bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk of tibial fracture after patella distallization and strategies for prevention
Authors: Paterson Roger 
Published: May 2017

Objectives: To identify the risk of spontaneous proximal tibial shaft fracture after distallization of the patella, and prevention strategies. Methods: Case reports and operative technique. Two cases of tibial fracture are presented, arising from a stress riser in the tibial crest due to a residual anterior cortical defect. There had been no warning symptoms before the fractures. Results: The fractures required internal fixation of the proximal tibial shaft. Discussion: Prevention requires check X-Ray prior to return to full activity after patella distallization, and possible further surgery if a residual cortical defect is identified. At the time of the index surgery, the risk of a residual cortical defect can be minimized by ensuring accurate apposition of the two anterior bone fragments, and applying compression across the site of an oblique osteotomy between those fragments where a bone segment is resected. Conclusion: Awareness of this potential complication should ensure effective preventative strategies.
Meniscal Allograft Transplantation: Factors Predicting Failure
Authors: Parkinson Ben , Smith Nicholas , Thompson Peter , Spalding Tim 
Published: May 2017

Background: Meniscal allograft transplantation (MAT) has been shown to provide a significant improvement in patient reported outcomes for individuals with post-menisectomy syndrome. The typical patients undergoing MAT often have multiple other pathologies that require treatment at the time of surgery and it is difficult to ascertain which factors influence the outcome. Hypothesis / Purpose: The aim of this study was to determine the predictors of meniscal allograft transplantation failure in a large series in order to refine the indications for surgery and better inform future patients. Study Design: Prospective case series. Methods: All patients undergoing MAT at a single institution between May 2005 and May 2014, with a minimum of one year follow up were prospectively evaluated and included in this study. Failure was defined as removal of the allograft, revision transplantation or conversion to a joint replacement. Patients were grouped according to the articular cartilage status at the time of surgery; Group 1 – intact or partial thickness chondral loss; Group 2 - full thickness chondral loss one condyle; Group 3 - full thickness chondral loss both condyles. The Cox proportional hazards model was used to determine significant predictors of failure (cartilage grade at the time of MAT, IKDC score, lateral or medial allografts, gender, additional procedures and tissue bank source), independently of other factors. Kaplan-Meier survival curves were produced for overall survival and significant predictors of failure in the Cox proportional hazards model. Results: There were 125 consecutive MATs performed, with one patient lost to follow up. The median follow up was 3 years (range 1 – 10 years). The 5 year graft survival for the entire cohort was 82% (97% group 1, 82% group 2, 62% group 3). The probability of failure in group 1 was 85% lower (95% confidence interval 13 – 97%) than in group 3 at any time. The probability of failure with lateral allografts was 76% lower (95% confidence interval 16 – 89%) than medial allografts at any time. Conclusion: This study showed that the presence of severe cartilage damage at the time of MAT and medial allografts were significantly predictive of failure. Surgeons and patients can use this information when considering the risks and benefits of surgery.
Fast Bowlers Knee - anterior impingement from the antero-medial tibia and femur
Authors: Reid MJ , Thompson SM , Dawahn R , Jones M , Williams A 
Published: May 2017

Objectives: Cricket is one of the world’s most popular team sports. In the past it was described as a sport of moderate risk for injury however at elite level, the international cricket timetable has massively expanded to encompass several new formats leaving very little time for recuperation. We report on a series of seven elite level fast bowlers that presented with a similar injury pattern to the antero-medial femoral condyle of the knee in the leading leg. We describe the presentation, investigation and treatment of this lesion and discuss the possible aetiology. This injury pattern has not previously been reported in the literature. Methods: 7 international level fast bowlers (two Indian and 5 English) presented to our clinic with knee pain in the lead leg (the right knee for left hand bowlers and the left knee for right handed). The mean age of the patients was 27 (20-32) and the mean duration of symptoms was 9 months (2 weeks to 2 years). In all patients a careful history and examination was undertaken followed by appropriate investigations. The main complaint was that of anterior knee pain which was restricting them from bowling. It was associated with a minor fixed flexion in three of the patients and all patients had an effusion at the time of presentation. There were no other symptoms. All patients underwent an MRI scan. A classical appearance of oedema within the medial femoral condyle (Figure 1) was noted. In 4 patients there was ascociated cartilage loss. The injury was also identified on SPECT scan (Figure 2) 3 patients were managed nonoperatively but due to more significant MRI and clinical findings Four went on to require arthroscopic surgery (Figure 3) in the form of microfracture of the lesion. Results: All patients returned to International cricket with a mean of 6 months in the non-operative group and 8 months in the operative group. Conclusion: Anterior impingement from the antero-medial tibia and femur can be a potentially career ending lesion in the fastbowler. A strong index of suspicion has to be exercised when a bowler attends with an effusion associated with episodic pain and localisation (which may be difficult to ascertain). This lesion may be present in the asymptomatic bowler, presenting with an associated injury in the same knee. This lesion is typical in this elite group and as such training schedules and medical staff need to be aware of it as a cause of significant injury.
Total Knee Arthroplasty in the 21st century: Why Do They Fail? A Fifteen-Year Analysis of 11, 135 Knees
Authors: Young Simon W , Koh Chuan Kong , Ravi Saiprasad , Zhu Mark , Vince Kelly G 
Published: May 2017

