bluuebunny/crossref_metadata_2025 huggingface dataset:
MICROBIOLOGICAL EPIDEMIOLOGY AT CHRIS HANI BARAGWANATH ACADEMIC HOSPITAL: POLYMICROBIAL OSTEOMYELITIS ANALYSIS
Authors: Hlapolosa Tiego , Kgagudi Paul , Jingo Maxwell
Published: November 2023

Most patients treated at our clinical setting present during chronic osteomyelitis stage, which is anecdotally likely to be poly-microbial. Adults with poly-microbial infection have a predilection for gram-negative bacteria and anaerobes, a scenario that hypothetically leads to a higher morbidity of poly-microbial osteomyelitis following trauma. Our study looks into the epidemiology of poly-microbial osteomyelitis treated at our Tumour and Infection unit.

Retrospective study of patients treated for osteomyelitis from 2016 to 2020. Records of eligible patients were retrieved for examination. Demographics such as age, sex and race were recorded. Clinical presentation, organisms cultured, including their anti-microbial sensitivities were documented.

There were 63 participants in the study. 31 (49.21%) had mono-microbial osteomyelitis with 32 (50.79%) having poly-microbial osteomyelitis. Majority of the poly-microbial patients presented with a sinus (68.75%) mostly located in the tibia (50%).

Multiple mixed pathogens (both gam-positive and gram-negative) were cultured in our patients and this comprised 71.21% of the total bacteria cultured. Staphylococcus Aureus was the commonest bacteria (30%) isolated, followed by Enterococcus faecalis (12%). The commonest gram-negative bacteriae cultured was Enterococcus cloacae (10%) followed by Acinetobacter baumannii (7%). Most enterobacteriacae species were sensitive to Ertapenem and Ceftazidime.

A slightly higher incidence of poly-microbial osteomyelitis was found in our study than that reported in literature. Furthermore, our study demonstrated a wide variety of organisms found in poly-microbial osteomyelitis, with a large contribution made by gram-negative anaerobic rod-shaped bacteria
SHORT-TERM CELECOXIB PROMOTES BONE FORMATION WITHOUT COMPROMISING ANTIBIOTIC EFFICACY IN EARLY ORTHOPAEDIC DEVICE-RELATED INFECTION: EVIDENCE FROM A RAT MODEL
Authors: Mdingi Vuyisa , Marais Leonard , Gens Lena , Mys Karen , Zeiter Stephan , Richards Geoff , Moriarty Fintan , Chittò Marco
Published: November 2023

We investigated the effects of non-steroidal anti-inflammatory drugs (NSAIDs) with different cyclooxygenase (COX) selectivity on orthopaedic device-related infections (ODRIs) in a rat model. We aimed to measure the impact of NSAID therapy on bone changes, bacterial load, and cytokine levels after treatment with antibiotics. We also compared the effects of long vs short-term celecoxib (a COX-2 inhibitor) treatment on the same outcomes.

Skeletally mature female Wistar rats were implanted with Staphylococcus epidermidis- contaminated polyetheretherketone (PEEK) screws in the proximal right tibia and monitored for 7 days. All animals received subcutaneous antibiotics (rifampicin plus cefazolin) for two weeks from day 7 to 21. In phase I of the study, rats were randomly assigned to receive 28 days of oral treatment with acetylsalicylic acid, ibuprofen, celecoxib, or vehicle control. In phase II, an additional group received seven days of celecoxib treatment from day 0 to 7. Bone changes were monitored using in vivo micro-CT and histology. Quantitative bacteriology was performed at euthanasia. Plasma samples were collected to measure cytokine levels on days 0, 6, 20, and 28.

Combination antibiotic therapy resulted in treatment success in 85.71% of cases, while the addition of long-term celecoxib treatment reduced it to 45.45%. Long-term celecoxib treatment significantly reduced bone loss (33.85% mean difference [95% CI 14.12–53.58], p=0.0004 on day 6 bone fraction) and periosteal reaction (0.2760 μm mean difference [95% CI 0.2073–0.3448], p<0.0001 on day 14 periosteal thickness) during early infection compared to the control group. Short- term celecoxib treatment showed similar radiological results without a reduction in treatment success (88.9%). No differences in the inflammatory markers were observed.

Our findings highlight the potential benefits of short-term use of celecoxib in improving bone fraction during the early post-infection period without impairing the efficacy of antibiotic therapy
IMPROVING THE DIAGNOSIS OF SPINAL TUBERCULOSIS AND OUR UNDERSTANDING OF ITS PATHOPHYSIOLOGY AND INTERACTION WITH HIV-1 CO-INFECTION
Authors: Waters Robyn , Held Michael , Dunn Robert , Laubscher Maritz , Adikary Nawaal , Coussens Anna
Published: November 2023

Specific and rapid detection methods for spinal tuberculosis, with sufficient sensitivity in HIV-1 co-infected individuals, are needed, to ensure early initiation of appropriate treatment to prevent physical disability and neurological fallout. In addition, understanding the systemic and local pathophysiology of spinal tuberculosis, and its interaction with HIV-1 infection, is crucial to guide future therapeutic interventions.

