bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decreased Time to Antibiotic Prophylaxis for Open Fractures at a Level One Trauma Center
Authors: Johnson Joey P. , Goodman Avi D. , Haag Adam M. , Hayda Roman A. 
Published: October 2017

Objective:
To determine whether time to administration of antibiotics decreased after the implementation of an open fracture working group and antibiotic prophylaxis protocol.

Design:
Retrospective cohort study.

Setting:
One Level 1 Trauma Center.

Patients:
Patients 18 years of age and older who sustained an open fracture and presented directly to our emergency department.

Intervention:
Prompt irrigation and debridement in the operating room and fracture stabilization dictated by the treating surgeon. Fifty patients were reviewed as the preintervention group, comprising the period before conception and before intervention. Fifty patients were included after the initiation of our protocol during the same time period 1 year later.

Main Outcome Measurements:
Time from entrance to the emergency department to ordering of antibiotics, time from ordering to administration of antibiotics, and time from entrance to the emergency department to administration of antibiotics.

Results:
After protocol implementation, time from admission to antibiotic administration decreased significantly from 123.1 to 35.7 minutes (P = 0.0003). Each component decreased significantly: admission to order decreased from 94.1 to 26.1 minutes, and order to administration decreased from 29.0 to 9.5 minutes (P = 0.0046 and P = 0.0003).

Conclusion:
Our study demonstrates a significantly reduced time to antibiotic prophylaxis for patients with open fractures after the implementation of a multidisciplinary working group. We hope that this provides a model for institutions to improve care and outcomes of these injuries.

Level of Evidence:
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Supracondylar Humeral Fracture Pearls and Pitfalls
Authors: Frick Steven L. , Mehlman Charles T. 
Published: October 2017

Summary:
Supracondylar humeral fractures are the most common type of pediatric elbow fracture. With proper treatment, these injuries usually heal well and the patients return to full function. However, a small percentage of these injuries may result in devastating complications and, thus, provoke anxiety in many surgeons treating them. This article provides tips for successful management of these injuries without complications and provides references for further study.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Ankle Fracture Pearls and Pitfalls
Authors: Parikh Shital N. , Mehlman Charles T. 
Published: October 2017

Summary:
Pediatric ankle fractures are common and have unique fracture characteristics because of the presence of distal tibial and fibular physes. When displaced (>3 mm widening of the physis or >2 mm intra-articular gap/step-off), these fractures are typically treated with anatomical reduction and internal fixation. Computed tomography is recommended for preoperative evaluation and surgical planning for intra-articular fractures. These fractures in younger children with substantial growth remaining should be followed closely to monitor for any growth disturbance. Pearls and pitfalls related to the treatment of these fractures would emphasize the physeal-respecting approach to their management.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Femoral Shaft Fracture Pearls and Pitfalls
Authors: Gordon J. Eric , Mehlman Charles T. 
Published: October 2017

Summary:
Pediatric femoral shaft fractures present many challenging patient care decisions. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention is commonplace in virtually all older children. Treatment is determined primarily by patient age as modified by clinical factors including mechanism of injury, weight, and skeletal maturity. Infants can be successfully treated by placement into a Pavlik harness, whereas children younger than 5 years are most commonly treated by early reduction and spica cast immobilization. Children aged up to 11 years are most commonly treated by flexible intramedullary nailing, whereas older children and adolescents, particularly with length unstable fractures should be treated with more rigid fixation such as lateral entry locked nails or submuscular plating.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Tibia Fracture Pearls and Pitfalls
Authors: Lovejoy Steven A. , Mehlman Charles T. 
Published: October 2017

Summary:
Tibial fractures in children present a wide array of challenges to the managing orthopaedic surgeon. Injuries cover a spectrum from subtle tibial spine fractures to comminuted high-energy shaft fractures requiring free flap coverage. Significant risks range from malunion and leg length discrepancy to infected nonunions and Volkmann ischemic contracture. This article offers evidence and experience-based advice that is aimed at helping the community orthopaedic surgeon taking call.
The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Forearm Shaft Fracture Pearls and Pitfalls
Authors: Herman Martin J. , Simon Matthew , Mehlman Charles T. 
Published: October 2017

