bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a Bilingual Health Education Program to Identify and Address Healthcare Misinformation in a Border Community
Authors: Mansour Sara , Holland Nathan , Saucedo Sergio , Ramirez Amadeus , Lane Mariela , Salisbury Joshua , Marwaha Komal , Fernandez Lorena , Allen Jesse , Garikiparthy Veeravenkata , Rodriguez Patricia , Renovato Laura , Land Maria , Belmares Ricardo , Chacon Jessica
Published: December 2024

El Paso Health Education and Awareness Team (EP-HEAT®) is a bilingual program focused on increasing health awareness and dispelling health-related misinformation in the U.S.-Mexico border region. EP-HEAT® consists of students, faculty, staff, and Promotoras. The primary objective of EP-HEAT® is to empower the community with healthcare resources in a culturally acceptable way. EP-HEAT® established the bilingual “In the Hot Seat with EP-HEAT®: Dispelling Myths in Healthcare” series commonly referred to as Myth Busters events. Community members were surveyed following the events. Our results showed the majority of EP-HEAT® event attendees identified as Hispanic and were older than 46 years of age. Following EP-HEAT® events, attendees felt comfortable teaching the information they learned to friends and family. Dispelling myths is instrumental for communities with limited access or knowledge of healthcare and diseases. EP-HEAT® events serve as a platform for evaluating the sources of community’s current health information, prevalence of healthcare myths, understanding the community’s health information needs, and disseminating accurate health information while dispelling myths in a culturally competent manner. Medical students need to become proficient in serving as educators, particularly in underserved areas. The skills developed by participating in EP-HEAT® myth-buster events provide information to the community while simultaneously providing opportunities for medical students to organize these events and allowing them to act as community-facing educators that may promote their professional identity development.
Cystic Fibrosis Experience of Care Survey: Patient–Caregiver–Clinician Collaborative Design and Implementation
Authors: Allen Stacy , Vetter Maxwell , Davison David W. , Cochrane Gemma , Uluer Ahmet , Jennings Deidre , Asfour Fadi , Sabadosa Kathryn A. , Bailey Julianna
Published: December 2024

People with cystic fibrosis (PwCF), families, and clinicians, partner to co-produce care, navigate access barriers, address mental health and social factors, follow specific infection prevention and control practices, and share decision-making regarding treatments and daily care. Standard patient satisfaction and experience of care surveys are not tailored to return relevant, actionable data for specific populations. To improve the care experience, the U.S. CF Foundation committed to fielding a national survey in 2015. In 2020, the onset of the COVID-19 pandemic prompted revisions to capture virtual care experiences, a mode of care delivery not previously offered to PwCF. Leveraging this opportunity, the CF Foundation also reorganized how stakeholders are engaged in survey design, implementation, and improving the care experience. These changes resulted in a focused survey instrument as well as equitable and transparent data reports available to all stakeholders.
Patient-Centered Primary Care Provider Communication and Emergency Room Visits by Medicaid Patients in the United States
Authors: Platonova Elena , Ning Xi , Pan Yinghao , Thompson Michael E
Published: December 2024

Ineffective primary care provider (PCP) communication may contribute to the overuse of emergency room (ER) care in the United States. We examined the relationship between PCP communication and ER visits within a Medicaid patient population using 2022 Health Center Patient Survey data collected by the US Health Resources and Services Administration (HRSA). Our sample was 1807 Medicaid patients who had used HRSA-funded health centers for at least 12 months. Our predictors were the Consumer Assessment of Healthcare Providers and Systems communication items. Our outcome was the number of ER visits (categorized into three levels) during the previous year. Using ordinal logistic regression, we found that patients whose PCPs always knew important information about their medical history and who always received helpful service from staff had 24% and 20% lower odds of using ER care, respectively. Patients who had seen their PCP for at least 5 years had 37% lower odds of using ER care. Effective PCP and staff communication and improved continuity of care can reduce unnecessary ER visits while improving quality and reducing healthcare cost.
Poetry of Motion: Ankle Biomechanics in Ballet Dance
Authors: Luo Emily Joan , Kutzer Katherine , Carvalho Kepler A.M. , Talaski Grayson M. , Ungs Madeline , Zirbes Christian , Casas Erik Jesus Huanuco , Acker Antoine , Easley Mark E. , de Cesar Netto Cesar
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

Ankle sprains are one of the most common acute injuries amongst ballet dancers and may lead to chronic ankle instability. Certain ballet positions, if performed incorrectly or with inadequate technique, can further increase the risk of bone and soft tissue injuries. Dancing en pointe, which forces the foot and ankle into extreme plantar flexion, has been reported as the most common mechanism of injury. While these injuries occur frequently, little research has been done to understand the biomechanics of the foot and ankle in ballet. The aim of this study was to use weightbearing computed tomography (WBCT) and distance mapping to describe ankle joint mechanics in various ballet positions.

Methods:

This was an institutional review board approved case study analyzing five healthy professional ballerinas. WBCT scans were taken bilaterally in five different positions: a control/neutral position, first position, fifth position, plié, and relevé (en pointe). A semi-automatic software was used to segment models of all bones proximal to the first distal phalanx. Talar dome and gutter articulations were selected manually, and distances along the entire tibiofibular interface and gutter articulations were calculated using a previously published protocol. The mean syndesmosis width was calculated at 1 cm, 3 cm, and 5 cm from the tibiotalar joint.

