bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of patient safety indicators and hospital-acquired conditions in those treated for unruptured cerebral aneurysms: establishing standard performance measures using the Nationwide Inpatient Sample database
Authors: Fargen Kyle M. , Rahman Maryam , Neal Dan , Hoh Brian L. 
Published: June 2013

Object
The Agency for Healthcare Research and Quality (AHRQ) patient safety indicators (PSIs) and the Centers for Medicare and Medicaid Services hospital-acquired conditions (HACs) are metrics used to gauge the quality of health care provided by health care institutions. The PSIs and HACs are publicly reported metrics and are directly linked to reimbursement for services. To better understand the prevalence of these adverse events in hospitalized patients treated for unruptured cerebral aneurysms, the authors determined the incidence rates of PSIs and HACs among patients with a diagnosis of unruptured aneurysm in the Nationwide Inpatient Sample (NIS) database.

Methods
The NIS, part of the AHRQ's Healthcare Cost and Utilization Project, was queried for all hospitalizations between 2002 and 2010 involving coiling or clipping of unruptured cerebral aneurysms. The incidence rate for each PSI and HAC was determined by searching the hospital records for ICD-9 codes. The SAS statistical software package was used to calculate incidences and perform multivariate analyses to determine the effects of patient variables on the probability of each indicator developing.

Results
There were 54,589 hospitalizations involving unruptured cerebral aneurysms in the NIS database for the years 2002–2010; 8314 patients (15.2%) underwent surgical clipping and 9916 (18.2%) were treated with endovascular coiling. One thousand four hundred ninety-two PSI and HAC events occurred among the 8314 patients treated with clipping; at least 1 PSI or HAC occurred in 14.6% of these patients. There were 1353 PSI and HAC events among the 9916 patients treated with coiling; at least 1 PSI or HAC occurred in 10.9% of these patients. Age, sex, and comorbidities had statistically significant associations with an adverse event. Compared with the patients having no adverse event, those having at least 1 PSI during their hospitalizations had significantly longer hospital stays (p < 0.0001), higher hospital costs (p < 0.0001), and higher mortality rates (p < 0.0001).

Conclusions
These results estimate baseline national rates of PSIs and HACs in patients with unruptured cerebral aneurysms. These data may be used to gauge individual institutional quality of care and patient safety metrics in comparison with national data.
Changes in pain behavior and glial activation in the spinal dorsal horn after pulsed radiofrequency current administration to the dorsal root ganglion in a rat model of lumbar disc herniation
Authors: Cho Hee Kyung , Cho Yun Woo , Kim Eun Hyuk , Sluijter Menno E. , Hwang Se Jin , Ahn Sang Ho 
Published: June 2013

Object
Herniated discs can induce sciatica by mechanical compression and/or chemical irritation caused by proinflammatory cytokines. Using immunohistochemistry methods in the dorsal horn of a rat model of lumbar disc herniation, the authors investigated the effects of pulsed radiofrequency (PRF) current administration to the dorsal root ganglion (DRG) on pain-related behavior and activation of microglia, astrocytes, and mitogen-activated protein kinase.

Methods
A total of 33 Sprague-Dawley rats were randomly assigned to either a sham-operated group (n = 10) or a nucleus pulposus (NP)–exposed group (n = 23). Rats in the NP-exposed group were further subdivided into NP exposed with sham stimulation (NP+sham stimulation, n = 10), NP exposed with PRF (NP+PRF, n = 10), or euthanasia 10 days after NP exposure (n = 3). The DRGs in the NP+PRF rats were exposed to PRF waves (2 Hz) for 120 seconds at 45 V on postoperative Day 10. Rats were tested for mechanical allodynia 10 days after surgery and at 8 hours, 1 day, 3 days, 10 days, 20 days, and 40 days after PRF administration. Immunohistochemical staining of astrocytes (glial fibrillary acidic protein), microglia (OX-42), and phosphorylated extracellular signal–regulated kinases (pERKs) in the spinal dorsal horn was performed at 41 days after PRF administration.

Results
Starting at 8 hours after PRF administration, mechanical withdrawal thresholds dramatically increased; this response persisted for 40 days (p < 0.05). After PRF administration, immunohistochemical expressions of OX-42 and pERK in the spinal dorsal horn were quantitatively reduced (p < 0.05).

