bluuebunny/crossref_metadata_2025_split huggingface dataset:
Higher-order clinical risk factor interaction analysis for overall mortality in maintenance hemodialysis patients
Authors: Yang Cheng-Hong , Moi Sin-Hua , Chuang Li-Yeh , Chen Jin-Bor 
Published: September 2020

Background and Aims: In Taiwan, approximately 90% of patients with end-stage renal disease receive maintenance hemodialysis. Although studies have reported the survival predictability of multiclinical factors, the higher-order interactions among these factors have rarely been discussed. Conventional statistical approaches such as regression analysis are inadequate for detecting higher-order interactions. Therefore, this study integrated receiver operating characteristic, logistic regression, and balancing functions for adjusting the ratio in risk classes and classification errors for imbalanced cases and controls using multifactor-dimensionality reduction (MDR-ER) analyses to examine the impact of interaction effects between multiclinical factors on overall mortality in patients on maintenance hemodialysis. Meterials and Methods: In total, 781 patients who received outpatient hemodialysis dialysis three times per week before 1 January 2009 were included; their baseline clinical factor and mortality outcome data were retrospectively collected using an approved data protocol (201800595B0). Results: Consistent with conventional statistical approaches, the higher-order interaction model could indicate the impact of potential risk combination unique to patients on maintenance hemodialysis on the survival outcome, as described previously. Moreover, the MDR-based higher-order interaction model facilitated higher-order interaction effect detection among multiclinical factors and could determine more detailed mortality risk characteristics combinations. Conclusion: Therefore, higher-order clinical risk interaction analysis is a reasonable strategy for detecting non-traditional risk factor interaction effects on survival outcome unique to patients on maintenance hemodialysis and thus clinically achieving whole-scale patient care.
Temporomandibular joint pain and associated magnetic resonance findings: a retrospective study with a control group
Authors: Eriksen Elisabeth Schilbred , Hellem Sølve , Skartveit Liv , Brun Johan G , Bøe Olav E , Moen Ketil , Geitung Jonn Terje 
Published: September 2020

Background To better understand and evaluate clinical usefulness of magnetic resonance imaging (MRI) in diagnosis and treatment of temporomandibular disorders (TMD), parameters for the evaluation are useful. Purpose To assess a clinically suitable staging system for evaluation of MRI of the temporomandibular joint (TMJ) and correlate the findings with age and some clinical symptoms of the TMJ. Material and Methods Retrospective analysis of 79 consecutive patients with clinical temporomandibular disorder or diagnosed inflammatory arthritis. Twenty-six healthy volunteers were included as controls. Existing data included TMJ pain, limited mouth opening (<30 mm) and corresponding MRI evaluations of the TMJs. Results The patients with clinical TMD complaints had statistically significantly more anterior disc displacement (ADD), disc deformation, caput flattening, surface destructions, osteophytes, and caput edema diagnosed by MRI compared to the controls. Among the arthritis patients, ADD, effusion, caput flattening, surface destructions, osteophytes, and caput edema were significantly more prevalent compared to the healthy volunteers. In the control group, disc deformation and presence of osteophytes significantly increased with age, and a borderline significance was found for ADD and surface destructions on the condylar head. No statistically significant associations were found between investigated clinical and MRI parameters. Conclusion This study presents a clinically suitable staging system for comparable MRI findings in the TMJs. Our results indicate that some findings are due to age-related degenerative changes rather than pathological changes. Results also show that clinical findings such as pain and limited mouth opening may not be related to changes diagnosed by MRI.
Risk of necrosis in the adjacent toe after one-toe fillet flap in diabetic foot: Retrospective study of 107 cases over 5 years
Authors: Kim Junhyung , Kim Kyubeom , Choi Jaehoon , Jeong Woonhyeok , Jo Taehee , Oh Sangho 
Published: September 2020

