bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of 28 Broken Syndesmosis Screws
Authors: Maten Josh W. Vander , Roebke Logan , Liu Jiayong
Published: November 2020

Category:

Ankle; Trauma

Introduction/Purpose:

Syndesmosis screw fixation remains a common standard of care in patients with syndesmosis injuries. Screw fracture is a relatively common occurrence in these patients. The purpose of this is study is to examine the screw characteristics of 28 syndesmosis screws that resulted in screw breakage.

Methods:

This retrospective study examined all tibia procedures from 2008 to 2019 at a level 1 trauma center. Patients that were treated with a syndesmosis screw that resulted in a screw breakage were included for further analysis. In total, 14 patients satisfied this criterion. A comprehensive analysis of the screw characteristics was then performed. Screw angle was determined using the fibular plate as the vertical axis. Distance of screw fracture also used the fibular plate as a reference point. The tibial plafond was used to determine screw placement. Screws were stratified into subcategories based on standard deviation for screw angle and screw placement.

Results:

28 screws were analyzed in 14 patients (6 males, 8 females). On average, 2 syndesmosis screws were placed with a range of 1 to 4. Average screw length was 50.54±5.67 (45-65) mm. Average screw width was 3.64±.36 (3.50-4.50). Average angle of screw placement was 88.70±(65.90-99.50). Eighteen (64.29%) of the screws were placed at an angle greater than 90 degrees. Six were between 80-90 (21.42%) degrees. Average height above the tibial plafond was 25.90±(9.75-49.90). Fifteen (53.57%) of the screws were placed between 20-30mm above the tibial plafond. Six (21.43%) were between 10-20 mm. Twelve screw fractures occurred within the fibula, 7 within the tibia, and 2 screws had a fracture within the fibula and tibia. The average fracture distance from the fibular plate was 14.81±2.36(0-36.23) mm.

Conclusion:

The aim of this study was to examine syndesmosis screw characteristics following fracture. Eighteen of the 28 screws were placed above a 90-degree angle and 15 were placed between 20-30mm above tibia plafond. This may suggest higher risk for screw fracture above 90 degrees and between 20-30mm above the tibial plafond, however, further analysis with more subjects should be done before any determination is made. [Table: see text]
BMI and Comorbidities in Patients with Syndesmosis Screw Breakage
Authors: Maten Josh W. Vander , Liu Jiayong , Roebke Logan
Published: November 2020

Category:

Ankle; Trauma

Introduction/Purpose:

Syndesmosis screw fixation remains a common standard of care in patients with syndesmosis injuries. Post-operative screw breakage is a common occurrence in these patients. The purpose of this is study is to compare BMI, comorbidities, and characteristics of patients who had a syndesmosis injury repaired with screw fixation resulting in screw failure. Numerous studies (21) have examined patients with syndesmosis screw fracture, focusing primarily on screw characteristics such as width, length, and screw material. Of those studies, only six considered BMI, while only one of the six differentiated BMI between patients with a broken screw and those without. Only three of the studies collected patient comorbidity data.

Methods:

This study examined all tibia procedures at a level 1 trauma center from 2008 to 2019. Only patients treated with syndesmosis screw fixation that resulted in a screw fracture were included for further analysis. In total, 14 patients satisfied this criterion. A comprehensive analysis of each patients BMI, comorbidities, and characteristics was then performed. Age, gender, height, weight, BMI, smoking status, diabetes, hypertension, alcohol abuse, and soft tissue conditions were all analyzed. Further examination of conditions with potential to impact bone quality such as osteoporosis, osteoarthritis, and rheumatoid arthritis were also included.

Results:

Eight females and 6 males with an average age of 42.43±13.90(20-43) were included in the analysis. The average number of comorbidities was 2.93±(0-6). BMI average was 38.92±(22.05-56.34) indicating Grade II obesity for the entire patient cohort. Six patients had a BMI > 40 or Grade III (morbidly obese) while only two patients had a satisfactory BMI < 25. All patients in the syndesmosis fracture group had more than one comorbidity apart from a single patient (case 3). Six patients had at least 2 comorbidities, 3 patients had 3, 2 patients had 2, and 2 patients had 6. Eight (57%) of 14 had post-operative complications including: Symptomatic hardware + removal (6), revision surgery (4), and compartment syndrome (1). Five patients retained their broken screw without complication.

