bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventing Spinal Cord Injury in Single-Staged Juxtarenal and Thoracoabdominal Endovascular Aortic Aneurysm Repair: An Evaluation of Cerebrospinal Fluid Catheter Drainage
Authors: Walter Corinna , Hirsch Kornelia , Heil Sabine , Taher Fadi , Falkensammer Jürgen , Gustorff Burkhard , Assadian Afshin
Published: December 2024

Objective:

This study offers a retrospective assessment of a single-center experience using cerebrospinal fluid catheters to reduce the risk of perioperative spinal cord injury in patients undergoing single-staged complex endovascular juxtarenal or thoracoabdominal aortic aneurysm repair.

Results:

A total of 97 patients were included. On average, 70.7%±14.4% of the aortic segment between the left subclavian artery and the aortic bifurcation was covered during the procedures. Of the 53 patients receiving cerebrospinal fluid drainage, 77.4% were prophylactic and 22.6% were in symptomatic patients. The overall spinal cord injury rate was 12.4%, with 8.3% experiencing transient spinal cord injury with immediate improvement after cerebrospinal fluid drainage, and 4.1% of patients suffering permanent spinal cord injury: 2 (2.1%) with minor deficits and 2 (2.1%) with paraplegia. The mean intraoperatively administered heparin dosage was 7500 international units, and an additional intravenous bolus of acetylsalicylic acid was given in 69 cases (71.1%), whereas the cerebrospinal fluid drain was in situ.

Conclusions:

The evaluation of the employed in-house protocol for single-staged complex endovascular juxtarenal and thoracoabdominal aortic aneurysm repair, focusing on cerebrospinal fluid catheter management in conjunction with necessary anticoagulant and antiplatelet medication, indicated that the use of a cerebrospinal fluid catheter is a feasible approach for spinal cord injury risk reduction in selected high-risk patients.

Clinical Impact

This study highlights the effectiveness of cerebrospinal fluid drainage (CSFD) in reducing spinal cord injury (SCI) rates from 12.4% to 4.1% during single-staged complex endovascular repair of juxtarenal and thoracoabdominal aortic aneurysms. Implementing CSFD within a standardized protocol achieved a 99.7% target visceral and renal vessel patency without major CSFD-related bleeding complications. These findings emphasize CSFD as a feasible and effective tool for SCI prevention in selected high-risk patients. While supporting on-demand catheter placement, this study underscores the potential of selective prophylactic CSFD use, contributing to safer, evidence-based strategies in managing high-risk aortic repairs.
Effects of Repetitive Transcranial Magnetic Stimulation on Poststroke Hemineglect: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials
Authors: Yang Fu-An , Lin Chueh-Ho , Chung Hung-Ning , Kuan Yi-Chun , Escorpizo Reuben , Chen Hung-Chou
Published: December 2024

Background

Although various repetitive transcranial magnetic stimulation (rTMS) and theta burst stimulation (TBS) protocols are used, their comparative effectiveness for treating poststroke hemineglect remains unassessed.

Objective

To investigate rTMS and TBS effects on clinical outcomes in poststroke hemineglect through a systematic review and network meta-analysis.

Methods

We searched PubMed, EMBASE, and Cochrane Library databases up to March 7, 2024, for trials on rTMS or TBS in poststroke hemineglect. Included studies involved rTMS or TBS with different protocols, sham, or no stimulation, assessing hemineglect severity or impact. The quality of the included studies was evaluated using the PEDro scale. The network meta-analysis was performed using ShinyNMA (version 1.01).

Results

We analyzed 13 studies with 309 participants. All studies included participants who had experienced right hemisphere stroke. All included studies had a fair to good quality based on PEDro score evaluation. Protocols included continuous TBS (cTBS), high-frequency rTMS (HF-rTMS), and low-frequency rTMS (LF-rTMS) targeting both contralesional and lesional sites. HF-rTMS on the lesional site significantly improved short-term results on the line bisection test and Catherine Bergego Scale; LF-rTMS on the contralesional site improved short-term line bisection; and cTBS on the contralesional site improved long-term line bisection. No severe adverse events or significant inconsistencies were reported.

