bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Circular Arc Internal Fixation for Tibio-Talo-Calcaneal Arthrodesis
Authors: Klaue Kaj , Mittlmeier Thomas , Zwipp Hans 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Stabilizing a tibio-talo-calcaneal arthrodesis in anatomical alignment allowing for weight bearing is a technical challenge. Normal anatomy demonstrates alignment of the heel, the subtalar facet, the talus, the ankle joint and the distal tibia on a regular curve. This curve lies on a vertical plane which is slightly angulated inwards in relation to the sagittal plane. Today’s hindfoot nails are either straight or bent. The hole which accommodates the implant is always straight and thus does not respect the normal alignment of the hindfoot. This technique may cause a plantar neurapraxia, the nail holds poorly the calcaneus and tends to create a hindfoot varus. Purpose of the study is to optimize the technique to stabilize the hindfoot in anatomical alignment. Methods: A preliminary trial using 15 cadaveric feet was performed to find the optimal shape of a central hindfoot nail. An instrumentation was designed to create a circular arc bore hole crossing the heel, the posterior subtalar facet, the tibio-talar joint and the distal tibia metaphysis. At the operation, the desired definitive position of the hindfoot is fixed temporarily with Kirschner wires. A guiding frame is fixed to three critical spots of the hindfoot to drill the central hole. Using an image amplifier the hole is bored using a motor driven end cutting flexible reamer which is seated within a rigid curved hull. The nail has the same shape than the hull and is impacted up to the distal tibia. A distal locking screw crossing the subtalar joint and a proximal locking screw within the tibia concludes the central fixation. 9 patients have been treated so far using this technique. Results: In vitro trials demonstrated an excellent spontaneous stability of the hindfoot after introduction of the nail. The pathology of the operated patients include post-traumatic, congenital and metabolic (diabetes) conditions. The mean follow-up is 12 months. We did observe 3 ruptures of the tibial locking screw which allowed for more spontaneous impaction. All cases went to consolidation without malunion or other complications. One diabetic patient developed a stable pseudarthrosis at the midfoot joints. All patients were treated for 2 weeks post-op with a closed circular cast without weight bearing. After 2 weeks our patients did practise partial weight bearing using a cam walker for other 6 weeks. Conclusion: The tibio-talo-calcaneal arthrodesis can be successfully treated using a central circular arc shaped nail respecting form fit function. The anatomical bony alignment of the hindfoot is preserved. Due to the safe approaches, the technique may prevent shortcomings such as neurological complications and non-unions. We expect a shorter period between surgical fixation and full weight bearing.
The Epidemiology of Lisfranc Injuries at the NFL Combine
Authors: Vopat Bryan G. , McHale Kevin J. , Beaulieu-Jones Brendin R. , Sanchez George , Logan Catherine , Whalen Jim , Guss Daniel , DiGiovanni Christopher W. , Provencher Matthew T. 
Published: October 2016

Category: Sports Introduction/Purpose: Lisfranc injuries can have detrimental consequences to an athlete’s career. If left inadequately treated, these injuries can result in persistent pain and lead to advanced osteoarthritis. Understanding the prevalence of these injuries in collegiate athletes and their effect on NFL draft position can help team physicians counsel future players and determine optimal treatment. The purpose of this study was to determine the epidemiology of Lisfranc injuries in players participating in the NFL combine and to determine the positions that are at higher risk for sustaining these injuries. Methods: Data was collected from the NFL combine website on all players who participated in the combine and had sustained a Lisfranc injury before entering the NFL from 2009 to 2015. Medical records, imaging, and treatments were reviewed on players who were identified with these injuries. The epidemiology of Lisfranc injuries was determined by evaluating the number of injuries, surgeries, games missed, position played and draft position of each player. Odds ratios were calculated using logistic regression to assess the risk of sustaining each injury by position. Two-sample, two-tailed T-tests were computed to assess games missed and draft position in players with operative versus non-operative management. Players with a Lisfranc injury as well a second primary midfoot injury (n=3) were excluded from analysis. Results: Thirty-nine(1.7%) players at the NFL combine had an isolated Lisfranc injury during their collegiate football career. Of these players, 27(69.2%) required surgical intervention. The average number of collegiate football games missed for this injury was 3.0±5.0. The average number of games missed for players requiring operative fixation was statistically greater(4.2±5.7) than those in the non-operative group (0.3 ±0.9, p=0.02). The average NFL draft position was 141.7±69.4, and 13(33.3%) went undrafted. There was no statistical difference in the average draft position(p=0.84) and number of undrafted players(p=0.15) between the operative and non-operative groups. No position was found to be at increased risk for Lisfranc injury; however, as a whole, offensive players had a significantly increased risk(Odds ratio=2.7, p = 0.01) of having a Lisfranc injury when compared to all other players. Overall, 24(61.5%) of the players with a Lisfranc injury played on offense. Conclusion: The majority of players who reported a Lisfranc injury required operative intervention, and offensive players were at a higher risk for this injury. Lisfranc requiring operative management did not significantly change a player’s draft position or chance of being drafted.
The Predicting Factor for Avascular Necrosis After Talus Fracture — the Study Based on CT Findings
Authors: Ikezawa Hiroko , Usami Norio , Hiraishi Eiichi , Inokuchi Suguru 
Published: October 2016

