bluuebunny/crossref_metadata_2025 huggingface dataset:
Is the use of abduction pillows crucial for post-operative rehabilitation following reverse total shoulder arthroplasty?
Authors: Cullen Mark M , Warren Eric , Hurley Eoghan T , Goltz Daniel E , Lorentz Samuel , Crook Bryan S , Adu-Kwarteng Kwabena , Levin Jay M , Klifto Christopher S , Anakwenze Oke A
Published: December 2024

Background

Surgeons often use abduction pillows after reverse total shoulder arthroplasty (rTSA), but evidence for their benefits is limited. This study compares outcomes for patients using a sling with or without an abduction pillow post-operatively.

Methods

A retrospective review was conducted on patients undergoing primary rTSA. Patients were grouped based on post-operative use of an abduction pillow or not. Data was collected at 6 weeks, 3 months, 6 months, 1 year, and final follow-up. Primary outcomes included rates of post-operative dislocation, range of motion, and patient-reported outcomes.

Results

Patients using an abduction pillow showed reduced forward flexion at 3 months (120° vs. 139°, p = 0.002) and 6 months (135° vs. 147°, p = 0.049). At 6 weeks, abduction was lower in the pillow group (90° vs. 124°, p = 0.01). There were no significant differences in other range-of-motion metrics or patient-reported outcomes. Using no pillow did not increase dislocation risk (OR: 1.67, p = 0.60), infection, readmission, revision, or repeat surgery rates.

Conclusions

Post-operative sling use without an abduction pillow after rTSA appears safe, with no increase in complications and similar patient satisfaction and outcomes.

Level of Evidence

Therapeutic Level III
Mid Term Survivorship of the Infinity Ankle Replacement in the National Joint Registry
Authors: Jennison Toby , Favier Barabara , Goldberg Andrew J. J.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The Infinity ankle replacement is a two component fixed bearing implant. It was introduced to the market in in 2014 is now the most commonly implanted ankle replacement globally. The National Joint Registry of England Wales and Northern Ireland is the largest ankle replacement registry in the world which captures outcomes of ankle replacements in a voluntary but mandated fashion. The primary aim of this study was to determine the failure rates of the Infinity ankle replacement in the UK.

Methods:

Data was collected prospectively by the NJR with all primary ankle replacements captured on proforma forms known as the NJR A1. All failures of ankle replacements are recorded using an NJR A2 form.

Results:

Overall 3781 implants have been implanted. The mean age was 68.5 and median BMI of 29, 60.5% male. 82.7% of patients were ASA 1 or 2 and the indication was osteoarthritis in 92.5%. Overall 60 implants have been revised. The most common reason was infection in 33 cases, followed by aseptic loosening of the tibia. Aseptic loosening of the talus only occurred in 2 cases. The failure rate of the Infinity was significantly better (P< 0.001) when compared to the expected number of revisions of 96.03. 20 revisions were exchange of polyethylene, with 15 revisions of both components. The 1 year failure rate is 0.5% (95% CI 0.3-0.7%). The 5 year failure rate is 2.2% (1.7%-2.8%), and 7 year survival in 225 patients is 3.5% (2.3-4.8%).

Conclusion:

The Infinity ankle replacement has lower failure rates than expected when compared to other contemporary ankle replacements. This data highlights the improvement in outcomes of a new fourth generation fixed bearing ankle replacement
Revolutionizing Achilles Tendon Repair: A Comprehensive Proposal Integrating the WALANT Technique for Percutaneous Achilles Tenorrhaphy
Authors: Felipe Albarrán Carlos , Letelier Hugo , Ignacio Escudero Mario , Birman Eddie , Nuñez Alfredo , Pino Felipe , Jose Pellegrini Manuel
Published: December 2024

Category:

Sports

Introduction/Purpose:

Achilles tenorrhaphy is one of the most common procedures performed in foot and ankle surgery, and percutaneous techniques are safe and achieve good outcomes. Over the past 20 years, the WALANT technique (Wide-awake local anesthesia no-tourniquet) has gained popularity due to its advantages: it does not depend on the availability of complex operating rooms or anesthetists, allows for intraoperative functional evaluation, presents lower costs, and few complications have been reported. However, there is scarce literature regarding the complications associated with the WALANT technique in foot and ankle surgery, especially in percutaneous Achilles tenorrhaphy.

Methods:

A retrospective cohort study included patients over 18 who underwent percutaneous Achilles tenorrhaphy using the Dresden technique, with a minimum follow-up of 6 months. The WALANT group was treated on an outpatient basis in a minor surgery theater, while the standard treatment (ST) group underwent surgery in the main theater with spinal anesthesia. Categorical data were analyzed using the Chi-square test, with statistical significance set at p = 0.05.

Results:

A total of 51 patients were included (19 WALANT and 32 ST), all male, with an average age of 43.1 years. There was one case of surgical wound infection (SWI) in the WALANT group (5.26%); there were no cases of SWI in the ST group, with no statistically significant differences (p=0.18). In the WALANT group, there were no cases of re-rupture, and in the ST group, there was 1 (6.3%) re-rupture that did not require reintervention; no statistically significant difference was found (p=0.19). Additionally, 15.79% of the WALANT group presented with transient hypoesthesia (up to 6 months) of the sural nerve, compared to 3.13% in the ST group, with no statistically significant differences (p=0.10). No cases of deep venous thrombosis were found in either group.

