bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model
Authors: Jazini Ehsan , Klocke Noelle , Tannous Oliver , Johal Herman S. , Hao John , Salloum Kanaan , Gelb Daniel E. , Nascone Jason W. , Belin Eric , Hoshino C. Max , Hussain Mir , O'Toole Robert V. , Bucklen Brandon , Ludwig Steven C. 
Published: December 2016

Objective:
We sought to determine the role of lumbopelvic fixation (LPF) in the treatment of zone II sacral fractures with varying levels of sacral comminution combined with anterior pelvic ring (PR) instability. We also sought to determine the proximal extent of LPF necessary for adequate stabilization and the role of LPF in complex sacral fractures when only 1 transiliac–transsacral (TI–TS) screw is feasible.

Materials and Methods:
Fifteen L4 to pelvis fresh-frozen cadaveric specimens were tested intact in flexion-extension (FE) and axial rotation (AR) in a bilateral stance gliding hip model. Two comminution severities were simulated through the sacral foramen using an oscillating saw, with either a single vertical fracture (small gap, 1 mm) or 2 vertical fractures 10 mm apart with the intermediary bone removed (large gap). We assessed sacral fracture zone (SZ), PR, and total lumbopelvic (TL) stability during FE and AR. The following variables were tested: (1) presence of transverse cross-connector, (2) presence of anterior plate, (3) extent of LPF (L4 vs. L5), (4) fracture gap size (small vs. large), (5) number of TI–TS screws (1 vs. 2).

Results:
The transverse cross-connector and anterior plate significantly increased PR stability during AR (P = 0.02 and P = 0.01, respectively). Increased sacral comminution significantly affected SZ stability during FE (P = 0.01). Two versus 1 TI–TS screw in a large-gap model significantly affected TL stability (P = 0.04) and trended toward increased SZ stabilization during FE (P = 0.08). Addition of LPF (L4 and L5) significantly improved SZ and TL stability during AR and FE (P < 0.05). LPF in combination with TI–TS screws resulted in the least amount of motion across all 3 zones (SZ, PR, and TL) compared with all other constructs in both small-gap and large-gap models.

Conclusions:
The role of LPF in the treatment of complex sacral fractures is supported, especially in the setting of sacral comminution. LPF with proximal fixation at L4 in a hybrid approach might be needed in highly comminuted cases and when only 1 TI–TS screw is feasible to obtain maximum biomechanical support across the fracture zone.
Functional Outcomes of Operative Management of Scapula Fractures in a Geriatric Cohort
Authors: Cole Peter A. , Gilbertson Jeffrey A. , Cole Peter A. 
Published: December 2016

Objectives:
To analyze functional outcomes, motion, and strength in patients 65 years of age and older who underwent operative management of a scapula fracture.

Design:
Retrospective review of prospective database.

Setting:
A single level-1 teaching trauma center.

Patients/Participants:
Two hundred fifty patients with scapula fractures were operated between January 2002 and March 2014. A review identified 16 geriatric patients 65 years of age and older.

Intervention:
All patients underwent operative treatment of a scapular fracture.

Main Outcome Measurements:
Disabilities of the Arm, Shoulder, and Hand (DASH), Short-Form Health Survey versions 1 and 2 (SF-36), Range of Motion (ROM), and Strength assessment at final follow-up 1 year or greater.

Results:
Outcomes were attained on 15/16 patients at a mean follow-up of 40 months (range = 12–114). All fractures were united. Three patients experienced minor perioperative complications (temporary delirium in 2 patients, urinary tract infection in 1). One patient required subsequent removal of an intraarticular screw, and 1 patient required resection of heterotopic ossification and requested implant removal. The mean ROM expressed as a percent of contralateral ROM ranged from 78% to 96%. The mean strength expressed as a percent of contralateral strength ranged from 76% to 92%. The mean DASH score was 8.4. SF-36 scores were comparable with the normal population. All patients returned to activities.

