bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel prostate cancer immunotherapy using prostate-specific antigen peptides and Candida skin test reagent as an adjuvant
Authors: Abdallah Al-Ola , Coleman Hannah , Kamel Mohamed , Davis Rodney , Landrum Teri , Spencer Horace , Mackintosh Sam , Mahmoud Fade A , Milojkovic Natasa , Wicker Chester , Arnaoutakis Konstantinos , Nakagawa Mayumi
Published: September 2018

Objectives:

Our group developed the use of the Candida skin test reagent as an adjuvant of cell-mediated immunity in designing a human papillomavirus therapeutic vaccine. Here, this technology is being applied for designing a prostate cancer immunotherapy.

Methods:

Peptides based on the prostate-specific antigen amino acid sequences were selected, synthesized, and evaluated in terms of their (1) solubility, (2) maturation effects on Langerhans cells by fluorescence-activated cell sorter analysis, and (3) recognition by peripheral immune cells from prostate cancer patients using interferon-γ enzyme-linked immunospot assay.

Results:

The peptides were soluble in 10 mM succinate at pH of 5 with 5% glycine, and they demonstrated no maturation effects on Langerhans cells from healthy donors. On the other hand, peripheral immune cells from 4 of 10 prostate cancer patients examined had positive responses in enzyme-linked immunospot assay to one or more prostate-specific antigen peptides.

Conclusion:

In summary, a design and a formulation of a novel prostate cancer immunotherapy are described. The immunogenicity of prostate-specific antigen peptides in some prostate cancer patients supports further development of this immunotherapy.
Arthroscopic Fixation of Osteochondral Avulsion Fracture of the Femoral Attachment of the Posterior Cruciate Ligament in an 82-Year-Old Patient: A Case Report
Authors: Ishikawa Masakazu , Kobayashi Kenji , Adachi Nobuo
Published: September 2018

Femoral avulsion fracture of the posterior cruciate ligament (PCL) is less common compared to the tibial side. Especially, femoral avulsion in an elderly patient is an extremely rare condition. Until now, there is no report that describes its treatment and clinical outcome in elderly patients. We demonstrate an 82-year-old female who presented with osteochondral avulsion fracture of the femoral attachment of the PCL. The osteochondral fragment was fixed with an arthroscopic transfemoral suture technique. After treatment, the pain was improved and the patient achieved previous daily activity within 6 weeks. After 6 months, plain X-ray and computed tomography scans demonstrated consolidation of osteochondral fragment. The Lysholm score was 78 points at final office visit. This simple and less invasive approach is useful for pain relief and earlier return to daily activity in an elderly patient with osteoporosis.
Zero-Coupon and Forward Yield Curves for Government of Ghana Bonds
Authors: Lartey Victor Curtis , Li Yao
Published: September 2018

This article seeks to provide a framework for modeling daily zero-coupon yield curve for Government of Ghana bonds based on secondary market daily trades. It also proposes method for modeling the forward yield curve. The current practice in Ghana is to produce yield curve for Government of Ghana bonds based on primary market weekly auctions. This article demonstrates the extraction and fitting of secondary market daily yield curves for Government of Ghana bonds, using bootstrapping and piecewise cubic hermite interpolation. The article also compares the piecewise cubic hermite method with the piecewise cubic spline method, the Nelson–Siegel–Svensson model, and the penalized smoothing spline method. Data used are the daily bond price data from the Ghana Fixed Income Market, accessible at the Central Securities Depository of Ghana. The results show yield curves that reflect the actual daily yield movements in the secondary bond market of Ghana. The results also show that the piecewise cubic hermite method fits the zero-coupon yield curve better than the other methods as far as the Ghanaian bond market is concerned. For the forward curves, we recommend that either or both of the piecewise cubic hermite method and the Nelson–Siegel–Svensson method could be used by the market participants.
Nightlife and Alcohol Consumption Among Youths: The Botellón Phenomenon in Spain
Authors: Pedrero-García Encarnación
Published: September 2018

In this article, we approach the botellón phenomenon as a widespread nightlife activity among Spanish youths. Botellón consists of youths meeting up, primarily on weekend nights, in open-air public spaces to talk and consume the alcoholic beverages that they have prepared. The objective of this study was to analyze the motives, attitudes, and consequences related to the practice of botellón during the leisure time of youth. A qualitative methodology has been used and speeches from 80 young people aged 14 years to 24 years have been analyzed in Seville (Southern Spain). These participants were arranged in 10 focus groups selected by stratified sampling from different public and semiprivate secondary schools and one public university. The results demonstrate that youths indicate that their primary motive for preferentially engaging in botellón is to come together and interact, not only with their group of friends but also with other peers. Regarding the societal perceptions of alcohol consumption, they stated that high social tolerance exists. Regarding social consequences, they believed that the legal measures taken to restrict alcohol consumption on the streets are not yielding successful results. In conclusion, we understand that a change in youth lifestyles has occurred over recent decades; hence, we believe that the solution to alcohol abuse is through the establishment of preventive educational programs that are applied from the earliest levels of educational instruction and supported through work within the family.
Passing as “Normal”: Adolescent Girls’ Strategies for Escaping Stigma of Premarital Sex and Childbearing in Ghana
Authors: Gyan Sylvia Esther
Published: September 2018

