bluuebunny/crossref_metadata_2025 huggingface dataset:
Preoperative Risk Factors for Subsequent Ipsilateral ACL Revision Surgery After an ACL Restoration Procedure
Authors: Sanborn Ryan M. , Badger Gary J. , Fleming Braden C. , Kiapour Ata M. ,   The BEAR Trial Team, Fadale Paul D. , Hulstyn Michael J. , Owens Brett D. , Proffen Benedikt , Sant Nicholas , Portilla Gabriela , Freiberger Christina , Henderson Rachael , Barnett Samuel , Costa Meggin , Chrostek Cynthia , Ecklund Kirsten , Micheli Lyle J. , Murray Martha M. , Yen Yi-Meng , Kramer Dennis E.
Published: November 2022

Background:

Anterior cruciate ligament (ACL) revision surgery is challenging for both patients and surgeons. Understanding the risk factors for failure after bridge-enhanced ACL restoration (BEAR) may help with patient selection for ACL restoration versus ACL reconstruction.

Purpose:

To identify the preoperative risk factors for ACL revision surgery within the first 2 years after BEAR.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Data from the prospective BEAR I, II, and III trials were used to determine the preoperative risk factors for ACL revision surgery. All patients with a complete ACL tear (aged 13-47 years, depending on the trial), who met all other inclusion/exclusion criteria and underwent a primary BEAR procedure within 30 to 50 days from the injury (dependent on the trial), were included. Demographic data (age, sex, body mass index), baseline patient-reported outcomes (International Knee Documentation Committee [IKDC] subjective score, Marx activity score), preoperative imaging results (ACL stump length, notch size, tibial slope), and intraoperative findings (knee hyperextension, meniscal status) were evaluated to determine their contribution to the risk of ipsilateral ACL revision surgery.

Results:

A total of 123 patients, with a median age of 17.6 years (interquartile range, 16-23 years), including 67 (54%) female patients, met study criteria. Overall, 18 (15%) patients required ACL revision surgery in the first 2 years after the BEAR procedure. On bivariate analyses, younger age ( P = .011), having a contact injury at the time of the initial tear ( P = .048), and increased medial tibial slope (MTS; P = .029) were associated with a higher risk of ipsilateral revision surgery. Multivariable logistic regression analyses identified 2 independent predictors of revision: patient age and MTS. The odds of ipsilateral revision surgery were decreased by 32% for each 1-year increase in age (odds ratio, 0.684 [95% CI, 0.517-0.905]; P = .008) and increased by 28% for each 1° increase in MTS (odds ratio, 1.280 [95% CI, 1.024-1.601]; P = .030). Sex, baseline IKDC or Marx score, knee hyperextension, and meniscal status were not significant predictors of revision.

Conclusion:

Younger age and higher MTS were predictors of ipsilateral ACL revision surgery after the BEAR procedure. Younger patients with higher tibial slopes should be aware of the increased risk for revision surgery when deciding to undergo ACL restoration.
Evaluation of the toxic effects of thimerosal and/or aluminum hydroxide in SH-SY5Y cell line
Authors: Öztürk Mehmet Evren , Yirün Anıl , Erdemli-Köse Selinay Başak , Balcı-Özyurt Aylin , Çakır Deniz Arca , Oral Didem , Erkekoğlu Pınar
Published: November 2022

In this study, we aimed to evaluate possible toxic effects of thimerosal, aluminum and combination of thimerosal and aluminum in SH-SY5Y cells. Inhibitory concentrations were determined by MTT assay; reactive oxygen species (ROS) were determined by a fluorometric kit and antioxidant/oxidant parameters were measured by spectrophotometric kits. Nuclear factor erythroid 2-associated factor 2 (Nrf2), norepinephrine (NE), dopamine transporter (DAT) and dopamine beta β-hydroxylase (DBH) levels were measured by sandwich ELISA kits while 8-hydroxy deoxyguanosine (8-OHdG) and dopamine levels were determined by competitive ELISA kits. Thimerosal (1.15 μM) and aluminum (362 μM) were applied to cells at inhibitory concentrations 20 (IC20s) for 24 h. ROS increased significantly in cells aluminum- and aluminum+thimerosal-treated cells. Glutathione levels decreased in aluminum group while total antioxidant capacity and protein oxidation levels increased significantly in aluminum and aluminum+thimerosal groups. Lipid peroxidation increased significantly in groups treated with aluminum and aluminum+thimerosal. Nrf2 levels and DNA damage were significantly higher in all groups while dopamine levels significantly increased in cells treated with thimerosal and aluminum+thimerosal, DAT levels were found to be higher in all experimental groups compared to the control. These findings showed that both thimerosal and aluminum can change oxidant/antioxidant status, cause DNA damage, alter dopamine and DAT levels. Changes seen in cells treated with combined exposure to aluminum and thimerosal are more pronounced. Special care should be taken while vaccinating sensitive populations and safer alternatives for aluminum and thimerosal should used.
Simulating time-to-event data subject to competing risks and clustering: A review and synthesis
Authors: Meng Can , Esserman Denise , Li Fan , Zhao Yize , Blaha Ondrej , Lu Wenhan , Wang Yuxuan , Peduzzi Peter , Greene Erich J.
Published: November 2022

