bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relation between body fat distribution, plasma concentrations of adipokines and the metabolic syndrome in patients with clinically manifest vascular disease
Authors: Schrover Ilse M , van der Graaf Yolanda , Spiering Wilko , Visseren Frank LJ 
Published: July 2018

Abstract

Introduction
We evaluated the relationship between adipokine plasma concentrations and body fat distribution and the metabolic syndrome.

Methods
In a cohort of 1215 patients with clinically manifest vascular disease the relation between subcutaneous adipose tissue, visceral adipose tissue, waist circumference, body mass index and plasma concentrations of adipsin, chemerin, monocyte chemoattractant protein-1, migration inhibitory factor, nerve growth factor, resistin, plasma amyloid A1, adiponectin, leptin, plasminogen activator inhibitor-1 and hepatic growth factor were cross-sectionally assessed with linear regression and adjusted for age and gender. The relation between adipokines and the metabolic syndrome was cross-sectionally evaluated using logistic regression. An adipokine profile was developed to measure the effect of combined rather than single adipokines.

Results
Adiposity was related to higher nerve growth factor, hepatic growth factor, migration inhibitory factor, leptin and adipsin and with lower chemerin, plasminogen activator inhibitor-1, resistin, plasma amyloid A1 and adiponectin. The strongest positive relations were between body mass index and adipsin (β 0.247; 95% CI 0.137–0.356) and leptin (β 0.266; 95% CI 0.207–0.324); the strongest negative relations were between body mass index and plasma amyloid A1 (β –0.266; 95% CI –0.386 to –0.146) and visceral adipose tissue and adiponectin (β –0.168; 95% CI –0.226 to –0.111). There was no relation between subcutaneous adipose tissue and adipokines. Odds for the metabolic syndrome were higher with each 1 SD higher hepatic growth factor (OR 1.21; 95% CI 1.06–1.38) and leptin (OR 1.26; 95% CI 1.10–1.45) and lower with each 1 SD higher adiponectin (OR 0.73; 95% CI 0.64–0.83) and resistin (OR 0.85; 95% CI 0.74–0.97). The adipokine profile was related to the metabolic syndrome (OR 1.03; 95% CI 1.00–1.06).

Conclusion
Plasma concentrations of adipokines are related to obesity and body fat distribution. The relation between adipokine concentrations and the metabolic syndrome is independent of visceral adipose tissue.
Is the Kidney Donor Risk Index a Useful Tool in Non-US Patients?
Authors: Young Ann , Knoll Greg A. , McArthur Eric , Dixon Stephanie N. , Garg Amit X. , Lok Charmaine E. , Lam Ngan N. , Kim S. Joseph 
Published: July 2018

Background: Deceased donor kidney allocation in the United States is guided by the Kidney Donor Risk Index (KDRI). The generalizability of the KDRI beyond the United States has not been widely studied. Objective: To assess the generalizability of the KDRI in a cohort of non-US (Canadian) deceased donor kidney transplant recipients. Design: Population-based retrospective cohort study. Setting: Ontario, Canada. Patients: Recipients of deceased donor kidneys from January 1, 2005, to March 31, 2011. Methods: Using administrative data, we analyzed a cohort of deceased donor kidney recipients in Ontario, Canada. The Kaplan-Meier method and Cox proportional hazards models were used to assess the relationship between KDRI and the outcomes of graft loss and death. KDRI was modeled continuously and categorically. The ability of models with KDRI to predict recipient outcomes beyond donor age was also explored. Model discrimination was assessed using c-statistics, evaluated at 5 years of follow-up. Results: A total of 1299 consecutive deceased donor kidney transplant recipients were included. The median follow-up was 5.5 years. Mean donor age increased from 27 to 64 years across ascending KDRI quintiles. The adjusted relative hazards (95% confidence interval) for total graft loss from Q2 to Q5 (referent = Q1) were 1.27 (0.89-1.80), 1.58 (1.13-2.22), 1.43 (1.01-2.02), and 2.15 (1.54-2.99), respectively. Increased relative hazards across KDRI quintiles were also observed for death-censored graft loss, but not death with graft function. All-cause mortality was increased for the highest KDRI quintile only. In this cohort, a model with KDRI performed better than a model with donor age alone ( P = .009). Limitations: Large health care databases may have precluded the complete capture of covariate data. Conclusions: In conclusion, the KDRI is generalizable to Canadian patients in Ontario and may help inform risk assessment beyond donor age. The performance of KDRI in other non-US settings, and the need for additional model refinement, warrants further study.
Resting Pain Level as a Preoperative Predictor of Success With Indirect Decompression for Lumbar Spinal Stenosis: A Pilot Study
Authors: Khalsa Amrit S. , Eghbali Areian , Eastlack Robert K. , Tran Stacie , Akbarnia Behrooz A. , Ledesma Justin B. , Mundis Gregory M. 
Published: July 2018

