bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid land use conversion in the Cerrado has affected water transparency in a hotspot of ecotourism, Bonito, Brazil
Authors: Chiaravalloti Rafael Morais , Tomas Walfrido Moraes , Uezu Alexandre , Shirai Henrique Yugo , Guaraldo Eliane , Aoki Camila , de Arruda Botelho Maria Tereza , Salvadori Juliane Ferreira
Published: November 2022

Background

Brazil is the largest exporter of soybeans worldwide. Albeit its economic importance, soybean expansion has led to important land use and land cover changes. In this paper, we evaluate the impact of soybean expansion on ecotourism, using as a case study of the Prata River (Bonito), Brazil; tourist destination where over 30,000 tourists per year came to float in crystal waters.

Methods

We first evaluated land cover and land use change in the region between 2010 and 2020, checking how and where soybean plantations have expanded. Second, based on monthly data of water transparency of the Prata River, Bonito, we created five possible models considering monthly rainfall and three categories of soybean expansion (slow, rapid and medium). The models were tested through generalized linear regression analysis and ranked through AIC and AIC weight.

Results

Our results show that soybean expanded from occupying 4% of the river basin in 2010 to 23% in 2020, expanding mostly over pasture areas (31%) and native vegetation (12.9%). We also showed that while soybean plantation was expanding rapid between 2014 and 2016, it played a significant role in increasing the number of days the water in the Prata River was classified as very turbid.

Conclusion

Our results emphasize the need for soybean expansion planning, considering better management of the soil (non-tilling), common agreements between different stakeholders and the scale up of initiatives that are already in place in the region (e.g. planning of the locations of legal reserves in a way that complement the environmental protection areas (e.g. Águas de Bonito), seting aside of conservation areas ("Área Prioritária Banhados") and payment for ecosystem service schemes) .

Implications for conservation

Our research shows the importance of considering the different impacts soybean may have on the landscape. We present clear paths to reduce possible economic and environmental impacts, and present the importance to scale up innitiatives that are already in place in the region, such as payment for ecosystem services schemes and protection of watersheds.
Real-life effectiveness of transitioning from paliperidone palmitate 1-monthly to paliperidone palmitate 3-monthly long-acting injectable formulation
Authors: Corbeil Olivier , Essiambre Anne-Marie , Béchard Laurent , Roy Audrey-Anne , Huot-Lavoie Maxime , Brodeur Sébastien , Chandrasena Ranjith , Thériault Chantale , Crocker Candice , Melun Jean-Pierre , Tibbo Phil , Demers Marie-France , Roy Marc-André
Published: November 2022

Background:

Non-adherence to antipsychotics in schizophrenia is associated with an increased risk of psychotic relapse and hospitalization, a risk that is reduced with the use of long-acting injectable (LAI) antipsychotics. Randomized clinical trials (RCTs) have demonstrated the efficacy of paliperidone palmitate 3-monthly (PP3M) for psychotic relapse prevention in schizophrenia, but it remains poorly documented among individuals treated in real-life settings who can benefit the most out of LAIs.

Objectives:

The objective of this study was to evaluate the effectiveness of PP3M in relapse prevention among patients with schizophrenia.

Methods:

This is a multicentre retrospective study conducted in four outpatients’ clinics across Canada. All consecutive patients with a main diagnosis of schizophrenia who initiated PP3M between June 2016 and March 2020 were included. The primary outcome was psychotic relapse, defined using broad and clinically relevant criteria.

Results:

Among 178 consecutive patients who were switched to PP3M, the 12-month relapse rate was 18.5% and the relapse-free survival probability was 0.788 (95% confidence interval [CI] = 0.725–0.856). Comorbid diagnoses of personality disorders and substance use disorders were associated with hazard rates (HRs) of 3.6 (95% CI = 1.8–7.3, p < 0.001) and 3.1 (95% CI = 1.6–6.2), respectively. Increased psychopathology severity was associated with an increased likelihood of relapse, while having a job or being in school was protective.

Conclusion:

These findings reinforce the necessity of conducting research in patients with comorbid psychiatric disorders who are typically underrepresented in RCTs, yet overrepresented in real-life settings, in order to better inform and guide clinical practice.
Assessing individual differences in attitudes towards touch in treatment settings: Introducing the touch & health scale
Authors: Vafeiadou Aikaterini , Bowling Natalie C , Hammond Claudia , Banissy Michael J
Published: November 2022

Individuals commonly receive touch in treatment settings, but there is limited research on how they perceive it. The current project sought to address this gap by: 1) developing the Touch & Health Scale (THS) - a novel instrument to measure attitudes to touch in treatment settings 2) assessing inter-individual differences in THS scores, and 3) examining the association between individuals’ THS scores and wellbeing. Data of a large U.K. adults sample ( N > 12,000) were used. THS showed Cronbach’s α between 0.636 and 0.816 and significant correlations ( p < 0.001) with day-to-day attitudes to touch. THS scores differed as a function of extraversion and avoidant attachment style. Participants with more positive attitudes to touch in treatment settings showed greater wellbeing. Overall, the study highlights the importance of a personalised approach to touch in treatment settings and provides a new scale that may act as a screening tool for this purpose.
Understanding the use of telehealth in the context of the Family Nurse Partnership and other early years home visiting programmes: A rapid review
Authors: Morrison Kathleen , Hughes Thomas , Doi Lawrence
Published: November 2022

Overview

This rapid review sought to understand the use of telehealth in early parenthood programmes sharing similarities with the Family Nurse Partnership.

