bluuebunny/crossref_metadata_2025 huggingface dataset:
Change in Grip and Pinch Strength Over the Course of a Game in Professional Baseball Pitchers
Authors: Erickson Brandon J. , Buchheit Paul , Rauch Joseph , Ciccotti Michael G. , Paul Ryan , Cohen Steven B.
Published: December 2024

Background:

Baseball pitching injuries can be related to fatigue. Changes in grip and pinch strength over the course of professional baseball games are unknown.

Hypothesis:

Grip and pinch strength will decrease as the number of innings pitched increases; injured pitchers will have a lower grip strength than uninjured pitchers.

Study Design:

Prospective cohort study.

Level of Evidence:

Level 3.

Methods:

Minor league pitchers for 1 affiliate of a single organization were included. Changes in dominant and nondominant grip, and middle and index finger pincer strength were recorded pregame and after each inning, and compared between players who sustained a shoulder/elbow injury and those who did not.

Results:

Of 41 pitchers included, 6 sustained a shoulder (n = 2) or elbow (n = 4) injury during the study period. Average grip strength for all pitchers was 124.5 ± 17 lb pregame and increased slightly after the first inning (125.2 ± 17 lb), then declined slowly after the second (120.7 ± 18.5 lb), third (119.2 ± 24 lb), and fourth (113.1 ± 19.6 lb) innings. There was a slight uptick in grip strength in the fifth (118.5 ± 23.6 lb) and sixth (121.3 ± 21.8 lb) innings, but pregame levels were not reached. Evaluating uninjured and injured pitchers, the grip strength of injured pitchers was lower at all timepoints. As a percentage of uninjured pitchers grip strength, injured pitcher grip strength was 94.8% pregame, and 97.9%, 95.4%, 81.8%, 87.7%, 82.3%, and 74.5% after the first to sixth innings, respectively.

Conclusion:

Dominant arm grip strength generally declined over the course of a game in professional baseball pitchers. Injured pitchers generally had weaker grip strength and a steeper decline in grip strength during games compared with uninjured pitchers.

Clinical Relevance:

Incremental loss of grip strength may increase injury risk in professional baseball pitchers.
Clinical utility of plasma microbial cell-free DNA sequencing in determining microbiologic etiology of infectious syndromes in solid organ transplant recipients
Authors: Shah Jesal R. , Sohail Muhammad Rizwan , Lasco Todd , Goss John A. , Mohajer Mayar Al , Khalil Sarwat
Published: December 2024

Background:

Metagenomic next-generation sequencing (mNGS) is increasingly being used for microbial detection in various infectious syndromes. However, data regarding the use of mNGS in solid organ transplant recipients (SOTR) are lacking.

Objectives:

To describe and analyze real-world clinical impact of mNGS using plasma microbial cell-free DNA (mcfDNA) in SOTR. Design: Retrospectively reviewed all adult SOTR who underwent mNGS testing using plasma mcfDNA at Baylor St Luke’s Medical Center from March 2017 to February 2023.

Methods:

Clinical impact (positive, neutral, and negative) was assessed using standardized objective criteria. Three Infectious Diseases physicians independently performed clinical adjudication to determine the correlation of mcfDNA results with clinical diagnosis. A descriptive analysis of the patient and clinical characteristics was performed.

Results:

A total of 113 mcfDNA tests in liver (42%), kidney (35%), lung (20%) and heart (13%) transplant recipients were performed in the study period. The most common clinical syndromes were pneumonia (36%), fever of unknown origin (16%), and intra-abdominal infections (15%). Most (80, 71%) of the mcfDNA test results were positive for microorganisms. Twenty-seven (24%) cases were classified as positive clinical impact, 82 (73%) were neutral and 4 (3%) were negative, respectively.

Conclusion:

In SOTR, mcfDNA sequencing can add a positive clinical impact in a quarter of the cases and identify microorganisms beyond conventional microbiological testing across clinical syndromes. The negative clinical impact was rare. However, larger prospective studies are needed to define the optimal timing and utilization of mcfDNA in the sequence of diagnostic evaluation for syndrome-specific workup in SOTR.

Metagenomic next-generation sequencing (mNGS) is a novel diagnostic tool that can identify difficult-to-detect microorganisms in SOTR. Our study demonstrates that the mNGS test resulted in a positive clinical impact in 1 out of 4 patients.
Two case reports of MDA5-type seronegative dermatomyositis
Authors: Balogh Lauren C , Chan Airiss R , Yacyshyn Elaine A , Gniadecki Robert
Published: December 2024

Dermatomyositis (DM) is an autoimmune idiopathic inflammatory myopathy with characteristic dermatologic manifestations. Myositis-specific autoantibodies (MSAs) delineate DM subtypes and their prognoses. Uncommonly, patients present with distinct clinical features of DM, including photosensitive dermatitis, heliotrope rash, Gottron’s papules, and nailfold changes; however, their autoimmune serology is negative for expected MSAs. Herein, we describe two unconventional cases of seronegative, amyopathic MDA5-DM and offer potential explanations, including fluctuating antibody levels, non-MSA pathophysiology, and limitations in current immunoassays.
Xi–Biden Summit coverage: Chinese media frames for global and domestic readers
Authors: Zhang Xiaoling , Shaw Gareth
Published: December 2024

