bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Efficacy of Once-Daily Nevirapine Dosing: A Multicohort Study
Authors: Calmy Alexandra , Vallier Nathalie , Nguyen Alain , Lange Joep MA , Battegay Manuel , de Wolf Frank , Reiss Peter , Lima Viviane D , Hirschel Bernard , Hogg Robert S , Yip Benita , Montaner Julio SG , Wit Ferdinand W 
Published: November 2009

Background Nevirapine (NVP) is often prescribed once daily in clinical practice in combination with a once daily nucleoside backbone. We investigated the relationship of NVP dosing with safety and efficacy. Methods Patients from the Dutch AIDS Therapy Evaluation in the Netherlands (ATHENA) cohort study, Canadian HAART Observational Medical Evaluation and Research (HOMER) cohort and Swiss HIV Cohort Study (SHCS) using NVP-based combination therapy either once daily or twice daily were included. Risk factors for discontinuing NVP because of hypersensitivity reactions (HSRs) were investigated using multivariate logistic regression. Risk factors for virological failure 96 weeks after NVP initiation were identified using logistic regression and Cox models. Results Of 5,636 patients (774 once daily and 4,862 twice daily), 268 (4.8%) discontinued NVP because of HSR between 2 and 18 weeks. Logistic regression showed that, compared with patients with detectable HIV type-1 (HIV-1) RNA starting twice-daily NVP, there was a significantly higher risk of discontinuation of once-daily NVP because of HSR in patients with detectable HIV-1 RNA at the start of NVP (odds ratio [OR] 1.52; P=0.04), whereas the risk was actually significantly lower in patients starting once-daily NVP with undetectable HIV-1 RNA (OR 0.44; P=0.04). Cox models showed that risk of virological failure was not different for twice- versus once-daily NVP in treatment-naive patients (twice-daily versus once-daily hazard ratio [HR] 1.01; P=0.95), treatment- experienced patients experiencing treatment failure (twice-daily versus once-daily HR 1.22; P=0.30) or patients with undetectable HIV-1 RNA simplifying treatment with NVP (twice-daily versus once-daily HR 1.29; P=0.30). Conclusions Initiation of a once-daily NVP-based regimen in patients with suppressed viraemia carries a low risk of treatment-limiting HSR. Once- or twice-daily NVP-based regimens appear to have similar antiretroviral efficacy.
Effects of HIV type-1 immune selection on susceptability to integrase inhibitor resistance
Authors: Tschochner Monika , Chopra Abha , Maiden Tanya M , Ahmad Imran F , James Ian , Furrer Hansjakob , Günthard Huldrych F , Mallal Simon , Rauch Andri , John Mina 
Published: November 2009

Background All site-specific interactions between HIV type-1 (HIV-1) subtype, human leukocyte antigen (HLA)-associated immune selection and integrase inhibitor resistance are not completely understood. We examined naturally occurring polymorphisms in HIV-1-integrase sequences from 342 antiretroviral-naive individuals from the Western Australian HIV Cohort Study and the Swiss HIV Cohort Study. Methods Standard bulk sequencing and sequence-based typing were used to generate integrase sequences and high-resolution HLA genotypes, respectively. Viral residues were examined with respect to drug resistance mutations and CD8+ T-cell escape mutations. Results In both predominantly subtype B cohorts, 12 of 38 sites that mediate integrase inhibitor resistance mutations were absolutely conserved, and these included the primary resistance mutations. There were 18 codons with non-primary drug resistance-associated substitutions at rates of up to 58.8% and eight sites with alternative polymorphisms. Five viral residues were potentially subject to dual-drug and HLA-associated immune selection in which both selective pressures either drove the same amino acid substitution (codons 72, 157 and 163) or HLA alleles were associated with an alternative polymorphism that would alter the genetic barrier to resistance (codons 125 and 193). The common polymorphism T125A, which was characteristic of non-subtype B and was also associated with carriage of HLA-B*57/*5801, increased the mutational barrier to the resistance mutation T125K. Conclusions Primary integrase inhibitor resistance mutations were not detected in the absence of drug exposure in keeping with sites of high constraint. Viral polymorphisms caused by immune selection and/or associated with non-subtype B might alter the genetic barrier to some non-primary resistance-associated mutations.
Efficacy of the novel parainfluenza virus haemagglutinin-neuraminidase inhibitor BCX 2798 in mice – further evaluation
Authors: Alymova Irina V , Watanabe Makiko , Boyd Kelli L , Chand Pooran , Babu Y Sudhakara , Portner Allen 
Published: November 2009