Study Design: Retrospective review of a single institution. Objective: To determine if resting leg pain level is a predictor of success for indirect decompression in the setting of lumbar spinal stenosis, with lower levels of rest pain correlating with greater likelihood of successful indirect decompression. Methods: Reviewed anterior or lateral lumbar interbody fusions from T12 to L5-S1 patients with a posterior-based pedicle screw-rod construct. Patients were separated into 2 groups based on a preoperative response to Oswestry Disability Index (ODI) Question 7 regarding level of pain at rest in the supine position. Responses of 0 to 2 (minimal rest pain) were group 1 (n = 54) and responses of 3 to 5 (significant rest pain) were group 2 (n = 16). Results: Preoperative difference was detected between groups 1 and 2, in ODI (38 vs 63, P < .001) and Numeric Rating Scale (NRS) back (6.8 vs 7.9, P = .023). Three-month NRS leg and back scores were significantly lower in group 1 (leg, 1.9 vs 4.8, P < .001; back, 3.5 vs 6.4, P = .001). A significant difference was further noted in the percentage decrease in NRS leg and back scores from pre- to 3 months postoperatively between groups 1 and 2 (leg, 68.4% vs 22.7%, P < .001; back, 40.0% vs 7.4%, P = .012). Group 1 reached minimal clinically important difference for leg pain more often than group 2 (83.3% vs 43.8%, P = .001). Conclusion: Preoperative assessment of rest pain level in the supine position has a significant association with reduction in NRS leg and back scores in patients undergoing indirect decompression for lumbar spinal stenosis. This tool may successfully indicate which patients will be candidates for indirect decompression with interbody fusion from an anterior or lateral approach.
Arthroscopic Primary Repair of Proximal Anterior Cruciate Ligament Tears: With or Without Additional Suture Augmentation?
Authors: Jonkergouw Anne , van der List Jelle P. , DiFelice Gregory S. 
Published: July 2018

Objectives: Over the last years, arthroscopic primary repair of anterior cruciate ligament (ACL) tears has shown excellent results owing to appropriate patient selection (only repairing proximal ACL tears and good tissue quality), minimal invasive surgery (arthroscopy) and focus on early range of motion. Some surgeons have repaired proximal ACL tears without suture augmentation while others have used internal suture augmentation to reinforce and thus protect the repaired ligament during range of motion. No studies have yet compared the two surgical techniques. The objective of this study was to compare failure rates, reoperation rates and patient-reported outcomes of arthroscopic primary repair with versus without suture augmentation. Methods: A retrospective search for all patients treated with suture anchor arthroscopic primary ACL repair between April 2008 and June 2016 was performed. All patients with isolated proximal ACL tears (type I) were included. Since the development of internal suture augmentation, this reinforcement was added to the repaired ACLs. Minimum follow-up length was 1.0 years. Results: A total of 56 patients were included (mean age 33 years (range: 14 - 57), 59% male) of which 28 (50%) patients received additional suture augmentation. Mean follow-up was 2.3 years (range: 1.0-9.2). Six of all patients had reruptured their repaired ACL (10.7%), of which four underwent uncomplicated ACL reconstruction and two were treated conservatively. Four reruptures were initially treated with primary repair only (4/28, 14.3%) and two patients with additional suture augmentation (2/28, 7.1%; p = 0.431). During follow-up, three patients underwent reoperation (5.4%; two for medial meniscus tear (one in each group) and one for tibial suture anchor removal of the suture augmentation). Patient-reported outcomes have so far been collected in 20 patients without reruptures (currently collecting), with mean Lysholm score of 96, modified Cincinnati 94, SANE 93, pre-injury Tegner 6.7, postoperative Tegner 6.3 and subjective IKDC 91. Objective IKDC was A in 90%, B in 5%, C in 5%. Conclusion: In this study, the total failure rate of arthroscopic primary ACL repair was 10.7% and was lower with additional suture augmentation (7.1%) than primary repair alone (14.3%). Patients with failed ACL repair underwent uncomplicated primary ACL reconstruction. We recommend adding suture augmentation in high-risk patients (i.e. adolescents, ones with hyperlaxity, high contact sports), to protect the repaired ligament, especially during early range of motion. These data support treating type I proximal ACL tears with arthroscopic primary repair.
Which Factors Increase the Risk of Re-Operation after Meniscus Surgery in the Skeletally Immature?
Authors: Patel Neeraj M. , Mundluru Surya , Beck Nicholas , Ganley Theodore J. 
Published: July 2018

