bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review of head-up tilt to improve consciousness in people with a prolonged disorder of consciousness
Authors: Ng Harriet , King Andrew
Published: July 2020

Objective:

This systematic review analysed the evidence for the effect of head-up tilt (passive-standing) on consciousness among persons in prolonged disorders of consciousness.

Data sources:

Articles were identified through primary database searching (Medline, CINAHL, AMED, The Cochrane Library) and post-citation searching (Scopus).

Review methods:

This review followed the PRISMA statement. The search strategy was created to find articles that combined any conceivable passive standing device, any measure of consciousness and disorders of consciousness of any origin. Inclusion criteria were any papers that evaluated the use of head-up tilt in adults in defined disorders of consciousness. Exclusion criteria included active stand studies, paediatric studies and animal studies. The search was completed independently by two researchers. Data collection and risk of bias assessment was completed using the Downs and Black tool.

Results:

6867 titles were retrieved (last search completed 21/6/20). Ten papers met the inclusion criteria: five examined the effects of a single head-up tilt treatment, and five the effects of head-up tilt regimes. Eighty-seven participants were randomised in three randomised controlled trials. In the remaining preliminary studies or case series, 233 participants were analysed. Quality was low, with only two high-quality studies available. Four studies were suitable for effect size analysis, where medium to large effect sizes were found. The two high-quality studies found head-up tilt had a large effect on consciousness.

Conclusion:

Overall there is some evidence that repeated passive standing on a tilt-table can improve consciousness, but the relevant studies provoke further questions.
Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial
Authors: Nigam Aishwarya , Satpute Kiran H , Hall Toby M
Published: July 2020

Objectives:

To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis

Design:

A randomised controlled trial.

Setting:

A general hospital

Subjects:

Forty adults with knee osteoarthritis (grade 1–3 Kellgren–Lawrence scale).

Interventions:

The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks.

Main Measures:

The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up.

Results:

Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up.

Conclusion:

In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.
Potential and unsolved problems of anti-PD-1/PD-L1 therapy combined with radiotherapy
Authors: Cao Yiyi , Li Wenbo , Wang ZhengJie , Pang Hua
Published: July 2020

Tumor immunotherapy has become one of the main treatments for tumors. Inhibition of the pathways involving programmed cell death receptor 1 (PD-1) and its ligand (PD-L1) has gained favor in anticancer therapy, and can effectively prolong the survival of patients with cancer; however, numerous patients have PD-1/PD-L1 inhibitor primary resistance. The efficacy of anti-PD-1/PD-L1 therapy is related to the host tumor microenvironment. Radiation therapy can promote the body’s antitumor immunity, change the tumor microenvironment, and synergize with anti-PD-1/PD-L1 treatment. Preclinical and clinical trials have shown that PD-1/PD-L1 inhibitor combined with radiotherapy has a significant effect. We review the synergistic antitumor mechanism and clinical trials of radiotherapy combined with anti-PD-1/PD-L1 therapy.
Equivalent biaxial strain evaluation in small punch testing using acoustic emission
Authors: Pullin Rhys , Jenkins Ifan , Cernescu Anghel , Edwards Allen
Published: July 2020

The small punch test initially used mainly in the nuclear sector proved to be an efficient method of estimating the mechanical properties of materials, including fracture toughness. In general, the fracture toughness is estimated based on a correlation with equivalent biaxial fracture strain. However, the latter depends on knowing the onset of the unstable fracture. In this article, the acoustic emission technique is used within the small punch test for estimating the unstable fracture initiation and determining the corresponding punch displacement from the load–displacement curve. Although, the acoustic emission signal can be slightly altered due to the location of the sensor, the results confirm the potential of the acoustic emission technique for detecting the onset of the unstable cracking and thus accurately estimating the equivalent biaxial fracture strain. The accumulated energy during the small punch test is one of the relevant acoustic emission parameters in estimating the fracture onset since it can be associated with the accumulated strain energy released by the deformed material.
Intensive care management of a rare case of pyrexia of unknown origin (Kikuchi-Fujimoto disease)
Authors: Crawshaw Helena , Rachakonda Kanaka S , Kim Leah , Enno Alar , Jegatheesan Thulasi
Published: July 2020

Kikuchi-Fujimoto disease is a rare, benign cause of necrotising lymphadenitis often presenting with fever. We describe a case of a 17-year-old boy with non-verbal autism presenting to our intensive care unit with prolonged fever of unknown cause. This case highlights the role of the intensive care unit in cases of diagnostic dilemma. The critical care community should be aware of Kikuchi-Fujimoto disease as although it is usually benign, it can rarely lead to acute airway compromise.
Hydroxychloroquine Alternatives for Chronic Disease: Response to a Growing Shortage Amid the Global COVID-19 Pandemic
Authors: Husayn Sameeha S. , Brown Jeremy D. , Presley Colby L. , Boghean Kelsey , Waller Jacquelyn D.
Published: July 2020

