bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incarcerated Medial Epicondyle Fractures With Elbow Dislocation: Risk Factors Associated With Morbidity
Authors: Vuillermin Carley , Donohue Kyna S. , Miller Patricia , Bauer Andrea S. , Kramer Dennis E. , Yen Yi-Meng 
Published: April 2017

Background:
Incarcerated medial epicondyle fractures in association with elbow trauma are rare and an absolute indication for intervention. Because of the infrequent nature, outcomes following this injury are not well documented. We studied a large cohort of these injuries to determine factors associated with functional outcomes. It was hypothesized that a greater duration between initial presentation and time of surgery would lead to poorer outcomes.

Methods:
A total of 32 patients aged 18 and under who underwent surgical treatment for an incarcerated medical epicondyle fracture at a level-1 pediatric trauma center from 2003 to 2015 were identified. All patients had a confirmed diagnosis of an incarcerated medial epicondyle at surgery. Medical records and radiographs were reviewed to determine the patient demographics, mechanism of injury, preoperative neurological symptoms, time of primary presentation, time of elbow reduction, and time to surgical intervention. Postoperative outcomes, including pain, range of motion, and ulnar nerve symptoms, were also collected. The Roberts outcome score was determined for each subject.

Results:
A radiographically confirmed elbow dislocation was identified in 25 subjects. The mean age at injury was 13.2 years (range, 7.3 to 17.8 y). Initial presentation was at a referring institution in 30 patients (94%). First closed reduction attempt of the ulnohumeral joint occurred in the emergency room in 24 subjects (75%); of these 7 subjects (22%) had a first reduction attempted in the emergency room at our institution, 2 patients experienced first elbow reduction during surgical intervention. The median time from first presentation to surgery was 21.9 hours (interquartile range, 15 to 40). Fourteen subjects displayed preoperative ulnar nerve symptoms. Of these, 9 subsequently reported postoperative ulnar nerve symptoms. There was no effect of time to surgical intervention on the Roberts outcome scores at follow-up, nerve symptoms, symptomatic hardware, or need for second surgery to remove hardware. There were 16 subjects with excellent outcomes, 13 with good outcomes, 3 with fair outcomes, and 0 with poor outcomes (based on the Roberts criteria).

Conclusions:
Incarcerated medial epicondyle fractures are commonly associated with ulnar nerve symptoms; however, they are not associated with a significant rate of other complications. There was no increased risk of complications in subjects who had a longer duration between initial presentation and surgery. This suggests that, while the presence of an incarcerated medial epicondyle fracture is certainly an indication for timely operative intervention; the injury in isolation does not need to be considered emergent. Other factors including neurovascular status and ability to achieve joint reduction may still necessitate emergency operative care.

Level of Evidence:
Level IV—therapeutic study, case series.
A Dose-Response Curve for a Gram-Negative Spinal Implant Infection Model in Rabbits
Authors: Laratta Joseph L. , Shillingford Jamal N. , Hardy Nathan , Lehman Ronald A. , Lenke Lawrence G. , Riew K. Daniel 
Published: April 2017

Study Design.
A randomized complete block animal spinal implant infection model with internal control.

Objective.
The aim of this study was to develop a spinal implant animal infection model to simulate postoperative gram-negative wound infection.

Summary of Background Data.
Implant-associated surgical site infections (SSIs) remain a dreaded complication of spinal surgery. Currently, over 30% of all spine SSIs are secondary to gram-negative bacteria. Traditional animal models have utilized gram-positive inoculums to simulate postoperative infection, but there exists no model in the literature for gram-negative infection in the setting of spinal instrumentation.

Methods.
Five New Zealand white female rabbits underwent simulated partial laminectomies and implantation of a 5 mm titanium wire adjacent to the spinous processes of vertebra T4, T9, L1, and L6 to mimic posterior spinal instrumentation. The second site, T9, was used as the sterile internal control sites, while all other sites were challenged with varying inoculums of Escherichia coli (EC American Type Culture Collection 25922): 102, 103, 104, 105, and 106 Colony Forming Units (CFU). The rabbits were sacrificed 4 days postoperatively and bacterial loads were assayed from the implants and surrounding tissue.