Conclusion:

The WALANT technique demonstrates no differences in complications between the two groups, indicating it is considered a safe technique regarding associated complications. It's worth mentioning that the WALANT technique is considered a more cost-effective option due to the lower use of resources.
Second-Look Needle Arthroscopy after Prior Surgical Treatment for Cartilage Lesions of the Ankle: The Amsterdam and New York City Perspectives
Authors: Walinga Alex , Butler James J. , Dahmen Jari , Stufkens Sjoerd , Robert Guillaume , Kennedy John G. , Kerkhoffs Gino M M. M.J.
Published: December 2024

Category:

Ankle; Sports

Introduction/Purpose:

The purpose of this prospective study was to evaluate the quality of the reparative cartilage during second-look needle arthroscopy following talar osteoperiostic grafting from the iliac crest (TOPIC) and autologous osteochondral transplantation (AOT) procedures for the management of large osteochondral lesions (OCLs) of the talus.

Methods:

Patients who underwent second-look needle arthroscopy following either TOPIC or AOT procedure were prospectively recruited. The primary outcome was the assessment of the quality of the reparative cartilage via second-look needle arthroscopy scored by the International Cartilage Repair Society (ICRS) score. The secondary outcomes were the number and nature of ad-hoc needle arthroscopy interventions and complications associated with these interventions.

Results:

Five patients underwent second-look needle arthroscopy following TOPIC procedure and 11 patients underwent second-look in-office needle arthroscopy following AOT. The mean ICRS in the TOPIC cohort was 9.4 ± 1.0 at a mean time of 24.4 months following the index procedure. The mean ICRS in the AOT cohort was 10.6 ± 1.3 at a mean time of 58.8 months following the index procedure. No complications were observed in either cohort.

Conclusion:

This study demonstrated that AOT and TOPIC lead to high-quality reparative cartilage at short-term to mid-term follow-ups, but further studies with larger patient cohorts and longer follow-ups are warranted. Furthermore, second-look needle arthroscopy is a safe and viable minimally invasive procedure that can effectively evaluate the quality of reparative cartilage following surgical intervention for OCLs of the talus. In addition to arthroscopic evaluation of the reparative cartilage, this procedure has therapeutic capabilities and can resect bony and soft tissue sources of anterior ankle impingement.
Sex-Specific Analysis in Patients Undergoing Talar OsteoPeriostic Grafting from the Iliac Crest (TOPIC) for Large Osteochondral Lesions of the Talus
Authors: Dahmen Jari , Gianakos Arianna , Hollander Julian , Rikken Quinten , Stufkens Sjoerd , Kerkhoffs Gino M M.M.J.
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

Talar OsteoPeriostic grafting from the Iliac Crest (TOPIC) is a novel technique for the treatment of large osteochondral lesions of the talus. It is the purpose of the present study to assess the gender-specific differences in the presentation and outcomes following TOPIC between male and female patients.

Methods:

A prospective comparative analysis was performed comparing consecutive female and male patients having been treated by the press-fit TOPIC procedure. Clinical comparative assessment pre-operatively and at 12 months of follow-up included determination of the Numeric Rating Scale (NRS) scores for pain during walking (primary outcome), at rest, and during stair-climbing. The Foot and Ankle Outcome Score (FAOS) was also assessed. A computed tomography (CT) scan was performed for lesion size, morphology and localization determination pre-operatively as well as 10-12 weeks postoperatively to assess union of the distal tibial osteotomy site and at 1 years postoperatively to assess consolidation of the graft as well as cyst development in the graft.

Results:

A total of 48 patients (30 women, 18 men) were eligible for inclusion. Both men and women demonstrated significant functional improvements post-operatively concerning the clinical outcomes with no significant differences between men and women (n.s.) except for a significantly greater improvement in postoperative FAOS pain scores in women. Men presented with OLTs significantly larger in both surface area (208 mm2 for males versus 155 mm2 for females, p< 0,05) as well as lesion volume (3.0 cm3 for males versus 1.8 cm3 for females, p< 0.05). At 1-year post-operatively, all patients with a CT scan (n=47) showed graft consolidation. Cyst formation was present in 11 females (37% of the group) and 10 males (59% of the group), respectively (p=0.24). There were no statistical differences in complication rates following the TOPIC procedure.

Conclusion:

Both male and female patients showed clinically relevant improvements in the clinical outcomes after undergoing the TOPIC procedure, with significant differences in pre-operative size. There were no statistical differences in complication rates following the TOPIC procedure, although a higher proportion of women did require hardware removal. TOPIC procedure is a good treatment strategy for large OLTs in both men and women.
Striding Towards Balance: Exploring Gender Representation and Regional Patterns in Orthopaedic Foot and Ankle Specialists
Authors: Jimenez Mosquea Thelma R. , Ubillus Hugo A. , Walls Raymond J.
Published: December 2024

Category:

Other

Introduction/Purpose:

Women have historically been underrepresented across all tiers of orthopedic surgery training. While it's widely acknowledged that a greater presence of women in faculty roles within foot and ankle fellowship programs correlates positively with the number of fellowship trainees, there remains a paucity of quantitative data on the representation of women at the foot and ankle subspecialty level. Although there may be a growing number of women participating in foot and ankle fellowship programs, this alone does not necessarily indicate improved gender representation, as statistical trends may be influenced by shifts in specialty preferences among applicants over recent decades. This study aims to address this gap by examining gender diversity among members of the American Orthopaedic Foot & Ankle Society.