We prospectively enrolled adult patients presenting with signs and symptoms of suspected spinal tuberculosis, at Groote Schuur Hospital, between November 2020 and December 2021. TB diagnostic testing was performed on open and CT-guided spinal biopsies using Xpert MTB/RIF Ultra compared to gold standards TB culture and histology. A highly sensitive droplet digital PCR assay for detecting and quantifying Mycobacterium tuberculosis complex (MTBC) and HIV-1 DNA was tested. Plasma inflammatory proteins were measured to assess systemic inflammation.

Xpert Ultra had a high sensitivity of 94.7% and specificity of 100% for STB against TB culture and histology in both open and CT-guided biopsy samples. The ddPCR assay confirmed TB detection in 94% of patients with positive Xpert Ultra results. Four patients with negative TB diagnostic results had MTBC DNA detected by ddPCR. HIV-1 DNA was detected in the spinal tissues from all HIV-1-infected patients. MTBC DNA levels were significantly higher in HIV-1-co-infected spinal tissue samples (p< 0.01). We identified four biomarkers significantly associated with higher bacterial burden at the disease site (p< 0.01).

Xpert Ultra and MTBC ddPCR improve the detection of STB. DdPCR can be utilized as an additional, highly sensitive tool for detecting and quantifying Mtb, in pathological samples that may be paucibacillary. These findings provide novel diagnostic and pathophysiologic insight into STB, in the context of HIV-1 infection, and provide rationale to include these tests in hospital and research settings for patients from communities burdened by TB and HIV-1.
IS MALNUTRITION CONTRIBUTING TO THE SEVERITY OF SUPRACONDYLAR FRACTURES IN CHILDREN? A RETROSPECTIVE REVIEW
Authors: Ragunandan Shiksha , Goller Ruan
Published: November 2023

The aims of this study was to determine the incidence of malnutrition in children with supracondylar fractures. It was hypothesised that the presence of malnutrition will increase the severity type of fractures.

The study was a retrospective, cross-sectional study at a single institution. Children between 0 years and 12 years of age, who sustained documented supracondylar fracture treated surgically as a result of low velocity trauma were included in the study. Patients who sustained high velocity trauma, who had known bone disorders or had incomplete chart data, were excluded from the study Data was captured from children's’ notes who have been treated surgically for supracondylar fractures from casualty, theatre and the clinic notes. The nutritional status of children and fracture grade were identified and the two sets of data were compared against each other to try to identify a possible relation between fracture severity and malnutrition. Data was analysed in STATA and 5% level of significance was used to signify statistically significant associations.

150 patients were identified and included in the study. The majority of patients reviewed were in the normal nutritional range according to their z-scores. The severity of the fracture was not only associated with a poorer nutritional status however children with high and low z-scores (over weight as well as undernourished children) had the more severe fracture patterns, while children with normal z-scores had a fracture patterns of varying severity.

Children who were malnourished were more likely to sustain more severe fracture types. The results highlighted the need for all children to have a good nutritional status as this may play a role in preventing more complex fractures.
DELAYED DISCHARGE OF PATIENTS WITH SUSPECTED NON-ACCIDENTAL INJURY
Authors: Simmons Dina , Robertson Anthony , Milner Brenda
Published: November 2023

Child abuse is an essential discussion within society and poses many challenges. The international literature describes patient and family based risk factors and suspicious injuries. We have created a protocol for the identification and investigation of children with suspected non-accidental injuries. The paediatric orthopaedic ward experiences many children being delayed in the ward once fit for discharge. This study aimed to quanitify those delayed discharges and describe the demographics and risk factors for abuse within the local population.

After obtaining ethics clearance, we conducted a retrospective review of records from the Teddy Bear Clinic, as well as admission records. The study examined demographic characteristics, family, injury characteristics and referral to Child Welfare. The delay of discharge from hospital was quantified and was compared to those characteristics.

Records were collected from 1 January 2015 to 31 December 2021. Seventy-nine complete records were included. There were 40 males and 39 females with an average age of 20 months. 75.9% were under 36 months old. 94.1% of the cases sustained lower limb fractures. Fifty-two cases had a delayed discharge. The delay ranged from 1 to 233 days. There was an association between an age less than 36 months and delayed discharge. There were no significant correlations between caregiver characteristics and delayed discharge. The later the completion of investigations, the more likely there would be a delay. There was also a significant correlation between referral to Child Welfare and delayed discharge.

Children under 36 months on this remain at highest risk for non-accidental injury. Delayed discharge was associated with age less than 36 months, upper limb fractures and referral to Child Welfare.

Despite the delayed discharge, most children returned to the same home environments
THE FASSIER TECHNIQUE FOR CORRECTION OF PROXIMAL FEMORAL DEFORMITY IN CHILDREN WITH OSTEOGENESIS IMPERFECTA
Authors: Mwelase Sandile , Maré Pieter , Marais Leonard , Thompson David
Published: November 2023

Children with osteogenesis imperfecta (OI) frequently present with coxa vara (CV). Skeletal fragility, severe deformity and limited fixation options make this a challenging condition to correct surgically. Our study aimed to determine the efficacy of the Fassier technique to correct CV and determine the complication rate.

Retrospective, descriptive case series from a tertiary hospital. We retrospectively reviewed records of a cohort of eight children (four females, 12 hips) with OI (6/8 Sillence type III, 2/8 type IV) who had surgical treatment with Fassier technique for CV between 2014 and 2020.

Inclusion Criteria: All patients with CV secondary to OI treated surgically with Fassier technique.

Exclusion Criteria: Patients older than 18 years; Patients with CV treated non-operatively or by surgical technique different to Fassier technique.

