bluuebunny/crossref_metadata_2025 huggingface dataset:
Cyclic Fatigue and Creep Resistance Testing of the PUMA SystemTM
Authors: Ellington J. Kent , Stecco Kathy
Published: January 2022

Category:

Ankle; Basic Sciences/Biologics; Trauma

Introduction/Purpose:

The PUMA System (Panther Orthopedics, Sunnyvale, CA) is an FDA cleared. superelastic, nitinol based fixation device for the ankle syndesmosis which provides stabilization without over-compression or loosening due to creep from cyclic loading. Objective The objective of this study was to test resistance to lengthening (creep) of the PUMA System in cyclic fatigue testing.

Methods:

Five PUMA System devices, each having a nitinol Body consisting of six layers, were cycle-tested between 20/40 pounds per cubic foot (lb/ft3) polyurethane foam Bone Blocks (Figure 1).[1] The PUMA System devices were set up with an initial device Active Length of approximately 66 millimeters (mm) between their polyether ether ketone (PEEK) Anchor buttons. All devices were tightened to a minimum of 11.1 Newtons (2.5 pounds force) and cycled at 5 cycles per second (5 Hz) for 4500 cycles to 2.4 mm displacement. Device Active Length was recorded pre- and post-testing. Devices were visually inspected for any break in the 30 nitinol layers. [1] ASTM F1839: Standard Specification for Rigid Polyurethane Foam for Use as a Standard Material for Testing Orthopedic Devices and Instruments.

Results:

None of the 30 layers incorporated in the 5 PUMA SystemTM device Bodies failed due to cyclic fatigue. Also, there was little-to-no difference between pre- and post-testing Active Length ( Figure 2 ). More specifically an average increase of only 0.2% in length with a with a Standard Deviation of 0.16% evidences no significant creep (Table 1).

Conclusion:

The PUMA SystemTM allows for ankle syndesmosis repair with an implant that experiences no significant creep as demonstrated in cyclic-fatigue testing under challenging displacement cycle testing.
A Biomechanical Investigation on the Effects of Deep Deltoid Ligament Repair Combined with Flexible and Rigid Syndesmotic Fixation
Authors: Femino John E. , Hajewski Christina , Goetz Jessica E. , Duchman Kyle R.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

The role of deep deltoid ligament (DDL) repair in the setting of an unstable syndesmotic injury is largely unknown, and the optimal fixation strategy for syndesmosis stabilization is controversial. The purpose of this study was to investigate the effect of an augmented, anatomic repair of the DDL combined with flexible or rigid syndesmotic stabilization using a cadaveric model.

Methods:

10 pairs of fresh-frozen through knee cadaveric specimens were used for biomechanical testing which included subjecting the specimens to 5 Nm of external rotation torque while under 750 N of axial compression. Whole-foot rotation angles were measured and rotation and translation of the fibula, tibia, and talus were tracked with optical motion capture. Specimens were tested intact and then after destabilization by sectioning the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament, interosseous ligament and membrane extending 7 cm proximal to the ankle joint, and both bands of DDL. The intact fibula was a surrogate for an anatomically fixed fibula. Each specimen underwent mechanical testing both with and without DDL reconstruction added to flexible syndesmotic stabilization using a suture button (SB) plus AITFL reconstruction. In the final test, the syndesmosis was rigidly stabilized using a 4.5 mm screw.

Results:

Destabilization increased the foot rotation under the applied axial load and torque to 170% (+-49%) of that of the intact case. After flexible syndesmotic stabilization (AITFL + SB) foot rotation was 109% (+-26%) of intact condition. Addition of the deltoid ligament reconstruction (AITFL + SB + DD) reduced rotation to 87% (+-31%) of the intact condition. Fixation with a screw alone came closest to the rotation of the intact specimen (93% +- 17% of intact), and like the flexible repair, the addition of DDL reconstruction to the screw increased rotational stability (85% +- 35% of intact).

Conclusion:

DDL reconstruction provides improved resistance to external rotation stress when added to both flexible and rigid syndesmotic stabilization. Although our results with both the flexible and rigid constructs demonstrated increased constraint to external rotation stress compared to the intact specimen, these results should be thought of as time zero data, and the implants likely experience some creep with early motion and graduated weight bearing. Our demonstration of increased stability with a deltoid ligament reconstruction suggests that this addition may be beneficial for unstable syndesmotic injuries.
Predictors of Deformity in Patients with Progressive Collapsing Foot Deformity and Valgus of the Ankle
Authors: Mansur Nacime S. , Lalevee Matthieu , Vivtcharenko Victoria , Dibbern Kevin N. , Ellis Scott J. , Deland Jonathan T. , Godoy-Santos Alexandre L. , Femino John E. , Auch Elijah , Netto Cesar de Cesar
Published: January 2022

Category:

Ankle; Hindfoot

Introduction/Purpose:

Markers of diagnosis and severity are well studied in patients with Progressive Collapsing Foot Deformity (PCFD). Medial facet subluxation (MFS) in weight-bearing computerized tomography (WBCT) has been established as an indicator of peritalar subluxation and an earlier detector of the disease. When the disease affects the ankle leading to a valgus talar tilt (class E), structures distal to this topography may behavior differently, trying to compensate proximal deformity. The aim of this study is to assess predictors of deformity in PCFD patients with and without valgus of the ankle. Our hypothesis is that MFS could not be used in class E patients as an accurate value for estimation and staging of PCFD.