Methods:

This cross-sectional study examined members of the American Orthopaedic Foot & Ankle Society (AOFAS) using the publicly accessible "Find a Doctor" page as of January 2024. Baseline data on gender, state, region, and year of graduation were collected. Specifically, the years of graduation were categorized into two periods: before and after 2013, enabling an evaluation of gender trends over the past decade. Gender information for each fellow was obtained from Healthgrades, while graduation year data were sourced from databases like AOFAS and professional profiles. Descriptive statistics were utilized to analyze baseline fellow data. This approach aimed to provide insights into the gender dynamics and temporal trends within the AOFAS membership, shedding light on potential shifts in the composition of orthopaedic foot and ankle specialists over time.

Results:

As of January 2024, our analysis revealed a total of 965 foot and ankle surgeons. Among them, 87.7% (847 out of 965) were men, while 12.3% (118 out of 965) were women. Prior to 2013, women accounted for 9.1% of the total, with men comprising 90.9%. Over the past decade, the representation of women nearly doubled to 17.3%, while men still dominated at 82.7%. Regional distribution of women surgeons was as follows: Midwest - 19% (n=22), Northeast - 22% (n=26), South - 36% (n=42), and West - 24% (n=28).

Conclusion:

While the representation of women in foot and ankle subspecialties is on the rise nationwide, a notable gender disparity persists. Over one-third of women foot and ankle surgeons are located in the South region. We suggest that future efforts focus on enhancing the consistency and quality of publicly accessible information regarding women surgeons in foot and ankle fellowship programs. Presently, there is no centralized, publicly available source of information on the gender distribution of applicants to foot and ankle fellowship programs and the allocation of positions filled.
Strutting in Style, Suffering in Silence: A Biomechanical Study of Hallux Valgus Deformity with High Heeled Shoes
Authors: Casas Erik Jesus Huanuco , Luo Emily Joan , Kutzer Katherine , Talaski Grayson M. , Carvalho Kepler A.M. , Schonhorst Nolan M. , Slivinskis Victor , Valvecchi Tommaso Forin , Kaplan Jonathan , Netto Cesar de Cesar
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

High heeled shoes (HH) have historically been thought to worsen existing hallux valgus (HV). However, no studies have shown if HH contribute to the pathophysiology of HV development. Weightbearing computed tomography (WBCT), distance mapping (DM), and coverage mapping (CM) allows for three- dimensional analysis of the forefoot and has been previously able to detect subtle differences in joint mechanics. However, no study has used WBCT to study 1st metatarsophalangeal (MTP) joint mechanics in HH. The aim of this study was to describe and compare DM and CM of the 1st MTP at varying HH heights.

Methods:

10 non-frequent HH wearing volunteers with no underlying foot/ankle pathology received bilateral WBCT scans at four different HH heights: 0 cm, 3 cm, 6 cm, 9cm. A semi-automatic software was used to segment the 1st MTP. Manual selection of the 1st metatarsal head and proximal phalangeal surface was performed. DM and CM differences were statistically evaluated using One-Way ANOVA test and Wilcoxon rank sum test. P values < 0.05 were considered statistically significant.

Results:

For both DM and CM, there was a statistically significant difference when comparing all HH height parameters to one another (p < 0.0001). When comparing each HH height individually to the 0 cm condition, all heights demonstrated a statistically significiant difference (p < 0.0001). More specifically, the plantar lateral aspect of the 1st MTP joint space demonstrated the greatest change in both DM and CM compared to the control at all HH heights.

Conclusion:

This study demonstrates for the first time that HH may contribute to the development of HV in previously healthy feet. Interestingly, the plantar lateral aspect of the 1st MTP was the most affected with increasing HH heights. Further research is needed to elucidate the long term effects of HH shoes on forefoot deformity development.
Surgical Timing for Charcot Foot Reconstruction: Pattern of Paradigm Shift from a Systematic Review of Recent Literature
Authors: Yik Tan Chin , Chua Chen Xi Kasia
Published: December 2024

Category:

Midfoot/Forefoot; Diabetes

Introduction/Purpose:

The optimal timing to surgically intervene in Charcot foot arthropathy remains controversial. Classical teaching is to avoid intervention in the active stage of Charcot foot, because of the worry of soft tissue and bony complications. However, several authors had advocated the paradigm shift to intervene early in active Charcot foot, to allow deformity correction and stabilization before further deformity develops. This article aims to investigate the current pattern of paradigm shift and the outcomes after intervention in the active and inactive stages of Charcot foot.

Methods:

This study was done in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). A literature search was done on Pubmed, Embase, Cochrane Library, and Clinicaltrials.gov. An effort was made to search for all relevant articles in unpublished sources such as conferences as well as the reference list of included studies. All relevant articles published within the last 5 years were included, with the exclusion of case reports.

Results:

269 articles were screened, and 17 studies were included. There were 11 studies with surgery in the inactive stage of Charcot foot, 6 studies with surgery in both the active and inactive stages of Charcot foot, and no study was done in the active stage alone. The amputation rate for surgery in the inactive stage was 10.5% while that of active and inactive stages was 12.3%. The re-operation rate for surgery in the inactive stage was 31.2% while that of active and inactive stages was 50.0%. The non-union rate after surgery in the inactive stage was 13.0% while that of active and inactive stages was 32.5%.

