bluuebunny/crossref_metadata_2025_split huggingface dataset:
Computer-Assisted Corrective Osteotomy of Malunited Pediatric Radial Neck Fractures—Three-Dimensional Postoperative Accuracy and Clinical Outcome
Authors: Weigelt Lizzy , Fürnstahl Philipp , Schweizer Andreas 
Published: July 2017

Summary:
Neglected or incorrect treatment of pediatric radial neck fractures may lead to symptomatic malunions. Computer-assisted corrective osteotomies with patient-specific guides have been proposed as a promising technique for the reconstruction of malunited long bone deformities. The aim of this study was to evaluate the accuracy and clinical outcome of this technique in children with malunited fractures of the radial neck. Four children [2 boys, 2 girls; mean age 12 (10–16) years] underwent computer-assisted closing wedge osteotomy of the radial neck. The contralateral uninjured side was used as a reconstruction template. Computed tomography were performed 8 weeks postoperatively to confirm bony consolidation and to quantify residual 3D rotational and translational displacement error. Clinical outcome [pain, range of motion (ROM)] and overall satisfaction were documented. Preoperative subluxation of the radial head could be corrected in 2 of 3 patients. One patient had to be revised because of secondary traumatic loss of reduction. At the last follow-up [mean 16 (range, 12–24) months], all patients were pain free for activities of daily living (preoperative pain: visual analog scale 6). Pain during sport activities could be substantially reduced (visual analog scale 8→2). Although the procedure failed to improve ROM, none of the patients had limitations regarding work, daily, or sports activities. Yet, restricted ROM was considered as a cosmetic problem in 1 patient. Full consolidation of the osteotomy site, with no signs of avascular necrosis of the radial head, was achieved in all patients. The deformity could be substantially reduced, from a 3D angle of 13–40 degrees to 3–7 degrees (58%–89% deformity correction). Computer-assisted corrective osteotomy is a novel technique for the treatment of radial neck malunions that led to adequate pain reduction and 3D accuracy of deformity correction in our small case series. Despite the lack of improved ROM, all patients were satisfied and would undergo the same procedure again.
Functional Outcomes of Elderly Patients With Nonoperatively Treated Acetabular Fractures That Meet Operative Criteria
Authors: Ryan Scott P. , Manson Theodore T. , Sciadini Marcus F. , Nascone Jason W. , LeBrun Christopher T. , Castillo Renan C. , Muppavarapu Ragu , Schurko Brian , O'Toole Robert V. 
Published: July 2017

Objectives:
To report functional outcomes of displaced acetabular fractures treated nonoperatively in the geriatric patient population.

Design:
Retrospective case series.

Setting:
Two Level I trauma centers.

Patients:
Twenty-seven patients 60 years of age or older who sustained displaced acetabular fractures during an 11-year period.

Intervention:
Nonoperative treatment.

Main Outcome Measurements:
Primary outcome measurements were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores and Short Form 8 (SF-8) scores. Secondary outcome measurements were conversion to open reduction and internal fixation or total hip arthroplasty and 1-year mortality.

Results:
Twenty-six patients completed the WOMAC and SF-8 surveys. The overall WOMAC score was 12.9 ± 15.6 (range, 0–59.4). The average physical SF-8 was 51.1 ± 8.7 (range, 30.4–58.6), and the average mental SF-8 was 55 ± 6.2 (range, 30.4–58.6). The 1-year mortality rate was 24%. Conversion of treatment occurred in 15% of patients.

Conclusions:
Elderly patients with fracture patterns that would qualify for operative treatment in younger healthy patients had surprisingly good outcome scores when treated nonoperatively.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Can Concurrent Abnormalities in Free Light Chains and Immunoglobulin Concentrations Identify a Target Population for Immunoglobulin Trials in Sepsis?*
Authors: Shankar-Hari Manu , Singer Mervyn , Spencer Jo 
Published: July 2017

Objectives:
Light chains κ and λ are immunoglobulin constituents but also circulate independently in blood as free light chains. We investigated whether a concomitant abnormality in free light chain and immunoglobulin levels could identify a high risk of death sepsis subpopulation to inform future IV immunoglobulin trials. We tested whether light chain allelic inclusion occurs in circulating B cells.

