bluuebunny/crossref_metadata_2025 huggingface dataset:
Short-Term Complications of Total Ankle Arthroplasty with and without Concomitant Bony and Soft Tissue Procedures: A Propensity Score Matched Analysis
Authors: Peri Mia , Whitaker Sarah , Cole Sarah , Anastasio Albert T. , Satalich James , O'Neill Conor N. , Patel Tejas , Easley Mark E. , Nunley James A. , Schweitzer Karl M.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

This retrospective cohort study compared short-term complication rates following total ankle arthroplasty (TAA), either alone or with concomitant soft tissue or bony procedures. Secondary independent risk factors were also examined as they related to postoperative outcomes in these groups.

Methods:

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried using current procedural terminology (CPT) codes to identify patients that underwent TAA (27702) between 2010 to 2021. Patients were then divided into cohorts consisting of patients who underwent TAA without concomitant procedures and patients who underwent TAA with one or more concomitant bony or soft tissue procedures. Procedures included in the development of cohorts are outlined in Table 1. Propensity score matching was then employed to account for any baseline demographic differences, and statistical analyses were performed to compare short-term complication rates between the matched cohorts.

Results:

A total of 2,225 patients undergoing TAA were identified, with 1,432 (64.4%) receiving TAA alone and 793 (35.6%) receiving TAA with ancillary procedure(s). After matching, 793 patients were included in each cohort. The ancillary cohort had longer operative times (172.8 vs. 144.1mins) and total length of hospital stay (LOS) (1.76 vs. 1.52 days). Rates for extended length of stay were significantly higher in the ancillary cohort compared to the simple cohort (21.2% vs 16.3%). No other complications varied significantly between cohorts, including the incidence of any adverse event (AAE). When controlling for all other variables, ASA classification of 4 was found to be an independent risk factor for development of AAE (odds ratio [OR] = 1.091, p = 0.04).

Conclusion:

Extended length of stay was the only variable found to be significantly different between simple and concomitant TAA cohorts. Additionally, in a subgroup analysis excluding tendon lengthening procedures, we observed greater morbidity probability in the additional procedures group. The only independent risk factor for postoperative complications was ASA class 4 status. Without significant difference in rates of any AAE other than extended LOS, the relative safety of ancillary TAA appears similar to that of simple TAA alone. Such knowledge can help inform surgical decision-making and assuage safety concerns for patients requiring TAA while having multiple foot and ankle pathologies.
Short-Term Efficacy Analysis of Spinal Cord Stimulation in the Treatment of Refractory Diabetic Foot Ulcers: A Retrospective Study of 57 Cases
Authors: Yao Xingchen , Zhao Hui , Liu Junpeng
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

This is the first study on the application of short-term spinal cord electrical stimulation for refactory diabetic foot ulcers. The purpose of this study is to evaluate its therapeutic effectiveness and update the comprehensive diagnosis and treatment process for diabetic foot ulcers based on existing therapeutic methods.

Methods:

Clinical data from 57 patients who underwent spinal cord electrical stimulation at our institution between May 2022 and November 2023 were retrospectively analyzed. The procedure involved the placement of temporary needle-like electrodes in the epidural space at the T10-T12 level using a puncture sheath. The electrical current is administered with a magnitude of 2.5-4.5 mA, a frequency of 50 Hz, and a pulse width of 240-300 μs, with a placement duration of 2 weeks. Patient demographics were recorded, with assessments of pain visual analog scale scores and foot temperatures conducted at pre-operation, postoperative day 3, postoperative 2 weeks, and postoperative 3 months. EuroQol- visual analog scale scores, Pittsburgh Sleep Quality Index, Ankle-Brachial Index, Semmes-Seinstein monofilament test, and ulcer area were recorded at pre-operation and postoperative 2 weeks. Repeated measures analysis of variance was employed to compare data differences at different time points, with P < 0.05 considered statistically significant.

Results:

The patients' pain visual analog scale scores decreased from 7.23 preoperatively to 3.64 at postoperative day 3, 2.89 at 2 weeks, with a slight increase to 5.84 at 3 months postoperatively (P < 0.05). Foot temperature increased from 30.19°C to 30.86°C at postoperative day 3, reaching 31.40°C at 2 weeks, and then decreased to preoperative levels at 3 months postoperatively (P < 0.05). At the 2-week postoperative assessment, there was a statistically significant improvement in EuroQol-Visual Analog Scale scores (77.91 from 66.70), PSQI (8.30 from 14.71), ABI (0.71 from 0.57), Semmes-Seinstein monofilament test (6.38 from 5.32), and ulcer area (11.36 cm² from 13.95 cm²). At 3 months postoperatively, there was no recurrence trend in ulcer area, and no patients required amputation due to disease progression.

Conclusion:

Short-term spinal cord electrical stimulation modulates vascular smooth muscle in the lower limbs, triggering vasodilation and thereby improving blood circulation to the lower extremities. Simultaneously, it mitigates clinical symptoms associated with diabetic foot ulcers by reducing peripheral nerve degeneration and blocking pain conduction. This dual effect significantly promotes the healing of ulcers in patients, greatly improving their quality of life. These findings provide a theoretical basis for the clinical application of long-term electrodes.
Short-term Outcomes of Arthroscopic Treatment of Freiberg’s Disease
Authors: Lee Kwang-Bok , Kim Do-Yeon , Kim Jong-Kil
Published: December 2024

Category:

Arthroscopy; Midfoot/Forefoot

Introduction/Purpose:

Freiberg’s disease is also known as avascular necrosis (AVN) of the metatarsal head. Surgical treatment for Freiberg’s disease has not been completely defined yet. The purpose of this retrospective study was to evaluate short-term outcomes following arthroscopic procedures for treating Freiberg’s disease.

