bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acromioclavicular Joint Injuries in the National Football League
Authors: Lynch T. Sean , Saltzman Matthew D. , Ghodasra Jason H. , Bilimoria Karl Y. , Bowen Mark K. , Nuber Gordon W. 
Published: September 2013

Background: Previous studies investigating acromioclavicular (AC) joint injuries in professional American football players have only been reported on quarterbacks during the 1980s and 1990s. These injuries have not been evaluated across all position players in the National Football League (NFL). Purpose: The purpose of this study was 4-fold: (1) to determine the incidence of AC joint injuries among all NFL position players; (2) to investigate whether player position, competition setting, type of play, and playing surface put an athlete at an increased risk for this type of injury; (3) to determine the incidence of operative and nonoperative management of these injuries; and (4) to compare the time missed for injuries treated nonoperatively to the time missed for injuries requiring surgical intervention. Study Design: Descriptive epidemiological study. Methods: All documented injuries of the AC joint were retrospectively analyzed using the NFL Injury Surveillance System (NFLISS) over a 12-season period from 2000 through 2011. The data were analyzed by the anatomic location, player position, field conditions, type of play, requirement of surgical management, days missed per injury, and injury incidence. Results: Over 12 NFL seasons, there were a total of 2486 shoulder injuries, with 727 (29.2%) of these injuries involving the AC joint. The overall rate of AC joint injuries in these athletes was 26.1 injuries per 10,000 athlete exposures, with the majority of these injuries occurring during game activity on natural grass surfaces (incidence density ratio, 0.79) and most often during passing plays. These injuries occurred most frequently in defensive backs, wide receivers, and special teams players; however, the incidence of these injuries was greatest in quarterbacks (20.9 injuries per 100 players), followed by special teams players (20.7/100) and wide receivers (16.5/100). Overall, these athletes lost a mean of 9.8 days per injury, with quarterbacks losing the most time to injury (mean, 17.3 days). The majority of these injuries were low-grade AC joint sprains that were treated with nonoperative measures; only 13 (1.7%) required surgical management. Players who underwent surgical management lost a mean of 56.2 days. Conclusion: Shoulder injuries, particularly those of the AC joint, occur frequently in the NFL. These injuries can result in time lost but rarely require operative management. Quarterbacks had the highest incidence of injury; however, this incidence is lower than in previous investigations that evaluated these injuries during the 1980s and 1990s.
New Protocol for Detection of Intron 22 Inversion Mutation From Cases With Hemophilia A
Authors: Kumar Praveen , Husain Nuzhat , Soni Priyanka , Faridi Nuzhat Jahan , Goel Sudhir Kumar 
Published: September 2013

Background: Hemophilia A is a X-linked recessive bleeding disorder characterized by qualitative and quantitative deficiency of factor VIII resulting from heterogeneous mutations in the factor VIII gene located in the Xq28 region. Intron 22 inversion (Inv22) mutation is one of the major causes of the protein alteration in factor VIII; its frequency is 40% to 50% in severe patients. Long polymerase chain reaction (PCR) and inverse PCR (I-PCR) have been used for the detection of Inv22 mutation. Objective: Development of new protocol for detection of Inv22 mutation. Method: We have designed a new method for the detection of Inv22 mutation in complementary DNA (cDNA) of patients. Real-time PCR targeting exons 21 to 22, 22 to 23, and 23 to 24 of factor VIII gene were used in cases with hemophilia A. Samples that were inversion positive by this new method were cross-checked by the conventional I-PCR method. We observed that region between exons 22 and 23 could not be amplified, while in negative cases and controls a 480 bp product is obtained. Result: The method was validated in 20 cases with severe hemophilia A by the new cDNA method, and 8 cases were inversion positive, whereas 12 were negative cases. The findings were confirmed by standard I-PCR method. Complete correlation was observed. Conclusion: Conventional long PCR and I-PCR methods are work intensive, prolonged, and sometimes difficult to be standardize. The cDNA method is short, involves 3 short-segment amplifications, and is easy to reproduce.
Reducing the risk of harm from intravenous potassium: A multi-factorial approach in the haematology setting
Authors: Barras Michael , Moore Diana , Pocock Daniel , Sweedman Myles , Wilkinson Cathy , Taylor Kerry , Morton James 
Published: September 2013