Data relating to the following parameters was collected and analyzed: demographic data, pre- and postoperative neck shaft angle (NSA), complications and NSA at final follow-up.

The mean age at operation was 5.8 years (range 2–10). The mean NSA was corrected from 96.8° preoperatively to 137º postoperatively. At a mean follow-up of 38.6 months, the mean NSA was maintained at 133°, and 83% (10/12) of hips had an NSA that remained greater than 120°. There was a 42% (5/12) complication rate: three Fassier–Duval rods failed to expand after distal epiphyseal fixation was lost during growth; one Rush rod migrated through the lateral proximal femur cortex with recurrent coxa vara; and one Rush rod migrated proximally and required rod revision.

The Fassier technique effectively corrected CV in children with moderate and progressively deforming OI. The deformity correction was maintained in the short term. The complication rate was high, but mainly related to the failed expansion of the Fassier–Duval rods.
GENETIC TESTING IN THE ORTHOPAEDIC CLINIC
Authors: Moosa Shahida
Published: November 2023

Medical Genetics is a transversal discipline with the potential to impact on every specialty and subspecialty in medicine and the allied health sciences. The completion of the human genome project resulted in technical advancements in genomics, genomic testing and our understanding of genetic disorders in general. These advancements have greatly enhanced our understanding of the role of genetics in Orthopaedic practice, with respect to both monogenic and complex disorders. Tygerberg Hospital is currently the only state hospital in South Africa to support genetic testing in the form of gene panels as part of routine care. This is complemented by more comprehensive research testing in the form of exome and genome sequencing as part of the Undiagnosed Disease Programme.

We audit the genetic and genomic testing done on patients referred from the Orthopaedic clinic over a period of 3 years (2020–2022) and review diagnostic rates and interesting results.

The largest group of patients referred (n=50) had a clinical diagnosis of osteogenesis imperfecta (OI). A 100% diagnostic yield was achieved for these patients with the identification of recurring variants (FKBP10, COL1A2). Further families (n=20) with much rarer conditions are presented with important implications on the orthopaedic and medical management, prognosis, and genetic counselling for the families.

We highlight the impact of genomic testing in the Orthopaedic clinic. Management changes and precision orthopaedic intervention were only possible due to a genetic diagnosis. We motivate for increased access to testing, especially for younger patients presenting with complex orthopaedic phenotypes.
AETIOLOGY OF CEREBRAL PALSY IN PATIENTS UNDERGOING ORTHOPAEDIC SURGERY FOR MUSCULOSKELETAL DEFORMITIES
Authors: Gamieldien Hammaad , Horn Anria , Mentz A. , Maimin D. , Van Heerden T. , Thomas M.
Published: November 2023

Cerebral Palsy (CP) is a group of disorders that affect movement and posture caused by injury to the developing brain. While prematurity and low birth weight are common causes in developed countries, birth asphyxia, kernicterus, and infections have been identified as predominant aetiologies in Africa. There is, however, very little information on the aetiology of CP in South Africa. The purpose of this study was to determine the aetiology, severity, and topographical distribution of CP in children undergoing orthopaedic surgery at our tertiary paediatric unit.

A retrospective folder review was performed for patients with CP that underwent orthopaedic surgery from July 2018 to June 2022. Data was collected on perinatal circumstances, aetiology or risk factors for developing CP, severity of disability as classified by the Gross Motor Function Classification Scale (GMFCS) and topographical distribution. Descriptive analysis was performed.

Two-hundred-and-thirty-four patients were included in the analysis. No specific aetiology could be identified in 51 (21.9%) patients. Hypoxic ischaemic encephalopathy (HIE) accounted for 23.6% of patients and was the most common aetiology across the different categories except for patients graded as GMFCS 2, in whom prematurity was the most common aetiology. Congenital brain malformations (10.5%) and cerebral infections, including HIV encephalopathy (11.4%) were the next most frequent aetiologies, followed by prematurity (7.6%), ischaemic stroke (6.8%) and intraventricular haemorrhage (6.3%). Fifty-two percent of patients were classified as GMFCS 4 or 5. There was a predominance of quadriplegic patients (37%) compared to hemiplegics (29%), diplegics (30%) and monoplegics (4%).

Most patients undergoing orthopaedic surgery for musculoskeletal sequelae of CP were severely disabled quadriplegic patients in whom HIE was the predominant cause of CP. This emphasises the need for intervention at a primary care level to decrease the incidence of this frequently preventable condition.
OPERATIVE VERSUS NONOPERATIVE MANAGEMENT OF DISTAL RADIUS FRACTURES IN ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS WITH AN ELDERLY SUBGROUP ANALYSIS
Authors: Bell Katrina , Oliver William , White Timothy , Molyneux Samuel , Clement Nicholas , Duckworth Andrew
Published: November 2023

This systematic review and meta-analysis aimed to compare the outcome of operative and non-operative management in adults with distal radius fractures, with an additional elderly subgroup analysis. The main outcome was 12-month PRWE score. Secondary outcomes included DASH score, grip strength, complications and radiographic parameters.

Randomised controlled trials of patients aged ≥18yrs with a dorsally displaced distal radius fractures were included. Studies compared operative intervention with non-operative management. Operative management included open reduction and internal fixation, Kirschner-wiring or external fixation. Non-operative management was cast/splint immobilisation with/without closed reduction. Version 2 of the Cochrane risk-of-bias tool was used.

