bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of tube dimensions on resonant frequency of stepped acoustic resonator
Authors: Yu Yanan , Zhou Jie , He Wen
Published: November 2024

An investigation of the effects of tube dimensions on resonant frequencies of stepped acoustic resonators is conducted. A linear acoustic theory is employed to model the plane wave propagation in the stepped resonator. The linear eigenvalue problem obtained by the method of separation of variables is solved to derive a frequency equation. Then, an experimental apparatus is established, in which the tube dimensions can be changed to adjust frequency. The variation pattern of resonant frequency with different lengths and diameters of the sub-tubes is analyzed theoretically and experimentally. The results suggest that the overall length determines the approximate scope of the resonant frequencies while the exact values of resonant frequencies and the relationship between resonant frequencies of each mode are determined by the ratio of sub-tube lengths and the ratio of sub-tube diameters. The calculated results are compared with the measured data. The comparative research declares that the derived frequency equation is an effective tool to calculate the resonant frequency of stepped resonator with adjustable size used in wide-band microphone calibration.
Effect of process parameters on the growth and microstructure of anodic films on 6061 aluminum alloy in alkaline electrolytes
Authors: Xue He , Shi Longfeng , Liu Cancan , Liang Jun
Published: November 2024

This study investigates the anodizing of 6061 aluminum alloy using an alkaline solution composed of sodium hydroxide (NaOH), sodium tetraborate (Na2B4O7) and potassium pyrophosphate (K4P2O7). The effects of the electrolyte compositions as well as temperature and voltage on the growth and microstructure of anodic films were investigated. Results showed that all these parameters have effects on the current density of the anodizing process and thickness of the anodic films. The current density increases with process parameters except for Na2B4O7, while as the process parameters increase, the anodic film thickness initially increases and then decreases. The morphology of the anodic film is notably affected by variables NaOH, Na2B4O7, temperature, and voltage. Increasing NaOH concentration and temperature resulted in a decrease in surface uniformity, while Na2B4O7 exhibited an opposite effect. Voltage significantly affected the diameter of the anodic film's pores, resulting in larger pores at higher voltages, which leading to poorer dyeing effect for the anodized samples.
Corrosion resistance of Si-Zn composite coating on AZ31 alloy
Authors: Zhang Jinghao , Hou Shusen , Li Wenxing , Li Yongfeng
Published: November 2024

To elevate the resistance to corrosion of magnesium alloys, silicon and zinc were simultaneously coated on the surface of AZ31 magnesium alloy using magnetron sputtering. The corrosion characteristics of the coated and uncoated samples were evaluated using electrochemical tests. Additionally, the antibacterial activity against Escherichia coli pathogens was assessed through the agar diffusion method. Compared to the AZ31 substrate and the sequentially sputtered Si and Zn coated samples, the Si-Zn composite coating specimens exhibited the minimal corrosion current density, and elevated charge impedance modulus (Z), transfer resistance (Rct), and phase angle. The simultaneous sputtering of Si-Zn composite coatings significantly slowed down the transmission of corrosive ions to the magnesium alloy surface, markedly enhancing the resistance to corrosion of magnesium alloy in SBF solution. Furthermore, the antibacterial activity of the simultaneously sputtered Si-Zn composite coating samples was superior to that of the AZ31 matrix. Therefore, the Si-Zn composite coating prepared by simultaneous sputtering possesses excellent corrosion resistance and antimicrobial properties.
Sensitivity of Concrete Embodied Carbon Emissions to Cement Production and Material Transportation
Authors: Cooper Michelle A. , Mukherjee Amlan
Published: November 2024

The objective of this study is to assess the sensitivity of concrete’s embodied global warming potential (GWP) to life-cycle assessment (LCA) parameters. Specifically, the study investigates the concrete mixture development stages of an LCA dealing with materials extraction, transportation to the production facility, and mixing at the production facility. These same stages are used to estimate a concrete mixture’s environmental impacts within environmental product declarations (EPDs). This study explores the framework of a spring-and-dashpot model to represent the carbon emissions from concrete production. The spring-and-dashpot model is introduced and verified in this work. The model identifies the two parameters within an LCA that most affect the GWP of a concrete mixture. Using this framework, the study investigates the sensitivity of a concrete mixture’s carbon emissions to those two most influential parameters. This model was used to assess the uncertainty of model-, laboratory-, and field-based concrete mixture designs. The mechanical performance and durability of concrete mixtures from laboratory and field data sets were compared with their calculated concrete GWPs and displayed no correlation, even accounting for GWP’s uncertainty, suggesting that a strong and durable concrete can also be sustainable.
Learning Driver Models for Automated Vehicles via Knowledge Sharing and Personalization
Authors: Kontar Wissam , Zhong Xinzhi , Ahn Soyoung
Published: November 2024