With the emergence of a novel severe acute respiratory syndrome coronavirus, investigators worldwide are scrambling to identify appropriate treatment modalities, develop accurate testing, and produce a vaccine. To date, effective treatment remains elusive. Chloroquine phosphate and hydroxychloroquine sulfate (HCQ), well-known antimalarial drugs effective in the treatment of systemic lupus erythematosus, rheumatoid arthritis, porphyria cutanea tarda, and chronic Q fever, are currently under investigation. The United States Food and Drug Administration recently issued an Emergency Use Authorization for CQ and HCQ use in the treatment of coronavirus disease 2019 (COVID-19). With spikes in HCQ use and demand, ethical considerations encompassing appropriate use, patient autonomy, nonmaleficence, and distributive justice abound. As drug experts, pharmacists are uniquely positioned to advocate for patients with chronic conditions necessitating HCQ use, assist in the appropriate prescribing of HCQ for COVID-19, and ensure patients and health care professionals are continually educated during this public health crisis. This review highlights the worldwide pandemic, describes appropriate HCQ use for chronic conditions, highlights available alternatives, and deliberates evolving ethical questions. With assistance from colleagues, state boards of pharmacy, and national organizations, pharmacists ensure the just distribution of valuable pharmaceuticals to patients having COVID-19 while supporting the needs of patients requiring HCQ for chronic conditions.
Greek education and cultural identity in Greek-speaking Judaism: The Jewish-Greek historiographers
Authors: Dhont Marieke
Published: July 2020

The style of the Jewish-Greek historiographers Eupolemus and Demetrius has often been evaluated as “bad Greek.” This is generally seen as evidence of their lack of education. The negative views on the language of Demetrius and Eupolemus are illustrative of a broader issue in the study of Hellenistic Judaism: language usage has been a key element in the discussion on the societal position of Jews in the Hellenistic world. In this article, I assess the style of the historiographers in the context of post-classical Greek, and conclude that their language reflects standard Hellenistic Greek. The linguistic analysis then becomes a starting point to reflect on the level of integration of Jews in the Greek-speaking world as well as to consider the nature of Jewish multilingualism in the late Second Temple period.
Adaptive estimations of tyre–road friction coefficient and body’s sideslip angle based on strong tracking and interactive multiple model theories
Authors: Ping Xianyao , Cheng Shuo , Yue Wei , Du Yongchang , Wang Xiangyu , Li Liang
Published: July 2020

Vehicle dynamic states and parameters, such as the tyre–road friction coefficient and body’s sideslip angle especially, are crucial for vehicle dynamics control with close-loop feedback laws. Autonomous vehicles also have strict demands on real-time knowledge of those information to make reliable decisions. With consideration of the cost saving, some estimation methods employing high-resolution vision and position devices are not for the production vehicles. Meanwhile, the bad adaptability of traditional Kalman filters to variable system structure restricts their practical applications. This paper introduces a cost-efficient estimation scheme using on-board sensors. Improved Strong Tracking Unscented Kalman filter is constructed to estimate the friction coefficient with fast convergence rate on time-variant road surfaces. On the basis of previous step, an estimator based on interactive multiple model is built to tolerant biased noise covariance matrices and observe body’s sideslip angle. After the vehicle modelling errors are considered, a Self-Correction Data Fusion algorithm is developed to integrate results of the estimator and direct integral method with error correction theory. Some simulations and experiments are also implemented, and their results verify the high accuracy and good robustness of the cooperative estimation scheme.
Multifunctional sandwich panel design with lithium-ion polymer batteries
Authors: Galos Joel , Fredriksson Claes , Das Raj
Published: July 2020

This paper investigates the mechanical properties of lithium-ion polymer (LiPo) batteries and their subsequent use in the design of multifunctional sandwich panels for automotive applications. Shear properties, flexural properties and compression properties of prismatic pouch LiPo batteries are determined experimentally through a hole-punch test, a three-point bending test and an in-plane compression test, respectively. This study is the first to characterize the shear properties of a lithium-ion battery, which are critical in sandwich panel design. The mechanical properties of the batteries obtained are then applied to existing analytical models of multifunctional sandwich panels consisting of carbon fibre composite facesheets and LiPo battery cores, which are currently being considered for use in automotive panel design. A material selection procedure for a stiffness-limited automotive car door panel subjected to bending shows that a trade-off between mechanical performance and cost can be achieved by using a composite sandwich panel with thin LiPo battery cores or by embedding larger LiPo batteries in lower-density polymer foam cores. The practicality and implementation aspects of using sandwich composites with LiPo battery cores in automotive design are also discussed.
Childhood Obesity: Is the Built Environment More Important Than the Food Environment?
Authors: Reis Wenes Pereira , Ghamsary Mark , Galustian Caroline , Galust Henrik , Herring Patti , Gaio Josileide , Dos Santos Hildemar
Published: July 2020

