bluuebunny/crossref_metadata_2025 huggingface dataset:
Blast resistance and energy absorption of sandwich panels with layered gradient metallic foam cores
Authors: Jing Lin , Zhao Longmao
Published: March 2017

The dynamic response, blast resistance and energy absorption capability of clamped square sandwich panels comparing two aluminum alloy face-sheets and a layered gradient metallic foam core, subjected to air-blast loading, were studied numerically in this paper. Graded sandwich specimens with six different core-layer arrangements and three different face-sheet thickness arrangements were examined, respectively, compared to those ungraded sandwich panels with an equivalent nominally mass. Simulation results show that the blast resistance and energy absorption capability of sandwich panels with layered gradient metallic foam cores could be improved by optimizing the arrangements of different density metallic foam core-layers, and the graded sandwich panel with low-middle-high density core configuration has the best blast resistance capability. The blast resistance of graded sandwich panels with different thickness arrangements for top and bottom face-sheets has no obvious change tendency, since the normal stress distributions of their sandwich cross sections are controlled simultaneously by face-sheets and gradient foam core.
Chasing some bodies: Tracing the embodiment of female refugees in transnational settings and reading tales of their bodies
Authors: Saramifar Younes
Published: March 2017

The way individuals embody their homeland has been addressed by several scholars. However, this article questions how female refugees embody transnational settings while seeking a new home and homeland. The tales of bodies are traced through the writings of three Iranian female refugees living in Europe. The article analyses their autobiographies through a critical reading of Thomas Csordas’s phenomenology of body–world relations and then diverges from him to draw inspiration from Deleuzian becoming. The study attempts to offer an anthropology of becoming to highlight how corporeality is the realm of bodies becoming.
Expansion, standardization, and densification of the criminal justice apparatus: Recent developments in Brazil
Authors: Fonseca David S
Published: March 2017

The democratic transition in Brazil witnessed the return of civil liberties and the emergence of a legal framework based upon respect for human rights and the adoption of extensive social entitlements. In recent years, the reduction of poverty and upward social mobility have also transformed the country’s social structure. In spite of these welcome changes, however, crime and prison rates went through a steep upsurge during the same period, undermining many of these more positive social changes. A number of reasons underlie the emergence of this predicament, ranging from large structural shifts to the piecemeal adoption of harsher criminal laws. Enmeshed in these developments nonetheless there is also important institutional modifications in the configuration of the criminal justice system. The present argument seeks to understand how the recent thrust in the modernization of state institutions helped to create this situation of crisis. The expansion, densification, and standardization of the criminal justice apparatus has prompted its greater effectiveness and, thus, contributed to the current predicament of high crime rates and mass incarceration in the country.
‘Handled with care’: Diffuse policing and the production of inequality in Amsterdam
Authors: de Koning Anouk
Published: March 2017

The intersection of race and the criminal justice system has been a longstanding topic of activism, public debate and research in the US context. In recent years, European countries have also seen a growing social and academic debate about the way racialized minorities are policed. Based on ethnographic research in Amsterdam, this article argues that in order to understand such racialized policing, we have to go beyond a narrow focus on the police itself, and instead examine the broader institutional landscape tasked with security. This institutional landscape is made up of penal and welfare actors who together enact what I call diffuse policing. Such diffuse policing envelops targeted persons and spaces in a dense web of surveillance, and disciplinary and reform interventions that are hard to escape or challenge. This article explores the cumulative effects of this dense security landscape, and argues that it produces significant inequalities among youths in Amsterdam.
Cylinder deactivation during dynamic diesel engine operation
Authors: Gosala Dheeraj B , Allen Cody M , Ramesh Aswin K , Shaver Gregory M , McCarthy James , Stretch Dale , Koeberlein Edward , Farrell Lisa
Published: March 2017

Cylinder deactivation can be implemented at low loads in diesel engines to improve efficiency and aftertreatment thermal management through reductions in pumping work and airflow, respectively. The rate of increase of torque/power during diesel engine transients is limited by the engine’s ability to increase the airflow quickly enough to allow sufficient fuel addition to meet the desired torque/power. The reduced airflow during cylinder deactivation needs to be managed properly so as to not slow the torque/power response. This paper demonstrates that it is possible to operate a diesel engine at low loads in cylinder deactivation without compromising its transient torque/power capabilities, a key finding in enabling the practical implementation of cylinder deactivation in diesel engines.
People Are More Generous to a Partner Who Pays Attention to Them
Authors: Ohtsubo Yohsuke , Yamaguchi Chiaki
Published: March 2017

