bluuebunny/crossref_metadata_2025 huggingface dataset:
Biomechanical Comparison of Fibertape Augmentation with Intercuneiform Adjunct and Cannulated Screws for Ligamentous Lisfranc Injuries: 3D Visualization of Complex Movement
Authors: Koroneos Zachary , Manto Kristen M. , Martinazzi Brandon , Stauch Chris M. , Bifano Shawn M. , Pace Gregory I. , Lewis Gregory , Aynardi Michael C.
Published: January 2022

Category:

Midfoot/Forefoot; Sports; Trauma

Introduction/Purpose:

The preferred method of fixation for ligamentous Lisfranc injuries is controversial, with the traditional method being transarticular screws. Unfortunately screw removal is often required leading surgeons to seek alternative fixation methods including fibertape constructs. Our lab has published biomechanical results on the safety and efficacy of a fibertape construct for the treatment of ligamentous Lisfranc injuries demonstrating biomechanical superiority with the supplementation of an intercuneiform limb. The purpose of this biomechanical study is to compare transarticular screws to a fibertape construct under loading and utilizing 3D visualization software.

Methods:

Three matched pairs of cadaveric specimens were dissected to allow for the placement of three screws on the dorsal aspect of the each bone involved in the Lisfranc complex. The diastasis between bones were measured at three midfoot joints in the Lisfranc articulation while each specimen was loaded to 75% of donor bodyweight. Measurements were obtained for the pre- injured specimens. The MC-2MT joint was sectioned under fluoroscopic imaging and re-measured to produce at least 2 mm of gapping. Specimens were then fixed with either transarticular screws or fibertape with an intercuneiform limb and computed tomography scans were performed. Post-fixation measurements were obtained for 250 N of axial loading with subsequent 100 N increases up to 650 N. CT scans were imported as DICOM images and the three bones were segmented to analyze the gapping that occurred at the dorsal, interosseous, and plantar portions of the ligament.

Results:

There were no significant differences detected for the diastasis between bones in the Lisfranc complex between the fibertape and screws. After loading to 650 N, no specimens had reached a diastasis of 2 mm through coordinate digitized measurements (Figure 1A and B). At 650 N of loading the fibertape specimens displayed an average diastasis of 0.78 mm while the specimens fixed with screws also displayed an average diastasis of 0.78 mm. 3D diastasis measurements showed coordinate digitized measurements were within 0.2 mm of those measured from 3D reconstruction of CT scans. The largest diastasis occurred at the dorsal aspect of the ligament.

Conclusion:

The use of a fibertape device involving a supplementary intercuneiform limb appears to provide a biomechanically viable alternative to screws for ligamentous Lisfranc injuries. Diastasis was verified using 3D computer models. Future efforts involve increasing the number of specimens, applying cyclic loading, and determining the effects on each portion of the ligament for each fixation type.
3D Assessment in Posttraumatic Ankle Osteoarthritis
Authors: Kvarda Peter , Heisler Lukas , Krähenbühl Nicola , Steiner Caspar S. , Ruiz Roxa , Susdorf Roman , Sripanich Yantarat , Barg Alexej , Hintermann Beat
Published: January 2022

Category:

Ankle; Ankle Arthritis; Hindfoot; Other

Introduction/Purpose:

Auto-generated 3-dimensional (3D) measurements based on weightbearing cone-beam computed tomography (CT) scan technology may allow for a more accurate hind- and midfoot assessment. The current study evaluated the reliability and clinical relevance of such measurements in patients with posttraumatic end-stage ankle osteoarthritis.

Methods:

Seventy-two patients treated at our institution for posttraumatic end-stage ankle osteoarthritis, with available weightbearing conventional radiographs and a cone-beam CT scan, were analyzed. Twenty healthy individuals aged between 40 and 70 years served as controls. Seven variables were measured on the conventional radiographs (2D) and compared to 3D measurements that were based on reconstructions from cone-beam CT scans. The reliability of each measurement was calculated and subgroups formed according to commonly observed deformities.

Results:

Inter- and intraobserver reliability was superior for 3D compared to 2D measurements. The accuracy of 3D measurements performed on osteoarthritic ankles was similar to 3D measurements performed on healthy individuals. Thirty-three of the 72 included patients (46%) evidenced an inframalleolar compensation of a supramalleolar/intra-articular ankle deformity (78% = varus compensation; 22% = valgus compensation), whereas 24 of those 72 patients (33%) showed no compensation or a further increase of a supramalleolar/intra-articular ankle deformity (67% = varus deformity; 33% = valgus deformity).

