bluuebunny/crossref_metadata_2025 huggingface dataset:
A rare case of Acrodermatitis continua of Hallopeau successfully treated with topical calcipotriol/betamethasone dipropionate ointment associated with Jaccaud’s arthropathy: A case report
Authors: Ngo Jennifer Lavina , Ramirez Quizon Mae , Balagat Rogelio
Published: November 2022

Acrodermatitis continua of Hallopeau (ACH) is a rare and localized form of pustular psoriasis that can lead to irreversible anonychia whereas Jaccoud’s arthropathy (JA) is a rare non-articular condition characterized by a deforming non-erosive arthropathy involving the digits. This case describes the first reported association of these two rare conditions in a 73-year-old Filipino male who was treated topically until remission of ACH. Because calcipotriol/betamethasone ointment works better and faster than clobetasol ointment, it may be considered as a preferred first-line treatment for ACH. This case also highlights the evaluation of joint symptoms in the context of psoriatic arthritis and JA, along with a discussion of its management. A multidisciplinary approach involving dermatology, rheumatology, and physiatry is essential in the care of these two rare conditions.
Erythromelalgia successfully treated with low-dose gabapentin in a pediatric patient
Authors: Phong Celine H , Birmingham Suzanne W , Rojek Nathan W
Published: November 2022

Primary erythromelalgia, while uncommon, may significantly decrease the quality of life of those affected. While many patients with erythromelalgia require systemic therapy, there is no standard of care for this condition. Herein, we report a 7-year-old girl who experienced resolution of erythromelalgia symptoms with no adverse effects after treatment with low-dose gabapentin. We also discuss the safety and efficacy of low-dose gabapentin in children for treatment of pain.
Treatment of segmental continuous hypertrophic myokymia of the limb with botulinum A toxin
Authors: Yousaf Muhammad Ismail Khalid , Ghani Mohammad Ravi , D’Aguiar Rosa Talita , Holiday Victoria , Brown Martin , Hedera Peter
Published: November 2022

Myokymia is defined as fluctuating hyperexcitability of muscle fibers caused by repetitive spontaneous contraction of motor units. Myokymia is generally benign with self-resolution, although symptomatic treatment with benzodiazepines, anticonvulsants, and muscle relaxants can be used. Botulinum toxins can also be utilized, although they are mostly used for symptomatic facial myokymia. Here, we report two patients who developed continuous myokymia, resulting in secondary hypertrophy, stiffness, and discomfort in the affected muscles. The first patient had a history of a tethered spinal cord and developed continuous myokymia in the S1 and S2 radicular regions of the left leg. The second patient underwent radiation therapy for lung cancer and developed brachial plexopathy with abnormal activity in the muscles supplied by the musculocutaneous nerve in the right arm. Both patients experienced sleep disturbance, focal discomfort, and restlessness. The anticonvulsants and muscle relaxants were ineffective. Chemodenervation with botulinum A toxin was initiated using either onabotulinumtoxinA or abobotulinumtoxinA. Both patients experienced a substantial reduction in myokymia, with ongoing reversal of muscle hypertrophy and significant improvement in reported subjective symptoms. Treatment with botulinum toxins can be highly effective in patients with symptomatic segmental continuous hypertrophic myokymia and may be considered first-line therapy.
Community-Based HIV and Viral Hepatitis Fellowship Evaluation: Results from a Qualitative Study
Authors: Bolduc Philip , Day Philip G. , Behl-Chadha Bittie , Karapanos Melissa , Carson-Sasso Vanessa , Simpson E. Hatheway , Hebert Scott
Published: November 2022

Purpose:

The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows’ perceptions of the program and its impact on their current positions and career trajectories.

Methods:

Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data.

Results:

Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program’s commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care.

Conclusion:

As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.
Book review: Christoph Scherrer and Ismail Karatepe (Eds) (2021). The Phantom of Upgrading in Agricultural Supply Chains: A Cross-country, Cross-crop Comparison of Smallholders
Authors: Goyal Meghna
Published: November 2022

Christoph Scherrer and Ismail Karatepe (Eds) (2021). The Phantom of Upgrading in Agricultural Supply Chains: A Cross-country, Cross-crop Comparison of Smallholders. Book Series Labour and Globalisation, 22(22 ). Nomos. 353 pp., US$45 (Paperback). ISBN: 9783985420049.
A Systematic Review of the Effect of Hearing Aids on Static and Dynamic Balance in Adults with Hearing Impairment
Authors: Mahafza Marina Tareq , Wilson Wayne J. , Brauer Sandra , Timmer Barbra H. B. , Hickson Louise
Published: November 2022

