bluuebunny/crossref_metadata_2025_split huggingface dataset:
Centralization of Pediatric Surgical Procedures in the United Kingdom
Authors: Durkin Natalie , Davenport Mark 
Published: September 2017

AbstractThe NHS provides more than 98% of all surgical procedures in infants and children in the United Kingdom through a comprehensive network of secondary (typically for the general surgery of childhood) and tertiary (specialist neonatal and specialist pediatric surgery) centers [n = 22]), typically located within large conurbations. It was originally envisaged that these specialized centers would be able to provide the full range of surgical interventions (aside from organ transplantation). However, there has been a trend toward centralization of some key procedures, previously thought to be within general neonatal surgery.The architype for centralization is the management of biliary atresia (BA). Since 1999, within England and Wales, this has been exclusively managed in three centers (King's College Hospital, London; Birmingham Children's Hospital and Leeds General Infirmary). All of these provide facilities for the diagnosis of BA, primary surgical management (Kasai portoenterostomy), and liver transplantation if required. The case for centralization was made by rigorous national outcome analysis during the 1990s showing marked disparity based on case volume and driven by parents' organizations and national media. Following centralization, national outcome data showed improvement and provided a benchmark for others to follow.The management of bladder exstrophy was later centralized in England and Wales, albeit not based on strict outcome data, to two centers (Great Ormond Street, London and Royal Manchester Children's Hospital).
The Incidence of Chromosomal Aberrations in Prenatally Diagnosed Isolated Agenesis of the Corpus Callosum
Authors: Rüland Anna , Gloning Karl-Philipp , Albig Matthias , Kagan Karl-Oliver , Hammer Rüdiger , Schälike Michael , Berg Christoph , Gembruch Ulrich , Geipel Annegret 
Published: September 2017

Abstract
Purpose To establish the prevalence of chromosomal aberrations in fetuses with an apparently isolated agenesis of the corpus callosum (ACC) on prenatal ultrasound.
Materials & Methods This was a retrospective study of complete isolated ACC at the time of ultrasound evaluation with respect to karyotype information. Within this group, a subgroup with non-malformation minor abnormalities, such as a single umbilical artery (SUA), polyhydramnios or fetal growth restriction (FGR), was investigated.
Results Complete ACC was diagnosed in 343 cases. Of them, 143 (41.6 %) were isolated, with 16 fetuses showing additional minor findings. In 76.2 % (109/143) karyotyping was performed. Additional array CGH analysis was performed in 7.7 % (11/143). Chromosomal aberrations were found in 4.6 % (5/109) overall, in 3.1 % (3/98) of those without any additional sonographic findings (all represented mosaic trisomy 8) and in 18.2 % (2/11) of those with minor abnormalities. The prevalence of pathogenic submicroscopic copy number variant (CNV) was 9 % (1/11).
Conclusion Fetal karyotyping is recommended in ACC, as trisomy 8 mosaicism should be considered despite otherwise unremarkable ultrasound. The role of novel techniques such as array CGH and its implication has to be explored in prospective studies.
How Do Patients Experience Individualized Medicine? A Qualitative Interview-based Study of Gene Expression Analyses in the Treatment of Breast Cancer
Authors: Schleidgen Sebastian , Thiersch Sandra , Wuerstlein Rachel , Marckmann Georg 
Published: September 2017

Abstract
Introduction In recent years, the hopes and expectations associated with so-called individualized medicine have been the subject of intense debate as has the medical potential of this approach. Questions about the uses of gene expression analyses for decisions on adjuvant systemic treatment options for patients with breast cancer have played a prominent role in this debate. There are a number of empirical studies on the effect of gene expression tests on the therapy decisions of physicians and the potentially conflicted decisions for patients. Very little attention has been paid to how patients perceive such approaches, the extent to which they feel included in the therapy decision, and the expectations they associate with such an approach.
Material and Methods Using qualitative explorative interviews, the study looked at how well patients with breast cancer understood the individualized treatment approaches and examined patientsʼ experiences and expectations with regard to gene expression analyses. The sample consisted of 8 patients who were diagnosed with primary hormone receptor-positive, HER2-negative breast cancer between 2013 and 2014 and who underwent gene expression analyses as part of their adjuvant therapy planning.
Results Patients were found to have a quite realistic view of the benefits of gene expression analyses, although it also became clear that the treatment could also raise false hopes. The statements by the interviewed women also illustrated the necessity of continuing to explore the possibilities and limits to joint decision-making in such complex medical contexts as individualized molecular genomic medicine. And finally, the interviews reflected the hope for individualized treatment in the broadest sense of the word.
Conclusion The results of the study highlight the challenge of taking psychosocial aspects of medical treatment sufficiently into consideration, given the ever increasing options for molecular genomic individualization.
Quality of Life, Sexuality, Anatomical Results and Side-effects of Implantation of an Alloplastic Mesh for Cystocele Correction at Follow-up after 36 Months
Authors: Fünfgeld Christian , Stehle Margit , Henne Brigit , Kaufhold Jan , Watermann Dirk , Grebe Markus , Mengel Mathias 
Published: September 2017

