bluuebunny/crossref_metadata_2025 huggingface dataset:
Clear Cell Renal Cell Carcinoma: A Comprehensive in silico Study in Searching for Therapeutic Targets
Authors: Naghdibadi Mohammadjavad , Momeni Maryam , Yavari Parvin , Gholaminejad Alieh , Roointan Amir
Published: February 2023

Introduction: Clear cell renal cell carcinoma (ccRCC) is recognized as one of the leading causes of illness and death worldwide. Understanding the molecular mechanisms in ccRCC pathogenesis is crucial for discovering novel therapeutic targets and developing efficient drugs. With the application of a comprehensive in silico analysis of the ccRCC-related array sets, the main objective of this study was to discover the top molecules and pathways in the pathogenesis of this cancer. Methods: ccRCC microarray datasets were downloaded from the Gene Expression Omnibus database, and after quality checking, normalization, and analysis using the Limma algorithm, differentially expressed genes (DEGs) were identified, considering the adjusted p value <0.049. The intensity values of the identified DEGs were introduced to the Weighted Gene Co-Expression Network Analysis (WGCNA) algorithm to construct co-expression modules. Functional enrichment analyses were performed using the DEGs in the disease-correlated module, and hub genes were identified among the top genes in a protein-protein interaction network and the disease most correlated module. The expression analysis of hub genes was done by utilizing GEPIA, and the GSCA server was used to compare the expression patterns of hub genes in ccRCC and other cancers. DGIdb database was utilized to identify the hub gene-related drugs. Results: Three datasets, including GSE11151, GSE12606, and GSE36897, were retrieved, merged, normalized, and analyzed. Using WGCNA, the DEGs were clustered into eight different modules. Translocation of ZAP-70 to immunological synapse, endosomal/vacuolar pathway, cell surface interactions at the vascular wall, and immune-related pathways were the topmost enriched terms for the ccRCC-correlated DEGs. Twelve genes including PTPRC, ITGAM, TLR2, CD86, PLEK, TYROBP, ITGB2, RAC2, CSF1R, CCR5, CCL5, and LCP2 were introduced as hub genes. All the 12 hub genes were upregulated in ccRCC samples and showed a positive correlation with the infiltration of different immune cells. According to the DGIdb database, 127 drugs, including tyrosine kinase inhibitors, glucocorticoids, and chemotaxis targeting molecules, were identified to interact with the hub genes. Conclusion: By utilizing an integrative bioinformatics approach, this experiment shed light on the underlying pathways in the pathogenesis of ccRCC and introduced several potential therapeutic targets for repurposing or developing novel drugs for an efficient treatment of this cancer. Our next step would be to assess the gene expression profiles of the identified hubs in different cell populations in the tumor microenvironment.
Kidney Involvement in Autoinflammatory Diseases
Authors: Zhang Changming , Peng Jiahui , Liu Zhihong , Zhou Qing
Published: February 2023

Background: Autoinflammatory diseases (AIDs) were first proposed 20 years ago and caused by dysregulation of the innate immune system, leading to episodes of systemic inflammation. Advances in next-generation sequencing and biological technology have resulted in the identification of new monogenic diseases and the corresponding signaling pathways that may guide us in targeted therapy. The kidney is a major target organ of various inflammatory processes. Summary: During systemic inflammation, increased pro-inflammatory cytokines, such as IL-6, IL-1β, and TNF, lead to over-transcription and release of acute phase reactant serum amyloid A (SAA). Sustained high SAA levels promote a cascade of pathophysiological events, including protein misfolding, protein fragmentation, and aggregation into highly ordered amyloid fibrils. Amyloid fibril deposition in the kidney cause progressive glomerular and vascular damage. Renal AA amyloidosis is a common and severe complication of AIDs, including familial Mediterranean fever, cryopyrin-associated periodic syndromes, TNF receptor-associated periodic fever syndrome, mevalonate kinase deficiency/hyper-IgD and periodic fever syndrome, and deficiency of adenosine deaminase 2. Amyloidosis may even be the first clinical manifestation in some patients, presenting with asymptomatic proteinuria, nephritic syndrome, progressive renal insufficiency, or end-stage kidney disease. In addition, major dysregulated pathways in different AIDs lead to endogenous inflammation, which is due to direct endothelial cytotoxicity caused by IL-1β, type I interferon, or possibly immune complexes. The kidney is frequently affected by various vasculitis, and kidney involvement is a major determinant of treatment options and outcomes. The renal vasculitis involved in AIDs includes renal artery Takayasu vasculitis, polyarteritis nodosa, and IgA vasculitis. Moreover, other kidney diseases, such as glomerulonephritis, lupus nephritis, and renal tubular dysfunction, were also reported in AIDs. Key Messages: Kidney manifestations can be a coexisting disease seen with AIDs. They may also be one of the characteristics of AIDs. Clinicians should be aware of the possibility that amyloidosis, vasculitis, or other kidney diseases may be associated with AIDs in order to make appropriate diagnosis and treatment. Kidney biopsy may be of great significance. Biologics, which switch off the underlying cytokine-mediated inflammatory process, have the potential to restore organ damage and improve the outcome in the very early stage of the disease.
Ocean Mesoscale and Frontal-Scale Ocean–Atmosphere Interactions and Influence on Large-Scale Climate: A Review
Authors: Seo Hyodae , O’Neill Larry W. , Bourassa Mark A. , Czaja Arnaud , Drushka Kyla , Edson James B. , Fox-Kemper Baylor , Frenger Ivy , Gille Sarah T. , Kirtman Benjamin P. , Minobe Shoshiro , Pendergrass Angeline G. , Renault Lionel , Roberts Malcolm J. , Schneider Niklas , Small R. Justin , Stoffelen Ad , Wang Qing
Published: February 2023

