bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of the COVID-19 Pandemic on a Cancer Fast-Track Programme
Authors: Martínez M. T. , Moragon S. , Ortega-Morillo B. , Montón-Bueno J. , Simon S. , Roselló S. , Insa A. , Viala A. , Navarro J. , Sanmartín A. , Fluixá C. , Julve A. , Soriano D. , Buch E. , Peña A. , Franco J. , Martínez-Jabaloyas J. , Marco J. , Forner M. J. , Cano A. , Silvestre A. , Teruel A , Bermejo B. , Cervantes A. , Chirivella Gonzalez I.
Published: November 2022

Introduction

The COVID-19 pandemic has disrupted many aspects of clinical practice in oncology, particularly regarding early cancer diagnosis, sparking public health concerns that possible delays could increase the proportion of patients diagnosed at advanced stages. In 2009, a cancer fast-track program (CFP) was implemented at the Clinico-Malvarrosa Health Department in Valencia, Spain with the aim of shortening waiting times between suspected cancer symptoms, diagnosis and therapy initiation.

Objectives

The study aimed to explore the effects of the COVID-19 pandemic on our cancer diagnosis fast-track program.

Methods

The program workflow (patients included and time periods) was analysed from the beginning of the state of alarm on March 16th, 2020 until March 15th, 2021. Data was compared with data from the same period of time from the year before (2019).

Results

During the pandemic year, 975 suspected cancer cases were submitted to the CFP. The number of submissions only decreased during times of highest COVID-19 incidence and stricter lockdown, and overall, referrals were slightly higher than in the previous 2 years. Cancer diagnosis was confirmed in 197 (24.1%) cases, among which 33% were urological, 23% breast, 16% gastrointestinal and 9% lung cancer. The median time from referral to specialist appointment was 13 days and diagnosis was reached at a median of 18 days. In confirmed cancer cases, treatment was started at around 30 days from time of diagnosis. In total, 61% of cancer disease was detected at early stage, 20% at locally advanced stage, and 19% at advanced stage, displaying time frames and case proportions similar to pre-pandemic years.

Conclusions

Our program has been able to maintain normal flow and efficacy despite the challenges of the current pandemic, and has proven a reliable tool to help primary care physicians referring suspected cancer patients.
Buckling of a column made of the functionally graded material with high-order polynomial mode shape
Authors: Elishakoff Isaac , Chotpatthamanon Chotpong , Reddy JN
Published: November 2022

In this study, we investigate the buckling of a column made of functionally graded materials in axial direction. The column is simply supported at both ends. The mode shape is represented by a polynomial whose power is increased from four to nine; this power only restricted by the possibility of the hand- or symbolic-manipulation. It is shown that the solutions stemming from lower-order polynomial are all contained in the solution associated with higher-order polynomials. Numerous novel solutions are uncovered that could be used as benchmark solutions versus numerous approximate techniques available for eigenvalue problems.
Gels of carrageenan-caprine whey protein concentrate: A physicochemical study
Authors: Ayunta Carolina A , Quinzio Claudia M , Iturriaga Laura B , Puppo María C
Published: November 2022

Mixed gels of carrageenan (Car) and caprine whey protein concentrate (WPCc) (pH 7) were studied and compared with those prepared with Car and commercial bovine whey protein concentrate (WPCb). Dynamic rheology studies indicate that gels with WPCc were weaker (lower G′) than those made with WPCb. However, textural parameters such as, hardness, springiness and cohesiveness were similar in both type of gels. The addition of CaCl2 incremented the elastic modulus (G′), hardness and adhesiveness of gels. The samples with caprine whey showed higher water holding capacity than samples with bovine whey. Confocal laser scanning microscope images of the gels, showed very different aspects according to the type of WPC used: WPCc-Car gels exhibited aggregates of proteins that interrupt the carrageenan network, while WPCb-Car gels showed a homogeneous appearance with proteins distributed throughout all the matrix.
The determinants of aggressive share buybacks: An empirical examination of U.S. publicly traded restaurant firms
Authors: Gim Jaehee , Jang SooCheong
Published: November 2022

It has become a common practice for restaurant firms to spend amounts exceeding their earnings on share buybacks by depleting their cash reserves or even by borrowing money. Given restaurant firms’ limited ability to generate internal cash and the high cost of debt financing, using these means to finance share buybacks could jeopardize restaurant firms’ long-term success. However, little is known about the factors influencing restaurant firms’ tendency toward this seemingly aggressive buyback behavior. This study revealed that the more restaurant firms’ earnings reduce, the greater their tendency is to conduct such aggressive share buybacks. This result could provide some evidence that managerial self-serving behavior plays a role in aggressive share buybacks in the restaurant industry. The study also demonstrated that the positive impact of reduced earnings on aggressive buybacks becomes stronger as a firm’s degree of franchising increases.
Qualities of Children’s Fear in Therapeutic Action Groups Addressing Post-separation Parental Stalking
Authors: Nikupeteri Anna , Marttala Pia , Laitinen Merja
Published: November 2022