Conclusion:

Most surgeons still prefer to intervene surgically in the inactive stage of Charcot foot. Amputation rate, re-operation rate, and non-union rates were higher in studies that included surgery in both active and inactive stages of Charcot foot. Therefore, surgeons should be cautious in deciding optimal surgical timing for Charcot foot reconstruction and avoid the active stage of the disease if possible.
Survival Comparison Following Below-the-Knee Amputation in Diabetic Patients with and without Hemodialysis
Authors: Lee Jaehyung , Kim Janghyun , Chae Sungkuk , Oh Seung ho , Cha Dongheon
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

Foot ulcers and subsequent amputations are disabling complications in diabetic patients, and major amputations, including below-knee amputations, leave patients with catastrophic disabilities. Diabetes is the most common cause of causing end-stage renal disease which results in hemodialysis, and patients with diabetes on hemodialysis have a higher prevalence of several co-morbidities compared to those without diabetes. The purpose of this study is to compare survival rates after below knee amputation in patients with diabetes who are on hemodialysis and those who are not.

Methods:

This retrospective study was conducted on patients with diabetes who underwent below-knee amputation at a single tertiary hospital from 2005 to 2015. Exclusion criteria applied to patients undergoing amputation for reasons not directly related to diabetes, such as trauma or tumor. The survival rate analysis involved categorizing patients into hemodialysis and non-hemodialysis groups at the time of amputation. Within the hemodialysis group, further analysis was performed by subdividing patients into three groups based on the duration of dialysis: Group A (≤5 years), Group B (5-10 years), and Group C (>10 years).

Results:

A total of 98 patients were enrolled, with 54 in the hemodialysis group and 44 in the non-hemodialysis group. The hemodialysis group exhibited a significantly lower survival rate after below-knee amputation than the non-hemodialysis group (p=0.010 by the log-rank test). The 1-year survival rate was 66.7% in the hemodialysis group, contrasting with the non-hemodialysis group's rate of 90.9%. Similarly, the 5-year survival rate was 20.4% in the hemodialysis group and 52.3% in the non-hemodialysis group. Subgroup analysis revealed no significant differences in survival among the three subgroups based on the duration of dialysis before amputation (A vs. B, p=0.560; A vs. C, p=0.661; B vs. C, p=0.870 by the log-rank test).

Conclusion:

Among diabetic patients who underwent below-knee amputation, those on hemodialysis at the time of amputation showed lower 1- and 5-year survival rates compared to those without hemodialysis. There was no significant association between the duration of hemodialysis before amputation and survival.
The Impact of the Osteopathic and Allopathic Merger on Foot and Ankle Case Log Volumes: A 2014-2023 ACGME Report Analysis
Authors: Shepard Samuel , Raszewski Jesse A. , Bartholomew Ania , Franko Gerrit , Karvelas Antonios , Brown Jim , Wynn Oakk , Hatic Safet
Published: December 2024

Category:

Other; Ankle

Introduction/Purpose:

The Accreditation Council for Graduate Medical Education (ACGME) Surgical Review Committee monitors the quantity of experiences through Current Procedural Terminology (CPT) codes logged by residents based on the procedures they perform. The ACGME currently requires a minimum of 20 specific foot and ankle procedures to be completed prior to graduation. These are defined as 15 'ankle fracture' cases and 5 'ankle, hindfoot, or midfoot arthroscopy' cases. The year 2020 marked a milestone change in residency training, as the Allopathic (MD) and Osteopathic (DO) residency accreditation merger resulted in unified graduate medical education training. The purpose of this study was to better understand the effect the merger had on the average number of cases, as well as the defined minimum cases for graduating orthopedic residents.

Methods:

A retrospective analysis of ACGME case logs examined the max and average number of adult orthopaedic cases related to both Leg/Ankle and Foot/Toes performed by graduating orthopaedic surgery residents from 2014 to 2023, spanning a 10-year period. Trends in case exposure were analyzed by assessing the average number of adult orthopaedic procedures during the study period. All data were sourced directly from the ACGME website.1 Descriptive statistics will be used along with unpaired t-tests to examine if there are statistical differences between pre and post merger averages (Microsoft Corporation, 2018. Microsoft Excel).

Results:

In 2014, 151 programs graduated 684 residents, compared to 197 programs in 2023 graduating 884 residents. The overall average of leg/ankle procedures prior to the merger was 176.74 (range 151.9-200.8, SD 18.9), which increased to 212.93 post-merger (range 206.5-219.9, SD 6.7; p = 0.006). Similarly, the total number of foot/toes procedures increased from a mean of 72.6 (range 62.5-83, SD 7.3) pre-merger to 82.9 post-merger (range 83.2-83.9, SD 1.1; p = 0.023). The average number of ankle fractures pre-merger was 58.3 (range 53-62.3, SD 3.7), which increased to 68.2 post-merger (range 66.6-69.7, SD 1.5; p < 0.01). Additionally, the average number of ankle arthroscopy procedures increased from 13.8 pre-merger (range 11.4-15.6, SD 1.7) to 15.3 post-merger (range 14.8-15.9, SD 0.5; p = 0.9).

