bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lateral Lumbar Interbody Fusion With rhBMP-2 can Achieve High Fusion Rates in Adult Spine Deformity Surgeries
Authors: Singh Vishwajeet , Oppermann Marcelo , Evaniew Nathan , Soroceanu Alex , Nicholls Fred , Jacobs W. Bradley , Thomas Ken , Swamy Ganesh 
Published: May 2022

Study design An ambispective, observational study of the prospective, institutional adult spine deformity (ASD) database. Objectives The study investigates the clinical and radiographic fusion rates with lateral interbody approach and rhBMP-2 in multiple-level lumbar fusion in the ASD population. Previous studies have reported over 10% pseudoarthrosis rate with multiple segment fusions. Lateral lumbar interbody fusion (LLIF) allows multiple-level, less-invasive access to the anterior lumbar spine. We hypothesized that fusion rates with lateral approach with rhBMP-2 use are superior to the published data on lumbar fusion in ASD patients. Methods The institutional ASD database was searched to identify eligible patients with two or more levels of LLIF (T12-L5), >4 levels of posterior instrumentations and >2 years of follow-up between the years 2010 and 2018. Antero-posterior and lateral 36-inch standing radiographs for each patient and computed tomography scans in select patients were studied to ascertain fusion status and patients were divided into two groups based on fusion status. Results The study included 179 patients with a mean age of 65.3 years and 74% female patients. The median number of interbody fusions was performed at 3 (IQR 3-4) levels. The mean follow-up duration was 4.4 years (SD = 1.9). 169 patients (94.5%) had successful arthrodesis, while 10 patients (5.5%) had radiological pseudoarthrosis at one level. Of the 10 patients, 8 (4.4%) were either clinically asymptomatic or had manageable back pain. Two patients (1.1%) required revision surgery for symptomatic pseudoarthrosis. Conclusion This is the largest known series of ASD patients investigating the fusion rates with multiple-level LLIFs. LLIF along with rhBMP-2 can achieve high fusion success across interbody fusion levels in multi-segmental ASD surgeries.
Foreign Institutional Ownership and Its Impact on Investment Efficiency in Manufacturing Firms: Evidence from Indian Capital Market
Authors: Banerjee Souvik , Mohanti Debaditya 
Published: May 2022

This article explores the impact of foreign institutional investor’s (FII) ownership on the investment efficiency of Indian manufacturing firms. In this article, unbalanced panel data is used, in total, 21,214 firm-year observations of 1,205 companies listed in Centre for Monitoring Indian Economy (CMIE) COSPI (CMIE Overall Share Price Index) are taken into account. The data range is from 2001 to 2019. This research article considers investment-investment opportunities sensitivity as the proxy for investment efficiency, where investment opportunities are measured Tobin’s Q. As per our findings FII’s ownership impacts investment efficiency in a negative way. It is further found that this inverse relationship between FII’s ownership and investment efficiency is more pronounced in resource abundant firms, compared to the resource constrained firms. In this study both fixed as well as random effect models are developed incorporating robust standard error, additionally system generalized method of moments (GMM) model as well as two step Heckman model are also used to check the robustness of the findings. This study adds to the existing literature as a pioneering study on impact of FII’s ownership on firm’s investment efficiency in the context of India, a large emerging market economy.
Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Multicenter Investigation of the Pluto Study
Authors: Hutchinson LE , Christino MA , Pennock AT ,   PLUTO Study Group, Kocher MS 
Published: May 2022

