bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of quantitative intra-operative electrodiagnosis during partial ulnar nerve transfer to restore elbow flexion
Authors: Suzuki O. , Sunagawa T. , Yokota K. , Nakashima Y. , Shinomiya R. , Nakanishi K. , Ochi M. 
Published: March 2011

The transfer of part of the ulnar nerve to the musculocutaneous nerve, first described by Oberlin, can restore flexion of the elbow following brachial plexus injury. In this study we evaluated the additional benefits and effectiveness of quantitative electrodiagnosis to select a donor fascicle. Eight patients who had undergone transfer of a simple fascicle of the ulnar nerve to the motor branch of the musculocutaneous nerve were evaluated. In two early patients electrodiagnosis had not been used. In the remaining six patients, however, all fascicles of the ulnar nerve were separated and electrodiagnosis was performed after stimulation with a commercially available electromyographic system. In these procedures, recording electrodes were placed in flexor carpi ulnaris and the first dorsal interosseous. A single fascicle in the flexor carpi ulnaris in which a high amplitude had been recorded was selected as a donor and transferred to the musculocutaneous nerve. In the two patients who had not undergone electrodiagnosis, the recovery of biceps proved insufficient for normal use. Conversely, in the six patients in whom quantitative electrodiagnosis was used, elbow flexion recovered to an M4 level. Quantitative intra-operative electrodiagnosis is an effective method of selecting a favourable donor fascicle during the Oberlin procedure. Moreover, fascicles showing a high-amplitude in reading flexor carpi ulnaris are donor nerves that can restore normal elbow flexion without intrinsic loss.
Gender differences in the anatomy of the distal femur
Authors: Gillespie R. J. , Levine A. , Fitzgerald S. J. , Kolaczko J. , DeMaio M. , Marcus R. E. , Cooperman D. R. 
Published: March 2011

Recently, gender-specific designs of total knee replacement have been developed to accommodate anatomical differences between males and females. We examined a group of male and female distal femora matched for age and height, to determine if there was a difference in the aspect ratio (mediolateral distance versus anteroposterior distance) and the height of the anterior flange between the genders. The Hamann-Todd Collection provided 1207 skeletally mature cadaver femora. The femoral length, the anteroposterior height, height of the lateral and medial flanges and the mediolateral width were measured in all the specimens. The mechanical axis of the femur, the cut articular width and the aspect ratio were assessed. Statistical analysis of the effect of gender upon the aspect ratio and the lateral and medial flanges was undertaken, controlling for age, height and race. The mean aspect ratio of male femora was 1.21 (sd 0.07) and of female femora it was 1.16 (sd 0.06) (p < 0.001). There was no significant difference between male and female specimens in the mean size of the lateral flange (6.57 mm (sd 2.57) and 7.02 mm (sd 2.36), respectively; p = 0.099) or of the medial flange (3.03 mm (sd 2.47) and 3.56 mm (sd 2.32), respectively; p = 0.67). Future work in the design of knee prostheses should take into account the overall variability of the anatomy of the distal femur.
The pattern of the fracture and displacement of the fragments predict the outcome in proximal humeral fractures
Authors: Foruria A. M. , de Gracia M. M. , Larson D. R. , Munuera L. , Sanchez-Sotelo J. 
Published: March 2011

Our aim was to determine the effect of the initial pattern of fracture and the displacement of fragments on the outcome of proximal humeral fractures treated conservatively. We followed 93 consecutive patients prospectively for one year. Final movement and strength were compared with those of the contralateral side. The final American Shoulder and Elbow Society score and the Disabilities of Arm, Shoulder and Hand and Short-Form 36 questionnaires were compared with those provided by the patient on the day of the injury. Radiographs and CT scans with three-dimensional reconstruction were obtained in all patients. The pattern of the fracture and the displacement of individual fragments were analysed and correlated with the final outcome. There were two cases of nonunion and six of avascular necrosis. The majority of the fractures (84 patients; 90%) followed one of the following four patterns: posteromedial (varus) impaction in 50 patients (54%), lateral (valgus) impaction in 13 (14%), isolated greater tuberosity in 15 (16%), and anteromedial impaction fracture in six (6%). Head orientation, impaction of the surgical neck and displacement of the tuberosity correlated strongly with the outcome. In fractures with posteromedial impaction, a poor outcome was noted as the articular surface displaced inferiorly increasing its distance from the acromion. A poorer outcome was noted as a fractured greater tuberosity displaced medially overlapping with the posterior articular surface. Lateral impaction fractures had a worse outcome than other patterns of fracture.
Validation of the classification system for acetabular chondral lesions identified at arthroscopy in patients with femoroacetabular impingement
Authors: Konan S. , Rayan F. , Meermans G. , Witt J. , Haddad F. S. 
Published: March 2011

