bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tibial Slope and Its Effect on Force in Anterior Cruciate Ligament Grafts: Anterior Cruciate Ligament Force Increases Linearly as Posterior Tibial Slope Increases
Authors: Bernhardson Andrew S. , Aman Zachary S. , Dornan Grant J. , Kemler Bryson R. , Storaci Hunter W. , Brady Alex W. , Nakama Gilberto Y. , LaPrade Robert F. 
Published: January 2019

Background: Previous work has reported that increased tibial slope is directly correlated with increased anterior tibial translation, possibly predisposing patients to higher rates of anterior cruciate ligament (ACL) tears and causing higher rates of ACL graft failures over the long term. However, the effect of changes in sagittal plane tibial slope on ACL reconstruction (ACLR) graft force has not been well defined. Purpose/Hypothesis: The purpose of this study was to quantify the effect of changes in sagittal plane tibial slope on ACLR graft force at varying knee flexion angles. Our null hypothesis was that changing the sagittal plane tibial slope would not affect force on the ACL graft. Study Design: Controlled laboratory study. Methods: Ten male fresh-frozen cadaveric knees had a posterior tibial osteotomy performed and an external fixator placed for testing and accurate slope adjustment. Following ACLR, specimens were compressed with a 200-N axial load at flexion angles of 0°, 15°, 30°, 45°, and 60°, and the graft loads were recorded through a force transducer clamped to the graft. Tibial slope was varied between −2° and 20° of posterior slope at 2° increments under these test conditions. Results: ACL graft force in the loaded testing state increased linearly as slope increased. This effect was independent of flexion angle. The final model utilized a 2-factor linear mixed-effects regression model and noted a significant, highly positive, and linear relationship between tibial slope and ACL graft force in axially loaded knees at all flexion angles tested (slope coefficient = 0.92, SE = 0.08, P < .001). Significantly higher graft force was also observed at 0° of flexion as compared with all other flexion angles for the loaded condition (all P < .001). Conclusion: The authors found that tibial slope had a strong linear relationship to the amount of graft force experienced by an ACL graft in axially loaded knees. Thus, a flatter tibial slope had significantly less loading of ACL grafts, while steeper slopes increased ACL graft loading. Our biomechanical findings support recent clinical evidence of increased ACL graft failure with steeper tibial slope secondary to increased graft loading. Clinical Relevance: Evaluation of the effect of increasing tibial slope on ACL graft force can guide surgeons when deciding if a slope-decreasing proximal tibial osteotomy should be performed before a revision ACLR. Overall, as slope increases, ACL graft force increases, and in our study, flatter slopes had lower ACL graft forces and were protective of the ACLR graft.
Anatomic Features of the Tibial Plateau Predict Outcomes of ACL Reconstruction Within 7 Years After Surgery
Authors: Kiapour Ata M. , Yang Daniel S. , Badger Gary J. , Karamchedu Naga Padmini , Murray Martha M. , Fadale Paul D. , Hulstyn Michael J. , Shalvoy Robert M. , Fleming Braden C. 
Published: January 2019