Conclusions

Our findings indicate that HF-rTMS targeting the lesional site is the preferred therapeutic approach for the short-term management of poststroke hemineglect. LF-rTMS directed at the contralesional site is a practical alternative. Moreover, cTBS targeting the contralesional site is a viable option because of its long-term effect.
Application of Cognitive Empathy Elements Into AI Chatbots: An Interview Study Exploring Patient-Physician Interaction
Authors: Alam Lamia , Mamun Tauseef Ibne , Mueller Shane T.
Published: December 2024

Among different components of empathy, cognitive empathy is a necessary facet to understand a patient’s perspectives tapping into their thoughts and reasonings. With the rise of AI chatbots within healthcare settings, it has become important to mirror these cognitive empathetic elements within these chatbots too. Symptom assessment AI chatbots can be valuable tools for initial screening or triage in healthcare settings. This paper seeks to understand the cognitive empathy elements present in patient-physician interactions and offers recommendations for integrating these elements into AI chatbots. This represents a novel exploration of cognitive empathy within the patient-physician context and the potential for incorporating it into patient-AI interactions. We interviewed 10 first-time mothers to explore possible communication patterns for establishing cognitive empathy between patient-physician. We identified incidents with critical interactions where the physician or midwife could develop a shared understanding or common ground with their patients even if they were not aligned at the beginning of the incidents. Six themes emerged from the interviews: (1) Shared Information, (2) Shared Decision-making, (3) Shared Sensemaking, (4) Shared Goals, (5) Communication about Outcomes, and (6) Tailoring to Circumstances. Based on the themes and the interactions extracted from the interviews, we developed design recommendations for symptom assessment/diagnostic reasoning AI chatbots. The design recommendations we provided in this paper offer guidance in developing cognitively more empathic AI chatbots as they are becoming an important part of building robust digital health solutions. Cognitive empathetic elements within these chatbots would allow the users or patients to make improved and empowered choices, decisions, and outcomes through optimal contribution from them with a complete information base.
Longitudinal trend in post-discharge estimated glomerular filtration rate in intensive care survivors
Authors: Glendell Rebecca M , Puxty Kathryn A , Shaw Martin , Sim Malcolm AB , Traynor Jamie P , Mark Patrick B , Andonovic Mark
Published: December 2024

Background:

Acute kidney injury (AKI) within the intensive care unit (ICU) is common but evidence is limited on longer-term renal outcomes. We aimed to model the trend of kidney function in ICU survivors using estimated glomerular filtration rate (eGFR), comparing those with and without AKI, and investigate potential risk factors associated with eGFR decline.

Methods:

This observational cohort study included all patients aged 16 or older admitted to two general adult ICUs in Scotland between 1st July 2015 and 30th June 2018 who survived to 30 days following hospital discharge. Baseline serum creatinine and subsequent values were used to identify patients with AKI and calculate eGFR following hospital discharge. Mixed effects modelling was used to control for repeated measures and to allow inclusion of several exploratory variables.

Results:

3649 patients were included, with 1252 (34%) experiencing in-ICU AKI. Patients were followed up for up to 2000 days with a median 21 eGFR measurements. eGFR declined at a rate of −1.9 ml/min/1.73m2/year ( p-value < 0.001) in the overall ICU survivor cohort. Patients with AKI experienced an accelerated rate of post-ICU eGFR decline of −2.0 ml/min/1.73m2/year compared to a rate of −1.83 ml/min/1.73m2/year in patients who did not experience AKI ( p-value 0.007). Pre-existing diabetes or liver disease and in-ICU vasopressor support were associated with accelerated eGFR decline regardless of AKI experience.

Conclusions:

ICU survivors experienced a decline in kidney function beyond that which would be expected regardless of in-ICU AKI. Long-term follow-up is warranted in ICU survivors to monitor kidney function and reduce morbidity and mortality.
Energy-efficient protocols for environmental monitoring in wireless sensor networks: A review
Authors: Rana Arzoo , Kaur Kiranbir , Kaur Prabhpreet , Bhatti Emmy
Published: December 2024

A wireless sensor network (WSN) is defined as an infrastructure-less wireless network containing a substantial amount of the sensor's data deployed in an ad hoc manner to form a network. Sensor nodes are used along with onboard process data to monitor the environment in a particular area. Sensors are connected to the base station, which also functions as a processing unit within the WSN system. A base station is used to share the data with the help of the internet. Sensor nodes within WSN have limited power, resulting in a reducing lifespan, especially in human-inaccessible locations. This paper reviews the energy-efficient protocols for environmental monitoring and energy-harvesting WSNs. This paper investigates three protocols, viz., the low energy adaptive clustering protocol, the distributed energy-efficient clustering protocol, and the stable election protocol. The result-driven approach followed in this paper presents a comparative analysis of these protocols to find the best protocol for energy efficiency. Throughput indicating packets received successfully at the base station has been evaluated in this paper. This metric indicates the effectiveness of the protocols in achieving a longer lifespan for the sensors. Furthermore, the dynamic deployment and challenges associated with environmental monitoring applications, considering the physical, network, and medium access control layers, have been discussed in this paper. Given the above, this paper presents a systematic literature review to identify the interdisciplinary work done by researchers towards the applications of WSNs in the field of environmental monitoring.
Antioxidant Properties of Virgin Coconut Oil and its Cytotoxicity Towards Human Keratinocytes
Authors: Zainodin Elly Liyana , Rashidi Nur Fatihah , Abdul Mutalib Haliza , Ishak Bashirah , Ghazali Ahmad Rohi
Published: December 2024

