bluuebunny/crossref_metadata_2025 huggingface dataset:
Advance in the pathogenesis of otitis media with effusion induced by platelet-activating factor
Authors: Liu Wei , Shi Lin , Feng Ya
Published: October 2024

A non-suppurative inflammatory disease of the middle ear with middle ear effusion and conductive hearing loss is called otitis media with effusion. Poor eustachian tube function, immunological factors, viral factors, and other factors are primarily involved in its pathophysiology, which has not yet been completely understood. Several researcher scholars have recently studied platelet-activating factor and they found that platelet-activating factor is closely associated to the occurrence, development, and outcome of otitis media with effusion. Platelet-activating factor is a significant element contributing to the extension of otitis media with effusion. In order to give a reference for further investigation into the mechanism and clinical management of this illness, the research status of platelet-activating factor and otitis media with effusion during the past two decades is reviewed in this study, along with the mechanisms of otitis media with effusion leading to otitis media with effusion.
Aerodynamics learning based on the development of an simplified conceptual glider design and flight testing
Authors: Ladeira Julia Kerkoff , Baumgratz Caroline Schwantes , Signor Fernanda , de Souza Carlos Eduardo
Published: October 2024

This study explores numerically and experimentally the conceptual design of a glider aircraft, focusing on achieving stable and efficient flight. The purpose of the work was the applied learning of aerodynamics for an undergraduate course in aerospace engineering. After research, simulations, and theoretical analyses, the project progressed to the practical stage, involving the construction and flight testing of the aircraft. This research included the identification of possible airfoils, consideration of Reynolds number limits and detailed analyses in XFLR5. Methods such as the Lifting Line Theorem and the Vortex Lattice Method were studied and applied in the project development.This approach underlines the study’s education aim - to demonstrate the practical application of theoretical knowledge. In summary, the design process, emphasizing the key milestones and challenges encountered during the manufacturing phase and the outcomes of the flight tests are discussed in detail. The project enabled the simulation and validation of aerodynamic concepts through construction, yielding flight results that were consistent with previous numerical predictions. This demonstrates that the proposed educational approach significantly enhances the practical application of theoretical knowledge in aerodynamics.
Impact of the hopper-air and overfire-air distribution on the low-NOx combustion performance within a 600 MWe staged arch-firing furnace
Authors: Zhang Qihao , Kuang Min , Cheng Shuting , Wu Xiaoyang , Ding Guozhu
Published: October 2024

Within a 600 MWe staged arch-firing furnace (SAF) having the staged hopper air (HA) and overfire air (OFA) as its last two air-staging layers, the present attention was focused on evaluating the impact of the HA:OFA distribution and determining an appropriate HA:OFA ratio used to improve the hopper environment and low-NO x performance. Accordingly, by varying the HA:OFA distribution at a total air ratio of 31%, four HA:OFA ratio settings of 11:20, 13.5:17.5, 16:15, and 18.5:12.5 were formed to compare the in-furnace flow, coal combustion, and NO x emissions. With increasing the HA flux to raise the HA:OFA ratio, all of combustion symmetry, the downward flame penetration, and the HA's combustion-aided effect on char firstly improved and then weakened, the OFA penetration became shallower, and the high-temperature flame in the upper furnace extended. Final performance indexes showed that both NO x emissions and burnout loss first declined and then ascended, meaning a rise-to-drop trend in the low-NO x performance as deepening the HA:OFA ratio. Among the four settings, the moderate HA:OFA = 13.5:17.5 achieved the optimal indexes with NO x emission of 543 mg/m3 (6% O2) and carbon in fly ash of 4.89%. Compared with its previous reference furnace (holding levels of 905 mg/m3 and 5.1% respectively in the two index aspects), the SAF furnace using such a HA:OFA distribution mode reduced significantly NO x by 40%, improved a little burnout, and dropped apparently the hopper temperatures by 500 K to eliminate its high overheating risk.
Comparison of random forest methods for conditional average treatment effect estimation with a continuous treatment
Authors: Tabib Sami , Larocque Denis
Published: October 2024

We are addressing the problem of estimating conditional average treatment effects with a continuous treatment and a continuous response, using random forests. We explore two general approaches: building trees with a split rule that seeks to increase the heterogeneity of the treatment effect estimation and building trees to predict [Formula: see text] as a proxy target variable. We conduct a simulation study to investigate several aspects including the presence or absence of confounding and colliding effects and the merits of locally centering the treatment and/or the response. Our study incorporates both existing and new implementations of random forests. The results indicate that locally centering both the response and treatment variables is generally the best strategy, and both general approaches are viable. Additionally, we provide an illustration using data from the 1987 National Medical Expenditure Survey.
A Rare Case Report on Definitive Radiotherapy in Sebaceous Carcinoma of the Eyelid
Authors: Ajith Kesav , Rathnadevi R. , Subathira B.
Published: October 2024

Introduction:

Sebaceous carcinomas are rare but potentially aggressive cutaneous malignancies. Surgical excision, albeit the primary modality of treatment, is associated with functional as well as cosmetic impairments. Radiotherapy offers an alternative treatment modality for those in whom surgical excision is not an option either due to medical reasons or patient preferences.

