bluuebunny/crossref_metadata_2025 huggingface dataset:
Validating Foot Center Axis and Ankle Rotation using Weight-Bearing CT
Authors: Rascoe Alexander S. , Aitchison Alexandra H. , Ridenour Ryan M. , Wang Miqi , Adams Samuel B.
Published: November 2022

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

Even as its popularity increases, there remain many unanswered questions regarding total ankle arthroplasty. One debate considers the proper rotation of the talar component to restore native, non-osteoarthritic anatomy. The foot center axis is a unique anatomic concept that considers the position of the native foot relative to the ankle. The present pilot study sought to evaluate the reproducibility of axial alignment measurements, including the foot center on weight-bearing CT in patients without ankle osteoarthritis.

Methods:

Following IRB approval, charts were reviewed to identify patients without ankle osteoarthritis, trauma or other deformity who received a weightbearing CT scan. A pilot group of n=8 patients were included for a total of n=10 limbs. Average age was 50.1 +/- 14 and there were 38% female patients. All measurements were made on MPR (multiplanar reformation) axial reconstructions. Cobb angle measurements between the anatomic foot center, the second, the fourth metatarsal and the gutter bisector or medial gutter line were recorded by n=4 observers. Intraclass correlation (ICC) was produced using a two-way random effects model with absolute agreement and other statistical testing was performed by IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY.

Results:

The average gutter bisector angle was 6.2 deg +/- 2.0 and the average angle between the medial base of the 1st metatarsal head, lateral base of the 5th metatarsal head and the posterior calcaneus was 33.0 deg +/- 2.6. Amongst the observers, the ICC for these landmarks were 0.95 and 0.96 respectively. The average cobb angle measurement between the gutter bisector angle and the second metatarsal was 8.3 deg +/- 7.3, with a corresponding ICC of 0.96. The average cobb angle measurement between the gutter bisector angle and the anatomic foot center was 5.6 deg +/- 4.3 and the average cobb angle measurement between the medial gutter line and the anatomic foot center was 6.23 deg +/- 6. Amongst the observers, the ICC for these measurements were 0.81 and 0.81 respectively.

Conclusion:

In a small pilot study of patients without osteoarthritis who underwent weight-bearing CT scans there was good (ICC>0.75-0.90) to excellent (ICC>0.90) agreement amongst observers for measurements of foot center axis and ankle rotation. These findings validate the reproducibility and agreement of these manually constructed measurements for assessing the relationship between the foot center axis and ankle rotation. Future studies will expand upon the use of these measurements to define non-arthritic anatomy. The anatomic foot center may be a useful guide for establishing intra-operative foot orientation when performing total ankle arthroplasty.
The Effect of Chilled vs Room Temperature Irrigation on Thermal Energy Dissipation During MIS Calcaneal Osteotomy
Authors: Reddy Sudheer C. , Schipper Oliver N. , Li Jihui
Published: November 2022

Category:

Hindfoot; Basic Sciences/Biologics; Other

Introduction/Purpose:

Minimally Invasive (MIS) calcaneal osteotomy has grown in popularity in recent years to address hindfoot deformity. A potential complication is thermal bone necrosis secondary to heat generation from the burr, leading to nonunion of the osteotomy. Irrigation is commonly employed to reduce this risk. The effect of irrigation on reducing this risk remains an understudied area. The purpose of this study was to evaluate the effect of cooled versus room-temperature irrigation on thermal energy dissipation on a temperature curve during calcaneal osteotomy using a Shannon burr.

Methods:

Ten cadaveric limbs (5 pairs) at room temperature (68 0F) were randomized to receive either cooled saline or room temperature irrigation during MIS calcaneal osteotomy. Two thermocouple probes (EL-USB-TC-LCD, Lascar Electronics) were inserted 5mm away from the plane of the osteotomy, on proximal and distal sides respectively (Fig. 1). The probes were inserted to a depth of 2cm. A 3 x 30mm Shannon burr was used to perform the osteotomy. The burr was run continuously under continuous irrigation using either room temperature (680F) and chilled (370F) irrigation, until the osteotomy was completed. All osteotomies were performed in approximately 60 seconds. Temperature was recorded at 15sec, 30sec, 45 sec and 60 sec for the two groups and used as a measure of thermal energy generation.

Results:

Both room temperature and chilled irrigation were effective in minimizing temperature change. On the proximal side, an overall mean increase of 2.60F (70.60F) with room temperature irrigation and a mean increase of 0.70F (68.70F) with chilled irrigation were observed at the 60 sec interval (p=0.09). On the distal side both irrigation methods were more effective in heat control (70.20F vs 67.10F; p=0.17).

Conclusion:

For the duration of a MIS calcaneal osteotomy, both continuous room temperature and chilled irrigation can reduce thermal energy generation. Use of chilled irrigation can be considered for osteotomies of denser bone that may take longer to perform and generate higher temperatures.
Bilateral Hindfoot Osteonecrosis Associated with Treatment for Cutaneous T-Cell Lymphoma
Authors: Ricci Gianni , Gruenberger Eric H. , Stewart Matthew G.
Published: November 2022

Category:

Hindfoot; Basic Sciences/Biologics

Introduction/Purpose:

There are reports of bilateral atraumatic osteonecrosis of the talus associated with some chemotherapy agenst for cutaneous T-cell lymphomas (CTCL), and systemic glucocorticoid treatment is by far the most common. We report the case of a 63-year old woman with CTCL previously treated with a high-affinity folate analog, pralatrexate, and multiple short- courses of prednisone dose packs who developed bilateral ankle and hindfoot stress fractures which progressed to hindfoot necrosis involving the talus and calcaneus.

