bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pain Deterioration Within 1 Year Predicts Future Decline of Walking Ability: A 7-Year Prospective Observational Study of Elderly Female Patients With Knee Osteoarthritis Living in a Rural District
Authors: Yamaguchi Naoki , Takahashi Tsuneari , Ueno Takashi , Hiyama Shuhei , Ogawa Masaya , Matsumura Tomohiro , Sasanuma Hideyuki , Takeshita Katsushi 
Published: September 2018

Introduction: Knee osteoarthritis (KOA) is commonly a main cause of locomotive syndrome. Consequently, appropriate timing of intervention is clinically important. Materials and Method: Fifty female patients of a primary care clinic in a rural district fulfilled the criteria for KOA and were recruited and underwent knee medical checkups. They initially underwent physical examination bilaterally of knees by an orthopedic surgeon, radiological evaluation, and they answered the outcome of Japanese Knee Osteoarthritis Measurement (JKOM). They were asked to answer JKOM 1 and 7 years after the initial checkup. Fourteen patients were lost to follow-up due to death or moving to a nursing home. Thirty-six patients were finally included and divided into 2 age-matched groups according to walking ability at the 7-year follow-up: group A, walking ability did not decline (n = 24), and group B, walking ability did decline (n = 12). The walking ability was measured as per ordinal classification as: 5 (walking without any aid), 4 (walking with a crutch), 3 (walking using walker), 2 (walking only possible in parallel bars), and 1 (wheelchair). We completed between-group comparisons of each of the 3 subsections of the JKOM (pain, limitation in mobility related to daily activity, and restriction of participation in social life and health perception), during each period. Results: There were significant differences in JKOM pain score (12.9 vs 18.3, P = .0058) and total score (41.3 vs 55.8, P = .0093) between the groups at 1-year follow-up, even though base scores did not differ. Discussion: Clinicians should pay attention to changes in perceived knee pain and should not continue prolonged conservative therapy in patients exhibiting rapid deterioration. Conclusion: Female patients with KOA whose pain deteriorated within 1 year may require early intervention to prevent future decline in walking ability.
Butterfly Vertebrae: A Systematic Review of the Literature and Analysis
Authors: Katsuura Yoshihiro , Kim Han Jo 
Published: September 2018

Study Design: Systematic review (Level 4) Objective: To summarize the demographics, clinical presentations, and conditions associated with butterfly vertebrae. Methods: A systematic search was performed of multiple databases. A total of 279 articles were identified for screening. Case series or case reports of butterfly vertebrae with adequate clinical detail were complied. Results: Eighty-two total articles (109 patients) were selected for final inclusion. Sixty-one percent of patients presented with a single butterfly vertebra, while 39% were multiple. The most common location for butterfly vertebrae was T1. Fifty-six percent of cases were associated with a syndrome, the most common being spondylocostal dysostosis. The presence of multiple butterfly vertebra was strongly associated with a syndrome or additional anomalies ( P < .001). Overall, the most common presenting complaint was low back pain. Seventy percent of patients had associated spinal disease. Other organ systems affected included musculoskeletal (43%), craniofacial (30%), neurologic (27%), cardiovascular (24%), genitourinary (23%), gastrointestinal (22%), laboratory abnormality (16%), and endocrine (9%). Conclusions: This study is the largest collection of butterfly vertebrae cases to date. Butterfly vertebrae are associated with spinal deformity and multiple butterfly vertebrae may indicate a syndromic illness. Low back pain or disc herniation may occur with lumbar butterfly vertebrae however the etiology of this phenomena has not been rigorously explained. Many diseases and syndromes are associated with butterfly vertebrae.
Multi-Center Studies of the Global Impact of Endometriosis and the Predictive Value of Associated Symptoms
Authors: Nnoaham Kelechi E. , Sivananthan Sivahami , Hummelshoj Lone , Jenkinson Crispin , Webster Premila , Kennedy Stephen H. , Zondervan Krina T. 
Published: September 2018

