Objective Functional Scores Research Articles

Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up

Background: Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients >50 years old; however, the long-term outcomes are unclear. Purpose: To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients >50 years old who have undergone primary ACL reconstruction. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were patients >50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up. Results: A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes ( P > .05). Concomitant partial medial meniscectomy ( P < .01) and meniscal repair ( P < .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations. Conclusion: In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression.

A metaheuristic-based optimization model for flight procedure design

In recent years, the continuous increase in air traffic has led to a saturation of available airspace. The new localizer performance with vertical guidance (LPV) instrument approach procedures (IAPs) offer additional capacity at aerodromes and in airspaces. To support their implementation, a specifically developed model focused on the improved IAP design process and optimized solution generation is proposed. The model provides a fully automated search of the solution space by employing the bee colony optimization metaheuristic algorithm. The resulting list of alternatives is ranked by the objective function score, which is affected by the balancing values of the complexity indicators and the achieved obstacle clearance height. The model’s capabilities are successfully validated against the challenging operational environment of Podgorica Airport. The model was initially developed to conduct IAP feasibility studies; however, it can also be used in the initial stages of airport planning projects or for IAP criteria validation.

The Long-Term Clinical and Radiographic Outcomes of Cerclage Cable Fixation for Displaced Acetabular Fractures Using a Posterior Approach: A Retrospective Cohort Study.

Background and Objectives: Cerclage cable fixation with 2 mm multiple-braided cables for displaced acetabular fractures has shown good midterm functional and radiographic outcomes. We retrospectively evaluated the clinical and radiographic outcomes of cerclage cable fixations over ten years. Materials and Methods: We extracted data for patients who underwent cerclage cable fixation for acetabular fractures at a single institution from 2007 to 2012. We adopted this procedure for acetabulum fractures with posterior column fractures. Postoperative reduction quality, complications, reoperations, and Japanese Orthopedic Association (JOA) hip objective functional scores were analyzed. Postoperative reduction quality was classified using plain radiography and computed tomography. Results: We evaluated nine patients with a mean follow-up period of 14.1 ± 2.6 years (range: 10.8-18.1 years). The mean age was 47.1 ± 15.5 years old (range: 28-74 years); the mean injury severity score was 13.6 ± 4.7 (range: 9-22). The most frequent type of fracture was a both-column fracture. Anatomical reduction quality was achieved in five cases. Four patients had hip osteoarthritis at the last follow-up; among them, one patient had worsening hip arthritis > 5 years after surgery, and one patient developed osteoarthritis > 10 years after surgery. Their postoperative reduction quality was worse than their anatomical reduction quality, and both engaged in physical labor. None of the patients underwent revision total hip arthroplasty. The mean JOA hip score was 90.9 ± 7.9 (range: 74-100); seven patients scored >90 at the last follow-up. Conclusions: Cerclage cable fixation showed satisfactory postoperative reductions and favorable long-term clinical outcomes. Long-term follow-up might be necessary for patients whose postoperative reduction is not anatomical to detect late occurrence of hip osteoarthritis, even if osteoarthritis is not evident during short-term follow-up periods.

Comparison of short-term clinical results between modified kinematically-aligned and guided motion bicruciate stabilized total knee arthroplasty

BackgroundBoth kinematically-aligned (KA) total knee arthroplasty (TKA) and bicruciate stabilized (BCS) TKA aim to reproduce the physiological knee kinematics. In this study, we compared the femoro-tibial component rotational mismatch between patients who underwent modified KA-TKA and those who received guided-motion BCS-TKA, and its influence on the clinical outcomes.MethodsIn this retrospective study, 77 consecutive patients were included and divided into two groups: subjects who underwent modified KA-TKA with Persona (KA Group; n = 42) and those who received BCS-TKA with JOURNEY II (BCS group; n = 35). Range of motion, the 2011 Knee Society Score (KSS), the rotational alignment of the femoral and tibial components, and the correlations between the rotational mismatch and the 2011 KSS subscales were examined.ResultsThe postoperative objective knee indicators (P = 0.0157), patient satisfaction (P = 0.0039) and functional activity scores (P = 0.0013) in the KA group were significantly superior to those in the BCS group 1 year postoperatively. There was no significant difference between the two groups observed in the rotational mismatch. In the BCS group, significant negative correlations were identified between the rotational mismatch and objective indicators, patient satisfaction, and functional activity scores but not in the KA group.ConclusionsThe short-term clinical results following KA-TKA showed superior objective knee indicators, patient satisfaction and functional activity scores. A negative correlation was observed between component rotational mismatch and the 2011 KSS subscales in the BCS group, compared to no relationship found between the two in the KA group. These findings suggested that KA-TKA has a relatively higher tolerance for rotational mismatch than BCS-TKA.

