bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic Review and Meta-Analysis of Drug-Eluting Balloon and Stent for Infrapopliteal Artery Revascularization
Authors: Zhang Jianbin , Xu Xiaojie , Kong Jie , Xu Rongwei , Fan Xueqiang , Chen Jie , Zheng Xia , Ma Bo , Sun Mingsheng , Ye Zhidong , Liu Peng
Published: January 2017

Background:

Drug-eluting balloon (DEB) and drug-eluting stent (DES) have been proposed for the treatment of infrapopliteal artery disease. We performed a systematic review and meta-analysis of the current available studies investigating outcomes of DEB and DES in the treatment of infrapopliteal artery disease.

Methods:

Multiple databases were systematically searched to identify studies investigating the outcomes of DEB and DES in the treatment of patients with infrapopliteal artery disease. The quality of studies was assessed by Cochrane Collaboration method. The demographic data, risk factors, outcomes, and antiplatelet strategy were extracted.

Results:

Nine studies were identified with 707 and 606 patients in DEB/DES and standard percutaneous balloon angioplasty (PTA)/bare metal stenting (BMS) group, respectively. The risk of target lesion revascularization (TLR; odds ratio [OR] = 0.38, 95% confidence interval [CI]: 0.23-0.63, P < .01), restenosis rate (OR = 0.30, 95% CI: 0.18-0.50, P < .01), and amputation rate (OR = 0.49, 95% CI: 0.29-0.83, P < .01) significantly decreased in the DES group. The overall survival (OR = 0.86, 95% CI: 0.56-1.32, P = .50) was similar in DES and standard PTA/BMS group; TLR (OR = 0.59, 95% CI: 0.32-1.09, P = .09), restenosis rate (OR = 0.49, 95% CI: 0.11-2.14, P = .35), amputation rate (OR = 1.32, 95% CI: 0.51-3.40, P = .57), and overall survival (OR = 1.40, 95% CI: 0.72-2.71, P = .32) were similar in DEB and standard PTA group.

Conclusion:

The present meta-analysis suggests that compared with standard PTA/BMS, DES may decrease the risk of clinically driven TLR, restenosis rate, and amputation rate without any impact on mortality. However, DEB has no obvious advantage in the treatment of infrapopliteal disease. Due to the limitations of our study, more randomized controlled trials, especially those for DEB, are necessary.
Everolimus-Eluting Stent for Patients With Critical Limb Ischemia and Infrapopliteal Arterial Occlusive Disease
Authors: Giaquinta Alessia , Vincenzo Ardita , De Marco Ester , Veroux Massimiliano , Veroux Pierfrancesco
Published: January 2017

Background:

Critical limb ischemia (CLI), despite revascularization, may result in minor or major amputations with devastating psychological effects and a negative impact on patient survival. Randomized clinical trials demonstrated that drug-eluting stents improve 1-year primary patency and decrease target lesion revascularization, compared to standard angioplasty and bare-metal stents, in patients with short occlusive below-the-knee lesions.

Objectives:

This prospective clinical study was designed to evaluate if one straight-line flow revascularization to the foot, using Xience-Prime Everolimus-Eluting Stent (EES), is an effective treatment of patients in Rutherford-Becker category 4 to 5 with distal popliteal and proximal tibial arteries long occlusive lesions up to 10 cm.

Methods:

All patients with angiographic documented segment P3 of popliteal artery and proximal tibial arteries stenosis >70%, and lesion length between 20 mm and 100 mm, meeting the inclusion criteria, were included in the Etna Registry. The end points assessed were 1- and 3-year primary patency, major amputation-free survival, target lesion revascularization, and wound healing rates.

Results:

Between June 2011 and April 2014, 122 patients were included in the study, with mean lesion length of 52.7 mm (range: 20-100 mm). The 1- and 3-year primary patency rates were 88.9% and 80.1%, respectively. The survival, major amputation-free survival, and target lesion revascularization rates were 88.1%, 93%, and 91.5% at 1-year and 70.4%, 89.3%, and 85.1% at 3-year follow-up, respectively. Primary patency influenced major amputation rate, which was 60% in patients with no target artery patency versus 5.4% in patients with patency ( P = .022). At 1-year follow-up, 78 (88.6%) of 88 patients improved 1 or more of their Rutherford-Becker category, and 48 (80%) of 69 patients had wound healing.

Conclusions:

The results of our study suggest that a conservative approach, with EES, seems feasible in selected patients with CLI and infrapopliteal artery occlusive disease.
The Effect of School Conditions on the Use of Restorative Justice in Schools
Authors: Payne Allison Ann , Welch Kelly
Published: January 2017

Previous research has demonstrated beneficial outcomes of using restorative justice techniques, rather than traditional punitive approaches, in response to student misbehavior. As with the use of restorative justice in criminal justice contexts, restorative discipline shifts the focus from punishment and isolation to reconciliation and reintegration. Although the use of restorative justice techniques has decreased student delinquency, resulted in better academic outcomes, and improved school climate, many schools today continue to implement punitive practices to control student behavior. The current research uses data from a nationally representative sample of schools to examine school conditions that influence the use of restorative responses to violence and misbehavior. Identifying the characteristics of a school that affect the likelihood that specific restorative justice techniques will be implemented can reveal opportunities for diminishing disparities, improving outcomes for students, and reducing the odds that students will subsequently become involved in the juvenile justice system.
Regional energy- and mobility-aware routing protocol for hybrid wireless mesh network
Authors: Shi Wenxiao , Chai Yuan , Liu Danni
Published: January 2017