Results:

Syndesmotic widening was greatest in first position at 5 cm above the tibiotalar joint (Mean: 9.39 mm). The relevé position consistently had the greatest syndesmotic narrowing at all heights along the syndesmosis. The anteromedial gutter had the largest range in regard to distance mapping, with greatest joint space width in fifth position (Mean: 4.99 mm) and narrowest joint space in plié (Mean: 2.68 mm). More specifically, in fifth position the anteromedial gutter space was 71% wider than the control position.

Conclusion:

This study is the first of its kind to mechanistically describe the ankle as it relates to ballet dancing. Interestingly, syndesmotic and tibiotalar joint space widening was greatest in first and fifth position, which may suggest that external rotation plays a greater contributing role in ankle instability compared to plantarflexion in ballet. Future research with larger cohorts and more WBCT stress positions is needed to comprehensively understand the foot and ankle joint mechanics in this demanding sport.
Posterior Ankle Impingement Syndrome: An Updated Review of Outcomes, Treatments, and Techniques
Authors: Lin Shu , Fine-Lease Paul , Wingo Taylor , Gianakos Arianna
Published: December 2024

Category:

Arthroscopy; Ankle

Introduction/Purpose:

Posterior ankle impingement syndrome (PAIS) is a common athletic injury, often associated in sports with repetitive ankle plantar flexion movements. The purpose of this study was to conduct a systematic review to evaluate the management and outcomes of patients with PAIS with focus on emerging operative techniques.

Methods:

A literature search was conducted using PubMed and Cochrane databases from within ten years from July 2013 to July 2023 in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Inclusion criteria consisted of all clinical studies evaluating posterior ankle impingement within the last ten years. Outcome measures included the following: visual analogue scale for pain (VAS), the American Orthopaedic Foot & Ankle Society Ankle-hindfoot score (AOFAS), return to sport time, and complication rates.

Results:

Nine studies evaluating 270 patients with a mean age of 24.7 years (mean range, 11.6-31.75 years) met inclusion criteria. Four studies were retrospective comparative studies evaluating open versus arthroscopic intervention. Five were case series, two evaluated open techniques, and three evaluated arthroscopic techniques. All studies that evaluated VAS pain and AOFAS clinical outcome scores reported improvements post-operatively for both groups. The return to sport ranges from 11.5 to 14.9 weeks with open treatment and 6.2 to 23.9 weeks with arthroscopic intervention. Arthroscopic group had six reported complications (2.83%), with infection and dysesthesia being the most reported. Open group also reported six complications (10.3%) with infection and sural nerve complications being the most commonly reported. Table 1 describes technical tips from each of the included studies.

Conclusion:

This study demonstrated that arthroscopic intervention for PAIS may result in quicker return to sports with lower rates of complications when compared with open excision and debridement. There are a variety of techniques utilized in order to afford ease and efficiency with minimally invasive arthroscopic strategies for PAIS. Future research including randomized controlled trials would be beneficial in order to clarify benefits of arthroscopic treatment of PAIS.
Pre-contoured Allograft Wedge Resorption and Complication Rates in Foot and Ankle Surgery at a Single Institution from 2017-2022
Authors: Boden Allison L. , Masry Seif El , DiGiovanni Grace , Demetracopoulos Constantine , Cody Elizabeth A.
Published: December 2024

Category:

Other; Basic Sciences/Biologics

Introduction/ Purpose:

Structural allografts have long been used in foot and ankle reconstructive surgery. Pre-contoured allograft wedges, manufactured in a variety of shapes and sizes for specific uses, have gained popularity in recent years due to their ease of use and ability to decrease operative time. A high rate of resorption of such pre-contoured allograft wedges was noted anecdotally by the senior authors, particularly in 2022. There is no known literature describing this phenomenon and thus, the purpose of this study was to identify the resorption and complication rates of pre-contoured allograft wedges over time.

Methods:

A retrospective review of patients who had a pre-contoured allograft wedge (Paragon28, Englewood, CO) implanted during foot and ankle surgery between 2017 and 2022 at a single institution by one of 10 surgeons was performed. Chart review was used to obtain demographic and implant information and confirm the surgical procedure(s) performed. Radiographic review was completed in order to identify patients with graft resorption and/or nonunion, confirm the site of allograft implantation, and determine the method of fixation used at the allograft site. A linear regression model was utilized to determine if there was a statistically significant association between the year and the number of cases of resorption.

Results:

In the 320 patients that met inclusion criteria, there were 334 wedges implanted. There were 24 grafts that resorbed and an additional 10 wedges that developed a non-union without resorption. Resorption was noted as early as 5.7 weeks post-operatively and as late as 36.6 weeks post-operatively (average 12.9 weeks). Of the allografts that resorbed, the majority were Lapidus wedges (38%) and Cotton wedges (56%) (Table 1). Resorption rates were highest in the last 2 years studied (Figure 1). Of the 78 wedges used in 2022, 11 wedges resorbed and there were 3 non-unions without resorption, for an overall complication rate of 18%. There was a statistically significant association between the year and the number of patients that had graft resorption (p = 0.03).

