bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of 4 Methods for Dynamization of Locking Plates: Differences in the Amount and Type of Fracture Motion
Authors: Henschel Julia , Tsai Stanley , Fitzpatrick Daniel C. , Marsh John L. , Madey Steven M. , Bottlang Michael 
Published: June 2017

Background:
Decreasing the stiffness of locked plating constructs can promote natural fracture healing by controlled dynamization of the fracture. This biomechanical study compared the effect of 4 different stiffness reduction methods on interfragmentary motion by measuring axial motion and shear motion at the fracture site.

Methods:
Distal femur locking plates were applied to bridge a metadiaphyseal fracture in femur surrogates. A locked construct with a short-bridge span served as the nondynamized control group (LOCKED). Four different methods for stiffness reduction were evaluated: replacing diaphyseal locking screws with nonlocked screws (NONLOCKED); bridge dynamization (BRIDGE) with 2 empty screw holes proximal to the fracture; screw dynamization with far cortical locking (FCL) screws; and plate dynamization with active locking plates (ACTIVE). Construct stiffness, axial motion, and shear motion at the fracture site were measured to characterize each dynamization methods.

Results:
Compared with LOCKED control constructs, NONLOCKED constructs had a similar stiffness (P = 0.08), axial motion (P = 0.07), and shear motion (P = 0.97). BRIDGE constructs reduced stiffness by 45% compared with LOCKED constructs (P < 0.001), but interfragmentary motion was dominated by shear. Compared with LOCKED constructs, FCL and ACTIVE constructs reduced stiffness by 62% (P < 0.001) and 75% (P < 0.001), respectively, and significantly increased axial motion, but not shear motion.

Conclusions:
In a surrogate model of a distal femur fracture, replacing locked with nonlocked diaphyseal screws does not significantly decrease construct stiffness and does not enhance interfragmentary motion. A longer bridge span primarily increases shear motion, not axial motion. The use of FCL screws or active plating delivers axial dynamization without introducing shear motion.
Transcranial Doppler Microemboli Monitoring for Stroke Risk Stratification in Blunt Cerebrovascular Injury
Authors: Bonow Robert H. , Witt Cordelie E. , Mosher Bryan P. , Mossa-Basha Mahmud , Vavilala Monica S. , Rivara Frederick P. , Cuschieri Joseph , Arbabi Saman , Chesnut Randall M. 
Published: June 2017

Objectives:
To assess whether microemboli burden, assessed noninvasively by bedside transcranial Doppler ultrasonography, correlates with risk of subsequent stroke greater than 24 hours after hospital arrival among patients with blunt cerebrovascular injury. The greater than 24-hour time frame provides a window for transcranial Doppler examinations and therapeutic interventions to prevent stroke.

Design:
Retrospective cohort study.

Setting:
Level I trauma center.

Patients:
One thousand one hundred forty-six blunt cerebrovascular injury patients over 10 years.

Interventions:
None.

Measurements and Main Results:
We identified 1,146 blunt cerebrovascular injury patients; 54 (4.7%) experienced stroke detected greater than 24 hours after arrival. Among those with isolated internal carotid artery injuries, five of nine with delayed stroke had positive transcranial Dopplers (at least one microembolus detected with transcranial Dopplers) before stroke, compared with 46 of 248 without (risk ratio, 5.05; 95% CI, 1.41–18.13). Stroke risk increased with the number of microemboli (adjusted risk ratio, 1.03/microembolus/hr; 95% CI, 1.01–1.05) and with persistently positive transcranial Dopplers over multiple days (risk ratio, 16.0; 95% CI, 2.00–127.93). Among patients who sustained an internal carotid artery injury with or without additional vessel injuries, positive transcranial Dopplers predicted stroke after adjusting for ipsilateral and contralateral internal carotid artery injury grade (adjusted risk ratio, 2.91; 95% CI, 1.42–5.97). No patients with isolated vertebral artery injuries had positive transcranial Dopplers before stroke, and positive transcranial Dopplers were not associated with delayed stroke among patients who sustained a vertebral artery injury with or without additional vessel injuries (risk ratio, 0.90; 95% CI, 0.21–3.83).

