bluuebunny/crossref_metadata_2025 huggingface dataset:
The Use of the Lateral Tibial Line to Assess Ankle Alignment: A Preliminary Investigation
Authors: Striano Brendan M. , Patel Shalin S. , Parker Emily Belle , Smith Jeremy , Vaughn Joshua , Harris Mitchel , Chiodo Christopher P.
Published: December 2023

Category:

Ankle; Trauma

Introduction/Purpose:

Although the medial clear space (MCS) is commonly used to assess talar alignment and ankle stability, its measurement is variable with multiple reported “normal” values. We have observed that the lateral tibial shaft is a reliable landmark to assess talar alignment. The objective of the current investigation was to determine the normal relationship of the lateral tibia to the superolateral talus using a tangent drawn inferiorly from the lateral tibial shaft, which we refer to as the “lateral tibial line” (LTL).

Methods:

The relationship of the LTL to the superolateral talus was assessed and characterized on ninety-nine standing ankle mortise radiographs in uninjured patients. This relationship was quantified by measuring the distance (in millimeters) between the LTL and the superolateral talus. Additionally, the inter-observer reliability of the LTL measurement, determined by three reviewers, was recorded and compared to medial clear space measurements.

Results:

The median value for the lateral tibial line was -0.50 mm with an interquartile range of -1.4mm - 0.0mm. The LTL was within 1mm of the lateral talus in 176 of 297 reviewer measurements (59.3%). Moreover, it was either lateral to or was at most 1mm medial to the lateral talus in 90.9% of cases. The LTL measurement also demonstrated good inter-observer reliability (0.764, 95% CI: 0.670-0.834), similar to the measurement of MCS (0.742, 95% CI: 0.539-0.846).

Conclusion:

The LTL is easily measured with good reliability for assessing the anatomic relationship of the tibia and talus. It uncommonly fell more than 1 mm medial to the superolateral talus. In other words, it was uncommon for the talus to shift lateral to this line, as might be seen with displaced ankle fractures. These findings will hopefully serve as a standard for future studies evaluating the role of the LTL in assessing lateral displacement and stability of isolated fibula fractures.
Time to Surgery Affects Wound Healing of Ankle Fractures
Authors: Guan Yuxi , Negron Nelson , Jiang Qiyun Jennifer , Park Janet J. , Kahn Mani , Kulsakdinun Chaiyaporn , Guo Yi
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

Ankle fractures are very common. Most unstable ankle fractures require surgical intervention in order to obtain better clinical outcomes. However, there is still conflicting evidence about the implications of time to surgery on post- operative wound complications.

Purpose of study:

To investigate if early or delayed surgery results in difference in wound complications in patients who underwent surgical intervention for ankle fracture.

Methods:

A retrospective review of 238 ankle fracture cases treated with open reduction and internal fixation (ORIF) from October 28, 2016, through May 12, 2022 was completed at our institution. Patients were divided into 4 groups based on the time to surgery. In group 1, surgery was within a week. In group 2, surgery was in 2nd week. In group 3, surgery was in 3rd week. In group 4, surgery was after 3 weeks. Wound complications including minor wound complication and wound infection were investigated. The other factors including BMI, smoking, diabetes, etc. were investigated as well to avoid confounding bias. Since most of patients accepted surgery either in first 4 days (early surgery group) or between 10 to 20 days (delayed surgery group) in this series of patients. We also analyzed those two time points. Data was analyzed using STATA.

Results:

238 patients with ankle fracture were analyzed. 36, 96, 71 and 35 patients were included in group 1, 2, 3 and 4 respectively. For BMI, smoking, and diabetes, no significant difference among 4 groups. The rate of minor wound complications in group 1, 2, 3 and 4 was 13.8%, 12.5%, 8.5% and 0%. The rate of wound infection in group 1, 2, 3 and 4 was 5.6%, 3.1%, 1.4% and 0%. For minor wound complication, there was significant decrease in group 4, as compared with group 1 and group 2 (p < 0.05). Interestingly, in term of early vs delayed surgery, both infection rate (13.3% vs 2.8%) and minor wound complication rate (33.3% vs 10.8%) significantly decreased in the delayed surgery group (p < 0.05).

Conclusion:

Delayed ORIF of ankle fracture resulted in decreased both minor wound complication rate and infection rate.
Tortuosity Angle of a Calcaneofibular Ligament on Magnetic Resonance Imaging & Stress Radiography
Authors: Kim Jin Su , Kim Sangbum
Published: December 2023

Category:

Ankle; Sports

Introduction/Purpose:

A lateral ankle sprain is one of the most common musculoskeletal injuries for both athletes and non- athletes, causing chronic ankle instability. Talar tilt angle on a radiograph used for diagnosis of chronic ankle instability(CAI), however, there were no reports of instability of calcaneofibular ligament(CFL) itself through an MRI. This study aimed to determine whether measuring tortuosity angles of CFL through oblique coronal imaging of MRI in CAI. We compared CFL’s tortuosity angle with the talar tilt angle, Cumberland ankle instability tool(CAIT), and ankle strength in patients without a history of ankle sprain or not.

Methods:

From March 2020 to May 2022, Of the total 120 cases, the CAI group (82 patients) took CFL’s tortuosity angle in MRI and talar tilt angle inradiograph. The control group (38 patients) included those without an ankle sprain who visited this hospital due to an Achilles tendon rupture. In the control group, the talar tilt angle could not be achieved due to pain.

