bluuebunny/crossref_metadata_2025_split huggingface dataset:
Preventive Osteopathic Manipulative Treatment and Stress Fracture Incidence Among Collegiate Cross-Country Athletes
Authors: Brumm Lynn F. , Janiski Carrie , Balawender Jenifer L. , Feinstein Adam 
Published: November 2013

Abstract

Context: Stress fractures are common among athletes, particularly distance runners, with many theories regarding the etiologic process of stress fractures and various studies identifying risk factors or suggesting preventive techniques. To our knowledge, no previous studies have discussed the possible causative effects of somatic dysfunction or the preventive capabilities of osteopathic manipulative treatment (OMT).

Objective: To apply a preventive OMT protocol for cross-country athletes to reduce the incidence of stress fractures.

Design: Cohort study.

Methods: Examinations of cross-country athletes at an NCAA (National Collegiate Athletic Association) Division I university were performed by supervising physician–examiners and first- and second-year osteopathic medical students during several consecutive academic years. Athletes re-enrolled in the study each year they continued to be eligible. The intervention included osteopathic structural examination and OMT that focused on somatic dysfunction identified in the pelvis, sacrum, and lower extremities.

Results: More than 1800 participant examinations were performed on 124 male and female participants by 3 supervising physician–examiners and 141 osteopathic medical students over the course of 5 consecutive academic years (2004-2005 to 2008-2009). Data from these academic years were compared with data from the previous 8 academic years (1996-1997 to 2003-2004). An average of 20 new participants enrolled yearly. The number of annual stress fractures per team ranged from 0 to 6 for male participants and 1 to 6 for female participants. The cumulative annual incidence of stress fractures for male participants demonstrated a statistically significant decrease from 13.9% (20 of 144) before intervention to 1.0% (1 of 105) after intervention, resulting in a 98.7% relative reduction in stress-fracture diagnosis (P=.019). The cumulative annual incidence for female participants showed a minimal decrease from 12.9% (23 of 178) before intervention to 12.0% (17 of 142) after intervention, an 8.5% relative reduction in stress-fracture diagnosis (P=.671). The cumulative annual incidence of all participants decreased from 13.4% (43 of 322) before intervention to 7.3% (18 of 247) after intervention, a 45% relative reduction in stress-fracture diagnosis (P=.156).

Conclusion: There was a statistically significant decrease in the cumulative annual incidence of stress fractures in male, but not female, cross-country athletes after receiving OMT.
Axioms, Osteopathic Culture, and a Perspective From Geriatric Medicine
Authors: Noll Donald R. , Sthole Havilah Julia , Cavalieri Thomas A. 
Published: November 2013

Abstract
Osteopathic medicine is a rapidly growing discipline in health care that has much to offer the wider biomedical community. A distinction of the osteopathic medical profession is the importance of an overall guiding philosophy. Despite the osteopathic medical profession's success, there remains concern about the profession's ability to maintain its unique identity. Among many factors that have contributed to the profession's success, certain axioms from its earliest days are pertinent to the profession's identity. Maintaining a knowledge and appreciation of osteopathic axioms can play an important role in safeguarding the profession's identity. These axioms encapsulate osteopathic philosophy and, moreover, are universally useful for patient care. As osteopathic geriatricians, the authors explore the value and meaning of these axioms for anyone who treats patients, but especially for the care of the elderly. The authors also propose a new axiom, derived from the experience of 2 of the authors: “First try to blame it on the medications.”
Subcutaneous Pellet Testosterone Replacement Therapy: The “First Steps” in Treating Men With Spinal Cord Injuries
Authors: Gray Kendra M. , DeRosa Angela 
Published: November 2013

AbstractThe authors describe the case of a 36-year-old man who presented with hormone level concerns 6 months after a rock climbing accident that resulted in paraplegia. Hypogonadism was diagnosed, and the patient received subcutaneous pellet testosterone replacement therapy. Within 6 months, the patient had substantial improvement in muscle function and was able to take several steps with the assistance of crutches or a walker. This case highlights the potential improvement in quality of life and overall prognosis resulting from the subcutaneous pellet form of testosterone when used as part of the overall treatment plan in such patients. Considering the overwhelming preponderance of hypogonadism in men with spinal cord injuries, the standard of care for such patients should include screening, laboratory hormone evaluation, and prompt treatment for testosterone deficiency.
Predicting Coverage of Transverse Subcostal Sonography With the Use of Previous Computed Tomography Before a Sonographic Liver Examination
Authors: Kang Tae Wook , Rhim Hyunchul , Lee Min Woo , Kim Wooil , Park Jung Gu 
Published: November 2013

