bluuebunny/crossref_metadata_2025_split huggingface dataset:
“Meniscal extrusion in ultrasound as a new diagnostic tool for evaluation of medial meniscus function”
Authors: Diermeier Theresa , Achtnich Andrea , Imhoff Andreas B , Wörtler Klaus , Petersen Wolf 
Published: April 2018

In MRI meniscal extrusion is normally described as pathologic finding and associated with a loss of function of the affected meniscus. We hypothesize that in healthy knees there is also physiological meniscal extrusion as a functional adjustment on various load bearing conditions. Therefore meniscal extrusion is described as the difference in extrusion between standing and lying position in ultrasound as a new diagnostic tool to evaluate the function of a meniscus. We analysed voluntary test persons with non-symptomatic knee, no further malalignment and without any operation to the knee in the past. At the beginning each patient was clinical examined to exclude ligament instability and afterwards the extrusion of the medial meniscus was measured in ultrasound in standing, with 20° of flexion, and lying position. To compare these measurments with the current gold standard every patient also got an MRI examination from the knee. Medial meniscus extrusion was defined as the distance between external boundry of medial tibial plate and the external base of the pars intermedia of medial meniscus At this time, 62 patients meet the inclusion criteria. In group I (25 persons, age 18-30 years) the average extrusion in lying position was 0,5 mm and 1,1 mm with full weight bearing. In group II (25 persons, age 31-50 years) the median extrusion in lying position was 1,1 mm and 1,8 mm with full weight bearing. In group III (25 persons, >50 years) the extrusion in lying position was 1,4 mm and 2,1 with full weight bearing. The determined meniscus extrusion of the medial meniscus in 62 healthy knees was 0.8 mm in the dynamic ultrasound examination. Based on our results, there is a physiological functional medial meniscal extrusion in healthy knees as an adjustment reaction on various loadbearing conditions. Although the absolute meniscus extrusion is elevated in elderly people, the adjustment is similar compared to the younger groups. In contrast to MRI scans, ultrasound examination allows a dynamic examination of the meniscus with various load bearing conditions. Therefore ultrasound examination of the meniscus represents a useful tool to proof the function of a meniscus.
Primary anatomical repair of proximal acl ruptures with suture anchors: 1 year follow-up
Authors: Hennings Jan 
Published: April 2018

ACL injuries are common. Going trough the literature, numerous studies show a healing potential for the repair of acl tears, histologically comparable to mcl healing. In this study, the postoperative follow-up after acl preservation was examined up to 1 year. We performed a prospective clinical follow-up in 13 sportive patients (case series, no comparison group). Inclusion criterias were a proximal avulsion tear of the acl, patient age under 50 years and surgery within 6 weeks after trauma. In an arthroscopic procedure, the quality of the acl tissue was examined and judged if suitable for a repair. Concomitant injuries were treated at the same time. Using a suture passer, a Bunnell stitch was created with a nonabsorbable suture through the anteromedial bundel as through the posterolateral bundel. The footprint of the acl was prepared with an awl for liberation of stem cells. The bundels were reattached to the origins of the footprint with two absorbable suture anchors. No drain was used. The postoperative protocoll was as follows: partial weight bearing for 4 weeks and wearing a protective brace with a limitation for extension and flexion of 0-0-90° for 4 weeks. At week 5, the brace was unlocked and range of motion and weight bearing were gradually increased at the level of comfort. Patients were examined at 6 weeks, 3 months, 6 months and 12 months after surgery. The stability was tested with the KT 1000, the subjective outcome with the ACL-RSI and the clinical outcome using the Tegner activity score, the Lysholm score, the KOOS score and the IKDC objective form. X-rays were done after 3 and 12 months, a MRI after 6 months. Between months 4 and 6, patients returned to their previous level of sport. All 13 patients have been included in the 1 year follow-up. No rerupture was seen. There have been no major complications, as minor complications we observed 2 effusions of the knee 7 days after surgery which were treated with aspiration. The patients presented the following outcomes after 1 year: the mean anterior translation difference in the KT 1000 was 0,85 mm; the median Tegner activity score was 6 (range from 5 to 9); the median Lysholm score 95,9; the median KOOS was 94,5. The IKDC was A in 9 of 13 patients, B in 3 and C in 1 patient. The ACL-RSI in the 6 week follow-up was 64,14%, indicating a high level of subjective stability and confidence. This score increased gradually to the 1 year follow-up (94,5%). X-rays showed no pathologic bone signal or tunnel widening. MRI showed appropriately positioned and continous ligaments with scar tissue and an irregular signal due to suture material. In this study, the results 1 year after surgery with an anatomical repair of the acl are promising. Nearly all patients returned to their previous sports level, indicating healing potential for acl injuries. If patient selection is done carefully, this technique is a supplement in the treatment algorithm of acl injuries.
The Anterolateral Complex of the Knee
Authors: Herbst Elmar , Albers Marcio , Imhoff Andreas , Fu Freddie , Musahl Volker 
Published: April 2018

