bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance evaluation of three signal decomposition methods for bearing fault detection and classification
Authors: Mathur Amit , Kumar Pradeep , Harsha S. P.
Published: November 2022

In the present study, the performance evaluation of the signal decomposition methods; variational mode decomposition, empirical mode decomposition, and ensemble empirical mode decomposition, for the ball bearing fault detection and classification for the experimentally recorded vibration signals has been done. This work proposed a novel hybrid sensitive mode selection method combining three statistical measures (energy-based index, fault correlation-based index, and Hausdorff distance-based index) and investigating the effect of the selected sensitive mode extracted by the decomposition methods for the bearing defect frequency detection. The vibration data have been acquired for the healthy and seeded faults of different sizes for the inner and outer raceway defects. The complete features dataset comprises five time-domain, four spectral-domain, and two non-linear statistical features. The k-Nearest Neighbor, Support Vector Machine, and Naive Bayes classifiers are used for fault classification and predict the results with four performance metrics: accuracy, sensitivity, precision, and F-score. Firstly, the results of signal decomposition employing hybrid sensitive mode functions and statistical analysis of condition indicators (RMS, kurtosis and crest factor) revealed that the VMD outperforms the other two techniques. Secondly, the fault classification results predicted that the k-Nearest Neighbor classifier outperforms the other two classifiers. This proposed novel sensitive mode selection method significantly improves the bearing fault classification performance metrics with the features extracted from the selective mode functions with all three decomposition methods.
The up-down-up pandemic news experience: A mixed-method approach to its negative and positive effects on psychological wellbeing
Authors: Nguyen An , Glück Antje , Jackson Daniel
Published: November 2022

Existing research has documented the dynamics of increased news consumption alongside – paradoxically – increased news avoidance during the Covid-19 pandemic, highlighting its adverse effects on mental health and emotional wellbeing. However, for methodological and theoretical reasons, research still lacks specifics on what types of negative psychological responses were directly triggered by pandemic news, how prevalent they were in the population, how they manifested in daily life, and what could be the alternatives to them. Further, the almost exclusive focus on negative effects has led to a relative negligence of the positive sides of pandemic news. This study takes a mixed-method approach to address these gaps, combining 59 interviews and a follow-up survey with a representative sample of 2,015 adults across the UK. We found that pandemic news consumption, driven primarily by the need for personalised surveillance in an uncertain situation, oscillated in parallel with its severity and associated lockdown restrictions. The influx of repetitive bad news triggered many negative feelings besides general pandemic anxiety – namely fear, despair and moral outage (anger and disgust). This led to various alterations of daily routines, including news avoidance. Such adverse effects were offset by the reassurance, happiness and hope that the news did, at least occasionally, brought to audiences during the pandemic. Participants suggested several potential “good news” categories that point to the need for constructive news forms that not only inform but also inspire, motivate and/or empower people in personal or collective ways.
An adaptive variational mode extraction method based on multi-domain and multi-objective optimization for bearing fault diagnosis
Authors: Yan Xiaoan , Yan Wangji , Yuen Ka-Veng , Yang Zhixin , Wang Xianbo
Published: November 2022

When a local fault in the rolling element bearing appears during operational running, the induced bearing vibration signal is essentially equivalent to a mixed multi-component signal, which usually includes multiple frequency components (e.g., periodic impulses, random impulses, discrete harmonics, and heavy environmental noise). This indicates that it is difficult to detect the weak periodic impulses related to bearing faults by traditional signal processing methods. Variational mode extraction (VME) as a new signal processing method with band-pass filtering properties can separate the desired periodic impulse component from the mixed multi-component signal due to its similar basis as the popular variational mode decomposition (VMD). However, the filtering performance of VME is significantly influenced by two parameters (i.e., penalty factor and center-frequency). To address this issue, all the previous work focused on single-domain and single-objective parameter optimization from the filtering signal or its envelope, whereas the objective function with a single-criterion cannot depict bearing fault signatures from the impulsiveness and cyclostationarity simultaneously in general cases. Therefore, to improve the bearing fault feature extraction ability and avoid the problem of artificial parameter selection of VME, this paper proposes an adaptive variational mode extraction method based on multi-domain and multi-objective optimization (AVME-MDMO), in which two key parameters of VME are automatically determined by multi-objective gray wolf optimizer (MOGWO) with a novel multi-objective function named integrated measure of sparsity-impact (IMSI) of square envelope (SE) and square envelope spectrum (SES). As a result, the optimal VME is employed to obtain the specific mode component and its corresponding SES for achieving bearing fault diagnosis. The effectiveness of the proposed method has been validated on simulation signal and experiment data of rolling element bearing. Besides, the comparison results demonstrate its superiority and robustness in excavating fault signatures over the VME or VMD with single-objective function, and the fast kurtogram.
Risk factors for elective and urgent open conversion after EVAR—a retrospective observational study
Authors: Haidar Haidar , Kapahnke Sebastian , Frese Jan P , Omran Safwan , Mueller Verena , Hinterseher Irene , Sommerfeld Manuela , Kaschina Elena , Konietschke Frank , Greiner Andreas , Buerger Matthias
Published: November 2022

Background

Endovascular aortic aneurysm repair (EVAR) has become the standard procedure for treating infrarenal abdominal aortic aneurysms (AAA). Various associated complications can lead to open conversion (OC). Thorough follow-up after the procedure is mandatory for the early detection of complications. Persisting perfusion of the aneurysm, a so-called endoleak (EL), paired with structural instability because of aortic wall atrophy and impaired cell functionality induced by EVAR, results in a high risk for aortic rupture.

