bluuebunny/crossref_metadata_2025_split huggingface dataset:
Revision interposition arthroplasty of the elbow
Authors: Larson A. N. , Adams R. A. , Morrey B. F. 
Published: August 2010

Between 1996 and 2008, nine patients with severe post-traumatic arthritis underwent revision of a failed interposition arthroplasty of the elbow with a further interposition procedure using an allograft of tendo Achillis at a mean of 5.6 years (0.7 to 13.1) after the initial procedure. There were eight men and one woman with a mean age of 47 years (36 to 56). The mean follow-up was 4.7 years (2 to 8). The mean Mayo Elbow Performance score improved from 49 (15 to 65) pre-operatively to 73 (55 to 95) (p = 0.04). The mean Disability of the Arm, Shoulder and Hand score was 26 (7 to 42). One patient was unavailable for clinical follow-up and one underwent total elbow replacement three months post-operatively. Of the remaining patients, one had an excellent, two had good, three fair and one a poor result. Subjectively, five of the nine patients were satisfied. Four continued manual labour. Revision interposition arthroplasty is an option for young, active patients with severe post-traumatic arthritis who require both mobility and durability of the elbow.
Septic arthritis or transient synovitis of the hip in children
Authors: Sultan J. , Hughes P. J. 
Published: August 2010

The crucial differentiation between septic arthritis and transient synovitis of the hip in children can be difficult. In 1999, Kocher et al introduced four clinical predictors which were highly predictive (99.6%) of septic arthritis. These included fever (temperature ≥ 38.5°C), inability to bear weight, white blood-cell count > 12.0 × 109 cells/L and ESR ≥ 40 mm/hr; CRP ≥ 20 mg/L was later added as a fifth predictor. We retrospectively evaluated these predictors to differentiate septic arthritis from transient synovitis of the hip in children over a four-year period in a primary referral general hospital. When all five were positive, the predicted probability of septic arthritis in this study was only 59.9%, with fever being the best predictor. When applied to low-prevalence diseases, even highly specific tests yield a high number of false positives and the predictive value is thereby diminished. Clinical predictors should be applied with caution when assessing a child with an irritable hip, and a high index of suspicion, and close observation of patients at risk should be maintained.
Predicting dissatisfaction following total knee replacement
Authors: Scott C. E. H. , Howie C. R. , MacDonald D. , Biant L. C. 
Published: August 2010

Up to 20% of patients are not satisfied with the outcome following total knee replacement (TKR). This study investigated the pre- and post-operative predictors of dissatisfaction in a large cohort of patients undergoing TKR. We assessed 1217 consecutive patients between 2006 and 2008 both before operation and six months after, using the Short-form (SF)-12 health questionnaire and the Oxford Knee Score. Detailed information concerning comorbidity was also gathered. Satisfaction was measured at one year when 18.6% (226 of 1217) of patients were unsure or dissatisfied with their replacement and 81.4% (911 of 1217) were satisfied or very satisfied. Multivariate regression analysis was performed to identify independent predictors of dissatisfaction. Significant (p < 0.001) predictors at one year included the pre-operative SF-12 mental component score, depression and pain in other joints, the six-month SF-12 score and poorer improvement in the pain element of the Oxford Knee Score. Patient expectations were highly correlated with satisfaction. Satisfaction following TKR is multifactorial. Managing the expectations and mental health of the patients may reduce dissatisfaction. However, the most significant predictor of dissatisfaction is a painful total knee replacement.
Electrocautery of the patellar rim in primary total knee replacement: beneficial or unnecessary?
Authors: Gupta S. , Augustine A. , Horey L. , Meek R. M. D. , Hullin M. G. , Mohammed A. 
Published: August 2010

The management of the patella during total knee replacement is controversial. In some studies the absence of patellar resurfacing results in residual anterior knee pain in over 10% of patients. One form of treatment which may be used in an endeavour to reduce this is circumferential patellar rim electrocautery. This is believed to partially denervate the patella. However, there is no evidence of the efficacy of this procedure, nor do we know if it results in harm. A retrospective comparative cohort study was performed of 192 patients who had undergone a primary total knee replacement with the porous coated Low Contact Stress rotating platform prosthesis without patellar resurfacing between 2003 and 2007. In 98 patients circumferential electrocautery of the patellar rim was performed and in 94 patients it was not. The two groups were matched for gender and age. The general Oxford Knee Score and the more specific patellar score for anterior knee pain were used to assess patient outcomes a minimum of two years post-operatively. No statistically significant differences were noted between the groups for either scoring system (p = 0.41 and p = 0.87, respectively). Electrocautery of the patella rim did not improve the outcome scores after primary total knee replacement in our patients.
Mid-term results of a custom-made short proximal loading femoral component
Authors: Santori F. S. , Santori N. 
Published: August 2010