Aims To describe the implementation of safety systems for the use of intravenous potassium chloride in haematology patients. Methods We assessed the use of intravenous potassium in a haematology ward at a tertiary hospital. Initially, we prospectively analysed the prescribing and administration of intravenous potassium to all patients over a two-week period. To complement this data, we retrospectively analysed all clinical incidents involving intravenous potassium and the dispensing patterns of potassium ampoules for the past 12 months. Drawing on evidence and recommendations from international safety literature, gaps in the safe use of potassium were identified, and a multi-factorial approach to system change was implemented. Results A total of 18 patients were analysed with 90 intravenous bags of potassium prepared on the ward using 624 ampoules. We identified multiple opportunities for error and a lack of standardisation of therapy. The following safety systems were introduced: (i) a new prescribing and monitoring form that included dose calculation, prescriber support and pre-printed orders; (ii) removal of potassium ampoules and introduction of premixed bags; (iii) independent double checking by nursing staff at point of administration; (iv) dedicated labelling of intravenous lines; (v) extensive clinician training supported by guidelines; and (vi) introduction of ‘smart pump’ infusion software. The number of incidents significantly reduced from 23 to 9 (p < 0.001), and the number of ampoules dispensed reduced from 10,100 to 0. Conclusions A multi-factorial approach to the safe prescribing, dispensing and administration of intravenous potassium has reduced the potential for patient harm in the haematology setting.
Inflammation, Functional Status, and Weight Loss During Recovery From Cardiac Surgery in Older Adults
Authors: DiMaria-Ghalili Rose Ann , Sullivan-Marx Eileen M. , Compher Charlene 
Published: September 2013

Objective: To determine the nutritional, inflammatory, and functional aspects of unintentional weight loss after cardiac surgery that warrant further investigation. Research Methods and Procedures: Twenty community-dwelling adults > 65 years old undergoing cardiac surgery (coronary artery bypass graft [CABG] or CABG + valve) were recruited for this prospective longitudinal (preoperative and 4–6 weeks postdischarge) pilot study. Anthropometrics (weight, standing height, and mid-arm and calf circumference), nutritional status (Mini-Nutritional Assessment™ [MNA]), appetite, physical performance (timed chair stand), muscle strength (hand grip) and functional status (basic and instrumental activities of daily living), and inflammatory markers (plasma leptin, ghrelin, interleukin [IL]-6, high-sensitivity[hs] C-reactive protein, and serum albumin and prealbumin) were measured. Results: Participants who completed the study ( n = 11 males, n = 3 females) had a mean age 70.21 ± 4.02 years. Of these, 12 lost 3.66 ± 1.44 kg over the study period. Weight, BMI, activities of daily living, and leptin decreased over time ( p < .05). IL-6 increased over time ( p < .05). Ghrelin, hs-CRP, and timed chair stand increased over time in those who underwent combined procedures ( p < .05). Grip strength decreased in those who developed complications ( p = .004). Complications, readmission status, and lowered grip strength were found in those with low preoperative MNA scores ( p < .05). Conclusion: After cardiac surgery, postdischarge weight loss occurs during a continued inflammatory response accompanied by decreased physical functioning and may not be a positive outcome. The impacts of weight loss, functional impairment, and inflammation during recovery on disability and frailty warrant further study.
Circulating dendritic cells of multiple sclerosis patients are proinflammatory and their frequency is correlated with MS-associated genetic risk factors
Authors: Thewissen Kristof , Nuyts Amber H , Deckx Nathalie , Wijmeersch Bart Van , Nagels Guy , D’hooghe Marie , Willekens Barbara , Cras Patrick , Eijnde Bert O , Goossens Herman , Van Tendeloo Viggo FI , Stinissen Piet , Berneman Zwi N , Hellings Niels , Cools Nathalie 
Published: September 2013

Background: The role of the adaptive immune system and more specifically T cells in the pathogenesis of multiple sclerosis (MS) has been studied extensively. Emerging evidence suggests that dendritic cells (DCs), which are innate immune cells, also contribute to MS. Objectives: This study aimed to characterize circulating DC populations in MS and to investigate the contribution of MS-associated genetic risk factors to DCs. Methods: Ex vivo analysis of conventional (cDCs) and plasmacytoid DCs (pDCs) was carried out on peripheral blood of MS patients ( n = 110) and age- and gender-matched healthy controls ( n = 112). Results: Circulating pDCs were significantly decreased in patients with chronic progressive MS compared to relapsing–remitting MS and healthy controls. While no differences in cDCs frequency were found between the different study groups, HLA-DRB1*1501+ MS patients and patients not carrying the protective IL-7Rα haplotype 2 have reduced frequencies of circulating cDCs and pDCs, respectively. MS-derived DCs showed enhanced IL-12p70 production upon TLR ligation and had an increased expression of the migratory molecules CCR5 and CCR7 as well as an enhanced in vitro chemotaxis. Conclusion: DCs in MS are in a pro-inflammatory state, have a migratory phenotype and are affected by genetic risk factors, thereby contributing to pathogenic responses.
Wide excision in right-sided colon cancer is associated with decreased survival
Authors: Olofsson F. , Buchwald P. , Elmståhl S. , Syk I. 
Published: September 2013

