bluuebunny/crossref_metadata_2025_split huggingface dataset:
Poster 251: Autograft Associated with Lower Risk of Repeat Revision Anterior Cruciate Ligament Reconstruction than Allograft: Results from a Large Integrated Healthcare System
Authors: Chang Richard , Royse Kathryn , Burfeind William , Ding David , Maletis Gregory , Heffner Michael 
Published: July 2022

Objectives: With the rising utilization of primary anterior cruciate ligament reconstruction (ACLR), the burden of revision ACLR (rACLR) has also increased. Graft choice for rACLR is complicated by patient factors and the remaining available graft options. This study examines the relationship between graft type at the time of rACLR and the risk of repeat rACLR (rrACLR). Methods: We conducted a cohort study from a US integrated healthcare system’s ACLR registry. The study population included patients with a primary isolated ACLR, between 2005-2020, who then went on to have an aseptic rACLR. Graft type used at revision surgery, classified as autograft versus allograft, was the exposure of interest. Multivariable Cox proportional hazard regression was used to evaluate the risk of aseptic rrACLR with ipsilateral and contralateral reoperation as secondary outcomes. Models included factors at the time of the revision procedure (age, gender, body mass index, smoking status, staged revision, femoral fixation, tibial fixation, femoral tunnel method, lateral meniscus injury, medial meniscus injury, and cartilage injury) and a factor from the primary ACLR (activity at injury) as covariates. Results: 1747 rACLR procedures were included. The crude cumulative aseptic rrACLR incidence at 8-years follow-up was 13.9% for allograft and 6.0% for autografts (Figure 1). Cumulative ipsilateral reoperation incidence at 8-years follow-up was 18.3% for allograft and 18.9% for autograft; contralateral reoperation cumulative incidence was 4.3% for allograft and 6.8% for autograft. With adjustment for covariates, a lower aseptic rrACLR risk was observed for autografts compared with allografts (HR=0.30, 95% CI=0.18-0.50, p <0.0001). No differences were observed for ipsilateral reoperation (HR=1.05, 95% CI=0.73-1.51, p=0.78) nor for contralateral reoperation (HR=1.33, 0.60-2.97, p=0.48) for autografts compared with allografts. Conclusions: The use of autograft at rACLR was associated with a 70% reduced risk of rrACLR compared to allograft in this large integrated health care system registry. When accounting for all reoperations after rACLR, we found no significant difference in risk between autograft and allograft. In order to minimize the risk of rrACLR, surgeons should consider using autograft for rACLR when possible. [Figure: see text]
Poster 256: The "N+10 Rule" to Avoid Graft Tunnel Mismatch in Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Using Independent Femoral Tunnel Drilling
Authors: Dart Scott , MacLean Ian , Barras Laurel , Moran Thomas , Werner Brian , Gwathmey F. Winston , Diduch David , Miller Mark , Graf Ryan 
Published: July 2022