Purpose: Fillet flap is a “spare part” concept. This technique allows the defect to be covered without donor site morbidity. Over the past 5 years, there were 107 diabetic foot cases of one-toe fillet flap in our hospital. After the operation, in some patients, there was necrosis of the adjacent toe that required additional amputation. The aim of our study was to determine the cause of necrosis of the adjacent toe after fillet flap. Methods: The patients were divided into two groups. One group had no necrosis of the adjacent toe (group A) after the operation, and the other group had necrosis of the adjacent toe that required additional amputation after the operation (group B). Then, to confirm the cause of the additional necrosis of the adjacent toe, χ 2 tests, Fisher’s tests, and logistic regression tests were performed. Results: A total of 107 patients were included, and 48 patients needed additional amputation. The logistic regression test revealed that a fillet flap at the metatarsophalangeal joint (MTPJ), horizontal sutures, and a fillet flap at the second toe were significant risk factors for developing necrosis. Conclusions: If a fillet flap with a second toe, fillet flap on MTPJ level and horizontal closure after fillet flap is needed, the chance of developing necrosis of the adjacent toe and additional revisional surgery must be communicated preoperatively.
Biomechanical analysis of distraction forces on the posterior meniscal roots to optimize early rehabilitation protocols
Authors: Ellermann Sophia , Kittl Christoph , Frank Andre , Wermers Jens , Glasbrenner Johannes , Briese Thorben , Raschke Michael J. , Herbort Mirco , Herbst Elmar 
Published: September 2020

Introduction: The aim of this study was to investigate the distraction forces of the medial and lateral posterior meniscal roots after repair (PMMR, PLMR) at different degrees of flexion and axial load. Hypotheses: It was hypothesized that with increasing axial load and flexion angle, the distraction forces on the meniscal roots increase continuously. Methods: Eight fresh-frozen human cadaveric knees were axially loaded in a custom made kinematics rigs with 0 N, 200 N and 400 N throughout a continuous flexion-extension cycle (0°-90°). The distraction forces acting on the PMMR and PLMR were determined in three scenarios: 1) native knee joint, 2) after bilateral detachment of the posterior meniscal roots and following root repair, 3) after resection of the anterior cruciate ligament (ACL). To measure the distraction forces, the FiberWire No. 2 (Arthrex, Inc.) sutures used for the root repairs were shuttled transtibially through a 2.4 mm bone tunnel and tied over a force sensor mounted on the anterior tibia with a pretension of 2 N. Statistical analysis was performed using a repeated- measures ANOVA with a post-hoc Bonferroni correction (p < 0.05). Results: Overall, the different investigated knee states as well as the degree of flexion showed a significant effect on the distraction forces on the posterior meniscal roots (p <0.01). An axial load of 200 N and 400 N resulted in a significant increase of the distraction forces on both menisci over the entire range of motion compared to an unloaded state (p < 0.01). When no axial load was applied, the distraction forces after PMMR and PLMR refixation were not significantly affected by the degree of flexion (p > 0.05). With axial loading of 200 N and 400 N, the distraction forces on the PLMR were significantly higher at flexion angles between 15° and 90° compared to full extension (p <0.01). In contrast, the distraction forces on the PMMR were highest close to extension (0° -30°) and decreased significantly towards 90° of flexion when the knees were loaded with 200 N and 400 N (p <0.01). When the ACL was removed, a significant increase of the distraction forces at the posterior meniscal roots was observed (p < 0.001). Conclusion: Axial loading significantly increases the distraction forces after posterior meniscal root repair. Therefore, axial loading should be avoided in the early postoperative phase. Furthermore, data of this study shows that passive exercise between 0° and 90° flexion can be performed without significantly affecting the forces acting on the menisci.
Ten year results following HTO - analysis of clinical outcome and survival rates in terms of TKA revision
Authors: Bode Lisa , Brenner Anna-Sophie , Eberbach Helge , Kloos Ferdinand , Niemeyer Philipp , Schmal Hagen , Bode Gerrit 
Published: September 2020

