bluuebunny/crossref_metadata_2025 huggingface dataset:
Knee Bone Age using MRI: Validation of a Novel Method to Reduce Hand Bone Age Radiographs
Authors: Meza Blake , LaValva Scott , Aoyama Julien , DeFrancesco Christopher , Striano Brendan , Shea Kevin , Nguyen Jie , Ganley Theodore , Carey James
Published: July 2020

Objectives:

Determining bone age in skeletally immature patients is critical for proper management and surgical planning. Pennock et al. recently created and validated a bone age atlas using the ossification pattern of the knee on MRI in pediatric patients, obfuscating the need for a hand radiograph and its associated cost, radiation exposure, and clinical inefficiency. This aim of this study was to create and validate a shorthand method of bone age determination using knee MRI.

Methods:

We identified patients who underwent both knee MRI and hand bone age radiograph within a ninety-day period. From the findings of Pennock et al., a stepwise algorithm for predicting bone age on knee MRI was developed for males and females separately, in collaboration with a pediatric musculoskeletal radiologist. Six raters at varying levels of training used the algorithm to assign a bone age to each knee MRI. Intraclass correlation coefficient (ICC) was used to compare each rater’s predicted knee bone age to the Greulich and Pyle (G&P) hand bone age and validate the shorthand algorithm. Inter- (two-way random, absolute agreement) and intra-rater (two-way mixed, absolute agreement ) reliability were also calculated using ICC.

Results:

Thirty-eight patients (44.7% females) underwent a knee MRI at a mean age of 12.8 years (range 9.3-15.7). The mean time between hand bone age x-ray and knee MRI was 20.2 days (range 0-88). The inter-rater reliability for the application of our shorthand algorithm was 0.81 (95% CI: 0.72 – 0.88), indicating good inter-observer agreement. The shorthand algorithm was also shown to be a reliable predictor of hand bone age across level of training, as medical students (ICC 0.77, 95% CI 0.60-0.88), residents (ICC 0.80, 95% CI 0.65-0.89), and attending physicians (ICC 0.80, 95% CI 0.63-0.89) all achieved strong correlation between predicted knee bone age and G&P hand bone age. All respondents also demonstrated consistency, with intra-rater ICCs between 0.85-0.93.

Conclusion:

This shorthand algorithm is a consistent, reliable and valid way to determine skeletal maturity using knee MRI in patients aged 10 to 15 and can be utilized across different levels of orthopaedic and radiographic expertise. We believe this method is readily applicable in a clinical setting and may reduce the need for routine hand bone age radiographs. [Figure: see text][Table: see text]
Incidence and Risk Factors for Prolonged Opioid Use after Arthroscopic Meniscal Surgery: An Analysis of 107,717 Cases
Authors: Baron Jacqueline , Shamrock Alan , Gulbrandsen Trevor , Wolf Brian , Duchman Kyle , Westermann Robert , Khazi Zain
Published: July 2020

Objectives:

The current opioid epidemic in the United States is a significant cause of increasing morbidity and mortality. The purpose of this study was to determine rate of opioid use before and after arthroscopic meniscal surgery, and assess patient factors associated with prolonged opioid use following primary arthroscopic meniscal surgery.

Methods:

Patients undergoing primary arthroscopic meniscal surgery procedures from 2007-2016 were retrospectively accessed from the Humana Inc. administrative claims database. Patients were categorized as patients who filled opioid prescriptions within 3 months (OU), within 1 month (A-OU), between 1 to 3 months (C-OU), and never filled opioid prescriptions (N-OU) before surgery. Rates of opioid use were evaluated preoperatively and longitudinally tracked for OU and N-OU cohorts. Prolonged opioid use was defined as continued opioid prescription filling at ≥3 months after surgery. Multiple logistic regression analysis was used to control for various patient characteristics and identify factors associated with opioid use at 12 months after surgery, with significance defined as P<0.05

Results:

There were 107,717 patients (54% female) that underwent arthroscopic meniscal surgery during the study period, of which 46.1% (n=49,630) were N-OU. One year after surgery, opioid fill rate was significantly higher in the OU group compared to the N-OU group with a relative risk of 6.98 (21.1% vs 3.02%; 95% CI: 6.61-7.36; p<0.0001). Multiple logistic regression model identified C-OU (OR:10.23, 95% CI: 9.74-10.76, p<0.0001) as the strongest predictor of opioid use at 12 months postoperatively. Furthermore, patients with acute preoperative opioid use (p<0.0001), preoperative diagnosis of diabetes mellitus (p<0.0001), hypertension (p<0.0001), chronic obstructive pulmonary disease (p<0.0001), anxiety or depression (p<0.0001), alcohol abuse (p= 0.0019), and tobacco use (p=0.0345) had a significantly increased odds of opioid use at 12 months postoperatively. However, males (p<0.0001) and patients <40 years (p<0.0001) had a significantly decreased odds of opioid use 12 months postoperatively.

