bluuebunny/crossref_metadata_2025 huggingface dataset:
Theoretical analysis and experimental validation of multi‐level friction damping system
Authors: Chien Chia‐Shang Chang , Guo Mei‐Ting
Published: June 2024

Most traditional passive friction dampers are limited to the design of single activated energy dissipation mechanism; therefore, when the seismic intensity is not strong enough to activate the mechanism, traditional friction dampers can only increase stiffness of the structure just like braces; only when the mechanism is activated will the energy dissipation elements perform energy absorption and assist the structure to absorb received seismic energy. The objective of this study is to improve this defect of traditional friction dampers, developing a Multi–Level Friction Damper (MFD) with a two‐stage energy dissipation mechanism, helping building structures (e.g., hospitals, high‐tech plants) reduce the acceleration responses of the superstructure. MFDs are proven to provide more comprehensive protection and have higher energy dissipation benefits than traditional friction dampers by the validation of numerical analysis and shaking table test. The study in turn performed parameter fitting with the results of the numerical simulation analysis and shaking table test, and the experimental results turned out to be satisfactory, validating the accuracy of the theoretical formulas.
Network pharmacology and molecular docking analysis of cold‐pressed rapeseed oil active components for anti‐inflammatory effects
Authors: Fu Jin , Huang Taocui , Shi Hui , Han Mei , Zhong Geng
Published: June 2024

Investigating the anti‐inflammatory effects of bioactive components present in cold‐pressed rapeseed oil through the use of network pharmacology and molecular docking methods. The components of cold‐pressed rapeseed oil were identified by liquid chromatography‐mass spectrometry. We then conducted Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analysis using bioinformatics databases on overlapping targets affected by active components and inflammation. Finally, molecular docking was used to predict the interactions between core components and key targets. Analysis identified 13 phenols, four steroids, and one retinoid in cold‐pressed rapeseed oil, with 143 overlapping targets related to inflammation. Bioinformatics analysis revealed that 25‐Hydroxycholesterol, Rosmarinic acid, 9‐cis‐Retinoic acid, Soyasapogenol B and α‐Tocopherol in cold‐pressed rapeseed oil could play a positive role in treating inflammation. They achieved this by regulating key targets (MMP9, EGFR, AKT1, ESR1, and PTGS2) involved in the peroxisome proliferator‐activated receptor signaling pathway and other related pathways. The molecular docking binding energy of the core components and the key targets were less than −5.0 kcal/mol, indicating that the components and the targets can be stably bound. This result indicated that the active components found in cold‐pressed rapeseed oil may exert an anti‐inflammatory effect through a synergistic mechanism involving multicomponent, multitarget and multipathway interactions.
Strengthening the family planning component of maternal health care: A new call to action to seize the opportunity provided by universal health coverage and primary healthcare frameworks
Authors: Tripathi Vandana , RamaRao Saumya , Kabra Rita , Raney Laura , Temba Anna , Wickstrom Jane , Sridhar Aparna
Published: June 2024

Synopsis

Scaling up postpartum and postabortion family planning requires stronger health system stewardship, community and private sector engagement, measurement, and financing. Maternal health leadership is essential.
Robotic‐assisted versus conventional laparoscopic management of deep endometriosis involving the sacral plexus and sciatic nerve: A comparative before and after study
Authors: Massimello Francesca , Merlot Benjamin , Chanavaz‐Lacheray Isabella , Volodarsky‐Parel Alex , Cela Vito , Kade Sandesh , Dennis Thomas , Roman Horace
Published: June 2024

Objective

To compare robotic‐assisted laparoscopy (RAL) and laparoscopy (LPS) for intraoperative and postoperative outcomes, and functional results after a 6‐month follow‐up period among patients having undergone excision of deep endometriosis (DE) involving the sacral plexus (SP) and sciatic nerve (SN).

Methods

A retrospective analysis of 100 patients included in our prospective database, who underwent surgical eradication of DE involving the SP and SN at our tertiary referral centre between September 2018 and June 2023. Patients were managed by LPS (n = 71) until 2021, and subsequently by RAL (n = 29).

Results

Baseline symptoms and distribution of DE lesions were comparable in the two groups. Nerve dissection, nerve shaving, and intra‐nerve dissection were performed in 55 (77.5%), 14 (19.7%), and 2 (5.6%) patients in the LPS group, respectively. Nerve dissection and nerve shaving were performed and in 24 (82.8%) and 5 (17.2%) patients in the RAL group, while no cases of intra‐nerve dissection were observed (P = 0.434). Mean operative times were 183.71 ± 85.32 min and 177.41 ± 77.19 min, respectively (P = 0.734). There were no reported cases of conversion to open surgery. Intraoperative and early postoperative complications were comparable between the two groups. At 6 months follow up, we observed a significant reduction in sciatic pain in both the LPS group (39.1% vs 15.6%, P < 0.001) and RAL group (37.5% vs 25%, P = 0.001), with no differences in terms of outcomes (P = 0.1).