Conclusions
Pulsed radiofrequency administration to the DRG reduced mechanical allodynia and downregulated microglia activity and pERK expression in the spinal dorsal horn of a rat model of lumbar disc herniation.
Febrile Response Following Megaprosthesis Replacement for Primary Bone Sarcoma
Authors: Kim Wanlim , Han Ilkyu , Lee Sang A. , Cho Hwan Seong , Kim Han Soo 
Published: June 2013

The presence of early postoperative fever after megaprosthesis replacement surgery is a concern for orthopedic oncologists due to the possibility of infection. The aims of the current study were to determine the incidences and patterns of fever and factors associated with its development and to determine the clinical significance of fever after megaprosthesis replacement surgery.
Seventy-one patients who had undergone megaprosthesis reconstruction for previously unoperated localized lower-extremity osteosarcoma were reviewed. No patient had evidence of infection preoperatively. Mean patient age was 23.72±16.84 years (range, 6.7–74 years), and average follow-up was 59.5 months (range, 4–240 months). Five postoperative surgical wound infections (4 deep, 1 superficial) occurred on postoperative days 5, 13, 14, 20, and 21. Fevers (body temperature of 38°C or higher) were present in 62 patients (87.3%) at some point during the first 2 postoperative weeks. Peak body temperature was observed on postoperative day 1 in 62% of the febrile patients. Of the 62 febrile patients, 94% were relieved of fever by postoperative day 5. No significant association was observed between the presence of fever and surgical wound infection. Body temperature curves in patients with infection showed that several atypical patterns, such as multiple fever peaks and persistent fever, were accompanied by physical findings within the normalization period.
Fever during the first 5 postoperative days is common after megaprosthesis replacement for bone sarcomas and seems to be a normal physiologic response to surgery. However, atypical fever patterns or additional physical findings require investigation.
Complications in Minimally Invasive Percutaneous Fixation of Thoracic and Lumbar Spine Fractures
Authors: Cappuccio Michele , Amendola Luca , Paderni Stefania , Bosco Giuseppe , Scimeca Giovanbattista , Mirabile Loris , Gasbarrini Alessandro , De Lure Federico 
Published: June 2013

Minimally invasive stabilization of thoracic and lumbar fractures without neurologic involvement is becoming a more frequent alternative to open fusion and conservative treatment.
The authors analyzed the complication rate and limits of this technique in a consecutive series of 99 patients (127 thoracolumbar vertebral fractures) who underwent this technique between May 2005 and November 2009. Eighty-three patients had only spine injuries, whereas 16 had polytrauma injuries (mean Injury Severity Score, 25.2). In these 16 patients, percutaneous fixation was performed as a damage control procedure. The most frequent construct was monosegmental: 1 level above and 1 level below the fractured vertebra. In the remaining 21 patients, multilevel construction was performed for multiple injuries. Complications were analyzed according to the period of onset (intra- and postoperative) and the severity (major and minor). Twelve (12%) complications were recorded: 4 (4%) were intraoperative, 6 (6%) were early postoperative, and 2 (2%) were late postoperative; 4 (4%) were minor and 8 (8%) were major. Mean follow-up was 52 months (range; 36–90 months). All patients except 1 were considered healed after 6-month follow-up. The failed patient had an initial kyphosis greater than 20°, and a posterior open reduction and fusion would have been more appropriate.
Minimally invasive stabilization of selected spine injuries is a safe technique with a low complication rate. The main goal of this approach is a fast recovery time, so any complication leading to an extended length of stay should be considered severe. An adequate learning curve is important to minimize complications.
Necrotizing Fasciitis in a Pediatric Orthopedic Population
Authors: Tancevski Aleksandar , Bono Kenneth , Willis Leisel , Klingele Kevin 
Published: June 2013