Existing routing protocols for hybrid wireless mesh network neglect the negative impact on network lifetime and route stability caused by energy constraints and mobility of mesh clients. To solve this issue, a regional energy- and mobility-aware routing protocol is proposed in this article. Both energy and mobility features in hybrid wireless mesh network are considered in this routing protocol. On one hand, within the communication transmission range, the intensity and degree of dispersion in energy consumption can be perceived. The node whose neighbor area has sufficient energy can be selected for network services, which can balance energy and extend the network lifetime. On the other hand, the mobility of clients is considered to enhance the stability and reduce network overhead. Therefore, regional energy- and mobility-aware routing protocol can balance network energy consumption, prolong network lifetime, and improve route stability. Simulation results via NS2 show that regional energy- and mobility-aware routing protocol can achieve better performance significantly.
Evaluating energy efficiency of Internet of Things software architecture based on reusable software components
Authors: Kim Doohwan , Choi Jae-Young , Hong Jang-Eui
Published: January 2017

Nowadays, Internet of Things technology has garnered a great amount of interest because it can make our life much easier, convenient, and even safer. Internet of Things devices can be connected to the Internet or to each other whenever and wherever in order to collect, process, and share information to support various services. In order to provide useful support, important issues related to security, performance, and energy consumption have to be considered. For example, important personal information can be easily exposed to others because Internet of Things can be easily hacked; low performance and high energy consumption can limit the effectiveness of devices. These issues can be considered as quality factors that need to be met in order to develop software applications in the Internet of Things domain. Energy consumption is critical to provide sustained service within mobile and wireless environments. To this end, this article focuses on how to develop Internet of Things software that takes low energy consumption into account. In particular, we propose energy evaluation techniques that are based on a software architecture that is designed to use reusable components. By performing an experiment, we could verify that our proposing method shows maximum 6.83% of error rate against code-based energy simulation. Our technique can help software engineers to judge whether or not software is developed to satisfy the particular requirements related with energy consumption.
Energy-efficient and reliable routing protocol for dynamic-property-based clustering mobile ad hoc networks
Authors: Oh Young-jun , Lee Kang-whan
Published: January 2017

Mobile ad hoc networks comprise mobile nodes. The nodes both send and receive messages and can communicate with each other. Thus, the network builds its own network structure that is not dependent on the infrastructure. Owing to the characteristics of mobile ad hoc networks, they have been used in environments of poor communication, such as those in which the infrastructure cannot be built; for example, disaster areas and war zones. In this article, we propose an advanced energy-conserving optimal path schedule algorithm. The proposed algorithm sets the routing path using the relative angle, which is the distance between the source node and the base station. Using simulation results, we compared the proposed algorithm to existing algorithms. The protocol used by the proposed algorithm provides a higher packet delivery ratio and lower energy consumption than the lowest ID clustering algorithm and the mobility-based metric for clustering in the mobile ad hoc network algorithm.
An adaptive weighting algorithm for accurate radio tomographic image in the environment with multipath and WiFi interference
Authors: Wang Manyi , Wang Zhonglei , Bu Xiongzhu , Ding Enjie
Published: January 2017

Radio frequency device-free localization based on wireless sensor network has proved its feasibility in buildings. With this technique, a target can be located relying on the changes of received signal strengths caused by the moving object. However, the accuracy of many such systems deteriorates seriously in the environment with WiFi and the multipath interference. State-of-the-art methods do not efficiently solve the WiFi and multipath interference problems at the same time. In this article, we propose and evaluate an adaptive weighting radio tomography image algorithm to improve the accuracy of radio frequency device-free localization in the environment with multipath and different intensity of WiFi interference. Field experiments prove that our approach outperforms the state-of-the-art radio frequency device-free localization systems in the environment with multipath and WiFi interference.
Hypervolemia screening in predialysis healthcare for hemodialysis patients using fuzzy color reason analysis
Authors: Chen Wei-Ling , Kan Chung-Dann , Lin Chia-Hung , Chen Ying-Shin , Mai Yi-Chen
Published: January 2017

Maintaining adequate dry weight and fluid volume balance is an important issue for dialysis patients. Malnutrition and sodium intake are the primary factors that cause fluid volume imbalance and changes in body weights. Inadequate dry weight control results in higher levels of blood pressures and is related to various complications, such as volume overload, hypertension, congestive symptoms, and cardiovascular diseases. Moreover, inadequate fluid removal provokes hypotension during dialysis treatment. Thus, we propose an early warning tool based on fuzzy color reason analysis in predialysis healthcare for hypervolemia screening. The anthropometric method is a rapid, non-invasive, and simple technique for estimating the total body water. In this study, Watson standard formula is employed to estimate cross-sectional standard of total body water with the patient characteristics, including gender, age, height, and weight. In contrast to the experienced anthropometric formulas, Watson formula has less than 2% of margin errors and provides a criterion as a reference manner to estimate the total body water in patient’s normal dry weight. In addition, inadequate dry weight and total body water controls will lead to higher blood pressures. The systolic blood pressure is also an indicator to evaluate pre-hypertension of 120–139 mmHg and hypertension of greater than or equal to 140 mmHg. Therefore, the levels of two indicators, total body water and systolic blood pressure, are parameterized with fuzzy membership grades to describe the normal and the specific ranges of undervolemia and hypervolemia. A color reason analysis utilizes a hue–saturation–value color model to design a color perceptual manner for separating normal condition from hypervolemia or undervolemia. Normalized hue angle and saturation value provide a promising visual representation with color codes to realize the patients’ diagnosis. Dialysis patients with hypertension demonstrated that the proposed model can be used in clinical applications. In addition, a healthcare chair is carried out to measure blood pressure and weight in predialysis. The proposed assistant tool integrates an electronic pressure monitor and an electronic weight monitor, and fuzzy color reason analysis is also intended to be established in an intelligent vehicle via a WiFi wireless local area network for cloud computing.
R-learning-based team game model for Internet of things quality-of-service control scheme
Authors: Kim Sungwook
Published: January 2017

