bluuebunny/crossref_metadata_2025_split huggingface dataset:
Urinary osteoprotegerin: a potential biomarker of lupus nephritis disease activity
Authors: Gupta R , Aggarwal A , Sinha S , Rajasekhar L , Yadav A , Gaur P , Misra R , Negi V S 
Published: March 2016

Objectives Urinary biomarkers may help in identification, treatment and assessment of response in patients with lupus nephritis (LN). Osteoprotegerin (OPG) is produced by the kidneys and lymphoid cells and may reflect renal disease activity better. The data on its utility are sparse. Methods Fifty-eight patients with active LN (AN), 24 with active non-renal disease (ANR) and 39 with inactive disease (ID) were included. Median disease duration was 32 (1–204) months and median age was 27 (12–50) years. AN patients were followed up every three months for one year. Urine and serum samples were collected for OPG measurement by ELISA (pg/ml) and urinary values were normalised for creatinine excretion (pg/mg). Urine samples from 24 healthy individuals (HCs) and 20 patients each of rheumatoid arthritis (RA) and diabetic nephropathy (DM) served as controls. Variables were expressed as median (range). Results At baseline, normalised urinary OPG (uOPG) was significantly higher ( p < 0.001) in AN (1229 (0–8577)) than ANR (236 (0–14713)), ID (463 (7–4253)), HCs (366 (120–2849)) and DM (350 (127–1577)) but it was not different from RA (1511 (122–8849)). uOPG correlated modestly with rSLEDAI ( r = 0.4, p < 0.001) and SLEDAI ( r = 0.31, p < 0.001) but not with serum OPG (sOPG). uOPG but not sOPG could differentiate between AN and ANR groups. In the longitudinal study, uOPG and sOPG decreased significantly with treatment at all follow-up visits but the trend of fall in sOPG was erratic. uOPG values at baseline, 3, 6, 9 and 12 months were 1229 (0–8577), 466 (3–4874), 104 (0–1598), 325 (0–4025) and 555 (6–6771) pg/mg, respectively. uOPG but not sOPG rose before conventional markers in three patients who had a relapse of LN. In two patients who developed chronic kidney disease, uOPG remained persistently high. For differentiating AN from ANR patients, uOPG performed the best on receiver operator characteristics analysis (AUC = 0.72) when compared with anti-dsDNA antibodies, C3, C4 and sOPG. Conclusion uOPG is derived from kidneys and helps differentiate active SLE patients with and without LN. It shows modest correlation with disease activity and has a potential to predict poor response to therapy and relapse of LN.
Fate of the Young Patient Undergoing Anterior Cruciate Ligament Reconstruction
Authors: Feller Julian , Webster KE 
Published: March 2016

Objectives: Younger age has been increasingly recognised as a risk factor for ACL graft rupture and contralateral ACL injury following ACL reconstruction. The purpose of the study was to evaluate the re-injury rate and explore factors that might be associated with increased risk. Methods: In this observational study, a cohort of 362 consecutive patients was identified from patients undergoing primary ACL reconstruction by a single surgeon form December 2004 to February 2012. Patients were under 20 years at the time of surgery and had a normal contralateral knee. The incidence of subsequent ACL injuries (graft rupture or contralateral ACL injury) was determined at a mean follow up time of 5 years (range 3-10). For further analysis the group was divided according to gender and age: under 18 or 18-19 at the time of surgery Results: The overall follow up rate was 89% (40/362 patients were unable to be contacted). Graft ruptures occurred in 60 patients (16.6%) at an average time of 1.9 years. Almost half (47%) occurred within the first postoperative year. The graft rupture rate was significantly higher in males (19.5%) than females (11.1%). The rupture rate in the youngest males (under 18) was the highest at 25.4%, which was significantly higher than females of the same age (11.7%) and males over 18 years (12.7%). Of the early graft ruptures, 75% occurred in the under 18 group. Contralateral ACL injuries occurred in 57 patients (15.7) at a longer average time of 3.7 years. There were no gender or age differences for contralateral ACL injuries. There were 4 patients who had a graft rupture as well as a contralateral ACL injury; therefore the total number of patients who had at least one further ACL injury subsequent to the primary surgery was 113 (31.2%). Conclusion: The high rate of subsequent ACL injury in younger patients was confirmed. Early graft ruptures are more prevalent in the very young and gender differences are more apparent for graft rupture, where the youngest males are at high risk. The high incidence of multiple ACL injuries in such a young cohort is concerning for future knee health.
Intravenous versus Intra-articular Tranexamic Acid in Patients Undergoing Primary Unilateral Total Knee Arthroplasty
Authors: Macdessi Samuel , Chen Darren , Goyal Navendu , Harris Ian , Kirsh George , Rowden Neville 
Published: March 2016

