bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethnicity and Antipsychotic Response
Authors: Frackiewicz Edyta J , Sramek John J , Herrera John M , Kurtz Neil M , Cutler Neal R 
Published: January 2017

OBJECTIVE: To review the data generated by studies examining interethnic/racial differences in response to antipsychotics. DATA SOURCES: A MEDLINE search (1966-19%) identified all articles examining differences in antipsychotic response among Caucasians, Asians, Hispanics, and African-Americans, as well as articles evaluating postulated mechanisms for these differences. STUDY SELECTION: All abstracts, studies, and review articles were evaluated. DATA SYNTHESIS: Ethnic/racial differences in response to antipsychotic medications have been reported and may be due to genetics, kinetic variations, dietary or environmental factors, or variations in the prescribing practices of clinicians. Studies suggest that Asians may respond to lower doses of antipsychotics due to pharmacokinetic and pharmacodynamic differences. Research relevant to African-Americans is limited, but some studies suggest that differences in this group may be due to clinician biases and prescribing practices, rather than to pharmacokinetic or pharmacodynamic variability. CONCLUSIONS: Future research directed at validating the hypotheses that different ethnic/racial groups show variations in response to antipsychotics should focus on homogenous ethnic groups, use recent advances in pharmacogenetic testing, and control for such variables as observer bias, gender, disease chronicity, dietary and environmental factors, and exposure to enzyme-inducing and -inhibiting agents. Clinicians should be aware that potential interethnic/racial differences in pharmacodynamics and pharmacokinetics may exist that can alter response to antipsychotics.
The Role of Reactive Drug Metabolites in Immune-Mediated Adverse Drug Reactions
Authors: Hess David A , Rieder Michael J 
Published: January 2017

OBJECTIVE: To highlight recent advances in the understanding of adverse drug reactions (ADRs), with a focus on models outlining interactions between drug metabolism, disease processes, and immunity. Specific mechanisms that identify the metabolic pathways responsible for drug bioactivation to reactive drug metabolites (RDMs) involved in the initiation and propagation of specific immune-mediated hypersensitivity reactions are discussed. Drug classes well known to be associated with immune-mediated ADRs are reviewed and the clinical implications of current research are discussed. DATA SOURCES: Original experimental research and immunologic review articles relevant to ADR diagnosis and etiology. DATA EXTRACTION: Results of relevant in vitro experiments and clinical reactions to drug therapy were compiled and reviewed. Critical discoveries concerning the identification of RDMs involved in ADRs were highlighted, with respect to RDM involvement in the production of an immune response to drug haptens. DATA SYNTHESIS: Drug adverse effects are classified according to clinical characteristics, immune interactions, and mechanistic similarities. Cytochrome P450 bioactivation of drug molecules to RDMs is a prerequisite to many ADRs. An electrophilic metabolite may react with cellular macromolecules (i.e., lipids, proteins, nucleic acids), resulting in direct cellular damage and organ toxicity. Covalent binding of an RDM to cellular macromolecules may also result in the formation of a hapten that is capable of eliciting a cellular or humoral immune response against drug or protein epitopes, culminating in the characteristic symptoms of hypersensitivity reactions. Mechanistic details concerning the identification of stable protein-metabolite conjugates and their interaction with the immune system remain unclear. Genetic imbalance between bioactivation and detoxification pathways, as well as reduced cellular defense against RDMs due to disease or concomitant drug therapy, act as risk factors to the onset and severity of ADRs. CONCLUSIONS: Adverse reactions to drug therapy cause significant morbidity and mortality. Identification of the pathways involved in drug bioactivation and detoxification may elucidate the potential of chemical agents to induce immune-mediated ADRs. Understanding the mechanisms of ADRs to current xenobiotics is helpful in the prevention and management of ADRs, and may prove useful in the design of novel therapeutic agents with reduced incidence of severe adverse events.
Arthrodesis of the First Metatarsophalangeal Joint: A Biomechanical Study Comparing Memory Compression Staples, Cannulated Screws, and a Dorsal Plate
Authors: Neufeld Steven K. , Parks Brent G. , Naseef George S. , Melamed Eyal A. , Schon Lew C. 
Published: January 2017