Obesity continues to be a health burden to society and new efforts may be needed to combat this epidemic. This study aims to investigate the contribution of parents education and level of income, food environment (grocery stores and fast food restaurants), and built environment (perceived safety, availability/quantity of parks) on childhood obesity. This cross-sectional observational study explored whether parents education and income level, built environment, and food environment can affect children with obesity. Participants were selected from 3 separate elementary schools located in an urban community with higher risk to have children with obesity in Montclair, California. Children living in families with low incomes have 2.31 times greater odds to be affected by obesity than children living in higher income homes. Children whose parents did not feel safe in their neighborhoods had odds of obesity 2.23 times greater than those who reported their neighborhoods as safe. Age also appeared to be a risk factor, and the odds of children affected by obesity among children 8 to 9 years was 0.79, and the odds of being affected by obesity among children 10 to 11 years of age was 0.36, when compared to children 6 to 7 years old. Findings suggest that low family income, perceptions of neighborhoods as unsafe, and young age are associated with higher body mass index (BMI) percentiles among children living in poor neighborhoods in Montclair, California.
Reappraising Diabetic Foot Ulcers: A Focus on Mechanisms of Ulceration and Clinical Evaluation
Authors: Aldana Paola C. , Cartron Alexander M. , Khachemoune Amor
Published: July 2020

Diabetic foot ulcers (DFU) are one of the most devastating complications of diabetes as they have significant effects on patient morbidity and mortality. Since their first description in the 19th century, our understanding of DFU has evolved as we uncover the mechanisms that mediate ulceration. In this review, we aim to summarize the various pathways that lead to the development of DFU in order to reappraise physicians’ understanding of these complex wounds. Relevant pathways include the following: (1) neuropathy (motor neuropathy, loss of protective sensation, and autonomic sympathetic dysfunction), (2) vascular disease (arterial ischemia, venous insufficiency, and microvascular changes), and (3) metabolism (signaling and immunological effects of hyperglycemia). We also discuss the clinical presentation of DFU and an evidence-based evaluation to assist clinicians in early identification and classification of these wounds to inform management of DFU. Finally, we summarize complications of DFU caused by the various pathways mediating ulceration and briefly overview DFU management in order to educate physicians about the potential risks if left untreated. A better understanding of the synergistic pathways leading to DFU is essential for clinicians to improve DFU diagnosis, tailor intervention, and mitigate significant patient morbidity and mortality.
Role of Bee Venom and Melittin on Restraining Angiogenesis and Metastasis in γ-Irradiated Solid Ehrlich Carcinoma-Bearing Mice
Authors: El Bakary Nermeen M. , Alsharkawy Asmaa Z. , Shouaib Zeinab A. , Barakat Emad M. S.
Published: July 2020

Pathological angiogenesis and apoptosis evasion are common hallmarks of cancer. The present work was an endeavor to evaluate the influence of bee venom (BV) or its major constituent melittin (MEL) as antiapoptotic and angiogenic regulator modifier on the tumor growth and the cell sensitivity to ionizing radiation targeting the improvement of cancer therapeutic protocols. BV (0.56 mg/kg/day) and MEL (500 µg/kg body weight/day) were injected intraperitoneally to mice bearing 1 cm3 solid tumor of Ehrlich ascites carcinoma (EAC) for 21 consecutive days. Mice were whole-body exposed to 1 Gray (Gy) of γ-radiation (2 fractionated doses). Treatment with BV or MEL markedly suppresses the proliferation of tumor in EAC mice. The concentrations of m-RNA for angiogenic factors (TNF-α, VEGF) as well as MMPs 2 and 9 activities and NO concentration were significantly decreased, combined with improvements in apoptotic regulators (caspase-3 activity) and normal cells redox tone (catalase and free radicals content) compared with EAC mice. Moreover, the histopathological investigation confirms the improvement exerted by BV or MEL in the EAC mice group or EAC + R group. Exposure to γ-radiation sustained the modulatory effect of BV on tumor when compared with EAC + BV mice. Convincingly, the role of BV or MEL as a natural antiangiogenic in the biological sequelae after radiation exposure is verified. Hence, BV and its major constituent MEL might represent a potential therapeutic strategy for increasing the radiation response of solid tumors.
New Metabolite With Inhibitory Activity Against α-Glucosidase and α-Amylase From Endophytic Chaetomium globosum
Authors: Qi Jianzhao , Wang Dacheng , Yin Xia , Zhang Qiang , Gao Jin-Ming
Published: July 2020

An efficient bioactive tracking separation strategy based on liquid-liquid extraction and high-speed counter-current chromatography (HSCCC) was developed and used to isolate bioactive natural products from the endophytic fungus Chaetomium globosum residing in Ginkgo biloba. Using HSCCC, the novel metabolite chaetoglobol acid (1) as well as 11 known compounds (2-12), including 6 chlorinated azaphilones and 3 cytochalasans, were successfully isolated. The structure of compound 1 was elucidated through spectroscopic analyses and HRESIMS data. Compound 1 possesses a rare C11-polyketide skeleton. All isolates were evaluated for their α-glucosidase and α-amylase inhibitory activities in vitro. Compound 1 showed high inhibition against α-glucosidase (IC50 = 3.04 μM), 18-fold higher than that of acarbose (IC50 = 54.74 μM), and also displayed moderate inhibitory activity against α-amylase (IC50 = 22.18 μM). As the results indicated that 1 has inhibitory effects against both α-glucosidase and α-amylase, 1 may be a promising candidate for mediating type 2 diabetes.
Herpes simplex virus type I–infected disorders alter the balance between Treg and Th17 cells in recurrent herpes labialis patients
Authors: Mei Xian-Xian , Lei Shan-Shan , Xu Li , Wu Shan , Gu Huan-peng , Du Yu , Zhao Ting , Xie Guan-qun , Fan Yong-Sheng , Pan Xiao-Ping , Bao Jie
Published: July 2020