Methods:

Chart Review

Results:

MRI was used for the diagnosis of stress fractures and osteonecrosis. The right foot was most symptomatic at presentation and was treated with a 6-month period of protected weight bering in a CAM boot. Follow up imaging demonstrated complete collapse of the talar dome. The patient underwent tibiotalarcalcaneal fusion which was complicated by wound healing issues requiring a skin graft. During this time, left sided symptoms worsened, and MRI confirmed insufficiency fractures with adjacent areas of edema and necrosis about the calcaneus, talus, and lateral malleolus. Considering her recent wound healing difficulties, the left foot was definitively treated in a CAM walker boot with some improvement in symptoms.

Conclusion:

Insufficiency fractures of the hindfoot are known to progress to osteonecrosis and are typically associated with long- term or high dose systemic steroid administration. Cases presenting after short-courses of oral steroids are uncommon; those associated with methotrexate (a lower affinity folate analog) are rare, and cases associated with pralatrexate or CTCL outside osteonecrosis of the jaw were not found during literature review. Despite cessation of chemotherapy and CTCL remission and early institution of protected weight, this patient rapidly progressed to bilateral hindfoot collapse. Providers and patients should be aware of the associated risks and potential for less favorable outcomes.
Return to Play and Performance Measures for National Football League Athletes Following Operative Ankle Fractures
Authors: Robbins Jordan , Jupiter Daniel , Panchbhavi Vinod K. , Weiss William M. , Hagedorn John C. , Chen Jie
Published: November 2022

Category:

Sports; Ankle; Trauma

Introduction/Purpose:

Ankle fractures are common injuries in the National Football League (NFL). Yet, there is a need for deeper understanding about the impacts of surgically managed ankle fractures on athletes' careers. Purpose: To investigate return to play (RTP) for NFL players after operative ankle fractures and the associated impacts on career longevity and player performance.

Methods:

NFL athletes that underwent surgery to repair ankle fractures between 2013 and 2018 were identified from injury reserve (IR) list transactions and press release archives. Athlete demographics and regular season metrics were collected for the seasons before and after injury. Athletes were then matched to uninjured controls. Statistical analysis was performed to evaluate for differences in recorded variables.

Results:

Of the 46 NFL athletes screened, 31 players fit study criteria. Nine (29.0%) players with surgically treated ankle fractures were unable to return to play in the NFL. Compared to the twenty-two (71.0%) athletes that successfully returned to play, players that did not RTP were no different (P > .05) in age, BMI, number of games or seasons played prior to injury, or snaps per game the season prior to injury. Players that did not RTP had a significantly lower (42.6%, P = .013) pre-injury season approximate value (SAV) from players that did RTP. Athletes that successfully returned to play spent an average of 98 days on IR and continued playing for 41 games across 3.5 seasons. There were no differences (P > .05) in SAV or snaps per game at 1 or 2 seasons following injury when compared to the athletes' pre-injury season or when compared to uninjured controls.

Conclusion:

NFL athletes that receive surgery to repair ankle fractures have a RTP rate of 71%. A high pre-injury SAV is a positive predictive measure for successful RTP. NFL players that do return see no difference in game time or performance metrics from pre-injury baseline or uninjured controls.
Surgical Site Infection after Foot and Ankle Surgery: A Retrospective Analysis of Incidence using a Low Concentration Chlorhexidine Gluconate (CHG) 0.05% in Sterile Water
Authors: Rushing Calvin J.
Published: November 2022

Category:

Other; Ankle; Bunion; Diabetes; Sports; Trauma

Introduction/Purpose:

Surgical site infection (SSI) after foot and ankle procedures adversely impacts both the quality and cost of health care delivery; increasing hospital length of stay, the number of re-operations, and readmission rate(s). The purpose of the present study was to assess the incidence of SSI in patients who underwent foot and ankle surgery with concurrent intraoperative lavage containing low concentration Chlorhexidine Gluconate (CHG) 0.05% in sterile water.

Methods:

Seventy-three patients underwent reconstructive foot and ankle procedures which utilized low concentration CHG 0.05% for intraoperative lavage between September 2020 and October 2021, at a single institution. Minimum follow-up for inclusion was at least 90 days; procedures with concurrent use of topical vancomycin powder, or prophylactic antibiotics postoperatively were excluded. Demographic data, and the incidence of complications including postoperative erythema, delayed wound healing, dehiscence, SSI, as well as reoperations were recorded. Univariate and multivariate analyses were performed.

Results:

Twelve complications occurred in 73 patients (16%): 1 erythema (1.4%), 4 delayed wound healing (5.5%), 1 dehiscence (1.4%), and 6 SSI's (8.2%). Of the 6 SSIs, 2 were superficial and 4 deep; representing an incidence rate of 2.7 and 5.5%, respectfully. Six reoperations were performed in 4 patients for deep SSI; 3 (75%) had a previously documented history of SSI after orthopedic surgery. A history of previous SSI infection after orthopedic surgery was identified as an independent predictor of future SSI following foot and ankle surgery (p <.05). No associations were identified for purported risk factors.

