bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review evaluating the efficacy of treadmill training in geriatric care as an intervention for improving balance and reducing fall risks in elderly population
Authors: Zafer Ayman Mohammed Ismail , Shanb Alsayed Abdelhameed , Alzahrani Matar AbduAllah , Sharma Ankita , Rizvi Moattar Raza
Published: April 2024

Background & Purpose Falls and balance issues are significant concerns for the elderly. Treadmill training is increasingly recognized as a potential intervention to improve balance and reduce fall risk in this population. This systematic review evaluates the effectiveness of treadmill training on balance in the elderly. Methods A comprehensive search was conducted in databases including MEDLINE, EMBASE, CINAHL Plus, PEDro, Cochrane Library, and ERIC from January 1, 1980, to May 31, 2023. The search focused on treadmill training’s impact on balance in older adults. From 74 identified studies, outcome measures were categorized into groups like “Balance Improvement,” “Gait Improvement,” “Mobility Enhancement,” “Muscle Strength Improvement,” “Cognitive Function and Quality of Life,” and others. Articles were excluded for reasons like irrelevance to treadmill training, language barriers, or duplication, resulting in 16 final studies. Results Treadmill training shows diverse positive effects on the elderly. Perturbation-based training reduces falls, and treadmill walking enhances balance and quality of life, particularly in institutionalized older individuals. Benefits were noted for Parkinson’s patients’ gait, cognitive changes in neurophysiology, fitness and mobility improvements through underwater treadmill sessions, and refined gait in hemiparetic patients. Conclusion Treadmill training interventions are promising for improving balance and mobility in the elderly, including those with Parkinson’s disease, spinal cord injuries, and age-related balance issues. While these interventions show potential, further research is needed to determine optimal protocols, durations, and combinations with other interventions. This could lead to a more comprehensive approach for addressing balance and mobility challenges in the elderly, promoting healthy aging and reducing fall risks.
Challenges of recruitment processes to a randomized dietary trial in irritable bowel syndrome
Authors: Roth Bodil , Ohlsson Bodil
Published: April 2024

Background Irritable bowel syndrome (IBS) is common with a global prevalence of 4%. Dietary regimes with a low content of fermentable oligo-, di-, and monosaccharides and polyol (FODMAP) or a starch- and sucrose-reduced diet (SSRD) have proven to be efficient. The aim of the present study was to describe the recruitment process for a randomized dietary trial with low FODMAP or SSRD for 4 weeks with a follow-up period of 5 months. Methods The County of Skåne, with 1,41 million inhabitants, was used as a base to perform a dietary trial in which IBS patients, age 18-70 years, were randomized to either low FODMAP or SSRD for 4 weeks. The estimated number of IBS patients in the actual age span was approximately 32,000. The trial was announced through lectures, letters to all primary healthcare centers (n=203), social media (two campaigns), and invitations to IBS patients identified in medical records (n=744). Results Three referrals arrived from the healthcare system, 17 patients contacted the investigators in person after receiving information from their healthcare center, and four patients contacted the investigators after recommendations from friends. Of these, 14 were enrolled in the study. From social media, 218 names were delivered, of which 93 fulfilled the study criteria and were willing to participate when contacted by the investigators (42.7%). Of the 3587 identified IBS patients in medical records in close proximity to the hospital, 744 were randomly contacted. Forty-eight patients (6.5 %) were willing to be included in the study. Thus, 155 patients with IBS were included in this study. Conclusions The inclusion rate for dietary intervention was very low considering the large population informed about the study. Announcements on social media seem to be the best way to recruit patients for intervention. Trial registration NCT05192603, 29/11/2021, ClinicalTrials.gov. The PRS URL is https://register.clinicaltrials.gov
CD24 and Oct4: Cancer stem markers expression correlates with histological subtyping of head and neck squamous cell carcinoma
Authors: Kashif Muhammad , Minhas Sadia , Shahzad Hafiz Muhammad , Pasha Muhammad Bilal , Shahzad Faheem , Tahir Romeeza , Jahan Shah , Afzal Nadeem
Published: April 2024

Background Head and neck squamous cell carcinoma (HNSCC) encompasses a diverse range of tumors with varying degrees of differentiation. Within tumors, cancer stem cells (CSCs) are believed to play a crucial role in tumor initiation, progression, and resistance to treatment. This study aimed to explore the expression of two CSC markers i.e. CD24 and Oct4, in patients with HNSCC. Methods The study included 85 patients diagnosed with HNSCC. Immunohistochemistry was used to evaluate the expression of CD24 and Oct4 in tumor tissues obtained from patients with HNSCC. Staining intensity and the proportion of positive tumor cells were analyzed and compared across the various HNSCC grades and histological subtypes. Results The findings revealed that the mean immunoreactivity score (IRS) for CD24 was significantly higher in non-conventional HNSCC subtypes compared to conventional types (p = 0.019). Additionally, a significant statistical association was observed between the IRS status of CD24 and histological subtypes (p = 0.043). Other demographic, clinical, and histological parameters showed non-significant associations with staining intensity, proportion score (PC), IRS status, and mean IRS (all p values > 0.05). Conclusions These findings indicate that CD24 could potentially serve as a CSC marker for distinguishing between conventional and non-conventional histological types of HNSCC. This suggests that CD24 holds promise as a valuable tool in identifying specific HNSCC subtypes characterized by CSCs.
The genome sequence of the Grey Shoulder-knot, Lithophane ornitopus (Hufnagel, 1766)
Authors: Boyes Douglas , Zilli Alberto ,   University of Oxford and Wytham Woods Genome Acquisition Lab,   Darwin Tree of Life Barcoding collective,   Wellcome Sanger Institute Tree of Life Management, Samples and Laboratory team,   Wellcome Sanger Institute Scientific Operations: Sequencing Operations,   Wellcome Sanger Institute Tree of Life Core Informatics team,   Tree of Life Core Informatics collective,   Darwin Tree of Life Consortium
Published: April 2024