Methods:

In this IRB-approved retrospective case-control study we analyzed WBCT acquisitions of 21 consecutive patients with PCFD presenting valgus of the ankle and 64 controls (flexible PCFD with no ankle involvement). MFS (percentage of uncoverage), middle facet incongruence angle, middle cuneiform-to-floor distance, forefoot arch angle, talonavicular uncoverage angle, hindfoot moment arm (HMA), Foot and Ankle Offstet (FAO) and talar tilt angle (TTA) were obtained and compared between groups using oneway ANOVA. A multivariate regression analysis was performed to evaluate which of the measurements influenced the alignment. A partition prediction model was also constructed to find how the variables contributed to the deformity and its aspects. Statistical significancy was set in p values <0.05.

Results:

We found differences among groups only for MFS, HMA, FAO and TTA, with a lower mean value of MFS in patients with valgus of the ankle. An inverse relation between MFS and TTA was obtained in this group, demonstrated by increase in the talar tilt and decrease in middle facet uncoverage. MFS affected FAO values in the control group (R2: 0.25) but not in the ankle valgus group (R2: 0.001), being that this last one was influenced mainly by the TTA (R2: 0.53). A FAO value higher than 12.14 was found to be a strong predictor of deformity at the ankle.

Conclusion:

MFS was lower in patients with PCFD and valgus of the ankle, demonstrated as a weak predictor of deformity severity. In this group of patients (class E), talar tilt angle and Foot and Ankle Offset should be used as disease markers. A FAO value above 12.14 must be appreciated as a possible sign of ankle involvement in PCFD patients.
Do Closed Suction Drains Affect Postoperative Wound Healing after Total Ankle Arthroplasty?
Authors: Moncman Tara G. , Fliegel Brian E. , Hameed Daniel , O'Neil Joseph T. , Pedowitz David I. , Daniel Joseph N.
Published: January 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Although most studies demonstrate no clear benefit of closed suction drains after total joint arthroplasty of the hip, knee, and shoulder, there is no study that has specifically looked at ankle arthroplasty. Despite the paucity of information regarding the potential benefit or lack thereof with postoperative closed suction drains after total ankle arthroplasty, they are still utilized in practice. The purpose of this study is to determine whether or not the use of closed suction drains after total ankle arthroplasty have an affect on wound complications in the first postoperative year.

Methods:

Following a 3:1 match of patients with-drains to those without-drains, 78 patients with-drains and 28 without-drains were included for analysis. The drain group consisted of patients who had drains placed in the immediate postoperative period and removed prior to discharge from the hospital. The without-drains group acted as the control. Demographic data including age, sex, tobacco use, alcohol use, and medical comorbidities (diabetes, bleeding disorders, anemia, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, history of leg ulcers or staphylococcus infection) were obtained. Follow-up data was collected and reviewed at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, for minor and major wound complications, as well as wound-related re-operations.

Results:

At 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, there was no statistically significant difference in wound complications with or without the use of a drain. Within the first postoperative year, a total of 4 (14.3%) patients with- drains and 24 (30.8%) patients without-drains had a wound complication. This was not statistically significant (p=0.148). The majority of wound complications were minor. A single superficial infection and two reoperations for major wound complications were noted, all of which were in patients who had a drain placed. Age, sex, tobacco use, alcohol use, as well as a history of diabetes, bleeding disorders, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, and history of leg ulcers or staphylococcus infection were similar between both groups. A history of anemia was significantly higher in the drain group, however this was not associated with an increased risk of postoperative wound complications.

Conclusion:

The use of a closed suction drain did not have an effect on postoperative wound complications in the first year after total ankle arthroplasty surgery. Based on the equivocal results in this study and that there is no clear consensus on the use of drains after total ankle arthroplasty surgery, the authors feel it is up to the individual surgeon to determine the necessity of use on a case-by-case basis.
Correlation of First Metatarsal Sagittal Alignment with Clinical and Functional Outcomes Following the Lapidus Procedure
Authors: Nishikawa Danilo Ryuko , Duarte Fernando A. , Saito Guilherme H. , Miranda Bruno R. , Netto Cesar de Cesar , Prado Marcelo P.
Published: January 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Lapidus procedure (LP) for hallux valgus (HV) requires an adequate control of first metatarsal (M1) sagittal alignment to avoid dorsiflexion. Otherwise, clinical and functional impairment, including transfer metatarsalgia may occur. This study aimed to evaluate the effects of pre- and postoperative measurements of M1 sagittal alignment on clinical and functional outcomes, and whether these variations would lead to transfer metatarsalgia or not.

Methods:

29 patients (36 feet) with a mean follow-up of 20 months after LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. M1 sagittal alignment analysis was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Decrease of FMDA means that the M1 dorsiflected (Figure 1). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were assessed. Radiographic, clinical and functional measurements were compared. Intraclass Correlation Coefficients (ICC) were calculated for FMDA and MA. Linear regression was used to assess the association of Δ-FMDA and Δ-MA with clinical and functional questionnaires. Based on that, we assessed our sample at different cut-off points to evaluate whether a given Δ-FMDA and/or Δ-MA measurement was significantly related to the Δ-Questionnaires.