Purpose

The goal of this study was to detect the risk factors for elective and urgent OC as a result of EVAR-induced pathophysiological changes inside the aortic wall.

Research Design

Retrospective data analysis was performed on all open aortic repairs from January 2016 to December 2020.

Data Collection and Analysis

Fifty patients were identified as treated by OC for failure of an infrarenal EVAR. The patients were divided into two subgroups, here depending on the urgency of surgery. Statistical analysis of patient characteristics and outcomes was performed.

Results

The most common indications for OC were various types of EL (74%), resulting in an aortic rupture in 15 patients. Patients with insufficient or absent follow-up were treated more frequently in an emergency setting (16% vs. 63%). The mortality rate was higher in cases of emergency OC (3% vs. 26%).

Conclusions

Particularly in cases of insufficient or absent follow-up, complications such as EL pose an enormous risk for fatal aortic rupture.
Using machine learning to predict help-seeking among 2016–2018 Pregnancy Risk Assessment Monitoring System participants with postpartum depression symptoms
Authors: Fischbein Rebecca , Cook Heather L , Baughman Kristin , Díaz Sebastián R
Published: November 2022

Background:

Despite the importance of early identification and treatment, postpartum depression often remains largely undiagnosed with unreported symptoms. While research has identified several factors as prompting help-seeking for postpartum depression symptoms, no research has examined help-seeking for postpartum depression using data from a multi-state/jurisdictional survey analyzed with machine learning techniques.

Objectives:

This study examines help-seeking among people with postpartum depression symptoms using and demonstrating the utility of machine learning techniques.

Methods:

Data from the 2016–2018 Pregnancy Risk Assessment Monitoring System, a cross-sectional survey matched with birth certificate data, were used. Six US states/jurisdictions included the outcome help-seeking for postpartum depression symptoms and were used in the analysis. An ensemble method, “Super Learner,” was used to identify the best combination of algorithms and most important variables that predict help-seeking among 1920 recently pregnant people who screen positive for postpartum depression symptoms.

Results:

The Super Learner predicted well and had an area under the receiver operating curve of 87.95%. It outperformed the highest weighted algorithms which were conditional random forest and stochastic gradient boosting. The following variables were consistently among the top 10 most important variables across the algorithms for predicting increased help-seeking: participants who reported having been diagnosed with postpartum depression, having depression during pregnancy, living in particular US states, being a White compared to Black or Asian American individual, and having a higher maternal body mass index at the time of the survey.

Conclusion:

These results show the utility of using ensemble machine learning techniques to examine complex topics like help-seeking. Healthcare providers should consider the factors identified in this study when screening and conducting outreach and follow-up for postpartum depression symptoms.
Non-contrast CT markers of intracerebral hemorrhage expansion: The influence of onset-to-CT time
Authors: Morotti Andrea , Li Qi , Mazzoleni Valentina , Nawabi Jawed , Schlunk Frieder , Mazzacane Federico , Busto Giorgio , Scola Elisa , Brancaleoni Laura , Giacomozzi Sebastiano , Simonetti Luigi , Laudisi Michele , Cavallini Anna , Zini Andrea , Casetta Ilaria , Fainardi Enrico , Dowlatshahi Dar , Padovani Alessandro , Arba Francesco
Published: November 2022

Background:

Hematoma expansion (HE) is an appealing therapeutic target in intracerebral hemorrhage (ICH) and non-contrast computed tomography (NCCT) features are promising predictors of HE.

Aims:

We investigated whether onset-to-CT time influences the diagnostic performance of NCCT markers for HE.

Methods:

Retrospective multicentre analysis of patients with primary ICH. The following NCCT markers were analyzed: hypodensities, heterogeneous density, blend sign, and irregular shape. HE was defined as growth ⩾6 mL and/or ⩾33%. We calculated the sensitivity, specificity, positive, and negative predictive values (PPVs and NPVs) of NCCT markers for HE, stratified by onset-to-CT time (<2 h, 2–4 h, 4–6 h, >6 h).

Results:

We included 1135 patients (median age 69, 53% males), of whom 307 (27%) experienced HE. Overall hypodensities had the highest sensitivity (0.68) and blend sign the highest specificity (0.87) for HE. Hypodensities were more common and had higher sensitivity (0.80) in patients with imaging within 2 h. The same result was observed for heterogeneous density, whereas irregular shape had a similar prevalence across time strata and higher sensitivity (0.79) beyond 6 h from onset. The frequency of blend sign increased with longer onset-to-CT time, whereas its specificity declined after 6 h from onset.