Objectives: The purpose of this study is to determine which factors heighten the risk for subsequent operations in skeletally immature patients undergoing meniscus surgery. Methods: A retrospective institutional database of 1,063 meniscus surgeries performed between 2000 and 2015 was reviewed. All procedures were performed in skeletally immature patients. Demographic and intra-operative information was recorded, as were concurrent injuries or operations and subsequent surgeries. Univariate analysis consisted of chi-square and independent-samples t-tests. Multivariate logistic regression was then performed to control for confounding factors. Results: The mean age at initial surgery was 13.4 years (standard deviation, SD, 2.2 years) and the average follow-up duration was 47 months (SD 54 months). Overall, 314 patients (29.5%) required repeat surgical intervention. 36% of all females required subsequent surgery compared to 26% of males (p<0.01). Discoid menisci underwent repeat operation more frequently than non-discoid menisci (35% vs. 27%, p=0.01). After accounting for confounders in a multivariate model, females had 2.2 times the odds of repeat surgery than males (95% CI 1.4-3.3, p<0.01) and each year of increasing age resulted in 1.3 times higher odds (95% CI 1.1 -1.4, p<0.01). The odds of subsequent surgeries were 4.2 times higher in those with flap tears (95% CI 1.8-9.7, p<0.01) and 2.9 times higher for discoid menisci (95% CI 1.4-6.0, p<0.01). Concomitant anterior cruciate ligament rupture or tibial spine fracture decreased the risk of needing additional surgeries in univariate analysis, but lost statistical significance in the multivariate model. Conclusion: Even when accounting for other factors in a multivariate model, female sex, increasing age, flap tears, and discoid meniscus were risk factors for subsequent procedures after meniscus surgery in skeletally immature patients. The re-operation rate in this population may be higher than previously reported. This study describes, for the first time, risk factors for repeat operations in skeletally immature patients undergoing meniscus surgery. These results can be used to counsel and monitor patients accordingly.
The Influence of Graft Tensioning Sequence on Tibiofemoral Orientation during Bicruciate and Posterolateral Corner Knee Ligament Reconstruction: A Biomechanical Study
Authors: Moatshe Gilbert , Chahla Jorge , Brady Alex , Dornan Grant , Muckenhirn Kyle , Kruckeberg Bradley , Engebretsen Lars , LaPrade Robert F. 
Published: July 2018