Conclusion:

Auto-generated 3D measurements of the hind- and midfoot are reliable in both healthy individuals and patients with posttraumatic end-stage ankle osteoarthritis. Such measurements may be crucial for a detailed understanding of the location and extent of hindfoot deformities, possibly impacting decision making in the treatment of end-stage ankle osteoarthritis.
High Reliability for Weightbearing CT Based Automated 3D Measurements to Assess Progressive Collapsing Foot Deformity
Authors: Kvarda Peter , Krähenbühl Nicola , Susdorf Roman , Burssens Arne , Ruiz Roxa , Barg Alexej , Hintermann Beat
Published: January 2022

Category:

Hindfoot; Midfoot/Forefoot; Other

Introduction/Purpose:

In progressive collapsing foot deformity (PCFD), hind- and midfoot deformities are paramount. However, an accurate assessment thereof, using weightbearing radiography, remains challenging. Automated three-dimensional (3D) measurements derived from weightbearing computed tomography (WBCT) scans may provide a more accurate approach for deformity assessment. In this study, automated 3D measurements based on WBCT were compared to two-dimensional (2D) measurements performed on weightbearing radiographs. Furthermore, it was investigated whether various stages of PCFD could be identified using automated 3D measurements.

Methods:

Twenty patients treated at our institution with either a flexible (N=10) or rigid (N=10) PCFD were identified, retrospectively analyzed and compared to a control group of thirty healthy individuals. Four angles and two distances measured on weightbearing radiographs were compared to the automated 3D measurements derived from WBCT scans.

Results:

In 5 out of 6 variables, the reliability of the measurements derived from weightbearing radiographs was lower than the automated measurements that derived from WBCT scans. The automated 3D measurements showed: the talar tilt in the ankle mortise was more valgus in patients with a rigid PCFD when compared to patients with a flexible PCFD; medial facet subluxation was present in all but one patient; patients with a sinus tarsi impingement evidenced a higher overlap between the talus and calcaneus (12.4+-2.6 mm) compared to patients without impingement (7.8+-3.9 mm; P=0.020).

Conclusion:

A higher reliability of automated 3D measurements derived from WBCT scans, was evident for most variables when compared to measurements based on weightbearing radiographs. Besides being less prone to errors, automated 3D measurements may provide more reliable information regarding the hind- and midfoot alignment in patients with PCFD. Future studies may show to what extent 3D measurements could contribute to current diagnostic algorithms and treatment concepts of patients with PCFD.
A Systematic Review of Third-Generation Total Talus Replacements
Authors: Lindsey Benjamin B. , Lindsey Benjamin B. , Sarfani Shumaila , Bettin Clayton C.
Published: January 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

Total talus replacement (TTR) has emerged as a novel treatment for talar avascular necrosis and severe trauma to the talus. Despite TTR first being described over 35 years ago, many questions still remain regarding the procedure. The objective of this study was to summarize the evidence on third-generation TTR's, focusing on surgical indications, surgical technique, prosthesis design, clinical outcomes, and postoperative complications.

Methods:

MEDLINE and EMBASE were queried and data abstraction was performed by 2 independent reviewers. Inclusion criteria for the articles were (1) peer-reviewed clinical studies with levels of evidence from I to IV, (2) with at least 5 patients, (3) reporting clinical outcomes of third-generation TTR's that were not done in conjunction with a total ankle arthroplasty, and (4) with a minimum clinical follow-up of at least 6 months.

Results:

Five studies met inclusion criteria for analysis including 101 ankles in 97 patients. The mean reported patient age was 52.8 years. The most common indication for TTR was avascular necrosis (86%), followed by trauma (10%), and tumor (4%). The mean follow up was 40 months. 98% of TTR's were performed through an anterior approach. There was significant variation in implant material, with 60% alumina ceramic, 27% cobalt chromium, 9% titanium, and 4% stainless steel. Only 3 studies obtained preoperative outcome measures, but these all demonstrated improvement at final follow up. Average dorsiflexion after TTR was 6.1 degrees and average plantarflexion was 35.1. Only 5% of ankles had complications requiring return to the operating room and only 2% of the total taluses were revised.

Conclusion:

While evidence is limited, short-term and mid-term results are promising for TTR as it demonstrates improvement in ankle function and has a low rate of revision. As the consequences of failure of a TTR are significant, including pantalar fusion or below knee amputation, higher quality studies and long-term results are needed to further evaluate this procedure.
Return to Driving after Elective Foot & Ankle Surgery: A Systematic Review
Authors: Lundy Alexander , Piscoya Andres S. , Bedrin Michael D. , Rodkey Daniel L. , Nelson Sarah , Eckel Tobin T.
Published: January 2022

Category:

Ankle; Arthroscopy; Midfoot/Forefoot; Other

Introduction/Purpose:

Studies investigating when patients can safely return to driving are becomingly increasingly numerous in the orthopedic literature because of the recognition of the importance of the activity to the lives of most adults. Previous systematic reviews have proven helpful by collecting and summarizing these studies to establish concise guidelines that can be presented to patients during the counseling surrounding a procedure. Having these guidelines can be even more crucial when discussing elective procedures. This systematic review summarizes the available studies investigating when it is safe to return to driving following elective foot and ankle procedures.

Methods:

A systematic review of the literature was performed using PubMed, Embase, and CINAHL to identify English-language studies from 1999 to present that investigate return to driving after right-sided elective foot and ankle procedures. Qualitative assessment of each of the included studies was performed independently by two authors. Then data from each study was extracted and broken down into distinct categories for comparison: study details, population, control group, method of evaluation, and results.

