bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cost Savings Opportunities in Perioperative Management of the Patients With Orthopaedic Trauma
Authors: Moody Alastair E. , Moody Catriona E. , Althausen Peter L. 
Published: November 2016

Summary:
Considerable opportunities for cost savings exist surrounding the perioperative management of patients with orthopaedic fracture and trauma. Scientific evidence is available to support each potential cost savings measure. Much of these data had been documented for years but has never been adhered to, resulting in millions of dollars in unnecessary testing and treatment. Careful attention to preoperative laboratory testing can save huge amounts of money and expedite medical clearance for injured patients. The use of a dedicated orthopaedic trauma operating room has been shown to improve resource utilization, decrease costs, and surgical complications. A variety of anesthetic techniques and agents can reduce operative time, recovery room time, and hospital lengths of stay. Strict adherence to blood utilization protocols, appropriate deep venous thrombosis prophylaxis, and multimodal postoperative pain control with oversight from dedicated hip fracture hospitalists is critical to cost containment. Careful attention to postoperative disposition to acute care and management of postoperative testing and radiographs can also be another area of cost containment. Institutional protocols must be created and followed by a team of orthopaedic surgeons, hospitalists, and anesthesiologists to significantly impact the costs associated with care of patient with orthopaedic trauma and fracture.
The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center
Authors: Mcphillamy Austin , Gurnea Taylor P. , Moody Alastair E. , Kurnik Christopher G. , Lu Minggen 
Published: November 2016

Objectives:
In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula.

Design:
Retrospective review.

Setting:
Level II Trauma center.

Patients:
828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures.

Intervention:
Operative treatment with conventional or generic implants.

Results:
The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period.

Conclusions:
Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used.

Level of Evidence:
Therapeutic Level III.
Effect of an Acid-sensing Ion Channels Inhibitor on Pain-related Behavior by Nucleus Pulposus Applied on the Nerve Root in Rats
Authors: Kobayashi Yoshihiro , Sekiguchi Miho , Konno Shin-ichi 
Published: November 2016

Study Design.
Controlled, interventional animal study.

Objective.
To examine the effect of an inhibitor of acid-sensing ion channel 3 (ASIC3) on pain-related behavior induced by application of the nucleus pulposus (NP) onto the dorsal root ganglion (DRG) in rats.

Summary of Background Data.
ASIC3 is associated with acidosis pain in inflamed or ischemic tissues and is expressed in sensory neurons and NP cells. The ASIC3 inhibitor, APETx2, increases the mechanical threshold of pain in models of knee osteoarthritis or postoperative pain. However, the efficacy of APETx2 for pain relief in the NP application model remains unknown.

Methods.
Autologous NP was applied to the left L5 nerve root of 183 adult female Sprague-Dawley rats. The DRGs were treated with NP plus one of the following four treatments: saline solution (SM), low (0.01 μg: LD), medium (0.1 μg: MD), or high dose (1.0 μg: HD) of APETx2. Behavioral testing was performed to investigate the mechanical withdrawal threshold using von Frey hairs. Expression of nerve growth factor, hypoxia-inducible factor-1α (HIF1α), activating transcription factor-3, and ionized calcium-binding adaptor molecule-1 was evaluated using immunohistochemistry. Statistical differences among multiple groups were assessed using the Steel test, the Tukey-Kramer test, and the Dunnett test. P < 0.05 were considered significant.

Results.
The thresholds in the HD group were higher than those in the SM group at Days 14 and 21 (P < 0.05). In the MD group, the threshold was higher than in the SM group at Day 14 (P < 0.05). High doses of APETx2 reduced the expression of HIF1α after Day 14 compared with the SM group (P < 0.05).

Conclusion.
APETx2 significantly improved pain-related behavior in a dose-dependent manner. APETx2 may inhibit ASIC3 and partly inhibit Nav1.8 channels. This ASIC3 channel inhibitor may be a potential therapeutic agent in early-stage lumbar disc herniation.