Conclusion:

The present study is the first to assess the utility of a low concentration CHG 0.05% as an intraoperative irrigation agent for the purpose of mitigating postoperative SSI after foot and ankle surgery. The data suggests a low incidence of deep SSI in patients without a documented history of previous SSI after orthopedic surgery; without the concurrent use of topical vancomycin or prophyaltic antibitiocs, postoperatively. Additional studies are warranted to better understand the potential association identified.
Projections and Epidemiology of Total Ankle and Revision Total Ankle Arthroplasty in the United States to 2030
Authors: Shah Jason A. , Schwartz Andrew M. , Farley Kevin X. , Khamis Karim Mahmoud , Attia Ahmed K. , Labib Sameh (Sam) A. , Kadakia Rishin J.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total ankle arthroplasty (TAA) utilization is increasing in the United States. As the incidence of this procedure grows, it is important for providers to understand the future projections for ankle arthroplasty and more importantly revision total ankle arthroplasty (rTAA).

Methods:

The national inpatient sample (USA) was queried from 2005 to 2017 for all TAA and rTAA. Poisson and linear regression analyses were performed to project annual incidence of TAA and rTAA to 2030, with subgroup analyses on septic rTAA.

Results:

There were 5315 TAAs performed in 2017, a 564% increase when compared to the TAAs performed in 2005. From 2017 to 2030, the incidence of TAAs is projected to increase from 110% to 796%. There were 1170 rTAAs performed in 2017, a 155% increase when compared to rTAAs performed in 2005. There was a 256% increase in the incidence of septic rTAAs from 2005 to 2017 with a projected increase between 22% and 120% by 2030.

Conclusion:

The incidence of both TAAs and rTAAs are projected to significantly increase over the next decade. Given the known risk factors of TAA and rTAA, these findings reinforce the need for thoughtful consideration when selecting patients for TAA.
Clinical Outcomes of Posterior Hindfoot Endoscopic Surgery using 1.9-mm Diameter Needle Arthroscopy for Posterior Ankle Impingement in Athletes
Authors: Shimozono Yoshiharu , Mizuno Yasuyuki , Funakoshi Noboru , Kobayashi Masahiko , Yamashita Fumiharu
Published: November 2022

Category:

Arthroscopy; Ankle; Hindfoot; Sports

Introduction/Purpose:

Posterior hindfoot endoscopy is a safe and effective treatment for posterior ankle impingement syndrome (PAIS). However, wound-healing problems following hindfoot endoscopy have been still reported. Recently, a novel 1.9- mm diameter needle-arthroscopic system has been introduced. Its small features can help reduce the risk of wound complications and can have the potential to make it earlier to return to play sports due to its minimally invasiveness. To our knowledge, no studies have been reported regarding PAIS treatment using a 1.9-mm diameter needle-arthroscopy. The purpose of this study was to report the clinical outcomes including return to sports following hindfoot endoscopic surgery using 1.9-mm diameter needle- arthroscopy for PAIS.

Methods:

Six patients who engaged in athletic activity (mean age 21.7 [range 16-34] years) and were treated by a hindfoot endoscopic surgery using a 1.9-mm diameter arthroscopic system (NanoScopeTM, Arthrex) for PAIS were included. In all patients, os trigonum was resected and flexor hallucis longus (FHL) tenosynovitis was debrided. American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score was evaluated and Visual analog scale (VAS) at 1 day and 2 weeks after surgery were recorded. Time to return to sports activity at preinjury level was also evaluated. Engaged sports included soccer (3 patients), ballet (2 patients), and lacrosse (1 patient).

Results:

The mean AOFAS score improved significantly from 77.7 to 100 after surgery (p<0.001). Mean VAS score at 1 day and 2 weeks were 1.5 (range 0-3) and 0.3 (range 0-1). respectively. All patients were able to return to full sports activities and the mean time to return to sports activities at preinjury level was 4.8 weeks (range 3-7 weeks). No complications were reported.

Conclusion:

Posterior hindfoot endoscopy using a 1.9-mm diameter needle-arthroscopy provided excellent clinical outcomes in the treatment of PAIS with relatively earlier return to play sports compared to conventional arthroscopy surgery, although this is not a comparative study. Minimum invasiveness with less postoperative pain using needle-arthroscopy may contribute to its early recovery. Further studies are required to support our results.
Relationship Between Macular Thickness and Visual Acuity in the Treatment of Diabetic Macular Edema With Anti-VEGF Therapy: Systematic Review
Authors: Wang Patrick , Hu Zoe , Hou Maggie , Norman Patrick A. , Chin Eric K. , Almeida David RP
Published: November 2022

Purpose:

To examine the relationship between central macular thickness (CMT) measured by optical coherence tomography (OCT) and visual acuity (VA) in patients with center-involving diabetic macular edema (DME) receiving antivascular endothelial growth factor (anti-VEGF) treatment.

Methods:

Peer-reviewed articles from 2016 to 2020 reporting intravitreal injections of bevacizumab, ranibizumab, or aflibercept that provided data on pretreatment (baseline) and final retinal thickness (CMT) and visual acuity (VA) were identified. The relationship between relative changes was assessed via a linear random-effects regression model controlling for treatment group.

Results:

No significant association between the logarithm of the minimum angle of resolution (logMAR) VA and CMT was found in 41 eligible studies evaluating 2667 eyes. The observed effect estimate was a 0.12 increase (95% CI, −0.124 to 2.47) in logMAR VA per 100 µm reduction in CMT after treatment change. There were no significant differences in logMAR VA between the anti-VEGF treatment groups.

