bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster 296: Incidence and Risk Factors for Contralateral Patellofemoral Instability
Authors: Duchman Kyle , Pennock Cole , an qiang , Westermann Robert
Published: August 2023

Objectives: Background:

Patellofemoral joint instability is common in young athletes and often requires surgical intervention. Incidence and risk factors for ipsilateral instability recurrence have been more discussed in the literature than contralateral instability events.

Purpose:

To evaluate the incidence and risk factors for contralateral patellofemoral instability in patients who have undergone patellar stabilization surgery.

Methods:

This retrospective study included 543 patients who had undergone medial patellofemoral ligament reconstruction and/or Fulkerson osteotomy as surgical management for lateral patellofemoral instability. The medical records of these patients were examined to evaluate the non-surgical knee. Available imaging of each affected knee was examined to evaluate for patella alta, skeletal maturity, trochlear dysplasia, tibial tubercle to trochlear groove (TT-TG) distance, and tibial tubercle to posterior collateral ligament (TT-PCL) distance. Demographic factors such as BMI, age, and sex were also examined. A second arm was done excluding patients with previous history of bilateral instability, assessing risk factors using the same methods. This yielded information about incidence and risk factors of “new onset” contralateral instability post-stabilization surgery.

Results:

Of the 543 patients examined, 205 (37.8%) had evidence of contralateral instability. Patella alta (OR, 2.4), skeletal immaturity (OR, 2.67), and younger age (p<0.0001) were associated with increased risk of bilateral instability. Sex, BMI, TT-TG distance, and TT-PCL distance, and trochlear dysplasia were not associated with increased risk of bilateral instability. In the second study, 63 out of 401 (15.71%) of patients had evidence of new onset contralateral instability post-surgery. Skeletal immaturity (OR, 3.65) was found to be associated with increased risk of instability.

Conclusions:

The incidence of bilateral patellofemoral instability was found to be 37.8%. Lower age, skeletal immaturity, and patella alta were found to be associated with increased risk of bilateral instability. Incidence of new-onset contralateral instability was found to be 15.71% and was only associated with skeletal immaturity.
Poster 299: Body mass index does not affect outcomes following isolated medial patellofemoral ligament reconstruction
Authors: Gibbs David , Kirven James , Abouljoud Moneer , Gonzalez Roberto , Ward Spencer , Flanigan David , Qin Charles , Magnussen Robert
Published: August 2023

Objectives:

Patellar instability may cause significant pain and disability and recurrent dislocations are often treated with reconstruction of the medial patellofemoral ligament (MPFL). Obesity is a known risk factor for complications following numerous surgical procedures, yet there exists a lack of data regarding the influence of body mass index (BMI) on outcomes following MPFL reconstruction. The purpose of this study was to evaluate complications and outcomes following isolated MPFL reconstruction in obese and non-obese patients. We hypothesized that patients with a BMI ≥ 30 would exhibit increased complication risk and worse patient-reported outcomes.

Methods:

A billing query identified all patients at one academic medical center who underwent isolated MPFL reconstruction over an 8 year period. Chart review extracted demographic, physical exam, radiographic, surgical, and complication data. Patients were contacted and outcomes were assessed with the Norwich Patellar Instability (NPI) score, Marx activity rating, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Complications and outcomes were compared based on the presence of a BMI ≥ 30 kg/m2.

Results:

A total of 161 patients who underwent isolated MPFL reconstruction were included. Of this cohort, there were115 with BMI < 30 and 46 with BMI ≥ 30. Early outcomes (time in brace, time to weight bearing) and postop complications (deep vein thrombosis, infection, pain, repeat dislocation/instability) were similar between groups (p>0.50). A total of 97 patients (60%) completed patient-reported outcomes at a mean of 5 years post-operative, with no differences noted in patient- reported outcomes based on BMI (Table).

Conclusions:

Obesity (defined as BMI ≥ 30) was not associated with increased complications of poorer patient- reported outcomes 5 years following isolated MPFL reconstruction. [Table: see text]
Poster 303: Radiographs Demonstrate Poor Interrater Reliability and Accuracy for Evaluation of Postoperative Healing for Osteochondral Allograft Transplants of the Knee
Authors: Dandu Navya , Elias Tristan , Allahabadi Sachin , Brusalis Christopher , Beals Corey , Trasolini Nicholas , Bodendorfer Blake , Haneberg Erik , Cole Brian , Yanke Adam
Published: August 2023

Objectives:

To evaluate the reliability of radiographs to evaluate healing of osteochondral allografts in the knee compared to CT scans as gold standard imaging.

Methods:

A retrospective review of prospectively enrolled patients who underwent osteochondral allograft transplantation for focal chondral defects of the knee was performed. At 6 months, all patients prospectively underwent CT scan of the knee. A retrospective review was performed to assess knee radiographs obtained in clinic at 3 and 6 months postoperatively. Three board-eligible orthopaedic sports fellows independently graded available radiographs while remaining blinded to the CT scan results. Separately, two board-eligible orthopaedic sports fellows graded CT scans utilizing the ACTOCA system, and their consensus measurements served as the gold standard for this study. Intraclass correlation (ICC) with a two-way random effects model and kappa coefficients were calculated for grades between the three raters.