Arthrodesis of the first metatarsophalangeal joint of 21 matched pairs of cadaver toes was performed in order to compare the strength of three methods of internal fixation: 1. two crossed cannulated screws, 2. a dorsal plate with an oblique 0.062 K-wire, and 3. two compression staples with an oblique 0.062 K-wire. Biomechanical testing with plantar force was carried out, and gapping across the fusion site was measured. Stiffness, load to 1-mm displacement, and force to failure was determined for each specimen. Both the plate and screw constructs were statistically stronger in force to failure and initial stiffness than the compression construct. Compression staples have an advantage in their ease of insertion and theoretical continuous compressive force across an arthrodesis site, but should be supplemented with a cast or other external immobilization until union is achieved.
Strength and Knot Security of Braided Polyester and Caprolactone/Glycolide Suture
Authors: Bibbo Christopher , Milia Marc J. , Gehrmann Robin M. , Patel Dipak V. , Anderson Robert B. 
Published: January 2017

Background: Appropriate suture selection is necessary in providing mechanical stability to soft tissue reconstructions. Caprolactone/glycolide (Panacryl™) became a popular suture, possessing excellent handling properties; however, clinical observations questioned the knot security of caprolactone/glycolide. Caprolactone/glycolide is still available on many commercial suture anchor systems. This study compared the security of the knots and ultimate tensile strength of braided caprolactone/glycolide suture to that of a commonly used suture material, braided polyester (Ethibond™). Materials: Suture knots of No. 2 braided polyester suture and No. 2 braided caprolactone/glycolide suture were submersed in a physiologic saline solution and stressed using a continuous (non-cyclic) load, simulating a single maximal loading event in a clinical setting. Continuous loading was done to achieve clinical suture knot failure (3-mm knot slippage), then continued until catastrophic suture failure (suture breakage) occurred. Ten trials of each suture were tested. Results: Force required to cause knot slippage of 3 mm was greater for braided polyester than for braided caprolactone/glycolide ( p <.0001, unpaired Students' t-test). Forces resulting in catastrophic failure were greater for braided polyester than braided caprolactone/glycolide ( p = .0284, unpaired Students' t-test). Conclusions: These data have important implications in the selection of suture materials for repair of soft tissue injuries. In the clinical setting, a single maximal loading event may result in suture failure. These data indicate that braided polyester possesses superior in-vitro mechanical properties and suggest that braided polyester may provide greater security in-vivo than braided caprolactone/glycolide suture.
Reproducibility of Plantar Pressure Measurements in Patients with Chronic Arthritis: A Comparison of One-Step, Two-Step, and Three-Step Protocols and an Estimate of the Number of Measurements Required
Authors: van der Leeden Marike , Dekker Jos H.M. , Siemonsma Petra C. , Lek-Westerhof Sandy S. , Steultjens Martijn P.M. 
Published: January 2017