We present a genome assembly from an individual male Lithophane ornitopus (the Grey Shoulder-knot; Arthropoda; Insecta; Lepidoptera; Noctuidae). The genome sequence is 508.6 megabases in span. Most of the assembly is scaffolded into 31 chromosomal pseudomolecules, including the Z sex chromosome. The mitochondrial genome has also been assembled and is 15.33 kilobases in length. Gene annotation of this assembly on Ensembl identified 18,397 protein coding genes.
Imbalanced Multiclass Data Classification Using Combined Data Sampling and Deep Learning Method
Authors: Shunmugasundaram Sivasankari
Published: April 2024

Multiclass Classification for finding pattern refers to classifying each data to part of the classes or labels that are generally more than two. The foremost challenge in classifying is with imbalanced data   that have large portion data known to be majority class, and small portion known as minority class that leads to poor understanding of samples and less accurate results. The existing works discussed Random Upsampling, Random Downsampling, SMOTE methods individually with FeedForward Neural Network and found Random Oversampling gave better results  .However, it generates more duplicate data and has less accuracy. Hence , this research work put forward Combined Random Over-Under Sampling approach that was preprocessed prior with Replacing Missing value with mean, Feature selection, Noise Filtering. Meanwhile this work extends the existing FeedForward Neural Network to Deep Learning . The proposed work is implemented in Rapidminer tool, assessed with appropriate evaluation measures for training and testing data individually.
Crop Prediction and Recommendation Using Ensemble of DL Models
Authors: Subbulakshmi B. , Nirmaladevi M. N. , Rithani R.
Published: April 2024

Agriculture remains the primary source of income in India and is characterised by a variety of crops, soil types and climatic conditions. This study suggests an additional ensemble model serving to give effective and speedy predictions and recommendations for crops. During the study data from nearly 8 distinct features was collected from various databases and 2201 instances were finalised. The data focussed on climatic conditions such as temperature, rainfall, crop type and soil features, particularly the ratio of nitrogen, potassium and levels of phosphorous. Research indicates that algorithms such as Neural Networks and XGBoost share high effectiveness and accuracy in developing crop yield prediction models. Extensive research conducted shows that the ensemble of XGBoost and MLP Classifier algorithms provide an accuracy of 99.39%. By predicting crop yield based on historical data, the study aims to give sound recommendations on the crops to be cultivated under various weather and soil conditions.
Inventory Model for Deteriorated Goods under Inflation and Permissible Delayed Payments
Authors: Verma Mini
Published: April 2024

As-built models play a leading role in analyzing many real-world situations encountered in places such as grocery and vegetable markets, market yards, and oil extraction industries. In this article, we developed an inventory model for depleted items and set an acceptable default for inflation. Given hismodel, the demand rate is assumed to depend on the inventory, and the deterioration ratefor each position follows a Weibull distribution. This model is developed under the circumstances depending on whether the credit life is less than the cycle timeAlso, in these scenarios, new model have been developed to obtain the EOQ. Finally, we analyze the results and present working examples
The Perception of Customers Towards Sustainable Practices in Indian Banks
Authors: E. S. Sina , Vennila D.
Published: April 2024

Sustainable Development (SD) is currently becoming more well-known. As a result, many kinds of organizations are working together to guarantee that sustainable development is noticed in pursuing their objectives, such as profit-making, providing social services, philanthropy, etc. Sustainable development (SD) is preserving the integrity of social and natural systems while pursuing economic growth. Non-Financial Reporting is a framework for organizations to report on their operations in this area, particularly about the triple bottom line or the accounting of the environment, society, and economy. 

Given their critical role in funding global economic and developmental activities, financial institutions, particularly banks, must contribute significantly to sustainable development. In this context, it is challenging to overstate how important it is for banks to behave responsibly as corporate citizens in society, particularly in a growing nation like ours. Their actions should demonstrate how they care about the environment and human rights. 

This paper emphasizes the significance of "Going green" and promoting sustainable practices in the Indian banking sector. The perception of customers toward Sustainable practices in Indian banks has not been the subject of much research. The study aims to comprehend how consumers feel about green banking services and their effectiveness and benefits. Friedman Ranking test and Chi-Square have been used as tools for the analysis.
Exploring the Conceptual Realm of Machine Learning in Small and Medium-sized Industries: A Qualitative Study
Authors: Raza Syed Shahid
Published: April 2024

