bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evolving concepts of the pathogenesis of rheumatoid arthritis with focus on the early and late stages
Authors: Coutant Frédéric , Miossec Pierre 
Published: October 2019

Purpose of review
To provide an overview of recently published work covering key mechanisms involved in the pathogenesis of rheumatoid arthritis (RA), with focus on the early and late stages.

Recent findings
Present understanding of RA pathogenesis has been mainly focused on the inflammatory process at the established phase of the disease, but recent work has shed light on important molecular and cellular mechanisms involved both at the early and late/refractory stages. In early RA, the involvement of anticitrullinated protein antibodies in RA induction has been identified with a critical role of the IL-23/Th17 axis in the control of their pathogenicity. At the late stage, RA may be viewed as a cell-autonomous genetic and epigenetic disease, characterized by altered cell death pathways in synoviocytes after long-term exposure to inflammation. An improved knowledge of these cell-intrinsic altered pathways is the basis for the targeting of pathogenic synoviocytes, as a new therapeutic alternative against resistance to current treatment targeting the immune system.

Summary
We summarize these pathological pathways, and their understanding will facilitate the design of new diagnostic tools and therapeutic strategies combining the targeting of pathogenic synoviocytes with current immune-targeted therapies.
Syndesmosis and Syndesmotic Equivalent Injuries in Tibial Plafond Fractures
Authors: Haller Justin M. , Githens Michael , Rothberg David , Higgins Thomas , Barei David , Nork Sean 
Published: October 2019

Objectives:
To identify the incidence and fracture characteristics associated with syndesmotic injury in tibial plafond fractures and report the incidence of posttraumatic osteoarthrosis (PTOA).

Design:
Retrospective comparative study.

Setting:
Two level-1 academic trauma centers.

Patients/Participants:
Of the 735 tibial plafond fractures (OTA/AO 43-B3 and 43-C) treated from January 2006 through December 2015, 108 patients (108/735, 15%) were identified with syndesmosis injury.

Intervention:
Either acute or missed syndesmotic injury.

Main Outcome Measurement:
PTOA.

Results:
Fourteen fractures (14/735, 2%) had missed syndesmotic injury. Volkmann fragment of ≤10 mm (P = 0.04) and fibular avulsion fracture (P = 0.05) were significantly more common in missed syndesmosis. Ninety fractures (14/14 missed, 76/94 acute) had greater than 12-month follow-up (mean, 26 months; range, 12–102 months). Nearly all patients with missed syndesmosis injury developed arthrosis (13/14, 93%), and 45% (34/76 fractures) of plafond fractures with acute syndesmosis injury developed arthrosis (P < 0.001). Although controlling for malreduction, patients with missed syndesmosis had significantly more PTOA development (P = 0.018). Controlling for malreduction, patients with syndesmotic fixation and a ≤10-mm Chaput or Volkmann fragment or fibular avulsion fracture (8/31, 26%) were less likely to develop PTOA than if they had a similar fracture pattern without syndesmotic fixation (9/10, 90%) (P = 0.011).

Conclusions:
Fifteen percent of tibia plafond fractures have a syndesmosis or syndesmotic equivalent injury. Missed syndesmosis injury has a high rate of PTOA development. Patients with a ≤10-mm Chaput or Volkmann fragment and/or fibular avulsion fracture benefit from syndesmotic fixation.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Miniplate Augmented Tension-Band Wiring for Comminuted Patella Fractures
Authors: Cho Jae-Woo , Kent William T. , Cho Won-Tae , Kim Jin-Kak , Moon Ki-Ho , Yeo Do-Hyun , Kim Beom-Soo , Oh Chang-Wug , Oh Jong-Keon 
Published: October 2019