Abstract
Introduction Pelvic organ prolapse can significantly reduce quality of life of affected women, with many cases requiring corrective surgery. The rate of recurrence is relatively high after conventional prolapse surgery. In recent years, alloplastic meshes have increasingly been implanted to stabilize the pelvic floor, which has led to considerable improvement of anatomical results. But the potential for mesh-induced risks has led to a controversial discussion on the use of surgical meshes in urogynecology. The impact of cystocele correction and implantation of an alloplastic mesh on patientsʼ quality of life/sexuality and the long-term stability of this approach were investigated.
Method In a large prospective multicenter study, 289 patients with symptomatic cystocele underwent surgery with implantation of a titanized polypropylene mesh (TiLOOP® Total 6, pfm medical ag) and followed up for 36 months. Both primary procedures and procedures for recurrence were included in the study. Anatomical outcomes were quantified using the POP-Q system. Quality of life including sexuality were assessed using the German version of the validated P-QoL questionnaire. All adverse events were assessed by an independent clinical event committee.
Results Mean patient age was 67 ± 8 years. Quality of life improved significantly over the course of the study in all investigated areas, including sexuality and personal relationships (p < 0.001, Wilcoxon test). The number of adverse events which occurred in the period between 12 and 36 months after surgery was low, with just 22 events reported. The recurrence rate for the anterior compartment was 4.5%. Previous or concomitant hysterectomy increased the risk of recurrence in the posterior compartment 2.8-fold and increased the risk of erosion 2.25-fold.
Conclusion Cystocele correction using a 2nd generation alloplastic mesh achieved good anatomical and functional results in cases requiring stabilization of the pelvic floor and in patients with recurrence. The rate of recurrence was low, the patientsʼ quality of life improved significantly, and the risks were acceptable.
How large are the globular cluster systems of early-type galaxies and do they scale with galaxy halo properties?
Authors: Forbes Duncan A. 
Published: September 2017

Abstract
The globular cluster (GC) systems of galaxies are well known to extend to large galactocentric radii. Here, we quantify the size of GC systems using the half number radius of 22 GC systems around early-type galaxies (ETGs) from the literature. We compare GC system sizes to the sizes and masses of their host galaxies. We find that GC systems typically extend to 4 times that of the host galaxy size; however, this factor varies with galaxy stellar mass from about 3 times for M* galaxies to 5 times for the most massive galaxies in the universe. The size of a GC system scales approximately linearly with the virial radius (R200) and with the halo mass (M200) to the 1/3 power. The GC system of the Milky Way follows the same relations as for ETGs. For ultra diffuse galaxies (UDGs), their GC system size scales with halo mass and virial radius as for more massive, larger galaxies. UDGs indicate that the linear scaling of GC system size with stellar mass for massive galaxies flattens out for low stellar mass galaxies. Our scalings are different to those reported recently by Hudson & Robison.
Automated influenza case detection for public health surveillance and clinical diagnosis using dynamic influenza prevalence method
Authors: Tsui Fuchiang , Ye Ye , Ruiz Victor , Cooper Gregory F , Wagner Michael M 
Published: September 2017

Abstract

Objectives
To assess the performance of a Bayesian case detector (BCD) for influenza surveillance and clinical diagnosis.

Methods
BCD uses a Bayesian network classifier to compute the posterior probability of a patient having influenza based on 31 findings from narrative clinical notes. To assess the potential for disease surveillance, we calculated area under the receiver operating characteristic curve (AUC) to indicate BCD’s ability to differentiate between influenza and non-influenza encounters in emergency department settings. To assess the potential for clinical diagnosis, we measured AUC for diagnosing influenza cases among encounters having influenza-like illnesses. We also evaluated the performance of BCD using dynamically estimated influenza prevalence, and measured sensitivity, specificity and positive predictive value.

