI. Reliability was analyzed in all cases. Validity was not measured for one of the adaptations of the DASH, nor was it measured for the SDQ. Conclusions The transcultural adaptation was satisfactory and the psychometric properties analyzed were similar to both the original version and other versions adapted to other languages.
Reference values of manual dexterity using Minnesota Rate of Manipulation Test for Indian adults
Authors: Rane Shamita S , Paul Anila , Mullerpatan Rajani P 
Published: February 2017

Introduction Dexterity assessment is an integral component of hand function evaluation. The Minnesota Rate of Manipulation Test is a valid and reliable tool to evaluate manual dexterity and has been used to study prognosis of therapy. Information available on its reference values is limited. Reference values are required to interpret, set realistic treatment goals, and assess the ability to return to employment. Therefore, manual dexterity was studied in healthy Indian adults to generate reference values. Methods A descriptive study was conducted on 900 subjects divided into three groups: Group 1: 18–30 years ( n = 300): Group 2: 31–60 years (n = 300), and Group 3: ≥61 years ( n = 300). The Minnesota Rate of Manipulation Test was used to evaluate manual dexterity. All subjects performed three trials (one practice + two test trials) of the five subtests. The average of two test trials was used to compute the Minnesota Rate of Manipulation Test score. Results The total score of the Minnesota Rate of Manipulation Test in Groups 1, 2, and 3 was 275.7 ± 24.1 s, 299.3 ± 31.9 s, and 357.4 ± 48.6 s, respectively. Manual dexterity was moderately associated with age ( r = 0.707, p < 0.001); however, differences between males and females were nonsignificant ( p = 0.306). Conclusion Manual dexterity declined with advancing age; however, differences between genders were not significant. These reference values of manual hand dexterity for healthy adult Indian people will be relevant for clinical assessment of hand function.
Follow‐up tricuspid annular plane systolic excursion predicts survival in pulmonary arterial hypertension
Authors: Mazurek Jeremy A. , Vaidya Anjali , Mathai Stephen C. , Roberts Justin D. , Forfia Paul R. 
Published: February 2017

Few studies have examined the utility of serial echocardiography in the evaluation, management, and prognosis of patients with pulmonary arterial hypertension (PAH). Therefore, we sought to evaluate the prognostic significance of follow‐up tricuspid annular plane systolic excursion (TAPSE) in PAH. We prospectively studied 70 consecutive patients with PAH who underwent baseline right heart catheterization (RHC) and transthoracic echocardiogram, who survived to follow‐up echocardiogram after initiation of PAH therapy. Baseline TAPSE was 1.6 ± 0.5 cm which increased to 2.0 ± 0.4 cm on follow‐up (P < 0.0001). The cohort was dichotomized by TAPSE at one‐year follow‐up: Group 1 (n = 37): follow‐up TAPSE ≥ 2 cm; Group 2 (n = 33): follow‐up TAPSE < 2 cm. Group 1 participants were significantly more likely to reach WHO functional class I–II status and achieve a higher six‐minute walk distance on follow‐up. Of the 68 patients who survived more than one year, 18 died (26.5%) over a median follow‐up of 941 days (range, 3–2311 days), with significantly higher mortality in Group 2 versus Group 1 (41.9% vs. 13.5%; P = 0.003). While baseline TAPSE stratified at 2 cm did not predict survival in this cohort, TAPSE ≥ 2 cm at follow‐up strongly predicted survival in bivariable models (hazard ratio, 0.21; 95% confidence interval, 0.08–0.60). In conclusion, follow‐up TAPSE ≥ 2 cm is a prognostic marker and potential treatment target in a PAH population.
The Modified Borg Dyspnea Scale does not predict hospitalization in pulmonary arterial hypertension
Authors: Banerjee Debasree , Kamuren Jane , Baird Grayson L. , Palmisciano Amy , Krishnan Ipsita , Whittenhall Mary , Klinger James R. , Ventetuolo Corey E. 
Published: February 2017

BackgroundBreathlessness is the most common symptom reported by patients with pulmonary arterial hypertension (PAH). The Modified Borg Dyspnea Scale (MBS) is routinely obtained during the six‐minute walk test in the assessment of PAH patients, but it is not known whether the MBS predicts clinical outcomes such as hospitalizations in PAH.MethodsWe performed a retrospective study of World Health Organization (WHO) Group 1 PAH patients followed at our center. The dates of the first three MBS and hospitalizations that occurred within three months of a documented MBS were collected. Marginal Cox hazard regression modeling was used to assess for a relationship between MBS and all‐cause as well as PAH‐related hospitalization.ResultsA total of 50 patients were included; most (92%) were functional class III/IV, 44% and 65% were treatment‐naïve prior to their first MBS and hospitalization, respectively. The first recorded MBS was inversely correlated with the first recorded six‐minute walk distance (6MWD) (r = –0.41, P < 0.01) but did not track with WHO functional class (r = 0.07, P = 0.63). MBS did not predict all‐cause (hazard ratio [HR], 0.91; 95% confidence interval [CI], 0.76–1.08; P = 0.28) or PAH‐related hospitalization (HR, 1.04; 95% CI, 0.89–1.23; P = 0.61), though there was a strong relationship between 6MWD and PAH‐related hospitalization (P = 0.01). These findings persisted after multivariable adjustment.ConclusionsBreathlessness as assessed by MBS does not predict all‐cause or PAH‐related hospitalization. Robust and validated patient‐reported outcomes are needed in pulmonary vascular disease.
Systematic review on risk factors of rotator cuff tears
Authors: Sayampanathan Andrew Arjun , Andrew Tan Hwee Chye 
Published: February 2017

