bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-ossification of the pelvis following hemipelvectomy for trauma
Authors: Wansbrough G. , Boyne N. , Pollard C. W. 
Published: February 2011

We present a patient who underwent delayed sub-periosteal hemipelvectomy for control of infection and to enable soft-tissue cover after trauma. At four months after amputation, clinical examination and radiographs demonstrated almost complete re-ossification of the hemipelvis. This has allowed the patient to regain sitting balance and to use a walking prosthesis designed for patients following disarticulation of the hip. After 14 months from injury, no perineal hernia has developed, and no dysfunction of pelvic organs is attributable to heterotopic bone formation or adhesions. The patient’s mobility with a prosthesis is similar to that expected of a through-hip amputee.
A medium-term comparison of hybrid hip replacement and Birmingham hip resurfacing in active young patients
Authors: Baker R. P. , Pollard T. C. B. , Eastaugh-Waring S. J. , Bannister G. C. 
Published: February 2011

We compared the medium-term clinical and radiological results of hybrid total hip replacement (THR) with metal-on-metal Birmingham hip resurfacing (BHR) in two groups of 54 young patients matched for age, gender, body mass index and pre-operative levels of activity. The clinical outcome was assessed by the University of California, Los Angeles (UCLA) activity score, the Oxford Hip Score (OHS) and the EuroQol scores. Radiologically, all hips were assessed for migration and osteolysis, the hybrid THRs for polyethylene wear and the BHRs for a pedestal sign. The mean follow-up of the patients with a hybrid THR was ten years and for those with a BHR, nine years. Four patients with a hybrid THR and one with a BHR had died. In each group five were lost to follow-up. The revision rate of the hybrid THRs was 16.7% (9 of 54) and of the BHRs 9.3% (5 of 54) (p = 0.195). Radiographs of a further eight hybrid THRs demonstrated wear and osteolysis, and they await revision (p = 0.008). Of the unrevised BHRs 90% had radiological changes, of which approximately 50% had progressed over the previous four years. All hybrid THRs demonstrated linear polyethylene wear with a mean of 1.24 mm (0.06 to 3.03). The BHRs recorded superior OHS (p = 0.013), UCLA (p = 0.008), and EuroQol visual analogue scores (p = 0.009). After nine years, patients with BHRs remained more active and had a lower rate of revision than those with hybrid THRs. Both groups demonstrated progressive radiological changes at medium-term follow-up.
Posterolateral corner injuries of the knee
Authors: Pacheco R. J. , Ayre C. A. , Bollen S. R. 
Published: February 2011

We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.
Is routine chemical thromboprophylaxis after total hip replacement really necessary in a Japanese population?
Authors: Yokote R. , Matsubara M. , Hirasawa N. , Hagio S. , Ishii K. , Takata C. 
Published: February 2011

Prophylaxis against venous thromboembolism after elective total hip replacement is routinely recommended. Our preference has been to use mechanical prophylaxis without anticoagulant drugs. A randomised controlled trial was performed to evaluate whether the incidence of post-operative venous thromboembolism was reduced by using pharmacological anticoagulation with either fondaparinux or enoxaparin in addition to our prophylactic mechanical regimen. A total of 255 Japanese patients who underwent primary unilateral cementless total hip replacement were randomly assigned to one of three postoperative regimens, namely injection of placebo (saline), fondaparinux or enoxaparin. There were 85 patients in each group. All also received the same mechanical prophylaxis during and after the operation, regardless of their assigned group. The primary measurement of efficacy was the presence of a venous thromboembolic event by day 11, defined as deep-vein thrombosis detected by ultrasonography, documented symptomatic deep-vein thrombosis or documented symptomatic pulmonary embolism. The duration of follow-up was 12 weeks. The rate of venous thromboembolism was 7.2% with the placebo, 7.1% with fondaparinux and 6.0% with enoxaparin (p = 0.95 for the comparison of all three groups). Our study confirmed the effectiveness and safety of mechanical thromboprophylaxis without the use of anticoagulant drugs after total hip replacement in Japanese patients.
Morphological analysis of collapsed regions in osteonecrosis of the femoral head
Authors: Motomura G. , Yamamoto T. , Yamaguchi R. , Ikemura S. , Nakashima Y. , Mawatari T. , Iwamoto Y. 
Published: February 2011

