bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Kinematic Symmetry Index of Gait Patterns Between Older Adults With and Without Low Back Pain
Authors: Sung Paul S. , Danial Pamela 
Published: March 2017

Study Design.
Cross-sectional study.

Objective.
To investigate the symmetry index for limb support patterns in right limb–dominant older adults with and without low back pain (LBP).

Summary of Background Data.
The effects of bilateral asymmetry on gait performance were reported; however, there is a lack of understanding on kinematic symmetry to assess subjects with LBP. This asymmetry might be related to increased compensatory patterns to the dominant side in subjects with LBP.

Methods.
Eighty-two right limb–dominant older adults (45 control subjects and 37 subjects with LBP) participated in the study. A three-dimensional motion capture system was used to measure temporal-spatial gait parameters (cadence, speed, stride length, step length, and limb support times). The symmetry index was the ratio of the gait cycle between the limbs to compare the dominance pattern between groups.

Results.
Although the symmetry index was not different between groups, the initial limb support (t = 2.07, P = 0.04) and terminal limb support (t = −2.26, P = 0.02) times were significantly different. The LBP group demonstrated significantly greater nondominant initial support times and dominant terminal support times. The single-limb support was not different between groups (t = 1.72, P = 0.09). The limb support pattern demonstrated a significant interaction between groups (F = 4.72, P = 0.03) regardless of gait speed (F = 0.91, P = 0.34).

Conclusion.
An asymmetrical gait pattern was evident in the LBP group as they demonstrated a longer double-limb support pattern due to a possible pain avoidance strategy. The control group demonstrated a symmetrical pattern for limb support in the stance phase. Clinicians need to consider asymmetric limb support patterns of gait modification similar to the control group when developing rehabilitation strategies for patients with LBP.

Level of Evidence: 3
Growth hormone in IVF cycles: any hope?
Authors: Hart Roger J. , Rombauts Luk , Norman Robert J. 
Published: March 2017

Purpose of review
Growth hormone (GH) has been used as an adjunct in ovulation induction and IVF for 25 years, particularly as an adjunct to ovarian stimulation for women who had a previous poor response to stimulation in an IVF cycle. It does not have US Food and Drug Administration approval for this use. Unfortunately, due to the problems inherent with recruiting women who have undergone unsuccessful IVF treatment cycles and their inevitable low live birth rate per initiated cycle, many studies performed to date have been underpowered.

Recent findings
Previous meta-analyses of studies performed in populations of women with a poor response to ovarian stimulation, demonstrated an increase in the live birth rate for the use of GH. With the recent publication of three studies and the presentation of the Australian LIGHT study, we undertook an updated meta-analysis.

Summary
Meta-analysis demonstrated a benefit for the use of the adjunct GH, with a reduction in the duration of ovarian stimulation required for oocyte retrieval, the collection of a greater number of oocytes than placebo, and an improvement in many of the early clinical parameters; however, there was no evidence of an increased chance of a live birth for the use of GH.
Free-style Deepithelialized Propeller Flaps: An Ideal Local Flap to Obliterate Wounds with Dead Space
Authors: Datli Asli , Suh HyunSuk , Kim Young Chul , Choi Doon Hoon , Hong Joon Pio (Jp) 
Published: March 2017

Background:
The reconstruction of the posterior trunk, especially with large dead spaces, remains challenging. Regional muscle flaps may lack adequate volume and reach. The purpose of this report was to evaluate the efficacy of deepithelialized free-style perforator-based propeller flaps to obliterate defects with large dead space.

Methods:
A total of 7 patients with defects on the posterior trunk with large dead spaces were evaluated. After complete debridement or resection, all flaps were designed on a single perforator adjacent to the defect, deepithelialized, and then rotated in a propeller fashion. Flaps were further modified in some cases such as folding the flap after deepithelialization to increase bulk and to obliterate the dead space.

Results:
The flap dimension ranged from 10 × 5 × 1 to 15 × 8 × 2.5 cm based on a single perforator. The rotation arch of the flap ranged from 90 to 180 degrees. Uneventful healing was noted in all cases. One case showed latent redness and swelling at 7 months after falling down, which resolved with medication. During the average follow-up of 28 months, there were no other flap and donor site complications.