Introduction: Varus deformity is a well-known risk factor for focal cartilage defects and even medial osteoarthritis of the knee due to increase of medial compartment peak pressure. High tibial osteotomy using angular-stable implants is an effective and standardized method unloading the medial compartment and resulting in pain reduction and excellent clinical follow-up. Until now only mid-term results have been published and little is known concerning conversion to total knee arthroplasty (TKA). Purpose of the present study is to examine long-term results with special focus on TKA convesion. Hypotheses: HTO results in good to excellent results in terms of functional outcome and TKA conversion even after ten years. Methods: All patients aged 18 – 65 years and treated with HTO due to focal cartilage lesions of the medial compartment or medial gonarthritis with underlying varus deformity between 01.01.2004 and 31.12.2013, were included in the present study. Lysholm score and visualized analog scale (VAS) were obtained pre- and postoperatively while Knee Osteoarthritis and Outcome Sccore (KOOS) and IKDC and TKA conversion rate were obtained postoperatively only. Statistical analysis was performed using SPSS Software 24.0 (IBM Corp. Armonk, USA). Results: 125 patients with a mean age of 44,4 +- 10,17 (Range 18,9 - 66,9) years were included in the present study. Mean follow-up (FU) was 118,4 +- 27,3 (Range 73,0 - 171) months. Lysholm score and VAS significantly improved at FU in comparison to preoperative valus. Patients presented good functional outcom even after ten years (KOOSpain 82,9 +- 14,4; KOOS symp 78,6+-17,6, KOOS adl 87,8+-13,3; KOOSsport 53,1+#30,4; KOOSQOL 70,2+-21,4;KOOS4 71,2+-18,2). Patients requiered TKA conversion in 12.8%, resulting in 87.2% TKA free survival-rates ten years after HTO implantation. Conclusion: HTO is a safe and effective method resulting in good functional outcome and low conversion rates to TKA even after ten years.
Genetic Insights of Primary knee osteoarthritis
Authors: Subramanyam Krishna , Poornima Subhadra 
Published: September 2020

Introduction: Knee Osteoarthritis (KOA) is charecterised by focal loss of joint articular cartilage, osteophyte formation and sub chondral bone remodelling. Common clinical symptoms include pain, stiffness, limitation of the joint movement and swelling. OA is the most common joint disease worldwide and the knee is the common site involved. Classical risk factors of OA include age, gender, weight, joint injury, trauma. However, family history/Hereditary component is the one of the crucial factors. knee OA is a complex disease with environmental and genetic factors associated with its development and progression. Hypotheses: It is classified as primary when no discernible cause is evident and secondary when a triggering factor is apparent. However primary OA possesses significant genetic component. Despite the fact that OA is a late onset advanced age disease the increasing incidence of OA individuals below the age of 55 years and the fact that the several members of the same family are affected suggest a genetic predisposition. Hence, there is a need to identify molecular biomarkers associated with primary early knee osteoarthritis Methods: Several Genome wide association studies and candidate gene studies have identified genetic variants involved in the pathogenesis of OA like VDR, MMP, TGF, GDF5, COL11A1 and VEGF. Currently, the majority of genetic association studies on disease risk focused on identifying the individual’s effect on single nucleotide polymorphisms (SNPs). Results: In the present study, ten gene polymorphisms were studied in Indian population. They are COL21, CRTL1, CRTM, ACE, VDR, GDF5, COG5, CYBA, SREBP2 and TGFβ1 genes which were selected based on their role in cartilage maintenance and bone remodelling. This is the first study in India which looked at the gene polymorphisms. Altogether 100 clinically diagnosed and radiologically confirmed early primary knee OA (KOA) cases and 100 controls with no musculoskeletal diseases, were recruited and molecular analysis was performed by routine PCR - RFLP techniques. Results indicated that COL21, CRTL1, ACE, GDF5, COG5, CYBA, SREBP2 and TGFβ1gene polymorphisms showed an association with the disease where as CRTM and VDR lack of association. Conclusion: These gene polymorphisms can be used as molecular biomarkers for identifying the individuals who are at risk of developing the disease ( primary knee osteoarthritis) and these molecular genotypes helps us in planning tailored treatment and management. It also help us to identify individuals who are at risk of developing knee osteoarthritis and preventive measures can be planned accordingly. To the best of our knowledge this is the first study in India which assessed these ten gene polymorphisms with primary early knee osteoarthritis.
Length change pattern of the medial structures of the knee and related reconstructions
Authors: Olbrich Arne , Herbst Elmar , Domnick Christoph , Glasbrenner Johannes , Raschke Michael J. , Frank Andre , Herbort Mirco , Kittl Christoph 
Published: September 2020