There have been considerable recent advances in the understanding and management of femoroacetabular impingement and associated labral and chondral pathology. We have developed a classification system for acetabular chondral lesions. In our system, we use the six acetabular zones previously described by Ilizaliturri et al. The cartilage is then graded on a scale of 0 to 4 as follows: grade 0, normal articular cartilage lesions; grade 1, softening or wave sign; grade 2, cleavage lesion; grade 3, delamination; and grade 4, exposed bone. The site of the lesion is further classed as A, B or C based on whether the lesion is less than one-third of the distance from the acetabular rim to the cotyloid fossa, one-third to two-thirds of the same distance and greater than two-thirds of the distance, respectively. In order to validate the classification system, six surgeons graded ten video recordings of hip arthroscopy.Our findings showed a high intra-observer reliability of the classification system with an intraclass correlation coefficient of 0.81 and a high interobserver reliability with an intraclass correlation coefficient of 0.88.We have developed a simple reproducible classification system for lesions of the acetabular cartilage, which it is hoped will allow standardised documentation to be made of damage to the articular cartilage, particularly that associated with femoroacetabular impingement.
Damage of an Oxinium femoral head and polyethylene liner following ‘routine’ total hip replacement
Authors: McCalden R. W. , Charron K. D. , Davidson R. D. , Teeter M. G. , Holdsworth D. W. 
Published: March 2011

We present a case of early retrieval of an Oxinium femoral head and corresponding polyethylene liner where there was significant surface damage to the head and polyethylene. The implants were retrieved at the time of revision surgery to correct leg-length discrepancy just 48 hours after the primary hip replacement. Appropriate analysis of the retrieved femoral head demonstrated loss of the Oxinium layer with exposure of the underlying substrate and transfer of titanium from the acetabular shell at the time of a reduction of the index total hip replacement. In addition, the level of damage to the polyethylene was extensive despite only 48 hours in situ. The purpose of this report is to highlight the care that is required at the time of reduction, especially with these hard femoral counter-faces such as Oxinium. To our knowledge, the damage occurring at the time of reduction has not been previously reported following the retrieval of an otherwise well-functioning hip replacement.
Revision rates after total joint replacement
Authors: Labek G. , Thaler M. , Janda W. , Agreiter M. , Stöckl B. 
Published: March 2011

In a systematic review, reports from national registers and clinical studies were identified and analysed with respect to revision rates after joint replacement, which were calculated as revisions per 100 observed component years. After primary hip replacement, a mean of 1.29 revisions per 100 observed component years was seen. The results after primary total knee replacement are 1.26 revisions per 100 observed component years, and 1.53 after medial unicompartmental replacement. After total ankle replacement a mean of 3.29 revisions per 100 observed component years was seen. The outcomes of total hip and knee replacement are almost identical. Revision rates of about 6% after five years and 12% after ten years are to be expected.
Ward-based rather than team-based junior surgical doctors reduce mortality for patients with a fracture of the proximal femur
Authors: Findlay J. M. , Keogh M. J. , Boulton C. , Forward D. P. , Moran C. G. 
Published: March 2011