Conclusion:

The diagnostic performance of NCCT markers is influenced by imaging time. Hypodensities identified four out of five patients with HE within 2 h from onset, whereas irregular shape performed better in late presenters. Our findings may improve the use of NCCT markers in future studies and trials targeting HE.
What is Sympathy? Understanding the Structure of Other-Oriented Emotions
Authors: Malbois Elodie
Published: November 2022

Sympathy (empathic concern) is mainly understood as a feeling for another and is often contrasted with empathy—a feeling with another. However, it is not clear what feeling for another means and what emotions sympathy involves. Since empirical data suggests that sympathy plays an important role in our social lives and is more closely connected to helping behavior than empathy, we need a more detailed account. In this paper, I argue that sympathy is not a particular emotion but a type of emotional experience: those that have another person as focus. I explain what this means and show that this sheds light on why sympathy, rather than empathy, directly motivates altruistic actions.
Diagnosis and treatment of acute isolated proximal internal carotid artery occlusions: a narrative review
Authors: Kargiotis Odysseas , Psychogios Klearchos , Safouris Apostolos , Spiliopoulos Stavros , Karapanayiotides Theodore , Bakola Eleni , Mantatzis Michail , Dardiotis Efthimios , Ellul John , Giannopoulos Sotirios , Magoufis Georgios , Tsivgoulis Georgios
Published: November 2022

The clinical manifestations of proximal (extracranial) internal carotid artery occlusions (pICAOs) may range from asymptomatic to acute, large, and devastating ischemic strokes. The etiology and pathophysiology of the occlusion, intracranial collateral status and patient’s premorbid status are among the factors determining the clinical presentation and outcome of pICAOs. Rapid and accurate diagnosis is crucial and may be assisted by the combination of carotid and transcranial duplex sonography, or a computed tomography/magnetic resonance angiography (CTA/MRA). It should be noted that with either imaging modalities, the discrimination of a pseudo-occlusion of the extracranial internal carotid artery (ICA) from a true pICAO may not be straightforward. In the absence of randomized data, the management of acute, symptomatic pICAOs remains individualized and relies largely on expert opinion. Administration of intravenous thrombolysis is reasonable and probably beneficial in the settings of acute ischemic stroke with early presentation. Unfortunately, rates of recanalization are rather low and acute interventional reperfusion therapies emerge as a potentially powerful therapeutic option for patients with persistent and severe symptoms. However, none of the pivotal clinical trials on mechanical thrombectomy for acute ischemic stroke randomized patients with isolated extracranial large vessel occlusions. On the contrary, several lines of evidence from non-randomized studies have shown that acute carotid endarterectomy, or endovascular thrombectomy/stenting of the ICA are feasible and safe, and pοtentially beneficial. The heterogeneity in the pathophysiology and clinical presentation of acute pICAOs renders patient selection for an acute interventional treatment a complicated decision-making process. The present narrative review will outline the pathophysiology, clinical presentation, diagnostic challenges, and possible treatment options for pICAOs.
Longitudinal Digital Glucometric Benchmarking to Evaluate the Impact of Institutional Diabetes Care Initiatives in Adults With Diabetes Mellitus Over the 2016-2020 Period
Authors: Barmanray Rahul D , Kyi Mervyn , Colman Peter G. , Fourlanos Spiros
Published: November 2022

Background:

While glucometric benchmarking has been used to compare glucose management between institutions, the value of longitudinal intra-institution benchmarking to assess quality improvement changes is not established.

Methods:

A prospective six-month observational study (October 2019–March 2020 inclusive) of inpatients with diabetes or newly detected hyperglycemia admitted to eight medical and surgical wards at the Royal Melbourne Hospital. Networked blood glucose (BG) meters were used to collect capillary BG levels. Outcomes were measures of glycemic control assessed by mean and threshold glucometric measures and comparison with published glucometric benchmarks. Intra-institution comparison was over the 2016-2020 period.

Results:

In all, 620 admissions (588 unique individuals) met the inclusion criteria, contributing 15 164 BG results over 4023 admission-days. Compared with the 2016 cohort from the same institution, there was increased BG testing (3.8 [SD = 2.2) vs 3.3 [SD = 1.7] BG measurements per patient-day, P < .001), lower mean patient-day mean glucose (PDMG; 8.9 mmol/L [SD = 3.2] vs 9.5 mmol/L [SD = 3.3], P < .001), and reduced mean and threshold measures of hyperglycemia ( P < .001 for all). Comparison with institutions across the United States revealed lower incidence of mean PDMG >13.9 or >16.7 mmol/L, and reduced hypoglycemia (<3.9, <2.8, and <2.2 mmol/L), when compared with published benchmarks from an earlier period (2009-2014).