Objectives: Tranexamic acid (TXA) is commonly used in primary total knee arthroplasty (TKA) to reduce blood loss, however the most appropriate route of administration is still debated. This study was conducted to compare the two most commonly used routes of TXA administration, intravenous (IV) and intra-articular (IA). Methods: This study was conducted as a non-inferiority, double blinded randomized trial to compare IA TXA with IV TXA in terms of efficacy in reducing blood loss as measured by post-operative Hb drop and transfusion rates. We hypothesized that IA TXA is not inferior to IV TXA in reducing blood loss and transfusion requirements. Results: One hundred and sixty eight patients were analysed. Mean day 1 and day 2 post-operative Hb values for both the groups were statistically similar (p=0.88, p=0.95 respectively). Also, no statistical difference was seen on comparison of change in Hb between pre-operative and day 1 or day 2 values (p=0.55, p=0.58 respectively). There were no transfusions given in either group. Conclusion: Intra-articular TXA is non-inferior to IV TXA in terms of fall in Hb and blood transfusion requirements. This trial further establishes and supports the use of IA TXA for primary TKA.
A New Method to Attain a Balanced Total Knee Arthroplasty
Authors: McAuliffe Michael , Roe J A , Garg G 
Published: March 2016

Introduction & Aims: The ANJRR has reported no improvement in early revision rates for patient matched versus conventional instrumentation and Nam et al demonstrated no improvement in PROMS or alignment data at 2 year follow-up patient matched TKA. Patient matched instrumentation may not provide clinically meaningful improvements. The purpose of this study was to assess whether a novel design process for patient matched cutting guides could both normalise soft tissue tension and produce a knee balanced mediolaterally and between 0 and 90°of flexion. Method: Patient specific guides of a novel and standard design were manufactured based on a novel design process and assessed via a prospective cohort study. The novel guides were applied to the intact knee in extension and/or flexion at the start of a TKA prior to soft tissue releases to mark bone resections. The guides contacted the femur and tibia simultaneously and acted to re-align the knee and tension the peri-articular soft tissues. 10 patients had novel guides applied in flexion and extension and 3 additional patients used guides in extension only. 9 patients had standard guides manufactured with the novel design process. We prospectively collected data on these 22 patients examining medial and lateral soft tissue laxity in maximum extension, 20 and 90° of flexion pre and post-operatively. Results: Soft tissue tension within parameters described for normal subjects was attained medially and laterally in: maximum extension in all 22 cases. For the 19 cases where the guides were used to plan the flexion resections; normal medial soft tissue tension was attained in 18/19 (94.7%) cases and normal lateral soft tissue tension in 16/19 (84.2%) cases. The 4 cases where normal soft tissue tension was not attained were outside this range by 1°. Post-operatively the mean difference in medial versus lateral laxity was 0.75°at 0°, 1.36° at 20° and 1.20° at 90°of flexion with a range of 0 - 4.5° across all positions and all knees. Pre-operatively the difference between medial and lateral laxity across all knees and positions ranged from 0 – 9°. Preoperatively the mean difference in medial versus lateral laxity was 4.43°at 0°, 5.25° at 20° and 1.64°at 90°of flexion. In the 19 cases where guides planned both the extension and flexion gap, 0 versus 90 ° flexion laxity on the medial side displayed a mean difference of 1.18° (range 0 - 3) and on the lateral side a mean difference of 1.52° (range 0 - 4.5) was recorded. To attain these balance parameters 16/22 (72.7%) cases utilised a 9mm poly and 6/22 (27.3%) utilised an 11mm poly. Conclusions: Patient Matched Instrumentation is widely used without clear benefit. This novel patient matched instrumentation design process shows promise for attaining soft tissue tension that is both normal and balanced. This may help diminish revision due to instability which was recorded as the revision diagnosis in 18.7% of patients (Lombardi 2013).
MPFL Reconstruction with TTT Versus TTT Alone for Recurrent Patella Instability
Authors: Annear Peter , Damasena Iswadi , Blythe Murray , Wysocki David 
Published: March 2016