People use relatively low-cost signals to maintain close relationships, in which they engage in costlier exchanges of tangible support. Paying attention to a partner allows an individual to communicate his or her interest in the relationship with the partner. Previous studies have revealed that when Person A pays attention to Person B, B’s feeling of intimacy toward A increases. If social attention strengthens the bond between A and B, it is predicted that A’s attention will also increase B’s generous behavior toward A. This study tested this prediction. Participants first engaged in a collaborative task using computers. In the task, the putative partner (a computer program) either paid or did not pay attention to participants (high attention condition vs. low attention condition). In the control condition, the partner could not choose when to pay attention to participants. They then played three rounds of the dictator game with the partner. Confirming the previous finding, perceived intimacy was highest in the high attention condition, in the middle in the control condition, and lowest in the low attention condition. More importantly, participants in the high attention condition decided to give more resources to their partner than those in the low attention condition (but the difference between the high attention condition and the control condition was not significant). In addition, self-reported intimacy was positively correlated with the resource allocated to the partner. The results of this study demonstrated that social attention fosters a partner’s generosity.
Transforming professional learning: Educational action research in practice
Authors: Hardy Ian , Rönnerman Karin , Edwards-Groves Christine
Published: March 2017

This article seeks to extend current understandings of educational action research, particularly how teachers’ actions, talk and ongoing relatings can serve as a vehicle for transforming their learning, including under current global conditions of more performative accountability. The research is grounded in Noffke’s (2009) understandings of the nature of the personal, professional and political dimensions that characterize action research. While validating Noffke’s (2009) dimensions, we also argue that specific instances of action research help provide insights into not just how action research might be currently understood, but details about how it has actually transformed teachers’ learning practices. To do so, we draw upon recent theorizing into the nature of educational practice, and an example of action research in one school in Australia. Specifically, and drawing upon Kemmis et al. (2014), we reveal the particular ‘doings’ (actions), ‘sayings’ (talk) and ‘relatings’ (relationships) that characterize specific instances of teachers’ learning during part of an action research cycle in this school, under current policy conditions. By indicating how this learning came about, we reveal how the personal, professional and political dimensions (Noffke, 2009) in action research settings are enacted, leading to transformed practice through specific doings, sayings and relatings under current conditions.
Sodium–glucose co-transporter type 2 inhibitors reduce evening home blood pressure in type 2 diabetes with nephropathy
Authors: Takenaka Tsuneo , Kishimoto Miyako , Ohta Mari , Tomonaga Osamu , Suzuki Hiromichi
Published: March 2017

Background:

The effects of sodium–glucose co-transporter type 2 inhibitors on home blood pressure were examined in type 2 diabetes with nephropathy.

Methods:

The patients with diabetic nephropathy were screened from medical records in our hospitals. Among them, 52 patients who measured home blood pressure and started to take sodium–glucose co-transporter type 2 inhibitors were selected. Clinical parameters including estimated glomerular filtration rate, albuminuria and home blood pressure for 6 months were analysed.

Results:

Sodium–glucose co-transporter type 2 inhibitors (luseogliflozin 5 mg/day or canagliflozin 100 mg/day) reduced body weight, HbA1c, albuminuria, estimated glomerular filtration rate and office blood pressure. Although sodium–glucose co-transporter type 2 inhibitors did not alter morning blood pressure, it reduced evening systolic blood pressure. Regression analyses revealed that decreases in evening blood pressure predicted decrements in albuminuria.

Conclusion:

The present data suggest that sodium–glucose co-transporter type 2 inhibitors suppress sodium overload during daytime to reduce evening blood pressure and albuminuria.
Perceived Barriers and Enablers of Help-Seeking for Substance Use Problems During Adolescence
Authors: Berridge Bonita J. , McCann Terence V. , Cheetham Ali , Lubman Dan I.
Published: March 2017

Aim. Receiving professional help early can reduce long-term harms associated with substance use. However, little is known about the factors that influence help-seeking for substance use problems during early-mid adolescence, prior to the emergence of disorder. Given that beliefs regarding help-seeking are likely to develop early, understanding adolescent views of help-seeking during this period is likely to provide important information for prevention and intervention efforts. The current study identifies perceptions that would facilitate or prevent adolescents from seeking support for substance use problems from formal and informal help sources. Method. Thirty-four 12- to 16-year-olds from two schools in Melbourne, Victoria, Australia, were recruited. A qualitative interpretative design was used, incorporating semistructured, audio-recorded interviews. Results. Three overlapping themes that reflected barriers or enablers to help-seeking were identified: approachability, confidentiality and trustworthiness, and expertise. Help-seeking was facilitated when adolescents believed that the help source would be supportive and understanding, would keep information confidential, and had expertise in the alcohol and drug field. Conversely, adolescents were reluctant to seek help from sources they believed would be judgmental, lacked expertise, or would inform their parents. Conclusions. These findings highlight perceptions that may influence help-seeking for alcohol and drug problems during adolescence. Further research is needed to determine if help-seeking can be facilitated by improving parents’ and peers’ knowledge and promoting health professionals’ expertise in working with young people’s alcohol and drug issues.
The Olympic Games as a News Shock
Authors: Langer Viktoria C. E. , Maennig Wolfgang , Richter Felix
Published: March 2017

The awarding of the Olympic Games to a certain city or the announcement of a city’s Olympic bid may be considered as a news shock that affects agents’ market expectations. A news shock implies potential impacts on the dynamic adjustment process that change not only the volatility but also the long-run steady-state levels of endogenous economic variables. In this study, we contribute to and extend previous researchers’ attempts to empirically test for the Olympic Games as a news shock by implementing full structural models and by matching Olympic hosts and bidders to structurally similar countries.
Racial Attributions in the Justice System and Support for Punitive Crime Policies
Authors: Peffley Mark , Hurwitz Jon , Mondak Jeffery
Published: March 2017