Materials and Methods:

Here we present a rare case report of an elderly Indian man with sebaceous carcinoma of the eyelid, for whom definitive radiotherapy was delivered as the primary modality of treatment.

Results:

There was a near complete response of the tumour to the definitive radiotherapy with acceptable toxicity. Discussion: Radiotherapy is a non-invasive alternative to surgical excision that has the advantage of better functional and cosmetic outcomes.
Work education and educational developments around sustainable livelihoods for sustainable career development and well-being
Authors: Caringal-Go JF , Carr SC , Hodgetts DJ , Intraprasert DY , Maleka M , McWha-Hermann I , Meyer I , Mohan KP , Nguyen MH , Noklang S , Pham VT , Prakongpan P , Poonpol P , Potgieter J , Searle R , Teng-Calleja M
Published: October 2024

Covid-19, Artificial Intelligence (AI), and Climate Change, have disrupted work education, rendering sustainability of careers and livelihoods a concern. This paper outlines a collaborative response to that challenge, offering opportunities for sustainable livelihoods in a work education cloud collaboration, Project SLiC (Sustainable Livelihoods Collaboration). We have joined forces across nation states in the Global South/North to share cloud resources, focused on teaching a postgraduate course, Sustainable Livelihoods. Online modules are stored in a secure cloud site, from which local courses draw-down, autochthonously, whichever resources fit workforce development in context. We outline modules, and an evaluative process, in a proof-of-concept trial. Finally, we envisage how this initial collaboration may morph into a whole degree, including research supervision. We close with a call to career development professionals to share their unique expertise and experiences at the work education frontline, on how to develop this sustainable careers project, for the greater good.
Multimodal imaging-based treatment recommendations for managing submacular hemorrhage
Authors: Venkatesh Ramesh , Prabhu Vishma , Chhablani Jay
Published: October 2024

Submacular haemorrhage (SMH) is an emergency, and the most important immediate action in the treatment of SMH is the early displacement or evacuation of subretinal heme from below the fovea, followed by simultaneous or sequential treatment of the underlying cause. Photoreceptor damage can occur immediately after the onset of SMH for a variety of reasons, including toxins released from the blood, the diffusion barrier created by the blood for oxygen delivery and nutrition to the outer retinal layers, and shearing forces on the outer retinal layers, resulting in permanent visual deterioration. A clinician's decision to treat SMH is influenced by a number of factors, including presenting visual acuity, duration of visual symptoms, SMH aetiology and characteristics, availability of intraocular gases and tissue plasminogen activator, and pars plana vitrectomy facilities. For many clinicians, the duration of visual symptoms is the most important and first consideration when planning SMH treatment. Very little emphasis is given to the SMH's imaging characteristics. Currently, there are several treatment options for SMH removal. There is a need to develop a simplified treatment algorithm for SMH that is less reliant on the patient's visual complaints, considers heme characteristics on basic retinal imaging, and has the potential to achieve uniform and predictable treatment outcomes in real-world situations. In this short article, we discuss the various factors that can assist clinicians in the management of SMH and present a simplified treatment algorithm based on the SMH's retinal imaging characteristics.
Different biliary tract cancers, same operation: Importance of cancer origin in patients with hilar-invading tumors
Authors: Ahmad Al-Saffar Hasan , Jansson Hannes , Danielsson Olof , Moro Carlos F. , Sturesson Christian
Published: October 2024

Background and Aims:

For patients with biliary tract cancer involving the hepatic hilum, major hepatic resection with extrahepatic bile duct resection may be required. In addition to perihilar cholangiocarcinoma (PHCC), the same extent of surgery is used in advanced gallbladder cancer (GBC) and intrahepatic cholangiocarcinoma (IHCC) with hilar involvement. Few studies compare prognostic factors and long-term outcomes across tumor types. This study compared risk characteristics and outcomes after surgery in all subtypes of biliary tract cancer with hilar involvement.

Methods:

Patients with biliary tract cancer with hilar involvement undergoing major liver resection and extrahepatic bile duct resection between 2011 and 2021 at a single center were retrospectively analyzed. The primary postoperative outcome was overall survival. Secondary outcomes were recurrence-free survival and postoperative complications. Survival analysis was performed with Cox regression analysis and Kaplan–Meier method.

Results:

One-hundred and eight patients were included. Seventy-three (67%) had PHCC, 24 (22%) had GBC, and 11 (10%) had IHCC. Hilar-invading IHCC and GBC had more adverse histopathological factors like lymph node positivity (p = 0.021), higher number of positive nodes (p = 0.043), and larger tumor size (p < 0.001) compared with PHCC. Peritoneal invasion and lymph node positivity were significant independent predictors for survival (p = 0.011 and p = 0.004, respectively). Median overall survival was 29 months for PHCC, 22 months for GBC and 21 months for IHCC (p = 0.53). IHCC tended to recur earlier (p = 0.046) than GBC and PHCC (6, 15, and 18 months, respectively).