Recurrent herpes labialis (RHL) is a common skin disease that is often caused by herpes simplex virus type I (HSV-1), but its immunology and pathogenesis remain unclear. The balance of Th17/Treg cells is crucial for maintaining immune homeostasis. This study aimed to investigate whether the balance of Th17/Treg cells and related cytokines may be a determinant occurrence in patients with RHL. This is a clinical experimental research based on clinical observation and analysis. We collected RHL patients from the outpatient clinic of the Department of Dermatology of Zhejiang Chinese Medical University (Hangzhou, China) in 2017, conducted questionnaire survey and signed informed consent. Peripheral blood was collected from 30 patients with RHL and 30 healthy volunteers. Flow cytometry was used to detect the percentages of Treg cells and Th17 cells. Protein microarrays coated with 20 cytokines related to T-cell subsets were performed. Enzyme-linked immunosorbent assay (ELISA) assay was conducted to further verify the expression levels of the cytokines that were screened by protein microarrays. Percentages of Th17/Treg cells in peripheral blood of RHL patients were significantly increased compared to those in healthy volunteers. The fold changes of GM-CSF, IL-4, TGF-β, IL-12, IL-10, IL-17F, and TNF-α were significantly increased compared with healthy volunteers. In addition, the expression of IL-4, IL-10, and TGF-β in the serum of RHL patients increased significantly. Our results indicated an imbalance of Th17/Treg cells in RHL, and this imbalance is probably an important factor in the occurrence, development, and recovery of RHL.
Arthroscopic Repair of Rotator Cuff Tears by Human Dermal Allograft Reconstruction vs Maximal Repair
Authors: Xu Jian , Ravipati Anjaneyulu Purnachandra Tejasw , King John-Paul , Coady Catherine , Wong Ivan
Published: July 2020

Objectives:

To determine healing rate of rotator cuff reconstruction with an acellular human dermal allograft compared with the gold standard arthroscopic maximal rotator cuff repair of large, chronic tears of the rotator cuff.

Methods:

Thirty patients with a two-tendon chronic retracted rotator cuff tear were enrolled in the study and were randomly allocated (15) to each group. All the patients were evaluated for structural integrity of repair using a 1.5T MRI at an average of 15 months after surgery. Rotator cuff arthropathy (RCA) and acromio-humeral distance (AHD) were graded using X-rays. Western Ontario Rotator Cuff (WORC), Disabilities of the Arm, Shoulder, and Hand (DASH), Marx Activity Rating Scale (MARX) scores, range of motion (ROM) of shoulder were analyzed.

Results:

The re-tear rate in the reconstruction group was 13% (2 of 15 patients) compared to 73% (11/15) in the repair group (p=0.008). Progression of RCA was seen in 7% (1/15) and 35.71% (5/15) of patients in the reconstruction and repair group, respectively (p=0.006). The change in AHD (preop-postop) was significantly higher in the repair (reduced by 2.27 mm) than the reconstruction group (increased by 0.1 mm) (P=0.006). Both groups had significant improvements in patient reported outcome scores. The reconstruction group had statistically significant better forward flexion (p= 0.01) and scapular plane abduction (p=0.03) compared to the repair group.

Conclusions:

Rotator cuff reconstruction with a dermal allograft demonstrated favorable structural healing rates and improved range of motion compared to maximal repair in the short term. Moreover, the maximal repair group were more likely to develop RCA than reconstruction. [Table: see text]
Synovial Fluid Biomarkers at the Time of Arthroscopy Predict 5-Year Outcomes
Authors: Manjunath Amit , Markus Danielle , Berlinberg Elyse , Kenny Lena , Strauss Eric , Kingery Matthew
Published: July 2020

Objectives:

Injury-induced molecular changes in the intra-articular microenvironment of the knee are thought to play a role in the development of post-traumatic osteoarthritis. The purpose of this study was to evaluate the association between post-traumatic synovial fluid biomarker concentrations and intermediate-term functional outcomes.

Methods:

Patients undergoing primary knee arthroscopy for ACL injury, meniscus injury, and/or focal chondral lesions were prospectively enrolled. Synovial fluid aspirate, collected immediately prior to surgical incision, was processed and analyzed using a multiplex magnetic bead immunoassay to determine the concentration of 10 pre-determined cytokines and chemokines. Patients with a minimum of five years of postoperative follow-up were surveyed with Visual Analog Pain Scale (VAS), Lysholm Knee Scoring Scale, and Knee Injury and Osteoarthritis Outcome Score Physical Function Shortform (KOOS-PS). Stepwise regression was used to fit a linear regression model and model accuracy was evaluated using k-fold cross validation.

