bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Randomized Controlled Trial With Mean 16-Year Follow-up Comparing Hamstring and Patellar Tendon Autografts in Anterior Cruciate Ligament Reconstruction
Authors: Björnsson Haukur , Samuelsson Kristian , Sundemo David , Desai Neel , Sernert Ninni , Rostgård-Christensen Lars , Karlsson Jón , Kartus Jüri 
Published: May 2016

Background: There is no consensus in the current literature on which surgical options render the best long-term results after anterior cruciate ligament (ACL) reconstruction in terms of clinical outcomes and the development of radiographic osteoarthritis (OA). Purpose: To investigate the long-term clinical and radiographic results after ACL reconstruction using either a patellar tendon (PT) autograft or a hamstring tendon (HT) autograft. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: This multicenter study was based on 2 previous randomized cohorts consisting of 193 patients who underwent unilateral primary ACL reconstruction using either a PT autograft or an HT autograft. The index surgical procedure was performed between September 1995 and January 2000. Clinical assessments, including knee laxity measurements, functional outcomes, patient-reported outcomes, and bilateral standing radiographs, were performed at the final follow-up examination. Results: At the long-term follow-up, 147 (76%) patients were examined: 61 in the PT group and 86 in the HT group. The mean (±SD) follow-up time was 191.9 ±15.1 months for the HT group and 202.6 ± 10.4 months for the PT group. Knee laxity measurements revealed significantly more patients with a normal pivot-shift test finding in the HT group compared with the PT group (71% vs 51%, respectively; P = .048); however, no significant differences were found in terms of the manual Lachman test or the KT-1000 arthrometer manual maximum test. The patients in the PT group had significantly more difficulty knee walking ( P = .049). There were no significant differences between the study groups in terms of patient-reported outcomes or range of motion in the reconstructed knee. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral healthy knee. However, there were no significant differences between the groups in terms of radiographic OA. Conclusion: Only minor and mostly insignificant differences were found between the PT and HT autograft groups in this long-term randomized controlled trial. In both groups, significantly more signs of radiographic OA were found in the reconstructed knee than in the contralateral knee.
Expanded lung T-bet+RORγT+CD4+T-cells in sarcoidosis patients with a favourable disease phenotype
Authors: Kaiser Ylva , Lepzien Rico , Kullberg Susanna , Eklund Anders , Smed-Sörensen Anna , Grunewald Johan 
Published: May 2016

Disease phenotypes of pulmonary sarcoidosis are distinguished by clinical rather than immunological criteria. We aimed to characterise patterns of CD4+T-cell lineage plasticity underlying the differences in clinical presentation and disease course between the acute form, Löfgren's syndrome, and the heterogeneous, potentially progressive “non-Löfgren” form.33 pulmonary sarcoidosis patients and nine controls underwent bronchoscopy with bronchoalveolar lavage. CD4+T-cell transcription factor, chemokine receptor and T-cell receptor expression, proliferation and cytokine production were assessed in the lavage fluid and peripheral blood using flow cytometry and multicolour FluoroSpot.CD4+T-cells simultaneously expressing the T-helper cell (Th)1 and Th17 transcriptional regulators T-bet and RORγT (T-bet+RORγT+) were identified in the lavage, but not blood, of all subjects, and to a significantly higher degree in Löfgren's patients. T-bet+RORγT+cells proliferated actively, produced interferon (IFN)γ and interleukin (IL)-17A, co-expressed the chemokine receptors CXCR3 and CCR6, and correlated with nonchronic disease. T-cell receptor-restricted Vα2.3+Vβ22+T-cells strongly co-expressed T-bet/RORγT and CXCR3/CCR6. Cytokine production was more heterogeneous in Löfgren's patients, with significantly higher IL-17A, IL-10, IL-22 and IL-2, but lower IFNγ.Here we demonstrate the presence of lung T-bet+RORγT+CXCR3+CCR6+CD4+T-cells and Th17-associated cytokines especially in sarcoidosis patients with a favourable prognosis, suggesting a Th1/Th17-permissive environment in the lung with implications for disease resolution.
Utility of measuring FEV0.75/FVC ratio in preschoolers with uncontrolled wheezing disorder
Authors: Nève Véronique , Hulo Sébastien , Edmé Jean-Louis , Boileau Sophie , Baquet Georges , Pouessel Guillaume , Thumerelle Caroline , Deschildre Antoine , Matran Régis 
Published: May 2016