Results:

Pre- and postoperative ICC of FMDA was 0.90 and 0.91 and MA was 0.94 and 0.88, respectively. FMDA showed significant variation after the LP, but MA did not. IMA and HVA improved significantly. Significant clinical and functional improvement were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between ΔFMDA with Δ-PCS-12 and Δ-LEFS (p=.028 and p=.02, respectively), meaning that excessive dorsiflexion of M1 as measured by FMDA led to a decrease in PCS-12 and LEFS. We found that at the cut-off point of quartile 50%, in which our sample was divided equally, patients with Δ-FMDA below 3.2 degrees of dorsiflexion had significantly improved results on Δ-PCS-12 compared to those with greater values (p=.029) (Figure 2).

Conclusion:

The present study showed that excessive dorsiflexion of M1 led to decreased outcome scores as measured by PCS- 12 and LEFS. It supports that M1 dorsiflexion should be avoided after the LP. However, slight dorsal deviation can occur and, even so, satisfactory outcomes can be obtained. Further prospective and comparative studies with larger populations are required to evaluate the effects of M1 inclination on clinical and functional outcomes.
Union Rates of Talar Neck Fractures with Critical Bone Defects Treated with Autograft
Authors: Patch David A. , McMurtrie James T. , Frazier Mason , Wills Bradley , Prather John C. , Viner Gean C. , Hill Margie J. , Johnson Michael D.
Published: January 2022

Category:

Trauma

Introduction/Purpose:

The purpose of this study was to evaluate union of talar neck fractures with critical bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. We hypothesized that acute autografting leads to reliable union rates.

Methods:

A case series at a Level I trauma center was performed to identify patients who underwent open reduction and internal fixation of talar neck fracture with proximal tibial autograft between 2015 and 2018. Inclusion criteria were age greater than 18 years and displaced talar neck fracture with critical bone defect treated with tibial autograft. Critical bone defect was defined as a gap greater than 5mm in the sagittal plane and greater than 1/3 of the width of the talar neck in the coronal plane. Post-operative foot CT scans were obtained for all patients to assess for union. Primary outcome was union and secondary outcomes were malunion, avascular necrosis, post-traumatic arthritis, and patient-reported outcomes (PRO) including PROMIS (Patient Reported Outcomes Measurement Information System), Foot and Ankle Measurements: Activity of Daily Living and Sports (FAAM ADL/Sports), Visual Analogue Scale for feet (VAS), Foot Function Index (FFI), and Short Form-36 (SF-36).

Results:

Twelve patients were included in the series. The average age was 34 years (17-59). The Hawkins classification of the fractures were four type II (33%) and eight type III (67%). Five fractures (42%) were extruded tali. Four fractures (33%) were open fractures, all being type III fractures. Union was achieved in eleven patients (92%). Nonunion occurred in one patient (8%), who had an open, extruded talus fracture and was a heavy smoker. Avascular necrosis occurred in 11 patients (92%). Ten patients (83%) had radiographic tibiotalar post-traumatic arthritis (PTA), and 12 patients (100%) developed subtalar PTA. Average PROMIS score was 37 (32-45) and average FAAM ADL and Sports was 61 (31-87) and 31 (0-71), respectively. Average VAS was 5 (0-10) and average FFI was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients.

Conclusion:

Tibial autograft in primary osteosynthesis of comminuted talar neck fractures with critical bone defects leads to reliable union rates and is an operative strategy that should be considered when treating these difficult fractures. Despite high union rates, secondary outcomes of AVN, PTA, and below-average PRO still occurred in the majority of patients.
Depressive Disorders Lead to Increased Complications after Pilon Fracture Surgery
Authors: Tahmid Syed , Broggi Matthew S. , Allen Jerad , Hernandez-Irizarry Roberto
Published: January 2022

Category:

Trauma; Other

Introduction/Purpose:

Given the increased survival of the polytrauma patient, the incidence of tibial pilon fractures has increased. Preoperative depression has been linked with worse morbidity and mortality following lower extremity surgery, however its effect on outcomes following tibial pilon fractures has not been studied. This studies purpose was to investigate the relationship between preoperative depression and potential complications following tibial pilon fracture surgery.

Methods:

This retrospective study utilized the Truven Marketscan claims database to identify patients who underwent outpatient tibial pilon fracture surgery from January 2009 to December 2018 based on Common Procedure Terminology (CPT) codes. The two cohorts entailed patients with and without preoperative depression based on International Classification of Diseases (ICD codes. The associated between preoperative depression and common postoperative complications following tibial pilon fracture was analyzed using chi square testing and multivariate analysis.

Results:

In total, 4,795 patients were identified for analysis. In those patients with preoperative depression, the complications associated with the greatest increased odds were infection (OR 1.59), wound complication (OR 1.31), ED visit pain (OR 1.29), hardware complications (OR 1.22), and DVT/PE (OR 1.14).

Conclusion:

Increased complications and use of healthcare resources have been associated following tibial pilon fracture surgery in persons with a preoperative diagnosis of depression. Acknowledgement of patient's preoperative depression can allow surgeons to tweak treatment protocols before and after surgery. Additional studies should be conducted to investigate the degree of modifiability of depression as a risk factor.
Relationships among mental health, social capital and life satisfaction in rural senior older adults: a structural equation model
Authors: Wang Xiaolei , Wang Panpan , Wang Peng , Cao Meijuan , Xu Xianrong
Published: January 2022

Background

Literature about life satisfaction in rural senior older adults is scarce. The aim of this research was to examine the relationships among mental health, social capital and life satisfaction in rural senior older adults.