The objective of this study was to clarify the layer-by-layer anatomy of the anterolateral complex of the knee. Twenty fresh-frozen human cadaveric knees (age range 38 - 56 yrs.) without any history of knee injury or surgery were used for this dissection study. After skin and subcutaneous tissue removal, the ITB was incised in its most anterior part and reflected posteriorly followed by blunt dissection of its deeper layers. Subsequently, an incision was made between the ITB and the short head of the biceps muscle with consecutive evaluation of the insertion site of the biceps tendon and its extensions. Once the deep layers of the ITB were identified, the connections to the lateral intermuscular septum and Kaplan fibers were cut. The superficial ITB was then reflected distally in order to assess the geographical relationship between the superficial and deep ITB as well as the distal anteromedial aspect of the biceps muscle. Finally, the anterolateral capsule was incised to evaluate its connections to the surrounding anatomic structures. The anterolateral aspect of the knee consists of three distinct layers. Superficially, the ITB with its insertion to Gerdy’s tubercle and extensions to the patella (iliopatellar band) was appreciated. Posterior reflection of the superficial ITB revealed a firm distinct connection of Kaplan fibers to the distal femoral metaphysis. The deep layer of the ITB runs from the Kaplan fibers in a distal direction and forms a functional arc. This arc is reinforced by the capsulo-osseous layer of the ITB, which originates from an area distal to the Kaplan fibers, the fascia of the lateral gastrocnemius and plantaris muscles. The distal half of the capsulo-osseous layer merges posteriorly with the fascia of the biceps muscle. The three layers of the ITB become confluent distally. Its insertion spanned from Gerdy’s tubercle to an area just posteriorly, with the capsulo-osseous layer forming the posterior part. The biceps muscle has fascial and aporoneurotical extensions, which insert to the proximal tibia together with the capsulo-osseous layer of the ITB. Layer 3 consists of the anterolateral capsule. In 7/20 (35%) specimens the mid-third capsular ligament was observed as a thickening within, but not separate from the anterolateral capsule. The anterolateral complex of the knee consists of the ITB with its three layers, the functional arc formed by the fibers between the distal femoral metaphysis and Gerdy’s tubercle, and the anterolateral capsule. In 35% of specimens a capsular thickening (mid-third capsular ligament) was identified. Surgeons should consider the complex anatomy of this functional unit, i.e. the anterolateral complex, when considering lateral extra-articular procedures.
The difference between the medial and lateral posterior tibial slope is associated with greater internal tibial rotation
Authors: Herbst Elmar , Imhoff Andreas , Irrgang James , Anderst William , Fu Freddie 
Published: April 2018

