bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimodal treatment of recurrent sinonasal cryptococcal granulomas in a horse
Authors: Stewart Allison J. , Salazar Tricia , Waldridge Bryan M. , Schumacher John , Welles Elizabeth G. , Hanson R. Reid , Sartin Eva A. , Lenz Stephen D. , Holland Merrilee , Beard Debra M. 
Published: September 2009

Abstract
Case Description—A 7-year-old 509-kg (1,120-lb) Tennessee Walking Horse mare was evaluated because of bilateral mucosanguinous nasal discharge, intermittent right-sided epistaxis, and worsening dyspnea of 9 months' duration.
Clinical Findings—Multiple masses in the nasopharynx were detected via endoscopic and radiographic examinations. Cytologic and histologic examinations of biopsy specimens of 1 mass revealed round yeasts with thick nonstaining capsules and occasional narrow-based budding that resembled cryptococcal organisms.
Treatment and Outcome—Oral administration of fluconazole and organic ethylenediamine dihydriodide and intermittent intralesional injections with fluconazole, amphotericin B, and formalin resulted in resolution of lesions for a period of 2.5 years. The horse then developed exophthalmos, recurring clinical signs, and extensive nasopharyngeal masses. The masses were surgically debulked via a large frontonasal bone flap, and the horse was treated with IV injections of amphotericin B and long-term oral administration of fluconazole. Clinical signs did not recur in the following 2-year period. A presumptive diagnosis of cryptococcosis was made following cytologic and histologic evaluations of the masses; results of serologic analysis and fungal culture confirmed infection with Cryptococcus neoformans.
Clinical Relevance—Cryptococcal infection of the upper respiratory tract in horses has previously been described as a uniformly fatal disease. As this case report illustrates, medical and surgical treatment of sinonasal cryptococcal granulomas in horses may be successful, but the importance of long-term follow-up and the potential for disease recrudescence should be considered. As efficacious antifungal agents become less expensive, their increased use will likely decrease mortality rates in horses with fungal infections.
Matrix-Induced Autologous Chondrocyte Implantation (MACI) Grafting for Osteochondral Lesions of the Talus
Authors: Schneider Timothy E. , Karaikudi Sriram 
Published: September 2009

Background: Articular cartilage is limited in its ability to repair itself. Matrix-induced Autologous Chondrocyte Implantation (MACI) is an established treatment method for such articular cartilage defects in the knee. Recently the technique has been used in the ankle. We present a series of patients treated with MACI for osteochondral defects of the ankle, and assess the functional and clinical results. Materials and Methods: From August 2003 to February 2006, 20 patients underwent MACI grafting for osteochondral defects in the ankle. Age ranged from 19 to 61 (mean, 36) years. Mean followup was 21.1 months. Clinical and functional evaluations were conducted using the AOFAS scoring system. Results: The mean size was 233 mm2. There was a significant improvement in mean AOFAS score from 60 (range, 25 to 87) to 87 (range, 41 to 100) ( p < 0.0001). Overall improvement in pain scores was also significant ( p < 0.0001). All osteotomies healed. Four patients required hardware removal and two underwent arthroscopic debridement for anterior impingement. There were two failures which are awaiting subsequent procedures. Conclusion: We believe MACI is a reliable treatment method for talar osteochondral defects. The method usually requires an intra-articular osteotomy, although this proved to be a reasonably simple aspect of the procedure for the treatment of cartilage defects of the talus. Level of Evidence: IV, Case Series
Analysis of Retrieved Agility™ Total Ankle Arthroplasty Systems
Authors: Vaupel Zachary , Baker Erin A. , Baker Kevin C. , Kurdziel Michael D. , Fortin Paul T. 
Published: September 2009