Conclusion:

Preoperative opioid use is a significant risk factor for opioid use at 12 months following surgery. Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, smoking status, and psychiatric diagnosis were independent risk factors for opioid use 1-year following surgery.
Outcomes of Arthroscopic Loose Body Management in Patella Instability: Medial Patellofemoral Ligament Neglect or Repair Versus Reconstruction
Authors: Carroll Alyssa , Pennock Kristina Johnson Andrew
Published: July 2020

Objectives:

Patellar instability is common in adolescents during their growth. Management of the actual patellar instability at the time of arthroscopic treatment for concomitant intra-articular loose body has been debated since many surgeons will manage first-time dislocations without surgery. To demonstrate that medial patellofemoral joint reconstruction, rather than neglect or repair of the ligament, should be performed at the time of arthroscopic loose body removal for first-time patellar instability events in children.

Methods:

Retrospective study design was performed on all patients who sustained a patellar instability event that resulted in an intra-articular loose body between 2011 and 2017 at our institution. Data was collected using ICD-9/10 and/or CPT codes. Patients included in the analysis were required to have a minimum of 24 month follow-up documented. We then performed chart review and radiographic review (XR and MRI). Variables collected included: demographics, weight, BMI, pain score, SANE score, Kujala score, subsequent recurrent instability, need for second surgery, growth plate status, trochlear dysplasia, TT-TG, Insall-Salvati ratio, and Blackburne-Peel ratio. Data analysis pooled the “neglect” and “repair” groups together and compared it to the “reconstruction” group. Continuous variables were examined for normal distribution and homogeneity and analyzed with ANOVA or Mann Whitney. Chi square was utilized for categorical variables.

Results:

64 patients (34 males, 30 females) with a mean age at surgery of 14 years (range 9 to 18) met criteria. These participants had a reported mean weight (kg) and BMI of 67.6 kg and 23.9, respectively. In our two-cohort analysis, the reconstruction cohort demonstrated significantly less subsequent instability, with the rate of recurrence being 58.7% in the neglect/repair compared to 16.7% in the reconstruction group (p=0.002). In addition, the reconstruction group demonstrated significantly less patients that required second surgery (p=0.024). The only continuous variable that showed any statistically significant difference was the Insall-Salvati ratio (p=0.048) with the reconstruction group being a mean 1.3 versus a mean 1.4 in the neglect/ repair group. There was no difference was found for age, weight, BMI, Blackburn ratio, TDI, TT-TG, Pain, SANE, Kujala score, satisfaction, or length of follow-up.

Conclusion:

Medial patellofemoral ligament reconstruction in the setting of adolescent patellar instability with an intra-articular loose body results in significantly less recurrent instability and reduced need for subsequent surgery compared to those who do not undergo a concomitant ligament reconstruction.
Accuracy of Correction and Postoperative Complications Associated with a PEEK Opening Wedge High Tibial Osteotomy Implant
Authors: Axibal Derek , Joyce Christopher , Houck Darby , Logterman Stephanie , Frank Rachel , Vidal Armando
Published: July 2020

Objectives:

To evaluate the accuracy of correction angle of an all-PEEK medial opening wedge high tibial osteotomy (HTO) system, as well as determine the effect of correction angle on postoperative complications.

Methods:

Retrospective review was performed on patients who underwent an HTO by the senior author using an all-PEEK HTO system between 2014-2018 with a >6-month follow-up were included. Measurements were performed and classifications formulated by three senior residents and the senior author. Lateral hinge fractures (LHF) were classified according to Takeuchi classification system. Bivariate statistics were performed.

Results:

Thirty HTOs in 27 patients were included (50% female; age, 37.8±10.8 years). Average follow-up was 16.2±10.1 months. Average post-operative radiographic valgus correction (Δ, 5.8±2.4°) was significantly less than that of the average implant correction angle (8.1±2.3°; p<0.001), indicating an overall average under-correction of 2.3±2.1°. There were 5 failures (16.7%; defined as approximately >5° loss of planned correction) that shared a common mechanism of medial cortical failure inferior to the implant. When selecting out the construct failures, the average correction accuracy of the 25 (83.3%) non-failures (1.5±1.2°) was significantly better than the 5 (16.7%) failures (6.3±1.8°; p=0.002). Four fractures (13.3%) were identified: 3 (10%) Takeuchi type I and 1 (3.3%) type III. All type I fractures were associated with >5° planned correction loss with medial cortex buckling. Overall, 9 knees (30%) experienced minor complications: neuropathy (n=1; 3.3%), deep vein thrombosis (n=2; 6.7%), and superficial infection (n=3; 10%).

Conclusion:

The use of an all-PEEK medial opening wedge HTO implant is a safe and effective system, with an acceptable average under-correction of 1.5° in patients not sustaining medial cortex failure. Loss of correction was associated with medial cortex failure and Takeuchi type I LHF. This is the first description of this failure mechanism (medial cortex buckling) that is specific to this implant and technique.
Comparing Rates of Tibial Spine Fractures to ACL Tears: A 7-Year Trend
Authors: LaValva Scott , Bram Joshua , Reese Thomas , Ganley Theodore , Aoyama Julien
Published: July 2020

Objectives:

Sometimes referred to as the “pediatric” ACL injury, tibial spine fractures, although less commonly seen, are believed to share the same injury mechanism as anterior cruciate ligament (ACL) tears. And while incidence rates of ACL tears have been known to be increasing in recent years, to our knowledge, trends in incidence rates of tibial spine fractures (TSFs) have not yet been reported in the literature. With sport specialization becoming a more commonly discussed topic, our goal was to report on the incidence rates of TSFs over a 7-year span at a single-center, and to compare rates of injury in these two conditions by sport and other patient characteristics.