Summary:
The aim of this study was to introduce various applications of miniplate augmented tension-band wiring (TBW) for comminuted patella fractures and to evaluate the clinical outcomes. Comminuted articular patella fractures were managed with anterior cortical miniplate fixation with a TBW technique from January 2014 to January 2016. The primary end point was radiographic union. Secondary end points were complications related to the procedure. Functional outcomes including range of motion were also evaluated. Thirty patients were followed up for a mean of 20 months (range, 12–28) postoperatively. The primary union rate was 96% (29 of 30 patients). Mean time to union was 3.2 months. One patient required additional surgery because of acute postoperative infection. Twenty-five patients recovered a full range of motion relative to the contralateral limb. The mean Bostman score at the last follow-up was 28.6 points (range, 26–30). In conclusion, miniplate augmented TBW is a versatile and useful technique for comminuted patella fracture fixation.
Tensioned Wire–Assisted Intramedullary Nail Treatment of Proximal Tibia Shaft Fractures: A Technical Trick
Authors: Nicolescu Razvan , Quinnan Stephen M. , Lawrie Charles M. , Hutson James J. 
Published: October 2019

Summary:
Proximal tibia shaft fractures are often challenging to manage because of their intrinsic tendency toward valgus and apex anterior deformity. In recent years, intramedullary nailing (IMN) has become more frequently used to treat these injuries, allowing for biologic advantages such as load-sharing, immediate weight-bearing, and avoidance of disruption of periosteal blood supply. Several adjunctive techniques, such as semiextended positioning, blocking screws, and external fixation, have been developed to assist with fracture reduction during IMN. We describe a new adjunctive reduction technique—tensioned wire–assisted IMN—for the treatment of proximal tibia shaft fractures. We have found that tensioned wire assistance facilitates fracture reduction during IMN, does not interfere with intraoperative image intensification, and is compatible with both standard nailing instrumentation and additional adjunctive techniques. We present tensioned wire nailing as a technical trick for anatomic and stable reduction of proximal tibia fractures and compare a cohort of proximal tibia shaft fractures managed with and without tensioned wire assistance.
Publication Rates of Posters From the Orthopaedic Trauma Association Annual Meeting 2011–2016: Posters Are Not Second Rate
Authors: Melvin Patricia R. , Cannada Lisa K. 
Published: October 2019

Objective:
To determine the publication rate of posters presented at the OTA annual meeting from 2011 to 2016.

Methods:
All posters presented at the OTA annual meetings from 2011 to 2016 were identified from the OTA's official website and confirmed through review of the OTA official programs. This information was then used to direct a search, and if the presentation was associated with a publication, publishing information was entered into the database.

Results:
From 2011 to 2016, there were a total of 875 posters with 473 associated publications (54%). The highest rate of publication was 64.1% of posters published in 2012. The posters were published at an average of 19.4 months after presentation. One hundred sixty posters were published in the Journal of Orthopaedic Trauma (35%).

Conclusion:
Our research demonstrated a 54% publication rate over a 6-year period of posters presented at the OTA annual meetings. This rate is higher than other publication rates for podium presentations in other societies (eg, American Academy of Orthopaedic Surgeons and American Academy for Surgery of the Hand). This validates the quality of research presented in poster format at the OTA annual meeting.
Mechanical Aspects of Intervertebral Disc Injury and Implications on Biomechanics
Authors: Desmoulin Geoffrey Thor , Pradhan Vikram , Milner Theodore Edgar 
Published: October 2019

Study Design.
This article comprises a review of the literature.

Objective.
The purpose of this study was to elucidate the different types of structural failures exhibited in intervertebral discs (IVDs), summarize their potential causes with respect to mechanical loading conditions and the consequences on cell homeostasis and biomechanics.

Summary of Background Data.
Many studies have been performed to gain insight into how discogenic back pain progresses in humans both in vitro and in vivo as well as in animal disc models. However, there is a major need to summarize the common factors which initiate the structural failures observed in IVDs and the typical biomechanical changes. This work could help in developing mechanisms aiming to restore the biochemical and biomechanical balance of IVDs.