Objectives: To determine the amount of tibial graft tunnel mismatch during application of the “N+10” rule in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BTB) graft using independent femoral tunnel drilling. To compare actual (measured) tibial tunnel length and desired (calculated) tibial tunnel length when using the “N+10” rule for independent femoral tunnel drilling. Methods: Twenty paired knees from 10 fresh frozen cadaveric specimens (5 female and 5 male specimens) underwent arthroscopic assisted bone-patellar tendon-bone ACL reconstruction using independent femoral tunnel drilling with either a hyperflexion accessory anteromedial portal (n=10) or flexible reamer technique (n=10). The prepared patellar tendon graft bone blocks were trimmed to 10 x 20mm for all specimens and the intertendinous distance (N) between the bone blocks was measured. The “N+10 Rule” was used to set the angle of the ACL tibial tunnel guide to the appropriate degree setting for drilling. The amount of excursion or recession of the tibial bone plug in relation to the anterior tibial cortical aperture was measured in both flexion and extension. A +/-6mm threshold was used to assess this strategy based on prior biomechanical aperture fixation studies. As a secondary outcome, the intraarticular distance (IAD) and the actual tibial tunnel length (TTL) were measured and compared to the planned TTL based on the equation: IAD + TTL = N + 20 (size of bone plug in millimeters) Results: The average BTB ACL intertendinous distance (N) was 47.5mm (SD =5.5mm). The average measured IAD was 27.2mm (SD=3.0mm). Using the “N+10 Rule”, the average mismatch of the tibial tunnel was 4.9mm (SD=3.6mm) and 3.8mm (SD=3.5mm) in flexion and extension, respectively. Both values fall within the +/- 6mm threshold. When comparing the actual measured tibial tunnel length (TTL) to the desired TTL, there was an average difference of 5.4mm (SD=3.9mm) Conclusions: The “N+10” rule resulted in an acceptable average mismatch in both flexion and extension using the threshold of +/- 6mm for 20 cadaveric knees. Measured actual TTL compared to the desired calculated TTL were acceptable 61% of the time using the same threshold. The “N+10” is a simple and effective intraoperative strategy for achieving desired tibial tunnel length to avoid excessive graft tunnel mismatch. [Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Poster 261: Increased TT-TG and Tibial Slope are Independent Predictors of ACLR Failure
Authors: Lee Eric , Kliethermes Stephanie , Scerpella Tamara , Chen Kallie 
Published: July 2022

Objectives: Tibial tubercle-trochlear groove (TT-TG) distance is a surrogate measure of valgus and rotational stress on the anterior cruciate ligament (ACL) and may predict ACL injury. Increased posterior tibial slope has been associated with risk of ACL re-tear but no studies have evaluated TT-TG as a predictor of ACL re-tear. We hypothesized TT-TG distance and posterior tibial slope would be independent predictors of ACL graft re-tear. Methods: All patients who underwent ACL revision surgery between 2010-2018 at a single institution were identified. A control cohort underwent primary ACL reconstruction (ACLR) between 2006-2015, with no evidence of graft failure at 8.1 ± 2.5 yrs post-op. Record review included anthropometrics, graft type, and estimated highest Tegner activity score at ≥ 6 months post primary ACLR. Magnetic resonance images (MRI) following native ACL tear (controls) or graft failure (revision cohort) were assessed for the following: 1) medial, lateral, and coronal tibial slope, 2) depth of tibial plateau concavity, 3) TT-TG distance, and 4) tunnel position. Logistic regression analyses were used to associate ACL graft failure with radiographic parameters, surgical variables, and demographics. Sensitivity analyses, excluding patients in the revision group with tunnel malposition, were performed to confirm multivariable results. Results: Participants included 153 revisions and 146 controls. Controls were older than revisions (26.6 ± 8.8 yrs vs. 20.6 ± 7.3 yrs). Mean TT-TG distance and lateral tibial slope values were smaller for the control vs. revision group (TT-TG = 9.4 ± 3.9 mm vs. 11.2 ± 4.2 mm; lateral tibial slope = 6.2o ± 3.4° vs. 7.2o ± 3.6°). TT-TG distance and lateral tibial slope were associated with increased risk of ACL graft failure by multivariable analysis (OR: 1.14, CI: 1.07, 1.22, p < 0.001 and OR: 1.11, CI: 1.02, 1.20, p = 0.007, respectively). With sensitivity analyses, age at index surgery, TT-TG distance, and lateral tibial slope remained significant predictors of ACL revision. Conclusions: Increased TT-TG distance, increased lateral tibial slope, and younger age are associated with increased odds of ACL graft failure. These patients may require a more comprehensive strategy to reduce the risk of ACL re-tear. [Table: see text]
Poster 266: The Effect of Bone Marrow Aspirate Concentrate Augmentation on ACL Reconstruction Allograft Volume and PROMs
Authors: Chung Christine , Statum Sheronda , Berlinberg Elyse , Lavoie-Gagne Ophelie , Patel Harsh , Cole Brian , Bach Bernard , Chahla Jorge , Yanke Adam , Verma Nikhil , Forsythe Brian 
Published: July 2022