Two decades of high-resolution satellite observations and climate modeling studies have indicated strong ocean–atmosphere coupled feedback mediated by ocean mesoscale processes, including semipermanent and meandrous SST fronts, mesoscale eddies, and filaments. The air–sea exchanges in latent heat, sensible heat, momentum, and carbon dioxide associated with this so-called mesoscale air–sea interaction are robust near the major western boundary currents, Southern Ocean fronts, and equatorial and coastal upwelling zones, but they are also ubiquitous over the global oceans wherever ocean mesoscale processes are active. Current theories, informed by rapidly advancing observational and modeling capabilities, have established the importance of mesoscale and frontal-scale air–sea interaction processes for understanding large-scale ocean circulation, biogeochemistry, and weather and climate variability. However, numerous challenges remain to accurately diagnose, observe, and simulate mesoscale air–sea interaction to quantify its impacts on large-scale processes. This article provides a comprehensive review of key aspects pertinent to mesoscale air–sea interaction, synthesizes current understanding with remaining gaps and uncertainties, and provides recommendations on theoretical, observational, and modeling strategies for future air–sea interaction research.

Significance Statement

Recent high-resolution satellite observations and climate models have shown a significant impact of coupled ocean–atmosphere interactions mediated by small-scale (mesoscale) ocean processes, including ocean eddies and fronts, on Earth’s climate. Ocean mesoscale-induced spatial temperature and current variability modulate the air–sea exchanges in heat, momentum, and mass (e.g., gases such as water vapor and carbon dioxide), altering coupled boundary layer processes. Studies suggest that skillful simulations and predictions of ocean circulation, biogeochemistry, and weather events and climate variability depend on accurate representation of the eddy-mediated air–sea interaction. However, numerous challenges remain in accurately diagnosing, observing, and simulating mesoscale air–sea interaction to quantify its large-scale impacts. This article synthesizes the latest understanding of mesoscale air–sea interaction, identifies remaining gaps and uncertainties, and provides recommendations on strategies for future ocean–weather–climate research.
Pancreatic Cancer with Vascular Involvement: Adherence to Current Standard-of-Care Associated with Improved Survival
Authors: Mohamed Abdimajid , Nicolais Laura , Fitzgerald Timothy L.
Published: February 2023

Multiagent chemotherapy regimens have revolutionized the treatment of patients with localized pancreatic cancer. Therefore, current guidelines recommend neoadjuvant multiagent chemotherapy (N-MAC) for patients with borderline resectable or locally advanced pancreatic cancer.

Methods

This study is a retrospective cohort study of National Cancer Data Base (NCDB) data for pancreatic cancer with vascular involvement.

Results

A total of 23 903 patients with vascular involvement were included and divided into 3 groups; no treatment (40.6%), medical treatment (36.6%), and resection (22.8%). Of the patients undergoing resection, 31.3% received neoadjuvant multiagent chemotherapy (N-MAC). The remainder were treated with postoperative adjuvant treatment (33.8%), surgery alone (24.9%), preoperative radiotherapy (8.3%), or single-agent preoperative chemotherapy (1.7%). Median survival for N-MAC was superior (28.42 months) when compared to neoadjuvant radiotherapy (20.73 months), neoadjuvant single-agent chemotherapy (20.8 months), postoperative adjuvant therapy (17.87 months), and surgery alone (10.12 months). N-MAC was associated with improved survival compared to postoperative multiagent chemotherapy (P-MAC) (28.4 vs 16.95, HR 1.82; CI 1.64-2.02, P < .0010) (Figure 1). The addition of radiation therapy to N-MAC did not improve survival (27.4 vs 29.8, HR .93; CI .83-1.05, P = .3). Clinical downstaging occurred in 40% of patients treated with N-MAC, and downstaging was associated with improved survival (HR .74; CI .64-.85, P < .001). N-MAC patients were more likely to undergo an R0 resection than P-MAC (74% v. 48, P < .001).