This preregistered systematic review examined the peer-reviewed scientific literature to determine the effect of hearing aids (HAs) on static and dynamic balance in adults with Hearing Impairment (HI). A search of the English language literature in seven academic databases identified 909 relevant articles published prior to July 2021. Ten articles contained studies that met the inclusion criteria for this review. Seven studies had measured static balance with five reporting improvements and one reporting no changes in balance with HA use. Two studies had measured dynamic balance with both reporting no changes with HA use. One study had measured both dynamic and static balance and reported no changes with HA use. For adults with HI, the evidence was equivocal that amplification from HAs improves balance. High quality studies investigating the effect of HAs on balance in adults with HI are needed given this field is likely to develop in response to the growing population of adults with hearing and balance impairment worldwide.
Surgical Options for Chronic Lateral Ankle Instability: How Has the Incidence of the Broström-Gould Procedure Evolved in the Past Decade?
Authors: Karzon Anthony L. , Bariteau Jason T. , Coleman Michelle M. , Kadakia Rishin J. , Jacobson Joseph E. , Labib Sameh (Sam) A.
Published: November 2022

Category:

Ankle; Trauma

Introduction/Purpose:

The past 50 years has seen significant development of surgical techniques aimed at treating chronic lateral ankle instability. Surgical procedures currently being performed can be classified as anatomic ligament reconstruction as well as nonanatomic, and more recently, anatomic repair by tenodesis. Anatomic reconstruction is successful at circumventing important shortcomings associated with nonanatomic repair such as impaired ankle kinematics and biomechanics. One variation of the anatomic repairs described in orthopedic literature demonstrating excellent long-term functional outcomes includes the Broström-Gould (BG) modification. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that the incidence of this surgical technique has risen in the past decade.

Methods:

The Truven MarketScan database was queried to identify patients who underwent a BG procedure from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of the BG procedure. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S.

Results:

In total, 160,457 BG procedures were identified in the database from 2009 to 2019. Annual volumes have increased by 89.9%, from 10,441 to 19,829 total procedures nationwide. Procedural incidence reported per 1,000,000 people increased by 76.6%, at 61.1 in 2019. Increased incidence was demonstrated in males and females ≤65 years, with the highest annual incidence found <55 years of age. Incidence stratified by region rose in the South, West, and Midwest regions of the United States by 81.7%, 75.4%, and 69.2%, respectively.

Conclusion:

The epidemiology of operative treatment for chronic lateral ankle instability has yet to be clarified in recent years. Our findings demonstrate that the annual volumes and incidence of the BG procedure has increased in the past 11 years. Growth in incidence was found in both sexes below the age of 65 years whereby the greatest annual incidence was found in ages below 55 years. Incidence significantly rose in all regions of the United States except for the Northeast. The insight provided by epidemiologic studies allows orthopedic surgeons to better adapt their practice to the current trends in the field.
Trending the Incidence of 1st MTP Joint Arthrodesis in the Past Decade
Authors: Karzon Anthony L. , Kadakia Rishin J. , Coleman Michelle M. , Labib Sameh (Sam) A. , Jacobson Joseph E. , Bariteau Jason T.
Published: November 2022

Category:

Bunion

Introduction/Purpose:

Arthrodesis of the first metacarpophalangeal joint (MTPJ) is frequently performed for the most common conditions affecting the great toe, hallux rigidus and hallux valgus. However, there is no detailed depiction of the procedural incidence in recent years. We hypothesize that stratified incidences of patients undergoing this procedure in the last decade has risen.

Methods:

The Truven MarketScan database was queried to identify patients who underwent 1st MTPJ arthrodesis from January 2009 to December 2019 based on CPT coding. Population estimates from the US Census Bureau were used to calculate the annual incidence of 1st MTPJ arthrodesis. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S.

Results:

In total, 184,016 1st MTPJ arthrodesis procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 70.8%, from 12,125 to 20,710 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 58.7%, at 63.8 in 2019. Growth in incidence was demonstrated in males and females of all defined age subgroups. Incidence stratified by region rose in all regions except for the Northeast, where a -0.5% change between 2010 and 2019 was noted, albeit insignificant.

Conclusion:

The epidemiology of 1st MTPJ arthrodesis has yet to be clarified in recent years. We have found that the annual volumes and incidence of 1st MTP arthrodesis has increased in the past decade. Growth in incidence was demonstrated in both sexes of all age cohorts as well as regionally in the United States. Identifying current trends in procedural incidences can help provide orthopedic surgeons with insight into temporal and quantitative changes in the field.
The Double Calcaneal Osteotomy for Pediatric Flatfoot
Authors: Kothari Ezan A. , Young Sean M. , Gilbert Shawn , Conklin Michael J.
Published: November 2022

Category:

Hindfoot

Introduction/Purpose:

The double calcaneal osteotomy combines a medial calcaneal sliding osteotomy and lateral column lengthening. Corrective osteotomies, as opposed to arthrodesis and arthroereises, are preferred for foot deformity correction in children and adolescents because they preserve joint mobility, shock absorption, and avoid concerns about adjacent joint degeneration. Individually, both types of osteotomies have demonstrated efficacy in achieving deformity correction and improved functional outcomes for patients. The literature regarding outcomes of this procedure in children is sparse. This retrospective study objectively analyzes outcomes of children who underwent double calcaneal osteotomies at our institution by comparing pre and postoperative radiographs and reporting postoperative complications. To our knowledge, this study contains the largest sample size of symptomatic flatfeet analyzed with regards to double calcaneal osteotomies in children.

