bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laser Capsulorrhaphy for Multidirectional Instability of the Shoulder
Authors: Joseph Thomas A. , Williams James S. , Brems John J. 
Published: July 2017

Background Clinical data on the efficacy of laser capsulorrhaphy for the treatment of multidirectional instability of the shoulder are limited. Hypothesis The diagnosis of multidirectional instability includes a spectrum of pathologic symptoms that warrants subclassification; laser capsulorrhaphy alone is not uniformly effective for all subtypes. Study Design Retrospective review of prospectively collected data. Methods Twenty-five shoulders in 21 patients were treated with laser capsulorrhaphy for multidirectional instability. Functional outcomes at a mean duration of 32 months' follow-up (range, 24 to 48 months) were recorded. Results Instability recurred in 60% of patients with congenital multidirectional instability, 17% of patients with acquired multidirectional instability, and 33% of patients with posttraumatic multidirectional instability (overall recurrence rate, 40%). Generalized ligamentous laxity was a risk factor for recurrence. Patient satisfaction rates were 40%, 83%, and 22% for the congenital, acquired, and posttraumatic subgroups. Reasons for dissatisfaction included recurrent instability, persistent pain, and inability to return to athletic activity at desired capacity. The overall mean postoperative Simple Shoulder Test score was 84%. The mean postoperative numeric rating score for pain was 3.3 (10-point scale). Conclusions Laser capsulorrhaphy may be effective for patients with acquired multidirectional instability secondary to repetitive microtrauma but is less predictable in the other subgroups.
Influence of Postoperative Immobilization on Tendon Length after Radiofrequency-Induced Shrinkage
Authors: Pötzl Wolfgang , Witt Kai-Axel , Hackenberg Lars , Heusner Till , Steinbeck Joern 
Published: July 2017

Background Despite the widespread use of radiofrequency-induced shrinkage of collagenous tissues, there have been no animal studies on the effects of postoperative immobilization after such treatment. Purpose To examine the effects of postoperative immobilization after radiofrequency energy treatment, with special emphasis on any tissue length increases. Study Design Controlled laboratory study. Methods The right patellar tendon of 60 New Zealand White rabbits was shrunk with a radiofrequency probe. Tendon length was measured intraoperatively before and after shrinkage and via radiographs immediately postoperatively and at 3, 6, and 9 weeks. Twenty rabbits were not immobilized, 20 were immobilized for 3 weeks, and 20 were immobilized for 6 weeks. Results In the nonimmobilized limbs, the tendon length increased 34.9% at 3 weeks and another 2.5% at 6 weeks, versus 11.2% at 3 weeks and 6.6% at 6 weeks in the immobilized limbs. Ten of the 20 rabbits that were immobilized for 6 weeks were sacrificed at 9 weeks and were found to have a further length increase of 10.8%. At 9 weeks, the tendons of this group were no longer significantly shorter than the tendons from rabbits that had not been immobilized. Conclusions Careful postoperative rehabilitation is imperative after radiofrequency-induced shrinkage. Without protection, exposure to normal physiologic loads places the shrunken tissue at risk of stretching out beyond the preshrinkage length. Clinical Relevance Shrunken tissue is at risk of stretching out after radiofrequency-induced shrinkage.
Injury Rates and Profiles in Female Ice Hockey Players
Authors: Schick Deanna M. , Meeuwisse Willem H. 
Published: July 2017