Results:

Among the 44 grafts prospectively imaged, 13 (29.5%) grafts had radiographs at 3 months and 28 (63.6%) grafts had radiographs available for evaluation at 6 months. Among three graders, assessment of integration demonstrated low to moderate reliability (ICC: 0.25-0.41). Contrary to this, assessment of qualities such as graft sclerosis and cyst formation on radiographs demonstrated poor interrater reliability with inability to reject the null hypothesis that all grades were assigned randomly (p>0.05) (Table 1). At 6 months, in patients with large cysts (> 3 mm) on CT, only 2/18 (11%) were accurately detected on radiographs and 5/18 (27.8%) were underestimated as small cysts. In patients with small cysts (< 3 mm) on CT, only 4/42 grafts (9.5%) were accurately graded, and 3/42 (7.1%) evaluated grafts were overestimated to have large cysts (Figure 1). Among patients who had small or large cysts at 6 months, only 1/21 (4.8%) and 1/3 (33.3%) radiographic assessments detected this cystic change at 3 months, respectively. Patients with crossing trabeculae on CT were associated with a mean radiographic integration score of 81.0 ± 15.7, which was significantly greater than those with a discernible cleft < 3 mm (mean 68.7 ± 19.3, p=0.01). However, these groups were not significantly different than radiographic scores for grafts that had discernible clefts > 3 mm (80.0 ± 19.7, p>0.05). Among the 23 patients with a 6-month radiograph available, 4 required subsequent surgery for symptomatic failure. Three (75%) of these patients demonstrated large cyst formation on CT scan at 6 months.

Conclusions:

Evaluation of osteochondral allograft healing by radiographs alone may be inaccurate and associated with missed abnormalities such as cyst formation. [Table: see text]
Poster 353: LOWER PSYCHOLOGICAL READINESS FOR RETURN TO SPORT AFTER ACL RECONSTRUCTION IS ASSOCIATED WITH REDUCED PERFORMANCE AND GREATER LIMB ASYMMETRY ON FUNCTIONAL TESTING
Authors: Christino Melissa , Coene Ryan , Cook Danielle , Kocher Mininder , Kramer Dennis , Yen Yi-Meng , Micheli Lyle , Milewski Matthew , Scott Elizabeth
Published: August 2023

Objectives:

The relationship between psychological and physical readiness for return to sport after anterior cruciate ligament reconstruction (ACLR) is not well understood. Psychological stress and psychological readiness were therefore evaluated at six months following primary ACLR along with standard functional patient reported outcome (PRO) instruments and physical performance tests to understand the relationship between the physical and psychological readiness in young athletes.

Methods:

Participants were evaluated at six months after ACLR with Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS), International Knee Documentation Committee Questionnaire (IKDC), PROMIS Psychological Stress Experience (PSE) and ACL Return to Sport After Injury Scale (ACL-RSI). Functional testing included gluteal, hamstring, and quadriceps strength testing, single leg hop (SLH), crossover hop, triple hop and timed 6-meter SLH. Patient characteristics and continuous and categorical variables were summarized. Pearson’s correlation coefficient and multivariable regression were used to determine associations between the limb symmetry index (LSI) on functional testing and PROs. Those with LSI deficits of less than 20% (better performance) were then compared to those with deficits greater than 20% (worse performance).

Results:

229 participants (89 male, 140 female) of median age 17 years (range 10.3 to 30.6 years) were enrolled. IKDC had a moderate negative correlation with PROMIS PSE (r=0.39 ; 95% CI=-0.49, -0.27; p<0.001) and a moderate positive correlation with ACL-RSI (r=0.55; 95% CI=0.46, 0.64; p<0.001) (Figure 1). 151 patients completed functional testing. ACL-RSI demonstrated a positive correlation with SLH LSI (r=0.21;95% CI=0.05, 0.35; p=0.01) and timed 6-meter SLH (r=0.28; 95% CI, 0.42; p=0.001) (Figure 2). When controlling for sex, age, and graft type, patients who had less than a 20% deficit on the SLH scored 17.9 points higher on ACL-RSI (p<0.001), and those with less than a 20% deficit on crossover hop testing scored average 13.9 points higher on ACL-RSI (p=0.04).

Conclusions:

At 6 months after ACLR, highe r psychological readiness for return to sport is associated with better performance and greater symmetry on hop testing, suggesting a potential link between physical and psychological recovery.
Poster 354: Biomechanical Comparison of Open versus Percutaneous Techniques for Primary Mid- Substance Achilles Tendon Repair: A Systematic Review and Meta-Analysis
Authors: Sequeira Sean , Imbergamo Casey , Guyton Gregory , Hembree Walter , Gould Heath , Lawson Jonathan
Published: August 2023

Objectives:

Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair.

Methods:

A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m).

Results:

Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques.

Conclusions:

The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.
Poster 358: Minutes Per Game and Usage Rate Associated with Time Loss after Ankle Injury: A Characterization of Foot and Ankle Injuries and Associated Risk Factors in National Basketball Association Athletes
Authors: Morikawa Landon , Brinkman Joseph , Crijns Tom , Vij Neeraj , Gill Vikram , Patel Karan , Chhabra Anikar , Tummala Sailesh
Published: August 2023

Objectives:

Injuries to the foot and ankle are more common in National Basketball Association (NBA) basketball compared to other professional sports. The goal of this study is to report the incidence and associated risk factors of foot and ankle injuries in the NBA athletes.

