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2019

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Articles 3001 - 3030 of 3514

Full-Text Articles in Medical Specialties

Distal Corporoplasty Using An Autologous Tunica In The Management Of Penile Prosthesis Pseudo Aneurysm, Michel Apoj, Elizabeth A. Phillips Jan 2019

Distal Corporoplasty Using An Autologous Tunica In The Management Of Penile Prosthesis Pseudo Aneurysm, Michel Apoj, Elizabeth A. Phillips

Articles

Inflatable penile prosthesis placement is an effective and safe treatment option for erectile dysfunction. The 5-year revision rate is low (7%) and revisions are most likely due to infection or mechanical problems with the device.

Penile prosthesis aneurysm is a rare complication that is managed surgically. The choice of graft used during tunical reinforcement is critical to avoid subsequent complications. The use of autologous grafts from distant tissue often leads to deformations of penile tissue in addition to the increase in operative time, morbidity, and cost of the operation. The use of synthetics increases the susceptibility to infection and decreases …


Neurogenesis In Neurodegenerative Diseases: Role Of Mfg-E8, Cletus Cheyuo, Monowar Aziz, Ping Wang Jan 2019

Neurogenesis In Neurodegenerative Diseases: Role Of Mfg-E8, Cletus Cheyuo, Monowar Aziz, Ping Wang

Faculty & Staff Scholarship

Neurodegenerative diseases are devastating medical conditions with no effective treatments. Restoration of impaired neurogenesis represents a promising therapeutic strategy for neurodegenerative diseases. Milk fat globule-epidermal growth factor-factor VIII (MFG-E8) is a secretory glycoprotein that plays a wide range of cellular functions including phagocytosis of apoptotic cells, anti-inflammation, tissue regeneration, and homeostasis. The beneficial role of MFG-E8 has been shown in cerebral ischemia (stroke), neurodegenerative diseases such as Alzheimer’s disease and Parkinson’s disease, and traumatic brain injury. In stroke, MFG-E8 promotes neural stem cell proliferation and their migration toward the ischemic brain tissues. These novel functions of MFG-E8 are primarily mediated …


Best Practices For Evaluation And Treatment Of Agitated Children And Adolescents (Beta) In The Emergency Department: Consensus Statement Of The American Association For Emergency Psychiatry, R. Gerson, N. Malas, V. Feuer, G. H. Silver, R. Prasad, M. M. Mroczkowski Jan 2019

Best Practices For Evaluation And Treatment Of Agitated Children And Adolescents (Beta) In The Emergency Department: Consensus Statement Of The American Association For Emergency Psychiatry, R. Gerson, N. Malas, V. Feuer, G. H. Silver, R. Prasad, M. M. Mroczkowski

Journal Articles

No abstract provided.


The Relationship Between Generalized Anxiety Disorder And Patient Age Among Emergency Department Patients, Mitchell Mcmurray Jan 2019

The Relationship Between Generalized Anxiety Disorder And Patient Age Among Emergency Department Patients, Mitchell Mcmurray

Scholarship in Medicine - All Papers

The objective of this study was to determine the relationship between Generalized Anxiety Disorder (GAD) and patient age in emergency department patients. The GAD-7 screening tool was used in an urban ED setting to survey patients about their anxiety, with a score of 8 or higher suggesting a diagnosis of GAD. Eligible participants included ED patients over the age of 18 with a painful condition ranging from 1-10 on the verbal numeric rating pain scale (VNRS). Participants were excluded if they were in distress and/or did not speak English. Of the 320 patients surveyed, the mean patient age was determined …


Dr. Kiran C. Patel College Of Osteopathic Medicine Graduate Programs, Nova Southeastern University Jan 2019

Dr. Kiran C. Patel College Of Osteopathic Medicine Graduate Programs, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.