Background: ACL injuries are being seen with increased frequency in pediatric and adolescent patients. Understanding patient and injury characteristics as well as treatment strategies are important to help guide future surgical decisions in the care of these young patients. Hypothesis/Purpose: To report the demographic characteristics and descriptive epidemiology of a large cohort of skeletally immature patients with complete ACL tears through a prospective, multicenter study. Methods: At 10 geographically diverse institutions in the United States, consecutive skeletally immature patients diagnosed with complete ACL tears between January 2016 and April 2020 were enrolled. Treatment was provided by one of 23 participating orthopedic surgeons. Patient demographics, including chronological and skeletal age, sex, race, ethnicity, as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected. Results: 748 skeletally immature patients were included in the final cohort; the mean chronological age was 12.3 years, and 62.3% were male. Mean skeletal age (13.2 years) was on average 0.9 years higher than mean chronological age (p<0.001). The median BMI percentile for the cohort was 71st (IQR, 45-88), and 10.8% were classified as obese (≥95th percentile). 5.3% reported a previous ipsilateral knee injury, and 32.5% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89.4%), with non-contact injuries the most common (61.5%). When stratified by sex, non-contact injury was significantly higher in females (68.3%) than males (57.4%) (p=0.005). The most common sport resulting in an ACL tear among males was football (41.2%) and among females was soccer (44.2%) (p<0.001). 99.9% percent of skeletally immature patients were treated surgically by one of four reconstruction techniques: transphyseal (52.7%), partial transphyseal (7.1%), all-epiphyseal (13.1%), and the physeal sparing iliotibial band (ITB) technique (27.0%). One patient underwent non-operative treatment. The most common surgical techniques for patients with a bone age younger than 13 years were physeal sparing with ITB (56.7%) and all-epiphyseal (21.8%), while in patients with a bone age of 13 years and older, transphyseal (71.1%) and physeal sparing with ITB (11.9%) were most common (p<0.001). Conclusion: This multicenter, prospective study is the first to describe the characteristics of an exclusively skeletally immature cohort with complete ACL tears. Almost all patients were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal age.
Change in Body Weight and Body Mass Index of Adolescents and Adults From Pre-Surgery to Post-Anterior Cruciate Ligament Reconstruction
Authors: Triplett Ashley N. , Woeber Nathan A. , Pivarnik James M. , Wilcox Christopher L. , Currie Katharine D. , Kuenze Christopher M. 
Published: May 2022

Background: Physical activity (PA) participation can moderate weight status and body mass index (BMI), with reduced PA being associated with weight gain and elevated BMI. Previous studies have observed lower PA engagement among individuals with a history of anterior cruciate ligament reconstruction (ACLR) when compared to their uninjured peers. This reduction in PA may be due to activity limitations during rehabilitation and failure of some patients to return to sport. Limited evidence has also shown an increase in body weight and BMI following surgery that may remain elevated in adolescent patients up to 2 years post-ACLR. Overall, body weight and BMI changes from pre-surgery to post-ACLR for adolescents and adults are not well-understood. Purpose: The purpose of this study was to assess change in body weight and BMI from pre-surgery to 6 months post-ACLR in adolescent and adult patients. Methods: A retrospective chart review was conducted including adult (age ≥20) and adolescent (ages 13-19) patients who underwent primary, unilateral ACLR and were previously enrolled in a prospective cohort study. BMI was calculated [weight (kg)/ height (m2)] for all adult participants and BMI percentile was calculated for all participants under the age of 20 to account for changes in growth and maturation during adolescence. Pre-surgery to 6-months post-ACLR values for body mass, absolute BMI, and BMI percentile were compared using paired sample t-tests. Statistical significance was established a priori as α≤0.05. Results: One hundred and 16 adolescents with ACLR (67 female; age= 16.7 ± 1.6yrs, months since surgery= 6.2 ± 0.7) and 63 adults (29 female; age= 27.2 ± 7.4yrs, months since surgery= 6.4 ± 0.7) participated. Adolescent participants experienced a significant increase in body mass (pre-ACLR= 70.1 ± 15.1kg, post-ACLR= 72.4 ± 16.9kg; p<0.001) and BMI percentile (pre-ACLR= 65 ± 25, post-ACLR= 67 ± 25; p=0.02) from pre-surgery to 6 months post-ACLR. Adult patients also experienced a significant increase in body mass (pre-ACLR= 80.2 ± 19.9kg, post-ACLR= 82.1 ± 20.1kg; p<0.001) and BMI (pre-ACLR= 26.1 ± 4.5kg/m2, post-ACLR= 26.7 ± 4.9kg/m2; p=0.006). Conclusion: Adults and adolescents experienced an increase in body weight and BMI in the 6 months following ACLR. Revising rehabilitation to extend beyond traditional musculoskeletal strengthening to include focus on incorporation and maintenance of healthy lifestyle behaviors related to diet and PA should be considered to help patients with ACLR to minimize the potential for negative long-term effects of weight gain following surgery.
Injury Characteristics Among Pediatric Athletes Who did and did not Undergo a CT Scan Following Concussion
Authors: Worrall Hannah M. , Miller Shane M. , Chung Jane S. , Stokes Mathew A. , Tow Stephanie , Cullum C. Munro , Jones Jacob C. 
Published: May 2022

