bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Intestinal Microbiota and Their Relationship With Patient Characteristics in Colorectal Cancer
Authors: Zhao Lu , Fang Yongkun , Zhang Jingqiu , Wei Chen , Ji Hao , Zhao Jiahao , Wang Daorong , Tang Dong
Published: December 2024

Background:

Gut microbiota are associated with the pathological features and development of colorectal cancer (CRC); however, how gut microbiota changes in patients with CRC is unknown. This study investigated the role of gut microbiota in the development and progression of CRC by retrospectively comparing the structural differences between the gut microbiota of patients with CRC and healthy individuals.

Methods:

Together with clinical data, we collected fecal samples from patients with CRC (n = 18) and healthy controls (n = 18) and performed 16S rRNA gene sequencing and alpha and beta diversity analysis to compare microbiota richness and diversity. Based on the differences in microbiota between the CRC and control groups, we identified disease-specific microbial communities after relevant factors. PICRUSt2 software was used to predict the differential microbial functions.

Results:

The CRC and control groups differed in both composition and abundance of intestinal microbiota. Firmicutes and Bacteroidetes were the most abundant phyla in both groups, while Verrucomicrobi was significantly more abundant in the CRC group. Megamonas, Lachnospira, and Romboutsia were more abundant in the control group; 18 genera differed significantly in abundance between the groups, which were found to involve 21 metabolic pathways. The distribution and abundance of gut microbiota differed significantly between patients with CRC with and without lymph node metastasis; at the genus level, the abundance of Rothia and Streptococcus was significantly higher and that of Bacteroides, Parabacteroides, and Oscillibacter was significantly lower in patients with lymph node metastasis.

Conclusions:

The gut microbiota is altered in CRC patients compared with healthy individuals, with specific changes in the microbiota associated with clinical and pathological features such as tumor stage, lymph node involvement, and tumor differentiation. Our findings elaborate to some extent on the link between the gut microbiota and CRC.
Organization manifesto
Authors: Zanoni Patrizia , Barros Marcos , Zulfiqar Ghazal
Published: December 2024

The Organization Manifesto celebrates 30 years of Organization as a vital force in critical management and organization studies. It reaffirms the journal’s commitment to radical pluralism, within a non-hegemonic mode that avoids reproducing relations of dominance and subordination. Central to scholarship published and welcomed in Organization are five performative forms of critical scholarship that engage with power in different ways: revealing hidden power dynamics, reconnecting fragmented relations, reimagining post-capitalist futures, rehearsing equitable practices, and rebelling against oppressive systems. These forms encourage a dynamic intellectual space that resists canonical constraints and aligns critique with evolving socio-political realities. As a living intellectual project, the manifesto stresses self-reflective engagement with the journal’s legacy and its contemporary role. It calls for action to foster community renewal through supporting diverse scholars, enacting caring practices in academia, promoting critical methodologies, and advancing scholarly activism. By emphasizing inclusivity, transdisciplinarity, and political engagement, the Organization Manifesto aims to sustain the journal as a leading platform for transformative critical scholarship. Looking ahead, it invites collective contributions to reimagine and co-construct practices that promote justice and equity in academia and beyond.
Shaping illiberal citizenries: Far-right justifications of educational structures
Authors: Giudici Anja , Pultar Anna
Published: December 2024

Educational structures do not only have pedagogical implications; by defining and ranking categories of teaching and learning, and by assigning individuals to these categories, they also contribute to shaping the identity and stratification of citizenries. It is this latter dimension that is often mobilised in the political debate on structures. Existing literature in sociology and politics shows that the main parties in post-World War II Europe have typically invoked liberal citizenship norms based on solidarity, autonomy and pluralism in this debate to appeal to both domestic electorates and international audiences. But what about those who disagree with liberal and egalitarian understandings of citizenship? This paper examines one such movement: the post-1945 Western European far right. Applying rigorous content analysis to an extensive original database of archival documents, we show that extreme and radical right parties and intellectual organisations largely advocate highly stratified education systems and justify this preference with social-order based citizenship norms – but we also find rhetorical variation. While existing theories of liberal-democratic education politics can serve to understand some of this variation, more specific theorising may be needed for educational research to develop a finer-grained understanding of the rhetorical and positional choices of actors who reject liberal-democratic principles.
Hydrodynamic analysis of U-shaped OWC with varying bottom profiles integrated with Π-breakwater
Authors: Muduli R. , Karmakar D.
Published: December 2024

