bluuebunny/crossref_metadata_2025 huggingface dataset:
Operationalising flexible planning coupled with ongoing assessment strategies. A pragmatic, longitudinal randomized study in U13 female volleyball team
Authors: Loureiro Manuel , Mesquita Isabel , Ramos Ana , Coutinho Patrícia , Ribeiro João , Clemente Filipe Manuel , Nakamura Fábio Yuzo , Afonso José
Published: December 2024

Embracing a tailor-made approach to training, the aim of this study was to understand how ongoing adaptation and planning of training sessions (through bidirectional feedback between planning and assessment) contrasts with a more rigid planning with only 4-weeks adaptations, and how those differences impact on learning trajectories. A longitudinal, randomized design with a qualitative analysis was conducted during a full season with 24 girls from a U-13 volleyball team: an experimental group (E.G.) had daily adjusted planning and a contrast group (C.G.) had 4-weeks adjusted planning. Data analysis considered reflective diaries, field notes, video analysis and ongoing assessments using Game Performance Assessment Instrument, to gain a deeper understanding of athletes’ progression and identify their struggles. Based on ongoing and punctual assessment (through GPAI) the planning of the two groups diverged significantly in content and drill structure. Ongoing assessment allowed to solve, in E.G., unpredictable issues as well as develop flexible planning to adapt the specific drills and re-adapt the content. Those adaptations occurred in many ways such as: type of the drill, setting goals and changing the content of the session. In C.G., 4 weeks adaptations were permitted to moderate the extending disparities between rigid planning and ongoing adaptations, aiming to balance the group's levels. Our findings highlighted the importance of bidirectional feedback between assessment and planning, informing the coaches to possible adaptation of the training. Given the differences in learning rates, unforeseen circumstances and players’ characteristics, flexible planning and assessment is paramount to effectively steer the learning process.
Critical analysis of media discourse and the politics of self-censorship in Afghanistan
Authors: Rahimi Abdul Wahab , Shah Zakir , Lu Jianping
Published: December 2024

This study analyzes the role of discursive strategies in the politics of self-censorship in Afghanistan, where political pressure, and independent media work together, and language plays a crucial role in implementing these strategies. Critical Discourse Analysis is used to explore the connection between language use and the exercise of power, focusing specifically on the portrayal of the post-2021 government’s legitimacy. The study analyzes 143 textual news stories and televised interviews collected from two domestic media (Tolo News, Ariana News) and one foreign-state media (Radio Azadi). The findings indicate that domestic media employ juxtaposition and factual discursive strategies to balance the politics of self-censorship when reporting on the legitimacy of the Islamic Emirate of Afghanistan, without directly challenging the power structure. In contrast, foreign-state media approach the legitimacy of the Islamic Emirate of Afghanistan through the lens of critical reporting, using strategic labeling to address critical perspectives and maintain an anti-IEA political stance.
Mediation role of body mass index in the relationship between food-specific serum immunoglobulin G reactivity and colorectal adenomas in a Chinese population: a cross-sectional study
Authors: Sun Guanchao , Ma Xiaona , Xu Shiping , Su Binbin , Chen Qianqian , Dong Xiaoyu , Wang Lihui , Wan Jun , Shi Hui
Published: December 2024

Background:

Colorectal adenomas (CAs) represent a significant global health issue, particularly in China, where lifestyle modifications have contributed to their increased prevalence. These adenomas are precursors to colorectal cancer. While high-fiber diets have been shown to decrease risk, the implications of food-specific serum immunoglobulin G reactivity (FSsIgGR) on CAs remain uncertain and warrant further investigation.

Objectives:

To investigate the association between FSsIgGR and the occurrence of CAs in the Chinese population, assess the mediating influence of body mass index (BMI), and offer insights into potential prevention strategies.

Design:

A retrospective cross-sectional study.

Methods:

This study is based on 8796 individuals who underwent colonoscopy at the Second Medical Center of Chinese PLA General Hospital from 2017 to 2021. We examined the relationship between FSsIgGR and CAs using logistic regression, controlling for various confounders. Interaction effects were explored through subgroup analysis. We addressed missing data using multiple imputation and confirmed the robustness of our findings through sensitivity analysis. The role of BMI as a mediator was quantified using structural equation modeling.

Results:

The cohort comprised 2703 patients diagnosed with CAs and 6093 polyp-free controls, with an average age of 50.1 years, of whom 70.1% were male. The analysis revealed a significant inverse association between FSsIgGR and the incidence of CAs (adjusted odds ratio = 0.97; 95% confidence interval: 0.95–0.99; p < 0.001). Dose–response analysis indicated a linear reduction in CAs risk correlating with an increased number of IgG-positive food items. Structural equation modeling showed that BMI mediated 6.02% of the effect on CAs risk ( p = 0.038).