Premarital sex and premarital childbearing is a source of stigma in many African communities and can negatively affect adolescent girls’ sexual and reproductive health experiences. This study seeks to provide insight into the strategies adolescent girls adopt to avoid stigmatization due to premarital sex and/or childbearing by their community members and families. Using a mixed methods approach, data were collected from a survey of 500 adolescent girls out of which 20 were purposively selected for in-depth interviews. The strategies adopted by adolescent girls to avoid stigma varied based on the pregnancy status of girls, that is whether they have never had a child (nonpregnant [NP]) or had ever had a child (ever-pregnant [EP]). To avoid stigma associated with premarital sex, some NP girls abstained from sex and others who were sexually active either kept their relationships secret or used contraceptives secretly. For the EP girls, some tried to minimize stigma to premarital childbearing by going back to school after childbirth or learning a trade or a vocation. Some EP girls also got married to the fathers of their babies to avoid stigma. Overall, the desire to feel accepted by community members pushed adolescent girls to adopt strategies to avoid the stigma associated with premarital sex and childbearing. It is recommended that there should be creation of awareness for community members on the need to support adolescent girls to minimize the risk they may be predisposed to in their sexual and reproductive health.
Customer Service Skill Development for Students With Autism Spectrum Disorder Using Video Modeling
Authors: Bross Leslie Ann , Zane Thomas L. , Kellems Ryan O.
Published: September 2018

Preparing secondary students with autism spectrum disorder (ASD) for a variety of potential professions is important to enhance their postsecondary employment outcomes. This article provides step-by-step guidelines for practitioners to use video modeling interventions to develop the customer service skills of students with ASD who are employed or participating in employment experiences in their communities. Video modeling is an evidence-based practice for learners with ASD that can be used as a viable workplace support.
Reflections on Recovered Memories: Comment on Patihis and Pendergrast (2019)
Authors: Lynn Steven Jay , Merckelbach Harald , Polizzi Craig P.
Published: September 2018

In this comment on Patihis and Pendergrast (this issue, p. 3), we challenge an assumption that underpins recovered memory therapies: that there exists a close link of traumatic experiences with dissociation. We further suggest that (a) researchers examine how therapists who believe in repressed memories instill this belief in clients and establish expectations that current problems can be interpreted in light of past traumatic experiences, (b) recovered memories could be classified and studied as a function of how events come to light and are interpreted, and (c) therapists routinely provide informed consent regarding recovered memories and suggestive techniques.
Teachers’ Insights Into Connected Learning Networks: Emerging Activities and Forms of Participation
Authors: Vartiainen Henriikka , Nissinen Saara , Pöllänen Sinikka , Vanninen Petteri
Published: September 2018

The aim of this socioculturally informed study is to explore teachers’ insights into connected-learning activities and networks. An instructional approach based on design-oriented pedagogy (DOP) was employed for a teachers’ in-service project in Finland. An open-ended design task for the participating teachers and educators from kindergartens (N = 27) and primary schools (N = 2) involved designing and implementing a forest-related learning project with their own students or kindergarten children. A deductive content analysis of openly published project portfolios revealed that the teachers and educators harnessed learner interest as a basis for connecting with peers, family, external experts, and extended environments through diverse physical and digital information resources, tool-mediated activities, and the externalization of the learners’ evolving object-oriented ideas. Conclusions are drawn about extended learning networks and activities that afforded inquiry activities to emerge.
Rates of Screening for Breast, Colorectal, and Cervical Cancers in Older People With Cognitive Impairment or Dementia: A Meta-Analysis
Authors: Law Marcus , Dhillon Sandeep , Herrmann Nathan , Friesen Farah , Dey Ayan K. , Li Abby , Ayala A. Patricia , Lenton Erica , Edwards Jodi D. , Swardfager Walter
Published: September 2018

Purpose: Cancer screening may not be appropriate for some older people. We compare the likelihood of screening for colorectal, breast, and cervical cancers in older people with versus without cognitive impairment or dementia. Method: Systematic search of MEDLINE, Embase, and PsycINFO (to March 9, 2018) for articles reporting screening for colon, breast, and cervical cancers in patients with and without cognitive impairment or dementia. Studies were summarized quantitatively (random effects meta-analysis), according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Studies reported data 1989-2008. The rate of screening for breast cancer by mammography was lower in women with cognitive impairment or dementia compared with those without (pooled odds ratio [OR] = 0.81, 95% confidence interval [CI] = [0.71, 0.91], p = .0007, six studies, N = 18,562). The rates of screening for cervical cancer by Pap smear (pooled OR = 0.88, 95% CI = [0.71, 1.08], p = 0.22, five studies, N = 409,131) and colorectal cancer by fecal occult blood test (pooled OR = 0.87, 95% CI = [0.55, 1.38], p = .55, two studies, N = 2,718) were not significantly lower in people with cognitive impairment or dementia. Conclusion: These historical rates provide a baseline for discussions around the need for more specific guidance to assist with decisions to discontinue screening. The study also identifies a gap in reported knowledge with respect to screening under current guidelines.
Brain Breaks Go To College
Authors: Feiler Kimberly E.
Published: September 2018