Results:

Eight studies met inclusion criteria. All of the studies investigate brake reaction time (BRT), via a driving simulator, as their primary outcome. A variety of objective and subjective secondary outcomes were collected. Patients undergoing right ankle or subtalar arthroscopic procedures have no significant difference in BRT compared to controls at 2 weeks post-operatively. 92% of patients undergoing right ankle arthroplasty had a BRT that was not significantly different to the control group at 6 weeks post- operatively. Patients who had an ankle arthrodesis had significantly delayed BRT compared to controls even past 1-year post- operatively. The majority of patients after corrective hallux valgus surgery have no significant difference in BRT at 6 weeks post- operatively compared to their pre-operative baselines depending upon how they are doing clinically. The included studies used a variety of patient reported outcomes that were helpful in predicting which patients would fail the driving simulation at the various timepoints.

Conclusion:

The recommendations from these reviewed studies can guide physicians when counseling their patients on when they can expect to safely return to driving after a specific, elective foot and ankle procedure. However, these recommendations are reliant on routine healing post-operatively and may need to be adjusted if a patient is experiencing any complications. A variety of patient surveys and other subjective scores can be very helpful in assuring a routine post-operative course.
Computerized Tomography Scans for Ankle Fracture: Diagnosis, Management and Surgical Plan Modifier
Authors: Mansur Nacime S. , Celestino Fausto Santana , Neves Caroline , Pereira Vinícius F. , Vargas Silva Pedro Debieux , Matsunaga Fabio Teruo , Nery Caio A. , Astur Diego C.
Published: January 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Ankle fractures are one of the most operated injuries in orthopedic practice. The decision upon the best management is based on the displacement of the bone fragments and the presence of associated lesions (osseous and/or soft tissues). The therapeutic decision is classically established upon plain radiographs, which might be temerarious due to the usual difficulty in analyzing those exams. In recent years, some authors have advocated that computed tomography could be used as an assistant instrument on the decision-making. Our study aims to demonstrate the superiority of the association between both methods on diagnosis, therapeutic decision, and surgical plan for these injuries.

Methods:

Patients diagnosed with an ankle fracture, between 2011 and 2016, and assessed with CT and X-ray were included in our investigation. Seven examiners with different degrees of experience analyzed the exams, determined the injuries, chose how they would treat, and the defined surgical strategy when applicable. This was done, at first, only with radiographs and after with the combination of CT and radiographs. The data were statistically compared.

Results:

Fifty-three patients were included. The medial malleolus fractures characteristics (posteromedial fragment and anterior colliculus), the presence of posterior malleolus fracture and its characteristics (displacement, bone fragment greater than 25%, posteromedial or posterolateral segment), syndesmosis injury, and the absence of deltoid ligament lesion were more noticeable from the combination of CT and radiography. Concerning surgical treatment, the prone position, the posterolateral surgical approach (rather than anterolateral) on lateral malleolus osteosynthesis, the decision to surgically treat the posterior malleolus fracture (through posterolateral approach with posterolateral plate), the option to include the syndesmosis approach in the treatment, and not to include deltoid ligament repair were more noticeable from the combination of CT and radiography, among all groups of expertise, with high inter-observer reliability.

Conclusion:

The usual radiographs may fail to demonstrate subtle lesions, as posterior malleolus fractures and syndesmotic injuries. The tomographic evaluation increases the precision of diagnosis and improves the quality of information that the surgeon receives, providing data that can positively affect patient care.
Shock Wave Therapy Associated with Eccentric Strengthening vs Isolated Eccentric Strengthening for Achilles Insertional Tendinopathy Treatment: A Double Blinded Randomized Clinical Trial
Authors: Mansur Nacime S. , Carrazzone Oreste L. , Matsunaga Fabio Teruo , Faloppa Flávio , Sugawara Tamaoki Marcel Jun
Published: January 2022

Category:

Sports; Other

Introduction/Purpose:

Lack of consensus inhibits Achilles insertional tendinopathy (AIT) management. The condition is usually treated with eccentric exercises (EE), despite its absence of satisfactory and standing results. Shock wave therapy (SWT) was presented as an alternative, but it is still supported by a paucity of studies that shows moderate outcomes. The purpose of this study is to determine if the association of shock wave therapy (SWT) with the eccentric exercises (EE) protocol improve rates of pain and function in patients with AIT.

Methods:

This was a single-centre, double blind, placebo-controlled, in parallel groups, randomized clinical trial. 119 patients diagnosed with AIT, were evaluated, and enrolled in the study from February 2017 to February 2019. They were divided in two treatment groups, SWT associated to EE (SWT group) and EE associated to sham (CON group). Three sessions of radial shockwaves (or sham) separated by 2 weeks and eccentric training for three months were applied. The primary outcome was the Victorian Institute of Sport Assessment-Achilles questionnaire (VISA-A) at 24 weeks. Secondary outcomes included the Visual Analogue Scale (VAS), Algometry, the Foot and Ankle Outcome Score (FAOS) and the 12 Item Short Form Health Survey (SF-12).