Results:

CFL’s tortuosity angle in MRI showed a significant difference of 76.5 ± 18.3º in the CAI group and 31.9 ± 5.4º in the control group(P < 0.001). The diagnostic cutoff value for CAI was more than 40º of the tortuosity angle. According to the measure of the isokinetic machine(Biodex), the CAI group shows a 22.8% deficit of the eversion strength. The tortuosity angle, talar tilt angle, and manual stress test show significantly different between both groups. However, CAIT and strength defect showed no significant results between both groups.

Conclusion:

CFL’s tortuosity angle through oblique coronary imaging of MRI, it’s average value was 31º degrees, and we can diagnose as CAI if CFL’s tortuosity angle is more than 40º.
Trends in Utilization of Charcot Reconstruction
Authors: Newton William , Chen Caroline , Morningstar Joshua L. , Gross Christopher E. , Scott Daniel
Published: December 2023

Category:

Ankle; Diabetes

Introduction/Purpose:

Charcot arthropathy of the foot and ankle is a challenging complication of peripheral neuropathy with a 0.1% and 5.0% incidence in the diabetic population. The purpose of this study is to assess rates of foot or ankle reconstructions (fusions) for Charcot arthropathy, describe the associated patient demographics and hospital settings, and project the volume of Charcot reconstructions anticipated to be performed in 2030.

Methods:

The National Inpatient Sample database was queried from 2016-2019 using International Classification of Diseases (ICD) codes for foot or ankle fusion (midfoot, hindfoot, or ankle) and a diagnosis of Charcot arthropathy, ultimately identifying 1,343 patients undergoing surgical procedures. Patient information collected included age, sex, race, primary payer status, year of surgery, length of hospital stays, and median household income quartile. Hospital information included bed size, census region, teaching status, and ownership.

Results:

Between 2016-2019, there were approximately 1,343 patients treated surgically with midfoot, hindfoot, or ankle arthrodesis for Charcot arthropathy, and the number of cases increased by 12.11% annually. Between 2019-2030, there is projected to be a 121.41% increase in the frequency of Charcot reconstruction procedures from 383 to 848 total annual cases. Patients undergoing these procedures are predominantly white, male, and in their 50s. The most common payers were Medicare and private insurance. The mean hospital length of stay was 5.80 days. The procedures performed were predominantly large, urban teaching hospitals in the south with a private, non-profit ownership structure.

Conclusion:

Surgical reconstruction of Charcot arthropathy of the foot and ankle is steadily increasing in prevalence. These patients are predominantly white, male, and in their 50s. It is important for orthopaedic foot and ankle surgeons to be trained in the surgical management and reconstruction of Charcot arthropathy to meet the expected growing surgical need, which is projected to be 848 procedures annually by 2030.
Ultrasound Guided Cryoablation of Morton’s Neuroma: Case Series Including Post-Ablation MRI Appearances
Authors: Lam Kimberly , Lampridis Vasileios , Singh Anjani , Sirikonda Siva , Mistry Alpesh , Ghany Jehan F. , Chandrasekar Coonoor , Narang Yajur , Cusack James , Mason Lyndon W.
Published: December 2023

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Morton’s neuroma (MN) is a very common compressive neuropathy of the interdigital nerve. Non- operative management is recommended initially and many therapies have been described. Cryoablation has shown promising results, however there are limited published studies in the literature. The purpose of this study was to assess the safety and efficacy of Cryoablation in patients with MN. A secondary aim was to evaluate post-procedure MRI appearances.

Methods:

A retrospective analysis was completed for 24 MN treated between June 2021 and September 2022. All patients had refractory MN symptoms after previous US guided steroid and LA injection within the previous year. Three patients also had refractory symptoms after prior alcohol ablation. Cryoablation was performed as a single outpatient procedure under continuous US monitoring and local anesthesia with 1 cycle for average of 2 minutes. Telephone follow up by radiology department with a 0–10 visual analogue scale (VAS) score was performed at 6 weeks and 3 months post-ablation. The patients were also encouraged to submit patient reported outcomes to a British Foot and Ankle Society (BOFAS) online scoring database as facilitated by the surgical team. Post-ablation MRI was performed to evaluate for post-procedure appearances at various intervals between 3 to 14 months.

Results:

24 MN were treated. The mean size of MN treated was 12.3mm. Technical success was 100% and all patients tolerated the procedure well under local anesthesia. Mean pre-procedure VAS pain score was 8, which reduced to 1 at 6 weeks, and 2 at 3 months follow up in the treated MN. There is high patient satisfaction with 20 cases (83%) very satisfied. Four cases had various persistent symptoms and would want to have it done again (17%). Post-ablation MRI showed various bone and soft tissue changes in the ablation zone. There were two cases of fibrosis in the intermetatarsal space and one residual neuroma observed on MRI, although the patients were asymptomatic in the ablation site. No complications occurred e.g. infection, fracture or thermal injury.