Category: Trauma Introduction/Purpose: Treatment of talus fracture is difficult. Because talus fracture often cause the avascular necrosis, and necessitate a prolonged non-weight-bearing period or arthrodesis in these cases. Identification of the fracture type that results in necrosis before a surgery may help in the determination of the planning of treatment and the prognosis. However, necrosis cannot be identified directly by a conventional fracture classification. We investigated the sites in which fracture lines of the talus are visible by using CT to determine the association between fracture of the talus and the occurrence of necrosis. Methods: Twenty-five patients (25 feet; 18 men and 7 women; mean age at the first visit, 48.4 years [range, 15–80 years]) treated through 2003 to 2013 were included in this study. Fracture lines were assessed using radiography and CT. According to the conventional classification, 12 neck fractures and 13 body fractures were found. The Inokuchi–Ogawa classification was used to assess the fracture line on the subtalar joint surfaces. A fracture line was defined as the line connecting 1 with the other point as follows: (a) the sulcus tali ; (b) the sinus tarsi; (c) between the lateral process and the lateral tubercle; and (d) the medial tubercle. MRI was used for the assessment of necrosis. The subjects were divided into the non-necrosis group (group A) and the necrosis group (group B), and relationship between fracture lines and appearance of necrosis was examined. Results: With the exclusion of 2 unclassifiable cases, group A consisted of 15 feet, whereas group B consisted of 8 feet. At the Inokuchi–Ogawa classification, 1fracture line was found in 8 feet,2:5, and and 3:1 in group A. In group B, all cases showed multiple fracture lines. Among the lines connecting a-b, a-c, and b-d, fracture was observed in more than 2 lines in the all cases . Conclusion: The most important factor for determining the prognosis of talus fracture is the presence or absence of necrosis. The results of this study indicate that fracture lines connecting a-b, a-c, and b-d interrupt major blood routes, and talus fracture more than 2 fracture lines were highly likely to develop avascular necrosis. Thus, fracture lines may predict the occurrence of necrosis and possible sites of its occurrence.
Haploidentical hematopoietic transplantation for the cure of leukemia: from its biology to clinical translation
Authors: Mancusi Antonella , Ruggeri Loredana , Velardi Andrea 
Published: October 2016