Conclusion:

Patients with syndesmosis screw breakage are a highly comorbid population. Patients in this study, on average, had a significantly elevated BMI potentially predisposing them to screw failure. In conclusion, future analysis of syndesmosis injuries should include BMI and comorbidities. Future studies should pay special attention to BMI as potential confounding variable when attempting to determine reasons for syndesmosis screw breakage. [Table: see text]
Cost Comparison of Suture Anchor Modified Broström Repair and Augmentation of the Modified Broström with FiberTape Device
Authors: Vannatta Emily , Stauch Chris M. , King Jesse , Kim Morgan S. , Luick Laura R. , Bifano Shawn M. , Juliano Paul J. , Aydogan Umur , Aynardi Michael C.
Published: November 2020

Category:

Ankle; Sports

Introduction/Purpose:

Augmentation of the Broström procedure with FiberTape device has been described for the treatment of chronic ankle instability. However, it has yet to be determined if the cost of the implant is negated by the benefits to the patient. The purpose of this study was to perform a comprehensive cost analysis by comparing the cost of surgical procedure, physical therapy visits, time off work, and any costs related to revision surgery between the Broström reconstruction with suture anchors alone versus augmentation with a FiberTape device.

Methods:

166 patients undergoing lateral ankle ligament repair were analyzed retrospectively. Patients underwent either a modified Broström ligament repair with two suture anchors or Broström ligament repair with FiberTape augmentation. All patients followed the same post-operative protocol for early weight bearing and initiation of physical therapy once the wound was healed. Timing of return to work and the total number of visits of physical therapy before discharge were recorded. Implant costs, facility charges and professional fees were obtained from billing records. Lost income for missed days of work was based on the Pennsylvania Bureau of Labor Statistics. Complications requiring return to the operating room were recorded. Patients were followed out to one year.

Results:

Aggregate cost in the modified Broström group was $2,219 more expensive than when augmenting with FiberTape ($20,970 vs. $18,751) despite an increased implant cost of $900. This difference was the result of a greater number of therapy visits and days out of work in the modified Broström group versus the augmentation group (14.9 vs 12.4) as well as a significantly higher amount of days out of work in the modified Broström group versus augmentation (63.3 vs. 53.8 days respectively). No statistically significant difference was found for operation time between groups, and failure rates were similar; 2.0% (1/49) for FiberTape and 3.4% (4/117) for modified Broström.

Conclusion:

The aim of this study was to explore the cost comparison of the modified Broström procedure for chronic ankle instability versus the FiberTape augmentation. Despite an upfront increase in implant costs, the average cost per procedure was lower for the augmentation group. The majority of cost savings occurred in decreases in the number of physical therapy visits and faster return to work times. The results of this study suggest that the use of FiberTape to augment modified Broström repair may have a financial benefit and cost savings to patients and the healthcare system.
Union of Foot/Ankle Arthrodesis: A Registry Study of Low-Intensity Pulsed Ultrasound (LIPUS)
Authors: White Neil J. , Lau Johnny T. , Ong Kevin , Kurtz Steven M. , Lin Sheldon S.
Published: November 2020

Category:

Ankle; Hindfoot; Midfoot/Forefoot; Trauma.

Introduction/Purpose:

To aid in healing and avoid costly revision surgery, bone grafts, growth factors, and bone stimulation devices are used as adjuncts to foot/ankle arthrodesis. This study evaluated the union rates of LIPUS as an adjunct to foot/ankle arthrodesis and the corresponding factors associated with improved healing.

Methods:

Foot/ankle arthrodesis patients were identified retrospectively from a prospective post-market arthrodesis/fracture registry for EXOGEN (Bioventus LLC, Durham, NC). Inclusion criteria were males or non-pregnant females 18 years of age or older at time of enrollment, known date of fracture, known start and end dates of LIPUS treatment, and known treatment success outcome. Treatment success was defined by both clinical (solid and pain-free on manual stress) and radiological (at least 3 of 4 cortices bridged on x-rays) criteria. Association between union rates and surgical treatments, comorbidities, and medications was tested with Chi-square tests.

Results:

A total of 235 primary and 16 revision foot/ankle arthrodesis patients used EXOGEN. 41.4% used EXOGEN within 90 days of the fracture/arthrodesis. Overall union rate was 86.9% (primary: 86.4%; revision: 93.8%). Having the comorbidity of diabetes, obesity, or current smoker was not associated with a higher non-union rate (p=0.779). Other comorbidities were also not associated with increased non-union rates (e.g., Charcot disease p=0.614, NSAID p=0.862, steroids p=0.647). EXOGEN use within 90 days of the fracture/procedure date was associated with improved union rates for the overall (p=0.004, odds ratio (OR) 3.7 (95% CI: 1.5-9.3)) and primary (p=0.007, OR 3.4 (95% CI: 1.3-8.6)) groups. For the overall group, union rates were 94.2% (EXOGEN use <=90 days post-fracture/procedure), 80.6% (91 to 365 days), and 84.6% (>365 days).