Conclusion:

Our findings suggest that FSsIgGR correlates with a reduced risk of developing CAs, with BMI partially mediating this effect. These results add a novel dimension to CAs risk assessment and prevention, highlighting potential dietary interventions.
Complement inhibition in seropositive generalized myasthenia gravis as rescue therapy in impending and effective treatment in frequently recurring impending myasthenic crisis—a case series
Authors: Menacher Martina , Ellssel Monika , Kwiedor Isabelle , Naumann Markus , Bayas Antonios
Published: December 2024

In seropositive myasthenia gravis (MG), complement inhibition has been shown to be an effective and a fast-acting therapeutic option. Myasthenic crisis (MC), usually preceded by impending MC, is a life-threatening complication requiring highly effective treatments with rapid onset of action. Currently used treatment options of MC are limited, consisting mainly of symptomatic and immune therapies, that is, intravenous immunoglobulins and plasma exchange/immunoadsorption. So far, there is only very limited data on complement inhibitors in impending or manifest MC or termination of frequently recurring impending crises. Here, we report three cases of acetylcholine receptor antibody positive MG, two with impending and one case suffering from high-frequency impending MC, where complement inhibition with eculizumab or ravulizumab resulted in a rapid and sustained remission. Meningococcal vaccination, mandatory when using complement inhibitors, did not result in symptom-worsening or manifest MC.
Intrinsic brain activity differences in drug-resistant epilepsy and well-controlled epilepsy patients: an EEG microstate analysis
Authors: Zhu Chaofeng , Zhang Jinying , Fang Shenzhi , Zhang Yuying , Li Juan , Wu Luyan , Huang Huapin , Lin Wanhui
Published: December 2024

Background:

Drug-resistant epilepsy (DRE) patients exhibit aberrant large-scale brain networks.

Objective:

The purpose of investigation is to explore the differences in resting-state electroencephalogram (EEG) microstates between patients with DRE and well-controlled (W-C) epilepsy.

Design:

Retrospective study.

Methods:

Clinical data of epilepsy patients treated at the Epilepsy Center of Fujian Medical University Union Hospital from January 2020 to May 2023 were collected for a minimum follow-up period of 2 years. Participants meeting inclusion and exclusion criteria were categorized into two groups based on follow-up records: W-C group and DRE group. To ensure that the recorded EEG data were not influenced by medication, all EEG recordings were collected before patients commenced any antiepileptic drug treatment. Resting-state EEG datasets of all participants underwent microstate analysis. This study comprehensively compared the average duration, frequency per second, coverage, and transition probabilities (TPs) of each microstate between the two groups.

Results:

A total of 289 individuals who met the criteria were included, categorized into the W-C group ( n = 112) and the DRE group ( n = 177). EEG microstate analysis revealed substantial variances between the two groups. The analysis highlights differences in three of four microstate classifications. Microstate transition analysis demonstrated altered probabilities in DRE patients. Increased probabilities were observed in TPAB, TPBA, TPBC, TPCB, TPBD, and TPDB. Decreased probabilities included TPCA, TPDA, TPAC, TPAD, TPCD, and TPDC.

Conclusion:

This study highlights distinctive EEG microstate parameters and TPs in DRE patients compared to those with W-C epilepsy. The results may potentially advance the clinical application of EEG microstates.
The impact of psoriatic arthritis on quality of life: a systematic review
Authors: James Lija , Hailey Louise H. , Suribhatla Rhea , McGagh Dylan , Amarnani Raj , Bundy Christine E. , Kirtley Shona , O’Sullivan Denis , Steinkoenig Ingrid , White Jonathan P. E. , Vivekanantham Arani , Coates Laura C.
Published: December 2024

Background:

Psoriatic arthritis (PsA) is a chronic inflammatory condition that can affect individuals of all ages. Patients may experience a range of physical and psychological issues.

Objective:

To examine the impact of PsA on an individual’s quality of life (QoL) and physical function.

Design:

A systematic review of the literature.

Data sources and methods:

A comprehensive search was conducted across seven electronic databases (Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, AMED, EMBASE, Global Health, MEDLINE and PsycINFO) to retrieve articles related to QoL and lifestyle in adults with PsA. The inclusion criteria were studies published between 2010 and 2021 that used outcomes validated in patients with PsA. The methodological quality was assessed using Joanna Briggs Institute Critical Appraisal Tools. Our primary outcomes were patient-reported outcomes (PROs) measuring QoL and the impact of disease on physical function. The secondary outcomes were assessments of fatigue, anxiety, depression, sleep, work productivity and employment.

Results:

The study included 37 comprehensive studies that examined the impact of PsA on QoL and physical function. The findings revealed that the impact of PsA extends to various aspects of life, including activities of daily living, physical, and emotional aspects, such as fatigue, sleep disturbance, anxiety and depression. Notably, people with PsA experience reduced health-related quality of life (HRQoL), particularly in emotional, social and mental health aspects. The severity of pain and/or fatigue is directly linked to decreased HRQoL. Importantly, those who fail to achieve minimal disease activity face challenges in work productivity and employment status.

Conclusion:

To conclude, our review underscores the significant impact of PsA on patients’ HRQoL beyond joint disease. The emotional, social, and mental aspects of PsA require compassionate and holistic management.