Purpose: Reconstruction of the medial patellofemoral ligament (MPFL) is increasingly used to restore the primary ligamentous restraint to patella dislocation. The purpose of this randomised controlled trial is to compare the 5 year results of the addition of autograft MPFL reconstruction to tibial tubercle transfer (TTT) and lateral release (LR) (reconstruction group) to TTT and LR alone (control group) for recurrent patella dislocation. Methods: Thirty-four patients (36 knees) were randomised to two groups. Two patients in the control group (TTT + LR) and three patients in the reconstruction group (MPFL + TTT + LR) group were lost to follow up at 5 years. Results: There were no significant differences in Kujala and Tegner scores or “insecurity” Visual Analogue Scale (VAS) at any time period. There was a trend to a lower average VAS in the reconstruction group at six weeks but also poorer average flexion. There were no significant differences in time to return to school, work or sports. Quantitative CT scans showed the reconstruction group had a significant improvement in average patella tilt (6 degrees vs -8 degrees, p = 0.03) and average congruence angle (13 degrees vs -11 degrees, p = 0.03) in the quadriceps contracted state. At 5 years the MPFL/TTT reconstruction group had a lower revision rate (2/17) compared to the control group of TTT alone (5/16). Conclusion: Patients who underwent an MPFL reconstruction in addition to a TTT had a comparatively significant improved patella congruence on quantitative CT Scan. At 5 years the MPFL/TTT reconstruction group had a lower but non significant revision rate compared to the control group of TTT alone.
Planning of High Tibial Osteotomy
Authors: Rahmadian Rizki , Lubis AMT , Singh C 
Published: March 2016

Introduction: High Tibial Osteotomy (HTO) is an establish technique for the treatment of varus malaligned knees. The aim of HTO is to reduce the load on the medial compartment by shifting the mechanical axis toward the lateral compartment. It is indisputable that appropriate patient selection, precise surgical planning, and correct operative techniques can provide favorable treatment outcomes of HTO. Method: Case Series. We reported four cases of HTO during clinical attachment in Gleneagles Hospital Kuala Lumpur Malaysia. Two cases are simple Open Wedge HTO, and two cases are Open Wedge HTO that performed simultaneously with posterolateral corner reconstruction. The assessment of lower limb alignment is based on an examination of clinical assessment and full standing radiographs, andplanned correction was achieved when the weight-bearing line passedthrough a target point located at 62% (Fujisawa point) ofthe tibial plateau width measured from themedial border of the tibial plateau. Result: We performed 90, 110, and 60 corrections to shift the weight bearing area to Fujisawa point. Post operative radiologic measurement shown all patients had a good alignment with 60, 50, and 60 valgus over correction, and with insignificant change of tibial slope. PLC instability was reconstruct with modified Larson’s technique by using semitendinous graft. In these cases, we used Tomifix plate (Sythes, Switzerland) as a bridging internal fixation with the principle of a locking compression plate (LCP), and ChronOS (Sythes, Switzerland) as a bone void filler. Conclusion: To achieve good results with HTO requires proper patient selection, good surgical planning, accurate surgical technique, and discipline rehabilitation. Reconstruction of the ligament abnormalities that affect the stability around the knee joint is necessary to achieve better results.
Three Dimensional Printing in Orthopaedic Surgery
Authors: Mulford Jonathan , MacKay N , Babazadeh S 
Published: March 2016