Methods:

From 2015 to 2019, 13 patients (15 feet) diagnosed with Freiberg’s disease were enrolled for arthroscopic surgery. Patients were divided based on the Smillie’s classification system (2 with stage I, 8 with stage II, 3 with stage III, 1 with stage IV, and 1 with stage V). Arthroscopic interventions, including synovectomy, debridement, chondroplasty, microfracture, and loose body removal, were performed for all patients without considering their Smillie's classification stages. Radiological outcomes were evaluated by X-rays (preoperatively and at 3, 6, and 12 months postoperatively) and MRIs (preoperatively and postoperative 12 months). Clinical outcomes were evaluated using the American Orthopedic Foot Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score and the Visual Analogue Scale (VAS) score. The range of motion (ROM) of the MTP joint was measured using a goniometer both preoperatively and postoperatively.

Results:

Radiological study showed no evidence of osteonecrosis progression in post-operative 12 months X-ray images of any cases. Postoperative 12-month MRIs showed reduction of bone-marrow edema, irregularity of subchondral bone, and cartilage defects in all cases. Significant improvements of AOFAS scores and VAS scores occurred at all postoperative time points compared to preoperative scores (P = 0.001). MTP joint ROM also showed improvement at the last follow-up (P = 0.001).

Conclusion:

Arthroscopic surgery for Freiberg’s disease showed excellent clinical outcomes, MTP joint ROM, and short-term outcomes regardless of grades (Smillie’s classification system) in radiological evaluation.
Stepping Up: A Functional Ambulation Study Across Multiple Levels of Non-Traumatic Amputation
Authors: Liu Hudson , Shan Holly , Luo Warren , Llaurado Luke , Young Ademide , Shah Kishan , Day John , Atves Jayson , Cooper Paul S.
Published: December 2024

Category:

Other

Introduction/Purpose:

The level of amputation for patients with non-traumatic foot pathologies is a complex decision that limb salvage surgeons face, with ambulation playing a crucial role in the quality of life and long-term survival of amputees. In recent years, gait sensors have been used to access ambulation. This study investigates functional outcomes of digit, ray, transmetarsal (TMA), and below-knee amputations (BKA) using wearable gait sensors.

Methods:

Between December 2021 and January 2024, adult patients who were able to ambulate unassisted, without experiencing pain, and without an open wound or lower extremity surgery in the preceding three months, were selected for participation. Inclusion was voluntary and offered to all patients who presented to the wound care center for a period of 3 years. Out of 451 patients, 77 patients who had undergone amputations at levels including digit amputation, ray resection, TMA, or BKA, were included in this analysis. Patient characteristics, preoperative factors, and surgical history were collected. Participants completed a standardized assessment protocol using wearable gait sensors. This involved completing a 120-second walk test at a self-selected pace. The data collected from the sensors were analyzed using the Motility Lab software, with statistical significance set at p < 0.05.

Results:

A total of 77 patients were included for analysis, comprising 30 (38.9%) digit, 12 ray (15.6%), 12 TMA (15.6%), and 23 BKA (29.9%). The average age (61.3 1.19 years), body mass index (30.8 0.71 kg/m2), and Charlson Comorbidity Index (4.9 0.2) did not differ between groups. Proportion of smokers (n=30, 34.8%), diabetes mellitus type II (n=54, 62.8%), chronic kidney disease (n=24, 29.1%), end stage renal disease (n=7, 8.1%) was similar across all four groups. There were no differences in gait speed (0.80 0.02 m/s, p=0.414), elevation mid-swing (1.62 0.14 cm, p=0.063), step duration (0.63 0.01s, p=0.066), cadence (96.2 1.2 steps/min, p=0.434), single limb support (34.4 0.3%, p=0.185), double limb support (29.2 0.6%, p=0.089), and stride length (0.97 0.02 m, p=0.225) across level of amputations.

Conclusion:

Our study shows comparable ambulatory function across all levels of amputation. This may highlight the importance of selecting the right amputation per patient, multidisciplinary limb salvage, and improvements in wearable aids. We encourage other large limb salvage centers to utilize wearable sensors to assess functionality of non-traumatic amputations.
Subchondral Bone Cysts Remodel after Correction of Varus Deformity in Ankle Arthritis
Authors: Zhang Ming-Zhu
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Subchondral bone cysts (SBCs) of the talus are frequently observed in ankle osteoarthritis (OA). It is unclear whether the cysts need an additional operation after correction of the varus deformity in ankle OA. The purpose of this study is to investigate the incidence of SBCs and the change after supramalleolar osteotomy (SMOT).

Methods:

Thirty-one patients treated by SMOT were retrospectively reviewed, 11 ankles with pre-operative cysts. After SMOT, the evolution of cysts was evaluated on weightbearing computerized tomography (WBCT) without management of cysts. The preoperative and postoperative tibial articular surface angle (TAS), tibio-talar surface angle (TTS), Foot and Ankle Offset (FAO), and hindfoot alignment calcaneal moment arm (HA) were compared.

Results:

At baseline, 11 (35.5%) of these 31 ankles had the SBCs, and the average maximum cyst volume was 65.86±60.53 mm3. By comparison with the pre and postoperative parameters, the TAS, TTS, FAO and HA were significantly corrected (P＜0.001). The number and volume of cysts were reduced dramatically (P＜0.05).

