bluuebunny/crossref_metadata_2025_split huggingface dataset:
An evaluation of a surgical telepresence system for an intrahospital local area network
Authors: Schneider A , Wilhelm D , Bohn U , Wichert A , Feussner H 
Published: July 2017

summary We evaluated a digital telepresence system in an operating theatre (OR) environment which enabled a consultant to join the surgical team from a remote site by audiovisual communication. The system is based on video transmission using a streaming technique, with a server and a client connected via a local area network (LAN). Two cameras can be remotely controlled: one camera is built into the OR lamp and a second, laparoscopic camera is mounted on a robotic arm. Another feature of the system is teledemonstration, which permits the remote consultant to demonstrate points of particular interest. We evaluated the system clinically in 237 cases. In 28 cases (12%), telepresence could not be established for various reasons, mainly human failure. In 42 cases (18%), the full potential of telepresence was used. Technical evaluation showed that a data rate of 2 Mbit/s provides sufficient audio and video quality, as well as reliable teledemonstration. The data transmission delay was acceptable for clinical purposes (video 0.92 s, audio 0.6s from OR to client, audio 0.7s from client to OR). The study showed that telepresence is a promising means of providing highly specialized expertise within the OR.
Poor Retention after Closed Reduction and Cast Immobilization of Low-Energy Tibial Shaft Spiral Fractures
Authors: Borg T. , Melander T. , Larsson S. 
Published: July 2017

Background and Aims: The aim of this retrospective study was to analyze retention in cast after closed reduction of low-energy two-fragment tibial shaft fractures. Material and Methods: The material consisted of 72 closed tibial shaft fractures AO/ASIF type A treated with closed reduction and plaster cast. Fractures were subgrouped according to the AO/ASIF classification and the initial fracture displacement was measured. Final alignment and the frequency of operative intervention due to early loss of reduction were analyzed. Results: 40 % of all fractures lost reduction and were operated on. The largest subgroup was A1.2 fractures, a spiral tibial shaft fracture with a fibular fracture at another level. Out of the 28 fractures in this group 61 % were converted from cast to early operative intervention. Conclusion: Closed reduction and cast treatment of spiral tibial shaft fractures AO/ASIF type A1.2 had a high failure rate.
Non-Constrained Titanium-Polyethylene Total Endoprosthesis in the Treatment of Hallux Rigidus
Authors: Ess P. , Hämäläinen M. , Leppilahti J. 
Published: July 2017

Background and Aims: To evaluate the outcome in a prospective 2-year follow-up study of a non-constrained titanium-polyethylene total endoprosthesis (ReFlexion®) in the treatment of hallux rigidus. Material and Methods: Ten patients with painful hallux rigidus were treated with non-constrained titanium-polyethylene total endoprosthesis (ReFlexion®). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring was used preoperatively and at follow-up. Results: At 2-year follow-up, the AOFAS scoring showed 5 instances of excellent, 1 of good, 2 of fair, and 2 of poor outcome. Eight patient were subjectively satisfied and dissatisfied. Five of the patients were painless, 4 had mild, occasional pain, and 1 had moderate, daily pain in the first metatarsophalangeal joint. The mean VAS was 7.6 (SD 2.0) preoperatively and 1.1 (SD 1.4) at 2-year follow-up (p < 0.001). Extension increased by a mean of 25 (13–38) degrees and flexion by a mean of 15 (2–35) degrees (p < 0.001). Eight patients had no activity limitations, while 1 had mild and 1 moderate limitations. Alignment of the metatarsophalangeal joint was good in 7 cases, but some degree of valgus malalignment was seen in 2 and symptomatic malalignment in 1. Complications included one subluxation of a prosthesis, one recurrence of severe valgus alignment and one superficial wound infection. Radiological loosening of one cementless phalangeal component was seen at follow-up. Conclusion: The non-constrained titanium-polyethylene total arthroplasty gave satisfactory 2-year outcome in 60 % of the patients. It is an alternative treatment for hallux rigidus in low demand patients. We do not recommended it for athletes and young people, because high forces acting on the prosthesis may cause a failure.
Pedicled Gastrocnemius Flap in Complicated Total Knee Arthroplasty
Authors: Papp A. , Kettunen J. , Miettinen H. 
Published: July 2017

Background and Aims: The aim of this study was to evaluate the results of complicated total knee arthroplasty operations treated with radical wound revision and a pedicled gastrocnemius muscle flap. Material and Methods: Retrospective analysis in a university hospital during a five-year-period. Results: Wound revision, debridement of the knee joint, replacing tibial plastics and a unilateral pedicled gastrocnemius muscle flap operation was performed to 10 patients after complicated total knee arthroplasty. After a median follow up time of 11.5 months 8/10 total knee arthroplasty joints were saved. Conclusions: As much as 80 % of patients could save their knee joint with this treatment protocol. Treatment of this problem needs good collaboration with orthopaedic and plastic surgeons.
The Epidemiology and Treatment Patterns of Postoperative Adhesion Induced Intestinal Obstruction in Varsinais-Suomi Hospital District
Authors: Kössi J. , Salminen P. , Laato M. 
Published: July 2017