Background

Virgin Coconut Oil (VCO) is rich in medium-chain fatty acids and bioactive constituents such as vitamin E and polyphenols, rendering it an appealing natural ingredient for medicinal and cosmeceutical skin applications. Its use on the skin warrants cytotoxicity assessment to ensure safety and efficacy. This study evaluated VCO's antioxidant properties and its cytotoxicity in human keratinocytes (HaCaT).

Methods

Fatty acid composition was analyzed using gas chromatography with a flame ionization detector (GC-FID). The antioxidant potential of serial doses of VCO (45%, 22.5%, 11.3%, 5.6% and 2.8%) was assessed by 2,2-Diphenyl-1- picrylhydrazyl (DPPH) and ferric-reducing/antioxidant power (FRAP) assays. Cytotoxicity was determined using the 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay on human keratinocytes.

Results

GC-FID analysis revealed lauric acid as the predominant fatty acid, accounting for 46.4% of the total composition. VCO exhibited dose-dependent antioxidant activity in the DPPH assay, with statistically significant differences across concentrations (F (4, 320) = 143.2, P < .0001) and compared to positive control Trolox (F(1, 320) = 13,201, P < .0001). The FRAP assay showed a statistically significant difference in ascorbic acid equivalent antioxidant capacity (AEAC) among various concentrations (F(4, 35) = 17.65, P = .02). A dose-dependent decrease in HaCaT cell viability was observed with IC50 identified at 17.8% v/v. VCO was mildly cytotoxic to HaCaT at 11.3% v/v (74.36 + 5.41% cell viability). One-way ANOVA showed significant differences across concentration groups (F(5, 150) = 69.68, P < .0001). Tukey's post-hoc indicated significant differences from the negative control ( P < .0001) and between the pairwise groups of 11.3% and 22.5% v/v ( P = .0001).

Conclusion

VCO possesses antioxidant properties, but future formulation and application for skin may consider using an optimal concentration below 11.3% v/v.
Autonomy and pluriversal energy futures in Ladakh, India
Authors: Joshi Neelakshi , Kothari Ashish
Published: December 2024

In Ladakh, a trans-Himalayan region of India, two drastically opposite visions of energy transition are colliding head-on. The first is a grassroots, indigenous approach that emphasises on low-impact and socioecologically just energy practices, meant primarily for local consumption. The other is a government and corporate driven, technocratic vision pushing for large-scale energy infrastructure and critical mineral mining, to supply energy to high-consumption areas outside Ladakh. At the heart of this conflict lies the issue of governance and democracy, decision-making regarding ‘development’ and the use of land and local resources. Since early 2023, drawing on a longer history of struggles, a movement for autonomy, constitutional safeguards and statehood for Ladakh has intensified. The top-down and large-scale energy projects planned for the region have been challenged in this movement. The hope is that autonomy would empower locals to control their lands and resources and steer their futures, including those related to energy. Analysing these protests, we argue that constitutional safeguards and autonomy are essential for protecting and promoting socioecologically just energy practices. The demand for autonomy challenges the extractive view of Ladakh as a peripheral sacrifice zone for modern energy needs. Instead, it could be the basis for promoting local pluriversal technologies, low-impact lifestyles and democratically run and managed energy systems. At the same time, Ladakhis have to deal with internal contestations regarding visions of ‘development’ and prosperity.
Expressions of emotions in minimal face perception stimuli
Authors: Šķilters Jurģis , Zariņa Līga , Ceple Ilze , Monstvilaite Alina , Umbraško Solvita , Bartušēvica Santa , Pinna Baingio
Published: December 2024

Face perception is considered to be a canonical example of configurational visual processing. However, not all facial information is equally important when reading facial expressions. The eyes and mouth seem to be crucial, but they seem to have different roles and significance. By varying the shape of the mouth, eyes, and other factors, we conducted two experiments: first, we examined eye movements depending on different facial configurations and different types of instructions (neutral and emotionally valenced); second, we used the same types of stimuli in a rating task. Our results indicate that the eyes provide a primary impact (when eye fixations are measured), which can be explained by the evolutionary need to establish gaze contact, but once facial expressions are observed, the mouth seems to be more significant.
Current status and management of peri-implantitis: A systematic review
Authors: Acar Buket , Guncu Guliz N.
Published: December 2024

Aim:

To systematically review the literature on the surgical and non-surgical methods for managing peri-implantitis.