Situated against the recent tumultuous backdrop of Sino–U.S. relations, this study examines the coverage of the November 2023 Xi–Biden Summit by the People’s Daily and China Daily. As authoritative, national-level media outlets reflecting party policies, the People’s Daily, published in Chinese, primarily caters to a domestic audience, while China Daily, in English, targets an international readership. Using framing analysis grounded in agenda-setting theory, this paper investigates how these two outlets presented the summit to foster public support for China’s U.S. policy, particularly after a decade of predominantly negative portrayals. The study examines which aspects were emphasized, downplayed, or omitted and identifies key similarities and differences in their approaches, considering the implications for their respective audiences. Our findings show that both the People’s Daily and China Daily portrayed the summit positively, highlighting President Xi’s diplomatic efforts and China’s commitment to constructive engagement with the United States. This approach emphasizes China’s growing global influence and its willingness to work with other major powers. However, while the People’s Daily focused on areas of agreement and cooperation for domestic readers, China Daily also addressed contentious issues by employing conflictual frames in line with Western news conventions. Additionally, China Daily emphasized cultural elements underscoring China’s heritage and civilization. This study offers valuable insights into how state media outlets frame and interpret such diplomatic events, revealing the nuances of Chinese media narratives and their impact on domestic and international audiences.
Less is More: Investigating Fragmented Life Narratives on the Humans of New York Facebook Page
Authors: Guo Li
Published: December 2024

This article explores social media engagement of fragmented life narratives. Specifically, representative comment threads below the posted story with the greatest number of comments on the Humans of New York Facebook page is scrutinized mainly utilizing a social-construction-centered division of narrative analysis. Ochs and Capps’ Dimensions of Living Narratives combined with Labov’s Six Part Model are employed as both theoretical framework and methodological approaches of the analysis. Main findings of this article are as follows: (1) Personal experiences in fragmented life narratives are socially forged and mobilized, namely become impersonal. (2) De-personalization and social forge are both reinforced by and resistant to the culture of social media. (3) Methodologically, this article demonstrates the boundary between divisions in narrative analysis is flexible and fluid. This research aims to uncover the intricate interplay between life narratives and social media and add nuance to the emerging field of narrative inquiry in the digital environment.
Form of Marriage as a Predictor of Intimate Partner Violence among Married Women in North-Central, Nigeria
Authors: Sulaiman Lanre Abdul-Rasheed
Published: December 2024

Intimate partner violence (IPV) is a serious social problem with devastating psychological, physical, and economic consequences. While various studies have investigated the causes of IPV, the influence of the type of marriage contracted has not been well explored. Thus, the study investigated the influence of the type of marriage contracted on IPV among married people in north-central Nigeria. The study adopted a cross-sectional survey method. The study population comprised married women who were 15 years of age and older and resided in north-central Nigeria. A multi-cluster sampling method was used to select the respondents for the survey. Both descriptive and inferential statistics were used to analyse the survey data. The descriptive statistics revealed that 67.5% of the sample experienced intimate partner violence in their current marital relationship. As for the form of intimate partner violence, the descriptive statistics revealed that 51%, 30.5%, and 19% of the respondents, respectively, experienced emotional, physical, and sexual IPV in their current marital relationship. The multivariate logistics regression model showed that women who engaged in forced marriage had 8.871 odds of experiencing IPV; women whose husbands had concubines had 23.504 odds of experiencing IPV; women who did court or civil marriage had 3.423 odds of experiencing IPV; and women in monogamous marriages had 1.505 odds of experiencing IPV. Household decision-making was also related to IPV. The study’s findings are germane because they can provide information for the creation of laws and initiatives that aim to stop violence against women.
A Semiotic Model to Investigate Sensory Metaphors by Comparing Architectural Photorealistic Rendered Images and Actual Constructed Buildings
Authors: Kayalar Rasiha , Uluğ Erçim
Published: December 2024

Photorealistic rendered images are the visuals of an architectural project which is not constructed but its design process is completed. They are presented to society and clients to represent what the building will look like. These images are typically presented to the public as a marketing strategy. In this regard, the photorealistic rendered images are pre-imaging of the actual constructed building. However, it is important to understand if these two mediums (dimensions) are semantically connoted same or different. Therefore, this research aims to analyse and understand these possible similarities and differences. It aims to reveal the metaphoric differences in terms of “architectural experiences” by a developed model in semiotics which is based on analysis of user experience’s systematic codification. In conclusion, this paper develops a research method that aims to demonstrate the connotation differences and it discusses how the mental attitude can be affected. In this regard, it explains how the representations of photorealistic renders create positive but misleading user experiences.
Examining How Electronic Word-of-Mouth Information Influences Customers’ Purchase Intention: The Moderating Effect of Perceived Risk on E-Commerce Platforms
Authors: Cuong Dam Tri
Published: December 2024