Conclusions:

Comprehensive digital-based glucometric benchmarking confirmed institutional quality improvement changes were followed by reduced hyperglycemia and hypoglycemia in a five-year comparison. Longitudinal glucometric benchmarking enables evaluation and validation of changes to institutional diabetes care management practices.
MAFLD: what 2 years of the redefinition of fatty liver disease has taught us
Authors: Grabherr Felix , Grander Christoph , Effenberger Maria , Schwärzler Julian , Tilg Herbert
Published: November 2022

Metabolic dysfunction–associated fatty liver disease (MAFLD) has appeared as the leading liver disease worldwide. Whereas the terminology nonalcoholic fatty liver disease (NAFLD) mainly reflected a negative selection and exclusion of alcohol-related liver disease (ALD), the new definition made its focus on the association of MAFLD with overweight/obesity, type 2 diabetes and metabolic risk factors especially also in normal weight/lean subjects. Several studies from the past 2 years have now used the new definition and have provided substantial information that this new definition might be accurate. Studies from the past 2 years have provided evidence that the new definition might be especially advantageous in the characterization and identification of patients with significant fibrosis. This has also been demonstrated in the well-known Rotterdam study in which the MAFLD-only group showed a higher rate of fibrosis and liver stiffness. MAFLD might also be able to predict all-cause mortality as demonstrated in the Third National Health and Nutrition Examination Survey. Furthermore, MAFLD might improve characterization of the cardiovascular risk of this patient population. As the term MAFLD has not yet been accepted universally, it remains important to coordinate efforts globally to adapt to this new definition and especially involve all specialities dealing with metabolic disorders such as diabetologists to further improve its definition and to prepare the medical community for its future use. The aim of this review is to summarize and critically address evidence emerging over the past 2 years that usage of the term MAFLD could be helpful in daily clinical practice.
Bacterial uropathogens, their associated factors, and antimicrobial susceptibility pattern among adult diabetic patients in two health centers at Kombolcha town, Northeastern Ethiopia
Authors: Oumer Ousman , Metaferia Yeshi , Gebretsadik Daniel
Published: November 2022

Objective:

Urinary tract infection has catastrophic health outcome among diabetes mellitus patients. This study was conducted to investigate prevalence of bacterial uropathogens, their antibiogram, and associated factors among diabetes mellitus patients in Kombolcha town.

Method:

Cross-sectional study was done from February to April 2020. A total of 282 study participants were involved and simple random technique was applied for enrollment of subjects. Well-constructed and pre-tested questionnaire was utilized to collect the data. Five to ten milliliters of mid-stream urine specimen was collected for microbiological data. Each sample was inoculated into cystine lactose electrolyte deficient medium, incubated overnight in aerobic atmosphere at 37°C for 24 h and finally biochemical tests were carried out. According to Kirby–Bauer disk diffusion method, the antimicrobial susceptibilities pattern of the bacteria was performed on Mueller–Hinton Agar. The data were analyzed with Statistical Package for Social Sciences version 23. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were performed. For statistical significance association, p value ⩽ 0.05 with a 95% confidence interval was considered

Results:

The general prevalence of urinary tract infection among study participants was 20.2% (57/282). Being female and having merchant occupation had a statistically significant association. Gram-negative bacteria accounted for 70.2% (40/57) and the leading isolate was Escherichia coli, followed by Klebsiella pneumoniae and Coagulase negative Staphylococcus. About 57.5% gram-negative and 35.3% gram-positive bacteria showed multidrug resistance.

Conclusion:

The general prevalence of significant bacteriuria was found to be consistent with similar studies conducted in different areas. The higher multidrug resistance rate was observed for the isolated bacteria. Health-care professionals should give due attention and follow rational antibiotic prescription practices to treat these infections.
Validation of the SMH Equations for the Estimation of the Total Body Water Volume in Hemodialysis Patients
Authors: Noori Nazanin , Sharma Parpia Arti , Wald Ron , Goldstein Marc B.
Published: November 2022

Background:

Online dialysis clearance monitors typically provide an accurate value for Kt. A value for V (total body water [TBW]) is required to calculate Kt/V, the measure of the adequacy of the delivered dialysis in hemodialysis (HD) patients. Using bioimpedance spectroscopy (BIS), we previously developed 2 sex-specific equations for the estimation of the TBW, which we have chosen to name the St Michael’s Hospital (SMH) equations.

Objective:

The objective of this study was to validate the SMH equations in a second distinct population of patients.

Design:

Cross-sectional study.

Setting:

Single center hemodialysis unit at St Michael’s Hospital, a tertiary care teaching hospital, in Toronto, Canada.

Patients:

Eighty-one adult HD patients who had been receiving conventional maintenance HD for at least 3 months.

Measurements:

Anthropometric measurements including weight, height, and waist circumference were collected. TBW was measured by BIS using the Body Composition Monitor (Fresenius Medical Care, Bad Homburg, Germany).

Methods:

The Bland-Altman method to calculate the bias and limits of agreement and the difference plot analysis were used to evaluate the difference between the BIS-TBW and the TBW derived from our equations (SMH equation) in this validation cohort.

Results:

The TBW values based on our equations had a high correlation with BIS-TBW (correlation coefficients = 0.93, P values < .01, bias = 1.8 [95% CI: 1-2.6] liter). Application of SMH equations closely predicted Kt/V, based on BIS value, in all categories of waist circumference.

Limitations:

Small sample size, single-center, not including peritoneal dialysis patients. A larger and more heterogeneous sample with more patients at the extremes of body mass index would allow for more detailed sub-group analyses in different races and different anthropometric categories to better understand the performance of these equations in discrete sub-groups of patients.

