bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of mechanical thresholds in a model of feline clinical acute pain and their correlation with the Glasgow Feline Composite Measure Pain Scale scores
Authors: Nicholls Daniel , Merchant-Walsh Molly , Dunne Jerry , Cortellini Natalia Parrilla , Adami Chiara 
Published: July 2021

Objectives The aim of this study was to evaluate the use of mechanical thresholds (MT), measured with the SMALGO (Small Animal ALGOmeter), and to determine whether there was a correlation between MT and Glasgow Feline Composite Measure Pain Scale (CMPS–Feline) scores in cats undergoing ovariohysterectomy. Methods Client-owned cats undergoing flank ovariohysterectomy were recruited. Pain scores for the pre- and postoperative periods were obtained using the CMPS-Feline in each cat by two independent investigators (A and B). Following CMPS–Feline scoring, MT were measured with the SMALGO, in the surgical area, pre- and postoperatively, only by investigator A. Each cat served as its own control for the comparison of pre- and postoperative variables. Reliability statistics were used to assess the level of inter-observer agreement (A vs B) with respect to pre- and postoperative CMPS–Feline scores, while Spearman’s correlation statistics were used to analyse the relationship between MT and CMPS–Feline scores. Results Twenty-nine cats completed the study. Preoperative MT (340 g [range 108–691]) were significantly higher than postoperatively (233 g [range 19–549]; P = 0.001). CMPS–Feline scores were not found to differ significantly between the preoperative period (2 [range 0–7] for investigator A and 3.2 ± 2.3 for investigator B) and postoperative period (2 [range 0–10] for investigator A and 3 [range 0–8] for investigator B) for either investigator. Reliability statistics revealed that the level of inter-observer agreement with respect to CMPS–Feline was fair for the preoperative assessments but poor for the postoperative evaluations. There was no correlation between MT and CMPS-Feline scores. Conclusions and relevance Although there was no correlation with CMPS–Feline scores performed at the same timepoint, MT increased postoperatively vs baseline. Assuming that, despite analgesia, susceptibility of the surgical area to mechanical stimulation would increase after surgery, this finding suggests that MT might be useful to assess feline surgical pain. The poor level of inter-observer agreement with respect to postoperative CMPS–Feline scores highlights the potential limitations of this scale.
High prevalence of comorbidities at diagnosis in immigrants with multiple sclerosis
Authors: Rotstein Dalia , Maxwell Colleen , Tu Karen , Gatley Jodi , Pequeno Priscila , Kopp Alexander , Marrie Ruth Ann 
Published: July 2021

Background: Multiple sclerosis (MS) has been associated with certain comorbidities in general population studies, but it is unknown how comorbidity may affect immigrants with MS. Objective: To compare prevalence of comorbidities in immigrants and long-term residents at MS diagnosis, and in matched control populations without MS. Methods: We identified incident MS cases using a validated definition applied to health administrative data in Ontario, Canada, from 1994 to 2017, and categorized them as immigrants or long-term residents. Immigrants and long-term residents without MS (controls) were matched to MS cases 3:1 on sex, age, and geography. Results: There were 1534 immigrants and 23,731 long-term residents with MS matched with 4585 and 71,193 controls, respectively. Chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease, migraine, epilepsy, mood/anxiety disorders, schizophrenia, inflammatory bowel disease (IBD), and rheumatoid arthritis were significantly more prevalent among immigrants with MS compared to their controls. Prevalence of these conditions was generally similar comparing immigrants to long-term residents with MS, although COPD, epilepsy, IBD, and mood/anxiety disorders were less prevalent in immigrants. Conclusion: Immigrants have a high prevalence of multiple comorbidities at MS diagnosis despite the “healthy immigrant effect.” Clinicians should pay close attention to identification and management of comorbidity in immigrants with MS.
A “Talent Agency” refers children for research: A case study
Authors: Schwebel David C , Johnston Anna , McClure Leslie A 
Published: July 2021

