bluuebunny/crossref_metadata_2025_split huggingface dataset:
Varus placement of the tibial component of Oxford unicompartmental knee arthroplasty decreases the risk of postoperative tibial fracture
Authors: Suda Yoshihito , Hiranaka Takafumi , Kamenaga Tomoyuki , Koide Motoki , Fujishiro Takaaki , Okamoto Koji , Matsumoto Tomoyuki 
Published: September 2022

Aims A fracture of the medial tibial plateau is a serious complication of Oxford mobile-bearing unicompartmental knee arthroplasty (OUKA). The risk of these fractures is reportedly lower when using components with a longer keel-cortex distance (KCDs). The aim of this study was to examine how slight varus placement of the tibial component might affect the KCDs, and the rate of tibial plateau fracture, in a clinical setting. Methods This retrospective study included 255 patients who underwent 305 OUKAs with cementless tibial components. There were 52 males and 203 females. Their mean age was 73.1 years (47 to 91), and the mean follow-up was 1.9 years (1.0 to 2.0). In 217 knees in 187 patients in the conventional group, tibial cuts were made orthogonally to the tibial axis. The varus group included 88 knees in 68 patients, and tibial cuts were made slightly varus using a new osteotomy guide. Anterior and posterior KCDs and the origins of fracture lines were assessed using 3D CT scans one week postoperatively. The KCDs and rate of fracture were compared between the two groups. Results Medial tibial fractures occurred after surgery in 15 patients (15 OUKAs) in the conventional group, but only one patient (one OUKA) had a tibial fracture after surgery in the varus group. This difference was significant (6.9% vs 1.1%; p = 0.029). The mean posterior KCD was significantly shorter in the conventional group (5.0 mm (SD 1.7)) than in the varus group (6.1 mm (SD 2.1); p = 0.002). Conclusion In OUKA, the distance between the keel and posterior tibial cortex was longer in our patients with slight varus alignment of the tibial component, which seems to decrease the risk of postoperative tibial fracture. Cite this article: Bone Joint J 2022;104-B(10):1118–1125.
Tourniquet use in patients undergoing tumour resection and endoprosthetic reconstruction of the knee
Authors: Gazendam Aaron M. , Schneider Patricia , Vélez Roberto , Ghert Michelle ,   on behalf of the PARITY Investigators
Published: September 2022

Aims The aim of this study was to determine the prevalence and impact of tourniquet use in patients undergoing limb salvage surgery with endoprosthetic reconstruction for a tumour around the knee. Methods We retrieved data from the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial; specifically, differences in baseline characteristics, surgical details, and postoperative functional outcomes between patients who had undergone surgery under tourniquet and those who had not. A linear regression model was created to evaluate the impact of tourniquet use on postoperative Toronto Extremity Salvage Scores (TESSs) while controlling for confounding variables. A negative-binomial regression model was constructed to explore predictors of postoperative length of stay (LOS). Results Of the 604 patients enrolled in the PARITY trial, 421 had tumours around the knee joint, of whom 225 (53%) underwent surgery under tourniquet. The tourniquet group was younger (p = 0.014), more likely to undergo surgery for a tumour of the tibia, and had shorter operating times by a mean of 50 minutes (95% confidence interval 30 to 72; p < 0.001). The adjusted linear regression model found that the use of a tourniquet, a shorter operating time, and a higher baseline TESS independently predicted better function at both three- and six-month follow-up. The negative-binomial regression model showed that tourniquet use, shorter operating time, younger age, and intraoperative tranexamic acid administration independently predicted a shorter LOS in hospital. Conclusion The results of this study show that in patients undergoing resection of a tumour around the knee and endoprosthetic reconstruction, the use of an intraoperative tourniquet is associated with a shorter operating time, a reduced length of stay in hospital, and a better early functional outcome. Cite this article: Bone Joint J 2022;104-B(10):1168–1173.
Reconstruction of Paprosky III defects with custom-made implants: do we get them in the correct position?
Authors: Wessling Martin , Gebert Carsten , Hakenes Tilman , Dudda Marcel , Hardes Jendrik , Frieler Sven , Jeys Lee M. , Hanusrichter Yannik 
Published: September 2022

