bluuebunny/crossref_metadata_2025 huggingface dataset:
Variations of I: Setting the Poetic Tone for Student-Voiced Action Research
Authors: Schoone Adrian , Bruce Judy , Piggot-Irvine Eileen , Turner-Adams Hana
Published: November 2022

In this article, we explore how the poetic rendering of an initial focus group transcript with five secondary school students in an alternative education setting in Aotearoa, New Zealand, set the tone for an entire action research. Each year, approximately 3,500 secondary school students are referred to alternative education provisions due to suspensions, exclusions, and truancy. Two-thirds of these students are rangatahi Māori (Māori young people). Alternative education teachers, however, know little about their students’ schooling histories. Using participatory action research, teachers explored critical moments from young people’s education journeys. Found poems created from the first focus group with students, including the creation of I poems, set the tone for action research. These poems exposed more widely the twofold I-Thou/I-It attitude that has shaped the students’ lived experiences, and as a response, researchers gave heed to I-Thou as they shaped the research approach.
Ghost Writings
Authors: Linnell Sheridan
Published: November 2022

Three interlocutors; three deaths; more than three stories that multiply, entangle and unwind. Illness, suicide, voluntary euthanasia, and the slippages in between. Turning to other-than-human beings. Becoming a mistress of ceremonies. Embracing a methodology of sighs. Throwing us into that place where we matter to each other—where everything matters even as it falls away.
Invasive materialities: War bunkers as disturbing nodes of collaboration
Authors: Daugbjerg Mads
Published: November 2022

This article discusses the qualities and affordances of the remaining World War II bunkers still found along Europe's Western coastline. Drawing on ethnographic and historical material from a Danish section of the line, and on my involvement in establishing an alternative film festival among these ruins, I explore the bunkers as ‘invasive’ materialities, that is, externally imposed structures, still conceived in various ways as foreign, intrusive or out of place. The bunkers continue to disturb the status quo, prompting different kinds of responses – of opposition and consternation but also certain kinds of allure and fascination. With the film festival as the main case, I trace the bunkers as products of various kinds of collaboration and as natural-cultural amalgams around which questions of protection, ownership, and rights come to matter, socially and materially. I argue that an ‘invasive’ analytics may further our understanding of the different relationships and agencies involved in these dynamics.
“You Have to Prove that You’re Homeless”: Vulnerability and Gatekeeping in Public Housing Prioritization Policies
Authors: Rita Nathalie , Garboden Philip M.E. , Darrah-Okike Jennifer
Published: November 2022

Building on theories of symbolic boundaries, this article explores the role of the state as gatekeeper to social programs, such as public housing. Using interviews with 75 randomly sampled households living in public housing in Honolulu County, we link contemporary research on gatekeeping with decades of work on how housing policy drives residential outcomes for marginalized groups. In particular, we consider the largely unexamined case of “local preferences,” which fast-track certain individuals into social programs based on locally established criteria. Our data suggest that these prioritization categories have evolved over time and are now largely focused on providing housing to those experiencing homelessness and victims of domestic violence. Ultimately, this apparently mundane bureaucratic process mediates relationships between social service agencies, individual needs, and overwhelming housing demand, all collaborating to construct symbolic boundaries across which deservingness is defined and adjudicated. We find that waitlist prioritization criteria cannot be reduced to a basic assessment of need as it necessarily instigates issues of definition (e.g., what is homelessness?) and legibility (e.g., how does one prove homelessness?). These collateral issues amplify the importance of institutional social capital and, in some cases, generate conflict between and within eligible communities.
Physiological and clinical impact in the carotid baroreceptor function following the surgical management of bilateral carotid body tumors
Authors: Mier y Teran-Ellis Santiago , Estrada-Rodriguez Humberto A , Anaya-Ayala Javier E , Lopez-Pena Gabriel , Contreras-Jimenez Emmanuel , Dominguez-Vega Rosa X , Gonzalez-Duarte Alejandra , Hinojosa Carlos A
Published: November 2022

Objective

The bilateral presentation of Carotid Body Tumors (CBT) is rare; the surgical resection of these masses remains the mainstay management due to the malignant potential. We aim to describe, classify, and quantify baroreceptor failure (BRF) after the surgical management of patients with bilateral CBT to better understand the clinical consequences.

Methods

Retrospective review of patients that underwent bilateral CBT resection to assess the changes in baroreceptor function. We describe the clinical events associated to BRF after surgery, baseline patient’s demographics, characteristics, comorbidities. Additionally, clinical and a quantitative evaluation of baroreceptor sensitivity were conducted using the Composite Autonomic Severity Score (CASS).

