bluuebunny/crossref_metadata_2025_split huggingface dataset:
AVOIDING POPLITEAL NEURO-VASCULAR INJURY DURING ILIOTIBIAL BAND ACL RECONSTRUCTION
Authors: Shea Kevin G , Tompkins Marc , Vuong Brian , VandenBerg Curtis , Shea Cooper , Wilson Phil , Green Dan , Ganley Ted , Ellis Henry 
Published: July 2021

Background: For patients with significant growth remaining, the Iliotibial Band ACL reconstruction technique has proven to be reliable procedure with minimal risk for growth disturbance. Recent dissection studies confirm the neuro-vascular bundle is within 1 cm of the ACL graft over the top position, confirming the importance of careful graft passage technique to avoid neurovascular injury. Purpose: The purpose of this study was to evaluate the over the top graft passage technique using pediatric 3-D knee models. Instrument placement for graft passage was assessed for its proximity to the posterior aspect of the femur, maintaining a safe distance from the neurovascular bundle. Materials and Methods: 3D knee models (ages 7, 9, 11 years) were printed from high resolution knee CT scans, including a hinge/pivot mechanism to allow for simulation of knee position during flexion and extension. Various curved tip instruments were used to evaluate the path of the graft passage, with several goals: 1. Allow the instrument to create a graft path through the posterior capsule in the most anatomic femoral position. 2. Keep the tip of the instrument close to posterior and lateral cortex of the femur, to avoid neurovascular injury. The instruments varied in design, arc of curvature, overall length, diameters. Results: Clamp passage was performed using a retrograde approach, i.e. through the notch, passing outside the periosteum of the postero-lateral femur (Figure 1). For some clamps, the arc of the curvature allowed for passage of the instrument with minimal risk of neurovascular injury. For some clamp configurations, the clamps deviated significant from the posterior aspect of the femur during graft passage, which may increase the risk of neurovascular bundle injury. In each case, an instrument was identified that met the criteria for safe passage, but different instruments were required based upon the size of the knee joint. Conclusions: The ITB ACL reconstruction is one of the best options for ACL reconstruction in the skeletally immature. The neurovascular structures are very close to the path for over the top graft placement. Due to the wide range of knee dimensions in this group, different clamp designs may be necessary for optimal over the top graft passage. 3D knee models may guide surgeons for procedure technique and optimal instrument selection for safe graft passage. [Figure: see text]
SELF-REPORTED SEVERITY OF MOOD SYMPTOMS IN PEDIATRIC PATIENTS WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS)
Authors: Spiegel Marshall , Minor Jon , Phu Nancy , Kliner Jared , Thirunagari Prem Kumar , Tramutolo David , Marx Tyler , Streeter Leslie , Mortazavi Mo 
Published: July 2021

Background: There are multiple subtypes identified in patients with Persistent Post Concussion symptoms (PPCS) in young athletes including mood subtype that is traditionally believed to be in higher incidence with PPCS. Although there may be an association of poor mood symptoms with worse PPCS outcomes, empirical analysis of patients’ mood symptoms and the duration of PPCS is scant. By better understanding the incidence of mood symptoms in pediatric PPCS, we may uncover other primary causes of ongoing brain dysfunction. Purpose: To explore the relationship between mood-symptom severity and the duration of PPCS. Methods: A retrospective cohort study of pediatric PPCS patients (age < 18 years) treated at private concussion clinic in Tucson, AZ between 7/2018 to 7/2019. Based on written questionnaires completed by patients at office visits, patients were assigned a mood and anxiety score between 0 and 3, with 0 being the least severe and 1 being the most severe. Patients were also classified into stages 1 through 4 based on PPCS duration (see table). [Table: see text] Results: Data from 59 pediatric patients (ages ranged from 7 to 17 with a mean age of 13.9, 33:26 female to male) were included. ANOVA yielded p-value of 0.94. Average (mean) mood and anxiety scores for each PPCS substage were as follows: 0.9 for stage 1 (n=23); 0.8 for stage 2 (n=18); 0.8 for stage 3 (n=13); 0.6 for stage 4 (n=5). Conclusion: Our review data showed no significance between PPCS stages in regard to average self-reported mood symptoms. Contrary to traditional thinking this preliminary data in pediatric athletes illustrates that mood severity does not increase with increasing PPCS stage. This may suggest that other domains such as migraine or vestibulocular dysfunction may be the primary source of ongoing symptoms.
IDENTIFICATION OF FACTORS ASSOCIATED WITH DISEASE PROGRESSION IN THE CONTRALATERAL HIP OF PATIENTS WITH SYMPTOMATIC FEMOROACETABULAR IMPINGEMENT
Authors: Khan Adam , Louer Craig R. , Abu-Amer Wahid , Pashos Gail , Garrido Cecilia Pascual , Clohisy John C. , Nepple Jeffrey J. 
Published: July 2021