This paper describes a learning framework for driver models of automated vehicles (AVs) via knowledge sharing and personalization. As a result of the inherent variability in the transportation system, exposing AVs to all potential driving scenarios through empirical testing is challenging. This limitation can render AVs unaware of certain critical situations, affecting their safe and efficient operation. To address this challenge, this paper proposes a collaborative training approach that enables the sharing of knowledge among AVs while maintaining personalized models tailored to each vehicle’s unique conditions. The method adopts a federated learning strategy to facilitate privacy-aware collaboration, sharing only model parameters and never raw data. Through experimental simulations, we demonstrate the framework’s capability to (i) learn unseen driving scenarios and (ii) personalize driver models to different driving styles (aggressive and passive). Codes and data are made available at the project page https://github.com/wissamkontar .
An adaptive prediction method based on VMD-GRU for future driving condition of vehicle
Authors: Chen Yong , Song Zeyu , Huang Yanmin
Published: November 2024

Driving conditions prediction plays an important role in energy-saving control strategy for electric vehicle. However, the complexity of the changes in road conditions poses a great challenge to the accurate prediction of driving condition. To address this problem, this paper proposes an adaptive Sliding Window (SW) and Gated Recurrent Unit (GRU) algorithm to predict the driving conditions in a short period, and the algorithm enables to adjust the size of the SW promptly when the driving conditions change frequently. A smaller window is adopted in the case of drastically changing speeds, and a larger window is adopted in the case of smooth speeds. Firstly, Principal Component Analysis (PCA) and k-means clustering are used to construct sample driving conditions with the same characteristics. Then the instantaneous frequency of the sample driving conditions is calculated by Hilbert transform and Variational Mode Decomposition (VMD), and the optimal window size applicable to the conditions with different frequencies is quantitatively calculated. The model provides precise predictions with root mean square error (RMSE), mean absolute error (MAE) and mean absolute percentage error (MAPE) of 0.8799, 0.5443 and 0.8362%, respective. The ablation experiments show that the improved SW enables the GRU prediction model to capture the trends of different driving conditions more accurately, and improves the accuracy and robustness of the prediction model.
Political Leadership, Institutional Memory and the Implementation of Health in All Policies: An Explanatory Case Study of the Health 2015 Public Health Programme in Finland
Authors: Tikkanen Mira , Kokkinen Lauri
Published: November 2024

Our study sought to examine how and why political leadership and institutional memory affected the implementation of Health 2015, a public health programme prepared following the principles of the Health in All Policies (HiAP) strategy, between 2001 and 2015 in Finland. We analysed the data using a realist explanatory case study method. We found that the HiAP strategy did not have a strong leader who was able to generate interest in HiAP among other policymakers. This contrasted with the Finnish success story in previous decades when several interested elected politicians and high-ranking civil servants promoted the implementation of healthy public policies. Our results also pointed to institutional amnesia. During the implementation of Health 2015, a transition to project-based implementation, the retirement of many long-term policymakers and a change from the financial steering of local authorities to steering by information took place. The subsequent institutional amnesia was followed by discontinuity of previous institutionalised HiAP implementation structures and practices, such as intersectoral working groups.
Technical Efficiency of Smallholder Dairy Farms in Rural Assam: A Double Bootstrap Data Envelopment Analysis Approach
Authors: Bayan Baban , Sahu Partha Pratim , Dutta Mrinal Kanti
Published: November 2024

Analysing a sample of 245 smallholder rural dairy farms in Assam, it is found that most dairy farms operate at technically inefficient level. The analysis of input-oriented conventional and bias-corrected data envelopment analysis (DEA) procedure entails that most farms produce milk below the production frontier with underlying scope of reducing variable input component up to 50% to retain the same level of output. Further, exploring the bias-corrected efficiency score determinants, it is found that input use decision is superior for male-headed households, farms that are involved in fodder cultivation, farms with proximity to markets and resource poor farmers whose dairy farming is mostly a principal source of income. The findings of the study indicate presence of ample scope and potential to leverage the technical efficiency (TE) and thereby increase the socio-economic wellbeing of the smallholder dairy farm households in the state. The study also points towards the need for sensitising farmers about the improved dairy farm technologies such as artificial insemination to produce more crossbred cattle along with building a strong network of extension machineries.
How Acculturation Shapes Sleep in Thai Women in the United States During Menopausal Transition: A Mediation and Moderation Analysis
Authors: Srimoragot Manassawee , Reutrakul Sirimon , Hershberger Patricia E. , Park Chang , Quinn Lauretta , Liese Kylea Laina , Balserak Bilgay Izci
Published: November 2024

Introduction:

This study examines acculturation’s impact on sleep quality, efficiency, and obstructive sleep apnea (OSA) risk among Thai women in the United States transitioning through menopause.

Methodology:

This cross-sectional descriptive study recruited 120 Thai women aged 40 to 65. Questionnaires assessed sleep quality (Pittsburgh Sleep Quality Index [PSQI]), OSA risk (Berlin), menopausal symptoms (Menopause Rating), acculturation (Suinn-Lew Asian Self-Identity Scale), and anxiety (Patient-Reported Outcome Measurement Information System). Data were analyzed using bivariate correlations, multivariable regression, and mediation/moderation analyses.

Results:

Mean age was 51.53 ( SD = 7.73) years. Most were good sleepers (PSQI <5: 80.83%) and 14.17% at high risk of OSA. Acculturation was associated with better sleep quality ( B = −1.086, p = .027) and higher sleep efficiency ( B = 2.425, p = .021). Mediation analysis indicated that length of stay in the United States indirectly affected sleep quality ( B = −0.022, p = .026) and efficiency ( B = 0.051, p = .018) via acculturation.