Conclusion:

Supramalleolar osteotomy can effectively correct the varus alignment and remodel the SBCs of talus in varus ankle arthritis. The regression of SBCs was observed after SMOT, additional intervention for the SBCs of the talus may not be necessary.
Survey of Utilization of WBCT within AOFAS Membership
Authors: Reddy Sudheer C. , Cesar Netto Cesar de
Published: December 2024

Category:

Other; Hindfoot

Introduction/Purpose:

WBCT (Weightbearing CT) has been increasingly employed to evaluate and treat patients with varied pathologies such as progressive collapsing foot deformity (PCFD), post-traumatic deformity, hallux valgus, ankle arthritis, Charcot arthropathy, lisfranc and syndesmosis injuries. However, little is known regarding its overall availability to foot and ankle providers and how it is being used in clinical practice. The goal of this study is to assess the utilization of WBCT among AOFAS members, identify the indications for use in clinical practice and potential barriers for implementation.

Methods:

A survey was emailed to AOFAS members inquiring about the use WBCT in clinical practice. Practice and demographic information were also collected. A total of 220 responses were collected over a 2-month period. Respondents were queried with respect to the availability of WBCT in practice, indications for use, frequency of use, ownership of the scanner and barriers to implementation.

Results:

58% of respondents did not have access to WBCT. Most respondents were in practice 10 yrs or more (69%). Single-specialty private practice was the most common practice type. Of those with access to WBCT, 5 or fewer scans were ordered per week (57% of respondents). Evaluation of hindfoot/ankle deformity was the most common indication (69% of respondents) with it being used as a preoperative evaluation tool approximately 25% of the time (57% of respondents). Radiology dept owned WBCT in most institutions (34%). 75% of respondents with WBCT use it postoperatively less than 25% of the time. Of those without WBCT, 94% stated they would like to have it with cost being the most significant barrier to implementation.

Conclusion:

Most respondents surveyed did not have access to WBCT, with cost being the greatest barrier. However, 94% of those without it would like to have it. For those with access, it is used 5 or fewer times per week with evaluation of hindfoot/ankle deformity being the most common indication.
The Effect of Operative Time on Short Term Total Ankle Arthroplasty Outcomes
Authors: Rodriguez Materon Solangel , Patel Dev , Trynz Samantha , Morningstar Joshua L. , Gross Christopher E. , Scott Daniel J.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The incidence of total ankle arthroplasty (TAA) continues to increase as outcomes and surgeon comfort with the procedure improve. There is a paucity of literature investigating the association between operative time (case duration) and postoperative outcomes following TAA. Thus, this study seeks to evaluate the relationship between total operative time and postoperative outcomes following TAA. We hypothesize that increased operative time is statistically significantly associated with an increased risk of 30-day postoperative complications in patients undergoing total ankle arthroplasty.

Methods:

The American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database was queried from 2007-2020 to identify 2,133 patients undergoing TAA. Demographics, medical comorbidities, concomitant procedures, hospital length of stay (LOS), and 30-day complication, readmission, and reoperation rates were compared between groups. Patients were excluded based on an operative time greater than 290 minutes (based on Inter-Quartile Range [IQR] proximity rule) to limit the influence of extreme outliers. The cohort was predominantly male (53.8%) and mean patient age was 64.10 (range 19-87) years with a mean BMI of 31.00 (range 17.14-57.78) m/kg2. The mean operative time of the cohort was 149.56 (standard deviation [SD]=49.60) minutes.

Results:

Demographic characteristics associated with increased operative time were younger age (p <.001), functionally dependent status (p=.041), general anesthesia instead of spinal (p <.001), not having diabetes (p <.001), and not having COPD (p=.005). Multivariate analysis, accounting for these variables, revealed that a 15-minute increase in operative time led to an increase in risk of any complication by 10% (p=.019), wound dehiscence by 30% (p=.005), urinary tract infection by 38% (p=0.009), readmission by 16% (p=0.003), reoperation by 16% (p=0.048), and extended length of stay by 6% (p=0.023). Increased operative (>1 SD above the mean), independently predicted readmission (OR=2.817; 95%CI=1.334-5.951; p=0.007), urinary tract infection (OR=6.410; 95%CI=1.384-29.6866; p=0.018), wound dehiscence (OR=5.127; 95%CI=1.282-20.508; p=0.021), and bleeding requiring transfusion (OR=18.364; 95%CI=1.846-182.682; p=0.013).

Conclusion:

The study found longer operative time during TAA is associated with a statistically significant increase in complications, including wound dehiscence, urinary tract infection, readmission, reoperation, and increased length of stay. Therefore, surgeons should prioritize measures to reduce operative time when appropriate while optimizing implant placement, deformity correction, and implant stability in TAA.
The Rate of Subsequent Hallux Interphalangeal Joint Fusion after First Metatarsophalangeal Fusion: A Large-Scale National Database Study
Authors: Alkaramany Eslam , Materon Solangel Rodriguez , Mansur Nacime Salomao Barbachan , Dai Amos , Guyton Gregory P.
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The development of adjacent joint arthritis following arthrodesis is a universal concern in orthopaedic surgery. Arthrodesis of the hallux metatarsophalangeal (MTP) joint is an effective and commonly performed treatment for first MTP arthritis and other conditions. Despite its widespread use, the risk of symptomatic degeneration at the interphalangeal joint remains undetermined and is a common question from patients considering the procedure. This study investigated the rate of subsequent hallux interphalangeal joint (IPJ) fusion following arthrodesis of the first MTP joint using a large commercial database.