Methods

This was a cross-sectional study. From July to October 2017, 245 senior older adults from 14 villages of Jinhua City in China were recruited. The Satisfaction with Life Scale (SWLS), the Chinese Version of the 12-item General Health Questionnaire (GHQ-12), the Social Capital Questionnaire (SCQ) and a self-designed questionnaire was administered to the participants. Structural equation modelling was implemented to analyse the relationships between mental health, social capital and life satisfaction in rural senior older adults.

Results

The structural equation model was fitting adequately (χ2/df = 1.785, P < 0.001; RMSEA = 0.059; CFI = 0.963). Life satisfaction was positively affected by income (β = 0.243, P = 0.01). Likewise, community canteen services improved life satisfaction (β = 0.288, P = 0.001). Social capital had direct positive prediction on life satisfaction (β = 0.342, P = 0.003) and indirectly improved life satisfaction through mental health (β =0.183, P = 0.007). Life satisfaction was impaired by poor mental health among senior older adults (β = − 0.395, P < 0.026).

Conclusions

Life satisfaction among rural senior older adults is a multifaceted well-being construct affected by income, community canteen services, social capital and mental health. The presented model highlights the positive effect of income, community canteen services, social capital and mental health. Appropriate home-based aged care, programs and policies are needed.
Impact of pre-event testing and quarantine on reducing the risk of COVID-19 epidemic rebound: a modelling study
Authors: Wong Ngai Sze , Lee Shui Shan , Mitchell Kate M. , Yeoh Eng-kiong , Wang Cheng
Published: January 2022

Background

With the evolving growth of the COVID-19 epidemic, travel restriction policies would need to be adjusted accordingly. Prohibition of mass event may be relaxed for social and economic benefits when virus transmission stops but could bear the risk of epidemic rebound. Against the background of the varied SARS-CoV-2 prevalence internationally, we modelled the potential impacts of pre-event interventions on epidemic risk of holding a mass event when COVID-19 is under control.

Methods

We developed a mathematical model of SARS-CoV-2 transmission in Guangdong Province, China, where local virus transmission ceased to occur. A large-scale international trade fair was assumed to be held, with influx of people from overseas and rest of China over a short period of time, who participated for 2-week. Scenarios of pre-event intervention (none, quarantine arrangement and polymerase chain reaction (PCR) testing for participants) were compared. The influence of contact pattern, SARS-CoV-2 prevalence outside the province and China, and testing coverage were examined in sensitivity analyses.

Results

In basecase scenario (no event), the epidemic has been under control since March 2020. The event would lead to the detection of 1% more confirmed cases by 31 July when community contact rate increases to pre-epidemic level. In event scenario without additional interventions, there would be 599 (93%) more new infections comparing with basecase scenario. To avert new infections, quarantining all participants before the event would be the most effective strategy, followed by quarantining all overseas participants and testing all other participants, and testing all participants before the event and on day 7. However, testing strategy is likely to be affected by the SARS-CoV-2 prevalence outside the event province.

Conclusions

Pre-event interventions are effective for reducing the risk of epidemic rebound caused by an international large-scale event. Universal testing for participants is likely to be an effective and feasible intervention.
Implementation fidelity of a nurse-led RCT-tested complex intervention, care coordination for health promotion and activities in Parkinson’s disease (CHAPS) in meeting challenges in care management
Authors: Connor Karen I. , Siebens Hilary C. , Mittman Brian S. , Ganz David A. , Barry Frances , McNeese-Smith Donna K. , Cheng Eric M. , Vickrey Barbara G.
Published: January 2022

Background

Parkinson’s disease (PD) complexity poses challenges for individuals with Parkinson’s, providers, and researchers. A recent multisite randomized trial of a proactive, telephone-based, nurse-led care management intervention - Care Coordination for Health Promotion and Activities in Parkinson’s Disease (CHAPS) - demonstrated improved PD care quality. Implementation details and supportive stakeholder feedback were subsequently published. To inform decisions on dissemination, CHAPS Model components require evaluations of their fidelity to the Chronic Care Model and to their implementation. Additionally, assessment is needed on whether CHAPS addresses care challenges cited in recent literature.

Methods

These analyses are based on data from a subset of 140 intervention arm participants and other CHAPS data. To examine CHAPS Model fidelity, we identified CHAPS components corresponding to the Chronic Care Model’s six essential elements. To assess implementation fidelity of these components, we examined data corresponding to Hasson’s modified implementation fidelity framework. Finally, we identified challenges cited in current Parkinson’s care management literature, grouped these into themes using open card sorting techniques, and examined CHAPS data for evidence that CHAPS met these challenges.

Results

All Chronic Care Model essential elements were addressed by 17 CHAPS components, thus achieving CHAPS Model fidelity. CHAPS implementation fidelity was demonstrated by adherence to content, frequency, and duration with partial fidelity to telephone encounter frequency. We identified potential fidelity moderators for all six of Hasson’s moderator types. Through card sorting, four Parkinson’s care management challenge themes emerged: unmet needs and suggestions for providers (by patient and/or care partner), patient characteristics needing consideration, and standardizing models for Parkinson’s care management. CHAPS activities and stakeholder perceptions addressed all these themes.

