bluuebunny/crossref_metadata_2025 huggingface dataset:
Severe Coronary Artery Calcifications in Chronic Kidney Disease Patients, Coupled with Inflammation and Bone Mineral Disease Derangement, Promote Major Adverse Cardiovascular Events through Vascular Remodeling
Authors: Morena-Carrere Marion , Jaussent Isabelle , Chenine Leila , Dupuy Anne-Marie , Bargnoux Anne-Sophie , Leray-Moragues Hélène , Klouche Kada , Vernhet Hélène , Canaud Bernard , Cristol Jean-Paul
Published: November 2024

Introduction: Cardiovascular (CV) diseases persist as the foremost cause of morbidity/mortality among chronic kidney disease (CKD) patients. This paper examines the values of coronary artery calcification (CAC) and biomarkers of CV on major adverse CV events (MACE)/CV death in a sample of 425 non-dialysis CKD patients. Methods: At inclusion, patients underwent chest multidetector computed tomography for CAC scoring and biomarkers of CV risk including CRP, mineral metabolism markers, fibroblast growth factor-23 (FGF-23), α-Klotho, osteoprotegerin, tartrate-resistant acid phosphatase 5b (TRAP5b), sclerostin, matrix gla protein (both dephosphorylated uncarboxylated [dp-ucMGP] and total uncarboxylated), and growth differentiation factor-15 (GDF-15) were measured. Patients were followed for a median of 3.61 years (25th–75th percentiles = 1.92–6.70). Results: Our results reported that CAC was a major independent factor of MACE/CV mortality showing a hazard ratio of 1.71 95% (confidence interval = 1.00–2.93) after adjustment for age, gender, diabetes, and history of CV events for patients with CAC >300. Interestingly, CAC effect was further enhanced in the presence of low levels of 25(OH) vitamin D3 or α-Klotho and high levels of intact parathyroid hormone (PTH), high-sensitive C reactive protein, FGF-23, osteoprotegerin, sclerostin, dp-ucMGP, or GDF-15. Conclusion: CAC constitutes a significant CV risk, further exacerbated by inflammation, hyperparathyroidism, and regulation of bone molecules implicated in calcification progression. This finding aligns with the original concept of multiple hits. Consequently, addressing the detrimental environment that fosters plaque vulnerability, reducing chronic low-grade inflammation, and normalizing mineral metabolism markers (such as vitamin D and PTH) and bone-regulating molecules may emerge as a viable therapeutic strategy.
Correlating Degree of Thyroid Tilt Independent of fo Control as a Mechanism for Phonatory Density with EGG and Acoustic Measures across Loudness Conditions
Authors: Aaen Mathias , Christoph Noor , McGlashan Julian , Sadolin Cathrine
Published: November 2024

Introduction: Traditionally, fundamental frequency increase has been viewed as largely associated with vocal fold length as a consequence of tilting the thyroid cartilage forward and downwards, a so-called thyroid tilt, caused by cricothyroid muscle contraction. Recent pilot studies in singers suggest vocal fold elongation independent from fo as related to a pedagogical parameter called ‘phonatory density’, suggesting a further discrete mechanism of the thyroid cartilage tilt related to voice quality. This study endoscopically, EGG, acoustically, and auditory-perceptually explores different vocal modes in relation to degree of phonatory density independent of changes in fo across loudness and voice quality conditions.
Methods: Case-control with 20 professional singers performing sustained-vowel samples (C4 males, B4 females) for 8 different voice quality conditions with different degrees of auditory-perceptual ‘density’ while undergoing endoscopic examination and concurrent EGG and acoustic measurement. Endoscopic vocal tract assessments were blindly rated according to a 33-item systematic assessment tool and a forced consensus paradigm. Manova, Spearman’s Rho, and factor density were calculated at p≤0,05. Auditory-perceptual assessments of 64 samples of the 8 voicing conditions were performed by 33 professional singing teachers. Fleiss’ kappa and percentage agreement were used to calculate assessor accuracy and inter-rater reliability.
Results: Forwards and downwards thyroid tilt was related to the perceptual category of ‘reduced density’ as the only statistically significant endoscopic assessment variable: ‘fuller density’ conditions exhibited little to no forward visible articulation of the thyroid cartilage, whereas reduced density conditions exhibited visible to marked forward articulation of the thyroid cartilage across tested conditions suggesting vocal fold elongation for reduced density conditions while maintaining an unchanged fo with high ICC for the assessors (r = .70 and r = .94 for male/female data sets respectively). Correlation analyses revealed negative correlations for SPL, Shimmer, and CPP measures for reduced density conditions, while Qx did not vary with statistical significance. Panel assessors accurately assessed the 8 tested conditions with 87% accuracy and good inter-rater reliability agreement (k 0.772 p<0,001).
Conclusion: Phonatory density, as an auditory-perceptual denotation of vocal weight, is controlled by the degree of thyroid cartilage tilt. The study documents systematic variations in vocal fold lengths across several conditions of loudness while fo is maintained. The findings suggest a further mechanism of the thyroid cartilage related to voice quality beyond the control of fo Further studies are needed to document pitch production mechanisms compensating for the maintenance of fo given vocal fold elongation during reduced density conditions.
Mahonia nanlingensis (Berberidaceae), a new species from China
Authors: WANG ZHONGDE , LAN YAOQING , HUANG QILIN , TONG YI
Published: November 2024

