bluuebunny/crossref_metadata_2025 huggingface dataset:
The Potential Diagnostic Accuracy of Let-7 Family for Cancer: A Meta-Analysis
Authors: Zhang Wen-Ting , Zhang Guo-Xun , Gao Shuai-Shuai
Published: July 2021

Background:

Cancer is a global public health problem affecting human health. Early stage of cancer diagnosis, when it is not too large and has not spread is important for successful treatment. Many researchers have proposed that the let-7 microRNA family can be used as a biomarker for cancer diagnosis. The aim of this meta-analysis is to evaluate whether let-7 family can be used as a diagnostic tool for cancer patients.

Methods:

We conducted a comprehensive literature search on PubMed, EMBASE, Web of Science, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (CNKI) and Wanfang database, updated to October 23, 2020. A random effects model was used to pool the sensitivity and specificity. Besides, we measured the diagnostic value using positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) were pooled. In addition, meta-regression and subgroup analysis were performed to explore the possible sources of heterogeneity, and Deeks’ funnel chart was used to assess whether there was publication bias.

Results:

31 studies from 15 articles were included in the current meta-analysis. The overall sensitivity, specificity, PLR, NLR, DOR and AUC were 0.80 (95% CI: 0.75-0.85), 0.81 (95% CI: 0.74-0.86), 4.2 (95% CI: 2.9-5.9), 0.24 (95% CI: 0.19-0.32), 17 (95% CI: 10-29) and 0.87 (95% CI: 0.84-0.90), respectively. Subgroup analysis shows that the let-7 family cluster of serum type showed a better diagnostic accuracy of cancer, especially the breast cancer. Although there is no publication bias, it still has some limitations.

Conclusions:

let-7 family can be considered as a promising non-invasive diagnostic biomarker for cancer.
Treating Alpelisib-Induced Hyperglycemia with Very Low Carbohydrate Diets and Sodium-Glucose Co-Transporter 2 Inhibitors: A Case Series
Authors: Blow Tahj , Hyde Parker N. , Falcone John N. , Neinstein Aaron , Vasan Neil , Chitkara Ritika , Hurd Maurice A. , Sardesai Sagar , Lustberg Maryam B. , Flory James H. , Volek Jeff S. , Goncalves Marcus D.
Published: July 2021

Alpelisib is a α-selective phosphatidylinositol 3-kinase (PI3K) inhibitor approved for treatment of postmenopausal women, and men, with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2–), PIK3CA-mutated, advanced breast cancer (ABC). Hyperglycemia is a common, on-target adverse effect that impairs treatment efficacy and increases the rate of treatment delays, dose reductions, and discontinuation. Currently, there are no clear guidelines on how to manage hyperglycemia due to alpelisib when metformin is not effective. In this case series, we review 3 subjects with ABC that developed hyperglycemia during alpelisib-fulvestrant therapy and were successfully managed with dietary and pharmacologic interventions. These cases provide anecdotal evidence to support the use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and very low carbohydrate diets to minimize hyperglycemia during alpelisib therapy.
Influence of pedal arch quality on 5-year survival and limb salvage in patients with diabetic foot ulcers undergoing peripheral angiography
Authors: Troisi Nicola , Guidotti Azzurra , Turini Filippo , Lombardi Renzo , Falciani Francesca , Baggiore Cristiana , Michelagnoli Stefano , Chisci Emiliano
Published: July 2021

Introduction

The aim of this study was to evaluate the influence of pedal arch quality on 5-year survival and limb salvage in diabetic patients with foot wounds undergoing peripheral angiography.

Methods

Between January 2014 and December 2014, 153 diabetic patients with foot wounds underwent peripheral angiography. Final foot angiograms were used to allocate patients according to pedal arch: complete pedal arch (CPA), incomplete pedal arch (IPA), and absent pedal arch (APA). Five-year survival and limb salvage rates were analyzed with Kaplan–Meier curves and compared by means of Gehan–Breslow–Wilcoxon test. Associations of patient and procedure variables with overall survival and limb salvage outcomes were sought with univariate and multivariate analyses.

Results

A below-the-knee (BTK) artery was the target vessel in 80 cases (52.3%). Five-year Kaplan–Meier rates of survival were similar in all groups ( p = 0.1): CPA 30%, IPA 27.5%, and APA 26.4%. Five-year limb salvage rates were significantly better in patients with CPA/IPA ( p < 0.001): CPA 95.1%, IPA 94.3%, and APA 67.3%. In the whole population study, multivariate analysis showed significant association of smoking ( p = 0.01), chronic renal failure ( p = 0.02), and severity of foot wounds ( p < 0.001) with survival. Coronary artery disease ( p = 0.03), severity of foot wounds ( p = 0.001), and pedal arch status ( p = 0.05) showed strong association with limb salvage.

Conclusions

Pedal arch quality significantly affected limb salvage but not survival at 5 years in patients with diabetic foot ulcers. Smoking, chronic renal failure, and severity of foot wounds affected overall survival, whilst coronary artery disease, and severity of foot wounds limb salvage.
Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis
Authors: Bi Guoshan , Wang Quanwen , Xiong Guozuo , Chen Jie , Luo Dongyang , Deng Jiangbei , Qin Xiao
Published: July 2021

Objective

The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs).

