bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress Ulcer Prophylaxis: Reducing Non-Indicated Prescribing After Hospital Discharge
Authors: Hatch Jacob B , Schulz Lucas , Fish Jeffrey T 
Published: September 2010

Background: Gastric acid suppressant medications used as stress ulcer prophylaxis (SUP) in the intensive care unit (ICU) are often prescribed inappropriately after discharge. We present tools to reduce the use and cost of non-indicated SUP. Objective: To reduce the non-indicated use of SUP after hospital discharge originally started in the ICU, using an education intervention and pharmacist-led medication reconciliation on patient care rounds and at hospital discharge. Methods: In a retrospective medical record review using a historic control, 356 consecutively admitted patients to the medical/surgical ICU at the University of Wisconsin Hospital were assessed for the appropriate use of SUP at admission to the ICU, at transfer to a general care unit, and at hospital discharge. The education intervention involved teaching both the medical and pharmacist staff about indications for SUP using a memorandum and a pocket guide. Pharmacists also conducted medication reconciliation during daily patient care rounds and at discharge to justify medication use. The outcome of this study is the percentage of patients prescribed non-indicated gastric acid suppressants at hospital discharge. This outcome is compared to a previous study conducted at our hospital. Results: Of 356 eligible patients, 308 (86.5%) received SUP while in the ICU. Thirty-nine (11%) were given continuing SUP after discharge from the hospital, of which 31 (8.7%) had no clear indication. This was a 64.3% reduction from the 24.4% found in the prior study (p < 0.0001). Conclusions: Educational materials that guide prescribing, pharmacist interaction on patient care rounds, and pharmacist-conducted medication reconciliation significantly reduced the prescribing of non-indicated gastric acid suppressant medications after hospital discharge.
Continuous Terlipressin Infusion as Rescue Treatment in a Case Series of Children with Refractory Septic Shock
Authors: Rodríguez-Núñez Antonio , Oulego-Erroz Ignacio , Gil-Antón Javier , Pérez-Caballero César , López-Herce Jesús , Gaboli Mireia , Milano Guillermo 
Published: September 2010

Background: Despite intensive therapy, refractory pediatric septic shock has a high rate of morbidity and mortality. Additional treatments are needed to improve outcomes in such cases. Objective: To report the clinical effects of continuous terlipressin infusion as rescue treatment for children with septic shock refractory to high catecholamine doses. Methods: Sixteen episodes of catecholamine-resistant septic shock were recorded in 15 children (aged from newborn to 15 years) who received compassionate rescue treatment with terlipressin at 6 pediatric intensive care units. Terlipressin treatment consisted of a loading dose (20 μg/kg) followed by continuous infusion at a rate of 4–20 μg/kg/h. Terlipressin was titrated at increases of 1 μg/kg/h to maintain mean arterial pressure (MAP) in normal range for age and to reduce catecholamine dosage. The main outcome was survival of the episode. Secondary outcomes included hemodynamic effects, ischemia, and terlipressin-related adverse events. Results: Terlipressin increased median MAP from 48 (range 42–63) to 68 (45–115) mm Hg 30 minutes after terlipressin administration (p < 0.01). MAP was subsequently sustained, which allowed for the reduction of norepinephrine infusion from 2 μg/kg/min (1–4) at baseline to 1.5 μg/kg/min (0.4–4) at 1 hour, 1.3 μg/kg/min (0–8) at 4 hours, 1 μg/kg/min (0–2) at 12 hours, 0.45 μg/kg/min (0–1.4) at 24 hours, and 0 μg/kg/min (0–0.6) at 48 hours (p < 0.05 vs baseline in all cases). In 8 (50%) of the 16 septic shock episodes the patients survived, 7 (44%) without sequelae. One patient survived with sequelae (minor amputation and mild cutaneous ischemia). Eight patients had signs of ischemia at admission; terlipressin induced reversible ischemia in another 4 patients. Meningococcal infection, prior ischemia, and MAP were risk factors for mortality. Conclusions: Continuous terlipressin infusion may improve hemodynamics and survival in some children with refractory septic shock. Terlipressin could contribute to tissue ischemia.
Oncology: Fixed-Dose Rasburicase 6 mg for Hyperuricemia and Tumor Lysis Syndrome in High-Risk Cancer Patients
Authors: Vines Ashleigh N , Shanholtz Carl B , Thompson Jennifer L 
Published: September 2010