After screening 1258 studies, 16 trials with 1947 patients (mean age 66yrs, 76% female) were included in the meta-analysis. Eight studies reported PRWE score and there was no clinically significant difference at 12 weeks (MD 0.16, 95% confidence interval [CI] −0.75 to 1.07, p=0.73) or 12 months (mean difference [MD] 3.30, 95% CI −5.66 to −0.94, p=0.006). Four studies reported on scores in the elderly and there was no clinically significant difference at 12 weeks (MD 0.59, 95% CI −0.35 to 1.53, p=0.22) or 12 months (MD 2.60, 95% CI −5.51 to 0.30, p=0.08). There was a no clinically significant difference in DASH score at 12 weeks (MD 10.18, 95% CI −14.98 to −5.38, p<0.0001) or 12 months (MD 3.49, 95% CI −5.69 to −1.29, p=0.002). Two studies featured only elderly patients, with no clinically important difference at 12 weeks (MD 7.07, 95% CI −11.77 to −2.37, p=0.003) or 12 months (MD 3.32, 95% CI −7.03 to 0.38, p=0.08).

There was no clinically significant difference in patient-reported outcome according to PRWE or DASH at either timepoint in the adult group as a whole or in the elderly subgroup.
A REVIEW OF CALCANEAL FRACTURES PRESENTING TO A SOUTH AFRICAN TERTIARY INSTITUTION
Authors: Nyalungu Mzwandile , Gqamana Loyiso
Published: November 2023

To identify the demographics, mechanisms of injury and treatment modalities of patients presenting at CHBAH with calcaneal fractures.

A retrospective study of all admitted patients with calcaneal fractures from 01 January 2018 to 31 December 2022. The data collected includes age, gender, side of injury, mechanism of injury, isolated injury versus polytrauma, open and close fractures, different treatment modalities and time to surgery. The descriptive data will be analysed, with results presented as frequency charts, histograms, and percentages.

A total of 98 patients showed a male predominance of 90.8% compared to 9.2% of females. The median age was 38 years, the commonest mechanism was from falls from height, accounting for 67.3% with gunshot injuries accounting for 5%. Bilateral fractures were observed in 5 patients, with similar total numbers between those isolated to the left (47) as compared to the injuries isolated to the right side (46). Calcaneus fractures associated with other injuries in polytrauma cases were observed in 17.4%, and open fractures were observed in 7 patients with 5 having occurred post gunshot injury.

A total of 48 patient required surgical treatment with the average time to surgery found to be 15 days. The surgical management varied, with open reduction and internal fixation with plate and screws in 68.7%, followed by 16.7% of patients who were treated with open reduction and internal screw fixation.

Calcaneal fractures occurred frequently amongst male patients secondary to fall from height. Half of the total patient number admitted had require a surgical intervention to treat the fracture, with open reduction and internal fixation with plate and screws being the frequent mode of fixation in this population group.
ESTABLISHING A CONSENSUS ON RESEARCH PRIORITIES IN ORTHOPAEDIC TRAUMA WITHIN SOUTH AFRICA
Authors: Render Luke , Maqungo Sithombo , Held Michael , Laubscher Maritz , Graham Simon M , Ferreira Nando , Marais Leonard Charles
Published: November 2023

Musculoskeletal (MSK) injuries are one of the leading causes of disability worldwide. Despite improvements in trauma-related morbidity and mortality in high-income countries over recent years, outcomes following MSK injuries in low and middle-income countries, such as South Africa (SA), have not. Despite governmental recognition that this is required, funding and research into this significant health burden are limited within SA.

This study aims to identify research priorities within MSK trauma care using a consensus-based approach amongst MSK health care practitioners within SA.

Members from the Orthopaedic Research Collaborative (ORCA), based in SA, collaborated using a two round modified Delphi technique to form a consensus on research priorities within orthopaedic trauma care. Members involved in the process were orthopaedic healthcare practitioners within SA.

Participants from the ORCA network, working within SA, scored research priorities across two Delphi rounds from low to high priority. We have published the overall top 10 research priorities for this Delphi process. Questions were focused on two broad groups - clinical effectiveness in trauma care and general trauma public health care. Both groups were represented by the top two priorities, with the highest ranked question regarding the overall impact of trauma in SA and the second regarding the clinical treatment of open fractures.

This study has defined research priorities within orthopaedic trauma in South Africa. Our vision is that by establishing consensus on these research priorities, policy and research funding will be directed into these areas. This should ultimately improve musculoskeletal trauma care across South Africa and its significant health and socioeconomic impacts.
THE TREATMENT, MANAGEMENT, DEMOGRAPHICS, AND ECONOMIC COSTS OF ORTHOPAEDIC INJURIES SUSTAINED IN MOTORCYCLE ACCIDENTS IN DELIVERY DRIVERS IN SOUTH AFRICA
Authors: Ward Joshua , Louw Frederick , Klopper Schalk , Schmieschek Maximilian
Published: November 2023

Motorcycle accident-related traffic accidents contribute significantly to the burden of orthopaedic injuries seen in the South African Healthcare system. Subsequent to the Covid-19 pandemic, there has been an increase in the number of delivery drivers on the roads of South Africa. Many of these delivery drivers have no formal employment contracts. We aim to describe the demographics and injury patterns in motorcyclists involved in time dependent delivery work in South Africa; and to quantify the cost to the state of their orthopaedic surgeries.