Methods:

Foot and ankle injury data from the 2015-16 through 2020-21 NBA seasons was queried and verified using a publicly available database. The truncated 2019-20 season was omitted from this study due to the COVID-19 pandemic. The primary outcome was the incidence of foot and ankle injuries, reported per 1000 game exposures (GEs). Secondary analysis was performed to identify risk factors for ankle injuries through bivariate analysis and multivariable logistic regression of player demographics, performance statistics, injury characteristics, and previous lower extremity injuries. Additionally, factors influencing the length of absence were assessed via negative binomial regression.

Results:

There were 728 structural foot and ankle injuries (5.34 per 1000 GEs) sustained by NBA players over 5 NBA seasons, with sprain/strain as the most common injury type (4.27 per 1000 GEs) (Table 1). The majority of ankle injury events (55%) resulted in 2-10 game absences (Table 4). The likelihood of sustaining an ankle injury was significantly associated with a greater number of games played, previous upper leg injury, and more games missed due to injury (Table 2). Increased length of absence due to ankle injury was significantly associated with greater height, minutes per game, usage rate, points per game, total rebounds per game, and a prior history of foot, ankle, and knee injuries (Table 3).

Conclusions:

The incidence of foot and ankle injuries was 5.34 per 1000 GEs in professional basketball players. Games played and previous history of upper leg injuries were found to be risk factors for ankle injuries. Factors associated with physiologic burden such as minutes per game and usage rate were associated with an increased severity of injury. [Table: see text][Table: see text][Table: see text][Table: see text]
Poster 364: Prospective Assessment of Outcomes after Femoral Condyle Osteochondral Allograft with Concurrent Meniscus Allograft Transplantation
Authors: Richards Jarod , Stannard James , Rucinski Kylee , Nuelle Clayton , Cook James
Published: August 2023

Objectives:

To report outcomes and associated risk factors for treatment failure (revision surgery or conversion to arthroplasty) in a consecutive series of patients undergoing concurrent femoral condyle osteochondral allograft (OCA) and meniscus allograft (MAT) transplantation using advances in tissue preservation and surgical techniques.

Methods:

Patients who underwent primary femoral condyle OCA transplantation and concomitant MAT (OCAT+MAT) between 2016-2020 with minimum 2-year follow up data regarding complications, failures, adherence, and patient reported outcome measures (PROMs) were analyzed. Patients who required OCA and/or MAT revision or conversion to artificial arthroplasty were defined as treatment failures. Patient reported outcome measures (PROMs) including VAS pain, IKDC, SANE, PROMIS Global Health and Physical Function, were collected at 3 and 6 months and then yearly after transplantation. Fisher’s exact tests were used to compare proportions and repeated measures ANOVA tests were used to compare longitudinal PROMs data for statistically significant (p<0.05) differences.

Results:

A total of 21 consecutively enrolled patients met inclusion criteria with mean age of 35 (15-54) years and mean BMI of 27 (19-36) kg/m2. OCAT+MAT was performed in the medial compartment in 14 cases and lateral compartment in 7 cases. Realignment osteotomies were performed in 4 cases. Initial success rate (mean follow-up of 44 mos) was 76% based on 1 revision and 4 arthroplasties performed. Overall success rate was 81% based on successful revision. Statistically significant (p<0.002) and clinically meaningful improvements were noted for all measured PROMs (VAS pain, IKDC, SANE, PROMIS) at 2-year follow up. Patients requiring conversion to arthroplasty were significantly older (mean age, 48.3 v 32.2 years, p=0.0076) than patients with successful outcomes. Nonadherence with postoperative restrictions and rehabilitation protocol was an independent risk factor for conversion to arthroplasty (p=0.022, OR=42).

Conclusions:

Combined femoral condyle OCA and meniscus allograft transplantation was associated with successful short- to mid-term outcomes in 81% of cases. Older age and nonadherenceto postoperative protocols are risk factors for decreased outcomes.
Poster 372: Women in Leadership in Orthopaedic Sports Medicine Societies Throughout the World
Authors: Meyers Jade , Ierulli Victoria , Hiemstra Laurie , Mulcahey Mary , Tanguilig Grace
Published: August 2023

Objectives:

The proportion of women in orthopaedic surgery is low compared to other specialties, despite a equal numbers of women and men entering the field of medicine. This gender disparity persists across various aspects of orthopaedic sports medicine. The purpose of this study was to characterize the number of women in leadership positions in orthopaedic sports medicine and arthroscopy societies throughout the world and compare the percentages of women vs men in leadership positions.

Methods:

Publicly available websites for orthopaedic sports medicine societies throughout the world were evaluated during March 2022. Non-surgical sports medicine societies were excluded, as were societies lacking publicly available leadership information. Data were collected as listed on the websites, and categorized into Board of Directors, Executive Committee, Office, Council (all typically included Presidential line, Vice-President, Treasurer, Secretary, or other specific high-ranking members), and Committee Chairs (excluded general committee members).