Conclusions

Most resected pancreatic cancer patients in this study with vascular involvement receive either postoperative or no adjuvant therapy. N-MAC increases downstaging, R0 resection rates, and survival.
Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties
Authors: Spector Chelsea L. , Hernandez Jennifer , Shatawi Zaineb , Quintero Luis A. , Rosenthal Andrew , Parreco Joshua P. , Buicko Jessica L.
Published: February 2023

Introduction

Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty.

Methods

The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty.

Results

There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656).

Discussion

Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.
Significant Hypophosphatemia Is Predictive of Brain Death in Severe Traumatic Brain Injury
Authors: Maniakhina Lana E. , Muir Sean M. , Tackett Nichole , Johnson Daniel , Mentzer Caleb J. , Mount Michael G.
Published: February 2023

Traumatic brain injury (TBI) is one of the most common causes of morbidity and mortality worldwide. Severe TBI carries the greatest risk of brain death progression. There are currently no laboratory markers that predict patient’s outcome. We hypothesize that the degree of hypophosphatemia (HP) in TBI is an indicator for progression to brain death. A total of 336 patients, ages 15-89, with a GCS of 8 or less at admission were identified and retrospectively analyzed. Demographics, laboratory studies, and brain death (BD) were collected. Univariate analysis demonstrated HP was correlated with BD ( P < .0002). Multivariate analysis showed that phosphate was the only measured electrolyte correlated to BD with a P value < .0001. Mechanism of hypophosphatemia may be related to BD progression and provide future areas for study.
Distribution of Hay-Hole Covers Prevents Injuries from Falls Through Hay Holes
Authors: Moore Katherine , Landis Jalen , Harshaw Nathaniel , Perea Lindsey L.
Published: February 2023

Hay-holes are openings on the second floor of barns used to drop feed to ground level. Hay-hole falls (HHFs) are a unique problem among Anabaptist communities, especially for children. To follow-up on our previous study that created the Anabaptist Youth Trauma Prevention Consortium with distribution of 231 hay-hole covers in South Central Pennsylvania, we compared a five-year period before cover distribution with the 5-year period after. Data were stratified by phase: Before Cover Implementation (BC): 1/2011-12/2016, After Cover Implementation (AC): 1/2017-12/2021. 49 patients met inclusion criteria. There was a 47% decrease in the number of HHF from the BC phase to the AC phase, suggesting that cover distribution has significantly impacted HHF incidence. Further investigation is needed to elucidate the long-term impact of cover distribution and to guide future interventions, such as another round of cover distribution or improvements in the design of these covers for long-term use.
Social Determinants of Health Impact Physical Recovery After Blunt Injury
Authors: Cockrell Benjamin E. , Haiflich Andrew N. , Lee Yann-Leei L. , Kinnard Christopher M. , Butts Charles C. , Polite Nathan M. , Mbaka Maryann I. , Bright Andrew C. , Simmons Jon D. , Williams Ashley Y.
Published: February 2023

As defined by the United States Department of Health and Human Services, the Social Determinants of Health (SDOH) are conditions in the environment that affect health function and outcomes. The SDOH are divided into the following categories: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community content. It is known that SDOH impact long-term health outcomes. The influence that SDOH have on physical recovery after acute injury is less understood, however. In this study, patients who suffered a traumatic blunt injury completed a survey 12-14 months post-injury to assess their SDOH and physical health before and after their injury. The results showed that for the cohort of patients studied SDOH was the greatest predictor of long-term recovery, having a stronger correlation with recovery than injury severity score (ISS) or hospital length of stay (HLOS).
The Larry Tube: Customized 3D Printed Laryngectomy Tubes Following Total Laryngectomy
Authors: Daoud Georges E. , von Windheim Natalia , Alfayez Yazen , Michaels Ross E. , Nyirjesy Sarah , Chinn Steven B. , Spector Matthew E. , VanKoevering Kyle K.
Published: February 2023

Objective:

To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA.

Methods:

A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes.

Results:

For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube.

