bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Fragility Index of Statistically Significant Findings From Randomized Controlled Trials Comparing the Management Strategies of Anterior Shoulder Instability
Authors: Davey Martin S. , Hurley Eoghan T. , Doyle Tom R. , Dashti Hasan , Gaafar Mohamed , Mullett Hannan 
Published: April 2022

Background: Debate centering on the management of anterior shoulder instability (ASI) in recent years has led to many randomized controlled trials (RCTs) being published on the topic. The fragility index (FI) has subsequently emerged as a novel method of assessing significant findings reported in RCTs, particularly those with small sample sizes. Purpose: To evaluate the FI of statistically significant findings in RCTs that reported the outcomes of management strategies of patients with ASI. Study Design: Systematic review; Level of evidence, 1. Methods: Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent reviewers performed a systematic review of RCTs focusing on the outcomes of management strategies of patients with ASI. There were 3 main categories of RCTs included: (1) nonoperative management in internal rotation (IR) versus external rotation (ER), (2) nonoperative management versus a surgical intervention, and (3) surgical management with arthroscopic Bankart repair versus open Bankart repair. The Fisher exact test was utilized to calculate the FI for the reversal of statistical significance in all statistically significant dichotomous outcomes. Results: A total of 21 RCTs were included, including 1589 shoulders (mean age, 29.4 years) with a mean follow–up of 26.8 months. There were 10 RCTs (831 shoulders) that reported outcomes after the nonoperative management of ASI in IR versus ER, with a mean FI of 6.8. There were 5 RCTs (324 shoulders) that reported outcomes comparing the nonoperative and operative management of ASI, with a mean FI of 3.5. There were 6 RCTs (434 shoulders) that reported outcomes after the operative management of ASI with either arthroscopic Bankart repair or open Bankart repair, with a mean FI of 9.6. Conclusion: The overall FI of RCTs reporting the outcomes of management strategies for patients with ASI was high, suggesting a moderate fragility of statistically significant outcomes including recurrence, revision stabilization, and return to play.
Meniscal Displacement and Loss of Load-Transmission Function After Radial Tear of the Lateral Meniscus in a Porcine Model: New Insights Into the Functional Dynamics of the Injured Meniscus
Authors: Hirose Takehito , Mae Tatsuo , Ogasawara Issei , Yamakawa Satoshi , Nakata Ken , Ohori Tomoki , Tsujii Akira , Okada Seiji 
Published: April 2022

Background: Meniscal extrusion/translation has been used as an index for meniscal treatment. However, the relationship between meniscal displacement and the degree of meniscal tear or load–transmission function of the lateral meniscus (LM) remains unclear. Purpose: To clarify the relationship between the width of the radial tear of the LM and (1) meniscal displacement or (2) resultant force through the meniscus under axial compressive load in the porcine model. Study Design: Controlled laboratory study. Methods: Eight intact porcine knees with or without a partial radial tear at the midbody of the LM (involving 30%, 60%, or 90% of its width) were investigated. Reflective markers were attached to the outer wall of the anterior, anteromiddle, posteromiddle, and posterior segments of the LM. A 300-N axial load was applied at 2 flexion angles (30° and 60°), and the 3–dimensional forces and trajectories of the knees were recorded. Marker movements were simultaneously tracked using a motion capture camera system. After total meniscectomy of the LM, the recorded knee trajectories were reproduced, and the resultant force through the LM was calculated (a force carried only by the meniscus in response to a load applied to the whole knee joint). Results: At both flexion angles, the change in distance (mean ± SD) between the anterior and posterior markers under load increased significantly more in the anteroposterior direction in LMs with a 90% tear than in intact LMs (30°, 0.4 ± 0.3 vs 1.4 ± 0.8 mm, P = .004; 60°, 0.1 ± 0.7 vs 1.4 ± 1.0 mm, P < .001 [intact vs 90% tear]). The change in distance between the anteromiddle and posteromiddle markers at 30° also significantly increased in LMs with a 90% tear (0.2 ± 0.2 vs 1.3 ± 1.2 mm, P = .02 [intact vs 90% tear]). The resultant force was significantly lower in LMs with a 90% tear than in intact LMs (30°, 125 ± 47 vs 48 ± 20 N, P < .001; 60°, 93 ± 46 vs 43 ± 11 N, P = .002 [intact vs 90% tear]). We found no significant differences in either meniscal displacements or resultant forces between intact LMs and those with 30% or 60% tears. Conclusion: LMs with a 90%-width midbody radial tear lost load–transmission function with their displacement relative to the tibia primarily in the anteroposterior direction in the porcine model. Clinical Relevance: Even 1 mm of displacement after meniscal injury is evidence that the load–transmission function of the meniscus is greatly impaired. When a displaced torn LM is diagnosed in preoperative imaging, meniscal repair surgery should be considered.
Intergenerational Socioeconomic Mobility and Cognitive Impairment Among Chinese Older Adults: Gender Differences
Authors: Fu Rong , Liu Yujun 
Published: April 2022

