bluuebunny/crossref_metadata_2025_split huggingface dataset:
Applying to Orthopaedic Residency and Matching Rates
Authors: Nasreddine Adam Y. , Gallo Robert 
Published: September 2019

Background:
The competitiveness of orthopaedics and recent changes in the residency application process have resulted in increased costs to both applicants and programs. Our purpose was to investigate changes in the orthopaedic residency application process between 1992 and 2017. Also, we aimed to determine an ideal number of applications that each student can submit without jeopardizing his or her probability of matching into an orthopaedic residency slot while concurrently reducing the excessive number of applications that are received by program selection committees.

Methods:
Retrospective data from both the Electronic Residency Application Service (ERAS) and the National Resident Matching Program (NRMP) were collected and analyzed for changes in the characteristics of applications, applicants, and programs over the study period. Using these data, the probability of matching into orthopaedics through the years was calculated and compared in order to propose an ideal number of applications for a medical student to submit to match into an orthopaedic residency.

Results:
Over the study period of 25 years, there has been an increase in the number of residency positions offered and a decrease in the number of applicants per offered position among U.S. senior medical students. Nonetheless, the average number of submitted applications per applicant significantly increased from 1992 to 2017, from 28 to 80 applications (p < 0.001). As a result, the overall costs to apply and review applications also have increased. There was no association between the increased number of submitted applications and the match rate. Our analysis showed that 50 applications per student offer is the most effective option without compromising the overall applicant match rate.

Conclusions:
Based on these data, we suggest encouraging students to limit the number of applications that they submit. This limit could reduce the cost for both applicants and programs while likely maintaining the current match rate and competitiveness of the specialty.
Guideline for Preclinical Studies of Bone Infections in Large Animals Based on a Systematic Review of 316 Non-Rodent Models
Authors: Jensen L.K. , Henriksen N.L. , Blirup S.A. , Jensen H.E. 
Published: September 2019

Background:
In recent years, animal models of bone infections have been used with increased frequency in order to evaluate novel diagnostic and anti-infective technologies, like antibacterial coating of bone implants or local antibiotic carrier products. Therefore, it is highly relevant to evaluate the scientific quality of existing bone infection models.

Methods:
We conducted a systematic review of 316 studies of large non-rodent animal models of bone infection (254 rabbit, 16 pig, 23 dog, 11 goat, and 12 sheep) and extracted data on study design, methodological quality, and postmortem evaluation of infection with respect to reporting and quantification of pathology and microbiology.

Results:
The review demonstrated a substantial lack of study-design information, which hampers reproducibility and continuation of the established work. Furthermore, the methodological study quality was found to be low, as the definition of infection, randomization, power analysis, and blinding were only seldomly reported. The use of histology increased in recent years, but a semi-quantitative scoring of the lesions was often missing, i.e. no objective quantification of outcome. Most of the studies focused on whether the inoculated bacteria were present within the bone tissue post mortem or not. However, very often the bacterial burden was not quantified. In many of the models, different antimicrobial interventions were examined and, although antimicrobial effects were commonly described, a lack of complete sterile outcome was observed in many models. On the basis of the systematic review, we established a study template providing a guideline for the standard reporting of animal models of bone infections, including details related to the animal, pathogen, infected animal, and postmortem analysis that are of crucial importance for validation of results and reproducibility.

Conclusions:
As the aim of many bone infection models is to examine the effect of an intervention, the guideline emphasizes the importance of objective quantification of outcome, e.g., blinded quantitative scoring of histological findings and quantification of bacterial burden within tissue and on inserted implants. Less than 5% of the analyzed studies adhered completely to the ideal form presented in the study template.