Results:

Of the 46 societies, 16 (34.8%) were in Europe, 10 (21.7%) in Asia, 6 (13.0%) in South America, 5 (10.9%) in North America, 3 in the Middle East (6.5%), 2 in Africa (4.4%), 2 in Australia (4.4%), and 2 were international organizations (4.4%). Four countries had more than one orthopaedic sports medicine society: Argentina, Israel, Australia, and Mexico. As represented by Figure 1, the Board of Directors were comprised of 2.5% women (4/161), the Executive Committees were 7.1% women (11/154), Committee Chairs were 9.4% women (13/138), Officers were 15.8% women (3/19), Councils were 5.9% women (1/17), and Spokespersons were 16.7% women (1/6). For the Board of Directors, North America and Europe led in women representation with 4.0% and 3.8%, South America had 2.0%, and societies from the Middle East and Asia reported no women. Regarding Executive Committee, North America had the most women with 27.8%, and the remaining regions ranged from 0.0-7.9%. For Committee Chairs, both European and International societies had around 8% women in leadership (8.0% and 7.7%, respectively), yet North America had double with 16.7% women. Of the regions reporting Officers, Asia and Europe had similar percentages (16.7% and 18.2%), whereas Australia reported zero women in office. Only one region reported electing a Council and two regions listed Spokespersons.

Conclusions:

This study highlights the gender disparities in leadership positions in orthopaedic sports medicine societies throughout the world. The visibility of women in high-ranking positions may contribute to the interest of women and other minorities in the field of sports medicine and help improve diversity. Future studies should investigate factors contributing to the paucity of women in leadership positions and identify ways to increase the proportion of women in orthopaedic sports medicine.
Poster 384: Inequalities in the Evaluation of Male vs. Female Athletes in Sports Medicine Research: A Systematic Review
Authors: Sonnier John , Johnson Emma , Hall Anya , Osman Alim , Connors Gregory , Freedman Kevin , Bishop Meghan , Paul Ryan
Published: August 2023

Objectives:

Female sport participation has steadily increased over the past several decades; however, inequalities still exist regarding participation rates, social norms, and available resources. It is possible that inequalities between male and female athletes extend beyond the performance of sport and into medical research. Therefore, the purposes of this systematic review were to 1) compare the number of published studies evaluating male vs. female athletes in various sports, and 2) identify which co-ed sports currently under-represent female athletes in the sports medicine literature.

Methods:

All non-review research studies published from 2017-2021 in six top sports medicine journals were considered for inclusion. Only sports medicine studies that isolated athletes, reported study outcomes specific to male and/or female patients, provided study outcomes for specific sport(s), and evaluated three or fewer different sports, were included. The total number of studies reporting on male and/or female athletes were compared for all sports, and odds ratios (OR) were calculated. Comparisons of study design, level of sport participation, outcomes assessed, and study quality were also made based on subject sex.

Results:

Overall, 669 studies were included the systematic review. Most of the included studies isolated male athletes (70.7%), while 8.8% isolated female athletes and 20.5% included both male and female athletes. Female athletes were more frequently studied in softball and volleyball, while male athletes were more commonly researched in baseball, soccer, American football, basketball, rugby, hockey, and Australian football. Notably, male athletes were largely favored in baseball/softball (91% vs. 5%, OR=18.2), rugby (72% vs. 5%, OR=14.4), soccer (65% vs. 15%, OR=4.3), and basketball (58% vs. 18%, OR=3.2).

Conclusions:

Sports medicine research has favored the evaluation of male athletes in most sports, including the majority of co-ed sports. Potential reasons for this inequality of research evaluation include availability of public and database data, financial and promotional incentive, a high percentage of sports medicine clinicians and researchers being male, and sex biases in sport. While the causes of these differences are multi-faceted, researchers should consider both sexes for study inclusion whenever possible and journals should support a more balanced representation of research publications regarding male and female athletes.
Poster 391: Are Sport-Related Injuries Becoming More Common in Collegiate Baseball Players?
Authors: Ishikawa Hiroaki , Cushman Daniel , Tashjian Robert , Chalmers Peter
Published: August 2023

Objectives:

Sport-related injuries remain a significant problem for collegiate baseball players. Prevention and management program of the injuries can be developed through epidemiological research aimed at defining the nature of injuries related to baseball. However, there is little information regarding the incidence and characteristics of the injuries among collegiate baseball players. The purpose of this study was to examine the current trends of sport-related injuries among collegiate baseball players in the PAC-12 conference.

Methods:

Demographic and injury data were obtained from a database of the PAC-12 Health Analytics Program (HAP) between 2016 and 2021. Injury incidence, type, mechanism, and outcome were analyzed. The annual injury incidence was defined as the number of injuries per total players for one year. Linear regression model was used to assess trends of the number of injuries over the 6 years.