Background Little data exist on injury rates and profiles in female ice hockey players. Objective To examine the incidence of injury in female ice hockey players and compare injury rates with those of male players. Study Design Prospective cohort study. Methods Six male and six female teams from the Canada West Universities Athletic Association were followed prospectively for one varsity season. Preseason medical history forms were completed by each player. Injury report forms and attendance records for each team session were submitted by team therapists. Results Male players reported 161 injuries, whereas female players reported 66 injuries. However, the overall injury rates for male (9.19 injuries per 1000 athlete-exposures) and female (7.77 injuries per 1000 athlete-exposures) players did not differ significantly. Ninety-six percent of injuries in female players and 79% in male players were related to contact mechanisms, even though intentional body checking is not allowed in female ice hockey. Women were more likely than men to be injured by contacting the boards or their opponent. Men sustained more severe injuries than women and missed about twice as many sessions (exposures) because of injury. Concussions were the most common injury in female players, followed by ankle sprains, adductor muscle strains, and sacroiliac dysfunction. Conclusion Although the injury rate in female ice hockey players was expected to be lower than that in male players because of the lack of intentional body checking, the injury rates were found to be similar.
Effect of Peripheral Afferent Alteration of the Lateral Ankle Ligaments on Dynamic Stability
Authors: Myers Joseph B. , Riemann Bryan L. , Hwang Ji-Hye , Fu Freddie H. , Lephart Scott M. 
Published: July 2017

Background The sensorimotor influence of the lateral ankle ligaments in muscle activation is unclear. Hypothesis The lateral ankle ligaments have significant sensorimotor influence on muscle activation. Study Design Controlled laboratory study. Methods Muscle-firing characteristics in response to a high-speed inversion perturbation and during gait were assessed in 13 normal subjects. Solutions (1.5% lidocaine or a placebo of saline) were injected bilaterally into the anterior talofibular and calcaneofibular ligaments (1.5 ml per ligament) to alter peripheral afferent influence. Subjects were again tested with the same protocol. Results The protective response of the anterior tibialis and peroneal muscles during inversion perturbation and mean muscle activation amplitude decreased during running after both injections. After injection, no significant differences were seen for muscle reflex latencies, maximum amplitude, time to maximum amplitude during inversion perturbation, or mean amplitude during walking. Conclusion The lateral ankle ligaments have a sensorimotor influence on muscle activation. Clinical Relevance Induced edema from the injected solutions may have altered the sensorimotor influence of the lateral ankle ligaments, thereby inhibiting the dynamic ankle stabilizers. This finding suggests that dynamic stability may be compromised because of swelling after joint injury.
Isokinetic Eccentric-to-Concentric Strength Ratios of the Shoulder Rotator Muscles in Throwers and Nonthrowers
Authors: Noffal Guillermo J. 
Published: July 2017

Background One of the possible mechanisms leading to shoulder injury may be a strength imbalance between those muscles that accelerate the upper limb and those responsible for deceleration. Many studies have examined shoulder balance through a concentric strength ratio of external and internal shoulder rotator muscles. Hypothesis A functional external eccentric-to-internal concentric ratio may be a better identifier of muscular imbalance in dominant and nondominant shoulders of throwers and nonthrowers. Study Design Controlled laboratory study. Methods Eccentric external and concentric internal peak torques were measured bilaterally in 59 men (16 throwers and 43 nonthrowers) at 300 deg/sec. Subjects were tested in the supine position with the shoulder abducted to 90° and the elbow flexed to 90°. Results Throwers exhibited significantly lower ratios than nonthrowers in their dominant limb; there was no difference between groups for the nondominant limb. Conclusions The lower ratio in the throwers’ dominant limb was attributed to significantly greater concentric internal rotation torques without concomitant eccentric external torque gains. Clinical Relevance Rehabilitation and injury prevention regimens that include functional exercises to improve eccentric external rotation strength may bring more balance to the dominant shoulder of throwing athletes.
Scapular Muscle Recruitment Patterns: Trapezius Muscle Latency with and without Impingement Symptoms
Authors: Cools Ann M. , Witvrouw Erik E. , Declercq Geert A. , Danneels Lieven A. , Cambier Dirk C. 
Published: July 2017

