bluuebunny/crossref_metadata_2025_split huggingface dataset:
BORDERLINE DYSPLASIA: ARE THESE HIPS ONLY MILDLY UNCOVERED?
Authors: McClincy Michael , Wylie James , Yen Yi-Meng , Novais Eduardo 
Published: March 2019

Background: Controversy surrounds classification and treatment of hips with a lateral center-edge angle (LCEA) between 18° and 25°. It remains undetermined as to whether open or arthroscopic procedures are best used to treat patients with borderline dysplasia. We hypothesized that patients with hip pain and borderline acetabular dysplasia have different features of acetabular morphology as determined by other relevant radiographic measures beyond the LCEA. Methods: A retrospective review of patients undergoing hip preservation surgery between January 2010 and December 2015 with either periacetabular osteotomy(PAO) or hip arthroscopy with a LCEA between 18° and 25° was performed. Anteroposterior, Dunn lateral and false profile radiographs were used to measure LCEA, Tönnis Angle, anterior center edge angle (ACEA), anterior (AWI) and posterior (PWI) wall indexes, the femoral epiphyseal acetabular roof (FEAR) index, joint space width, crossover sign, posterior wall sign, P/A index, and femoral alpha angle. An agglomerative hierarchical clustering analysis was then performed on the continuous radiographic variables to identify different subtypes of hip pathomorphology among this patient cohort. There were sex-specific trends in hip morphology. Therefore, we proceeded to perform separate cluster analyses for each sex. Results: Ninety-nine patients underwent surgery in the study period, 77 (78%) were female, and 81 (82%) of these had complete radiographic images for cluster analysis. Mean age was 22.6 years. Hip arthroscopy was performed in 41% of patients and periacetabular osteotomy was performed in 59% of patients. The ACEA (45%), FEAR Index (34%), and AWI (30%) were the most commonly abnormal radiographic parameters among all patients. In female patients, the ACEA (55%), FEAR Index (42%), and AWI (34%) were the most commonly abnormal radiographic parameters. In male patients, an insufficient PWI (48%) was the most common radiographic abnormality. For females, we identified three clusters representing different patterns of hip morphology: impingement morphology; lateral acetabular deficiency, and anterolateral acetabular deficiency (Table 1A). For males, we identified three clusters: postero-lateral acetabular deficiency with global cam morphology, postero-lateral acetabular deficiency with focal cam morphology, and lateral acetabular deficiency without cam morphology (Table 1B). Conclusions: A comprehensive evaluation of radiographic parameters in patients with LCEA 18-25° identifies sex-specific trends in hip morphology and shows a large proportion of dysplastic features among these patients. A thorough evaluation of all pelvic morphology, not just lateral coverage, should be considered when indicating these patients for hip preservation surgeries. Further studies are needed to investigate the outcomes of patients within each of the identified clusters to determine optimal treatment options for each group. [Table: see text][Table: see text]
COULD LOWER EXTREMITY INJURIES INCREASE BMI IN CHILDREN?
Authors: Mastrocola Marissa , McCoy Amanda , Gleeson Rubello 
Published: March 2019

PURPOSE: The purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients. INTRODUCTION: Over the past 30 years, childhood obesity has significantly increased. Lack of physical activity and rising levels of sedentary living are associated with rising childhood obesity. As the effects of childhood obesity are long lasting, it is important to characterize childhood conditions that lead to increases in BMI. Traumatic lower extremity injuries in children commonly result in casting and forced immobilization. Children and adolescents who cease physical activity at a younger age are at a higher risk for weight gain and inactive lifestyles as adults. Presently, the data examining short term and longitudinal effects of injury on weight changes are lacking. Therefore, the purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients. METHODS: Eighty eight subjects aged 5 to 18 with lower extremity fractures managed with non-weight bearing for a minimum of 6 weeks were identified. This group was compared to a cohort of controls, who presented to the pediatric orthopaedic clinic for upper extremity injuries. For each subject, BMI was calculated from height and weight data obtained at each clinic visit for which the data were available for a minimum of 6 months. Percent change in BMI was then calculated and compared between the lower extremity injury group and controls utilizing ANOVA. Logistic regression was then performed to determine if age, gender, and undergoing surgery were correleated with a BMI change of greater than 10%. RESULTS: The results of initial ANOVA analysis demonstrated no difference in BMI trends between children with lower extremity injuries and controls. On average, both groups showed a modest increase in BMI over time (lower extremity injuries = 3.40%, controls = 3.23%). Logistic analysis of the lower extremity revealed male gender to be associated with a 10% increase in BMI during the study period, though this was not significant (p = 0.153) CONCLUSIONS: Our investigation yielded a negative result. As there is limited literature on BMI trends in children, our power calculation may have underestimated the subjects needed to demonstrate a statistically significant difference between groups. SIGNIFICANCE: The increases observed in both groups may indicate that the experience of being injured is associated with increases in BMI regardless of the location of injury. Further investigation would involve assessing BMI trends prospectively to identify opportunities to obviate possible weight gain with injury.
GENDER DISPARITIES IN PATIENT-REPORTED OUTCOMES OF SPORTS-RELATED CONCUSSION PATIENTS
Authors: Rizzone Katherine , Hollaway Jessica , Houck Jeffrey 
Published: March 2019

