bluuebunny/crossref_metadata_2025_split huggingface dataset:
New Radiographic Analysis of Sesamoid Rotation in Hallux Valgus: Comparison with Conventional Evaluation Methods
Authors: Kuwano Takashi , Nagamine Ryuji , Sakaki Kazuhiro , Urabe Ken , Iwamoto Yukihide 
Published: January 2017

The position of the hallucal sesamoids needs to be included in evaluation of hallux valgus. In order to quantify the rotational position of the hallucal sesamoids, a new weightbearing tangential radiograph was established by means of a specially designed tangential positioning device. This device has a depression, and a tangential radiograph is taken with the metatarsophalangeal joint at 45° dorsiflexion. A lead marker plate is placed on the depression to show the horizontal plane, and the sesamoid rotation angle (SRA) is measured. The SRA is the angle between the tangential line of the most inferior aspect of the medial-lateral sesamoids and the lead marker line. The SRA was compared with values of the four-grade scale and seven-position scale which were measured from the antero-posterior view, with respect to the hallux valgus angle (HVA), by means of conventional methods. Measurements were made of 58 feet in 29 patients with hallux valgus and 64 feet in 32 normal subjects. The SRA showed the highest correlation among the three parameters (r = 0.817). Some cases had a disparity regarding the position of the sesamoids between the tangential view and the AP view due to misclassification on the AP view. We conclude that the scale of position of the sesamoid on the AP view is not valid in some cases, whereas the SRA is useful for assessing quantitatively the rotational position of the hallucal sesamoids in cases of hallux valgus.
Percutaneous Plating of Distal Tibial Fractures
Authors: Khoury Amal , Liebergall Meir , London Eli , Mosheiff Rami 
Published: January 2017

This article presents our experience with 24 patients who had distal tibial fractures and were treated by percutaneous plate fixation. Distribution of the fractures according to the AO/OTA classification was as follows: five patients suffered from a 43 A type fracture, six from a 43 B type fracture, and 13 from a 43 C type fractures. Four of the fractures were open. Exclusion criteria included 43 C3 fractures and Gustilo III open fractures. All fractures showed radiographic signs of union enough to enable full weightbearing within an average time of 12.3 weeks. All patients showed a good range of motion (average dorsiflexion 12° and average plantiflexion 18°). Two fractures united with mal-union: one with an 8° valgus deformity and another with a 7° varus deformity. Both cases, which had a metaphyseal component, were treated by means of a “soft” (flexible and manually adjustable) AO 3.5 mm reconstruction plate. Except for one case of superficial infection, no infections were detected in any of the patients. The biological percutaneous plate fixation of distal tibial fractures with no extensive intra-articular involvement is a good soft tissue preserving technique. It provides a rigid and anatomical fixation in most cases. We conclude that type B fractures with one intact column can be fixed with either “soft” or “rigid” plates, and type A and C fractures with a metaphyseal component should be fixed with “rigid” plates (AO 4.5 mm Dynamic Compression Plate). In these fractures the reduction should be performed cautiously due to the tendency of sagittal plane mal-reduction.
Effect of Arch Supports on Ankle—Subtalar Complex Instability: A Biomechanical Experimental Study
Authors: Tochigi Yuki 
Published: January 2017

Background: Subtalar instability, which may cause persistent symptoms after severe inversion ankle sprains, often involves failure of the interosseous talocalcaneal ligament (ITCL). While several clinicians have reported surgical treatment for this pathology, nonsurgical management policy has not been well considered. Previously, it was proposed that ITCL failure possibly causes looseness of the tarsal arch construction resulting in abnormal ankle—subtalar kinematics occurring with axial forces. In the current study the author hypothesized that arch-support insole functions to improve abnormal joint kinematics in ankle—subtalar complex instability. Methods: Five fresh-frozen cadaver lower extremities with simulated ankle—subtalar complex instability, which was created by combined sectioning of the anterior talofibular ligament (ATFL) and the ITCL, were subjected to a biomechanical experiment. Cyclic axial loading from 9.8 to 668 N was applied with a material testing machine, while three-dimensional angular displacements in both the ankle and subtalar joints were determined with electric goniometers. The specimens were tested before and after inserting an arch-support insole that supports the medial-longitudinal and transverse arches of the foot. Results: Inserting the insole decreased the maximum ankle internal rotation, from 3.3° ± 0.9° to 2.3° ± 0.4° ( p = .028), while subtalar rotation was not significantly changed. Conclusions: The medial longitudinal arch-support insole reduced abnormal ankle internal rotation created by combined sectioning of the ATFL and ITCL, likely due to improved arch configuration stability.
Bilateral Chronic Proximal Plantar Fasciopathy: Treatment with Electrohydraulic Orthotripsy
Authors: Ogden John A. , Cross G. Lee , Williams Sharrona S. 
Published: January 2017