Simulation studies play an important role in evaluating the performance of statistical models developed for analyzing complex survival data such as those with competing risks and clustering. This article aims to provide researchers with a basic understanding of competing risks data generation, techniques for inducing cluster-level correlation, and ways to combine them together in simulation studies, in the context of randomized clinical trials with a binary exposure or treatment. We review data generation with competing and semi-competing risks and three approaches of inducing cluster-level correlation for time-to-event data: the frailty model framework, the probability transform, and Moran’s algorithm. Using exponentially distributed event times as an example, we discuss how to introduce cluster-level correlation into generating complex survival outcomes, and illustrate multiple ways of combining these methods to simulate clustered, competing and semi-competing risks data with pre-specified correlation values or degree of clustering.
A Culturally Adaptive Approach to First Nations evaluation consulting
Authors: Street Catherine , Kendall Belinda , McGhie Tina , O’Flaherty Lauren , Schaeffer Darren
Published: November 2022

Cultural safety is of utmost concern across the evaluation world, particularly given the way that evaluation and research have historically been implicated in colonising practices of the West. This article aims to examine the meaning of cultural safety in the context of an Aboriginal majority-owned consulting organisation that provides evaluation services to organisations where First Nations governance systems and processes may be unknown. This is a critically reflexive article that considers how the dual aims of contributing to self-determination and building First Nations business capacity may be managed in such evaluation projects. We apply Duke et al.’s Culturally Adaptive Governance Framework to our own evaluation work in striving for evaluations to be experienced as culturally safe by Aboriginal and Torres Strait Islander stakeholders and for evaluation outcomes to be relevant and useful from the perspective of both Aboriginal and Torres Strait Islander stakeholders and our clients. We then reflect on the implications for the evaluation, social policy and for First Nations business sectors.
Client Outcomes in Graduate Trainee-Provided Psychotherapies: A Mixed Model and Exploratory Analysis
Authors: Roseborough David J. , Chigbu Kingsley U. , Jergensen Kate B.
Published: November 2022

Purpose: This study used a linear mixed model and descriptive analysis of quantitative, archival data to evaluate improvement among clients receiving graduate trainee-delivered individual psychotherapy ( N = 421), and for those in dialectical behavior therapy ( n = 52). Method: The OQ 45.2 was administered to clients on a session-by-session basis. This analysis gave attention to an overall course of recovery and to meaningful interaction effects: to those variables serving as potential moderators. We gave attention to both attrition and deterioration, based on Lambert’s earlier observation of this elevated risk among trainees. Results: Analysis showed evidence of client improvement (change over time), broadly. Distinct trajectories emerged early in treatment for participants who went on to improve versus those who deteriorated. Discussion: Clinical and training implications are discussed, including the importance of giving attention to these unique and potentially distinct trajectories early in a clinical relationship.
Case Report: A Giant Epignathus with a Well-Developed Skeleton of Head and Neck
Authors: Goto Shintaro , Nakazawa Atsuko , Yoshizawa Tadashi , Aoki Masahiko , Hirabayashi Takeshi , Seino Hiroko , Morohashi Satoko , Kijima Hiroshi
Published: November 2022

Epignathus is an extremely rare teratoma found in the oral cavity or oropharyngeal region of newborns, whose pathogenesis is poorly understood. We describe a giant epignathus arising from the oropharynx in a newborn. The giant tumor completely obstructed the airway of the newborn resulting in death. Histological and radiological examination of the tumor reveals the presence of a remarkably well-developed skeleton of the head and neck. A row of teeth, the axis and atlas, thyroid and salivary glands, trachea, and cerebral tissue are all detected within the tumor. These findings suggest that the epignathus is fetus-in-fetu which is considered a type 0 germ cell tumor in accordance with current literature.
Optimizing Drug Response Study Design in Patient-Derived Tumor Xenografts
Authors: Weiss Jessica , Pham Nhu-An , Pintilie Melania , Li Ming , Liu Geoffrey , Shepherd Frances A , Tsao Ming-Sound , Xu Wei
Published: November 2022

Patient-derived tumor xenograft (PDX) models were used to evaluate the effectiveness of preclinical anticancer agents. A design using 1 mouse per patient per drug (1 × 1 × 1) was considered practical for large-scale drug efficacy studies. We evaluated modifiable parameters that could increase the statistical power of this design based on our consolidated PDX experiments. Real studies were used as a reference to investigate the relationship between statistical power with treatment effect size, inter-mouse variation, and tumor measurement frequencies. Our results showed that large effect sizes could be detected at a significance level of .2 or .05 under a 1 × 1 × 1 design. We found that the minimum number of mice required to achieve 80% power at an alpha level of .05 under all situations explored was 21 mice per group for a small effect size and 5 mice per group for a medium effect size.
The effect of copper on phase transformation, microstructure and mechanical characterization of Ni50-xTi50Cux shape-memory alloy
Authors: Radhamani Rajeshkannan , Balakrishnan Muralidharan
Published: November 2022