Methods:

Patients who underwent a double calcaneal osteotomy over the past 5 years at our institution were analyzed. Pre and postoperative weightbearing radiographs of the foot were measured (Figure 1). Paired t tests were used to compare pre and postoperative measurements. Statistical significance was set at α < 0.05. Additional factors analyzed for each procedure include total operative time, torniquet time, hardware used for fixation, type of graft, concomitant procedures, and post-operative complications such as infection, nerve injury, nonunion, and reoperation.

Results:

A total of 20 patients and 26 feet were studied. Significant correction from pre to postoperative radiographic measurement was noted for the talo-first metatarsal angle, talonavicular coverage angle, calcaneal pitch, and tibiocalcaneal angle (p < 0.001). Complications were noted in 3 of the 20 patients, or 3 of 26 feet, and included infection, painful hardware, and hardware failure.

Conclusion:

The double calcaneal osteotomy was found to be effective in correcting the radiographic parameters associated with flatfoot deformity in children and adolescents with symptomatic flatfeet. The average postoperative radiographic measurements for the 26 feet analyzed were significantly improved from preoperative measurements. Pediatric orthopedists should strongly consider the double calcaneal osteotomy for appropriate surgical candidates.
Postoperative Isokinetic Evertor Strength is Important Prognostic Factor Following Arthroscopic Modified Brostrom Procedure in Chronic Ankle Instability
Authors: Lee Sung Hyun , Yoo Byung min
Published: November 2022

Category:

Sports; Arthroscopy

Introduction/Purpose:

Isokinetic eccentric muscular weakness has been considered an etiological factor for CAI by previous studies. It is widely accepted that initial management should be nonoperative in patients with CAI. In case of failure, however, surgical treatment may be considered. Even though, there were some studies evaluate the isokinetic muscle strength in sprain or CAI patients, there was few studies that investigate the isokinetic muscular result after arthroscopic modified brostrom (MBP) for CAI. The objective of this study was to evaluate the isokinetic ankle strength at 2 years after MBP and determine the effect of isokinetic ankle strength on clinical outcome.

Methods:

Between 2018 and 2019, we performed a retrospective review of 74 patients who underwent arthroscopic MBP and followed up to 2 years postoperatively with isokinetic strength test. Functional evaluation consisted of the Foot and Ankle Outcome Score (FAOS). Isokinetic peak torque values of dorsiflexion, plantarflexion, eversion and inversion at 2 angular velocities (30°/s and 120°/s) were measured in the injured and normal ankles. Paired t-test were performed to evaluate postoperative improvement of weakness (ratio of impaired side/intact side) of ankle strength, and linear regression test were performed for their correlation to clinical outcome using SPSS 20.0.

Results:

All clinical scores and isokinetic muscle strength were improved postoperatively. All units in FAOS except symptom unit corelated positively to the postoperative inversion strength (p<0.05, all). In addition, sports unit in FAOS was corelated to postoperative plantarflexion strength (p<0.05).

Conclusion:

Functional scores and all isokinetic muscle strength were significantly improved after arthroscopic MBP. However, the weakness of postoperative isokinetic eversion strength was still negative factor for clinical outcome after surgery.
A Case Series Evaluating Complications of Foot and Ankle Surgeries in Patients with Neuromuscular Disease
Authors: Levine Joshua , Mavrommatis Sophia , Vang Sandy , Anderson Sarah A.
Published: November 2022

Category:

Other

Introduction/Purpose:

Patients with neuromuscular diseases such as cerebral palsy often deal with foot and ankle deformity or dysfunction. These same patients are also living longer due to advances in medicine. This creates a significant population of patients that could benefit from corrective surgery. However, some surgeons are hesitant to offer surgery due to concern for complications. There is little in the literature to describe outcomes for foot and ankle surgery in this patient population. This study will provide information regarding complications associated with foot and ankle surgery in patients with neuromuscular disease. The primary study outcome was to describe the overall complication rates associated with foot and ankle surgery in patients with neuromuscular disease.

Methods:

The charts of neuromuscular patients undergoing foot and ankle surgery by the senior author from March 2010 to March 2020 were reviewed. Charts were analyzed for demographic data, medical history and diagnoses, and surgical treatment information. Index procedures were evaluated for any complications. For the purpose of our study, we identify an index procedure as the first surgical episode on a given extremity for a unique foot and ankle pathology. Charts were then analyzed for the presence or absence of a postoperative complication. We defined complication as the post-operative occurrence of wound dehiscence, superficial or deep infection, nonunion or delayed union, or a post-operative medical complication.

Results:

46 patients with 57 extremities, and 66 index surgeries were identified. 20% of the index surgeries (13 of 66) had one or more complications. Patients ranged in age from 12 to 70 year of age with a mean of 33.8 years. Females comprised 61% of the patient cohort. CP was the most common neuromuscular diagnosis at 52% (24 of 46 patients). The number of procedures performed during a patient's index surgery ranged from 1 to 15 (mean: 3.4). Achilles lengthening was the most common procedure, performed in 44% of patients. A summary of complications can be seen in the attached table, along with patient demographic data.