Results

From 1986 to 2020, a total 146 CBT resections were performed in 132 patients in our institution. Tumors were removed bilaterally in staged procedures in seven patients with a mean age of 61 years (Standard Deviation 11), six (85%) were females, and there was no family history of paragangliomas. The clinical presentation were palpable masses in 5 (71%), and odynophagia in 2 (29%) cases; malignant histopathology following surgery was found in one case. BRF occurred in one patient after unilateral CBT resection, consisting of bradycardia and a 40 s asystole that was not previously associated to BR sensitivity. Three (43%) patients presented BRF in the immediate postoperative period of the contralateral CBT excision, consisting of volatile hypertensive crisis in two cases, and supraventricular tachycardia in one. All the patients developed (100%) chronic baroreceptor sensitivity symptoms consisting in syncope, vertigo and fatigue in 4 (57%), tachycardia in 2 (28%), and orthostatic headache in one (14%). Autonomic testing showed mixed sympathetic and parasympathetic failure in five (71%), severe sympathetic failure in 1 (14%), and parasympathetic dysfunction in one patient (14%).

Conclusions

Postoperative autonomic assessment confirmed BRF in all studied patients that underwent staged bilateral CBT resection with mixed, sympathetic, and parasympathetic dysfunction. Further studies are necessary to evaluate the incidence and physiological mechanisms of these sequelae to anticipate possible complications and offer the appropriate perioperative management.
Open versus endovascular repair of primary infected thoracic and abdominal aortic aneurysms
Authors: Kritayakirana Kritaya , Narueponjirakul Natawat , Aimsupanimitr Punthita , Chaichote Chonlathorn , Uthaipaisanwong Apinan , Kittayarak Chanapong
Published: November 2022

Objective

Primary infected aortic aneurysms are life-threatening if not treated promptly, but still possess a high mortality rate following open repair. The goal of treatment is to prevent rupture and clear infection. An endovascular approach is accepted as a bridge to definitive open repair. Our study compares the outcomes of endovascular versus conventional open repair of infected aortic aneurysms.

Method

A single-center retrospective review was conducted of data from January 2012 to December 2021. Patients were categorized into three cohorts according to aortic involvement: thoracic aortic aneurysm (TAA), thoracoabdominal aortic aneurysm (TAAA), and abdominal aortic aneurysm (AAA). The primary endpoint was survival rate and the assessment of any associated factors.

Result

Ninety‐nine patients presented with infected aortic aneurysms. Of the 56 patients who presented with infected TAA, 38 patients underwent thoracic endovascular aortic repair and 18 patients underwent open TAA repair. Forty patients presented with infected AAA, of which 21 patients underwent endovascular aortic repair and 19 patients underwent open repair. Three patients presented with infected TAAA and all underwent open repair. The mean age was 67 years (range 33–88); 74 patients (74.8%) were men and 71 patients (71.7%) had immune dysfunction. Mean follow-up time was 24 months in the endovascular repair group and 38 months in the open repair group. The probability survival rate in the endovascular repair group was 86%, 86%, 77% and 51% at 1 year, 2 years, 5 years and 10 years, respectively, and in the open repair group this was 81%, 81%, 76%, and 64% at 1 year, 2 years, 5 years and 10 years, respectively.

Conclutions

Endovascular repair for primary infected aortic aneurysms plays an important role in current practice as an alternate to open surgery or used as bridging to definitive open surgical repair. No significant difference was observed in either short- or long-term survival in patients with infected aortic aneurysm undergoing open or endovascular repairs.
Embolic protection devices for carotid artery stenting: A network meta-analysis
Authors: Giannopoulos Stefanos , Sagris Marios , Giannopoulos Spyridon , Tzoumas Andreas , Kokkinidis Damianos G , Texakalidis Pavlos , Koutsias George , Volteas Panagiotis , Jing Li , Malgor Rafael D
Published: November 2022

Objectives

Carotid artery stenting (CAS) is an alternative treatment option for patients at high risk for carotid endarterectomy (CEA) but has been correlated with increased risk for distal embolization and periprocedural stroke despite the use of adjunctive embolic protection devices (EPD). This study compared four types of EPDs and their intra and periprocedural related complications.

Methods

A systematic review of the literature was conducted in PubMed/Medline to identify studies that investigated the outcomes of CAS with adjuvant use of EPDs, including Proximal Balloon (PB), Distal Filter (DF), and Distal Balloon (DB) strategy. Continuous flow reversal performed via transcarotid approach by a commercially available device as an embolic protection strategy was intentionally excluded based on its distinct procedural characteristics and lack of availability outside of the United States. This network meta-analysis was performed according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines.