Background: CDC and AAP guidelines discourage routine neuroimaging following concussion, as CT scans are only indicated if severe intracranial injury is suspected. Validated prediction rules such as Pediatric Emergency Care Applied Research Network (PECARN) criteria have decreased the number of unnecessary pediatric head CTs; however, are still commonly performed following pediatric sport-related concussion (SRC). Hypothesis/Purpose: To determine differences in injury characteristics and outcomes in athletes who did and did not undergo head CT following SRC. Methods: Data were prospectively collected from participants enrolled in the North Texas Concussion Network Registry (ConTex) between August 2015-May 2021. Participants aged 5-18 diagnosed with SRC and presenting within 30 days were included. Participants were separated into 2 groups based on whether they had a CT scan following SRC: CT (negative scan) and no CT. Positive CTs were excluded. Groups were matched in age and time to presentation (≤14, >14-30 days). Demographics, concussion-related details, and 3-month outcome variables were analyzed including days to symptom resolution (≤30 vs >30 days) and return-to-play (RTP). Results: 324 participants were included: 162 in each group. There were no significant differences between the groups in sex, race, ethnicity, or previous concussion history. Differences in injury-related characteristics are reported in Table 1. Participants in the CT group were more likely to be participating in unorganized events (p=0.05), and less likely to continue playing following SRC (p=0.003) than the no CT group. The CT group more frequently reported head to surface mechanism of injury than the no CT group. Significantly higher rates of loss of consciousness (LOC), amnesia, and vomiting following SRC were reported in the CT group. At 3-months post-SRC, the no CT group reported RTP a week sooner than the CT group (28.8±22.3 vs 35.7±27.3 days, p=0.019). However, there was no difference in prolonged recovery (>30 days: 29.6 vs 40.5%, p=0.07) or overall RTP rates (91.9 vs 85.8%, p=0.09) between the no CT and CT groups. Conclusion: Pediatric athletes who underwent CT following SRC exhibited significantly different injury-related characteristics compared to those who did not, but the differences observed did not impact symptom resolution or return-to-play. While LOC and vomiting differences align with the PECARN prediction rules and likely contribute to decision to perform CT, the additional differences of participating in an unorganized event, head-to-surface impact, and amnesia are not part of PECARN criteria. Further research is needed to discover which variables may contribute to unnecessary head CTs following SRC. [Table: see text]
Higher Student Confidence in their Schools’ Academic Support Associated with Lower Adverse Academic Concern Following Concussion
Authors: Halstead Mark , Snedden Traci , Valovich Tamara , Wilson Julie , Master Christina , Grady Matthew , Fazekas Matt , Santana Jonathan , Zaslow Tracy , Miller Shane , Howell David ,   the PRiSM Concussion Research Interest Group
Published: May 2022

Background: Concussion may cause physical and cognitive deficits that can affect the ability of students to perform at their typical academic level in school. Symptomatic students and their parents have previously reported concern about the impact of concussion on school performance. However, student confidence in their school’s ability to support return to school and its relationship with recovery time and overall academic concern has not been investigated. Hypothesis/Purpose: To determine if student confidence in their school’s ability to support return to school following concussion is associated with recovery time and other academic concerns. Methods: Student-athletes were enrolled in the Sport Concussion Outcomes in Pediatrics (SCOPE) study by a physician or athletic trainer across seven sites. Students and their parent/guardian completed the Concussion Learning Assessment and School Survey (CLASS) along with other standardized assessments. Participants were grouped based on responses to the CLASS question about confidence in their school’s ability to support return to school (very confident vs. not/mildly/moderately confident). Symptom resolution time, initial symptom severity, academic outcomes and parent-reported expected academic supports were evaluated using separate Chi-squared analyses. Results: A total of 141 patients were included; 72 (51%) reported being very confident in their school’s ability to support return to school. There was no significant difference in time to symptom resolution between groups (p = 0.84; mean difference= 0.9 days [95% CI= -7.4, 9.2]). The group who was very confident in school support reported a significantly lower initial symptom severity (p <0.001; mean difference= 0.12 [95% CI= 0.05, 0.18]). A higher proportion of those who felt very confident in school support reported no concern about concussion affecting school learning and performance (Table 2; 36% vs 10%, p=0.005). A lower proportion of those who felt very confident in their school support felt the concussion might affect their grades compared to those who expressed no/mild/moderate confidence in school support (Table 2; 56% vs 23%, p=0.001). Conclusion: In this multi-center study, although there was no difference in symptom resolution between groups, students who reported being very confident in their schools’ ability to support return to school had a lower initial symptom severity, expressed less concern about the concussion affecting their school learning, performance, and grades. These findings support recommendations for a collaborative team to assist students returning to school following concussion. [Table: see text][Table: see text]
Concussion Profile Screen Ocular Subtype Score and Objective Findings of Oculomotor Dysfunction in Pediatric Concussion Patients
Authors: Thirunagari Prem Kumar , Sarva Saikaashyap , Rieiro Hector , Polec Tanya , Bell Matthew , Pita Monica , Maes Luke , Harris Delaney , Streeter Leslie , Minor Jon , Mortazavi Mo 
Published: May 2022

