bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of a combination of umeclidinium/vilanterol on exercise endurance in patients with chronic obstructive pulmonary disease: two randomized, double-blind clinical trials
Authors: Maltais François , Singh Sally , Donald Alison C. , Crater Glenn , Church Alison , Goh Aik H. , Riley John H. 
Published: December 2014

Objective: Exercise intolerance is a hallmark of chronic obstructive pulmonary disease (COPD). Methods: Patients with COPD were randomized in two multicentre, double-blind, incomplete block crossover studies. Patients received two of six treatments in sequence (12 weeks each): placebo, umeclidinium (UMEC)/vilanterol (VI) (125/25 mcg or 62.5/25 mcg), VI (25 mcg) or UMEC (62.5 mcg or 125 mcg). Exercise endurance time (EET) and trough forced expiratory volume in 1 second (FEV1) (Week 12) were co-primary endpoints. Safety was monitored throughout. Results: Both studies showed similar 3-hour post-dose EET improvements from baseline for UMEC/VI (Week 12). Significant EET improvements were observed with both UMEC/VI doses versus placebo at Week 12 in Study 418 (UMEC/VI 125/25 mcg: 65.8 s; p = 0.005; UMEC/VI 62.5/25 mcg: 69.4 s; p = 0.003), but not in Study 417, where a placebo effect was evident. Post hoc integrated data analysis showed significant but smaller EET improvements for both UMEC/VI doses versus placebo at Week 12 (UMEC/VI 125/25 mcg: 47.5 s; p = 0.002; UMEC/VI 62.5/25 mcg: 43.7 s; p = 0.001). Both studies showed trough FEV1 improvements at Week 12 for both UMEC/VI doses. The incidence of adverse events was similar between treatment groups within each study. Conclusions: UMEC/VI improved lung function and EET.
A Comparative Study Between Total Contact Cast and Pressure-Relieving Ankle Foot Orthosis in Diabetic Neuropathic Foot Ulcers
Authors: Chakraborty Partha Pratim , Ray Sayantan , Biswas Dibakar , Baidya Arjun , Bhattacharjee Rana , Mukhopadhyay Pradip , Ghosh Sujoy , Mukhopadhyay Satinath , Chowdhury Subhankar 
Published: December 2014

Background: Off-loading of the ulcer area is extremely important for the healing of plantar ulcers. Off-loading with total contact cast (TCC) may be superior to other off-loading strategies studied so far, but practical limitations can dissuade clinicians from using this modality. This study was conducted to evaluate the efficacy of TCC compared with that of a pressure-relieving ankle foot orthosis (PRAFO) in healing of diabetic neuropathic foot ulcers and their effect on gait parameters. Methods: Thirty adult diabetic patients attending the foot clinic with neuropathic plantar ulcers irrespective of sex, age, duration and type of diabetes were randomly assigned to 1 of 2 off-loading modalities (TCC and PRAFO). Main outcome measures were ulcer healing after 4 weeks of randomization and effect of each of the modalities on various gait parameters. Results: The percentage reduction of the ulcer surface area at 4 weeks from baseline was 75.75 ± 9.25 with TCC and 34.72 ± 13.07 with PRAFO, which was significantly different ( P < .001). The results of this study however, showed that most of the gait parameters were better with PRAFO than with TCC. Conclusions: This study comprehensively evaluated the well known advantages and disadvantages of a removable (PRAFO) and a nonremovable device (TCC) in the treatment of diabetic neuropathic foot ulcer. Further studies are needed involving larger subjects and using 3D gait analysis to collect more accurate data on gait parameters and wound healing with different off-loading devices.
ASA Grade and Elderly Patients With Femoral Neck Fracture
Authors: Yeoh C. J. C. , Fazal M. A. 
Published: December 2014

