bluuebunny/crossref_metadata_2025 huggingface dataset:
Poster 191: Suture Anchor-Based Quadriceps Tendon Repair Results in Improved Patient Reported Outcomes Compared to the Transosseous Tunnel Technique
Authors: Trasolini Nicholas , Walsh Justin , Darbandi Azad , Rice Richard , Forsythe Brian , Verma Nikhil , Cole Brian , Yanke Adam , Dandu Navya
Published: July 2022

Objectives:

Recent biomechanical studies have compared traditional transosseus (TO) quadriceps tendon repairs to newer techniques for suture anchor (SA) repair. However, clinical studies comparing the two techniques are limited. The purpose of this study was to compare failure rates and patient reported outcomes between TO and SA quadriceps tendon repairs.

Methods:

Following IRB approval, patients who underwent primary repair for quadriceps tendon rupture with transosseus tunnel (TO) or suture anchor (SA) techniques between January 2009 and August 2018 were identified from a prospectively maintained institutional database and retrospectively reviewed. Patients were contacted by email or telephone interview for satisfaction (1-10 scale), current function (1-100 scale), failure (retear), and revision surgeries; International Knee Documentation Committee score (IKDC), Knee Injury and Osteoarthritis Outcomes Score (KOOS), Lysholm questionnaire outcomes were also collected.

Results:

Seventy patients (92.1%) were available by phone or email at a mean of 4.64±2.53 years postoperatively (transosseus sutures: 34 and suture anchor: 42). Out of these 70 patients, there were 10 failures for an overall failure rate of 14.29% (Table 1). Failure rates were not significantly different between treatment groups (TO: 5/34, 14.71% vs SA: 5/42, 11.90%, p=.622) (Figure 1). Patients in each repair group had similar satisfaction ratings (SA: 9.17±1.95 vs TO: 8.31±2.30, p=.102). The SA group reported higher subjective function (SA: 89.08±8.40 vs TO: 76.14±23.52, p=.003) and significantly greater final IKDC scores (72.30 ± 22.08 vs 56.80 ± 16.62; p=.041).

Conclusions:

In conclusion, there is no significant difference in failure rate between transosseus and suture anchor repairs for quadriceps tendon ruptures at a mean of 4.64±2.53 years of follow-up. Most failures occur secondary to a traumatic reinjury within the first year post-operatively. Patients who underwent suture anchor repair reported significantly greater subjective function and final IKDC, KOOS Pain, and KOOS Quality of Life scores. [Figure: see text][Table: see text]
Poster 198: Risk of Injury During Proximal Hamstring Repair: Anatomy of the Posterior Femoral Cutaneous Nerve
Authors: Gould Heath , Dreese James , Remy Lindsay
Published: July 2022

Objectives:

Injury to the posterior femoral cutaneous nerve (PFCN) has been described after proximal hamstring repair and fixation of ischial tuberosity avulsion fractures. Variations in the location of the PFCN and its branches have not been described. The purpose of this study was to identify the location and number of branches of the PFCN in relation to the origin of the proximal hamstring tendons.

Methods:

Fifteen lower torso human cadaveric specimens were dissected in prone position. Skin and subcutaneous tissues were reflected to expose the gluteal and hamstring musculature. The distances between the ischial tuberosity and lateral border of the hamstring, PFCN, perineal branch of the PFCN, and descending femoral branch of the PFCN were measured with digital calipers. Measurements were repeated 3 times and averaged.

Results:

The PFCN was 30.5 ±11.4 mm lateral to the central tip of the ischial tuberosity (range, 15.7 to 52.0 mm). The average longitudinal distance from the tip of the ischial tuberosity to the point where the perineal branch crossed the hamstrings was 24.1 ±15.0 mm (range, 9.9 to 52.2 mm). The average longitudinal distance to the point where the descending cutaneous branch crossed the hamstrings was 83.3 ±21.3 mm (range, 41.3 to 110.3 mm). The PFCN was nearest to the inferior border of the gluteus maximus 45.8±13.6 mm lateral to the ischial tuberosity (range, 13.6 to 62.1 mm). Eleven specimens had one identifiable perineal branch; four had two distinct perineal branches.

Conclusions:

The PFCN was in close proximity to the surgical approach utilized during proximal hamstring repair, with the perineal branch consistently crossing the surgical field transversely. The location of these nerves varied substantially among the specimens tested, with some nerves positioned less than 1cm from the ischial tuberosity and some specimens having two perineal branches.
Poster 233: The Presence of a Jumping J-Sign is Driven Primarily by Trochlear Factors and not Patella Alta or TT-TG Distance
Authors: Hevesi Mario , Cregar William , Zavras Athan , Trasolini Nicholas , Yanke Adam , Dandu Navya
Published: July 2022

Objectives:

The J-sign is a commonly utilized physical exam measurement in the assessment of a patellar instability patient. A severe preoperative J-sign, classified as a “jumping J sign”, has demonstrated associations with poorer short-term postoperative outcomes, and a jumping quality may persist as a bothersome symptom even after successful stabilization. Successful surgical treatment requires an understanding of the anatomic drivers of the jumping quality of a J-sign. Therefore, the objective of this study is to determine the underlying anatomic factors which contribute to a jumping J-sign.