Conclusion:
The deepithelialized propeller flap can be used efficiently to obliterate dead spaces in the posterior trunk and retains advantages such as having a good vascular supply, adequate bulk, sufficient reach without tension, and minimal donor site morbidity.
Various Types of Minor Trauma to Hair Follicles During Follicular Unit Extraction for Hair Transplantation
Authors: Park Jae Hyun , You Seung Hyun 
Published: March 2017

Background:When performing follicular unit extraction (FUE), various types of minor hair follicle trauma unapparent during follicular unit strip surgery are likely to occur. However, no studies have examined such damage.Methods:In total, 100 grafts were randomly selected from each of 42 patients who underwent FUE with a 1-mm-diameter sharp punch. A ×5.5 magnifying loupe and a ×60 magnifying binocular microscope were used. The transection rate (TR), paring, fractures of and damage to the dermal papilla (DP) areas, and hair bulb partial injury were assessed.Results:Observation with the magnifying loupe revealed an average TR of 7.40%, and 4.31, 1.90, 1.52, and 0.43 hair follicles per 100 grafts exhibited paring, fracture, DP partial injury, and hair bulb partial injury, respectively. An average of 9.21 telogen hairs were observed. Microscopic examination revealed a TR of 6.34%, and 9.07, 1.95, 0.79, and 1.24 hair follicles per 100 grafts exhibited paring, fracture, DP injury, and hair bulb partial injury, respectively. An average of 16.62 telogen hairs were observed.Conclusions:Various types of minor hair follicle damage occur during FUE as shown by loupe and microscopic examination of the grafts. Especially paring and hair bulb injury were more apparent under microscopic examination. These minor hair follicle injuries should be considered when choosing operative method or surgical techniques.
Pretrimmed versus Direct Nonshaven Follicular Unit Extraction
Authors: Park Jae Hyun , You Seung Hyun 
Published: March 2017

Background:
Shaving the donor area is one of the major deterrents preventing hair transplant patients from selecting follicular unit extraction (FUE). A minimal shaved donor area is possible in strip surgery, but the strip method is not applicable if the patient wishes to avoid a linear donor scar, wishes to minimize postoperative pain, or has insufficient scalp laxity. In these cases, nonshaven FUE (NS-FUE) is potentially a very good choice.

Methods:
A total of 42 patients were enrolled. Both pretrimmed and direct NS-FUE were performed during a single session in each patient. The 2 methods were compared regarding the time taken to punch 50 grafts, transection rate, and calculated density (number of hairs per graft).

Results:
The mean time taken to punch 50 grafts was significantly longer in the pretrimmed method than the direct method (3.4 minutes versus 2.6 minutes; P < 0.001). The mean transection rate was similar in both methods (8.8% for the pretrimmed method and 7.5% for the direct method; P > 0.05). The mean calculated density was significantly higher in the pretrimmed method than the direct method (2.23 hairs per graft versus 2.15 hairs per graft; P < 0.05). The length of the harvested hair was 1–4 mm in the pretrimmed method, compared with 0.4–0.8 mm in the direct method.

Conclusion:
Depending on the proficiency and preference of doctors and the case indications, pretrimmed and direct NS-FUE are both useful techniques for hair transplantation.
Knowledge and Attitude Toward Corneal Donation Among High School Children in Northern India
Authors: Gupta Parul Chawla , Duggal Mona , Jamir Limalemla , Sharma Drishti , Kankaria Ankita , Sathyanath Shreyaswi , Kaur Rupinder , Rana Kirtan , Ram Jagat 
Published: March 2017

Purpose:
To assess the knowledge and attitude of school-going adolescents regarding corneal donation in government and private schools in an urban area of Northern India.

Methods:
A school-based cross-sectional study was conducted in an urban field practice area of Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. A total of 365 participants of the seventh to 10th grade were enrolled from a government school and a private school. A pretested, semistructured, self-administered, bilingual (English and Hindi) questionnaire was used to assess the sociodemographic profile and knowledge and attitude related to corneal donation.

Results:
Most (87%) (confidence interval, 83.1%–90.0%) participants had heard about corneal donation. Only 2% of students answered all the knowledge-related questions correctly. None knew about the national toll-free number for corneal donation. Three-fourth (72%) supported the idea of corneal donation. Of them, only 44% (confidence interval, 41.0–47.1) were willing to pledge to donate their own eyes. Fears and myths were the persistent barriers. The government and private schools differed in both knowledge and attitude, with the latter performing better.

