bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mid-term Results of 1-stage Revision Total Knee Arthroplasty for Periprosthetic Joint Infection With a Sinus Tract
Authors: Lausmann Christian , Wollny Anne , Citak Mustafa , Gehrke Thorsten , Beil Frank Timo , Lee Min-Jae , Unter Ecker Niklas 
Published: February 2024

Background: Patients presenting with a sinus tract over total knee arthroplasty (TKA) are challenging cases of periprosthetic joint infection (PJI). A 2-stage revision TKA has long been considered the gold standard for the management of PJI. At our institution, approximately 85% of patients with PJI, including patients with a sinus tract, undergo 1-stage revision TKA. Purpose: We sought to evaluate rates of reinfection and reoperation and predictors of failure of 1-stage revision TKA in patients with a concomitant sinus tract. Methods: We retrospectively reviewed patients with PJI and a sinus tract overlying TKA who underwent 1-stage revision TKA following a well-defined surgical protocol at our institution between January 2001 and December 2018. Of 170 patients included, 69 patients (40.6%) had a sinus tract overlying TKA; 101 patients without a sinus were the propensity-matched control group. Result: The success rate of controlling reinfection with 1-stage revision TKA with a concomitant sinus was 78.3% with a mean follow-up of 4.8 years. The most common intraoperatively isolated organisms in patients with a sinus tract were coagulase-negative Staphylococcus in 28 patients (40.6%), Staphylococcus aureus in 12 patients (17.2%), and polymicrobial infection in 14 patients (20.3%). A sinus tract in line with the surgical wound was associated with a higher risk of reoperation than a sinus tract away from the wound. Conclusion: Our retrospective study suggests that 1-stage revision TKA may be a viable treatment option for patients presenting with a sinus tract. A sinus in line with the former incision was associated with a higher rate of revision. Surgeons should take into consideration this risk for revision before performing a 1-stage exchange surgery.
Experimental evaluation of the plunger technique: A method of cyclic manual aspiration thrombectomy for treatment of acute ischemic stroke
Authors: Poulos Demitria A , Keith James S , Froehler Michael T , Good Bryan C 
Published: February 2024

Background Mechanical thrombectomy via direct aspiration is a rapid treatment for acute ischemic stroke. This method often results in the partial ingestion of the clot or “corking” of the catheter tip. Cyclic aspiration may take advantage of the mechanical properties of the clot, resulting in greater clot ingestion and overall procedure success. Methods An in vitro analysis was performed comparing static and cyclic (plunger technique) aspiration. Embolus analogs were used to create occlusions in a mock circulatory flow loop, and one aspiration attempt (first pass effect) using either a static or plunger technique was performed. The percent ingestion of each embolus analog was recorded for each trial. Results Static aspiration for 0% and 50% hematocrit embolus analogs resulted in ingestions of 12.8 ± 4.6% and 15.1 ± 10.0%, respectively, while plunger technique (cyclic) aspiration resulted in 15.8 ± 7.3% and 34.4 ± 19.5% ingestion. Complete ingestion was observed only with 50% hematocrit analogs, occurring in 30% of plunger and 10% of static cases. Statistical differences were determined between the two aspiration techniques for the 50% hematocrit samples, with the plunger technique yielding significantly more ingestion. In addition, the plunger technique was shown to maintain a negative vacuum pressure throughout the duration of cyclic plunging. Conclusions The plunger technique for manual cyclic aspiration resulted in higher rates of complete ingestion and greater average % ingestions when compared to static aspiration. Increased clot ingestion can result in a higher rate of complete reperfusion during the first aspiration attempt, maximizing the number of patients with good clinical outcomes.
Randomized trial of mechanotherapy for the treatment of stress urinary incontinence in women
Authors: Nakib Nissrine , Sutherland Suzette , Hallman Kevin , Mianulli Marcus , R Boulware David 
Published: February 2024