Methods:

All patients undergoing evaluation for patellar instability at a single institution between 2013-2021 with an available knee MRI were included. Patients with a prior history of knee surgery were excluded. The presence of a jumping J-sign and its relationship to patellofemoral measures including Caton Deschamps Index (CDI), trochlear dysplasia, tibial tubercle to trochlear groove distance (TT-TG), tibial tubercle lateralization, coronal mechanical axis, trochlear bump height, and knee rotation angle were recorded based on measurements using standardized 1.5T MRIs. Statistical analysis was performed in RStudio (software version 4.1.0, R Foundation for Statistical Computing, Vienna, Austria).

Results:

67 patients met inclusion criteria (42 female, 25 male, age: 20.3±8.2 years) and were evaluated. Thirteen patients (19%) demonstrated a jumping J-sign on physical exam. On univariate analysis, increasing CDI (Odds Ratio [OR] increase of 1.5 per 0.1 increase in CDI, p=0.048) and increasing trochlear bump height (1.7 OR increase per mm bump height) were significantly associated with a jumping J-sign. Additionally, a jumping J-sign was associated with the presence of Dejour A (Odds Ratio [OR]: 1.1, p=0.02) and Dejour B (OR: 2.4, p<0.01) but not Dejour C (p=0.14) or D (p>0.99) trochlear dysplasia. In contrast, TT-TG, tubercle lateralization, mechanical axis, and knee rotation angle were not significant drivers of a jumping J-sign (p³0.17). On multivariate analysis, Dejour A (OR: 1.25, p=0.04) and Dejour B (OR: 1.4, p<0.01) trochlear dysplasia as well as trochlear bump height (1.09 OR increase per mm bump height, p=0.01) were significantly associated with a jumping J-sign. Patella alta was not associated with a jumping J-sign after accounting for trochlear dysplasia and bump height (OR: 1.04, p=0.12).

Conclusions:

The presence of a jumping J-sign is determined by the interaction of trochlear dysplasia and bump height. While patients with increasing degrees of patella alta demonstrate an increased incidence of a jumping J-sign, this physical exam finding has a multifactorial etiology and is driven primarily by correlation with underlying trochlear factors including dysplasia.
Poster 239: Limb Malalignment Fails to Influence Clinical Outcomes of Meniscal Repair
Authors: Palumbo Reid , Cavendish Parker , Milliron Eric , Milliron Eric , Dibartola Alex , Duerr Robert , Magnussen Robert , Kaeding Christopher , Flanigan David , Swinehart Steven
Published: July 2022

Objectives:

Lower limb malalignment causes differences in tibiofemoral contact pressures and may influence outcomes following meniscal repair. Our objective was to evaluate clinical outcomes of meniscal repair in malaligned knees to determine if limb malalignment portends an inferior outcome. We hypothesized that medial meniscus repairs performed in varus knees and lateral meniscus repairs performed in valgus knees would result in poorer patient-reported outcomes when compared to a neutrally aligned knee.

Methods:

Patients who underwent meniscal repair at a single institution between 2006 and 2018 were identified by retrospective chart review. Patients between the ages of 18 and 65 with full-length weight bearing lower limb radiographs were included. Patients with varus alignment (> 3 degrees) and a medial meniscus repair, or valgus alignment (>3 degrees) and a lateral meniscus repair were considered “at-risk”. Outcomes were assessed through identification of additional surgery on the index meniscus and patient-reported outcome measures (PROMs): Knee Injury and Osteoarthritis Outcome Score (KOOS), Marx activity score, and International Knee Documentation Committee subjective score (IKDC). Failure rates and PROMs were compared between the at-risk and not at risk groups.

Results:

A total of 58 patients were included with a mean follow-up of 1.6 years. A total of 12 patients were classified as “at-risk”. Repeat surgery on the index meniscus was performed in 1 of 12 “at risk” patients (8.3%) and 7 of 46 (15.2%) in the “not at risk” group (p = 1.00). There were no significant differences between the two groups in KOOS subscales: pain (82.8 vs 85.6, p = 0.55), symptoms (78.2 vs 80.8, p = 0.64), ADLs (88.4 vs 92.9, p = 0.27), Sport/Rec Function (63.8 vs 69.2, p = 0.57), or QOL (58.9 vs 62.3, p = 0.69). There was also no difference in IKDC score (66.9 vs 72.5, p = 0.41) or Marx score (4.2 vs 5.0, p = 0.63) between the two groups.

Conclusions:

Pre-operative knee malalignment does not appear to negatively influence clinical outcomes of meniscal repair when compared to normal knee alignment. [Table: see text]
Poster 245: Periarticular Local Infiltrative Anesthesia after Anterior Cruciate Ligament Reconstruction: A Comparison to Regional Adductor Canal Block with Matched Sub-Analysis
Authors: Schaver Andrew , Glass Natalie , Duchman Kyle , Wolf Brian , Westermann Robert
Published: July 2022

Objectives:

There is a paucity of literature that directly compares postoperative pain control and hospital recovery after using periarticular local infiltrative anesthesia (LIA) or regional anesthesia with an adductor canal block (ACB) for ambulatory anterior cruciate ligament reconstruction (ACLR) surgery. Additional studies are needed to investigate the analgesic efficacy of both ACB and LIA in patients undergoing ACLR surgery with concomitant procedures. The purpose of this study is to compare postoperative pain and recovery after anterior cruciate ligament reconstruction (ACLR) in patients who received an adductor canal block (ACB) or periarticular local infiltrative anesthesia (LIA).

