bluuebunny/crossref_metadata_2025 huggingface dataset:
SHOULDER SEPTIC ARTHRITIS IN PAEDIATRICS AND ADOLESCENTS: A RETROSPECTIVE REVIEW OF CLINICAL PRESENTATION, BACTERIOLOGICAL PROFILE, AND OUTCOMES
Authors: Mukansi Nyiko
Published: November 2023

Shoulder septic arthritis is uncommon and frequently misdiagnosed, resulting in severe consequences. This study evaluated the demographics, bacteriological profile, antibiotic susceptibility, treatment regimens, and clinical outcomes.

This is a 10-year retrospective observational analysis of 30 patients (20 males and 10 females) who were treated for septic arthritis of the shoulder. The data collecting process utilised clinical records, laboratory archives, and x-ray archives. We gathered demographic information, pre- and post-intervention clinical data, serum biochemical markers, and the results of imaging examinations. All patients had a surgical arthrotomy and joint debridement in the operating room, and specimens were taken for culture and sensitivity testing. The specimens were cultivated for at least seventy-two hours. Shoulder joint ranges of motion, comorbidities, and the presence of osteomyelitis were assessed clinically to determine the outcome. All statistical analyses were conducted using the STATA 17 statistical software. Analysis of correlation between categorical variables was performed using the chi-squared test.

The majority of the study patients were black Africans (97%). The age range of the group was from 8 days to 17 years. At presentation, 33% of patients had a low-grade fever, whereas the majority (60%) had normal body temperature. The average length of symptoms was 3.9 days (ranged from 1 day to 15 days), and the majority of patients had an increased white cell count (83%) and C-reactive protein (98%). There was accumulation of fluid in the joint of all individuals who received shoulder ultrasound imaging. We noted a significant incidence of gram-positive cocci, which were mostly susceptible to first-line antibiotics. Shoulder stiffness affected 63% of patients and chronic osteomyelitis affected 50% of individuals. Neither the severity nor the duration of the symptoms was related to an increased risk of osteomyelitis.

The results of this study revealed that the clinical characteristics and bacterial profile of septic arthritis of the shoulder conform to typical patterns. The likelihood of osteomyelitis and an unfavourable prognosis is considerable.
IN PATIENTS WITH HAND SEPSIS, DO BEDSIDE DEBRIDEMENT AND OPERATING THEATRE DEBRIDEMENT HAVE SIMILAR CLINICAL OUTCOMES, HOSPITAL COST, AND TIME TO DISCHARGE IN A DISTRICT HOSPITAL SETTING IN SOUTH AFRICA?
Authors: Kruger Carolien
Published: November 2023

In patients with hand sepsis does bedside debridement compared to operating theatre debridement have similar clinical outcomes, hospital cost and time to discharge in a District Hospital setting in South Africa?

A case series of 130 adult patients presenting to a district level orthopaedic unit over 1 year with hand sepsis requiring debridement. All included patients were debrided at the bedside (i.e. the emergency room, ward, OPD) under wrist or digital block. Patients excluded from the study included patients with necrotising soft tissue infections that required debridement in theatre. A cost analysis was done based on operating theatre (OT) costs saved as defined by Samuel1 et al. If an average theatre time of 45 min is taken then the cost saved per patient is approximately R1500 and approximately R300000 for the patients included in the case series. This excludes ward and other hospital costs related to a longer hospital admission.

The mean time to discharge for the included patients was 24 hours. This study suggests that bedside debridement can be a viable and cost effective option for selected cases of hand sepsis that can avoid the high cost and time associated with operating theatre debridement with similar outcomes.

This has implications for the future treatment of hand sepsis in resource constrained settings were operating theatre time is not only very expensive but also very scarce.
ANTIBIOTIC-TARGETED CEMENT RODS IN CHRONIC OSTEOMYELITIS: LONG-TERM OUTCOMES FROM A LEVEL ONE SOUTH AFRICAN TRAUMA CENTRE
Authors: Nicolaou Caterina , Sekeitto Allan Roy , Milner Brenda , Urrea Juan David
Published: November 2023

Fracture related infection, in particular chronic osteomyelitis, requires complex management plans. Meta analyses and systematic reviews have not found a gold standard of treatment for this disease. In 2017 an alternative treatment protocol was undertaken in our institution; whereby staged surgery with the use of cheaply manufactured tailored antibiotic cement rods was used in the treatment of chronic osteomyelitis, secondary to traumatic long bone fractures. Short term outcomes for this protocol demonstrated a 75.7% microbiological resolution to a negative culture and a good clinical outcome of 84.2% overall was demonstrated in terms of sinus resolution, skin changes, pain and function. Our aim now was to assess the long term outcomes of this treatment strategy.

A cross-sectional study of patients who had previously undergone the set treatment protocol was performed. Patient satisfaction, effects on activities of daily living, return to work and clinical improvement at 5 years following the intervention were assessed using a patient questionnaire and the validated AAOS lower limb score.

The average AAOS lower limb score was 88 which was en par to other similar studies. 80% of patients had returned to some form of work. Ongoing mild pain was a persistent problem for 50% of the patients however 98% of the patients were overall satisfied with the treatment satisfaction at 5 years. Only 1 patient required further treatment. 8 patients could not be located for follow up.