Conclusions:

In maintenance HD patients, our previously derived equations to estimate the TBW using weight and waist circumference appear to be valid in a distinct patient population. Given the centrality of TBW to the calculation of small molecule clearance, the SMH equations may enhance the measurement of dialysis adequacy and inform practice.
Do Teachers Perceive “A Shared Sense of Us”? – Social Identity Leadership of Kindergarten Principals in Mainland China
Authors: Hsieh Chuan-Chung , Li Hui-Chieh , Liang Jyun-Kai , Sun Xue-Meng
Published: November 2022

Soar in the children population following the termination of Mainland China’s three-decade-old one-child policy has aroused attention and concern of the quality of early childhood education, especially the leadership and management approaches of kindergarten principals. However, practical tools for assessing kindergarten principal leadership have not yet been developed in Mainland China. Identity leadership (IL) is a new model in leadership research, and the Identity Leadership Inventory (ILI) facilitates leadership assessment in different contexts with diverse samples. This is the first study to explore principal identity leadership in a Chinese educational context. The Principal-ILI (P-ILI) Chinese version was administered to kindergarten principals and teachers from municipalities and provinces all over Mainland China. A total of 2743 valid responses were collected from 498 kindergartens. Results revealed not only good reliability and validity of P-ILI in the Chinese educational context, but also high perceived IL of most kindergarten principals as well as differences in IL perceived by respondents of different ages, positions, and kindergarten types.
Race, Gender, and Teacher Equity Beliefs: Construct Validation of the Attributions of Mathematical Excellence Scale
Authors: Jacobson Erik , Cross Francis Dionne , Willey Craig , Wilkins-Yel Kerrie
Published: November 2022

Teachers’ beliefs can have powerful consequences on instructional decisions and student learning. However, little research focuses on how teachers’ beliefs about the role of race and gender in mathematics teaching and learning influence educational equity within classrooms. This gap is partly due to the lack of studies focused on variation within classrooms, which in turn is hampered by the lack of instruments designed to measure mathematics-specific equity beliefs. In this study of 313 preservice and practicing elementary teachers, we report evidence of construct validity for the Attributions of Mathematical Excellence Scale. Factor analyses provide support for a four-factor structure, including genetic, social, personal, and educational attributions. The findings suggest that the same system of attribution beliefs underlies both racial and gender prejudice among elementary mathematics teachers. The Attributions of Mathematical Excellence Scale has the potential to provide a useful outcome measure for equity-focused interventions in teacher education and professional development.
Creating Enduring Customer Value
Authors: Sheth Jagdish N. , Uslay Can
Published: November 2022

Definition precedes measurement. The authors define and discuss value, customers and processes to create value. To do so, they distinguish between three business philosophies (product-centric, competition-centric and customer-centric), three types of customers (user, payer and buyer) and three primary types of value (performance, affordability and service) based on these customers’ preferences. They introduce and give examples of 10 unique ways of creating value for customers and conclude with research questions for creating enduring customer value.
Validation of the Mayo Periprosthetic Joint Infection Risk Score for Total Ankle Arthroplasty
Authors: Schon Lew C. , Chien Bonnie Y. , Noori Naudereh B. , Day Jonathan , Zhang Zijun
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Periprosthetic joint infection (PJI) is a devastating complication of arthroplasty. The well known PJI risk factors are useful for identifying high-risk patients but would be even more helpful for clinical decision-making if they are converted to a risk assessment scores. The Mayo Prosthetic Joint Infection Risk Score was based on the data of total hip and knee arthroplasty and has not been validated for application for total ankle arthroplasty.

Methods:

A series of 398 consecutive cases of total ankle arthroplasty, with minimal follow-up of 6 months, was reviewed for Mayo Periprosthetic Joint Infection Risk Score (Mayo score) and PJI. The patients' Mayo scores and PJI was examined by logistic regression. T-test was performed to compare the Mayo score between the non-infected TAA cases and infected cases. Receiver Operating Characteristic (ROC) was used to identify the critical value of Mayo score for total ankle arthroplasty.

Results:

There were 12 cases of PJI or 3.0% in the series. Of the 398 patients, the Mayo scores were in the range from -4 to 13 (median 2; interquartile range (IQR) 0-4). Preliminary analysis showed that, by logistic regression, the probability of PJI was increased as increases of the Mayo scores (Fig A). The mean Mayo score of the PJI patients (8.6+-1.8) was significantly greater than the rest of the patients (mean Mayo score 1.9+-3.4; p < .0001). ROC analysis showed that, when a Mayo score was greater than 5, the patient has a high probability of PJI (sensitivity = 100%; specificity = 86.9%; Fig B).