Methods:

Patients who underwent hallux interphalangeal arthrodesis after hallux metatarsophalangeal arthrodesis were identified from a large national commercial insurance database using CPT code identification (PearlDiver). The Kaplan-Meier curve for survivorship free of subsequent interphalangeal fusion was generated covering 10 years from the index operation.

Results:

Of 87,890 patients who had first metatarsophalangeal arthrodesis, 808 patients (0.91%) subsequently underwent subsequent hallux interphalangeal joint arthrodesis within 10 years. Because CPT codes were reported without laterality, it is possible that a small subset of patients may have undergone a subsequent contralateral IP fusion, and therefore this result should be regarded as an upper limit of the possible rate.

Conclusion:

This is the first large-scale data to address the common patient concern of subsequent degeneration of the interphalangeal joint following metatarsophalangeal fusion. The rate of subsequent fusion is less than 1%, a result that highlights the durability of the clinical result of the first MTP fusion and should reassure patients and surgeons considering the procedure relative to motion-sparing alternatives.
Tibiotalar and Tibiotalocalcaneal Arthrodesis Complication Rates by Surgical Construct
Authors: Shen Peter C. , Balu Abhinav R. , Dalloul John M. , Bergman Rachel , Chang Shaun , Kelikian Armen , Patel Milap , Kadakia Anish R. , Mutawakkil Muhammad Y.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Ankle arthrodesis (AA) is the gold standard for effectively treating end stage ankle arthritis. Anterior anatomic plate fixation has been shown to provide rigid reliable fixation across the fusion site. Tibiotalocalcaneal arthodesis (TTCA) with a retrograde intramedullary nail is an excellent alternative that can be used to address concomitant subtalar arthritis, correct severe hindfoot deformity, and avoid extensive soft tissue dissection. This study evaluates rates of complications and their effect on fusion across the ankle joint in AA with concomitant subtalar arthrodesis in TTCA.

Methods:

This was an IRB-approved retrospective cohort study of patients between 2013-2023 at a single institution who underwent tibiotalar arthrodesis. Patients with longitudinal follow-up were included. Outcomes analyzed in this study included bony union and complications such as revision surgery due to nonunion, irrigation and debridement for infection, removal of symptomatic hardware, and development of postoperative deep venous thrombosis (DVT). T-tests were conducted to determine p-values for the outcome measures and analysis was performed in Microsoft Excel and Python 3.11.7.

Results:

This study included 102 patients who were followed for an average of 1.4 years postoperatively. TTCA was performed using an intramedullary nail in 49 patients; AA was performed with anterior anatomic plate in 53 patients. For patients who underwent TTCA with intramedullary nail, 6% underwent revision surgery for nonunion, 8% underwent I&D for infection, 12% underwent symptomatic hardware removal, and 2% were diagnosed with postoperative DVT. Eleven percent of patients who underwent AA with anterior anatomic plate underwent revision for nonunion, 8% underwent I&D for infection, 9% underwent symptomatic hardware removal, and 0 patients were diagnosed with DVT. There were no significant differences in complication rates between these two groups.

Conclusion:

With the right indication, tibiotalar arthrodesis complication and union rate is comparable in isolated AA and TTCA. Concomitant subtalar joint fusion did not influence ankle joint fusion rate. There were no significant differences in rates of revision surgery due to nonunion, I&D for infection, removal of symptomatic hardware, or postoperative DVT.
Time Critical Charcot Foot Reconstructions Can Still be Performed in the Absence of Preoperative Glycemic Control When Delivered by MDT
Authors: Ahmed Shuaib , Bakir Adnan , Hester Thomas , Manu Chris , Vainieri Erika , Kavarthapu Venu
Published: December 2024

Category:

Diabetes; Midfoot/Forefoot

Introduction/Purpose:

The management of glycemic levels in the perioperative setting is considered vital for reducing post-operative complications among patients with diabetes undergoing elective foot and ankle surgery. The current guidelines recommend a target HbA1c of 8.5. Patients waiting for Charcot foot deformity corrections with complicated diabetes often have extremely impaired mobility levels and fail to achieve adequate pre-operative glycemic control and risk getting their surgeries cancelled or postponed as a result. In our diabetic foot unit, the multidisciplinary team (MDT) recommends proceeding with surgery even if the target HbA1c levels are not achieved for those patients waiting for time-critical Charcot foot reconstructions despite their best efforts. To review the patient outcomes among patients with diabetes and variable pre-operative glycemic control undergoing Charcot foot reconstructions.

Methods:

We have reviewed the clinical outcomes of consecutive patients that had undergone elective Charcot foot reconstructions under the senior author with a minimum follow-up of 12 months. We have also reviewed the glycemic control achieved at 12 months post-reconstruction.

Results:

A total of 18 patients were operated between October 2020-August 2022. This included 8 midfoot, 2 hindfoot and 8 combined hindfoot-midfoot reconstructions. There were 11 males, with mean age 56.7 years (34-77). 10 had type 1 diabetes and 8, type 2. The mean preoperative HbA1c was 7.9 (5.4-11.8). The mean duration of waiting for surgery since the decision was 11 months. In 7 patients, the recommended target of 8.5 was not achieved (non-target group) within 6 weeks of their surgery. After one year 61% (n= 11) of the patients were able to mobilise independently in shoes. There was no difference in the outcomes between the patient groups with or without the targeted glycemic control. Postoperative HbA1c levels were available for 11 patients at 12 months.