AbstractThe present review describes the biology of human leukocyte antigen haplotype mismatched (“haploidentical”) transplantation, its translation to clinical practice to cure leukemia, and the results of current transplantation protocols. The 1990s saw what had been major drawbacks of haploidentical transplantation, ie, very strong host-versus-graft and graft-versus-host alloresponses, which led respectively to rejection and graft-versus-host disease (GVHD), being overcome through transplantation of a “mega-dose” of T cell–depleted peripheral blood hematopoietic progenitor cells and no posttransplant pharmacologic immunosuppression. The absence of posttransplant immunosuppression was an opportunity to discover natural killer cell alloreactions that eradicated acute myeloid leukemia and improved survival. Furthermore, it also unveiled the benefits of transplantation from mother donors, a likely consequence of the mother-to-child interaction during pregnancy. More recent transplantation protocols use unmanipulated (without ex vivo T-cell depletion) haploidentical grafts combined with enhanced posttransplant immunosuppression to help prevent GVHD. Unmanipulated grafts substantially extended the use of haploidentical transplantation with results than even rival those of matched hematopoietic transplantation. In T cell–depleted haploidentical transplantation, recent advances were made by the adoptive transfer of regulatory and conventional T cells.
Treatments and Outcomes of Patients With Extranodal Natural Killer/T-Cell Lymphoma Diagnosed Between 2000 and 2013: A Cooperative Study in Japan
Authors: Yamaguchi Motoko , Suzuki Ritsuro , Oguchi Masahiko , Asano Naoko , Amaki Jun , Akiba Takeshi , Maeda Takeshi , Itasaka Satoshi , Kubota Nobuko , Saito Yoshihiro , Kobayashi Yukio , Itami Jun , Ueda Kyoko , Miyazaki Kana , Ii Noriko , Tomita Naoto , Sekiguchi Nodoka , Takizawa Jun , Saito Bungo , Murayama Tohru , Ando Toshihiko , Wada Hideho , Hyo Rie , Ejima Yasuo , Hasegawa Masatoshi , Katayama Naoyuki 
Published: October 2016

Purpose To elucidate the management and outcomes of patients with extranodal natural killer/T-cell lymphoma, nasal type (ENKL), who were diagnosed between 2000 and 2013 in Japan. Patients and Methods Data from 358 patients with ENKL diagnosed between 2000 and 2013 from 31 institutes were retrospectively analyzed. Results Patients’ median age was 58 years, and 257 (72%) had localized disease. The most common first-line treatment was radiotherapy with dexamethasone, etoposide, ifosfamide, and carboplatin (RT-DeVIC) (66%) for localized ENKL and L-asparaginase–containing chemotherapy (30%) for advanced ENKL. With a median follow-up of 5.8 years, overall survival (OS) rates at 5 years for localized and advanced ENKL were 68% and 24%, respectively. The prognostic index of natural killer lymphoma was validated in our study, although only 4% of patients with localized ENKL were classified as high risk. With a median follow-up of 5.6 years, OS and progression-free survival at 5 years in the 150 patients who received RT-DeVIC in clinical practice were 72% (95% CI, 63% to 78%) and 61% (95% CI, 52% to 69%), respectively. Toxicities of RT-DeVIC were comparable to those in a previous trial. Multivariate analysis in patients with localized ENKL who received RT-DeVIC identified elevated soluble interleukin-2 receptor as an independent predictive factor for worse OS and progression-free survival (adjusted hazard ratios, 2.28 and 2.46; 95% CI, 1.24 to 4.23 and 1.42 to 4.28; P = .008 and .0014, respectively). Conclusion Favorable OS in response to new treatments was demonstrated in a large number of patients. Improved treatment approaches are needed for localized ENKL exhibiting elevated pretreatment soluble interleukin-2 receptor.
Human Papillomavirus Drives Tumor Development Throughout the Head and Neck: Improved Prognosis Is Associated With an Immune Response Largely Restricted to the Oropharynx
Authors: Chakravarthy Ankur , Henderson Stephen , Thirdborough Stephen M. , Ottensmeier Christian H. , Su Xiaoping , Lechner Matt , Feber Andrew , Thomas Gareth J. , Fenton Tim R. 
Published: October 2016