Discussion:

Acculturation significantly affects sleep among Thai women; higher acculturation correlates with better sleep quality and efficiency. Acculturation did not affect OSA risk, suggesting context-specific influences that may benefit sleep through increased social integration. Future research should explore underlying mechanisms in immigrant populations.
Utilizing Theoretical Domains Framework to Determine Barriers to Evidence-Based Recommendations in Non-Valvular Atrial Fibrillation
Authors: White Evan , Kane-Gill Sandra L. , Jain Sandeep , Medico Charles , Ansani Nicole , Coons James C.
Published: November 2024

Background:

Implementation of evidence-based guidelines in patient care is inefficient. Only 14% of new research are routinely adopted into clinical practice. The atrial fibrillation (AF) practice guidelines recommend anticoagulation in men with a CHA2DS2-VASc score greater than or equal to 2 and in women with a CHA2DS2-VASc score greater than or equal to 3. Despite these recommendations, oral anticoagulation prescribing rates were found to be as low as 51%. Existing frameworks, such as the Theoretical Domain Framework (TDF), are used in implementation science to identify behavior changes to overcome barriers to guideline adoption.

Objective:

In this project, we explored behavioral themes and barriers that prevented clinician adherence to evidence-based recommendations for patients with non-valvular atrial fibrillation (NVAF) and developed interventions to overcome those barriers.

Methods:

Nine focused interviews were conducted with stakeholders across multiple disciplines involved with NVAF care. Interview questions were based on the TDF and designed to determine behavior changes necessary to increase appropriate anticoagulation prescribing and decrease unnecessary NVAF hospital admissions. The interviews were transcribed and coded using NVivo 12 qualitative data analysis software (released 2018). Themes were documented, and interventions were then developed to address the barriers.

Results:

TDF interviews yielded 4 main barrier themes regarding appropriate NVAF management in 2 theoretical domains. These themes were lack of knowledge, cost of anticoagulation, patient refusal to take anticoagulation, and social determinants of health. The theoretical domains were knowledge and environmental context and resources.

Conclusion and Relevance:

Based on our limited interviews, the TDF framework informed potential barriers contributing to the underutilization of appropriate anticoagulation in patients with NVAF. Techniques for behavior change interventions may be applied to overcome the identified barriers.
On Comfort(s)
Authors: Daniel Ronn , Kuljanin Stefan
Published: November 2024

Although physical comfort is a self-evidently important goal in interior design projects, whose definition is usually assumed to be obvious and straightforward (a measurable outcome of the interaction of material and anatomical variables), in practice comfort has proven itself one of the most mysterious of human spatial possibilities. Comfort has radically shifted its meanings across historical epochs and across cultures. Rather than a simple and quantifiable spatial reality, comfort should be understood as a malleable social ideology – comfort as the unstable consequence of cultural ideas about bodies, including ideas about gender, class, decorum, custom, and race, overlaid onto shifting technological, material, economic, social and ideological circumstances. Understood this way, physical comfort can be reanimated as a pliable design variable – as it has shifted previously, so it can be reshaped today. The goal of this visual essay, crafted as seven open-ended drawings framed by short introductory observations, is to pry comfort loose from simplistic understandings and invite new investigations into its mysteries and future possibilities.
Management of late postoperative capsular bag distension syndrome – two year case series
Authors: Otrošinová Marianna , Novák Jan , Krásnik Vladimír
Published: November 2024

Introduction

Late capsular bag distension syndrome (CBS) is a rare complication of the ^lcataract surgery.

Aim

The aim is to present 9 cases with delayed presentation and describe their successful management with surgical approach.

Method

A two-year retrospective review of 9 cases was undertaken. Anterior segment optical coherence tomography (AS-OCT) was used to confirm this diagnosis. Aspiration of the milky fluid with 26 gauge needle followed by capsular bag lavage was performed and aspirated fluid was examined.

Results

Patients showed signs of late CBS 6,56 ± 1,94 years after uncomplicated phacoemulsification with intraocular lens (IOL) implantation into the capsular bag. All 9 patients presented with a turbid fluid collection within the distended capsular bag. AS-OCT showed a hyper-reflective material in the space between the IOL and distended posterior capsule.

Conclusion

Awareness of the manifestations of CBS and choice of the correct imaging modality may lead to regular diagnosis and successful treatment. Management with aspiration of the milky fluid and lavage of the capsular bag is technically safe and effective procedure. It has the advantage of microbial testing of the fluid. AS-OCT is useful tool to differentiate this condition clearly from IOL opacification and posterior capsule opacification.
Juxta-anastomotic stenosis in the forearm native arteriovenous fistula: Open surgery or angioplasty?
Authors: Dominijanni Sara , Sfara Germana , Tatangelo Paola , Cancellieri Roberto , Spinelli Alessio , Centi Alessia , Mariani Ilaria , Ammirati Luigi Maria , Marrone Giulia , Mudoni Anna , Noce Annalisa , Palumbo Roberto
Published: November 2024

Background:

The juxta-anastomotic stenosis (JAS) represents the major complication of arteriovenous fistula (AVF) during the first months after the surgery and the approach to JAS can be surgical or radiological.