Methods:

This was a retrospective comparison study of all patients presenting between 1/1/2010 and 1/1/17 with either a TSF or an ACL tear at a single pediatric hospital. Medical records were queried for all TSFs and ACL tears using ICD-10 and ICD-9 codes. Incidence rates of both injuries over time were compared against one another. Incidence rates were further stratified based on sex, race, age, BMI, and sport/mechanism of injury, and bivariate analyses were performed to find significant differences between groups.

Results:

43 patients with a TSF and 947 patients with an ACL tear were identified during the study dates. On graphical analysis of the rates of ACL tears and TSFs treated at our center, there was an upward trend in the yearly incidence of both injuries, particularly in the last two years. TSF age ranged from 3 to 17 years with an average of 12.5 ± 2.8 years. ACL tear age ranged from 6 to 24 years with an average of 15.2 ± 2.3 years. Comparisons of sport, age, sex, and BMI were all found to have significant differences (p < .001 for all) between the two injuries. Race was not found to be significantly different between the two injuries.

Conclusion:

Our data supports the hypothesis that, similar to ACL tears, incidence rates of TSFs have been increasing in recent years. Injury during sport was found to be significantly different between the two injuries, with football being the most common sport for TSFs and soccer being the most common sport for ACL tears. ACL tears also draw from a slightly older age population (15.2 ± 2.3 years) than TSFs (12.5 ± 2.8 years), and TSFs are more commonly seen in males and those with lower BMI when compared to ACL tears. [Figure: see text][Figure: see text]
Preoperative Opioid Use is Associated with Inferior Patient Reported Outcomes and Prolonged Opioid Use after Patellofemoral Stabilization Surgery
Authors: Khazi Zain , Hajewski Christina , Glass Natalie , Wolf Brian , Duchman Kyle , Westermann Robert , Bollier Matthew , Shamrock Alan
Published: July 2020

Objectives:

The purpose of the study was to investigate the association between preoperative opioid use and persistent postoperative use, and determine the impact of preoperative opioid use on patient reported outcomes (PROs) in patients undergoing patellofemoral stabilization surgery.

Methods:

A retrospective analysis of 60 patients after patellofemoral stabilization surgery with a minimum of 2-year follow-up was performed using a prospectively-collected patellar instability registry. Patients were categorized as opioid naïve (n=48) or preoperative opioid users (n=12). Postoperative opioid use was assessed for all patients at 2 and 6 weeks. Knee Injury and Osteoarthritis Outcome Score (KOOS) and Kujala questionnaires were administered at baseline, and 6 months and 2 years postoperatively.

Results:

Preoperative opioid use was identified as an independent risk factor for postoperative opioid use at 2- and 6-weeks following surgery (p=0.0023 and p<0.0001, respectively). Preoperative opioid use was associated with significantly lower KOOS and Kujala scores at baseline, 6 months and 2 years postoperatively. Both groups significantly improved from baseline KOOS and Kujala scores at 6 months and 2 years postoperatively. Regardless of preoperative opioid use, opioid use at 6 weeks after surgery was associated with worse KOOS scores at 6 months and 2 years postoperatively.

Conclusion:

In patients undergoing patellofemoral stabilization surgery, preoperative opioid use was predictive of postoperative use. Additionally, preoperative opioid use was associated with worse PROs at 6 months and 2 years following surgery. [Table: see text][Table: see text]
Graft Preparation with Intraoperative Vancomycin Decreases Infection after Anterior Cruciate Ligament Reconstruction: A Review of 1640 Cases
Authors: Shamrock Alan , Cates William , Cates Robert , an qiang , Wolf Brian , Bollier Matthew , Duchman Kyle , Westermann Jacqueline Baron Robert
Published: July 2020

Objectives:

Septic arthritis is a rare but devastating complication following anterior cruciate ligament (ACL) reconstruction. Reported infection rates following ACL reconstruction are low, but associated with high morbidity including reoperation and inferior clinical outcomes. The purpose of the current study was to investigate the rate of infection after ACL reconstruction with and without graft preparation with vancomycin irrigant.

Methods:

All ACL reconstructions performed from May 2009-August 2018 at a single, large academic institution were reviewed and categorized based on vancomycin use. Those with <90-day follow-up, intraoperative graft preparation with an antibiotic other than vancomycin, or previous ipsilateral knee infection were excluded. Infection was defined as a return to the operating room for irrigation and debridement within 90 days of ACL reconstruction. Descriptive and inferential statistical analysis using t-tests and Poisson regression were performed, with statistical significance defined as p<0.05.

Results:

In total, 1,640 patients (952 males; 58.0%) with a mean age of 27.7 + 11.4 years underwent ACL reconstruction (1,379 primary procedures; 84.1%) and were included for analysis. Intraoperative vancomycin was used in 798 cases (48.7%) while 842 ACL reconstructions (51.3%) were performed without intraoperative vancomycin. There were eleven total infections (0.7%), with ten infections occurring in patients without vancomycin-soaked grafts (1.2%) and one infection occurring in grafts soaked in vancomycin (0.1%; p=0.008). Age (p=0.571), gender (p=0.707), smoking (p=0.407), surgeon (p=0.124), and insurance type (p=0.616) were not associated with postoperative infection. There was an 89.5% relative risk reduction with the use of intraoperative vancomycin. Increased body mass index (BMI) (p=0.029), increased operative time (p=0.001), and absence of ACL graft preparation with vancomycin (p=0.032) independently predicted postoperative infection.