Mahonia nanlingensis (Berberidaceae), a new species from Nanling Mountains in China, is described and illustrated. It is distinguished morphologically from allied species by its 7–9 fine-toothed leaflets, the rounded or cordate apex of the outer sepals, narrowly incised apex of petals, truncate stamen anthers and broadly discoid stigma. Phylogenetic analysis based on chloroplast and nuclear ribosomal DNA (nrDNA) sequences further supports its recognition as a new species. Due to habitat disturbance and medicinal use, M. nanlingensis is assessed as “Vulnerable” (VU) according to the IUCN Red List categories and criteria.
Lectotypification of five names in Bambusa (Poaceae, Bambusoideae, Bambuseae) of India
Authors: SAHA KUNTAL , GHOSH POULAMI , BHATTACHARYA SUBHASMIT , CHANDRAN MANOJ , NEGI RANJANA
Published: November 2024

N/A
A new species of Pseudoliparis (Malaxidinae, Orchidaceae) from New Guinea
Authors: MARGOŃSKA HANNA B.
Published: November 2024

N/A
Lightning and Radar Measures of Mixed-Phase Updraft Variability in Tracked Storms during the TRACER Field Campaign in Houston, Texas
Authors: Bruning Eric C. , Brunner Kelcy N. , van Lier-Walqui Marcus , Logan Timothy , Matsui Toshi
Published: November 2024

Properties of 7488 thunderstorms are summarized for June–September 2022 during the Tracking Aerosol Convection Interactions Experiment (TRACER) field campaign Houston, Texas, using polarimetric weather radar and VHF 3D Lightning Mapping Array data. Automated tracking of storms linked each instrument’s measurements to a data-defined, time-evolving storm footprint. Within each storm, the depth and magnitude of episodic columns of radar differential reflectivity and specific differential phase quantified the prevalence of updrafts that activated mixed-phase precipitation pathways. Lightning measurements further distinguished the degree of rimed precipitation formation: the fraction of tracks with lightning varied from day to day and cells with lightning had stronger polarimetric columns. Track-level correlation of the lightning flash rate with radar polarimetric measures had substantial spread, showing that lightning provides an additional signal of mixed-phase precipitation processes that can complement future studies of thermodynamic and aerosol controls on cloud microphysics in the Houston region.
Engineering the filial self. Negotiating the moral construction of filial piety at different government levels in China
Authors: Meinhof Marius , Zhang Yiming
Published: November 2024

This article draws on discourse analysis of central and local government texts alongside ethnographic fieldwork conducted in China to depict the negotiation and implementation of filial piety ( xiao), as advocated in the moral construction framework, across different levels of government in China. We show how heterogeneous actors within the Chinese state fill the vague framework of the discourse on filial piety with their concerns and visions of a ‘better’ individual, family, or society, and how they try to connect through the concept of ‘promoting xiao’. We examine three levels of government: The central government's grand narrative of moral construction in propaganda texts on xiao; how local governments pick up, use, and negotiate this discourse in their self-presentations and reports on local promotion of xiao on the online propaganda platform Xuexi Qiangguo; and grassroots government organisations’ approaches to promote xiao within their neighbourhoods.
Burning out, fading away, and the sophomore slump: Critics’ versus fans’ ratings of music artists’ album quality over time
Authors: Webster Gregory D. , Zander Lysann
Published: November 2024

Folk psychology posits that music artists’ first albums are considered their best, whereas later albums draw fewer accolades, and that artists’ second albums are considered worse than their first—a phenomenon called the “sophomore slump.” This work is the first large-scale multi-study attempt to test changes in album quality over time and whether a sophomore slump bias exists. Study 1 examined music critics, sampling all A, B, and C entries from The New Rolling Stone Record Guide (2,078 album reviews, 387 artists, 38 critics). Study 2 examined music fans, sampling crowdsourced Rate Your Music ratings of artists with at least one Rolling Stone top 500 album (4,030 album reviews, 254 artists). Using multilevel models, both studies showed significant linear declines in ratings of artists’ album quality over artists’ careers; however, the linear effects were qualified by significantly positive quadratic effects, suggesting slightly convex patterns where declines were steeper among earlier (vs later) albums. Controlling for these trends, a significant and substantial sophomore slump bias was observed for critics’ ratings, but not for fans’ ratings. We discuss theoretical perspectives that may contribute to the observed effects, including regression to the mean, cognitive biases and heuristics, and social psychological accounts.
Evaluation of Door-to-Needle Times Between Alteplase and Tenecteplase for Acute Ischemic Stroke at Two Academic Medical Centers
Authors: Monkemeyer Nicholas J. , Marino Kaylee K. , Goodberlet Melanie Z. , Anderson Christopher , Bresette Linda , Webb Andrew J. , Singhal Aneesh , Ware Lydia R.
Published: November 2024

Background:

Off-label tenecteplase use for acute ischemic stroke (AIS) has increased due to ease of administration and comparable efficacy and safety to alteplase.

Objective:

This study aimed to evaluate time to thrombolysis before and after transition from alteplase to tenecteplase for treatment of AIS at 2 institutions.