Methods:

From 01/02/2016 to 31/12/2020, a total of 976 radiocephalic fistulas have been performed. The 15.9% of AVF was malfunctioned due to JAS. A retrospective analysis was conducted on 156 patients with JAS, in order to compare the primary outcome of surgery and percutaneous angioplasty (PTA) in JAS treatment, in the lower forearm in a follow-up of 24 months.

Results:

Ninety patients underwent to surgery and 66 to PTA, mean age was 63.43 ± 14.54 and 65.10 ± 15.10 years, respectively. Frequencies of diabetes mellitus and arterial hypertension were similar by groups. Cardiovascular disease was present in 20% of the surgery patients and in 42.4% PTA patients ( p = 0.04). The primary assisted patency was 84.4% and 71.1% in the surgery group at 12 and 24 months and 54.5% and 69.6% in the PTA group. The secondary patency at 24 months was 95.6% for surgery group and 96.9% for PTA group, without a statistical significance. During the study period, 10 AVFs (11.1%) showed a restenosis in the surgical group and 14 (21.2%) in the PTA group.

Conclusions:

This retrospective study suggests a higher restenosis rate after PTA than surgery. However, the statistical analysis shows that the failure rate of the two procedures is comparable. A dedicated multidisciplinary team could represent the goal for a good clinical practice in the treatment of JAS.
Cardiac Amyloidosis Versus Other Restrictive Cardiomyopathies: A Retrospective Analysis of Cardiovascular Outcomes and Arrhythmic Burden
Authors: Sagalov Andrew , Ullah Waqas , Brailovsky Yevgeniy , Buhnerkempe Michael , Scaife Steve , Kulkarni Abhishek , Labedi Mohamed , Hegde Shruti
Published: November 2024

Background:

The arrhythmic burden and cardiovascular risks of cardiac amyloidosis compared with other types of restrictive cardiomyopathies (RCM), such as hemochromatosis and cardiac sarcoid, have not been well characterized in the literature. An increase in emphasis on screening has resulted in more diagnoses of cardiac amyloidosis and a larger data pool to analyze the cardiovascular outcomes of this cardiomyopathy.

Methods and results:

We queried the National Inpatient Sample (NIS) database to identify all adult patients diagnosed with cardiac amyloidosis or other RCM between the years 2016 and 2019. Discharge-weighted analysis using survey regressions accounts for discharge weights and characteristics found to be significantly different between groups. A total sample size of 13 345 patients was obtained, including cardiac amyloidosis (N = 8365; 62.7%) and other RCM (N = 4980; 37.3%). Cardiac amyloidosis was associated with a significantly increased risk of stroke (Odds ratio = 3.91: 95% confidence interval = [2.15, 7.11], P < .001) and ventricular tachycardia (1.98 [1.35-2.91], P < .001). Cardiac amyloidosis had a decreased risk of atrial fibrillation (0.56 [0.47-0.68], P < .001). Significant differences in risk were not observed among the different types of heart block and supraventricular arrhythmias. In-hospital mortality was similar between the 2 groups ( P = .72).

Conclusions:

Cardiac amyloidosis was associated with an increased risk of stroke and ventricular tachycardia compared to other types of RCM. Significant differences in in-hospital mortality, bundle branch blocks, and supraventricular arrhythmias were not appreciated. A subgroup analysis comparing light chain (AL) and wild-type transthyretin (ATTR) amyloidosis outcomes would further delineate the cardiovascular risks of cardiac amyloidosis.
Fear of the Dark: Concomitant Use of Direct Oral Anticoagulants and Antiseizure Medications
Authors: Karakis Ioannis
Published: November 2024

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Impact of aspirin dosage on prognosis and coronary artery complications in pediatric Kawasaki disease patients
Authors: Pan Liuyan , Liu Fei , Li Huanzhou , Zhang Bin , Zhu Yingyao , Gu Yingjie , Zheng Aibin
Published: November 2024

Kawasaki disease is a common systemic vasculitis in children, and early treatment is critical to prevent coronary artery complications. This study aimed to evaluate the impact of different aspirin dosages on the prognosis of Kawasaki disease. A total of 161 children diagnosed with Kawasaki disease were enrolled and divided into four groups based on the dosage of aspirin: 30–34 mg/kg, 35–39 mg/kg, 40–44 mg/kg, and 45–49 mg/kg. Demographic characteristics, pre-treatment laboratory indicators, post-treatment laboratory indicators, the incidence of coronary artery complications, and the rate of IVIG resistance were compared across the groups. No significant differences were found in baseline characteristics such as age, gender, weight, IVIG treatment choice, IVIG treatment duration, or the proportion of patients diagnosed before the age of 1 year. Laboratory indicators before and after treatment were also similar between groups. However, at 3-4 weeks after the onset of illness, the incidence of coronary artery complications was significantly higher in the high-dose aspirin groups compared to the low-dose aspirin group. Additionally, the high-dose aspirin group had a longer duration of fever and a higher proportion of recurrent fever compared to the low-dose group. The results suggest that although aspirin dosage did not appear to have a clear impact on the overall prognosis of Kawasaki disease, high-dose aspirin administered in the 3-4 weeks following disease onset may increase the risk of coronary artery complications and is associated with a higher incidence of recurrent fever. Caution is therefore advised in selecting aspirin dosages to minimize unnecessary risks.
Efficacy, safety, and prognostic factors of capecitabine plus temozolomide regimen in patients with atypical thymic carcinoids
Authors: Liu Man , Yan Xu , Lin Xiaoxuan , Chen Luohai , Wang Yu , Luo Yanji , Lin Yuan , He Qiao , Chen Jie , Zhang Ning
Published: November 2024

Background and objectives:

Atypical thymic carcinoids (ATCs) are rare mediastinal malignancies that lack established treatment guidelines. Capecitabine and temozolomide (CapTem) has demonstrated significant efficacy in pancreatic neuroendocrine neoplasms (NENs), while its applicability and effectiveness in ATCs remain underexplored. This study seeks to investigate the efficacy, safety, and prognostic factors associated with CapTem in ATC patients.