Characterization of cancer survivors clustered by subjective and objective cognitive function scores.

Cancer-related cognitive impairment (CRCI) is a prevalent condition that significantly impacts the quality of life of individuals who receive cancer treatment. Clinical management of CRCI presents challenges due to the absenceof a standardized assessment. This study identified clinically relevant phenotypic clusters of CRCI based on subjective and objective cognitive function scores. In this cross-sectional study, participants were clustered using the VARCLUS™ based on subjective cognitive impairment assessed through the PROMIS® version 1.0 short-form subscales of cognitive abilities and cognitive concerns and the CANTAB Cambridge Cognition® scores, which included measures of visuospatial working memory capacity, visual episodic memory, new learning, working memory, executive function, and sustained attention. Each cluster's characteristics were described using demographics, physical and psychosocial factors (physical function, affect, optimism, and social support), and psychoneurological symptoms (anxiety, depression, fatigue, neuropathic pain, and sleep disturbance). We obtained five clusters from a total of 414 participants, where 99% were female, and 93% were self-reported white. Clusters 4 and 5 showed the highest PROMIS® cognitive abilities and the lowest measures of cognitive concern, while Clusters 1 and 2 showed the lowest cognitive abilities and the highest cognitive concerns. Clusters 4 and 5 had higher education, income, employment, and higher scores in physical function, positive affect, optimism, and social support. Additionally, individuals in these clusters were less prone to experience severe cancer-related psychoneurological symptoms. Our clustering approach, combining subjective and objective cognitive function information, shows promise in identifying phenotypes that hold clinical relevance for categorizing patient presentation of CRCI and facilitating individualized management strategies.

Short-term Comparison of Survivorship and Functional Outcomes for Metaphyseal Cones with Short and Long Stems in Revision Total Knee Arthroplasty.

Printed porous titanium metaphyseal cones have become a mainstay for managing bone loss in revision total knee arthroplasty (rTKA). A short or long stem is routinely used when implanting a cone to augment fixation and offload stresses. This retrospective analysis compared the short-term survivorships and functional outcomes for use of a short or long stem with a metaphyseal cone.A total of 179 cases using metaphyseal cones and stems with median follow-up of 1.95 years (interquartile range, 1.00-2.14) were compared based on stem type. There were 55 cases with long stem(s) and 124 cases with short stem(s). Cases with both long and short stems were excluded. Demographics, Kaplan-Meier survivorships, and preoperative and 1-year postoperative patient-reported outcome measures (PROMs; 2011 Knee Society Score [KSS] objective knee score, function, and satisfaction scores; EuroQol five-dimension scale; and Short Form Survey Physical Component Summary and Mental Component Summary scores) were compared using t-tests with a significance level of α = 0.05. There were no significant differences in body mass index (mean ± standard deviation) or sex (men [%]) between the short and long stem cohorts (32.3 ± 5.3, 36.3% and 31.5 ± 5.5, 38.2%, respectively; p > 0.05). Patients who had short stems were younger (65.9 ± 8.8 vs. 69.0 ± 9.4, p = 0.0323).Revision-free survivorship for the femoral or tibial component was 100% for long stems and 98.2% for short stems at 1 and 2 years, respectively (log-rank p = 0.6330). The two revisions in the short group were for infection, thus the survivorship for aseptic loosening was 100% at 2 years for both cohorts. There were no significant differences in preoperative or postoperative PROMs.This study demonstrated that highly porous printed metaphyseal cones provided rTKA with excellent early survivorship and similar PROMs whether a short or long stem was used. Additional studies will be needed to discern longer term differences.