Conclusion:

The merger between MD and DO residency programs in 2020 has led to a significant increase in the average number of orthopedic surgery procedures related to the foot and ankle performed by graduating residents. This indicates a positive impact on the training and exposure of orthopedic surgery residents in these areas. The findings suggest that the merger has helped to enhance the educational experience and preparedness of orthopedic surgery residents in foot and ankle procedures, meeting the ACGME requirements for graduation.
The Influence of Extraosseous Talar Vascular Luminal Diameter on the Development of Osteochondral Lesions of the Talar Dome
Authors: Aslan Lercan , Ghandour Samir , Gedik Cihad C. , Ashkani-Esfahani Soheil , Guss Daniel , Waryasz Gregory R. , Bejarano-Pineda Lorena , DiGiovanni Christopher W. , Kwon John Y.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Osteochondral lesions of the talus (OLT) impact both sedentary individuals and athletes, affecting both daily function as well as athletic performance. Purported causations include trauma, genetics, and hypovascularity. Although it is known that the talar dome’s vascularity is mainly supplied the posterior tibialis artery (PTA) and to a lesser degree the sinus tarsi artery (STA), the pathophysiological impact of talar dome hypovascularity on OLT remains poorly studied. Our first hypothesis was that the patients with OLT have a lower diameter of PTA (dPTA) and STA (dSTA), and the second hypothesis was that among the group of the patients with OLT, the patients that require surgery have a lower d PTA and dSTA.

Methods:

This was a retrospective study that included 77 patients with OLT, and for the control group 77 patients with peroneal tendinitis. To mitigate the effect of comorbidities the patients between 30 to 40 years of age were included and the ones with a history of smoking, diabetes, rheumatologic, and peripheral artery diseases were excluded. The dPTA measurements were done in three different levels for all groups: at the level of 1 cm above plafond, at the level of plafond and at the level of medial malleolar tip (MMT). dSTA was measured at the level of talar neck. Area, volume, depth, and localization of OLT were recorded, as well.

Results:

The study group had significantly lower dPTA at three levels (1.05±0.22mm, 0.99±0.18mm, 0.98±0.31mm, proximal to distal) compared to the control group (1.25±0.23mm, 1.20±0.22mm, 1.14±0.18mm, proximal to distal) (P< 0.001). The dSTA was also lower in study group as compared to control group (0.5±0.11mm vs. 0.57±0.08mm, respectively P=0.001). ROC Curve analysis revealed the cutoff values for OLT occurrence after ankle injury as; 1.115 mm for the level of 1 cm above plafond, 1.075 mm for the level of plafond,1.055 mm for the level of MMT, 1.085 mm for mean dTPA and 0.5665mm for dSTA (Table-1). A significant negative correlation was observed between OLT size area (mean: 42.24±24.76 mm2) and arterial diameters (P< 0.01, P< 0.01, and P=0.014 for three different levels of dPTA and P< 0.001 for dSTA).

Conclusion:

Smaller dPTA and dSTA appear to be associated with the occurrence of OLT, with the defect size inversely correlated to arterial diameters. The determined cutoff values for dPTA may help clinicians identify high risk patients to develop OLT after an acute ankle injury. Further elucidation of these vascular abnormalities, particularly dPTA, could hold significant prognostic potential and be used to predict disease progression as well as the likelihood of surgical success in OLT treatment.
The Influence of Resilience on Outcomes after Total Ankle Arthroplasty
Authors: McCahon Joseph A.S , Massaglia Joseph , Moncman Tara G. , Riebesell Samantha , Parekh Selene G. , Pedowitz David I. , Daniel Joseph N.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Resiliency is the ability to recover from stressful events and has been shown to correlate with patient outcomes following certain orthopaedic procedures. The purpose of this study was to determine the relationship between resiliency and outcomes following TAA.

Methods:

A retrospective analysis of patients undergoing primary TAA between April 2015 and September 2022 was performed (N =83). Data included demographics, comorbidities, complications, pre- and post-operative visual analog scale (VAS) pain and Foot and Ankle Ability Measure (FAAM) functional scores, Brief Resilience Scale (BRS) scores and surgical satisfaction. Patients were defined as having low resilience (LR), normal resilience (NR), or high resilience (HR) based on a BRS score of < 3, 3-4.30, and > 4.3, respectively.

Results:

High resilience patients had significantly higher postoperative FAAM ADL, Sports, and Overall scores as well as a significantly greater increase from preoperative scores compared to LR and NR patients. Low resilience patients had significantly lower FAAM Sports and Overall scores compared to normal and high resilience patients. BRS scores positively correlated with postoperative FAAM scores. We found no difference in satisfaction or VAS between the three cohorts.

Conclusion:

Although functional improvements following TAA are expected, those patients with HR at baseline are more likely to experience greater improvements in functional outcomes following surgery.
Detection of Geographic Atrophy Guided by Optical Coherence Tomography Sub-RPE Illumination Analysis in Patients With Intermediate Age-Related Macular Degeneration
Authors: Szigiato Andrei , Maatouk Christopher M. , Azar Alexander E. , Alsaloum Peter , Talcott Katherine E. , Singh Rishi P. , Rachitskaya Aleksandra V.
Published: December 2024