Conclusion

Both LPS and RAL result in significant long‐term relief of symptoms associated with SP and SN endometriosis. Although surgeons found that RAL improved the quality of excision of these specific DE localizations, our study did not reveal significant advantages in terms of its outcomes.
Genetic manipulations of nonmodel gut microbes
Authors: Jin Wen‐Bing , Guo Chun‐Jun
Published: June 2024

Hundreds of microbiota gene expressions are significantly different between healthy and diseased humans. The “bottleneck” preventing a mechanistic dissection of how they affect host biology/disease is that many genes are encoded by nonmodel gut commensals and not genetically manipulatable. Approaches to efficiently identify their gene transfer methodologies and build their gene manipulation tools would enable mechanistic dissections of their impact on host physiology. This paper will introduce a step‐by‐step protocol to identify gene transfer conditions and build the gene manipulation tools for nonmodel gut microbes, focusing on Gram‐negative Bacteroidia and Gram‐positive Clostridia organisms. This protocol enables us to identify gene transfer methods and develop gene manipulation tools without prior knowledge of their genome sequences, by targeting bacterial 16s ribosomal RNAs or expanding their compatible replication origins combined with clustered regularly interspaced short palindromic repeats machinery. Such an efficient and generalizable approach will facilitate functional studies that causally connect gut microbiota genes to host diseases.
Heterogeneous distribution of viscosupplements in vivo is correlated to ex vivo frictional properties of equine cartilage
Authors: Vishwanath Karan , McClure Scott R. , Bonassar Lawrence J.
Published: June 2024

Intra‐articular injections of hyaluronic acid (HA) are the cornerstone of osteoarthritis (OA) treatments. However, the mechanism of action and efficacy of HA viscosupplementation are debated. As such, there has been recent interest in developing synthetic viscosupplements. Recently, a synthetic 4 wt% polyacrylamide (pAAm) hydrogel was shown to effectively lubricate and bind to the surface of cartilage in vitro. However, its ability to localize to cartilage and alter the tribological properties of the tissue in a live articulating large animal joint is not known. The goal of this study was to quantify the distribution and extent of localization of pAAm in the equine metacarpophalangeal or metatarsophalangeal joint (fetlock joint), and determine whether preferential localization of pAAm influences the tribological properties of the tissue. An established planar fluorescence imaging technique was used to visualize and quantify the distribution of fluorescently labeled pAAm within the joint. While the pAAm hydrogel was present on all surfaces, it was not uniformly distributed, with more material present near the site of the injection. The lubricating ability of the cartilage in the joint was then assessed using a custom tribometer across two orders of magnitude of sliding speed in healthy synovial fluid. Cartilage regions with a greater coverage of pAAm, that is, higher fluorescent intensities, exhibited friction coefficients nearly 2‐fold lower than regions with lesser pAAm (Rrm = −0.59, p < 0.001). Collectively, the findings from this study indicate that intra‐articular viscosupplement injections are not evenly distributed inside a joint, and the tribological outcomes of these materials is strongly determined by the ability of the material to localize to the articulating surfaces in the joint.
Third‐generation posterior‐stabilised cemented system for total knee arthroplasty: Survivorship and outcomes after 20‐year follow‐up
Authors: Patiño Contreras José Luis , Sebastián Pérez Victoria , Antonio Checa García , Jorge Montejo Sancho , Javier Martínez Martín
Published: June 2024

Purpose

Total knee arthroplasty is a common procedure due to increased life expectancy and ageing populations, necessitating implants with long‐term efficacy. After some initial designs, the third‐generation modular posterior‐stabilised NexGen® prosthesis aimed to enhance kinematics and reduce complications. This study evaluates the long‐term outcomes, survivorship, revision rates and complications of this implant. With promising results observed up to 15 years in previous studies, this investigation aims to assess the implant's performance over extended follow‐up periods, aiding in optimal implant selection for improved patient outcomes.

Methods

We carried out a retrospective study on 263 total knee arthroplasties performed in our centre between 1998 and 2002. Statistical analysis of complications was performed and study of survival using the Kaplan–Meier method and competing risk analysis were calculated. Description of reinterventions and complications were also included.

Results

Results show a 20‐year prosthesis survival rate of 90.8% for revision due to any reason, with an estimated survival of 92.3% considering competitive events. Estimated survivorship at 20 years is 98% for aseptic loosening as the end point, and an estimation of 98.80% considering competitive events. Twenty revisions were performed, with 10 cases due to infection and 10 for noninfectious reasons and three of them due to aseptic loosening. Radiographic analysis revealed radiolucent lines, but no clinical evidence of loosening was observed in these cases.

Conclusion

This study offers survivorship data from longer follow‐up periods, what is difficult to find in the reported literature and showed excellent results of this implant in terms of survivorship and low rates of revision in our cohort.

Level of Evidence

Level IV.
Chitosan‐based scaffold augmentation to microfractures: Stable results at mid‐term follow‐up in patients with patellar cartilage lesions
Authors: De Marziani Luca , Boffa Angelo , Andriolo Luca , Di Martino Alessandro , Filardo Giuseppe , Zaffagnini Stefano
Published: June 2024

Purpose

Patellar cartilage lesions are a frequent and challenging finding in orthopaedic clinical practice. This study aimed to evaluate a chitosan‐based scaffold's mid‐term clinical and imaging results patients with patellar cartilage lesions.

Methods

Thirteen patients (nine men, four women, 31.3 ± 12.7 years old) were clinically evaluated prospectively at baseline, 12, 24 and at a final minimum follow‐up of 60 months (80.2 ± 14.7) with International Knee Documentation Committee (IKDC) subjective, Knee Injury and Osteoarthritis Outcome Score and Tegner scores. A magnetic resonance analysis was performed at the last follow‐up using the Magnetic resonance Observation of CArtilage Repair Tissue (MOCART) 2.0 score.