Background Human parainfluenza virus type 1 (hPIV-1) causes serious respiratory tract infections, especially in children. This study investigated the efficacy of the novel haemagglutinin-neuraminidase (HN) inhibitor BCX 2798 in the prophylaxis of lethal and the treatment of non-lethal parainfluenza virus infection in mice. Methods In the prophylaxis model, 129x1/SvJ mice were inoculated with a 90% lethal dose of a recombinant Sendai virus, in which the HN gene was replaced with that of hPIV-1 (rSeV[hPIV-1HN]). The mice were intranasally treated either once or for 5 days with 1 or 10 mg/kg/ day of BCX 2798, starting 4 h before infection. In the therapeutic model, mice were infected with 100 plaque-forming units of rSeV(hPIV-1HN) per mouse and treated intranasally with 0.1, 1 or 10 mg/kg/day of BCX 2798 for 5 days, starting 24 or 48 h after infection, or for 4 days starting 72 h after infection. Results Similar to multiple dosing, a single intranasal prophylaxis with 1 or 10 mg/kg of BCX 2798 protected approximately 40% or 90%, respectively, of mice from death by rSeV(hPIV-1HN) infection. BCX 2798 also significantly reduced virus lung titres (in a dose- and time- dependent manner) and reduced histopathological changes in the airways of non-lethally infected mice at multiple intranasal dosages in the therapeutic model, with the lowest effective dosage being 0.1 mg/kg/day administered 24 h after infection. Conclusions BCX 2798 was effective in the prophylaxis of lethal and in the therapy of non-lethal parainfluenza virus infection in mice, suggesting further consideration of BCX 2798 for clinical trials.
Potential risk factors associated with the use of cidofovir to treat benign human papillomavirus-related disease
Authors: Donne Adam J , Hampson Lynne , He Xiaotong T , Day Philip JR , Salway Fiona , Rothera Michael P , Homer Jarrod J , Hampson Ian N 
Published: November 2009

BackgroundCidofovir is currently being used off-licence to treat different viral infections, such as benign low-risk human papillomavirus (HPV)-related recurrent respiratory papillomatosis (RRP). There are concerns over the safety of this practice as rat studies demonstrated a high malignant transformation rate. As yet, there are no clinical reports of cidofovir-induced malignant changes in humans.MethodsTelomerase immortalised human keratinocytes (hTert) stably expressing E6 proteins from either low-risk HPV6b or high-risk HPV16 and vector control cells were treated with either low-dose (5 μg/ml) or higher dose (30 μg/ml) cidofovir for 2 days and the effects evaluated by clonogenic survival assays. Based on these results, gene expression microarray analysis was performed on cidofovirtreated low-risk E6 and vector cells before, during and after drug treatment, and the results verified by real-time PCR.ResultsBoth low-risk and high-risk E6-expressing cells show significantly improved long-term survival compared with vector control cells when exposed to 5 μg/ml cidofovir for 2 days, (hTert T6E6 P=0.0007, hTert T16E6 P=0.00023 and hTert vector control P=0.62). Microarray and real-time PCR analyses of low-dose cidofovir-treated low-risk E6-expressing cells revealed changes in gene expression that are known to be associated with malignant progression, which were not observed in drug-treated vector control cells.ConclusionsThis is the first report that cidofovir can both increase cell survival and induce alterations in gene expression that are known to be associated with malignant transformation in cells transduced only with the E6 gene from low-risk HPV. It is our belief that these data provide cause for concern over the off-license use of this drug to treat RRP.
The Effect of High-Fidelity Simulation Training on Medical-Surgical Graduate Nurses' Perceived Ability to Respond to Patient Clinical Emergencies
Authors: Gordon Christopher James , Buckley Tom 
Published: November 2009

Background:
Recognition of and early intervention for patients with acutely deteriorating conditions is often the responsibility of medical-surgical nurses. This study examined the effect of simulation on medical-surgical graduate nurses' perceived ability and confidence in responding to patient clinical emergencies.

