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Liu J, Hein D, Huffman C, Rao BM, Cooper J, Ebraheim NA. Surgical outcomes of non-periprosthetic distal femur fragility fractures treated with a locking plate. Ann Jt 2022; 7:32. [PMID: 38529163 PMCID: PMC10929273 DOI: 10.21037/aoj-22-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/06/2022] [Indexed: 03/27/2024]
Abstract
Background Management of distal femur fractures can be challenging, particularly in the aged female population. This retrospective study aims to analyze the surgical outcomes of aged female patients with non-periprosthetic distal femur fractures treated with a locking plate. Methods This is an IRB approved retrospective review conducted at a level 1 trauma center. Fifty-five female patients (mean age of 71 years) with non-periprosthetic distal femur fractures underwent open reduction internal fixation using a locking plate from 2005 to 2019. The average follow-up time was 67 weeks from the date of injury. Criteria used for diagnosis of nonunion included one or more of the following: (I) three consecutive months without progression of healing on postoperative radiographs, (II) a total of nine months postoperative without complete healing, or (III) the physician diagnosed nonunion using clinical judgement. Outcome data was analyzed and compared amongst patients with and without obesity or diabetes. Statistical analysis was performed utilizing Microsoft Excel 2022 Data Analysis ToolPak with a standard statistically significant P value of <0.05. Results Thirty-two patients (58%) with distal femur fractures achieved union after initial treatment while 23 patients (42%) were diagnosed with nonunion. Fourteen patients (61%) underwent revision with 9 of these patients (64%) achieving union while 5 patients (36%) had persistent nonunion. Average healing time from initial treatment to union was 29 weeks, while average time from definitive treatment to union was 22 weeks. Obese patients [body mass index (BMI) >30 kg/m2] had a nonunion rate of 65%, while non-obese patients had a nonunion rate of 28%. Patients with diabetes had a nonunion rate of 65%, while patients without diabetes had a nonunion rate of 28%. Conclusions Union can be successfully achieved in aged female patients with distal femur fractures treated with locking plates; however, the risks for nonunion and revision remain high. Patients with obesity and diabetes appear to be at an increased risk of nonunion (P=0.008 and 0.008, respectively). However, further research should be conducted with a prospective study or multivariate analysis and increased number of patients to reaffirm this data.
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Affiliation(s)
- Jiayong Liu
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - David Hein
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Christopher Huffman
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Brian M Rao
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Jonathan Cooper
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
| | - Nabil A Ebraheim
- Department of Orthopedic Surgery, University of Toledo Medical Center, Toledo, OH, USA
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Huffman C, Cardis MA. Image: Atypical chondrodermatitis nodularis due to in-ear headphones. Br J Dermatol 2021; 185:e199. [PMID: 34496030 DOI: 10.1111/bjd.20702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/01/2021] [Accepted: 07/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- C Huffman
- MedStar Georgetown University, Washington, DC, USA
| | - M A Cardis
- MedStar Georgetown University, Washington, DC, USA
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Huffman C. Exercise Interventions for the Management of Huntington's Disease. Strength Cond J 2019. [DOI: 10.1519/ssc.0000000000000479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jaeger AS, Murrieta RA, Goren LR, Crooks CM, Moriarty RV, Weiler AM, Rybarczyk S, Semler MR, Huffman C, Mejia A, Simmons HA, Fritsch M, Osorio JE, Eickhoff JC, O’Connor SL, Ebel GD, Friedrich TC, Aliota MT. Zika viruses of African and Asian lineages cause fetal harm in a mouse model of vertical transmission. PLoS Negl Trop Dis 2019; 13:e0007343. [PMID: 30995223 PMCID: PMC6488094 DOI: 10.1371/journal.pntd.0007343] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 04/29/2019] [Accepted: 03/27/2019] [Indexed: 12/13/2022] Open
Abstract
Congenital Zika virus (ZIKV) infection was first linked to birth defects during the American outbreak in 2015/2016. It has been proposed that mutations unique to the Asian/American-genotype explain, at least in part, the ability of Asian/American ZIKV to cause congenital Zika syndrome (CZS). Recent studies identified mutations in ZIKV infecting humans that arose coincident with the outbreak in French Polynesia and were stably maintained during subsequent spread to the Americas. Here we show that African ZIKV can infect and harm fetuses and that the S139N substitution that has been associated with the American outbreak is not essential for fetal harm. Our findings, in a vertical transmission mouse model, suggest that ZIKV will remain a threat to pregnant women for the foreseeable future, including in Africa, Southeast Asia, and the Americas. Additional research is needed to better understand the risks associated with ZIKV infection during pregnancy, both in areas where the virus is newly endemic and where it has been circulating for decades.