As health education specialists, we are called to practice what we promote. American adult physical activity levels are low, and too much time is spent sedentary. New habits can be learned early in adult life in the higher education setting. Most time students and faculty spend in higher education learning environments is spent while sedentary—this norm must change. Brain breaks in formal learning environments have worked well in K-12 schools; they can be incorporated into higher education in order to reengage students and improve their academic achievement. Brain Breaks are short (2-5 minutes), movement-based activities to break-up prolonged periods of sitting by students, thus increasing physical activity. Health and health-related college courses provide an ideal platform to begin adding back in brain breaks and active learning strategies where there has traditionally been little to none.
Linguistic and Psychometric Validation of the Thai Version of Simplified Diabetes Knowledge Scale: A Measure of Knowledge of Diabetes in a Thai Population
Authors: Khunkaew Saneh , Fernandez Ritin , Sim Jenny
Published: September 2018

Purpose

To develop a linguistically and psychometrically validated Thai version of the Simplified Diabetes Knowledge Scale (T-SDKS) for adults with Type 2 diabetes mellitus (T2DM).

Design

A cross-sectional study was carried out among people with T2DM.

Methods

Consecutive sampling was undertaken to recruit participants at the outpatient diabetes clinic of a hospital in Northern Thailand.

Results

A total of 502 patients with T2DM were recruited. The mean age of the participants was 60.2 years, and 60.5% were female. The T-SDKS attained a reliability coefficient of .79. The item-total correlation value was greater than 0.20 for each item, and the inter-item correlation ranged between 0.03 and 0.49. Respondents attained a mean percentage knowledge score of 42.39% ± 15.45 on T-SDKS.

Discussion/conclusions

The T-SDKS has demonstrated to be a brief and simple diabetes knowledge assessment tool to use in a busy clinical setting.

Implication for practice

The findings can be used to improve health education interventions.
Effect of Terms of Trade on Economic Growth of China
Authors: Jebran Khalil , Iqbal Amjad , Bhat Kalim-Ullah , Ali Arshad
Published: September 2018

This study investigates the effect of terms of trade (TOT) on the economic growth of China over the period 1980–2013. Autoregressive distributed lag (ARDL) model proposed by Pesaran, Shin, and Smith (2001, Journal of Applied Econometrics, 16(3), pp. 289–326) is applied for examining the short-run and long-run associations. The causality analysis between variables is analyzed by using Granger causality test and variance decomposition test. The ARDL model reveals that TOT significantly and adversely affect economic growth in the short run as well as in the long run. The results also imply positive short-run and long-run effect of labor and capital on the economic growth of China. The Granger causality results reveal significant bidirectional causal relationship between economic growth and capital, and between capital and labor force. The results show unidirectional causality from TOT to labor force. The variance decomposition results show that most of the innovation in economic growth is explained by its own innovation, while other variables have very small contributions to its innovations. The notable findings of the study suggest that TOT deterioration is relatively important for enhancing the economic growth of China.
Ankle Arthroplasty
Authors: Allport Jack , Bennett Adam , Ramaskandhan Jayasree , Siddique Malik
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) has been shown to be an effective treatment for end stage ankle arthritis. Achieving normal anatomical alignment has been shown to be important in long term outcomes and revision rates. Recent data from the British NJR has shown that revision rates are higher in patients with pre-operative fixed equinus. Although there is literature about surgical techniques to deal with pre-operative equinus we are not aware of any papers presenting patient outcomes. We present patient reported outcomes for our cohort of patients with pre-operative fixed equinus compared to those able to achieve a plantigrade ankle.

Methods:

This is a single surgeon, retrospective cohort study of consecutive cases. A mobile bearing prosthesis was used (Mobility TAA system, DePuy, Raynham, Massachusetts, USA). Cases were identified from a locally held joint registry which routinely records PROMS data pre-operatively and at annual intervals post-operatively. Patients undergoing primary TAA between March 2006 and June 2014 were included, revision procedures along with those with inadequate PROMS data were excluded. PROMS scores used were FAOS (WOMAC Pain, Function and Stiffness), SF-36 scores and patient satisfaction. All pre-operative lateral weight bearing xrays were reviewed to screen for potential fixed equinus deformity (tibia-sole angle >90 degrees). Clinical records were then reviewed to confirm clinical diagnosis of fixed equinus deformity.