Background: First generation total ankle arthroplasty (TAA) systems showed high rates of failure. The Agility™ (DePuy, Warsaw, IN) TAA system, a second generation design, had improved outcomes; however, implant failure due to loosening of the metallic components persisted. The purpose of this study was to analyze the damage modes and radiographic mode(s) of failure observed in retrieved Agility™ TAA. Materials and Methods: Ten devices were collected and each component was analyzed for common damage modes using microscopy. Clinical damage was analyzed with postoperative implant and preoperative revision procedure radiographs. Results: Analyses revealed damage/wear to retrieved components, including abrasion, dishing, and pitting. These third-body wear particles may be a precursor to wear debris induced osteolysis which could cause component loosening. Seven TAA systems were removed due to loosening or subsidence, suggesting component damage/wear may lead to clinically observed component loosening. Retrieval analysis indicated the polyethylene experiences edge loading, resulting in increased contact stresses to polyethylene in the primary articulation region and wear. Conclusion: Since poor clinical outcomes have been associated with component instability and osteolysis, analyzing retrieved components wear and damage may be an important step toward improving implant design, thereby decreasing wear debris induced osteolysis and improving clinical outcomes. Level of Evidence: IV, Case Series
Preoperative Footbaths Reduce Bacterial Colonization of the Foot
Authors: Aaron B. Y. , Adeyemo Folorunso O. , Samarji Richard 
Published: September 2009

Background: Previous studies have demonstrated higher infection rates following elective procedures on the foot and ankle compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to ascertain if preoperative chlorhexidine bathing decreased the number of bacteria on the forefoot. Materials and Methods: From October 2005 to October 2006, a prospective study was undertaken to evaluate 44 consecutive patients undergoing planned, elective surgery of the foot and ankle. (mean age, 43.9 years; range, 17 to 85 years; 25 female, 19 male). Twenty-two patients were assigned to each group. They were randomly assigned to have preoperative footbath with chlorhexidine gluconate (Hibitane) (Group 1) 20 minutes before surgery or placebo (Group 2). Culture swabs were taken from all web spaces, nail folds, toe surfaces and proposed surgical incision sites before the preoperative bath, during the procedure and immediately after surgery. Results: In Group 1, bacteria grew on the intraoperative culture in 60% and 0% of immediate postoperative cultures. In Group 2, 96% of intraoperative cultures and 16% of postoperative cultures. The difference in the intraoperative bacterial count was statistically significant ( p = 0.002). The difference in postoperative bacterial counts was marginally significant ( p = 0.055). No complications were recorded in either group. Conclusion: These data indicate that chlorhexidine provides better reduction in skin flora than placebo. Based of these data, we recommend the use of a chlorhexidine footbath in addition to standard surgical preparatory agent before foot and ankle surgery.
Proximal First Metatarsal Opening Wedge Osteotomy with a Low Profile Plate
Authors: Shurnas Paul S. , Watson Troy S. , Crislip Timothy W. 
Published: September 2009

Background: Many surgical procedures have been described for the correction of metatarsus primus varus associated with hallux valgus deformity. The purpose of this study was to present the results of the proximal metatarsal opening wedge (PMOW) osteotomy using the Arthrex LPS® first metatarsal system. Materials and Methods: Eighty-four patients (90 feet) underwent PMOW osteotomy with distal bunionectomy. There were 78 patients (93%) and 84 (93%) feet available for followup. Mean followup was 2.4 (range, 2.0 to 3.2) years from the time of the index surgery. Pre- and postoperative clinical examination, level of activity, patient derived subjective satisfaction score, radiographic measurements, and visual analogue scale (VAS) score for pain were obtained and evaluated retrospectively. Results: The mean preoperative VAS score was 5.9 (± 2.2), compared with a mean postoperative score of 0.5 (± 0.8). The mean 1–2 IMA preoperatively was 14.5 (±3.3) degrees, compared with postoperative measurements of 4.6 (± 2.8) degrees. The mean hallux valgus angle (HVA) improved from a mean of 30 (range, 22 to 64) degrees preoperatively to 10 (range, −15 to +18) degrees. The mean time to radiographic union was 5.9 (range, 4 to 14) weeks. There was one nonunion, one delayed union, mild hallux varus in two patients, severe hallux varus in two patients, recurrent hallux valgus in three patients (including the nonunion) and no instances of plate failure there was no significant difference in mean preoperative (74.8 degrees ± 11) compared to postoperative (67.9 degrees ± 10) total MTP joint range of motion. Ninety percent of patients reported good to excellent subjective results after the index surgery. Conclusion: We believe PMOW osteotomy was near ideal in terms of reliable, predictable correction and healing. Length of the first metatarsal was maintained and patients ambulated safely in a CAM walking boot immediately after surgery. We believe a first web space release may result in hallux varus and increased distal metatarsal articular angle (DMAA) was associated with hallux valgus recurrence. Level of Evidence: IV, Retrospective Case Series
Radiographic Correlation of Hallux MP Fusion Position and Plate Angle
Authors: Leaseburg J. Thaddeus , DeOrio James K. , Shapiro Shane A. 
Published: September 2009