Purpose: To evaluate the prevalence of geographic atrophy (GA) lesions in patients with a diagnosis of intermediate age-related macular degeneration (iAMD). Methods: A retrospective cross-sectional study was performed of patients with an International Classification of Diseases, 10th Revision, diagnosis of iAMD. The primary outcome was the percentage of eyes diagnosed with iAMD with an undocumented GA lesion identified on imaging. Multiple logistic regression was used to assess risk factors for atrophic lesions in patients with iAMD. Results: The study included 690 eyes of 428 patients with a diagnosis of iAMD. The mean age was 79.4 ± 8.4 years, and 66.3% of patients were women. Forty-nine eyes (7.1%) were graded as having GA lesions, and 34% of these eyes had foveal involvement. The mean visual acuity (VA) was better in patients without GA lesions than in patients with GA lesions (72.9 ± 12.9 letters vs 66.4 ± 13.8 letters; P = .001). No systemic comorbidity was associated with an increased risk of GA lesions in this cohort. Conclusions: A notable proportion of eyes diagnosed with iAMD by eye care providers had underlying GA lesions in this real-world cohort. The use of optical coherence tomography as an adjunctive tool helped increase the detection of early GA in these patients.
Using Youth Participatory Action Research to Examine Structural Violence and Youth Mental Health
Authors: Fisher Tiarra , Gubrium Aline , Dixon Saharra , Chan Jazmine , Weil Mira , Simoun Alya , Egan Justine , Beatriz Elizabeth , Salerno Valdez Elizabeth
Published: December 2024

Mental health is impacted by structural factors such as poverty, access to care and quality education, racism, homophobia, transphobia, violence, and housing insecurity. The current study adds to the extant literature by providing data obtained in collaboration with racialized and minoritized young people, with the purpose of understanding how structural violence affects their mental health and, ultimately, to suggest community-driven policy. We engaged a diverse sample of young people—including Black, Latinx, and/or LGBTQ+, housing insecure, and living with a disability in a youth participatory action research project. In spring 2021, youth participants examined how structural racism and other systems of oppression influence adolescent health inequities. Participatory arts-based methods were utilized to conduct community and identity building activities, define research questions and photo prompts, perform data collection (photos), engage in group thematic analysis, and make recommendations at the state policy level. Also, individual semi-structured interviews were conducted with participants. Our findings reveal that lack of awareness about mental health, cost, and wait times; invalidation of their experiences; and mental health stigmas were major structural barriers to the health and well-being of participants. These insights highlight the importance for public health researchers and practitioners alike to have a deep understanding of youth-specific experiences to develop effective community-based interventions that address the structural sources of poor mental health outcomes for youth.
Targeting Enterobacter cloacae attenuates osteolysis by reducing ammonium in multiple myeloma
Authors: Yang Qin , Zhu Yinghong , Jian Xingxing , Qiu Yi , Zhu Yan , Zhao Lia , He Yanjuan , An Gang , Qiu Lugui , Guo Jiaojiao , He Nihan , Abudumijiti Huerxidan , Hu Cong , Chen Xun , Huang Siqing , Feng Xiangling , Li Xin , Liu Jing , Xu Yajing , Zhou Wen
Published: December 2024

Multiple myeloma (MM)-induced bone disease affects not only patients' quality of life but also their overall survival. Our previous work demonstrated that the gut microbiome plays a crucial role in MM progression and drug resistance. However, the role of altered gut microbiota in MM bone disease remains unclear. In this study, we show that intestinal E. cloacae is significantly enriched in MM patients with osteolysis. Through fecal microbial transplantation and single bacterial colonization experiments in a 5TGM1 MM mouse model, we found that intestinal colonization of E. cloacae promotes osteolysis by increasing circulating ammonium levels. Elevated ammonium promotes osteoclastogenesis by increasing Trap protein levels in osteoclast precursors and by acetylating and stabilizing CCL3 protein in MM cells. Inhibition of ammonium synthesis, using E. cloacae with a deleted dcd gene, along with probiotic supplementation, alleviated osteolysis in MM. Overall, our work suggests that E. cloacae promotes osteolysis in MM by synthesizing ammonium. This establishes a novel mechanism and potential intervention strategy for managing MM with osteolysis.
How I Manage Patients with Unexplained Cytopenia
Authors: Malcovati Luca , Cazzola Mario
Published: December 2024

The term "unexplained cytopenia" is used to describe a condition characterized by peripheral blood (PB) cytopenia that cannot be attributed to identifiable causes using conventional tests or to any concomitant diseases. Unexplained cytopenia requires clinical attention and further investigation to identify individuals at risk of developing a hematologic neoplasm. The available evidence suggests that somatic mutation analysis may effectively complement the diagnostic work-up and clinical management of unexplained cytopenia. Indeed, the presence or absence of somatic mutation(s) in myeloid genes shows high positive and negative predictive values for myeloid neoplasms (MN). Mutation analysis is also crucial for identifying patients with clonal cytopenia of undetermined significance (CCUS), a condition at increased risk of developing a MN. Recently, clinical/molecular prognostic models have been developed, providing valuable tools for the personalization of clinical and molecular surveillance. Most patients with CCUS show mild cytopenia and do not require therapeutic intervention. Currently, there is no treatment approved for CCUS, and transfusion therapy is the sole therapeutic option for patients with severe symptomatic cytopenia. However, this field has been emerging as a domain of active clinical investigation. This article presents four case studies of patients with unexplained cytopenia, which hematologists may encounter in their clinical practice.
Odronextamab monotherapy in R/R DLBCL after progression with CAR T-cell therapy: Primary analysis of the ELM-1 study
Authors: Topp Max S. , Matasar Matthew J. , Allan John N. , Ansell Stephen M. , Barnes Jeffrey A. , Arnason Jon E. , Michot Jean-Marie , Goldschmidt Neta , O'Brien Susan M. , Abadi Uri , Avivi Irit , Cheng Yuan , Flink Dina M. , Zhu Min , Brouwer-Visser Jurriaan , Chaudhry Aafia , Mohamed Hesham , Ambati Srikanth , Crombie Jennifer L.
Published: December 2024