The fast expansion of the information technology industry has removed the limitations of time and location for Internet users. Individuals now use electronic word-of-mouth (eWOM) while engaging online, especially on community-focused platforms such as e-commerce websites (Shopee, Lazada, TikTok Shop, etc.). This research investigates how eWOM information influences customers’ purchase intentions on e-commerce platforms, using the Information Acceptance Model (IACM). Additionally, the research investigates how perceived risk moderates its impacts on the usefulness of information and its acceptance, as well as the connection between acceptance of information and the desire to buy. The proposed model was validated using partial least squares (PLS) via data from 339 respondents interested in eWOM information during online purchases on e-commerce websites in Vietnam. Based on the findings, the usefulness of information was positively impacted by factors such as its quality, credibility, information needs, and attitude towards information. The usefulness of information positively influenced its acceptance. Similarly, the acceptance and attitude towards information positively impacted purchasing intention. Perceived risk performed as a negative moderator in the association involving the usefulness of information and its acceptance, as well as in the link between information acceptance and purchase intention.
A Study on English Language Teachers’ Lexical Attrition in Chinese Contexts
Authors: Hu Qiqin , Kouider Bochra
Published: December 2024

Research in the field of language attrition suggests that the use of a foreign language (FL) diminishes among language learners when it ceases to be actively employed. The present study aimed to investigate whether similar patterns of lexical attrition occurred among FL teachers, who were generally considered to possess a strong resistance to FL attrition. Specifically, this study sought to explore issues related to lexical attrition in the FL competence of English as a Foreign Language (EFL) teachers within Chinese educational contexts. A questionnaire consisting of 34 items and a self-report scale on vocabulary were administered to a sample of 105 EFL teachers from 43 junior high schools in China, accompanied by interviews with 10 participants. The results revealed that five factors, namely teachers’ language contact, initial language proficiency, teachers’ concerns about maintaining language proficiency, teachers’ attitudes toward language learning, and artificially-intervened language use, accounted for 42% of the total variance and significantly influenced EFL teachers’ lexical attrition. Notably, initial language proficiency and language contact emerged as the most influential predictors of lexical attrition among teachers. These findings indicated that EFL teachers’ lexical attrition closely resembled that observed in other FL learner groups in China, which might have adverse implications for FL education in diverse ways. This research would provide valuable insights for improving the professional development of EFL teachers and enhancing FL education in such contexts.
Perspectives of Canadian Plastic Surgeons on the Surgical Management of Pressure Injuries
Authors: Opingari Erika , Laurent Romain , Wan Ho Yee , Wallace David L. , Rogers Alan D.
Published: December 2024

Introduction: Pressure injuries, particularly among patients with spinal cord injuries and the elderly, significantly contribute to morbidity, mortality, and financial sequelae. Surgical interventions, including debridement and flaps, may improve outcomes, especially for stage 3 and 4 pressure injuries. This survey assesses Canadian plastic surgeons’ perspectives and practices regarding the surgical management of these injuries. Methods: A web-based survey was distributed to 405 registered members of the Canadian Society of Plastic Surgeons (CSPS) and remained open for a 6-week period. The 16-question survey explored management practices for pressure injuries and the training associated with resident education. Results: Responses from 129 surgeons (31.8%) were analyzed. Of these, 85% manage stage 3 or 4 pressure injuries, though only 67.5% performed both debridement and flap coverage. The majority believe care should ideally occur in community facilities with plastic surgery coverage rather than being centralized in academic centers, although careful patient selection, perioperative planning, and rehabilitation are critical to justify the surgical investment. Most respondents (83%) agreed that plastic surgery residents should be proficient in both debridement and flap coverage by the end of their training. Conclusion: The survey indicates that most surgeons prefer managing pressure injuries in facilities with adequate plastic surgery support rather than exclusively at academic centers. However, structured management pathways and enhanced training in pressure injury care remain crucial. Future healthcare policy and research should focus on improving care delivery and patient outcomes, ensuring that all facilities involved in this care are equipped with the necessary resources and multidisciplinary expertise.
BCG therapy for bladder cancer: Exploring patient experiences and concerns through artificial intelligence-based social media analysis
Authors: Khene Zine-Eddine , Tachibana Isamu , Bhanvadia Raj , Ausmann Hagan , Margulis Vitaly , Lotan Yair
Published: December 2024

Background

There is a notable disparity between the guidelines for BCG therapy in non-muscle invasive bladder cancer (NMIBC). Reddit has emerged as a popular online platform for individuals seeking information and exchanging their experiences related to bladder cancer.

Objective

To investigate and classify public opinions about intravesical BCG therapy as shared on Reddit, a popular social media platform.

Methods

This study employed an artificial intelligence-based approach to examine discussions related to intravesical BCG therapy on a social media platform over the past ten years. An artificial intelligence framework was developed to categorize these conversations into distinct topics and thematic categories. This framework included a partially supervised model for processing natural language (using BERT [Bidirectional Encoder Representations from Transformers]), a method for reducing data complexity, and an algorithm for clustering. Additionally, each conversation was assessed for sentiment.

Results

A total of 1223 unique discussions related to BCG therapy were analyzed, comprising 110 unique posts and 1113 comments from 268 distinct authors. We identified four overarching thematic groups: 1) BCG administration procedures, (2) hesitancy in initiating or maintaining BCG treatment, (3) issues related to BCG shortage and alternative treatments, and (4) side effects of BCG treatment. Sentiment analysis of the 1223 discussions revealed that 25.2% (308) exhibited a negative sentiment, 58.3% (713) were neutral, and 16.5% (202) showed a positive sentiment.