Introduction: Femoroacetabular Impingement (FAI) is one of the most common causes of hip osteoarthritis. Nevertheless, the factors contributing to symptom development and FAI disease progression are poorly understood. Hypothesis/Purpose: The purpose of this study was to (1) investigate rates of initial and subsequent symptom development in the contralateral hip of patients with FAI, and (2) identify predictors of disease progression (symptom development) in the contralateral hip. Methods: This prospective study included a minimum 5 year follow-up of the contralateral hip in 179 patients undergoing FAI surgery. Symptoms (moderate pain) were monitored over the study course. Univariate analysis compared patient and FAI imaging characteristics of patients developing symptoms to those who remained asymptomatic. Results: 146 patients (146 hips, 81.5%) were included (min 5 year, mean 6.7 years). Thirty-nine (26%) presented with symptoms in the contralateral hip while 34 (23%) developed symptoms. Head-neck offset ratio (HNOR) on AP pelvis radiographs was significantly lower among hips that developed symptoms (0.164 vs. 0.153 p=0.025). Maximum alpha angle (p=0.413), lateral center edge angle (p=0.704), and crossover sign (p=0.115) were not predictive of symptoms. Patients with a UCLA activity score greater than 9 were less likely to develop symptoms (14% vs. 46%, p=0.081), but this was not statistically significant. The total arc of rotation in extension (35.740 vs 45.140, p=0.012) and 900 of flexion (40.00 vs 50.800, p=0.009) as well as external rotation at 900 of flexion (28.940 vs 36.590, p=0.020) were decreased in hips developing symptoms. Internal Rotation in flexion was not significantly decreased in symptomatic patients (11.060 vs 14.20, p=0.113). Conclusions: We identified unique radiographic and physical exam findings that are associated with symptom development in patients with FAI. Specifically, decreased hip rotation arc and decreased HNOR were strongly associated with disease progression and may represent important factors for future risk modeling in FAI patients.
NEURAL ACTIVITY AND LANDING BIOMECHANICS: EXPLORING THE RELATIONSHIPS BETWEEN THE BRAIN, BODY, AND ACL INJURY-RISK
Authors: Criss Cody R. , Grooms Dustin R. , Diekfuss Jed A. , Anand Manish , Slutsky-Ganesh Alexis B. , DiCesare Christopher A. , Myer Gregory D. 
Published: July 2021

Background: Anterior cruciate ligament (ACL) injuries predominantly occur via non-contact mechanisms, secondary to motor coordination errors resulting in aberrant frontal plane knee loads that exceed the thresholds of ligament integrity. However, central nervous system processing underlying high injury-risk motor coordination errors remain unknown, limiting the optimization of current injury reduction strategies. Purpose: To evaluate the relationships between brain activity during motor tasks with injury-risk loading during a drop vertical jump. Methods: Thirty female high school soccer players (16.10 ± 0.87 years, 165.10 ± 4.64 cm, 63.43 ± 8.80 kg) were evaluated with 3D biomechanics during a standardized drop vertical jump from a 30 cm box and peak knee abduction moment was extracted as the injury-risk variable of interest. A neuroimaging session to capture neural activity (via blood-oxygen-level-dependent signal) was then completed which consisted of 4 blocks of 30 seconds of repeated bilateral leg press action paced to a metronome beat of 1.2 Hz with 30 seconds rest between blocks. Knee abduction moment was evaluated relative to neural activity to identify potential neural contributors to injury-risk. Results: There was a direct relationship between increased landing knee abduction moment and increased neural activation within regions corresponding to the lingual gyrus, intracalcarine cortex, posterior cingulate cortex, and precuneus (r2= 0.68, p corrected < .05, z max > 3.1; Table 1 & Figure 1). Conclusion: Elevated activity in regions that integrate sensory, spatial, and attentional information may contribute to elevated frontal plane knee loads during landing. Interestingly, a similar activation pattern related to high-risk landing mechanics has been found in those following injury, indicating that predisposing factors to injury may be accentuated by injury or that modern rehabilitation does not recover prospective neural control deficits. These data uncover a potentially novel brain marker that could guide the discovery of neural-therapeutic targets that reduce injury risk beyond current prevention methods. [Table: see text][Figure: see text]
MECHANISM OF INJURY IMPACTS CONCUSSION RECOVERY
Authors: Caze Todd J. , Ellis Christine , Knell Gregory ,   August Price PsyD, Abt John , Burkhart Scott 
Published: July 2021

