bluuebunny/crossref_metadata_2025_split huggingface dataset:
Fasting and Postprandial Plasma Citrulline and the Correlation to Intestinal Function Evaluated by 72‐Hour Metabolic Balance Studies in Short Bowel Jejunostomy Patients With Intestinal Failure
Authors: Fjermestad Hilde , Hvistendahl Mark , Jeppesen Palle Bekker 
Published: January 2017

AbstractBackground: Fasting plasma citrulline (p‐citrulline) is a marker of functional enterocyte mass. However, the optimal timing of measurement in relation to meals has yet to be clarified. Furthermore, p‐citrulline has been proposed to be a surrogate marker for small bowel length and intestinal absorption parameters in short bowel syndrome patients with intestinal failure (SBS‐IF). Materials and Methods: Eight patients with SBS‐IF and 8 healthy controls (HCs) were given a standardized mixed test meal, and p‐citrulline was measured 15 minutes before and 60, 120, and 180 minutes after completion of the meal. The patients with SBS‐IF had their intestinal absorption of wet weight, energy, macronutrients, and electrolytes measured in relation to 72‐hour metabolic balance studies. We investigated the possible correlations between p‐citrulline and short bowel length, absorptive parameters, and the dependence on parenteral support (PS). Results: In the patients with SBS‐IF, we found a 12% (P = .041) reduction in postprandial citrulline levels after 180 minutes. In the HCs, there was a 13% postprandial reduction at 60 minutes (P = .018). No significant correlations between fasting p‐citrulline and bowel length, bowel absorptive function, or the dependence on PS were found. Even when excluding 2 patients in whom the intestinal absorption was adjacent to the intestinal insufficiency borderlines, these correlations were not significant. Conclusion: Based on findings in this small study, the optimal timing of p‐citrulline measurement is on fasting samples. However, p‐citrulline seems insufficiently discriminative to serve as a valid biomarker of bowel length, bowel absorptive function, or dependence on PS in patients with SBS‐IF.
Can a Barthel score be derived from the FIM?
Authors: Nyein Kyaw , McMichael Linsey , Turner-Stokes Lynne 
Published: January 2017

Objective: To establish whether a Barthel score derived by translation from the motor items of the Functional Independence Measure (FIM) would equate to the directly scored measure.Design: Conversion criteria for motor item scores on the FIM scale to Barthel scores were first developed. To test these criteria, 40 consecutive patients were assessed for Barthel and FIM scores by the multidisciplinary team who were unaware of the conversion criteria. The derived Barthel score was compared with the directly scored Barthel Index.Results: A very high degree of correlation was observed between total scores of the direct and derived Barthel (Spearman's rho = 0.99), which is highly significant, and no significant differences were seen between scores for any of the individual items (Wilcoxon signed rank test). Item by item analysis across the study population was undertaken to confirm the conversion criteria. Absolute agreement between the two methods ranged from 75 to 100% and kappa values from 0.53 to 1.0.Conclusions: This study demonstrates that a Barthel Index can be derived from the motor items of the FIM and there is a good agreement with the directly assessed Barthel score. Although a larger study may help to delineate the exact conversion criteria for one item, the current system provides an accurate and usable translation of the total score and serves as a major step towards achieving a common language in outcome measurement for rehabilitation.
A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy
Authors: Nitz JC , Burns YR , Jackson RV 
Published: January 2017

Objectives: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. Design: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. Results: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. Conclusion: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.
Episodic status migrainosus: A novel migraine subtype
Authors: Singh Tarun D , Cutrer F Michael , Smith Jonathan H 
Published: January 2017