Conclusion:

Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway.
An image recognition measurement approach and uncertainty for overspeed governors employed in elevator safety
Authors: Zhang Yongming , Zhao Yicheng , Yan Zhe , Feng Shuangchang , Chen Jie
Published: February 2023

Elevator safety is closely related to public safety. Overspeed governor is a crucial part of the elevator safety system. Its inspection and calibration involve the measurement of tripping velocity. The frequently-used contact-type measurement method has risks. This paper proposes a non-contact image-recognizing measurement method by the camera, which includes the processes of rotor centre recognition, feature points matching, and tripping switches recognition. The velocity curve can be obtained by feature points displacement based on the rotor centre. Tripping switches recognition can determine the electrical and mechanical tripping velocities in the speed curve. The experimental results demonstrate that the proposed method has no significant difference from the common contact-type measurement method, while it significantly eliminates the risks of physical damage and improves measurement safety. Moreover, this paper proposes the deduction and calculation of measurement uncertainty decided by camera performance. Due to the enhancement of measuring safety, the proposed method will have further application in the field of elevator inspection.

Practical application: The research on tripping velocity measurement for overspeed governor in this paper is principally based on image recognition with the help of a camera. The experiment result indicates that the proposed method is capable of completing the speed measurement for the overspeed governor without contact. The proposed method significantly mitigates the risks of physical damage and improves measurement safety rather than the contact-type measurement method. The proposed non-contact image-recognizing method can substitute for the existing contact-type method and contributes to the inspection, maintenance, and management of elevators, which will have further application prospects.
Seeking Help for Tinnitus and Satisfaction With Healthcare Providers Including Diagnosis, Clinical Services, and Treatment: A Scoping Review
Authors: Carmody Natalie , Eikelboom Robert H. , Tegg-Quinn Susan
Published: February 2023

The objective of this scoping review was to describe the extent and type of evidence related to seeking help for tinnitus and satisfaction with healthcare providers including diagnosis, services and treatments along the clinical pathway. The selection criteria were adults aged 18 and over with tinnitus who sought help and where patient satisfaction with healthcare providers was reported. Online databases MEDLINE (OvidSP), Embase (OvidSP), PsycINFO (OvidSP) and CINAHL plus (EBSCO) were searched for original studies in English. The search had no date limit. Twenty-one records were eligible for data extraction. Studies reported that the most common healthcare providers seen were general practitioners, ear, nose and throat specialists and audiologists. Depression and tinnitus severity were related to an increase in the number of times help was sought and the type of healthcare provider seen may also impact patient satisfaction. The majority of participants were unlikely to receive a referral to a specialist at the initial GP consultation. Although there is limited research in this area, help-seekers for tinnitus were generally dissatisfied and reported negative interactions with healthcare providers. However, once in a specialised tinnitus clinical setting, studies reported that most help-seekers were satisfied and had positive interactions with healthcare providers.
Theorising the Politics of Tourism: Global Travel and the Nation-State
Authors: Fayard Gregory
Published: February 2023

Despite tourism being one of the largest industries in the world and key to the economies of many countries, there has been little effort to systematically connect the nation-state to global circuits of tourism. Most theoretical work centres around international flows of capital and issues of policy choice, sidelining how states as sovereign, territorial institutions are constructed through global travel. Using a constructivist approach to the state, the present paper redresses these gaps by building a theory of the state-tourism nexus that synthesises multiple historic and contemporary examples, demonstrating the major mechanisms connecting tourism to the global institutionalisation and positioning of states. Including both domestic and foreign travel, this theoretic illustrates how travel flows are useful for state leaders in constituting, imagining, legitimising and territorialising the nation-state.

Théoriser la politique du tourisme : le tourisme international et l’État-nation
Non-performing Assets and Institutional Quality Indicators: Evidence from Developing Countries
Authors: Goyal Shikha , Prosad Jaya Mamta , Mishra Nandita , Singhal Nikita
Published: February 2023

This research studies the drivers of non-performing assets (NPAs) in developing countries. The author applied panel regression methodology to establish the links between bank-specific macroeconomic factors and institutional environment NPAs on country-level panel data of developing countries for the period spanning from 2010 to 2020. The long-held theory that NPAs cause economic growth is tested using the panel Granger causality test. Panel cointegration tests were further applied to look at whether there is a long-term relationship between the two variables. The findings of the study indicated that loan defaults often occur at a lower rate during periods of high economic growth, which consequently leads to reduced amounts of NPAs. A bigger banking sector should be more stable than a small banking sector if a strong systemic risk regulatory framework is in place. Finally, the present research shows how crucial the institutional environment is in enhancing banks’ credit quality. NPAs are significantly decreased in developing nations when there is a greater improved institutional environment.
Psychoactive Substance Use Disorder in HIV-Infected Adolescents in Botswana: A Comparison Between the Congenitally Infected and Behaviorally Infected Adolescents
Authors: Olashore Anthony A , Paruk Saeeda , Brooks Merrian , Chiliza Bonginkosi
Published: February 2023

