bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hip Joint Pathology as a Leading Cause of Groin Pain in the Sporting Population
Authors: Rankin Alan T. , Bleakley Chris M. , Cullen Michael 
Published: May 2015

Background: Chronic hip and groin pain offers a diagnostic challenge for the sports medicine practitioner. Recent consensus suggests diagnostic categorization based on 5 clinical entities: hip joint–, adductor-, pubic bone stress injury–, iliopsoas-, or abdominal wall–related pathology. However, their prevalence patterns and coexistence in an active population are unclear. Purpose: This study presents a descriptive epidemiology based on a large sample of active individuals with long-standing pain in the hip and groin region. The objectives were to examine the prevalence of key clinical entities, document coexisting pathologies, and present prevalence patterns based on key demographics. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A retrospective review was conducted of clinical records of all hip and groin injuries seen between January 2006 and December 2011 under the care of a single experienced sports medicine consultant. In all cases, imaging was undertaken by a team of specialist musculoskeletal radiologists. Diagnoses were categorized according to 5 clinical entities using contemporary diagnostic nomenclature. The chi-square test was used to compare observed and expected frequencies across each subgroup’s prevalence figures based on sex, age, and sports participation. Results: Full medical records were retrieved from 894 patients with chronic hip and groin pain. The majority of patients were male (73%), aged between 26 and 30 years, and participating in footballing codes (soccer, rugby, and Gaelic sports) or running. A total of 24 combinations of clinical entities were found. There were significant differences ( P < .001) in prevalence patterns based on age, sex, and sports activity. Adductor-related pain or pubic bone stress injury rarely presented in isolation. Hip joint pathology was the most common clinical entity (55.98%) and was significantly more likely to present in isolation. The majority of hip joint pathologies related to femoroacetabular impingement (40%), labral tears (33%), and osteoarthritis (24%). These figures were significantly different across male and female patients ( P < .001), with a higher percentage of cases of femoroacetabular impingement and labral tears in male and female patients, respectively. Conclusion: Chronic hip and groin pain is often associated with multiple clinical entities. Hip joint pathology is the most common clinical entity and is most likely to relate to femoroacetabular impingement, labral tears, and osteoarthritis. These pathologies seem to be associated with secondary breakdown of surrounding structures; however, underpinning mechanisms are unclear.
Sertraline-induced periorbital purpura: a case report
Authors: Kayhan Fatih , Eken Zahide Eriş , Uguz Faruk 
Published: May 2015

Objective: The incidence of mild to severe levels of spontaneous bleeding due to the usage of selective serotonin reuptake inhibitors (SSRIs) is relatively low. Although the exact mechanism is not known, it is thought that inhibition of the serotonin transporter together with a decrease in platelet serotonin could be responsible for the bleeding. Therefore, the use of SSRIs in conjunction with anti-aggregants may predispose to or exacerbate the risk of bleeding. In this case report, we describe a 44-year-old female patient with a diagnosis of anxiety disorder who spontaneously developed periorbital purpura during treatment with sertraline. Conclusion: Abnormal bleeding after treatment with an SSRI should be kept in mind, and alternative non-SSRI drugs of choice in such cases would be more appropriate. More extensive and comprehensive studies focusing on hemostasis and bleeding disorders are needed for SSRIs such as sertraline.
Chronic neurokinin-1 receptor antagonism fails to ameliorate clinical signs, airway hyper-responsiveness or airway eosinophilia in an experimental model of feline asthma
Authors: Grobman Megan , Graham Amber , Outi Hilton , Dodam John R , Reinero Carol R 
Published: May 2015