Purpose: This prospective study was designed to evaluate the effect of American Society of Anaesthesiologists (ASA) score on time to surgery, length of hospital stay, and 30-day mortality in elderly patients with femoral neck fracture. Methods: A total of 249 patients admitted with femoral neck fracture were included in the study. Mean age was 84 years (95% confidence interval 83 to 85). Two patients were ASA I, 110 patients were ASA II, 125 were ASA III, and 12 were ASA IV. Results: The mean time to surgery was 18.9 hours for ASA I patients, 34.4 hours for ASA II patients, 42.8 hours for ASA III patients, and 61 hours for ASA IV patients ( P = .005). The mean hospital stay was 11.5 days (6.3-15.2) for ASA I patients, 17.6 days (4.2-98.8) for ASA II patients, 22.9 days (4.1-120.3) for ASA III patients, and 29 days (2.4-86.0) for ASA IV patients ( P = .026); 85% of the patients who died within 30 days of admission were of ASA III-IV. Conclusion: Our study shows that patients with higher ASA score have delay in surgery, longer hospital stay, and increase in 30-day mortality. We conclude that ASA grade is a simple and effective tool to predict the above-mentioned outcomes in these patients.
Central Defect Type Partıal ACL Injury Model on Goat Knees
Authors: Karakılıç Bekir , Taşkıran Emin , Doğanavşargil Başak , Çelik Salih 
Published: December 2014

Objectives: The aim of this study is to investigate the primary healing capacity of the anterior cruciate ligament (ACL) and the possible effect of fat pad excision on it. For this purpose, a central defect type ACL injury model was performed. Histopathological and biomechanical studies were performed on this model. Methods: Total of ten female adolescent Anatolian Black Goats were included in the study. A midsubstance central defect was created successfully with a four mm. arthroscopic punch in the ACLs of right knees of all the subjects through a medial mini-arthrotomy and goats were assigned to groups whether the fat pad was preserved (group I, n=5) or excised completely (group II, n=5). The left knees served as control. The histopathological evaluations of the defect area were performed utilizing Hematoxylene-Eosine, Masson Trichrome, Van Gieson, and elastic Van Gieson staining as well as measurement of type I collagen immunohistochemically in one sample from each group at 10th week postoperatively. The remaining knees were evaluated biomechanically at the 12th week, measuring anterior tibial translation (ATT) of the knee joints at 90 degrees of flexion and tensile properties (Maximum Tensile Load (MTL), Maximum Elongation (ME), Stiffness (S), failure mode (FM)) of the femur-ACL-tibia complex. Statistical analysis was performed utilizing SPSS v18 package program. Mann – Whitney U and Wilcoxon’s signed rank test were used for inter and intragroup analysis, respectively. Statistical significance was set at 0.05. Results: Histopathological analysis revealed that the central defect area was fully filled macroscopically and microscopically. However, mucoid degeneration was observed in group II. Relative collagen type I content increased in group II. There was no significant difference both within and between groups in terms of ATT values (p=0.715 and p=0.149 respectively). There was no statistical significance between and within groups in terms of MTL and ME; however group II demonstrated greater stiffness than group I (p=0,043) Overall (n=16 knees), tibial avulsion was the commonest mode of failure (n=9) in both control and operated knees. Conclusion: These findings revealed that the central defect type partial ACL injury model acted stable on A-P direction and had full healing capacity. The excision of the fat-pad had no additional effect except increased stiffness. Tibial insertion site seemed to be the weakest portion of the femur-ACL-tibia complex in adolescent goat knees.
Incidence of Meniscal Tears Accompanying ACL Ruptures
Authors: Tatari Mehmet Hasan , Guliyev Vugar 
Published: December 2014

