bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anatomical Facial Nerve Findings in 209 Consecutive Atresia Cases
Authors: Goldsztein Hernan , Roberson Joseph B. 
Published: January 2013

ObjectiveDescribe intraoperative facial nerve findings in 209 consecutive atresia cases. Identify preoperative and intraoperative anatomical variants that should alert the surgeon to potential high‐risk facial nerve anatomy.Study DesignCase series with chart review.SettingTertiary care subspecialty private practice.MethodsRetrospective review of 209 consecutive atresia cases treated between 2007 and 2011. Descriptive analysis of intraoperative findings. Logistical regression models with generalized estimating equations were used to examine the effect of preoperative variables over the operative findings.ResultsTwo hundred and nine consecutive patients (ages 2‐48) underwent atresia repair between 2007 and 2011. Preoperative Jahrsdoerfer Scale was 9 (23%), 8 (42%), 7 (19%), 6 (2%), 5 or less (2%). The facial nerve was found to have an abnormal course in 39% of the cases and not identified in 1%. It was congenitally dehiscent in 53% of cases and was surgically exposed in 10%. The most common site of congenital dehiscence was in the tympanic segment (57%). Facial‐stapes contact was found in 11% of cases. The stapedius tendon was absent in 30% of cases. A single patient had a mild transient postoperative paresis (House‐Brackmann 2).ConclusionAtresia repair remains one of the most challenging procedures in otology. In spite of modern preoperative imaging, the facial nerve remains at risk. When performing surgery on patients with preoperative facial nerve paresis and/or lower Jahrsdoerfer scores, the surgeon should be aware of a higher incidence of facial nerve abnormalities. Thorough knowledge of anatomical variations and meticulous surgical technique are mandatory to safely perform these surgeries.
Biomechanical Performance of a New Device for Medial Malleolar Fractures
Authors: Patel Tejas , Owen John R. , Byrd William A. , Graves Ryan B. , Chande Ruchi D. , Mounasamy Varatharaj , Adelaar Robert S. , Wayne Jennifer S. 
Published: January 2013

Background: Displaced medial malleolus fractures require surgical repair because of the critical role the structure plays in normal joint function. Various approaches exist, but options are limited for small fragment fractures. This study compared repair with the Medial Malleolar Sled fixation system (Trimed, Inc, Valencia, CA) to lag screws in 2 modes of biomechanical loading in a cadaveric model. Methods: A Müller type B medial malleolus fracture was simulated on matched pairs of cadaveric lower extremities and repaired with the sled or 2 cancellous lag screws. Tibial distraction (tension, n = 10) or internal rotation (torsion, n = 11) was applied. Fragment movement was measured in the sagittal (tension and torsion) and transverse (torsion-only) planes. Fragment movement at 1 mm and 2 mm (clinical malunion) of gapping during tension and at 2, 4, 6, and 8 N-m during torsion was analyzed via paired t tests. Results: In tension, the load at the 2-mm gap was statistically lower for screws ( P = .026). Opening angle was statistically larger for the sled at the 1-mm ( P = .0004) and 2-mm ( P = .008) gap. In torsion, gapping was statistically lower for the sled (ranging from P = .0013 at 4 N-m to P = .0187 at 8 N-m). No differences were detected for opening angle or transverse plane movement. Conclusion: The sled appeared stronger in tension and as effective as lag screws in torsion. The sled may be a viable option for fractures too small for 4.0- or 3.5-mm lag screws. Clinical Relevance: The sled may be suitable in applications where a tension band would normally be considered and may provide stronger fixation in osteoporotic bone compared with lag screw fixation.
Costs and Benefits of Routine Histopathological Examination of Hammertoe Specimens
Authors: Malzberg Andrew B. , Vulcano Ettore , O’Malley Martin J. , Deland Jonathan T. , Ellis Scott J. 
Published: January 2013