Conclusion:

While complications of allograft wedges in foot and ankle surgery have previously been described, including nonunion, resorption of pre-contoured wedges has not. Over a 5-year period at a single institution, there was a wedge resorption rate of 7% and an overall radiographic complication rate of 10%. There was an increase in allograft resorption cases as well as overall resorption rate and complication rate in 2022 compared to previous years. The majority of cases in which there was a complication occurred with the use of a Cotton or Lapidus wedge; however, no concrete identifiable patient or surgical risk factors were identified.
Radiographic Measurement of Distal Metatarsal Articular Angle Does Not Correlate with In-Vivo Deformity for Juvenile Bunion Deformity
Authors: O’Sullivan Michael , Coe Kelsie , Zide Jacob R. , Hartman Rusty , Riccio Anthony I.
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Correction of juvenile bunion deformities has historically been fraught with high recurrence rates leading to dissatisfaction among patients and surgeons alike. It is now recognized that these historically poor results have likely been due to a failure to correct the elevated distal articular metatarsal angle (DMAA) encountered in the vast majority of juvenile bunions. Though preoperative planning for deformity correction hinges on plain radiographic measurement of the DMAA, accuracy of this measurement in the juvenile population has not been studied. The purpose of this study is to compare plain radiographic measurements of the DMAA to in-vivo DMAA measurement.

Methods:

This is an IRB-approved retrospective r¬eview of prospectively enrolled patients over a 4-year period at single pediatric institution who underwent a scarf osteotomy for management of a juvenile bunion deformity. Children with neurologic disorders, autoimmune disease, congenital foot or extremity deformities, or history of prior ankle or foot surgery were excluded. Pre-operative DMAA was measured on standardized weight-bearing foot radiographs. In-vivo DMAA goniometric measurement was made at the time of surgery following capsulotomy and direct visualization of the articular surface of the metatarsal head. A Pearson’s correlation coefficient was calculated to assess the relationship between radiographic and in-vivo measurements.

Results:

19 feet in 20 patients with an average age at surgery of 15.9 years (range 13.1 -17.9 years) met inclusion criteria. Radiographic DMMA averaged 25.2o (range 7o - 32o) and intra-operative DMAA averaged 18.1o (range 5o - 69o). Pearson correlation coefficient revealed no correlation between radiographic and in-vivo DMAA measurements (r=0.186, p=0.45). Repeat analysis after removing three outliers with very high in-vivo DMAA measurements (greater than 40o) also showed no correlation between radiographic and anatomic DMAA measurements (r=0.051, p=0.85). As the in-vivo DMAA increased, radiographic measurements were more likely to underrepresent the true degree of deformity present (Figure 1).

Conclusion:

Plain radiographic DMAA measurements do not correlate to actual articular deformity in children with juvenile bunions. Moreover, as the degree of in-vivo DMAA increases, radiographic assessment is increasingly likely to underrepresent the extent of deformity correction required to achieve a normal DMAA intra-operatively. Surgeons should therefore not rely solely on plain radiography for preoperative planning or to assess adequacy of surgical correction of the juvenile bunion deformity. This is of particular importance for those performing minimally invasive bunion surgery as neither the amount of desired correction nor the surgical correction achieved can be reliably determined using plain radiography alone.
Radiographic Predictors of Surgical Management of Symptomatic Calcaneal Spurs: A Retrospective Cohort Study
Authors: McCahon Joseph A.S , Kohring Adam , Schultz Matthew , Massaglia Joseph , Parekh Selene G. , Pedowitz David I. , Daniel Joseph N.
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

Insertional Achilles tendinopathy (IAT) is one of the most common causes of posterior heel pain and affects thousands of patients every year. Enthesophytes can form at the Achilles tendon insertion in response to excessive loads and lead to pain and discomfort. There is limited evidence regarding patient factors associated with likelihood of failing non-operative management, specifically the size of the enthesophyte and its proximity to the posterior heel skin. The purpose of this study was to investigate the relationship between radiographic characteristics of retrocalcaneal enthesophytes in IAT and likelihood of failing non-operative management.

Methods:

A retrospective cohort study of 295 patients diagnosed IAT with symptomatic enthesophytes were identified and separated into operative and nonoperative cohorts. A power analysis was conducted and determined that a minimum of 100 patients within each cohort was required. All patients had lateral weight bearing radiographs which were used to measure the Calcaneal Spur-to-Skin Distance (CSK), Calcaneal Spur Width (CSW), Calcaneal Spur Height (CSH), and the Fowler-Philip Angle (FPA). Demographic and radiographic parameters were compared between both groups. Multivariate regression analysis was performed to identify independent risk factors associated with failing nonoperative management.

Results:

The operative group had significantly smaller CSK (6.0 mm vs. 6.6 mm; p = .02), larger CSW (7.9 mm vs 6.2 mm; p < .001), and larger CSH (14.1 mm vs. 11.1 mm; p < .001) compared to the nonoperative group. There was no significant between-group difference in FPA (61.9° nonoperative vs 63.3° operative; p = .052). Multivariate logistic regression analysis demonstrated CSK, CSW, and CSH as independent risk factors for failing nonoperative management.