We performed a consecutive case series study at all of the hospitals draining the study region over the period of one year. Epidemiological, clinical and cost to hospital data was collected from medical records, digital radiographs, theatre invoices and a dedicated patient questionnaire.

Provisional

So far 41 delivery drivers were captured by the study over a period of 11 months. All drivers were male and the vast majority foreign nationals. 11 patients were polytraumatised and 5 required admission to an intensive care unit. The most common injury patterns were closed femur fractures (17) followed by tibial shaft fractures (13). The average cost of surgery was R35 049 and average cost of ward stay R44 882 at an average of 10 days admission in a general ward. Overall, an estimated total of R 3.1 million rand was spent on these injuries.

Informally employed “app users” performing delivery work on motorcycles in South Africa have added a significant burden to the cost of state healthcare since 2020. The vast majority of these patients are foreign nationals who do not hold South African licences or health insurance. They are sustaining high energy injuries typical of motorcycle-car accidents and many of them are left with lifelong loss of function.
NUMBER OF DISTAL RADIAL FRACTURES IN THE ELDERLY WILL INCREASE BY MORE THAN HALF BY 2040: PREDICTION MODELLING USING NATIONAL DATA
Authors: Bell Katrina , Yapp Liam , White Timothy , Molyneux Samuel , Clement Nicholas , Duckworth Andrew
Published: November 2023

The aim was to predict the number and incidence of distal radius fractures in Scotland over the next two decades according to age group, categorised into under 65yrs(<65) and 65yrs and older (≥65), and estimate the potential increased operative burden of this.

The number of distal radius fracture in Scotland was isolated from the Global Burden of Disease database and this was used, in addition to historic population data and population estimates, to create a multivariable model allowing incorporation of age group, sex and time. A Negative Binomial distribution was used to predict incidence in 2030 and 2040 and calculate projected number of fractures according to the population at risk. A 20.4% operative intervention rate was assumed in the ≥65 group (local data).

In terms of number of fractures, there was a projected 61% rise in the ≥65 group with an overall increase of 2099 fractures per year from 3417 in 2020 (95% confidence interval (CI) 2960 – 3463) to 5516 in 2040 (95% CI 4155–5675). This was associated with 428 additional operative interventions per year for those ≥65yrs. The projected increase between 2020 and 2040 was similar in both sexes (60% in females, 63% in males), however the absolute increase in fracture number was higher in females (2256 in 2020 [95% CI 1954–2287] to 3620 in 2040 [95% CI 2727–3721]) compared to males (1160 [95% CI 1005–1176] to 1895 [95% CI 1427–1950]). There was a 4% projected fall in the number of fractures in those <65.

Incidence of distal radius fractures is expected to considerably increase over the next two decades due to a projected increase in the number of fractures in the elderly. This has implications for the associated morbidity and healthcare resource use.
REASONS FOR TOTAL KNEE ARTHROPLASTY REVISIONS: A RETROSPECTIVE COHORT STUDY
Authors: Arakkal Ashley , Daoub Mohammad , Nortje Marc , Hilton Thomas , Le Roux Johan , Held Michael
Published: November 2023

The aim of this retrospective cohort study was to investigate the reasons for total knee arthroplasty (TKA) revisions at a tertiary hospital over a four-year period. The study aimed to identify the primary causes of TKA revisions and shed light on the implications for patient care and outcomes.

The study included 31 patients who underwent revisions after primary knee arthroplasty between January 2017 and December 2020. A retrospective approach was employed, utilizing medical records and radiological findings to identify the reasons for TKA revisions. The study excluded oncology patients to focus on non-oncologic indications for revision surgeries. Patient demographics, including age and gender, were recorded. Data analysis involved categorizing the reasons for revision based on clinical assessments and radiological evidence.

Among the 31 patients included in the study, 9 were males and 22 were females. The age of the patients ranged from 43 to 81, with a median age of 65 and an interquartile range of 18.5. The primary reasons for TKA revisions were identified as aseptic loosening (10 cases) and prosthetic joint infection (PJI) (13 cases). Additional reasons included revision from surgitech hemicap (1 case), patella osteoarthritis (1 case), stiffness (2 cases), patella maltracking (2 cases), periprosthetic fracture (1 case), and patella resurfacing (1 case). The findings of this retrospective cohort study highlight aseptic loosening and PJI as the leading causes of TKA revisions in the examined patient population.

These results emphasize the importance of optimizing surgical techniques, implant selection, and infection control measures to reduce the incidence of TKA revisions. Future research efforts should focus on preventive strategies to enhance patient outcomes and mitigate the need for revision surgeries in TKA procedures.
DETERMINING THE SAFETY AND ACCESSIBILITY OF DIRECT POSTERIOR PORTALS INTO THE KNEE WITH RESPECT TO THE NEUROVASCULAR STRUCTURES: A CADAVERIC STUDY
Authors: Greenwood Kelsi , Molepo Maketo , Mogale Nkhensani , Keough Natalie , Hohmann Erik
Published: November 2023

The posterior compartments of the knee are currently accessed arthroscopically through anterior, posteromedial or posterolateral portals. A direct posterior portal to access the posterior compartments has been overlooked due to a perceived high-risk of injury to the popliteal neurovascular structures. Therefore, this study aimed to investigate the safety and accessibility of a direct posterior portal into the knee.