Results

An overall significant clinical improvement in the scores was observed from baseline to all follow‐ups, with stable clinical results from 24 months to the mid‐term evaluation. The IKDC subjective score passed from 46.3 ± 20.0 at baseline to 70.1 ± 21.5 at the last follow‐up (p = 0.029). Symptoms' duration before surgery negatively correlated with the clinical improvement from baseline to the final follow‐up (p = 0.013) and sex influenced the improvement of activity level from the preoperative evaluation to the final follow‐up, with better results in men (p = 0.049). In line with the clinical findings, positive results were documented in terms of cartilage repair quality with a mean MOCART 2.0 score of 72.4 ± 12.5.

Conclusions

Overall, the use of this chitosan‐based scaffold provided satisfactory results with a stable clinical improvement up to mid‐term follow‐up, which should be confirmed by further high‐level studies to be considered a suitable surgical option to treat patients affected by patellar cartilage lesions.

Level of Evidence

Level IV, prospective case series.
Are transmembrane 6 superfamily member 2 gene polymorphisms associated with steatohepatitis after pancreaticoduodenectomy?
Authors: Mori Tomotaka , Ozawa Eisuke , Sasaki Ryu , Shimakura Akane , Takahashi Kosuke , Kido Yoko , Kanda Yasuko , Matsuo Satoshi , Tajima Kazuaki , Beppu Asami , Nakao Yasuhiko , Fukushima Masanori , Haraguchi Masafumi , Miuma Satoshi , Miyaaki Hisamitsu , Adachi Tomohiko , Eguchi Susumu , Okano Shinji , Nakao Kazuhiko
Published: June 2024

Aim

After pancreaticoduodenectomy, 20–40% of patients develop steatotic liver disease (SLD), and steatohepatitis can be a problem. Although patatin‐like phospholipase domain‐containing 3 protein (PNPLA3) and transmembrane 6 superfamily member 2 (TM6SF2) polymorphisms are involved in SLD and steatohepatitis development, whether this is the case after pancreaticoduodenectomy is unclear.

Methods and Results

Forty‐three patients with pancreatic cancer who underwent pancreaticoduodenectomy at our hospital between April 1, 2018, and March 31, 2021, were included. We extracted DNA from noncancerous areas of residual specimens after pancreaticoduodenectomy and determined PNPLA3 and TM6SF2 gene polymorphisms using real‐time polymerase chain reaction. SLD was defined as a liver with an attenuation value of ≤40 HU or a liver‐to‐spleen ratio of ≤0.9 on computed tomography. We defined high hepatic fibrosis indexes (HFI) instead of steatohepatitis as a Fibrosis‐4 index of ≥2.67 or nonalcoholic fatty liver disease fibrosis score of ≥0.675 in patients with SLD. The cumulative incidence of SLD (P = 0.299) and high HFI (P = 0.987) after pancreaticoduodenectomy were not significantly different between the PNPLA3 homozygous and minor allele groups. The incidences of high HFI at 1 year after pancreaticoduodenectomy were 16.8% and 27.0% in the TM6SF2 major homozygous and minor allele groups, respectively, with a significant difference in the cumulative incidence (P = 0.046).

Conclusion

The TM6SF2 minor allele may contribute to steatohepatitis development after pancreaticoduodenectomy.
Adherence to therapeutic gastroscopy guidelines for acute esophageal food bolus impaction: Impact on adverse outcomes and length of stay
Authors: Pan Fei Yang , Duong Tuan Anh , Davis Kimberley J. , Smale Matthew , Kapoor Sahil , Rogge Claudia
Published: June 2024

Background and Aim

According to the European Society of Gastrointestinal Endoscopy (ESGE), gastroscopy should be conducted within 6 h for complete obstruction and 24 h for incomplete obstruction due to food bolus impaction. This study explores whether adults with acute esophageal food bolus (FB) impaction experience adverse outcomes when their time to esophagogastroduodenoscopy (EGD) deviates from the recommended guidelines.

Methods

A retrospective review was performed on the records of 248 patients who presented at the study site between 2015 and 2022 with symptoms of FB impaction.

Results

Two hundred and forty‐eight patients underwent EGD for FB impaction. Grade 1 (erosion, ulceration), Grade 2 (tear), and Grade 3 (perforation) complications were present in 31.6%, 6.9%, and 0.8% of cases, respectively. Of the 134 (54.0%) patients with complete obstruction, 51 (38.1%) received EGD within the recommended 6 h. Of the 114 (46%) patients with incomplete obstructions, 93 (81.6%) received EGD within the recommended 24 h. There was no statistically significant correlation between length of stay (LOS) post‐EGD and any of ingestion to presentation time, presentation to EGD time, or ingestion to EGD time. Age and complication level were greater predictors of longer LOS than presentation to EGD time. Patients who presented in hours were significantly more likely to receive EGD within the 6‐ and 24‐h guidelines than those who presented out of hours (50.7% vs 22.0%).

Conclusion

Neither time to EGD from ingestion of food bolus nor time to EGD from hospital presentation correlated with complication rate, complication severity, or length of stay post‐EGD.
Oxidative balance score and associations with dyslipidemia and mortality among US adults: A mortality follow‐up study of a cross‐sectional cohort
Authors: Kong Xiufang , Gao Xinghui , Wang Wei
Published: June 2024

Background

Oxidative stress has been implicated in the pathogenesis and progression of dyslipidemia. We aimed to investigate the association between the oxidative balance score, and dyslipidemia, as well as to assess the mortality risk associated with oxidative balance score in patients with dyslipidemia.