Background: Multiple anatomic features of the femoral condyles and tibial plateau have been shown to influence knee biomechanics and risk of anterior cruciate ligament (ACL) injury. However, it remains unclear how these anatomic factors affect the midterm outcomes of ACL reconstruction. Hypothesis: Decreased femoral notch width, increased posterior and coronal slopes, and decreased concavity of the tibial plateau are associated with inferior clinical, patient-reported, and osteoarthritis-related outcomes 7 years after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Prospectively collected data from 44 patients who did not have a subsequent graft or contralateral ACL failure within 7 years after unilateral ACL reconstruction were reviewed (mean ± SD age, 23.7 ± 9.2 years; 64% women). Notch width (after notchplasty), posterior slopes of the medial and lateral tibial plateau, maximum depth of the medial tibial plateau, and coronal tibial slope were measured from magnetic resonance images. Anatomic predictors of side-to-side differences in anterior-posterior knee laxity, Knee injury and Osteoarthritis Outcome Score (KOOS), medial joint space width, and side-to-side differences in Osteoarthritis Research Society International (OARSI) x-ray score, measured at 7 years, were identified with linear regression (bivariate) and stepwise regression (multivariate). Results: Increased posterior slope of the lateral tibial plateau was associated with increased side-to-side difference in knee laxity (bivariate model only), increased side-to-side difference in the OARSI score, and decreased KOOS subscores ( R2 > .10, P < .05). Increased posterior slope of the medial tibial plateau was associated with a higher side-to-side difference in the OARSI x-ray score (bivariate model only) and lower KOOS subscores ( R2 > .11, P < .03). Increased coronal tibial slope was associated with lower KOOS subscores ( R2 > .11, P < .03). Decreased medial tibial depth was associated with increased knee laxity as well as decreased KOOS subscores (ie, quality of life and symptoms; R2 > .12, P < .03). Postoperative notch width was not a significant predictor for any surgical outcome. None of the anatomic features were predictive of medial joint space width narrowing. Conclusion: Results partially support the hypothesis and highlight the importance of knee anatomy on several outcomes of ACL reconstruction among patients without subsequent graft or contralateral ACL injures. Increasing slopes in the coronal and sagittal planes with decreasing concavity of the medial tibial plateau lead to less favorable outcomes 7 years after surgery.
Observational Pain Assessment Instruments for Use With Nonverbal Patients at the End-of-life: A Systematic Review
Authors: Tapp Diane , Chenacher Sara , Gérard Ngangue Patrice Alain , Bérubé-Mercier Philippe , Gelinas Celine , Douville Frédéric , Desbiens Jean-François 
Published: January 2019

Purpose: To review studies pertaining to the reliability and validity of observational pain assessment tools for use with nonverbal patients at the end-of-life, a field of research not documented by previous systematic reviews. Methods: Databases (PubMed, Embase, Epistemonikos, the Cochrane Library, and CINAHL) were systematically searched for studies from study inception to February 21, 2016 (update in May 9, 2018). Two independent reviewers screened study titles, abstracts, and full texts according to inclusion and exclusion criteria. Disagreements were resolved through consensus. Reviewers also extracted the psychometrics properties of studies of observational pain assessment instruments dedicated to a noncommunicative population in palliative care or at the end-of-life. A comprehensive quality assessment was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) to derive poor, fair, good or excellent ratings for the psychometric tests reported in each study. Results: Four studies linked to 4 different tools met the inclusion criteria. Study populations included dementia, palliative care and severe illness in the context of intensive care. All the studies included in this review obtained poor COSMIN ratings overall. Conclusions: At this point, it is impossible to recommend any of the tools evaluated given the low number and quality of the studies. Other analyses and studies need to be conducted to develop, adapt, or further validate observational pain instruments for the end-of-life population, regardless of the disease.
Creating “Memorable Moments” to Excite the Intramural Sports Experience
Authors: Gaskins David A. , King Todd W. 
Published: January 2019