Conclusions:
Microemboli burden is associated with higher risk of stroke due to internal carotid artery injuries, but monitoring was not useful for vertebral artery injuries.
Bullous Pemphigoid: Use of C4d Immunofluorescent Staining in a Case With Repeated Negative Conventional Direct Immunofluorescence Studies
Authors: Kassaby Sarah S. , Hicks Alexander , Leicht Stuart , Youngberg George A. 
Published: June 2017

Abstract:
Direct immunofluorescence (DIF) using frozen section material from a fresh/preserved perilesional biopsy is the gold standard for the immunopathologic diagnosis of bullous pemphigoid (BP). DIF in BP shows linear dermoepidermal junction (DEJ) staining for C3, with or without staining for IgG. In some situations, only a formalin-fixed lesional biopsy is obtained (with no fresh/preserved perilesional biopsy for DIF). In this setting, paraffin section C4d immunohistochemistry has proven to be diagnostically useful, demonstrating linear DEJ positivity for C4d. We present a novel use of C4d staining for the diagnosis of BP, specifically analyzing C4d perilesional frozen section DIF in a case where standard perilesional frozen section DIF for IgG/C3 was available, but was negative. An 80-year-old woman presented with a pruritic bullous lesion on her left upper extremity, clinically thought to represent BP. Lesional histologic findings were typical for BP, but perilesional frozen section DIF staining was negative for IgG and C3. A second set of biopsies processed at a different laboratory yielded the same result. A diagnosis of bullous scabies was considered. Subsequently, perilesional frozen section DIF for C4d was obtained, which showed strong linear DEJ positivity, confirming the diagnosis of BP. DIF for C4d is widely used in transplant pathology, since C4d is persistent in tissue, versus C3. Our case demonstrates that perilesional frozen section DIF staining for C4d may be positive and diagnostic in BP, even when conventional DIF staining for IgG and C3 is negative.
Detection of High-Risk Histologic Features and Tumor Upstaging of Nonmelanoma Skin Cancers on Debulk Analysis: A Quantitative Systematic Review
Authors: Singh Babu , Dorelles Adriana , Konnikov Nellie , Nguyen Bichchau M. 
Published: June 2017

BACKGROUND
Histologic analysis of tumor debulks from Mohs micrographic surgery (MMS) or wide local excision may lead to the detection of adverse features missed on initial biopsy.

OBJECTIVE
Determine the incidence of (1) high-risk features on debulk analysis compared with initial biopsy and (2) upstaging of tumors on debulk analysis according to the American Joint Committee of Cancer-7th Edition (AJCC-7) and the Brigham and Women's Alternative (BWH) staging criteria.

MATERIALS AND METHODS
A comprehensive search strategy using PubMed/MEDLINE, Web of Science, and EMBASE was conducted to identify articles published from 1960 to present that detail histology of initial biopsy and debulked tumor.

RESULTS
Fourteen studies, encompassing 2,565 cases of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were included in the data extraction process. BCCs (30.9%) were reclassified from a low-risk histologic subtype to a high-risk subtype on debulk analysis (p < .001). Cases with perineural invasion (89.4%) were detected on debulk analysis. SCC tumors (9.1% and 11.1%) were upstaged according to the AJCC-7 and BWH Alternative criteria, respectively. Ninety percent of high-risk BWH T2b SCCs were inaccurately staged lower on initial biopsy.

CONCLUSION
Tumor debulk analysis in MMS may aid in the identification of additional high-risk features, thereby improving staging accuracy, treatment decisions and patient outcomes.
Early Cleft Lip Repair Revisited: A Safe and Effective Approach Utilizing a Multidisciplinary Protocol
Authors: Hammoudeh Jeff A. , Imahiyerobo Thomas A. , Liang Fan , Fahradyan Artur , Urbinelli Leo , Lau Jennifer , Matar Marla , Magee William , Urata Mark 
Published: June 2017

Background:The optimal timing for cleft lip repair has yet to be established. Advances in neonatal anesthesia, along with a growing body of literature, suggesting benefits of earlier cleft lip and nasal repair, have set the stage for a reexamination of current practices.Methods:In this prospective study, cleft lip and nasal repair occurred on average at 34.8 days (13–69 days). Nasal correction was achieved primarily through molding the nasal cartilage without the placement of nasal sutures at the time of repair. A standardized anesthetic protocol aimed at limiting neurotoxicity was utilized in all cases. Anesthetic and postoperative complications were assessed. A 3-dimensional nasal analysis compared pre- and postoperative nasal symmetry for unilateral clefts. Surveys assessed familial response to repair.Results:Thirty-two patients were included (27 unilateral and 5 bilateral clefts). In this study, the overall complication rate was 3.1%. Anthropometric measurements taken from 3-dimensional-image models showed statistically significant improvement in ratios of nostril height (preoperative mean, 0.59; postoperative mean, 0.80), nasal base width (preoperative mean, 1.96; postoperative mean, 1.12), columella length (preoperative mean, 0.62; postoperative mean, 0.89; and columella angle (preoperative mean, 30.73; postoperative mean, 9.1). Survey data indicated that families uniformly preferred earlier repair.Conclusions:We present evidence that early cleft lip and nasal repair can be performed safely and is effective at improving nasal symmetry without the placement of any nasal sutures. Utilization of this protocol has the potential to be a paradigm shift in the treatment of cleft lip and nasal deformity.
Unusual Cause of Thoracic Wall Pain in a Kayaker: A Case Report
Authors: Evans Guy Morgan , Bhogal Gurjit 
Published: June 2017