The pote­ntial of machine learning in small and medium busine­sses remains largely untappe­d. Through a qualitative study, it is e­xplored how the SMEs can practically apply ML to optimize processes and spark innovation. We­ aimed to demystify key conce­pts like supervised le­arning, data preparation, and model evaluation. Re­al-world examples across industries de­monstrate ML's versatility, from enhancing de­cision-making to improving efficiency. Our rese­arch highlights the transformative power of ML, e­specially for resource-constraine­d SMEs. With some guidance, eve­n small teams can implement ML solutions that unlock ne­w opportunities. Though adoption has barriers, from data to skills, ML’s value for SMEs is cle­ar. With a strategic approach, companies of all sizes can tap into its possibilitie­s. Current re­search on implementing machine­ learning in small and medium ente­rprises has gaps. More investigation is re­quired to understand adoption challenge­s fully, highlight successes, and mee­t unique needs. A qualitative­ approach that explores expe­riences and perspe­ctives can provide those rich insights. Some­ small and medium companies use machine­ learning, but many face hurdles adopting it. Re­search case studies showcase­ machine learning success storie­s, though each company's path differs. By understanding individual difficultie­s, researchers can he­lp more small and medium enterprises use machine learning appropriate­ly. This literature revie­w examines machine le­arning models, adoption trends, triumphs, and example­s in small and medium enterprise­s. Moreove­r, it also examines the advantage­s and obstacles SMEs encounter whe­n adopting ML tactics.
Arguments Favoring Epistemic Justification of Religious Belief: A Critique
Authors: Cherukarayil Sijo Sebastian
Published: April 2024

In the epistemological trajectory of Philosophy of Religion, contemporary religious epistemologists seem to have undertaken the task of attestation of religious beliefs, their defence, ascertainment and justification, resorting to sanctioned methods of epistemic justification. The models of epistemic justification of religious beliefs they have adopted were intended to bring in a kind of objectivity into religious realm and make meaningful assertions on shared experiences.  The acclamation of such esteemed epistemic attempts should be viewed as   feverish attempts made by religious epistemologists to subject religious beliefs to standard epistemic treatment. In this paper, three contemporary models of justification of religious beliefs by three outstanding religious epistemologists, namely, Alvin Plantinga whose theory of proper basicality and the warrant, the epistemological holism with the application of Lakatosian principle in Philosophy of Science by Nancey Murphy and the cumulative case evidentialism by Richard Swinburne are critically analyzed using the parameters of logical consistency, methodological acumen, norms of  belief formation, the role of subjectivity, features of religious language and the hermeneutic dynamics.
Case Comment: Yagnaseni Patel v. The General Manager, Mahanadi Coalfields Ltd. & Ors. 2023 LiveLaw (Ori) 76
Authors: Verma Saumya
Published: April 2024

This case commentary analyses the legal issue involved in the case of Yagnaseni Patel v. The General Manager, Mahanadi Coalfields Ltd. According to the Orissa High Court, the daughter has a claim to the father's property, the right is conferred at birth and the provisions respecting the rights apply on and from the date of the Amendment Act, 2005. The High Court stated that even though her father died before the 2005 Amendment, the daughter had a right. The Bench cited the case of Vineeta Sharma v. Rakesh Sharma and Others 2020 (II) OLR (SC) 569: (2020) 9 SCC 1 in which the Apex Court held that a daughter shall remain as coparcener throughout life, regardless of whether her father was alive when the law was amended in 2005 or not, emphasizing that the law is retrospective.

Keywords: “Hindu Succession Act”, “Property Right”, “Coparcenary Right”, “Retrospective Effect”
Digital competencies of Donbass teachers: analysis of the current state and development vectors
Authors: Grom E.
Published: April 2024

The article analyzes the state of integration of digital technologies into the practical activities of teachers of educational organizations of the Donetsk People's Republic in the context of the development of digital competencies. The processes of integration into the educational space of the Russian Federation, the transition to the updated Federal State Educational Standards, work on preserving and improving the quality of educational results, taking place in a difficult socio-political situation, changes in ethnic identity, shortage of personnel, technical infrastructure, forced work in mixed and remote formats exacerbate the methodological, didactic and organizational problems of introducing new technologies in the educational environment. The study interprets the results of a survey of teachers, analyzes the subjective experience of using digital technologies in the educational process, which allows us to see the overall picture of the formation of digital competencies of teachers to determine the vectors of further development.
Relevance of research in the field of readiness of participants of the educational process to interact in the electronic information educational environment
Authors: Bulat Roman , Baychorova Khafiza
Published: April 2024

The article presents the results of a comparative analysis of current topics of dissertation research in the field of education sciences. The authors prove the lack of attention to research in the field of digital didactics of higher education. The importance of scientific substantiation and practical development of the "terms of reference" for software developers is argued on the basis of generally recognized fundamental didactic conditions for the effectiveness of the educational process. The most urgent tasks of scientific research in the field of digital didactics are formulated. As a result, the relevance of research in the field of readiness of participants of the educational process to interact in the electronic information educational environment is substantiated
Perception of the Media Discourse on Migration in Spain before and During Covid-19: Different Stakeholders’ Views and Good Practices
Authors: García-Castillo Noelia , Bueno Doral Tamara , Hänninen Liisa
Published: April 2024

Owing to Covid-19, migration was not a main media topic in Spain in 2020. However, the spring of 2021 witnessed an upturn in media coverage of migration, which coincided with the regional election campaigns and the Ceuta migrant crisis. In this study, our main objectives were to i) analyze the opinions of various stakeholders, both individuals and civil society organizations, regarding media discourse on migration and forced migration before and during the pandemic, and ii) compile and propose good practices to improve these narratives and hence their potential effect on the integration of migrants. For this purpose, we conducted 25 interviews in 2019 with highly vulnerable, forcibly displaced people. We also administered an open-ended questionnaire to 16 representatives of national and international stakeholders, including policy-makers, non-governmental organizations, researchers, educators, businesses, and migrants, in the spring of 2021. The collected data displayed a wide range of perspectives from different stakeholders regarding the potential consequences of media discourse on migrants. In addition, we compiled the existing and novel proposals for good practices that may counteract biased communication and, consequently, give rise to the development of new measures for potential replication in other regions.
Telejornalismo e educação: entre o papel pedagógico e a abordagem de soluções
Authors: Bispo Jemima , Goulart de Andrade Ana Paula , Falcão Luiz Felipe , Martins Simone
Published: April 2024