Conclusion:

Union rates for foot/ankle arthrodesis with adjunctive LIPUS were comparable to other therapies with and without other adjuncts (Table 1). Known risk factors for non-union, such as smoking and Charcot disease, were not found to be associated with healing for the LIPUS patients. This suggests the possibility that LIPUS was able to mitigate potential patient risk factors and may offer a low risk post-operative adjunct in difficult healing scenarios. [Table: see text]
Quality and Readability of Online Information on Ankle Instability
Authors: Willegger Madeleine , Schwarz Gilbert M. , Lisy Marcus
Published: November 2020

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Ankle sprains are among the most common sports injuries and up to 60% of patients experience long- term ankle disability or develop chronic ankle instability. Proper patient information is essential in both conservative and surgical treatment. The rising role of the internet has revolutionized the way patients acquire health-related information. Nevertheless, inaccurate or outdated online resources could lead to misinformation about the nature of ankle instability and the treatment options. Aim of this study was to evaluate the quality, accuracy and readability of free available online resources regarding ankle instability.

Methods:

Three search terms (‘ankle instability’, ‘ankle instability treatment’, ‘ankle laxity’) were searched using the three biggest search engines (Google, Bing, Yahoo). Quality and accuracy of online patient information was evaluated by using the EQIP36 and a custom 25-item list based on recommendations of the AOFAS. Readability was assessed by evaluating the Flesch-Kincaid score.

Results:

A total of 102 online resources were included in this study. The mean 25-item-score was 9.45 (range 1-22) and the mean EQIP 36-score was 40.72 (range 17.65-65.71). The average Flesch-Kincaid score reached 110.60 (range 10-176) and 97% of evaluated websites exceeded the recommended 8th grade reading level for patient information. Quality was significantly higher with reading levels of college graduates (p<0.001). There was no difference regarding search terms or search engines.

Conclusion:

Available online information on ankle instability showed huge differences regarding the quality, readability and accuracy. Inappropriate advanced reading levels of high-quality websites could be incomprehensible to patients. Foot and ankle specialists should be aware of the low quality and readability of the majority of online resources and provide patients with adequate website-links.
Incidence of Chondral and Osteochondral Lesions in Ankle Fracture Patients Identified with Ankle Arthroscopy Following Rotational Ankle Fracture
Authors: Williamson Emilie , Rosas Kevin , Dankert John , Toale James P. , Hurley Eoghan T. , Egol Kenneth , Kennedy John G.
Published: November 2020

Category:

Ankle; Trauma

Introduction/Purpose:

It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture.

Methods:

The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant.

Results:

Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001).

Conclusion:

Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.
Outcomes Following Microfracture for Osteochondral Lesions of the Talus in Female Patients
Authors: Williamson Emilie , Gianakos Arianna L. , Hurley Eoghan T. , Kennedy John G.
Published: November 2020

Category:

Ankle; Arthroscopy; Sports

Introduction/Purpose:

Microfracture (Mfx) is typically indicated for patients who have symptomatic osteochondral lesions of the talus (OLT) which are smaller in size. However, there is scant literature focusing exclusively on female patients, who may require specific consideration as compared to male counterparts. The purpose of this study was to evaluate the outcomes of Mfx in the treatment of OLT in the females population.

Methods:

A retrospective analysis comparing patients treated with Mfx for OLT was performed, to include all patients treated between 2007 and 2015. Clinical outcomes were evaluated using the Foot and Ankle Outcome Scores (FAOS) and Short-Form 12 (SF-12). Magnetic resonance imaging (MRI) at final follow-up was evaluated with the modified magnetic resonance observation of cartilage repair tissue (MOCART) score.

Results:

Thirty-one females were included. The mean patient age was 39.6 +- 17.2 years with mean follow-up of 48.4 +- 24.8 months. The mean preoperative and postoperative FAOS score was 53.3 +- 22.9 and 73.2 +- 18.2 (p < 0.001), and the mean preoperative and postoperative SF-12 score was 40.6 +- 11.1 and 56 +- 15.1 (p < 0.001). The final MOCART score was 59.3 +-24.5. Overall, 6 (19.4%) patients required a further surgery, 4 patients (12.9%) were considered failures, 2 (6.5%) patients required a distraction arthroplasty and 2 patients (6.5%) required a repeat bone marrow stimulation.

Conclusion:

The outcomes following Mfx for OLT in females were good at mid term follow up. However, the final MOCART scores were poor, indicating poor cartilage repair tissue and a poor harbinger for long term outcomes.
Preoperative Depression Influences Outcomes Following Total Ankle Arthroplasty
Authors: Wilson Jacob M. , Schwartz Andrew M. , Farley Kevin X. , Bariteau Jason T.
Published: November 2020

Category:

Ankle; Ankle Arthritis; Other

Introduction/Purpose:

Total ankle arthroplasty (TAA) is a successful procedure and its incidence is increasing. While a diagnosis of depression is known to effect outcomes following other procedures, its effect on outcomes following TAA are unknown. Therefore, the purpose of this study was to assess the contribution of depression to outcomes following TAA. We hypothesized depression would lead to increased rates of 90-day complications.

