bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rotational Dynamics of the Normal Distal Tibiofibular Joint With Weight-Bearing Computed Tomography
Authors: Lepojärvi Sannamari , Niinimäki Jaakko , Pakarinen Harri , Leskelä Hannu-Ville 
Published: February 2016

Background: The normal distal tibiofibular joint is strongly stabilized by the syndesmosis, where previous cadaveric, biomechanical studies demonstrated only minimal widening and posterior translation of the fibula in external rotation of the ankle. However, little is known about normal rotational dynamics of the distal tibiofibular joint in upright weight-bearing conditions. The purpose of this study was to investigate the normal anatomy and rotational dynamics of the distal tibiofibular joint under physiological conditions on weight-bearing cone beam computed tomography (WBCT). Methods: In a cross-sectional study of 32 subjects, low-dose WBCT scans of uninjured bilateral ankles were performed. Normal intersubject and intrasubject variation in neutral position and changes in maximal internal and external rotation of the ankle were studied. Sagittal translation of the fibula, anterior and posterior widths of the distal tibiofibular syndesmosis, tibiofibular clear space (TFCS), and rotation of the fibula were measured. Results: In the neutrally loaded ankle, the fibula was located anteriorly in the tibial incisura in 88% of the subjects. When the ankle was rotated, mean anteroposterior motion was 1.5 mm and mean rotation of the fibula was 3 degrees. There was no significant change in TFCS between internal and external rotation. Large intersubject variation was detected, but intrasubject variation between ankles was less than 1 mm and 1 degree. Conclusions: This study provides reference values to evaluate the dynamics of the normal distal tibiofibular joint. The internal control of the contralateral ankle seemed to be a better reference than the population-based normal values. Clinical Relevance: The current study provides the reference values to evaluate the rotational dynamics of a normal distal tibiofibular joint.
Association of Metatarsalgia After Hallux Valgus Correction With Relative First Metatarsal Length
Authors: Nakagawa Satoru , Fukushi Jun-ichi , Nakagawa Takeshi , Mizu-uchi Hideki , Iwamoto Yukihide 
Published: February 2016

Background: Metatarsalgia is frequently associated with hallux valgus. The aim of this study was to evaluate how the relative length and position of the first metatarsal head influenced metatarsalgia and plantar callosities beneath the lesser metatarsal heads. Methods: A retrospective analysis of the clinical data and radiographs of 102 cases was performed at a mean follow-up of 16 months after biplane interlocking osteotomies. Clinical evaluation was made using the Japanese Society for Surgery of the Foot (JSSF) hallux scale. Radiologic evaluation was made with standard weight-bearing anteroposterior radiographs, and the hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA), distal metatarsal articular angulation (DMAA), and the sesamoid position were evaluated. Relative first metatarsal length (RML) was determined according to Nilsonne/Morton’s technique. Results: The mean preoperative HVA decreased from 37 to 3 degrees, and the mean IMA from 17 to 4 degrees. The mean JSSF-hallux score improved from 56 to 96 points. The mean preoperative area of plantar callosities decreased from 3.1 to 1.5 mm2. Sixty percent of metatarsalgia cases improved, and 85% of painless callosities disappeared postoperatively. Among radiologic parameters, postoperative RML was most significantly associated with JSSF score ( P < .0001) and the presence of postoperative metatarsalgia ( P < .0001). Receiver operating characteristic analysis revealed that the RML cut-off point was −3 mm for avoiding metatarsalgia, with an area under the curve of 0.88, a specificity of 88%, and a sensitivity of 85%. Conclusion: Preservation of relative first metatarsal length during first metatarsal osteotomy was important to prevent postoperative metatarsalgia. Level of Evidence: Level IV, retrospective case series.
Detection of Leptospira DNA in urine and presence of specific antibodies in outdoor cats in Germany
Authors: Weis Sonia , Rettinger Anna , Bergmann Michele , Llewellyn Julia R , Pantchev Nikola , Straubinger Reinhard K , Hartmann Katrin 
Published: March 2016

