bluuebunny/crossref_metadata_2025 huggingface dataset:
Mobile bearing leads to less proximal medial tibial strain following UKA in comparison with fixed bearing in a cadaver setup
Authors: Heyse Thomas J. , Taylan Orcun , Slane Joshua , van Lenthe Harry , Peersman Geert , Scheys Lennart
Published: May 2020

Aims and Objectives:

Inexplicable pain to the medial proximal tibia is a frequent finding leading to revision after unicondylar knee arthroplasty (UKA). This study is an effort to find out, if there are any differences between mobile (MB) and fixed bearing (FB) UKA designs in terms of resulting strain in the medial proximal tibia as measured in an in vitro cadaver setup. It was hypothesized that MB UKA would result in lower bone strain.

Materials and Methods:

Five pairs of fresh-frozen full leg cadaver specimens were mounted in a kinematic rig that applied a dynamic squatting motion knee flexion after prior 3D CT. The rig allowed for 6 degrees-of-freedom at the knee while forces were applied to the quadriceps and hamstrings. During testing, an infrared camera system tracked the location of reflective markers attached to the tibia and femur with bicortical bone pins. Tibial cortical bone strain was measured with stacked strain gauge rosettes attached at predefined anterior and posterior positions on the medial cortex. Sensor outputs were recorded at 2000 Hz and synchronized with kinematic data prior and after pairwise implantation of MB and FB UKA directly comparing those between left and right knees from the same donor.

Results:

Bone strain values consistently increased with increasing flexion angle. FB UKA significantly increased strain in the anterior region of the medial tibial bone, while MB closely replicated strain values of the native knee.

Conclusion:

Proximal tibial bone strain seems to be lesser following MB UKA in comparison with FB UKA. Clinical studies will have to show, if this translates into a higher rate of pain problems with FB UKA.
3D-ANALYSIS OF LOWER LIMB ANATOMY: NORMAL VALUES FOR JOINT ANGLES AND ALIGNMENT
Authors: Fürmetz Julian , Sass Jan , Jalali Jalil , Degen Nikolaus , Böcker Wolfgang , Thaller Peter
Published: May 2020

Aims and Objectives:

The analysis of lower limb anatomy is mandatory in deformity surgery and total knee replacement. Standard values for joint angles and alignment are only available for 2D images using long standing and lateral radiographs. In contrast, 3D bone models realistically represent the anatomy and are independent of position and projection. Using a self-developed, standardised and validated protocol for 3D analysis of lower limb geometry, standard values for specific joint angles and axes can be obtained in a young cohort for the first time.

Materials and Methods:

After power and sample size analysis, 60 thin-slice CTs of the entire leg were analysed (30 patients, 13 f, 17 m; age = 33.8 [18-50 years]). After segmentation all 24 relevant bony landmarks were set using our standardised analysis method. Results of joint angles and mechanical axis deviation are calculated automatically. Mean values are stated with standard deviations to describe a possible reference range.

Results:

The mean neck-shaft angle (NSA) was 133±10° and the mean medial proximal femoral angle (MPFA) 85±9°. Around the knee joint, the mean mechanical lateral distal femoral angle (mLDFA) was 87±4° and the medial proximal tibial angle (MPTA) 88±5°. Medial and lateral slope averaged 12±7° and 9±8°. The deviation of the frontal mechanical leg axis from the knee joint center (MAD frontal) was 7±15mm and the mechanical femoro-tibial angle (HKA) 175±6°. Women showed a smaller mLDFA than men (86.4° vs. 87.8°, p<0.05) and a larger joint line convergence angle (JLCA 2.5° vs. 1.4°, p<0.01) representing a more valgiform anatomy.

Conclusion:

The standardised 3D analysis enabled reference ranges for the relevant joint angles and axes to be defined on the 3D bone model for the first time. The results redefine reference ranges for 3D measurements similar to existing 2D measurements on long standing radiographs. The systematic analysis of the complex 3D anatomy results in a multitude of new questions and possibilities in preoperative planning.
Long term results after ACL-reconstruction in childhood and adolescence
Authors: Zimmerer Alexander , Ellermann Andree
Published: May 2020

Aims and Objectives:

Ruptures of the anterior cruciate ligament in childhood and adolescence are severe injuries with increasing incidence over the last years. It is known today that the course of an unstable knee joint during growth can lead to poor subjective and objective results. The aim of the study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in children and adolescents at least 15 years after surgery.

Materials and Methods:

We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence with a follow-up of at least 15 years. In these patients, the Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS), and Lysholm Score were collected, and clinical and MRI examinations were performed.

Results:

A total of 32 patients were identified, 5 of whom refused to participate. The average age at the time of surgery was 12 years, the average follow-up time was 17 years. In 3 patients a traumatic re-rupture was observed. None of the included patients showed a growth disorder at follow-up. The following subscores were found for the KOOS: KOOSpain 89, KOOSSymptom 82, KOOSADL 92, KOOSSport 75, KOOSQOL 82. The Tegner Activity score was 5.8, the Lysholm score 86 points. 13 of the 27 patients could also be examined clinically and by magnetic resonance imaging. In the MRI images, 95% of the patients showed intact grafts without evidence of cartilage or meniscus damage. The average lateral difference in the KT-1000 measurement was 1.5 mm.