Method:
Fifty medical-surgical graduate students participated in high-fidelity immersive simulations. Questionnaires completed before and after simulation asked participants to rate their perceived ability and confidence.

Results:
After simulation, participants reported increased confidence in their ability to perform both technical and nontechnical aspects of responding to patient clinical emergencies. Ninety-four percent of participants identified formal debriefing as the most useful aspect of the simulation experience.

Conclusion:
Medical-surgical graduate nurses' confidence and perceived technical and nontechnical skills during patient clinical emergencies are enhanced following simulation. The ability of graduates to transfer the increased confidence and perceived advanced resuscitation skills following simulation to the clinical environment needs to be investigated.

J Contin Educ Nurs
2009;40(11):491–498.
Creating a Culture of Professional Development: A Milestone Pathway Tool for Registered Nurses
Authors: Cooper Elizabeth 
Published: November 2009

The nursing shortage continues to be a significant threat to health care. Creating a culture of professional development in health care institutions is one way to combat this shortage. Professional development refers to a constant commitment to maintain one's knowledge and skill base. Increasing professional development opportunities in the health care setting has been shown to affect nurse retention and satisfaction. Several approaches have been developed to increase professional development among nurses. However, for the most part, these are “one size fits all” approaches that direct nurses to progress in lock step fashion in skill and knowledge acquisition within a specialty. This article introduces a milestone pathway tool for registered nurses designed to enhance professional development that is unique to the individual nurse and the specific nursing unit. This tool provides a unit-specific concept map, a milestone pathway template, and a personal professional development plan.J Contin Educ Nurs2009;40(11):501–508.
Surgical Planning and Procedures for Difficult Total Knee Arthroplasty
Authors: Feng-Chen Kao , Kuo-Yao Hsu , Yuan-Kun Tu , Ming-Chih Chou 
Published: November 2009

Most total knee arthroplasties (TKAs) are performed for minimal knee joint deformities with standard techniques and instrumentation. However, patients with extra-articular deformities, severe varus and valgus deformities, and posttraumatic arthrosis pose unique challenges to surgeons. Each deformity requires different modifications of surgical technique or prosthesis used to successfully perform TKA and optimize postoperative results.
The surrounding tissues connect the femur and the tibia at the anterior, posterior, medial, and lateral walls of the knee joint. The medial soft tissues should be released for varus deformities and lateral soft tissues should be released for valgus deformities. The posterior soft tissue may be released for flexed deformities. The anterior quadriceps and patellar tendon may be adjusted while approaching the knee joint for posttraumatic arthrosis. A more constrained knee prosthesis may be needed for more severe deformities.
Reproducibility and Accuracy of Templating Uncemented THA With Digital Radiographic and Digital TraumaCad Templating Software
Authors: Anil Kumar Panamoottil G. , Kirmani Sayyied J. , Humberg Heike , Kavarthapu Venu , Li Patrick 
Published: November 2009

The reproducibility and accuracy of a digital software templating program on digital images was examined for primary uncemented total hip arthroplasty (THA). Forty-five patients waiting for an uncemented THA had templating performed of their digital picture archiving and communication systems (PACS) pelvic images with the TraumaCad software program (Orthocrat Ltd, Petach-Tikva, Israel). Acetabular cup size, femoral stem size, and femoral offset were noted by 2 observers, and again by 1 of the observers a week later. Through correlation coefficients and significance testing, the degree of intraobserver and interobserver variability was evaluated, as well as the level of accuracy for digital templating.
Excellent correlation was found for all data sets, with no significant difference between them in intraobserver reproducibility. Also in terms of interobserver reproducibility, we found good levels of correlation, with no significant difference between the data sets. In terms of accuracy, the correlation was at least acceptable with no significant difference between any of the data sets.
The use of the TraumaCad digital software program provides a reliable method of templating digital images for uncemented THAs. There is little intraobserver and interobserver variability, and the method produces an acceptable level of accuracy.
Noise Characteristics of Surgical Space Suits
Authors: Pearlman Ronald C. , Sandidge Olisa 
Published: November 2009