Human Macular Müller Cells Rely More On Serine Biosynthesis To Combat Oxidative Stress Than Those From The Periphery, Ting Zhang, Ling Zhu, Michele C. Madigan, Wei Liu, Weiyong Shen, Svetlana Cherepanoff, Fanfan Zhou, Shaoxue Zeng, Jianhai Du, Mark C. Gillies Jan 2019

Human Macular Müller Cells Rely More On Serine Biosynthesis To Combat Oxidative Stress Than Those From The Periphery, Ting Zhang, Ling Zhu, Michele C. Madigan, Wei Liu, Weiyong Shen, Svetlana Cherepanoff, Fanfan Zhou, Shaoxue Zeng, Jianhai Du, Mark C. Gillies

Faculty & Staff Scholarship

Abstract The human macula is more susceptible than the peripheral retina to developing blinding conditions such as age-related macular degeneration, diabetic retinopathy. A key difference between them may be the nature of their Mu¨ ller cells. We found primary cultured Mu¨ ller cells from macula and peripheral retina display significant morphological and transcriptomic differences. Macular Mu¨ ller cells expressed more phosphoglycerate dehydrogenase (PHGDH, a rate-limiting enzyme in serine synthesis) than peripheral Mu¨ ller cells. The serine synthesis, glycolytic and mitochondrial function were more activated in macular than peripheral Mu¨ ller cells. Serine biosynthesis is critical in defending against oxidative stress. …


Automobile Restraint Use Among Patients In Motor Vehicle Crashes: Factors Associated With Noncompliance, Ashley A. Brent Jan 2019

Automobile Restraint Use Among Patients In Motor Vehicle Crashes: Factors Associated With Noncompliance, Ashley A. Brent

Scholarship in Medicine - All Papers

Despite the 1968 U.S. law requiring that all vehicles have seat belts in every seat, many drivers and passengers choose not to use them. This is an important healthcare issue when the there is an estimated $917 billion spent annually on hospital services due to noncompliance with seat belt use.1 Previous literature has demonstrated that patients who are noncompliant with seatbelts are not only “more likely to use more hospital resources because they are more severely injured”, but also less likely to have health insurance, thus incurring more debt for the hospitals serving them1. Conversely, restraint compliance has …


Implementing The Summer Food Service Program Within The Healthcare Setting, Laura M. Plencner, Margo Quiriconi, Sarah Sentmore, Molly Krager Jan 2019

Implementing The Summer Food Service Program Within The Healthcare Setting, Laura M. Plencner, Margo Quiriconi, Sarah Sentmore, Molly Krager

Posters

The Summer Food Service Program was established to ensure that children continue to receive adequate nutrition while school is out. This poster describes how the program was implemented in the Children's Mercy Kansas City healthcare system from 2016-2018.


Comparing Rates Of Macrosomia And Neonatal Hypoglycemia Of Differing Treatment Modalities Of Gestational Diabetes Mellitus, Ashleigh Milbrath Jan 2019

Comparing Rates Of Macrosomia And Neonatal Hypoglycemia Of Differing Treatment Modalities Of Gestational Diabetes Mellitus, Ashleigh Milbrath

Physician Assistant Scholarly Project Posters

Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, …


Social Aspects Of Food-Sensitive Adults, Jean Elizabeth Duane Jan 2019

Social Aspects Of Food-Sensitive Adults, Jean Elizabeth Duane

Electronic Theses and Dissertations

People living with food-related illnesses find themselves subjugated by commonly held ideologies causing awkwardness in social situations. The current study is a qualitative analysis addressing how people with celiac disease (CD) navigate social situations in light of dominant beliefs that influence behaviors. Initially, I identify macro-level patriarchal, religious, sexist, ableist and etiquette-related commensality ideologies that disadvantage those with CD. Drawing from the communication narrative sense making (CNSM) theory that supports storytelling and memorable messages as a sense-making tool for individuals diagnosed with chronic illness and their family members, this work highlights retrospective stories and memorable messages from 20 randomly selected …


An Exploratory Study Examining The Associations Between Sunlight Exposure, Sleep Behaviours And Sleep Outcomes During An Arctic Summer, Margaret M. Lubas, Ralitsa S. Maduro, Mariana Szklo-Coxe Jan 2019

An Exploratory Study Examining The Associations Between Sunlight Exposure, Sleep Behaviours And Sleep Outcomes During An Arctic Summer, Margaret M. Lubas, Ralitsa S. Maduro, Mariana Szklo-Coxe