Chronic osteomyelitis remains a complex disease to treat. This treatment protocol demonstrates favourable microbiological, serological and clinical short term outcomes and favourable patient satisfaction and functional long term outcomes at 5 years. Our study highlights antibiotic targeted cement rods as a feasible treatment option in managing chronic osteomyelitis.
FACTORS ASSOCIATED WITH DISSEMINATION AND COMPLICATIONS OF ACUTE BONE AND JOINT INFECTIONS IN CHILDREN
Authors: Mdingi Vuyisa , Maré Pieter , Marais Leonard
Published: November 2023

Paediatric bone and joint infections remain common in low- and middle-income countries (LMICs). We aimed to determine the complication rate and incidence of disseminated infection in paediatric bone and joint infections in an LMIC setting. Secondly, we aimed to elucidate factors associated with complications and disseminated disease.

We retrospectively reviewed our database for children that presented with bone and joint infections between September 2015 and March 2019. Data were extracted to identify factors that were associated with development of complications and disseminated infection.

We analysed 49 children. The median age at presentation was 6 years (range 1 month to 12 years). Locally advanced disease was present in 13 children (27%). The remaining 36 children were evenly divided (18/49 each, 37%) between isolated AHOM and SA, respectively. Disseminated disease was present in 16 children (33%) and was associated with locally advanced disease, an increase in number of surgeries and an increased length of stay. Twenty-six complications were documented in 22 (45%) children. Chronic osteomyelitis developed in 15/49 (31%) cases, growth arrest in 5/49 (10%), and pathological fracture, DVT and septic shock in 2/49 (4%) each. Complicated disease was associated with locally advanced disease, a higher number of surgeries, disseminated disease and an increased length of stay. Sixty five percent of cases cultured Staphylococcus aureus, while 25% (12/49) were culture negative. The median time from admission to surgery was one day, and the median time from onset of symptoms to surgery was seven days.

We found a high complication rate. One third of patients had locally advanced disease, and this was associated with the development of complications and disseminated disease. Further studies are needed to be able to predict which children will have poor outcomes.
STAPHYLOCOCCAL OSTEOARTICULAR INFECTIONS ASSOCIATED WITH BLOOD STREAM INFECTIONS IN CHILDREN: IS PROLONGED IV ANTIBIOTIC THERAPY ALWAYS INDICATED?
Authors: Leppan Matthew , Horn Anria
Published: November 2023

Staphylococcus aureus osteo-articular infections (OAI) are frequently accompanied by blood stream infections (BSI) diagnosed by positive blood culture (BC). Microbiological protocols in adults advise prolonged intravenous antibiotics and repeat BC 48-hourly in the presence of a BSI, however evidence to support the systematic employment of these guidelines in paediatric patients is lacking. We aimed to determine whether there was an increased incidence of orthopaedic and systemic complications in patients with s aureus BSI, and whether a shorter duration of intravenous antibiotics was associated with the development of complications.

Following ethical approval, the departmental surgical database was searched for patients that underwent surgery for acute OAI over a 5-year period. Patients with no sample taken for BC were excluded, as were those with other or no organisms identified from any site. Demographic and clinical data were captured, including duration of IV antibiotics and development of complications. Statistical significance was set at p<0.05.

Following exclusions, 44 patients with a median age of 85 months remained to be analysed. Thirty patients (68%) had a positive BC. A positive BC was associated with a higher rate of systemic complications (p=0.026) but not orthopaedic complications (p=0.159). Patients who had developed any complication had a significantly longer duration of IV antibiotic treatment compared to those without complications (p<0.001). The presenting CRP levels were significantly higher in patients that developed complications (p=0.004).

Patients with staphylococcal BSI in association with an OAI are at increased risk of developing systemic complications. In our cohort, a shorter duration of antibiotic use was not associated with the development of complications, which does not support the systematic use of long courses of IV antibiotics in s aureus BSI. Further research will be required to determine the ideal protocol for these patients.
RUBBER BAND SYNDROME: A CASE REPORT OUTLINING THE DIAGNOSIS AND SURGICAL MANAGEMENT OF A RARE ORTHOPAEDIC CONDITION IN SOUTH AFRICA
Authors: Mattushek Stephen , Joseph Troye , Twala Makhaya , Reddy Kuvashan
Published: November 2023

In Asia, traditional bands are placed around limbs of children to ward off evil spirits and ensure good health. This practice may lead to the Rubber Band Syndrome (RBS) a rare paediatric condition described mainly in Asia which results from a forgotten thread or elastic band applied to the limb of a child. Because pressure necrosis beneath the band is slow, rapid healing of tissues over the band can obscure its presence. This makes the condition difficult to diagnose and distinguish from other infective conditions. This study presents the first case of RBS reported in South Africa.

Case: The patient aged 18 months presented with a swollen hand, circumferential scar and discharging sinus on the wrist. A radiograph was negative. In theatre the volar wound was explored. Debridement revealed a yellow rubber band deep to the wrist flexors and neurovascular bundles but superficial to the extensor retinaculum. Complete removal of the rubber band and antibiotics was followed by rehabilitation with Occupational Therapy. At a 3 month follow up, there was no evidence of infection, sensation was normal and motor function of the hand restored.

In this case, the structures through which the band had already passed were intact and overlay the band. It would appear that as the band slowly eroded the underlying structures it was followed by healing along the tract until the band exited deep to these structures. The band may come to rest on bone causing osteomyelitis if allowed to progress.

