bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reliability of Casting Indices Among Members of an Orthopaedic Surgery Residency
Authors: Williams Nathan D. , Rush Jeremy K. , Schmitz Matthew R. , Johnson Anthony E. 
Published: November 2016

Background:
Multiple casting indices have been described to evaluate the adequacy of cast placement in pediatric distal forearm fractures. The aim of this study was to determine the intrarater and interrater reliability of the measurements of 5 common casting indices among members of an orthopaedic surgery residency program. The cast index, 3-point index, gap index, padding index, and Canterbury index were evaluated.

Methods:
This was a single-center prospective cohort reliability study that included 12 members of an orthopaedic surgery residency. Participants were placed into 1 of 4 groups by level of training: physician assistants, junior residents, senior residents, and attending orthopaedic surgeons. Twelve radiographs of casted pediatric distal forearm fractures were measured by each participant on 2 separate occasions. Statistical analysis using the intraclass correlation coefficient was used to determine the intrarater and interrater reliability.

Results:
The cast index was the only casting index to meet our criteria for good intrarater and interrater reliability.

Conclusion:
Continued use of the cast index as a tool to assess pediatric distal forearm cast application is supported by this study.

Level of Evidence:
Level 2.
Autism Spectrum Disorder and Avoidant/Restrictive Food Intake Disorder
Authors: Lucarelli Jennifer , Pappas Demetra , Welchons Leah , Augustyn Marilyn 
Published: November 2016

CASE: Kendra is a 4-year-old girl with autism spectrum disorder (ASD) who presents for follow-up of feeding problems to her pediatric clinician. She is an only child in a family where both parents are scientists. Feeding concerns date to infancy, when she was diagnosed with Gastroesophageal Reflux Disease (GERD) associated with persistent bottle refusal and the acceptance of few pureed foods. At 13 months, milk and peanut allergies were diagnosed. Following a feeding clinic evaluation at 24 months, she was prescribed a soy milk supplement and an H2 blocker. There was no concern for oral-motor dysfunction. She was also referred to early intervention for feeding therapy. However, her parents terminated participation after 6 months because she became anxious and had tantrum prior to treatment groups.
She was seen in another feeding program at 3 years; zinc, folate, thyroid, and a celiac panel were normal, and an endoscopy was negative for eosinophilic esophagitis. She began individual feeding therapy, where concerns for rigidity, difficulty transitioning, and limited peer interactions led to a neuropsychological evaluation. Kendra was diagnosed with an ASD and avoidant/restrictive food intake disorder (ARFID). Her cognitive skills were average, and expressive and receptive language skills were low average.
Her diet consisted of French fries, Ritz crackers, pretzels, and 32 ounces of soy formula daily. She had stopped accepting Cheerios and saltines 2 months prior. She controlled other aspects of feeding, insisting on a specific parking spot at a fast food restaurant and drinking from a particular sippy cup. Her parents accepted these demands with concern about her caloric intake, which they tracked daily.
Following diagnosis with ARFID, she resumed feeding therapy using a systematic desensitization approach with rewards. At the first session, she kissed and licked 2 new foods without gagging. Her mother appeared receptive to recommendations that included continuing the “food game” at home, replacing 1 ounce of soy formula by offering water each day, limiting between-meal grazing, and refusing specific feeding demands.
Currently, her parents plan to discontinue feeding therapy with concerns that the treatment was “too harsh.” Her father produces logs of her caloric and micronutrient intake as evidence that she did not replace missed formula with other foods and reports that she subsequently became more difficult to manage behaviorally. Her father now demands to see randomized controlled trials of feeding therapy approaches. Her weight is stable, but she has now limited her pretzel intake to a specific brand. How would you approach her continued care?
Pattern of Colon Cancer Lymph Node Metastases in Patients Undergoing Central Mesocolic Lymph Node Excision: A Systematic Review
Authors: Bertelsen Claus A. , Kirkegaard-Klitbo Anders , Nielsen Mingyuan , Leotta Salvatore M. G. , Daisuke Fukumori , Gögenur Ismail 
Published: November 2016

BACKGROUND:
Extended mesocolic lymph node dissection in colon cancer surgery seems to improve oncological outcome. A possible reason might be related to metastases in the central mesocolic lymph nodes.

