bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gait Patterns Differ Between ACL-Reconstructed Athletes Who Pass Return-to-Sport Criteria and Those Who Fail
Authors: Di Stasi Stephanie L. , Logerstedt David , Gardinier Emily S. , Snyder-Mackler Lynn 
Published: April 2013

Background: The current standard of practice for an athlete to return to sport after anterior cruciate ligament (ACL) reconstruction is varied. Attempt to return to activity is typically advised 6 months after surgery, but functional performance deficits and gait abnormalities are often still evident and may have important implications on future function. Hypothesis: When comparing the involved and uninvolved limbs, patients who failed return-to-sport (RTS) criteria would demonstrate (1) smaller peak knee angles, extensor moments, and peak power absorption at the knee of the involved limb and (2) larger peak hip angles, extensor moments, and peak power generation of the involved limb. Study Design: Controlled laboratory study. Methods: A total of 42 patients completed functional and biomechanical gait assessment 6 months after ACL reconstruction. Functional testing involved an isometric quadriceps strength test, 4 single-legged hop tests, and 2 self-report questionnaires. Three-dimensional motion analysis was used to measure sagittal plane kinematics and kinetics of the hip and knee. A mixed-model analysis of variance and post hoc t tests were used to compare the limb symmetry of those who passed and those who did not pass RTS criteria. Minimal clinically important differences were calculated from healthy gait data and used to further define meaningful limb asymmetries. Results: Twenty of the 42 (48%) patients passed RTS criteria 6 months after ACL reconstruction. Patients who did not pass the criteria demonstrated statistically significant differences between limbs on all kinematic and kinetic variables at the knee ( P ≤ .027). Clinically meaningful asymmetries at the hip were also identified in this group. Only kinetic asymmetries at the knee were identified in the patients who passed RTS criteria. Conclusion: Athletes who demonstrate superior functional performance 6 months after ACL reconstruction may have fewer abnormal and asymmetrical gait behaviors than their poorer performing counterparts. Patients who did not pass RTS criteria not only demonstrated larger kinematic and kinetic asymmetries between limbs but also appeared to use a gait strategy more closely aligned with athletes early after ACL rupture. Clinical Relevance: Poor performance on a battery of functional performance measures may be related to the presence of movement asymmetries in athletes after ACL reconstruction. Objective RTS criteria have the potential to provide information to clinicians who determine when these athletes return to activity, and may aid in the prescription of targeted rehabilitation to address underlying movement asymmetry.
Isolated Spring Ligament Failure as a Cause of Adult-Acquired Flatfoot Deformity
Authors: Orr Justin D. , Nunley James A. 
Published: April 2013

Background: Adult-acquired flatfoot deformity is usually secondary to failure of the tibialis posterior tendon, with secondary injury to the surrounding osseous-ligamentous complex. Rarely, patients may present with a normal tibialis posterior tendon and an isolated injury of the plantar calcaneonavicular, or spring, ligament. The current study describes the clinical presentation and operative management of 6 patients with isolated spring ligament ruptures who presented with symptomatic flexible flatfoot deformities. Methods: Six consecutive patients with unilateral flatfoot deformities secondary to spring ligament failure were operatively treated at one institution between 2003 and 2010. All patients presented with symptomatic flatfoot deformities recalcitrant to conservative management. No patients had previous flatfoot reconstructive surgery, but all had undergone some combination of orthotic use, immobilization, or activity modifications prior to operative treatment. In each case, intraoperative findings demonstrated a tear of the spring ligament complex with a normal tibialis posterior tendon. To address the deformities, spring ligament repairs and adjunctive flatfoot reconstructions were performed. A retrospective chart study was performed to document patient presentation, demographics, and outcomes. Results: Average patient age was 42 years. All 6 patients were female. All patients presented with medial foot pain for a mean of 27 months prior to presentation. Spring ligament abnormality was demonstrated in all 5 patients who received preoperative magnetic resonance imaging. Intraoperatively, all 6 patients demonstrated spring ligament tears and no significant tibialis posterior tendon abnormality. All 6 patients underwent spring ligament repairs with or without adjunctive flatfoot reconstructions. At mean follow-up of 13 months, all but 1 patient were pain-free without orthotics, and all patients were without residual deformity. There was a single patient with delayed bone graft healing and no other minor or major complications in this series. Conclusions: Adult-acquired flatfoot deformity is usually secondary to tibialis posterior tendon failure but in rare cases may be secondary to isolated spring ligament injury without tibialis posterior tendon abnormality. This unique clinical entity should be considered in patients who present with flatfoot deformities. In this study, although preoperative magnetic resonance imaging was not required, it identified a suspected spring ligament tear in all cases in which it was used. Thorough intraoperative exploration can identify an injury to the spring ligament and a normal tibialis posterior tendon. Failure to recognize an isolated spring ligament injury as the primary cause of a flatfoot deformity could lead to inappropriate operative management. Level of Evidence: Level IV, retrospective study.
Isolated Subtalar Arthrodesis Through Minimal Incision Surgery
Authors: Carranza-Bencano A. , Tejero-García S. , Del Castillo-Blanco G. , Fernández-Torres J. J. , Alegrete-Parra A. 
Published: April 2013