Level of Evidence: N/A
Analysis of Sagittal Parameters in Patients Undergoing One- or Two-Level Closing Wedge Osteotomy for Correcting Thoracolumbar Kyphosis Secondary to Ankylosing Spondylitis
Authors: Hua Wen-bin , Zhang Yu-kun , Gao Yong , Liu Xian-zhe , Yang Shu-hua , Wu Xing-huo , Wang Jing , Yang Cao 
Published: November 2016

Study Design.
Retrospective analysis of clinical records.

Objective.
To assess and compare the improvement in sagittal balance after one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis (AS).

Summary of Background Data.
Closing wedge osteotomy represents a common approach to correct kyphosis in AS. Although several reports have described the outcomes of one- or two-level closing wedge osteotomy in terms of sagittal parameters, data comparing the outcomes of these procedures are scarce.

Methods.
Between January 2010 and December 2014, 22 patients with AS underwent closing wedge osteotomy (one-level, 12 patients; two-level, 10 patients) for correcting thoracolumbar kyphosis (mean follow-up, 24.8 months; range, 12–60 months). Preoperative and postoperative chin-brow vertical angle, and the sagittal parameters of the vertebral osteotomy segment were documented and compared. Perioperative and postoperative complications were also recorded.

Results.
The chin-brow vertical angle improved significantly, from 55.0° ± 27.3° to 4.7° ± 4.9° and from 38.2° ± 14.9° to 3.2° ± 5.4° in the one-level and two-level groups, respectively. The total correction (thoracic kyphosis and lumbar lordosis) was 32.8° ± 18.2° and 53.7° ± 9.4° in the one-level and two-level groups, respectively. No death, complete paralysis, or vascular complications occurred during the procedure, but cerebrospinal fluid leak was noted in one and two patients from the one-level and two-level groups, respectively. A distal pedicle screw adjacent to the osteotomy segment became loose during surgery in one patient (one-level group). Postoperatively, no transient neurological deficit, infection, delay union, or loosening or breaking of the internal fixation devices was observed. Osteotomy site fusion was achieved in all patients, and the Oswestry Disability Index scores improved significantly.

Conclusion.
Closing wedge osteotomy is effective and safe for correcting thoracolumbar kyphosis in patients with AS. Significant correction and improvement in all sagittal parameters were noted in both groups, but two-level closing wedge osteotomy provided better correction.

Level of Evidence: 3
The Azygos Vein Is at Potential Risk of Injury From Malpositioning of Left Thoracic Pedicle Screw in Thoracic Adolescent Idiopathic Scoliosis Patients
Authors: Jiang Jun , Qian Bang-ping , Qiu Yong , Wang Bin , Yu Yang , Zhu Ze-zhang 
Published: November 2016

Study Design.
A computed tomography study.

Objective.
To evaluate the changed position of azygos vein in patients with thoracic adolescent idiopathic scoliosis (AIS) and to analyze the potential risk of injury of azygos vein from thoracic pedicle screw placement in these patients.

Summary of Background Data.
It has been widely recognized that the anatomic positions of structures adjacent to the vertebrae may change in patients with AIS. To date, no study had evaluated such change of azygos vein in patients with AIS.

Methods.
Twenty-five patients with thoracic AIS and 17 age-matched normal teenagers were included in the present study. Axial computed tomography images from T7 to T10 level were obtained to evaluate azygos vein-vertebral angle (defined as 0° when the azygos vein was located directly laterally to the left and 180° when directly laterally to the right). The percentage of azygos vein located in the direction of left screw passage was calculated to analyze the potential risk of injury from left pedicle screw placement.

Results.
The azygos vein-vertebral angles were significantly smaller in patients with AIS when compared with normal teenagers from T7 to T10 level (P < 0.001). The percentage of azygos vein at high risk of injury from left pedicle screw placement was 80% (20/25) at T7 level, 84% (21/25) at T8 level, 76% (19/25) at T9 level, and 72% (18/25) at T10 level in patients with AIS. No azygos vein was found to be at risk of injury from right pedicle screw placement in patients with AIS. The azygos vein was safe from pedicle screw placement on both sides in normal teenagers.