Objectives Feline allergic asthma is a common chronic lower airway disease characterized by clinical signs attributed to eosinophilic inflammation, airway hyper-responsiveness (AHR) and airway remodeling. Tachykinins released from sensory nerves and immune cells bind neurokinin-1 (NK-1) receptors in the lung. The resultant neurogenic airway inflammation has been implicated in asthma pathogenesis. In mouse models and spontaneous human asthma, NK receptor antagonists reduce bronchospasm and inflammation. We hypothesized that chronic administration of maropitant, an NK-1 receptor antagonist, would decrease clinical signs of asthma, AHR and eosinophilic inflammation in experimentally asthmatic cats. Methods Cats (n = 6) induced to have asthma using Bermuda grass allergen (BGA) were enrolled in a randomized, prospective, placebo-controlled crossover design study. Cats received either oral maropitant (2 mg/kg) or placebo q48h for 4 weeks; following a 2 week washout, cats were crossed-over to the alternate treatment. Study endpoints included subjective clinical scoring systems after BGA challenge, ventilator-acquired pulmonary mechanics to assess AHR after bronchoprovocation with methacholine, and collection of bronchoalveolar lavage fluid to quantify airway eosinophilia. Statistical analysis was performed using a Mann–Whitney rank sum test with P <0.05 considered significant. Results Administration of maropitant for 1 month in experimentally asthmatic cats produced no significant difference in clinical scoring scheme ( P = 0.589 and P = 1.0), AHR ( P = 0.818) or airway eosinophilia ( P = 0.669) compared with placebo. Conclusions and relevance Chronic administration of maropitant was ineffective at blunting clinical signs, AHR and airway eosinophilia in experimental feline asthma and thus cannot be recommended as a novel treatment for this disorder.
Post t-PA transfer to hub improves outcome of moderate to severe ischemic stroke patients
Authors: Yaghi Shadi , Harik Sami I , Hinduja Archana , Bianchi Nicolas , Johnson Debra M , Keyrouz Salah G 
Published: May 2015

Background and Purpose Telemedicine offers rural hospitals the ability to treat acute ischemic stroke on site with intravenous tissue plasminogen activator (t-PA). Most patients are subsequently transferred to a hub hospital with a primary stroke center for post t-PA care. There is little evidence that such transfer is beneficial. The purpose of our study is to determine whether the transfer of patients to hub hospitals is beneficial. Methods We retrospectively analyzed data from our prospectively collected cohort in the AR SAVES (Stroke Assistance through Virtual Emergency Support) telestroke network from November 2008 till January 2012. We compared the outcome of patients who were transferred to a “hub” with those who remained at the “spoke” hospital where thrombolysis took place. We stratified patients according to stroke severity using admission NIHSS scores into two groups: patients with mild stroke (NIHSS <8) and those with moderate to severe stroke (NIHSS ≥8). We defined good outcome as a modified Rankin Scale (mRS) score ≤2. Statistical analysis was performed using Fisher’s exact test, two-tailed, and significance was considered at p < 0.05. Results Out of 894 telestroke consultations, 206 patients received thrombolytic therapy; 134 patients had moderate to severe strokes and 160 patients (78%) were transferred to the hub after thrombolytic therapy. The percentage of patients with good outcome at 3 months was similar between patients transferred to hub and those who stayed at the spoke (61% vs. 55%, p = NS). However, when only patients with moderate to severe strokes were analyzed, patients transferred to the hub were more likely to have good outcomes at three months post t-PA (50% versus 24%, p = 0.026). Conclusions Patients with moderate to severe ischemic strokes who were treated with t-PA in a telestroke network may potentially benefit from expert care at a primary stroke center.
Telephone-based low intensity therapy after crisis presentations to the emergency department is associated with improved outcomes
Authors: Bidargaddi Niranjan , Bastiampillai Tarun , Allison Stephen , Jones Gabrielle M , Furber Gareth , Battersby Malcolm , Richards David 
Published: May 2015

Introduction In Australia there is an overwhelming need to provide effective treatment to patients presenting to the Emergency Department (ED) in mental health crisis. We adapted Improving Access to Psychological Therapies service model (IAPT) from the National Health Service (NHS) method for the large scale delivery of psychological therapies throughout the United Kingdom to an Australian ED setting. This telephone-based low intensity therapy was provided to people presenting in crisis to the EDs with combinations of anxiety, depression, substance use, and suicidal thinking. Methods This uncontrolled study utilised session-by-session, before-and-after measures of anxiety and depression via Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder-7 (GAD-7). Results Of 347 eligible post-crisis ED referred patients, 291 (83.9%) engaged with the IAPT team. Most patients (65%) had attended the ED previously on an average of 3.9 (SD = 6.0) occasions. Two hundred and forty one patients received an average of 4.1 (SD = 2.3) contacts of low-intensity psychological therapies including 1.2 (SD = 1.7) community outreach visits between 20th Oct 2011 and 31st Dec 2012. Treated patients reported clinically significant improvements in anxiety, depression and suicidal ideation. Uncontrolled effect sizes were moderate for anxiety (0.6) and depression (0.6). Discussion The Australian ED IAPT program demonstrated that the UK IAPT program could be adapted for emergency mental health patients and be associated with similar clinical benefits as the original program. Funding The Flinders Medical Centre IAPT program received Emergency Department project funding from the Australian Commonwealth Government through the Council of Australian Governments (COAG) and the South Australian Government initiative, Every Patient Every Service (EPES).
Neurovascular reconstruction with flow diverter stents for the treatment of 87 intracranial aneurysms: Clinical results
Authors: Giacomini Leonardo , Piske Ronie L , Baccin Carlos E , Barroso Marcelo , Joaquim Andrei F , Tedeschi Helder 
Published: May 2015

