bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalência de aleitamento materno e fatores associados no município de Londrina-PR
Authors: Souza Sarah Nancy Deggau Hegeto de , Migoto Michelle Thais , Rossetto Edilaine Giovanini , Mello Debora Falleiros de
Published: March 2012

OBJETIVO: Descrever a prevalência do aleitamento materno e fatores associados no município de Londrina-PR. MÉTODOS: Estudo quantitativo, descritivo, entrevistando 770 acompanhantes de crianças menores de 12 meses, durante a campanha de vacinação antipoliomielite, em agosto de 2008. RESULTADOS: Na primeira hora, foram amamentadas 72,5% das crianças; 33,8% estavam em aleitamento materno exclusivo de zero a seis meses, no quarto mês, 53,7% e no sexto mês 7,8%; 51,5% em aleitamento materno continuado entre 9 e 12 meses. As mulheres que mais amamentaram tinham idade igual ou superior a 35 anos, escolaridade de terceiro grau, mais de um filho e estavam em licença-maternidade. CONCLUSÃO: os índices de aleitamento materno do município apresentaram evolução, porém faz-se necessário analisar as ações nos serviços de saúde para melhora desses índices.
Canto Gregoriano: redutor de ansiedade de mães com filhos hospitalizados
Authors: Almeida Ana Paula , Silva Maria Júlia Paes da
Published: March 2012

OBJETIVO: Verificar a presença de alteração do estado de ansiedade das mães de crianças hospitalizadas com a audição de canto Gregoriano. MÉTODOS: Pesquisa descritiva, exploratória, correlacional com análise quantitativa, quase experimental. A coleta dos dados foi realizada no período de julho de 2009 a fevereiro de 2010. A amostra inicial foi de 71 mães e destas 28 concluíram todas as etapas da pesquisa. RESULTADOS: O uso do canto Gregoriano diminuiu o estado de ansiedade das mães de crianças hospitalizadas em um hospital pediátrico de atenção quaternária acomodadas em quartos individuais. CONCLUSÃO: É necessário investigar os possíveis efeitos do canto Gregoriano em outros ambientes do hospital e em outras formas de acomodação do cliente.
Gravidez na adolescência: percepções das mães de gestantes jovens
Authors: Fernandes Amanda de Oliveira , Santos Júnior Hudson Pires de Oliveira , Gualda Dulce Maria Rosa
Published: March 2012

OBJETIVO: Conhecer as experiências e percepções de mães cujas filhas engravidaram durante a adolescência. MÉTODOS: Pesquisa de abordagem qualitativa, realizada em hospital de ensino na cidade de São Paulo, com coleta de dados realizada por meio de roteiro de entrevista semiestruturada e com participação de dez mães de adolescentes. RESULTADOS: Antes da gravidez, as mães orientaram as filhas a respeito da sexualidade, o que originou sentimentos de surpresa quando souberam da gravidez. Apesar disso, as mães fizeram-se presentes em todo o processo gravídicopuerperal. Não foram identificadas mudanças significativas no relacionamento familiar em função da gravidez precoce. CONCLUSÃO: A figura materna surge como representativa, tanto durante como após a gestação da adolescente, fato que propicia o suporte, a fim de que a adolescente tenha gestação mais segura e para que possa retomar seus projetos de vida.
Preditores da Síndrome de Burnout em enfermeiros de serviços de urgência pré-hospitalar
Authors: França Salomão Patrício de Souza , De Martino Milva Maria Figueiredo , Aniceto Edna Verissimo dos Santos , Silva Lemoel Leandro
Published: March 2012

OBJETIVO: Analisar os preditores da Síndrome de Burnout apresentados por enfermeiros de serviços de urgência pré-hospitalar móvel. MÉTODOS: Estudo descritivo, exploratório, quantitativo com 38 enfermeiros. Utilizou-se questionário estruturado acrescido do Maslach Burnout Inventory em setembro de 2010. Na análise dos dados, foram usadas técnicas de estatística descritiva e inferencial (teste t-Student e teste F (ANOVA)). A verificação da hipótese de igualdade foi realizada pelo teste F de Levene e a de normalidade pelo teste de Shapiro-Wilk. RESULTADOS: A variabilidade expressa pelo coeficiente de variação não se mostrou elevada, desde que a referida medida foi, no máximo, igual a 33,17. CONCLUSÃO: Não houve diferença estatisticamente significante entre as variáveis estudadas e as dimensões sintomatológicas da Síndrome de Burnout. A Síndrome pode estar mais relacionada com fatores organizacionais do trabalho do que com o tipo de atividade desenvolvida pelos profissionais ou de achados sociodemográficos.
Depressão em idosos inscritos no Programa de Controle de hipertensão arterial e diabetes mellitus
Authors: Sass Arethuza , Gravena Angela Andréia França , Pilger Calíope , Mathias Thais Aidar de Freitas , Marcon Sonia Silva
Published: March 2012