Methods

We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay.

Results

Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = −39.04; p = .002) and the length of hospital stay (MD = −0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14–0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding.

Conclusion

Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.
The dead and the abhorred: Mindhunter and the persistence of mother-blame
Authors: Byers Michele , Collins Rachael
Published: July 2021

In her study of violent protagonists in American literature, Wilson-Scott argues that “mothers are frequently used as the principle traumatizing factor, demonized and depersonalized in order to reassert their violent offspring’s humanity” (p. 191). Further, Wilson-Scott states that her work “reveals the persistent assumption that mothers make monsters” (p. 193). Taking our tacit agreement with Wilson-Scott as a starting point, we argue along with her that mother-blame remains a central motif of mainstream cultural narratives about violent masculinity. The focus of this essay is on the strategies through which mother-blame is used to validate the authorial authenticity of the male serial killer and his ways of knowing and of being in the world. In this essay we offer the first season of the popular Netflix series Mindhunter (2017–) as a case study and ask how the representation of the serial killer’s insight and seemingly accurate understanding of his own pathology is linked to its antithesis, woman-hate, and often, the pathologizing of the mother.
The influence of possession status on the physical output of male international hockey players
Authors: Cunniffe Eoin , Connor Mark , Beato Marco , Grainger Adam , McConnell Walter , McCarthy Persson Ulrik , Delahunt Eamonn , Boreham Colin , Blake Catherine
Published: July 2021

The aims of this investigation were to describe the physical output of hockey relative to possession status, and to identify differences in physical output during each possession category with respect of match result. Ten international matches were analysed utilizing Sportscode to identify in and not in possession instances. 24 players (age 26 ± 4) wore a 10 Hz GPS device to track physical output. Linear Mixed Models and post hoc pairwise comparisons were utilised to compare the physical output in each possession category within each position and relative to match result. Significant main effects were found for possession status on several physical output metrics (p ≤ 0.05). For all positions except forwards, not in possession instances were more physically demanding than in possession instances for metrics such as relative total distance, explosive distance, and high-speed running (>5.5 m.s−1). No significant difference was identified between possession category physical output aligned with match result (p > 0.05). This study shows for the first time that not in possession instances were more physically demanding than in possession instances for defenders, outside backs and midfielders. For not in possession instances, relative total distance and high-speed running was, on average, 13% and 41% higher compared to in possession instances. Furthermore, there was no statistical difference in physical output for any position during each possession category relative to the match result.
Improving hand function after spinal cord injury
Authors: Fridén Jan , House James , Keith Michael , Schibli Silvia , van Zyl Natasha
Published: July 2021

Nerve transfer surgery has expanded reconstructive options for restoring upper extremity function following spinal cord injury. By adding new motor donors to the pool already available through tendon transfers, the effectiveness of treatment should improve. Planning which procedures and in which order to perform, along with their details must be delineated. To meet these demands, refined diagnostics are needed, along with awareness of the remaining challenges to restore intrinsic muscle function and to address spasticity and its consequences. This article summaries recent advances in surgical reanimation of upper extremity motor control, together with an overview of the development of neuro-prosthetic and neuromodulation techniques to modify recovery or substitute for functional losses after spinal cord injuries.
Girls and activism in a neoliberal time: How teen girls from Toronto negotiate care, activism, and extraordinary girlhood
Authors: Benigno Tina Belinda
Published: July 2021

Recently, a number of prominent teen girl activist leaders have been gaining the world’s attention, but how do girls not in the public eye and with less social power think about activism? Moreover, how do girls who may not exclusively define themselves as activists, negotiate their own desire to contribute to social change with challenges they identify as holding them back from doing so? Through qualitative research with eight teenage girls in Toronto, I explore the ways these teen girls define the “activist,” their role in activism, and the challenges holding them back from being more active. My methodology is congruent, reflecting my feminist and youth studies commitment to girls leading research, and my findings indicate that such an approach is crucial in order to truly understand how girls with less social power and public visibility experience the world and their roles within it. Doing so also challenge pre-conceived notions and standards of extraordinary girlhood. The findings coincide with what Catherine Rottenberg refers to as neoliberal feminism. The extraordinariness implicit in visible activism framed the girls from my study’s views on what it would take to be a true activist themselves, which was both intimidating and also at times is in contention with their monumental care and concern for loved ones.
Treatment-emergent adverse events occurring early in the treatment course of cladribine tablets in two phase 3 trials in multiple sclerosis
Authors: Oh Jiwon , Walker Bryan , Giovannoni Gavin , Jack Dominic , Dangond Fernando , Nolting Axel , Aldridge Julie , Lebson Lori A , Leist Thomas P
Published: July 2021

Background

Treatment-emergent adverse events (TEAEs) that occur close to treatment initiation may negatively affect overall tolerability and adherence. It is important to develop a clear understanding of potential early TEAEs after initiating treatment with cladribine tablets.

Objective

To identify TEAEs that begin early in the course of treatment in patients enrolled in CLARITY and ORACLE-MS studies.