Clinical Relevance:
Anti-infective interventions must be tested in preclinical animal models before implementation in human patients, and optimal design and validation is essential for a high translational value.
“Doctor, What Happens After My Meniscectomy?”
Authors: Smith John-Rudolph H. , Houck Darby A. , Kraeutler Matthew J. , McCarty Eric C. , Frank Rachel M. , Vidal Armando F. 
Published: September 2019

➤ It is imperative that surgeons educate their patients on what to expect following a meniscectomy.➤ A high preinjury activity level, younger age, medial meniscectomy, and smaller meniscal resection play a role in reducing the time until patients are able to return to sport.➤ Improved clinical outcomes can be expected for male patients without obesity who are undergoing medial meniscectomy with minimal meniscal resection. Varus or valgus deformities, preexisting degenerative changes in the knee, and anterior cruciate ligament deficiency negatively impact outcomes following meniscectomy.➤ Failure rates following meniscectomy are relatively low compared with meniscal repair and discoid saucerizations, although revision rates are increased in patients undergoing lateral meniscectomy.➤ Meniscectomy increases the risk of developing knee osteoarthritis (OA), particularly in female patients with obesity who undergo large meniscal resection. Because of the risk of developing OA, there is a corresponding increase in the likelihood of total knee arthroplasty following meniscectomy.
Association Between Rotator Cuff Muscle Size and Glenoid Deformity in Primary Glenohumeral Osteoarthritis
Authors: Aleem Alexander W. , Chalmers Peter N. , Bechtold Daniel , Khan Adam Z. , Tashjian Robert Z. , Keener Jay D. 
Published: September 2019

Background:
Although glenoid morphology has been associated with fatty infiltration of the rotator cuff in arthritic shoulders, the association of rotator cuff muscle area with specific patterns of glenoid wear has not been studied. The purpose of our study was to assess the associations of glenoid deformity in primary glenohumeral osteoarthritis and rotator cuff muscle area.

Methods:
A retrospective study of 370 computed tomographic (CT) scans of osteoarthritic shoulders was performed. Glenoid deformity according to the modified Walch classification was determined, and retroversion, inclination, and humeral-head subluxation were calculated using automated 3-dimensional software. Rotator cuff muscle area was measured on sagittal CT scan reconstructions. A ratio of the area of the posterior rotator cuff muscles to the subscapularis was calculated to approximate axial plane potential force imbalance. Univariate and multivariate analyses to determine associations with glenoid bone deformity and rotator cuff measurements were performed.

Results:
Patient age and sex were significantly related to cuff muscle area across glenoid types. Multivariate analysis did not find significant differences in individual rotator cuff cross-sectional areas across glenoid types, with the exception of a larger supraspinatus area in Type-B2 glenoids compared with Type-A glenoids (odds ratio [OR], 1.5; p = 0.04). An increased ratio of the posterior cuff area to the subscapularis area was associated with increased odds of a Type-B2 deformity (OR, 1.3; p = 0.002). Similarly, an increase in this ratio was significantly associated with increased glenoid retroversion (beta = 0.92; p = 0.01) and humeral-head subluxation (beta = 1.48; p = 0.001). Within the Type-B glenoids, only posterior humeral subluxation was related to the ratio of the posterior cuff to the subscapularis (beta = 1.15; p = 0.001).

Conclusions:
Age and sex are significantly associated with cuff muscle area in arthritic shoulders. Asymmetric glenoid wear and humeral-head subluxation in osteoarthritis are associated with asymmetric atrophy within the rotator cuff transverse plane. Increased posterior rotator cuff muscle area compared with anterior rotator cuff muscle area is associated with greater posterior glenoid wear and subluxation. It is unclear if the results are causative or associative; further research is required to clarify the relationship.

Level of Evidence:
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Long-Term Outcomes of Pectoralis Major Transfer for the Treatment of Irreparable Subscapularis Tears
Authors: Ernstbrunner Lukas , Wieser Karl , Catanzaro Sabrina , Agten Christoph A. , Fornaciari Paolo , Bauer David E. , Gerber Christian 
Published: September 2019

Background:
One recognized salvage option in the treatment of an irreparable subscapularis tear is the pectoralis major tendon transfer (PMT). We aimed to analyze the long-term clinical and imaging outcome of PMT for irreparable subscapularis deficiency.