Methods:

This is a retrospective cohort study. Data was collected from the Nationwide Readmission Database (NRD) for all patients undergoing TAA. Patients were screened for a documented preoperative diagnosis of depression. Two cohorts (those with and without depression) were created. Logistic regression was then performed to assess the contribution of a pre-operative diagnosis of depression on rates of 90-day complications, while controlling for patient demographic and comorbid data.

Results:

Overall 8,047 patients underwent TAA during the study period. Of these, 11.4% (918) had a pre-operative diagnosis of depression. Compared to patients without depression, patients with depression had a 1.61 (95% Confidence Interval [CI]: 1.31- 1.98) times increased odds of non-home discharge and a 34% increased odds (Odds ratio [OR] 1.34, 95%CI 1.15-1.57) of extended LOS (>2 days). In addition, patients were at increased risk of prosthetic complication (OR 1.39, 95%CI 1.10-1.74), wound complication (OR 1.59, 95%CI 1.11-2.29), prosthetic joint infection (OR 1.82, 95%CI 1.06-3.15), superficial surgical site infection (OR 1.62, 95%CI 1.02-2.58), and occurrence of at least one medical complication (OR 1.32, 95%CI 1.03-1.68).

Conclusion:

Depression in patients undergoing TAA is common and should be recognized by providers. Furthermore, it is associated with increased healthcare utilization and complications following surgery. Further research should be performed to determine if depression is a modifiable risk factor.
Prevalence and Related Factors of Flexible Flatfoot in School-Aged Children: A Cross-Sectional Study
Authors: Xiaojun Liang , Hong-Mou Zhao
Published: November 2020

Category:

Other; Midfoot/Forefoot

Introduction/Purpose:

There is a greater prevalence of flexible flatfoot (FFF) among children; however, most of them are physiological, and the associated factors are still in debate. The purpose of current cross-sectional study was to investigate the FFF prevalence of 6 to 13 years Han nationality children in Northwest China; and to investigate the potential relative factors correlated with FFF.

Methods:

A total of 1,059 children aged from 6 to 13 years were included. Dynamic footprints according to FootScan system were collected from both feet. The relationship of FFF with age, gender, side, body mass index (BMI), foot length-width ratio (LWR), and contact area were investigated.

Results:

The percentage of FFF decreased from 39.5% at 6 years to 11.8% at 12 years, and reached a platform at 12 to 13 years. Overweight (OR 1.35, 95%CI 1.03-1.77) and obese (OR 2.43, 95%CI 1.81-3.26) showed positive correlation with percentage of FFF children; but only obese (OR 3.25, 95%CI 2.19-4.82) showed positive correlation in small age group (6 to 9 years). The mean LWR was larger in healthy children, and still larger in small and large age groups (P < 0.01). The mean midfoot contact area percentage was larger in FFF than healthy foot (P < 0.01). No correlation was found between FFF prevalence and gender or side.

Conclusion:

The prevalence of FFF decreases with age, and reached a platform at 12 to 13 years. The prevalence of FFF is positively correlated with increased BMI, especially in small aged children; and the prevalence of FFF is positively correlated with decreased LWR.
Clinical Analysis on the Treatment of Kaschin-Beck Disease of the End-Stage Ankle by Tibiotalocalcaneal Arthrodesis Using Lateral Approach With Platelet-Rich Plasma
Authors: Yi Li , Xiaojun Liang , Hong-Mou Zhao
Published: November 2020

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Objective To study the effectiveness of treated Kaschin-Beck Disease of the ankle by tibiotalocalcaneal arthrodesis using lateral approach with autologous platelet-rich plasma.

Methods:

Retrospective analysis was conducted on the clinical effect of our department on the treatment of 23 patients (25 ankle joints) with severe Kaschin-Beck Disease from May 2014 to May 2016. All patients were treated with tibiotalocalcaneal arthrodesis by using lateral approach of fibula osteotomy with distal fibula cancellous bone combined with autologous platelet rich plasma for bone grafting and internal fixation with full thread cannulated screws or auxiliary lateral plate. Surgical time, blood loss, joint fusion time, delayed wound healing, infection, nonunion of osteotomy surface, chronic pain and other complications were recorded. VAS score and AOFAS ankle and hind foot score were compared before and at the last follow-up.

Results:

The mean healing time was 14.7 weeks. Postoperative wound healing was delayed in 3 patients. One patient developed superficial infection 1 week after surgery. Bone graft absorption, nonunion of osteotomy surface and loosening of internal fixation were observed in 2 patients. The bone healed at 13 weeks after surgery. 22patients were followed up for an average of 15.7 months. The postoperative AOFAS score was 76 points, and the postoperative VAS score was 2 points with statistically significant differences from the preoperative AOFAS (t=19.13, P<0.01) and VAS (t=17.27, P<0.01). In 21 cases, tibial calcaneal joint fusion was performed in the first stage, and the fusion rate was 87.5%.21 patients received the first stage of bone fusion after surgery, and the fusion rate was 87.5%.