Background Flow diverter stents represent a new endovascular tool to treat complex aneurysms, such as giant, large, wide-necked and fusiform. The highly dense mash of these stents reduces inflow and outflow inside the aneurysm, resulting in intra aneurysmal thrombosis and stent endothelialization. Objectives To present the results of treatment of intracranial aneurysms with flow diverter stents in a single center. Methods Retrospective review of 77 patients with 87 aneurysms treated using two different types of flow diverter stent, the Pipeline Embolization Device and SILK stent, between October 2010 and September 2013 in an interventional neuroradiology center. Results Flow diverter stent placement was successful in 98% of the lesions and resulted in an immediate major stasis within most of the treated aneurysms. The overall aneurysm occlusion rate at six months and 18 months was 80% and 84% respectively. Symptomatic complications occurred in 11 patients (14.3%) with morbidity in eight (10.4%) and mortality in three patients (3.9%). Conclusion Flow diversion is a promising technique for treatment of challenging intracranial aneurysms with acceptable morbidity. A high rate of complete occlusion for small large necked aneurysms, a low morbidity and mortality rate and no recanalization encourage their use in these aneurysms. Further studies accessing long-term aneurysm occlusion and recanalization are required.
Risk factors for coil protrusion into the parent artery and associated thrombo-embolic events following unruptured cerebral aneurysm embolization
Authors: Ishihara Hideaki , Ishihara Shoichiro , Niimi Jun , Neki Hiroaki , Kakehi Yoshiaki , Uemiya Nahoko , Kohyama Shinya , Yamane Fumitaka 
Published: May 2015

Objective Advances in vascular reconstruction devices and coil technologies have made coil embolization a popular and effective strategy for treatment of relatively wide-neck cerebral aneurysms. However, coil protrusion occurs occasionally, and little is known about the frequency, the risk factors and the risk of thrombo-embolic complications. Method We assessed the frequency and the risk factors for coil protrusion in 330 unruptured aneurysm embolization cases, and examined the occurrence of cerebral infarction by diffusion-weighted magnetic resonance imaging (DW-MRI). Result Forty-four instances of coil protrusion were encountered during coil embolization (13.3% of cases), but incidence was reduced to 33 (10% of cases) by balloon press or insertion of the next coil. Coil protrusion occurred more frequently during the last phase of the procedure, and both a wide neck (large fundus to neck ratio) (OR = 1.84, P = 0.03) and an inadequately stable neck frame (OR = 5.49, P = 0.0007) increased protrusion risk. Coil protrusions did not increase the incidence of high-intensity lesions (infarcts) on DW-MRI (33.3% vs 29% of cases with no coil protrusion). However, longer operation time did increase infarct risk ( P = 0.0003). Thus, tail or loop type coil protrusion did not increase the risk of thrombo-embolic complications, if adequate blood flow was maintained. Conclusion Coil protrusion tended to occur more frequently in cases of wide-neck aneurysms with loose neck framing. Moderate and less coil protrusion carries no additional thrombo-embolic risk, if blood flow is maintained, which can be aided by additional post-operative antiplatelet therapy.
Vitamin D in Foot and Ankle Fracture Healing
Authors: Bernhard Andrew , Matuk Jorge 
Published: May 2015

Vitamin D is a generic name for a group of essential vitamins, or secosteroids, important in calcium homeostasis and bone metabolism. Specifically, efficacy of vitamin D with regard to bone healing is in question. A literature review was performed, finding mostly large studies involving vitamin D effects on prevention of fractures and randomized animal model studies consisting of controlled fractures with vitamin D interventions. The prevention articles generally focus on at-risk populations, including menopausal women and osteoporotic patients, and also most often include calcium in the treatment group. Few studies look at vitamin D specifically. The animal model studies often focus more on vitamin D supplementation; however the results are still largely inconclusive. While recent case reports appear promising, the ambiguity of results on the topic of fracture healing suggests a need for more, higher level research. A novel study design is proposed to help determine the efficacy on vitamin D in fracture healing. Levels of Evidence: Therapeutic, Level IV: Systematic Review
Traumatic bifrontal extradural haematoma resulting from superior sagittal sinus injury: case report
Authors: Bimpis Alexios , Marcus Hani J , Wilson Mark H 
Published: May 2015