ObjectivesThe purpose of this study was to assess the coverage of transverse subcostal sonography in the supine position by using computed tomography (CT) performed before a sonographic liver examination as a predictor of sonographic coverage.MethodsA total of 124 patients (87 men and 37 women; mean age, 55.55 years; range, 24–79 years) who underwent abdominal CT and subsequent liver sonography were enrolled. All patients were assessed for the coverage of transverse subcostal sonography in the supine position by consensus of 2 radiologists. We evaluated the correlation between the level of the posterior rib against the liver dome on axial CT and a sonographic coverage scoring system using Spearman partial correlation analysis. The optimal cutoff value of the liver position and other potential factors associated with sonographic coverage were analyzed.ResultsAmong age, sex, body mass index, interposition of bowel around the gallbladder fossa, atrophic changes from cirrhotic liver, and liver position, liver position was the only independent factor associated with sonographic coverage (P < .001). Liver position and the sonographic coverage score were moderately negatively correlated, with statistical significance (r = −0.44; P < .001). The optimal cutoff value for the level of the hepatic dome was at the 10th posterior rib on axial CT.ConclusionsLiver position is the only independent factor associated with the coverage of transverse subcostal sonography in the supine position. If it is above the 10th posterior rib level, we can predict difficulty in adequate sonographic coverage of the liver.
Assessment of Left Ventricular Diastolic Dysfunction Based on the Intraventricular Velocity Difference by Vector Flow Mapping
Authors: Chen Ming , Jin Jia-mei , Zhang Yuhui , Gao Yi , Liu Sheng-lin 
Published: November 2013

ObjectivesThe diastolic intraventricular velocity difference represents diastolic function of the left ventricle (LV). Here we analyzed the LV diastolic intraventricular velocity difference in patients with impaired LV function based on the ventricular flow rate profile by vector flow mapping.MethodsPatients with LV diastolic dysfunction were divided into 2 groups: chronic heart failure with restricted filling (group 1; n = 27) and hypertension with abnormal relaxation (group 2; n = 34). Healthy participants were identified as controls (group 3; n = 22). Left ventricular inflow color Doppler findings were analyzed by the vector profile model with the vector flow mapping technology offline. The flow velocity rates at the base and apex of the LV were measured from vector profiles with the vector flow mapping technology. The diastolic intraventricular velocity difference was calculated from flow velocity rates.ResultsThe diastolic intraventricular velocity difference calculated from vector flow mapping was significantly lower in both groups with LV diastolic dysfunction than the control group (mean ± SD, 79.95 ± 9.88 cm/s in controls versus 40.35 ± 6.80 cm/s in group 1 and 48.50 ± 6.03 cm/s in group 2; P < .001 for both). The diastolic intraventricular velocity difference had a significant association with the ejection fraction (P = .0002) and deceleration time (P = .0306). The peak atrial contraction velocity was negatively related to the diastolic intraventricular velocity difference (P = .0003).ConclusionsThe diastolic intraventricular velocity difference derived from the LV velocity rate by the vector profile model on vector flow mapping can be potentially used for quantitative assessment of LV diastolic function. Vector flow mapping proved to be clinically practical for reflecting LV diastolic dysfunction in pathologic states.
Distal Pectoralis Major Tears
Authors: Lee Sun Joo , Jacobson Jon A. , Kim Sung-Moon , Fessell David , Jiang Yebin , Girish Gandikota , Magerkurth Olaf 
Published: November 2013