Background: Visual abnormalities and oculomotor dysfunction are common findings in pediatric concussion patients. Not only are these symptoms reported by patients subjectively, but they can be measured objectively using clinical tools including oculomotor tracking (OMT) devices. Purpose: To identify trends between levels of subjective visual symptoms and objective oculomotor findings on OMT. Methods: Retrospective cohort of 65 patients (12-21 years old) from 11/05/20 to 6/10/21. Each visit, the concussion clinical profile (CP) screen was completed, which has a total score (0-89) and a weighted ocular subtype score (0-3) based on five vision focused questions in the screen. At the same visit, the OMT device (250 Hz video-eye tracker inside a headset) measured various biodata including microsaccade (MS) magnitude, vertical and horizontal saccadic latency. Near point convergence (NPC) was measured by a physician. Patients were classified into low grade (n=48) or high grade (n=17) using an ocular subtype score threshold of 1.5. A paired two sample t-test was used to compare both groups objective OMT data. Results: The low grade group had an average MS magnitude of 1.06 degrees, an average vertical saccadic latency of 217.49 ms, an average horizontal saccadic latency of 198.16 ms, and a physician measured NPC of 8.75 cm. The high grade group had an average MS magnitude of 1.21 degrees, an average vertical saccadic latency of 234.37 ms, an average horizontal saccadic latency of 202.24 ms, and a physician measured NPC of 13.82 cm ( Table 1 ). T-tests for MS magnitude and NPC revealed statistically significant differences between the two groups for both variables (p= 0.02 and p=0.003, respectively). The t-test for vertical latency had a p-value of 0.06. The low grade group had an average CP score of 9.3 while the high grade group had an average CP score of 43.7 with a statistically significant difference. Conclusion: Patients who report high grade visual symptoms on CP screen ocular subtype score show trends of higher MS magnitudes and saccadic latencies on OMT and higher NPC on exam. Furthermore, low grade patients report significantly lower CP scores compared to high grade patients suggesting visual abnormalities play a central role in overall symptom burden. Further studies are needed to confirm this trend and to evaluate the role of vision on the overall clinical picture of pediatric concussion patients. [Table: see text]
Mechanical Properties of Pediatric Knee Ligaments and The Iliotibial Band
Authors: Sanchez Mark , Gupta Anshal , Rohde Matt , Storaci Hunter , Sherman Seth , Ganley Ted , Shea Kevin 
Published: May 2022