Design and methods:

Thirty-eight ATC patients treated with CapTem at our center were analyzed. We assessed the objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and treatment-related adverse effects. We also examined patients’ clinicopathological characteristics and their correlations with CapTem efficacy.

Results:

The cohort achieved a 15.8% ORR and 89.5% DCR, with a median PFS of 13.0 months. Multivariate analysis identified the platelet-to-lymphocyte ratio (PLR) as a significant independent prognostic factor for PFS, with a PLR ⩾ 235 associated with shorter PFS (7 months vs. undefined, p = 0.0004). Age was an independent prognostic factor for OS, with patients over 50 years experiencing shorter OS (36 months vs. undefined, p = 0.015). Safety analysis showed rare severe toxicities and no treatment-related fatalities.

Conclusion:

CapTem is an effective and well-tolerated treatment for ATC patients. Pretreatment PLR and age appear to be potential prognostic markers for CapTem therapy; however, these results warrant validation in larger patient cohorts.
Demystifying environmental health-related diseases: Using ICD codes to facilitate environmental health clinical referrals
Authors: Stoneham Melissa , Schneider Peter , Dodds James
Published: November 2024

Background: The burden of disease of Aboriginal and Torres Strait Islander people is estimated as 2.3 times that of the broader Australian population, with between 30% and 50% of health inequalities attributable to poor environmental health. Objective: Although many Australian states and territories have clinical policy initiatives that seek to reduce the burden of preventable disease in this population, including field-based environmental health clinical referrals (EHCRs), there is little consistency across the jurisdictions, resulting in less potential to break the cycle of recurrent diseases within the home environment. Method and Results: This study addresses this inconsistency by recommending recognition and categorisation of environmental health risks to allow for accurate diagnosis and comparability across health services and locations by using the International Statistical Classification of Diseases and Related Health Problems (ICD) system, already in use in hospitals. Conclusion and Implications: Developing a list of mutually agreed environmental health attributable diseases for the EHCR process using assigned ICD-10-AM codes would influence the provision of primary care to include recognition of the impact of environmental health conditions and allow environmental health staff to provide a response and education at both community and household levels to break disease cycles.
Musical Reward in Young Children
Authors: Kragness Haley E. , Mehl Kendra , Belfi Amy M.
Published: November 2024

Musical pleasure stems from an interplay of social, emotional, and cognitive factors. In adults, there are large individual differences in musical reward, with some individuals (deemed “hyperhedonic” to music) reporting very high reward and others (deemed “anhedonic” to music) reporting very low reward. Musical anhedonia is, therefore, a selective lack of pleasure in response to music, defined by self-reported low musical reward in the absence of generalized anhedonia. While this phenomenon has been investigated in adults in recent years, little is known about musical anhedonia or musical reward more generally in children. To address this, we investigated parents’ perceptions of musical reward in their children. We adapted a questionnaire of musical reward (the Barcelona Musical Reward Questionnaire [BMRQ]). Parents ( N = 500) responded to the adapted questionnaire (children’s BMRQ [cBMRQ]) and a widely used questionnaire of temperament (Children's Behavior Questionnaire—Very Short Form) concerning their 3- to 7-year-old children. As with adults, there was large individual variation in musical reward. A subset of participants rated their children’s experience of musical reward as very low, but did not rate them as having temperamental negative affectivity. Results point to substantial individual variation in musical reward in early childhood and suggest that musical anhedonia may already be apparent in early childhood.
Anterior Cruciate Ligament Reconstruction With The Rectus Femoris Autograft – Results From The First 80 Patients
Authors: Rego MCF , Rego MCF , Mameri ES , Barroso BG , Helito CP , Franciozi CES
Published: November 2024

Objectives

To report on the clinical outcomes and complications following anterior cruciate ligament (ACL) reconstruction using a novel rectus femoris autograft, including its clinical efficacy and safety.

Methods

Retrospective case series of patients undergoing isolated primary anatomic ACL reconstruction, with an outside-in technique, using a novel a rectus femoris autograft. Non-inclusion criteria consisted of partial tears; prior ipsilateral knee surgery; concomitant ligament, meniscus or cartilage procedures; follow-up shorter than 6 months. The primary clinical outcome measure was Lysholm score, including the percentage of patients achieving a previously published patient acceptable symptom state (PASS). Secondary outcomes included the observed rates for complications, as well as graft failure rate.