A high index of suspicion of RBS is needed in children presenting with a circumferential scar and a non-healing wound, especially on the wrist or ankle. Careful debridement and complete removal of the band are essential to resolve symptoms and restore function
15 YEARS ON: A PROSPECTIVE COMPARISON OF PONSETI CASTING VERSUS SURGICAL TREATMENT OF CLUBFOOT
Authors: Crawford Haemish , Recordon James , Stott Sue , Halanski Matthew , Mcnair Peter , Boocock Mark
Published: November 2023

In 2010, we published results of Ponseti versus primary posteromedial release (PMR) for congenital talipes equinovarus (CTEV) in 51 prospective patients. This study reports outcomes at a median of 15 years from original treatment.

We followed 51 patients at a median of 15 years (range 13–17 years) following treatment of CTEV with either Ponseti method (25 patients; 38 feet) or PMR (26 patients; 42 feet). Thirty-eight patientsd were contacted and 33 participated in clinical review (65%), comprising patient reported outcomes, clinical examination, 3-D gait analysis and plantar pressures.

Sixteen of 38 Ponseti treated feet (42%) and 20 of 42 PMR treated feet (48%) had undergone further surgery. The PMR treated feet were more likely to have osteotomies and intra- articular surgeries (16 vs 5 feet, p<0.05). Of the 33 patients reviewed with multimodal assessment, the Ponseti group demonstrated better scores on the Dimeglio (5.8 vs 7.0, p<0.05), the Disease Specific Instrument (80 vs 65.6, p<0.05), the Functional Disability Inventory (1.1 vs 5.0, p<0.05) and the AAOS Foot & Ankle Questionnaire (52.2 vs. 46.6, p < 0.05), as well as improved total sagittal ankle range of motion in gait, ankle plantarflexion range at toe off and calf power generation. The primary PMR group displayed higher lateral midfoot and forefoot pressures.

Whilst numbers of repeat surgical interventions following Ponseti treatment and primary PMR were similar, the PMR treated feet had greater numbers of osteotomies and intra-articular surgeries. Outcomes were improved at a median of 15 years for functional data for the Ponseti method versus PMR, with advantages seen in the Ponseti group over several domains. This study provides the most comprehensive evaluation of outcomes close to skeletal maturity in prospective cohorts, reinforcing the Ponseti Method as the initial treatment of choice for idiopathic clubfeet
CIVILIAN GUNSHOT FRACTURES OF THE ACETABULUM
Authors: Antoni Anna , Laubscher Kim , Blankson Benjamin , Berry Kirsty , Swanepoel Stefan , Laubscher Maritz , Maqungo Sithombo
Published: November 2023

Acetabulum fractures caused by civilian firearms represent a unique challenge for orthopaedic surgeons. Treatment strategies should include the assessment of infection risk due to frequently associated abdominal injuries and maintenance of joint function. Still, internationally accepted treatment algorithms are not available. The aim of the study was to increase knowledge about civilian gunshot fractures of the acetabulum by describing their characteristics and management at a high-volume tertiary hospital.

All adult patients admitted to our hospital between January 2009 and December 2022 with civilian gunshot fractures of the acetabulum were included in this descriptive retrospective study.

In total our institution treated 301 patients with civilian gunshot fractures of the hip joint and pelvis during the observation period, of which 54 involved the acetabulum. Most patients were young males (88,9%) with a mean age of 29 years. Thirty patients (55,6%) had associated intraabdominal or urological injuries. Fracture patterns were mostly stable fractures with minor joint destruction amenable to conservative fracture treatment (n=48, 88,9%). Orthopaedic surgical interventions were performed in 21 patients (38,9%) with removal of bullets in contact with the hip joint via arthrotomy or surgical hip dislocation as most frequent procedures. Most patients received antibiotics on admission (n=49, 90,7%). Fracture related infections of the acetabulum were noted in six patients (11,1%) while the mortality in the study population was low with one demised patient (1,9%) due to the trauma burden.

Most civilian acetabulum gunshot fractures are associated with intraabdominal or urological injuries. In comparison to the literature on extremity gunshot fractures, there is an increased risk of infection in our study population. The decision for surgical wash-out and bullet removal should be based on contamination and anticipated joint destruction, while osteosynthesis or primary arthroplasty are rarely necessary for these injuries.
QUANTITATIVE ULTRASOUND AND MRI IMAGING OF THE BUTTOCKS AND THIGHS IN A SEATED POSITION
Authors: Mogale Nkhensani , van Schoor Albert , Scott Justin , Schantz Daniel , Ilyasov Viktor , Bush Tamara Reid , Slade Jill M
Published: November 2023

Pressure ulcers are a common occurrence in individuals with spinal cord injuries, and are attributed to prolonged sitting and limited mobility. This therefore creates the need to better understand soft tissue composition, in the attempt to prevent and treat pressure ulcers. In this study, novel approaches to imaging the soft tissue of the buttocks were investigated in the loaded and unloaded position using ultrasound (US) and magnetic resonance imaging (MRI).

Twenty-six able-bodied participants (n=26, 13 males and 13 females) were recruited for this study and 1 male with a spinal cord injury. Two visits using US were required, as well as one MRI visit to evaluate soft tissue thickness and composition. US Imaging for the loaded conditions was performed using an innovative chair which allowed image acquisition in the seated upright position and MRI was done in the lateral decubitus position and loading was applied to the buttocks using a newly developed MRI compatible loader. The unloaded condition was a lateral decubitus position. Soft tissue was measured between the peak of the ischial tuberosity (IT) and the proximal femur and skin.