Background: Plantar pressure measurement may be a helpful evaluation tool in patients with foot complaints. Determination of dynamic pressure distribution under the foot may give information regarding gait, progress of disorders, and the effect of treatment. However, for these measurements to have clinical application, reproducibility, consistency, and accuracy must be ascertained. We compared the reproducibility of measurements among one-step, two-step, and three-step protocols for data collection in patients with arthritis. In addition, the number of measurements needed for a consistent average was determined for the protocol that was found to be the most reproducible. Methods: Twenty patients with foot complaints secondary to arthritis participated in the study. Each patient was tested with a pressure platform system using two of the three testing protocols. Reproducibility of contact time and maximal peak pressure were assessed. Intraclass Correlation Coefficients (ICC) were calculated for measurement results among protocols. In stage two of the study, the number of measurements needed for a consistent average was determined by calculating the first three measurements, the first five measurements, and then all seven measurements for both feet. ICC of three, five, and seven measurements were compared. The two-step protocol (13 patients), which was found in stage one of the study to be the most reproducible, was used for this determination. Results: Reproducibility was found to be reasonable or good for all three measurement protocols. The mean values of contact time for the one-step protocol were found to be higher than the mean values of contact time for the two-step or three-step protocols in both feet. The differences between the one-step and three-step protocols were statistically significant for the left foot only. The mean peak pressure did not show statistically-significant differences among the three protocols. The one-step and three-step protocols were not used for stage two of the study. Using the two-step protocol, three measurements were found to be sufficient for obtaining a consistent average. Conclusions: The results of our study indicated that the one-step, two-step, and three-step protocols of collecting plantar pressure measurements in patients with foot complaints secondary to chronic arthritis were all similar. However, the use of the two-step protocol is recommended over the one-step and three-step protocols; the one-step protocol produced a longer stance phase that did not resemble normal walking and when comparing the two-step and three-step protocols, the two-step protocol was less time consuming and less strenuous for patients with painful feet.
Reliability of Visual Measurement of Forefoot Alignment
Authors: Cornwall Mark W. , McPoil Thomas G. , Fishco William D. , Hunt Lea , Lane Camilla , O'Donnell Deborah 
Published: January 2017

Background: The purpose of this study was to determine the interrater reliability of visual rating of forefoot frontal plane deformities among clinicians with different training. Methods: Thirty individuals (16 men and 14 women) between the ages of 22 and 52 years of age participated in the study. None of the patients had a history of congenital deformity, pain, or trauma in the lower extremities during the 6 months before the study. Three clinicians of different educational backgrounds and experience visually evaluated each of the patients and rated forefoot alignment. None of the clinicians knew the rating assigned by either of the other two clinicians. Results: The results of this study showed that two of the clinical raters agreed 61.7% of the time, but neither of them agreed with the third clinician more than 15% of the time. Conclusion: This study indicates that the commonplace method of visually rating forefoot frontal plane deformities is unreliable and of questionable clinical value.
The Single Medial Approach to Triple Arthrodesis: A Cadaver Study
Authors: Jeng Clifford L. , Tankson Cedric J. , Myerson Mark S. 
Published: January 2017

Background: Triple arthrodesis is traditionally done through a two-incision approach. In certain high-risk patients, it may be desirable to do the procedure through a single medial incision to avoid lateral wound healing problems. Method: A cadaver study was undertaken to determine the percentage of surface area of each hindfoot joint that could be prepared through a single medial incision. Five cadaver legs were assigned to the single-incision group, and one cadaver leg was used as the “standard” two-incision specimen. Results: Through the single-incision approach, 91% of the talonavicular joint, 91% of the subtalar joint, and 90% of the calcaneocuboid joint could be prepared. These results were comparable to the two-incision cadaver specimen results. Conclusions: A single-incision medial approach for triple arthrodesis is a safe and effective technique in the management of hindfoot deformity and arthritis in certain high-risk patients.
Medial Deviation of the First Metatarsal in Incipient Hallux Valgus Deformity
Authors: Munuera Pedro V. , Dominguez Gabriel , Polo Juan , Rebollo Jesús 
Published: January 2017

Background: The aim of this study was to determine whether excessive medial deviation of the first metatarsal (excessive intermetatarsal angle) is present in the initial phase of hallux valgus. Methods: The intermetatarsal angle between the first and second metatarsals (1–2 IMA) was radiographically studied in 49 normal feet and in 49 feet with mild hallux valgus deformity. Results: The results demonstrated a statistically significant difference in the mean intermetatarsal angle between the two groups (8.76 degrees in normal feet; 9.98 degrees in affected feet). However, we believe that is not clinically significant. Other authors, comparing the 1–2 IMA in patients with or without more advanced hallux valgus, reported greater differences than those obtained in this study. Conclusions: Excessive medial deviation of the first metatarsal is not a causal factor but rather a consequence of hallux valgus deformity.
Variation of the Distal Metatarsal Articular Angle with Axial Rotation and Inclination of the First Metatarsal
Authors: Robinson Andrew H.N. , Cullen Nicholas P. , Chhaya Neal C. , Sri-Ram K. , Lynch Andy 
Published: January 2017