Objectives: Three dimensional (3D) printing technology has many current and future applications in orthopaedics. The objectives of this article are to review published literature regarding applications of 3D technology in orthopaedic surgery with a focus on knee surgery. Methods: A narrative review of the applications of 3D printing technology in orthopaedic practice was achieved by a search of computerised databases, internet and reviewing references of identified publications. Results: There is current widespread use of 3D printing technology in orthopaedics. 3D technology can be used in education, preoperative planning and custom manufacturing. Custom manufacturing applications include surgical guides, prosthetics and implants. Many future applications exist including biological applications. 3D printed models of anatomy have assisted in the education of patients, students, trainees and surgeons. 3D printed models also assist with surgical planning of complex injuries or unusual anatomy. 3D printed surgical guides may simplify surgery, make surgery precise and reduce operative time. Computer models based on MRI or CT scans are utilised to plan surgery and placement of implants. Complex osteotomies can be performed using 3D printed surgical guides. This can be particularly useful around the knee. A 3D printed guide allows pre osteotomy drill holes for the plate fixation and provides an osteotomy guide to allow precise osteotomy. 3D printed surgical guides for knee replacement are widely available. 3D printing has allowed the emergence of custom implants. Custom implants that are patient specific have been particularly used for complex revision arthroplasty or for very difficult cases with altered anatomy. Future applications are likely to include biological 3D printing of cartilage and bone scaffolds. Conclusion: 3D printing in orthopaedic surgery has and will continue to change orthopaedic practice. Its role is to provide safe, reproducible, reliable models with reduced operative time and improves patient outcomes compared to traditional surgical techniques. Long term follow up of the techniques is still required.
A Performance Review Utilising Administratively Collected Hospital Patient Information and Coding Data
Authors: Rimmington Dale 
Published: March 2016

Objectives: Collection of data and self audit can be a difficult undertaking in orthopaedic private practice. The aim of this study is to demonstrate that review of administratively collected patient information can provide useful information for self-audit and clinical outcomes. Methods: Baseline coding, Financial and Limited Adverse Outcome Screening (LAOS) data relating to a single Orthopaedic Surgeon’s Knee Practice at one private hospital, relating to surgical admissions between the 31st January 2013 and the 31st March 2015 was analysed. Measures looked at included; absolute numbers of surgical procedures, breakdown of procedures according to coding, readmissions within 30 days, length of stay per procedure, return to theatre, adverse events including thromboembolism, infection and bleeding. Results: Administratively collected data proved to be a useful self- audit and monitoring tool. It is not a substitute for prospectively collected clinical data. The strength of this data is that it is relatively easily accessed and may alert the individual to trends in their practice that may prompt further investigation and practice modification. This information is already being provided to insurers and statutory bodies without clinical interpretation and is becoming increasingly important as insurers look to stop funding certain adverse outcomes that require treatment. The process maybe mutually beneficial to both clinician and hospital. The clinician gets to access the data to assist in outcomes evaluation/ improvement whilst the hospital benefits through more accurate recording of adverse events and potentially better coding of data. Conclusion: Procurement and basic analysis of administratively collected data can be performed by a solo practitioner without access to any extra research resources. This data allows performance monitoring and may stimulate further practice evaluation and change.
Twelve Year Outcomes of Oxinium Total Knee Arthroplasty Compared to the Same Cobalt Chrome Prosthesis
Authors: Vertullo Christopher , Lewis Peter , Graves Stephen , Kelly Lan , Myers Peter 
Published: March 2016

Introduction: Alternative bearings surfaces to Cobalt Chrome (Co-Cr), such as Oxidised have been introduced in an attempt to reduce polyethylene wear and hence decrease TKA loosening and lysis. While non-comparative reports have been described as promising, no short or long term clinical studies exists showing the superiority of Oxinium on a polyethylene bearing surfaces. In this study, we investigate the long-term outcomes of Oxinium and Co-Cr TKR in a “like for like” or matched cohort analysis of the Genesis II design (Smith & Nephew, Memphis, TN, USA). Using data from a large national joint replacement registry we selected cohorts that used only the cruciate retaining design, with the same method of fixation and polyethylene type, differing only in the femoral component bearing surfaces. Our primary hypothesis was that Oxinium TKA would have a lower cumulative percent revision than the same Co-Cr prosthesis at 12 years for all causes of revision. Our secondary hypothesis was that Oxinium TKA would have a lower loosening/ lysis rate and lower rate of non-infective revision than the same Co-Cr prosthesis at 12 years. Methods: Cumulative percent revision and revision diagnosis data were obtained from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 1 September 1999, until 31 December 2013. Results: At 12 years the cumulative percent revision of the Co-Cr Genesis II of 4.8 % (95%: CI 4.2, 5.4) for all causes was not statistically different to the Oxinium Genesis II CPR of 7.7 % (95%: CI 6.2, 9.5) (For the entire period, Hazard Ratio = 1.09 (95%: CI 0.92, 1.29), p = 0.329). The CPR for all causes was not different in the under 55 years old age group (Figure 3) (HR= 1.06 (0.68, 1.66) p=0.798).). Subgroup analysis of the CPR for loosening /lysis in both groups overall was not different (HR= 0.87 (95%: CI 0.61, 1.26), p = 0.461) Subgroup analysis of all causes of revisions excluding infection in both groups overall was not different (HR = 0.87 (95%: CI 0.71, 1.06), p = 0.155) . No difference in CPR was found between the Oxinium and Co-Cr groups for any age category for all causes of revision, loosening/lysis or non-infective causes, except for loosening/lysis in the >75 years old group (p=0.033). In these patients, Oxinium TKA had a higher CPR due to uncertain reasons. Conclusions: In this AOANJRR age stratified matched cohort study, Oxinium femoral components did not reduce revision rates due to all causes, loosening/lysis or when infection as a cause of revision was removed, compared to the same Co-Cr femoral component, across all age groups including patients who were under 55 years of age.
Feasibility of an Australian Knee Osteotomy Registry
Authors: Vertullo Christopher 
Published: March 2016