Conclusion:

We identified an overall complication rate of 20%, with 12% wound complication rate and 7% nonunion rate. These rates were similar to previous literature on elective foot and ankle surgery. Our infection rate of 9% is higher than previously reported in the general foot and ankle literature. Of note, 31% of the total complications were in patients with spina bifida even though they made up just 9% of the population. We conclude that foot care of adult patients with neuromuscular disease s should be aware of the unique surgical challenges that this population faces.
Clinical and Radiologic Outcomes of the 3-Component Salto Total Ankle Arthroplasty for End-Stage Ankle Osteoarthritis
Authors: Lim Jung-Won , Jung Hong-Geun , Im Jemin
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

As the popularity of total ankle arthroplasty (TAA) increases and indications expand, surgeons require a better understanding of which factors are associated with the outcome. In this study, we evaluate the early clinical and radiologic outcomes of the Salto mobile bearing 3-component total ankle prosthesis.

Methods:

TAA was performed in 119 consecutive ankles (117 patients) by a single surgeon using 3-component Salto total ankle implant from June 2014 to May 2020. A prospectively collected database was used to identify all patients who underwent primary TAA with a minimum 1-year follow-up. All patients were followed up at two weeks, six weeks, three months, six months, at one year and yearly thereafter. Clinical outcome scoring was done pre-operatively and post-operatively. American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot functional score, pain VAS, satisfaction score and clinical range of motion (ROM) were collected along with weight-bearing radiographs of the ankle. Post-operative coronal, sagittal alignment of the component were evaluated with radiographs.

Results:

The average follow-up was 22.1 months (range, 12-79). Mean VAS pain score decreased from 6.7 (range, 3-10) pre- operatively to 1.7 (range, 0-8) at last follow-up (p < 0.05). AOFAS score increased from 49.3 (range 8-85) to 85.1 (range 31-100) at last follow-up (p < 0.05). Eighty eight percent of the patients was satisfied with the surgical results at the last follow-up. There were 9 cases (7%) with complication. 1 case had low grade infection, 6 cases had wound marginal necrosis, and 2 cases had acute periprosthetic infection that was managed by irrigation and debridement without replacing the implants. Post-operative radiographic angles checked serially and significantly changed from preoperative status (p < 0.05).

Conclusion:

The TAA series using single Salto 3-componenet implant showed favorable radiologic and clinical outcomes. Also, the radiologic parameters showed statistically significant improvement.
Comparison of Clinical and Radiographic Outcomes Between Modified Lapidus and Proximal Reverse Chevron Metatarsal Osteotomy in Hallux Valgus Concomitant with Metatarsus Adductus
Authors: Lim Jung-Won , Im Jemin , Jung Hong-Geun
Published: November 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Operative treatment of hallux valgus (HV) in the setting of metatarsus adductus (MA) is reported to be difficult and poorer radiographic outcomes. Reduced space between the first and second metatarsals makes it difficult to translate the first metatarsal head laterally. This study aimed to compare the clinical and radiographic outcomes between HV with MA patients treated with modified Lapidus procedures and those with reverse proximal chevron metatarsal osteotomy (PCMO).

Methods:

The study included the patients of HV with MA (58 feet). 16 feet (Group 1) had been treated with modified Lapidus procedures by the senior author from December 2012 to November 2019. 42 feet (Group 2) had been treated with PCMO from February 2012 to March 2017. For the clinical assessment, visual analog scale (VAS) pain scores, AOFAS scores, and patients' postoperative satisfaction were evaluated. Radiographic assessment was performed with HV angle (HVA), intermetatarsal angle (IMA), and the first- to fifth-metatarsal width (1-5 MTW).

Results:

The mean follow-up duration was 16.8 (range, 12-54) months in Group 1, and 31.8 (range, 24-62) months in Group 2. The mean pain VAS score and AOFAS score improved from preoperative to the final follow-up in both group, however, Group 1 showed more significant improvement in clinical outcomes (ΔVAS: 6.0+-1.9 (Group 1) vs 5.1+-2.1(Group 2) (p=0.024), ΔAOFAS: 40.8+-11.5 (Group 1) vs 30.0+-11.3 (Group 2) (p=0.031)). As to radiographic assessment, Group 1 also showed more significant improvement in HVA and IMA (ΔHVA: 39.1+-9.1 (Group 1) vs 27.5+-9.8 (Group 2) (p<0.001), ΔIMA: 13.1+-3.0 (Group 1) vs 9.4+-4.5 (Group 2) (p=0.004).

Conclusion:

This study demonstrated that the HV patients with concomitant MA that treated with modified Lapidus procedures showed more significant clinical and radiographic improvement than those with PCMO. For the management of the HV patients accompanying MA in the setting of large preoperative HVA, modified Lapidus procedures would be good surgical option.
Early Results with the Use of Synthetic Cartilage Implant Augmented with 3D Printed Baseplate to Prevent Implant Subsidence for Treatment of Hallux Rigidus
Authors: Madi Naji S. , Fletcher Amanda N. , Chopra Aman , Parekh Selene G.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus (HR) of the first metatarsophalangeal joint (MTPJ) is a common arthritic disease which causes pain and stiffness. Synthetic cartilage implant (SCI) resurfacing has become a popular treatment option since it has similar biomechanical properties as native cartilage, reduces pain, and preserves MTPJ motion. However, recent studies have reported on implant subsidence leading to SCI treatment failure and subsequent revision surgery. A novel solution involves proximally inserting a custom 3D printed baseplate in the metatarsal head to prevent SCI subsidence. The purpose of this study is to evaluate the clinical and radiographic outcomes of patients who underwent SCI resurfacing augmented with a 3D printed beasplate for the treatment of HR by a single surgeon.