Background: The purpose of this study was to evaluate the cost and benefit of routinely submitting hammertoe specimens for histopathological examination. We hypothesized that such examination rarely shows a new diagnosis and seldom alters postoperative care. Materials and Methods: Three hundred and fourteen proximal interphalangeal (PIP) joint and 37 extensor tendon specimens from 187 consecutive hammertoe correction surgeries were submitted by 2 surgeons for histopathological examination between January 2009 and December 2011. Each patient’s chart was reviewed to determine whether the histopathological examination revealed a diagnosis other than degenerative joint or degenerative tendon and whether subsequent patient management was altered. The total reimbursements for professional charges were calculated using the average reimbursement from common insurance providers for two Current Procedural Terminology (CPT) codes: 88304 (soft tissue examination) and 88311 (decalcification). Results: Almost all of the specimens were diagnosed as degenerative: 97.5% (307/314) of the PIP specimens and all (37/37) of the tendon specimens. Seven PIP specimens (2.2%, 7/314) from 5 patients (2.7%, 5/187) and no tendon specimens had other diagnoses. These diagnoses were rheumatoid arthritis (5/314, 1.6%), osteomyelitis (1/314, 0.3%), and pigmented villonodular synovitis (PVNS) (1/314, 0.3%). Only the PVNS was a new diagnosis. A total of $56,750 was spent to determine 1 new diagnosis. Conclusion: The routine submission of hammertoe specimens for pathological evaluation was not cost-efficient. Our analysis showed that new diagnoses were rarely found and patient management was not affected. Level of Evidence: Level IV, retrospective case series.
Severity of Diabetic Foot Infection and Rate of Limb Salvage
Authors: Wukich Dane K. , Hobizal Kimberlee B. , Brooks Maria Mori 
Published: January 2013

Background: Foot infections are limb-threatening complications in patients with diabetes mellitus (DM), and proper classification of the severity of diabetic foot infection (DFI) is important in determining an effective antibiotic regimen, the need for hospitalization and surgery, and the risk of amputation. Our hypothesis was that patients with severe DFI would have a longer hospitalization than those with moderate DFI. The purposed of this study was 2-fold. The first purpose was to define DFI using readily available clinical information and objective parameters outlined by consensus statements. The second purpose of this study was to assess rates of amputation and limb salvage for hospitalized patients with DFI. Methods: The database of a single academic foot and ankle program was reviewed for patients who were hospitalized for a DFI from 2006 to 2011. Inpatient and outpatient electronic medical records identified 100 patients. Severe DFI was defined as having 2 or more objective findings of systemic toxicity and/or metabolic instability at the time of initial assessment. Results: The length of stay was significantly shorter for patients with a moderate infection than for those with a severe infection (median 5 days vs 8 days, P = .021). A nonsignificant trend was observed that indicated higher rates of limb salvage in patients with moderate infections compared with patients with severe infections (94% vs 80%, P = .081). Conclusion: Patients with severe DFI had a median hospital stay that was 60% longer than that of patients with moderate DFI. In this sample, 55% of patients with a severe DFI required some type of amputation compared with 42% of patients with a moderate DFI. Level of Evidence: Level III, retrospective control cohort study.
Assessing the Safe Direction of Instruments During Posterior Ankle Arthroscopy Using an MRI Model
Authors: Yoshimura Ichiro , Naito Masatoshi , Kanazawa Kazuki , Ida Takahiro , Muraoka Kunihide , Hagio Tomonobu 
Published: January 2013

Background: The safety of posterior ankle arthroscopy is still the subject of debate. The purpose of this study was to evaluate the anatomical relationship between the posterior portals and the neurovascular structures using magnetic resonance imaging (MRI) to determine the safety of posterior portals in posterior ankle arthroscopy. Methods: Forty ankles from 38 patients who had undergone MRI scanning for ankle disorders were assessed (18 males, 20 females). For each ankle, the angles of the presumed position of the portals to the posterior neurovascular structures and the malleoli were measured on 4-mm proximal slices from the anterior tip of the fibula. The shortest distance from the sural nerve and the tibialis posterior neurovascular bundle to the position of the posterior portals was measured. Results: The average distance between the posteromedial portal and the tibialis posterior neurovascular bundle was 18 ± 3 mm, whereas the average distance between the posterolateral portal and the sural nerve was 15 ± 3 mm. In 100% of ankles, there were no neurovascular structures lying within the region between the anterior tip of fibula and the posteromedial portal or between the posterior tip of fibula and the posteromedial portal. In 32 ankles (80%), the medial neurovascular structures were present on the medial side of the line running between the anterior tip of medial malleolus and the posteromedial portal. Conclusion: The posterior neurovascular structures were not in immediate proximity to where we estimated the posteromedial and posterolateral portals to be located. Clinical Relevance: The findings of the present MRI-based study suggest that arthroscopic instruments oriented toward the fibula may be safely introduced into the posterior ankle without injuring the neurovascular structures.
Influence of Approach and Implant on Reduction Accuracy and Stability in Lisfranc Fracture-Dislocation at the Tarsometatarsal Joint
Authors: Schepers Tim , Oprel Pim P. , Van Lieshout Esther M. M. 
Published: January 2013

