bluuebunny/crossref_metadata_2025_split huggingface dataset:
Altered Movement Biomechanics in Chronic Ankle Instability, Coper, and Control Groups: Energy Absorption and Distribution Implications
Authors: Kim Hyunsoo , Son S. Jun , Seeley Matthew K. , Hopkins J. Ty 
Published: June 2019

Context
Patients with chronic ankle instability (CAI) exhibit deficits in neuromuscular control, resulting in altered movement strategies. However, no researchers have examined neuromuscular adaptations to dynamic movement strategies during multiplanar landing and cutting among patients with CAI, individuals who are ankle-sprain copers, and control participants.

Objective
To investigate lower extremity joint power, stiffness, and ground reaction force (GRF) during a jump-landing and cutting task among CAI, coper, and control groups.

Design
Cross-sectional study.

Setting
Laboratory.

Patients or Other Participants
A total of 22 patients with CAI (age = 22.7 ± 2.0 years, height = 174.6 ± 10.4 cm, mass = 73.4 ± 12.1 kg), 22 ankle-sprain copers (age = 22.1 ± 2.1 years, height = 173.8 ± 8.2 cm, mass = 72.6 ± 12.3 kg), and 22 healthy control participants (age = 22.5 ± 3.3 years, height = 172.4 ± 13.3 cm, mass = 72.6 ± 18.7 kg).

Intervention(s)
Participants performed 5 successful trials of a jump-landing and cutting task.

Main Outcome Measure(s)
Using motion-capture cameras and a force plate, we collected lower extremity ankle-, knee-, and hip-joint power and stiffness and GRFs during the jump-landing and cutting task. Functional analyses of variance were used to evaluate between-groups differences in these dependent variables throughout the contact phase of the task.

Results
Compared with the coper and control groups, the CAI group displayed (1) up to 7% of body weight more posterior and 52% of body weight more vertical GRF during initial landing followed by decreased GRF during the remaining stance and 22% of body weight less medial GRF across most of stance; (2) 8.8 W/kg less eccentric and 3.2 W/kg less concentric ankle power, 6.4 W/kg more eccentric knee and 4.8 W/kg more eccentric hip power during initial landing, and 5.0 W/kg less eccentric knee and 3.9 W/kg less eccentric hip power; and (3) less ankle- and knee-joint stiffness during the landing phase. Concentric power patterns were similar to eccentric power patterns.

Conclusions
The CAI group demonstrated altered neuromechanics, redistributing energy absorption from the distal (ankle) to the proximal (knee and hip) joints, which coincided with decreased ankle and knee stiffness during landing. Our data suggested that although the coper and control groups showed similar landing and cutting strategies, the CAI group used altered strategies to modulate impact forces during the task.
The Prevalence of Pain in People With Chronic Ankle Instability: A Systematic Review
Authors: Al Adal Saeed , Pourkazemi Fereshteh , Mackey Martin , Hiller Claire E. 
Published: June 2019

ObjectiveTo identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI.Data SourcesWe searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017.Study SelectionEligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded.Data ExtractionStudies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance.Data SynthesisOf the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies.ConclusionsPain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.
Self-Expanding Metallic Stents in Malignant Biliary Obstruction-Patency and Clinical Efficacy: A Prospective Study from North India Tertiary Center
Authors: Gupta Ankit , Gupta Gaurav Kumar , Gawande Atul , Kumar Manoj , Tak Vijyant , Pokharna Rupesh Kumar , Sharma Shyam Sundar , Nijhawan Sandeep 
Published: June 2019