Conclusion:

Radiographic measurements of retrocalcaneal enthesophytes are a simple and reliable method for predicting which patients have a higher likelihood of failing nonoperative management of IAT.
Radiographs Over-Estimates Joint Space Narrowing in Hallux Rigidus in Comparison to Weight-Bearing Computed Tomography
Authors: Fayed Aly M. , Mallavarapu Vineel , Mansur Nacime Salomao Barbachan , de Cesar Netto Cesar
Published: December 2024

Category:

Other; Bunion

Introduction/Purpose:

Twenty years ago, Coughlin and Shurnas proposed a clinical and radiographic classification grading scale for hallux rigidus (HR). Radiographic grading was based on weight-bearing anteroposterior and lateral conventional radiographs. Radiographic metrices include joint space width, a narrowing percentage of the dorsal joint space, and sesamoidal changes such as enlargement, irregularities, and sclerosis. Dorsal osteophytes were the main findings in all grades. The aim of this study was to compare hallux rigidus radiographic findings between conventional and weight-bearing computed tomography (WBCT). We hypothesized that radiographs overestimate joint space narrowing due to bone overlap and osteophytes.

Methods:

In this IRB approved study, all patients who had weight-bearing radiographs and WBCT for HR were included. Patients with previous hallux surgeries or associated severe hallux valgus were excluded. The first metatarsophalangeal joint (1st MTPJ) was measured using the summation method. (figure1) Dorsal osteophytes were measured. We measured the percentage of narrowing of the dorsal articular surface on a weight-bearing lateral/sagittal view. We evaluated the proximal phalanx (P1), first metatarsal (M1), and sesamoids (SS) for cysts. (Figure 1) All measurements were performed by two fellowship-trained orthopaedic foot and ankle surgeons. A comparison between groups was performed using the t-test or the Mann-Whitney U test according to data normality. Inter-rater reliability was evaluated using inter class correlation coefficient. Significant differences were established for p-values under 0.05.

Results:

The study included 21 patients; 13 were males. The average age was 55.9 ± 12.5 and the BMI was 28.9 ± 6.5. The joint space width was significantly larger on WBCT (1.9mm ± 0.44) vs. (0.92mm ± 0.53) (P < 0.001). WBCT showed less narrowing of the dorsal articular surface (46.59% ± 18.8%) vs. (22.78% ± 8.71). There was no difference in the size of dorsal spurs (4.57 mm ± 1.49) vs. (4.39 mm ± 1.56) (P = 0.684). WBCT detected loose bodies in nine patients, while radiographs detected them only in six patients. Sesamoid changes were appreciated on the WBCT image of all patients.

Conclusion:

Radiographic parameters of the Coughlin classification of hallux rigidus are better evaluated with WBCT. WBCT showed less narrowing of the dorsal joint space as it’s not affected by the overlap of other bones. Dorsal spurs may give the false impression of joint space narrowing on radiographs. Dedicated radiographic sesamoid views (not routinely ordered) are required to study sesamoid changes. The detection of less joint space affection could potentially lead to more joint sparing surgeries.
Readability of Patient Education Material on Ankle Arthroplasty
Authors: Fanfan Dino , Todd George , Murray Daniel , Chapman Cary B.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Health literacy has recently gained attention in the literature as it has been consistently shown to be an important predictor of patient outcomes. Total ankle arthroplasty (TAA) has recently increased in popularity, and it tracks that patient education regarding this procedure should be comprehensive and easily understandable. However, few studies have examined online patient educational materials (PEMs) for TAA for easy consumption and comprehension among the general public. The purpose of this study was to assess the readability of total ankle arthroplasty PEMs found on the websites of the top 100 orthopedic hospitals in the United States.

Methods:

The top 100 ranked orthopedic hospitals were identified from the U.S. News and World Report website. Our search was performed on Google with the name of the hospital as listed on the report followed by the words “total ankle arthroplasty.” We stratified the hospital websites based on their ranking in the report and evaluated their websites using four unique validated readability assessment tools: Coleman-Liau Index, Flesch Reading Ease test, Flesch-Kincaid grade level, and Gunning Fog Index. Statistical analysis was conducted to compare readability scores between hospitals in the upper and lower 50th percentiles.

Results:

56 unique websites were evaluated. There were no statistically significant differences in the readability outcomes across percentiles for the Coleman-Liau Index, Flesch-Kincaid, Gunning-Fog Index, and Flesch Reading Ease. The average scores were 11.87, 10.04, 12.93, and 50.04, respectively. 28% of websites were written at or below an 8th grade reading level. Higher ranked institutions had significantly higher word counts for TAA PEMs on average. There was no significant differences between higher and lower ranked hospital websites in the readability of TAA PEMs according to any of the four assessments.