Objectives Clinical manifestation of infection with Leptospira species in cats is rare. Nevertheless, cats can develop specific antibodies against the spirochetes after infection. In Canada, Taiwan and the USA it was recently demonstrated that naturally infected cats can also shed DNA from pathogenic Leptospira species in their urine, but the zoonotic potential of infected cats is still unclear. The objective of this study was to demonstrate if outdoor cats in Germany shed DNA from pathogenic Leptospira species in their urine. As a second aim, antibody prevalence was determined. Methods Two hundred and fifteen outdoor cats were prospectively recruited. Urine samples were tested by real-time PCR targeting the lipL32 gene of pathogenic Leptospira species. Antibody titres against eight serovars (Australis, Autumnalis, Bratislava, Canicola, Copenhageni, Grippotyphosa, Pomona, Saxkoebing) belonging to seven serogroups (Australis, Autumnalis, Canicola, Grippotyphosa, Icterohaemorrhagiae, Pomona, Sejroe) were determined by microscopic agglutination test. Results Urine samples from 7/215 cats (3.3%; 95% confidence interval [CI] 0.9−5.7) were PCR-positive. Specific antibodies were detected in 35/195 cats (17.9%; 95% CI: 12.5−23.3) with titres ranging from 1:100 to 1:6400. Australis, Bratislava and Grippotyphosa were the most common serovars. Conclusions and relevance Outdoor cats in Germany can shed DNA from pathogenic Leptospira species. Therefore, outdoor cats should be considered as a possible source of infection for dogs or humans. Further studies are needed to determine the role of Leptospira species as a cause of disease in cats.
The adjective in Dutch-French codeswitching: Word order and agreement
Authors: Vanden Wyngaerd Emma 
Published: February 2016

Aims and Objectives: This paper investigates the word order and adjectival agreement patterns in French-Dutch codeswitched Determiner Phrases (DPs). It examines the predictions made by two theoretical points of view: the approach by MacSwan (2009) within the Minimalist Program (MP) and the Matrix Language Framework (MLF) (Myers-Scotton & Jake, 2009). Methodology: The predictions of these frameworks are compared to data gathered in a grammaticality judgment task. In total, 120 codeswitched sentences were presented aurally to participants, who were asked to rate the sentences on a three-point scale. Originality: While some previous work on word order within codeswitched DP’s exists, this paper is the first study investigating the adjectival agreement patterns in codeswitching. Data and Analysis: Statistical analysis of the data showed that the MacSwan approach is a better predictor for the grammaticality judgments, as sentences predicted to be grammatical by the MP were rated higher than sentences predicted to be ungrammatical by the same model. This difference was statistically significant. There was no significant difference in rating for the predictions of the MLF. Conclusions: The results of the judgment task in combination with the results of previous research on codeswitching highlight the importance of a combination of data from both naturalistic and experimental settings. Implications: The predictions of the Minimalist approach have the upper hand over the predictions of the MLF. However, it remains is important to integrate results from other experimental methodologies, such as naturalistic data and results from psycholinguistic and neurolinguistic studies.
Reconstruction of Vertebral Bone Defects using an Expandable Replacement Device and Bioactive Glass S53P4 in the Treatment of Vertebral Osteomyelitis: Three Patients and Three Pathogens
Authors: Kankare J. , Lindfors N. C. 
Published: March 2016

Background and Aims: Bioactive glass S53P4 is an antibacterial bone substitute with bone-bonding and osteostimulative properties. The bone substitute has been successfully used clinically in spine; trauma; orthopedic; ear, nose, and throat; and cranio-maxillofacial surgeries. Bioactive glass S53P4 significantly reduces the amount of bacteria in vitro and possesses the capacity to kill both planktonic bacteria and bacteria in biofilm. Three patients with severe spondylodiscitis caused by Mycobacterium tuberculosis, Candida tropicalis, or Staphylococcus aureus were operatively treated due to failed conservative treatment. The vertebral defects were reconstructed using bioactive glass S53P4 and an expandable replacement device. Material and Methods: Decompression and a posterolateral spondylodesis, using transpedicular fixation, were performed posteriorly in combination with an anterior decompression and reconstruction using an expandable vertebral body replacement device. For patients 1 and 2, the expander was covered with bioactive glass S53P4 only, and for patient 3, the glass was mixed with autograft bone. Results: The patients healed well with complete neurological recovery. Fusion was observed for all patients. The total follow-up was 4 years for patient 1, 1 year and 8 months for patient 2, and 2 years and 2 months for patient 3. No relapses or complications were observed. Conclusion: The antibacterial properties of bioactive glass S53P4 also make it a suitable bone substitute in the treatment of severe spondylodiscitis.
Ultrasound Screening of Men with Coronary Artery Disease for Abdominal Aortic Aneurysms: A Prospective Dual Center Study
Authors: Vänni V. , Hakala T. , Mustonen J. , Turtiainen J. , Rissanen T. T. , Kajander O. , Ilveskoski E. , Koivumäki J. , Eskola M. , Hernesniemi J. 
Published: March 2016