This study examined the impact of intergenerational socioeconomic mobility on the risk of cognitive impairment in a cohort of Chinese older adults aged 60 years and older. Data were derived from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey. Logistic regression models were performed to assess the impact of three dimensions of socioeconomic mobility (occupational mobility, educational mobility, and residential mobility) on the risk of cognitive impairment. We found that men who were stable with non-professional jobs across generations had a higher risk of cognitive impairment than their counterparts who experienced upward occupational mobility compared to their father. This pattern was not observed in women. There was little evidence that educational mobility or residential mobility affected cognitive impairment in later life. The findings have implications for advancing supportive policies and practices related to maximizing the benefits of education and career advancements for cognition in later life.
Foods and Beverages Available to Nurses in Hospital Cafeterias, Vending Machines, and Gift Shops
Authors: Horton Dias Cynthia E. , Dawson Robin M. , Harris Diane M. , Wirth Michael D. , Abshire Demetrius A. 
Published: April 2022

Purpose Hospitals are important workplaces for nurses with many perceived barriers to healthy eating, but objective assessments are lacking. This study evaluated the healthfulness of hospital consumer food environments. Design Cross-sectional observational; Setting: South Carolina; Subjects: Cafeterias, vending machines (VM), and gift shops (GS) in hospitals of varying size, urbanization, and region. Measures Using the Hospital Nutrition Environment Scan (HNES), primary outcomes of interest included availability, access, prices, and location of healthy foods in relation to nursing units. Analysis Descriptive and inferential statistics by independent samples t-test, ANOVA, Mann–Whitney U, χ2, or Fisher’s exact test as appropriate. Results Thirty-one hospitals were observed from December 2019 to February 2020. Average composite HNES score (n = 28) was 46.3 ± 14.9 (−45 to 173 range), indicating sub-optimal food environments. Cafeterias (n = 31) scored an average of 30.9 ± 10.5 (−33 to 86 range). Average VM (n = 31) and GS (n = 28) scores were 11.6 ± 6.0 (−6 to 55 range) and 2.9 ± 4.0 (−6 to 32 range), respectively. Small hospitals (≤100 beds) had lower average cafeteria score (22.4 ± 10.3) than extra-large hospitals (≥500 beds; 42 ± 5.2, P < .01). Small hospitals also had lower composite HNES scores (34.4 ± 17.1) compared to extra-large hospitals (61.0 ± 14.4, P = .02). Data regarding availability, access, prices, and location were also reported. Conclusion Due to abundant availability of unhealthy foods and beverages, hospital consumer food environments scored low on observations using the HNES, highlighting the opportunity to improve the healthfulness of facility offerings.
Three-Dimensional Assessment of Eustachian Tube in Patients With Cleft Palate Versus Controls: A CBCT Study
Authors: Hasani Mahvash , Ajami Shabnam , Farzinnia Golnoush 
Published: April 2022

To compare the morphological characteristics of the Eustachian tube (ET) between patients with cleft palate and healthy controls with the use of cone-beam computed tomography (CBCT). Retrospective assessment of treated nonsyndromic patients with cleft palate and a control group. CBCT images of 51 patients with cleft palate who had previously undergone surgery to close the cleft palate and a control group of 51 patients were included in this study. Syndromic patients were excluded. The cleft group were divided into 3 groups according to the palatoplasty technique, which was done in the infancy period to close the cleft palate (Nadjmi modification of Furlow, Sommerlad, and V-Y pushback). Finally, ET length (ETL), ET angle, and auditory tube angle (ATA) were measured in all patients. The ETL, ETA, and ATA in the cleft and the normal control groups were 29.73 ± 3.14 and 32.18 ± 3.34 mm, 33.18 ± 2.57 and 35.40 ± 3.93, and 141.64 ± 4.13 and 138.87 ± 4.96, respectively. All 3 features were statistically significant among the groups (All Ps < .05). ETL and ETA were significantly higher in Nadjmi modification of Furlow and Sommerlad palatoplasty techniques compared to the V-Y pushback technique, while there was no significant difference in the ATA between the palatoplasty groups. Cleft palate can significantly affect the morphological characteristics of the ET. Type of the infancy palatoplasty can influence some of its dimensions.
Clinical Course and Predictors of Subsequent Recurrence and Survival of Patients With Ipsilateral Breast Tumor Recurrence
Authors: Baek Soo Yeon , Kim Jisun , Chung Il Yong , Ko Beom Seok , Kim Hee Jeong , Lee Jong Won , Son Byung Ho , Ahn Sei-Hyun , Lee Sae Byul 
Published: April 2022