ObjectivesDistinction between musculotendinous tears of the pectoralis major and distal tendon avulsions is important, as the latter typically requires surgical repair. The objective of this study was to characterize the sonographic appearances of surgically proven distal tendon avulsion tears of the pectoralis major.MethodsA retrospective search of the radiology database (2001–2011) revealed 22 cases of pectoralis major tears on sonography, of which 9 had surgical correlation. Sonograms were retrospectively characterized by 3 fellowship‐trained musculoskeletal radiologists in consensus with respect to the location and size of the fluid collection and the presence of tendon or tendonlike tissue superficial to the biceps brachii tendon.ResultsAt surgery, complete distal tendon avulsions or tears of the sternal head of the pectoralis were present in all 9 cases: isolated in 6 and combined with clavicular head tears in 3. The location of the fluid collection was at the musculotendinous junction in 89% (8 of 9) and medial to the biceps brachii tendon in 11% (1 of 9), with a mean largest dimension of 3.8 cm (range, 0.7–6.2 cm). In no case was fluid seen at the humeral attachment of the pectoralis. In 67% (6 of 9), linear thickened hypoechoic tissue was seen superficial to the biceps brachii tendon, which simulated an abnormal but intact tendon, whereas in 33% (3 of 9), a normal distal pectoralis tendon was seen.ConclusionsSurgically proven distal pectoralis major tendon avulsions most commonly showed fluid collections at the musculotendinous junction and not at the humeral shaft, with either a normal tendon or hypoechoic tendonlike tissue over the biceps brachii long‐head tendon. These findings may potentially cause misdiagnosis of distal tendon avulsions or tears as musculotendinous injuries.
Sonographically Guided Costotransverse Joint Injections
Authors: Deimel George W. , Hurdle Mark F. B. , Murthy Naveen , Cartwright J. Adam , Smith Jay , Pingree Matthew J. 
Published: November 2013

ObjectivesThe primary purpose of this study was to describe and validate a novel sonographically guided costotransverse (CTRV) joint injection technique.MethodsThe bilateral T3–T10 CTRV joints of an unembalmed cadaveric specimen were localized using a 12–3‐MHz linear array transducer. A 22‐gauge, 2.5‐in spinal needle was directed into the CTRV joint using an in‐plane, lateral‐to‐medial approach under direct sonographic guidance. After needle placement, 3‐dimensional computed tomographic (CT) images were obtained to assess the locations of the needle tips. This step was followed by injection of an iodinated contrast agent and repeated CT to assess the contrast flow pattern. An experienced musculoskeletal radiologist reviewed the CT images and assessed the accuracy of the injections (intra‐ or extra‐articular). For intra‐articular injections, a quantitative assessment of the percentage of injectate within the joint was performed.ResultsA total of 16 sonographically guided CTRV joint injections were completed on a single torso‐pelvis specimen. Using our technique, 11 of 16 sonographically guided CTRV joint injections (68.8%) placed the contrast agent into the target joint. Quantitative analysis of the arthrograms showed 6 of 11 intra‐articular injections (54.5%) with greater than 50% injectate within the joint capsule.ConclusionsTo our knowledge, this study is the first to determine the feasibility of sonographically guided CTRV joint injections. Overall, 68.8% of injection attempts produced acceptable CTRV joint arthrograms, which compares favorably to a previously reported 76% accuracy rate for fluoroscopically guided CTRV joint injections. Although these injections are technically challenging, the use of sonographic guidance to perform CTRV joint injections is feasible and warrants further investigation to establish its role in the management of patients presenting with thoracic pain syndromes.
Charts for Fetal Age Assessment Based on Fetal Sonographic Biometry in a Population From Cali, Colombia
Authors: Briceño Freddy , Restrepo Humberto , Paredes Ricardo , Cifuentes Rodrigo 
Published: November 2013

ObjectivesTo create reference charts for fetal age assessment based on fetal sonographic biometry in a population of pregnant women living in the third largest city in Colombia and compare them with charts included in ultrasound machines.MethodsThe study data were obtained from women with a single pregnancy and confirmed gestational age between 12 and 40 completed weeks. All women were recruited specifically for the study, and every fetus was measured only once for biparietal diameter, head circumference, abdominal circumference, and femur length. Polynomial regression models for gestational age as a function of each fetal measurement were fitted to estimate the mean and standard deviation. Percentile curves of gestational age were constructed for each fetal measurement using these regression models.ResultsBiparietal diameter, head circumference, abdominal circumference, and femur length were measured in 792 fetuses. Tables and charts of gestational age were derived for each fetal parameter. A cubic polynomial model was the best‐fitted regression model to describe the relationships between gestational age and each fetal measurement. The standard deviation was estimated by simple linear regression as a function of each fetal measurement. Comparison of our gestational age mean z scores with those calculated by reference equations showed statistically significant differences (P < .01).ConclusionsWe present a set of reference charts, tables, and formulas for fetal age assessment based on fetal sonographic biometry. The results support the recommendation that these charts and tables could be more appropriate for assessing fetal age in Colombian populations than those currently included in the software of ultrasound machines.
Sonographic Findings Predictive of Central Lymph Node Metastasis in Patients With Papillary Thyroid Carcinoma
Authors: Yoo Yeon Hwa , Kim Jeong-Ah , Son Eun Ju , Youk Ji Hyun , Kwak Jin Young , Kim Eun-Kyung , Park Cheong Soo 
Published: November 2013

