bluuebunny/crossref_metadata_2025 huggingface dataset:
Small Interfering RNA in Colorectal Cancer Liver Metastasis Therapy
Authors: Xie Junlin , Wang Shubin
Published: July 2022

Colorectal cancer (CRC) is associated with numerous genetic disorders and cellular abnormalities, and liver metastasis is a common health concern in patients with CRC. Exploring newer and more efficient therapies to block liver metastasis is pivotal for prolonging patient survival. Therefore, small interfering RNAs (siRNAs) are expected to be remarkable tools capable of regulating gene expression by participating in a process called RNA interference (RNAi). RNAi is a biological process among eukaryotes wherein specific messenger RNA (mRNA) molecules are destroyed and gene expression is inhibited. This technology is a promising therapeutic agent in the treatment of CRC liver metastasis (CRLM). Nevertheless, crucial problems in siRNA therapeutics, including inherent poor serum stability and nonspecific uptake into biological systems, must be recognized. For this reason, delivery systems are being developed in an attempt to solve these problems. Here, we discuss the utility of siRNA therapy for the treatment of CRCLM by targeting the major metastasis-related signaling pathways. siRNA therapy has the potential to be one of the most effective methods for CRLM treatment in the future.
Weighted Correlation Network Analysis of Cancer Stem Cell-Related Prognostic Biomarkers in Esophageal Squamous Cell Carcinoma
Authors: Zhao Mengnan , Jin Xing , Chen Zhencong , Zhang Huan , Zhan Cheng , Wang Hao , Wang Qun
Published: July 2022

Background: The role of cancer stem cells in esophageal squamous cell carcinoma (ESCC) remains unclear. Methods: The mRNA stemness index (mRNAsi) of 179 ESCC patients (GSE53625) was calculated using a machine learning algorithm based on their mRNA expression. Stemness-related genes were identified by weighted correlation network analysis (WGCNA) and LASSO regression, whose associations with mutation status, immune cell infiltrations, and potential compounds were also analyzed. The role of these genes in proliferation and their expressions was assessed in ESCC cell lines and 112 samples from our center. Results: The ESCC samples had significantly higher mRNAsi than the normal tissues. Patients with high mRNAsi exhibited higher worse OS. Seven stemness-related genes were identified by WGCNA and LASSO regression, based on which a risk-predicted score model was constructed. Among them, CST1, CILP, PITX2, F2RL2, and RIOX1 were favorable for OS, which were adverse for DPP4 and ZFHX4 in the GSE53625 dataset. However, RIOX1 was unfavorable for OS in patients from our center. In vitro assays showed that CST1, CILP, PITX2, F2RL2, and RIOX1 were pro-proliferated, which were opposite for DDP4 and ZFHX4. In addition, SMARCA4, NOTCH3, DNAH5, and KALRN were more mutated in the low-score group. The low-score group had significantly more memory B cells, monocytes, activated NK cells, and Tregs and less macrophages M2, resting mast cells, and resting dendritic cells. Conclusions: Seven stemness-related genes are significantly related to the prognosis, gene mutations, and immune cell infiltration of ESCC. Some potential anticancer compounds may be favorable for OS.
Threshold-free multi-attributes physical layer authentication based on expectation–conditional maximization channel estimation in Internet of Things
Authors: Jing Tao , Huang Hongyan , Wu Yue , Gao Qinghe , Huo Yan , Sun Jiayu
Published: July 2022

With the number of Internet of Things devices continually increasing, the endogenous security of Internet of Things communication systems is growingly critical. Physical layer authentication is a powerful means of resisting active attacks by exploiting the unique characteristics inherent in wireless signals and physical devices. Many existing physical layer authentication schemes usually assume physical layer attributes obey certain statistical distributions that are unknown to receivers. To overcome the uncertainty, machine learning–based authentication approaches have been employed to implement threshold-free authentication. In this article, we utilize an expectation–conditional maximization algorithm to provide the physical layer attribute estimates required for the authentication phase and a logistic regression model to achieve threshold-free physical layer authentication. Moreover, a Frank–Wolfe algorithm is considered to achieve fast convergence of the logistic regression parameters and multi-attributes are adopted to increase the differentiation of transmitters. Simulation results demonstrate that the obtained attribute estimates are sufficient to provide a reliable source of data for authentication and the proposed threshold-free multi-attributes physical layer authentication scheme can effectively improve authentication accuracy, with the false alarm rate P f reduced to 0.0263% and the miss detection rate P m reduced to 0.3466%.
“Life-altering”: A qualitative analysis of social media birth stories from mothers of children with Down syndrome
Authors: Kammes Rebecca R , Lachmar E Megan , Douglas Sarah N , Schultheiss Hannah
Published: July 2022

Perinatal depression/anxiety is a significant concern for mothers of children with Down syndrome. This is influenced by the way the Down syndrome diagnosis is shared with parents. This study examined social media posts from mothers regarding experiences of the birth of their child with Down syndrome. Forty-three total stories were coded using thematic content analysis. Results highlighted the experiences of mother’s who received a diagnosis of Down syndrome for their newborn. Two themes were found with relevant subthemes (i.e., receiving the diagnosis—mother’s intuition, confirmation of the diagnosis, influence of potential health concerns, initial emotions, impact of the medical professional; Processing the diagnosis—life-altering, child not meeting expectations, reframing the diagnosis, impact of partner and others). Findings highlight the need for medical personnel to understand this identity-changing process, as perinatal depression/anxiety looks different for these mothers. There is also a need to help them engage in services accordingly.
The reliability and usefulness of a novel basketball standardized shooting task
Authors: Daub Bryce D , McLean Blake D , Heishman Aaron D , Coutts Aaron J
Published: July 2022