In the present study, the fixed U-OWC integrated with Π-shaped breakwater is analysed considering three different bottom profiles (straight, inclined, and curved) of the interior chamber of the U-OWC. The hydrodynamic performance is assessed based on the theoretical maximum efficiency, radiation susceptance and conductance, reflection, transmission and dissipation coefficients and force coefficient on the top lip wall of U-OWC and front face of breakwater. The influence of geometric variations such as width of U-channel, draft of U-OWC, draft and width of breakwater and distance between the two structures on the hydrodynamic performance is analysed using Boundary Element Method (BEM). The study depicts that the presence of a wider U-channel width impairs the energy conversion efficiency of the U-OWC and increasing the draft of the U-OWC improves the efficiency of the device. Further, changing the bottom profile of the internal chamber of U-OWC changes the natural frequency of the device without hampering the efficiency. In addition, as the distance between the two structures is increased, transmission of waves decreases. The influence of wave force on the breakwater is noted to be maximum when the leading U-OWC structure has a curved bottom. The study on the variation of the bottom profile of the fixed U-OWC integrated with breakwater will be helpful in the design and analysis of efficient hybrid floating breakwater system.
An unsupervised multiclass fault diagnosis method and application based on affine-invariant Riemannian metric and spectral clustering
Authors: Tong Lingling , Lv Zhimin
Published: December 2024

In modern industrial environments, critical components are crucial for the stability and safety of mechanical systems. However, current research on multiclass fault diagnosis using vibration signals has not sufficiently considered the temporal dependencies of data, the coupling between variables, and the scarcity of labeled data. To address these challenges, we propose a novel unsupervised multiclass fault diagnosis method based on the affine-invariant Riemannian metric and spectral clustering (AIRMSC). This method simultaneously accounts for temporal dependencies and variable coupling relationships, effectively resolving the issue of scarce labeled data. Specifically, our method first captures the dynamic states of time-series data through covariance matrices, encapsulating both the temporal dependencies and variable coupling relationships. To enhance the interpretability of the diagnostic results, we utilize the AIRM from Riemannian geometry to evaluate the similarity between matrices and construct complex networks on the manifold of symmetric positive definite matrices. Spectral clustering is then applied to partition these networks, effectively achieving data clustering. The proposed method has been validated using simulated data, the Case Western Reserve University (CWRU) bearing dataset, and actual data from a silicon steel production line. On the CWRU dataset, it achieved a diagnostic accuracy of 98.33%. Compared with existing methods, the proposed AIRMSC proves to be a highly effective unsupervised fault diagnosis approach.
Cost and access dynamics of JAK inhibitors utilized for dermatologic care
Authors: Visingardi Joseph , Sherwood Bryan
Published: December 2024

Janus Kinase (JAK) inhibitors may offer a more cost effective option for patients rather than biologics. This study sought to investigate if market competition has reduced the price and expanded access for those on JAK inhibitors. We utilized CMS Medicare spending data from 2018 to 2022 to investigate costs per dose, per beneficiary and change in total beneficiaries over time. Over this time frame baricitinib had a 26% cost per dose increase, 237% increase in total beneficiaries on the medication and 210% increase in cost per beneficiary. Upadacitinib had an 18% cost increase per dose, 1341% increase in beneficiaries on the medication and 289% increase in cost per beneficiary. Ruxolitinib had an 0.8% increase in cost per dose, 1534% increase in patients on the brand and 57% increase in cost per beneficiary. Tofacitinib had a 28% increase in cost per dose, 10% reduction in beneficiaries on the medication and 35% increase in cost per beneficiary. Tofacitinib XR had a 30% increase in cost per dose, 10% increase in patients on the medication and 60% increase in cost per beneficiary. Overall utilization and costs for each of the medications has increased over this time frame despite the increased utilization of biologics and the black box warning on these medications in this elderly population. This class of medications, despite its risks, may still not be the most cost-effective class for the individual and broader healthcare system.
Eculizumab in thymoma-associated myasthenia gravis: a real-world cohort study
Authors: Jin Lei , He Dingxian , Zeng Quantao , Tan Song , Shi Jianquan , Liu Ying , Zou Zhangyu , Song Jie , Yan Chong , Huan Xiao , Wang Yuan , Yang Lei , Xi Jianying , Wu Zongtai , Liu Ziqi , Zheng Jianming , Zhao Chongbo , Chu Xianglin , Luo Sushan
Published: December 2024

Background:

Thymoma-associated myasthenia gravis (TAMG) is a subtype of myasthenia gravis (MG) that is associated with more severe symptoms and a relatively poor prognosis. Eculizumab, an inhibitor to target human C5 component of the complement cascade, is considered a treatment option for refractory generalized MG (gMG).

Objectives:

To explore the safety and efficacy of eculizumab in patients with TAMG.

Design:

This is an observational multicenter real-world cohort study to assess TAMG who were treated with eculizumab from June 2023 to June 2024.

Data sources and methods:

Clinical features associated with thymoma-associated multi-organ autoimmunity (TAMA), Myasthenia Gravis Activities of Daily Living (MG-ADL) score, and the incidence of treatment-emergent adverse events (TEAEs) were prospectively collected.

Results:

Overall, 42 patients with gMG were treated with eculizumab at 5 research centers, of whom 22 patients with TAMG were finally included. This cohort had a mean age of 51.5 ± 12.1 years and an average disease duration of 4.0 ± 4.3 years. Regarding thymomas, the World Health Organization (WHO) histological classification was primarily B2 and B3 (63.7%), and Masaoka staging was predominantly IV (45.5%). Nine participants (40.9%) switched from efgartigimod to eculizumab aiming at a better clinical improvement and reducing steroid use. By week 12, the MG-ADL score decreased to 4.8 ± 4.7 (baseline: 11.7 ± 6.0), and the corticosteroid dose reduced to 23.2 ± 26.5 mg (baseline: 41.8 ± 63.9 mg). Two patients with TAMA showed significant improvement in skin lesions and thrombocytopenia. Two TEAEs were recorded including COVID-19 and herpes labialis infection. Four patients (18.2%) died of respiratory or circulatory failure owing to thymoma metastasis.