Results:

Both groups showed significant improvement with the corresponding treatment in the study period. However, there were no between-group differences (all ps > 0.05) in any of the outcomes. At the 24th week evaluation, the SWT group exhibited a mean VISA-A of 63.2 (CI 8.0) and the CON group of 62.3 (CI 6.9), p=0.876. Failures were higher in the SWT (38.3% to 11.5%, p=0.002) and recurrences were superior in the CON side (34.6% to 17.0%, p=0.047). There were no complications.

Conclusion:

Extracorporeal shockwave therapy does not potentialize the effects of eccentric strengthening in the management of Achilles insertional tendinopathy.
Complications Associated with Anesthetic Choice for Elective Foot and Ankle Surgery
Authors: Martin John R. , Kisana Haroon , Hui Clayton , Stecher Chad , Hustedt Joshua
Published: January 2022

Category:

Ankle; Ankle Arthritis; Arthroscopy; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma

Introduction/Purpose:

Wide-awake anesthesia (local anesthesia without sedation) is rarely utilized during elective foot and ankle surgery. As such, the rate of post-operative complications following wide-awake foot and ankle surgery is unknown. The aim of this study was to compare rates of early post-operative complications for wide-awake anesthesia to general/local anesthesia with sedation for elective foot and ankle procedures conditional on a wide range of observable patient characteristics and risk factors.

Methods:

Patients that underwent an elective foot or ankle surgery were identified in the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) dataset. The rate of thirty-day post-operative complications was compared between patients who received wide-awake anesthesia and those who received general/local anesthesia with sedation using logistic regressions that controlled for patient risk factors.

Results:

Between 2005 and 2017, 85,363 patients were identified has having any foot and ankle procedure. After excluding observations with missing anesthesia type data information and non-elective foot and ankle procedures, the analytic cohort had 16,743 patients. There were 1,401 (8.4%) patients who underwent wide-awake anesthesia and 15,342 (91.6%) patients who underwent general/local anesthesia with sedation over the entire sample. Starting in 2007, there was an annual increase in the likelihood of using general/local anesthesia with sedation for foot and ankle procedures of 0.7 percentage points (p = 0.001). Overall, general/local anesthesia with sedation increased the odds of experiencing any complication within the first thirty days by 1.523 (95% CI 1.152 - 2.014).

Conclusion:

Although wide-awake surgery is rarely performed for elective foot and ankle procedures, utilization of local anesthesia without sedation may result in fewer post-operative complications in the first thirty days. Existing trends in the use of sedation for foot and ankle procedures show that physicians are increasingly favoring general/local anesthesia with sedation, but our findings caution against this choice and suggest that post-operative complication rates may correspondingly increase.
Rates of Complications Following Lower Extremity Amputations: A Retrospective Chart Review
Authors: Martinazzi Brandon , Koroneos Zachary , Stauch Chris M. , Manto Kristen M. , Ptasinski Anna , Aynardi Michael C.
Published: January 2022

Category:

Ankle; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Trauma; Other

Introduction/Purpose:

Lower extremity amputations are commonly used in the field of orthopaedics to treat infections, trauma, and severe complications associated with diabetic foot ulcers. These procedures are often associated with high rates of unplanned reoperations, hospitalizations, and numerous postoperative complications. As a result, lower extremity amputations place added physical, emotional and financial stress on patients which can negatively impact outcomes. The aim of this study was to evaluate types of postoperative complications and the rate at which they occurred in an effort to improve future patient outcomes.

Methods:

Following institutional board approval, all patients at a single academic institution that underwent lower extremity amputation, by a single surgeon, from January 2017 to December 2020 were queried using hospital electronic medical records. Patient charts were followed from the date of surgery until their last follow up appointment in order to identify potential complications.

Results:

135 patients underwent lower extremity amputation from 2017-2020. 102 were male (75.5%) and 33 were female (24.4%). The average age of the patients identified was 61.1. The oldest patient was 95 and the youngest patient was 13. The average number of days to a noted complication following amputation was 93.3. The earliest complication occurred 11 days after surgery, while the longest occurred 396 days. Of the 135 patients, 7 patients had revision of their amputation (5.2%), 4 had significant wound dehiscence (3%), 7 had delayed wound healing and excess fluid drainage (5.2%), 4 had postoperative infection (3%), and 4 were noted to have developed phantom limb (3%).

Conclusion:

Lower extremity amputations continue to be associated with high rates of postoperative complications. This data demonstrates that additional surgical revisions and delayed wound healing were the most common postoperative complications in our cohort.
Clinical Outcomes of Peroneal Tendon Tears: A Systematic Review
Authors: Mercer Nathaniel P. , Gianakos Arianna L. , Mercurio Angela M. , Kennedy John G.
Published: January 2022

Category:

Ankle; Sports

Introduction/Purpose:

The purpose of this study was to provide an overview of the available evidence on peroneal tendon tears and the outcomes after surgical intervention.

Methods:

A systematic review of the literature was performed using MEDLINE, Embase, and Cochrane. Criteria for inclusion were clinical studies reporting outcomes after treatment for peroneal tendon tear from August 2010 to August 2020.

