bluuebunny/crossref_metadata_2025 huggingface dataset:
Concordance Between 11C-PIB-PET and Clinical Diagnosis in a Memory Clinic
Authors: Patricio Chrem Mendez , Gabriela Cohen , Julieta Russo Maria , Marcos Fernandez Suarez , Federico Nahas , Griselda Russo , Claudio Wierszylo , Santiago Paz , Leonardo Tabaschi , Jorge Campos , Alejandra Amengual , Janus Kremer , Salvador Guinjoan , Ramon Leiguarda , Gustavo Sevlever , Silvia Vázquez , Ricardo Allegri
Published: March 2015

Introduction:

Today, ligands that bind to fibrillar β-amyloid are detectable by Positron Emission Tomography (PET) allowing for in vivo visualization for Abeta burden. However, amyloid plaques detection per se does not establish Alzheimer’s Disease diagnosis. In this sense, the utility of amyloid imaging to improve clinical diagnosis was settled only for specific clinical scenarios and few studies have assessed amyloid molecular neuroimaging in a broader clinical setting. The aim of this study is to determine the frequency of PiB amyloid findings in different diagnostic syndromes grouped into high and low probability pre- test categories, taking into account pre-test clinical assumption of the presence of AD related pathology.

Methods:

144 patients were assigned into categories of high or low pretest probability according to clinical suspicion of AD pathology. The high probability group included: amnestic Mild Cognitive Impairment (MCI), amnestic and other domains MCI, Dementia of Alzheimer’s Type (DAT), Posterior Cortical Atrophy (PCA), logopenic Primary Progressive Aphasia (PPA), Cerebral Amyloid Angiopathy and mixed dementia. The low assumption group included: normal controls, non-amnestic MCI, non-logopenic PPA and Frontotemporal Dementia (FTD).

Results:

Only normal controls and DAT patients (typical and atypical presentation) were the most consistent across clinical and molecular diagnostics. MCI, non-logopenic PPA and FTD were the syndromic diagnoses that most discrepancies were found.

Discussion:

This study demonstrates that detecting in vivo amyloid plaques by molecular imaging is considerably frequent in most of the dementia syndromes and shows that there are frequent discordance between molecular diagnosis and clinical assumption.
Evaluation of the Utility of the Revised Get Ready to Read! for Spanish-Speaking English-Language Learners Through Differential Item Functioning Analysis
Authors: Farrington Amber L. , Lonigan Christopher J. , Phillips Beth M. , Farver JoAnn M. , McDowell Kimberly D.
Published: March 2015

Children who are Spanish-speaking English-language learners (ELLs) comprise a rapidly growing percentage of the population in U.S. schools. To determine which of these children have weaker emergent literacy skills and are in need of intervention, it is necessary to assess emergent literacy skills accurately and reliably. In this study, 1,318 preschool children were administered the Revised Get Ready to Read! (GRTR-R), and item-response theory analyses were used to evaluate and compare the item-level characteristics of the measure. Results of differential item functioning (DIF) analysis identified significant DIF for seven items. Correlational analysis demonstrated that ELL children’s scores on the GRTR-R were more strongly related to oral language skills than were non-ELL children’s scores. These results support the use of the GRTR-R as a screening tool for identifying ELL children who are at risk for developing reading problems.
A budding yeast's perspective on aging: The shape I'm in
Authors: Smith Jessica , Wright Jill , Schneider Brandt L
Published: March 2015

Aging is exemplified by progressive, deleterious changes that increase the probability of death. However, while the effects of age are easy to recognize, identification of the processes involved has proved to be much more difficult. Somewhat surprisingly, research using the budding yeast has had a profound impact on our current understanding of the mechanisms involved in aging. Herein, we examine the biological significance and implications surrounding the observation that genetic pathways involved in the modulation of aging and the determination of lifespan in yeast are highly complicated and conserved.
Placement optimization of actuators and sensors for gyroelastic body
Authors: Hu Quan , Zhang Jingrui
Published: March 2015

Gyroelastic body refers to a flexible structure with a distribution of stored angular momentum provided by fly wheels or control moment gyroscopes. The angular momentum devices can exert active torques to the structure for vibration suppression or shape control. This article mainly focuses on the placement optimization issue of the actuators and sensors on the gyroelastic body. The control moment gyroscopes and angular rate sensors are adopted as actuators and sensors, respectively. The equations of motion of the gyroelastic body incorporating the detailed actuator dynamics are linearized to a loosely coupled state-space model. Two optimization approaches are developed for both constrained and unconstrained gyroelastic bodies. The first is based on the controllability and observability matrices of the system. It is only applicable to the collocated actuator and sensor pairs. The second criterion is formulated from the concept of controllable and observable subspaces. It is capable of handling the cases of both collocated and noncollocated actuator and sensor pairs. The illustrative examples of a cantilevered beam and an unconstrained plate demonstrate the clear physical meaning and rationality of the two proposed methods.
Robotic neurorehabilitation system design for stroke patients
Authors: Xu Baoguo , Song Aiguo , Zhao Guopu , Xu Guozheng , Pan Lizheng , Yang Renhuan , Li Huijun , Cui Jianwei , Zeng Hong
Published: March 2015