Summary:
Pediatric forearm shaft fractures are the third most common fracture in children, and the forearm is the third most mobile joint in the body (with a nearly 180 degree arc of motion). The goals of treatment are aimed squarely at achieving satisfactory anatomic alignment (within defined parameters) as the consequences of malunion can be permanent forearm stiffness and deformity. Nonoperative treatment approaches still dominate care of the youngest age groups while surgical intervention has become increasingly common in older children. This article will offer evidence and experience-based tips intended to benefit the community orthopedic surgeon caring for children during the course of their on-call duties.
Cutaneous Presentation of Mesothelioma With a Sarcomatoid Transformation
Authors: Klebanov Nikolai , Reddy Bobby Y. , Husain Sameera , Silvers David N. , Grossman Marc E. , Tsao Hensin 
Published: October 2017

Abstract:
Malignant pleural mesothelioma is a rare neoplasm of mesodermal origin. Cutaneous involvement of malignant pleural mesothelioma is a very rare entity, with only 11 cases reported in the literature. Here, we describe the case of a 75-year-old man with stage IV epithelioid pleural mesothelioma, presenting with a cutaneous eruption 5 months after initial diagnosis, which revealed sarcomatoid features on skin biopsy. Histological analysis of malignancy progression through immunohistochemical staining of the pleural, lymph node, and skin tissue revealed gradual loss of calretinin and gain of desmin, supporting a transformation from epithelioid to sarcomatoid tissue. To our knowledge, this is the first reported case of an epithelioid to sarcomatoid transformation of malignant pleural mesothelioma manifesting in a cutaneous presentation.
Polyalkylimide: A Nonstable Filler Over Time
Authors: Schelke Leonie W. , Velthuis Peter J. , van Dijk Marijke R. 
Published: October 2017

BACKGROUND
Polyalkylimide hydrogel is supposed to be a permanent, biocompatible implant. However, years after subcutaneous implantation clinical complications are seen.

OBJECTIVE
To increase the understanding of the changes that occur over time in this subdermal implanted filler.

MATERIALS AND METHODS
The extruded filler material of 34 patients was evaluated by histologic examination.

RESULTS
In most patients who had cosmetic disturbances but no complaints, histology showed no immune cells in or around the filler material. In patients with an acute inflammatory response, giant cell invasion was seen in and around the filler material. Patients with chronic complaints showed a neutrophilic cell influx in the extruded filler. In all patients, degeneration and calcification of the material was noted. The polyalkylimide hydrogel changed over time, both macroscopically and microscopically. As in most of the patients no immune response was seen around the filler material, this may indicate that the material is biocompatible.

CONCLUSION
The authors conclude that a dermal filler should not be judged solely on its biocompatible characteristics but also on the degradation process over time in the human body.
Selective ß1-Blockers Are Not Associated With New-onset Diabetes Mellitus in Hypertensive Patients
Authors: Park Yoonjee , Choi Byoung Geol , Rha Seung-Woon , Baek Man Jong , Ryu Yang Gi , Choi Se Yeon , Byun Jae Kyeong , Shim Min Suk , Mashaly Ahmed , Li Hu , Jang Won Young , Kim Woohyeun , Kang Jun Hyuk , Choi Jah Yeon , Park Eun Jin , Park Sung Hun , Lee Sunki , Na Jin Oh , Choi Cheol Ung , Lim Hong Euy , Kim Eung Ju , Park Chang Gyu , Seo Hong Seog , Oh Dong Joo 
Published: October 2017

Background:
Although ß-blockers are known to increase new-onset diabetes mellitus (DM), previous evidence have been controversial. It has been suggested that newer vasodilatory ß-blockers yield better glycemic control than older nonselective agents. The aim of this study was to evaluate the diabetogenicity of currently used newer ß-blockers based on ß1 receptor selectivity in a series of Asian population.

Methods:
We investigated a total of 65,686 hypertensive patients without DM from 2004 to 2014. Patients with hemoglobin (Hb) A1c ≤6.0%, fasting blood glucose ≤110 mg/dL, and no history of diabetes or diabetic treatment were enrolled for analysis. Patients were divided into the ß-blockers group and non-ß-blockers group. Propensity score matching (PSM) analysis using a logistic regression model was performed to adjust for potential confounders. The primary end point was the cumulative incidence of new-onset DM, defined as a fasting blood glucose ≥126 mg/dL or HbA1c ≥6.5%, and major adverse cardiac and cerebral events (MACCE), defined as a composite of total death, nonfatal myocardial infarction, and cerebrovascular accidents. We investigated predictors of new-onset DM and MACCE based on 2 models, including clinical risk factors and co-medications, respectively.

