bluuebunny/crossref_metadata_2025 huggingface dataset:
The fate of acetabular fracture fixation at 10 years: rates of conversion to arthroplasty
Authors: Kiran Manish , Frostick Rhiannon , Elnahal Walid , Spence David , Acharya Mehool , Ward Anthony , Chesser Tim JS
Published: November 2022

Background:

Post-traumatic arthritis, implant failure, non-union or avascular necrosis may result in a total hip arthroplasty (THA) after acetabular fracture fixation (AFF). The aim of this study was to report the occurrence of THA after AFF and analyse factors that predict its occurrence.

Patients and methods:

All patients with AFF between 2010 and 2014, in a major trauma centre, were included. Patients treated conservatively or with acute THA were excluded. Data regarding classification of fracture, details of surgery and follow-up using EQ-5D and Oxford Hip Score (OHS) were recorded prospectively. Postoperative radiographs and CT scans were analysed for accuracy of reduction. The number of patients who underwent secondary THA and indications were recorded.

Results:

122 patients with a mean age of 42 years were included. At a mean follow-up of 10 years, the mean OHS was 39 (range 22–48) and EQ-5D was 22 (range 10–25). THA was performed in 10 patients (8%), 50% of which were performed between 2–5 years after AFF. Age >40 years, posterior dislocation and presence of posterior wall fracture, were the only factors associated with progression to THA. The survivorship of fixation at 5 years was 95% (95% CI, 91–98%) and at 10 years was 91% (95% CI, 86–96%).

Conclusions:

Conversion to THA after AFF was 8%, with even anatomically reduced posterior wall fractures having a poor prognosis. A period of follow-up of at least 5 years is suggested in patients with risk factors.
Challenging the hidden curriculum: Building a lived process for responsibility in responsible management education
Authors: Hibbert Paul , Wright April L
Published: November 2022

This essay argues that conceptualisations of responsibility in the responsible management education literature are generally superficial or unstated. We propose that this leads to practical understandings of responsibility being drawn from the hidden curriculum of socialised learning in the background of formal educational contexts. To disrupt this and enable critical thought and action, we argue for the integration of three perspectives that can be combined in a dynamic, lived process. First, we suggest that evidence-based management challenges us to seek out evidence to inform responsible management practice in ways that are thoughtful, critical and reflexive. Second, we argue that an interpretive approach employing philosophical hermeneutics connects responsibility to situated judgement about how we should interpret evidence available to us in the context of lived human experience in dialogue with others. Third, deconstruction reveals (aspects of) the ways in which the hidden curriculum constructs responsibility in the context of responsible management education texts and talk – and helps us to remain open to other possibilities. We integrate these three perspectives to arrive at a definition of responsibility as a lived process with implications for students, educators and the institutions they inhabit.
The usability and effect of an mHealth disease management platform on the quality of life of patients with paroxysmal atrial fibrillation – The emPOWERD-AF study
Authors: Lazaridis Charalampos , Bakogiannis Constantinos , Mouselimis Dimitrios , Tsarouchas Anastasios , Antoniadis Antonios P , Triantafyllou Konstantinos , Fragakis Nikolaos , Vassilikos Vassilios P
Published: November 2022

Atrial fibrillation (AF) is the most common arrhythmia. myAlgos is an mHealth disease management system consisting of physician-oriented platform and patient-oriented smartphone app. Our purpose was to assess the usability of myAlgos by physicians and patients and the effect of myAlgos on the quality of life (QoL) in patients with paroxysmal AF (PAF). Physicians rated the platform with the Post-Study System Usability Questionnaire (PSSUQ). Patients rated the app with the mHealth App Usability Questionnaire (MAUQ). The e-medicine Platform for Optimizing the Workflow in hEaRt Diseases (emPOWERD-AF) study investigated the effect of myAlgos in PAF patients randomized to full/control version. QoL was measured by the Atrial Fibrillation Effect on QualiTy-of-life (AFEQT) and 5-level EQ-5D (EQ-5D-5L) questionnaires. myAlgos got a PSSUQ score of 2.52 ± 0.36 by five physicians and a MAUQ score of 79.9% by 33 patients. In emPOWERD-AF, 80 patients were randomized 1:1 (58.1 ± 8.7 years, 66% male). The median AFEQT change at 6 months was +2.63% in full version users and −1.63% in controls ( p < .001). The myAlgos platform and app were easy-to-use and improved QoL in patients.
Study on the effect of hydrocarbon structure on the reactivity of the three-way catalytic converter
Authors: Uenishi Toru
Published: November 2022

The effect of hydrocarbon structures on reduction of nitric oxide and oxidation of carbon monoxide and hydrocarbons on the palladium-rhodium catalyst supported on aluminum-cerium-zirconium oxide was examined with fixed-bed flow reactor using synthetic gas. As regards olefinic hydrocarbons, the lower the number of carbon atoms, the higher the rate of reduction of nitric oxide, the lower the number of carbon atoms, the greater the rate of oxidation of hydrocarbons and carbon monoxide. Olefinic hydrocarbons have a π bond and are highly adsorbed on catalytic sites. Consequently, it may be hypothesized that if the number of carbon atoms increases, the adsorption ability becomes too high and the reactivity of the hydrocarbons decreases. On the other hand, for paraffinic hydrocarbons, the greater the number of carbon atoms, the greater the rate of reduction of nitric oxide, and the more carbon atoms there are, the higher the oxidation rate of the hydrocarbon. In the case of paraffinic hydrocarbons, there are only σ bonds and less adsorption on the catalyst site, it is therefore assumed that the greater the number of carbon atoms, the greater the reactivity of the hydrocarbon. The results of the effects of these hydrocarbon structures on the overall three-way catalytic reaction activity provide an indicator of the development of new catalysts.
Enacting overlapping exchanges to address market concerns: Evidence on sustainable and conventional coffee markets in Uganda
Authors: Onyas Winfred I.
Published: November 2022