Background: Approximately 2 million children sustain a concussion annually with the majority recovering within 28 days. However, some children take longer to recover suggesting more research is necessary to determine what factors prolonged return to activity/sport. Hypothesis/Purpose: The purpose of this study was to examine the relationship between mechanism of injury (MOI) and protracted recovery (>28 days). It was hypothesized that those who sustained a concussion via head-to-head or head-to-ground were at greater risk of recovery lasting longer than 28 days than other MOIs (head-to-body, head-to-object). Methods: Children aged 8-18 years who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. Patients were evaluated within seven days of injury and remained under clinical care until cleared to return to activity/sport. Average days of recovery along with crude hazard ratios were calculated based on MOI. Results: A total of 282 children (age: 13.9±2.2 years) were diagnosed with a concussion. Total recovery was 22.1±11.3 days overall, and by MOI was as follows: head-to-object (n=52, 22.1±12.7 days), head-to-body (n=36, 22.9±11.5 days), head-to-head (n=106, 21.3±10.9 days), head-to-ground (n=79, 22.7±11.0 days). Compared to a head-to-object MOI, the risk (95% CI) of delayed recovery by MOI was as follows: head-to-body (1.75, 0.65-4.70), head-to-head (1.66, 0.72-3.80), head-to-ground (1.70, 0.71-4.06). Conclusion: Contrary to our hypothesis, the head-to-head and head-to-ground MOIs were not associated with a greater risk of a protracted recovery in this sample of adolescents. These preliminary findings suggest that MOI may not be an important clinical indicator when being treated acutely in a specialty concussion clinic. Future research should consider angle and velocity of impact as a factor of recovery.
IDENTIFYING TRENDS IN MICROSACCADE RATE ON OCULOMOTOR TRACKER IN EARLY VS LATE STAGE PEDIATRIC CASES WITH PERSISTENT POST-CONCUSSION SYMPTOMS (PPCS)
Authors: Thirunagari Prem Kumar , Phu Nancy , Tramutolo David , Rieiro Hector , Polec Tanya , Marx Tyler , Streeter Leslie , Minor Jon , Mortazavi Mo 
Published: July 2021

Background: Oculomotor and visual processing deficits occur commonly after brain injury in young athletes. A subset of these concussed athletes do experience prolonged recoveries or PPCS with ongoing oculomotor deficits and visual symptoms. There have been limited studies conducted to determine the significance of oculomotor tracking (OMT) testing in the pediatric population, and even less investigating the role of microsaccades. Hence, investigations on microsaccades(MS), physiological adjustive micro eye movements critical in visual processing and central/peripheral visual integration, may provide insight on the role of visual dysfunction in PPCS course, prognosis, and management. Purpose: The purpose of this study is to identify possible MS rate trends and differences between early and late stage PPCS pediatric patients. Methods: A retrospective cohort study of 41 pediatric patients with PPCS or symptoms greater than one month from injury. Data was collected from 7/1/2018 to 12/1/2019 and the age group ranged from 8 to 21 years. For each participant, using the OMT device we measured the number of saccades generated, the size and speed of the microsaccades, the area covered and the ratio of vertical-to-horizontal direction component of the fixational eye movements, using a 250 Hz video-eye tracker mounted inside a HTC Vive VR headset. Participants were instructed to fixate on a central dot for 140 seconds, in 20-second intervals. Patients were classified into early or late stages of PPCS (early stage: 1-6 months; late stage: >6 months) to compare MS rate between stages. Exclusion criteria included history of visual disorders, learning disorders, seizure disorder, or intracranial hemorrhage. Results: 27 patients were in the early stage while 14 patients were in the late stage. The early stage group had a mean MS rate of 125 beats/min while the late stage group had a mean MS rate of 116 beats/min. A two sample t-test assuming no difference between early and late stage patients resulted in a p value of 0.51. Conclusion: There is a potential trend in declining MS numbers with progressive PPCS stage. Although the t-test didn’t show statistical significance, this could be due to the small sample size of our study. Future studies are needed to validate this initial finding and to identify the significance of microsaccade patterns in concussion prognosis and management. [Figure: see text]
ARTHROSCOPIC BANKART REPAIR FOR ADOLESCENT UNIDIRECTIONAL SHOULDER INSTABILITY: CLINICAL AND RADIOGRAPHIC PREDICTORS OF REVISION SURGERY AND INSTABILITY
Authors: Egger Anthony C. , Broida Sam , Willimon S. Clifton , Austin Thomas , Perkins Crystal A. 
Published: July 2021