Background Patient-Reported Outcomes Measurement Information System (PROMIS) scales have been utilized to assess symptoms in a variety of medical conditions but have not been previously examined in patients with sports-related concussions. Our objective was to analyze PROMIS scores of University of Rochester Medical Center’s concussion patients to assess for demographic differences in symptoms and recovery. Methods: ICD9/10 codes retrospectively identified 214 concussion patients (51% female) less than 30 years old (mean age 15.1 +/- 2.3 years) with PROMIS metrics for physical function, pain and depression. Minimal clinically important difference for these domains is considered 4 points. Two-way ANOVA assessed the influence of gender on PROMIS domains with age as a covariate. T-tests measured the association of gender with the number of previous concussions and clinic visits. Multiple linear regression was utilized to assess the influence of the listed variables on the number of clinic visits. Results: Females initially present with 4.0 points lower physical function (95% Confidence interval (CI) 1.5-6.6), 5.8 points (95% CI 3.3-8.3) higher pain interference and 5.4 points (95% CI 2.7-8.2) higher depression compared to males (p <0.01). The history of previous concussions did not differ by gender (1.2 ± 0.1 for females vs. 1.2 ± 0.1 for males), however, the number of visits per episode of care was greater for females (females=8.7±0.4 vs. males=5.3±0.6, p <0.01). Multiple linear regression showed that gender, pain rating, and physical function were significant predictors of the number of clinic visits (r-value = 0.35, p <0.01). Conclusions: In our clinic, females and males report concussion at the same prevalence, but post-concussive females experienced statistically significant greater pain and depression and lower physical function compared to their male counterparts. Gender was not associated with the number of previous concussions, but did influence the number of visits. The combination of gender, physical function, and pain were significantly correlated with number of visits, and these variables may be considered in future efforts to determine prognosis of recovery at intake post-concussion.
THE UTILITY OF STABILITY AND TEAR LOCATION IN A CLASSIFICATION SYSTEM FOR DISCOID MENISCUS SURGICAL PLANNING
Authors: Yang Brian W. , Logan Catherine , Williams Kathryn , Tepolt Frances , Paschos Nikolaos , Kocher Mininder S. 
Published: March 2019