Methods:

Study Design: Retrospective comparison studyA retrospective review of a prospectively collected ACL registry was performed. Patients underwent ACLR at a single institution between January 2015 and September 2020 and received long-acting local anesthesia with a pre-operative ultrasound-guided ACB or peri-articular LIA after surgery. Visual Analog Scale (VAS) pain scores, milligram morphine equivalents (MME) consumed in the post-anesthesia care unit (PACU), and total hospital recovery time were compared. Univariate analysis was used to compare VAS pain and MME totals between overall groups and groups matched for age, sex, BMI, graft type, and meniscal treatment. A p-value < 0.05 indicated statistical significance.

Results:

There were 265 knees (253 patients) included (LIA, 157 knees; ACB, 108 knees). Overall, VAS pain scores before hospital discharge (LIA 2.6 ± 1.5 vs. ACB 2.4 ± 1.4, p=0.334) and total MMEs were similar (LIA 17.6 ± 7.6 vs. ACB 18.5 ± 6.7 (MME), p=0.134). Total time to discharge also did not significantly differ (LIA 137.5 (IQR:116-178) vs. ACB 147 (IQR:123-183) (min), p=0.118). Matched sub-analysis (LIA and ACB, n=94) did not reveal significant differences in VAS pain before discharge (LIA 2.4 ± 1.4 vs ACB: 2.7 ± 1.5, p=0.122) or total MMEs (LIA 18.6 ± 6.7 vs. ACB 17.9 ± 7.1, p=0.532).

Conclusions:

The use of ACB or LIA resulted in similar pain levels and opioid consumption during early recovery after ACLR surgery.
Poster 251: Autograft Associated with Lower Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction than Allograft: Results from a Large Integrated Healthcare System
Authors: Chang Richard , Royse Kathryn , Burfeind William , Ding David , Maletis Gregory , Heffner Michael
Published: July 2022

Objectives:

With the rising utilization of primary anterior cruciate ligament reconstruction (ACLR), the burden of revision ACLR (rACLR) has also increased. Graft choice for rACLR is complicated by patient factors and the remaining available graft options. This study examines the relationship between graft type at the time of rACLR and the risk of repeat rACLR (rrACLR).

Methods:

We conducted a cohort study from a US integrated healthcare system’s ACLR registry. The study population included patients with a primary isolated ACLR, between 2005-2020, who then went on to have an aseptic rACLR. Graft type used at revision surgery, classified as autograft versus allograft, was the exposure of interest. Multivariable Cox proportional hazard regression was used to evaluate the risk of aseptic rrACLR with ipsilateral and contralateral reoperation as secondary outcomes. Models included factors at the time of the revision procedure (age, gender, body mass index, smoking status, staged revision, femoral fixation, tibial fixation, femoral tunnel method, lateral meniscus injury, medial meniscus injury, and cartilage injury) and a factor from the primary ACLR (activity at injury) as covariates.

Results:

1747 rACLR procedures were included. The crude cumulative aseptic rrACLR incidence at 8-years follow-up was 13.9% for allograft and 6.0% for autografts (Figure 1). Cumulative ipsilateral reoperation incidence at 8-years follow-up was 18.3% for allograft and 18.9% for autograft; contralateral reoperation cumulative incidence was 4.3% for allograft and 6.8% for autograft. With adjustment for covariates, a lower aseptic rrACLR risk was observed for autografts compared with allografts (HR=0.30, 95% CI=0.18-0.50, p <0.0001). No differences were observed for ipsilateral reoperation (HR=1.05, 95% CI=0.73-1.51, p=0.78) nor for contralateral reoperation (HR=1.33, 0.60-2.97, p=0.48) for autografts compared with allografts.

Conclusions:

The use of autograft at rACLR was associated with a 70% reduced risk of rrACLR compared to allograft in this large integrated health care system registry. When accounting for all reoperations after rACLR, we found no significant difference in risk between autograft and allograft. In order to minimize the risk of rrACLR, surgeons should consider using autograft for rACLR when possible. [Figure: see text]
Poster 256: The "N+10 Rule" to Avoid Graft Tunnel Mismatch in Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Using Independent Femoral Tunnel Drilling
Authors: Dart Scott , MacLean Ian , Barras Laurel , Moran Thomas , Werner Brian , Gwathmey F. Winston , Diduch David , Miller Mark , Graf Ryan
Published: July 2022

Objectives:

To determine the amount of tibial graft tunnel mismatch during application of the “N+10” rule in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft using independent femoral tunnel drilling. To compare actual (measured) tibial tunnel length and desired (calculated) tibial tunnel length when using the “N+10” rule for independent femoral tunnel drilling.

Methods:

Twenty paired knees from 10 fresh frozen cadaveric specimens (5 female and 5 male specimens) underwent arthroscopic assisted bone-patellar tendon-bone ACL reconstruction using independent femoral tunnel drilling with either a hyperflexion accessory anteromedial portal (n=10) or flexible reamer technique (n=10). The prepared patellar tendon graft bone blocks were trimmed to 10 x 20mm for all specimens and the intertendinous distance (N) between the bone blocks was measured. The “N+10 Rule” was used to set the angle of the ACL tibial tunnel guide to the appropriate degree setting for drilling. The amount of excursion or recession of the tibial bone plug in relation to the anterior tibial cortical aperture was measured in both flexion and extension. A +/-6mm threshold was used to assess this strategy based on prior biomechanical aperture fixation studies. As a secondary outcome, the intraarticular distance (IAD) and the actual tibial tunnel length (TTL) were measured and compared to the planned TTL based on the equation: IAD + TTL = N + 20 (size of bone plug in millimeters)

Results:

The average BTB ACL intertendinous distance (N) was 47.5mm (SD =5.5mm). The average measured IAD was 27.2mm (SD=3.0mm). Using the “N+10 Rule”, the average mismatch of the tibial tunnel was 4.9mm (SD=3.6mm) and 3.8mm (SD=3.5mm) in flexion and extension, respectively. Both values fall within the +/- 6mm threshold. When comparing the actual measured tibial tunnel length (TTL) to the desired TTL, there was an average difference of 5.4mm (SD=3.9mm)

Conclusions:

The “N+10” rule resulted in an acceptable average mismatch in both flexion and extension using the threshold of +/- 6mm for 20 cadaveric knees. Measured actual TTL compared to the desired calculated TTL were acceptable 61% of the time using the same threshold. The “N+10” is a simple and effective intraoperative strategy for achieving desired tibial tunnel length to avoid excessive graft tunnel mismatch. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Poster 261: Increased TT-TG and Tibial Slope are Independent Predictors of ACLR Failure
Authors: Lee Eric , Kliethermes Stephanie , Scerpella Tamara , Chen Kallie
Published: July 2022

Objectives:

Tibial tubercle-trochlear groove (TT-TG) distance is a surrogate measure of valgus and rotational stress on the anterior cruciate ligament (ACL) and may predict ACL injury. Increased posterior tibial slope has been associated with risk of ACL re-tear but no studies have evaluated TT-TG as a predictor of ACL re-tear. We hypothesized TT-TG distance and posterior tibial slope would be independent predictors of ACL graft re-tear.

Methods:

All patients who underwent ACL revision surgery between 2010-2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006-2015, with no evidence of graft failure at 8.1 ± 2.5 yrs post-op. Record review included anthropometrics, graft type, and estimated highest Tegner activity score at ≥ 6 months post primary ACLR. Magnetic resonance images (MRI) following native ACL tear (controls) or graft failure (revision cohort) were assessed for the following: 1) medial, lateral, and coronal tibial slope, 2) depth of tibial plateau concavity, 3) TT-TG distance, and 4) tunnel position. Logistic regression analyses were used to associate ACL graft failure with radiographic parameters, surgical variables, and demographics. Sensitivity analyses, excluding patients in the revision group with tunnel malposition, were performed to confirm multivariable results.

Results:

Participants included 153 revisions and 146 controls. Controls were older than revisions (26.6 ± 8.8 yrs vs. 20.6 ± 7.3 yrs). Mean TT-TG distance and lateral tibial slope values were smaller for the control vs. revision group (TT-TG = 9.4 ± 3.9 mm vs. 11.2 ± 4.2 mm; lateral tibial slope = 6.2o ± 3.4° vs. 7.2o ± 3.6°). TT-TG distance and lateral tibial slope were associated with increased risk of ACL graft failure by multivariable analysis (OR: 1.14, CI: 1.07, 1.22, p < 0.001 and OR: 1.11, CI: 1.02, 1.20, p = 0.007, respectively). With sensitivity analyses, age at index surgery, TT-TG distance, and lateral tibial slope remained significant predictors of ACL revision.

Conclusions:

Increased TT-TG distance, increased lateral tibial slope, and younger age are associated with increased odds of ACL graft failure. These patients may require a more comprehensive strategy to reduce the risk of ACL re-tear. [Table: see text]
Poster 266: The Effect of Bone Marrow Aspirate Concentrate Augmentation on ACL Reconstruction Allograft Volume and PROMs
Authors: Chung Christine , Statum Sheronda , Berlinberg Elyse , Lavoie-Gagne Ophelie , Patel Harsh , Cole Brian , Bach Bernard , Chahla Jorge , Yanke Adam , Verma Nikhil , Forsythe Brian
Published: July 2022

Objectives:

Prior studies have correlated MRI-calculated tendon volume with biomechanical properties of ACL allografts in porcine models. Bone marrow aspirate concentrate (BMAC) has been shown to improve biomechanical graft strength in other animal studies. We sought to assess the effects of BMAC on ACL bone-tendon-bone (BTB) allograft volume and PROMs.

Methods:

The study population included 66 patients with both a 3-month and 9-month MRI from an IRB-approved, double-blinded, randomized control trial comparing patients undergoing ACL reconstruction (ACLR) with BTB allograftBMAC. The primary outcome was tendon volume at 9 months, with a secondary outcome of change in tendon volume between 3-9 months. Knee Injury and Osteoarthritis Outcome Score Junior (KOOS-Jr), Tegner activity scale, and International Knee Documentation Committee (IKDC) were obtained pre-operatively and at 1 year.

Results:

The final analysis included 32 BMAC study patients (BMAC volume=2.420.90 mL, soak time=17.83.15 mins) and 34 control patients. Baseline demographics, physical exam features, and PROs did not vary between groups. Average 9-month tendon volume was 773280 mm3 in BMAC patients and 743224 mm3 in controls ( P=0.634). Mean change in tendon volume between 3-9 months was 1175 mm3 in BMAC patients and -21120 mm3 in controls ( P=0.552). Tendon volume was not associated with KOOS-Jr (beta=7.26 mm3/point, 95 % Confidence Interval [CI]=-13.21-27.72, P=0.476), Tegner (beta=-0.53 mm3/point, 95% CI=-2.40-1.45, P=0.596), or IKDC (beta=5.18 mm3/point, 95% CI=-10.59-20.95, P=0.513). There was a nonsignificant, negative correlation between tendon volume and KT-1000 translation (beta=-0.56 mm3/cm, 95% CI=-1.15-0.04, P=0.065).