ABSTRACT
Background and Aims: Endoscopic insertion of self-expandable metallic stent (SEMS) is now accepted as first line modality of treatment for palliation in unresectable extra-hepatic biliary obstructive jaundice. This study was done to assess the clinical efficacy and duration of patency of endoscopically inserted metallic stent in un-resectable malignant biliary obstruction. Materials and Methods: Between 2015 to 2017, 101 patients who underwent ERCP and SEMS placement for palliation of malignant biliary obstruction were included prospectively. Main outcome measures were technical success, clinical success, mean duration of SEMS patency, clinical efficacy, rate of biliary re-intervention and survival of patients. Results: Overall technical success and clinical success was achieved in 93% and 82.2% respectively. Mean duration of SEMS patency was 109 days. Analysis in subgroup of patients classified according to site of obstruction (Hilar -68, Distal CBD-33) showed that median duration of stent patency was significantly better in distal biliary stricture (135 days vs 95 days), whereas re-intervention rates were higher in higher biliary stricture than distal stricture (41% Vs 6%). Seven patients with hilar biliary stricture suffered post-SEMS insertion cholangitis. Conclusion: SEMS placement is feasible palliative method for un-resectable malignant biliary obstruction with acceptable technical and clinical success. The duration of SEMS patency and clinical efficacy is significantly better in distal biliary stricture whereas re-intervention rate is higher in hilar biliary stricture.
Results of periacetabular osteotomy in adolescent and young adult hip dysplasia
Authors: Abdelhamid Mohamed Adel , Ragheb Eissa , Seddik Mahmoud 
Published: June 2019

Background
Dysplasia of the hip is one of the most common causes of secondary osteoarthritis because of its associated structural instability. The Bernese periacetabular osteotomy (PAO) now is the preferred and the gold standard procedure for the treatment of symptomatic acetabular dysplasia.

Objective
The primary aim of our study was to evaluate the results of PAO in the treatment of adolescent and young adult patients with symptomatic hip dysplasia.

Patients and methods
This prospective case series’ study included 22 patients (26 hips, 13 left hips, 13 right hips) with hip dysplasia after surgical reorientation of the acetabulum by PAO procedure. This study included three male patients and 19 female patients. The mean age of our patients was 23 years (13–40 years). The mean follow-up period was 15 months (6–24 months). Twenty-one hips had undergone isolated PAO, while five hips had undergone combined surgery with the PAO at the same time (three hips had proximal femoral varus osteotomy and two hips had arthrotomy and osteochondroplasty).

Results
Twenty-five hips had good clinical and radiographic outcomes with respect to hip function and radiographic parameters. One patient developed avascular necrosis (AVN) of the femoral head 6 months after PAO and was treated by total hip replacement 1 year after PAO. The mean lateral central edge angle was 10.57°±11.61° preoperatively and was corrected to a mean value of 31.96°±4.42° with a mean correction of 21.38°. The mean postoperative acetabular index was 7.57°±1.81°, with a mean correction of 15.34°. In our series, the mean postoperative Harris hip score was 91.36±4.14, and the mean improvement was 29.08.

Conclusion
The PAO is an effective and valuable method for preservation of the natural hip joint and should be learned in a specialized center before using it in clinical practice.
Evaluating the effect of direct-acting agents on liver fibrosis, by real-time elastography, Fibroscan and FIB4 score in chronic HCV patients
Authors: Mansour Raed H. , Zaky Samy , El Kassas Mohamed , Mamdouh Haitham , Esmat Gamal 
Published: June 2019

Background
One of the most important questions is what happens with liver fibrosis following a sustained virological response (SVR), although the current anti-HCV therapies were not designed to be antifibrotic. Liver biopsy was replaced by multiple noninvasive means, which were validated in chronic HCV patients, such as Fibroscan, seromarkers such as aminotransferase-to-platelet ratio index (APRI) and FIB4 scores, and new nonvalidated means such as real-time elastography (RTE). The aim of the study was to evaluate the early changes of liver fibrosis after direct-acting agents (DAAs) using these noninvasive means.

Materials and methods
This was a prospective study that included 200 chronic HCV-naive patients during the period spanning from December 2014 to January 2016. All patients received sofosbuvir − based treatment regimen (with or without pegylated interferon). They were evaluated using Fibroscan, RTE, APRI and FIB4 scores at the baseline and SVR24.

Results
All the studied patients showed a statistically significant decline in ALT, AST, liver stiffness (by Fibroscan), elasticity index (RTE), FIB4 score and APRI score, regardless of the response to DAAs. Moreover, there was a significant increase in platelet count from baseline to SVR24. The average improvement of the liver stiffness in different fibrosis stages was 22%. There was a positive correlation between stiffness score and all other fibrosis markers before and after treatment.