Objective Ethical standards state research participation must be voluntary and free of coercion and undue influence, but what if a third party appears to engage in research-relevant coercion, without the researchers’ knowledge? This case study describes this type of situation and its resolution. Methods We are engaged in a randomized clinical trial evaluating pedestrian safety with 7- and 8- years old. Depending on children's rate of learning, families receive up to $1275 for their time. We recently learned a third-party “talent agency,” a firm placing children in modeling and acting jobs, was referring families to our research with the expectation that families would share 20% of study reimbursements. Results We sensed clear impropriety, but identified no ethical violations on our part as researchers. Once paid a study reimbursement, participants can spend funds how they wish. We were concerned, however, that the third-party was exploitatively coercing families to participate. Conclusions We pursued four avenues to resolve the issue. First, we documented the situation to our university Institutional Review Board. Second, we contacted the talent agency and requested they stop referring families to our research. They agreed. Third, we retained children engaged in our study who were referred from the talent agency; removing them partway through the clinical trial could impact study results. In doing so, we explained that we were unaware of the talent agency referral and that they were not obligated by us to offer a portion of the study reimbursement to the talent agency. Last, we asked newly enrolled families about their referral source.
Quality Assurance for Small-Field VMAT SRS and Conventional-Field IMRT Using the Exradin W1 Scintillator
Authors: Huang Zike , Qiao Jian , Yang Cui , Liu Ming , Wang Jiazhou , Han Xu , Hu Weigang 
Published: July 2021

Background: Plastic scintillator detector (PSD) Exradin W1 has shown promising performance in small field dosimetry due to its water equivalence and small sensitive volume. However, few studies reported its capability in measuring fields of conventional sizes. Therefore, the purpose of this study is to assess the performance of W1 in measuring point dose of both conventional IMRT plans and VMAT SRS plans. Methods: Forty-seven clinical plans (including 29 IMRT plans and 18 VMAT SRS plans with PTV volume less than 8 cm3) from our hospital were included in this study. W1 and Farmer-Type ionization chamber Exradin A19 were used in measuring IMRT plans, and W1 and microchamber Exradin A16 were used in measuring SRS plans. The agreement between the results of different types of detectors and TPS was evaluated. Results: For IMRT plans, the average differences between measurements and TPS in high-dose regions were 0.27% ± 1.66% and 0.90% ± 1.78% ( P = 0.056), and were −0.76% ± 1.47% and 0.37% ± 1.34% in low-dose regions ( P = 0.000), for W1 and A19, respectively. For VMAT SRS plans, the average differences between measurements and TPS were −0.19% ± 0.96% and −0.59% ± 1.49% for W1 and A16 with no statistical difference ( P = 0.231). Conclusion: W1 showed comparable performance with application-dedicated detectors in point dose measurements for both conventional IMRT and VMAT SRS techniques. It is a potential one-stop solution for general radiotherapy platforms that deliver both IMRT and SRS plans.
Home-Based Electrical Stimulation to Accelerate Wound Healing—A Double-Blinded Randomized Control Trial
Authors: Zulbaran-Rojas Alejandro , Park Catherine , El-Refaei Nesreen , Lepow Brian , Najafi Bijan 
Published: July 2021

Background: Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing. Methods: Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL). Results: Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm2 vs 4W: 5.8 ± 8.0 cm2, P = 0.002). Average of wound area was unchanged in the CG ( P = 0.982). The self-report adherence to daily home-therapy was 93.9%. Conclusions: Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.
Somnolence and Dizziness During Mirogabalin Treatment in Patients With Neuropathic Pain Related to Lumbar Disease Who Switched From Pregabalin: A Retrospective Study
Authors: Akazawa Tsutomu , Inoue Gen , Tanaka Masahiro , Umehara Tasuku , Nagai Toshihiro , Oshita Yusuke , Imura Takayuki , Miyagi Masayuki , Saito Wataru , Sako Kosuke , Nomura Satoshi , Hiyama Akihiko , Katoh Hiroyuki , Sakai Daisuke , Sato Masato , Yoshida Atsuhiro , Iinuma Masahiro , Niki Hisateru , Takaso Masashi , Watanabe Masahiko 
Published: July 2021