OBJETIVO: Identificar a presença de sintomas depressivos em idosos inscritos no Programa de controle de hipertensão arterial e diabetes mellitus em um município do Noroeste do Paraná. MÉTODOS: Estudo descritivo transversal, realizado nas unidades básicas de saúde de Sarandi - PR, com 100 idosos cadastrados no Programa Hiperdia. A seção de saúde mental do questionário Brazil Old Age Schedule (BOAS) foi usada. Os testes Mann-Whitney e Qui-quadrado foram empregados para analisar a associação entre sintomas de depressão e características sociodemográficas e estado nutricional. RESULTADOS: A maioria dos idosos era do sexo feminino (82,0%). A prevalência de sintomas depressivos foi de 30,0%, dos quais 20,0% classificados como depressão maior. Os sintomas depressivos foram mais frequentes nas mulheres (31,7%); em idosos com 80 anos e mais (33,3%); sem nenhuma escolaridade (39,1%), que moravam só (43,7%) e que apresentavam baixo peso (33,3%) ou obesidade (32,5%). CONCLUSÃO: As equipes da estratégia saúde da família devem estar atentas para a presença de sintomas depressivos em idosos, sobretudo aqueles que pertencem aos grupos de convivência já instalados.
(In) Segurança alimentar em familias de pré-escolares de uma zona rural do Ceará
Authors: Aires Julliana dos Santos , Martins Mariana Cavalcante , Joventino Emanuella Silva , Ximenes Lorena Barbosa
Published: March 2012

OBJETIVOS: Detectar a prevalência da (in) segurança alimentar entre as famílias residentes na zona rural de Maranguape e verificar a associação entre as variáveis socioeconômicas e o grau de (in) segurança alimentar. MÉTODOS: Estudo descritivo, com abordagem quantitativa, realizado no Centro de Saúde da Família (CSF) na zona rural de Maranguape-Ceará em setembro de 2009. A amostra constituiu-se de 200 famílias com crianças pré-escolares atendidas no CSF, sendo aplicada a Escala Brasileira de Insegurança Alimentar (EBIA). RESULTADOS: Das famílias, 12% apresentaram segurança alimentar e 88% insegurança alimentar. Constatou-se associação estatisticamente significante entre a prevalência da (in) segurança alimentar e a escolaridade do responsável (p<0,0001), número de moradores no domicílio (p=0,018) e renda familiar (p<0,0001). CONCLUSÃO: Com a aplicação da EBIA, pôde-se diagnosticar a (in) segurança alimentar, o que possibilita ao enfermeiro propor ações de educação em saúde, visando a melhorar os cuidados relativos à alimentação.
Avaliação de website sobre assistência de enfermagem na sala de recuperação pós-anestésica
Authors: Lins Thaís Honório , Marin Heimar de Fátima
Published: March 2012

OBJETIVOS: Desenvolver um website sobre a assistência de enfermagem em sala de recuperação pós-anestésica e avaliar o conteúdo, apresentação e atualização das informações. MÉODOS: Foi utilizada metodologia de Clement Mok, DADI, composta por definição, arquitetura, design e implementação. A avaliação do website foi realizada por enfermeiros por meio de um questionário contendo itens sobre autoridade, conteúdo geral, apresentação e confiabilidade das informações. Para a análise dos dados, foi utilizada a estatística descritiva. RESULTADOS: Os resultados foram satisfatórios, tendo como aprovação de 99,67%. Comprovou-se que a construção e disponibilização de informações sobre a temática referida no website são confiáveis e válidas. CONCLUSÃO: A importância e a relevância da World Wide Web para a transmissão de informações, em especial, para a enfermagem permitem uma aproximação do conhecimento científico à prática de atualização e de troca de experiências, independente da localização geográfica.
Adaptação e validação do Cardiac Patients Learnings Needs Inventory para pacientes brasileiros
Authors: Galdeano Luzia Elaine , Rossi Lídia Aparecida , Dantas Rosana Aparecida Spadoti , Rodrigues Manuel Alves , Furuya Rejane Kiyomi
Published: March 2012

OBJETIVOS: Adaptar culturalmente o Cardiac Patients'Leaning Needs Inventory para uso no Brasil e testar sua confiabilidade (consistência interna e estabilidade) em pacientes brasileiros com doença arterial coronariana. MÉTODOS: Participaram do estudo 65 pacientes com infarto agudo do miocárdio, internados em um hospital público do interior do Estado de São Paulo. Para a coleta dos dados, foram utilizados um instrumento para caracterização sociodemográfica e a versão em português do Cardiac Patients Leaning Needs Inventory. A consistência interna foi estimada com base no alfa de Cronbach. A estabilidade foi medida apoiada no teste-reteste e calculada pelo teste t de Student. O nível de significância adotado foi 0,05. RESULTADOS: Identificou-se consistência interna alta (0,96 na primeira medida e 0,78 na segunda). O domínio que apresentou melhor consistência interna foi Fatores de Risco (α= 0,91). CONCLUSÃO: A versão adaptada manteve as equivalências conceituais, semânticas e idiomáticas da versão original e apresentou confiabilidade e estabilidade adequadas.
A Pharmacodynamic Study of the P-glycoprotein Antagonist CBT-1® in Combination With Paclitaxel in Solid Tumors
Authors: Kelly Ronan J. , Robey Robert W. , Chen Clara C. , Draper Deborah , Luchenko Victoria , Barnett Daryl , Oldham Robert K. , Caluag Zinnah , Frye A. Robin , Steinberg Seth M. , Fojo Tito , Bates Susan E.
Published: March 2012

Background.

This pharmacodynamic trial evaluated the effect of CBT-1® on efflux by the ATP binding cassette (ABC) multidrug transporter P-glycoprotein (Pgp/MDR1/ABCB1) in normal human cells and tissues. CBT-1® is an orally administered bisbenzylisoquinoline Pgp inhibitor being evaluated clinically. Laboratory studies showed potent and durable inhibition of Pgp, and in phase I studies CBT-1® did not alter the pharmacokinetics of paclitaxel or doxorubicin.

