bluuebunny/crossref_metadata_2025_split huggingface dataset:
Histomorphological Investigation of Microfracture Location in a Rabbit Osteochondral Defect Model
Authors: Kilic Ali Ihsan , Hapa Onur , Ozmanevra Ramadan , Pak Theresa , Akokay Pınar , Ergur Bekir Ugur , Kosay Mustafa Can 
Published: August 2023

Background: Microfracture is the most common treatment for cartilage defects of the knee. In microfracture surgery, holes are randomly drilled into the subchondral bone. The effect of the hole's location on its interaction with the cartilage defect site and its influence on the healing process is currently uncertain. Purpose: To investigate the effects of different microfracture locations on healing in a rabbit knee osteochondral defect model. Study Design: Controlled laboratory study. Methods: A total of 29 adult New Zealand White rabbits were divided into 5 groups. In the healthy cartilage control group (n = 5), no surgical procedure was performed. Cylindrical full-thickness cartilage defects (5 × 3 mm) were created in the patellar groove of the remaining 24 rabbits. In the defect control group (n = 6), only the defect was created. A microfracture was performed at the 12-o’clock position (group peripheral single; n = 6), centrally (group central; n = 6), and at the 12- and 6-o’clock positions (group peripheral double; n = 6) of the defect. The animals were sacrificed after 8 weeks. Cartilage healing was evaluated by International Cartilage Regeneration & Joint Preservation Society (ICRS) score, modified O’Driscoll score, immunohistochemical analysis (type 1 collagen, type 2 collagen, and aggrecan), and scanning electron microscopy analysis. Results: In group peripheral double, better cartilage healing was observed in all parameters compared with the other groups ( P < .05). Group peripheral double had the greatest amount of filling, with 79% of the defect area filled with fibrocartilage repair tissue. Group peripheral single demonstrated filling of 73% of the defect area, group central 56%, and the defect control group 45%. The ICRS score was significantly higher in group peripheral single compared with group central and the defect control group. Type 2 collagen and aggrecan immunoreactivity were significantly stronger in group central than group peripheral single and the defect control group ( P < .05). Conclusion: Microfracture performed at the peripheral margin of the defect had better filling characteristics in a rabbit model. This study suggests that interaction of pluripotent cells released from the microfracture site with the intact cartilage may enhance the quality of the repair tissue. Clinical Relevance: The location of microfracture holes in relation to the peripheral border of the osteochondral defect (to the intact cartilage) is important in both the quality and the quantity of the newly formed repair tissue.
Primary Stability and Bone Contact Loading Evaluation of Suture and Screw based Coracoid Graft Fixation for Anterior Glenoid Bone Loss
Authors: Ritter Daniel , Hachem Abdul-Ilah , Scheibel Markus , Raiss Patric , Denard Patrick J. , Campagnoli Alexander , Wijdicks Coen A. , Bachmaier Samuel 
Published: August 2023

Background: Reconstruction techniques for anterior glenoid bone loss have seen a trend from screws to suture-based fixations. However, comparative biomechanical data, including primary fixation and glenoid-graft contact pressure mapping, are limited. Hypothesis: Suture-based bone block cerclage (BBC) and suspensory suture button (SB) techniques provide similar primary fixation and cyclic stability to double-screw fixation but with higher contact loading at the bony interface. Study Design: Controlled laboratory study. Methods: In total, 60 cadaveric scapulae were prepared to simulate anterior glenoid bone loss with coracoid autograft reconstruction. Graft fixation was performed with 3 different techniques: (1) an interconnected all-suture BBC, (2) 2 SB suspensions, and (3) 2 screws. Initial compression was analyzed during primary fixation. Cyclic peak loading with 50 N and 100 N over 250 cycles at 1 Hz was performed with a constant valley load of 25 N. Optical recording and pressure foils allowed for spatial bone block tracking and contact pressure mapping at the glenoid-graft interface. Load-to-failure testing was performed at a rate of 1.5 mm/s with ultimate load and stiffness measured. Results: Initial graft compression was higher with screw fixation (141 ± 5 N) compared with suture-based fixations ( P < .001), with BBC fixation providing significantly higher compression than SB fixation (116 ± 7 N vs. 91 ± 5 N; P < .001). Spatial bone block migration and ultimate failure load were similar between the BBC and screw groups. The SB group showed significantly increased bone block translation (3.1 ± 1.0 mm; P≤ .014) and rotation (2.5°± 1.4°; P≤ .025) and significantly lower ultimate failure load (180 ± 53 N) compared with the BBC ( P = .046) and screw ( P = .002) groups. Both suture-based fixations provided significantly increased graft-glenoid contact loading with higher pressure amplitudes ( P≤ .032) and contact pressure after cyclic loading (+13%; SB: P = .007; BBC: P = .004) compared with screw fixation. Conclusion: Both SB and interconnected cerclage fixation improved dynamic contact loading compared with screw fixation in a biomechanical glenoid bone loss model. Cerclage fixation was biomechanically comparable with screw fixation but with a greater variability. SB fixation showed significantly lower primary fixation strength and greater bone block rotation and migration. Clinical Relevance: Suture-based bone block fixations improved graft-glenoid contact loading, but the overall clinical consequence on healing remains unclear.
Evaluation of peritoneal dialysis prescriptions in uremic rats
Authors: Nuñez-Durán Esther , Westlund Jessica , Najar Deman , Ebefors Kerstin 
Published: August 2023