OBJECTIVE:
The purpose of this study was to describe the pattern of mesocolic lymph node metastases, particularly in central lymph nodes, and the risk of skip, aberrant, and gastrocolic ligament metastases as the argument for performing extended lymph node dissection.

DATA SOURCES:
EMBASE and PubMed were searched using the terms colon or colorectal with sentinel node, lymph node mapping, or skip node; lymph node resection colon; and complete or total and mesocolic excision.

STUDY SELECTION:
Studies describing the risk of metastases in central, skip, aberrant, and gastrocolic ligament lymph node metastases from colon adenocarcinomas in 10 or more patients were included. No languages were excluded.

MAIN OUTCOME MEASURES:
The risk of metastases in the central mesocolic lymph nodes was measured.

RESULTS:
A total of 2052 articles were screened, of which 277 underwent full-text review. The 47 studies fulfilling the inclusion criteria were very heterogeneous, and meta-analyses were not considered appropriate. The risk of central mesocolic lymph node metastases for right-sided cancers varies between 1% and 22%. In sigmoid cancer, the risk is reported in ≤12% of the patients and is associated with advanced T stage.

LIMITATIONS:
The retrospective design and heterogeneity, in terms of definitions of lymph node location, tumor sites, stage, morphology, pathology assessment, and inclusion criteria (selection bias), of the included studies were limitations. Also, anatomic definitions were not uniform.

CONCLUSIONS:
The present literature cannot give a theoretical explanation of a better oncological outcome after extended lymph node dissection. Consensus for a standardization of anatomical definitions and surgical and pathological assessments is warranted for future mapping studies.
Inadvertent Splenectomy During Resection for Colorectal Cancer Does Not Increase Long-term Mortality in a Propensity Score Model: A Nationwide Cohort Study
Authors: Lolle Ida , Pommergaard Hans-Christian , Schefte David F. , Bulut Orhan , Krarup Peter-Martin , Rosenstock Steffen J. 
Published: November 2016

BACKGROUND:
Previous studies suggest that long-term mortality is increased in patients who undergo splenectomy during surgery for colorectal cancer. The reason for this association remains unclear.

OBJECTIVE:
The purpose of this study was to investigate the association between inadvertent splenectomy attributed to iatrogenic lesion to the spleen during colorectal cancer resections and long-term mortality in a national cohort of unselected patients.

DESIGN:
This was a retrospective, nationwide cohort study.

SETTINGS:
Data were collected from the database of the Danish Colorectal Cancer Group and merged with data from the National Patient Registry and the National Pathology Databank.

PATIENTS:
Danish patients with colorectal cancer undergoing curatively intended resection between 2001 and 2011 were included in the study.

MAIN OUTCOME MEASURES:
The primary outcome was long-term mortality for patients surviving 30 days after surgery. Secondary outcomes were 30-day mortality and risk factors for inadvertent splenectomy. Multivariable and propensity-score matched Cox regression analyses were used to adjust for potential confounding.

RESULTS:
In total, 23,727 patients were included, of which 277 (1.2%) underwent inadvertent splenectomy. There was no association between inadvertent splenectomy and long-term mortality (adjusted HR = 1.15 (95% CI, 0.95–1.40); p = 0.16) in the propensity score-matched model, whereas 30-day mortality was significantly increased (adjusted HR = 2.31 (95% CI, 1.71–3.11); p < 0.001). Inadvertent splenectomy was most often seen during left hemicolectomy (left hemicolectomy vs right hemicolectomy: OR = 24.76 (95% CI, 15.30–40.06); p < 0.001).

LIMITATIONS:
This study was limited by its retrospective study design and lack of detailed information on postoperative complications.

CONCLUSIONS:
Inadvertent splenectomy during resection for colorectal cancer does not seem to increase long-term mortality. The previously reported reduced overall survival after inadvertent splenectomy may be explained by excess mortality in the immediate postoperative period.
Hypoactive sexual desire dysfunction in community-dwelling older women
Authors: Zeleke Berihun M. , Bell Robin J. , Billah Baki , Davis Susan R. 
Published: November 2016

Abstract

Objective:
To determine the prevalence of hypoactive sexual desire dysfunction (HSDD) and its associated factors in women aged 65 to 79 years.