Results:

Nine studies evaluating 336 patients (146 males/190 females) and 336 ankles were included in this review. The mean age of included patients was 46.3 years (range, 46.0 - 56.9 years). The weighted mean follow-up was 23.8 months (range 9.2 - 78.0 months. Five surgical interventions were reported: primary repair with tenodesis, primary repair without tenodesis, FDL tendon transfer, FHL tendon transfer, and allograft reconstruction. Four studies recorded the AOFAS score, with a weighted mean preoperative score of 69.6 and a weighted mean postoperative score of 88.8. FAAM score was measured in 3 studies, which showed an improvement from 41.1 preoperatively to 84.4 postoperatively. The average overall complication rate was 38.7% (130/336) with the most commonly reported minor complication being ankle pain, which made up 46.2% of all minor complications (56/121). Primary repair without tenodesis was associated with a higher complication rate compared to any other surgical intervention (p=.001176).

Conclusion:

The current systematic review showed that overall clinical outcomes were positive in lieu of the different modalities of surgical intervention for peroneal tendon tears.
The Triplanar Hallux Abducto Valgus Classification System: Is it Valid?
Authors: Padovano Alexander G. , Lalli Trapper , Tennant Joshua N. , Martin Kevin D. , Santrock Robert D.
Published: January 2022

Category:

Bunion

Introduction/Purpose:

Historically, two-dimensional radiographic study techniques have been used to classify and describe hallux valgus deformities and guided treatment based on severity of deformity in the transverse plane only. These two-dimensional radiographic studies and were not able to assess rotational deformity and may explain the high recurrence and dissatisfaction rates which have been reported. Recently, a triplanar hallux abducto valgus classification (THAVC) system was proposed. This key elements of this classification system are the pathologic alignments in all three anatomic planes. The THAVC system is intended to clarify the deformity and apply a triplanar anatomic algorithm for treatment. To our knowledge, this classification system has not been validated. Our objective was to assess the intra-reader and inter-reader reliability of the THAVC.

Methods:

After approval by the Institutional Review Board, patients with hallux abducto valgus (HAV) were identified from a foot and ankle registry. Electronic medical records and digital radiographs were reviewed by the principal investigator (PI). Selected radiographs were then deidentified of patient information and assembled in a digital slide presentation and presented to the reviewers. The eligibility criteria required complete weightbearing radiographic studies and represented varying degrees of HAV. The reviewers included three board certified, fellowship trained orthopaedic foot and ankle surgeons. Images of twenty cases of hallux valgus and five normal cases were distributed electronically, who independently classified all 25 cases according to the THAVC system for a total of 75 observations. After an eight week washout period, the order of the HAV cases was randomized and redistributed to the reviewers. The three reviewers were blinded to the results of the both radiographic reviews until after statistical analysis had occurred.

Results:

We evaluated the intra-reader consistency by Cohen's kappa for the agreement between two measurements from the same reader. The average kappa value from three readers was 0.241 with 95% CI (0.093-0.374), indicating a fair agreement. The inter-reader agreement was 0.046 with 95% CI (-0.041-0.112), showing poor agreement between readers.

Conclusion:

The Triplanar HAV Classification is the first classification system that utilizes anatomic, multi-plane evaluation. Our results indicate while this is the first known HAV classification system, by this analysis it lacks reliability. This study shows that the reading of 2D radiographs still present a difficulty in assessing a 3D problem. Perhaps a scoring system utilizing advanced imaging such as 3D WBCT could prove more reliable and applicable.
The impact of phacoemulsification surgery on vision-related quality of life in senile cataract patients
Authors: Akpolat Cetin , Demir Mehmet , Cevher Seval , Ozturk Sibel Zorlu , Yesiltas Sumeyra
Published: January 2022

Background:

Phacoemulsification surgery may have beneficial effects on the quality of life of patients with senile cataract. These effects can be evaluated with the help of questionnaires and tests.

Purpose:

To evaluate the effect of the phacoemulsification surgery on the vision-related quality of life (VR-QOL) in patients with senile cataract using the 25-item National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25) and functional independence measure (FIM) tests.

Methods:

The data collection was prospective. NEI-VFQ-25 and FIM tests were measured by a masked ergo-therapist. The patients who underwent phacoemulsification surgery were included in this study. Mean best-corrected visual acuity (BCVA), NEI-VFQ-25 and FIM scores were compared in the preoperative period and at least 3 months after the surgery according to demographic properties including gender, age, education status, as well as the BCVA level and laterality.

Results:

Preoperative mean BCVA and NEI-VFQ-25 composite scores improved significantly ( p < 0.001 and p = 0.001, respectively). All NEI-VFQ-25 subscale scores except the general health ( p = 0.235) and driving ( p = 0.226) showed a significant postoperative increase. The postoperative NEI-VFQ-25 composite scores showed a significant increase in all subgroup analyses ( p < 0.05 for all). Patients with poorer BCVA, bilateral surgery, and low education status had lower preoperative NEI-VFQ-25 composite scores than the patients with better BCVA, unilateral surgery, and high education status ( p = 0.026, p = 0.016, and p = 0.032, respectively). All FIM scores were similar in the preoperative and postoperative periods regardless of subgroup analyses ( p > 0.05 for all).