While intramural sports contests do not enjoy the same widespread media exposure and attention as collegiate and professional athletics, they still produce special memories for the participants. It is the fun, stress release, joy of teamwork, thrill of competition, opportunity to escape the monotony of everyday life, and the emotional arousal which are generated by recreational sports programs that are the reasons why people participate. The “memorable moments” concept examines strategies on marketing implication and maintaining programmatic quality. The basic components of a “memorable moment” are intangible elements and include enjoyment or exhilaration, personal value, and something that is atypical. While intangibles result from the competition itself a variety of specific tangible techniques such as a public address announcer, spectator seating, campus media coverage, special promotions and activities, a national anthem, game programs, commercial sponsorship, and videotaping, can be employed to further emphasize and complement these aspects. The implementation of these tangibles and increasing the attractiveness of the participatory experience has tremendous positive marketing implications. The foremost advantage is the excitement and heightened awareness of programs that is engendered through expanded word-of-mouth. Tangibles also assist in improving visibility of programs and facilitates elevated recognition and exposure throughout the institution. The benefits of these effects often translated into more participants, greater receptiveness toward budget requests, improved networking opportunities both within and outside the institution, and enhanced respect from upper-level administrators. Although the “memorable moments: concept offers numerous exceptional strengths, its implementation also requires certain important commitments and programming adjustments. Timelines and advance planning are even more crucial when programs include additional enhancements. Furthermore, financial and personnel requirements are increased as well as the time and coordination necessary for special game logistical arrangements. Potential problems and issues must also be addressed. Rescheduling requests, inclement weather, spectator control for large crowds, and decisions related to determining which activities or games will receive special attention, what degree of auxiliary features will be utilized, and how to ensure the “memorable moments” remain something special are the most prominent topics to be considered. The reasons for participating in intramural sports are many and varied. However, fun, enjoyment, and the thrill of competition are usually at the heart of the decision to become involved in these activities. “Memorable moments” represents an excellent strategy to inspire and magnify thee feelings among participants while also displaying the program on center stage in an extraordinary marketing medium.
Efficacy and safety of endovascular treatment in acute ischemic stroke due to cervical artery dissection: A 15-year consecutive case series
Authors: Bernardo Francisco , Nannoni Stefania , Strambo Davide , Puccinelli Francesco , Saliou Guillaume , Michel Patrik , Sirimarco Gaia 
Published: January 2019

Background Limited observational data are available on endovascular treatment in acute ischemic stroke due to cervical artery dissection. Three studies comparing endovascular treatment with standard medical therapy or intravenous thrombolysis in cervical artery dissection-related acute ischemic stroke did not demonstrate superiority of endovascular treatment. Efficacy and the choice of endovascular treatment technique in this setting remain to be established. Aims To assess the potential efficacy and safety of endovascular treatment compared to intravenous thrombolysis alone or to no revascularization treatment in our center. Methods We selected all consecutive patients with cervical artery dissection-related acute ischemic stroke and intracranial occlusion from the Acute STroke Registry and Analysis of Lausanne between 2003 and 2017. We compared clinical and neuroimaging data of patients treated by endovascular treatment versus patients receiving intravenous thrombolysis or patients without revascularization treatment. Safety analysis included symptomatic intracranial hemorrhage, major radiological hemorrhages (parenchymal hematoma 1, parenchymal hematoma 2, and subarachnoid hemorrhage) and mortality within seven days. We assessed favorable clinical outcome (modified Rankin Scale 0-2) at three months using a binary logistic regression model. Results Of the 109 patients included, 24 had endovascular treatment, 38 received intravenous thrombolysis alone, and 47 had no revascularization treatment. Endovascular treatment patients had a higher rate of recanalization at 24 h. Major radiological hemorrhages occurred more often in endovascular treatment patients (all with bridging therapy) than in patients without revascularization treatment (p = 0.026), with no differences in symptomatic intracranial hemorrhage or mortality within seven days. Favorable clinical outcome at three months did not differ between groups (endovascular treatment versus intravenous thrombolysis p = 0.407; endovascular treatment versus no revascularization treatment p = 0.580). Conclusions In this single-center cohort of cervical artery dissection-related acute ischemic stroke with intracranial occlusion, endovascular treatment with prior intravenous thrombolysis may increase the risk of major radiological but not symptomatic intracranial hemorrhage. Despite the lack of clear superiority in our cohort, endovascular treatment should currently not be withheld in these patients.
Out-of-office blood pressure measurement for the diagnosis of hypertension in pregnancy: Survey of Canadian Obstetric Medicine and Maternal Fetal Medicine specialists
Authors: Tran KC , Potts J , Robertson J , Ly K , Dayan N , Khan NA , Chan W 
Published: January 2019