Bone preservation and physiological distribution of forces on the proximal femur are key elements in introducing a successful uncemented total hip replacement. In order to achieve this, in the mid 1990s, we developed an ultra short proximal loading custom-made component with a lateral flare, a high femoral neck osteotomy and without a diaphyseal stem. We report the outcome of 129 custom-made hydroxyapatite-coated uncemented short femoral components inserted into 109 patients between June 1995 and May 2004. The mean age of the patients was 51 years (21 to 71) and the mean follow-up was eight years (4.9 to 14.1). Bone behaviour around the implant was studied on the post-operative radiographs. The mean Harris hip score improved from 44 (8 to 66) pre-operatively to 95 (76 to 100) at final follow-up. The Western Ontario MacMaster University Osteoarthritis index was 93 of 100 at final review. None of the patients reported thigh pain. A total of five hips were revised, three for polyethylene liner exchange and two for complete revision of the acetabular component. No femoral components were revised. The radiological changes in the proximal femur were generally good, as evidenced by spot welds both on the medial and lateral aspects of the femur. No component migrated. The presence of a lateral flare and use of a high osteotomy of the femoral neck provided good clinical and radiological results. The absence of a diaphyseal portion of the stem did not impair stability.
A review of the use of common antiplatelet agents in orthopaedic practice
Authors: Dineen P. F. , Curtin R. J. , Harty J. A. 
Published: August 2010

Antiplatelet agents are widely prescribed for the primary and secondary prevention of cardiovascular events. A common clinical problem facing orthopaedic and trauma surgeons is how to manage patients receiving these agents who require surgery, either electively or following trauma. The dilemma is to balance the risk of increased blood loss if the antiplatelet agents are continued peri-operatively against the risk of coronary artery/stent thrombosis and/or other vascular event if the drugs are stopped. The traditional approach of stopping these medications up to two weeks before surgery appears to pose significant danger to patients and may require review.This paper covers the important aspects regarding the two most commonly prescribed antiplatelet agents, aspirin and clopidogrel.
Recognising anaemia and malnutrition in vascular patients with critical limb ischaemia
Authors: Shah M , Martin A , Myers B , MacSweeney S , Richards T 
Published: August 2010

INTRODUCTION Anaemia is a common problem in surgical patients. Patients with critical limb ischaemia (CLI) suffer chronic inflammation, repeated infection, require intervention, and can have a protracted hospital stay. The aims of this study were to assess anaemia and nutritional status in patients presenting with CLI. PATIENTS AND METHODS Two observational studies were undertaken, initially a retrospective series of 27 patients with CLI. Patient demographics, clinical details, transfusion status and in-patient laboratory haemoglobin values (Hb) were recorded. In a prospective series of 32 patients, laboratory markers to identify the cause for anaemia were assessed. Further nutritional status was assessed by records of height, weight, body mass index and a validated scoring system. RESULTS In the retrospective series, 15 patients (56%) were anaemic. Ten (37%) were transfused a median of 2 units (range, 2–13), a total of 35 units. Patients who were transfused had lower Hb on admission (P = 0.0019), most were anaemic on admission (90%). At discharge, most patients were anaemic (n = 23; 83%). In the prospective series of 32 patients, 20 (63%) were anaemic. Nutritional assessment was performed on 18, only seven patients were scored undernourished. This was increased to 23 by an independent assessor. Anaemia was associated with malnutrition (n = 17; P = 0.049) and an increased hospital stay (mean 25 days [SD 16] vs mean 12 days [SD 8], P = 0.0125; total 513 vs 144 bed days). CONCLUSIONS Anaemia and poor nutrition are common and not recognised in vascular patients presenting with critical limb ischaemia. Anaemia is associated with and increased length of hospital stay.
Internal or external wall diameter for abdominal aortic aneurysm screening?
Authors: Thapar A , Cheal D , Hopkins T , Ward S , Shaloub J , Yusuf SW 
Published: August 2010