Methods

This post hoc analysis of CLARITY and ORACLE-MS safety populations assessed the incidence of TEAEs, serious TEAEs, drug-related TEAEs, and TEAEs leading to discontinuation in patients receiving cladribine tablets or placebo within 2, 6, and 12 weeks after treatment initiation.

Results

By Week 12, 61.3% of patients treated with cladribine tablets 3.5 mg/kg and 55.2% treated with placebo experienced a TEAE. More patients receiving cladribine tablets versus placebo experienced a drug-related TEAE by Week 12 (34.7% vs. 23.2%). The most common TEAEs reported with cladribine tablets were: headache (7.2%), lymphopenia (6.8%), and nausea (6.0%). Patients receiving cladribine tablets and placebo reported similar proportions of serious TEAEs (2.2% vs. 1.7%) and TEAEs leading to treatment discontinuation (1.6% vs. 1.4%).

Conclusion

Cladribine tablets were well tolerated during the first 12 weeks as evidenced by a low incidence of TEAEs leading to treatment discontinuation.
A retrospective analysis of changes in lymphocyte levels in patients with multiple sclerosis during and after Tecfidera® treatment
Authors: Baeva Maria-Elizabeth , Baev Philip Boris , Nelson Jill , Kazimirchik Anna , Vorobeychik Galina
Published: July 2021

Background

There are currently no best practice recommendations for lymphocyte subset monitoring for patients with multiple sclerosis (pwMS) on disease-modifying therapies including Tecfidera® (dimethyl fumarate, DMF). However, there have been several cases of pwMS on DMF without severe lymphopenia who had high CD4:CD8 T cell ratios and went on to develop progressive multifocal leukoencephalopathy.

Objective

Our objective was to characterize the changes in immune profile during and after DMF treatment in pwMS.

Methods

A retrospective analysis of longitudinal data from 299 pwMS who have been treated with DMF at the Fraser Health Multiple Sclerosis Clinic in British Columbia, Canada. The blood test results were taken from January 1, 2013 to April 1, 2020.

Results

Our results suggest that CD8+ T cells had the highest proportional decrease compared to other lymphocyte subset populations and overall lymphocyte count in response to DMF treatment. CD56+ Natural Killer cells were similarly decreased in response to DMF treatment. CD4:CD8 T cell ratio was the measurement that had the highest rate of change in response to DMF initiation and discontinuation.

Conclusion

CD8+ T cell count and CD4:CD8 T cell ratio may be a more sensitive measurement of the immune landscape of patients with MS on DMF.
Integrating virtual reality in qualitative research methods: Making a case for the VR-assisted interview
Authors: Mathysen Dennis , Glorieux Ignace
Published: July 2021

Virtual reality (VR) is still very much a niche technology despite its increasing popularity since recent years. VR has now reached a point where it can offer photorealistic experiences, while also being consumer-friendly and affordable. However, so far only a very limited amount of software has been developed for the specific purpose of conducting (social science) research. In this article, we illustrate that integrating virtual reality to good effect in social science research does not necessarily require specialized hardware or software, an abundance of expertise regarding VR-technology or even a large budget. We do this by discussing our use of a method we have come to call ‘VR-assisted interviews’: conducting a (semi-structured) interview while respondents are confronted with a virtual environment viewed via a VR-headset. This method allows respondents to focus on what they are seeing and experiencing, instead of having them worry about how to operate a device and navigate an interface they are using for the first time. ‘VR-assisted interviews’ are very user-friendly for respondents but also limits options for interactiveness. We believe this method can be a valuable alternative, both because of methodological and practical considerations, for more complex applications of VR-technology in social science research.
Does College Education Promote Entrepreneurship Education in China?
Authors: Zhou Yilin , Li Hongbo , Shahzad Fakhar
Published: July 2021

The Higher Education Expansion (HEE) policy implemented by the Chinese government in 1999 provides an exceptional opportunity to study the impact of university and college education (graduates) on entrepreneurship in China using an econometric approach. The study applied secondary data from the National Bureau of Statistics of China (NBS) to examine the role of entrepreneurship education on Chinese entrepreneurship intentions from 2005 to 2019. The study used fully modified ordinary least squares (FMOLS) and ordinary least squares (OLS) to estimate the long-run association between the variables. The study further accounts for endogeneity using two-stage least squares (2SLS). The findings show that graduates (undergraduates, master’s, and postgraduates) positively influence entrepreneurship education. This means that people who have passed through the higher education system are likely to have taken a program or programs in entrepreneurship that motivate them to create new business. The acquisition of knowledge and skills about entrepreneurship seems to rise with graduates. Moreover, entrepreneurship education increases entrepreneurship intentions in China. However, human capital decreases entrepreneurship intentions. The government should leverage further the policy benefits and promote the passion of entrepreneurship education within colleges and universities.
Obesity and the Latissimus Dorsi Flap: A Radiologic Study
Authors: Choo Joshua H. , Vivace Bradley J. , Meredith Luke T. , Kachare Swapnil , Lee Thomas J. , Kachare Milind , Wilhelmi Bradon J.
Published: July 2021