Methods:

This retrospective cohort study included adult patients receiving thrombolysis for AIS before and after transition from alteplase to tenecteplase at 2 academic medical centers from January 1, 2020 to January 31, 2024. The primary endpoint was door-to-needle (DTN) time, defined as minutes from hospital arrival to thrombolysis administration. Notable secondary endpoints included time from last known well (LKW) to thrombolysis, time from brain imaging to thrombolysis, hospital length of stay (LOS), and incidence of symptomatic intracranial hemorrhage (sICH).

Results:

A total of 328 patients (168 tenecteplase and 160 alteplase) were included. Patients were 51.5% female with a median (interquartile range [IQR]) age of 70 [58-80] years and initial National Institutes of Health Stroke Scale (NIHSS) score of 8 [5-14]. There was no statistically significant difference in DTN time (60 vs 56 minutes), time from LKW to thrombolysis (134 vs 147.5 minutes), or time from brain imaging to thrombolysis (32 vs 31 minutes) between tenecteplase and alteplase. Hospital LOS (5.7 vs 4.9 days) and the rates of sICH (3% vs 3.8%) were similar between groups.

Conclusion and Relevance:

Tenecteplase and alteplase had comparable DTN times for treatment of AIS and similar safety endpoints. Further studies are warranted to identify opportunities to streamline DTN times with tenecteplase.
Examining the behavior of a two-connected-spring pendulum according to non-resonance and resonance conditions
Authors: Amer TS , Elhagary Mohammed A , Hassan Seham S , Galal Abdallah A
Published: November 2024

This paper focuses on the planar forced oscillations of a particle linked to its support point through a system comprising two nonlinear springs arranged in series with two viscous dampers. The motion of this point is restricted to being on an elliptic route. Three degrees-of-freedom (DOF) characterize the system’s motion, explained by two differential equations (DEs) and another algebraic equation derived using Lagrange’s equations. The traditional method of multiple-time scales (MMTS) is applied in the context of the time realm. The dynamics of forced and damped oscillations is explored in this work, highlighting non-resonant conditions along with two distinct external resonances. Furthermore, stationary periodic states influenced by external resonances are examined, and the stability of each case is evaluated. The asymptotic solutions of the controlling equations are solved up to the third approximation. The classification of resonance cases is based on the second and third order of the approximate solutions. Therefore, the solvability criteria and the modulation equations (ME) are obtained. The Routh–Hurwitz conditions (RHCs) serve as the basis for assessing the stability and instability criteria. A discussion and graphical representations of the time histories, frequency response curves (FRC), and stability regions are provided to demonstrate the beneficial effects of different physical parameter inputs on the system’s performance. The obtained outcomes can improve the performance of spring-based mechanical systems like vibrational isolation devices, shock absorbers, and suspension mechanisms. Additionally, they have the potential to enhance stability and control in robotic limbs and aircraft landing gear systems, ensuring better stress absorption and stability.
Insights Into the Epidemiology of Peripheral Nerve Injuries in the United States: Systematic Review
Authors: Randall Zachary D. , Navarro Brendan J. , Brogan David M. , Dy Christopher J.
Published: November 2024

Background:

Peripheral nerve injuries (PNI) range from mild neurapraxia to severe transection, leading to significant morbidity. Despite their impact, the societal implications of PNI in the United States are not well understood. This study aims to systematically review the literature on PNI epidemiology in the United States. We hypothesize that this review will reveal significant gaps in the understanding of PNI incidence, demographics, and economic impact.

Methods:

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we queried the literature for studies on PNI that reported at least one of the following: incidence rates, demographics, affected nerve distribution, injury mechanisms, surgical intervention rates, and associated direct costs. Exclusion criteria included non-English publications, abstracts, conference proceedings, reviews, or editorials, studies published before 2000, non-US studies, or studies focusing solely on digital nerves or plexus injuries.

Results:

Fifteen studies met the inclusion criteria. Data indicate a higher incidence of upper extremity nerve injuries compared with lower extremity injuries. The literature lacks comprehensive reporting on surgical intervention rates, with no recent data since 2013. There is a notable absence of nationwide epidemiological data on PNI mechanisms and recent cost data, with most information over a decade old and primarily focused on inpatient costs, neglecting outpatient visits, physical therapy, and medication expenses.

Conclusion:

The epidemiological data on PNI are limited and outdated, highlighting the need for further research. Future studies should focus on recent trends in PNI incidence, injury mechanisms, and financial burden, including comprehensive reporting on surgical interventions, to inform strategies aimed at improving patient outcomes and health care resource allocation.
BERT with an Augmented Cross-attention Decoder (BERT-ACD) for Binary and Fine-grained Multiband Sentiment Detection
Authors: Ashir Abubakar M. , Taha Mohammed Abdulghani
Published: November 2024