The purpose of this investigation was to develop a basketball shooting performance test and subsequently assess the tests measurement characteristics and construct validity. The novel standardized shooting task (SST) was comprised of 60 free throw attempts followed by a 4-min spot-to-spot shooting segment (including seven sequential locations either outside the 3-point line or at a 15-foot mark, depending upon player role). After development of the SST, 28 (male = 16, female = 12) NCAA Division I basketball players completed the task on separate days (Part 1; reliability) and then following a standard basketball practice (Part 2; sensitivity). SST performance collected from 13 males was then compared with shots made during live practices and expert ranking's (Part 3; construct validity). Interday reliability (Part 1) measures were: intraclass correlations coefficient = 0.77–0.86; coefficient of variation = 1.9–12.0%. There were no significant differences ( p>0.05) between days for any performance variables. From pre- to post-practice (Part 2) repeated measures analyses of variance showed a significant difference ( p = 0.03) for shots made in 4-min (MAKE4MIN; pre = 51.6 ± 8.8, post practice = 48.7 ± 9.3), while no significant differences were detected for any other variables. Results from Part 3 indicated large correlations for Shooter Rank versus MAKE4MIN ( r = 0.814, p = 0.001) and Shooter Rank versus shooting percentage in live play ( r = 0.815, p = 0.001). These data demonstrate the SST poses sufficient reliability and sensitivity to detect meaningful changes in performance, as well as adequate construct validity. Therefore, offering an ecologically valid measurement which can be incorporated to athlete monitoring strategies in elite basketballers.
Obsessive-compulsive disorder and related disorders
Authors: Sloan Rebecca
Published: July 2022

Obsessive-compulsive disorder (OCD) is a mental illness characterised by recurrent, intrusive thoughts that are usually associated with repetitive mental or physical behaviours. The thoughts and behaviours are often distressing and difficult to control. They take up significant amounts of time, impacting on the person’s ability to live their daily life. OCD affects approximately 1 to 2% of the population during their lifetime. Despite this high prevalence, the diagnosis is frequently missed or delayed. Patients may wait years or decades to start treatment. There are several effective treatments available and many patients can be successfully managed within primary care. This review briefly discusses additional disorders that are associated with OCD, including body dysmorphic disorder.
Primary sclerosing cholangitis and primary biliary cholangitis
Authors: Perry Michael , Pathak Anjali
Published: July 2022

Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare and progressive cholestatic liver diseases that can result in end-stage liver disease. It is known that PSC and PBC patients have worse health outcomes compared with the general population. Both conditions share confusingly similar names, but do have significant differences in their epidemiology, aetiology, presentation, diagnosis, management and potential complications. This article aims to provide an overview of PSC and PBC for GPs.
Captura corporativa, fake news procannabis y posición de los consumidores ante su regulación
Authors: Isorna Folgar Manuel , Burillo-Putze Guillermo , José Villanueva-Blasco Víctor
Published: July 2022

Introducción. La captura corporativa es el proceso en el que las decisiones políticas responden a un interés particular de carácter privado, en detrimento del interés público. La industria del cannabis ha desarrollado estrategias de captura de políticas y de difusión de fake news (noticias falsas) con el objeto de fomentar una visión del cannabis como sustancia inocua e, incluso, sanadora de enfermedades, promoviendo así una buena imagen de esta sustancia, de las corporaciones y consumidores, presionando para su legalización. Objetivos. (1) Analizar las estrategias de difusión de mensajes y fake news promotoras del cultivo, consumo y regulación del cannabis a través de distintos canales, y (2) explorar el posicionamiento frente al debate legislativo sobre esta sustancia en una muestra de estudiantes universitarios consumidores de cannabis. Metodología. (1) Estudio de carácter exploratorio para identificar y analizar las estrategias de la industria y, (2) estudio no probabilístico con muestreo por conveniencia mediante encuesta telemática difundida entre estudiantes de 11 universidades españolas (439 participantes). Resultados y conclusiones. La promoción del cultivo y del consumo de cannabis, relativizando sus efectos perjudiciales y presentándolo como una sustancia medicinal, aparece en las distintas estrategias utilizadas por la industria para difundir una imagen positiva del cannabis y de los consumidores. Estos mensajes tienen correspondencia con el posicionamiento de los consumidores, de los que el 82.6 % apoya alguna forma de regulación del cannabis.
Management of periprosthetic joint infection of shoulder arthroplasty: Single-stage versus two-stage protocols. A systematic review and meta-analysis of the literature
Authors: Fiore Michele , Ferra Lorenzo , Giannini Claudio , Sambri Andrea , Filippini Matteo , Tedeschi Sara , Zamparini Eleonora , Viale Pierluigi , De Paolis Massimiliano , Guerra Enrico
Published: July 2022

Background

The treatment of shoulder prosthetic joint infections (PJIs) requiring removal of the prosthesis is not well defined. This article aims to systematically review and compare the results of the literature in single-stage and two-stage protocols in the treatment of shoulder PJI.