Introduction: The increasing prevalence of obesity in patients with breast cancer has prompted a reappraisal of the role of the latissimus dorsi flap (LDF) in breast reconstruction. Although the reliability of this flap in obese patients is well-documented, it is unclear whether sufficient volume can be achieved through a purely autologous reconstruction (eg, extended harvest of the subfascial fat layer). Additionally, the traditional combined autologous and prosthetic approach (LDF + expander/implant) is subject to increased implant-related complication rates related to flap thickness in obese patients. The purpose of this study is to provide data on the thicknesses of the various components of the latissimus flap and discuss the implications for breast reconstruction in patients with increasing body mass index (BMI). Methods: Measurements of back thickness in the usual donor site area of an LDF were obtained in 518 patients undergoing prone computed tomography–guided lung biopsies. Thicknesses of the soft tissue overall and of individual layers (e.g., muscle, subfascial fat) were obtained. Patient, demographics including age, gender, and BMI were obtained. Results: A range of BMI from 15.7 to 65.7 was observed. In females, total back thickness (skin, fat, muscle) ranged from 0.6 to 9.4 cm. Every 1-point increase in BMI resulted in an increase of flap thickness by 1.11 mm (adjusted R 2 of 0.682, P < .001) and an increase in the thickness of the subfascial fat layer by 0.513 mm (adjusted R 2 of 0.553, P < .001). Mean total thicknesses for each weight category were 1.0, 1.7, 2.4, 3.0, 3.6, and 4.5 cm in underweight, normal weight, overweight, and class I, II, III obese individuals, respectively. The average contribution of the subfascial fat layer to flap thickness was 8.2 mm (32%) overall and 3.4 mm (21%), 6.7 mm (29%), 9.0 mm (30%), 11.1 mm (32%), and 15.6 mm (35%) in normal weight, overweight, class I, II, III obese individuals, respectively. Conclusion: The above findings demonstrate that the thickness of the LDF overall and of the subfascial layer closely correlated with BMI. The contribution of the subfascial layer to overall flap thickness tends to increase as a percentage of overall flap thickness with increasing BMI, which is favourable for extended LDF harvests. Because this layer cannot be separated from overall thickness on examination, these results are useful in estimating the amount of additional volume obtained from an extended latissimus harvest technique.
RISK FACTORS FOR FAILURE FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN A PEDIATRIC POPULATION: A NOVEL PREDICTION ALGORITHM
Authors: Lemme Nicholas J. , Yang Daniel S. , Barrow Brooke , O’Donnell Ryan , Daniels Alan , Cruz Aristides I.
Published: July 2021

Background:

Pediatric anterior cruciate ligament (ACL) reconstruction is becoming increasingly common, however, there is limited literature on the risk factors for failure in this demographic.

Hypothesis/Purpose:

In the present study we sought to: 1. To determine the rate of pediatric ACL reconstruction (ACLR) failure requiring revision surgery in a nationally representative sample. 2. To determine the associated patient/injury-specific risk factors for ACLR failure. 3. To examine the differences in the rate and risks of failure between pediatric and adult patients.

Methods:

Patient records were drawn from Humana individual health plans and Medicare medical records. Adult and pediatric patients who underwent primary ACLR and subsequent reoperation for either ACL revision surgery or a revision meniscal procedure between 2011-2016 were identified. Multivariate regression was used to determine the significant risk factors for ACL revision and overall reoperation rates in pediatric and adult patients. A risk algorithm was developed to predict the risk of ACL revision following pediatric ACL reconstruction.

Results:

Pediatric patients were significantly more likely to require ACL revision within one year (OR=1.97, 95%CI 1.57-2.45, p<0.0001) and five years (OR=3.22, 95%CI 2.77-3.72, p<0.0001) following their index ACLR compared to adults. Survivorship of the index ACL procedure was significantly decreased in pediatric patients (log-rank test p<0.0001) (Figure 1). Pediatric patients were also at higher risk of sustaining a contralateral ACL tear compared to adults (5.9% vs. 1.4%, respectively, p<0.0001). Meniscus injury was a risk factor for overall re-operation (OR=2.18, 95%CI 1.67-2.89 p<0.0001) as well as ACL revision (OR=2.28, 95%CI=1.66-3.21, p<0.0001) in the pediatric cohort. This increased risk was sustained despite the type of meniscal tear intervention, with patients undergoing concurrent meniscal repair (OR=1.84, 95%CI 1.43-2.38, p<0.0001) or meniscectomy (OR=2.20, 95%CI 1.72-2.82, p<0.0001) having a higher likelihood of requiring a revision ACLR. Concomitant MCL injury but not LCL injury was a risk factor for ACL revision in this cohort (OR=1.70, 95%CI 1.31-2.19, p<0.0001). Male sex and (OR=0.78, 95%CI 0.63-0.96, p=0.0204) and being >14 years old (OR=0.62, 95%CI 0.45-0.86, p=0.0035) was associated with a decreased risk of overall reoperation. The risk algorithm demonstrated the highest probability for ACLR failure in females, less than 15 years of age, with concomitant meniscus and MCL injury, demonstrating a 36% risk of failure (Table 1).