How do members of racial groups explain the large disparity in the way Blacks and Whites are treated by the criminal justice system in the United States? And how do such explanations (attributions) influence support for punitive crime control policies in America, as well as arguments against such policies? Our study of the structure, sources, and consequences of racial attributions in the justice system, using original survey data in Washington state, contributes to the literature in several ways. First, unlike traditional measures of racial prejudice—that is, racial resentment and stereotypes—our measure of racial attributions distinguishes cleanly between dispositional explanations (e.g., Blacks’ aggressive nature) and discrimination. Second, we examine the attributions of three pivotal groups with different experiences with legal authorities: Latinos, Blacks, and Whites. Third, an issue framing experiment demonstrates the power of both attributions for shaping support for the death penalty and arguments against the policy based on racial justice.
Autonomous Driving Systems: A Preliminary Naturalistic Study of the Tesla Model S
Authors: Endsley Mica R.
Published: March 2017

Autonomous and semiautonomous vehicles are currently being developed by over14 companies. These vehicles may improve driving safety and convenience, or they may create new challenges for drivers, particularly with regard to situation awareness (SA) and autonomy interaction. I conducted a naturalistic driving study on the autonomy features in the Tesla Model S, recording my experiences over a 6-month period, including assessments of SA and problems with the autonomy. This preliminary analysis provides insights into the challenges that drivers may face in dealing with new autonomous automobiles in realistic driving conditions, and it extends previous research on human-autonomy interaction to the driving domain. Issues were found with driver training, mental model development, mode confusion, unexpected mode interactions, SA, and susceptibility to distraction. New insights into challenges with semiautonomous driving systems include increased variability in SA, the replacement of continuous control with serial discrete control, and the need for more complex decisions. Issues that deserve consideration in future research and a set of guidelines for driver interfaces of autonomous systems are presented and used to create recommendations for improving driver SA when interacting with autonomous vehicles.
Decision-making interventions to stop the global atrial fibrillation-related stroke tsunami
Authors: Cerasuolo Joshua O , Montero-Odasso Manuel , Ibañez Agustin , Doocy Shannon , Lip Gregory YH , Sposato Luciano A
Published: March 2017

Atrial fibrillation affects 33.5 million people worldwide and its prevalence is expected to double by 2050 because of the aging population. Atrial fibrillation confers a 5-fold higher risk of ischemic stroke compared to sinus rhythm. We present our view of the role of shared medical decision-making to combat global underutilization of oral anticoagulation for stroke prevention in atrial fibrillation patients. Oral anticoagulation underuse is widespread as it is present within atrial fibrillation patients of all risk strata and in countries across all income levels. Reasons for oral anticoagulation underuse include but are probably not limited to poor risk stratification, over-interpretation of contraindications, and discordance between physician prescription preferences and actual administration. By comparing a catastrophic event to the consequences of atrial fibrillation related strokes, it may help physicians and patients understand the negative outcomes associated with oral anticoagulation under-utilization and the magnitude to which oral anticoagulations neutralize atrial fibrillation burden.
Transfer of the musculocutaneous nerve branch to the brachialis muscle to the triceps for elbow extension: anatomical study and report of five cases
Authors: Bertelli J. A. , Soldado F. , Ghizoni M. F. , Rodríguez-Baeza A.
Published: March 2017

We report the study of the anatomical feasibility of transferring the nerve to the brachialis muscle to the upper medial head motor branch that innervate the triceps, and outcomes of such transfers in restoring elbow extension in five patients with posterior cord lesion of the brachial plexus. The length of the branches to the brachialis muscle measured 7.6 cm and the triceps upper medial head motor branch was 5 cm in 10 adult cadavers. Five male patients were treated with this transfer 5 months after the injury (range 4 to 6 months) after posterior cord injury of the brachial plexus with a mean follow-up of 31 months (range 28 to 36 months). Elbow extension scored M4 in all cases. No complications occurred. These preliminary results suggest that transferring the nerve to the brachialis muscle is an effective technique for the reconstruction of elbow extension after posterior cord brachial plexus injuries.