Background Discoid meniscus (DM) is a congenital variant that typically affects the lateral meniscus of the knee. Despite the presence of multiple classification systems for DM, no system has demonstrated utility in treatment planning. We performed a retrospective review of discoid menisci that underwent surgical intervention at our institution to assess for discoid meniscus characteristics associated with surgical treatment with or without repair. Next, we propose a new method of classifying lateral discoid meniscus and demonstrate its efficacy in predicting surgical treatment. Methods We searched the orthopedic database at our institution for patients who underwent surgical treatment for lateral discoid meniscus between 1991 and 2017. Clinical records were reviewed to determine the type of DM surgery performed (surgery with or without repair) as well as DM morphology, stability, tear presence, tear location, and tear type. Univariate associations between DM characteristics and surgery type were calculated and multivariable logistic regression models of surgery type were created. Based on the univariate analysis and logistic regression models, we propose a new classification system for discoid meniscus. Results There were 434 knees with discoid lateral menisci that received surgical treatment at our institution between 1991 and 2017. In univariate analysis, unstable menisci (93%, p<0.001) and menisci with a tear including the periphery (75%, p<0.001) were more likely to receive surgery with repair. By itself, instability demonstrated 89% sensitivity and 94% specificity in predicting surgery with repair. The main effects logistic regression model including stability and tear showed that that the odds of unstable lateral discoid menisci receiving surgery with repair was 133.1 times higher than stable menisci (p<0.001) while lateral discoid menisci that had a tear including the periphery had 6.54 times higher odds of receiving repair than those that had a tear in the central portion only (p<0.001). Conclusions/Significance Lateral discoid menisci stability and tear location were associated with surgical treatment type in both univariate analysis and logistic regression models (Table 1). Based on our results and clinical relevance, we propose a classification system for DM with utility in surgical treatment planning. Menisci are classified by stability (Stable (S0), Unstable (S1)), morphology (Incomplete (M0), Complete (M1)), and Tear (No tear (T0), Central tear (T1), or Peripheral tear (T2)) (Figure 1). Tables and Figures [Table: see text][Figure: see text]
OUTCOMES OF ARTHROSCOPIC BANKART REPAIR IN THE PEDIATRIC AND ADOLESCENT POPULATION: HIGH RATES OF FAILURE
Authors: Pandya Nirav K. , Kramer Jonathan 
Published: March 2019

BACKGROUND Shoulder instability is an increasingly common problem in the pediatric and adolescent population. As with anterior cruciate ligament reconstruction, surgical intervention in this population is becomingly increasingly common. Yet, although failure rates are much higher in this active population there has been limited examination of this population in the literature. The purpose this study was to review treatment of adolescent shoulder instability and to discuss factors influencing its management; particularly recurrent instability. METHODS A retrospective cohort study was performed at a single center. Inclusion criteria consisted of all adolescent aged patients identified who (1) had complaints of shoulder instability, (2) had radiographic findings consistent with anterior-inferior capsulolabral injury, (3) had documented evidence of a dislocation event, and (4) underwent arthroscopic shoulder stabilization. Patient demographics, pre-operative history and physical, imaging, surgical details, and post-operative complications were analyzed. RESULTS Thirty-six patients were identified with a mean follow-up 3.07 ± 1.2 years. The average patient age at the time the index procedure was 16.03 ± 1.67 years. All patients underwent arthroscopic shoulder stabilization consisting of arthroscopic Bankart repair. Five patients also underwent a remplissage. Nine patients (25.0%) developed a repeat dislocation following surgery. This occurred on average 20.67 months postoperatively (range 5-51 months). No single sport was associated with a statistically significant increased risk of re-dislocation. American football was the most common sport in both the stable and re-dislocated groups. Patients who re-dislocated had a higher frequency of a Hill-Sachs lesion on MRI (89%) compared to those who did not re-dislocate (52%) (p=0.048). Off-track lesions were not associated with repeat instability. CONCLUSIONS / SIGNIFICANCE The current study demonstrates that adolescent patients treated with arthroscopic shoulder stabilization have a high rate of recurrence of shoulder dislocations, particularly in the setting of a concomitant Hills-Sachs lesion. Patients may benefit from more aggressive stabilization strategies and techniques. Further prospective multi-center studies are necessary to determine the reasons for the high rate of re-dislocation in this population and develop strategies for prevention.
COMPARISON OF POSTOPERATIVE PAIN SCORES AND MEDICATION USAGE BETWEEN THREE PAIN CONTROL STRATEGIES FOR PEDIATRIC ANTERIOR CRUCIATE LIGAMENT (ACL) SURGERY
Authors: Lovejoy John F. , Santana Lisgelia , Atanda Alfred , Mandel David , Day Jason , Kiebzak Gary M. 
Published: March 2019