Conclusion:

The use of vancomycin-soaked grafts was associated with a ten-fold reduction in postoperative infection after ACL reconstruction (0.1% versus 1.2%; p=0.032). Other risk factors for postoperative infection after ACL reconstruction included increased BMI and increased operative time. [Table: see text][Table: see text][Table: see text][Table: see text]
Single-Stage Revision Anterior Cruciate Ligament Reconstruction: Experience with 92 cases (41 elite athletes), Using an Algorithm
Authors: Borque Kyle , Jones Mary , Ball Simon , Williams Andy , White Nathan
Published: July 2020

Objectives:

The increased prevalence of anterior cruciate ligament (ACL) reconstructions has led to an increased need for revision ACL reconstructions. Despite the lack of comparative literature, two-stage revisions are often undertaken under the pretense they are safer. Through careful patient selection, pre-operative planning, and meticulous attention to detail, single stage revisions can be performed with good outcomes, decreasing healthcare costs, morbidity and recovery time for the patient. The objective of this paper is to present an algorithm (Figure 1) to determine single-stage or two-stage approaches to ACL revision with good outcomes in recreational and elite athletes.

Methods:

All revision ACL reconstructions performed by the senior author from September 2009 to July 2016, with minimum two year follow-up, were retrospectively reviewed. Outcomes measured were: any further surgery, graft re-rupture, re-revision, Tegner score, and knee injury and osteoarthritis outcomes score (KOOS). For the elite athlete population, return to play time, duration and level compared to pre-injury were also determined.

Results:

Ninety-four procedures were performed in 93 patients. This included 41 in elite athletes. In this series only 2 (2%) two-stage procedures were undertaken. At an average of 4.3 years (range: 2-8.5 years) post surgery, there had been two re-revisions. There were two further instances of graft failure which had not been re-revised. The graft failure rate was therefore 4.3%. There were 17 subsequent procedures, including six arthroscopic partial meniscectomies, five removal of prominent implants, and one total knee arthroplasty. The average Tegner score was 8.2 preoperatively, and 7.1 at follow up. At follow up, the average KOOS scores were 79.3 for symptoms, 88.0 for pain, 94.2 for activities of daily living, 73.6 for sport, and 68.9 for quality of life. Thirty-six of 41 elite athletes returned to play, at an average of 338 days post surgery. At an average of 4.6 years, 29 were still playing professionally. Of these, 15 were at the same level, and 14 at a lower level. Five players returned to play but have since retired. This occurred at an average of 3.1 years post op, at an age of 30.

Conclusion:

Single stage ACL revisions can be performed reliably in the majority, but not all, patients with persistent or recurrent instability following failed ACL reconstruction with good clinical outcomes and return to play, even in the elite athletic population. [Figure: see text]
Pregnancy Outcome Patterns of Medicaid-Eligible Women, 1999-2014: A National Prospective Longitudinal Study
Authors: Studnicki James , Fisher John W. , Reardon David C. , Craver Christopher , Longbons Tessa , Harrison Donna J.
Published: July 2020

Introduction:

The number and outcomes of pregnancies experienced by a woman are consequential determinants of her health status. However, there is no published research comparing the patterns of subsequent pregnancy outcomes following a live birth, natural fetal loss, or induced abortion.

Objectives:

The objective of this study was to describe the characteristic patterns of subsequent pregnancy outcomes evolving from each of three initiating outcome events (birth, induced abortion, natural fetal loss) occurring in a Medicaid population fully insured for all reproductive health services.

Methods:

We identified 7,388,842 pregnancy outcomes occurring to Medicaid-eligible women in the 17 states which paid for abortion services between 1999-2014. The first known pregnancy outcome for each woman was marked as the index outcome which assigned each woman to one of three cohorts. All subsequent outcomes occurring up to the fifth known pregnancy were identified. Analyses of the three index outcome cohorts were conducted separately for all pregnancy outcomes, three age bands (<17, 17-35, 36+), and three race/ethnicity groups (Hispanic, Black, White).

Results:

Women with index abortions experienced more lifetime pregnancies than women with index births or natural fetal losses and were increasingly more likely to experience another pregnancy with each subsequent pregnancy. Women whose index pregnancy ended in abortion were also increasingly more likely to experience another abortion at each subsequent pregnancy. Both births and natural fetal losses were likely to result in a subsequent birth, rather than abortion. Women with natural losses were increasingly more likely to have a subsequent birth than women with an index birth. All age and racial/ethnic groups exhibited the characteristic pattern we have described for all pregnancy outcomes: abortion is associated with more subsequent pregnancies and abortions; births and fetal losses are associated with subsequent births. Other differences between groups are, however, apparent. Age is positively associated with the likelihood of a birth following an index birth, but negatively associated with the likelihood of a birth following an index abortion. Hispanic women are always more likely to have a birth and less likely to have an abortion than Black or White women, for all combinations of index outcome and the number of subsequent pregnancies. Similarly, Black women are always more likely to have an abortion and less likely to experience a birth than Hispanic or White women.