Conclusion:

Phacoemulsification surgery can provide a satisfying improvement in VR-QOL in patients with cataracts. As a valid and reliable test, the NEI-VFQ-25 scale can be used to measure the visual function after the ocular surgeries.
Management of noninfectious scleritis
Authors: Abdel-Aty Ahmad , Gupta Akash , Del Priore Lucian , Kombo Ninani
Published: January 2022

Scleritis is a manifestation of inflammatory eye disease that involves the sclera. It can be divided into multiple subtypes, including diffuse anterior, nodular anterior, necrotizing, and posterior scleritis. In many cases, scleritis is restricted to the eye; however, it can occur in the context of systemic illness, particularly autoimmune and infectious conditions. Patients with autoimmune conditions, such as rheumatoid arthritis, inflammatory bowel disease, systemic lupus erythematosus, and polyangiitis with granulomatosis, may develop scleritis flares that may require topical and systemic therapy. Initial therapy typically involves oral nonsteroidal anti-inflammatory drugs (NSAIDs); however, it is important to address the underlying condition, particularly if systemic. Other treatment regimens typically involve either local or systemic steroids or the use of immunomodulatory agents, which have a wide range of efficacy and documented use in the literature. There is a myriad of immunomodulatory agents used in the treatment of scleritis including antimetabolites, calcineurin inhibitors, biologics, and alkylating agents. In this review, we highlight the various subtypes of noninfectious scleritis and explore each of the mainstay agents used in the management of this entity. We explore the use of steroids and NSAIDs in detail and discuss evidence for various immunomodulatory agents.
The bidirectional temporal relationship between headache and affective disorders: longitudinal data from the HUNT studies
Authors: Giri Samita , Tronvik Erling Andreas , Hagen Knut
Published: January 2022

Background

Few prospective population-based studies have evaluated the bidirectional relationship between headache and affective disorder. The aim of this large-scale population-based follow-up study was to investigate whether tension-type headache (TTH) and migraine had increased risk of developing anxiety and depression after 11 years, and vice-versa.

Methods

Data from the Trøndelag Health Study (HUNT) conducted in 2006-2008 (baseline) and 2017-2019 (follow-up) were used to evaluate the bidirectional relationship between migraine and TTH and anxiety and depression measured by Hospital Anxiety and depression Scale (HADS). The population at risk at baseline consisted of respectively 18,380 persons with HADS score ≤ 7 and 13,893 without headache, and the prospective data was analyzed by Poisson regression.

Results

In the multi-adjusted model, individuals with HADS anxiety (HADS-A) and depression scores (HADS-D) of ≥8 at baseline nearly doubled the risk of migraine (Risk rations (RR) between 1.8 and 2.2) at follow-up whereas a 40% increased risk (RR 1.4) was found for TTH. Vice versa, the risk of having HADS-A and HADS-D scores of ≥8 at follow-up were increased for TTH (RR 1.3) and migraine (RR 1.3-1.6) at baseline. Migraine with aura was associated with 81% (RR 1.81, 95% 1.52-2.14) increased risk of HADS-A score of ≥8.

Conclusions

In this large-scale population-based follow-up study we found a bidirectional relationship between anxiety and depression and migraine and TTH. For anxiety, this bidirectional association was slightly more evident for migraine than TTH.
Practice effect and test-retest reliability of the Mini-Mental State Examination-2 in people with dementia
Authors: Lee Ya-Chen , Lee Shu-Chun , Chiu En-Chi
Published: January 2022

Background

The Mini-Mental State Examination-Second Edition (MMSE-2) consists of three visions: a brief version (MMSE-2:BV), a standard version (MMSE-2:SV), and an expanded version (MMSE-2: EV). Each version was equipped with alternate forms (blue and red). There was a lack of evidence on the practice effect and test-retest reliability of the three versions of the MMSE-2, limiting its utility in both clinical and research settings. The purpose of this study was to examine the practice effect and test-retest reliability of the MMSE-2 in people with dementia.

Methods

One hundred and twenty participants were enrolled, of which 60 were administered with the blue form twice (i.e., the same-form group, [SF group]) and 60 were administered with the blue form first and then the red form (alternate-form group, [AF group]). The practice effect was evaluated using a pairedt-test and Cohen’sd. The test-retest reliability was examined using the intraclass correlation coefficient (ICC).

Results

For the practice effects, in the SF group, no statistically significant differences were found for the MMSE-2:BV and MMSE-2: EV total scores and eight subtests (p = 0.061–1.000), except for the MMSE-2:SV total score (p = 0.029). In the AF group, no statistically significant differences were found for all three versions of the total scores and subtests (p = 0.106–1.000), except for the visual-constructional ability subtest (p = 0.010). Cohen’sdof all three versions’ total scores and subtests were 0.00–0.20 and 0.00–0.26 for SF group and AF group, respectively. For the test-retest reliability, ICC values for all three versions and eight subtests in SF and AF groups were 0.60–0.93 and 0.56–0.93, respectively.

