bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hexapod Frame Stacked Transport for Tibial Infected Nonunions With Bone Loss: Analysis of Use of Adjunctive Stability
Authors: Napora Joshua K. , Weinberg Douglas S. , Eagle Blake A. , Kaufman Bram R. , Sontich John K. 
Published: March 2017

Objectives:
The stacked hexapod bone transport technique is an effective treatment for infected tibial nonunions with bone loss. The purpose of this study was to evaluate the patients' risk factors and timing for requiring adjunctive stabilization.

Design:
Retrospective cohort study.

Setting:
Level 1 trauma center.

Patients/Participants:
Seventy-five patients with infected posttraumatic nonunions of the tibia.

Intervention:
Resection of nonunion with application of stacked hexapod frame for bone transport.

Main Outcome Measurements:
Parameters measured included age, sex, diabetes, smoking, use of a free flap, bone defect size, length in frame, external fixation index, and direction of lengthening. Outcomes recorded: removal of frame, below knee amputation, or adjunctive stability. Further analysis evaluated location of nonunion, timing of adjunctive stabilization, and type of fixation.

Results:
The average patient age was 45.7 ± 12.5 years, 76% patients were men, 11% were diabetic, and 44% were smokers. Forty two percent had soft tissue defects that required a free flap. Thirty-eight patients had removal of frame, whereas 36 patients required adjunctive stability of the hexapod frame. Patient receiving adjunctive stabilization had a longer length of time in the hexapod frame (P = 0.026) and were more likely to require a free flap (P = 0.053). Ninety-three percent docking site nonunions occurred after the removal of the frame (P = 0.032); whereas 79% regenerate nonunions occurred before the hexapod frame was removed (P = 0.029).

Conclusions:
The use of a hexapod frame for the infected tibial nonunions with bone loss is an effective method for achieving union and eradicating infection in a difficult orthopaedic patient population. Use of adjunctive stabilization is a reasonable technique to address delayed regenerate and docking site nonunions.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Radiographic Review of Helical Blade Versus Lag Screw Fixation for Cephalomedullary Nailing of Low-Energy Peritrochanteric Femur Fractures: There is a Difference in Cutout
Authors: Stern Lorraine C. , Gorczyca John T. , Kates Stephen , Ketz John , Soles Gillian , Humphrey Catherine A. 
Published: March 2017

Objectives:
To compare the rate of cutout of helical blades and lag screws in low-energy peritrochanteric femur fractures treated with a cephalomedullary nail (CMN).

Design:
Retrospective review.

Setting:
Academic medical center.

Patients:
Overall, this study included 362 patients with an average age of 83 year old, a majority of whom were women, and had sustained a low-energy peritrochanteric femur fracture treated with a CMN. All patients had at least 3 months of clinical and radiographic follow, with an average follow-up of 11 months and a range of 3–88 months follow-up.

Intervention:
Cephalomedullary nailing with the use of a helical blade or single lag screw for proximal fixation.

Main Outcome Measurements:
Cutout of the helical blade or lag screw.

Results:
Twenty-two cutouts occurred, 14 (15.1%) of 93 patients with helical blades and 8 (3.0%) of 269 patients with lag screws. Cutout with the helical blade was significantly more frequent than with the lag screw (P = 0.0001). The average tip–apex distance (TAD) was significantly greater for those patients who experienced cutout both for the helical blades (23.5 vs. 19.7 mm; P = 0.0194) and lag screws (24.5 vs. 20.0 mm; P = 0.0197). An absolute TAD predictive of cutout could not be determined.

Conclusions:
When the helical blade was used, implant cutout occurred at a significantly higher rate compared with lag screw fixation. There was not a threshold TAD that was predictive of cutout for either implant.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Effectiveness Analysis of a Part-Time Rapid Response System During Operation Versus Nonoperation*
Authors: Kim Youlim , Lee Dong Seon , Min Hyunju , Choi Yun Young , Lee Eun Young , Song Inae , Park Jong Sun , Cho Young-Jae , Jo You Hwan , Yoon Ho Il , Lee Jae Ho , Lee Choon-Taek , Do Sang Hwan , Lee Yeon Joo 
Published: March 2017

Objectives:
To evaluate the effect of a part-time rapid response system on the occurrence rate of cardiopulmonary arrest by comparing the times of rapid response system operation versus nonoperation.

