bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic Proximal Hamstring Repair: Portal Site Anatomy - A Cadaveric Study
Authors: Ryan Michael K. , Beason David P. , Emblom Benton A.
Published: July 2018

Objectives:

Hamstring injuries commonly cause pain, weakness and functional limitations. While most hamstring injuries involve the musculotendinous junction or muscle belly, proximal hamstring tendon avulsions are a subset of hamstring injuries that are frequently more debilitating. Nonoperative treatment has demonstrated poor outcomes, thus surgical repair has become the mainstay. Open surgical repair has been the standard, but improved endoscopic techniques have enabled proximal hamstring fixation with decreased risk of infection and numbness, without the morbidity of a large, posterior incision. Prior anatomic studies described relevant anatomy near the proximal hamstring origin at the ischial tuberosity in the setting of an open repair, but literature describing pertinent anatomy during endoscopic repair is sparse. This cadaveric study enhances knowledge and safety of endoscopic proximal hamstring repair by describing pertinent anatomy surrounding four commonly used endoscopic portals.

Methods:

Ten fresh-frozen pelvis specimens (5 M, 5F) underwent endoscopic proximal hamstring repair and dissection with evenly distributed laterality (5 R, 5 L). Proximal hamstring ruptures were simulated endoscopically with an arthroscopic knife. Endoscopic repair was then completed on each specimen through four endoscopic portals (Inferolateral, Medial, Superolateral and Accessory Superior) using two double-loaded 3.0 mm polyether ether ketone (PEEK) suture anchors and two 3.75 mm PEEK knotless screw-in anchors. After repair, portal tracts were maintained by inserting four 2.0 mm k-wires through cannulas placed through the portals, securing the wires in bone in the ischial tuberosity beyond the zone of repair. The specimen was dissected in layers around the wires, and measurements from portal tracts to nine pertinent anatomic structures were obtained using a digital caliper. Each measurement was repeated three times, then averaged to obtain a composite mean. Measurements were statistically verified with an intraclass correlation coefficient (ICC), all but two of which were above 0.90.

Results:

Ten cadaveric specimens demonstrated a mean age and BMI of 45.4 and 27.3, respectively. With respect to anatomic measurements, on average no portal tract was closer than 2.0 cm to the sciatic nerve, inferior gluteal neurovascular bundle or posterior cutaneous nerve, and all double-row repairs were easily completed with good fixation through these four portals (Table 1). Additional anatomic landmarks surrounding the hamstring origin were identified endoscopically, and when routinely located, each landmark helped improve reproducibility and safety of endoscopic proximal hamstring repair (Figure 1).

Conclusion:

This cadaveric study of the proximal hamstring origin maps the anatomic landscape encountered endoscopically, and supports the efficacy and safety of endoscopic proximal hamstring repair. [Table: see text][Figure: see text]
What is The Impact of PAO Surgery on Patient Function and Activity Levels?
Authors: Petrie Jeff , An Tonya , Schoenecker Perry , Zaltz Ira , Kim Young-Jo , Millis Michael B. , Beaule Paul , Sierra Rafael J. , Trousdale Robert , Sucato Daniel J. , Podeszwa David , Sink Ernest , Clohisy John C.
Published: July 2018

Objectives:

The Bernese periacetabular osteotomy (PAO) is becoming a widely utilized procedure. Patients are younger, highly active, and may desire to return to sport activity. Counseling and managing expectations in these patients is challenging as there is limited information regarding activity level after PAO. The purpose of this study was to analyze physical activity levels after PAO in a large, prospective multicenter cohort.

Methods:

Assessment of prospectively collected data from a multicenter group included 456 hips treated by PAO for hip dysplasia. After exclusions, 359 hips (80 male, 279 female) remained with a mean age of 25.9 years and mean BMI of 25. Demographics, radiographic measures, and clinical outcomes were evaluated preoperatively, at 1 year follow-up, and at minimum 2 years postoperatively (mean 44.9 months). Activity level was assessed with the University of California-Los Angeles (UCLA) activity score, patients were stratified into low, moderate, and high activity groups based on preoperative function. Descriptive statistics and linear regressions were performed for the primary outcome of change in UCLA.

Results:

UCLA scores were improved on average 0.6 points at final follow up (p = 0.001). When stratified, the low activity and moderate activity groups had significant improvement in UCLA scores (p<.0001 and p=0007) while the high activity group saw a decrease in UCLA scores (p<.0001). mHHS, HOOS Pain, and HOOS Sports and Recreation scores were significantly improved across all activity levels. Univariable linear regression analysis identified prior ipsilateral surgery, arthroscopy at time of PAO, and preoperative ACEA to be predictors of the change in UCLA score (p<0.05). With the multivariable model, the effect of prior ispilateral surgery was maintained (p = 0.002).

Conclusion:

The data suggests that improvements in activity level and function can be expected following PAO surgery, with greater gains experienced by patients with lower preoperative level of activity. [Figure: see text][Figure: see text]
Indomethacin Does Not Reduce Heterotopic Ossification In Two-incision Distal Biceps Repairs
Authors: Hudson Justin , Dunphy Taylor R. , Butler Rebecca K. , Mirzayan Raffy
Published: July 2018

Objectives:

Our objective was to evaluate whether indomethacin would reduce the incidence of heterotopic ossification (HO) after two-incision distal biceps repairs.