Methods:
A questionnaire-based, cross-sectional study was conducted amongst community-dwelling older women. Participants were recruited between April and August 2014 from a national database based on electoral rolls. Sexual function and sexual distress were assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised, respectively. HSDD was defined as the presence of both low sexual desire and sexually related personal distress.

Results:
The mean ± SD age of the 1,548 women was 71 ± 3.4 years and 52.6% were partnered. Among the participants, 88.0% (95% confidence interval [CI], 86.3%-89.6%) had low sexual desire, 15.5% (95% CI, 13.8%-17.4%) had sexually related personal distress, and 13.6% (95% CI, 11.9%-15.4%) had HSDD. The HSDD was more common among partnered than among unpartnered women (23.7% vs 5.9%; P < 0.001). Being partnered (adjusted odds ratio [AOR] = 4.21; 95% CI, 2.50-7.07), having vaginal dryness during intercourse (AOR = 2.37; 95% CI, 1.58-3.55), having symptomatic pelvic floor dysfunction (AOR = 1.92; 95% CI, 1.29-2.92), and having moderate-to-severe depressive symptoms (AOR = 4.15; 95% CI, 2.16-7.96) were independently associated with having HSDD. In a subanalysis, HSDD was more common among sexually active than sexually inactive women (31.5% vs 17.3%; P < 0.001). Furthermore, 32% (95% CI, 27.7%-38.3%) of partnered sexually active women had HSDD, as did 22% (95% CI, 11.5%-37.8%) of unpartnered sexually active women.

Conclusions:
HSDD is common and associated with potentially modifiable risk factors in older women. It should not be assumed that unpartnered older women are sexually inactive or are not distressed by low sexual desire.
Transient Ischemic Attack and Cognitive Impairment: A Review
Authors: Ganzer Christine A. , Barnes Andrea , Uphold Constance , Jacobs Alan R. 
Published: November 2016

ABSTRACT
Transient ischemic attack (TIA) is a neurologic deficit resulting from focal ischemia in the brain, spinal cord, or retina. Historically, the definition included symptom resolution within 24 hours. However, recent studies investigating cognition after TIA suggest that deficits in executive function persist at 7 days post-TIA, although few studies have examined these effects long term. Recent advances in neuroimaging techniques provide emerging evidence of permanent microvascular tissue damage in the brain, suggesting that the effects of TIA may persist beyond resolution of focal symptoms. A further challenge is that there is debate concerning the clinical definition of TIA and the use of diagnostic neuroimaging studies and standardization of neuropsychological tests used to evaluate cognitive deficits in this population. Subtle changes in memory, attention, and problem-solving abilities may negatively influence an individual’s ability to adopt positive health behaviors. Despite advances in the field, more research is needed; hence, the purpose of this article is to provide an overview of clinical factors for clinicians and researchers to consider when investigating cognitive deficits among post-TIA populations. Definitions of TIA are reviewed, and the importance of neuropsychological evaluation and neuroimaging correlates of TIA in establishing a positive diagnosis will be discussed. Nurses especially in advanced practice roles are uniquely positioned to assess and implement treatments in at-risk groups and therefore should be knowledgeable about these possible cognitive effects.
Predictors of Persistent or Recurrent Disease After Loop Electrosurgical Excision Procedure
Authors: Cejtin Helen E. , Zimmerman Lindsay , Mathews Melissa , Patel Ashlesha 
Published: November 2016

Objective
Follow-up recommendations after an excisional procedure vary depending on whether or not there is a positive ectocervical or endocervical margin or endocervical curettage (ECC). The purpose of this study was to evaluate the importance of these findings in predicting recurrent/persistent (r/p) disease in a sample of human immunodeficiency virus (HIV)-seropositive and -negative patients.

Materials and Methods
Loop electrosurgical excision procedures with a concurrent ECC performed at the Cook County ambulatory clinic between September 29, 2008, and April 15, 2014 were included in this study. Chart review was performed to collect demographic data, pathology results, and all subsequent cytology or histology. We examined the association of these factors with r/p disease using χ2 and Fisher exact tests as well as log-binomial regression.