This paper examines the way in which parental stalking — as a form of domestic abuse — raises fear in children and affects their sense of safety. The study draws on three therapeutic action groups involving 13 children who have experienced stalking by their fathers/stepfathers after the parents’ separation. The research question is as follows: How does children’s sense of fear manifest in therapeutic action groups? The qualitative analysis revealed three qualities of fear among the children: (1) internalised, (2) constant and (3) episodic. Internalised fear appeared as a child’s mental state that materialised as an overwhelming sentiment in the group sessions and elsewhere. Constant fear activated at times, and the senses of fear and security alternated both in the sessions and elsewhere. Episodic fear related to the children’s memories of violent events and father’s stalking behaviour. The children were able to sense security in the group and in daily life owing to a temporal distance to their father’s stalking. Our findings underscore the importance of professionals’ awareness of the qualities of children’s fear and the significance of assessing their fear and sense of safety in a child-centered manner in therapeutic practices.
How the context of reception affects the meaning of RCT evidence
Authors: Carmel Simon
Published: November 2022

This article takes as a case study a set of disagreements in the early 2000s about randomised controlled trial (RCT) evidence for a newly developed drug in the field of intensive care medicine. The interpretation of RCT findings – and in particular, the application of these findings to clinical practice – were contested among research-active intensive care doctors, despite their shared professional and epistemic values. I examine the arguments about scientific interpretation and application to clinical practice advanced by two readily identifiable groups. The analysis documents how four particular aspects of scientific knowledge were perceived and portrayed differently by the two groups, and notes how each group was associated with different kinds of routine work practices and external networks. My argument is that these differences give rise to distinctive hermeneutic frames and orientations towards the scientific results and disparities in their consequential judgements regarding the legitimate use of the newly developed drug, and I extend Stones and Turner’s concept situationally specific habitus to make the link between context and hermeneutic frames and orientations. The analysis has implications for furthering our understanding of how the clinical meaning attributed to scientific evidence is affected by the context of reception of results, even where epistemic and professional values are shared.
Loving globalization: High-growth enterprises and public opinion on globalization in Europe
Authors: Kiratli Osman S
Published: November 2022

Building upon the “new” new trade theory, this article proposes that the regional business demography plays a prominent role in shaping Europeans’ preferences on globalization. Specifically, I argue, regional populations of high-growth enterprises that take advantage of internationalization and export opportunities drive positive attitudes on globalization, especially among the “losers” of import competition. Regression models on cross-sectional survey data from Eurobarometer surveys covering ten waves between 2015 and 2019 supplemented by a series of macro-level covariates establish that residents in regions with higher shares of high-growth enterprises are more likely to view globalization as an opportunity. More importantly, the positive association between regional high-growth enterprise shares and support for globalization is particularly pronounced among lower-educated and lower-skilled individuals.
Alien domesticity: representing home during a pandemic
Authors: Luvaas Brent
Published: November 2022

Cultural geography and the related disciplines of urban sociology and anthropology have long focused their theoretical lenses on the city as a space of lived multiplicity. This photographic essay focuses its lens on the home as such a space. During the pandemic lockdown of 2020–2021, many of us spent more time in our homes than we ever had before, working, teaching, schooling, shopping, and barricading ourselves from the outside world. This essay borrows from the often ambiguous and anonymizing aesthetics of street photography to depict the multiple, overlapping worlds of home during a pandemic. Home, as depicted here, is an always unfinished process of affective assemblage and dissolution. The images featured seek to capture that lack of resolution, the messy emotional texture of home life under lockdown.
Resemiotization: tracing the movement of resources in landscape architectural design trajectories
Authors: Price Christine , Archer Arlene
Published: November 2022

University students in landscape architecture need to mobilize a range of resources in their design trajectories in order to resolve their designs. Often design education settings are influenced by design traditions of the global north, and thus may favour particular ways of knowing. This article aims to contribute to a multimodal pedagogy for diversity exploring the ways in which diverse students mobilize resources to move between spatial, verbal and visual modes in a landscape architectural design trajectory. It specifically traces the resources that one student brings to her learning environment in a university in South Africa, and identifies the experiential, social, semiotic, interactive and pedagogical resources she deploys. The authors demonstrate how these resources shape and prompt the student’s meaning-making processes, and how she mobilizes these resources to move her design trajectory forward. They do this by building on Kress and Van Leeuwen’s Reading Images (2006) model of visual grammar, adapted for three-dimensional space, and Kress’s notions of design in Multimodality (2010). The concept of resemiotization is key here to recognizing and understanding the meaning-making potential of modes. The authors argue that the affordances of different modes prompt resemiotization of resources at different times in the design trajectory, moving between material expression and nonmaterial (re)conceptualization. The processes of resemiotization can thus generate emergent meanings and transform them within the student’s landscape design trajectories. This approach to pedagogy can valorize the agency, identity, ways of knowing and resourcefulness of diverse meaning-makers.
Michel Pastoureau and the history of visual communication
Authors: Aiello Giorgia , Van Leeuwen Theo
Published: November 2022