Conclusion:

Our findings underscore a discrepancy between the readability of online PEMs on TAA and the average literacy level of the U.S. population. Despite the importance of health literacy in informed decision-making, most PEMs are written in language that may be inaccessible to many. Collaboration between healthcare professionals and patients is essential to develop clear and concise PEMs that bridge the literacy gap and empower patients to make informed healthcare decisions. Future efforts should focus on creating accessible materials using plain language techniques and incorporating patient feedback to ensure effectiveness in enhancing patient understanding and decision-making in the context of TAA.
Return to Sport and Clinical Outcomes Among Athletes Following Turf Toe Repair
Authors: Cho David , Drakos Mark , O'Malley Martin , Johnson A. Holly , Shamrock Alan , Kukadia Saanchi , Josephson Brian
Published: December 2024

Category:

Midfoot/Forefoot; Sports

Introduction/Purpose:

Turf toe, a plantar plate injury of the first metatarsophalangeal joint, commonly occurs in athletes participating in outdoor cutting sports. To the knowledge of the authors, this study reports on clinical and return to sport outcomes after surgical repair of turf toe for the largest cohort of patients presenting with a Grade III turf toe injury. The purpose of this study is to identify risk factors for turf toe and analyze foot function after turf toe injury and surgical repair. This study reports on clinical outcomes and return to sport for athletic patients treated for a turf toe injury at our institution. We hypothesize that patients will have significant improvement in pre- to postoperative clinical outcomes and quickly return to sport after surgical repair.

Methods:

This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Inclusion criteria included athletes of at least high school level competition who underwent plantar plate repair at the first metatarsophalangeal joint between 2016 to 2023 by 3 fellowship-trained foot and ankle orthopedic surgeons. Excluded were patients with histories of ipsilateral forefoot surgeries, rheumatoid arthritis, or gout. Twenty-eight patients were identified. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Return to sport surveys were distributed to patients at least one year postoperatively.

Results:

The average time from surgery to final follow-up was 2.8 (range, 1-5.3) years. PROMIS scores were found to significantly improve for Physical Function, Pain Interference, Pain Intensity, and Global Physical Health domains. 21 return to sport surveys were completed from the patient cohort. 19 out of 21 (90.5%) of patients were able to return to pre-injury levels of physical competition with an average time to return to sport was 20.35 (range, 12-32) weeks.

Conclusion:

This study compared short- to medium-term patient-reported clinical outcomes and return to sport data for athletes after a Grade III turf toe injury and surgical repair. Patients demonstrated significant improvement in patient-reported outcomes and were able to return to sport approximately five months after surgery.
Return to Work Outcomes Related to Operative Versus Nonoperative Treatment of Calcaneal Fractures
Authors: Luo Emily Joan , Wu Kevin , Eaton Kaleb , Talaski Grayson M. , Anastasio Albert T. , Adams Samuel B.
Published: December 2024

Category:

Hindfoot; Trauma

Introduction/Purpose:

Calcaneal fractures are a common work-related injury that can be treated both operatively and nonoperatively. Operative management typically consists of open reduction with internal fixation via either an extensile lateral or sinus tarsi approach. Conservative treatment employs a combination of immobilization, rest, and elevation. Given that return to work is a critical milestone for many of these patients, it is crucial that the best management option is chosen. While there have been studies that compared operative versus conservative treatment, there has been no summative review on this topic. Thus, the goal of this study was to conduct a systematic review and meta-analysis on the impact of operative versus nonoperative management on return to work outcomes.

Methods:

MEDLINE (PubMed), Embase (Elsevier), and Cochrane Library were searched for the concepts of calcaneal fracture and return to work. Inclusion criteria consisted of studies that reported on operative or nonoperative treatment of calcaneal fractures and outcomes relating to timing of return to work. Abstract only studies, biomechanical studies, cadaveric studies, case reports, studies involving pediatric patients, and non-English texts were excluded. Factors that were extracted included fracture type, pre-injury workload, mechanism of injury, treatment, return to work, functional outcomes, and complications. Revman 5.3 software was used for meta-analysis. Studies that did not qualify for meta-analyses were described qualitatively.

Results:

2462 studies were identified on initial search. 52 texts met inclusion and exclusion criteria. A total of 3338 patients were included. Operative management had significantly improved return to work outcomes compared to nonoperative treatment, with an overall mean difference of 40.79 days [95% Confidence Interval (CI), -69.55 to -12.03, p < 0.05]. Operative treatment was also associated with significantly lower pain scores [Mean difference: -1.14; 95% CI, -2.24 to -0.04, p < 0.05] and higher SF-36 scores [Mean difference: 13.89; 95% CI, 7.69 to 20.10, p < 0.0001]. Operative treatment did have expectedly higher risk of all complications compared to the nonoperative group [Risk Ratio: 1.80; 95% CI, 1.22 to 2.66, p < 0.05].

Conclusion:

While operative management was associated with higher risk of complications, patients had improved return to work, pain, and functional outcomes compared to nonoperative treatment. Careful consideration should be taken when determining treatment options for calcaneal fracture patients. Further research is needed to better elucidate differences between operative treatment options.
Use of Gastric Electrical Stimulation May Predict Hospital Length of Stay in Patients with Gastroparesis Syndromes
Authors: Guzman Rojas Patricia , Naing Le Yu , Mathur Prateek , Stocker Abigail , Mandzhieva Bayarmaa , Daniels Michael W. , Abell Thomas L.
Published: December 2024

Introduction:

Gastric electrical stimulation (GES) offers potential benefits for patients with drug-refractory gastroparesis syndromes (GpS). However, its impact on reducing hospital readmissions, particularly within 30 days post-discharge, remains unclear. GES placement might positively influence 30-day readmissions in patients frequently hospitalized for GpS symptoms.