Methods:

Electronic health records were queried from August 2017 to August 2021 for patients who were treated with SCI (Cartiva Synthetic Cartilage Implant; Cartiva Inc., Alpharetta, GA) augmented with a custom 3D printed baseplate by a single surgeon. Through a dorsal approach to the MTPJ, the custom 3D printed baseplate is inserted in the metatarsal head and the SCI implant is positioned two millimeters proud from the cortex. An akin osteotomy is then performed and fixed with a staple. For the study, surgical indications included symptomatic HR and revision of previously failed SCI treatment. Patient demographics, body mass index (BMI), medical comorbidities, and followup periods were recorded. Preoperative and postoperative range of motion, visual analog scale (VAS) pain scores, and x-ray imaging were compared. Descriptive and univariate statistics were used to analyze data.

Results:

Twenty-one patients underwent SCI resurfacing augmented with a 3D printed baseplate. The cohort consisted of 18 females, and presented with a mean BMI of 30.4+-5 Kg/m2, mean age of 56.4+-10 years, and mean followup of 9.8+-13 months since the procedure. Patients experienced a significant improvement in VAS pain (P=0.002) scores. The SCI augmented with 3D printed baseplate survivorship was 90.4%, with only two (9.5%) patients requiring revision to first MTPJ arthrodesis for SCI subsidence and sesamoidal arthritis. Two (9.5%) patients additionally underwent reoperation for staple removal and infection. The first MTPJ space was maintained on x-ray imaging for 19 (90.5%) patients, with only two (9.5%) patients demonstrating implant subsidence.

Conclusion:

SCI resurfacing augmented with a custom 3D printed baseplate demonstrated significant improvements in pain and prevented implant subsidence in patients suffering from symptomatic HR. Future prospective studies should be performed to expand upon the clinical outcomes data analyzing this novel technique to prevent SCI subsidence in the treatment for HR.
The Position and Morphology of the Peroneus Longus Tubercle in Hallux Valgus: A Weight-Bearing CT Assessment
Authors: Marusza Christopher James , Stringer Howard , Redfern James , Sangoi Dhrumin , Welck Matthew , Mason Lyndon W. , Malhotra Karan
Published: November 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

The peroneus longus is one of the main dynamic stabilisers of the first ray acting through its primary insertion at the first metatarsal base and has the theoretical possibility to be defunctioned in hallux valgus (HV). In this study, our primary objective was to report and compare the position and morphology of the peroneus longus tubercle (PLT) in feet with and without HV, using weightbearing CT (WBCT).

Methods:

A retrospective analysis of WBCT scans was completed using 40 feet in 23 patients. Feet were divided into two equal groups - the normal, 'non-hallux valgus' (non-HV) group and the 'HV' group (Mean age 60.45 and 60.60 respectively). The morphology and position of the PLT was assessed between groups. The intermetatarsal angle (IMA) and metatarsal pronation angle (MPA) were assessed. We also introduce and have assessed the novel measurements of tubercle-to-floor distance (T-F distance), the bisecting angle of the PLT, tubercle-to-metatarsals angle (T-MT angle) as well as the metatarsal cross-sectional area.

Results:

Between the non-HV group and the HV group, significant differences were found in the T-F distance (mean 26.7mm and 23.35mm respectively, p = .001), illustrating a lower medial column in HV. There was a moderate correlation between IMA and T- F distance (r = -.475, p < .001) confirming depression of the first ray with increasing IMA. The bisecting angle was lower in the HV group as compared to non-HV (mean 61.65 degrees and 66.60 degrees respectively, p=0.017), demonstrating pronation of the PLT in relation to the floor in the HV. We found a significant difference in T-MT angle between the HV and non-HV groups (mean 31.85 degrees and 35.85 degrees respectively, p=0.041) and a strong correlation between the T-MT angle and bisecting angle (r = .817, p< .001) suggesting the pronation occurred in the first metatarsal to a larger degree than the remainder of the forefoot.

Conclusion:

In this study we have demonstrated a difference in the position of the PLT between HV and non-HV individuals, with a pronated PLT noted in individuals with HV.
Incidence of Venous Thromboembolism Following TAA: Does Chemoprophylaxis Work?
Authors: Martinazzi Brandon J. , Nam Hannah , Dopke Kelly , Mansfield Kirsten N. , Koroneos Zachary , Ptasinski Anna , Manto Kristen , Kirchner Gregory , Aynardi Michael C.
Published: November 2022

Category:

Ankle Arthritis; Ankle; Other

Introduction/Purpose:

Venous thromboembolism is a devastating and costly complication following TAA. The true incidence of VTE is unknown and the decision to prescribe chemoprophylaxis in foot and ankle surgery continues to be debated. At our institution, all patients receive a four-week course of chemoprophylaxis following TAA. The purpose of this study was to evaluate the incidence of VTE at our institution in patients receiving routine chemoprophylaxis.