In this article, a neurorehabilitation system combining robot-aided rehabilitation with motor imagery–based brain–computer interface is presented. Feature extraction and classification algorithm for the motor imagery electroencephalography is implemented under our brain–computer interface research platform. The main hardware platform for functional recovery therapy is the Barrett Whole-Arm Manipulator. The mental imagination of upper limb movements is translated to trigger the Barrett Whole-Arm Manipulator Arm to stretch the affected upper limb to move along the predefined trajectory. A fuzzy proportional–derivative position controller is proposed to control the Whole-Arm Manipulator Arm to perform passive rehabilitation training effectively. A preliminary experiment aimed at testing the proposed system and gaining insight into the potential of motor imagery electroencephalography-triggered robotic therapy is reported.
On a Jansen leg with multiple gait patterns for reconfigurable walking platforms
Authors: Nansai Shunsuke , Rojas Nicolas , Elara Mohan Rajesh , Sosa Ricardo , Iwase Masami
Published: March 2015

Legged robots are able to move across irregular terrains and those based on 1-degree-of-freedom planar linkages can be energy efficient, but are often constrained by a limited range of gaits which can limit their locomotion capabilities considerably. This article reports the design of a novel reconfigurable Theo Jansen linkage that produces a wide variety of gait cycles, opening new possibilities for innovative applications. The suggested mechanism switches from a pin-jointed Grübler kinematic chain to a 5-degree-of-freedom mechanism with slider joints during the reconfiguration process. It is shown that such reconfigurable linkage significantly extend the capabilities of the original design, while maintaining its mechanical simplicity during normal operation, to not only produce different useful gait patterns but also to realize behaviors beyond locomotion. Experiments with an implemented prototype are presented, and their results validate the proposed approach.
Vibration attenuation in two-link flexible mechanical arms with periodic composite materials
Authors: Zhang Yan , Kang Xue-wei , Jiang Lin-hua , Han Lin , Chu Hong-qiang , Zhu Qiao
Published: March 2015

We introduce the periodic composite materials, so-called phononic crystals, to the flexible mechanical arms systems. Due to the transfer matrix method and the Bloch theorem, the theoretical solution of band structure of the two-link model is deduced and then verified by the frequency response by the finite element method. The influence of the included angle of arms to vibration characteristics is analyzed. The frequency response of the two-link flexible arms with/without phononic crystals is investigated. The results illustrate that, by using the periodic composite materials, some frequency ranges with strong attenuation can be obtained. This study provides a new way to eliminate vibrations in flexible mechanical arms.
Numerical study of droplet evaporation in coupled high-temperature and electrostatic fields
Authors: Zuo Ziwen , Wang Junfeng , Huo Yuanping , Fan Yajun
Published: March 2015

The evaporation of a sessile water droplet under the coupled electrostatic and high-temperature fields is studied numerically. The leaky dielectric model and boiling point evaporation model are used for calculating the electric force and heat mass transfer. The free surface is captured using the volume of fluid method accounting for the variable surface tension and the transition of physical properties across the interface. The flow behaviors and temperature evolutions in different applied fields are predicted. It shows that in the coupled fields, the external electrostatic field restrains the flow inside the droplet and keeps a steady circulation. The flow velocity is reduced due to the interaction between electric body force and the force caused by temperature gradient. The heat transfer from air into the droplet is reduced by the lower flow velocity. The evaporation rate of the droplet in the high-temperature field is decreased.
Economical evaluation of a cogeneration system for a building complex
Authors: Adıgüzel Nesrin , Çomakli Ömer , Ekmekci İsmail , Pusat Saban
Published: March 2015

In this study, the suitability of using cogeneration system for the Aktürk Building Complex (located in İstanbul) was investigated using electricity and heat consumption data by considering five different cogeneration system capacities (800, 1200, 1400, 2000 and 2600 kW). The different capacities were compared using data of the payback period of investment, amount of net savings, ratio of meeting demand and part-load efficiency of the cogeneration system. Although payback periods of the investment for different capacities are close to each other, 1200 kW capacity cogeneration system is proved to be suitable for the Aktürk Building Complex because it has the shortest payback period (1 year 5 months).
Dynamical equations of multibody systems on Lie groups
Authors: Yu Wenjie , Pan Zhenkuan
Published: March 2015

The Euler–Poinaré principle is a reduced Hamilton’s principle under Lie group framework. In this article, it is applied to derive a hybrid set of dynamical equations of rigid multibody systems, which include four parts: the classical Euler–Lagrange equations of rigid bodies in their translational coordinates of mass center; Euler–Poinaré equations via orientation matrices and their related angular velocities; the constraint equations due to different joints in Cartesian coordinates and Lie groups; and the reconstruction equations between special orthogonal groups and their Lie algebras. The generalized mass matrices of dynamical equations are constant, which is computationally efficient. All the equations can be constructed systematically and can be solved easily. The construction equations can be used to design Lie group integrators of multibody system dynamics. The procedure presented in this article can be extended easily to flexible multibody systems, systems with non-holonomic constraints, and so on.
Outcomes of covered expandable stents for the treatment of TASC D aorto-iliac occlusive lesions
Authors: Tewksbury Robert , Taumoepeau Lupe , Cartmill Andrew , Butcher Anna , Cohen Toby
Published: March 2015

Introduction

Aortoiliac arterial occlusive disease is frequently encountered in the management of lower limb vascular insufficiency. We report our experience with covered balloon-expandable stents for treatment of TASC D lesions of the abdominal aorta and common iliac arteries.