Conclusion:

Transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long-term results. Secondary arthrosis signs can only be detected sporadically in MRI
Functional knee phenotypes - A novel classification for the lower limb alignment based on the native alignment in young non-osteoarthritic patients
Authors: Moser Lukas , Hess Silvan , Behrend Henrik , Hirschmann Michael
Published: May 2020

Aims and Objectives:

In total knee arthroplasty (TKA), the postoperative coronal alignment is a key factor for good clinical outcome. At the same time, the optimal alignment has been under debate recently. This debate usually focuses on the overall limb alignment while the details of the alignment, such as femoral or tibia alignment, are neglected. This might be partly because there is no concept which incorporates all parameters in a comprehensive and simple way. The purpose of this study was therefore to establish such a concept for the coronal knee alignment.

Materials and Methods:

The hospital registry was searched for patients older than 16 and younger than 45 years, who received a CT according to the Imperial Knee Protocol. Patients with prosthesis, osteoarthritis, fractures or injury of the collateral ligaments were excluded. Finally, 308 non-osteoarthritic knees of 160 patients remained (102 males and 58 females, mean age ± standard deviation (SD) 30±7 years). The following coronal alignment parameters were measured using a validated software (KneePLAN 3D, Symbios Orthopédie S.A): hip-knee-ankle angle (HKA, angle formed by the lines connecting the centers of the femoral head, the knee and the talus), femoral mechanical angle (FMA, angle between the mechanical axis of the femur and the tangent to the distal femoral condyles) and tibial mechanical angle (TMA, angle between the mechanical axis of the tibia and the tangent to the tibial plateau). Phenotypes for the limb, femur and tibia were defined based on these measurements. A phenotype thereby consists of a phenotype specific mean value (HKA, FMA or TMA value) and covers a range of ± 1.5° from this mean (e.g. 180°± 1.5). The phenotype specific mean values represent 3° increments of the angle starting from the rounded overall mean value of the angle.

Results:

Out of 125 possible phenotypes, 43 were found in these non-osteoarthritic knees (35 male, 26 female and 18 mutual phenotypes). The most common functional knee phenotype in males was NEUHKA0°NEUFMA0°NEUTMA0° (19%), followed by VARHKA3°NEUFMA0°VARTMA0° (8.2%). The most common phenotype in females was NEUHKA0°NEUFMA0°NEUTMA0° (17.7%), closely followed by NEUHKA0° NEUFMA0°VALTMA0° (16.6%).

Conclusion:

The functional knee phenotype concept better represents the variability of the coronal knee alignment than the conventional system of valgus, varus and neutral. Furthermore, it should enable a more detailed discussion about the coronal alignment and TKA alignment goals.
High Accuracy of Second Generation Unyvero ITI Automated Multiplex PCR Analysis of Joint Fluid Aspirate in Low-Grade Prosthetic Hip and Knee Joint Infections
Authors: Suren Christian , Feihl Susanne , Cabric Sabrina , Banke Ingo , Haller Bernhard , Trampuz Andrej , von Eisenhart-Rothe Rüdiger , Prodinger Peter Michael
Published: May 2020

Aims and Objectives:

A major obstacle for the treatment of prosthetic joint infections (PJIs) is the identification of the organism causing it. While the diagnostic criteria ruling PJIs in or out have become ever more accurate, detecting the causative pathogen(s) still relies mostly on conventional culture. The aim of this study was to evaluate the diagnostic potential of a second generation multiplex PCR assay (Unyvero ITI G2, Curetis AG, Holzgerlingen, Germany) used on synovial fluid specimens.

Materials and Methods:

Prospectively collected frozen joint fluid specimens from 26 patients undergoing arthroplasty revision surgery of the hip or knee for any reason were tested as per the manufacturer’s protocol. The sensitivity and specificity were calculated using the Chi-squared-test and a combination of the serum CRP level, leukocyte count, erythrocyte sedimentation rate, joint fluid culture, tissue biopsy culture, and tissue biopsy histology served as gold standard.

Results:

Of the 26 cases included in the study, 15 were infected and 11 aseptic. Conventional joint fluid culture showed a sensitivity 0.67 and a specificity of 0.91. Joint fluid multiplex PCR yielded a sensitivity of 0.8 and a specificity of 1.0.

Conclusion:

This is the first study to assess the second generation Unyvero ITI cartridge on joint fluid aspirate for the detection of prosthetic joint infection. In our setting, the method achieved a higher diagnostic accuracy than conventional culture. We conclude that, to improve pathogen detection before revision surgery, this method represents a valuable tool.
Arthrofibrosis of the knee: clinical result after early vs. late arthroscopic arthrolysis of 100 patients
Authors: Alm Lena , Klepsch Leonard , Akoto Ralph , Frosch Karl-Heinz
Published: May 2020

Aims and Objectives:

Distal femoral or tibial fractures as well as anterior cruciate ligament (ACL) tears can be associated with postoperative arthrofibrosis of the knee. So far, there are only a few studies that analyse this entity. The aim of the study is to evaluate potential risk factors that influence the outcome of patients with arthrofibrosis. We hypothesize that early arthroscopic arthrolysis is associated with a better postoperative outcome.

Materials and Methods:

100 patients (at the time of the abstract submission n=59) with arthroscopic arthrolysis of postoperative arthrofibrosis of the knee were included in the retrospective study. They were clinically examined with a minimum follow-up of 2 years (mean 25±6 months). Arthrofibrosis was shown in 51% of the cases after ACL lesions, in 14% after femoral and tibial fractures, in 12% after infection and in 10% after patella fractures. The study population was divided into early (less than 3 months; n=19, mean 1.5 months) and late (more than 3 months; n=40, mean 8.7 months) arthroscopic arthrolysis after primary surgery.