Conclusion

Online social media often contains detailed personal experiences with BCG therapy, not commonly found in medical literature. Understanding these experiences can help medical professionals improve care and treatment adherence in NMIBC.
Biomechanical Comparison of Nitinol Compression Staples vs Fully Threaded Lag Screws for Talonavicular Arthrodesis Following 24-Hour Incubation at Body Temperature
Authors: Garlapaty Ashwin , Cook James , Bezold Will , Schweser Kyle M.
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

Arthrodesis of the talonavicular joint is indicated for injury- and arthritis-related pain. The standard treatment for talonavicular arthrodesis is lag screw fixation. Despite favorable results using lag screw fixation, it is associated with significant effects on foot biomechanical motion, and suboptimal complication rates. Nitinol staples have been used for talonavicular arthrodesis for their potential to address shortcomings of lag screw fixation. This study tested the null hypothesis that nitinol staples would not be significantly different from fully threaded lag screws based on biomechanical properties.

Methods:

Cadaveric feet (n=10) were acquired from 5 donors. Either nitinol staples or two cannulated lag screws were used to perform surgical arthrodesis of the talonavicular joint. Samples were incubated for 24-hours at 38°C, allowing for activation of the thermal nitinol compression properties. 38°C was chosen to mimic in vivo conditions. Biomechanical motion analysis was conducted. Specimens were loaded to 445N and held for 1 minute. A continuous compressive load of 445N was applied while cycling between plantarflexion to dorsiflexion for 10 cycles and then inversion to eversion for 10 cycles. Data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p< 0.05) differences were determined.

Results:

No statistically significant differences in functional biomechanical testing properties were noted between nitinol compression staple fixation and lag screw fixation for talonavicular arthrodesis following 24 hours of incubation. Static compression, plantarflexion, dorsiflexion, inversion, and eversion testing resulted in nonsignificant translation in the X, Y, and Z planes, as well as nonsignificant rotation in roll, pitch, and yaw directions.

Conclusion:

Based on clinically relevant biomechanical properties measured during robotic testing, nitinol staples can be considered an appropriate option for talonavicular arthrodesis. Further work to assess long term outcomes of nitinol compression staples for talonavicular arthrodesis is currently ongoing. Biomechanical Data Mean translation and rotation for static and dynamic cyclical compression testing in plantarflexion, dorsiflexion, inversion, and eversion of the foot to assess talo- navicular arthrodesis fixation.
Comparing Intraoperative and Postoperative Complications of Shape-Memory Nitinol Staples for Arthrodesis Across the Midfoot and Hindfoot
Authors: Balu Abhinav R. , Dalloul John M. , Shen Peter C. , Bergman Rachel , Chang Shaun , Kelikian Armen , Patel Milap , Kadakia Anish R. , Mutawakkil Muhammad Y.
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

Shape-memory nitinol staples are an increasingly common construct used for arthrodesis of the foot. In evaluating this new construct, a comprehensive understanding of the various complications associated with staple arthrodesis is necessary in addition to overall fusion outcomes. Therefore, the purpose of this study is to analyze complications associated with staple arthrodesis across the midfoot and hindfoot to determine if any differences exist in the rate of complications between these two joint complexes.

Methods:

This IRB approved retrospective cohort study examined patients from a single institution who underwent midfoot or hindfoot arthrodesis between 2013 and 2023. Inclusion criteria mandated postoperative CT scans for fusion assessment, excluding those without scans or lost to follow-up. Complications of interest were non-union requiring revision, infection, symptomatic hardware removal, and DVT occurrence. Statistical analysis was performed with ANOVA and t-tests using Python 3.11.7 and Microsoft Excel.

Results:

A total of 29 patients underwent arthrodesis across 39 joints in the midfoot while 31 patients underwent arthrodesis across 60 joints in the hindfoot with either staples alone or staples and screws. There was no significant difference in the rate of overall complications between joints fused with staples in the midfoot (9.5%) as compared to the hindfoot (11.1%). Likewise, there was no significant difference in complication rates for joints fused with screws and staples between the midfoot (33.3%) and hindfoot (24.2%). There was no significant difference in rates of staple mechanical failure, with staples breaking at similar rates in both the midfoot (10.3%) and hindfoot (8.3%).

Conclusion:

The complication rate of isolated staples as a fixation construct does not differ significantly between the midfoot and the hindfoot. The same is true of joint staple and screw constructs. However, overall rates of complications are high for joint staple and screw constructs, warranting further investigation with larger datasets.
Comparison of Short-Term Reoperations, Complications, and Failures Using Non-Stemmed vs Stemmed Implants for Total Ankle Arthroplasty in Patients with Deformity
Authors: Ahmad Heba , Shofoluwe Ade , Gauvain Taggart , McGarvey William , Greaser Michael C.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The purpose of this study is to investigate potential differences in short term complications, reoperations, and failure in stemmed versus non-stemmed total ankle arthroplasty implants in patients with varying degrees of coronal plane deformity.

Methods:

A four year retrospective chart review of patients at a single academic institution (January 2018 – January 2022) with a minimum of 1 year clinical follow up was performed. Patients’ pre and post operative coronal alignment was measured from mortise weightbearing radiographs using the midline tibiotalar angle. These alignment angles were separated into three categories of pre-operative deformity: < 10 degrees, 10-20 degrees, and >20 degrees for both stemmed and non-stemmed total ankles implants. Each of those categories have total cases, and failure/complication sub-category for each subset of deformity. Medical records were reviewed to determine the incidence of complications, reoperations, and revisions. Radiographic analysis included preoperative and postoperative tibiotalar alignment, tibial implant positioning, the presence of periprosthetic radiolucency or cysts, and evidence of subsidence or loosening.