Uncontrolled wheezing disorder is common in preschoolers and disease control assessment is challenging as parents frequently overestimate the extent to which their child's disease is controlled. This is the first study of forced expiratory volume int s (FEVt)/forced vital capacity (FVC) ratio measurements (i.e.FEV1/FVC, FEV0.75/FVC and FEV0.5/FVC) in wheezy preschoolers in relation to disease control. Our objective was to evaluate whether FEVt/FVC ratios less than the lower limit of normal (LLN; z-score <−1.64) were associated with uncontrolled wheezing disorder in preschoolers.Valid FVC, FEV1, FEV0.75and FEV0.5values were obtained in 92 healthy and 125 wheezy (62% uncontrolled) children (3–5 years). Associations between spirometry value <LLN, disease classification (healthy/wheezy) and disease control classifications (controlled/uncontrolled disease) were estimated using logistic regression.FEV0.75/FVC or FEV0.5/FVC ratios <LLN were associated with wheezing disorder (OR 9.78, 95% CI 3.70–25.88 and OR 6.64, 95% CI 2.24–19.66; all p<0.001). Only an FEV0.75/FVC ratio <LLN was associated with uncontrolled wheezing disorder (OR 2.53, 95% CI 1.12–5.68; p=0.025).FEV0.75/FVC ratio is a useful surrogate outcome index to evaluate the control of the wheezing disease of preschoolers.
Epidemiology and survival of idiopathic pulmonary fibrosis from national data in Canada
Authors: Hopkins Robert B. , Burke Natasha , Fell Charlene , Dion Genevieve , Kolb Martin 
Published: May 2016

Idiopathic pulmonary fibrosis (IPF) is a rare disease, with estimates of prevalence varying considerably across countries due to paucity in data collection. The aim of this study was to investigate the prevalence and incidence of IPF in Canada using administrative data requiring minimal extrapolation.We used mandatory national administrative data from 2007–2011 to identify IPF cases of all ages with an International Classification of Diseases (Version 10, Canadian) diagnosis code of J84.1. We used a broad definition that excluded cases with subsequent diagnosis of other interstitial lung diseases, and a narrow definition that required further diagnostic testing prior to IPF diagnosis. We explored survival and quality of life.For all ages, the broad prevalence of IPF was 41.8 per 100 000 (14 259 cases) and was higher for men. The incidence rate was 18.7 per 100 000 (6390 cases) and was higher for men. The narrow prevalence was 20.0 per 100 000 (6822 cases) and incidence was 9.0 per 100 000 (3057 cases). The 4-year risk of death was 41.0% and the quality of life with IPF after 2 years was lower than for Global Initiative for Chronic Obstructive Lung Disease stage IV chronic obstructive pulmonary disease.Using comprehensive national data, the prevalence of IPF in Canada was higher than other national estimates, suggesting that either IPF may be more common in Canada or that data capture may have been previously limited.
Observation of viable alloskin vs xenoskin grafted onto subcutaneous tissue wounds after tangential excision in massive burns
Authors: Zuo Haibin , Song Guodong , Shi Wen , Jia Jun , Zhang Yonghu 
Published: May 2016

Abstract

Background
Staged excision and grafting with viable cryopreserved alloskin or fresh pigskin at an early stage is a main strategy for wound management in massive burns. Alloskin is the gold standard of a biological temporary skin substitute, and the main drawback to its wider use is the limited number of donors. In this paper, we compare the use of fresh pigskins to cryopreserved alloskins as temporary skin substitutes on subcutaneous tissue wounds after tangential excision by observing the clinical performances of these grafts in cases of a massive burn.

Methods
We selected six adult massive burn patients undergoing tangential excision and skin grafting on subcutaneous tissue wounds (TESGSTW) at our burn center from January 1, 2003 to December 31, 2013. The general clinical data and survival percentage of skins at postoperative weeks (POWs) 1, 2, and 3 were analyzed. In our clinical practice, we also observed the phenomenon that several viable cryopreserved alloskin or fresh pigskin grafts used as temporary coverage on subcutaneous tissue wounds had long-term survival after repeated desquamation. The macroscopic and histological results of one typical case were also analyzed.