Methods

We performed a mortality follow‐up study of a cross‐sectional cohort of 26,118 adults from the National Health and Nutrition Examination Survey 1999–2018. The total oxidative balance score was calculated by 16 dietary nutrients (dietary oxidative balance score) and four lifestyle factors (lifestyle oxidative balance score). Weighted Cox proportional hazard model was applied to determine the relationship between oxidative balance score and all‐cause or cardiovascular disease (CVD) mortality within the dyslipidemia group.

Results

During a median follow‐up of 118 months, 2448 all‐cause deaths (766 CVD‐related) occurred. A significant negative correlation was observed between total oxidative balance score, dietary oxidative balance score, lifestyle oxidative balance score, and dyslipidemia. The multivariable‐adjusted odds ratios and 95% CIs for dyslipidemia were 0.86 (0.77–0.97), 0.80 (0.72–0.91), and 0.63 (0.56–0.70), respectively, when comparing the second, third, and fourth quartiles of total oxidative balance score to the reference lowest quartile (P for trend <0.0001). Increasing total oxidative balance score was inversely associated with all‐cause (hazard ratio [HR] = 0.98, 95% CI 0.98–0.99) and CVD‐specific mortality (HR = 0.98, 95% CI 0.97–0.99) in participants with dyslipidemia.

Conclusions

Oxidative balance score is inversely associated with dyslipidemia and linked to all‐cause and CVD‐related mortality, highlighting the potentially protective role of an antioxidant‐rich diet against dyslipidemia.
Association between chronic intestinal failure etiology and eGFR trajectory in adults receiving home parenteral nutrition: A retrospective longitudinal cohort study
Authors: Kopczynska Maja , Miller Bethany , White Katherine L. , Green Darren , Barrett Maria , Ahmed Saadat , Cloutier Anabelle , Taylor Michael , Teubner Antje , Abraham Arun , Carlson Gordon , Lal Simon
Published: June 2024

Background

Patients with chronic intestinal failure (CIF) are at increased risk of developing renal impairment. The aim of this study was to evaluate the occurrence of chronic kidney disease (CKD) in patients dependent on home parenteral nutrition (HPN) and assess risk factors for renal impairment, including patients with all mechanisms of CIF.

Methods

This was a cohort study of patients initiated on HPN between March 1, 2015, and March 1, 2020, at a national UK IF Reference Centre. Patients were followed from their first discharge with HPN until HPN cessation or the end of follow‐up on December 31, 2021.

Results

There were 357 patients included in the analysis. Median follow‐up time was 4.7 years. At baseline, >40% of patients had renal impairment, with 15.4% fulfilling the criteria for CKD. Mean estimated glomerular filtration rate (eGFR) decreased significantly during the first year after initiation of HPN from 93.32 ml/min/1.73 m2 to 86.30 ml/min/1.73 m2 at the first year of follow‐up (P = 0.002), with sequential stabilization of renal function. Increased age at HPN initiation and renal impairment at baseline were associated with decreased eGFR. By the end of follow‐up, 6.7% patients developed renal calculi and 26.1% fulfilled the criteria for CKD.

Conclusion

This is the largest study of renal function in patients receiving long‐term HPN. After the first year following HPN initiation, the rate of decline in eGFR was similar to that expected in the general population. These findings should reassure patients and clinicians that close monitoring of renal function can lead to good outcomes.
The role of the most cranial trochlear orientation in patellar maltracking to better characterise trochlear morphology
Authors: Giovannetti de Sanctis Edoardo , Toanen Cecile , Guarino Amedeo , Pineda Tomas , Deroche Etienne ,   Resurg, Dejour David H.
Published: June 2024

Purpose

The purpose of our study is to describe a magnetic resonance imaging quantitative parameter to assess the morphology of the trochlea that could be measurable from normal to high‐grade trochlear dysplasia while evaluating the most proximal slice with trochlear cartilage.

Methods

Two groups of patients have been compared: patients with no patellofemoral pain, no previous trauma and undergoing surgery for a suspected isolated meniscal tears (group A) and patients with objective patellar instability (group B). The cranial trochlear orientation (CTO) angle is defined as the angle between the posterior bicondylar line and the most lateral and most medial points on the subchondral bone covered by cartilage digitised on the first and most cranial image with the trochlear cartilage clearly visible.

Results

The final cohort included 253 patients (109 in group A and 144 in group B). CTO was significantly higher in group B (−2.5 ± 8.4 vs. −10.8 ± 5,1; p < .001). Moreover, 75% of knees in group B had a CTO > −7°, while 75% of knees in group A had a CTO < −7°. CTO was measurable in all 253 knees, whereas the lateral trochlear inclination and the sulcus angle were measurable in only 202 knees. The entire cohort was also divided into knees with CTO ≤ 0° and CTO > 0°. All knees with a CTO > 0 were in group B, and 49% of knees with CTO < 0 were in group B. CTO was positively correlated with lateral patellar tilt.

Conclusions

CTO is the only parameter that can be measured on the most cranial slice, in every patient, even in high‐grade trochlear dysplasia. According to this new system, the axial trochlear shape may be divided into two types: a positive CTO and a negative CTO, with the trochlea serving, respectively, as a medial and lateral barrier.

Level of Evidence

Level III.
Clinical outcomes following transtibial medial meniscal root repair are maintained at long‐term follow‐up
Authors: Moore Michael , Levitt Sarah , Lin Charles C. , Wolfe Isabel , Alaia Erin , Meislin Robert , Strauss Eric J. , Jazrawi Laith , Alaia Michael J. , Kaplan Daniel
Published: June 2024

Purpose

To evaluate long‐term outcomes of patients treated with posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and to identify patient surgical and magnetic resonance imaging (MRI) characteristics associated with improved outcomes.