Background: Patients with end-stage kidney disease (ESKD) require dialysis or transplantation for their survival. There are few experimental animal models mimicking the human situation in which the animals are dependent on dialysis for their survival. We developed a peritoneal dialysis (PD) system for rats to enable long-term treatment under controlled conditions. Method: Rats were chemically nephrectomised using orellanine to render them uremic. Two studies were performed, the first with highly uremic rats on PD for 5 days, and the other with moderately uremic rats on PD for 21 days. Blood and dialysate samples were collected repeatedly from the first study and solute concentrations analysed. Based on these values, dialysis parameters were calculated together with generation rates allowing for kinetic modelling of the effects of PD. In the second study, the general conditions of the rats were evaluated during a longer dialysis period. Results: For rats with estimated glomerular filtration rate (GFR) 5–10% of normal (moderately uremic rats), five daily PD cycles kept the rats in good condition for 3 weeks. For highly uremic rats (GFR below 3% of normal), more extensive dialysis is needed to maintain homeostasis and our simulations show that a six daily and four nightly PD cycles should be needed to keep the rats in good condition. Conclusion: In conclusion, the PD system described in this study can be used for long-term studies of PD on uremic dialysis-dependent rats mimicking the human setting. To maintain whole body homeostasis of highly uremic rats, intense PD is needed during both day and night.
Evaluation of a Telehealth-Based Pharmacist Led Chronic Care Management Program
Authors: Dohrn Ashley , Hoskins Rachel , Collier Lauren , Kennelty Korey 
Published: August 2023

Background: Clinical pharmacy services improve several patient chronic disease outcomes. This review evaluates a pharmacist-led chronic care management (CCM) program partnered with a health system for patient outcomes and sustainability. Methods: A mixed methods evaluation based on the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework was completed. Patient A1c and blood pressure readings were retrospectively collected from the electronic health record from August 2018-April 2022. Patients that completed >4 CCM visits with a diagnosis of diabetes and/or hypertension were included. Results: 557 patients enrolled, 53 had uncontrolled systolic blood pressure (SBP), SBP >130 mmHg. Average SBP at baseline was 141.0 mmHg and average SBP at 6 months was 130.2 mmHg, ( P < .001). 76 patients had uncontrolled diabetes, A1c > 7%. Average A1c at baseline = 9.1% and average A1c at 6 months = 8.3%, ( P < .001). 4464 CCM visits with 247 disease-state targeted patients were completed over 44-month with a 100% adoption rate across clinic locations. Implementation facilitators included patient medication cost concerns, disease burden, provider revenue generation, CCM dedicated software, streamlined call process, and remote EMR access. Implementation barriers included provider discomfort “selling the program,” potential patient costs, unclear need from patient, pharmacists not considered providers, pharmacist cost, multi-platform software, reprioritized stakeholder support, and lack of partner site diversification. Program maintenance showed revenue generation was $5925.31-$8879.89 from August 2021-May 2022 and profitability was $3385.61-$1614.23. Conclusion: This study provides lessons learned, strategies for implementation, and ideas for process efficiencies leading to maintenance of a telehealth pharmacist-led CCM service.
Admission Early Warning Score and Neonatal Outcome in a Resource-limited Settings
Authors: Alao Michael Abel , Ude Ifeoma Azuka , Tongo Olukemu Oluwatoyin , Ibrahim Olayinka Rasheed , Ezema Chukwubuikem Frank , Oloyede Praise Opeyemi , Ayede Adejumoke Idowu 
Published: August 2023