Background and Aims: According to the heterogeneous results of previous studies, the prevalence of abdominal aortic aneurysm seems high among men with coronary artery disease. The associating risk factors for abdominal aortic aneurysm in this population require clarification. Our objective was to assess the prevalence of non-diagnosed abdominal aortic aneurysms in men with angiographically verified coronary artery disease and to document the associated co-morbidities and risk factors. Material and Methods: Altogether, 407 men with coronary artery disease were screened after invasive coronary angiography in two series at independent centers. Risk factor data were recorded and analyzed. Results and Conclusion: The mean age of the study cohort was 70.0 years (standard deviation: 11.0). The prevalence of previously undiagnosed abdominal aortic aneurysms in the whole screened population of 407 men was 6.1% (n = 25/407). In a multivariate analysis of the whole study population, the only significant risk factors for abdominal aortic aneurysm were age (odds ratio: 1.04, 95% confidence interval: 1.00–1.09) and history of smoking (odds ratio: 3.13, 95% confidence interval: 1.26–7.80). Non-smokers with abdominal aortic aneurysm were significantly older than smokers (mean age: 80.7 (standard deviation: 8.0) vs 68.0 (standard deviation: 11.1), p = 0.003), and age was a significant risk factor only among non-smokers (p = 0.011; p = 0.018 for interaction). Among smokers, the prevalence of abdominal aortic aneurysm was 8.8%, and 72% (n = 18/25) of all diagnosed abdominal aortic aneurysm patients were smokers. Prevalence of undiagnosed abdominal aortic aneurysms among patients with coronary artery disease is high, and history of smoking is the most significant risk factor for abdominal aortic aneurysm. Effectiveness of selective screening of abdominal aortic aneurysm in male patients with coronary artery disease warrants further studies.
Comparison Between Minimally Invasive and Open Gastrectomy for Gastric Cancer in Europe: A Systematic Review and Meta-analysis
Authors: Kostakis I. D. , Alexandrou A. , Armeni E. , Damaskos C. , Kouraklis G. , Diamantis T. , Tsigris C. 
Published: March 2016

Aims: We compared laparoscopic and robotic gastrectomies with open gastrectomies and with each other that were held for gastric cancer in Europe. Methods: We searched for studies conducted in Europe and published up to 20 February 2015 in the PubMed database that compared laparoscopic or robotic with open gastrectomies for gastric cancer and with each other. Results: We found 18 original studies (laparoscopic vs open: 13; robotic vs open: 3; laparoscopic vs robotic: 2). Of these, 17 were non-randomized trials and only 1 was a randomized controlled trial. Only four studies had more than 50 patients in each arm. No significant differences were detected between minimally invasive and open approaches regarding the number of retrieved lymph nodes, anastomotic leakage, duodenal stump leakage, anastomotic stenosis, postoperative bleeding, reoperation rates, and intraoperative/postoperative mortality. Nevertheless, laparoscopic procedures provided higher overall morbidity rates when compared with open ones, but robotic approaches did not differ from open ones. On the contrary, blood loss was less and hospital stay was shorter in minimally invasive than in open approaches. However, the results were controversial concerning the duration of operations when comparing minimally invasive with open gastrectomies. Additionally, laparoscopic and robotic procedures provided equivalent results regarding resection margins, duodenal stump leakage, postoperative bleeding, intraoperative/postoperative mortality, and length of hospital stay. On the contrary, robotic operations had less blood loss, but lasted longer than laparoscopic ones. Finally, there were relatively low conversion rates in laparoscopic (0%–6.7%) and robotic gastrectomies (0%–5.6%) in most studies. Conclusion: Laparoscopic and robotic gastrectomies may be considered alternative approaches to open gastrectomies for treating gastric cancer. Minimally invasive operations are characterized by less blood loss and shorter hospital stay than open ones. In addition, robotic procedures have less blood loss, but last longer than laparoscopic ones.
Hemorrhage after Major Pancreatic Resection: Incidence, Risk Factors, Management, and Outcome
Authors: Ansari D. , Tingstedt B. , Lindell G. , Keussen I. , Ansari D. , Andersson R. 
Published: March 2016