Results.
No evidence for infection was observed in any of the sterile control sites. The lowest inoculum of E. coli (102 CFU) did not produce a reliable infection. Inoculation with 103 CFU created a consistent soft tissue infection, but inconsistent infection on implants. Inoculation with 105 CFU was required to consistently produce both soft tissue and implant infection.

Conclusion.
Consistent soft tissue and implant infection was produced with inoculation of 105 CFU of E. coli. Gram-negative infections represent greater than 30% of all spinal SSIs, and this animal model can reliably reproduce such infections with spinal instrumentation that can guide future development of anti-infective therapies.

Level of Evidence: 2
The New MIRUS System for Short-Term Sedation in Postsurgical ICU Patients*
Authors: Romagnoli Stefano , Chelazzi Cosimo , Villa Gianluca , Zagli Giovanni , Benvenuti Francesco , Mancinelli Paola , Arcangeli Giulio , Dugheri Stefano , Bonari Alessandro , Tofani Lorenzo , Belardinelli Andrea , De Gaudio A. Raffaele 
Published: April 2017

Objectives:
To evaluate the feasibility and safety of the MIRUS system (Pall International, Sarl, Fribourg, Switzerland) for sedation with sevoflurane for postsurgical ICU patients and to evaluate atmospheric pollution during sedation.

Design:
Prospective interventional study.

Setting:
Surgical ICU. February 2016 to December 2016.

Patients:
Postsurgical patients requiring ICU admission, mechanical ventilation, and sedation.

Interventions:
Sevoflurane was administered with the MIRUS system targeted to a Richmond Agitation Sedation Scale from –3 to –5 by adaptation of minimum alveolar concentration.

Measurements and Main Results:
Data collected included Richmond Agitation Sedation Scale, minimum alveolar concentration, inspired and expired sevoflurane fraction, wake-up times, duration of sedation, sevoflurane consumption, respiratory and hemodynamic data, Simplified Acute Physiology Score II, Sepsis-related Organ Failure Assessment, and laboratory data and biomarkers of organ injury. Atmospheric pollution was monitored at different sites: before sevoflurane delivery (baseline) and during sedation with the probe 15 cm up to the MIRUS system (S1) and 15 cm from the filter-Reflector group (S2). Sixty-two patients were enrolled in the study. No technical failure occurred. Median Richmond Agitation Sedation Scale was –4.5 (interquartile range, –5 to –3.6) with sevoflurane delivered at a median minimum alveolar concentration of 0.45% (interquartile range, 0.4–0.53) yielding a mean inspiratory and expiratory concentrations of 0.79% (sd, 0.24) and 0.76% (sd, 0.18), respectively. Median awakening time was 4 minutes (2.2–5 min). Median duration of sevoflurane administration was 3.33 hours (2.33–5.75 hr), range 1–19 hours with a mean consumption of 7.89 mL/hr (sd, 2.99). Hemodynamics remained stable over the study period, and no laboratory data indicated liver or kidney injury or dysfunction. Median sevoflurane room air concentration was 0.10 parts per million (interquartile range, 0.07–0.15), 0.17 parts per million (interquartile range, 0.14–0.27), and 0.15 parts per million (interquartile range, 0.07–0.19) at baseline, S1, and S2, respectively.

Conclusions:
The MIRUS system is a promising and safe alternative for short-term sedation with sevoflurane of ICU patients. Atmospheric pollution is largely below the recommended thresholds (< 5 parts per million). Studies extended to more heterogeneous population of patients undergoing longer duration of sedation are needed to confirm these observations.
Successful Treatment of Stable Vitiligo by Low-Density Cultured Autologous Melanocyte Transplantation Combined With Narrowband Ultraviolet B Therapy
Authors: Yao Lei , Liu Yuanyuan , Song Yang , Zhong Shuxia , Li Shanshan 
Published: April 2017

BACKGROUND
Cultured autologous melanocyte transplantation (CMT) is an effective treatment for stable vitiligo, but the current method is time consuming and expensive because of the requirement of a large number of melanocytes.

OBJECTIVE
To assess the clinical effect of low-density CMT combined with narrowband ultraviolet B (NB-UVB) in treating stable vitiligo.

