bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spontaneous Correction of External Tibiofemoral Rotational Deformity and Tibial Tuberosity-Trochlear Groove Measurements Occurs After Medial Patellofemoral Ligament Reconstruction in Fixed or Obligatory Dislocators
Authors: Aitchison Alexandra , Lin Kenneth , Green Daniel 
Published: July 2021

Objectives: Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified as potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group. Methods: A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05. Results: A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI. Conclusions: The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism. [Table: see text][Table: see text]
Lateral Extra-Articular Tenodesis Reduces the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes
Authors: Balendra Ganesh , Willinger Lukas , Jones Mary , Williams Andy , Borque Kyle 
Published: July 2021

Objectives: Lateral extra-articular tenodesis (LET) has been shown to decrease the re-rupture rates in cases of ACL reconstruction (ACLR) at high risk of failure when combined with hamstring (HS) autograft ACLR. The effects of LET have never been evaluated in elite athletes and have only sparingly been assessed when combined with bone-patellar tendon-bone (BTB) ACLR. The purpose of this study was to assess the efficacy and safety of the addition of a LET. Methods: A retrospective consecutive series of elite athletes who underwent primary ACL reconstruction by the senior author during the period of January 2005 to June 2018 were evaluated. An elite athlete was defined as one who is either paid or participates in national or international level competition in their sport. The primary outcome measure was undergoing revision ACLR, while the secondary outcome was the need for any further operative procedure. Chi square test was used to determine differences and statistical significance was defined as p < 0.05. Results: 456 elite athletes underwent ACLR during this time period. Overall 9.1% (31 of 339) underwent revision ACLR. In the ACLR + LET group, 3.4% (4 of 117) underwent ACLR revision (relative risk reduction [RRR], 0.626, p = 0.045) (table 1). Subgroup analysis by graft type yielded similar ratios, but did not reach statistical significance (Tables 2 and 3). There was no difference in re-operation rates between the ACLR alone and ACLR + LET groups (33.9% vs 30.7%, p = 0.531). Conclusions: The addition of a LET significantly reduced the rate of revision ACLR in elite athletes and did not increase the rate of subsequent operations.
Glenoid Bone Loss After First-Time Posterior Instability Events: A Prospective Cohort Study
Authors: Owens Brett , Slaven Sean , LeClere Lance , Donohue Michael , Tennent David , Cameron Kenneth , Posner Matthew , Dickens Jonathan , Bedrin Michael 
Published: July 2021

Objectives: To prospectively determine the amount of bone loss associated with posterior instability and to determine predisposing factors based on pre-instability imaging. Methods: A total of 714 athletes were evaluated prospectively for 4+ years. At baseline, every patient received a subjective history of shoulder instability as well as bilateral noncontrast shoulder magnetic resonance imaging (MRI) regardless of any reported history of shoulder instability. The cohort was prospectively followed during the study period, and those who were diagnosed with posterior glenohumeral instability were identified. Postinjury MRIs with contrast were obtained and compared with the screening MRI. Glenoid version, perfect-circle-based bone loss was measured for each patient’s pre- and post-injury MRI using previously described methods. Results: Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 5 athletes (7 shoulders) sustained a first-time posterior instability event (1 dislocation, 5 subluxations), and one athlete (1 shoulder) sustained a recurrent posterior instability event. At baseline, 6 out of 8 shoulders were noted to have some level of dysplasia and/or bone loss. Glenoid bone loss increased significantly after instability event in terms of percentage linear bone loss (6.96 ± 4.66 versus 13.54% ± 4.66, p=0.014) and total area of bone loss (3.51 ± 2.78 versus 8.10 ± 3.25, p= 0.009). Baseline glenoid retroversion >10° was associated with a significant greater percentage of bone loss (2.58 ± 1.94 versus 5.79 ± 1.28, p=0.028). Conclusions: Patients with posterior instability tend to have baseline dysplasia and/or glenoid bone loss. Glenoid bone loss of 8.1% was observed after index posterior instability event, with baseline glenoid retroversion >10° being associated with more bone loss.
The Effect of Single Sport Specialization in Youth Sports: A Prospective Cohort Study
Authors: Campbell Richard , Weekes Danielle , Mattson Meghan , Tjoumakaris Fotios , Pepe Matthew , Tucker Bradford , Lee Donghoon 
Published: July 2021