Results:
Mean follow-up duration was 30.91 ± 23.14 months in the entire group before adjustment. The ß-blockers group had a significantly higher incidence of new-onset DM and MACCE than the non-ß-blockers group. After PSM, analysis of a total of 2284 patients (1142 pairs, C-statistic = 0.752) showed no difference between the 2 groups in new-onset DM or MACCE. In multivariate analysis after PSM, baseline HbA1c, stroke, heart failure, nonselective ß-blockers, and age were independent predictors of new-onset DM. Selective ß1-blockers did not increase new-onset DM after adjustment for other antihypertensive medication and statins.

Conclusions:
In the era of newer ß-blockers, selective ß1-blockers were not associated with new-onset DM. More evidence is needed to verify this relationship and the underlying mechanisms.
Dose–Effect of Irbesartan on Cyclooxygenase-2 and Matrix Metalloproteinase-9 Expression in Rabbit Atherosclerosis
Authors: Li Lihua , Li Juan , Yi Jing , Liu Hang , Lei Han 
Published: October 2017

Abstract:
Irbesartan has previously shown antiatherosclerotic effects on human carotid atherosclerotic plaques. Our study aimed to assess the dose–effect of irbesartan on cyclooxygenase-2 (COX-2) and matrix metalloproteinase-9 (MMP-9) in rabbit atherosclerotic aorta. New Zealand rabbits were randomly divided into 6 groups: normal control (NC), high cholesterol (HC), low-dose (10 mg·kg−1·day−1), medium-dose (20 mg·kg−1·d−1), and high-dose (30 mg·kg−1·d−1) irbesartan and celecoxib (20 mg·kg−1·d−1). Except for the NCs, rabbits were fed a HC diet for 14 weeks to induce atherosclerosis. Aortic atherosclerotic lesions and messenger RNA and protein expression of COX-2, MMP-9, and nuclear factor-κB (NF-κB) were subsequently measured. The surface area of aortic atherosclerotic lesions was visibly larger in the HC group than in NCs (P < 0.01), but showed considerable reduction with medium- and high-dosage irbesartan and celecoxib treatments (P < 0.01). In medium- and high-dosage irbesartan and celecoxib groups, COX-2 and MMP-9 expression and NF-κB activity were significantly lower than in the high-cholesterol group (P < 0.01). No significant differences in treatment effects were observed between the high-dosage irbesartan and celecoxib groups (P > 0.05). Our results indicate that medium and high doses of irbesartan and celecoxib have antiatherosclerotic effects in aortic plaques via inhibition of COX-2 and MMP-9 by suppressing NF-κB activation. High-dose irbesartan has effects similar to celecoxib.
An Algorithmic Approach to Operative Management of Complex Pediatric Dog Bites: 3-Year Review of a Level I Regional Referral Pediatric Trauma Hospital
Authors: Alizadeh Kaveh , Shayesteh Ali , Xu Min Li 
Published: October 2017

Background:
Incidence of dog bites continues to rise among the pediatric population and serves as a public health threat for the well-being of children. Plastic surgeons are at the forefront of initial management and eventual outcome of these devastating injuries. This study set out to determine the nature of dog bite injuries treated over a 3-year period at a large level 1 pediatric trauma center.

Methods:
A retrospective review of emergency room records of all pediatric patients (age, 0–18 years old) who sustained dog bites between January 2012 and December 2014 were gathered. All details about age of patient, location and severity of dog bites, type of dog breed, antibiotics given, and emergency versus operative treatment were recorded and analyzed.

Results:
One hundred eight patients aged 5 months to 18 years old were treated in the emergency department after suffering dog bite injuries during the study period. The highest incidence of dog bites occurred in preschool children. The mean age for patients who required operative repair was lower than the mean age for patients who underwent primary closure in the emergency department. The location of injury was most commonly isolated to the head/neck region. Of the 56 cases that had an identified dog breed, pit bulls accounted for 48.2% of the dog bites, and 47.8% of pit bull bites required intervention in the operating room.