Conclusion.
The changed relative anatomic position of azygos vein in patients with thoracic AIS places the azygos vein at high potential risk of injury from excessively long left pedicle screw placement. Spine surgeons should choose appropriate screw length to avoid anterior cortex perforation.

Level of Evidence: 3
Cutaneous Metastatic Melanoma Resembling a Halo Nevus, in the Setting of PD-1 Inhibition
Authors: Harvey Nathan Tobias , Millward Michael , Macgregor Kirstie , Bucat Robert Paul , Wood Benjamin Andrew 
Published: November 2016

Abstract:
Malignant melanoma is a common source of cutaneous metastases and can occasionally adopt a histological appearance which mimics a primary melanocytic lesion, either benign or malignant. The authors describe a case of new cutaneous deposits of metastatic melanoma in a 70-year-old woman with a prominent admixed lymphocytic infiltrate, imparting a striking resemblance to a halo nevus. The authors believe this appearance was a direct reflection of treatment with pembrolizumab, a humanized antibody against the immune checkpoint inhibitor programmed death-1. With increasing use of immune-modulating drugs, this potential histological mimic may be seen more frequently in the future.
Cannabinoid Receptor 2 Functional Variant Contributes to the Risk for Pediatric Inflammatory Bowel Disease
Authors: Strisciuglio Caterina , Bellini Giulia , Miele Erasmo , Martinelli Massimo , Cenni Sabrina , Tortora Chiara , Tolone Carlo , Miraglia del Giudice Emanuele , Rossi Francesca 
Published: November 2016

Goals:
We conducted a case-control association analysis to establish the role of a common CB2 functional variant, Q63R, in the susceptibility to inflammatory bowel disease (IBD).

Background:
Endocannabinoids may limit intestinal inflammation through cannabinoid receptor 1 and/or 2 (CB1, CB2).

Study:
We genotyped 217 pediatric IBD patients [112 Crohn’s disease (CD), 105 ulcerative colitis (UC)] and 600 controls for the CB2-Q63R variant by Taqman assay. Data were collected from clinical records on age at diagnosis, disease activity, duration and location, extraintestinal manifestations, therapy, clinical relapses, and need for surgery.

Results:
We found a significant association of the CB2-R63 variant with IBD (allele frequencies, P=0.04; genotype distributions, P=0.0006), in particular with CD (allele frequencies, P=0.002; genotype distributions, P=0.00005) and with UC only for genotype distributions (P=0.03). RR carriers showed an increased risk for developing IBD [odds ratio (OR)=1.82; P=0.0002 for IBD; OR=2.02; P=10−1 for CD; OR=1.63; P=0.02 for UC at 95% confidence interval]. Upon genotype-phenotype evaluation, RR patients showed an increased frequency of moderate-to-severe disease activity at diagnosis in the case of both CD and UC (P=0.01 and P=0.02, respectively) and also an earlier clinical relapse in UC (P=0.04). In UC, all the clinical features related to the CB2 risk allele were still significantly associated with the variant when analyzed using a multivariate logistic regression model (P=0.001).

Conclusions:
The CB2-Q63R variant contributes to the risk for pediatric IBD, in particular CD. The R63 variant is associated with a more severe phenotype in both UC and CD. Taken together, our data point toward the involvement of the CB2 receptor in the pathogenesis and clinical features of pediatric IBD.
Antiviral Treatment for Colonic Cytomegalovirus Infection in Ulcerative Colitis Patients Significantly Improved Their Surgery Free Survival
Authors: Wang Yinghong , Aggarwal Pankaj , Liu Xiuli , Lu Haiyan , Lian Lei , Wu Xianrui , Guo Shibin , Aggarwal Nitin , Lashner Bret , Shen Bo 
Published: November 2016

Background:
The frequency of cytomegalovirus (CMV) colitis in steroid-refractory inflammatory bowel disease has been reported to range from 15.8% to 34.0%. Infected patients are more likely to become hospitalized, have longer lengths of stay, and higher mortality rates. Current data are limited to small scale studies and showed conflicting result regarding the role of antiviral therapy.

Aims:
(1) To investigate the role of antiviral treatment in ulcerative colitis (UC) patients with CMV infection. (2) To investigate the role of viremia in the outcomes of these patients.