In modern times, it has been observed that Internet of things technology makes it possible for connecting various smart objects together through the Internet. For the effective Internet of things management, it is necessary to design and develop service models that ensure appropriate level of quality-of-service. Therefore, the design of quality-of-service management schemes has been a hot research issue. In this work, we formulate a new quality-of-service management scheme based on the IoT system power control algorithm. Using the emerging and largely unexplored concept of the R-learning algorithm and docitive paradigm, system agents can teach other agents how to adjust their power levels while reducing computation complexity and speeding up the learning process. Therefore, our proposed power control approach can provide the ability to practically respond to current Internet of things system conditions and suitable for real wireless communication operations. Finally, we validate the introduced concept and confirm the effectiveness of the proposed scheme in comparison with the existing schemes through extensive simulation analysis.
Joint relay and jammer selection in Internet of Things systems
Authors: Li Zhen , Jing Tao , Huo Yan
Published: January 2017

In this article, we consider the physical layer security issue in Internet of Things systems, in which there exist a sensing transceiver pair, a number of candidate nodes, and an eavesdropper. The transceiver pair needs to select a jammer node and a relay node among the candidate nodes so as to preserve the secrecy of the communications. Considering the diversity of candidate channels and the limited available power, it is infeasible to scan all the nodes and find the optimal one. We formulate this jammer and relay selection problem as an optimal stopping problem under a fixed sensing order. Then, through applying dynamic programming solution, we propose a low-complexity approach to obtain the optimal sensing order. The performance of the proposed selection scheme is evaluated through numerical results.
“Time–Location–Frequency”–aware Internet of things service selection based on historical records
Authors: Qi Lianyong , Dai Peiqiang , Yu Jiguo , Zhou Zhili , Xu Yanwei
Published: January 2017

The advertised quality of an Internet of things service is not always trustable due to the exaggerated quality propagation and dynamic network environment. Therefore, it is more trustable to evaluate the Internet of things service quality based on the historical execution records of service. However, an Internet of things service often has multiple historical records whose invocation time and location are different, which makes it necessary to weigh each historical record of an identical Internet of things service. Besides, for different candidate Internet of things services, their invocation frequencies are often varied, which may also affect the final service selection decision of target user. In view of the above two challenges, a novel service selection approach “Time–Location–Frequency”–aware Service Selection Approach is put forward in this article. In Time–Location–Frequency–aware Service Selection Approach, we first weigh each historical record of an Internet of things service, based on its service invocation time and location; afterward, we weigh each candidate Internet of things service based on its invocation frequency; finally, with the derived two kinds of weights, we evaluate each candidate Internet of things service and return the quality-optimal one to the target user. At last, through a set of experiments deployed on a real service quality data set WS-DREAM, we validate the feasibility of our proposal.
Increasing network lifetime using data compression in wireless sensor networks with energy harvesting
Authors: Kim Sunyong , Cho Chiwoo , Park Kyung-Joon , Lim Hyuk
Published: January 2017

In wireless sensor networks powered by battery-limited energy harvesting, sensor nodes that have relatively more energy can help other sensor nodes reduce their energy consumption by compressing the sensing data packets in order to consequently extend the network lifetime. In this article, we consider a data compression technique that can shorten the data packet itself to reduce the energies consumed for packet transmission and reception and to eventually increase the entire network lifetime. First, we present an energy consumption model, in which the energy consumption at each sensor node is derived. We then propose a data compression algorithm that determines the compression level at each sensor node to decrease the total energy consumption depending on the average energy level of neighboring sensor nodes while maximizing the lifetime of multihop wireless sensor networks with energy harvesting. Numerical simulations show that the proposed algorithm achieves a reduced average energy consumption while extending the entire network lifetime.
A Framework for Developing and Using Shared Mental Models in Human-Agent Teams
Authors: Scheutz Matthias , DeLoach Scott A. , Adams Julie A.
Published: January 2017

Converging evidence from psychology, human factors, management and organizational science, and other related fields suggests that humans working in teams employ shared mental models to represent and use pertinent information about the task, the equipment, the team members, and their roles. In particular, shared mental models are used to interact efficiently with other team members and to track progress in terms of goals, subgoals, achieved and planned states, as well as other team-related factors. Although much of the literature on shared mental models has focused on quantifying the success of teams that can use them effectively, there is little work on the types of data structures and processes that operate on them, which are required to operationalize shared mental models. This paper proposes the first comprehensive formal and computational framework based on results from human teams that can be used to implement shared mental models for artificial virtual and robotic agents. The formal portion of the framework specifies the necessary data structures and representations, whereas the computational framework specifies the necessary computational processes and their interactions to build, update, and maintain shared mental models.
The Clinical Implications of Youth Sports Concussion Laws: A Review
Authors: Bell Jeneita M. , Master Christina L. , Lionbarger Michael R.
Published: January 2017