Results:

39 patients (mean age: 41.56 +/- 15.98 years, mean postoperative follow-up: 6.79 +/- 0.72 years) were included in the study. Mean Lysholm, KOOS-PS, and VAS scores were 83.67 +/- 17.64, 88.37 +/- 12.79, and 11.03 +/- 19.84, respectively. 11 patients had undergone further ipsilateral knee surgery during the follow-up period. Of the remaining 28 patients, a model consisting of VEGF, TIMP-2, and MMP-3 was found to most accurately predict intermediate-term functional outcomes. Regardless of the type or extent of injury, these three biomarkers were able to explain 60.35%, 34.75%, and 39.38% of the variability in Lysholm, KOOS-PS, and VAS scores, respectively.

Conclusions:

By measuring the concentrations of MMP-3, TIMP-2, and VEGF at the time of surgery, functional outcomes and level of pain can be predicted at 5 years postoperatively with moderate accuracy. This suggests that these biomarkers may play an important role in the development of post-traumatic osteoarthritis and may serve as potential targets for therapeutic intervention. [Table: see text]
The impact of distance and the crow hop on medial elbow stress during an interval throwing program
Authors: Cross Austin , Smith Grace , Gulledge Caleb , Koolmees Dylan , Moutzouros Vasilios , Makhni Eric , Lizzio Vincent
Published: July 2020

Objectives:

Rehabilitation programs following ulnar collateral ligament reconstruction include an interval throwing program in order to gradually increase stress and prevent excessive elbow valgus loads. These programs often instruct players to use the crow hop, even at short distances, in order to reduce stress on the reconstructed ligament. The purpose of the study was to evaluate the impact of the crow hop on medial elbow stress at various distances of an interval throwing program.

Methods:

High school and college-aged baseball players were recruited for this study. Players threw at distances of 30, 45, 60, 90, 120, 150, and 180 feet. At each distance, participants made 3 throws while using a crow hop and 3 throws without using a crow hop with the instruction to throw on an arc. A wearable device recorded elbow torque, arm slot, arm speed, and shoulder rotation. Ball velocity was measured using radar gun.

Results:

A total of 20 players participated in this study. Overall elbow torque at each distance was 12.9, 20.5, 26.3, 31.9, 34.7, 36.1, and 37.1 Nm, respectively. There was no difference in elbow stress for throws with a crow hop compared to throws without a crow hop at any distance of throwing (p > 0.05). There was no difference in elbow torque for throws at 150 feet compared to 120 feet (p = 0.10) or 150 feet compared to 180 feet (p = 0.83); however, there were significant increases in elbow torque between every other throwing distance (p < 0.05).

Conclusions:

Medial elbow torque significantly increases at greater throwing distances of a standard interval throwing program, although the effect becomes less pronounced at longer distances as players maximize effort. The crow hop does not affect medial elbow torque at any distance of throwing.
The Presence of Patellar Apprehension in Higher Degrees of Flexion Identifies Patients with Patella Alta and or Severe Trochlear Dysplasia
Authors: Colatruglio Matthew , Flanigan David , Magnussen Sarah Harangody Robert
Published: July 2020

Objectives:

Recurrent patellar instability is frequently treated surgically with reconstruction of the medial patellofemoral ligament (MPFL). Patients with significant patella alta, trochlear dysplasia, and/or an elevated tibial tubercle-trochlear groove (TT-TG) distance may benefit from a concurrent bony procedure such as a tibial tubercle osteotomy or trochleoplasty. The indications to include such procedures are traditionally based on imaging criteria, but remain controversial. Patellar apprehension is common in patients with patellar instability but typically resolves in higher degrees of knee flexion. We hypothesis that the persistence of patellar apprehension at greater than 60 degrees of knee flexion is associated with patella alta, increased TT-TG distance, and trochlear dysplasia.

Methods:

Seventy-six patients with recurrent patellar instability were prospectively identified in a sports medicine clinic. Patellar apprehension was evaluated in each patient. Apprehension was defined as the patient reporting that the patella felt unstable to lateral patellar translation. Apprehension was first assessed at full knee extension and repeated assessed as the knee was flexed in 10 degrees intervals as measured with a goniometer. The degree of flexion at which patellar apprehension disappeared was recorded. Plain films and MRI were obtained in all patients. Patellar height was assessed with the Caton-Deschamps (CD) index and trochlear morphology was assessed through measurement of the sulcus angle and depth on MRI and classification with the Dejour classification system. Imaging measurements of patients in which apprehension resolved by 60 degrees of knee flexion were compared with measures for those with apprehension that persisted deeper into flexion.

Results:

Apprehension resolved by 60 degrees of flexion in 55 patients and persisted into deeper flexion in 21 patients. The patients with delayed resolution of apprehension demonstrated a higher CD Index, elevated TT-TG distance, increased higher sulcus angle, decreased trochlear depth, and a higher incidence of Dejour B, C, or D dysplasia (all p < 0.05, Table 1). Of the 21 patients with delayed resolution of apprehension, 18 had either Dejour B, C, or D dysplasia or a Caton-Deschamps Index of at least 1.3. Delayed resolution of apprehension was present in 11 of the 16 patients with Dejour B, C, or D dysplasia.

