bluuebunny/crossref_metadata_2025_split huggingface dataset:
Static and Dynamic Quadriceps Stretching Exercises in Patients With Patellofemoral Pain: A Randomized Controlled Trial
Authors: Lee Jin Hyuck , Jang Ki-Mo , Kim Eunseon , Rhim Hye Chang , Kim Hyeong-Dong 
Published: February 2021

Background: Limited data are available on the effect of stretching exercise in patients with patellofemoral pain (PFP) who have inflexible quadriceps, which is one of the various causes of PFP syndrome. This study compares quadriceps flexibility, strength, muscle activation time, and patient-reported outcomes after static and dynamic quadriceps stretching exercises in patients with PFP who had inflexible quadriceps. Hypothesis: Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes would improve with dynamic quadriceps stretching as compared with static quadriceps stretching exercises. Study Design: Randomized controlled trial. Level of Evidence: Level 2. Methods: Of the 44 patients included in the study, 20 performed static stretching and 24 performed dynamic stretching. Quadriceps flexibility was assessed by measuring the knee flexion angle during knee flexion in the prone position (the Ely test). Muscle strength and muscle activation time were measured using an isokinetic device. The patient-reported outcomes were evaluated using the visual analogue scale for pain and anterior knee pain scale. Results: No significant differences in quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in the involved knees were found between the 2 groups ( P values > 0.05). Conclusion: Quadriceps flexibility and strength, muscle activation time, and patient-reported outcomes in patients with PFP who had inflexible quadriceps showed no significant differences between the static and dynamic quadriceps stretching exercise groups. Clinical Relevance: Both static and dynamic stretching exercises may be effective for improving pain and function in patients with PFP who have inflexible quadriceps.
Optimal cut-off points for adherence measure among patients with type 2 diabetes in primary care clinics: a retrospective analysis
Authors: Lim Ming Tsuey , Ab Rahman Norazida , Teh Xin Rou , Chan Chee Lee , Thevendran Shantini , Ahmad Hamdi Najwa , Lim Ka Keat , Sivasampu Sheamini 
Published: February 2021

Background: Medication adherence measures are often dichotomized to classify patients into those with good or poor adherence using a cut-off value ⩾80%, but this cut-off may not be universal across diseases or medication classes. This study aimed to examine the cut-off value that optimally distinguish good and poor adherence by using the medication possession ratio (MPR) and proportion of days covered (PDC) as adherence measures and glycated hemoglobin (HbA1c) as outcome measure among type 2 diabetes mellitus (T2DM) patients. Method: We used pharmacy dispensing data of 1461 eligible T2DM patients from public primary care clinics in Malaysia treated with oral antidiabetic drugs between January 2018 and May 2019. Adherence rates were calculated during the period preceding the HbA1c measurement. Adherence cut-off values for the following conditions were compared: adherence measure (MPR versus PDC), assessment period (90-day versus 180-day), and HbA1c target (⩽7.0% versus ⩽8.0%). Results: The optimal adherence cut-offs for MPR and PDC in predicting HbA1c ⩽7.0% ranged between 86.1% and 98.3% across the two assessment periods. In predicting HbA1c ⩽8.0%, the optimal adherence cut-offs ranged from 86.1% to 92.8%. The cut-off value was notably higher with PDC as the adherence measure, shorter assessment period, and a stricter HbA1c target (⩽7.0%) as outcome. Conclusion: We found that optimal adherence cut-off appeared to be slightly higher than the conventional value of 80%. The adherence thresholds may vary depending on the length of assessment period and outcome definition but a reasonably wise cut-off to distinguish good versus poor medication adherence to be clinically meaningful should be at 90%.
Pharmacokinetics of Tobramycin Administered at the Beginning of Intermittent Hemodialysis Session (ESRD Study)
Authors: Giroux Marjolaine , Bouchard Nicolas , Henderson Anik , Lam Lesly , Tran Van Anh Sylvie , Projean Denis , Tessier Jean-François , Lepage Laurence , Gavra Paul , Ouellet Georges , Vallée Michel , Lafrance Jean-Philippe 
Published: February 2021