Methods:

After obtaining IRB approval, all two-incision distal biceps tendon repairs performed between 2008 and 2015 by 17 surgeons in a multi-center (14) integrated, health care system were retrospectively reviewed. Indomethacin use was confirmed by the use of our pharmacy database search of a prescription being filled 10 days prior and up to 6 weeks after to surgery. A minimum of 1 year of follow-up was required for all patients. Variables recorded were patient demographics, time from injury to surgery, re-operation rate, infection, re-rupture, nerve complications, and time to release from medical care. Inclusion criteria included age 18 and over, primary repairs using the two-incision technique with bone tunnel - suture fixation. A Fischer Exact test was performed to test for significance.

Results:

146 patients met our inclusion criteria. The average age was 48 years (range: 23-69). All (100%) were male. The non-dominant side was involved in 76 patients (52.1%). There was no difference in age, gender, time from injury to surgery in groups receiving indomethacin to those not receiving it (P>0.05). 109 (74.7%) patients underwent distal biceps repair without indomethacin and 6 (5.5%) patients developed HO. In 37 patients who received indomethacin prophylaxis, 5 (13.5%) patients developed HO. There was no statistically significant difference in HO formation between patients who received indomethacin prophylaxis and those who did not (P=0.14).

Conclusion:

Based on our findings and the risk of gastrointestinal complications, we do not recommend indomethacin prophylaxis for two-incision distal biceps repairs.
Incidence and Risk Factors for Failure of Arthroscopic Posterior Capsulolabral Reconstruction
Authors: Bradley James P. , Arner Justin W. , Jayakumar Sachidhanand , Vyas Dharmesh
Published: July 2018

Objectives:

Risk factors and outcomes of revision arthroscopic posterior capsulolabral repair is not well defined. It is hypothesized that athletes who require revision arthroscopic posterior unidirectional capsulolabral repair will have poorer outcomes and return to play with risk factors including younger age, injury size, bone loss, anchor number, and anchor type.

Methods:

A review of 161 shoulders who underwent arthroscopic posterior capsulolabral repair using modern techniques at minimum 2 year follow up was completed. In addition to surgical data, ASES, stability, ROM, strength, and pain scores were compared pre- and post-operatively as well as return to sport. Those who required revision surgery were identified and compared to those not undergoing revision.

Results:

Twenty shoulders required revision surgery (12.4%) at 5.3 year follow-up. Significant risk factors included female gender (p = 0.001), dominant shoulder (p = 0.005), and concomitant rotator cuff injury (p = 0.029). Patients with 3 or fewer anchors were more likely to require revision (OR = 3.48). There was no difference after normalization to tear size and location (p > 0.05). Return to sport at the same level was significantly lower if revision surgery was required (15.4% vs. 64.3%) (p = 0.004). All patients had significant improvements in ASES, pain, ROM, and strength after the original surgery, however, those who required revision surgery had less improvement (p < 0.05). Stability improved significantly in non-revision athletes (p < 0.001), but did not in revision patients (p = 0.662).

Conclusion:

Athletes required revision arthroscopic posterior capsulolabral repair at an incidence of 12.4% and had poorer outcome scores and return to play with risk factors being dominant shoulder surgery, female gender, concomitant rotator cuff injury, and the use of 3 or fewer anchors. This data is essential for patient selection, optimal treatment techniques, and patient education as posterior shoulder instability failure requiring revision has not previously been evaluated. [Table: see text]
Does Labral Reconstruction Prevent Osteoarthritis After Posterior Shoulder Instability: A Population-Based Study
Authors: Lee Julia , Woodmass Jarret Murray , Wu Isabella , Camp Christopher L. , Dahm Diane L. , Krych Aaron John
Published: July 2018

Objectives:

Diagnosis of and treatment for posterior shoulder instability (PSI) has improved with advances in surgical technique and radiographic imaging. It is unknown if PSI, or surgical measures to correct PSI, affect the progression of osteoarthritis in the glenohumeral joint. The purpose of this study is to evaluate the effect of posterior capsulolabral reconstruction (PCLR) and demographic risk factors on the rate of radiographic progression of osteoarthritis in shoulders with PSI.

Methods:

The study population included 115 patients (14 females, 101 males) diagnosed with PSI between January 1994 and July 2012 with an average follow up of 12.5years (range 5-23). Medical records were reviewed to evaluate patient demographics, surgical intervention, and radiographic progression of osteoarthritis. Kaplan Meier survival was used to estimate survival and Cox models were used to examine associations with osteoarthritis progression.

Results:

Overall, 16/115 (14%) patients had radiographic progression of glenohumeral arthritis with 5-year survival at 88.3% (95% CI 79.7%-97.3%). Age ≥30 at the time of instability was associated with arthritis progression (p<0.05). The number of previous dislocations, sport, and gender each did not affect progression (p>0.05). PCLR with at least one anchor along the posterior glenoid rim was performed in 56/115 (48%) of patients. There was no difference in the rate of radiographic arthritic progression in those who underwent PCLR and those who did not (7/56, 13% vs 10/59, 17%, p>0.05). One male patient who underwent PCLR progressed to end-stage arthritis, necessitating a shoulder arthroplasty at age 53.