Materials and Methods:
The Cleveland Clinic pathology database identified 1478 patients who had colon biopsy and were tested for CMV during 1990 to 2013. After inclusion and exclusion, 41 UC patients were selected. Among them, 24 (58.5%) received treatment, 17 (41.5%) did not. A total of 14 demographic data and 4 clinical outcomes (surgery free survival, hospitalization, rehospitalization, and mortality) were compared between treated and nontreated patients. The same outcomes were also compared in patients who received treatment based on their viremia status.

Results:
All demographic variables are similar between those treated and nontreated groups. Antiviral therapy significantly improved the surgery free survival within 30 days, and lasted 70 months (P<0.01). In contrast, hospitalization, rehospitalization, and mortality were comparable (P>0.05). No significant difference was observed in any of the clinical outcomes based on viremia status.

Conclusions:
Our small scale study demonstrates that antiviral treatment for colonic CMV infection significantly improves the surgery free survival short-term and long-term in patients with UC.
Nonclassic features of pseudohypoparathyroidism type 1A
Authors: Shoemaker Ashley H. , Jüppner Harald 
Published: November 2016

Purpose of review
To provide readers with a review of contemporary literature describing the evolving understanding of the pseudohypoparathyroidism type 1A (PHP1A) phenotype.

Recent findings
The classic features of PHP1A include multihormone resistance and the Albright Hereditary Osteodystrophy phenotype (round facies, short stature, subcutaneous ossifications, brachydactyly, and early-onset obesity. Obesity may be because of a decrease in resting energy expenditure because most patients do not report significant hyperphagia. Patients with PHP1A have an increased risk of type 2 diabetes. In addition to brachydactyly and short stature, orthopedic complications can include spinal stenosis and carpal tunnel syndrome. Hearing loss, both sensorineural and conductive, has been reported in PHP1A. In addition, ear–nose–throat findings include decreased olfaction and frequent otitis media requiring tympanostomy tubes. Sleep apnea was shown to be 4.4-fold more common in children with PHP1A compared with other obese children; furthermore, asthma-like symptoms have been reported. These new findings are likely multifactorial and further research is needed to better understand these nonclassic features of PHP1A.

Summary
Along with the Albright Hereditary Osteodystrophy phenotype and hormone resistance, patients with PHP1A may have additional skeletal, metabolic, ear–nose–throat, and pulmonary complications. Understanding these nonclassic features will help improve clinical care of patients with PHP1A.
Impact of Community Health Workers on Elderly Patients’ Advance Care Planning and Health Care Utilization
Authors: Litzelman Debra K. , Inui Thomas S. , Griffin Wilma J. , Perkins Anthony , Cottingham Ann H. , Schmitt-Wendholt Kathleen M. , Ivy Steven S. 
Published: November 2016

Background:
Advance care planning (ACP) is recommended for all persons to ensure that the care they receive aligns with their values and preferences.

Objective:
To evaluate an ACP intervention developed to better meet the needs and priorities of persons with chronic diseases, including mild cognitive impairment.

Research Design:
A year-long, pre-post intervention using lay community health workers [care coordinator assistants (CCAs)] trained to conduct and document ACP conversations with patients during home health visits with pre-post evaluation.

Subjects:
The 818 patients were 74.2 years old (mean); 78% women; 51% African American; 43% white.

Measures:
Documentation of ACP conversation in electronic health record fields and health care utilization outcomes.

Results:
In this target population ACP documentation rose from 3.4% (pre-CCA training) to 47.9% (post) of patients who had at least 1 discussion about ACP in the electronic health record. In the 1-year preintervention period, there were no differences in admissions, emergency department (ED) visits, and outpatient visits between patients who did and did not have ACP discussion. After adjusting for prior hospitalization and ED use histories, ACP discussions were associated with a 34% less probability of hospitalization (hazard ratios, 0.66; 95% confidence interval, 0.45–0.97), and similar effects are apparent on ED use independent of age and prior ED use effects.