Methods

A rapid review protocol was developed in accordance with Cochrane Rapid Reviews Methods Guidance. Medline, Cochrane Library, and CINAHL databases were searched. Inclusion criteria were developed using population, intervention, comparator, outcome, study design, and timeframe components. Two reviewers searched, screened, and extracted data. AMSTAR was used for critical appraisal. Results were synthesised narratively.

Results

Searches yielded 18 studies out of 881 for inclusion. Findings were identified across seven domains: acceptability and accessibility; therapeutic relationships; flexibility offered by telehealth; participation and engagement; confidentiality and privacy; equipment and technical considerations; and training and support.

Conclusion

Telehealth provides unique opportunities to improve access to early years health services for young mothers. However, considerable accessibility barriers remain in the form of connectivity issues, access to appropriate technology, and the acceptability of remote healthcare delivery. This review presents a timely overview of the opportunities and challenges associated with the use of telehealth in early parenthood and family-based programmes.
Where to Look? Alcohol, Affect, and Gaze Behavior During a Virtual Social Interaction
Authors: Ariss Talia , Fairbairn Catharine E. , Sayette Michael A. , Velia Brynne A. , Berenbaum Howard , Brown-Schmidt Sarah
Published: November 2022

COVID-19 forced social interactions to move online. Yet researchers have little understanding of the mental-health consequences of this shift. Given pandemic-related surges in emotional disorders and problematic drinking, it becomes imperative to understand the cognitive and affective processes involved in virtual interactions and the impact of alcohol in virtual social spaces. Participants ( N = 246) engaged in an online video call while their gaze behavior was tracked. Before the interaction, participants were randomly assigned to receive an alcoholic or control beverage. Participants’ affect was repeatedly assessed. Results indicated that a proportionally larger amount of time spent gazing at oneself (vs. one’s interaction partner) predicted significantly higher negative affect after the exchange. Furthermore, alcohol independently increased self-directed attention, failing to demonstrate its typically potent social-affective enhancement in this virtual context. Results carry potential implications for understanding factors that increase risk for hazardous drinking and negative affect in an increasingly virtual world.
What Are the Effects of Posterior Corrective Surgery, With or Without Thoracoplasty, on Pulmonary Function in Adolescent Idiopathic Scoliosis? A Systematic Review and Meta-analysis
Authors: Turner Henry , McManus Robin , Kiely Pat
Published: November 2022

Study Design

Systematic review and meta-analysis

Objectives

This study’s objective is to provide a critical review of the current literature regarding the changes in pulmonary function (PF) in Adolescent idiopathic scoliosis (AIS) patients who have undergone posterior spinal fusion and instrumentation (PSF), with and without thoracoplasty (TP).

Methods

A comprehensive search was performed using the following databases: EMBASE, PubMed, EBSCOhost (CINAHL and Medline) and OpenGrey. Our focus was on studies that compared pre-and postoperative percent-predicted values of forced vital capacity (%FVC) or forced expiratory volume in 1 second (%FEV1) in AIS patients who had undergone PSF, with and without TP, with a minimum 2-year follow-up. The risk of bias for included studies was assessed using the ROBINS-I (“Risk Of Bias In Non-randomised Studies - of Interventions”) tool. Mean change scores were depicted using forest plots.

Results

Fifteen studies met our inclusion criteria. The results of our analysis suggest that PSF with TP caused a significant deterioration of %FVC in individuals with moderate AIS, with no significant effect on %FEV1. It also showed a minor improvement of FEV1% in individuals with moderate AIS after PSF only, but no significant change in %FVC.

Conclusions

PSF with TP caused a significant deterioration of % FVC while PSF alone caused a minor improvement of FEV1% in individuals with moderate AIS with a minimum 2-year follow-up.
Book review: Shubhra Chakrabarty and Utsa Patnaik (2017). Agrarian and Other Histories: Essays for Binay Bhushan Chaudhuri
Authors: Prasad Archana
Published: November 2022

Shubhra Chakrabarty and Utsa Patnaik (2017). Agrarian and Other Histories: Essays for Binay Bhushan Chaudhuri. Tulika Books, xxiv + 324 pp., INR 695. (Hardback).
Power Asymmetry and Unequal Exchange in the Agricultural Value Systems: Case Study of Paddy
Authors: Kumar Manish
Published: November 2022

This article discusses the heterogeneity and power asymmetry within Agricultural Value Systems (AVS). The power asymmetry arises due to the peculiar nature of cultivation and noncultivation sections of the AVS and also because of different factor endowments within the farming community. The power asymmetry in AVS siphons off surplus from cultivation to noncultivation segments of the AVS. The theoretical discussion in this article is followed by an example of paddy value systems in India. The article suggests that merely connecting farmers with the markets will not be sufficient because of the systemic existence of power asymmetry.
Book review: Mukulika Banerjee (2022). Cultivating Democracy: Politics and Citizenship in Agrarian India
Authors: Kumar Manish
Published: November 2022