Methods:

This prospective study included 110 patients admitted with GpS to a university-affiliated hospital over 5 years. The cohort had a mean age of 42 years. Hospital admissions were categorized into GpS-related flares and non-GpS-related causes. The Wilcoxon signed-rank test and generalized linear models (GLM) were used to compare pre-and post-GES outcomes.

Results:

The 110 patients had 1,690 admissions, of which 760 (45.0%) were related to GpS flare-ups. Less than 2% of admissions occurred within 30 days of GES placement. After GES placement, the median number of gastroparesis-related admissions decreased from 3 to 2 ( p = .002), and the median length of stay (LOS) dropped from 12.5 days to 7.5 days ( p = .004). The median LOS for GES placement was 1.0 days [1.0, 3.8].

Conclusions:

GES placement significantly reduced the number of gastroparesis-related admissions and the overall length of stay in hospitalized GpS patients. Our GLM analysis revealed that each additional day of hospitalization slightly decreased the odds of experiencing GpS-related symptoms. These findings suggest that GES can reduce hospital burden and improve quality of life in GpS patients. Further research into strategies for minimizing hospital admissions for severe gastroparesis flares, including bioelectric interventions, is recommended.
Purification of C1 Esterase Inhibitor from Human Plasma
Authors: Verma Sachin , Makadia Savan , Dolia Sheetal , Pawar Amit , Kumar Narendra
Published: December 2024

Background

Plasma-derived human C1-esterase inhibitor (C1-INH) concentrates are indicated for the treatment of acute episodes of hereditary angioedema. Intravenous C1-INH concentrate provides rapid relief to patients with acute hereditary angioedema symptoms.

Objective

To develop a safe and efficient purification process for C1-INH from human plasma.

Design

A combination of anion exchange and hydrophobic interaction chromatography was used to purify C1-INH from human plasma.

Method

The cold insoluble fraction (cryoprecipitate) was separated via centrifugation; then, the cryoprecipitate-poor plasma was subjected to different separation techniques to purify C1-INH. First, separation was performed using diethylaminoethyl (DEAE) anion exchange chromatography to capture coagulation factors. Then, C1-INH was purified from the remaining plasma using quaternary amine (a strong anion exchanger) chromatography, followed by DEAE (a weak anion exchanger) chromatography. The final product was purified via hydrophobic interaction chromatography, followed by ultrafiltration to concentrate the purified C1-INH. This process is cost-effective because coagulation factors were captured before C1-INH purification and the waste fraction after the capture stage was diverted to Cohn fractionation to isolate other potential plasma products.

Results

The final C1-INH preparation had a specific activity of >12 IU/mg protein, which is sufficient for its intended purpose. The purified preparation was characterized via sodium dodecyl sulfate–polyacrylamide gel electrophoresis, and coagulation factors were measured in the purified preparation. Furthermore, viral activity decreased via solvent detergent treatment and virus filtration.

Conclusion

We successfully developed a purification process for C1-INH from human plasma. This process is easily adaptable and has been successfully scaled up to approximately 15-fold. It can be further scaled up for the large-scale production of C1-INH.
The scale question as an urban question: The making of homo urbanicus amid state entrepreneurialism
Authors: Zhang Yong
Published: December 2024

This research bridges two influential strands of literature on urban China—state entrepreneurialism and homo urbanicus (城市人). By revisiting how China’s post-reform urban transformation has unfolded and connecting it to current development strategies, this research provides a fresh perspective on the country’s urbanization processes and their implications for future governance. The analysis proposes an alternative periodization of three phases: anti-migration urbanism, anti-settlement urbanism, and anti-civitas urbanism. Beyond understanding urbanization as a crisis-driven, state-rescaling phenomenon pivoting around the blending of state and market forces, this research repositions the concept of homo urbanicus, or the urban citizen, as central to understanding the urban question in China’s governance strategies. The study urges scholars to reconsider urbanization not only as a structural transformation but as a transformative redefinition of citizenship critical to understanding China’s ongoing drive to “people-centered urbanzation”.
The role of multimodality imaging in aortic valve assessment: A review
Authors: Besir Besir , Kapadia Samir
Published: December 2024

Aortic stenosis (AS) is one of the most prevalent valvular diseases. Doppler echocardiography is the most common imaging modality for the assessment of AS severity. Cardiac catheterization is also used when there are discrepancies between clinical and echocardiographic data. However, there exist many pitfalls in the assessment of the flow rate and pressure gradient by both imaging strategies. Doppler echocardiography assumes a circular left ventricular outflow tract (LVOT) and a flat velocity profile through the LVOT and does not account for pressure recovery. While cardiac catheterization accounts for pressure recovery, the formulas used to calculate oxygen consumption needed for cardiac output are also a source of inaccuracy in assessing the aortic valve area (AVA). Therefore, less flow-dependent modalities can be used to assess AS severity. Those methods can be divided into non-invasive such as 3-dimensional and resting flow rate assessment of AVA, invasive such as valvular resistance and valvulo-arterial impedance, and surrogate markers like the degree of aortic valve calcification, the degree of cardiac damage, and the delay between left ventricular and aortic systolic pressure peaks. Multimodality imaging, specifically dobutamine stress echocardiography and non-contrast cardiac computed tomography (CT) can also be used to assess the severity of moderate AS with discordant criteria on Doppler echocardiography. Finally, cinefluoroscopy, cardiac CT, cardiac magnetic resonance, and nuclear imaging can be used to assess prosthetic aortic valves when valve dysfunction is suspected or when there is discordance between the echocardiographic assessment and the patient's clinical status.
Assessment of Valve Hemodynamics Following Transcatheter Versus Surgical Aortic Valve Replacement in Women With Small Aortic Annulus
Authors: Fadel Elie , Diep Calvin , Calin Eliza , Masson Jean-Bernard , Potvin Jeannot , Gobeil Jean-François , Noiseux Nicolas , Kalavrouziotis Dimitri , Mohammadi Siamak , Stevens Louis-Mathieu , Forcillo Jessica
Published: December 2024