This research is related to the investigation of the influence of copper additions on phase transformation, microstructure and mechanical characterization of equiatomic NiTi shape-memory alloys. A typical vacuum arc melting furnace was used in the preparation of Ni50-xTi50Cux (x = 2, 5, 10, and 15 at.%) shape-memory alloys. The crystalline phase formation and phase transformation temperature were studied using X-ray diffraction and a differential scanning calorimeter. The morphology and chemical composition of the annealed samples were investigated using a field emission scanning electron microscope and energy-dispersive X-ray spectrometer analysis. The Vickers microhardness test was utilized in the analysis of the homogeneity of the alloy. The experimental results obtained from X-ray diffraction confirmed the coexistence of austenite and martensite phases along with the presence of a Ti2Ni and minor rutile phases. The crystalline sizes of the alloys were in the range of 42 to 78nm. An energy-dispersive spectrometer validated the distinct phases and precipitates in the alloys. The size and dispersion of the secondary phase in the alloy showed a significant influence on the increased hardness from 407HV to 470HV. The following NiTiCu alloy compositions were employed for low-temperature applications since their transition temperatures were below 100°C.
“I Use Sunglasses . . . the Sun Can Ruin the Eyes”: Latino Day Laborers’ Lay Strategies to Reduce Dangers at Work
Authors: Rangel Maria Lizette , Arevalo Mariana , Mercader Clara , Fernández-Esquer Maria Eugenia
Published: November 2022

Latino day laborers (LDLs) are at a high risk for injury and accidents at work and have limited socioeconomic resources to deal with their consequences. While little is known about LDLs’ perceptions of their own vulnerability at the workplace, less is known about the strategies they adopt to confront these risks. The purpose of this qualitative study was to assess LDLs’ perceptions of their workplace dangers and to document the strategies they adopt and endorse to confront them. Guided by a participatory research approach, four focus groups stratified by age were conducted with 34 LDLs in Houston, Texas. Main focus group themes were identified using a combination of qualitative analysis methods involving a thematic analysis conducted by the interview team, LDL advisors, and bilingual Latino researchers. All participants were Latino males (mean age = 40), the majority reported having completed sixth grade or less (64.2%) and having lived in the United States for an average of 12.7 years. We described three categories of strategies to reduce risk for workplace injury generated by local LDLs (practical knowledge and job experience, interpersonal, and personal). These strategies should be explored and encouraged to assist in planning risk-reduction programs, presented in the voice and language of Latino “inside experts” with firsthand experience. The findings of the focus group suggest that LDLs already possess a broad repertoire of strategies to cope with risks at work that can be incorporated in safety programs for LDLs and other immigrant Latino workers.
Validity and Reliability of the Chinese Version of the Edinburgh Postnatal Depression Scale for Fathers of Newborns
Authors: Jen Wei-Hsuan , Hung Tai-Ho , Chen Ching-Yen , Tsai Yun-Fang
Published: November 2022

Studies often use the Edinburgh Postnatal Depression Scale (EPDS) or the Beck Depression Inventory–II (BDI-II) as a screening tool for depression in new mothers or fathers following the birth of an infant, but no studies have evaluated EPDS as a predictor of postnatal depression for new fathers in a Chinese population. This study aimed to test the validity and reliability of a Chinese version of the EPDS for fathers of newborns in Taiwan. The study included 368 parents with newborns ≤2 months of age and without any health problems. Construct and criterion-related validities were assessed and Cronbach’s alpha was used for measuring internal consistency reliability. The receiver operating characteristic (ROC) curve analyzed the optimal cutoff score for the EPDS. Scores for the Chinese EPDS were significantly higher for fathers who were >34 years of age, employed in a professional occupation, and participated in feeding their infant ( p < .05). Mean scores among the fathers for the EPDS and BDI-II were significantly correlated ( r = .64, p < .001). The Cronbach’s alpha was .83 for the EPDS; ROC curve analysis revealed the optimal cutoff of the EPDS was ≥8 points and the area under the ROC curve was 0.91. The EPDS had good validity and reliability and should therefore be considered suitable for the evaluation of postnatal depression in fathers of newborn infants in Taiwan.
Increased ten-eleven translocation methylcytosine dioxygenase one in dorsal root ganglion contributes to inflammatory pain in CFA rats
Authors: Liu Yun , Zhang Ling , Xu Zhen-hua , Zhu Jie , Ma Jia-ling , Gao Yan-ping , Xu Guang-Yin
Published: November 2022

DNA hydroxylation catalyzed by Tet dioxygenases occurs abundantly in neurons in mammals. However, effects of ten-eleven translocation methylcytosine dioxygenase 1 (TET1) expression and hydroxymethylation status on neuron injury remain unclear. This study was designed to explore the effects of TET1 and TET2 expression in the inflammatory pain of rats induced by complete Freund’s adjuvant (CFA). Mechanical paw withdrawal threshold (PWT) and thermal withdrawal latency (TWL) were detected to assess pain behavior. The expression of TET1 and TET2 were measured in the dorsal root ganglion (DRG) with western blotting analysis. Immunofluorescence staining is employed to detect the expression and co-location of TRPV1 with TET1. Intrathecal administration of Bobcat339 was used to inhibit TET1 function in dorsal root ganglion. The paw withdrawal threshold and thermal withdrawal latency of rats were significantly reduced after CFA Injection. Western blot results showed that the expression of TET1 was significantly increased at 3 days after CFA injection, but TET2 had no statistical difference. Immunofluorescence results showed that TET1 was co-localized with TRPV1. Intrathecal administration of Bobcat339 improved mechanical and thermal pain threshold in CFA rats. Our findings highlight the role of TET1 in chronic inflammatory pain model. The expression of TET1 was increased in CFA rats, and suppression of TET1 will ameliorate inflammatory pain.
Successful pregnancy in a patient with short bowel syndrome after surgical rehabilitation and sGLP-2 treatment: novel report on endogenous GLP-2 levels at delivery and during breastfeeding
Authors: MV Gentilini , M Doeyo , M Ortega , L Illidge Perez , C Rumbo , PC Arriola Benitez , A Crivelli , M Rumbo , H Solar , GE Gondolesi
Published: November 2022