Conclusion:

This real-world study demonstrates the efficacy of eculizumab in achieving symptom control and corticosteroid reduction for TAMG. It may also be a therapeutic option for refractory TAMG and TAMA.

Trial registration:

NCT04535843.
Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway
Authors: Kim Laura H. , Catapang Marisa , Polderman Nonnie , Humphreys Robert , Mammen Cherry , Jugnauth Eleonora , Matsell Douglas G.
Published: December 2024

Background:

In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children’s Hospital (BCCH) and multiple regional clinics.

Objective:

The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP.

Design, setting, and patients:

This was a retrospective cohort study of children with NS in BC.

Measurements and methods:

We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna).

Results:

Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m2 vs 3492, IQR 3397-3644 mg/m2, P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional).

Limitations:

Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance).

Conclusion:

Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.
Feasibility Study for COSMIC Study - Comparing Open SCARF Osteotomy and Minimally Invasive Chevron Osteotomy for Hallux Valgus Correction
Authors: Kakwani Rajesh , Hutt Nicholas , Townshend David , Murty Aradhyula , Kakwani Mehak , Pujol Andrea , Griffiths Alexandra
Published: December 2024

Category:

Bunion; Other

Introduction/Purpose:

Minimally invasive surgery for hallux valgus deformity is gaining popularity over the traditional Open scarf osteotomy. Emerging evidences are showing similar clinical outcomes but further studies are needed to ascertain this. The aim of this study was to assess the feasibility of conducting a randomised controlled trial to compare the patient recorded and clinical outcomes for the surgical management of Hallux Valgus between open scarf osteotomy (OS) and minimally invasive chevron osteotomy (MICA).

Methods:

Patients suitable for surgical correction were invited to participate. Post op rehabilitation was standardised for both groups. Patients completed a validated questionnaire (Manchester Oxford Foot questionnaire and EQ-5D) preoperatively and post operatively at 6 months and 1 year. Radiological parameters and range of motion were measure pre and post operatively. A total of 41 patients were eligible for the study, 31 were successfully recruited and operated between Dec 2017 and June 2022.

Results:

17 patients were randomised to MIS (15 female, mean age 51 years) and 14 to OS (13 female, mean age 51 years). Both groups have a significant improvement in the MOXFQ parameters (walking, pain and social) at 6m and 12m, as well as radiological parameters. VAS improved for OS at 6m (p=0.048) and 12m (p=0.025) but only improvement at 6m was seen for MICA (p=0.059 and p=0.054 at 12m). There was no improvement in EQ-5D in either group at 12 months and no difference in surgical time (p=0.53).There was a higher number of complication in the MICA group with 5 removal of metalwork (29.4%) and 2 superficial infections (11.8%) vs none in the OS group.

Conclusion:

Both surgical options show similar clinical results but higher complication rate was seen with MICA. A larger study is needed to evaluate further.
Fix While You Can: A Systematic Review on Outcomes of Fixation for Osteochondral Lesions of the Talus
Authors: Rikken Quinten , Dahmen Jari , Nakasa Tomoyuki , Stufkens Sjoerd , Kerkhoffs Gino M M.M.J.
Published: December 2024

Category:

Ankle

Introduction/Purpose:

The primary aim of the present study is to assess the clinical success rate of fixation for osteochondral lesions of the talus (OLT). The secondary outcomes concern the union rate and adverse events.

Methods:

A systematic literature search of PubMed, Embase (Ovid), and Cochrane Library was performed up to December 2023. The primary outcome was the pooled clinical success rate following fixation with 95% confidence interval (95%-CI). Secondary outcomes concerned the union rate, complication rate, and revision rate.

Results:

A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. The pooled clinical success rate was 92% [95%-CI: 87% – 95%]. The pooled union rate was 91% [95%-CI: 87% - 94%]. A sub-analysis found superior success rate for patients treated with bone-peg (98% [95%-CI: 89 – 100] compared to non-metal screw and pin (84% [95%-CI: 68 – 93]), P=0.03. The pooled complication and revision rate were 1% [95%-CI: 0 - 4] and 6% [95%-CI: 0 - 4], respectively.

Conclusion:

Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 cases, with a low reported complication rate. These findings show that when a symptomatic OLT is fixable physicians should always consider fixation.
Fixation for Osteochondral Lesions of the Talus with Open Lift, Drill, Fill and Fix (LDFF) Results in Excellent Two-Year Clinical Outcomes
Authors: Rikken Quinten , Dahmen Jari , Lambers Kaj , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M
Published: December 2024

Category:

Ankle

Introduction/Purpose:

Outcomes after fixation of osteochondral lesions of the talus (OLTs) are currently underreported in literature. Clinical and radiological outcomes after the open fixation procedure ‘lift-drill-fill-fix’ (LDFF) for OLT with an osteochondral fragment are unknown. The advantages of fixation over other surgical techniques is the preservation of the native hyaline cartilage, immediate stabilization of the fragment and restoration of the talar dome congruency, as well as facilitating subchondral bone healing.