Conclusion:

In this small series, ultrasound guided Cryoablation was deemed safe and effective treatment for MN. Clinical advantages of the procedure are good patient tolerance, single outpatient procedure, high patient satisfaction and reduced risk of scarring or residual neuroma. Further controlled prospective studies would be beneficial.
Validity of the Center-Center Method for Syndesmotic Fixation Axis Against the Trans-Syndesmotic Axis: A Cross-Sectional Study
Authors: Nakajima Hirofumi , Yamaguchi Satoshi , Mikami Yukio , Kimura Seiji
Published: December 2023

Category:

Trauma; Ankle

Introduction/Purpose:

In surgery for ankle fractures with tibiofibular diastasis, it is important to vertically grasp the distal tibiofibular joint. However, it is difficult to do that because the tibiofibular joint surface is not under direct vision. Center-center method (CC) is an intraoperative fluoroscopic technique to determine the position of the syndesmotic clamp. CC has been reported to reduce the risk of syndesmotic malreduction, but It is unclear whether the axis by CC (CC axis) coincides with the axis perpendicular to the distal tibiofibular joint (trans-syndesmosis axis: TS axis). Therefore, the present study aims to 1) measure the difference between the CC axis and TS axis, and 2) compare the measured values when CC is performed at different distances from the ankle joint surface.

Methods:

The subjects were 150 patients who underwent CT scans for ankle joint disease and lower extremity trauma. CC is a method in which the ankle joint is rotated, and the midpoint of the anteroposterior margin of the tibia and fibula is superimposed by fluoroscopy. In the present study, CC was performed using Digitally reconstructed radiography (DRR) created from a CT image. At the ankle joint surface (0mm), CC axis and TS axis were projected onto the CT axis linked with DRR. The angle between the axes was measured (inter-axes angle). Also, the distance of the intersection of these axes through the medial cortex of the tibia was measured (inter-axes distance). It was also performed at 10mm and 20mm proximal to the ankle joint surface. One-way repeated measures analysis of variance and the post hoc Bonferroni tests were used to compare the measured values' difference according to the articular surface's height.

Results:

Overall, the TS axis was externally rotated relative to the CC axis, with a mean inter-axes angle of 8.5±6.8degrees. The inter-axes angle of 0mm, 10mm, and 20mm were 1.9±4.0degrees, 10±5.3degrees, and 13±5.1degrees, respectively (p < 0.001). Also, the intersection point of the TS axis with the medial tibial cortex was anterior to the intersection of the CC axis, with an inter-axes distance of 7.7±6.3mm overall. The inter-axes distance of 0mm, 10mm, and 20mm were 2.0±4.2mm, 9.0±4.9mm, and 11.3±5.2mm, respectively (p < 0.001). Both the inter-axes angle and the inter-axes distance were larger when the CC method was performed higher to the tibial plafond (P < .001), with the post hoc tests showing significant differences among all heights.

Conclusion:

The TS axis was externally rotated to the CC axis and positioned slightly anteriorly. Also, the inter-axes angle and distance were larger when the CC method was performed higher to the tibial plafond. If the surgeon aimed to clamp the syndesmosis along the TS axis, the CC method should be applied closer to the ankle joint surface, and the medial tip of the forceps be placed slightly anterior to the point determined by the CC axis.
Weight-bearing CT Scan Analysis in Hallux Valgus Treated with Minimally Invasive Surgery
Authors: Ahumada Ximena , Protasowicki Nicolas , Pellegrini Manuel J. , Carcuro Giovanni , Chaparro Felipe , Ortiz Cristian A.
Published: December 2023

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Hallux valgus (HV) is one of the most prevalent foot deformities. Coronal metatarsal rotation (pronation) has been recognized as a key element in HV deformity and an important prognostic factor for recurrence. With the advent of weight-bearing CT (WBCT), accurate pronation measurement has improved. The Minimally Invasive Bosh Akin (MIBA) surgery has proven to be effective in treating HV deformity. The literature analyzing correction of pronation in HV surgery is lacking.

Purpose:

To compare the transverse and coronal plane deformity correction by WBCT in HV patients treated with MIBA surgery.

Methods:

We retrospectively analyzed HV deformity in patients who underwent MIBA surgery with preoperative and at least 3 months postoperative WBCT for comparison. Intermetatarsal angle (IMA), hallux valgus angle (HVA), and alpha angle (AA) for first metatarsal pronation were measured by 2 different observers. The intraclass and interclass correlation were determined. Pre and postoperative measurement changes were established by T-test for related samples. the p-value for statistical significance was set at < 0.05.

Results:

37 feet were included. Intraclass correlation was 0.97 /0.92 for IMA; 0.95/0.91 for AA and 0.99/0.97 for HVA preoperative. Postop it was 0.97/ 0.96 for IMA, 0.97/0.92 for AA, and 0.98 and 0.96 for HVA. Interclass correlation was 0.95 for IMA; 0.7 for AA and 0.82 for HVA preoperative. Postop, was 0.82 for IMA, 0.8 for AA, and 0.79 for HVA. Mean preoperative / postoperative AA was 8.9 degrees and 6.9 degrees respectively, resulting in a first ray pronation change of –2.0 degrees, p< 0.054. The media preoperative and postoperative IMA was 13.6 degrees and 6.8 degrees, demonstrating a significant change (P < .005). The media preoperative and postoperative HVA was 28.7 (8.8) and 13.1 (9.0), demonstrating a significant change (P < .005).