Mukulika Banerjee (2022). Cultivating Democracy: Politics and Citizenship in Agrarian India. New York: Oxford University Press. ISBN 97801973993 (Hardback), xiv + 237 pp., ₹995.
An Unusual Cause of Cerebral Infarction in a Tanzanian School Child
Authors: Lodhia Jay , Chipongo Hilary , Sadiq Adnan , Khelef Khadija , Bosco Kenan , Dekker Marieke
Published: November 2022

Pediatric stroke is uncommon. A traumatic cause of pediatric ischemic stroke is even rarer. Ischemic stroke due to intraluminal thrombus can be acutely treated with thrombolysis but various factors in sub-Saharan Africa make this unfeasible. We present a case of an eight-year-old Tanzanian boy who sustained penetrating trauma to his palate developing an ischemic stroke of his right middle cerebral artery territory.
Digital Expressions of Church: The Online Identity of Free Churches as a Mirror of Their Missional Mentality
Authors: Bartholomä Philipp
Published: November 2022

Free churches traditionally operated in a “revivalistic mode,” primarily reaching those who had already been religiously socialized. Within post-Christendom, however, they find it increasingly difficult to reach the growing segments of the population that are thoroughly unchurched. Against this backdrop, we assume that free church websites are mirrors of their ecclesial identity and missional mentality. This qualitative study of the online presence of German free church congregations not only sheds light on these churches’ basic missional mind-set but also reveals whether the well-tried “mode of revival” continues until this day or whether a more sensitive contextual awareness is already emerging.
Chronicle of a “crisis” foretold: Asylum seekers and the case of Roxham Road on the Canada-US border
Authors: Côté-Boucher Karine , Vives Luna , Jannard Louis-Philippe
Published: November 2022

Irregular crossings at the Canada-US border between 2017 and 2019 made headlines and pervaded political debates. Drawing on the literature on the instrumentalization of migration crises and on the disappearance of asylum in Canada, this article interrogates the “crisis” framing of these arrivals. We argue that, at its core, this framing builds on the incremental erasure of asylum seekers as a legal and political reality from the Canadian public sphere over the last three decades. During this period and leading up to 2017, there was a shift in the public understanding of asylum from an international obligation to a problem that had been dealt with and erased. When this “problem” resurfaced in 2017, it shattered the illusion. Over the past two decades, Canada and the United States have created a hostile border architecture that channels migrants towards a narrow section of the Quebec-New York border known as Roxham Road. This generated pressures on Quebec's migrant settlement resources, providing the elements for a framing of these arrivals as a “crisis” and paving the way for the implementation of exceptional measures within a very tight framework, with massively expanded budgets, and with the participation of a range of public and private actors at times unfamiliar with the international protection system and unprepared to meet the needs of asylum seekers. The discussion concludes with an examination of two main legacies of the Roxham Road events: the articulation of a Canada-specific form of border humanitarianism and the solidification of an old policy aspiration – the elimination of the agentic asylum seeker.
Ultrasound Imaging and Prevalence of Intrasheath Peroneal Tendon Subluxation in Asymptomatic Volunteers
Authors: Kanal Shefali , Gross Christopher E. , Hoch Caroline P. , Davis Leah
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Intrasheath peroneal tendon subluxation is typically an incidental finding in athletes with sports-related injuries and is characterized by a temporary reversal in the anteroposterior positions of the peroneus longus (pL) and peroneus brevis (pB) tendons within their common tendon sheath. It is currently unclear whether intrasheath subluxation represents normal physiologic or pathologic tendon motion. This study aims to determine the normal variation in motion of supramalleolar pB and pL tendons in multiple ankle positions and to determine the overall prevalence of intrasheath tendon subluxation in asymptomatic volunteers.

Methods:

Static sonographic images of the peroneal tendons in 22 asymptomatic volunteers were collected in the neutral position, in eight fixed ankle positions (active and passive pronation, dorsiflexion, supination, and plantarflexion), and during dynamic ankle circumduction. The center of each tendon in relation to the lateral fibular cortex and in relation to each other was measured in each position and used to calculate absolute and percentage displacement. Two-way ANOVA was used to determine the significance of passive versus active motion and two-tailed paired sample t-test was used to compare the mean displacement of pL and pB in active and passive positions.

Results:

Intrasheath subluxation was not visualized in any static position but was visualized in 33% of patients during active ankle circumduction, regardless of direction or laterality. Percent displacement was greatest in active ankle plantarflexion (55%) for pB and in active pronation (34%) for pL. A statistically significant difference in the tendon positions in relation to each other was found in the anteroposterior direction (p=0.026), but there were no statistically significant differences between active and passive motions or with ankle positioning. A non-painful ankle 'snap' was palpated by the sonographer in all cases of intrasheath subluxation.