Background: Patients presenting for treatment of chronic plantar fasciopathy often have bilateral involvement. When various nonoperative treatments fail, subsequent intervention may be problematic, especially since bilateral surgery (bilateral fascial release) may not be realistic because of variable, frequently restrictive postoperative weightbearing limitations. Methods: Twenty-three patients (46 heels) were treated with electrohydraulic high-energy orthotripsy to the plantar entheses of both feet while under the same anesthesia (conscious sedation). Following orthotripsy, all patients immediately were fully weightbearing and resumed normal activities of daily living and work, usually within 24 hours. Progressive return to athletic activities was allowed. Patients were assessed by three outcome parameters: (1) pain measured objectively by a dolorimeter combined with the patient's subjective evaluation of the level of pain; (2) pain after 5 minutes of walking upon arising; and (3) pain with daily activities. All pain measurements were done by the visual analog scale. Results: Patients initially experienced varied pain relief responses. This included earlier pain relief in one heel compared to the other, as well as better pain relief in one heel than the other at the 6- and 12-week evaluations, but with much less variance at the 1-year evaluation. By 3 months following orthotripsy, 28 heels (61%) had good or excellent results. These results were maintained or improved at 1 year. In 18 heels (39%), the outcome was fair or poor. Nineteen heels received a second orthotripsy application; one patient requested a second orthotripsy treatment of only one heel, while nine patients requested a second treatment of both heels. The outcome showed further improvement following the second application of orthotripsy. At 1 year after one or two orthotripsy applications, 19 patients (38 heels) were satisfied with the results in both heels (83%), while four patients (eight heels) still had an unsatisfactory outcome (17%). Conclusion: Electrohydraulic high-energy orthotripsy is a reasonable nonincisional method for treating patients with bilateral chronic proximal plantar fasciopathy under a single anesthetic without the prolonged nonweightbearing status often recommended for patients following unilateral open or endoscopic fascial release.
Squamous Cell Carcinoma Arising in Chronic Osteomyelitis in Foot and Ankle
Authors: Altay Murat , Arikan Murat , Yildiz Yusuf , Saglik Yener 
Published: January 2017

Background: Squamous cell carcinoma arising from chronic osteomyelitis is uncommon, and although most occur in the lower extremities, occurrence in the foot and ankle is rare. Methods: Between February, 1991, and May, 2003, we treated 14 patients (13 men and one woman) with squamous cell carcinomas arising in chronic osteomyelitis. The foot and ankle were affected in seven patients, and these comprised our study group. All seven patients were male, with a mean age of 59.5 (range 54 to 63) years. An average of 27 (range 4 to 50) years passed between draining of the osteomyelitis and the diagnosis of the malignancy. Average followup was 68 (22 to 147) months. Results: Six patients had amputations and one had limb salvage. Regional lymph node clearance was done in four patients, but metastasis occurred in only one patient who later died of the disease. Conclusion: In treating recalcitrant ulcers that have not responded to conventional modes of therapy, malignancy should be ruled out and a biopsy done. The treatment of choice for squamous cell carcinoma is amputation. Routine regional lymphadenectomy at the time of amputation seems unnecessary, but regional lymphadenopathy persisting for 3 months after amputation warrants surgical intervention.
Efficacy and Tolerability of Low-dose Simvastatin and Niacin, Alone and in Combination, in Patients With Combined Hyperlipidemia: A Prospective Trial
Authors: Stein Evan A. , Davidson Michael H. , Dujovne Carlos A. , Hunninghake Donald B. , Goldberg Ronald B. , Illingworth D. Roger , Knopp Robert H. , Miller Valery T. , Frost Philip , Isaacsohn Jonathan L. , Mitchel Yale B. , Melino Michael R. , Shapiro Deborah , Tobert Jonathan A. 
Published: January 2017