Methods:

This study describes the results of open LDFF treatment in a prospective, multicentre, nonrandomized, noncomparative clinical trial of 42 ankles in 40 patients with a 2-year follow-up period. The primary outcome measure in this study was the numeric rating scale (NRS) of pain during walking. Secondary outcome measures included the NRS of pain during rest, running and stairclimbing, the foot and ankle outcome sore (FAOS), and the mental component scale (MCS) and physical component scale (PCS) of the short form 36 (SF-36), and the radiological union rate as well as the level of the subchondral bone layer as measured on 1-year postoperative CT.

Results:

A total of 40 ankles which underwent fixation of an OLT with a fragment were prospectively included with 2-years follow-up. The primary outcome, pain during walking, significantly improved with 3.5 (95% CI 2.4-4.6) points on the NRS (p=< 0.001). Significant improvement was also seen for the NRS of pain during rest (p=< 0.001), pain during running (p=< 0.001) and pain during stair climbing (p=< 0.001). Additionally, all subscales of the FAOS, and the MCS and PCS significantly improved as well. Postoperative CT-scans showed union in 88% of the lesions 1-year after the procedure, a flush subchondral bone layer in 88%, and a depressed subchondral bone layer in 12%.

Conclusion:

Open fixation by means of LDFF for OLT results in a significant improvement of clinical outcomes up-to mid-term follow-up. Radiological follow-up shows a union rate and a flush subchondral bone layer in 88% of lesions. These results indicate that open fixation should always be considered when an osteochondral fragment is present as it leads to an excellent improvement in PROMs.
Focused Extracorporeal Shock Wave Therapy for Painful Nonunion of Fracture of Interphalangeal Coalition
Authors: Shimozono Yoshiharu , Mori Daisuke , Mizuno Yasuyuki , Funakoshi Noboru , Kobayashi Masahiko , Yamashita Fumiharu
Published: December 2024

Category:

Lesser Toes; Trauma

Introduction/Purpose:

It has been reported that fractures of interphalangeal coalition often result in delayed union or nonunion. Although there are scattered reports of surgical treatment of painful nonunion after fractures of the interphalangeal coalition, there is currently lack of data on the efficacy of extracorporeal shock wave therapy (ESWT) for nonunion of fractures of the interphalangeal coalition. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy for patients with painful nonunion of fractures of the interphalangeal coalition.

Methods:

A total of 7 patients (7 feet) diagnosed with painful nonunion due to persistent pain and no tendency toward bony fusion at least 3 months after fracture of the interphalangeal coalition from 2022 to 2023 were included in this study. Focused ESWT was performed in all patients. There were 2 males and 5 females with a mean age of 51.3 years (range, 23-62). The fourth toe was present in two cases, and the fifth toe in five cases. The mean time from the date of injury to the start of ESWT was 3.8 months (range, 3-5 months). 4000 shots at 0.25 mJ/mm2 (4 Hz) was administered at 2-week intervals. Visual analog scale (VAS) before and after ESWT were recorded.

Results:

The attainment of complete bony union was documented in all seven patients (Figure 1). The application of focused ESWT was carried out a mean of 2.8 times (range, 2-4 times), and the mean duration from the initiation of treatment to the confirmation of bony union was 1.8 months (range, 1-2 months). In all cases, the symptoms of swelling and pain were successfully alleviated. The VAS scores exhibited a significant improvement, with the mean VAS score decreasing from 3.9 (range, 2-6) before ESWT to 0 after the achievement of union.

Conclusion:

Fractures occurring at interphalangeal coalitions have been reported to require a considerable amount of time for bony union, and surgical intervention has been reported in cases of painful nonunion. However, in the present study, all 7 cases of painful nonunion achieved complete bony fusion following focused ESWT. Moreover, bony union was observed within just 2 months of the start of ESWT. These findings suggest that focused ESWT is a valuable treatment option for achieving bony fusion in cases of painful nonunion of fractures at the interphalangeal coalitions.
Foot and Ankle Patient Education Materials and Artificial Intelligence Chatbots: A Comparative Analysis
Authors: Parekh Aarav S. , McCahon Joseph A.S , Nghe Amy , Pedowitz David I. , Daniel Joseph N. , Parekh Selene G.
Published: December 2024

Category:

Other; Sports

Introduction/Purpose:

On its current trajectory, AI chatbots may become the primary source of information for patient education material in the field of orthopaedics. Despite this, there has been no evaluation of the accuracy and validity of foot and ankle patient education material generated by AI platforms. The purpose of this study was to perform a comparative analysis of foot and ankle patient education material generated by the ai chatbots, as they compare to the AOFAS recommended patient education website, footcaremd.org.