Results
For influenza surveillance, BCD differentiated between influenza and non-influenza encounters well with an AUC of 0.90 and 0.97 with dynamic influenza prevalence (P < 0.0001). For clinical diagnosis, the addition of dynamic influenza prevalence to BCD significantly improved AUC from 0.63 to 0.85 to distinguish influenza from other causes of influenza-like illness.

Conclusions and policy implications
BCD can serve as an influenza surveillance and a differential diagnosis tool via our dynamic prevalence approach. It enhances the communication between public health and clinical practice.
Tranexamic Acid in Orthopaedic Trauma Surgery: A Meta-Analysis
Authors: Gausden Elizabeth B. , Qudsi Rameez , Boone Myles D. , O'Gara Brian , Ruzbarsky Joseph J. , Lorich Dean G. 
Published: September 2017

Aim:
To systematically review and quantify the efficacy of tranexamic acid (TXA) use in reducing the risk of receiving a blood transfusion in patients undergoing orthopaedic trauma surgery, in reducing blood loss, and risk of thromboembolic events.

Methods:
A systematic literature search was performed using MEDLINE, Embase, ClinicalTrials.gov, and conference proceeding abstracts from 2014 to 2016. A minimum of 2 reviewers screened each study and graded quality. The primary outcome measure was the risk of receiving a blood transfusion in the TXA group versus control. A meta-analysis was performed to construct a combined odds ratio (OR) of receiving a blood transfusion, mean difference (MD) of blood loss, and OR of thromboembolic events.

Results:
Twelve studies were included in the quantitative analysis (1,333 patients). The risk of blood transfusion was significantly less in patients who were administered TXA compared with controls [OR 0.407; 95% confidence interval (CI) 0.278–0.594, I2 = 34, Q = 17, P ≤ 0.001]. There was significantly less blood loss in the TXA group compared with controls, as the mean difference was 304 mL (95% CI, 142–467 mL) (I2 = 94, Q value = 103, P < 0.001). There was no significant difference in risk of symptomatic thromboembolic events (OR 0.968; 95% CI, 0.530–1.766, I2 = 0, Q value = 5, P = 0.684).

Conclusions:
In patients with orthopaedic trauma, TXA reduces the risk of blood transfusion, reduces perioperative blood loss, and has no significant effect on the risk of symptomatic thromboembolic events. More high-quality studies are needed to ensure the safety of the drug in these patients.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Induced Membrane Technique: Pearls and Pitfalls
Authors: Masquelet Alain C. 
Published: September 2017

Summary:
The induced membrane technique for reconstruction of bone defects has proved its effectiveness and is now widely accepted. The 2 stages procedure, implying a cement spacer in the first stage and a huge bone graft in the second stage, responds to rigorous technical details involving each phase of the procedure. Prerequisites for the technique, cement spacer, bone fixation, time between the 2 stages, grafting, and postoperative course are reported and discussed.
Preoperative Evaluation and Optimization for Reconstruction of Segmental Bone Defects of the Tibia
Authors: McClure Philip K. , Alrabai Hamza M. , Conway Janet D. 
Published: September 2017

Summary:
Reconstruction of segmental bone defects requires a large commitment both on the part of the patient and the physician. Investing in preoperative evaluation and optimization is the only logical way to pursue such an endeavor. Unfortunately, detailed studies regarding segmental bone defects and preoperative factors are relatively lacking owing to the relatively low incidence of the problem. Fortunately, other orthopaedic pathologies (arthritis, ligamentous injuries about the knee) have high prevalence and consistency, allowing detailed analysis of preoperative factors. We review this literature, and that directly involving segmental bone defects when available, to guide surgeons planning segmental bone defect reconstruction.
“Iatrogenic” Segmental Defect: How I Debride High-Energy Open Tibial Fractures
Authors: Southam Brendan R. , Archdeacon Michael T. 
Published: September 2017