Conclusions:
Operative treatment for displaced fractures in patients 65 years of age and older is safe and can yield good functional results and return to function.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BH4 improves postprandial endothelial function after a high-fat meal in men and postmenopausal women
Authors: Shah Yashesh , Bass Leon , Davison Gareth W. , Seigler Nichole , Pollock Jennifer S. , Thomas Jeff , Harris Ryan A. 
Published: December 2016

Abstract

Objective:
The timing and duration of menopause is important when evaluating the risk for cardiovascular disease in postmenopausal women, likely related in part to nitric oxide (NO) bioavailability. The flow-mediated dilation (FMD) test is a noninvasive assessment of NO bioavailability in humans, and tetrahydrobiopterin (BH4) is essential for NO synthesis. A high-fat meal (HFM) has been used to increase lipemia and reduce NO bioavailability. Thus, this study sought to determine if menopausal transition has any impact on the postprandial endothelial function response to a HFM, and evaluate the effect of BH4 on postprandial endothelial function in postmenopausal women and men.

Methods:
Utilizing a randomized, double-blind, placebo-controlled design, sex-steroid hormones and FMD were determined in 30 older adults (10 postmenopausal women aged below 3 y [W < 3], 10 postmenopausal women aged above 10 y [W > 10], and 10 men) at baseline and 4 hours after the ingestion of a HFM alone or a HFM with BH4 (HFM + BH4; 5 mg/kg).

Results:
Data are presented as mean ± SEM. Independent of treatment, postprandial testosterone was significantly (P < 0.05) decreased in men (−64 ± 11 ng/dL), whereas no changes were observed in W < 3 or W > 10 group. In addition, concentrations of progesterone were higher (P = 0.019) and the testosterone/estradiol ratio was lower (P = 0.026) in all groups after the ingestion of HFM + BH4 compared with the ingestion of HFM alone. Overall, an increase in FMD was observed after the ingestion of HFM + BH4 (Δ1.9% ± 0.6%), whereas no change in FMD was observed after the ingestion of HFM alone (Δ−0.7% ± 0.6%).

Conclusions:
Co-ingestion of BH4 with a HFM not only alters the sex-steroid hormone ratio, it improves postprandial FMD after a HFM regardless of postmenopause status or sex.
Impact of Contact Lens Material, Design, and Fitting on Discomfort
Authors: Stapleton Fiona , Tan Jacqueline 
Published: December 2016

Objective:
To review the effect of contact lens (CL) material, design, and fitting characteristics on CL discomfort.

Methods:
A PubMed search identified publications describing subjective comfort and CL material, fitting, and design parameters. The review included clinical signs associated with discomfort that may be a consequence of these parameters.

Results:
Reduced lens movement or more CL tightness were associated with improved comfort. Increased lens-induced paralimbal conjunctival staining and indentation, considered as quasi-indicators of CL fitting or edge design, were also associated with better comfort. No recent studies have evaluated varying CL design parameters and subjective comfort. Silicone hydrogel CLs are no different in comfort compared with hydrogel CLs. Lower equilibrium water content is associated with improved comfort in hydrogel CL wear. Coefficient of friction shows promise as a material factor potentially associated with comfort. Lid wiper epitheliopathy and lid-parallel conjunctival folds have been linked with comfort in established wearers.

Conclusions:
Recent studies have confirmed the association between more mobile CLs and more discomfort, whereas closer conformity of the CL to the bulbar conjunctiva improved subjective comfort. There is no evidence to support the perceived comfort difference between silicone hydrogel and hydrogel CL. There has been limited progress in understanding the impact of varying specific CL design parameters. Although specific clinical signs may be predictive of discomfort, their role in the natural history of discomfort remains unclear. A better understanding of the relationship between coefficient of friction and comfort and strategies to improve lubricity may hold promise for limiting CL discomfort.
Vector Analysis of 1-Year Astigmatic Outcomes From a Randomized Fellow Eye Comparison of Photorefractive Keratectomy Using 2 Excimer Laser Platforms
Authors: Toy Brian C. , Manche Edward E. 
Published: December 2016

Objective:
To compare the astigmatic outcomes of photorefractive keratectomy (PRK) with a wavefront-guided (WFG) and a wavefront-optimized (WFO) excimer laser performed on two different platforms.

Methods:
Setting: institutional.

Design:
Prospective, randomized, fellow eye comparison clinical trial.

Participants:
A total of 142 eyes of 71 patients with myopia of 12 diopters (D) or less and astigmatism of 3D or less were enrolled at the Byers Eye Institute at Stanford between April 2009 and March 2011.

Intervention:
One eye of each patient underwent WFG-PRK with the VISX CustomVue Star S4 IR (Abbott Medical Optics, Abbott Park, IL) and the contralateral eye underwent WFO-PRK with the Wavelight Allegretto Eye-Q 400-Hz laser platform (Alcon, Inc., Hüenberg, Switzerland). Alpins vector analysis of astigmatism was performed using manifest refraction measured preoperatively and 12 months postoperatively and vertexed to the corneal plane. Eyes were stratified for subgroup analysis based on preoperative manifest astigmatism.