Background: Rasburicase is indicated for the initial management of plasma uric acid levels in adults receiving anticancer therapy who are at risk for acute tumor lysis syndrome (TLS) and subsequent hyperuricemia. The labeled dose is 0.2 mg/kg/day administered intravenously over 30 minutes for up to 5 days. Our institutional adult guidelines recommend rasburicase 6 mg for uric acid levels >8 mg/dL in most adults with TLS, or 4–8 mg/dL in high-risk patients. Repeat closing is indicated for uric acid levels >4 mg/dL determined ≥12 hours following the initial dose. Objective: To determine the efficacy of a single dose of rasburicase 6 mg per institutional adult TLS guidelines to decrease uric acid levels to <4 mg/dL by day 3, as well as to determine the effect on serum creatinine and phosphorus concentrations. The secondary objectives were to evaluate the appropriateness of our institutional guidelines and identify TLS risk factors. Methods: The study was approved by the University of Maryland Medical Center Institutional Review Board. A retrospective review of all adults between July 2008 and February 2009 who received at least one 6-mg dose of rasburicase, with redosing, if indicated, before day 3, was conducted. Subsequent TLS monitoring over 7 days after initial dosing was recorded. Patients were excluded if dosing did not adhere to institutional guidelines. Results: We observed a decline in median uric acid levels from 9.2 mg/dL (interquartile range 8.1–10.4) on day 1 to between 1.8 (1.0–3.8) on day 3 and 3.8 mg/dL (2.1–4.4) on day 7 (p < 0.0001) with 2 patients requiring repeat dosing before day 3 (n = 34). The majority of the population was hyperuricemic (>8 mg/dL; 76%) or at high risk for TLS (85%). Conclusions: A 6-mg dose of rasburicase effectively decreased uric acid to <4 mg/dL by day 3, rarely requiring repeat dosing, in a high-risk population.
Telomerase Recruitment in Saccharomyces cerevisiae Is Not Dependent on Tel1-Mediated Phosphorylation of Cdc13
Authors: Gao Hua , Toro Tasha B , Paschini Margherita , Braunstein-Ballew Bari , Cervantes Rachel B , Lundblad Victoria 
Published: September 2010

Abstract
In Saccharomyces cerevisiae, association between the Est1 telomerase subunit and the telomere-binding protein Cdc13 is essential for telomerase to be recruited to its site of action. A current model proposes that Tel1 binding to telomeres marks them for elongation, as the result of phosphorylation of a proposed S/TQ cluster in the telomerase recruitment domain of Cdc13. However, three observations presented here argue against one key aspect of this model. First, the pattern of Cdc13 phosphatase-sensitive isoforms is not altered by loss of Tel1 function or by mutations introduced into two conserved serines (S249 and S255) in the Cdc13 recruitment domain. Second, an interaction between Cdc13 and Est1, as monitored by a two-hybrid assay, is dependent on S255 but Tel1-independent. Finally, a derivative of Cdc13, cdc13–(S/TQ)11→(S/TA)11, in which every potential consensus phosphorylation site for Tel1 has been eliminated, confers nearly wild-type telomere length. These results are inconsistent with a model in which the Cdc13–Est1 interaction is regulated by Tel1-mediated phosphorylation of the Cdc13 telomerase recruitment domain. We propose an alternative model for the role of Tel1 in telomere homeostasis, which is based on the assumption that Tel1 performs the same molecular task at double-strand breaks (DSBs) and chromosome termini.
Profiling Sex-Specific piRNAs in Zebrafish
Authors: Zhou Xiang , Zuo Zhixiang , Zhou Fang , Zhao Wei , Sakaguchi Yuriko , Suzuki Takeo , Suzuki Tsutomu , Cheng Hanhua , Zhou Rongjia 
Published: September 2010