INTRODUCTION: The treatment of adolescent shoulder instability can be a challenging problem, with multiple patient and radiographic risk factors for recurrent instability. Although glenoid bone loss has been well described, humeral bone loss has gained more recent attention. The purpose of this study is to evaluate the incidence and clinical outcomes of “off track” shoulder lesions and their association with clinical outcomes. METHODS: A retrospective IRB approved study was performed to identify patients less than 19 years of age treated with isolated arthroscopic anterior labral repair for unidirectional shoulder instability. Radiographic measurements of glenoid diameter, % glenoid bone loss, glenoid track, hill-sachs interval (HIS), HS/glenoid track ratio, and intact anterior articular angle (IAAA) were performed for all patients with magnetic resonance imaging (MRI). All patients were contacted at final follow-up to collect outcome scores (PASS and SANE scores, activity level). A multivariable logistic regression analysis was performed to identify predictors of revision surgery or subjective instability (RI). RESULTS: 86 patients were identified to meet inclusion criteria and 69 of these patients, 53 males and 16 females with a median age of 16 years [15, 17], had minimum 1-year clinical follow-up and were included in assessment of clinical outcomes and multivariable analysis. 12 patients (17%) had revision surgery and 10 patients had subjective instability without revision (14%) In univariate analysis (Table 1), patient height was the only patient factor which was significantly different between the revision/instability (RI) cohort and the non-revision/instability (NRI) cohort. All 86 patients were included in radiographic analysis. Intra- and inter-rater reliability (ICCs) for radiographic measurements are presented in table 2. Agreement was good and excellent for all measurements with the exception of inter-rater reliability of IAAA. Multivariable regression analysis demonstrated that HS/glenoid track ratio was not a predictor for RI. PASS and SANE scores at final follow-up were significantly lower in the RI cohort (79.5 and 70) respectively) as compared to the NRI cohort (94 and 90 respectively), p<0.001. 42 patients (69%) returned to the same or higher level of sports following surgery and this was no different between RI and NRI cohorts. CONCLUSIONS: 31% of adolescent patients in our cohort experienced RI following arthroscopic bankart repair and this was associated with inferior PASS and SANE scores. Off-track lesions were not predictive of failure with primary repair.
Microlite-group minerals: tracers of complex post-magmatic evolution in beryl–columbite granitic pegmatites, Maršíkov District, Bohemian Massif, Czech Republic
Authors: Chládek Štěpán , Uher Pavel , Novák Milan , Bačík Peter , Opletal Tomáš 
Published: July 2021

AbstractMicrolite-group minerals occur as common replacement products after primary and secondary columbite-group minerals (CGM) in albitised blocky K-feldspar and in coarse-grained, muscovite-rich units of the Schinderhübel I, Scheibengraben and Bienergraben beryl–columbite pegmatites in the Maršíkov District (Silesian Unit, Bohemian Massif, Czech Republic). Textural and compositional variations of microlite-group minerals were examined using electron probe micro-analyses and microRaman spectroscopy (μRS). A complex post-magmatic evolution of the pegmatites and the following microlite populations (Mic) and related processes were found: (1) precipitation of U, Na-rich and F-poor Mic I on cracks in CGM; (2) alteration of Mic I to U-rich together with Na- and F-poor Mic II; and (3) partial replacement of Mic I and II by Mic III with a distinct Na, U and Ti loss and Ca and F gain. Stage (2) includes an extensive leaching of Na, without U loss. The final stage (3) produced euhedral-to-subhedral oscillatory zoned Ca and F enriched Mic III with distinctly different composition to the previous F-poor andA-site vacant Mic II. Aggregates of fersmite are associated commonly with Mic III. Distal Mic IIId occurs locally on cracks in K-feldspar or quartz, with compositions analogous to Mic III. Compositional variations and textural features of microlite-group minerals during dissolution–reprecipitation processes serve as sensitive tracers of post-magmatic evolution in granitic pegmatites recording complex interactions between magmatic pegmatite units and externally derived, hydrothermal metamorphic fluids.
Update on recent key publications in lung oncology: picking up speed
Authors: Rittmeyer Achim , Schiwitza Annett , Sahovic Lejla , Eul Bastian , Andreas Stefan 
Published: July 2021