Conclusion:

Intrasheath subluxation is a fairly common occurrence seen in one third of our volunteers. Our results suggest that a snapping ankle in otherwise asymptomatic patients is highly suggestive of intrasheath peroneal tendon subluxation and can be well-documented with dynamic ultrasound. Establishing the normal ranges of motion of supramalleolar peroneal tendons may assist in the evaluation of patients with lateral ankle pain.
The Fall and Rise of Total Ankle Arthroplasty: A Database Analysis of Procedural Incidence Between 2009 and 2019
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; Ankle Arthritis; Hindfoot; Trauma

Introduction/Purpose:

Ankle osteoarthritis accounts for one of the most common ankle joint pathologies. Although total ankle arthrodesis has been the mainstay treatment for degenerative end-stage ankle arthritis, the popularity of total ankle arthroplasty has been on the rise due improved implant design, technologies, and postoperative outcomes. Yet, there remains a paucity of epidemiologic data in recent years on the incidence of total ankle arthroplasty in the United States. 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 total ankle arthroplasty 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 total ankle arthroplasty. Volume and incidence were estimated for annual sums, gender, age subgroups, and four statistical geographical regions of the U.S.

Results:

In total, 41,060 total ankle arthroplasty procedures were identified in the database from 2009 to 2019. Annual volumes have increased significantly by 136.1%, from 2,180 to 5,147 total procedures nationwide. Procedural incidence reported per 1,000,000 people significantly increased by 120.8%, at 15.9 in 2019. Significant growth in incidence was demonstrated in males and females below the age of 65 years with the highest annual incidence found in people under the age of 54. Incidence stratified by region rose in all regions of the United States with the South and West seeing the most notable increases.

Conclusion:

The epidemiology of TAA has yet to be clarified in recent years. We found that annual volumes and incidence of TAA has increased in the past decade. Growth in incidence was demonstrated in both sexes > 54 years as well as in all regions of the US. While ankle arthroplasty succeeds in mitigating certain complications associated with arthrodesis such as impaired ankle motion, gait changes and adjacent joint arthritis, orthopedic surgeons must remain mindful of the significant consequences associated with revision ankle arthroplasty. Describing epidemiology with stratified procedural incidence can help orthopedists adapt to the ever-evolving changes in the field.
Does the Radiographic Lateral View of the Lesser Toe Matter in a Trauma? A Retrospective Analyses of 378 Radiographs
Authors: Kitaki Danilo P. , Gonçalves João Paulo P.
Published: November 2022

Category:

Trauma; Lesser Toes

Introduction/Purpose:

Evaluate the importance of a radiographic lateral view in diagnosing lesser toes traumatic conditions.

Methods:

Between January 2018 and March 2018, 378 radiographs of 126 patients evaluated in an emergency care hospital for trauma in the lesser toe were retrospectively evaluated for presence of lesser toes traumatic conditions. Patients were selected if a complete series of radiographs were performed, anteroposterior (AP), lateral (LA) and Oblique (OB). Radiographs of the same patient were duplicated and divided in two groups: standard group (AP and OB) and complete group (AP + LA + OB). Images were examined by four independent examiners with different degrees of experience. Each examiner randomly evaluated the same patient twice (one for each group). Kappa index was used to evaluate intra and inter-examiner concordance, and the two- proportion equality test was used to calculate statistical significance.

Results:

Mean age of patients was 37,2 years (4-85yr), 144 injuries were diagnosed in standard group (28,6%) and 266 injuries (52,8%) in complete group (p<0,001). Individually, each examiner had an improvement in the number of lesions diagnosed when comparing group assessment (p<0,001). Kappa index was superior to 0,60 for all examiners in standard group.

Conclusion:

Addition of true lateral view was able to detect misdiagnosed injuries in lesser toes trauma and improved the number of diagnosed lesions in 84,6%.
Calcaneus Fracture Fixation: Assessing the Adequacy of the Sinus Tarsi Surgical Fixation Technique
Authors: Kuljic Nebojsa , Kolla Lee A. , Thiessen Trent , Willms Scott
Published: November 2022

Category:

Trauma; Hindfoot

Introduction/Purpose:

Intra-articular calcaneus fractures are devastating injuries, and life-changing for patients that develop post-traumatic arthritis, a common outcome. Debate exists as to whether non-operative symptomatic management, or operative treatment, best manages these injuries, partially due to the difficulty of achieving anatomic subtalar joint reduction. Traditionally, a large, lateral extensile incision has been used, plagued with soft tissue complications quoted at rates upwards of 22%. A less invasive incision, the limited sinus tarsi approach (ST-a), has become more common, proposed to lower complication rates without compromising radiographic nor clinical outcomes. The primary purpose of this study was to objectively assess the adequacy of joint reduction along with the associated soft tissue complications using the ST-a and compare it to the standards of the lateral extensile incision.

Methods:

All calcaneus fractures fixated through the ST-a at our institution were reviewed between March 2017 and Jan 2020. Inclusion criteria included the presence of preoperative and post-operative X-rays and CT scans. Primary outcomes were radiographic measures, including Bohler's angle on X-ray, and the maximum summative step deformity at the posterior facet of the subtalar joint in all three planes on CT scan. Secondary clinical outcomes included soft tissue complications (infection, delayed wound healing) and the need for reoperation.