Materials and methods:

An electronic search for randomised controlled trials published between 2019 and 2023 in the English language was performed with the Medline/PubMed database according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The specific search terms were “periimplantitis”, “non-surgical treatment”, “surgical treatment” and combinations of these terms.

Results:

The initial search yielded 2,704 relevant articles. Most of these articles were excluded based on publication type and year. At this stage, only two articles were excluded from the study because they were not written in English. Of the remaining 98 articles, seven were eliminated because the full text could not be accessed, and the others were excluded because their study topics and types were not within the scope of this review. Six out of the 51 studies, whose full texts were assessed for eligibility, were further excluded. Finally, 45 articles that met the inclusion criteria of this review were evaluated.

Conclusion:

Personalised and evidence-based approaches in the treatment of peri-implantitis are at the forefront in achieving the long-term success of peri-implantitis therapy. Further evidence is needed for the outcomes of surgical or non-surgical peri-implantitis treatment methods applied alone or with adjunctive therapies.
A mid-20th century stratigraphical Anthropocene is recognisable in the birth-area of the industrial revolution
Authors: Sellers Hannah , Williams Mark , Berrio Juan Carlos , De Sabbata Stef , Rose Neil L , Turner Simon D , Yang Handong , Bennion Helen , Sayer Carl D , Roberts Neil , Wrisdale Amy , Aquino-Lopez Marco A
Published: December 2024

The formalisation of the Anthropocene as a subdivision of the Geological Time Scale has been under debate. Its stratigraphic boundary has been proposed as a precise Global boundary Stratotype Section and Point (GSSP) in the mid-20th century, but it is part of an episode of human-induced changes to the Earth System that have unfolded over millennia. Here we attempt to identify stratigraphical patterns of the Anthropocene from a previously well studied lake sedimentary archive from the English Midlands, located in one of the most heavily human-modified landscapes in the UK, and the birthplace of the Industrial Revolution. Our analysis is predicated on the sedimentary succession of Groby Pool, a small lake situated to the immediate northwest of Leicester. We have found that whilst proxy signals for biotic change are indicative of significant landscape and consequent ecological changes prior to the 20th century, the signal from radiogenic fallout and rapid increase in spheroidal carbonaceous particles indicative of fossil-fuel combustion yield a clear mid and later 20th century stratigraphical signature that corresponds with the Great Acceleration of the post-WWII period. We therefore demonstrate clear stratigraphical signatures in the oldest Industrial Revolution landscape on Earth that are consistent with a mid-20th century start point for the Anthropocene.
Digital platforms in the agricultural sector: Dynamics of oligopolistic platformisation
Authors: Sauvagerd Monja , Mayer Maximilian , Hartmann Monika
Published: December 2024

This paper introduces the concept of ‘oligopolistic platformisation’ to capture the specific dynamics of collaboration and competition between multinational upstream agribusinesses and Big Tech companies in the agricultural (ag) sector. We examine this phenomenon through the lens of Van Dijck et al.’s platform mechanisms: datafication, selection and commodification. Multinational agribusinesses operate sectoral ag platforms that analyse spatial, weather and agronomic data to optimise farming operations, whilst Big Tech companies provide the digital infrastructure, including cloud computing, data analytics and artificial intelligence. We explore how these pre-existing oligopolistic market structures influence the process and outcomes of platformisation in the ag sector. Using expert interviews, field observations, economic relationship mapping and an extensive literature review, we investigate relationships amongst multinational agribusinesses and between agribusinesses and Big Tech companies. Our findings reveal that Big Tech and multinational agribusinesses are collaboratively establishing digital platforms as the core organisational form of digital agriculture, aiming to consolidate most services. This collaboration blurs the lines between traditionally distinct industries, fostering overlapping ecosystems and mutually beneficial economic relationships in an already highly concentrated market. This dynamic has the potential to reinforce the market position of established companies, increase farmers’ dependency on agribusinesses and contribute to fragmented and siloed data systems.
Associations Between Leisure Physical Activity and Mathematics Interest: A Longitudinal Analysis
Authors: Zhang Yuhuan , Wang Lidong , Li Tian , Ma Xiao
Published: December 2024