Tissue thickness reliability for US was excellent, ICC=0.934–0.981 with no significant differences between the scan days. US and MRI measures of tissue thickness were significantly correlated (r=0.68–0.91). US underestimated unloaded tissue thicknesses with a mean bias of 0.39 – 0.56 for total tissue and muscle + tendon thickness. When the buttocks were loaded, total tissue thickness was reduced by 64.2±9.1%.

US assessment of soft tissue thicknesses was reliable in both positions. The unloaded measurements using US were validated with MRI with acceptable limits of agreement, albeit tended to underestimate tissue thickness. Tissue thickness, but not fatty infiltration of muscle played a role in how the soft tissue of the buttocks responded to loading.
EPIDEMIOLOGY AND PATTERN OF ORTHOPAEDIC INJURIES CAUSED BY DELIVERY MOTORBIKE ACCIDENTS (DMBA) AT A SOUTH AFRICAN TERTIARY HOSPITAL
Authors: Nzimande David , Sukati Falethu
Published: November 2023

Trauma patients present with different injuries and some of them require emergency surgical procedures. Orthopaedic department at Steve Biko Academic Hospital (SBAH) have seen an increasing number of patients presenting with serious orthopaedic injuries due to Delivery Motorbike Accidents (DMBA). The aim of the study was to establish the epidemiology and pattern of orthopaedic injuries sustained following Delivery Motorbike Accident.

Motor Vehicle Accident (MVA) administration office at SBAH in emergency department was approached for patients registers used between 1 January 2020 and 31 December 2022. There patients were registered as Motor Vehicle Accident (MVA), Motorbike Accident (MBA) and Pedestrian Vehicle Accident (PVA) by the administration office. The details of patients classified as MBA were collected and used to obtain clinical data from medical and radiological records in the form of patient's files and PACS respectively.

Approximately 240 patients presented to Emergency department with orthopaedic injuries following a motorbike accident. About 78 files could not be retrieved from the patient's records department. About 74patients had their occupation recorded as unknown or unemployed. Approximately 70 patients had their occupation indicated in the file by the Clinicians or Administration Clerks. About 40 patients had their occupation as delivery man or working for a delivery company. 16 patients did not have images on the PACS system. Most of the patients were males, presented after hours and sustained multiple injuries that were managed surgically. Very few patients had their helmet status indicated in the file.

The study suggests that accidents due to delivery motorbikes are prevalent at SBAH and result in orthopaedic injuries. Almost 50% of patients who had their occupation indicated in the file were delivery employees. A follow up prospective study is recommended to ensure complete collection of data from patients at presentation to ED.
THE IMPACT OF HIV INFECTION ON WOUND HEALING AND FRACTURE UNION IN PATIENTS WITH CLOSED ANKLE FRACTURES TREATED WITH A PLATE OSTEOSYNTHESIS AT A TERTIARY LEVEL HOSPITAL
Authors: Rachoene Thabang , Sonke Khanyile , Rachuene Archie , Mpho Tladi
Published: November 2023

Fractures of the ankle are common, and they mostly affect young adults. Wound complications are not uncommon following the fixation of these fractures. This study evaluated the impact of HIV on wound healing after plate osteosynthesis in patients with closed ankle fractures.

This is an observational retrospective study of patients operated on at a tertiary level hospital. We reviewed hospital records for patients above 18 years of age who presented with wound breakdown following ankle open reduction and internal fixation. The patients’ hospital records were retrieved to identify all the patients treated for closed ankle fractures and those who developed wound breakdown. Patients with Pilon fractures were excluded. The National Health Laboratory System (NHLS) database was accessed to retrieve the CD4 count, viral load, haematology study results, and biochemistry results of these patients at the time of surgery and subsequent follow-up. The x-rays were retrieved from the electronic picture archiving system (PACS) and were assessed for fracture union at a minimum of 3 months follow-up.

We reviewed the medical records of 172 patients with closed ankle fractures treated from 2018 to 2022. Thirty-one (18.0%) developed wound breakdown after surgery, and they were all tested for HIV. Most of the patients were male (58.0%), and the average age of the cohort was 43.7 years (range: 21 years to 84 years). Ten of these patients (32.2%) were confirmed HIV positive, with CD4 counts ranging from 155 to 781. Viral load levels were lower than detectable in 40% of these patients. All patients progressed to fracture union at a minimum of 3 months follow-up.

We observed no difference between HIV-positive and HIV-negative patients in terms of wound breakdown and bone healing post-plate osteosynthesis for closed ankle fractures.
NOVEL SOLUTION TO THE ARTHROPLASTY BACKLOG PROBLEM IN A TERTIARY ACADEMIC INSTITUTION
Authors: Sikhauli Nkhodiseni , Pietrzak Jurek RT , Sekeitto Allan R , Chuene Mabua , Almeida Richard , Mokete Lipalo
Published: November 2023

Hip and knee joint arthroplasty wait list has been getting outrageously long in South Africa with some tertiary hospital reporting more than 5 years of waiting time. This has been further compounded by covid 19 pandemic. There is plateau of ideas on how best to address the backlogs in high volume tertiary centers, with catchup list, out reach program, private partnership seeming unsustainable. We sought to look for sustainable solution to the problem and we looked not far but inside the system.