MATERIALS AND METHODS
The authors treated 8 patients with CMT at a low cell density (less than 2.5 × 104 cells/cm2). Among them, 6 patients underwent NB-UVB therapy after CMT.

RESULTS
All the 6 patients treated with low-density CMT combined with NB-UVB obtained more than 90% repigmentation at the 1-year follow-up.

CONCLUSION
The authors' data suggest that low-density CMT combined with NB-UVB can be an effective form of surgical treatment for stable vitiligo.
Effect of Electroacupuncture at The Zusanli Point (Stomach-36) on Dorsal Random Pattern Skin Flap Survival in a Rat Model
Authors: Wang Li-Ren , Cai Le-Yi , Lin Ding-Sheng , Cao Bin , Li Zhi-Jie 
Published: April 2017

BACKGROUND
Random skin flaps are commonly used for wound repair and reconstruction. Electroacupuncture at The Zusanli point could enhance microcirculation and blood perfusion in random skin flaps.

OBJECTIVE
To determine whether electroacupuncture at The Zusanli point can improve the survival of random skin flaps in a rat model.

MATERIALS AND METHODS
Thirty-six male Sprague Dawley rats were randomly divided into 3 groups: control group (no electroacupuncture), Group A (electroacupuncture at a nonacupoint near The Zusanli point), and Group B (electroacupuncture at The Zusanli point). McFarlane flaps were established. On postoperative Day 2, malondialdehyde (MDA) and superoxide dismutase were detected. The flap survival rate was evaluated, inflammation was examined in hematoxylin and eosin–stained slices, and the expression of vascular endothelial growth factor (VEGF) was measured immunohistochemically on Day 7.

RESULTS
The mean survival area of the flaps in Group B was significantly larger than that in the control group and Group A. Superoxide dismutase activity and VEGF expression level were significantly higher in Group B than those in the control group and Group A, whereas MDA and inflammation levels in Group B were significantly lower than those in the other 2 groups.

CONCLUSION
Electroacupuncture at The Zusanli point can effectively improve the random flap survival.
The Nasal Tip Rotation Flap for Reconstruction of the Lateral Nasal Tip, Anterior Ala, and Soft Triangle: The Authors' Experience With 55 Patients
Authors: Benoit Anastasia , Hollmig S. Tyler , Leach Brian C. 
Published: April 2017

BACKGROUND
Defects of the lateral nasal tip, anterior ala, and soft triangle subunits lack reconstructive options that are consistently satisfactory. For such defects, the novel anterior-based nasal tip rotation flap provides functional and aesthetic results in a single operative session.

OBJECTIVE
To describe the authors' experience with the nasal tip rotation flap, including patient selection and design modifications to enhance aesthetic success.

METHODS
An IRB-approved retrospective database review of nasal tip rotation flap repairs was performed at the Medical University of South Carolina and Stanford University Medical Center. The design and surgical technique of this flap are described and illustrated, emphasizing factors such as nasal shape and defect location in modifying flap design.

RESULTS
The nasal tip rotation is a single-stage, local flap that provides optimal tissue match with recapitulation of the native topography of the nasal tip and incision lines that are well hidden at the junction of cosmetic subunits. The mechanics of the flap distribute closure tension widely across the alar rim without focal notching or airway compromise.

CONCLUSION
The nasal tip rotation flap is a reliable, cosmetically elegant repair that fills a gap in the reconstructive options for anterior ala and soft triangle defects on the nose.
Nurse practitioner–physician comanagement of primary care patients: The promise of a new delivery care model to improve quality of care
Authors: Norful Allison Andreno , Swords Kyleen , Marichal Mickaela , Cho Hwayoung , Poghosyan Lusine 
Published: April 2017

Background:
The U.S. primary care system is under tremendous strain to deliver care to an increased volume of patients with a concurrent primary care physician shortage. Nurse practitioner (NP)–physician comanagement of primary care patients has been proposed by some policy makers to help alleviate this strain. To date, no collective evidence demonstrates the effects of NP–physician comanagement in primary care.