Several studies indicate that the noise generated by performing orthopedic surgery has the potential to cause hearing loss. Noise-induced hearing loss was found in 50% of the orthopedic surgeons studied using audiometric testing, with a greater incidence associated with years of practice.
Noise produced by several orthopedic surgical instruments such as saws, drills, and hammers during surgery exceeds 100 dB, especially during knee replacement procedures. In one study, surgical space suits (personal protection systems) were suggested to help protect against noise-induced hearing loss, although space suit manufacturers do not market them as noise-reduction devices. A research protocol was developed to determine if commercially available surgical space suits help to reduce noise at the surgeon's ear. With the commercially available personal protection systems used in this research, there was no significant extra-helmet noise decrease by wearing the space suit. Sound inside the helmet at the level of the ear averaged 61dBA, approximately the level of conversational speech, which may explain the difficulty the surgical staff may have hearing speech in the operating room when the space suit is worn with the fan on.
If surgical noise is to be decreased, earplugs or muffs must be worn not only by the surgeon, but also by all personnel in the operating theater. At greatest risk may be the anesthesiologist, who may experience several orthopedic surgeries in a single day and is positioned close to the patient.
Multivariate Analysis of Prognostic Factors in Synovial Sarcoma
Authors: Koh Kyoung Hwan , Cho Eun Yoon , Kim Dong Wook , Seo Sung Wook 
Published: November 2009

Many studies have described the diversity of synovial sarcoma in terms of its biological characteristics and clinical features. Moreover, much effort has been expended on the identification of prognostic factors because of unpredictable behaviors of synovial sarcomas. However, with the exception of tumor size, published results have been inconsistent.
We attempted to identify independent risk factors using survival analysis. Forty-one consecutive patients with synovial sarcoma were prospectively followed from January 1997 to March 2008. Overall and progression-free survival for age, sex, tumor size, tumor location, metastasis at presentation, histologic subtype, chemotherapy, radiation therapy, and resection margin were analyzed, and standard multivariate Cox proportional hazard regression analysis was used to evaluate potential prognostic factors. Tumor size (>5 cm), nonlimb-based tumors, metastasis at presentation, and a monophasic subtype were associated with poorer overall survival. Multivariate analysis showed metastasis at presentation and monophasic tumor subtype affected overall survival. For the progression-free survival, monophasic subtype was found to be only 1 prognostic factor.
The study confirmed that histologic subtype is the single most important independent prognostic factors of synovial sarcoma regardless of tumor stage.
Range of Flexion After Primary TKA: The Effect of Soft Tissue Release and Implant Design
Authors: Ahmed Issaq , Gray Andrew C. , van der Linden Marietta , Nutton Richard 
Published: November 2009

Range of motion following total knee arthroplasty (TKA) is a crucial measure of clinical outcome. The purpose of this randomized, controlled study was to determine which factors are predictive of postoperative range of flexion. Fifty-six patients received either a standard or a high-flexion design NexGen Legacy Posterior-Stabilized TKA (Zimmer, Warsaw, Indiana). The relationship between preoperative flexion, intraoperative flexion, and range of flexion 1 year postoperatively was determined. The influence of soft tissue release and the type of femoral component was also investigated.
A significant correlation existed between preoperative flexion, intraoperative flexion, and maximum flexion 1 year postoperatively. Patients who had a preoperative range of flexion less than the mean range of flexion for the overall group gained flexion, whereas patients with a preoperative range of flexion greater than the mean range of flexion lost flexion. The degree of soft tissue release performed and the type of implant used had no influence on maximum flexion at 1 year.
The principal predictive factor of postoperative range of flexion, regardless of the degree of soft tissue release or implant design, is the preoperative and intraoperative range of flexion.
Arthrodiatasis for the Treatment of Perthes' Disease
Authors: Aly Tarek A. , Amin Osama A. 
Published: November 2009