Background: Combination lipid-lowering therapy may be desirable in patients with elevated low-density lipoprotein cholesterol, high triglycerides, and low high-density lipoprotein cholesterol. This study was conducted to determine the lipid-lowering efficacy of the combination of low-dose simvastatin and niacin in patients with combined hyperlipidemia and low high-density lipoprotein cholesterol. Methods and Results: In this multicenter, prospective, randomized trial, 180 patients with hyper cholesterolemia and hypertriglyceridernia and/or low high-density lipoprotein cholesterol were randomized to combination simvastatin (10 mg/day) and niacin (0.75 g/day) or to either drug alone for 9 weeks. The dose of niacin was doubled (from 0.75 g/day to 1.5 g/day) in both the combination and niacin arms for the remaining 8 weeks. The combination of simvastatin, 10 mg/day, and niacin, 1.5 g/day, reduced total. low-density lipoprotein, and very low-density lipoprotein cholesterol and triglycerides by 248, 29%, 45%, and 31%, respectively, while increasing high-density lipoprotein cholesterol by 31%. The addition of niacin to simvastatin did not enhance the low-density lipoprotein cholesterol-lowering effect of simvastatin; however, the combination was more effective than either monotherapy at raising high-density lipoprotein cholesterol and lowering very low-density lipoprotein cholesterol ( P <.05). More patients discontinued treatment because of an adverse event in the niacin ( P <.03) and combination groups ( P =.06) than the simvastatin group. Conclusions: Treatment of patients with combined hyperlipidemia and/or low high-density lipoprotein with combination low-dose simvastatin and niacin resulted in large reductions in total, low-density lipoprotein, and very low-density lipoprotein cholesterol and increases in HDL cholesterol. Although the combination was well tolerated in the current trial, its safety needs to be evaluated in larger trials of longer duration.
Cardioprotective Effects of Red Blood Cells on Ischemia and Reperfusion Injury in Isolated Rat Heart: Release of Nitric Oxide as a Potential Mechanism
Authors: Yang B.C. , Nichols W.W. , Mehta J.L. 
Published: January 2017

Background: Circulating cells influence myocardial function during ischemia and reperfusion. (eg, neutrophils exacerbate, and platelets protect the myocardium from deterioration). This study was designed to determine the role of red blood cells on myocardial function following ischemia and reperfusion in isolated rat hearts. Methods and Results: Exposure of buffer-perfused hearts to 40 minutes of total ischemia followed by 30 minutes of reperfusion resulted in myocardial dysfunction and injury, indicated by decrease in the force of cardiac contraction (FCC, −25 ± 4%). increase in the coronary perfusion pressure (CPP, +20 ± 3%) and decrease in myocardial superoxide dismutase (SOD, 2.5 ± 0.2 vs 3.5 ± 0.4 U/mg protein in sham ischemic hearts, P < .05). Perfusion of the hearts with washed rat red blood cells showed significant protective effects against ischemia and reperfusion, indicated by minimal change in FCC (-10 ± 4%) and CPP (+3 ± 3%) (both P < .01 vs buffer alone perfused hearts) and preservation of myocardial SOD activity (2.8 ± 0.4 U/mg protein, P < .05 vs buffer alone perfused hearts). The cardioprotective effects of red blood cells were attenuated when the red blood cells were preincubated with the nitric oxide synthase inhibitors Nw-nitro-L-arginine (L-NNA, 5 times 10-4M) or Nw-nitro-L-arginine methyl ester (L-NAME, 5 times 10-1M) at 37°C for 60 minutes before perfusion of the heart. Perfusion of hearts with the nitric oxide precursor L-arginine (2 times 10-4M) also exerted significant protective effects on FCC (-14 ± 4%). CPP (+12 ± 3%) and myocardial SOD activity (2.9 ± 0.2 U/mg protein) following ischemia and reperfusion. In other studies, washed rat red blood cells expressed nitric oxide synthetase activity which was inhibited by both l-NNA and L-NAME. Conclusions: These results suggest that red blood cells exert cardioprotective effects against ischemia and reperfusion at least in part by the L-arginine-nitric oxide pathway in isolated rat hearts.
Tedisamil Attenuates Ventricular Fibrillation in a Conscious Canine Model of Sudden Cardiac Death
Authors: Friedrichs G.S. , Abreu J.N. , Cousins G.R. , Chi L. , Borlak J. , Lucchesi B.R. 
Published: January 2017