Results

Overall, 45 studies, consisting of 7600 participants satisfied the predetermined search criteria and were included in this network meta-analysis. Overall, 13 studies provided data regarding the number of patients with new ischemic lesions detected in the DW-MRI. DF (OR: 3.15; 95% CI: 1.54–6.44; p = 0.002) and DB (OR: 2.28; 95% CI: 1.58–3.29; p < 0.001) were associated with higher odds of new ischemic lesions compared to PB on DW-MRI imaging. No statistical difference was identified between DB versus DF groups (OR: 1.48; 95% CI: 0.73–2.59; p = 0.317). 36 and 27 studies reported on periprocedural stroke and transient ischemic attack (TIA) rates, respectively, showing similar odds of neurologic adverse events between all three groups.

Conclusions

PB deployment during CAS is superior to DF and DB in preventing distal embolization phenomena. However, no statistically significant difference in TIA and stroke rate was found among any of the analyzed EPD groups. Further research is warranted to investigate the association of embolic phenomena on imaging after CAS with clinically significant neurologic deficits.
Examining Podcast Listeners’ Perceptions of the Journalistic Functions of Podcasts
Authors: Whipple Kelsey , Ashe Ivy , Cueva Chacón Lourdes M.
Published: November 2022

Podcasting is a well-established medium with a rapidly growing audience but no established ethical standards or professional practices across a wide variety of genres. Through a representative national survey of American internet users ( n = 1,025), this research examined how much podcast listeners ( n = 529) trust podcasts as a source of news and how they evaluate their journalistic merit. Podcast listeners trust podcasts less than most other sources of information, with the exception of online news and satirical news programs. And though listeners agree that podcasting is a form of journalism, a way to stay informed about news and current events, and a valuable source of information, they’re more skeptical of podcasts when comparing them to traditional news sources of information. Age is the only demographic category that predicts listening frequency.
Spinal Cord Stimulation for Painful Diabetic Neuropathy
Authors: Yeung Andrea M. , Huang Jingtong , Nguyen Kevin T. , Xu Nicole Y. , Hughes Lorenzo T. , Agrawal Brajesh K. , Ejskjaer Niels , Klonoff David C.
Published: November 2022

Spinal cord stimulation (SCS) technology has been recently approved by the US Food and Drug Administration (FDA) for painful diabetic neuropathy (PDN). The treatment involves surgical implantation of electrodes and a power source that delivers electrical current to the spinal cord. This treatment decreases the perception of pain in many chronic pain conditions, such as PDN. The number of patients with PDN treated with SCS and the amount of data describing their outcomes is expected to increase given four factors: (1) the large number of patients with this diagnosis, (2) the poor results that have been obtained for pain relief with pharmacotherapy and noninvasive non-pharmacotherapy, (3) the results to date with investigational SCS technology, and (4) the recent FDA approval of systems that deliver this treatment. Whereas traditional SCS replaces pain with paresthesias, a new form of SCS, called high-frequency 10-kHz SCS, first used for pain in 2015, can relieve PDN pain without causing paresthesias, although not all patients experience pain relief by SCS. This article describes (1) an overview of SCS technology, (2) the use of SCS for diseases other than diabetes, (3) the use of SCS for PDN, (4) a comparison of high-frequency 10-kHz and traditional SCS for PDN, (5) other SCS technology for PDN, (6) deployment of SCS systems, (7) barriers to the use of SCS for PDN, (8) risks of SCS technology, (9) current recommendations for using SCS for PDN, and (10) future developments in SCS.
In-Hospital Symptoms of Depression and Anxiety are Strong Risk Factors for Post-Stroke Depression 90 Days After Ischemic Stroke
Authors: Elias Stefany , Benevides Maria Luiza , Pereira Martins André Luiz , Martins Gladys Lentz , Sperb Wanderley Marcos Ana Beatriz , Nunes Jean Costa
Published: November 2022

Background and Purpose

Acute ischemic stroke (AIS) and depression are the major causes of disability and decreased quality of life worldwide. Psychiatric disorders are common after stroke, especially post-stroke depression (PSD), which affects one-third of survivors. Although frequent, little is known about the real complexity of the pathophysiology and the factors associated with PSD.

Methods

This research aimed to provide data about risk factors and predictors of PSD 90 days after AIS. A cohort study was conducted in a tertiary stroke center located in southern Brazil. We interviewed 148 patients with AIS who were consecutively hospitalized between January 2020 and January 2021. The Hospital Anxiety and Depression Scale (HADS) was applied during hospitalization and at follow-up 90 days after AIS. Furthermore, sociodemographic, clinical, and radiological variables were investigated. Predictive factors were assessed using univariate and multivariate linear regression. The impact of the COVID-19 pandemic on the data was also evaluated.

Results

The frequency of PSD 90 days after AIS was 33.9%. In-hospital symptoms of depression and anxiety each represented a 2-fold risk for PSD at follow-up. Furthermore, the HADS – anxiety score 90 days after AIS was strongly associated with the HADS – depression value 90 days after stroke (R: .71; B: .56; P < .01).