Conclusion:

Patients with biliary tract cancer with hilar involvement undergoing major liver resection and resection of extrahepatic bile ducts had similar overall survival regardless of subtype, while IHCC recurred earlier. Peritoneal cancer invasion was common in all subtypes, including PHCC, and was an independent prognostic factor. This finding may support routine reporting of peritoneal invasion-status in resected biliary tract cancer.
Six years of Project ECHO: Implementation and evaluation of a hospice-led multiprofessional education programme
Authors: Joddrell Phil , Manson Jane , Kyeremateng Sam , Pilkington Gerlinde , Ariss Steven , Lowrie Kinga , McTague Laura , Taylor Paul M
Published: October 2024

Objectives: This article reports on the implementation and evaluation of an established technology-enabled collaborative learning programme (Project ECHO) at an independent UK hospice in the North of England over a 6-year period. Methods: An independent audit of collated, anonymised data from the programme is used to report attendance patterns and session evaluations. Results: The results show a gradual increase in attendances, programmes, sessions and hours of education, coupled with consistently positive evaluation reports. Conclusion: This supports existing evidence that Project ECHO is an effective method of delivering remote healthcare education, demonstrating impact on the first three levels of Moore’s education framework; participation, satisfaction and learning. Future expansion in terms of geography and topics covered is proposed, alongside enhanced evaluation methods to demonstrate impact at the higher levels of Moore’s framework.
Effect of the community of simulated participant model on the identity formation of simulated participants: A qualitative study
Authors: Delibalta Bilge , Güner Yasemin , Üçüncüoğlu Melek , Duman Dilbaz Ayşenur , Akturan Selçuk , Elçin Melih
Published: October 2024

Health professional education is rooted in patient interaction. The utilization of the simulated participant method is a widely accepted approach in this regard, as it enables students to engage in experiences that closely resemble real patient interactions. So, the simulated participants need to be well-prepared and well-engaged in the concept of their roles. The purpose of the study is to evaluate a new model for identity formation of simulated participants based on communities of practice theory. An 8-month follow-up study with pre- and post-interviews, observations, and reflective diaries designed with a qualitative approach. The results were categorized together under the five themes: “motivation of simulated participants”, “background of simulated participants”, “interaction between simulated participants as a part of a community of practice”, “limitations from simulated participants’ perspectives”, and “roles of simulated participants in simulation”. Our model based on communities of practice theory is an effective method for the formation of identities of simulated participants. Educators have the responsibility to improve the quality of simulated participant–based simulation. Our model can be thought of as an effective tool to use in this regard.
Collaborative timber joint assembly: Augmented reality for multi-level human-robot interaction
Authors: Rogeau Nicolas , Rezaei Rad Aryan
Published: October 2024

This research introduces an innovative Augmented Reality (AR) workflow for Human-Robot Interaction (HRI) in timber construction. The approach leverages human dexterity and adaptability alongside the strength and precision of robotic arms to assemble timber structures connected by wood-wood connections. While research in the field of automated construction generally focuses on singular interactions, such as robot agents carrying components and human agents attaching them, this paper explores multiple degrees of interaction involving cooperation or collaboration between agents. A new algorithmic framework is developed to automate the generation of holographic instructions and allocate assembly tasks to human and robot agents according to their abilities. The application to a full-scale demonstrator reveals that certain elements necessitate collaboration for assembly, while others can exclusively be assembled manually or robotically. Ultimately, the research also highlights the benefits of AR in assisting manual assembly, simulating robot trajectories, and increasing safety during collaborative tasks.
Spectral ruins: Empathy with inanimate material movements
Authors: Tursack Hans
Published: October 2024

Simulations are interactive, lively models of material events. Working with simulations that require the consideration of mass, gravity, and texture becomes an embodied experience. Much like video games, simulations imitate the physics of the material world and, as such, engage us corporeally. This dynamic between interactive model and user is particularly generative when the content of a simulation is inanimate, or inorganic materials. Digital models of static matter in motion offer the user a unique opportunity to relate to things that are typically understood as inert or nonliving. While empathy with the nonliving is a complex relationship to authentically construct, the ecological implications of this interaction are significant. This paper uses critical tools from video game studies and media theory to study simulations in experimental architecture and contemporary fine art practice. The essay posits a thesis informed by ecocriticism that users can build a tactile, bodily understanding of material behaviors by designing and interacting with tools built into animation, gaming, and visual coding platforms. A series of case-studies in art and design are examined with particular emphasis on their use of digital physics engines and code libraries that imitate natural behaviors.
Generative artificial intelligence tools for diverse learning styles in design education
Authors: Chandrasekera Tilanka , Hosseini Zahrasadat , Perera Ubhaya , Bazhaw Hyscher Anna
Published: October 2024