Conclusion:

Women experiencing repeated pregnancies and subsequent abortions following an index abortion are subjected to an increased exposure to hemorrhage and infection, the major causes of maternal mortality, and other adverse consequences resulting from multiple separation events.
Books and Posters: Creating Conversations That Result in Learning
Authors: Hartman Nathan S. , Conklin Thomas A.
Published: July 2020

Pairing poster conversations with individual reading selections for students in MBA and undergraduate organizational behavior and leadership courses is a rewarding method for students to share their learning. Presenters share their posters with peers in a gallery walk format. This grants students an opportunity to convey their learning experiences in an unscripted way, which allows for organic and immediate conversation among class participants. Combining reading selections with poster conversations generates more engagement between students than perhaps simply requiring term papers alone. The activity is an interesting approach that encourages interaction and rich dialogue.
Performing Bollywood Broadway: Shillong Chamber Choir as Bollywood’s Other
Authors: Chatterjee Sebanti
Published: July 2020

This article attempts to explore the performativity that surrounds choral music in contemporary India. 1 1 Choral music was discovered in Western civilization and Christianity. As a starting point, it had the Gregorian reforms of the 6th century. Choir primarily refers to a vocal ensemble practising sacred music inside church settings as opposed to chorus which indicates vocal ensembles performing in secular environments. Multiple singers rendered sacred polyphony 1430 onwards. By the end of the century a standardized four-part range of three octaves or more became a feature. The vocal parts were called superius (later, soprano), altus, tenor (from its function of ‘holding’ the cantus-firmus) and bassus (Unger 2010, 2–3). Moving beyond its religious functions, the Shillong Chamber Choir locates itself within various sounds. Hailing from Meghalaya in the north- eastern part of India, the Shillong Chamber Choir has many folksy and original compositions in languages such as Khasi, Nagamese, Assamese and Malayalam. However, what brought them national fame was the Bollywoodisation 2 2 Bollywood refers to the South Asian film industry situated in Mumbai. The term also includes its film music and scores. of the choir.

With its win in the reality TV Show, India’s Got Talent 3 3 India’s Got Talent is a reality TV series on Colors television network founded by Sakib Zakir Ahmed, part of Global British Got Talent franchise. in 2010, the Shillong Chamber Choir introduced two things to the Indian sound-scape—reproducing and inhabiting the Bollywood sound within a choral structure, and introducing to the Indian audience a medley of songs that could be termed ‘popular’, but which ultimately acquired a more eclectic framework. Medley is explored as a genre. The purpose of this article is to understand how ‘Bollywood Broadway’ is the mode through which choral renditions and more mainstream forms of entertainment are coming together.
Lower verbalizability of visual stimuli modulates differences in estimates of working memory capacity between children with and without developmental language disorders
Authors: Arslan Seçkin , Broc Lucie , Mathy Fabien
Published: July 2020

Background and aims

Children with developmental language disorder (DLD) often perform below their typically developing peers on verbal memory tasks. However, the picture is less clear on visual memory tasks. Research has generally shown that visual memory can be facilitated by verbal representations, but few studies have been conducted using visual materials that are not easy to verbalize. Therefore, we attempted to construct non-verbalizable stimuli to investigate the impact of working memory capacity.

Method and results

We manipulated verbalizability in visual span tasks and tested whether minimizing verbalizability could help reduce visual recall performance differences across children with and without developmental language disorder. Visuals that could be easily verbalized or not were selected based on a pretest with non-developmental language disorder young adults. We tested groups of children with developmental language disorder (N = 23) and their typically developing peers (N = 65) using these high and low verbalizable classes of visual stimuli. The memory span of the children with developmental language disorder varied across the different stimulus conditions, but critically, although their storage capacity for visual information was virtually unimpaired, the children with developmental language disorder still had difficulty in recalling verbalizable images with simple drawings. Also, recalling complex (galaxy) images with low verbalizability proved difficult in both groups of children. An item-based analysis on correctly recalled items showed that higher levels of verbalizability enhanced visual recall in the typically developing children to a greater extent than the children with developmental language disorder. Conclusions and clinical implication: We suggest that visual short-term memory in typically developing children might be mediated with verbal encoding to a larger extent than in children with developmental language disorder, thus leading to poorer performance on visual capacity tasks. Our findings cast doubts on the idea that short-term storage impairments are limited to the verbal domain, but they also challenge the idea that visual tasks are essentially visual. Therefore, our findings suggest to clinicians working with children experiencing developmental language difficulties that visual memory deficits may not necessarily be due to reduced non-verbal skills but may be due to the high amount of verbal cues in visual stimuli, from which they do not benefit in comparison to their peers.
Book review: Amrita Mahale, Milk Teeth
Authors: Ravindranath Divya
Published: July 2020

Amrita Mahale, Milk Teeth. Context, 2018, 320 pp., ₹599. ISBN: 978-9387894327
Treatment Outcomes in Septic Arthritis of the Foot and Ankle in People Who Inject Drugs
Authors: Shields Margaret V. , Toppo Alexander , Menendez Mariano E. , Tybor David , Dewire Peter , Wurcel Alysse , Salzler Matthew
Published: July 2020

Background:

Although injection drug use (IDU) is a known risk factor for septic arthritis (SA) of the foot and ankle (F&A), disease and hospitalization outcomes are poorly characterized. We evaluated national trends, demographic characteristics, and hospitalization outcomes of SA of the F&A in people who inject drugs vs those who do not.