The recent passage of state youth sports concussion laws across the country introduces clinical implications for health care professionals caring for student-athletes. Although the laws were established to provide protections for student-athletes and prevent adverse outcomes, efforts aimed at implementation have uncovered various challenges in concussion diagnosis and management. Some of the most salient issues include medical evaluation, return to play, and return to learn. For this reason, health care professionals play a pivotal role in determining the critical next steps after a student is removed from play with a suspected concussion. Also, state laws may influence an influx of concussion patients to health care facilities and, thereby, present various unforeseen challenges that can be mitigated with adequate clinical preparation. This is key to helping student-athletes recover and resume regular activities in sports, recreation, and education. This review describes the various components of state youth sports concussion laws relevant to clinical practice and nuances that health care professionals should appreciate in this context. Additionally, concussion tools and strategies that can be used in clinical practice are discussed.
Evaluation of the characteristics of various types of finishing coils for the embolization of intracranial aneurysms in an experimental model with radiolucent coils
Authors: Ota Keisuke , Matsubara Noriaki , Miyachi Shigeru , Izumi Takashi , Ito Masashi , Asai Takumi , Yamanouchi Takashi , Wakabayashi Toshihiko
Published: January 2017

In endovascular coil embolization of intracranial aneurysms, very soft coils, often called “finishing coils,” are usually selected in the final stage of coil embolization. The authors developed a radiolucent coil made of thin nylon thread to evaluate the performance of coils under a situation simulating the course of embolization. The characteristics of various types of finishing coils were investigated using radiolucent coils. Experimental embolization was performed with a silicone aneurysm filled with radiolucent coils simulating the final stage of embolization. Three indices, i.e. area, perimeter, and circularity of the inserted coils, were investigated on the X-ray images after coil insertion. The coils used were as follows: Target Ultra Helical, MicroPlex Hypersoft, Axium Helix, ED Coil Extrasoft, and DeltaPlush. In the analysis of area and perimeter, there were significant differences in multiple comparisons. There was no significant difference in circularity, although it was generally ranked in order by coil brand. Target Ultra and MicroPlex Hypersoft had higher scores for area and perimeter and lower scores for circularity, in contrast to DeltaPlush, which had lower scores for area and perimeter and a higher score for circularity. Based on these results, the finishing coils were divided into three groups: Target Ultra Helical and MicroPlex Hypersoft; Axium Helix and ED Coil Extrasoft; DeltaPlush. They are better for use in early, midst, and end of finishing, respectively. The characteristics of various finishing coils were evaluated, and the results obtained reflected actual clinical experience and provide useful information to appropriately select finishing coils.
Manual aspiration thrombectomy using a Penumbra catheter in patients with acute migrated MCA occlusion
Authors: Baik Sung Hyun , Kwak Hyo Sung , Hwang Seung Bae , Chung Gyung Ho
Published: January 2017

Background

We retrospectively assessed the efficacy and safety of manual aspiration thrombectomy (MAT) using a Penumbra catheter in patients with acute migrated middle cerebral artery (MCA) occlusion.

Methods

We conducted a retrospective review of patients who underwent MAT using Penumbra 4 or 5 MAX reperfusion catheters for the treatment of acute MCA occlusion between January 2012 and December 2015. A migrated thrombus was defined as distal migration greater than ≥1 cm on initial cerebral angiography compared with preprocedural angiographic findings. We evaluated immediate angiographic results and clinical outcomes through a review of electronic medical records and compared clinical outcomes between migrated and non-migrated MCA occlusions.

Results

During this period, 98 patients underwent MAT using Penumbra catheters for treatment of acute MCA occlusions. Of these, 19 (19.4%) had a migrated MCA thrombus on initial cerebral angiography compared with preprocedural angiographic findings. The overall rate of successful recanalization (TICI grade ≥ 2b) was 90.8%. The rate of successful recanalization in the migrated thrombus group was 94.7% (18/19). Overall procedure time for recanalization in the migrated thrombus group was significantly shorter than that in the non-migrated thrombus group ( p = 0.001). Although the difference was not significant, there was a trend toward more favorable clinical outcomes in the migrated thrombus group compared to the non-migrated thrombus groups (78.9% versus 60.8%, p = 0.231).

Conclusion

MAT appears to be safe and can achieve a high rate of successful recanalization and favorable clinical outcomes with short procedure time and without serious complications in patients with acute migrated MCA occlusion.
Predictors for Rehabilitation Outcome in Asian Geriatric Hip Fracture Patients
Authors: Gatot Cheryl , Chou Andrew Chia Chen , Howe Tet Sen , Yeo William , Chong Hwei Chi , Koh Joyce Suang Bee
Published: January 2017

Purpose

To identify predictors for rehabilitation outcome in Asian geriatric hip fracture patients.

Methods

Records of 153 consecutive Asian patients aged 61 to 99 years who underwent surgery for hip fracture and were followed up for at least one year were reviewed. They were stratified into 4 age-groups: 60–69 years (n=27), 70–79 years (n=70), 80–89 years (n=50), and ≥90 years (n=6). Any comorbidity, regardless of severity, was recorded. Pre-injury and postoperative functional status was evaluated using the 36-item Short Form Health Survey. Relative functional gain (RFG) is equal to absolute functional gain (physical component summary [PCS] score at one year minus PCS score at 6 weeks) divided by the maximum potential gain (maximum PCS score minus PCS score at 6 weeks). RFG of <0.5 and ≥0.5 is defined as poor and good rehabilitation outcome, respectively.