INTRODUCTION The national abdominal aortic aneurysm (AAA) screening programme measures internal wall diameter; however, UK intervention criteria use external wall diameter. Our aim was to determine the clinical significance of the difference between these two measurements. PATIENTS AND METHODS Fifty patients on an aneurysm surveillance programme were ultrasound scanned by two experienced vascular scientists, blinded to the other's results. Maximum anteroposterior internal wall and maximum anteroposterior external wall diameters were measured. RESULTS The median difference between internal and external diameter was 6 mm (IQR 6–7) for scientist 1 and 7 mm (IQR 5–8) for scientist 2. This was statistically significant (P < 0.0002). External wall diameter displayed less interobserver variability m vs 6 mm). CONCLUSIONS Screening measurements underestimate aneurysm size by 6 mm and display greater variability in comparison external wall measurements. These findings should be understood to prevent a delay in the detection and treatment of AAAs.
Determination of Ester Content in Different Kinds of Biodiesel
Authors: Faria Fátima D. , Cerqueira Klaire O. , Leal Glaucia P. , Pereira Rosana C. L. , Neto Manoel J. R. G. 
Published: August 2010

Abstract
Since the beginning of the Brazilian National Program of Production and Use of Biodiesel, Petrobras Research Center has been working in the evaluation of several raw materials for biodiesel production. Soybean, castor oil, animal fat, palm oil, and other raw materials have been studied. In Brazil, international methodologies have been used to analyze biodiesel samples. The existing international methods are not applicable to biodiesel samples from all sources. Due to the variety of existing raw materials in the country, it was necessary to develop a method for the determination of total ester content of biodiesel from any source, including animal fat, castor oil, palm, coconut, and others. A new Brazilian standard method, ABNT NBR 15764:2009 [1], was developed using gas chromatography and a mixture of esters as an external standard.
Segregation in Vacuum Arc Remelted Zirconium Alloy Ingots
Authors: Jardy A. , Leclerc F. , Revil-Baudard M. , Guerin P. , Combeau H. , Rebeyrolle V. 
Published: August 2010

Abstract
Vacuum arc remelting of zirconium alloy ingots is a key step in the manufacturing process of fuel assembly components in nuclear reactors. The control of the analytical homogeneity is indeed fundamental to ensure the quality and the in-reactor performance of the final products. For this reason, together with other industrial companies, AREVA NP/CEZUS has undertaken for more than 20 years a partnership with the Nancy School of Mines, which has developed a specific code named SOLidification during Arc Remelting (SOLAR). The mathematical model is based on the solution of the coupled transient heat, momentum, and solute transport equations, under laminar or turbulent flow conditions, during the remelting and cooling of a cylindrical ingot. An important part of the overall work is the careful validation of numerical simulations. For this purpose, specific sets of thermophysical data have been determined for various zirconium alloys. The model results show good agreement with the observation of 6 tons ingots remelted under industrial conditions. The specific case of a single melt M5™M5 is a trademark of AREVA NP. ingot was recently studied. The corresponding results are presented and discussed. The chemistry analysis has been enriched with structure examinations, aiming at improving the knowledge of solidification mechanisms in zirconium alloys. The use of SOLAR code to evaluate the ingot chemistry contributes to constantly improving the melting process applied to zirconium alloys in AREVA NP/CEZUS.
High prevalence of genu varum/valgum in European children with low vitamin D status and insufficient dairy products/calcium intakes
Authors: Voloc A , Esterle L , Nguyen T M , Walrant-Debray O , Colofitchi A , Jehan F , Garabedian M 
Published: August 2010