Methods.

CBT-1® was dosed at 500 mg/m2 for 7 days; a 3-hour infusion of paclitaxel at 135 mg/m2 was administered on day 6. Peripheral blood mononuclear cells (PBMCs) were obtained prior to CBT-1® administration and on day 6 prior to the paclitaxel infusion. 99mTc-sestamibi imaging was performed on the same schedule. The area under the concentration–time curve from 0–3 hours (AUC0-3) was determined for 99mTc-sestamibi.

Results.

Twelve patients were planned and enrolled. Toxicities were minimal and related to paclitaxel (grade 3 or 4 neutropenia in 18% of cycles). Rhodamine efflux from CD56+ PBMCs was a statistically significant 51%–100% lower (p < .0001) with CBT-1®. Among 10 patients who completed imaging, the 99mTc-sestamibi AUC0-3 for liver (normalized to the AUC0-3 of the heart) increased from 34.7% to 100.8% (median, 71.9%; p < .0001) after CBT-1® administration. Lung uptake was not changed.

Conclusion.

CBT-1® is able to inhibit Pgp-mediated efflux from PBMCs and normal liver to a degree observed with Pgp inhibitors studied in earlier clinical trials. Combined with its ease of administration and lack of toxicity, the data showing inhibition of normal tissue Pgp support further studies with CBT-1® to evaluate its ability to modulate drug uptake in tumor tissue.
Variable cost of prey defense and coevolution in predator–prey systems
Authors: Tien Rebecca J. , Ellner Stephen P.
Published: March 2012

Predation acts as a selective pressure, driving prey adaptation. Predators can also evolve counter‐defenses to increase the likelihood of successful attack. Investment in either trait can be costly, leading to a trade‐off between the traits and other fitness components. Costs for defense have been shown experimentally to depend on environmental factors such as resource availability. This suggests that costs can increase with population size, rather than remaining constant as models often assume. Using a quantitative trait model with predator–prey coevolution, we investigate how both population and trait dynamics are affected by density‐dependent prey defense cost (“variable cost”) vs. density‐independent cost (“fixed cost”). We assume predator counter‐defense cost is always density independent. We also investigate the effect of relative speeds of prey and predator evolution on population and trait dynamics, by varying a parameter that determines each population's additive genetic variance. For both models, increasing the speed of predator evolution always has a stabilizing effect on the dynamics, while increasing the speed of prey evolution (within a biologically reasonable range) is largely destabilizing. Within the plausible range of prey evolution speed, variable cost of prey defense is more stabilizing than fixed cost. Our results suggest that density‐dependent costs of defense can have important effects on predator–prey dynamics, even when evolution is relatively slow. Our results might also help to explain why many real populations do not display predator–prey cycles.
Encountering Culture through Gender Norms in International Education: The Case of Volunteers in Ecuador
Authors: McGivern Martha
Published: March 2012

Demonstrating how international education programs can be used to study theoretical issues relevant to comparative education, this article reports on a scholarly analysis of 83 handover letters written by US participants in a volunteer program in Ecuador to their incoming counterparts between 2006 and 2010. It applies Swidler's notion of ‘unsettled lives' to the comparativists' framework of undoing gender and argues that focused on cultural differences, participants are able to see gender inequality in a way they cannot at home. This increased gender consciousness is a key component in undoing gender. These programs stop short, however, of providing opportunities for less gendered or more equal social interaction.
Student Mobility and Internationalization: Trends and Tribulations
Authors: Knight Jane
Published: March 2012

There is no question that internationalization, and particularly international student mobility, has transformed the higher education landscape in the last decade. It has brought diverse benefits to students, institutions, communities and countries. But there are unanticipated outcomes and risks as well. The purpose of this article is look at the complexities and current trends of student mobility and to invite reflection on some of the new developments and unintended consequences. These include granting and recognition of academic credentials; diploma and accreditation mills; collaborative programs such as joint or double degree programs and twinning and franchise arrangements; the great brain race and its implications for brain gain, brain drain, and brain train; the competitiveness agenda; status building and world rankings; regional identity and global citizenship. These macro issues often become an implicit part of the culture or environment of international education without being questioned. Focusing on some worrisome trends and outcomes of new developments in student mobility and internationalization does not deny the multitude of positive results; it is only an attempt to encourage a 360–degree look at the current state of student mobility and to encourage more research and reflection on some important trends and unexpected results.
Graduate Student Training and the Reluctant Internationalism of Social Science in the USA
Authors: Miller-Idriss Cynthia , Shami Seteney
Published: March 2012

In the US academy, there is significant disciplinary variation in the extent to which graduate students are encouraged to or discouraged from studying abroad and doing fieldwork overseas. This article examines this issue, focusing on US graduate training in the social sciences and the extent to which students are discouraged from developing international expertise. Data is drawn from a mixed-methods study conducted from 2005–2010 by the Social Science Research Council and funded by the US Department of Education's International Research and Studies Program. This article argues that key cultural dynamics in the nomothetic social science disciplines in the USA steer graduate students away from contextual international study and thus work against university internationalization efforts more broadly. Scholars of comparative and international education need to be aware of these kinds of disciplinary cultural dynamics in order to fully understand how university internationalization efforts succeed or fail.
Are Sojourners Natural Comparativists? Critical Perspectives on the Learning Experiences of International Students
Authors: Schweisfurth Michele
Published: March 2012