Methods

An in-depth search on PubMed/Scopus/Web of Science databases and cross-referencing search was carried out concerning the articles reporting detailed data on the topic.

Results

A total of 486 shoulder PJIs were included: 137 treated with single-stage and 349 with two-stage procedure. A similar distribution between early and not-early infections (19.1% vs 80.9%) was found between the two groups. The overall rate of success in terms of PJI eradication was significantly higher in the single-stage group (95.6% vs 85.7%, p < 0.001). The non-infection-related complications rate was 13.8% in the single-stage group and 37.6% in the two-stage group ( p < 0.001), the non-infection-related revision rate was 8% and 18.9%, respectively ( p = 0.005).

Discussion

The single-phase protocol showed a higher success rate in eradicating the infection and a lower complication rate. However, the low number of patients included, the low quality of the articles, the lack of data on clinical severity and bacteriological virulence suggest caution in conclusions.
Safety and efficacy of pegcetacoplan in paroxysmal nocturnal hemoglobinuria
Authors: Wong Raymond S.M.
Published: July 2022

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, acquired, hematologic disease characterized by complement-mediated hemolysis, thrombosis, and various degrees of bone marrow dysfunction. Until recently, C5 inhibition with eculizumab or ravulizumab represented the only therapies approved for patients with PNH by the United States Food and Drug Administration (US FDA). Although C5-inhibitors reduce PNH-related signs and symptoms, many patients continue to exhibit persistent anemia and require frequent blood transfusions. In May 2021, pegcetacoplan became the third US FDA-approved treatment for adults with PNH, and the first to target C3, a complement component upstream of C5. The novel strategy of inhibiting proximal complement activity with pegcetacoplan controls C5-mediated intravascular hemolysis and prevents C3-mediated extravascular hemolysis. Here, we review the results from multiple pegcetacoplan clinical studies on the efficacy and safety of pegcetacoplan treatment in adults with PNH. This review summarizes findings from three studies in complement-inhibitor-naïve patients with PNH (PADDOCK [phase Ib], PALOMINO [phase IIa], PRINCE [phase III; pegcetacoplan versus standard treatment excluding complement-inhibitors]), and one phase III study (PEGASUS) that compared eculizumab to pegcetacoplan in patients who remained anemic (hemoglobin levels < 10.5 g/dL) despite stable eculizumab treatment (⩾3 months). These studies found that pegcetacoplan contributed to superior improvements in primary and secondary endpoints related to hemoglobin levels and other hematologic parameters and provided effective management of anemia and anemia-related complications (i.e. transfusion burden, reticulocyte production, and fatigue). Furthermore, we summarize results from the 32-week open-label period from the PEGASUS trial, which confirmed the long-term safety and durable efficacy of pegcetacoplan as demonstrated by sustained improvements in clinical and hematologic outcomes in pegcetacoplan-treated patients. Pegcetacoplan is approved for the treatment of adults with PNH in the United States (Empaveli™) and for adult patients who remain anemic after at least 3 months of stable C5-inhibitor therapy in the European Union (Aspaveli®) and Australia (Empaveli; also approved for patients intolerant to C5-inhibitors).
Gyan Fresh: Digital Transformation of Dairy Business with Resilience and Technology Innovation
Authors: Mishra Anubhav , Shukla Anuja
Published: July 2022

Gyan Dairy, headed by the Agarwal brothers, was a privately held subsidiary of C. P. Milk, started as a small dairy unit in 2007. Gyan Dairy became one of the largest regional players in the state of Uttar Pradesh (India). The Indian government imposed the most strict and longest lockdown in 2019 to tackle the COVID-19 pandemic. This raised severe challenges for businesses, especially the dairy industry, which relies heavily on the movement of people and vehicles to ensure the delivery of products to consumers. Gyan dairy launched Gyan Fresh app to integrate the app-based home delivery business model for its dairy products. This case discusses the story of Gyan Fresh, which enabled self-orders and brought disruptive changes in the Indian dairy market and consumer behaviour. Furthermore, the case discusses the challenges and the next steps to expand the business, retain consumers and streamline the distribution channels.
Paper 06: The Natural History of Nonoperative Treatment of Posterior Instability in a High Demand Population
Authors: Bedrin Micheal , Yow Bobby , Nelson Sarah , LeClere Lance , Dickens Jonathan , Mescher Patrick
Published: July 2022

Objectives:

Nonoperative management of posterior shoulder instability is common, however there is limited data available to assess the pathomorphology of nonoperative management. The purpose of this study is to evaluate glenohumeral pathomorphology in shoulders with posterior glenohumeral instability treated nonoperatively.

Methods:

We conducted a retrospective review of a consecutive series of patient with isolated posterior shoulder instability defined as an isolated posterior labral tear with a corresponding positive Jerk or Kim test. Patients were excluded if they had prior shoulder surgery or absence of a Jerk or Kim test. Non-operative management was defined as a trial of formal physical therapy pursuit of nonsurgical modalities for a minimum 6 months. Patients who underwent non-operative management and subsequently had a repeat MRI of the initially injured shoulder were identified, and the two studies were compared to evaluate for changes in glenoid bone loss, glenoid morphology, cartilage injuries, and the presence of concurrent pathology. Our primary outcome was glenoid changes associated with failure of non-operative management, which was defined as reoperation and/or medical separation from the military due to the injured shoulder. Secondary outcomes included evaluation of potential risk factors for failure of non-operative management including glenoid bone loss, glenoid version, and posterior humeral head subluxation. Continuous variables were compared with student’s t-test or Fisher exact test when appropriate. Categorical variables were analyzed using Chi-squared. Multivariable regression analysis was used to evaluate risk factors for failure.