Design:
Retrospective cohort study.

Setting:
A 1,360-bed tertiary care hospital.

Patients:
Adult patients admitted to the general ward were screened. Data were collected over 36 months from rapid response system implementation (October 2012 to September 2015) and more than 45 months before rapid response system implementation (January 2009 to September 2012).

Interventions:
None.

Measurements and Main Results:
The rapid response system operates from 7 am to 10 pm on weekdays and from 7 am to 12 pm on Saturdays. Primary outcomes were the difference of cardiopulmonary arrest incidence between pre-rapid response system and post-rapid response system periods and whether the rapid response system operating time affects the cardiopulmonary arrest incidence. The overall cardiopulmonary arrest incidence (per 1,000 admissions) was 1.43. Although the number of admissions per month and case-mix index were increased (3,555.18 vs 4,564.72, p < 0.001; 1.09 vs 1.13, p = 0.001, respectively), the cardiopulmonary arrest incidence was significantly decreased after rapid response system (1.60 vs 1.23; p = 0.021), and mortality (%) was unchanged (1.38 vs 1.33; p = 0.322). After rapid response system implementation, the cardiopulmonary arrest incidence significantly decreased by 40% during rapid response system operating times (0.82 vs 0.49/1,000 admissions; p = 0.001) but remained similar during rapid response system nonoperating times (0.77 vs 0.73/1,000 admissions; p = 0.729).

Conclusions:
The implementation of a part-time rapid response system reduced the cardiopulmonary arrest incidence based on the reduction of cardiopulmonary arrest during rapid response system operating times. Further analysis of the cost effectiveness of part-time rapid response system is needed.
Splash Safety During Dermatologic Procedures Among US Dermatology Residents
Authors: Korta Dorota Z. , Chapman Lance W. , Lee Patrick K. , Linden Kenneth G. 
Published: March 2017

BACKGROUND
Dermatologists are at potential risk of acquiring infections from contamination of the mucous membranes by blood and body fluids. However, there are little data on splash safety during procedural dermatology.

OBJECTIVE
To determine dermatology resident perceptions about splash risk during dermatologic procedures and to quantify the rate of protective equipment use.

METHODS
An anonymous on-line survey was sent to 108 United States ACGME-approved dermatology residency programs assessing frequency of facial protection during dermatologic procedures, personal history of splash injury, and, if applicable, reasons for not always wearing facial protection.

RESULTS
A total of 153 dermatology residents responded. Rates of facial protection varied by procedure, with the highest rates during surgery and the lowest during local anesthetic injection. Over 54% of respondents reported suffering facial splash while not wearing facial protection during a procedure. In contrast, 88.9% of respondents correctly answered that there is a small risk of acquiring infection from mucosal splash. Residency program recommendations for facial protection seem to vary by procedure.

CONCLUSION
The authors' results demonstrate that although facial splash is a common injury, facial protection rates and protective recommendations vary significantly by procedure. These data support the recommendation for enhanced facial protection guidelines during procedural dermatology.
Histological Mohs Maps Improve the Accuracy of Dermatology Residents' Interpretations of Mohs Slides: A Pilot Study
Authors: Tiger Jeffrey B. , Ganesh Zai , Mouzakis John , Iwamoto Satori 
Published: March 2017

BACKGROUND
Effective Mohs surgery depends on accurate histopathological identification and mapping of tumor burden to ensure complete removal of tumor.

OBJECTIVE
The purpose of this study is to evaluate whether using a photograph of the histopathological slide as the Mohs map improves mapping accuracy.

MATERIALS AND METHODS
Single-blinded pilot study. Five dermatology residents at one academic institution mapped 11 cases of basal cell carcinoma using both traditional hand-drawn maps and color photographic maps. Residents' marked maps were assessed for global diagnostic accuracy, sensitivity, and specificity compared with the Mohs map verified by the attending surgeon on the day of surgery.

RESULTS
Diagnostic accuracy, sensitivity, and specificity were higher using the photographic Mohs maps compared with using the traditional hand-drawn maps (58.2% vs 29.1%, 84.5% vs 76.4%, and 87.1% vs 70.8%, respectively). These results were statistically significant for accuracy and specificity, but not for sensitivity.