PurposeIn squamous cell carcinomas of the head and neck (HNSCC), the increasing incidence of oropharyngeal squamous cell carcinomas (OPSCCs) is attributable to human papillomavirus (HPV) infection. Despite commonly presenting at late stage, HPV-driven OPSCCs are associated with improved prognosis compared with HPV-negative disease. HPV DNA is also detectable in nonoropharyngeal (non-OPSCC), but its pathogenic role and clinical significance are unclear. The objectives of this study were to determine whether HPV plays a causal role in non-OPSCC and to investigate whether HPV confers a survival benefit in these tumors.MethodsMeta-analysis was used to build a cross-tissue gene-expression signature for HPV-driven cancer. Classifiers trained by machine-learning approaches were used to predict the HPV status of 520 HNSCCs profiled by The Cancer Genome Atlas project. DNA methylation data were similarly used to classify 464 HNSCCs and these analyses were integrated with genomic, histopathology, and survival data to permit a comprehensive comparison of HPV transcript-positive OPSCC and non-OPSCC.ResultsHPV-driven tumors accounted for 4.1% of non-OPSCCs. Regardless of anatomic site, HPV+ HNSCCs shared highly similar gene expression and DNA methylation profiles; nonkeratinizing, basaloid histopathological features; and lack of TP53 or CDKN2A alterations. Improved overall survival, however, was largely restricted to HPV-driven OPSCCs, which were associated with increased levels of tumor-infiltrating lymphocytes compared with HPV-driven non-OPSCCs.ConclusionOur analysis identified a causal role for HPV in transcript-positive non-OPSCCs throughout the head and neck. Notably, however, HPV-driven non-OPSCCs display a distinct immune microenvironment and clinical behavior compared with HPV-driven OPSCCs.
Impact of Health Insurance Expansion on the Treatment of Colorectal Cancer
Authors: Loehrer Andrew P. , Song Zirui , Haynes Alex B. , Chang David C. , Hutter Matthew M. , Mullen John T. 
Published: October 2016

Purpose Colorectal cancer is the third most common cancer and the third leading cause of cancer deaths in the United States. Lack of insurance coverage has been associated with more advanced disease at presentation, more emergent admissions at time of colectomy, and lower survival relative to privately insured patients. The 2006 Massachusetts health care reform serves as a unique natural experiment to assess the impact of insurance expansion on colorectal cancer care. Methods We used the Hospital Cost and Utilization Project State Inpatient Databases to identify patients with colorectal cancer with government-subsidized or self-pay (GSSP) or private insurance admitted to a hospital between 2001 and 2011 in Massachusetts (n = 17,499) and three control states (n = 144,253). Difference-in-differences models assessed the impact of the 2006 Massachusetts coverage expansion on resection of colorectal cancer, controlling for confounding factors and secular trends. Results Before the 2006 Massachusetts reform, government-subsidized or self-pay patients had significantly lower rates of resection for colorectal cancer compared with privately insured patients in both Massachusetts and the control states. The Massachusetts insurance expansion was associated with a 44% increased rate of resection (rate ratio = 1.44; 95% CI, 1.23 to 1.68; P < .001), a 6.21 percentage point decreased probability of emergent admission (95% CI, −11.88 to −0.54; P = .032), and an 8.13 percentage point increased probability of an elective admission (95% CI, 1.34 to 14.91; P = .019) compared with the control states. Conclusion The 2006 Massachusetts health care reform, a model for the Affordable Care Act, was associated with increased rates of resection and decreased probability of emergent resection for colorectal cancer. Our findings suggest that insurance expansion may help improve access to care for patients with colorectal cancer.
Pomalidomide for Symptomatic Kaposi's Sarcoma in People With and Without HIV Infection: A Phase I/II Study
Authors: Polizzotto Mark N. , Uldrick Thomas S. , Wyvill Kathleen M. , Aleman Karen , Peer Cody J. , Bevans Margaret , Sereti Irini , Maldarelli Frank , Whitby Denise , Marshall Vickie , Goncalves Priscila H. , Khetani Vikram , Figg William D. , Steinberg Seth M. , Zeldis Jerome B. , Yarchoan Robert 
Published: October 2016