Conclusion:

Ankle joint and subtalar joint can be well exposed through the lateral approach of fibular osteotomy. The distal fibula autograft with sufficient cancellous bone mass and the combination of autologous platelet rich plasma graft can promote bone healing, and the reliable internal fixation can help achieve satisfactory clinical effect of tibiotalocalcaneal arthrodesis.
Triple Osteotomy for Correction of Hallux Valgus with an Increased Distal Metatarsal Articular Angle
Authors: Yi Li , Xiaojun Liang , Hong-Mou Zhao
Published: November 2020

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

At present, there is a wide range of surgical methods for the treatment of hallux valgus with an increased distal metatarsal articular angle, there are not many reports on the effectiveness of this method that triple osteotomy and lateral soft tissue release. To study the clinical effect of triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle.

Methods:

A retrospective analysis of the clinical data of 23 patients (35 feet) with an increased distal metatarsal articular angle and undergoing triple osteotomy and lateral soft tissue release between January 2010 and December 2014 in Xi’an Hong Hui Hospital was conducted including 7 male (12 feet) and 16 female (23 feet). Their average age was (45.7+-15.2) years (range: 21˜66 years). The hallux valgus angle (HVA), the intermetatarsal angle (1-2 IMA) and the distal metatarsal articular angle (DMAA) in weightbearing dorsoplantar radiographs of the foot before operation and at final follow-up visit were compared. The preoperative and the final follow-up clinical functional outcomes were evaluated by the American Orthopaedic Foot & Ankle Society Hallux metatarsophalangeal-interphalangeal (AOFAS-MTP-IP) scale and a visual analogue scale (VAS).

Results:

The average follow-up time was (19.1+-7.3) months (range: 10˜32 months). There are no such severe complications as nonunion, avascular necrosis. The pain of first metatarsophalangeal joint was apparent release after operation 6 months. The incomplete range of motion in the first metatarsophalangeal joint occured at three patient (4 feet), but the symptoms disappeared after functional exercise. The HVA, IMA and DMAA were significantly improved from preoperative (47.6+-6.4)°, (18.6+-2.1)° and (34.7+-7.2)° to the latest follow-up (16.7+-4.3)°, (8.2+-2.2)°and (9.0+-4.5)°(P<0.01). The preoperative AOFAS score was 56.6+-3.9 points, which was significantly different from 89.2+-2.1 points (P<0.01). The postoperative VAS score has declined from 6.0+-0.8 points to 0.8+-0.7 points with statistically significant differences (P<0.01). According AOFAS score, 22 feet got an excellent result, 6 good and 5 fair. The function was good and excellent in 84.8%.

Conclusion:

Triple osteotomy and lateral soft tissue release in treatment of hallux valgus with an increased distal metatarsal articular angle which can gain good result in respect of functional and radiological outcomes. It is important to correct the distal metatarsal articular angle and functional training of the first metatarsophalangeal joint after operation.
The Lateral Drawer Test: A Novel Clinical Test to Assess Mortise Instability in Weber B Fibula Fractures
Authors: Zhao John Z. , Williams Caroline , Broughton Kimberly K. , Miller Christopher P. , Kwon John Y.
Published: November 2020

Category:

Ankle; Trauma

Introduction/Purpose:

Assessment of mortise stability is paramount in determining appropriate management of ankle fractures. While instability is readily apparent in bimalleolar or trimalleolar ankle fractures, determination of instability in the apparent isolated Weber B fibula fracture often requires further investigations such as stress radiography. While several authors have previously demonstrated poor predictive value of physical examination findings such as tenderness, ecchymosis and swelling with instability, no previous investigation has examined the ability of a translational test to determine deltoid ligament injury. The goal of this study is to test the validity of a novel clinical test, the lateral drawer test, in determining mortise instability in a cohort of patients with Weber B fibula fractures.

Methods:

Patients presenting with isolated fibula fractures were prospectively identified by an orthopaedic nurse practitioner or resident. Three views of the ankle as well as gravity stress views (GSV) were obtained. Prior to examining radiographs, two foot & ankle fellowship-trained orthopaedic surgeons (JYK, CPM) performed and graded the lateral drawer test. (Grade 0: no instability/symmetric to contralateral ankle, Grade I: translation < 5mm, Grade II: translation >= 5mm) While the surgeons were made aware of the presence of a Weber B fibula fracture, radiographs were not visualized prior to conducting the drawer test. Medial clear space (MCS) was measured. VAS pain scores were obtained before and after testing. The results of the lateral drawer test results were compared with radiographic measurements of MCS.

Results:

The study has thus far prospectively enrolled 14 consecutive patients with Weber B ankle fractures. Six (43%) patients demonstrated radiographic instability with widening of the medial clear space >= 5 mm on GSV. When correlated with MCS measurement, the lateral drawer test demonstrated a sensitivity of 83.3%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 88.9% for determining instability. There was a strong correlation between the lateral drawer test grade and amount of MCS widening (⍴=0.82, p=0.0003). Patients tolerated the lateral drawer test well with an average increase of 1.6 on the VAS pain scale after testing.