Lesson Traumatic bilateral extradural haematoma resulting from injury to the superior sagittal sinus is rare; in such cases, early surgical evacuation of the haematoma and control of bleeding from the sinus can achieve an excellent patient outcome.
What Is the Impact of Online Training in Mind–Body Skills?
Authors: Kemper Kathi J. , Lynn Joanne , Mahan John D. 
Published: May 2015

Background. Mind–body skills (MBS) training is popular, but in-person training can be inconvenient and costly. We assessed the impact of online MBS training on clinicians’ and trainees’ stress, mindfulness, and confidence in providing calm, compassionate care. Methods. This was a prospective cohort trial. Trainees entering medical school; graduate programs in nursing, social work, and dietetics; and residencies in family medicine and pediatrics at a large Midwestern academic health center were invited to complete online surveys before and 12 weeks after enrolling in online elective integrative health courses on MBS training or not. The elective offered no course credit and had no mandated deadlines for completion. Results. At baseline, the 60 who engaged in MBS training were similar to the 43 who did not in terms of profession, gender, perceived stress levels, mindfulness, resilience, and compassion. MBS participants engaged in a median of 3 of 12 available modules with a bimodal distribution peaking at 1 to 2 and 12 modules. Twelve weeks later, those who participated in MBS showed significantly greater improvements in measures of stress, mindfulness, and confidence in providing calm, compassionate care than those who did not. Conclusions. Online elective training offers a feasible strategy to improve mindfulness, stress, and confidence in providing calm, compassionate care. Additional studies are needed to determine the impact of required versus elective courses, the optimal dosage and content of training, and the costs and benefits of online versus in-person training.
Arthroscopic Findings After Traumatic Shoulder Instability in Patients Older Than 35 Years
Authors: Robinson Elisabeth C. , Thangamani Vijay B. , Kuhn Michael A. , Ross Glen 
Published: May 2015

Background: Shoulder instability in the older patient traditionally has received less attention in the literature than in the younger patient population. However, when traumatic dislocation does occur, these patients often still have frequent pain, disability, and even continued instability. Purpose: To characterize the pathoanatomy of traumatic anterior shoulder instability in the older patient population and to discuss the correlating symptoms that ultimately led to operative treatment. Study Design: Case series; Level of evidence, 4. Methods: Patients with a history of an initial traumatic anterior shoulder instability event occurring after the age of 35 years who underwent arthroscopic surgical intervention were prospectively enrolled. Exclusion criteria included posterior instability, major fractures of the shoulder girdle, and multidirectional instability. All patients initially underwent a period of nonoperative rehabilitation. Operative treatment was performed if a patient continued to have pain and/or instability. Operative reports and arthroscopic pictures were reviewed for pathoanatomical findings. Results: A total of 27 patients (28 shoulders) met the inclusion criteria and were analyzed in this study (22 men and 5 women; mean age, 55 years; age range, 35-74 years). Surgical intervention was performed for recurrent instability in 7 patients, pain for 8 patients, and pain with instability for 13 patients. Arthroscopic findings demonstrated 18 rotator cuff tears (RCTs) (64.3%) and 18 Bankart lesions (64.3%). Nine patients had both an RCT combined with a Bankart lesion (32.1%). Three humeral avulsion of the glenohumeral ligament (HAGL) lesions (10.7%) and 2 anterior labral periosteal sleeve avulsion (ALPSA) lesions (7.1%) were found. All shoulders demonstrated Hill-Sachs lesions of various size and depth. Conclusion: Traumatic shoulder instability in the older patient may result in a wide array of pathologic findings as well as a diversity of clinical presentations. These findings suggest that the clinical diagnostician should maintain a high index of suspicion for RCT, Bankart lesions, and HAGL lesions in older patients who remain symptomatic after traumatic anterior shoulder instability.
Absorption mechanisms of Cu2+ on a biogenic bixbyite-like Mn2O3 produced by Bacillus CUA isolated from soil
Authors: Zhang Zhijun , Lai Jing , Yin Hui , Feng Xionghan , Tan Wenfeng , Liu Fan 
Published: May 2015