Conclusions

The present study highlighted a noteworthy frequency of PSD 90 days after AIS. Psychiatric variables during hospitalization and in the follow-up appeared to be the leading associated factors with PSD. These data might support the determination of which patients require more psychiatric management.
Cavernous sinus dural arteriovenous fistula embolized via a rare anastomosis between the facial vein and the superficial temporal vein
Authors: Ando Mitsushige , Maki Yoshinori , Hojo Masato , Hatano Taketo
Published: November 2022

A cavernous sinus dural arteriovenous fistula (CSdAVF) is an abnormal communication between the dural branches of the internal and external carotid arteries and the cavernous sinus. Transvenous embolization is the first choice to resolve CSdAVFs, and various venous access routes have been reported. However, transvenous embolization of a CSdAVF through a rare venous anastomosis between the facial and superficial temporal veins using a quadruple coaxial catheter system is scarce in the literature. A 30-year-old woman presented with a typical triad of CSdAVF that was supplied by the inferolateral and meningohypophyseal trunks and several dural branches of the external carotid artery. CSdAVF was solely draining through the right superior ophthalmic vein to the bilateral facial veins. The right facial vein had a rare anastomosis, with the superficial temporal vein terminating in the external jugular vein. Transvenous targeted embolization of CSdAVF was performed through the right superior ophthalmic vein. The rare anastomosis between the right superficial temporal vein and the right facial vein was used as the access route for CSdAVF. The quadruple coaxial catheter system was effective in overcoming the long and tortuous access route and stabilizing the movement of the microcatheter for target embolization. CSdAVF was successfully embolized with microcoils. This is the first report of a CSdAVF embolized via a rare anastomosis between the facial vein and the superficial temporal vein. A quadruple coaxial catheter system can overcome this unusual access route.
Fatty syringomyelia mimicking lipoma with spinal cord pilocytic astrocytoma
Authors: Arjipour Mahdi , Ownagh Farid , Eftekharian Mohamadmehdi
Published: November 2022

The reporting case is a 27 year-old woman. She was admitted with complaints of clumsy gait and dysesthesia over her upper limbs and spasticity in the legs. The investigations revealed a long segment cervical intramedullary tumor, associated with whole cord syringomyelia. The superior part of syringomyelia image intensity matched intramedullary lipoma completely. C1–C5 intramedullary tumor was resected grossly under microscopic view, and a fat-containing liquid exited the syringomyelia cavity at its superior pole. After a transient paresis just following the surgery, neurological condition was improved. The follow-up imaging showed that the fatty syringomyelia reduced in dimensions. Conclusion. According to this case and another similar case due to instability, it appears that as a rare phenomenon, syringomyelia liquid content sometimes could have fatty droplets which could mimic intramedullary lipoma with an unknown mechanism. It seems these fat droplets in syringomyelia would not change its natural history.
Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution
Authors: Hecker Andreas , Schmaranzer Florian , Huber Christoph , Maurer Jonas , Egli Rainer J. , Eberlein Sophie C. , Klenke Frank M.
Published: November 2022

Background:

Different surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft.

Purpose:

To evaluate the midterm results of primary surgical repair and suture augmentation to treat KD.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed.

Results:

The mean difference in pre- to postinjury Tegner scores was –2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament–Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7–mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments ( P = .007, .004, and .006, respectively).

Conclusion:

Primary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage.
Miyoshi Muscular Dystrophy Due to Novel Splice Site Variants in DYSF Gene
Authors: Bryant Grace , Moore Steven A. , Nix James S. , Rice Grace , Gokden Murat , Veerapandiyan Aravindhan
Published: November 2022

Dysferlinopathies are a group of phenotypically heterogeneous disorders caused by pathogenic variants in the DYSF (DYStrophy-associated Fer-1-like) gene encoding dysferlin. The phenotypic spectrum includes Miyoshi muscular dystrophy (MMD), limb-girdle muscular dystrophy type R2, distal myopathy with anterior tibial onset, and isolated hyperCKemia. MMD is characterized by muscle weakness and atrophy predominantly affecting the calf muscles with symptoms onset between 14 and 40 years of age. There is no clear phenotype – genotype correlation for dysferlinopathy. We describe a 15-year-old girl who presented with a phenotype consistent with MMD. However, she was initially treated for presumed polymyositis without improvement. Subsequent genetic testing revealed two novel variants in DYSF: c.3225dup (p.Gly1076Trpfs*38) in exon 30 and c.3349-2A > G (Splice acceptor) in intron 30. No dysferlin was detected in a muscle biopsy using immunostains and western blots, a result consistent with dysferlinopathy that supports the pathogenicity of the DYSF variants.
Speech-In-Noise Comprehension is Improved When Viewing a Deep-Neural-Network-Generated Talking Face
Authors: Shan Tong , Wenner Casper E. , Xu Chenliang , Duan Zhiyao , Maddox Ross K.
Published: November 2022