Substance use is a major obstacle to preventing and managing HIV among adolescents, who account for 30% of new infections in many parts of the world, including Botswana. Unfortunately, there is a paucity of data on adolescent substance use, especially in the region. Therefore, this study aimed to determine the pattern of psychoactive substance use in adolescents living with HIV (ALWHIV). It also aimed to compare and explore the pattern of substance use disorders and associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Six hundred and thirty-four ALWHIV were interviewed using a sociodemographic questionnaire, the WHO drug questionnaire, and DSM-5 criteria for substance use disorder. The participants’ mean age (SD) was 17.69 (1.6) years, with a male predominance (n = 336, 53%), and the majority (n = 411, 64.8%) were CIAs. Alcohol was the most used substance among the participants, with 15.8% admitting to its current use. The BIAs were more likely to have SUD (χ2 = 17.2, P < .01), use more than one substance (χ2 = 20.3, P < .01), and more likely to use all psychoactive substances except for inhalants. In the CIAs, regular participation in religious activities was negatively associated with SUD (AOR = 0.36; 95% CI: 0.17-0.77), while struggling with HIV status acceptance was positively associated with SUD (AOR = 2.54; 95% CI: 1.15-5.61) in the BIAs. This study showed a huge burden and similar pattern of substance use disorders among the ALWHIV in Botswana, as reported elsewhere. It also identified the dissimilarities between the BIAs and CIAs regarding substance-related issues and suggested the need for differentiated care.
Defining the Self in Terms of Power, Plurality and Social Embeddedness–The Model of the Agonistic Self
Authors: Džinović Vladimir , Grbić Sanja , Vesić Dragan
Published: February 2023

The paper offers an analytical framework for conceptualization and research of the structure and dynamics of the agonistic self, relying on Hermans’ dialogical self theory and Foucault’s analytics of power. In a multiple-case study, 9 teachers participated in a two-phase Agonistic Self Interview. A deductive-inductive thematic analysis of the data yielded an analytical framework comprising 4 categories: Functions of Voices, Power Relations (with two sub-categories: Forms of Exercising Power and Practices for Exercising Power and Resistance), Types of Relations Between Voices, and Institutional Context. The paper offers the analytical concept of a strategic situation along with novel methodological tools for the research and analysis of the self as embedded in interpersonal relationships and sociocultural and institutional context. The psychological relevance of the findings is discussed in terms of relations between dominance and maintaining plurality within the self and relations between the stability and social contextualization of the self.
Depression representations on the most popular Russian-language YouTube channels
Authors: Mikhaylova Oxana
Published: February 2023

This article analyzes the mental health discourse on the most popular Russian-language channels on YouTube. The main research focus is depression representations. In total 345 videos were examined, issued since 2015 and till 2021. Using theoretical thematic analysis, the content creator types are identified, and these types are compared in terms of their portrayals of depression. The findings demonstrate that the most popular Russian-language content was made by (1) specialists on mental health, (2) influencers and celebrities, (3) documentalists, and (4) experientialists. The channels of popular science, those with TV recordings, religious, esoteric, and artistic channels were found to be watched less, despite also featuring mental health. The results regarding depression representations showed that most content creators describe depression as an illness. Additionally, the depression portrayals from the contemporary, popular Russian-language YouTube channels generally correspond with contemporary medical perspectives on depression, and the authors discussed depression using words and collocations from the medical discourse. Therefore, it could be assumed that the Russian-language representations of depression on this platform are based on the medical explanatory model of depression and are highly medicalized. The paper contributes to studies of mental health discourse reception across cultures and media, as well as the literature on depression representations.
The (de-)radical(-ising) potential of r/IncelExit and r/ExRedPill
Authors: Thorburn Joshua
Published: February 2023

This article introduces two forums, r/IncelExit and r/ExRedPill, that have organically emerged in recent years to provide a pathway out of the manosphere for men and boys. Based upon preliminary findings from a broader digital ethnography project, this piece highlights the potential benefits these spaces can offer individuals engaging with them. Furthermore, this article flags opportunities that exploring these forums can offer to academic inquiry on the nature of (de-)radicalisation within the manosphere, along with theoretical issues debated within the critical studies of men and masculinities field. It is also proposed that such forums could serve as an alternative space to provide socially alienated young men and boys with information emphasising the importance of consent and respectful relationships, away from formal school curricula. Finally, this article also discusses the potential effects that neoliberalism may have in shaping how young men approach dating.
Individual Benefits of Continuing Higher Education. The Case of a Swiss Business School
Authors: Baumann Sheron , Keimer Imke
Published: February 2023