Conclusion
There was a significant improvement of liver stiffness after 12 weeks of end of treatment, regardless of the DAA regimen used, and regardless of the treatment outcome (response), as evidenced by Fibroscan, RTE, FIB4 and APRI scores.
Factors affecting the prognosis of traumatic acute subdural hematomas
Authors: Elhawary Magdy A. , El Shokhaiby Usama M. , Ali Wafik E. , Gafar Abdallah M. , Abd El Rahman Ahmed A. 
Published: June 2019

Background
Trauma is the most frequent cause of young adult (under 45 years of age) fatalities worldwide, and traumatic brain injury accounts for up to 50% of these deaths. The incidence of traumatic brain injuries is increasing globally, largely due to an increase in motor vehicle use in low-income and middle-income countries.

Purpose
The aim of study was to investigate the factors that modulate the prognosis of patients with traumatic acute subdural hematoma.

Patients and methods
This study was conducted on 30 patients with acute traumatic subdural hematoma managed in the Department of Neurosurgery, ER, and Surgical ICU, Al-Azhar University Hospitals. All the data collected were statistically analyzed and the results were compared with the international results. Our recommendations were based on that comparison.

Results
Mortality rate was 53.3% (16 patients) in our study. The mean and SD of age in our study was 46.3±20.6 years. The range of age was 64 years (21–85 years). There was no statistical difference between sexes as regards age (P=0.393). The entire study population was subjected to logistic regression analysis, severity of injury, presence of a secondary injury especially hypoxia or both hypoxia and hypotension. Polytrauma, status of conscious level at admission, anemia, thickness of hematoma, and necessity for endotracheal intubation were enrolled. The hypoxia and lower Glasgow coma scale at admission were found to be significant predictors of mortality.

Conclusion
Traumatic acute subdural hematoma still has a high mortality rate despite all developments in neurosurgical interventions. Initially low Glasgow coma scale and hypoxia are important parameters that correlate with the mortality rate.
The prognostic value of lymphocyte-to-monocyte ratio in nephropathy of type 2 diabetes mellitus
Authors: Alsayyad Mohammad M. , Abd Alsamie Hesham S. 
Published: June 2019

Background
Inflammatory markers like interleukin-1, 6, and 8, transforming growth factor-β (TGF-β)1, and tumor necrosis factor-α have been found to be associated with diabetic nephropathy (DN), indicating that its pathogenesis may be inflammatory. These inflammatory markers are not routinely used, so, creating the need for easily and routinely done markers aim to enhance the prognostic process of diabetic microvascular complications. Lymphocyte-to-monocyte ratio (LMR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) can be routinely assessed, in addition to being considered as predictors for the survival of patients in renal diseases and malignancies.

Aim
The aim was to evaluate the prognostic value of LMR in DN of type 2 diabetes mellitus, and to compare it with other ratios: NLR and PLR.

Patients and methods
A case–control study including 100 type 2 diabetes mellitus patients and 25 apparently healthy controls. It was carried out at the inpatient and outpatient clinics, Internal Medicine Department, Al-Azhar University Hospital, New Damietta. Three groups were formed according to urinary albumin-to-creatinine ratio; group I, type 2 diabetics with normoalbuminuria, group II, type 2 diabetics with increased albuminuria, with further division into group IIA: with microalbuminuria/group IIB: macroalbuminuria or overt DN, and group III: controls. Full history, clinical examination, and laboratory tests: urinary albumin-to-creatinine ratio and complete urine analysis, complete blood count with assessment of LMR, NLR, and PLR, beside, blood sugar, HbA1c, renal function with assessment of estimated glomerular filtration rate, liver function, abdominal ultrasonography, fundus examination, and ECG were done for all the participants.

Results
The LMR mean was 2.4/2.8/3.2/2.1 in group I/IIA/IIB/III, respectively, showing the increasing ratios in parallel with the progression of DN severity and albuminuria through the groups, with the highest ratios in group IIB of overt DN. The NLR mean was 1.8/2.9/3.7/1.2 and the PLR mean was 175, 8/249, 2/277, 3/108, 3 in the corresponding group. Receiver operating characteristic curve analysis for ratios between groups I and IIA demonstrated that with a best cutoff point of 2.66 for the LMR, the sensitivity was 44%, the specificity: 92% (the ability of the LMR to predict DN risk); 2.2 for the NLR, the sensitivity: 84%, the specificity: 98%; 207 for the PLR, the sensitivity: 72%, and the specificity: 80%. So, in predicting the DN risk, NLR came first as regards the specificity followed by LMR and then PLR, but followed by PLR and then LMR as regards the sensitivity.