The integration of Artificial Intelligence (AI) is transforming design education by automating processes and enhancing learning. Early exposure to AI offers students a competitive edge in critical thinking and problem-solving. AI tools can inspire space planning, improve workflow, reduce cognitive load, and foster creativity. This study explores how the VARK model, which categorizes learning styles into Visual, Auditory, Reading/Writing, and Kinesthetic, influences student engagement with AI tools. In an interior design classroom study involving 32 sophomore students, AI tools were used to create floor plans and generate 3D images. The study assessed the correlation between learning styles and technology acceptance. Results revealed no strong correlations between individual learning styles and perceived ease of use, perceived usefulness, or actual use of AI tools. However, visual and kinesthetic learners displayed higher engagement, suggesting that these modalities may benefit more from AI-enhanced design education. The study also confirmed that perceived ease of use and usefulness are critical factors in technology acceptance, aligning with the Technology Acceptance Model (TAM). The findings suggest that AI tools can be broadly effective across diverse learning styles, with a universal perception of their utility in design education. This research highlights the potential of AI to support creative problem-solving and prepare students for future challenges in a digital design landscape. While learning styles influence engagement, AI tools’ usability and educational benefits are consistently recognized, demonstrating their transformative potential in design education.
Because of thương: Listening to the voices of Vietnamese early childhood educators
Authors: Pham Hoa , Phan Anh Ngoc Quynh , Tesar Marek
Published: October 2024

This paper explores the self-authoring of two early childhood educators in Vietnam’s disadvantaged areas, Ha and Dong, to understand their marginalization and resilience in their daily practices. Guided by a Bakhtinian view, teachers’ self-authoring is conceptualized as an ongoing process in which the teachers articulate authoritarian discourses, and integrate them with their ideas to develop their internally persuasive discourses—their own knowledge of themselves as professionals. Data was collected via semi-structured interviews and photo elicitation; and analyzed in parallel with Bakhtin’s theoretical concept of self-authoring and the post-structuralist feminist approach. The findings represent the political, social, and gendered discourses addressing and being addressed by the preschool teachers. The study suggests that compassion and devotion to work for children contribute to the teachers’ making sense of their professional roles. This paper calls for a need to center the voices of Vietnamese early childhood teachers in policy-making, teacher training, and research practices, towards educational sustainability.
Learning, sharing and caring: Pedagogical features of parents’ educational activism
Authors: Fretwell Nathan
Published: October 2024

Scholars of social movements have afforded increasing attention in recent years to pedagogical processes and practices within activist organisations. This article contributes to the ‘pedagogical turn’ in social movement studies by exploring pedagogical features of parents’ educational activism. Drawing on qualitative data collected from parent-led campaign groups operating in England, UK, the article attends to three aspects of activist pedagogy evident within the campaigns. The first concerns the learning that occurs through engaging in activism. The second, internal and external processes of knowledge-sharing. And third, parents’ perceptions of the educative potential of activism as a means for imparting democratic values to their children. I argue that the pedagogical dimension is a central feature of parents’ activism. Indeed, such activism constitutes itself a form of civic education in which democratic values and ideals are transmitted from one generation to another.
Risk analysis of visceral pleural invasion in malignant solitary pulmonary nodules that appear touching the pleural surface
Authors: Zhu Ziwen , Jiang Weizhen , Zhou Danhong , Zhu Weidong , Chen Cheng
Published: October 2024

Background:

The preoperative determination of visceral pleural invasion (VPI) in patients with malignant solitary pulmonary nodules (SPNs) is essential for determining the surgical range and selecting adjuvant chemotherapy.

Objectives:

This study aimed to systematically investigate risk factors of VPI in patients with SPN and construct a preoperative predictive model for such patients.

Design:

This is a retrospective study. The clinical, radiological, and pathological characteristics of study subjects were reviewed, and the groups with and without VPI were compared.

Methods:

Multivariate logistic analysis was utilized to identify independent risk factors for VPI. Moreover, a predictive nomogram was constructed to assess the likelihood of VPI occurrence.

Results:

Of the 364 enrolled cases, SPNs adjacent to the pleura with VPI were found in 110 (30.2%) patients. By incorporating four preoperative variables, including tumor diameter (>2 cm), maximum computed tomography value (>200 Hu), air bronchogram sign, and age, a preoperative predictive nomogram was constructed. The nomogram demonstrated good discriminative ability, with a C-index of 0.736 (95% CI (0.662–0.790)). Furthermore, our data indicated that the air bronchogram sign (odd ratio (OR) 1.81, 95% CI (0.99–3.89), p = 0.048), a maximum diameter >2 cm (OR 24.48, 95% CI (8.43–71.07), p < 0.001), pathological type (OR 5.01, 95% CI (2.61–9.64), p < 0.001), and Ki-67 >30% (OR 2.95, 95% CI (1.40–6.21), p = 0.004) were overall independent risk factors for VPI.

Conclusion:

This study investigated the risk factors for VPI in malignant SPNs touching the pleural surface. Additionally, a nomogram was developed to predict the likelihood of VPI in such patients, facilitating informed decision-making regarding surgical approaches and treatment protocols.
The face-cube illusion by Jean Beuchet
Authors: Devinck Frédéric , Quaireau Christophe
Published: October 2024

The face-cube illusion was made by Jean Beuchet in 1966 (as indicated in the device) and this effect was not published. For this reason, it seems important to present this visual phenomenon. The effect is obtained from connected curved wire construction presented in three-dimensional space. The orientation of wires can be modified, and it can be perceived as either a cube or a face depending on one's viewing point.
Cerebral salt wasting syndrome in a child with central diabetes insipidus following surgery for recurrent craniopharyngioma: A case report
Authors: Virú-Loza Manuel André
Published: October 2024