Background Altered muscle activity in the scapular muscles is commonly believed to be a factor contributing to shoulder impingement syndrome. However, one important measure of the muscular coordination in the scapular muscles, the timing of the temporal recruitment pattern, is undetermined. Purpose To evaluate the timing of trapezius muscle activity in response to an unexpected arm movement in athletes with impingement and in normal control subjects. Study Design Prospective cohort study. Methods Muscle latency times were measured in all three parts of the trapezius muscle and in the middle deltoid muscle of 39 “overhand athletes” with shoulder impingement and compared with that of 30 overhand athletes with no impingement during a sudden downward falling movement of the arm. Results There were significant differences in the relative muscle latency times between the impingement and the control group subjects. Those with impingement showed a delay in muscle activation of the middle and lower trapezius muscle. Conclusion The results of this study indicate that overhand athletes with impingement symptoms show abnormal muscle recruitment timing in the trapezius muscle. The findings support the theory that impingement of the shoulder may be related to delayed onset of contraction in the middle and lower parts of the trapezius muscle.
A Randomized Comparison of Patellar Tendon and Hamstring Tendon Anterior Cruciate Ligament Reconstruction
Authors: Feller Julian A. , Webster Kate E. 
Published: July 2017

Background Patellar and hamstring tendon autografts are the most frequently used graft types for anterior cruciate ligament reconstruction, but few direct comparisons of outcomes have been published. Hypothesis There is no difference in outcome between the two types of reconstruction. Study Design Prospective randomized clinical trial. Methods After isolated anterior cruciate ligament rupture, 65 patients were randomized to receive either a patellar tendon or a four-strand hamstring tendon graft reconstruction, and results were reviewed at 4, 8, 12, 24, and 36 months. Results Pain on kneeling was more common and extension deficits were greater in the patellar tendon group. There were greater quadriceps peak torque deficits in the patellar tendon group at 4 and 8 months but not thereafter. In the hamstring tendon group, active flexion deficits were greater from 8 to 24 months, and KT-1000 arthrometer side-to-side differences in anterior knee laxity at 134 N were greater. Cincinnati knee scores, International Knee Documentation Committee ratings, and rates of return to preinjury activity levels were not significantly different between the two groups. Conclusions Both grafts resulted in satisfactory functional outcomes but with increased morbidity in the patellar tendon group and increased knee laxity and radiographic femoral tunnel widening in the hamstring tendon group.
Low Regional Tibial Bone Density in Athletes with Medial Tibial Stress Syndrome Normalizes after Recovery from Symptoms
Authors: Magnusson Håkan I. , Ahlborg Henrik G. , Karlsson Caroline , Nyquist Fredrik , Karlsson Magnus K. 
Published: July 2017

Background Although the exact cause of medial tibial stress syndrome is unclear, changes in bone metabolism are likely to be involved. Hypothesis Localized low bone mineral density at the junction of the middle and distal thirds of the tibia in patients with medial tibial stress syndrome develops in conjunction with the symptoms; these changes are reversible and are not inherited. Study Design Prospective cohort study. Methods Bone mineral density in 14 adult male athletes with long-standing medial tibial stress syndrome was measured when they were symptomatic and after recovery (mean follow-up, 5.7 years). Repeat measurements were also made prospectively in 13 nonathlete control subjects and single measurements were made in 18 healthy athletes. Results Bone mineral density was 9% ± 11% higher in the proximal tibia but 11% ± 12% lower in the tibial region corresponding to pain in patients when compared with nonathlete control subjects. It increased by 19% ± 11% in the region of pain after recovery from symptoms and, at follow-up, was no lower than in nonathlete control subjects. Conclusion Athletes with medial tibial stress syndrome and increased scintigraphic uptake regain normal tibial bone mineral density after recovery from symptoms. Initially localized low bone mineral density is not an inherited condition, but instead may develop in conjunction with the symptoms.
A Modified Technique of Reconstruction for Complete Acromioclavicular Dislocation: A Prospective Study
Authors: Tienen Tony G. , Oyen Jan F. C. H. , Eggen Peter J. G. M. 
Published: July 2017