Despite early and ongoing calls for a systematic engagement with history, social semiotics has largely emphasized research on the synchronic rather than diachronic dimensions of meaning-making. And while the ‘instability’ of semiotic practices (see Kress’s Multimodality: A Social Semiotic Approach to Contemporary Communication, 2010) and the importance of semiotic change (see Van Leeuwen’s Introducing Social Semiotics, 2005) have become key themes in semiotics, there is still a need for a dynamic approach to the study of visual and multimodal communication, focusing not only on describing how meaning-making resources and their uses are changing, but also on why they are changing. In this article, the authors focus on the importance of the work of medieval historian Michel Pastoureau for the social semiotic study of visual communication, highlighting that this work can help us further refine and even rethink key social semiotic concepts such as modes and media, provenance, and context. Pastoureau’s work shows how we can make theoretical statements about instability, change and innovation more concrete and, ultimately, empirically based. His approach can also help us understand semiotic change and its relation to social and cultural (and also economic and technological) change more broadly, often with the aid of the (crucial) normative discourses that shape semiotic practices over time.
The ‘geobiography’ of an extraordinary artifact, or a conserved relic from the Iranianized ‘Dacha’ culture
Authors: Sholeh Mahsa , Lotfi Sahand
Published: November 2022

Since one of cultural geography’s aims is to understand how human cultures influence the landscape, the geobiography of a modest artifact can be a readable clue concerning a larger cultural context. This article discusses how diasporic cultural mobility finds its way from the place of origin to the place of settlement. The story begins in Soviet Russia in the twilight of the 1930s when the Red Revolution has driven many people to flee their homeland and continues in Iran before and during World War II. A family of White emigrants from Ukraine came to Iran in the 1930s. They tried to relive sweet memories of distant years in the village of Damavand outside Tehran by finding a Russian-style summer residence, ‘dacha’, in the context of Iranian culture and geographical territory. In late Summer 1941, a taxi driver entrusted an old engraved copper pot to them as a guarantee to return and take them to Tehran, which Allied forces had occupied. Four generations have continuously cared for this unbreakable relic, whose story, valued much more than the object itself, illustrates the cultural dynamics of migration in the form of portable property. A geobiographical approach helps us better understand diasporic cultural practices in a new socio-cultural context: 1930s–40s Iran.
Review on the performances and applications of mesh-fabrics
Authors: Liu Lele , Ma Pibo
Published: November 2022

Mesh-fabrics that enable flexible designability and structural mechanical load-bearing have been developing rapidly in the past several decades. Currently, there is an increasing demand for mesh-fabrics with lightweight and high strength in engineering fields. Nevertheless in practice, design, manufacture, and application of mesh-fabrics are often dealt with separately, which could lead to the performances of final products unable to meet the need of specific scenes. This article introduced the classifications and preparation processes of mesh-fabrics. The mechanical properties under various load conditions were described. Then different methods of structural and numerical simulations were reviewed. Current application status of mesh-fabrics were summarized; Finally, several suggestions have been provided to address challenges for the research, development, and application of mesh-fabrics. Look forward to the future, it is expected that mesh-fabrics will play a key role in innovative and high technology engineering fields.
Retrospective Study of Orbital and Orbitozygomaticomaxillary Complex Fractures Treated at Aalesund Hospital Between 2002 and 2017
Authors: Lein Ingvild Årøen , Bjørnland Tore , Loro Lado Lako
Published: November 2022

Study Design

Retrospective study.

Objective

To evaluate patient demographics, surgical management, and complications of orbital and orbitozygomaticomaxillary complex (OZMC) fractures treated at a district hospital in Norway.

Methods

The medical records of patients with orbital fractures treated at Aalesund hospital between January 2002 and July 2017 were reviewed. Data on demographics, signs and symptoms, cause of injury, fracture type, associated fractures, surgical management, and complications were collected.

Results

A total of 36 patients were reviewed. Males predominated (1:4.1), and fractures occurred mostly in patients 40–59 years (mean 41.8 years). Interpersonal violence was the leading cause of injury, followed by falls. Alcohol was significantly associated with assault caused fractures ( P = .001). Orbitozygomaticomaxillary fractures were the most frequent, followed by pure orbital fractures. Clinical findings included periorbital ecchymosis (72%), swelling (56%), sensory nerve dysfunction (53%), diplopia (22%), and restricted eye motility (22%). Commotio cerebri was observed in more than half of our sample and 47% had other facial bone fractures. Referral to tertiary hospitals was done in 19% of the cases. The main treatment done was open reduction and internal fixation (ORIF) (45%). Infection was diagnosed in 17% and managed with antibiotics.