Background: This study assessed the variability of plate bend in regard to final metatarsophalangeal (MP) fusion angles and toe-to-floor distance. We hypothesized that the final MP angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance would be dictated solely by the magnitude of the bend in the plate. Materials and Methods: This is a retrospective analysis of 35 sequential patients who underwent MP fusion with a low-contour titanium plate. Postoperative weightbearing radiographs were analyzed for plate angle, MP fusion angle, the angle of the proximal phalanx to the floor, and the weightbearing toe-to-floor distance. Results: We found statistical correlation between plate angle and MP angle and between plate angle and the angle of the proximal phalanx to the floor. However, there was low correlation between plate angle and with toe-to-floor distance. In addition, we noted many outliers, which resulted in higher or lower correlation of the MP angle to the expected plate angle and, thus, a relationship between angles that was far from linear. Conclusion: Care needs to be taken when relying solely on the bend in the plate to determine the final position of the toe in MP fusions. Although the association between plate bend and MP angle and proximal phalanx to floor angle was strong, the association between the bend in the plate and weight bearing toe-to-floor distance was variable. This could result in the toe hitting the shoe or the need to vault over the toe. Therefore, the surgeon must match the plate to each patient's anatomy to ensure proper weight bearing toe-to-floor distance and not rely on plate angle exclusively. Level of Evidence: IV, Retrospective Case Series
Effect of Eccentric Exercise Program for Early Tibialis Posterior Tendinopathy
Authors: Kulig Kornelia , Lederhaus Eric S. , Reischl Steve , Arya Shruti , Bashford Greg 
Published: September 2009

Background: Morphology and vascularization of painful tibialis posterior (TP) tendons before and after an intervention targeting the degenerated tendon were examined. Functional status and pain level were also assessed. Materials and Methods: A10-week twice daily, progressive eccentric tendon loading, calf stretching program with orthoses was implemented with ten, early stage TP tendinopathy subjects. TP tendons were imaged by grayscale and Doppler ultrasound at INITIAL and POST evaluations to assess the tendon's morphology and signs of neovascularization. The Foot Functional Index (FFI), Physical Activity Scale (PAS), 5-Minute Walk Test, and single heel raise (SHR) test were completed at INITIAL and POST evaluations. The Global Rating Scale (GRS) was completed at 6 months followup. One-way ANOVA was used to compare the FFI at INITIAL, POST, and 6-MONTH time points. Paired t-tests were used to compare means between the remaining variables. The level of significance was p = 0.05. Results: There was a significant difference in FFI total, pain, and disability at the three time-points. Post-hoc paired t-tests revealed that the FFI scores were lower for the total score and pain and disability subcategories when comparing from INITIAL to POST and INITIAL to 6-MONTH evaluations ( p < 0.05 for all). The number of SHR increased significantly on the involved side from INITIAL to POST evaluation ( p = 0.041). The GRS demonstrated minimum clinically important differences for improvements in symptoms at 6-MONTH. Tendon morphology and vascularization remained abnormal following the intervention. Conclusion: A 10-week tendon specific eccentric program resulted in improvements in symptoms and function without changes in tendon morphology or neovascularization. Level of Evidence: IV, Case Series
Ultrasound Guidance for Intra-articular Injections of the Foot and Ankle
Authors: Khosla Shaun , Thiele Ralf , Baumhauer Judith F. 
Published: September 2009