Previous studies have indicated a positive association between physical activity (PA) and mathematics achievement. The present study explored the association of PA outside school with math interest using longitudinal data from Kaifeng, a medium-sized city in Central China. A two-tier multilevel logistic model was conducted using 2,132 students’ math test scores, self-reported PA frequency, and math learning-related experience in December 2019 and January 2021. Socioeconomic status, school location, and sex were all controlled. The results showed that physical exercise frequency and physical exercise per class outside school had a significant positive impact on mathematics interest ([Formula: see text];[Formula: see text]), as did previous mathematics interest ([Formula: see text]) and self-educational expectation ([Formula: see text];[Formula: see text]). It indicated that regular physical exercise outside of school can lead to increased mathematics interest.
Self-Assessment Techniques in Clinical Studies in Public Universities in Anambra State: Benefits and Alignment With Supervisors Evaluation as Perceived by Medical Students
Authors: Ezeugo Nneka Chinyere , Eleje Lydia Ijeoma , Obiasor Gideon Ebuka , Mbelede Njideka Gertrude , Osonwa Kalu Eke , Metu Ifeoma Clementina , Eleje George Uchenna
Published: December 2024

OBJECTIVES

This research explores the perceptions of medical students regarding self-assessment techniques in clinical studies at public universities in Anambra State, Nigeria. Specifically, it investigates the benefits of these techniques and their perceived alignment with formal evaluations conducted by supervisors.

METHODS

Utilizing a descriptive cross-sectional study design, data were collected from 273 consenting medical students through an online questionnaire. The questionnaire was developed to capture students’ demographics, experiences with self-assessment, and perceptions of its benefits in relation to supervisor evaluations.

RESULTS

Results indicate a balanced representation of gender among respondents, with the majority falling within the 21‒25 years’ age range, and nearly equal participation from students at the 500 and 600 levels across two institution types, Federal and State. The findings reveal a positive alignment between students’ perception of self-assessments and formal evaluations, with no significant discrepancies observed between institutions or levels of study. Additionally, participants widely perceive self-assessment as beneficial for enhancing confidence, identifying learning gaps, fostering professional growth, and improving communication skills. Furthermore, students from both institutions and across different levels of study report similar perceived benefits from engaging in self-assessment practices.

CONCLUSIONS

There is a strong alignment between medical students’ perceptions of self-assessments and formal evaluations, with no significant differences found across institutions or stages of study. Overall, self-assessment was viewed as valuable for boosting confidence, identifying areas for improvement, supporting professional development, and enhancing communication skills. Further exploration of students’ perspectives will offer valuable insights for educators to design effective learning strategies and promote lifelong learning habits among medical students.
Effects of nozzle geometry, compression ratio and cerium oxide nanoparticles on algae biodiesel performance in a VCR diesel engine with hydrogen addition
Authors: Rajendran Arunraj , Maria Panneer Selvam Amala Justus Selvam
Published: December 2024

This paper discusses an exploratory analysis of performance and emissions characteristics of a variable compression ratio (VCR) diesel engine using various compression ratios, nozzle hole configurations, and injection timings. Results will be employed to further elucidate interactions among those parameters as well as their influence upon the operation efficiency and environmental output. An engine was tested on the B20 biodiesel blend from the transesterification of algal oil. The sample, which contained nano-additives with cerium oxide (CeO2) at a concentration of 75 ppm, underwent extensive analysis using scanning electron microscopy and energy dispersive X-ray analysis (FTIR). The study included different compression ratios such as 16:1, 17:1, 18:1, and 19:1, utilizing nozzle designs with hole diameters of 2, 3, 4, and 5 mm. Additionally, it also examines the effects of hydrogen injection at time intervals of 3, 4, and 5 ms, aiming to comprehend the interaction between these parameters and their impact on the performance outcome. The presence of CeO2 75 ppm resulted in a significant reduction in emissions, as well as improved combustion efficiency. The configuration resulted in a 6.1% improvement in brake thermal efficiency (BTE), as well as a decrease in brake specific fuel consumption (BSFC) from 250 g/kWh to 200 g/kWh. Improving the number of holes in the nozzle revealed a drop in the temperature of the exhaust gas up to 250°C. Reduced nitrogen oxide (NOX) emissions and improved cylinder pressure accompanied these decreases, thanks to the increased heat release rates generated by hydrogen addition. The addition of CeO2 nanoparticles to the B20 blended fuel, along with modifications to the nozzle hole design and hydrogen injection, not only reduces emission values but also lowers fuel consumption, lowers exhaust gas temperature (EGT), and improves combustion efficiency.
Noninferiority of Copper Dressings Compared to Negative Pressure Wound Therapy in Diabetic Foot – An RCT Study
Authors: Melamed Eyal A. , Dabbah Jihad , Roth Tohar , Borkow Gadi , Pinzur Michael S.
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

Compare the wound healing rate, cost, and convenience between Negative Pressure Wound Therapy (NPWT) and Copper OxideDressings (COD) in the management of diabetic foot wounds (DFW).