Methods:

ChatGPT, Google Bard, and Bing AI were used to generate patient educational materials on ten of the most common foot and ankle conditions. The content from these ai language model platforms was analyzed and compared with footcaremd.org for accuracy of included information. Accuracy was determined for each of the ten conditions on a basis of included information regarding background, symptoms, causes, diagnosis, treatments, surgical options, recovery procedures, and risks or preventions.

Results:

When compared to the reference standard of the AOFAS website: footcaremd.org, the AI language model platforms consistently scored below 60% in accuracy rates in all categories of the articles analyzed. ChatGPT was found to contain an average of 46.2% of key content across all included conditions when compared to footcaremd.org. Comparatively, Google Bard contained an average of 36.5% and Bing AI contained 28.0% of information included on footcaremd.org.

Conclusion:

AI language model generated patient education regarding common foot and ankle conditions provides limited content accuracy across all three AI chatbot platforms. Clinicians should be aware of the increasing popularity of these platforms and be prepared to answer questions or clarify misunderstandings, and when appropriate direct patients to more validated education material such as footcaremd.org.
Hands-on or Gloved Approach? Unveiling Patient Experiences in Orthopaedic Foot and Ankle Clinics
Authors: Conway Yvonne C. , Rincon Andrea B. , Simister Samuel , Sierra Frank , Kreulen Christopher D. , Giza Eric
Published: December 2024

Category:

Other

Introduction/Purpose:

Current literature suggests that patients feel medical exam gloves are often overused or used inappropriately, while also having concerns about the possibility of cross-contamination with glove utilization. Additionally, there is very little research on the effect that glove use has on patient’s perceptions of physical exam quality and surgeon personability. The purpose of this research project is to determine whether patients that are having their foot and ankle examined prefer their orthopaedic surgeon to wear medical exam gloves.

Methods:

Anonymous surveys were administered and collected during clinic for two different fellowship trained foot and ankle orthopaedic surgeons at a single institution. Any patient willing to sign a consent form was included. Patient age, gender, and reason for visit were collected along with a survey of 5 questions on glove utilization. Survey questions were scored on a Likert scale, with 1=strongly agree, 2=agree, 3=neutral, 4=disagree, and 5=strongly disagree. Descriptive statistics, data normalcy, and appropriate significance tests were used to analyze results while controlling for glove utilization (yes or no), gender (female or male), and age group (< 39, 40-49, 50-59, 60-69, and 70+), at p< 0.05 significance.

Results:

In total, 99 patients agreed to complete the survey (53.5% female and 36.4% male, with a mean age of 55.3 and 54.8, respectively). Overall, physicians used gloves more with male than female patients (33.3 vs 9.43%, p =0.059), although males were slightly more agreeable to preferring no gloves (2.86 vs. 3.17). When the physician wore gloves, patients were more agreeable to glove use for themselves (2.5 vs. 3.24, p=0.001) and for others (2.21 vs. 3.0, p< 0.001). Patients across all groups were agreeable with glove use when examining wounds (range 1.74–2.47.) For all patients, gender, glove use, and age had no effect on agreeing that their physical exam was thorough (average 1.61±0.726) and on disagreeing that gloves effected provider demeanor (average 3.32±0.874).

Conclusion:

In general, glove use by foot and ankle orthopaedic surgeons did not negatively impact patient perception of physical examination thoroughness, nor did it confer less personability onto their physician. While patients across all groups demonstrated a slight preference for glove use during wound examinations, glove use preference in general was otherwise neutral. These results suggest that, on average, the utilization of gloves does not impact patient care and may therefore be up to the discretion of the provider.
High Rates of Return to Play with No Deterioration in Performance Following Acute Achilles Tendon Ruptures in Athletes Participating in the National Hockey League
Authors: Butler James J. , Phadke Rohan , Puleo James , Lehane Kevin , Samsonov Alan P. , Rosenbaum Andrew , Kennedy John G.
Published: December 2024

Category:

Sports; Other

Introduction/Purpose:

The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the National Hockey League (NHL).

Methods:

Athletes participating in the NHL who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play, time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, plus/minus rating, assists, goals, game-winning goals, penalty minutes, power play assists, power play goals, production, points, short-handed assists, short-handed goals, shootout goals, shooting percentage and time on ice per game.

Results:

Eighteen athletes sustained an AATR in the NHL (0.000481 per 10,000 athlete-exposures). The mean age was 27.9±3.6 years and the mean BMI was 26.3±1.6kg/m2. There were 7 (38.9%) AATRs sustained by defenseman, 7 (38.9%) AATRs sustained by centers, 1 (5.6%) AATR sustained by right wings, 1 (5.6%) AATR sustained by left wings, 1(5.6%) AATR sustained by goaltenders and 1 (5.6%) AATR sustained by forwards. Seventeen athletes (94.4%) underwent surgical intervention. The mean number of games played prior to injury was 480.2±240.6. The RTP rate to the NHL was 88.8% at mean time of 4.8 ± 2.5 months. The mean number of games missed due to injury was with 45.1±19.4 games. There was no statistically significant difference in pre-injury performance outcomes compared to post-injury performance outcomes (p>0.05).