Conclusions:

There was no statistically significant relationship between the change in logMAR VA and change in CMT as well as no significant effect of the type of anti-VEGF treatment on the change in logMAR VA. Although OCT analysis, including measurements of CMT, will continue to be an integral part of the management of DME, further exploration is needed on additional anatomic factors that might contribute to visual outcomes.
A phase 2 study of interleukin-22 and systemic corticosteroids as initial treatment for acute GVHD of the lower GI tract
Authors: Ponce Doris M. , Alousi Amin M. , Nakamura Ryotaro , Slingerland John , Calafiore Marco , Sandhu Karamjeet S. , Barker Juliet N. , Devlin Sean , Shia Jinru , Giralt Sergio , Perales Miguel-Angel , Moore Gillian , Fatmi Samira , Soto Cristina , Gomes Antonio , Giardina Paul , Marcello LeeAnn , Yan Xiaoqiang , Tang Tom , Dreyer Kevin , Chen Jianmin , Daley William L. , Peled Jonathan U. , van den Brink Marcel R. M. , Hanash Alan M.
Published: November 2022

Graft-versus-host disease (GVHD) is a major cause of morbidity and mortality following allogeneic hematopoietic transplantation. In experimental models, interleukin-22 promotes epithelial regeneration and induces innate antimicrobial molecules. We conducted a multicenter single-arm phase 2 study evaluating the safety and efficacy of a novel recombinant human interleukin-22 dimer, F-652, used in combination with systemic corticosteroids for treatment of newly diagnosed lower gastrointestinal acute GVHD. The most common adverse events were cytopenias and electrolyte abnormalities, and there were no dose-limiting toxicities. Out of 27 patients, 19 (70%; 80% confidence interval, 56%-79%) achieved a day-28 treatment response, meeting the prespecified primary endpoint. Responders exhibited a distinct fecal microbiota composition characterized by expansion of commensal anaerobes, which correlated with increased overall microbial α-diversity, suggesting improvement of GVHD-associated dysbiosis. This work demonstrates a potential approach for combining immunosuppression with tissue-supportive strategies to enhance recovery of damaged mucosa and promote microbial health in patients with gastrointestinal GVHD. This trial was registered at www.clinicaltrials.gov as NCT02406651.
Determining venous thromboembolism risk in patients with adult-type diffuse glioma
Authors: Burdett Kirsten Bell , Unruh Dusten , Drumm Michael , Steffens Alicia , Lamano Jonathan , Judkins Jonathan , Schwartz Margaret , Javier Rodrigo , Amidei Christina , Lipp Eric S. , Peters Katherine B. , Lai Albert , Eldred Blaine S. C. , Heimberger Amy B. , McCortney Kathleen , Scholtens Denise M. , Horbinski Craig
Published: November 2022

Venous thromboembolism (VTE) is a life-threating condition that is common in patients with adult-type diffuse gliomas, yet thromboprophylaxis is controversial because of possible intracerebral hemorrhage. Effective VTE prediction models exist for other cancers, but not glioma. Our objective was to develop a VTE prediction tool to improve glioma patient care, incorporating clinical, blood-based, histologic, and molecular markers. We analyzed preoperative arterial blood, tumor tissue, and clinical-pathologic data (including next-generation sequencing data) from 258 patients with newly diagnosed World Health Organization (WHO) grade 2 to 4 adult-type diffuse gliomas. Forty-six (17.8%) experienced VTE. Tumor expression of tissue factor (TF) and podoplanin (PDPN) each positively correlated with VTE, although only circulating TF and D-dimers, not circulating PDPN, correlated with VTE risk. Gliomas with mutations in isocitrate dehydrogenase 1 (IDH1) or IDH2 (IDHmut) caused fewer VTEs; multivariable analysis suggested that this is due to IDHmut suppression of TF, not PDPN. In a predictive time-to-event model, the following predicted increased VTE risk in newly diagnosed patients with glioma: (1) history of VTE; (2) hypertension; (3) asthma; (4) white blood cell count; (5) WHO tumor grade; (6) patient age; and (7) body mass index. Conversely, IDHmut, hypothyroidism, and MGMT promoter methylation predicted reduced VTE risk. These 10 variables were used to create a web-based VTE prediction tool that was validated in 2 separate cohorts of patients with adult-type diffuse glioma from other institutions. This study extends our understanding of the VTE landscape in these tumors and provides evidence-based guidance for clinicians to mitigate VTE risk in patients with glioma.
A randomized, placebo-controlled phase 3 trial of the PI3Kδ inhibitor leniolisib for activated PI3Kδ syndrome
Authors: Rao V. Koneti , Webster Sharon , Šedivá Anna , Plebani Alessandro , Schuetz Catharina , Shcherbina Anna , Conlon Niall , Coulter Tanya , Dalm Virgil A. , Trizzino Antonino , Zharankova Yulia , Kulm Elaine , Körholz Julia , Lougaris Vassilios , Rodina Yulia , Radford Kath , Bradt Jason , Kucher Klaus , Relan Anurag , Holland Steven M. , Lenardo Michael J. , Uzel Gulbu
Published: November 2022