P35: A Systematic review on the outcomes of the reverse shoulder arthroplasty versus hemiarthroplasty for the 3- and 4- part proximal humeral fractures in the elderly population

Abstract Background The hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) are common surgical methods in of the proximal humerus management, where the surgical fixation is not feasible. Our aim is to analyse the most recent data to inform choices on best management for managing 3- and 4 -part fracture dislocations of the proximal humeral fractures in the elderly population. Methods The Medline, PubMed and Scopus databases were searched in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify the relevant literature to include for analysis. The inclusion criteria involved English language, functional outcomes, revision rates, hemiarthroplasty, and reverse total shoulder arthroplasty. The exclusion criteria were publications before 2018, systematic reviews and meta-analysis, other management options such as conservative management, surgical fixation, and total anatomical shoulder replacement. Results The data collected included study design and level of evidence, number of patients and patients’ characteristics, follow-up time post-surgery, functional outcomes, range of movement, Constant score, subjective scores including Disability of Arm and Shoulder (QuickDASH) and American Shoulder and Elbow Score (ASES), and revision rates. Conclusions The evidence suggests that RTSA is the new gold standard management for 3- and 4-part fracture dislocations of the proximal humerus in a selected group of patients over 65 years old with irreparable rotator cuff. The available literature is medium quality, requiring more robust evidence including prospective large cohort studies utilising unified objective and subjective functional outcome scores.

Modifiable Physical Factors That Influence Physical Function for People Receiving Peritoneal Dialysis

People receiving peritoneal dialysis experience physical function decline, impairing their ability to complete everyday activities, leading to poorer quality of life. Physical factors, including cardiorespiratory fitness, muscle strength, physical activity, and sedentary behavior are associated with physical function. However, little is known about this relationship, or temporal changes of these factors in this cohort. This study aimed to explore modifiable physical factors that are associated with physical function, identify which factor has the strongest influence, and explore temporal changes. Adults receiving peritoneal dialysis underwent objective and self-reported physical function, cardiorespiratory fitness, muscle strength, physical activity and sedentary behavior assessments 3 times over a 12-month observation period (at baseline, 6 months, and 12 months). Eighty-two participants underwent assessments. All modifiable physical factors were predominantly moderate to strongly associated with physical function at baseline. Cardiorespiratory fitness had the strongest and most consistent influence with every meter conferring a 0.08-unit (P< 0.01) and 0.01-unit (P< 0.05) increase in self-report and objective physical function score, respectively. Temporal changes were observed for modifiable physical factors with significant mean changes in cardiorespiratory fitness (-9.8%), quadricep strength (-5%), moderate-to-vigorous (-25.9%) and total (-16.2%) physical activity, and sedentary behavior (+7.1%). The results of this study indicate that cardiorespiratory fitness could be routinely monitored to detect risk of physical function decline and targeted through intervention to enhance physical function for people receiving peritoneal dialysis. Nevertheless, all factors should be considered when designing interventions to mitigate temporal changes and induce the numerous health benefits offered by being physically active.

Associations of brain-derived neurotrophic factor rs6265 polymorphism and cognitive function in breast cancer survivors from a cross-sectional study.

Breast cancer survivors (BCS) often complain of cancer-related cognitive impairment (CRCI) during and even months after completing primary cancer treatments, particularly chemotherapy. The etiology of CRCI is unknown, but associations of CRCI with germline genetic polymorphisms have been reported, including Brain-Derived Neurotrophic Factor (BDNF) rs6265 polymorphism. The current study investigated the associations of specific BDNF rs6265 with CRCI. Cancer-related cognitive impairment was assessed using subjective reports of cognitive symptoms (the version 1.0, 8-item short-forms of the Patient-Reported Outcomes Measurement Information System®) and computerized objective cognitive function scores (CANTAB®). BDNF rs6265 genotypes were determined from buccal swabs. The associations of specific BDNF rs6265 with CRCI were examined by either one-way analysis of variance or the Kruskal-Wallis test followed by post hoc tests and rank-based regression analysis. We examined 356 female BCS. The mean (SD) age was 55.6 (9.8) years old, the median (IQR) years since cancer diagnosis were 4.0 (6.0), and 331 (92.7%) were self-described as White. BCS carrying the Met/Met genotype showed poorer results on 'visual episodic memory and new learning' and 'spatial working memory and executive function.' This relationship was observed regardless of prior chemotherapy. Our findings suggest that carrying the BDNF rs6265 Met/Met genotype increases the risk for CRCI in BCS. These results are foundational in nature and provide important information to identify mechanisms underpinning CRCI.