Conclusion:

To the best of our knowledge, this is the first study that evaluates the radiological changes in HV surgery with WBCT. The MIBA osteotomy for HV deformity has significant power to correct the transverse plane deformity. Even though the coronal plane deformity correction wasn’t statistically significant, it showed a strong tendency, which might be demonstrated by utilizing a bigger sample. The only measurement that didn’t have an excellent agreement was the preop AA.
Zone 2 5th Metatarsal Fractures Treated Nonoperatively Have Similar Time to Healing to Those Treated Operatively
Authors: Kingery Matthew T. , Kadiyala Manasa , Walls Raymond J. , Ganta Abhishek , Konda Sanjit , Egol Kenneth A.
Published: December 2023

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

The purpose of this study was to quantify the time to clinical and radiographic healing in Zone 2 proximal 5th metatarsal (MT) fractures and to compare these outcomes to those of Zone 2 fractures treated operatively.

Methods:

A retrospective cohort study of all Zone 2 metatarsal fractures seen at a single large, urban, academic medical center between December 2012 and April 2022 was performed. Zone 2 injuries were defined as fractures entering the proximal 4-5 MT articulation on the oblique radiographic view. Clinical healing was characterized by the return to baseline ambulatory function without discomfort and a lack of tenderness on physical examination. Radiographic healing was defined as complete osseous consolidation. A total of 374 patients with Zone 2 proximal 5th MT fractures were included in the analysis. The mean age of patients was 53.8 +/- 16.6 years, and 74.3% were female.

Results:

93.3% of patients with Zone 2 metatarsal fractures were treated nonoperatively. In the nonoperative group, 6.6% experienced delayed bony union with incomplete radiographic healing after 6 months, compared to 16.0% of the operative group (p = 0.095). However, by 1 year post-injury, 98.9% of patients who underwent nonoperative management and 96.0% of operative patients demonstrated radiographic union. Two patients failed nonoperative management and underwent operative fixation for symptomatic nonunions. There was no difference in time to radiographic healing between patients treated nonoperatively and those treated operatively (4.4 +/- 2.8 months vs 5.4 +/- 4.7 months, p = 0.413). Similarly, there was no difference in time to clinical healing between both groups (2.3 +/- 1.9 months vs 2.6 +/- 3.8 months, p = 0.723).

Conclusion:

Zone 2 5th metatarsal base fractures, which are often incorrectly referred to as Jones fractures despite being proximal to the fractures originally characterized by Jones, can be successfully treated with nonoperative management. There is no evidence that operative treatment leads to significantly faster clinical or radiographic healing for patients.
An unusual complication after endoscopic clipping of a gastric ulcer
Authors: Ramu Lakshman , Kian-Tak Soo , Tay Gerald Ci-An
Published: December 2023

A 72-year-old patient presented with malaena secondary to two antral ulcers which were discovered in oesophagogastroduodenoscopy (OGD) after admission. One of the ulcers with a visible vessel was injected with adrenaline and clipped with an OVESCO clip. The patient continued to have coffee ground vomitus on the following day with a drop in haemoglobin level. Repeat OGD showed a large intra-mural haematoma with the clip still in situ and no bleeding from the surface of the ulcer. Patient underwent a coil embolization of the distal gastroduodenal artery (GDA), right gastroepiploic artery and a medial branch of the GDA. Repeat OGD showed that the submucosal haematoma had evacuated, leaving a large, clean-based mucosal defect.
Utilising high-dimensional data in randomised clinical trials: A review of methods and practice
Authors: Cherlin Svetlana , Bigirumurame Theophile , Grayling Michael J , Nsengimana Jérémie , Ouma Luke , Santaolalla Aida , Wan Fang , Williamson S Faye , Wason James MS
Published: December 2023

Introduction

Even in effectively conducted randomised trials, the probability of a successful study remains relatively low. With recent advances in the next-generation sequencing technologies, there is a rapidly growing number of high-dimensional data, including genetic, molecular and phenotypic information, that have improved our understanding of driver genes, drug targets, and drug mechanisms of action. The leveraging of high-dimensional data holds promise for increased success of clinical trials.

Methods

We provide an overview of methods for utilising high-dimensional data in clinical trials. We also investigate the use of these methods in practice through a review of recently published randomised clinical trials that utilise high-dimensional genetic data. The review includes articles that were published between 2019 and 2021, identified through the PubMed database.

Results

Out of 174 screened articles, 100 (57.5%) were randomised clinical trials that collected high-dimensional data. The most common clinical area was oncology (30%), followed by chronic diseases (28%), nutrition and ageing (18%) and cardiovascular diseases (7%). The most common types of data analysed were gene expression data (70%), followed by DNA data (21%). The most common method of analysis (36.3%) was univariable analysis. Articles that described multivariable analyses used standard statistical methods. Most of the clinical trials had two arms.

Discussion

New methodological approaches are required for more efficient analysis of the increasing amount of high-dimensional data collected in randomised clinical trials. We highlight the limitations and barriers to the current use of high-dimensional data in trials, and suggest potential avenues for improvement and future work.
Should continuous deep sedation until death be legally regulated in Switzerland? An exploratory study with palliative care physicians
Authors: Tomczyk Martyna , Andorno Roberto , Jox Ralf J.
Published: December 2023

Background:

In Switzerland, continuous deep sedation until death (CDSUD) is not legally regulated and the current clinical practice guidelines on palliative sedation from 2005 do not refer to it. In contrast, in France, a neighbouring country, CDSUD is regulated by a specific law and professional guidelines. International studies show that in culturally polymorphic countries, there are variations in the end-of-life practices between linguistic regions and that a linguistic region shares many cultural characteristics with the neighbouring country.