This article tackles an underexplored topic in the Market Studies literature—the enactment of exchange practices in overlapping markets. Based on an ethnographic study, the article examines a contested market space in which sustainable and conventional coffee buyers compete to enact exchanges with farmers. At the center of this competition are farmers, whose subsistence challenges heavily influence the choice of market(s) they operate in. An Exchange Entanglements framework for analyzing overlapping exchanges is developed, which accounts for market concerns, calculative power asymmetries, and the (re)configuration of market entities. The article builds our understanding of how exchanges are enacted to account for concerns in overlapping markets, and develops a characterization of overlapping market exchanges. It questions the extent to which dominant market actors can address farmers’ subsistence challenges, and highlights the problematic challenge of enacting concerned markets that serve marginalized market actors.
Long term WEB results – still going strong at 5 years?
Authors: Alpay Kemal , Nania Alberto , Raj Rahul , Numminen Jussi , Parkkola Riitta , Rautio Riitta , Downer Jonathan
Published: November 2022

Objective

The aim of our multi-center study is to examine 5-year radiological outcomes of intracranial aneurysms (IAs) treated with the Woven EndoBridge (WEB).

Methods

All patients treated with WEB between January 2013 and December 2016 were included. Patient and aneurysm characteristic data was collected from the electronic patient record. Aneurysm occlusion was assessed using a 3-grade scale: complete occlusion, neck remnant, and aneurysm remnant. Complete occlusion and neck remnant were considered as adequate occlusion, whereas aneurysm remnant was assessed as an inadequate occlusion.

Results

A total of 66 patients (72.7% female) with 66 IAs (n = 25 acutely ruptured) were treated with WEB. The mean age of patients was 55.6 years (range: 36–71 years). The mean width of the aneurysm neck was 4.5 mm (range: 2−9 mm). 5-year imaging follow-up data was not available for 16.6% patients (n = 11). During the follow up period, 14.5% of IAs (n = 8/55) required retreatment within 24 months of initial treatment with the WEB. A total of 55 IAs were analyzed for 5-year radiological outcome. Of these, including IAs required retreatment, 47.3% of IAs (n = 26/55) were occluded completely, 36.4% (n = 20/55) had neck remnant and 16.3% (n = 9/55) had recanalized. 83.7% of IAs were occluded adequately. None of the IAs rebled after initial treatment with WEB.

Conclusion

WEB can provide acceptable adequate occlusion rates at 5 years. Furthermore, recanalization appears to be unlikely after the first two years post-treatment. The results of large studies are needed to confirm these promising long term radiological outcomes
Enhancement and extraction of periodic transient based on hybrid intelligent fusion algorithm and its application in rolling bearing fault detection
Authors: Yan Lu , Juan Du , En-Jie Ding , Ke Liu
Published: November 2022

Weak fault detection of rolling bearing presents difficult, because the periodic transient signature produced via localized incipient damage is easily submerged by various interference components and background noise. Hybrid intelligent fusion method is a breakthrough strategy for revealing feature frequency of rolling bearing fault by comprehensively using a variety of intelligent signal processing technologies, possessing the advantage of each technology. Considering the rolling bearing often construct a transmission device combination with gear and shaft, its vibration signal is often vulnerable to other multi-morphology components, such as harmonic modulation, noise. Thus, how to identify the fault frequency in repetitive transients is crucial to accurately identify rolling bearing fault detection. To address this issue, a novel hybrid intelligent method is proposed to effectively apply on periodic transients extraction, enhancement and rolling bearing fault diagnosis. The innovation of this method is to solve three problems, namely, the separation of multi-morphology components, noise reduction without periodic transients distortion, weak fault frequency enhancement. The proposed method is tested and validated on simulated signal, rolling bearing fault signal from accelerated rolling bearing degradation rig. In addition, comparisons with other classical rolling bearing fault detection methods have been conducted to highlight the superiority of the proposed methodology.
Multiple object tracking with extended occlusions
Authors: Lukavský Jiří , Oksama Lauri , Děchtěrenko Filip
Published: November 2022