Purpose:
This is the first review to synthesize all available studies that compare the effects of NP–physician comanagement to an individual physician managing primary care.

Methods:
The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) framework guided the conduct of this systematic review. Five electronic databases were searched. Titles, abstracts, and full texts were reviewed, and inclusion/exclusion criteria were applied to narrow search results to eligible studies. Quality appraisal was performed using Downs and Black’s quality checklist for randomized and nonrandomized studies.

Results:
Six studies were identified for synthesis. Three outcome categories emerged: (a) primary care provider adherence to recommended care guidelines, (b) empirical changes in clinical patient outcomes, and (c) patient/caregiver quality of life. Significantly more recommended care guidelines were completed with NP–physician comanagement. There was variability of clinical patient outcomes with some findings favoring the comanagement model. Limited differences in patient quality of life were found. Across all studies, the NP–physician comanagementcare delivery model was determined to produce no detrimental effect on measured outcomes and, in some cases, was more beneficial in reaching practice and clinical targets.

Practice Implications:
The use of NP–physician comanagement of primary care patients is a promising delivery care model to improve the quality of care delivery and alleviate organizational strain given the current demands of increased patient panel sizes and primary care physician shortages. Future research should focus on NP–physician interactions and processes to isolate the attributes of a successful NP–physician comanagement model.
Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes
Authors: Beauvais Brad , Richter Jason P. , Kim Forest S. 
Published: April 2017

Background:
As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear.

Purpose:
The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance.

Methodology/Approach:
Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income.

Results:
Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income.

Practice Implications:
Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.
Safety of the Inactivated Japanese Encephalitis Virus Vaccine IXIARO in Children
Authors: Dubischar Katrin L. , Kadlecek Vera , Sablan Benjamin , Borja-Tabora Charissa Fay , Gatchalian Salvacion , Eder-Lingelbach Susanne , Mueller Zsuzsanna , Westritschnig Kerstin 
Published: April 2017

Background:
Japanese encephalitis remains a serious health concern in Asian countries and has sporadically affected pediatric travelers. In the present study, we monitored the safety profile of the Japanese encephalitis virus vaccine IXIARO (Valneva Austria GmbH, Vienna, Austria) in a pediatric population.

Methods:
We randomized 1869 children between 2 months and 17 years of age in an age-stratified manner to vaccination with IXIARO or one of the control vaccines, Prevnar (formerly Wyeth Pharmaceuticals Inc., now Pfizer Inc., Kent, United Kingdom) and HAVRIX 720 (GlaxoSmithKline Biologicals, Rixensart, Belgium). Adverse events (AEs) (unsolicited and solicited local and systemic AEs), serious AEs and medically attended AEs were assessed up to day 56 and month 7 after the first dose.

Results:
Incidences of AEs, serious AEs or medically attended AEs did not differ significantly between the groups in any age stratum. AEs were most frequent in children <1 year of age and decreased with age. AEs of special interest, predefined as AEs associated with potential hypersensitivity/allergy or neurologic disorders up to day 56, were reported in 4.6% (IXIARO) versus 6.3% (Prevnar) in the ≥2 months to <1 year age group and 3.4% (IXIARO) versus 3.3% (HAVRIX) in the ≥1 to <18 years age group. Fever, the most frequent systemic reaction in 23.7% of infants to 3.8% of adolescents, decreased with age and did not differ between groups.

Conclusions:
The safety profile of IXIARO was comparable to the control vaccines in terms of overall AE rates, serious AEs and medically attended AEs.
Identifying Undiagnosed Pediatric Mental Illness in the Emergency Department
Authors: Downey La Vonne A. , Zun Leslie S. 
Published: April 2017

Background
It is well known that pediatric psychiatric patients frequent emergency department (ED), but the number of patients with undiagnosed psychiatric illness presenting to an ED is not well known. Identification and referral of these patients may provide an opportunity for improved patient care. The primary study objective was to identify a tool that can screen for unsuspected psychiatric illness in pediatric patients who present to the ED with non–psychiatric-related complaints.