Objectives:

This study aimed to explore the attitudes of palliative care physicians from the French-speaking part of Switzerland on the question of whether CDSUD should be legally regulated in the country, and to identify their arguments. Our study also aimed to assess whether a hypothetical Swiss law on CDSUD should be similar to the current legal regulation of this practice in France.

Design:

We conducted a multicentre exploratory qualitative study based on face-to-face interviews with palliative care physicians in the French-speaking part of Switzerland.

Methods:

We analysed the interview transcripts using thematic analysis, combining deductive and inductive coding.

Results:

Most of the participants were opposed to having specific legal regulation of CDSUD in Switzerland. Their arguments were diverse: some focused on medical and epistemological aspects of CDSUD, whereas others emphasized the legal inconvenience of having such regulation. None had the opinion that, if CDSUD were legally regulated in Switzerland, the regulation should be similar to that in France.

Conclusion:

This study allows to better understand why palliative care physicians in French-speaking Switzerland may be reluctant to have legal regulation of CDSUD. Further studies covering the whole country would be needed to gain a more complete picture of Swiss palliative care physicians on this question.
Yoga Plus Mantram Repetition to Reduce Chronic Pain in Veterans With Post-Traumatic Stress Disorder: A Feasibility Trial
Authors: Groessl Erik J. , Hafey Carol , McCarthy Adhana , Hernandez Rahil M. , Prado-Nava Miguel , Casteel Danielle , McKinnon Symone , Chang Douglas G. , Ayers Catherine R. , Rutledge Thomas R. , Lang Ariel J. , Bormann Jill E.
Published: December 2023

Background

Veterans with post-traumatic stress disorder (PTSD) are more likely to report chronic pain than veterans without PTSD. Yoga has been shown to reduce both chronic pain and PTSD symptoms in clinical trials. The goal of our study was to assess the feasibility and acceptability of conducting a randomized controlled trial (RCT) that combined yoga and mantram repetition (Yoga + MR) into one program for military veterans with both chronic pain and PTSD.

Methods

In this feasibility RCT, 27 veterans were randomized to either Yoga + MR or a relaxation intervention. Due to the COVID-19 pandemic, in-person recruitment, assessments, and intervention attendance were re-evaluated. Although remote delivery of aspects of the study were utilized, interventions were delivered in-person. Feasibility benchmarks met included full recruitment in 12 months or less, 75%+ retention at initial follow-up assessment, 50%+ attendance rate, and 75%+ of participants satisfied with the interventions.

Results

The sample was racially and ethnically diverse, and 15% of participants were women. Participant recruitment lasted approximately 11 months. Out of 32 participants initially randomized, two participants asked to be dropped from the study and three did not meet PTSD symptom criteria. For the remaining 27 participants, retention rates were 85% at 12 weeks and 81% at 18 weeks. Participants attended 66% of in-person yoga and 55% of in-person relaxation sessions. Satisfaction was high, with 100% of yoga participants and 75%/88% of relaxation participants agreeing or strongly agreeing they were satisfied with the intervention/instructors. After 12 weeks (end of intervention), Yoga + MR participants reported reduced back-pain related disability (primary outcome), reduced alcohol use, reduced fatigue, and increased quality of life, while relaxation group participants reported reductions in pain severity, PTSD symptoms, and fatigue.

Conclusions

Amidst many research challenges during the pandemic, recruitment, retention, and efficacy results from this feasibility trial support advancement to a larger RCT to study Yoga + MR for chronic pain and PTSD.
Shuffling toward paramedic practitioners in the United States
Authors: O'Meara Peter
Published: December 2023

In the United States (U.S.), the Subcommittee on Adaptability and Innovation of the National Emergency Medical Services Advisory Council (NEMSAC) recently recommended that a clinically focused Master of Science in Paramedicine (MSP) be developed as the standard minimum academic degree to meet the educational needs of paramedic practitioners in the U.S. Despite the significance of this initiative and support within EMS agencies and amongst paramedics, the advisory has met with fierce opposition from fire agencies and associations, some employer groups and surprisingly the National Association of Emergency Medical Technicians.
Ageing in DIY and alternative cultures: Exploring forms of masculinity and adult play in Jackass forever
Authors: Willing Indigo , Bennett Andy , Thorpe Holly , Green Ben
Published: December 2023

This article explores ageing in alternative cultures and co-existing forms of hyper and alternative masculinity in the US film Jackass Forever released in 2022. The film is a continuation of the original Jackass show launched in 2000. Although a highly profitable franchise, we argue Jackass is part of an alternative culture through its playfulness and pranks that are also dangerous and revel in self-humiliation. Most of the stunts and skits also adopt a DIY approach and reflect forms of perceived masculine and adolescent pranking and clowning. We argue that such alternative and DIY-influenced activities allow men to keep enjoying alternative, ‘carnivalesque’ forms of adult play well into middle-age and can have a pro-social and beneficial impact across men's life course. Yet even if subversive, Jackass can still also reproduce masculine constraints, including suppressing the expression of boundaries and vulnerable emotions.
Collaborative effect of Csnk1a1 haploinsufficiency and mutant p53 in Myc induction can promote leukemic transformation
Authors: Fuchs Stijn N. R. , Stalmann Ursula S. A. , Snoeren Inge A. M. , Bindels Eric , Schmitz Stephani , Banjanin Bella , Hoogenboezem Remco M. , van Herk Stanley , Saad Mohamed , Walter Wencke , Haferlach Torsten , Seillier Lancelot , Saez-Rodriguez Julio , Dugourd Aurélien J. F. , Lehmann Kjong-Van , Ben-Neriah Yinon , Gleitz Hélène F. E. , Schneider Rebekka K.
Published: December 2023