Background and Objectives: There is a renewed interest in the successful use of aminoglycosides due to increasing resistance in gram-negative infections. Few studies to date have examined the pharmacokinetics (PK) of intradialytic infusions of tobramycin. This study sought to characterize the pharmacokinetic profile of intradialytically administered tobramycin in infected patients receiving chronic intermittent hemodialysis and to determine whether it is possible to achieve favorable PK targets. Design, Setting, Participants, and Measurements: In this prospective pharmacokinetic study, a single dose (5 mg/kg) of tobramycin was administered intradialytically to 11 noncritically ill patients undergoing chronic intermittent hemodialysis. Blood samples were collected at selected time to determine tobramycin serum concentrations. The PK analysis was performed using Phoenix™ NLME. The efficacy exposure outcome for nonsevere gram-negative infections sensitive to tobramycin with a minimum inhibitory concentration ≤1 were maximum concentration (Cmax ≥ 10 mg/L) and area under the curve (AUC24 h > 30 mg⋅h/L). For toxicity, the goal was to identify plasma trough concentrations <2 mg/L. Results: Tobramycin disposition was best described by a one-compartment model using a total clearance composed of the systemic clearance and a transitory hemodialysis clearance. Tobramycin mean (SD) Cmax, trough levels, and AUC24h were 13.1 (1.3) mg/L, 1.32 (0.47) mg/L, and 61 (23) mg⋅h/L, respectively. Monte Carlo simulation run with 1000 virtual patients showed that a 5 mg/kg dose of tobramycin administered intradialytically can outperformed the usual low-dose postdialysis dosing (80% meeting all targets versus <1%, respectively). Conclusions: A single high dose of tobramycin can achieve favorable PK outcome when administered using intradialytic infusions in hemodialysis patients. This practical dosing regimen may represent an effective and safer alternative to the usual dosing in the treatment of nonsevere gram-negative infections.
Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience
Authors: Lofrese Giorgio , Scerrati Alba , Balsano Massimo , Bassani Roberto , Cappuccio Michele , Cavallo Michele A. , Cofano Fabio , Cultrera Francesco , De Iure Federico , Biase Francesco Di , Donati Roberto , Garbossa Diego , Menegatti Marta , Olivi Alessandro , Palandri Giorgio , Raco Antonino , Ricciardi Luca , Spena Giannantonio , Tosatto Luigino , Visani Jacopo , Visocchi Massimiliano , Zona Gianluigi , De Bonis Pasquale 
Published: February 2021

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( P = 0.12) to the burr ( P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( P = 0.15). Use of curved chisel reduced the surgical times ( P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( P = 0.04) and shorter waiting times for surgery ( P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.
Posterior Cruciate Ligament Reconstruction With Independent Suture Tape Reinforcement: An In Vitro Biomechanical Full Construct Study
Authors: Levy Bruce A. , Piepenbrink Marina , Stuart Michael J. , Wijdicks Coen A. 
Published: February 2021