Methods
The MINI International Neuropsychiatric Interview for Children and Adolescents screening tool was administered to 200 pediatric consenting patients and guardians. The inclusion criteria were English-speaking patients who presented in the ED with a nonpsychiatric complaint who were stable and able to communicate. The study was conducted in a level 1 trauma center ED of an inner-city hospital that serves a predominantly African American and Hispanic population. This study was institutional review board approved.

Results
The study populations consisted of 53% African American (107), 45% Hispanic (90), 1% white (2), and 0.5% Asian (1). Their age range was divided, with 49% between 12 and 14 years (98) and 51% between 15 and 17 years (102). The sex was evenly split, with 50% male (100) and 50% female (100). The 41% who did screen positive for an undiagnosed mental illness had a range of diagnoses. The top modules with positive results were oppositional defiant (13.5%, 27), attention-deficit/hyperactivity disorder (13%, 25), depression (10%, 11), conduct disorder (9%, 19), and anxiety (5%, 11).

Conclusions
The pediatric Mini International Neuropsychiatric Interview was effective in screening for undiagnosed mental illness in pediatric patients who presented to the ED with no psychiatric-related illness. The screening tool indicated that 41% of pediatric patients screened positive for an undiagnosed mental illness, with attention deficit–related disorders being the most widely seen. Further study should be conducted to test the tools used in a range of ED settings.
Minimally Invasive, Organ-preserving Surgery for Large Submucosal Tumors in the Abdominal Esophagus
Authors: Kanehira Eiji , Tanida Takashi , Kamei Aya , Takahashi Kodai 
Published: April 2017

Background:
Surgical resection of submucosal tumors (SMTs) in the abdominal esophagus is not standardized. Enucleation may be a minimally invasive option, whereas its oncological validity is not very clear. Moreover, how to treat the esophageal wall defect after enucleation and necessity of additional antireflux procedure are also undetermined.

Methods:
In 13 patients with a SMT originating the abdominal esophagus laparoscopic enucleation was performed with preserving the integrity of submucosa. When the muscular layer defect was <4 cm it was directly closed by suturing, whereas it was left open in case the defect was larger. Fundoplication was added when the esophagus was dissected posteriorly or the myotomy was not closed.

Results:
Tumors were resected en-bloc without rupture in all cases. In 5 patients myotomy was closed, whereas in the remaining 8 it was left open. In 11 patients fundoplication was added (Toupet in 5 and Dor in 6). The patients developed neither regurgitation nor stenosis postoperatively. The histopathologic findings revealed leiomyoma in 9 patients, whereas the other 4 were miscellaneous. The average tumor size was 5.5 cm (range, 2.8 to 8.8). Microscopically surgical margin was negative in all cases.

Conclusions:
Laparoscopic enucleation of SMTs in the abdominal esophagus seems to be safe, reproducible operation enabling preservation of function of the lower esophagus and esophagogastric junction. Even when the muscular defect is not approximated additional fundoplication can minimize the risk of postoperative reflux disease.
Technical and Survival Risks Associated With Esophagojejunostomy by Laparoscopic Total Gastrectomy for Gastric Carcinoma
Authors: Yamamoto Manabu , Kawano Hiroyuki , Yamaguchi Shohei , Egashira Akinori , Minami Kazuhito , Morita Masaru , Sakaguchi Yoshihisa , Toh Yasushi 
Published: April 2017

Background:
We performed esophagojejunostomy after totally laparoscopic total gastrectomy (TLTG) using functional end-to-end anastomosis (FEEA) as the first choice and laparoscopic-assisted total gastrectomy (LATG) using a circular stapler with a transorally inserted anvil as the second choice.

Patients and Methods:
We examined 109 patients with gastric cancer who underwent TLTG and LATG. Among these, 100 patients underwent TLTG and the rest underwent LATG.

Results:
The length of resected esophageal segment in LATG patients was significantly longer than that in TLTG patients (P<0.001). The length of the resected esophagus segment was inversely correlated with body mass index in cases of esophagojejunostomy by FEEA (P<0.05). Multivariate analysis revealed that T factor, N factor, and severe complications were the independent factors for survival.

Conclusions:
Esophagojejunostomy using FEEA or a circular stapler with a transorally inserted anvil should be selected according to the length of the resected esophageal segment and/or body mass index.