This contribution examines individual benefits of continuing higher education courses provided by a business school. Lifelong learning is important when it comes to keeping up with changing professional requirements and conditions. Adult education and training courses in the form of continuing higher education offer an organized and systematic possibility to further develop oneself. However, empirical evidence on the benefits to graduates is sparse. This article aims to expand the state of knowledge through a Swiss case. Using univariate and multivariate analyses of survey data ( n = 1615), benefits contributing to the satisfaction with practice oriented, non-formal education for working professionals are examined. The analyses focus on satisfaction with one of three types of continuing education programs as a measure for the overall benefit to the graduates. The findings provide important indications for the design of continuing education programs in the context of professional higher education. They reveal that subjectively, monetary benefits as well as increases in personal competence are secondary to the overall benefit accrued through the completion of courses. Instead, career development and the enhancement of specific professional competence significantly contribute to the satisfaction of professionals completing continuing higher education.
Arthroscopic Bankart Repair: Surgical Pearls
Authors: Sukmawan Jefri
Published: February 2023

The glenohumeral joint provides a wide range of motion, but is also particularly vulnerable to instability. Anterior instability is the most common type of shoulder instability. It can be due to either subluxation or dislocation. The evaluation and management of such instability is dependent on many factors and a thorough understanding is necessary to achieve an optimal outcome. A variety of treatment options, both surgical and non-surgical, exist to manage anterior instability, however, selecting the optimal surgical treatment is not always simple. The treatment plan should be individualized for all patients. Arthroscopic Bankart repair is a reliable surgical treatment to return the athlete and non-athlete back to activities. It has become a standard method and can successfully restore range of motion and stability and yield successful outcomes with low recurrence rate. To obtain a succesful surgery, it is imperative that the surgeon be aware of all technical pearls of how to effectively perform a successful arthroscopic Bankart repair.
Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
Authors: Butar Butar John C. P.
Published: February 2023

Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus.

Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears.

Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis.

Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT.

RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT.

The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique.
Indications and Settings for Ankle Arthroscopy
Authors: Boedijono Dimas R
Published: February 2023

Ankle arthroscopy has been on the slow rise from around the year 2000 after its inception in the 1940s. After the foundation of IOSSMA shortly followed by INAFAS, the number of cases that had been done with arthroscopy increased dramatically in Indonesia. Nowadays, it becomes a very handy tool for helping patients to alleviate the ankle pain as long as the indication is fulfilled. This short lecture will give some light for orthopaedic surgeons who are interested in Ankle arthroscopy by learning the proper indication and how to setup the operating theater for the procedure.
POL Reconstruction: a Necessity or an Accessory
Authors: Nelwan Bobby N
Published: February 2023

The MCL is the knee ligament that is most commonly injured but is quite often neglected in terms of in-depth research and understanding. This is due to the belief in good healing abilities that there is a belief that MCL injuries are almost certain to be cured conservatively. Commonly, recurrent rupture after ACL reconstruction is due to neglect of MCL rupture. This prompted researchers and orthopedic sports surgeons to think about the importance of the MCL, initiate in-depth research on the MCL, and initiate repair of the ligament. Surgical indications include high-grade MCL injuries, valgus instability that persists on conservative therapy, and low-grade MCL injuries with other ligamentous injuries.

The MCL consists of the superficial MCL (sMCL), deep MCL (dMCL) and the Posterior Oblique Ligament (POL).It stabilizes the medial of the knee against the valgus and rotation. The sMCL attachment to the femur covers the EM (Epicondyle Medial) and has a long attachment proximal to the tibia distally. The course of the dMCL has a sloping path from its attachment at the posterior distal of EM to the anterior distal of the proximal tibia. The posterior oblique ligament consists of three arms: the superficial, central (tibial), and capsular. The central arm is the largest and thickest part of the POL.

The POL attachment to the medial condyle of the femur is somewhat more posterior and proximal than the EM or posterior and distal to the adductor tubercle, extending to the distal aspect of the semimembranosus tendon and is a thickening of the posterior medial capsule, with a distinct attachment to the medial meniscus. It is fused anteriorly with the sMCL but can be identified by the orientation of the fibers.