Results

In univariate analysis, age 80–89 years (p=0.026), arthritis (p=0.082), and hypercholesterolaemia (p=0.014) were predictors for RFG. In multivariate analysis, age 80–89 years (p=0.016) remained a predictor for poor RFG, and hypercholesterolaemia remained a predictor for good RFG.

Conclusion

Poor rehabilitation outcome was associated with patient age of 80–89 years; an orthogeriatric approach may be beneficial in optimising rehabilitation outcome in elderly hip fracture patients.
Preoperative Radiography versus Computed Tomography for Surgical Planning for Ankle Fractures
Authors: Leung Ka Hei , Fang Christian Xin Shuo , Lau Tak Wing , Li Leung Frankie Ka
Published: January 2017

Purpose

To review preoperative radiography and computed tomography (CT) of the ankle in 69 patients who underwent surgery for ankle fractures to determine the value of CT in diagnosis and surgical planning.

Methods

Preoperative radiography and CT of the ankle of 46 women and 23 men aged 17 to 90 (mean, 48.8) years were reviewed. CT was deemed necessary when radiographs showed the following features: (1) comminuted fracture of the medial malleolus involving the tibial plafond, (2) comminuted fracture of the posterior malleolus, (3) presence of loose bodies, and/or (4) suspected Chaput or Volkman fracture fragment. Two orthopaedic surgeons independently reviewed the radiographs to look for any of the above features for which CT was indicated. In patients whose radiographs did not show any of the above features, each surgeon formulated a surgical plan based on radiographs alone and decided if any modification was needed after reviewing the CT scan.

Results

Based on radiographs of the 69 patients, 19 (28%) patients had features of posterior malleolar comminution (n=7), medial malleolar comminution (n=7), suspected Chaput fracture fragment (n=1), suspected Volkman fracture fragment (n=1), and combination of 2 lesions (n=3), and were deemed to require CT. In 10 (20%) of the remaining 50 patients, the surgical plan was modified after review of the CT scan. The intra- and inter-observer agreement was good to excellent.

Conclusion

Radiography alone is not adequate for surgical planning for ankle fractures. More accurate imaging tools such as CT are needed to enable a more accurate diagnosis and surgical planning.
Preoperative Ropivacaine with or without Tramadol for Femoral Nerve Block in Total Knee Arthroplasty
Authors: Tang Qi-Feng , Li Xiao-Lin , Yu Li-Xin , Hao Yue-Feng , Lu Guo-Hai
Published: January 2017

Purpose

To compare the analgesic effect of preoperative ropivacaine with or without tramadol for femoral nerve block in total knee arthroplasty (TKA).

Methods

14 men and 46 women aged 59 to 80 years who were American Society of Anesthesiologists (ASA) grade I or II and were scheduled for TKA were randomised to receive preoperative femoral nerve block with 20 ml of 0.375% ropivacaine plus tramadol 0 mg (n=15), 50 mg (n=15), or 100 mg (n=15), or no preoperative femoral nerve block (control) [n=15]. Femoral nerve block was performed by a single anaesthesiologist before the standardised combined spinal epidural anaesthesia. Postoperatively, patient-controlled analgesia was given. The visual analogue score (VAS) for pain at rest and on movement was recorded at 8, 12, 24, 48, and 72 hours. Passive knee range of motion (ROM) was measured at 24, 48, and 72 hours.

Results

The 4 groups were comparable in terms of age, gender, weight, ASA grade, and operating time. Compared with patients who received no femoral nerve block or ropivacaine alone, those who received femoral nerve block with 20 ml of 0.375% ropivacaine plus tramadol 50 mg or 100 mg recorded a lower VAS for pain at rest and on movement at 8 to 72 hours, longer sensory and motor block time, and lower demand, delivery, and total amount of patient-controlled analgesia. The passive knee ROM at 24 to 72 hours was greater in patients with femoral nerve block than in those without.

Conclusion

Preoperative femoral nerve block with 20 ml of 0.375% ropivacaine and 100 mg tramadol resulted in the best analgesic effect.
Microfracture Technique versus Carbon Fibre Rod Implantation for Treatment of Knee Articular Cartilage Lesions
Authors: Dasar Uygar , Gursoy Safa , Akkaya Mustafa , Algin Oktay , Isik Cetin , Bozkurt Murat
Published: January 2017

Purpose

To compare the microfracture technique with carbon fibre rod implantation for treatment of knee articular cartilage lesions.

Methods

10 men and 30 women aged 22 to 56 (mean, 37.4) years underwent microfracture (n=20) or carbon fibre rod implantation (n=20) for International Cartilage Repair Society grade 3 to 4 knee articular cartilage lesions after a mean of 12.2 months of viscosupplementation and physiotherapy. Clinical outcome at 6 and 12 months was assessed using the Tegner-Lysholm score and modified Cincinnati score. Magnetic resonance imaging (MRI) outcome at 12 months was assessed by a radiologist. The modified magnetic resonance observation of cartilage repair tissue (MOCART) score was evaluated.