Este trabalho tensiona jornalismo de soluções com experiências do telejornalismo comprometido com a transformação. Considerando a centralidade do telejornalismo em um país com baixa escolarização, inclusive midiática, pretende-se compreender se as narrativas apresentadas no Jornal Nacional (Rede Globo) são capazes de denunciar e anunciar maneiras de enfrentar desigualdades com uma “cobertura rigorosa e convincente de respostas a problemas sociais” (Rede de Jornalismo de Soluções, 2022). A ele se somam a dramaturgia do telejornalismo (Coutinho, 2012) e o papel pedagógico da informação audiovisual (Cerqueira, 2018). A abordagem empírica envolve pesquisa documental de reportagens sobre educação e sua oferta desigual no Brasil. A metodologia escolhida é análise da materialidade audiovisual (Coutinho, 2018). Quatro eixos de análise foram propostos: a) valores-notícia depreendidos da seleção dos elementos das reportagens; b) estruturas narrativas e dramáticas na apresentação dos conflitos e soluções; c) potencial educativo e enquadramento pelo qual é apresentado; d) observação de soluções ou mera denúncia dos problemas. Como resultado, depreende-se que as narrativas do Jornal Nacional não fazem opção pelo modelo em temas factuais e de apresentação de pesquisas. A postura é a de exibir “o que deu errado” sem expandir esse sentido para encontrar respostas para problemas socioculturais e econômicos.
Una aproximación jurídica a la prostitución en Colombia
Authors: Rincón Hernández María Sofía , Hernández López Verónica
Published: April 2024

La presente ponencia tiene como objeto proponer un modelo de regulación de la prostitución en Colombia, estableciendo mecanismos de protección para las personas en situación de prostitución, alternativas productivas para aquellas que quieran salir de esta y medidas de prevención para desincentivar dicha práctica, de conformidad con el modelo abolicionista. El texto se dividirá en: i) introducción; ii) metodología; iii) el marco jurídico de la prostitución en el derecho nacional e internacional: se hace una breve descripción del estado del arte del derecho sobre la prostitución en Colombia y en derecho comparado; iv) descripción de la prostitución en Colombia: se explica la realidad de las personas que ejercen esta actividad en el país y los riesgos que enfrentan en el día a día; v) prostitución en tiempos de covid-19: se explicará el impacto negativo de la pandemia en las personas que ejercen dicha práctica; vi) la justificación del modelo propuesto: se argumenta la necesidad de la regulación de la prostitución en Colombia; y, por último; vii) conclusiones: se estipulan las reflexiones finales que se logran identificar a lo largo del trabajo investigativo.
Ketamine induced acute systolic heart failure
Authors: Saliba Fares , Mina Jonathan , Aoun Laurence , Khattar Georges , Bou Sanayeh Elie , Jdaidani Jennifer , Al Saidi Ibrahim
Published: April 2024

Background: Studies have shown major cardiovascular effects associated with ketamine use disorder including dose-dependent negative inotropic effects. Preoperative ketamine use has been linked to ketamine-induced stress cardiomyopathy. Case presentation: A 28-year-old female with a history of recurrent cystitis and ketamine use disorder (twice weekly for 14 years) presented with bilateral lower extremity oedema and shortness of breath for 3 months. She was tachycardic with a troponin level of 0.07 ng/ml and a B-type natriuretic peptide (BNP) level of 2511 pg/ml. Electrocardiogram showed normal sinus rhythm and transthoracic echocardiography (TTE) showed left ventricular ejection fraction (EF) of 15%, dilated left ventricle, and severe tricuspid and mitral regurgitation. Computed tomography (CT) scan of the chest and abdomen showed bilateral pleural effusions with congestive hepatopathy and ascites. The patient was started on intravenous furosemide, metoprolol, and sacubitril/valsartan. Rheumatological workup including complement levels, and antinuclear anti-double-stranded DNA was negative. A repeat TTE 2 weeks later revealed an EF of 25% and moderate tricuspid regurgitation. Four months later, the EF was 54% with normal left ventricular cavity size. Conclusion: Although ketamine use disorder is increasing, data on long-term side effects is minimal. Screening for ketamine use disorders should be considered in patients presenting with acute systolic heart failure. Long-term studies are needed to evaluate the benefits of adding ketamine screening to standard urine toxicology.
Using an international research network to CONNECT through mentorship experiences in cardiothoracic surgical research
Authors: O'Keefe-McCarthy Sheila , Magboo Rosalie , Pedrosa Rafaela , Bruneau Jill , Fredericks Suzanne , Van Valen Richard , Chen Yingyan , Then Karen
Published: April 2024

CONNECT is an international virtual research network aiming to strengthen collaborative research across cardiac surgery. This is the second in a series of five articles that introduces CONNECT mentorship.
A sector fit for the future?
Authors: De-Freitas Alesha
Published: April 2024

The Fawcett Society has published a new report arguing England's childcare system is ‘falling behind the rest of the world’. Alesha De-Freitas, director of policy at the Fawcett Society, shares more about the report and its recomendations for reform.
THE MANAGEMENT OF CRITICAL BONE DEFECTS: OUTCOMES OF A SYSTEMATIC APPROACH
Authors: Tsang Shao-Ting J , van Rensburg Adrian Jansen , Epstein Gadi , Venter Rudolph , van Heerden Jason , Ferreira Nando
Published: April 2024

Introduction

The reconstruction of segmental long bone defects remains one of the holy grails of orthopaedic surgery. The optimal treatment of which remains a topic of great debate. This study aimed to evaluate the outcomes following the management of critical-sized bone defects using a classification-based treatment algorithm.