CONCLUSION
Using histopathological photographs as the Mohs map significantly improved accuracy and specificity within a small group of residents with limited Mohs experience. More research is warranted to evaluate whether using histopathological photographs improves accuracy of Mohs mapping for experienced Mohs surgeons in a real-world setting, and whether this translates to improved clinical outcomes.
IGG4-RELATED OPHTHALMIC DISEASE PRESENTING AS CHOROIDAL AND ORBITAL LESIONS
Authors: Gange William S. , Holland Stephen M. , De Alba Felipe 
Published: March 2017

Purpose:
To report a case of IgG4-related ophthalmic disease (IgG4-ROD) which presented as choroidal and orbital lesions.

Methods:
Case report.

Results:
A 64-year-old man presented with left eye photopsias and a history of IgG4-related perirenal fibrosis. Fundoscopic examination showed multiple bilateral yellow choroidal lesions, and optical coherence tomography showed multiple choroidal lesions. Magnetic resonance imaging of the orbits showed an enhancing lesion present circumferential to the optic nerve, but greater medially, abutting the posterior surface of the left globe. Workup for infectious, autoimmune, and malignant etiologies was negative, and the patient has responded well to treatment with rituximab.

Conclusion:
IgG4-related disease is a systemic fibroinflammatory disease, which often presents in another location, as in our patient. In cases of uncertain choroidal and orbital lesions, a thorough workup for other etiologies is indicated, and lymphoma must be ruled out. Steroids are the mainstay of treatment for IgG4-ROD, however, small case series and our patient responded well to rituximab. To our knowledge, this is the first reported case of choroidal and orbital lesions secondary to IgG4-ROD.
MANAGEMENT OF METASTATIC BREAST CARCINOMA OF IRIS WITH INTRAOCULAR BEVACIZUMAB INJECTIONS
Authors: Akinci G. Ece , Hondur Ahmet M. , Tezel Tongalp H. 
Published: March 2017

Purpose:
To describe intraocular use of bevacizumab for a metastatic breast carcinoma of the iris resistant to advanced systemic chemotherapy protocols, for which conventional treatment would be local radiotherapy or brachytherapy.

Methods:
Case report.

Results:
A 65-year-old woman, who was previously diagnosed with breast carcinoma and treated with radical mastectomy coupled with radiotherapy and chemotherapy, presented with an iris mass in her left eye. Four successive intravitreal injections of bevacizumab resulted in progressive regression of the tumor to an almost indiscernible size at 8 months, along with blunting of the highly complex tumor vascular network on fluorescein angiography. At 12 months, the patient's visual acuity remained 20/20, and no ocular or systemic adverse effects were encountered.

Conclusion:
Intravitreal bevacizumab can offer a simpler and safer solution to treat metastatic iris tumors compared with other treatment options. This report of bevacizumab for treating iris metastasis from breast carcinoma may broaden the treatment options for similar neoplasms of the iris.
Myopic Laser Corneal Refractive Surgery Reduces Interdevice Agreement in the Measurement of Anterior Corneal Curvature
Authors: Jin Haiying , Ou Zhongmin , Guo Haike , Zhao Peiquan 
Published: March 2017

Objectives:
To investigate interdevice differences and agreement in the measurement of anterior corneal curvature obtained by different technologies after laser corneal refractive surgery.

Methods:
The prospective study comprised 109 eyes of 109 consecutive patients who had undergone laser-assisted in situ keratomileusis (LASIK). Preoperative and postoperative corneal parameters were measured by Scheimpflug imaging (Pentacam), Placido-slit-scanning (Orbscan) and auto-keratometry (IOLMaster). Preoperative and postoperative anterior corneal curvatures (K readings) were compared between devices. Interdevice agreement was evaluated by Bland–Altman analysis.

Results:
Preoperatively, the difference of K reading for Pentacam–IOLMaster (0.04±0.20 D) was not statistically significant (P=0.059). The differences between Pentacam–Orbscan and Orbscan–IOLMaster were 0.20±0.34 D (P<0.001) and −0.17±0.29 D (P<0.001), respectively. After surgery, no difference was found for Pentacam–Orbscan (−0.05±0.38, P=0.136). The differences between Pentacam–IOLMaster and Orbscan–IOLMaster were 0.13±0.29 D (P<0.001) and 0.19±0.34 D (P<0.001). Preoperative interdevice agreement (95% limit of agreement [LOA]) between Pentacam and Orbscan, Pentacam and IOLMaster, and Orbscan and IOLMaster were 1.31 D, 0.79 D and 1.14 D, respectively. The 95% LOAs decreased to 1.47 D, 1.14 D, and 1.34 D after refractive surgery.

