bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Clinical and Ultrasound Imaging Outcomes Between Corticosteroid and Hypertonic Dextrose Injections for Chronic Supraspinatus Tendinopathy
Authors: Lin Che-Li , Yang Ming-Ta , Lee Yu-Hao , Chen Yi-Wen , Vitoonpong Timporn , Huang Shih-Wei
Published: November 2022

Background:

Both corticosteroids and hypertonic dextrose injections are commonly used for chronic supraspinatus tendinopathy.

Purpose:

To compare the supraspinatus echogenicity and clinical effects of echo-guided hypertonic dextrose versus corticosteroid injection for treating chronic supraspinatus tendinopathy.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The authors performed a secondary data analysis of a previous clinical trial including patients who received normal saline versus hypertonic dextrose injection; patients who received corticosteroid injection were recruited between August 2017 and July 2021. Baseline patient data were matched among these 3 groups at a 1:1:1 ratio. At baseline and 2, 6, and 12 weeks after the intervention, the authors compared morphological changes (supraspinatus thickness and echogenicity) and clinical parameters (visual analog scale [VAS] for pain, Shoulder Pain and Disability Index [SPADI], and range of motion [ROM]). Analysis of variance was used to compare mean changes from baseline among the groups.

Results:

A total of 75 patients (25 in each group) were included. At 2-week follow-up, both the dextrose and the steroid groups exhibited improvement in VAS scores (mean difference [MD] from baseline: –2.0 in dextrose group; –3.3 in steroid group (P < .001)), SPADI scores (MD from baseline: –10.6 in dextrose group; –24.6 in steroid group (P < .001)), and flexion ROM (MD from baseline: 13.6° in dextrose group; 21.1° in steroid group) ( P =.001). At 6 weeks after injection, the hypertonic dextrose group exhibited more favorable echogenic improvement in supraspinatus tendon morphology compared with the other 2 groups ( P < .001). However, the steroid group showed significantly more improvement in clinical parameters compared with the other 2 groups at both week 6 (MD from baseline: VAS, –3.2; SPADI, –26.6; flexion ROM, 21.5°) and week 12 (MD from baseline: VAS, –2.5; SPADI, –20.4; flexion ROM, 15.2°) ( P < .001 for all).

Conclusion:

Hypertonic dextrose injection improved supraspinatus echogenicity after 6 weeks but provided short-term symptomatic relief in the patients with chronic supraspinatus tendinopathy when compared with corticosteroid or saline injections. Steroid injection exerted a more favorable clinical effect at weeks 6 and 12 but demonstrated a negative effect on the supraspinatus.
Comparing the Anatomical Landmarks Versus the Coracoid-Based Landmarks Techniques for Coracoclavicular Stabilization After High-Grade Acromioclavicular Injury: A Biomechanical Study
Authors: Klabklay Prapakorn , Kwanyuang Atichart , Tangjatsakow Preyanun , Kala Sataporn , Suklim Phachara , Naknual Nutnicha , Chuaychoosakoon Chaiwat
Published: November 2022

Background:

In acute high-grade acromioclavicular (AC) joint injuries, the aim of treatment is robust reduction and stabilization of the joint. The anatomical landmarks method is most commonly used for stabilization, but loss of reduction often occurs because of the suture tunnels.

Purpose/Hypothesis:

The purpose was to evaluate and compare the stability of coracoclavicular (CC) stabilization using the anatomical landmarks and coracoid-based landmarks techniques in treating a high-grade AC joint injury. It was hypothesized that stabilization using coracoid-based landmarks would provide better stability.

Study Design:

Controlled laboratory study.

Methods:

Twenty fresh-frozen cadaveric shoulders (8 male and 2 female pairs) were randomized into 2 operative technique groups: 10 shoulders in the anatomical landmarks group and 10 shoulders in the coracoid-based landmarks group. The CC ligaments and AC capsule were cut at the midlevel, and CC stabilization and AC capsule repair were performed. For the anatomical landmarks technique, two 2.5-mm clavicular tunnels were created at 25 and 45 mm from the AC joint, while for the coracoid-based landmarks technique, two 2.5-mm clavicular tunnels were drilled using the medial and lateral borders of the coracoid base to choose the tunnel sites. Before injury creation and after stabilization, each shoulder underwent a loading force of 70 N in the superior and anteroposterior directions, and the displacement distance and stiffness were compared between the 2 techniques using the paired t test.

Results:

The mean difference in displacement before and after stabilization was higher in the anatomical landmarks technique than the coracoid-based landmarks technique (1.82 ± 3.52 vs –0.18 ± 4.78 mm in the superior direction and 7.47 ± 9.35 vs 1.76 ± 3.91 mm in the anteroposterior direction), but none of the differences in displacement or stiffness were statistically significant between the groups.

Conclusion:

No significant biomechanical differences in displacement or stiffness were seen between the anatomical landmarks technique and the coracoid-based landmarks technique.