Objectives: Prior studies have correlated MRI-calculated tendon volume with biomechanical properties of ACL allografts in porcine models. Bone marrow aspirate concentrate (BMAC) has been shown to improve biomechanical graft strength in other animal studies. We sought to assess the effects of BMAC on ACL bone-tendon-bone (BTB) allograft volume and PROMs. Methods: The study population included 66 patients with both a 3-month and 9-month MRI from an IRB-approved, double-blinded, randomized control trial comparing patients undergoing ACL reconstruction (ACLR) with BTB allograftBMAC. The primary outcome was tendon volume at 9 months, with a secondary outcome of change in tendon volume between 3-9 months. Knee Injury and Osteoarthritis Outcome Score Junior (KOOS-Jr), Tegner activity scale, and International Knee Documentation Committee (IKDC) were obtained pre-operatively and at 1 year. Results: The final analysis included 32 BMAC study patients (BMAC volume=2.420.90 mL, soak time=17.83.15 mins) and 34 control patients. Baseline demographics, physical exam features, and PROs did not vary between groups. Average 9-month tendon volume was 773280 mm3 in BMAC patients and 743224 mm3 in controls ( P=0.634). Mean change in tendon volume between 3-9 months was 1175 mm3 in BMAC patients and -21120 mm3 in controls ( P=0.552). Tendon volume was not associated with KOOS-Jr (beta=7.26 mm3/point, 95 % Confidence Interval [CI]=-13.21-27.72, P=0.476), Tegner (beta=-0.53 mm3/point, 95% CI=-2.40-1.45, P=0.596), or IKDC (beta=5.18 mm3/point, 95% CI=-10.59-20.95, P=0.513). There was a nonsignificant, negative correlation between tendon volume and KT-1000 translation (beta=-0.56 mm3/cm, 95% CI=-1.15-0.04, P=0.065). Conclusions: In this study, BMAC did not affect tendon volume at 9 months after ACLR. PRO-scores were not significantly associated with tendon volume. Both BMAC patients and controls showed improvements in KOOS Jr, Tegner, and IKDC. Biomechanical and histologic studies are warranted to better elucidate the relationship between BMAC augmentation, PRO scores, and ligamentization in ACL allograft reconstruction. [Table: see text][Table: see text][Table: see text]
Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes
Authors: Kavookjian Jan , LaManna Jacqueline B. , Davidson Patricia , Davis Jean W. , Fahim Shahariar Mohammed , McDaniel Cassidi C. , Ekong Gladys , Todd Andrew , Yehl Kirsten , Cox Carla 
Published: July 2022

Purpose: The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). Methods: A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists’ ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. Results: Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. Conclusion: To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.
A Guide to Orthodontic Devices for Trainees in Orthognathic Surgery
Authors: Girard Alisa O. , Lake Isabel V. , Chen Jonlin , Dorfmann Sabrina , Maduekwe Uma , Lopez Christopher D. , Ickow Ilana , Yang Robin 
Published: July 2022

Purpose: Despite the interplay between orthodontics and orthognathic surgery, trainees in plastic surgery and oral and maxillofacial surgery do not receive formal training in orthodontics and associated hardware. This study aims to help surgical trainees better understand the role of orthodontic treatment in achieving enhanced dental occlusion and alignment and optimize surgical decision making. Methods: A review of recent literature was conducted to consolidate current practices for the use of orthodontic devices commonly used in orthognathic surgical patients. Results: Orthodontic treatments may be preventive, interceptive, and/or corrective. Braces and clear aligners are popular devices used to correct tooth positioning via 3 orders of control: first (“in-out” and rotation), second (mesio-distal angulation or “tip”), and third order (inclination or torque). Further, various treatments exist for skeletal and dental malocclusions, which may occur in transverse (crossbites, narrow arches) and/or sagittal (over/underbites) planes. Palatal expanders such as the Hyrax or Haas assist in correction of transverse deficiencies. Appliances for sagittal corrections typically take advantage of patient’s remaining growth and include a variety of headgear types (cervical, high-pull, occipital, reverse-pull), functional appliances (fixed or removable), or simply the use of interdental elastics. Conclusion: As patients are increasingly seeking orthodontic care in conjunction with surgery, it is important for surgical trainees to develop a strong understanding of the various orthodontic devices used.
Enrichment of BTK Leu528Trp mutations in patients with CLL on zanubrutinib: potential for pirtobrutinib cross-resistance
Authors: Blombery Piers , Thompson Ella R. , Lew Thomas E. , Tiong Ing Soo , Bennett Rory , Cheah Chan Y. , Lewis Katharine Louise , Handunnetti Sasanka M. , Tang Chloe Pek Sang , Roberts Andrew , Seymour John F. , Tam Constantine S. 
Published: July 2022