In everyday life, we often view objects through a limited aperture (e.g., soccer players on TV or cars slipping into our blind spot on a busy road), where objects often move out of view and reappear in a different place later. We modelled this situation in a series of multiple object tracking (MOT) experiments, in which we introduced a cover on the edges of the observed area and manipulated its width. This method introduced systematic occlusions, which were longer than those used in previous MOT studies. Experiment 1 ( N = 50) showed that tracking under such conditions is possible, although difficult. An item-level analysis confirmed that people made more errors in targets that were covered longer and more often. In Experiment 2 ( N = 50), we manipulated the tracking workload and found that the participants were less affected by the cover when the tracking load was low. In Experiment 3 ( N = 50), we asked the participants to keep track of the objects’ identities (multiple identity tracking [MIT]). Although MIT is subjectively more demanding, memorising identities improved performance in the most difficult cover conditions. Contrary to previous reports, we also found that even partial occlusions negatively affected tracking.
A phase III, multi-arm multi-stage covariate-adjusted response-adaptive randomized trial to determine optimal early mobility training after stroke (AVERT DOSE)
Authors: Bernhardt Julie , Churilov Leonid , Dewey Helen , Donnan Geoffrey , Ellery Fiona , English Coralie , Gao Lan , Hayward Kathryn , Horgan Frances , Indredavik Bent , Johns Hannah , Langhorne Peter , Lindley Richard , Martins Sheila , Ali Katijjahbe Md , Middleton Sandy , Moodie Marj , Pandian Jeyaraj , Parsons Brooke , Robinson Thompson , Srikanth Velandai , Thijs Vincent ,   On behalf of the AVERT DOSE Trialist Collaboration
Published: November 2022

Rationale:

The evidence base for acute post-stroke rehabilitation is inadequate and global guideline recommendations vary.

Aim:

To define optimal early mobility intervention regimens for ischemic stroke patients of mild and moderate severity.

Hypotheses:

Compared with a prespecified reference arm, the optimal dose regimen(s) will result in more participants experiencing little or no disability (mRS 0–2) at 3 months post-stroke (primary), fewer deaths at 3 months, fewer and less severe complications during the intervention period, faster recovery of unassisted walking, and better quality of life at 3 months (secondary). We also hypothesize that these regimens will be more cost-effective.

Sample size estimates:

For the primary outcome, recruitment of 1300 mild and 1400 moderate participants will yield 80% power to detect a 10% risk difference.

Methods and design:

Multi-arm multi-stage covariate-adjusted response-adaptive randomized trial of mobility training commenced within 48 h of stroke in mild (NIHSS < 7) and moderate (NIHSS 8–16) stroke patient strata, with analysis of blinded outcomes at 3 (primary) and 6 months. Eligibility criteria are broad, while excluding those with severe premorbid disability (mRS > 2) and hemorrhagic stroke. With four arms per stratum (reference arm retained throughout), only the single treatment arm demonstrating the highest proportion of favorable outcomes at the first stage will proceed to the second stage in each stratum, resulting in a final comparison with the reference arm. Three prognostic covariates of age, geographic region and reperfusion interventions, as well as previously observed mRS 0–2 responses inform the adaptive randomization procedure. Participants randomized receive prespecified mobility training regimens (functional task-specific), provided by physiotherapists/nurses until discharge or 14 days. Interventions replace usual mobility training. Fifty hospitals in seven countries (Australia, Malaysia, United Kingdom, Ireland, India, Brazil, Singapore) are expected to participate.

Our novel adaptive trial design will evaluate a wider variety of mobility regimes than a traditional two-arm design. The data-driven adaptions during the trial will enable a more efficient evaluation to determine the optimal early mobility intervention for patients with mild and moderate ischemic stroke.
Report on the Academic Conference on Crime Control, Security and New Technologies
Authors: Thönnes Christian
Published: November 2022

From 29 to 30 August 2022, a diverse group of international researchers convened under the Arctic northern lights in Tromsø. They set out to discuss some of the most pressing questions facing European criminal and public security law. This scientific event was co-organised by the Research Group on Crime Control and Security Law at The Arctic University of Norway under Nandor Knust and Jon Petter Rui, and the Otto Hahn Research Group on Alternative and Informal Systems of Crime Control and Criminal Justice at the Max Planck Institute for the Study of Crime, Security and Law under Emmanouil Billis. As Emmanouil Billis and Nandor Knust noted in their opening speech, the conference had set itself the goal of critically assessing how modern technologies, and especially artificial intelligence (AI), can serve to strengthen the efficiency and effectiveness of crime control and criminal justice systems, while at the same time complying with established ruleof-law principles and human-rights standards. In my report, I summarize the conference’s main discursive themes.
Relationship Between Diagnostic Anatomic Shoulder Parameters and Degenerative Rotator Cuff Tears: An MRI Study
Authors: Gulcu Anil , Aslan Ahmet , Dincer Recep , Özmanevra Ramadan , Huri Gazi
Published: November 2022

Background:

Numerous radiographic measurement methods related to rotator cuff tears (RCTs) have been described. The most widely used of these parameters is the critical shoulder angle (CSA) as measured via radiography. However, magnetic resonance imaging (MRI) measurements provide more accurate results than direct radiography.

Purpose:

To determine the relationship between anatomic shoulder parameters and RCT type via MRI scans.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

The data and physical examination notes of 389 patients were retrospectively analyzed, and 242 patients were included in the study. Patients were divided into 2 groups: those with RCT (n = 127) and those without RCT (control group; n = 115). Using suitable MRI sections, the CSA, lateral acromial angle, acromial index, superior glenoid inclination, acromion–greater tuberosity impingement index, and acromiohumeral distance were compared between the RCT and control groups. The correlation of these shoulder parameters with the presence of RCT was investigated, and the predictive value of each parameter was examined using receiver operating characteristic (ROC) analysis.

Results:

There were significant positive relationships between the presence of RCT and CSA, acromial index, acromion–greater tuberosity impingement index, and superior glenoid inclination, with the strongest correlation belonging to CSA ( r = 0.716). There were also significant negative relationships between presence of RCT and lateral acromial angle ( r = –0.510) and acromiohumeral distance ( r = –0.222). The ROC analysis revealed CSA to be the best predictor for the presence of RCT (area under the ROC curve = 0.899).