Methods:
Twenty-eight consecutive patients representing 30 shoulders underwent PMT at a mean age of 53.0 years (range, 35 to 67 years). At a mean of 19.7 years (range, 18 to 22 years) postoperatively, 24 shoulders (80%) were clinically examined and 21 were radiographically and sonographically assessed. The long-term results were compared with preoperative findings and previously published short-term results.

Results:
The mean relative Constant score (percentage of age and sex-matched normal scores; CS%) and the Subjective Shoulder Value (SSV) both improved significantly from preoperatively (CS%, 47%, and SSV, 22%) to postoperatively (CS%, 77%, and SSV, 71%; p < 0.001 for both). All patients rated their results as good or excellent. Active anterior elevation was improved from preoperatively (120°) to postoperatively (131°), but the difference was not significant. Active internal and external rotation decreased significantly from the short-term (32-month) follow-up to the time of the latest follow-up (p = 0.005 and p = 0.002, respectively); however, internal rotation remained at 6 points compared with the 8 points recorded at short-term follow-up and external rotation decreased only from a mean of 51° to 39°. Loss of active range of motion was not observed subjectively and was not subjectively limiting, represented by the high ultimate SSV and overall satisfaction. Four shoulders (19%) showed evidence of glenohumeral arthropathy (Samilson and Prieto grade 3), but clinically were mildly symptomatic to asymptomatic at the time of the latest follow-up (CS% range, 67% to 88%; SSV range, 70% to 80%). Rupture of the PMT was sonographically identified in 2 patients (10%) and was associated with radiographic evidence of advanced cuff tear arthropathy (Hamada stages ≥4). Six (20%) of the initial 30 shoulders were revised, and 1 (4%) of the 24 shoulders that were clinically examined underwent reverse total shoulder arthroplasty.

Conclusions:
At long-term follow-up, PMT for isolated and combined subscapularis tears is associated with good to excellent clinical results. Although one-third of the shoulders developed mildly symptomatic or asymptomatic osteoarthritis, the need for salvage with use of reverse total shoulder arthroplasty was rare.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Topical and Intravenous Tranexamic Acid for Total Knee Replacement
Authors: Jules-Elysee Kethy M. , Tseng Audrey , Sculco Thomas P. , Baaklini Lila R. , McLawhorn Alexander S. , Pickard Amanda J. , Qin WeiGe , Cross Justin R. , Su Edwin P. , Fields Kara G. , Mayman David J. 
Published: September 2019

Background:
Tranexamic acid (TXA) is an antifibrinolytic drug. Topical administration of TXA during total knee arthroplasty (TKA) is favored for certain patients because of concerns about thrombotic complications, despite a lack of supporting literature. We compared local and systemic levels of thrombogenic markers, interleukin (IL)-6, and TXA between patients who received intravenous (IV) TXA and those who received topical TXA.

Methods:
Seventy-six patients scheduled for TKA were enrolled in this randomized double-blinded study. The IV group received 1.0 g of IV TXA before tourniquet inflation and again 3 hours later; a topical placebo was administered 5 minutes before final tourniquet release. The topical group received an IV placebo before tourniquet inflation and again 3 hours later; 3.0 g of TXA was administered topically 5 minutes before final tourniquet release. Peripheral and wound blood samples were collected to measure levels of plasmin-anti-plasmin (PAP, a measure of fibrinolysis), prothrombin fragment 1.2 (PF1.2, a marker of thrombin generation), IL-6, and TXA.

Results:
At 1 hour after tourniquet release, systemic PAP levels were comparable between the IV group (after a single dose of IV TXA) and the topical group. At 4 hours after tourniquet release, the IV group had lower systemic PAP levels than the topical group (mean and standard deviation, 1,117.8 ± 478.9 µg/L versus 1,280.7 ± 646.5 µg/L; p = 0.049), indicative of higher antifibrinolytic activity after the second dose. There was no difference in PF1.2 levels between groups, indicating that there was no increase in thrombin generation. The IV group had higher TXA levels at all time points (p < 0.001). Four hours after tourniquet release, wound blood IL-6 and TXA levels were higher than systemic levels in both groups (p < 0.001). Therapeutic systemic TXA levels (mean, 7.2 ± 7.4 mg/L) were noted in the topical group. Calculated blood loss and the length of the hospital stay were lower in the IV group (p = 0.026 and p = 0.025).