Conclusion:

The presence of patellar apprehension in higher degrees of knee flexion is associated with patella alta, increased TT-TG distance, and more severe trochlear dysplasia. Further work is needed to evaluate utility of this exam finding to inform surgical decision-making in this population.
Defining the Borderline Hip: High Variability in Acetabular Coverage and Femoral Deformity
Authors: Schwabe Maria , Pascual-Garrido Cecilia , Clohisy John , Nepple Elizabeth Graesser Jeffrey
Published: July 2020

Objectives:

Borderline acetabular dysplasia is radiographically defined as a lateral center edge angle (LCEA) of 20-25 degrees. It is well accepted that some borderline hips have instability while others have primarily impingement. The optimal management of borderline dysplasia is challenging and particularly complex due to the anatomic variability that exists among patients but has not been well characterized. The purpose of this current study was to investigate the variability in hip deformity present on low-dose CT in a cohort of patients with symptomatic borderline acetabular dysplasia.

Methods:

Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. Radiographic evaluation included LCEA, acetabular inclination, anterior center edge angle (ACEA), and alpha angles on AP, Dunn, and frog views. All patients underwent low-dose pelvic CT for preoperative planning. Femoral deformity was assessed with femoral version, alpha angle (measured at 1:00 increments), and maximum alpha angle. Radial acetabular coverage was calculated according to standardized clockface positions [measured from 8:00 (posterior) to 4:00 (anterior)] and defined as normal, undercoverage, or overcoverage relative to 1 SD from the mean of normative values.

Results:

The mean LCEA was 22.1+1.4, while the mean acetabular inclination was 10.3+3.3. The mean ACEA in the group was 25.3+5.8 (range 10.1-43.9), with 16% having an ACEA < 20 and 50% having an ACEA < 25. The mean femoral version was 17.9° (range -4° to 59°). The mean maximal alpha angle was 57.2° (range 43° to 81°) with 61.4% greater than 55°. Lateral coverage (RAC at 12:00) was deficient in 74.1% of cases. Anterior coverage (RAC at 2:00) was highly variable with 17.1% undercoverage, 72.9% normal, and 10.0% overcoverage. Posterior coverage (RAC at 10:00) was also highly variable with 30.0% undercoverage, 62.9% normal, and 7.1% overcoverage. The three most common patterns of coverage were: isolated lateral undercoverage (31.4%), normal coverage (18.6%), and lateral and posterior undercoverage (17.1%).

Conclusion:

Patients with borderline acetabular dysplasia demonstrate highly variable three-dimensional deformities including anterior, lateral, and posterior acetabular coverage, femoral version, and alpha angle. Comprehensive deformity characterization in the population is important to guide diagnosis and treatment decisions. [Figure: see text][Figure: see text][Figure: see text]
Are Chondrocytes Overlying Cam Morphology Suitable for Therapeutic Use?
Authors: Coleman Mitchell , Westermann Robert
Published: July 2020

Objectives:

Cam-type femoroacetabular impingement (FAI) results in extra bone and cartilage on the anterolateral femoral head-neck junction, causing abnormal contact between the femur and the acetabulum. We investigated whether chondrocytes isolated from cam lesions in FAI patients are metabolically similar to normal chondrocytes and therefore a potential option for therapeutic use via autologous implantation.

Methods:

Cam cartilage was obtained intraoperatively from 7 human patients with cam lesions (Alpha angle > 60 degrees) (4 arthroscopy, 2 arthroplasty, and 1 periacetabular osteotomy). Healthy femoral and acetabular articular cartilage was obtained from 8 Yucatan minipig hips for comparison. Chondrocytes were extracted from the cartilage then cultured at a high density for up to 1 week. Mitochondrial stress testing procedures (with 2 mM oligomycin, 2.5 mM carbonyl cyanide p-trifluoromethoxy-phenylhydrazone (FCCP), 2 mM rotenone, 5 mM antimycin A) for determination of the chondrocytes basal and maximal respiration were performed.

Results:

No significant differences in basal (p = 0.73) or maximum (p = 0.40) respiration were found when comparing chondrocytes from cam lesions to normal porcine articular chondrocytes. There was a significant difference in maximum respiration when comparing chondrocytes from cam lesions in patients who underwent a total hip arthroplasty to chondrocytes from other cam lesions (p = 0.007).

Conclusion:

Basal and maximum respiration in chondrocytes from cartilage overlying cam lesions suggests a similar level of respiration to healthy articular chondrocytes. Given the importance of mitochondria to cartilage homeostasis, this study supports that chondrocytes overlying non-arthritic femoral cam lesions may be a novel source of healthy chondrocytes.
Intact Ligamentum Teres Predicts Superior Prognosis in Borderline Dysplastic Patients: A Matched Pair Controlled Study with Minimum Five-Year Outcomes Following Hip Arthroscopy
Authors: Domb Benjamin , Chen Sarah , Walker-Santiago Rafael , Shapira Jacob , Rosinsky Philip , Lall Ajay , Maldonado David
Published: July 2020

Objectives:

(1) To report minimum five-year patient reported outcomes (PROs) in borderline dysplastic patients with ligamentum teres (LT) tears who underwent hip arthroscopy and (2) to compare these PROs to a pair-matched control group of borderline dysplastic hips without LT tears.