Methods

A retrospective study of 30 patients who underwent aortoiliac stenting with the Atrium Advanta V12 from March 2010 to September 2012 was conducted. Patient demographic data, clinical signs and symptoms and procedural details were recorded. Outcomes assessed were primary patency, secondary patency, technical success, complications, limb salvage and survival.

Results

Median age was 67 years (range 48–84) and 40% of patients underwent treatment for critical limb ischaemia. Median follow-up was 13 months (range 3–38 months). Stent configuration comprised of long iliac stents in 20 patients, a large diameter aortic stent with iliac stenting in six patients, and aortic stent alone in four patients. Radiological success was achieved in 100% and the complication rate was 6%. Primary patency at 6, 12 and 24 months was 97%, 90% and 79%, respectively. Four cases of in-stent stenosis were reported, with three of these undergoing re-interventions resulting in a secondary patency rate of 97% at the end of follow-up. One patient death occurred within the follow-up period.

Discussion

This case series demonstrates that treatment of complex aortoiliac occlusive disease with covered balloon-expandable stents can have acceptable results with good patency and good clinical outcome. Secondary patency rates are comparable to open surgical revascularisation, with lower morbidity.
Recent developments in vascular ultrasound technology
Authors: Hoskins PR , Kenwright DA
Published: March 2015

This article describes four technologies relevant to vascular ultrasound which are available commercially in 2015, and traces their origin back through the research literature. The technologies are 3D ultrasound and its use in plaque volume estimation (first described in 1994), colour vector Doppler for flow visualisation (1994), wall motion for estimation of arterial stiffness (1968), and shear wave elastography imaging of the arterial wall (2010). Overall these technologies have contributed to the understanding of vascular disease but have had little impact on clinical practice. The basic toolkit for vascular ultrasound has for the last 25 years been real-time B-mode, colour flow and spectral Doppler. What has changed over this time is improvement in image quality. Looking ahead it is noted that 2D array transducers and high frame rate imaging continue to spread through the commercial vascular ultrasound sector and both have the potential to impact on clinical practice.
My patient is injured: identifying foreign bodies with ultrasound
Authors: Lewis David , Jivraj Aman , Atkinson Paul , Jarman Robert
Published: March 2015

Patients commonly present to the emergency department with a suspected retained foreign body, following penetrating injury. While plain radiography is often the first line in identifying radio-opaque foreign bodies, radiolucent foreign bodies such as wood and plastic can easily be missed. Furthermore, real-time visualization of such a foreign body can assist in its removal. This article evaluates the use of point-of-care ultrasound by emergency physicians in the identification and removal of soft-tissue foreign bodies along with describing the appropriate technique and highlighting the potential pitfalls. An illustrated case example is presented that highlights the benefits of point-of-care ultrasound foreign body detection and guided removal.
The lived experience of US parents of children with autism spectrum disorders
Authors: Corcoran Jacqueline , Berry Amber , Hill Stephanie
Published: March 2015

Current US statistics indicate that 1 in 68 children is diagnosed with an autistic spectrum disorder (Centers for Disease Control (2014) Prevalence of autism spectrum disorder among children aged 8 years—autism and developmental disabilities monitoring network, 11 Sites, United States, 2010. Morbidity and Mortality Weekly Report (MMWR)). The lived experience of parents with children diagnosed with autism spectrum disorder is important to know since quantitative studies have indicated that higher rates of mental disorders exist in this population as compared to parents of typically developing children (Yirmiya and Shaked (2005) Psychiatric disorders in parents of children with autism: a meta-analysis. Journal of Child Psychology and Psychiatry 46: 69–83). This study was a meta-synthesis of the qualitative literature in this area embedded within a systematic review. A comprehensive search and review yielded 14 studies. A total of six major themes were identified: (a) emotional stress and strain; (b) adaptation; (c) impact on the family; (d) services; (e) stigmatization; and (f) appreciating the little things. Implications of these results are discussed.
Expression of genes of the cardiac and renal renin–angiotensin systems in preterm piglets: is this system a suitable target for therapeutic intervention?
Authors: Kim Eleanor , Eiby Yvonne , Lumbers Eugenie , Boyce Amanda , Gibson Karen , Lingwood Barbara
Published: March 2015

Objectives:

The newborn circulating, cardiac and renal renin–angiotensin systems (RASs) are essential for blood pressure control, and for cardiac and renal development. If cardiac and renal RASs are immature this may contribute to cardiovascular compromise in preterm infants. This study measured mRNA expression of cardiac and renal RAS components in preterm, glucocorticoid (GC) exposed preterm, and term piglets.

Methods:

Renal and cardiac RAS mRNA levels were measured using real-time polymerase chain reaction (PCR). Genes studied were: (pro)renin receptor, renin, angiotensinogen, angiotensin converting enzyme (ACE), ACE2, angiotensin type 1 receptor (AT1R) and angiotensin type 2 receptor (AT2R).