Background and Aims: The epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction have been poorly investigated in Finland. This study evaluated the epidemiology and treatment patterns of postoperative adhesion induced intestinal obstruction in a well defined geographical area (Hospital District). Material and Methods: All inpatient episodes between 1.1.1999 and 31.12.1999 due to postoperative adhesion induced intestinal obstruction in Varsinais-Suomi Hospital District were evaluated retrospectively using individual patient records. Results: 123 hospitalizations due to postoperative adhesion-related intestinal obstruction were observed during the study period. The total number of preceding operations was 176 considering altogether 101 patients. The most prevalent single initial operations causing adhesion induced intestinal obstruction were colorectal, upper abdominal, and female reproductive system procedures. Of all treatment episodes 32 % were operative and mortality was 2 %. The median days of hospital stay (range) of all inpatient episodes, operative episodes, and conservative episodes were 6 (1–58), 11 (2–34) and 4 (1–58), respectively. Patient dependent factors associated with increased likelihood to operative treatment of obstruction were: female gender (40 % in females vs 23 in males, P = 0.042) and previous gynaecological surgery (70 % of the patients, P = 0.032). Intraoperative findings were obstruction in 70 %, strangulation in 20 %, necrosis in 8 %, and perforation in 2 % of operations. Bowel resection was needed in 38 % of operations. Preceding gynaecological surgery increased the likelihood of bowel strangulation as an intraoperative finding. Conclusion: The epidemiology, treatment patterns and results of postoperative adhesion induced intestinal obstruction are of the average international level in the Varsinais-Suomi Hospital District. The treatment patterns among the different hospitals in the Hospital District are similar. Female gender is associated with increased risk for operative treatment of adhesive obstruction. Previous gynaecological surgery increases the likelihood of operative treatment and complicated obstruction.
The Role of Biofeedback Therapy in Functional Proctologic Disorders
Authors: Kairaluoma M. , Raivio P. , Kupila J. , Aarnio M. , Kellokumpu I. 
Published: July 2017

Background and Aims: The question which patients with functional proctologic disorders truly benefit from the biofeedback has not been equivocally resolved. The aim of this study was to assess our results of biofeedback therapy in patients with anal incontinence or constipation. Material and Methods: Fifty-two consecutive patients who were treated with biofeedback therapy between January 1998 and March 2002 were studied. Data was collected from our proctologic database. Results: Of the twenty-two patients with anal incontinence who underwent biofeedback therapy during the study period, twenty patients had incontinence affecting quality of life. Twelve patients (60 percent) benefited from biofeedback as judged by improvement of incontinence symptoms affecting quality of life; all four patients with partial sphincter defects, three out of four patients after secondary repair, three out of five patients with persistent incontinence after rectal prolapse surgery and two out of seven patients having idiopathic incontinence. Of the thirty patients who underwent biofeedback therapy for constipation, twenty-five had intractable symptoms of constipation. Constipation resolved in sixteen patients (64 percent); in thirteen out of nineteen (68 percent) of those with pelvic floor dysfunction (PFD) and in three out of six (50 percent) having combined PFD and slow transit constipation. In patients with PFD constipation was resolved in ten out of thirteen patients (77 percent) with anismus but in only three out of six (50 percent) having other causes. Conclusions: Biofeedback therapy improves incontinence after sphincter repairs and in patients with partial external sphincter defects, but does not improve idiopathic incontinence. Biofeedback is also effective in patients with constipation, especially when anismus is the only cause for symptoms of constipation and difficult evacuation.
Unstable Trochanteric Fractures Augmented with Calcium Phosphate Cement
Authors: Mattsson P. , Larsson S. 
Published: July 2017