Background Many procedures, both nonoperative and operative, have been described for treatment of complete acromioclavicular dislocations. The best primary treatment, however, still remains unclear. Purpose We present a new surgical technique in which the clavicle is reduced to an anatomic position, the coracoacromial ligament is transferred to the clavicle, and acromioclavicular joint fixation is accomplished with the use of absorbable, braided suture cord. Methods Twenty-one patients underwent the modified technique of reconstruction. Patients were included only if they had sustained a Rockwood type V acromioclavicular dislocation and were extremely active in competitive sports before dislocation occurred. Results Eighteen patients returned to their sports without pain within 2.5 months after operation. The mean follow-up was 35.7 months. The average Constant score at last follow-up was 97. Radiographs taken at this time confirmed anatomic reduction in 18 patients, residual subluxation in 2 patients, and, in 1 patient, redislocation of the joint that occurred because of infection. Six patients had radiographic evidence of coracoclavicular ossifications. All patients developed a wide scar. Conclusions Considering its operative simplicity, the advantage of absorbable augmentation of the clavicular reduction, and the low rate of recurrence, this technique may be an attractive alternative in this particular group of patients.
Effects of Braiding on Tensile Properties of Four-Strand Human Hamstring Tendon Grafts
Authors: Millett Peter J. , Miller Bruce S. , Close Matthew , Sterett William I. , Walsh William , Hawkins Richard J. 
Published: July 2017

Background Anterior cruciate ligament reconstruction is commonly performed with autogenous hamstring tendon grafts. Purpose To ascertain the effects of braiding on ultimate tensile strength and stiffness of hamstring tendon graft. Study Design Controlled laboratory study. Methods Sixteen fresh-frozen semitendinosus and gracilis tendons were harvested from eight matched (right and left) human cadaveric specimens. Both sets of hamstring tendons from each matched pair were doubled, creating a four-strand graft. Grafts were then randomized so that one graft from each matched pair was braided and the other remained unbraided. The diameter of each graft construct was recorded. Grafts were tested to failure on a materials testing machine. Results There were no significant differences in cross-sectional area before or after braiding. Fifteen of 16 tendons failed midsubstance; 1 failed at the lower clamp. Braiding reduced the initial tensile strength and stiffness of human hamstring tendon grafts in this study by 35.0% and 45.8%, respectively. Conclusions Braiding may place the collagen fibers in a suboptimal orientation for loading that results in a weaker graft. We do not recommend the use of braiding if the strongest, stiffest initial graft is desired.
Perinatal Risks of Untreated Depression during Pregnancy
Authors: Bonari Lori , Pinto Natasha , Ahn Eric , Einarson Adrienne , Steiner Meir , Koren Gideon 
Published: July 2017

Objective: To review the literature on the perinatal risks involved in untreated depression during pregnancy. Method: We searched Medline and medical texts for all studies pertaining to this area up to the end of April 2003. Key phrases entered were depression and pregnancy, depression and pregnancy outcome, and depression and untreated pregnancy. We did not include bipolar depression. Results: While there is wide variability in reported effects, untreated depression during pregnancy appears to carry substantial perinatal risks. These may be direct risks to the fetus and infant or risks secondary to unhealthy maternal behaviours arising from the depression. Recent human data suggest that untreated postpartum depression, not treatment with antidepressants in pregnancy, results in adverse perinatal outcome. Conclusion: The biological dysregulation caused by gestational depression has not received appropriate attention: most studies focus on the potential but unproven risks of psychotropic medication. No in-depth discussion of the role of psychotherapy is available. Because they are not aware of the potentially catastrophic outcome of untreated maternal depression, this imbalance may lead women suffering from depression to fear teratogenic effects and refuse treatment.
Testing the Goodness-of-Fit of a Multifaceted Preventive Intervention for Children at Risk for Conduct Disorder
Authors: Realmuto George M , August Gerald J , Egan Elizabeth A 
Published: July 2017