Surgical treatment of craniopharyngiomas in children can produce disorders related to water and sodium such as central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS). The combination of both in children is unusually reported in the literature and is associated with high mortality. The management of CSWS is based on fluid therapy. Fludrocortisone is useful in children with CSWS who do not respond to fluid management. The objective of the paper is to describe the case of 6 years and 10 months old male child with hypopituitarism secondary to a craniopharyngioma surgery performed 7 months before, who presented to the emergency department due to recurrent craniopharyngioma. The child presented a combination of CDI and CSWS following surgery for this recurrent tumor. Therapy with fludrocortisone was effective. Pediatric patients as the one of this report can help build the foundation for subsequent systematic reviews or trials.
Poster 135: Tranexamic Acid for Rotator Cuff Repair: A Systematic Review & Meta-Analysis of Randomized Controlled Trials
Authors: Hurley Eoghan , Levin Jay , Rodriguez Kaitlyn , Karavan Mark , Helmkamp Joshua , Alaia Michael , Klifto Christopher , Anakwenze Oke
Published: October 2024

Objectives:

The purpose of this study was to perform a systematic review of the randomized controlled trials in the literature to evaluate the use of tranexamic on arthroscopic rotator cuff repair.

Methods:

Two independent reviewers performed the literature search based on the PRISMA guidelines with a third author resolving any discrepancies. RCTs comparing TXA to a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures and shoulder swelling. A p value < 0.05 was deemed statistically significant.

Results:

Six RCTs with 450 patients were included in this review. Overall, 6 studies evaluated intra-operative visualization with 4 studies finding a significant difference in favor of TXA. With TXA patients had a lower average postoperative VAS score of 3.3, and with the control, patients had an average VAS score of 4.1, which was statistically significant (p = 0.001). With TXA the average weighted operation time was 79.3 minutes and with the control the average operation time was 88.8 minutes, which was statistically significant (p = 0.001). No study found any difference in post-operative pump pressures or swelling.

Conclusions:

TXA improved visualization, operative time and subsequent postoperative pain levels in patients undergoing ARCR.
Poster 141: In Vitro Inflammatory Response to Surgical Scaffolds for Rotator Cuff Repair
Authors: Smith Richard , Dakin Stephanie , Carr Andrew , Snelling Sarah
Published: October 2024

Objectives:

Surgical scaffolds are used to augment rotator cuff tendon repairs. Interactions between recruited immune cells and tendon-resident stromal cells influence whether the scaffold is integrated or rejected by the body. The primary aim of this in vitro study was to compare the inflammatory response of human monocytes to different surgical scaffolds. The secondary aim was to determine how this monocyte response affects the behavior of human rotator cuff tendon-derived stromal cells in vitro.

Methods:

Primary human monocytes were cultured on four commercially available scaffolds: LARS ligament (synthetic); GraftJacket (allograft), Permacol (xenograft, cross-linked), and Conexa (xenograft, noncross-linked). Secreted inflammatory proteins were measured after 1 and 10 days. Foreign body giant cell formation was assessed after 10 days. Proliferation and gene expression of tendon stromal cells were assessed after being grown in a conditioned medium from monocyte-scaffold cultures.

Results:

After 10 days, monocytes cultured on the Conexa scaffold secreted the highest levels of the pro-inflammatory markers GM-CSF, IL-8, and IL-10 (fig. 1). After 1 day, tendon stromal cells incubated in conditioned media from Conexa-monocyte cultures expressed lower Collagen Type VI and increased MMP3 and MMP6 mRNA (fig. 2). Foreign Body Giant Cell formation was most prominent in monocytes cultured on the Permacol scaffold (Figure 3).

Conclusions:

In vitro experiments demonstrated that xenograft scaffolds elicited a more pronounced pro-inflammatory response in human monocytes compared to synthetic and allograft scaffolds. Inflammatory cytokines secreted by monocytes in response to xenografts may modulate scaffold integration through paracrine signaling to tendon stromal cells. These findings may help explain the clinical performance of xenograft scaffolds for tendon repair and inform future scaffold design.
Poster 150: Subscapularis CT Evaluation in Patients following Treatment for Proximal Humerus Fractures: Reverse versus Anatomical Total Shoulder Arthroplasty
Authors: Gaj Eduardo , Pagnotta Susanna , Criseo Natale , Maggiori Alessandro , Forsythe Brian , Gamsarian Vahram , Mirle Vikranth , Khazi-Syed Daanish , Chang Joshua , Giallorenzi Maria Agostina , De Carli Angelo
Published: October 2024

Objectives:

Hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) are both reliable treatment options for complex proximal humerus fractures. While the role of the subscapularis tendon is well defined in HA, its role in RTSA has not been clearly demonstrated. The purpose of our study is to evaluate the role of the subscapularis tendon in patients treated with HA and RTSA and investigate its association with clinical outcomes.