Conclusions

The incidence of orbital and OZMC fractures in Moere and Romsdal county in western Norway was low, occurring mainly in males over 40 years. The mechanism of injury was predominantly interpersonal violence and falls. A high proportion of the sample had minor traumatic brain injury (mTBI).
Identifying and analyzing effects of interdependencies on construction contractor payment risks
Authors: Kenyatta Mark Obegi , Gwaya Abednego Oswald , Masu Sylvester Munguti , Ajwang Patrick
Published: November 2022

Literature suggests that interdependencies may expose construction contractors to payment risks. However, prior research has tended to assume a disconnected perspective, which ignores the interdependence effect. To bridge this gap, a network of incompatible practices was built using judgments from subject matter experts in payment dispute cases in Kenya. After that, social network analysis (SNA) techniques such as Eigenvector and Lambda partitioning were used to analyze it. Ten interdependencies that expose contractors to payment risk were identified. The interdependence between the payment upon verified performance and the failure to match the work done with the amounts paid initiates and transmits most of these risks. In line with the power-law principle, fewer than 20% initiate and transmit more than 80% of the risks. This study demonstrates how economizing strategies can influence the choice of practices, complement blockchain decentralization measures, and improve the analysis of payment dispute cases.
Persona: How Professional Women in China Negotiate Gender Performance Online
Authors: Miao Weishan , Tian Xiaoli
Published: November 2022

With the shift of social interaction to online venues, do women still conform to existing gender norms? This article examines the online performance of professional women in urban China and their interactions with workplace colleagues on WeChat, a popular Chinese social media app that is an important venue for workplace interaction. As interviews showed, workplace interactions on WeChat perpetuated traditional gender norms of hegemonic masculinity, and professional women accommodated to those existing gender norms by using particular “personas.” Three major personas were identified: one that emphasized professional identity and downplayed gender identity; another that accentuated femininity and downplayed professional identity; and a third that performed femininity to please male workplace supervisors by confirming their masculinity. Persona is used as an analytical term to capture the WeChat activities of these professional women because, compared to online self-presentation, the persona represented a strategic conformity to existing norms and the women distanced themselves from their assumed personas. The use of social media, therefore, reproduced and reinforced conformity to existing gender norms because the online gendered persona constituted a comprehensive and enduring constraint.
Reliability and Validity of the Adapted Chinese Version of the Quality of Life Profile for Spine Deformities in Adolescents With Idiopathic Scoliosis
Authors: Hu Miao , Cai Zhuyun , Yang Yue , Hong Xinjie , Zhang Zheng , Wang Ce , Zhou Xuhui , Meng Yichen , Zhao Jianquan
Published: November 2022

Study Design

Retrospective cohort study.

Objective

To evaluate the cross-cultural adaptability and internal consistency of the Chinese version of the Quality-of-Life Profile for Spine Deformities (QLPSD) questionnaire in mainland China.

Methods

The original QLPSD was translated from Spanish into Chinese with proper cross-cultural adaptation based on the American Academy of Orthopaedic Surgeons guidelines. A total of 129 AIS patients referring to our institution from February 2021 to January 2022 were enrolled in this study. The effects of ceiling and floor were evaluated and the reliability was verified by examining the internal consistency (the Cronbach’s α coefficient). Interclass Correlation Coefficient (ICC) was used to test and retest reliability. The C-QLPSD dimensions were compared with the domains in Chinese version of 36-Item Short Form Health Survey (SF-36) and Scoliosis Research Society-22 (SRS-22) questionnaires using Pearson correlation coefficient to assess the concurrent validity.

Results

No significant floor and ceiling effects in C-QLPSD was observed. The total Cronbach’s α was estimated at .914, ranging from .768 in back pain dimensions to .862 in psychosocial function dimensions. The C-QLPSD dimensions indicated satisfactory test-retest reliability with ICC range of .784-.870. Construct validity analysis revealed that C-QLPSD was well correlated with SRS-22 and SF-36. The values of total correlation coefficient were calculated at -.924 and -.871, respectively, which were both statistically significant ( P < .05).

Conclusion

The adapted Chinese version of QLPSD had good internal consistency and excellent test-retest reliability, which can be used to assess the outcome among Chinese-speaking patients with adolescent idiopathic scoliosis.
Transit communication via Twitter during the COVID-19 pandemic
Authors: Zhang Wenwen , Barchers Camille , Smith-Colin Janille
Published: November 2022

Transit providers have used social media (e.g., Twitter) as a powerful platform to shape public perception and provide essential information, especially during times of disruption and disaster. This work examines how transit agencies used Twitter during the COVID-19 pandemic to communicate with riders and how the content and general activity influence rider interaction and Twitter handle popularity. We analyzed 654,345 tweets generated by the top 40 transit agencies in the US, based on Vehicles Operated in Annual Maximum Service (VOM), from January 2020 to August 2021. We developed an analysis framework, using advanced machine learning and natural language processing models, to understand how agencies’ tweeting patterns are associated with rider interaction outcomes during the pandemic. From the transit agency perspective, we find smaller agencies tend to generate a higher percentage of COVID-related tweets and some agencies are more repetitive than their peers. Six topics (i.e., face covering, essential service appreciation, free resources, social distancing, cleaning, and service updates) were identified in the COVID-related tweets. From the followers’ interaction perspective, most agencies gained followers after the start of the pandemic (i.e., March 2020). The percentage of follower gains is positively correlated with the percentage of COVID-related tweets, tweets replying to followers, and tweets using outlinks. The average like counts per COVID-related tweet is positively correlated with the percentage of COVID-related tweets and negatively correlated with the percentage of tweets discussing social distancing and agency repetitiveness. This work can inform transportation planners and transit agencies on how to use Twitter to effectively communicate with riders to improve public perception of health and safety as it relates to transit ridership during delays and long-term disruptions such as those created by the COVID-19 public health crisis.
Charcot Ankle Deformity: Can the Limb be Salvaged?
Authors: Aminian Arash , Choi Daniel , Saghaeidehkordi Jalal , Black James , Lee David , Harris Thomas G.
Published: November 2022