Summary:
High-energy, open tibial shaft fractures may result in significant comminution, bone loss, and soft tissue injuries. Early, thorough debridement of all nonviable tissue is of critical importance in treating these fractures as an inadequate initial debridement increases the risk of infection and nonunion. Large iatrogenic bone and soft tissue defects can result from debridement and will require subsequent reconstruction by both orthopaedic and plastic surgeons. Although a variety of approaches exist to address these reconstructions, successful management of bone defects remains a considerable challenge. In this article, we detail our approach to debridement and reconstruction of segmental tibial defects and provide a review on the literature on this topic.
Ilizarov Treatment Protocols in the Management of Infected Nonunion of the Tibia
Authors: McNally Martin , Ferguson Jamie , Kugan Raj , Stubbs David 
Published: September 2017

Objectives:
We present a treatment algorithm comprising 4 Ilizarov methods in managing infected tibial nonunion, using nonunion mobility and segmental defect size to govern treatment choice.

Design:
Decision protocol analysis study.

Setting:
A university-affiliated teaching hospital.

Patients/Participants:
Seventy-nine patients were treated with 1 of 4 Ilizarov protocols. All patients had undergone at least one previous operation, 38 had associated limb deformity, and 49 had nonviable nonunions. Twenty-six had a new muscle flap at the time of Ilizarov surgery, and 25 had preexisting flaps reused.

Intervention:
Twenty-six cases were treated with monofocal distraction, 19 with monofocal compression, 16 with bifocal compression/distraction, and 18 with bone transport.

Main Outcome Measurements:
The primary outcome measure was the absence of recurrent infection. Secondary outcomes included bone union, complications, the Association for the Advancement of Methods of Ilizarov (ASAMI) bone and functional classification scores, and any need for further unplanned surgery.

Results:
Infection was eradicated in 76 cases (96.2%) with a mean follow-up duration of 40.8 months (range 6–131). All 3 infection recurrences occurred in the monofocal compression group. Following the initial Ilizarov method alone, union was achieved in 68 cases (86.1%) and was highest among the monofocal distraction (96.2%) and bifocal compression/distraction groups (93.8%). Monofocal compression achieved the lowest union rate (73.7%), significantly lower ASAMI scores, and a refracture rate of 31.6%. Bone transport secured union in 77.8% with a 44.4% unplanned reoperation rate. However, infection-free union was 100% after further treatment.

Conclusions:
Monofocal compression is not recommended for treating infected, mobile nonunions. Distraction (monofocal or bifocal) was effective and achieved higher rates of union and infection clearance.

Level of Evidence:
Level III.
Effects of Contact Lens Wear on Biometry Measurements for Intraocular Lens Calculations
Authors: Meyer Jay J. , Kim Michelle J. , Kim Terry 
Published: September 2017

Objectives:
To determine the effects of contact lens (CL) wear on biometry measurements for cataract surgery and whether a CL hiatus can reduce the prediction error of intraocular lens (IOL) calculations.

Methods:
Retrospective, interventional case series of eyes that received repeat biometry measurements for IOL calculations after discontinuing hard or soft CLs for at least 14 days. Primary outcome measures: intersession change in axial length, average keratometry, astigmatism, and axis. Secondary outcome measures: change in recommended IOL power and toricity, postoperative refraction prediction error.

Results:
Thirty-two eyes of 16 patients had a mean duration of CL wear (12 hard and 20 soft) of 39.5 years (range, 29–55 years) and mean CL hiatus duration of 25 days (range, 14–56 days). Mean absolute intersession change in axial length was 0.016 mm (range, 0–0.05 mm), average keratometry 0.31 D (range, 0.02–1.01 D), astigmatism 0.41 D (range, 0.01–1.10 D), and axis 6.3° (range, 0–28°). The IOL power predicting the lowest postoperative spherical equivalent changed for 17 of 32 eyes (by 0.5 D for 12 eyes and 1.0 D for five eyes). Recommended IOL toricity changed for nine of 14 eyes (by 0.75 D for six eyes and 1.50 D for three eyes). The median absolute prediction error of IOL calculations was 0.69 D (range, 0.19–2.93 D) before and 0.57 D (range, 0.01–2.82 D) after the CL hiatus (P=0.16).

Conclusions:
Contact lens wear may affect biometry measurements and subsequent IOL power and toricity selection. For some eyes, repeating biometry measurements after a CL hiatus may improve the accuracy of IOL calculations.
Short-Term Comfort Responses Associated With the Use of Eyelid Cleansing Products to Manage Demodex folliculorum
Authors: Ngo William , Jones Lyndon , Bitton Etty 
Published: September 2017

Purpose:
To quantify the discomfort over time of various eyelid cleansers against Demodex.