Results

80 patients (53% male; mean age 28.95 ± 8,04 years) were included, with a mean follow up of 18.03 months (± 6,94; min 6, max 28). The mean postoperative Lysholm was 97.08 (± 2.63; min 90, max 100), with 100% of patients achieving PASS. There were three instances of graft amputation during harvest (3/83 = 3.61%), all of which occurred within the first 10 cases. An overall post-operative complication rate of 6.25% was observed, with 4 instances of hematoma at the graft harvest site (4/80 = 5%), one infection (1/80 = 1.25%) and no instances of graft failure (0/80 = 0%) at final follow-up.

Conclusion

The rectus femoris autograft is a suitable graft option for ACL reconstruction, with demonstrated clinical efficacy and safety in this initial case series. Potential benefits include a minimally invasive harvest technique without the need for additional instruments, and an observed length of around 30cm, which can be tailored to multiligament or revision cases. Longer follow-up and comparative studies are needed in the future in order to assess the long-term efficacy and failure rates.
Biomechanical Evaluation of Ultra-High-Strength Suture Wire Versus Thinner Tape in Vertical Inside-Out Meniscal Suture
Authors: Faria JLR , Araujo IF , Santos APG , More ADO , Salim R , Roesler CRM
Published: November 2024

Objectives

Meniscal injuries are common and can significantly affect the function of the knee joint. Surgical repair is often necessary, with meniscal preservation being preferable to meniscectomy. This study aimed to compare the biomechanical properties of ultra-high-strength suture wire and thinner tape used in vertical inside-out meniscal suture.

Methods

Twenty-eight porcine knees were selected for this controlled biomechanical evaluation in a laboratory setting. The knees were divided into two groups: Group S (vertical inside-out meniscal sutures using ultra-high molecular weight polyethylene [UHMWPE] suture wire) and Group T (vertical inside-out meniscal sutures using UHMWPE tape). A 1.5 cm longitudinal lesion was created in the lateral meniscus, followed by two vertical sutures on the femoral surface of the meniscus. Biomechanical analyses were performed using a testing machine, including cyclic loading tests and load-to-failure tests.

Results

The results showed no significant difference in lesion widening after cyclic testing or in load-to-failure between the two groups. However, the system stiffness at the 5th and 30th cycle was significantly higher in Group T compared to Group S. The system stiffness at maximum load-to-failure did not differ significantly between the groups. These findings suggest similar biomechanical behavior of the two materials under radial loads.

Conclusion

Thinner tapes used in meniscal suture showed biomechanical outcomes comparable to ultra-high-strength suture wires, making them attractive options for meniscal repair due to their reduced thickness, which may result in less cartilage abrasion. Further research and clinical studies are necessary to validate these results.
Is a Pre-Operative MRI Anterolateral Ligament Injury Related to Anterior Cruciate Ligament Reconstruction Failure? A Prospective Cohort Study with Minimum 5 Year Follow Up
Authors: Helito CP , Sobrado MF , Silva AGM , Pécora JR , Gobbi RG
Published: November 2024

Objectives

To evaluate the clinical outcomes and failure rate of ACL reconstruction in patients with and without ALL injury diagnosed by magnetic resonance imaging (MRI) at a minimum five year follow up

Methods

A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (Control group) of ALL injury on preoperative MRI. Both groups underwent reconstruction of the ACL with autologous hamstrings grafts. The Lysholm and subjective International Knee Documentation Committee (IKDC) scores, KT-1000 and pivot shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury and presence of knee hyperextension were evaluated.

Results

A total of 156 patients were evaluated. No significant preoperative differences were found between the groups. In the postoperative evaluation, patients in the control group had a lower reconstruction failure rate (14.3% vs 4.6%; P = .049) and better clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.3; P < .0001). Although the pivot shift was similar, KT-1000 revealed worse results for the ALL injury group (2.8 +/- 1.4 mm) compared to the control group (1.9 +/- 1.3 mm) (p = 0.00018). Patients in the ALL injury group also presented a worsening of the knee instability from two to five years according to the KT-1000 (2.4 +/- 1.6 vs 2.8 +/- 1.4; p=0.038).

Conclusion

Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after ACL reconstruction. Patients with concomitant ALL injury showed a higher rerupture rate and worse functional scores. Also, knee stability tends to worsen from 2 to 5 years in cases of associated ALL injury.
Outcomes of cruciate ligament reconstruction on patients with associated anterolateral injury
Authors: Guerreiro JPF , Rosa LB , Gonçalves EL , Curcio ARR , Bignardi PR , Daniel MV
Published: November 2024

Objectives

Evaluate if there is a significant difference in isolated reconstruction of the ACL in patients with or without pre-operative associated injury of the ALL.

Methods

Transversal retrospective study by patient’s files analysis and LYNSHOLM and IKDC questionaries to patients with isolated reconstruction of the ACL.

Results

The 52 patients were separated in 2 groups: 19 with associated ALL injury and 33 without associated injury. None of the patients with associated ALL injury suffered new ACL tear, but 21,1% had injured other structures, while 6,1% of patients without associated ALL injury suffered new ACL tear and 18,2% injured another structure (p=0,544). The return to activities at the same preoperative level was observed in 60% with associated ALL injury and 72% without associated injury (p=0,309). The LYSHOLM score demonstrated a median of 81,1 points with associated ALL injury and 90,1 without associated injury, and the IKDC, 70,3 points with associated injury and 76,7% without associated injury (p=0,112).