Pregnant patients with short bowel syndrome (SBS) and chronic intestinal failure (CIF) can successfully reach to term their pregnancies while on parenteral nutrition (PN) but with high rates of complications. The combination of rehabilitation surgery, combined with the use of novel treatment with enterohormones, especially semisynthetic glucagon-like peptide 2 (sGLP-2), has increased the chances to achieve intestinal sufficiency. Here, we report the case of a 33-year-old female with SBS/CIF (anatomy type 2), weaned off PN using sGLP-2 for 3.7 years, discontinued when she became pregnant. She was able to carry the pregnancy to term without any additional PN support. Considering that, we queried if the endogenous GLP-2 (eGLP-2) levels in this SBS patient, during the pregnancy and breastfeeding period, could be like those presented in healthy pregnant women and in non-pregnant SBS patients. Also, we inquired if there was any passage or increase in the plasmatic eGLP-2 from the fetus to the mother. Thus, we determined eGLP-2 levels in paired neonatal (cord blood) and maternal plasma samples from the SBS pregnant patient ( n = 1), healthy pregnant women (controls, n = 2), and non-pregnant SBS patients ( n = 12). The results indicated that the SBS pregnant patient showed higher eGLP-2 levels than non-SBS pregnant patients and healthy pregnant women along all the period studied. Furthermore, we found that the maternal sample had higher eGLP-2 levels than the neonatal sample, suggesting that fetal contribution to maternal eGLP2 levels would be minor. In conclusion, this study not only reports for the first time a case of a patient with SBS that was able to achieve intestinal adaptation after combining the use of autologous reconstructive surgery and sGLP-2, but also enlightens the possibility of carrying out an uneventful pregnancy and lactation without any nutritional support and remaining independent of sGLP-2.
Surrogate lower limb design for ankle-foot orthosis mechanical evaluation
Authors: Thibodeau Alexis , Dumond Patrick , Kim Joongho , Lemaire Edward D
Published: November 2022

Purpose

This study designs and provides a pilot evaluation of a novel surrogate lower limb (SLL) that provides anatomically realistic three-dimensional (3D) foot motion, based on a literature consensus of passive lower limb motion. This SLL is intended to replace single axis surrogates currently used in mechanical testing of ankle-foot orthoses (AFO).

Material and Methods

The SLL design is inspired by the Rizzoli foot model, with shank, hindfoot, midfoot, forefoot, and toe sections. Ball and socket joints were used between hindfoot-midfoot (HM)-forefoot sections. Forefoot-toes used a hinge joint. Three-dimensional printed nylon, thermoplastic polyurethane (TPU) and polylactic acid (PLA), as well as casted silicone rubber were used to re-create foot components. After fabrication, motion capture was performed to measure rotation using fiducial markers. The SLL was then loaded under both static and cyclic loads representing a 100 kg person walking for 500,000 cycles.

Results

Most joints were within 5° of target angles. The SLL survived static loads representing 1.5 times body weight for both static and cyclical loading.

Conclusions

This SLL moved as designed and survived testing loads, warranting further investigation towards enabling essential mechanical testing for AFO currently on the market, and helping to guide device prescription.
The Dormant Volcano: Social Media and the Temple Mount, Jerusalem
Authors: Cohen Yoel , Lev-On Azi
Published: November 2022

Social media have become primary venues for pubic conversations, but we know very little about how and where holy places are discussed in social media and who participates in these conversations. To address these questions, we look at the Temple Mount, one of the most significant places to the three ancient monotheistic religions, which is of great importance in political, national, and other contexts. The research question is twofold: In what contexts are discussions taking place in the Hebrew Facebook-sphere around the Temple Mount? And, what are the leading social media venues where the Temple Mount is discussed? Data collection took place in 2017, when Israel celebrated 50 years since capturing the mount, and experienced a major security event—the “metal detector crisis,” followed by major clashes between Jews and Palestinians. We found that the Temple Mount is portrayed prominently in three contexts: national, religious, and security and that “ ordinary” social media interest in it is limited to groups of mostly nationalist and religious Jews who demand prayer rights on the mount and rarely cross to become an issue for the broader Israeli social media public until a major security development initiates an “ extraordinary” discourse involving many more individuals and groups. In one sense, the discourse about the Temple Mount is reminiscent of a “dormant volcano” that does not erupt regularly, but when it does, no one knows how the eruption will end. Lessons for the representation of holy places in social media are discussed.
European academic talents liminal position in China from the resource-based view
Authors: Mouritzen Mikkel Rønnow
Published: November 2022