Background: In recent years there has been an increase in the use of minimally invasive techniques, such as arthroscopy, percutaneous, and minimally invasive incisions, for foot and ankle surgery. The purpose of this study was to analyze the fusion rate and clinical results of isolated subtalar arthrodesis (ISA) using the novel and original technique of minimal incision surgery (MIS). Methods: There were a total of 77 feet in 76 patients who underwent ISA and were followed for 50 months on average (range, 15-108). The first 30 cases were evaluated retrospectively, and 47 cases were evaluated prospectively. MIS without tourniquet was used in all cases and fusion was assessed radiographically and clinically. Clinical outcome measures used were the Angus and Cowell Scoring System, AOFAS Ankle-Hindfoot, the SF-36, and a patient satisfaction questionnaire 12 months after the intervention. Results: Radiographic and clinical consolidation was achieved in 92% of cases. Main outcomes were “good” in 57 patients as determined by the Angus and Cowell criteria, with 13 “fair” and 7 “poor” results. In the prospective group, AOFAS scores improved by 47.6 points (95% CI: 50.7-42.5) 12 months after surgical intervention. SF-36 outcomes improved by 14.5 points (95% CI: 11.58-17.31) in the mental summary component and 4.2 points (95% CI: 2.2-6.1) in the physical summary component. We recorded no cases of early complications such as wound infections, neurovascular damage, or delayed wound healing. Conclusions: To our knowledge, the present series represents the largest study on subtalar arthrodesis using minimally invasive surgery. The data obtained showed a similar rate of bony union and clinical outcomes compared with the literature, but without early wound complications. ISA using the MIS technique was a good option for patients at greater risk of wound healing complications. Level of Evidence: Level IV, case series.
Functional Rehabilitation With a Foot Plate Modification for Circular External Fixation
Authors: Blair James A. , Owens Johnny G. , Saucedo Joey , Hsu Joseph R. ,   Skeletal Trauma Research Consortium (STReC)
Published: April 2013

Background: Customized foot plates attached to the foot ring of an ankle-spanning circular external fixator present a unique opportunity for patients undergoing complex lower-extremity limb salvage to participate in highly advanced weight-bearing physical therapy. The purpose of this study was to identify the rehabilitation capabilities afforded by this external fixator modification. Methods: Surgical logs and radiographs were reviewed to identify all lower-extremity limb salvage patients from February 2008 to December 2010 treated with an ankle-spanning circular external fixator and a customized foot plate treated by the same orthopedic surgeon and enrolled in our institution’s Return To Run clinical pathway. Medical records were reviewed to identify a series of exercises that each patient was able to perform. Results: Eleven patients were identified. All patients were treated by the same physical therapist. All 11 patients were able to bear full weight on their foot plates and perform regular and split squats. Six of 11 patients were able to ambulate unassisted, and 5 patients required a cane. All 11 patients could navigate stairs and use an elliptical and stair-stepping machine. Six of 11 patients could perform single-leg hack squats. Eight of 11 patients were able to perform double-leg shuttle jumps, although only 5 of 11 patients could perform single-leg shuttle jumps. Five of 11 patients were able to perform a single-leg balance. Only 1 patient was able to run on the foot plate. Conclusions: Patients undergoing lower-extremity limb salvage with an ankle-spanning circular external fixator and a customized foot plate were able to participate in highly advanced weight-bearing physical therapy exercises during the osseous and soft-tissue healing process. Level of Evidence: Level IV, retrospective case series.
Risk Factors for Postoperative Wound Complications of Calcaneal Fractures Following Plate Fixation
Authors: Ding Liang , He Zhimin , Xiao Haijun , Chai Leizi , Xue Feng 
Published: April 2013