Methods:
This was a prospective, randomized, controlled, crossover, open-label study that enrolled 26 participants. The cleansers used in this study were Biotissue Cliradex (CD), OCuSOFT Lid Scrubs Plus (OP), OCuSOFT OUST Demodex Swabstix (ODS), TheraTears Theralid (TT), NovaBay Avenova (NA). Bausch+Lomb Sensitive Eyes Plus saline was used as a control. Participants were asked to close their eyes as the product was gently rubbed (10 cycles of gentle lateral motion) into the eyelashes. Participants verbally rated their discomfort (0 = no discomfort, 10 = maximum tolerable discomfort) every 15 sec for the first 5 min, and every 30 sec for 5 min after, for a total of 10 min. The order of products used was randomized, and washout period between cleansing was 48 hr.

Results:
Twenty-five participants completed the study (mean age=26±6). There was no significant difference in discomfort scores at pre-application. The discomfort levels of saline, OP, and NA over the 10-min period were not significantly different than their pre-application discomfort at all time points (all P≥0.99). The discomfort of CD was significantly higher than pre-application levels between t=15 sec and t=180 sec (all P≤0.01), with maximum median (interquartile range [IQR]) discomfort of 3.0 (5.0) occurring at t=45 sec. The discomfort of TT was significantly higher than pre-application levels between t=45 and t=90 (all P<0.02), with maximum median (IQR) discomfort of 1.0 (1.5) occurring at t=75 sec. The discomfort of ODS was significantly higher than pre-application levels starting from t=60 sec and onward, with maximum median (IQR) discomfort of 6.0 (5.0) occurring at t=300 sec.

Conclusion:
Of the cleansers used in this study, the ones that induced significant discomfort were CD, TT, and ODS. The results from this study may help clinicians educate patients about what to expect when approaching the topic of eyelid Demodex treatment.
Investigation of Ocular Tear Ferning in Controlled and Uncontrolled Diabetic Subjects
Authors: Masmali Ali M. , Maeni Yahya A. , El-Hiti Gamal A. , Murphy Paul J. , Almubrad Turki 
Published: September 2017

Objectives:
To investigate the ocular tear film in controlled and uncontrolled diabetes mellitus (DM) subjects and the relationship between dry eye and diabetes.

Methods:
One hundred twenty-four diabetes adults (65 male and 59 female, with 62 controlled and 62 uncontrolled DM) were assessed by McMonnies dry eye questionnaire, tear break-up time (TBUT), phenol red thread (PRT) test. In addition, tear samples were collected from the lower tear meniscus of right eyes and dried onto glass slides under controlled room temperature (25°C) and humidity (40%). The glass slides were observed using a digital microscopy and the tear ferning (TF) patterns observed were graded based on Masmali TF grading scale. Patients with a HbA1c value below 6.5% were defined as “controlled DM” and those with a HbA1c value above 6.5% were defined as “uncontrolled DM.” The Spearman's correlation coefficient was used to determine the relationship between various tests.

Results:
Several subjects having dry eye varied depending on the test used. McMonnies questionnaire scores suggested that 28 subjects (23%) showed dry eye (score >14.5), of whom 23 subjects (82%) showed uncontrolled diabetes. The TF patterns showed that 44 subjects (35.5%) showed dry eyes (Grade ≥2), of whom 32 subjects (72.7%) showed uncontrolled diabetes. Phenol red thread test found that 46 subjects (37%) showed dry eye (wetting <10 mm), of whom 38 subjects (82.6%) showed uncontrolled diabetes. Tear break-up time found that 57 subjects (46%) showed dry eye (time <10 sec), of whom 45 subjects (78.9%) showed uncontrolled diabetes. In controlled diabetic subjects, TF grades showed medium negative correlations with both TBUT and PRT (−0.374 and −0.349, respectively). In uncontrolled subjects, TF grades have a strong negative correlation with TBUT (−0.539) and a medium negative correlation with PRT (−0.410).

Conclusions:
Dry eye disease is common in diabetic subjects, particularly in people with poor diabetic control. Uncontrolled blood glucose level seemed to be a risk factor for dry eye syndrome. Tear ferning test showed a correlation between diabetes and dry eye in diabetic subjects and can be used as a reliable test to evaluate the quality of the ocular tear film.