Conclusion:

This current study found that AATRs were an uncommon injury in the NHL with an incidence of 0.000481 per 10,000 athlete-exposures over a 14 year period. Sustaining an AATR was associated with a 88.8% return to play rate to the NHL together at a mean time of 4.8 ± 2.5 months with no deterioration in athletic performance. Although sustaining an AATR in the NHL poses a temporary setback, the findings of this study demonstrate that sustaining an AATR does not have a catastrophic effect on the NHL athlete's career.
Immediate Effects of Education on the Manual Ankle Anterior Drawer Test: A Study Using Cadaveric Ankles and Three-Dimensional Kinematic Analysis
Authors: Nakajima Hirofumi , Yamaguchi Satoshi , Kimura Seiji , Horii Manato , Toguchi Kaoru , Ito Ryu , Sasho Takahisa , Ohtori Seiji
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Manual anterior drawer test (ADT) is widely used for evaluating ankle instability. However, implementing the maneuver with an appropriate method and correct assessments is challenging, particularly for less experienced examiners. An effective strategy to learn the proper technique is mandatory. However, no study has investigated the effect of education on the ADT. This study aimed to clarify whether an educational workshop for senior orthopaedic residents will improve ankle kinematics during the ADT and instability assessment.

Methods:

The subjects were 20 senior orthopaedic residents. Three fresh-frozen cadaveric ankles were used to create intact, anterior talofibular ligament (ATFL)-cut, and ATFL/calcaneofibular ligament (CFL)-cut models. Infrared markers were attached to the tibia and talus, and three-dimensional kinematics of the ankle joint were measured using a motion capture system (Figure), with the primary outcome being the ATFL length change during the ADT. Examiners first performed the maneuver on the three ankles using their own methods. The examiners also assessed ankle instability in three grades compared to the contralateral side. Subsequently, a one-hour educational workshop consisting of documents, videos, and hands-on sessions was conducted. Afterward, the examiners performed the ADT again on the same three ankles. The ATFL length changes were compared before and after the workshop using paired t-tests. The ankle instability assessments were compared using Chi-square tests.

Results:

Before the educational workshop, the ATFL length changes were 2.4 ± 0.8 mm, 7.6 ± 3.0 mm, and 6.1 ± 2.7 mm in the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The ATFL length changes significantly increased to 3.2 ± 1.2 mm (P = 0.02), 10.0 ± 2.5 mm (P = 0.005), and 8.4 ± 2.4 mm (P = 0.007) after the workshop. Before the educational workshop, 9 (45%), 7 (35%), and 7 (35%) examiners assessed ankle instability correctly for the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The number of examiners with correct assessments did not increase in either ankles after the workshop (P = 0.14–0.81).

Conclusion:

We found that the ADT technique, evaluated using cadaveric ankle models and three-dimensional kinematic analysis, improved after the educational workshop for senior orthopedic residents. However, the ankle instability assessments did not change. The short-period workshop, including the lecture and hands-on sessions, successfully improved the ADT maneuver. However, further research is required to determine a more effective training method for correct assessments.
Impact of Academic Background on Orthopaedic Foot and Ankle Fellowship Match Outcomes
Authors: Bryan Choy Kenneth , Cannada Lisa K. , White Peter , Steinmann Scott , Cohn Randy , Bitterman Adam
Published: December 2024

Category:

Other

Introduction/Purpose:

In recent years, there has been an increase in doctors of osteopathic medicine (DO) applying for orthopaedic residency, which has led to an increase in osteopathic residents applying for fellowships. The purpose of this study was to evaluate the change in degree type of applicants to foot and ankle fellowships over the last 12 years and to evaluate the differences in match rates between osteopathic and allopathic applicants.

Methods:

SF Match data from 2012 to 2023 was analyzed. There were 1082 applicants for adult foot and ankle fellowships from 2012-2023. There were 74 osteopathic applicants (11.4%) and 573 allopathic applicants (88.6%). There were 435 (40.2%) international medical graduates who were excluded from this analysis. The degree type, number of applicants, and number of matched applicants into orthopaedic foot and ankle fellowship was reviewed. Trends regarding number of applicants and match rates based on applicant degree were evaluated.

Results:

Osteopathic applicants ranged from a low of 2 in 2018 to a high of 11 in 2016, (mean 6.2 +/- 2.6), with no statistically significant change (r=-0.12, p=0.34). Match rate for osteopathic applicants increased from 75.0% (6 of 8) in 2013 to 100.0% (5 of 5) in 2023, (mean 91.2% +/- 9.9%), with a significant increase (r=0.72, p=0.003). Allopathic applicants ranged from a low of 37 in 2022 to a high of 63 in 2014 (mean 47.8 +/- 6.9), with a significant decrease (r=-0.7, p=0.003). Match rate for allopathic applicants ranged from a low of 88.0% (44 of 50) in 2013 to a high of 100.0% (37 of 37) in 2022, (mean 94.5% +/- 4.5%), with a significant increase over the study period (r=0.79, p=0.0007).