Results:

42/90 (46.7%) patients failed a 6-month trial of nonoperative management after being diagnosed with posterior glenohumeral instability and went onto receive an arthroscopic stabilization procedure. The failure group demonstrated a significantly greater humeral head subluxation ratio than the cohort of patients who survived nonoperative management (0.65 ± 0.2 vs 0.62 ± 0.2; p = 0.0375). Of those who failed nonoperative management only 17 had repeat MRI’s for comparison with initial MRI’s, which revealed a significantly greater increase in glenoid bone loss (6.54 ± 1.59 vs 2.68 ±1.71; p = 0.00274). The mean time from index MRI and repeat MRI was 488 days (95% CI 317 to 658).

Conclusions:

In patients that underwent 6-months of nonoperative management for isolated posterior glenohumeral instability, failure occurred approximately 47% of the time and was associated with a greater posterior humeral head subluxation ratio on index MRI than those who did not fail. Additionally, those who had repeat MRI on average 1.3 years later demonstrated greater glenoid bone loss when compared to the index MRI.
Paper 15: Micro-Fragmented Adipose Tissue versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Prospective Randomized Controlled Trial at 2-year follow-up
Authors: Di Martino Alessandro , Andriolo Luca , Boffa Angelo , Poggi Alberto , Kon Elizaveta , Filardo Giuseppe , Zaffagnini Stefano
Published: July 2022

Objectives:

Pre-clinical and clinical studies supported the use of intra-articular micro-fragmented adipose tissue (MF-AT) injections to address knee osteoarthritis (OA), suggesting their safety and clinical benefits. Nevertheless, no high-level studies investigated the potential of MF-AT over other biological products like platelet-rich plasma (PRP). The aim of this randomized controlled trial (RCT) was to compare a single injection of MF-AT to PRP in terms of clinical outcome and disease-modifying properties in patients with symptomatic knee OA.

Methods:

A total of 118 patients with symptomatic knee OA were randomly assigned to: single intra-articular MF-AT vs single intra-articular PRP injection. All patients were evaluated before the injection and at 1, 3, 6, 12, and 24 months with the International Knee Documentation Committee (IKDC) subjective score, the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscales, the EuroQol-Visual Analogue Scale (EQ-VAS) and EuroQol-5D (EQ-5D), and the Visual Analogue Scale (VAS). The treated knees were evaluated at baseline and at 6, 12, and 24 months of follow-up with radiographs and high-resolution (1.5 T) magnetic resonance imaging (MRI) with the Whole-Organ Magnetic Resonance Imaging Score (WORMS).

Results:

Both MF-AT and PRP provided a statistically and clinically significant improvement up to the last follow-up of 24 months. No differences were found between MF-AT and PRP groups in terms of adverse events (18.9% vs 10.9%), failures (15.1% vs 25.5%), and all clinical outcomes at all follow-ups. Radiographs and MRI findings did not show significant changes after the injection, neither as improvement, nor as disease progression, with no intergroup difference. Patients with moderate/severe OA treated with MF-AT showed a significantly higher IKDC improvement at 6 months compared to PRP (15.7±19.0 vs 8.6±14.2, p=0.041). Similarly, more patients with moderate/severe OA treated with MF-AT reached the minimal clinically important difference (MCID) for the IKDC subjective score at 6 months compared to the PRP group (75.0% vs 34.6%, p=0.005).

Conclusions:

A single intra-articular injection of both MF-AT and PRP provided a significant clinical improvement up to 24 months in patients with symptomatic knee OA. Both treatments showed a comparable low number of failures and adverse events, without signs of disease progression. Overall, no differences could be documented in both clinical and imaging results between the two biological approaches. Compared with PRP, MF-AT provided a higher clinical improvement at 6 months in moderate-severe OA.
Paper 32: All-inside meniscus repair leads to higher rate of failure compared to inside-out meniscus repair in elite athletes
Authors: Webster Emily , Jones Mary , Williams Andy , Borque Kyle
Published: July 2022

Objectives:

The popularization of ‘all-inside’ meniscal repair devices has led to a paradigm shift away from the historical gold standard of ‘inside-out’ meniscus repair but without comparative studies to support the change. The purpose of this study was to compare the failure rate of ‘all-inside’ and ‘inside-out’ meniscus repair performed in elite athletes.

Methods:

A retrospective review was performed of all professional or national/international level amateur athletes who underwent meniscal repair between January 1, 2013 and December 31, 2018, with a minimum of two year follow-up. Repairs were classified as ‘all-inside’ or ‘inside-out’ depending on the type of repair performed. Failure was defined as undergoing a subsequent surgery to address a persistent meniscal tear following repair.