Results:

In 51% of the cases (n=30) a normal range of motion could be postoperatively achieved (extension/flexion 0/140°). Patients with early arthroscopic arthrolysis showed significant more often a normal postoperative range of motion in comparison to patients with late revision (84% vs. 35%; p<0.001). Furthermore, patients with early arthrolysis had a significant lower postoperative flexion deficit than the late arthrolysis group (4° vs. 27°, p<0.001). The postoperative extension deficit was also significantly lower in the early arthrolysis group (0.4° vs. 3°; p=0,021). Postoperative functional scores were significantly higher after arthroscopic arthrolysis in comparison to before arthrolysis (Lysholm 85,1±11 vs. 41,3±9, p=0,049; Tegner 6,1±1 vs. 3,2±2, p=0,035; Cincinnati Rating Scale 83,1±13 vs. 52,1±16, p=0,046).

Conclusion:

Arthrofibrosis of the knee can be successfully treated with arthroscopic arthrolysis. Good postoperative results can be gained in treating flexion and extension deficits. Early arthroscopic arthrolysis shows significant better results in postoperative range of motion in comparison to late arthroscopic arthrolysis.
What do patients expect from osteosynthetic stabilization of proximal tibial fractures?
Authors: Hellinger Lena , Keppler Alexander M. , Ihle Christoph , Stuby Fabian , Saier Tim
Published: May 2020

Aims and Objectives:

Surgical treatment of proximal tibial fractures is often associated with complications and postoperative limitations in knee motion. Unrealistic patient expectations of the operation may lead to dissatisfaction with the surgical outcome despite successful surgery. The hypothesis of this study was that patients with proximal tibial fracture have very high expectations of surgical intervention in terms of painlessness, return to work and sport ability. Further, underestimation of the risk for the development of secondary gonarthrosis was hypothesized.

Materials and Methods:

From 2017-2018, n=79 patients (n=35 w, mean age 48 years ±13.6 years) with proximal tibial fracture were prospectively and consecutively enrolled at three level A trauma centers. Preoperatively, demographic data, fracture classification according to AO classification, the HSS -Knee Surgery Expectations Survey using the 4-point Likert scale, the workload according to REFA criteria and the non-standardized expectations regarding the return to work/sport ability and the secondary risk for developing gonarthrosis were collected and analysed. A statistical significance of p<0.05 was assumed.

Results:

81% (n=63) of the patients expect a maximum duration of incapacity for work of 12 weeks regardless of age, gender and workload (n.s.). 74% (n=58) expect a return to work and 70% (n=55) a return to sport with no or only minor restrictions. Younger patients (younger than 55 years) had significantly higher expectations of an unrestricted return to work (p=0.045) and sport (p=0.04). Gender and workload had no significant influence on this expectation (n.s.). 33% (n=26) do not expect any residual pain postoperatively, regardless of activity. Younger patients expect significantly less residual pain than older patients (p=0.03). 92% (n=73) expect a completely normal knee joint or only minor differences to a healthy knee, regardless of age, gender and workload (n.s.). At least 72% (n=57) of the patients consider an unrestricted or only slightly restricted knee function to be at least important, regardless of age, sex and workload (n.s.). 29% (n=23) of the patients, regardless of age, sex and workload (n.s.) assume that the operation prevents secondary gonarthrosis.

Conclusion:

The results confirm our hypothesis that patients have very high expectations of the surgical treatment of proximal tibial fractures. For younger patients in particular, an unrestricted return to sport, work and painlessness is very important. The risk assessment regarding developing secondary gonarthrosis seems unrealistic. This study should help surgeons to discuss realistic expectations and results of osteosynthetic stabilization of proximal tibial fractures with their patients in order to improve patients’ satisfaction.
Comparable surgery time for robotic assisted total knee arthroplasty after initial learning curve
Authors: Savov Peter , Tücking Lars-René , Windhagen Henning , Ettinger Max
Published: May 2020

Aims and Objectives:

In the past years, further development in knee replacement still continues. Computer-assisted surgery techniques in total knee arthroplasty (TKA) are on the rise. One point of criticism is the prolonged time of surgery and associated cost as known from old techniques like navigation. The primary objective of this study was to determine the learning curve for the time of surgery and accuracy in implant positioning for an imageless robotic system for TKA.

Materials and Methods:

In this prospective study, the first 30 robotic-assisted TKA from a single senior surgeon were analyzed with regard to time of surgery and accuracy of implant position on the basis of the intraoperative plan and the postoperative x-rays. This data was compared to the last 30 manual TKAs of the same surgeon with the same prosthesis. Evaluation of the learning curve was performed with CUSUM analysis. The time of surgery after finishing the learning curve in the robotic group was compared to the manual group.

Results:

The learning curve in the robotic group for surgery time was finished after 11 cases. The robotic experience did not affect the accuracy of implant positioning, such as limb alignment and restoration of the joint line. The mean absolute deviation of the postoperative limb alignment to the intraoperative plan was 2° (+/- 1,1). The mean absolute deviation of the medial proximal tibial (mPTA) and distal lateral femoral angle (dLFA) was 1° (+/- 0,9) for both. The mean surgery time in the robotic group after finishing the learning curve was 66 minutes (+/- 4,2) and in the total manual group 67 minutes (+/- 3,5) (n.s.).

Conclusion:

After finishing the initial learning curve of 11 cases for robotic-assisted TKA the time of surgery is equal to the manual conventional technique. However, there is no learning curve for implant positioning with the imageless robotic system. The implementation of the intraoperative plan is accurate to 1° with the robotic system.
Functional outcome in patients following cartilage regenerative treatement: outcome at minimum follow-up of 12 months
Authors: Zantop Thore , Zantop Christian , Hönninger Anja , Hauner Dominik , Warminski Przemyslaw , Angele Peter
Published: May 2020

Aims and Objectives:

Full thickness cartilage defects may be devastating for the patients. Even though, the surgical options have improved, only limited information for returning to sports. Aim of this study was therefore to compare the functional outcome and the return to sports rate of patients following cartilage regenerative treatment at a minimum follow up of 12 months.