This article explores global talent flows in a Chinese context before and immediately after the introduction of Covid-19 measures by focusing on European researchers’ migration experiences as liminal experiences betwixt and between space, institutions, and countries. These experiences are part of a broader understanding of global talent flows in a period where the Chinese economy is transforming from production-based to knowledge-based but simultaneously challenged by a global pandemic. Working with a mixed dataset that includes both semi-structured interviews and survey data, the paper finds that European researchers are under the impression that they are considered a valuable resource by their host institution. The paper explores the value of European researchers in China through the resource-based view and connects it to their ability to connect their Chinese institutions internationally and introduce new publication possibilities. However, by combining bridge decay with liminality, this paper also concludes that the liminal position that European researchers find themselves within is also a significant risk as some of the elements that make them valuable might be challenged by periods of crisis. Finally, China offers an extreme case as a rising science nation that is important to study continuously but even more so during a crisis.
Vaccine Hesitancy in COVID-19: A Behavioural Economics Approach—A Systematic Literature Review
Authors: Siram Bhargavi , Shah Muskaan , Panda Rasananda
Published: November 2022

The vaccination drive for the COVID-19 pandemic was initiated globally more than a year ago, with booster shots being the new addition currently. There are some setbacks regarding the acceptance of the vaccine that the government needs to tackle to achieve a fully vaccinated ecosystem. Vaccine hesitancy is not a new concept and has been witnessed by people for decades. In simple terms, vaccine hesitancy refers to a situation where people are reluctant to get vaccinated despite its availability. This is due to technological retrogression, superstitions, doubt towards the government and misinformation. This paper is a systematic literature review to analyse the behavioural economics theories shown by people towards vaccines in the SARS-CoV-2 pandemic. We aim to connect psychological and economic factors that lead to this hesitancy through behavioural economics. Availability bias, omission bias, confirmation bias, incentives, anticipated regret, illusory correlation, recency effect, tailoring and framing are the biases that influence decision-making under the behavioural economics framework. This paper is an attempt to analyse these principles and explain potential barriers to vaccine acceptance and intervention strategies for medical professionals and the state.

JEL Classifications: D03, D70, I18
Emergency Medicine Clinician Experiences Addressing Uncertainty in First-Trimester Bleeding
Authors: Nord Garrison A , Doty Amanda MB , Monick Andrew J , McCarthy Danielle M , Casten Robin J , Aldeen Amer Z , Nawrocki Philip S , Rising Kristin L
Published: November 2022

The purpose of this work is to understand Emergency Department (ED) clinicians’ experiences in communicating uncertainty about first-trimester bleeding (FTB) and their need for training on this topic. This cross-sectional study surveyed a national sample of attending physicians and advanced practice providers (APPs). The survey included quantitative and qualitative questions about communicating with patients presenting with FTB. These questions assessed clinicians’ frequency encountering challenges, comfort, training, prior experience, and interest in training on the topic. Of 402 respondents, 54% reported that they encountered challenges at least sometimes when discussing FTB with patients where the pregnancy outcome is uncertain. While the majority (84%) were at least somewhat prepared for these conversations from their training, which commonly addressed the diagnostic approach to this scenario, 39% strongly or moderately agreed that they could benefit from training on the topic. Because the majority of ED clinicians identified at least sometimes encountering challenges communicating with pregnant patients about FTB, our study indicates a need exists for more training in this skill.
Value Creation and Value Appropriation
Authors: Kumar V. , Srivastava Rajendra
Published: November 2022

This article discusses the nine research studies compiled for the Journal of Creating Value (JCV) special issue, which has embarked on securing a deeper understanding of the divergent aspects of defining, measuring and maximizing value. Altogether, the nine studies collectively offer insights in this regard that are applicable to a wide range of organizations. This special issue runs the gamut of management actions in terms of value management and prepares companies for the future. The proposed classification framework in this article categorizes the nine studies based on their focus on value creation potential and value appropriation potential. Further, this article identifies and delineates future research directions that extend beyond the path forward identified by each of the studies themselves. Overall, this article is aimed to serve as a guide to understand and appreciate this special issue on a topic of vital interest.
Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation
Authors: Teramoto Atsushi , Murahashi Yasutaka , Takahashi Katsunori , Watanabe Kota , Yamashita Toshihiko
Published: November 2022

Category:

Arthroscopy; Ankle; Sports

Introduction/Purpose:

Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, many reports have described postoperative cast immobilization and the avoidance of weight-bearing for a certain period of time. Accelerated rehabilitation (AR), in which the period of immobilization is kept to a minimum and early weight-bearing exercises are actively introduced, may be helpful for an early return to sport. The purpose of this study was to investigate the therapeutic outcomes of ALLR with AR including the minimum duration of postoperative ankle immobilization and proactive early weight-bearing.

Methods:

A total of 23 ankles of 22 patients (11 men, 11 women; mean age 38.7 years) who underwent ALLR for chronic lateral ankle instability were investigated. Postoperative management included the avoidance of weight-bearing until postoperative day (POD) 3, after which full weight-bearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. Preoperative and postoperative major symptoms, ankle range of motion (ROM), stress X-ray assessment, anterior translation (AT) measured with a capacitance-type strain sensor, the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated.

