bluuebunny/crossref_metadata_2025_split huggingface dataset:
Porcine Tracheal Mucosa-Derived Decellularized Patch to Prevent Septal Perforation in a Rabbit Model
Authors: Kim So Jeong , Jung Soo Yeon , Lee Min Ji , Bae Jung Ho , Kim Han Su 
Published: September 2020

Background Nasal septal perforation is caused by bilateral septal mucosal injuries resulting from nasal trauma and septal surgeries. Previous studies have reported that biocompatible materials may be effective for repairing nasal septal perforations. However, they were primarily used for treatment; no study has investigated their use for prevention of nasal septal perforation. Objective To determine whether porcine tracheal mucosa-derived decellularized patch can prevent the progression of nasal mucosa injuries to septal perforations. Methods Bilateral nasal septal mucosal defects were surgically induced in 36 rabbits. Silastic sheets were applied bilaterally in all rabbits, and decellularized mucosal patch was applied unilaterally (n = 12) or bilaterally (n = 12) at the defect site in the respective experimental groups. Between 1 and 8 weeks postoperatively, the animals were sacrificed, and their nasal septa were completely removed. The excised septa were examined macroscopically and microscopically (histopathological examinations). Moreover, glycosaminoglycan (GAG) estimations of the septa were performed to evaluate mucosal regeneration and mechanical properties. Results Septal perforations occurred in 5 animals in the control group (5/12; 42%), 1 in the unilateral group (1/12; 9%), and in none in the bilateral group. Compared with the control group, the experimental groups showed significantly different mucosal and cartilage regeneration. Conclusion Decellularized porcine tracheal mucosa can prevent mucosal defects from progressing to septal perforation, promote the repair of mucosal defects, and protect the nasal cartilage.
Interactive videoconferencing in the redesign of a health-care quality improvement workshop for the coronavirus disease 2019 pandemic
Authors: Seow Yee Ting , Teo Shao Chu , Yap William , Foo Zann , Tan Kok Hian 
Published: September 2020

Introduction: The Blended Quality Improvement (QI) Workshop is a programme designed to provide learners with basic tools and techniques in QI using a combination of e-learning and face-to-face classroom interactions. To adapt to the coronavirus disease 2019 (COVID-19) situation for safe social distancing since the end of January 2020, SingHealth Duke-NUS Institute for Patient Safety & Quality (IPSQ) suspended all face-to-face workshops. However, the need for effective QI training remains. Objective: The aim was to develop an effective virtual interactive Blended QI Workshop through videoconferencing. Methods: The workshop was redesigned by reviewing the curriculum and incorporating the use of interactive functions. The new workshop took place virtually via a video conferencing platform and incorporated the use of interactive polling, game, videos and case study. A total of 23 learners attended the two pilot runs that took place on 28 April 2020 and 22 May 2020. A survey assessed learners’ reactions and satisfaction with the training and preference in using video conferencing tools during disease and non-disease outbreak situations, while the quizzes assessed learners’ learning in QI knowledge. The results on the improvement in QI knowledge were compared to the original blended e-learning and face-to-face workshop ( n=63) that took place before the COVID-19 pandemic. Results: The gain in QI knowledge from virtual and from face-to-face Blended QI Workshops was statistically significant ( p<0.01, n=86). However, there was no statistically significant difference in the gain in QI knowledge with both content delivery approaches ( p=0.13). All 23 learners agreed that the video conferencing platform was convenient, 20 (87.0%) felt that the platform was effective in delivering content and 18 (78.3%) were keen to use video conferencing tools for QI workshops during disease outbreak situations. Remarkably, a substantial number of learners ( n=11; 47.8%) preferred the use of interactive video conferencing to supplement face-to-face classroom-based Blended QI Workshops for non-disease outbreak situations. Conclusion: The virtual interactive Blended QI Workshop was as effective as the face-to-face Blended QI Workshop based on learners’ views and gains in QI knowledge post workshop. The success of virtual QI workshops makes them a new norm in the post-COVID-19 environment.
Protecting the privacy of technology users who have cognitive disabilities: Identifying areas for improvement and targets for change
Authors: Cobigo Virginie , Czechowski Konrad , Chalghoumi Hajer , Gauthier-Beaupre Amelie , Assal Hala , Jutai Jeffery , Kobayashi Karen , Grenier Amanda , Bah Fatoumata 
Published: September 2020