Clinical Relevance:

Either stabilization technique can be utilized for repair of the CC ligaments in an acute AC injury setting.
“Machine-Dependent”: The Lived Experiences of Patients Receiving Hemodialysis in Pakistan
Authors: Shouket Haseeba , Gringart Eyal , Drake Dierdre , Steinwandel Ulrich
Published: November 2022

This study aimed to explore the lived experiences of patients receiving maintenance hemodialysis in Pakistan. Purposive sampling was used to recruit 24 patients and six healthcare professionals, each participated in a semi-structured interview. Interpretive Phenomenological Analysis was used to analyze interviews’ data. Two superordinate themes, “The experience of hemodialysis” and “The conceptualizations of hemodialysis” as well as six sub-themes were identified. The experience of hemodialysis was related to, the implications of HD procedure on everyday life, social, cognitive, emotional, financial, and occupational influences. While all participants recognized the importance of hemodialysis for their survival, their conceptualizations of the treatment varied. Despite facing multiple challenges, optimism and independence were observed among participants. Stigma related to hemodialysis, and role adaptation, which appear unique to the Pakistani context, highlight a need for tailored interventions designed to enhance and maintain the mental health of patients receiving hemodialysis in Pakistan.
Climate-Related Disasters and Children’s Health: Evidence from Hurricane Harvey
Authors: Raker Ethan J.
Published: November 2022

Children have been theorized as vulnerable to the health consequences of climate change, but data limitations have hampered prior studies of climate-related disasters in the United States. In this article, the author exploits the interruption of a health survey in Houston by Hurricane Harvey, linked to local flooding data ( n = 1,123, ages 5–17 years). Multivariable models on a matched sample show that Harvey led to worse parent-reported health among children six to nine months later, particularly in flooded communities. Further evidence suggests that household life disruption and home damage were key mechanisms and that severe exposure correlated with larger health declines among immigrants, including Hispanic and Asian or other-race children and those younger than 10 years. Integrating these findings with life-course theory and climate science, the author argues that through disasters, climate change should be conceptualized as a risk factor for heath and intragenerational disparities within cohorts and for intergenerational inequalities as newer cohorts experience more extreme weather.
Patients’ Preferences for Androgen Deprivation Therapy in the Treatment of Intermediate-Risk Prostate Cancer
Authors: De Brian , Lowenstein Lisa M. , Corrigan Kelsey L. , Andring Lauren M. , Kuban Deborah A. , Cantor Scott B. , Volk Robert J. , Hoffman Karen E.
Published: November 2022

Background. For men with intermediate-risk prostate cancer (IRPC), adding short-term androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) has shown efficacy, but men are often reluctant to accept it because of its impact on quality of life. Methods. We conducted time tradeoffs (score of 1 = perfect health and 0 = death) and probability tradeoffs with patients aged 51 to 78 y who had received EBRT for IRPC within the past 2 y. Of 40 patients, 20 had received 6 mo of ADT and 20 had declined. Utility assessments explored 4 ADT-related side effects: hot flashes, fatigue, loss of libido/erectile dysfunction, and weight gain. Results. The most commonly reported “worst” treatment-related complication of ADT was fatigue (50% in both cohorts) followed by reduced libido/erectile dysfunction (40% in both cohorts). The utilities for fatigue were mean = 0.71 and median = 0.92 and for reduced libido/erectile dysfunction were mean = 0.81 and median = 0.92. Utilities did not differ significantly between cohorts. Assuming a 6-mo course of ADT, men reported being willing to trade 3 mo of life expectancy to avoid fatigue due to ADT and 1.8 mo to avoid sexual side effects. Patients in the ADT cohort were willing to accept the side effects of ADT in exchange for a mean 8% absolute increase in survival, whereas patients in the no ADT cohort required a 16% increase ( P < 0.001). Conclusions. When considering treatment with ADT, men with IRPC identified fatigue and sexual dysfunction as the most bothersome side effects. Patients who declined ADT expected a larger survival benefit than those who opted for treatment. Both groups expected a survival benefit exceeding that shown by recent trials, suggesting some men may be selecting treatments inconsistent with their preferences.

Highlights

This study demonstrates that prostate cancer patients receiving radiation therapy are reluctant to receive androgen deprivation therapy (ADT) most commonly due to anticipated fatigue and loss of libido/erectile dysfunction. Men who had received ADT reported they would require an average 8% absolute increase in survival to tolerate its side effects, whereas those who declined ADT would require an average 16% increase. Required thresholds are well above the estimated absolute survival benefit for ADT demonstrated in recent clinical trials, suggesting an unmet need for improved patient education regarding the risks and benefits of ADT.
Synovial Inflammation in Patients with Hallux Valgus is Similar to Changes Seen in Those with Hallux Rigidus
Authors: Karzon Anthony L. , Kadakia Rishin J. , Coleman Michelle M. , Labib Sameh (Sam) A. , Jacobson Joseph E. , Bariteau Jason T.
Published: November 2022

Category:

Basic Sciences/Biologics; Bunion

Introduction/Purpose:

Hallux valgus and hallux rigidus are common disorders that can have functional limitations for patients. Although both involve pathology centered around the first metatarsophalangeal joint (MTPJ), the surgical management for both greatly varies. Inflammatory changes in a joint play a critical role in the development of pain and dysfunction. It has been postulated previously that patients with bunion deformity can develop arthritic changes in the long-term. The purpose of this work is to study and compare the synovial tissue inflammation in patients with hallux valgus and hallux rigidus.