Level of evidence: IV
History and current state of immunotherapy in glioma and brain metastasis
Authors: McGranahan Tresa , Li Gordon , Nagpal Seema
Published: March 2017

Malignant brain tumors such as glioblastoma (GBM) and brain metastasis have poor prognosis despite conventional therapies. Successful use of vaccines and checkpoint inhibitors in systemic malignancy has increased the hope that immune therapies could improve survival in patients with brain tumors. Manipulating the immune system to fight malignancy has a long history of both modest breakthroughs and pitfalls that should be considered when applying the current immunotherapy approaches to patients with brain tumors. Therapeutic vaccine trials for GBM date back to the mid 1900s and have taken many forms; from irradiated tumor lysate to cell transfer therapies and peptide vaccines. These therapies were generally well tolerated without significant autoimmune toxicity, however also did not demonstrate significant clinical benefit. In contrast, the newer checkpoint inhibitors have demonstrated durable benefit in some metastatic malignancies, accompanied by significant autoimmune toxicity. While this toxicity was not unexpected, it exceeded what was predicted from pre-clinical studies and in many ways was similar to the prior trials of immunostimulants. This review will discuss the history of these studies and demonstrate that the future use of immune therapy for brain tumors will likely need a personalized approach that balances autoimmune toxicity with the opportunity for significant survival benefit.
Moving Toward a Unified Platform for Insulin Delivery and Sensing of Inputs Relevant to an Artificial Pancreas
Authors: Graf Anneke , McAuley Sybil A. , Sims Catriona , Ulloa Johanna , Jenkins Alicia J. , Voskanyan Gayane , O’Neal David N.
Published: March 2017

Advances in insulin pump and continuous glucose monitoring technology have primarily focused on optimizing glycemic control for people with type 1 diabetes. There remains a need to identify ways to minimize the physical burden of this technology. A unified platform with closely positioned or colocalized interstitial fluid glucose sensing and hormone delivery components is a potential solution. Present challenges to combining these components are interference of glucose sensing from proximate insulin delivery and the large discrepancy between the life span of current insulin infusion sets and glucose sensors. Addressing these concerns is of importance given that the future physical burden of this technology is likely to be even greater with the ongoing development of the artificial pancreas, potentially incorporating multiple hormone delivery, glucose sensing redundancy, and sensing of other clinically relevant nonglucose biochemical inputs.
Ideology and Voice
Authors: Vorauer Jacquie D. , Quesnel Matthew S.
Published: March 2017

What situational forces might enhance ethnic minority group members’ voice and ability to exert social influence during exchanges with dominant group members? Two experiments involving face-to-face dyadic intergroup interaction examined whether making multiculturalism salient to minority group members would increase the extent to which they persuaded a dominant interaction partner of their own point of view on a series of controversial social issues. Results were consistent with this hypothesis and further indicated that minority group members expressed their own point of view more clearly and directly when multicultural ideology was made salient to them as compared to when it was not, which contributed (marginally) to their heightened persuasiveness. Salient multiculturalism did not have comparable effects on dominant group members’ persuasiveness or clarity of expression. These results raise the possibility that making multicultural ideology salient might set the stage for minority group members to have a stronger voice in intergroup exchanges.
Conservatives Are More Reluctant to Give and Receive Apologies Than Liberals
Authors: Hornsey Matthew J. , Schumann Karina , Bain Paul G. , Blumen Sheyla , Chen Sylvia X. , Gómez Ángel , González Roberto , Guan Yanjun , Kashima Emiko , Lebedeva Nadezhda , Wohl Michael J. A.
Published: March 2017

This article examines the proposition that conservatives will be less willing than liberals to apologize and less likely to forgive after receiving an apology. In Study 1, we found evidence for both relationships in a nine-nation survey. In Study 2, participants wrote an open-ended response to a victim of a hypothetical transgression they had committed. More conservative participants were less likely to include apologetic elements in their response. We also tested two underlying mechanisms for the associations: social dominance orientation (SDO) and entity beliefs about human nature. SDO emerged as a stronger and more consistent mediator than entity beliefs. Apologies are theorized to be a rhetorical vehicle for removing power inequities in relationships posttransgression. Consistent with this theorizing, it was those who are relatively high in commitment to equality (i.e., those high in liberal ideology and low in SDO) who are most likely to provide and reward apologies.
Religious People Endorse Different Standards of Evidence When Evaluating Religious Versus Scientific Claims
Authors: McPhetres Jonathon , Zuckerman Miron
Published: March 2017

Recent research has begun to investigate the relationship between religion and science. However, it remains unclear whether religious and nonreligious people differ on the standards of evidence used when evaluating claims in religious versus scientific contexts. Across three studies ( N = 702), we presented participants with effects that were attributed to scientific methodology or to God and asked them to rate how many more times an effect needs to be repeated in order to have certainty in the outcome. Results showed that religious people requested fewer repetitions compared to nonreligious people when an effect was attributed to prayer, and fewer repetitions when an effect was attributed to prayer compared to scientific methodology. Nonreligious people were relatively consistent across conditions. These results suggest that religious people have less stringent standards of evidence when evaluating nonscientific claims. Directions for future research are also discussed.
Childhoods as political projects: A comparison between cultural nationalism and minority activism in Japan
Authors: Cangià Flavia
Published: March 2017

Recent studies in the social sciences have focused the attention on the role of children in cultural politics, in particular on children’s experiences in nationalism, as well as on their participation in inter-ethnic relations. In line with this research, this study aims to investigate the relationship between childhood and political action and to conceptualize “childhood” as a contested political notion. More specifically, it discusses variations in the definition of “childhood” in “majority” and “minority” like contexts with a special focus on Japan. This article compares the Agency for Cultural Affairs and its programs for the promotion of “Japanese culture,” with the Dōwa Education’s programs on the buraku issue, and discusses how the resulting definitions of “childhood” are based upon various representations of “group identities” and upon different conceptions of educational processes. In this sense, the notion of “childhood” reflects a variety of political projects based on various institutional agendas, upon which different understandings of children’s role in society depend.
Prolonged expiratory apnoea with cyanosis in Arnold Chiari II malformation
Authors: Zafar Adnan , Hussain Nahin
Published: March 2017