Students who spend a period of time studying outside of their own national systems have a number of advantages in terms of developing a comparative perspective on education. The experience of living and studying abroad provides them with the opportunity to act as participant observers of at least two different systems, and the natural juxtaposition of these experiences should, in theory, help these individuals to better understand their own and the other education systems. This article uses a number of sources to interrogate this assumption. It draws on findings from research conducted by the author and colleagues on international students in the United Kingdom, in order to explore the potential and limitations of a period of international study in informing a learner's comparative perspective. While such students evidently adopt a comparative discourse in discussing their experiences, questions are raised about the validity and depth of these understandings.
Some Conceptual Tensions in Financial Reporting
Authors: Biondi Yuri , Glover Jonathan , Jamal Karim , Ohlson James A. , Penman Stephen H. , Sunder Shyam , Tsujiyama Eiko
Published: March 2012

SYNOPSIS

We examine four key conceptual tensions that are at the heart of many financial reporting dilemmas: stocks versus flows, ex ante versus ex post, conventions versus economic substance, and top-down design versus bottom-up evolution as sources of accounting practice. Associated with each of these conceptual dimensions is an accounting duality; in some cases, one side (e.g., stocks) is easier to measure in a reliable manner, while the other side (e.g., flows) is easier to measure in other instances. We suggest that financial reporting would benefit from a willingness to pay attention to, and find compromise between, both sides of these tensions; forcing a choice of one over the other does not serve to improve financial reporting.

JEL Classification: M40.
Bladder Diverticulum: Clinicopathologic Spectrum in Pediatric Patients
Authors: Alexander Riley E. , Kum Jennifer B. , Idrees Muhammad
Published: March 2012

Urinary bladder diverticula are a relatively rare finding in both the adult and pediatric population. Their presence in the adult population has long been associated with the development of urothelial carcinoma within the lesion. Our goal is to analyze a relatively large pediatric patient population with urinary bladder diverticula to expand the body of knowledge on the associated clinical symptomatology, congenital syndromes associated with the entity, and treatment methods and to further investigate if there is any reason to suspect malignant transformation within the pediatric population. A search for pediatric patients (0–19 years of age) from 1990 to 2011 revealed 47 patients with 60 diverticula within the specified age range. Clinical records and histologic slides for all cases were pulled for review, and statistical analysis was performed on the results. The most common findings were vesicoureteral reflux (68%), recurrent urinary tract infection (55%), and hydronephrosis (40%). Fourteen of 47 (30%) patients had an associated congenital syndrome/malformation. Diverticular size range was 0.5–10 cm with a mean of 2.56 cm. No patient was found to have overt malignancy or dysplastic changes within the diverticula or bladder at the time of pathologic evaluation. High association with recognizable clinical symptoms and additional urinary tract abnormalities leads to early identification and treatment. A sizable percentage of those found to have bladder diverticula within the pediatric population will have a congenital syndrome. No association with malignancy is seen within pediatric bladder diverticula; it is an extremely unlikely event in these young patients.
Load Response of the Tarsal Bones in Patients with Flatfoot Deformity: In Vivo 3D Study
Authors: Kido Masamitsu , Ikoma Kazuya , Imai Kan , Maki Masahiro , Takatori Ryota , Tokunaga Daisaku , Inoue Nozomu , Kubo Toshikazu
Published: March 2012

Background:

The objective of this study was to evaluate the bone rotation of each joint in the hindfoot and compare the load response in healthy feet with that in flatfeet by analyzing the reconstructive three-dimensional (3D) CT image data during weightbearing.

Methods:

CT scans of 21 healthy feet and 21 feet with flatfoot deformity were taken in non-load condition followed by full-body weightbearing load condition. The images of the hindfoot bones were reconstructed into 3D models. The volume merge method in three planes was used to calculate the position of the talus relative to the tibia in the tibiotalar joint, the navicular relative to the talus in talonavicular joint, and the calcaneus relative to the talus in the talocalcaneal joint.

Results:

The talar position difference to the load response relative to the tibia in the tibiotalar joint in a flatfoot was 1.7 degrees more plantarflexed in comparison to that in a healthy foot ( p = 0.031). The navicular position difference to the load response relative to the talus in the talonavicular joint was 2.3 degrees more everted ( p = 0.0034). The calcaneal position difference to the load response relative to the talus in the talocalcaneal joint was 1.1 degrees more dorsiflexed ( p = 0.0060) and 1.7 degrees more everted ( p = 0.0018).

Conclusion:

Referring to previous cadaver study, regarding not only the cadaveric foot, but also the live foot, joint instability occurred in the hindfoot with load in patients with flatfoot.

Clinical Relevance:

The method used in this study might be applied to clinical analysis of foot diseases such as the staging of flatfoot and to biomechanical analysis to evaluate the effects of foot surgery in the future. Level of Evidence: III
Classification and Treatment of Supramalleolar Deformities
Authors: Knupp Markus , Stufkens Sjoerd A.S. , Bolliger Lilianna , Barg Alexej , Hintermann Beat
Published: March 2012

Background:

Supramalleolar osteotomies are increasingly popular for addressing asymmetric arthritis of the ankle joint. Still, recommendations for the indication and the use of additional procedures remain arbitrary. We preoperatively grouped different types of asymmetric arthritis into several classes and assessed the usefulness of an algorithm based on these classifications for determining the choice of supramalleolar operative procedure and the risk factors for treatment failure.