Materials and Methods:

A total of 50 Patients (32 male, 18 female) undergoing cartilage regeneration using a Matrix-associated chondrocyte transplantation (MACT, Novocart, TETEC, Aesculap) (27 femorotibial, 23 patellofemoral) were evaluated at a minimum follow-up of 12 months. Follow-up was performed using a multifactorial functional analysis including isokinetic strength measurements (BTE-primus), proprioceptive tests (MTF tests), a tapping test and a 3d-motion analysis (myomotion, Noraxon) during single leg squats, bilateral drop jumps and single leg hop tests. Agility was assessed using a lateral speedchase (Globalspeed, Hemsbach). Clinical results were recorded using Tegner and Lysholm score.

Results:

Patients showed a Lysholm score of 86,3 +/-10,3 and 84,0 +/-13,9 for male and female, respectively. The tegner score was significantly reduced when compared to preoperatively (male 4,72 +/-1,6, female 4,75 +/-1,5). Thigh circumference was reduced by an average of 3,6 cm for male and 4,4 cm for female patients. The tapping test revealed no differences between male and female patients providing a leg symmetry index (LSI) of 102,0 (+/-8,4) with an overall average frequency of 10,14 (+/-1,27). During single leg squat male patients had a significantly lower knee flexion of 55,8 (+/-8,5) of the postoperative leg compared to the non-injured leg (62,2 +/-8,2) whereas the knee abduction was -6.8 (+/-15,1) and -11,8 -11,82 (+/-16,6) for the postoperatively and non-injured leg, respectively. Evaluating the single leg hop, the LSI of distance values was 90,8 (+/-11,9) and for height values 84,0 (+/-16,0) for the male patients. There was a trend towards reduced ROM with regard to knee flexion of the injured leg to the non-injured. Cutting time during lateral speedchase showed a LSI of 98,29 (+/-13,8) and 99,44 (+/-8,2) for male and female patients, respectively.

Conclusion:

This prospective analysis of patients following cartilage regeneration implicates that the use of a multifactorial “return-to-sports” analysis 12 months postoperatively provides a good correlation to the clinical outcome and scores. At this FU point, Patients following MACT show knee joint function that is close to normal.
Patients outcome after distal femur- and proximal tibia replacement
Authors: Graulich Tilman , Kranz Caroline , Korallus Christoph , Örgel Marcus , Haertle Marco , Omar Mohamed , Krettek Christian , Panzica Martin
Published: May 2020

Aims and Objectives:

Mega-knee-arthroplasty are rare and indications are heterogeneous after fracture, tumour and infection. The outcome after distal femur- and/or proximal tibia replacement are unclear. We therefore wanted to analyse the postoperative outcome in case of primary and revision surgery. We hypothesize that I) Implantation of distal femur- and/or proximal tibia replacement are associated with reduced range of motion and function compared to the contralateral side and II) implantation in case of primary surgery is associated with better outcome than in case of revision surgery.

Materials and Methods:

We retrospectively analysed all patients in our trauma department between 1998 and 2017 who underwent a MUTARS distal femur replacement or proximal tibia replacement (Implantcast GmbH, Buxtehude, Germany). We collected general patients’ data, rang of motion, determined the Toronto extremity selvage score (TESS), musculoskeletal tumour society score (MSTS), knee society score (KSS) and Western Ontario MacMaster questionnaire (WOMAC) Score. Knee extension and flexion force was measured.

Results:

We included 59 patients with a mean age of 65+/-20 years. Out of these we had 19 (32%) male and 40 (68%) female patients. Mean follow up (f/up) was 36+/-57 month (range: 1-218). Indication for R-TKA was periprosthetic fractures (n=14), tumour (n=16), infection (n=10), traumatic fracture (n=14), aseptic loosening (n=3) and pathologic fracture (n=2). Indication for primary implantation was given in 33 (56%) patients and for implantation in case of revision surgery in 26 (44%) patients. Mean TESS was 66+/-33, mean MSTS was 14+/-7, mean KSS was 49+/-30, mean WOMAC was 36+/-26. Mean flexion on the operated side was 83°+/-24° compared to the healthy side (115°+/-20°) (p<0.001). Mean extension force on the operated side at 60° was 20+/-12 (Nm) compared to 77+/-58 (Nm) on the not operated side (p=0.31). Mean flexion force on the operated side at 60° was 32+/-26 (Nm) compared to 53+/-42 (Nm) on the not operated side (p=0.43). In case of revision surgery significant worse function scores in the TESS and KSS could be overserved (both p<0.05).

Conclusion:

Implantation of a distal femur- and/or proximal tibia replacement are associated with loss of flexion, a trend to reduced extension and flexion power compared to the contralateral side. In case of primary surgery better functional results in terms of function Scores can be expected than in case of revision surgery.
Repair vs. Reconstruction for Acute Isolated ACL Tears- 2-Year Results of a Prospective Randomized Study
Authors: Glasbrenner Johannes , Kösters Clemens , Spickermann Lena , Kittl Christoph , Domnick Christoph , Herbort Mirco , Raschke Michael J. , Schliemann Benedikt
Published: May 2020

Aims and Objectives:

Recently, due to the development of new techniques, ACL repair has returned back into focus of experimental and clinical research. Newer studies highlight the fact that ACL repair can lead to satisfying functional results and healing rates. Aim of the present study was to compare the functional results after ACL repair in comparison to primary ACL reconstruction for acute isolated ACL tears. It was hypothesized, that functional results and knee joint stability after ACL repair are comparable to those after ACLR.