Materials & Methods

A retrospective review of all patients undergoing treatment for segmental diaphyseal defects of long bones at a tertiary-level limb reconstruction unit was performed. The management of the bone defect was standardised as per the classification by Ferreira and Tanwar (2020).

Results

A total of 96 patients (mean age 39.8, SD 15.2) with a minimum six months follow-up were included. Most bone defects were the result of open fractures (75/96) with 67% associated with Gustilo-Anderson IIIB injuries. There was a statistical difference in the likelihood of union between treatment strategies with more than 90% of cases undergoing acute shortening and bone transport achieving union and only 72% of cases undergoing the induced membrane technique consolidating (p=0.049). Of those defects that consolidated, there was no difference in the time to bone union between strategies (p=0.308) with an overall median time to union 8.33 months (95% CI 7.4 — 9.2 months). The induced membrane technique was associated with a 40% risk of sepsis.

Conclusions

This study reported the outcomes of a standardised approach to the management of critical-sized bone defects. Whilst overall results were supportive of this approach, the outcomes associated with the induced membrane technique require further refinement of its indications in the management of critical-sized bone defects.
ADDUCTOR CANAL BLOCKS: PROOF OF CONCEPT FOR THE MANAGEMENT OF CHRONIC PAIN FOLLOWING COMPLEX LOWER LIMB INJURIES?
Authors: Bell Roland , Nayak Mayur , Perello Antonio , Allen Edward , Lee Sang Yob , Mellington Andrew , Guryel Enis
Published: April 2024

Introduction

The regionalisation of major trauma in the UK has significantly improved outcomes for patients with severe, lower limb injuries. Chronic pain after complex lower limb injuries is well documented, but seems to remain a problem despite better clinical and radiological outcomes. We hypothesised that pain was mediated through the saphenous nerve, especially as most tibial injuries affected the soft tissues medially. As a proof of concept, we undertook adductor canal blocks to understand pain aetiology.

Materials & Methods

Patients with chronic pain following complex lower limb trauma or congenital deformity correction have been selected and underwent an adductor canal block by one of our trauma anaesthetist that specialises in this procedure. Their outcomes were recorded in their clinical records and patients were contacted by phone to document their experiences.

Results

14 patients with chronic, treatment refractory lower limb pain who were being managed in our orthoplastics clinic following complex, lower limb trauma were identified. Six of those patients had required plastic coverage. Of these 14 patients, all stated their pain completely resolved after the procedure and then returned between 24 hours and 4 weeks after the procedure. Two patients underwent a saphenous nerve diversion after conduction of the blocks, reporting subsequent resolution of their complaints.

Conclusions

As a proof of concept, we report that the saphenous nerve underlies chronic pain in patients with complex lower limb injuries. An adductor canal block is an effective diagnostic tool for these patients. Saphenous diversion may offer a permanent solution in patients who respond well to saphenous nerve block. A prospective study is planned to objectively measure pain and quality of life scores after treatment of complex injuries and pre and post adductor canal block.
POSTOPERATIVE OUTCOMES OF ILIZAROV FRAME FIXATION IN THE LOWER LIMB: AN EVALUATION OF PATIENT-REPORTED OUTCOME MEASURES AND ALIGNMENT
Authors: Murray Elspeth , Connaghan Jordann , Creavin K , Egglestone Anthony , Jamal Bilal
Published: April 2024

Introduction

By utilising the inherent variability achievable with circular frames, surgeons can manage a wide spectrum of complex injuries, and can deal with deformity at multiple levels, in multiple planes. The aim of this study was to assess functional outcomes utilising patients reported outcome measures (PROMs) of patients being treated with circular (Ilizarov) frame fixation for complex lower limb injuries and assess these results in conjunction with the observed postoperative alignment of the patients’ limbs.

Materials & Methods

Cases were identified using a prospectively collected database of adult patients presenting between July 2018 and August 2021. Functional outcomes were assessed using the American Orthopaedic Foot and Ankle Score (AOFAS), the 5-level EQ-5D (EQ5D5L), the Lysholm Knee Scoring Scale (LKSS), the Olerud-Molendar Ankle Score (OMAS), and the Tegner Activity Scale (TAS). Postoperative radiographs were analysed for fracture union and to quantify malunion (as described in Dror Paleys Principles of Deformity Correction).

Results

The mean AOFAS, EQ5D5L, LKSS and OMAS scores showed an initial drop from pre-op to early time points and then steady increase over the early, mid, late and frame-off time points, with a resultant score higher than pre-op. Malunion was found in 35 (41.7%) patients, 7 patients had a malunion within 5 degrees of normal, 15 from 5–10 degrees of normal, 12 from 10–15 degrees of normal and 2 out with 15 degrees of normal.