Method

Triggered by the fire that engulfed part of the hospital, we found ourself refuged at the sister tertiary hospital with no access to theatre time. We visited districts hospitals within the cluster and discovered state of the art facility underutilized. We presented a plan to establish a satellite arthroplasty center which was greatly embraced by the management. We partnered with the trade to setup an arthroplasty service in this district hospital. Employed 3 retired nurses and 2 parttime anaesthetist all on yearly contract. We developed pathways for patient selection according to American Society of Anaesthesiologist(ASA).

232 total joint arthroplasties were performed in 15-month, 33%Hips and 67%Knees. The average hospital stay was 2,3± 2days. We had 1 mortality(# NOF) and 2 cases of PJI treated successfully with debridement antibiotic and implant retention. We had 5 cases of intraoperative calcar femur fracture managed with cables and all stable at 6weeksand 3month. Over 76% of the cases were performed by fellows as the primary surgeons.

Primary hip and knee total joint replacement can be safely performed in a district hospital. Employing motivated retired staff was key to the success of this project. Fellowship trainees performed most of the operations. We suggest that other academic hospitals with long waiting list can look at emulating this model within their district.
PREDICTING TRANSFUSION REQUIREMENTS FOR PRIMARY HIP AND KNEE ARTHROPLASTY: DESIGNING A REGIONAL SERVICE FOR HIGH-VOLUME ARTHROPLASTY SURGERY
Authors: Patel Vijay , Hayter Edward , Hodgson Harry , Barter Reece , Anakwe Raymond
Published: November 2023

Extended patient waiting lists for assessment and treatment are widely reported for planned elective joint replacement surgery. The development of regionally based Elective Orthopaedic Centres, separate from units that provide acute, urgent or trauma care has been suggested as one solution to provide protected capacity and patient pathways. These centres will adopt protocolised care to allow high volume activity and increased day-case care. We report the plan to establish a new elective orthopaedic centre serving a population of 2.4 million people. A census conducted in 2022 identified that 15000 patients were awaiting joint replacement surgery with predictions for further increases in waiting times

The principle of care will be to offer routine primary arthroplasty surgery for low risk (ASA 1 and 2) patients at a new regional centre. Pre-operative assessment and preparation will be undertaken digitally, virtually and/or in person at local centres close to the where patients live. This requires new and integrated pathways and ways of working. Predicting which patients will require perioperative transfusion of blood products is an important safety and quality consideration for new pathways. We reviewed all cases of hip and knee arthroplasty surgery conducted at our centre over a 12-month period and identified pre-operative patient related predictive factors to allow us to predict the need for the perioperative transfusion of blood products.

We examined patient sex, age, pre-operative haemaglobin and platelet count, use of anti-coagulants, weight and body mass index to allow us to construct the Imperial blood transfusion tool.

We have used the results of our study and the transfusion tool to propose the patient pathway for the new regional elective orthopaedic centre which we present.
LATERAL LIGAMENT RECONSTRUCTION USING ANTERIOR HALF OF PERONEUS LONGUS
Authors: Abramson Michael , McCollum Graham
Published: November 2023

Ankle sprains are common injuries. Most of them involve the lateral ligament complex. 20–40%% of these injuries will go onto develop symptomatic chronic lateral instability (CLI) and require surgical intervention.

The gold standard surgical treatment remains the Brostom-Gould. There are however certain scenarios where this may be unsuitable, such as in hyperlaxity, poor native tissue or revision surgeries. In these situations, a reconstruction with some form of augmentation or grafting is necessary. The anterior half of peroneus longus (AHPL) has gained in popularity as an autograft due to its favourable tendon properties, ease of harvesting, and low reported morbidity. This technique has been adopted by the senior author in these situations. Our primary aim was to assess patient reported outcomes and satisfaction following this surgery. Our secondary objectives were to assess return to sports, donor site morbidity and to report any surgical complications.

We performed a retrospective single surgeon study on all patients who underwent CLI reconstruction using the anterior half of peroneus longus between 2014 and 2021. Data was collected prospectively. The Karlsson foot and ankle scoring chart as well as a simple satisfaction table were used to assess outcomes. Minimum follow up was 1 year.

44 patients met the inclusion criteria. 23 women, 21 men. The average age was 37.0 (+−13.5). 24 were very satisfied with the surgery, 10 were satisfied, 6 were fair and 4 were dissatisfied. The average Karlsson score improved from 65/90 (34–77) to 85/90 (range 45–90). The average return to sport was 5 months. There was 1 non-surgical complication recorded. There was no repeat surgery for a complication, or recurrent instability and no donor-site morbidity was reported.

The results of our study demonstrates that the CLIR using AHPL is a reliable, predictable and safe
APTIDÃO FÍSICA DE ACORDO COM O NÚMERO DE PASSOS EM MULHERES ADULTAS E IDOSAS
Authors: Da Silva Júnior João Pedro , De Jesus Guimarães Luís Fabiano , Rosa Bergamo Raiany , Leandro Araújo Timóteo , Keihan Rodrigues Matsudo Victor , Mahecha Matsudo Sandra Marcela
Published: November 2023