Objective To report a case series of a novel migraine subtype, which we term as episodic status migrainosus (ESM), characterized by attacks of migraine exclusively lasting more than 72 hours. We hypothesized that this would represent a novel nosologic entity, possibly an unstable migraine phenotype with a high conversion rate to chronic migraine (CM). Methods We conducted a retrospective review of patients diagnosed with status migrainosus at the Mayo Clinic, Rochester, between January 2005 and December 2015. All the records were then manually reviewed for patients with migraine headaches exclusively lasting more than 72 hours. Results We identified 18 patients with ESM, with a female predominance (15(83.3%)) and a median age of onset of 16.5 (IQR 13–19) years. The median monthly attack frequency was two (IQR 1–3), with each attack lasting a median duration of seven (IQR 4–12.5) days. Stress was the most commonly reported precipitant (11 (61.1%)). Migraine with aura was common (10 (55.6%)), as was comorbid depression (10 (55.6%)). Fifteen (83.3%) patients developed CM at a median of 7.8 (IQR 2.6–21.9) years from their first attack. There was no significant association between the time to the development of chronic migraine with either attack frequency or duration. Conclusions and relevance We report the existence of a novel migraine subtype, episodic status migrainosus. This migraine subtype appears to have similar clinical characteristics to episodic migraine with or without aura, except for a notably high tendency to progress to chronic migraine.
Epilepsy in hemiplegic migraine: Genetic mutations and clinical implications
Authors: Prontera P , Sarchielli P , Caproni S , Bedetti C , Cupini LM , Calabresi P , Costa C 
Published: January 2017

Objective We performed a systematic review on the comorbidities of familial/sporadic hemiplegic migraine (F/SHM) with seizure/epilepsy in patients with CACNA1A, ATP1A2 or SCN1A mutations, to identify the genotypes associated and investigate for the presence of mutational hot spots. Methods We performed a search in MEDLINE and in the Human Gene Mutation and Leiden Open Variation Databases for mutations in the CACNA1A, ATP1A2 and SCN1A genes. After having examined the clinical characteristics of the patients, we selected those having HM and seizures, febrile seizures or epilepsy. For each gene, we determined both the frequency and the positions at protein levels of these mutations, as well as the penetrance of epilepsy within families. Results Concerning F/SHM-Epilepsy1 (F/SHME1) and F/SHME2 endophenotypes, we observed a prevalent involvement of the transmembrane domains, and a strong correlation in F/SHME1 when the positively charged amino acids were involved. The penetrance of epilepsy within the families was highest for patients carrying mutation in the CACNA1A gene (60%), and lower in those having SCN1A (33.3%) and ATP1A2 (30.9%) mutations. Conclusion Among the HM cases with seizure/epilepsy, we observed mutational hot spots in the transmembrane domains of CACNA1A and ATP1A2 proteins. These findings could lead to a better understanding of the pathological mechanisms underlying migraine and epilepsy, therein guaranteeing the most appropriate therapeutic approach.
Chronic paroxysmal headache secondary to an orbital metastatic leiomyosarcoma: A case report
Authors: Choi Hyun Ah , Lee Mi Ji , Chung Chin-Sang 
Published: January 2017

Background Intraorbital lesions associated with symptomatic trigeminal autonomic cephalalgias (TACs) are rarely reported. We present a case of orbital metastatic leiomyosarcoma, presenting with chronic paroxysmal hemicrania-like headache. Case report A 43-year-old man presented with a severe paroxysmal headache in his left periocular and frontal area for a year. The attacks occurred 10–12 times per day, lasting 10–15 minutes with ipsilateral lacrimation and conjunctival injection. Neurological examination and brain MRI without contrast were unremarkable. Different medications were tried, without beneficial effects. A follow-up contrast-enhanced brain MRI performed one year after the baseline MRI revealed an enhancing mass in the left superior oblique muscle. Orbital metastatic leiomyosarcoma arising from the thigh was revealed. He received gamma knife surgery, which completely resolved the headache. Discussion Intraorbital lesion should be considered a possibility in patients with headache mimicking TACs. Baseline contrast-enhanced MRI is essential, and repeated MRI scans might be needed if clinically indicated.
Osteochondral Allograft Transplantation of the Knee: Analysis of Failures at 5 Years
Authors: Frank Rachel M. , Lee Simon , Levy David , Poland Sarah , Smith Maggie , Scalise Nina , Cvetanovich Gregory L. , Cole Brian J. 
Published: January 2017