Aims The aim of this study was to examine the implant accuracy of custom-made partial pelvis replacements (PPRs) in revision total hip arthroplasty (rTHA). Custom-made implants offer an option to achieve a reconstruction in cases with severe acetabular bone loss. By analyzing implant deviation in CT and radiograph imaging and correlating early clinical complications, we aimed to optimize the usage of custom-made implants. Methods A consecutive series of 45 (2014 to 2019) PPRs for Paprosky III defects at rTHA were analyzed comparing the preoperative planning CT scans used to manufacture the implants with postoperative CT scans and radiographs. The anteversion (AV), inclination (IC), deviation from the preoperatively planned implant position, and deviation of the centre of rotation (COR) were explored. Early postoperative complications were recorded, and factors for malpositioning were sought. The mean follow-up was 30 months (SD 19; 6 to 74), with four patients lost to follow-up. Results Mean CT defined discrepancy (Δ) between planned and achieved AV and IC was 4.5° (SD 3°; 0° to 12°) and 4° (SD 3.5°; 1° to 12°), respectively. Malpositioning (Δ > 10°) occurred in five hips (10.6%). Native COR reconstruction was planned in 42 cases (93%), and the mean 3D deviation vector was 15.5 mm (SD 8.5; 4 to 35). There was no significant influence in malpositioning found for femoral stem retention, surgical approach, or fixation method. Conclusion At short-term follow-up, we found that PPR offers a viable solution for rTHA in cases with massive acetabular bone loss, as highly accurate positioning can be accomplished with meticulous planning, achieving anatomical reconstruction. Accuracy of achieved placement contributed to reduced complications with no injury to vital structures by screw fixation. Cite this article: Bone Joint J 2022;104-B(10):1110–1117.
Soliton phenomena in normal and anomalous dispersion regions in Er-doped mode-locked fiber lasers based on Cr2Si2Te6 saturable absorbers
Authors: Xu Nannan , Sun Shuo , Shang Xinxin , Zhang Huanian , Li Dengwang 
Published: September 2022

Investigations of optical solitons have always been a hot topic due to their important
scientific research value. In recent years, ultrafast lasers based on
two-dimensional materials such as saturable absorbers (SAs) have
become the focus of optical soliton research. In this work, various
soliton operations are demonstrated in Er-doped fiber lasers (EDFLs)
based on SAs. First, a low-threshold passively
mode-locked EDFL with traditional soliton output is constructed, and
the pump threshold is as low as 10.1 mW. Second, by adjusting
the net dispersion of the cavity, stable dissipative soliton operation
can also be obtained. Traditional soliton mode-locked operation with
controllable Kelly sidebands from first order to fourth order is
realized by adjusting the pump power in a double-ended pumped
structure, and the SNR is as high as 55 dB. All results prove
that used as SA material has great
potential and wide application prospects in investigating optical
soliton operations in mode-locked fiber lasers with both normal and
anomalous dispersion.
High-fluence relay-based disposable photoacoustic-ultrasonic endoscopy for in vivo anatomical imaging of gastrointestinal tract
Authors: Wen Xue , Lei Peng , Huang Shengxin , Chen Xiaoyu , Yuan Yanchi , Ke Di , Liu Rui , Liang Jiaxi , Wang Erqi , Wei Bo , Xiong Kedi , Yang Sihua 
Published: September 2022

Photoacoustic endomicroscopy combined with ultrasound (PAEM-US) has been a long-standing expectation for gastrointestinal tumor examination. Here, we introduce a prototype disposable PAEM-US catheter and corresponding power interface unit, featuring catheter switchability, self-internal three-dimensional scanning, and system repeatability for gastrointestinal endoscopy. By utilizing high-fluence relays, cascade insertion loss of the optical waveguide is minimized to 0.6 dB with a high performance of power resistance, and a focus-customizable acousto-optic coaxial probe is designed for high-sensitivity optical-resolution photoacoustic imaging. Imaging capability was demonstrated with in vivo anatomical imaging at 30 frames per second. Imaging results showed co-registered microscopic visualization of the microvascular and stratification of the rat colorectum with lateral resolution of 18 μm and axial resolution of 63 μm, holding great potential in the clinical detection of gastrointestinal diseases.
Factors associated with in-hospital mortality of patients admitted to an intensive care unit in a tertiary hospital in Malawi
Authors: Kachingwe Mtisunge , Kazidule Kayambankadzanja Raphael , Kumwenda Mwafulirwa Wezzie , Chikumbanje Singatiya Stella , Baker Tim 
Published: September 2022

Objective
To determine factors associated with in-hospital death among patients admitted to ICU and to evaluate the predictive values of single severely deranged vital signs and several severity scoring systems.