Validity of cognitive function assessed by a subjective cognitive decline questionnaire as compared with objective cognitive tests in community‐dwelling older adults in China

AbstractBackgroundSubjective cognitive decline (SCD) has been recognized as an early symptom of age‐related cognitive decline, but research on the validity of SCD questionnaire in the elderly population is limited. Thus, we aimed to evaluate the validity of a 7‐item SCD questionnaire in Chinese older adults.MethodThe study included 1585 participants (53.6% women; mean [SD] age: 78.7 [4.4] years) who completed the SCD questionnaire, Hasegawa Dementia Scale (HDS), and Mini‐Mental State Examination (MMSE) from the Rugao Longevity and Ageing Study (RuLAS) in 2019. MCI was defined according to established education‐specific cut‐off values of HDS and MMSE scores. We used sensitivity, specificity, Youden’s Index, and the receiver operating characteristic (ROC) curves to evaluate the discriminant ability of the SCD questionnaire. Spearman correlation coefficients were also used to measure the strength of correlation between SCD scores and objective cognitive function scores.ResultThe SCD score (range: 0‐7) with the cut‐off value of 4 displayed moderate‐to‐good sensitivity (Sen = 0.52) and specificity (Spec = 0.69), with Youden’s index of 0.21 and the area under the curve (AUC) of 0.62, in distinguishing cognitive impairment defined by objective cognitive tests. In addition, SCD scores have low‐to‐moderate correlations with overall scores of two cognitive tests (rHDS = ‐0.23; rMMSE = ‐0.28). Correlations between domain‐specific SCD and corresponding objective cognitive function scores ranged from ‐0.05 to ‐0.31.ConclusionOur study supported a reasonable discriminant ability of a 7‐item SCD questionnaire among Chinese older adults.

An Analysis of Optimization for Car PBS Scheduling Based on Greedy Strategy State Transition Algorithm

The differences in constraints between an automotive painting workshop and a final assembly workshop can lead to production scheduling disruptions, and using the Painted Body Store (PBS) in automotive manufacturing can optimize production scheduling to meet the production requirements of the final assembly workshop. This is achieved by establishing a multi-objective mixed-integer optimization scheduling model for PBS and solving the model using a state transition algorithm based on the greedy strategy; finally, a comparison was made with the classical genetic algorithm. The results show that the optimal objective function is achieved when the body sequence movement iterations for data sets N and R are 34 and 54, respectively. At this point, the highest objective function scores are 23.46 and 49.79, and vehicles entering the PBS scheduling system from the painting-to-assembly line require 31 and 38 sequence adjustments, respectively. Compared with the classical genetic algorithm, the simulation results show that the state transition algorithm based on the greedy strategy is significantly better; it can also perform well in discrete sequence movement operations, demonstrating strong global search capabilities and fast convergence. It provides a new approach for optimizing vehicle scheduling in the automotive painting-to-assembly line.

Long-Term clinical results of patellofemoral arthroplasty for isolated patellofemoral osteoarthritis.

The aim of this study was to explore the clinical outcomes and long-term survival of patellofemoral arthroplasty in treatment of isolated patellofemoral osteoarthritis. We retrospectively studied a total of 46 type Y-L-Q PFAs that were designed at our institution in 38 patients. Implant survivorship was analyzed with a follow-up of 18.9-29.6years. Knee Society Score (KSS), Oxford Knee Score (OKS), and University of California Los Angeles activity scale (UCLA) were used to assess functional outcomes. The implant survivorship was 83.6% at 15years, 76.8% at 20 years, and 59.4% at 25years 14 PFAs in 12 patients were revised into total knee arthroplasty at 16.0 ± 6.7years; 13 for progression of tibiofemoral osteoarthritis and one for polyethylene wear. The mean Knee Society Score objective scores and functional scores were 73.0 ± 17.5 (range, 49-95) and 56.4 ± 28.9 (range, 5-90), respectively. The mean Oxford Knee Score was 25.8 ± 11.5 (range, 8-44). Type Y-L-Q patellofemoral arthroplasty can be an effective method for treating isolated patellofemoral osteoarthritis with satisfactory survival.