Few studies have analyzed necrotizing fasciitis in children, and all have relied on cases of necrotizing fasciitis in the abdomen, head, and neck region. The authors sought to correlate the preoperative values of several laboratory tests previously validated in the adult literature, such as the Laboratory Risk Indicator for Necrotizing Fasciitis, with surgically confirmed necrotizing fasciitis in children to provide clinical guidance for the preoperative laboratory workup of necrotizing fasciitis.
A retrospective chart review was performed on consecutive patients younger than 18 years with a diagnosis of necrotizing fasciitis. A total of 13 patients with an average age of 7.9 years (range, 9 months-16 years) were included. Ten (76.9%) infections were found in the lower extremity and 3 (23.1%) in the upper extremity. Seven (53.8%) patients had ecchymosis on examination. All patients presented with an elevated white blood cell count. No amputations were performed, and no mortality occurred. All patients underwent surgery within 24 hours of presentation.
Elevated temperature, white blood count, erythrocyte sedimentation rate, and C-reactive protein values are typically seen in pediatric patients with necrotizing fasciitis; however, no correlation existed between other the preoperative laboratory values with the previously described scoring systems, such as the Laboratory Risk Indicator for Necrotizing Fasciitis. Aggressive monitoring of signs and symptoms is suggested, even if a patient does not meet all conventional diagnostic criteria. The authors recommend prompt surgical debridement and early administration of antibiotics, which should include clindamycin.
Results With 98 Endo-Modell Rotating Hinge Prostheses for Primary Knee Arthroplasty
Authors: Bistolfi Alessandro , Lustig Sebastien , Rosso Federica , Dalmasso Paola , Crova Maurizio , Massazza Giuseppe 
Published: June 2013

Rotating hinge knee prostheses have been developed as an advancement of the fixed hinge models. Some authors suggest that this type of prosthesis is associated with a greater risk of aseptic loosening because of the increased stresses to the bone-prosthesis interface; therefore, they are scarcely used as primary implants. The current authors evaluated of a series of 98 rotating hinge knee arthroplasties Endo-Modell (Waldemar LINK GmbH and Co, Hamburg, Germany) implanted for knee osteoarthritis.
The Hospital for Special Surgery Knee Score and the Knee Society Score were used for the clinical and radiographic evaluation. Log-rank or Wilcoxon tests were used to test the statistical significances, and the Kaplan-Maier method was used to calculate the implant survival probability. After a medium follow-up of approximately 174 months, the clinical scores showed a statistically significant improvement from the pre- to postoperative period. The complication rate was high, and the cumulative implants survival rate was 88.7% at 1 year, 85.9% at 5 years, 79.8% at 10 years, and 75.8% at 15 years. The Endo-Modell rotating hinge implants demonstrated no significant risk of aseptic loosening, and the hinge was not a primary cause of failure. However, the overall failure rate was higher than that of unhinged implants; therefore, this prosthesis is recommended for cases of instability and revision rather than primary knee arthroplasty.
One-year Mortality After Isolated Pelvic Fractures with Posterior Ring Involvement in Elderly Patients
Authors: Bible Jesse E. , Kadakia Rishin J. , Wegner Adam , Richards Justin E. , Mir Hassan R. 
Published: June 2013

Previous 1-year mortality studies of pelvic fractures in elderly patients have focused on pubic rami fractures, in elderly patients with multiple injuries, or both. Baseline information on the 1-year mortality of isolated pelvic fractures in elderly patients is unavailable. The purpose of this study was to evaluate the 1-year mortality of elderly patients (aged 60 years or older) after isolated pelvic fractures with posterior ring involvement (Orthopaedic Trauma Association type 61-B and C).
All patients aged 60 years or older treated for pelvic injuries at a single Level I trauma center over a 12-year period were retrospectively reviewed (N=1223). Exclusion criteria were associated injuries to other body systems (Abbreviated Injury Scale greater than 2), ballistic injuries, long bone fractures, concurrent acetabular fractures, and type 61-A fractures or isolated pubic rami fractures without posterior involvement. Mortality data were obtained from the Social Security Death Index. Seventy patients met the inclusion criteria. Patients treated nonoperatively were significantly older compared with those treated operatively. However, the Charlson Comorbidity Index did not significantly differ between treatment groups. A significantly higher percentage of type-B fractures (83.0%) were treated nonoperatively compared with type-C fractures, which were treated operatively 88.2% of the time. Mortality rates at 3 and 6 months and 1 year postoperatively were 7.1%, 11.4%, and 12.9%, respectively. These results suggest that the 1-year mortality rates of isolated pelvic fractures in elderly patients are lower than those reported previously for hip fractures and pelvic fractures with concurrent injuries. Although age was identified as a significant variable differing between patients treated operatively vs nonoperatively, comorbidities were not.
Anterior Versus Posterior Fixation for the Treatment of Lumbar Pyogenic Vertebral Osteomyelitis
Authors: Si Meng , Yang Zhi-ping , Li Zhen-feng , Yang Qiang , Li Jian-min 
Published: June 2013