Listening in a noisy environment is challenging, but many previous studies have demonstrated that comprehension of speech can be substantially improved by looking at the talker's face. We recently developed a deep neural network (DNN) based system that generates movies of a talking face from speech audio and a single face image. In this study, we aimed to quantify the benefits that such a system can bring to speech comprehension, especially in noise. The target speech audio was masked with signal to noise ratios of −9, −6, −3, and 0 dB and was presented to subjects in three audio-visual (AV) stimulus conditions: (1) synthesized AV: audio with the synthesized talking face movie; (2) natural AV: audio with the original movie from the corpus; and (3) audio-only: audio with a static image of the talker. Subjects were asked to type the sentences they heard in each trial and keyword recognition was quantified for each condition. Overall, performance in the synthesized AV condition fell approximately halfway between the other two conditions, showing a marked improvement over the audio-only control but still falling short of the natural AV condition. Every subject showed some benefit from the synthetic AV stimulus. The results of this study support the idea that a DNN-based model that generates a talking face from speech audio can meaningfully enhance comprehension in noisy environments, and has the potential to be used as a visual hearing aid.
Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran
Authors: Mirafzali Sedigheh , Akbari Sari Ali , Iranpour Abedin , Alizadeh Somayeh
Published: November 2022

Introduction

Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers’ ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors.

Methods

This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach’s alpha of 85%. Data were analyzed using SPSS software version 16.

Results

The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05.

Conclusion

Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.
Locating the ‘Local’ in the Diversity and Development Debate: Analysing Evidence from the Field
Authors: Takhar Krishan
Published: November 2022

The locals of Neemrana are perceived as kaamchor [slackers] and rude, and as dehatis entrenched in the ‘traditional culture’. To Gunnar Myrdal, the developed ‘modern man’ is the obverse—one who transcends tradition. Then, the locals need ‘development’ and ‘modernisation’ as they merely have ‘culture’. Thus, are the locals merely cultural beings? This article argues through the help of empirical data that the locals are not only ‘cultural beings’ but also ‘development beings’. This is shown through studying Jhunda (a tall shurb), which is simultaneously a part of both culture and economic development as well. Thus, it is argued that culture/development may not be separate entities as widely believed. Although, the dominant development machinery working through the instrumentalities of the state and private industry in the region have excluded the local culture and people, the researcher argues that the epistemic treatment of the locals and thus their inclusion has possibilities of offering value to the development process at large. But how do we situate and theorise the locals and local culture and their potential contributions in the larger development theory? To address the same, the locals and local culture are treated as a ‘diversity’ as in multiculturalism.
Metaphyseal Fracture Displacement is Predictive of Intra-Articular Displacement in Adolescent Triplane Ankle Fractures
Authors: Mundluru Surya , Romero Joseph , Greenhill Dustin , Zide Jacob R. , Wimberly Robert L. , Riccio Anthony , Thome Andrew P.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Triplane ankle fractures are a commonly encountered pediatric injury with potential long-term sequelae if not appropriately managed. Computed tomography (CT) imaging is frequently obtained in the workup of a triplane fracture, however the radiation and cost associated with CT imaging is not benign. We aim to determine the utility of a novel and simple plain radiographic measurement as a predictor of intra-articular displacement in adolescent triplane ankle fractures.

Methods:

An IRB approved, retrospective review of all adolescent triplane ankle fractures from 2003-2013 was performed at a single level 1 pediatric trauma center. Plain radiographs (XR) and CT imaging obtained at initial presentation were independently reviewed by three orthopaedic surgeons. Maximum articular displacement and step off were measured using digital calipers on AP, mortise and lateral XRs as well as on axial, coronal, and sagittal CT imaging. In addition, maximal metaphyseal fracture displacement was recorded on lateral XR. Articular displacement and step off were compared between the two imaging modalities using student's t-test. Pearson and Spearman coefficients were used to identify correlations between XR and CT measurements.

Results:

87 triplane ankle fractures were identified to meet inclusion criteria with a mean age of 12.9 years old (10-16 years old). XR was found to underestimate fracture displacement by 233% in the sagittal plane (1mm vs.3.3mm on sagittal CT; p<0.05). XR underestimated displacement by 24% in the coronal plane (2.3mm on AP XR vs. 2.9mm on coronal CT; p<0.05), and articular step off by 184% in the coronal plane and 177% in the sagittal plane (p<0.05). Axial CT demonstrated a significantly greater amount of articular displacement (4.2mm, range 0-19mm) when compared to coronal (2.9mm, range 0-18.7mm) and sagittal (3.3mm, range 0- 11mm) cuts (p<0.05). 65 patients demonstrated metaphyseal fracture displacement >=1mm on lateral XR, of whom 61 demonstrated articular displacement of >2.5mm on CT (positive predictive value of 94%).