Materials and Methods:

A prospective randomized study (Level of evidence 1) including a total of 85 patients with acute ACL tears was performed. Patients were randomized to undergo either ACL repair or primary ACL reconstruction with a semitendinosus autograft. The preinjury activity level and function were recorded. Follow-up examinations were performed at six weeks, six, twelve and 24 months postoperatively. At each follow up, the Tegner activity scale, the International Knee Documentation Committee (IKDC) subjective score and the Lysholm score were acquired. Furthermore, anterior tibial translation (ATT) was evaluated by Rolimeter testing. The rate of recurrent instability and other complications were recorded.

Results:

79 patients could be re-evaluated (follow-up rate 93%). No significant differences between ACL repair and ACLR were found for the Tegner, IKDC and Lysholm score at any time of the follow-up. ATT was increased in the ACL repair group ( ATT 1.9 vs. 0.9). This difference was statistically significant (p=0.0086). Seven patients (17%) of the ACL repair group presented with recurrent instability and underwent single-stage revision reconstruction with hamstring autografts. Another three patients showed increased laxity with insufficient healing after ACL repair but did not require revision. In the ACLR group, five patients (13%) sustained a re-tear after return to their previous activity level. However, in three cases, a two-staged revision was required. Recurrent instability was associated with young age and higher Tegner scores in both groups.

Conclusion:

Functional results after ACL repair for acute tears are comparable to those after ACLR. However, the rate of ACL insufficiency seems to be slightly increased after ACL repair. In the revision situation, single-stage revision was possible in all cases following primary repair, whereas after primary reconstruction, a two-staged revision had to be performed in three of five cases. The current study supports the use of ACL repair as an option to treat acute ACL tears.
Thermography in persistent postoperative pain after knee surgery
Authors: Friedrich David , Köhne Manuel
Published: May 2020

Aims and Objectives:

Background: Postoperative persistent pain occurs in approximately 10% of surgically treated patients. It incapacitates and reduces quality of life in those affected. The aetiology is poorly understood, predictive factors are currently unknown, diagnosis and therapy are difficult.

Objectives:

To evaluate the benefit of dermal thermography in the diagnosis and therapy of persistent postoperative pain.

Study design:

retrospective, Level of evidence IV

Materials and Methods:

A single surgeon performed highly standardized ACL reconstructions, arthroscopies and total endoprotheses of the knee. Patients were seen six weeks postoperative for clinical and thermographic evaluation. Regions of interest were defined for the affected knee, a control region defined for the contralateral knee. The thermographic image was used to pinpoint a site for subcutaneous local anaesthesia. The clinical evaluation was then repeated.

Results:

Patients in total (n=133), arthroscopy (n=21), total endoprothesis (n=42), ACL (n=50). If the temperature difference (TD) between the site of pathology and the average ipsilateral knee temperature was negative, pathology was classified as hypothermic (n=19), otherwise hyperthermic (n=94). Arthroscopically treated patients showed a TD of 0,88 ± 0,39 °C in hyperthermic (n=12) and -0,811 ± 0,623 °C in hypothermic (n=9) knees. Prosthetically treated patients showed a TD of 1,29 ± 0,51 °C in hyperthermic (n=37) and -0,88 ± 0,33 °C in hypothermic (n=5) knees. ACL treated patients showed a TD of 1,20 ± 0,48 °C in hyperthermic (n=45) and -0,62 ± 0,41 °C in hypothermic (n=5) knees. The difference in temperature between the site of pathology and the average temperature of the ipsilateral knee was significant for all subgroups: arthroscopy-hypothermic p < 0,001, arthroscopy-hypothermic p < 0,005; endoprothesis-hyperthermic p < 0,001, endoprothesis-hypothermic p < 0,004; ACL-hyperthermic p < 0,001, ACL-hypothermic p < 0,027. In contrast to the hyperthermic groups (for all p < 0,001), there was no significant difference between the site of pathology and the contralateral control region in the hypothermic groups. All patients reported a reduction of pain and better mobility after subcutaneous infiltration with Scandicain 2% at the thermographically defined site of pathology.

Conclusion:

Thermography is useful to pinpoint sites of pathology in persistent postoperative pain. Two types of thermal abnormality could be identified at the site of pathology: hypo- and hyperthermic. Local anaesthesia at the site of pathology resulted in pain reduction and improved mobility. Further studies are necessary to understand the postoperative thermal changes in order to devise a suitable therapy.
Analyzing passenger and freight vehicle movements from automatic-Number plate recognition camera data
Authors: Hadavi Sheida , Rai Heleen Buldeo , Verlinde Sara , Huang He , Macharis Cathy , Guns Tias
Published: May 2020