Results:
WFG-PRK and WFO-PRK were similar regarding surgically induced astigmatism, difference vector, magnitude of error, correction index, flattening index, and index of success. The angle of error was 60% less in the WFG group compared with the WFO group (4.9±1.1° vs. 11.8±2.4°, P=0.01).

Conclusions:
WFG-PRK with the VISX CustomVue Star S4 IR and WFO-PRK with the Alcon WaveLight Allegretto Eye-Q 400-Hz excimer laser platform produce similar astigmatic results in myopic patients; however, the WFG mode may produce slightly more predictable astigmatic corrections.
Meibomian Gland Dysfunction and Contact Lens Discomfort
Authors: Arita Reiko , Fukuoka Shima , Morishige Naoyuki 
Published: December 2016

Abstract:
Meibomian glands are located in the eyelids and secrete meibum, which gives rise to the lipid layer of the tear film. Changes to these glands can lead to the development of meibomian gland dysfunction (MGD), which is associated with various ocular symptoms such as fatigue, dryness, burning sensation, and heavy sensation. The diagnosis of MGD thus relies on evaluation of ocular symptoms, meibum condition, and lid margin abnormalities. The recent development of noninvasive meibography and tear interferometry has provided important insight into meibomian gland structure and function, respectively. Wearers of contact lenses complain of ocular symptoms that are thought to be attributable to a variety of causes, such as a diminished aqueous or mucin layer of the tear film, changes in tear protein concentration, and altered meibomian gland structure or function. Many studies have examined the relation between contact lens wear and meibomian gland changes. Such studies have found that lens wear is associated with adverse changes in meibomian gland morphology and in the condition of the lid margin and meibum, suggesting that contact lenses negatively affect meibomian glands. Meibomian gland dysfunction-like changes in meibomian glands induced by contact lens wear may thus be responsible for at least some of the ocular symptoms in lens wearers.
Early Reoperation Rate, Complication, and Outcomes in Resident-performed Glaucoma Surgery
Authors: Hsia Yen C. , Lee Jun Hui , Cui Qi N. , Stewart Jay M. , Naseri Ayman , Porco Travis , Stamper Robert L. , Han Ying 
Published: December 2016

Purpose of the Study:
The purpose of the study was to examine reoperation rate and complications of resident-performed glaucoma surgeries within the first 90 postoperative days.

Materials and Methods:
A retrospective study of resident-performed glaucoma filtering surgeries at the San Francisco Veterans Affairs Medical Center between 2002 and 2014 was performed. Patients requiring reoperation within 90 days of the initial surgery were included in our study. Combined surgeries were excluded. Complications and the rates of reoperation within the first 90 days were evaluated. Clinical outcomes for those who needed reoperations were evaluated at the 1-year follow-up.

Results:
Total of 180 cases were reviewed [34 trabeculectomy, 85 Ex-PRESS shunt, and 61 Ahmed glaucoma valve (AGV)]. One hundred and four eyes developed complications, most commonly choroidal effusion (65.3%), followed by hypotony (45.2%) and wound leak (32.7%). Complications were comparable among the 3 groups, except that filtering surgery had significantly more wound leak than AGV (P<0.001). Seven (3.9%) cases required reoperation within first 90 days. There was no reoperation for trabeculectomy group. Reoperation rate was 4.7% for Ex-PRESS and 4.9% for AGV (P=0.74). Indications for reoperation were persistent wound leak (4 cases) and tube occlusion/revision (3 cases). For the 7 patients who required reoperations, their intraocular pressure at 1-year postreoperation was significantly decreased compared with intraocular pressure before the initial glaucoma surgery (P<0.001) with similar number of glaucoma medications and stable visual acuity.

Conclusions:
Glaucoma incisional surgeries performed by third-year ophthalmology residents had acceptable and comparable reoperation rates and complication rates for patients with trabeculectomy, Ex-PRESS, and AGV. Clinical outcomes for the patients requiring reoperation were favorable.
Orbital Cellulitis Following Uncomplicated Aqueous Shunt Surgery
Authors: Beck Daniel E.R. , El-Assal Karim S.L. , Doherty Mark D. , Wride Nicholas K. 
Published: December 2016

Purpose:
To date, there have only been 5 reported cases of orbital cellulitis following implantation of an aqueous tube shunt for glaucoma. Previously reported cases have involved eyes with significant comorbidities and successful management has often required the removal of the device alongside systemic antibiotic therapy.