ObjectivesTo analyze sonographic findings suggesting central lymph node metastasis of papillary thyroid carcinoma and to evaluate the influence of associated chronic lymphocytic thyroiditis on the diagnostic performance of sonography for predicting central lymph node metastasis.MethodsA total of 124 patients (101 female and 23 male; mean age, 47.5 years; range, 21–74 years) underwent sonographically guided fine‐needle aspiration in central lymph nodes from January 2008 to July 2011. Sonographic features of size, shape, margin, thickening of the cortex, cortical echogenicity, presence of a hilum, cystic changes, calcification, and vascularity of enlarged lymph nodes were analyzed before fine‐needle aspiration and classified into 2 categories (probably benign and suspicious). Sonographic findings were correlated with the pathologic diagnosis and associated chronic lymphocytic thyroiditis. Receiver operating characteristic curve analysis was performed to assess the diagnostic performance of sonography for predicting central lymph node metastasis according to the associated thyroiditis.ResultsFifty‐one lymph nodes (39.5%) were malignant, and 73 (60.5%) were benign. On univariate analysis, size, shape, margin, cortical thickening, cortical echogenicity, cystic changes, calcification, and vascularity were significantly different between the benign and metastatic nodes (P < .05). On multivariate analysis, eccentric cortical thickening (odds ratio, 26.59; 95% confidence interval [CI], 3.26–216.66) and hyper echogenicity of the cortex (odds ratio, 18.46; 95% CI, 2.44–139.64) were significantly associated with malignant nodes (P < .05). The area under the curve values for sonography for predicting metastasis were 0.756 (95% CI, 0.618–0.894) in chronic lymphocytic thyroiditis–positive patients and 0.971 (95% CI, 0.938–1.000) in negative patients.ConclusionsEccentric cortical thickening and cortical hyperechogenicity were the sonographic findings predictive of central lymph node metastasis from papillary thyroid carcinoma. The diagnostic performance of sonography for predicting metastasis was superior in chronic lymphocytic thyroiditis–negative patients than in positive patients.
Shear Wave Elastography for Differentiation of Benign and Malignant Thyroid Nodules
Authors: Zhang Binglan , Ma Xuelei , Wu Nana , Liu Lei , Liu Xiaoxiao , Zhang Jing , Yang Jinrong , Niu Ting 
Published: November 2013

ObjectivesThe purpose of this study was to assess the performance of shear wave elastography for identification of benign and malignant thyroid nodules using meta‐analysis.MethodsPubMed, MEDLINE, Embase, the Cochrane Library, and the China National Knowledge Infrastructure were searched. Patients' clinical characteristics, sensitivity, specificity, positive predictive value, and negative predictive value were extracted. The diagnostic odds ratio and summary receiver operating characteristic curve were used to examine the accuracy of shear wave elastography. A meta‐analysis was performed to evaluate the clinical utility of shear wave elastography for identification of benign and malignant thyroid nodules.ResultsThe summary sensitivity and specificity for the diagnosis of malignant thyroid nodules by shear wave elastography were 0.84 (95% confidence interval [CI], 0.76–0.90) and 0.90 (95% CI, 0.87–0.92), respectively. The pooled positive likelihood ratio was 7.39 (95% CI, 4.09–13.35), and the negative likelihood ratio was 0.20 (95% CI, 0.13–0.29). The summary diagnostic odds ratio was 41.35 (95% CI, 17.38–98.41), and the summary area under the receiver operating characteristic curve was 0.92 (Q* = 0.8538).ConclusionsShear wave elastography has high sensitivity and specificity in the evaluation of thyroid nodules and can potentially reduce unnecessary fine‐needle aspiration biopsies.
Application of Real‐time Ultrasound Elastography for Differential Diagnosis of Breast Tumors
Authors: Gong Xia , Wang Yi , Xu Ping 
Published: November 2013