Conclusion:

Since 2012, there has been no statistically significant change in the number of osteopathic applicants for foot and ankle fellowship. While both osteopathic and allopathic applicants experienced a significant increase in match rates, there was no significant difference in match rates.
Impact of Social Deprivation on Forefoot Surgical Outcomes
Authors: Compton Tyson , Wagers Kade , Braun Emma , Presson Angela , Nixon Devon
Published: December 2024

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The impact of social environment on specific health outcomes is a topic of increasing interest in orthopedics. Conflicting lines of research suggest that social deprivation may impact orthopedic outcomes. There are limited reports on the influence of social deprivation on orthopedic foot and ankle procedures. The purpose of this study was to examine the effect of social deprivation on patient reported outcomes for patients undergoing forefoot surgery.

Methods:

This retrospective cohort study included 477 patients who underwent hallux valgus correction or hallux rigidus procedures between 2015 and 2022. Patient social deprivation was defined using the Area Deprivation Index (ADI), a validated metric of deprivation discretized geographically by zip code and defined by factors including education, income, employment, and housing quality. Patients meeting inclusion criteria were categorized into either a high or low social deprivation group based on the national median ADI of 50. PROMIS (Patient-Reported Outcomes Measurement Information System) Physical Function (PF) and Pain Interference (PI) scores were collected pre-operatively and then at 6 weeks and 6 months post-operatively. We compared high and low social deprivation groups at baseline and then longitudinally at 6 weeks and 6 months post-operatively, adjusting for demographic covariates including age, gender, race/ethnicity, marital status, and employment status. Statistical significance was defined as p < 0.05.

Results:

At baseline before surgery, PROMIS-PF and PROMIS-PI scores were similar between high and low social deprivation groups. At 6 weeks and 6 months after surgery, there were also no significant differences between high and low deprivation groups for either PROMIS-PF or PROMIS-PI. The only variable that delineated outcomes was employment status, with disabled and unemployed patients exhibiting greater pain (p < 0.001, p = 0.006, respectively) and less function (p < 0.001, p = 0.010, respectively) before surgery. When adjusting for baseline pain score, disabled patients also had greater pain on average after surgery (p = 0.031). Both groups (high and low social deprivation) demonstrated similar improvements in pain and function at 6 months after surgery.

Conclusion:

Patients undergoing forefoot surgery with greater social deprivation reported similar pain and physical function outcomes as patients with low deprivation before and after surgery. These findings suggest that patients with higher social deprivation can achieve equivalent post-surgical outcomes after forefoot surgery as compared to patients with lower social deprivation. Further investigations are needed to explore these relationships at longer-term follow-up as well with other common foot and ankle surgeries.
In Step or Out of Sync? Analyzing Gender Variances in Orthopaedic Foot and Ankle Fellowship Match Rates
Authors: Choy Kenneth Bryan , Cannada Lisa K. , White Peter , Steinmann Scott , Cohn Randy , Bitterman Adam
Published: December 2024

Category:

Other

Introduction/Purpose:

Previous literature has noted that a higher proportion of females than males matched into all orthopaedic surgery fellowships from 2010-2014. However, this has not been investigated specifically in regards to foot and ankle fellowships or with more recent match data. Therefore, the purpose of this study was to evaluate the trends in applicant gender for orthopaedic surgery foot and ankle fellowships over the last 11 years and to evaluate the differences in match rates between male and female applicants.

Methods:

San Francisco Match from 2013 to 2023 was analyzed. There were 986 applicants for foot and ankle fellowships from 2013-2023. There were 395 (40.1%) international medical graduates who were excluded from this analysis, leaving 591 applicants in the study cohort. There were 126 female applicants (21.3%) and 465 Male applicants (78.7%). The gender, number of applicants, and number of matched applicants into orthopaedic foot and ankle fellowship was reviewed. In addition, trends regarding number of applicants and match rates based on gender were evaluated.

Results:

Female applicants ranged from a low of 6 in 2013 to a high of 14 in 2023, (mean 11.5+/- 2.8) with no statistically significant change (r=0.4, p=0.097). Match rate for female applicants increased from a low of 76.9% (10 of 13) in 2017 to 100.0% (14 of 14) in 2022, (mean 92.1% +/- 8.7%), with no statistically significant change (r=0.45, p=0.07). Male applicants ranged from a low of 32 in 2023 to a high of 58 in 2014 (mean 42.3 +/- 8.0), with a significant decrease (r=-0.89, p=0.00004). Match rate for male applicants ranged from a low of 86.5% (45 of 52) in 2013 to a high of 100.0% (32 of 32) in 2023 (mean 95.1% +/- 4.9%), with a significant increase (r=0.95, p=0.000002).