Methods:

Data was prospectively collected for patients who underwent hip arthroscopy during September 2008 and August 2013. Patients were included if had a preoperative diagnosis of borderline dysplasia [lateral center-edge angle (LCEA) of 18°- 25°] and had preoperative and minimum five-year postoperative modified Harris Hip Scores (mHHS), Non-Arthritic Hip Scores (NAHS), and Visual Analogue Scale for pain (VAS) scores. Exclusion criteria were Tönnis grade osteoarthritis >1, previous hip conditions, any prior ipsilateral hip surgery, or workers’ compensation status. Two borderline dysplastic groups were created. An LT tear group was matched 1:1 to a control group (no LT tear) with similar age, sex, body mass index (BMI), and laterality via propensity score matching. Significance was set at P < 0.05.

Results:

24 LT tear patients (24 hips) were matched 24 patients (24 hips) without an LT tear. There was no significant difference in age, sex, BMI, or laterality between groups. Mean age was 36.2 ± 17.2 and 34.9 ± 15.9 years for the control and LT tear group, respectively (P = 0.783). There were 17 (70.8%) and 16 (66.7%) females in the control and LT tear group, respectively and the mean preoperative LCEA was 23.3° and 22.2° in the control and LT tear group, respectively. No differences were observed between groups in baseline PROs, intraoperative findings, or surgical procedures, except for LT treatment. Five-year postoperative PROs were comparable in both groups, with the control group exhibiting superior Veterans RAND 12-Item Health Survey Mental Component (VR-12M) (P = 0.041) and Short Format 12 Mental Health (SF-12M) (P = 0.042). The control group exhibited less pain and higher satisfaction with surgery; however, this trend was not significant. Finally, the LT tear group was significantly less likely to achieve the patient acceptable symptomatic state (PASS) for mHHS (P = 0.022).

Conclusion:

Following hip arthroscopy, patients with borderline dysplasia and LT tears demonstrated favorable PROs at minimum five-year follow-up. Outcomes were similar to a pair-matched control group without LT tears, with the control group showing higher VR-12M and SF-12M scores. Furthermore, borderline dysplastic patients with LT tears were significantly less likely to achieve the PASS for mHHS.
Acetabular Dysplasia: Three-Dimensional Deformity Predictors of the Diagnosis of Symptomatic Instability Treated with Periacetabular Osteotomy
Authors: Schwabe Maria , Pascual-Garrido Cecilia , Clohisy John , Graesser Elizabeth , Nepple Jeffrey
Published: July 2020

Objectives:

Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia.

Methods:

Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups.

Results:

Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92.

Conclusion:

We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia.
The Evaluation of Trochlear Osseous Morphology: An Epidemiologic Study
Authors: Yalçin Sercan , Onor Gabriel , Kaar Scott , Pace lee , Ferrua Paolo , Farrow Lutul
Published: July 2020

Objectives:

The purpose of this study is to investigate the prevalence of the trochlear dysplasia in our study population.

Methods:

We obtained 692 skeletally mature femoral specimens from the [Blinded Institution], [Blinded Collection]. Five observers were asked to evaluate each specimen for trochlear dysplasia on a scale between 0 and 3 (0 – normal/no dysplasia; 1 – mild dysplasia; 2 – moderate dysplasia; 3 – severe dysplasia). Each observer made initial evaluations for interobserver reliability. Each observer then re-evaluated each specimen one month later to determine intraobserver reliability. We evaluated inter and intraobserver reliability utilizing intraclass correlation coefficient (ICC). All statistics were performed with SPSS v.25 (IBM, USA).

Results:

The interobserver ICC of first and second evaluation of all observers were found to be 0.906 [0.894-0,916] and 0.904 [0.892-0.915], respectively. The intraobserver ICC of observers were as follows: Reviewer1: 0.799 [0.771-0.825]; Reviewer2: 0.686 [0.645-0.724]; Reviewer3: 0.808 [0.781-0.832]; Reviewer4: 0.787 [0.757-0.814]; Reviewer5: 0.778 [0.747-0.806]. These results show intra and interobserver correlation was good to excellent. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for first evaluation, by reviewer, are as follows: Reviewer 1: 82.7%, 12.1%, 4.0%, 1.2%; Reviewer 2: 37.3%, 26.2%, 27.5%, 9.1%; Reviewer 3: 57.9%, 28.0%, 12.1%, 1.9%; Reviewer 4: 64.2%, 25.6%, 7.7%, 2.6%; Reviewer 5: 65.6%, 14.9%, 12.3%, 7.2%. The percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia for second evaluation, by reviewer, are as follows: Reviewer 1: 78.8%, 16.6%, 3.6%, 1.0%; Reviewer 2: 40.3%, 26.4%, 23.3%, 10.0%; Reviewer 3: 42.2%,35.1%, 18.8%, 3.9%; Reviewer 4: 57.4%, 31.9%, 8.2%, 2.5%; Reviewer 5: 73.7%, 8.2%, 9.7%, 8.4%. In total, the percentages of normal trochlea, mild dysplasia, moderate dysplasia and severe dysplasia were 60.00%, 22.51%, 12.72%, 4.77%; respectively.