The objective of this study was to investigate the effect of lateral and medial posterior tibial slope (PTS) and meniscal slope (PMS) on in-vivo anterior tibial translation (ATT) and internal tibial rotation (IR) during downhill running on the healthy contralateral knee twenty-four months after ACL reconstruction. Forty-two individuals (twenty-six males; mean age 21.2 ± 6.9 years) who underwent unilateral ACL reconstruction were included in this study. Morphologic parameters were measured on 3 T magnetic resonance images (MRI) using the 3D DESS sequence on the ACL reconstructed and healthy contralateral knee. Lateral and medial PTS and PMS were measured according to the method described by Hudek et al. Briefly, the tibial shaft axis was determined by connecting the centroids of two circles fitting the tibial shaft on the central sagittal MRI slice. The PTS and PMS were determined by the angle between the tibial shaft axis and the line connecting the two most proximal anterior and posterior subchondral bone and meniscal points in the center of each joint compartment. Three-dimensional in-vivo kinematics data were acquired using dynamic stereo x-ray during downhill running (3.0 m/s, 10° slope) at 150 Hz twenty-four months after unilateral ACL reconstruction. A multiple regression analysis was performed (p < .05). The lateral and medial PTS and PMS as well as the differences between the medial and lateral compartment slopes were not significantly related to ATT in the healthy contralateral knees twenty-four months after ACL reconstruction (p > .05). The lateral and medial PTS and PMS were not significantly related to peak internal tibial rotation (p > .05). However, the difference between the medial and lateral PTS as well as PMS was associated with greater internal tibial rotation (PTS: b=1.55, p < .001; PMS: b = .71, p = .02). The most important finding of the present study is that the difference between the medial and lateral posterior tibial and meniscal slope are related to in-vivo internal tibial rotation during downhill running. ATT was not significantly influenced by the tibial bony and meniscal morphology. Taking into account the results of the present study, the difference between the medial and the lateral PTS and PMS may contribute to IR when an ACL injury occurs. However, the analyzed movement was a straight-ahead run without any cutting or pivoting maneuvers commonly related to ACL tears. In such motion patterns, the correlations may be even stronger compared to the results of this study.
A prospective multicentric analysis of patient data and functional tests of standard knee prosthesis compared to individualized knee prosthesis implantation (NexGen CR vs. ConforMIS iTotal CR)
Authors: Dirks Alena , Bergmann Martin , Mai Sabine , Müller David , Siebert Werner 
Published: April 2018

Knee prosthesis have traditionally been developed using average knee morphologies. However, patient-specific knee implants are now available, which are designed on the basis of an individual patient anatomy with preoperative CT scan. The Aim of this study was a comprehensive comparison of patient reports and blinded functional tests between patients who received a conventional implant (OTS, Zimmer NexGen CR Flex) and patients with a patient-specific implant (CIM, ConforMIS iTotal). 121 patients with either a ConforMIS iTotal CR prosthesis (ConforMIS, Bedford USA, 60 patients) or a NexGen CR Flex prosthesis (Zimmer, Winterthur Switzerland, 61 patients) were prospectively recorded. Both patient group reveal no significant differences in BMI or age. However, patients in ConforMIS group were examined on an average of two months earlier than control group. The follow-up examinations were blinded and the collected data consist of the Knee Society Score (KSS) as well as functional tests consisting of an 8 m “walk” (WALK), a “Timed-Up-and-Go” (TUG) and the “Timed Up and Down Stairs” Test (TUDS). The “aggregated locomotor function (ALF) score” was then calculated based on the addition of the average times of the three function tests (ALF = WALK + TUG + TUDS). A 2-sample t-test was used to compare the functional tests between the CIM and OTS prosthesis groups. The analysis of functional tests showed no significant difference between patients of both cohorts. Patients which received a ConforMIS prosthesis moved as quickly as patients with a conventional prosthesis (p> 0.05 each). In addition, the ALF values showed no significant difference between the two groups (21.2 s vs. 21.7 s, p = 0.67). Furthermore, also the KSS scores did not differ in the two cohorts. The results of this blinded follow-up study demonstrates, that patients with individualized knee prosthesis had no benefit in functional activities of daily life (WALK, TUG and TUDS) in comparison to patients with conventional knee endoprosthesia. Additionally, this study revealed no evidence of improved patient satisfaction, pain relief or fulfillment of expectations as measured by the KSS.
Anatomical variation of the distal femur - a CT data analysis of 24,042 knees
Authors: Merz Cornelia , Steinert Andre , Kurtz Wiliam , Köck Franz Xaver , Beckmann Johannes 
Published: April 2018

Based on a large quantity of CT data, variations in distal femoral geometry was examined and evaluated for TKA. A retrospective study was performed on 24,042 data sets generated during the process of designing individual knee implants. Following parameters were recorded for the distal femur: Femoral absolute anterior-posterior (AP) and medial-lateral (ML) extent, lateral and medial condyle and trochlea size, distal condylar offset (DCO) between lateral and medial condyle, and the difference between medial and lateral posterior condylar offset (PCO) measured in AP direction. Variable patient geometry was found with analysis of the AP and ML extent. Approximately one-third of the patients would experience size conflicts of +/- 3 mm with standard arthroplasty systems. 62% of the knees had a DCO> 1 mm. 83% of the distal femur had a mediolateral difference in PCO> 2 mm, which corresponds to about 3° external rotation and does not correlate with the femoral size. There is a distinct variability of femoral AP and ML extent as well as offsets / asymmetries. Medial and lateral PCOs are different and do not correlate with femoral size. This first results in mismatches between size of implant and individual knee anatomy and secondly in possible softtissue release and different femoral external rotations to adapt systems with fixed distal geometry to the individual situation.
Functional outcomes in Hirschsprung disease patients after
transabdominal Soave and Duhamel procedures
Authors: Widyasari Amira , Pavitasari Winona Alda , Dwihantoro Andi , Gunadi  
Published: April 2018