Design:
Prospective cohort study.

Setting:
Adult general ICUs.

Patients:
Adult sepsis patients without any documented immune comorbidity.

Interventions:
None.

Measurements and Main Results:
Serum total free light chain, immunoglobulin G, immunoglobulin A, and immunoglobulin M were measured on ICU days 1, 3, and 7. Population normal ranges defined normal and abnormal categories. Logistic regression models tested any independent relationship between high free light chain, immunoglobulins and hospital mortality. CD19 B-cell subsets expressing cell surface κ and λ were quantified by flow cytometry; their frequencies were compared against healthy subjects and correlation assessed against free light chain concentrations. On ICU day 1, high free light chain λ and high free light chain κ were seen in 46.5% and 75.3% of the study cohort (n = 101). Low immunoglobulin levels were commonplace (45.5%) at ICU admission. ICU admission day free light chain and immunoglobulin concentrations were significantly correlated. Septic patients had significantly more CD19 B cells expressing both κ and λ compared with healthy controls (median [interquartile range] 4.1% [2.4–11.0] vs 1.3% [1.2–2.9], respectively; p = 0.0001); these correlated with free light chain concentrations.

Conclusions:
To our knowledge, abnormalities and associations of free light chain in critically ill adults with sepsis have not been previously reported. The additional prognostic value of free light chain λ and the significance of allelic inclusion in B cells in sepsis require further investigation.
Glomangiosarcoma Arising from a Prior Biopsy Site
Authors: Maselli Amy M. , Jambhekar Amani V. , Hunter John G. 
Published: July 2017

Summary:
Glomangiosarcoma represents a rare malignant variant of the benign glomus tumor that typically presents as a tender, slowly growing nodule with a predilection for the lower extremities. Unlike their benign counterparts, glomangiosarcomas may display aggressive characteristics such as large size, local invasion, and a tendency to recur after excision. Although wide local excision remains the treatment of choice, rare cases of systemic metastasis have been previously reported. We present a case of glomangiosarcoma arising at a prior biopsy site after excision of an unknown soft tissue lesion.
Animation Deformity in Postmastectomy Implant-Based Reconstruction
Authors: Nigro Lauren C. , Blanchet Nadia P. 
Published: July 2017

Background:
Despite increasing interest in prepectoral implant-based reconstruction to avoid animation deformity (AD), the prevalence of this deformity and patient attitudes toward it have not been extensively studied. The purpose of this study was to report on AD in the breast reconstruction population and identify those at highest risk.

Methods:
A retrospective chart review was completed for patients at least 6 months postoperative from subpectoral, implant-based breast reconstruction using acellular dermal matrix in the lower pole. Patient age, BMI, and implant size were collected. A questionnaire was distributed to the patients. Returned questionnaires were compiled and data were analyzed.

Results:
Eighty-four of 108 patients (77.8%) returned the questionnaire with 62 (75.6%) reporting AD; 75.6% of patients were aware of AD, 14.6% considered it moderate, and 11% considered it severe. No statistically significant differences in age, body mass index, implant size, or athleticism were found between those who noted AD versus those who did not. Forty-one of 79 patients (51.9%) would have been interested in an initial surgical procedure without AD; interest dropped significantly if the alternative surgery involved increased risk, cost, or additional stages of reconstruction.

Conclusion:
The prevalence of AD in subpectoral implant-based breast reconstruction is significantly higher than in subpectoral augmentation. The majority of patients expressed interest in an alternative procedure to avoid AD unless it involved increased risk, cost, or additional surgeries. We found insignificant differences in age, athleticism, BMI, and implant size between patients who note AD and those who do not. Further study is necessary to better define patients at risk for AD to guide patient-centered breast reconstruction.
Elizabeth Croll: ASPS Patient of Courage 2016
Authors: Gosain Arun K. 
Published: July 2017