It is hypothesized that the interruption of the blood supply is an important factor causing femoral head osteonecrosis in the early stages of Legg-Calvé-Perthes disease. Currently, treatment by containment is recommended to direct and guide remodeling of the softened femoral head as it evolves from fragmentation through ossification. The goal of this study was to show the results of arthrodiatasis to induce height recovery of the femoral head and to achieve true ambulatory nonweight-bearing containment.
Forty-two patients younger than 8 years with a diagnosis of Perthes' disease were studied. Twenty-three patients (9 class B and 14 class C according to Herring's classification) were treated with an articulated distraction technique and 19 patients (11 class B and 8 class C) were treated conservatively as a control group. Arthrodiatasis or articulated distraction of the hip combines off-loading of muscles and body forces with distraction of the joint space by means of an external fixator that crosses the hip joint. Radiologically, 21 patients (91%) had satisfactory results and 2 (9%) had unsatisfactory results. Clinically, the results were good in 21 patients (92%), fair in 1 (4%), and poor in 1 (4%). In patients treated conservatively, 14 patients (72%) had satisfactory results and 5 (28%) had unsatisfactory results. Clinically, 71% had good results, 17% had fair, and 12% had poor.
We conclude that hip joint containment by articulated arthrodiatasis (plus adductors and psoas minimal tenotomy surgery) is an effective method in the management of Perthes' disease in patients younger than 8 years, classified B and C, and associated with a highly reduced range of abduction. Restoration of clinical abnormalities and satisfactory radiological parameters are achieved in high percentages.
Spontaneous Disappearance of Lumbar Disk Herniation Within 3 Months
Authors: Nozawa Satoshi , Nozawa Asae , Kojima Hisashi , Shimizu Katsuji 
Published: November 2009

Although spontaneous regression of disk herniation is a well-known phenomenon, the time taken for the condition to resolve has not been detailed in previous studies.
This article describes a case of vanishing lumbar disk herniation in a 33-year-old man. The patient experienced sudden severe lumbar pain while lifting a 240-kg weight while attempting a Donkey Calf Raise during muscle training. The pain persisted despite the use of a lumbar corset and nonsteroidal anti-inflammatory drugs. Twelve days after onset, sensory disturbance appeared in the right L5 dermatome, and a manual muscle test of the right anterior tibial muscle revealed level 3. The pain gradually spread over the right lower extremity and the indistinct lumbago changed to localized back pain at the L4/5 vertebral level. Magnetic resonance imaging (MRI) of the lumbar spine 12 days after onset revealed a large disk herniation at L4/5. T2-weighted images demonstrated the herniated disk with a sequestrated disk fragment, which compressed the right L5 nerve root. Over the following month, his pain gradually diminished and he was able to resume his muscle-building program. Follow-up MRI 3 months after the lumbar injury showed complete disappearance of the extruded disk material. This is the first reported case of disk herniation that disappeared within only 3 months, as previous reports have reported that a minimum 30-week period was needed. Clinical awareness of the possibility that disk herniation may resolve within a relatively short time may aid both correct informed consent and treatment.
Osteoid Osteoma: A Diagnosis for Radicular Pain of Extremities
Authors: Ebrahimzadeh Mohamad H. , Ahmadzadeh-Chabock Hosein , Ebrahimzadeh Ali Reza 
Published: November 2009

Osteoid osteoma is a benign tumor commonly found in young patients. The most interesting feature of the tumor is its peculiar obvious pain. The intensity of pain produced by osteoid osteoma is unproportionate to its nature and size. Much has been written about the mechanism of this symptom of the tumor and the specific characteristics of the pain that can be misleading when appearing as radicular pain especially when some subtle neurologic signs and symptoms accompany the pain.
In this article, 12 patients who were referred to our clinic with radicular pain and neurological signs and symptoms months after initiation of symptoms between 2000 and 2008 are presented. Of these 12 patients, most were first thought to have root compression disease before being referred to our hospital.
Precise history taking and special attention to physical examinations led to a suspicion of osteoid osteoma. Plain radiographs, computed tomography, and bone scans indicated osteoid osteoma, and excisional biopsy confirmed its diagnosis.
Osteoid osteoma should always be considered in young patients with radicular pain, even with subtle neurological signs and symptoms.