Background: The electrophysiologic and antifibrillatory properties of tedisamil (KC-8857;3,7-di-(cyclopropylmethyl)-9,9-tetramethylene-3,7-diazabicyclo[3.3.1]-nonane dihydrochloride) were studied in a conscious canine model of sudden cardiac death. Methods and Results: Three to five days after surgically induced myocardial infarction (2-hour occlusion of the left anterior descending coronary artery), animals were subjected to programmed electrical stimulation to identify those at risk for ischemia-induced ventricular fibrillation. Sixty minutes after tedisamil (10 mg/kg, administered orally) PES was repeated. Tedisamil increased the ventricular effective refractory period from 106 ± 6 to 134 ± 7 ms (P < .05) compared to placebo treatment. which did not alter the ERP (123 ± 6 to 116 ± 5 ms). Tedisamil prolonged the QTc interval. from a predrug value of 308 ± 14 to 327 ± 14 ms, postdrug. The extent of the surgically induced anterior wall myocardial infarct did not differ between groups. tedisamil, 29 ± 2%, and placebo, 28 ± 2% of the left ventricle. Conclusions: Tedisamil conferred protection against ischemia induced ventricular fibrillation; 7 of 10 tedisamil-treated dogs survived. compared to 4 of 14 surviving in the vehicle treated group (P < .05). Although we observed instances of vomiting and/or diarrhea in several dogs after a single oral administration of tedisamil. the data indicate that oral administration of tedisamil provides protection from ischemia-induced ventricular fibrillation in the postinfarcted conscious canine. The mechanism by which tedisamil achieves its antifibrillatory effect may be related to its ability to prolong the ERP of the ventricular myocardium without altering ventricular conduction velocity.
Uncovering Clinical Knowledge in Expert Psychiatric Nursing Practice
Authors: McElroy Ellen C. 
Published: January 2017

BACKGROUND: Psychiatric nursing has been referred to as a specialty area of nursing that is fading away because of the failure of its members to develop a theoretical base for practice. Benner (1984) maintained there is knowledge embedded in expert practice that can be usedfor theory development. OBJECTIVES: The purpose of this interpretive study was to uncover clinical knowledge embedded in the paradigm cases of expert psychiatric nurses. STUDY DESIGN: Heideggerian bermeneutics was the method that guided the study. Analysis of data was based on the seven-stage process described in Diekelmann, Allen, and Tanner (1989). RESULTS: Three relational themes, Uncovering Dangerousness in Psychiatric Nursing Practice, Acknowledging and Marking the Boundaries, and Reflection on Practice, emergedfrom the data. The major finding of the study was the constitutive pattern, the Primacy of the Nurse-Patient Relationship in Psychiatric Nursing Practice. CONCLUSIONS: Embedded in the paradigm cases in this study were descriptions of theoretical knowledge being refined and extended through reflection on practice experience. Clinical knowledge consistent with competencies in all seven of Benner's nursing domains also was present in the paradigm cases.
The Johnson Behavioral Systems Model as a Framework for Patient Outcome Evaluation
Authors: Poster Elizabeth C. , Dee Vivien , Randell Brooke P. 
Published: January 2017

BACKGROUD: Although there is a great deal of interest in the outcome of the nursing care of psychSitcpatients, there is little empirical research about the effectiveness of nursing care. METHODS: This study evaluated the medical record documentation by nurses as an important database (N=380patients). The predicted patient outcome instrument developed by the authors was used to collect the data related to patient demographics, acuity, nursing diagnosis, short-and long-term goals, and nursing interventions. The Johnson Behavioral System Model was the nursing conceptualframework used. FINDINGS: Overall, 80% of the predicted patient outcomes were achieved by the time of discharge, with increased length of stay being a factor in increasing the likelihood of achievement ofgoals. A positive link wasfound between achievement of outcomes at time of discharge and nursing interventions. A nursing theoreticalframework made it possible to prescribe nursing care as a distinctionfrom medical care. CONCLUSION: This study showed the importance of the nursing database in the medical records and the effectiveness of nursing interventions on predicted patient outcomes achieved by the time of discharge.
Bridging the Gap Between Psychiatric Hospitalization and Community Care: Cost and Quality Outcomes
Authors: Chiverton Patricia , Tortoretti Donna , La Forest Marylee , Walker Patricia Hinton 
Published: January 2017