Background Neonatal mortality has remained a major public health concern in low- and middle-income countries. Early warning scoring (EWS) systems minimize hospital mortality by providing rapid and efficient care; however, their effectiveness in low- and middle-income countries is unknown. Method This study is a retrospective analysis of neonates admitted to the University College Hospital in Nigeria between January and December 2019. We evaluate the accuracy of significant modified early warning scores (sMEWS) in predicting neonatal in-hospital mortality and associated risk factors. Results The majority (254; 68.5%) of the 371 admitted newborns were late preterm to term, and 54.7% were males; 173 (48.7%) required resuscitation at admission in the emergency department (ED). One hundred and thirty-seven had sMEWS, which decreased to 22 (5.9%) 72 h post-admission. Univariable analysis shows that sMEWS at admission were associated with sepsis, perinatal asphyxia, and the necessity for resuscitation. Multivariable logistic regression indicated that outborns (adjusted odds ratio [AOR]: 2.218; 95% confidence interval [CI], 1.125–4.371), need for resuscitation at admission (AOR: 5.501; CI, 3.350–9.034) and persistence of sMEWS 72 h post-admission (AOR: 9.693; CI, 2.181–43.079), were associated with sMEWS. Significantly associated with excess mortality were sMEWS at admission (AOR: 3.530; CI, 1.721–7.240) and sMEWS 72 h post-admission (AOR: 5.931; CI, 5.944 –64.385). Conclusions The sMEWS performed moderately well as an EWS in a neonatal emergency unit. Excess mortality was associated with the need for resuscitation in the ED and the persistence of sMEWS 72 h post-admission.
Efficacy and Safety of Transarterial Chemoembolization with DC Beads LUMI in the Treatment of HCC: Experience from a Tertiary Centre
Authors: Biondetti Pierpaolo , Lanza Carolina , Carriero Serena , Arrigoni Francesca , Bevilacqua Margherita , Ruffino Aurora , Triggiani Sonia , Sorce Adriana , Coppola Andrea , Ierardi Anna Maria , Venturini Massimo , Guzzardi Giuseppe , Carrafiello Gianpaolo 
Published: August 2023

Purpose The aim of this study was to describe the safety and efficacy profiles of TACE using DC Beads LUMI. Materials and methods We retrospectively analyzed 90 patients with HCC who underwent TACE with DC Bead LUMI™ between November 2018 and November 2020 at Fondazione IRCCS Cà Granda Policlinico Hospital in Milan, Italy. Patient- and tumour-related factors were registered, including the number of treated lesions, dose of DC Beads LUMI™, dose of Epirubicin, DC Beads LUMI™ target tumour coverage (LC) according to the percentage of target nodule involvement (LC1-0%–25%, LC2-25%–50%, LC3-50%–75%, LC4 75%–100%). Treatment efficacy was obtained through reviewing the follow-up imaging for evidence of response in target lesion(s), according to modified response criteria in solid tumours (mRECIST) criteria with the following outcomes: complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Safety assessment was based on the quantitative and qualitative recording of the adverse events, classified according to CIRSE classification. Results Seventy-two patients were enrolled, and 95 procedures were carried out. We observed a target tumour response rate at 1 month with CR in 68%, PR in 10.3% 11.8%, SD in 13%, PD in 7.2%, and an overall tumour(s) (whole liver) response at 1 month with CR in 58.9%, PR in 12.6%, SD in 10.5% and PD in 18%. We found a significant association ( p < 0.01) between tumour response CR or CR + PR and the number of the target lesion(s). CIRSE classification grade I and grade II complications were recorded, respectively, in 11 (11.6%) and 6 (6.3%) procedures. No grade III-IV-V complications occurred. Conclusion TACE using DC Beads LUMI is a safe and effective treatment option for patients with HCC.
aBnormal motION capture In aCute Stroke (BIONICS): A Low-Cost Tele-Evaluation Tool for Automated Assessment of Upper Extremity Function in Stroke Patients
Authors: Zamin Syed A. , Tang Kaichen , Stevens Emily A. , Howard Melissa , Parker Dorothea M. , Seals Allyson , Jiang Xiaoqian , Savitz Sean , Shams Shayan 
Published: August 2023