Conclusion:
Corneal refractive surgery changed the preoperative and postoperative interdevice differences in corneal curvature measurements and reduced interdevice agreement, indicating that the devices are not interchangeable.
Sub-basal Corneal Nerve Plexus Analysis Using a New Software Technology
Authors: Batawi Hatim , Shalabi Nabeel , Joag Madhura , Koru-Sengul Tulay , Rodriguez Jorge , Green Parke T. , Campigotto Mauro , Karp Carol L. , Galor Anat 
Published: March 2017

Purpose:
To study sub-basal corneal nerve plexus (SCNP) parameters by in vivo corneal confocal microscopy using a new software technology and examine the effect of demographics and diabetes mellitus (DM) on corneal nerves morphology.

Methods:
A Confoscan 4 (Nidek Technologies) was used in this cross-sectional study to image the SCNP in 84 right eyes at the Miami Veterans Affairs eye clinic. Images were analyzed using a new semiautomated nerve analysis software program (The Corneal Nerve Analysis tool) which evaluated 9 parameters including nerve fibers length (NFL) and nerve fibers length density (NFLD). The main outcome measure was the examination of SCNP morphology by demographics, comorbidities, and HbA1c level.

Results:
Interoperator and intraoperator reproducibility were good for the 9 parameters studied (Intraclass Correlations [ICCs] 0.73–0.97). Image variability between two images within the same scan was good for all parameters (ICC 0.66–0.80). Older individuals had lower SCNP parameters with NFL and NFLD negatively correlating with age (r=−0.471, and −0.461, respectively, P<0.01 for all). Patients with diabetes had lower mean NFLD 10987.6 μm/mm2 (±3,284.6) and NFL 1,289.5 μm/frame (±387.2) compared with patients without diabetes (mean NFLD 15077.1 μm/mm2 [±4,261.3] and NFL 1750.0 μm/frame [±540.7]) (P<0.05 for all). HbA1c levels in patients with diabetes were inversely correlated with NFL and NFLD (r= −0.568, and −0.569, respectively, P<0.05 for all).

Conclusions:
The Corneal Nerve Analysis tool is a reproducible diagnostic software technique for the analysis of the SCNP with confocal microscopy. Older age, DM, and higher level of HbA1c were associated with a significant reduction in SCNP parameters.
Conjunctivochalasis and Related Factors in an Adult Population of Iran
Authors: Hashemi Hassan , Rastad Hadith , Emamian Mohammad Hassan , Fotouhi Akbar 
Published: March 2017

Objectives:
To determine the prevalence of conjunctivochalasis and its determinants in a middle-aged Iranian population.

Methods:
This population-based study was conducted in the context of the second phase of Shahroud Eye Cohort Study in 2014. Of 4,737 participants aged 45 to 69 years who participated in the second phase, the data of 4,702 participants were available for this report. A diagnosis of conjunctivochalasis was made based on the physician's judgment on ophthalmic examinations.

Results:
Diagnosis of conjunctivochalasis in at least one eye was confirmed in 295 (6.2%) participants. The prevalence of unilateral and bilateral conjunctivochalasis was 0.7% and 5.5%, respectively. Older age (odds ratio [OR] = 1.96, 95% confidence interval [CI]: 1.22–3.15), use of Losartan (an angiotensin II receptor antagonist) (OR=1.47, 95% CI: 1.05–2.08), Meibomian Gland Dysfunction (OR=2.32, 95% CI: 1.78–3.03), Pinguecula (OR=0.57, 95% CI: 0.42–0.77), and blepharitis (OR=0.24, 95% CI: 0.07–0.77) had a significant association with conjunctivochalasis.