Trial registration:

The PROSPERO international prospective register of systematic reviews – CRD42021257395.
Situating AI policy: Controversies covered and the normalisation of AI
Authors: Liebig Laura , Jobin Anna , Güttel Licinia , Katzenbach Christian
Published: December 2024

Artificial intelligence has become an issue in public policy. Multiple documents issued by public sector actors link artificial intelligence to a wide range of issues, problems or goals and propose corresponding measures and interventions. While there has been substantial research on national and supranational artificial intelligence strategies and regulations, this article is interested in unpacking the processes and priorities of artificial intelligence policy in the making. Conceptually, this article takes a controversy studies lens onto artificial intelligence policy, and complements this with concepts and insights from policy studies. Empirically, we investigate the emergence of German artificial intelligence policy based on content analyses of policy documents and expert interviews. The findings reveal a late, but then powerful institutionalisation of artificial intelligence policy in German federal politics. Artificial intelligence policy in Germany focuses on funding research and supporting industry actors in networked configurations, much more than addressing societal concerns on inequality, discrimination or political economy. With regard to controversies, we observe that German policy is evading controversies by normalising artificial intelligence both with regard to taking artificial intelligence integration in all sectors of society for granted, as well as by accommodating artificial intelligence issues into the routines and institutions of German policy.
Enhancing Workplace Wellness: A Comprehensive Approach to Sleep Apnea Screening in Onsite Health
Authors: Kozan Selina , Kreider Kathryn Evans , Derouin Anne
Published: December 2024

Background:

This quality improvement project aimed to increase the screening rate for OSA in individuals aged 18 and above with obesity (body mass index [BMI] ≥30).

Methods:

This quality improvement study occurred from March 2023 to August 2023 using a two-independent pre-implementation post-implementation design. The STOP-Bang Questionnaire (SBQ) was implemented during annual exams, chronic disease management visits, and Department of Transportation (DOT) physicals.

Findings:

There were 946 patients involved in the study, including 471 in the pre-implementation group and 475 in the post-implementation group. OSA screening increased from 14.1% to 71.6% after implementing the screening protocol in the general population and 26.7% to 90.4% in the commercial driver’s license (CDL) holder population. Of the CDL holders screened in the pre-intervention group, 15 (65.2%) were at intermediate to high risk for OSA (SBQ ≥3), and in the post-intervention group, 33 (50%) had an SBQ score of ≥3.

Conclusions/Application to Practice:

Standardized OSA screening is crucial because it is common but underdiagnosed. Screening for OSA during DOT exams promotes community safety. Earlier identification of at-risk patients leads to earlier diagnosis and treatment of OSA to prevent long-term complications, reduce healthcare costs, improve patient outcomes, and improve community safety.
Framing Intra-Team Conflicts in a New Venture: The Interplay of Conflict Resolution Frames and Negotiation Strategies
Authors: Dunn Mary B.
Published: December 2024

This experiential exercise introduces students to the role that frames play in conflict management and negotiation. Understanding frames is important because they serve as lenses through which negotiators define a conflict and select strategies to resolve it. Students will apply conflict resolution frames to a situation that occurred within an entrepreneurial team, but key details have been disguised and fictionalized. Engaging in this exercise allows students to experience how framing conflicts in terms of interests, rights, or power affects the process of negotiation, the choice of situationally appropriate strategies, and the outcomes for individuals and their organizations. Students will consider ways to reframe negotiations around shared interests to benefit the collective. The exercise can be used across management and entrepreneurship courses, but may fit best in negotiation and organizational behavior. It works well in any format, traditional and online, with graduate and undergraduate students.
Addressing Pre-exposure Prophylaxis Awareness and Knowledge Gaps Among Lebanese Medical Professionals: A Cross-Sectional Study
Authors: Azzi Akel , Chartouni Carine , Sakr Charlyne , Ibrahim Racha , Bou Chebel Zeina , Haddad Elie , Chehata Nabil , Choucair Jacques , Pozniak Anton , Saliba Gebrael
Published: December 2024

OBJECTIVE

In Lebanon, HIV prevalence among key populations such as men who have sex with men is high at 12%, warranting a need for targeted healthcare efforts. Pre-exposure prophylaxis (PrEP) is an effective prevention measure, yet global challenges persist, including limited awareness of PrEP among healthcare professionals. This study investigates PrEP awareness within the Lebanese medical community.

METHODS

A survey targeted 201 participants from the Saint Joseph University of Beirut, Faculty of Medicine, comprising students, residents, and physicians. Analyses, including chi-square tests, mid- P exact test, and point-biserial correlation, assessed PrEP knowledge and perceptions.

RESULTS

Significant disparities in PrEP awareness were noted among medical students, residents, and physicians, revealing misconceptions about its purpose, administration, and effectiveness. Positive correlations between age and awareness among medical students suggest evolving awareness during medical education. Residents exhibited higher awareness compared to physicians, emphasizing the impact of recent training. No significant correlation based on specialty was found among physicians, indicating the need for uniform PrEP education across all medical fields.