Study Design: Multicenter retrospective study. Objectives: To investigate adverse events (AEs) in patients with neuropathic pain related to lumbar disease who switched to mirogabalin from pregabalin. Methods: This study surveyed the records of 82 patients with peripheral neuropathic leg pain related to lumbar disease who switched to mirogabalin from pregabalin. We evaluated AEs associated with pregabalin and mirogabalin, the continuation rate of mirogabalin, and the pain-relieving effect at 4 weeks after switching from pregabalin to mirogabalin. We compared patients who switched due to lack of efficacy (LoE group) and patients who switched due to AEs (AE group). Results: The incidence rates of somnolence and dizziness with pregabalin were 12.2% and 14.6%, respectively, while the incidence rates with mirogabalin were reduced to 7.3% for somnolence and 4.9% for dizziness. The incidence of AEs with pregabalin was significantly higher in the AE group (LoE group: 11.1%, AE group 100%), especially for somnolence (LoE group: 3.2%, AE group: 47.1%) and dizziness (LoE group: 4.8%, AE: 52.9%). After switching, the incidences of AEs with mirogabalin were not significantly different between the 2 groups (LoE group: 15.9%, AE group: 23.5%), including for somnolence (LoE group: 7.9%, AE group: 5.9%) and dizziness (LoE group: 4.8%, AE group: 5.9%). There were no significant differences in continuation rate of mirogabalin or the pain-relieving effect between groups. Conclusions: The patients who experience somnolence and dizziness with pregabalin might be able to continue safely receiving treatment for their pain by switching to mirogabalin.
Etoricoxib Can Reduce Post-Operative Morphine Consumption and Pain Score in Patients Undergoing Lumbar Laminectomy Compare to Acetaminophen: A Randomized Trial
Authors: Weraarchakul Supanut , Sae-Jung Surachai 
Published: July 2021

Study Design: Randomized controlled trial. Objectives: This prospective trial aimed to compare the effectiveness of etoricoxib and acetaminophen in terms of post-operative morphine consumption and pain score in patients undergoing lumbar laminectomy. Methods: Forty lumbar-laminectomy patients aged between 18 and 50 years were enrolled, randomized, and allocated into either the etoricoxib group or the acetaminophen group. The measures assessed were the amount of morphine consumed and pain visual analog score (VAS) at 12, 24, and 48 hours after surgery. Adverse events were recorded. Results: Patients in the etoricoxib group had statistically significantly lower morphine consumption than those in the acetaminophen group at 12 hours ( P-value = .006), 24 hours ( P-value = .006) and 48 hours ( P-value = .011). Patients in the etoricoxib group had lower VAS scores than those in the acetaminophen group at 0, 12, 24, 48 hours, the difference being statistically significant at 48 hours ( P < .001). Conclusions: Compared to acetaminophen, etoricoxib can significantly reduce post-operative morphine consumption and improve the pain score at 12, 24, and 48 hours.
Surgical Outcomes after Bucket Handle Meniscus Repairs: analysis of a large contained cohort study
Authors: Tucker Lue-Yen , Vieira Amy , Ding David 
Published: July 2021

Objectives: Comprising approximately 10% of all mensiscus tears, bucket-handle meniscus tears are large longitudinal vertical meniscus tears that have an attached fragment flipped into the intercondylar notch. Meniscectomy would often result in significant meniscal loss and increased joint loading. Alternatively, meniscus repair attempts to restore the function of the meniscus and aims to preserve joint mechanics. The objective of this observational data-only study is to evaluate the long-term risk of subsequent ipsilateral knee surgery in patients who underwent a bucket handle meniscus repair and assess risk factors associated with subsequent knee surgical intervention. Methods: We performed an electronic health records search for all patients who underwent arthroscopic knee meniscal repairs from 2011 to 2018. Natural language processing was used to search for terms of interest in the long operative notes to determine if these surgeries were performed for bucket handle meniscus tears. These patients comprised our initial cohort. Study subjects were followed for at least one year and up to five years with censoring at death, membership disenrollment, or 12/31/2019. Baseline patient characteristics and outcomes (i.e., subsequent operative procedures, deep surgical site infections, and deep venous thrombosis) were evaluated via a database review. Descriptive statistics were employed. Results: The median follow-up time was 4.2 years (interquartile range [IQR] 2.7-5.0 years). A total of 1353 patients underwent meniscus repair surgery for a bucket-handle meniscus tear. The median age was 24 years (IQR 17-34). During the follow-up period, 492 subsequent ipsilateral procedures were performed in 272 (20.1%) patients. 59 (4.3%) patients underwent a subsequent repeat meniscus repair and 164 (12.1%) patients underwent a subsequent meniscectomy. The median time to first procedure was 41.1 months (IQR 23.3-60 months). Younger age and lower BMI were significant risk factors for having subsequent surgery (adjusted odds ratio [aOR] 1.04, 95% Confidence Interval [95%CI] 1.02-1.05, and aOR 1.60, 95%CI 1.09-2.35, respectively). Patients undergoing concomitant ACL reconstruction had a lower risk of undergoing subsequent surgery (aOR 0.66, 95%CI 0.50-0.88). Conclusions: This is the largest reported contained patient cohort study on outcomes after bucket-handle meniscus repair. 20% of patients underwent repeat surgery during the follow-up time period with 4.3% experiencing a subsequent repeat meniscus repair and 12% experiencing a subsequent meniscectomy. Risk factors for subsequent surgery include younger age and lower BMI. Concomitant ACL reconstruction at time of bucket-handle meniscus repair reduced the risk of subsequent reoperation.
QUADRICEPS TENDON AUTOGRAFT HAS LOWER MRI SIGNAL THAN HAMSTRING TENDON AUTOGRAFT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTIONS IN ADOLESCENT ATHLETES
Authors: Alcoloumbre David , Aitchison Alexandra , Mintz Douglas , Green Daniel , Cordasco Frank 
Published: July 2021