Category:

Diabetes; Ankle

Introduction/Purpose:

Diabetes mellitus (DM) may result in Charcot arthropathy (CA) in 0.1% to 2.5% of diabetic patients. Complications may arise including joint dislocation, deformities, ulcerations, and limb amputation. Surgical intervention has been shown to improve patient's walking ability and health-related quality of life compared to use of orthotics in addition to reduction of ulcer, bone infection, use of orthoses, and amputation. A retrospective review of patients with ankle charcot arthropathy was performed with hindfoot nail fixation. The aim of the study was to determine radiographic healing, complication rates of surgical intervention, and patients' ability to ambulate with therapeutic inserts or boots. The results obtained from this study serve to provide evidence for intervention via operative fixation and limb salvage in this cohort of patients.

Methods:

A retrospective review of patients treated with hindfoot nail with CA of the ankle was performed between 2016 to 2022. The demographic data, BMI, cause of the charcot arthropathy, the pre-operative radiographic deformity, and prior wounds and infection data was recorded. We identified 18 consecutive patients that underwent surgical intervention. The surgical technique included bimalleolar exposure, correction of the deformity, hindfoot fusion nail with or without structural femoral head graft. The follow up data collected included post-operative complications, radiographic evaluation of union, and clinical data on type of shoe wear or boots used for ambulation.

Results:

We identified 17 consecutive patients undergoing hindfoot deformity correction with hindfoot nail. The average follow- up for the patients was 1.7 year. The cause of neuropathy was diabetes in 15 patient and idiopathic in 2 patients. The average BMI for the cohort was 29.5. The initial 90-day complications rate for surgical intervention was 17%; with one superficial infection, one deep infection, and one death related to a cardiac event. At latest follow up 12 patients were ambulating with a CROW boot, 3 in diabetic shoes with therapeutic inserts, 1 below knee prosthesis, and 1 patient is in the initial perioperative period of healing. Radiographic union was seen in 12 patient, 3 patients had stable pseudo-union of the ankle joint with neutral alignment.

Conclusion:

The development of an acquired ankle deformity is associated with a poor quality of life. Traditional treatment of CA has shown to be effective when resolving infection and avoiding amputation. Our study supports the use of hindfoot nail for deformity correction/fixation and limb salvage of ankle CA patients. This patient population is highly comorbid but can have meaningful improvement in ambulator status post-surgery in a CROW boot or shoes with therapeutic insoles.
Tarsal Coalition is Not Necessarily Associated with a Flatfoot Deformity: A Cohort of Clinically Misdiagnosed Cases and Alignment Features in 41 Feet
Authors: Ansah-Twum Jeremy , Zhu Mingjie , Carpenter Melissa L. , Sempson Sera , Hunt Kenneth J. , Myerson Mark S. , Li Shuyuan
Published: November 2022

Category:

Hindfoot; Ankle; Midfoot/Forefoot

Introduction/Purpose:

Tarsal coalition has been historically reported to be associated with a flatfoot deformity. There are however case reports demonstrating that it can be found in cavovarus and clubfoot deformities. The goal of this study was to retrospectively review all weightbearing CT (WBCT) scans that were taken in one medical center, to investigate the clinically diagnosed as well as missed cases of tarsal coalition, and to determine the hindfoot alignment and arch height features of each case.

Methods:

800 WBCT scans were reviewed separately by two senior fellowship trained foot and ankle surgeons. The structure of the hindfoot and midfoot was carefully examined in all three views to screen for different types of tarsal coalition. For cases that were diagnosed with tarsal coalition on WBCT, the medical charts were then reviewed to determine the original clinical diagnoses. Hindfoot alignment and arch height features of the midfoot were subsequently evaluated on WBCT scans.

Results:

There were 41 feet that were diagnosed with tarsal coalition on WBCT (Figure 1). The clinical diagnosis of coalition was only made in 15 feet and 26 symptomatic feet were clinically missed. Among the 26 symptomatic feet diagnosed on WBCT but clinically missed, 16 had a clinical diagnosis of congenital or acquired flatfoot, 3 with subtalar arthritis, 1 with talonavicular arthritis, 1 with peroneal tendinopathy and a cavovarus foot deformity, 2 with cavovarus deformity and midfoot arthritis, 2 with posttraumatic ankle arthritis, and 1 with subtalar impingement. A valgus hindfoot was found in 19 feet, a neutral hindfoot in 18, and a varus hindfoot in 4 feet. In the midfoot, 38 feet had a positive (>=1) distal medial cuneiform/fifth metatarsal arch height index, and 3 feet had a negative index (<1); all 41 feet had a positive proximal cuneiform/cuboid height index (>=1).