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Affiliation(s)
- Anna S. Jaeger
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities; St. Paul, MN, United States of America
| | - Reyes A. Murrieta
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University; Ft. Collins, CO, United States of America
| | - Lea R. Goren
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities; St. Paul, MN, United States of America
| | - Chelsea M. Crooks
- Department of Pathobiological Sciences, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Ryan V. Moriarty
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Andrea M. Weiler
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Sierra Rybarczyk
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Matthew R. Semler
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Christopher Huffman
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Andres Mejia
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Michael Fritsch
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Jorge E. Osorio
- Department of Pathobiological Sciences, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Jens C. Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Shelby L. O’Connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Gregory D. Ebel
- Arthropod-Borne and Infectious Diseases Laboratory, Department of Microbiology, Immunology and Pathology, Colorado State University; Ft. Collins, CO, United States of America
| | - Thomas C. Friedrich
- Department of Pathobiological Sciences, University of Wisconsin-Madison; Madison, WI, United States of America
- Wisconsin National Primate Research Center, University of Wisconsin-Madison; Madison, WI, United States of America
| | - Matthew T. Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities; St. Paul, MN, United States of America
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Ekwemalor K, Asiamah E, Adjei- Fremah S, Huffman C, Ismail H, Worku M. 097 Effect of a Mushroom (Coriolus versicolor) Based Probiotic on the expression of Toll-like receptors in Goat Neutrophils. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Huffman C, Facey N, Adjei-Fremah S, Ekwemalor K, Young L, Asiamah E, Ismail H, Worku M. 145 Evaluation of a Commercial Supplement in Sheep and Goat Twins. J Anim Sci 2016. [DOI: 10.2527/ssasas2015-145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Huffman C, Torguson R, Fatemi O, Chen F, Gai J, Suddath W, Satler L, Pichard A, Waksman R. Comparison of Bleeding Outcomes After Percutaneous Coronary Intervention in Patients With Versus Without Aortic Stenosis. Am J Cardiol 2015; 116:1106-9. [PMID: 26256579 DOI: 10.1016/j.amjcard.2015.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/20/2022]
Abstract
Aortic stenosis (AS) is associated with an increased risk of bleeding, but little is known about the risk of bleeding during percutaneous coronary intervention (PCI) in patients with AS. In the era of transcutaneous aortic valve implantation, understanding the bleeding risks associated with AS is critical. This retrospective study included 7,926 patients who underwent PCI from 2004 to 2013. Patients were categorized according to the presence of significant AS: moderate or severe AS (n = 354) and mild or no AS (n = 7,572). The National Cardiovascular Data Registry (NCDR) definition of a bleeding event (transfusion, prolonged hospital stay, or decrease in hemoglobin >3.0 mg/dl) was used as the primary outcome, and the NCDR PCI Bleeding Risk Score was used to control for the underlying risk of bleeding because of baseline characteristics. Patients with AS had significantly higher NCDR PCI Bleeding Risk Scores and higher rates of bleeding events. Logistic regression showed that the NCDR PCI Bleeding Risk Score did predict bleeding outcomes. There was not, however, an independent association between AS and bleeding outcomes. The addition of AS to the risk score using net reclassification improvement did not enhance the model's ability to predict bleeding (p = 0.71). These data suggest that the NCDR PCI Bleeding Risk Score appropriately adjusts for bleeding risks in patients with AS. In conclusion, although patients with AS are more likely to have bleeding complications after PCI, the increased risk of bleeding is driven by the patients' baseline co-morbidities rather than their AS.