Background The incidence of stroke and stroke-related hemiparesis has been steadily increasing and is projected to become a serious social, financial, and physical burden on the aging population. Limited access to outpatient rehabilitation for these stroke survivors further deepens the healthcare issue and estranges the stroke patient demographic in rural areas. However, new advances in motion detection deep learning enable the use of handheld smartphone cameras for body tracking, offering unparalleled levels of accessibility. Methods In this study we want to develop an automated method for evaluation of a shortened variant of the Fugl-Meyer assessment, the standard stroke rehabilitation scale describing upper extremity motor function. We pair this technology with a series of machine learning models, including different neural network structures and an eXtreme Gradient Boosting model, to score 16 of 33 (49%) Fugl-Meyer item activities. Results In this observational study, 45 acute stroke patients completed at least 1 recorded Fugl-Meyer assessment for the training of the auto-scorers, which yielded average accuracies ranging from 78.1% to 82.7% item-wise. Conclusion In this study, an automated method was developed for the evaluation of a shortened variant of the Fugl-Meyer assessment, the standard stroke rehabilitation scale describing upper extremity motor function. This novel method is demonstrated with potential to conduct telehealth rehabilitation evaluations and assessments with accuracy and availability.
Individual Differences in Response to Transcranial Direct Current Stimulation With Language Therapy in Subacute Stroke
Authors: Stockbridge Melissa D. , Elm Jordan , Teklehaimanot Abeba A. , Cassarly Christy , Spell Leigh-Ann , Fridriksson Julius , Hillis Argye E. 
Published: August 2023

Background Transcranial direct current stimulation (tDCS) can be used to improve post-stroke aphasia. However, given the mixed evidence for its efficacy, individual differences may moderate the relative benefit of this strategy. In planned exploratory subgroup analyses, we examined whether age, education, sex, brain-derived neurotrophic factor status, and baseline performance individually impacted improvement in picture naming between baseline and 1 week after the end of the therapy, then whether the combination of factors that predicted recovery of naming and discourse differed for those who received concurrent tDCS. Objective Examine whether individual differences influenced the effect of tDCS on language recovery. Methods In this randomized, double-blind, sham-controlled, efficacy study of tDCS combined with language therapy for subacute post-stroke aphasia, patients completed an evaluation including the Philadelphia Naming Test and Cookie Theft picture description, which was analyzed for Content Units (CU) and Syllables/CU. Individual factors were examined using linear models including the interaction between treatment group and subgroup. Results Significant interactions were observed between tDCS group and both age and education. The predictors of a positive response to tDCS differed from the predictors of a positive response to language treatment alone. While baseline performance was an important predictor of future performance regardless of treatment group, responses to treatment without tDCS were influenced by age whereas responses to treatment with tDCS were not. Conclusions Age and education influence the efficacy of different treatment strategies. Refinement of treatment selection is important to the overall individualization and optimization of post-stroke patient care. Trial Registration: ClinicalTrials.gov NCT02674490.
Ruptured vertebrobasilar junction aneurysm supplied by reversed flow from the anterior spinal artery: Illustrative case report
Authors: Gonce Collin E , Prather Kiana Y , Bauer Andrew M , Shakir Hakeem J , Jen Shyian S , Graffeo Christopher S 
Published: August 2023

Background and Importance In patients with vertebral artery (VA) occlusion, spontaneous flow reversal may occur in the anterior spinal artery (ASA) as a source of compensatory supply to the posterior circulation. Turbulent flow and increased flux through these small arteries may predispose to luminal damage and intracranial aneurysm formation. We report a novel case of a ruptured ASA–VA junction aneurysm in a patient with chronic bilateral VA occlusion, successfully treated with endovascular embolization. Clinical Presentation A 62-year-old female with uncontrolled hypertension presented with acute-onset headache, emesis, neck stiffness, and decreased level of consciousness. Head computed tomography demonstrated diffuse cisternal subarachnoid hemorrhage with intraventricular extension and ventriculomegaly. Computed tomography angiography showed left VA atresia and chronic right VA occlusion just distal to the posterior inferior cerebellar artery origin, as well as a complex, bilobed aneurysm at the ASA–VA junction. Angiography demonstrated flow reversal from the ASA into the distal stump of the occluded right VA, which in turn filled the aneurysm. Of note, the patient's posterior circulation was predominantly supplied by the dilated ASA, and associated collaterals from ASA and right VA stump. The aneurysm was accessed and embolized using superselective microcatheterization over a soft microguidewire through the right cervical VA perforators supplying retrograde flow into and through the ASA. Conclusion ASA–VA aneurysms are exceedingly rare, and generally associated with atypical flow dynamics. Dynamic treatment strategies may be needed, especially in the setting of subarachnoid hemorrhage.
The effect of occlusion location and technique in mechanical thrombectomy for minor stroke
Authors: Abecassis Isaac Josh , Almallouhi Eyad , Chalhoub Reda M. , Helal Ahmed , Naidugari Janki R. , Kasab Sami Al , Bass Eric , Ding Dale , Saini Vasu , Burks Joshua D. , Maier Ilko L. , Jabbour Pascal , Kim Joon-Tae , Wolfe Stacey , Rai Ansaar , Psychogios Marios-Nikos , Samaniego Edgar , Arthur Adam S. , Yoshimura Shinichi , Howard Brian , Alawieh Ali , Fragata Isabel , Cuellar Hugo , Polifka Adam , Mascitelli Justin , Osbun Joshua , Crosa Roberto , Matouk Charles , Park Min S. , Levitt Michael R. , Dumont Travis , Williamson Richard W. , Spiotta Alejandro M. , Starke Robert M. 
Published: August 2023