Conclusion:

One should be aware that patients with tarsal coalition do not always present with a flatfoot and hindfoot valgus, since many can have a variety of hindfoot and midfoot alignment features. In cases presenting with history of trauma, degenerative arthritis, as well as a cavovarus or clubfoot deformity, tarsal coalition can easily be clinically overlooked. References: - Lemley F, Berlet G, Hill K, Philbin T, Isaac B, Lee T. Current concepts review: Tarsal coalition. Foot Ankle Int. 2006 Dec;27(12):1163-9. - Van Rysselberghe NL, Souder CD, Mubarak SJ. Unsuspected tarsal coalitions in equinus and varus foot deformities. J Pediatr Orthop B. 2020 Jul;29(4):370-374.
The Effects of Socioeconomic Status on Outcomes Following Total Ankle Arthroplasty
Authors: Athar Mohammad S. , Khan Ryan , Awoke Adam , Khoshbin Amir , Daniels Timothy R. , Halai Mansur
Published: November 2022

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

There is limited literature on the effects of socioeconomic factors on outcomes after total ankle arthroplasty (TAA). In the setting of hip or knee arthroplasty, patients of a lower socioeconomic status demonstrate poorer post- operative satisfaction, longer lengths of stay, and larger functional limitations. It is important to ascertain whether this phenomenon is present in ankle arthritis patients. This is the first study to address the weight of potential socioeconomic factors in affecting various socioeconomic classes, in terms of how they benefit from ankle arthroplasty.

Methods:

This is retrospective cohort study of 447 patients who underwent a TAA. Primary outcomes included pre-operative and final follow-up AAOS pain, AAOS disability, and SF-36 scores. We then used postal codes to determine median household income using Canadian 2015 census data. Incomes were divided into quintiles based on equal amounts over the range of incomes. These income groups were then compared for differences in outcome measures. Statistical analysis was done using unpaired t- test.

Results:

A total of 447 patients were divided into quintiles by income. From lowest income to highest income, the groups had 54, 207, 86, 64, and 36 patients, respectively. The average time from surgery to final follow up was 85.6 months. Interestingly, we found that patients within the middle household income groups had significantly lower AAOS disability scores compared to the lowest income groups at final follow-up (26.41 vs 35.70, p=0.035). Furthermore, there was a trend towards middle income households and lower post-operative AAOS pain scores compared to the lowest income group (19.57 vs 26.65, p=0.063). There was also a trend toward poorer AAOS disability scores when comparing middle income groups to high income groups post- operatively (26.41 vs 32.27, p=0.058). Pre-operatively, patients within the middle-income group had more pain, compared to the lowest and the highest income groups.

Conclusion:

Patients from middle income groups who have undergone TAA demonstrate poorer function and possibly more pain, compared to lower and higher income groups. This suggests that TAA is a viable option for lower socioeconomic groups and should not be a source of discouragement for surgeons. In this circumstance there is no real disparity between the rich and the poor. Further investigation is needed to explore reasons for diminished performance in middle class patients.
Treatment of Pediatric and Adolescent Talus Osteochondral Lesions
Authors: Ayvaz Elif Y.
Published: November 2022

Category:

Ankle

Introduction/Purpose:

Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions.

Methods:

Osteochondral lesions of the Talus are defined as any damage involving both articular cartilage and subchondral bone of the talar dome, and this condition is associated with persistent ankle pain and disability. The incidence of osteochondral lesions of the talus is increasing in the pediatric and adolescent population. There are a few studies regarding surgical treatment. The aim of this study is to report that need for surgical treatment is higher than expected in aforementioned lesions.

Results:

Average age was 14,5 (10-18) at beginning of the treatment. 69,2% of our patients were female. Foundation of conservative treatment was activity modification. 9 of our 13 patients were treated surgically. Arthroscopic debridement and microfracture surgery as well as various techniques were applied to all operated patients. In 7 of the operated patients (n=9), the lesion was on the right side and there was a history of trauma before the complaints started. While the mean AOFAS scores of the operated patients were 47 (24-75) before the operation, it was 83.8 in the last follow-up. While the mean AOFAS scores of our conservatively treated patients were 38.2 (21-74) before treatment, the mean AOFAS scores at the last follow-up after treatment (mean follow-up 2 years) were 70 (17-100). There were no minor and major postoperative complications and no need of reoperation. At the final follow up there was significant improvement in clinical results in all patients treated surgically and conservatively.

Conclusion:

Talus osteochondral lesions at younger ages is an increasing problem. Conservative management with close follow up is the mainstay of the treatment. However, need of surgical treatment may be higher than expected and the short-term results of surgical with various techniques are successful.
Opioid Use for Operative Foot and Ankle Fractures: A Systematic Review
Authors: Badin Daniel , Ortiz-Babilonia Carlos D. , Gupta Arjun , Leland Christopher R. , Musharbash Farah , Parrish James M. , Aiyer Amiethab A.
Published: November 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Patients treated operatively for foot and ankle fractures may be at higher risk of undertreated pain as well as overuse of opioid medications. We sought to synthesize the recent literature investigating use of opioids for analgesia following foot and ankle fracture surgery. To accomplish this, we aimed to determine the patterns of opioid use and prescription (e.g., quantity, duration, incidence of persistent use), risk or protective factors for persistent opioid use, and clinical outcomes (e.g., relief of pain, adverse events) associated with opioid use in this population.