Activated phosphoinositide 3-kinase delta (PI3Kδ) syndrome (APDS) is an inborn error of immunity with clinical manifestations including infections, lymphoproliferation, autoimmunity, enteropathy, bronchiectasis, increased risk of lymphoma, and early mortality. Hyperactive PI3Kδ signaling causes APDS and is selectively targeted with leniolisib, an oral, small molecule inhibitor of PI3Kδ. Here, 31 patients with APDS aged ≥12 years were enrolled in a global, phase 3, triple-blinded trial and randomized 2:1 to receive 70 mg leniolisib or placebo twice daily for 12 weeks. Coprimary outcomes were differences from baseline in the index lymph node size and the percentage of naïve B cells in peripheral blood, assessed as proxies for immune dysregulation and deficiency. Both primary outcomes were met: the difference in the adjusted mean change (95% confidence interval [CI]) between leniolisib and placebo for lymph node size was −0.25 (−0.38, −0.12; P = .0006; N = 26) and for percentage of naïve B cells, was 37.30 (24.06, 50.54; P = .0002; N = 13). Leniolisib reduced spleen volume compared with placebo (adjusted mean difference in 3-dimensional volume [cm3], −186; 95% CI, −297 to −76.2; P = .0020) and improved key immune cell subsets. Fewer patients receiving leniolisib reported study treatment-related adverse events (AEs; mostly grades 1-2) than those receiving placebo (23.8% vs 30.0%). Overall, leniolisib was well tolerated and significant improvement over placebo was notable in the coprimary endpoints, reducing lymphadenopathy and increasing the percentage of naïve B cells, reflecting a favorable impact on the immune dysregulation and deficiency seen in patients with APDS. This trial was registered at www.clinicaltrials.gov as #NCT02435173.
A Novel 6-DOF Force-Sensed Human-Robot Interface for an Intuitive Teleoperation
Authors: Li Zihao , Xie Fugui , Ye Yanlei , Li Peng , Liu Xinjun
Published: November 2022

The teleoperation of a 6 degrees-of-freedom (DOF) manipulator is one of the basic methods to extend people’s capabilities in the wide variety of applications. The master interface based on the force/torque (FT) sensor could provide the full-dimension intuitive teleoperation of a 6-DOF robot since it has the ability to trigger 6-DOF command input. However, due to the force coupling, noise disturbance and unlimited input signals of the FT sensor, this force-sensed interface could not be widely used in practice. In this paper, we present an intuitive teleoperation method based on the FT sensor to overcome these challenges. In this method, the input signals from the force-sensed joystick were filtered and then processed to the force commands by force limit algorithm, with the merits of anti-interference, output limitation, and online velocity adjustment. Furthermore, based on the admittance control and position controller, the manipulator could be teleoperated by the force commands. Three experiments were conducted on our self-designed robotic system. The result of the first experiment shows that the interfered force from the force coupling could be effectively suppressed with the limitation of the input force through force limit algorithm. Then, a parameter was introduced in the other two experiments to adjust the velocity online practically with force limit algorithm. The proposed method could give a practical solution to the intuitive teleoperation based on the FT sensor.
Enhanced pain facilitation rather than impaired pain inhibition in burning mouth syndrome female patients
Authors: Gremeau-Richard Christelle , Pionchon Paul , Mulliez Aurélien , Dualé Christian , Dallel Radhouane
Published: November 2022

Background

Deficient endogenous pain modulation has been implicated in the development and exacerbation of chronic orofacial pain. To date, relatively little is known regarding the function of the endogenous pain modulation in patients with burning mouth syndrome (BMS). This case–control study investigated endogenous pain modulation in women with BMS.

Methods

Conditioned pain modulation (CPM) was assessed upon temporal summation (TSP) of thermal pain. Forty female subjects, 20 BMS patients and 20 age-matched control subjects, were included in a 2 session-protocol. Mechanical and thermal pain thresholds were measured on the forearm and hand. TSP was obtained using repetitive laser-evoked thermal stimuli applied on the non-dominant hand, at an intensity yielding to moderate pain. During TSP, CPM was produced by immersing the contralateral foot in a water bath at painful cold (8 °C) temperature. In control conditions, the foot was immersed in a water bath at not painful (30 °C) temperature.

Results

BMS was not associated with any impairment in thermal as well as mechanical extracephalic pain thresholds. TSP and CPM efficacy were similar in BMS patients and control subjects. However, BMS patients exhibited enhanced extracephalic heat hyperalgesia.

Conclusion

This study reveals that there is no impairment of endogenous pain inhibition mechanisms in BMS patients, but rather an increase in pain facilitation.
Post-traumatic endophthalmitis prophylaxis: a systematic review and meta-analysis
Authors: Van Swol Joshua M. , Myers Walter K. , Beall Jonathan A. , Atteya Miriam M. , Blice Jeffrey P.
Published: November 2022

Purpose

The goal of this study is to determine if certain aspects of endophthalmitis prophylaxis strategies are superior to others.

Design

This investigation is a systematic review and meta-analysis.

Methods

All studies specifying a type of prophylaxis strategy and resulting rates of endophthalmitis were included. Time course, method of administration, and antibiotic regimen, and confounding factors were collected and included for meta-regression.

Results

Time courses greater than 24 h did not significantly improve outcomes. Likewise, intraocular and/or intravenous antibiotic administration methods did not significantly outperform oral administration. No antibiotic regimens performed differently from vancomycin/ ≥ 3rd generation cephalosporin except for ciprofloxacin monotherapy which yielded significantly worse outcomes.