Conclusion:

The lateral drawer test demonstrates high sensitivity, specificity, PPV and NPV for detecting instability in patients presenting with Weber B fibula fractures. While further validation is required in a larger cohort of patients, the lateral drawer test may offer an adjunct tool via physical examination to predict mortise stability.
Recurrent Spontaneous Macular Hole Formation and Resolution in a Patient With Previous Vitrectomy
Authors: Massamba Nathalie , Chin Eric K. , Almeida David R.P.
Published: November 2020

Purpose:

We report a case of recurrent macular hole (MH) formation and spontaneous closure in the absence of any vitreoretinal interface abnormality.

Methods:

A 49-year-old man presented for his annual ocular examination with no specific ocular complaints. He had a history of retinal detachment in the left eye, which was treated years prior with vitrectomy and scleral buckle. During a routine follow-up, the patient was discovered to have a full-thickness MH. Optical coherence tomography revealed the formation of an MH with spontaneous closure after 3 months without intervention. One month later, the MH recurred but once again closed spontaneously over 4 months.

Results:

The patient remained asymptomatic during the entire follow-up without any symptoms, vision changes, or therapeutic intervention.

Conclusions:

To our knowledge, this is the first known case report of recurrent spontaneous opening and closure of an MH in the absence of any vitreoretinal interface abnormality, as revealed by macular optical coherence tomography imaging.
Theorizing socio-environmental reproduction in China’s countryside and beyond
Authors: Lord Elizabeth
Published: November 2020

Over the past four decades, pollution and other forms of environmental degradation have radically transformed China’s landscape. So have the ambitious greening policies implemented to tackle these problems. During the same period, an enormous gap in wealth and amenities has arisen between the modernizing cities and rural areas, the latter playing an important, and often ignored, role in China’s environmental project. This paper identifies two paradoxical processes transforming rural environments: the mobilization of rural efforts to green the nation and the ruralization of pollution. While seemingly contradictory, both processes illustrate how the rural is expendable and malleable to state interests. This article proposes the concept of socio-environmental reproduction to theorize the environmental paradox in which many rural communities find themselves in contemporary China, as their environmental work and sacrifices sustain economic and political systems. This concept builds on the work on social reproduction by feminist scholars, particularly those who have sought to integrate the environment into their analyses. This paper proposes to expand the concept to include all the environmental work and sacrifices that certain people are asked to make to fuel the economic system, preserve political stability, and protect privileged spaces from pollution. As a whole, this article shows how China’s rural–urban divide is constitutive of the country’s environmental project and how national greening initiatives enable uneven development. Furthermore, this case foreshadows what will likely occur elsewhere as countries seek to green themselves. As the ecological era unfolds in China and elsewhere, it exposes how deep social divides are mobilized to fulfill environmental objectives. This paper theorizes the environmental work and sacrifices that risk falling on the shoulders of the most vulnerable.
Your Coefficient Alpha Is Probably Wrong, but Which Coefficient Omega Is Right? A Tutorial on Using R to Obtain Better Reliability Estimates
Authors: Flora David B.
Published: November 2020

Measurement quality has recently been highlighted as an important concern for advancing a cumulative psychological science. An implication is that researchers should move beyond mechanistically reporting coefficient alpha toward more carefully assessing the internal structure and reliability of multi-item scales. Yet a researcher may be discouraged upon discovering that a prominent alternative to alpha, namely, coefficient omega, can be calculated in a variety of ways. In this Tutorial, I alleviate this potential confusion by describing alternative forms of omega and providing guidelines for choosing an appropriate omega estimate pertaining to the measurement of a target construct represented with a confirmatory factor analysis model. Several applied examples demonstrate how to compute different forms of omega in R.
Failure of Responsive Regulation? Pharmaceutical Marketing, Corporate Impression Management and Off-Label Promotion of Enzalutamide in Europe
Authors: Mulinari Shai , Davis Courtney , Ozieranski Piotr
Published: November 2020

“Responsive regulation” has been proposed to offset pharmaceutical industry illicit behavior in areas such as drug marketing based on self-regulation backed up with threats of government sanctions. We explore the efficacy of responsive regulation by tracing recent investigations by the UK pharmaceutical industry self-regulatory authority into the firm Astellas’s illicit promotion of a top-selling prostate cancer drug. Using documentary data, we reveal a ruthless company culture reflected in the illicit, so-called off-label promotion across Europe and the deceptive “impression management” by company managers during the course of investigations in the UK. We argue for a more probing, adversarial and government-led regulatory approach instead of the self-regulatory approach that shields breaching companies from enforcement actions and associated public scrutiny.
An experimental study on change of gas permeability depending on pore structures in three species (hinoki, Douglas fir, and hemlock) of softwood
Authors: Jang Eun-Suk , Yuk Jee-Hoon , Kang Chun-Won
Published: November 2020