Conclusion:

Plain radiographs appear to underestimate the articular displacement of triplane fractures. Maximal metaphyseal fracture displacement is easily measured on XR and appears to correlate with articular displacement. Maximal metaphyseal fracture displacement >= 1mm is strongly predictive of articular displacement above the commonly accepted threshold for operative intervention. This finding should raise suspicion for significant articular displacement that may not be appreciated on XR and should prompt consideration of a CT before a decision is made on definitive treatment.
Morphology of Posterior Malleolus Fractures Associated with Tibial Shaft Fractures
Authors: Myatt Darren , Mason Lyndon W. , Stringer Howard , Fischer Benjamin
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 in males and 11.5 per 100,000 person-years in women. There are several studies which have demonstrated a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22-92.3%. Recent work by Hendrickx et al has highlighted distal third and spiral tibial shaft fracture patterns as independent predictors of occult posterior malleolus fracture. We hypothesize that this rotational element will be highlighted in the Mason & Molloy Classification of occult posterior malleolus fractures seen in tibial shaft fractures.

Methods:

Objectives Our primary outcome in this study was to identify any extension of tibial fractures to the posterior malleolus and describe its morphology. Study Design & Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NHS Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over the age of 16, with a diaphyseal tibial fracture and who underwent a CT of the affected lower limb. The Mason and Molloy posterior malleolus fracture classification system was used to describe the morphology of the fracture

Results:

764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. A total of 83 (27.7%) cases were classifiable using the Mason and Molloy classification. There were 8 type 1 (9.6%), 43 type 2 (51.8%), 5 type 2B (6.0%) and 27 type 3 (32.5%). The majority of the posterior malleolar fractures (n=75, 90.4%) were undisplaced pre-surgical intervention. The majority of PM fractures occurred in type 42A1 (65 of 142 tibia fractures) and 42B1 (11 of 16).

Conclusion:

The majority of the PM fractures associated with tibial fractures occur as a consequence of a rotational mechanism. Unlike, the PM fractures of the ankle, the majority of PM fractures associated with tibia fractures are undisplaced. We theorise that unlike the force transmission in ankle fractures where the rotational force is in the axial plane in a distal-proximal direction, in the PM fractures related to fractures of the tibia, the rotational force in the axial plane progresses from proximal-distal. Therefore, the force transmission which exits posteriorly, finally dissipates the force and thus unlikely to displace.
The Use of Cheilectomy with Hemispheric Reamers in Combination with Autologous Matrix-Induced Chondrogenesis in Treatment of Patients with Hallux Rigidus
Authors: Nurmukhametov Maxim R. , Bialik Evgeny , Makarov Maxim , Makarov Sergey , Bialik Valerii , Nesterenko Vadim
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus (HR) is a common disease that occurs, according to the literature, in 2-10% of the population. However, currently there is no single approach to the choice of a surgical method for the treatment of this disease. It is known that the most common method at early stages of HR is cheilectomy, and the first metatarsophalangeal (1st MTP) joint arthrodesis at late stages. On the other hand, autologous matrix-induced chondrogenesis (AMIC) is known to be successfully applied in the presence of the osteochondral defects in the ankle, knee and hip joints. In this regard, we proposed to use cheilectomy in combination with this technique in treatment of patients with HR.

Methods:

Cheilectomy with AMIC was performed in 35 patients with HR. The operation technique included removing of the osteophytes from the metatarsal bone head and the proximal phalanx basement, clearing of the cartilage defect, microfracturing and covering the metatarsal bone head by the collagen memebrane, then - suturing the memebrane to the periosteum by absorbable thread. 16 patients underwent cheilectomy using hemispheric reamers. The results of surgical treatment were assessed using visual analog scale (VAS) of pain, AOFAS scale and range of motion (ROM) in 1st MTP joint. Also foot X-ray and MRI before and 3, 6, 12 months after the surgery were used.

Results:

In patients who underwent cheilectomy without reamers (1st group), the median ROM before the surgery was 20o, VAS of pain - 72.5, AOFAS - 49. As for the patients who underwent cheilectomy with reamers (2nd group), the median ROM was also 20o, VAS of pain - 70, AOFAS - 52.In the 1st group, after a year of observation, the median VAS of pain decreased to 10, ROM increased to 72.5o and AOFAS - to 82.5.In the 2nd group, after 12 months the median VAS of pain decreased to 7.5, ROM increased to 77o, AOFAS - to 85.On the radiographs 12 months after the surgery, there was some narrowing of the joint space compared to the first day after the operation. However, the ROM in the 1st MTP joint, on the contrary, increased.