Introdução: A análise do número de passos tem sido associada com diversas variáveis relacionadas à saúde de idosos, na aptidão física, composição corporal, capacidade funcional e sua redução está relacionada com diversas doenças crônicas não transmissíveis. A redução do número de passos/dia está associada com desfechos negativos na composição corporal, desenvolvimento de doenças e risco de morte por câncer. Objetivo: Determinar o perfil de aptidão física e capacidade funcional de acordo com o nível de atividade física avaliados de mulheres adultas praticantes de atividades físicas. Métodos: Participaram deste estudo 159 mulheres praticantes regulares de atividade física com idade entre 50 a 86 anos (69,55±7,9 anos) participantes do Projeto Longitudinal de Envelhecimento e Aptidão Física de São Caetano do Sul. O nível de atividade física foi mensurado pelo número de passos, por pedômetro (Digiwalker C 700/SW 200), por sete dias consecutivos. A avaliação da aptidão física foi realizada pela força de membros superiores e inferiores e agilidade. A capacidade funcional foi mensurada pela mobilidade e equilíbrio. A análise estatística utilizada foi ANOVA One-Way, seguido de Post Hoc Bonferroni e nos dados não paramétricos utilizou-se os testes de Kruskal-Wallis e Mann-Whitney. O número de passos foi dividido em tercil (tercil 1 < 5.618 passos/dia; tercil 2 5.619-9.054 passos/dia e tercil 3 > 9.055 passos/dia). O nível de significância adotado foi de p<0,05. Resultados: Foi encontrado que o tercil 3 resultou em diferenças estatisticamente significantes nas variáveis antropométricas: peso, IMC, circunferência de cintura e circunferência de quadril, variáveis neuromotoras: força de membros inferiores e agilidade e na capacidade funcional em mobilidade geral e locomoção. Conclusão: mulheres que se encontram com o padrão de passos diários superior a 9050 obtiveram melhor perfil de aptidão física e capacidade funcional.
PERFIL MÓRBIDO E DESFECHO CLÍNICO DOS IDOSOS INTERNADOS POR COVID-19
Authors: De Azevedo Ferreira Maria Izabel , Colares Maia Luciana , De Azevedo Daniela
Published: November 2023

Introdução: Os idosos tem papel importante na cadeia de transmissão e contaminação do coronavírus, sendo a parcela com maior probabilidade de desenvolvimento de doença grave e, consequentemente, morte. Objetivo: Investigar a relação entre o perfil mórbido e desfecho clínico dos idosos infectados pelo coronavírus, a fim de compreender a relação entre esses elementos e suas repercussões epidemiológicas em saúde. Materiais e métodos: Trata-se de uma pesquisa transversal, quantitativa e descritiva realizada em um hospital público brasileiro. Participaram da pesquisa 194 idosos, com idade igual ou superior a 60 anos, de qualquer gênero, raça e procedência, que foram internados devido infecção pelo COVID-19. O objeto do estudo foram os prontuários médicos eletrônicos. Para análise das informações coletados, foi executada tabulação em planilha, seguida de análise descritiva. Os dados foram aplicados em condição de regressão logística, por meio do programa STATA. Resultados: Dos pacientes, 51,0% eram homens. A maioria apresentava idade entre 70-74 anos (22,68%). Os sintomas admissionais predominantes foram dispneia e tosse, totalizando quase 100% das queixas. A comorbidade mais relatada foi a hipertensão arterial sistêmica, diagnóstico presente em 65,46% dos prontuários analisados. As variáveis idade e presença de comorbidade mostraram significância positiva quando relacionadas ao desfecho de óbito. Conclusões: A população estudada possui particularidades que devem ser contempladas no cuidado à saúde, adequando as estratégias de assistência, recuperação e reabilitação da funcionalidade, a fim de manter a qualidade de vida na velhice.
Little Chahta News Bird: Indigenous Periodicals and the Performance of Nationhood
Authors: Hughes Bethany
Published: November 2023

ABSTRACT: This article explores the Biskinik , a monthly newspaper produced by the Choctaw Nation of Oklahoma and in continuous circulation since 1978. It draws together methodological and theoretical investments from Native American and Indigenous Studies and Performance Studies in order to demonstrate how tribal newspapers such as the Biskinik are active sites of nations performing themselves. They curate actions and enact a story in which the nation is central. Explicating how performance and performativity reveal the ongoing process of Indigenous sovereignty within periodical publication, the article focuses on a 2022 issue of the Biskinik . It argues that the Biskinik should be read as a curation of Choctaw performance and a performance of Choctaw-ness, and as such the newspaper enacts nationhood in a complex and continuous movement of connection.
The Role of Breathy Voice in Hmu Tone Perception
Authors: Liu Wen , Peng Gang , Kong Jiangping
Published: November 2023

Previous studies on tone perception have mainly focused on the role of
F 0, while there are few but increasing studies on the effect of non-modal
phonation. This study investigates the role of non-modal phonation in
perceiving the five level tones used in Hmu, in which the lowest level
tone (T11) is often referred to as “breathy voice”. First, an acoustic
analysis was conducted on those tones to determine the voice quality and
whether breathiness is limited to specific tones, revealing that breathiness
only co-occurs with T11. Second, a perception experiment was performed
to investigate whether breathiness can influence T11 identification.
Results show that identification scores significantly differ only for the
pairs of two continua that involve T11. This suggests that, relative to
other tones, native speakers rely on breathiness in T11 identification,
which derives from the accompanying phonation in its production. These
findings shed light on how, alongside F 0, non-modal phonation
contributes to tone perception, which demonstrates a new kind for the
role of phonation in tonal contrasts. Considering these results, it is thus
necessary to incorporate phonation cues when defining tone.
Arabs at the 6th World Festival of Youth and Students: UGEMA in the USSR, 1957
Authors: Bishop Elizabeth
Published: November 2023