It is still not fully understood how genetic haploinsufficiency in del(5q) myelodysplastic syndrome (MDS) contributes to malignant transformation of hematopoietic stem cells. We asked how compound haploinsufficiency for Csnk1a1 and Egr1 in the common deleted region on chromosome 5 affects hematopoietic stem cells. Additionally, Trp53 was disrupted as the most frequently comutated gene in del(5q) MDS using CRISPR/Cas9 editing in hematopoietic progenitors of wild-type (WT), Csnk1a1–/+, Egr1–/+, Csnk1a1/Egr1–/+ mice. A transplantable acute leukemia only developed in the Csnk1a1–/+Trp53–edited recipient. Isolated blasts were indefinitely cultured ex vivo and gave rise to leukemia after transplantation, providing a tool to study disease mechanisms or perform drug screenings. In a small-scale drug screening, the collaborative effect of Csnk1a1 haploinsufficiency and Trp53 sensitized blasts to the CSNK1 inhibitor A51 relative to WT or Csnk1a1 haploinsufficient cells. In vivo, A51 treatment significantly reduced blast counts in Csnk1a1 haploinsufficient/Trp53 acute leukemias and restored hematopoiesis in the bone marrow. Transcriptomics on blasts and their normal counterparts showed that the derived leukemia was driven by MAPK and Myc upregulation downstream of Csnk1a1 haploinsufficiency cooperating with a downregulated p53 axis. A collaborative effect of Csnk1a1 haploinsufficiency and p53 loss on MAPK and Myc upregulation was confirmed on the protein level. Downregulation of Myc protein expression correlated with efficient elimination of blasts in A51 treatment. The “Myc signature” closely resembled the transcriptional profile of patients with del(5q) MDS with TP53 mutation.
High-risk and silent clonal hematopoietic genotypes in patients with nonhematologic cancer
Authors: Stonestrom Aaron J. , Menghrajani Kamal N. , Devlin Sean M. , Franch-Expósito Sebastià , Ptashkin Ryan N. , Patel Swara Y. , Spitzer Barbara , Wu Xiaodi , Jee Justin , Sánchez Vela Pablo , Milbank Jennifer H. , Shah Ronak H. , Mohanty Abhinita S. , Brannon A. Rose , Xiao Wenbin , Berger Michael F. , Mantha Simon , Levine Ross L.
Published: December 2023

Clonal hematopoiesis (CH) identified by somatic gene variants with variant allele fraction (VAF) ≥ 2% is associated with an increased risk of hematologic malignancy. However, CH defined by a broader set of genotypes and lower VAFs is ubiquitous in older individuals. To improve our understanding of the relationship between CH genotype and risk of hematologic malignancy, we analyzed data from 42 714 patients who underwent blood sequencing as a normal comparator for nonhematologic tumor testing using a large cancer-related gene panel. We cataloged hematologic malignancies in this cohort using natural language processing and manual curation of medical records. We found that some CH genotypes including JAK2, RUNX1, and XPO1 variants were associated with high hematologic malignancy risk. Chronic disease was predicted better than acute disease suggesting the influence of length bias. To better understand the implications of hematopoietic clonality independent of mutational function, we evaluated a set of silent synonymous and noncoding mutations. We found that silent CH, particularly when multiple variants were present or VAF was high, was associated with increased risk of hematologic malignancy. We tracked expansion of CH mutations in 26 hematologic malignancies sequenced with the same platform. JAK2 and TP53 VAF consistently expanded at disease onset, whereas DNMT3A and silent CH VAFs mostly decreased. These data inform the clinical and biological interpretation of CH in the context of nonhematologic cancer.
Enhancing agricultural value chains through technology adoption: a case study in the horticultural sector of a developing country
Authors: Valdes Rodrigo , Gómez David , Barrantes Luz
Published: December 2023

Background

The development of agricultural value chains in developing countries has been the focus of much international interest, prompting the exploration of technology adoption strategies. These strategies hinge upon a multitude of factors like farmer characteristics, farm structure, location, organizational and institutional elements, as well as information-related factors.

Purpose

In this study, we delve into the influential social and productive factors that underpin technology adoption among small horticultural producers in Chile.

Design/methodology/approach

Data pertaining to the five primary horticultural crops in Chile—namely, corn, lettuce, tomato, cucumber, and onion—were collected, considering their respective cultivated areas. A comprehensive evaluation of 13 technologies encompassing cultural practices, crop improvement, and irrigation was conducted. The methodological approach comprised two stages. Initially, an ordered probit model was employed to analyze the adoption intensity of cultural practices, crop improvement, and irrigation. Subsequently, a Kruskal–Wallis test was utilized to compare the means across technology adoption groups.

Results

The findings reveal a positive correlation between technology adoption intensity and the level of education, composition of the family nucleus, and investment intensity. Moreover, the production system’s location emerged as the most critical determinant for technology adoption.