Results
There were 242 women included for analysis. Of these, 9 LEEP specimens showed invasive cancer or adenocarcinoma in situ, and 15.7% were HIV positive. Mean follow-up was 16.4 months. On bivariate analysis, HIV serostatus, LEEP histology, ectocervical margin, endocervical margin, and ECC were all associated with r/p disease. On multivariate regression, only HIV serostatus and ECC were associated with r/p disease. Among women with either a positive endocervical or ectocervical margin or ECC, the prevalence of r/p disease is 29% if they are HIV negative, and 75% if they are positive.

Conclusions
In our study, ECC seems more predictive of r/p disease than margin status. Most HIV-positive women with positive margins or ECC have r/p disease, whereas most HIV-negative women do not. One should consider HIV serostatus when deciding whether or not to perform repeat excision.
Early Changes of Irradiated Parotid Glands Evaluated by T1rho-Weighted Imaging: A Pilot Study
Authors: Zhou Nan , Chu Chen , Dou Xin , Li Ming , Liu Song , Guo Tingting , Zhu Lijing , Liu Baorui , Chen Weibo , He Jian , Yan Jing , Zhou Zhengyang , Yang Xiaofeng 
Published: November 2016

Objective
The aim of the study was to confirm the feasibility of T1rho-weighted imaging to evaluate the dynamic changes of parotid glands in patients with nasopharyngeal carcinoma (NPC) undergoing intensity-modulated radiation therapy.

Methods
Twenty-six NPC patients (19 men; 7 women; mean [SD] age, 48.9 [13.4] years) underwent the following 3 serial T1rho-weighted imaging: within 2 weeks before radiotherapy (RT, pre-RT), 5 weeks after the beginning of RT (mid-RT), and 4 weeks after RT (post-RT). Parotid volumes, T1rho values, mean radiation doses, and xerostomia degrees were recorded. Change rates of parotid T1rho values were correlated with parotid atrophy rates, mean radiation doses, and xerostomia degrees.

Results
During RT, parotid volume decreased (atrophy rate, 32.7 [8.1%] at mid-RT and 27.9 [10.0%] at post-RT compared with pre-RT; both P < 0.001) and parotid T1rho values increased (change rate, 25.0 [15.8%] at mid-RT and 30.1 [18.0%] at post-RT compared with pre-RT, both P < 0.001) significantly. The change rate of parotid T1rho value correlated with the atrophy rate significantly at post-RT (r = 0.301, P = 0.047). Intraobserver and interobserver reproducibility of parotid T1rho measurements were excellent (intraclass correlation coefficient, 0.974 and 0.956, respectively).

Conclusions
Dynamic changes of radiation-induced parotid damage in NPC patients who underwent intensity-modulated radiation therapy could be noninvasively evaluated by T1rho-weighted imaging.
“Fat Brook” in the Popliteal Fossa: Cadaveric and Clinical Investigation With Magnetic Resonance Imaging
Authors: Song Yoonah , Lee Seunghun , Paik Doo-Jin , Bae Jiyoon 
Published: November 2016

Objective
This study aimed to describe the “fat brook” (FB) in the popliteal fossa of a cadaver and to evaluate its clinical significance.

Methods
Ten fresh cadaveric knees underwent magnetic resonance imaging and histologic analyses. In addition, magnetic resonance imaging images from 321 patients (108 men, 213 women; mean age, 49.8 years; age range, 5–92 years) were retrospectively reviewed. Two radiologists independently determined the presence/absence of the FB and internal derangement of the knee.

Results
The FB was present in all cadaveric specimens without synovial lining or joint communication. In the clinical study, the prevalence of FB was 97.8% (314/321). The FB was associated with effusion (P = 0.001) and tear of the medial meniscus (P = 0.022). There was no significant association between prevalence of FB and age or other structures. Determining FB and internal derangement of the knee had excellent interobserver agreement (concordance correlation coefficient = 0.966, 0.834–1.000).

