bluuebunny/crossref_metadata_2025_split huggingface dataset:
Thermal Microdebridement Does Not Affect the Time Zero Biomechanical Properties of Human Patellar Tendons
Authors: Silver William P. , Creighton R. Alexander , Triantafillopoulos Ioannis K. , Devkota Aaditya C. , Weinhold Paul S. , Karas Spero G. 
Published: December 2004

Background Thermal microdebridement for the treatment of chronic tendinopathy has recently been introduced. The effect of thermal microdebridement on the biomechanical properties of human tendons, however, remains unknown. Hypothesis Thermal microdebridement does not affect the biomechanical properties of human patellar tendons in a cadaveric model at the time of initial treatment. Study Design Controlled laboratory study. Methods The central 15 mm of 12 matched, human (mean age, 71 years; 8 male, 4 female), fresh-frozen patellar tendons was divided into 3 equal 5-mm specimens. The treatment group (n = 12) underwent thermal microdebridement with a radiofrequency probe. A sham treatment group (n = 12) underwent insertion of a deactivated probe. The control group (n = 12) underwent no treatment. After treatment, each specimen was tested to failure in a servo-hydraulic materials testing machine at an elongation rate of 3 mm/s. One-way repeated measures analysis of variance was used to determine differences between groups. Results No significant difference in ultimate stress at failure, elastic modulus, strain energy density, or strain at maximum load was found between the groups. The ultimate stress at failure for the treatment, sham, and control groups was 61.0, 66.7, and 63.0 MPa, respectively ( P = .653), and the strain at maximum load was 0.12, 0.11, and 0.09, respectively ( P = .279). Conclusions Thermal microdebridement does not affect the biomechanical properties of cadaveric human patellar tendons at the time of initial treatment. Clinical Relevance It may be safe to proceed with aggressive rehabilitation after thermal microdebridement of the patellar tendon. However, the results in this cadaveric model should be interpreted with caution. Additional studies using an in vivo model will be required to completely assess the effects of thermal microdebridement on the biomechanical properties of human patel-lar tendons.
Revision Arthroscopically Assisted Anterior Cruciate Ligament Reconstruction with Previously Unharvested Ipsilateral Autografts
Authors: O'Neill Daniel B. 
Published: December 2004

Background Revision anterior cruciate ligament reconstruction requires flexibility and variability in treatment options. This study analyzed the functional outcomes and graft stability of 48 consecutive revision anterior cruciate ligament reconstructions using previously unharvested ipsilateral autografts. Hypothesis Using previously unharvested ipsilateral autografts will achieve similar outcomes to other graft choices in revising previously failed anterior cruciate ligament reconstructions. Study Design Prospective nonrandomized clinical trial. Methods Forty-eight patients (48 operations) were observed for 2 to 13 years (mean, 90 months). All agreed to have revision reconstruction with ipsilateral autografts. The details of the technique varied according to the original graft choice and the abnormality encountered. Concomitant procedures were necessary in 40 (84%) of 48 knees. Twenty-three patients (48%) had revision reconstruction with previously unharvested ipsilateral autogenous hamstring tendons. Ten (21%) were 2-stranded grafts, and 13 (27%) were 4-stranded (quadrupled) autografts. Twenty-five patients (52%) had revision reconstruction with previously unharvested ipsilateral patellar tendon autografts, 6 (12%) using the 2-incision rear-entry method and 19 (40%) using the single-incision technique. Results Results were evaluated with Lysholm and Gillquist scores and International Knee Documentation Committee ratings, including KT-2000 arthrometer examinations. Seventy-three percent of the patients had International Knee Documentation Committee normal (A) or nearly normal (B) knees (42% of the patients had A knees and 42% had B knees). Twelve percent of patients had C knees, and 4% had a D rating. Sixty-seven percent of the knees had a KT-2000 arthrometer side-to-side difference of 3 mm or less, and an additional 21% of the knees had a side-to-side difference of 3 to 5 mm; therefore, 94% of the grafts were functional or partially functional. Six percent of grafts had more than 5 mm of laxity and were considered failures. Conclusions Previously unharvested ipsilateral autografts proved reliable in improving function and stability in revision anterior cruciate ligament reconstruction. However, outcomes were less favorable with revision reconstructions than with primary reconstructions.
Biomechanical Rationale for Development of Anatomical Reconstructions of Coracoclavicular Ligaments after Complete Acromioclavicular Joint Dislocations
Authors: Costic Ryan S. , Labriola Joanne E. , Rodosky Mark W. , Debski Richard E. 
Published: December 2004