Conclusion:

The results showed that cheilectomy in combination with AMIC allows to relieve pain and significantly improve the quality of life of patients with HR; the results in patients who underwent cheilectomy using hemispheric reamers were better, therefore, in most cases we recommend to use these reamers. Also, this technique, unlike isolated cheilectomy or arthrodesis, can be used at any stage of HR.
Reduction Quality in Posterior Malleolar Fractures using the Modified Posteromedial Ankle Approach
Authors: Pino Felipe , Soto Christian I. Bastias , Lagos Leonardo , Urbina Christian
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Several studies have documented which of the posterior ankle approaches has the best exposure of the posterior malleolus. However, no study has made a correlation between the quality of posterior fragment reduction using CT scan and the approach used. The purpose of this study was to assess the quality of reduction of posterior malleolus fractures in patients with trimalleolar ankle fractures operated with the modified posteromedial approach.

Methods:

A retrospective search was performed in two Health Centers between 2014 and 2021 for patients with ankle fracture dislocations associated with types two, three and four PM fractures according to the Bartonicek classification3. In relation with the inclusion criteria, patients included in the study had complete trauma ankle set radiographs and CT scans with axial, sagittal and coronal planes pre and postoperative and in all of them a direct reduction and internal fixation of the posterior malleolus was achieved with the modified posteromedial approach. All procedures were performed by six experienced Foot and Ankle Surgeons. 48 patients met the inclusion criteria (29 women and 19 men) with a mean age of 46 years (range 23-80). 6 patients required two stage management with an initial external fixation because of irreducible fracture-dislocations or soft tissue compromise and in a second time the final ORIF.

Results:

Axial CT Plane Evaluation Evaluation of the morphology of the fractured PM according to the Bartonicek classification on the CT scan axial planes showed type II in 11 patients, type III in 31 patients and type IV in 7 patients. In relation to fibular position at the fibular notch 39 patients showed adequate reduction. Four patients showed diastasis or GAP >= 2mm as a consequence of intercalary fragment unreduced. Sagittal CT Plane Evaluation Sagittal CT plane evaluation showed anatomical reduction (<2mm) in 45 patients and poor reduction in 3 patients. Fourteen patients showed residual impaction either in posteromedial (type III fractures) or posterolateral fragments (type II, III or IV fractures).

Conclusion:

In conclusion, we think the modified posteromedial approach is a good option to manage trimalleolar fractures, since we achieved an anatomic posterior malleolus fracture reduction in 94% of our patients.
Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma
Authors: Holmberg Dag , Lagergren Jesper
Published: November 2022

Background:

Barrett’s esophagus (BE) can progress to esophageal adenocarcinoma (EAC), a tumor characterized by rapidly increasing incidence and poor survival. We describe patterns of occurrence and risk factors for BE and EAC and how they may influence healthcare.

Methods:

We searched PubMed and Cochrane databases for English-language publications using the search terms Barrett’s esophagus and esophageal adenocarcinoma. We mainly considered systematic reviews with meta-analysis, randomized clinical trials, population-based observational studies, and international clinical guidelines. The results were synthesized into a narrative review.

Results:

The prevalence of BE (currently approximately 1% among adults) and incidence of EAC (current global age-standardized incidence rate of 0.9/100 000 person-years) have increased in many regions during the last 5 decades, particularly in North America, Northwestern Europe, and Australia. The increasing incidence is likely attributed to the increasing prevalence of the main risk factors, that is, gastroesophageal reflux disease (GERD) and obesity, combined with a decreasing prevalence of the protective exposure Helicobacter pylori-infection. GERD and obesity are now increasingly prevalent also in Asia, indicating that the incidence of EAC will continue to increase globally. Dysplastic BE and early EAC are readily endoscopically treated, and represent ideal conditions for screening because of their strong association with more advanced EAC. But such screening requires targeting of high-risk individuals, who remain to be better delineated.

Conclusions:

The changing prevalence rates of GERD, obesity, and Helicobacter pylori-infection might drive continued increasing EAC incidence rates worldwide. Targeted screening programs incorporating combinations of risk factors for BE and EAC may reduce mortality in EAC.
You can’t just bring people here and then not feed them: A case in support of Indigenous-led training environments
Authors: Ambtman-Smith Vanessa , Wysocki Koral , Bomberry Victoria , Reitmeier Veronica , Nightingale Elana
Published: November 2022