Conclusions

The factors under scrutiny furnish direct and indirect evidence of their impact on the productivity and competitiveness of agricultural value chains. Thus, this paper significantly contributes to comprehending the role of technology adoption in designing and executing rural development strategies within developing countries.
Analysis of the Genetic Characteristics and Metastatic Pathways of G1 and G2 Colorectal Neuroendocrine Neoplasms
Authors: Wang Zhijie , Chen Qichen , Zhao Fuqiang , Sun Li , Qiu Yixian , Cheng Huanqing , Qin Jiayue , Wang Huina , Shi Susheng , Cao Shanbo , Liu Qian
Published: December 2023

Objective

G1 and G2 colorectal neuroendocrine neoplasms (NENs) are a group of rare and indolent diseases. We aimed to delineate their genetic characteristics and explore their metastatic mechanisms.

Methods

We used next-generation sequencing technology for targeted sequencing for 54 patients with G1 and G2 colorectal NENs. We delineated their genetic features and compared the genetic characteristics between metastatic NENs and nonmetastatic NENs. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis was utilized to explore their abnormal pathways and study their potential metastatic mechanisms.

Results

We collected 23 metastatic NENs and 31 nonmetastatic NENs. In the whole cohort, the common mutated genes were NCOR2, BRD4, MDC1, ARID1A, AXIN2, etc. The common copy number variations (CNVs) included amplification of HIST1H3D, amplification of HIST1H3E, and loss of PTEN. The KEGG enrichment analysis revealed that PI3K-Akt, MAPK, and Rap1 were the major abnormal pathways. There were significantly different genetic features between metastatic NENs and nonmetastatic NENs. The metastatic NENs shared only 47 (22.5%) mutated genes and 6 (13.3%) CNVs with nonmetastatic NENs. NCOR2, BRD4, CDKN1B, CYP3A5, and EIF1AX were the commonly mutated genes in metastatic NENs, while NCOR2, MDC1, AXIN2, PIK3C2G, and PTPRT were the commonly mutated genes in nonmetastatic NENs. Metastatic NENs presented a significantly higher proportion of abnormal pathways of cell senescence (56.5% vs 25.8%, P = .022) and lysine degradation (43.5% vs 16.1%, P = .027) than nonmetastatic NENs.

Conclusion

G1 and G2 colorectal NENs are a group of heterogeneous diseases that might obtain an increased invasive ability through aberrant cell senescence and lysine degradation pathways.
Reading Border through Desire: Queer Indigenous Theory, Nordic Settler Colonialism, and Trans Aesthetics
Authors: Kyrölä Kata
Published: December 2023

This article examines the Swedish fantasy-horror-romance film Gräns (Border, dir. Ali Abbasi, 2018) through queer Indigenous thought and the notion of trans aesthetics, exploring how the film may sensitize its viewers to seeing and feeling with gender variance, queer desire, and the trauma of settler colonialism. Drawing on Eve Tuck's call for desire-based research, the article asks what is at stake in queer, trans, and decolonial readings of films that are not necessarily identifiable as such at the surface level. Border centers on a love story between two gender-fluid trolls who pass as human and whose kin have been subjected to genocide, dislocation, and mutilation, but the film's reception largely misses the connection to the treatment of Indigenous Sámi people and transgender people within Nordic settler states. The article argues that Border's ecstatic depiction of gender-fluid desires, bodies, and sex, alongside its examination of the psychic consequences of settler colonial violence, make it a thus far unique film in the Nordic context — even though this examination happens through the distancing effect of trolls as metaphorical Natives. The main characters embody wrongness in the settler nation-state, in heteronormative society, and ultimately in the delimiting category of the human, but the film imagines rightness in nature as a queer, gender-fluid space where all creatures can just be. Through employing notions of trans aesthetics, the (non)sovereign erotic, refusal, and haunting, the article proposes desire-based readings of cinema that envision ways of feeling and existing beyond humancentric, settler, binary notions of gender and sexuality.
Their Bodies, Their Selves: Reflexivity and Embodiment in 2010s Women's Autobiographical Author-Performer TV Dramedies
Authors: Levy Yael
Published: December 2023

During the 2010s, American television witnessed a growing attention to and presence of women, both in TV representation and in TV creation and production. As part of that development, the self-representation of women who are both the creators and the stars of their shows — such as Lena Dunham (creator and star of Girls; HBO, 2012 – 17), Tig Notaro (creator and star of One Mississippi, Amazon, 2015 – 17), Issa Rae (creator and star of Insecure, HBO, 2016 – 21), Pamela Adlon (creator and star of Better Things, FX, 2016 – 22), and Frankie Shaw (creator and star of Smilf, Showtime, 2017 – 19) — has been on the rise. This article examines these five dramedies in which women both exert authorial voices in telling their own stories and bring to bear performative embodiment in starring in these autobiographical texts. The textual multilayeredness of these author-performers’ autobiographical dramedies, the article shows, reveals the ways in which authorship and performance operate in the realm of women's televisual representation.
The applicability of noncontact sensors in the field of rehabilitation medicine
Authors: Choo Yoo Jin , Moon Jun Sung , Lee Gun Woo , Park Wook-Tae , Chang Min Cheol
Published: December 2023

A noncontact sensor field is an innovative device that can detect, measure, or monitor physical properties or conditions without direct physical contact with the subject or object under examination. These sensors use a variety of methods, including electromagnetic, optical, and acoustic technique, to collect information about the target without physical interaction. Noncontact sensors find wide-ranging applications in various fields such as manufacturing, robotics, automobiles, security, environmental monitoring, space industry, agriculture, and entertainment. In particular, they are used in the medical field, where they provide continuous monitoring of patient conditions and offer opportunities in rehabilitation medicine. This article introduces the potential of noncontact sensors in the field of rehabilitation medicine.
BUILDING THE PERSPECTIVE OF A STRAIGHT LINE ALONG THE PICTURE TRAIL AND THE VANISHING POINT
Authors: Sal'kov N. , Kadykova Nina
Published: December 2023