Conclusions

Future antibiotic strategies should strongly consider the risks of antibiotic treatment > 24 h and administration methods other than the oral antibiotic forms. In addition, providers should be wary of using ciprofloxacin monotherapy for endophthalmitis prophylaxis when treating open globe injuries.
Genome-wide association studies revealed complex genetic architecture and breeding perspective of maize ear traits
Authors: Khatun Mita , Monir Md Mamun , Lou Xiangyang , Zhu Jun , Xu Haiming
Published: November 2022

Background

Maize (Zea Mays) is one of the world’s most important crops. Hybrid maize lines resulted a major improvement in corn production in the previous and current centuries. Understanding the genetic mechanisms of the corn production associated traits greatly facilitate the development of superior hybrid varieties.

Result

In this study, four ear traits associated with corn production of Nested Association Mapping (NAM) population were analyzed using a full genetic model, and further, optimal genotype combinations and total genetic effects of current best lines, superior lines, and superior hybrids were predicted for each of the traits at four different locations. The analysis identified 21–34 highly significant SNPs (−log10P > 5), with an estimated total heritability of 37.31–62.34%, while large contributions to variations was due to dominance, dominance-related epistasis, and environmental interaction effects ($${h}_{D+}^2\hat{=}$$

h

D
+

2

=
^

14.06% ~ 49.28%), indicating these factors contributed significantly to phenotypic variations of the ear traits. Environment-specific genetic effects were also discovered to be crucial for maize ear traits. There were four SNPs found for three ear traits: two for ear length and weight, and two for ear row number and length. Using the Enumeration method and the stepwise tuning technique, optimum multi-locus genotype combinations for superior lines were identified based on the information obtained from GWAS.

Conclusions

Predictions of genetic breeding values showed that different genotype combinations in different geographical regions may be better, and hybrid-line variety breeding with homozygote and heterozygote genotype combinations may have a greater potential to improve ear traits.
Modulation of physiological and biochemical traits of two genotypes of Rosa damascena Mill. by SiO2-NPs under In vitro drought stress
Authors: Hajizadeh Hanifeh Seyed , Azizi Sahar , Rasouli Farzad , Okatan Volkan
Published: November 2022

Background

Drought is a major abiotic stress that restricts plant growth and efficiency although some nutrients such as silicon improve drought tolerance by regulating the biosynthesis and accumulating some osmolytes. In this regard, a completely randomized factorial design was performed with three factors including two genotypes (‘Maragheh’ and ‘Kashan’), three concentrations of silicon dioxide nanoparticles (SiO2-NPs) (0, 50, and 100 mg L− 1), and five concentrations of PEG (0, 25, 50, 75, and 100 g L− 1) with three replications.

Results

The findings showed that drought stress decreased protein content and it was improved by SiO2-NPs, so the genotype of ‘Maragheh’ treated with 100 mg L− 1SiO2-NPs had the highest protein content. Under severe drought stress, had a higher membrane stability index (MSI) than ‘Kashan’, and the ‘Maragheh’ explants subjected to 100 mg L− 1SiO2-NPs exhibited the uppermost MSI. The explants supplemented with 100 mg L− 1SiO2-NPs sustained their photosynthetic parameters more in comparison with other treatments under drought stress conditions and as well as 100 mg L− 1SiO2-NPs showed higher content of protein and proline of ‘Maragheh’ than ‘Kashan’. Drought stress reducedFm,Fv/Fm, andFv, while SiO2-NPs treatment enhanced these parameters. SiO2-NPs also improved water deficit tolerance by enhancing the activity of antioxidant enzymes such as catalase (CAT), peroxidase (POD), guaiacol peroxidase (GPX), and superoxide dismutase (SOD) and reducing lipid peroxidation and H2O2concentration.

Conclusions

According to the findings, the genotype ‘Maragheh’ was more tolerance to drought stress than ‘Kashan’ by improving water balance, antioxidant enzyme activities, and membrane stability as it was obtained from the unpublished previous evaluation in in vivo conditions and we concluded based on these results, in vitro culture can be used for drought screening in Damask rose plants. The results of the current study revealed that the induced drought stress by polyethylene glycol (PEG) in two Damask rose genotypes was ameliorated with SiO2-NPs and the tolerance genotypes were better than the sensitive ones in response to SiO2-NPs treatment.
Von Hippel–Lindau syndrome with a rare complication of dilated cardiomyopathy: a case report
Authors: Yu Ming , Du Beibei , Yao Shuai , Ma Jianghong , Yang Ping
Published: November 2022

Background

Von Hippel–Lindau (VHL) syndrome is an autosomal dominant hereditary disease affecting multiple organs, with pheochromocytoma in 26% of cases. However, VHL syndrome with congestive heart failure and dilated cardiomyopathy as the primary clinical manifestations has been rarely reported.

Case presentation

A 35-year-old male patient was admitted to the hospital with dyspnea. The patient had a history of cerebellar hemangioblastoma that had been resected, and a one-year history of hypertension. Echocardiography and cardiac magnetic resonance imaging demonstrated a dilated left ventricle, decreased systolic function, and nonischemic myocardial changes. Contrast-enhanced abdominal computed tomography showed pheochromocytoma, neoplastic lesions, and multiple cysts in the kidneys and pancreas. Genetic analysis revealed a missense mutation of the VHL gene, c.269 A > T (p.Asn90Ile), which was identified as the cause of the disease. Dilated cardiomyopathy and VHL syndrome type 2 were diagnosed. The patient was administered a diuretic, α-blocker, β-blocker, and an angiotensin receptor neprilysin inhibitor (ARNI), but refused pheochromocytoma resection. At the six-month follow-up, the patient was asymptomatic with improved cardiac function.