Results:

All the genes studied were expressed in the kidney; neither renin nor AT2R mRNA were detected in the heart. There were no gestational changes in (pro)renin receptor, renin, ACE or AT1R mRNA levels. Right ventricular angiotensinogen mRNA levels in females were lower in preterm animals than at term, and GC exposure increased levels in male piglets. Renal angiotensinogen mRNA levels in female term piglets were lower than females from both preterm groups, and lower than male term piglets. Left ventricular ACE2 mRNA expression was lower in GC treated preterm piglets. Renal AT2R mRNA abundance was highest in GC treated preterm piglets, and the AT1R/AT2R ratio was increased at term.

Conclusions:

Preterm cardiac and renal RAS mRNA levels were similar to term piglets, suggesting that immaturity of these RASs does not contribute to preterm cardiovascular compromise. Since preterm expression of both renal and cardiac angiotensin II-AT1R is similar to term animals, cardiovascular dysfunction in the sick preterm human neonate might be effectively treated by agents acting on their RASs.
Choosing the optimal method in programmatic colorectal cancer screening: current evidence and controversies
Authors: Castells Antoni
Published: March 2015

Colorectal cancer (CRC) is an important health problem all over the world, being the third most common cancer and the second leading cause of cancer-related death in Western countries. The most important strategy for CRC prevention is screening (i.e. secondary prevention). Since it is widely accepted that adenomas and serrated polyps are the precursors of the vast majority of CRC, early detection and removal of these lesions is associated with a reduction of CRC incidence and, consequently, mortality. Moreover, cancers detected by screening are usually diagnosed at early stages and, therefore, curable by endoscopic or surgical procedures. This review will be address CRC screening strategies in average-risk population, which is defined by those individuals, men and women, 50 years of age or older, without any additional personal or familial predisposing risk factor. In order to maximize the impact of screening and ensure high coverage and equity of access, only organized screening programs (i.e. programmatic screening) should be implemented, as opposed to case-finding or opportunistic screening. For that reason and considering that the optimal approach for colorectal screening may differ depending on the scenario, this review will be focused on the advantages and limitations of each screening strategy in an organized setting.
Productivity Growth of Taiwanese International Tourist Hotels in a Metafrontier Framework
Authors: Yu Ming-Miin , Chen Li-Hsueh
Published: March 2015

Due to the vigorous development of the tourism industry in Taiwan, the number of international tourist hotels has been on an upward trend. To survive in an increasingly competitive environment, it is important to seek out improvement in performance. This study measures the performance of fifty-four international tourist hotels in Taiwan from 2008 to 2011 by using the metafrontier Malmquist productivity index. This index satisfies the requirement of circularity, is immune to linear programming infeasibility, overcomes the problem of base period dependency, and considers the heterogeneity among hotels. To investigate sources of productivity change, this index can be further decomposed into within-group efficiency change, within-group technical change, and technical leadership change. The empirical results indicate that the use of different technologies by hotels affects the productivity change. Both within-group efficiency and technical changes are the main factors of productivity change. Chain hotels are technology leaders, and independent hotels are followers. By identifying each competitor’s productivity change, operators can refer to appropriate best-practice hotels to improve their operations.
Reducing Sugar-Sweetened Beverage Intake Among Students
Authors: Tipton Julia A.
Published: March 2015

The amount of sugar-sweetened beverages (SSBs) consumed by U.S. youth has nearly doubled since the 1970s. The majority of children between 2 and 19 years drink SSBs on any given day. Many serious health problems such as childhood overweight and obesity, type 2 diabetes, kidney disease, and cardiovascular problems have been linked to SSBs. This article provides an overview of school-based interventions and policies that have successfully contributed to a reduction in sugar-sweetened intake among children. School nurses and nurses in other community-based settings are well positioned to promote intake of more healthful beverages among children using strategies recommended in this article.
Chromogranin A and cortisol at intraoperative repeated noxious stimuli: Surgical stress in a dog model
Authors: Höglund Odd Viking , Hagman Ragnvi , Stridsberg Mats
Published: March 2015

Objectives:

Biomarkers representing sympathetic tone and the surgical stress response are measured to objectively evaluate surgical techniques and anaesthetic protocols. If a part of the intraoperative procedure is repeated on the contralateral organ, one animal may potentially serve as its own control and, if so, may minimize the problem of individual differences of the stress response to anaesthesia and surgery. This study aimed to investigate the use of chromogranin A for measurement of the intraoperative sympathetic tone. Additional aims were to investigate chromogranin A and cortisol as indicators of the intraoperative surgical stress response caused by repeated noxious stimuli in dogs subjected to ovariohysterectomy and thereby to investigate the possibility of one dog serving as its own control.

Methods:

Experiments were carried out on 10 dogs subjected to ovariohysterectomy. Perioperative blood samples (0–6) were collected after premedication, immediately before induction of anaesthesia (0), after induction of anaesthesia and before incision (1), before (2) and after (3) removal of the first ovary, after a 15-min pause before removal of the second ovary (4), after removal of the second ovary (5) and after closing the abdomen (6). Plasma chromogranin A and cortisol were analysed.

Results:

Plasma chromogranin A did not change. Plasma cortisol concentration did not change between before anaesthesia and opening of the abdomen. Plasma cortisol increased at removal of the first ovary. Cortisol did not change at removal of the second ovary but remained increased compared to initial sample.