Conclusions

CHAPS, a supportive nurse-led proactive Parkinson’s care management program, improved care quality and is designed to be reproducible and supportive to clinicians. Findings indicated CHAPS Model fidelity occurred to the Chronic Care Model and fidelity to implementation of the CHAPS components was demonstrated. Current Parkinson’s care management challenges were met through CHAPS activities. Thus, dissemination of CHAPS merits consideration by those responsible for implementing changes in clinical practice and reaching people in need.

Trial registration

ClinicalTrials.gov as NCT01532986, registered on January 13, 2012.
Inequalities in prevalence of birth by caesarean section in Ghana from 1998-2014
Authors: Okyere Joshua , Duah Henry Ofori , Seidu Abdul-Aziz , Ahinkorah Bright Opoku , Budu Eugene
Published: January 2022

Background

Caesarean section (CS) is an intervention to reduce maternal and perinatal mortality, for complicated pregnancy and labour. We analysed trends in the prevalence of birth by CS in Ghana from 1998 to 2014.

Methods

Using the World Health Organization’s (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1998-2014 Ghana Demographic and Health Surveys (GDHS) were analysed with respect of inequality in birth by CS. First, we disaggregated birth by CS by four equity stratifiers: wealth index, education, residence, and region. Second, we measured inequality through simple unweighted measures (Difference (D) and Ratio (R)) and complex weighted measures (Population Attributable Risk (PAR) and Population Attributable Fraction (PAF)). A 95% confidence interval was constructed for point estimates to measure statistical significance.

Results

The proportion of women who underwent CS increased significantly between 1998 (4.0%) and 2014 (12.8%). Throughout the 16-year period, the proportion of women who gave birth by CS was positively skewed towards women in the highest wealth quintile (i.e poorest vs richest: 1.5% vs 13.0% in 1998 and 4.0% vs 27.9% in 2014), those with secondary education (no education vs secondary education: 1.8% vs 6.5% in 1998 and 5.7% vs 17.2% in 2014) and women in urban areas (rural vs urban 2.5% vs 8.5% in 1998 and 7.9% vs 18.8% in 2014). These disparities were evident in both complex weighted measures of inequality (PAF, PAR) and simple unweighted measures (D and R), although some uneven trends were observed. There were also regional disparities in birth by CS to the advantage of women in the Greater Accra Region over the years (PAR 7.72; 95% CI 5.86 to 9.58 in 1998 and PAR 10.07; 95% CI 8.87 to 11.27 in 2014).

Conclusion

Ghana experienced disparities in the prevalence of births by CS, which increased over time between 1998 and 2014. Our findings indicate that more work needs to be done to ensure that all subpopulations that need medically necessary CS are given access to maternity care to reduce maternal and perinatal deaths. Nevertheless, given the potential complications with CS, we advocate that the intervention is only undertaken when medically indicated.
Diagnostic clues of IOP pulsation on applanation tonometry in carotid-cavernous fistula patients
Authors: Lee Hyunkyu , Yoon Sumin , Baek Sehyun
Published: January 2022

Background

Carotid-cavernous fistula (CCF) is an abnormal communication between the cavernous sinus and the carotid arterial system and exhibits typical symptoms of red eye, diplopia, blurred vision, headache, and murmur. However, the symptoms for CCF may vary and can lead to misdiagnosis. IOP pulsations provide a hint leading to suspicion of CCF. We report three cases related to CCF differential diagnosis: two cases of CCF patients and one case of conjunctivitis with corkscrew conjunctival vessels.

Case presentation

The case 1 patient, with a typical unilateral CCF, exhibited significant IOP pulsation in Goldmann tonometry measurements in the affected eye. The case 2 patient did not show typical symptoms of CCF except asymmetric upper eyelid swelling (right > left). In clinical evaluation, IOP elevation in the right eye and IOP pulsation in both eyes were noted. Based on radiology, the patient was diagnosed with bilateral CCF. The case 3 patient was referred to our institution for differential diagnosis of CCF. The patient had corkscrew conjunctival vessels in both eyes, which had appeared after he had been revived through CPR (cardiopulmonary resuscitation) 25 years prior. IOP pulsation was not observed in Goldmann tonometry. Radiology test result for arterio-venous fistula was negative in the case 3 patient.

Conclusion

For diagnosis of CCF, IOP pulsation by Goldmann applanation tonometry exhibits a good correlation with the disease in our cases and provides useful diagnostic clues.
Motivational determinants of physical activity in disadvantaged populations with (pre)diabetes: a cross-cultural comparison
Authors: De Man Jeroen , Kasujja Francis Xavier , Delobelle Peter , Annerstedt Kristi Sidney , Alvesson Helle Mölsted , Absetz Pilvikki , Wouters Edwin , Daivadanam Meena , Guwatudde David , Puoane Thandi , Remmen Roy , Tabana Hanani , Van Olmen Josefien
Published: January 2022

Background

Understanding motivational determinants of physical activity (PA) is essential to guide the implementation of PA at individual and population level. Knowledge about the cross-cultural generalizability of these determinants is lacking and they have mostly been studied as separate factors. This study compares a motivational process model across samples from diverse populations with, or at risk of diabetes.