Methods:

Ninety-two patients (94 ankles) were followed prospectively and assessed clinically and radiographically 43 months after a supramalleolar osteotomy for asymmetric arthritis of the ankle joint.

Results:

Significant improvement of the clinical scores was found. Postoperative reduction of radiological signs of arthritis was observed in mid-stage arthritis. Age and gender did not affect the outcome. Ten ankles failed to respond to the treatment and were converted to total ankle replacements or fused.

Conclusions:

Supramalleolar osteotomies can be effective for the treatment of early and midstage asymmetric arthritis of the ankle joint. However, certain subgroups have a tendency towards a worse outcome and may require additional surgery. Therefore preoperative distinction of different subgroups is helpful for determination of additional procedures. Level of Evidence: II, Prospective Comparative Study
Complications of Syndesmotic Screw Removal
Authors: Schepers Tim , Van Lieshout Esther M.M. , de Vries Mark R. , Van der Elst Maarten
Published: March 2012

Background:

Currently, the metallic syndesmotic screw is the gold standard in the treatment of syndesmotic disruption. Whether or not this screw needs to be removed remains debatable. The aim of the current study was to determine the complications which occur following routine removal of the syndesmotic screw following operative treatment of unstable ankle fractures.

Methods:

This was a retrospective study with consecutive cases in a Level-2 Trauma center. All patients with routine removal of a syndesmotic screw, following the treatment of an unstable ankle fracture, between January 1, 2004 and November 30, 2010 were included. Complications recorded were: 1) minor or major wound infection following removal of the syndesmotic screw, 2) recurrent syndesmotic diastasis, and 3) unnecessary removal of a broken screw, not recognized during preoperative planning prior to surgery.

Results:

A total of 76 patients were included. A wound infection occurred in 9.2% (N=7) of which 2.6% (N=2) were deep infections requiring reoperation. Recurrent syndesmotic diastasis was found in 6.6% (N=5) of patients, and in 6.6% (N=5) screws were broken at the time of implant removal. In the group with recurrent diastasis the screws were removed significantly earlier compared with the group without recurrent diastasis (Mann- Whitney U-test; p= 0.011) and the group with screw breakage had their screws significantly longer in place compared with the group without breakage ( p = 0.038).

Conclusion:

A total of 22.4% complications occurred upon routine removal of the syndesmotic screw. Removal might therefore be considered only in selected cases with complaints, after a minimum of eight to twelve weeks and using antibiotic prophylaxis during removal. Level of Evidence: IV, Retrospective Case Study
Boyd Amputation in Adults
Authors: Tosun Bilgehan , Buluc Levent , Gok Umit , Unal Cigdem
Published: March 2012

Background:

Foot ulcerations resulting in amputation are one of the most devastating consequences of diabetes mellitus and peripheral arterial disease. In foot amputations, Boyd amputation has been even less accepted than Syme amputation due to its dependence on calcaneotibial osseous union in adults.

Methods:

Fifteen Boyd amputations were performed for 14 adults. The indications for amputation were diabetic ulceration of the foot in eight patients, ischemic disease of the lower extremity in four and salvage of the deformed foot due to peripheral neuropathy in one patient. One patient with scleroderma had bilateral amputations due to digital ischemic necrosis.

Results:

Complete wound healing was documented in seven feet of six patients. Further revisions to a more proximal amputation level were required in seven patients.

Conclusion:

Despite the high failure rate, we believe Boyd amputation is still a good option in some patients to try to preserve length. Level of Evidence: IV, Retrospective Case Series
Plantar and Calcaneocuboid Joint Pressure after Isolated Medial Column Fusion versus Medial and Lateral Column Fusion: A Biomechanical Study
Authors: Nadaud Joshua P. , Parks Brent G. , Schon Lew C.
Published: March 2012

Background:

We compared forefoot and calcaneocuboid pressure in isolated medial column fusion (1-3 tarsometatarsal fusion) versus medial and lateral column fusion (1-5 tarsometatarsal fusion) in a neutral, inversion, and eversion loading model in stance gait phase.

Methods:

Twelve fresh-frozen cadaveric specimens were cyclically loaded to 720 N at 0.5 Hz for 30 cycles. Plantar and calcaneocuboid joint pressures were measured in neutral, inversion, and eversion in the intact foot, with isolated medial column fusion, and with medial and lateral column fusion.

Results:

Lateral pressure was higher in the medial and lateral column fusion group than isolated medial column fusion and intact in neutral (55.8 ± 14.8 versus 46.2 ± 13.6 and 45.5 ± 14.8 kPa, respectively) and eversion (80.7 ± 18.4 versus 61.8 ± 13.7 and 60.2 ± 18.2 kPa, respectively) ( p ≤ 0.001). Calcaneocuboid pressure was higher in medial and lateral column fusion than isolated medial column fusion and intact in neutral (1436.7 ± 210.6 versus 1073.7 ± 282.5 and 1084.9 ± 337.6, respectively; p = 0.001) and inversion (1518.3 ± 270.5 versus 1310.5 ± 298.8 and 1237.1 ± 401.9, respectively; p = 0.02). Using combined position data, calcaneocuboid pressure was significantly higher in the medial and lateral column group than in both other groups. The isolated medial column fusion group did not differ significantly from the intact group in any measurement.

Conclusion:

Medial and lateral column fusion significantly increased lateral and calcaneocuboid pressures with loading compared with isolated medial column fusion and the intact state. No difference was observed between isolated medial column fusion and the intact state.