Community & Environmental Health Faculty Publications

Few evidence-based recommendations exist for maintaining healthy sleep during Arctic summers. Our study aimed to examine associations between sleep hygiene, sunlight exposure and sleep outcomes in workers living in and/or near the Arctic Circle during a 24-h light period. A survey was administered July 2017 to 19 workers at 3 Arctic base camps in Northeastern Alaska. Participants with poorer sleep hygiene reported increased sleepiness (r=.62, p=0.01); this correlation remained moderately strong, albeit not statistically significant (NS), after controlling for shift work (r=.46, p=0.06). No other statistically significant correlations between sleep hygiene and sleep outcomes were found. Weekly daytime (8pm) sunlight …


Family-Based Intervention For Patients With Type 2 Diabetes Via Wechat In China: Protocol For A Randomized Control Trial, Linqi Mao, Jun Lu, Qi Zhang, Yuxi Zhao, Gang Chen, Mei Sun, Fengshui Chang, Xiaohong Li Jan 2019

Family-Based Intervention For Patients With Type 2 Diabetes Via Wechat In China: Protocol For A Randomized Control Trial, Linqi Mao, Jun Lu, Qi Zhang, Yuxi Zhao, Gang Chen, Mei Sun, Fengshui Chang, Xiaohong Li

Community & Environmental Health Faculty Publications

Background

China has the largest number of cases of diabetes with a high rate of uncontrolled blood sugar. Many studies show that family members’ involvement is related to better glycemic control. However, there is a significant problem with low participation of family members. The widespread use of WeChat provides an opportunity for family members to support their diabetic loved ones in their type 2 diabetes self-management practices. The main aim of this study is to examine the effectiveness of a family-based intervention via WeChat.

Methods

A parallel, two-group, randomized controlled trial will be conducted in the central urban area of …


Toxic Environmental Risk Factors For Alzheimer's Disease: A Systematic Review, Oluwaseyi Olayinka, Olaniyi O. Olayinka, Brook T. Alemu, Muge Akpinar-Elci, George T. Grossberg Jan 2019

Toxic Environmental Risk Factors For Alzheimer's Disease: A Systematic Review, Oluwaseyi Olayinka, Olaniyi O. Olayinka, Brook T. Alemu, Muge Akpinar-Elci, George T. Grossberg

Community & Environmental Health Faculty Publications

There is growing evidence of a possible association between toxic environmental factors and Alzheimer’s disease (AD), a disabling neurodegenerative condition with no known cause. Previous reviews of toxic environmental factors for AD either focused on occupational exposures or used a non-systematic methodology. The objective of this systematic review is to assess the evidence on the link between AD and exposure to a variety of toxic environmental risk factors beyond the work environment. Structured database search was used to identify relevant studies. Twenty-nine eligible studies examining the effect of various toxic environmental agents including electromagnetic fields, solvents, pesticides, toxic metals, and …


Ua1b3/4 Wellness Committee, Wku Archives Jan 2019

Ua1b3/4 Wellness Committee, Wku Archives

WKU Archives Collection Inventories

Records created by and about the Wellness Committee.


Ua66/13/2 Ogden College Of Science & Engineering Public Health Centers, Wku Archives Jan 2019

Ua66/13/2 Ogden College Of Science & Engineering Public Health Centers, Wku Archives

WKU Archives Collection Inventories

Records related to Public Health Centers.


Topical Photodynamic Therapy Induces Immunosuppression: Potential Role Of Lipid Mediator Platelet-Activating Factor, Christina E. Borchers, Christine M. Rapp, Elizabeth Cates, Amy Williams, Jeffery B. Travers Jan 2019

Topical Photodynamic Therapy Induces Immunosuppression: Potential Role Of Lipid Mediator Platelet-Activating Factor, Christina E. Borchers, Christine M. Rapp, Elizabeth Cates, Amy Williams, Jeffery B. Travers