Purpose Kaposi's sarcoma (KS) is a multicentric tumor caused by Kaposi's sarcoma–associated herpesvirus. Unmet needs include therapies that are oral, anthracycline sparing, and deliverable in resource-limited settings. We evaluated pomalidomide, an oral immune modulatory agent, in patients with symptomatic KS. Methods The primary objectives were to assess tolerability, pharmacokinetics, and activity. Initial dosage level was 5 mg once per day for 21 days per 28-day cycle, with a de-escalated level of 3 mg if not tolerable, and aspirin 81 mg once per day thromboprophylaxis. HIV-infected patients required controlled viremia with either persistent KS despite 3 months of antiretroviral therapy (ART) or progressive KS despite 2 months of ART. Evaluations included tumor response and health-related quality of life (HRQL). Results Twenty-two patients were treated; 15 (68%) were HIV infected, 17 (77%) had advanced (T1) disease, and 17 (77%) previous KS therapy excluding ART. All were treated with 5 mg because no dose-limiting toxicities occurred. Over 156 cycles, the grade 3/4 adverse events possibly attributable to therapy were neutropenia (23 cycles, 10 patients), infection (1 cycle), and edema (1 cycle). Sixteen patients responded (73%; 95% CI, 50% to 89%): nine of 15 HIV-infected patients (60%; 95% CI, 32% to 84%) and all seven HIV-uninfected patients (100%; 95% CI, 59% to 100%). Median time to response was 4 weeks (range, 4 to 36 weeks). HRQL showed no impairment during therapy and improved satisfaction with appearance at end therapy ( P = .03). Significant increases in CD4+ and CD8+ cells were seen in patients with and without HIV, together with a transient increase in Kaposi's sarcoma–associated herpesvirus viral load at week 4 ( P = .05). Conclusion Pomalidomide is well tolerated and active in KS regardless of HIV status. Responses were rapid, with improved self-reported outcomes, and occurred in advanced and heavily pretreated disease. Correlative studies support, at least in part, an immunologic mechanism of activity.
Perioperative Surgical Home in Pediatric Settings: Preliminary Results
Authors: Thomson Karen , Pestieau Sophie R. , Patel Janish J. , Gordish-Dressman Heather , Mirzada Ariana , Kain Zeev N. , Oetgen Matthew E. 
Published: October 2016

BACKGROUND:
The Perioperative Surgical Home (PSH) is a patient-centered, team-based approach that aims to improve the value of perioperative care. We implemented a PSH for patients with adolescent idiopathic scoliosis who were undergoing posterior spinal fusion at Children’s National Health System. We hypothesized that this PSH would improve patient surgical outcomes and reduce hospital length of stay (LOS).

METHODS:
A multidisciplinary group created evidence-based protocols for the preoperative, operative, postoperative, and postdischarge care of this patient population. After a 5-month design and training period, PSH for spinal fusion was implemented in March 2015, with reduction in LOS as the primary outcome measure. Anesthesia comanagement of patients additionally allowed a new pathway for patients to recover in the postanesthesia care unit and reduce intensive care unit utilization. Patients before and after the implementation of the PSH were compared on clinical and efficiency metrics.

RESULTS:
The spinal fusion PSH achieved the primary outcome measure by a significant reduction in LOS. Care improvement was illustrated by achievement of the secondary outcome measure of reduced perioperative transfusion.

CONCLUSIONS:
The PSH model presented a ready structure that proved successful at our institution for patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion.
First visual record of rare purple dogwhelks (Nucella lapillus) on the Atlantic coast of Nova Scotia, Canada
Authors: Ehlers Sonja M. , Ellrich Julius A. 
Published: October 2016

The dogwhelk Nucella lapillus is a rocky intertidal gastropod of the North Atlantic coast. Individual shell color varies. Common colors range between white and brown, with darker dogwhelks being more affected by heat stress than lighter-colored conspecifics. Other reported shell colors are black, mauve, pink, yellow, and orange from European coasts, red and grey from the Bay of Fundy coast of New Brunswick and Nova Scotia (Canada), and purple, black, gray, yellow, and orange from the coasts of Maine and Massachusetts (USA), with purple being considered as a rare color. On the Atlantic coast of Nova Scotia, dogwhelks are active from April until November, but information on dogwhelk shell color is missing for this coast. On 16 June 2016, we found two purple dogwhelks in the mid-to-high intertidal zone of a moderately wave-exposed rocky shore near Duncans Cove, on the Atlantic coast of Nova Scotia while collecting dogwhelks (n= 1000) for manipulative field experiments. All other dogwhelks collected on that day were of common white and brown colors. During earlier dogwhelk collections in Atlantic Nova Scotia (between 2011-2013) and field surveys in Duncans Cove (between 2014-2016), we did not find any purple dogwhelks, indicating the rareness of this color in that region. Interestingly, the purple dogwhelks were detected on a relatively cool day (12.3 ± 0.4 °C, mean ± se, n= 96 temperature measurements) compared to the intertidal temperatures of all other survey days (≥ 18.2 ± 0.5 °C), suggesting that purple dogwhelks may find it less thermally stressful to venture out of crevices and macroalgal cover under relatively cool temperatures. Our observations provide the first visual record of rare purple dogwhelks on the Atlantic coast of Nova Scotia, Canada.