In contemporary times, research in sentiment analysis has taken deeper steps into a finer and more granular analysis, transcending beyond the traditional binary or ternary classification of sentiment/opinion into positive, negative, or neutral. With the increasing complexity and challenging nature of such tasks, large language models inspired by transformer architecture are frequently deployed to address such challenges. Despite recorded improvements, challenges in identifying different levels, strengths or bands of sentiment intensity and the aspect for which the sentiment is expressed remain unresolved. In this article, we propose a banded sentiment analysis system for categorizing texts into 7 meaningful and relatable bands of sentiment for modern applications. It is also capable of performing aspect-based sentiment analysis in the same pipeline. The system architecture is inspired by the transformer language model with a BERT-based encoder and a newly proposed cross-attention, non-autoregressive decoder with augmented inputs. The decoder receives an n-gram-based augmented input sequence embedding that is specifically extracted from the original input, which comprises a list of the subjects, descriptive phrases, and modification phrases that underscore cases of amplification or undertone in a sentence. Rule-based tree parsing was proposed for use with dependency parsing for the extraction of these augmented inputs for the cross-attention decoder. Extensive experiments were conducted under different architecture setups and conditions with popular sentiment analysis datasets (Amazon reviews 2023, IMDB Movies review, SST-5 and SST-2 datasets) to verify the efficacy of the system. Extended labeling was also performed on the SST-5 dataset to generate 7 sentiment classes with the help of GPT4 and Bard. Experiments validate the efficacy of the proposed models.
The availability of common patient-reported outcome measures in hand surgery across Europe
Authors: Aman Martin , Pennekamp Anna , Prahm Cosima , Czarnecki Piotr , Van der Heijden Brigitte , Harhaus Leila
Published: November 2024

Many European healthcare systems emphasize value-based care to improve outcomes and control costs. Assessing function and satisfaction in hand surgery relies on patient reported outcome measures. This study evaluates the use of these outcome measures across Europe, focusing on diversity and language validation.

A comprehensive database search for hand-specific patient reported outcome measures assessed availability for all official languages in Europe focusing on transculturally adapted and validated versions of available questionnaires. The study identified 47 European countries with 41 unique languages. The Disabilities of the Arm, Shoulder and Hand Questionnaire is the most available outcome measure, translated into 41 languages. Availability of other outcome measures varied significantly by language. Gaps in the availability of hand specific patient reported outcome measures exist across Europe. To assist in translating and validating such questionnaires, an exemplary Standard Protocol Items: Recommendations for Interventional Trials checklist is provided as supplementary material.

Level of evidence: IV
Unlocking athlete potential: The evolution of coaching strategies through artificial intelligence
Authors: Pashaie Sajjad , Mohammadi Sardar , Golmohammadi Hamed
Published: November 2024

Artificial intelligence (AI) is rapidly transforming sports coaching, offering new tools to enhance athlete performance and training methods. However, the balance between leveraging AI’s capabilities and maintaining the human touch in coaching remains a critical challenge. This study investigates how AI can be effectively integrated into sports coaching while maintaining the essential human elements of leadership, mentorship, and personalized support. The research aims to provide a framework for combining AI technology with traditional coaching strategies to optimize performance. Using Grounded Theory (GT) methodology, the study conducted expert interviews and performed a detailed literature review to understand the interaction between AI and sports coaching. The resulting “Synergy Theory” model explains how AI can enhance training while highlighting the importance of maintaining ethical standards and human-centered coaching practices. The research reveals that AI can considerably improve performance analysis, injury prevention, and training customization. However, over-reliance on AI risks undermining the human aspects of coaching. The findings underscore the need for technological literacy among coaches and the ethical integration of AI in sports. Challenges such as data quality, resistance to technology, and privacy concerns must also be addressed. The present article is one of the first studies to comprehensively explore the ethical, practical, and technical considerations of integrating AI into sports coaching. This study also offers practical recommendations for balancing AI technology with traditional coaching methods.
The scope of demand-driven material requirements planning in operative purchasing of a multi-national company: A case study
Authors: Shamsuzzoha Ahm , Jaakkola Tuomas
Published: November 2024

The objective of this study is to address existing study gaps by defining what materials are demand-driven material requirements planning (DDMRP) suitable and building a tool that helps to identify such materials. The research problems are approached with three different questions about suitability, features of the identification tool, and financial impact. The research methodology consists of a mixed method case study approach, where semi-structured interviews were conducted with supply chain professionals from the case company, and quantitative data related to the case company’s operations was analyzed. The data consisted of the relevant data of over 10,000 purchased materials. The findings of this study suggest that there are no certain characteristics that materials suitable for DDMRP have, but the potential must be defined individually in the case of every purchased material. The tool initially developed in this study helps to identify materials that meet the requirement of providing potential positive financial impact if brought into DDMRP scope by analyzing historical demand data, lead times, and inventory carrying costs.
Transulnar approach as an alternative access site for neuroendovascular procedures
Authors: Gómez-Pena Sara , Trejo Carmen , Pérez-García Carlos , López-Frías Alfonso , Rosati Santiago , Schmolling Ángela H , Moreu Manuel
Published: November 2024

Objective

This study aims to describe our experience and safety considerations associated with the use of the transulnar approach in neurointerventional procedures when radial access is not feasible.

Methods

A prospective exploratory analysis was conducted on 35 patients who underwent diagnostic or therapeutic neuroangiography via transulnar approach due to radial access limitations. Technical aspects of the transulnar approach, patient demographics, procedural details, and complications were documented. Statistical analysis was performed using SPSS Statistics software.