Results:

Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in ROM. There were significant improvements in the mean talar tilt angle (from 12° to 5.6°), in the mean anterior drawer distance (from 8.2 mm to 4.4 mm) on stress X-rays, and in the mean AT (from 10.5 mm to 4.6 mm). The JSSF scale improved significantly (from 68.8 to 96.8), and the SAFE-Q improved significantly on all subscales. Complete return to sport was achieved by 75% of the patients at 8 weeks after surgery.

Conclusion:

When AR with proactive weight-bearing exercises was implemented from POD 3 without ankle immobilization after ALLR, there were significant improvements in both objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.
CT Analysis of the Posteromedial Neurovascular Bundle in Patients with End Stage Ankle Arthritis for Planning of Total Ankle Replacement Surgery
Authors: Toumazos Kimon , Stavrou Peter , Gauthier-Kwan Olivier , Brown Christopher H.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Aim of this study is to identify reliable anatomical landmarks of the posterior tibial neurovascular bundle during Total Ankle Replacement (TAR) to minimise the risk of iatrogenic injury. Secondary aim is to identify if there is associated translation of the bundle when anterior translation of the talus is present.

Methods:

A radiological landmark protocol was devised to create a consistent method for measuring the relations of the bundle to the tibia, talus and medial gutter line when measured at levels mimicking those of resection undertaken in TAR. Analysis between patients with and without anterior subluxation was undertaken.

Results:

Total of 42 ankles were reviewed with 38% patient having anterior translation of the talus. At the tibiotalar joint, the bundle lies less than 5mm lateral to the medial gutter line and less than 8mm posterior to the posterior tibia. The same measurements at 10mm superior to the tibiotalar joint are less than 8mm and less than 6.5mm respectively. At 5mm distal to the dome of the talus, the bundle is less than 4mm lateral to the medial gutter line and between 8.4-16.0mm posterior to the posterior talus. The bundle to posterior tibia distance does not increase in the sagittal plane for patients with anterior subluxation of the talus.

Conclusion:

This study provides relevant guidance for surgeons to use intraoperatively when undertaking tibial and talus resections in TAR to identify their relations to the vulnerable neurovascular structures. The measurements of this study indicate for the first time that there is not an increased risk of iatrogenic injury during bone resection at the tibia in patients with anterior subluxation of the talus.
Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery and Higher Ambulation Rates Than Below- Knee Amputation
Authors: Trimm Conner D. , Ordaz Angel , Pedowitz Jason M. , Foran Ian M.
Published: November 2022

Category:

Diabetes; Midfoot/Forefoot; Trauma; Other

Introduction/Purpose:

The level of amputation in patients with severe lower extremity pathology often presents a challenge. Surgeons are often confronted with deciding between a transmetatarsal amputation (TMA) or below-knee amputation (BKA). Certainly, in cases where patients are candidates for a TMA, the decision might seem rather straightforward. However, the literature has demonstrated that minor foot amputations, like TMAs, often have high rates of revision and often necessitate a higher level of amputation. This study compared revision rates, need for higher level of amputation, post-operative ambulatory rates, and the demographics between patients undergoing either TMA or BKA.

Methods:

This was a retrospective analysis of patients who underwent BKA or TMA and received follow-up care at a single academic medical center from January of 2013 to May of 2021. Demographic and medical historical data was collected and compared between patients undergoing BKA or TMA. A binary logistic regression model was used to evaluate independent predictors for necessitation of revision surgery and/or higher levels of amputation between the two groups. Secondary outcomes included hospital length of stay, as well as ambulatory and wound status at last patient follow-up. Statistical significance was defined as p<.05.

Results:

A total of 367 patients underwent either BKA (n=293) or TMA (n=74). On binary logistic regression, significant independent predictors of needing surgical revision were undergoing TMA (OR 2.29, CI 1.23-4.27, p=.009) and peripheral arterial disease (PAD) (OR 2.28, CI 1.12-4.6, p=.023). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.4, CI 2.01-9.63, p<.001) and presence of PAD (OR 6.18, CI 2.12- 17.98, p<.001). Secondary outcomes showed that more TMA patients were ambulatory (56.8%) on last follow-up compared to BKA patients (30.9%). Hospital length of stay was significantly greater in the BKA group (17.3 +- 21.2) vs the TMA group (13.6 +- 10.9) (p=.04). There was no significant difference between BKA and TMA groups with respect to healed incisions at last follow-up (58.3% and 51.4% respectively).

Conclusion:

This study found transmetatarsal amputations to have a higher risk of re-operation and need for revision amputation compared to below-knee amputations. Transmetatarsal amputations had a higher chance of returning patients to independent ambulation. These findings are consistent with the literature suggesting higher reoperation rates in minor foot amputations. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations warranting further vascular work-up for patients with severe PAD and absent pulses.
Prevalence of Orthopaedic Knee Scooter-Related Injury: Risk Factor Analysis and Patient Safety Perceptions in a Prospective Cohort
Authors: Walsh John P. , Hsiao Mark S. , Rosevear Landon , McDermott Ryland , Gupta Shivali , Watson Troy S.
Published: November 2022

Category:

Other; Trauma

Introduction/Purpose:

There is a paucity of research investigating the harms associated with the orthopaedic knee scooter (OKS) and patient safety perceptions. This prospective study aimed to define the prevalence of OKS-related injuries, identify patient risk factors and describe the patient perceptions of OKS safety.