Methods

This was a single‐centre, retrospective study evaluating patients who had undergone a PMMR repair using a transtibial suture pullout technique with two locking cinch sutures. This was performed as a follow‐up to previously published 2‐year and 5‐year outcome studies, using the same cohort. All patients from the prior short‐term and midterm studies were invited to participate. Patient‐reported outcome (PROs) scores, including the International Knee Documentation Committee (IKDC) and Lysholm scores, were collected. Previously collected demographic data were updated based on review of the electronic medical record. Patient outcomes were assessed preoperatively, as well as at 2‐year, 5‐year and 8‐year postoperatively. MRI outcome measurements were assessed at 2‐year and 5‐year follow‐ups. All statistical analysis was performed using SPSS version 26.

Results

Seventeen patients of the original 18 patients (94.4%) were included in the final analysis. Additionally, three patients who had additional ipsilateral surgery were excluded from the analysis of PROs. The IKDC score significantly increased from 44.7 ± 11.6 at preoperative baseline to 71.2 ± 21.3 at 8‐year post‐operation (p = 0.001). There were no significant differences in IKDC score between 2‐year and 8‐year follow‐ups (p = n.s.) or 5‐year and 8‐year follow‐ups (p = n.s.). The Lysholm score significantly increased from 49.6 ± 7.3 at preoperative baseline to 76.4 ± 17.2 at 8‐year follow‐up (p < 0.001). There was no significant difference in Lysholm scores between 2‐year and 8‐year follow‐ups (p = n.s.) or 5‐year and 8‐year follow‐ups (p = n.s.). A linear regression analysis found that 5‐year IKDC scores were significantly correlated with 8‐year IKDC scores (β = 0.681, p = 0.038). At 8‐year follow‐up, four (23.5%) patients required additional procedures on their operative knee (one total knee arthroplasty conversion).

Conclusion

Patients treated with repair of PMMRT had maintenance of clinical outcome improvements at long‐term follow‐up despite worsening MRI outcomes at short‐term and medium‐term follow‐ups. While a high proportion of patients required additional procedures on their operative knee at 8‐year follow‐up, few of these patient's additional procedures were related to failure of their primary surgery. Providers and patients may expect durable clinical outcomes following the repair of PMMRT, irrespective of radiographic appearance.

Level of Evidence

Level IV.
Combined ACLR and lateral extra‐articular tenodesis with a continuous iliotibial band autograft is a viable option in a population of athletes who participate in pivoting sports
Authors: Lutz Christian , Casin Charles , Pioger Charles , Jacquot Xavier , Jaeger Jean‐Henri , Van Hille William
Published: June 2024

Purpose

The aim of this study was to evaluate the clinical results, return to sport and complications after anterior cruciate ligament reconstruction (ACLR) associated with lateral extra‐articular tenodesis using continuous plasty with an iliotibial band.

Methods

This was a prospective multicentre study involving 186 patients who had surgery for anterior cruciate ligament (ACL) rupture. Patients with multiligament ruptures and revision surgery were excluded from the study. All patients included were involved in pivoting sports and wished to resume their activity after surgery. Patients were assessed at a minimum 2‐year follow‐up using functional and psychological questionnaires (subjective International Knee Documentation Committee [IKDC], Tegner, Lysholm and ACL‐RSI scores), ligament assessment including instrumented laxity measurement (Rolimeter), Lachman test and pivot shift and isokinetic testing. Return to sport was assessed using a questionnaire, and complications and repeat surgeries were recorded.

Results

At a mean follow‐up of 43.1 months, the subjective IKDC, Lysholm, ACL‐RSI and objective IKDC scores were significantly improved (59.8 vs. 94.5 p < 0.0001, 75 vs. 99 p < 0.0001, 60 vs. 93 p < 0.0001, IKDC A 0% vs. 72%, B 12% vs. 27%, C 60% vs. 1% D 28% vs. 0% p < 0.0001). The Tegner activity level was 9 (3–10) before the accident and 9 (3–10) at the last review. Seventy‐six percent of the patients had returned to sports at the same level. The differential laxity was 6.6 mm (±1.7) preoperatively and 1.1 mm (±1.4) postoperatively. Additionally, 97% were equal in pivot shift at the last follow‐up. At the 6‐month isokinetic assessment, the muscle strength recovery for the quadriceps and hamstring was over 85% compared with the healthy side for 79% and 70% of the patients, respectively. Ten patients had graft rupture (5.6%). Four (2.4%) patients had a contralateral ACL rupture, and seven (4%) underwent a reoperation with meniscectomy.

Conclusion

Anterior ligament reconstruction with lateral extra‐articular tenodesis using a continuous strip of iliotibial band enables 76% of patients in a population with a high demand for sports to resume their activities at the same level. The clinical results and complication rates, particularly reruptures (5.6%), were similar to those of other techniques involving lateral extra‐articular tenodesis.

Level of Evidence

Level II.
Comparable results in total knee arthroplasty using the ROSA knee system versus the conventional technique: A retrospective propensity‐matched cohort study
Authors: Hax Jakob , Leuthard Louis , Baumann Gregor , Preiss Stefan , Stadelmann Vincent A. , Worlicek Michael
Published: June 2024

Purpose

Robotic‐assisted total knee arthroplasty (RA‐TKA) is an increasingly popular alternative that may increase the accuracy of conventional TKA techniques. This study aims to evaluate RA‐TKA accuracy and compare its radiographic and clinical outcomes to conventional TKA (cTKA).