Conclusion:

This study showed a high correlation between the Mayo score and PJI in total ankle arthroplasty, which is the same trend as in total knee and hip arthroplasty. The preliminary results suggest that strategically focusing on the patients, who have a Mayo score > 5, could be a more efficient approach to prevent PJI after total ankle arthroplasty.
Arthroscopic Articular Reduction for Posterior Malleolar Fracture using a “Handlebar”
Authors: Taki Masanori , Hio Naohiro
Published: November 2022

Category:

Trauma; Ankle; Arthroscopy

Introduction/Purpose:

Posterior malleolar fracture (PMF) of the ankle is one of the most challenging fractures to reconstruct. Recent studies suggest that the intra-articular step-off of PMFs should be <1 mm. However, very few surgical approaches for PMF repair allow direct visualization of the intra-articular fracture. The arthroscopic handlebar technique, our novel surgical method for the reduction and fixation of PMFs, involves the restoration of PMFs under arthroscopy and the use of Kirschner wire as a handlebar, which penetrates the fractured posterior malleolus.

Methods:

The arthroscopic handlebar technique was used in patients with a displaced AO/OTA type-44 ankle trimalleolar fracture (Haraguchi type 1 or 2 PMF). After fibular fracture reduction and internal fixation, the lateral side of the PMF was pierced with a Kirschner wire, such that it emerged from the medial edge of the PMF. The wire was guided through the medial incision to the outside, creating a bar that could be used to control the PMF, similar to the handlebar of a bicycle. Then, anterior ankle arthroscopy was performed. The PMF was reduced using the handlebar and a bone reduction forceps under arthroscopy. Subsequently, the PMF was fixed via the anterior incision using several screws. Eleven consecutive patients who had underwent this arthroscopic procedure and who were followed for at least one year and their postoperative AOFAS score, postoperative articular step-offs in CT sagittal section, and surgical complications were retrospectively evaluated.

Results:

The patients included four men and seven women (mean age 57.8 years [range 20-81 years]). The Haraguchi classification was type 1 in 4 cases and type 2 in 7 cases. The postoperative AOFAS score +- standard deviation was 93.1+-10.9 points. In one patient, CT revealed that a postoperative articular step-off of 1.5 mm remained at the PMF. In all other patients, the articular step-off of the PMF was <1 mm. Surgical complications revealed one case of dorsal foot neuropathy that healed spontaneously.

Conclusion:

This arthroscopic procedure provides an easier and less invasive approach to treat PMF. Articular PMF reduction can be performed under anterior ankle arthroscopic guidance. Surgeons can confirm the entire articular reduction status of the PMF. We believe that using this surgical procedure will change the standard of care for PMF cases.
Post-Operative Lucency Formation Amongst Stemmed vs Non-Stemmed Total Ankle Arthroplasty Constructs
Authors: Thompson John M. , Berlet Gregory C. , Togher Cody J. , Houng Brian E. , Vacketta Vincent G.
Published: November 2022

Category:

Ankle Arthritis; Ankle; Hindfoot

Introduction/Purpose:

Current available total ankle replacement constructs offer either proximal projecting pegs (non- stemmed) in various shapes or large stem (stemmed) designs to the superior aspect of the tibia component. Each design offers inherent stability and unique function. Periprosthetic radiolucency can develop post-operatively and lead to adverse effects. However, the incidence and clinical significance of lucency formation amongst stemmed and non-stemmed constructs is poorly understood.

Methods:

A retrospective radiographic and chart analysis was performed of 256 patients, under a single orthopedic practice, who underwent primary TAA between 2013-2019 with one of 3 total ankle systems. Pre-operative ankle characteristics, intraoperative procedures, as well as post-operative angles, lucency formation, region of lucency formation, and patient outcomes were analyzed.

Results:

Patients' mean age 65.5 yrs., male n=126 and female n=127, a mean follow-up of 24.3 months for our patient cohort. A total of 149 stemmed and 107 non-stemmed constructs were analyzed. Incidence of periprosthetic tibial lucency formation 33.2%, stemmed implants 10.0%, and 65.4% for non-stemmed implant (p value 0.00001).

Conclusion:

This paper describes the incidence of periprosthetic formation amongst a stemmed and non-stemmed total ankle arthroplasty cohort. Statistical significance was found when analyzing stemmed vs. non-stemmed incidence of radiolucency formation, this did not correlate with increased incidence of post-operative complications.
Stress Shielding and Aseptic Loosening in Fully Porous-Coated vs Smooth Stemmed Tibial Implants in Total Ankle Arthroplasty
Authors: Togher Cody J. , Perkins Jacob M. , Thompson John M. , Hyer Christopher F. , Berlet Gregory C.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Porous coating on the osseous interface of implants has gained increased popularity in total ankle replacement surgery. With the integration of porous coating into the newer generation of implants, this theoretically increases the chances of osseous ingrowth and survivorship in total ankle replacements. Alternatively, literature in hip replacement surgery has shown increased rates of stress shielding, aseptic loosening, thigh pain, and cystic formation around stemmed femoral implants extensively coated with porous surfaces. While some ankle prostheses have integrated porous coating technology with stemmed tibial implants, there is little to no research investigating the potential negative effects this may have on longevity or aseptic loosening secondary to a stress shielding effect.

Methods:

Our study identified 9 patients who underwent total ankle arthroplasty via a smooth-stemmed tibial prosthesis and matched these patients based on implant age with patients who received fully porous-coated tibial implants. We reviewed radiographs and compared postoperative rates of backside loosening and cystic formation secondary to stress shielding between the two groups. We also compared rates of heterotopic ossification between the two groups. A homoscedastic t-test was used to identify any statistical significance, which was defined as P < 0.05.