Background: A fairly high prevalence of wound complications after open reduction and internal plate fixation (ORIF) of closed calcaneal fractures via the extensile lateral approach has been reported. The goal of this study was to analyze and identify independent risk factors for wound complications among closed calcaneal fractures undergoing ORIF. Methods: The medical records of all closed calcaneal fracture patients who underwent ORIF from July 2005 to July 2012 were reviewed to identify those who developed a wound complication. Then we constructed a univariate and multivariate logistic regression to evaluate the independent associations of potential risk factors for surgical wound complication. Records showed 479 patients who underwent ORIF of a closed calcaneal fracture from July 2005 to July 2012. The patients were followed for 3 to 28 months, with an average follow-up period of 14.2 months. Eleven patients had bilateral fractures, for a total of 490 fractured calcanei. Results: The overall rate of postoperative wound complications following ORIF of closed calcaneus fractures was 17.8% (87 wound complications in 490 operations). With the regression model, smoking history (odds ratio, 5.79; 95% CI: 1.55 to 21.70; P = .009), diabetes mellitus (odds ratio, 6.23; 95% CI: 1.37 to 28.31; P = .018), Sanders type (odds ratio, 5.44; 95% CI: 2.02 to 14.64; P = .001), number of residents and/or fellows present during the case (odds ratio, 1.63; 95% CI: 1.06 to 2.52; P = .028), duration of surgery (odds ratio, 4.54; 95% CI: 1.46 to 14.12; P < .001), estimated blood loss (odds ratio, 1.02; 95% CI: 1.01 to 1.04%; P < .001), and 10 or more people present in the operating room during the entire case (odds ratio, 2.30; 95% CI: 1.79 to 2.94; P < .001) were risk factors for wound complication. Tourniquet use (odds ratio, 0.02; 95% CI: 0.00 to 0.08; P < .001), which was associated with a decreased risk for the development of a wound complication, was observed as a protective factor. Diabetes mellitus, Sanders type, and smoking were the strongest risk factors for postoperative wound complication after adjusting for all other variables. Conclusions: Smoking, diabetes mellitus, Sanders type, number of residents and/or fellows present during the case, duration of surgery, estimated blood loss, and high number of persons present in the operating room during the entire case were related to an increased risk for postoperative wound complication of closed calcaneal fractures following ORIF. Tourniquet use was associated with a decreased risk for the development of a wound complication. Level of Evidence: Level III, retrospective comparative series.
The effect of thematically related play on engagement in storybook reading in children with hearing loss
Authors: Pataki Kristen W , Metz Alexia E , Pakulski Lori 
Published: April 2013

Purpose: This study examined whether theme-related play increased subsequent engagement in storybook reading in preschool children with typical hearing and with hearing loss. Method: This study employed a counterbalanced experimental design. In all sessions, participants engaged in free play first and then were read a storybook. In the experimental condition, the play materials matched the theme of the book, and in the control condition it did not. Conditions were presented in random order. Storybooks had language at the early preschool level and had characters, plots, and illustrations. Twenty-three preschool-aged children participated, 12 with typical hearing and 11 with hearing loss. Engagement during storybook reading was measured using a modified Child Behaviour Rating Scale (CBRS; Mahoney, 1998), consisting of five Items: Attention to Activity, Involvement, Cooperation (Attention subscale), and Affect and Joint Attention (Socio-emotional subscale). Results: Play that matched the theme of the storybook selectively enhanced engagement, particularly the Affect Item and the Socio-emotional Subscale of the CBRS, in participants with hearing loss. Conclusions: Thematically related play prior to reading leads to increased interaction with the reader and more positive emotion during reading for children with hearing loss. Implementing this approach is simple and fun for school and home settings.
A systematic review of rehabilitation protocols following surgical repair of the extensor pollicis longus
Authors: Wood Thomas J , Sameem Mojib , Farrokhyar Forough , Strumas Nick 
Published: April 2013