We performed a retrospective study of a departmental database to assess the efficacy of a new model of orthopaedic care on the outcome of patients with a fracture of the proximal femur. All 1578 patients admitted to a university teaching hospital with a fracture of the proximal femur between December 2007 and December 2009 were included. The allocation of Foundation doctors years 1 and 2 was restructured from individual teams covering several wards to pairs covering individual wards. No alterations were made in the numbers of doctors, their hours, out-of-hours cover, or any other aspect of standard patient care. Outcome measures comprised 30-day mortality and cause, complications and length of stay. Mortality was reduced from 11.7% to 7.6% (p = 0.007, Cox’s regression analysis); adjusted odds ratio was 1.559 (95% confidence interval 1.128 to 2.156). Reductions were seen in Clostridium difficile colitis (p = 0.017), deep wound infection (p = 0.043) and gastrointestinal haemorrhage (p = 0.033). There were no differences in any patient risk factors (except the prevalence of chronic obstructive pulmonary disease), cause of death and length of stay before and after intervention. The underlying mechanisms are unclear, but may include improved efficiency and medical contact time. These findings may have implications for all specialties caring for patients on several wards, and we believe they justify a prospective trial to further assess this effect.
Does morbid obesity affect the outcome of total hip replacement?
Authors: McCalden R. W. , Charron K. D. , MacDonald S. J. , Bourne R. B. , Naudie D. D. 
Published: March 2011

We evaluated the outcome of primary total hip replacement (THR) in 3290 patients with the primary diagnosis of osteoarthritis at a minimum follow-up of two years. They were stratified into categories of body mass index (BMI) based on the World Health Organisation classification of obesity. Statistical analysis was carried out to determine if there was a difference in the post-operative Western Ontario and McMaster Universities osteoarthritis index, the Harris hip score and the Short-Form-12 outcome based on the BMI. While the pre- and post-operative scores were lower for the group classified as morbidly obese, the overall change in outcome scores suggested an equal if not greater improvement compared with the non-morbidly obese patients. The overall survivorship and rate of complications were similar in the BMI groups although there was a slightly higher rate of revision for sepsis in the morbidly obese group. Morbid obesity does not affect the post-operative outcome after THR, with the possible exception of a marginally increased rate of infection. Therefore withholding surgery based on the BMI is not justified.
Race/Ethnicity Is Not Associated With Mortality in the PICU
Authors: Epstein David , Wong Carolyn F. , Khemani Robinder G. , Moromisato David Y. , Waters Karen , Kipke Michele D. , Markovitz Barry P. 
Published: March 2011

OBJECTIVE:
To determine if a difference in survival exists between children of different racial/ethnic groups who were admitted to the PICU, after controlling for severity of illness (pediatric index of mortality 2).

METHODS:
We used the largest national clinical PICU database (Virtual PICU Performance System) with data from 31 hospitals, from 2005 to 2008. Children 18 years and younger were included. We collected demographic, pediatric index of mortality 2, diagnosis, and PICU mortality data. Logistic regression models were constructed to identify PICU mortality risk factors.

RESULTS:
The analysis of 80 739 patients revealed that, after controlling for severity of illness, being female (odds ratio [OR]: 1.12 [95% confidence interval (CI): 1.02–1.24] P = .019), 1 month or younger (OR: 1.39 [95% CI: 1.17–1.65] P &lt; .001) or 12 years or older (OR: 1.34 [95% CI: 1.17–1.52] P &lt; .001), or having an infectious diagnosis (OR: 2.22 [95% CI: 1.83–2.71] P &lt; .001) or oncologic diagnosis (OR: 1.50 [95% CI: 1.14–1.99] P = .004) increased PICU mortality. Having “other” insurance type (OR: 1.58 [95% CI: 1.11–2.24] P = .010) or being Asian/Indian/Pacific Islander (OR: 1.35 [95% CI: 1.01–1.81] P = .042) seemed also to be mortality risk factors; however, because of heterogeneity and small group sizes (1.7% and 2.5% of the study population, respectively), these results are inconclusive.

CONCLUSIONS:
Although gender, age, and diagnosis showed an effect on severity of illness-adjusted PICU mortality, race/ethnicity did not. Additional investigation is warranted because the present results (ie, insurance type) may be proxy measurements for other influences not collected in this database, such as sociocultural and socioeconomic factors.
Effectiveness of Preventive Dental Treatments by Physicians for Young Medicaid Enrollees
Authors: Pahel Bhavna T. , Rozier R. Gary , Stearns Sally C. , Quiñonez Rocio B. 
Published: March 2011

OBJECTIVE:
To estimate the effectiveness of a medical office–based preventive dental program (Into the Mouths of Babes [IMB]), which included fluoride varnish application, in reducing treatments related to dental caries.