Conclusion:

The study outcomes showed that CSA as measured on MRI is the best predictor for determining the presence of RCTs. In patients with shoulder pain attributed to RCT, it may be helpful to examine the CSA on MRI.
Muscle Activity During Scapular Muscle Exercises With Multijoint Compound Movement: Analysis Using Fine-Wire and Surface Electrodes
Authors: Adachi Gen , Oshikawa Tomoki , Akuzawa Hiroshi , Kaneoka Koji
Published: November 2022

Background:

Improvements in motor control of the scapular muscles are important for the prevention and rehabilitation of shoulder and elbow injuries in overhead athletes.

Purpose:

To clarify scapular muscle activity during multijoint compound movement exercises using fine-wire and surface electrodes.

Study Design:

Descriptive laboratory study.

Methods:

Sixteen healthy men performed 5 types of exercises (cat and dog, trunk rotation, A-exercise, T-exercise, and Y-exercise). Muscle activity was measured as percentage of maximum voluntary isometric contraction (%MVIC) by using fine-wire electrodes in the rhomboid major (Rhom) and using surface electrodes in the upper (UT), middle (MT), and lower (LT) trapezius and serratus anterior (SA) muscles. The Rhom/UT, MT/UT, LT/UT, and SA/UT muscle activity ratios were calculated. One-way analysis of variance was used to compare the %MVIC and muscle activity ratios between exercises.

Results:

There was no significant difference in Rhom activity between the exercises (34.6-54.2%MVIC; P = .25). LT activity was significantly greater in the trunk rotation (58.0 ± 24.6%MVIC) and Y-exercise (63.2 ± 40.1%MVIC) than in the cat and dog scapular retraction (19.6 ± 9.3%MVIC) and A-exercise (28.2 ± 14.2%MVIC) ( P < .05). SA activity was significantly greater in the cat and dog scapular protraction (26.7 ± 11.0%MVIC) and Y-exercise (25.6 ± 19.3%MVIC) than in the other exercises ( P < .05). The SA/UT activity ratio in the cat and dog scapular protraction exercise (9.64 ± 8.48) was significantly higher than in the other exercises ( P < .05).

Conclusion:

All the exercises were effective for activating the Rhom. The trunk rotation and Y-exercise were effective for activating the LT, and the cat and dog scapular protraction exercise was effective for activating the SA while suppressing the UT.

Clinical Relevance:

These results enable exercise selection based on muscle activity characteristics (moderate [20%-50%MVIC] and high [>50%MVIC] levels contribute to muscle activation) to prevent and rehabilitate shoulder and elbow injuries.
Presence of Anemia and Its Severity is Associated with Worse Outcomes Following Open Reduction Internal Fixation of Ankle Fractures
Authors: Ortiz-Babilonia Carlos D. , Badin Daniel , Gupta Arjun , Aiyer Amiethab A.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Preoperative anemia has been associated with significant postoperative morbidity following various types of orthopaedic procedures. However, to our knowledge, there is no study assessing postoperative outcomes following open reduction internal fixation (ORIF) of ankle fractures with varying severity of anemia. The purpose of this study was to determine the influence of preoperative anemia severity on 30-day postoperative outcomes following ankle fracture ORIF.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program registry was queried from 2005 to 2019 for patients undergoing ankle fracture ORIF. Patients were stratified into 3 cohorts: non-anemic (hematocrit > 36% for women, >39% for men), mildly anemic (hematocrit 33%-36% for women, 33%-39% for men), and moderately to severely anemic (hematocrit <33% for both women and men) based on World Health Organization definitions. Patients with missing hematocrit data were excluded. Univariate analyses were utilized to assess differences in patient characteristics between cohorts. Multivariate logistic regressions controlling for differences between subgroups were performed to assess the effect of preoperative anemia on 30-day postoperative outcomes. Statistical significance was set at P<0.05.

Results:

In total, 22,413 patients that underwent ORIF for ankle fractures were included. Of these, 15,739 (70.22%) were not anemic, while 4,243 (18.93%) and 2,431 (10.85%) were mildly and moderately to severely anemic, respectively. Multivariate analysis revealed that mild preoperative anemia in patients undergoing ankle fracture ORIF was associated with higher odds of any adverse event (OR 1.62, P<0.001), superficial surgical site infections (SSIs) (OR 1.46, P=0.047), deep SSIs (OR 2.06, P=0.022), sepsis (OR 2.83, P=0.002), 30-day readmission (OR 1.61, P<0.001), and extended length of stay (LOS) (OR 1.56, P<0.001). Similarly, moderate to severe anemia in these patients was also associated with increased odds of any adverse event (OR 1.94, P<0.001), deep SSIs (OR 2.77, P=0.006), sepsis (OR 3.55, P=0.001), readmission (OR 2.07, P<0.001), and extended LOS (OR 2.21, P<0.001). In addition, moderate to severe anemia patients were associated with higher odds of unplanned reoperation (OR 2.31, P<0.001) and progressive renal insufficiency (OR 3.74, P=0.048).