Summary:
Mrs. Elizabeth Croll was selected as an American Society of Plastic Surgeons (ASPS) Patient of Courage in 2016. During a boating accident that occurred within 1 month after graduating from Harvard Business School, she was struck by an oncoming boat and suffered severe facial trauma, resulting in an open skull injury with loss of her right eye. She has since undergone multiple reconstructive surgical procedures beginning in 1997 and continuing up to the month before she was awarded the ASPS Patient of Courage. During this time, she got married, started a family, and continued an ambitious business career. Mrs. Croll is the epitome of an individual who has overcome tragedy to further her career, her community, and access to medical care for indigent children.
Vismodegib for Locally Advanced Periocular and Orbital Basal Cell Carcinoma: A Review of 15 Consecutive Cases
Authors: Wong Kai Yuen , Fife Kate , Lear John T. , Price Richard D. , Durrani Amer J. 
Published: July 2017

Summary:
Basal cell carcinoma (BCC) is the most common periocular skin cancer and can lead to significant morbidity. We assess the effectiveness of vismodegib, a first-in-class Hedgehog signaling pathway inhibitor, in the management of periocular and orbital BCCs based on clinical response, tolerability, and orbital content preservation. All patients with periocular or orbital BCCs who met criteria for vismodegib treatment were recruited prospectively between May 2012 and 2014 from 2 hospitals. Patients received oral vismodegib (150 mg daily) until disease progression, unacceptable toxicity, or withdrawal. All patients were followed up monthly. Patient demographics, tumor size, treatment duration including dosing regimen, adverse events, response rate, duration of response, progression-free survival, and disease-free survival were analyzed. All 15 patients had biopsy-proven BCCs with no metastatic disease at presentation. The mean age was 74 years and 10 patients (67%) had orbital involvement. The mean lesion longest dimension was 51 mm and 7 cases (47%) represented recurrence following previous surgery and/or radiotherapy. The mean treatment duration was 13 months and mean follow-up duration 36 months. Ten patients (67%) had a complete response, 3 (20%) had a partial response, and 2 had progressive disease following an initial partial response (13%). The partial response of 55% in 1 patient allowed subsequent surgical resection with clear margins. Vismodegib is effective for treating periocular and orbital BCCs with orbital salvage of patients who otherwise would have required exenteration. There is a neoadjuvant role for vismodegib but further studies are required.
The (Dis) Utility of a Change in Troponin I for Diagnosis of Non–ST-Segment Elevation Myocardial Infarction in an Observation Unit
Authors: Patsias Iani , Swanson Benjamin , Hudson Michael , Parikh Sachin , Nour Khaled , Jacobsen Gordon , McCord James 
Published: July 2017

Background:
Observation units (OUs) may be an efficient and effective setting to diagnose and risk stratify patients with coronary ischemia and myocardial infarction (MI). Given improved cardiac troponin I (cTnI) assays and expanded utilization of OUs, it is not uncommon for patients with mildly elevated cTnI to be evaluated in OUs. We investigated the serial cTnI results in OU patients to determine whether absolute or relative cTnI changes were useful for the diagnosis of MI.

Methods:
This was a retrospective study of 260 patients placed in the OU from a single center in 2007, with an initial cTnI in the indeterminate range of 0.04–0.2 ng/ml (Siemens ultrasensitive), and a second cTnI was drawn at 6 hours. The diagnosis of MI was determined based on the third universal definition of MI by consensus review of 2 cardiologists, with adjudication by a third cardiologist in case of disagreement.

Results:
Of the 260 patients, 25 (9.6%) were determined to have MI at OU presentation. The optimal absolute and relative change in cTnI for MI diagnosis by receiver operating characteristic curve analysis were 0.02 ng/ml and 40%, respectively. There was initial cardiologist disagreement in 60% (15/25) of MI cases despite full review of serial cTnI and cardiac testing results. At 30 days, there were 3 adverse events: 2 deaths and 1 MI.

Conclusions:
The diagnosis of MI in OU with low-level cTnI elevation is problematic. Furthermore, there is only marginal diagnostic utility of serial changes in cTnI in this patient population.
Effect Evaluation of a Randomized Trial to Reduce Infectious Illness and Illness-related Absenteeism Among Schoolchildren: The Hi Five Study
Authors: Denbæk Anne Maj , Andersen Anette , Bonnesen Camilla Thørring , Laursen Bjarne , Ersbøll Annette Kjær , Due Pernille , Johansen Anette 
Published: July 2017

Background:
Previous school-based hand hygiene interventions have reported to successfully reduce infectious illness among schoolchildren. But few studies have tested the effect in large populations with adequate statistical power and analyses. The aim of this study was to evaluate whether a school-based multicomponent intervention to improve handwashing among schoolchildren, the Hi Five study, succeeded in reducing infectious illness and illness-related absenteeism in schools.