Methods:

Sixty-eight consecutive patients with proximal humeral fractures were prospectively enrolled in the study between June 2015 and May 2020 (RTSA = 36; HA = 32). Shoulder CT scans were performed pre- and postoperatively, and subscapularis muscle cross-sectional area (SMCSA) and supraspinatus fossa cross-sectional area (SFCSA) were measured. SMCSA/SFCSA ratio was employed to standardize values. Patient-reported outcomes (PROs) and range of motion (ROM) were evaluated at the final follow-up.

Results:

RTSA group demonstrated higher PROs compared to HA patients: Constant Score (p = .0001), Quick Dash (p = .0006), Simple Shoulder Test (p = .01). ROM was better in RTSA than HA: internal rotation (p = .0047 adduction and p = .026 abduction), external rotation (p = .001 adduction and p = .026 abduction) and forward flexion (p < .0001). Reduction of subscapularis size of >35% occurred in 20 RTSA and 8 HA (p = 0.01). The loss of subscapularis surface was greater in the RTSA patients (p = 0.018).

Conclusions:

RTSA demonstrated better results compared to HA, providing better PROs and ROM. Postoperative reduction in subscapularis size was significantly higher in RTSA compared to HA. Subscapularis condition demonstrated no correlation with functional outcomes in RTSA.
Poster 174: Is Articular Width or Epicondylar Width Superior to Age to Optimize Radius of Curvature Matching in Capitellar Osteochondral Allografts?
Authors: Chan Charles , Sueyoshi Tetsuro , Maruyama Masahiro , Nissen Carl , Shea Kevin
Published: October 2024

Objectives:

There is growing interest to use matched distal humeral osteochondral allograft (OCA) for treatment of osteochondritis dissecans (OCD) of the capitellum due to concerns of donor site morbidity in osteochondral autograft transplantation surgery. Current graft match processes utilize the epicondylar width (EW) of the distal humerus, though little information is available regarding the correlation of this measurement to the radius of curvature (ROC) of the capitellum. The purpose of this study was to characterize the correlation between the EW and ROC as well as to evaluate two additional candidate parameters including patient age and the distal humeral articular width (AW).

Methods:

Forty patients (age ≤18) were identified for analysis. The capitellar cartilage ROC was measured on the sagittal plane of each magnetic resonance imaging (MRI) study at the level where the corresponding radial head was greatest in diameter (fig. 1). The EW (fig. 2) and the AW (fig. 3), which is bordered by the medial articular border of the trochlea and the lateral articular border of the capitellum, were also measured on the axial plane of each MRI study at maximal width. R2 correlation coefficients were calculated for ROC to EW, AW, and patient age (fig. 4). Intra-observer and inter-observer reliability measurements were performed to assess precision and validity of method.

Results:

The mean sagittal cartilage ROC, EW, and AW were 11.05 mm, 60.79 mm, and 44.31 mm. When measured against ROC, patient age had poor correlation with a R2 value of 0.46 whereas EW and AW demonstrated strong correlation with R2 values of 0.68 and 0.76 respectively. Intra-observer correlation coefficients were 0.93, 0.96, and 0.95 for ROC, EW, and AW respectively. Inter-observer correlation coefficients were 0.79, 0.94, and 0.94 for ROC, EW, and AW, respectively.

Conclusions:

Our results suggest that both AW and EW demonstrate superior correlation to capitellar ROC in comparison to age, and AW may be superior to EW. AW may be considered for utilization as a distal humeral allograft matching parameter particularly in patients that may have altered epicondylar morphology such as in the throwing athlete. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Poster 181: Hip Arthroscopy with Concomitant Periacetabular Osteotomy Demonstrates Excellent Outcomes and Survivorship at Minimum 10-Year Follow-Up
Authors: Domb Benjamin , Kahana-Rojkind Ady , Parsa Ali , Bruning Rachel , Padmanabhan Saiswarnesh , LaReau Justin
Published: October 2024

Objectives:

Multiple studies have shown that hip arthroscopy with concomitant periacetabular osteotomy (PAO) is a safe and effective treatment option for patients presenting with Symptomatic acetabular dysplasia and intra-articular pathology. While excellent short- and mid-term outcomes have been previously reported, there exists a paucity of literature investigating long-term outcomes of hip arthroscopy with concomitant PAO. The purpose of this study was to report minimum 10-year follow-up results and survivorship of hip arthroscopy with concomitant PAO to treat acetabular dysplasia and intraarticular pathologies such as femoroacetabular impingement (FAI) and labral tears.

Methods:

Data from October 2010 to December 2012 was prospectively collected and retrospectively reviewed to identify patients undergoing hip arthroscopy with concomitant PAO. Patients were included in the present analysis if they had preoperative and minimum 10-year patient reported outcomes (PROs) documented for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Scored Sports-Specific Subscale (HOS-SSS), and pain on a visual analog scale (VAS), as well as the International Hip Outcome Tool (iHOT-12) and patient satisfaction score on a 0-10 scale.