Abstract
Background
Several pull-through procedures have been described for Hirschsprung
disease (HSCR) with varying functional outcomes. The voluntary bowel movement
(VBM) and the absence of soiling or constipation after pull-through remain the
most important markers of good outcome. We aimed to compare the functional
outcomes in HSCR patients following Soave and Duhamel procedures.

Methods
Krickenbeck classification was utilized to determine VBM, soiling
and constipation for patients who underwent Soave and Duhamel pull-through at Dr.
Sardjito Hospital, Indonesia from 2013 to 2016.

Results
Fifty-three patients were ascertained (Soave: 23 males and 2 females
vs. Duhamel: 22 males and 6 females, p = 0.26).
Ninety-three and 88% patients had a VBM following Duhamel and Soave pull-through,
respectively (p = 0.66). Constipation frequency
was significantly higher in Soave than Duhamel groups (24% vs. 4%; p = 0.04) with OR of 8.5 (95% CI = 1.0–76.7), whereas
soiling rate was similar between Duhamel (21%) and Soave (8%) groups (p = 0.26). Furthermore, the risk of constipation was
increased ~ 21.7-fold in female patients after Soave procedure and was almost
statistically significant (p = 0.05).

Conclusions
The constipation rate is higher in patients who underwent Soave than
Duhamel procedure, but the VBM and soiling frequencies are similar. The
constipation risk following Soave pull-through might be increased by the female
gender. Furthermore, a multicenter study with a larger sample of patients is
necessary to clarify and confirm our findings.
Isotopes in cultural heritage: present and future possibilities
Authors: Nord Anders G. , Billström Kjell 
Published: April 2018

Abstract
This paper is focused on methodology and scientific interpretations by use of isotopes in heritage science—what can be done today, and what may be accomplished in the near future? Generally, isotopic compositions could be used to set time constraints on processes and manufacturing of objects (e.g. the 14C technique). Furthermore, isotopic compositions (e.g. Sr and Pb isotopes) are useful for tracing the origin of a component or a metal. The concepts isotope and isotopic fractionation are explained, and the use of stable respectively radioactive isotopes is exemplified. Elements which today have a large potential in heritage research are reviewed, and some recent and less known applications from the literature are summarized. Useful types of mass spectrometers are briefly described, and the need for reliable standards as well as accurate measurements and corrections is stressed. In future, further chemical elements may be utilized for isotope studies in heritage science, and possible candidates are discussed. The paper may in particular be valuable to readers less acquainted with the use of isotopic measurements. The many examples from referenced papers and also results from the authors’ studies in this field may inspire imaginative and inquisitive scientists to try new applications utilizing isotope data in heritage science.
Impact of type 2 diabetes mellitus on short‐term and long‐term outcomes of patients with esophageal squamous cell cancer undergoing resection: a propensity score analysis
Authors: Yao Wang , Meng Yuqi , Lu Mingjian , Fan Wenzhe , Huang Jinhua , Li Jiaping , Zhu Zhihua 
Published: April 2018

AbstractBackgroundThe association between type 2 diabetes mellitus (T2DM) and the risk of esophageal cancer remains unclear. The present study aimed to evaluate the impact of T2DM on short‐term outcomes and long‐term survival in patients with esophageal squamous cell cancer (ESCC).MethodsThe present retrospective study included 862 patients diagnosed with ESCC between January 2001 and December 2010. Among them, 280 patients had T2DM. A 1:1 propensity score‐matched cohort consisting of 280 patients with and 280 without T2DM was selected from the 862 patients. The associations between T2DM and clinicopathologic characteristics were assessed using the χ2 or Fisher's exact test. Survival of ESCC patients with and without T2DM was calculated by using the Kaplan–Meier method and compared by using the Cox regression model between the two groups.ResultsThe occurrence rate of anastomotic leakage was significantly higher in patients with T2DM than in those without T2DM (P < 0.001). In the subgroup with weight loss rate ≤ 5.05%, ESCC patients with T2DM had a significant longer overall survival than did those without T2DM (P = 0.003), whereas in the subgroup with weight loss rate > 5.05%, the patients without T2DM showed a longer survival (P = 0.001). Univariate and multivariate analysis results showed that T2DM was not an independent prognostic factor for patient survival.ConclusionsType 2 diabetes mellitus is not an independent prognostic factor in patients with ESCC. However, the combination of T2DM with severe weight loss would be a predictor of poor prognosis.
Integrative analysis of gene expression profiles reveals specific signaling pathways associated with pancreatic duct adenocarcinoma
Authors: Li Jun , Tan Wenle , Peng Linna , Zhang Jialiang , Huang Xudong , Cui Qionghua , Zheng Jian , Tan Wen , Wu Chen , Lin Dongxin 
Published: April 2018

