bluuebunny/crossref_metadata_2025_split huggingface dataset:
N6-methyladenosine demethylases Alkbh5/Fto regulate cerebral ischemia-reperfusion injury
Authors: Xu Kaiwei , Mo Yunchang , Li Dan , Yu Qimin , Wang Lu , Lin Feihong , Kong Chang , Balelang Meita Felicia , Zhang Anqi , Chen Sijia , Dai Qinxue , Wang Junlu 
Published: April 2020

Background: Although N6-methyladenosine (m6A) plays a very important role in different biological processes, its function in the brain has not been fully explored. Thus, we investigated the roles of the RNA demethylases Alkbh5/Fto in cerebral ischemia-reperfusion injury. Methods: We used a rat model and primary neuronal cell culture to study the role of m6A and Alkbh5/Fto in the cerebral cortex ischemic penumbra after cerebral ischemia-reperfusion injury. We used Alkbh5-shRNA and Lv-Fto ( in vitro) to regulate the expression of Alkbh5/Fto to study their regulation of m6A in the cerebral cortex and to study brain function after ischemia-reperfusion injury. Results: We found that RNA m6A levels increased consecutive to the increase of Alkbh5 expression in both the cerebral cortex of rats after middle cerebral artery occlusion, and in primary neurons after oxygen deprivation/reoxygenation. In contrast, Fto expression decreased after these perturbations. Our results suggest that knocking down Alkbh5 can aggravate neuronal damage. This is due to the demethylation of Alkbh5 and Fto, which selectively demethylate the Bcl2 transcript, preventing Bcl2 transcript degradation and enhancing Bcl2 protein expression. Conclusion: Collectively, our results demonstrate that the demethylases Alkbh5/Fto co-regulate m6A demethylation, which plays a crucial role in cerebral ischemia-reperfusion injury. The results provide novel insights into potential therapeutic mechanisms for stroke.
YOUTH KICKER’S KNEE: LATERAL DISTAL FEMORAL HEMIPHYSEAL ARREST SECONDARY TO CHRONIC REPETITIVE MICROTRAUMA
Authors: Dempewolf Michael , Kwan Kevin , Sherman Benjamin , Schlechter John A. 
Published: April 2020

Background: Year-round competitive sports places the youth athlete at risk for injury from chronic repetitive stress. Various conditions have been reported secondary to overuse. Stress injuries to the distal femoral physis in active adolescents are rare. Hypothesis/Purpose: The purpose if this report is to highlight 3 male youth soccer players who presented with a lateral distal femoral hemiphyseal arrest and subsequent unilateral genu valgum deformity in their dominant “kicking leg” due to repetitive microtrauma a phenomenon we refer to as youth kicker’s knee. Methods: A retrospective review of adolescents that presented to our orthopedic clinic for lateral distal femoral hemiphyseal arrest secondary to chronic repetitive kicking was performed from 2010 to 2018. History, physical exam and imaging findings were obtained as well as the treatment course for all adolescents. Results: All patients were 14 years of age, and all participated in year-round high intensity soccer and American football. Patient specific data is summarized in Table 1 and 2. Imaging studies demonstrated aberration of the distal lateral femoral physis in all. (Figure 1) To address their limb deformity all adolescents were surgically treated with guided growth which was successful in correcting the mechanical axis in 2 of the 3 adolescents Patient Numbers (PN) 1 and 3. (Figure 2) The adolescent (PN 2) that failed to correct was definitively treated with a lateral distal femoral opening osteotomy successfully realigning his limb. Conclusion: Our series illustrates a unique presentation of a chronic overuse / stress injury in hyper sporting adolescents resulting in an ipsilateral genu valgum deformity. Understanding adolescent growth and developmental characteristics is paramount to appropriate care, prevention, and treatment of physeal injuries that may occur from repetitive overuse and avoid surgery in these young athletes when possible. [Table: see text][Table: see text][Figure: see text][Figure: see text]
GENDER DIFFERENCES IN REPORTED RECOVERY TIME FROM SPORTS-RELATED CONCUSSION IN DUAL GENDER SPORTS FROM 2012-2017
Authors: Burkhart SO , Ellis CS , Jones CA , Smurawa TM , Polousky JD 
Published: April 2020