Background Surgical treatments of complete acromioclavicular joint dislocations replace or reconstruct the coracoclavicular ligaments with a single structure and do not account for the anatomical variance of each ligament in the design. Purpose To evaluate the cyclic behavior and structural properties of an anatomic tendon reconstruction of the coracoclavicular ligament complex after a simulated acromioclavicular joint dislocation. Study Design Controlled laboratory study. Methods Cyclic loading followed by a load-to-failure protocol (simulated dislocation) of the normal coracoclavicular ligament complex was performed and repeated after an anatomic reconstruction on the same specimen (n = 9). The anatomical reconstruction consisted of a semitendinosus tendon that replicated the direction and orientation of both the trapezoid and conoid ligaments. Results The coracoclavicular ligament and anatomical reconstruction complexes had clinically insignificant (<3 mm) permanent elongation after cyclic loading. The stiffness and ultimate load of the coracoclavicular ligament complex (60.8 ± 12.2 N/mm and 560 ± 206 N) were significantly greater than for the anatomical reconstruction complex (23.4 ± 5.2 N/mm and 406 ± 60 N), respectively (P < .05). Further analysis of the complexes revealed a 40% decrease in the bending stiffness of the clavicle after the simulated dislocation and failure of the normal coracoclavicular ligament complex (P < .05), which contributed to the diminished properties of the anatomic reconstruction. Conclusions The low level of permanent elongation after cyclic loading suggests that the anatomic reconstruction complex could withstand early rehabilitation; however, the decrease in the structural properties and stiffness of the clavicle should be considered in optimizing the anatomic reconstruction technique. Clinical Relevance Despite the differences compared to the normal coracoclavicular ligament complex, the anatomical reconstruction complex more closely approximates the stiffness of the coracoclavicular ligament complex than current surgical constructs, and the incorporation of biological tissue could improve the overall structural properties with healing.
Menisci are Efficiently Transduced by Recombinant Adeno-Associated virus Vectors in Vitro and in Vivo
Authors: Madry Henning , Cucchiarini Magali , Kaul Gunter , Kohn Dieter , Terwilliger Ernest F. , Trippel Stephen B. 
Published: December 2004

Background Meniscal tears remain an unsolved problem in sports medicine. Gene transfer is a potential approach to enhancing meniscal repair. Recombinant adeno-associated virus is a method of gene transfer that has advantages over previously used approaches to this problem. Hypothesis Direct gene transfer to meniscal cells can be accomplished using recombinant adeno-associated virus in vitro and in vivo. Study Design Controlled laboratory study. Methods Recombinant adeno-associated viruses containing the reporter gene lacZ were tested for their ability to achieve gene transfer into lapine and human meniscal cells in vitro and into lapine meniscal defects in vivo. Results were assessed by detecting β-galactosidase, the enzyme encoded by the lacZ gene. Results Maximal efficiency of gene transfer was 81.6% ± 6.6% for lapine and 87.2% ± 14.8% for human meniscal cells in vitro. Expression of the transferred gene continued for the 28-day duration of the study. When the recombinant adeno-associated virus vector was injected into meniscal tears in a lapine meniscal tear model, transgene expression continued in meniscal cells adjacent to the tear for at least 20 days in vivo. Conclusions The data suggest that recombinant adeno-associated virus vectors can directly and efficiently transfer and stably express foreign genes in isolated lapine and human meniscal cells in vitro and in lapine meniscal defects in vivo. Clinical Relevance This direct gene transfer approach may form a basis for improved treatments of meniscal tears.
Arthroscopic Bankart Repair Using Suture Anchors in Athletes
Authors: Ide Junji , Maeda Satoshi , Takagi Katsumasa 
Published: December 2004