Conclusion:

The results suggest chromogranin A is a poor indicator of intraoperative sympathetic tone during elective surgery in dogs. Cortisol measurement was useful for assessment of intraoperative noxious stimuli. However, at these test conditions, neither plasma chromogranin A nor plasma cortisol was useful for assessment of repeated intraoperative noxious stimuli where one dog served as its own control.
Does Race Belong on Sports Blogs? Solidarity and Racial Discourse in Online Baseball Fan Forums
Authors: McGovern Jen
Published: March 2015

Sport scholars have produced prolific research examining the nexus of sport, communication, and race, but this research typically centers on media content and not on fans’ engagement with that content. As sports blogs grow in popularity, it is important to understand their role in facilitating fan communication about important social issues like race. This article examines how sporting ideologies interact with the unique context of interactive blogging spaces to influence fan discourse about race, ethnicity, and sport. By examining blog content and fan discussions on seven interactive baseball blogs, I show that social expectations of sports blogs typically discouraged racial discourse, thus upholding the racial status quo. When discussions about race occurred, they proceeded differently depending on the blogging environment. Fans were hostile when discussing race in blogging environments that didn’t encourage social solidarity. If blogging environments were structured to generate community solidarity, fans were more likely to politely dismiss race or to joke about the topic, though they did show some potential for substantial, meaningful conversations about race. This research underscores the importance of understanding how unique interactive contexts of new media spaces and broader cultural meanings work together to shape fan communication about sport.
Sleep Quality in Patients with Rotator Cuff Disease
Authors: Khazzam Michael S. , Mulligan Ed , Shirley Zachary , Brunette Meredith
Published: March 2015

Objectives:

Sleep disturbance may be an important prognostic variable driving patients to seek treatment for rotator cuff disease related shoulder pain. Currently, little is known on the influence of rotator cuff pathology on sleep. The purpose of this study was to determine which patient factors correlate with sleep disturbance in patients with atraumatic rotator cuff disease.

Methods:

A prospective, nonrandomized single surgeon cross-sectional cohort study was performed evaluating the effects of rotator cuff disease on sleep quality. Time-zero prior to treatment intervention outcomes data was collected including the Single Assessment Numeric Evaluation Rating (SANE), American Shoulder and Elbow Score (ASES), Pittsburgh Sleep Quality Index (PSQI), patient demographics and medical comorbidities. Statistical analysis included Pearson correlation and multiple regression analysis to determine which patient reported factors were associated with sleep quality disturbance.

Results:

147 shoulders in 131 subjects 66 right 49 left 16 bilateral (66 male, 65 female) with a mean age 56.4 were enrolled. There were 92 subjects with rotator cuff tendinitis, and 34 subjects full thickness rotator cuff tears confirmed on MRI. The mean SANE was 48, VAS 4.85, ASES 52, PSQI 8.26±5.0, and 92% of subjects reported nocturnal shoulder pain. Pearson correlation coefficient determined that female sex (males -0.23, p=0.001), higher pain VAS score (+0.26, p=0.003)), depression (+0.39, p<0.0001), presence of low back pain (+0.36, p<0.0001) smoking (+0.22, p=0.01), diabetes (+0.19, p=0.03), presence of osteoarthritis (+0.19, p=0.03), and NSAID use (+0.17, p=0.05) were associated with poor sleep quality. Factors associated with worse sleep quality. Age, SANE, ASES, presence of full thickness RCT, presence of biceps pain, or cervical spine symptoms were not 1predictive and did not correlate with worse sleep quality.

Conclusion:

Based on our findings pain, female gender, depression, presence of low back pain, smoking, diabetes mellitus, and prior NSAID use are all factors associated with worse sleep quality in patients with rotator cuff disease. These results demonstrate that the sleep quality does not seem to correlate with severity of rotator cuff pathology.
The Effect Of Concomitant Glenohumeral Joint Capsule Release During Rotator Cuff Repair - A Comparative Study Of 195 Patients
Authors: McGrath Jordan , Lam Patrick Hong , Tan Martin , Murrell George A.C.
Published: March 2015

Objectives:

Background: There is debate as to whether to operate or defer surgery on patients with concomitant rotator cuff tear and shoulder stiffness. The purpose of this study was, therefore, to compare the outcomes in those patients who had both their rotator cuff tear and shoulder stiffness treated with patients who had a rotator cuff repair but no stiffness.

Methods:

Methods: 1232 primary arthroscopic rotator cuff repairs were performed during the study period, including 44 patients who received a concomitant glenohumeral joint capsule release for ipsilateral shoulder stiffness, forming the stiffness group. A chronologically matched group of four rotator cuff repair-only patients before and after each stiffness patient were chosen from the consecutive list of rotator cuff repairs. Twenty-five patients from the stiffness group and 170 patients from the non-stiffness group met the inclusion criteria, leaving a total cohort of 195 patients. Patients completed modified L’Insalata Questionnaires for patient-ranked pain and function scores pre-operatively, intra-operatively, and at one week, six weeks, 12 weeks, six months and two-years post-operatively, while examiners recorded range of motion, strength, and presence of impingement signs.