Apnoea associated with Arnold Chiari malformation is a known entity and can be obstructive or central. Differentiating between two types is vital to deciding management pathway and prognosticating disease process.
Choosing Wisely
Authors: Chan Emilie , Hemmelgarn Brenda , Klarenbach Scott , Manns Braden , Mustafa Reem , Nesrallah Gihad , McQuillan Rory
Published: March 2017

Purpose of review:

The purpose of this review is to contribute to the Choosing Wisely Canada campaign and develop a list of 5 items for nephrology health care professionals and patients to re-evaluate based on evidence that they are overused or misused.

Sources of information:

A working group was formed from the Canadian Society of Nephrology (CSN) Clinical Practice Guidelines Committee. This working group sequentially used a multistage Delphi method, a survey of CSN members, a modified Delphi process, and a comprehensive literature review to determine 10 candidate items representing potentially ineffective care in nephrology. An in-person vote by CSN members at their Annual General Meeting was used to rank each item based on their relevance to and potential impact on patients with kidney disease to derive the final 5 items on the list.

Key messages:

One hundred thirty-four of 609 (22%) CSN members responded to the survey, from which the CSN working group identified 10 candidate-misused items. Sixty-five CSN members voted on the ranking of these items. The top 5 recommendations selected for the final list were (1) do not initiate erythropoiesis-stimulating agents in patients with chronic kidney disease (CKD) with hemoglobin levels greater than or equal to 100 g/L without symptoms of anemia; (2) do not prescribe nonsteroidal anti-inflammatory drugs for individuals with hypertension or heart failure or CKD of all causes, including diabetes; (3) do not prescribe angiotensin-converting-enzyme inhibitors in combination with angiotensin II receptor blockers for the treatment of hypertension, diabetic nephropathy or heart failure; (4) do not initiate chronic dialysis without ensuring a shared decision-making process between patients, their families, and their nephrology health care team; and (5) do not initiate dialysis in outpatients with CKD category G5-ND in the absence of clinical indications.

Limitations:

A low survey response rate of both community and academic nephrologists could contribute to sampling bias. However, the purpose of this report is to generate discussion, rather than study practice variation.

Implications:

These 5 evidence-based recommendations aim to improve outcomes and individualize care for patients with kidney disease, while reducing inefficiencies and preventing harm.
The effect of oral tranexamic acid administration on blood loss and hospital costs in patients undergoing total knee arthroplasty
Authors: Akman Budak , Aksu Burak Çağrı , Uluçay Çağatay , Kılınçoğlu Volkan , Özler Turhan , Altıntaş Faik
Published: March 2017

Aim:

Total knee arthroplasty is a kind of major orthopaedic operation that may go with serious amount of peroperative blood loss. Tranexamic acid administration (an antifibrinolytic agent) is one of the most common strategy among the various blood preserving strategies used in major surgeries associated with high volume blood loss. The aim of this study is to evaluate effectiveness of oral tranexamic acid in reducing blood loss and blood transfusion in total knee arthroplasty procedures. In addition hospital costs were also compared.

Materials-Methods:

Between 2013-2016, 256 total knee arthroplasty procedure performed by six different staff surgeons in our clinic. 125 patients appropriate for our study criteria were included in our study and retrospectively evaluated. 49 patients in study group were administered 15 mg/kg tranexamic intravenous infusion before relasing intraoperative tourniquet and continued as oral 500 mg tranexamic acid three times with 6 hours interval in the first postoperative 24 hours.76 patients were not administered tranexamic acid and compromised the control group. Information on pateints’s demographics, preoperative and postoperative 24th hour hemoglobin and hematocrit values, postoperative 24th hour drain volumes and blood transfusions were obtained from patient files retrospectively.

Results:

Postoperative 24th hour drain volumes were significiantly less in tranexamic acid administered group (283 130 cc) than that of control group (383 135 cc) (p<0,001). Decrease in hemoglobin and hematocrit values in the postoperative 24th hour were significiantly less in study group (1,73 g/dL-%6,13) than those of control group (2,92 g/dL -%8,63) (P<0,001). Both number of total erythrocyte suspensions (ES) transfused and number of patients transfused were higher in control group than those of study group. (52 ES and 45 patients versus 18 ES and 14 patients) Calculated average ES per patient were 0.37 in study group and 0.68 in control group. (P=0,009). As a result blood bank costs were reduced %50 in study group as compared to control group.