Introduction Endometriosis can be difficult to diagnose clinically and models that use symptoms to predict whether the disease is present or not are based on limited patient populations. Endometriosis also influences health-related quality of life, but little is known about its impact across the world. We therefore initiated two integrated multi-center studies to collect prospective, standardized, epidemiological data, to 1) examine the global impact of endometriosis and relative effect of risk-factors, and 2) develop a symptom-based diagnostic tool. Methods The Global Study of Women's Health (GSWH) and the Women's Health Symptom Survey (WHSS) prospectively recruit 18–45 year old women having a laparoscopy across 23 and 19 centers, respectively, worldwide. Women with a previous surgical diagnosis of endometriosis are excluded. Multi-lingual patient questionnaires and a surgical questionnaire, incorporating validated instruments, are used to collect the data. The GSWH aims to recruit >2,000 women by December 2009; the WHSS to recruit 1,000 women in each of the two model-generating and validation stages. Results A six-week pilot study in Oxford, UK, established the feasibility of the study protocols. Of 32 eligible women, 27 participated (response rate - 84.4%); 26% completed the questionnaire online. Endometriosis was found in 47.4%. Extrapolating the recruitment rates from the pilot study, the target sample sizes for the GWSH and WHSS were deemed feasible. Conclusions Using standardized data collection, the GSWH and WHSS will provide insight into the global impact of endometriosis and develop a validated, symptom-based, diagnostic tool. They have the potential to provide the basis for future, longitudinal, follow-up studies and a collaborative Endometriosis Biobank implementing standardized collection of DNA and tissue samples
Deep Pelvic Endometriosis: From Diagnosis to Wellness
Authors: Saccardi Carlo , Cocco Andrea , Tregnaghi Alberto , Cosmi Erich , Baldan Nicola , Ancona Ermanno , Litta Pietro S. 
Published: September 2018

Purpose to determine the efficacy of laparoscopic excision of deep pelvic endometriosis (DPE). Methods One hundred and two highly symptomatic women with DPE underwent clinical examination, transvaginal ultrasound, nuclear magnetic resonance (NMR) and sonovaginography. Among the 102 women, 50 patients, with severe symptoms, underwent laparoscopic excision of DPE. Endoscopic surgery was performed with complete separation of the rectovaginal space and resection of the node. In the case of vaginal involvement vaginal exeresis was performed, in the case of rectal wall involvement of more than 50%, segmental bowel resection was performed. Operative data as well as dysmenorrhea, dyspareunia, chronic pelvic pain and dyschezia before and 6 and 12 months after surgical treatment were recorded. Results Mean operative time was 126.4 ± 34.7 min, mean blood loss was 76.2 ± 22 ml. In 17 (34%) cases we performed excision of the posterior vaginal fornix due to vaginal wall involvement. In six (12%) cases we performed excision of the rectal wall. At 12-month follow-up 39 (78%) women revealed absent or mild dysmenorrhea, 45 (90%) women revealed absent or mild dyspareunia, 46 (92%) women revealed absent or mild chronic pelvic pain, 48 (96%) women revealed absent or mild dyschezia. Conclusions Surgical management of DPE could be a radical approach for this disease but conservative for the patients, ensuring good improvement in symptoms and good patient satisfaction, and only performing vaginal or rectal exeresis when strictly necessary.
Single Port Access Laparoscopy (SPAL) for Endometrioma Excision
Authors: Angioni Stefano , Mereu Liliana , Maricosu Giovanni , Mencaglia Luca , Melis Gian Benedetto 
Published: September 2018

Puropose To evaluate the feasibility of single port access laparoscopy (SPAL) for the treatment of ovarian endometrioma. Case Report Three patients affected by single ovarian endometrioma underwent cyst excision using a laparoendoscopic single port approach with a new multiport, reusable trocar, and flexible, curved and standard laparoscopic instruments. Results No conversion to multi-access standard laparoscopic technique was required and no intraoperative or postoperative complications were observed. The mean operative time was 40 minutes. Conclusions We conclude that single portal access laparoscopy is feasible, safe and effective for the excision of ovarian endometrioma, with good results in terms of cosmesis, postoperative pain and patient satisfaction. This approach may be indicated in patients with single cysts without dense adherences in the bowel and/or deep infiltrating endometriosis.
Leptin and Antioxidant Profile in Infertile Women with Endometriosis
Authors: Osman Hussein G. , El-Refaey Abdel Aziz A. , Aziz Abdel Aziz F. Abdel , El-Sokkary Ahmed M.A. , El-Saeed Rasha A. 
Published: September 2018