Methods.
The different types of structural failures encountered in IVDs were reviewed from published literature. The types of mechanical loading causing these injuries and their physiological and biomechanical consequences were then summarized and linked to ongoing research in this area.

Results.
The most prominent structural failures associated with IVDs are annulus tears, disc prolapse, endplate damage, disc narrowing, radial bulging, and osteophyte formation in the vertebrae. IVDs were found to be vulnerable to compression, flexion, axial rotation, and complex loading mechanisms through single impact, cyclical, and continuous loading. However, chronic loadings had a more damaging impact on the spine. Significant consequences include imbalance of metabolic enzymes and growth factors, alteration in stress profiles of IVDs and a decrease in mechanical stiffness resulting in impaired biomechanics of the spine.

Conclusion.
The mode of loading has an important impact on the severity and nature of failures seen in IVDs and the resulting consequences to biomechanics. However, further research is necessary to better understand to the mechanisms that link injury to degeneration and regeneration of IVD tissues.

Level of Evidence: 3
Gender-Associated Differences in Sacral Morphology Do Not Affect Feasibility Rates of Transsacral Screw Insertion. Radioanatomic Investigation Based on Pelvic Cross-sectional Imaging of 200 Individuals
Authors: Balling Horst 
Published: October 2019

Study Design.
Retrospective radioanatomic single-center cohort study.

Objective.
To investigate sex-specific differences in transsacral corridor dimensions, determine feasibility rates of transsacral screw placement without extended safety zones around planned screw positions, and develop an index defining sacral dysmorphism (SD) irrespective of transsacral corridor diameters.

Summary of Background Data.
Previously reported SD definitions used radiologically identifiable pelvic characteristics or predefined minimum diameter thresholds of transsacral corridors in the upper sacral segment including safety zones for screw placement. Technical progress of surgical 3D image guidance improved sacral screw insertion accuracy questioning established minimum diameter threshold–based SD definitions.

Methods.
Datasets from cross-sectional pelvic imaging of 100 women and 100 men presenting to a general hospital from July 2018 through August 2018 were included in a database to evaluate transsacral trajectory rates, and dimensions of transsacral corridor lengths, widths (TSCWs), and heights (TSCHs) in sacral segments I to III (S1–3). SD was assumed, if no transsacral trajectory was found in S1 with a corridor diameter of at least 7.5 mm.

Results.
Women presented significantly higher rates of transsacral trajectories in the inferior sector of S1 (P = 0.03), and larger transsacral corridor lengths in S2 (superior sector, P = 0.045), and S3 (central position, P = 0.02). In men, significantly higher feasibility rates were found for the placement of two transsacral screws in S2 (P = 0.0002), and singular screws in S3 (P = 0.006), with larger S1- (P = 0.0002), and central S2-TSCWs (P = 0.006). SD was prevalent in 17% of women, and 16% of men (P = 0.85). Calculating TSCW ratios of S1 and S2 was significantly indicative for SD at values below a threshold of 0.8 in women (P < 0.00001), and men (P = 0.0004).

Conclusion.
SD is independent of sex despite significant differences in sacral morphology. An index defining SD irrespective of absolute transsacral corridor dimensions is presented to reliably differentiate dysmorphic from nondysmorphic sacra in women and men.

Level of Evidence: 2
Differences Between Mothers' and Fathers' Perception of Their Adolescents' Pain Before and After Parent Training Through The Comfort Ability Pain Management Program
Authors: Donado Carolina , Turrisi Taylor , Wihak Tessa , Coakley Rachael B. 
Published: October 2019

ABSTRACT:

Objective:
To evaluate differences in how mothers and fathers perceive and respond to their adolescents' chronic pain before and after The Comfort Ability Program (CAP), a 1-day cognitive-behavioral intervention, and to compare outcomes between mother-father dyads and mothers who attended the intervention alone.