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Affiliation(s)
- Christopher Huffman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Rebecca Torguson
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Omid Fatemi
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Fang Chen
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jiaxiang Gai
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - William Suddath
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Lowell Satler
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Augusto Pichard
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Ron Waksman
- Division of Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.
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Huffman C, Torguson R, Chen F, Pichard A, Satler L, Kent K, Suddath W, Waksman R. CRT-701 Should a New Bleeding Risk Score be Developed to Account for the Added Risks in Patients With Moderate or Severe Aortic Stenosis Who Undergo Percutaneous Coronary Intervention? JACC Cardiovasc Interv 2014. [DOI: 10.1016/j.jcin.2013.12.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Bander J, Mauer A, Huffman C, Sharma S, Coller B, Ahamed J. ACTIVE TGF-BETA-1 IS MORE COMMONLY DETECTABLE IN PLASMA OF PATIENTS WITH AORTIC STENOSIS THAN CARDIAC CATHETERIZATION CONTROLS. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)61319-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
End-stage renal disease, cirrhosis, obesity, tachycardia, and extreme stress have all been shown to result in impaired left ventricular function. It is becoming clear, however, that the cardiomyopathies associated with these states are reversible after resolution of the underlying process. In this article, we present the current data demonstrating that renal transplantation, liver transplantation, and bariatric surgery can lead to reversal of uremic, cirrhotic, and obesity cardiomyopathies, respectively. We also discuss the reversibility of tachycardia-induced cardiomyopathy after radiofrequency ablation or pharmacologic therapy for rate or rhythm control and the reversibility of stress-induced cardiomyopathy with supportive care.
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Affiliation(s)
- C Huffman
- Department of Internal Medicine, Mount Sinai Hospital, New York, NY 10029, USA.
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Clark R, Huffman C, Swerdoff R, Matsumoto A. Potent DHT suppression by the novel dual 5? -reductase inhibitor dutasteride does not effect bone density, bone metabolism or lipid profiles in healthy men. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1569-9056(03)80632-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ross AK, Davis PJ, Dear Gd GL, Ginsberg B, McGowan FX, Stiller RD, Henson LG, Huffman C, Muir KT. Pharmacokinetics of remifentanil in anesthetized pediatric patients undergoing elective surgery or diagnostic procedures. Anesth Analg 2001; 93:1393-401, table of contents. [PMID: 11726413 DOI: 10.1097/00000539-200112000-00008] [Citation(s) in RCA: 222] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Remifentanil hydrochloride is an ultra-short-acting opioid that undergoes rapid metabolism by tissue and plasma esterases. We aimed to characterize the pharmacokinetics and determine the hemodynamic profile of remifentanil after a single-bolus dose in children aged 0 to 18 yr. Forty-two children undergoing elective surgical procedures received remifentanil 5 microg/kg infused over 1 min. Patients were divided into age groups as follows: young infants (< or =2 mo), older infants (> 2 mo to < 2 yr), young children (2 to < 7 yr), older children (7 to < 13 yr), adolescents (13 to < 16 yr), and young adults (16 to < 18 yr). Arterial blood samples were collected and analyzed by mass spectroscopy to determine remifentanil pharmacokinetic profiles. Hemodynamic measurements for remifentanil's effect were made after the infusion. Methods of statistical analysis included analysis of variance and linear regression, with significance at P < or = 0.05. Complete remifentanil pharmacokinetic data were obtained from 34 patients. The volume of distribution was largest in the infants < 2 mo (mean, 452 mL/kg) and decreased to means of 223 to 308 mL/kg in the older patients. There was a more rapid clearance in the infants < 2 mo of age (90 mL. kg(-1). min(-1)) and infants 2 mo to 2 yr (92 mL. kg(-1). min(-1)) than in the other groups (means, 46 to 76 mL. kg(-1). min(-1)). The half-life was similar in all age groups, with means of 3.4 to 5.7 min. Seven subjects (17%) developed hypotension related to the remifentanil bolus. Remifentanil showed an extremely rapid elimination similar to that in adults. The fast clearance rates observed in neonates and infants, as well as the lack of age-related changes in half-life, are in sharp contrast to the pharmacokinetic profile of other opioids. Remifentanil in a bolus dose of 5 microg/kg may cause hypotension in anesthetized children. IMPLICATIONS The pharmacokinetics of remifentanil were studied in children from birth to 18 yr. Remifentanil was found to have age-related changes in clearance and volume of distribution, but not half-life. The increased clearance observed in young infants is in contrast to other opioids.