The purpose of this study is to analyze the pore structure for the heartwood, intermediate wood, and sapwood sections in three species of softwood (hinoki, Douglas fir, and hemlock) and to investigate the correlation of gas permeability depending on pore structure. For this study, gas permeability and pore size were measured by capillary flow porometry, and classification of a novel method was performed to determine the type of pores (through pores, blind pores, and closed pores) based on International Union of Pure and Applied Chemistry (IUPAC). Gas permeability, through pore porosity, and pore size increased from heartwood to sapwood. The results of multiple regression analysis showed that through pore porosity, mean pore size, and bulk density were significant factors affecting gas permeability.
Identification and utilization of copy number information for correcting Hi-C contact map of cancer cell lines
Authors: Khalil Ahmed Ibrahim Samir , Muzaki Siti Rawaidah Binte Mohammad , Chattopadhyay Anupam , Sanyal Amartya
Published: November 2020

Background

Hi-C and its variant techniques have been developed to capture the spatial organization of chromatin. Normalization of Hi-C contact map is essential for accurate modeling and interpretation of high-throughput chromatin conformation capture (3C) experiments. Hi-C correction tools were originally developed to normalize systematic biases of karyotypically normal cell lines. However, a vast majority of available Hi-C datasets are derived from cancer cell lines that carry multi-level DNA copy number variations (CNVs). CNV regions display over- or under-representation of interaction frequencies compared to CN-neutral regions. Therefore, it is necessary to remove CNV-driven bias from chromatin interaction data of cancer cell lines to generate a euploid-equivalent contact map.

Results

We developed the HiCNAtra framework to compute high-resolution CNV profiles from Hi-C or 3C-seq data of cancer cell lines and to correct chromatin contact maps from systematic biases including CNV-associated bias. First, we introduce a novel ‘entire-fragment’ counting method for better estimation of the read depth (RD) signal from Hi-C reads that recapitulates the whole-genome sequencing (WGS)-derived coverage signal. Second, HiCNAtra employs a multimodal-based hierarchical CNV calling approach, which outperformed OneD and HiNT tools, to accurately identify CNVs of cancer cell lines. Third, incorporating CNV information with other systematic biases, HiCNAtra simultaneously estimates the contribution of each bias and explicitly corrects the interaction matrix using Poisson regression. HiCNAtra normalization abolishes CNV-induced artifacts from the contact map generating a heatmap with homogeneous signal. When benchmarked against OneD, CAIC, and ICE methods using MCF7 cancer cell line, HiCNAtra-corrected heatmap achieves the least 1D signal variation without deforming the inherent chromatin interaction signal. Additionally, HiCNAtra-corrected contact frequencies have minimum correlations with each of the systematic bias sources compared to OneD’s explicit method. Visual inspection of CNV profiles and contact maps of cancer cell lines reveals that HiCNAtra is the most robust Hi-C correction tool for ameliorating CNV-induced bias.

Conclusions

HiCNAtra is a Hi-C-based computational tool that provides an analytical and visualization framework for DNA copy number profiling and chromatin contact map correction of karyotypically abnormal cell lines. HiCNAtra is an open-source software implemented in MATLAB and is available athttps://github.com/AISKhalil/HiCNAtra.
Role of tumor cell senescence in non-professional phagocytosis and cell-in-cell structure formation
Authors: Gottwald Dorian , Putz Florian , Hohmann Nora , Büttner-Herold Maike , Hecht Markus , Fietkau Rainer , Distel Luitpold
Published: November 2020

Background

Non-professional phagocytosis is usually triggered by stimuli such as necrotic cell death. In tumor therapy, the tumors often disappear slowly and only long time after the end of therapy. Here, tumor therapy inactivates the cells by inducing senescence. Therefore, study focused whether senescence is a stimulus for non-professional phagocytosis or whether senescent cells themselves phagocytize non-professionally.

Results

Senescence was induced in cell lines by camptothecin and a phagocytosis assay was performed. In tissue of a cohort of 192 rectal cancer patients senescence and non-professional phagocytosis was studied by anti-histone H3K9me3 and anti-E-cadherin staining. Senescent fibroblasts and pancreas carcinoma cells phagocytize necrotic cells but are not phagocytized. In the tissue of rectal carcinoma, senescent cells can phagocytize and can be phagocytized. A high number of senescent cells and, at the same time, high numbers of non-professional phagocytizing cells in the rectal carcinoma tissue lead to an extremely unfavorable prognosis regarding overall survival.