Background: Assessment and management of postoperative pain in the pediatric population after ACL surgery can be challenging, and the optimal approach to pain control remains controversial. Recent studies have shown that the use of intraoperative nerve blocks may reduce the need for opioids to control pain in the immediate postoperative period. However, it is not clear which block type is the most beneficial for the pediatric outpatient setting. The objective of our study was to compare effectiveness of pain control between three different pain management strategies in the pediatric ACL population. Methods: A retrospective chart review from 2013-2017 of patients ages 12-17 receiving an elective ACL reconstruction. Three types of analgesia were included: femoral nerve block, combined femoral + sciatic block, and intraarticular injection of bupivacaine with cold therapy in the Post Anesthesia Care Unit (PACU) (each used by three different surgeons as their standard preference in three different hospitals), n = 50 per group. The primary variable was postoperative pain scores (visual analog scale 1-10) in the PACU. Secondary variables collected were demographic data, graft type, time in PACU and intraoperative/postoperative opioid use. Results: The mean (+ SD) age of the cohort was 15.3 + 1.4 years; there were no differences in age, BMI or ratio of boys and girls between the 3 groups (n=50 per group). However, the femoral nerve block group had a significantly lower percentage of Caucasians (28%, P = 0.002) compared to the group with combined blocks (58%) and intraarticular injection (56%). Less than 50% of patients in the combined nerve block group had opioids intraoperatively or in the PACU compared to nearly 100% of patients in the other two groups (P < 0.0001). Also, for patients receiving opioids, the total intraoperative morphine equivalents and PACU pain scores (all patients) were significantly less in the combined block group (P < 0.001). For patients receiving opioids in the PACU, the total morphine equivalents was significantly higher in the intraarticular injection group compared to the nerve block groups (P < 0.0001). Total time in the PACU was 25% longer for patients in the combined block group (P < 0.0001). Conclusion: Patients in the combined femoral and sciatic nerve block group had significantly better pain scores in the PACU with less cumulative morphine equivalent consumption compared to the femoral nerve block group and the intraarticular injection group.
ARTICULAR CARTILAGE THICKNESS OF THE PEDIATRIC KNEE: IMPLICATIONS FOR CARTILAGE IMPLANTATIONS
Authors: Rustad Audrey , Anchustegui Nicolas G. , Troyer Stockton , Shea Cooper , Dingel Aleksei , Shea Kevin 
Published: March 2019

Background: While access to pediatric tissue for cartilage conditions is limited, recent research on the use of pediatric cartilage tissue for implantation has shown promising results. These pediatric grafts may include bulk osteochondral allografts, morselized cartilage, or cellular manipulation products. The purpose of this study was to evaluate the parameters of cartilage thickness in different regions of the pediatric knee from a larger pediatric knee specimen research database. Methods: CT Scans of 12 skeletally immature knees ranging from ages 7 to 11 were evaluated. Cartilage thickness measurements were taking in the following regions: 1. Femoral Condyles - Cahill Zones 1, 2, 4, and 5 (Fig. 1) on coronal plane CT images, the region of greatest cartilage thickness on medial and lateral femoral condyles using coronal plane CT images, and Cahill Zones A, B, and C on sagittal plane CT images (Fig. 2). 2. Tibial Plateau – the region of greatest cartilage thickness identified on the medial and lateral sides of the tibial plateau using coronal plane CT images (Fig. 1). 3. Patella – the region of greatest cartilage thickness identified on axial and sagittal CT images (Fig. 3 and 4). Results: The cartilage on the medial femoral condyle had an average thickness of 4.86 mm ± 0.61 mm at its thickest point and the cartilage on lateral femoral condyle had an average thickness of 3.71 mm ± 0.52 mm at its thickest point. The cartilage on the medial tibial plateau had an average thickness of 2.80 mm ± 0.26 mm at its thickest point and the cartilage on the lateral tibial plateau had an average thickness of 3.29 mm ± 0.45 mm at its thickets point. The cartilage on the midpoints of Cahill zones 1, 2, 3, and 4 had an average thickness of 2.93 mm ± 0.62 mm, 3.42 mm ± 0.66 mm, 2.81 mm ± 0.46 mm, and 3.30 mm ± 0.73 mm respectively. The cartilage on the midpoints of Cahill zones A, B, and C had an average thickness of 3.81 mm ± 0.68 mm, 4.40 mm ± 0.49 mm, and 3.82 mm ± 0.68 mm respectively. The cartilage at its thickest point on the patella had an average thickness of 4.53 mm ± 0.38 mm from an axial view and 4.40 mm ± 0.49 mm from a sagittal view (Fig. 5 and 6). Conclusion: Pediatric knees demonstrate relatively thick cartilage regions in multiple zone of the knee, compared with adult specimens. Increasing access to and use of this tissue for cartilage grafts, non-manipulated tissue, and manipulated tissue offer significant opportunity to address cartilage loss. Osteochondral allograft procedures may benefit from access to such tissue, with relatively high volume and thickness of normal articular cartilage. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Bridge-Enhanced ACL Repair: Two Year Results of the First In Human Study
Authors: Murray Martha M. , Kalish Leslie , Fleming Braden C. , Flutie Brett , Thurber Laura , Freiberger Christina , Henderson Rachael , Perrone Gabriel , Proffen Benedikt , Kramer Dennis E. , Yen Yi-Meng , Micheli Lyle J. 
Published: March 2019