Conclusions
The FB might be a part of the superficial layer of superficial fascia and not be mistaken for a fat fracture or Morel-Lavallée lesion.
Predicting and Early Monitoring Treatment Efficiency of Cervical Cancer Under Concurrent Chemoradiotherapy by Intravoxel Incoherent Motion Magnetic Resonance Imaging
Authors: Zhu Li , Zhu Lijing , Wang Huanhuan , Yan Jing , Liu Baorui , Chen Weibo , He Jian , Zhou Zhengyang , Yang Xiaofeng 
Published: November 2016

Objective
The aim of this study was to explore the potential of intravoxel incoherent motion magnetic resonance (MR) imaging in predicting and measuring responses to concurrent chemoradiotherapy (CCRT) in advanced cervical cancers.

Methods
Thirty-seven patients with advanced cervical cancers scheduled for CCRT underwent MR examinations including intravoxel incoherent motion sequence with 9 b values (0–800 s/mm2) before CCRT, 2 and 4 weeks after the initiation of CCRT, and immediately after CCRT. Apparent diffusion coefficient, f, D, and D* values were obtained during the course. The maximum diameter of the tumor was measured to determine the treatment efficiency.

Results
At the end of CCRT, 25 patients were classified as complete response and 12 as partial response. The pretreatment f of cervical cancer showed its efficiency in predicting partial response and complete response with an area under receiver operating characteristic curve of 0.768. During CCRT, the apparent diffusion coefficient, D, and D* values kept on rising, whereas f increased first and then decreased after 4 weeks of CCRT.

Conclusions
Intravoxel incoherent motion MR imaging held great potential in both predicting and early monitoring treatment efficiency of advanced cervical cancer under CCRT.
Cell chirality: its origin and roles in left–right asymmetric development
Authors: Inaki Mikiko , Liu Jingyang , Matsuno Kenji 
Published: November 2016

An item is chiral if it cannot be superimposed on its mirror image. Most biological molecules are chiral. The homochirality of amino acids ensures that proteins are chiral, which is essential for their functions. Chirality also occurs at the whole-cell level, which was first studied mostly in ciliates, single-celled protozoans. Ciliates show chirality in their cortical structures, which is not determined by genetics, but by ‘cortical inheritance’. These studies suggested that molecular chirality directs whole-cell chirality. Intriguingly, chirality in cellular structures and functions is also found in metazoans. InDrosophila, intrinsic cell chirality is observed in various left–right (LR) asymmetric tissues, and appears to be responsible for their LR asymmetric morphogenesis. In other invertebrates, such as snails andCaenorhabditis elegans, blastomere chirality is responsible for subsequent LR asymmetric development. Various cultured cells of vertebrates also show intrinsic chirality in their cellular behaviours and intracellular structural dynamics. Thus, cell chirality may be a general property of eukaryotic cells. InDrosophila, cell chirality drives the LR asymmetric development of individual organs, without establishing the LR axis of the whole embryo. Considering that organ-intrinsic LR asymmetry is also reported in vertebrates, this mechanism may contribute to LR asymmetric development across phyla.This article is part of the themed issue ‘Provocative questions in left–right asymmetry’.
Stochastic left–right neuronal asymmetry inCaenorhabditis elegans
Authors: Alqadah Amel , Hsieh Yi-Wen , Xiong Rui , Chuang Chiou-Fen 
Published: November 2016

Left–right asymmetry in the nervous system is observed across species. Defects in left–right cerebral asymmetry are linked to several neurological diseases, but the molecular mechanisms underlying brain asymmetry in vertebrates are still not very well understood. TheCaenorhabditis elegansleft and right amphid wing ‘C’ (AWC) olfactory neurons communicate through intercellular calcium signalling in a transient embryonic gap junction neural network to specify two asymmetric subtypes, AWCOFF(default) and AWCON(induced), in a stochastic manner. Here, we highlight the molecular mechanisms that establish and maintain stochastic AWC asymmetry. As the components of the AWC asymmetry pathway are highly conserved, insights from the model organismC. elegansmay provide a window onto how brain asymmetry develops in humans.This article is part of the themed issue ‘Provocative questions in left–right asymmetry’.