Conclusion:

Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in patients undergoing ORIF for ankle fractures. This association seems to be dose dependent, as the odds of adverse events increases with increases in anemia severity. Medical optimization of patients with moderate to severe anemia should take precedence.
Statistical Shape Model-Based Tibiofibular Assessment of Syndesmotic Ankle Lesions using Weightbearing CT
Authors: Peiffer Matthias , Last Matthias , Burssens Arne , Mits Sophie De , Buedts Kristian , Victor Jan M. , Audenaert Emmanuel
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint alignment. These lesions, especially when subtle, present a deceitful diagnostic challenge. Current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Accurate diagnosis of syndesmotic lesions should involve 3D weightbearing osseous imaging in combination with - preferably automated- inclusion of patient-specific ligamentous information. Therefore, our aim is two-fold: (1) to construct a three-dimensional articulated statistical shape model of the normal distal tibiofibular joint with inclusion of ligamentous morphometry and (2) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data.

Methods:

Training data comprised non-weightbearing CT scans from asymptomatic controls (N= 76, Mean age 63 +/- 19 years), weightbearing CT scans from patients with syndesmotic ankle injury (N = 13, Mean Age 35 +/- 15 years) and their weightbearing healthy contralateral side (N = 13). CT scan segmentation was used to generate 3D bone models in the control and patient group. All ankles were aligned based on the tibia. Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization and compactness. The predicted ligament length in patients with syndesmotic lesions was compared to healthy controls by use of two-tailed Two- Sample student's t-test.

Results:

Our presented skeletal shape model described the training data with an accuracy of 0.23 +/- 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 +/- 0.12 mm. Mean length of the Anterior inferior tibiofibular ligament was 12.26 +- 1.89mm for the control cases, 12.32 +- 1.58 mm for the contralateral cases and 14.13 +- 1.48 mm for the cases with syndesmotic lesions. Statistically significant differences were found between the latter two (95% CI [ 0.323.29], p = 0.017) There was a significant correlation between presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001).

Conclusion:

Statistical shape modelling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmotic ankle lesions under weightbearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an 'anterior open-book injury' of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture (Figure 1).
Results of Minimally Invasive Distal Metatarsal Osteotomies (Dmmo) Limited to the 2nd and 3rd Rays: About 112 Cases
Authors: Piclet-Legre Barbara
Published: November 2022

Category:

Lesser Toes

Introduction/Purpose:

The objective of this study was to evaluate the clinical and radiological results of DMMO limited to the second and third rays in patients suffering from metatarsalgia with lesion of the plantar plate of the second ray associated with a hallux valgus. Our hypothesis was that this gesture allowed an improvement of the clinical and paraclinical symptoms

Methods:

For this retrospective, single-center, single-operator study, 112 patients (mean age 65.52 years, 91% women, 127 feet) operated between June 2015 and October 2020 were included based on the following criteria: metatarsalgia complicated by lesion of the plantar plate with hallux valgus. Secondary metatarsalgia, congenital malformation, pes cavus, Freiberg's disease, gastrocnemius retraction were excluded The surgery began with DMMOs of the 2nd and 3rd metatarsals, then a minimally invasive chevron osteotomy adjusted the length of the 1st metatarsal in relation to the lateral rays. The position of the toes was guided by a bandage for 2 weeks relayed by a molded orthoplasty for 4 weeks. Support was complete with a rigid flat shoe. At a mean follow-up of 3 years (14-80 months), the AOFAS functional score and radiographic measurements (Maestro criteria, bone consolidation) were evaluated.

Results:

The clinical improvement was significant with an AOFAS score going from 44.9 to 91.8 (p>0.05)We observed 8.7% of complications: 4 transfer metatarsalgia on the 4th or 5th metatarsal, 1 asymptomatic callus under M4, 1 asymptomatic nonunion of M2, 5 spontaneously resolving delayed consolidation, 1 algodystrophy.The radiographic improvement was significant on our morphotypes which were disharmonious in 92% with M45 hypoplasia in 76% and long M23 in 16%.Indeed, the DMMO limited to the 2nd and 3rd metatarsal allowed a significant reduction in the difference in length between the 3rd and 4th metatarsal (p>0.05)Our 4 cases of transfer metatarsalgia under M4 or under M5 were not explained radiologically by relative length anomaly.

Conclusion:

Performing DMMO limited to the 2nd and 3rd metatarsals appears to be a reliable solution in the management of metatarsalgia by lesion of the plantar plate associated with hallux valgus, the risk of transfer metatarsalgia was not increased compared to the data of literature.
Older Age is Not a Contraindication for Surgical Treatment of Closed Calcaneal Fractures using the Sinus Tarsi Approach
Authors: Reed Logan , Mihas Alexander K. , Andrews Nicholas A. , Wall Kevin , Agarwal Abhinav , Spitler Clay A. , Johnson Michael D.
Published: November 2022

Category:

Hindfoot; Trauma

Introduction/Purpose:

The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years; however, the literature surrounding early complications rates based on age differences for this specific approach is lacking. The objective of this study was to determine if rates of early complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of calcaneus fractures using the ST approach.

Methods:

A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria was based on an age greater than 18 years old, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative CT scan, and a minimum of 90 days follow-up. Patients were divided into two groups: those under the age of 50 and those over the age of 50. Measurement outcomes included wound dehiscence, superficial surgical site infection, deep infection, and implant removal.