Conclusion

Our results demonstrated that the practice effect could be minimized when alternate forms of the MMSE-2 were used. The MMSE-2 had good to excellent test-retest reliability, except for three subtests (i.e., visual-constructional ability, registration, and recall). Caution should be taken when interpreting the results of visual-constructional ability, registration, and recall subtests of the MMSE-2.
Unseen, unheard: a qualitative analysis of women’s experiences of exclusively expressing breast milk
Authors: Anders Lisa A. , Robinson Karen , Ohlendorf Jennifer M. , Hanson Lisa
Published: January 2022

Background

Breast milk feeding has numerous benefits for women and infants. Positive maternal experiences with breast milk feeding impacts exclusivity, duration, and maternal mental health. Most research focuses on women feeding directly at the breast. Some women elect to feed exclusively expressed milk to their healthy, term infants rather than feed directly at the breast. Little is known about what constitutes a positive experience among this population. Therefore, the aim of this study was to explore women’s experiences of exclusive expression (EE).

Methods

Interviews were conducted via Microsoft Teams to collect qualitative data from a purposive sample of 21 women practicing EE. Interviews were analyzed for themes.

Results

Three themes: Unseen and Unheard, Doing it My Way, and Getting into the Groove, and 8 subthemes: Breast is Best, Missed Opportunities for Healthcare Provider Support, Fighting for it, What Works for Us, A Sense of Control, Preparation, Tricks of the Trade, and Making it Manageable were identified. Despite challenges, including a lack of support from healthcare providers and a lack of acknowledgement as breastfeeding mothers, exclusive expression offered participants a method to continue breast milk feeding in a way that they found to be satisfying.

Conclusion

This study provides insight into experiences of exclusive expression that clinicians can use to improve their support of breast milk feeding during perinatal encounters. Societal pressure to feed from the breast may have negative emotional consequences for women electing to exclusively express. There is a need for more information and support for breast milk expression from healthcare providers along with a reframing of how breast milk feeding is discussed and promoted.
Fibrinogen/albumin ratio as a promising predictor of platinum response and survival in ovarian clear cell carcinoma
Authors: Chen Wei , Shan Boer , Zhou Shuling , Yang Huijuan , Ye Shuang
Published: January 2022

Background

This study aims to evaluate the role of the fibrinogen/albumin ratio (FAR) in predicting platinum resistance and survival outcomes of patients with ovarian clear cell carcinoma (OCCC).

Methods

Coagulation function and D-dimer, serum albumin, CA125 and HE4 levels were measured before surgery in OCCC patients undergoing initial surgery in our institution. FAR was calculated as fibrinogen/albumin level. The correlation between these indicators and clinicopathological features, platinum response, and survival outcomes was further analyzed. The Kaplan-Meier method and multivariable Cox regression model were used to assess the effects of FAR on progression-free survival (PFS) and overall survival (OS).

Results

Advanced stage patients accounted for 42.1% of the 114 participants. Optimal cytoreductive surgery was achieved in 105 patients, and the complete resection rate was 78.1%. FAR was associated with tumor stage, residual tumor and platinum response. A receiver operating characteristic curve for predicting platinum response showed that the optimal cutoff point of the FAR was 12%. The sensitivity was 73.3% and the specificity was 68.2%. In multivariate analysis, FAR ≥12% (HR = 4.963,P = 0.002) was an independent risk factor for platinum resistance. In addition, FAR and D-dimer proved to be independent negative factors for outcomes including both PFS and OS. The median follow-up time was 52 months. A high FAR (≥ 12%) showed a stronger correlation with poor OS and PFS in the subgroup analysis of advanced and completely resected patients.

Conclusions

The FAR might be a potential preoperative biochemical marker for predicting treatment response and oncological outcomes in OCCC patients.
Development and palliative care staff reactions to a sleep regulation educational intervention
Authors: Capezuti Elizabeth , Zadeh Rana Sagha , Brigham Michael Ames , Dias Brooke Ana , Kim Benjamin Chanhee , Lengetti Evie , Erikson Belle , Swezey Nancy , Krieger Ana C.
Published: January 2022

Background

In palliative care, sleep and circadian rhythm problems are common symptoms. Nonpharmacological interventions are available; however, health care providers are not aware of these or lack the knowledge to effectively implement in practice. This study reports the content and design development of the PRIME™ (Program for Improving & Managing Environments for Sleep) sleep online educational intervention as well as the evaluation of the intervention by practicing nurses with a focus on perceived acceptability and satisfaction.

Methods

Development of the education employed a multi-step process that assesses the current state of the science in this area (literature reviews), the needs of regional target recipients (hospice/palliative care staff), expert recommendations and views of a national pool of hospice/palliative workers. A cross-sectional, descriptive study with key staff informants evaluated the acceptability and usability of the modules using both scale-response items to rate the content and design of the modules and overall satisfaction and five open-response questions to suggest changes to the educational intervention.

Results

Among 31 palliative care professionals, most rated the content and design favorably. A total of 20 participants provided suggestions to improve the educational intervention. Their comments were categorized into six themes: Integration into Practice; Content, Exercises and Material Provided by Modules; User Interface and Design; and Adapt and Expand Modules for Public, Family and Caregivers.