Results:

Results: Patients from both groups had significantly improved clinical outcomes at the two-year follow-up as compared to pre-operative values. Stiffness patients had 0/25 (0%) re-tears at two years, significantly less (p = 0.009) than the non-stiffness patients (34/170 [20%]). Range of motion was similar between groups at two-years for forward flexion, abduction and external rotation, while the non-stiffness group had a superior range of internal rotation (p < 0.02).

Conclusion:

Discussion: The good outcomes of rotator cuff repair with glenohumeral joint capsule release suggest that there is no advantage in delaying surgical repair of a rotator cuff tear to allow for stiffness to resolve. In contradistinction, the data presented in this paper suggests that shoulder stiffness with glenohumeral joint capsule release, confers an advantage in terms of repair integrity.
A Prospective Randomized Comparison using MRI of Two Distinct Allogenic Tissue Constructs for Anterior Cruciate Ligament Reconstruction
Authors: Rose Michael , Farooqi Mehwish , Quilici Samantha , Crawford Dennis C.
Published: March 2015

Objectives:

To compare the radiographic and clinical outcomes of anterior cruciate ligament (ACL) reconstruction using quadrupled hamstring tendon (HT) allograft vs. doubled tibialis anterior (TA) allograft.

Methods:

Methods: A prospective randomized controlled trial (PRCT) at a single center was conducted with enrollment from 7/2010 to 4/2012. One hundred subjects undergoing primary ACL reconstruction were randomized to either HT or TA allograft (47 vs. 53, respectively). Subjects completed KOOS, IKDC, Tegner, VR-12, and Lysholm outcomes measure pre-operatively, and then post-operatively at the 6 month and 24 month time period. Arthrometric testing using KT-1000 (MEDmetric® Corporation) was applied at 6 months post-operatively. At this time patients also underwent MRI to evaluate allograft integrity and ligamentization. The signal to noise quotient (SNQ) was calculated via the Impax markup tool (Afga HealthCare®) using sagittal non-contrast T2 weighted MRI (Figure 1) as follows: SNQ = (Signal graft - Signal Quadriceps)/Signal Background

Results:

MRIs were obtained in the HT (n=22, 53%, 205.6 ± 35.7 days) and TA (n=23, 47%, 187.3 ± 26.0 days) groups. The average SNQ for the HT and TA allografts were .94 ± 3.03 and 4.14 ± 3.64, respectively (p = 0.12). There was no correlation between MRI SNQ and subject age, BMI, sex, graft diameter or smoking status. With arthrometric testing there was a trend for the HT allografts to have increased laxity as compared to contralateral side but the magnitude of difference was not clinically relevant (average 0.88 vs. 0.40mm, respectively). At an average of 2.4 ± 0.4 years there was no difference detected between groups in any of the outcomes scores with each showing improvement from baseline (Table 1). Allograft re-tear rates were similar between groups (9.5% HT vs. 4.5% TA, p=1.0).

Conclusion:

Limited data exists directly comparing different ACL allograft soft tissue constructs. Specifically, to the author’s knowledge this is the first prospective RCT comparing quadrupled hamstring tendon and doubled tibialis anterior allografts. Our data indicate no difference in graft failure rate, rate of ligamentization, and similar significant improvement from baseline with respect to subjective outcomes scores between each treatment group after more than two years.
Arthroscopic Repair of Anterior Labroligamentous Periosteal Sleeve Avulsion Lesions Does Not Have an Increased Failure Rate Compared to Arthroscopic Bankart Repair
Authors: Shaha James S. , Song Daniel J. , Cook Jay B. , Rowles Douglas J. , Bottoni Craig R. , Shaha Steven H. , Tokish John M.
Published: March 2015

Objectives:

Anterior labroligamentous periosteal sleeve avulsion lesions (ALPSA) have been identified as a potential risk factor for failure of an arthroscopic labral repair. The objective of this study was to compare the failure rates and clinical outcomes of arthroscopic ALPSA repair to arthroscopic Bankart repair. Additionally, the role of glenoid bone loss on failure rates was analyzed within each group.

Methods:

This was a retrospective review of 72 consecutive patients with anterior shoulder instability (73 shoulders) who underwent an anterior arthroscopic labral repair at a single military institution by one of three Sports medicine fellowship trained orthopaedic surgeons. At the time of surgery, a diagnostic arthroscopy identified 13 (17.8%) ALPSA lesions and 60 (82.2%) isolated Bankart lesions. All lesions were repaired and placed on standard post-operative protocol. Data was collected on demographics, the Western Ontario Shoulder Instability (WOSI) score, SANE score, and recurrence rates. Failure was defined as recurrent dislocation. Additionally, glenoid bone loss in all patients was calculated using a standardized technique on preoperative images. Outcomes were analyzed by type of initial lesion. The effect of bone loss on failure rate was analyzed between and within groups.

Results:

The average age at surgery was 26.3 years (range, 20-42) with an average follow-up of 53.3 months (range, 28-63). There were 13 distinct ALPSA lesions and 60 Bankart lesions identified on diagnostic arthroscopy. There were no significant differences between groups with respect to any demographic data. There was 1 failure (7.7%) in the ALSPA group and 8 failures (13.3%) in the Bankart group (p=0.10). There was no significant difference between groups for WOSI or SANE scores. There was no significant difference in glenoid bone loss between groups. The ALPSA group had 13.1% glenoid bone loss compared to 13.5% in the Bankart group (p=0.88).