Tourniquet Use Improves Intraoperative Parameters, Leading to Similar Postoperative Outcomes Compared With No Tourniquet Use in Anterior Cruciate Ligament Reconstruction: A Prospective, Double-Blind, Randomized Clinical Trial

To examine the effect of tourniquet use in arthroscopic anterior cruciate ligament reconstruction in terms of: (1) intraoperative visualization with operative time and consumption of sterile saline, and (2) intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum creatine phosphokinase (CPK) and hemoglobin (Hb) concentrations, clinical outcomes, and graft healing. In this prospective randomized clinical trial, patients were assigned to tourniquet inflation (tourniquet-up) or tourniquet deflation (tourniquet-down) groups. Primary outcomes were intraoperative visualization with operative time and sterile saline consumption. Secondary outcomes were intra- and postoperative blood loss, postoperative pain, opioid consumption, swelling, serum CPK, Hb concentration, subjective and objective functional scores, and graft healing. Intraoperative visualization was satisfactory in 100 of 100 cases in the tourniquet-up group and 64 of 100 cases in the tourniquet-down group (P < .05). The mean operative time was 58.4 ± 5.7 minutes in the tourniquet-up group and 72.5 ± 8.6 minutes in the tourniquet-down group (P < .05). The mean sterile saline consumption was 6.4 ± 2.5 L in the tourniquet-up group and 8.7 ± 4.6 L in the tourniquet-down group (P < .05). The respective amounts of estimated intraoperative and postoperative blood loss were 95.3 ± 25.1 mL and 240.3 ± 44.5 mL in the tourniquet-up group and 230.2 ± 22.3 mL and 75.6 ± 15.3 mL in the tourniquet-down group (P < .05). Our results showed no significant difference in postoperative pain, opioid consumption, percentage of patients using opioids, swelling, mean serum CPK and Hb levels, subjective and objective functional scores, or graft healing (P > .05) between the 2 groups. Tourniquet use during anterior cruciate ligament reconstruction significantly improves intraoperative visualization, shortens operative time, and decreases intraoperative sterile saline consumption and blood loss without serious adverse events or greater complication rates based on early postoperative outcomes. Level I, randomized controlled trial.

Single document text summarization addressed with a cat swarm optimization approach.

The availability of a tremendous amount of online information bringing about a broad interest in extracting relevant information in a compact and meaningful way, prompted the need for automatic text summarization. Hence, in the proposed system, the automated text summarization has been considered as an extractive single-document summarization problem, and a Cat Swarm Optimization (CSO) algorithm-based approach is proposed to solve it, whose objective is to generate good summaries in terms of content coverage, informative, anti-redundancy, and readability. In this work, input documents are pre-processed first. Then the cat population is initialized, where each individual (cat) in a binary vector is randomly initialized in the search space, considering the constraint. The objective function is then formulated considering different sentence quality measures. The Best Cat Memory Pool (BCMP) is initialized based on the objective function score. After that, individuals are randomly distributed for position updating to perform seeking/tracing mode operations based on the mixture ratio in each iteration. BCMP is also updated accordingly. Finally, an optimal individual is chosen to generate the summary after the last iteration. DUC-2001 and DUC-2002 data sets and ROUGE measures are used for system evaluation, and the obtained results are compared with the various state-of-the-art methods. We have achieved approximately 25% and 5% improvement on ROUGE-1 and ROUGE-2 scores on the datasets over the best existing method mentioned in this paper, revealing the proposed method’s superiority. The proposed system is also evaluated considering the generational distance, CPU processing time, cohesion, and readability factor, reflecting that the system-generated summaries are readable, concise, relevant, and fast. We have also conducted a two-sample t-test, and one-way ANOVA test showing the proposed approach is statistically significant.

Clinical Results of Revision TKA in Patients With Presumed Metal and Cement Allergy.