Objectives: Hamstring tendon autograft (HTA) is a common graft choice for anterior cruciate ligament (ACL) reconstructions in skeletally immature patients. However, quadriceps tendon autografts (QTA) have recently shown superior preliminary outcomes in this population. The objective of this study was to evaluate graft maturity by comparing MRI signal intensity of HTA and QTA used in primary ACL reconstruction. Given the promising preliminary results of QTA reconstructions in our center, we hypothesized that QTA would have lower signal than HTA at both 6 and 12 months. Methods: Patients under the age of 18 who underwent a primary ACL reconstruction between 2011 and 2018 by the senior authors using either a HTA or QTA with available MRIs at 6 and 12 months post-operatively were included. Signal intensity ratio (SIR) was measured on sagittal MRI by averaging the signal at three regions of interest (ROIs) along the ACL graft (Figure 1) and dividing each by the signal of the tibial footprint of the PCL. Statistical analysis was performed to determine interrater reliability and differences between time points and groups. Results: 71 patients (38 in the HTA group and 33 in the QTA group) were reviewed retrospectively. Age, sex, and type of surgery were not different between groups (Table 1). There was no significant difference in SIR between groups on the 6-month MRI. At 12 months, SIR of the QTA group was significantly less that in the HTA group ( p=.029). Within the HTA group, there was no significant difference in SIR between time points. In the QTA group, there was a significant decrease in SIR between the 6 month and 12-month post-operative MRI ( p=.045) (Figure 2). Conclusions: The decrease in signal between 6 and 12 months post-operatively suggests quicker graft maturation and improved structural integrity of QTA as compared to HTA (Figure 3). This provides evidence that one year postoperatively, QTA may have a superior rate of incorporation and synovialization as compared to the HTA. [Table: see text]
Biomechanical analysis of ideal knee flexion angle for ACL graft tensioning utilizing multiple femoral and tibial tunnel locations
Authors: Guth Jared , Akhavan Sam , Schimoler Patrick , Miller Mark , Hammarstedt Jon 
Published: July 2021