CONCLUSION

Addressing PrEP awareness gaps among medical professionals is crucial for effective HIV prevention in Lebanon, necessitating tailored educational strategies integrated into medical curricula and ongoing professional development.
Automated Syndesmotic Distance, Area, and Volume Measurements Using 3D Segmentations of Weightbearing Computed Tomography Scans
Authors: Ghandour Samir , Gholipour Alireza , Guss Daniel , Waryasz Gregory R. , Bejarano-Pineda Lorena , Kwon John Y. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

Syndesmotic injuries may be associated with subsequent instability, even following operative fixation of etiologic fractures. The development of advanced imaging techniques like weightbearing computed tomography (WBCT) has enabled clinicians to identify subtle syndesmotic instability under physiologic conditions that would otherwise go undetected using conventional CT scans. Moreover, the normal reference ranges for the syndesmotic interval distance, area at 1 cm above the plafond, and volume 5 cm above the plafond have been established. These measurements, however, may be cumbersome and time-consuming to perform. This validation study aims to develop and evaluate the reliability of an automated algorithm that automatically segments WBCTs of the ankle and performs dimensional measurements.

Methods:

Five bilateral WBCT scans of individuals with operatively confirmed syndesmotic instability were included (10 ankles). An independent observer manually performed the anterior tibiofibular distance (ATFD) at 1 cm above the plafond, posterior talofibular distance (PTFD) at 1 cm above the plafond, the syndesmotic area (SA) at 1 cm above the plafond using 2D ROI, and the syndesmotic volume (SV) at 5 cm above the plafond using 3D ROI. Visage software was used to perform the measurements manually. The same WBCT scans were fed into the automated algorithm to perform the same measurements. The time required to perform the manual and automated measurements was recorded for comparison. The intraclass correlation coefficient (ICC) was measured for repeated automated measurements to evaluate the automation's consistency

Results:

The manual measurements required 19 (+/-4) minutes on average to perform for each case compared to 9 (+/-1) minutes for the automated measurements (P< 0.05). The ICC between the repeated automated measurements for each case was 0.99.

Conclusion:

Our automated syndesmosis dimension measurement tool can efficiently perform the ATFD, PTFD, SA, and SV measurements as reliably as an expert clinician would with significantly less time. Incorporating such a tool into existing healthcare software infrastructure, particularly in foot and ankle clinics, may expand the accessibility of this tool and provide immediate data for clinicians to support their decision-making in real time.
Can ChatGPT Answer Patient Questions Regarding Ankle Fractures & Fixation?
Authors: Kelley Raegan , Mika Aleksander , Luther Lauren , Schultz Jacob , Mitchell Phillip , Strasser Nicholas L.
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

The contemporary patient has access to numerous resources on common orthopaedic procedures. Recently, artificial intelligence (AI) driven chatbots have become mainstream, allowing patients to interact with interfaces which supply convincing, human-like answers to posed questions. ChatGPT, a recently developed AI-based chat application, is one such application that has garnered rapid growth and popularity and exhibited high functionality in answering common patient questions regarding a gambit of orthopaedic procedures. While ChatGPT has previously demonstrated reliability in answering questions regarding elective orthopaedic procedures, there is little evidence of its effectiveness in the acute, traumatic setting. Given the likelihood that patients may call on this technology for preoperative education, we sought to determine whether ChatGPT could appropriately answer frequently asked questions (FAQs) regarding traumatic ankle fractures.

Methods:

Ten FAQs regarding ankle fractures were posed to the chatbot during a conversation thread with no follow up questions or repetition. Each FAQ was analyzed for accuracy using an evidence-based approach. Answers were rated as “Excellent requiring no clarification”, “Satisfactory requiring minimal clarification”, Satisfactory requiring moderate clarification” or “Unsatisfactory response requiring significant clarification.”

Results:

Of the answers given by the chatbot none received an “unsatisfactory” rating with four not requiring any correction and the majority either requiring minimal (4/10) or moderate (2/10) clarification. Although several answers require nuanced clarification, the chatbot's responses were generally unbiased and evidence based, even for controversial topics.

Conclusion:

The chatbot effectively provides evidence-based responses to common patient FAQs regarding ankle fractures and fixation, presenting the information in a way that most patients can understand. This resource may serve as a valuable clinical tool in the future especially in the acute, traumatic setting.
Comparison of Achilles Tendon Ruptures Treated with Open, Percutaneous, or Mini-Open Repair Techniques: A Meta-Analysis
Authors: Cho Thomas , Liu Jiayong , Shendge Shradha , Sohn Elisabeth , Mustapha Rayanne
Published: December 2024

Category:

Trauma; Sports

Introduction/Purpose:

Achilles tendon ruptures is the most common tendon rupture in the lower extremity, causing pain and disability. This injury most commonly occurs in those who engage in physical activities, such as soccer and basketball. Historically the most common surgical technique that was used was the open repair technique, then followed the percutaneous repair technique, and even more recently the mini-open repair technique. Although there have been previous studies that looked at the differences between two of these techniques, there is no meta-analysis to compare all three surgical techniques. The primary purpose of this study was to compare the outcomes between the three surgical techniques for Achilles tendon rupture, which are open repair, percutaneous repair, and mini-open repair.