Abstract
Piwi proteins and their partner small RNAs play an essential role in fertility, germ-line stem cell development, and the basic control and evolution of animal genomes. However, little knowledge exists regarding piRNA biogenesis. Utilizing microfluidic chip analysis, we present a quantitative profile of zebrafish piRNAs expressed differentially between testis and ovary. The sex-specific piRNAs are derived from separate loci of repeat elements in the genome. Ovarian piRNAs can be categorized into groups that reach up to 92 members, indicating a sex-specific arrangement of piRNA genes in the genome. Furthermore, precursor piRNAs preferentially form a hairpin structure at the 3′end, which seem to favor the generation of mature sex-specific piRNAs. In addition, the mature piRNAs from both the testis and the ovary are 2′-O-methylated at their 3′ ends.
Anemia of Chronic Disease and Chronic Periodontitis: Does Periodontal Therapy Have an Effect on Anemic Status?
Authors: Pradeep A. R. , Anuj Sharma , Arjun Raju P.  
Published: September 2010

Background: As the periodontal tissues mount an immune inflammatory response to bacteria and their products, the systemic challenge with these agents also induces a major vascular response. Certain inflammatory cytokines produced during periodontal inflammation can depress erythropoietin production leading to the development of anemia. The aim of this study is to investigate whether patients with chronic periodontitis have an anemic status, and subsequently, to analyze the effect of non‐surgical periodontal therapy on the anemic status of subjects over a 6‐month period.Methods: A total of 187 patients with chronic periodontitis participated in the study. After red blood cell analyses, 60 patients with hemoglobin concentrations below reference ranges entered into the second part of the study in which patients were treated with non‐surgical periodontal therapy. Clinical parameters and red blood cell analyses were repeated at 3 and 6 months.Results: In the first part of the study, 33.6% of patients had hemoglobin concentrations below normal reference ranges. In the second part of the study, all red blood cell parameters and clinical parameters showed statistical improvements over a 6‐month period.Conclusion: The present study strengthens the hypothesis that chronic periodontitis may lead to anemia and provides evidence that non‐surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis with greater improvement in females.
The Clamshell Osteotomy: A New Technique to Correct Complex Diaphyseal Malunions
Authors: Russell George V. , Graves Matt L. , Archdeacon Michael T. , Barei David P. , Brien Glenn A. , Porter Scott E. 
Published: September 2010

BACKGROUND:
The treatment of complex diaphyseal malunions is challenging, requiring extensive preoperative planning and precise operative technique. We have developed a simpler method to treat some of these deformities.

METHODS:
Ten patients with complex diaphyseal malunions (including four femoral and six tibial malunions) underwent a clamshell osteotomy. The indications for surgery included pain at adjacent joints and deformity. After surgical exposure, the malunited segment was transected perpendicular to the normal diaphysis proximally and distally. The transected segment was again osteotomized along its long axis and was wedged open, similar to opening a clamshell. The proximal and distal segments of the diaphysis were then aligned with use of an intramedullary rod as an anatomic axis template and with use of the contralateral extremity as a length and rotation template. The patients were assessed clinically and radiographically at a mean of thirty-one months (range, six to fifty-two months) after the osteotomy.

RESULTS:
Complete angular correction was achieved in each case; the amount of correction ranged from 2° to 20° in the coronal plane, from 0° to 32° in the sagittal plane, and from 0° to 25° in the axial plane (rotation). Correction of length ranged from 0 to 5 cm, and limb length was restored to within 2 cm in all patients. All osteotomy sites were healed clinically by six months. While no deep infections occurred, superficial wound dehiscence occurred in two patients along the approach for the longitudinal portion of the osteotomy, emphasizing the importance of careful soft-tissue handling and patient selection.

CONCLUSIONS:
The clamshell osteotomy provides a useful way to correct many forms of diaphyseal malunion by realigning the anatomic axis of the long bone with use of a reamed intramedullary rod as a template. This technique provides an alternative that could decrease preoperative planning time and complexity as well as decrease the need for intraoperative osteotomy precision in a correctly chosen subset of patients with diaphyseal deformities.

LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION:
“The Clamshell Osteotomy: A New Technique to Correct Complex Diaphyseal Malunions” (2009;91:314-24).
Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia
Authors: Krych Aaron J. , Howard James L. , Trousdale Robert T. , Cabanela Miguel E. , Berry Daniel J. 
Published: September 2010

BACKGROUND:
When surgeons perform total hip arthroplasty for hips with a high dislocation related to developmental dysplasia of the hip, obtaining long-term stable implant fixation and optimizing patient function remain challenges. The purpose of this paper was to evaluate the results of cementless arthroplasty with a simultaneous subtrochanteric shortening osteotomy in a group of patients with Crowe type-IV developmental dysplasia of the hip.

METHODS:
In a retrospective study, we evaluated the results and complications of twenty-eight consecutive primary cementless total hip arthroplasties in twenty-four patients (twenty women and four men), all of whom had Crowe type-IV developmental dysplasia of the hip. The arthroplasty was performed in combination with a subtrochanteric shortening osteotomy and with placement of the acetabular component at the level of the anatomic hip center. The patients were evaluated at a mean of 4.8 years postoperatively.

RESULTS:
The mean Harris hip score increased from 43 points preoperatively to 89 points at the time of final follow-up (p < 0.01). Twelve (43%) of the twenty-eight hips had an early or late complication or a reoperation. Two (7%) of the twenty-eight subtrochanteric osteotomies were followed by nonunion. There was one instance of isolated loosening of the femoral stem. One acetabular component loosened, and one acetabular liner disengaged. Four hips dislocated postoperatively. All remaining components were well-fixed at the time of the last radiographic follow-up. No sciatic neurapraxic injuries were identified.

CONCLUSIONS:
Cementless total hip arthroplasty combined with a subtrochanteric femoral shortening osteotomy in patients with a high hip dislocation secondary to developmental dysplasia was associated with high rates of successful fixation of the implants and healing of the osteotomy site and a mean postoperative Harris hip score of 89 points. The complication rate, however, was substantially higher than that associated with primary total hip arthroplasty in patients with degenerative arthritis.

LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION:
“Total Hip Arthroplasty with Shortening Subtrochanteric Osteotomy in Crowe Type-IV Developmental Dysplasia” (2009;91:2213-21).
Comparison of the Clinical Results of Three Posterior Cruciate Ligament Reconstruction Techniques
Authors: Kim Sung-Jae , Kim Sung-Hwan , Kim Sul-Gee , Kung Yun-Pei 
Published: September 2010

BACKGROUND:
Despite its technical complexity, arthroscopic tibial inlay reconstruction of the posterior cruciate ligament has biomechanical advantages over transtibial procedures. The purpose of this study was to compare the clinical results of arthroscopic tibial inlay single-bundle and double-bundle techniques with those of the conventional transtibial single-bundle technique.

METHODS:
We evaluated twenty-nine patients treated with primary posterior cruciate ligament reconstruction and followed for longer than two years. Eight patients were treated with a transtibial single-bundle procedure; eleven, with an arthroscopic inlay single-bundle procedure; and ten, with an arthroscopic inlay double-bundle procedure. An Achilles tendon allograft was used in all cases. Each patient was evaluated on the basis of the Lysholm knee score, the mean side-to-side difference in tibial translation as measured on Telos stress radiographs, and the side-to-side difference in the range of motion of the knee.

RESULTS:
The mean side-to-side difference (and standard deviation) in posterior tibial translation differed significantly between the arthroscopic tibial inlay double-bundle group (3.6 ± 1.43 mm) and the transtibial single-bundle group (5.6 ± 2.0 mm) (p = 0.023), although there was no significant difference between the arthroscopic inlay single-bundle group (4.7 ± 1.62 mm) and the transtibial group (p = 0.374). The mean range of motion and Lysholm scores were similar among the three groups.

CONCLUSIONS:
Despite its technical difficulty, the arthroscopic tibial inlay double-bundle technique is our preferred method of reconstruction of the posterior cruciate ligament because it stabilizes posterior tibial translation better than do the other two methods.

LEVEL OF EVIDENCE:
Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION:
“Comparison of the Clinical Results of Three Posterior Cruciate Ligament Reconstruction Techniques” (2009;91:2543-9).
Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate
Authors: Kolb Werner , Guhlmann Hanno , Windisch Christoph , Koller Heiko , Grützner Paul , Kolb Klaus 
Published: September 2010

BACKGROUND:
High tibial osteotomy has been recognized as a beneficial treatment for osteoarthritis of the medial compartment of the knee. The purpose of this prospective study was to assess the short-term results of opening-wedge high tibial osteotomies with locked plate fixation.