Results:

While the smooth-stem group showed no rates of backside cystic formation or stress shielding, the follow-up matched porous-coated group showed a rate of 55% of cystic formation and potential loosening secondary to stress shielding observed on final radiographic follow up (P < 0.01). There was no statistical difference between the two groups in their rates of heterotopic bone formation (P = 0.37).

Conclusion:

Despite having a relatively small sample size, this data shows that there is some consistency with the hip arthroplasty literature suggesting an increased risk for stress shielding in fully porous-coated stemmed tibial implants compared to smooth- stemmed tibial implants in total ankle arthroplasty.
Outcomes of Lisfranc Injuries in NCAA Football Players
Authors: Tortora Peter , Portnoff Brandon , Abdeen Ahmed , Koroneos Zachary , Aynardi Michael C.
Published: November 2022

Category:

Sports; Midfoot/Forefoot

Introduction/Purpose:

While Lisfranc injuries are relatively infrequent, they are typically season-ending injuries for NCAA football players, and their impact on an athlete's future is poorly understood. In this study, we sought to define the rate of return to competition for NCAA Division I football players who sustained a Lisfranc injury, and analyze the effects on athletic performance and career outcomes.

Methods:

NCAA Division I football players who sustained Lisfranc injuries between 2012-2017 were identified and evaluated for their return to play in the season following their injury. Recorded demographic variables included position, class rank, and games played during the pre- and post-injury seasons. The underclassmen athletes who met performance criteria were then compared to matched, uninjured controls based on conference, position, age, and statistics. Career outcomes were evaluated for all athletes who sustained a Lisfranc injury based on whether they performed at the NFL Combine and/or played in at least 1 NFL game. Seniors were excluded from performance analysis because they did not have a post-injury NCAA season, but were included in career outcomes.

Results:

Sixty Lisfranc injuries were identified, 48 of which were sustained by underclassmen, who returned to play in the immediate post-injury season at a rate of 87.5%, and 95.8% returned at some point in their college careers. Of the players who met performance criteria, only quarterbacks showed statistically significant differences compared to controls for interceptions/game (p=0.0438), yet all positions experienced mild performance declines or stagnation across virtually all statistics, on average. However, 33.3% of athletes went on to perform at the NFL Combine, and 31.3% of athletes played in an NFL game, compared to 31.7% and 36.7%, respectively, for controls. Surprisingly, when evaluated separately, athletes who sustained a Lisfranc injury in their senior year had nearly identical career outcomes (Combine - 33.3%, NFL - 33.3%) compared to underclassmen.

Conclusion:

NCAA Division I football players return to play at a high rate following Lisfranc injuries, and largely maintain their athletic performance relative to uninjured controls. Moreover, Lisfranc injuries do not appear to have a significant impact on an athlete's ability to compete at an NFL-level.
Effect of Internal Bracing on Broström Operation Clinical Outcomes
Authors: Waggett Raines M. , Hoch Caroline P. , Ottofaro Trevor D. , Scott Daniel J. , Gross Christopher E.
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

When patients fail conservative management for chronic lateral ankle instability, a Broström procedure is often recommended. The purpose of this study was to investigate the postoperative trends between Broström recipients who were and were not augmented with suture tape, while secondarily assessing the relationship between demographics and medical history with postoperative outcomes for those patients.

Methods:

We conducted a retrospective review of 125 patients treated with a modified Broström by a single fellowship-trained foot and ankle surgeon at an academic medical center between 2016 and 2020. Overall, 39 patients received suture tape augmentation, 95 underwent a primary Broström and 30 a revision, and 24 were operated on with a nanoscope. Various demographics, medical history, patient-reported outcome measures (PROMs) (e.g., Foot and Ankle Outcome Score [FAOS], Foot and Ankle Ability Measure [FAAM]), and postoperative outcomes were collected. Average follow-up was 1.0 years (0.25-4.58).

Results:

There were no differences in any postoperative PROMs (i.e., FAOS, FAAM) between suture tape augmentation cohorts. Similarly, no difference existed in follow-up duration or complication rate. The only significant difference between cohorts pertained to the proportion of patients who underwent a reoperation specifically for incision and debridement (suture tape=71.4%, no suture tape=0.0%; p=.013). Furthermore, when analyzing the primary and revision Broström operation cohorts, there were no differences in any postoperative PROM, follow-up duration, or complication. Finally, when analyzing cohorts whose procedures did and did not use a nanoscope, there was no difference in any PROMs, complications, or reoperation rate, but follow-up duration was significantly longer for those whose procedures did not use a nanoscope (nanoscope=0.71 years, no nanoscope=1.13 years; p=.003). (Table 1)

Conclusion:

Neither suture tape augmentation or revision status was found to affect postoperative outcomes or PROMs for the Broström operation. However, unlike the control group, no patients who did not received suture tape augmentation underwent reoperation for deep infection, and these patients had a lower complication rate. The only variable that showed a difference in postoperative outcomes was whether a patient was concomitantly operated on with a nanoscope, in which their follow-up duration was reduced. Based on their overall predictiveness, preoperative PROMs may provide insight into clinical success following a Broström operation.
Population genetic study of 17 Y-STR Loci of the Sorani Kurds in the Province of Sulaymaniyah, Iraq
Authors: Albarzinji Balnd M. , Abdulkarim Farhad M. , Hussein Shaho A. , Rashid Dlshad , Lazim Hayder
Published: November 2022

Background

The Kurds as an ethnic group are believed to be a combination of earlier Indo-European tribes who migrated and inhabited a mountainous area thousands of years ago. However, as it is difficult to describe the precise history of their origin, it is necessary to investigate their population relationship with other geographical and ethnic groups.