Conclusion:

Compared to adults, pediatric patients have an increased likelihood of ACL revision surgery, contralateral ACL tears, and meniscal reoperation within 5 years of an index ACLR. [Table: see text][Figure: see text]
RELIABILITY OF NOVEL ULTRASOUND MEASUREMENT FOR DETERMINING PATELLA POSITION
Authors: Greenberg Elliot , Rotunno Nicole , Brown Naomi
Published: July 2021

Background:

Patellar dislocations are common among youth athletes. A detailed understanding of patellofemoral anatomy is critical to determine patient prognosis and guide treatment and decision making. Recent literature suggests that measures of patella position relative to the trochlear groove may help identify individuals at risk of repetitive dislocations. While these measures were described using MRI, it is plausible that ultrasound imaging can be utilized to provide similar information in a more cost-effective and time-efficient manner.

Purpose:

To determine intra and inter-rater reliability of two newly described ultrasound-based measures of patella positioning within two novice examiners.

Methods:

Subjects were seated with the limb supported in full knee extension and neutral rotation. (Figure 1a) The examiners independently gathered all images and were blinded to each other’s measures for the duration of the study. The transducer was positioned transversely, on the anterior aspect of the knee such that the lateral trochlear ridge, center of trochlear groove, and proximal portion of the patellar tendon were all visible in cross-section. (Figure 1b) Two linear measures were obtained, representing the distance from midpoint of the patellar tendon to a) the center of trochlear groove (MPT-CTG) and b) the lateral trochlear ridge (MPT-LTR). Reliability was assessed using intraclass correlation coefficients (ICC). The average of two measures were used for data analysis. There was a minimum of 1 week between assessments for those subjects with repeated testing.

Results:

A total of 11 subjects (mean age 15.3) without history of knee pathology were included. There were no significant differences (p>0.05) in either measurement between limbs with MPT-CTG and MPT-LTR values (mean±sd) as follows: MPT-CTG right 8.4mm ± 3.0, left 8.4mm ± 3.3; MPT-LTR right 12.2mm ± 2.7, left 11.6mm ± 2.3. For reliability analysis, each knee served as a discrete variable, yielding a total of 22 data points for evaluation. Inter-rater reliability (n=22) was moderate to good for both measures, with ICC values of 0.724 and 0.814 for MPT-CTG and MPT-LTR, respectively. Intra-rater reliability (n=10) was good to excellent with ICC values of 0.913 and 0.794 for MPT-CTG and MPT-LTR, respectively. (Table 1)

Conclusions:

This new measure of patella positioning demonstrated moderate to excellent reliability and may be a practical, cost-effective alternative to MRI. While it is encouraging that the subjects in this sample demonstrated no side-to-side differences in either measure, future research should focus on establishing criterion validity and reliability amongst individuals with patellar instability. [Figure: see text][Table: see text]
ARE SEGOND FRACTURES OF THE TIBIA PATHOGNOMONIC FOR ACL TEARS IN THE PEDIATRIC AND ADOLESCENT POPULATION?
Authors: Kushare Indranil , Ghanta Ramesh Babu , Kastan Kristen , Stone Tracie , Wunderlich Nicole A. , McHorse Grant
Published: July 2021

Background:

Segond fractures (avulsion fractures of the proximal lateral tibia) are considered to be pathognomonic for anterior cruciate ligament (ACL) tears in adult patients.

Purpose:

To describe the largest case series of pediatric Segond fractures and associated intra-articular injuries of the knee to determine if these fractures are pathognomonic for ACL tears in young patients.

Methods:

IRB-approved retrospective study of patients under 20 years who presented with Segond fracture to a tertiary children’s hospital between 2009-2019. Demographics, clinical data, imaging features, associated injuries, and treatment information were collected.

Results:

55 patients (46 males, 9 females) with mean age 15.2 years (11.8-19.1) with Segond fractures of the proximal tibia on radiology imaging were identified (Fig.1.2). Diagnosis of associated injuries was established based on clinical examination, radiology report and findings during arthroscopy. Average Segond fracture size was 2.7 x 9.5mm as measured on standard knee radiographs. Magnetic resonance imaging (MRI) was obtained in 49/55(89%) patients. Associated injuries included anterior cruciate ligament (ACL) tears (39 patients, 70.9%), tibial eminence fractures (9, 16.4%), and all other injuries (7, 12.7%) (Table 1.1). Among Segond fractures found with ACL tears, 12 (30.8%) were contact injuries, 30 (76.9%) were sports injuries. In associated tibial spine fractures, 7 (78%) injuries were contact in nature and were sports related. When age was compared between the patient group with ACL tears (mean 15.7 years) to the ones with tibial spine fractures ( mean 13.9 years), there was a statistically significant difference(p=0.007). 12/55 (21.8%) had associated articular cartilaginous injuries, 3 of which required surgical intervention. 37/55 (67.3%) patients had meniscal injury. 3 (5.5%) patients suffered multi-ligament injuries. Overall, 87.2% of the patients required surgical management for associated intra-articular injuries of the knee.

Conclusion:

The Segond (tibial avulsion) fracture is associated with intra-articular injuries the pediatric population, most commonly ACL tears and meniscus tears. However, the largest case series in the pediatric population suggests that they are not pathognomonic for ACL tears as a notable proportion of patients, especially the ones who are younger in age, have tibial eminence fractures or no ACL tears. [Table: see text][Figure: see text]
DOES A CONTINUOUS PERIPHERAL NERVE BLOCK REDUCE HOME OPIOID USE IN CHILDREN AND ADOLESCENTS FOLLOWING ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION? THE ENVELOPE PLEASE.
Authors: Schlechter John A. , Harrah Tanner , Gornick Bryn , Sherman Benjamin
Published: July 2021

Background:

Anterior cruciate ligament reconstruction (ACLR) is commonly performed in youth athletes. Opioid misuse and addiction have reached alarming proportions.