Conclusion

Cardiac involvement is an atypical manifestation in VHL syndrome. Early diagnosis with genetic screening is essential for avoiding life-threatening complications associated with VHL. The management of this rare manifestation of VHL syndrome requires further investigation.
Hepatic dysfunction and adverse outcomes after total arch repair of acute type a aortic dissection: application of the MELD-XI score
Authors: Lin Xinfan , Xie Linfeng , Jiang Debin , Wu Qingsong , He Jian , Chen Liangwan
Published: November 2022

Background

This study was aimed to investigate the incidence and outcomes of patients with postoperative hepatic dysfunction (PHD) after total arch repair of acute type A aortic dissection, and further explore the risk factors for severe adverse outcomes.

Methods

The clinical data of 227 patients with AAAD treated by modified triple-branched stent graft implantation from January 2020 to January 2021 were collected retrospectively. Including preoperative, surgical and postoperative data. Logistics regression was used to determine the independent risk factors of severe adverse outcomes in postoperative HD patients.

Results

In the early stage after operation, a total of 153 patients were complicated with PHD, accounting for 67.4%. The incidence of severe adverse outcomes in patients with PHD was 43.1%. We found that preoperative moderate/severe pericardial effusion [odds ratio (OR): 11.645, 95% confidence interval (CI): 1.144, 143.617, P = 0.045], preoperative imaging data suggest the celiac trunk involvement [OR: 6.136, 95% CI 1.019, 36.930, P = 0.048], CPB time > 180 min [OR: 4.855, 95% CI 1.218, 15.761, P = 0.034], decreased early postoperative serum albumin [OR: 0.935, 95% CI 0.856, 0.985, P = 0.026] were independent risk factors for severe adverse outcomes in patients with PHD.

Conclusions

PHD was associated with increased early mortality and morbidity. Preoperative moderate/severe pericardial effusion, preoperative celiac trunk involvement, cardiopulmonary bypass (CPB) time > 180 min and decreased early postoperative serum albumin were identified as independent risk factors for severe adverse outcomes in patients with PHD.
Overcrowding analysis in emergency department through indexes: a single center study
Authors: Colella Ylenia , Di Laura Danilo , Borrelli Anna , Triassi Maria , Amato Francesco , Improta Giovanni
Published: November 2022

Introduction

Overcrowding in the Emergency Department (ED) is one of the major issues that must be addressed in order to improve the services provided in emergency circumstances and to optimize their quality. As a result, in order to help the patients and professionals engaged, hospital organizations must implement remedial and preventative measures. Overcrowding has a number of consequences, including inadequate treatment and longer hospital stays; as a result, mortality and the average duration of stay in critical care units both rise. In the literature, a number of indicators have been used to measure ED congestion. EDWIN, NEDOCS and READI scales are considered the most efficient ones, each of which is based on different parameters regarding the patient management in the ED.

Methods

In this work, EDWIN Index and NEDOCS Index have been calculated every hour for a month period from February 9th to March 9th, 2020 and for a month period from March 10th to April 9th, 2020. The choice of the period is related to the date of the establishment of the lockdown in Italy due to the spread of Coronavirus; in fact on 9 March 2020 the Italian government issued the first decree regarding the urgent provisions in relation to the COVID-19 emergency. Besides, the Pearson correlation coefficient has been used to evaluate how much the EDWIN and NEDOCS indexes are linearly dependent.

Results

EDWIN index follows a trend consistent with the situation of the first lockdown period in Italy, defined by extreme limitations imposed by Covid-19 pandemic. The 8:00–20:00 time frame was the most congested, with peak values between 8:00 and 12:00. on the contrary, in NEDOCS index doesn’t show a trend similar to the EDWIN one, resulting less reliable. The Pearson correlation coefficient between the two scales is 0,317.

Conclusion

In this study, the EDWIN Index and the NEDOCS Index were compared and correlated in order to assess their efficacy, applying them to the case study of the Emergency Department of “San Giovanni di Dio e Ruggi d’Aragona” University Hospital during the Covid-19 pandemic. The EDWIN scale turned out to be the most realistic model in relation to the actual crowding of the ED subject of our study. Besides, the two scales didn’t show a significant correlation value.
Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice
Authors: Liu Jing , Tao Yang , Haikun Wang , Lanfang Yang , Jingyi Lu , Ping Yao
Published: November 2022

Background

Triclosan, an antimicrobial agent in personal care products, could be absorbed into the human body through the digestive tract. This animal experiment aimed to clarify the effects of triclosan exposure on the microbiome and intestinal immune functions in healthy and ulcerative colitis models.

Methods

Balb/c mice were maintained on an AIN-93G diet containing 80ppm triclosan dissolved in polyethylene as vehicle or vehicle alone for 1 week or 4 weeks. In the end, the mice were sacrificed, blood samples and colon tissues were collected for analysis of inflammation, and fecal samples were collected for 16 S rRNA sequencing of gut microbiota. To establish ulcerative colitis mice model, at the beginning of the 4th week, mice maintained on the diet with or without triclosan were treated with 2% Dextran sulfate sodium(DSS) in drinking water for 1 week. Then mice were sacrificed for analysis of colitis and gut microbiota.