Results
In this study, the first three TESGSTW operations were performed at 2–3, 5–8, and 11–16 days post-injury. The operation areas were 30.3 ± 7.9 % total body surface area (TBSA), 19.0 ± 6.0 % TBSA, and 12.0 ± 1.7 % TBSA, respectively. The survival percentage of the cryopreserved alloskins or fresh pigskins at POWs 1, 2, and 3 were 80.0 ± 10.0 % vs 75.7 ± 5.3 % (t = 1.01, P = 0.16), 71.2 ± 10.6 % vs 66.4 ± 6.2 % (t = 1.09, P = 0.30), and 48.7 ± 2.5 % vs 35.0 ± 7.0 % (t = 3.83, P = 0.03), respectively. The microscopic observation of the survival of alloskins or pigskins in one typical case showed rete ridges and a basilar membrane at the joint of the epidermis and dermis at an early stage; these structures disappeared with extended time post-operation.

Conclusions
From the clinical observations, fresh pigskin and cryopreserved alloskins could be used with equal effectiveness at an early stage (within 2 weeks post-operation) as temporary coverage on massive burns after TESGSTW. After engraftment, several cryopreserved alloskins or fresh pigskins could co-survive in a massive burn patient for an extended amount of time. The co-survival of alloskin and pigskin will provide clues for further research into skin transplantation.
POWER LEVEL EFFECTS ON THORIUM-BASED FUELS IN PRESSURE-TUBE HEAVY WATER REACTORS
Authors: Bromley Blair Patrick , Edwards Geoffrey W.R. , Sambavalingam Pranavan 
Published: May 2016

Lattice and core physics modeling and calculations have been performed to quantify the impact of power/flux levels on the reactivity and achievable burnup for 35-element fuel bundles made with Pu/Th or U-233/Th. The fissile content in these bundles has been adjusted to produce on the order of 20 MWd/kg burnup in homogeneous cores in a 700 MWe-class pressure-tube heavy water reactor, operating on a once-through thorium cycle. Results demonstrate that the impact of the power/flux level is modest for Pu/Th fuels but significant for U-233/Th fuels. In particular, high power/flux reduces the breeding and burnup potential of U-233/Th fuels. Thus, there may be an incentive to operate reactors with U-233/Th fuels at a lower power density or to develop alternative refueling schemes that will lower the time-average specific power, thereby increasing burnup.
Barriers and facilitators to end-of-life communication in advanced chronic organ failure
Authors: Van den Heuvel Liza AMC , Hoving Ciska , Schols Jos MGA , Spruit Martijn A , Wouters Emiel FM , Janssen Daisy JA 
Published: May 2016

Aim: The aim of this quantitative, cross-sectional study was to identify barriers and facilitators to end-of-life communication experienced by family caregivers of patients with advanced chronic organ failure and to examine agreement in barriers and facilitators between family caregivers and patients. Methods: Patients and family caregivers were interviewed using the barriers and facilitators questionnaire. Agreement was determined using intraclass correlation coefficients for continuous variables and Cohen's kappa for categorical variables. Results: A total of 158 patients and family caregiver dyads were included. The most important barriers for family caregivers were related to uncertainty about expected care and focus on staying alive instead of dying. The facilitators were related to trust in and competence of their physician and earlier experiences with death in their (social) environment. For most barriers and facilitators, agreement between patients and family caregivers was fair to moderate. Conclusion: Differences in barriers and facilitators between patients and family caregivers ask for an individual approach to facilitate end-of-life communication.
Nerve injuries associated with supracondylar fractures of the humerus in children
Authors: Kwok I. H. Y. , Silk Z. M. , Quick T. J. , Sinisi M. , MacQuillan A. , Fox M. 
Published: May 2016

Aims We aimed to identify the pattern of nerve injury associated with paediatric supracondylar fractures of the humerus. Patients and Methods Over a 17 year period, between 1996 and 2012, 166 children were referred to our specialist peripheral nerve injury unit. From examination of the medical records and radiographs were recorded the nature of the fracture, associated vascular and neurological injury, treatment provided and clinical course. Results Of the 166 patients (111 male, 55 female; mean age at time of injury was seven years (standard deviation 2.2)), 26 (15.7%) had neurological dysfunction in two or more nerves. The injury pattern in the 196 affected nerves showed that the most commonly affected nerve was the ulnar nerve (43.4%), followed by the median (36.7%) and radial (19.9%) nerves. A non-degenerative injury was seen in 27.5%, whilst 67.9% were degenerative in nature. Surgical exploration of the nerves was undertaken in 94 (56.6%) children. The mean follow-up time was 12.8 months and 156 (94%) patients had an excellent or good clinical outcome according to the grading of Birch, Bonney and Parry. Conclusion Following paediatric supracondylar fractures we recommend prompt referral to a specialist unit in the presence of complete nerve palsy, a positive Tinel’s sign, neuropathic pain or vascular compromise, for consideration of nerve exploration. Take home message: When managed appropriately, nerve recovery and clinical outcomes for this paediatric population are extremely favourable. Cite this article: Bone Joint J 2016;98-B:851–6.
Review of the outcomes of complex acetabular reconstructions using a stemmed acetabular pedestal component
Authors: Stihsen C. , Hipfl C. , Kubista B. , Funovics P. T. , Dominkus M. , Giurea A. , Windhager R. 
Published: May 2016