Background and Aims: Nodal involvement is the most important prognostic factor in colon cancer. Although theoretically appealing, it is not known if wider mesenteric excision improves the oncological result. The aim of this retrospective study was to investigate whether wider mesenteric excision yields a superior oncological result. Material and Methods: Depending on the resection length, 333 cases of locally radical right-sided hemicolectomies due to adenocarcinoma were compared for perioperative morbidity and mortality, disease-free survival, and long-term survival. Results: Postoperative mortality was significantly higher in the quartile with the longest resections, p = 0.003. In a multivariate analysis adjusted for age, stage, emergency operation, adjuvant chemotherapy, and year of operation, a negative relationship between resection length and 5-year overall survival was noted, p = 0.01. No differences in the causes of death or in the incidence of local or distant recurrences were noted between groups. Conclusions: Wider excision in right-sided hemicolectomies was not associated with any oncological benefit but an increased postoperative mortality and a decreased 5-year overall survival. These findings may suggest consideration to perform wide mesenteric resections routinely. Further research is warranted to define which patients benefit from wider resections.
Closure of skin incision after thyroidectomy through a supraclavicular approach: a comparison between tissue adhesive and staples
Authors: Yang Y.-L. , Xiang Y.-Y. , Jin L.-P. , Pan Y.-F. , Zhou S.-M. , Zhang X.-H. , Qu J.-M. 
Published: September 2013

Background: The objective of this study was to compare the effectiveness and cosmetic results of tissue adhesive or surgical staples in thyroidectomy through a supraclavicular incision. Methods: This was a prospective, randomized study of consecutive patients undergoing thyroidectomy by a supraclavicular approach. Eligible patients were randomized into two groups: one group had the incision closed with tissue adhesive (the experimental group) and the other with surgical staples (the control group). The main outcomes included operative time, early postoperative pain measured by Visual Analog Scale, incidence of wound dehiscence and infection, perceived cosmetic outcome, and overall patient satisfaction by using Patient Satisfaction Assessment Form. Results: There were 151 consecutive patients assessed for eligibility, and 132 patients were enrolled over 22 months. The clinical characteristics of the patients in the two groups were similar. Main outcomes were assessed in the first 24 h postoperatively, the first month, and the third month postoperatively. Operation time was longer in the experimental group ( P = 0.027). Mean Visual Analog Scale scores for pain were lower in the experimental group in the early postoperative period ( P < 0.001). No patients developed surgical site infections or wound dehiscence. Lower scores for scar assessment and higher overall satisfaction levels at the first month after surgery were found in the experimental group compared to the control group ( P < 0.001). There was no significant difference between the two groups at the third month postoperatively in perceived cosmetic result ( P = 0.052) or overall satisfaction ( P = 0.059). Conclusions: Tissue adhesive is effective and reliable in skin closure for thyroid surgery. While this closure may take somewhat longer to perform, it leads to less postoperative pain, more acceptable wound cosmesis, and higher patient satisfaction levels in short postoperative follow-up.
An 8-year follow-up study of 221 consecutive hip fracture patients in Finland: analysis of reoperations and their direct medical costs
Authors: Lüthje P. , Helkamaa T. , Nurmi-Lüthje I. , Kaukonen J.-P. , Kataja M. 
Published: September 2013

Background: Some hip fracture patients need one or more reoperations because of complications following initial operative treatment. Aims: The aim of this study was to identify all further surgical interventions in a cohort of patients with hip fractures over a period of 8 years after index fracture. Immediate direct costs of these reoperations were also calculated. Material and Methods: This retrospective study investigated 221 consecutive patients with hip fractures operated on at two different hospitals in southeastern Finland. The study period in hospital A was from 1 February 2003 to 31 January 2004, and in hospital B from 1 February 2003 to 30 April 2004. About 50% were femoral neck fractures, 41% trochanteric fractures, and 9% subtrochanteric fractures. Patients’ medical records were checked from the hospital records and confirmed manually. Short- and long-term complications were recorded. Survival analysis was performed using a life-table method. The actual costs for reoperations and other further procedures for each patient were calculated using diagnosis-related groups–based costs for both hospitals in 2012. Results: A total of 20 patients (9%) needed reoperations. Overall, 10 patients (8.9%) with a femoral neck fracture (n = 112), 8 patients (8.7%) with trochanteric fracture (n = 92), and 2 patients (10.5%) with subtrochanteric fracture (n = 19) were reoperated on. The median interval between the primary operation of the acute hip fracture (n = 20) and the first reoperation was about 300 days (range: 2 weeks to 82 months). Among the women reoperated on, the excess mortality was lower than among those undergoing a single operation. The median costs of treatment per patient with one or more reoperations were €13,422 in hospital A (range: €1616–€61,755), €11,076 in hospital B (range: €1540–€17,866), and €12,850 in the total study group (p = 0.43). In the case of infections (3 patients), the mean costs per patient were €28,751 (range: €11,076–€61,755). Conclusions: Almost 10% of hip fracture patients required reoperations, and these reoperations caused significant direct costs to health care. However, direct costs account for only approximately 25% of the first year’s total costs. These costs should be taken into account when evaluating the economics of hip fractures and the burden of health care.
Toward technology-supported surgical training: the potential of virtual simulators in laparoscopic surgery
Authors: Beyer-Berjot L. , Aggarwal R. 
Published: September 2013