Metal and cement allergy affects a small subset of patients, causing severe pain and often systemic reaction after total knee arthroplasty (TKA). Revision with ceramic-surfaced femoral components has been reported to resolve these symptoms of metal allergy, but no solution currently is available for patients with allergies to metal and bone cement. Five patients (5 knees) with documented metal allergy were revised with custom porous-coated ceramic femoral components (Magnesia-stabilized Zirconia) from January 2007 to January 2013. An additional 23 patients (23 knees) met inclusion criteria from 2007 to 2015, but because the ceramic implant was unavailable, they underwent different treatment based on their underlying allergy to metal, cement, or both. Inclusion criteria included the history of clinically documented severe metal allergy, severe pain, swelling, and effusion >1 year after TKA, negative workup for infection, loosening, and ligament imbalance. Knee Society scores were compared for each cohort. Mean Knee Society scores for all 5 patients revised with custom cementless ceramic femoral components improved significantly for objective score (preoperative, 39 ± 5; most recent visit, 90 ± 2) and function score (preoperative, 33 ± 8; most recent visit 93 ± 4) (P < .0001). The 12 knees revised with off-the-shelf cemented ceramic-coated femoral components had similar results. The 7 unrevised knees (including 4 knees with allergy to metal and bone cement) and the 4 knees revised with standard CoCr femoral components did not improve and worsened over time. Symptoms resolved in the 5 patients revised with custom ceramic implants and in the 12 patients revised with ceramic-coated components, but did not improve in the patients unrevised or revised with CoCr femoral components. Symptoms presumed to be associated with metal or cement allergy improve with the use of ceramic femoral surfaces, but patients who are allergic both to metals and bone cement would be candidates only for porous-coated ceramic implants fixed without bone cement.

The social support, mental health, psychiatric symptoms, and functioning of persons with schizophrenia participating in peer co-delivered vocational rehabilitation: a pilot study in Taiwan

BackgroundVocational peer support (VPS) services are recovery-oriented interventions in modern psychiatric care for persons with schizophrenia. However, few VPS services are found in Taiwan. Hence, a pilot program of peer co-delivered vocational rehabilitation to support persons with schizophrenia in Taiwan was proposed and evaluated.MethodsSix peers were trained and were willing to co-lead and assist workplace problem-solving groups and care skills training in an extended vocational rehabilitation program from August 2017 to December 2018. The social support, mental health, psychiatric symptoms, and functioning of service users were assessed before and after peer co-delivered services, and the assessments were based on the following: Social Support Scale (SSS), Chinese Health Questionnaire-12 (CHQ-12), Brief Psychiatric Rating Scale (BPRS), Global Assessment of Function (GAF), and the Chinese version of the Social Functioning Scale (C-SFS).ResultsThe recruited 46 service users were mostly middle-aged (49.1 ± 9.8), with 27 being male (58.7%). After interventions, 42 service users who completed the program had a significantly increased SSS score (149.1 ± 31.8 vs. 161.2 ± 35.0, df = 41, t = 2.70, p = 0.01) and subscale of friend-peer dimension (44.4 ± 12.0 vs. 53.2 ± 13.2, df = 41, t = 4.72, p < 0.001). The objective (GAF: 69.8 ± 9.8 vs. 72.6 ± 8.8, df = 41, t = 3.50, p = 0.001) and subjective social functional scores (C-SFS: 75.2 ± 8.8 vs. 78.1 ± 9.5, df = 41, t = 2.59, p = 0.01) both significantly increased. The weekly wage elevated significantly (37.5 ± 35.5 vs. 43.6 ± 38.0, df = 41, t = 2.57, p = 0.01) and the BPRS-18 score decreased significantly, too (31.2 ± 6.7 vs. 29.3 ± 5.0, df = 41, t = − 2.83, p = 0.007).ConclusionsPeer co-delivered vocational rehabilitation services may enhance the social support received by persons with schizophrenia and improve their occupational outcomes. The pilot program proposed can thus be a model for non-Western countries with limited resources allocated by governments to support persons with schizophrenia. Trial registration: ClinicalTrials NCT04767204, retrospectively registered on Feb 23, 2021.

Revision Arthroscopic Bankart Repair Versus Arthroscopic Latarjet for Failed Primary Arthroscopic Stabilization With Subcritical Bone Loss.