AimUntil now, there has been no consensus as to whether stemmed acetabular components are appropriate for use in patients undergoing revision total hip arthroplasty (THA) who have major acetabular defects or pelvic discontinuity. We wished to address this deficiency in the literature.Patients and MethodsWe carried out a retrospective study of 35 patients (six men and 29 women) with a mean age of 68 years (37 to 87), with major acetabular defects who underwent revision THA between 2000 and 2012.ResultsAt a mean follow-up of 63 months (24 to 141), a total of 15 patients (43%) had required at least one further operation. Six implants (17%) loosened aseptically, four (11%) were further revised for infection and two (6%) for technical failure. By taking revision for any reason as the endpoint, the rate of survival of the implant was 61% after five years; by taking revision for aseptic loosening as the end point, it was 78%. The cumulative five-year survival for aseptic loosening was 94% in patients without pelvic discontinuity, and 56% in those with pelvic discontinuity.ConclusionThese results indicate a significantly worse survival in patients with pelvic discontinuity (p = 0.020) and we advise caution in the use of the pedestal component in patients with major acetabular defects and pelvic discontinuity who require revision THA. As a result of these findings we have stopped using this implant and prefer to use particulate bone grafts protected with an anti-protrusion cage and posterior column plate fixation, if necessary. Take home message: Based on these poor results, we advise caution if using the pedestal component in patients with major acetabular defects with the presence of a pelvic discontinuity. Cite this article: Bone Joint J 2016;98-B:772–9.
A comparison between the direct anterior and posterior approaches for total hip arthroplasty
Authors: Malek I. A. , Royce G. , Bhatti S. U. , Whittaker J. P. , Phillips S. P. , Wilson I. R. B. , Wootton J. R. , Starks I. 
Published: May 2016

Aims We assessed the difference in hospital based and early clinical outcomes between the direct anterior approach and the posterior approach in patients who undergo total hip arthroplasty (THA). Patients and Methods The outcome was assessed in 448 (203 males, 245 females) consecutive patients undergoing unilateral primary THA after the implementation of an ‘Enhanced Recovery’ pathway. In all, 265 patients (mean age: 71 years (49 to 89); 117 males and 148 females) had surgery using the direct anterior approach (DAA) and 183 patients (mean age: 70 years (26 to 100); 86 males and 97 females) using a posterior approach. The groups were compared for age, gender, American Society of Anesthesiologists grade, body mass index, the side of the operation, pre-operative Oxford Hip Score (OHS) and attendance at ‘Joint school’. Mean follow-up was 18.1 months (one to 50). Results There was no significant difference in mean length of stay (p = 0.07), pain scores on the day of surgery, the first, second and third post-operative days (p = 0.36, 0.23, 0.25 and 0.59, respectively), the day of mobilisation (p = 0.12), the mean OHS at six and 24 months (p = 0.08, and 0.29, respectively), the incidence of infection (p = 1.0), dislocation (p = 1.0), re-operation (p = 0.21) or 28 days’ re-admission (p = 0.06). Significantly more patients in the DAA group achieved a planned discharge target of three days post-operatively (68% vs 56%, p = 0.007). The rate of periprosthetic femoral fractures was significantly higher in the DAA group (p = 0.04). Conclusion We conclude that there is no difference in clinical outcomes between the DAA and the posterior approach in patients undergoing THA when an ‘Enhanced Recovery’ pathway is used. However, a significantly higher rate of periprosthetic femoral fractures remains a concern with the DAA, even in experienced hands. Take home message: Our results show that the DAA for THA is not superior to posterior approach when ‘Enhanced Recovery’ pathway is used. Cite this article: Bone Joint J 2016;98-B:754–60.
Description of a quality improvement training programme for health professionals in the ministry of health and social services in Namibia
Authors: Nangombe Julia Paul , Amukugo Hans Justus 
Published: May 2016