Background: Sport-related concussion (SRC) is one of the leading injuries among athletes. Previous epidemiological studies have reported incidence rates of concussion among dual gender sports in which both males and females participate including; soccer, basketball, and baseball/softball yet minimal research has been conducted on differences in recovery time following concussion in the dual gender sports mentioned above. Purpose: The purpose of this study was to examine injury reporting trends associated with recovery time from concussion in dual gender sports from 2012-2017. Methods: Athletes with a reported SRC, ages 12 to 18 participating in baseball, softball, basketball, and soccer from 2012 to 2017 were included in the current study. Injury and exposure data was extracted and analyzed from the Rank One Health Injury Surveillance Database (ROH ISD). SRC counts, percentages, and recovery time in days were reported based on extracted data. All demographic and raw data were summarized using descriptive statistics with point estimates and 95% confidence intervals calculated for all end points. Independent sample t-tests were performed at <0.05 to measure significant differences between groups. Results: 1,306 athletes (males=583, females=723) with an SRC and corresponding date of return to play recorded in the ROH ISD and participating in dual gender sports were analyzed. 242 baseball/softball SRCs (male=103, mean recovery days=17.82; female=139, mean recovery days=22.12), 458 basketball SRCs (male=187, mean recovery days=20.16; female=271, mean recovery days=23.29), and 606 soccer SRCs (male=193, mean recovery days=19.96; female=413, mean recovery days=23.71) were included. A statistically significant difference in recovery time was observed in male and female soccer SRCs ( t=2.09, p=0.02). No significant differences were observed in recovery time in baseball/softball ( t=1.59, p=0.057) and basketball ( t=1.49, p=0.068). Conclusions: This is the first study of its kind to examine gender differences in report recovery time from SRCs in dual gender sports where both males and females participate. Significant gender differences were observed in reported recovery time in soccer athletes. Sports specialization, level of play, injury education level among participants, and training regiments could all be potential causes for the observed differences. Further research is warranted to explore these gender differences and identify potential causes for these findings.
USING MOVEMENT SCREENING TESTS AND BIOMECHANICAL ANALYSIS TO DIFFERENTIATE POST-CONCUSSION PEDIATRIC SOCCER ATHLETES FROM HEALTHY CONTROLS
Authors: Burkhart Scott O. 
Published: April 2020

Background: Recently, 2 controlled prospective studies of collegiate student-athletes identified 1.6 to 2.5 increased risk of subsequent lower extremity injury following concussion (Books et al., 2016; Lynall et al., 2015). The purpose of the study is to determine the potential clinical utility and application of the Functional Movement Screen (FMS), Y Balance Test (YBT), Tuck Jump Assessment (TJA), and Landing Error Scoring System (LESS) in a sample of post-concussion soccer athletes and a sample of healthy age and gender matched soccer athlete controls to identify differences. Differentiation was defined as significance in raw score performance on the FMS, YBT, TJA, LESS. Prospective data was collected on lower extremity injury within 6-months post-concussion. Methods: The study participants were administered the FMS, YBT, TJA, and LESS in successive order by a licensed athletic trainer. All measures were administered in a biomechanical lab setting. Post-concussion soccer athletes were administered the FMS, YBT, TJA, and LESS after receiving formal medical clearance from a licensed physician. Post-concussion soccer athletes were matched with healthy soccer athlete controls by age, gender, and years of participation. All study participants were administered screening measures at rest. All demographic and raw data were summarized using descriptive statistics with point estimates and 95% confidence intervals calculated for all end points. Independent sample t-tests were performed at <0.05 to measure significant differences between groups. Results: 50 (17 female, 33 male; mean age=14.1; mean years of participation=6.8) post-concussion soccer athletes and 50 (17 female, 33 male; mean age=14.3; mean years of participation=6.7) matched soccer athlete controls were administered the FMS, YBT, TJA, and LESS. Significant differences were observed between the post-concussion and control groups on FMS Deep Squat ( t=-9.76, p=<0.001), Inline Lung ( t=-8.43, p=<0.001), and LESS total score (t=-9.21, p=<0.001). No other significant differences were observed. Conclusions: The current study identified the FMS, YBT, TJA, and LESS as potential movement screening tests in which differences could be observed in a sample of post-concussion and healthy control soccer athletes. Results from the current study identified specific differences between groups with respect to movement screening test performance on the FMS Deep Squat, Inline Lunge, and LESS total score. Further research is warranted to clearly define the observed differences. Clinicians should consider these findings when providing recommendations and discussing recovery in concussion patients.
PERIACETABULAR OSTEOTOMY IN ACTIVE DUTY U.S. MILITARY PERSONNEL: A SINGLE CENTER’S EXPERIENCE WITH A MINIMUM OF TWO YEARS FOLLOW-UP
Authors: Murtha Andrew S. , Schmitz Matthew R. 
Published: April 2020