Methods
A combined retrospective and prospective cohort study of patients admitted to the adult ICU in a tertiary hospital in Malawi was conducted between January 2017 and July 2019. Predefined potential risk factors for in-hospital death were studied with univariable and multivariable logistic regression models, and the performance of severity scores was assessed.

Results
The median age of the 822 participants was 31 years (IQR 21–43), and 50% were female. Several factors at admission were associated with in-hospital mortality: the presence of one or more severely deranged vital signs, adjusted odds ratio (aOR) 1.9 (1.4–2.6); treatment with vasopressor aOR 2.3 (1.6–3.4); received cardiopulmonary resuscitation aOR 1.7 (1.2–2.6) and treatment with mechanical ventilation aOR 1.5 (1.1–2.1). Having had surgery had a negative association with in-hospital mortality aOR 0.5 (0.4–0.7). The predictive accuracy of the severity scoring systems had varying sensitivities and specificities, but none were sufficiently accurate to be clinically useful.

Conclusions
In conclusion, the presence of one or more severely deranged vital sign in patients admitted to ICU may be useful as a simple marker of an increased risk of in-hospital death.
Analysis of predicted factors for bronchoalveolar lavage recovery failure: An observational study
Authors: Shimoda Masafumi , Tanaka Yoshiaki , Morimoto Kozo , Abe Taro , Asaga Reina , Nakajima Kei , Okamura Ken , Yoshimori Kozo , Ohta Ken 
Published: September 2022

BackgroundThe bronchoalveolar lavage (BAL) recovery rate should generally be more than 30% for effective diagnosis. However, there have been no reports investigating a target bronchus for BAL, and the cause of BAL recovery failure is uncertain. Therefore, this study detected predictive factors for BAL recovery failure through investigations on a target bronchus for BAL by using a 3D image analysis system. Therefore, this study detected predictive factors for BAL recovery failure.Materials and methodsWe retrospectively collected data from 338 adult patients who underwent BAL procedures at Fukujuji Hospital from June 2018-March 2022. Factors correlated with the BAL recovery rate were detected. Furthermore, the patients were divided into the failure group (recovery rate <30%; 36 patients) and the success group (recovery rate ≥30%; 302 patients), and data were compared between the two groups by analysing the target bronchus by using a 3D image analysis system.ResultsThe patients in the failure group were older (median 74.5 years old [IQR 68.0–79.0] vs. median 70.0 years old [IQR 59.0–76.0],p= 0.016), more likely to be male (n = 27 [75.0%] vs. n = 172 [57.0%],p= 0.048), more likely to have COPD (n = 7 [19.4%] vs. n = 14 [4.6%],p= 0.003), and more likely to perform a target site of BAL other than the middle/lingual lobe (n = 11 [30.5%] vs. n = 35 [11.6%],p= 0.004) than those in the success group. The area of the bronchial wall was positively related to the recovery rate (r = 0.141,p= 0.009), and the area of the bronchial wall in the failure group was lower than that in the success group (median 10.5 mm2[interquartile range (IQR) 8.1–14.6] vs. median 14.5 mm2[11.4–19.0],p<0.001).ConclusionThe study shows that a thin bronchial wall, COPD, and a target site of BAL other than the middle/lingual lobe were identified as the predicted factors for BAL recovery failure. The weakness of the bronchial wall might cause bronchial collapse during the BAL procedure.
Body mass index and stroke risk among patients with diabetes mellitus in Korea
Authors: Song Do Kyeong , Hong Young Sun , Sung Yeon-Ah , Lee Hyejin 
Published: September 2022

Background
Obesity and diabetes mellitus (DM) are both associated with cardiovascular disease. This study aimed to evaluate the association between body mass index (BMI) and stroke risk among patients with DM in Korea since relatively few studies have analyzed this area in detail.

Methods
We analyzed a total of 56,051 DM patients aged >30 years from the Korean National Health Insurance Service Cohort who had undergone at least one national health examination between 2002 and 2012. BMI scores were divided into six categories, while hazard ratios for stroke were calculated using Cox proportional hazard models.