Abstract
The covalent Bruton’s tyrosine kinase inhibitors (BTKis) are highly effective for the treatment of chronic lymphocytic leukemia (CLL). The dominant resistance mechanism observed with the BTKi ibrutinib is the development of BTK Cys481 codon mutations. Whether a similar resistance mutation profile exists for the newer-generation, more selective BTKi zanubrutinib is unknown. In samples referred for diagnostic next-generation sequencing in patients with progressive CLL, we observed an enrichment in the kinase-dead BTK Leu528Trp mutation in patients treated with zanubrutinib compared with ibrutinib (54%; 7 of 13 vs 4%; 1 of 24, P = .001). We describe 2 patients with BTK Leu528Trp mutations who showed clinical cross-resistance and progressive enrichment of the BTK Leu528Trp mutation over time when treated with the noncovalent BTKi pirtobrutinib. Both patients subsequently responded to venetoclax-based treatment. In summary, we have identified an enrichment of the BTK Leu528Trp mutation arising in patients treated with zanubrutinib that may impart cross-resistance to the noncovalent inhibitor pirtobrutinib and therefore may have implications for sequencing of these treatments in CLL.
Impact of COVID-19 social distancing measures on lung transplant recipients: decline in overall respiratory virus infections is associated with stabilisation of lung function
Authors: de Zwart Auke E.S. , Riezebos-Brilman Annelies , Lunter Gerton A. , Neerken Ewald C.U. , van Leer-Buter Coretta C. , Alffenaar Jan-Willem C. , van Gemert Anna P. , Erasmus Michiel E. , Gan Christiaan T. , Kerstjens Huib A.M. , Vonk Judith M. , Verschuuren Erik A.M. 
Published: July 2022

BackgroundCoronavirus disease 2019 (COVID-19) social distancing measures led to a dramatic decline in non-COVID-19 respiratory virus infections, providing a unique opportunity to study their impact on annual forced expiratory volume in 1 s (FEV1) decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs).MethodsAll FEV1values of LTRs transplanted between 2009 and April 2020 at the University Medical Center Groningen (Groningen, The Netherlands) were included. Annual FEV1change was estimated with separate estimates for pre-social distancing (2009–2020) and the year with social distancing measures (2020–2021). Patients were grouped by individual TDLF frequency (frequent/infrequent). Respiratory virus circulation was derived from weekly hospital-wide respiratory virus infection rates. Effect modification by TDLF frequency and respiratory virus circulation was assessed. CLAD and TDLF rates were analysed over time.Results479 LTRs (12 775 FEV1values) were included. Pre-social distancing annual change in FEV1was −114 (95% CI −133– −94) mL, while during social distancing FEV1did not decline: 5 (95% CI −38–48) mL (difference pre-social distancingversusduring social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV1decline compared with the infrequent TDLF subgroup (−150 (95% CI −181– −120)versus−90 (95% CI −115– −65) mL; p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53, 95% CI 0.33–0.85; p=0.008) and severe TDLF (OR 0.34, 0.16–0.71; p=0.005) as well as lower CLAD incidence (OR 0.53, 95% CI 0.27–1.02; p=0.060). Effect modification by respiratory virus circulation indicated a significant association between TDLF/CLAD and respiratory viruses.ConclusionsDuring COVID-19 social distancing the strong reduction in respiratory virus circulation coincided with markedly less FEV1decline, fewer episodes of TDLF and possibly less CLAD. Effect modification by respiratory virus circulation suggests an important role for respiratory viruses in lung function decline in LTRs.
Increasing physical activity in severe asthma: a systematic review and meta-analysis
Authors: McLoughlin Rebecca F. , Clark Vanessa L. , Urroz Paola D. , Gibson Peter G. , McDonald Vanessa M. 
Published: July 2022