Introduction Information Technologies (IT) may serve assistive roles that facilitate the interaction of people living with cognitive disabilities (CD) within their environments. However, there are some notable concerns related to privacy threats associated with the use of IT. The purpose of this study was to examine how assistive technology developers may best adapt over time to develop their IT to be resilient against threats to privacy. We therefore focused on the following areas: (1) developers’ knowledge and practices related to privacy protection; (2) challenges when applying recommended practices, and; (3) preferred channels to acquire knowledge. Method We conducted semi-structured interviews with ten technology developers who are members of the AGE-WELL network undertaking research and development of assistive technologies to be used by people who have cognitive disabilities. We used an inductive-deductive method for the analysis of qualitative data to examine participant responses and generate themes related to the study goals. Results Principal themes that emerged from the data include practices specific to populations with CD, challenges to obtaining consent to use of information, and preferred channels to acquire knowledge. Conclusion We identify areas of focus for developing a knowledge mobilization strategy to improve relevant policies and practices.
Does Exposure to Primary Care Early in the Didactic Phase of the Physician Assistant (PA) Curriculum Influence Field Choice Post-Graduation?
Authors: Gruver Michelle , Gamber Michelle 
Published: September 2020

Background Over the past 10 years, the nation has witnessed a significant increase in the number of physician assistant (PA) education programs. Primary care shortages throughout the United States have reached a staggering deficiency. The purpose of this project was to expand the primary care workforce in the Commonwealth of Virginia by increasing exposure to primary care setting early in the academic didactic year of physician assistant schooling. Methods This innovative research project originated in 2017 and was inclusive of PA students ranging from 20 to 44 years of age, across multiple demographics, conducted during the first year of didactic studies. This cross-sections study examined a total size of 115 students over from three different cohort years that participated in the free medical clinic completed a pre/post exposure survey. Results This study highlighted that an increased exposure to primary care in the early didactic phase of physician assistant graduate studies yielded a moderate increase in the interest to pursue a career in primary care upon graduation. Throughout the 2016 to 2017, 2017 to 2018, and 2018 to 2019 academic cohorts, 19% more from baseline indicated at the end of their primary care experience that they were more likely to practice in the field of primary care following the free medical clinic experience. Conclusions This study demonstrates a positive influence of early exposure to primary care for Physician Assistant students with the increased affinity to practice in the field upon graduation and has set a foundation for continuation of data collection in future PA cohorts.
Exploring the Potential of Artificial Intelligence and Machine Learning to Combat COVID-19 and Existing Opportunities for LMIC: A Scoping Review
Authors: Naseem Maleeha , Akhund Ramsha , Arshad Hajra , Ibrahim Muhammad Talal 
Published: September 2020

Background: In the face of the current time-sensitive COVID-19 pandemic, the limited capacity of healthcare systems resulted in an emerging need to develop newer methods to control the spread of the pandemic. Artificial Intelligence (AI), and Machine Learning (ML) have a vast potential to exponentially optimize health care research. The use of AI-driven tools in LMIC can help in eradicating health inequalities and decrease the burden on health systems. Methods: The literature search for this Scoping review was conducted through the PubMed database using keywords: COVID-19, Artificial Intelligence (AI), Machine Learning (ML), and Low Middle-Income Countries (LMIC). Forty-three articles were identified and screened for eligibility and 13 were included in the final review. All the items of this Scoping review are reported using guidelines for PRISMA extension for scoping reviews (PRISMA-ScR). Results: Results were synthesized and reported under 4 themes. (a) The need of AI during this pandemic: AI can assist to increase the speed and accuracy of identification of cases and through data mining to deal with the health crisis efficiently, (b) Utility of AI in COVID-19 screening, contact tracing, and diagnosis: Efficacy for virus detection can a be increased by deploying the smart city data network using terminal tracking system along-with prediction of future outbreaks, (c) Use of AI in COVID-19 patient monitoring and drug development: A Deep learning system provides valuable information regarding protein structures associated with COVID-19 which could be utilized for vaccine formulation, and (d) AI beyond COVID-19 and opportunities for Low-Middle Income Countries (LMIC): There is a lack of financial, material, and human resources in LMIC, AI can minimize the workload on human labor and help in analyzing vast medical data, potentiating predictive and preventive healthcare. Conclusion: AI-based tools can be a game-changer for diagnosis, treatment, and management of COVID-19 patients with the potential to reshape the future of healthcare in LMIC.
The fate of femoral head autograft in acetabular reconstruction in dysplastic hips at midterm
Authors: Hamrayev Arif Jan , Buyukkuscu Mehmet Ozbey , Misir Abdulhamit , Gursu Sukru Sarper 
Published: September 2020