Conclusions:
Knowledge among the selected high school children was poor. Although many supported the idea, only a few were willing to donate. We suggest that program components be evaluated from time to time. Future studies should explore the role of strengthening Information Education and Communication (IEC) activities among high school students for motivating community members to pledge to donate for corneal donation.
Comparing the Effects of Particulate Matter on the Ocular Surfaces of Normal Eyes and a Dry Eye Rat Model
Authors: Han Ji Yun , Kang Boram , Eom Youngsub , Kim Hyo Myung , Song Jong Suk 
Published: March 2017

Purpose:
To compare the effect of exposure to particulate matter on the ocular surface of normal and experimental dry eye (EDE) rat models.

Methods:
Titanium dioxide (TiO2) nanoparticles were used as the particulate matter. Rats were divided into 4 groups: normal control group, TiO2 challenge group of the normal model, EDE control group, and TiO2 challenge group of the EDE model. After 24 hours, corneal clarity was compared and tear samples were collected for quantification of lactate dehydrogenase, MUC5AC, and tumor necrosis factor-α concentrations. The periorbital tissues were used to evaluate the inflammatory cell infiltration and detect apoptotic cells.

Results:
The corneal clarity score was greater in the EDE model than in the normal model. The score increased after TiO2 challenge in each group compared with each control group (normal control vs. TiO2 challenge group, 0.0 ± 0.0 vs. 0.8 ± 0.6, P = 0.024; EDE control vs. TiO2 challenge group, 2.2 ± 0.6 vs. 3.8 ± 0.4, P = 0.026). The tear lactate dehydrogenase level and inflammatory cell infiltration on the ocular surface were higher in the EDE model than in the normal model. These measurements increased significantly in both normal and EDE models after TiO2 challenge. The tumor necrosis factor-α levels and terminal deoxynucleotidyl transferase–mediated dUTP nick end labeling–positive cells were also higher in the EDE model than in the normal model.

Conclusions:
TiO2 nanoparticle exposure on the ocular surface had a more prominent effect in the EDE model than it did in the normal model. The ocular surface of dry eyes seems to be more vulnerable to fine dust of air pollution than that of normal eyes.
Optimal Dosing of Risperidone and Olanzapine in the Maintenance Treatment for Patients With Schizophrenia and Related Psychotic Disorders
Authors: Yoshimura Yusaku , Takeda Toshihiko , Kishi Yoshiki , Harada Toshiki , Nomura Akira , Washida Kenji , Yoshimura Bunta , Sato Kojiro , Yada Yuji , Aoki Shozo 
Published: March 2017

Abstract

Objectives
This study aims to determine the optimal tolerability dose ranges of risperidone (RIS) and olanzapine (OLZ) administered during schizophrenia maintenance phase.

Methods
Two-year continuation rates of prescription at discharge were examined using a retrospective cohort study method. Adult patients with schizophrenia and related psychotic disorders, receiving antipsychotic monotherapy with RIS or OLZ at discharge, were included. The primary outcome measures were the time to treatment discontinuation and 2-year continuation rates at 4 modal dose ranges of each drug. We estimated the optimal tolerability dose ranges by comparing the continuation rates at various modal doses.

Results
Of 648 patients, 344 received RIS and 304 received OLZ. The RIS 2-year continuation rates at 4 daily modal dose ranges were significantly different (0.5–2.5 mg: 46.0%, 3.0–5.0 mg: 40.0%, 5.5–7.5 mg: 30.0%, and 8.0–10.0 mg: 28.0%), with the difference favoring RIS at lower doses (0.5–5.0 mg) more than higher doses (5.5–10.0 mg). In contrast, there were no significant differences among OLZ 4 modal dose ranges (2.5–7.5 mg: 49.1%, 10.0–15.0 mg: 42.6%, 17.5–22.5 mg: 40.9%, and 25.0–30.0 mg: 39.0%). The time to treatment discontinuation significantly favored OLZ over RIS. However, it did not significantly differ between RIS and OLZ at lower doses.