Methods:

A prospective study of patients aged 25 to 75 years undergoing either surgical management of hallux valgus or hallux rigidus between January 2021 and December 2021 was conducted following IRB approval. Tissue samples from the synovium were collected at the time of procedure and sent for processing and histology. The samples were graded in a blinded fashion based on the degree of inflammation. Morphological features of the synovectomy specimens undergoing histopathologic analysis were scored by synovial lining cell layer hyperplasia, the extent of inflammatory synovium infiltration, as well as pannus formation via activation of synovial stroma and resident cells. All parameters were graded from 0 (absent), 1 (slight), 2 (moderate), to 3 (strong). Statistical analysis was conducted to compare the level of inflammation between patients who had hallux valgus and those that had hallux rigidus.

Results:

A total of twenty-one samples were collected. One sample was excluded as there was inadequate tissue for analysis. There were eight patients with hallux rigidus and twelve patients with hallux valgus. Mean age at the time of sample collection was 59.3 years (SD=11.9). There was no significant difference in the synovium inflammatory scores (M=5.0, SD=2.25) between the two groups, t(18)= 1.704, p=.106, ([CI .95]: -0.388, 3.722). Moreover, Cohen's effect size value (d=0.78) suggests medium to high practical significance.

Conclusion:

Understanding the intra-articular impact of hallux valgus is important when considering treatment options. The amount of inflammation in the synovial tissue of hallux valgus patients in this study was similar to that of patients with hallux rigidus suggesting that there is intra-articular inflammation in patients with hallux valgus. Further work will need to be performed to determine if this increased inflammation influences outcomes or has an effect on treatment.
Analyzing Risk Factor for Wound Healing after Delayed Primary Closure of Diabetic Foot
Authors: Kim Ki Chun , Kim Sung-Jae , Lee Hong Seop , Song Se Yong , Young Kiwon , Lee Kyung-tai , Sung Il-Hoon
Published: November 2022

Category:

Diabetes; Other

Introduction/Purpose:

Part of hospitalized diabetic foot disease patients with infectious necrosis develop wound dehiscence after delayed primary closure for improved wound status without erythema and induration following appropriate wound management, amputation, and vascular intervention. Dehisced wound could be the source of reinfection, further admission, financial burden. We aimed to analyze predictors for failure of wound management.

Methods:

We retrospectively reviewed medical records and find 105 patients with delayed primary closure among 403 ischemic and/or infectious diabetic foot admitted cases from 2013 to 2021. Vascular intervention was performed for patient with ankle brachial index (ABI) less than 0.8. Total stitches were removed two to three weeks after delayed primary closure. Wound dehiscence was decided when it was developed within two weeks. Eighty-two cases (78.1%) with wound healing were designated as group I, and twenty-three cases (21.9%) with dehiscence were designated as group II. Two groups were compared for various demographic, laboratory and physical state. Then, multivariate logistic regression analysis was done to find predictors for failure of wound management.

Results:

In univariate analysis between two groups, smoking, wound site, initial C-reactive protein (CRP), White blood cell count (WBC), albumin (initial and adjacent to closure) and sequential negative culture result between two groups among 22 potential risk factors. In multivariate logistic regression analysis performed with variables showing p <0.05 during univariate comparison, there was no significant predictor.

Conclusion:

The wound healing ratio for delayed primary closure reached to 78.1% in patients with improved wound status and ABI more than 0.8 in ischemic and/or infectious diabetic foot disease irrelevant to specific factors.
Comparison of Diagnostic Accuracy of Virtual Assessments vs In-Clinic Assessment in the Foot & Ankle Clinic
Authors: Lau Johnny T. , Gotal Tamara
Published: November 2022

Category:

Basic Sciences/Biologics; Other

Introduction/Purpose:

Remote video consultations between clinicians and patients have been increasing in popularity3, and while there is a universal consensus that virtual assessments play an integral role in delivering health care to remote locations there has not been any longitudinal investigations into the diagnostic accuracy between virtual consultations and that of in-clinic assessments. Accordingly, our study aims to validate the diagnostic acuity of virtual consultation of patients in comparison to in- clinic assessments along with assessing the satisfaction that patients have experienced with their virtual assessments.

Methods:

The Foot & Ankle clinic at Toronto Western Hospital prospectively collected data via virtual video assessment of patients from March 2020 till April 2021. We retrospectively analyzed the diagnoses of virtual assessments vs. in-clinic assessments and whether there was a change in diagnosis from these visits. 582 patients were assessed via virtual video consultations of which we used the University Health Network Electronic Patient Records to compare the diagnoses documented in the consultation notes done virtually & the in-clinic notes. Along with this the satisfaction scores were populated for the 192 patients who answered the questionnaire. Satisfaction scores were weighted 0-5, of which 0 represented 'Not At All' and 5 represented 'Definitely'.

Results:

Analysis of the 582 virtual video consults resulted in 30% of those patients who required in-clinic examination. Assessing these patients, we found a diagnostic accuracy of 95%, with most of the virtual assessments having an appropriate diagnosis. We did nonetheless find that 10% of patients assessed in-clinic demonstrated additional pathology in conjunction with the pathology diagnosed virtually. Assessment of the satisfaction scores demonstrated that 78.6% of patients were satisfied (4/5 & 5/5) with the virtual assessment and 8.34% were not satisfied (1/5 & 0/5).