Conclusions:

In this study, BMAC did not affect tendon volume at 9 months after ACLR. PRO-scores were not significantly associated with tendon volume. Both BMAC patients and controls showed improvements in KOOS Jr, Tegner, and IKDC. Biomechanical and histologic studies are warranted to better elucidate the relationship between BMAC augmentation, PRO scores, and ligamentization in ACL allograft reconstruction. [Table: see text][Table: see text][Table: see text]
One Earth, One Humanity Versus the Virus: Examining the Global COVID-19 Social Partnership Communication Networks on Social Media
Authors: Liu Wenlin , Yang Aimei , Shin Jieun , Li Yiqi , Sun Jingyi , Qu Yan , Zhen Lichen , Min Kim Hye , Dong Chuqing
Published: July 2022

The COVID-19 pandemic has posed severe challenges that require collaborative efforts from multi-sector organizations. Guided by an institutional theory framework that considers how both organizational fields and national level contexts affect organizations’ social partnership communication, the current study examines the COVID-19-related social partnership communication network on social media. The cross-national study using semantic network analysis and exponential random graph models (ERGMs) first maps the meaning of COVID-19 social partnership network, and then investigates the role of organizational fields and a country’s political system, economic system, educational system, and cultural system on the formation of interorganizational communication ties surrounding the relief efforts of COVID-19. Results reveal the importance of the political system—such as the presence of populist government, economic disparity, and uncertainty avoidance cultural orientation in shaping the social media-based social partnership communication network. In addition, NGOs from multiple issue areas are actively engaged in the network, whereas corporations from manufacturing and financial industries are active players.
Agonistic Terms of Peace in Kashmir: Kashmiriyat, Distributive Politics and Islam
Authors: Dar Rayees Ahmad
Published: July 2022

Kashmiriyat as a peculiar secular formation posits Rishi tradition as central to Islam in Kashmir. However, the dialectical process of Islamic acculturation also led the Muslim identity in Kashmir to disentangle itself from any essential association with it. The article, thus, argues that Kashmiriyat alone cannot underpin any inclusive notion of democracy in Kashmir. In so far as Kashmiriyat is concerned with the religious orthodoxy implicated in subversion and violence, it is argued that religious orthodoxy, irrespective of its sociopolitical implications, being the only mode of social representation of religion cannot be eliminated in any ultimate sense. Nevertheless, it is the social antagonism that makes any religious orthodoxy to emerge, transform and ultimately face its own contingency. Thus, more than any narrative of harmony and co-existence surrounding Kashmiriyat, it is the democratic space reflective of the underlying sociopolitical antagonisms that can channelise orthodoxy in a socially productive manner. The article also highlights that the process of socio-economic development in Kashmir (referred to here as ‘distributive politics’) straddles different discourses and mainly enhances the discursive depth of the narrative in power.
Correlation of Change in Macular Thickness With Change in Visual Acuity in Diabetic Macular Edema: Post Hoc Analysis of VISTA and VIVID Trials
Authors: Nanegrungsunk Onnisa , Gu Sophie Z. , Bressler Susan B. , Du Weiming , Amer Fouad , Moini Hadi , Bressler Neil M.
Published: July 2022

Purpose: To assess the correlation between the change in central subfield thickness (CST) and change in best-corrected visual acuity (BCVA) in eyes with diabetic macular edema (DME) treated with fixed-dosing intravitreal aflibercept injection (IAI). Methods: This post hoc analysis of the VISTA and VIVID randomized controlled clinical trials, in which 862 eyes with central-involved DME were randomly assigned to IAI 2 mg every 4 weeks (2q4; 290 eyes), IAI 2 mg every 8 weeks after 5 initial monthly doses (2q8; 286 eyes), or macular laser (286 eyes) and followed through 100 weeks. Correlations between the change in CST and change in BCVA from baseline to weeks 12, 52, and 100 were assessed using the Pearson correlation. Results: The respective correlations ( r [95% CI]) at weeks 12, 52, and 100 were −0.39 (−0.49 to −0.29), −0.27 (−0.38 to −0.15), and −0.30 (−0.41 to −0.17) in the 2q4 arm and −0.28 (−0.39 to −0.17), −0.29 (−0.41 to −0.17), and −0.33 (−0.44 to −0.20) in the 2q8 arm. Linear regression analysis of the correlation at week 100, adjusted for relevant baseline factors, showed CST changes accounted for 17% of the variance in BCVA changes; every 100-µm decrease in CST was associated with a 1.2-letter increase in BCVA ( P = .001). Conclusions: Correlations between the change in CST and change in BCVA after 2q4 or 2q8 fixed-dosing IAI for DME were modest. Although a change in CST might be important in determining the need for antivascular endothelial growth factor for DME at follow-up, it was not a good surrogate for VA outcomes.
Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes
Authors: Kavookjian Jan , LaManna Jacqueline B. , Davidson Patricia , Davis Jean W. , Fahim Shahariar Mohammed , McDaniel Cassidi C. , Ekong Gladys , Todd Andrew , Yehl Kirsten , Cox Carla
Published: July 2022

Purpose:

The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM).

Methods:

A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists’ ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias.

Results:

Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome.

Conclusion:

To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.
A Guide to Orthodontic Devices for Trainees in Orthognathic Surgery
Authors: Girard Alisa O. , Lake Isabel V. , Chen Jonlin , Dorfmann Sabrina , Maduekwe Uma , Lopez Christopher D. , Ickow Ilana , Yang Robin
Published: July 2022

Purpose:

Despite the interplay between orthodontics and orthognathic surgery, trainees in plastic surgery and oral and maxillofacial surgery do not receive formal training in orthodontics and associated hardware. This study aims to help surgical trainees better understand the role of orthodontic treatment in achieving enhanced dental occlusion and alignment and optimize surgical decision making.