Abstract:
Chest wall injuries are common in paddle-based sports such as kayaking. We present the case of a 46-year-old amateur kayaker who presented with signs and symptoms in keeping with a rib stress response or fracture. The patient failed to respond to conservative management and subsequent imaging revealed an obstructed left kidney with associated hydronephrosis. This case report highlights the importance of considering the wider differential diagnoses when managing athletes participating in paddle-based sports, especially when symptoms fail to settle with appropriate conservative management.
Differences in Athletic Performance Between Sportsmen With Symptomatic Femoroacetabular Impingement and Healthy Controls
Authors: Mullins Karen , Hanlon Michael , Carton Patrick 
Published: June 2017

Objective:
Femoroacetabular impingement (FAI) is a commonly recognized condition in athletes characterized by activity-related hip pain and stiffness, which if left untreated can progress to hip osteoarthritis. The aim of the study was to determine the effect of symptomatic FAI on performance in young athletes based on the hypothesis that athletes with FAI would show deficits in performance compared with healthy controls.

Design:
The functional performance of a cohort of preoperative, competitive sportsmen with symptomatic FAI (FAI group, n = 54), was compared with that of a group of age, sex and activity-level matched controls (n = 66).

Outcome Measures:
Participants performed functional tests including a 10-m sprint, a modified agility T-test, a maximal deep squat test and a single-leg drop jump (reactive strength index). Hip range of motion was assessed by measuring maximal hip flexion, abduction, and internal rotation (at 90 degree hip flexion).

Results:
The FAI group was significantly slower during the 10-m sprint (3%, P = 0.002) and agility T-test (8%, P < 0.001); flexion, abduction, and internal rotation values for the FAI group were reduced compared with controls (P < 0.001). No significant differences between groups were identified for squat depth or reactive strength index. The FAI group also reported higher levels of anterior groin pain during the 10-m sprint, modified agility T-test, and while squatting.

Conclusions:
Many sportsmen with confirmed FAI continue sports participation up to and after diagnosis, despite issues with activity-related pain and stiffness. This study highlights the functional limitations in speed, agility, and flexibility that are likely to be present in this group of FAI patients.
Outcomes and Time to Emergence of Auditory Skills After Cochlear Implantation of Children With Charge Syndrome
Authors: Young Nancy M. , Tournis Elizabeth , Sandy Jenelle , Hoff Stephen R. , Ryan Maura 
Published: June 2017

Objective:
Review perioperative complications, benefits, and the timeframe over which auditory skills develop in children with CHARGE syndrome who receive a cochlear implant (CI).

Study Design:
IRB-approved retrospective chart review of children with CHARGE syndrome who had at least 12 months of cochlear implant use.

Setting:
Tertiary care children's hospital.

Patients:
Twelve children, seven males and five females. Mean age implant = 3.5 years (1.7–8.2 yr); mean duration follow-up = 4.7 years (1.5–10.1 yr).

Intervention:
Cochlear implantation.

Main Outcome Measures:
Auditory skills categorized into four levels, temporal bone imaging findings, perioperative complications, time to emergence of speech perception, expressive communication mode.

Results:
All children imaged with magnetic resonance imaging had cochlear nerve deficiency in at least one ear. Speech awareness threshold improved with the CI compared with aided preoperative in 83% of children, with means of 51.7 dB SAT preoperative and 27.1 dB with the CI (p ≤ 0.002). Overall, four children improved to auditory Level 2 (improved detection), three obtained Level 3 (closed-set speech perception), and three had open-set speech perception with their CIs (Level 4) that was first evident at 3.5, 3.3, and 0.8 years postimplant testing. Two children had minimal or limited improvement. One child with hypoplasia of the cochlear nerve obtained open-set levels.