Results:

259 cases were identified, 95 cases were excluded based on our criteria leaving 164 cases for analysis (mean follow up 61.6 months). 144 were classified as neutral and 20 as fixed equinus. The fixed equinus group were significantly younger (neutral 64.2 vs equinus 53.9, p=0.0002), there was no difference in BMI or length of follow up. There was no difference in baseline scores except WOMAC stiffness, with the fixed equinus group significantly worse (36.9 vs 25.6, p=0.0014). Final PROMS score, change from baseline and patient satisfaction was the same in all domains for both groups. There was no difference in revision rates.

Conclusion:

A pre-operative fixed equinus deformity does not negatively impact on clinical outcomes in patients undergoing TAA. We are not aware of any previous studies to compare results. As expected the equinus group showed higher levels of stiffness pre-operatively. Contrary to the British NJR dataset we did not find a difference in revision rates.
Minimally Invasive versus Open Hallux Valgus Surgery
Authors: Frigg Arno , Pellegrino Alex , Maquieira Gerardo
Published: September 2018

Category:

Bunion

Introduction/Purpose:

About 20% of patients suffer from stiffness (arthrofibrosis) after hallux valgus surgery. Minimally Invasive Surgery (MIS) has been invented to reduce the rate of unfavorable result, MIS enjoys increasing popularity with both surgeons and patients and is applied in a growing number of cases. It is being advertised as delivering better results due to reduced soft tissue injury and quicker recovery while effecting a similar amount of deformity correction. However, to date there are no scientific data to support this claim. The aim of the current project is to fill this lacuna by comparing the outcomes of MIS and open hallux valgus surgeries prospectively at our institution.

Methods:

From 01/2014 to 12/2015, 123 patients were operated: 75 open (average age 51 years, 91% female) and 48 MIS (age 47 years, 88% female). Inclusion criteria were either open Chevron/Scarf or MIS-Chevron at our Foot and Ankle Center with 5 different hospitals and three surgeons. Exclusion criteria were radiological signs of osteoarthritis, extension of less than 30°, pain on motion or during the night, and all other hallux valgus surgeries (lapidus, open wedge, Akin and buniektomy only). Radiographs were taken of all patients 6 weeks and 1 year postop. All patient charts were screened by an independent research assistant for complications and reoperations. All radiographs were measured by two independent observers. All patients were examined in a blinded control by an independent study nurse at 24±6 months after surgery for the clinical results (for parameters please see Tab. 1).

Results:

All clinical and radiographic results, as well as all additional surgeries, reoperations and complications are shown in Tab.1. The results show that open and MIS surgery achieved a similar gain in AOFAS-score, flexion, extension, VAS and subjective foot value. The scar was significantly smaller in MIS than open, but the satisfaction with the scar was similar. The radiographic correction was equal. Open surgery was combined with more additional procedures than MIS, especially Weil osteotomies and plantar plate repairs. The rate of CRPS, prolonged pain, and stiffness was equal. The reoperation rate was significantly higher for MIS due to a screw removal rate of 34%.

Conclusion:

MIS is an interesting concept, but it enjoys no advantages over open surgery, at least when carried out with current methods. Calls for open-trained surgeons to switch to MIS are therefore premature. Both surgical techniques have similar clinical and radiological outcomes, while MIS had a higher screw removal rate. Furthermore, complex cases have to be operated with open surgery.
Optimal Treatment and Management of Proximal Fifth Metatarsal Fractures
Authors: Heijboer Reinout , Breuking Sofie , Hagemeijer Noortje , Guss Daniel , DiGiovanni Christopher
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Proximal fifth metatarsal fractures (PFMF) are among the most common fractures of the foot, and may be subdivided into tuberosity avulsion fracture, Jones fracture, and proximal diaphyseal fracture. However, for Jones fractures and proximal diaphyseal fractures optimal treatment is still debated in literature. The Torg criteria are used in deciding to treat surgically or conservative, whereby Torg type I and II indicates conservative treatment, and type III indicates surgical treatment. Yet failure rates of both management options vary and derive from small study groups. The aim of this study was to compare failure rates after surgical- and conservative treatment of Jones fractures and proximal diaphyseal fractures, to evaluate the incidence of treatment failure, and to assess factors associated with healing difficulties of PFMF.

Methods:

A total of 1,133 adult patients that were diagnosed and treated for PFMF between 2005 and 2015 in a tertiary care foot and ankle referral center were included. Retrospective chart review recorded patient demographics, suspected risk factors for impaired healing of PFMF (rheumatoid arthritis, diabetes mellitus, osteoporosis, nutritional and hormonal disorders, foot deformities, (neuropathic) arthropathy of the foot and/or ankle and peripheral neuropathy of the lower extremity), and treatment indication. Multivariable logistic regression analysis was used to determine factors associated with healing difficulties. Propensity score matching was used to minimize selection bias between treatments in Jones fractures and proximal diaphyseal fractures.