Objective To investigate the role of leptin hormone and oxidative stress in the pathogenesis of endometriosis among infertile women. Methods Blood samples and peritoneal fluid were collected from women undergoing laparoscopy. The study group included 24 infertile women with endometriosis, while 14 women with unexplained infertility represented the control group. Leptin hormone levels and three markers of antioxidants, including total antioxidant capacity (TAC), catalase (CAT) enzyme and superoxide dismutase (SOD) enzyme were estimated. Results Peritoneal fluid leptin concentrations were significantly higher in infertile endometriotic women compared with the control group. The levels of TAC, CAT and SOD were significantly lower in both serum and peritoneal fluid of infertile endometriotic women compared with controls. There was no significant difference in serum leptin concentrations between the studied groups. Conclusions Peritoneal leptin and oxidative stress may be an active factor in the pathogenesis and/or progression of endometriosis.
Evaluation of the Impact of Endometriotic Lesions on Patient'S Pelvic Pain Symptoms
Authors: Saccardi Carlo , Borghero Angela , Cosmi Erich , Conte Lorena , Caserta Donatella , Litta Pietro 
Published: September 2018

Purpose To verify if different endometrial lesions determine the diagnostic symptom panel for a specific symptom. Methods We recruited 537 women with endometriosis who underwent laparoscopic surgery. Data on patient characteristics, severity of pelvic pain symptoms, disease stage and anatomical characteristics of endometriotic lesions were collected and analyzed by univariate analysis, followed by multiple logistic regression. Results We observed a strong inverse relationship between pain symptoms and, respectively, the age of women at surgery (OR 0.885; p<0.05) and nulliparity (OR 5.6; p<0.05). A significant association between dysmenorrhea and nulliparity (OR 10.1; p< 0.01) and dysmenorrhea and rAFS stage (OR 4.7; p<0.05) was also confirmed. Finally a strong relationship was found between the presence of a rectovaginal endometriotic nodule and pain symptoms: dyspareunia (OR 13.8, p<0.001) and dysmenorrhea (OR 2.3, p<0.05). Significant relationships were found between the presence of peri-annexial adherences and, respectively, bilateral endometrioma (p<0.01) and size of endometrioma (p<0.05); between the presence of pelvic adherential syndrome and, respectively, bilateral ovarian cyst (p<0.01), size of ovarian cyst (p<0.01) and rectovaginal nodule (p<0.01). A strong relationship was found also between a rectovaginal nodule and the presence of entero-uterine adherences (p<0.01) and Douglas obliteration (p<0.01). Conclusions: It was not possible determine a precise relationship between a specific pain symptom and the anatomic-surgical characteristics of endometriotic lesions, even though a strong association was seen between a rectovaginal endometriotic nodule and deep dyspareunia. Typical clinical features of endometriosis are probably determined by the association of different characteristics of lesions and different pathogenic mechanisms.
Uterine Lymphatic and Blood Micro-Vessels in Women with Endometriosis through the Menstrual Cycle
Authors: Hey-Cunningham Alison J. , Ng Foong Wei , Busard Milou P.H. , Berbic Marina , Manconi Frank , Young Lawrence , Zevallos Hector Barrera-Villa , Russell Peter , Markham Robert , Fraser Ian S. 
Published: September 2018