Background: Stress urinary incontinence (SUI) presents as unintentional urine leakage associated with activities. It significantly affects quality of life (QoL) and is the most common type of incontinence in women. Current treatment options, particularly non-surgical therapies, are lacking. Objective: To assess the efficacy of mechanotherapy provided by the Flyte® intra-vaginal device during pelvic floor muscle training (PFMT). Design: This was a randomized, controlled, double-blinded trial. Materials and methods: Flyte is a repeat use device for conditioning and strengthening the pelvic floor muscles (PFMs). It provides two-part mechanotherapy. Part 1 is the stretching and preloading of the PFM from the internal wand. Part 2 integrates mechanical pulses which elicit muscle cellular and tissue level responses that trigger cellular regeneration, improve neuromuscular facilitation and motor learning. Subjects used the device for 5 min/day for 12 weeks. Subjects (144) were randomized and evaluated at 6 and 12 weeks. Arm A (72) received both Part 1 and Part 2 mechanotherapy for 12 weeks, whereas Arm B (72) received Part 1 therapy for 6 weeks, then crossed over to full therapy. Mean age was 50, 49, respectively, prior pelvic/abdominal surgery 26%, 46%, and previous incontinence treatments 13%, 22%. The primary endpoint was 24-h pad weight (24-HR PW) at 6 weeks. Secondary endpoints were 24-HR PW at 12 weeks and QoL [International Consultation on Incontinence Questionnaire (ICIQ), Urinary Incontinence Quality of Life (IQOL)]. Results: Part 1 therapy had a greater than anticipated therapeutic effect. Thus, the study was underpowered to identify differences between study arms. Therefore, data were pooled to assess the effects of mechanotherapy. Twenty four-HR PW was significantly reduced at 6 weeks ( p = <0.0001), with further reduction from 6 to 12 weeks ( p = <0.0001). Data were stratified based on 24-HR PW severity. Significant reductions were noted in all severity groups (mild p = <0.0001, moderate p = <0.0001, severe p = <0.01). QoL was similarly improved at 6 weeks (ICIQ p = <0.0001, IQOL p = <0.0001), and 12 weeks (ICIQ p = <0.0001, IQOL p = <0.0001). Compliance was >80% at 6 weeks and 70% at 12 weeks. Conclusion: Two-part mechanotherapy significantly improved 24-HR PW and QoL across all severities of SUI. Improvements were noted in as little as 2 weeks and appeared to be sustained through 2-year follow up. Trial registration: Registered on ClinTrials.gov (NCT02954042).
Cellular Enhancement of Frozen Meniscus Allograft Combining Native Meniscus and Mesenchymal Stromal Cell Injections
Authors: Struijk Caroline , Lydon Katherine L. , Husen Martin , Verdonk Peter , Michielsen Jozef , van Wijnen Andre J. , Krych Aaron J. , Saris Daniel B.F. 
Published: February 2024

Objective This proof-of-concept study investigated an improved cell-based injection therapy combining mesenchymal stem cells (MSCs) and meniscus cells (MCs) to support superior meniscus allograft repopulation and early revival compared to injecting MSCs alone. Design In this controlled laboratory study, frozen meniscus allograft samples were injected vertically with a cell suspension containing different ratios of MSCs and MCs or control (lactated ringers) and cultured for 28 days. Samples were analyzed weekly for cell viability, migration, and metabolism using histological and biochemical assays. Tissue medium was analyzed for matrix metalloproteinase (MMP) expression using zymography. Results Cellular repopulation of frozen allografts injected with different cell suspensions was validated by immunohistochemistry. Significant higher DNA content was evidenced in grafts treated with suspensions of MCs or MC:MSC (1:4 ratio). Cell metabolic activity was significantly different between all treated groups and control group after 1 week. Allografts injected with MCs showed significantly more cell proliferation than injections with MSCs. MMP2 activity was detected in medium of all grafts cellularized with MCs with or without MSCs. Scanning electron microscopy (SEM) analysis showed resolution of the needle puncture, but not in the control group. Cell labeling of MCs upon injection of mixed MC:MSC suspensions revealed a gradual increase in the cell ratio. Conclusions The findings of this study establish that injection of MCs with or without MSCs enhances the cellularity of meniscus allograft to support early graft revival and remodeling.
Re-estimation of the burden of serious fungal diseases in Uganda
Authors: Bongomin Felix , Kwizera Richard , Namusobya Martha , van Rhijn Norman , Andia-Biraro Irene , Kirenga Bruce J. , Meya David B. , Denning David W. 
Published: February 2024