Results:

In total, 489(43.2%) patients were diagnosed with a tuberosity avulsion fracture, 391(34.5%) patients with a Jones fracture and 253(22.3%) patients with a proximal diaphyseal fracture. In the tuberosity fracture group, a nonunion was found in 5.3%(25/473) of the patients treated conservatively and in 0%(0/16) treated operatively. For the Jones fractures and proximal diaphyseal fractures the non-union rate for conservative treatment was 10%(35/337) and 5.9%(14/238), and for surgical treatment 11%(6/54) and 0%(0/15), respectively. No independent risk factors for complicating the healing process of PFMF were identified. With propensity score matching, 37 patients treated operatively were matched to 37 patients undergoing conservative treatment. The risk for a nonunion was lower in the operative group compared to the conservative treatment group (relative risk 0.8, P=0.006).

Conclusion:

In this propensity-matched cohort, surgical treatment for Jones fractures and proximal diaphyseal fractures were associated with better fracture healing compared to conservative treatment. In addition, no factors were found to be associated with healing difficulties of proximal fifth metatarsal fractures.
Radiographic Analysis of Total Ankle Replacements
Authors: Le Vu (Brian) , Escudero Mario , Penner Murray , Wing Kevin , Younger Alastair , Veljkovic Andrea , Barahona Maximiliano
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle replacements (TAR) are an increasingly common treatment for end-stage ankle arthritis but evidence on optimal alignment is not as well-established as in the hip and knee arthroplasty literature. Many believe that restoration of coronal and sagittal alignment is critical, while others suggest malalignment within a certain range has no impact on failure (Braito et al. 2015). There is controversy on the ideal TAR component positioning to minimize failure and requiring revision surgery. In this study we examine 9 radiographic measures of TARs, 6 of which have previously been described for TARs, 1 commonly used on preoperative ankles, and 2 novel measures on a database of 146 TARs to identify predictors of TAR re-operation.

Methods:

A retrospective review was performed on the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis, selecting for all total ankle replacements done at a single institution by one of three fellowship-trained foot and ankle surgeons between September 2004 and June 2015. Those with complete series of anteroposterior and lateral standing ankle radiographs both preoperative and postoperative, and minimum of 1 year of follow-up were included. Measurements were performed on the postoperative radiographs and included: coronal and sagittal distal tibial component angles, talar center migration, talar tilt angle, lateral talar station, tibial axis-talus ratio, talar component gamma angle, anterior and posterior tibial component overhang and underhang. Standard descriptive statistical methods were used to analyze the data.

Results:

Of a total of 296 TARs, 146 were included and 14 TARs failed (9.6%), defined as requiring re-operation, 8 of which were metal-component revisions (5%). The TARs were stratified into those with measurements within previously published normal values and those that fall outside that range. Time to failure ranged from 1.4 to 9.6 years. Our preliminary data analysis showed that TARs with coronal distal tibial component angles between 87-93 degrees demonstrated an odds ratio of 0.11 for re-operation compared with those beyond that range, p=0.003. TARs with talar tilt angles of 0 degrees demonstrated an odds ratio of 0.24 for re-operation compared with those whose talar tilt was not zero, p=0.02.

Conclusion:

Post-operative coronal alignment of TARs, namely distal tibial component angle and talar tilt, appear to be associated with TAR-reoperation. Specifically, if the measurements are within previously described normal limits, the odds ratio for re-operation is low and statistically significant. Further data analysis is underway and may demonstrate more parameters of significance in predicting TAR failure.
Driving After Total Ankle Arthroplasty
Authors: McDonald Elizabeth , Pedowitz David , Shakked Rachel , Daniel Joseph , Nicholson Kristen , Winters Brian , Raikin Steven
Published: September 2018

Category:

Ankle

Introduction/Purpose:

With the increase in number of total ankle arthroplasty surgery, physician guidelines on when to begin to consider patients’ return to driving is valuable. The ability to accurately and efficiently determine when a patient can return to driving is important both from a patient safety and a medicolegal perspective. The purpose of the study was to determine when patients’ brake reaction time (BRT) returns to a safe value after right total ankle arthroplasty. We also aimed to identify predictive factors that may identify those patients who may not be safe to drive.

Methods:

After institutional review board approval, fifty-five patients undergoing right total ankle arthroplasty were recruited prospectively. Patient demographics include an age range of 43 to 83 years (median 63 years), of which 31 were male (56%) and 24 were female (44%). BRT was tested at six weeks and repeated weekly until patients achieved a passing BRT. A control group of twenty healthy patients was used to establish a passing BRT of 0.850 seconds. Patients were given a validated, novel driver readiness survey to complete of which a 10/15 point or higher score was considered passing.