Methods:
The Hi Five study was a three-armed cluster-randomized controlled trial involving 43 randomly selected Danish schools; two intervention arms involving 14 schools each, and 15 control schools. Infectious illness days, infectious illness episodes and illness-related absenteeism were estimated in multilevel regressions, based on available cases of text messages answered by parents and based on questionnaire data reported by schoolchildren, respectively.

Results:
At follow-up, children in the intervention schools did not differ from the control schools in number of illness days [odds ratio (OR)I-arm I: 0.91 (0.77–1.07) and ORI-arm II: 0.94 (0.79–1.12)] and illness episodes [ORI-arm I: 0.95 (0.81–1.11) and ORI-arm II: 0.98 (0.84–1.16)] or in reporting illness-related absenteeism [ORI-arm I: 1.09 (0.83–1.43) & ORI-arm II: 1.06 (0.81–1.40)].

Conclusions:
The multicomponent Hi Five intervention achieved no difference in the number of illness days, illness episodes or illness-related absenteeism among children in intervention schools compared with control schools. It is noteworthy that one of the main components in the intervention, a mandatory daily handwashing before lunch, was only implemented by 1 of 3 of teachers in intervention schools.
Pitch Counts in Youth Baseball and Softball: A Historical Review
Authors: Feeley Brian T. , Schisel Jessica , Agel Julie 
Published: July 2017

Objective:
Pitching injuries are getting increased attention in the mass media. Many references are made to pitch counts and the role they play in injury prevention. The original purpose of regulating the pitch count in youth baseball was to reduce injury and fatigue to pitchers. This article reviews the history and development of the pitch count limit in baseball, the effect it has had on injury, and the evidence regarding injury rates on softball windmill pitching.

Data Source:
Literature search through PubMed, mass media, and organizational Web sites through June 2015.

Results:
Pitch count limits and rest recommendations were introduced in 1996 after a survey of 28 orthopedic surgeons and baseball coaches showed injuries to baseball pitchers' arms were believed to be from the number of pitches thrown. Follow-up research led to revised recommendations with more detailed guidelines in 2006. Since that time, data show a relationship between innings pitched and upper extremity injury, but pitch type has not clearly been shown to affect injury rates. Current surveys of coaches and players show that coaches, parents, and athletes often do not adhere to these guidelines. There are no pitch count guidelines currently available in softball.

Conclusions:
The increase in participation in youth baseball and softball with an emphasis on early sport specialization in youth sports activities suggests that there will continue to be a rise in injury rates to young throwers. The published pitch counts are likely to positively affect injury rates but must be adhered to by athletes, coaches, and parents.
Vestibular Function in Adults With Epilepsy of Unknown Etiology
Authors: Hamed Sherifa A. , Tohamy Amal M. , Oseilly Amira M. 
Published: July 2017

Objective:
This study aimed to evaluate vestibular function in adults with chronic epilepsy of unknown etiology in the inter-ictal period.

Background:
Epilepsy is a chronic medical disorder. Life-long therapy may be required in one-third of patients. Epilepsy is associated with comorbid somatic conditions which impairs patients’ quality of life.

Methods:
This cross-sectional study included 28 with generalized tonic clonic (GTC) convulsions and 14 and 3 with temporal (TLE) and frontal lobe (FLE) epilepsies with secondary generalization (all were on regular carbamazepine therapy) and 40 healthy control subjects. The patients’ mean age was 34.97 ± 7.35 years and the duration of illness was 18.75 ± 7.99 years. All underwent videonystagmography (VNG).