Conclusions:
Given that therapeutic levels were reached with topical TXA and the lack of a major difference in the mechanism of action, coagulation, and fibrinolytic profile between topical TXA and a single dose of IV TXA, it may be a simpler protocol for institutions to adopt the use of a single dose of IV TXA when safety is a concern.

Level of Evidence:
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Confronting the Opioid Crisis: Practical Pain Management and Strategies
Authors: Mir Hassan R. , Miller Anna N. , Obremskey William T. , Jahangir A. Alex , Hsu Joseph R. 
Published: September 2019

Abstract:
The United States is in the midst of an opioid crisis. Clinicians have been part of the problem because of overprescribing of narcotics for perioperative pain management. Clinicians need to understand the pathophysiology and science of addiction to improve perioperative management of pain for their patients. Multiple modalities for pain management exist that decrease the use of narcotics. Physical strategies, cognitive strategies, and multimodal medication can all provide improved pain relief and decrease the use of narcotics. National medical societies are developing clinical practice guidelines for pain management that incorporate multimodal strategies and multimodal medication. Changes to policy that improve provider education, access to naloxone, and treatment for addiction can decrease narcotic misuse and the risk of addiction.
Hip Joint Capsular Anatomy, Mechanics, and Surgical Management
Authors: Ng K.C. Geoffrey , Jeffers Jonathan R.T. , Beaulé Paul E. 
Published: September 2019

➤ Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability.➤ The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension).➤ To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions.➤ It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic.➤ During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
TCIRG1 Transgenic Rescue of Osteoclast Function Using Induced Pluripotent Stem Cells Derived from Patients with Infantile Malignant Autosomal Recessive Osteopetrosis
Authors: Chen Weili , Twaroski Kirk , Eide Cindy , Riddle Megan J. , Orchard Paul J. , Tolar Jakub 
Published: September 2019

Background:
Osteoclasts are hematopoietic stem cell-derived multinucleated cells necessary for bone remodeling and resorption. TCIRG1 encodes a protein that is an adenosine triphosphate (ATP)-dependent vacuolar proton pump required for this process. Recessive loss-of-function mutations in both copies of this gene lead to impairment of osteoclast function, with increased bone density, increased skeletal mass, and early mortality.

Methods:
We isolated fibroblasts from a patient with the compound heterozygous TCIRG1 mutations c.1549G>A (p.517D>N) and c.2236C>T (p.746Q>X), and reprogrammed them into iPS (induced pluripotent stem) cells. The function of osteoclasts derived from these cells was then rescued by transgenic expression of TCIRG1 cDNA.

Results:
In addition to the known effects of TCIRG1 loss of function, iPS cell-derived osteoclasts from this patient had reduced expression of the bone remodeling enzymes cathepsin K (CTSK) and tartrate-resistant acid phosphatase (TRAP), leading to reduced in vitro bone remodeling. Expression of both genes and pit formation were restored in iPS cell-derived osteoclasts following transgenic restoration of TCIRG1 expression.

Conclusions:
Transgenic overexpression of TCIRG1 was sufficient to restore osteoclast function in iPS cell-derived osteoclasts from a patient with infantile malignant autosomal-recessive osteopetrosis.

Clinical Relevance:
This work provides a proof of concept for an autologous approach to treating osteopetrosis, potentially avoiding the risks associated with hematopoietic stem cell transplantation in a young patient population.
Superior Mesenteric Artery Syndrome Complicated by Gastric Mucosal Necrosis Following Congenital Scoliosis Surgery
Authors: Moyer Kathleen , Thompson George H. , Poe-Kochert Constance , Splawski Judy 
Published: September 2019

Case:
This is a report of severe superior mesenteric artery (SMA) syndrome in an 11-year-old girl with congenital scoliosis following posterior spinal fusion and segmental spinal instrumentation. This was complicated by gastric mucosal necrosis but resolved satisfactory with prolonged nasogastric suction, intravenous fluids, and total parental nutrition.