Results:

At 6 weeks, 50 patients (91%) achieved a passing BRT and were considered safe to drive, and the passing group average BRT was 0.662 seconds. At 9 weeks, 52 patients (100%) of those who completed the study achieved a passing BRT. Patients that failed at 6 weeks had statistically greater visual analog scale (VAS) for pain (p=0.037) and significantly diminished ankle plantarflexion (p=0.029). There is a significant (p<0.001) and large (r=-0.455) correlation between BRT and the validated driver readiness survey scores. 5/5 (100%) patients that failed the BRT also failed the driver readiness survey (p=0.049). Interestingly, males were more likely to think they were ready to drive based on their driver readiness survey but were no more likely to pass the BRT than females (p=0.002).

Conclusion:

Over 90% of patients may be eligible to return to driving as early as 6 weeks post-operatively. Indications that a patient is not safe to return to driving at 6 weeks are higher VAS, limited plantarflexion, and a failed driver readiness survey. Although many factors determine whether a patient may safely return to driving, patients may be informed that BRT normalizes 9 weeks after right total ankle arthroplasty.
A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery
Authors: Saini Sundeep , McDonald Elizabeth , Nicholson Kristen , Rogero Ryan , Chapter Megan , Winters Brian , Pedowitz David , Raikin Steven , Daniel Joseph
Published: September 2018

Category:

Other

Introduction/Purpose:

The purpose of our study was to assess opioid consumption patterns following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription.

Methods:

Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test.

Results:

A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not.

Conclusion:

Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.
Conventional Ultra-high Molecular Weight Polyethylene versus Highly Cross-linked Polyethylene from Semi-constrained, Fixed-bearing Total Ankle Arthroplasty Systems
Authors: Schipper Oliver , Haddad Steven , Fullam Spencer , Pourzal Robin , Wimmer Markus
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

The aim of this study was to compare the polyethylene wear rate, particle size, and particle shape of primary semi-constrained, fixed-bearing, bone-sparing total ankle arthroplasty using conventional ultra-high molecular weight polyethylene (CPE) versus highly cross-linked polyethylene (HXLPE) by applying a level walking input using a joint simulator.

Methods:

Two fixed-bearing total ankle replacement systems with different types of polyethylene liners were tested: 1.) CPE sterilized in ethylene oxide, and 2.) HXLPE sterilized with gas plasma after electron beam irradiation. Three implants for each design underwent wear testing using gravimetric analysis over 5 million simulated walking cycles. A fourth implant was used as a load soak control. Equivalent circle diameter (ECD) and equivalent shape ratio (ESR) were computed to determine particle size and particle shape, respectively.

Results:

The mean wear rate from 1.5-5 million cycles (MC) was 2.0±0.3mg/MC for HXLPE and 16.7±1.3mg/MC for CPE (P < 0.001). The total number of particles per cycle generated for HXLPE and CPE were 0.17x106 particles/cycle and 0.53x106 particles/cycle, respectively (P < 0.001). The mean ECD of HXLPE particles (0.22 ±0.11μm) was significantly smaller than the mean ECD of CPE particles (0.32±0.14μm) (P<0.001). HXLPE particles were significantly more round than CPE particles (P<0.001).

Conclusion:

HXLPE liners had a significantly lower wear rate and produced significantly fewer and rounder particles than CPE liners. The results of this study suggest that HXLPE has more favorable wear characteristics for total ankle arthroplasty.
Comparison Between Weightbearing and Non-weightbearing Measurements for Evaluation of Tibiofibular Syndesmotic Injuries
Authors: Shakoor Delaram , Osgood Greg , Orapin Jakrapong , Qahnavieh Iman Khodarahmi , Thawait Gaurav , Ficke James , Schon Lew , Demehri Shadpour
Published: September 2018

Category:

Ankle

Introduction/Purpose:

The distal tibiofibular syndesmosis maintains the integrity of ankle mortise during weight bearing. Syndesmotic injuries are common and even slight malreduction are associated with long-term development of tibiotalar osteoarthritis. Radiographic as well as CT based measurements are being employed to detect syndesmotic injuries, however, subtle injuries are commonly overlooked. In the present study we intend to investigate whether measurements obtained from weight-bearing (WB) cone-beam computed tomography (CBCT) images are different from measurements obtained from NWB images in subjects with clinical suspicion of syndesmotic injury and “inconclusive” plain radiograph findings

Methods:

In this prospective study, following IRB approval, the injured ankles of 20 patients (10 men and 10 women; mean age: 46.1 years; range: 19-82) with persistent ankle pain following ankle trauma and clinical suspicion of syndesmotic injury underwent simultaneous WB and NWB CBCT scans. Following a detailed literature review, a set of 21 syndesmotic related measurements in all WB and NWB images, assessing fibular displacement in medio-lateral, cranio-caudal, antero-posterior planes were performed by three independent readers. Inter-observer and intra-observer reliabilities were evaluated by intra-class correlation (ICC) and Pearson/Spearman’s correlation, respectively. We used Paired student t-tests or Wilcoxon-rank-sum tests to compare the measurements from the two scans. Bootstrapping with 10000 samples was used to extract P-values for 99% uncertainty levels

Results:

we observed almost perfect intra-observer reliability for WB and NWB measurements (r = 0.8-0.98). Inter-observer reliability was significant for all measurement with overall fair to perfect agreement (ICC=0.36-0.97). Mean values of medio-lateral measurements including posterior tibiofibular distance, tibiofibular clear space and diastasis were significantly higher in WB images compared to NWB CBCT images (P-value< 0.05). Mean values of angular measurement, bi-malleolar angle, lateral clear space and fibular length were significantly lower in WB images (P-value<0.05). The difference between other measurements were not statistically significant.