Introduction The goal of this systematic review was to determine which rehabilitation protocol (static, dynamic or early active) yields the best outcomes following repair of the extensor pollicis longus (EPL) tendon in the following domains: total active motion (TAM), grip strength and range of motion. Methods A comprehensive and systematic literature search was run. The retrieved abstracts and titles were screened by two independent reviewers. Rehabilitation protocols were classified as static, dynamic or early active. Methodological quality of included randomized controlled trials and cohort studies were assessed using the SIGN50 scale. Results Fifteen articles were included in the final analysis ( κ = 0.8). From this total, five studies employed static splinting, 12 dynamic splinting and two early active splinting. Static splinting yielded ‘excellent’/‘good’ results ranging from 50% (minimum) to 60% (maximum) on the TAM classification system and a weighted mean TAM of 73.0 ± 24.0° (range 58.75–85°). Dynamic splinting studies demonstrated ‘excellent’/‘good’ results ranging from 64.4% (minimum) to 98% (maximum) and a weighted mean TAM of 111.2 ± 11.7° (range 89–134°) ( P < 0.001 and mean difference of 38.2 (95% confidence interval: 32.2–44.2). In one study, early active motion resulted in 83% of patients having ‘excellent’/‘good’ ratings. Discussion The available level II–IV evidence suggests better outcomes when using dynamic splinting over static splinting for rehabilitation of the EPL tendon repair. Further evidence is required to clinically confirm the differences between early active and dynamic rehabilitation protocols.
Diagnostic evaluation of paediatric pulmonary hypertension in current clinical practice
Authors: Beghetti Maurice , Berger Rolf M.F. , Schulze-Neick Ingram , Day Ronald W. , Pulido Tomás , Feinstein Jeffrey , Barst Robyn J. , Humpl Tilman 
Published: April 2013

Current paediatric pulmonary hypertension (PH) diagnostic algorithms include some testing specifically for paediatrics, but it is unclear if this is used in clinical practice. We describe the current diagnostic workup of the TOPP (Tracking Outcomes and Practice in Paediatric Pulmonary hypertension) registry for suspected PH.We investigated 456 patients enrolled until February 2010. The majority had ECGs (94%), echocardiograms (96%) and/or chest radiographs (89%) performed and these were the noninvasive tests most frequently used for evaluation of suspected PH. No patient had all three tests considered normal, suggesting the potential for the combined use to rule out PH.For evaluation of complications associated with heart catheterisation (HC) we analysed a total of 908 HCs reported until February 2012. Of these, 554 were at diagnosis and 354 in follow-up. Complications were reported in 5.9% with five deaths considered related to HC, suggesting a higher rate of HC complications compared to adult studies. However, current recommendations support HC in paediatric PH. A proper application of the risk/benefit ratio for HC requires further data. Most children did not undergo the diagnostic workup currently recommended for adults, which highlights either incomplete awareness of current guidelines and/or challenges their appropriateness for children.
COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers
Authors: Akkermans Reinier P. , Biermans Marion , Robberts Bas , ter Riet Gerben , Jacobs Annelies , van Weel Chris , Wensing Michel , Schermer Tjard 
Published: April 2013