Conclusions
It is suggested that the optimal tolerability dose range during maintenance treatment is 0.5 to 5.0 mg/d for RIS and 2.5 to 30 mg/d for OLZ, and that RIS at lower doses is comparable with OLZ at lower doses.
New Scoring System for Evaluating Patulous Eustachian Tube Patients
Authors: Ikeda Ryoukichi , Kikuchi Toshiaki , Oshima Hidetoshi , Miyazaki Hiromitsu , Hidaka Hiroshi , Kawase Tetsuaki , Katori Yukio , Kobayashi Toshimitsu 
Published: March 2017

Objective:To assess the efficacy of patulous Eustachian tube handicap inventory (PHI) for patulous Eustachian tube (PET) patients.Study Design:Prospective.Setting:Tertiary referral center.Subjects:A prospective survey of medical records in Sen-En Hospital identified 31 ears of 31 patients with definite PET who received insertion of the silicone plug as surgical treatment group, 29 ears of 29 patients treated with self-instillation of physiological saline solution as conservative treatment group, and 29 ears of 29 patients of sensorineural hearing loss without findings of PET treated between June 2015 and December 2015.Method:Diagnosis of definite PET was based on the proposal on PET diagnosis criteria announced by the Otological Society of Japan. The evaluation scale of PHI was modified from the Japanese version of the tinnitus handicap inventory-12 (THI-12). The classification for grading of severity is defined as follows: 1) no handicap (0–8), 2) mild handicap (10–16), 3) moderate handicap (18–24), and 4) severe handicap (26–40), matching the severity grades of tinnitus handicap inventory-25 (THI-25). The outcome measurement was modified from the previous scoring system and is defined as 1) complete relief, 2) significant improvement, 3) slight improvement, 4) unchanged, and 5) worse, and is applied according to the classification for grading of severity. The PHI was conducted at the first visit to our center for all patients in the three groups. For cases requiring surgery for plug insertion, patulous Eustachian tube handicap inventory 10 (PHI 10) was also conducted postsurgery after the treatment (postsurgery).Results:The findings from questions 1 to 7 and 9 to 11 were significantly different between the surgical (presurgery) and conservative treatment groups (p < 0.05). Taking these results, we analyzed 10 questions excluding questions 8 and 12 (PHI 10). The total score of PHI 10 averaged 19.5 ± 9.3 (n = 31) and 30.6 ± 8.6 (n = 29) in the surgical treatment (presurgery) and conservative treatment groups, respectively, with a significant difference (p < 0.05). Internal consistency reliability testing of the PHI 10 yielded a Cronbachαof 0.887 for all questions. In the surgical treatment (presurgery) and conservative treatment groups, there were 0 (0%) and 3 cases (12%) of no handicap, 3 (10%) and 13 cases (50%) of mild handicap, 6 (19%) and 4 cases (15%) of moderate handicap, and 22 (71%) and 6 cases (23%) of severe handicap, respectively. There was a significant correlation between the PHI 10 and Likert scale (r = 0.796,p < 0.01). In the surgical group, the presurgery and postsurgery PHI 10 scores (n = 25) were 29.6 ± 8.5 and 7.8 ± 11.3, respectively.Conclusion:The PHI 10 is suitable for evaluating severity of PET if the patients have been diagnosed as definite PET. Furthermore, this scoring system could be suitable for surgical treatment assessment.
Tests of Eustachian Tube Function: the Effect of Testing Technique on Tube Opening in Healthy Ears
Authors: Smith Matthew E. , Blythe Andrew J. C. , Baker Charlotte , Zou Charlie C. , Hutchinson Peter J. A. , Tysome James R. 
Published: March 2017

Objective:
There is no agreement on the best clinical test for Eustachian tube (ET) dysfunction. Numerous tests have been developed to detect ET opening, and all require a patient to perform a Valsalva, Toynbee or sniff maneuver, or to swallow on demand. We aimed to characterize existing tests of ET function in healthy ears, and identify the optimal method and patient maneuver for each test. Our own normative data is presented alongside published comparisons.

Study Design:
Diagnostic test cohort study.

Setting:
Tertiary referral center.

Patients:
Seventy-five healthy ears from 42 volunteers.

Interventions:
Six tests of ET function, each performed using multiple different patient maneuvers.

Main Outcome Measure:
Detected ET opening rate for each test-maneuver combination.

Results:
The highest detected opening rates were: Sonotubometry 94%; nine-step test inflation/deflation 93/94%; continuous impedance 88%, patient-reported opening 79%; observed tympanic membrane movement 78%; and Tubo-tympano-aerodynamic-graphy 76%. Valsalva maneuvers were most effective at opening the ET. Toynbee and swallow maneuvers were more effective when performed without water, when compared to with water. For Valsalva and sniff maneuvers, there was significant correlation between the peak nasopharyngeal pressure generated and the ET opening rate.