Conclusion:
Children with large dog bite injuries require more immediate care in a level 1 pediatric trauma hospitals in order to optimize their hospitalization course and eventual outcome.
Nasal Duplication Combined with Cleft Lip and Palate: Surgical Correction and Long-Term Follow-Up
Authors: Long Kanharith , Yamaguchi Kazuaki , Lonic Daniel , Long Vanna , Chhoeurn Vuthy , Lo Lun-Jou 
Published: October 2017

Background:
Diprosopus dirrhinus, or nasal duplication, is a rare entity of partial craniofacial duplication.

Methods:
The case we present is the first report of diprosopus dirrhinus associated with complete cleft lip and palate. The baby was born in Cambodia at full term by normal vaginal delivery with no significant perinatal and family history. Physical examination revealed significant facial deformity due to the duplicated nose and the left complete cleft lip/palate on the right subset.

Results:
There were 4 nostrils; both medial apertures including the cleft site were found to be 10–15 mm deep cul-de-sac structures without communication to the nasopharynx. The upper third of the face was notable for hypertelorism with a duplication of the soft-tissue nasion and glabella. Between the 2 nasal dorsums, there was a small cutaneous depression with a lacrimal fistula in the midline. Surgical treatment included the first stage of primary lip and nose repair and the second stage of palatoplasty.

Conclusions:
The patient was followed up at the age of 10 years showing satisfactory results for both aesthetic and functional aspects. Further management in the future will be required for the hypertelorism and nasal deformity.
Quality and Variability of Cardiovascular Rehabilitation Delivery
Authors: Somanader Deborah S. , Chessex Caroline , Ginsburg Liane , Grace Sherry L. 
Published: October 2017

Purpose:
Cardiac care, including cardiovascular rehabilitation (CR), is most effective if it is high-quality. The aim of this study was to describe CR quality, using the recently developed Canadian Cardiovascular Society CR quality indicators (QIs). Difference in quality between CR sites was also assessed.

Methods:
Secondary analysis was conducted on an observational, prospective, multisite CR program evaluation cohort. A convenience sample of patients from 1 of 3 CR programs was approached at their first CR visit, and consenting participants completed a survey. Clinical data were extracted from charts pre- and postprogram. Of the 30 CR QIs, 21 (70.0%) were assessable: 10 process, 9 outcome, and 2 structure QIs.

Results:
Of 411 consenting patients, 209 (53.0%) completed CR. The greatest quality was observed for assessment of blood pressure (98.1%), communication with primary health care at CR discharge (94.2%), and patient enrollment (94.0%). The lowest quality was observed for wait time from hospital discharge (9.2%), assessments of blood glucose (42.1%), and lipid control (53.0%). Of the 7 QIs that had an established benchmark, quality for 2 (28.6%) was above the benchmark (particularly assessment of blood pressure). Significant between-site differences were observed in 11 (64.7%) QIs. The magnitude of quality differences between sites was largest for assessment of lipid control (72.6%), assessment of blood glucose control (69.0%), and wait time in median days from referral to enrollment (30.6 days).

Conclusion:
There is wide variability in CR program quality, both overall and between CR sites. Quality improvement in particular aspects of CR care is required.
PREVALENCE OF POLYPOIDAL CHOROIDAL VASCULOPATHY IN WHITE PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Lorentzen Thomas D. , Subhi Yousif , Sørensen Torben L. 
Published: October 2017

Purpose:
Polypoidal choroidal vasculopathy (PCV) is a disease with significant inter-ethnical differences. In this study, we systematically review the literature on the prevalence of PCV in whites referred with a diagnosis of exudative age-related macular degeneration (AMD).

Methods:
We searched PubMed, Embase, the Cochrane Library, and the Web of Science on 24 March, 2017 for studies evaluating the prevalence of PCV in white patients with exudative AMD. Data extraction and risk of bias assessments were performed in duplicate. Studies were included for a qualitative review and a meta-analysis, including subgroup analysis for differences in age and sex.

Results:
We included data from 11 studies (>2,200 participants). For diagnosis, indocyanine green angiography was used together with a set of supporting criteria on fundus examination and optical coherence tomography. Extramacular location was more prevalent in eyes with PCV. Drusen was present in the fellow eye in 17% to 27%. Pooled prevalence of PCV in white patients with exudative AMD was 8.7% (confidence interval 95%: 7.2%–10.3%). Patients with PCV were 3.7 years (confidence interval 95%: 2.1 years–5.3 years) younger than those with other exudative AMD. Sex did not differ significantly.