Conclusion

No significant statistic difference was observed for graft injury or new lesions in other structures, satisfaction with the injured knee or subjective IKDC score. Return to activities was similar in both groups with or without associated ALL injury and the LYSHOLM subjective score demonstrated better results with significant statistical difference in the group without LAL associated injury.
Patellar Dysplasia and Cell-Based Cartilage Repair Outcomes
Authors: Retzky J , Palahres GM , Tacher R , Gomoll AH , Strickland S
Published: November 2024

Objectives

We aimed to evaluate the relationship between Wiberg patella type and outcomes following cell-based cartilage repair (autologous chondrocyte implantation [ACI] or particulated juvenile allograft cartilage transplantation [PJAC]) for the treatment of patellar chondral lesions at minimum 2-year follow-up. We hypothesized that Wiberg classification of patella shape would have no impact on patient-reported outcome measures (PROMs) or graft survival.

Methods

Patients undergoing ACI or PJAC for full-thickness patellar chondral defects between 2016-2020 were retrospectively reviewed following Institutional Review Board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, Veterans Rand 12 (VR-12) Mental, and VR-12 Physical scores, from pre- to postoperative and the percentage of patients who achieved the MCID for IKDC and Kujala scores were compared for the Wiberg A versus Wiberg B versus Wiberg C groups. Log-rank test was used to evaluate for differences in survival between subgroups.

Results

Fifty-nine patients (63 knees) were included, with an average age of 33.3±8.6 years, median BMI of 26.0 kg/m2 (interquartile range:21.8–30.2 kg/m2), and median time to follow up of 3.5 years (interquartile range:2.6–4.2 years). Twenty-six patellae (41%) were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg A versus B versus C groups with respect to change in PROMs from pre- to postoperative or the percentage of patients who achieved the MCID for IKDC or Kujala scores (p>0.05 for all). There were no differences in survival between groups (p=0.45).

Conclusion

Wiberg patella type has no impact on patient-reported outcomes or graft survival at midterm follow-up. Patella dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures.
Establishing Minimal Detectable Change Thresholds for the International Knee Documentation Committee and Kujala Scores at One and Two Years After Patellofemoral Joint Arthroplasty
Authors: Kunze K , Palhares GM , Uppstrom TJ , Gomoll AH , Stein BES , Strickland SM
Published: November 2024

Objectives

To define the minimal detectable change (MDC) for the international knee documentation committee (IKDC) and Kujala scores one and two years after patellofemoral joint arthroplasty (PFA).

Methods

A distribution-based method was applied to establish MDC thresholds among 225 patients undergoing primary PFA at a single high-volume musculoskeletal-care center. Stability of change in MDC achievement was explored by quantifying the proportion of achievement at one- and two-year postoperative timepoints. Multivariable logistic regression analysis was performed to explore the association between sociodemographic and operative features on MDC achievement.

Results

MDC thresholds for the Kujala score were 10.3 (71.1% achievement) and 10.6 (70.4% achievement) at one- and two years, respectively. The MDC thresholds for the IKDC score were 11.2 (78.1% achievement) and 12.3 (69.0% achievement) at one- and two years, respectively. Predictors of achieving the MDC for the Kujala and IKDC scores at both time points were lower preoperative Kujala and IKDC scores, respectively. Preoperative thresholds of ≤ 24.1 and 7.6 for the Kujala and IKDC scores, respectively, were associated with a 90% MDC achievement probability. When preoperative thresholds approached 64.3 and 48.3 for the Kujala and IKDC, respectively, MDC achievement probability reduced to 50%.

Conclusion

The MDC thresholds for the Kujala and IKDC scores two years after PFA were 10.6 and 12.3, respectively. Clinically significant health status changes were maintained overall, with a slight decrease in achievement rates between one and two years. MDC achievement was associated with disability at presentation. These findings may assist knee surgeons with patient selection and the decision to proceed with PFA by better understanding the patient-specific propensity for MDC achievement.
The Impact of a Target-Based Approach Conservative Treatment in Patients Waiting for Total Knee Replacement
Authors: Campos GC , Costa AHD , Piovesana LG , Piedade SR , Miranda JB , Zorzi AR
Published: November 2024

Objectives

We are certainly far from a consensus on the best form of knee osteoarthritis treatment or on an effective treatment recommendation. Moreover, indication for total knee arthroplasty still subjective and depends on several aspects such as physician’s experience, patient’s perception and also the treatment carried out so far. There is a non-negligible number of patients who end up undergoing arthroplasty when they could improve with conservative treatment if they had access to adequate treatment. The objective of this study is to evaluate the impact of an individualized conservative treatment in part of OA patients referred for surgical treatment, awaiting total knee replacement.

Methods

We enrolled 77 patients referred to the knee surgery outpatient clinic of a University Hospital, with indication of total knee arthroplasty. They were divided into two groups: treatment group received target-based approach care and the waiting group received standard treatment. All patients underwent radiographic analysis according to Kellgren & Lawrence, functional evaluation with application of the VAS scale, WOMAC questionnaire, SF-36 questionnaire, 6MWT and muscular strength evaluation.