Conclusion

Senescent cells can be non-professionally phagocytized and at the same time they can non-professionally phagocytize in vivo. In vitro experiments indicate that it is unlikely that senescence is a strong trigger for non-professional phagocytosis. Combined high rates of non-professional phagocytosis and high rates of senescence are an extremely poor prognostic factor for overall survival.
Avian phenotypic convergence is subject to low genetic constraints based on genomic evidence
Authors: Chen Yu-Chi , Kuo Hao-Chih , Lo Wen-Sui , Hung Chih-Ming
Published: November 2020

Background

Phenotypic convergence between distinct species provides an opportunity to examine the predictability of genetic evolution. Unrelated species sharing genetic underpinnings for phenotypic convergence suggests strong genetic constraints, and thus high predictability of evolution. However, there is no clear big picture of the genomic constraints on convergent evolution. Genome-based phylogenies have confirmed many cases of phenotypic convergence in birds, making them a good system for examining genetic constraints in phenotypic convergence. In this study, we used hierarchical genomic approaches to estimate genetic constraints in three convergent avian traits: nocturnality, raptorial behavior and foot-propelled diving.

Results

Phylogeny-based hypothesis tests and positive selection tests were applied to compare 16 avian genomes, representing 14 orders, and identify genes with strong convergence signals. We found 43 adaptively convergent genes (ACGs) associated with the three phenotypic convergence cases and assessed genetic constraints in all three cases, from (amino acid) site mutations to genetic pathways. We found that the avian orders shared few site mutations in the ACGs that contributed to the convergent phenotypes, and that these ACGs were not enriched in any genetic pathways. In addition, different pairs of orders with convergent foot-propelled diving or raptorial behaviors shared few ACGs. We also found that closely related orders that shared foot-propelled diving behavior did not share more ACGs than did distinct orders, suggesting that convergence among these orders could not be explained by their initial genomic backgrounds.

Conclusions

Our analyses of three avian convergence events suggest low constraints for phenotypic convergence across multiple genetic levels, implying that genetic evolution is unpredictable at the phylogenetic level of avian order. Ours is one of first studies to apply hierarchical genomic examination to multiple avian convergent cases to assess the genetic constraints in life history trait evolution.
Effect of acute noise trauma on the gene expression profile of the hippocampus
Authors: Lee Chang Ho , Kim Kyung Woon , Lee So Min , Kim So Young
Published: November 2020

Background

This study aimed to investigate the changes in the expression of hippocampal genes upon acute noise exposure.

Methods

Three-week-old Sprague–Dawley rats were assigned to control (n = 15) and noise (n = 15) groups. White noise (2–20 kHz, 115 dB sound pressure level [SPL]) was delivered for 4 h per day for 3 days to the noise group. All rats were sacrificed on the last day of noise exposure, and gene expression in the hippocampus was analyzed using a microarray. Pathway analyses were conducted for genes that showed differential expression ≥ 1.5-fold andP ≤ 0.05 compared to the control group. The genes included in the putative pathways were measured using quantitative reverse transcription-polymerase chain reaction (qRT-PCR).

Results

Thirty-eight upregulated genes and 81 downregulated genes were identified. The pathway analyses revealed that upregulated genes were involved in the cellular responses to external stimuli and immune system pathways. qRT-PCR confirmed the upregulation of the involved genes. The downregulated genes were involved in neuronal systems and synapse-related pathways, and qRT-PCR confirmed the downregulation of the involved genes.

Conclusions

Acute noise exposure upregulated the expression of immune-related genes and downregulated the expression of neurotransmission-related genes in the hippocampus.
Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability
Authors: Levasseur Mélanie , Routhier Sonia , Clapperton Irma , Doré Chantal , Gallagher Frances
Published: November 2020

Background

Social participation is restricted for approximately half the older adult population but is critical in fostering community vitality, promoting health, and preventing disabilities. Although targeted through interventions by community organizations, healthcare professionals and municipalities, little is known about the needs of older adults to participate socially, especially in rural areas. This study thus aimed to identify and prioritize the social participation needs of older adults living in a rural regional county municipality.

Methods

A participatory action research was conducted in a rural regional county municipality (RCM) in Quebec, Canada, with a convenience sample of 139 stakeholders, including older adults, caregivers, healthcare and community organization managers, healthcare and community organization workers, community partners and key informants.

Results

Facilitators and barriers to social participation are related to personal factors (e.g., health, interests, motivation), the social environment (e.g., availability of assistance or volunteers) and the physical environment (e.g., distance to resources, recreational facilities and social partners). Nine older adults’ needs emerged and were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, 5) having access to meeting places near home and adapted to their health condition, and 6–9 (no preferred order) being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Differences emerged when prioritizing needs of older adults with disabilities (greater need for assistance, accessibility and adapted activities) and older adults living in a rural area (greater need for transportation).

Conclusions

To promote active participation in the community, the social participation needs of older women and men living in rural areas must be addressed, especially in regard to transportation, information, adapted activities, assistance and accessibility. The first part of this action research will be followed by community selection and implementation of initiatives designed to ultimately foster their social participation.