Conclusions:

Tranexamic acid administered as single intraoperative intravenous dose and sequentially continued as 500 mg oral dosage 3 times with six hours interval in the first postoperatve24 hours is a significiantly effective approach in preventing bloos loss and reducing hospital costs in total knee arthroplasty procedures. In addition easiness and convinience of oral administration of tranexamic acid makes the approach more advantageous.
The prevalance of femoroacetabular impingement findings on radiological survey of the emergeny service patients with trauma
Authors: Polat Gökhan , Şahin Koray , Arzu Ufuk , Aşık Mehmet
Published: March 2017

Femoroacetabular impingemet (FAI) is a disease causing hip pain in young-adult population and can be diagnosed frequently on asymptomatic stage. The European studies on this subject show that 20-25% of the population actually has asymptomatic FAI. Actually, there is no study in Turkey on this topic. The purpose of our study is to determine the prevalance of FAI on the X-rays of the patients who applied to the emergency service with trauma.

Materials-Methods:

Patients applied between September 2015 and January 2016 aged 18-65 and who has pelvis AP and frog leg X-rays were included. Pelvic graphs on which both iliac crests and proximal femurs are seen, the X-ray tube is centralised to the symphysis pubis and the obturator foramens are symmetrical were included. The graphs with fractures or ligamentous injuries affecting the pelvic ring, fractures on long bones of the lower limbs, arthrosis on coxofemoral joint and findings of previous pelvic and hip surgery were excluded. Totally 3487 patients were evaluated and 528 of them were included. Alpha, lateral central edge (LCE), Tönnis and collodiaphyseal angle were measured. The morphological anomalies (FAI, dysplasia) were noted. The measured alpha angle value above 55° graphs were accepted as CAM type; Tönnis angle below 4° angle or LCE angle above 39° were accepted as Pincer type impingement. The graphs with LCE angle below 25° or with Tönnis angle above 10° were considered as dysplasia.

Results:

The average age of the 528 included patients was 43,38. 323 were female and 205 were male. We determined 15,5% CAM, 11,1% Pincer and 4,7% combined type FAI in these 528 patients.The ratios were noted in female group, 4,6% CAM, 13,3% Pincer and 1,5% combined type; in male group 32,7% CAM, 7,8% Pincer 9,8% combined type. Average alpha angle on pelvis AP graphs was 48,9° on right and 47,8° on left side. Average alpha angle on pelvis frog leg graphs was 51,7° on right, 49,8° on left side. Average LCE angle was 32,9° on right and 34,7° on left side. Average Tönnis angle was 6,7° for right and 5,8° for left side. SPSS.21 were used to analyse the data.

Discussion:

FAI can be seen in population asymptomatically with a seriously high rates. In our study, we evaluated the asypmtomatic patients with trauma applying to the emergency service and we found radiological FAI findings rate 19,5% in females and 50,2% in males.
A novel technique in repair of radial meniscus tear
Authors: Aşcı Murat , Kurnaz Recep , Balta Orhan , Güneş Taner
Published: March 2017

Introduction:

Radial meniscus tears are seen in young patients, especially with anterior cruciate ligament ruptures. Repair of complet radial meniscus tear is necessary for the meniscus functions. The most important factor for success of the meniscus repair is primary stability, but it is still unknown which technique is ideal repair technique.

Aim:

We developed a new suture technique named Cross Horizontal Loop(CHL). In this novel technique the contact between meniscal tissue and suture is more than Horizontal Loop(HL) that routinely used today. So, we think that this technique will provide better fixation than HL. We aimed to compare 2 repair techniques (CHL vs. HL) using human lateral menisci biomechanically with cyclic loading and load to failure tests

Materials-Methods:

We used 20 intact lateral meniscus obtained from patients that operated (total knee replacement) for varus gonarthrosis in our clinic. All menisci were cut radially. In the first group (n:10) menisci were repaired with standart horizontal loop technique, and in the second group (n:10) cross horizontal loop technique were used for repair. All specimens were tested with load to failure test after cyclic loading test (500 cyclus X 5-30 N).

Results:

Both groups have similar failure load (71,4±17,52 N vs. 77,9±28,49 N; p:0,559) and stiffness (24,46±19,19 N vs. 24,48±15,87 N; p:0,818). CHL group has less peak displacement (6,26±1,24 mm vs. 8,4±1,92 mm; p:0,010).

Conclusions:

This novel repair technique decreases the amount of displacement according to standard technique while as strong as standart technique routinely used. In this way; we believe that it will increase the rate of healing in clinical use. [Table: see text][Figure: see text]
The Gracilis-Semitendinosus Indeks
Authors: Sever Gokhan Bulent , Budeyri Aydin , Cankus Mehmet Cenk , Bostanci Levent
Published: March 2017

Aim:

According to the ethnic demographical backgrounds, gracilis(G), and semitendinosus(ST) tendon antropometric properties may vary among the individuals of Turkish and active sporter patient populations. In this study, aimed was to define the G and ST tendon proportional anatomical corellations intraoperatively prior to graft harvesting that are uniquely specific to the Turkish ethnicity.