The sMCL biomechanics found tension in the anterior aspect of the ligament when flexed about 90 degrees and externally rotated. In the posterior part of the sMCL, tension during full extension and internal rotation. The anterior part of the dMCL relaxes at 0-30 degrees and tension at an angle of 60 degrees to full flexion, while the posterior part of the dMCL relaxes more when flexed at 0-100 degrees. The POL is the posterior part of the MCL complex, which will be tensioned during Full Extension and internal rotation. The MCL complex is different in its response to changes in length to the extension, flexion, and knee rotation. The MCL is not isometric.

The role of POL, which is quite prominent in the medial corner of the posterior knee, holds the movement of internal rotation, so this ligament is not accessory. Rupture of POL requires reconstruction to maintain the internal rotation stability of the knee joint. Furthermore, in performing reconstruction, the POL must be tightened and fixed in full knee extension and neutral rotation to reproduce its anatomical length and prevent over-tightening.
Adding a Lateral Extraarticular tenodesis to ACL Reconstruction in 2022
Authors: Dave Lee Yee Han
Published: February 2023

Lateral extra-articular tenodesis (LET) is a procedure used to control anterolateral rotatory laxity. It was first described to treat the ACL deficient knee prior to advent of intra-articular reconstruction. The aim was adding a lateral soft tissue restraint away from the central pivot of the knee to improve rotational control. The recent evidence from the STABILITY RCT has shown that the addition of LET to hamstring autograft ACLR in young patients (14-25 years ) results in clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years postoperatively. This has subsequently been verified by various authors that adding a lateral soft tissue restraint to an intraarticular ACL reconstruction reduced both primary and revision ACL graft failures. The current indication for adding an LET to ACL surgery are : in high grade knee laxity in clinic detected on physical examination, patients with joint laxity, chronic ACL injuries, athletes returning to pivot sports after surgery and in revision ACL cases.
Management of Cartilage Lesions Based on Etiology : OCD versus Acute Traumatic Lesions
Authors: Sulistiani Athiyah
Published: February 2023

Treatment of articular cartilage lesions in the knee remains a challenge. A wide range of options is available nowadays, including conservative measures, simple arthroscopic interventions, marrow tapping techniques, osteochondral auto/allografting, cell-based techniques, growth factors and emerging gene therapy techniques.

Osteochondritis dissecans (OCD) is first described by Konig in 1888. Its prevalence is estimated at 15 to 30 cases per 100.000. The lateral aspect of the medial femoral condyle is the classic site, repetitive trauma with microscopic fractures below the surface of the joint of clogging of the tiny blood vessels inside the bone associated with a number of differing medical conditions. OCD is commonly found in older children and adolescents who actively participate in sports. It is different from acute traumatic cartilage lession, as they happen due to a direct compaction injuries, such as occur in the patellofemoral joint. The more common mechanism is a rotational injury to the knee or shearing force across the articular cartilage. Patellar dislocation may lead to osteochondral fracture through this mechanism and is responsible for 40-50% of osteochondral lesions around the femoral condyles. It is most common in young active patients aged 20-40 years. Treatment options are variable and dependent on many factors, including patient age and activity level, location and size of the defect, meniscal status, limb alignment, concomitant knee pathologies, chronicity, and comorbidities. Treatment of cartilage lesions is differentiated not based on its etiology but based on the severity of the cartilage lesions such as size, depth, shape and description of the walls (contained, partially contained or opened), and the resource capabilities of each centre. What needs to be understood is that OCD lesions are disease-related, whereas acute traumatic lesions may occur in otherwise healthy cartilage due to mechanical trauma.
When and What to Consider Knee Arthroscopy Surgery in Post-COVID 19 Infected Patients
Authors: Yudhadibrata Permana
Published: February 2023

Coronavirus disease 19 (COVID-19) is the worst pandemic ever recorded in history, as of this day more than 545 million people infected and more than 6 million cumulative deaths. COVID 19 is primarily respiratory disease, however non-respiratory presentations that could be manifested are venous and arterial thromboembolic events. Both pulmonary embolism (PE) and deep vein thrombosis (DVT) are the most frequently thrombotic events in COVID-19.

Knee arthroscopy surgery is the one of the most common orthopedic surgical procedures nowadays, with the most common procedures are meniscectomy, meniscal repair and cruciate ligament reconstruction. Although knee arthroscopy is known to be a safe procedure, several complications could be found with the 3 most common complications are DVT, effusion and synovitis, and PE.

We reported a case series of four patients with DVT post knee arthroscopy anterior cruciate ligament reconstruction during 2021. The DVT diagnosis was retained on clinical presentation and elevated of D-dimer testing.