Results:

Preliminary data reveals that stemmed implants have a higher incidence of reoperations/complications overall, with more reoperations/complications in the < 10 degree and 10 – 20 degree data set. Our preliminary data also shows that in patients with high degree of deformity (>20 degrees), stemmed implants have a lower incidence of reoperation/complications.

Conclusion:

Preliminary data shows that in patients with higher degree of deformity (>20 degrees), stemmed implants have a lower incidence of reoperation/complications, however more data from our retrospective study will be gathered to draw a more definitive conclusion. Multiple factors play a role in determining whether a patient should receive a stemmed versus non stemmed total ankle arthroplasty implant. Various patient factors also play a role in the outcomes of total ankle arthroplasty in patients with deformity. Patients with higher degrees of coronal plane deformity may benefit from stemmed total ankle implants.
Comparison of X-ray and Computed Tomography Scan in the Diagnosis and Classification of Tillaux-Chaput Fractures in Adults
Authors: Massri-Pugin Jafet , Matamoros Gabriel , Morales Sergio , Lira María Jesús , Mery Pablo , Díaz Gonzalo , Filippi Jorge
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Anterolateral distal tibial fractures, also known as Tillaux-Chaput fractures (TCF), have slowly gained attention, considering the risk of chronic pain and osteoarthritis if not appropriately managed. This study aimed to compare the diagnostic accuracy of ankle radiographs in diagnosing and classifying TCF with computed tomography (CT) scans in the adult population.

Methods:

A retrospective review of ankle fractures evaluated at a single institution between 2013-2023 was performed. Inclusion criteria were patients aged >18 years and evaluation with ankle radiographs and CT scan. Exclusion criteria were distal tibial/pilon fractures,or prior ankle surgery. A matching 1:2 was performed on patients with and without TCF. A radiologist evaluated the TCF under CT scan and classified the fractures according to Rammelt’s classification: type 1,extraarticular avulsion; type 2,fracture with involvement of the incisura; type 3, fracture with impaction of the anterolateral plafond. His answers were used as a comparison parameter. Three foot and ankle surgeons assessed the radiographs and described if the TCF was present (yes/no). If present, they classified the TCF by subtype. The sensitivity(Sn), specificity(Sp), positive predictive value(PPV), and negative predictive value(NPV) of the radiographs for detecting TCF were calculated. Fleiss's Kappa coefficient measured the interobserver agreement for each subtype. P-values < 0.05 were considered significant.

Results:

1134 acute ankle fractures were initially evaluated, of which 481 met the eligibility criteria. The prevalence of TCF was 17.3% (83/481), with 37 (44.6%) type 1, 37 (44.6%) type 2, and 9 (10.8%) type 3. Using radiographs, the overall Sn, Sp, PPV, and NPV for the diagnosis of TCF were 50.2% (95% CI 45.8-54.6), 69.9% (95% CI 65.9-73.9), 62.5% (95% CI 58.3-66.8%), and 58.4% (95% CI 54.1-62.7), respectively. There was disagreement between surgeons using X-rays and the radiologist under CT scan for all subtypes (type 1: κ -0.54, type 2: -0.31, type 3: -0.27, p< 0.001). Under CT scan, the global interobserver agreement was moderate for the TCF classification (κ 0.62) and its subtypes.

Conclusion:

This study demonstrated that ankle radiographs have low diagnostic accuracy for TCF in adults. Therefore, a CT scan should be routinely used when a TCF is suspected.
Comparisons of the Therapeutics for Diabetic Neuropathic Pain: Prospective Cohort Study, Seoul, Korea
Authors: Ahn Jiyong , Shahriarirad Reza , Kwon Kyeongeon , Bejarano-Pineda Lorena , Waryasz Gregory R. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

Treating chronic diabetic peripheral neuropathic pain poses significant clinical challenges due to variable outcomes and failed trials, along with the difficulty in objectively evaluating improvement and accounting for confounding factors. This study aims to investigate the treatment outcomes of three drugs (pregabalin, gabapentin, duloxetine) for chronic diabetic peripheral neuropathy.

Methods:

From June 2019 to June 2021, 180 patients with type 2 diabetes diagnosed with diabetic peripheral neuropathic pain received treatment with pregabalin, gabapentin, or duloxetine. The study protocol was approved by the institution’s IRB. Patients were consented and enrolled in a single Korean - center, prospective, randomized cohort study with 60 participants per drug group. Treatment lasted for 3 months, and participants were randomly assigned to groups at a 1:1:1 ratio using 3-multiple block randomization. Group 1 received Gabapentin (300mg bid), Group 2 received Pregabalin (75mg bidX mg ), and Group 3 received Duloxetine (30mg bid PO daily). Efficacy and safety were assessed every 2 weeks over a 6-week period. Baseline assessments included lipidemia profile, blood viscosity tests, BUN/Cr, OT/PT, and HbA1c. Clinical evaluations were performed using the Korean version of pain DETECT, categorizing degrees of improvement.