Methods

A retrospective examination of patients with bi‐ or tricompartmental knee osteoarthritis who underwent RA‐TKA (RObotic Surgical Assistant system) or cTKA and were prospectively documented in the TKA registry. Accuracy was assessed using standardized radiographic implant position evaluations, namely femoral and tibial coronal angles and femoral and tibial sagittal angles. Baseline demographics, surgery details and 6‐ and 12‐month post‐TKA patient‐reported outcomes (PROMs; e.g., Oxford Knee Score [OKS] and Core Outcome Measures Index) were compared between RA‐TKA and propensity score‐matched cTKA patients.

Results

Overall correlation between preset and 6‐week postoperative angle measurements for RA‐TKA was low with significant differences noted only for mean tibial sagittal angles (84.6° [RA‐TKA] vs. 82.3° [cTKA]) (p < 0.001). The study groups were demographically similar, although RA‐TKA patients had slightly longer operative times and higher blood loss but shorter inpatient stays. There were sustainable improvements in all PROMs already at 6 months, yet RA‐TKA patients had significantly higher OKS values over their conventional counterparts at this time point.

Conclusion

Radiological and clinical outcomes were comparable between RA‐TKA and cTKA. The robotic‐assisted system demonstrated higher accuracy in the coronal than sagittal plane and RA‐TKA patients achieved better short‐term outcomes for pain and disability. While both methods are similar in the hands of a skilled surgeon, long‐term studies are necessary to establish clear method superiority.

Level of Evidence

Level III, therapeutic study.
Subacromial balloon spacer massive rotator cuff tear treatment systematic review and meta‐analysis: Patient selection and physical therapy may be keys to outcome success
Authors: Sirignano Michael , Nyland John , Krupp Ryan
Published: June 2024

Purpose

Subacromial balloon spacer implantation (SBSI) efficacy for massive rotator cuff tear treatment was evaluated based on perceived shoulder function, active shoulder mobility, pain, complications and research study methodological quality. The purpose was to better discern the efficacy of this device from both surgical and rehabilitative perspectives to improve patient outcomes.

Methods

PubMed, EMBASE and Cochrane Library databases were searched (1 January 2010 to 1 June 2024) using ‘balloon spacer’, ‘subacromial spacer’, ‘subacromial balloon spacer’, ‘shoulder spacer’ and ‘inspace’ terms. Pre‐surgery (baseline), 12‐month (12‐m) and 24‐month (24‐m) post‐SBSI mean changes were compared using one‐way ANOVA and Scheffe post hoc tests, and comparative study effect sizes were calculated (p ≤ 0.05).

Results

This review consists of 27 studies with 894 patients (67.8 ± 5 years of age) and 29.4 ± 17‐month follow‐up. Modified Coleman Methodology Scores (MCMS) revealed fair overall quality (mean = 61.4 ± 11). Constant–Murley scores improved from 34.8 ± 6 (baseline), to 64.2 ± 9 (12‐m) and 67.9 ± 8 (24‐m) (12‐m, 24‐m > baseline, p < 0.001). ASES scores improved from 35.1 ± 14 (baseline), to 83.3 ± 7 (12‐m) and 81.8 ± 5 (24‐m)(12‐m, 24‐m > baseline, p < 0.001). VAS pain scores improved from 6.6 ± 1 (baseline), to 2.6 ± 1 (12‐m) and 2.0 ± 1 (24‐m) (12‐m, 24‐m < baseline, p < 0.001). Flexion increased from 108.5 ± 25° (baseline), to 128.5 ± 30° (12‐m) and 151.2 ± 14° (24‐m) (24‐m > 12‐m, baseline, p = 0.01). Abduction increased from 97.7 ± 24° (baseline) to 116.3 ± 23° (12‐m) and 142.3 ± 15° (24‐m) (24‐m > 12‐m, baseline, p = 0.02). External rotation (ER) in adduction changed from 33.1 ± 7° (baseline) to 32.5 ± 4° (12‐m) and 53.9 ± 9° (24‐m)(24‐m > 12‐m, baseline, p = 0.01). ER at 90° abduction increased from 56.3 ± 3° (baseline) to 83.5 ± 5° (12‐m) and 77.1 ± 4° (24‐m) (24‐m, 12‐m > baseline, p = 0.01). Comparison studies, however, displayed insignificant results with small effect sizes.

Conclusion

Despite overall fair MCMS scores, at 24‐m post‐SBSI, shoulder function improved and pain decreased. More rigorous comparative studies, however, revealed insignificant findings. Patients with the potential to re‐establish the essential glenohumeral joint force couple that depresses the humeral head on the glenoid fossa and who comply with physical therapy may be more likely to achieve success following SBSI.