Results:

Fifteen patients were eligible for analysis and 12 had complete minimum 10-year follow-up (80.0%) at mean 10.2 years postoperation. There were 10 females (83.3%) and 2 males (16.7%) included in the study with a mean age and BMI of 24.4 years and 24.5 kg/m2, respectively. The mean lateral center-edge angle (LCEA) of all included hips in the analysis increased from 13.8° to 29.8° postoperatively ( P<0.05) and the anterior center-edge angle (ACEA) increased from 14° to 28.8° postoperatively ( P<0.05). Additionally, the Tönnis angle of acetabular inclination decreased from 17.9° to 7.3° postoperatively ( P<0.05) and the alpha angle decreased from 56.5° to 52.1° postoperatively ( P<0.05). There was significant improvement in all PROs from baseline to minimum 10-year follow-up (mHHS; NAHS; HOS-SSS, P< 0.05). All patients achieved high rates of MCID for mHHS, NAHS, and HOS-SSS, as well as high rates of PASS for mHHS and VAS. The 10-year survivorship for all patients included in the analysis was 83.3% with 2 patients (16.7%) progressing to total hip arthroplasty (THA) at mean 58.0 months postoperatively. Additionally, 2 patients (16.7%) underwent subsequent ipsilateral revision hip arthroscopy at mean 79.5 months postoperatively.

Conclusions:

Patients with dysplasia and intra-articular pathology such as labral tears and FAI can be safely treated using hip arthroscopy with concomitant PAO. These patients can achieve excellent long-term outcomes and high rates of survivorship at minimum 10 years postoperation.
Poster 296: Comparing Outcomes of Osteochondral Allograft Transplantation of the Knee Preserved by the Missouri Osteochondral Preservation System to Standard Preservation Methods
Authors: Perez Andres , Hanna Adeeb J. , Destine Henson , Campbell Michael P. , Kern Nathaniel , Tucker Bradford S. , Freedman Kevin B.
Published: October 2024

Objectives:

Osteochondral allograft (OCA) transplantation is an established surgical intervention for full-thickness chondral defects. Standard Preservation (SP) protocols currently allow for osteochondral allografts to be stored for a maximum of 28 days after procurement. The Missouri Osteochondral Allograft Preservation System allows for grafts to be stored for at least 60 days after procurement. The purpose of this study is to compare clinical and radiographic outcomes in patients that have undergone OCA transplantation utilizing Missouri Osteochondral Allograft Preservation System (MOPS) to standard preservation protocols.

Methods:

Retrospective review identified all patients who underwent OCA transplantation between 2012 and 2018. Patients without appropriate follow-up, postoperative outcomes, or necessary imaging were excluded. All patients had at least 2-year follow-up data. Patient demographics, outcomes, and graft information were compared between patients who received grafts preserved by MOPS and standard preservation as previously defined.

Results:

Sixty-four patients were included. Twenty-five were in the MOPS group and 39 in the SP group. Members of the MOPS group were younger at the time of surgery than those in the SP group (28.6 ± 10.7 years in MOPS vs. 36.7 ± 10.9 in SP group, P = 0.005). Seventy-six grafts were analyzed with 39 grafts in the MOPS group and 37 in the SP group. Grafts in the MOPS group were stored longer (average 50.03 days) than grafts in the SP group (average 23.18 days) (P < 0.001). No difference between groups was found in complications or reoperation rates. Outcomes between the 2 groups showed no statistical differences for complications or revisions as well as similar Knee Injury and Osteoarthritis Outcome Scores for Joint Replacement, International Knee Documentation Committee scores, 12-item psychosocial safety climate scores, and 12-item mental health component summary scores.

Conclusions:

Grafts preserved using the MOPS were stored for more than double the length of time than grafts preserved with standard preservation techniques. There was no difference in postoperative outcomes following OCA transplantation regardless of preservation method used.
Poster 328: Effect of Knee Aspiration prior to ACL Reconstruction Surgery on Subsequent Surgery: A Randomized Clinical Trial
Authors: Inclan Paul , Rai Muhammad , Chen Ling , Brophy Robert
Published: October 2024

Objectives:

The traumatic effusion associated with an acute anterior cruciate ligament (ACL) rupture contains pro-inflammatory cytokines, chemokines and matrix degrading enzymes. Aspiration of the effusion may help reduce the burden of joint inflammation. However, the short and mid-term implications of routine aspiration have not been well documented. The primary objective of this prospective, randomized control trial is to determine whether routine pre-operative aspiration upon presentation to the orthopaedic clinic impacts (a) all-cause re-operation rate in patients undergoing ACL reconstruction (ACLr) and, more specifically, (b) rate of surgical debridement for postoperative arthrofibrosis, a common clinical sequela of ACLr.

Methods:

Eligible patients presented to a single, academic sports surgeon with an acute ACL rupture and were clinically indicated for ACLr. Both sexes were included in this study. Exclusion criteria included pre-existing osteoarthritis (Kellgren-Lawrence grade 3 or greater), focal chondral injury (International Cartilage Repair Society grade 3 or higher), concurrent ipsilateral extra-articular injury, history of contralateral knee injury, or age greater than 62 years. Patients were randomized to either routine preoperative care or in-office aspiration of their traumatic effusion upon initial presentation. Patients underwent routine diagnostic arthroscopy at the time of ACLr to evaluate for concurrent chondral or meniscal pathology. Patients underwent standard postoperative rehabilitation and follow-up care.