Conclusion:
Polypoidal choroidal vasculopathy is not a rare subtype of exudative AMD in whites—it is present in approximately one in 11 patients.
Early haemorrhage control and management of trauma-induced coagulopathy: the importance of goal-directed therapy
Authors: Stensballe Jakob , Henriksen Hanne H. , Johansson Pär I. 
Published: October 2017

Purpose of review
The aim of this study was to discuss the recent developments in trauma-induced coagulopathy and the evolvement of goal-directed therapy.

Recent findings
Mortality from major trauma continues to be a worldwide problem, and massive haemorrhage remains a major cause in 40% of potentially preventable trauma deaths. Development of trauma-induced coagulopathy challenges 25–35% of the patients further increasing trauma mortality. The pathophysiology of coagulopathy in trauma reflects at least two distinct mechanisms: Acute traumatic coagulopathy, consisting of endogenous heparinization, activation of the protein C pathway, hyperfibrinolysis and platelet dysfunction, and resuscitation associated coagulopathy. Clear fluid resuscitation with crystalloids and colloids is associated with dilutional coagulopathy and poor outcome in trauma. Haemostatic resuscitation is now the backbone of trauma resuscitation using a ratio-driven strategy aiming at 1:1:1 of red blood cells, plasma and platelets while applying goal-directed therapy early and repeatedly to control trauma-induced coagulopathy.

Summary
Trauma resuscitation should focus on early goal-directed therapy with use of viscoelastic haemostatic assays while initially applying a ratio 1:1:1 driven transfusion therapy (with red blood cells, plasma and platelets) in order to sustain normal haemostasis and control further bleeding.
Risks and management of long-term corticosteroid use in chronic rhinosinusitis
Authors: Campbell Raewyn G. 
Published: October 2017

Purpose of review
The purpose of this review is to provide an update on the use and risks of long-term corticosteroids in the management of chronic rhinosinusitis (CRS).

Recent findings
Long-term use of systemic corticosteroids is not indicated in the management of CRS due to the associated side effects and potential complications. Therefore, recent research has focused on the safety and efficacy of topical corticosteroid, particularly second-generation corticosteroids, and their modes of administration. Second-generation corticosteroids are more potent and have less systemic bioavailability than their first-generation counterparts. However, caution must be taken with concomitant use of more than two types of corticosteroids (topical, systemic, inhaled etc.) and also with their dosage and frequency of administration to avoid adrenal suppression, growth suppression in children, elevated intraocular pressure or epistaxis. Research is ongoing into therapies that may reduce corticosteroid resistance which has been demonstrated in some nasal polyps.

Summary
Corticosteroids play an essential role in the management of CRS; however, use must be tailored to the patient-specific disease and requires ongoing review and regular reevaluation by their physician.
Long QTc During Methadone Maintenance
Authors: Westermeyer Joseph , Thuras Paul , Yoon Gihyun , Batres-y-Carr Tegan 
Published: October 2017

Abstract
Our goal consisted of describing the 4-year prevalence, contributors, and interventions for long QTc's in methadone maintenance treatment. Cardiologists' diagnosis of long QTc defined case-ness in 62 patients. Long QTc categories, drawn from epidemiological reports, encompassed 440 to 469 (borderline), 470 to 499 (moderate), and 500+ milliseconds (severe). Data collection included electrocardiograms, demographic characteristics, contributors to long QTc, and interventions-plus-outcomes (defined by resolution of long QTc). Of 62 patients, 21 had 39 long QTc episodes—a 4-year case prevalence of 34%, and an annual episode incidence of 15.7 per 100. Contributing factors identified in 36 of 39 episodes consisted of medication management (n = 19), illicit drug use (n = 11), and other factors (n = 6). Long QTc reverted to normal in 38 of 39 episodes. Of 21 patients, 12 (57%) experienced one or two recurrences. Methadone maintenance treatment physicians normalized most episodes as outpatients, often in collaboration with patients' primary care physicians. One fifth of episodes required hospitalization and other specialty care. Lack of timely QTc normalization may have accounted for one sudden death.