Methods:

A review of recent literature was conducted to consolidate current practices for the use of orthodontic devices commonly used in orthognathic surgical patients.

Results:

Orthodontic treatments may be preventive, interceptive, and/or corrective. Braces and clear aligners are popular devices used to correct tooth positioning via 3 orders of control: first (“in-out” and rotation), second (mesio-distal angulation or “tip”), and third order (inclination or torque). Further, various treatments exist for skeletal and dental malocclusions, which may occur in transverse (crossbites, narrow arches) and/or sagittal (over/underbites) planes. Palatal expanders such as the Hyrax or Haas assist in correction of transverse deficiencies. Appliances for sagittal corrections typically take advantage of patient’s remaining growth and include a variety of headgear types (cervical, high-pull, occipital, reverse-pull), functional appliances (fixed or removable), or simply the use of interdental elastics.

Conclusion:

As patients are increasingly seeking orthodontic care in conjunction with surgery, it is important for surgical trainees to develop a strong understanding of the various orthodontic devices used.
Enrichment of BTK Leu528Trp mutations in patients with CLL on zanubrutinib: potential for pirtobrutinib cross-resistance
Authors: Blombery Piers , Thompson Ella R. , Lew Thomas E. , Tiong Ing Soo , Bennett Rory , Cheah Chan Y. , Lewis Katharine Louise , Handunnetti Sasanka M. , Tang Chloe Pek Sang , Roberts Andrew , Seymour John F. , Tam Constantine S.
Published: July 2022

The covalent Bruton’s tyrosine kinase inhibitors (BTKis) are highly effective for the treatment of chronic lymphocytic leukemia (CLL). The dominant resistance mechanism observed with the BTKi ibrutinib is the development of BTK Cys481 codon mutations. Whether a similar resistance mutation profile exists for the newer-generation, more selective BTKi zanubrutinib is unknown. In samples referred for diagnostic next-generation sequencing in patients with progressive CLL, we observed an enrichment in the kinase-dead BTK Leu528Trp mutation in patients treated with zanubrutinib compared with ibrutinib (54%; 7 of 13 vs 4%; 1 of 24, P = .001). We describe 2 patients with BTK Leu528Trp mutations who showed clinical cross-resistance and progressive enrichment of the BTK Leu528Trp mutation over time when treated with the noncovalent BTKi pirtobrutinib. Both patients subsequently responded to venetoclax-based treatment. In summary, we have identified an enrichment of the BTK Leu528Trp mutation arising in patients treated with zanubrutinib that may impart cross-resistance to the noncovalent inhibitor pirtobrutinib and therefore may have implications for sequencing of these treatments in CLL.
Impact of COVID-19 social distancing measures on lung transplant recipients: decline in overall respiratory virus infections is associated with stabilisation of lung function
Authors: de Zwart Auke E.S. , Riezebos-Brilman Annelies , Lunter Gerton A. , Neerken Ewald C.U. , van Leer-Buter Coretta C. , Alffenaar Jan-Willem C. , van Gemert Anna P. , Erasmus Michiel E. , Gan Christiaan T. , Kerstjens Huib A.M. , Vonk Judith M. , Verschuuren Erik A.M.
Published: July 2022

Background

Coronavirus disease 2019 (COVID-19) social distancing measures led to a dramatic decline in non-COVID-19 respiratory virus infections, providing a unique opportunity to study their impact on annual forced expiratory volume in 1 s (FEV1) decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs).

Methods

All FEV1values of LTRs transplanted between 2009 and April 2020 at the University Medical Center Groningen (Groningen, The Netherlands) were included. Annual FEV1change was estimated with separate estimates for pre-social distancing (2009–2020) and the year with social distancing measures (2020–2021). Patients were grouped by individual TDLF frequency (frequent/infrequent). Respiratory virus circulation was derived from weekly hospital-wide respiratory virus infection rates. Effect modification by TDLF frequency and respiratory virus circulation was assessed. CLAD and TDLF rates were analysed over time.

Results

479 LTRs (12 775 FEV1values) were included. Pre-social distancing annual change in FEV1was −114 (95% CI −133– −94) mL, while during social distancing FEV1did not decline: 5 (95% CI −38–48) mL (difference pre-social distancingversusduring social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV1decline compared with the infrequent TDLF subgroup (−150 (95% CI −181– −120)versus−90 (95% CI −115– −65) mL; p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53, 95% CI 0.33–0.85; p=0.008) and severe TDLF (OR 0.34, 0.16–0.71; p=0.005) as well as lower CLAD incidence (OR 0.53, 95% CI 0.27–1.02; p=0.060). Effect modification by respiratory virus circulation indicated a significant association between TDLF/CLAD and respiratory viruses.

Conclusions

During COVID-19 social distancing the strong reduction in respiratory virus circulation coincided with markedly less FEV1decline, fewer episodes of TDLF and possibly less CLAD. Effect modification by respiratory virus circulation suggests an important role for respiratory viruses in lung function decline in LTRs.
Increasing physical activity in severe asthma: a systematic review and meta-analysis
Authors: McLoughlin Rebecca F. , Clark Vanessa L. , Urroz Paola D. , Gibson Peter G. , McDonald Vanessa M.
Published: July 2022

Introduction

Physical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity in reducing the risk of these outcomes, little is known about optimal interventions for increasing physical activity in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing physical activity in severe asthma.