Level of Evidence

Level IV.
Partially PEG‐Grafted Poly(Terphenyl Piperidinium) Anion Exchange Membranes with Balanced Properties for Alkaline Fuel Cells
Authors: Chu Dongrui , Shao Runan , Zhang Jingjing , Zhou Qiyu , Zheng Zhichao , Xu Yangyang , Liu Lei
Published: June 2024

Poly(ethylene glycol) (PEG) or oligo (ethylene glycol) (OEG) grafted anion exchange membranes (AEMs) exhibit improved ionic conductivity, high alkaline stability, and subsequent boosted AEM fuel cell performance, but too much PEG/OEG side chains may can result in a reduction in the ion exchange capacity (IEC), which can have adverse effects on ion transport. Here, a series of partially PEG‐grafted poly(terphenyl piperidinium) with different side chain length are synthesized using simple postpolymerization modification to produce AEMs with balanced properties. The polar and flexible PEG side chains are responsible for the controlled water uptake and swelling, superior hydroxide conductivity (122 mS cm−1 at 80 °C with an IEC of 1.99 mmol g−1), and enhanced alkaline stability compared to the reference sample without PEG grafts (PTP). More importantly, the performance of AEM fuel cell (AEMFC) with the membrane containing partial PEG side chains surpasses that with PTP membrane, demonstrating a highest peak power density of 1110 mW cm−2 at 80 °C under optimized conditions. This work provides a novel approach to the fabrication of high‐performance AEM materials with balanced properties for alkaline fuel cell application.
Development of an algorithm for proton dose calculation in magnetic fields
Authors: Gu Yue , Wang Yuxiang , Liu Meiqi , Lu Hsiao‐Ming , Yang Yidong
Published: June 2024

Background

The advantages of proton therapy can be further enhanced with online magnetic resonance imaging (MRI) guidance. One of the challenges in the realization of MRI‐guided proton therapy (MRPT) is accurately calculating the radiation dose in the presence of magnetic fields.

Purpose

This study aims to develop an efficient and accurate proton dose calculation algorithm adapted to the presence of magnetic fields.

Methods

An analytical‐numerical radiation dose calculation algorithm, Proton and Ion Dose Engine (PRIDE), was developed. The algorithm combines the pencil beam algorithm (PBA) with a novel iterative voxel‐based ray‐tracing algorithm. The new ray‐tracing method uses fewer assumptions and ensures broader applicability for proton beam trajectory prediction in magnetic fields, and has been compared to Wolf's method and Schellhammer's method. The accuracy of PRIDE algorithm was validated on three phantoms and two practical plans (one single‐field water plan and one prostate tumor plan) in different magnetic field strengths up to 3.0 T. The validation was performed by comparing the results against the Monte Carlo (MC) simulations, using the global gamma index criteria of 2%/2 mm and 3%/3 mm with a 10% threshold.

Results

PRIDE showed good agreement with MC in homogeneous and slab heterogeneous phantom, achieving gamma passing rates (%GPs) above 99% for 2%/2 mm criteria when magnetic field strength is not greater than 1.5 T. Although the agreement decreased for scenarios involving high proton energy (240 MeV) and strong magnetic field (3.0 T), the 2%/2 mm %GPs still remained above 98%. In lateral heterogeneous phantom, the accuracy of PRIDE decreased due to the PBA's limitation. For the two practical plans in different magnetic fields, %GPs exceeded 98% and 99% for 2%/2 mm and 3%/3 mm criteria, respectively.

Conclusions

PRIDE can perform efficient and accurate proton dose calculation in magnetic fields up to 3.0 T, and is expected to work as a useful tool for proton dose calculation in MRPT.
Optimizing spot intensity with lower bound constraints for IMPT: Exposing shortcomings and introducing an enhanced strategy
Authors: Han Dong , Tong Jingdong , Yang Yu , Liu Hongcheng , Liang Xiaoying , Yaddanapudi Sridhar , Park Chunjoo , Tan Jun , Furutani Keith , Beltran Chris , Lu Bo
Published: June 2024

Background

Intensity Modulated Proton Therapy (IMPT) is a sophisticated radiation treatment allowing for precise dose distributions. However, conventional spot selection strategies in IMPT face challenges, particularly with minimum monitor unit (MU) constraints, affecting planning quality and efficiency.

Purpose

This study introduces an innovative Two‐Stage Mixed Integer Linear Programming (MILP) method to optimize spot intensity in IMPT with Lower Bound (LB) constraints. This method seeks to improve treatment planning efficiency and precision, overcoming limitations of existing strategies.

Methods

Our approach evaluates prevalent IMPT spot selection strategies, identifying their limitations, especially concerning MU constraints. We integrated LB constraints into a MILP framework, using a novel three‐phase strategy for spot pool selection, to enhance performance over traditional heuristic methods and L1 + L∞ strategies. The method's efficacy was tested in eight study cases, using Dose‐Volume Histograms (DVHs), spot selection efficiency, and computation time analysis for benchmarking against established methods.

Results

The proposed method showed superior performance in DVH quality, adhering to LB constraints while maintaining high‐quality treatment plans. It outperformed existing techniques in spot selection, reducing unnecessary spots and balancing precision with efficiency. Cases studies confirmed the method's effectiveness in producing clinically feasible plans with enhanced dose distributions and reduced hotspots, especially in cases with elevated LB constraints.

Conclusions

Our Two‐Stage MILP strategy signifies a significant advancement in IMPT treatment planning. By incorporating LB constraints directly into the optimization process, it achieves superior plan quality and deliverability compared to current methods. This approach is particularly advantageous in clinical settings requiring minimum spot number and high MU LB constraints, offering the potential for improved patient outcomes through more precise and efficient radiation therapy plans.
A review on 4D cone‐beam CT (4D‐CBCT) in radiation therapy: Technical advances and clinical applications
Authors: Zhang Yawei , Jiang Zhuoran , Zhang You , Ren Lei
Published: June 2024