Purpose To evaluate the clinical course and long-term outcomes of patients with ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery (BCS) and identify independent prognostic factors for further recurrence. Methods In this retrospective study, we reviewed the records of 327 patients who experienced IBTR after undergoing BCS for breast cancer at Asan Medical Center during 1990–2013. Overall survival (OS) after IBTR and cumulative incidence rates of recurrences after IBTR were calculated. The association of clinicopathological factors with survival and the development of further recurrence after IBTR was determined in multivariate analysis. Results At a median follow-up of 127.7 months, 97 patients experienced recurrence after IBTR. The 5-year and 10-year cumulative incidence rates of recurrence after IBTR were 32% and 41%, respectively. The 5-year and 10-year OS rates after IBTR were 86.6% and 70.3%, respectively. In multivariate analysis, hormone receptor negativity was associated with decreases in OS after IBTR (hazard ratio [HR] 2.83, 95% confidence interval [CI] 1.18–6.78). Patients with longer disease-free interval (DFI) had decreased risks of second recurrence (HR .99, 95% CI .99–1.00), and second locoregional recurrence (LRR) (HR .98, 95% CI .97–.99). Lymphovascular invasion (LVI) of IBTR was associated with increased recurrence rates (second recurrence-free survival, HR 3.58, 95% CI 2.16–5.94; second LRR free survival, HR 5.21, 95% CI 2.77–9.78; second distant metastasis-free survival, 2.11, 95% CI 1.04–4.30) and lower survival rates (OS after IBTR, HR 4.64, 95% CI 2.23–9.67). Conclusions Despite subsequent recurrences during long-term follow-up, the survival rates after IBTR remained high. Patients with hormone receptor-negative tumors, shorter DFI, and tumors that present LVI of IBTR had higher risks for recurrence and poor survival rates after IBTR. The study findings may help in understanding the course and prognosis of IBTR patients and identifying high-risk IBTR to establish management strategies.
Autologous Iris transplant as plug for macular hole retinal detachment in highly myopic eyes
Authors: Tamburrelli Ciro , Rispoli Marco , Gentile Francesca , Tamburrelli Anna Clara 
Published: April 2022

Purpose To describe the anatomic and visual outcomes of eyes undergoing autologous iris transplantation for macular hole retinal detachment. Methods Seven consecutive patients with macular hole retinal detachment were enrolled in a single-arm prospective study. All patients underwent pars plana vitrectomy with autologous iris transplantation placed in the subretinal space as a plug to close the macular hole; in one case, a posterior retinal break was also closed with the same technique. Results Seven patients (2 males and 5 females) with a mean age of 69.14 ± 7.79 years (range 58–80 years) were followed up for a period of six months. The best-corrected visual acuity improved from 2.44 ± 0.48 logMAR (20/2000) preoperatively to 1.90 ± 0.26 logMAR (20/800) 6 months after surgery. Optical coherence tomography analysis showed retinal adhesion around the iris plug, and the retina remained dry in the follow-up period. Conclusions In this series of macular hole retinal detachments, autologous iris transplantation placed as a plug over the retinal pigment epithelium facing the macular hole opening or directly over the bare sclera achieved anatomical success with improvement in visual function.
‘Do I have to say I’m gay?’: Using a video booth for public visibility and impact
Authors: Einarsdóttir Anna , Mumford Karen A , Siriviriyakul Sudthasiri , Sayli Melisa 
Published: April 2022