Background: Besides early diagnosis, an anatomical and stable reduction is paramount for obtaining a favorable outcome. The current study looked at the influence that the type of approach for tarsometatarsal injuries has on the accuracy of the reduction and the effect that the type of fixation has on stability. Methods: Consecutive patients treated surgically for an acute Lisfranc injury were included. All radiographs were reassessed for accuracy and secondary displacement following either a closed or an open approach and in terms of the type of fixation (Kirschner wires alone or a combination of screws and plates and Kirschner wires). A total of 28 patients were included. Six patients were treated with closed reduction and percutaneous fixation and 22 with open reduction internal fixation. Sixteen patients were treated with Kirschner wires only (6 closed, 10 open), 7 with screws with or without Kirschner wires, and 5 with medial plating with or without Kirschner wires. Results: In the closed reduction group, 2 of 6 (33%) reductions were considered acceptable versus 19 of 22 (86%) in the open group ( P = .021). All 6 secondary displacements occurred in the Kirschner wire fixation group (37.5%) versus none in the rigid fixation group ( P = .024). Conclusion: The results demonstrate that open reduction and internal fixation with screws or plate resulted in better reduction and better maintenance of reduction in both low- and high-energy Lisfranc injuries. These results should be further evaluated in light of functional outcome. Level of Evidence: Level III, retrospective comparative case series.
Patterns of serum laboratory monitoring for safety and efficacy in patients on chronic statin therapy
Authors: Lowe Rachel N. , Marrs Joel C. , Saseen Joseph J. 
Published: January 2013

Objective: To describe safety and efficacy laboratory monitoring of statin therapy at the University of Colorado Hospital Outpatient Clinics over a period of 3 years prior to the revised United States Food and Drug Administration statin labeling. Methods: This retrospective, observational study evaluated serum laboratory monitoring for safety and efficacy of statin therapy between July 2008 and June 2011. Adult patients prescribed chronic statin therapy were included. The primary objective of this study was to describe the frequency of outpatient liver function tests, lipid panels, and creatine kinase for patients on chronic statin therapy. Results: A total of 143 patients met study criteria. Over a 3-year period, the mean maximum frequency of measurements per patient of serum hepatic transaminases, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) was higher than lipid panel measurements (5.2 ± 4.4 and 4.2 ± 2.0 respectively, p = 0.021). Only 22 of 143 patients (15.4%) had an elevation in ALT or AST. All elevations were less than three times the upper limit of normal and statin therapy was continued without changes in response to these elevations. Creatine kinase, though not a routine monitoring test, was infrequently measured (mean maximum frequency of measurements per patient 0.3 ± 0.8). Conclusion: Serum hepatic transaminases were routinely monitored in patients treated with chronic statin therapy. Given the absence of significant serum hepatic transaminase elevations, and clinician response to minor elevations, our data indicate that routine serum laboratory evaluations for statin toxicity are excessive.
Essential role of the IRF8-KLF4 transcription factor cascade in murine monocyte differentiation
Authors: Kurotaki Daisuke , Osato Naoki , Nishiyama Akira , Yamamoto Michio , Ban Tatsuma , Sato Hideaki , Nakabayashi Jun , Umehara Marina , Miyake Noriko , Matsumoto Naomichi , Nakazawa Masatoshi , Ozato Keiko , Tamura Tomohiko 
Published: January 2013

Key Points
IRF8 induces the Klf4 gene in myeloid progenitors; this transcription factor cascade is essential for Ly6C+ monocyte development. IRF8 binding to genomic targets promotes H3K4me1, a chromatin signature for promoter-distal enhancers, thereby inducing gene expression.
Pomalidomide plus low-dose dexamethasone is active and well tolerated in bortezomib and lenalidomide–refractory multiple myeloma: Intergroupe Francophone du Myélome 2009-02
Authors: Leleu Xavier , Attal Michel , Arnulf Bertrand , Moreau Philippe , Traulle Catherine , Marit Gerald , Mathiot Claire , Petillon Marie Odile , Macro Margaret , Roussel Murielle , Pegourie Brigitte , Kolb Brigitte , Stoppa Anne Marie , Hennache Bernadette , Bréchignac Sabine , Meuleman Nathalie , Thielemans Beatrice , Garderet Laurent , Royer Bruno , Hulin Cyrille , Benboubker Lotfi , Decaux Olivier , Escoffre-Barbe Martine , Michallet Mauricette , Caillot Denis , Fermand Jean Paul , Avet-Loiseau Hervé , Facon Thierry 
Published: January 2013