Conclusion:
The prevalence of conjunctivochalasis in our study was less than other reports from Asian population. Conjunctivochalasis has a significant association with some eyelid disorders and the use of Losartan which should be noted when diagnosing and treating this disease.
Advantages of Minimal Access versus Conventional Aortic Valve Replacement in Elderly or Severely Obese Patients
Authors: Pisano Calogera , Totaro Pasquale , Triolo Oreste Fabio , Argano Vincenzo 
Published: March 2017

Objective The aim of our study was to investigate potential clinical advantages of minimal access versus conventional surgical approach in older and severely obese patients undergoing isolated aortic valve replacement (AVR). Methods One hundred thirty-five patients undergoing isolated primary AVR were enrolled. Propensity score matching was used to compare 42 selected patients operated on ministernotomy (MS, group B) with 42 selected patients operated on full sternotomy (FS, group A). Results After propensity score matching, the two groups were comparable in terms of preoperative characteristics. Cardiopulmonary bypass time was significantly longer in MS group compared with the FS group [median (95% confidence level or CL), 103 (98.7–106.4) vs 94 (83.6–99) minutes, respectively; P = 0.0019]. No significant difference was observed in aortic cross-clamp time [median (95% CL), 73 (71.1–78.2) vs 69.5 (62.7–83) minutes; P = 0.4]. Significantly shorter ventilation time [median (95% CL), 13 (12–16.4) vs 24 (22–25) hours; P = 0.00018], intensive care unit stay [median (95% CL), 1 vs 2 days; P = 0.00017], and hospital stay [median (95% CL), 8.5 (8–10.8) vs 13.5 (11.1–14) days; P = 0.00030] were shown in the MS group. The age subgroup analysis showed that statistical significance for mechanical ventilation, intensive care unit, and hospital stay was specific for patients older than 75 years. The analysis of body mass index quartile showed that statistical significance for mechanical ventilation was specific for patients in the fourth quartile. Conclusions Minimal access AVR is a reproducible, safe, and effective surgical option in patients candidate for isolated AVR, and our study suggests a faster recovery when used in severely obese or older patients.
Modeling Outcomes
Authors: Nellis Joseph R. , Chung Timothy K. , Agarwal Nandita , Torres Jose E. , Holgren Sarah E. , Raghavan Madhavan L. , Turek Joseph W. 
Published: March 2017

Objective Numerous surgical approaches regarding aortic arch advancement for neonatal arch hypoplasia have been described. These repairs can be classified into two categories: those that incorporate a patch and those that do not. The decision between repairs remains largely experiential, rather than empirical, because of the limited number of reported outcomes. We report early outcomes from neo-nates undergoing modified aortic arch advancement with an anterior patch and our experience using computational fluid dynamic modeling to better understand the hemodynamic consequences associated with this repair. Methods A retrospective review of neonates undergoing aortic arch advancement with anterior patch in 2014 at a single institution was performed. Anatomical, perioperative, and follow-up data were collected. Three-dimensional cardiac magnetic resonance images were used to generate computational fluid dynamic models of the modified anterior patch and direct end-to-side repairs. Cardiac waveform inputs were simulated and hemodynamic analyzed. Results Ten neonates underwent modified aortic arch advancement. No hemodynamically significant gradients were observed at a median follow-up of 0.77 (0.30–1.2) years. Asymmetrical flow was observed in the end-to-side repair, whereas more concentric laminar flow was observed throughout the modified model. Spatial variations in velocities immediately distal to the anastomosis were greater in the end-to-side model (0.35 vs 0.17 m/s, P < 0.001). Time-averaged variations in wall shear stress during systole were greater in the end-to-side model at the same location (3.44 vs 1.98 dynes/cm2, P <0.001). Conclusions Early outcomes after the use of an anterior patch for neonatal hypoplastic aortic arch repair show favorable hemodynamic outcomes.
Continuity of Care in Older Adults With Multiple Chronic Conditions: How Well Do Administrative Measures Correspond With Patient Experiences?
Authors: DuGoff Eva H. 
Published: March 2017

ABSTRACT
Continuity of care (COC) is a fundamental component of primary care and particularly important to older adults who are managing multiple chronic conditions. Administrative measures of continuity are often used to evaluate care coordination interventions, but it is not known whether administrative continuity are correlated with patient reports of continuity among older adults with multiple chronic conditions (MCCs). The objective of this study is to assess the concordance of administrative continuity indices and patient reports of continuity among older adults with MCCs. We use patient survey data collected from July to October 2011 linked to administrative claims data collected from July 2010 to December 2011 for 710 Medicare Advantage Chronic Care Special Needs Plan beneficiaries living in the US South. Among older adults with two or more conditions, the Usual Provider of Care Index was not associated with any patient experience measure; COC Index was associated with informational and management continuity items. These findings suggest that among older adults with MCCs, the administrative continuity measures have limited concordance with patient reported continuity measures.