Using data generated from a ‘video booth’, this paper explores how LGBT+ identifying individuals and allies navigate public visibility in front of a video camera. The video booth was set up in eight different NHS organisations in the UK to enable users to record short messages (30 s maximum) about their working life and/or experiences of LGBT+ employee networks, using a self-operated tablet system. The workplace context had an impact on how people represented themselves in front of the camera with prioritisation of professional identities and positive work-self. LGBT+ visibility was further masked by the inclusion of allies. We also discuss ethics and privacy issues related to using video booth methodology and signal how this methodology can best be used for future research purposes.
Early- and Mid-Term Results of Abdominal Endovascular Aneurysm Repair Using an Aortic Cuff Prior to the Main Body to Prevent Type II Endoleaks
Authors: Mikami Takuma , Kawaharada Nobuyoshi , Kamada Takeshi , Kuroda Yosuke , Yasuda Naomi , Sato Hiroshi , Naraoka Syuichi 
Published: April 2022

Purpose: Postoperatively persistent type II endoleaks (T2ELs) in abdominal endovascular aneurysm repair (EVAR) are known risk factors for long-term aneurysm enlargement. Therefore, various measures have been proposed to prevent T2ELs. Notably, the Kilt technique, which can be used in patients with dumbbell-shaped morphology, employs an aortic cuff deployed in the distal seal zone before the main body. Although previous studies have successfully applied this technique for preventing T2ELs, the mid- and long-term outcomes remain unclear. This study aimed to report the early- to mid-term outcomes in cases where an aortic cuff technique was used to prevent T2ELs. Materials and Methods: This retrospective single-center study analyzed 9 patients (mean age, 79 years; range, 69–88 years; 8 men) with abdominal aortic aneurysms. All patients underwent EVAR using an aortic cuff to prevent T2ELs. The primary end points were technical success (successful deployment) and clinical success (no T2ELs). Secondary end points included morbidity, reintervention, and aortic remodeling during follow-up. Results: The technical success rate was 100%. There were no intraprocedural or postoperative complications. No deaths or reinterventions occurred. Postoperative computed tomography showed no endoleaks in 6 patients, while T2ELs from the lumbar artery outside the aortic cuff deployment range were noted in 3 patients. However, no T2ELs were observed in the artery in the aortic cuff deployment range in any patient. The average number of successfully occluded arteries was 4.2 (range, 2–8). All patients had follow-up >6 (mean, 18.6; range, 6–36) months. Aneurysm sac shrinkage occurred in 5 patients during the follow-up period, whereas aneurysm size was stable in 3 patients. In contrast, only 1 patient showed transient dilation of the aneurysm sac enlargement; however, this dilation remained unchanged even after 1.5 years. Conclusion: The aortic cuff technique is a favorable endovascular method for preventing T2ELs in EVAR. The present study showed that a single aortic cuff could easily and reliably occlude arteries branched from the aneurysm sac.
Anterior Capsule Reconstruction in the Setting of PVNS
Authors: Lukosius Eric , Chopra Aman , Parekh Selene 
Published: April 2022

Background: Pigmented villonodular synovitis (PVNS) is a benign proliferative disease affecting tendon sheaths and synovial tissue. Pigmented villonodular synovitis in the foot and ankle has a high rate of recurrence, which can be destructive if incompletely removed. This case series analyzes functional outcomes after PVNS operative resection with an anterior ankle capsular reconstruction, using a novel technique. Methods: Three patients with PVNS underwent surgery between 2010 and 2020. The operative technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion for the ankle and subtalar joints, visual analog scale (VAS) for pain, and return to daily activities was assessed along with appropriate radiographs and magnetic resonance imaging (MRI) imaging. Results: All 3 surgeries had a mean follow-up period of 52.3 (range, 4-123) months and resulted in successful recovery as assessed by the VAS and self-reported activity. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were not statistically different. No complications or recurrence of PVNS was observed. Conclusion: Further investigation is warranted to better understand the clinical outcomes of this technique designed to successfully eliminate PVNS recurrence. Level of Evidence: IV- Retrospective case series
Trabecular Bone Remodeling as a New Indicator of Osteointegration After Posterior Lumbar Interbody Fusion
Authors: Segi Naoki , Nakashima Hiroaki , Shinjo Ryuichi , Kagami Yujiro , Ando Kei , Machino Masaaki , Ito Sadayuki , Koshimizu Hiroyuki , Tomita Hiroyuki , Ouchida Jun , Imagama Shiro 
Published: April 2022