Background: Substantial research about the mechanical properties of adult knee ligaments exists, but comparatively little is known about the pediatric knee. Choosing a graft for ligament reconstruction in pediatric patients is limited by the lack of knowledge of the mechanical properties of those ligaments and potential graft options in the skeletally immature. Purpose: Describe the mechanical properties of the ACL, PCL, MCL, LCL, and iliotibial band (ITB) in pediatric patients. Methods: Skeletally immature fresh frozen whole knees from 18 human cadavers (mean specimen age = 10.4 years) were thawed and the ligaments grossly dissected with bone block attachments intact, and length, width, and thickness were measured. Specimens were tested as a single unit (for those containing multiple bundles) and hydrated throughout testing. Each specimen was secured in an MTS machine and underwent a tensile loading protocol to measure ultimate tensile strength, ultimate tensile strain, and linear modulus. Results: Under testing, the ACL exhibited ultimate tensile strength (8.7 +/- 4.1 MPa), ultimate tensile strain (54.4 +/- 20.8%), and linear modulus (31.0 +/- 22.8 MPa) that were similar to the PCL (9.8 +/- 6.6 MPa, 48.6 +/- 22.1%, and 47.9 +/- 53.5 MPa, respectively). The LCL ultimate tensile strength was 18.7 +/- 6.5 MPa, ultimate tensile strain was 57.2 +/- 22.2%, and linear modulus was 68.7 +/- 50.8 MPa, compared to the MCL (19.5 +/- 13.9 MPa, 38.9 +/- 15.7%, and 93.3 +/- 75.1 MPa, respectively). Finally, the ITB demonstrated an ultimate tensile strength of 11.8 +/- 4.4 MPa, ultimate tensile strain of 42.6 +/- 14.9%, and linear modulus of 55.5 +/- 27.7 MPa. Conclusion: The ITB demonstrated greater ultimate tensile strength and a higher linear modulus than the ACL and PCL, with a lower ultimate tensile strain. Conversely, the ITB demonstrated lower values for ultimate tensile strength and linear modulus than the LCL and MCL. The ITB may serve as a reasonable substitute for native ACL and PCL reconstruction due to similar ultimate tensile strengths. The ITB may be less well-suited to reconstruct the LCL and MCL due to more significant differences in ultimate tensile strength. [Table: see text][Figure: see text]
Patient Reported Outcome Measures in Pediatric Anterior Cruciate Ligament Reconstruction: Does Promis Correlate with Pedi-Ikdc?
Authors: Williams Brendan A. , Johnson Mitchell , Pridgen Eric , McNeely Lia W. , Ganley Theodore J. 
Published: May 2022

Background: The Pedi-IKDC is a well-established patient reported outcome (PRO) measure used in knee and sports surgery. Recently, the computer adaptive PROMIS test has emerged as an alternative measure of patient function in this realm, but it is unclear if it captures information similar to the Pedi-IKDC and other PROs. Hypothesis/Purpose: The purpose of this study was to evaluate the strength of correlation between PROMIS and Pedi-IKDC scores for pediatric anterior cruciate ligament reconstruction (ACLR) patients during the postoperative period. Methods: Pediatric (<18yo) patients undergoing primary ACLR at a single urban tertiary care children’s hospital were identified. Patients completing both PROMIS and Pedi-IKDC within 2 weeks of each other were included. PROMIS domains including Physical Function, Anxiety, Depressive Symptoms, Fatigue, Peer Relationships, and Pain Interference were compared with the Pedi-IKDC using Pearson or Spearman correlations. Correlations were performed between Pedi-IKDC and PROMIS domains within subgroups based on timing of survey completion post-operatively (<6 weeks, 6-12 weeks, 3-6 months, 6-9 months, and >9 months). Multivariable robust regression modeling was performed to generate an equation of best fit to calculate a patient’s projected Pedi-IKDC result from PROMIS subdomains. Results: Study criteria were met by 150 patients. The cohort averaged 15.0 ± 2.2 years of age, was 50.7% male and underwent predominantly quadriceps (55.3%) or hamstring (36.7%) tendon ACLR. Score correlations appeared stronger with increased follow-up (Table 1.1). Both PROMIS Physical Function and Pain scores demonstrated moderate correlation to IKDC scores at 6-9 months (R=0.689, p<0.001; R=-0.556, p<0.001) and >9 month (R=0.487, p=0.001; R=-0.429, p=0.003) post-operatively. Across all timepoints, Pedi-IKDC and PROMIS Physical function demonstrated a strong correlation (R=0.844, p<0.001) while PROMIS Pain interference showed a moderate correlation (R=-0.541, p<0.001). A conversion equation for predicting Pedi-IKDC score was generated from PROMIS Physical Function and Pain Interference subdomains based on forward stepwise variable selection for robust regression model. This model demonstrates strong predictive ability for Pedi-IKDC (R⁁2=0.752, p<0.001) (Figure 1.2). Conclusion: The results from this study suggest that Pedi-IKDC demonstrates moderate to strong correlation with PROMIS physical function and pain interference domains following pediatric ACLR. Together, these two PROMIS domains also provide a reasonably strong prediction of a patient’s Pedi-IKDC score at a similar postoperative timepoint. These findings serve to facilitate cross-study outcome comparisons and can aid in the reduction of patient survey burden. Further work will be necessary to confirm these results across a broader patient cohort with longer periods of postoperative follow-up. [Table: see text]