Objectives: Anterior cruciate ligament (ACL) injury is a common disorder in athletes and in most cases, meniscal tears accompany. These meniscal tears can be the result of the initial trauma or the consecutive injuries in the unoperated patients. The aim of the study was to compare the incidence of meniscal tears in the patients operated because of ACL defficiency in the early or late period after the initial trauma. The age of the patient and meniscal tear pattern were the other subjects compared. Methods: The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236). Results: The groups included 42, 72 and 129 patients respectively. Among all groups, it was shown that in 125 cases (% 51.4), a meniscal tear accompanied the ACL tear. In Group 1, 18 cases (% 42.8) had meniscal tears while 29 patients (% 37) in Group 2 and 78 patients (% 60.4) in Group 3 had any kind of meniscal tear. Bucket handle tears constituted 38 % of all tears in Group 1, 53 % in Group 2 and 56 % in Group 3. There was a significant statistical difference between the groups among the presence of meniscal tear and the period between the initial trauma and operation time. When the patients accepted the operation in the first six months after the initial trauma, the incidence of the meniscal injury decreased significantly (chi-square test) (p <0,01). There was no statistical difference between three groups among the percentage of bucket handle tears (variance analysis: p=0,196). The statistical difference was not important between the groups among the age of the patients in relation with the pattern of the meniscal tears (variance analysis: p=0,236) Conclusion: We can say that the incidence of meniscal tears can be decreased if the patients with ACL injury are operated early after the initial trauma. Earlier ACL reconstruction means less meniscal tear.
The Effects of Additional Mechanical External Compression on Hemarthrosis After Arthroscopic External Capsular Release
Authors: Bilge Onur , Yel Mustafa , Doral Mahmut Nedim 
Published: December 2014

Objectives: Arthroscopic external capsular release has been frequently used especially in the treatment of symptomatic lateral patellar hyperpression syndrome. Hemarthrosis was reported among one of the most important complications of this procedure. The aim of this study was to demonstrate the effects of the postoperative application of mechanical external compression -in patients who undergone arthroscopic lateral capsular release- on the rates of postoperative bleeding and on pain scores. Methods: In this study, different clinical evaluations of 39 patients, who were diagnosed both clinically and radiologically as lateral patellar hyperpression syndrome and who were treated with arthroscopic external capsular release by radiofrequency probe, were compared retrospectively. The patients were evaluated in two groups: Group I (external capsular release, N:19) and Group II (external capsular release + mechanical external compression, N:20). The mean age of the patients was 38.5 +/- 7.3 and 42.3 +/-7.8, in group I and group II, respectively. The female / male ratio and right / left ratio was 17/2 and 16/4, and 9/10 and 9/11 in group I and group II, respectively. Postoperative drainage, cold compression, postoperative 24 hours of bed rest was applied to all patients. In addition, knee range of motion together with quadriceps strengthening exercises was started after postoperative 24 hours in both groups. In group II, mechanical external lateral compression with a steril roll bandage was applied just lateral to the patella and it was ended after one week. The clinical evaluations of the patients were performed first with VAS scoring preoperatively, at 1st and 6th month postoperatively and second with measurements of intraarticular bleeding amounts within the postoperative drains. For the statistical evaluations of the data, variance analysis and independent t-test were used. Results: The amounts of bleeding through the drains were 94.2 ml +/- 29.9 and 43.0 ml +/- 16.3 in group I and II, respectively (p<0.05). The VAS scores were found to decrease significantly at both early postoperative and late postoperative periods compared with preoperative period, in both groups (p<0.05). Although the decrease in VAS scores of early postoperative period was found to be more in group II than in group I, this decrease was not significant. Conclusion: One of the most frequent complications after arthroscopic external capsular release has been reported to be hemarthrosis, which is related with worse clinical outcomes after this surgical procedure. The most important result of this study revealed that the addition of immediate postoperative mechanical external compression application lateral to patella decreased postoperative amount of bleeding and subsequent hemarthrosis, without adding a significant clinical effect on VAS scores. In addition to the results of this study, prospective randomized studies are required further.
Measurement of Regional Bone Density of the Knee Following Anterior Cruciate Ligament Rupture by Computed Tomography
Authors: Balcı Ali , Gezer Naciye Sinem , Tatari Mehmet Hasan , Erduran Mehmet , Saleky Behzad , Kaya Erol , Özaksoy Dinç 
Published: December 2014