Conclusion
LMR may be considered as a surrogate inflammatory marker for DN in early stages and in between stages, but it is not better than NLR as a screening tool for DN diagnosis.
Frequency of destructive spondyloarthropathy among patients on regular hemodialysis
Authors: Kotb Hend G. , Gad Adela M. , Mohamed Nagwa Abd El-Ghaffar , EL-Din Reham M.N. 
Published: June 2019

Objective
Musculosk eletal complications occur in patients suffering from chronic kidney diseases. The cause of destructive spondyloarthropathy (DSA) among those patients is not well known. This study aims to study the frequency of DSA among hemodialysis patients.

Patients and methods
The study was conducted on 75 patients known to be end-stage renal disease patients: they were divided into three groups: chronic kidney disease on regular hemodialysis for more than or equal to 5 years group (n=25), patients on regular hemodialysis for less than 5 years group (n=25), and end-stage renal disease prior to hemodialysis as a control group (n=25). All of them were subjected to: full medical history, clinical examination, and plain radiographs of the whole spine in two views. Serum beta 2-microglobulin (β2-M) levels were determined.

Results
A comparison of β2-M serum levels in three groups showed a highly significant difference being highest in group I and lowest in group III (P<0.001). There was high statistically significant increase in the frequency of DSA in group I compared with group II and in group II compared with group III (P<0.001). As regards the affected site among positive cases, DSA was observed to affect the cervical region in 82.35% more than the lumbar in 11.76%, and rarely to involve both cervical and lumbar in the same patient in 5.88%, DSA was observed to affect men (58.8%) more than the women (41.2 %). Comparison of age, duration of dialysis, and intact parathyroid hormone levels between positive and negative DSA cases revealed that DSA is significantly more prevalent in older age patients (P<0.05), and those with long dialysis duration (P<0.001), and those having higher intact parathyroid hormone levels (P<0.001).

Conclusion
DSA is the most serious spinal complication in patients on long-term hemodialysis. Serum β2-M is elevated in patients receiving long-term hemodialysis (>5 years) and is positively correlated with destructive changes (DSA).
Echocardiographic assessment of right ventricular functions in children after surgical repair of Tetralogy of Fallot
Authors: Shehata Eslam M.A. , El Nagar El-Sayed M. , El Dsoky Shara Mohamed , Abu-Farag Ibrahim M. 
Published: June 2019

Introduction
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Between 3.5 and 10% of the patients with congenital heart disease have TOF, with males and females being affected equally.

Aim
The aim of this study is to assess right ventricular (RV) functions in children after surgical repair of TOF and to detect echocardiographic indices of prognostic value in these cases.

Patients and methods
This is a cross-sectional analytic study. It was conducted at Bab Elsharia Hospital of Al-Azhar University in Cairo over a period of 18 months from May 2017 till October 2018. It included 30 children who underwent surgical repair for TOF.

Results
A study was conducted on 30 children, comprising 11 male and 19 female children, and their mean age was 54.30±24.30 months. RV function assessment has been employed by MRI in eight cases, and conventional two-dimensional and Doppler echocardiography and finally tissue Doppler imaging in all cases. Postoperative echocardiography showed that the mean value of tricuspid annular plane systolic excursion was 14.78±4.53 mm, Myocardial Performance Index was 0.45±0.07, and RV end-diastolic diameter/left ventricular end-diastolic diameter was 1.03±0.27.