Conclusion:

Our study demonstrates that high diagnostic accuracy is attainable through virtual video assessments, thus making it an integral tool for delivery of health care to patients at a time when the COVID-19 pandemic has created significant barriers. Given the constraints placed on our health care systems, this study also demonstrates that patients are satisfied with the virtual assessments conducted through the OTN system. [GT1] Additionally, the implications of such a tool provides benefits to reducing costs to health care systems and to patients who live in remote locations.
Non-Anatomic All-Inside Arthroscopic Anterior Talofibular Ligament Repair with a High Position Anchor Shows Inferior Clinical Outcomes: A 3D-CT Based Analysis in Chronic Ankle Instability Patients
Authors: Lee Sung Hyun
Published: November 2022

Category:

Arthroscopy; Sports

Introduction/Purpose:

In chronic ankle instability (CAI), it is important to repair the anterior talofibular ligament (ATFL) at the anatomic origin site. However, there are limited reports on the clinical outcomes according to anatomical ATFL repair. The purpose of this study is to compare the clinical outcomes after arthroscopic ATFL repair, according to whether the anchor is fixed at an anatomic position.

Methods:

We performed a retrospective review of consecutive patients who underwent arthroscopic ATFL repair for CAI and were available for a minimum of 2 years follow-up. The patients were divided into three groups according to the anchor position at the distal fibula on 3-dimensional computer tomography: group A, anatomical arthroscopic ATFL repair; group S, sub- anatomical arthroscopic ATFL repair; and group N, non-anatomical arthroscopic ATFL repair. The pain (visual analogue scale [VAS]) score, foot and ankle outcome score (FAOS), and the Karlsson ankle functional score were measured as subjective outcomes. Posturographic analysis and radiologic evaluation using stress radiographs and axial view magnetic resonance imaging were performed as objective outcomes.

Results:

Of 96 patients, 16 were excluded based on the exclusion criteria, and 80 were evaluated (group A, n = 24; group S, n = 42; and group N, n = 14). The mean age of the patients was 34.5 years, and the mean follow-up period was 27.4 months. A between-group comparison revealed significant differences in the FAOS, Karlsson score, and fall risk evaluated by posturography at the final follow-up. Post hoc analysis revealed that group A patients showed better clinical scores in the FAOS than group N patients in all five domains (all p < 0.017). Patients in groups A and S showed better Karlsson score and fall risk than those in group N (p = 0.004 and 0.013, respectively). In terms of objective outcomes, patients in groups A and S showed better outcomes in fall risk than those in group N (both p = 0.001).

Conclusion:

Non-anatomic ATFL repair showed inferior outcomes compared to anatomic ATFL repair. When performing arthroscopic ATFL repair, the anchor should be fixed in the anatomical position to improve prognosis.
Predisposing Factors for Posttraumatic Osteoarthritis after Operation for Malleolus Fracture in Patients Aged 50 Years Or Less with a Minimum Follow-Up of 5 Years
Authors: Lee Sung Hyun , Yoo Byung min , Youngchae Choi , Sung-ju Kang
Published: November 2022

Category:

Trauma; Ankle Arthritis

Introduction/Purpose:

The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged 50 years or less.

Methods:

We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 group according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between various risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score.

Results:

The data of 332 patients who met the study inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritic change was 27.7% (non-arthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (p = 0.011; adjusted odds ratio [OR] >= 30, 6.56), fracture-dislocation injury (p = 0.025; adjusted OR, 4.06), posterior malleolus (PM) fracture (p = 0.031, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (p = 0.034; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the non-arthritis group (p <0.05).

Conclusion:

Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were significant risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation.
The Efficiency of Highly Porous β-Tricalcium Phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in Midfoot Joint Arthrodesis
Authors: Lee Wonyong , Prat Dan , Chao Wen , Farber Daniel C. , Wapner Keith L.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Nonunion is one of the most common and devastating complications following midfoot joint arthrodesis. Many different types of bone grafts and bone substitutes have been used to promote osseous fusion. However, there is no consensus on the gold standard bone grafting material and whether biologic materials should be used alone or in combination. The purpose of this study is to investigate the efficiency of highly porous β-tricalcium phosphate (β-TCP) with Bone Marrow Aspirate Concentrate (BMAC) in midfoot joint arthrodesis.

Methods:

This retrospective comparative study included patients who underwent midfoot joint arthrodesis using compression screws from January 2014 to May 2019. A total of 44 patients (46 feet) including 89 joints were included in this study. The cohort was then stratified into two groups: 25 patients (26 feet) in arthrodesis with highly porous β-TCP and BMAC (group A) and 19 patients (20 feet) in arthrodesis without highly porous β-TCP and BMAC (group B). The osseous union rate was compared between the two groups. Demographic and operative data including age, sex, body mass index (BMI), smoking, etiology of arthritis, comorbidities such as diabetes mellitus and rheumatoid arthritis, number of joints fixed, use of bone graft or bone substitute, and postoperative midfoot anatomic alignment in the two groups were compared.

Results:

There was a significant difference in the union rate between the two groups: 91.5 % (43 out of 47 joints) in arthrodesis with highly porous β-TCP and BMAC (group A) and 76.2 % (32 out of 42 joints) in arthrodesis without highly porous β-TCP and BMAC (group B) (P = 0.048). During the follow-up period, a total of four postoperative complications were reported in this study. In group A, two patients developed hardware irritation, and all of them underwent removal of hardware procedure. In group B, one patient had a superficial wound infection, which was resolved completely without further treatment. The other patient in group B developed a deep wound infection with dehiscence, and it was managed with irrigation and debridement followed by vacuum assisted wound closure therapy.