Conclusions:
Patients with chronic diseases including mild cognitive impairment can engage in ACP conversations with trusted home health care providers. Having ACP conversation is associated with significant reduction in seeking urgent health care and in hospitalizations.
Management of venous thromboembolism in myeloproliferative neoplasms
Authors: Barbui Tiziano , De Stefano Valerio 
Published: November 2016

Purpose of review
Venous thromboembolism is frequent in chronic myeloproliferative neoplasms (MPN). The current strategy for its management includes cytoreductive therapy and antithrombotic prophylaxis, but many issues remain uncertain. In this review, the risk factors and prevention of recurrences will be discussed.

Recent findings
Around one-third of patients with polycythemia vera and essential thrombocythemia experience a major thrombosis at diagnosis or during follow-up. According to the European Leukemia Net guidelines, these patients must be included in the high-risk group for thrombotic recurrence and should be treated with cytoreduction and antiplatelet or anticoagulant drugs in the presence of arterial or venous thrombosis, respectively. Despite this treatment, the annual incidence of recurrence after the first venous thrombosis varies from 4.2 to 6.5% on vitamin K-antagonists and is doubled after discontinuation. The highest incidence of recurrence occurs after cerebral and hepatic vein thrombosis (8.8 and 8 per 100 pt-years, respectively). The occurrence of major bleeding on vitamin K-antagonists is similar to a non-MPN population and accounts for a rate of 1.8–2.4 per 100 pt-years.

Summary
After venous thrombosis, the incidence of recurrence in MPN remains elevated, which suggested there was a need to review the current recommendations of primary and secondary prophylaxis.
Attenuation of Choroidal Thickness in Patients With Alzheimer Disease
Authors: Trebbastoni Alessandro , Marcelli Michela , Mallone Fabiana , D’Antonio Fabrizia , Imbriano Letizia , Campanelli Alessandra , de Lena Carlo , Gharbiya Magda 
Published: November 2016

Introduction:
To compare the 12-month choroidal thickness (CT) change between Alzheimer disease (AD) patients and normal subjects.

Methods:
In this prospective, observational study, 39 patients with a diagnosis of mild to moderate AD and 39 age-matched control subjects were included. All the subjects underwent neuropsychological (Mini Mental State Examination, Alzheimer disease Assessment Scale-Cognitive Subscale, and the Clinical Dementia Rating Scale) and ophthalmological evaluation, including spectral domain optical coherence tomography, at baseline and after 12 months. CT was measured manually using the caliper tool of the optical coherence tomography device.

Results:
After 12 months, AD patients had a greater reduction of CT than controls (P≤0.05, adjusted for baseline CT, age, sex, axial length, and smoking).

Discussion:
CT in patients with AD showed a rate of thinning greater than what could be expected during the natural course of aging.
Complementary learning systems within the hippocampus: a neural network modelling approach to reconciling episodic memory with statistical learning
Authors: Schapiro Anna C. , Turk-Browne Nicholas B. , Botvinick Matthew M. , Norman Kenneth A. 
Published: November 2016

A growing literature suggests that the hippocampus is critical for the rapid extraction of regularities from the environment. Although this fits with the known role of the hippocampus in rapid learning, it seems at odds with the idea that the hippocampus specializes in memorizing individual episodes. In particular, the Complementary Learning Systems theory argues that there is a computational trade-off between learning the specifics of individual experiences and regularities that hold across those experiences. We asked whether it is possible for the hippocampus to handle both statistical learning and memorization of individual episodes. We exposed a neural network model that instantiates known properties of hippocampal projections and subfields to sequences of items with temporal regularities. We found that the monosynaptic pathway—the pathway connecting entorhinal cortex directly to region CA1—was able to support statistical learning, while the trisynaptic pathway—connecting entorhinal cortex to CA1 through dentate gyrus and CA3—learned individual episodes, with apparent representations of regularities resulting from associative reactivation through recurrence. Thus, in paradigms involving rapid learning, the computational trade-off between learning episodes and regularities may be handled by separate anatomical pathways within the hippocampus itself.This article is part of the themed issue ‘New frontiers for statistical learning in the cognitive sciences’.