Background: The primary focus of periacetabular osteotomy (PAO) literature has been survivorship until hip arthroplasty. This endpoint overlooks its impact on young, active patients. Hypothesis/Purpose: This study sought to assess the impact of the PAO on the careers of active duty members of the United States Armed Forces. Methods: A retrospective review identified 38 patients who underwent PAO performed by a single surgeon at an academic, military medical center from January 2014 through April 2017. Twenty-one of the patients were active duty United States military service members (16 female, 5 male) and had a minimum 28 months of post-operative follow-up at the time of review. Preoperative and postoperative duty restrictions were noted and referrals to the U.S Army and U.S. Air Force Medical Evaluation Boards (MEB) were queried. Results: The average age at surgery was 25.6 years (range, 19-40y). Preoperatively, sixteen patients (94.1%) were on duty restrictions, one had been referred to the MEB, and records were not available on three patients who separated from the military prior to review. Average follow-up was 3.4 years (range, 2.3 – 5.4y). Among the patients without a preoperative MEB referral, 85.0% remained on active duty (n = 12) or completed their military service commitment (n=5). Of the fourteen patients with temporary duty restrictions preoperatively, 35.7% (n=5) were relieved of their restrictions and returned to full duty and 50% (n=7) were retained on active service with permanent duty restrictions. Such permanent duty restrictions typically consisted of modifications to the aerobic component of the semiannual military fitness testing. Six patients (28.6%) were referred to the MEB including one who was referred prior to PAO. Of these patients, two were deemed fit to retain on active service with permanent duty restrictions, two were medically separated for non-hip conditions, and two were medically separated for a hip condition. The average Veteran Affairs (VA) disability score related to hip pathology in patients referred to MEB was 16% (range 0-40%). Conclusion: This is the first study to look at the PAO in active duty military service members. In patients with symptomatic acetabular dysplasia, PAO may provide an opportunity to relieve preoperative duty restrictions and allow for continued military service. Further study with the inclusion of patient reported outcomes are necessary assess the impact of the procedure in this active patient population.
INFLUENCE OF LOWER EXTREMITY STATIC ALIGNMENT ON DYNAMIC KNEE VALGUS IN ADOLESCENTS FOLLOWING ACL RECONSTRUCTION
Authors: VandenBerg Curtis D. , Mueske Nicole M. , Abousamra Oussama , Feifer Daniel , Sarkisova Natalya , Katzel Mia J. , Pace J. Lee , Wren Tishya A. L. 
Published: April 2020