This cross-sectional study comprised a sample of 95 formalin-embalmed cadaveric knees and 9 fresh-frozen knees. Cannulas were inserted into the knees, 16mm from the vertical plane between the medial epicondyle of the femur and medial condyle of the tibia and 8 and 14mm (females and males respectively) from the vertical plane connecting the lateral femoral epicondyle and lateral tibial condyle. Landmarks were identified in full extension and cannula insertion was completed with the formalin-embalmed knees in full extension and the fresh-frozen in 90-degree flexion. Posterior aspects of the knees were dissected from superficial to deep, to assess potential damage caused by cannula insertion. Incidence of neurovascular damage was 9.6% (n=10); 0.96% medial cannula and 8.7% lateral cannula. The medial cannula damaged one small saphenous vein (SSV) in a male specimen. The lateral cannula damaged one SSV, 7 common fibular nerves (CFN) and both CFN and lateral cutaneous sural nerve in one specimen. All incidences of damage occurred in formalin-embalmed knees. The posterior horns of the menisci were accessible in all specimens.

A medial-lying direct posterior portal into the knee is safe in 99% of occurrences. The lateral-lying direct posterior portal is of high risk to the CFN.
"Battlefield and Classroom": Indigenous Student-Soldiers and US Imperialism in the Carlisle Indian School Press
Authors: Hunziker Alyssa A.
Published: November 2023

ABSTRACT: The late nineteenth and early twentieth century saw the beginnings of US empire abroad and simultaneously the crystallization of the US assimilation era at home. While off-reservation Native American boarding schools like the Carlisle Indian Industrial School (1879–1918) developed national recognition, the US began to acquire overseas territories in Cuba, Hawai'i, Guam, the Philippines, and Puerto Rico. Students at schools like Carlisle produced white-edited, school-controlled periodicals like the Indian Helper , the Red Man and Helper , the Arrow , and the Carlisle Arrow . Reading Carlisle's periodicals, this essay traces the experiences of thirty-eight Carlisle students who enlisted in the Spanish-American and Philippine-American Wars and wrote about their experiences across the US's new empire. Although such periodicals have long been read as colonial documents, these newspapers, newsletters, and magazines nevertheless offer insights into Native students' writing and Native soldiers' voices at war, including their impressions of—and, sometimes, identification with—Filipinos, Puerto Ricans, and Native Hawaiians. Carlisle's administrators often used student-soldiers' reprinted letters to demonstrate successful assimilation which promised to transform Native peoples into patriotic US soldiers. These new "war correspondents" could then provide first-hand accounts of some of the Spanish-American and Philippine-American Wars most famous battles. Although largely meant to legitimate assimilative education systems, reprinted letters by Native student-soldiers often detail their everyday lives at war, including interactions with other Indigenous and non-Indigenous communities overseas. This essay ultimately argues for more generous readings of Native voices in these otherwise heavily censored letters. Despite their framing in the periodicals as willing agents of US empire, these reprinted letters by Native students underscore how the US military was likewise a site of trans-Indigenous exchange that provided the material circumstances for connection and solidarity.
Orthodox Judaism's Concept of the Political
Authors: Ben Ami Itamar
Published: November 2023

Abstract: Guided by concepts advanced in Carl Schmitt's The Concept of the Political , this article attempts to formulate Orthodox Judaism's concept of the political. While it is evident that different Orthodox groups hold different and sometimes opposing political views, the question remains whether Orthodoxy as such possesses a foundational conceptualization of the sphere of the political that might be also be framed as "Orthodox." The article presents three possible internal Orthodox conceptualizations of "the political," yet highlights each of these positions' failure to integrate Orthodox commitment to halakha within a truly political framework. The first conceptualization negates the political in a manner that subsumes this realm under the purview of halakha. The second acknowledges the political as a secular realm standing outside the boundaries of halakha. The third possesses a religious understanding of the political that is nonetheless non-halakhic. In order to present an Orthodox concept of the political, the article turns to two thinkers who offered a critique of the epistemological regime of modernity (which is responsible for the existence of the political as a distinct sphere) from an Orthodox stance: Isaac Breuer and the young Leo Strauss. Their reflection on the political as such led them to call for a politicization of Orthodoxy's very commitment to halakha. Retrieving Breuer's and Strauss's truly Orthodox concept of the political enables the formulation of a novel, hitherto underdeveloped Orthodox critique of Zionism. Whereas Zionist voices tend to comprehend the exilic stance of Orthodoxy as apolitical compared to their own attempt to politicize Jewish existence, Breuer and Strauss argue that it is precisely Zionism that fails to offer a concept of the political that is truly Jewish.
Post-Religious-Zionism: Alternative Ideas of Jewish Statism in the Writings of Moshe Koppel
Authors: Katsman Hayim
Published: November 2023

Abstract: This article discusses the rise of the Israeli conservative movement, and examines the dominance of religious-Zionists within the movement. The article focuses on the ideology of Moshe Koppel, the chair of the Kohelet Policy Forum and a dominant figure in the conservative movement. Through an analysis of Koppel's political writings, this article presents Koppel's unique worldview, and demonstrates how it is a critique of the secular-Zionist hegemony, and also of the "classical" religious-Zionist worldview. The article argues that Koppel's ideology appeals to religious-Zionists, who have undergone a political crisis as a result of their failure to convince the general Israeli public to oppose the evacuation of Gaza settlements in 2005. Koppel's worldview addresses the need for religious-Zionists to justify their commitment to Jewish settlement in the Occupied Palestinian territories in a way that will appeal tonon-Orthodox Jews as well. This is a key factor in the Israeli right's conscious attempt to achieve political hegemony in Israel.
The Children of Death Never Die: Specters of the Early Zionist Past
Authors: Halperin Liora R.
Published: November 2023