Introduction: Aim of the study was to investigate the length changes of the medial structures and related reconstructions. It was assumed that the three fibre sections (anterior/middle/posterior) of the superficial medial collateral ligament (sMCL) have different length change patterns, which cannot be imitated by current reconstructions. Hypotheses: The three fibre sections (anterior/middle/posterior) of the superficial medial collateral ligament (sMCL) cannot be imitated by current reconstructions. Methods: Measurements were made on eight cadaveric knees. The knee joints were clamped in a custom-made open chain extension structure. For this purpose, the portions of the quadriceps and the iliotibial tract were aligned according to their fibre direction and statically loaded using hanging weights. The respective tibial and femoral insertion points of the sMCL anterior/middle/posterior fibres were marked by small pins. Similarly, pins were inserted at the tibial and femoral attachment sites of the posterior oblique ligament (POL). In order to imitate the Lind reconstruction, a pin was additionally inserted on the tibial semitendinosus insertion site. Pin combinations accounting for the anterior/middle/posterior sMCL, the POL, and the Lind reconstruction were connected using a high resistant suture. Then the length change patterns were measured using a rotary encoder from 0-120° knee flexion. Statistical analysis was performed using 2-way repeated-measures ANOVA and a post-hoc Bonferroni correction (p <0.05). Results: The anterior and posterior fibres of the sMCL showed a reciprocal behaviour (p< 0.001). The anterior fibres showed a length reduction (2%) up to a flexion of 20°, followed by an elongation of 5% at 120° flexion, which means that the anterior fibres are tight in knee flexion. Conversely, the posterior fibres of the MCL showed an initial length reduction of 4% at 20° flexion. This was followed by an isometric range (20° - 80°) and a further length reduction of 8% in deep flexion (120°). Thus, the posterior fibres of the MCL were tight in extension. The three parts of the POL showed a constant reduction of 25% between 0° and 120°. The Lind reconstruction with the tibial pin at the semitendinosus insertion site showed similar length changes compared to the sMCL (n.s.). Furthermore, the Lind reconstruction was dependent on the femoral placement of the pins (p <.001). The tibial placement had no significant influence. Conclusion: The anterior portion of the sMCL was tight in flexion, whereas the posterior portion was tight in extension. This reciprocal behavior could not be imitated by a single point to point reconstruction. When surgically applying these reconstructions, special attention should be paid to the femoral insertion.
Short-term results of primary total knee replacement: the experience of the Tashkent Medical Academy and Wiltze Memorial hospital
Authors: Madrakhimov Sarvar , Karimov Murodulla 
Published: September 2020

Introduction: To analyze and evaluate the short-term results of 82 patients after primary total knee replacement (TKR) Methods: A prospective study of 82 patients (54 women and 28 men) with 82 TEC operations was conducted at the Multidisciplinary clinic of the Tashkent Medical Academy (Tashkent, Uzbekistan) and the Wiltse Memorial hospital (Suwon, Republic of Korea) from November 2018 to January 2020. The age of patients ranged from 52 to 87 years (average age 61 years). The diagnosis of grade 3 – 4 osteoarthritis of the knee (Kellgren and Lawrence) was confirmed in all patients. The hospital for Special Surgery (HSS) scale, volume of movement, visual analog pain scale (VAS), and patient satisfaction questionnaire with the Knee Society Knee Scoring System were used as functional assessment criteria. Results: The mean duration of follow-up and hospitalization was 16 months (±6.7) and 11 days (±2.6), respectively. The average volume of movements was 100, 6⁰ (±4, 5⁰) at the end of the observation period. All patients demonstrated adequate knee stability and returned to their previous daily activities. YOUR average score was 1.8 (±3.3) points over a 6-month period. Satisfaction with the outcome of the operation was 82.7 % in the 12-month postoperative period. In the study, there was not a single case of postoperative mortality, periprosthetic infection, revision surgery. Conclusion: To date, in the course of clinical observation of patients with osteoarthritis of the knee who underwent primary TKR, the results were found to be satisfactory. Also, further research with a large cohort and subsequent long-term monitoring is needed, and the question of creating a single register and institutional databases is raised, in view of the expected increase in the number of revision interventions.
A comparative study of functional outcome of transtibial and transportal femoral tunneling techniques for arthroscopic ACL reconstruction
Authors: Date Sudeep 
Published: September 2020