Methods

MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for physical activity-based intervention studies that assessed physical activity outcomes (e.g.steps per day, time spent undertaking physical activity) in adults with severe asthma. Data on asthma-related (e.g.asthma control) and health-related outcomes (e.g.HRQoL) were assessed as secondary outcomes. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible.

Results

Four randomised controlled trials (all 12 weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in physical activity was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps per day and time spent undertaking physical activity), and an unsupervised pedometer-based intervention (steps per day). Meta-analyses showed that physical activity interventions had an overall positive effect on steps per day (mean difference (MD) 1588, 95% CI 399–2778; p=0.009, I2=23), asthma control (MD −0.65, 95% CI −0.95–−0.35; p<0.0001, I2=0%) and HRQoL (MD 0.56, 95% CI 0.10–1.01; p=0.02, I2=16%) compared to control.

Conclusion

While there is some evidence supporting the effectiveness of interventions in improving physical activity in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.
Lung allograft transbronchial cryobiopsy for critical ventilated patients: a randomised trial
Authors: Loor Karina , Culebras Mario , Sansano Irene , Álvarez Antonio , Sacanell Judith , García-de-Acilu Marina , Berastegui Cristina , Polverino Eva , Clofent David , de Gracia Javier
Published: July 2022

Background

Transbronchial lung cryobiopsy is an emerging technique for diagnosing pulmonary rejection. However, no prospective studies of this procedure for critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit (ICU) have been performed.

Methods

From March 2017 to January 2020, we performed a prospective, randomised, comparative study to assess the diagnostic yield, histological quality and safety of transbronchial lung biopsy using biopsy forceps, a 1.9-mm cryoprobe or a 2.4-mm cryoprobe.

Results

89 out of 129 consecutive transbronchial biopsy procedures (forceps group, 28 procedures; 1.9-mm cryoprobe group, 31 procedures; 2.4-mm cryoprobe group, 30 procedures) were randomised. Compared with lung samples from the forceps and 1.9-mm cryoprobe groups, lung samples from the 2.4-mm cryoprobe group allowed the most definitive diagnoses (p<0.01 and p=0.02, respectively), the most diagnoses of acute lung rejection (p<0.01 and p=0.01, respectively) and the most diagnoses of rejection severity (p<0.01 and p<0.01, respectively). These samples were larger (p<0.01 and p=0.04, respectively), had the most adequate alveolar tissue (p<0.01 and p=0.02, respectively), had more vessels per procedure (p<0.01 and p=0.01, respectively) and had no significant crush artefacts. Moderate bleeding was observed in 23% of cases (p=0.01 and p=0.08, respectively). No severe bleeding was observed.

Conclusions

Transbronchial lung biopsy using a 2.4-mm cryoprobe allows the safe collection of lung tissue samples from critically ill lung transplant recipients who require mechanical ventilation in the ICU and has good diagnostic performance.
Reference equations for evaluation of spirometry function tests in South Asia, and among South Asians living in other countries
Authors: Leong Wei Yee , Gupta Ananya , Hasan Mehedi , Mahmood Sara , Siddiqui Samreen , Ahmed Sajjad , Goon Ian Y. , Loh Marie , Mina Theresia H. , Lam Benjamin , Yew Yik Weng , Ngeow Joanne , Lee Jimmy , Lee Eng Sing , Riboli Elio , Elliott Paul , Tan Geak Poh , Chotirmall Sanjay H. , Wickremasinghe Ananda R. , Kooner Jaspal S. , Khawaja Khadija I. , Katulanda Prasad , Mridha Malay K. , Jha Sujeet , Ranjit Mohan Anjana , Pradeepa Guha , Kasturiratne Anuradhani , Chambers John C.
Published: July 2022

Background

There are few data to support accurate interpretation of spirometry data in South Asia, a major global region with a high reported burden of chronic respiratory disease.

Method

We measured lung function in 7453 healthy men and women aged ≥18 years, from Bangladesh, North India, South India, Pakistan and Sri Lanka, as part of the South Asia Biobank study. First, we assessed the accuracy of existing equations for predicting normal forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1) and FEV1/FVC ratio. Then, we used our data to derive (n=5589) and internally validate (n=1864) new prediction equations among South Asians, with further external validation among 339 healthy South Asians living in Singapore.

Results

The Global Lung Initiative (GLI) and National Health and Nutrition Examination Survey consistently overestimated expiratory volumes (best fit GLI-African American, mean±sdz-score: FEV1−0.94±1.05, FVC −0.91±1.10; n=7453). Age, height and weight were strong predictors of lung function in our participants (p<0.001), and sex-specific reference equations using these three variables were highly accurate in both internal validation (z-scores: FEV10.03±0.99, FVC 0.04±0.97, FEV1/FVC −0.03±0.99) and external validation (z-scores: FEV10.31±0.99, FVC 0.24±0.97, FEV1/FVC 0.16±0.91). Further adjustment for study regions improves the model fit, with highest accuracy for estimation of region-specific lung function in South Asia.