Results

Among the 35 procedures, the transulnar approach demonstrated a high success rate (97.14%), with only one procedural failure. Indications for transulnar access included larger ulnar artery caliber (46%), radial artery spasm (37%), severe tortuosity of the radial artery (17%), and other anatomical considerations. Complications were rare, with only two access-related complications observed: a type I hematoma and ulnar artery vasospasm. No major bleeding episodes occurred, highlighting the safety profile of transulnar access.

Conclusion

The transulnar approach represents a feasible alternative for neurointerventional procedures when radial access is not achievable. It offers high success rates and minimal complications, comparable to the radial approach. Anatomical considerations, safety profile, and patient preference support its consideration as a secondary option in neurointerventional practice. Further research and larger studies are warranted to validate its efficacy and safety in a broader patient population.
Effect of oral zinc and steroids on long COVID hyposmia and hypogeusia
Authors: Chiang Yi-Fang , Jiang Rong-San
Published: November 2024

Objective:

We studied the prognosis of olfactory and gustatory dysfunctions in patients with long COVID (Coronavirus Disease 2019) after treatment with oral zinc and steroids.

Methods:

We measured olfactory and gustatory functions of long COVID patients at their first visits, and after 2–4 months of treatment with oral zinc and steroids using the traditional Chinese version of the University of Pennsylvania Smell Identification Test and the Waterless Empirical Taste Test. We also assessed by phone the recovery of olfactory and gustatory functions at a mean of about 10 months of follow-up.

Results:

Among our 71 long COVID patients, 34 complained of loss of smell and taste. Their objective test results showed 88.2% hyposmic, 23.5% hypogeusic at the first visit. After treatment, 77.8% of the patients were hyposmic, and 16.7% were hypogeusic. After a mean follow-up of 10.35 months, 91.2% of the patients reported improvement in their olfactory function. Among the 36 patients who had complained only of smell loss, the objective test results showed 75% hyposmic at their first visit. After treatment, 71.4% of the patients were hyposmic. After a mean of 10.42 months of follow-up, 77.8% of the patients reported improvement in their olfactory function. Only one patient complained of taste loss.

Conclusions:

We found that olfactory dysfunction in most long COVID patients persisted for more than 10 months.
Anatomic posterolateral corner reconstruction with autografts provides superior stability compared to non-anatomic reconstruction in the setting of combined grade 3 posterolateral corner injury and single bundle posterior cruciate ligament reconstruction
Authors: Franciozi CES , Mameri ES , Schumacher FC , Credidio MV , Luzo MVM , Kubota MS
Published: November 2024

Objectives

To compare anatomic versus non-anatomic-posterolateral-corner (PLC) reconstructions with autografts for grade 3 posterolateral corner knee lesions combined with single bundle posterior cruciate ligament (PCL) reconstruction.

Methods

An outcome comparative study of chronic PCL lesions submitted to single bundle PCL reconstruction combined with a grade 3 PLC injury from Hughston and Fanelli classifications treated either by anatomic or non-anatomic PLC-reconstruction with autografts with at least 24 months of follow-up. Outcomes: Lysholm, IKDC, Tegner, side-to-side-difference (SSD) from posterior and varus stress radiographs, IKDC objective scores for posterior drawer, varus stress, dial test and recurvatum. Student’s t- and two-proportion Z-test were used. Power for sample size was 88.2%.

Results

Thirty-nine patients were evaluated: 18 in the Anatomic-PLC-group and 21 in the Non-anatomic-PLC-group. Mean follow-up: 28.3 months (range 24 to 59 months). Preoperatively, no significant differences were observed between the two groups in terms of age; time from injury until surgery; Lysholm; subjective IKDC; posterior, varus, external rotation or recurvatum laxity; stress radiographs; incidence of associated ligament and meniscus injuries. Postoperatively, no significant differences were observed for Lysholm (p=0.189), subjective IKDC (p=0.261), Tegner (p=0.385), mean improvement in Lysholm and IKDC scores (p=0.144, p=0.354, respectively), posterior tibial translation on stress radiographs [postoperative SSD (p=0.205) and percentage of patients with unacceptable (≥8mm) asymmetry (p=0.912)]; and complications. Significant differences favoring Anatomic-PLC-group were observed for Posterior-Drawer-Test (0.83±0.51 vs 1.1±0.43,p=0.046); Varus-Stress-Gapping at 30o (0.5±0.78 vs 1.14±0.85, p=0.01); Tibial-External-Rotation both 30o (33.3% vs 80.9%, p=0.002) and 90o (16.6% vs 47.6%, p=0.041); Asymmetrical-Recurvatum (5.5% vs 47.6%, p=0.00362); SSD-Lateral-Gapping-Varus-Stress-Radiographs (1.8±2.1 vs 3.35±2.28, p=0.028). Failure (presence of any of the following: Posterior Drawer ≥ 2+, Varus Stress ≥ 2+, SSD ≥ 8mm on Posterior-Radiograph or ≥ 4mm on Varus-Stress-Radiograph): 5% Anatomic versus 19% Non-anatomic, no statistical difference, p=0.103.