Conclusion:

Radiographic progression of glenohumeral arthritis occurred 14% of patients with PSI. Age ≥30 at the time of initial instability was associated with radiographic progression of glenohumeral arthritis.
Correlation Between Synovial Fluid Biomarker Concentrations and Bone Marrow Edema Lesion Volume in Patients with Acute ACL Ruptures
Authors: Anil Utakarsh , Werner Jordan , Jejurikar Neha , Kenny Lena , Pham Hien , Liu James , Mastio Michele , Burke Christopher , Strauss Eric Jason
Published: July 2018

Objectives:

Bone marrow edema lesions (BMELs) frequently occur following acute anterior cruciate ligament (ACL) rupture secondary to the pivot-shift mechanism of injury. The aim of the current study is to evaluate whether synovial fluid biomarker concentrations are associated with bone edema lesion volume as measured by magnetic resonance imaging (MRI) in patients undergoing ACL reconstruction.

Methods:

A total of 53 patients (26 females, 27 males, mean age 35.0 years [range 18-59]) undergoing ACL reconstruction with MRI knee scans available for analysis participated in the study. Synovial fluid was collected intra-operatively and analyzed for 10 biomarkers hypothesized to be involved in inflammation and post-traumatic osteoarthritis. BMELs were identified on MRI and their volumes (cm3) were quantified on two independent occasions using FireVoxel imaging software for image segmentation and region-of-interest drawing. The correlation between synovial fluid biomarker levels and BMEL volume was evaluated using Spearman’s correlation coefficient. Measurement reliability was assessed using intraclass correlation coefficient (ICC) analysis. Significance was set at p<0.05.

Results:

Mean time from initial injury to synovial fluid aspiration was 319 days (std. dev. 892; range 15-4320) and mean lesion volumes were: tibial=6.4 cm3 (range 0-38.6); femoral=5.8 cm3 (range 0-34.0); total=12.2 cm3 (range 0-50.5). Measurement reliability of BMEL volume was excellent [ICC(2,1)=0.968 (CI 0.945-0.981)]. Analysis of patients with MRI within 30 days of injury (n=35) showed increased tibial BMEL volume was significantly (p<0.05) correlated to decreased concentrations of interleukin (IL)-6 (ρ=-0.481), IL-1 receptor antagonist (ρ=-0.361), and vascular endothelial growth factor (VEGF) (ρ=-0.397) and increased time from injury to aspiration was correlated to decreased concentration of IL-6 (ρ=-0.463), monocyte chemotactic protein-1 (ρ=-0.453), VEGF (ρ=-0.457), IL-1Ra (ρ=-0.448), and matrix metalloproteinase (MMP)-3 (ρ=-0.426). However, among all patients, synovial fluid biomarker levels had no significant correlations to BMEL volume or time from injury to aspiration.

Conclusion:

Analysis of synovial fluid at the time of ACL reconstruction demonstrated that increased volume of injury-associated BMEL on MRI performed within 30 days of initial injury was significantly correlated to decreased concentrations of pro-inflammatory and growth factor cytokines. These findings suggest that the impact of the pivot-shift mechanism of injury and presence of BMEL may have an affect the local joint microenvironment. [Table: see text]
Jones Fracture in the Elite Athlete: Patient Reported Outcomes following Fixation with BMAC
Authors: Carney Dwayne , Chambers Monique C. , Kromka Joseph James , LaBaze Dukens , West Robin Vereeke , Musahl Volker , Lesniak Bryson P. , Hogan MaCalus Vinson
Published: July 2018

Objectives:

Jones’ fractures, 5th metatarsal metaphyseal-diaphyseal junction fractures, are a debilitating injury for the elite athlete, particularly in cutting/pivoting sports. These injuries are usually managed surgically due to the high rate of nonunion and re-fracture. Despite primary screw fixation, delayed union and nonunion are not uncommon. Bone marrow aspirate concentrate (BMAC), an autologous source of hematopoietic and mesenchymal stem cells, has been used to augment healing due to the poor healing potential in the watershed region. We hypothesize that open reduction internal fixation (ORIF) augmented with BMAC will improve patient-reported outcome measures following Jones’ fractures in athletes.

Methods:

This study was a prospectively collected and maintained review of elite athletes that underwent intramedullary screw fixation augmented with BMAC for Jones’ fractures at an academic medical institution. All patients were evaluated preoperatively and postoperatively to assess differences in patient reported outcomes including VAS, PROMIS, FAAM, SF-12 scores, return to play, and complications. Student’s t test was used in statistical comparison of the preoperative and postoperative outcome scores. P < 0.05 was considered significant.

Results:

A total of 41 elite athletes were treated with ORIF with BMAC for a Jones fracture with a mean age of 25.59 years (range 19-42). There were 26 (63%) males and 15 females included in the study. Type of athlete ranged across the following sport activities: football, basketball, soccer, volleyball. Of note, patients had significantly improved with lower visual analog score for pain (mean Δ3.56, p= 0.001), higher FAAM scores (mean Δ 43.6, p< 0.001), and PASS scores (increased from 11% to 85%, p< 0.001) at 6 months. Additionally, patients showed improvement in SF12, PROMIS10, and FAAM scores at 12 months, although this was not statistically significant due to insufficient follow up at this time. The average numbers of days lost to competition was 131 days. All patients that have returned to elite competitive sport activity report minimal to no pain.