Methods:
Parents completed the Pain Catastrophizing Scale (PCS) and Helping for Health Inventory (HHI) at baseline (preintervention) and at 1 week, 1 month, and 3 months after intervention. Confirmatory factor analyses evaluated construct validity and invariances of the scales. Paired t tests compared scores between mothers and fathers. Unpaired t tests compared mother-father dyads (n = 33) and mothers who attended the intervention alone (n = 73).

Results:
PCS baseline showed significant construct instability between maternal and paternal interpretations. However, 1 week after intervention, construct stability improved between parents. On the PCS and HHI, in which lower scores represent more adaptive parenting behaviors, fathers scored significantly lower than mothers at baseline (PCS: 22.6 [7.7] vs 28.0 [11.4], p value = 0.033; HHI: 16.0 [8.1] vs 20.6 [9.6], p value = 0.029). At 3 months after intervention, PCS scores for both mothers and fathers significantly decreased from baseline (mothers: p value = 0.009; fathers: p value = 0.052) and converged (mothers: 18.6 [11.2] vs fathers: 18.3 [13.2]; p value = 0.786). Mother and father HHI scores were significantly lower at 3 months than baseline (mothers: 13.2 [9.5], p value = 0.005; fathers: 15.0 [12.7], p value = 0.017), although improvement of construct stability between parents was less evident.

Conclusion:
Findings suggest that mothers and fathers may differentially perceive and respond to their adolescents' pain and that CAP parent-training intervention may help align their thinking. The results further demonstrate that both parents make adaptive changes after intervention, reinforcing the value of including both parents in pediatric treatment for chronic pain.
Assessing the content specificity of interpretation biases in community adolescents with persistent and interfering pain
Authors: Lau Jennifer Y.F. , Badaoui Maryam , Meehan Alan J. , Heathcote Lauren C. , Barker Edward D. , Rimes Katharine A. 
Published: October 2019

Abstract
The tendency to select threatening over benign interpretations of ambiguous bodily sensations and cues characterises young people with chronic pain. However, previous studies disagree over whether these biases extend to nonbodily harm situations such as social evaluation. Understanding the content of these biases is crucial to the development of pain management strategies seeking to modify such biases. Two hundred forty-three young people aged 16 to 19 years completed an expanded version of the Adolescent Interpretation of Bodily Threat task. Using a factor-analytic approach, we removed items that did not consistently associate with bodily harm or social evaluation. Next, we examined whether the variance underlying negative and benign interpretations of bodily harm and social evaluation situations were best represented as a common factor (ie, one-factor model), 2 distinct factors (ie, 2-factor model), or one common and 2 distinct factors (ie, 2-factor bifactor model) in all adolescents. We then compared youth with and without persistent and impairing pain on factor scores derived from the best-fitting model. Although negative interpretations of bodily harm and social evaluation situations emerged as distinct factors, benign interpretations across situations were best captured by a common factor and 2 situation-specific factors (ie, bifactor model). Group comparisons showed that young people with moderate-to-high pain interference were more likely to endorse negative interpretations across all situations, and less likely to manifest a general benign interpretational style, than youth without interfering pain, although some of these group differences were explained by co-occurring anxiety and depressive symptoms. Replication of these findings is needed.
A somatosensory cortex input to the caudal dorsolateral striatum controls comorbid anxiety in persistent pain
Authors: Jin Yan , Meng Qian , Mei Lisheng , Zhou Wenjie , Zhu Xia , Mao Yu , Xie Wen , Zhang Xulai , Luo Min-Hua , Tao Wenjuan , Wang Haitao , Li Jie , Li Juan , Li Xiangyao , Zhang Zhi 
Published: October 2019