Patients with relapsed/refractory (R/R) diffuse large B-cell lymphoma (DLBCL) progressing after chimeric antigen receptor T-cell therapy (CAR T) have dismal outcomes. The prespecified post-CAR T expansion cohort of the ELM-1 study investigated the efficacy and safety of odronextamab, a CD20×CD3 bispecific antibody, in patients with disease progression after CAR T. Sixty patients received IV odronextamab weekly for 4 cycles followed by maintenance until progression. The primary endpoint was objective response rate (ORR) by independent central review. The median number of prior lines of therapy was 3 (range 2-9), 71.7% were refractory to CAR T, and 48.3% relapsed within 90 days of CAR T. After a median follow-up of 16.2 months, ORR and complete response (CR) rate were 48.3% and 31.7%, respectively. Responses were similar across prior CAR T products and time to relapse on CAR T. Median duration of response was 14.8 months and median duration of CR was not reached. Median progression-free survival and overall survival were 4.8 months and 10.2 months, respectively. The most common treatment-emergent adverse event was cytokine release syndrome (48.3%; no Grade ≥3 events). No cases of immune effector cell-associated neurotoxicity syndrome were reported. Grade ≥3 infections occurred in 12 patients (20.0%), two of which were COVID-19. Odronextamab monotherapy demonstrated encouraging efficacy and generally manageable safety, supporting its potential as an off-the-shelf option for post-CAR T patients. This trial was registered at www.clinicaltrials.gov as #NCT02290951.
Adaptive Dead Zone Compensation Control Method for Electro-Hydrostatic Actuators Under Low-Speed Conditions
Authors: Jiang Haoyi , Ling Zhenfei , Zhou Fengqi , Sun Maowen , Liu Hao , Xu Lilin , Yao Yeming , Ouyang Xiaoping , Yang Huayong
Published: December 2024

This study proposes an accurate dead zone compensation control method for electro-hydrostatic actuators (EHAs) under low-speed conditions. Specifically, the nonlinear dead zone characteristics under low-speed conditions are summarized based on numerous EHA experiments. An adaptive compensation function (ACF) is then constructed for the dead zone. Next, this study proposes an adaptive dead zone compensation control method for EHAs by integrating the ACF with a virtual decomposition controller (VDC) based on the established EHA model. The stability of the proposed control method is also proven. Finally, the proposed control method is verified using an EHA platform. The test results show that the dead zone trajectory tracking errors of EHAs are significantly reduced when combined with the ACF. Furthermore, since most EHAs are controlled by adjusting the motor speed, the method presented in this study is simpler and easier to use than methods that employ flow compensation.
Bilateral primary vitreoretinal lymphoma masquerading as fungal endophthalmitis- a case report
Authors: Agarwal Manisha , Muralidhar Alankrita , Jain Tanya , Katre Prashant , Gandhi Arpan , Gupta Priyanka , Gupta Charu , Narain Shishir
Published: December 2024

Purpose

To report a case of bilateral primary vitreoretinal lymphoma (PVRL) masquerading as endophthalmitis in a patient with a history of bilateral cataract surgery and COVID-19.

Observation

A 60-year-old male patient presented with diminution of vision in both the eyes. There was a history of bilateral cataract surgery done 2 months back at a gap of one week and COVID-19 infection treated with high dose systemic corticosteroids. Patient presented with dense vitritis with yellowish sub-retinal pigment epithelium (RPE) deposits in both the eyes six weeks after cataract surgery. It was clinically suspected to be endophthalmitis. Diagnostic vitrectomy was done in both the eyes and vitreous sample was negative on microbiological and cytological examination. Multimodal imaging along with sub retinal biopsy helped in confirming the diagnosis. Management was done using multiple intravitreal methotrexate injections and remission was achieved.

Conclusion

Vitritis with sub-RPE yellowish deposits may be mistaken for infectious endophthalmitis specially in a patient with a history of intraocular surgery or immunosuppression. PVRL is a great masquerader and is to be kept in mind while diagnosing a middle-aged patient with infectious or non-infectious uveitis.
Biopriming of Maize with their endophyte Aspergillus fumigatus reinforces their resistance to salinity stress and improves their physiological traits
Authors: Yassin Marwa A. , George Nelly , Shabaan Lamis , Gouda Yousra
Published: December 2024