Conclusions

Circular frame fixation is an attractive option in complex lower limb trauma where alternative fixation methods are unsuitable. Whilst post-operative success to the surgeon might be determined radiographically, patient reported outcomes give a functionally important, objective measure of the success of the surgery to the patient.
THE ‘OSTEOSTASIS’ AND ITS FIVE PRINCIPLES: APPLICATION IN LIMB LENGTHENING
Authors: Guichet Jean-Marc , Clementi Daniele
Published: April 2024

Introduction

Humans Functions (locomotion, protection of organs, reproduction) require a strong support system (bones). The ‘Osteostasis’ is the ability of maintaining the bone structure, its mechanical characteristics and function. Five principles are required for an efficient bone system:

Basic Requirements:

1) Stability and 2) Function. Repair System (like house building in desert or sea):

3) Roads (vessels), 4) Materials (calories, proteins), 5) Workers (bone cells).

Analysis of bone problems through these principles bring to optimised treatments.

Materials & Methods

Measurements (>700 lengthening, 32-year follow-up, Full WB Albizzia/G-Nails FWBAG): Bone-DEXA, WB conditions, muscle, fat, etc.

Principle-1. Solid bone replacement with a 100% biocompatible and reliable FWBAG with sports (POD0).

Principle-2. Bone, Muscle & neural integrity for function Principle-3. Vascular flow lesions induce non-healing (arteriography). Muscle activity accounts for 90% of bone blood flow, ×10 by sports. Required: Checks (arteriography) and treatments (training)

Principle-4. Food (NRV Kcal × 2–3, 20–25% proteins).

Principle-5. Maintain bone cells and increase them. Suppress ‘opening’, ‘venting’, ‘drainages’.

Results

Principle1. Nail fracture (1.2%), nail dysfunction (0%) with FWBAG.

Principle2. Intensive sports preop and from POD0 - Principle3. Increased preop vascular supply & muscle force, postop resistance sports fasten recovery. Wheel-chair or low activity decreases healing.

Principle4. 6–9 cm circumference loss (non WB-nails or no proper training); 0 cm circumference loss (gain <10 cm) with intense resistance training + high calory intake. - Principle5. Bone cells preservation (no opening, IM saw, increasing bone cells) allow Healing Index down to 8D/cm.

Conclusions

The ‘5P’ allow reaching treatment targets by optimisation of problem solving, maintaining Osteostasis. What would I like or tolerate for me? How can I reach it? Full WB and sports from POD0 was a target 38 years-ago, still not enforced by most of us. Resistance sports, high-calory intake suppress muscle loss and fasten healing, thanks to muscle blood flow and the ‘5P’.
ANTEGRADE INTRAMEDULLARY FEMORAL LENGTHENING AND DISTAL TEMPORARY HEMIEPIPHYSIODESIS FOR COMBINED DEFORMITY CORRECTION
Authors: Laufer Andrea , Frommer Adrien , Gosheger Georg , Toporowski Gregor , Rölfing Jan Duedal , Antfang Carina , Roedl Robert , Vogt Bjoern
Published: April 2024

Introduction

Coronal malalignment and leg length discrepancies (LLD) are frequently associated. Temporary hemiepiphysiodesis (tHED) is commonly employed for the correction of limb malalignment in skeletally immature patients. For treatment of LLD greater than 2 cm, lengthening with intramedullary legnthening nails is a safe and reliable technique. However, the combined application of these approaches in skeletally immature patients has not yet been investigated.

Materials & Methods

Retrospective radiological and clinical analysis of 25 patients (14 females, 11 males) who underwent intramedullary femoral lengthening with an antegrade PRECICE® lengthening nail as well as tHED of the distal femur and / or proximal tibia between 2014 and 2019. tHED was conducted by implantation of flexible staples (FlexTack™) either prior (n = 11), simultaneously (n = 10), or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4).

Results

The median initial LLD was 39.0 mm (35.0–45.0). 21 patients (84%) presented valgus and 4 (16%) showed varus malalignment. Leg length equalization was achieved in 13 patients at skeletal maturity (62%). The median LLD of patients with a residual LLD > 10 mm was 15.5 mm (12.8–21.8). Limb realignment was obtained in nine of seventeen skeletally mature patients (53%) in the valgus group, and in one of four patients (25%) in the varus group.

Conclusions

The combination of antegrade femoral lengthening and tHED can efficiently correct LLD and coronal limb malalignment in skeletally immature patients. Nevertheless, achieving limb length equalization and realignment may render difficult in cases of severe LLD and angular deformity. Furthermore, the reported techniques ought to be thoroughly planned and executed and require regular clinical and radiological examinations until skeletal maturity to avoid - or timely detect and manage - adverse events such as overcorrection and rebound of deformity.
PATIENT-REPORTED OUTCOME MEASURES (PROMS) AND INCIDENCE OF SECONDARY TOTAL KNEE ARTHROPLASTY (TKA) IN SCHATZKER GRADE V AND VI TIBIAL PLATEAU FRACTURES MANAGED BY CIRCULAR EXTERNAL FIXATION (CEF): A 15-YEAR SINGLE-CENTRE EXPERIENCE
Authors: Tareef Tareq , Groom William , Moulder Elizabeth , Muir Ross , Barron Elizabeth , Hadland Yvonne , Sharma Hemant
Published: April 2024

Introduction

Schatzker V & VI tibial plateau fractures are serious life-changing injuries often resulting in significant complications including post-traumatic arthritis. Reported incidence of secondary TKA following ORIF of all tibial plateau fractures is 7.3% and 13% for Schatzker V & VI tibial. This study reports a 15-year single centre experience of CEF of Schatzker V & VI fractures including PROMs and incidence of secondary TKA. This study was approved by the local Institutional board.