Introduction Endovascular mechanical thrombectomy (MT) is an established treatment for large vessel occlusion strokes with a National Institutes of Health Stroke Scale (NIHSS) score of 6 or higher. Data pertaining to minor strokes, medium, or distal vessel occlusions, and most effective MT technique is limited and controversial. Methods A multicenter retrospective study of all patients treated with MT presenting with NIHSS score of 5 or less at 29 comprehensive stroke centers. The cohort was dichotomized based on location of occlusion (proximal vs. distal) and divided based on MT technique (direct aspiration first-pass technique [ADAPT], stent retriever [SR], and primary combined [PC]). Outcomes at discharge and 90 days were compared between proximal and distal occlusion groups, and across MT techniques. Results The cohort included 759 patients, 34% presented with distal occlusion. Distal occlusions were more likely to present with atrial fibrillation (p = 0.008) and receive IV tPA (p = 0.001). Clinical outcomes at discharge and 90 days were comparable between proximal and distal groups. Compared to SR, patients managed with ADAPT were more likely to have a modified Rankin Scale of 0–2 at discharge and at 90 days (p = 0.024 and p = 0.013). Primary combined compared to ADAPT, prior stroke, multiple passes, older age, and longer procedure time were independently associated with worse clinical outcome, while successful recanalization was positively associated with good clinical outcomes. Conclusions Proximal and distal occlusions with low NIHSS have comparable outcomes and safety profiles. While all MT techniques have a similar safety profile, ADAPT was associated with better clinical outcomes at discharge and 90 days.
Early Complication Rates Are Equivalent Between Isolated Cartilage Restoration and Concomitant Cartilage Restoration and Osteotomy of the Knee
Authors: Bohlen Hunter , Karasavvidis Theofilos , Wen Deborah , Wong Francis K.L. , Wang Dean 
Published: August 2023

Objective Realignment osteotomy performed concomitantly with cartilage restoration typically requires early restricted weightbearing and can add significant morbidity, potentially leading to an increased risk of early perioperative complications. The purpose of this study was to compare the 30-day complication rates after isolated cartilage restoration (ICR) versus concomitant cartilage restoration and osteotomy (CRO) using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Design NSQIP registries between 2006 and 2019 were queried using Current Procedural Terminology codes to identify patients undergoing ICR (autologous chondrocyte implantation, osteochondral autograft transfer, or osteochondral allograft transplantation) and CRO (with concomitant high tibial osteotomy, distal femoral osteotomy, and/or tibial tubercle osteotomy). Complications rates between treatment groups were compared using multivariate logistic regression analyses adjusted for sex, age, steroid use, and respiratory status. Results A total of 773 ICR and 97 CRO surgical procedures were identified. Mean patient ages were 35.9 years for the ICR group and 31.2 years for the CRO group. Operative time was significantly longer in the CRO group (170.8 min) compared with the ICR group (97.8 min). Multivariate analysis demonstrated no significant differences in rates of PE, VTE, and all-cause readmission between the ICR and CRO groups. No events of wound disruption, SSI and reoperation were found in the CRO group, while the ICR group was characterized by low rates of wound disruption, reoperation, and SSI (<1.1%). Conclusions These findings further support concomitant osteotomy with cartilage restoration when appropriate and aid surgeons in the preoperative counseling of patients undergoing cartilage restoration treatment.