Objectives: During a multiple knee ligament reconstruction, the graft tensioning order may influence the final tibiofemoral orientation and corresponding knee kinematics. Therefore, the objective of this study was to biomechanically evaluate the effect of different graft tensioning sequences on knee tibiofemoral orientation following multiple knee ligament reconstruction in a bicruciate ligament (anterior cruciate ligament [ACL] and posterior cruciate ligament [PCL]) with posterolateral corner [PLC] injured knee. Methods: Ten non-paired, fresh-frozen human cadaveric knees were utilized for this study. Following reconstruction of both cruciate and posterolateral corner ligaments and proximal graft fixation, each knee was randomly assigned to each of four graft tensioning order groups: (1) PCL → ACL → PLC, (2) PCL → PLC → ACL, (3) PLC → ACL → PCL and (4) ACL → PCL → PLC. The tibiofemoral orientation after graft tensioning was measured and compared to the intact states. Results: Tensioning the ACL first (tensioning order 4) resulted in posterior displacement of the tibia at 0° by 1.7 ± 1.3 mm compared to the intact state (p=0.002) (Figure 1). All tensioning orders resulted in significantly increased anterior tibial translation compared to the intact state at higher flexion angles ranging from 2.7 mm to 3.2 mm at 60° and 3.1 mm to 3.4 mm at 90° for tensioning orders 1 and 2 respectively (all p<0.001). There was no significant difference in tibiofemoral orientation in the sagittal plane between the tensioning orders at higher flexion angles. All tensioning orders resulted in increased internal tibial rotation (all p<0.001). Tensioning and fixing the PLC first (tensioning order 3) resulted in the most increases in internal rotation of the tibia; 2.4° ± 1.9°, 2.7° ± 1.8° and 2.0° ± 2.0° at 0°, 30° and 60° respectively (Table 1). Conclusion: None of the tensioning orders restored intact knee tibiofemoral orientation. Tensioning the posterolateral corner first should be avoided in bicruciate knee ligament reconstruction with a concurrent posterolateral corner reconstruction because it significantly increased tibial internal rotation. We recommend that the PCL be tensioned first, followed by the ACL to avoid posterior translation of the tibia in extension where the knee is primarily loaded with most activities and finally the PLC. [Figure: see text][Table: see text]
Bacterial Biofilms Are Associated With Tunnel Widening In Failed ACL Reconstructions
Authors: Flanigan David C. , Everhart Joshua Scott , DiBartola Alex , Moley James , Dusane Devendra , Magnussen Robert A. , Kaeding Christopher C. , Stoodley Paul 
Published: July 2018

Objectives: Technical errors, traumatic re-injury, and biologic failure all play a potential role in failure after ACL reconstruction (ACLR). Recent work has demonstrated the frequent presence of biofilms on failed ACLR grafts. Tunnel widening is commonly observed upon presentation for revision ACLR but the relationship between biofilm presence and tunnel widening is unclear. The purpose of this study is to determine whether tunnel widening is associated with bacterial biofilms in failed ACL reconstructions. Methods: 34 consecutive revision ACLR cases and 5 primary ACLR controls were included. Tissue biopsies were obtained from tibial, femoral, and intra-articular segments of revision cases and torn native ligament as well as excess hamstring graft after fixation from primary ACLR controls. Clinical cultures as well as PCR for bacterial DNA with a universal primer were obtained on all patients. Fluorescence microscopy was used to visually confirm presence of biofilm. No patients had clinical signs of infection. Tunnel diameters were measured on pre-operative 3-dimensional imaging. Results: Bacterial DNA was present in 87% of cases and 20% of controls. Cultures were only positive (coagulase negative staphyloccous sp.) in one revision case, the widest measured tunnel diameters were in this same case (20.1 mm for the tibial tunnel and 16.9 mm for the femoral tunnel) Bacterial DNA was positively associated with wider femoral tunnels (median 10.6 mm with detectable bacterial DNA, median 7.6 mm without detectable bacterial DNA; p=0.04 Wilcoxon rank-sum). There was a trend toward higher rates of bacterial DNA in tibial tunnels with diameters greater than 12.5 mm (LR chi square p= 0.12). Fluorescence microscopy confirmed presence of staphylococcal biofilms adherent to the soft tissue graft surface (Figure 1) as well as inert fixation material including monofilament suture, braided suture, and PEEK and metal interference screws. Conclusion: Bacterial biofilms are commonly encountered on failed ACLR grafts. These biofilms do not cause clinically apparent infection symptoms but are associated with tunnel widening and may contribute to biologic failure.
Internal Brace ACL Repair is Associated with High Failure Rate in the First Two Years Post-Surgery
Authors: Gagliardi Alexia Georgia , Carry Patrick M. , Daoud Ariel Kiyomi , Parikh Harin Bhavin , Albright Jay C. 
Published: July 2018