Introduction: Acl reconstruction has revolutionarised the sports medicine world lately. Various methods of reconstruction have been advocated in the literature recently. ACL injury results in severe morbidity to an athletes career. The aim for anatomical reconstruction is to harvest the ACL graft at a more anatomical location on both the tibia and the femur. The purpose of this study is to compare the functional outcomes of the two methods of the graft harvestis to compare the functional outcomes of the two methods of the graft harvest Hypotheses: 60 patients were included in the study with complete ACL tear and were assessed at 3 6 and 9 months on the basis of various scores and relevant elements. Methods: All patients who were planned for arthroscopic ACL reconstruction surgery from the OPD, who were willing and fit the inclusion criteria were included in the study. They were then examined clinically with special tests i.e. Lachman’s test, anterior drawer test, pivot shift test and McMurray’s test and the findings were recorded including any associated meniscal injuries. They were then evaluated using 3 different evaluation systems i.e. IKDC, Lysholm and pain VAS. Results: Average mean age of the patients undergoing ACL reconstruction was (26%) in Transtibial and 23.3%. 90% of them were males. Majority of them were males (58%). The average IKDC score of transportal patients was significantly higher than transtibial patients at 6 months followup [P=0.001]. The average Lysholm knee score of transportal patients was significantly higher than the transtibial patients [P=0.047]. The average pain on VAS score of transportal group was significantly lower than transtibial at 6 months followup [P<0.001]. Complication of instability was more common in transtibial patients, 11(36.7%), when compared to transportal patients, 9(30%), however this difference was not significant [P=0.58]. Conclusion: Our study clearly stated that the transportal technique for acl reconstruction fetched superior results as compared to the transtibial technique in terms of knee instability, pain and other domains.
The Validation of a Pocket Worn Activity Tracker for Step Count and Physical Behavior in Older Adults during Simulated Activities of Daily Living
Authors: Ummels Darcy , Bijnens Wouter , Aarts Jos , Meijer Kenneth , Beurskens Anna J. , Beekman Emmylou 
Published: September 2020

Purpose: The purpose of this study was to validate optimized algorithm parameter settings for step count and physical behavior for a pocket worn activity tracker in older adults during ADL. Secondly, for a more relevant interpretation of the results, the performance of the optimized algorithm was compared to three reference applications Methods: In a cross-sectional validation study, 20 older adults performed an activity protocol based on ADL with MOXMissActivity versus MOXAnnegarn, activPAL, and Fitbit. The protocol was video recorded and analyzed for step count and dynamic, standing, and sedentary time. Validity was assessed by percentage error (PE), absolute percentage error (APE), Bland-Altman plots and correlation coefficients. Results: For step count, the optimized algorithm had a mean APE of 9.3% and a correlation coefficient of 0.88. The mean APE values of dynamic, standing, and sedentary time were 15.9%, 19.9%, and 9.6%, respectively. The correlation coefficients were 0.55, 0.91, and 0.92, respectively. Three reference applications showed higher errors and lower correlations for all outcome variables. Conclusion: This study showed that the optimized algorithm parameter settings can more validly estimate step count and physical behavior in older adults wearing an activity tracker in the trouser pocket during ADL compared to reference applications.