Purpose: To evaluate the acetabular cup and graft survival in patients who underwent total hip arthroplasty (THA) with the diagnosis of dysplastic hip osteoarthritis and received a femoral head autograft due to acetabular coverage deficiency. Methods: Between January 2005 and December 2016, 83 hip prostheses of 80 patients who underwent THA using femoral head autografts and were followed up for at least 2 years were retrospectively evaluated. Seventy-four hips of the remaining 71 patients (57 female (80%)) were included. Mean patient age at surgery was 51 ± 16 (range 18–76) years. The mean follow-up duration was 76 ± 25 (range 25–161) months. Acetabular inclination and graft thickness, contact length, percentage of coverage, and graft resorption were examined on postoperative and final follow-up radiographs. The presence of a radiolucent area around the acetabular and femoral components indicating loosening was also evaluated. Results: The mean postoperative acetabular component inclination was 44 ± 5.1° (range 30–48°) with mean graft coverage of 34 ± 4.8% (range 24–46%). In all patients, autograft union with the pelvis was seen and the lateral overflow was remodeled. Fifteen patients (20%) underwent revision surgery due to aseptic acetabular component loosening in four, nontraumatic recurrent dislocations in eight, periprosthetic infection in one, acetabular component protrusion in one, and traumatic hip dislocation in one. Conclusion: In patients with osteoarthritis secondary to developmental hip dysplasia, the use of femoral head autografts to eliminate acetabular coverage deficiency during THA achieves acceptable midterm postoperative radiological outcomes. Increased acetabular bone stock may be beneficial in possible future revision surgeries.
Tibial crest alignment technique-an effective technique to improve coronal alignment of tibial component in tka for arthritic knees
Authors: Dalal Shaival , Aminake Ghislain , Chandratreya Amit , Kotwal Rahul 
Published: September 2020

Introduction: Long term survivorship in Total Knee Arthroplasty is significantly dependent on prosthesis alignment.Accuracy of component positioning relies on alignment guides for making precise and accurate bone cuts. Hypotheses: The aim of this study was to determine, compare and analyse the coronal alignment of the tibial component of a single implant system using 3 different techniques. Methods: Retrospective study of cases from a prospectively collected database. Radiological assessment included measurement of the coronal alignment of tibial components of total knee arthroplasties, and its deviation from the mechanical axis. A comparison study of intramedullary, extramedullary and tibial crest alignment methods was performed. Results: 66 consecutive patients (3 groups of 22 each). Mean BMI was 26. The mean angle of deviation from the mechanical axis was significantly lesser (p< 0.05) in the Tibial crest alignment group patients compared to the other 2 groups. Moreover, the number of outliers (+/-3 degrees) were 2 and 4 in the intra and extramedullary group, whereas there were none in the tibial crest group. The inter and intraclass correlation coefficient was 0.8 and 0.9 respectively. Conclusion: The Tibial Crest Alignment Technique is an effective technique to produce consistent results to achieve optimal coronal alignment of the tibial component in TKA, even in patients with high BMI.
Three-dimensional realignment and slope reducing osteotomy with anatomic ACL reconstruction in patients with revision anterior cruciate ligament deficiency
Authors: Imhoff Andreas B. , Feucht Matthias , Achtnich Andrea , Imhoff Florian , Herbst Elmar , Diermeier Theresa 
Published: September 2020