Conclusion:

Intramedullary screw fixation of Jones’ fractures with BMAC results in optimal surgical outcomes in the elite athlete. The use of patient reported outcomes continues to be a focus of quality measures and should guide clinical decision making for surgical intervention, return to play, and to assess impact of treatment. A higher powered and long-term study with validated patient-reported outcomes is needed to confirm our observations.
The Effect of Humeral and Ulnar Tunnel Placement on Achieving UCL Graft Isometry
Authors: Lall Ajay C. , Beason David P. , Dugas Jeffrey R. , Cain E. Lyle
Published: July 2018

Objectives:

The elbow medial ulnar collateral ligament (UCL) is frequently injured in throwing athletes, most commonly baseball pitchers. When conservative management fails, surgical intervention can allow the athlete to return to sport. While extensive research has been devoted to UCL graft incorporation and outcomes based on varying surgical techniques, there is a paucity of literature available addressing optimal bone tunnel placement in achieving medial UCL graft isometry. The purpose of this study is to assess the effect of humeral and ulnar bone tunnel placement on achieving UCL graft isometry through elbow range-of-motion.

Methods:

Ten fresh-frozen cadaveric upper extremities were dissected to expose the native UCL in its entirety. Three equidistant humeral and ulnar tunnels were created at each UCL footprint. Suture was passed between nine possible tunnel combinations for each elbow affixed to an isometry guage. Each elbow was moved through a 120-degree arc of motion for each tunnel combination at 0, 30, 60, 90, and 120 degrees. Measured changes in isometry gauge tension were recorded and analyzed using one-way analysis of variance (ANOVA) with Tukey’s HSD for pairwise comparisons. A p-value of 0.05 was used to determine significance for all tests.

Results:

There was an overall significant effect (p < 0.0001) of tunnel placement at all degrees of flexion measured. Pairwise comparisons revealed increases in displacement between the central and posterior tunnel positions of the medial epicondyle, with significant differences (p=0.0009) occurring when paired with both the central and posterior aspect of the sublime tubercle. Profound differences (p < 0.0001) were noted between the anterior and posterior humeral tunnel positions. No significant differences noted between ulnar tunnel locations at any humeral location. Figure 1: Tunnel placement in the central part of the medial epicondyle (Centralepi) was generally the most isometric grouping, with Centralepi - Anteriortub being the most isometric combination of all. Data are represented as mean +/- SEM.

Conclusion:

Isometric graft placement of the medial elbow UCL is undoubtedly dependent upon optimal tunnel placement and even slight deviations from the native centroid at either the medial epicondyle or sublime tubercle can possibly lead to early graft failure or abnormal joint kinematics. This information can aid surgeons in performing isometric single bone tunnel UCL reconstruction or repair procedures in the future.
Performance and Return to Sport Following Ulnar Nerve Transposition/Decompression in Professional Baseball Players
Authors: Erickson Brandon J. , Chalmers Peter Nissen , D’Angelo John , Ma Kevin , Romeo Anthony A.
Published: July 2018

Background:

Isolated ulnar nerve decompression/transposition is an uncommon surgery amongst professional baseball players.

Purpose:

To determine the rate of return to sport (RTS) and performance upon RTS in professional baseball players following isolated ulnar nerve decompression/transposition, including those who required an ulnar nerve transposition/decompression following ulnar collateral ligament reconstruction (UCLR), and to determine if outcomes differ between players with isolated ulnar nerve decompression/transposition and matched controls.

Hypothesis:

There is a high rate of RTS in professional baseball players undergoing isolated ulnar nerve decompression/transposition with no significant difference in RTS rate or performance (specifically related to the primary outcome performance variables of earned run average (ERA), WHIP ((walks +hits)/innings pitched), wins above replacement (WAR), and on base + slugging percentage (OPS)) between cases and controls.

Methods:

All professional baseball players who underwent isolated ulnar nerve decompression/transposition between 2010-2016 were included. Demographic and performance data (pre and post surgery) for each player was recorded. Performance metrics were then compared between cases and a group of matched controls.

Results:

Overall 52 players, 83% pitchers (14 who underwent prior UCLR) were included. Most surgeries (92%) were anterior subcutaneous transpositions. Overall, 62% of players were able to successfully RTS and 56% returned to the same or a higher level. There was no significant difference between cases and controls in the majority of performance metrics pre-operative or post-operatively, specifically ERA, WHIP, WAR, and OPS. When players who had a UCLR prior to their ulnar nerve transposition/decompression were compared to controls with a history of a UCLR but who did not go on to have an ulnar nerve transposition/decompression, the only performance difference of all the recorded metrics was cases allowed more walks per 9 innings (4.4 vs. 2.8; p=0.011).