Background and Aims: Internally fixed unstable trochanteric fractures might be difficult to retain in position during healing. Secondary displacement might lead to malunion and poor functional result. The aim with this study was to measure whether augmentation with resorbable calcium-phosphate cement could improve fracture stability as shown in biomechanical studies. Material and Methods: 26 ambulatory patients with an unstable trochanteric fracture were randomized to treatment with a sliding screw device alone (Controls) or the same device combined with calcium-phosphate cement for augmentation (Augmented). All patients were allowed unrestricted weight bearing after surgery. Fracture movement was measured with radiostereometry (RSA) at 1 and 6 weeks and at 6 months. Results: Two patients died during the study period due to unrelated causes and another three were excluded due to technical problems with the RSA in two and concomitant illness in one. 21 patients (11 Augmented and 10 Controls) were followed according to the study protocol. At 1 week the augmented fractures had moved on average 1.9 ± 1.7 mm while movement in the controls was 4.0 ± 2.4 mm (p < 0.05). The average total movement from the day after surgery until 6 months, when all fractures had healed, was 7.8 ± 6.2 mm for the augmented fractures and 13.2 ± 4.3 mm for the controls (p < 0.05). Varus angulation was the most pronounced rotational movement for both groups although augmented fractures revealed less varus angulation compared with controls at all time points. Rotation around the longitudinal and transversal axes were small with no significant differences between treatment groups. Conclusion: Augmentation with calcium-phosphate cement improved the stability of unstable trochanteric fractures fixed with a sliding screw device. The improvement was most pronounced for varus angulation and lateral and distal migration of the head and neck fragment.
Polyurethane Foam as an Integral “Core” Component of Automotive Headliner
Authors: Dolgopolsky I. , Duley J. A. 
Published: July 2017

Automotive headliner technology today consists of designing and manufacturing complex sandwich constructions with decorative, structural, acoustical, and energy-absorbing functions. The use of polyurethane semi-flexible foam as a core material for headliner construction has witnessed a substantial global increase. Further sophistication of headliner construction imposes additional demands requiring high performance semi-rigid foam. This paper discusses the desirable properties to be achieved, material characteristics, and processing issues. An ideal headliner foam should combine high stiffness and rigidity, low density, specific and uniform airflow, acoustical properties, dimensional stability over the wide range of temperatures, and thermoformability. Design of headliner semi-flexible (semi-rigid) polyurethane foam requires more innovative approaches than those used for conventional foams. Introducing foam into headliners puts additional constraints on the foam, due to the variety of composite constructions and methods of headliner manufacturing. Optimal foam characteristics for headliner fabrication cannot always be easily defined a priori. Results derived from customary test methods and additional testing, in particular—thermoanalytical techniques such as DMA—can be used for foam characterization and headliner processing optimization. Future demands for headliner foam that can be foreseen are a lower weight with increased stiffness, recyclability, energy management, shorter processing cycle, and reduced overall cost.
Psychophysical Assessment of Simulated Assembly Line Work: Combinations of Transferring and Screw Driving Tasks
Authors: Krawczyk Sheila , Armstrong Thomas J. , Snook Stover H. 
Published: July 2017

Upper extremity cumulative trauma disorders have been linked to the repeated and/or forceful exertions and/or awkward postures sometimes required by upper extremity intensive work. The combined effect of these physical stressors can be evaluated using psychophysical methods. The purpose of this study was to examine different combinations of repetitive upper extremity work using established psychophysical methods to determine design recommendations for upper extremity tasks. The tasks studied simulated assembly line type work where a part is transferred from a storage bin and attached with a pneumatic tool to another larger part. Twenty-four experienced industrial workers performed five combination tasks of transferring an object along a conveyor and screw driving using a pistol shaped pneumatic screwdriver: 100% transfer; 75% transfer and 25% screw drive; 50% transfer and 50% screw drive; 25% transfer and 75% screw drive; and 100% screw drive. The cycle time was 24 seconds. Each combination task was performed for an hour. Overall, transferring, and screw driving perceived exertions were measured using 10 cm visual analog scales (VAS) with verbal descriptions at the endpoints. The left and right sides corresponded to “Easiest imaginable work” at 0 cm, and “Hardest imaginable work” at 10 cm, respectively. Body part discomfort surveys were utilized to assess discomfort from each of the tasks. The overall perceived exertion (VAS) rating increased, as the task utilized more of one upper extremity than the other and involved more of either the transferring or screw driving tasks. The mean overall VAS ratings were 5.3, 4.3, 3.5, 4.4, and 5.3 for the five combination tasks, respectively. As the transferring (or screw driving) proportion of the task increased, the transferring (or screw driving) VAS increased. A repeated measures ANOVA showed that the combination task effect was significant (p<0.01). This psychophysical data can provide guidance in the analysis and design of upper extremity work. Since less varied work which utilized more of one upper extremity than the other had greater overall perceived exertion, upper extremity tasks should be designed as varied as possible utilizing as many body parts as possible. Body part discomfort surveys verified that this decreased discomfort severity and distributed the discomfort more evenly throughout the different body parts. This study provides evidence of the positive effects of work enlargement.
A Paediatric Discharge Letter: The Views of General Practitioners
Authors: Dawson Kenneth , Capaldi Nadine 
Published: July 2017