Results:

All treatments significantly improved painDETECT scores at 6 weeks of medication compared to their baseline (p=0.001). The mean HbA1c of the three groups showing symptomatic improvement by more than 50% was 9.424 (95% CI, 8.17-10.68) for Group 1, 10.430 (95% CI, 8.65-12.21) for Group 2, and 7.718 (95% CI, 6.74-8.70) for Group 3. There was no significant difference in HbA1c between Groups 1 and 2 regarding symptom improvement by more than 50%. However, the HbA1c of Group 3 was significantly lower than that of Groups 1 and 2 (p=0.001). Improvement of the symptom over 50% varied with HbA1c levels among three groups (p=0.001) . Adverse effects such as dizziness and nausea were significantly higher in the duloxetine group compared to pregabalin and gabapentin groups (p=0.001).

Conclusion:

All three medications effectively alleviated chronic diabetic peripheral neuropathic pain compared to their baseline level with no difference between the groups. However, HbA1c levels could be considered when selecting drugs because the HbA1c level when symptoms improve is different between the gabapentin, pregabalin, and duloxetine groups. There was no significant difference in the improvement of painDETECT scores in the three treatment groups up to the second week. However, by the sixth week, the pregabalin and duloxetine groups exhibited significantly more improvement in painDETECT scores than the gabapentin group (p=0.001).
Contribution of the Anterior Talofibular Ligament on Ankle Joint Stability: A Finite Element Study
Authors: Minagawa Akinobu , Ito Kohta , Ogihara Naomichi , Kubota Makoto , Kimura Tadashi , Kihara Takumi , Saito Mitsuru
Published: December 2024

Category:

Ankle; Basic Sciences/Biologics

Introduction/Purpose:

Ankle sprains typically occur when the ankle twists inward, with 73% involving damage to the ankle's lateral ligaments, and 20-40% progressing to chronic ankle instability (CAI). Repairing the anterior talofibular ligament (ATFL) has shown favorable outcomes postoperatively for CAI, suggesting the crucial role of the ATFL in ankle stability. However, it still remains unclear how the ATFL contributes to ankle stability. The present study aims to clarify the contribution of the ATFL to ankle stability through a three-dimensional (3D) finite element analysis of an anatomical foot model.

Methods:

We constructed a 3D finite element model of the human foot by extracting foot bones and the outer surface of the foot from computer tomography images, which were then meshed with tetrahedral elements. Material properties of bones and soft tissues were assigned based on existing literature. Ligaments surrounding the ankle and foot joints, as well as the plantar aponeurosis, were represented using tension-only truss elements. Surface-to-surface contacts between bones were modeled with a frictionless contact approach. The proximal ends of the tibia and fibula were anchored in the space, while external forces were applied to the calcaneus in the anterior and medial directions. We calculated the resulting translational and rotational movements of the foot bones in response to these forces. To examine the role of the ATFL in ankle joint stability, we repeated the calculations with the ATFL removed from the foot model.

Results:

When anterior external forces were applied, both the intact and ATFL-removed models exhibited forward talus translation and inversion rotation. However, in the latter, these movements were notably more pronounced due to the absence of the ligament connecting the distal fibula to the talus in the anteroinferior direction. The talus exhibited differing displacement patterns from the early stages of forward loading in the ATFL-removed model. Similarly, under the medial external force, larger talus inversion was observed in the ATFL-removed model. The present study demonstrated that the ATFL plays a crucial role in maintaining stability of the ankle joint when external forces are applied in the forward and/or medial directions to the foot.

Conclusion:

The ankle joint movements observed in the ATFL-removed model were consistent with what is seen in clinical settings and supported by existing research. The direction of talar displacement during loading seems to be linked to the structure of the ATFL, suggesting ankle joint instability. These findings enhance our understanding of the effects of ATFL on CAI and may provide insights into the underlying pathology of ankle joint disorders associated with ATFL injury.
Conversion Painful Ankle Arthrodesis to Total Ankle Arthroplasty: Case Series and Literature Reviews
Authors: Chen Jen-Hung
Published: December 2024

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

Pain following an ankle arthrodesis continues to be a challenging problem. Degenerative changes in the adjacent joints also have been reported by several authors. Extending the fusion to the hindfoot may increase the nonunion rate and, hence, undermine the results of the procedure, while limiting function. Given the complexity of this clinical situation, conversion total ankle arthroplasty (TAA) has arisen as a valid treatment choice.

Methods:

From 2018 to 2023, twelve total ankle arthroplasties with Inbone II (Wright Medical Technology, Arlington, Tennessee) were performed in patients who had undergone a prior ankle arthrodesis. Five of them were nonunion of previous ankle arthrodesis and seven of them were due to adjacent hindfoot arthritis. The mean period of ankle arthrodesis status was 18.5 years (range, 1 to 26). The mean age was 63.7 years old (range, 55 to 77). The preoperative ankle joint weight-bearing plain films, lower limbs split scanography and CT were obtained. Due to hindfoot adjacent arthritis following previous ankle arthrodesis, concomitant subtalar arthrodesis was performed in all three patients and talonavicular arthrodesis was performed in two patients. Immediate weight bearing ambulation with protection was allowed postoperatively. The mean follow-up duration was 42.6 months (range, 8 to 65).