Background: Dynamic limb valgus, particularly high knee abduction moments, are a known risk factor for anterior cruciate ligament (ACL) injury. High knee abduction moments may result from poor static anatomic limb alignment, faulty biomechanics, or a combination of both. The distinction is important because anatomic limb alignment is difficult to change, while dynamic factors can be addressed through neuromuscular or biomechanical training. Hypothesis/Purpose: This study assessed the influence of static (lower extremity anatomic alignment) and dynamic (kinematic and kinetic) factors on external knee abduction moments during side-step cutting in uninjured adolescent athletes. Methods: This retrospective study included 43 adolescents with recent unilateral ACL reconstruction (mean age 15.3 years, SD 2.0, range 10-21; 17/43 female; 3-12 months post-surgery, mean 6.5, SD 2.1). Frontal plane hip to ankle imaging (EOS) was used to measure mechanical axis deviation (perpendicular distance from the center of the femoral condyles to the mechanical axis line connecting the center of the femoral head to the center of the talar dome) and tibial-femoral angle. Femoral anteversion was measured during physical examination. 3D motion capture provided lower extremity kinematics and kinetics during quiet standing and during the loading phase (initial contact to peak knee flexion) of an anticipated 45° side-step cut, with 2-3 trials per limb averaged for analysis. Relationships among imaging, static motion capture, and dynamic motion capture measures were investigated using correlation, and backward stepwise linear regression was used to evaluate potential predictors of average dynamic knee abduction moment. Results: Dynamic knee abduction moment was best predicted by a combination of dynamic measures: knee and hip abduction, external knee rotation, lateral trunk lean towards the planting foot, and ankle inversion during cutting (Table 1.1). Although EOS frontal plane tibial-femoral angle was correlated with dynamic knee abduction moment (r=0.24, p=0.02), no static/anatomic variables entered the model once the dynamic measures were included. Conclusion: Knee abduction moments during side-step cutting were related to dynamic factors reflecting frontal plane trunk, hip, knee, and ankle motion, as well as external knee rotation. Static (anatomic) lower limb alignment did not influence knee abduction moments once these dynamic factors were considered. Knee abduction moments and ACL injury risk are therefore not dictated by anatomic alignment and can be altered through neuromuscular/biomechanical training. [Table: see text]
PEDIATRIC ORTHOPEDIC RADIOGRAPH REDUCTION: A QUALITY IMPROVEMENT INITIATIVE
Authors: Lander Sarah , Michels Julie , Brayer Anne , Obudzinski Sarah , D’amore Taylor , Chess Mitchel , Wakeman Derek , Cook P. Christopher , Sanders James 
Published: April 2020

Background: Children are more vulnerable to ionizing radiation which increases health risks later in life including cancer. An interdepartmental team developed an algorithm to guide providers ordering extremity radiographs in pediatric patients with musculoskeletal (MSK) injuries. Purpose: Reduce unnecessary pediatric radiation/extremity radiographs through development and implementation of an interdepartmental designed algorithm. Determine utility, safety, and efficacy of the algorithm through retrospective and prospective analysis. Methods: Our study was performed at an academic pediatric trauma center. An interdepartmental committee including pediatric orthopedic surgery, emergency medicine, trauma, and radiology providers created a MSK injury imaging algorithm (Figure 1). We retrospectively validated the algorithm for efficacy and safety through chart review of pediatric patients seen in the ED with MSK extremity injury, identified through CPT code, from 6/24/2016 through 8/31/2016. We determined the number of extra radiographs per patient and identified if injuries would be missed utilizing our protocol. After retrospective validation, guideline implementation was undertaken through multidisciplinary education. The imaging guideline was prospectively implemented in the pediatric ED from 6/24/2018 through 8/31/2018. We continued to prospectively evaluate through selecting one week every month over the following eight months to determine sustainability of the implemented algorithm. Results: Our interdepartmental team in 2016 developed a pediatric MSK radiograph protocol (Figure 1). A retrospective chart and radiograph review of 295 pediatric patients between 6/24/2016 through 8/31/2016 was analyzed correlating physical examination to appropriate radiographs. Utilizing the protocol, the review revealed an average of 2.75 extra radiographs per patient. No injuries were missed. Providers including orthopedic and emergency medicine attendings, mid-levels, and residents were educated through meetings, emails, and having the protocol posted and easily accessible. Our protocol was implemented 6/24/18 and underwent prospective enrollment and review through 8/31/18 which revealed a reduction to 0.72 radiographs per patient (P-value <0.001) (Figure 2). Eight month follow up revealed a sustainable reduction in extra radiographs per patient (Figure 3). Conclusion: Reduction of unnecessary radiation to pediatric patients with MSK extremity injuries was accomplished through development and implementation of a safe and effective imaging algorithm. The multidisciplinary approach combined with widespread education of pediatric providers improved buy-in driving a sustainable system improvement. [Figure: see text][Figure: see text][Figure: see text]
OCULOMOTOR FUNCTION IN ADOLESCENT ATHLETES FOLLOWING CONCUSSION
Authors: Zaslow Tracy , Mueske Nicole M. , Yu Gene J. , Conrad-Forrest Adriana , Edison Bianca , Wren Tishya A. L. 
Published: April 2020