This study was designed to observe the clinical outcome of anterior versus posterior instrumentation in the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine.
Twenty-three patients underwent either anterior (anterior fixation group) or posterior fixation (posterior fixation group) combined with a single-stage anterior radical debridement and had an average follow-up of 38 months. Clinical evaluation was performed using the Oswestry Disability Index and visual analog scale. Serial tests of the erythrocyte sedimentation rate and C-reactive protein levels were used to monitor for infection recurrence. Radiography was performed pre- and postoperatively to assess the deformity correction and for bony fusion. Serial erythrocyte sedimentation rate and C-reactive protein levels reflect the active state of infection and can guide postoperative treatment. Patients in the anterior fixation group showed significantly better results on the Oswestry Disability Index than those in the posterior fixation group 2 years postoperatively. The visual analog scale values demonstrated a significant difference between the 2 groups at 1 and 2 years postoperatively, with pain significantly improved in the anterior fixation group. Radiological results showed no significant difference in fusion time, deformity correction, and cage subsidence.
Both anterior and posterior fixation had satisfactory outcomes and were reliable and safe for the treatment of Pyogenic vertebral osteomyelitis of the lumbar spine. Patients with anterior fixation may achieve better postoperative results, such as better well being and less pain.
Successful Treatment of Concomitant Ipsilateral Intracapsular and Extracapsular Hip Fractures
Authors: Taniguchi Daigo , Fujiwara Hiroyoshi , Kobashi Hiroaki , Mori Gen , Yoshida Takashi , Oda Ryo , Kubo Toshikazu 
Published: June 2013

Femoral neck fractures and intertrochanteric fractures often occur in elderly patients, but simultaneous ipsilateral intra- and extracapsular hip fractures are rare. Either osteosynthesis or femoral head prosthesis is performed, but careful rehabilitation is necessary because of the instability of the fracture, even postoperatively.
This article describes a 76-year-old man who fell and sustained concomitant ipsilateral intra- and extracapsular hip fractures. The patient was treated with a femoral head prosthesis with a polished cemented stem combined with locking plate osteosynthesis. Weight-bearing gait was possible 1 day postoperatively, and bone union was achieved at postoperative week 8. The locking plate had excellent angular stability, even when the screw fixation was monocortical, leading to a reduced risk of intraoperative redislocation without disturbing stem insertion.
Sufficient fixation was obtained as a result of the molding effect of the cement stem and the tension band function of the plate. These effects collectively made it possible to achieve full weight-bearing gait immediately postoperatively. Although the intramedullary blood circulation was disturbed by the cement, periosteal blood circulation was retained by the virtue of the locking plate, which facilitated early bone union.
La patrimonialisation des espaces naturels en débat : la réforme du Parc national des Pyrénées (France)
Authors: Clarimont Sylvie 
Published: June 2013

Plus de quarante ans après sa création, le Parc national des Pyrénées demeure toutefois mal accepté par des acteurs locaux qui refusent l’onction patrimoniale des périmètres de protection. La réforme de son statut consécutive à la loi de 2006 provoque un regain de conflictualité. L’article se propose, à partir du dépouillement de la presse quotidienne régionale (journal Sud-Ouest) : d’identifier les acteurs en conflit, d’appréhender leur argumentaire et de mettre en évidence leurs représentations de l’espace naturel. Plus largement, l’analyse de ce type de source permet de saisir l’image du parc national diffusée dans le premier quotidien régional.
L’association Pierrine Gaston-Sacaze et la patrimonialisation de la flore en vallée d’Ossau (Pyrénées Occidentales – France)
Authors: Albert-Llorca Marlène , Garreta Raphaële 
Published: June 2013