Methods:

A Randomized controlled trial (RCT) lasting three months with 46 Diabetic Foot Wounds (DFW), recovering from infectious episodes that necessitated debridement or partial foot amputation. Patients in whom the wound was stable with resolution of the infection and in whom NPWT was indicated were enrolled in the study: 23 patients in the COD arm and 23 in the control NPWT arm. NPWT was succeeded by Aquacell extra or Granuflex dressings for up to 3 months. The primary endpoint was wound size reduction, assessed by an artificial intelligence program. The study was set as a non-inferiority study with a 20% margin. Secondary endpoints were convenience to the patient and caregiver, and pain, were assessed by visual analog score (VAS); application time (minutes), and calculated cost.

Results:

Twenty-three patients participated in the study in each arm. Seven patients dropped from the study in the NPWT arm and one in the COD group. The initial wound area was 19.9±4.36 and 14.1±2.32 cm2 in the COD and NPWT arms, respectively (p=0.25). Wound size reduction was statistically significant non-inferior of the COD Arm compared to the NPWT (p=0.04) and superior in the last visit (T-test, p=0.032). COD therapy was more convenient for the patients - VAS was 8.44 vs. 5.33; (p=0.002) and the medical personnel (8.29 vs. 6.0; p=0.007) and less painful (1.15 vs. 2.19; p=0.67) compared to NPWT. The COD's mean application time was shorter (8.5 vs. 13.25 minutes; p< 0.001). The cost of COD was calculated to be 84% less than NPWT treatment.

Conclusion:

This RCT study indicates statistically significant non-inferiority of COD dressing therapy than NPWT in terms of wound healing rate of DFW. Better convenience and reduced costs in the COD arm justify initial copper dressing attempts in patients with diabetic foot wounds before NPWT treatment.
Optimizing Total Ankle Arthroplasty Analysis: A Comprehensive Assessment of Alignment and Patient-Reported Outcome Measures via Weight-Bearing CT
Authors: Felipe Albarrán Carlos , Ignacio Escudero Mario , Felipe Muñoz Carlos , Birman Eddie , Letelier Hugo , Chaparro Felipe , Carcuro Giovanni , Jose Pellegrini Manuel
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Osteoarthritis (OA) of the tibiotalar joint is associated with a high degree of morbidity, comparable to the final stages of renal and heart failure. The incidence of OA in the tibiotalar joint is as high as 47.7 per 100,000 inhabitants, most of whom will require surgical intervention to improve their quality of life. To date, there is scarce literature on the alignment in Total Ankle Arthroplasty (TAA) and its implications for patient-reported outcome measures (PROMs). Furthermore, no evidence has yet analyzed the association between alignment assessed with weight-bearing CT (WB-CT) and PROMs.

Methods:

A prospective cohort study was conducted, including all TAAs performed between 2015 and 2023, with a minimum follow-up of 12 months and a WB-CT taken within the first 12 months postoperatively. Revision TAAs, those lost to follow-up, and cases lacking WB-CT in the first 12 months were excluded. The anterior distal tibial angle (ADTA) and medial distal tibial angle (MDTA) were assessed with WB-CT, along with the internal rotational angle of the talar component. TAAs exhibiting an ADTA or MDTA with angles outside the range of normality were considered to have misaligned prostheses. The PROMs were assessed in the preoperative scenario and again at 2 months, 6 months, 1-year and 2-year post-surgery. The association between alignment and PROMs was evaluated using the Mann-Whitney test, while the association between the internal rotation of the talar component and PROMs was analyzed with the Spearman test. Statistical significance was set at p=0.05.

Results:

74 TAAs were included. No statistically significant difference was found between correctly aligned and misaligned prostheses in the ADTA or MDTA and PROMs. However, the internal rotation angle of the talar component showed a statistically significant association with both the vitality component (p = 0.01, rho = -0.52) and the physical function component (p < 0.01, rho = 0.60) of the SF-36 score. Meanwhile, the VAS, AOFAS, FAAM, FAOS, and SMFA showed no statistical association.