Background:Limited evidence is available regarding the recommended technique of revision surgery for recurrent shoulder instability. Only 1 previous study has compared the results of soft tissue repair and the Latarjet technique in patients with persistent shoulder instability after primary surgical stabilization.Purpose/Hypothesis:To evaluate the results of revision surgery in patients with previous surgical stabilization failure and subcritical glenoid bone defects, comparing repeated Bankart repair versus arthroscopic Latarjet technique. The hypothesis was that Latarjet would be superior to soft tissue procedures in terms of objective and subjective functional scores, recurrence rates, and range of movement.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 45 patients (mean age, 29.1 ± 8.9 years) with subcritical bone loss (<15% of articular surface) who had undergone revision anterior shoulder instability repair after failed Bankart repair. Of these, 17 patients had arthroscopic Bankart repair and 28 had arthroscopic Latarjet surgery. Patients were evaluated at a minimum of 2 years postoperatively with the Rowe score, Western Ontario Shoulder Instability Index, and Subjective Shoulder Value. Subluxation or dislocation episodes were considered failures.Results:No statistically significant differences were found between groups in age, sex, sporting activity, preoperative Rowe score, or the presence of hyperlaxity or bony lesions. At revision arthroscopy, 20 shoulders showed a persistent Bankart lesion, 13 a medially healed labrum, and 6 a bony Bankart. In 6 patients, no abnormalities were present that could explain postoperative recurrence. In the Bankart repair group, 7 patients underwent isolated Bankart procedures; in the remaining 10 cases, a capsular shift was added. No significant differences were found between the Bankart and Latarjet groups in outcome scores, recurrence rate (11.8% vs 17.9%, respectively), or postoperative athletic activity level. The mean loss of passive external rotation at 0° and 90° of abduction was similar between groups.Conclusion:Arthroscopic Latarjet did not lead to superior results compared with repeated Bankart repair in patients with subcritical glenoid bone loss and recurrent anterior shoulder instability after Bankart repair.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53–0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

CrackWeb : A modified U-Net based segmentation architecture for crack detection

Classical image processing methods demands heavy feature engineering, as well as they are not that precise, when it comes to manual extraction of relevant features in real life scenarios amid to various lighting conditions and other factors.Thus, detection of cracks using methods based on classical image processing techniques fails to provide satisfactory results always. Hence, we have proposed a deep convolutional neural network, that is not based on manual extraction of features as mentioned above. We proposed a modified U-Net architecture, and replaced all of its convolutional layers with residual blocks, inspired from the ResNet architecture. For evaluation of our model Dice Loss is used as our objective function and F1 score as a metric. Other than that, for better convergence and optimization, a learning rate scheduler and AMSGRAD optimizer was utilized.

Implant-free iliac crest bone graft procedure shows anatomic remodelling without redislocation in recurrent anterior shoulder instability after short-term follow-up.

With the help of a J-shaped bicortical iliac crest bone graft, the morphology of the glenoid can be augmented without having to use screws to achieve glenohumeral stability. The aim of this retrospective clinical study was to evaluate the clinical stability and function of the shoulder joint as well as the radiological remodelling process and arthropathic outcomes following the J-bone graft technique. 34 patients with recurrent shoulder dislocations and bony glenoid defects were treated with the J-bone graft technique between 2010 and 2018 at our level-I trauma centre. 15 patients (18 shoulders) could be recruited for the study. Pain levels, ASES, UCLA, SST, DASH, Rowe and WOSI Scores were collected using questionnaires. In 13 patients (16 shoulders) the Constant Score, ROM, CT with 3D reconstruction of the glenoid to assess the graft remodelling and X-rays were performed additionally. None of the patients suffered subluxations or recurrent dislocations during the follow-up period. The overall complication rate was 11%. The evaluation using objective and subjective shoulder function scores yielded good-to-excellent results. Radiological assessment at follow-up showed a low rate of moderate-to-severe arthritis (12%) and a high rate of shoulders without any signs of arthritic degeneration (53%). The CT scans all revealed an almost complete restoration of the glenoid with none of the grafts being resorbed. A rise in the average glenoid circumference and glenoid area could be demonstrated between preoperative measurements (81.6 and 82.4%, respectively) and follow-up measurements (104 and 102.5%, respectively). The results of this study show a successful stabilisation of the shoulder joint and a low complication rate following the J-bone graft technique. Remodelling of the bone graft could be demonstrated, which in turn led to an almost perfect glenoid surface area of 100%.