Background: Osteochondral allograft transplantation (OAT) is being performed with increasing frequency, and the need for reoperations is not uncommon. Purpose: To quantify survival for OAT and report findings at reoperations. Study Design: Case series; Level of evidence, 4. Methods: A review of prospectively collected data of 224 consecutive patients who underwent OAT by a single surgeon with a minimum follow-up of 2 years was conducted. The reoperation rate, timing of reoperation, procedure performed, and findings at surgery were reviewed. Failure was defined by revision OAT, conversion to knee arthroplasty, or gross appearance of graft failure at second-look arthroscopic surgery. Results: A total of 180 patients (mean [±SD] age, 32.7 ± 10.4 years; 52% male) who underwent OAT with a mean follow-up of 5.0 ± 2.7 years met the inclusion criteria (80% follow-up). Of these, 172 patients (96%) underwent a mean of 2.5 ± 1.7 prior surgical procedures on the ipsilateral knee before OAT. Forty-eight percent of OAT procedures were isolated, while 52% were performed with concomitant procedures including meniscus allograft transplantation (MAT) in 65 (36%). Sixty-six patients (37%) underwent a reoperation at a mean of 2.5 ± 2.5 years, with 32% (21/66) undergoing additional reoperations (range, 1-3). Arthroscopic debridement was performed in 91% of patients with initial reoperations, with 83% showing evidence of an intact graft; of these, 9 ultimately progressed to failure at a mean of 4.1 ± 1.9 years. A total of 24 patients (13%) were considered failures at a mean of 3.6 ± 2.6 years after the index OAT procedure because of revision OAT (n = 7), conversion to arthroplasty (n= 12), or appearance of a poorly incorporated allograft at arthroscopic surgery (n = 5). The number of previous surgical procedures was independently predictive of reoperations and failure; body mass index was independently predictive of failure. Excluding the failed patients, statistically and clinically significant improvements were found in the Lysholm score, International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, and Short Form–12 physical component summary at final follow-up ( P < .001 for all), with inferior outcomes (albeit overall improved) in patients who underwent a reoperation. Conclusion: In this series, there was a 37% reoperation rate and an 87% allograft survival rate at a mean of 5 years after OAT. The number of previous ipsilateral knee surgical procedures was predictive of reoperations and failure. Of the patients who underwent arthroscopic debridement with an intact graft at the time of arthroscopic surgery, 82% experienced significantly improved outcomes, while 18% ultimately progressed to failure. This information can be used to counsel patients on the implications of a reoperation after OAT.
Is an Anterolateral Ligament Reconstruction Required in ACL-Reconstructed Knees With Associated Injury to the Anterolateral Structures? A Robotic Analysis of Rotational Knee Stability
Authors: Noyes Frank R. , Huser Lauren E. , Jurgensmeier Darin , Walsh James , Levy Martin S. 
Published: January 2017