Objectives: Large numbers of youth participate in both team and individual sports. In recent years, sports specialization has become increasingly popularized in younger athletes. There is concern that early sports specialization increases the risk of overuse injuries in youth athletes. The purpose of this investigation was to determine the prevalence of sport specialization in youth athletes, and prospectively examine whether specialization correlates with an increased incidence of athletic injury. Methods: 895 high school freshman athletes were enrolled starting in 2016, with the intent of following them through the completion of their high school careers. They were recruited from 3 high schools within the same school district. Sports specialization was defined as participating in a single sport in excess of 6 months of the year at the exclusion of other sports. Athletes’ demographic information, sport commitment and injury history were collected through a sports specialization and injury survey. The same athletes were queried again at the conclusion of each season to collect injury information. Athletic training records were used to corroborate, in order to ensure capture of all injuries reported to health care personnel. Results: Of the 895 athletes, 216 (24.1%) reported sport specialization at some point during their high school sports careers. Specialized athletes were exposed to significantly more sports activity (8.41 hours/week vs 7.10 hours/week, p<0.00001 ). They were also much more likely (70.6% vs 25.1%, p< .00001) to compete on a club or travel team for their sport. Male athletes were more likely to specialize than females (27.0% vs 19.3%, p<0.0072). Baseball (12.1% of specialized athletes vs 4.9% of all athletes, p<0.000032) main sport athletes were the only athletes significantly more likely to report specialization. Specialized athletes were significantly more likely than their nonspecialized counterparts to report an injury (39.8% vs 33.2%, p< 0.0271). These athletes suffered from higher severity injuries, requiring more time to recover than their peers. (p<0.0483). Despite the higher propensity for injury in specialized athletes and greater tendency for specialization in males, female athletes were more likely to report injures (p<0.0053). The most common reported injuries were of the knee, ankle, and head (18.6%, 18.2%, 16.6% of all injuries respectively). Season ending injuries were also most commonly knee, ankle, and head injuries (48.5%, 15.2%, 12.1% respectively), with 30.3% of all reported season ending injuries being ACL tears. Conclusions: Specialized student athletes tend to have significantly more injuries than non-specialized athletes, as well as more severe injuries than non-specialized athletes. This is one of the largest and most comprehensive studies to date, evaluating the effect of sports specialization on the incidence of athletic injury in high school athletes.
Murine bone marrow mesenchymal stromal cells have reduced hematopoietic maintenance ability in sickle cell disease
Authors: Tang Alice , Strat Ana Nicolle , Rahman Mahmudur , Zhang Helen , Bao Weili , Liu Yunfeng , Shi David , An Xiuli , Manwani Deepa , Shi Patricia , Yazdanbakhsh Karina , Mendelson Avital 
Published: July 2021

AbstractSickle cell disease (SCD) is characterized by hemolytic anemia, which can trigger oxidative stress, inflammation, and tissue injury that contribute to disease complications. Bone marrow mesenchymal stromal cells (MSCs) tightly regulate hematopoietic stem cell (HSC) homeostasis in health and disease, but their functionality in SCD remains unclear. We identified for the first time that murine SCD MSCs have altered gene signatures, reduced stem cell properties, and increased oxidative stress, due in part to hemolysis. Murine SCD MSCs had lower HSC maintenance ability in vitro and in vivo, as manifested by increased HSC mobilization and decreased HSC engraftment after transplant. Activation of Toll-like receptor-4 through p65 in MSCs further contributed to MSC dysfunction. Transfusions led to an improved MSC and HSC oxidative state in SCD mice. Improving the regulation between MSCs and HSCs has vital implications for enhancing clinical HSC transplantation and gene therapy outcomes and for identification of new molecular targets for alleviating SCD complications.
How do lizard niches conserve, diverge or converge? Further exploration of saurian evolutionary ecology
Authors: Pelegrin Nicolás , Winemiller Kirk O. , Vitt Laurie J. , Fitzgerald Daniel B. , Pianka Eric R. 
Published: July 2021

Abstract
Background
Environmental conditions on Earth are repeated in non-random patterns that often coincide with species from different regions and time periods having consistent combinations of morphological, physiological and behavioral traits. Observation of repeated trait combinations among species confronting similar environmental conditions suggest that adaptive trait combinations are constrained by functional tradeoffs within or across niche dimensions. In an earlier study, we assembled a high-resolution database of functional traits for 134 lizard species to explore ecological diversification in relation to five fundamental niche dimensions. Here we expand and further examine multivariate relationships in that dataset to assess the relative influence of niche dimensions on the distribution of species in 6-dimensional niche space and how these may deviate from distributions generated from null models. We then analyzed a dataset with lower functional-trait resolution for 1023 lizard species that was compiled from our dataset and a published database, representing most of the extant families and environmental conditions occupied by lizards globally. Ordinations from multivariate analysis were compared with null models to assess how ecological and historical factors have resulted in the conservation, divergence or convergence of lizard niches.

Results
Lizard species clustered within a functional niche volume influenced mostly by functional traits associated with diet, activity, and habitat/substrate. Consistent patterns of trait combinations within and among niche dimensions yielded 24 functional groups that occupied a total niche space significantly smaller than plausible spaces projected by null models. Null model tests indicated that several functional groups are strongly constrained by phylogeny, such as nocturnality in the Gekkota and the secondarily acquired sit-and-wait foraging strategy in Iguania. Most of the widely distributed and species-rich families contained multiple functional groups thereby contributing to high incidence of niche convergence.