Conclusion:

Since 2013, there has been no statistical significant change in the number of female applicants and female applicant match rate for orthopaedic foot and ankle fellowship. The number of male applicants experienced a significant decrease over the study period, with a significant increase in match rate. Although male applicants had a slightly higher match rate than female applicants, there was no statistical significant difference.
Influence of Normal and Pathologic Windlass Mechanism During Dorsiflexion of the Hallux
Authors: Kihara Takumi , Wukelic Corey , Thorhauer Eric , Sangeorzan Bruce , Ledoux William R.
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

When the windlass mechanism (WM) is engaged, the plantar aponeurosis (PA) is pulled distally by extension of the first metatarsophalangeal joint (MTPJ1), shortening the sole of the foot and raising the medial longitudinal arch (MLA). It has also been reported that the WM is associated with hallux valgus and hallux rigidus. Although this function has been known for a long time, there are few reports on the movement of the foot bones under pathological conditions. In this study, we used cadaveric feet to compare the movements of the foot bones under three conditions: normal tendon loads, an overpulled Achilles tendon, and a sectioned PA with normal tendon loads.

Methods:

Ten fresh cadaveric foot specimens were used. The foot was attached to a tibial loading frame with 20% body weight loads applied. Each specimen was scanned in seven configurations (first proximal phalanx angles 0-60°, each 10° apart) and three conditions (normal loads, overpulled Achilles, and sectioned PA) using a LineUP cone-beam computed tomography (CBCT) scanner. The foot bones in the neutral position under normal loading were segmented from the CBCT scan volumes in Mimics Research software v23.0. Bone kinematics between the 20 additional scans were determined via volumetric image registration in custom MATLAB software for each segmented bone. Using additional custom MATLAB code, we calculated the height of the navicular, the MLA angle defined as the three points (the farthest point of the first metatarsal head, the medial process of the calcaneus, and the apex of the navicular tuberosity), and the motion of the joints on the foot in 3D.

Results:

The height of the navicular was significantly lower at 0, 30, and 60 degrees in the pathological conditions compared to normal (Normal vs overpulled Achilles: 2.9, 3.2, 5.4 mm, p< 0.01, normal vs sectioned PA: 5.2, 5.6, 5 mm, p=0.04, at 0°, 30°, and 60° respectively). The MLA angle was significantly different at all angles for the overpulled Achilles compared to the normal (-3°, -3.5°, -3.6°, p< 0.02). At the tarsometatarsal (TMT) joint, there was no significant differences in any direction. At the cuneonavicular joint, there was less plantarflexion (normal: -6.1, -10.8, overpulled Achilles: -2.8, -6.6, p< 0.01 at 30° and 60° respectively) and less eversion (normal: 24.7, overpulled Achilles: 27.9, p< 0.01 at 60°) in the overpulled Achilles compared to normal.

Conclusion:

In this study, a three-dimensional model was used to measure the function of the WM. We found that the WM was affected by the pathological conditions of the Achilles tendon and sectioning the PA. The results of this study suggest that WM dysfunction may not affect the TMT joint but does affect the cuneonavicular joint. This might suggest the WM induced MTPJ1 pathologies are driven by the cuneonavicular joint.
Insurance Payor Status and Outcomes in Foot and Ankle Surgery
Authors: Luo Emily Joan , Rowe Dana , Wu Kevin , Bethell Mikhail Alexander , Adu-Kwarteng Kwabena , Anastasio Albert T. , Adams Samuel B.
Published: December 2024

Category:

Other

Introduction/Purpose:

The increasing prevalence of foot and ankle procedures in the United States has coincided with rising costs of care, exposing socioeconomic disparities within this area of orthopedics. Insurance payor status is one such factor that can affect the quality and accessibility of medical care and has been implicated in orthopedic patient outcomes. While previous studies in other fields of orthopedics have demonstrated an association between insurance status and access to treatment, length of hospital stay, postoperative outcomes and complication rates, no comprehensive review has explores this relationship in foot and ankle surgery. Thus, the goal of this study is to examine the association between insurance payor status and outcomes in foot and ankle procedures.

Methods:

A systematic review of five databases was conducted, focusing on the interplay between insurance coverage and foot/ankle procedures. Included studies reported on insurance payor status and patient outcomes following foot and ankle surgery. Extracted outcomes included time to be seen by a provider, complication and revision rates, post-operative Emergency Department (ED)/Urgent Care utilization, readmission rates, hospital length of stay, pain, functional scores, discharge destinations, return to work/activity, and follow-up. Meta-analyses were performed using the Revman 5.3 software. Studies that did not qualify for meta-analyses were described qualitatively.

Results:

Of 1401 studies identified, 24 texts met inclusion and exclusion criteria. Across the 24 studies, there were a total of 20,950 patients. Noninsured patients had a 59% higher risk of ED/urgent care utilization within 30 days of surgery compared to insured patients [Risk Ratio (RR) = 1.59, 95% Confidence Interval (CI) = 1.18 to 2.12, p < 0.05]. Privately insured patients were seen 3.65 days earlier than patients with government insurance [95% CI = 2.02 to 5.27, p < 0.0001]. Worker’s Compensation patients tended to have poorer outcomes, higher pain scores, and lower functional scores. Similarly, Medicaid patients also fared worse on functional scores and had delayed access to appointments and treatments.

Conclusion:

Patients without private insurance have worser pain and functional outcomes, delayed access to care, and increased utilization of emergency resources following foot and ankle procedures. It is crucial for providers to be cognizant of these discrepancies when caring for patients. Further research is needed to better understand the nuances of these insurance-related disparities within foot and ankle subspecialties.