Objective: To determine the importance of parents' global adaptive functioning as a predictor of participation rate and subsequent child social competence outcome in 3 program components of an evidence-based, multifaceted, preventive intervention for at-risk children. Method: Families of program children ( n = 124, mean age 6.6 years at recruitment) were offered 3 program components that continued for 3 years: a 6-week summer program, a biweekly family program that included concurrent parent and child education and skills training groups, and a flexibly tailored home visitation family support program. We used structural equation modelling to test hypotheses about the effects of parental characteristics on program attendance in each of the program components over 3 years, as well as their relation to children's social competence. Results: Predictors of attendance included child IQ, socioeconomic status (SES), and single-parent status for some components but not others, depending on parents' global adaptive functioning. Predictors of child social competence outcome were mediated by attendance in specific program components and were dependent on parent global adaptive functioning. Some components contributed decisively to social competence outcomes, and others did not, despite subjects' participation. Conclusions: Common family characteristics (that is, child IQ, SES, and single-parent status) predict program attendance differently, depending on parents' global adaptive functioning. Parents' global adaptive functioning determined whether attendance in specific program components mediated children's social competence. In this preventive intervention, as in clinical practice, only knowledge of the goodness-of-fit between participant characteristics and program attributes can ensure optimum benefit.
Factors Affecting Medical Students' Selection of Canadian Psychiatric Residency Programs: Part I—A Comparison with American Peers
Authors: Leverette John , Massabki Albert , Peterson Heather 
Published: July 2017

Objective: The introduction of a national process to match Canadian medical students to postgraduate year-one (PGY-1) positions in psychiatry created for the first time a cohort of subjects whose choices of a particular training program could be evaluated and compared with American peers. The primary goal of this study was to determine the factors affecting the students' selection of the specific postgraduate programs in which they would train and to compare the findings with those in the American literature. Method: A self-administered questionnaire was sent to 110 trainees who began training in July 1994 identified in the 16 Canadian university departments of psychiatry. Results: Canadian trainees, like their American counterparts, relied heavily on nonprogrammatic factors in program choice, but differed in emphasizing vocational prospects after residency. Conclusion: When competing for enrolment within a reduced pool of applicants, program directors need to recognize how programs are evaluated, what factors are controllable, and how best to market the individual assets of their programs.
Being Underweight Is an Independent Risk Factor for Poor Outcomes Among Acutely Critically Ill Children
Authors: Chen Ming‐Yin , Yang Yao‐Jong 
Published: July 2017

AbstractBackground: Malnutrition is associated with impaired immune function; thus, nutrition status assessment is crucial in critical care medicine. We aimed to investigate the impact of being underweight or overweight on major sequelae and mortality among healthy children with an intensive care unit admission. Methods: In this retrospective study, 282 patients aged 1 month to 18 years were enrolled on intensive care unit admission between 2011 and 2012. Children were excluded if they had underlying chronic diseases and were transferred to other hospitals or discharged against medical advice. The patients were further categorized into 3 nutrition status groups according to the weight‐for‐age (W/A) z score. Results: The prevalence rates of being underweight and overweight, based on W/A z scores of ≤–2 and ≥2, were 8.2% and 5.7%, respectively. Patients who were underweight were younger and had a higher rate of mortality, poor outcomes, and longer duration of mechanical ventilation than those with a normal weight. The patients with mortality or major sequelae had significantly higher rates of being underweight, noninfectious diseases and hypotension, and higher Pediatric Index of Mortality 2 (PIM2) score and creatinine level (all P < .01). In multivariate logistic regression interpretation, the W/A z score ≤–2 (95% CI, 2.992–47.508; P < .001) and PIM2 score (95% CI, 1.094–1.413; P = .001) were independent risk factors for a poor outcome. Conclusion: Being underweight and having a PIM2 score on admission were independent risk factors for poor clinical outcomes among critically ill children without underlying diseases.
Latin America: Nader Entessar: Political Development in Chile: From Democratic Socialism to Dictatorship. K.P. Bagchi and Co., Calcutta, 1980, vii, 206p., Rs. 45.
Authors: Shivkumar V. , Saleth R. Maria , Chopra H. S. 
Published: July 2017

Robert Harvey: Portugal : Birth of a Democracy. Macmillan Co., New Delhi, 1978, viii, 151 p., £3.95. Vasant Kumar Bawa: Latin American Integration. Radiant Publishers, New Delhi, 1980, xx, 244p., Rs. 60.