Clinical Relevance:

It may be advisable to avoid fusing the lateral column in tarsometatarsal arthrodesis if possible to avoid pressure increase in the forefoot and hindfoot.
Plantar versus Dorsomedial Locked Plating for Lapidus Arthrodesis: A Biomechanical Comparison
Authors: Klos Kajetan , Simons Paul , Hajduk Anne-Sophie , Hoffmeier Konrad Leopold , Gras Florian , Fröber Rosemarie , Hofmann Gunther O. , Mückley Thomas
Published: March 2012

Background:

Lapidus arthrodesis with a plate and a compression screw is an established procedure in hallux valgus surgery. The present study was performed to investigate the potential benefit of a compression screw combined with a plantarly applied angle-stable, anatomically precontoured plate or a dorsomedially applied angle-stable plate.

Methods:

In six pairs of human cadaver specimens, one specimen each was randomized to receive a dorsomedial H-shaped plate, while the other received a plantar plate. Bone mineral density was measured with peripheral quantitative computed tomography. The specimens were loaded quasi-statically, followed by cyclic loading. Finally, they were loaded to failure. In the static tests, stiffness and range of motion (ROM) data were obtained. In the cyclic tests, the constructs' displacement was studied. In the load-to-failure test, stiffness and maximum load to failure were measured.

Results:

The two groups did not differ significantly with regard to BMD (p = 0.25). Any significant differences observed were in favor of the plantar constructs, which had greater initial stiffness (p = 0.028) and final stiffness (p = 0.042), a smaller ROM (p = 0.028), and a greater load to failure (p = 0.043). There was no significant difference regarding displacement (p = 0.14).

Conclusion:

In the static tests, the plantar angle-stable plate construct was superior to the dorsomedial angle-stable plate construct.

Clinical Relevance:

Plantar plating appears to offer biomechanical benefit. Clinical studies will be required to show whether this translates into earlier resumption of weightbearing and into lower rates of nonunion.
Interosseous Talocalcaneal Ligament Reconstruction with Hamstring Autograft under Subtalar Arthroscopy: Case Report
Authors: Liu Chen , Jiao Chen , Hu Yuelin , Guo Qin Wei , Wand Cheng , AO Yingfang
Published: March 2012

Level of Evidence: V, Expert Opinion
Syndesmotic Fixation in Supination-External Rotation Ankle Fractures: A Prospective Randomized Study
Authors: Pakarinen Harri J. , Flinkkilä Tapio E. , Ohtonen Pasi P. , Hyvönen Pekka H. , Lakovaara Martti T. , Leppilahti Juhana I. , Ristiniemi Jukka Y.
Published: March 2012

Background:

This study was designed to assess whether transfixion of an unstable syndesmosis is necessary in supination-external rotation (Lauge-Hansen SE/Weber B)-type ankle fractures.

Methods:

A prospective study of 140 patients with unilateral Lauge-Hansen supination-external rotation type 4 ankle fractures was done. After bony fixation, the 7.5-Nm standardized external rotation (ER) stress test for both ankles was performed under fluoroscopy. A positive stress examination was defined as a difference of more than 2 mm side-to-side in the tibiotalar or tibiofibular clear spaces on mortise radiographs. If the stress test was positive, the patient was randomized to either syndesmotic transfixion with 3.5-mm tricortical screws or no syndesmotic fixation. Clinical outcome was assessed using the Olerud-Molander scoring system, RAND 36-Item Health Survey, and Visual Analogue Scale (VAS) to measure pain and function after a minimum 1-year of followup.

Results:

Twenty four (17%) of 140 patients had positive standardized 7.5-Nm ER stress tests after malleolar fixation. The stress view was positive three times on tibiotalar clear space, seven on tibiofibular clear space, and 14 times on both tibiotalar and tibiofibular clear spaces. There was no significant difference between the two randomization groups with regards to Olerud-Molander functional score, VAS scale measuring pain and function, or RAND 36-Item Health Survey pain or physical function at 1 year.

Conclusion:

Relevant syndesmotic injuries are rare in supination-external rotation ankle fractures, and syndesmotic transfixion with a screw did not influence the functional outcome or pain after the 1-year followup compared with no fixation. Level of Evidence: II, Prospective Comparative Study
Combined Medial and Lateral Anatomic Ligament Reconstruction for Chronic Rotational Instability of the Ankle
Authors: Buchhorn Tomas , Sabeti-Aschraf Manuel , Dlaska Constantin E. , Wenzel Florian , Graf Alexandra , Ziai Pejman
Published: March 2012

Background:

This study aimed to extend knowledge on the arthroscopic evaluation of the unstable ankle joint and the outcome of ligament reconstruction on rotational instability. In contrast to previous studies, we investigated the combined repair of lateral and medial ligaments.

Methods:

Ninety-six patients underwent medial and lateral ligament reconstruction between 2006 and 2008, 81 of whom, with a mean age of 31.9 (range, 14 to 44) years, completed the 12-month followup and were therefore included in this study ( Table 1 ). Clinical, radiographic, and concomitant arthroscopic examination was performed prior to the ligament stabilization. Postoperative followup included clinical and radiographic evaluation after 3, 6, and 12 months.

Results:

Arthroscopy showed a lesion of the anterior fibulotalar ligament (AFTL), calcaneofibular ligament (CFL), and tibiocalcanear ligament (TCL) (Deep part of deltoid ligament complex) in 67 patients. An avulsion of the proximal insertion point of the ATTL was additionally found in 14 cases. Clinical results 3 months after surgery showed a significant increase in the AOFAS-Hindfoot Score as well as a significant decrease of the Visual Analogue-Scale for pain (VAS) ( p < 0.0001). This outcome persisted at the 12-month examination.