Introduction: Current incidence of recurrent anterior cruciate ligament (ACL) instability is 5%, but revision surgery is challenging and requires a thorough analysis of potential risk factor. Moreover, recurrent and chronic ACL instability can result in medial tibio-femoral osteoarthritis (OA). Beside various soft tissue patterns, bony morphologies like a steep posterior tibial slope are associated with an increased anterior tibial translation (ATT) and rotatory instability in the ACL deficient knee. To address the instability and the osteoarthritis a combined procedure is necessary in these patients, however, little is known about the efficacy of such combined procedures. Therefore, the objective of this study was to evaluate the patient reported outcomes and knee stability following combined high tibial osteotomy (HTO) with ACL reconstruction in middle-aged patients with recurrent or chronic cruciate ligament deficiency and mild to moderate medial compartment osteoarthritis (OA). Hypotheses: Methods: Surgical reports and prospectively collected patient reported outcome scores (IKDC, Lysholm, WOMAC, VAS for pain, and Tegner activity score) as well as clinical examination were evaluated retrospectively with a mean follow up of 45.2 ± 14.7 months. Inclusion criteria were 1) high tibial osteotomy with concomitant anatomic ACL reconstruction. Data at final followup were compared to baseline values using the Wilcoxon signed rank test (p < 0.05). Results: 44 patients met the inclusion criteria. 16/44 suffered a graft failure after primary ACL reconstruction, and 8/44 had chronic ACL instability, but had a previous subtotal medial meniscus resection. Mean patient age at surgery was 38.2 ± 10.5 years (range: 18 – 63) with a mean varus alignment of 4.5° ± 1.5°. All patient reported significantly improved outcome scores at final follow-up (VAS 4.3 to 1.5, Lysholm 52.4 to 73.5, IKDC 56.5 to 70.9). However, the change in Tegner score at final follow-up (3.4 to 4.5) was not significant. At final followup 25/44 patients had a removal of the fixation plate. Conclusion: The results of this study indicate, that high tibial osteotomy combined with anatomic single bundle ACL reconstruction is a good treatment option in active middle aged patients suffering from recurrent or chronic ACL deficiency with mild to moderate medial compartment OA. At a median follow-up of 24 months patient reported outcome scores were improved. Especially in patients with multiple ACL reconstruction failures realignment osteotomies should be considered.
Effect of tranexamic acid on the timing of drainage tube removal in total knee arthroplasty
Authors: Jinliang Wang , Xuan Wei 
Published: September 2020

Introduction: To investigate the effect of tranexamic acid on the removal time of drainage tube in the first unilateral total knee arthroplasty. Hypotheses: The timing of removing the drinage system can be changed when using TXA. Methods: From June 2017 to December 2018, 182 patients (42 males and 140 females) who planned to undergo primary unilateral total knee replacement were included.Age (68.1±7.1) years (60-76 years).According to the random number table method, it was divided into four groups: 45 cases of Tranexamic acid group 1 (TXA1), 46 cases of Tranexamic acid group 2 (TXA2), 46 cases of Tranexamic acid group 3 (TXA3) and None Tranexamic acid group (NTXA).TXA1-3 group intraoperative intravenous infusion combined with local application of tranexamic acid;NTXA group was locally perfused in the joint cavity with 100ml normal saline only after surgery.Differences in drainage volume, total blood loss, invisible blood loss, degree of postoperative joint swelling, Hospital for special surgery (HSS) and visual analogue scale (VAS) of pain were compared among the four groups. Results: The postoperative drainage volume of TXA1˜3 groups was 85.5±34.3ml, 189.4±72.3ml and 215.3±93.4ml, respectively, which was less than that of the non-tranexamic acid group (351.3±113.5ml). The overall difference was statistically significant (F=11.5,P=0.005). The postoperative drainage volume of tranexamic acid 1 group was less than that of tranexamic acid 2 and 3 groups.The total postoperative blood loss was 699.0±255.7ml, 710.4±296.1ml, and 715.8±248.2ml in the tranexamic acid 1-3 groups, respectively, which was less than 1130.5±354.2ml in the non-tranexamic acid group, and the overall difference was statistically significant (F=13.1,P=0.001).On the 4th day after the operation, the knee swelling degree of the tranexamic acid 1- 3 groups was 1.25±0.07, 1.13±0.12, and 1.12±0.13, respectively, which were smaller than that of the non-tranexamic acid group (1.43±0.22), and the overall difference was statistically significant (F=8.23, P=0.015).There were 2 cases of positive bacterial culture in non-tranexamic acid group and tranexamic acid group.There were 3 cases of hematoma in the non-tranexamic acid group,and 1 case of delayed wound healing. Conclusion: The application of tranexamic acid after TKA can reduce postoperative drainage volume, latent blood loss and total blood loss.The removal of the drainage tube 18h after the operation can not only fully drain,relieve pain, promote the recovery of knee joint function, but also effectively reduce the risk of infection caused by the drainage tube.
First clinical results after lateral epicodyle osteotomy and meniscus subluxation in the repair of tibial plateau fractures
Authors: Korthaus Alexander , Ballhause Tobias Malte , Kolb Jan-Philipp , Krause Matthias , Frosch Karl-Heinz , Hartel Maximilian J. 
Published: September 2020