Methods:

Following institutional board approval, a retrospective chart review was conducted for all patients that underwent TAA from 2018-2021 by a single surgeon. Patients were followed from the time of surgery to their six-week follow-up. Demographics and the type of chemoprophylaxis was recorded. For comparison, a large online database was queried using ICD and CTP codes in order to determine the incidence of VTE at 2 week and 6 weeks postoperatively for patients that underwent TAA and did not receive any form of chemoprophylaxis.

Results:

At our institution, from 2018-2021, 56 patients underwent TAA. The mean age of our cohort was 60.9 (Range, 56-83). In our cohort, 31 patients were male, 25 were female, and the mean patient BMI was 33.8 (Range, 21-56.2). Of the 56 patients, 12 received aspirin (81 mg), 25 received aspirin (325 mg), 16 received enoxaparin (40 mg), 2 received apixaban (5 mg), and 1 received rivaroxaban (20 mg). The total incidence of VTE at 6 weeks was 0%. For comparison, using a large online database (from 2011- 2021), 1,463 patients underwent TAA and did not receive postoperative chemoprophylaxis. Of these patients, 13 (0.89%) developed a postoperative VTE at 6-weeks following surgery.

Conclusion:

At our institution, the rate of VTE at 6-weeks postoperatively was 0%. This was lower than a large online database rate (0.89%) in patients that did not receive chemoprophylaxis. Further investigation is needed.
Prophylaxis for the Prevention of PJI after TAA: Is It Economically Justifiable?
Authors: Martinazzi Brandon J. , Kirchner Gregory , Nam Hannah , Dopke Kelly , Mansfield Kirsten N. , Ptasinski Anna , Aynardi Michael C.
Published: November 2022

Category:

Ankle Arthritis; Ankle; Other

Introduction/Purpose:

Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons will use intraoperative vancomycin powder or copiously irrigate the surgical site with Povidone-iodine to prevent this outcome. Additionally, many surgeons will prescribe a short course of postoperative antibiotics. However, the efficacy of such prophylaxis continues to be debated, and little is known about the cost-effectiveness of these agents. Therefore, the purpose of this study was to perform a 'break-even' analysis to determine the number of cases that could be performed while only preventing a single PJI and still breaking even on cost.

Methods:

The literature was searched to determine the rate of PJI and the mean cost of total ankle replacement. The prices of topical vancomycin powder and Povidone-iodine were obtained from our institution's purchasing records. An online drug database was then used to determine the cost of a 14 day twice daily course of Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg). A break-even analysis was then performed to determine the absolute risk reduction (ARR) necessary to make a drug cost-effective. Using the ARR, we calculated the number of patients that would need to be treated with these agents to prevent a single PJI (NNT).

Results:

The price of intraoperative vancomycin powder was found to be $3.06 while povidone-iodine was found to cost $3.64. Sulfamethoxazole/Trimethoprim (800/160 mg), Cephalexin (500 mg), and Amoxicillin/Potassium Clavulanate (875/125 mg) were determined to cost $3.00, $3.64, and $14.51, respectively. At the prices obtained Vancomycin Powder, Povidone-iodine, Sulfamethoxazole/Trimethoprim, and Cephalexin were all cost-effective if the initial rate decreased by ARRs of 0.01%. Likewise, Amoxicillin/Potassium Clavulanate was cost-effective if the initial rate decreased by an ARR of 0.03%. Additional analyses run found that all drugs-maintained cost-effectiveness even if the initial rate of PJI was as low as 0.1%.

Conclusion:

PJI following TAA is devastating and costly. Despite the ongoing debate regarding the efficacy of prophylactic measures to reduce the risk of PJI in TAA, limited is known about their cost-effectiveness. Our study demonstrates that intraoperative vancomycin powder, povidone-iodine lavage, and multiple commonly prescribed antibiotics are all highly cost- effective to prevent PJI following TAA. We feel that a tailored approach to taking measures to reduce PJI with cost-effectiveness in mind is crucial to providing value-based care.
Trends in Workplace-Related Eye Injuries in the United States From 2011 Through 2020
Authors: Patel Akash , Berkowitz Sean , Sridhar Jayanth , Durrani Alia , Patel Shriji
Published: November 2022

Purpose:

To provide insight into the current scope of workplace-related eye injuries (WREIs) by describing the demographic profiles and causes of WREIs from the years 2011 through 2020.

Methods:

The US Bureau of Labor Statistics (BLS) dataset on WREIs injuries was used. Descriptive data generated included the frequency of eye injuries, the setting, and demographic data.

Results:

The BLS reported an estimated 237 590 WREIs in the study timeframe. In that time, the incidence fell from 2.4 to 1.7 per 10 000 workers. These injuries commonly occurred in men (77.1%), White individuals (36.3%), those aged 25 to 34 years (26.9%), and those in the service (23.0%) and production (18.5%) industries. On average, WREIs resulted in a median of 2 missed workdays, with only 5.0% missing more than 1 month of work. Between 2019 and 2020, there was a 15.6% reduction in total WREIs in the US but a 39.3% increase in WREIs among healthcare workers.