Conclusion:

This study investigated the efficiency of highly porous β-TCP and BMAC to promote bony healing in midfoot joint arthrodesis. A significantly higher union rate was shown when arthrodesis was performed with highly porous β-TCP and BMAC compared to arthrodesis without them, suggesting that highly porous β-TCP and BMAC can be a viable and effective adjunct to the fixation in midfoot joint arthrodesis.
Degenerative Injuries of the Metatarsophalangeal Plantar Plate on Magnetic Resonance Imaging: A New Perspective
Authors: Mann Tania S. , Nery Caio A. , Baumfeld Daniel
Published: November 2022

Category:

Lesser Toes

Introduction/Purpose:

The magnetic resonance imaging diagnostic criteria for a complete tear of metatarsophalangeal plantar plate are well-established. However, more subtle abnormalities can also occur and be a source of pain. The objectives of this study are to determine the prevalence of degenerative plantar plate injuries in patients with metatarsalgia who underwent magnetic resonance imaging examination of the forefoot and describe the main abnormalities found. Our hypothesis is that mild capsular fibrosis will have high sensitivity but low specificity for plantar plate degenerative injuries.

Methods:

A retrospective cross-sectional study was conducted with 85 consecutive individuals (105 feet) with metatarsalgia who underwent forefoot magnetic resonance imaging examinations using a specific protocol to study metatarsophalangeal plantar plate. An experiment observer classified second toe plantar plate as normal, complete rupture or degenerative lesion and described the main MRI findings.

Results:

A normal plantar plate was observed in 75 (71.4%) of the 105 feet assessed, in 25 (24%) feet there were degenerative plantar lesions, and in 5 (4.6%) feet there were complete ruptures. Degenerative injury of the plantar plate was best identified in coronal short-axis intermediate-weighted images, with high sensitivity (92%). Pericapsular fibrosis below the intermetatarsal ligament was identified in 96% of cases, with high sensitivity (96%) for diagnosis of degenerative plantar plate injury.

Conclusion:

Degenerative lesions of the metatarsophalangeal plantar plate were more prevalent than complete ruptures and were best viewed in coronal short-axis intermediate-weighted sequences. Pericapsular fibrosis below the intermetatarsal ligament was the indirect finding most strongly associated with degenerative plantar plate injury.
Percent Weightbearing in Foot and Ankle X-rays
Authors: Martella Jessica , Chen Jie
Published: November 2022

Category:

Other; Ankle; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Weightbearing x-rays remain standard of care in diagnosing and evaluating foot and ankle injuries and are crucial for clinicians to evaluate foot alignment and ligamentous injuries. Failure for patients to place adequate body weight on x-ray may produce a radiograph that inaccurately demonstrates foot alignment and injury. The objective of the study was to evaluate the percentage of body weight a patient puts on his/her foot during weight bearing x-ray.

Methods:

Study participants (n= 278) included patients requiring a clinically indicated x-ray. They were asked to place body weight on foot/ankle during x-ray. The radiograph categories included: lateral foot, AP ankle, oblique ankle and lateral ankle. The scale was concealed from patients and wrapped in a pad and placed on platform as to avoid any bias. The scale measured the weight each patient placed on their foot during each radiograph. The scale was connected to Bluetooth and data was recorded on computer during imaging. The percent of body weight placed on x-ray was calculated using weight during radiograph and weight measured in clinic.

Results:

Acute injury was defined as pain/injury of duration less than or equal to 3 months with chronic being pain greater than 3 months. Percent bodyweight data in both acute and chronic groups is as follows. Lateral foot acute: mean= 47.39%, max=84.94%, median=46.90%, min= 6.25%; lateral foot chronic: mean=54.80%, max =99.87%, median=54.44%, min=11.56%. AP ankle acute: mean= 56.74%, max=99.51%, median=56.36%, min=6.63%; AP ankle chronic: mean=58.90%, max=97.90%, median=58.42%, min=11.58%. Oblique ankle acute: mean=57.68%, max=98.32%, median=57.40%, min =6.27%; oblique ankle chronic: mean=58.91%, max=96.15%, median=58.46%, min=17.17%. Lateral ankle acute: mean= 50.42%, max=97.92%, median=50.41%, min=11.52%; lateral ankle chronic: mean= 50.03%, max=82.12%, median=50.32%, min=14.10%. Please see attached graphs.

Conclusion:

Preliminary data suggests patients are not placing full body weight during weightbearing x-ray (lateral foot, AP ankle, oblique ankle, lateral ankle). In lateral foot x-rays, patients with acute injuries place less weight during x-ray as compared with patients of chronic conditions (p=0.02). In the categories of AP ankle, oblique ankle and lateral ankle x-rays, the difference in means between acute/chronic was not statistically significant. We plan to further analyze the data to determine how injury type and time since injury changes the percent body weight placed on foot during x-ray as this may affect how patients are diagnosed via radiographs.FIG
Can Sociodemographic Factors be Used to Help Predict Outcomes in Charcot Neuroarthropathy?
Authors: Martinazzi Brandon J. , Mansfield Kirsten N. , Dopke Kelly , Ptasinski Anna , Stauch Chris M. , Koroneos Zachary , Nam Hannah , Kirchner Gregory , Aynardi Michael C.
Published: November 2022

Category:

Diabetes; Other

Introduction/Purpose:

The diabetic Charcot foot, or Charcot neuroarthropathy, is a devastating condition that arises secondary to longstanding diabetes, peripheral neuropathy, and trauma. One of the many challenges associated with the Charcot patient is the lack of data exploring factors that may predict long-term outcomes. Therefore, the purpose of this study was to evaluate how certain sociodemographic factors may influence mortality and the need to undergo lower extremity amputation in patients with Charcot.