Results:

Thirty patients were included with an average age of 48.9 +- 13.9 (n=24 males, n=6 females) and Sanders classification of 2.8. Pre-operatively, the mean Bohler's angle and summative posterior facet step deformity were 5.8 +- 16.6° and 17.2 +- 9.3mm, respectively. These radiographic outcomes were significantly improved postoperatively to 27.2 +- 7.7° and 5.3 +- 2.9mm. Soft tissue complication rates were half that of the comparative extensile approach.

Conclusion:

Using the ST-a, radiographic joint reduction was acceptable compared to literature standards. There was subsequently a lower incidence of soft tissue complications than previously quoted for the lateral extensile approach. Although technically more demanding, the ST-a is a valuable method for the treatment of intra-articular calcaneal fractures and should be considered when planning operative management of intra-articular calcaneus fractures.
Arthroscopic-Assisted Minimal Invasive Surgery for Weber C Ankle Fractures: Comparation to Open Reduction Internal Fixation
Authors: Lee Sung Hyun , Yoo Byung min
Published: November 2022

Category:

Trauma; Arthroscopy

Introduction/Purpose:

After acceptable reduction and internal fixation for ankle fractures, some patients regularly suffer from residual symptoms, presumably due to occult intra-articular injuries. Recently, arthroscopic-assisted technique for ankle fractures was introduced. However, there was no previous study that investigate the outcomes of arthroscopic-assisted minimal invasive surgery (MIS) for pronation type ankle fractures. The aim of this study was to compare the clinical outcomes after arthroscopic- assisted MIS surgery to conventional open reduction internal fixation (ORIF) for Weber C ankle fractures.

Methods:

Between 2016 and 2019, 86 patients with Weber C type ankle fractures with minimum 2 years follow up were included. Patients were sorted to 2 groups according to operation technique (MIS group (n=34): arthroscopic-assisted MIS, ORIF group (n=52): conventional ORIF). In MIS group, fibula fractures were fixed using fibula nail. Medial and posterior malleolus fractures were fixed using cannulated screw arthroscopically assisted with pin point wound. Syndesmosis injury was treated with arthroscopic reduction and screw fixation. Intraarticular lesions such as loose body or osteochondral lesion of talus were removed or debrided arthroscopically. Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS). In addition, postoperative complications including posttraumatic arthritis were evaluated.

Results:

There were no significant differences between 2 groups in VAS, FAOS. There were 2 cases of postoperative infections and 4 cases of wound problems in ORIF group, but there was no complication in MIS group. There were 1 cases of obvious advanced posttraumatic arthritis in MIS group and 3 cases in ORIF group.

Conclusion:

Arthroscopic-assisted minimal invasive surgery was effective treatment option with low rate of wound problem in for Weber C ankle fractures.
What Makes Plantar Heel Spur Painful? A Matched Case-Control Study
Authors: Lee Wonyong , Metgud Neha A. , Moore Michelle
Published: November 2022

Category:

Hindfoot; Other

Introduction/Purpose:

Plantar heel spur has been considered one of the reasons for heel pain in plantar fasciitis although its pathophysiology is not clear. The purpose of this study is to investigate the demographic and radiographic differences between the plantar fasciitis cohort and age/sex-matched control cohort, and identify risk factors that make plantar heel spurs painful.

Methods:

Patients who visited the office under the diagnosis of plantar fasciitis from September 2020 to December 2021 and age/sex-matched control cohort were included. Demographics and radiographic findings between the two groups were compared. A subgroup analysis was performed on only patients who had plantar heel spur. Patients who had plantar feel spur from the study group and the control group were extracted. All demographics and radiographic data were compared between the two subgroups and a multivariable logistic regression analysis was performed to identify independent risk factors that make plantar heel spur painful.

Results:

76 patients were enrolled in the study group (Painful heel) and age/sex-matched control group (Non-painful heel). BMI was significantly higher in the study group compared to the control group: 33.2 vs 28.7 (P < .001). In the study group, plantar heel spur was present in 67.1% (51 out of 76), while in 38.2% (29 out of 76) in the control group (P < .001). In the subgroup analysis, BMI in the study group was significantly higher compared to the control group: 34.6 vs 30.3 (P < .001). All variables which can have an effect on painful plantar heel spur in patients with plantar fasciitis were included in a multivariable logistic regression analysis. The analysis through this subgroup comparison identified high BMI as an independent risk factor of painful plantar heel spur.