Conclusion:

Although pre-operative glycemic optimization should be aimed for, the time critical Charcot foot reconstructions can still be performed in the absence of targeted glycemic control if delivered by MDT.
Topic Modeling of Foot & Ankle International: An AI-Driven Analysis of Journal Topics & Trends
Authors: Baird Henry , Gallegos Mauricio , Morningstar Joshua L. , McDonald Weston E. , Scott Daniel J. , Gross Christopher E.
Published: December 2024

Category:

Other

Introduction/Purpose:

Natural Language Processing (NLP) can aid in navigating and synthesizing vast amounts of text data. Topic modeling, a subset of NLP, can identify topics and trends that might otherwise remain obscured in large text datasets. These techniques can be used to assess the dynamic and rapidly growing landscape of the orthopedic literature quickly and objectively. The field of foot and ankle orthopaedic research is rapidly changing with the evolution and implementation of new techniques and implants. This study employed an advanced topic model (Bidirectional Encoder Representations from Transformers Topic (BERTopic) Model), to analyze the trends and key topics in Foot & Ankle International literature from 1980 to 2023.

Methods:

Text from the titles and abstracts of 4945 original articles & reviews published from 1980 to 2023 were included and used to train the BERTopic AI model. AI-generated topics were then analyzed by frequency (i.e. number of studies classified to that topic) & popularity (i.e. “hot” & “cold” topic trends, based on linear regression models of topic frequency from 2018-2023). The BERTopic model yielded 41 distinct topics.

Results:

The top 10 most common topics from 1980-2023 (Figure 1A) were Hallux Valgus: Treatment, Ankle Replacement, Diabetic Foot Disease, Achilles Injury and Treatment, Plantar Fasciitis, Pes Planus: Treatment, Calcaneal Fractures, Osteochondral Lesions of the Talus, Plantar Foot Pressure, and Peroneal Tendon Tears. The most popular or “hot” topics from 2018-2023 (Figure 1B) were Pes Planus: Radiographical Assessment of Foot Alignment, Hallux Valgus: Biomechanics, Ankle Arthrodesis, Ankle Instability: Deltoid Ligament, Ankle Replacement, Achilles Injury and Treatment, Tarsal Tunnel, Bone Grafting, Supramalleolar Osteotomy, and Peroneal Tendon Tears; while the least popular or “cold” topics were Ankle Replacement: Surveys, Hallux Valgus: Treatment, Calcaneal Fractures, Osteochondral Lesions of the Talus, Hallux Rigidus: Treatment, Chronic Ankle Instability, Foot and Ankle-specific Patient Reported Outcome Measures, Syndesmotic Instability, and Lisfranc Injuries.

Conclusion:

This study demonstrates the power of AI in efficiently distilling and analyzing evolving research topics and trends, as well as the dynamic nature of foot and ankle orthopaedic research. The hottest topics over the past 5 years were Pes Planus: Radiographical Assessment of Foot Alignment, Hallux Valgus: Biomechanics, Ankle Arthrodesis, and Ankle Instability. However, recent years have seen increases in publications regarding total ankle replacement. These techniques may be used to complement traditional literature reviews and meta-analyses.
Weightbearing Computed Tomography Can Accurately Detect Subtle Lisfranc Instability
Authors: Bhimani Rohan , Daniel Thompson John , Suh Nina , Kadakia Rishin J. , Bariteau Jason T. , M.M.J. Kerkhoffs Gino M , Coleman Michelle M.
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Early detection of Lisfranc instability is critical for improving clinical outcomes, but more subtle instability can be difficult to diagnose. Weightbearing computed tomography (WBCT) provides a unique opportunity to evaluate such injuries in three dimensions (3D) while under physiologic load. This study aimed to assess the utility of one-dimensional, two-dimensional, and three-dimensional measurements on weight-bearing computed tomography (WBCT) to diagnose subtle instability in isolated ligamentous Lisfranc injuries.

Methods:

Ten cadaveric specimens underwent WBCT evaluation of the Lisfranc joint complex in the intact state and subsequently with sequential sectioning of the dorsal Lisfranc ligament (DLL) and interosseous Lisfranc ligament (IOL) to create subtle Lisfranc instability, and finally after transectioning of plantar Lisfranc ligament (PLL) to create complete Lisfranc instability. Measurements performed on WBCT images included: (1) Lisfranc joint (medial cuneiform-base of second metatarsal) volume, (2) Lisfranc joint area, (3) C1-C2 intercuneiform area, (4) C1-M2 distance, (5) C1-C2 distance, (6) M1-M2 distance, (7) first tarsometatarsal (TMT1) alignment, (8) second tarsometatarsal (TMT2) alignment, (9) TMT1 dorsal step off distance, and (10) TMT2 dorsal step-off distance.

Results:

In subtle Lisfranc injury state, Lisfranc joint volume and area, C1-M2 distance and M1-M2 distance measurements on WBCT significantly increased, when compared with the intact state (P values 0.001 to 0.014). Additionally, Lisfranc joint volume and area, C1-M2 distance, M1-M2 distance, TMT2 alignment and TMT2 dorsal step off measurements were increased in complete Lisfranc injury state. Of all measurements, C1-M2 had the largest area under the curve (AUC) of 0.96 (sensitivity = 90%; specificity = 90%), followed by Lisfranc volume (AUC = 0.90; sensitivity = 80%; specificity = 80%) and Lisfranc area (AUC = 0.89; sensitivity = 80%; specificity = 100%).