Conclusion:

Anterior subcutaneous transposition is the most common surgery in professional baseball players to address ulnar nerve compression. Players have a 62% rate of RTS. Upon RTS, players performance compared to matched controls remains the same in the majority of performance metrics including ERA, WHIP, WAR, and OPS. Post-operatively, pitchers with a UCLR prior to ulnar nerve transposition/decompression performed the same as matched controls with prior UCLR.
Type VIII Slap Repair: Patient-Reported Outcomes Of 34 Patients With Minimum 4-year Follow-up
Authors: Arner Justin W. , Fourman Mitchell Stephen , Bayer Steven , De SA Darren L. , Vyas Dharmesh , Bradley James P.
Published: July 2018

Objectives:

Type VIII superior labrum anterior posterior (SLAP) tears - described as SLAP II injuries with posterior extension of the labral tear to the 6 o’clock aspect of the glenoid - have been shown in short-term outcome work to be a source of noted shoulder instability, pain, and reduced function/range of motion in both throwing and non-throwing athletes. Limiting our evaluation and effective treatment of these injuries in both the professional athlete and weekend warrior is our lack of mid- and long-term post-operative outcomes after surgical repair. It is hypothesized that Type VIII SLAP repairs would fare poorly, particularly in the throwing cohort, at mid- to long-term follow-up.

Methods:

With a minimum 4-year follow-up after Type VIII SLAP repair by a single surgeon, return to sport, KJOC, ASES, stability, range of motion, and pain were compared between throwers, contact, and non-contact athletes.

Results:

With an average follow-up of 6.2 years, 34 athletes (19 throwers, 5 contact athletes, 10 non-contact athletes), with a mean age of 24.4 years were evaluated. Significant (p < .0001) improvements were observed between pre- and post-operative pain, range of motion, and ASES total and functional scores in throwers and non-throwers. Stability improved but was not significant (Table 1). There were no post-operative differences between throwers and non-throwers (Table 2). Pre-operative ASES functional score was significantly lower in contact athletes than in throwers and non-contact athletes (p < .01), but post-operatively improved significantly with no difference between groups (Table 3, 4). Overall, there was no difference in return to sport between groups as 73.7% of throwers and 93.3% of non-throwers returned (Table 4) and 62.5% of throwers and 57.9% of non-throwers (p = .73) returned to the same level. Further, 89.5% of throwers and 100% of non-throwers (p = .49) said that their surgery was worthwhile.

Conclusion:

Given the paucity of literature, current surgical outcomes of athletes who have undergone Type VIII SLAP repairs is limited, particularly in mid- and long-term function and return to sport. The current findings suggest that surgical repair of Type VIII SLAP lesions contributes to significant improvements in pain, function, and shoulder range of motion that persists >4 years after repair. However, stability changes after injury appear more chronic in nature. Further, thrower and non-throwers appear to have similar outcomes, which has not previously been seen in short term studies. [Table: see text][Table: see text][Table: see text][Table: see text]
Effectiveness of ASA for VTE Prophylaxis in Arthroscopic Rotator Cuff Repair
Authors: Austin Luke , Wowkanech Charles Dante , Cypel Bret , Alyea Eric Gordon , Gaston Tara , Pontes Manuel , Williams Gerald R.
Published: July 2018

Objectives:

Venous thromboembolic disease (VTED) is a rare complication following arthroscopic rotator cuff repair (RCR). Historical rates of symptomatic VTED after arthroscopic shoulder surgery, DVT and PE, are 0.26%, and 0.01-0.21%, respectively. At present, the American Academy of Orthopaedic Surgeons (AAOS) and American College of Chest Physicians (ACCP) have no prophylaxis guidelines specific to shoulder arthroscopy. Despite this, many surgeons prescribe Aspirin (ASA) for chemical prophylaxis following RCR. The efficacy of ASA as a thromboprophylaxis after shoulder arthroscopy is unknown, but there are risks associated with its’ use. The purpose of this study is to evaluate the effectiveness of chemical prophylaxis (ASA) and mechanical prophylaxis vs. mechanical prophylaxis alone in preventing VTED following RCR.

Methods:

A total of 914 patients underwent RCR between the months of January 2010 and January 2015. A retrospective case control study was performed. The control group (n=484) consisted of patients treated with perioperative mechanical VTED prophylaxis (compression boots) and early mobilization. The study group (n=430) also utilized perioperative mechanical prophylaxis and early mobilization, and added chemical prophylaxis (ASA 81 mg daily) for four weeks after surgery. The primary outcome was symptomatic VTED (DVT/PE). Chart records were collected and evaluated for six months after surgery. Patient demographics and other surgical complications were also analyzed.

Results:

A total of 7 VTED events occurred during the study period, 6 DVTs and 1 PE. The total rate of VTED was 0.88%, DVT was 0.77%, and PE was 0.11%. There was no significant different between DVT (p=0.88, 95% CI= -1.36% - 1.65%) or PE (p=0.45, 95% CI = -0.77% - 1.50%) between the control and study groups. The control group (no ASA) recorded an incidence of 0.62% DVT and 0.00% PE. As compared to the study group (ASA), which recorded an incidence of 0.47% DVT and 0.23% PE. The control group had significantly greater number of documented current smokers (8.68% vs 3.72%, p= 0.0003). The study group had a statistically significant higher mean age of subject (59.1 vs 57.7, p=0.0055), as well as more subjects undergoing revision RCR surgery (4.67% vs 1.86%, p= 0.021).

Conclusion:

Based on our study of 914 patients, ASA does not provide a clinically significant reduction in VTED rates in patients undergoing RCR. We conclude that the use of mechanical prophylaxis and early mobilization is a sufficient method of VTED prophylaxis in this low risk population.
Biomechanical Analysis of All-Suture Anchor Fixation for Rotator Cuff Repair
Authors: Bernardoni Eamon , Frank Rachel M. , Veera Shreya S. , Griffin Justin W. , Waterman Brian Robert , Shewman Elizabeth , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N.
Published: July 2018

Objectives:

Suture anchors are commonly utilized during arthroscopic rotator cuff repair (RCR). Recently, all-suture suture-anchor (ASSA) constructs have been introduced for RCR; however, the biomechanical properties of these implants are poorly understood. The purpose of this study was to compare the biomechanical properties of ASSA to conventional suture anchor (CSA) fixation during RCR.