Objective: To study the views of General Practitioners on the use of shortened, structured and handwritten discharge letters from a Paediatric Unit. Design: A structured questionnaire sent to a 20% sample of the General Practitioners who regularly refer patients to Westmead Hospital. Setting: A tertiary level Teaching Hospital and General Practice. Main outcome measures: Quantified responses to structured questionnaire. Results: Overall satisfaction exists with the structured handwritten letter; the majority of General Practitioners favoured supplying the parents with a copy of the discharge summary. Conclusion: Structured hand written notes are acceptable if care is taken with their processing.
Historical Perspectives of Nursing's Professionalism
Authors: Crowder Eleanor L.M. 
Published: July 2017

The issue of nursing's professionalism is one that has concerned nurses and others for a considerable period of time. With the current furor concerning entry into practice the concern is not likely to abate. In this paper the author explores reasons for examining the past and J.H. Plumb's uses of the past. Historical evidence regarding nurses concerns about professionalism is discussed. The lack of congruence about a definition of professionalism is presented by showing eleven different definitions in chart form, given by professionals from different disciplines. Elements of professionalism, considered by the author to be central to the issue, are explored in historical context. By weaving those elements into the social fabric, nursing's progress toward professional status will be demonstrated.
Case Report: An incidentaloma that catches your eye - adrenal myelolipoma
Authors: D'Addosio Rosanna , Rojas Joselyn , Bermúdez Valmore , Ledesma Flor , Hoedebecke Kyle 
Published: July 2017

Background: Adrenal incidentaloma refers to the incidental finding of a tumor in the adrenal gland, where nonfunctional forms are the most common variant. Myelolipoma is a rare (0.08-0.4%) occurrence characterized by adipose and hematopoietic tissue. The aim of this case report is to describe the diagnosis and appropriate management of a myelolipoma in an asymptomatic patient, which was originally considered an incidental hepatic hemangioma prior to being identified as a giant adrenal adenoma. Case description: The patient was a 54 year old obese female with a recent diagnosis of diabetes type II and dyslipidemia with recent ultrasound imaging suggestive of a hepatic hemangioma. An MRI was performed revealing a 7x6cm lesion in the right adrenal area indicating a giant adrenal adenoma. An adrenalectomy was performed without complications. The pathology report identified a myelolipoma. Discussion: The incidence of myelolipoma has recently increased due to advances in radiological techniques. Its etiology is unclear and the most accepted theories support a myeloid cell metaplasia in the embryonic stage as a result of stress, infections, or adrenocorticotropic hormone or erythropoietin stimulus. Contributing components may include bone morphogenetic protein 2 and β-catenin, as well as the presence of the chromosomal translocation (3, 21) (q25; p11). Despite its benign nature, the association with other adrenal lipomas must be ruled out. A biochemical evaluation is essential for detecting subclinical states, such as Cushing syndrome and pheochromocytoma. Conclusion: Adrenal myelolipomas are rare benign tumors that are generally asymptomatic. Uncertainty still exists surrounding their etiology. Surgical management depends on hormone production, tumor size, high risk features on imaging and patient consent. Additional information is needed to better understand myelolipomas, their etiology, and clinical management. Incidentalomas may confuse the physician and patient. Ensuring proper multidisciplinary management based on the clinical guidelines of endocrinology allowed a satisfactory resolution of this case.
CNS cell-type localization and LPS response of TLR signaling pathways
Authors: McCarthy Gizelle M. , Bridges Courtney R. , Blednov Yuri A. , Harris R. Adron 
Published: July 2017

Background: Innate immune signaling in the brain has emerged as a contributor to many central nervous system (CNS) pathologies, including mood disorders, neurodegenerative disorders, neurodevelopmental disorders, and addiction. Toll-like receptors (TLRs), a key component of the innate immune response, are particularly implicated in neuroimmune dysfunction. However, most of our understanding about TLR signaling comes from the peripheral immune response, and it is becoming clear that the CNS immune response is unique. One controversial aspect of neuroimmune signaling is which CNS cell types are involved. While microglia are the CNS cell-type derived from a myeloid lineage, studies suggest that other glial cell types and even neurons express TLRs, although this idea is controversial. Furthermore, recent work suggests a discrepancy between RNA and protein expression within the CNS. Methods: To elucidate the CNS cell-type localization of TLRs and their downstream signaling molecules, we isolated microglia and astrocytes from the brain of adult mice treated with saline or the TLR4 ligand lipopolysaccharide (LPS). Glial mRNA and protein expression was compared to a cellular-admixture to determine cell-type enrichment. Results: Enrichment analysis revealed that most of the TLR pathway genes are localized in microglia and changed in microglia following immune challenge. However, expression of Tlr3 was enriched in astrocytes, where it increased in response to LPS. Furthermore, attempts to determine protein cell-type localization revealed that many antibodies are non-specific and that antibody differences are contributing to conflicting localization results. Conclusions: Together these results highlight the cell types that should be looked at when studying TLR signaling gene expression and suggest that non-antibody approaches need to be used to accurately evaluate protein expression.