Key Points
Combination of pomalidomide with dexamethasone is highly active and can salvage end stage myeloma refractory to lenalidomide and bortezomib. Current data suggest pomalidomide 4 mg/day on days 1 to 21 per 28-days cycle with dexmethasone should be studied in future phase 3 trials.
Regions of XY homology in the pig X chromosome and the boundary of the pseudoautosomal region
Authors: Skinner Benjamin M , Lachani Kim , Sargent Carole A , Affara Nabeel A 
Published: January 2013

Abstract

Background
Sex chromosomes are subject to evolutionary pressures distinct from the remainder of the genome, shaping their structure and sequence content. We are interested in the sex chromosomes of domestic pigs (Sus scrofa), how their structure and gene content compares and contrasts with other mammalian species, and the role of sex-linked genes in fertility. This requires an understanding of the XY-homologous sequence on these chromosomes.
To this end, we performed microarray-based comparative genomic hybridisation (array-CGH) with male and female Duroc genomic DNA on a pig X-chromosome BAC tiling-path microarray. Putative XY-homologous BACs from regions of interest were subsequently FISH mapped.

Results
We show that the porcine PAR is approximately 6.5-6.9 Mb at the beginning of the short arm of the X, with gene content reflective of the artiodactyl common ancestor. Our array-CGH data also shows an XY-homologous region close to the end of the X long arm, spanning three X BACs. These BACs were FISH mapped, and paint the entire long arm of SSCY. Further clones of interest revealed X-autosomal homology or regions containing repetitive content.

Conclusions
This study has identified regions of XY homology in the pig genome, and defined the boundary of the PAR on the X chromosome. This adds to our understanding of the evolution of the sex chromosomes in different mammalian lineages, and will prove valuable for future comparative genomic work in suids and for the construction and annotation of the genome sequence for the sex chromosomes. Our finding that the SSCYq repetitive content has corresponding sequence on the X chromosome gives further insight into structure of SSCY, and suggests further functionally important sequences remain to be discovered on the X and Y.
Pre-Study protocol MagPEP: a multicentre randomized controlled trial of magnesium sulphate in the prevention of post-ERCP pancreatitis
Authors: Fluhr Gabriele , Mayerle Julia , Weber Eckhard , Aghdassi Ali , Simon Peter , Gress Thomas , Seufferlein Thomas , Mössner Joachim , Stallmach Andreas , Rösch Thomas , Müller Martina , Siegmund Britta , Büchner-Steudel Petra , Zuber-Jerger Ina , Kantowski Marcus , Hoffmeister Albrecht , Rosendahl Jonas , Linhart Thomas , Maul Jochen , Czakó László , Hegyi Péter , Kraft Matthias , Engel Georg , Kohlmann Thomas , Glitsch Anne , Pickartz Tilman , Budde Christoph , Nitsche Claudia , Storck Kirsten , Lerch Markus M 
Published: January 2013

Abstract

Background
Acute pancreatitis is the most common complication of diagnostic and therapeutic endoscopic retrograde cholangiopancreatography (ERCP). In spite of continuing research, no pharmacologic agent capable of effectively reducing the incidence of ERCP-induced pancreatitis has found its way into clinical practise. A number of experimental studies suggest that intrapancreatic calcium concentrations play an important role in the initiation of intracellular protease activation, an initiating step in the course of acute pancreatitis. Magnesium can act as a calcium-antagonist and counteracts effects in calcium signalling. It can thereby attenuate the intracellular activation of proteolytic digestive enzymes in the pancreas and reduces the severity of experimental pancreatitis when administered either intravenously or as a food supplement.

Methods
We designed a randomized, double-blind, placebo-controlled phase III study to test whether the administration of intravenous magnesium sulphate before and after ERCP reduces the incidence and the severity of post-ERCP pancreatitis. A total of 502 adult patients with a medical indication for ERCP are to be randomized to receive either 4930 mg magnesium sulphate (= 20 mmol magnesium) or placebo 60 min before and 6 hours after ERCP. The incidence of clinical post-ERCP pancreatitis, hyperlipasemia, pain levels, use of analgetics and length of hospital stay will be evaluated.