IntroductionAs incidence rates for lung cancer are still very high and lung cancer remains the most deadly cancer since the turn of the millennium, efforts have been made to find new approaches in cancer research. This systematic review highlights how therapeutic options were extended and how the development of new drugs has picked up speed during the last 20 years.MethodsA systematic search was performed in PubMed, Cochrane Library and the European Union Trial Register and 443 records were identified. Our inclusion criteria constituted completed phase I, II and III studies investigating drugs approved by the European Medicines Agency (EMA). Overall, 127 articles were analysed.ResultsDuring the 5 year interval from 2015 to 2020, significantly more drugs were approved after phase III, and occasionally after phase II, trials than between 2000 and 2005 (p=0.002). Furthermore, there was a significant time difference (p=0.00001) indicating an increasingly briefer time interval between the publication of phase I and phase III results in the last few years.DiscussionDue to novel therapeutic approaches, numerous new drugs in lung oncology were approved. This has improved symptoms and prognoses in patients with advanced lung cancer. However, faster approval could make it difficult to scrutinise new options regarding safety and efficacy with sufficient diligence.
Comorbidities of primary headache disorders: a literature review with meta-analysis
Authors: Caponnetto Valeria , Deodato Manuela , Robotti Micaela , Koutsokera Maria , Pozzilli Valeria , Galati Cristina , Nocera Giovanna , De Matteis Eleonora , De Vanna Gioacchino , Fellini Emanuela , Halili Gleni , Martinelli Daniele , Nalli Gabriele , Serratore Serena , Tramacere Irene , Martelletti Paolo , Raggi Alberto ,   On behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
Published: July 2021

Abstract
Background
Primary headache disorders are common and burdensome conditions. They are associated to several comorbidities, such as cardiovascular or psychiatric ones, which, in turn, contribute to the global burden of headache. The aim of this study is to provide a comprehensive description of the pooled prevalence of comorbidities of primary headache disorders using a meta-analytical approach based on studies published between 2000 and 2020.

Methods
Scopus was searched for primary research (clinical and population studies) in which medical comorbidities were described in adults with primary headache disorders. Comorbidities were extracted using a taxonomy derived from the Global Burden of Disease (GBD) study. We compared prevalence of comorbidities among headache sufferers against general population using GBD-2019 estimates, and compared comorbidities’ proportions in clinical vs. population studies, and by age and gender.

Results
A total of 139 studies reporting information on 4.19 million subjects with primary headaches were included: in total 2.75 million comorbidities were reported (median per subject 0.64, interquartile range 0.32–1.07). The most frequently addressed comorbidities were: depressive disorders, addressed in 51 studies (pooled proportion 23 %, 95 % CI 20–26 %); hypertension, addressed in 48 studies (pooled proportion 24 %, 95 % CI 22–26 %); anxiety disorders addressed in 40 studies (pooled proportion 25 %, 95 % CI 22–28 %). For conditions such as anxiety, depression and back pain, prevalence among headache sufferers was higher than in GBD-2109 estimates. Associations with average age and female prevalence within studies showed that hypertension was more frequent in studies with higher age and less females, whereas fibromyalgia, restless leg syndrome, and depressive disorders were more frequent in studies with younger age and more female.

Conclusions
Some of the most relevant comorbidities of primary headache disorders – back pain, anxiety and depression, diabetes, ischemic heart disease and stroke – are among the most burdensome conditions, together with headache themselves, according to the GBD study. A joint treatment of headaches and of these comorbidities may positively impact on headache sufferers’ health status and contribute to reduce the impact of a group of highly burdensome diseases.