Conclusion:
Auditory skills may develop slowly in children with CHARGE syndrome who receive a CI but most can achieve at least improved detection. In our series, half acquired some speech perception ability. Cochlear nerve deficiency is frequent, but should not be a contraindication to implantation.
Baseline Hepatitis B Virus Titer Predicts Initial Postpartum Hepatic Flare
Authors: Liu Jinfeng , Wang Jing , Qi Caijing , Cao Furong , Tian Zhen , Guo Dandan , Yan Taotao , Li Qian , Yang Shujuan , Fu JianJun , Tang Xianmei , Kou Xiaoni , Liu Na , Jiang Zicheng , Zhao Yingren , Chen Tianyan 
Published: June 2017

Background and Goals:
A series of changes in the immune system occur during pregnancy and puerperium. Currently, we aim to characterize both the natural changes in liver inflammation and its association with hepatitis B viremia during this special period.

Patients and Methods:
Chronic hepatitis B (CHB) gravidas were recruited and followed up to 52 weeks postpartum. Virological and biochemical parameters were assessed throughout the period.

Results:
A total of 1097 CHB mothers had finished the entire follow-up including 451 accepting telbivudine, 178 accepting tenofovir, and 468 without antiviral therapy. Among the mothers, 11.94% went through hepatic flare in the first trimester and the rate decreased to 2.1% at the time of delivery. Nevertheless, a much higher frequency (19.78%) was observed in the early postpartum. Interestingly, alanine aminotransferase level decreased along with the development of pregnancy and then suddenly increased in the first month of puerperium. In addition, a downward trend was observed on the titer of HBsAg and HBeAg after delivery. Of note, an obvious higher frequency of alanine aminotransferase flare was revealed in mothers with high viremia (>6 log10 IU/mL). With multivariate analysis, only hepatitis B virus titer at baseline was strongly associated with hepatic flare during early postpartum (95% confidence interval, 1.012-3.049, P=0.045). The predictive rates of hepatic flare at baseline viral load of 6, 7, and 8 log10 IU/mL were 16.67%, 28.30%, and 30.60%, respectively.

Conclusions:
CHB gravidas with high viremia should be monitored closely during entire pregnancy, and extended antiviral therapy is recommend to those mothers with baseline viremia >7 log10 IU/mL.
Highly Concentrated Preterm Formula as an Alternative to Powdered Human Milk Fortifier
Authors: Willeitner Andrea , Anderson Michael , Lewis Jami 
Published: June 2017

ABSTRACTObjective:The aim of the study was to assess clinical feasibility and tolerance of concentrated preterm formula at 30 kcal/oz (CPF30) to fortify human milk to a caloric density of 24 kcal/oz, compared to conventional powdered human milk fortifier (PHMF).Study Design:Very low birth weight neonates were stratified by birth weight and randomized to receive human milk fortification using CPF30 or PHMF. Infants were monitored from first introduction of human milk fortification, until fortified feeds were well tolerated. Primary outcome was weight gain; secondary outcomes included other measures of feeding intolerance (residual gastric aspirates, feeds held, prokinetic therapy), sepsis, and death. The clinical and study personnel were blinded to the intervention.Results:No significant differences in weight gain or other measures of feeding tolerance were demonstrated between CPF30 and PHMF. Macronutrient intake was similar between both groups. Infants with a birth weight of ≥ 1000 g who received CPF30, experienced fewer days NPO (nil per os; nothing per mouth) and a trend toward lower incidence of NEC, compared with those who received PHMF.. The amount of human milk consumed was significantly lower in the CPF30 group.Conclusions:Both fortifiers were similarly well tolerated. Fortification of human milk with CPF30 is a safe and feasible alternative to conventional PHMF.
The Past, Present, and Future of Neurorehabilitation: From NUSTEP Through IV STEP and Beyond
Authors: Harris Susan R. , Winstein Carolee J. 
Published: June 2017

Purposes:
To present the history and aims of the STEP conferences; describe the interdependence of prevention, prediction, plasticity, and participation; reflect on where we stand today regarding those 4 Ps; and discuss how future neurorehabilitation should look for individuals with movement disorders.

Key Points:
Physical therapists have focused primarily on tertiary prevention, emphasizing primary/secondary prevention far less. Predicting optimal response to intervention is essential for primary prevention. Research examining neurorehabilitation effects mediated by brain plasticity is evolving from an emphasis on impairment outcomes toward examination of participation outcomes.