AbstractBackgroundPancreatic duct adenocarcinoma (PDAC) remains a major health problem because conventional cancer treatments are relatively ineffective against it. Microarray studies have linked many genes to pancreatic cancer, but the available data have not been extensively mined for potential insights into PDAC. This study attempted to identify PDAC‐associated genes and signaling pathways based on six microarray‐based profiles of gene expression in pancreatic cancer deposited in the gene expression omnibus database.MethodsPathway network methods were used to analyze core pathways in six publicly available pancreatic cancer gene (GSE71989, GSE15471, GSE16515, GSE32676, GSE41368 and GSE28735) expression profiles. Genes potentially linked to PDAC were assessed for potential impact on survival time based on data in The Cancer Genome Atlas and International Cancer Genome Consortium databases, and the expression of one candidate gene (CKS2) and its association with survival was examined in 102 patients with PDAC from our hospital. Effects of CKS2 knockdown were explored in the PDAC cell lines BxPC‐3 and CFPAC‐1.ResultsThe KEGG signaling pathway called “pathway in cancer” may play an important role in pancreatic cancer development and progression. Five genes (BIRC5, CKS2, ITGA3, ITGA6 and RALA) in this pathway were significantly associated with survival time in patients with PDAC. CKS2 was overexpressed in PDAC samples from our hospital, and higher CKS2 expression in these patients was associated with shorter survival time. CKS2 knockdown substantially inhibited PDAC cell proliferation in vitro.ConclusionsAnalysis integrating existing microarray datasets allowed identification of the “pathway in cancer” as an important signaling pathway in PDAC. This integrative approach may be powerful for identifying genes and pathways involved in cancer.
The Effect of Supraphysiological Estradiol on Pregnancy Outcomes Differs Between Women With PCOS and Ovulatory Women
Authors: Wei Daimin , Yu Yunhai , Sun Mei , Shi Yuhua , Sun Yun , Deng Xiaohui , Li Jing , Wang Ze , Zhao Shigang , Zhang Heping , Legro Richard S , Chen Zi-Jiang 
Published: April 2018

Abstract

Context
Supraphysiological estradiol exposure after ovarian stimulation may disrupt embryo implantation after fresh embryo transfer. Women with polycystic ovary syndrome (PCOS), who usually overrespond to ovarian stimulation, have a better live birth rate after frozen embryo transfer (FET) than after fresh embryo transfer; however, ovulatory women do not.

Objective
To evaluate whether the discrepancy in live birth rate after fresh embryo transfer vs FET between these two populations is due to the variation in ovarian response (i.e., peak estradiol level or oocyte number).

Design, Setting, Patients, Intervention(s), and Main Outcome Measure(s)
This was a secondary analysis of data from two multicenter randomized trials with similar study designs. A total of 1508 women with PCOS and 2157 ovulatory women were randomly assigned to undergo fresh or FET. The primary outcome was live birth.

Results
Compared with fresh embryo transfer, FET resulted in a higher live birth rate (51.9% vs 40.7%; OR, 1.57; 95% CI, 1.22 to 2.03) in PCOS women with peak estradiol level &gt;3000pg/mL but not in those with estradiol level ≤3000 pg/mL. In women with PCOS who have ≥16 oocytes, FET yielded a higher live birth rate (54.8% vs 42.1%; OR, 1.67; 95% CI, 1.20 to 2.31), but this was not seen in those with &lt;16 oocytes. In ovulatory women, pregnancy outcomes were similar after fresh embryo transfer and FET in all subgroups.

Conclusions
Supraphysiological estradiol after ovarian stimulation may adversely affect pregnancy outcomes in women with PCOS but not in ovulatory women.