Methods:

Following institutional board approval, all patients from 2015-2021 with a diagnosis of Charcot Foot were queried using hospital electronic medical records. Demographics collected included sex, age, race, and insurance coverage. Outcomes recorded were the need to undergo major amputation and mortality rate. Statistical analysis was then run to determine if sex, age, race, and insurance coverage was associated with increased risk of needing a major amputation or death.

Results:

From 2015-2021, 80 Charcot patients with a mean age of 60 (Range, 84-32) were identified. Of these patients, 58 were male, 26 were female, 71 were white, 3 were African American, and 6 were identified as other. In our cohort, 47 patients had government funded insurance and 33 had private insurance. Amputation occurred in 22 patients and death in 15. Government funded insurance (RR: 9.8, 95% CI:1.4-71.1, P = 0.0236) and age over 65 was associated with an increased risk of death (RR: 2.5, 95% CI: 1.02 to 6.17; P = 0.044). No statistically significant increased risk of death or amputation was found in white, African American, male, or female patients. Government insurance was also not associated with an increased risk for amputation (Table 1).

Conclusion:

Charcot Neuroarthropathy is associated with high rates of morbidity and mortality. In our cohort, there was an increased risk of mortality in patients with government funded insurance and patients over the age of 65. Further investigation exploring the role of sociodemographic factors is warranted.
Few Randomized Controlled Trials in Foot and Ankle Orthopaedics Include Sociodemographic Patient Data
Authors: Martinazzi Brandon J. , Kirchner Gregory , Nam Hannah , Mansfield Kirsten N. , Dopke Kelly , Ptasinski Anna , Bonaddio Vincenzo , Koroneos Zachary , Aynardi Michael C.
Published: November 2022

Category:

Other

Introduction/Purpose:

Social determinants of health play a major role in patient care. Factors such as race, education, and income have all been shown to impact patient outcomes in orthopaedic surgery. While retrospective studies are often limited by data availability, prospective randomized controlled trials (RCTs) are able to select their own patient demographics to be included in their analyses. However, the representation of sociodemographic data within RCTs regarding foot and ankle surgery is undefined. Therefore, the purpose of this study was to determine the incidence of sociodemographic data being reported in contemporary foot and ankle RCTs.

Methods:

RCTs within the PubMed database from 2016-2021 were searched using the search term 'Foot and Ankle Surgery.' Each article's journal of publication, year of publication, and outcome of interest were recorded. Articles were separated into the following outcomes of interest: Infection prevention, pain control, surgical outcomes, and non-operative outcomes. The full text of each article was reviewed to identify sociodemographic variables within the results or tables versus any part of the article (i.e., results or otherwise). Sociodemographic variables collected were race, ethnicity, insurance status, income, work status, and education. We then used the Fisher exact test to compare inclusion of sociodemographic data by journal, year, and outcome type.

Results:

A total of 34 studies across 15 different journals were included in our analysis. Of the 34 studies, 12 were grouped into operative outcomes, 11 into pain control, 7 into non-operative outcomes, and 4 into infection prevention. Race was reported in the results in 2 studies (5.9%), ethnicity in 1 (2.9%), insurance status in 0, income in 0, work status in 1 (2.9%) and education in 1 (2.9%). In any section other than the results, race was reported in 3 studies (8.8%), ethnicity in 1 (2.9%), insurance status in 3 (8.8%), income in 4 (11.8%), work status in 2 (5.9%), and education in 1 (2.9%). There was no difference found when comparing sociodemographic data to journal (p=0.127), year of publication (p=0.495), or outcome studies (p=0.439).

Conclusion:

The overall rate of sociodemographic data reported in foot and ankle RCTs is low. There was no difference in the reporting of sociodemographic data between journal, year of publication, or outcome of study.
Hemoglobin A1C in Charcot: Can It Predict a BKA?
Authors: Martinazzi Brandon J. , Manto Kristen , Bonaddio Vincenzo , Kirchner Gregory , Nam Hannah , Aynardi Michael C.
Published: November 2022

Category:

Diabetes; Ankle; Trauma; Other

Introduction/Purpose:

Charcot Foot is a serious and potentially limb-threatening complication of longstanding diabetes, peripheral neuropathy, and trauma. One of the many challenges that surgeons face when treating the Charcot Foot is predicting long-term outcomes. Therefore, the purpose of this study was to determine if hemoglobin A1C level was associated with an increased risk of BKA in Charcot Foot patients.

Methods:

Following institutional board approval, all patients from 2015-2021 with a diagnosis of Charcot Foot were queried using hospital electronic medical records. Patients were separated into two groups. Group A consisted of patients with a diagnosis of Charcot and a hemoglobin A1C3 6.5%, while group B consisted of patients with a diagnosis of Charcot and hemoglobin A1C < 6.5%. Statistical analysis was then performed to determine the relative risk of a BKA in patients exposed to a hemoglobin A1C3 6.5%, compared to those with a hemoglobin A1C < 6.5%. Only patients with a documented A1C around the time of diagnosis were included.