Results:

A total of 175 patients (186 fractures) were included with 108 patients in the <50 age group and 86 patients in the >50 age group. Mean age was 34.8 and 58.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.3% vs. 1.9%, P=0.761), superficial surgical site infection (1.3% vs. 0.9%, P=0.816), and deep infection (5.1% vs. 4.6%, P=0.876) as compared to the younger group. Eleven (10.2%) fractures in <50 age group required implant removal compared to 13 (16.7%) fractures in the >50 age group (P=0.193). Postoperative Gissane and Bohler angles were not significantly differnet between the two groups.

Conclusion:

Calcaneal fractures can be debilitating injuries, especially in the older patient population. The present study found that patients with intraarticular calcaneus fractures treated via the ST approach maintain similar early complication rates as compared to younger individuals.
Reliability of Weight-Bearing Ultrasonography for Assessment of Sesamoid Position and Rotation: A Cadaveric Study
Authors: Saengsin Jirawat , Vaseenon Tanawat , Klongkaew Phatchaya , Kanthawang Thanat , Chalidapong Pawee
Published: November 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Ultrasonography is increasingly used to evaluate the stability of various joint in the field of foot and ankle. This study aims to assess sesamoid position and rotation under stimulated weight bearing condition compared to the standard weight-bearing imaging. All the measurements were assessed using ultrasonography, fluoroscopy, and direct gross measurement under weight-bearing condition. We hypothesize that there is a correlation between ultrasonographic and fluoroscopic position and rotation measurements, or between ultrasonographic and direct gross measurements.

Methods:

Fifteen fresh below-knee amputated cadaveric specimens were simulated with 600N force weight bearing condition. The data of sesamoid rotational and metatarsal rotation were measured under ultrasound (GE, LOGIQ E-9 ultrasound machine, Chicago, Illinois, USA), fluoroscopy, and direct measurement method. And also, joint congruity and grading of sesamoid position were subjectively evaluated under three methods by investigators. The set-up axis of rotation measuring was controlled by digital Halo machine. Correlations of the sesamoid and metatarsal rotation on each method were analyzed using Pearson's correlations. The agreement of joint congruity and grading of sesamoid position on each method were described.

Results:

A total of 15 feet from 15 cadavers were included to the study. The correlation of sesamoid and metatarsal rotation between ultrasonography and fluoroscopy were 0.78 and 0.58, respectively. The correlation of sesamoid and metatarsal rotation between ultrasonography and gross measurement were 0.88 and 0.74, respectively. The correlation of sesamoid and metatarsal rotation between fluoroscopy and gross measurement were 0.65 and 0.47, respectively. For joint congruity evaluation, there were 100% agreement between fluoroscopy and gross measurement and 93.3% agreement between ultrasonography and gross measurement. For sesamoid position, there was 7% agreement between ultrasonography and fluoroscopy. Inter- and intra- observer reliability between the MSK radiologist and the foot-ankle surgeon were substantial.

Conclusion:

Weight-bearing ultrasonography is ability to assess the grading of sesamoid and metatarsal rotation including joint congruity assessment when compared with fluoroscopy. However, the sesamoid position could not be evaluated by ultrasonography. The benefits of non-radiation hazard and mobile device usage could allow investigator to easily evaluate deformity in the clinic.
Return to Play after High Ankle Sprains in Athletes: A Systematic Review and Meta-Analysis
Authors: Salameh Motasem , Blankenhorn Brad D.
Published: November 2022

Category:

Sports

Introduction/Purpose:

Syndesmotic ankle sprains, or high ankle sprains, are a challenging lower extremity injury, especially among high level athletes. The management of such injuries is still controversial, with a paucity of evidence on treatment protocols and unpredictability regarding the time lost to participate in sports following injury. Full recovery and return to play for syndesmotic injuries has been reported to require more than twice the time compared to standard, lateral ankle sprains The goal of this systematic review and meta-analysis was to provide orthopedic surgeons with the most updated evidence on high ankle sprains in athletes. Our primary objective was to report updated prevalence and time to return to play (RTP) after surgical or non-surgical management of syndesmotic injuries.

Methods:

A meta-analysis and systematic review of the literature was performed with adherence to the preferred reporting items for systematic reviews and meta analyses (PRISMA) guidelines. PubMed, Cochrane Library, and Google Scholar were queried in August 2021 for case series, cohorts, and randomized controlled trials that evaluated return to play time after ankle syndesmotic sprains. The primary outcome was the injury prevalence and time to RTP. Secondary outcomes were complications, functional outcomes, as well as recurrent injuries and reoperations after the initial management of an ankle syndesmotic sprain with no associated ankle fracture. To assess risk of bias, the Joanna Briggs institute critical appraisal tool was used for case series, the Newcastle Ottawa scale for comparetive studies and Rob2 for randomized clinical trials.

Results:

18 articles were eligible for meta-analysis with a total of 1133 syndesmotic sprains. Four studies managed their patients with surgical intervention, nine articles reported non-surgical management, and three articles used both surgical and non-surgical methods. Two studies did not specify management method. The overall RTP was 99% (95% CI 0.96, 1.00), the overall mean RTP was 52.32 days (95% CI 39.01, 65.63). Pooled RTP for surgically treated patients was 70.94 days (95% CI 47.04, 94.85, while it was 39.33 days (95% CI 28.78, 49.88) for non-surgically treated cases. A low incidence of recurrence and complications were reported. Moreover platelet rich plasma injection was found to decrease the time needed to return to play in atheletes with high grade syndesmotic injuries.