Conclusions
After surgical repair of TOF, the RV systolic and diastolic dysfunction can be detected in most patients by echocardiography in the form of prolonged Myocardial Performance Index, low value of tricuspid annular plane systolic excursion, and decreased myocardial velocities of RV. There is a significant relation between the use of transannular patch and RV dysfunction after complete surgical repair of TOF.
A comparative study between the effect of intrathecal hyperbaric bupivacaine with fentanyl and hyperbaric levobupivacaine with fentanyl for knee arthroscopy
Authors: Hussien Ayman Esmail , Abdel Halim Mohamed Adel Gawad 
Published: June 2019

Background
The use of levobupivacaine as a pure S (−) enantiomer of bupivacaine was progressively increased due to lower cardiotoxicity and neurotoxicity and shorter motor block duration. The aim of this work was to compare the effectiveness of lower-dose local anesthetics’ use together with higher opioid dose to decrease the side effects of drugs. We compared sensorial, motor block levels and side effects of equal doses of hyperbaric bupivacaine and levobupivacaine with intrathecal fentanyl addition in knee arthroscopy.

Patients and methods
After hospital ethics committee approval and getting written informed consent from patients, 100 patients with American Society of Anesthesiologists grade I–II, aged 18–40 years were included in the study. They were randomized to either group A receiving 7.5 mg (1.5 ml) hyperbaric levobupivacaine with 25 μg (0.5 ml) fentanyl, or group B receiving 7.5 mg (1.5 ml) hyperbaric bupivacaine with 25 μg (0.5 ml) fentanyl.

Results
Hemodynamic parameters such as the 45th minute mean arterial pressure of group B was found to be lower (P<0.05). In group A, maximum sensorial block level and postoperative visual analog scale scores were higher (P<0.05). Onset of motor block time, time to maximum motor block, time to sensorial block, reversal of two dermatome and first analgesic need were similar in both groups.

Conclusion
Intrathecal hyperbaric levobupivacaine–fentanyl combination is a better and good alternative to bupivacaine–fentanyl combination in knee arthroscopy, as it maintains hemodynamic stability.
Relationship of vitamin D level and microalbuminuria in type 2 diabetic patients
Authors: Abdallah Amany M. , Moustafa Nariman , Soliman Somayh , Abdullatief Bossy , El-Ghaffar Nagwa Abd 
Published: June 2019

Background
Great prevalence of patients with type 2 diabetes mellitus (T2DM) has been witnessed in the last decades worldwide. The global prevalence has been estimated to reach 6.4% among adults at the beginning of the current decade. Diabetic nephropathy is considered the most common complication that affects the kidney and plays as a leading cause of end-stage kidney disease. The presence of proteinuria in diabetic patients is a sign of risk. Vitamin D is a multitrait steroid hormone involved in a wide spectrum of cell regulatory and metabolic functions. Multiple diseases were observed to be frequently associated with low levels of vitamin D.

Objective
To estimate the level of vitamin D in T2DM patients, to assess its relation to microalbuminuria, and to estimate the effect of vitamin D replacement on these patients.

Patients and methods
A case–control study was conducted on 50 T2DM patients having microalbuminuria (group 1), 50 T2DM patients with no microalbuminuria (group 2), and 50 apparently healthy persons (group 3) (the control group), Routine tests such as complete blood count, fasting blood glucose, 2 h postprandial blood glucose, glycosylated hemoglobin’, liver enzyme tests [alanine aminotransferase (ALT), aspartate aminotransferase (AST)], kidney function tests (urea, creatinine), lipid profiles [cholesterol, Triglyceride (TG)], serum albumin, calcium, phosphorus, intact parathyroid hormone (PTH), 25-hydroxycholecalciferol in the blood, and urinary albumin/creatinine ratio were done.

Results
The study showed highly statistically significant decrease of vitamin D level in group 1 (diabetes with microalbuminuria) compared with group 2 (diabetes without microalbuminuria) and group 3 (control) (P<0.001). A statistically significant negative correlation was found between microalbuminuria and vitamin D (r=−0.946). It also showed a highly statistically significant decrease of microalbuminuria after treatment with vitamin D compared with before treatment. There was a highly statistically significant decrease of glycosylated hemoglobin after vitamin D replacement.

Conclusion
This study demonstrated that vitamin D was significantly deficient in diabetic patients in comparison with the control group and it is significantly deficient in T2DM with microalbuminuria compared with T2DM without microalbuminuria. It showed that microalbuminuria was significantly improved after treatment with vitamin D but not to nonmicroalbminuric level. These findings indicated that there is a potential role of vitamin D in diabetic nephropathy pathogenesis.