Abstract: This chapter considers the curious and perennial recurrence, in Zionist periodicals, memoirs and historiographic literature, of the claim that Palestinian Arabs referred to Jews in Palestine in the late nineteenth and early twentieth century as " Awlad al-mawt " (Children of Death). Invocations of this term are typically paired with ideologically laden statements of Zionists overcoming this characterization by demonstrating their capacity for physical strength and willingness to employ violence. Evoking a legacy of conflict with Palestinian Arabs, a longstanding European trope of Jews lacking vitality, and the promise of Jewish revival, Awlad al-mawt , in multiple dialectical variations and transliterations, became a byword for Jewish transformation but also for a lingering anxiety about its ultimate impossibility. By tracing the usages and context of this term throughout the twentieth century, from its first known appearances just before the Kishinev Pogrom of 1903 through 1948, it argues that ambivalence about early Zionist strength informs evolving anxieties about the Zionist-Palestinian conflict, the inherent precarity of Zionism as a settler project, and the attendant militarization of Zionist and Israeli society.
Russian Policy Toward Turkey Since the 2010s
Authors: Moreau Odile
Published: November 2023

ABSTRACT: Historically, the Ottoman Empire and Russia have had recurrent conflicting relations since the eighteenth century and, particularly, from the beginning of the "Eastern Question". Indeed, almost all the wars to which the Ottoman Empire was a party had Russia as an opponent. However, Russia's relations with the Republic of Turkey have been evolving. Indeed, the Soviet Union was one of the first countries to recognise the young Republic of Turkey. Then, during the Cold War, Turkey, which joined the Transatlantic Alliance in 1952, played a strategic role as NATO's Middle Eastern bulwark against the USSR. After the break-up of the USSR, the return of Russian regional dominance in the first decade of the twenty-first century led to competitive relations between Russia and Turkey. However, they have intensified and diversified since the 2010s. We will consider the evolution of Russian policy towards Turkey since the 2010 decade by analysing its stakes and the highlights of a complex strategic alliance. Russia's intervention in Syria in 2015 generated developments in its relationship with Turkey. From 2017, a turning point in the relations between Russia and Turkey has been the issue of the war exit and the future of Syria. In addition, in order to diversify its military logistical arms purchases and move away from a relationship of dependence on NATO, in 2017 Turkey intensified its rapprochement with Russia. Indeed, Russia procured S-400 air defence system missiles for Turkey and negotiated a nuclear energy agreement. This rapprochement between Russia and Turkey irritates the US and NATO, generating collateral effects.
Reconfigurable optical crosshaul architecture for 6G radio access networks
Authors: Tao Yijie , Ranaweera Chathurika , Edirisinghe Sampath , Lim Christina , Nirmalathas Ampalavanapillai , Wosinska Lena , Song Tingting
Published: November 2023

The radio access network (RAN) architecture is undergoing a significant evolution to support the next-generation mobile networks and their emerging applications. To realize scalable and sustainable deployment and operations, RAN needs to consider the requirements of 6G and beyond wireless technologies such as ultra densification of cells, higher data rates, ubiquitous coverage, and new radio spectrum in the millimeter-wave band. This calls for a careful redesign of every aspect of RAN, including its crosshaul. The crosshaul is an important network segment in future RAN, capable of transporting diverse traffic types with varying stringent requirements within RAN. The crosshaul towards 6G is envisioned to be highly intelligent, reconfigurable, and adaptable to dynamic service requirements and network conditions. To this end, we propose a software defined network (SDN)-enabled reconfigurable optical crosshaul architecture (ROCA) that supports heterogeneous crosshaul transport technologies and dynamic functional splittings. ROCA enables efficient and intelligent control of the crosshaul data plane. The proposed architecture with a set of the next-generation RAN (NG-RAN) transport interfaces is evaluated using network models built on the ns-3 network simulator. Simulation results demonstrate the strengths and weaknesses of different crosshaul interfaces in agreement with the understanding of respective NG-RAN interfaces from the literature, which validates the modeling accuracy. We then demonstrate the reconfigurability of the architecture using a dynamic scenario with different reconfiguration strategies for meeting the user and network demands. The results indicate that ROCA serves as a scalable and flexible foundation for supporting high-capacity delay-stringent RAN that can be used in 6G and beyond wireless technologies.
Novel photo-thermal functionality in silicon photonic chips with 2D graphene oxide films
Authors: Moss David
Published: November 2023