Conclusion

Anatomic posterolateral corner reconstruction with autografts provided superior stability compared to non-anatomic reconstruction in the setting of combined grade 3 posterolateral corner injuries and single bundle posterior cruciate ligament reconstruction.
Lateral hinge fracture does not compromise postoperative alignment of valgus open wedge high tibial osteotomy
Authors: Cruz PG , Paula RE , Mozella AP , Albuquerque RSP , Cordeiro A , Couto A
Published: November 2024

Objectives

Verify whether the previously planned correction with osteotomy was achieved and, in cases with hinge fracture, whether the accuracy of the correction was affected. In addition, identify the fracture characteristics responsible for inaccurate repair, including the type of fracture and the location of the hinge

Methods

Retrospective evaluation of patients who underwent tibial osteotomy with medial opening wedge and fixation with locking plate. The sample size was based on other similar studies available in the literature. After applying the exclusion and inclusion criteria, data from 47 participants were used. The research participants underwent the same surgical procedure, divided into two groups: patients without lateral cortical fracture and patients with fractures. Patients with fractures were compared to patients without fractures in terms of the statistical difference in the axis of correction of lower limb alignment.

Results

In the preoperative period, the following measurements were evaluated: Tibiofemoral Angle, Tibial Slope, mPtA (Medial Proximal Tibial Angle), Joint Obliquity (JLCA). In the immediate postoperative period: Tibiofemoral angle, tibial slope, mPtA, joint obliquity. In the late postoperative period: Tibiofemoral Angle, Tibial Slope, mPtA, Joint Obliquity, MAD (Mechanical Axis Deviation) and correction achieved between groups. There was no statistical difference between the groups in the preoperative, immediate postoperative and late postoperative periods.

Conclusion

No statistical differences were found between the group with and without lateral cortical fracture. We conclude that lateral cortical fracture does not cause loss of alignment correction as long as a rigid fixation method is used.
Measure of risk of fall in severe knee osteoarthritis patients using Techbalance device
Authors: Ooka NHM , Pessoa ALC , Runco GM , Matta MRS , Oliveira LP
Published: November 2024

Objectives

Knee Osteoarthritis prevalence increase is due to rise of life expectancy and ageing of the population. Ageing also affects gait and balance leading to increase of fall risk. To track this risk, newer and portable devices using accelerometers and gyroscopes are used in monitoring falls, because postural stability and balance compromise increase risk of falls (RF). The combination of accelerometer and gyroscope in portable devices are defined as Inertial Mobility Unity (IMU). Our study aims to assess RF using an IMU (Techbalance®) in patients with knee osteoarthritis.

Methods

Cross-sectional study in 133 eldery patients with knee osteoarthritis. The sample is divided in 2 groups, Group 1: no previous fall in the last year, Group 2: history of fall in the last year. Techbalance assessment of RF generates two scores: TechFragilidade is a clinical evaluation of frailty of the patient. TechEscore consists in 14 tasks to evaluate balance and posture assisted by a smartphone-like device IMU positioned on the girdle of the patient (center of mass). The RF assessment using the Techbalance was compared to both low-risk and high-risk of falls and the statistics analysis were performed with Chi-square, Mann-Whitney, and Spearman tests.

Results

Mean age was 65 (± 6,3) years. TechEscore and TechFragilidade scores correlate positively to risk of fall ( p<0.05 e <0.01, respectively) and negatively with SF12 physical ( p<0.05). TechFragilidade score (r = 0,313, p < 0,01) has a higher correlation to risk of fall than TechEscore score (r = 0,247, p < 0,01) ( z = 2,004; p < 0,023).

Conclusion

Our study showed that Techbalance was able to correlate RF in knee osteoarthritis patients combining frailty assessment and balance and postural evaluation using an IMU.
Pressure center behavior and plantar pressure distribution in patients undergoing total knee atropasty surgery
Authors: Filho UCS , Teixeira EM , Araujo HRS , Assis BR , Jacob TC , Azevedo FGS
Published: November 2024

Objectives

The study aimed to analyze the center of pressure behavior in individuals undergoing total knee arthroplasty (TKA), using a plantar pressure platform as an assessment tool.

Methods

Seventeen participants, with an average age of 71.23 years, diagnosed with knee osteoarthritis and undergoing TKA for the first time, were included. Inclusion criteria required participants to have no neurological dysfunctions, prior use of lower limb prostheses, or deformities on the plantar surfaces. The experimental protocol involved data collection on center of pressure behavior, arch index, and pain using the Visual Analog Scale, both with eyes open and closed.

Results

Revealed significant differences in anteroposterior center of pressure behavior (COPAP) and center of pressure area between moments with eyes open and closed. There were statistically significant variations in COPAP, indicating an influence of visual condition on postural stability. Other variables, such as arch index, average displacement speed, and percentage of pressure on the feet, did not show significant differences.