Dermatology Faculty Publications

opical photodynamic therapy (PDT), or blue light therapy, isa procedure using a photosensitizing agent, or precursoragent 5-aminolevulinic acid (5-ALA), and is commonly usedto treat precancerous actinic keratosis. The 5-ALA is takenup by skin lesions through targeting cells with high turnoverthat are metabolically active (malignant proliferation) andconverted to the photoactive drug protoporphyrin IX.Following exposure to blue light, significant cell destructionoccurs which has been linked to the generation of reactiveoxygen species (1). Though PDT is effective, several studieshave suggested that this procedure results inimmunosuppression, which might limit the effectiveness ofthis therapy. Our group has demonstrated previously thatexperimental PDT of keratinocyte cell lines …


Case Report: Steroid Responsive Mesothelioma-Related Pleural Effusion, Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy Munn Jan 2019

Case Report: Steroid Responsive Mesothelioma-Related Pleural Effusion, Mena Shehata, Fouad Zaid, Peter Ottaviano, Yousef Shweihat, Nancy Munn

Internal Medicine

Malignant pleural mesothelioma (MPM) is an asbestos-related tumor arising in the pleural cavity. Symptoms reflect extension of disease and include shortness of breath and chest pain. Unexplained pleural effusion and pleural pain in patients exposed to asbestos should raise the suspicion of MPM. The most common radiologic presentation is ipsilateral pleural effusion with or without pleural thickening or a mass. Thoracoscopic biopsy remains the most appropriate procedure for definitive diagnosis of mesothelioma. Despite advancement in diagnostic procedures and biomolecular research, this tumor nevertheless has poor prognosis. Mesothelioma remains a diagnostic and therapeutic challenge and is likely to remain one in …


Melanoma Research Insights: Impact, Trends, Opportunities, Elsevier Analytical Services Jan 2019

Melanoma Research Insights: Impact, Trends, Opportunities, Elsevier Analytical Services

Public Reports

Melanoma is a type of cancer that occurs when the skin cells that produce melanin become malignant. This report examines the landscape of melanoma research using Scopus, a source-neutral abstract and citation database, curated by independent subject matter experts.


Dna Damage And Cytokine Production In Non-Target Irradiated Lymphocytes, Jane Bryant, Laura Shields, Christopher Hynes, Orla L. Howe, Brendan Mcclean, Fiona Lyng Jan 2019

Dna Damage And Cytokine Production In Non-Target Irradiated Lymphocytes, Jane Bryant, Laura Shields, Christopher Hynes, Orla L. Howe, Brendan Mcclean, Fiona Lyng

Articles

In advanced radiotherapy, treatment of the tumor with high-intensity modulated fields is balanced with normal tissue sparing. However, the non-target dose delivered to surrounding healthy tissue within the irradiated volume is a potential cause for concern. Whether the effects observed are caused after exposure to out-of-field radiation or bystander effects through neighboring irradiated cells is not fully understood. The goal of this study was to determine the effect of exposure to out-of-field radiation in lymphocyte cell lines and primary blood cells. The role of cellular radiosensitivity in altering bystander responses in out-of-field exposed cells was also investigated. Target cells were …


Liquid Mosquito Repellent Ingestion In Children, Saptharishi Lalgudi Ganesan, Mounika V. Reddy, Karthik Narayanan Ramalingam, Muralidharan Jayashree, Sunit C. Singhi, Karthi Nallasamy, Arun Bansal, Arun K. Baranwal Jan 2019

Liquid Mosquito Repellent Ingestion In Children, Saptharishi Lalgudi Ganesan, Mounika V. Reddy, Karthik Narayanan Ramalingam, Muralidharan Jayashree, Sunit C. Singhi, Karthi Nallasamy, Arun Bansal, Arun K. Baranwal

Data and Test Instruments

No abstract provided.


Electrographic Seizure Burden And Outcomes Following Pediatric Status Epilepticus, Saptharishi Lalgudi Ganesan, Cecil Hahn Jan 2019

Electrographic Seizure Burden And Outcomes Following Pediatric Status Epilepticus, Saptharishi Lalgudi Ganesan, Cecil Hahn

Data and Test Instruments

No abstract provided.


Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections In Acutely Ill Children: A Retrospective Case-Control Study, Saptharishi Lalgudi Ganesan, Ankita Mehta, Md, Keshavmurthy Lakshmikantha, Muralidharan Jayashree, Vikas Gautam, Pallab Ray Jan 2019

Community-Acquired Methicillin-Resistant Staphylococcus Aureus Infections In Acutely Ill Children: A Retrospective Case-Control Study, Saptharishi Lalgudi Ganesan, Ankita Mehta, Md, Keshavmurthy Lakshmikantha, Muralidharan Jayashree, Vikas Gautam, Pallab Ray

Data and Test Instruments

No abstract provided.


Antibodies In The Diagnosis, Prognosis, And Prediction Of Psychotic Disorders., Thomas A Pollak, Jonathan P Rogers, Robert G Nagele, Mark Peakman, James M Stone, Anthony S David, Philip Mcguire Jan 2019

Antibodies In The Diagnosis, Prognosis, And Prediction Of Psychotic Disorders., Thomas A Pollak, Jonathan P Rogers, Robert G Nagele, Mark Peakman, James M Stone, Anthony S David, Philip Mcguire

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Blood-based biomarker discovery for psychotic disorders has yet to impact upon routine clinical practice. In physical disorders antibodies have established roles as diagnostic, prognostic and predictive (theranostic) biomarkers, particularly in disorders thought to have a substantial autoimmune or infective aetiology. Two approaches to antibody biomarker identification are distinguished: a "top-down" approach, in which antibodies to specific antigens are sought based on the known function of the antigen and its putative role in the disorder, and emerging "bottom-up" or "omics" approaches that are agnostic as to the significance of any one antigen, using high-throughput arrays to identify distinctive components of the …


Urban Aerobiological Risk Mapping Of Ornamental Trees Using A New Index Based On Lidar And Kriging: A Case Study Of Plane Trees, Raúl Pecero-Casimiro, Santiago Fernández-Rodríguez, Rafael Tormo-Molina, Alejandro Monroy-Colín, Inmaculada Silva-Palacios, Juan Pedro Cortés-Pérez, Ángela Gonzalo-Garijo, J. M. Maya-Manzano Jan 2019

Urban Aerobiological Risk Mapping Of Ornamental Trees Using A New Index Based On Lidar And Kriging: A Case Study Of Plane Trees, Raúl Pecero-Casimiro, Santiago Fernández-Rodríguez, Rafael Tormo-Molina, Alejandro Monroy-Colín, Inmaculada Silva-Palacios, Juan Pedro Cortés-Pérez, Ángela Gonzalo-Garijo, J. M. Maya-Manzano

Articles

Ornamental trees bring benefits for human health, including reducing urban pollution. However, some species, such as plane trees (Platanus sp.), produce allergenic pollen. Consequently, urban maps are a valuable tool for allergic patients and allergists, but they often fail to include variables that contribute to the “building downwash effect”, such as the width and shape of streets and the height of buildings. Other factors that directly influence pollen dispersion (slopes and other geographical features) also have not traditionally been discussed. The LiDAR (Laser Imaging Detection and Ranging) technique enables one to consider these variables with high accuracy. This work proposes …


Pelvic Examinations For Ovarian Cancer Screening In Asymptomatic Adult Women, Riann Collar Jan 2019

Pelvic Examinations For Ovarian Cancer Screening In Asymptomatic Adult Women, Riann Collar

Physician Assistant Scholarly Project Posters

There is discrepancy amongst organizations and the medical community whether bimanual pelvic examinations should be performed in asymptomatic women for routine screening. The purpose of this literature review was to determine whether bimanual pelvic examinations are beneficial for screening for ovarian cancer in comparison to no screening. In addition, research was conducted to see if healthcare providers’ professional beliefs align with the evidence and national recommendations, to determine women’s thoughts and beliefs regarding pelvic examinations, and identify other screening methods if bimanual pelvic exams are determined to be an invalid screening tool. Throughout reviewing peer reviewed articles and high-quality evidence, …


Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt Jan 2019

Parenteral Ascorbic Acid For Treatment Of Sepsis, Lindsey Hiatt

Physician Assistant Scholarly Project Posters

Sepsis kills nearly 1 million people each year in the United States and sepsis-related hospitalizations cost approximately $24 billion annually (Paoli, Reynolds, Sinha, Gitlin, & Crouser, 2018). Current treatment guidelines are limited to targeted antibiotics and hemodynamic support. While antibiotics are the definitive treatment to eradicate the infectious pathogen, there are currently no standard-of-care treatments that consistently and successfully attenuate the damage sustained to the body by its own inflammatory response to infection. Many different treatments have been trialed and failed to show improved outcomes. Vitamin C, or ascorbic acid, has long been associated with supporting immune function, and has …


Use Of Beta-Antagonists Or Hmg-Coa Reductase Inhibitors For Cardioprotection During Chemotherapy In Oncology Patients, Nicole Streich Jan 2019

Use Of Beta-Antagonists Or Hmg-Coa Reductase Inhibitors For Cardioprotection During Chemotherapy In Oncology Patients, Nicole Streich

Physician Assistant Scholarly Project Posters

Over the years, oncologists are better able to fight cancer and have increased cancer survival, but we are also finding that these lifesaving therapies can affect the heart and other parts of the body in a negative way. Chemotherapy is excellent at destroying cancer cells, but it also causes collateral damage to other healthy cells. There are certain chemotherapeutic agents that are known to cause cardiotoxicity. Currently we are monitoring the heart function of the patients who are receiving these cardiotoxic drugs prior to starting the chemotherapy as well as during and after treatment. However, there are currently no recommendations …


Glucagon-Like Peptide-1s Compared To Sulfonylureas In The Treatment Of Adults Diagnosed With Type Ii Diabetes Mellitus In Primary Care, Tracy Kirchner Jan 2019

Glucagon-Like Peptide-1s Compared To Sulfonylureas In The Treatment Of Adults Diagnosed With Type Ii Diabetes Mellitus In Primary Care, Tracy Kirchner

Physician Assistant Scholarly Project Posters

Type II diabetes mellitus (T2DM) is a prevalent disease in our country. Bullard et al. (2018) report approximately 21 million adults have T2DM in the United States. “The total estimated cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced productivity” (Yang et al., 2018). Treatment of T2DM is individualized to each patient based on their co-morbidities, fiscal responsibility, and route of administration options. Sulfonylureas and Glucagon-like Peptide-1s (GLP-1) are two classes of antidiabetic drugs that are available for use as second line treatment options after metformin. This review …


Obesity: Modern Medicine Vs. Lifestyle, Jenny Christianson Jan 2019

Obesity: Modern Medicine Vs. Lifestyle, Jenny Christianson

Physician Assistant Scholarly Project Posters

• Obesity is a rising epidemic, and is one of the most common, costly and preventable health problems the world is experiencing today (Center for Disease Control and Prevention, [CDC], 2017).

• From this, it is important to establish an effective treatment plan that can be implemented across the nation for maximum patient benefit.

• Lifestyle changes such as diet and exercise are important to any health care plan and are equally necessary to reduce health risks. However, in certain patients, lifestyle changes are not enough due to the maladaptive biologic process in their brain. Thus, additional treatment options need …


Rigid Nail Fixation For Treatment Of Femur Fractures In Children Aged 6 To 12 Years: A Review, Brielle Payne Plost, David M. Bennett, Andrew W. Parsons, Matthew G. Wharton Jan 2019

Rigid Nail Fixation For Treatment Of Femur Fractures In Children Aged 6 To 12 Years: A Review, Brielle Payne Plost, David M. Bennett, Andrew W. Parsons, Matthew G. Wharton

UNM Orthopaedic Research Journal

Although femoral shaft fractures are common in children, treatment using rigid intramedullary nail fixation remains controversial owing to concerns of avascular necrosis (AVN) and disruption of growth of the proximal femur. We examined studies on AVN complications and proximal femur deformity after rigid nail fixation in children aged 6 to 12 years. Of the 13 studies included, nine had no incidents of AVN or clinically significant proximal femur deformity using a greater trochanter entry point. Four studies showed cases of AVN or proximal femoral deformity in patients treated with intramedullary nails through a starting point at or near the piriformis …