Background: The distal metatarsal articular angle (DMAA) is a radiographic measure of the orientation of the first metatarsal articular surface. There is debate with regards to the accuracy, reproducibility, and validity of measurement of the DMAA in the literature. This study aimed to test the validity of the measurement of the DMAA from standard radiographs, to explore the trigonometric relationship of the first metatarsal rotation and the DMAA, and to assess interobserver reliability. Methods: Thirty-four separate dry cadaver first metatarsal bones were mounted onto a customized light-box-protractor, allowing controlled incremental changes in rotation and inclination. A series of 39 digital photographs were taken of each metatarsal in 5-degree increments of rotation between 30 degrees supination and 30 degrees pronation at 10, 20 and 30 degrees of inclination. Three reviewers performed blinded DMAA measurements from each photographic image; the data were collated for statistical analysis. The data were analysed using a mixed effects linear model comparing the DMAA with rotation of the first metatarsal. Results: A strong statistically significant trend of increasing score with increasing pronation of the metatarsal was observed, the relationship was approximately linear. There was a strong effect of inclination, but the strength of this varied with rotation and was amplified at higher inclinations. Interobserver error was noted in line with other studies, but even allowing for this interobserver error, the linear relationship was maintained. Conclusions: This study showed that the DMAA varies significantly in a linear pattern with axial rotation of the first metatarsal. Inclination of the first metatarsal also affects the magnitude of the angle. This study does not refute the DMAA as an entity but does confirm the inaccuracy of extrapolating the DMAA from plain anteroposterior radiographs.
First Metatarsal Bone: An Anatomic Study
Authors: ElSaid Ahmed G. , Tisdel Christopher , Donley Brian , Sferra James , Neth Donald , Davis Brian 
Published: January 2017

Background: The purpose of this study was to establish the range of anatomic variations of the first metatarsal bone, including both the angulations of the articular surfaces and the dimensions of the bone in a large sample. Methods: Four hundred and seventy-eight first metatarsal bones of 239 cadaver specimens were studied. The following parameters were recorded: the distal metatarsal articular angle (DMAA), distal metatarsal articular surface shape, proximal metatarsal articular angle (PMAA), the first metatarsal bone length and width at the mid-region of the shaft, and the existence of a joint between the bases of the first and second metatarsals. These parameters were correlated to the specimen's age, sex, race, height, and weight. The DMAA and PMAA were measured from a digital picture of the first metatarsal bone by a specially designed computer analysis program. Results: Males and African-American race had a longer and wider metatarsal. The joint between the first and second bases was present in 25% of the population. The DMAA ranged from − 14 degrees of medial deviation to 30 degrees of lateral deviation with an overall average of 8.21 degrees. The DMAA increased 1 to 3 degrees with every 10 years in age for both right and left bones with a p value of < 0.01 and < 0.001, respectively, and the average increase from 20 to 60 years of age was 4.5 degrees. The PMAA ranged from −13.8 degrees of lateral deviation to 12.7 degrees of medial deviation with an overall average of −1 degrees. PMAA significantly deviated laterally in the presence of a joint between the bases of the first and second metatarsals (p < 0.001). The male and female means for the DMAA and PMAA were nearly equal. Conclusions: The DMAA had a wider range than reported in the literature, and it increased with age. The first-second metatarsal joint was accompanied by lateral deviation of the PMAA. Clinical Relevance: Laterally deviated PMAA could predispose to a varus deformity of the first metatarsal.
Incidence of Foot and Ankle Injuries in West Point Cadets with Pes Planus Compared to the General Cadet Population
Authors: Levy Jonathan C. , Mizel Mark S. , Wilson L. Samuel , Fox William , McHale Kathleen , Taylor Dean C. , Temple H. Thomas 
Published: January 2017