Conclusion:

High BMI was the one single independent predictor of painful heel spur resulting in plantar fasciitis heel pain. Concerning the treatment for plantar fasciitis, we need to counsel patients on emphasizing protection and cushioning for plantar heel to relieve axial loading and weight loss to decrease BMI.
3D Printed Total Talus Replacement after Free Vascularized Medial Femoral Condyle Osteocutaneous Flap for Avascular Necrosis of the Talus Leads to Poor Clinical Outcomes
Authors: Madi Naji S. , Chopra Aman , Fletcher Amanda N. , Mithani Suhail K. , Parekh Selene G.
Published: November 2022

Category:

Hindfoot

Introduction/Purpose:

Talar avascular necrosis (AVN) is a difficult pathology to diagnose and manage. Traditional treatment options include both joint sparing procedures (vascularized bone graft, core decompression, intraosseous stem cell injection) and joint sacrificing procedures (arthrodesis or arthroplasty). Three dimensional (3D) printed total talus replacement (TTR) has recently gained more popularity as an intervention to salvage joint motion in patients with talus pathology. Although vascularized bone grafting can treat localized talar AVN, failure of this procedure to improve talar vascularity and prevent further subchondral collapse may require revision surgery. This is the first study to compare outcomes of patients with talar AVN who underwent primary 3D printed TTR and patients who underwent a secondary TTR subsequent to failure of a free vascularized medial femoral condyle (MFC) flap.

Methods:

This case series analyzed the outcomes of two patients who underwent a secondary 3D printed TTR subsequent to failure of the index revascularization procedure using an MFC flap in 2016. These patients were compared to a cohort of patients who underwent a primary 3D printed TTR to treat talar AVN between 2016 and 2019. Preoperative and postoperative assessment included ankle range of motion, foot and ankle outcome score (FAOS), visual analogue scale (VAS) pain scores, and radiographic imaging. A minimum 12-month follow-up period was reported for patients.

Results:

Within the group that underwent a secondary TTR after a failed revascularization, both patients had a mean followup of 23.5 months. The 25 patients in the comparison group who all underwent a primary 3D printed TTR had an mean follow-up period of 22.1 (range:12-43) months. All patients in the study experienced improved VAS pain scores and ankle dorsiflexion post- operatively. In the secondary 3D printed TTR group, both patients demonstrated reduced plantarflexion of 20 degrees and ankle motion of 15 degrees relative to the comparison group which showed a minimal increase in both. When analyzing FAOS functional outcome score subscales, patient two demonstrated improvement in pain from 44 to 46, symptoms from 29 to 46, and activities of daily living from 47 to 76. Patient one experienced a decrease in sports and recreation from 15 to 5 and quality of life from 38 to 31.

Conclusion:

This case series demonstrated poor functional outcomes of two patients who underwent 3D printed TTR after talar revascularization with MFC grafts when compared to the cohort of patients who solely underwent a primary 3D printed TTR for talar AVN. Further investigation is warranted to determine which patients may benefit from a revascularization procedure or a primary 3D printed TTR.
Patient Reported Outcomes Analysis with Cartiva Implant
Authors: Maestre Stephanie , Hogan MaCalus V. , Hasselman Carl T. , Kline Alex J. , Yan Alan Y.
Published: November 2022

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

There has been an increased use of Cartiva implant in patients with first MTP arthritis. There are limited studies analyzing patient reported outcomes (PROs) with Cartiva implant. The goal of this study is to analyze validated patient reported outcomes on Cartiva patients.

Methods:

From a multi-center single institution, we analyzed patients who received the Cartiva implant and submitted PROs from December 2016 to December 2019. The following outcomes were analyzed: Foot and Ankle Ability Measure (FAMM), Global Rate of Change (GRC), and Patient Acceptable Symptom State (PASS). The PROs were analyzed by examining the postoperative score at any time interval after the procedure, a difference between preoperative score and postoperative time interval score (delta score), and at different time periods 0-2 months and >2 months after the procedure.

Results:

Of the 175 Cartiva patients, the average age was 57.1 years with 68% females and 32% males. The overall mean delta FAMM score was 5.5. The mean FAMM score at 0-2 months were 61.6 with the mean delta score -9.2. At > 2 months, the mean FAMM score was 74.7, and the mean delta score was 10.9. With GRC scores, overall GRC score 45.6 % report better, 35.1% report no change, 11.9% report worse. At 0-2 months, 38.1% report better, 42.9% report no change, and 19.1 % report worse. At > 2 months, 41.2% report better, 35.3% no change, 23.5% report worse. As for PASS scores, 53.3% said no, and 46.6% said yes.

Conclusion:

Overall FAMM scores with Cartiva implant overall show improvement compared to preoperative score. FAMM scores at 0-2 months are worse than preoperative but are better at >2month timeframe. There is a minimal difference between patients feeling better or no change after their procedure in GRC and PASS scores and analyzing at 0-2 and >2 month timeframes. Further studies are needed.
Impact of BMI on Outcomes after First Metatarsophalangeal Joint Arthrodesis
Authors: Manz Wesley J. , Webb Alexander R. , Fuqua Andrew , Novack Joseph C. , Coleman Michelle M. , Kadakia Rishin J. , Bariteau Jason T.
Published: November 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

First metatarsophalangeal joint (MTPJ) arthrodesis is a commonly performed procedure for patients with various disorders of the first ray including hallux rigidus, severe hallux valgus, failed 1st MTPJ replacement, and failed hallux valgus correction. Outcomes are generally favorable and similar outcomes have been shown in the young and elderly. It is well documented that medical comorbidities have deleterious effects on outcomes in foot and ankle surgery. Obesity - in particular - has been broadly studied among the foot and ankle literature and has been associated with increased complications. Presently, there is a paucity of studies examining obesity's effect on outcomes of 1st MTPJ arthrodesis. This study's purpose was to evaluate outcomes following 1st MTPJ arthrodesis in obese vs non-obese patients.