Abstract
Chronic pain and anxiety symptoms are frequently encountered clinically, but the neural circuit mechanisms underlying the comorbid anxiety symptoms in pain (CASP) in context of chronic pain remain unclear. Using viral neuronal tracing in mice, we identified a previously unknown pathway whereby glutamatergic neurons from layer 5 of the hindlimb primary somatosensory cortex (S1) (GluS1), a well-known brain region involved in pain processing, project to GABAergic neurons in the caudal dorsolateral striatum (GABAcDLS). In a persistent inflammatory pain model induced by complete Freund's adjuvant injection, enhanced excitation of the GluS1→GABAcDLS pathway was found in mice exhibiting CASP. Reversing this pathway using chemogenetic or optogenetic approaches alleviated CASP. In addition, the optical activation of GluS1 terminals in the cDLS produced anxiety-like behaviors in naive mice. Overall, the current study demonstrates the putative importance of a novel GluS1→GABAcDLS pathway in controlling at least some aspects of CASP.
Characteristics of Physician Assistant Students Planning to Work in Primary Care: A National Study
Authors: Larson Eric H. , Frogner Bianca K. 
Published: October 2019

Purpose
While the number of physician assistants (PAs) participating in the primary care workforce continues to rise, the proportion of PAs practicing in primary care rather than other specialties has decreased. The purpose of this study was to identify the characteristics of matriculating PA students planning to enter primary care specialties and compare them with students planning on entering other specialties.

Methods
Data from the Physician Assistant Education Association Matriculating Student Survey (MSS) from 2013 and 2014 were analyzed. In a series of bivariate analyses, demographic characteristics, educational backgrounds, clinical experiences, and practice expectations of students intending to enter primary care practice were compared with those of their counterparts who did not intend to enter primary care. Logistic regression was used to assess the overall importance of demographic, background, and practice expectations variables on practice intentions.

Results
A total of 9283 students responded to the MSS from 2013 and 2014. More than half (58.3%) stated an intention to practice in primary care upon graduation. Those students were more likely than their counterparts to be married, to be Hispanic or Asian, and to have participated in community service prior to starting PA training. They were also less likely to view high income as essential to their careers and more likely to view practicing in rural or underserved areas favorably.

Conclusions
The findings of this study could be used to identify student characteristics associated with an interest in primary care and could contribute to more successful student recruitment and PA curriculum design, especially for PA training programs with a mission focused on producing primary care PAs.
Benign Paroxysmal Positional Vertigo in the Elderly: A Single-center Experience
Authors: Nahm HyunJoo , Han Kyujin , Shin Jung Eun , Kim Chang-Hee 
Published: October 2019

Objectives:
Dizziness and balance problems are common in the elderly, and benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness. The aim of this study is to investigate the subtype distribution of geriatric BPPV in a single tertiary referral center, and compare the treatment efficacy according to the subtype of BPPV.

Study Design:
Retrospective study.

Setting:
Tertiary referral academic center.

Patients:
The consecutive 316 elderly patients diagnosed with BPPV between March 2013 and March 2019 were included.

Main Outcome Measures:
Using a head-roll and Dix-Hallpike tests, subtype of BPPV was determined. Once the diagnosis of BPPV was made, patients were treated by its corresponding canalith repositioning maneuver (CRM).

Results:
Among 316 elderly patients with BPPV, 143 patients (45%) were diagnosed with posterior semicircular canal BPPV, 46 patients (15%) were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, 126 patients (40%) were diagnosed with LSCC cupulolithiasis, and 1 patient (0%) was diagnosed with anterior semicircular canal BPPV. While 66 and 63% of the patients with posterior semicircular canal BPPV and LSCC canalolithiasis recovered after one session of CRM, only 32% of the patients with LSCC cupulolithiasis recovered after one session of CRM.

Conclusion:
The proportion of LSCC cupulolithiasis was higher in the elderly, and treatment efficacy by CRM is lower in LSCC cupulolithiasis than other subtypes of BPPV. High prevalence of LSCC cupulolithiasis may be explained by a delay between onset of BPPV and patient's presentation to the tertiary referral hospital or pathophysiology of ageotropic positional nystagmus other than otoconial attachment on the LSCC cupula in the elderly.