Methods:

We searched multiple databases, including PubMed, Google Scholar, and EMBASE, from the inception to November 2023. The eligibility for articles selected included being a comparative study between two of the surgical techniques and having included at least one outcome that was of interest in this study. Meta-analysis was processed by RevMan Web for the open versus percutaneous and open versus mini-open repair groups, and the continuous variables (AOFAS score, ATRS score, average operating time) in the percutaneous versus mini-open group. The Fisher test was used for the dichotomous variables in the percutaneous versus mini-open group due to the small sample sizes. A p-value of ≤ .05 was considered statistically significant.

Results:

26 studies including a total of 1898 patients met the inclusion criteria. The percutaneous group had a significantly higher sural nerve injury rate (p < 0.001), lower infection rate (p = 0.006), higher AOFAS score (p = 0.03), higher ATRS score (p = 0.03), and shorter average operating time (p < 0.001) than the open group. In relation to the mini-open group, the percutaneous group had a significantly lower AOFAS score (p = 0.02), lower ATRS score (p = 0.001), shorter average operating time (p < 0.001), higher re-rupture rate (p = 0.03), and higher sural nerve injury rate (p = 0.05). The open group had significantly a higher infection rate (p = 0.04) than the mini-open group.

Conclusion:

Percutaneous repair had advantages in infection rate, AOFAS score, ATRS score, and average operating time compared to the open repair group. However, the mini-open repair seems to be the superior technique, having advantages in AOFAS score, ATRS score, re-rupture and sural nerve injury rates compared to the percutaneous repair and having a lower infection rate than open repair. In the future, more studies with larger sample sizes should be done to further determine which operative technique is most beneficial.
Comparison of Dorsal and Plantar Approaches for Hoffmann Resection Arthroplasty in Rheumatoid Forefoot
Authors: Bastias Gonzalo F. , Pino Felipe , Parada Cristian , Jofre Magdalena , Henriquez Hugo , Chaparro Felipe
Published: December 2024

Category:

Midfoot/Forefoot; Lesser Toes

Introduction/Purpose:

Forefoot involvement in patients with Rheumatoid Arthritis (RA) is the most frequent reason for consultation in patients with Rheumatoid Arthritis. Although the use of biologics has substantially improved forefoot deformity at the time of consultation, there are still patients with severe deformities who are not candidates for joint-sparing procedures. Resection arthroplasty is a commonly used procedure for severe deformities of the lesser toes, To our knowledge, no studies have compared the use of plantar and dorsal approaches from the point of view of functional and radiological results and associated complications.

Methods:

Retrospective study including RA patients with symptomatic foot deformities who underwent 1stMTP arthrodesis and Hoffman resection arthroplasty using a double dorsal longitudinal or transverse plantar approach. AOFAS and VAS scores were applied to all patients pre-and postoperatively at one-year follow-up. In addition, radiological results were evaluated by reestablishing the post-resection metatarsal formula in weight-bearing radiographs. General complications and those associated with the type of approach were recorded.

Results:

Twenty-four patients were included and divided into two groups: dorsal approach (DA) with 11 patients and plantar approach (PA) with 13 patients. All hallux arthrodesis showed complete healing. Patients in both groups achieved a statistically significant improvement in function and pain compared to their preoperative status. A comparison between both approaches showed no significant differences in the AOFAS scores (p=0.17) and VAS scores (p=0.88). There were no significant differences in the rates of complications associated with the approach or restoration of the metatarsal formula.

Conclusion:

Dorsal and plantar approaches presented similar results in terms of function and postoperative pain. In this group of patients, there were no significant differences in complications associated with the approach. The metatarsal formula was successfully re-established in both groups.
Comparison of Intermediate-Term Prognosis Between Surgical and Non-Surgical Treatments for Early-Stage Osteoarthritis Conjunction with Chronic Ankle Instability
Authors: Cho Byung-Ki , Choi Seung-myung , Kim Sunghoo , Kim Yoon-ho
Published: December 2024

Category:

Ankle Arthritis; Sports

Introduction/Purpose:

Repetitive ankle sprains can cause various intra-articular pathologies, and there is a relatively clear consensus on the relationship between chronic ankle instability and osteoarthritis. However, information on the natural course in patients with chronic ankle instability and treatment options for preventing degenerative changes remain limited. This study aimed to compare the intermediate-term prognoses between patients with surgical and non-surgical treatment.

Methods:

This study included 44 patients who underwent lateral stabilization procedure (anatomical ligament repair or reconstruction) and 62 patients with conservative treatment for chronic ankle instability conjunction with early-stage arthritis of Takakura grade 2. Daily living and sport activities were evaluated using the Foot and Ankle Ability Measure (FAAM). Progression of osteoarthritis was evaluated through periodic weight-bearing radiographs. Additionally, the correlation between clinical evaluation score and the presence of progressive osteoarthritis was analyzed.

Results:

The FAAM score significantly improved from a mean of 48.8 points preoperatively to 83.6 points at final follow-up (p < .001) in the surgical group, while it also improved in the non-surgical group from a mean of 65.9 points to 74.1 points (p = 0.188). There was no significant difference in daily living ability of the FAAM score between the two groups at final follow-up (88.6 vs 81.4 points, p = 0.385), but the surgical group showed better results than the non-surgical group in sports ability (79.4 vs. 67.3 points, p < .001). The incidence of progression of osteoarthritis grade was not significantly different between surgery group (15.9%) and non-surgical group (17.7%) (p = 0.861).