Clinical Practice Recommendations:
(1) Capitalize on primary and secondary prevention. (2) Administer simple, environmentally relevant predictive measures. (3) Partner with researchers to examine exercise-induced brain plasticity effects via neuroimaging. (4) Encourage physical activity to promote secondary prevention of lifestyle-related diseases and enhance participation. (5) Integrate psychological/social sciences with physiological sciences to move forward with advances in mindful health and patient-centered practices.
Research Design Options for Intervention Studies
Authors: Lobo Michele A. , Kagan Sarah H. , Corrigan John D. 
Published: June 2017

Purpose:
To review research designs for rehabilitation.

Summary of Key Points:
Single-case, observational, and qualitative designs are highlighted in terms of recent advances and ability to answer important scientific questions about rehabilitation.

Statement of Conclusions:
Single-case, observational, and qualitative designs can be conducted in a systematic and rigorous manner that provides important information that cannot be acquired using more common designs, such as randomized controlled trials. These less commonly used designs may be more feasible and effective in answering many research questions in the field of rehabilitation.

Recommendations for Clinical Practice:
Researchers should consider these designs when selecting the optimal design to answer their research questions. We should improve education about the advantages and disadvantages of existing research designs to enable more critical analysis of the scientific literature we read and review to avoid undervaluing studies not within more commonly used categories.
Reliability and Validity of the 50-ft Walk Test for Idiopathic Toe Walking
Authors: Christensen Catie , Haddad Amanda , Maus Elizabeth 
Published: June 2017

Purpose:
To evaluate interrater reliability and concurrent validity of the 50-ft walk test (FWT) for children with idiopathic toe walking (ITW).

Methods:
Thirty children, 6 to 13 years old, with ITW participated. During the 50-FWT, an accelerometer counted total steps. A physical therapist counted the number of toe-walking steps. The number of toe-walking steps was divided by the total steps to calculate a toe-walking percentage. Interrater reliability was assessed by correlating the toe-walking percentage obtained by 2 raters using an intraclass correlation coefficient. Concurrent validity was evaluated by correlating the toe-walking percentage calculated by the GAITRite and therapist using a Spearman ρ.

Results:
There was excellent interrater reliability and concurrent validity. Experience level did not impact the therapist's ability to identify a toe-walking step.

Conclusions:
The 50-FWT demonstrated excellent interrater reliability and concurrent validity. It can be used to obtain a percentage of toe walking in children 6-13 years of age with ITW.
Extended Versus Narrow-spectrum Antibiotics in the Management of Uncomplicated Appendicitis in Children
Authors: Cameron Danielle B. , Melvin Patrice , Graham Dionne A. , Glass Charity C. , Serres Stephanie K. , Kronman Matthew P. , Saito Jacqueline M. , Rangel Shawn J. 
Published: June 2017

Objective:
The aim of this study was to compare the effectiveness of extended versus narrow spectrum antibiotics in preventing surgical site infections (SSIs) and hospital revisits in children with uncomplicated appendicitis.

Summary of Background Data:
There is a paucity of high-quality evidence in the pediatric literature comparing the effectiveness of extended versus narrow-spectrum antibiotics in the prevention of SSIs associated with uncomplicated appendicitis.

Methods:
Clinical data from the ACS NSQIP-Pediatric Appendectomy Pilot Project were merged with antibiotic utilization data from the Pediatric Health Information System database for patients undergoing appendectomy for uncomplicated appendicitis at 17 hospitals from January 1, 2013 to June 30, 2015. Patients who received piperacillin/tazobactam (extended spectrum) were compared with those who received either cefoxitin or ceftriaxone with metronidazole (narrow spectrum) after propensity matching on demographic and severity characteristics. Study outcomes were 30-day SSI and hospital revisit rates.

Results:
Of the 1389 patients included, 39.1% received piperacillin/tazobactam (range by hospital: 0% to 100%), and the remainder received narrow-spectrum agents. No differences in demographics or severity characteristics were found between groups following matching. In the matched analysis, the rates of SSI were similar between groups [extended spectrum: 2.4% vs narrow spectrum 1.8% (odds ratio, OR: 1.05, 95% confidence interval, 95% CI 0.34–3.26)], as was the rate of revisits [extended spectrum: 7.9% vs narrow spectrum 5.1% (OR: 1.46, 95% CI 0.75–2.87)].

Conclusions:
Use of extended-spectrum antibiotics was not associated with lower rates of SSI or hospital revisits when compared with narrow-spectrum antibiotics in children with uncomplicated appendicitis. Our results challenge the routine use of extended-spectrum antibiotics observed at many hospitals, particularly given the increasing incidence of antibiotic-resistant organisms.