Background: Visual impairments affect up to 90% of patients post-concussion. These impairments may include deficits in fixation accuracy, smooth pursuit, saccadic latencies, vergence, accommodation, and vestibule-ocular reflexes. Quantitative assessment of oculomotor function may provide a sensitive and objective measure of concussion diagnosis and recovery since coordinated eye movements require the use of diverse and widely dispersed areas of the brain. This study quantified oculomotor function over time in adolescents following concussion. Hypothesis/Purpose: We hypothesized that adolescent concussion patients would demonstrate deficits of oculomotor function that would resolve by the time of return to play (RTP) and remain stable after RTP. Methods: 13 adolescent athletes diagnosed with mild to moderate concussion (7 male; mean age 15.1, SD 2.1, range 10-17 years) were prospectively evaluated at their initial visit (mean 18, range 4-43 days post-concussion), at the time of clearance to RTP (mean 46, range 12-173 days post-concussion), and one month later (mean 26, range 20-41 days after RTP). 11 controls without past concussion or injury (3 male; mean age 12.3, SD 3.1, range 8-17 years) were also tested at similar time points. Eye tracking was recorded as participants followed a target moving on a screen in predefined patterns related to sinusoid and trapezoid smooth pursuit, vergence, saccade, and anti-saccade. Metrics characterizing the speed, accuracy, and variability of tracking were compared between groups and visits using t-tests and linear mixed-effects regression. Results: At their initial visit, patients tended to have greater overshoot and greater variability in tracking compared with controls (Table 1.1). Overshoot and variability of tracking during sinusoid smooth pursuit (both overall variability and variability of overshoot) decreased from initial visit to RTP (Table 1.2). Undershoot during sinusoid smooth pursuit tended to decrease from RTP to 1-month follow-up. The rate of convergence in the distance vergence task increased while the rate of divergence decreased between these time points. Conclusion: The main oculomotor deficits observed in concussed adolescents related to overshoot and variability of tracking during sinusoid smooth pursuit. These deficits resolved by the time of RTP and generally remained stable or continued improving after RTP. These results suggest that oculomotor function recovers sufficiently under current conservative treatment protocols. [Table: see text][Table: see text]
SINGLE-LEG HOP TESTING AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IS NOT PREDICTIVE OF GRAFT RUPTURE IN ADOLESCENT PATIENTS
Authors: Yao Jie J , Snetselaar Jordan , Schmale Gregory A. , Saper Michael 
Published: April 2020

Background: Safe return to sport (RTS) after anterior cruciate ligament (ACL) reconstruction is difficult to determine in adolescent patients. Return of strength and dynamic knee stability can be assessed with functional single-leg hop testing as part of a formal RTS assessment. However, it is unclear whether performance during single-leg hop testing can predict future ACL graft rupture. Hypothesis/Purpose: To investigate differences in single-leg hop testing between adolescent patients who experienced a graft rupture after ACL reconstruction and those that did not. Methods: A retrospective review of adolescent patients whom underwent primary ACL reconstruction with a hamstring (HS) autograft identified 16 patients (10 girls, 6 boys) with single-leg hop testing data prior to graft failure. A nearest neighbor match algorithm was used to age-, sex-, surgeon-, and graft-match 16 patients without graft rupture. All patients followed a standardized rehabilitation protocol following surgery. As part of a formal RTS test, assessment of function and dynamic strength/stability was performed using 4 different single-leg hop tests: single hop for distance, triple hop for distance, triple crossover hop for distance, and timed hop. The recovery of muscle strength was defined by a limb symmetry index (LSI) ≥ 90%. Bivariate analyses were performed to compare the two groups. Results: The mean age of the entire cohort at the time of surgery was 14.6 ± 1.5 years. Patients completed their RTS test at 29.0 ± 5.4 weeks. There were no statistically significant differences in demographics, graft size, or time to RTS test between groups. There were no statistically significant differences in LSIs on the single hop (p=0.90), triple hop (p=0.36), crossover hop (p=0.41), or timed hop (p=0.48). The mean LSIs on each of the four hop tests were 92.3 ± 14.7, 95.1 ± 6.1, 95.8 ± 7.1, and 98.6 ± 7.9, respectively. Passing rates were similar between groups (p=0.54). Conclusion: Performance on single-leg hop tests 6 months after surgery is not predictive of graft rupture following ACL reconstruction with HS autograft in adolescent patients. Further investigation of alternative RTS measures and different time frames for testing in this high-risk population is needed.