Results:

From 2015 to 2021, 80 patients were diagnosed with Charcot Foot. Of these patients, 59 met our inclusion criteria. Of the 59 patients, 20.3% (12/59) went on to require a BKA and 79.6% (47/59) did not. In our cohort, 54.2% of patients had a hemoglobin A1C3 6.5% and 45.8% (27/59) had a hemoglobin A1C < 6.5%. The relative risk of BKA in patients with an A1C3 6.5% was 2.5 (95% CI: 0.76-8.4; p=0.13).

Conclusion:

Charcot Foot is a debilitating and potentially limb-threatening complication. While our results suggest an associated increased risk of BKA in patients with an A1C3 6.5%, there was no statistical significance found. As such, further investigation is needed.
Safety and efficacy of endoscopic ultrasound as a diagnostic and therapeutic tool in pediatric patients: a multicenter study
Authors: Ragab Khalid Mohamed , El-Kassas Mohamed , Madkour Ahmad , Okasha Hussein Hassan , Agwa Ramy Hassan , Ghoneem Elsayed Awad
Published: November 2022

Background:

Despite the well-established diagnostic and therapeutic applications of endoscopic ultrasound (EUS) in adults, data about its use in children are limited. In this study, we tried to assess the feasibility, safety, and clinical impact of EUS in pediatric patients.

Methods:

Data of pediatric patients (<18 years) referred for EUS over a 3-year period to the endoscopy units of four Egyptian tertiary centers were retrospectively analyzed. Significant impact was defined as a new diagnosis or treatment attributed to the EUS procedure.

Results:

Twenty-four diagnostic and five therapeutic EUS procedures were conducted in 29 children with a median age of 9 years. Indications for EUS included assessment of solid pancreatic mass ( n = 3), pancreatic cyst ( n = 2), suspected chronic pancreatitis ( n = 9), pancreatic pseudocyst (PPC) ( n = 5), recurrent hypoglycemia ( n = 1), bile duct mass ( n = 1), subepithelial lesion (esophageal, duodenal or anorectal) ( n = 4), mediastinal mass ( n = 1), pelvic mass ( n = 3), and mass at splenic hilum ( n = 1). Therapeutically, five patients underwent cystogastrostomy for symptomatic PPC with 100% technical and clinical success. EUS was able to diagnose 21 out of the other 24 patients. EUS-guided tissue acquisition was performed in 11 patients with definitive histopathological diagnosis in 10 patients (91%). There was no procedure-related major complication, while minor complications occurred in two cases (transient pain in one case, temporary fever, and vomiting in two cases).

Conclusion:

Standard linear EUS equipment and accessories can be used safely and effectively in selected pediatric patients for diagnostic and therapeutic purposes.
Behavior of unreinforced dry-jointed masonry walls at corners under lateral loads
Authors: Avasthi Rajat , Bansal Nitin , Rai Durgesh C
Published: November 2022

This study is based on the simultaneous application of in-plane and out-of-plane seismic loads on unreinforced dry masonry (URM) walls. The mode of failure under such a type of loading is the separation of the corner portion from the rest of the structure. This type of failure generally occurs in old masonry structures in which the strength of the mortar has deteriorated, and the floor of the structure is weakly coupled with the rest of the structure. Such structures generally lack the box-type behavior of masonry buildings. Single-story dry-stacked masonry models were considered and subjected to bidirectional loading to study such failures. These masonry models were developed and analyzed using the finite-element (FE) software package Abaqus, and results were verified using experimental testing of the half-scaled model. Simplified corner failure mechanisms and limiting acceleration formulation were proposed based on the observed failure pattern.
CPAP for secondary cardiovascular prevention in obstructive sleep apnoea patients: not only one moon, but many stars
Authors: Baillieul Sébastien , Shah Neeraj M. , Dharmasena Rivindi , Schiza Sophia , Testelmans Dries , Pataka Athanasia
Published: November 2022

While continuous positive airway pressure (CPAP) therapy has a strong evidence base for the treatment of obstructive sleep apnoea (OSA), its impact on cardiovascular comorbidity remains unclear. This journal club reviews three recent randomised controlled trials aimed to evaluate the impact of CPAP therapy in secondary prevention of cerebrovascular and coronary heart disease (SAVE trial), comorbid coronary heart disease (RICCADSA trial) and in patients admitted with acute coronary syndrome (ISAACC trial). All three trials included patients with moderate-to-severe OSA and excluded patients with severe daytime sleepiness. When CPAP was compared with usual care, they all reported no difference in a similar primary composite end-point including death from cardiovascular disease, cardiac events, and strokes. These trials faced the same methodological challenges, including a low primary end-point incidence, the exclusion of sleepy patients, and a low CPAP adherence. Therefore, caution must be taken when broadening their results to the wider OSA population. Although randomised controlled trials provide a high level of evidence, they may not be sufficient to capture the diversity of OSA. Large-scale, real-world data may be able to provide a more rounded and generalisable picture of the effects of routine clinical use of CPAP on cardiovascular morbimortality.
Functional and quantitative evaluation of the 20S proteasome in serum and intracellular in145 moroccan patients with hematologic malignancies
Authors: Filali Hassan , El Yaagoubi Ouadie Mohamed , Ayoub Lahmadi  , Quessar Asmaa , Antri Said El , Samaki Hamid , Aboudkhil Souad
Published: November 2022

Background

Regulatory degradation of intracellular proteins plays an essential role in most biological processes, particularly in the control of cell proliferation and differentiation.