Objectives: The purpose of this study was to determine the regional bone mineral density changes of the knee after anterior cruciate ligament rupture and correlate with the duration after injury, age and gender of the patient. Methods: 31 patients, diagnosed as anterior cruciate ligament rupture with between June 2010 and February 2014, were included in this retrospective study. The measurements were performed in seven predetermined regions by using axial and sagittal plane computed tomography images. The mean trabecular bone densities of these certain regions were measured in terms of Hounsfield units by using a circular region of interest approximately 10-15 mm in diameter. Results: The trabecular bone densities at four of seven regions were negatively correlated with the duration after injury in Spearman’s correlation analysis. The bone densities of D1 (anteromedial area of the proximal tibia), D2 (anterolateral area of the proximal tibia), D3 (posteromedial area of the proximal tibia) and D4 (posterocentral area of the proximal tibia) regions had statistically significant negative correlation with preoperative duration (P<0.05, r -0.410, -0.501, -0.418 and -0.439, respectively). Multiple linear regressions analysis demonstrated independent negative correlation between the duration after injury and only D1 region (p=0.009). Conclusion: The present study demonstrated that, bone mineral density of the knee decreases by the time after ACL rupture particularly in anteromedial area of proximal tibia corresponding to ACL fixation area (D1). Thus, prolonged preoperative duration may decrease bone quality and influence the success of reconstructive surgery.
Anterior Cruciate Ligament Reconstruction Using an Achilles Tendon Allograft Graft
Authors: Mermerkaya Musa Uğur , Atay Ahmet Özgür , Bekmez Şenol , Karaaslan Fatih , Alkan Erkan , Doral Mahmut Nedim 
Published: December 2014

Objectives: To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop (EndoButton-CL®) on the femoral side, and an IS/staple on the tibial side. Methods: We retrospectively reviewed data on 46 patients who underwent arthroscopic ACL reconstruction with Achilles tendon allografting. Fixation was performed with a bioabsorbable IS (the IS group) in 24 patients (mean age 26.5 years), and with the EndoButton-CL device (the EB group) in 22 patients (mean age 28.1 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively. Results: The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (p>0.05). Femoral TW at the proximal and middle levels (on both anteroposterior and lateral views) in the IS group was significantly greater than in the EB group (p<0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (p>0.050). Conclusion: Femoral ACL graft fixation using an EndoButton-CL reduced femoral TW compared to use of an IS.
Reducing Intra-Articular Haemarthrosis After Arthroscopic Anterior Cruciate Ligament Reconstruction
Authors: Karaaslan Fatih , Karaoğlu Sinan , Mermerkaya Musa Uğur 
Published: December 2014

Objectives: A significant proportion of surgeons use intra-articular drains after arthroscopic anterior cruciate ligament (ACL) reconstruction. Haemarthrosis and pain adversely affects the functional outcome of ACL reconstruction. The purpose of the study was to evaluate the effect of tranexamic acid (TXA) administration to minimize pain and stiffness of knee joint by reducing haemarthrosis. Methods: The study enrolled 123 patients who underwent arthroscopic anterior cruciate ligament reconstruction in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group (71 patients) received both intravenous and intra-articular TXA. The control group (52 patients) did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 minutes before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 minutes before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 hours. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively. Results: The mean (± SD) postoperative volume of blood loss from the drain in the TXA and control groups was 100.6 ± 72mL and 164.3 ± 75mL ml, respectively. The difference between the two groups was significant (p < 0.005). Conclusion: This prospective randomized study showed that during arthroscopic anterior cruciate ligament reconstruction, TXA reduced blood loss and helped to reduce haemarthrosis amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for puncturing associated with arthroscopic anterior cruciate ligament reconstruction without enhancing the risk of deepssssssahrombosis.
Are Early Results of Robotic Assisted Medial Unicompartmental Knee Arthroplasty Successful?
Authors: Haklar Uğur , Ulusoy Ertuğrul , Şimşek Tayfun , Terzi Nuray 
Published: December 2014