ObjectiveThe prevalence of lower limb deformities physiologically decreases after 5 years of age. It remains high in some tropical and subtropical regions where it has been associated with severe vitamin D deficiency, low calcium/milk intakes, malnutrition, and/or fluoride overexposure. Very little data is available in apparently healthy Caucasian children and adolescents.DesignWe evaluated the prevalence of genu varum/valgum and other clinical symptoms, and assessed vitamin D status and markers of calcium metabolism in 226 apparently healthy European full-time boarders (7–16 years) seen during winter–spring and fed a cereal-based diet with little access to meat, milk, and dairy products. A cohort of 71 white children and adolescents hospitalized for acute illness served as age-matched controls.ResultsAssociation studies showed a high prevalence of lower limb deformities (36%) and higher alkaline phosphate activities in the 21% of children and adolescent full-time boarders with serum 25-(OH)D levels ≤30 nmol/l, and low serum calcium in the 74% of boarders with 25-(OH)D levels ≤50 nmol/l, compared with boarders with higher vitamin D status. No such anomalies were found in the control cohort despite lower serum 25-(OH)D levels.ConclusionsLow 25-(OH)D levels, at least during winter–spring, combined with additional risk factors such as very low calcium/milk intakes and possibly digestive disorders, are associated with an increased risk of genu varum/valgum in European children and adolescents. Thus, dietary fortification, or supplementation with vitamin D, may be recommended, at least during the winter, to European children and adolescents with either none or insufficient calcium/dairy product intakes.
Atenolol Exposure and Risk for Development of Adverse Metabolic Effects: A Pilot Study
Authors: Navare Hrishikesh A. , Frye Reginald F. , Cooper‐DeHoff Rhonda M. , Shuster Jonathan J. , Hall Karen , Schmidt Siegfried O. F. , Turner Stephen T. , Johnson Julie A. 
Published: August 2010

Study Objective. To evaluate whether the level of systemic exposure to atenolol explains observed interindividual differences in adverse metabolic responses.Design. Open‐label, prospective, pharmacokinetic pilot substudy of the Pharmacogenomic Evaluation of Antihypertensive Responses (PEAR) study.Setting. General clinical research center.Patients. Fifteen hypertensive adults (mean age 46 ± 8.9 yrs) who were enrolled in the PEAR study.Intervention. Patients received atenolol therapy for at least 8 weeks, with 5 of those weeks at a dosage of 100 mg/day and then underwent a 2–hour oral glucose tolerance test during a pharmacokinetic study visit.Measurements and Main Results. Twenty‐hour plasma atenolol concentrations were measured during the pharmacokinetic visit. Glucose and insulin levels were measured during the 2–hour oral glucose tolerance test, and fasting plasma lipid, glucose, and insulin levels were measured at baseline and after 8 weeks of atenolol treatment. A significant association was noted between atenolol area under the concentration‐time curve (AUC) and change in fasting glucose level when adjusted for covariates (p=0.0025); the effect was strongest in women. No significant relationship was noted between plasma atenolol concentration and glucose AUC during oral glucose tolerance testing (r=0.08, p=0.78), nor between atenolol AUC and change in triglyceride levels (r=0.13, p=0.63).Conclusion. Higher plasma atenolol exposure may be a risk factor for an increase in fasting plasma glucose level during atenolol treatment. These findings require confirmation in a larger sample.
Drug Adsorption Efficacy and Palatability of a Novel Charcoal Cookie Formulation
Authors: Klein‐Schwartz Wendy , Doyon Suzanne , Dowling Thomas 
Published: August 2010

Study Objectives. To determine the effect of a novel charcoal cookie formulation compared with a standard aqueous charcoal product on the absorption of orally administered cimetidine, and to compare the palatability of the two charcoal products.Design. Prospective, open‐label, three‐way, crossover trial.Setting. General clinical research center.Subjects. Eight healthy volunteers (five men, three women; mean age 23.4 yrs).Intervention. After an overnight fast, each subject ingested a single cimetidine 800‐mg tablet. Fifteen minutes later, subjects were randomly assigned to receive either water (control), three charcoal cookies (equivalent to 7.2 g of charcoal), or 7.2 g of aqueous activated charcoal suspension. Subjects then received each of the other study treatments—cimetidine with water, cimetidine with charcoal cookies, and cimetidine with charcoal suspension—separated by a 1‐week washout period between each treatment.Measurements and Main Results. Venous blood samples were obtained before and 8 hours after administration of the cimetidine dose. Noncompartmental pharmacokinetic analysis was performed, and area under the plasma concentration‐time curve (AUC) and maximum plasma concentration (Cmax) were compared for each study drug combination. In addition, subjects evaluated the palatability of each charcoal product by using a visual analog scale. Both charcoal products effectively adsorbed cimetidine, resulting in decreased absorption of most of the cimetidine dose. No significant difference was noted in the median percent decrease in cimetidine AUC between the charcoal suspension and charcoal cookie (91.8% vs 82.1%, p=0.505). Similarly, no significant difference was noted in the median percent decrease in Cmax between the two charcoal formulations (82.6% vs 64.0%, p=0.574). The palatability scores, however, were significantly higher for the charcoal cookie than for the charcoal suspension. All study drugs were well tolerated, and no adverse events were reported.Conclusion. The new charcoal cookie formulation appears to be as effective as the aqueous charcoal suspension at reducing absorption of cimetidine. In addition, the charcoal cookie was rated as more palatable than the aqueous charcoal suspension, suggesting that the charcoal cookie could be an attractive alternative to the charcoal slurry for managing drug overdoses.
Analysis of Linezolid‐Associated Hematologic Toxicities in a Large Veterans Affairs Medical Center
Authors: Minson Quentin , Gentry Chris A. 
Published: August 2010