Purpose:

To evaluate whether a continuous peripheral nerve block (CPNB) with placement of an elastomeric reservoir ball would decrease the need for home opioid analgesia when compared to a single-shot peripheral nerve block (SPNB) following ACLR in children and adolescents.

Methods:

A continuous cohort was analyzed via retrospective review of prospectively collected data following ACLR by a single surgeon. Group 1 had ACLR at our in-patient hospital and received a 72-hour CPNB. Group 2 had ACLR at our outpatient surgery centers and received a SPNB. Post-operative pain management included cryotherapy, oral acetaminophen and ibuprofen. A prescription for 10 doses of hydrocodone/acetaminophen (5/325mg) was provided in a sealed envelope with instructions to only be used for uncontrolled pain. On a three-day written log all children recorded their post-op Visual Analog Scale (VAS), amount of ibuprofen, acetaminophen and hydrocodone taken. Those reporting no narcotics needed to provide the unopened envelope and unfilled prescription. Hydrocodone utilization was converted to morphine milligram equivalents (MME). 1 mg hydrocodone = 1 MME. A state Controlled Substance Utilization Review and Evaluation System (CURES) inquiry was made on all participants in the peri-operative period. Demographic and operative data were collected. This study was powered to detect a difference of 20% in rate of narcotic consumption, should one exist, at beta=0.80, alpha<0.05. All analyses were performed using SPSS v. 26 with alpha set at p<0.05 to declare significance.

Results:

One hundred ninety-six patients were included in the study with an average age of 15 years (range 10-19y). 58 (30%) took hydrocodone/acetaminophen post ACLR, 39 female (67.2%) 19 male (32.8%). The CPNB group consumed 4.7 MME 95 % Confidence Interval (CI) 2.5-6.9 vs 6.5 MME 95 % CI 4.3-8.7 in the SPNB group (p=0.427) There were no significant differences in demographics, operative data or VAS scores. (Table).

Conclusion:

Home narcotic use can be negated in 70% of children and adolescents following ACLR regardless of duration of peripheral nerve block. In those requiring narcotics, the average utilization was only 1.3 pills of hydrocodone/acetaminophen with no child using more than 10 pills. The MME can be diminished with a CPNB however not significant enough to recommend routine use. We postulate the sealed envelope was as a barrier and psychological deterrent to filling the opioid prescription. [Table: see text]
ASSESSING THE ACCURACY, QUALITY, AND READABILITY OF ONLINE PATIENT RESOURCES ON TARSAL COALITION
Authors: Zhang Hui , Foster Brian K. , Seeley Mark A.
Published: July 2021

Background:

The internet is an inexpensive and convenient source for health information. However, without regulation, the quality and accuracy of the information is unknown. Tarsal coalition is a common cause of pediatric foot pain and disability.

Hypothesis/Purpose:

We hypothesized that the online patient information on tarsal coalition is of low accuracy, low quality, and of poor readability. Additionally, we hypothesized that sources found on the first search page were of higher quality, greater accuracy, and more readable.

Methods:

A cross-sectional review of the internet was performed using the term “tarsal coalition” on the 3 most popular search engines. Unique sites were categorized based on authorship and search result order. Websites were evaluated using a novel content score based on the AAOS OrthoInfo site on tarsal coalition (max score: 20), JAMA Benchmark and DISCERN scores for quality, and Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) for readability.

Results:

A total of 47 unique websites were evaluated. They ranged from professional organization/society websites to websites for individual practices and professional blogs. The average content score was 13.1 (range: 4-20). The average DISCERN score was 34.2 (range: 19-57.5). We did find a positive correlation between the content score and DISCERN scores of the included resources (p=0.04). The average 11.4 (range 8.5-15.5). Only 2 of the websites (4%) were written at or below an 8th grade reading level, which has been documented as the average reading level of the general population in the United States. Websites that were authored by physicians had greater DISCERN and readability scores compared to academic and private practice websites (DISCERN 40.4 vs 32.3 (p=0.001) and 31.7 (p=0.01), respectively, FKGL 13.0 vs 10.4 (p=0.002) and 11.1 (p=0.03), respectively, FRE 31.5 vs 48.7 (p=0.0001) and 45.2 (p=0.025), respectively). Finally, we noted that websites which appeared on the first page of the search engine results were not of higher quality than those that appeared on later pages (DISCERN 32.6 vs 39.8, p=0.002).

Conclusions:

Online patient resources on tarsal coalition are of low quality, inaccurate, and too complex for the average reader. Physician authored websites may serve as better resources compared to academic or private practice sites. Physicians should caution patients using the internet for information on tarsal coalition.
HEALTH OUTCOMES AMONG FORMER FEMALE COLLEGIATE GYMNASTS: THE INFLUENCE OF SPORT SPECIALIZATION, CONCUSSION, AND DISORDERED EATING
Authors: Sweeney Emily A , Howell David R , Seehusen Corrine N. , Tilley David , Casey Ellen
Published: July 2021

Background:

Over 1,500 collegiate gymnasts compete each year. Injury rates among these athletes are high, yet little is known about their long-term health outcomes.