Purpose: Rotator cuff tears (RCTs) occur commonly, especially among certain groups of individuals. In this meta-analysis, we aim to identify risk factors for RCTs. Methods: We searched MEDLINE for 210 articles. Seventeen articles were selected for systematic review, of which 10 were eligible for meta-analysis. Data was analysed with Review Manager 5.3, using Mantel–Haenszel statistics and random effect models. Results: A total of 6653 individuals were analysed. The odds of sustaining a RCT on the dominant hand was 2.30 times more than the non-dominant hand (95% confidence interval (CI): 1.01–5.25, Z = 1.99, p = 0.05; Heterogenity: τ2 = 0.38, χ2 = 8.84, df = 2 ( p = 0.01), I2 = 77%). The odds of an individual aged 60 years and above sustaining a RCT was 5.07 times higher than an individual less than 60 years old (95% CI: 2.45–10.51, Z = 4.37, p < 0.001; Heterogenity: τ2 = 0.47, χ2 = 25.24, df = 3 ( p < 0.001), I2 = 88%). Female gender was not a significant association, with an odds ratio of 0.98 when compared to the male gender (95% CI: 0.66–1.45, Z = 0.09, p = 0.93; Heterogenity: τ2 = 0.20, χ2 = 44.24, df = 5 ( p < 0.001), I2 = 89%). Conclusions: Hand dominance and older age are associated with RCTs. More studies are required for further assessment of associations and risk factors of RCTs.
Efficacy analysis of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture
Authors: Zhang Chuanyi , Lin Lie , Liang Junbo , Wang Bin , Chen Guofu , Chen Haixiao 
Published: February 2017

Purpose: Sternoclavicular joint is an amphiarthrodial joint formed by the clavicle and sternal manubrium. This joint becomes chronically unstable in case of a medial clavicle dislocation or fracture, and improper treatment could cause malformation and pain. We aimed to determine the efficacy of a novel sternoclavicular hook plate for treatment of unstable sternoclavicular joint dislocation or fracture. Methods: Between June 2011 and December 2013, the sternoclavicular hook plate was used to surgically treat 32 adult patients with unstable sternoclavicular joint dislocation or fracture. Of these, 12 and 5 patients suffered from anterior and posterior dislocation of the sternoclavicular joint, respectively, 10 had medial clavicle fracture, and 5 had fracture dislocation. For anterior fracture dislocation, the standard sternoclavicular hook plate was used, while for the posterior dislocation, screws were added at the distal end of the hook plate, anterior to the sternal manubrium, to prevent postoperative redislocation. Results: No intraoperative complications were observed during the procedure. Postoperative X-ray and computed tomography revealed normal anatomical positions of sternoclavicular joints and excellent positions of internal fixation. About 3–6 months after surgery, all patients achieved primary healing without redislocation of the sternoclavicular joint along with satisfactory restoration of anatomical structures of the medial clavicle; nine patients had swelling but no pain around the sternoclavicular joints. Internal fixation was removed in 29 patients 6–12 months postoperatively and no sequelae were observed. Conclusion: This novel sternoclavicular hook plate demonstrated excellent efficacy and could provide a reliable therapeutic approach for this kind of trauma.
Can local infiltration analgesia increase satisfaction in postoperative short-term pain control in total knee arthroplasty?
Authors: Barastegui David , Robert I , Palau E , Haddad S , Reverte-Vinaixa M , Lorente L , Cots M 
Published: February 2017

Background: One of the major challenges to total knee arthroplasty (TKA) is optimal pain control. Effective analgesia is capital in fast-track surgery programs to allow patient’s early functional outcomes. Objectives: Compare length of stay (LOS) short-term pain control, and patients’ satisfaction at 1 month between local infiltration analgesia (LIA) combined with femoral nerve block (FNB) and FNB only in patients undergoing TKA. Patients and methods: Two hundred and fifty-four patients were included in a randomized prospective study and distributed in two groups. The first group received an intraoperative LIA (150 mL mixture of ropivacaine 2.0 mg/mL + ketorolac 30 mg + adrenaline 10 μg/mL) combined to an FNB. The control group had only an FNB. Demographical data and visual analog scale (VAS) score were obtained preoperatively, at 36 h after surgery and at the 15-day follow-up. Patients’ satisfaction at 1 month was also evaluated. Statistical analysis data was performed. Results: No differences in demographical data and preoperative VAS score were observed between both groups. LIA group had a lower VAS score at 36 h after surgery (1.34 ± 1.31 vs. 3.68 ± 1.932 in the control group, p = 0.00), but these differences were not maintained at the 15-day follow-up (4.51 ± 1.889 vs. 4.11 ± 1.940 in the control group, p > 0.05). LOS and patients’ satisfaction were comparable between groups. Patients with LIA had no additional complications. Conclusions: LIA is a safe adjuvant to FNB to reduce perioperative pain during the first 36 h after TKA. Its effects wean with time, but do cover the first crucial hours of rehabilitation in a fast-track program. LIA seems don’t modify postoperative course nor patient’s satisfaction at short-term follow-up. The final impact of LIA on surgical outcome is still to be determined.