Results:

The mean visual analog scale pain score improved from 75 preoperatively to 10 at the latest follow up. The mean AOFAS hindfoot score increase from 32.5 to 76. The mean range of motion of ankle joints from 5.2 degree (range, 0~10) to 37.5 degree (range, 20~50). Eleven patients were satisfied with the results, but one were still unsatisfied. Preoperative pain improved much more about 6 weeks postoperatively and gait improved about 3 months postoperatively. No complications including infection, wound poor healing, or early prosthesis failure were found during follow-up.

Conclusion:

Ankle arthrodesis takedown with conversion to TAA has been proposed to patients with pain related to an ankle arthrodesis in an effort to improved functional outcomes. Short-term follow-up after conversion of ankle arthrodesis to TAA demonstrated pain relief and improved function in a majority of patients. The rate of complications, particularly talar component settling and migration, is cause for concern. By means of takedown ankle arthrodesis to TAA and arthrodesis of the hindfoot adjacent arthritic joints simultaneously, the ankle joint movement was regained and hindfoot pain was relieved. Long-term follow up is still needed.
Distance Mapping of Subtalar Joint after Total Ankle Arthroplasty - A Pilot Study
Authors: Acker Antoine , Scala Victoria A. , Talaski Grayson M. , Luo Emily Joan , Wu Kevin , Carvalho Kepler A.M. , Acker Antoine , Casas Erik Jesus Huanuco , Valvecchi Tommaso Forin , Easley Mark E. , de Cesar Netto Cesar
Published: December 2024

Category:

Hindfoot; Ankle Arthritis

Introduction/Purpose:

Patients with ankle arthritis often present with concomitant subtalar joint deformity, as the subtalar joint may compensate for ankle malalignment. This compensation in the subtalar joint may manifest as joint space narrowing and sinus tarsi impingement. The objective of this study was to use 3D distance maps (DMs) from weightbearing computed tomography (WBCT) images to see if altering alignment of the tibiotalar joint with total ankle arthroplasty alters alignment of the subtalar joint. We hypothesized that, in patients with ankle arthritis, improving alignment of the tibiotalar joint from total ankle arthroplasty would increase the mean distances across the subtalar joint, indicative of improved alignment.

Methods:

A retrospective review of WBCT data of randomly selected patients who underwent total ankle arthroplasty between February 2022-July 2023 was performed as a pilot study. Using principal components analysis, the calcaneus was divided into 9 regions on the posterior facet, 4 regions in the sinus tarsi, 1 region in the middle facet, and 1 region in the anterior facet of the subtalar joint, as shown in Figure 1. 3D distance technique was used to objectively measure joint space across the subtalar joint. DMs were measured in millimeters, and DMs of the posterior facet and sinus tarsi were also averaged. Descriptive analysis was performed.

Results:

A total of 15 patients were included – 10 patients with preoperative and 5 patients with postoperative WBCT scans. The mean DMs in all regions increased postoperatively, showing a trend toward improved alignment. The greatest change in mean DM was seen in the middle facet articulation, from 1.78 mm preoperatively to 2.44mm postoperatively. The sinus tarsi was the second highest change, from a mean DM of 2.45 mm preoperatively to 2.80 postoperatively.

Conclusion:

This pilot study demonstrates that improved tibiotalar alignment through total ankle arthroplasty results in changes in the subtalar joint. Further study with adequate power is warranted to quantify the effect that improved tibiotalar alignment has on subtalar alignment.
Effect of Arthrodesis of the First-Metatarsophalangeal Joint on the Alignment and Stability of the First-Tarsometatarsal Joint: A Large Sample-Sized Radiographic Study
Authors: Guo Yi , Hirpara Ankit , Zhu Mingjie , Carpenter Melissa L. , Joseph Stephan , Huo Donglai , Singh Navsharan , Mardakhaev Edward , Hunt Kenneth , Myerson Mark , Li Shuyuan
Published: December 2024

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

The hallux metatarsophalangeal (MTP) joint plays an important role in maintaining mobility of the first ray and arthrodesis of this joint is used to treat a variety of deformities. Intuitively, fusion of a joint may cause instability of an adjacent joint, however, recent studies have shown that hallux MTP arthrodesis in patients with hallux valgus can improve the stability of the first-tarsometatarsal (TMT) joint. The goal of this study was to investigate the impacts of hallux MTP arthrodesis on the alignment of the first TMT joint in a large sample-sized cohort.

Methods:

This was a retrospective study that included one group of patients without hallux valgus (Control Group ) and one group with hallux valgus deformity. Pre-operative and six-month post-operative weight-bearing radiographs were used to evaluate the alignment of the hallux and the first TMT joint. The parameters included the hallux valgus angle (HVA), 1-2 intermetatarsal angle (IMA), first metatarsal–medial cuneiform angle (1MCA), medial cuneiform–first metatarsal angle (MC1A), relative cuneiform slope (RCS), and distal medial cuneiform angle (DMCA). A paired t-test was used to study the impact of first MTP arthrodesis on the above parameters, and an independent t-test was used to compare the difference of the surgical effect on those parameters between the two groups. Possible linear regression relationship was analyzed among those variants.