Results

The treatment group presented lower perception regarding pain intensity (P = 0.017). As well as improvement in the quality of life compared to the waiting group, an increase in SF-36 scores was observed in the SF-36 AF (P = 0.49) and SF-36 AS (P = 0.013), SF-36 EGS (P = 0.003) and SF-36 V (P = 0.042). In the treatment group there was improvement in the functional capacity of the lower limb, as demonstrated by reduction of knee extensor torque deficit (P <0.001) and increase in distance in the 6MWT (P <0.001).

Conclusion

Target-besed approach conservative treatment improved symptoms and quality of life in OA patients with an indication for total knee replacement.
Anatomical Study of Medial Patellar Stabilizers
Authors: LHC Araújo , MLC Cavalcante
Published: November 2024

Objectives

To study the anatomy of the medial patellar stabilizers and their relationship with adjacent structures.

Methods

Anatomical study on 15 knees, six from cadaver donors and nine from suprapatellar amputation.

Results

The medial ligament complex was identified in the dissected knees. The characteristics of the ligaments, the insertion sites, the morphometry and the relationships with adjacent structures were documented.

Conclusion

The medial ligament complex was identified in the dissected knees. The characteristics of the ligaments, the insertion sites, the morphometry and the relationships with adjacent structures were documented.
Cross-sectional Effects of Isolated Meniscal Tears on In Vivo Biomechanics of the Knee: A Systematic Review of Motion Analysis Studies
Authors: Mameri ES , Gustafson JA , Gonzalez FF , Leporace G , Metsavaht LF , Chahla J
Published: November 2024

Objectives:

To systematically review the effects of meniscal tears on in vivo knee biomechanics, with a focus on kinematic and kinetic outcome measures.

Methods:

Databases were queried for level I-IV studies that met the following criteria: in vivo studies of gait or motion analysis, cohorts with isolated meniscal pathology, and kinematics and/or kinetics outcome measures. Demographic data, methods of motion analysis, tasks performed, and kinematics and kinetics outcomes were extracted. Standardized mean differences with a random-effects model were calculated to compare cohorts with meniscal tears and healthy controls when outcomes were homogeneous.

Results:

Thirteen studies were eligible, with a pooled sample of 176 medial meniscal and 74 lateral meniscal tears. Eleven studies assessed gait biomechanics. There was considerable variability in reported outcomes and motion capture methods. Meta-analysis revealed statistically significant decreases in peak knee flexion angle, range of adduction-abduction, and internal-external rotation (p < 0.05) for the pooled sample of lateral meniscus tears. In terms of kinetics, although qualitative evidence in individual studies suggested alterations (e.g., decreased total support moment of the injured limb), quantitative analysis failed to demonstrate significant differences in peak knee flexion moment and peak knee adduction moment (p ≥ 0.05).

Conclusion:

Lateral meniscus tears significantly impact in vivo knee kinematics across all three planes of motion. No significant differences were observed in the kinetics of medial meniscus tears, and the evidence for their impact on kinematics remains conflicting. Our findings suggest that analyzing more demanding functional tasks may be necessary to detect the biomechanical changes caused by meniscal tears.
Ochronotic Arthropathy of the Knee: A Case Report
Authors: SANTOS MARZO NUNES , COUTO RICARDO DAVID , BRUSTOLIM DANIELE
Published: November 2024

Alkaptonuria (AKU) is a low-prevalence genetic inherited disease expressed in an autosomal recessive and monogenic manner, characterized by a tissue accumulation of homogentisic acid (HGA). It is more severe in male patients, with arthritic symptoms as the earliest clinical picture in most cases.

This enzyme deficiency metabolic disorder causes an increase in HGA, an intermediary in the metabolism of amino acids normally excreted in the urine. Homogentisic aciduria can be observed in patients with alkaptonuria, manifested by darkening of the first-morning urine. Ochronosis, a tissue homogentisic acid accumulation, progresses with connective tissue pigmentation and severe ochronotic joints osteoarthropathy. Ochronosis can also occur in the eyes, ears, skin, and heart valves. Also, are seen blackened kidneys and prostate stones, injuries to muscles and tendons, as well as fractures.

We present a case report of a 60-year-old male patient who previously underwent two arthroscopies of the left knee due to pain with no predefined etiology.

After a year, he sought a referral orthopedic hospital complaining of diffuse pain and persistent edema due to severe lateral femolotibial and patellofemoral osteoarthritis and valgus deformity.

Total arthroplasty of the left knee was indicated and performed, with a suspected diagnosis of ochronosis intraoperatively and confirmed with additional tests. The patient has been followed up for 2 years after left knee arthroplasty, with a favorable outcome.
The Search for the Primitive Church and the End of the CMS Mission of Help to Travancore, ca. 1830-1840
Authors: McKee Gary
Published: November 2024

This article demonstrates that the rhetoric of returning to the primitive church was a significant motivating factor in evangelical Protestant missions in the early nineteenth century. This language is apparent across denominational agencies and geographical locations. I will demonstrate that it was a particularly strong motivating factor in the Church Missionary Society’s ”Mission of Help” to the Syrian Christians of Travancore. Yet a combination of ecclesiastical and political factors served to thwart this mission endeavor and raises abiding questions regarding the usefulness of such language in mission motivation.