Background: Posterior cruciate ligament (PCL) reconstruction is commonly performed to restore joint stability and prevent posterior tibial translation at higher flexion angles. However, persistent knee laxity after reconstruction is often reported. Purpose: To biomechanically evaluate the effect of independent suture tape (ST) reinforcement on different PCL reconstruction techniques. Study Design: Controlled laboratory study. Methods: PCL reconstruction using porcine bones and quadrupled bovine tendons was performed using 2 techniques: (1) an all-inside method using suspensory adjustable loop devices (ALDs) in the tibia and femur and (2) a method using an interference screw on the tibial and an ALD on the femoral site. Both were tested with and without an additional ST for 4 groups (n = 8 per group). Each construct underwent biomechanical testing involving 3000 loading cycles in 3 stages. After position-controlled cycles simulating full range of motion, force-controlled loading from 10 to 250 N and then from 10 to 500 N were performed before pull-to-failure testing. Elongation, stiffness, and ultimate strength were evaluated. Results: The highest ultimate load (1505 ± 87 N), a small total elongation (2.60 ± 0.97 mm), and stiffness closest to the native human ligament (156.3 ± 16.1 compared with 198.9 ± 33.5 N/mm; P = .192) was seen in the all-inside technique using ST. Intragroup comparison revealed that reinforcement with ST produced a smaller total elongation for the screw fixation (Screw-ALD, 6.06 ± 3.60 vs Screw-ALD ST, 2.50 ± 1.28 mm; P = .018) and all-inside techniques (ALD-ALD, 4.77 ± 1.43 vs ALD-ALD ST, 2.60 ± 0.97 mm; P = .077), albeit the latter was not significantly different. Elongation for constructs without ST increased more rapidly at higher loads compared with elongation for ST constructs. The ultimate strength was significantly increased only for constructs using the all-inside technique using ST (ALD-ALD, 1167 ± 125 vs ALD-ALD ST, 1505 ± 87 N; P = .010). Conclusion: Adding an independent ST to PCL reconstruction led to improvement in the studied metrics by reducing the total elongation and increasing the ultimate strength, independent of the technique used. Clinical Relevance: PCL reconstruction using additional ST reinforcement was biomechanically favorable in this study. ST reinforcement in the clinical setting could decrease knee laxity after PCL reconstruction, providing better joint stability and improved functional outcomes.
Temporal Utilization of Physical Therapy Visits After Anterior Cruciate Ligament Reconstruction
Authors: Burroughs Patrick J. , Kahan Joseph B. , Moore Harold G. , Grauer Jonathan N. , Gardner Elizabeth C. 
Published: February 2021

Background: Physical therapy (PT) rehabilitation is critical to successful outcomes after anterior cruciate ligament reconstruction (ACLR). Later-stage rehabilitation, including sport-specific exercises, is increasingly recognized for restoring high-level knee function. However, supervised PT visits have historically been concentrated during the early stages of recovery after ACLR. Purpose/Hypothesis: To assess the number and temporal utilization of PT visits after ACLR in a national cohort. We hypothesized that PT visits would be concentrated early in the postoperative period. Study Design: Descriptive epidemiological study. Methods: The Humana PearlDiver database was searched to identify patients who underwent ACLR between 2007 and 2017. Patients with additional structures treated were excluded. The mean ± SD, median and interquartile range (IQR), and range of number of PT visits for each patient were determined for the 52 weeks after ACLR. PT visits over time were also assessed in relation to patient age and sex. Results: In total, 11,518 patients who underwent ACLR met the inclusion criteria; the mean age was 32.62 ± 13.70 years, and 42.7% were female patients. Of this study cohort, 10,381 (90.4%) had documented PT postoperatively; the range of PT visits was 0 to 121. On average, patients had 16.90 ± 10.60 PT visits (median [IQR], 16 [9-22]) after ACLR. Patients completed a mean of 52% of their PT visits in the first 6 weeks, 75% in the first 10 weeks, and 90% in the first 16 weeks after surgery. Patients aged 10 to 19 years had the highest number of PT visits (mean ± SD, 19.67 ± 12.09; median [IQR], 18 [12-25]), significantly greater than other age groups ( P < .001). Conclusion: PT after ACLR is concentrated in the early postoperative period. Physicians, therapists, and patients may consider adjusting the limited access to PT to optimize patient recovery. Clinical Relevance: As supervised PT visits may be limited, the appropriate temporal utilization of supervised PT visits must be maximized. Strategies to ensure sessions for later neuromuscular and activity-specific rehabilitation are needed.
Arthroscopic Suture Fixation of Tibial Eminence Fracture
Authors: Treme Gehron P. , Richter Dustin L. 
Published: February 2021