Conclusion

The visual condition, especially the difference between eyes open and closed, impacts the center of pressure behavior in patients undergoing TKA. The decrease in the center of pressure area with closed eyes suggests an adaptive response of the neuromuscular system to visual deprivation. This study emphasizes the importance of considering visual factors in the assessment of balance in pre-TKA patients, providing valuable insights for physiotherapeutic interventions and preoperative guidance.
Quality of Life in Women After Total Knee Arthroplasty With Valgus Deformity
Authors: Zorzi AR , Bento AF , Almeida LV , Campos GC , Piedade SR
Published: November 2024

Objectives

While traditional indicators focus on implant survivor, the assessment of quality of life encompasses broader dimensions, such as the experience of pain, mobility, the ability to perform daily activities, and mental well-being. Given the anatomical, psychological, and cultural differences found in females, and the rarity of valgus deformity, which comprises only 10% of total knee arthroplasty cases, there is a significant gap in available data, highlighting the importance of research directed towards this specific group of patients.

Methods

This observational study involved 20 participants with valgus deformity who underwent total knee arthroplasty at an university hospital. The study was previously approved by the Research Ethics Committee (CAAE: 58487222.5.0000.5404). The assessment of function, quality of life and pain was carried out using the WOMAC, EuroQol-5D 3L, Kujala and Visual Analogue Scale for pain (VASpain) questionnaires.

Results

The participants, all female, had an average age of 68.3 years ∓ 9.4SD, with an average weight of 78.6 kg ∓ 13.5SD, average height of 1.57 m ∓ 0.07SD and Average BMI of 24.7 ∓ 4.4 SD. Post-surgical follow-up time was on average 79.6 months ∓ 37.3SD, with 73.9% of cases on the right knee and 26.1% on the left side. The average pain VAS was 2.9 points. The Kujala scale presented an average of 66.9 points. WOMAC presented an average of 15.6 points ∓ 12.2 SD, with a minimum of 3.1 and a maximum of 61.5. EuroQol 5D 3L demonstrated good quality of life, with at least 61 points in 80% of all cases.

Conclusion

In conclusion, most participants experienced mild to moderate post-surgery pain, but the intervention substantially improved quality of life, enabling daily activities resumption.
Genicular block in total knee arthroplasty: a randomized clinical study
Authors: Lima PHR , Paganini GB , Oliveira AD , De Almeida GDB , De Moura CP , De Oliveira SG
Published: November 2024

Objectives

Our randomized clinical study aims to assess genicular nerve block performed intraoperatively compared to a control group without regional block, concerning pain and functional parameters.

Methods

The randomized clinical trial involved 28 patients with primary gonarthrosis scheduled for total knee arthroplasty due to disease progression and failure of conservative treatment.Patients were randomly assigned to two groups: control (Group C) and the proposed intervention (Group I).At the end of the surgical procedure, Group I received levobupivacaine infusion, while Group C received saline solution, targeting the medial-superior, lateral-superior, and medial-inferior genicular nerves.Parameters such as pain, muscle strength, joint effusion, orthostatic capacity, and ambulation were evaluated before and after surgery. Patients also recorded daily pain levels for five days post-procedure, as well as tramadol consumption.Statistical analysis was performed to compare the effects between the groups, adopting a p-value < 0.05 as the significance level.

Results

For the characterization of the cohort based on age and BMI variables, tests indicate no evidence that the studied groups have different profiles.In comparing variables such as Visual Analogue Scale, Muscle Strength, Joint Effusion, and Ambulation/Orthostasis between preoperative and postoperative day 1 evaluations, only one characteristic shows a significant difference. In the Muscle Strength variable, Group I exhibits a greater reduction (p=0.016).Throughout the study's follow-up period, none of the patients experienced any complications related to the surgical procedure.

Conclusion

The genicular nerve block performed intraoperatively during total knee arthroplasty surgeries, when done in isolation, proved ineffective in reducing postoperative pain and did not result in any benefit for early return to ambulation.The authors believe that further studies on the matter are necessary, with a larger number of patients, in order to better describe the outcomes of the intervention.
Surgical Treatment Of Chronic Patellar Tendon Rupture Using A Two-Stage Technique With Patellar Transosseous Traction: A Case Series
Authors: Faria JLR , Neto RVR , Pavao DM , Titonelli VE , Maia PAV , Albuquerque RSP
Published: November 2024

Objectives

This study aims to describe the clinical results of a novel surgical technique used in patients with chronic patellar tendon rupture, high patella, and non-reducible quadriceps shortening.

Methods

A cross-sectional study design was utilized, involving 5 patients treated with the described surgical technique. These patients were reassessed at 10, 24, and 48 weeks post-surgery. The techniques included staged surgery using patellar transosseous traction in the first stage and a modified Kelikian technique in the second stage.

Results

The study reported satisfactory functional and pain-related outcomes (Lysholm and IKDC scales), reduction in patellar height, and restoration of the full active range of motion in the affected knee.

Conclusion

The two-stage surgical technique for chronic patellar tendon rupture, incorporating patellar transosseous traction and a modified Kelikian technique, is simple, reproducible, and yields satisfactory clinical results.
Validation Of Risk Stratification Protocol For Total Knee Arthroplasty
Authors: FB Loures , GM Queiroz , DL Rosa , GM Runco , LP Oliveira , VS Gameiro
Published: November 2024

Objectives

The main objective of the study was to validate the protocol for performing TKA without admission to the ICU in the postoperative period. The secondary objective was to evaluate the transfusion rate blood flow for the same specific group of patients after surgery.