L’association Pierrine Gaston-Sacaze fut créée en 1992 à Béost, village de la vallée d’Ossau (Pyrénées Atlantiques) où naquit le personnage dont elle a pris le nom. Son premier objectif était de célébrer le centenaire de sa mort et, plus largement, de retrouver et sauvegarder son œuvre. Pratiquement oublié après son décès, en 1893, Gaston-Sacaze fut présenté de son vivant comme un prodige et salué à ce titre. Alors que c’était un simple berger, il aurait appris seul plusieurs arts et sciences, notamment la botanique, où ses compétences furent reconnues par de grands naturalistes de son époque. Une association portant le nom d’un « pâtre-botaniste » ne pouvait manquer de s’intéresser à la botanique et à la flore. Cette contribution montre que les activités de l’association dans ce domaine rattachent la flore de la vallée à la mémoire de Pierrine Gaston-Sacaze, présenté comme une figure emblématique de l’identité ossaloise. Cette mise en relation permet de suggérer que la vallée a une flore totalement singulière. Non pas du fait des caractéristiques botaniques des plantes, mais parce qu’elles deviennent des « lieux de mémoire » d’un passé que l’on veut perpétuer parce qu’on s’identifie à lui. Cette appropriation symbolique de la flore permet d’en faire une partie intégrante du patrimoine ossalois.
Conservation, valorisation, labellisation : la mise en patrimoine des hauts-lieux pyrénéens et les recompositions de l’action territoriale
Authors: Bénos Rémi , Milian Johan 
Published: June 2013

Cet article propose un cadre d’analyse pour traiter des dynamiques relationnelles entre le patrimoine naturel et l’action publique territorialisée. La grille développée met en avant trois notions clefs, celles de conservation, de valorisation et de labellisation, pour lire et comprendre les formes prises par le processus de patrimonialisation. Au-delà des logiques initiales de conservation et de valorisation au croisement desquelles émerge la mise en patrimoine, nous insistons ici sur le rôle joué par la montée en puissance depuis une quinzaine d’années d’un nouveau référentiel d’action territoriale, la labellisation. Celui-ci a introduit de nouvelles normes et de nouvelles légitimités politiques, mettant en évidence l’importance des logiques de distinction et de reconnaissance qui alimentent les processus de patrimonialisation. Ce cadre est appliqué à l’analyse croisée de deux figures emblématiques des Pyrénées, Gavarnie et Canigou, deux hauts-lieux « naturels » où se sont superposés différents dispositifs de conservation. Leur reconnaissance est certes fondée sur les spécificités de leur naturalité, mais leur valeur patrimoniale tient aussi à leur caractère syncrétique associant à leurs particularités physiques des éléments culturels. L’article expose ainsi comment dans la dynamique de la labellisation, des formes plus contemporaines de patrimonialisation ont pu émerger, renouvelant ainsi la mise en récit et la mise en scène de ces hauts-lieux. L’analyse souligne aussi combien, d’un site à l’autre, l’appropriation et l’interprétation de la labellisation peuvent diverger.
Processus de construction d’une ressource territoriale valorisant le patrimoine naturel et culturel en Loire tourangelle
Authors: Pin Benoit , Rode Sylvain , Servain Sylvie 
Published: June 2013

L’inscription par l’Unesco du Val de Loire au patrimoine mondial au titre des paysages culturels vivants et évolutifs a concrétisé l’émergence de nouvelles représentations du patrimoine ligérien et favorisé des projets de développement locaux mobilisant ce dernier. Bien que reconnu internationalement, le patrimoine ligérien n’est pas approprié dans son ensemble par les populations locales. Différentes visions du patrimoine se côtoient, matérialisant tout autant les sensibilités que l’influence de l’action publique et de la société civile sur les représentations. Le présent travail s’attache à démonter le caractère « construit » de la dimension patrimoniale du paysage et cherche à présenter pourquoi et comment ce patrimoine est mobilisé en tant que ressource pour des projets de développement locaux. L’analyse est conduite à l’échelle principale de deux communes (Bréhémont et Chouzé-sur-Loire) qui se sont engagées dans des processus de valorisation du patrimoine. Elle est complétée par des analyses menées à l’échelle d’un tronçon de la Loire (depuis Tours jusqu’à la confluence entre la Loire et la Vienne) permettant de mettre en perspective les réalités de terrain d’un patrimoine servant de support aux projets de développement locaux.