Results:

158 (106 lateral and 52 medial) meniscal repairs were performed on elite athletes during this time period. Overall, 38 out of 158 (24.1%) underwent subsequent meniscectomy or revision meniscal repair. 27 of 88 (30.7%) of ‘all-inside’ meniscal repairs failed versus 11 of 70 (15.7%) of ‘inside-out’ meniscal repairs (p=0.029). For medial meniscus repairs, ‘all-inside’ failed at a higher rate than ‘inside-out’ medial meniscus repairs (58.6% vs 26.1%. p=0.019) but no statistical difference was found in lateral meniscus repairs (16.9% vs 10.6%, p=0.354). Overall 23 out of 52 (44.2%) of medial meniscus repairs failed compared to 15 of 106 (14.2%) of lateral meniscus repairs (p=0.00003) Cruciate ligament reconstruction was performed at the same time with 27 of 29 ‘all-inside’ medial meniscus repairs, 21 of 23 ‘inside-out’ medial meniscus repairs, 45 of 59 ‘all-inside’ lateral meniscus repairs but only 18 of 47 ‘inside-out’ lateral meniscal repairs.

Conclusions:

‘All-inside’ meniscal repair led to a higher rate of failure compared to ‘inside-out’ meniscus repair in elite athletes. Medial meniscus repairs failed at a high rate than lateral meniscal repairs. This difference is even more noteworthy considering that only a minority of inside out lateral meniscal repairs were done in conjunction with a cruciate ligament reconstruction versus the majority of the other three groups studied. Due to the increased knee loading in elite sports, clinically relevant differences between the medial and lateral meniscus as well as repair strategies were elucidated that may not be in the general population. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/fb465a3d-3b0f-451f-8fad-0d1332b8b428/1/Meniscal_repair_chart.docx None None None
Paper 33: Serum and Urine Biomarkers for Treatment Monitoring after Meniscal Allograft Transplantation in a Preclinical Canine Model
Authors: Stoker Aaron , Leary Emily , Bozynski Chantelle , Stannard James , Cook James , Ewing Michael
Published: July 2022

Objectives:

To analyze serum and urine biomarker concentrations for their capabilities in delineating differences in assessments of pain and functional outcomes after meniscus allograft transplantation (MAT) in a preclinical canine model. The study was designed to test the hypothesis that serum and urine biomarkers could be used for prognostic (1- and 3-month post-surgical time points) and diagnostic (6-month time point) assessments, based on strong associations with clinically relevant pain and function outcomes after MAT.

Methods:

Twelve adult, purpose-bred research hounds were included and underwent medial meniscal release (MR) to induce medial compartment gonarthrosis. Three months following MR, medial MAT was performed using: fresh-frozen meniscus (n=4), fresh meniscus (n=4), or fresh menisco-tibial OCA (n=4). Serum and urine from all dogs were collected preoperatively and at 1, 3, and 6 months following MAT. Validated outcome measures for pain, function, effusion, knee range of motion, and gait kinetics were collected at these same timepoints. To develop a prognostic panel of biomarkers, biomarker data from the 1-month and 3-month post-MAT surgery timepoints were used to model 6-month outcomes. A diagnostic panel of biomarkers was developed using biomarker data from the 6-month post-MAT surgery to model 6-month outcomes.

Results:

Across prognostic biomarker panels, serum biomarkers were mainly represented. A panel including serum IL-6, IL-8, IL-10, and IL-18 had strong model fit for prognostication of the gait kinetics outcome, operated limb %Total Pressure Index (%TPI) (R2=.45). Whereas, a biomarker panel including serum CTX-II and OPG had strong model fit for prognostication of the primary pain-related outcome, VAS pain (R2=.52). Across diagnostic biomarker panels, a panel including serum MMP-1 and MMP-3 and urine PINP and TIMP-1 had strong model fit as diagnostic biomarkers for %TPI (R2=.86). Whereas, a panel including urine CTX-I, CTX-II, IL-8, MMP-2, and TIMP-1 had strong model fit as diagnostic biomarkers for VAS pain (R2=.44).

Conclusions:

Biomarker panels of selected serum and/or urine proteins highly correlate with clinically-relevant metrics for pain and function outcomes in a preclinical model of meniscus allograft transplantation.
Paper 38: Conservative Treatment of Osteochondritis Dissecans of the Humeral Capitellum among Young Baseball Players
Authors: Kida Yoshikazu , Takatsuji Kenta , Sukenari Tsuyoshi , Furukawa Ryuhei , Minami Masataka , Morihara Toru , Takahashi Kenji , Kotoura Yoshihiro
Published: July 2022

Objectives:

The goals of treatment of osteochondritis dissecans of the humeral capitellum (OCD) are morphological healing and early return to sports and these are often contradictive. The purpose of this study was to evaluate our conservative treatment of OCD and establish the appropriate treatment.

Methods:

We retrospectively reviewed 206 patients with OCD who were treated conservatively at first visit our hospital and affiliated institutions from 2009 to 2019. Exclusion criteria were loss and less than 1 year follow-up. Mean age was 12.1 years (8-15). All patients were advised to stop or limit throwing and underwent physical therapy. Depending on the stage and healing process, at least, after waiting for the lateral wall of the capitellum to heal throwing was permitted to resume. Age at first visited, OCD Stage (Ⅰ; radiolucent area, Ⅱ; nondisplaced fragmentation, Ⅲ; loose body), clinical result (complete healing, partial healing, surgery required), and when to return to play were evaluated statistically.