Materials-Methods:

The study was begun with 50 active sporting patients who were undergone arthroscopic graft anterior cruciate ligament hamstring tendon reconstruction(aACLHTR) in 2013-2014 at our institution. 15 patients were excluded due to premature graft ruptures, and not meeting the minimum of 4hrs/w active sporting criteria. This retrospective cohort was conducted with a total of 35 knees. Inclusion criteria were; Turkish ethnicity, having been undergone aACLHTR between 2013-2014, having been at an age of 16-50 years, having eligible intraoperative antropometric records, having consistent postoperative follow-ups, having been diagnosed to have complete ACL tear, having no ipsilateral/contralateral, congenital/acquired limb deformities or trauma, surgery or lymphedema history. Exclusion criteria were unwillingness to give written consent, having been a premature graft rupture during harvesting, having insufficient data recordings to meet the eligibility criteria. All the surgeries were performed by one senior surgeon who was blind to the study. All the demographical data, and measurements were recorded by a research assistant who was blind to the study. Pearson correlation coefficients were calculated to detect linear relationship between numerical variables. Beta coefficients were estimated by univariate linear regression analysis. All analysis were performed by using SPSS for windows version 22.0 considering the P<0.05 as statistically significant.

Results:

Mean age 29.9±8.3, Female/Male ratio %8.6/91.4, Right/Left ratio %68.6/31.4, Mean BMI 27.2±4.5, Mean limb length 87.8±6.4 Mean ST length 26.8±2.1, Mean G length 24.06±2.2, Mean ST thickness 6mm±0.9, Mean G thickness 4.5±0.8. ST-G thickness, and ST-G length correlations were r=0.754, p=0.001, r=0.614, p=0.001 respectively. Univariate linear regression analysis revealed statistically significant relationships; 56.8% of variation in G thickness was explained by ST. 1 mm increase in ST thickness resulted in 0.68 mm increase in G thickness, and 37.7% of variation in G length was explained by ST. 1 mm increase in ST length resulted in 0.68 mm increase in G length.

Conclusions:

With the ST-G index, surgeons would be intraoperatively able to template aACLHTR with a more durable, and adequate planning of hamstring graft construct combination unique to sporters’ demographic specifics, and to sports’ biomechanical specifics. Thus, the possiblity of antropometrically inadequate graft combinations would be precautioned. [Figure: see text]
Anatomıc femoral tunnel drilling in acl reconstruction without using of an accessory medial portal and evaluation of femoral tunnel positioning using 3-d computed tomography
Authors: Karaaslan Fatih , Karaoğlu Sinan
Published: March 2017

Background and Purpose:

Characterization of the insertion site anatomy in anterior cruciate ligament reconstruction has recently received increased attention in the literature, coinciding with a growing interest in anatomic reconstruction. The purpose of this study is to report a modified novel transportal technique to approach the center of anatomical femoral footprint in anterior cruciate ligament (ACL) reconstruction and to investigate the accurate femoral tunnel position with 3-dimensional computed tomography (3D-CT). Materials-Methods: We evaluated 11 patients who underwent primary ACL reconstruction using a modified transportal technique to approach the center of anatomical femoral footprint in single bundle ACL reconstruction with hamstring autograft. Their femoral tunnel positions were investigated with 3D-CT postoperatively according to the quadrant method by three orthopedic surgeons.

Results:

According to the quadrant method with 3D-CT, the femoral tunnel was measured at a mean of 33,49% ± 5,59% from the proximal condylar surface (parallel to the Blumensaat line) and 32,93% ± 3,82% from the notch roof (perpendicular to the Blumensaat line) with good interobserver (intraclass correlation coefficients [ICC], 0,991and 0,858, respectively with 0,975 – 0,997%95 CI) and intraobserver reliability (ICC, 0.875 and 0.893, respectively with 0,663 – 0,956%95 CI).

Conclusions:

Our modified transportal technique is anticipated to provide anatomical placement of the femoral tunnel during ACL reconstruction than the former traditional transtibial techniques. This technique is reproducible and also easier to perform than classic transportal technique does not need extra arthroscopic portal. [Figure: see text]
A novel Medial Patellofemoral Ligament Reconstruction Technique; Preliminary Clinical Results
Authors: Sezer Hasan Basri , Armağan Raffi , Kanar Muharrem , Eren Osman Tuğrul
Published: March 2017