Modern urban-transport planning requires evidence-based insights into current transport flows to better understand the needs and impacts of policymaking. Urban transport includes passenger and freight vehicles, which have different behavior, and the need for such a separation is often ignored in research and practice [1]. New digital data sources provide an opportunity to better understand urban transport and identify where policy interventions are required. We review the literature on digital counting techniques to monitor transport flows, including loops, Automatic-Number Plate Recognition (ANPR) cameras and floating car data. We further investigate the potential of ANPR cameras, which are widely deployed, and which can be augmented with vehicle category information. This article presents the methodology that we follow for transforming raw augmented ANPR camera data into practical knowledge for city planners. Our is aim is to provide a better understanding of passenger and freight vehicle movements and stops, identifying similarities and differences between vehicle categories. We demonstrate our methodology on a case study for the Mechelen-Willebroek district in Belgium, encompassing augmented data from 122 ANPR cameras for a period of two weeks. Additionally, we also look at the car-reduced zone and how time restrictions affect the different vehicle categories’ actions. The findings are validated with GPS data from heavy-good vehicles in the same period. The potential of augmented ANPR camera data and promising themes and applications of this data source are illustrated through the case study.
Clinical outcomes and anesthetic management of pregnancies with placenta previa and suspicion for placenta accreta undergoing intraoperative abdominal aortic balloon occlusion during cesarean section
Authors: Li Peng , Liu Xia , Li Xiangkui , Wei Xinchuan , Liao Juan
Published: May 2020

Background

This retrospective study aimed to compare the clinical outcomes of parturients with placenta previa (PP) and placenta accreta (PA) according to their severity, when they were managed with intraoperative abdominal aortic balloon occlusion (IAABO) during cesarean section.

Methods

We retrospectively examined 57 cases of PP and suspicion for PA in which IAABO was performed during cesarean section between April 2014 and June 2016. Based on preoperative examination and clinical risk factors, patients were divided into the low suspicion PA group and the high suspicion PA group. We compared the demographic characteristics, methods of anesthesia, intra- and postoperative parameters, and maternal and neonatal outcomes.

Results

The two groups showed similar demographic characteristics and intraoperative outcomes. Four women underwent cesarean hysterectomy. Eight neonates were admitted to the neonatal intensive care unit and three did not survive. Neonatal Apgar scores were significantly higher in the low suspicion PA group. Eight patients experienced postoperative femoral artery thrombosis and one patient complicated hematoma in the front wall of the common femoral artery. Patients who received neuraxial anesthesia showed significantly lower intraoperative blood loss, lower intraoperative, postoperative and total blood transfusion and shorter surgery than patients who received general anesthesia.

Conclusions

Our data suggested that the severity of aberrant placental position does not affect intraoperative blood loss during a cesarean section while the IAABO is performed. We propose that neuraxial anesthesia is preferred for conducting these surgeries without contraindications.
Cigarette smoking and smokeless tobacco use among male south Asian migrants in the United Arab Emirates: a cross-sectional study
Authors: Ali Raghib , Loney Tom , Al-Houqani Mohammed , Blair Iain , Aziz Faisal , Al Dhaheri Salma , El Barazi Iffat , Soteriades Elpidoforos S. , Shah Syed M.
Published: May 2020

Background

Few data were available on smoking and smokeless tobacco use in South Asian migrants in the United Arab Emirates (UAE). This study aimed to identify the prevalence and correlates of cigarette smoking and smokeless tobacco use in male South Asian migrants in the UAE.

Methods

We used a cross-sectional study to recruit a random representative sample of male South Asian migrants, including Indian (n = 433), Pakistani (n = 383) and Bangladeshi (n = 559) nationalities. We used multivariable logistic regression analysis to identify significant correlates of cigarettes smoking and smokeless tobacco use.

Results

1375 South Asian migrant adult males participated in the study (response rate 76%) with a mean age of 34 years (SD ± 10). The overall prevalence of cigarette smoking was 28% (95%CI 25–30%) and smokeless tobacco use was 11% (95%CI 10–13%). The prevalence of current cigarette smoking was 21, 23, and 37% among participants from India, Pakistan and Bangladesh, respectively. The prevalence of current smokeless tobacco use was 6, 12, and 16% for Indian, Pakistani, and Bangladeshi participants, respectively. Among study participants, Bangladeshi nationality, hypertension, and alcohol use were significant correlates of current cigarette smoking. Significant correlates of smokeless tobacco use included increased age, less than college level education, alcohol use, and Pakistani or Bangladeshi nationality.

Conclusions

Current smoking and smokeless tobacco use in South Asian migrants represent a significant public health burden in the UAE. Effective public health measures are needed to reduce tobacco use in this migrant population.
LncRNA WTAPP1 promotes cancer cell invasion and migration in NSCLC by downregulating lncRNA HAND2-AS1
Authors: Zhang Li , Jin Chengyan , Yang Guiyun , Wang Bin , Hua Peiyan , Zhang Yan
Published: May 2020

Background

Long non-coding RNA (lncRNA) Wilms Tumor 1 Associated Protein Pseudogene 1 (WTAPP1) has been reported to be a critical player in the angiogenesis and migration of endothelial progenitor cells, while its involvement in cancer biology remains unknown. This study was carried out to investigate the role of WTAPP1 in non-small cell lung cancer (NSCLC).

Methods

The expression of WTAPP1 and lncRNA HAND2 Antisense RNA 1 (HAND2-AS1) in plasma and tissues from NSCLC patients was detected by qRT-PCR. A 5-year follow-up study was carried out to explore the prognostic value of WTAPP1 for NSCLC. Overexpression experiments were performed to analyze the interaction between WTAPP1 and HAND2-AS1. Cell invasion and migration were evaluated by Transwell assays.

Results

The expression of WTAPP1 was upregulated in NSCLC. The survival analysis showed that low plasma levels of WTAPP1 were accompanied with high survival rate. HAND2-AS1 was downregulated in NSCLC and inversely correlated with WTAPP1 across tumor tissues. Overexpression of WTAPP1 resulted in downregulation of HAND2-AS1 in NSCLC cells, while overexpression of HAND2-AS1 did not affect the expression of WTAPP1. Overexpression of WTAPP1 led to promoted, while overexpression of HAND2-AS1 resulted in inhibited invasion and migration of NSCLC cells. In addition, overexpression of HAND2-AS1 partially attenuated the effects of overexpressing WTAPP1. In addition, WTAPP1 did not affect cancer cell proliferation.