Background Multiple hypertension guidelines recommend out-of-office measurements for the diagnosis of hypertension in non-pregnant adults, whereas pregnancy guidelines recommend in-office blood pressure measurements. The objective of our study was to determine how Canadian Obstetric Medicine and Maternal Fetal Medicine specialists measure blood pressure in pregnancy. Methods An email survey was sent to 69 Canadian Obstetric Medicine and Maternal Fetal Medicine specialists in academic centers across Canada to explore the practice patterns of blood pressure measurement in pregnant women. Results The response rate was 48%. The majority of respondents (63.6%) preferred office blood pressure measurement for diagnosing hypertension, but relied on home blood pressure readings for ongoing monitoring and management of hypertension during pregnancy (59.4%). The preferred method of out-of-office blood pressure measurement was home monitoring; 24-hour ambulatory blood pressure monitoring was not used due to limited availability and cost. Conclusions There is wide practice variation in methods of measuring blood pressure among Canadian specialists managing hypertension in pregnancy.
The Relationships Between Time in Range, Hyperglycemia Metrics, and HbA1c
Authors: Beck Roy W. , Bergenstal Richard M. , Cheng Peiyao , Kollman Craig , Carlson Anders L. , Johnson Mary L. , Rodbard David 
Published: January 2019

Background: As the use of continuous glucose monitoring (CGM) increases, there is a need to better understand key metrics of time in range 70-180 mg/dL (TIR70-180) and hyperglycemia and how they relate to hemoglobin A1c (A1C). Methods: Analyses were conducted utilizing datasets from four randomized trials encompassing 545 adults with type 1 diabetes (T1D) who had central-laboratory measurements of A1C. CGM metrics were calculated and compared with each other and A1C cross-sectionally and longitudinally. Results: Correlations among CGM metrics (TIR70-180, time >180 mg/dL, time >250 mg/dL, mean glucose, area under the curve above 180 mg/dL, high blood glucose index, and time in range 70-140 mg/dL) were typically 0.90 or greater. Correlations of each metric with A1C were lower (absolute values 0.66-0.71 at baseline and 0.73-0.78 at month 6). For a given TIR70-180 percentage, there was a wide range of possible A1C levels that could be associated with that TIR70-180 level. On average, a TIR70-180 of 70% and 50% corresponded with an A1C of approximately 7% and 8%, respectively. There also was considerable spread of change in A1C for a given change in TIR70-180, and vice versa. An increase in TIR70-180 of 10% (2.4 hours per day) corresponded to a decrease in A1C of 0.6%, on average. Conclusions: In T1D, CGM measures reflecting hyperglycemia (including TIR and mean glucose) are highly correlated with each other but only moderately correlated with A1C. For a given TIR or change in TIR there is a wide range of possible corresponding A1C values.
Topical Corticosteroid Pretreatment Mitigates Cellular Damage After Caustic Injury to the Nasal Upper Airway Epithelium
Authors: Huang Zhenxiao , Velasquez Nathalia , Nguyen Alan , Ye Ting , Le Wei , Bravo Dawn T. , Hwang Peter H. , Zhou Bing , Nayak Jayakar V. 
Published: January 2019