Results:

Eighty-seven patients were enrolled in this study, with 46 (53%) patients randomized to and undergoing preoperative aspiration (Table 1). At a mean follow-up of 2.56 years, 14 patients (16%) underwent re-operation for any reason  and 10 (11.5%) patients underwent debridement of arthrofibrosis (Table 2). Preoperative aspiration was not significantly associated with a decreased rate of arthrofibrosis (Figure 1) or re-operation (Figure 2). However, it was significantly associated with a longer time to debridement for arthrofibrosis (125 days vs 457 days, p = 0.0029).

Conclusions:

Preoperative aspiration does not modify rates of subsequent surgery following ACLr. In patients who develop arthrofibrosis after ACLr, preoperative aspiration is associated with a delay in the development of arthrofibrosis. This could be due to a decrease in burden of intraarticular inflammation after aspiration. Further study is needed to assess why aspiration delays the onset of arthrofibrosis and whether aspiration impacts long-term outcomes such as the development of post-traumatic OA.
Poster 339: Outcomes of Anterior Cruciate Ligament Reconstruction in Competitive Ice Hockey Players: Outcomes, Reoperations, and Return to Play at 7 Years Mean Follow-Up
Authors: Feroe Aliya , Lamba Abhinav , Regan Christina , Marigi Erick , Stuart Michael
Published: October 2024

Objectives:

Ice hockey is a physically demanding sport, with young athletes prone to anterior cruciate ligament (ACL) injuries. Currently, there is a paucity of data examining the results of ACL reconstruction (ACLR) in competitive hockey players. The purpose of this study was to assess return to hockey (RTH) and reoperation rates following ACLR for ACL injuries in a cohort of competitive hockey players.

Methods:

All competitive ice hockey players (including, youth, high school, juniors, collegiate, or professional) with a history of ACL injury and subsequent ACLR at a single academic institution between 2000 and 2022 were identified. Exclusion criteria included ACL injuries that did not occur during hockey, history of ACLR prior to hockey injury, and recreational hockey players. Graft failure was defined as a retear (as determined via clinical or advanced imaging evaluation) and/or revision ACLR.

Results:

Ultimately, 50 knees in 44 hockey players were included at a mean (± standard deviation) follow-up time of 7.0 years ± 5.4 years (Table 1). The mean age at the time of index surgery was 18.9 years ± 3.0 years, with 38 males (76%), and the distribution of bone-patellar tendon-bone (BPTB) and hamstring tendon (HT) autografts was 40 (80%) and 10 (20%), respectively. RTH occurred in 66% of hockey players at a mean of 10.2 months ± 6.2 months. Graft failure occurred in 9 knees (18%) at a mean of 5.9 years ± 5.8 years after the index ACLR. All patients who sustained a retear underwent reoperation. Kaplan-Meier survivorship free from surgical failure of the entire cohort was 94% at 1 year, 88% at 5 years, 74% at 10 years, and 67% at 15 years (Figure 1A). BPTB autograft demonstrated a lower failure rate compared with HT autograft (13% vs 40%; P = 0.041) and was associated with better survival compared with HT autograft up to 15 years after the index ACLR (80% vs 39%; P = 0.047; Figure 1B).

Conclusions:

ACL injury remains a concern for competitive hockey players after ACLR. Return to competitive ice hockey was observed in 66% of athletes after ACLR, with 18% of hockey players experiencing graft failure and undergoing subsequent reoperation. BPTB autograft was associated with better survival than HT autograft.
Poster 371: ChatGPT: An Effective Tool for Patients to Understand Platelet-Rich Plasma in Orthopedic Surgery
Authors: Samsonov Alan , Butler James , Roof Mackenzie , Kennedy John
Published: October 2024

Objectives:

Web-based technology has augmented healthcare delivery for both patients and providers. ChatGPT, a free and easily accessible artificial intelligence (AI) chatbot, has the potential to further optimize current practice. The chatbot has cemented itself as an informative resource for orthopaedic patients, but its use in ortho-biologics, particularly platelet-rich plasma (PRP), has not been described. The purpose of this study was to assess the quality of information provided by ChatGPT in response to frequently asked questions about the use of PRP in orthopedic surgery.

Methods:

ChatGPT was posed 10 frequently asked questions about the use of PRP in orthopedic surgery in a conversational thread. Responses were recorded and no follow-up queries or clarification was obtained. The responses were subsequently graded “A,” “B,” “C,” or “F,” corresponding with “excellent response,” “adequate response needing mild clarification,” “inadequate response needing moderate clarification,” and “poor response needing severe clarification.”

Results:

Of the 10 responses, 1 was grade “A,” 7 were grade “B,” 2 were grade “C,” and 0 were grade “F.” Overall, ChatGPT provided good quality responses to the prompts.

Conclusions:

ChatGPT provided sufficient responses to questions regarding PRP in orthopedic surgery, utilizing appropriate language to provide responses representative of the current literature surrounding PRP. The biggest limitation to superior chatbot performance is the lack of robust consensus on the use and preparation of PRP. This study accentuated the possibility for ChatGPT to serve as an additional informative resource for orthopedic surgery patients who want to learn about PRP.