Patients and Methods:
We present a 53-year-old man with severe orbital cellulitis, 3 months after routine implantation of a Baerveldt tube shunt for primary open angle glaucoma. The patient was managed medically, with topical and systemic antibiotic therapy. The patient went on to make a full recovery with the tube in situ.

Results and Conclusions:
We report that a more conservative approach (without tube removal) to be successful in a case where there is no evidence of tube exposure. It is important to appreciate that in some cases of orbital cellulitis without clear signs of intraocular involvement, a tube can be left in situ.
The Lifestyle Change Experiences of Cancer Survivors
Authors: Tsay Shiow-Luan , Ko Wang-Sheng , Lin Kuan-Pin 
Published: December 2016

ABSTRACT

Background:
Leading a healthy lifestyle not only alleviates the physical problems but also improves the quality of life of cancer survivors. Healthcare professionals should understand the benefits of altering lifestyle behaviors to provide effective intervention programs to assist cancer survivors to improve their health.

Purpose:
The aim of this study was to understand the experiences of cancer survivors in changing their lifestyle after a cancer diagnosis.

Methods:
A qualitative descriptive study was conducted on 13 cancer survivors who were sampled purposively from a regional teaching hospital in central Taiwan. Data were collected using in-depth interviews that were guided by semistructured, open-ended questions and analyzed using content analysis.

Results:
The analysis of interview data revealed four main themes: motivation of lifestyle change, exploring ways toward a healthy lifestyle, making adjustments in lifestyle, and feeling the benefits of lifestyle changes. In striving for survival, an unwillingness to bear the suffering from treatment and their acceptance of responsibility and gratitude to family members prompted most of the participants to change their lifestyle proactively. They had received inadequate lifestyle guidance and sought health lifestyle information on their own. After a period of research and self-contemplation, most of the participants adopted a consistently healthy lifestyle, changed their dietary consumption habits, abstained from tobacco and alcohol, and managed emotional problems that were caused by the disease. Participants who changed to a healthy lifestyle realized benefits in the physical, emotional, and life domains.

Conclusions/Implications for Practice:
It is hoped that these findings help healthcare professionals to better appreciate that a cancer diagnosis is a critical opportunity to link the disease to lifestyle choices in the minds of cancer survivors. Healthcare professionals should ask cancer survivors about their lifestyle and then provide appropriate advice and education on healthy lifestyles and related benefits.
Differences in Hospital Risk-standardized Mortality Rates for Acute Myocardial Infarction When Assessed Using Transferred and Nontransferred Patients
Authors: Barbash Ian J. , Zhang Hongwei , Angus Derek C. , Reis Steven E. , Chang Chung-Chou H. , Pike Francis R. , Kahn Jeremy M. 
Published: December 2016

Background:
One in 5 patients with acute myocardial infarction (AMI) are transferred between hospitals. However, current hospital performance measures based on AMI mortality exclude these patients from the evaluation of referral hospitals.

Objective:
To determine the relationship between risk-standardized mortality for transferred and nontransferred patients at referral hospitals.

Research Design:
This is a retrospective cohort study.

Subjects:
Fee-for-service Medicare claims from 2011 for patients hospitalized with a primary diagnosis of AMI, at hospitals admitting at least 15 patients in transfer.

Measures:
Hospital-specific risk-standardized 30-day mortality rates (RSMRs) for 2 groups of patients: those admitted through transfer from another hospital, and those natively admitted without a preceding or subsequent interhospital transfer.

Results:
There were 304 hospitals admitting at least 15 patients in transfer. These hospitals cared for 77,711 natively admitted patients (median, 254; interquartile range, 162–321), and 11,829 patients admitted in transfer (median, 26; interquartile range, 19–46). Risk-standardized mortality rates were higher for natively admitted patients than for those admitted in transfer (mean, 11.5%±1.2% vs. 7.2%±1.1%). There was weak correlation between hospital performance as assessed by RSMR for patients natively admitted versus those admitted in transfer (Pearson r=0.24, P<0.001); when performance was arrayed by quartile, 102 hospitals (33.6%) differed at least 2 quartiles of performance across the 2 patient groups.