Conclusion:
Based on ET opening detection rates, we recommend the use of dry swallows with sonotubometry and the nine-step test. When testing patient-reported opening and observed membrane movement, and when performing Tubo-tympano-aerodynamic-graphy and impedance tests, we recommend the use of Valsalva maneuvers. Further studies are required to explore the association between the test technique and results in ears with ET dysfunction.
Secondary Endolymphatic Hydrops
Authors: Ferster Ashley P. O’Connell , Cureoglu Sebahattin , Keskin Nevra , Paparella Michael M. , Isildak Huseyin 
Published: March 2017

Hypothesis:
A review of the most recent literature will provide clinicians with an update of secondary endolymphatic hydrops, aiding in diagnosis and treatment of affected patients.

Background:
Secondary endolymphatic hydrops is a pathologic finding of the inner ear resulting in episodic vertigo and intermittent hearing loss. It is a finding for which extensive research is being performed.

Methods:
A review of the most recent literature on secondary endolymphatic hydrops was performed using PubMed literature search.

Results:
Recent investigation of secondary endolymphatic hydrops has brought attention to traumatic and inflammatory insults as causes for secondary endolymphatic hydrops. Such etiologies, including postsurgical effects of cochlear implantation and endolymphatic sac ablation; otosclerosis and its operative intervention(s); acoustic and mechanical trauma; medications; and systemic inflammatory processes, have been determined as causes of secondary lymphatic hydrops. Histopathological slides for many of the etiologies of secondary endolymphatic hydrops are presented.

Conclusion:
Through an understanding of the pathophysiology and etiologies of secondary endolymphatic hydrops, clinicians will gain a better understanding of this complex disease process, which will aid in treatment of patients with this disease process.
New biomarkers and imaging approaches for the diagnosis of deep venous thrombosis
Authors: Schaefer Jordan K. , Jacobs Benjamin , Wakefield Thomas W. , Sood Suman L. 
Published: March 2017

Purpose of review
Symptoms suggestive of deep vein thrombosis (DVT) are extremely common in clinical practice, but unfortunately nonspecific. In both ambulatory and inpatient settings, clinicians are often tasked with evaluating these concerns. Here, we review the most recent advances in biomarkers and imaging to diagnose lower extremity DVT.

Recent findings
The modified Wells score remains the most supported clinical decision rule for risk stratifying patients. In uncomplicated patients, the D-dimer can be utilized with risk stratification to reasonably exclude lower extremity DVT in some patients. Although numerous biomarkers have been explored, soluble P-selectin has the most promise as a novel marker for DVT. Imaging will be required for many patients and ultrasound is the primary modality. Nuclear medicine techniques are under development, and computed tomography (CT) and magnetic resonance venography are reasonable alternatives in select patients.

Summary
D-dimer is the only clinically applied biomarker for DVT diagnosis, with soluble P-selectin a promising novel biomarker. Recent studies have identified several other potential biomarkers. Ultrasound remains the imaging modality of choice, but CT, MRI, or nuclear medicine tests can be considered in select scenarios.
Management of acute asthma exacerbations
Authors: Stenson Erin K. , Tchou Michael J. , Wheeler Derek S. 
Published: March 2017

Purpose of review
Herein, we review the current guidelines for the management of children with an acute asthma exacerbation. We focus on management in the emergency department, inpatient, and ICU settings.

Recent findings
The most recent statistics show that the prevalence of asthma during childhood has decreased in certain demographic subgroups and plateaued in other subgroups. However, acute asthma accounts for significant healthcare expenditures. Although there are few, if any, newer therapeutic agents available for management of acute asthma exacerbations, several reports leveraging quality improvement science have shown significant reductions in costs of care as well as improvements in outcome.

Summary
Asthma is one of the most common chronic conditions in children and the most common reason that children are admitted to the hospital. Nevertheless, the evidence to support specific agents in the management of acute asthma exacerbations is surprisingly limited. The management of acute exacerbations focuses on reversal of bronchospasm, correction of hypoxia, and prevention of relapse and recurrence. Second-tier and third-tier agents are infrequently used outside of the ICU setting. Reducing the variation in treatment is likely to lead to lower costs and better outcomes.