BACKGROUND: Current changes in the health care system require the development of interventions that reduce length of stay and provide alternatives to hospitalization while maintaining quality and consumer satisfaction OBJECTIVES: The objectives were to (a) investigate differences in quality indicators for patients receiving case management services; (b) measure satisfaction of patients enrolled in the case management intervention; and (c) reduce costs related to high utilization of services as a result of recidivism and rehospitalization. STUDY DESIGN: Inpatients were randomly assigned to either an intervention (n = 121) or control group (n = 122). The intervention group received transitional case management services; the control group received traditional care. RESULTS: No differences were found between the two groups on the Beck Depression Inventory or the Mini-Mental Status Examination. Ninety-six percent of the patients and 95% of their caregivers were very pleased with the case management intervention Fewer patients in the intervention group (9 vs. 16 in the control group) were readmitted to the hospital over the course of the project. Similarly, only 1 patient in the intervention group versus 18 patients in the control group used the emergency department. Even considering the cost of providing case management services, an overall savings of $175,375 occurredfor the intervention group. CONCLUSIONS: Transitional case management services maintained quality and reduced costs with a high level of consumer satisfaction.
Group Therapy for Survivors of Childhood Sexual Abuse Who Are Severely and Persistently Mentally Ill
Authors: Kriedler Maryhelen C. , Einsporn Richard L. , Zupancic Melissa K. , Masterson Colleen 
Published: January 2017

BACKGROUND: Few researchers have investigated the effectiveness of long-term group psychotherapy with women who have a core issue of childhood sexual abuse, particularly those who are designated as being severely and persistently mentally ill (SPMI). Women so labeled are usually treated within a biological framework. Medications and supportive care are often the preferred therapies, denying the necessity of dealing with past traumatic issues. OBJECTIVES: The objective of this pilot study was to determine the outcome of long-term; time-limited group therapy with women designated as SPMI. The study addressed rate of improvement in symptomatology and self-esteem scores in women who are SPMI and those not designated SPMI.a STUDY DESIGN: A quasi-experimental design was used. The sample (N = 72) consisted of women older than 18 years who were sexually abused as children. The experimental group was made up of women labeled SPMI (n = 13), and the control group was composed of those who had not been designated SPMI (n = 59). The intervention consisted of 50 weeks of group therapy using a family systems modeL The instruments, which included the Beck Depression Inventory, the Symptom Check List-90-Revised and the Rosenberg Self-Esteem Scale, were administered at sessions I and 50. RESULTS: Results indicated that women labeled SPMI had lower self-esteem and higher symptomatology scores before receiving the group therapy, but both groups achieved comparable improvement in scores at the end of 50 weeks of group therapy. CONCLUSION: The results indicated that women labeled as SPMI could benefit from group therapy that addressed the core issue of childhood sexual trauma.
Langerhans Cell Histiocytosis
Authors: Park Ligaya , Schiltz Clayton , Korman Neil 
Published: January 2017

Background: The cutaneous presentation of Langerhans cell histiocytosis (LCH) is very rare and can be highly variable among individuals, which can often lead to a delay in diagnosis. Objective: To discuss a case report and literature review of important clinical indicators, histology, diagnosis, evaluation, and treatment guidelines. Methods: Case report and literature review. Results: Skin biopsies positive for CD1a and/or langerin are diagnostic for LCH. A thorough review of systems, baseline laboratory tests, and imaging studies can determine the extent of LCH. Treatment of cutaneous disease is largely based on case report and small case studies, but baseline treatment should generally begin with oral or topical steroids. When patients have more severe disease that requires a systemic approach, the efficacy of therapy should be assessed 6 weeks into therapy, with subsequent treatment intensification in patients with limited response. Conclusion: Owing to the rarity of this condition, there are no specific guidelines for treatment of LCH, but guidelines put forth by the Histiocyte Society assist in categorization and basic treatment approaches for patients with systemic disease.