Background: Ultrasound has been increasingly utilized in procedures involving intra-articular injections. This study's purpose was to compare the accuracy of intra-articular injections of the foot and ankle using palpation versus dynamic ultrasound in a cadaver model. Materials and Methods: Fourteen lightly embalmed cadaver specimens without notable osteoarthritis were used. A 0.22-gauge needle was placed by a foot and ankle orthopaedic surgeon into the first and second tarsometatarsal joints, subtalar joint, and ankle joint. The needle was initially placed using palpation, evaluated with ultrasound by an experienced rheumatologist, and re-inserted if necessary. Needle placement was confirmed with injection of an Omnipaque™/methylene blue solution and examined under fluoroscopy, followed by dissection. Results: Palpation and ultrasound were 100% accurate in subtalar and ankle joint injections. Using palpation, the needle was correctly placed into the first TMT joint in three of 14 cadavers, and in four of 14 cadavers for the second TMT joint. Using ultrasound, the needle was correctly placed into the first TMT joint in ten of 14 cadavers, and into the second TMT joint in eight of 14 cadavers. When grouped, ultrasound was significantly more accurate for intra-articular needle placement compared to palpation in the midfoot ( p = 0.003). On three specimens, dye extended beyond the second TMT joint. Conclusion: Intra-articular injections of the subtalar and ankle joints can be successfully performed utilizing palpation alone. Ultrasound guidance significantly increases injection accuracy into the TMT joints compared to palpation alone and therefore US or Fluoroscopy is performed when injecting these TMT joints. When using selective diagnostic injections into a TMT joint to assess for the symptomatic joint and potential need for arthrodesis, the injected anesthetic may not remain isolated within that joint. These isolated TMT injections should not be done to answer that question without fluoroscopy confirmation with radiopaue dye demonstrating the injected fluid remained within the one joint of interest.
Effects of Growth Regulators on In vitro Propagation and Tuberization of Four Dioscorea Species
Authors: Islam Md. Tariqul , Keller E. R. Joachim , Dembele D. Philibert 
Published: September 2009

Nodal explants of 12 accessions from four species of yam (Dioscorea spp.) were cultured for six weeks on MS to evaluate the influence of IAA, Kn, NAA and BAP on the production of leaves and microtubers. Four Dioscorea polystachya Turcz., three each of D. bulbifera L. and D. sansibarensis Pax. and two D. japonica Thunb. accessions were used. Five and 10 mg/l of Kn along with IAA and sucrose, and 0.2 and 0.5 mg/l of NAA, sucrose and with or without BAP were used in four treatments. The accessions Yam 23 and Yam 25 of D. sansibarensis failed to initiate any leaf under four treatments. The remaining accessions produced 0.11 to 1.76 leaves per explant. The medium containing IAA with higher concentration of Kn (10 mg/l) and 3% sucrose was found to be best for in vitro production of leaf (0.71/explant) and the most productive species was D. japonica (1.36), followed by D. polystachya (1.19/explant). At the same culture period, Yam 16 of D. bulbifera failed to initiate any microtuber at IAA with Kn, and NAA with or without BAP. The remaining accessions produced 0.09 to 1.15 microtubers per explant. Lower concentration of Kn (5 mg/l) with IAA and sucrose was favourable for producing microtubers (0.61/explant on an average), the best species being D. sansibarensis (1.27) followed by D. japonica (0.59/ explant). Finally, the presence of BAP adversely affected the production of microtuber among Dioscorea species. Key words: Dioscorea spp., Microtuber, Nodal culture, Propagation D.O.I. 10.3329/ptcb.v18i1.3260 Plant Tissue Cult. & Biotech. 18(1): 25-35, 2008 (June)
In vitro Regeneration of Vitex negundo L. - A Multipurpose Woody Aromatic Medicinal Shrub
Authors: Jawahar M. , Ravipaul S. , Jeyaseelan M. 
Published: September 2009

A rapid and efficient protocol was developed for inducing indirect organogenesis using leaf explants of Vitex negundo L. Explants were cultured on MS with different concentrations of 2,4-D and IAA in combination with BAP for callus induction. The frequency of callus induction increased with increasing concentration of IAA (0.3 mg/l) and BAP (0.3 mg/l) at optimal level. The shoot buds appeared emerging as green coloured protuberances on the callus. The high frequency of shoot bud initiation and shoot proliferation was observed on MS containing 0.3 mg/l IAA and 0.3 mg/l BAP. The regenerated shoots were successfully rooted on MS supplemented with 0.5 mg/l IBA. Rooted plants were transferred to pots containing sand, soil and manure in the ratio of 1 : 1 : 1. Nearly 90% survival of in vitro plants were recorded. Key words : Vitex negundo, In vitro, Leaf, Callus, Regeneration D.O.I. 10.3329/ptcb.v18i1.3263 Plant Tissue Cult. & Biotech. 18(1): 37-42, 2008 (June)
Purification and Partial Characterization of Lectins from In vitro Cultures of Ricinus communis
Authors: Chaudhary Harshita , Sood Neelu 
Published: September 2009