Purpose Endometriosis is a common disease, associated with persistent and severe symptoms including infertility and pain, however, pathogenesis remains poorly understood. It has been hypothesized that fragments of viable endometrial tissue shed at menstruation reach the peritoneal cavity and other distant sites by retrograde menstruation and dissemination into the lymphatic system. In this study, uterine lymphatic and blood micro-vessel populations were compared in women with and without endometriosis during the menstrual cycle. Methods Paraffin-embedded hysterectomy specimens from premenopausal women with histologically normal endometrium (37 control and 42 endometriosis) were obtained. Immunohistochemical staining was performed with antibodies for D2–40 (lymphatic endothelium), CD31 (pan-endothelial marker), and endoglin (activated endothelial cells in angiogenesis). Lymphatic (LVD) and blood (BVD) micro-vessel density were quantified with an automated cellular imaging system using color and morphometric properties to identify micro-vessels. Results Subtle but significant differences in uterine BVD and LVD were detected in endometriosis. LVD was significantly increased in basal layer endometrium of endometriosis patients during the proliferative phase (mean ± SD = 54.3 ± 20.1 vs. 41.4 ± 9.9, p = 0.025). Endoglin-positive BVD was increased in the subepithelial region of endometrium in endometriosis during the secretory phase (19.3 ± 16.6 vs. 6.4 ± 8.2, p = 0.038). Conclusions This report for the first time demonstrates that endometrial LVD is altered in women with endometriosis and supports changes in BVD in these women. These alterations are likely to contribute to pathogenesis of endometriosis, through lymphatic spread and increased angiogenic potential of shed endometrial fragments.
Factors Affecting the Preferred Surgical Technique in Pediatric Anterior Cruciate Ligament Reconstruction
Authors: Patel Neeraj M. , Talathi Nakul S. , Talwar Divya , Fabricant Peter D. , Kocher Mininder S. , Ganley Theodore J. , Lawrence J. Todd R. 
Published: September 2018