Methods:

Fourteen fresh-frozen matched pair human cadaveric shoulders (average age 52 ± 13 years) with no documented prior rotator cuff tears or shoulder surgery were dissected. The supraspinatous tendon was isolated and detached from its footprint, and then was repaired in an anatomical position. Specimens were randomized into two repair constructs: Q-FIX double-loaded ASSA (N=7) and TWINFIX double-loaded conventional suture anchor (CSA) (N=7) (Smith & Nephew, Andover, MA). Each construct was cyclically loaded from 10 to 160 N for 100 cycles at 100N/s, and then pulled to failure at 1mm/s starting from the zero position. Load, crosshead displacement, failure mode, and time were recorded. Correlations between BMD, tendon gage length, maximum load, and stiffness were assessed. The groups were statistically analyzed with independent samples t-test, Fisher’s exact test, and a linear regression analysis, with p<0.05 considered significant.

Results:

There was no statistically significant difference in maximum load (ASSA: 617.73±177.8, CSA: 545.13±212.98 N, p=0.339), cyclic extension (ASSA: 7.88±1.33, CSA: 8.49±2.14 mm, p=0.117), construct stiffness (ASSA: 62.43±11.06, CSA: 68.14±10.77 N/mm, p=0.973), or extension at maximum load (ASSA: 17.03±4.73, CSA: 15.45±1.73 mm, p=0.122) between the ASSA and CSA groups. Failure modes consisted of suture tearing out of the tendon (ASSA: N=3, CSA: N=3) and anchor pull out (ASSA: N=4, CSA: N=4), with no difference in failure mode between groups (p=0.99). An association trended towards significance between higher BMD and higher maximum load in the CSA group (p=0.053) but not the ASSA group (p=0.125)

Conclusion:

ASSA constructs for RCR have similar biomechanical properties compared to CSA constructs. Additional clinical data is necessary to determine if these biomechanical results can be translated clinically.
Expanding Meaningfulness in Literacy Research: Possibilities of a Relational Perspective
Authors: Lysaker Judith
Published: July 2018

In this article, I consider expanding meaningfulness in literacy research by exploring the possibilities offered by a relational perspective on literacy and its study. An interdisciplinary relational perspective is outlined and used to rethink what happens when we engage in reading and writing. Questions guiding this exploration include: What makes literate activity meaningful, and how might a relational perspective enhance meaningfulness in studying this activity? What does a relational perspective look like as a theoretical frame for literacy research, and why might such a perspective be needed now? A synthesis of literacy research representing a relational perspective will be presented and examples of methodological applications offered. I conclude with the consequences of a relational perspective including implications for student well-being, assessment practices, and capacities for social justice work.
The impact of long working hours on the health of German employees
Authors: Müller Grit , Tisch Anita , Wöhrmann Anne Marit
Published: July 2018

Excessive working hours have negative consequences for employees’ health. Looking deeper into this problem, this article examines how employers’ needs for more intense working or more flexible working hours affect their employees’ psychosomatic health. A German representative survey of 13,452 full-time employees found that long working hours, work intensity (deadline and performance pressure) and flexibility requirements (permanent availability, changes in working hours) were significantly related to psychosomatic health complaints. When considering future work design and practices, these findings show which unfavourable working conditions are to be avoided to maintain the psychosomatic health of employees.
White supremacy, white counter-revolutionary politics, and the rise of Donald Trump
Authors: Inwood Joshua
Published: July 2018

To understand and contextualize Donald Trump's election as President of the United States, we must place his election in the context of a white counter-revolutionary politics that emerging from the specific geographic configurations of the US racial state. While academics and political commentators have correctly located the election of Trump in the context of white supremacy, I argue we need to coordinate our understanding of white supremacy and the electoral politics that fueled Trump's rise in the context of anti-Black racism by examining how the US racial state turns to whiteness to prevent change. Throughout the development of the United States, whiteness has long stood as a bulwark against progressive and revolutionary change so much so that when the US racial state is in economic and political crisis, bourgeoisie capitalism appeals to the white middle and working classes to address that crisis.
Mucous Cyst at the Interphalangeal Joint of the First Toe Caused by Contact Pressure With the Second Toe due to Hallux Valgus
Authors: Tonogai Ichiro , Yamasaki Yuhei , Nishisho Toshihiko , Sairyo Koichi
Published: July 2018

A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes— considered the cause of the mucous cyst—and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangeal-interphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus.
Osteochondral Lesions of the Talus
Authors: Steele John R. , Dekker Travis J. , Federer Andrew E. , Liles Jordan L. , Adams Samuel B. , Easley Mark E.
Published: July 2018