Background: Tibial eminence fractures account for up to 5% of knee injuries with an effusion in the pediatric population. Displaced fractures require reduction and operative fixation via arthroscopic or open techniques. Indications: Arthroscopic suture fixation and screw fixation are 2 of the most commonly described techniques for tibial eminence fracture treatment. We describe our preferred technique of arthroscopic suture fixation given the versatility of this technique and decreased risks of hardware irritation or impingement, need for reoperation, and minimal risk of physeal damage. Technique Description: The arthroscopic suture fixation technique uses a standard anteromedial and anterolateral portal. After the fracture bed and hematoma are debrided and any interposing structures (ie, meniscus) are removed from the fracture site, 2 nonabsorbable sutures are passed through the substance of the anterior cruciate ligament (ACL). Using an ACL guide, 2 separate transtibial tunnels are drilled with a bone bridge in between—one at the anterolateral aspect of the fracture base and one at the anteromedial aspect. One limb from each suture is pulled out from each of the bone tunnels. The fragment is then reduced, and the sutures are tensioned and fixated using knotless suture anchors. Results: Overall prognosis following tibial eminence fracture fixation is favorable with more than 80% of patients returning to prior level of activity. Arthrofibrosis may occur in up to 25% of patients. Although some residual laxity may remain, there is a high return to sport and no difference in rate of subsequent ACL injury or surgery compared with a match cohort of pediatric ACL reconstructions. Discussion: Arthroscopic suture fixation of displaced tibial eminence fractures is a reliable technique with high return to sport and low risk of reoperation. Arthrofibrosis is common; thus, early, controlled knee range of motion following surgery is critical.
When the impossible becomes possible: COVID-19’s impact on work and travel patterns in Swedish public agencies
Authors: Hiselius Lena Winslott , Arnfalk Peter 
Published: February 2021

Abstract
Background
The COVID-19 pandemic has rapidly led to some of the most revolutionary changes in private and professional life around the world. While the extent and duration of these changes are not certain, they have already had a great impact on travel patterns. This is also the case in Sweden, despite its relatively liberal approach to restrictions, which relies on voluntary measures such as social distancing and self-monitoring for symptoms.

Methodology
Due to the pandemic, a shift to telework and virtual meetings is being tested in what can be seen as a large-scale experiment, and the knowledge and experience from that experiment may have lasting effects on everyday life. This study seeks to analyse the effects of government and public agencies’ recommendations on meeting and travel behaviour on employees at five public agencies in Sweden.

Results
The results indicate that the public authorities surveyed were well prepared and had a ‘backup collaboration solution’, at least technically, to make a rapid behavioural shift when travel was not an option. Though the Swedish government’s and Public Health Authority’s strong recommendations have led to the most dramatic reductions in work-related travel in modern times, the operations in Swedish agencies continue to function, along with the employees’ communications and collaborations. These results indicate that there is great potential for digital tools to influence if and how we commute and make business trips. The COVID-19 pandemic has shown that such tools can make the impossible possible.
Role of PGE2 in colonic motility: PGE2 attenuates spontaneous contractions of circular smooth muscle via EP4 receptors in the rat colon
Authors: Karaki Shin-Ichiro , Tanaka Ryo 
Published: February 2021

AbstractColonic motor activity is important for the formation and propulsion of feces. The production of prostaglandins (PGs) in colonic tissue is considered to play a critical role in the generation and regulation of colonic motility. In this study, we investigated the inhibitory effects of PGE2 and selective agonists of four EP receptors on the spontaneous phasic contractions, called ‘giant contractions’ (GCs), of mucosa-free circular smooth muscle strips from the rat middle colon. Neural blockade with tetrodotoxin (TTX) increased the frequency and amplitude of the GCs by about twofold. However, inhibiting PG production with piroxicam reduced the GC frequency in the presence of TTX, but did not affect the GC amplitude. In the presence of both TTX and piroxicam, exogenous PGE2 and each EP receptor agonist were cumulatively added to the tissue bath. In this setting, PGE2, the EP2 agonist ONO-AE1-259, and the EP4 agonist ONO-AE1-329, but not the EP1 agonist ONO-AE-DI-004 or the EP3 agonist ONO-AE-248, concentration-dependently reduced the GC frequency and amplitude. The PGE2-induced inhibition of GC frequency and amplitude was inhibited by the EP4 antagonist ONO-AE3-208, but not by the EP1/2 antagonist AH6809. Immunohistochemistry revealed the EP2 and EP4 receptors were localized in perinuclear sites in circular smooth muscle cells. EP2 immunoreactivity was also located in GFAP-immunoreactive enteroglia, whereas EP4 immunoreactivity was also located in HU (embryonic lethal, abnormal vision [ELAV] protein; a marker of all myenteric neurons)-immunoreactive myenteric nerve cell bodies. These results suggest that the PGs produced in the colonic tissue inhibit the GC frequency and amplitude of circular muscle in the rat middle colon, and is mediated by EP4 receptors expressed in the smooth muscle cells.
Analgesic efficacy and safety of erector spinae plane block in breast cancer surgery: a systematic review and meta-analysis
Authors: Zhang Ying , Liu Tieshuai , Zhou Youfa , Yu Yijin , Chen Gang 
Published: February 2021