Results:

A total of 193 patients were enrolled. There were 115 patients that were stageⅠ with a mean age of 11.2 years, 63 patients that were stageⅡ with a mean age of 13.2 years, and 15 patients that were stageⅢ with a mean age of 14.1 years (Table 1), and these differences were statistically significant (p<0.01). Collectively, complete healing was observed in 70.4%, partial healing in 17.4%, surgery in 12.2% of stageⅠ, complete healing in 50.8%, partial healing in 12.7%, surgery in 36.5% of stageⅡ, and complete healing in 0%, partial healing in 26.7%, surgery in 73.3% of stageⅢ (Fig 1). Of the 47 patients who underwent surgery, arthroscopic debridement for OCD lesions was selected for 79%, osteochondral autograft transplantation was selected for 16%, and fixation was selected for 4% (Fig 2). The mean period of return to play was 8.6 months; < 6 months was 42%, 6 months- 1 year was 39%, 1 year-1.5 year was 16%, and 1.5%< was 3%.

Conclusions:

In this study, OCD lesions likely to heal when the OCD stage were early. Even if surgery was needed after failed conservative treatment, most of the patients were treated by arthroscopic debridement which was a relatively minimally invasive procedure. Conservative treatment of OCD was successful when the treatment is begun in early stage of the disease. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/e5e18779-1cc0-4cc6-814b-a97204c6da85/1/file.pdf
Paper 43: Long-term Outcomes of an All-Arthroscopic Matrix-Assisted Autologous Chondrocyte Transplantation Technique
Authors: Ibarra Clemente , Olivos-Meza Anell , Velasquillo Cristina , Barbosa Fernando , Ramirez-Carrera Myriam , Villalobos-Cordova Felix , Madrazo-Ibarra Antonio
Published: July 2022

Objectives:

To evaluate the long-term clinical and magnetic resonance imaging outcomes of patients treated with an all-arthroscopic matrix-assisted autologous chondrocyte transplantation (MACT) technique for articular cartilage lesions of the knee.

Methods:

A total of 63 patients (21 women, 42 men) with a mean age of 35 ± 9.2 years, were treated with an all-arthroscopic MACT technique for articular cartilage lesions of the knee. Patients were prospectively evaluated preoperatively and after 2, 5, and 10 years of the surgery using multiple clinical scores: Lysholm, Tegner, International Knee Documentation Committee (IKDC), and the Knee injury and Osteoarthritis Outcome Score (KOOS); as well as with magnetic resonance imaging (MRI) T2-mapping at the same time points. Failure was defined as a reoperation because of symptoms caused by the primary repaired defect or a patient improvement of <10 points in the IKDC subjective score between the preoperative value and the final follow-up value.

Results:

Patients showed statistically significant clinical improvement in all PROM scores at 2, 5, and 10 years postoperative (PO) compared to their preoperative status. MRI T2-Mapping values of the repaired tissue decreased from 59.0 ± 14.6 ms preoperatively to 44.4 ± 15.6 ms at 10 years PO (P= 0.008), showing no statistical differences compared to the native cartilage values (39.1 ± 4.0 ms, P= 0.398). A surgical failure rate of 1.5% was documented, which was increased to 33% when clinical failures were also considered. Among all the analyzed factors linked to the likelihood of failure, lesions >4cm2 were the only ones to show statistical significance (P= 0.024).

Conclusions:

Patients treated with this arthroscopic MACT technique showed good and long-lasting clinical outcomes, as well as close to native cartilage characteristics on MRI T2-mapping. A limited number of failures were observed at 10 years PO, with most failures being in the first two years after treatment. Big chondral lesions (>4cm2) were found to have a greater likelihood of failing. UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/9e2d9f3a-b8a0-4921-9952-144a0de7acd7/1/Base_Px_AMECI_-_Clinica_2.pdf UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/e39a94d5-bbc5-4e27-8493-786a2237cef3/1/Patient-Reported_Outcome_Measures_1.pdf UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/aba360a2-961d-4b2e-a4fa-1049626e23d3/1/MRI_T2-Mapping_2.pdf UPLOAD- https://planion-client-files.s3.amazonaws.com/AOSSM/blobs/d9c78782-8a61-446f-b0e7-24873b631a5a/1/kaplan_meier.pdf
Paper 44: Does femoral osteoplasty enhance clinical outcomes and survivorship of FAI surgery at long-term follow-up beyond fifteen years?
Authors: Parilla Frank , Garrido Cecilia Pascual , Ince Deniz , Pashos Gail , Clohisy John , Nepple Jeffrey
Published: July 2022

Objectives:

Cam-type femoroacetabular impingement (FAI) is now well-established as a risk factor for intra-articular damage (labrum and articular cartilage) and secondary osteoarthritis. Long-term studies of FAI surgery are critical in understanding clinical outcomes, refining surgical treatments and predicting osteoarthritis progression. Nevertheless, studies beyond 15 years are uncommon. Although femoral osteoplasty is now common practice in treating cam FAI, long-term data supportive of this procedure and its ability to alter the natural history of FAI are not available. The purpose of this study was to analyze the long-term clinical outcomes and survivorship of symptomatic FAI treatment by arthroscopic correction of labral pathology alone or in combination with femoral osteoplasty (structural FAI correction).