In order to investigate the mechanisms of collapse in osteonecrosis of the femoral head, we examined which part of the femoral head was the key point of a collapse and whether a collapsed region was associated with the size of the necrotic lesion. Using 30 consecutive surgically removed femoral heads we retrospectively analysed whole serial cut sections, specimen photographs, specimen radiographs and histological sections. In all of the femoral heads, collapse consistently involved a fracture at the lateral boundary of the necrotic lesion. Histologically, the fractures occurred at the junction between the thickened trabeculae of the reparative zone and the necrotic bone trabeculae. When the medial boundary of the necrotic lesion was located lateral to the fovea of the femoral head, 18 of 19 femoral heads collapsed in the subchondral region. By contrast, when the medial boundary was located medial to the fovea, collapse in the subchondral region was observed in four of 11 femoral heads (p = 0.0011). We found that collapse began at the lateral boundary of the necrotic lesion and that the size of the necrotic lesion seemed to contribute to its distribution.
Improved Zr-2.5Nb Pressure Tubes for Reduced Diametral Strain in Advanced CANDU Reactors
Authors: Bickel G. A. , Griffiths M. , Douchant A. , Douglas S. , Woo O. T. , Buyers A. 
Published: February 2011

Abstract
In an Advanced CANDU Reactor (ACR) (ACR is a registered trademark of Atomic Energy of Canada Limited), pressure tubes of cold-worked Zr-2.5Nb materials will be used in the reactor core to contain the fuel bundles and the light water coolant. They will be subjected to higher temperature, pressure, and flux than those in a CANDU (CANDU is a registered trademark of Atomic Energy of Canada Limited) reactor, and accordingly require a thicker wall (6.5 mm for ACR versus 4.2 mm for CANDU). In order to ensure that these tubes will perform acceptably over their 30-year design life in such an environment, a study to model and forecast the performance of these thicker pressure tubes has been undertaken. One of the main requirements for the pressure tube is to have low diametral creep. Based on previous experience with CANDU reactor pressure tube performance and manufacture, an assessment of the grain structure and texture of the ACR pressure tubes indicates that the in-reactor creep deformation will be improved. Analysis of the distribution of texture parameters from a trial batch of 26 tubes shows that the variability is reduced relative to tubes fabricated in the past. This reduction in variability together with a shift to a coarser grain structure will result in a reduction in diametral creep design limits and thus a longer economic life for the fuel channels of the advanced CANDU reactor.
Receptor for advanced glycation end-products expression in subcutaneous adipose tissue is related to coronary artery disease
Authors: Rodiño-Janeiro B K , Salgado-Somoza A , Teijeira-Fernández E , González-Juanatey J R , Álvarez E , Eiras S 
Published: February 2011