ABSTRACT: The Sixth International Festival of Youth and Students for Peace and Friendship ( VIème Festival Mondial de la jeunesse et des étudiants pour la paix et l'amitié ) took place in Moscow in 1957, bringing 30,000 foreigners straight into the heart of socialism. Guests from 131 different countries were present; historian Kristen Roth-Ey identifies the "openness of ordinary Soviets to contacts with ordinary foreigners" as the Moscow event's most remarkable feature: "many delegates found themselves literally surrounded by crowds of Soviets, some with questions, some looking for an autograph or to exchange a pin or shake hands, and some, perhaps many, just looking." As Roth-Ey points out, the Soviet communist party encouraged this kind of friendliness (which is germane to our wider conversation about Arab-Soviet internationalism); A. N. Shelepin, head of the Komsomol (the communist youth organization), explained, "we must run the festival in such a way that the overwhelming majority of participants leave Moscow as our friends. That's our main task, that's our general line." In part because invitations went to individuals, not to official organizations – in part because of the scale of the event – a "freewheeling, informal spirit" distinguished a culmination of post-World War II euphoria during the summer of 1957.
The Union of Soviet Friendship Societies and its Cultural Centres in the 1970s: Orientalism and Soft Power in the Middle East
Authors: Casula Philipp
Published: November 2023

ABSTRACT: "Arabs are eager to read the works of Tolstoy or of Dostoevsky, but these are not what they are offered. They would find at the Soviet Publishing House in Cairo the collected works of Lenin for as little as 30 piastres, but this is not what they want". Thus Mohamed Heikal, one of Nasser's closest advisors, described the Soviet ineptness in cultural exchanges. This paper will assess the ineffective Soviet cultural outreach t to the Arab world by analysing documents from the Union of Soviet Societies for Friendship and Cultural Contacts (SSOD) collected at the GARF (R-9576). In contrast to its predecessor, "Vsesoiuznoe Obshchestvo Kul'turnoi Sviazi s zagranitsei" — Всесоюзное общество культурной связи с заграницей (All-Union Society for Cultural Relations with Foreign Countries) VOKS, the SSOD is far less researched. The material under scrutiny comprises communications between the officials of Soviet Cultural Centres in the Middle East and the presidium of the SSOD, reports on events, lists of Soviet literature, schedules of film screenings, and minutes of meetings. The selection of documents focuses on the period between 1972 and 1979 relating to the activities in North and South Yemen, Lebanon, Egypt, and Syria. Adopting Edward Said's notion of Orientalism, the analysis uncovers how Soviet pragmatism (Vasil'ev) is reflected in individual officials' choices, their interactions as well how infelicitously they represented the USSR in the Arab World, undermining Soviet "soft power" in the region.
Russia's Policy Goals after Two Decades after the American Invasion of Iraq
Authors: Geukjian Ohannes
Published: November 2023

ABSTRACT: This article examines Russia's policy goals in the Middle East (ME) and the former Soviet space (FSS) after the American invasion of Iraq in 2003 and its impact on Moscow's broader foreign relations. Russia did not support the invasion of Iraq because Moscow was against the unilateral use of force without special authorization by the UN Security Council (SC). After losing Iraq in 2003 and Libya in 2011, both former Soviet client states, Russia used its military power to prevent externally imposed regime change in Ukraine and Syria and positioned itself as a major player in the wider ME and beyond. We use the concept of positional goods to analyse not only Russia's behaviour on the basis of Iraq's case, but also the implications of US hegemony. We argue that Russia as a revisionist power and through its efforts to assume regional dominance wanted to achieve great power status. Russia also sought multilateralism to change the liberal international order and proposed multi-regional cooperation within the framework of international institutions. Still, the Russian leadership has advocated a multipolar world order in which Russia would hold a special role as a great power and would contribute to global stability.
Terahertz beam with radial or orthogonal to laser polarization from a single-color femtosecond filament
Authors: Nikolaeva I. A. , Shipilo D. E. , Panov N. A. , Rizaev G. E. , Pushkarev D. V. , Mokrousova D. V. , Seleznev L. V. , Zhang N. , Liu W. , Ionin A. A. , Kosareva O. G.
Published: November 2023

At the selected frequencies from 0.3 to 10 THz we measured the two-dimensional (2D) distributions of fluence and polarization of terahertz (THz) emission from a single-color femtosecond filament. At the majority of frequencies studied, the THz beam has a donut-like shape with azimuthal modulations and radial polarization. At the maximal modulation, THz beam takes the form of the two lobes and polarization of the THz field degenerates into orthogonal to the laser pulse polarization direction. Violation of the radially polarized donut beam shape is due to destructive interference of THz waves driven by light pressure directed along the laser beam propagation axis and ponderomotive force parallel to the laser polarization.
Practical semi-quantum key distribution with one-way key and one basis
Authors: Wang Ke , Yang Xiu-Qing , Li Ting-Yu , Lin Ya-Qian , Hai Na , Yin Zhen-Qiang
Published: November 2023

Semi-quantum key distribution (SQKD) protocols are used to distribute secret keys between a quantum party and a classical party. However, existing SQKD protocols rely on two-way communication, and may still be vulnerable to Trojan horse side-channel attacks where Eve sends her own photon into a receiver’s apparatus and measures the reflected photon to estimate the key. In this paper, we propose a practical SQKD with one-way key. This requires that the single photons travelling through the one-way channel are used to encode bit information, and the returned photons are used to quantify Eve’s information, thus reducing the security analysis of the Trojan horse attack in SQKD. Meanwhile, our protocol with one basis enjoys security advantage in practical SQKD systems when source flaws are taken into account. In particular, the present protocol is secure under practical conditions when weak coherent pulses (WCP) are used. Our simulation results show that the protocol using WCP can distribute secret keys over a distance of 110 km without decoy states.
Deep learning-based age estimation from clinical Computed Tomography image data of the thorax and abdomen in the adult population
Authors: Kerber Bjarne , Hepp Tobias , Küstner Thomas , Gatidis Sergios
Published: November 2023