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Affiliation(s)
- A K Ross
- Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA
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Abstract
We report on an infant with Weaver syndrome, neoplasia and cardiovascular anomalies. Stage 4S neuroblastoma underwent spontaneous resolution. Three neoplasms have been reported in Weaver syndrome: another stage 4S neuroblastoma [Muhonen and Menezes, 1990: J Pediatr 116:596-599], an ovarian endodermal sinus tumor [Derry et al., 1999: J Med Genet 36:725-728], and a sacrococcygeal teratoma [Kelly et al., 2000: Am J Med Genet 95:492-495]. No case was associated with cardiovascular anomalies. Our patient had VSD and PDA, and although several other patients with Weaver syndrome have had cardiovascular anomalies, they were shown not to have neoplasia.
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Affiliation(s)
- C Huffman
- Medical College at Ohio, Toledo, USA
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Abstract
OBJECTIVE To examine the nurse-technology relationship via a case study of ultrasonography in women's health nursing practice. DESIGN Exploratory case study using ethnographic methods. SETTING Outpatient obstetric and gynecology clinic of a large teaching hospital. PARTICIPANTS Three nurses, two technicians, and one physician. RESULTS Two of the nurses and the physician were very "nurse-like" in their use of the technology of ultrasonography to fulfill the traditional nursing purposes of observation, teaching, and comforting. The third nurse was nurse-like in talk, but at times "technician-like" in performance, allowing the technology to pull her away from nursing purposes. CONCLUSIONS The expert nurses bent the technology to nursing purposes. Sonographers performed in accordance with professional training and experience, rather than with gender expectations. The subtle differences between expert nurse use and technical use (by novice nurses or technicians) of ultrasonography may provide a strong rationale against current efforts to substitute technically trained or technically oriented personnel for expert nurses.
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Affiliation(s)
- C Huffman
- Department of Obstetrics and Gynecology, Bowman Gray School of Medicine, Wake Forest University, Winston-Salem, NC, USA
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Fuseau E, Webster C, Asgharnejad M, Huffman C. 1-21-09 Naratriptan oral pharmacokinetics in migraine subjects. J Neurol Sci 1997. [DOI: 10.1016/s0022-510x(97)84989-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
1. Cigarette smoking has been identified as the single most important source of preventable morbidity and premature mortality in the United States for each of the past 25 years. Despite a smoking rate of 50% to 84%, persons with psychiatric illness have not been the target of any documented smoking health risk education in current literature. 2. Most nurses view smoking health risk education as a nursing function, but few actually provide this care for patients due to perceived ineffectiveness of health risk education, belief that smoking is not a health risk, and lack of knowledge base to provide the care. 3. Data from the study reported on in the article reflected that nurses were providing smoking health risk information to less than 50% of patients. Nurses were not identifying nicotine dependence as a nursing problem and therefore were making no plans to provide nursing interventions to resolve it.
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Affiliation(s)
- C R Buchanan
- Mental Health Clinic, Department of Veterans Affairs Domiciliary, White City, Oregon
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