Background and Aims: Hemorrhage is a rare but dreaded complication after pancreatic surgery. The aim of this study was to examine the incidence, risk factors, management, and outcome of postpancreatectomy hemorrhage in a tertiary care center. Materials and Methods: A retrospective observational study was conducted on 500 consecutive patients undergoing major pancreatic resections at our institution. Postpancreatectomy hemorrhage was defined according to the International Study Group of Pancreatic Surgery criteria. Results: A total of 68 patients (13.6%) developed postpancreatectomy hemorrhage. Thirty-four patients (6.8%) had a type A, 15 patients (3.0%) had a type B, and the remaining 19 patients (3.8%) had a type C bleed. Postoperative pancreatic fistula Grades B and C and bile leakage were significantly associated with severe postpancreatectomy hemorrhage on multivariable logistic regression. For patients with postpancreatectomy hemorrhage Grade C, the onset of bleeding was in median 13 days after the index operation, ranging from 1 to 85 days. Twelve patients (63.2%) had sentinel bleeds. Surgery lead to definitive hemostatic control in six of eight patients (75.0%). Angiography was able to localize the bleeding source in 8/10 (80.0%) cases. The success rate of angiographic hemostasis was 8/8. (100.0%). The mortality rate among patients with postpancreatectomy hemorrhage Grade C was 2/19 (10.5%), and both fatalities occurred late as a consequence of eroded vessels in association with pancreaticogastrostomy. Conclusion: Delayed hemorrhage is a serious complication after major pancreatic surgery.Sentinel bleed is an early warning sign. Postoperative pancreatic fistula and bile leakage are important risk factors for severe postpancreatectomy hemorrhage.
Three-month risk-benefit profile of anticoagulation after stroke with atrial fibrillation: The SAMURAI-Nonvalvular Atrial Fibrillation (NVAF) study
Authors: Arihiro Shoji , Todo Kenichi , Koga Masatoshi , Furui Eisuke , Kinoshita Naoto , Kimura Kazumi , Yamagami Hiroshi , Terasaki Tadashi , Yoshimura Sohei , Shiokawa Yoshiaki , Kamiyama Kenji , Takizawa Shunya , Okuda Satoshi , Okada Yasushi , Nagakane Yoshinari , Kameda Tomoaki , Hasegawa Yasuhiro , Shibuya Satoshi , Ito Yasuhiro , Nakashima Takahiro , Takamatsu Kazuhiro , Nishiyama Kazutoshi , Matsuki Takayuki , Homma Kazunari , Takasugi Junji , Tokunaga Keisuke , Sato Shoichiro , Kario Kazuomi , Kitazono Takanari , Toyoda Kazunori ,   for the SAMURAI Study Investigators
Published: March 2016

Aims This study was performed to determine the short-term risk-benefit profiles of patients treated with oral anticoagulation for acute ischemic stroke or transient ischemic attack using a multicenter, prospective registry. Methods A total of 1137 patients (645 men, 77 ± 10 years old) with acute ischemic stroke/transient ischemic attack taking warfarin (662 patients) or non-vitamin K antagonist oral anticoagulants (dabigatran in 205, rivaroxaban in 245, apixaban in 25 patients) for nonvalvular atrial fibrillation who completed a three-month follow-up survey were studied. Choice of anticoagulants was not randomized. Primary outcome measures were stroke/systemic embolism and major bleeding. Results Both warfarin and non-vitamin K antagonist oral anticoagulants were initiated within four days after stroke/transient ischemic attack onset in the majority of cases. Non-vitamin K antagonist oral anticoagulant users had lower ischemia- and bleeding-risk indices (CHADS2, CHA2DS2-VASc, HAS-BLED) and milder strokes than warfarin users. The three-month cumulative rate of stroke/systemic embolism was 3.06% (95% CI 1.96%–4.74%) in warfarin users and 2.84% (1.65%–4.83%) in non-vitamin K antagonist oral anticoagulant users (adjusted HR 0.96, 95% CI 0.44–2.04). The rate of major bleeding was 2.61% (1.60%–4.22%) and 1.11% (0.14%–1.08%), respectively (HR 0.63, 0.19–1.78); that for intracranial hemorrhage was marginally significantly lower in non-vitamin K antagonist oral anticoagulant users (HR 0.17, 0.01–1.15). Major bleeding did not occur in non-vitamin K antagonist oral anticoagulant users with a CHADS2 score <4 or those with a discharge modified Rankin Scale score ≤2. Conclusions Stroke or systemic embolism during the initial three-month anticoagulation period after stroke/transient ischemic attack was not frequent as compared to previous findings regardless of warfarin or non-vitamin K antagonist oral anticoagulants were used. Intracranial hemorrhage was relatively uncommon in non-vitamin K antagonist oral anticoagulant users, although treatment assignment was not randomized. Early initiation of non-vitamin K antagonist oral anticoagulants during the acute stage of stroke/transient ischemic attack in real-world clinical settings seems safe in bleeding-susceptible Japanese population.
Population physiologically-based pharmacokinetic model incorporating lymphatic uptake for a subcutaneously administered pegylated peptide
Authors: Offman Elliot , Phipps Colin , Edginton Andrea N. 
Published: March 2016