Conclusions:

Men, White individuals, and younger workers might be at increased risk for WREIs. Public health interventions targeted toward improving access to and the quality of protective equipment in these groups and in fields involved in the primary or secondary sectors of industry and healthcare might be the most cost-effective measure to reduce the impact of WREIs on the US workforce.
A pragmatic approach to ethical research collaboration with Indigenous communities: A case study with the Penan people of Long Lamai, Malaysia
Authors: Dunaway Michael , Allred Shorna , Somchanhmavong Amy Kuo , Zaman Tariq
Published: November 2022

It is paramount that research relevant to Indigenous communities be conducted in partnership with them through free and prior informed consent. Historically, much research was extractive in nature, performed without Indigenous community consent, and often applied a deficit-framing. Some academic professional societies have developed guidelines for ethically conducting research with Indigenous communities to avoid these unethical practices. However, missing from these ethical research declarations are the specifics on research implementation or how research can be enriched through an ethical research approach. In 2010, the Association of American Geographers’ (AAG, now known as the American Association of Geographers) Indigenous Peoples Specialty Group (IPSG) wrote a Declaration of Key Questions About Research Ethics with Indigenous Communities outlining several questions that researchers should ask themselves when collaborating with Indigenous communities. We selected the AAG’s ethical principles for this study as it was one of the first environmentally oriented professional societies to make such a declaration. It is also among the world’s largest professional societies with over 10,000 members across 100 countries, with nearly upward of 7000 in attendance at its annual conference. The IPSG’s Declaration organizes their key questions around several elements: (1) Formulating the Project, (2) Identities of the Researchers, (3) Partnerships, (4) Benefits, (5) Findings, and (6) Deepening Relationships. This article discusses how each of the elements in the IPSG’s Declaration can be addressed for a wide range of research projects, providing specific examples from the Global Citizenship and Sustainability (GCS) program, a community-based partnership between Cornell University, the Institute of Social Informatics and Technological Innovations at the Universiti Malaysia Sarawak, and Penan village leaders in Long Lamai, Malaysia. This article argues that GCS’ research was enhanced through a non-extractive, community-based, and collaborative research mindset and further describes questions based on the IPSG’s Declaration that researchers can ask themselves throughout their research processes. This article serves as a foundation for researchers collaborating with Indigenous communities to think about their research to give agency to those communities while conducting innovative research. This article has been written in consultation with a community-chosen representative of Long Lamai, Borneo.
Essential thrombocythemia: challenges in clinical practice and future prospects
Authors: Godfrey Anna L. , Green Anna C. , Harrison Claire N.
Published: November 2022

Essential thrombocythemia (ET) was first described in 1934, and subsequently, progress has been made in better understanding the molecular pathogenesis and which patients may have greatest risk of progression or vascular events. However, it has been more than a decade since a new therapy has been approved for ET. We are beginning to understand more comprehensively both the heterogeneity of this disease, which is largely driven by driver mutation status, as well as the effect of disease-related symptoms, such as fatigue, on patients. In this review we provide a practical overview of diagnosis and management of ET with focus on challenging patient scenarios and some consideration of what comprehensive care might entail. Finally, we also discuss newer therapies and how these might be assessed.
Erenumab versus topiramate: post hoc efficacy analysis from the HER-MES study
Authors: Ehrlich Marc , Hentschke Christian , Sieder Christian , Maier-Peuschel Monika , Reuter Uwe
Published: November 2022

Objective

HER-MES was the first head-to-head, phase 4 trial to assess the tolerability and effectiveness of erenumab against standard of care treatment (topiramate). This post hoc analysis compared the efficacy of erenumab with topiramate in patients who completed the trial on study medication.

Methods

Post hoc sensitivity analysis was performed using the full analysis set. Outcomes assessed included the proportion of patients with a ≥50% reduction in monthly migraine days (MMD) from baseline (50% responder rate), over the last 3 months (months 4, 5, and 6) of the double-blind treatment phase (DBTP), the 50% responder rate during the first month of the DBTP, and change from baseline in MMD during the DBTP. Multiple imputation was done for efficacy values of patients who discontinued study treatment.

Results

Patients (N = 777) were randomly assigned (1:1) to either 70 or 140 mg/month erenumab (N = 389) or 50–100 mg/day topiramate (N = 388). Of these, 334 patients (85.9%) receiving erenumab, and 231 patients (59.5%) receiving topiramate completed the DBTP on study medication. Patients on study medication until the end of the DBTP received a mean dose of 119 mg/month for erenumab and 92 mg/day for topiramate. At month 1, a significantly greater proportion of patients receiving erenumab (39.2%) reported ≥50% reduction in MMD from baseline compared with those receiving topiramate (24.0%; p < 0.001). In the last 3 months, a significantly larger proportion of patients receiving erenumab (60.3%) achieved ≥50% reduction in MMD from baseline compared with those receiving topiramate (43.3%; p < 0.001). Patients receiving erenumab demonstrated significantly greater reductions in MMD during the last 3 months from baseline versus those receiving topiramate (− 6.13 vs − 4.90; 95% CI: − 1.87 to − 0.61; p < 0.001).