Study Objectives. To characterize linezolid‐associated hematologic toxicities in a large clinical practice setting and to examine the variables associated with development of hematologic toxicities; a secondary objective was to characterize other linezolid‐associated toxicities in this population.Design. Retrospective medical record review.Setting. Academic Veterans Affairs medical center.Patients. Four hundred forty‐four patients (mean age 63.7 yrs) who received 544 courses of linezolid from 2004–2007.Measurements and Main Results. Pertinent laboratory data were collected at baseline, periodically throughout each linezolid course, and up to 31 days after discontinuation. The frequencies of grade 1–2 and grade 3–4 thrombocytopenia were 7.6% and 5.2%, respectively. Grade 3–4 anemia developed in 18.8% of courses; each of the patients had baseline grade 1–2 anemia. Linezolid was discontinued because of toxicity in 35 (6.4%) of the 544 courses. Independent variables associated with grade 3–4 thrombo‐cytopenia included a baseline hemoglobin level of less than 10.5 g/dl, presence of immunosuppression, and a baseline platelet count of 50–99.9 × 103/mm3. Independent variables associated with development of grade 3–4 anemia included presence of a cardiovascular condition, urologic condition, immunosuppression, and a baseline platelet count of 50–99.9 × 103/mm3. Other toxicities reported with linezolid included diarrhea (6.6% of courses), followed by nausea (4.4%) and vomiting (4.0%).Conclusion. The overall rates of thrombocytopenia and anemia for patients receiving linezolid were found to be higher than those in phase III clinical trials. This may be attributable in part to the inclusion of patients with comorbidities that were exclusion criteria in the phase III clinical trials. Clinicians should be aware of variables associated with the development of severe thrombocytopenia and anemia in patients receiving linezolid so that they may predict which patients are likely to develop these toxicities and consider potential alternative therapies in those patients.
Phylogenetic Analysis ofYpthima multistriata(Lepidoptera: Satyridae) Showing Nonclinal Geographic Variation in Voltinism
Authors: Noriyuki Suzuki , Matsumoto Takashi , Nishida Takayoshi 
Published: August 2010

AbstractIn most insects, geographic variations in voltinism exhibit latitudinal clines, which have been conventionally regarded as a result of climatic adaptation. In contrast, Ypthima multistriata Bulter (Lepidoptera: Satyridae) shows enigmatic patterns of voltinism, ranging from one generation a year, with adult emergence in June or midsummer; to two generations, with adults emerging in June and September; to several generations with adults emerging intermittently from spring to autumn. Local populations with different voltinism patterns are geographically intermingled, suggesting at best a weak relation between voltinism and climatic factors. Y. multistriata populations are highly localized and the species has suffered recent reductions in density, suggesting that the voltinism differences may be of phylogenetic origin and also leading to the species being classified as endangered. To examine whether the geographic variation in voltinism is phylogenetically constrained, we constructed genealogical trees and a haplotype network of populations of Y. multistriata. The phylogenetic analyses of the mitochondrial cytochrome oxidase I (COI) region revealed that phylogenetically close populations, despite close geographic proximity, often display different voltinism. The haplotype network showed the same trends. Similarly, an analysis of molecular variance revealed that the voltinism types hardly accounted for the variance. Thus, we concluded that geographic variation in voltinism of Y. multistriata is at best only slightly attributable to phylogenetic constraints and instead may be due mainly to adaptation to the unique ecological selective regime of each population.