Results:

There were 32 patients in the control group (age 57.93 ±9.07) and 62 patients in hallux valgus group (age 65.26± 12.84). In control group, except for HVA, there was no change in any of the above parameters between the pre and post surgical images; while in hallux rigidus group, the HVA, IMA, 1MCA, MC1A, and RCS were significantly reduced after surgery (p < 0.05). The RCS increased slightly in control group, but decreased significantly in hallux rigidus group (p < 0.05). Between the two groups, there was a significant difference in the impact of surgery on HVA, IMA, MC1A and RCS. In hallux rigidus group, correlation detected between pre-post operative IMA with HVA and MC1A, HVA with 1MCA, 1MCA with RCS and DMCA, MC1A with RCS, RCS with DMCA.

Conclusion:

Hallux MTP arthrodesis improved the alignment of the first-TMT joint in patients with hallux valgus, but this change had no correlation with either the pre and postoperative IMA or HVA changes. There was no significant improvement nor worsening of the TMT alignment in patients without hallux valgus.
From Tourism to Agro-processing: Wekesa the Hustler
Authors: Agasha Ester , Rono Lucy Jepchoge , Nabachwa Sarah
Published: December 2024

As Great Lakes Safaris, a Ugandan tour and travel company, expanded, so did the needs of its clients. This prompted the company’s proprietor, Amos Masaba Wekesa, to diversify to closely related fields to accommodate this demand. He spotted opportunities in the Ugandan National Parks, where he built several eco-friendly lodges. Relatedly, he took advantage of the blue waters of Lake Victoria to branch into marine tourism and co-patterned with his friends to buy their first water bus—MV Kazinga. However, the advent of the COVID-19 pandemic devastated the tourism industry, pushing Wekesa into the unrelated agro-processing business. The birth of his new venture, PELA Commodities Limited (PCL), was circumstantial and a survival backup plan due to the COVID-19 disruptions. As life returns to normal, Wekesa has to think critically about his diversification strategy and ensure he is well-positioned for success in his tourism and agro-processing businesses. He is worried that his new PLC business could become a distraction to his core Tourism business. He wonders if this will not stretch his current resources or devalue the quality of his services.
Blood RNA transcripts show changes in inflammation and lipid metabolism in Alzheimer's disease and mitochondrial function in mild cognitive impairment
Authors: Iga Jun-ichi , Yoshino Yuta , Ozaki Tomoki , Tachibana Ayumi , Kumon Hiroshi , Funahashi Yu , Mori Hiroaki , Ueno Mariko , Ozaki Yuki , Yamazaki Kiyohiro , Ochi Shinichiro , Yamashita Masakatsu , Ueno Shu-ichi
Published: December 2024

Background

Abnormal immunity in the periphery has been reported in the pathogenesis of Alzheimer's disease (AD).

Objective

In this study, blood transcriptome analyses of patients with AD, those with mild cognitive impairment (MCI) due to AD, and heathy controls were performed to elucidate immune-related pathophysiology.

Methods

The sample included 63 participants from a complete enumeration study of elderly people in Nakayama town (the Nakayama Study), who were over 65 years of age, diagnosed as (1) healthy controls (N = 21, mean age: 83.8 years), (2) having MCI due to AD (N = 20, mean age: 82.6 years), or (3) having AD (N = 21, mean age: 84.2 years). Every participant underwent blood tests, magnetic resonance imaging, and questionnaires about lifestyle and cognitive function. With transcriptome analysis, differential gene expressions in the blood of the three groups were evaluated by gene ontology, pathway enrichment, and ingenuity pathway analyses, and quantitative real-time PCR was performed.

Results

Neutrophil extracellular trap signaling was increased, and lipid metabolism (FXR/RXR activation, triacylglycerol degradation) was decreased in AD, whereas MCI showed protective responses via decreased neutrophil extracellular trap signaling and mitochondrial functions such as upregulation of the sirtuin pathway and downregulation of oxidative stress.

Conclusions

Based on these findings and consistent with other published studies, immune cells appear to have important roles in the pathogenesis of AD, and the transcriptome in blood may be useful as a biomarker for diagnosis via monitoring immunity in MCI and AD.
Bio-cultural Aspects of First-feeding Practices Among Hilly Tribal Infants: A Qualitative Observational Study
Authors: Samakya Srividhya
Published: December 2024

Objective

This study delves into the biocultural aspects of first-feeding practices among Porja hilly tribe living in Andhra Pradesh, India.

Materials and Methods

This community-based qualitative observational study was conducted among 44 tribal infants whose mothers were purposively selected through the inclusion of criteria of having given birth in the last 60 days. The study period was carried out between May 2023 and October 2023. Semi-structured household surveys and in-depth interview schedules guided the study. Qualitative data was analysed using the thematic framework approach, which allows the analysis of the interview transcripts, field notes and informal conversations to find the associations between the expressions without missing the gut feelings and ingrained cultural notions around the practices.

Results

Three major themes with two sub-themes were generated from thematic analysis, such as (1) first feeding, (2) denied feeding and (3) delayed feeding. These findings provided the details account for the cultural reasons for pre-lacteal feeding by practicing colostrum avoidance and delayed breastfeeding practices on the Porja tribal neonates

Discussion

The persistence of culture-specific traditional beliefs in shaping neonatal health is a pressing issue. The study’s findings highlight the importance of preserving beneficial traditional methods while addressing harmful practices. This approach could significantly improve the health status of tribal newborn babies, particularly in resource-poor settings with inadequate neonatal services.