Methods:

A retrospective cohort study of 94 patients undergoing first MTPJ fusion over the age of 18 with a diagnosis of hallux valgus or hallux rigidus was performed. Surgical and postoperative outcomes, Visual Analog Pain scale (VAS), and Short Form 36 (SF-36) surveys were examined and stratified into 2 patient groups: BMI < 30 and 3 30, with sub-analyses conducted between Obesity class I (30-34.9) and Obesity class II (35-39.9) patients. Continueous, normally distributed data were compared with independent sample t-tests, while comparisons of categorical data were made using chi-squared tests. Alpha and beta were assumed to be 0.05 and 0.8, respectively.

Results:

Average overall VAS and SF-36 physical component scores improved significantly at 6 months (P< 0.0001, 0.006) and 1- year postoperative visits (P <0.0001, 0.007) following 1st MTP fusion in the cohort as a whole. No differences in VAS or SF-36 scores were found between the obese (BMI > 30) or non-obese cohorts. Amongst BMI classified subgroups, significantly greater changes in preoperative to 6-month and 1-year postoperative VAS pain were observed in the Obesity class I patients vs. Obsesity class II or greater (P=0.043, 0.022).

Conclusion:

Our study showed first MTPJ fusion reliably improves pain and physical quality-of-life in arthritic obese and non- obese patients without differences in nonunion, complications, or patient-reported measures. Additionally, we observed that obese patients experienced comparable improvements in VAS pain and SF-36 physical function scores as their non-obese peers. Our findings asset that first MTPJ fusion is an effective procedure for correction of MPTJ pathology in the obese.
Impact of Low Social Support Systems on Post-Operative Outcomes of Ankle, Hindfoot and Midfoot Surgery
Authors: Manz Wesley J. , Novack Joseph C. , Fink Juliet , Zaldumbide Joel A. , Jacobson Joseph E. , Bariteau Jason T.
Published: November 2022

Category:

Other; Hindfoot; Midfoot/Forefoot; Trauma

Introduction/Purpose:

Degenerative conditions of the ankle, hindfoot and midfoot can markedly limit mobility, and functional disability due to bone and joint pathology has been demonstrated to predict mortality, and in some cases, decrease life expectancy by up to 10 years. Optimizing outcomes in surgical treatment of these conditions is therefore essential and requires analysis of both medical interventions and psychosocial factors. Physicians have only recently begun to identify social support to be a key factor in post-operative functional ability, though our understanding of their impact on surgical outcomes is limited. The purpose of this study was to elucidate the link between low social support and postoperative surgical foot and ankle outcomes.

Methods:

A single-center, prospective study was conducted on patients who underwent elective or non-elective ankle, hindfoot, or midfoot surgery between 2015 and 2019. Patients who were pre-operatively and post-operatively assessed at 6 month or 1 year follow up using the Short Form Health Survey (SF-36), Life-Space Assessment survey (LSA), and/or visual analog scale (VAS) for pain were administered a social support survey scoring the individuals social support system. Patient reported outcomes were compared between low social support patients (score <= 13) and high social support patients (score > 13).

Results:

Preoperative baseline and 6 month LSA scores in the low social support group were significantly lower compared to the normal social support group (P = 0.044, P = 0.038), a trend not observed at the 1 year post-operative mark. Low social support pre-operative SF-36 MCS scores (P = 0.015) were significantly lower than the high social support group with no difference detected in pre-operative SF-36 PCS scoring. At 6-month follow-up, the low social support group had significantly lower SF-36 PCS scores (P = 0.031) and SF-36 MCS scores (P = 0.006) compared to the high social support group. At 1 year follow up, these differences in PCS (P = 0.04) and MCS (P= 0.007) persisted. No significant differences in VAS scores were observed.

Conclusion:

Among adults undergoing foot and ankle surgery, low perceived social support was associated with lower degrees of perceived mental well-being and physical wellbeing up to 1 year postoperatively.
Arthroscopic Reduction and Internal Fixation of Talus Fractures: An All-Inside Soft-Tissue Preserving Technique
Authors: Martin Kevin D. , Curatolo Christian , Gallagher James , Alvarez Paul
Published: November 2022

Category:

Arthroscopy; Hindfoot; Trauma

Introduction/Purpose:

Talus fractures, although rare, can lead to devastating complications of posttraumatic osteoarthritis (PTA), mal-union, non-unions, and avascular necrosis (AVN). The timing and method of fixation has been controversial, especially for open and extruded fractures. The purpose of this study is to present short-term outcomes using a posterior talus arthroscopic reduction internal fixation (TARIF) technique. The authors hypothesized that talus fractures reduced arthroscopically and fixed percutaneously would have similar outcomes with reduced overall complications compared to traditional open techniques.