Results

The 2 groups were comparable in terms of age, body mass index, lesion location, lesion size, duration of symptoms, and coexisting pathology. The microfracture group had a higher preoperative Tegner-Lysholm score (39.4±7.3 vs. 34.4±4.9, p=0.015) and modified Cincinnati score (36.4±7.2 vs. 30.4±4.0, p=0.002) than the carbon fibre rod group. At 12 months, change in both scores was significant within each group (p<0.001) and was higher in the microfracture than carbon fibre rod group (p<0.001). MRI showed minimal regenerative tissue. Lobulation, oedema, and hypertrophy were more commonly found in the regeneration tissue after carbon fibre rod implantation than microfracture. At 12 months, the MOCART score was higher in the microfracture than carbon fibre rod group (59 vs. 47, p<0.001).

Conclusion

Microfracture is superior to carbon fibre rod implantation in terms of clinical and radiological outcome.
Relationship between Pull-Out Strength and Oscillation Angle in Bipolar Cups: An in vitro Study
Authors: Kaku Nobuhiro , Tabata Tomonori , Tsumura Hiroshi
Published: January 2017

Purpose

To compare the past and present bipolar hip arthroplasty (BHA) models in terms of balance between pull-out strength and oscillation angle (OA).

Methods

The pull-out strength and OA of 8 BHA models were compared: UPF-II, IBC, and Tandem XLPE (Smith & Nephew); Ringloc x (Biomet); J-FX (DePuy); Bipolar (Nakashima Medical); Multipolar (Zimmer); and Centrax (Stryker).

Results

Respectively for the UPF-II, IBC, Tandem, Ringloc, J-FX, Nakashima Bipolar, Multipolar, and Centrax, the mean pull-out strength was 2219 N, 3303 N, 1503 N, 951 N, 1453 N, 1856 N, 1536 N, and 753 N, whereas the mean OA was 54.2°, 53.8°, 64.0°, 73.2°, 63.0°, 65.4°, 55.6°, and 75.4°. The OA was lower in the integrated types. For pull-out strength of the locking mechanism, the integrated type (IBC and Nakashima) was stronger than the metal or polyethylene ring-lock type (all others). The pull-out strength and OA were negatively correlated ( r= −0.881, p=0.007), and the balance between the 2 varied for different models.

Conclusion

There is a trade-off between the pull-out strength and OA; optimal balance between the 2 should be based on each patient's need.
Proximal versus Distal Screw Placement for Biceps Tenodesis: A Biomechanical Study
Authors: De Villiers Daniel Johannes , Loh Brian , Tacey Mark , Keith Prue
Published: January 2017

Purpose

To assess the maximum and end torque of a fourth-generation composite humerus model with no screw inserted or with a screw inserted in the distal (subpectoral) position or proximal (suprapectoral) position.

Methods

24 large-size, fourth-generation composite humeri were randomised to the control (n=8), proximal (n=8), or distal (n=8) group. For the latter 2 groups, an 8-mm-head interference screw (7times25 mm) was inserted at 1 cm proximal and 1 cm distal to the superior aspect of the insertion of the pectoralis major tendon, respectively. The maximum and end torque of each humerus was assessed.

Results

Respectively for the control, proximal, and distal groups, the maximum torque was 81.8, 78.7, and 74.3 Nm, and the end torque was 80.7, 78.6, and 71.8 Nm; only the difference between control and distal groups was significant (p=0.005 for maximum torque and p=0.033 for end torque). All fractures in both control and proximal groups involved the distal 1/3 humerus. In the distal group, the fractures involved either the distal 1/3 humerus (n=6) or the screw-hole (n=2); the difference between the 2 types of fracture was not significant in terms of maximum torque (75.7 vs. 70.0, p=0.086) or end torque (75.3 vs. 61.4, p=0.40).

Conclusion

Compared with proximal placement of an interference screw, distal placement decreased the maximum torque (though not significantly) and may increase the risk of proximal humeral fracture.
Review Article: Risk Factors for Poor Outcome following Surgical Treatment for Rotator Cuff Tear
Authors: Sahni Vishal , Narang Ashish M
Published: January 2017

The Medline database was searched using key words: ‘rotator cuff’, ‘tear’, and ‘treatment’. 12 studies that involved (1) surgical treatment for rotator cuff tear, (2) measurement of pre- and post-operative pain score, functional score, and/or patient satisfaction, (3) patients that failed to improve functionally or had poor satisfaction, (4) preoperative examination of risk factors that could lead to poor outcome, and (5) a minimum follow-up of 6 months were reviewed to identify risk factors associated with poor outcome following surgical treatment for rotator cuff tear. The most common risk factor was tear size, followed by open compensation claim, age, and time from injury to surgery.
Posterior Spinal Instrumented Fusion for Idiopathic Scoliosis in Patients with Multisystemic Neurodegenerative Disorder: A Report of Two Cases
Authors: Loh Kwong Weng , Chan Chris Yin Wei , Chiu Chee Kidd , Hasan Mohd Shahnaz Bin , Kwan Mun Keong
Published: January 2017

Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) syndrome is a progressive multisystemic neurodegenerative disorder. MELAS syndrome impairs oxidative phosphorylation and predisposes patients to lactic acidosis, particularly under metabolic stress. We report 2 siblings with MELAS-associated idiopathic scoliosis who underwent posterior spinal instrumented fusion with measures taken to minimise anaesthetic and surgical stress, blood loss, and operating time.
The Use of a 3-Dimensional Computed Tomography Bone Database to Evaluate the Risk of Distal Contact between the Rasp Tip and the Endosteal Cortical Bone
Authors: Connor Emmalynn , Cowie Jonathan G , Wuestemann Thies , Howell Jonathan R , Whitehouse Sarah L , Crawford Ross W
Published: January 2017

Purpose

To use a 3-dimensional computed tomography (CT) bone database to evaluate the risk of distal contact between the rasp tip and the endosteal cortical bone.