Osteochondral lesions of the talus (OLTs) are a difficult pathologic entity to treat. They require a strong plan. Lesion size, location, chronicity, and characteristics such as displacement and the presence of subchondral cysts help dictate the appropriate treatment required to achieve a satisfactory result. In general, operative treatment is reserved for patients with displaced OLTs or for patients who have failed nonoperative treatment for 3 to 6 months. Operative treatments can be broken down into cartilage repair, replacement, and regenerative strategies. There are many promising treatment options, and research is needed to elucidate which are superior to minimize the morbidity from OLTs.
Resolution of Large Outer Retinal Fold Following Retinal Detachment Surgery With Visual Acuity Restoration to 20/20: A Case Report and Literature Review
Authors: Alhabshan Rashed , Sabbagh Osama , Patronas Marena
Published: July 2018

Purpose:

To report a case of macular fold formation following surgical repair of rhegmatogenous retinal detachment in a 57-year-old man treated with pars plana vitrectomy (PPV), subretinal fluid endodrainage, gas-fluid exchange and sulfur hexafluoride tamponade, and postoperative face-down positioning. We also discuss etiology and prevention of macular fold following retinal detachment surgery and review the literature regarding current trends in the management of this complication.

Methods:

Case report and literature review.

Results:

The macular fold has resolved spontaneously with eventual flattening of and restoration of vision to 20/20 at 12 months postoperatively.

Conclusions:

This case and other recently published reports suggest good outcomes with conservative management of outer retinal folds and partial thickness macular folds. Further research is needed to identify clinical and imaging features that could be used to build criteria to guide management of this complication.
Highly cytotoxic natural killer cells are associated with poor prognosis in patients with cutaneous T-cell lymphoma
Authors: Mundy-Bosse Bethany , Denlinger Nathan , McLaughlin Eric , Chakravarti Nitin , Hwang Susan , Chen Li , Mao Hsiaoyin Charlene , Kline David , Youssef Youssef , Kohnken Rebecca , Lee Dean Anthony , Lozanski Gerard , Freud Aharon G. , Porcu Pierluigi , William Basem , Caligiuri Michael A. , Mishra Anjali
Published: July 2018

Key Points

Paradoxically higher NK-cell activity in CTCL patients is associated with increased expression of phosphorylated STAT5. These highly effective NK cells are associated with poor prognosis in patients with leukemic CTCL.
RETRACTED ARTICLE: Exosome-mediated transfer of lncRNA PART1 induces gefitinib resistance in esophageal squamous cell carcinoma via functioning as a competing endogenous RNA
Authors: Kang Min , Ren Meiping , Li Yan , Fu Yuqiong , Deng Minmin , Li Changping
Published: July 2018

Background

Currently, resistance to tyrosine kinase inhibitors, such as gefitinib, has become a major obstacle in improving the clinical outcome of patients with metastatic and advanced-stage esophageal squamous cell carcinoma (ESCC). While cell behavior can be modulated by long non-coding RNAs (lncRNAs), the roles of lncRNAs within extracellular vesicles (exosomes) are largely unknown. Therefore, we investigated the involvement and regulatory functions of potential lncRNAs enclosed in exosomes during formation of chemoresistance in human ESCC.

Methods

Gefitinib-resistant cell lines were established by continuously grafting TE1 and KYSE-450 cells into gefitinib-containing culture medium. LncRNA microarray assay followed by RT-qPCR were used to verify the differential expression of lncRNA Prostate Androgen-Regulated Transcript 1 (PART1) between gefitinib resistant and parental cell lines. RNA fluorescence in situ hybridization (FISH) was used to investigate whether extracellular PART1 could be incorporated into exosomes and transmitted to recipient cells. Subsequently, a series of in vitro assays and a xenograft tumor model were used to observe the functions of lncRNA PART1 in ESCC cells. A signal transduction reporter array, bioinformatics analysis, western blotting, and immunofluorescence were carried out to verify the regulation of PART1 and its downstream Bcl-2 signaling pathway.

Results

lncRNA PART1 was upregulated in gefitinib-resistant cells when compared to parental ESCC cells. It was found that STAT1 can bind to the promoter region of lncRNA PART1, resulting in its activation. Knockdown of lncRNA PART1 potently promoted the gefitinib-induced cell death, while elevated PART1 promoted gefitinib resistance by competitively binding to miR-129 to facilitate Bcl-2 expression in ESCC cells. In addition, extracellular PART1 could be incorporated into exosomes and transmitted to sensitive cells, thus disseminating gefitinib resistance. Clinically, high levels of serum lncRNA PART1 in exosome were associated with poor response to gefitinib treatment in ESCC patients.

Conclusions

LncRNA PART1 promotes gefitinib resistance by regulating miR-129/Bcl-2 pathway, and may serve as a therapeutic target for ESCC patients.
Phenformin alone or combined with gefitinib inhibits bladder cancer via AMPK and EGFR pathways
Authors: Huang Yanjun , Zhou Sichun , He Caimei , Deng Jun , Tao Ting , Su Qiongli , Darko Kwame Oteng , Peng Mei , Yang Xiaoping
Published: July 2018

Background

In previous studies, we have shown that the combination of metformin and gefitinib inhibits the growth of bladder cancer cells. Here we examined whether the metformin analogue phenformin, either used alone or in combination with gefitinib, could inhibit growth of bladder cancer cells.

Methods

The growth‐inhibitory effects of phenformin and gefitinib were tested in one murine and two human bladder cancer cell lines using MTT and clonogenic assays. Effects on cell migration were assessed in a wound healing assay. Synergistic action between the two drugs was assessed using CompuSyn software. The potential involvement of AMPK and EGFR pathways in the effects of phenformin and gefitinib was explored using Western blotting.