ObjectiveObesity, a risk factor for coronary artery disease (CAD), is associated with inflammation and reactive oxygen species (ROS) production, while advanced glycation end-products, through their receptor (AGER or RAGE), play an important role on these processes. The aim of this study was to analyze the expression levels of RAGE, NADPH oxidase subunits, and catalase in adipose tissue in relation with CAD.Design and methodsPatients undergoing heart surgery were included in two groups: with and without CAD. Epicardial adipose tissue (EAT) and subcutaneous adipose tissue (SAT) biopsies were analyzed for gene expression by RT-quantitative PCR, immunohistochemistry, or western blot.ResultsRAGE mRNA and protein expression in SAT from patients with CAD was lower than in patients without CAD. However, there was no change in EAT from patients with or without CAD. P22-PHOX and RAGE gene expression were higher in EAT than in SAT, whereas catalase mRNA levels were lower. NADPH oxidase subunits and catalase mRNA expression were not influenced by CAD. Whereas NADPH oxidase-dependent oxidative response of SAT and EAT to lipid circulating levels could be different; glycemic levels were not related with the analyzed genes expression.ConclusionsThis study demonstrates that RAGE expression in SAT, but not in EAT, is down-regulated in patients with CAD with respect to those without CAD. Although changes were not observed for NADPH oxidase subunits or catalase expression between CAD and non-CAD patients, a possible relationship between ROS production and RAGE expression in adipose tissues cannot be ruled out.
A unique exonic splicing mutation in the CYP17A1 gene as the cause for steroid 17α-hydroxylase deficiency
Authors: Qiao Jie , Han Bing , Liu Bing-Li , Liu Wei , Wu Jia-Jun , Pan Chun-Ming , Jiang He , Gu Ting , Jiang Bo-Ren , Zhu Hui , Lu Ying-Li , Wu Wan-Ling , Chen Ming-Dao , Song Huai-Dong 
Published: February 2011

Background17α-Hydroxylase/17,20-lyase deficiency (17OHD) caused by a mutation in the CYP17A1 gene is characterized by hypertension, hypokalemia, and abnormal development of the genitalia. The majority of CYP17A1 mutations are located in the coding sequence, and several intronic splicing site mutations have been reported.ObjectiveA 2.5-year-old girl with 46,XY disordered sex development exhibited a nearly normal basal cortisol level and reduced sexual steroids. This study is aimed to explore the molecular basis and analyze its possible influence on the phenotype of the patient.Methods and resultsMutation analysis revealed compound heterozygous CYP17A1 mutations, with c.985_987delinsAA in one allele and a synonymous substitution (c.1263G>A) in another allele. In vitro expression analysis of the allelic minigene showed that the novel nucleotide variation located in exon 8 induces a splicing signal, which results in an aberrant splicing of CYP17A1 mRNA and a missing portion of exon 8. The translation product includes the deletion of six or seven amino acids from residue position 415 without causing a frameshift. Consistent with the result of molecular modeling, functional studies in transiently transfected HEK-293T cells with the aberrantly spliced enzyme proteins showed that the deleted proteins completely abolished the enzyme activity. However, RT-PCR indicated the existence of a small fraction of normal, functionally intact enzyme, which may explain the partial masculinization of this patient.ConclusionThis is the first description of an exonic splicing mutation in CYP17A1 relevant to the 17OHD phenotype. It also demonstrates the importance of studying synonymous change in such patients with less severe phenotype.
Screening for Visual Impairment in Children Ages 1–5 Years: Update for the USPSTF
Authors: Chou Roger , Dana Tracy , Bougatsos Christina 
Published: February 2011

CONTEXT:
Screening could identify preschool-aged children with vision problems at a critical period of visual development and lead to treatments that could improve vision.

OBJECTIVE:
To determine the effectiveness of screening preschool-aged children for impaired visual acuity on health outcomes.

METHODS:
We searched Medline from 1950 to July 2009 and the Cochrane Library through the third quarter of 2009, reviewed reference lists, and consulted experts. We selected randomized trials and controlled observational studies on preschool vision screening and treatments, and studies of diagnostic accuracy of screening tests. One investigator abstracted relevant data, and a second investigator checked data abstraction and quality assessments.

RESULTS:
Direct evidence on the effectiveness of preschool vision screening for improving visual acuity or other clinical outcomes remains limited and does not adequately address whether screening is more effective than no screening. Regarding indirect evidence, a number of screening tests have utility for identification of preschool-aged children with vision problems. Diagnostic accuracy did not clearly differ for children stratified according to age, although testability rates were generally lower in children 1 to 3 years of age. Treatments for amblyopia or unilateral refractive error were associated with mild improvements in visual acuity compared with no treatment. No study has evaluated school performance or other functional outcomes.