Conclusion:

This systematic review and meta-analysis showed high rates of return to play after syndesmotic sprains in professional athletes regardless of surgical vs non-surgical treatment with surgically treated athletes needing more time to return to play compared to those treated non-surgically. Platelet rich plasma injections are safe and may improve time to RTP. Future comparative studies with larger sample size and subanalyis of grade of syndesmotic injury are required for better assessment of outcomes and complications.
Cystoid Macular Edema Arising 10 Years After Cessation of Pentosan Polysulfate Sodium Successfully Treated With Bevacizumab
Authors: Szelog Jason T. , Shah Neil S. , Camejo M. David
Published: November 2022

Purpose:

To describe a patient initially diagnosed with age-related macular degeneration (AMD) who was ultimately determined to have progressing pentosan polysulfate sodium (PPS)–associated maculopathy leading to secondary cystoid macular edema (CME) 10 years after cessation of PPS.

Methods:

An interventional case report is presented.

Results:

A 57-year-old woman diagnosed with AMD presented with unilateral worsening vision and metamorphopsia from CME. A detailed history showed a 3-year course of PPS, which had been discontinued 10 years previously. This led to the diagnosis of PPS-associated maculopathy. After topical NSAID and corticosteroid treatment failed, intravitreal bevacizumab resolved the symptoms. CME developed in the fellow eye 5 months later and also responded to bevacizumab.

Conclusions:

This case emphasizes the importance of a thorough review of past medication and medical histories in patients with pigmentary retinopathy and supports the use of antivascular endothelial growth factor therapy as an option to treat CME secondary to PPS-associated maculopathy.
Minimal residual disease in patients with diffuse large B-cell lymphoma undergoing autologous stem cell transplantation
Authors: Merryman Reid W. , Redd Robert A. , Taranto Eleanor , Ahmed Gulrayz , Jeter Erin , McHugh Kristin M. , Brown Jennifer R. , Crombie Jennifer L. , Davids Matthew S. , Fisher David C. , Freedman Arnold S. , Jacobsen Eric , Jacobson Caron A. , Kim Austin I. , LaCasce Ann S. , Ng Samuel Y. , Odejide Oreofe O. , Parry Erin M. , Jacene Heather , Park Hyesun , Dahi Parastoo B. , Nieto Yago , Joyce Robin M. , Chen Yi-Bin , Shipp Margaret A. , Herrera Alex F. , Armand Philippe
Published: November 2022

Improved biomarkers are required to guide the optimal use of autologous stem cell transplantation (ASCT) in patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL). We hypothesized that minimal residual disease (MRD) identified using immunoglobulin high-throughput sequencing in apheresis stem cell (ASC) samples, post-ASCT peripheral blood mononuclear cell (PBMC), and plasma samples could predict relapse. We studied 159 patients with R/R DLBCL who underwent ASCT, of whom 98 had an ASC sample and 60 had post-ASCT surveillance samples. After a median post-ASCT follow-up of 60 months, the 5-year progression-free survival (PFS) was 48%. MRD was detected in of 23/98 (23%) ASC samples and was associated with very poor PFS (5-year PFS 13% vs 53%, P < .001) and inferior overall survival (52% vs 68%, P = .05). The sensitivity and specificity of ASC MRD positivity for progression and death were 36% and 93%, respectively. Positive ASC MRD remained a significant predictor of PFS in multivariable analysis (hazard ratio [HR], 3.7; P < .001). Post-ASCT surveillance MRD testing of plasma, but not PBMC samples, reliably identified patients with an impending relapse. A positive plasma MRD result was associated with inferior PFS (HR, 3.0; P = .016) in a multivariable analysis. The median lead time from MRD detection to relapse was 62 days (range, 0-518 days). In conclusion, the detection of MRD in ASC samples is associated with a very high risk of relapse, justifying alternative treatment strategies or trials of novel consolidation options in these patients. Furthermore, post-ASCT MRD monitoring may facilitate the evaluation of the early initiation of treatment at molecular relapse. This trial has been registered at www.clinicaltrials.gov as #NCT02362997.
Spatiotemporal gait parameters in young individuals wearing an age simulation suit compared to healthy older individuals
Authors: Laurentius Thea , Quandel Johannes , Bollheimer Leo Cornelius , Leonhardt Steffen , Ngo Chuong , Lüken Markus
Published: November 2022

Introduction

Aging is accompanied by changes in muscle mass, strength and loss of sensory, visual and auditive functions. However, these changes do not occur linearly, most spatiotemporal gait parameters change with aging. Age simulation suits have been invented to give young people an impression of the implications of being older and may be a useful tool in the scientific setting for gerontology research to validate any study concept before it becomes a pilot study. The rationale behind this study was to investigate the effects of an age simulation suit on gait parameters in young healthy adults and to compare the altered gait with healthy older, community-dwelling citizens.

Methods

Subjects were 14 healthy young adults (6 female) and 8 healthy older (4 female) individuals with a mean (± SD) age of 24.8 ± 3.4 years and 72 ± 1.9 years, respectively. After initial baseline measurements had been taken and a familiarization phase, the younger subjects walked for 15 min without and 15 min with an age simulation suit on an instrumented treadmill. The older subjects walked once for 15 min on the same treadmill without wearing an age simulation suit. The walking speed was self-selected for all subjects.