Conclusion:

WBCT scan can accurately diagnose subtle Lisfranc instability. Among the measurements, C1-M2 distance exhibited the highest level of accuracy. The 2D Joint Area and 3D Joint Volume also proved to be accurate, with 3D volume measurements of the Lisfranc joint displaying the most significant absolute difference between the intact state and increasing severity of Lisfranc instability. These findings suggest that 2D Joint Area and 3D Joint Volume have potential as supplementary measurements to more accurately diagnose subtle Lisfranc injuries.
Weightbearing Protocols and Outcomes in Open Surgical Management of Haglund Syndrome: A Retrospective Analysis
Authors: Hinton Zoe , Kutzer Katherine , Morrissette Kali , Wu Kevin , Krez Alexandra , Anastasio Albert T. , Amendola Annunziato
Published: December 2024

Category:

Ankle; Hindfoot

Introduction/Purpose:

Surgical options to address Haglund deformity include endoscopic and open approaches. After surgery, patients receive varying degrees of weightbearing limitation (nonweightbearing, touchdown weight bearing, or partial weight bearing). Given the scarcity of large-scale literature on the topic, this study aims to evaluate the impact of postoperative weightbearing protocols on outcomes after open surgical management of Haglund Syndrome.

Methods:

Following institutional approval, a retrospective review of patients undergoing surgery at a single institution by *** providers for Haglund Syndrome was performed. Patients were included if the surgery was performed by a currently active, fellowship-trained Foot and Ankle orthopaedic surgeon, without simultaneous management of other foot pathologies. This cohort of patients was reviewed for the following variables: date of birth, body mass index (BMI), smoking status (never, quit, active), American Society of Anesthesiologists Physical Status Classification (ASA), date of surgery, laterality, type of repair (corkscrew, speed bridge, suture anchor), current procedural terminology codes (CPT), postoperative weightbearing recommendations, postoperative outcomes (Achilles rupture, wound breakdown, persistent pain, debilitating plantarflexion weakness, revision), and date of most recent follow up. Statistical analysis was conducted using R with statistical significance set at p < 0.05.

Results:

Across 390 patients, the cohort averaged 55.14 years old and was 66.4% female. Postoperative recommendations varied from NWB (68.7%), TDWB (14.4%), WBAT (13.8%), and PWB (2.3%). Overall, 75 (19.2%) patients experienced a complication, including 40 (10.3%) persistent pain, 32 (8.2%) wound breakdowns, and 1 (10.3%) rupture, with 7 (1.8%) requiring revision. There were no significant differences in characteristics including age, diabetes, gender, BMI, and smoking status between weightbearing protocol groups. There were no statistically significant differences in complication rate between weightbearing protocols (p= 0.48354). The WBAT group experienced the highest rate of pain (14.8%) and a higher rate of the need for revision surgery in the WBAT group (3.7%), though not significant. The highest rate of wound breakdown occurred in the NWB group (9.7%).

Conclusion:

The study suggests that postoperative weightbearing protocols do not significantly influence the outcomes of open surgical treatment for Haglund Syndrome. This indicates that surgeons may choose the most appropriate weightbearing protocol based on individual patient needs and preferences. Future research should aim to further validate these findings and explore the impact of postoperative immobilization on outcomes in more granular detail.
Machine Learning Quantification of Fluid Volume in Eyes With Retinal Vein Occlusion Treated With Aflibercept: The REVOLT Study
Authors: Khan Mohammad A. , Sodhi Simrat K. , Orr Samantha , Golding John , Pereira Austin , Patel Ashley , Oakley Jonathan D. , Russakoff Daniel B. , Dhawan Anuradha , Pattathil Niveditha , Choudhry Netan
Published: December 2024

Purpose: To evaluate the combined relationship between ischemia, retinal fluid, and layer thickness measurements with visual acuity (VA) outcomes in patients with retinal vein occlusion (RVO). Methods: Swept-source optical coherence tomography (OCT) data were used to assess retinal layer thickness and quantify intraretinal fluid (IRF) and subretinal fluid (SRF) using a deep learning–based, macular fluid segmentation algorithm for treatment-naïve eyes diagnosed with visual impairment resulting from central RVO (CRVO) or branch RVO (BRVO). Patients received 3 loading doses of 2 mg intravitreal aflibercept injections and were then put on a treat-and-extend regimen. Image analysis was performed at baseline and postoperatively at 3 months and 6 months. The baseline OCT morphologic features and fluid measurements were correlated with the changes in best-corrected VA (BCVA) using the Pearson correlation coefficient ( r). Results: The study comprised 49 eyes. A combined model incorporating thickness in the outer plexiform layer (OPL), retinal nerve fiber layer (RNFL), and presence of IRF had the strongest overall correlation for CRVO ( r = 0.865; P < .05). For BRVO, the addition of IRF to the OPL–inner nasal model had a strong correlation ( r = 0.803; P < .05). The baseline ischemic index in the deep capillary complex showed a notable correlation with the 6-month change in BCVA for CRVO ( r = 0.9101; P < .001) and BRVO ( r = 0.9200; P < .001). Conclusions: A combined model of IRF volume, OPL, and RNFL layer thicknesses, along with ischemic indices, provides the best correlation to BCVA changes. Combined fluid and layer segmentation of OCT images provides clinically useful biomarkers for RVO patients. These results give insight into the pathology of RVOs and describe the relationship between deep capillary complex ischemia and OPL/RNFL thickness in BCVA outcomes.
Exploring the Intersections of Gender Dynamics, Sexual Behaviour, and the Hazard of Reporting Sexually Transmitted Infections among Women in Pakistan: An Intersectional Feminist Perspective Utilizing PDHS (2017–18) Data
Authors: Sheikh Qurra-tul-ain Ali
Published: December 2024