Methods

Measurement invariance of barrier identified regulation, barrier self-efficacy and social support was assessed in a rural Ugandan sample (n = 712) and disadvantaged samples with high proportions of immigrants in urban South Africa (n = 566) and Sweden (n = 147). These motivational determinants were then compared through multigroup structural equation modeling.

Results

The studied motivational constructs showed scalar invariance. Latent mean levels of perceived social support and barrier self-efficacy were lower in South Africa and Sweden. Structural models (for different PA outcomes) were not consistent across settings except for the association between perceived social support and identified regulation. Identified regulation was only associated with vigorous PA in Uganda and with moderate PA in South Africa. The association between social support and PA outcomes ranged from weak to not significant and the association between self-efficacy and PA was not significant. Self-reported PA was highest in Uganda and lowest in Sweden. Self-reported vigorous PA was significantly related to lower hemoglobin A1c levels, while moderate PA was not.

Conclusions

Findings suggest that: 1) it is feasible to compare a motivational process model across diverse settings; 2) there is lower perceived social support and self-efficacy in the urban, migrant samples; 3) identified regulation is a more promising determinant of PA than self-efficacy or social support in these populations; 4) associations between motivational determinants and PA depend on the perceived type and/or intensity of PA; 5) perceived relatedness functions as a basic psychological need across diverse settings; and 6) people’s perception of the PA they perform depends on their perceived level of intensity of PA which would have major implications for health promotion.
The impact of economic recession on the health of migrant fathers over time: results from the Growing up in Ireland longitudinal study
Authors: Villarroel Nazmy , MacFarlane Anne , Roura Maria , Basogomba Alphonse , Bradley Colette , LeMaster Joseph W. , Hannigan Ailish
Published: January 2022

Background

The relationship between economic conditions and health can depend on both the health outcome measured and the composition of the population. Analysis of outcomes by both ethnicity and country of birth has been recommended. The aim of our study is to explore the impact of recession on self-rated health and depression of migrant fathers in Ireland over time, considering both ethnicity and country of birth.

Methods

Longitudinal data from waves of a population-representative cohort study (Growing up in Ireland, 2008–2013) was used with Wave 1 collected before the recession and Wave 2 collecting information on how the recession affected families. Socio-demographic variables, self-rated health and depression were compared across three groups of fathers classified by self-identified ethnicity and country of birth: White Irish (n = 5628), Other White European (EU-10) (n = 431), and Black African (n = 192) using chi-square tests and logistic regression models. Rates of follow-up were compared across groups at Wave 3.

Results

Prior to the recession, the rate of employment was lowest for African fathers (51% vs 81% for EU-10 fathers and 92% for Irish fathers, p < 0.001). At Wave 2, African families were more likely to have experienced a very significant effect of the recession (40.1% compared to 22.4% for families from EU-10 and 21.3% for Irish families, p < 0.001). However, the impact of the recession on depression and self-rated health was only found in Irish fathers. By Wave 3, rates of follow-up were lower for migrant fathers, particularly for EU-10 fathers.

Conclusions

Understanding the relationship between economic conditions and health is complex and may be related to multiple dimensions of socio-economic advantage and disadvantage. African families were already more likely to be disadvantaged prior to the recession and that pattern persisted during the recession. Further research on attrition rates of migrants in population cohort studies is needed and the development of effective strategies for recruitment, follow-up and analysis.
Autoantigen microarrays reveal myelin basic protein autoantibodies in morphea
Authors: Zhu Jane L. , Paniagua Ricardo T. , Chen Henry W. , Florez-Pollack Stephanie , Kunzler Elaine , Teske Noelle , Rainwater Yevgeniya Byekova , Li Quan-Zhen , Hosler Gregory A. , Li Wenhao , Ramirez Denise M. O. , Monson Nancy L. , Jacobe Heidi T.
Published: January 2022

Background

Morphea is an autoimmune, sclerosing skin disorder. Despite the recent emphasis on immune dysregulation in morphea, the role of autoantibodies in morphea pathogenesis or utility as biomarkers are poorly defined.

Methods

Autoantigen microarray was used to profile autoantibodies from the serum of participants from the Morphea in Adults and Children (MAC) cohort. Clinical and demographic features of morphea patients with myelin basic protein (MBP) autoantibodies were compared to those without. MBP immunohistochemistry staining was subsequently performed in morphea skin to assess for perineural inflammation in areas of staining. Immunofluorescence staining on mouse brain tissue was also performed using patient sera and mouse anti-myelin basic protein antibody to confirm the presence of MBP antibodies in patient sera.

Results

Myelin basic protein autoantibodies were found in greater frequency in morphea (n = 50, 71.4%) compared to systemic sclerosis (n = 2, 6.7%) and healthy controls (n = 7, 20%). Patients with MBP antibodies reported pain at higher frequencies. Morphea skin biopsies, highlighted by immunohistochemistry, demonstrated increased perineural inflammation in areas of MBP expression. Immunofluorescence staining revealed an increased fluorescence signal in myelinated areas of mouse brain tissue (i.e. axons) when incubated with sera from MBP antibody-positive morphea patients compared to sera from MBP antibody-negative morphea patients. Epitope mapping revealed target epitopes for MBP autoantibodies in morphea are distinct from those reported in MS, and included fragments 11–30, 41–60, 51–70, and 91–110.