Background: The effect of an anterolateral ligament (ALL) reconstruction on rotational knee stability and corresponding anterior cruciate ligament (ACL) graft forces using multiple knee loading conditions including the pivot-shift phenomenon has not been determined. Purpose: First, to determine the rotational stability and ACL graft forces provided by an anatomic bone–patellar tendon–bone ACL reconstruction in the ACL-deficient knee alone and with an associated ALL/iliotibial band (ITB) injury. Second, to determine the added rotational stabilizing effect and reduction in ACL graft forces provided by an ALL reconstruction. Study Design: Controlled laboratory study. Methods: A 6 degrees of freedom robotic simulator was used to test 7 fresh-frozen cadaveric specimens during 5 testing conditions: intact, ACL-sectioned, ACL-reconstructed, ALL/ITB-sectioned, and ALL-reconstructed. Lateral and medial tibiofemoral compartment translations and internal tibial rotations were measured under Lachman test conditions, 5-N·m internal rotation, and 2 pivot-shift simulations. Statistical equivalence within 2 mm and 2° was defined as P < .05. Results: Single-graft ACL reconstruction restored central tibial translation under Lachman testing and internal rotation under 5-N·m internal rotation torque ( P < .05). A modest increase in internal rotation under 5-N·m internal rotation torque occurred after ALL/ITB sectioning of 5.1° (95% CI, 3.6° to 6.7°) and 6.7° (95% CI, 4.3° to 9.1°) at 60° and 90° of flexion, respectively ( P = .99). Lateral compartment translation increases in the pivot-shift tests were <2 mm. ALL reconstruction restored internal rotation within 0.5° (95% CI, –1.9° to 2.9°) and 0.7° (95% CI, –2.0° to 3.4°) of the ACL-reconstructed state at 60° and 90° of flexion, respectively ( P < .05). The ALL procedure reduced ACL graft forces, at most, 75 N in the pivot-shift tests and 81 N in the internal rotation tests. Conclusion: Although the ALL reconstruction corrected the small abnormal changes in the internal rotation limit at high flexion angles, the procedure had no effect in limiting tibiofemoral compartment translations in the pivot-shift test and produced only modest decreases in ACL graft forces. Accordingly, the recommendation to perform an ALL reconstruction to correct pivot-shift abnormalities is questioned. Clinical Relevance: The small changes in rotational stability after ALL/ITB sectioning would not seem to warrant the routine addition of an ALL reconstruction in primary ACL injuries. Clinical exceptions may exist, as in grossly unstable grade 3 pivot-shift knees and revision knees. However, the concern exists of overconstraining normal tibial rotations.
Multiple Constituencies Activities and Standards: A Framework for Evaluating the Effectiveness of Public Personnel Departments
Authors: Straus Stephen K. 
Published: January 2017

Previous research has failed to produce an appropriate framework for evaluating the effectiveness of public personnel departments. The lack of such a framework impedes the quality of decision making by personnel practitioners and of research by academicians. An appropriate framework should take into account the competing demands of the groups served by and able to influence public personnel departments. This article presents the Multiple Constituencies Activities and Standards Framework (MCAS), which has been applied in North Carolina counties. MCAS provides evaluations by various groups (constituents) of the activities of their personnel departments, and compares those evaluations to ratings achieved by other personnel departments over time.
Improvement in Favre-Racouchot Disease Treated with a Combination Medium-Depth Chemical Peel Containing Jessner's Solution/35% Trichloroacetic Acid
Authors: Foster K. W. , Fincher E. F. , Moy R. Kissel; R. L. 
Published: January 2017

Introduction: Favre-Racouchot disease is a condition typified by grouped comedones occurring on sun-damaged skin. This disorder affects mainly white men who have had extensive exposure to sun and harsh weather and has been estimated to occur in 6% of persons older than 50 years. Although topical retinoids have been the mainstay of therapy for this condition, many patients have an incomplete response to this therapeutic modality, and other treatments such as manual extraction, oral isotretinoin, staged excision, dermabrasion, and combination approaches have been attempted. Materials and Methods: A combination medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid was used to treat a 53 year-old white woman with Favre-Racouchot disease. The patient showed no response to topical retinoids applied twice daily for greater than 16 weeks and a more superficial combination peel consisting of Jessner's solution/20% trichloroacetic acid. Complicating factors included preexisting rosacea and early rhinophyma. Results: After treatment with a medium-depth chemical peel containing Jessner's solution/35% trichloroacetic acid, marked improvement was noted with concomitant resolution of >90% of comedones. No postoperative complications, such as prolonged erythema, scarring, viral reactivation, or bacterial infection, were observed. The patient was pleased with the overall result. Discussion: These results demonstrate the utility of combination medium-depth chemical peels containing Jessner's solution/35% trichloroacetic acid in the management of Favre-Racouchot disease that is resistant to more conservative therapies. We recommend the judicious use of this procedure in patients who do not respond to more conservative measures.
Single-Stage Male Body Contouring after Massive Weight Loss—A Case Report
Authors: Thomas Mohan , D'Silva James Allen , Verma Harikumar Menon; Sachin 
Published: January 2017