Conclusion:

Patients with early medial osteoarthritis accompanied by chronic lateral ankle instability who underwent surgical and non-surgical treatment showed similar intermediate-term clinical outcomes. However, in terms of sports activity ability, the surgical group showed superior results compared to the non-surgical group. The radiological prognosis based on the Takakura grade of degenerative arthritis also showed similar results in both groups. There was a significant difference in clinical evaluation scores between patients with and without progressive osteoarthritis.
Correlation Second-Look Arthroscopy and Magnetic Resonance Image after Arthroscopic Microfracture for Osteochondral Lesions of the Talus
Authors: Lee Kwang-Bok , Kim Jong-Kil
Published: December 2024

Category:

Ankle; Arthroscopy

Introduction/Purpose:

Arthroscopic microfracture is a commonly used surgical technique for treating osteochondral lesions of the talus. Long-term clinical outcomes have generally been found satisfactory. However, there are few studies that accurately evaluate the quality of cartilage repair after microfracture and its relationship with clinical outcomes. The purpose of this study is to analyze the status of cartilage repair after microfracture using second-look arthroscopy and magnetic resonance imaging (MRI), and compare it with clinical outcomes.

Methods:

Fifty patients underwent second-look arthroscopy and magnetic resonance imaging (MRI) 12.4 months after microfracture (range, 6-19 months). The MRI performed prior to the second-look arthroscopy was evaluated using the magnetic resonance observation of cartilage repair tissue (MOCART) score. Clinical outcomes were assessed using the Foot and Ankle Outcome Score (FAOS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, and the Short Form-36 (SF-36) score.

Results:

In second-look arthroscopy, 13 ankles (39%) exhibited abnormal findings according to ICRS overall repair grades. The postoperative MOCART score was 74.2 (range, 25 to 95). 16 patients (32%) had a mismatch between the MRI and second-look arthroscopic findings. All functional score including FAOS, AOFAS and SF-36 were improved between the preoperative and last follow-up evaluation (p < 0.001). The mean postoperative FAOS scores were 88.8 for grade-I and II ankles (n=37) and 82.9 for grade-III and IV ankles (n=13). There was good correlation between FAOS scores and ICRS grades (p = 0.018). The analysis of the correlation between postoperative FAOS and factors for MOCART evaluation showed that the degree of defect infill (p < 0.001) and subchondral bone (p=0.014) had statistical significance.

Conclusion:

The second-look arthroscopic evaluation conducted 12.4 months after arthroscopic microfracture indicated incomplete healing in 39% of the lesions. A 32% mismatch between second-look arthroscopy and MRI highlights the challenge for MRI in precisely depicting cartilage repair. Nonetheless, even in the presence of this mismatch, clinical outcomes are predicted to be unfavorable when inadequate cartilage defect infill or the existence of subchondral bone edema is observed on MRI.
Creation of a Custom 3D Algorithm for Proper Alignment of Straight Nails in Tibiotalocalcaneal Arthrodesis
Authors: Subasi Omer , Tung Wei Shao , Hollander Julian , Ghandour Samir , Taseh Atta , Nassour Nour , Aratikatla Adarsh , Ebrahimi Alireza , Burgesson Bernard , Ashkani-Esfahani Soheil , Kwon John Y.
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Tibiotalocalcaneal (TTC) arthrodesis is a complex procedure for severe ankle and hindfoot pathologies like end-stage osteoarthritis or avascular necrosis of the talus. Proper calcaneal fixation with the talus and tibia is crucial for postoperative stability and neurovascular protection in intramedullary nailing. A cadaveric study by Hyer et al. showed that a wire placed anterograde through the tibial shaft may miss the calcaneus medially. Methodologic limitations included a limited number of cadavers, non-loaded specimens, and a lack of critical examination of hindfoot alignment. This study aims to determine the feasibility of using weightbearing computed tomography (WBCT) and 3D segmentation software to ascertain an optimal entry point for a straight intramedullary nail in TTC arthrodesis in weightbearing patients.

Methods:

A total of 100 normal ankles (48 left, 52 right) from 52 patients (Age: 39.9 ± 16.7 years; Gender: 68% F; BMI: 28.1 ± 5.8 kg/m^2) with WBCT scans were obtained and subsequently segmented for inclusion in the study. A novel mathematical algorithm was developed to determine the 3D intersection of the distal tibial central axis extension at the inferior calcaneus. The algorithm approximates the central axis by mapping the center point of the tibial medulla at each CT slice, from the shaft to the tibiotalar joint using 3D surface contours in the axial plane. Then, the central axis is extended through the talus and calcaneus to approximate its exit point on the inferior surface of the calcaneus for each individual ankle (Figure 1a). A 2D linear transformation (affine transformation) was applied to obtain a heat map of all intersection points on the inferior surface of the calcaneus.

Results:

The mean (SD) polar angle of the central axis with respect to the ground was 84.9 ± 2.3 degrees. The root mean (SD) square error of the affine transformation was 1.62 ± 1.02 mm, demonstrating the validity of mapping. The exit points of the central axis across all patients fall predominantly along the sustentaculum tali (Figure 1b).