Cone‐beam CT (CBCT) is the most commonly used onboard imaging technique for target localization in radiation therapy. Conventional 3D CBCT acquires x‐ray cone‐beam projections at multiple angles around the patient to reconstruct 3D images of the patient in the treatment room. However, despite its wide usage, 3D CBCT is limited in imaging disease sites affected by respiratory motions or other dynamic changes within the body, as it lacks time‐resolved information. To overcome this limitation, 4D‐CBCT was developed to incorporate a time dimension in the imaging to account for the patient's motion during the acquisitions. For example, respiration‐correlated 4D‐CBCT divides the breathing cycles into different phase bins and reconstructs 3D images for each phase bin, ultimately generating a complete set of 4D images. 4D‐CBCT is valuable for localizing tumors in the thoracic and abdominal regions where the localization accuracy is affected by respiratory motions. This is especially important for hypofractionated stereotactic body radiation therapy (SBRT), which delivers much higher fractional doses in fewer fractions than conventional fractionated treatments. Nonetheless, 4D‐CBCT does face certain limitations, including long scanning times, high imaging doses, and compromised image quality due to the necessity of acquiring sufficient x‐ray projections for each respiratory phase. In order to address these challenges, numerous methods have been developed to achieve fast, low‐dose, and high‐quality 4D‐CBCT. This paper aims to review the technical developments surrounding 4D‐CBCT comprehensively. It will explore conventional algorithms and recent deep learning‐based approaches, delving into their capabilities and limitations. Additionally, the paper will discuss the potential clinical applications of 4D‐CBCT and outline a future roadmap, highlighting areas for further research and development. Through this exploration, the readers will better understand 4D‐CBCT's capabilities and potential to enhance radiation therapy.
The use of parenteral nutrition in patients with inflammatory bowel disease: A detailed guide on the indications, risks, and benefits
Authors: Kohler David , Freid Hannah , Cholewka Jennifer , Miller Megan , Gold Stephanie L.
Published: June 2024

Malnutrition is estimated to affect roughly 30%–80% of patients with inflammatory bowel disease (IBD). In those patients who cannot tolerate sufficient oral nutrition or there is no possibility for placing an enteral nutrition tube, parenteral nutrition offers a lifesaving alternative. However, this is not without risk. For patients with IBD, understanding the indications, contraindications, and complications associated with parenteral nutrition is crucial. In this review, we will discuss the indications and contraindications for parenteral nutrition in patients with IBD, the common complications associated with intravenous nutrition, the use of parenteral nutrition in special populations, such as in pediatric and perioperative patients, and the impact of parenteral nutrition on IBD‐related outcomes.
Reducing police response times: Optimization and simulation of everyday police patrol
Authors: Dewinter Maite , Jagtenberg Caroline , Vandeviver Christophe , Dau Philipp M. , Vander Beken Tom , Witlox Frank
Published: June 2024

Police forces around the world are adapting to optimize their current practices through intelligence‐led and evidence‐based policing. This trend towards increasingly data‐driven policing also affects daily police routines. Police patrol is a complex routing problem because of the combination of reactive and proactive tasks. Moreover, a trade‐off exists between these two patrol tasks. In this article, a police patrol algorithm that combines both policing strategies into one strategy and is applicable to everyday policing, is developed. To this end, a discrete event simulation model is built that compares a p‐median redeployment strategy with several benchmark strategies, that is, p‐median deployment, hotspot (re)deployment, and random redeployment. This p‐median redeployment strategy considers the continuous alternation of idle and non‐idle vehicles. The mean response time was lowest for the p‐median deployment strategy, but the redeployment strategy results in better coverage of the area and low mean response times.
Game changers in international higher education
Authors: Dennis Marguerite J.
Published: June 2024

In March 2024's column I shared some of the game changers in U.S. higher education. This month's article will feature some of the game changers taking place worldwide. The purpose of both articles is to bring awareness to policies and initiatives that may impact your administrative work now, and potentially, in the future.
A Label‐Efficient Framework for Automated Sinonasal CT Segmentation in Image‐Guided Surgery
Authors: Sahu Manish , Xiao Yuliang , Porras Jose L. , Amanian Ameen , Jain Aseem , Thamboo Andrew , Taylor Russell H. , Creighton Francis X. , Ishii Masaru
Published: June 2024

Objective

Segmentation, the partitioning of patient imaging into multiple, labeled segments, has several potential clinical benefits but when performed manually is tedious and resource intensive. Automated deep learning (DL)‐based segmentation methods can streamline the process. The objective of this study was to evaluate a label‐efficient DL pipeline that requires only a small number of annotated scans for semantic segmentation of sinonasal structures in CT scans.

Study Design

Retrospective cohort study.

Setting

Academic institution.

Methods

Forty CT scans were used in this study including 16 scans in which the nasal septum (NS), inferior turbinate (IT), maxillary sinus (MS), and optic nerve (ON) were manually annotated using an open‐source software. A label‐efficient DL framework was used to train jointly on a few manually labeled scans and the remaining unlabeled scans. Quantitative analysis was then performed to obtain the number of annotated scans needed to achieve submillimeter average surface distances (ASDs).

Results

Our findings reveal that merely four labeled scans are necessary to achieve median submillimeter ASDs for large sinonasal structures—NS (0.96 mm), IT (0.74 mm), and MS (0.43 mm), whereas eight scans are required for smaller structures—ON (0.80 mm).

Conclusion

We have evaluated a label‐efficient pipeline for segmentation of sinonasal structures. Empirical results demonstrate that automated DL methods can achieve submillimeter accuracy using a small number of labeled CT scans. Our pipeline has the potential to improve pre‐operative planning workflows, robotic‐ and image‐guidance navigation systems, computer‐assisted diagnosis, and the construction of statistical shape models to quantify population variations.

Level of Evidence

N/A