Methods

Using a 3-dimensional CT bone database, the rasps for Exeter stems of 125 mm in length and body size 1, with a femoral offset of 37.5, 44, or 50 mm were compared with those for Exeter stems of 150 mm in length and same body size with the corresponding femoral offset. Rasp geometry was determined using an engineering drawing software.

Results

Of the 631 femurs in the database, 238 (187 Caucasian and 51 Asian) were of appropriate femoral offset and proximal body size to receive a stem with an offset of 37.5, 44, or 50 mm. Of these, 145 (115 Caucasian and 30 Asian) femurs were of champagne-flute type; the prevalence was comparable between the 2 populations (61% vs. 59%, p=0.729). When using the 150-mm rasp, 70 (55 Caucasian and 15 Asian) of the 238 femurs had distal contact between the rasp and femoral cortex; the prevalence was comparable between the 2 populations (29% vs. 29%, relative risk=1.0, p=1.0). Distal contact between the rasp and femoral cortex occurred more commonly in champagne-flute-type femurs than other femurs in the anteroposterior plane (28% [41/145] vs. 2% [2/93], relative risk=13.1, p<0.001) and in the mediolateral plane (27% [39/145] vs. 14% [13/93], relative risk=1.92, p=0.019). When using the 125-mm rasp, only one femur (with a canal flare index of 4.52) had distal contact in the mediolateral plane with an offset of 37.5 mm. Distal contact between the rasp and femoral cortex occurred more often with the 150-mm rasp than the 125-mm rasp in both planes (p<0.001).

Conclusion

The use of a shorter stem may enhance anatomic fit in patients with a narrow femoral canal and prevent distal contact between the rasp and femoral cortex.
Acetabular Revision with Bone Grafting and Cementation for Aseptic Loosening after Primary Charnley Low-Friction Hip Arthroplasty with Structural Bulk Autografts
Authors: Mohammed Riazuddin , Drampalos Efstathios , Siney Paul , Purbach Bodo , Kay Peter
Published: January 2017

Purpose

To review the outcome of acetabular revision with bone grafting and cementation for aseptic loosening after primary Charnley low-friction hip arthroplasty with structural bulk autografts in 15 patients.

Methods

Records were reviewed for 3 men and 12 women aged 31 to 72 (mean, 53) years who underwent acetabular revision with bone grafting and cementation for aseptic loosening at a mean of 12.4 (range, 6.6–20.3) years after primary Charnley low-friction hip arthroplasty with superolateral structural bulk autografts from the femoral head for dysplastic hip (n=14) or bone loss secondary to acetabular fracture (n=1).

Results

After a mean follow-up of 6.7 (range, 1.1–14.5) years, the mean Merle d'Aubigné and Postel score improved from 8.55 to 16.5. Bridging trabeculae was noted in 10 hips and graft remodelling in 5 hips. Five hips had ectopic ossification of Brooker grade 1 to 2. The mean hip centre of rotation was 21.6 (range, 16.2–30.6) mm. Two women required re-revision for aseptic loosening of the acetabulum after 8.5 and 6.6 years. The first one underwent re-revision with solid allograft for superolateral deficiency of the acetabulum. The second one underwent re-revision with solid and morselised bone allografts for loosened acetabulum. One patient had superior migration of the acetabulum for 9 mm at year 2, but it was asymptomatic. One patient had a dislocation that was reduced with manipulation under anaesthesia. Three patients had trochanteric non-union and presented with lateral thigh pain and tenderness, but no further surgery was performed.

Conclusion

The medium-term outcome of acetabular revision with bone grafting and cementation is satisfactory. Repeat bone grafting is required to restore the anatomic acetabular position and bone loss secondary to acetabular loosening.
Four-Level Anterior Cervical Discectomy and Fusion for Cervical Spondylotic Myelopathy
Authors: Wang Shan-Jin , Ma Bin , Huang Yu-Feng , Pan Fu-Min , Zhao Wei-Dong , Wu De-Sheng
Published: January 2017

Purpose

To review the outcome of 32 consecutive patients who underwent 4-level anterior cervical discectomy and fusion (ACDF) with cages and plates and were followed up for at least 5 years.

Methods

Records of 19 men and 13 women aged 48 to 69 years who underwent 4-level ACDF with cages and plates for myelopathy (n=11) or myeloradiculopathy (n=21) at C3 to C7 by a single surgeon and were followed up for a minimum of 5 years were reviewed. Clinical outcome was assessed using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Japanese Orthopaedic Association (JOA) score for pain or myelopathic symptoms. Radiographic evaluation included fusion rate, range of motion, cervical lordosis (C2-to-C7 Cobb angle), and disc height.