Purpose The purpose of this study was to evaluate the results in selected high-risk patients who underwent arthroscopic stabilization of shoulders with recurrent anterior instability. Hypothesis Arthroscopic stabilization using suture anchors is useful for athletes younger than 25 years or for contact athletes without a large bone loss of glenohumeral articulation. Study Design Prospective cohort study. Methods The study group comprised 55 patients, with a mean follow-up of 42 months (range, 25-72 months). Thirty-two patients had recurrent dislocations, 14 had recurrent subluxations, and 9 had recurrent subluxations after a single dislocation. Rowe score, range of motion, recurrence, and sports activities were evaluated. Results Mean Rowe score improved from 30.1 to 92.3 points; 45 scores (82%) were excellent, 5 (9%) good, 1 fair (2%), and 4 (7%) poor. Patients had lost a mean of 4° of external rotation in adduction. Four (7%) had recurrence. The recurrence rate in contact athletes (9.5%, 2 of 21) was not statistically different from that in noncontact athletes (6%, 2 of 34). Forty-four (80%) returned at the same levels. The complete return rate in overhead-throwing athletes (68%, 17 of 25) was lower than that in nonoverhead athletes (90%, 27 of 30) (P = .0423). Five patients had unsatisfactory results. Conclusion Arthroscopic stabilization is a reliable procedure in selected high-risk patients.
High expression of cyclin B1 predicts a favorable outcome in patients with follicular lymphoma
Authors: Björck Erik , Ek Sara , Landgren Ola , Jerkeman Mats , Ehinger Mats , Björkholm Magnus , Borrebaeck Carl A. K. , Porwit-MacDonald Anna , Nordenskjöld Magnus 
Published: December 2004

AbstractSubstantial research has been dedicated to the study of the relationship between genetic mechanisms regulating cell functions in tumors and how those tumors respond to various treatment regimens. Because these mechanisms are still not well understood, we have chosen to study the genetic makeup of 57 tumor samples from patients with follicular lymphoma (FL). Our goal was to develop a prognostic tool, which can be used as an aid in determining FL patients with tumors genetically predisposed to a successful treatment with the CHOP (cyclophosphamide, vincristine, doxorubicin, prednisone) regimen. To select relevant genes, high-density oligonucleotide arrays were used. There were 14 genes highly expressed in FL patients that responded well to CHOP chemotherapy, and 11 of these were involved in G2/M transition of the cell cycle, in mitosis, or in DNA modulation. A high expression of CCNB1 (cyclin B1), CDC2, CDKN3A, CKS1B, ANP32E, and KIAA0101, but not of the proliferation-related antigen Ki-67, was associated with better survival rate in a univariate analysis. CCNB1 expression had an independent prognostic value when included in a multivariate analysis together with the 5 parameters of the follicular lymphoma international prognostic index.
Plasma Catecholamines and the Counterregulatory Responses to Hypoglycemia in Infants: A Critical Role for Epinephrine and Cortisol
Authors: Jackson Lesley , Williams Fiona L. R. , Burchell Ann , Coughtrie Michael W. H. , Hume Robert 
Published: December 2004

AbstractThe purpose of this study was to define plasma catecholamine responses as part of the counterregulatory hormonal reaction to hypoglycemia in infants after a regular 3- to 4-h feed was omitted. Hormone levels were assessed once, at the end of the fast or at hypoglycemia. The 121 infants were subdivided into three groups for analysis: normoglycemia (n = 94, 78%); transient hypoglycemia (n = 11, 9%); or severe and persistent hypoglycemia (n = 16, 13%). The severe and persistent hypoglycemic group had significantly higher levels of cortisol and epinephrine than the normoglycemic group. Norepinephrine and glucagon levels did not differ between the groups. Human GH levels were higher in the transiently hypoglycemic group but not in the severe and persistent hypoglycemic group. Prefeed blood lactate levels differed significantly among the groups and were highest in the severe and persistent groups. Multiple regression analysis showed that cortisol levels were significantly higher in infants who had severe and persistent hypoglycemia. The counterregulatory hormonal response in infants to severe and persistent hypoglycemia was limited to elevations in only cortisol and epinephrine levels but did not involve glucagon or human GH. This limited hormonal response may also contribute to the frequent occurrence of hypoglycemia in these infants.
Residual β-Cell Function More than Glycemic Control Determines Abnormalities of the Insulin-Like Growth Factor System in Type 1 Diabetes
Authors: Hedman Christina A. , Frystyk Jan , Lindström Torbjörn , Chen Jian-Wen , Flyvbjerg Allan , Ørskov Hans , Arnqvist Hans J 
Published: December 2004