Introduction: Body contouring surgeries after massive weight loss are done with the goal to improve the patient's aesthetic appearance and quality of life. Usually this is performed as a staged procedure, but we are presenting a single-stage procedure, emphasizing the fact that single-stage procedures improve the patient's degree of satisfaction and do not jeopardize the patient's health status. Methods: Body contouring was done as a single-stage procedure in a 25-year-old man after he had lost 30 kg. The loose skin on the abdomen, anterior and lateral chest, and back, along with residual fat deposits, were addressed by liposuction, abdominoplasty, and chest-contouring surgery using boomerang flaps. Results: Aesthetically acceptable results could be obtained by combining these procedures. Total operative time was 6 hours. There were no perioperative complications. All incisions healed in primary intention. Discussion: Although body contouring after massive weight loss in men is usually treated as a staged procedure, in well-selected cases, it can be done as a single-stage procedure without compromising results or safety. Although a larger series of such cases would prove this more emphatically, this case report certainly demonstrates the feasibility of single-stage contouring in men. Young patients without comorbid conditions are ideal candidates.
Breast Augmentation: Minimizing Postoperative Nausea and Vomiting (PONV), Maximizing Patient Satisfaction
Authors: Eisenberg Ted S. 
Published: January 2017

Introduction: This study evaluates postoperative nausea and vomiting (PONV) after bilateral submuscular saline breast augmentation surgery. The efficacy of a particular protocol of medications and anesthetics, used during the preoperative, intraoperative, and postoperative phases of care, is evaluated. Materials and Methods: Preoperatively, all but 2 patients (who were allergic to sulfa) received 200 mg of Celebrex capsule, a cyclooxygenase (COX)-2 inhibitor, along with Alka Seltzer Gold or Bicitra, and had the option of taking 5 mg of Valium. Six patients with a prior history of nausea and vomiting were given Emend 40 mg PO within 3 hours of surgery, and Benadryl was withheld from these 6 patients to evaluate the effects of Emend. All patients received intravenous propofol, Versed, and fentanyl for induction. Intraoperatively, they were given intravenous Zofran 4 mg, Benadryl 25 mg, and Decadron 8 mg. Sevofluorane gas was used, and no nitrous gas was used. Postoperatively, patients were advised to take Celebrex. They were given supplemental prescriptions for Zofran ODT 4 mg and Valium 5 mg. Patients were advised that they could use antacids like Rolaids or Turns for postoperative nausea if needed. The questionnaire evaluated PONV on the day of surgery and on the following 2 days; patient satisfaction with the overall surgical experience was evaluated, and results of their operation were reported on a scale from 0 to 10. Results: In all, 72.6% of the 241 patients reported no nausea and vomiting on the day of surgery. The numbers of patients who reported no nausea and vomiting on the first and second days after surgery were similar, at 73% and 75.5%, respectively. On average, the remaining 27.4% had some PONV (“3” on the 0 to 10 scale) on all 3 days. A total of 94% of patients reported a “10” to rate their overall experience, and 90% gave a “10” rating for the results of their operation. Conclusions: My approach, which evolved over 10 years with 3000 patients, has improved my results from several days of extreme postoperative nausea and vomiting to almost zero. I attribute much of this success to the use of Decadron, Zofran, Benadryl, and Emend, all of which may affect multiple pathways and nausea receptor sites. During surgery, I use a laryngeal mask airway (LMA) and eliminate nitrous; I believe this may help decrease postoperative nausea and vomiting. I also use Celebrex, which may possibly lower the amount of narcotic needed during and after surgery. Finally, I believe that the outstanding level of patient satisfaction reported in the study is directly related to the fact that patients had minimal or no nausea and vomiting after surgery.