Results:

A total of 2188 injuries (1434 sport-related injuries, 66%; 754 non-sport-related injuries, 34%) occurred in 6 years. The number of sport-related injuries significantly increased from 2016 (n = 75; annual incidence, 8.5 per 100 player-years) to 2021 (n = 378; annual incidence, 43.0 per 100 player- years) ( R2 = .735; P = .029) (Figure 1). Most of the sport-related injuries occurred in pitchers (33.6%). The majority of sport-related injuries were acute (76.6%), resulted in missed time (68.8%), and were new injuries (86.9%). Most sport-related injuries were caused by non-contact events (53.2%) and occurred during in-season games (39.9%) and practice (47.4%). Only 1.3% of sport-related injuries did not result in a return to previous activity level. The shoulder was the most commonly-injured anatomic area, followed by the arm/elbow. Shoulder impingement-related injuries were the most common specific diagnoses (n = 98), followed by ulnar collateral ligament (UCL) injuries (n = 63), hamstring muscle strains (n = 60), ankle ligament sprains (n = 46), and hand/wrist fractures (n = 40). Surgical interventions were performed on 5.1% of shoulder impingement-related injuries, 41.3% of UCL injuries, 35.0% of hand/wrist fractures, and none on hamstring muscle strains or ankle ligament sprains. The average days to clearance for shoulder impingement-related injuries, UCL injuries, hamstring muscle strains, ankle ligament sprains, and hand/wrist fractures were 23 ± 62, 167 ± 197, 18 ± 30, 33 ± 155, and 40 ± 51 days, respectively.

Conclusions:

The number of sport-related injuries among collegiate baseball players has increased over the past 6 years. Shoulder impingement-related injuries followed by UCL injuries, hamstring muscle strains, ankle ligament sprains, and hand/wrist fractures are the most common specific diagnoses among this cohort of collegiate baseball players. Of the most common specific diagnoses, UCL injuries often require surgical interventions and most impact playing time.
Investigating the Impact of Community Volunteerism on the Mental Health of Medical Students
Authors: Duncan Sheina A. , Sperling Gabriel L. , Moy Matthan I. , Hansen Regina , Soudah Chris K. , Rodriguez Patrick , Rego Andrea , Rojas Vivian N. , Paul Melody , Robicheaux Joseph A. , Chen Carrie , Thang Christopher , Agana Denny Fe G.
Published: August 2023

OBJECTIVE

This study aimed to analyze the impact of community service on the mental health of medical students through their perception of stress.

METHODS

The 10-item Perceived Stress Scale was used to measure the stress levels of 82 medical students over a 3-month period. Additional survey questions gauged students’ weekly volunteer experiences in clinical and nonclinical settings and their perceived effects on stress and quality of life.

RESULTS

Results found an inverse relationship between the number of clinical volunteer hours and perceived stress ( P = .0497). Nonclinical and total volunteer hours were correlated with both reduced perceived stress levels (nonclinical P = .0095, total P = .0052) and better quality of life (nonclinical P = .0301, total P = .0136). All individual perceived stress scores fell into the low or moderate stress ranges of the Perceived Stress Scale per the week-to-week analysis.

CONCLUSION

The preliminary results raised important research questions about the impact of volunteering on medical student perceived stress. As medical students face higher levels of stress in comparison to the general population, it is exceedingly important to determine methods to decrease their risk of compromising their mental health. This study may aid in decision-making and research in favor of or against offering community service opportunities as part of the core medical education curriculum.
The Importance of Hip Abductor and Adductor Muscles in Balance and Mobility Tasks After a Stroke: A Systematic Review
Authors: Lanza Marcel B , Frakes Nathan , Callaghan Kerry , Shipper Andrea Goldstein , Shabnam Lateef , Gray Vicki
Published: August 2023

The aim of this systematic review was to identify the association between muscle strength, activation, and structure of the hip abductor-adductor muscles and balance and mobility tasks in individuals post stroke. The present systematic review is comprised of 37 research articles, with 911 individuals that had a stroke. The extracted data included the study population, sample size, sex, stroke side of paresis, time poststroke, and evaluated measurements. We concluded that stronger hip abductors and adductors (both paretic and nonparetic legs) resulted in quicker voluntary step, and faster walking speed and cadence. Also, stronger paretic hip abductors were associated with a faster completion of the timed up and go test, higher ambulation ability, better control of the centre of mass, and quicker stair climbing. Overall, it demonstrated a lateral induced step to the paretic side, increased muscle activation of the gluteus medius of the paretic leg, and increased nonparetic hip abductor muscle activation. The strength and ability to activate the hip abductor and adductor muscles appears to be related to better performance during balance or mobility tasks in individuals with stroke. Therefore, the present systematic review results suggest that improving muscle strength and activation of the hip abductor and adductor muscles might help individuals with stroke to avoid falls.
OSNA Total Tumor Load for the Prediction of Axillary Involvement in Breast Cancer Patients: Should We use Different Thresholds According to the Intrinsic Molecular Subtype? MOTTO Study
Authors: Bernet L , Hardisson D , Rodrigo M , Córdoba A , Sancho M , Peg V , Ruiz I , Godey F , Sánchez-Méndez JI , Prat A
Published: August 2023

Aims:

To assess the impact of the molecular subtype (MS) on the total number of CK19 mRNA copies in all positive SLN (TTL) threshold, to predict non-SLN affectation, and to compare 5 years progression-free survival (PFS) according to the risk of recurrence (ROR) group by PAM50.