Background: The relationship between pes planus and injuries of the lower extremity is controversial. However, few studies have used standardized means of evaluating and defining pes planus, and none have had a controlled patient population. The objective of this study was to evaluate an ideal population of physically active individuals to establish a potential correlation between pes planus, as defined by a standardized method, and injuries to the lower extremity. Methods: A standardized technique for evaluating arch height, based on a midfoot ratio established by Harris mat print calculations, was used to assess a consecutive series of 512 newly entered West Point cadets. Pes planus was defined as more than 2 standard deviations above the mean midfoot ratio of the population. After 46 months, a retrospective chart review was done to identify lower extremity injuries sustained in this group of young healthy patients. The results of the footprint analysis were correlated with the medical record findings. Results: Thirty-three cadets were found to have pes planus; 13 had only left foot involvement, 15 had right foot only involvement, and five had bilateral pes planus. There were no cavus feet. Statistically significant relationships were seen between the degree of pes planus and total number of injuries sustained ( p = 0.007), the overall size of the foot and total number of injuries ( p = 0.041), left flat feet and left midfoot injuries ( p = 0.028), left pes planus and right midfoot injuries ( p = 0.008), left pes planus and left knee injuries ( p = 0.038), and right pes planus and right knee injuries ( p = 0.027). Women had smaller feet ( p = 0.000), smaller midfoot ratios (right, p = 0.013; left p = 0.003), yet they had an increased number of injuries (Pearson's coefficient −0.119; p = 0.007). Conclusions: The current study found significant relationships between pes planus and number of injuries sustained over a 4-year period at West Point. While women were found to have smaller feet and lesser degrees of pes planus, they sustained more injuries than men.
Diabetic Foot Complications in a Northern Canadian Aboriginal Community
Authors: Reid Kristin S. , Martin Bruce D. , Duerksen Frank , Nicolle Lindsay E. , Garrett Mark , Simonsen J. Neil , Trepman Elly , Embil John M. 
Published: January 2017

Background: Limited access to basic foot care and protective footwear may contribute to diabetic foot complications. The purpose of this study was to determine the prevalence of foot complications, ongoing foot care, and footwear use in diabetic subjects in a remote northern Canadian Aboriginal community. Methods: This was a cross-sectional cohort study of 169 diabetic people, including interview, physical examination, and retrospective chart review. Results: The mean age of the 169 diabetic individuals in the study was 56 ± 12 years and their duration of diabetes 10 ± 7 years. There were 139 (82%) individuals who had 418 diabetic foot complications (average, 3.0 complications per subject with complications), including toenail pathology, foot and ankle deformities, calluses, impaired pulses, neuropathy, past or present ulcer, amputation, and Charcot arthropathy. Risk classification showed that 69 (41%) individuals were at risk for future ulceration. Fifty-five (33%) individuals had inadequate footwear for their foot risk category, and only 11 (17%) of 66 individuals in the higher risk categories (categories 2 and 3) had suitable footwear. In a 7-year period, only 0.7 screening foot examinations per diabetic subject per year were documented. However, during this period, foot problems accounted for 498 (18%) local emergency room visits, 359 (16%) hospitalization days, 109 (11%) nonemergency transfers, and 4 (6%) emergency transfers to a tertiary care hospital. Conclusions: Foot and ankle complications of diabetes in this remote Aboriginal community were common and associated with substantial morbidity. Preventive diabetic foot screening examinations and footwear were inadequate. The results suggest that programs for prevention and early detection of complications are needed, including foot screening, provision of appropriate footwear, and foot care.