Background

Prosthesis-patient mismatch (PPM) has been shown to be related to worse survival and hemodynamic outcomes following valve replacement. Women with aortic stenosis (AS) have a smaller annulus than their male counterpart, making them more susceptible to PPM. The objective of this study was to compare the incidence of PPM in a female population with small aortic annulus (SAA) undergoing transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) using the Carpentier Edwards Magna Ease bioprosthetic valves (19-21 mm) and the Edwards Sapien 3 and Sapien 3 Ultra transcatheter valves (20-23 mm).

Methods

This retrospective study was conducted using harmonized databases from two high-volume cardiac surgery centers. Female patients with SAA (≤23 mm) measured by echocardiography who underwent SAVR or TAVR between 2011 and 2022 were included. Patients with pure aortic regurgitation were excluded. The primary endpoint was to compare the incidence of moderate to severe PPM, both measured and predicted, in women receiving TAVR versus SAVR. Secondary endpoints included various clinical outcomes.

Results

A total of 426 women were included. 64.8% underwent SAVR (mean age: 75) and 35.2% underwent TAVR (mean age: 81). SAVR patients received 19- or 21-mm prostheses (32% and 68%, respectively). Almost all TAVR patients (94%) were assigned a 23 mm prosthesis, with the others receiving a 20 mm prosthesis. While 53% of SAVR patients were predicted to have a moderate to severe PPM (P-PPM), 39% of TAVR patients were predicted to do so ( P = .005). When it came to measured PPM (M-PPM), 73% of SAVR versus 32% of TAVR patients had moderate to severe PPM ( P < .001). Proportions were lower when adjusting for BMI > 30 (P-PPM - SAVR: 25%; TAVR: 19%; P = .148; M-PPM – SAVR: 64%; TAVR: 23%; P < .001).

Conclusion

In women with SAA, a larger proportion of SAVR patients had moderate to severe P-PPM or M-PPM compared to TAVR patients. Adjusting for BMI > 30 showed similar trends, although overall proportions were lower.
Concomitant cardiac amyloidosis and aortic stenosis: update on diagnosis and management
Authors: Omer Mohamed H. , Shafqat Areez , Zenses Anne Sophie , Ahmad Omar , Alsergani Hani , Chetrit Michael , Fadel Bahaa , Tournoux Francois , Mohty Dania
Published: December 2024

Concomitant aortic stenosis (AS) and cardiac amyloidosis (CA) represent a significant and increasingly recognized clinical challenge, particularly in elderly populations. This review aims to present current knowledge on the prevalence, clinical characteristics, imaging findings, outcomes and management strategies for patients with both AS and CA. Studies indicate that transthyretin cardiac amyloidosis (ATTR-CA) frequently coexists with AS, especially in patients undergoing transcatheter aortic valve replacement (TAVR), with prevalence rates ranging from 4% to 16%. The dual pathology exacerbates heart failure risk, increases mortality, and complicates therapeutic decision-making. Diagnosing CA in the presence of AS is complex due to overlapping clinical and imaging features. A multi-parametric diagnostic approach is essential, incorporating clinical assessment, advanced echocardiography, cardiac magnetic resonance imaging, and bone scintigraphy of the heart. The presence of CA influences the management of AS, often favoring TAVR over surgical valve replacement due to increased surgical risk. Emerging pharmacological treatments for ATTR-CA offer survival benefits and may alter the natural disease progression. This review highlights the need for heightened clinical awareness, early diagnosis through advanced imaging modalities, and tailored therapeutic strategies to improve outcomes in patients with concomitant AS and CA.
Mid-term Clinical and Hemodynamic Outcomes in Patients Treated for Aortic Regurgitation and/or Ascending Aorta Aneurysm: The 3-Year Flight of the AVIATOR Registry
Authors: Tastet Lionel , Salaun Erwan , de Heer Frederieck , Kluin Jolanda , El-Hamamsy Ismail , Chauvette Vincent , Laubriet Aline Jazayeri , Karalko Mikita , Kolesar Adrian , Rudez Igor , Verbrugghe Peter , de Hubsch Alejandro Crespo , Hlubocký Jaroslav , Rosa Rubina , Jasinski Marek , Hecht Sébastien , Dinges Christian , Yiu Patrick , Ceresa Fabrizio , Chirichilli Ilaria , de Kerchove Laurent , Lansac Emmanuel , Pibarot Philippe ,   On Behalf of the Aortic Valve Repair Research Network Investigators of AVIATOR Registry
Published: December 2024

Background

There are few prospective and large registries on outcomes after aortic valve repair/sparing or replacement in patients with aortic valve regurgitation (AR), with or without ascending aorta aneurysm.