Conclusion:

In our cohort of patients with TAA, coronal or sagittal misalignment, as assessed with WB-CT, shows no association with PROMs. It's worth mentioning that PROMs are subjective, multifactorial measures that should be interpreted with caution, and the importance of achieving correct alignment should not be minimized. Although internal rotation of the talar component is associated with better PROMs, to date, no cutoff value has been described, and further efforts should be made to elucidate the optimum internal rotation of the talar component.
Outcomes Following Early Weight Bearing in Syndesmotic Injuries: A Randomized Controlled Trial
Authors: Khaleel Mubinah , Durante Elizabeth C. , Hawkins Sam , Della Rocca Gregory J. , Stannard James P. , Crist Brett D. , Schweser Kyle M.
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Syndesmotic injuries occur in 10% of ankle fractures. Restoration and maintenance of the distal tibiofibular stability is crucial. The literature regarding time to weight bearing is scarce, with the majority recommending greater than 6 weeks of non-weight bearing. No studies examine whether early weight bearing as tolerated is safe in syndesmotic injuries, and current early weight bearing studies after ankle fractures typically exclude syndesmotic injuries.

Purpose:

The purpose of this randomized controlled trial is to measure differences between early weight bearing at 2 weeks and delayed weight bearing at 6 weeks in terms of outcomes, hardware failure, and loss of reduction at 1 year.

Methods:

All rotational ankle fractures in patients over 18 were enrolled preoperatively. Only those who received syndesmotic fixation were randomized post-operatively to early vs delayed weight bearing. No fracture types were excluded. All syndesmotic fixation utilized suture buttons. A total of 39 patients were enrolled. Primary outcome was maintenance of reduction at 1 year comparing post-operative and 1 year CT scan of both ankles. Secondary outcomes included pain scores, surgical experience (SSQ-8), AAOS Foot and Ankle, range of motion, and complications. Data was analyzed using unpaired t-test and Fishers exact. Statistical significance was set at p < 0.05.

Results:

16 patients were randomized to early weight bearing and 23 patients to delayed. The early weight bearing group had a significantly higher pain score (4.69 ± 2.84 vs 2.87 ± 2.31, p = 0.039) at the baseline 2 week visit. At 1 year, dorsiflexion in the early weight bearing group was significantly higher (14.2° ± 3.97° vs 7.71° ± 4.46°) than the delayed group (p = 0.017). There was no significant difference in syndesmotic malreduction, loss of reduction, pain scores, PROs, development of arthritis or complication rates at any other timepoint.

Conclusion:

Early weight bearing is safe following syndesmotic fixation in ankle fractures, at least in those receiving suture button fixation.
Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study
Authors: Li Ying , Li Wenjing
Published: December 2024

Category:

Hindfoot; Arthroscopy

Introduction/Purpose:

The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study is to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis in the treatment of septic ankle and hindfoot arthritis.

Methods:

A retrospective consecutive case-series study was conducted involving 6 patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded.

Results:

The study cohort comprised 2 males and 4 females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (P = .007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (P = .046). All patients had achieved osseous consolidation, with an hindfoot infection control rate of 100%.

Conclusion:

One-stage arthroscopic ankle and TTC arthrodesis with external fixation stands as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.
Outcomes of Pilon Fractures
Authors: Lundeen Anna , Anderson Sarah , Swenson Riley , Nguyen Mai
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

Pilon fractures are debilitating injuries with consequences affecting patients long-term and require unplanned surgical interventions. Post-operative complications such as infection, non-union, and post traumatic osteoarthritis require unplanned surgical interventions and further worsen outcomes. The primary aim of this study was to determine survivorship of the native ankle joint through evaluation of subsequent procedures and complications.

Methods:

A retrospective chart review of pilon fractures was performed within a large healthcare system, including a level one trauma center, from 2010 to 2022. Patients with less than 6 months of follow-up were excluded. The primary outcome, survivorship of the native ankle joint, was determined by collecting ankle fusion, arthroplasty, and amputation data. Demographics, injury characteristics, and comorbidities (diabetes mellitus (DM), vascular disease, smoking status) were collected.

Results:

Our cohort included 386 patients with an average age of 48.5 years, 51.6% were male. 11.4% had DM and 45.1% were smokers. 61.4% had a high energy mechanism and 23.6% were open fractures. Patients had an average of 2.8 operations, including irrigation and debridement, ORIF, bone graft, free flap, hardware removal, and definitive management with arthrodesis, arthroplasty, and amputation. Nonunion, high energy, open fracture, and infection were all associated with unplanned procedures (p< 0.01). 31 patients lost their native ankle, with 11 ankle fusions, 6 total ankle arthroplasty, and 14 amputations. Infection was associated with ankle fusion and amputation (p< 0.01). Those with infection were 15.6x more likely to undergo fusion. Open fractures were associated with amputation (p< 0.01). Diabetes and vascular disease were associated with amputation (p< 0.05).