By and large, academic research in geography has advanced the colonial project, and been synonymous with extractive and reductionist research practices that subjugate Indigenous people. To counteract these harmful impacts and produce research that supports the needs of communities, advancing Indigenous sovereignty over research is vital. By presenting a case study of an Indigenous research space at a Canadian University, we argue that Indigenous training environments are more than a shared, physical space; they provide essential emotive and relational spaces of collaborative learning, wherein trainees practice relationship-building, reciprocity, and accountability. This article argues that decolonizing academic spaces dedicated to Indigenous geographic research will be essential to meeting the ethical imperative of Indigenous control over knowledge production. There is a current deficit of culturally appropriate spaces that support both the whole person and their learning. We highlight the impact of Indigenous training environments in nurturing respectful, long-standing relationships with peers, community, and research partners; a critical element of Indigenous geographies, yet one of the most challenging aspects of upholding meaningful and decolonizing research. By drawing on our diverse perspectives and research projects, we reflect on how an Indigenous-led training environment, rooted in Indigenous ways of knowing, can contribute to relational accountability both within and outside of these spaces. As more communities assert their authority over these processes, the need for respectful research grows, and it is anticipated that this article will provide a useful guide and support for emerging Indigenous training environments.
FLT3ITD drives context-specific changes in cell identity and variable interferon dependence during AML initiation
Authors: Li Yanan , Yang Wei , Patel Riddhi M. , Casey Emily B. , Denby Elisabeth , Mendoza-Castrejon Jonny , Rodriguez-Lopez Priscilla , Magee Jeffrey A.
Published: November 2022

Acute myeloid leukemia (AML) initiation requires multiple rate-limiting mutations to cooperatively reprogram progenitor cell identity. For example, FLT3 internal tandem duplication (FLT3ITD) mutations cooperate with a variety of different initiating mutations to reprogram myeloid progenitor fate. These initiating mutations often skew toward either pediatric or adult AML patient populations, though FLT3ITD itself occurs at similar frequencies in both age groups. This raises the question of whether FLT3ITD might induce distinct transcriptional programs and unmask distinct therapeutic vulnerabilities when paired with pediatric, as opposed to adult AML-initiating mutations. To explore this possibility, we compared AML evolution in mice that carried Flt3ITD/NUP98-HOXD13 (NHD13) or Flt3ITD/Runx1DEL mutation pairs, which are respectively most common in pediatric and adult AML. Single-cell analyses and epigenome profiling revealed distinct interactions between Flt3ITD and its cooperating mutations. Whereas Flt3ITD and Flt3ITD/Runx1DEL caused aberrant expansion of myeloid progenitors, Flt3ITD/NHD13 drove the emergence of a pre-AML population that did not resemble normal hematopoietic progenitors. Differences between Flt3ITD/Runx1DEL and Flt3ITD/NHD13 cooperative target gene expression extended to fully transformed AML as well. Flt3ITD/NHD13 cooperative target genes were enriched in human NUP98-translocated AML. Flt3ITD/NHD13 selectively hijacked type I interferon signaling to drive expansion of the pre-AML population. Blocking interferon signaling delayed AML initiation and extended survival. Thus, common AML driver mutations, such as FLT3ITD, can coopt different mechanisms of transformation in different genetic contexts. Furthermore, pediatric-biased NUP98 fusions convey actionable interferon dependence.
Long-term effect of dupilumab on prevention of lung function decline in patients with uncontrolled moderate-to-severe asthma: ATLAS trial design
Authors: De Prado Gomez Lucia , Pavord Ian , Busse William , Brightling Christopher E. , Wechsler Michael E. , Rabe Klaus F. , Zhang Mei , Xing Jun , Jacob-Nara Juby A. , Rowe Paul J.
Published: November 2022

Background

Many patients with asthma experience loss of lung function over time, and in certain patients this can lead to progressive obstructive patterns similar to COPD. Patients with severe asthma may experience accelerated lung function decline (LFD). However, characteristics and risk factors for LFD in asthma have not been well described. Dupilumab may prevent or slow the rate of LFD in patients with uncontrolled, moderate-to-severe asthma. ATLAS trial is designed to evaluate the role of dupilumab in preventing/slowing LFD over a period of 3 yearsversusstandard-of-care therapy.

Methods

ATLAS (clinicaltrials.gov identifierNCT05097287) is a randomised, double-blind, placebo-controlled, multicentre study that will include adult patients with uncontrolled moderate-to-severe asthma. ∼1828 patients will be randomised (2:1) to dupilumab 300 mg or placebo in combination with maintenance therapy every 2 weeks for 3 years. The primary objective is to assess the effect of dupilumab on preventing or slowing LFD by year 1 in the exhaled nitric oxide fraction (FeNO) population (patients withFeNO≥35 ppb). The effect of dupilumab in slowing the rate of LFD by year 2 and year 3 in bothFeNOand total populations, exacerbations, asthma control, quality of life, biomarker changes and utility ofFeNOas a biomarker of LFD will also be evaluated.

Discussion

ATLAS is the first trial assessing the effect of a biologic on LFD, designed to establish the role of dupilumab in prevention of long-term loss of lung function and its potential effect on disease modification, which may provide unique insights into asthma pathophysiology, including predictive and prognostic factors of LFD.