Conclusion:

Of syndesmotic measurements available in the literature, certain measurements are different between WB and NWB CBCT examinations with moderate to perfect intra- and inter-observer reliability in post-traumatic ankles with clinical suspicion of syndesmotic injury and inconclusive plain radiographs. These measurements should be further investigated for detection of biomechanical instability associated with syndesmotic injury compared to those obtained from asymptomatic ankles
Ankle and Hindfoot Kinematics of a Next Generation Total Ankle Replacement During Simulated Gait
Authors: Sturnick Daniel , Saito Guilherme , Ellis Scott , Demetracopoulos Constantine
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle arthroplasty (TAA) has developed as a viable treatment option for end-stage ankle arthritis. The primary benefit proposed with TAA is that allows for maintained motion of the ankle and hindfoot joint compared to the alternative option of an ankle arthrodesis. Consequently, recent TAA systems have focused on designs that advance kinematic function. Cadaveric gait simulation is a valuable tool for investigating the direct effects of surgical procedures and devices on foot and ankle biomechanics. The objective of this study was to assess whether a next generation TAA system permits normal ankle and hindfoot kinematics using cadaveric gait simulation.

Methods:

Ten mid-tibia cadaveric specimens were secured to a static mounting fixture relative a six-degree of freedom robotic platform to simulate gait in native-intact and TAA conditions. A force plate was moved relative to the stationary specimen through an inverse tibial kinematic path calculated from in vivo data while extrinsic tendons were actuated using physiologic loads (Figure 1A). Ankle and hindfoot kinematics were measured from reflective markers attached to bones via surgical pins. TAA was performed using a next generation, fixed bearing total ankle system by a fellowship trained foot and ankle surgeon using manufacturer described protocol (Cadence Total Ankle, Integra LifeSciences). Ankle and hindfoot joint kinematics were directly measured using the same kinematic inputs and muscle force as the intact condition. Non-parametric, bias-corrected bootstrapping was used to calculate 95% confidence intervals to compare motion between intact and total ankle replacement conditions.

Results:

Analyses revealed that no significant difference in average ankle or hindfoot joint kinematics were found between intact and TAA conditions (Figure 1B). This result was consistent in each the ankle, subtalar, and talonavicular joints, and in each plane of motion.

Conclusion:

This study found that normal kinematics were permitted on average by a next generation, fixed bearing TAA. This finding may indicate that improved functional outcomes following could be expected. However, increased variability and some characteristic differences in the paths of motion throughout stance were observed qualitatively. This report represents an initial analysis of preliminary data, future work will include further analyses and investigation on the influence of factors such as component position and alignment on outcomes. That said, the findings of this study are encouraging and may represent improved kinematic performance in new TAA designs.
The Impact of Lower Back Pain on Functional Outcomes for Ankle Arthritis Treated with Arthroplasty and Arthrodesis
Authors: Symes Michael , Younger Alastair , Penner Murray , Veljkovic Andrea , Wing Kevin
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Numerous studies have demonstrated that concomitant lower back pain (LBP) results in worse functional outcomes in patients undergoing surgical treatment for the management of end stage hip and knee arthritis. However, no equivalent studies have analysed the impact of back pain on the outcomes of patients with end stage ankle arthritis. Furthermore, given that two widely accepted surgical options exist in the treatment of ankle arthritis, namely total ankle arthroplasty (TAA) and ankle arthrodesis (AA), it is possible that one surgical technique may be superior in patients with LBP. The aim of this study was to determine the incidence of LBP in people with ankle arthritis, analyse its effect on functional outcomes, and explore whether there was a treatment advantage from either TAA or AA.

Methods:

Prospectively collected data from the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis was analysed in this study. All patients with ankle arthritis who underwent surgery performed by three fellowship-trained foot and ankle surgeons at a single institution between January 2003 and July 2012 were studied. Patient demographics were collected pre-operatively, including the absence or presence of back pain, and post-operative follow up was performed at 2 and 5 years, evaluating patient-reported functional outcome measures including the Ankle Arthritis Score (AAS) and the 36-item short form survey (SF-36). Using a linear regression model, a multivariate analysis was performed to examine the relationship between back pain, TAAs and AAs.