Results

In MTT and clonogenic assays, phenformin was > 10‐fold more potent than metformin in inhibiting bladder cancer cell growth. Phenformin also potently inhibited cell migration in wound healing assays, and promoted apoptosis. AMPK signaling was activated; EGFR signaling was inhibited. Phenformin was synergistic with gefitinib, with the combination of drugs showing much stronger anticancer activity and apoptotic activation than phenformin alone.

Conclusions

Phenformin shows potential as an effective drug against bladder cancer, either alone or in combination with gefitinib.
Improved total magnetization direction determination by correlation of the normalized source strength derivative and the reduced-to-pole fields
Authors: Zhang Henglei , Ravat Dhananjay , Marangoni Yára R. , Chen Guoxiong , Hu Xiangyun
Published: July 2018

The knowledge of total magnetization (magnitude and direction) makes it easier to interpret magnetic anomalies. We have developed a simple crosscorrelation-based method to determine the total magnetization direction of a magnetic source from the vertical derivative of normalized source strength (dNSS) and the reduced-to-pole (RTP) magnetic fields. For most source types, the spread of the dNSS field (or its half-width) is similar to that of the RTP field computed with the correct total magnetization direction, and, thus, the comparison results in a more meaningful correlation coefficient than other functions used in the literature. We have determined the utility of our method using several compact source types (i.e., sphere, dike, horizontal sheet, vertical and horizontal cylinders, and prism). Moreover, the existing methods for determining the direction can be unstable at low latitudes due to noise amplification. A filter that isolates the main features of the anomaly of interest, when applied to both the fields being correlated, improves the performance of the method. We also implement a stabilizing amplitude threshold filter that made the method stable at low latitudes. Model tests indicate that our method estimates the total magnetization directions accurately for low inclinations of total magnetization and inducing field directions. We applied the method to estimate the total magnetization direction of magnetic anomalies in the north and central part of the Goiás Alkaline Province in central Brazil. The RTP fields from the total magnetization directions derived from our method meet the expectations of anomaly symmetry and centering on the outcrops or the edges of the alkaline intrusive bodies. In addition, we found that the resulting magnetic and gravity models of the Goiás Alkaline intrusives were consistent with the geologic model of inverted conical diatremes.
Simultaneous reconstruction of seismic reflections and diffractions using a global hyperbolic Radon dictionary
Authors: Ibrahim Amr , Terenghi Paolo , Sacchi Mauricio D.
Published: July 2018

We have developed a new transform with basis functions that closely resemble seismic reflections and diffractions. The new transform is an extension of the classic hyperbolic Radon transform and accounts for the apex shifts of the seismic reflection hyperbolas and the asymptote shifts of the seismic diffraction hyperbolas. The adjoint and forward operators of the proposed transform are computed using Stolt operators in the frequency domain to increase the computational efficiency of the transform. This new transform is used, in conjunction with a sparse inversion algorithm, to reconstruct common-shot gathers. Our tests indicate that this new transform is an efficient tool for interpolating coarsely sampled seismic data in cases in which one cannot use small data windows to validate the linear event assumption that is often made by Fourier-based reconstruction methods.
Interpretation of borehole sonic measurements acquired in vertical transversely isotropic formations penetrated by vertical wells
Authors: Maalouf Elsa , Torres-Verdín Carlos
Published: July 2018

Detecting vertical transversely isotropic (VTI) formations and quantifying the magnitude of anisotropy are fundamental for describing organic mudrocks. Methods used to estimate stiffness coefficients of VTI formations often provide discontinuous or spatially averaged results over depth intervals where formation layers are thinner than the receiver aperture of acoustic tools. We have developed an inversion-based method to estimate stiffness coefficients of VTI formations that are continuous over the examined depth interval and that are mitigated for spatial averaging effects. To estimate the coefficients, we use logs of frequency-dependent compressional, Stoneley, and quadrupole/flexural modes measured with wireline or logging-while-drilling (LWD) instruments in vertical wells penetrating horizontal layers. First, we calculate the axial sensitivity functions of borehole sonic modes to stiffness coefficients; next, we use the sensitivity functions to estimate the stiffness coefficients of VTI layers sequentially from frequency-dependent borehole sonic logs. Because sonic logs exhibit spatial averaging effects, we deaverage the logs by calculating layer-by-layer slownesses of formations prior to estimating stiffness coefficients. The method is verified with synthetic models of homogeneous and thinly bedded formations constructed from field examples of organic mudrocks. Results consist of layer-by-layer estimates of [Formula: see text], [Formula: see text], [Formula: see text], [Formula: see text], and [Formula: see text]. We observe three sources of error in the estimated coefficients: (1) bias error originating from deaveraging the sonic logs prior to the sequential inversion, (2) error propagated during the sequential inversion, and (3) error associated with noisy slowness logs. We found that the relative bias and uncertainty of the estimated coefficients are largest for [Formula: see text] and [Formula: see text] because borehole modes exhibit low sensitivity to these two coefficients. The main advantage of our method is that it mitigates spatial averaging effects of sonic logs, while at the same time it detects the presence of anisotropic layers and yields continuous estimations of stiffness coefficients along the depth interval of interest.