CONCLUSIONS:
Although treatments for amblyopia or unilateral refractive error can improve vision in preschool-aged children and screening tests have utility for identifying vision problems, additional studies are needed to better understand the effects of screening compared with no screening.
Febrile Seizures: Guideline for the Neurodiagnostic Evaluation of the Child With a Simple Febrile Seizure
Authors:   Subcommittee on Febrile Seizures
Published: February 2011

OBJECTIVE:To formulate evidence-based recommendations for health care professionals about the diagnosis and evaluation of a simple febrile seizure in infants and young children 6 through 60 months of age and to revise the practice guideline published by the American Academy of Pediatrics (AAP) in 1996.METHODS:This review included search and analysis of the medical literature published since the last version of the guideline. Physicians with expertise and experience in the fields of neurology and epilepsy, pediatrics, epidemiology, and research methodologies constituted a subcommittee of the AAP Steering Committee on Quality Improvement and Management. The steering committee and other groups within the AAP and organizations outside the AAP reviewed the guideline. The subcommittee member who reviewed the literature for the 1996 AAP practice guidelines searched for articles published since the last guideline through 2009, supplemented by articles submitted by other committee members. Results from the literature search were provided to the subcommittee members for review. Interventions of direct interest included lumbar puncture, electroencephalography, blood studies, and neuroimaging. Multiple issues were raised and discussed iteratively until consensus was reached about recommendations. The strength of evidence supporting each recommendation and the strength of the recommendation were assessed by the committee member most experienced in informatics and epidemiology and graded according to AAP policy.CONCLUSIONS:Clinicians evaluating infants or young children after a simple febrile seizure should direct their attention toward identifying the cause of the child's fever. Meningitis should be considered in the differential diagnosis for any febrile child, and lumbar puncture should be performed if there are clinical signs or symptoms of concern. For any infant between 6 and 12 months of age who presents with a seizure and fever, a lumbar puncture is an option when the child is considered deficient in Haemophilus influenzae type b (Hib) or Streptococcus pneumoniae immunizations (ie, has not received scheduled immunizations as recommended), or when immunization status cannot be determined, because of an increased risk of bacterial meningitis. A lumbar puncture is an option for children who are pretreated with antibiotics. In general, a simple febrile seizure does not usually require further evaluation, specifically electroencephalography, blood studies, or neuroimaging.
Factors Associated with Response to Methylphenidate in Advanced Cancer Patients
Authors: Yennurajalingam Sriram , Palmer J. Lynn , Chacko Ray , Bruera Eduardo 
Published: February 2011

Abstract

Learning Objectives
After completing this course, the reader will be able to: Identify the specific patient characteristics associated with response to methylphenidate as treatment for cancer-related fatigue.Compare day 1 patient response to methylphenidate to day 8 response and evaluate as a predictor of long-term improvement.
CME This article is available for continuing medical education credit at CME.TheOncologist.com

Background.
There has been increasing interest in the use of methylphenidate for cancer-related fatigue (CRF) in patients with advanced cancer. However, there is limited literature on the specific patient characteristics associated with response to methylphenidate. Our objective of this study was to identify the specific patient characteristics associated with response to methylphenidate and to compare day 1 response with day 8 response.

Methods.
We retrospectively reviewed the records of patients in two prospective controlled clinical trials that we had conducted who had received methylphenidate for cancer-related fatigue. Baseline patient characteristics, symptoms (as assessed by the Edmonton Symptom Assessment System [ESAS] and Functional Assessment of Chronic Illness Therapy-Fatigue [FACIT-F]), and response (change in fatigue) at the end of day 1 treatment were analyzed to determine their association with response to methylphenidate on day 8.