Results:
Compared with controls, patients had frequent vestibular symptoms including dizziness (62.22%) (p = 0.0001) and sense of imbalance (44.44%) (p = 0.0001). Eleven patients (24.44%) had central vestibular dysfunction (p = 0.0001); 9 (20%) had mixed vestibular dysfunction and one (2.22%) had peripheral vestibular dysfunction (p = 0.0001). Abnormalities were observed in saccadic (44.4%) and pursuit (42.2%) eye movements, optokinetic nystagmus (42.2%) and positioning/positional (11.11%) and caloric (13.33%) testing. TLE and FLE were associated with more VNG abnormalities than GTC. No significant differences were observed in the demographic and clinical characteristics between patients with and without VNG abnormalities.

Conclusion:
Vestibular manifestations are frequent in patients with epilepsy. This may be a result of the permanent damaging effect of chronic epilepsy on the vestibular cortical areas and/or a toxic effect from prolonged carbamazepine therapy on the peripheral and central vestibular systems.
Epidemiology and location of primary retrieval missions in a Scottish aeromedical service
Authors: Neagle Gregg , Curatolo Lisa , Ferris John , Donald Mike , Hearns Stephen , Corfield Alasdair R. 
Published: July 2017

Introduction
Prehospital critical care teams comprising an appropriately trained physician and paramedic or nurse have been associated with improved outcomes in selected trauma patients. These teams are a scarce and expensive resource, especially when delivered by rotary air assets. The optimal tasking of prehospital critical care teams is therefore vital and remains a subject of debate. Emergency Medical Retrieval Service (EMRS) provides a prehospital critical care response team to incidents over a large area of Scotland either by air or by road.

Methods
A convenience sample of consecutive EMRS missions covering a period of 18 months from May 2013 to January 2015 was taken. These missions were matched with the ambulance service information on geographical location of the incident. In order to assess the appropriateness of tasking, interventions undertaken on each mission were analysed and divided into two subcategories: ‘critical care interventions’ and ‘advanced medical interventions’. A tasking was deemed appropriate if it included either category of intervention or if a patient was pronounced life extinct at the scene.

Results
A total of 1279 primary missions were undertaken during the study period. Of these, 493 primary missions met the inclusion criteria and generated complete location data. The median distance to scene was calculated as 5.6 miles for land responses and 34.2 miles for air responses. Overall, critical care interventions were performed on 17% (84/493) of patients. A further 21% (102/493) of patients had an advanced medical intervention. Including those patients for whom life was pronounced extinct on scene by the EMRS team, a total of 42% (206/493) taskings were appropriate.

Discussion
Overall, our data show a wide geographical spread of tasking for our service, which is in keeping with other suburban/rural models of prehospital care. Tasking accuracy is also comparable to the accuracy shown by other similar services.
One Hundred Twenty-One Resected Solid Pseudopapillary Tumors of the Pancreas
Authors: Xu Yadong , Zhao Guochao , Pu Ning , Nuerxiati Abulimiti , Ji Yuan , Zhang Lei , Rong Yefei , Lou Wenhui , Wang Dansong , Kuang Tiantao , Xu Xuefeng , Wu Wenchuan 
Published: July 2017

Objectives
The aims of this study were to introduce our experience with treating patients with pancreatic solid pseudopapillary tumors (SPTs) and to investigate the clinical risk factors for recurrence of SPTs because no consensus has been established to date.

Methods
One hundred twenty-one patients underwent surgical resection from January 2008 to December 2015 in our institution. Clinical data were collected from the standardized reports.

Results
Of the 121 patients, 93 (76.9%) were women, 28 (23.1%) were men, and the mean age at diagnosis was 33.7 years (range, 11–68 years). Sixty patients were subjected to short-term complications, and 8 patients experienced long-term complications, some of whom may require surgery. The tumor located in the distal pancreas (P = 0.02), and a Ki-67 index value > 1.5 (P = 0.01) indicated malignancy according to the World Health Organization 2000 classification. One hundred three patients responded to follow-up, and 3 cases (2.9%) were subject to liver metastases. Recurrence was more frequently observed in tumors classified as high-grade malignancies according to the World Health Organization 2010 classification (P = 0.013), synchronous metastases (P < 0.001), peripancreatic fat infiltration (P = 0.018), and lymphovascular invasion (P < 0.001).

Conclusions
Evaluating the risk of the recurrence of SPTs still requires systematic and multicenter trials in the future, even some pathological features showed statistical differences.