Conclusions

A molecular classification of morphea based on distinct autoantibody biosignatures may be used to differentially classify morphea. We have identified anti-MBP as a potential antibody associated with morphea due to its increased expression in morphea compared to healthy controls and systemic sclerosis patients.
Preoperative short-course radiotherapy followed by consolidation chemotherapy for treatment with locally advanced rectal cancer: a meta-analysis
Authors: Wu Haoyan , Fan Chuanwen , Fang Chao , Huang Libin , Li Yuan , Zhou Zongguang
Published: January 2022

Background

The addition of consolidation chemotherapy to preoperative short-course radiotherapy during the prolonged interval between the completion of radiation and surgery in locally advanced rectal cancer (LARC) could enhance pathologic response and might act on potential micrometastasis. We performed this meta-analysis to evaluate whether short-course radiotherapy followed by consolidation chemotherapy (SCRT/CCT) could be a neoadjuvant treatment option compared with conventional long-course chemoradiotherapy (LCCRT).

Methods

We searched the PubMed, EMBASE, MEDLINE, and Cochrane Library databases. The primary endpoints were pathological outcomes, and the secondary endpoints included survival rate, sphincter preservation rate, R0 resection rate and toxicity. RevMan 5.3 was used to calculate pooled risk ratio (RRs) and 95% confidence intervals (CIs).

Results

A total of seven eligible studies and 1865 participants were included in this meta-analysis. Compared with the LCCRT, SCRT/CCT increased pathologic complete response (pCR) rate [RR = 1.74, 95% CI (1.41, 2.15), P < 0.01] and led to a lower proportion of patients with adjuvant pathologic tumor stage 3–4 (ypT3-4) disease [RR = 0.88, 95% CI (0.80, 0.97), P = 0.01] or lymph node positive (ypN +) disease [RR = 0.83, 95% CI (0.71, 0.98), P = 0.02]. In addition, the disease-free survival (DFS) was better in SCRT/CCT group [RR = 1.10, 95% CI (1.02, 1.18), P = 0.01], while overall survival rate and toxicity and surgical procedures were similar between two groups.

Conclusion

Based on better pathological outcomes and DFS in SCRT/CCT group, we recommended preoperative short-course radiotherapy followed by consolidation chemotherapy as the optional neoadjuvant treatment for LARC.
Trends in the pursuit of multiple orthopedic surgery fellowships among orthopedic trainees in Saudi Arabia
Authors: Alomar Abdulaziz Z.
Published: January 2022

Background

The increase in the enrollment of orthopedic surgery residents in multiple fellowship programs has gained considerable interest. Different factors may determine the specialty and number of fellowships trainees enroll in. This study aimed to elucidate these factors and determinants among orthopedic trainees.

Methods

This is a descriptive cross-sectional study, which was conducted among orthopedic surgical trainees (residency and fellowship training programs) in Saudi Arabia, between March 2021 and May 2021. The data were obtained through an online anonymous questionnaire aiming to clarify the most influential factors that determine the number of fellowships trainees choose, as well as to compare the choice of single fellowships with those of multiple ones.

Results

Two hundred and fifty orthopedic trainees (201 (80%) males and 49 (20%) females) completed the survey. Among them, 216 (86%) and 34 (14%) were residents and fellows, respectively, and 81% (n = 203) of the trainees preferred multiple fellowship training, and 22% (n = 47) preferred a single fellowship specialty. Notably, the male trainees preferred multiple fellowships to a single one (85% vs. 62%, p-value = 0.001), while the female trainees preferred single fellowships to multiple ones (38% vs. 15%, p-value = 0.001). The expected rate of income (17% vs. 9%), job opportunities in the private sector (17% vs. 9%), and availability and guarantee of jobs (33% vs. 23%) were the most significant factors that influenced the choices of the participants toward enrolling in multiple fellowships (p-values = 0.001, 0.001, and 0.004, respectively).

Conclusions

The study demonstrated that most of the orthopedic trainees in Saudi Arabia prefer the pursuits of multiple fellowship programs. Further, the female trainees preferred single fellowships, whereas the male ones preferred multiple fellowships. The main influencing factors for pursuing multiple fellowships were determined to be private job opportunities, financial gains, and job guarantees.
Loss of RPS27a expression regulates the cell cycle, apoptosis, and proliferation via the RPL11-MDM2-p53 pathway in lung adenocarcinoma cells
Authors: Li Hongyan , Zhang Hong , Huang Guomin , Bing Zhitong , Xu Duling , Liu Jiadi , Luo Hongtao , An Xiaoli
Published: January 2022

Background

Depletion of certain ribosomal proteins induces p53 activation, which is mediated mainly by ribosomal protein L5 (RPL5) and/or ribosomal protein L11 (RPL11). Therefore, RPL5 and RPL11 may link RPs and p53 activation. Thus, this study aimed to explore whether RPs interact with RPL11 and regulate p53 activation in lung adenocarcinoma (LUAD) cells.

Methods

The endogenous RPL11-binding proteins in A549 cells were pulled down through immunoprecipitation and identified with a proteomics approach. Docking analysis and GST-fusion protein assays were used to analyze the interaction of ribosomal protein S27a (RPS27a) and RPL11. Co-immunoprecipitation and in vitro ubiquitination assays were used to detect the effects of knockdown of RPS27a on the interaction between RPS27a and RPL11, and on p53 accumulation. Cell cycle, apoptosis, cell invasion and migration, cell viability and colony-formation assays were performed in the presence of knockdown of RPS27a. The RPS27a mRNA expression in LUAD was analyzed on the basis of the TCGA dataset, and RPS27a expression was detected through immunohistochemistry in LUAD samples. Finally, RPS27a and p53 expression was analyzed through immunohistochemistry in A549 cell xenografts with knockdown of RPS27a.