Results.
A total of 82 patients with advanced cancer who received methylphenidate for CRF were included in our review. The median age was 55 years, 66% were female, 74% were white, and the most common cancer type was breast (37%). Fifty out of 82 patients (61%) responded to methylphenidate (≥7 points in FACIT-F). The intensity of baseline fatigue positively correlated with the response to methylphenidate (p &lt; .001). Change in fatigue in response to methylphenidate was not associated with intensity of baseline depression, anxiety, drowsiness, or daily opioid dose. Better improvement of fatigue after treatment on day 1 was associated with more improvement with fatigue on day 8 as assessed by FACIT-F (p = .0004) and ESAS (p = .0001). Day 1 response as a predictor of day 8 response had a sensitivity of 0.84, a positive predictive value of 0.67, and specificity of 0.6.

Conclusions.
Response to methylphenidate is associated with higher baseline fatigue but not with higher baseline depression or sedation. Additionally, day 1 improvement is highly sensitive as a predictor of long-term improvement.
Determinants of Common Mental Disorders Detection by General Practitioners in the Primary Health Care in Brazil
Authors: Gonçalves Daniel A. , Fortes Sandra , Tófoli Luís Fernando , Campos Mônica Rodrigues , De Jesus Mari Jair 
Published: February 2011

Objective: Common Mental Disorders (CMD) are highly prevalent among patients attending primary care. Many of these disorders remain unrecognized by general practitioners (GPs), with the detection rates varying from 30 to 60%. This study aims to evaluate the CMD detection rates by Primary Heath Care (PHC) practitioners in Brazil—and factors that affect CMD detection. Methods: A cross sectional study was conducted with users of five PHC units in the city of Petrópolis. The CMD prevalence of psychiatric morbidity was estimated by the General Health Questionnaire-12, and the physician's CMD detection was evaluated by a questionnaire completed by GPs after each consultation. Results: Seven hundred and fourteen subjects participated of the study, and 400 (56%) were screened positive using GHQ-12 cut-off point of 2/3. GPs diagnosed 379 people with CMD (53.1%), and 256(36%) subjects were detected by both GHQ and the GPs with an OR of 3.04 (95%CI 2.23–4.13). CMD detection accuracy by GPs was 65%. There was a strong association between the detection of CMD and the report of medically unexplained physical symptoms by GPs. Being female, married, and a frequent service user was also related to higher detection rates. Conclusion: CMD detection rate was similar to those reported worldwide, but contrary to other studies, the presence of MUS increased detection rates. The high frequency of CMD in Primary Health Care highlights the need for improving GP and health worker's training in order to enable them to accurately recognize and treat psychological distress with evidence-based interventions.
A Japanese Scale to Assess Anxiety Severity: Development and Psychometric Evaluation
Authors: Mimura Chizu , Nishioka Miho , Sato Noriyuki , Hasegawa Ryoko , Horikoshi Ryu , Watanabe Yoshinori 
Published: February 2011

Objective: This study developed a Japanese self-rating anxiety scale, the Himorogi Self-rating Anxiety Scale (HSAS), and tested psychometric properties of its use in Japanese psychiatric patients. Methods: The process of developing the scale consisted of an intensive literature review, assessment of existing instruments, and detailed discussion on the content of the newly developed scale. Data for psychometric evaluation were collected from 419 outpatients of psychiatric clinics. The Hamilton Rating Scale for Anxiety Interview Guide (HAMA-IG) and the Sheehan Patient Rated Anxiety Scale (SPRAS) were used as standards against which the HSAS was compared. Results: Confirmatory factor analysis revealed a unifactorial nature for the HSAS and fewer insignificant items in the HSAS than the HAMA-IG and the SPRAS. Cronbach's alpha and test-retest coefficients indicated sufficient reliability. High correlation with the HAMA-IG and the SPRAS indicated evidence of convergence for the HSAS. ROC analysis showed high ability to distinguish between the presence and absence or remission of anxiety. Analysis of descriptive data suggested a larger dynamic range for the HSAS than the HAMA-IG and the SPRAS. Conclusions: The HSAS is a brief scale to assess anxiety severity, demonstrating evidence of good psychometric properties. It is recommended for use in research and clinical practice.