Conclusion:

Contrary to previously published data, we did not find patients with ALPSA lesions to be at an increased risk for failure of an arthroscopic repair compared to an isolated Bankart repair, nor was there a difference in functional outcomes between groups. Finally, the presence of an ALPSA lesion was not predictive on increased glenoid bone loss in this population.
Clinical Outcomes Following Revision Shoulder Arthroscopic Capsulolabral Stabilization
Authors: Shin Jason J. , Mascarenhas Randhir , Yanke Adam Blair , Nicholson Gregory P. , Cole Brian J. , Romeo Anthony A. , Verma Nikhil N.
Published: March 2015

Objectives:

The purpose of this study was to assess clinical outcomes in patients following revision shoulder arthroscopic capsulolabral stabilization. The hypothesis was that revision arthroscopic stabilization would offer predictable clinical outcomes in appropriately selected patients.

Methods:

Sixty-two patients (63 shoulders) with failure of primary instability repairs were treated with revision arthroscopic shoulder stabilization at a mean follow-up of 46.9 ± 16.8 months (range, 15-78). Forty-six male patients and 16 females with a mean age of 23.2 ± 6.9 years (range, 14.7 - 47.2) met the inclusion criteria for the study. Revision arthroscopic stabilization was indicated in patients with recurrent instability with limited glenoid bone loss. Clinical outcomes were evaluated using validated patient reported outcome questionnaires including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, visual analog pain scale and Western Ontario Shoulder Instability Index. In addition, patients were queried for recurrent instability events (subluxation or dislocation) or revision surgery.

Results:

At final follow-up, the mean post-operative Western Ontario Shoulder Instability normalized score was 80.1 (range, 15.0 - 100). There were clinically significant improvements in American Shoulder and Elbow Surgeons scores from 63.7 pre-operatively to 85.1 post-operatively (P < 0.001), Simple Shoulder Test scores from 61.8 pre-operatively to 90.9 post-operatively (P < 0.001), and VAS pain scores from 2.89 pre-operatively to 0.81 post-operatively (P < 0.001). Recurrent instability occurred in 12 shoulders (19.0 %), with number of prior surgeries and hyperlaxity found to be significant risk factor for failure (P < 0.001 and P = 0.04, respectively).

Conclusion:

Arthroscopic revision stabilization of the shoulder can result in satisfactory outcomes in patients who have failed previous capsulolabral repair. Increased number of prior surgeries and hyperlaxity are predictive of poor outcome. Longer-term studies are required to determine whether similar results are maintained over time, and to provide guidance on focused clinical indications.
Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft Versus Allograft in Young Patients
Authors: Atanda Alfred , O’Brien Daniel Francis , Kraeutler Matthew John , Flato Russell R. , Salminen Matthew Robert , Henrichsen Kevin , Kane Patrick , Dodson Christopher C. , Cohen Steven B. , Ciccotti Michael G.
Published: March 2015

Objectives:

Traditionally, bone-patella tendon-bone (BTB) autograft has been the gold standard graft choice for younger, athletic patients requiring ACL reconstruction. However, donor site morbidity, post-operative patella fracture, and increased operative time have led many surgeons to choose BTB allograft for their reconstructions. Opponents of allografts feel that slower healing time, higher rate of graft failure, and potential for disease transmission makes them undesirable graft choices in athletic patients. The purpose of this study is to evaluate the clinical outcomes, both subjective and objective, of young patients that who have undergone either BTB autograft or allograft reconstructions with a minimum of 2-year follow-up.

Methods:

One hundred and twenty patients (60 autograft, 60 allograft), age 25 and below at time of surgery, were contacted after being retrospectively identified as patients having an ACL reconstruction with either a BTB allograft or autograft by one senior surgeon. Patients were administered the Lysholm Knee Scoring Scale and IKDC Subjective Knee Evaluation questionnaires. Fifty (25 BTB autograft and 25 BTB allograft) of the 120 returned for physical examination as well as completion of a single leg hop test and laxity evaluation using a KT-1000 arthrometer evaluation. Of the 120 patients contacted, there were a total of 7 failures (5.8%) requiring revision, 6 in the allograft group (86%) and 1 in the autograft group (14%).

Results:

The average Lysholm scores were 89.0 and 89.56 and the average IKDC scores were 90.8 and 92.1 in the autograft and allograft groups respectively. The differences in the Lysholm scores and the IKDC scores were not significant. The single leg hop and KT-1000 scores were also not significantly different. One autograft patient had a minor motion deficit. Three allograft patients had a grade 1 Lachman and pivot glide. One autograft patient and two allograft patients had mild patellafemoral crepitus. There was no significant difference in anterior knee pain between the two groups

Conclusion:

There is no significant difference in patient-rated outcome between ACL reconstructions using BTB autografts versus allografts. However, the overall study group did reveal an increased failure rate requiring revision in the allograft group.
Does Chondrolysis Occur after Corticosteroid-analgesic Injections? An Analysis of Patients Treated for Adhesive Capsulitis of the Shoulder
Authors: Baumgarten Keith M. , Helsper Elizabeth
Published: March 2015

Objectives:

There has been growing concern about the deleterious effects of local anaesthetics on articular cartilage. Clinical studies using continuous infusions of local anaesthetics and basic science studies that model both continuous and single injection of local anaesthetics have demonstrated chondrotoxicity. However, clinical studies do not exist that assess for the risk of chondrolysis on non-arthritic joints exposed to single or intermittent corticosteroid/analgesic injections.