Methods:

Using the Nationwide Inpatient Sample, we identified all patients aged 15-64 with a principal discharge diagnosis of SA of the F&A from 2000 to 2013 and evaluated if they were related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes in these groups.

Results:

From 2000 to 2013, there were an estimated 14,198 hospitalizations for SA of the F&A in the United States, and 11% were associated with IDU (SA-IDU). Compared to SA unrelated to IDU, people with SA-IDU were significantly more likely to be younger, black, and have Medicaid or no insurance. People with SA-IDU were significantly more likely to leave against medical advice (9.7% vs 1.4%, P < .001), have a longer length of stay (9.2 vs 6.8 days, P < .001), and incur increased hospital charges ($58 628 vs $38 876, P = .005). People with SA-IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, P < .001) or arthrotomy (2.2% vs 11.0%, P < .001) of the foot.

Conclusion:

People with SA-IDU of the F&A had suboptimal hospitalization outcomes with greater costs. Recognizing risk factors and proactively addressing potential complications of substance use disorder in the hospital should be prioritized by the orthopedic community.

Level of Evidence:

Level III, retrospective cohort study.
Can the effects of the mitochondrial DNA mutations found in Leber’s hereditary optic neuropathy be protective against the development of cluster headache in smokers?
Authors: Rozen Todd D
Published: July 2020

Is it possible that some mitochondrial DNA (mtDNA) mutations enhance the risk of developing a headache disorder while other mutations actually confer a protective effect? Mitochondrial disorders have been linked to migraine but very rarely to cluster headache (CH). The true pathogenesis of CH is unknown but a linkage to cigarette smoking is irrefutable. Leber’s hereditary optic neuropathy is a syndrome of bilateral vision loss that typically manifests in a patient’s 20s and 30s, is male predominant, and its sufferers are heavy smokers and heavy drinkers. Tobacco exposure is so linked to the condition that only smokers appear to develop vision loss while nonsmokers remain unaffected carriers of their mutations. In essence, the Leber’s hereditary optic neuropathy population is the CH population but at present there have been no reported cases of CH in this mitochondrial subgroup. Thus, could the effects of the mtDNA mutations found in Leber’s hereditary optic neuropathy, which involve complex I of the electron transport chain, actually confer a protective effect against the development of CH? This article will delve into this theory.
Robust optimization for composite blade of wind turbine based on kriging model
Authors: Zheng Yuqiao , Ma Huidong , Wei Jianfeng , Zhu Kai
Published: July 2020

Structural optimization models often feature many uncertain factors, which can be handled by robust optimization. This work presents a complete robust optimization program for composite blade based on the kriging approximation model. Two case studies were given and performed using a genetic algorithm. The first being typical optimization, where the first natural frequency of the blade is selected as the optimized objective and the optimal sizing distribution for the entire blade shell is sought to ignore the uncertain factors. The other case determines the standard deviation of the optimized objective in the first case as another optimization goal. Moreover, a 6 σ robustness for the optimization results of the two cases was evaluated. The result shows that typical optimization increases the first natural frequency of the blade by 19%, while its robustness level has a reduction of 61% compared with the first blade. Nevertheless, the robust optimization not only results in an increment of 15.4% in the first natural frequency of the blade but also increases its robustness level by up to 90%. Therefore, the proposed approach can effectively improve optimization objectives, especially reduce the impacts of uncertainties on the objective functions.
Synchronizations of tree-ring δ18O time series within and between tree species and provinces in Korea: a case study using dominant tree species in high elevations
Authors: Choi En-Bi , Sano Masaki , Park Jun-Hui , Kim Yo-Jung , Li Zhen , Nakatsuka Takeshi , Hakozaki Masataka , Kimura Katsuhiko , Jeong Hyun-Min , Seo Jeong-Wook
Published: July 2020

The current study was initiated to test the synchronizations of tree-ring δ18O (hereafter δ18OTR) time series within and between tree species and provinces, which are about 144 km apart from each other in Korea. For the test, a 50-year δ18OTRtime series (1966–2015) was developed using four trees from each tree species which arePinus densifloraandQuercus mongolicafrom Songnisan National Park andTaxus cuspidata,Pinus koraiensis,Abies koreana, andQuercus mongolicafrom Jirisan National Park. Their synchronizations were evaluated usingt-value, Gleichläufigkeit (Glk), and Expressed Population Signal (EPS). The meant-values and Glk scores within the tree species ranged 5.2–11.2 (p < 0.05) and 69–83%, and between the tree species ranged 6.1–13.2 (p < 0.05) and 73–81%, respectively. The meant-value and Glk score between the regions were 4.3 (p < 0.05) and 72%, respectively. Furthermore, the EPS showed higher than 0.85, which is the generally accepted threshold value in dendrochronology, except forQ. mongolicaat Songnisan National Park for which the value is 0.83 calculated by only two δ18OTRtime series. Based on the statistical results, we concluded that a δ18OTRchronology established using more than four trees could serve as a promising reference for dating an undated wood without considering the tree species, as well as for research on climate in the past.
Physiological and transcriptome analysis of Poa pratensis var. anceps cv. Qinghai in response to cold stress
Authors: Dong Wenke , Ma Xiang , Jiang Hanyu , Zhao Chunxu , Ma Huiling
Published: July 2020