Conclusion:

Rotational instability of the ankle joint in most cases has an injury of the lateral ligaments and a component of the deltoid, the TCL, but rarely with a combined lesion of the TCL and the anterior tibiotalar ligament (ATTL) (Superficial part of deltoid ligament complex). The combined lateral and medial ligament reconstruction with an anchor technique had a good clinical outcome with high patient satisfaction with few complications. Level of Evidence: IV, Retrospective Case Series
Subtalar Joint Arthroereisis in the Management of Pediatric Flexible Flatfoot: A Critical Review of the Literature
Authors: Metcalfe Stuart A. , Bowling Frank L. , Reeves Neil D.
Published: March 2012

Background:

Pediatric flexible flatfoot is a common deformity for which a small, but significant number undergo corrective surgery. Arthroereisis is a technique for treating flexible flat- foot by means of inserting a prosthesis into the sinus tarsi. The procedure divides opinion in respect of both its effectiveness and safety.

Methods:

A database search up until 2010 was used to find articles regarding arthroereisis in pediatric patients. We summarized the findings of this study.

Results:

Seventy- six studies were identified. Eight of the nine radiographic parameters reported show significant improvement following arthroereisis reflecting both increased static arch height and joint congruency. Calcaneal inclination angle demonstrated the least change with only small increases following arthroereisis. Arthroereisis remains associated with a number of complications including sinus tarsi pain, device extrusion, and under-correction. Complication rates range between 4.8% and 18.6% with unplanned removal rates between 7.1% and 19.3% across all device types.

Conclusion:

Current evidence is limited to consecutive case series or ad hoc case reports. Limited evidence exists to suggest that devices may have a more complex mode of action than simple motion blocking or axis altering effects. The interplay between osseous alignment and dynamic stability within the foot may contribute to the effectiveness of this procedure. Although literature suggests patient satisfaction rates of between 79% to 100%, qualitative outcome data based on disease specific, validated outcome tools may improve current evidence and permit comparison of future study data. Level of Evidence: II, Metanalysis
Gastrocnemius Contracture Caused by Traumatic Injury without Fracture: A Case Report
Authors: Takigami Junsei , Hashimoto Yusuke , Yamasaki Shinya , Hara Yo , Nishikino Shoichi , Nakamura Hiroaki
Published: March 2012

Level of Evidence: V, Expert Opinion
Direct Plantar Approach to Henry's Knot for Flexor Hallucis Longus Transfer
Authors: Amlang Michael , Rosenow Maria C. , Friedrich Adina , Zwipp Hans , Rammelt Stefan
Published: March 2012

Background: Transfer of the flexor hallucis longus (FHL) tendon is an established method to replace a dysfunctional Achilles tendon. When using a single incision, the FHL tendon has to be transferred as a single stranded graft into the calcaneus and the distal FHL stump cannot be directly attached to the flexor digitorum longus tendon (FDL). Another concern with tendon retrieval is neurovascular damage. We report our results with a direct plantar approach for tendon harvest. Methods: A direct plantar approach to the master knot of Henry with reattachment to its distal stump while protecting the medial plantar nerve was used allowing a double stranded FHL-transfer in 25 cases of a severely dysfunctional Achilles tendon in 24 consecutive patients. Patients were evaluated prospectively and at an average followup of 73 (range, 20 to 121) months. Results: No wound healing problems and no lesion of the medial plantar nerve occurred. The subjective result was rated as excellent in 18 (72%), good in five (20%), and fair in one case (8%). The AOFAS hindfoot score averaged 95.4 (range, 61 to 100) points and the AOFAS hallux score averaged 97.6 (range, 87 to 100) points. No loss of plantarflexion force was observed in the big toe as compared to the contralateral side. Conclusion: The plantar approach to Henry's knot allowed the use of a double stranded FHL transplant. The distal stump was attached to the FDL tendon to preserve flexion at the great toe without damaging to the medial plantar nerve.

Level of Evidence: IV, Case Series
Ankle and Hindfoot Fusions: Comparison of Outcomes in Patients with and without Diabetes
Authors: Myers Thomas G. , Lowery Nicholas J. , Frykberg Robert G. , Wukich Dane K.
Published: March 2012

Background: Patients with diabetes mellitus (DM) are believed to have higher complication rates when undergoing ankle and hindfoot fusions, but data is lacking. The purpose of this study was to compare the postoperative outcomes of major foot and ankle arthrodeses in patients with and without DM. Another goal was to evaluate what effect glycemic control had on the outcomes of patients with diabetes. Methods: A retrospective review of charts from operative years 2005 to 2010 was performed. Inclusion criteria encompassed patients requiring major hindfoot and/or ankle fusion. Exclusion criteria included any patient who did not have at least 6-month followup. Seventy four patients with DM were matched with 74 non-DM patients based on age, gender, and length of surgery. Significance was set at p < 0.05 with associated 95% confidence intervals. Results: The overall complication rate was found to be significantly higher in patients with DM, a history of tobacco use, and peripheral neuropathy. The postoperative infection rate was found to be significantly higher in patients with DM, poor long-term glucose control (Hgb A1c levels greater than or equal to 7%), a history of tobacco use, peripheral artery disease, and peripheral neuropathy. Our rate of noninfectious complications was found to be significantly higher in patients with DM, poor short-term glucose control (a preoperative glucose greater than 200 mg/dL), a history of tobacco use, and previous solid organ transplantation. Patients greater than or equal to 65 years of age were significantly associated with fewer overall complications and postoperative infections. Conclusion: This study confirmed our hypothesis that patients with DM were at increased risk for postoperative complications after foot and/or ankle arthrodesis when compared to patients without DM. A secondary finding of this study demonstrated patients with poor short- and long-term glucose control experienced more complications.