Aging is an important risk factor for disease, leading to morphological change that can be assessed on Computed Tomography (CT) scans. We propose a deep learning model for automated age estimation based on CT- scans of the thorax and abdomen generated in a clinical routine setting. These predictions could serve as imaging biomarkers to estimate a “biological” age, that better reflects a patient’s true physical condition. A pre-trained ResNet-18 model was modified to predict chronological age as well as to quantify its aleatoric uncertainty. The model was trained using 1653 non-pathological CT-scans of the thorax and abdomen of subjects aged between 20 and 85 years in a 5-fold cross-validation scheme. Generalization performance as well as robustness and reliability was assessed on a publicly available test dataset consisting of thorax-abdomen CT-scans of 421 subjects. Score-CAM saliency maps were generated for interpretation of model outputs. We achieved a mean absolute error of 5.76 ± 5.17 years with a mean uncertainty of 5.01 ± 1.44 years after 5-fold cross-validation. A mean absolute error of 6.50 ± 5.17 years with a mean uncertainty of 6.39 ± 1.46 years was obtained on the test dataset. CT-based age estimation accuracy was largely uniform across all age groups and between male and female subjects. The generated saliency maps highlighted especially the lumbar spine and abdominal aorta. This study demonstrates, that accurate and generalizable deep learning-based automated age estimation is feasible using clinical CT image data. The trained model proved to be robust and reliable. Methods of uncertainty estimation and saliency analysis improved the interpretability.
Refined Fuzzy Profile Matching
Authors: Rácz Gábor , Sali Attila , Schewe Klaus-Dieter
Published: November 2023

A profile describes a set of properties, e.g. a set of skills a person may have or a set of skills required for a particular job. Profile matching aims to determine how well a given profile fits to a requested profile and vice versa. Fuzzyness is naturally attached to this problem. The filter-based matching theory uses filters in lattices to represent profiles, and matching values in the interval [0,1], so the lattice order refers to subsumption between the concepts in a profile. In this article the lattice is extended by additional information in form of weighted extra edges that represent partial quantifiable relationships between these concepts. This gives rise to fuzzy filters, which permit a refinement of profile matching. Another way to introduce fuzzyness is to treat profiles as fuzzy sets. In the present paper we combine these two aproaches. Extra edges may introduce directed cycles in the directed graph of the ontology, and the structure of a lattice is lost. We provide a construction grounded in formal concept analysis to extend the original lattice and remove the cycles such that matching values determined over the extended lattice are exactly those resulting from the use of fuzzy filters in case of crisp profiles. For fuzzy profiles we show how to modify the weighting construction while eliminating the directed cycles but still regaining the matching values. We also give sharp estimates for the growth of the number of vertices in this construction.
Faktor-faktor yang Memengaruhi Kejadian Stunting di Wilayah Sangatta Kalimantan Timur
Authors: Syafiie Periskha Bunda , Sarangnga Christina
Published: November 2023

Latar belakang. Prevalensi stunting di Kabupaten Kutai Timur pada 2020 sebanyak 1515 kasus. Di Sangatta, tercatat 290 anak mengalami stunting per Februari 2020 dari total 4615 anak yang melakukan kunjungan posyandu (6,28%). Faktor determinan penyebab stunting di Indonesia di antaranya kelahiran prematur, panjang lahir pendek, tidak mendapatkan Air Susu Ibu eksklusif selama enam bulan pertama, pendidikan dan pengetahuan ibu yang rendah, paparan infeksi berulang, status gizi ibu, dan praktik pemberian makanan pendamping yang tidak kompeten.Tujuan. Mengetahui faktor-faktor yang berpengaruh terhadap kejadian stunting pada anak usia 6-59 bulan di Sangatta, Kabupaten Kutai Timur, Kalimantan Timur.Metode. Penelitian menggunakan desain case control, dilakukan di semua Puskesmas di Sangatta pada November-Desember 2021. Subjek penelitian adalah anak usia 6-59 bulan yang melakukan kunjungan posyandu dalam periode penelitian. Sebanyak 230 anak dipilih dengan consecutive sampling. Analisis data menggunakan analisis multivariat regresi logistik.Hasil. Angka kejadian stunting berhubungan dengan jenis kelamin laki-laki (p=0,036 dengan OR:1,9; IK:1,04-3,47), tidak mendapatkan ASI eksklusif (p=0,036 dengan OR:1,9; IK:1,04-3,47), dan Bayi Berat Lahir Rendah (p=0,04 dengan OR:2,7; IK:1,05-7,37), diikuti dengan faktor pengetahuan ibu (p=0,02). Golongan pendapatan merupakan faktor confounding (perancu).Kesimpulan. Variabel yang berhubungan signifikan dengan kejadian stunting adalah jenis kelamin, pemberian ASI eksklusif, berat badan saat lahir, dan pengetahuan ibu yang merupakan faktor prediktif dominan terhadap kejadian stunting pada anak usia 6-59 bulan di Sangatta.