Conclusion

WTAPP1 may promote cancer cell invasion and migration in NSCLC by downregulating lncRNA HAND2-AS1.
Effect of 1,5-anhydroglucitol levels on culprit plaque rupture in diabetic patients with acute coronary syndrome
Authors: Su Gong , Gao Ming-Xi , Shi Gen-Ling , Dai Xi-Xi , Yao Wei-Feng , Zhang Tao , Zhuang Shao-Wei
Published: May 2020

Background

Postprandial hyperglycemia was reported to play a key role in established risk factors of coronary artery diseases (CAD) and cardiovascular events. Serum 1,5-anhydroglucitol (1,5-AG) levels are known to be a clinical marker of short-term postprandial glucose (PPG) excursions. Low serum 1,5-AG levels have been associated with occurrence of CAD. However, the relationship between 1,5-AG levels and coronary plaque rupture has not been fully elucidated. The aim of this study was to evaluate 1,5-AG as a predictor of coronary plaque rupture in diabetic patients with acute coronary syndrome (ACS).

Methods

A total of 144 diabetic patients with ACS were included in this study. All patients underwent intravascular ultrasound examination, which revealed 49 patients with plaque rupture and 95 patients without plaque rupture in the culprit lesion. Fasting blood glucose (FBG), hemoglobin A1c(HbA1c) and 1,5-AG levels were measured before coronary angiography. Fasting urinary 8-iso-prostaglandin F2α(8-iso-PGF2α) level was measured and corrected by creatinine clearance.

Results

Patients with ruptured plaque had significantly lower serum 1,5-AG levels, longer duration of diabetes, higher HbA1cand FBG levels than patients without ruptured plaque in our study population. In multivariate analysis, low 1,5-AG levels were an independent predictor of plaque rupture (odds ratio 3.421; P = 0.005) in diabetic patients with ACS. The area under the receiver-operating characteristic curve for 1,5-AG (0.658, P = 0.002) to predict plaque rupture was superior to that for HbA1c(0.587, P = 0.087). Levels of 1,5-AG were significantly correlated with urinary 8-iso-prostaglandin F2αlevels (r = − 0.234, P = 0.005).

Conclusions

Serum 1,5-AG may identify high risk for coronary plaque rupture in diabetic patients with ACS, which suggests PPG excursions are related to the pathogenesis of plaque rupture in diabetes.
Presence of Borrelia miyamotoi infection in a highly endemic area of Lyme disease
Authors: Marcos Luis A. , Smith Kalie , Reardon Kelsey , Weinbaum Fredric , Spitzer Eric D.
Published: May 2020

A series of cases in the Northeast of the US during 2013–2015 described a new Borrelia species, Borrelia miyamotoi, which is transmitted by the same tick species that transmits Lyme disease and causes a relapsing fever-like illness. The geographic expansion of B. miyamotoi in the US also extends to other Lyme endemic areas such as the Midwestern US. Co-infections with other tick borne diseases (TBD) may contribute to the severity of the disease. On Long Island, NY, 3–5% of ticks are infected by B. miyamotoi, but little is known about the frequency of B. miyamotoi infections in humans in this particular region. The aim of this study was to perform a chart review in all patients diagnosed with B. miyamotoi infection in Stony Brook Medicine (SBM) system to describe the clinical and epidemiological features of B. miyamotoi infection in Suffolk County, NY. In a 5 year time period (2013–2017), a total of 28 cases were positive for either IgG EIA (n = 19) or PCR (n = 9). All 9 PCR-positive cases (median age: 67; range: 22–90 years) had clinical findings suggestive of acute or relapsing infection. All these patients were thought to have a TBD, prompting the healthcare provider to order the TBD panel which includes a B. miyamotoi PCR test. In conclusion, B. miyamotoi infection should be considered in the differential diagnosis for flu-like syndromes during the summer after a deer tick bite and to prevent labeling a case with Lyme disease.
Correction to: Targeting TR4 nuclear receptor suppresses prostate cancer invasion via reduction of infiltrating acrophages with alteration of the TIMP-1/MMP2/MMP9 signals
Authors: Ding Xianfan , Yang Dong-Rong , Xia Liqun , Chen Bide , Yu Shicheng , Niu Yuanjie , Wang Mingchao , Li Gonghui , Chang Chawnshang
Published: May 2020

An amendment to this paper has been published and can be accessed via the original article.
Apolipoprotein CIII predicts cardiovascular events in patients with coronary artery disease: a prospective observational study
Authors: Katzmann Julius L. , Werner Christian M. , Stojakovic Tatjana , März Winfried , Scharnagl Hubert , Laufs Ulrich
Published: May 2020

Background

Apolipoprotein CIII (apoCIII) is associated with triglyceride-rich lipoprotein metabolism and has emerged as independent marker for risk of cardiovascular disease. The objective was to test whether apoCIII is regulated postprandially and whether apoCIII concentrations in native and chylomicron-free serum predict future cardiovascular events in patients with stable coronary artery disease (CAD).

Methods

ApoCIII concentrations were measured in native and chylomicron-free serum in the fasting state and after a standardized oral fat load test in 195 patients with stable CAD. Clinical follow-up was 48 months. Chylomicron-free serum was prepared by ultracentrifugation (18,000 rpm, 3 h). The log-rank test and Cox regression analyses were used to investigate the association of apoCIII with recurrent cardiovascular events.