Conclusions

The data suggest that the PRIME™ educational intervention can be an effective tool to train direct-care palliative care professionals on interventions for use in their daily practice. We also demonstrated that the educational intervention is feasible to deliver online and that the online modules appealed to respondents, suggesting that future delivery of the educational intervention can use the same or similar modes of presentation.
Genome-wide analysis of circular RNAs and validation of hsa_circ_0086354 as a promising biomarker for early diagnosis of cerebral palsy
Authors: Hu Yuanyuan , Bian Xuzhao , Wu Chao , Wang Yan , Wu Yang , Gu Xiaoqin , Zhuo Suyan , Sun Shiquan
Published: January 2022

Background

Cerebral palsy (CP) is a spectrum of non-progressive motor disorders caused by brain injury during fetal or postnatal periods. Current diagnosis of CP mainly relies on neuroimaging and motor assessment. Here, we aimed to explore novel biomarkers for early diagnosis of CP.

Methods

Blood plasma from five children with CP and their healthy twin brothers/sisters was analyzed by gene microarray to screen out differentially expressed RNAs. Selected differentially expressed circular RNAs (circRNAs) were further validated using quantitative real-time PCR. Receiver operating characteristic (ROC) curve analysis was used to assess the specificity and sensitivity of hsa_circ_0086354 in discriminating children with CP and healthy controls.

Results

43 up-regulated circRNAs and 2 down-regulated circRNAs were obtained by difference analysis (fold change > 2, p < 0.05), among which five circRNAs related to neuron differentiation and neurogenesis were chosen for further validation. Additional 30 pairs of children with CP and healthy controls were recruited and five selected circRNAs were further detected, showing that hsa_circ_0086354 was significantly down-regulated in CP plasma compared with control, which was highly in accord with microarray analysis. ROC curve analysis showed that the area under curve (AUC) to discriminate children with CP and healthy controls using hsa_circ_0086354 was 0.967, the sensitivity was 0.833 and the specificity was 0.966. Moreover, hsa_circ_0086354 was predicted as a competitive endogenous RNA for miR-181a, and hsa_circ_0086354 expression was negatively correlated to miR-181a expression in children with CP.

Conclusion

Hsa_circ_0086354 was significantly down-regulated in blood plasma of children with CP, which may be a novel competent biomarker for early diagnosis of CP.
Characteristics of the deventilation syndrome in COPD patients treated with non-invasive ventilation: an explorative study
Authors: Lüthgen Mareike , Rüller Stephan , Herzmann Christian
Published: January 2022

Background

Non-invasive ventilation (NIV) is a recommended treatment for COPD patients suffering from chronic hypercapnic respiratory failure. Prolonged dyspnea after mask removal in the morning, often referred to as deventilation syndrome, is a common side effect but has been poorly characterized yet. This study aimed to explore the pathomechanism, identify risk factors and possible treatment strategies for the deventilation syndrome.

Methods

A prospective, controlled, non-blinded study was conducted. After a night with established NIV therapy, the patients underwent spirometry, blood gas analyses and 6-min walking tests (6MWT) directly, at 2 and 4 h after mask removal. Dyspnea was measured by the modified Borg scale. Bodyplethysmography and health-related quality of life (HRQoL) questionnaires were used. Patients suffering from deventilation syndrome (defined as dyspnea of at least three points on the Borg scale after mask removal) were treated with non-invasive pursed lip breathing ventilation (PLBV) during the second night of the study.

Results

Eleven of 31 patients included (35%) met the given criteria for a deventilation syndrome. They reported significantly more dyspnea on the Borg scale directly after mask removal (mean: 7.2 ± 1.0) compared to measurement after 2 h (4.8 ± 2.6; p = 0.003). Initially, mean inspiratory vital capacity was significantly reduced (VCmax: 46 ± 16%) compared to 2 h later (54 ± 15%; p = 0.002), while no changes in pulse oximetry or blood gas analysis were observed. Patients who suffered from a deventilation syndrome had a significantly higher mean airway resistance (Reff: 320 ± 88.5%) than the patients in the control group (253 ± 147%; p = 0.021). They also scored significantly lower on the Severe Respiratory Insufficiency Questionnaire (SRI; mean: 37.6 ± 10.1 vs 50.6 ± 16.7, p = 0.027). After one night of ventilation in PLBV mode, mean morning dyspnea decreased significantly to 5.6 ± 2.0 compared to 7.2 ± 1.0 after established treatment (p = 0.019) and mean inspiratory vital capacity increased from 44 ± 16.0% to 48 ± 16.3 (p = 0.040).

Conclusions

The deventilation syndrome is a serious side effect of NIV in COPD patients, characterized by increase of dyspnea. It is associated with decrease in vital capacity, exercise tolerance after mask removal and lower HRQoL. Patients with high airway resistance are at greater risk of suffering from morning dyspnea. Ventilation in PLBV mode may prevent or improve the deventilation syndrome.

Trial registration: The study was registered in the German Clinical Trials Register (DRKS00016941) on 09 April 2019.