IntroductionPhysical inactivity is common in asthma and is recognised as an important modifiable risk for poor clinical outcomes such as impaired asthma control and health-related quality of life (HRQoL). Despite evidence supporting the role of physical activity in reducing the risk of these outcomes, little is known about optimal interventions for increasing physical activity in those with severe disease. This systematic review and meta-analysis evaluates the effectiveness of interventions in increasing physical activity in severe asthma.MethodsMEDLINE, the Cumulative Index to Nursing and Allied Health Literature, Embase, PubMed, Informit, SPORTDiscus and Cochrane databases were searched up to September 2021 for physical activity-based intervention studies that assessed physical activity outcomes (e.g.steps per day, time spent undertaking physical activity) in adults with severe asthma. Data on asthma-related (e.g.asthma control) and health-related outcomes (e.g.HRQoL) were assessed as secondary outcomes. The revised Cochrane Risk of Bias tool was used to assess risk of bias. Random-effects meta-analyses synthesised data where possible.ResultsFour randomised controlled trials (all 12 weeks in duration) including 176 adults with moderate-to-severe asthma were included. An increase in physical activity was reported with a moderate-vigorous intensity aerobic and resistance training intervention (steps per day and time spent undertaking physical activity), and an unsupervised pedometer-based intervention (steps per day). Meta-analyses showed that physical activity interventions had an overall positive effect on steps per day (mean difference (MD) 1588, 95% CI 399–2778; p=0.009, I2=23), asthma control (MD −0.65, 95% CI −0.95–−0.35; p<0.0001, I2=0%) and HRQoL (MD 0.56, 95% CI 0.10–1.01; p=0.02, I2=16%) compared to control.ConclusionWhile there is some evidence supporting the effectiveness of interventions in improving physical activity in adults with severe asthma, higher-quality, large-scale studies of longer duration are needed to determine the optimal intervention.
Lung allograft transbronchial cryobiopsy for critical ventilated patients: a randomised trial
Authors: Loor Karina , Culebras Mario , Sansano Irene , Álvarez Antonio , Sacanell Judith , García-de-Acilu Marina , Berastegui Cristina , Polverino Eva , Clofent David , de Gracia Javier 
Published: July 2022

BackgroundTransbronchial lung cryobiopsy is an emerging technique for diagnosing pulmonary rejection. However, no prospective studies of this procedure for critically ill lung transplant recipients who require mechanical ventilation in the intensive care unit (ICU) have been performed.MethodsFrom March 2017 to January 2020, we performed a prospective, randomised, comparative study to assess the diagnostic yield, histological quality and safety of transbronchial lung biopsy using biopsy forceps, a 1.9-mm cryoprobe or a 2.4-mm cryoprobe.Results89 out of 129 consecutive transbronchial biopsy procedures (forceps group, 28 procedures; 1.9-mm cryoprobe group, 31 procedures; 2.4-mm cryoprobe group, 30 procedures) were randomised. Compared with lung samples from the forceps and 1.9-mm cryoprobe groups, lung samples from the 2.4-mm cryoprobe group allowed the most definitive diagnoses (p<0.01 and p=0.02, respectively), the most diagnoses of acute lung rejection (p<0.01 and p=0.01, respectively) and the most diagnoses of rejection severity (p<0.01 and p<0.01, respectively). These samples were larger (p<0.01 and p=0.04, respectively), had the most adequate alveolar tissue (p<0.01 and p=0.02, respectively), had more vessels per procedure (p<0.01 and p=0.01, respectively) and had no significant crush artefacts. Moderate bleeding was observed in 23% of cases (p=0.01 and p=0.08, respectively). No severe bleeding was observed.ConclusionsTransbronchial lung biopsy using a 2.4-mm cryoprobe allows the safe collection of lung tissue samples from critically ill lung transplant recipients who require mechanical ventilation in the ICU and has good diagnostic performance.