Background: Despite several well-described operative techniques, the optimal management of anterior cruciate ligament (ACL) injuries in pediatric patients remains unclear. Purpose: To identify surgeons’ preferred ACL reconstruction techniques and postoperative protocols for pediatric patients of various ages. Study Design: Cross-sectional study. Methods: An electronic survey was administered to surgeons in the Pediatric Research in Sports Medicine (PRiSM) society, resulting in a cohort of experienced respondents who performed a relatively high volume of ACL reconstructions in skeletally immature patients. Surgeon and practice demographic information was recorded. The survey presented the scenario of a patient who had a physical examination and imaging consistent with an acute, isolated ACL tear. The respondents were asked to select their preferred reconstruction technique for female and male patients at consecutive skeletal ages from 8 to 15 years. Surgeons were also asked about postoperative protocol. Results: Of 103 surgeons, 88 (85%) responded to the survey, the majority of whom (68%) performed more than 25 pediatric ACL reconstructions annually. The greatest variation in technique was from ages 11 to 13 years in female patients and from 11 to 14 years in male patients. The modified MacIntosh was the most frequently used technique for patients aged 8 to 10 years. An all-epiphyseal technique was preferred over a broader age range in male patients than female patients, with peak use at age 11 in both. A partial transphyseal (hybrid) technique was preferred in slightly older patients, with peak use at age 12 in female patients and 13 in male patients. The transphyseal technique was most widely used at age 13 and older in female patients and 14 and older in male patients. The impact of fellowship training (pediatrics, sports, or both) on technique preference was statistically significant for male patients aged 11 to 13 and female patients 11 and 12 (all P < .05). Surgeons with pediatric orthopaedic training tended to prefer an all-epiphyseal reconstruction, while those with both pediatric and sports medicine training preferred the modified MacIntosh. Conclusion: The preferred ACL reconstruction technique varied considerably, especially for patients aged 11 to 13 years. The modified MacIntosh reconstruction was favored in patients aged 10 years or younger, while the transphyseal technique was preferred in female patients aged 13 years and older and in male patients 14 years and older. The surgeon’s fellowship training was significantly associated with his or her preferred surgical technique.
Impact of Vancomycin Treatment on Human Mesenchymal Stromal Cells During Osteogenic Differentiation
Authors: Bariteau Jason , Kadakia Rishin , Traub Brian , Willett Nick 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Vancomycin is often delivered locally for surgical site infection prophylaxis. Recent reports of possible osteotoxicity have led to uncertainty concerning vancomycin’s safety in the setting of arthrodesis and bone healing. Bone formation during arthrodesis takes place as recruited human mesenchymal stromal cells (hMSCs) proliferate and differentiate into mature osteoblasts. The purpose of this research was to determine the impact of vancomycin treatment on hMSCs during osteogenic differentiation. Methods: Human MSCs were cultured in MSC growth media to an appropriate confluence. Cells were cultured for 24 hours to facilitate adherence, after which the media was aspirated and replaced with osteogenic differentiation media (Lonza, Switzerland). Osteogenic differentiation media was supplemented with vancomycin powder to yield solutions with concentrations of 0, 50, 500 & 5000 µg/mL. Fresh vancomycin powder was added with every media change. MSCs viability and proliferation were assessed via live/dead staining with 1 µM calcein-AM and 0.5 µM ethidium homodimer-1 (EthD-1) after 1, 3, and 7 days of differentiation and vancomycin treatment. Mineralization of differentiated cells was assessed via staining with 40 mM alizarin red (ARS; pH 4.1) after 21 days. Semi-quantification of the degree of mineralization was performed by measuring absorbance values at 405 nm using a microplate reader. Microscopy was used for qualitative evaluation. Results: Cell viability decreased with increasing vancomycin concentrations. Impairment of hMSC proliferation was also observed with increasing concentrations of vancomycin. MSCs treated with 5000 µg/mL vancomycin demonstrated significantly less cell growth compared to all other treatment groups (P=0.0001). Absorbance measurements from each well stained with alizarin red was used for semi-quantification of the degree of mineralization. As vancomycin concentrations were increased, absorbance levels decreased (Figure). This reduction in mineralization was also demonstrated qualitatively; with alizarin red less apparent in the wells with increasing vancomycin concentrations (Figure). Conclusion: Local vancomycin is utilized for prevention of infection, often in procedures that necessitate the formation of new bone. Bone healing requires migration, proliferation and differentiation of hMSCs. This work demonstrates impaired viability and function of hMSCs following vancomycin as well as decreased osteoblastic mineralization. Future work will require in vivo studies aimed at determining relative nonunion rates in the setting of vancomycin prophylaxis. Still, the results of this study suggest that vancomycin may be toxic to hMSCs and caution should be exercised by providers when considering vancomycin in foot and ankle patients requiring bony healing following fracture or arthrodesis.
Effect of Bone Morphogenetic Protein-2/Hydroxyapatite on Ankle Fusion with Bone Defect in an Rabbit Animal Model
Authors: Lee Kwang-Bok , Dang Le Hoang Nam 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Revision arthrodesis surgery after total ankle arthroplasty failure has a problem related with large bone defect management after implant removal. Although autogenous bone is a standard method for the reconstruction of bone defects, it often causes complications such as wound problem, infection, fracture, hematoma, persistent pain and a limited amount of bone.Recombinant human bone morphogenetic protein-2 (rhBMP-2) has a powerful osteoinductive ability, it plays essential roles in bone regeneration strategies. The purpose of this study is to evaluate the substitute ability of rhBMP-2 for autologous bone in rabbit ankle fusion model with distal tibia bone defect. Methods: Bone defect (5 X 5 X 8 mm) was created in the distal tibia between media and lateral malleolus include cartilage. Ankle fusion was performed by 1 cannulated screw from lateral malleolus and various treatments on bone defect. Fifteen male white New Zealand rabbits were divided into three groups of 5 animals on each groups dependent on treatment method; Group I (control, no treatment into defect), II (autogenous bone treatment), III (rhBMP-2/ hydroxyapatite treatment). Bone formation on defect and the union of the ankle joint was evaluated by X-ray, micro-CT scan and histological at 8 weeks and 12 weeks postoperatively. Results: X-ray and micro-CT shows higher bone formation on defect in group II and III than group I at 8 weeks and 12 weeks. According to histological results, completely union between distal tibia and talus in group III, partially union in group II and nonunion in group I. Conclusion: These findings indicate the BMP-2/Hydroxyapatite has a bone fusion effect comparable to autogenous bone, and suggest that rhBMP-2/Hydroxyapatite can be used to substitute for autogenous bone in ankle fusion with a bone defect, thereby overcome the limitations of autogenous bone.