Methods

A total of 2,026 patients enrolled prospectively in The Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR) were included in this analysis. The primary endpoint was the composite of all-cause death or aortic valve and/or aorta reintervention.

Results

1,630 (80%) received surgical repair/sparing versus replacement in 396 (20%). During a mean follow-up of 3.8 ± 1.9 years, 187 (9.2%) events occurred, including 106 reinterventions and 81 deaths. The incidence of the composite endpoint was higher in the replacement versus repair group (25.3% vs. 11.8%; log-rank p < 0.001). In particular, the incidence of death was higher in the replacement versus repair group (21.9% vs. 4.5%; p < 0.001), while the incidence of reintervention was comparable between groups (8.2% vs. 5.1%; p = 0.16). AR ≥ grade 2 (mild-to-moderate) at discharge (2.9%) was more common in repair versus replacement (3.5% vs. 0.3%; p < 0.0001). AR (Grade 2) at discharge was significantly associated with higher incidence of the primary endpoint (adjusted HR: 2.60 [95% CI 1.01–6.74]; p = 0.04).

Conclusion

Surgical repair was associated with better survival than replacement at mid-term follow-up without increased risk of reoperation. However, the incidence of postoperative AR ≥ grade 2 was higher in repair than in replacement surgery. AR ≥ grade 2 at discharge was a strong predictor for reintervention during follow-up, stressing the importance of achieving complete correction of AR at the time of aortic valve repair.
Dispersant-assisted rotating liquid film reactor separation strategy for low-grade palygorskite purification with improved dye absorption performance
Authors: Wang Qihui , Liu Xiaoli , Jiang Chao , Wang Xingpeng , Wu Linlin , Li Huiyu , Tian Weiliang , Feng Yongjun
Published: December 2024

Palygorskite (Pal) shows great potential for physical, chemical and biological uses due to its colloidal, catalytic and adsorption properties. Pal mines, however, are facing the challenge of low-grade materials (5–15%), making it difficult to use Pal in emerging fields such as new materials, environmental protection and health. Therefore, there is an urgent need to develop an efficient method for separating and purifying Pal to obtain high purity levels. Hence, we have developed a dispersant-assisted rotating liquid film reactor separation strategy based on sodium hexametaphosphate as the dispersant. This strategy utilizes the double electron layer of Pal and the density difference between impurities to achieve effective disaggregation and purification of Pal bundles through the promotion of repulsive driving effects. Under optimal conditions, the purity of Pal can be increased from less than 10% to over 80%. This research presents a novel approach to the efficient refining of low-grade Pal. The crudely purified Pal’s adsorption capacity for methylene blue increased from 84.2 to 256.4 mg g–1.
Contrasting assemblages of secondary minerals after beryl from the granitic pegmatites Drahonín IV and Věžná I; evidence for high variability of mineralised fluids in the Rožná-Olší ore field area, Czech Republic
Authors: Novák Milan , Gadas Petr , Sobek Kamil , Toman Jiří , Šikola Drahoš
Published: December 2024

This work presents data for the mineral assemblages, composition and Raman spectroscopy of proximal secondary Be and associated minerals in pseudomorphs after beryl from granitic pegmatites located along the contacts of major regional geological units. The pegmatites differ in their position relative to the ductile to brittle shear zones within the Rožná-Olší ore field (U-deposit), Czech Republic. Extensive dissolution of beryl crystals in the beryl–columbite pegmatites Drahonín IV and Věžná I situated within or close to the shear zones is evident in contrast to minor alteration of beryl in the Dolní Rožínka and Kovářová pegmatites located outside of the shear zones. Near-total replacement of beryl crystals, up to 40 cm in length, from the Drahonín IV pegmatite, located in the Olší shear zone formed the following secondary Be minerals in order of their abundance: bavenite–bohseite > bertrandite ≫ milarite > hydroxylgugiaite. This assemblage is also characterised by the presence of sulfides (pyrite, galena, sphalerite) and zeolites. Such an extensive replacement process required a substantial fluid flow and is very possibly related to the pre-uranium quartz–sulfide and carbonate–sulfide mineralisation events within the Rožná-Olší ore field. Alteration products resulting from breakdown of beryl in the Věžná I pegmatite follow the sequential substages (bertrandite + K-feldspar ± harmotome → epididymite + K-feldspar → hydroxylgugiaite + K-feldspar) and locally show cross-cutting textures. These assemblages were generated by post-magmatic residual fluids (early assemblage bertrandite + K-feldspar) as well as fluids related to a retrograde stage of metamorphism, compositionally contrasting with the host serpentinite, and perhaps also hydrothermal processes associated with the Olší shear zone. The pegmatites Dolní Rožínka and Kovářová, located outside of the shear zones, exhibit only a low degree of alteration and have differing textural and paragenetic development. Highly variable assemblages of secondary minerals after beryl are excellent mineral indicators of hydrothermal overprinting in granitic pegmatites during a variety of subsolidus processes.