METHODS:
We used longitudinal claims and enrollment data for all children aged 72 months or younger enrolled in North Carolina Medicaid from 2000 through 2006. Regression analyses compared subgroups of children who received up to 6 IMB visits at ages 6 to 35 months with children who received no IMB visits. Analyses were adjusted for child and area characteristics.

RESULTS:
Children enrolled in North Carolina Medicaid with ≥4 IMB visits experienced, on average, a 17% reduction in dental-caries–related treatments up to 6 years of age compared with children with no IMB visits. When we simulated data for initial IMB visits at 12 and 15 months of age, there was a cumulative 49% reduction in caries-related treatments at 17 months of age. The cumulative effectiveness declined because of an increase in treatments from 24 to 36 months, an increase in referrals for dental caries occurred with increasing time since fluoride application, and emergence of teeth not initially treated with fluoride.

CONCLUSIONS:
North Carolina's IMB program was effective in reducing caries-related treatments for children with ≥4 IMB visits. Multiple applications of fluoride at the time of primary tooth emergence seem to be most beneficial. Referrals to dentists for treatment of existing disease detected by physicians during IMB implementation limited the cumulative reductions in caries-related treatments, but also contributed to improved oral health.
Neurodevelopmental Outcomes of Triplets or Higher-Order Extremely Low Birth Weight Infants
Authors: Wadhawan Rajan , Oh William , Vohr Betty R. , Wrage Lisa , Das Abhik , Bell Edward F. , Laptook Abbot R. , Shankaran Seetha , Stoll Barbara J. , Walsh Michele C. , Higgins Rosemary D. ,   for the Eunice Kennedy Shriver National Institute of Child Health & Human Development Neonatal Research Network
Published: March 2011

BACKGROUND:
Extremely low birth weight twins have a higher rate of death or neurodevelopmental impairment than singletons. Higher-order extremely low birth weight multiple births may have an even higher rate of death or neurodevelopmental impairment.

METHODS:
Extremely low birth weight (birth weight 401–1000 g) multiple births born in participating centers of the Neonatal Research Network between 1996 and 2005 were assessed for death or neurodevelopmental impairment at 18 to 22 months' corrected age. Neurodevelopmental impairment was defined by the presence of 1 or more of the following: moderate to severe cerebral palsy; mental developmental index score or psychomotor developmental index score less than 70; severe bilateral deafness; or blindness. Infants who died within 12 hours of birth were excluded. Maternal and infant demographic and clinical variables were compared among singleton, twin, and triplet or higher-order infants. Logistic regression analysis was performed to establish the association between singletons, twins, and triplet or higher-order multiples and death or neurodevelopmental impairment, controlling for confounding variables that may affect death or neurodevelopmental impairment.

RESULTS:
Our cohort consisted of 8296 singleton, 2164 twin, and 521 triplet or higher-order infants. The risk of death or neurodevelopmental impairment was increased in triplets or higher-order multiples when compared with singletons (adjusted odds ratio: 1.7 [95% confidence interval: 1.29–2.24]), and there was a trend toward an increased risk when compared with twins (adjusted odds ratio: 1.27 [95% confidence: 0.95–1.71]).

CONCLUSIONS:
Triplet or higher-order births are associated with an increased risk of death or neurodevelopmental impairment at 18 to 22 months' corrected age when compared with extremely low birth weight singleton infants, and there was a trend toward an increased risk when compared with twins.
Cerebral Oxygenation Is Depressed During Sleep in Healthy Term Infants When They Sleep Prone
Authors: Wong Flora Y. , Witcombe Nicole B. , Yiallourou Stephanie R. , Yorkston Sophie , Dymowski Alicia R. , Krishnan Lalitha , Walker Adrian M. , Horne Rosemary S. C. 
Published: March 2011

OBJECTIVE:
Prone sleeping is a major risk factor for the sudden infant death syndrome and is associated with lower blood pressure and impaired arousability from sleep, both of which may be signs of cerebral hypoxia. However, the impact of sleep position on cerebral oxygenation during infancy remains unknown. We assessed the effects of sleeping position, sleep state, and postnatal age on cerebral oxygenation by measuring tissue oxygenation index (TOI) during the first 6 months of infancy.