Methods

After approval of the study by the Institution’s Research Ethics Committee,270 cases of TKA performed between January 2020 and December 2021. All patients undergoing TKA in the period had followed the screening protocol defined by orthopedists, anesthetists and clinicians, after reviewing the literature. The seven criteria used were: age up to 75 years, body mass index up to 35 kg/m2, ASA score classification I or II (American Society of Anesthesiology), non-smoker, no previous history of ischemic disease (coronary or cerebral), creatinine clearance greater than 60mL/min, hemoglobin greater than 12g/dL, osteoarthritis with deformity treatable with a primary prosthesis.

Results

270 patients who underwent TKA between January 2020 and December 2021 were included in the study, following the pre-defined screening protocol. The sample consisted of 182 female and 88 male patients. The average age was 65.5, ranging between 39 and 75 years. Only one patient required ICU surveillance after the surgical procedure, due to hemodynamic instability, giving the screening protocol a positive predictive value of 99.6%. Although there was a significant decrease in serum levels, no patient presented hemodynamic symptoms or clinical indication for blood transfusion.

Conclusion

The proposed screening protocol demonstrated that, following the criteria established, TKA can be performed without the need for ICU reservation, without typing preoperative blood supply and/or reserve of blood products, without compromising patient safety. The rational use of health resources allows the coverage of a greater number of patients, increasing the effectiveness of the system.
Clinical Outcomes of Combined Reconstruction of the Medial Patellofemoral Ligament (MPFL) and Medial Quadriceps Tendon-Femoral Ligament (MQTFL) at a Minimum Follow-up of 2 Years
Authors: EF Temponi , Carvalho LH , LFM Soares , MBJ Goncalves , FS Pimenta , Fávero RC
Published: November 2024

Objectives:

To report patient-reported outcome measures (PROMs) following isolated combined MPFL and MQTFL reconstruction in cases of patellar instability at a minimum follow-up of 2 years and to assess potential complications.

Methods:

A retrospective analysis of prospectively collected data was performed on consecutive skeletally mature patients who underwent isolated combined MPFL and MQTFL reconstruction between January 1, 2020, and May 31, 2022. Data were collected on physical examination, return to sport, and occurrence of complications. Patients completed Kujala and International Knee Documentation Committee (IKDC) Scores (PROMs) pre-operatively and at final follow-up.

Results:

A total of 82 patients underwent combined MPFL and MQTFL reconstruction, with 7 patients (8%) lost to follow-up. The mean follow-up time was 3.2 ± 0.7 years (range, 2.2 to 5.8). The mean pre-operative Kujala knee function score was 62 points (range, 39-76), which increased to 86 points (range, 86-93) at final follow-up (P = 0.00004). The mean pre-operative IKDC score was 42.5 (range, 39.1-44.8) points, increasing to 73 points (range, 70.1-75.9) at final follow-up (P = 0.00894). No instances of post-operative patellar fracture, infection, hematoma, or instability were reported. Minor complications were observed in 13.33% (10/75) of cases.

Conclusion:

In this series, combined MPFL and MQTFL reconstruction resulted in patellar stability, significant improvements in clinical and functional outcomes, and no major complications.
Selective embolization of genicular arteries after total knee arthroplasty with persistent synovitis and pain
Authors: MARCIA UCHOA DE REZENDE; , VALLE LEONARDO GUEDES MOREIRA , DE ASSIS ANDRE MOREIRA , GALASTRI FRANCISCO LEONARDO , AFFONSO BRENO BOUERI , NASSER FELIPE
Published: November 2024

Objectives

To document the effects of embolization of branches of genicular arteries in patients with pain and synovitis after total knee arthroplasty due to osteoarthritis (OA)

Methods

Prospective case series of eight patients (nine knees) with persistent pain, effusion, stiffness, and synovitis after knee arthroplasty submitted to transcatheter arterial embolization since August 2021. Clinical outcomes were evaluated at baseline, one and two years with EQ5D, WOMAC (0-96) and KOOS. All patients had their knees aspirated at the operating room to ascertain lack of infection.

Results

Abnormal neovessels were identified in all cases. One patient remained with cutaneous color changes even after two years of the procedure in both knees. No tissue necrosis, dermal ulcers, or peripheral ulcers. Three patients required to do the procedure more than once (twice in two and thrice in one). EQ5D improved from an average of 0.9063±0.05 to 0,9562±0.04 (one year), and 0.9828±0.02 at 2 years. WOMAC pain improved from 1.83±2 to 1.33±1(one year ) and 0 at 2 years (only three patients, i.e., four knees performed the procedure only once and reached de 2-year follow-up mark). Stiffness improved from 1±1.5 to 0.5±1.2(one year) and 0 (2-year). Baseline WOMAC function was 9.5±6.2 improving to 3.1±2.3 (one year) and 1.75±0.96 at two years. WOMAC total (0-96) WOMAC total reduced from average of 12.3 to ±7.4 to 4.7±2.9(one year) and 1.75±0.96 (two years). KOOS general improved from 75.8±11.3 to 84±4.3 at one year and to 88±3.4 at two years. All patients improved in all parameters continuously.

Conclusion

Embolization of branches of genicular arteries in patients with persistent pain, stiffness, effusion, and synovitis, after total knee arthroplasty, due to OA, may provide long lasting improvements in pain, function, and quality of life.