Conclusions:
For Medicare patients with AMI, hospital-specific RSMRs for natively admitted patients are only weakly associated with RSMRs for patients transferred in from another hospital. Current AMI performance metrics may fail to provide guidance about hospital quality for transferred patients.
Do Inactive Older Adults Who Increase Physical Activity Experience Less Disability
Authors: Song Jing , Gilbert Abigail L. , Chang Rowland W. , Pellegrini Christine A. , Ehrlich-Jones Linda S. , Lee Jungwha , Pinto Daniel , Semanik Pamela A. , Sharma Leena , Kwoh C. Kent , Jackson Rebecca D. , Dunlop Dorothy D. 
Published: December 2016

Background
Physical inactivity is a leading risk factor for developing disability. Although randomized clinical trials have demonstrated improving physical activity can reduce this risk in older adults with arthritis, these studies did not specifically evaluate inactive adults.

Objectives
The aim of this study was to evaluate the relationship of changes in physical activity with disability changes among initially inactive adults with or at high risk of knee osteoarthritis from Osteoarthritis Initiative.

Methods
Inactive persons were identified at baseline based on the US Department of Health and Human Services classification (no [zero] 10-minute session of moderate-to-vigorous [MV] activity over 1 week) from objective accelerometer monitoring. Two years later, physical activity change status was classified as follows: (1) met Federal physical activity guidelines (≥150 MV minutes/week acquired in bouts ≥10 minutes), (2) insufficiently increased activity (some but <150 MV bout minutes/week), or (3) remained inactive. Disability at baseline and 2 years was assessed by Late Life Disability Instrument limitation and frequency scores. Multiple regression evaluated the relationship of physical activity change status with baseline–to–2-year changes in disability scores adjusting for socioeconomics, health factors, and baseline disability score.

Results
Increased physical activity showed a graded relationship with improved disability scores in Late Life Disability Instrument limitation (P < 0.001) and frequency scores (P = 0.027). While increasing MV activity to guideline levels showed the greatest reduction, even insufficiently increased physical activity was related to reduced disability.

Conclusions
Findings support advice to increase MV physical activity to reduce disability among inactive adults with or at high risk of knee osteoarthritis, even when guidelines are not met.
Alemtuzumab Induction and Delayed Acute Rejection in Steroid-Free Simultaneous Pancreas-Kidney Transplant Recipients
Authors: Bank Jonna R. , Heidt Sebastiaan , Moes Dirk Jan A. R. , Roelen Dave L. , Mallat Marko J. K. , van der Boog Paul J.M. , Vergunst Manon , Jol-van der Zijde Cornelia M. , Bredius Robbert G. M. , Braat Andries E. , Ringers Jan , van Tol Maarten J. D. , Claas Frans H. J. , Reinders Marlies E. J. , de Fijter Johannes W. 
Published: December 2016

BackgroundThe optimal immunosuppressive regimen in simultaneous pancreas-kidney transplant (SPKT) recipients that prevents acute rejection episodes (AREs) and allows optimal outcome remains elusive.MethodsThis cohort study assessed incidence and time to AREs in 73 consecutive SPKT recipients receiving alemtuzumab induction and steroid-free maintenance with tacrolimus and mycophenolate mofetil. A cohort with single high-dose antithymocyte globulin (ATG; n = 85) and triple therapy served as controls. In addition, we provided mechanistic insights in AREs after alemtuzumab depletion, including composition and alloreactivity of lymphocytes (flow cytometry and mixed lymphocyte reaction) plasma alemtuzumab levels (enzyme-linked immunosorbent assay), and maintenance drug exposure.ResultsOverall number of AREs at 3 years was significantly lower with alemtuzumab versus ATG induction (26.0% vs 43.5%; adjusted hazard ratio, 0.38;P= 0.029). Most AREs (94.6%) with ATG occurred within the first month, whereas 84.2% of AREs with alemtuzumab occurred beyond 3 months. Patients with and without an ARE in the steroid-free alemtuzumab group showed no differences in composition of lymphocytes, or in alemtuzumab levels. Of note, more than two thirds of these AREs were preceded by empiric tacrolimus and/or mycophenolate mofetil dose adjustments due to viral infections, leukopenia, or gastrointestinal symptoms.ConclusionsAlemtuzumab induction resulted in a significant lower incidence of AREs. Empiric dose adjustments beyond 3 months in the absence of steroids carry a significant risk for subsequent rejection in SPKT recipients.