Results

RPS27a was identified as a novel RPL11 binding protein. GST pull-down assays revealed that RPS27a directly bound RPL11. Knockdown of RPS27a weakened the interaction between RPS27a and RPL11, but enhanced the binding of RPL11 and murine double minute 2 (MDM2), thereby inhibiting the ubiquitination and degradation of p53 by MDM2. Knockdown of RPS27a stabilized p53 in an RPL11-dependent manner and induced cell viability inhibition, cell cycle arrest and apoptosis in a p53-dependent manner in A549 cells. The expression of RPS27a was upregulated in LUAD and correlated with LUAD progression and poorer prognosis. Overexpression of RPS27a correlated with upregulation of p53, MDM2 and RPL11 in LUAD clinical specimens. Knockdown of RPS27a increased p53 activation, thus, suppressing the formation of A549 cell xenografts in nude mice.

Conclusions

RPS27a interacts with RPL11, and RPS27a knockdown enhanced the binding of RPL11 and MDM2, thereby inhibiting MDM2-mediated p53 ubiquitination and degradation; in addition, RPS27a as important roles in LUAD progression and prognosis, and may be a therapeutic target for patients with LUAD.

Graphical Abstract
The FACAM study: protocol for a randomized controlled study of an early interdisciplinary intervention to support women in vulnerable positions through pregnancy and the first 5 years of motherhood
Authors: Pontoppidan Maiken , Nygaard Lene , Thorsager Mette , Friis-Hansen Mette , Davis Deborah , Nohr Ellen Aagaard
Published: January 2022

Background

Inequality in health can have profound short- and long-term effects on a child’s life. Infants develop in a responsive environment, and the relationship between mother and infant begins to develop during pregnancy. The mother’s ability to bond with the fetus and newborn child may be challenged by mental health issues which can cause impaired functioning and poorer health outcomes. Families with complex problems need interdisciplinary interventions starting in early pregnancy to be prepared for motherhood and to ensure healthy child development. This study aims to examine the effects of an early and coordinated intervention (the Family Clinic and Municipality (FACAM) intervention) offered to vulnerable pregnant women during pregnancy and the child’s first year of life on the mother-child relationship, maternal social functioning, mental health, reflective functioning, well-being, parental stress, and the development and well-being of the child.

Methods

The study is a prospective randomized controlled trial where we will randomize 320 pregnant women enrolled to receive antenatal care at the family clinic at Odense University Hospital, to either FACAM intervention or usual care. The FACAM intervention consists of extra support by a health nurse or family therapist during pregnancy and until the child starts school. The intervention is most intensive in the first 12 months and also includes attachment-based support provided either individually or in groups. The participants are assessed at baseline, and when the infant is 3 and 12 months old. The primary outcome is maternal sensitivity measured by the Coding Interactive Behavior (CIB) instrument. Secondary outcomes include prenatal parental reflective functioning, mental well-being, depressive symptoms, breastfeeding duration, maternal satisfaction, child development, parent competence, parental stress, and activities with the child.

Discussion

The trial is expected to contribute knowledge about the effect of early coordinated support in antenatal and postnatal care for vulnerable pregnant women and their families.

Trial registration

ClinicalTrials.gov NCT03659721. Registered on September 6, 2018
Diagnosis of visceral and cutaneous leishmaniasis using loop-mediated isothermal amplification (LAMP) protocols: a systematic review and meta-analysis
Authors: Erber Astrid Christine , Sandler Peter Julian , de Avelar Daniel Moreira , Swoboda Ines , Cota Gláucia , Walochnik Julia
Published: January 2022

Sensitive, reliable and fast diagnostic tools that are applicable in low-resource settings, at the point of care (PoC), are seen as crucial in the fight against visceral leishmaniasis (VL) and cutaneous leishmaniasis (CL). Addressing the need for a PoC test, several diagnostic tests, including serological and molecular methods, have been developed and evaluated in the past. One promising molecular method, already implemented for diagnosis of a range of diseases, is the loop-mediated isothermal amplification (LAMP) protocol. In this systematic review and meta-analysis, using a comprehensive search strategy, we focus on studies evaluating the performance of LAMP for the diagnosis of leishmaniasis in humans and other mammals such as dogs, compared with microscopy and/or any other molecular diagnostic method. A meta-analysis, pooling sensitivity and specificity rates and calculating areas under the curve (AUCs) in summary receiver operating characteristic (SROC) plots, was conducted on datasets extracted from studies, grouped by clinical condition and sample type. We found high sensitivity and specificity for LAMP when compared with microscopy and PCR using blood samples, with pooled estimate values of > 90% for all subgroups, corresponding to calculated AUC values > 0.96, except for LAMP compared to microscopy for diagnosis of CL. However, only a limited number of studies were truly comparable. Most of the observed heterogeneity is likely based on true differences between the studies rather than sampling error only. Due to simple readout methods and low laboratory equipment requirements for sample preparation compared to other molecular methods, LAMP is a promising candidate for a molecular (near-)PoC diagnostic method for VL and CL.

Graphical Abstract