Level of Evidence: III, Retrospective Comparative Study
Arthroscopic Four-Step Treatment for Chronic Ankle Instability
Authors: Ventura Alberto , Terzaghi Clara , Legnani Claudio , Borgo Enrico
Published: March 2012

Background: Chronic lateral ankle instability is a condition of perception of giving way and persistent pain usually following multiple ankle sprains. Open reconstructive procedures carry the disadvantages of subtalar joint stiffness and potential morbidity at the harvesting site. Recently, arthroscopic treatment of chronic lateral ankle instability has been proposed in order to minimize invasiveness, reduce operating time, and allow a faster rehabilitation period. The purpose of our paper was to assess the outcomes in terms of postoperative recovery and return to sport following arthroscopic reconstruction of lateral ankle instability. Methods: Ninety patients with chronic lateral ankle instability were treated at our Department from 2004 to 2009. Mean age was 32.4 (range, 17 to 56) years. All patients underwent a four-step operative procedure, including: synovectomy, debridement of ATFL lesion borders, capsular shrinkage, and 21-day immobilization and nonweightbearing. Results: Followup examination at an average of 4 years after surgery showed significant improvement of mean AOFAS scale (preoperative, 63.5; postoperative, 92.3; p < 0.001) and average Karlsson score (preoperative, 61.8; postoperative, 88.4; p < 0.001). Mean Tegner rating changed from 3.6 preoperatively to 4.9 at followup ( p < 0.001). Articular stability as assessed by Sefton scale significantly improved from a preoperative value of 4.0 to 1.8 ( p < 0.001). Most patients (96.6%) rated the success of their surgery as good to excellent. Conclusion: Based on our results, we propose arthroscopic treatment as a suitable option for moderate chronic ankle joint laxity in patients with a complete ATFL lesion.

Level of Evidence: IV, Retrospective Cohort Study
The Influence of Heel Height on Frontal Plane Ankle Biomechanics: Implications for Lateral Ankle Sprains
Authors: Foster Alicia , Blanchette Mark G. , Chou Yi-Chen , Powers Christopher M.
Published: March 2012

Background: Wearing high heel shoes is thought to increase an individual's likelihood of experiencing a lateral ankle sprain. The purpose of this study was to evaluate the influence of heel height on frontal plane kinematics, kinetics, and electromyographic (EMG) activity of the ankle joint during walking. Methods: Eighteen healthy women participated. Three-dimensional kinematics, ground reaction forces, and EMG signals of the tibialis anterior (TA) and peroneus longus (PL) were recorded as subjects ambulated in high (9.5 cm) and low (1.3 cm) heel shoes at a self-selected walking velocity. Peak ankle plantarflexion, peak ankle inversion angle, and the peak ankle inversion moment during the stance phase of gait were evaluated. The EMG variables of interest consisted of the normalized average signal amplitude of the TA and PL during the first 50% of the stance phase. Paired t-tests were used to assess differences between the two shoe conditions. Results: When compared to the low heel condition, wearing high heels resulted in significantly greater peak ankle plantarflexion and inversion angles ( p < 0.001). In addition, the peak inversion moment and PL muscle activation was found to be significantly higher in the high heel condition ( p < 0.001). No difference in TA muscle activity was found between shoe conditions ( p = 0.30). Conclusion: The plantarflexed and inverted posture when wearing high heels may increase an individual's risk for experiencing a lateral ankle sprain. Clinical Relevance: Data obtained from this investigation highlights the need for increased awareness and proper education related to the wearing of high heel shoes.
Osteosynthesis of Talar Body Shear Fractures Assisted by Hindfoot and Subtalar Arthroscopy: Technique Tip
Authors: Sitte Wolfgang , Lampert Christoph , Baumann Patrick
Published: March 2012

Level of Evidence: V, Expert Opinion
A Semi-Preemptive Computational Service System with Limited Resources and Dynamic Resource Ranking
Authors: Leu Fang-Yie , Chao Keng-Yen , Lee Ming-Chang , Lin Jia-Chun
Published: March 2012

In this paper, we integrate a grid system and a wireless network to present a convenient computational service system, called the Semi-Preemptive Computational Service system (SePCS for short), which provides users with a wireless access environment and through which a user can share his/her resources with others. In the SePCS, each node is dynamically given a score based on its CPU level, available memory size, current length of waiting queue, CPU utilization and bandwidth. With the scores, resource nodes are classified into three levels. User requests based on their time constraints are also classified into three types. Resources of higher levels are allocated to more tightly constrained requests so as to increase the total performance of the system. To achieve this, a resource broker with the Semi-Preemptive Algorithm (SPA) is also proposed. When the resource broker cannot find suitable resources for the requests of higher type, it preempts the resource that is now executing a lower type request so that the request of higher type can be executed immediately. The SePCS can be applied to a Vehicular Ad Hoc Network (VANET), users of which can then exploit the convenient mobile network services and the wireless distributed computing. As a result, the performance of the system is higher than that of the tested schemes.