Background: It is of utmost importance to monitor any change in the epidemiology of fungal diseases that may arise from a change in the number of the at-risk population or the availability of local data. Objective: We sought to update the 2015 publication on the incidence and prevalence of serious fungal diseases in Uganda. Methods: Using the Leading International Fungal Education methodology, we reviewed published data on fungal diseases and drivers of fungal diseases in Uganda. Regional or global data were used where there were no Ugandan data. Results: With a population of ~45 million, we estimate the annual burden of serious fungal diseases at 4,099,357 cases (about 9%). We estimated the burden of candidiasis as follows: recurrent Candida vaginitis (656,340 cases), oral candidiasis (29,057 cases), and esophageal candidiasis (74,686 cases) in HIV-infected people. Cryptococcal meningitis annual incidence is estimated at 5553 cases, Pneumocystis pneumonia at 4604 cases in adults and 2100 cases in children. For aspergillosis syndromes, invasive aspergillosis annual incidence (3607 cases), chronic pulmonary aspergillosis (26,765 annual cases and 63,574 5-year-period prevalent cases), and prevalence of allergic bronchopulmonary aspergillosis at 75,931 cases, and severe asthma with fungal sensitization at 100,228 cases. Tinea capitis is common with 3,047,989 prevalent cases. For other mycoses, we estimate the annual incidence of histoplasmosis to be 646 cases and mucormycosis at 9 cases. Conclusion: Serious fungal diseases affect nearly 9% of Ugandans every year. Tuberculosis and HIV remain the most important predisposition to acute fungal infection necessitating accelerated preventive, diagnostic, and therapeutic interventions for the management of these diseases.
Impact of Recovery Colleges in Postsecondary Institutions in Canada – Preliminary Findings
Authors: Paul Sayani , Battistelli Rachael , Arbour Simone 
Published: February 2024

This paper describes the preliminary findings of the implementation of recovery colleges - a strengths-based, peer-driven, mental health learning model in five postsecondary institutions in Canada. Using exploratory methods and a sample of 124 participants completing a pre-participation and 72 completing a post-participation survey we aimed to answer two research questions; (1) Who is accessing the postsecondary recovery college? and (2) How is recovery college participation impacting students individually and interpersonally? Addressing the first research question, 80% were female students, between the ages of 18–25 years (73%), and 73% were in their second year of study. With regards to the second research question, recovery college participation improved students’ knowledge of coping and life skills and supported their mental health and wellbeing. Results provide evidence of impact of recovery college in postsecondary settings and may contribute to mental health system transformation to explore novel ways to support emerging adults’ mental health.
Expert Opinion, Real-World Classification, and Decision-Making in Thoracolumbar Burst Fractures Without Neurologic Deficits?
Authors: Camino-Willhuber Gaston , Bigdon Sebastian , Dandurand Charlotte , Dvorak Marcel F. , Öner Cumhur F. , Schnake Klaus , Muijs Sander , Benneker Lorin M. , Vialle Emiliano , Tee Jin W. , Keynan Ory , Chhabra Harvinder S. , Joaquim Andrei F. , Popescu Eugen C. , Canseco Jose A. , Holas Martin , Kanna Rishi M. , Aly Mohamed M. , Fallah Nader , Schroeder Gregory D. , Spiegl Ulrich , El-Skarkawi Mohammad , Bransford Richard J. , Rajasekaran Shanmuganathan , Vaccaro Alexander R. 
Published: February 2024

Study Design Retrospective analysis of prospectively collected data. Objectives To compare decision-making between an expert panel and real-world spine surgeons in thoracolumbar burst fractures (TLBFs) without neurological deficits and analyze which factors influence surgical decision-making. Methods This study is a sub-analysis of a prospective observational study in TL fractures. Twenty two experts were asked to review 183 CT scans and recommend treatment for each fracture. The expert recommendation was based on radiographic review. Results Overall agreement between the expert panel and real-world surgeons regarding surgery was 63.2%. In 36.8% of cases, the expert panel recommended surgery that was not performed in real-world scenarios. Conversely, in cases where the expert panel recommended non-surgical treatment, only 38.6% received non-surgical treatment, while 61.4% underwent surgery. A separate analysis of A3 and A4 fractures revealed that expert panel recommended surgery for 30% of A3 injuries and 68% of A4 injuries. However, 61% of patients with both A3 and A4 fractures received surgery in the real world. Multivariate analysis demonstrated that a 1% increase in certainty of PLC injury led to a 4% increase in surgery recommendation among the expert panel, while a .2% increase in the likelihood of receiving surgery in the real world. Conclusion Surgical decision-making varied between the expert panel and real-world treating surgeons. Differences appear to be less evident in A3/A4 burst fractures making this specific group of fractures a real challenge independent of the level of expertise.
Understanding Decision Making as It Influences Treatment in Thoracolumbar Burst Fractures Without Neurological Deficit: Conceptual Framework and Methodology
Authors: Dandurand Charlotte , Öner Cumhur F. , Hazenbiller Olesja , Bransford Richard J. , Schnake Klaus , Vaccaro Alexander R. , Benneker Lorin M. , Vialle Emiliano , Schroeder Gregory D. , Rajasekaran Shanmuganathan , El-Skarkawi Mohammad , Kanna Rishi M. , Aly Mohamed , Holas Martin , Canseco Jose A. , Muijs Sander , Popescu Eugen Cezar , Tee Jin Wee , Camino-Willhuber Gaston , Joaquim Andrei Fernandes , Keynan Ory , Chhabra Harvinder Singh , Bigdon Sebastian , Spiegel Ulrich , Dvorak Marcel F. 
Published: February 2024