Conclusion:

A straight nail passing through the sustentaculum tali places surrounding neurovascular structures at risk and can also compromise the biomechanical stability of the implant. Our novel 3D algorithm shows that intraoperative adjustment of the starting point lateral to the central tibial axis is required to obtain optimal alignment of the hindfoot nail. Additionally, the novel algorithm can also be used preoperatively to estimate the required calcaneal medialization and ensure precise implant positioning. Proper nail alignment may potentially improve the success of TTC arthrodesis and decrease the risk of postoperative complications, including implant failure.
Debridement, Antibiotics, and Implant Retention (DAIR) vs 1.5-Stage Revision vs 2-Stage Revision in Periprosthetic Ankle Joint Infection: A Systematic Review
Authors: Izzo Antonio , Carbone Claudia , Festa Enrico , Balato Giovanni , Mariconda Massimo , Lintz François , Bernasconi Alessio
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle replacement (TAR) is gaining momentum as surgical option in end-stage ankle osteoarthritis. Periprosthetic joint infection (PJI) is one of the most common complications and its management may be challenging. Our aim was to define the eradication rate and limits of the surgical procedures performed to treat PJI after TAR.

Methods:

This systematic review followed the PRISMA checklist and was registered in the Open Science Framework platform. Multiple databases were searched including clinical studies in which PJI after TAR was diagnosed and treated. Data were harvested regarding the cohort, the study design, the diagnostic criteria and the surgical treatment for PJI. The methodological index for nonrandomized studies (MINORS) was used to assess the methodological quality of studies. Three groups were built based on the surgical procedure performed by authors: Group 1 for debridement, antibiotics, and implant retention (DAIR), Group 2 for 1.5-stage revision (1.5-stage) and Group 3 for 2-stage revision procedures (2-stage).

Results:

Fourteen cohorts (eight studies,152 infected TARs, 152 patients; 44% females, mean age: 61.4 years) were included. All studies had a retrospective design. Ankle pain with swelling and increased local temperature usually led to a suspicion of PJI. In 100% of cases the diagnosis was confirmed through synovial fluid analysis with positive blood tests. Microorganisms were identified in 92% (range,64%-100%) of cases. The definition of eradication of the infection was heterogenous ( ‘no more surgery’ (4 studies)), normal clinical-serological markers (2 studies), negative intraoperative cultures (2 studies). The eradication rate in DAIR, 1.5-stage and 2-stage groups was 64% (39/58 patients) 91% (11/12) and 89% (47/54),respectively. The incidence of below-knee amputation was 6.5% at 38.6-month follow-up. MINORS score was 8/16 for noncomparative studies and 14.6/24 for comparative ones (moderate quality).

Conclusion:

Decision-making in PJI after TAR is based on small-sample retrospective studies of moderate quality. In this review, the estimated effectiveness of DAIR and exchange procedures to eradicate the infection was two-thirds and nine-tenths, respectively. In case of failure, below-knee amputation is not uncommon.
Differences in Postoperative Outcomes of Common Foot and Ankle Procedures Performed by Orthopedic Surgeons and Podiatrists
Authors: Chao Myra S. , Heo Kevin Yunhao , Coleman Michelle M. , Guyton Gregory P.
Published: December 2024

Category:

Ankle; Midfoot/Forefoot

Introduction/Purpose:

In the United States, there has been a substantial rise in podiatrists to address the increasing prevalence of foot and ankle pathologies. Although this may improve accessibility to foot and ankle care, there may be differences in the quality of care delivered by podiatrists compared to orthopedic surgeons. Some studies have found that patients treated by podiatrists have higher postoperative complication rates and length of hospital stay. With a growing emphasis on patient-centered care, there is a need for research investigating these differences so patients can make informed decisions when selecting providers. The purpose of our study is to compare postoperative complications in common foot and ankle procedures performed by orthopedic surgeons and podiatrists.

Methods:

A national database was queried to identify patients 18 years and older who underwent forefoot surgery (including fusion and bunionectomy), hindfoot or midfoot fusion, rotational ankle fracture fixation, ankle arthrodesis, or ankle arthroplasty from 2009-2022. Provider variable codes were then utilized to identify patients who underwent the corresponding procedures by orthopedic surgeons and podiatrists. Univariate analyses and multivariate logistic regressions were performed to compare 90-day rates of medical and surgical complications between the two provider categories for each procedure while controlling for age, sex, diabetes, smoking, and obesity.

Results:

Overall, 34,807 patients underwent foot and ankle (F&A) procedures by an orthopedic surgeon and 43,787 patients by a podiatric surgeon. Orthopedic patients were older (51.77 versus 50.79; p< 0.001), had a higher comorbidity index (Charlson Comorbidity Score 1.13 versus 0.97; p< 0.001), and were more likely to undergo surgery from an inpatient facility (16.18% versus 2.18%; p< 0.001). Comparing 90-day complication rates, podiatry patients exhibited higher rates of complications, including neuritis, nonunion, prosthetic complications, and wound debridement across various procedures when compared to orthopedic surgeons.