ObjectivesThe purpose of this study was to explore the clinical value of real‐time ultrasound elastography in differentiating malignant from benign breast tumors and to determine an optimal cutoff for the traced area ratio by receiver operator characteristic (ROC) analysis for differential diagnosis between malignant and benign breast masses.MethodsFrom October 2010 to June 2011, 102 patients with 192 breast tumors were enrolled. Conventional sonograms and real‐time elastograms were obtained from the patients. The sensitivity, specificity, and accuracy rates for sonography and elastography were calculated, and an ROC analysis was performed.ResultsTumors with an elasticity grade of 4 or higher were defined as malignant. The sensitivity, specificity, and accuracy of elastography were 92.65%, 73.39%, and 81.25%, respectively. These values were similar to those for conventional sonography. However, when the techniques were combined, the sensitivity, specificity, and accuracy increased to 88.23%, 95.97%, and 93.23%. A value of 1.65 was determined to be the traced area ratio cutoff by the ROC analysis and was used in this study for differential diagnosis. The sensitivity, specificity, and accuracy of this value were 76.47%, 96.77%, and 89.58%, respectively.ConclusionsBoth conventional sonography and ultrasound elastography could be used to differentiate malignant and benign breast tumors. If these techniques were combined, the diagnostic values would improve. In addition, a traced area ratio of 1.65 could be used as a cutoff to differentiate benign and malignant breast tumors.
Comparison of Sonography With Sonographically Guided Fine‐Needle Aspiration Biopsy and Core‐Needle Biopsy for Initial Axillary Staging of Breast Cancer
Authors: Ahn Hye Shin , Kim Sun Mi , Jang Mijung , La Yun Bo , Kim Sung-Won , Kang Eunyoung , Park So Yeon , Moon Woo Kyung , Choi Hye Young 
Published: November 2013

ObjectivesThe purpose of this study was to determine the roles of sonography and sonographically guided fine‐needle aspiration biopsy and core‐needle biopsy for initial axillary staging of breast cancer.MethodsOf 220 patients with breast cancer who underwent preoperative or prechemotherapy sonography for axillary staging, 52 patients who underwent sonographically guided fine‐needle aspiration biopsy and core‐needle biopsy for cortical thickening or a compressed hilum of lymph nodes on sonography were prospectively enrolled. Sonography and fine‐needle aspiration biopsy/core‐needle biopsy findings were compared with final pathologic results from sentinel lymph node biopsy or axillary lymph node dissection.ResultsForty‐eight patients met the final study criteria; we excluded 4 who had received primary systemic chemotherapy and showed negative fine‐needle aspiration biopsy/core‐needle biopsy results and negative final postoperative pathologic results. The positive predictive value of axillary sonography was 54%. The sensitivity and specificity of fine‐needle aspiration biopsy were 73% and 100%, respectively, and those of core‐needle biopsy were 77% and 100%. Results did not differ significantly between sonographically guided core‐needle biopsy and fine‐needle aspiration biopsy. The complication rates of fine‐needle aspiration biopsy and core‐needle biopsy were both 4%, and fine‐needle aspiration biopsy and core‐needle biopsy cost $180 and $350, respectively.ConclusionsBoth sonographically guided fine‐needle aspiration biopsy and core‐needle biopsy were useful for axillary staging of breast cancer with high sensitivity. However, fine‐needle aspiration biopsy is recommended based on the advantages of low cost and minimal invasiveness.
Measuring water accumulation rates using GRACE data in areas experiencing glacial isostatic adjustment: The Nelson River basin
Authors: Lambert A. , Huang J. , van der Kamp G. , Henton J. , Mazzotti S. , James T. S. , Courtier N. , Barr A. G. 
Published: November 2013

AbstractGravity Recovery and Climate Experiment (GRACE) satellite‐derived total water storage can be obscured by glacial isostatic adjustment. In order to solve this problem for the Nelson River drainage basin in Canada, a gravity rate map from 110 months (June 2002 to October 2011) of GRACE gravity data was corrected for glacial isostatic adjustment using an independent gravity rate map derived from updated GPS vertical velocities. The GPS‐based map was converted to equivalent gravity rate using a transfer function developed from GPS and absolute‐g data at colocated sites. The corrected GRACE gravity rate map revealed a major positive anomaly within the drainage basin, which was independently shown by hydrological data to be due to changes in water storage. The anomaly represents a cumulative increase at its center of about 340 mm of water, reflecting a progression from extreme drought to extremely wet conditions.