Materials & Methods

All patients from 2007 – 2022 with Schatzker V or VI fractures treated with CEF were identified from a departmental limb reconstruction registry and included in this retrospective study. Patients’ demographics were collected from electronic institutional patient system. Further data was collected for secondary intervention, adverse events, and alignment at discharge. All deceased patients at the time of the study were excluded.

Each participant completed a questionnaire about secondary intervention, EQ-5D-3L and Oxford Knee Score (OKS).

Results

90 patients (from 130 eligible) with an average age of 58.3 years completed the questionnaire. At an average follow up of 7.4 years (SD=3.8) the incidence of secondary TKA was 7.8%. There was no significant correlation between articular incongruity and the incidence of secondary TKA.

The mean OKS score was 31.7 (SD=13.3). The mean EQ-VAS was 69.3 (SD=23.3) and the mean EQ-5D Index was 0.595 (SD=0.395), both were significantly lower than UK normal population means.

Conclusions

This study is probably one of the largest and with the longest follow-up reporting the outcomes of Schatzker V and VI fractures treated with CEF. It appears that articular incongruity has no significant correlation with secondary TKA. Patients reported EQ-5D-3L scores were significantly lower than those for the normal UK population, and the average EQ-VAS has deteriorated with time.

This study would be relevant in counselling and consenting patients with this severe injury.
GUIDED GROWTH SURGERY FOR TREATMENT OF PATELLAR INSTABILITY IN GENU VALGUM
Authors: Aithie Joanna , Oag Erlend , Butcher Rachael , Messner Juergen
Published: April 2024

Introduction

Genu valgum is a common presentation in paediatric patients with congenital limb deformities. The aim of this study is to assess the outcome of guided growth surgery in paediatric patients referred via our physiotherapy pathway with isolated genu valgum and associated patellar instability.

Materials & Methods

Patients were identified from our prospective patellar instability database. Inclusion criteria was acquired or congenital genu valgum associated with patellar instability in skeletally immature patients. The mechanical lateral-distal femoral angle was assessed on long leg alignment radiographs (mLDFA <85 degrees). Surgical treatment was the placement of a guided growth plate (PediPlate, OrthoPediatrics, USA) on the medial distal femoral physis (hemi-epiphysiodesis). KOOS-child scores were collected pre-operatively and post-operatively (minimum at 6 months).

Results

Eleven patients (seven female) with mean age of 12(range 5–15) were identified. Five patients had congenital talipes equinovarus(CTEV), one fibular hemimelia, one di-George syndrome, one septic growth arrest and three had idiopathic genu valgum. Pre- and post-operative KOOS-child scores showed overall improvement: 58(range 36–68) to 88(65–99) and knee symptoms subscores: 64(43–71) to 96(68–100) p<0.01, t-test.

Mean follow-up was 10 months (range 3–23). No subsequent dislocations/subluxations occurred during follow-up.

Conclusions

Guided growth surgery is an effective way of treating symptomatic patellar instability in skeletally immature patients with genu valgum in the absence of other structural pathology. It was most common in our cohort in patients with unilateral CTEV. We would recommend to screen syndromic and congenital limb deformity patients for patellar instability symptoms in the presence of genu valgum.
DOES GAIT LAB ASSESSMENT ASSIST IN DECISION MAKING IN PAEDIATRIC LIMB RECONSTRUCTION SURGERY?
Authors: Aithie Joanna , Herman Jan , Holt Katherine , Gaston Mark , Messner Juergen
Published: April 2024

Introduction

Limb deformity is usually assessed clinically assisted by long leg alignment radiographs and further imaging modalities (MRI and CT). Often decisions are made based on static imaging and simple gait interpretation in clinic. We have assessed the value of gait lab analysis in surgical decision making comparing surgical planning pre and post gait lab assessment.

Materials & Methods

Patients were identified from the local limb reconstruction database. Patients were reviewed in the outpatient clinic and long leg alignment radiographs and a CT rotational limb profile were performed. A surgical plan was formulated and documented. All patients then underwent a formal gait lab analysis. The gait lab recommendations were then compared to the initial plan.

Results

Twelve patients (8 female) with mean age of 14 (range 12–16) were identified. Nine were developmental torsional malalignments, one arthrogryposis, one hemiparesis secondary to spinal tumour resection and one syndromic limb deficiency. The gait lab recommended conservative management in four patients and agreed with eight surgical plans with one osteotomy level changing.

Five patients are post-operative: two bilateral distal tibial osteotomies, two de-rotational femoral osteotomy with de-rotational tibial osteotomies and one bilateral femoral de-rotational osteotomies.