Objectives: To compare graft/internal brace survival, self-reported functional outcomes, and joint laxity in adolescents who underwent quadriceps tendon patellar autograft (QPA) reconstruction versus ACL repair with internal brace ligament augmentation. Methods: We identified all adolescent and pediatric subjects who underwent primary ACL reconstruction or repair with internal brace augmentation between January 2013 and January 2016. Only subjects with a minimum of 6 months of follow-up were included. Graft failure, range of motion (ROM), complications, and demographic information including age and gender was collected. Failure was defined as the need for revision surgery or MRI-confirmed graft/internal brace failure. Subjects were prospectively contacted by telephone and were invited to either schedule a follow-up appointment or to complete research questionnaires over the phone. Objective joint laxity measures, KT1000, were obtained from a subset of subjects (N=25 QPA and N=6 repair group) that completed the research visit. Wilcoxon rank sum tests were used to compare IKDC and joint laxity measure. Multi-variable Cox proportional hazards regression analyses were used to compare failure-free survival in the two groups during the first 24 months post-surgery. Results: The final cohort included 132 patients in the QPA group (52% female) and 19 patients in the repair group (53% female). The repair group tended to be younger (mean: 14.1 yrs, ±2.9 vs 15.5 yrs, ±1.8). Median duration of follow-up was 2.1 years [range: 0.5-4 years] in the repair group compared to 1.2 years [range: 0.5-4 years] in the QPA group. Within the first 24 months post-surgery, the cumulative incidence of failure was 3.8% (5/132) in the QPA group compared to 52.6% (10/19) in the repair group. After adjusting for age, the hazard of failure in the repair group was 22.1 [95% CI: 6.7 to 73.2, p <0.0001] times the hazard of failure in the QPA group. KT-1000 side-to-side joint laxity measures in the repair group [Median: 2.5 mm, range: -1 mm to 7 mm] were significantly [p=0.0212] higher than the joint laxity measures in the QPA group [Median: 1.0 mm, range: -1 mm to 4 mm]. There was no difference [p= 0.3826] in IKDC scores in the repair group [N=53, median: 97, range: 58-100] compared to the QPA group [N=10, median: 94, range: 32-100]. Conclusion: Failure rate and joint laxity measures were significantly increased in the internal brace repair group relative to the QPA group. Failure-free survival in the repair group was less than 50% at two years.The high failure rate in the repair group should be considered when selecting the appropriate intervention for the pediatric adolescent athlete with an ACL injury.
Relationship Between Pitcher Fatigue and Medial Elbow Torque in Baseball Pitchers: A Simulated Game Analysis
Authors: Makhni Eric C. , Meldau Jason E. , Stephens Jeff , Okoroha Kelechi , Lizzio Vincent A. , Meta Fabien , Ahmad Christopher S. , Moutzouros Vasilios 
Published: July 2018

Objectives: The incidence of overuse injury to the elbow in baseball pitchers continues to rise, despite exhaustive efforts at pitch count regulations and emphasis on proper throwing mechanics. The goal of this study was to determine if the medial elbow experiences increased torque levels as the pitcher fatigues through the course of a simulated game. Methods: Competitive baseball pitchers were recruited for this simulated game study. Medial elbow torque was assessed using a validated mobile sensor that recorded medial elbow torque during the throwing motion. A radar gun was used to capture pitch velocity for each recorded pitch. Each pitcher completed a simulated game consisting of 6 innings and a standardized pitching scheme of fastballs, curveballs, and change-ups. Visual analog scores (VAS) measuring fatigue were recorded in between each inning. In total, each pitcher threw 90 pitches. Data was recorded every pitch to include ball velocity, medial elbow torque, arm speed, arm rotation, and arm slot. Results: A total of 11 pitchers (average age 17.6 years; range 15-20 years) completed the study. No adverse outcomes were noted with use of the mobile sensor. VAS scores increased 0.716 points per inning pitched (p<0.001). Medial elbow torque also was found to increase with successive innings, with an increase of 0.836 Nm each inning (p<0.001), while average pitch velocity was found to decrease as the game progressed (0.28 mile per hour decrease per inning; p<0.001). Fastballs generated the highest amount of medial elbow torque. There were no differences found in arm rotation or arm speed as the game progressed. However, the arm slot was found to decrease with each successive inning (0.731 degree decrease per inning; p<0.001). Conclusion: In this simulated game analysis, pitchers were noted to experience increase fatigue after each successive inning. While the average fastball velocity decreased from inning-to-inning, the medial elbow torque was found to increase, signifying a possible risk factor for overuse injury to the medial elbow.