Hypothesis/Purpose:

The purpose of our study was to describe health-related outcomes of former collegiate gymnasts and to evaluate how early sport specialization, concussion history, and disordered eating (DE) influence current health. We hypothesized that gymnasts who specialize early would report more injuries and would have worse physical health currently; that gymnasts who sustained concussions will be more likely to seek mental health treatment during their sport careers; and that gymnasts with DE would report more injuries.

Methods:

473 former female collegiate gymnasts completed a survey (Table 1) that was distributed through social media. Participants were grouped according to early (<14 years) or late (> or equal to 14 years) specialization, whether they sustained a concussion during gymnastics participation, and whether they reported a history of DE or not. We determined the number of participants who had time-loss injuries, menstrual dysfunction, reasons for retirement from sport, functional outcome measures, and whether participants had sought mental health care during college.

Results:

The median age of gymnastics specialization was 8 years [interquartile range=6-11 years]. A significantly greater proportion of early specializers sustained injuries requiring surgery (60% vs. 44%; p=0.02), however, the proportion of time-loss injuries sustained during college, reasons for retirement, and current pain and physical function scores did not significantly differ between the early and late specializers (Table 2). Forty-two percent of participants sustained a concussion. Those with a concussion were more likely to have sought mental health treatment during college (32% vs. 23%; p=0.03), and to have a diagnosis of anxiety disorder (16% vs. 9%; p=0.01) than those with no concussion history (Table 3). Thirty-four percent reported DE during college. Those in the DE group had an increased risk of osteoporosis during college (4% vs 0%; p=0.003), secondary amenorrhea (16% vs 9%; p=0.02), and had an increased risk of time-loss injury (78% vs 65%; p=0.004) (Table 4). In addition, they had worse PROMIS pain (11.5 vs 10.2; p=0.007) and physical function scores (12.2 vs 11; p=0.01) after college.

Conclusion:

It is important for clinicians, coaches, and gymnasts to be aware of the risks of early specialization, concussions, and DE, all of which are common in former collegiate gymnasts. Counseling regarding these risks and prevention strategies for these health problems should be a focus of further research. [Table: see text][Table: see text][Table: see text][Table: see text]
STRONGER THAN EVER! ADOLESCENT ATHLETES SHOW STRENGTH GAINS WITHIN THE UNINJURED LEG AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Greenberg Elliot , Bram Joshua , Ganley Theodore
Published: July 2021

Background:

The restoration of quadriceps strength after anterior cruciate ligament reconstruction (ACLR) is critical to restore optimal patient function and reduce the incidence of secondary ACL injury. Strength is typically quantified during return to sport assessments, by comparing the strength in the involved limb to that of the uninvolved limb. A limb symmetry index (LSI) is calculated and used to determine if any residual strength deficits persist. Recent evidence demonstrates that the uninvolved limb may lose strength during ACLR recovery and suggests that pre-operative uninvolved limb strength values may offer a better representation and more stringent indicator of strength recovery after ACLR. However, this body of literature is limited and no studies have specifically evaluated this occurrence within youth athletes.

Purpose:

To evaluate the change in strength in the uninvolved limb from pre-operative to 6 months post-ACLR, and assess the effect of pre-operative strength comparison on 6-month post-op LSI.

Methods:

A retrospective cohort analysis of pediatric patients (≤18 years) undergoing primary ACLR from 1/2018-1/2020 without concomitant multi-ligamentous reconstruction was conducted. Isokinetic peak torque values for the uninvolved and involved quadriceps were extracted at pre-operative (uninvolved only) and 6 months post-operative. Strength changes were analyzed using paired-samples t-test.

Results:

Complete data was available for a total of 17 subjects (mean age 15.1±1.7, 53% female). Pre-operative strength assessment was performed a mean of 11.5 days (range 1-26) prior to surgery. The mean 6-month post-operative assessment occurred at 177 days (range 127-246). The uninvolved limb was significantly stronger (p<0.001) at 6 months compared to preoperatively, with a mean improvement of 12.1ft/lbs (95%CI 18.3 – 7.2) with a change from 82.4ft/lbs to 95.1 ft/lbs. The LSI was calculated using both pre-operative and 6-month post-operative uninvolved limb values and demonstrated substantially lower LSI values when using concurrent 6-month data (LSIpre 91.3% vs LSI6M 76.9%).

Conclusions:

Among this sample, the uninvolved limb got stronger during post-ACLR recovery and comparison to concurrently assessed strength values led to a more stringent determination of LSI. Differences in rehabilitation programming, adolescent physiology, and pre-injury training patterns may explain why these results differ than those found in older cohorts.
Comparison of Anterior Cruciate Ligament Injury Rates In High School and Middle School Sports Over a 30-year Period
Authors: Rauh Mitchell J. , Schmitt Laura C. , Paterno Mark V.
Published: July 2021

Background:

Anterior cruciate ligament (ACL) injuries are a major concern in interscholastic sports. Comparison of ACL injuries between high school (HS) and middle school (MS) athletes over multiple years is limited.