Methods:

Cohort with infiltrating breast cancer with intra-operative metastatic SLN detected by one-step nucleic acid amplification (OSNA) assay who underwent subsequent ALND. Logistic regression was used to assess a possible interaction between TTL and MS(Triple Negative, Her-2-Enriched, Luminal A, or Luminal B), or hormone receptors (HR: positive or negative) by immunohistochemistry (IMH). Cox regression was used to compare PFS and OS in the 3 ROR groups (high, medium, or low).

Results:

TTL was predictive of non-SLN affectation in both univariate (OR [95% CI]: 1.72 [1.43, 2.05], P < .001) and multivariate (1.55 [95% CI: 1.04, 2.32], P = .030) models, but MS-IMH or HR-IMH, and their interactions with TTL were not (best multivariate model: HR + main effect OR 1.16 [95% CI: 0.18, 7.64], P = .874; interaction OR: 1.04 [0.7, 1.55], P = .835; univariate model: HR + main effect OR: 1.44 [95% CI: 0.85, 2.44], P = .180). PFS was lower in the high-risk ROR group (81.1%) than in the low-risk group (93.9%) (HR: 3.68 [95 CI: 1.70, 7.94], P < .001).

Conclusions:

our results do not provide evidence to support the utilization of subtype-specific thresholds for TTL values to make therapeutic decisions on the axilla. The ROR group was predictive of 5 years-PFS.
Evaluation of Immunohistochemical Expression of Heparanase in Helicobacter pylori-Associated Chronic Gastritis
Authors: Ahmed Sheren Farrag Mahmoud , Abdelrahman Mona Mohammed , Mohammed Maisa Hashem
Published: August 2023

Background:

Chronic gastritis (CG) is a very common disease. More than half of the worldwide population suffers from symptoms of CG. This disease has received great attention since the discovery of H. pylori as the most important cause of CG. Symptoms experienced by patients with CG are attributed to H. pylori-induced inflammatory reactions. Heparanase (HPSE) is a mammalian β-endoglucoronidase. In inflammation; HPSE degrades and remodels the extracellular matrix’s heparan sulfate polysaccharide chains liberating heparan sulfate-bound cytokines and chemokines, HPSE also facilitates movement of inflammatory cells.

Aims:

This study aimed to detect the function of HPSE in CG by correlating levels of HPSE expression with histopathological features of CG, including H. pylori infection, acute and chronic inflammatory cells, mucosal atrophic and/or metaplastic features.

Methods:

Ninety-five upper endoscopic-guided gastric punch biopsies were enrolled in this study. From each specimen, formalin-fixed and paraffin-embedded tissue blocks were prepared. Tissue sections were stained by Hematoxylin and eosin, Giemsa, and anti-heparanase antibody.

Results:

HPSE expression was statistically associated with H. pylori infection ( P-value < .000), and intensity of chronic lymphocytic inflammatory infiltrate in the gastric mucosal tissues ( P = .004). High levels of HPSE expression were also related to the presence of neutrophils in the gastric surface epithelium and lamina propria ( P-value < .009).

Conclusions:

HPSE expression was upregulated in H. pylori-associated chronic gastritis. Thus, future therapeutic agents that could specifically inhibit HPSE enzyme activity, may aid in the reduction of sequelae of H. pylori infection.
Changes of migraine aura with advancing age of patients
Authors: Scutelnic Adrian , Drangova Hristina , Klein Antonia , Slavova Nedelina , Beyeler Morin , Lippert Julian , Silimon Norbert , Meinel Thomas R. , Arnold Marcel , Fischer Urs , Riederer Franz , Mattle Heinrich P. , Jung Simon , Schankin Christoph J.
Published: August 2023

Aim

Given the similar presentation of migraine aura and acute ischemic stroke, advancing patient age might change the characteristics of migraine with aura (MA) and be clinically important. Clinical data, however, are limited. Experimental studies indicate a decrease in the magnitude of cortical spreading depression (CSD), the pathophysiological correlate of migraine aura, with advancing age. Our study aimed to assess the influence of age on the clinical features of MA.

Methods

Three hundred and forty-three patients were interviewed using a structured questionnaire. The questions covered the headache characteristics and symptom types including the characteristics of the C-criterion, as defined by the International Classification of Headache Disorders 3rd Edition. The association of age with MA characteristics was assessed.

Results

The median age was 29 (IQR 28–52) and 235 of the 343 patients were women (69%). Individual symptoms of the C-criterion such as gradual aura spreading over longer than 5 min (P < 0.001), two or more aura symptoms occurring in succession (P = 0.005), duration of at least one MA symptom for longer than 60 min (P = 0.004), and associated headache (P = 0.01) were more frequent in younger patients. The number of symptoms (P = 0.003) including the C-characteristics decreased with increasing age (P < 0.027). Patients with sensory (P < 0.001), motor (P = 0.04) and speech disturbance (P = 0.02) were younger, and older patients with headache had less photophobia (P = 0.04) and phonophobia (P = 0.03). Sensitivity analyses yielded similar results.