Methods:

This single-surgeon prospective study recruited a cohort of 134 consecutive patients undergoing surgery at a community-based orthopaedic clinic from 6/2020 to 4/2021. Our primary outcome informed an a priori power analysis. Standardized data collection protocol included three forms that patients completed. The prevalence of OKS-related injury, patient risk factors, and patient perceptions were analyzed. Alpha values of P <0.05 were considered statistically significant, and a 95% confidence interval was reported (95CI).

Results:

There were 118 (88%) patients eligible for analysis. The prevalence of patient falls was 37.3% (44/118), and the prevalence of patient injury was 15.3% (18/118). A sedentary lifestyle was a significant risk factor (P=0.001) for injury, with a relative risk of 3.32 (1.47- 7.46 95CI) and an absolute risk difference of 26%. Age, height, weight, diabetes was not found to be risk factors for injury. Patient perception of OKS safety at study enrollment (P=0.049) and study exit (P=0.004) were significantly lower for injured patients.

Conclusion:

Despite a high prevalence of patient falls, there is a low absolute risk of injury. Sedentary patients are at increased risk of OKS-related injury. Patients with a history of injury perceive OKSs to be less safe and are less likely to use an OKS in the future but are not less likely to recommend an OKS to a friend. Future studies should verify prevalence data in multiple settings and assess the effectiveness of patient education or surgeon screening measures in reducing OKS-related injury.
How Does Surgical Technique Affect Fluid Permeability? A Laboratory Study Comparing Nanofracture, Microfracture and Fine Wire Drilling Approaches
Authors: Warren James , Brockett Claire , Canden Ahranee , Farndon Mark A.
Published: November 2022

Category:

Basic Sciences/Biologics; Ankle; Arthroscopy; Sports

Introduction/Purpose:

Current surgical practice for the treatment of osteochondral lesions in the ankle involves using one of three techniques to promote blood flow from subchondral bone tissue to the defect site, improving the rate of healing. These different techniques: - fine-wire drilling, nanofracture and microfracture, involve disrupting the trabecular bone. However, the size and method of these techniques means this varies in terms of penetration depth and diameter. Additionally, each technique causes differing degrees of damage to the trabecular structure, and the ability of fluid to flow through the porous structure. The aim of this study was to compare the influence of the different techniques on the fluid permeability of the tissue following by assessing the flow of radiopaque contrast agent using μCT image analysis.

Methods:

Fresh-frozen cadaveric tali specimens (n=12) were prepared through creating a 10mm diameter chondral defect in three different regions of each talus. Each region then underwent one of three surgical techniques: 1) Fine wire drilling, 2) Nanofracture or 3) Microfracture, undertaken by a single surgeon.0.1 ml radiopaque contrast agent (OmnipaqueTM 300) was then added to each region and imaged using a clinical μCT scanner (SCANCO Medical AG, 73.6 μm resolution) The amount of contrast agent that permeated through each different region was assessed through imaging processing.

Results:

The μCT analysis indicated that across the 12 samples, eight nanofracture regions demonstrated flow of contrast agent to the depth of the fracture site or deeper. Some lateral flow was also observed in these sites. Eight microfracture regions demonstrated that the flow of contrast agent was localised to the fracture site and a preferential flow laterally. In only one sample, did a fine wire drilling region demonstrate any fluid flow. In this sample, contrast agent had permeated through the drilling site to the bottom and some sub-site permeation was observed. However, in all samples that showed no permeation of contrast agent through the fracture site, there was a layer of contrast agent on the chondral surface or minor permeation through to the sub- chondral surface.

Conclusion:

Nanofracture showed improved fluid permeability throughout the surrounding trabecular structure, when compared to microfracture and fine wire drilling. Microfracture appears to allow some fluid flow, but this is confined to the immediate area around the fracture site, while fine wire drilling appears to allow almost no fluid flow through the surrounding trabecular tissue. This conclusion is reinforced by previous literature that concluded the damage to the structure of the trabecular tissue is reduced when using nanofracture, compared to the other two techniques.
Dual Posteromedial Portal Technique for Surgical Repair of an Unstable Medial Meniscal Ramp Lesion
Authors: Green Joshua S. , Yalcin Sercan , Moran Jay , McLaughlin William M. , Medvecky Michael J.
Published: November 2022

Background:

Medial meniscal ramp lesions, which commonly occur in the setting of anterior cruciate ligament (ACL) ruptures, are defined as structural lesions at the medial meniscocapsular junction and can involve the posteromedial capsular attachments or most peripheral aspect of the meniscus. Unstable ramp lesions can lead to rotational instability within the knee and may play a role in ACL graft failure if left untreated. The novel use of dual posteromedial portals, similar to those used in an arthroscopic labral repair, may allow for enhanced visualization, optimal access to the posteromedial compartment, and easier manipulation of the instrumentation for successful surgical repair of hidden ramp lesions.

Indications:

Surgical repair of medial meniscal ramp lesions is indicated in patients with a clinically unstable meniscus when probed during arthroscopy.