AbstractBackgroundAlthough most reported biogenic Mn oxides are hexagonal birnessites, other types of biogenic Mn oxides also commonly occur in the environment. However, sorption characteristics and underlying mechanisms of the adsorption of heavy-metal ions on these biogenic Mn oxides are still rarely addressed. In this study, the sorption mechanisms of Cu(II) on a low valence biogenic Mn oxide, poorly crystallized bixbyite-like Mn2O3(α-Mn2O3), were investigated.ResultsThe maximum adsorption capacity of Cu(II) onto this biogenic Mn oxide at pH 6.00 was 796 mmol/kg (0.45 mol Cu mol−1Mn). The complex structure of adsorbed Cu(II) was constrained using Cu extended X-ray absorption fine structure (EXAFS) analysis, combined with structural parameters of the biogenic Mn oxide with alternately arranged regular and distorted MnO6octahedra obtained through multiple-FEFF fitting of Mn EXAFS data. The sorbed Cu(II) was found to coordinate with the biogenic Mn oxide particle edges as inner-sphere complexes. At a relatively low Cu2+loading (233 mmol/kg, pH 6.00), Cu(II) adsorbed onto the biogenic Mn oxide with two types of coordinated complexes, i.e., (1) coordinated with one regular/distorted MnO6octahedron as a monodentate-mononuclear complex and (2) with two adjacent MnO6octahedra as a bidentate-binuclear complex. While, at a relatively high Cu2+loading (787 mmol/kg, pH 6.00), only one type of coordinated complex was constrained, the adsorbed Cu(II) coordinated with one regular/distorted MnO6octahedron as a monodentate-mononuclear complex.ConclusionsThis research extends further insight into the bacterial Mn(II) oxidation in the environment and serves as a good reference for understanding the interactions between metal ions and biogenic low valence Mn oxides, which are still poorly explored either theoretically or practically.
Central venous-to-arterial carbon dioxide difference as a prognostic tool in high-risk surgical patients
Authors: Robin Emmanuel , Futier Emmanuel , Pires Oscar , Fleyfel Maher , Tavernier Benoit , Lebuffe Gilles , Vallet Benoit 
Published: May 2015

AbstractIntroductionThe purpose of this study was to evaluate the clinical relevance of high values of central venous-to-arterial carbon dioxide difference (PCO2gap) in high-risk surgical patients admitted to a postoperative ICU. We hypothesized that PCO2gap could serve as a useful tool to identify patients still requiring hemodynamic optimization at ICU admission.MethodsOne hundred and fifteen patients were included in this prospective single-center observational study during a 1-year period. High-risk surgical inclusion criteria were adapted from Schoemaker and colleagues. Demographic and biological data, PCO2gap, central venous oxygen saturation, lactate level and postoperative complications were recorded for all patients at ICU admission, and 6 hours and 12 hours after admission.ResultsA total of 78 (68%) patients developed postoperative complications, of whom 54 (47%) developed organ failure. From admission to 12 hours after admission, there was a significant difference in mean PCO2gap (8.7 ± 2.8 mmHg versus 5.1 ± 2.6 mmHg;P = 0.001) and median lactate values (1.54 (1.1-3.2) mmol/l versus 1.06 (0.8-1.8) mmol/l;P = 0.003) between patients who developed postoperative complications and those who did not. These differences were maximal at admission to the ICU. At ICU admission, the area under the receiver operating characteristic curve for occurrence of postoperative complications was 0.86 for the PCO2gap compared to Sequential Organ Failure Assessment score (0.82), Simplified Acute Physiology Score II score (0.67), and lactate level (0.67). The threshold value for PCO2gap was 5.8 mmHg. Multivariate analysis showed that only a high PCO2gap and a high Sequential Organ Failure Assessment score were independently associated with the occurrence of postoperative complications. A high PCO2gap (≥6 mmHg) was associated with more organ failure, an increase in duration of mechanical ventilation and length of hospital stay.ConclusionA high PCO2gap at admission in the postoperative ICU was significantly associated with increased postoperative complications in high-risk surgical patients. If the increase in PCO2gap is secondary to tissue hypoperfusion then the PCO2gap might be a useful tool complementary to central venous oxygen saturation as a therapeutic target.