Conclusion

The frequency of typical characteristics of migraine aura and migraine headache including photophobia and phonophobia decreases with advancing patient age. This might have potentially difficult implications for the diagnosis of MA in the elderly.
VariantscanR: an R-package as a clinical tool for variant filtering of known phenotype-associated variants in domestic animals
Authors: Boeykens Fréderique , Bhatti Sofie F. M. , Peelman Luc , Broeckx Bart J. G.
Published: August 2023

Background

Since the introduction of next-generation sequencing (NGS) techniques, whole-exome sequencing (WES) and whole-genome sequencing (WGS) have not only revolutionized research, but also diagnostics. The gradual switch from single gene testing to WES and WGS required a different set of skills, given the amount and type of data generated, while the demand for standardization remained. However, most of the tools currently available are solely applicable for human analysis because they require access to specific databases and/or simply do not support other species. Additionally, a complicating factor in clinical genetics in animals is that genetic diversity is often dangerously low due to the breeding history. Combined, there is a clear need for an easy-to-use, flexible tool that allows standardized data processing and preferably, monitoring of genetic diversity as well. To fill these gaps, we developed the R-package variantscanR that allows an easy and straightforward identification and prioritization of known phenotype-associated variants identified in dogs and other domestic animals.

Results

The R-package variantscanR enables the filtering of variant call format (VCF) files for the presence of known phenotype-associated variants and allows for the estimation of genetic diversity using multi-sample VCF files. Next to this, additional functions are available for the quality control and processing of user-defined input files to make the workflow as easy and straightforward as possible. This user-friendly approach enables the standardisation of complex data analysis in clinical settings.

Conclusion

We developed an R-package for the identification of known phenotype-associated variants and calculation of genetic diversity.
Drivers of plateau adaptability in cashmere goats revealed by genomic and transcriptomic analyses
Authors: Wu Cuiling , Ma Shengchao , Zhao Bingru , Qin Chongkai , Wu Yujiang , Di Jiang , Suo Langda , Fu Xuefeng
Published: August 2023

Background

The adaptive evolution of plateau indigenous animals is a current research focus. However, phenotypic adaptation is complex and may involve the interactions between multiple genes or pathways, many of which remain unclear. As a kind of livestock with important economic value, cashmere goat has a high ability of plateau adaptation, which provides us with good materials for studying the molecular regulation mechanism of animal plateau adaptation.

Results

In this study, 32 Jiangnan (J) and 32 Tibetan (T) cashmere goats were sequenced at an average of 10. Phylogenetic, population structure, and linkage disequilibrium analyses showed that natural selection or domestication has resulted in obvious differences in genome structure between the two breeds. Subsequently, 553 J vs. T and 608 T vs. J potential selected genes (PSGs) were screened. These PSGs showed potential relationships with various phenotypes, including myocardial development and activity (LOC106502520, ATP2A2, LOC102181869, LOC106502520, MYL2, ISL1, and LOC102181869 genes), pigmentation (MITF and KITLG genes), hair follicles/hair growth (YAP1, POGLUT1, AAK1, HES1, WNT1, PRKAA1, TNKS, WNT5A, VAX2, RSPO4, CSNK1G1, PHLPP2, CHRM2, PDGFRB, PRKAA1, MAP2K1, IRS1, LPAR1, PTEN, PRLR, IBSP, CCNE2, CHAD, ITGB7, TEK, JAK2, and FGF21 genes), and carcinogenesis (UBE2R2, PIGU, DIABLO, NOL4L, STK3, MAP4, ADGRG1, CDC25A, DSG3, LEPR, PRKAA1, IKBKB, and ABCG2 genes). Phenotypic analysis showed that Tibetan cashmere goats has finer cashmere than Jiangnan cashmere goats, which may allow cashmere goats to better adapt to the cold environment in the Tibetan plateau. Meanwhile, KRTs and KAPs expression in Jiangnan cashmere goat skin was significantly lower than in Tibetan cashmere goat.

Conclusions

The mutations in these PSGs maybe closely related to the plateau adaptation ability of cashmere goats. In addition, the expression differences of KRTs and KAPs may directly determine phenotypic differences in cashmere fineness between the two breeds. In conclusion, this study provide a reference for further studying plateau adaptive mechanism in animals and goat breeding.
Analytical method for detecting outlier evaluators
Authors: Wu Yujie , Curhan Sharon , Rosner Bernard , Curhan Gary , Wang Molin
Published: August 2023

Background

Epidemiologic and medical studies often rely on evaluators to obtain measurements of exposures or outcomes for study participants, and valid estimates of associations depends on the quality of data. Even though statistical methods have been proposed to adjust for measurement errors, they often rely on unverifiable assumptions and could lead to biased estimates if those assumptions are violated. Therefore, methods for detecting potential ‘outlier’ evaluators are needed to improve data quality during data collection stage.

Methods

In this paper, we propose a two-stage algorithm to detect ‘outlier’ evaluators whose evaluation results tend to be higher or lower than their counterparts. In the first stage, evaluators’ effects are obtained by fitting a regression model. In the second stage, hypothesis tests are performed to detect ‘outlier’ evaluators, where we consider both the power of each hypothesis test and the false discovery rate (FDR) among all tests. We conduct an extensive simulation study to evaluate the proposed method, and illustrate the method by detecting potential ‘outlier’ audiologists in the data collection stage for the Audiology Assessment Arm of the Conservation of Hearing Study, an epidemiologic study for examining risk factors of hearing loss in the Nurses’ Health Study II.