Medial Patellofemoral ligament(MPFL) is the main passive stabilizer of the patellofemoral joint. MPFL is injured in the 2/3 rds of the patients after patella luxation. In this study we present a novel aproach to the anatomical MPFL reconstruction and preliminary results of the technique. We operated 7 patients(4 female and female and 3 male) who applied to our clinic after a patella luxation episode. The mean age was 27,1 years(16-42). The mean follow up time was 23,5 months(24-35). We evaluated the patients clinically and radiologically for concommitant pathologies. 1 patient had patellar cartilage demage and patella alta, 1 patient had medial collateral ligament rupture, 1 patient had lateral collateral ligament and anterior cruciate ligament rupture and these pathologies were treated as well. The operation was done in the supine position on a radiolucent table and under the image intensifier control. The semitendinosus autograft was prepared. The femoral tunnel was drilled and double strand graft was introduced in the femoral tunnel and secured with ToggleLoc femoral fixation device(Biomet). The graft was advanced over the facia to the patellar side and passed through the 2 patellar tunnels and tied to each other. After exercising the knee the graft tension was rechecked at 30 degrees of knee flexion. Early postoperatively range of motion and quadriceps strenghtening exercises were carried out and patients were allowed to bear weight. All of the patients had full range of motion and free of pain. Postoperative x-ray and MRI examinations revealed the correction of patellar tilt and lateral shift of the patella in all patients. The only complication was a fissure of patella in 1 patient in the 6th week of rehabilitation due to anteriorly located patellar tunnel and heavy exercise. We immobilsed the patient in a brace and the patient returned to rehabilitation after 6 weeks when the fissure healed. All the patients returned to the previous functional level. Our anatomical MPFL technique uses ToggleLoc for the femoral side but implant free at the patellar side. The technique provided excellent preliminiary result in all of the patients. The technique allows graft retensioning again and again from both the femoral and the patellar side. The double bundle reconstruction seems to immitate the natural behaviour of the MPFL. However patellar tunnels carry a substantial risk of patella fracture and must be placed with great attention.
Efficacy of Bone Marrow-Stimulating Technique in Rotator Cuff Repair
Authors: Bilsel İsmail Kerem , Yıldız Fatih , Kapıcıoglu Mehmet , Uzer Gokcer , Elmadag Mehmet , Pulatkan Mehmet Anil , Esrefoglu Mukaddes , Bozdag Ergun , Milano Guiseppe
Published: March 2017

Background:

This study investigates the effect of microfracture as a bone marrow-stimulating(BMS) technique on rotatory cuff(RC) healing using a chronic RC tear model.

Methods:

Chronic retracted RC tendon tear model was created in the subscapularis(SSC) tendons of 20 New Zealand rabbits, bilaterally. The tendons were repaired after eight weeks using a single-row configuration with suture anchors. In right shoulders, tendons were repaired in a standard fashion(control group). In left shoulders, microfractures were performed on the SSC footprint before repair(microfracture group). The animals were sacrificed 8 and 16 weeks after repair. The repaired tendons were tested biomechanically for their ultimate failure load, linear stiffness and elongation at failure. Gross and histological evaluation of the tendon-to-bone healing was evaluated.

Results:

In every sample, the SSC tendon was attached to its footprint on the lesser tuberosity. In microfracture group, collagen fibers were organized in relatively ticker bundles at both time intervals. The mean ultimate failure load of microfracture was significantly greater than that of control group at 8 (148.4+31 N vs. 101.4+26 N; p=0.011) and 16 (155+30 N vs. 114.9+25 N; p=0.017) weeks after repair, respectively. There were no significant differences between the two groups at each time interval for linear stiffness (15.9+2.7N/mm vs. 15.8+1.3N/mm, p=0.798 and 16.9+4.3N/mm vs. 17.1+3.6N/mm, p=0.848, respectively) and elongation at failure (4.7+1.1 mm vs. 4.7+1.3 mm, p=0.848 and 4.8+1.5 mm vs. 4.9+0.9 mm, p=0.749, respectively).

Conclusions:

The BMS technique of microfracture on the tuberosity of the repaired chronic rotator cuff tear promotes the dynamic tendon healing with significant ultimate force to failure and apparent microscopic findings.
Increasing number of small hole diameter microfracture compared with traditional microfracture in same size cartilage defects and effect of HA based aselluler scaffold. An animal study
Authors: Uzer Gökçer , Elmadağ Nuh Mehmet , Yıldız Fatih , Güzel Yunus , Tok Olgu Enis
Published: March 2017

Purpose:

The purpose of this study is small hole microfracure method comparing with traditional microfracture method and investigation of effect of HA based acellular matrix scaffold on microfracture area.

Materials-Methods:

21 Twenty-one New Zealand white rabbits were used for the in vitro portion of this study, bilateral knee joint from the same rabbit were same technic. An articular cartilage defect was established in the femoral trochlear groove about 5 mm. Control group was established alone microfracture (MF). 6 groups were formed in this study and each group has 3 rabbits and their six knees. In 3 groups were applied different number of small diameter hole microfracture (4,5,6 small holes microfracture respectively)and the other 3 groups were applied different number of small diameter hole microfracture (4,5,6 small holes micro fracture respectively added HA based acellular matrix scaffold in the same size ostechondral lesion. The regenerated tissues were harvested for gross morphology, histology at 12 weeks postoperatively.

Results:

Cartilage were regenerated, maintaining a constant thickness of cartilage. MF group has worse Wakitani scores than 6 small diameter holes mıcrofracture groups(group 6 and group 7) in either parameter of the score. (p=0,043, p=0,016) Matrix addition did not contribute to healing. (p=1,000)

Conclusions:

Increasing number of the small diameter holes microfracture (minimum %15 of defect size) improves cartilage repair compared with traditional MF in the same size ostechondral lesion. Also small diameter holes microfracture combined with HA-based AM implantation didn’t result in improved quality of the regenerated cartilage tissue.