Conclusions

This post hoc analysis demonstrated significantly superior efficacy of erenumab versus topiramate in achieving a ≥50% reduction in MMD with an early onset of efficacy.

Trial registration

ClinicalTrials.gov NCT03828539.
Regulation of aging by balancing mitochondrial function and antioxidant levels
Authors: Yoshina Sawako , Izuhara Luna , Kamatani Naoyuki , Mitani Shohei
Published: November 2022

Aging is the deterioration of physiological mechanisms that is associated with getting old. There is a link between aging and mitochondrial function. However, there is an unresolved relationship between ATP levels and aging. To address this issue, we administered febuxostat (FBX), an inhibitor of human xanthine oxidase (XO)/xanthine dehydrogenase (XDH), to C. elegans. We used C. elegans as a model to evaluate the effects of FBX and to challenge the enigma of the relationship between ATP and lifespan. In this study, we showed that FBX protects mitochondria and prevents age-related muscle deterioration in C. elegans. In addition, we showed that FBX administration could increase ATP levels without overloading the mitochondria while extending the lifespan. We also showed that the combination of FBX and an antioxidant as a protection against ROS prolongs lifespan more. We have shown that the antioxidant effects and increased ATP levels may lead to antiaging effects.
Analysis of the ethanol stress response mechanism in Wickerhamomyces anomalus based on transcriptomics and metabolomics approaches
Authors: Li Yinfeng , Long Hua , Jiang Guilan , Gong Xun , Yu Zhihai , Huang Mingzheng , Guan Tianbing , Guan Yuanyuan , Liu Xiaozhu
Published: November 2022

Background

Wickerhamomyces anomalus (W. anomalus) is a kind of non-Saccharomyces yeast that has a variety of unique physiological characteristics and metabolic features and is widely used in many fields, such as food preservation, biomass energy, and aquaculture feed protein production. However, the mechanism of W. anomalus response to ethanol stress is still unclear, which greatly limits its application in the production of ethanol beverages and ethanol fuels. Therefore, we checked the effects of ethanol stress on the morphology, the growth, and differentially expressed genes (DEGs) and metabolites (DEMs) of W. anomalus.

Results

High concentrations of ethanol (9% ethanol and 12% ethanol) remarkably inhibited the growth of W. anomalus. Energy metabolism, amino acid metabolism, fatty acids metabolism, and nucleic acid metabolism were significantly influenced when exposing to 9% ethanol and 12% ethanolstress, which maybe universal for W. anomalus to response to different concentrations of ethanol stressl Furthermore, extracellular addition of aspartate, glutamate, and arginine significantly abated ethanol damage and improved the survival rate of W. anomalus.

Conclusions

The results obtained in this study provide insights into the mechanisms involved in W. anomalus response to ethanol stress. Therefore, new strategies can be realized to improve the ethanol tolerance of W. anomalus through metabolic engineering.
Characterization of key aroma compounds and regulation mechanism of aroma formation in local Binzi (Malus pumila × Malus asiatica) fruit
Authors: Wang Qinghua , Gao Fan , Chen Xuexue , Wu Wenjiang , Wang Lei , Shi Jiangli , Huang Yun , Shen Yuanyue , Wu Guoliang , Guo Jiaxuan
Published: November 2022

Background

Volatile components are important secondary metabolites essential to fruit aroma quality, thus, in the past decades many studies have been extensively performed in clarifying fruit aroma formation. However, aroma components and biosynthesis in the fruit of Binzi (Malus pumila × Malus asiatica), an old local species with attractive aroma remain unknown.

Results

We investigated two Binzi cultivars, ‘Xiangbinzi’ (here named high-fragrant Binzi, ‘HFBZ’) and ‘Hulabin’ (here named low-fragrant Binzi, ‘LFBZ’) by monitoring the variation of volatiles and their precursors by Gas Chromatography–Mass Spectrometer (GC–MS), as well as their related genes by RNA-seq during post-harvest ripening. We firstly confirmed that ‘HFBZ’ and ‘LFBZ’ fruit showed respiratory climacteric by detecting respiratory rate and ethylene emission during post-harvest; found that esters were the major aroma components in ‘HFBZ’ fruit, and hexyl 2-methylbutyrate was responsible for the ‘fruity’ note and most potent aroma component, followed by ethyl acetate, ethyl butanoate, (E)-2-hexenal, and 1-hexanol. Regarding aroma synthesis, fatty acid metabolism seemed to be more important than amino acid metabolism for aroma synthesis in ‘HFBZ’ fruit. Based on RNA-seq and quantitative reverse transcription PCR (RT-qPCR), LOX2a, LOX5a, ADH1, and AAT1 genes are pointed to the LOX pathway, which may play a vital role in the aroma formation of ‘HFBZ’ fruit.

Conclusion

Our study firstly investigated the aroma components and related genes of Binzi fruit, and provided an insight into the fragrant nature of Malus species.