The aim of this study was to establish which cut-off point for the forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ratio (i.e.fixed 0.70 or lower limit of normal (LLN) cut-off point) best predicts accelerated lung function decline and exacerbations in middle-aged smokers.We performed secondary analyses on the Lung Health Study dataset. 4045 smokers aged 35–60 years with mild-to-moderate obstructive pulmonary disease were subdivided into categories based on presence or absence of obstruction according to both FEV1/FVC cut-off points. Post-bronchodilator FEV1decline served as the primary outcome to compare subjects between the categories.583 (14.4%) subjects were nonobstructed and 3230 (79.8%) subjects were obstructed according to both FEV1/FVC cut-off points. 173 (4.3%) subjects were obstructed according to the fixed cut-off point, but not according to the LLN cut-off point (“discordant” subjects). Mean±sepost-bronchodilator FEV1decline was 41.8±2.0 mL·year−1in nonobstructed subjects, 43.8±3.8 mL·year−1in discordant subjects and 53.5±0.9 mL·year−1in obstructed subjects (p<0.001).Our study showed that FEV1decline in subjects deemed obstructed according to a fixed criterion (FEV1/FVC <0.70), but non-obstructed by a sex- and age-specific criterion (LLN) closely resembles FEV1decline in subjects designated as non-obstructed by both criteria. Sex and age should be taken into account when assessing airflow obstruction in middle-aged smokers.
Social consequences of sleep disordered breathing on patients and their partners: a controlled national study
Authors: Jennum Poul , Ibsen Rikke , Kjellberg Jakob 
Published: April 2013

We aimed to evaluate the total costs to patients and their partners of sleep apnoea and obesity hypoventilation syndrome (OHS) and their treatment, as this is poorly described in families.Using data from the Danish National Patient Registry and other public databases, all patients and their partners with a diagnosis of sleep apnoea (n=30 278) or OHS (n=1562) were included. They were compared with age-, sex- and community location-matched citizens at a ratio 1:4 (120 506 and 6241 control subjects, respectively). Direct and indirect costs were evaluated for patients and their partners.Sleep apnoea and OHS patients and their partners had higher rates of health-related contact, medication use and unemployment, and lower income levels. Excess yearly direct net health and foregone earnings (indirect costs) were €2174 and €7981 prior to diagnosis, and €3988 and €12 022 after diagnosis for sleep apnoea and OHS, respectively. The comparable annual mean excess health-related costs for spouses were €1965 and €2862 before diagnosis, and €2307 and €3079 after diagnosis, for sleep apnoea and OHS patients, respectively. These socioeconomic consequences were present up to 12 years before first diagnosis, and increased as the disease advanced.Sleep-disordered breathing has major socioeconomic consequences for patients and their spouses years before and after diagnosis.
High-Yield RNA-Extraction Method for Saliva
Authors: Pandit Pratibala , Cooper-White Justin , Punyadeera Chamindie 
Published: April 2013

BACKGROUND
The use of salivary diagnostics is increasing because of its noninvasiveness, ease of sampling, and the relatively low risk of contracting infectious organisms. Saliva has been used as a biological fluid to identify and validate RNA targets in head and neck cancer patients. The goal of this study was to develop a robust, easy, and cost-effective method for isolating high yields of total RNA from saliva for downstream expression studies.

METHODS
Oral whole saliva (200 μL) was collected from healthy controls (n = 6) and from patients with head and neck cancer (n = 8). The method developed in-house used QIAzol lysis reagent (Qiagen) to extract RNA from saliva (both cell-free supernatants and cell pellets), followed by isopropyl alcohol precipitation, cDNA synthesis, and real-time PCR analyses for the genes encoding β-actin (“housekeeping” gene) and histatin (a salivary gland–specific gene).

RESULTS
The in-house QIAzol lysis reagent produced a high yield of total RNA (0.89–7.1 μg) from saliva (cell-free saliva and cell pellet) after DNase treatment. The ratio of the absorbance measured at 260 nm to that at 280 nm ranged from 1.6 to 1.9. The commercial kit produced a 10-fold lower RNA yield. Using our method with the QIAzol lysis reagent, we were also able to isolate RNA from archived saliva samples that had been stored without RNase inhibitors at −80 °C for &gt;2 years.

CONCLUSIONS
Our in-house QIAzol method is robust, is simple, provides RNA at high yields, and can be implemented to allow saliva transcriptomic studies to be translated into a clinical setting.