Background: Osteotomy about the knee is a currently relatively neglected area of joint preserving research. HTO indications, frequency, complications, and outcomes of HTO in Australia remain relatively ill-defined. The success & existence of the ANJRR allows the implementation of a relatively inexpensive & comprehensive HTO Registry in Australia. Aims: Establish a comprehensive “opt-out” AKS Sponsored Australian HTO Registry using ANJRR existing resources. Establish a minimum HTO dataset for international data sharing with countries such as Sweden, New Zealand and Finland. Discussion: Benefits: AKS surgeons to define patient outcomes more accurately and objectively in High Tibial Osteotomy Will allow AKS surgeons to improve patient selection criteria for HTO Creates a multinational standard data-set to investigate a joint preserving procedure & fosters international collaboration to improve surgeons’ knowledge and patient outcomes in HTO Will assist in the management of what is often a difficult problem ie osteoarthritis in younger, active patients. Barriers: Cost Data Compliance Legislation & Data Security
Leptin Signaling Is Not Required for Anorexigenic Estradiol Effects in Female Mice
Authors: Kim Joon S. , Rizwan Mohammed Z. , Clegg Deborah J. , Anderson Greg M. 
Published: March 2016

Abstract
Estradiol and leptin are critical hormones in the regulation of body weight. The aim of this study was to determine whether this cross talk between leptin receptor (LepRb) and estrogen receptor-α (ERα) signaling is critical for estradiol's anorexigenic effects. Leprb-Cre mice were crossed with Cre-dependent Tau-green fluorescent protein (GFP) reporter, Stat3-flox or Erα-flox mice to generate female mice with GFP expression, signal transducer and activator of transcription 3 (STAT3) knockout (KO), or ERα KO, specifically in LepRb-expressing cells. The proportion of Leprb-GFP cells colocalizing ERα was high (∼80%) in the preoptic area but low (∼10%) in the mediobasal hypothalamus, suggesting that intracellular cross talk between these receptors is minimal for metabolic regulation. To test whether estradiol enhanced arcuate leptin sensitivity, ovarectomized mice received varying levels of estradiol replacement. Increasing estrogenic states did not increase the degree of leptin-induced STAT3 phosphorylation. LepRb-specific STAT3 KO mice and controls were ovarectomized and given either chronic estradiol or vehicle treatment to test whether STAT3 is required for estrogen-induced body weight suppression. Both groups of estradiol-treated mice showed an equivalent reduction in body weight and fat content compared with vehicle controls. Finally, mice lacking ERα specifically in LepRb-expressing neurons also showed no increase in body weight or impairments in metabolic function compared with controls, indicating that estradiol acts independently of leptin-responsive cells to regulate body weight. However, fecundity was impaired in in Leprb-ERα KO females. Contrary to the current dogma, we report that estradiol has minimal direct actions on LepRb cells in the mediodasal hypothalamus and that its anorexigenic effects can occur entirely independently of LepRb-STAT3 signaling in female mice.