Introduction and Aims: As national total knee arthroplasty (TKA) registries evolve, there is an increasing trend towards publication of hospital and surgeon-level outcome data, with the goal of stimulating efforts to optimise the results of TKA. Such efforts first require understanding of the current mechanisms of TKA failure. Previous reports on revision TKA from tertiary referral centres lack data on the overall denominator, thus the relative importance of each failure mechanism leading to TKA revision over long term follow up remains unclear. The aim of this study was to analyse reasons for revision following primary TKA, and assess their relative frequencies over long-term follow-up. Methodology: 11,134 primary TKA performed between 2000-2015 at one of three tertiary referral hospitals were identified. ‘Failure’ was defined as patients undergoing subsequent revision surgery involving change of of one or more components or reoperation for deep periprosthetic joint infection (PJI). Patients were identified from a combination of the New Zealand National Joint Registry and individual search of patient records and clinical coding (ICD-9 and ICD-10). All relevant clinical records, radiographs, and lab results were obtained from all New Zealand hospitals to identify the primary reason for revision according to a standardised protocol. Results: A total of 357 (3.2%) failures over the 15 year period were identified. Of these, 36% were revised within one year and 56% were revised within 2 years of primary TKA. Periprosthetic joint infection (PJI) encompassed 48% of all reasons for revision, followed by aseptic loosening (15%), secondary patella resurfacing (14%), tibio-femoral instability (9%), stiffness (5%), polyethylene wear (2.5%), periprosthetic fracture (2.3%), patella maltracking (1.9%) and extensor mechanism discontinuity (0.9%). In the first 5 years following primary TKA, the most common reason for revision was PJI (52%), from 5-10 years PJI and aseptic loosening (35% each), and from 10-15 years aseptic loosening (41%). Conclusion: In this large cohort of patients with comprehensive follow up, PJI was the dominant reason for failure particularly in the first 10 years. Aseptic loosening becomes more important after 10 years follow up. Efforts to improve outcomes following primary TKA should focus on these areas, particularly prevention of PJI.
Success of Debridement and Implant Retention for Periprosthetic Joint Infection in TKA – Does The Surgeon Matter?
Authors: Young Simon W , Zhu Mark , Ravi Saiprasad , Cowley Richard , Luey Chris 
Published: May 2017

Introduction: Prosthetic joint infection (PJI) is a devastating complication following total knee arthroplasty (TKA). In acute haematogenous and early post-operative PJI, debridement and implant retention (DAIR) is often the initial treatment and reported success rates vary. The aim of this study was to identify factors affecting the success of DAIR and in particular whether involvement of a lower limb arthroplasty surgeon (LLA) can affect outcome. Method: In a multicentre review over a 15 year period we identified 137 patients undergoing DAIR for first episode PJI following primary TKA at one of three tertiary hospitals. Patients receiving arthroscopic washouts, culture negative PJI, and previous PJIs were excluded. Data on patient, hospital, and surgical factors were identified including age of implant, time to theatre, presence of gross purulence, bacterial subtype, inflammatory markers, relevant comorbidities, whether modular component exchange was performed, and whether a lower limb arthroplasty surgeon performed the procedure. Treatment success was defined as infection eradication characterized by no clinical failure (healed wound and painless joint) or infection recurrence, and no mortality or further surgery due to PJI within minimum two-year follow up post DAIR. Multivariate analysis was performed using a logistic regression model to identify factors associated with successful DAIR. Results: Overall failure rate of DAIR in TKA was 42%. A specialist arthroplasty surgeon was present in 49% of cases. Arthroplasty surgeons performed modular exchange in 92% of cases compared to 57% for other surgeons (RR1.6, P <0.01). On multivariate analysis, involvement of a specialist arthroplasty surgeon was the only factor associated with a significant increase in success of DAIR (OR 2.94, P=0.01). Age of prosthesis less than 90 days and the lack of macroscopic purulence (OR 2.44, p=0.04) increased DAIR success on univariate analysis only. Conclusions: Involvement of a specialist arthroplasty surgeon was associated with a 2.9 times higher success rate for DAIR in TKA. Specialist arthroplasty surgeons were more likely to perform modular exchange. This study suggests surgical technique and thorough debridement is likely to be important to the success of DAIR in TKA.
Femoral Stress Fracture Following Meniscal Failure
Authors: Witherow Dr Greg 
Published: May 2017