Ricinus lectins have proven to be quite useful in biological and medical research because of their haemagglutinating, mitogenic, antitumor and toxic properties. In the Indian medicine system, the leaf, root and seed oil of this plant species have been used for the treatment of inflammation and liver disorders. The two major lectins Ricin and RCA have toxic and haemagglutination activities. The micropopagation of Ricinus was standardized using MS medium supplemented with different concentrations of IAA, IBA, NAA, BAP and Kinetin. Kinetin (0.5 mg/l) + NAA (1.0 mg/l) combination was found to be optimal for raising in vitro complete plants within 4 weeks. Using Affinity chromatography galactose binding lectins were isolated from the in vitro grown plants, in vivo leaves and mature seeds. The isolated fractions were further characterized for their molecular weight using SDS-PAGE, haemagglutination activity, pH and thermostability. In the purified fractions, the protein bands other than those corresponding to reported subunits of Ricinus lectins, indicated the presence of some more hitherto unexplored lectins. However, the seeds proved to be a rich source of lectins more than in in vitro grown plants. The seeds are available only from the mature plant at the end of growing season, hence consistent supply of lectins is not possible using conventional methods. Thus in vitro raised plants can prove to be rich source of lectins other than seeds, which can be of great therapeutic and commercial use. Key words: Ricinus communis, Lectins, In vitro, Micropropagation, Ricin, RCA, Haemagglutination, Purification and Characterization D.O.I. 10.3329/ptcb.v18i2.3269 Plant Tissue Cult. & Biotech. 18(2): 89-102, 2008 (December)
Impact of Pharmacist Interventions in Patients with Dyslipidemia: A Systematic Review
Authors: Charrois Theresa L. , Zolezzi Monica , Koshman Sheri , Pearson Glen , Makowsky Mark , Tsuyuki Ross T. 
Published: September 2009

Purpose: To determine the effect of pharmacistled interventions in dyslipidemia on clinical and process outcomes. Methods: Search: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts, HealthSTAR, Pascal, MEDLINE In-Process & Other Non-Indexed Citations, CINAHL Plus with Full Text, Health-Source: Nursing Edition, Academic Search Complete, BIOSIS Previews, Science Citation Index Expanded and Social Sciences Citation Index were searched from their inception to September 2008. Where possible an RCT filter was used. Article screening and selection: Inclusion criteria were: 1) RCTs and 2) pharmacist-provided pharmaceutical care, either independently or as part of a health care team or a collaborative agreement (team-directed) with other health care providers. There were no restrictions on language, sample size, study duration or practice setting. Quality assessment: Risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and studies were judged as low, high or unclear risk of bias. Data Extraction: Data extraction was performed by 2 independent reviewers using a standardized data collection form. Outcomes: The primary outcome was absolute reduction in LDL cholesterol. Secondary outcomes included proportion of patients at target, initiation/modification of lipid therapy, compliance with lipid therapy, health-related quality of life and patient satisfaction. Data Analysis: Data were analyzed using a random effects model with analysis based on the Der-Simonian-Laird method. Calculations included odds ratio for dichotomous data and weighted mean difference (WMD) or standardized mean differences for continuous data. Subgroup analyses or meta-regression were conducted to investigate possible sources of heterogeneity. An indirect comparison of pharmacist-directed versus pharmacist collaborative care interventions was done. Sensitivity analysis was performed based on risk of bias. Results: A total of 8422 articles were retrieved from the search. From these, 114 articles were selected for full review, and 12 articles were included. The overall difference in LDL ( n = 543 patients) was not statistically significant (WMD −0.09 mmol/L, 95% CI −0.23, 0.04). The difference in total cholesterol was statistically significant (WMD −0.16, 95% CI −0.30, −0.02). Patients followed by a pharmacist were 3 times more likely to be at target (OR 2.9, 95% CI 1.1–7.5) and 2 times more likely to have their cholesterol measured (OR 2.4, 95% CI 1.6–3.6). Conclusions: Pharmacist interventions in a variety of settings have an impact on the lowering of total cholesterol. Patients receiving interventions that included pharmacist care were more likely to be at target and have their lipid panel measured. The types of interventions provided by pharmacists vary in terms of setting and components.