Purpose:

To examine the incidence of ACL injury in HS female [HS-F] and male [HS-M], and MS female [MS-F] and male [MS-M] sports over a 30-year period.

Methods:

We studied 55,147 athletes who competed in interscholastic sports at a secondary school from 1988 to 2018. Data included ACL injuries incurred during interscholastic sports, and clinically confirmed by a physician. Injury rates per 100,000 AEs (practice and games where the athlete was at risk of ACL injury) were calculated for gender, sport, and contact status. Incidence rate ratios [RR] and 95% confidence intervals (CIs) were used to compare injury rates.

Results:

The incidence rate of ACL injury for HS athletes (4.15/100,000 AEs) was almost three times greater (RR=2.63, 95%CI: 1.7-4.2; p<0.0001) than the incidence rate for MS athletes (1.58/100,000 AEs). The risk of sustaining an ACL injury among HS-F athletes (4.26/100,000 AEs) was similar to HS-M athletes (4.06/100,000 AEs) (RR=1.05, 95%CI: 0.7-1.6; p=0.81). The risk of sustaining an ACL injury among MS-F athletes (1.06/100,000 AEs) was less than MS-M athletes (1.96/100,000 AEs) (RR=0.54, 95%CI: 0.2-1.4; p=0.21). While the risk of incurring an ACL injury occurrence was four times greater (RR=4.01, 95%CI: 1.7-9.4; p=0.0002) among HS-F athletes than MS-F athletes, the risk of ACL injury was twice as high (RR=2.08, 95%CI: 1.2-3.7; p=0.009) among HS-M athletes than MS-M athletes. ACL injuries were incurred in 15 HS sports and was greatest for HS-F basketball (25.5/100,000 AEs; p<0.001), HS-M football (20.6/100,000 AEs), and HS-F soccer (20.4/100,000 AEs). ACL injuries were sustained in 7 MS sports and was highest for MS-F softball (9.1/100,000 AEs), MS-M basketball (6.3/100,000 AEs) and MS-M football (5.0/100,000 AEs). The risk of contact-related ACL injury (1.73/100,000 AEs) was almost two times greater than non-contact-related ACL (0.96/100,000 AEs) (RR=1.80, 95%CI: 1.2-2.7; p<0.001). The rate of contact ACL injury was highest among HS-M (3.38/100,000 AEs) while the rate for noncontact ACL injury greatest among HS-F (2.44/100,000 AEs).

Conclusions:

The risk for ACL injury is higher in HS than in MS for both sexes. Non-contact ACL injuries were more likely to occur among HS-F athletes while contact injuries were highest for HS-M athletes, suggesting the effects of maturation and competition may play a role with increasing competition level.
NATIONWIDE ETHNIC/RACIAL DIFFERENCES IN SURGICAL TREATMENT OF DISCOID MENISCUS IN CHILDREN: A PHIS DATABASE STUDY
Authors: Milewski Matthew D. , Coene Ryan P. , McFarlane Kelly H. , Williams Kathryn A. , Feldman Lanna , Beck Jennifer J.
Published: July 2021

Background:

Discoid meniscus, a congenital meniscus variant, may have greater incidence in Asian populations. No United States population-based studies have examined the discoid meniscus ethnic/racial distribution.

Hypothesis/Purpose:

In pediatric patients undergoing meniscus surgery, we hypothesize that ethnic/racial variability exists in patients with discoid meniscus and this variability is different than in patients with isolated medial meniscus tears.

Methods:

The Pediatric Health Information System (PHIS) was queried from 48 hospitals to examine patients 18 years of age and younger between 2015 and 2019, using ICD-10 codes. A cohort of patients treated surgically for discoid meniscus was compared to a cohort of patients treated surgically for medial meniscal tear. These two populations were compared based on age, gender, ethnicity/race, CPT® code, insurance, urban vs rural, and region of country. Univariate testing and multivariable logistic modeling were used to test for associations.

Results:

A discoid meniscus cohort of 399 children (median age, 13.0 years) was compared to a medial meniscus tear cohort of 3157 children (median age, 16.0 years) (p<0.001) (Table 1). Hispanic/Latino children accounted for 36.8% of the discoid meniscus and 22.7% of the medial meniscus populations (p<0.001). Among pediatric patients that had surgery for discoid meniscus or medial meniscus, Hispanic/Latino children had 2.4 times the odds of surgery for discoid meniscus compared to white patients after adjusting for age and insurance (p<0.001) (Table 2). Asian children also had 2.4 times the odds of surgery for discoid meniscus compared to white patients (p=0.017).

Conclusion:

This study shows a significant association of ethnicity/race with discoid versus medial meniscus surgical treatment in children. Among pediatric patients that had surgery for discoid or medial meniscus, Hispanic/Latino and Asian patients were significantly more likely to have surgery for discoid meniscus than white patients. Hispanic/Latino children made up a greater percentage of the population having surgery for a discoid meniscus versus medial meniscus. When evaluating pediatric patients, younger age and Asian or Hispanic/Latino ethnicity should increase attention to the possibility of a discoid meniscus. [Table: see text][Table: see text]