Conclusion:

Common foot and ankle procedures performed by podiatrists may be associated with higher postoperative complications affecting quality of care which could be attributed to differences in training, case volume and variety, and surgical techniques between orthopedic surgeons and podiatrists. Although access to foot and ankle procedures has improved, these data raise questions about the safety of procedures performed by podiatrists. Thus, additional highly powered studies are needed to investigate these postoperative differences to ensure that patients have all the information necessary to make informed decisions regarding their care.
Does Subspecialty Matter: Outcomes after Ankle Fracture Surgery
Authors: Zhu Justin , Seddio Anthony , Gouzoulis Michael , Grauer Jonathan N.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Orthopaedists are increasingly pursuing subspecialization after residency. However, few studies have compared ankle fracture surgery outcomes between orthopaedists from different subspecialty backgrounds. This study aims to investigate the effect of subspecialization on patient outcomes following surgical intervention for ankle fractures.

Methods:

The PearlDiver M161 Ortho administrative dataset was utilized to identify patients (average age: 54.48) who received ankle fracture surgery. Cohorts were created based on the subspecialty of the operating surgeon (foot & ankle, trauma, non-foot & ankle non-trauma). Rates of surgeon-reported medical and surgical adverse events within 90 days were compared between the three fellowship cohorts using multivariate logistic regression with the “non-foot&ankle non-trauma” cohort serving as the reference. 5-year implant removal rates were also compared between cohorts using a Kaplan-Meier curve.

Results:

Data from 146,421 patients receiving ankle fracture surgery were assessed (70.0% female). No significant differences were found in 5-year implant removal rates between the fellowship cohorts (p=0.8). Compared to the other cohorts, the foot&ankle subspecialty cohort demonstrated significant decreases in major adverse events (OR: 0.82 [0.74-0.91], p< 0.001), which was comprised of decreases in acute kidney injuries (OR: 0.75 [0.62-0.91], p=0.005), pneumonia (OR: 0.70 [0.56-0.87], p=0.002), and urinary tract infections (OR: 0.79 [0.68-0.91], p=0.001) following ankle fracture surgery. The foot & ankle cohort also demonstrated lower readmission rates (OR: 0.79 [0.67-0.93], p< 0.005).

Conclusion:

Foot & ankle surgeons demonstrated superior perioperative outcomes and readmission rates for their patients following ankle fracture surgery compared to trauma surgeons and orthopaedic surgeons of other subspecialty backgrounds.
Alzheimer's disease: A case study involving EEG-based fE/I ratio and pTau-181 protein analysis through nasal administration of Saraswata Ghrita
Authors: Badal Robin , Ranjan Shivani , Kumar Lalan , Shekhawat Lokesh , Patel Ashok Kumar , Yadav Pramod , Prajapati Pradeep Kumar
Published: December 2024

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that impairs memory, language, and cognitive functions and currently has no definitive cure. Saraswata Ghrita (SG), a traditional Ayurvedic remedy administered nasally, offers a holistic approach and is believed to directly affect brain functions through its unique delivery route.

Objective

This study aimed to evaluate the effectiveness of SG in improving cognitive function and neurochemical biomarkers in a patient with AD. Key outcomes included electroencephalography-based excitation/inhibition (fE/I) ratio, and levels of phosphorylated Tau-181 (pTau-181), serotonin, dopamine, acetylcholine, and dehydroepiandrosterone (DHEA).

Methods

A 90-day proof-of-concept clinical trial was conducted with one AD patient. Nasal administration of SG was performed twice daily. Measurements included EEG spectral power analysis across 1–48 Hz, cognitive function assessed by Alzheimer's Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Quality of Life in Alzheimer's Disease (QoL-AD) scales, and biochemical analyses of pTau-181, serotonin, dopamine, acetylcholine, and DHEA.

Results

Notable improvements were observed: ADAS-Cog score decreased from 40 to 36, QoL-AD score increased from 23 to 31, MMSE score improved from 13 to 18, and MoCA score increased from 8 to 13. Biochemical markers showed a decrease in pTau-181 (12.50 pg/ml to 6.28 pg/ml), an increase in acetylcholine (13.73 pg/ml to 31.83 pg/ml), while serotonin and DHEA levels rose, and dopamine levels decreased (39.14 pg/ml to 36.21 pg/ml).

Conclusions

SG demonstrated potential in enhancing cognitive functions and neurochemical markers in AD, with the nasal route proving safe and effective. These findings suggest the value of traditional Ayurvedic treatments in contemporary AD management.
An experimental framework for conjoint measures of olfaction, navigation, and motion as pre-clinical biomarkers of Alzheimer's disease
Authors: Biljman Katarina , Gozes Illana , Lam Jacqueline CK , Li Victor OK
Published: December 2024

Elucidating Alzheimer's disease (AD) prodromal symptoms can resolve the outstanding challenge of early diagnosis. Based on intrinsically related substrates of olfaction and spatial navigation, we propose a novel experimental framework for their conjoint study. Artificial intelligence-driven multimodal study combining self-collected olfactory and motion data with available big clinical datasets can potentially promote high-precision early clinical screenings to facilitate timely interventions targeting neurodegenerative progression.