Methods:

A retrospective review of patient treated for adhesive capsulitis of the shoulder with at least one intra-articular injection of corticosteroid and local anaesthetic was performed. Inclusion criteria were a diagnosis of primary or intrinsic and systemic secondary adhesive capsulitis and a minimum two year follow-up period. Exclusion criteria were patients with extrinsic secondary adhesive capsulitis. Prospective follow-up was performed to obtain patient-determined outcome scores, range of motion, and radiographs to determine the presence of chondrolysis.

Results:

Fifty-six patients with a mean age of 52.5+7.23 years were enrolled in this study at a mean follow-up of 54 months. The mean number of injections performed was 1.45+0.69 (range 1-4). The mean amount of methylprednisolone acetate used per patient was 111 mg (range 80-320 mg). A mean of 3 ml 0.25% bupivicaine (range 0-12 ml), 2.94 ml of 0.5% bupivicaine (range 0-8.5 ml), and 5.46 ml 1% lidocaine (range 0-16.5 ml) was used per patient. At final follow-up, the mean WOOS was 91.4+14.2%, DASH was 6.66+9.60, SPADI was 7.41+11.4, and SANE was 92.7+10.1%. The Shoulder Activity Score was 8.25+4.71. Initial mean active forward elevation was 110+24º and external rotation was 13+19º. At final follow-up, mean forward elevation (155+11º) and external rotation (65+14º) were improved (P<0.0001). Passive and active forward elevation, external rotation, internal rotation, and cross-body adduction demonstrated no significant differences with the unaffected contralateral shoulder. There was no radiographic evidence of chondrolysis in any patient. Twelve patients (21.4%) did not respond to the nonoperative treatment and required arthroscopic capsular release.

Conclusion:

This study did not demonstrate chondrolysis in patients treated with intraarticular corticosteroid and local anaesthetic for adhesive capsulitis. At final follow-up, this cohort had normalized patient-derived outcome scores and symmetric range of motion with the contralateral shoulder. The findings of this study do not support the cessation of using intraarticular analgesic/corticosteroid injections for the treatment of adhesive capsulitis. However, the authors do recommend caution and surveillance with continued intra-articular use of corticosteroid/anaesthetic combinations.
Functional Outcomes of Anatomic Anterior Cruciate Ligament Reconstruction: Accessory Medial Portal versus Transtibial
Authors: Stucken Charlton , Flato Russell R. , Salminen Matthew Robert , Cohen Steven B.
Published: March 2015

Objectives:

Transtibial (TT) and accessory medial portal (AM) techniques are two of the most widely used methods for drilling the femoral tunnel in anterior cruciate ligament (ACL) reconstructions, both with the common goal of placing the graft centrally or anatomically in the ACL footprint. While previous studies have looked at drilling through a standard anteromedial portal, no study has investigated clinical outcomes, femoral tunnel length, and radiographic evaluation after drilling from either an AM portal or TT technique. The purpose of this paper is to compare these results for a single surgeon performing “anatomic” ACL reconstruction. In addition to the femoral tunnel lengths, radiographic tunnel obliquity and femoral starting points were compared between the two methods.

Methods:

Over a three-year period all patients who underwent anatomic ACL reconstruction by a single surgeon were evaluated for eligibility. During surgery, the center of the anatomic femoral footprint (just posterior to the bifurcate ridge) was marked with an awl viewed through the medial portal and the tibial tunnel was drilled first. If the exact mark could be reached through a transtibial approach using a freehand pin (no guide), then it was utilized; otherwise, an accessory medial portal was created and used for femoral drilling (with the knee placed in hyperflexion). Seventy-five patients met inclusion criteria for evaluation of tunnel length and radiographic analysis (tunnel obliquity, clockface starting point). The mean age of the patient population was 29.8 (+/- 10.3). Functional outcomes (IKDC scores) were evaluated at a minimum of 24 month follow-up (Avg = 26 months; range:24-32 months).

Results:

In the study group of 75 patients (TT group, 47; AM group, 28) there were no significant differences between AM (74.8 +/- 13.6) and TT (75 +/- 12.9) with regard to postoperative IKDC score (p = 0.95). There was a significant difference (p < 0.001) between femoral tunnel lengths, with AM tunnels averaging 34.5mm (+/- 3.3) and TT tunnels averaging 42.13 mm (+/- 6.3). There was a significant difference in femoral tunnel obliquity (AM 39.5 +/- 6.45 degrees, TT 27.2 +/- 7.7 degrees, p<0.001) and femoral starting point (AM 9:59 o’clock +/- 20 mins, TT 10:12 o’clock +/- 18 mins, p<0.001) on AP radiograph.

Conclusion:

This study demonstrates no significant difference in functional outcomes for ACL reconstruction between AM and TT techniques when the femoral starting point is independently judged as anatomic between techniques. Nearly 40% of the time the anatomic femoral footprint could not be reached from a TT portal and thus conversion to AM was necessary. AM tunnel lengths of less than 30mm were rare in this study.