Methods:

We followed PRISMA guidelines for our review. We systematically searched PubMed, Embase, Scopus, Cochrane, and Web of Science. We included studies published from 2010 to present that assessed patterns of opioid use, risk factors for increased opioid use, and outcomes associated with opioid use following foot/ankle fracture surgery. Two reviewers performed title/abstract screening and full-text review. The quality of included studies was evaluated using MINORS criteria.

Results:

In our review, 1713 articles were assessed and 18 were included (Figure 1). MINORS scores ranged from 13 to 18, indicating moderate study quality. Overall, there was wide variability in opioid use between and within studies. Rates of postoperative persistent opioid use ranged from 7-39%. Risk factors for increased opioid use included preoperative opioid exposure, mental health disorders, tobacco consumption, and certain injury patterns. Protective factors were spinal anesthesia, peripheral nerve block, and postoperative ketorolac. Opioid use was not associated with decreased pain or improved satisfaction. Opioid use was associated with increased rates of pain-related emergency department visits and readmission. Preoperative opioid use was associated with the greatest odds of increased postoperative use.

Conclusion:

There is a high incidence of persistent opioid use after foot and ankle fracture surgery. Opioid use was associated with negative health outcomes without decreasing pain levels or increasing patient satisfaction after foot/ankle fracture surgery. The wide variability of reported opioid use emphasizes the need for standardized guidelines for postoperative opioid use in this patient population, and our findings suggest that lower opioid prescription may be advisable.
A novel RIPK1 inhibitor reduces GVHD in mice via a nonimmunosuppressive mechanism that restores intestinal homeostasis
Authors: Yu Xiaoliang , Ma Haikuo , Li Bohan , Ji Yuting , Du Yayun , Liu Siying , Li Zhanhui , Hao Yongjin , Tian Sheng , Zhao Cong , Du Qian , Jin Zhongqin , Zhu Xueming , Tian Yuanyuan , Chen Xin , Sun Xue , Yang Chengkui , Zhu Fang , Ju Jie , Zheng Yunjing , Zhang Wei , Wang Jingrui , Yang Tao , Wang Xinhui , Li Jingjing , Xu Xiangping , Du Shujing , Lu Haohao , Ma Feng , Zhang Haibing , Zhang Yi , Zhang Xiaohu , Hu Shaoyan , He Sudan
Published: November 2022

Intestinal epithelial cells (IECs) are implicated in the propagation of T-cell–mediated inflammatory diseases, including graft-versus-host disease (GVHD), but the underlying mechanism remains poorly defined. Here, we report that IECs require receptor-interacting protein kinase-3 (RIPK3) to drive both gastrointestinal (GI) tract and systemic GVHD after allogeneic hematopoietic stem cell transplantation. Selectively inhibiting RIPK3 in IECs markedly reduces GVHD in murine intestine and liver. IEC RIPK3 cooperates with RIPK1 to trigger mixed lineage kinase domain-like protein-independent production of T-cell–recruiting chemokines and major histocompatibility complex (MHC) class II molecules, which amplify and sustain alloreactive T-cell responses. Alloreactive T-cell–produced interferon gamma enhances this RIPK1/RIPK3 action in IECs through a JAK/STAT1-dependent mechanism, creating a feed-forward inflammatory cascade. RIPK1/RIPK3 forms a complex with JAK1 to promote STAT1 activation in IECs. The RIPK1/RIPK3-mediated inflammatory cascade of alloreactive T-cell responses results in intestinal tissue damage, converting the local inflammation into a systemic syndrome. Human patients with severe GVHD showed highly activated RIPK1 in the colon epithelium. Finally, we discover a selective and potent RIPK1 inhibitor (Zharp1-211) that significantly reduces JAK/STAT1-mediated expression of chemokines and MHC class II molecules in IECs, restores intestinal homeostasis, and arrests GVHD without compromising the graft-versus-leukemia (GVL) effect. Thus, targeting RIPK1/RIPK3 in IECs represents an effective nonimmunosuppressive strategy for GVHD treatment and potentially for other diseases involving GI tract inflammation.
Pharmacokinetics, pharmacodynamics, safety, and efficacy of crizanlizumab in patients with sickle cell disease
Authors: Kanter Julie , Brown R. Clark , Norris Cynthia , Nair Santosh M. , Kutlar Abdullah , Manwani Deepa , Shah Nirmish , Tanaka Chiaki , Bodla Shankaranand , Sanchez-Olle Gessami , Albers Urs , Liles Darla
Published: November 2022