Objectives: Despite more anatomic reconstruction of the ACL, graft failure rate has been reported to be greater than 5% at 5 years. There is concern that anatomic reconstructions may not result in an isometric graft and may predispose the graft to stretching. The current biomechanical study evaluated excursion of the ACL with different drill points for both femoral and tibial tunnels. The purpose was to evaluate the excursion of the ACL with both anatomic and non-anatomic tunnel combinations and determine the optimal flexion angle to tension the ACL to minimize stretching of the graft during motion. Methods: Ten cadaveric knee specimens, mid-femur to mid-tibia, were dissected of skin and subcutaneous tissue. The ACL was sectioned and the femoral and tibial attachments were marked prior to excision. A 1/16 inch drill was used to create a tunnel in the center of the ACL footprint on the tibia and femur and additional tunnels were made 5mm from the original tunnel (Figure 1). A suture was passed through each tunnel combination (Femur A-F; Tibia A-E) and was attached to a string potentiometer. The knee was ranged from full extension to 120 degrees of flexion for 10 cycles while mounted in a custom fixture that measured angle of flexion in the sagittal plane. The change in length (excursion) of the suture during movement was recorded for each combination of femoral and tibial tunnels. Results: Anatomic reconstruction of the ACL with tunnel placement in the center of the femoral (femoral tunnel A) and tibial (tibial tunnel A) footprint did not result in an isometric graft, with excursion of the ACL during knee motion of 7.46mm (SD 2.7mm). The tunnel combination that resulted in the least amount of excursion during knee motion was a reconstruction with a femoral footprint 5mm anterior to the femoral (femoral tunnel D) and 5mm posterior to the tibial footprint (tibial tunnel D) (4.2mm, SD 1.37mm). The tunnel combination that resulted in the most amount of excursion during knee motion was utilized femoral footprint 5mm proximal to the femoral (femoral tunnel F) and 5mm posterior to the tibial footprint (tibial tunnel D) (9.81mm, SD 2.68mm). In an anatomic tunnel placement, we found the angle with the most excursion of the ACL to occur at 2.84 degrees of flexion (SD 4.22). Conclusions: Anatomic ACL reconstruction results in significant excursion of the ACL during range of motion. If not tensioned properly, the ACL can stretch during range of motion, potentially leading to re-rupture. In order to prevent stretching of the graft, the current biomechanical study recommends tensioning an anatomic ACL reconstruction at its point of maximal exertion, or about 10 degrees of flexion. We also determined optimal flexion angles for tensioning the ACL for tunnel combinations that may be non-anatomic. [Table: see text][Table: see text][Table: see text]
The Severity of Acetabular Retroversion Does Not Influence Outcomes of Arthroscopic Management of FAI
Authors: Day Molly , Seiffert Kayla , An Qiang , Larson Christopher , Westermann Robert 
Published: July 2021

Objectives: Controversy exists regarding optimal treatment of FAI in the setting of acetabular retroversion. The purpose of this study was to investigate changes in pain and function among patients with acetabular retroversion treated with hip arthroscopy. Secondarily, to assess if the severity of posterior wall deficiency influences post-operative outcomes following hip arthroscopy. Methods: A retrospective review of patients with acetabular retroversion with hip arthroscopic surgery at a single institution was performed. Acetabular retroversion was defined by three radiographic criteria: the presence of crossover sign, ischial spine sign, and posterior wall sign. Anteroposterior radiographs were used to measure lateral center edge angle (LCEA), Tonnis grade, anterior wall index (AWI) and posterior wall index (PWI), and alpha angle. Patient-reported outcome (PROs) included modified Harris Hip Score (MHHS), visual analog scale (VAS) and quality of life with Veterans RAND-12 (VR-12). Spearman correlation coefficients were used to determine correlation of PWI with pre- and post-PROs. Multivariate analysis was performed and generalized estimating equation was used to determine independent predictors for outcome scores. Significance was set at p<0.05. Results: Between 2013 and 2019, 138 patients with FAI and acetabular retroversion underwent hip arthroscopy, 67% were female. The average follow-up was 29 months, with minimum of 6 months. Average preoperative LCEA 28, alpha angle 70.1, postoperative alpha angle 44.6 (p<0.05). All PROs demonstrated significant improvement from preoperative baseline to follow-up scores (MHHS (59.5 +/- 14.7 vs 80.8 +/- 18.8), VAS (6.3 +/- 1.7 vs 3.0 +/- 2.7), p<0.0001). Four patients (3%) underwent revision procedures. Upon multivariate analysis, no association between PWI and PROs was not found. Preoperative mHHS was the strongest predictor of clinical outcome. Conclusions: This is the largest study of patients with acetabular retroversion assessing for a correlation between PWI on patient-reported outcomes following arthroscopic management of FAI. In patients with acetabular retroversion, outcomes are good following arthroscopic management with low complication and revision rate following hip arthroscopy. Posterior wall deficiency was not a predictor of poor outcome in patients with acetabular retroversion. In this single surgeon selected series, the severity of retroversion (measured by PWI) does not appear to have a threshold or any correlation with postoperative outcomes in following FAI treatment.