Results

Of the 195 patients included, 92 had a cardiovascular event, and 103 did not. 97% were treated with a statin. No significant changes in apoCIII concentration were observed after the oral fat load test. The apoCIII concentration was associated with event-free survival independent of conventional risk factors. This association reached statistical significance only for apoCIII concentration measured in chylomicron-free serum (hazard ratio [95% confidence interval] for apoCIII above the mean: postprandial: 1.67 (1.06–2.29), P = 0.028, fasting: 2.09 (1.32–3.32), P = 0.002), but not for apoCIII concentration measured in native serum (postprandial: 1.47 [0.89–2.43], P = 0.133, fasting: 1.56 [0.95–2.58], P = 0.081). The effects were independent of other risk factors.

Conclusions

ApoCIII concentrations in chylomicron-free serum are independently associated with event-free survival in patients with CAD both in fasting and postprandial state. This findings support considering apoCIII for risk assessment and attempting to test the hypothesis that lowering apoCIII reduces residual cardiovascular risk.

Take home message

Apolipoprotein CIII concentration measured in chylomicron-free serum predicts recurrent cardiovascular events in patients with stable coronary artery disease.

Trial registration

The trial which included the participants of this study was registered at https://clinicaltrials.gov (NCT00628524) on March 5, 2008.
Risk factors of distant metastasis after surgery among different breast cancer subtypes: a hospital-based study in Indonesia
Authors: Anwar Sumadi Lukman , Avanti Widya Surya , Nugroho Andreas Cahyo , Choridah Lina , Dwianingsih Ery Kus , Harahap Wirsma Arif , Aryandono Teguh , Wulaningsih Wahyu
Published: May 2020

Background

More than one third of breast cancer patients including those that are diagnosed in early stages will develop distant metastasis. Patterns of distant metastasis and the associated risks according to the molecular subtypes are not completely revealed particularly in populations of patients with delayed diagnosis and advanced stages.

Methods

Breast cancer patients (n= 1304) admitted to our institute (2014–2017) were evaluated to identify the metastatic patterns and the associated risks. Metastatic breast cancers at diagnosis were found in 245 patients (18.7%), and 1059 patients were then grouped into non-metastatic and metastatic groups after a median follow-up of 3.8 years.

Results

Infiltration of the tumor to the skin and chest wall prevailed as the most powerful predictor for distant metastasis (OR 2.115, 95% CI 1.544–2.898) particularly in the luminal A-like subtype (OR 2.685, 95% CI 1.649–4.371). Nodal involvement was also significantly associated with the risk of distant metastasis (OR 1.855, 95% CI 1.319–2.611), and the risk was higher in the Luminal A-like subtype (OR 2.572, 95% CI 1.547–4.278). Luminal A-like subtype had a significant higher risk of bone metastasis (OR 1.601, 95% CI 1.106–2.358). In respect to treatment, a combination of anthracyclines and taxanes-based chemotherapy was significantly associated with lower distant organ spread in comparison with anthracycline-based chemotherapy (OR 0.510, 95% CI 0.355–0.766) and the effect was stronger in Luminal A-like subtype (OR 0.417, 95% CI 0.226–0.769). Classification into Luminal and non-Luminal subtypes revealed significant higher risks of bone metastasis in the Luminal subtype (OR 1.793, 95% CI 1.209–2.660) and pulmonary metastasis in non-Luminal breast cancer (OR 1.445, 95% CI 1.003–2.083).

Conclusion

In addition to guiding the treatment plan, a comprehensive analysis of clinicopathological variables including the molecular subtypes could assist in the determination of distant metastasis risks of breast cancer patients. Our study offers new perspectives concerning the risks of distant metastasis in breast cancer subtypes in order to plan intensive surveillance or escalation of treatment particularly in a setting where patients are predominantly diagnosed in late stages.
Prognostic value of neuron-specific enolase for small cell lung cancer: a systematic review and meta-analysis
Authors: Tian Zhoujunyi , Liang Chaoyang , Zhang Zhenrong , Wen Huanshun , Feng Hongxiang , Ma Qianli , Liu Deruo , Qiang Guangliang
Published: May 2020

Background

Neuron-specific enolase (NSE) has become a widely used and easily attainable laboratory assay of small cell lung cancer (SCLC). However, the prognostic value of NSE for SCLC patients remains controversial. The aim of the study was to evaluate the correlation between elevated serum NSE before therapy and survival of SCLC patients.

Methods

We performed a systematic review and meta-analysis. A systematic literature search was conducted in PubMed, Embase, and the Cochrane Central Register from the inception dates to December 2019. Eligible articles were included according to inclusion and exclusion criteria; then, data extraction and quality assessment were performed. The primary outcome was overall survival (OS), and the secondary endpoint was progression-free survival (PFS).

Results

We identified 18 studies comprising 2981 patients. Pooled results revealed that elevated NSE was associated with worse OS (HR = 1.78, 95% CI 1.55–2.06, p < 0.001) and PFS (HR = 1.50, 95% CI 1.16–1.93, p = 0.002). In subgroup analysis, elevated NSE did not predict worse OS in patients who received only chemotherapy (HR 1.22, 95% CI 0.96–1.55, p = 0.10) or part of whom received surgical resection before chemotherapy and radiotherapy (HR = 2.16, 95% CI 0.82–5.69, p = 0.12).

Conclusion

Elevated serum NSE before any therapy of SCLC patients may be a negative prognostic factor for OS and PFS. The prognostic value of NSE for OS was particularly observed in patients treated by standard management.