Results
Overall stroke risk was positively associated with BMI for both men and women. For ischemic stroke, the risk was positively associated with BMI in women. However, for me, only patients with the highest BMI were at increased risk compared with patients with a BMI of 20–22.4 kg/m2. For hemorrhagic stroke, the risk was significantly associated with BMI with a U-shaped association in men. In women, only patients with the lowest BMI had an increased risk of hemorrhagic stroke compared with patients that have a BMI of 20–22.4 kg/m2.

Conclusion
BMI was positively associated with the overall risk of stroke among DM patients in Korea. The risk of ischemic stroke was higher in obese patients compared to overweight or normal-weight patients. However, the risk of hemorrhagic stroke was higher in slimmer patients compared with overweight or obese patients.
Preoperative state of autonomic regulation in patients with adolescent idiopathic scoliosis
Authors: Ivanova A. A. , Khorev I. A. , Lebedeva M. N. 
Published: September 2022

Objective. To analyze the state of autonomic regulation of the heart rate in patients with adolescent idiopathic scoliosis before the upcoming surgical treatment of spinal deformity.Material and Methods. The study included 30 patients with adolescent idiopathic scoliosis who were admitted for surgical treatment from January to April 2021. There were 28 female and 2 male patients. The heart rate variability (HRV) registration was carried out on the VNS-micro vegetotester, with Poly-Spectrum.NET software, Neurosoft (Russia). The study was conducted for 5 minutes in the supine position and for 5 minutes after the active orthostatic test. Temporal and spectral indicators of heart rate were analyzed.Results. When analyzing HRV at rest, an increase in the temporal indicators of the heart rate and the power of high-frequency wave oscillations was recorded, which indicates both an increased activity of autonomic regulation in general and the predominance of the regulatory influence o of the parasympathetic division of the autonomic nervous system. A decrease in all spectral components during an active orthostatic test and an increase in stress index values by 3.5 times indicate a significant stress of regulatory systems.Conclusion. Analysis of HRV in patients with adolescent idiopathic scoliosis at rest revealed increased autonomic activity with a predominant effect of the parasympathetic division of the autonomic nervous system. The state of exercise-induced energy deficit, registered after an active orthostatic test, indicates a significant preoperative stress of the regulatory systems and refers this category of patients to a group of increased risk of complications associated with hemodynamic instability.
Retrospective analysis of restoration of the anatomy of the damaged thoracic and lumbar spinal motion segment using transpedicular repositioning device
Authors: Usikov V. D. , Kuftov V. S. , Monashenko D. N. 
Published: September 2022

Objective. To carry out a retrospective analysis of the restoration of the anterior and posterior vertebral body heights and the elimination of deformation of the anterior spinal canal wall caused by thoracic and lumbar spine injury, based on the data of spiral computed tomography (SCT).Material and Methods. The study analyzed SCT data and case histories of 50 patients with thoracolumbar spinal cord injury operated on at different times after injury: up to 10 days – Group 1 and 11–30 days – Group 2. All patients underwent spinal reposition using a transpedicular device. The preoperative and postoperative SCT parameters were compared with the initial ones, which were calculated. The restoration of vertebral body heights and the elimination of deformation of the anterior spinal canal wall were compared in two groups depending on the distraction of interbody spaces and changes in the angle of segmental deformity.Results. In Group 1, the anterior and posterior dimensions of the vertebral body were restored, on average, by 95.3 ± 1.9 and 96.9 ± 1.4 % of the initial height; in Group 2 – by 87.4 ± 4.2 and 96.6 ± 1.8 %, respectively. The maximum restoration of the anterior dimensions of the vertebral bodies was achieved with distraction of the anterior interbody spaces closer to 100 % of the original size in the first and second groups. The maximum recovery of the posterior dimensions of the vertebral bodies was obtained by distraction of the posterior interbody spaces by 97 % or more of the original dimensions. The maximum elimination of the displacement of bone fragments from the spinal canal was obtained by distraction of the interbody spaces to a distance close to 100 % of the initial one, and when the obtained angle of segmental deformity coincided with the initial one.Conclusion. In the first 10 days after the injury, a greater percentage of the restoration of the anterior and posterior vertebral body heights and a decrease in the deformation of the anterior wall of the spinal canal were obtained. It was possible to maximally eliminate the deformation of the anterior wall of the spinal canal and restore the height of the anterior and posterior walls of the damaged vertebra by approaching the obtained dimensions of interbody spaces and the angle of segmental deformity to the initial ones.
Vertebral bone density in Hounsfield units as a predictor of interbody non-union and implant subsidence in lumbar circumferential fusion
Authors: Leonova O. N. , Baikov E. S. , Peleganchuk A. V. , Krutko A. V. 
Published: September 2022