Study Design This paper presents a description of a conceptual framework and methodology that is applicable to the manuscripts that comprise this focus issue. Objectives Our goal is to present a conceptual framework which is relied upon to better understand the processes through which surgeons make therapeutic decisions around how to treat thoracolumbar burst fractures (TL) fractures. Methods We will describe the methodology used in the AO Spine TL A3/4 Study prospective observational study and how the radiographs collected for this study were utilized to study the relationships between various variables that factor into surgeon decision making. Results With 22 expert spine trauma surgeons analyzing the acute CT scans of 183 patients with TL fractures we were able to perform pairwise analyses, look at reliability and correlations between responses and develop frequency tables, and regression models to assess the relationships and interactions between variables. We also used machine learning to develop decision trees. Conclusions This paper outlines the overall methodological elements that are common to the subsequent papers in this focus issue.
Using Equipoise to Determine the Radiographic Characteristics Leading to Agreement on Best Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficits
Authors: Dandurand Charlotte , Dvorak Marcel F. , Hazenbiller Olesja , Bransford Richard J. , Schnake Klaus J. , Vaccaro Alexander R. , Benneker Lorin M. , Vialle Emiliano , Schroeder Gregory D. , Rajasekaran Shanmuganathan , El-Skarkawi Mohammad , Kanna Rishi M. , Aly Mohamed M. , Holas Martin , Canseco Jose A. , Muijs Sander , Popescu Eugen C. , Tee Jin Wee , Camino-Willhuber Gaston , Joaquim Andrei Fernandes , Keynan Ory , Chhabra Harvinder Singh , Bigdon Sebastian , Spiegel Ulrich , Öner Cumhur F. 
Published: February 2024

Study Design Retrospective analysis of prospectively collected data. Objectives Our goal was to assess radiographic characteristics associated with agreement and disagreement in treatment recommendation in thoracolumbar (TL) burst fractures. Methods A panel of 22 AO Spine Knowledge Forum Trauma experts reviewed 183 cases and were asked to: (1) classify the fracture; (2) assess degree of certainty of PLC disruption; (3) assess degree of comminution; and (4) make a treatment recommendation. Equipoise threshold used was 77% (77:23 distribution of uncertainty or 17 vs 5 experts). Two groups were created: consensus vs equipoise. Results Of the 183 cases reviewed, the experts reached full consensus in only 8 cases (4.4%). Eighty-one cases (44.3%) were included in the agreement group and 102 cases (55.7%) in the equipoise group. A3/A4 fractures were more common in the equipoise group (92.0% vs 83.7%, P < .001). The agreement group had higher degree of certainty of PLC disruption [35.8% (SD 34.2) vs 27.6 (SD 27.3), P < .001] and more common use of the M1 modifier (44.3% vs 38.3%, P < .001). Overall, the degree of comminution was slightly higher in the equipoise group [47.8 (SD 20.5) vs 45.7 (SD 23.4), P < .001]. Conclusions The agreement group had a higher degree of certainty of PLC injury and more common use of M1 modifier (more type B fractures). The equipoise group had more A3/A4 type fractures. Future studies are required to identify the role of comminution in decision making as degree of comminution was slightly higher in the equipoise group.
Prediction Model and Risk Factor Analysis of Adjacent Segment Disease After L4-5 Transforaminal Lumbar Interbody Fusion Through Preoperative Radiographic Features
Authors: Zhang Zi-Jian , Chen Lu , Zhu Lei , Shi Hang , Zhang Fu-Yu , Jiang Zan-Li , Wu Xiao-Tao 
Published: February 2024