Abstract
The GH-IGF-I axis is disturbed in patients with type 1 diabetes. Our aim was to investigate whether abnormalities are found in patients in very good glycemic control and, if so, to estimate the role of residual β-cell function. Patients with hemoglobin A1c (HbA1c) less than 6% (reference range, 3.6–5.4%) were selected for the study. Twenty-two men and 24 women, aged 41.3 ± 13.8 yr (mean ± sd), with a diabetes duration of 17.8 ± 14.6 yr participated. Healthy controls (15 women and nine men), aged 41.3 ± 13.0 yr, were also studied. Overnight fasting serum samples were analyzed for HbA1c, C peptide, free and total IGFs, IGF-binding proteins (IGFBPs), GH-binding protein, and IGFBP-3 proteolysis. HbA1c was 5.6 ± 0.5% in patients and 4.4 ± 0.3% in controls. Total IGF-I was 148 ± 7 μg/liter in patients and 178 ± 9 μg/liter in controls (P &lt; 0.001). Free IGF-I, total IGF-II, IGFBP-3, and GH-binding protein were lower, whereas IGFBP-1, IGFBP-1-bound IGF-I, and IGFBP-2 were elevated compared with control values. Patients with detectable C peptide (≥100 pmol/liter) had higher levels of total IGF-I, free IGF-I, and total IGF-II and lower levels of IGFBP-1 and IGFBP-2 than those with an undetectable C peptide level despite having identical average HbA1c. IGFBP-3 proteolysis did not differ between patients and controls. Despite very good glycemic control, patients with type 1 diabetes and no endogenous insulin production have low free and total IGF-I. Residual β-cell function, therefore, seems more important for the disturbances in the IGF system than good metabolic control per se, suggesting that portal insulin delivery is needed to normalize the IGF system.
Spinal Cord Injury without Radiographic Abnormality in Children, 2 Decades Later
Authors: Pang Dachling 
Published: December 2004

AbstractOBJECTIVE:Much new research has emerged since1982, when the original description of spinal cord injury without radiographic abnormality (SCIWORA) as a self-contained syndrome was reported. This article reviews new and old data on SCIWORA, from the past 2 decades.METHODS:This article reviews what we have learned since 1982 about the unique biomechanical properties of the juvenile spine, the mechanisms of injuries, the profound influence of age on injury pattern and outcome, the magnetic resonance imaging (MRI) features, and management algorithms of SCIWORA.RESULTS:The increasing use of MRI in SCIWORA has yielded ample evidence of damage in virtually all nonbony supporting tissues of the juvenile vertebral column, including rupture of the anterior and posterior longitudinal ligaments, intervertebral disc disruption, muscular and interspinal ligament tears, tectorial membrane rupture, and shearing of the subepiphyseal growth zone of the vertebral endplates. These findings provide the structural basis for the postulated “occult instability” in the spine of a patient after SCIWORA. MRI also demonstrated five classes of post-SCIWORA cord findings: complete transection, major hemorrhage, minor hemorrhage, edema only, and normal. These “neural” findings are highly predictive of outcome: patients with transection and major hemorrhage had profoundly poor outcome, but 40% with minor hemorrhage improved to mild grades, whereas 75% with “edema only” attained mild grades and 25% became normal. All patients with normal cord signals made complete recovery.The large pool of clinical data from our own and other centers also lends statistical power to uphold most of our original assertions regarding incidence, causes of injury, pathophysiology, age-related changes in the malleability of the spine, vectors of deformation, and the extreme vulnerability of young children to severe cord injury, particularly high cervical cord injury. Thoracic SCIWORA has been identified as an important subset, comprising three subtypes involving high-speed direct impact, distraction from lap belts, and crush injury by slow moving vehicles. Computation of the sensitivities of MRI and somatosensory evoked potentials in detecting SCIWORA shows that both tests were normal in 12 to 15% of children with definite, persistent myelopathy; all of these children were nevertheless braced for 3 months because of their clinical syndrome. Children with transient deficits but abnormal MRI and/or somatosensory evoked potentials were also braced, but the 60% with transient deficits and normal MRI and somatosensory evoked potentials were not braced. This is a change from our original policy in 1982 of bracing all children with persistent or transient deficits, brought on by our new MRI and electrophysiology data.CONCLUSION:Injury prevention, prompt recognition, use of MRI and electrophysiological verification, and timely bracing of SCIWORA patients remain the chief measures to improve outcome.
Intramedullary Cervical Spine Germinoma: Case Report
Authors: Huang Jason H. , Tsui Irena , Judkins Alexander R. , Simon Erin , Birknes John K. , Sutton Leslie N. 
Published: December 2004

Abstract

OBJECTIVE AND IMPORTANCE:
We report an extremely rare case of primary intramedullary germinoma in the cervical spinal cord arising in an 18-year-old man who had not undergone previous surgery or irradiation.