Crizanlizumab is an anti–P-selectin monoclonal antibody indicated to reduce the frequency/prevent recurrence of vaso-occlusive crises (VOCs) in patients with sickle cell disease (SCD) aged ≥16 years. This analysis of an ongoing phase 2, nonrandomized, open-label study reports the pharmacokinetics (PK), pharmacodynamics (PD), safety, and efficacy of crizanlizumab 5.0 mg/kg (N = 45) and 7.5 mg/kg (N = 12) in patients with SCD with a history of VOCs. The median treatment duration was 104.7 and 85.7 weeks in the 5.0 and 7.5 mg/kg groups, respectively. For both doses, serum crizanlizumab concentrations rose to near maximum levels shortly after infusion, and near complete and sustained ex vivo P-selectin inhibition was observed. Grade ≥3 adverse events (AEs) occurred in 48.9% and 33.3% of patients in the 5.0 and 7.5 mg/kg groups, respectively; only 1 event was deemed treatment-related (7.5 mg/kg group). No treatment-related serious AEs occurred. One infusion-related reaction was recorded (5.0 mg/kg, grade 2 “pain during infusion”), which resolved without treatment withdrawal. Infections occurred in 57.8% and 41.7% of patients in the 5.0 and 7.5 mg/kg groups, respectively; none were drug-related. No treatment-related bleeding events were reported. No patients developed immunogenicity. The median (range) absolute reduction from baseline in the annualized rate of VOCs leading to a health care visit was −0.88 (−14.7 to 13.3) and −0.93 (−2.0 to 0.4) in the 5.0 and 7.5 mg/kg groups, respectively. Results here demonstrate the PK/PD properties of crizanlizumab in patients with SCD and the potential sustained efficacy and long-term safety of the drug after >12 months’ treatment. This trial was registered at www.clinicaltrials.gov as #NCT03264989.
Acute lung injury associated with 5-fluorouracil and oxaliplatinum combined chemotherapy
Authors: Trisolini R. , Lazzari Agli L. , Tassinari D. , Rondelli D. , Cancellieri A. , Patelli M. , Falcone F. , Poletti V.
Published: November 2022

Diarrhoea, T-CD4+ lymphopenia and bilateral patchy pulmonary infiltrates developed in a male 60 yrs of age, who was treated with oxaliplatinum and 5-fluorouracil for unresectable rectum carcinoma. The findings from transbronchial lung biopsy and bronchoalveolar lavage (BAL) were consistent with an organizing diffuse alveolar damage pattern. Once extensive microbiological studies proved negative, corticosteroids were given and a complete remission of clinical and radiological abnormalities was achieved. It is concluded that the aforementioned pathological manifestations were due to chemotherapy and included a pulmonary adverse reaction, a feature never previously associated with oxaliplatinum and 5-fluorouracil regimens.
Lung dendritic cells and host immunity to infection
Authors: Lambrecht B.N. , Prins J-;B. , Hoogsteden H.C.
Published: November 2022

The lung is a portal of entry for numerous microbial pathogens, against which evolution has created an adequate innate and adaptive immune response. Dendritic cells (DCs) are central to the integration of innate and specific immunity. These cells are located within the epithelium and interstitium of the lung where they are influenced by the innate immune system.

Upon recognition and internalization of microbial antigens, DCs migrate to the draining lymph nodes of the lung to initiate the specific cellular and humoral immune response. By their capacity to integrate stimuli derived from the pathogen, the host and the environment, they are specialized to induce a protective immune response while at the same time avoiding damage to the host.

It is becoming increasingly clear that dendritic cells are involved in the induction of immunity to viruses, bacteria, mycobacteria and fungi. Some pathogens subvert the function of dendritic cells to escape immune recognition. Not surprisingly, if dendritic cell function fails, the consequence for the host is immunodeficiency.
Dynamic analysis of gene signatures in the progression of COPD
Authors: Jiang Junchao , Chen Shengsong , Yu Tao , Chang Chenli , Liu Jixiang , Ren Xiaoxia , Niu Hongtao , Huang Ke , Li Baicun , Wang Chen , Yang Ting
Published: November 2022

Aims

Oxidative stress is an important amplifying mechanism in COPD; however, it is unclear how oxidative stress changes and what its exact amplification mechanism is in the pathological process. We aimed to dynamically analyse the progression of COPD and further elucidate the characteristics of each developmental stage and unveil the underlying mechanisms.

Methods

We performed a holistic analysis by integrating Gene Expression Omnibus microarray datasets related to smoking, emphysema and Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification based on the concept of gene, environment and time (GET). Gene ontology (GO), protein–protein interaction (PPI) networks and gene set enrichment analysis (GSEA) were used to explore the changing characteristics and potential mechanisms. Lentivirus was used to promoteHIF3Aoverexpression.

Results

In smokersversusnonsmokers, the GO term mainly enriched in “negative regulation of apoptotic process”. In later transitions between stages, the main enriched terms were continuous progression of “oxidation-reduction process” and “cellular response to hydrogen peroxide”. Logistic regression showed that these core differentially expressed genes (DEGs) had diagnostic accuracy in test (area under the curve (AUC)=0.828) and validation (AUC=0.750) sets. GSEA and PPI networks showed that one of the core DEGs,HIF3A, strongly interacted with the ubiquitin-mediated proteolysis pathway. Overexpression ofHIF3Arestored superoxide dismutase levels and alleviated the reactive oxygen species accumulation caused by cigarette smoke extract treatment.

Conclusion

Oxidative stress was continuously intensified from mild emphysema to GOLD 4; thus, special attention should be paid to the identification of emphysema. Furthermore, the downregulatedHIF3Amay play an important role in the intensified oxidative stress in COPD.