Study Design A retrospective study. Objective To investigate the risk of adjacent segment disease (ASD) after L4-5 transforaminal lumbar interbody fusion (TLIF) in patients diagnosed with lumbar spinal stenosis (LSS), a prediction model for ASD is established and validated. Methods A retrospective study was carried out on a sample of 290 patients who underwent L4-5 TLIF at Zhongda Hospital, Southeast University, from January 2015 to January 2021. The study collected baseline data and preoperative radiographic features of L3-4 and L5-S1. The determination of the outcome variable was based on X-ray results spanning over 24 months and JOA scores. Multivariate logistic regression was used to identify the risk factors in constructing a nomogram. Results Independent risk factors for L3-4 degeneration after TLIF included osteoarthritis of L3-4 facet joints, L3-4 foraminal stenosis, L4 upper endplate osteochondritis, L3-4 local lordosis angle, and L3-4 spinal stenosis. Independent risk factors for L5-S1 degeneration after TLIF included osteoarthritis of L5-S1 facet joints, L5-S1 intervertebral disc degeneration, L5-S1 spinal stenosis, L5-S1 coronal imbalance, and S1 upper endplate osteochondritis. A predictive model was developed. The AUC for the prediction models at L3-4 and L5-S1 were .945 and .956. The calibration curve demonstrated good consistency between the predicted and actual probabilities. The DCA curve indicated the clinical benefit and practical value of this predictive model. Conclusion This study established nomograms for postoperative degeneration at L3-4 and L5-S1 based on selected preoperative radiographic features. These models provide a valuable auxiliary decision-making system for clinicians and aid in early surgical decisions.
Immediate and Short-Term Effects of In-Shoe Heel-Lift Orthoses on Clinical and Biomechanical Outcomes in Patients With Insertional Achilles Tendinopathy
Authors: Alghamdi Nabeel Hamdan , Pohlig Ryan T. , Seymore Kayla D. , Sions Jaclyn Megan , Crenshaw Jeremy R. , Grävare Silbernagel Karin 
Published: February 2024

Background: Physical therapists frequently employ heel lifts as an intervention to reduce Achilles tendon pain and restore function. Purpose: To determine the short-term effect of heel lifts on clinical and gait outcomes in participants with insertional Achilles tendinopathy (IAT). Study Design: Case series; Level of evidence, 4. Methods: Participants with IAT underwent eligibility screening and completed assessments at baseline and 2 weeks later. Primary outcomes included symptom severity (Victoria Institute of Sports Assessment-Achilles [VISA-A]), gait analysis with the 10-m walk-test at 2 speeds (normal and fast), and pain during walking. Pain and gait analysis were assessed under 3 conditions: before fitting 20-mm heel lifts, immediately after heel-lift fitting, and after 2 weeks of wearing heel lifts. Ultrasound images and measurements at the Achilles insertion were obtained from prone and standing positions (with and without heel lifts). Spatiotemporal gait parameters and tibial tilt angles were evaluated at normal speed using inertia measurement units during the 3 study conditions. Differences between the conditions were analyzed using paired t test or analysis of variance. Results: Overall, 20 participants (12 female, 13 with bilateral IAT; mean age, 51 ± 9.3 years; mean body mass index 31.6 ± 6.8 kg/m2) completed all assessments. Symptom severity (VISA-A) of the more symptomatic side significantly improved at 2 weeks (60 ± 20.6) compared with baseline (52.2 ± 20.4; P < .01). Pain during gait (Numeric Pain Rating Scale) was significantly reduced immediately after heel-lift fitting (0.7 ± 2.0) when compared with baseline (2.2 ± 2.7, P = .043). Spatiotemporal gait parameters and tibial tilt angle before and after using heel lifts at normal walking speed were not significantly different; however, gait speed, stride length, and tibial tilt angle on both sides increased significantly immediately after using heel lifts and were maintained after 2 weeks of wear. Conclusion: Using heel lifts not only improved symptom severity after 2 weeks but also immediately reduced pain during gait and had a positive impact on gait pattern and speed.