Zea mays L. (Maize) is one of the most crucial world’s crops, for their nutritional values, however, the water scarcity and consequent soil salinization are the major challenges that limit the growth and productivity of this plant, particularly in the semi-arid regions in Egypt. Recently, biopriming has been recognized as one of the most efficient natural-ecofriendly approaches to mitigate the abiotic salt stress on plants. The haploid (128) and triploid (368) seeds of maize were selected as model verities for assessing their resistance to salt stress and mitigating their effect by fungal-biopriming. Overall, the haploid and triploid plants viabilities were drastically affected by salt concentration, at 500 mM of NaCl. At 500 mM NaCl, the fresh weights of the triploid and haploid seedlings were reduced by ~ 5 and 6.1 folds, compared to the controls, ensuring slightly higher salt resistance of the triploid than haploid ones. The pattern of the endophytic fugal isolates was plausibly changed with the salt concentration for both plant types, Aspergillus fumigatus isolate was emerged with the higher NaCl concentration (400–500 mM), and their morphological identity was molecularly confirmed and deposited into Genbank with accession # PQ200673. The fungal bioprimed seeds of the haploid and triploid plants were irrigated with 400 mM NaCl. The fungal-bioprimed plants displayed a significant improvement on the shoot density, fibrous roots, root length, shoot length, and leaves numbers and areas of the stressed-plants by ~ 1.7 folds, compared to control, ensures the triggering of different salt resistance machineries in plants upon fungal biopriming. The total antioxidant enzymes activities “catalase, peroxidase, superoxide dismutase” of the salt-stressed bioprimed maize plants were increased by ~ 4.7–5.3%, compared to control, confirming the mitigating effect of the salinity stress on plants upon fungal biopriming. The chlorophyll and carotenoids contents were significantly increased of the salt stressed maize upon biopriming with A. fumigatus. The expression of the sod, apx2, nhx11, hkt1, H + -PPase, nced of the plant salt stressed was strongly increased in response to A. fumigatus biopriming, normalized to β-actin gene. The expression of apx2 was dramatically increased by about 30 and 43 folds, in response to fungal biopriming. The nhx1 was significantly up-regulated by 18.9 fold in response to fungal biopriming, compared to control.
Health-care resource use and costs associated with inflammatory bowel disease in northwest London: a retrospective linked database study
Authors: UI-Haq Zia , Causin Luiz , Kamalati Tahereh , Kahol Durgesh , Vaikunthanathan Trishan , Wong Charlotte , Arebi Naila
Published: December 2024

Background

With 20–40% of patients who have inflammatory bowel disease (IBD) not responding to therapy, resource use and costs can be high. We performed a descriptive analysis of health-care data for IBD management in the National Health Service to explore potential areas for improvement.

Methods

In this exploratory study, we analysed real-world data from the Discover dataset for adults with a diagnosis of incident IBD recorded in northwest London, UK, between 31 March, 2016, and 31 March, 2020. We compared mean visit numbers and primary and secondary care costs per patient to examine resource use and costs for active disease versus remission.

Results

We included 7,733 patients (5,872 with ulcerative colitis [UC], 1,427 with Crohn’s disease [CD], and 434 with codes for both [termed IBD-undefined in this study]). Remission was recorded in 19,218 (82%) of 23,488 observations for UC, 4,686 (82%) of 5,708 for CD, and 1,122 (65%) for IBD-undefined observations. Health-care resource use was significantly higher with active disease in all settings except primary care for UC. Total health-care costs were greater with active disease than remission for all diagnoses (all p < 0.0001). The main driver of costs was inpatient hospital care among those with active disease; elective inpatient costs were high among patients with UC and IBD-undefined in remission.

Conclusions

Higher health-care resource use and costs were observed with active disease, which underscores the importance of early induction and maintenance of remission in UC and CD. Updated strategies that incorporate treat to target may offer cost benefits by the offsetting of biologic drug costs with a reduction in costly inpatient hospital stays.

Trial registration

This trial was not registered as it used pseudonymised retrospective data.
Everyday life and boredom of people living with dementia in residential long-term care: a merged methods study
Authors: Gebhard Doris , Frank Julia I.
Published: December 2024

Background

Everyday life in residential long-term care is widely portrayed as boring. However, empirical evidence on this topic remains limited, particularly for the vulnerable group of people living with dementia. A better understanding of everyday life and the associated experiences of boredom could facilitate the development of practical strategies to reduce boredom in this target group. The aim of this study is therefore to analyse everyday activities, daily routines and the frequency and types of boredom in people living with dementia in residential long-term care.

Data and methods

In five long-term care facilities, participants were observed for two days in 20-minute time slots (from 7 am to 7 pm) using the Maastricht Electronic Daily Live Observation Tool. Semi-structured interviews were conducted with people living with dementia about their daily routines and experiences of boredom. Qualitative content analysis based on Mayring was applied, using the five boredom types from Goetz et al. as deductive categories. Observational data was analysed descriptively and merged with qualitative data on daily routines. In all, 46 people living with dementia (average age: 84.65 ± 7.15 years, 89.13% female, average DSS: 6.50 ± 3.15) were observed at 2760 time points. Of these, 17 participants took part in the interviews.

Results

The residents spend 47.5% of their day doing nothing and follow a routine that is strongly determined by communal meals. 62.5% of participants are bored, with 18.5% describing boredom as a constant/prevalent condition in their everyday lives. All five types of boredom are reflected in the interviews, with apathetic boredom being the most common.

Conclusions

Although people living with dementia follow almost the same daily routine in residential long-term care, they experience everyday life very differently, ranging from no boredom, to feelings of pleasant relaxation when bored to strongly negative feelings such as hopelessness and frustration. These findings suggest that interventions to prevent or reduce boredom need to be personalised in order to effectively combat the highly individual nature of boredom. Person-centred dementia care provides a valuable intervention strategy to meet this requirement.

Clinical trial number

Not applicable.