METHODS:
From September 2002 to November 2005, fifty-one consecutive medial opening-wedge high tibial osteotomies were performed. The mean age of the patients at the time of the index operation was forty-nine years. The preoperative and postoperative factors analyzed included the grade of arthritis of the tibiofemoral compartment (the Ahlbäck radiographic grade), the anatomic tibiofemoral angle, patellar height, the Hospital for Special Surgery rating system score, and the Lysholm and Gillquist knee score.

RESULTS:
Postoperatively, one superficial wound infection occurred. Fifty of the fifty-one osteotomies healed after an average period of 12.9 weeks (range, eight to sixteen weeks) without bone grafts. A nonunion developed in a sixty-two-year-old patient who was a cigarette smoker. The average postoperative tibiofemoral angle was 9° of valgus. Forty-nine patients were followed for a mean of fifty-two months. The average score on the Hospital for Special Surgery rating system was 86 points at the time of the most recent follow-up. The rating was excellent in twenty-eight patients (57%), good in twelve (24%), fair in four (8%), and poor in five (10%). The average score on the Lysholm and Gillquist knee-scoring scale was 83 points. According to these scores, the outcome was excellent in nine patients (18%), good in thirty-one (63%), fair in three (6%), and poor in six (12%). Four knees failed after an average of thirty-six months.

CONCLUSIONS:
Our results suggest that an opening-wedge high tibial osteotomy with locked plate fixation allows a correct valgus angle to be achieved with good short-term results.

LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION:
“Opening-Wedge High Tibial Osteotomy with a Locked Low-Profile Plate” (2009;91:2581-8).
Arthroscopic Repair of Circumferential Lesions of the Glenoid Labrum
Authors: Tokish LT COL John M. , McBratney MAJ Colleen M. , Solomon CDR Daniel J. , LeClere LT Lance , Dewing LCDR Christopher B. , Provencher CDR Matthew T. 
Published: September 2010

BACKGROUND:
Symptomatic pan-labral or circumferential (360°) tears of the glenohumeral labrum are an uncommon injury. The purpose of the present study was to report the results of surgical treatment of circumferential lesions of the glenoid labrum with use of validated outcome instruments.

METHODS:
From July 2003 to May 2006, forty-one shoulders in thirty-nine patients (thirty-four men and five women) with a mean age of 25.1 years were prospectively enrolled in a multicenter study and were managed for a circumferential (360°) lesion of the glenoid labrum. All patients had a primary diagnosis of pain and recurrent shoulder instability, and all underwent arthroscopic repair of the circumferential labral tear with a mean of 7.1 suture anchors. The outcomes for thirty-nine of the forty-one shoulders were assessed after a mean duration of follow-up of 31.8 months on the basis of the rating of pain and instability on a scale of 0 to 10, a physical examination, and three outcome instruments (the Single Assessment Numeric Evaluation score, the modified American Shoulder and Elbow Surgeons score, and the Short Form-12 score).

RESULTS:
Significant improvement was noted in terms of the mean pain score (from 4.3 to 1.1), the mean instability score (from 7.3 to 0.2), the mean modified American Shoulder and Elbow Surgeons score (from 55.5 to 89.6), the mean Short Form-12 score (from 75.7 to 90.0), and the mean Single Assessment Numeric Evaluation score (from 36.7 to 88.5). Six shoulders required revision surgery because of recurrent instability (two), recalcitrant biceps tendinitis (two), or postoperative tightness (two). All patients returned to their preinjury activity level.

CONCLUSIONS:
Pan-labral or circumferential lesions are an uncommon yet extensive injury of the glenohumeral joint that may result in recurrent instability and pain. The present study demonstrates that arthroscopic capsulolabral repair with suture anchor fixation can restore the stability of the glenohumeral joint and can provide a reliable improvement in subjective and objective outcome measures.

LEVEL OF EVIDENCE:
Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

ORIGINAL ABSTRACT CITATION:
“Arthroscopic Repair of Circumferential Lesions of the Glenoid Labrum” (2009;91:2795-802).