Methods:

We performed a retrospective study on 14 consecutive patients undergoing primary posterior arthroscopic reduction internal fixation for talus fractures from August 2020 to January 2021. All cases were performed completely arthroscopically, utilizing a posterior approach and cannulated screws. Patient demographics, fracture pattern, perioperative complications, and radiographic findings were collected.

Results:

The mean age of our cohort was 37.3 years (range, 19-75), including 8 males and 6 females, with 58% utilizing nicotine. Motor vehicle accidents accounted for 64% of injuries, followed by falls and gunshot wounds. Fracture location included 9 body fractures, 5 neck fractures Hawkins type 2 (1), 3 (3), and 4 (1). Five fractures were open injuries, 2 of which had vascular injuries that underwent irrigation and debridement followed by external fixation. Intraoperatively, all patients had 2-3 anterior to posterior 3.5mm cannulated headless screws placed with a mean tourniquet time of 87 minutes (range, 0 - 88). Postoperatively, all fractures had the articular surface restored to within 2mm on radiographs. No patients required antibiotics and no debridement's were performed. No acute AVN has been recorded.

Conclusion:

Our short-term results indicate posterior arthroscopic reduction internal fixation of talus fractures is safe and able to restore the articular surfaces. It also suggests that an all-inside soft tissue preserving technique may reduce short term complications.
Atypical Presentation of Tubulointerstitial Nephritis and Uveitis Syndrome, a Rare Disease
Authors: Fram Brandon , Randolph Jessica , Saadeh-Jackson Stephanie
Published: November 2022

Purpose:

To expand the current knowledge of tubulointerstitial nephritis and uveitis syndrome (TINU), which might assist other ophthalmologists in recognizing and treating patients with this rare disease.

Methods:

A patient with atypical demographics and features was compared with previously described TINU cases. The case was analyzed in terms of how it compares with more “classic” cases, and the differences were identified.

Results:

The diagnosis of TINU is ultimately clinical, although aided by previous studies. Thus, it might present challenges when patients do not have the typical demographics or presenting features of TINU.

Conclusions:

Our patient showed features that deviated from classic TINU. Knowledge of the disease and a comprehensive view of the patient’s medical state might help lead to accurate diagnosis and treatment.
Retinal Vasculitis in a Patient With Isaacs Syndrome and Inclusion Body Myositis
Authors: Martinez-Velazquez Luis , Zhou Paul , López-Font Francisco J. , Hoyek Sandra , Feldman Candace H. , Amato Anthony A. , Sobrin Lucia , Patel Nimesh A.
Published: November 2022

Purpose:

To report a case of bilateral occlusive retinal vasculitis in a patient with autoimmunity.

Methods:

A case was analyzed and a literature review performed.

Results:

A 55-year-old woman with autoimmune diagnoses of Isaacs syndrome and inclusion body myositis (IBM) reported decreased vision for 3 months. A fundus examination showed peripheral intraretinal hemorrhages in the right eye and an inferotemporal subhyaloid hemorrhage with adjacent intraretinal hemorrhages and preretinal fibrosis in the left eye. Fluorescein angiography showed temporal peripheral leakage and capillary dropout in both eyes, consistent with occlusive vasculitis. Scatter laser treatment to peripheral areas of retinal nonperfusion was followed by an intravitreal bevacizumab injection. Four months later, vision had stabilized at 20/15 in both eyes and the peripheral leakage had resolved.

Conclusions:

This patient developed retinal vasculitis associated with the rare autoimmune neuromuscular disorders of Isaacs syndrome and IBM. An extensive workup showed the most plausible mechanism for the vasculitis was autoimmunity with a history of previously elevated antibodies levels associated with the antiphospholipid syndrome.
Environmental justice and the state
Authors: Harrison Jill Lindsey
Published: November 2022

In this article, I address a set of recent publications that explicitly critique U.S. environmental justice (EJ) movements and scholars for looking to the state for protection from environmental harm. These publications have argued that U.S. EJ movements and scholars have become preoccupied with seeking justice through state institutions instead of through other routes of change, that they do so principally through overly cooperative practices that cede the terms of debate to the state, and that engaging with the state inherently perpetuates injustice. Their arguments make important, incisive contributions to EJ studies and raise sobering questions about EJ activists’ engagement with the state. In this article, I highlight some of these contributions, but I also critique their arguments on two grounds: First, drawing on various studies, I argue that these publications’ empirical characterizations of EJ activism understate the diversity of tactics EJ activists use. Second, I argue that they treat the state as a wholly and inevitably repressive instrument of capital, and that this leads them to make politically problematic recommendations that dismiss the ways in which states also serve other ends, can be made to do so more meaningfully, must be made to do so, and are being made to do so. Reductionist characterizations of the state too easily dismiss the prospects for change through the state—including reforms that are modest but nevertheless reduce harm as well as “nonreformist reforms” that more fundamentally support justice, all of which can be pursued through both collaborative and confrontational practices. I draw on recent theoretical and empirical research from political ecology, political geography, and Native American and Indigenous studies—scholarship that treats the state in a more relational fashion and which intersects with or exists largely outside of EJ studies—to theorize my arguments and provide illustrative examples.