Technique Description:

This surgical technique video demonstrates a dual posteromedial portal arthroscopic approach to repair an unstable medial meniscal ramp lesion using a case example from a patient with a concomitant ACL rupture.

Results:

Surgical repair of medial meniscal ramp lesions has been reported to show improvements in meniscus healing and knee stability.

Discussion/Conclusion:

The use of dual posteromedial portals offers improved accessibility to the posteromedial compartment of the knee and provides excellent visibility during the surgical repair of a medial meniscal ramp lesion. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Aetiology of hospitalized fever and risk of death at Arua and Mubende tertiary care hospitals in Uganda from August 2019 to August 2020
Authors: Blair Paul W. , Kobba Kenneth , Kakooza Francis , Robinson Matthew L. , Candia Emmanuel , Mayito Jonathan , Ndawula Edgar C. , Kandathil Abraham J. , Matovu Alphonsus , Aniku Gilbert , Manabe Yukari C. , Lamorde Mohammed
Published: November 2022

Background

Epidemiology of febrile illness in Uganda is shifting due to increased HIV treatment access, emerging viruses, and increased surveillance. We investigated the aetiology and outcomes of acute febrile illness in adults presenting to hospital using a standardized testing algorithm of available assays in at Arua and Mubende tertiary care hospitals in Uganda.

Methods

We recruited adults with a ≥ 38.0 °C temperature or history of fever within 48 h of presentation from August 2019 to August 2020. Medical history, demographics, and vital signs were recorded. Testing performed included a complete blood count, renal and liver function, malaria smears, blood culture, and human immunodeficiency virus (HIV). When HIV positive, testing included cryptococcal antigen, CD4 count, and urine lateral flow lipoarabinomannan assay for tuberculosis. Participants were followed during hospitalization and at a 1-month visit. A Cox proportional hazard regression was performed to evaluate for baseline clinical features and risk of death.

Results

Of 132 participants, the median age was 33.5 years (IQR 24 to 46) and 58.3% (n = 77) were female. Overall, 73 (55.3%) of 132 had a positive microbiologic result. Among those living with HIV, 31 (68.9%) of 45 had at least one positive assay; 16 (35.6%) had malaria, 14 (31.1%) tuberculosis, and 4 (8.9%) cryptococcal antigenemia. The majority (65.9%) were HIV-negative; 42 (48.3%) of 87 had at least one diagnostic assay positive; 24 (27.6%) had positive malaria smears and 1 was Xpert MTB/RIF Ultra positive. Overall, 16 (12.1%) of 132 died; 9 (56.3%) of 16 were HIV-negative, 6 died after discharge. High respiratory rate (≥ 22 breaths per minute) (hazard ratio [HR] 8.05; 95% CI 1.81 to 35.69) and low (i.e., < 92%) oxygen saturation (HR 4.33; 95% CI 1.38 to 13.61) were identified to be associated with increased risk of death.

Conclusion

In those with hospitalized fever, malaria and tuberculosis were common causes of febrile illness, but most deaths were non-malarial, and most HIV-negative participants did not have a positive diagnostic result. Those with respiratory failure had a high risk of death.
Spatiotemporal dynamics and potential ecological drivers of acute respiratory infectious diseases: an example of scarlet fever in Sichuan Province
Authors: Li Cheng , Liao Rujun , Zhu Wenhui , Jiang Guiyu , Wang Yumeng , Li Ling , Zhang Tao , Lv Qiang
Published: November 2022

Object

Scarlet fever is an acute respiratory infectious disease that endangers public health and imposes a huge economic burden. In this paper, we systematically studied its spatial and temporal evolution and explore its potential ecological drivers. The goal of this research is to provide a reference for analysis based on surveillance data of scarlet fever and other acute respiratory infectious illnesses, and offer suggestions for prevention and control.

Method

This research is based on a spatiotemporal multivariate model (Endemic-Epidemic model). Firstly, we described the epidemiology status of the scarlet fever epidemic in Sichuan Province from 2016 to 2019. Secondly, we used spatial autocorrelation analysis to understand the spatial pattern. Thirdly, we applied the endemic-epidemic model to analyze the spatiotemporal dynamics by quantitatively decomposing cases into endemic, autoregressive, and spatiotemporal components. Finally, we explored potential ecological drivers that could influence the spread of scarlet fever.

Results

From 2016 to 2019, the incidence of scarlet fever in Sichuan Province varied much among cities. In terms of temporal distribution, there were 1–2 epidemic peaks per year, and they were mainly concentrated from April to June and October to December. In terms of transmission, the endemic and temporal spread were predominant. Our findings imply that the school holiday could help to reduce the spread of scarlet fever, and a standard increase in Gross Domestic Product (GDP) was associated with 2.6 folds contributions to the epidemic among cities.

Conclusion

Scarlet fever outbreaks are more susceptible to previous cases, as temporal spread accounted for major transmission in many areas in Sichuan Province. The school holidays and GDP can influence the spread of infectious diseases. Given that covariates could not fully explain heterogeneity, adding random effects was essential to improve accuracy. Paying attention to critical populations and hotspots, as well as understanding potential drivers, is recommended for acute respiratory infections such as scarlet fever. For example, our study reveals GDP is positively associated with spatial spread, indicating we should consider GDP as an important factor when analyzing the potential drivers of acute infectious disease.