Conclusions

Limb deformity correction is major surgery with long rehabilitation and recovery period. Gait lab analysis can identify who would benefit from conservative management rather than surgery with our study showing changes to surgical planning in one third of patients. The gait lab analysis helps to identify patients with functional and neuromuscular imbalances where correcting the bony anatomy may not actually benefit the patient.
Effect of radiotherapy on local control and overall survival in spinal metastasis of non-small-cell lung cancer after surgery and systemic therapy
Authors: Wang Shengdong , Chen Zehao , Wang Keyi , Li Hengyuan , Qu Hao , Mou Haochen , Lin Nong , Ye Zhaoming
Published: April 2024

Aims

Radiotherapy is a well-known local treatment for spinal metastases. However, in the presence of postoperative systemic therapy, the efficacy of radiotherapy on local control (LC) and overall survival (OS) in patients with spinal metastases remains unknown. This study aimed to evaluate the clinical outcomes of post-surgical radiotherapy for spinal metastatic non-small-cell lung cancer (NSCLC) patients, and to identify factors correlated with LC and OS.

Methods

A retrospective, single-centre review was conducted of patients with spinal metastases from NSCLC who underwent surgery followed by systemic therapy at our institution from January 2018 to September 2022. Kaplan-Meier analysis and log-rank tests were used to compare the LC and OS between groups. Associated factors for LC and OS were assessed using Cox proportional hazards regression analysis.

Results

Overall, 123 patients with 127 spinal metastases from NSCLC who underwent decompression surgery followed by postoperative systemic therapy were included. A total of 43 lesions were treated with stereotactic body radiotherapy (SBRT) after surgery and 84 lesions were not. Survival rate at one, two, and three years was 83.4%, 58.9%, and 48.2%, respectively, and LC rate was 87.8%, 78.8%, and 78.8%, respectively. Histological type was the only significant associated factor for both LC (p = 0.007) and OS (p < 0.001). Treatment with targeted therapy was significantly associated with longer survival (p = 0.039). The risk factors associated with worse survival were abnormal laboratory data (p = 0.021), lesions located in the thoracic spine (p = 0.047), and lumbar spine (p = 0.044). This study also revealed that postoperative radiotherapy had little effect in improving OS or LC.

Conclusion

Tumour histological type was significantly associated with the prognosis in spinal NSCLC metastasis patients. In the presence of post-surgical systemic therapy, radiotherapy appeared to be less effective in improving LC, OS, or quality of life in spinal NSCLC metastasis patients.

Cite this article: Bone Jt Open 2024;5(4):350–360.
The Name and Nature of “Chinese-Language Philosophy”
Authors: Yang Xiaobo
Published: April 2024

The rise of “Chinese-language philosophy” (Hanyu zhexue 漢語哲學) as a new trend in Chinese philosophical studies signifies an effort to legitimize Chinese philosophy in a new light. This article explores several pivotal inquiries regarding this trend: What does Hanyu zhexue refer to? Under what circumstances did it arise, and why has it gained prominence primarily within Chinese academia? Is Chinese philosophy inherently language-specific? By drawing comparisons with the similar phenomenon of “Japanese-language philosophy,” we approach the prospects of “Chinese-language philosophy” with caution. We argue that an excessive focus on language in philosophy risks fostering a language-centric ontology that overshadows the foundations shared by all philosophical traditions and human languages—namely, the lived experiences and social practices of human beings.
Terahertz deep learning fusion computed tomography
Authors: Hung Yi-Chun , Su Weng-Tai , Chao Ta-Hsuan , Lin Chia-Wen , Yang Shang-Hua
Published: April 2024

Terahertz (THz) tomographic imaging based on time-resolved THz signals has raised significant attention due to its non-invasive, non-destructive, non-ionizing, material-classification, and ultrafast-frame-rate nature for object exploration and inspection. However, the material and geometric information of the tested objects is inherently embedded in the highly distorted THz time-domain signals, leading to substantial computational complexity and the necessity for intricate multi-physics models to extract the desired information. To address this challenge, we present a THz multi-dimensional tomographic framework and multi-scale spatio-spectral fusion Unet (MS3-Unet), capable of fusing and collaborating the THz signals across diverse signal domains. MS3-Unet employs multi-scale branches to extract spatio-spectral features, which are subsequently processed through element-wise adaptive filters and fused to achieve high-quality THz image restoration. Evaluated by geometry-variant objects, MS3-Unet outperforms other peer methods in PSNR and SSIM. In addition to the superior performance, the proposed framework additionally provides high scalable, adjustable, and accessible interface to collaborate with different user-defined models or methods.
Active manipulation for Goos-Hänchen shift of guided-wave via a metasurface of silicon-nanoscale semi-spheres on SOI waveguide
Authors: Zhang Yongqi , Sun DeGui , Yu Miao , Xu Yameng , Chen Zhuo
Published: April 2024

Goos-Hänchen shift of total internal reflection (TIR) is the light beam movement without external driving, so envisioned to have potential manipulation of optical beams. In this article, with a silicon-on-insulator (SOI) waveguide corner structure, a variable equivalent permittivity of guided wave is modelled, and then the equivalent electric polarizabilities and the Goos-Hänchen shift of guided wave are modelled. Consequently, with a 2.0-µm SOI waveguide corner structure and an abrupt phase change of ∼0.5π caused by a vertically inserted metasurface of nanoscale semi-spheres having a 450-nm radius can reach the GH shifts of 2.1 µm for TE- and TM-mode, respectively, which are verified by both the FDTD simulation results of 1.93 µm with a reflectivity of about 62% and the experimental results of 2.0 µm with ∼60%. Therefore, this work has efficiently modelled the optical feature response of semi-sphere metasurface to guided wave and the active manipulation for the GH shifts of guided-wave, opening more opportunities to develop the new functionalities and devices for Si-based photonic integrated circuit (PIC) applications.