Results

Seventeen Short Tandem Repeat markers on the Y chromosome (Y-STR) included in the AmpFLSTR™ Yfiler™ PCR Amplification Kit (Thermo Fisher Scientific, USA) were used to type DNA samples from the Sorani (Central) Kurdish population in Sulaymaniyah province. One hundred fifty-seven haplotypes were obtained from 162 unrelated male individuals. The highest and lowest gene diversities were DYS385a/b (GD = 0.848) and DYS392 (GD = 0.392), respectively. The haplotypes were used to predict the most likely haplogroups in the Sulaymaniyah population.

Conclusion

Haplogroup prediction indicated predominance (28%) of subclade J2 (44/157) in the Sorani Kurds, northeast of Iraq. The pairwise genetic distance results showed that the Kurdish group clustered along with Asian populations, whereas the furthest countries were Europeans and Africans.
Dual-modal in vivo assessment for electrophysical and hemodynamic characteristics of cerebral edema induced by lipopolysaccharide
Authors: Li Weitao , Zhang Yameng , Xie Qian , Qi Xinping , Yao Liuye , Ning Xue , Qian Zhiyu
Published: November 2022

The pathological features of cerebral edema are complicated. The intracranial pressure (ICP) is regarded as the most important indicator for monitoring cerebral edema. Recently, multi-parameter has been used to explore the types and pathogenesis of cerebral edema and design effective treatment strategies. This research focused on investigating the characteristic of the cerebral edema induced by lipopolysaccharide (LPS) in rats by using simultaneous electrophysical and hemodynamic parameters. The results showed that neurophysiologic parameters (firing rate (FR) and the power spectrum of local field potential (LFP power)) and hemodynamic parameters (relative concentration of oxygenated hemoglobin (ΔCHbO2), relative concentration of deoxyhemoglobin ΔCHbR) and relative cerebral blood flow (rCBF)) were linearly correlated, and the Pearson’s correlation coefficient was changed by pathological progression of cerebral edema induced by LPS. Furtherly, the treatment after two agents were observed successfully through these multi-parameters. Our findings revealed the relationship between neural activity and hemodynamic response during the progression of cerebral edema and provided a multi-parameter solution for cerebral edema functional monitoring and anti-edema drug efficacy evaluation.
Return of non-ACMG recommended incidental genetic findings to pediatric patients: considerations and opportunities from experiences in genomic sequencing
Authors: Bowling Kevin M. , Thompson Michelle L. , Kelly Melissa A. , Scollon Sarah , Slavotinek Anne M. , Powell Bradford C. , Kirmse Brian M. , Hendon Laura G. , Brothers Kyle B. , Korf Bruce R. , Cooper Gregory M. , Greally John M. , Hurst Anna C. E.
Published: November 2022

Background

The uptake of exome/genome sequencing has introduced unexpected testing results (incidental findings) that have become a major challenge for both testing laboratories and providers. While the American College of Medical Genetics and Genomics has outlined guidelines for laboratory management of clinically actionable secondary findings, debate remains as to whether incidental findings should be returned to patients, especially those representing pediatric populations.

Methods

The Sequencing Analysis and Diagnostic Yield working group in the Clinical Sequencing Evidence-Generating Research Consortium has collected a cohort of pediatric patients found to harbor a genomic sequencing-identified non-ACMG-recommended incidental finding. The incidental variants were not thought to be associated with the indication for testing and were disclosed to patients and families.

Results

In total, 23 "non-ACMG-recommended incidental findings were identified in 21 pediatric patients included in the study. These findings span four different research studies/laboratories and demonstrate differences in incidental finding return rate across study sites. We summarize specific cases to highlight core considerations that surround identification and return of incidental findings (uncertainty of disease onset, disease severity, age of onset, clinical actionability, and personal utility), and suggest that interpretation of incidental findings in pediatric patients can be difficult given evolving phenotypes. Furthermore, return of incidental findings can benefit patients and providers, but do present challenges.

Conclusions

While there may be considerable benefit to return of incidental genetic findings, these findings can be burdensome to providers and present risk to patients. It is important that laboratories conducting genomic testing establish internal guidelines in anticipation of detection. Moreover, cross-laboratory guidelines may aid in reducing the potential for policy heterogeneity across laboratories as it relates to incidental finding detection and return. However, future discussion is required to determine whether cohesive guidelines or policy statements are warranted.