CLINICAL PRESENTATION:
The patient had a 2-month history of intermittent neck pain and a 4-week history of bilateral hand paresthesias and weakness. A magnetic resonance imaging scan demonstrated a heterogeneous cervical spine lesion with marked contrast enhancement extending from C3 to C6.

INTERVENTION:
The patient underwent a cervical laminotomy with tumor resection, and pathological examination revealed the tumor to be a germinoma. He recovered well from the surgery with minimal neurological deficits. A postoperative magnetic resonance imaging scan of the brain and spinal cord did not show any other tumors. In addition, imaging studies of the mediastinum, testes, and the rest of the body also did not demonstrate any other tumors. The patient received local radiation as well as three courses of chemotherapy.

CONCLUSION:
To our knowledge, this is the first report of an intramedullary cervical spine germinoma with confirmed tissue diagnosis. Although extremely uncommon, the possibility of germinoma should be included in the differential diagnosis for primary intramedullary spinal cord tumors.
Cardiac Injury after Subarachnoid Hemorrhage Is Independent of the Type of Aneurysm Therapy
Authors: Miss Jacob C. , Kopelnik Alexander , Fisher Landis A. , Tung Poyee P. , Banki Nader M. , Lawton Michael T. , Smith Wade S. , Dowd Christopher F. , Zaroff Jonathan G. 
Published: December 2004

Abstract

OBJECTIVE:
Subarachnoid hemorrhage (SAH) is associated with cardiac injury and dysfunction. Whether aneurysm clipping versus coiling has a differential effect on the risk of troponin release and left ventricular (LV) dysfunction after SAH is unknown. It is hypothesized that aneurysm treatment does not affect the risk of developing cardiac injury and dysfunction.

METHODS:
The study included 172 consecutive SAH patients who underwent clipping (n = 109) or coiling (n = 63) aneurysm therapy. Hemodynamic data were collected, cardiac troponin I was measured, and echocardiography was performed on the 1st, 3rd, and 6th days after enrollment. A cardiac troponin I measurement of more than 1.0 μg/L was considered abnormal. For each echocardiographic examination, a blinded observer measured LV ejection fraction (abnormal if &lt;50%) and quantified LV regional wall motion abnormalities. The incidence of cardiac outcomes in the treatment groups was compared using odds ratios (ORs).

RESULTS:
The coiled patients were older than the clipped patients (mean age, 59 ± 13 yr versus 53 ± 12 yr; t test, P &lt; 0.001) and were more likely to have posterior aneurysms (33% versus 18%; χ2 test, P = 0.019). There were no significant between-group differences in the risk of cardiac troponin I release (coil 21% versus clip 19%; OR = 0.89, P = 0.789), regional wall motion abnormalities (33% versus 28%; OR = 0.76, P = 0.422), or LV ejection fraction lower than 50% (16% versus 17%; OR = 1.06, P = 0.892). No patient died of cardiac causes (heart failure, myocardial infarction, or arrhythmia).

CONCLUSION:
Surgical and endovascular aneurysm therapies were associated with similar risks of cardiac injury and dysfunction after SAH. The presence of neurocardiogenic injury should not affect aneurysm treatment decisions.
Trigeminal Neuralgia Caused by a Pontine Abscess: Case Report
Authors: Bekar Ahmet , Kocaeli Hasan , Yilmaz Emel , Doğan Şeref 
Published: December 2004

Abstract

OBJECTIVE AND IMPORTANCE:
Various intracranial abnormalities, including infectious conditions, may manifest as trigeminal neuralgia.

CLINICAL PRESENTATION:
A 33-year-old man presented with a 15-day history of right-sided facial pain and numbness. Neurological examination revealed diminished corneal reflex and facial sensation in the right V1–V2 distribution. Magnetic resonance imaging revealed a contrast-enhancing lesion centered at the right pons with extension of the enhancement to the sphenoid sinus.

INTERVENTION:
Broad-spectrum antibiotics were administered for 6 weeks. This resulted in alleviation of symptoms and resolution of the lesion as revealed by repeat magnetic resonance imaging.

CONCLUSION:
Presentation of a pons abscess with trigeminal neuralgia is rare, and to the best of our knowledge has not been reported previously. The patient was treated successfully with antibiotics alone.