Results

The age simulation suit reduced the walking speed from 4.1 ± 0.7 km/h to 3.3 ± 0.5 km/h (p < 0.001) in young adults with no differences compared to older adults (2.9 ± 0.6 km/h, p = 0.9). Step width increased from 8.7 ± 2.2 cm to 12.1 ± 2.2 cm (p < 0.001) and did not differ from older participants (11.1 ± 4.3 cm, p = 0.37). The stride length was reduced (132.6 ± 5.9 cm vs 118.1 +—6.6 cm, p < 0.001), but still did not match the old control group (94.5 ± 5.6 cm, p < 0.05). Wearing the suit increased thestride time of young subjects (from 1,152 to 1,316 ms, p < 0.001) and was different compared to the older control group (1,172 ms, p = 0.53). The coefficient of variation (COV) of spatiotemporal parameters did not differ between young (both not wearing the suit and wearing the suit) and older subjects. The standard deviation of lateral symmetry, an in-house marker from the instrumented treadmill that serves as a marker of gait variability, differed between young subjects without the suit and older subjects (5.89 ± 1.9 mm vs 14.6 ± 5.7 mm, p < 0.001) but not between young subjects wearing the suit and older subjects (16.4 ± 7.4 mm vs 14.6 ± 5.7 mm, p = 0.53).

Conclusion

Wearing an age simulation suit while walking on a treadmill with a self-selected walking speed alters some, but not all, measured spatiotemporal parameters to approximate a gait pattern similar to that of an older individual.
Acquired drug resistance interferes with the susceptibility of prostate cancer cells to metabolic stress
Authors: Catapano Jessica , Luty Marcin , Wróbel Tomasz , Pudełek Maciej , Piwowarczyk Katarzyna , Kędracka-Krok Sylwia , Siedlar Maciej , Madeja Zbigniew , Czyż Jarosław
Published: November 2022

Background

Metformin is an inhibitor of oxidative phosphorylation that displays an array of anticancer activities. The interference of metformin with the activity of multi-drug resistance systems in cancer cells has been reported. However, the consequences of the acquired chemoresistance for the adaptative responses of cancer cells to metformin-induced stress and for their phenotypic evolution remain unaddressed.

Methods

Using a range of phenotypic and metabolic assays, we assessed the sensitivity of human prostate cancer PC-3 and DU145 cells, and their drug-resistant lineages (PC-3_DCX20 and DU145_DCX20), to combined docetaxel/metformin stress. Their adaptation responses have been assessed, in particular the shifts in their metabolic profile and invasiveness.

Results

Metformin increased the sensitivity of PC-3 wild-type (WT) cells to docetaxel, as illustrated by the attenuation of their motility, proliferation, and viability after the combined drug application. These effects correlated with the accumulation of energy carriers (NAD(P)H and ATP) and with the inactivation of ABC drug transporters in docetaxel/metformin-treated PC-3 WT cells. Both PC-3 WT and PC-3_DCX20 reacted to metformin with the Warburg effect; however, PC-3_DCX20 cells were considerably less susceptible to the cytostatic/misbalancing effects of metformin. Concomitantly, an epithelial–mesenchymal transition and Cx43 upregulation was seen in these cells, but not in other more docetaxel/metformin-sensitive DU145_DCX20 populations. Stronger cytostatic effects of the combined fenofibrate/docetaxel treatment confirmed that the fine-tuning of the balance between energy supply and expenditure determines cellular welfare under metabolic stress.

Conclusions

Collectively, our data identify the mechanisms that underlie the limited potential of metformin for the chemotherapy of drug-resistant tumors. Metformin can enhance the sensitivity of cancer cells to chemotherapy by inducing their metabolic decoupling/imbalance. However, the acquired chemoresistance of cancer cells impairs this effect, facilitates cellular adaptation to metabolic stress, and prompts the invasive front formation.
Ultra-confined Propagating Exciton–Plasmon Polaritons Enabled by Cavity-Free Strong Coupling: Beating Plasmonic Trade-Offs
Authors: Wang Yipei , Luo Aoning , Zhu Chunyan , Li Zhiyong , Wu Xiaoqin
Published: November 2022

Hybrid coupling systems consisting of transition metal dichalcogenides (TMD) and plasmonic nanostructures have emerged as a promising platform to explore exciton–plasmon polaritons. However, the requisite cavity/resonator for strong coupling introduces extra complexities and challenges for waveguiding applications. Alternatively, plasmonic nano-waveguides can also be utilized to provide a non-resonant approach for strong coupling, while their utility is limited by the plasmonic confinement-loss and confinement-momentum trade-offs. Here, based on a cavity-free approach, we overcome these constraints by theoretically strong coupling of a monolayer TMD to a single metal nanowire, generating ultra-confined propagating exciton–plasmon polaritons (PEPPs) that beat the plasmonic trade-offs. By leveraging strong-coupling-induced reformations in energy distribution and combining favorable properties of surface plasmon polaritons (SPPs) and excitons, the generated PEPPs feature ultra-deep subwavelength confinement (down to 1-nm level with mode areas ~ 10–4 of λ2), long propagation length (up to ~ 60 µm), tunable dispersion with versatile mode characters (SPP- and exciton-like mode characters), and small momentum mismatch to free-space photons. With the capability to overcome the trade-offs of SPPs and the compatibility for waveguiding applications, our theoretical results suggest an attractive guided-wave platform to manipulate exciton–plasmon interactions at the ultra-deep subwavelength scale, opening new horizons for waveguiding nano-polaritonic components and devices.