Results

Triclosan exposure to common mice enhanced the levels of p-NF-κb and Toll-like receptor 4 (TLR4), and decreased the Occludin in the colon. Triclosan exposure to DSS-induced mice increased the level of inflammatory cytokines, reduced the levels of Occludin, and exacerbated the degree of damage to intestinal mucosa and crypt, infiltration of inflammatory cells and atypia of glandular cells. Low-grade intraepithelial neoplasia appeared. Both in common and DSS-induced mice, triclosan exposure changed the diversity and composition of gut microbiota. Fecal samples showed higher enrichment of sulfate-reducing bacteria and Bacteroides, and less butyrate-producing bacteria.

Conclusion

Triclosan exposure induced disturbance of gut microbiota and exaggerated experimental colitis in mice. And changes in the composition of gut microbiota were characterized by the increase of harmful bacteria, including sulfate-reducing bacteria and Bacteroides, and the reduction of protective probiotics, butyrate-producing bacteria.
Brain tumour segmentation based on an improved U-Net
Authors: Zheng Ping , Zhu Xunfei , Guo Wenbo
Published: November 2022

Background

Automatic segmentation of brain tumours using deep learning algorithms is currently one of the research hotspots in the medical image segmentation field. An improved U-Net network is proposed to segment brain tumours to improve the segmentation effect of brain tumours.

Methods

To solve the problems of other brain tumour segmentation models such as U-Net, including insufficient ability to segment edge details and reuse feature information, poor extraction of location information and the commonly used binary cross-entropy and Dice loss are often ineffective when used as loss functions for brain tumour segmentation models, we propose a serial encoding–decoding structure, which achieves improved segmentation performance by adding hybrid dilated convolution (HDC) modules and concatenation between each module of two serial networks. In addition, we propose a new loss function to focus the model more on samples that are difficult to segment and classify. We compared the results of our proposed model and the commonly used segmentation models under the IOU, PA, Dice, precision, Hausdorf95, and ASD metrics.

Results

The performance of the proposed method outperforms other segmentation models in each metric. In addition, the schematic diagram of the segmentation results shows that the segmentation results of our algorithm are closer to the ground truth, showing more brain tumour details, while the segmentation results of other algorithms are smoother.

Conclusions

Our algorithm has better semantic segmentation performance than other commonly used segmentation algorithms. The technology we propose can be used in the brain tumour diagnosis to provide better protection for patients' later treatments.
Whole-genome analysis of monozygotic Brazilian twins discordant for type 1 narcolepsy: a case report
Authors: Campos João H. C. , Aguilar Ana C. R. , Antoneli Fernando , Truzzi Giselle , Briones Marcelo R. S. , Ferreira Renata C. , Coelho Fernando M. S.
Published: November 2022

Background

Narcolepsy type 1 (NT1) is a rare and chronic neurological disease characterized by sudden sleep attacks, overwhelming daytime drowsiness, and cataplexy. When associated with a sudden loss of muscle tone (cataplexy) narcolepsy is classified as type 1, while the absence of cataplexy indicates type 2. Genetic, degenerative, and immunological hypotheses to explain the pathophysiology of NT1 are still a matter of debate. To contribute to the understanding of NT1 genetic basis, here we describe, for the first time, a whole genome analysis of a monozygotic twin pair discordant for NT1.

Case presentation

We present the case of a pair of 17-year-old male, monozygotic twins discordant for NT1. The affected twin had Epworth Sleepiness Scale (ESS) of 20 (can range from 0 to 24), cataplexy, hypnagogic hallucinations, polysomnography without abnormalities, multiple sleep latency tests (MSLT) positive for narcolepsy, a mean sleep latency of 3 min, sleep-onset REM periods SOREMPs of 5, presence of alleleHLA-DQB1*06:02, and Hypocretin-1 level of zero pg/mL (normal values are > 200 pg/mL). The other twin had no narcolepsy symptoms (ESS of 4), normal polysomnography, MSLT without abnormalities, presence of alleleHLA-DQB1*06:02, and Hypocretin-1 level of 396,74 pg/mL. To describe the genetic background for the NT1 discordant manifestations in this case, we present the whole-genome analysis of this monozygotic twin pair. The whole-genome comparison revealed that both twins have identical NT1 pathogenic mutations in known genes, such asHLA-DQB1*06:02:01,HLA-DRB1*11:01:02/*15:03:01. The affected twin has the expected clinical manifestation while the unaffected twin has an unexpected phenotype. The unaffected twin has significantly more frameshift mutations as compared to the affected twin (108 versus 75) and mutations that affect stop codons (61 versus 5 in stop gain, 26 versus 2 in start lost).

Conclusions

The differences observed in frameshift and stop codon mutations in the unaffected twin are consistent with loss-of-function effects and protective alleles, that are almost always associated with loss-of-function rare alleles. Also, overrepresentation analysis of genes containing variants with potential clinical relevance in the unaffected twin shows that most mutations are in genes related to immune regulation function, Golgi apparatus, MHC, and olfactory receptor. These observations support the hypothesis that NT1 has an immunological basis although protective mutations in non-HLA alleles might interfere with the expression of the NT1 phenotype and consequently, with the clinical manifestation of the disease.