Introduction: Recently, a novel extended approach for comminuted lateral tibial plateau fractures was introduced. It includes a lateral epicondyle osteotomy and meniscus subluxation allowing for an almost complete overview of the lateral tibial plateau. First clinical results are presented. Hypotheses: We hypothesized, that a superior visualization using the novel approach in demanding cases leads to improved radiologic and clinical outcomes. Methods: A consecutive case series of ten in which the approach was used was followed prospectively. The cases were classified using the “10-segment classification” and the “AO classification”. To evaluate the clinical and radiological results, the Rasmussen score was applied. Results: Excellent to good clinical and radiological results were encountered after a median follow-up of 8,6 (IQR 4,3) months. The clinical score amounted to a median of 25 (IQR 2,8) and the radiological score a median of 17 (IQR 2,0). Conclusion: The early results after the treatment of demanding cased with a high degree of joint comminution presented are promising with excellent to good results, only. At the same time, despite an extended surgical procedure, no complications were encountered in the cohort. As suggested by the authors before, tibial plateau fractures should be managed using a stepwise approach with extension of the approach as individually required.
Megaprosthesis as a treatment modality for persistent distal femoral nonunion in middle aged adults
Authors: Agarwal Shashank , Pawar Inder , Kumar Anil , Verma Anjul , Kumar Pawan 
Published: September 2020

Introduction: Managing distal femur non-union can be a struggle for any orthopedician as it brings along many perplexities which may not lead to satisfactory patient outcome. The target in these cases should be to reduce the morbidity and allow early rehabilitation of the patient and to accomplish this, megaprostheses can be a feasible option. The orthodox use of megaprostheses is in the musculo-skeletal oncologic surgeries but its use can be extended to traumatic etiologies. These can be offered as a single stage definite procedure in patients who have already undergone several previous surgeries. Here we report a series of four cases of persistent non-union of distal femur treated with megaprostheses and recommend this modality for achieving the desired goal but the indication should be meticulously selected. Hypotheses: Megaprosthesis as a definitive treatment option in persistent distal femur non-union and prevention of repeated surgical intervention. Methods: Four cases of persistent distal femur nonunion with failed osteosynthesis were selected who were initially treated with a distal femur locking plate. Results were assessed in terms of range of motion, limb length discrepancy, knee society score and osteointegration of the components. Results: The mean age of the patients at the time of DFEPR was 49 years (42-55). The mean follow up of patients was for approximately 2 years, with the longest follow up being 3.5 years for the first operated case of the series. The range of motion was from full extension to about 105 degrees of flexion with two patients having an extension lag of 10 degrees. Patients were ambulatory without support. Postoperatively, the mean knee society score was 83 (78–88) at last follow-up as compared to 29 (21-36) in the pre-operative period. No case of infection or loosening was reported. There was 1 cm of shortening in one patient in the operated limb which was compensated by giving shoe raise. Good osseointegration of the megaprosthesis was revealed on both anteroposterior and lateral radiographs. Conclusion: Although there are very limited studies on the use of megaprosthesis for traumatic cases, it can be considered as an alternative when we are left with only arthrodesis or amputation as the final option. Despite the operative challenges, there is marked improvement in pain and functional capacity as experienced by these severely limited patients, which are the hallmarks of a successful salvage. The use of distal femur mega-prosthesis is a novel acumen in cases, where bone stock at the fracture site at distal end of femur is so severely compromised that traditional revision osteosynthesis would not provide stable and durable fixation. The indications for this surgery must be rigorously selected and should only complement osteosynthesis procedures, which remain the reference treatment option.