The patient’s mean age was 35,25 years, and all of the patients had no risk factors of DVT, although they had COVID-19 infection within 3 months before surgery. The most common clinical presentation was swelling on the lower leg (around the ankle) with slightly pain and numbness. Only one patient had severe pain around the thigh. All of the patients had elevated D-dimer testing result with mean of D-dimer 1250 (normal value < 500). Only one patient had sonography testing and found proximal DVT. One of the patients had DVT at post operative day (POD) 3, one at POD 4 and the other two at POD 5. Three of the patients improved with oral anticoagulant therapy using rivaroxaban (XARELTO). In one patient the symptom was not improved after two days oral anticoagulant therapy and underwent thrombectomy by vascular surgeon.

DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection. Routinely administration of thromboprophylaxis agent was not recommended, pre-operative risk assessment of DVT should be used, especially in post-COVID 19 patients.
A Rare Case: Ganglion Cysts in the Proximal Tibiofibular Joint Causes Lateral Side Knee Pain: A Case Report
Authors: Rawung Rawung. Bayu Valentino , Yanuarso  , Nelwan Bobby Natanel
Published: February 2023

Introduction:

Proximal tibiofibular joint (PTFJ) ganglion cysts are very rare. The pathophysiology remains unclear. Lateral knee pain was present in dominant case, and some cases accompanied with common peroneal nerve symptoms. In cases of chronic trauma, it is sometimes confused with proximal tibiofibular joint instability. Thorough examination and investigations such as MRI are highly recommended. There is no consensus of management, but some studies indication that excision of the ganglion associated with low recurrences number.

Method:

We report a case of 28 yeara-old woman, with a chief complain of pain on the lateral side of her right knee. Pain increasing on one last year. She had a trauma on her knee in 5 years ago. She was diagnosis with Lateral Instability of her knee by a previous surgeon and refer to our clinic for second opinion. In physical exam we found, tenderness around fibula head, Lachman, McMurray, Lelli’s test was negative. Shuck test was not evident.. MRI was done and showing partial tear of anterior horn of lateral meniscus and partial tear of anterior proximal tibia fibula ligament also a fluid collection around the fibular head. We planned to repair the meniscus through arthroscopic and stabilize the Proximal tibiofibular joint with open surgery.

Results:

Standard arthroscopic surgery was performed. Tear anterior horn meniscus was repair using inside out technique. In open surgery we found the anterior proximal tibiofibular ligament quite stable, and also we found a ganglion cyst around the PTFJ. We decided to leave the anterior PTFJ ligament, and excise the ganglion until its sac and follow up the case forward.

Conclusion:

Symptoms of pain caused by ganglion cysts in PTFJ, although rarely, can be very disturbing. The history of chronic trauma obscures this case with instability condition. There for careful diagnosis is required. Excision of the ganglion into the sac is the treatment of choice because of the very low recurrence rate. The complex anatomical composition of the lateral side of the knee can cause pain to arise from various components. The presence of PTFJ ganglion cysts should not be ignored
Do High-Flexion Total Knee Arthroplasty Have More Adverse Events™
Authors: Dusak I Wayan Suryanto , Ciatawi Kartini
Published: February 2023

Introduction:

High-flexion knee prosthesis was proposed to result in better outcomes after knee arthroplasty. However, latest meta-analysis revealed that this implant indeed only produced better range of motion (ROM) and no benefits in other functional outcomes, including weight-bearing flexion. Moreover, recent studies suggested that more complications occurred in high-flexion total knee arthroplasty (TKA) instead.

Objectives:

This study focuses on the adverse events of high-flexion TKA compared to standard TKA in mid to long term of follow-up.

Methods:

Systematic search was done in online databases, i.e. Pubmed, ScienceDirect, ClinicalKey. We only included studies with a minimum follow-up duration of 5 years, expecting that this mid to long term follow-up could provide a better picture of the outcomes.

Results:

Seven studies were included in the final quantitative analyses, involving a total of 2,693 knees in high-flexion TKA and 3,892 knees in standard TKA. High-flexion TKA significantly had higher revision surgery compared to standard TKA (p = 0.03), 41(1.52%) and 53 (1,36%) knees, respectively. Loosening was not statistically different between those groups. Generally, radiolucent line was also more frequently observed in high-flex TKA (p = 0.01), 7.43% V 3.83% at femoral side and 5.69% V 4.41% at tibial side. Although infection and instability were higher in high-flexion knee, only a few studies found the occurrence of these parameters. Four studies evaluated the incidence of osteolysis and none was found in both groups.

Conclusion:

Considering that high-flexion TKA may only yield on better ROM but carry a bigger risk of adverse events, one has to cautiously weighing up the benefits and risks when planning of delivering a high-flexion TKA.