Objective. To determine the values of Hounsfield units (HU) of the lumbar vertebrae predicting unsatisfactory radiological results of circumferential interbody fusion at the lumbar level.Material and Methods. The data of patients who underwent a single-level decompression and stabilization intervention at the L4–L5 or L5–S1 level for degenerative diseases of the spine were analyzed. The CT images of the lumbar spine were assessed before surgery with the measurement of HU values of the vertebral bodies at the intervention level, as well as CT images one year after surgery to evaluate the degree of interbody block formation and subsidence of the cage. Three groups of patients were distinguished: patients with a formed interbody bone block and without cage subsidence (control group), patients with failed fusion and patients with cage subsidence.Results. The study presents CT data of 257 patients. The incidence of non-union was 32.3 % (83/257), and of cage subsidence – 43.6 % (112/257). The proportion of patients with reduced bone mineral density (BMD) was 26.1 % (67/257). Patients with non-union and subsidence had higher ODI scores (p = 0.045 and p = 0.050, respectively) compared to controls. The presence of fusion failure and subsidence is associated with reduced BMD (p < 0.05), HU values of vertebrae (p < 0.05), and higher ODI score (p < 0.05). According to the ROC analysis, threshold HU values were determined equal to 127 HU, 136 HU and 142 HU for the L4, L5, S1 vertebral bodies, respectively. Upon reaching these values, the risk of a combination of fusion failure and subsidence increases significantly (p = 0.022).Conclusions. Patients with non-union and cage subsidence have less satisfactory clinical outcomes. The HU values of the vertebral bodies equal to 127 HU, 136 HU and 142 HU for the L4, L5, and S1, respectively, are advisable to use in practice to predict non-union and subsidence after a single-level decompression and stabilization intervention at the lower lumbar levels.
Microbiological spectrum of causative agents of implant-associated infection in the treatment of complications of transpedicular fixation of the spine using the negative pressure method
Authors: Tsiskarashvili A. V. , Gorbatyuk D. S. , Melikova R. E. , Pkhakadze T. Ya. , Kazmin A. I. , Suleimanov M. A. 
Published: September 2022

Objective. To analyze the leading pathogens of implant-associated infection (IAI) after spinal surgery and identification of trends in the change in the pattern of microorganisms at the stages of treatment using the negative pressure method (NPWT systems).Material and Methods. The results of microbiological cultures of 25 patients with IAI of the spine were studied. The frequency of occurrence of Gram-positive and Gram-negative pathogens was estimated. The leading pathogens in the species spectrum were identified. Changes in the structure of identified microorganisms were studied at various time intervals of treatment.Results. A total of 136 microbiological studies were performed in 25 patients at the stages of treatment with the negative pressure method, with the identification of microorganisms in 127 (93.3 %) cases. The frequency of gram-negative microflora was 50.0 %, gram-positive – 42.6 %, Candida sp. – 0.7%, in 15.4 % microbial associations with the dominance of gram-negative microflora were identified at all periods of treatment. Not only the diversity of the isolated flora was noted (E. faecalis – 16.5 %, P. aeruginosa – 14.2 %, K. pneumoniae – 11.0 %, S. aureus and A. baumannii – 9.4 % each and S. epidermidis – 8.6 %), but also changes in the spectrum of flora at the stages of treatment: on the 1st and 2nd weeks from the first debridement intervention and the installation of the NPWT system, E. faecalis was most often detected, on the 3rd and 4th weeks – P. aeruginosa and A. baumannii, during the 2nd month – E. faecalis and P. aeruginosa, later – gram-negative bacteria against the background of an increase in the incidence of K. pneumoniae. The frequency of verification of other species of microorganisms had no statistically significant differences. Microbial associations were found from the 2nd month of treatment. The change in pathogens was noted in 72 % of cases during the treatment of IAI of the spine. On average, this treatment required 7–8 NPWT dressing changes per patient. This method of treatment made it possible to achieve both negative results of microbiological examination and stable relief of the infectious process.Conclusion. IAI, which complicates surgical interventions on the spine, is characterized by a change in pathogens during treatment, which requires not only multiple debridement with the replacement of the NPWT dressing, but also adequate long-term rational (etiologically justified) antibacterial therapy, based on the control of data on both the spectrum and on microbial resistance.