Results

Our simulation study shows that our method not only can detect true ‘outlier’ evaluators, but also is less likely to falsely reject true ‘normal’ evaluators.

Conclusions

Our two-stage ‘outlier’ detection algorithm is a flexible approach that can effectively detect ‘outlier’ evaluators, and thus data quality can be improved during data collection stage.
Key outcomes for reporting in studies of pregnant women with multiple long-term conditions: a qualitative study
Authors: Lee Siang Ing , Hanley Stephanie , Vowles Zoe , Plachcinski Rachel , Azcoaga-Lorenzo Amaya , Taylor Beck , Nelson-Piercy Catherine , McCowan Colin , O’Reilly Dermot , Hope Holly , Abel Kathryn M. , Eastwood Kelly-Ann , Locock Louise , Singh Megha , Moss Ngawai , Brophy Sinead , Nirantharakumar Krishnarajah , Thangaratinam Shakila , Black Mairead
Published: August 2023

Background

Maternal multiple long-term conditions are associated with adverse outcomes for mother and child. We conducted a qualitative study to inform a core outcome set for studies of pregnant women with multiple long-term conditions.

Methods

Women with two or more pre-existing long-term physical or mental health conditions, who had been pregnant in the last five years or planning a pregnancy, their partners and health care professionals were eligible. Recruitment was through social media, patients and health care professionals’ organisations and personal contacts. Participants who contacted the study team were purposively sampled for maximum variation. Three virtual focus groups were conducted from December 2021 to March 2022 in the United Kingdom: (i) health care professionals (n = 8), (ii) women with multiple long-term conditions (n = 6), and (iii) women with multiple long-term conditions (n = 6) and partners (n = 2). There was representation from women with 20 different physical health conditions and four mental health conditions; health care professionals from obstetrics, obstetric/maternal medicine, midwifery, neonatology, perinatal psychiatry, and general practice. Participants were asked what outcomes should be reported in all studies of pregnant women with multiple long-term conditions. Inductive thematic analysis was conducted. Outcomes identified in the focus groups were mapped to those identified in a systematic literature search in the core outcome set development.

Results

The focus groups identified 63 outcomes, including maternal (n = 43), children’s (n = 16) and health care utilisation (n = 4) outcomes. Twenty-eight outcomes were new when mapped to the systematic literature search. Outcomes considered important were generally similar across stakeholder groups. Women emphasised outcomes related to care processes, such as information sharing when transitioning between health care teams and stages of pregnancy (continuity of care). Both women and partners wanted to be involved in care decisions and to feel informed of the risks to the pregnancy and baby. Health care professionals additionally prioritised non-clinical outcomes, including quality of life and financial implications for the women; and longer-term outcomes, such as children’s developmental outcomes.

Conclusions

The findings will inform the design of a core outcome set. Participants’ experiences provided useful insights of how maternity care for pregnant women with multiple long-term conditions can be improved.
Rational application of EGFR-TKI adjuvant therapy in patients with completely resected stage IB-IIIA EGFR-mutant NSCLC: a systematic review and meta-analysis of 11 randomized controlled trials
Authors: Zhang Shu-Ling , Yi Xiao-Fang , Huang Le-Tian , Sun Li , Ma Jie-Tao , Han Cheng-Bo
Published: August 2023

Purpose

To determine the role and rational application of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) adjuvant therapy in patients with completely resected stage IB-IIIA EGFR-mutant non-small-cell lung cancer (NSCLC).

Method

Randomized controlled trials (RCTs) that compared the survival outcomes between adjuvant EGFR-TKIs and adjuvant chemotherapy or a placebo, or between different EGFR-TKI treatment durations for resected NSCLC, were eligible for inclusion. Disease-free survival (DFS) and overall survival (OS) with hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated as effective measures using random-effect or fixed-effect models. Subgroup analysis was also performed.

Results

Eleven RCTs involving 2102 EGFR-mutant NSCLC patients with or without EGFR-TKI adjuvant therapy were included. For all stage IB-IIIA NSCLC patients, EGFR-TKIs adjuvant therapy could not only significantly improve DFS (HR 0.43, 95% CI 0.30–0.63, P < 0.001) and 2- and 3-year DFS rates, but also improve OS (HR 0.72, 95% CI, 0.54–0.96, P = 0.024), compared with chemotherapy or the placebo. Further subgroup analyses indicated prolonged OS from first-generation EGFR-TKI adjuvant therapy in stage III patients, compared with chemotherapy or the placebo (HR for OS, 0.34; 95% CI, 0.18–0.63; P = 0.001). Of note, osimertinib adjuvant therapy led to the OS benefit expanding from stage III to stage II-III patients, with significantly improved DFS and a lower risk of brain recurrence, compared with the placebo. A 2-year treatment duration with EGFR-TKI adjuvant therapy showed a significantly lower recurrence risk than a ≤ 1-year duration.

Conclusion

The DFS advantage from first-generation EGFR-TKI adjuvant therapy can translate into an OS benefit in stage III NSCLC patients. Osimertinib might be more suitable for adjuvant therapy than first-generation EGFR-TKIs, because of the lower recurrence rate and the potential OS benefit even in early-stage patients. The optimal treatment duration for EGFR-TKIs at different stages of disease needs to be validated.