Methods:

A retrospective comparative study was performed on two consecutive, longitudinal cohorts of patients with isolated cam-type FAI that underwent surgical treatment of labral pathology either with femoral osteoplasty (HSLO group, 23 hips) or without femoral osteoplasty (HS group, 17 hips). These cohorts were captured immediately prior to and after implementation of femoral osteoplasty into our practice and have been previously reported on at mean 2-year followup. The current study investigated clinical outcomes and survivorship at minimum 15-year followup. Patients with pincer or combined cam-pincer morphologies were excluded. Clinical outcomes were measured with the modified Harris hip score (mHHS). Kaplan-Meier survival was assessed for THA-free and reoperation-free survivorship.

Results:

The HSLO group included 23 hips followed for a mean of 16.0 ±0.6 years, and the HS group 17 hips followed for 19.7 ±1.2. The HSLO group had a significantly higher final mHHS (82.7 vs. 64.7, p=0.002) and mHHS improvement (18.4 vs. 6.1, p=0.02) compared to the HS group. The rate of THA conversion (22% vs. 59%, P=0.02) and overall reoperation (22% vs. 70%, P=0.003) were significantly lower in the HSLO group. THA conversion occurred at a mean of 5.8 ±2.5 years postoperatively in the HSLO group, and 7.1 ±4.0 years in the HS group. The HSLO group had significantly greater 15-year THA-free survivorship (78% vs 41%, p=0.02) and reoperation-free survivorship (78% vs. 29%, p=0.003) by Kaplan-Meier analysis.

Conclusions:

This study demonstrates better long-term clinical outcomes and survivorship with combined arthroscopy and femoral osteoplasty compared to arthroscopy alone. These long-term data strongly support the current practice of femoral osteoplasty in patients with cam FAI morphologies and suggest that this treatment alters the natural history of FAI. [Figure: see text]
Paper 46: Comparing Midterm Outcomes of High-Level Athletes Versus Nonathletes Undergoing Primary Hip Arthroscopy: A Propensity Matched Comparison with Minimum 5-year Follow-Up *ACCEPTED TO AJSM*
Authors: Jimenez Andrew , Monahan Peter , Owens Jade , Lall Ajay , Domb Benjamin , Maldonado David
Published: July 2022

Objectives:

(1) To report mid-term outcomes of HLA following primary hip arthroscopy and (2) to compare their results to a propensity-matched cohort of NA patients.

Methods:

Data were prospectively collected and retrospectively reviewed from February 2008 to November 2015 for HLA (professional, college, or high school) who underwent primary hip arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS). HLA were included if they had preoperative, minimum 2-year, and minimum 5-year follow-up data for the Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score Sports-Specific Subscale (HOS-SSS). Radiographic and intraoperative findings, surgical procedures, patient-reported outcome scores (PROs), the patient acceptable symptomatic state (PASS), the minimal clinically important difference (MCID) and the return to play were reported. The HLA study group was propensity-matched to a control group of NA patients for comparison.

Results:

A total 65 HLA (67 hips) were included in the final analysis with mean follow-up time of 74.6 ± 16.7 months. HLA showed significant improvement in all PROs recorded, achieved high rates of MCID and PASS for mHHS (74.6% and 79.4% respectively) and HOS-SSS (67.7% and 66.1% respectively), and returned to sport at high rates (80.4%). When compared to the propensity-matched NA control group, HLA reported higher baseline but comparable postoperative scores for the mHHS and NAHS. HLA patients achieved MCID and PASS for mHHS at similar rates as NA patients, but they achieved PASS for HOS-SSS at higher rates which trended toward statistical significance (66.1% vs 48.4%; P = .07). NA underwent revision arthroscopic surgery at similar rates compared to HLA patients (14.9% vs 9.0%; P = .424).

Conclusions:

Primary hip arthroscopy results in favorable mid-term outcomes in HLA. When compared to a propensity-matched NA control group, HLA demonstrated a tendency toward higher rates of achieving PASS for HOS-SSS but similar arthroscopic revision rates at minimum 5-year follow-up. [Figure: see text][Figure: see text][Table: see text]
Paper 48: Elite Female Athletes Demonstrate Greater Improvement in Patient Reported Outcome Scores and Equal Rate of Return to Sport Compared to Elite Male Athletes After Hip Arthroscopy: A Sex-Based Comparison in Professional and Collegiate Athletes *ACCEPTED TO AJSM*
Authors: Domb Benjamin , Glein Rachel , Miecznikowski Kara , Maldonado David , MD,MS Ajay Lall , Jimenez Andrew
Published: July 2022

Objectives:

(1) To report minimum 2-year patient reported outcome scores (PROs) and return to sport for elite female athletes undergoing hip arthroscopy for femoroacetabular impingement (FAI) and (2) to compare clinical results with a matched control group of elite male athletes.

Methods:

Data on all consecutive female athletes who underwent primary hip arthroscopy performed by the senior author (X.X.X.) between March 2009 and July 2018 were collected. Patients were considered eligible if they underwent hip arthroscopy for labral tears or FAI and participated in collegiate or professional athletics within 1 year of surgery. Minimum 2-year PROs were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and RTS status. The percentage of patients achieving minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were also recorded. These patients were then matched to elite male athletes for comparison.