AbstractPurposePhysiologically-based pharmacokinetic (PBPK) models provide a rational mechanistic approach for predicting the time course of macromolecules in plasma. Population PBPK models for large molecules necessitate incorporation of lymphatic circulation to mechanistically account for biodistribution. Moreover, characterization of subcutaneous absorption requires consideration of the microvascular transit from the injection site to the systemic circulation. A PBPK model for a pegylated peptide conjugate, previously developed for primates, was modified to describe the lymphatic uptake in a population of humans by incorporation of interindividual variability in the lymphatic circulation and a unique lymphatic drainage compartment (LDC). The model was then used to simulate the time course of the drug in a population of humans and compared to the same drug administered to a group of human subjects participating in a first-in-human study.MethodsOrgan, blood and lymph masses for the population were sampled from either normal or log-normal distributions. Blood flows were calculated for each organ based on mean organ perfusion per gram of organ tissue and lymphatic flow was set as a fixed fraction of blood flow. Interindividual variability in lymphatic volume was assumed to be similar to that of blood volume. The volume of the LDC was parameterzed as a fraction of the injection volume. Sensitivity analysis was performed to study uncertain parameters and distribution assumptions.ResultsThe population generator was capable of simulating a virtual population incorporating the lymphatic circulation. Incorporation of a LDC resulted in similar line shape relative to the observed data and incorporation of anthropometric variability accounted for individual differences in the absorption and elimination phases across all dose cohorts. Line shape was sensitive to the inclusion of LDC while peak and elimination portions of the time course were influenced by the magnitude of variance assumed for blood volume and renal clearance, respectively.ConclusionLymphatic circulation can be incorporated into a population PBPK model assuming similar interindividual variability as observed for blood volume. Incorporation of an LDC, where the volume of this transit compartment is proportional to the SC injection volume may be an important mechanistic means of predicting the transit from the SC depot to the systemic circulation.
Clinical vignettes and global health considerations of infertility care in under-resourced patients
Authors: Chow Erika Tiffanie , Mahalingaiah Shruthi 
Published: March 2016

AbstractThe ability to receive standard of care for a diagnosis of infertility is a factor of one’s financial state and educational level, which are often correlated. Providing infertility care in an under-resourced tertiary care environment provides challenges but also opportunities for unique successes in creating a family. Among the under-represented populations are recent immigrants and refugees. Challenges arise when the infertility treatment is futile or when the standard of care is inaccessible due to cost and scheduling. Unique accomplishments are noted when families are built and hope is restored for couples fleeing from genocide and war-inflicted countries. This article will highlight two clinical vignettes from the Division of Reproductive Endocrinology and Infertility clinic at Boston University School of Medicine/Boston Medical Center. Thereafter, the article will summarize the barriers to care in the United States among those with low socioeconomic status, with non-dominant racial status (non-Caucasian), and with refugee status. All identifiers have been removed and names altered in the patient vignettes.
Alcohol misuse in older people
Authors: Rao Rahul , Crome Ilana 
Published: March 2016

SummaryThe clinical and public mental health aspects of alcohol misuse in older people (both men and women) have increasing relevance for both old age and addiction psychiatrists. Clinical presentations are often complex and involve a number of different psychiatric, physical and psychosocial factors. The assessment, treatment and aftercare of alcohol-related and comorbid other mental disorders will also involve a broad range of interventions from a wide range of practitioners. Given its growing clinical relevance, there are particular areas, such as alcohol-related brain damage and drug interactions with alcohol, that deserve special attention.