The aim of this paper is to describe the quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia. The Practice Oriented Theory of Dickoff (1968) was used as practical guidelines to develop the conceptual framework. This framework was employed during the research and the educational programme development process. During the research process, the agent was the researcher; recipients (Managers/leadership and health professionals); the context (MoHSS head office and healthcare facilities); dynamics (findings for objective one and two); Procedure (research process) and terminus (foundations for development of educational programme). For the educational programme developing process, agent (quality specialist), recipients (health professional), context (health facilities), procedure (training programme for health professionals), dynamics, (challenges hampering successful implementation of the programme) and the terminus (knowledge, skills and abilities acquired through the training programme). During the development of the quality improvement training programme, two main theories were adapted. The most prominent one was a model by Meyer and Van Niekerk (2008), which was adapted to guide the process of developing the training programme. Kolb’s experiential learning theory was used to explain the learning process and styles of developing knowledge through experiences.The content of the training programme was derived from five main themes, 17 sub-themes and the conceptual framework based on the situation analysis about challenges faced by the health care facilities. The five themes were lack of implementation of policies and guidelines; inadequate resources; lack of interpersonal relationships; inadequate understanding of quality assurance and quality improvement; and inadequate research to provide evidence-based information during treatment and patient care.The educational programme consisted of the purpose / aim, objectives, structure / design, facilitation process, implementation process, and evaluation of the programme.
Intrafamiliale Zeitallokation, Haushaltsproduktion und Frauenerwerbstätigkeit / Intrafamily Allocation of Time, Home Production, and Female Labor Force Participation
Authors: Althammer Jörg , Wenzler Simone 
Published: May 2016

Zusammenfassung
Der vorliegende Aufsatz analysiert die intrafamiliale Zeitallokation im theoretischen Kontext der neueren Haushaltsökonomie und liefert einen mikroökonomisch fundierten Ansatz zur Quantifizierung der Leistungen im Haushalt. Unter Verwendung der Daten der neunten Welle des sozioökonomischen Panels werden die theoretischen Ergebnisse empirisch umgesetzt; dabei zeigt sich, daß ökonomische Parameter einen eigenständigen Beitrag zur Erklärung der Erwerbspartizipation und der intrafamilialen Rollenverteilung leisten und die im Haushalt erbrachte Wertschöpfung in Abhängigkeit von Familiengröße und dem Erwerbsstatus der Frau zwischen 43 % und 152 % der Wertschöpfung am Arbeitsmarkt ausmacht.
Ein räumliches Modell der Bank / A Spatial Model of a Banking Firm
Authors: Schöler Klaus 
Published: May 2016

Zusammenfassung
Ausgangspunkt für diesen Beitrag ist die empirische Beobachtung regionaler Märkte für Bankkredite. Dieses Phänomen bedarf einer Erklärung, da der Transport von Finanzdienstleistungen geringe und in vielen Fällen entfernungsunabhängige Kosten verursacht. Transportkosten können - im Gegensatz zu güterproduzierenden Unternehmen - nicht die Ursache für regionale Kreditmärkte sein. Als Grund für das beschriebene Phänomen wird die räumlich begrenzte Diffusion kostenloser Informationen über die Kreditnehmer angenommen. Mit steigender Entfernung zwischen Bank und Kreditnehmer reduzieren sich die kostenlos verfügbaren Informationen und führen entweder zu Kreditausfällen oder zu steigenden Kosten der Bank für Informationsbeschaffung. In beiden Fällen entsteht ein regionaler Kreditmarkt, der unter alternativen Bedingungen untersucht wird.
Energieeinsparung als Versicherung gegen Marktrisiken / Saving Energy as Insurance against Market Risk
Authors: Kreuzberg Peter 
Published: May 2016

Zusammenfassung
Viele Investitionen in die Einsparung konventioneller Energieträger gelten als unwirtschaftlich, weil sie ihre Kapitalkosten nicht erwirtschaften. Am Beispiel von öleinsparenden Projekten wird in der vorliegenden Arbeit gezeigt, daß die traditionell verwendeten Kapitalkosten vermutlich stark überhöht sind. Das empirisch geschätzte, statistisch signifikante „Öl-BETA“ weist ein negatives Vorzeichen auf und liefert ein Indiz für die Eigenschaft der Energieeinsparung als Versicherung gegen systematische Marktrisiken. Die risikoangepaßten Kapitalkosten liegen unter diesen Umständen unterhalb der Verzinsung risikoloser Anlagen.