This study examined the factors influencing women's susceptibility to sexually transmitted infections (STIs) in Pakistan from an intersectional feminist perspective. The research analyzed sexual behavior, spouse-related dynamics, patriarchal structure, and socioeconomic and demographic factors to understand the complex realities faced by women in this societal context using the 2017–2018 Pakistan Demographic and Health Survey. In applying intersectional feminist perspectives, statistical analyses, including chi-squared tests and multivariate logistic regressions, were employed to explore the factors influencing reported STI levels. The findings revealed that 35.8 percent of women reported experiencing STIs within the past year. Contrary to expectations, women who exhibited sexual empowerment were prone to report STIs, highlighting the impact of power dynamics and gender norms on women's sexual health. In addition, there was a negative correlation between women's participation in decision making regarding contraceptive use and the reporting of STIs, suggesting that women's autonomy in reproductive choices does not necessarily lead to improved sexual health outcomes. To effectively combat this issue, this article presents an integrated approach that challenges negative masculine attitudes, promotes healthy sexual behaviors, and emphasizes communication and shared responsibility for sexual health within marital relationships. Interventions should prioritize fostering marital fidelity, enhancing communication between partners, and empowering women to make conversant decisions about contraception.
SPDEF ameliorates UUO-induced renal fibrosis by transcriptional activation of NR4A1
Authors: Wang Hongshuang , Wei Ziheng , Xu Chang , Fang Fang , Wang Zheng , Zhong Yan , Wang Xiangting
Published: December 2024

Nuclear receptor 4A1 (NR4A1) is a gene that increases the likelihood of chronic kidney disease (CKD) and contributes to its development. Previous research has shown that the SAM pointed domain containing Ets transformation-specific transcription factor (SPDEF) can activate NR4A1, but its mechanism of action in renal fibrosis is not yet clear. In this study, we used adenovirus to create a mouse kidney model with a specific knockdown of NR4A1 gene. Our results showed that the knockdown of NR4A1 can accelerate unilateral ureteral obstruction (UUO)-induced renal fibrosis in mice, and overexpression of NR4A1 can significantly reduce transforming growth factor-β1-induced (TGF-β1) fibrosis in HK-2 cells. Additionally, we found that overexpression of SPDEF can improve UUO-induced renal fibrosis in mice and TGF-β1-induced fibrosis in HK-2 by transcriptionally activating NR4A1. These findings suggest that SPDEF can activate NR4A1 transcriptionally and improve renal fibrosis.
Thioredoxin-interacting protein (TXNIP) inhibition promotes retinal ganglion cell survival and facilitates M1-like microglial transformation via the PI3K/Akt pathway in glaucoma
Authors: Chen Junjue , Zhong Huimin , Shen Bingqiao , Yu Huan , Zhang Yang , Han Ruiqi , Huang Ping , Huang Shouyue , Zhong Yisheng
Published: December 2024

Background

Glaucoma is a group of heterogeneous neurodegenerative diseases with abnormal energy metabolism and imbalanced neuroinflammation in the retina. Thioredoxin-interacting protein (TXNIP) is involved in glucose and lipid metabolism, and associated with oxidative stress and inflammation, however, not known whether to be involved in glaucoma neuropathy and its underlying mechanisms.

Methods

To establish the chronic ocular hypertension (COH) mice model. Western blot, RT-PCR, immunofluorescence and F-VEP were used to detect neuroinflammation level, glial activation and RGCs survival in retina of wild type, TXNIP knockout and MCC950 treatment COH mice. Microglia high-pressure cultured model was constructed. Western blot, RT-PCR and immunofluorescence were used to investigate the proinflammatory cytokines secretion, glucose uptake and phenotype transformation in wild type, TXNIP knockout and overexpressed microglia combined with IL-17A treatment. Finally, we explored the possible underlying mechanisms using relevant pathway inhibitor interventions.

Results

In this study, for the first time we reported that TXNIP expression was remarkably increased in experimental glaucomatous retina of chronic ocular hypertension (COH) mice, and it was mainly expressed in the ganglion cells layer (GCL). In addition, we found that ablation of TXNIP promoted retinal ganglion cells (RGCs) survival and alleviated visual function impairment in experimental glaucoma. Then, we explored the spatiotemporal consistency between glial activation and retinal inflammation levels in COH mice respectively with TXNIP-deficiency and under treatment of a thermo-containing protein domain 3 (NLRP3) inhibitor MCC950, and the results indicated that TXNIP probably mediated neuroinflammation in glaucomatous retina by activating microglia. Furthermore, upregulation of TXNIP was found in pressure-stimulated microglia, whereas silencing TXNIP facilitated microglial polarization trending towards M1 type and reduced glucose transporter-1 (Glut-1) expression on microglia under high pressure in vitro. Moreover, IL-17A was found to play a role in acting synergistically with TXNIP upon the regulation of microglia polarity transformation. Finally, knockout of TXNIP was revealed to promote PI3K phosphorylation, whereas inhibition of PI3K by LY294002 effectively suppressed Glut-1 expression, glucose uptake, and M1-like transformation tendency in microglia obtained from TXNIP-deficiency mice under high pressure stimulation.

Conclusions

TXNIP is significantly involved in the inflammation-related neuropathy of experimental glaucoma and probably facilitates M1-like microglial transformation via PI3K/Akt pathway.
Development of an optimized protocol for protoplast-to-plant regeneration of selected varieties of Brassica oleracea L.
Authors: Stelmach-Wityk Katarzyna , Szymonik Kamil , Grzebelus Ewa , Kiełkowska Agnieszka
Published: December 2024

Background

Brassica oleracea L. is a key plant in the Brassicaceae family, known for popular vegetables like cabbage, broccoli, kale and collard. Collard (B. oleracea var. viridis) is a non-heading leafy vegetable grown in urban farms and community gardens in the United States and Europe. Improving collard and other Brassica germplasm can benefit from both traditional and new plant breeding technologies (NPBTs), such as CRISPR-Cas mediated transformation. An efficient transformation or protoplast fusion can only be achieved with a robust and reproducible protocol for protoplast-to-plant regeneration. This research focuses on optimizing in vitro culture conditions to enhance cell divisions, microcallus formation, and the regeneration of shoots and roots in four Brassica oleracea varieties, including collard.