Background Topical corticosteroids are currently employed to reduce established airway inflammation; their prophylactic use might help limit cellular damage against harmful stimuli. Objectives To determine the effects of a prophylactic topical application of budesonide (BD) on an in vivo nasal epithelium injury model induced by trichloroacetic acid (TCA). Methods C57Bl/6 mice were exposed to intranasal TCA topical application. Three groups received topical intranasal BD, saline solution, or no intervention prior to a single topical exposure to TCA. Controls were not exposed to TCA. Whole nasal cavity coronal sections were analyzed at 1, 3, and 6 days postinjury at tissue and cellular levels using histopathological analysis, immunofluorescent staining, and fresh tissue RNA microarray analysis. Results Prophylactic topical corticosteroid exposure protected the nasal epithelium from acute damage, maintaining epithelial thickness and cell survival. Six days following TCA exposure, epithelial and cellular changes were less pronounced on the BD-treated group compared to all exposure groups. The microarray analysis was used to evaluate the gene transcripts in all treatment groups. Ciliary tip protein, Sentan, and submucosal protein S100b were identified as potential factors in epithelial airway protection; immunofluorescent staining corroborated their presence and location within the respiratory epithelium. Conclusion Topical corticosteroid treatment to the nasal epithelium can mitigate several of the early deleterious effects of acute epithelial damage in experimental airway injuries caused by TCA. These findings suggest a novel, direct cytoprotective effect of corticosteroids on the nasal epithelium, and the potential of expanding the use of prophylactic periprocedural topical corticosteroids for respiratory epithelial tissues.
Mortality in US veterans with pulmonary hypertension: a retrospective analysis of survival by subtype and baseline factors
Authors: Trammell Aaron W. , Shah Amit J. , Phillips Lawrence S. , Michael Hart C. 
Published: January 2019

Pulmonary hypertension (PH) occurs when the pulmonary vasculature is itself diseased or becomes affected secondarily by comorbid conditions, commonly left heart or lung disease. The high prevalence of chronic cardiopulmonary conditions among patients served by Veterans Health Administration (VHA) suggests this population may be particularly susceptible to PH. We sought to identify clinical features and outcomes in veterans diagnosed with PH. We utilized the VHA Corporate Data Warehouse to identify veterans diagnosed between January 1, 2003 and September 30, 2015, assess relevant patient characteristics and their survival time. The effects of PH subtype and baseline factors on outcome were estimated by Cox modeling. There were 110,564 veterans diagnosed with PH during the study period. These veterans were predominantly male, had median age 70.2, and had a high burden of comorbid conditions. PH was frequently due to left heart and/or lung disease. Average survival after PH diagnosis was 3.88 years. Compared with other types, PH due to left heart disease, lung disease or both had shorter survival. This large retrospective study of veterans demonstrates the significance of PH due to left heart and/or lung disease which was common and had high risk of death. Multi‐comorbidity was common and added to risk. These findings underscore the need for risk assessment tools for subjects with non‐Group 1 PH and novel management strategies to improve their outcome. This study details the largest retrospective cohort assembled for evaluation of secondary PH and allows hypothesis‐generating inquiries into these common conditions that are rarely prospectively studied.
Oesophageal obstruction due to trichobezoars in two cats
Authors: Woerde Dennis J , Hoffmann Karon L , Kicinski Anne , Brown Narelle L 
Published: January 2019

Case series summary This case series describes two cats diagnosed with oesophageal obstruction due to trichobezoars. Both cases presented for acute dyspnoea, with thoracic radiographs revealing changes consistent with oesophageal foreign material causing ventral displacement of the trachea. Endoscopic removal was unsuccessful and both cases required surgical intervention. Case 1 died within 24 h of trichobezoar removal, likely from aspiration pneumonia. Case 2 developed laryngeal collapse 10 days after trichobezoar removal and required a permanent tracheostomy. Case 2 has been followed up for >1 year without any further complications. Relevance and novel information There is minimal published information on oesophageal trichobezoars in cats. These cases provide information on presentation, radiographic findings and complications associated with oesophageal trichobezoars. The intention of this case series is to increase the index of suspicion for this syndrome among clinicians treating feline patients.
Cognitive function predicts work disability among multiple sclerosis patients
Authors: Kavaliunas Andrius , Tinghög Petter , Friberg Emilie , Olsson Tomas , Alexanderson Kristina , Hillert Jan , Karrenbauer Virginija Danylaite 
Published: January 2019

Background In multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted. Objective To determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test. Methods A register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability. Results After one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02). Conclusion Cognitive function is to a high extent associated with multiple sclerosis patients’ future work disability, even after adjusting for other factors.