SUBJECTS AND METHODS:
Seventeen healthy term infants (8 girls and 9 boys) were recruited as study participants. Infants were studied at ages 2 to 4 weeks, 2 to 3 months, and 5 to 6 months by use of daytime polysomnography, with additional measurements of blood pressure (Finometer, FMS Finometer Medical Systems, Amsterdam, Netherlands) and tissue oxygenation index (TOI) (NIRO 200 spectrophotometer, Hamamatsu Photonics KK, Tokyo, Japan).

RESULTS:
In infants who slept in the prone position, TOI was lower in both quiet sleep (QS) and active sleep (AS) at age 2 to 4 weeks and in QS at age 2 to 3 months (P &lt; .05). TOI was lower in AS compared with QS in infants aged 2 to 4 weeks (P &lt; .05). When the infants reached 5 to 6 months of age, TOI was greater in AS (P &lt; .05), as there was a profound decrease in TOI during QS (P &lt; .05) over this period. No relationship was identified between blood pressure and TOI at any age.

CONCLUSIONS:
In healthy infants cerebral oxygenation is reduced during sleep in the prone position. This reduction may underpin the reduced arousability from sleep exhibited by healthy infants who sleep prone, a finding that provides new insight into potential risks of prone sleeping and mechanisms of sudden infant death syndrome.
Novel Solution to Cement Strength Retrogression
Authors: Gibson Sarah 
Published: March 2011

Abstract
When Portland cement is exposed to high temperature environments it experiences "strength retrogression", which is characterized by the breakdown of the set cement matrix. This results in loss of zonal isolation and/or pipe support, impacting the operational life span of the wellbore and its eventual abandonment. To prevent this, it is standard industry practice to incorporate extra silica into the cement slurry. Silica flour or sand is usually dry-blended with the bulk cement at concentrations of 35-40% bwoc. However, this methodology carries health risks, complicates operations (especially off-shore) and introduces costs that could be avoided.
With the North Sea being a mature drilling arena, it requires ever more complicated well bores to access remaining deposits and therefore operators are continually looking for more cost-effective methods of achieving this. Coupled with the desire to reduce the impact on the environment of our work, a new method for introducing silica to cement slurries was introduced. Since its arrival to the market in 2003, the use of a liquid strength retrogression prevention additive has steadily been gaining acceptance throughout the industry. This paper reviews the benefits of such a system, especially during exploration work and short rig hire contracts, and some of the issues encountered in bringing these gains to customers. Overcoming handling and shelf-life problems will lead to reduced costs and allow more operators to take advantage of this solution.
Continuous Motion Rig. A Detailed Study of a 750 Ton Capacity, 3600 m/hr Trip Speed Rig
Authors: Grinrød Mads , Krohn Helge 
Published: March 2011

Abstract
The basic principles for a Continuous Motion Rig (CMR) has been presented earlier (IADC/SPE128253).The CMR concept allows jointed pipe to be run or pulled in a continuous manner.
Several benefits besides significant improvement in tripping speed results from continuous movement of pipe. This new rig concept can be used on all rigs –on or offshore where well costs, well safety and efficiency are important issues.
The CMR concept based on a 750 ton system has been studied in a Joint Industry Project (JIP).
This paper discusses aspects of the Continuous Motion Rig such as system benefits, equipment, control system and layout based on findings in the Joint Industry Project. Design basis in JIP was set at 3600 m/hr trip speed corresponding to 1 m/sec continuous running or pulling of drill pipe. High efficiency demands a fully automated rig as concerns surface processes involved in normal drilling operations. This automation requires rethinking control systems. Continuous motion technology opens up possibilities to explore and exploit deeper deposits economically.