In eukaryotes, intracellular proteolysis is largely provided by the Ubiquitin / Proteasome system. Alterations and dysfunction of protein degradation by the Ubiquitin / Proteasome system, such as transcription factors, cell cycle regulators or tumor suppressor proteins, have been linked to human.

Pathologies, including blood cancers. Mainly localized in the nucleus and cytoplasm of cells, the proteasome can be detected in the cell culture supernatant or in the peripheral blood of patients.

This study deals with the problems of the search for serum markers specific to certain pathologies and which would be useful in the prevention, diagnosis and monitoring of cancers and which could be used as a therapeutic tool.

Methods

The functional and quantitative analysis of the proteasome is carried out at the serum and subcellular level during a pathological phenomenon in a population of 145 Moroccan patients (sex ratio: 1.10 / average age: 47.9 ± 15, 3 years) using an indirect ELISA test and a follow-up of the fluorescence emitted after enzymatic digestion of specific peptides by proteolytic activity (chymotrypsin-like).

Results

The evolutionary trend proteasome subcellular is significantly linked to the rate of chymotrypsin-like activity. The entire population of 60 patients called back for a second blood test.

After three months of treatment reported a significant drop in the rate and the activity of the proteasome in serum and intracellular level.

Conclusions

Although the serum proteasome level is a potential new tool for the monitoring of.

Patientswithliquid cancer.

Trial registration: retrospectively registered.
The effects of combined spinal-epidural analgesia and epidural anesthesia on maternal intrapartum temperature: a randomized controlled trial
Authors: Yao Zhiping , Zhou Jingxin , Li Shuying , Zhou Wenqin
Published: November 2022

Background

Labor epidural analgesia has been suggested to be associated with intrapartum fever. We designed this study to investigate the effects of epidural analgesia and combined spinal-epidural analgesia on maternal intrapartum temperature.

Methods

Four hundred healthy nullipara patients were randomly assigned to receive either epidural analgesia (EA group) or combined spinal-epidural analgesia (CSEA group). Maternal temperature was measured hourly after analgesia administration. The primary outcome was the incidence of maternal fever, and the secondary outcomes were the duration of analgesia, analgesia to full cervical dilation and analgesia to delivery. Neonatal outcomes and other basic labor events were also recorded.

Results

Maternal temperature gradually increased with time in both analgesia groups during labor. However, the CSEA group had a lower incidence of maternal fever, and a lower mean maternal temperature at 5 h, 6 h, and 9 h after analgesia. In addtion, the CSEA group also had a shorter time of analgesia duration, analgesia to full cervical dilation, analgesia to delivery, and less dose of epidural local anesthetic than the EA group.

Conclusion

Our findings suggest that combined spinal-epidural analgesia is associated with a lower risk of intrapartum fever than epidural analgesia.

Trial registration

ChiCTR1900026606. Registered on 16/10/2019.
Expression of 5-hydroxytryptamine 7 receptor in intestinal mucosa correlates with the degree of intestinal inflammation in Crohn’s disease
Authors: Xu Zhangwei , Chen Jason J. , Mei Qiao , Li Yang , Xu Jianming
Published: November 2022

Background

Crohn’s disease (CD), an inflammatory bowel disease (IBD), is a complex and heterogeneous disease characterized by nonspecific transmural inflammation of the gastrointestinal tract. CD has a variety of potential causes with no effective treatment available yet. Current clinical laboratory findings from patients do not provide direct indication of the status of mucosal inflammation in the intestine. Recently, it has been found that intestinal inflammation is generally associated with increased levels of 5-hydroxytryptamine (5-HT), which acts as an important gastrointestinal signaling molecule in intestinal homeostasis by stimulating specific receptors. Most previous researches were carried out in vitro or with animal models, and there was a lack of authentic clinical research. In this study, clinical specimens from patients with Crohn’s disease were used to investigate the expression of 5-hydroxytryptamine 7 receptor (5-HT7R) in the induction and development of chronic non-specific inflammatory bowel disease.

Methods

Patients with CD admitted to the Department of Gastroenterology in the First Affiliated Hospital of Anhui Medical University between June 2014 and January 2018 were recruited, among which 28 were in active disease and 32 were in remission. In addition, 20 patients who had no obvious abnormality by colonoscopy in the hospital during the same time period were recruited into the control group. Data of clinical disease activity (CDAI), CD endoscopic score (SES-CD) and magnetic resonance score (MaRIA) were collected from those two groups of patients. The expression and distribution of 5-HT7R were investigated and their correlations with clinical CDAI, MaRIA, and endoscopic SES-CD scores were analyzed.

Results

Our study demonstrated that 5-HT7R is expressed in intestinal neurons and CD11C-positive cells in human colon. In CD11c/CD86 double-positive cells in the bowel, 5-HT7R expression was significantly increased in the inflammatory area in the bowel of CD patients, and it was closely related to disease severity, MaRIA, and SES-CD scores.

Conclusion

The expression of 5-HT7R was significantly correlated with the degree of gut inflammation in CD patients and could be a potential biomarker for disease activity and the therapeutic efficacy in patients with Crohn’s Disease.