Conclusions
Comparison of empirical patterns with those generated by null models suggests that ecological filters promote limited sets of trait combinations, especially where similar conditions occur, reflecting both niche convergence and conservatism. Widespread patterns of niche convergence following ancestral niche diversification support the idea that lizard niches are defined by trait-function relationships and interactions with environment that are, to some degree, predictable and independent of phylogeny.
Role of community health volunteers in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Malawi: a qualitative study
Authors: Safary Elvis , Mwandeti Micrina , Matanje Beatrice , Beiersmann Claudia , Mtaita Caroline , Shiroya Veronica , Winkler Volker , Deckert Andreas , Kumar Pratap , Phiri Sam , Neuhann Florian 
Published: July 2021

Abstract
Background
In recent years, there has been greater recognition of the important role of community health volunteers in many countries and their important role informs many health programs. This include health education, provision of services such as screening, monitoring and referral to health facilities. Their roles are better understood in the areas of communicable diseases like HIV infection, Tuberculosis and Malaria however little is known about their role in non-communicable diseases. This study seeks to explore perception of CHVs’ functions, tasks, and their fulfilment in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Lilongwe, Malawi.

Methods
This was a qualitative naturalistic research design utilizing observation and semi-structured interviews with community health volunteers working in Lilongwe, Malawi. Interviews were carried out with the researcher. Participants were recruited from the ZaMaC project. An interview guide was developed with a category-guided deductive approach. The interviews were recorded through note taking. Data analysis was performed using content analysis approach.

Results
Community health volunteers have multiple roles in prevention and monitoring of hypertension. They act as health educators and provide lifestyle counselling. They screened for hypertension and monitored blood pressure and assisted community members to navigate the health system such as linkage to health facilities. These roles were shaped in response to community needs.

Conclusion
This study indicates the complexities of the roles of community health volunteer in identifying people with elevated BP for diagnosis and monitoring of hypertension. Understanding community health volunteers’ roles provides insight into their required competencies in provision of their daily activities as well as required training to fill in their knowledge gaps.
Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario – a randomized, controlled simulation trial
Authors: Ecker Hannes , Kolvenbach Simone , Stranz Sebastian , Herff Holger , Wetsch Wolfgang A. 
Published: July 2021

Abstract
Background
Endotracheal intubation continues to be the gold standard for securing the airway in emergency situations. Difficult intubation is still a dreadful situation when securing the airway.

Objective
To compare VieScope with Glidescope and conventional Macintosh laryngoscopy (MAC) in a simulated difficult airway situation.

Methods
In this randomized controlled simulation trial, 35 anesthesiologists performed endotracheal intubation using VieScope, GlideScope and MAC in a randomized order on a certified airway manikin with difficult airway.

Results
For the primary endpoint of correct tube position, no statistical difference was found (p = 0.137). Time until intubation for GlideScope (27.5 ± 20.3 s) and MAC (20.8 ± 8.1 s) were shorter compared to the VieScope (36.3 ± 10.1 s). Time to first ventilation, GlideScope (39.3 ± 21.6 s) and MAC (31.9 ± 9.5 s) were also shorter compared to the VieScope (46.5 ± 12.4 s). There was no difference shown between handling time for VieScope (20.7 ± 7.0 s) and time until intubation with GlideScope or MAC. Participants stated a better Cormack & Lehane Score with VieScope, compared to direct laryngoscopy.

Conclusion
Rate of correct tracheal tube position was comparable between the three devices. Time to intubation and ventilation were shorter with MAC and Glidescope compared to VieScope. It did however show a comparable handling time to video laryngoscopy and MAC. It also did show a better visualization of the airway in the Cormack & Lehane Score compared to MAC.

Trial registration
The study was registered at the German Clinical Trials Register www.drks.de (Identifier: DRKS00024968) on March 31st 2021.
A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status
Authors: Fakhari Ali , Farahbakhsh Mostafa , Esmaeili Elham Davtalab , Azizi Hosein 
Published: July 2021

Abstract
Background
A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs.

Methods
A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results
A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide.

Conclusions
Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.
Low CT attenuation and high fatty infiltration rate of psoas are risk factors for incisional hernias after appendicectomy: a cross-sectional single-center study from China
Authors: Du Xuechao , Sun Pengtao , Yan Yuchang , Gong Xiang , Lian Yufei , Pan Zhenyu 
Published: July 2021

Abstract
Background
Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas’ CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH.

Methods
In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas’ CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups’ indices were then compared. A logistic regression model was applied to assess the effects of psoas’ CT measurement parameters on the occurrence of IH.

Results
One hundred twenty patients were included in this study. The psoas’ CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients’ psoas’ CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas’ CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH.

Conclusions
When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.