Results:

Seventy-three female athlete hips were included with a mean follow-up of 65.1 ± 27.9 months. They demonstrated significant improvement from preoperative to latest follow-up for mHHS, NAHS, HOS-SSS, and VAS (P < .05). When outcomes were compared to a control group of male athletes, female athletes demonstrated lower preoperative scores, similar postoperative scores, and significantly greater magnitude of improvement (delta value) for mHHS, NAHS, and VAS. Female athletes also achieved MCID at higher rates than male athletes for HOS-SSS (85.1% vs 70.0%, P = .035) and NAHS (79.1% vs 62.9%, P = .037). RTS rates were similar between the two groups (Females: 67.1%, Males: 67.1%, P > 0.999).

Conclusions:

Elite female athletes undergoing primary hip arthroscopy for FAI demonstrated significant improvement in PROs and high rates of return to play, which were similar to a matched group of male athletes. Female athletes exhibited greater improvement in PROs (mHHS, NAHS, VAS) and achieved MCID (HOS-SSS, NAHS) at higher rates when compared to a control cohort of male athletes. [Figure: see text][Figure: see text][Table: see text]
Paper 52: Sex-Based Differences in Outcomes After MPFL Reconstruction
Authors: Hurley Eoghan , Bi Andrew , Mojica Edward , Campbell Kirk , Strauss Eric , Markus Danielle
Published: July 2022

Objectives:

The purpose of the current study was to investigate whether pain, function, satisfaction, or return to play (RTP) differ between sexes post-operatively in those undergoing MPFL reconstruction for symptomatic patellar instability.

Methods:

A retrospective review of patients who underwent an MPFL reconstruction for symptomatic patellar instability was performed. Kujala score, Visual Analogue Scale (VAS), patient satisfaction, willingness to undergo surgery again, revisions, return to play (RTP) and MPFL-RSI score were evaluated. Clinical outcomes were compared between male and female patients. A p value of <0.05 was considered to be statistically significant.

Results:

Our study included 141 knees that underwent MPFLR, and the patient population was 69.5% female. Post-operatively, the mean VAS score at rest was 1.0 ± 1.7 in male patients and 1.6 ± 2.1 in female patients (p= 0.0963). The mean Kujala score was 88.8 ± 13.3 and 83.5 ± 16.1 for male and female patients respectively (p=0.1062). Overall, there was a significant difference in RTP, with male patients returning at higher rates (58.1% vs 33.3%, p = 0.0479). The mean VAS score during activity was significantly lower in male patients at 1.8 compared to female patients at 3 (p=0.016). MPFL-RSI-score was also significantly worse in female patients (69.5 vs 55.6, p = 0.0098). While female patients had slightly higher rates of recurrent subjective instability (14.3% vs 11.7%) and re-dislocation (2% vs 0%), the difference was not statistically significant (p = 0.6731 and 0.3490, respectively). Female patients demonstrated higher rates of additional surgery at long term follow up, though this difference was also not statistically significant (12.2% vs 4.6%, p = 0.1674).

Conclusions:

Female patients had worse clinical outcomes than males undergoing MPFLR for patellar instability, with significantly lower rates of RTP, VAS score during sport and MPFL-RSI scores with a trend towards lower Kujala score and VAS score.
Paper 61: Surgical Management of Distal Clavicle Fractures in Skeletally Immature Athletes
Authors: Jasty Naveen , Heyworth Benton
Published: July 2022

Objectives:

The objective of this study was to characterize distal clavicle fractures in a cohort of pediatric and adolescent athletes who underwent operative treatment at a single, tertiary-care pediatric center, including surgical techniques used and resultant clinical outcomes.

Methods:

A retrospective review was performed of all clavicle fractures extending to the level of the corococlavicular ligaments or more lateral, which were treated operatively at a single tertiary-care pediatric hospital between the years of 2005-2020. Patients >19 years-old or those with pathological fractures were excluded. Radiographic fracture characteristics, surgical techniques, time to radiographic healing, return to sports, and complications were analyzed.

Results:

Fifty-two patients were identified, with mean age 13.8 ± 2.2 years. The majority of fractures were classified as Nenopoulus type IIB (transverse, displaced; 42.3%) or type IIIB (oblique, displaced; 26.9%), though type IIA (transverse, minor displacement; 3.8%), IV (comminuted; 11.6%) , and V (AC dislocation; 15.4%) patterns were also observed. Primary direction of displacement was posterior in 90% of cases and superior in 10%. Plate fixation was performed in 53.8% of surgeries, with locking plate (26.9%) and hook plate (17.3%) most frequent. Suture-based fixation was performed in 32.7% of cases (Figure 1). Rate of implant removal was 66% after plate fixation, the majority of which (72.2%) were planned at the time of primary fixation. Total complication rate, including unplanned removal of implant, was higher in the plate fixation group (25%) than in the suture-based fixation group (11.2%). Time to radiographic healing was not significantly different between plate and suture-based constructs (2.9 vs. 2.9 months, p = 0.96) though patients with suture-based constructs returned to sport faster (2.5 vs. 3.6 months, p = 0.014).

Conclusions:

Posteriorly displaced fractures comprised the vast majority of surgically-treated distal clavicle fractures in pediatric and adolescent athletes. When chosen in the appropriate patient, based on age and fracture pattern, suture-only constructs can lead to similar time to radiographic healing and faster return to sports compared to plate-based constructs, with significantly reduced need for removal of hardware. These data provide a foundation for future comparative research to further elucidate precise surgical indications and optimal treatment approaches in this population. [Table: see text]