Objectives: To discuss the effect of meniscal failure. Methods: A presentation of a series of cases followed by a literature review and conclusion Results: A presentation of a series of cases of femoral fracture following arthroscopic meniscectomy and also after failure of meniscal function following a tear. A review of the historical perspectives of the causes of the condylar breakdown. A discussion of the likely cause of femoral condylar fracture and its management. Conclusion: An understanding of the effect of loss of meniscal function and the patients who are at risk.
The Complimentary Contributions of the Anterolateral Ligament and the Lateral Meniscus to the Control of Rotational Knee Laxity
Authors: Lording Tim , Corbo Gillian , Burkhart Tim , Getgood Alan 
Published: May 2017

Objectives: Anatomical studies consistently describe an anatomical connection between the anterolateral ligament (ALL) and the lateral meniscus. The aim of this study was to investigate the role of the ALL and lateral meniscal posterior root (LMPR) in internal rotational (IR) control in the ACL deficient knee. Methods: Sixteen cadaveric knees were potted into a hip simulator proximally and a six degree of freedom load cell distally. Positional data for femur and tibia were collected using a navigation system. Testing was performed in 15° increments from extension to 90° of flexion under a 5 Nm internal rotational torque. Specimens were tested in the intact state and after division of the ACL (ACL-), before randomization to division of the ALL (ALL-/M+) or LMPR (ALL+/M-), and finally after division of the remaining structure (ALL-/LMPR-). A one-way ANOVA was performed for each sectioning condition at each knee flexion angle (α = 0.05). Results: In extension, there was no significant increase in IR after division of the ACL. After division of the LMPR, there was a significant increase in IR compared to the intact state of 2.93° (p<0.05). Division of the ALL caused only a small increase in IR compared to the intact state (0.87°, NS). Division of the ALL after the LMPR caused no additional increase in IR. At 30° flexion, division of the ALL caused a greater magnitude increase in IR when compared to the intact state than division of the LMPR (4.04° vs 1.32°), although neither reached statistical significance. At 45° flexion, division of the ALL increased IR compared to the intact state by 10.92° (p<0.05), whilst IR caused by division of the PRLM did not reach significance. This pattern of ALL dominance was maintained at 60° and 75° of knee flexion, where the increase in IR was significant compared to both the intact and ACL deficient states. Discussion: The ALL and LMPR demonstrate complimentary roles in the control of internal rotation, with the meniscal root more important near extension and the ALL beyond 30° of flexion. These results do not support anatomical ALL reconstruction for control of the pivot shift. LMPR repair may improve stability and have benefits for chondroprotection.
Multifocal brain involvement in a patient with hairy cell leukemia successfully treated with rituximab and cladribine
Authors: Perry Anamarija M. , Matsuda Kant , Wadhwa Vikram , Hewitt Donna , Almiski Muhamad , Johnston James B. , Banerji Versha 
Published: May 2017

Key PointsBrain involvement, although rare, can occur in HCL. The combination of cladribine and rituximab is a highly effective treatment of HCL with brain involvement.
RETRACTED ARTICLE: Is early intervention using Mansoura-VV uterine compression sutures an effective procedure in the management of primary atonic postpartum hemorrhage? : a prospective study
Authors: El Refaeey Abd Elaziz A. , Abdelfattah Hosam , Mosbah Alaa , Gamal Anas M. , Fayla Emad , Refaie Waleed , Zaied Abdelhady , Barakat Rafik I. , Seleem Amal K. , Maher Mohammed 
Published: May 2017

Abstract
Background
Postpartum hemorrhage is the leading cause of maternal death, uterine atony accounts for 75-90% of primary postpartum hemorrhage. The efficacy of the Uterine compression suture in the treatment of atonic postpartum hemorrhage is time-tested and can be said to be almost established.The aim of this study was to assess the role of the Mansoura-VV uterine compression suture as an early intervention in the management of primary atonic postpartum hemorrhage.

Methods
This prospective observational study included 108 women with primary atonic PPH over a period of 44 months. Uterine atony was diagnosed when the uterus was soft and failed to respond to ordinary ecbolics. Early intervention by Mansoura-VV uterine compression sutures was carried out within 15 min of the second dose of ecobolics and before progressing to any further surgical procedure.

Results
Following the Mansoura-VV uterine compression sutures, uterine bleeding was controlled in all except one patient (107/108 cases; 99.07%) who required additional bilateral uterine vessels ligation. Another case (0.93%) was subjected to re-laparotomy due to intraperitoneal hemorrhage. Packed RBC transfusion was needed in 10 cases (9.25%). Admission to ICU was needed in 9 cases (8.33%) because of associated medical conditions. One week following the procedure, 1 case (0.93%) was diagnosed with haematometra.