Background

Low temperature limits the growth and development and geographical distribution of plants. Poa pratensis is a cool-season turfgrass mainly grown in urban areas. However, low winter temperature or cold events in spring and autumn may cause P.pratensis mortality, affecting the appearance of lawns. P.pratensis var. anceps cv. Qinghai (PQ) is widely distributed in the Qinghai-Tibet Plateau above 3000 m. PQ has greater cold tolerance than the commercially cultivated P.pratensis varieties. However, existing studies on the response mechanism of PQ to low temperatures have mainly focused on physiological and biochemical perspectives, while changes in the PQ transcriptome during the response to cold stress have not been reported.

Results

To investigate the molecular mechanism of the PQ cold response and identify genes to improve the low-temperature tolerance of P.pratensis, we analyzed and compared the transcriptomes of PQ and the cold-sensitive P.pratensis cv. ‘Baron’ (PB) under cold stress using RNA sequencing. We identified 5996 and 3285 differentially expressed genes (DEGs) between the treatment vs control comparison of PQ and PB, respectively, with 5612 DEGs specific to PQ. Based on the DEGs, important Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, such as “starch and sucrose metabolism”, “protein processing in endoplasmic reticulum”, “phenylalanine metabolism” and “glycolysis/gluconeogenesis” were significantly enriched in PQ, and “starch and sucrose metabolism”, “phenylpropanoid biosynthesis”, “galactose metabolism” and “glutathione metabolism” were significantly enriched in PB. In addition, the “glycolysis” and “citrate cycle (TCA cycle)” pathways were identified as involved in cold tolerance of P.pratensis.

Conclusions

As we know, this is the first study to explore the transcriptome of P.pratensis var. anceps cv. Qinghai. Our study not noly provides important insights into the molecular mechanisms of P.pratensis var. anceps cv. Qinghai responds to cold stress, but also systematically reveals the changes of key genes and products of glycolysis and TCA cycle in response to cold stress, which is conductive to the breeding of cold-tolerance P.pratensis genotype.
Solitary vertebral metastatic glioblastoma in the absence of primary brain tumor relapse: a case report and literature review
Authors: Li Zu-Gui , Zheng Min-Ying , Zhao Qi , Liu Kai , Du Jia-Xing , Zhang Shi-Wu
Published: July 2020

Background

Metastatic glioblastoma presenting as a solitary osteolytic cervical vertebral mass without primary brain tumor relapse is extremely rare with only 1 reported case in the literature. Because of its rarity, it can be easily overlooked and misdiagnosed, posing a diagnostic dilemma.

Case presentation

A 51-year-old man with right temporal glioblastoma was initially treated by tumor resection, radiotherapy and chemotherapy. Eighteen months after surgery, he was readmitted with complaints of neck pain for 2 weeks. Follow-up magnetic resonance imaging (MRI) and fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) revealed a solitary FDG-avid osteolytic lesion in the 4th cervical vertebral body without other abnormal FDG-uptake in the body and in the absence of local recurrence at the resection cavity. Because of the sudden worsening situation and intractable neck pain, the patient underwent tumor resection. Postoperatively, the pain was obviously reduced and the situation was improved. Interestingly, the immunohistochemical findings of glial fibrillary acidic protein (GFAP) indicated the characteristic of metastatic glioblastoma, despite that the histopathological findings of Hematoxylin & Eosin (H&E) staining was suspicious of osteoclastoma. According to the clinical history, imaging findings, pathological and immunohistochemical results, a final diagnosis of solitary vertebral metastasis from glioblastoma without central nervous system (CNS) relapse was confirmed. Then, the patient received radiotherapy on spine and adjuvant chemotherapy with temozolomide. However, he died suddenly 2 months after the tumor resection, nearly 21 months after the initial diagnosis.

Conclusion

We emphasize that metastatic glioblastoma should be considered in the differential diagnosis of a solitary FDG-avid osteolytic vertebral mass on PET/CT. And the diagnosis of extracranial metastasis (ECM) from glioblastoma can be achieved through clinical history, imaging findings, pathological examination, and immunohistochemical staining with GFAP.
Unusual ectopic ACTH syndrome in a patient with orbital neuroendocrine tumor, resulted false-positive outcome of BIPSS:a case report
Authors: Tan Huiwen , Chen Dawei , Yu Yerong , Yu Kai , He Weiming , Cai Bowen , Jiang Su , Tang Ying , Tong Nanwei , An Zhenmei
Published: July 2020

Background

Cushing’s syndrome has been described as a complex endocrine disorder characterized with high cortisol concentration. Correct and early diagnosis of Cushing’s syndrome is challenging. According to the latest guideline, bilateral inferior petrosal sinus sampling (BIPSS) is considered to be the gold standard for the differential diagnosis. However, in some unusual cases, this method may be false positive. Here, we presented a rare case of orbital neuroendocrine tumor secreting adrenocorticotrophic hormone with false positive inferior petrosal sinus sampling.