Conclusions
If magnesium sulphate is found to be effective in preventing post-ERCP pancreatitis, this inexpensive agent with limited adverse effects could be used as a routine pharmacological prophylaxis.

Trial registration
Current Controlled Trials ISRCTN46556454
Total white blood cell count or neutrophil count predict ischemic stroke events among adult Taiwanese: report from a community-based cohort study
Authors: Wu Tzy-Haw , Chien Kuo-Liong , Lin Hung-Ju , Hsu Hsiu-Ching , Su Ta-Chen , Chen Ming-Fong , Lee Yuan-Teh 
Published: January 2013

Abstract

Background
Evidence about whether white blood cell (WBC) or its subtypes can act as a biomarker to predict the ischemic stroke events in the general population is scanty, particularly in Asian populations. The aim of this study is to establish the predictive ability of total WBC count or subtypes for long-term ischemic stroke events in the cohort population in Taiwan.

Methods
The Chin-Shan Community Cohort Study began from 1990 to 2007 by recruiting 1782 men and 1814 women of Chinese ethnicity. Following a total of 3416 participants free from ischemic stroke events at baseline for a median of 15.9 years; we documented 187 new incident cases.

Results
The multivariate relative risk for the comparison of the participants in the fifth and first WBC count quintiles was 1.67 (95% confidence interval [CI], 1.02–2.73; P for trend=0.03), and the corresponding relative risk for neutrophil count was 1.93 (95% CI, 1.13–3.29; P for trend=0.02). The discriminative ability by WBC and neutrophil counts were similar (area under the receiver operating characteristic curve, 0.600 for adding WBC, 0.610 for adding neutrophils, 0.595 for traditional risk factor model). In addition, the net reclassification improvement (NRI) values between the neutrophil and white blood cell count models were not significant (NRI, =-2.60%, P=0.35), indicating the similar discrimination performance for both WBC and neutrophil counts.

Conclusions
WBC and neutrophil count had a similar ability to predict the long-term ischemic stroke events among Taiwanese.
Sublingual misoprostol versus standard surgical care for treatment of incomplete abortion in five sub-Saharan African countries
Authors: Shochet Tara , Diop Ayisha , Gaye Alioune , Nayama Madi , Sall Aissata Bal , Bukola Fawole , Blandine Thieba , Abiola Okunlola Michael , Dao Blami , Olayinka Ogunbode , Winikoff Beverly 
Published: January 2013

Abstract

Background
In low-resource settings, where abortion is highly restricted and self-induced abortions are common, access to post-abortion care (PAC) services, especially treatment of incomplete terminations, is a priority. Standard post-abortion care has involved surgical intervention but can be hard to access in these areas. Misoprostol provides an alternative to surgical intervention that could increase access to abortion care. We sought to gather additional evidence regarding the efficacy of 400 mcg of sublingual misoprostol vs. standard surgical care for treatment of incomplete abortion in the environments where need for economical non-surgical treatments may be most useful.

Methods
A total of 860 women received either sublingual misoprostol or standard surgical care for treatment of incomplete abortion in a multi-site randomized trial. Women with confirmed incomplete abortion, defined as past or present history of vaginal bleeding during pregnancy and an open cervical os, were eligible to participate. Participants returned for follow-up one week later to confirm clinical status. If abortion was incomplete at that time, women were offered an additional follow-up visit or immediate surgical evacuation.

Results
Both misoprostol and surgical evacuation are highly effective treatments for incomplete abortion (misoprostol: 94.4%, surgical: 100.0%). Misoprostol treatment resulted in a somewhat lower chance of success than standard surgical practice (RR = 0.90; 95% CI: 0.89-0.92). Both tolerability of side effects and women’s satisfaction were similar in the two study arms.

Conclusion
Misoprostol, much easier to provide than surgery in low-resource environments, can be used safely, successfully, and satisfactorily for treatment of incomplete abortion. Focus should shift to program implementation, including task-shifting the provision of post-abortion care to mid- and low- level providers, training and assurance of drug availability.

Trial registration
This study has been registered at clinicaltrials.gov as NCT00466999 and NCT01539408