Background and Aims: The mastery of manual skills that are indispensable for the performance of surgical tasks is a competence specific to surgery. One way of facilitating this acquisition is to move the training out of the operating room and all of its restrictions. Surgical training out of the operating room, also called simulation, has spread widely in the past decade, especially in laparoscopic and endoscopic surgery. Material and Methods: This review assesses the role of virtual reality (VR) simulators in laparoscopic surgery and their actual impact on technical skills. Results and Conclusions: There is a wealth of simulators, ranging from low- to high-fidelity simulators incorporating haptic feedback. They comprise basic tasks, procedural modules, and full procedures. Virtual reality simulators have shown acceptable fidelity and validity evidence. Moreover, training out of the operating room on virtual reality simulators has demonstrated its positive impact on basic skills during real laparoscopic procedures in patients. The benefit of virtual reality over simple video trainers remains unclear for teaching basic skills. However, virtual reality simulators provide automatic feedback that permitted to design structured competency-based curricula and allow deliberate practice. Finally, advanced procedures and patient-specific models have been designed on virtual reality simulators, and further investigations are still awaited to appraise their educational value.
The use of pre- or postoperative antibiotics in surgery for appendicitis: A systematic review
Authors: Daskalakis K. , Juhlin C. , Påhlman L. 
Published: September 2013

Background and Aim: The aim of this study was to review the literature regarding the use of pre- and/or postoperative antibiotics in the management of appendicitis, using data obtained from PubMed and the Cochrane Library. Material and Methods: A literature search was conducted using the terms “appendicitis” combined with “antibiotics.” Studies were selected based on relevance for the evidence on prophylactic and postoperative treatment with regard to the route and duration of drug administration and the findings of surgery. Results: Patients with acute appendicitis should receive preoperative, broad-spectrum antibiotics. The use of postoperative antibiotics is only recommended in cases of perforation, and treatment should then be given intravenously, for a minimum period of 3–5 days for adult patients, until clinical signs such as fever resolve and laboratory parameters such as C-reactive protein curve and white blood cell (WBC) start to decline. Conclusion: Preoperative antibiotic prophylaxis is recommended in all patients with acute appendicitis, whereas postoperative antibiotics only in cases of perforation.
Down-regulation of NF-κB signaling by Gordonia bronchialis prevents the activation of gut epithelial cells
Authors: Smaldini Paola L , Stanford John , Romanin David E , Fossati Carlos A , Docena Guillermo H 
Published: September 2013

The immunomodulatory power of heat-killed Gordonia bronchialis was studied on gut epithelial cells activated with pro-inflammatory stimuli (flagellin, TNF-α or IL-1β). Light emission of luciferase-transfected epithelial cells and mRNA expression of IL-1β, TNF-α, IL-6, CCL20, IL-8 and MCP-1 were measured. NF-κB activation was assessed by immunofluorescence and immunoblotting, and induction of reactive oxygen species (ROS) was evaluated. In vivo inhibitory properties of G. bronchialis were studied with ligated intestinal loop assay and in a mouse model of food allergy. G. bronchialis promoted the down-regulation of the expression of CCL20 and IL-1β on activated epithelial cells in a dose-dependent manner. A concomitant blocking of nuclear p65 translocation with increased production of ROS was found. In vivo experiments confirmed the inhibition of CCL20 expression and the suppression of IgE sensitization and hypersensitivity symptoms in the food allergy mouse model. In conclusion, heat-killed G. bronchialis inhibited the activation of NF-κB pathway in human epithelial cells, and suppressed the expression of CCL20. These results indicate that G. bronchialis may be used to modulate the initial steps of innate immune activation, which further suppress the allergic sensitization. This approach may be exploited as a therapy for intestinal inflammation.