The article is exclusively applied and methodical in nature and is intended for the study of constructions in the section "Perspective". The paper considers the construction of the perspective of a straight line of the general position with the help of a picture trace and a vanishing point. In perspective, the traces of a straight line are the points of intersection with the picture and subject planes. Vanishing point – the perspective of an improper point of a straight line. The article discusses the picture trail, the vanishing point and the construction of a straight line segment by means of these perspective points. In textbooks for builders, such a task is not set at all and is not considered. Three authors have solutions in textbooks for architects: A.G. Klimukhin, Yu.I. Koroev and T.S. Timrot. However, they also have some disadvantages, which are discussed in this article. In the work proposed to the reader, such an arrangement of geometric components is performed that there is neither parallelism nor perpendicularity between them, that is, they are all located at acute angles to each other, which means that a general case of construction is proposed for consideration. So, we have a right angle only between the horizontal and frontal planes of projections, as well as between the picture and object (horizontal plane of projections) planes. The angles between the other geometric components are exceptionally sharp: a straight line of general position in the P1/P2 system is taken, it is also a straight line of general position in the P1/K system. Thus, the article considers, unlike other textbooks, the general case of a direct task.
DIAGNOSIS OF MELANOMA: CURRENT STATE AND PROSPECTS (literature review)
Authors: Guseynov Arif , Guseynov T. , Sedov S.
Published: December 2023

The article reflects the main factors influencing the survival of patients. The basic principles of diagnosing melanoma are presented. Methods for diagnosing skin melanoma, including invasive and non-invasive methods, are presented in detail and with justification. Among non-invasive methods for diagnosing skin melanoma, the role of physical examination and dermatoscopy in cases of suspected melanoma is emphasized. Among instrumental examination methods, the use of such research methods as ultrasound, computed tomography, magnetic resonance imaging, positron emission tomography is considered. Among laboratory methods, methods of molecular genetic research and determination of biomarkers of skin melanoma are presented. Among the invasive methods, the use of such biopsy methods as excisional and incisional biopsy is considered, with clarification of the indications and contraindications for their use. At the end of the work, the basic requirements for the early diagnosis of skin melanoma are listed. In conclusion, the latest trends in the diagnosis of skin melanoma, new non-invasive methods and an algorithm for diagnosing skin melanoma are identified.
Difficulties of differential diagnosis of sarcoidosis and lymphoproliferative disease
Authors: Rapcun M. , Belyaeva Elena
Published: December 2023

Sarcoidosis is a systemic inflammatory disease of unknown origin. It belongs to the group of interstitial lung diseases, difficult to diagnose pathologies that require a multidisciplinary approach. A clinical case of the complexity of differential diagnosis of sarcoidosis and lymphoproliferative disease in a young patient is presented. The role of morphological verification in establishing the final diagnosis is shown.
"STOP TRYING TO WIN!" CONTINUITY AND REFRAMINGS IN A DOLL'S HOUSE, PART 2.
Authors: Vatain-Corfdir Julie
Published: December 2023

Under what terms can the twenty-first century stage bring Nora Helmer back into her husband’s house? Lucas Hnath’s A Doll’s House, Part 2 (2017) attempts the paradoxical exercise of re-opening the discussion between characters which the end of Henrik Ibsen’s play had irrevocably separated, as though to satisfy our postmodern appetite for sequels (Genette, Eco). This paper examines the form of Hnath’s play as both a continuation of the “drama of ideas” concept and as a modern reframing, with more abstraction, irony and immediacy, of Ibsen’s issues. It argues that Hnath’s play participates in an ambition to “declassicize” Ibsen (as encouraged by Fuchs), while reaffirming the Norwegian playwright as our “contemporary” according to Agamben’s conception of the term. Beyond its endlessly open discussion of gender issues, this paper also seeks to replace Hnath’s play within American theatrical traditions, questioning how far innovation can go within the bounds of realism.
FROM LA VIUDA TO LETTERS FROM CUBA: FAMILY CORRESPONDENCE IN MARÍA IRENE FORNÉS’ THEATER.
Authors: González Crespán Araceli
Published: December 2023

María Irene Fornés (1930-2018) developed a theatrical career inextricably linked to Off-Off-Broadway for more than forty years. One of her most celebrated techniques for writing springs from the chance operation of opening a text, choosing a phrase, sentence or paragraph, and writing it on the blank page to act as inspiration. In fact, her theater abounds with pieces from many varied sources, multiple references as well as objects found in thrift shops. La Viuda, written in Spanish and published in Havana in 1961, was her first play. In 2000, the curtain falls on her theatrical career with the premiere of Letters from Cuba, her last published play. Texts from both the opening and closing landmarks of this most distinguished playwright draw inspiration from different sets of family correspondence. The coincidence in using personal letters as found objects allows for an analysis that will deal with the adaptation from private written texts to a theatrical medium as a signature feature of her theater, concentrating on how they trigger the conception of the play and how they also condition the performance. The article will analyze the adaptation of letters on the stage by considering both formal and thematic aspects, such as references to time and space, the theatrical actions displayed by different characters, the set and stage design, as well as the tone of each piece