Results

The mean follow-up was 66 months. All patients had good recovery of muscle strength and resolution of limb sensory disturbance, except for 4 who still had some numbness. The mean VAS for neck and arm pain improved from 14.2 to 6.84 (p=0.012); the mean NDI improved from 31.62 to 12.17 (p<0.01); and the mean JOA score improved from 10.1 to 13.9 (p=0.027). The mean percentage of recovery was 62.9. The mean Cobb angle improved from 10.24° to 1.28° (p=0.019); the mean disc height improved from 4.12 to 6.58 mm (p<0.01). 30 (94%) patients achieved solid fusion.

Conclusion

Multilevel ACDF using PEEK cages and plates is safe and effective for multilevel cervical spondylotic myelopathy and achieves satisfactory mid-term outcome.
Comparison of Early Outcome of Weil Osteotomy and Distal Metatarsal Mini-Invasive Osteotomy for Lesser Toe Metatarsalgia
Authors: Yeo Nicholas Eng Meng , Loh Bryan , Chen Jerry YongQiang , Yew Andy Khye Soon , Ng Sean YC
Published: January 2017

Purpose

To compare the 6-month outcome of Weil osteotomy with distal metatarsal mini-invasive osteotomy (DMMO) in 33 patients with lesser toe metatarsalgia.

Methods

Records of 33 patients who underwent Weil osteotomy (n=20, 41 toes) or DMMO (n=13, 22 toes) for lesser toe metatarsalgia by a single surgeon were reviewed. 25 of them had a concurrent procedure on the 1st toe. Outcome at 6 months was assessed using the visual analogue score (VAS) for pain, American Orthopaedic Foot and Ankle Society (AOFAS) lesser toe metatarsophalangeal-interphalangeal (MTP-IP) score, and the RAND-36 score.

Results

The 2 groups were comparable in terms of age, gender, and preoperative MTP joint range of motion (ROM), VAS for pain, AOFAS lesser toe MTP-IP score, and RAND-36 scores. At 6 months, the Weil osteotomy group had a higher RAND-36 (mental) score (92 vs. 78, p=0.026), and the DMMO group had a higher percentage of toes with greater MTP joint ROM (p=0.043). All patients achieved bone union within 6 months. Two patients in the DMMO group had prolonged oedema until 3 months post-surgery.

Conclusion

DMMO is a safe and reliable alternative to Weil osteotomy for metatarsalgia and can preserve ROM of the MTP joints.
Z-Plasty of the Flexor Hallucis Longus Tendon at Tarsal Tunnel for Checkrein Deformity
Authors: Lee Jae Hoon , Kim Young Jun , Baek Jong Hun , Kim Dong Hee
Published: January 2017

Purposes

To review the outcome of Z-plasty of the flexor hallucis longus (FHL) tendon at the tarsal tunnel for checkrein deformity in 8 patients.

Methods

Records of 6 males and 2 females aged 14 to 67 (mean, 39.5) years who underwent Z-plasty (lengthening) of the FHL tendon at the tarsal tunnel for checkrein deformity in the first and second toes by a single surgeon were reviewed. All patients had undergone 3 months of conservative treatment. The mean time from injury to surgical treatment was 8.4 (range, 5–12) months. All patients had associated injuries including distal tibiofibular fracture (n=6), distal fibular fracture (n=1), and crush injury around the ankle (n=1); they were treated with intramedullary nailing (n=6), long leg splinting (n=1), and short leg splinting (n=1).

Results

After a mean follow-up of 3.4 (range, 1–7) years, the FHL tendon was lengthened by a mean of 1.7 (range, 1.6–1.8) cm, and the mean American Orthopedic Foot and Ankle Society hallux score increased from 59 (range, 52–67) to 89 (range, 80–90). No patient had recurrence, nerve injury, or tarsal tunnel syndrome, although one patient had sensory disturbance of the posterior tibial nerve in the forefoot, which resolved spontaneously at week 2.

Conclusion

Z-plasty of the FHL tendon at the tarsal tunnel is a viable option for correction of checkrein deformity.
Intramedullary and Intra-Osseous Arthrodesis of the Hallux Metatarsophalangeal Joint
Authors: Drampalos Efstathios , Vun Shen Hwa , Fayyaz Irfan
Published: January 2017

Purpose

To review the outcome of arthrodesis of the hallux metatarsophalangeal (MTP) joint in 23 patients.

Methods

Records of 9 men and 14 women aged 27 to 88 (mean, 57) years who underwent arthrodesis of the hallux MTP joint using an intramedullary device and an intra-osseous device were reviewed. Indications for surgery were severe hallux valgus (n=15), hallux rigidus (n=6) and rheumatoid arthritis (n=2). Outcome measures included visual analogue score (VAS) for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) hallux score, bone union, hallux valgus angle (HVA), dorsiflexion angle (DA), complications, revision, and patient satisfaction.

Results

The mean follow-up was 19 (range, 6–38) months. The mean AOFAS score improved from 29 to 75.4 (p<0.0001) and the mean VAS for pain improved from 8.1 to 2.4 (p<0.0001). 20 (86%) of the patients were satisfied with the outcome. The mean HVA was 14° and the mean DA was 22°. 19 (83%) of the toes had a well-aligned hallux. 21 (91%) of the patients achieved arthrodesis of the hallux MTP joint. The remaining 2 patients underwent revision surgery for failed fusion or infected non-union; they continued to have transfer metatarsalgia despite bone union.

Conclusion

The intramedullary and intra-osseous devices for arthrodesis of the hallux MTP joint achieved good outcome in terms of AOFAS score, VAS for pain, HVA, DA, bone union, and patient satisfaction.