Abstract
Background
Surgical resection is considered to be the primary and most effective therapy for breast cancer, postoperative pain is an issue gaining significant attention. In recent years, erector spinae plane block (ESPB) has attracted much attention in postoperative analgesia, but its effectiveness is still controversial. This meta-analysis was implemented to verify the clinical analgesic efficacy and safety of erector spinae plane block in patients undergoing breast cancer surgery.

Methods
We searched PubMed, EMBASE, Web of Science, the Cochrane Library and ClinicalTrials.gov for randomized controlled trials (RCTs) comparing ESPB with general anesthesia (GA) in breast cancer surgery that were published before December 25, 2020. The primary outcome was opioid consumption at the first 24 h after surgery, while secondary outcomes included pain scores at 1, 6,12 and 24 h after surgery, opioid consumption at 1, 6 and 12 h after surgery, intraoperative opioid consumption, number of patients who need for rescue analgesia, and the incidence of postoperative nausea and vomiting (PONV).

Results
Eleven randomized controlled trials involving 679 patients met the study inclusion criteria and were included in this study. In comparison to GA group, the ESPB group showed a significant reduction in morphine consumption at the first 24 h after surgery by a mean difference (MD) of − 7.67 mg [95% confidence interval (CI) − 10.35 to − 5.00] (P <  0.01). In addition, the ESPB group showed lower pain scores than the GA group in the four time periods (1, 6, 12 and 24 h after surgery). ESPB group significantly reduce the intraoperative consumption of fentanyl, the need for postoperative rescue analgesia, and the incidence of PONV.

Conclusions
Ultrasound-guided ESPB is an effective approach for reducing morphine consumption and pain intensity within the first 24 h after breast cancer surgery, compared with GA alone.
Spinal anaesthesia with Chloroprocaine HCl 1% for elective lower limb procedures of short duration: a prospective, randomised, observer-blind study in adult patients
Authors: Ghisi Daniela , Boschetto Giorgia , Spinelli Alessandra Maria , Giannone Sandra , Frugiuele Jacopo , Ciccarello Marcello , Bonarelli Stefano 
Published: February 2021

Abstract
Background
This prospective, randomised, observer-blinded study has been conducted in patients undergoing procedures of the lower extremities to evaluate the time to complete block resolution of 2-chloroprocaine 1% at three intrathecal doses (30, 40 and 50 mg).

Methods
After informed consent, we enrolled 45 male and female patients, aged 18–65 years, ASA score I-II, BMI 18–32 kg/m2, undergoing elective lower limb procedures lasting ≤40 min and with a requested dermatomeric level of sensory block ≥ T12.
The patients were randomised in a 1:1:1 ratio to receive Chloroprocaine HCl 1% at one of the three different intrathecal doses (Group 30 = 30 mg, Group 40 = 40 mg or Group 50 = 50 mg). The progression and regression of both sensory and motor blocks were evaluated blindly. Urine and venous blood samples were collected for pharmacokinetic analysis.

Results
Times to regression of spinal blocks were 1.76 ± 0.35 h, 2.13 ± 0.46 h and 2.23 ± 0.38 h, in Group 30, 40 and 50 respectively: the 30 mg dose showed a significantly faster resolution of spinal block than the 40 mg (p = 0.034) and the 50 mg (p = 0.006). Time to readiness for surgery was significantly reduced with the dose of 50 mg when compared to dose of 30 mg (p = 0.0259).

Conclusions
The doses of 50 mg and 40 mg yielded a longer resolution of spinal block than the dose of 30 mg. Nevertheless, the dose of 30 mg resulted in a higher secondary failure rate.

Trial registration
Registration of clinical trial: clinicaltrials.gov (NCT02481505).