Case presentation

A 48-year-old woman was admitted to West China Hospital of Sichuan University, presenting with fatigue, whole body edema for 1 year, alopecia and skin pigmentation for 5 months. Hormonal profiles including plasma cortisol and adrenocorticotrophic hormone (ACTH) measurements and low-dose dexamethasone inhibition test suggested that the patient had Cushing’s syndrome. However, during tumor location phase, the results of high-dose dexamethasone inhibition test (HDDST) contradicted desmopressin (DDAVP) stimulation test. Thus, BIPSS was employed, and its results indicated a pituitary origin. Interestingly, MRI of sellar region showed an innocent pituitary but caught a serendipitous lesion in the lateral rectus muscle of left eye, which was later proved to be an orbital neuroendocrine tumor secreting ACTH by pathological and immunohistochemical results. ACTH level of the patients was < 0.1 ng/L and cortisol level was 51.61 nmol/L 1 week after surgery. At 24 months follow-up, the patient appeared stable with no complaints nor any symptoms of Cushing’s syndrome, including moon face, purple striate and central obesity. The patient’s life quality also improved significantly.

Conclusion

We reported a rare case of endogenous Cushing’s syndrome due to ectopic ACTH secreting from an orbital neuroendocrine tumor. This unique case of orbital EAS suggests that orbital venous blood backflow, owning to abnormal anatomic structures, may possibly lead to false positive BIPSS results.
Patient reported outcome data from acromegaly patients treated with injectable somatostatin receptor ligands (SRLs) in routine clinical practice
Authors: Geer Eliza B. , Sisco Jill , Adelman Daphne T. , Ludlam William H. , Haviv Asi , Liu Shuqian , Mathias Susan D. , Gelbaum Dana , Shi Lizheng
Published: July 2020

Background

Acromegaly patients managed on Somatostatin receptor ligands (SRLs), the most common first-line pharmacotherapy for acromegaly, may still experience acromegaly symptoms such as headache, sweating, fatigue, soft tissue swelling, and joint pain, even those with normal IGF-1. Additionally, treatment with SRLs may cause injection site reactions and other side effects such as gastro-intestinal (GI) symptoms. This study utilized patient-reported outcome measures to examine the burden associated with acromegaly and its treatment for patients receiving a stable dose of long-acting SRLs in routine clinical practice.

Methods

US acromegaly patients on a stable dose of SRL seen by their treating healthcare provider in the past 12 months completed a one-time online survey including the Acro-TSQ, an acromegaly-specific tool for assessing symptom burden and treatment satisfaction and convenience.

Results

One hundred five patients were enrolled (mean age 49.9 years, 79.1% female). Patients experienced numerous symptoms, including > 80% who experienced joint pain, acro-fog, swelling of soft tissue, and fatigue/weakness. Many symptoms occurred constantly, while some occurred at the end of the injection cycle, even among those with IGF-1 < = 1.0 ULN. Injection site reactions were common. Patients were moderately satisfied with their current treatment; symptoms and side effects often affected daily activities. On average, patients reported > 3 acromegaly provider visits/year.

Conclusions

Despite receiving a stable dose of SRL and regular visits with an acromegaly healthcare provider, US acromegaly patients in routine clinical practice, and even the subgroup with normal IGF-1, report significant burden of disease and treatment.
The prevalence and characteristics of non-functioning and autonomous cortisol secreting adrenal incidentaloma after patients’ stratification by body mass index and age
Authors: Podbregar Ana , Janez Andrej , Goricar Katja , Jensterle Mojca
Published: July 2020

Background

The escalating prevalence of adrenal incidentaloma (AI) has been associated with the improvement of radiologic techniques and widespread imaging in aging population. It is currently unclear whether patients with obesity more likely develop AI and the current rise in the prevalence of AI could be at least partly associated with the respective rise in obesity. We compared the prevalence and characteristics of non-functional (NF) and autonomous cortisol secreting (ACS) adrenal incidentalomas (AIs) after the study population was stratified by different body mass indexes (BMI) and age groups.

Methods

Retrospective cross-sectional study comprising of 432 patients (40.6% male, 59.4% female) with NFAI (N = 290) and ACS (N = 142), of median age 63.4 (54.0–71.6) years and median BMI 28.6 (25.5–31.7) kg/m2. The data collection contained 11.132 points including demographic, anthropometric, radiologic, hormonal and metabolic parameters.

Results

We observed 68–87% higher prevalence of AI across different age groups in NFAI and ACS in obese/overweight compared to normal weight subjects. Patients with ACS were older (P = 0.008), with higher basal cortisol (P < 0.001), lower basal DHEAS (P = 0.001), lower suppression DHEAS (P = 0.027) and higher aldosterone (P = 0.039). AIs with ACS were larger than NFAI (P < 0.001). Interestingly, ACS group had lower body mass (P = 0.023) and did not differ in BMI, blood pressure, heart rate, lipid profile, fasting glucose and presence of diabetes mellitus type 2 when compared to NFAI., By contrast to the similarity of metabolic profiles in ACS and NFAI, some components of adverse metabolic traits were rather associated with higher BMI and older age, in particular in NFAI.

Conclusion

The prevalence of NFAI and ACS were significantly higher in overweight/obese subgroup across the age distribution. Stratification by age and BMI displayed significant differences in some metabolic traits, in particular in NFAI.