On-chip integration of two-dimensional (2D) materials with unique structures and distinctive properties endow integrated devices with new functionalities and improved performance. With a high flexibility in modifying its properties and a strong compatibility with various integrated platforms, graphene oxide (GO) becomes an attractive 2D material for implementing functional hybrid integrated devices. Here, we demonstrate novel functionalities that go beyond the capabilities of conventional photonic integrated circuits, by harnessing the photo-thermal effects in 2D GO films integrated onto them. These include all-optical control and switching, optical power limiting, and non-reciprocal light transmission. The 2D layered GO films are on-chip integrated with precise control of their thicknesses and sizes. Benefitting from the broadband response of 2D GO films, all the three functionalities feature a very wide operational bandwidth. By fitting the experimental results with theory, we also extract the changes in material properties induced by the photo-thermal effects, which reveal interesting insights about 2D GO films. These results highlight the versatility of 2D GO films in implementing functional integrated photonic devices for a range of applications.
CGG toolkit: Software components for computational genomics
Authors: Vasileiou Dimitrios , Karapiperis Christos , Baltsavia Ismini , Chasapi Anastasia , Ahrén Dag , Janssen Paul J. , Iliopoulos Ioannis , Promponas Vasilis J. , Enright Anton J. , Ouzounis Christos A.
Published: November 2023

Public-domain availability for bioinformatics software resources is a key requirement that ensures long-term permanence and methodological reproducibility for research and development across the life sciences. These issues are particularly critical for widely used, efficient, and well-proven methods, especially those developed in research settings that often face funding discontinuities. We re-launch a range of established software components for computational genomics, as legacy version 1.0.1, suitable for sequence matching, masking, searching, clustering and visualization for protein family discovery, annotation and functional characterization on a genome scale. These applications are made available online as open source and include MagicMatch, GeneCAST, support scripts for CoGenT-like sequence collections, GeneRAGE and DifFuse, supported by centrally administered bioinformatics infrastructure funding. The toolkit may also be conceived as a flexible genome comparison software pipeline that supports research in this domain. We illustrate basic use by examples and pictorial representations of the registered tools, which are further described with appropriate documentation files in the corresponding GitHub release.
Efficiency of octenidine dihydrochloride alcohol combination compared to ethanol based skin antiseptics for preoperative skin preparation in dogs
Authors: Eigner Fabian , Keller Stefanie , Schmitt Sarah , Corti Sabrina , Nolff Mirja C.
Published: November 2023

Objective

To quantify the bacterial burden after skin disinfection using an alcohol octenidine dihydrochloride combination (Octenisept®) compared to an 74.1% ethanol 10% 2-propanol combination (Softasept N®).

Study design

Prospective randomized clinical trial.

Material & methods

61 dogs undergoing clean or clean-contaminated surgeries (excluding surgeries on the gastrointestinal tract) were randomly assigned to group O (skin disinfection with alcohol and octenidine dihydrochloride after washing with octenidine containing soap) or to control group C (skin disinfection using the ethanol-2-propanol combination after washing with a neutral soap without antiseptic ingredients). Samples were then taken from 8 different locations within the surgical field at four different stages: after clipping, after washing, after disinfection and one hour later. At each stage, two different sampling techniques (wet-dry swab technique (WDS) and contact plates (CP)) were used for quantitative analysis of bacterial counts.

Results

WDS detected about 100-fold more bacteria compared to CP sampling in cases with high bacterial burden, but was not accurate enough to detect small numbers. CP sampling was therefore used for comparison of treatment protocols. 30 dogs were assigned to group O and 31 to group C. A relative reduction of 69% in group O and 77 percent in group C was observed after the soap wash. No significant differences were detected between both groups. Washing and disinfection resulted in a reduction of bacterial counts of 99.99% in group O versus 99.7% in group C (p = 0.018). Bacterial reduction one hour after washing and disinfection was significantly higher in group O (99.9%) than in group C (98.5%, p = 0.001).

Conclusion

Additional octenidine dihydrochloride provided a slightly better decontamination effect after disinfection, particularly one hour after, which means it may only be indicated in longer surgeries. WDS is more sensitive but less specific to detect bacteria on the skin than the CP sampling.
Impact of voluntary testing on infectious disease epidemiology: A game theoretic approach
Authors: Pepiot Amandine , Supervie Virginie , Breban Romulus
Published: November 2023

The World Health Organization recommends test-and-treat interventions to curb and even eliminate epidemics of HIV, viral hepatitis, and sexually transmitted infections (e.g., chlamydia, gonorrhea, syphilis and trichomoniasis). Epidemic models show these goals are achievable, provided the participation of individuals in test-and-treat interventions is sufficiently high. We combine epidemic models and game theoretic models to describe individual’s decisions to get tested for infectious diseases within certain epidemiological contexts, and, implicitly, their voluntary participation to test-and-treat interventions. We develop three hybrid models, to discuss interventions against HIV, HCV, and sexually transmitted infections, and the potential behavioral response from the target population. Our findings are similar across diseases. Particularly, individuals use three distinct behavioral patterns relative to testing, based on their perceived costs for testing, besides the payoff for discovering their disease status. Firstly, if the cost of testing is too high, then individuals refrain from voluntary testing and get tested only if they are symptomatic. Secondly, if the cost is moderate, some individuals will test voluntarily, starting treatment if needed. Hence, the spread of the disease declines and the disease epidemiology is mitigated. Thirdly, the most beneficial testing behavior takes place as individuals perceive a per-test payoff that surpasses a certain threshold, every time they get tested. Consequently, individuals achieve high voluntary testing rates, which may result in the elimination of the epidemic, albeit on temporary basis. Trials and studies have attained different levels of participation and testing rates. To increase testing rates, they should provide each eligible individual with a payoff, above a given threshold, each time the individual tests voluntarily.