Objectives: Robotic surgery studies have been increasing in literature in the past years due to its operative advantages on reducing error and improving functional success in partial knee arthroplasty. Methods: Data were prospectively collected in 21 patients (31 knees) who underwent MAKOplasty, robotic assisted unicondylar medial knee arthroplasty, between June 2013 – January 2014 in our clinic with an average follow-up time of 5.5 months. Clinical outcomes were evaluated with American Knee Society Scoring System. Additionally, intra-operative digitally planned implant positions on the robot’s software were compared with post-operative radiographic component alignment. In the radiographic evaluation; anatomic axis of the tibia was observed in the coronal plane. Tibial posterior slope and flexion angle of the femoral component were observed in the sagittal plane. Results: Pre-operatively 1 patient was scored fair (60 points) and 20 patients were scored poor (mean, 46.6 points) on American Knee Society Scoring System. Post-operatively all 21 patients had excellent knee scores (mean, 99.67 points). Function-wise 7 patients were scored fair (mean, 60 points) and 14 patients were scored poor (mean, 30.7 points) again on American Knee Society Functional Scoring System. Post-operatively all 21 patients exhibited excellent function scores (mean, 99.04 points). In the radiological evaluation, intra-operative robotic analyses were compared with post-operative radiographic alignment. No significant difference was observed statistically (paired t-test, p < 0.05). This comparison is valuable as Lonner, Hernigou, Collier report that mal-alignment by as little as 2° may predispose to implant failures. Conclusion: Robotic assistance greatly improves clinical and functional outcomes and may help prevent implant failures due to surgical error and mal-alignment in partial knee arthroplasty.
Reducing Blood Loss in Simultaneous Bilateral Total Knee Arthroplasty
Authors: Karaaslan Fatih , Mermerkaya Musa Ugur , Karaoglu Sinan , Baktır Ali 
Published: December 2014

Objectives: We asked whether tranexamic acid administration could reduce blood loss and blood transfusion requirements after simultaneous bilateral total knee arthroplasty (TKA). This study examined the role of different method of tranexamic acid administration in TKA. Methods: The study enrolled 81 patients who underwent simultaneous bilateral total knee replacement in a prospective, randomized, double-blind study. The patients who were randomized into the TXA group received both intravenous and intra-articular TXA. The control group did not receive TXA. The anesthetist, surgeon, and observer were blinded to the study group (double-blinded). TXA was administered as a bolus dose of 15 mg/kg 10 min before the inflation of the tourniquet on the first side. This was followed by continued intra-articular administration of 3 g at 10 min before the deflation of the tourniquet. Intravenous infusion of 10 mg/kg/h was continued for the next 3 h. Equal volumes of placebo were administered at the same rate and by the same route. We measured volume of drained blood 48 hours postoperatively, decrease in hemoglobin levels 12 hours postoperatively, amount of blood transfused, and number of patients requiring allogenic blood transfusion (BT). Results: Mean (± SD) postoperative volume of drained blood was lower in the group receiving tranexamic acid (509.39 ± 224.97mL) than in control subjects (961.37 ± 427.99mL). The mean hemoglobin decrease 12 hours postoperatively was lower in patients receiving tranexamic acid (2.07 ± 1.11g/dL) than in control subjects (3.21 ± 1.05g/dL). The amount of blood transfused and number of patients requiring blood transfusion were lower in patients receiving tranexamic acid than in control subjects. Conclusion: This prospective randomized study showed that during simultaneous bilateral TKA, TXA reduced blood loss and helped to reduce the BT amount and frequency with negligible side effects. With regard to the administration route, combined intravenous–intra-articular administration of TXA significantly reduces blood loss and the need for BT associated with bilateral simultaneous total knee replacement without enhancing the risk of deep vein thrombosis.