Objectives: The Bridge-Enhanced ACL Repair (BEAR) procedure is an alternate form of anterior cruciate ligament (ACL) surgery that involves suture repair of the ligament combined with a scaffold to bridge the gap between the torn ligament ends. In this paper, we report outcomes of this procedure and a non-randomized concurrent control group receiving ACL reconstruction with quadrupled hamstring tendon autograft. We hypothesized that patients treated with Bridge-Enhanced ACL Repair would have physical exam findings, patient reported outcomes and adverse events at one and two years that were similar to patients treated with ACL reconstruction. Methods: This was an observational cohort study. Twenty patients were enrolled. Ten patients received a Bridge-Enhanced ACL Repair (BEAR®) and 10 received a hamstring autograft ACL reconstruction. Outcomes were assessed at time points up to 2 years post-operatively, including the International Knee Documentation Committee (IKDC) Subjective Score, the IKDC Objective score, KT-1000 testing for AP laxity and functional testing. Results: There were no graft or repair failures in the first two years after surgery. The IKDC Subjective Scores in both groups improved significantly from baseline (p< 0.0001) but were similar in BEAR and ACL reconstruction groups at 12 and 24 months. An IKDC Objective score of A (normal) was found in 44% of the patients in the BEAR group and 29% of the patients in the ACL reconstruction group at two years; no patients in either group had a grade of C (abnormal) or D (severely abnormal). KT-1000 testing demonstrated a side to side difference that was similar in the two groups at 2 years (mean(±SD) 1.9(± 2.1) mm in the BEAR group, 3.1(± 2.7) mm in the ACLR group). Functional hop testing results were similar in the two groups at 1 and 2 years after surgery. Hamstring strength indices measured by dynamometer were significantly higher at all time points in the BEAR group than in the hamstring autograft group (mean percentages relative to contralateral side at two years, 98.6%(±10.5%) vs 56.3%(±19.0%), p=0.0001). Conclusion: In a small first-in-human study, Bridge-Enhanced ACL Repair produced similar outcomes to ACL reconstruction with autograft quadruple bundle hamstring tendon.
RETRACTED ARTICLE: TMED3 promotes cell proliferation and motility in breast cancer and is negatively modulated by miR-188-3p
Authors: Pei Jing , Zhang Jing , Yang Xiaowei , Wu Zhengsheng , Sun Chenyun , Wang Zhaorui , Wang Benzhong 
Published: March 2019

Abstract
Background
The role of TMED3 involved in cancers has been seldom described, let alone in breast cancer. To explore the clinicopathological significance of TMED3 expression and the biological roles involved in breast cancer cells, we undertook the study.

Methods
Immunohistochemistry was performed to observe the pattern of TMED3 expression in breast cancer tissues, totaling 224 cases; followed by detailed statistical analysis between TMED3 expression versus clinicopathological information available. To explore the role of TMED3 involved in the malignant behaviors of breast cancer cells, wound-healing and Transwell assays were conducted to evaluate the variation of migration and invasion of MCF-7 and MDA-MB-231 cells whose TMED3 has been stably silenced using lenti-viral based short hairpin RNA (shRNA) vectors. MTT, clonogenic assay and xenograft nude mice model were undertaken to observe the variation of proliferation both in vitro and in vivo.

Results
It was shown that elevated TMED3 markedly correlated with ER, PR, Her-2 status, and lymph nodes metastases in addition to significant association with poor overall prognosis. In vitro, TMED3 was shown to promote proliferation, migration and invasion of breast cancer cells. Moreover, miR-188-3p was identified as a novel negative regulator of TMED3 in breast cancer, which can slow down the proliferation, migration and invasion of MCF-7 cells. Results from in vivo xenograft nude mice models showed that lenti-viral based miR-188-3p re-expression can markedly impair the tumor growth.

Conclusions
Our data define and bolster the oncogenic role of TMED3 in breast cancer.