Conclusion

We present improved equations for predicting lung function in South Asians. These offer the opportunity to enhance diagnosis and management of acute and chronic lung diseases in this major global population.
Adrenal function recovery after durable oral corticosteroid sparing with benralizumab in the PONENTE study
Authors: Menzies-Gow Andrew , Gurnell Mark , Heaney Liam G. , Corren Jonathan , Bel Elisabeth H. , Maspero Jorge , Harrison Timothy , Jackson David J. , Price David , Lugogo Njira , Kreindler James , Burden Annie , de Giorgio-Miller Alex , Faison Sarai , Padilla Kelly , Martin Ubaldo J. , Garcia Gil Esther ,   the PONENTE Study Group
Published: July 2022

Background

Oral corticosteroid (OCS) dependence among patients with severe eosinophilic asthma can cause adverse outcomes, including adrenal insufficiency. PONENTE's OCS reduction phase showed that, following benralizumab initiation, 91.5% of patients eliminated corticosteroids or achieved a final dosage ≤5 mg·day−1(median (range) 0.0 (0.0–40.0) mg).

Methods

The maintenance phase assessed the durability of corticosteroid reduction and further adrenal function recovery. For ∼6 months, patients continued benralizumab 30 mg every 8 weeks without corticosteroids or with the final dosage achieved during the reduction phase. Investigators could prescribe corticosteroids for asthma exacerbations or increase daily dosages for asthma control deteriorations. Outcomes included changes in daily OCS dosage, Asthma Control Questionnaire (ACQ)-6 and St George's Respiratory Questionnaire (SGRQ), as well as adrenal status, asthma exacerbations and adverse events.

Results

598 patients entered PONENTE; 563 (94.1%) completed the reduction phase and entered the maintenance phase. From the end of reduction to the end of maintenance, the median (range) OCS dosage was unchanged (0.0 (0.0–40.0) mg), 3.2% (n=18/563) of patients experienced daily dosage increases, the mean ACQ-6 score decreased from 1.26 to 1.18 and 84.5% (n=476/563) of patients were exacerbation free. The mean SGRQ improvement (–19.65 points) from baseline to the end of maintenance indicated substantial quality-of-life improvements. Of patients entering the maintenance phase with adrenal insufficiency, 32.4% (n=104/321) demonstrated an improvement in adrenal function. Adverse events were consistent with previous reports.

Conclusions

Most patients successfully maintained maximal OCS reduction while achieving improved asthma control with few exacerbations and maintaining or recovering adrenal function.
Major cardiovascular events in patients with severe COPD with and without asthma: a nationwide cohort study
Authors: Bonnesen Barbara , Sivapalan Pradeesh , Kristensen Anna Kjær , Lassen Mats Christian Højbjerg , Skaarup Kristoffer Grundtvig , Rastoder Ema , Sørensen Rikke , Eklöf Josefin , Biering-Sørensen Tor , Jensen Jens-Ulrik Stæhr
Published: July 2022

Background

Chronic low-grade inflammation as in asthma may lead to a higher risk of cardiovascular events. We evaluated whether patients with COPD and asthma have a higher risk of acute cardiovascular events than patients with COPD without asthma.

Methods

Nationwide multicentre retrospective cohort study of Danish outpatients with a specialist diagnosis of COPD with or without asthma. Patients with both COPD and asthma were propensity-score matched 1:2 to patients with COPD without asthma. The primary end-point was severe major adverse cardiac events (MACE), defined as mortal cardiovascular events and events requiring revascularisation or hospitalisation.

Results

A total of 52 386 Danish patients with COPD were included; 34.7% had pre-existing cardiovascular disease, and 20.1% had asthma in addition to their COPD. Patients with pre-existing cardiovascular disease were then propensity-score matched: 3690 patients with COPD and asthmaversus7236 patients with COPD without asthma, and similarly, for patients without pre-existing cardiovascular disease (6775 matched with 13 205). The risk of MACE was higher among patients with asthma and COPDversusCOPD without asthma: hazard ratio (HR) 1.25 (95% CI 1.13–1.39, p<0.0001) for patients with pre-existing cardiovascular disease and HR 1.22 (95% CI 1.06–1.41, p=0.005) for patients without pre-existing cardiovascular disease.

Conclusion

Among patients with COPD, asthma as a comorbid condition is associated with substantially increased risk of cardiovascular events. The signal was an increased risk of 20–25%. Based on our study and other smaller studies, asthma can be considered a risk factor for cardiovascular events among COPD patients.
Simulation and Experimental Study on Improving Electrochemical Machining Stability of Highly Convex Structures on Casing Surfaces Using Backwater Pressure
Authors: Ge Zhenghui , Chen Wangwang , Zhu Yongwei
Published: July 2022

Casing parts are regarded as key components of aero-engines. Most casing parts are attached to convex structures of different shapes, whose heights range from hundreds of microns to tens of millimeters. Using profiling blocky electrodes for electrochemical machining (ECM) of casing parts is a commonly adopted method, especially when highly convex structures. However, with an increase in the convex structure height, the flow fields of the machining areas become more complex, and short circuits may occur at any time. In this study, a method to improve the flow field characteristics within a machining area by adjusting the backwater pressure is proposed and validated through simulation and experiment analyses. The simulation results demonstrated that the back-pressure method can significantly improve the uniformity of the flow field around the convex structure compared with the extraction and open outlet modes. Subsequently, the back-pressure value was optimized at 0.5 MPa according to the simulation results. The experimental results showed that using the optimized back-pressure parameters, the cathode feed-rate increased from 0.6 to 0.7 mm/min, and a 16.1 mm tall convex structure was successfully machined. This indicates that the back-pressure method is suitable and effective for electrochemical machining of highly convex structures with blocky electrodes. In this study, we propose a method to improve the electrochemical machining stability of a convex structure on a casing surface using backwater pressure, which has achieved remarkable results.