Results

The protocol of protoplast release, purification and immobilization was optimized to obtain a suitable number and quality of protoplasts from seven cultivars of B. oleracea. The protoplast isolation efficiency after digestion of young leaves in optimized enzyme solution reached on average 2.5 × 106 of cells per gram of fresh weight. Protoplasts were embedded in thin alginate layers and subjected to culture in three different media. Protoplasts of all studied cultivars were viable (88.2%), underwent cell wall resynthesis and re-entered mitotic divisions in the 5th day of culture. After 30 days of culture, protoplast-derived cells of all the tested cultivars formed microcallus. Six cultivars regenerated shoots, although the shoot formation efficiency strongly depended on the genotype and composition of the regeneration medium. The regeneration medium supplemented with 1 mg l−1 of NAA, 1 mg l−1 of 2iP, 0.02 mg l−1 GA3 and with 2% of mannitol showed the highest shoot formation efficiency for five cultivars of B. oleracea.

Conclusions

The results of this research have led to the development of a robust protoplast-to-plant regeneration protocol for four varieties of B. oleracea that could be exploited as a tool for production of transformants and somatic hybrids. Furthermore, we present the first successful regeneration of protoplast-derived plants of collard, an overlooked but valuable variety of Brassica oleracea.
Human blood metabolites and gastric cancer: a Mendelian randomization analysis
Authors: Zhang Chao , Huang Dao Lai , Zhou Kun , Cai Jin Tao , Liu Dang , Tan Ming Hao , Zhu Guan Yu , Wu Xiang Hua
Published: December 2024

Background

Gastric cancer (GC) remains one of the predominant malignant tumors within the digestive tract, yet its underlying biological mechanisms remain elusive. The primary objective of this study is to delineate the causal relationship between circulating metabolites and GC.

Method

The primary Mendelian randomization (MR) analysis was based on three large GWAS datasets. While the inverse variance weighted served as the primary analysis technique for investigating causal relationships, additional sensitivity analyses were facilitated through methods such as MR-PRESSO, the weighted median, and MR-Egger. Subsequently, replication, meta-analysis, and multivariable MR were executed using another GC GWAS.

Results

The results of this study indicated significant associations between three metabolites 3-methyl-2-oxovalerate (OR 5.8, 95%CI: 1.53–22.05, p = 0.0099), piperine (OR 2.05, 95%CI: 1.13–3.7, p = 0.0175), Phe-Phe dipeptide (OR 0.16, 95%CI: 0.03–0.93, p = 0.0409) and GC.

Conclusion

The present study provides evidence supporting a causal relationship between these three circulating metabolites and GC risk. Elevated levels of 3-methyl-2-oxovalerate and piperine may increase the risk of GC, while Phe-Phe dipeptide may have a protective effect. By integrating genomics and metabolomics, we offer a novel perspective on the biological mechanisms underlying GC. Such insights have the potential to enhance strategies for the screening, prevention, and treatment of GC.
Early therapeutic efficacy of condoliase chemonucleolysis for lumbar disc herniation
Authors: Kobayashi Kazuyoshi , Sato Koji , Morita Yoshinori
Published: December 2024

Background

Low back pain is often caused by lumbar disc herniation (LDH). Treatment of LDH is possible using chemonucleolysis of the nucleus pulposus with condoliase injection. However, onset of the therapeutic effect varies among patients, with improvement from an early stage to 3 months post-injection. This study was performed to identify the characteristics of early responders to condoliase therapy.

Methods

A retrospective cohort study was performed in 371 consecutive patients (259 males, 112 females; age, 49.9 ± 18.7 years; follow-up period, 13.1 ± 7.4 months) treated with condoliase injection for LDH between August 2018 and January 2024. Chemonucleolysis was performed with 1 mL of condoliase (1.25 U/mL) injected into the intervertebral nucleus pulposus. Clinical assessments were made before injection and 1 day, and 1, 4 and 12 weeks post-injection. Pain was measured on a visual analogue scale. Herniation parameters were evaluated on axial MRI. The herniated disc volume was measured on plain lumbar radiography. Demographic and clinical data were taken from medical charts. Multivariate logistic regression analysis was used to identify factors with independent relationships with treatment efficacy.

Results

Improvement of leg pain from baseline by ≥ 50% occurred in 21% of cases within one day after condoliase treatment. Patients with this improvement at 1 week post-injection were defined as early responders (n = 142, 38.3%). In multivariate analysis, age < 40 years (p = 0.022, odds ratio (OR): 1.71, 95% confidence interval (CI): 1.12–4.35), Pfirrmann Grade II or III at baseline (p = 0.032, OR: 1.86, 95% CI: 1.17–5.41), and a high intensity MRI signal in the herniation (p = 0.041, OR: 1.87, 95% CI: 1.06–5.27) were significantly associated with early improvement. No patients had anaphylactic shock or neurologic sequelae.

Conclusions

This study confirms the safety and efficacy of chemonucleolysis with condoliase for treating patients with painful LDH. Age, high-intensity MRI signals, and baseline Pfirrmann grade were significant factors associated with early improvement.