Study Design Retrospective cohort study. Objectives We newly found that trabecular bone remodeling (TBR) often appeared in the fixed adjacent vertebrae during bony fusion. Thus, TBR might indicate osteointegration. Hence, we aimed to investigate whether TBR in the early postoperative period could predict future bony fusion after posterior lumbar interbody fusion (PLIF). Methods We retrospectively analyzed 78 patients who underwent one-level PLIF. Demographic data were reviewed. Using computed tomography (CT) images taken at 3 months and 1 year postoperatively, we investigated the vertebral endplate cyst (VEC) formation, TBR in the vertebral body, cage subsidence, and clear zone around pedicle screw (CZPS). Results TBR had high interobserver reliability regardless of cage materials. VECs, TBR, and both were found in 30, 53, and 16 patients at 3 months postoperatively and in 30, 65, and 22 patients at 1 year postoperatively, respectively. The incidence of VEC, which indicates poor fixation, was lower in early (3 months postoperatively) TBR-positive patients, with a significant difference at 1 year postoperatively (3 months, P = .074; 1 year, P = .003). Furthermore, 3 (5.7%) of the 53 early TBR-positive patients had CZPS without instability at 1 year postoperatively. In 25 TBR-negative patients, 1 (4.0%) had pedicle screw cutout requiring reoperation, 1 (4.0%) had pseudarthrosis, and 4 (16%) had CZPS. Conclusions Patients with early TBR (3 months) did not experience pedicle screw cutout nor pseudarthrosis and had significantly fewer VECs than those without early TBR. Thus, TBR may be a new radiological marker of initial fixation after PLIF.
Medium-term outcomes of short stems in total hip arthroplasty
Authors: Morales De Cano Jaime Jose , Molina Ramon Clos , Puertolas Estela Trias 
Published: April 2022

Background Prosthetic surgery has shown good short-term results with the use of short stems, results comparable with the experience of conventional stems. The aim of this study was to investigate and describe the characteristics and clinical course of patients operated on with the short stem GTS in the medium term. Methods Between November 2010 and September 2014, 152 primary hip prostheses were operated on in 142 patients with a mean follow-up of 95.49 months (range 75–120). We analyzed the intraoperative and postoperative complications and the reviews performed during the follow-up. Results One intraoperative complications occurred; case in which a femoral calcar fracture occurred and a screw was required during the operation. The clinical evaluation at the end of the follow-up, according to the Merle D’Aubigne Scale, showed the mean value was 17.3684 (SD 0,79472), with a survival at the end of the follow-up of 99.3% of the placed GTS stems. Conclusions GTS short stems have shown good results after more than 6 years of follow-up, with comparable results to conventional uncemented stems. Short-stem hip arthroplasty is an advanced way to preserve bone stock while protecting soft tissue
Orthopedic Providers’ Preferences for Education and Training on Psychosocial Clinical Research Initiatives: A Qualitative Investigation
Authors: Sagar Isabell , Popok Paula J. , Reichman Mira , Lester Ethan G. , Doorley James , Bakhshaie Jafar , Vranceanu Ana Maria 
Published: April 2022

Introduction: Psychosocial factors (e.g., depression, anxiety) increase risk for chronic pain, disability, and other health complications following acute orthopedic traumatic injury. Orthopedic providers lack skills to address these factors. Education around psychosocial factors of recovery and psychosocial clinical and research initiatives could address this gap. The purpose of this study was to understand orthopedic trauma providers’ preferences for the design and distribution of educational materials to facilitate psychosocial initiative implementation. Methods: We conducted live-video, semi-structured focus groups with outpatient orthopedic trauma providers across three Level 1 Trauma Centers, using a hybrid inductive-deductive approach to analyze qualitative data and extract themes and subthemes characterizing providers’ recommendations for appropriate psychosocial education. Results: Four themes described providers’ recommendations for receiving educational materials: (1) provide foundational knowledge and tools about psychosocial factors; (2) provide information regarding a psychosocial initiative's purpose and procedures; (3) leverage educational materials to maximize buy-in to psychosocial clinical research initiatives; and (4) deliver information concisely, clearly, and electronically. Conclusion: Orthopedic providers recommended ways to optimize design and dissemination of education on psychosocial care. Optimizing knowledge of psychosocial factors and clinical and research initiatives facilitates providers’ ability to appropriately target the often-underdressed psychosocial component of recovery in orthopedics.