Results:

In total, 451 patients were studied. 164 patients (36.4%) presented with concomitant LBP. At presentation, the LBP group had worse AAS scores (54.8 vs 57.8 p < 0.04), SF-36 PCS (32.5 vs 28.9 p <0.01), and SF-36 MSC (51.8 vs 47.8 p < 0.01). At 2 years postoperatively, the AAS score was the same in both groups (28.9 vs 26.8 p = 0.3), but patients with LBP had worse SF-36 PCS (42.1 vs 36.6 p <0.02) and SF-36 MSC (54.1 vs 51.1 p < 0.001). These results where repeated at the 5 year mark. There was no difference between TAA or AA (p > 0.05) in any of the functional outcome scores at 2 or 5 years post-operatively.

Conclusion:

The results of this study suggest there is no advantage of TAA over AA in the treatment of ankle arthritis in patients with concomitant lower back pain. Although pre-operative back pain resulted in worse SF-36 outcomes at 2 and 5 years post-operatively, this was not the case for AAS scores.
The Other Adjacent Joint
Authors: Symes Michael , Veljkovic Andrea , Penner Murray , Younger Alastair , Younger Alastair , Wing Kevin
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Accepted surgical treatment options for end-stage ankle arthritis include total ankle arthroplasty (TAA) and ankle arthrodesis (AA). Although they have comparable clinical outcomes, TAA is growing in popularity and one reason for this is that TAA, compared to AA, better preserves range of motion and function at the ankle, and results in a gait pattern that more closely replicates normal controls. This has the theoretical benefit of protecting adjacent articulations and thereby limiting degenerative changes from occurring in other joints. Although multiple studies have analysed the impact of both TAA and AA on adjacent joint disease in the foot, little data exists on their impact on the knee. This study explored the relationships between knee pain, TAA and AA in patients with end-stage ankle arthritis.

Methods:

Prospectively collected data was used from the Canadian Orthopaedic Foot and Ankle Society (COFAS) database of ankle arthritis at a single institution by three fellowship-trained foot and ankle surgeons between January 2003 and July 2012. In total, 342 patients were studied, with patient demographics collected pre-operatively, and post-operative follow up performed at the 5 year mark. All patients were examined for the development or resolution of knee pain, as well as patient-reported outcome measures including the Ankle Osteoarthritis Scale (AOS). Using a linear regression model, a multivariate analysis was performed to examine the relationship between knee pain, TAAs and AAs.

Results:

In the 233 patients that presented without knee pain pre-operatively, 22% who underwent TAA developed knee pain at 5 years, compared to 16% of AA patients (p>0.05). In this group, patients who underwent TAA had statistically significant better outcomes in terms of AOS Pain (p<0.02), AOS Difficulty (p<0.05) and AOS Total Scores (p<0.02). In the 109 patients who presented with knee pain, knee pain resolved in 47% of TAA patients vs 38% of AA patients at 5 years (p<0.05). There was no statistically significant difference in AOS outcomes (p>0.05) between patients who underwent TAA and AA. Compared with patients who did not have knee pain pre-operatively, the presence of pre-operative knee pain resulted in worse AOS (p<0.02), with no difference between TAA and AA.

Conclusion:

In those patients presenting without knee pain, TAA did result in more superior functional outcomes, with no significant difference in development of knee pain compared to AA. In patients with pre-operative knee pain, TAA had benefits of improved resolution of knee pain, with no difference in functional outcomes when compared with AA. Regardless of surgical technique, the presence of pre-operative knee pain was an independent adverse predictor of outcome in patients with tibiotalar arthritis.
3D-printed Talar Components for the Reconstruction of Large Osteochondral Lesions of the Talus
Authors: Wang Bibo
Published: September 2018

Category:

Ankle

Introduction/Purpose:

The reconstruction of large osteochondral lesions of the talus (OLTs) presents a clinical challenge. In this study, a biomechanical experiment was performed using 3D-printed talar components for the reconstruction of large talar lesions, and intra-articular stress tests were conducted before and after implantation.

Methods:

Eight cadaveric ankle specimens were used in this study. After the specimen was fixed on an Instron mechanical testing machine, a piece of Fuji pressure-sensitive film was inserted into the articular cavity. A vertical pressure of 1500-N was applied to the ankle when it was in different positions, i.e. neutral, 10 degrees of dorsiflexion, and 14 degrees of plantar flexion. The total pressure-bearing area and the pressure intensity (MPa) on the talus were calculated to determine their changes before and after implantation.

Results:

The pressure-bearing area of the talus varied with the ankle position in the following order: 10 degrees of dorsiflexion > neutral position > 14 degrees of plantar flexion (P<0.05). The pressure intensity exerted on the talus varied in ascending order: 10 degrees of dorsiflexion < neutral position < 14 degrees of plantar flexion (P<0.05). However, the intensity of the pressure on the graft was insignificantly different from the overall pressure intensity on the talus (P>0.05).

Conclusion:

Treatment using a 3D-printed talar component can achieve precise reconstruction of a large OLT after the surgical removal of the talar lesion. The pressure intensity on the repaired site did not change before and after the operation, indicating the clinical feasibility of this approach.