Conclusions:

This study shows that although there was no absolute criteria to grade trochlear dysplasia, observers had similar opinions on the degree of dysplasia. Also, our cohort shows that moderate to severe dysplasia is not uncommon as it is present in around 17% of knees in our cohort. This is the first epidemiologic study evaluating the prevalence of trochlear dysplasia in the normal population.
Synovial Fluid Biomarkers in the Osteoarthritic Knee: Differences in Concentration with Progression of Radiographic Severity
Authors: Whitney Darryl , Klein David , Rodriguez Tiffany , Kenny Lena , Strauss Eric , Kingery Matthew
Published: July 2020

Objectives:

The purpose of the current study was to analyze the synovial fluid concentrations of known inflammatory biomarkers in the setting of symptomatic osteoarthritis (OA) of the knee and assess for any differences in biomarker concentrations based on the extent of radiographic disease.

Methods:

Patients presenting with knee complaints were invited to provide synovial fluid samples from the symptomatic knee during their initial office visit. For this study, a subset of patients with OA was analyzed. The concentration of 16 synovial fluid biomarkers was measured, including TIMP-1, TIMP-2, TIMP-3, MMP-13, IL-6, MCP-1, MIP-1β, VEGF, bFGF, eotaxin, IL-1Ra, MMP-1, MMP-3, MMP-9, RANTES, and TSG-6. Samples were analyzed using a multiplex magnetic bead immunoassay. Patients were divided into a low-grade OA group (K-L ≤ 2 or OARSI ≤ 1) or a high-grade cartilage OA group (K-L ≥ 3 or OARSI ≥ 2).

Results:

101 patients were included in this analysis. There was a significant difference in MIP-1β (p=0.025) and bFGF (p=0.015) concentrations between OARSI grade groups. Patients with high-grade joint space narrowing had significantly greater concentrations of MIP-1β (p=0.022) and bFGF (p=0.003). There was a significant difference in MIP-1β concentration between K-L grade groups (p=0.013). Patients in the high-grade K-L group had a significantly greater concentration of MIP-1β (p=0.020).

Conclusions:

The synovial fluid concentrations of two synovial fluid biomarkers were found to differ significantly based on the extent of radiographic OA present. MIP-1β is a pro-inflammatory growth factor known to induce the synthesis of other inflammatory factors including interleukins and TNF-α. bFGF is a growth factor that is known to promote chondrogenesis, angiogenesis, wound healing, and granulation tissue formation. Continued study of synovial fluid biomarkers in the setting of symptomatic OA may improve our understanding of the pathogenesis of disease and identify treatment targets in an attempt to halt disease progression.
SAUCERIZATION OF DISCOID LATERAL MENISCI. HOW MUCH RESIDUAL WIDTH IS RIGHT?
Authors: Abdalla Abdalla , Meadows Molly , Rauer Thomas , Chan Charles , Ganley Theodore , Shea Kevin , Gamble JAMES , Gamble Jamison
Published: July 2020

Objectives:

Discoid lateral meniscus (DLM) is a congenital anomaly of the knee where the normally “O” shaped lateral meniscus has redundant tissue filling the “O” and covering the lateral tibial plateau. The redundant tissue can degenerate and cause mechanical symptoms and pain. Treatment of symptomatic DLM is arthroscopic saucerization to reshape the meniscus to a more normal contour. Enough tissue must be removed to eliminate mechanical symptoms but not too much as to create instability. The residual width of the meniscus is crucial at the popliteus hiatus because here the peripheral rim is unattached to the capsule. The literature recommends a residual width of 6-8 mm. The primary purpose of this research was to determine the width of the meniscus at the popliteal hiatus in normal specimens. Our null hypothesis was that a residual width of 6-8 millimeters will be sufficient for saucerization of DLM.

Methods:

We made direct measurements of lateral meniscus radial width from the outer rim at the popliteus hiatus to the inner edge (Figure 1) in 19 specimens (ages 2 months to 11 years.) We measured one four-year-old specimen with bilateral complete DLM (Figure 2.) We also measured 39 digital images of specimens (ages 1-month to 12-years) using ImageJ. Finally, we made direct measurements of 8 skeletally mature specimens.

Results:

Figure 3 shows the relationship of meniscus width as a function age. The average width of specimens <3-years-old was 5.5mm. The average width of the ten-year-old specimens was 12mm. The average width of the skeletally mature specimens was 16mm. The four-year-old DLM specimen measured 19 mm.

Conclusions:

We rejected our null hypothesis. Direct measurements suggest that a residual width of 6-8mm is insufficient for children 8-years and older. A width of at least a full centimeter more closely approximates our findings, and for adolescents consider a residual rim of 15 mm. For children less than six-years-old a residual width of 6-8mm is sufficient.