Conclusions:
All pediatric spine surgeons should be aware of SMA syndrome following spine surgery. This case demonstrates that although rare, significant complications such as gastric mucosal necrosis can occur. When present, it can be treated successfully with prolonged conservative management. Comanagement with pediatric gastroenterology and pediatric general surgery is recommended.
Produced-Water Reinjection in Deep Offshore Miocene Reservoirs, Block 17, Angola
Authors: Mainguy Marc , Perrier Sebastien , Buré Erwan 
Published: September 2019

SummaryIn this paper we examine the changes in the injectivity of wells reinjecting produced water in two fields from Block 17, offshore Angola. This analysis suggests that the water quality has a direct impact on well injectivity during matrix injection. Well impairment caused by desulfated seawater treated with membrane technology appears immaterial in comparison with the injectivity declines observed during produced-water reinjection (PWRI). The decline rate is much quicker for the field with the worst quality of treated produced water. Injectivity enhancements observed during seawater-injection tests demonstrate that the matrix decline is partially reversible. However, permanent damage also develops with time; it is not possible to recover the initial injectivity after a long period of injection with produced water.The analysis also shows that fracture injection can effectively mitigate the strong injectivity declines experienced in the field with the worst quality of treated produced water. Fracture injection comes with higher injection pressures, even when operating the wells at low flow rates. As a result, the injectivity index (II), as conventionally defined, displays a strong flow-rate dependency, making it inappropriate for measuring the well performance in fracture condition. Besides the limitations of the high injection pressures, fracture injection was found detrimental to injection conformance in wells with commingled water injection in several reservoir layers. In this situation, most of the injection is thought to take place in the shallowest layer where the fracture is likely to grow, leaving little injection for deeper reservoir layers.
Adaptation and Validation of a Spanish version of the Treatment Burden Questionnaire in Patients with Multiple Sclerosis
Authors: Ysrraelit Maria Celica , Fiol Marcela Paula , Peña Fernando Vazquez , Vanotti Sandra , Terrasa Sergio Adrián , Tran Viet Thi , Montori Victor M , Correale Jorge 
Published: September 2019

Abstract
Background: The Treatment Burden Questionnaire (TBQ) is a self-reported measure of the effect of treatment workload on patient wellbeing. We sought to validate the TBQ in Spanish and use it to estimate the burden of treatment in Argentinian patients with multiple sclerosis (MS). Methods: The TBQ was forward-backward translated into Spanish. Two focus groups and 25 semi-structured interviews focused on wording and possible item exclusion. Validation was performed in 2 steps. First, 162 patients across a range of MS severity completed the questionnaire. Confirmatory factor analysis assessed the dimensional structure of the TBQ. Construct validity was assessed by studying correlations with fatigue and quality of life (QoL). Then, in a second cohort of 171 patients, we evaluated the association between TBQ scores and patients’ sex, age, education level, employment status, type of MS, disease duration, comorbidities, EDSS, pharmacological treatment and medication adherence. Results: The questionnaire presented a 3-factor structure in which burden was related to pharmacological treatment; comprehensive health assistance; and psycho-social-economic context. Composite reliability was > 0.8 for all factors. TBQ showed positive correlation with fatigue (rs= 0.467, p=0.006), negative correlation with QoL (rs -0.446, p=0.009). For the second cohort, total TBQ score was 43 (SD 29). Lowest scores were observed on self-monitoring (0.53, SD 1.3) and highest for administrative load (4.2, SD 3.4). Inverse association was found between the TBQ score and medication adherence (r 0.243 p=0.001). TBQ scores also correlated with daily patient pill/injection requirements (r 0.175 p=0.020). Individuals receiving injectable treatment scored higher than patients on oral drugs (total TBQ 51 (SD 32) vs 39 (SD 27) p=0.002). Conclusions: The TBQ in Spanish is a reliable instrument and showed adequate correlation with QoL and adherence scales in MS patients. TBQ may benefit health resources allocation and provide tailor therapeutic interventions to construct a minimally disruptive care.