Conclusion
Early intervention in cases of primary atonic PPH using the Mansoura-VV uterine compression sutures is an easy, rapid and effective method in controlling PPH in low resource settings.

Trial registration
The study was registered at clinicaltrial.gov, Identifiers: NCT03117647 “retrospectively registererd” registered at April 7, 2017.
Patterns of regional recurrence in papillary thyroid cancer patients with lateral neck metastases undergoing neck dissection
Authors: Xu Jason J. , Yu Eugene , McMullen Caitlin , Pasternak Jesse , Brierley Jim , Tsang Richard , Zhang Han , Eskander Antoine , Rotstein Lorne , Sawka Anna M. , Gilbert Ralph , Irish Jonathan , Gullane Patrick , Brown Dale , de Almeida John R. , Goldstein David P. 
Published: May 2017

Background Practice variability exists for the extent of neck dissection undertaken for papillary thyroid carcinoma (PTC) metastatic to the lateral neck nodes, with disagreement over routine level V dissection. Methods We performed a retrospective medical record review of PTC patients with lateral neck nodal metastases treated at University Health Network from 2000 to 2012. Predictive factors for regional neck recurrence, including extent of initial neck dissection, were analyzed using Cox regression. Results Out of 204 neck dissections in 178 patients, 110 (54%) underwent selective and 94 (46%) had comprehensive dissection including level Vb. Mean follow-up was 6.3 years (SD). Significant predictors of regional failure were the total number of suspicious nodes on preoperative imaging ( p = 0.029), largest positive node on initial neck dissection ( p < 0.01), and whether patients received adjuvant radiotherapy ( p = 0.028). The 5-year ipsilateral regional recurrence rate was 8 and 9% with selective and comprehensive dissection, respectively ( p = 0.89). Conclusion The extent of neck dissection did not predict the probability of regional recurrence in PTC patients presenting with lateral neck metastases.
College student perceptions about the incorporation of cultural elements in fashion design
Authors: Yen Hui-Yun , Hsu Chiu-I 
Published: May 2017

AbstractThe cultural and creative industries have received considerable global attention in recent years; in particular, the close relationship between these industries and design has been identified. Because mysterious and attractive East Asian aesthetic are a crucial contemporary style, this study examined a fashion exhibition held in the New York Metropolitan Museum, which entitled “China: Through the Looking Glass” and conducted a literature review, scale design, survey and data analysis, and factor analysis about the incorporation of cultural elements in fashion design. Subsequently, the perceptions of college students with various educational backgrounds on several selected exhibits were identified and analyzed. The results were revealed that: (1) the research scale can be used as a reference for related design teaching and in the appraisal of fashion products in the design industry; (2) cultural connotations are more notable in design than the technical aspects; (3) compared with students of other backgrounds, students with a background in fashion design emphasized more on the technical and professional aspects and expressed a preference for design pieces with experimental qualities, such as those made with stiff materials and having exaggerated styles, and neutral and neat straight lines.
Heat-resistant cytosolic malate dehydrogenases (cMDHs) of thermophilic intertidal snails (genus Echinolittorina): protein underpinnings of tolerance to body temperatures reaching 55°C
Authors: Liao Ming-ling , Zhang Shu , Zhang Guang-ya , Chu Yun-meng , Somero George N. , Dong Yun-wei 
Published: May 2017

ABSTRACT
Snails of the genus Echinolittorina are among the most heat-tolerant animals; they experience average body temperatures near 41–44°C in summer and withstand temperatures up to at least 55°C. Here, we demonstrate that heat stability of function (indexed by the Michaelis–Menten constant of the cofactor NADH, KMNADH) and structure (indexed by rate of denaturation) of cytosolic malate dehydrogenases (cMDHs) of two congeners (E. malaccana and E. radiata) exceeds values previously found for orthologs of this protein from less thermophilic species. The ortholog of E. malaccana is more heat stable than that of E. radiata, in keeping with the congeners' thermal environments. Only two inter-congener differences in amino acid sequence in these 332 residue proteins were identified. In both cases (positions 48 and 114), a glycine in the E. malaccana ortholog is replaced by a serine in the E. radiata protein. To explore the relationship between structure and function and to characterize how amino acid substitutions alter stability of different regions of the enzyme, we used molecular dynamics simulation methods. These computational methods allow determination of thermal effects on fine-scale movements of protein components, for example, by estimating the root mean square deviation in atom position over time and the root mean square fluctuation for individual residues. The minor changes in amino acid sequence favor temperature-adaptive change in flexibility of regions in and around the active sites. Interspecific differences in effects of temperature on fine-scale protein movements are consistent with the differences in thermal effects on binding and rates of heat denaturation.