Conclusion:

This study demonstrates the burden pilon fractures place on patients, with an average of 2.8 operations per patient. With modern surgical technique, joint survivorship is likely for most patients at 92%. Notably, the presence of diabetes, vascular disease, open fracture, and infection were all significantly associated with loss of the native joint. Injury characteristics, such as high energy and open fractures, significantly affect the need for unplanned procedures following these devastating injuries.
Prospective Evaluation of Rate of Hindfoot/Ankle Fusion with Augment Injectable Bone Graft
Authors: Priester Jacob , Kreulen Christopher D. , Shaheen Phillip J. , Giza Eric , Simister Samuel
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Augment® Bone Graft is a mixture of rhPDGF-BB, beta-TCP and bovine collagen which has received FDA approval for use as a substitute for autografts during hindfoot and/or ankle arthrodesis. Although a recent meta analysis demonstrated that the rhPDGF-BB and beta-TCP mixture has comparable CT fusion rates and radiographic union rates to those of autografts, these studies excluded patients with prior joint site arthrodesis. In our study, we specifically use Augment® Injectable Bone Graft (AIBG) which has only very recently received labeling change approval. The goals of our study are to assess fusions rates in patients who receive AIBG during hindfoot and/or ankle arthrodesis, and then subsequently compare fusion rates between primary vs. revision hindfoot and/or ankle arthrodesis as primary outcomes.

Methods:

We prospectively enrolled patients aged 18-85 who underwent subtalar, calcaneocuboid, talonavicular, and/or ankle arthrodesis from one of two academic surgeons including both primary and revisions fusions. The patients received AIBG and were excluded if any other graft material was used. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions.

Results:

62 patients met inclusion criteria, 50 patients had a 4-month postoperative CT scan to assess for fusion with 78% of the CT scans (39 out of 50) demonstrating fusion at that time. There were only 3 revision fusion patients, with 1 of the 3 failing to fuse. 54 of the patients were followed through their 6 month visits, 44 patients through 1 year, and 24 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS, FFI, FAAM, and VR12 showing statistically significant improvement.

Conclusion:

This prospective study demonstrates that Augment® Injectable Bone Graft is an acceptable alternative to allograft for either primary or revision hindfoot arthrodesis procedures with 78% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures. Long term follow up data is being collected.
Prospective Examination of Outcomes Following Implantation with 3D Printed Custom Total Talus for Talar Avascular Necrosis
Authors: Morningstar Joshua L. , Scott Daniel J. , Gross Christopher E.
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

End stage talar avascular necrosis (AVN) is a difficult diagnosis to manage clinically. Management options will vary based on severity and functional goals with current treatments including conservative measures, hindfoot fusions, and total talus replacement (TTR). The induction of three-dimensional (3D) printing and computer-aided design (CAD) into orthopaedic surgery has increased the ability to treat this complex pathology through patient specific 3D printed talus replacements, while sacrificing less range of motion than joint fusions. This purpose of this study is to report prospectively collected clinical and patient reported outcome measures (PROMs) of patients implanted with a custom 3D printed TTR in a multi-institutional prospective study.

Methods:

Patients presenting to clinic for talar avascular necrosis at one of 8 institutions were prospectively enrolled and implanted with a custom 3D printed total talus replacement at both academic and private settings. Patients had demographics, range of motion (ROM), and PROMs collected preoperatively, at 6 weeks, 3 months, 6 months, and 12 months. PROMs included VAS pain score and Foot and ankle outcome score (FAOS). Adverse events were analyzed in patients with minimum 6 weeks of follow-up and the preoperative and follow-up PROMs for patients with minimum 6-month follow-up were analyzed. A total of 18 subjects (17 patients) were enrolled in the study, with all subjects reaching 6 weeks minimum follow-up and 10 patients achieving 6 months of follow-up.

Results:

The cohort was majority male (55.6%) with mean age 46.8±14.65 years and BMI 33.5±7.25 kg/m2. There were no adverse events related directly to the implant at 6-week follow-up. However, there were 2 serious adverse events (complications) documented, one case of wound dehiscence at 5 weeks postoperatively, and one deep wound infection at 2 weeks postoperatively. Subjects pain scores improved at 6 months postoperatively, with VAS scores statistically significantly decreasing (31.3 ± 31.83 points; p=.0222). All FAOS subscales showed significant improvement from preoperative to 6 months postoperatively with the greatest change coming in FAOS QOL (39.8 ± 28.06; p<.0001) followed by FAOS Pain (29.4 ± 25.13; p=.0004). (Table 1) Additionally, at 6 months postoperatively, 90% of patients indicated good or excellent satisfaction.

Conclusion:

Implementation of custom 3D printed total talus replacement was found to have low rates of short-term adverse events and proved to be safe and effective for the treatment of end stage avascular necrosis. Patients were largely satisfied at 6 months postoperatively and showed considerable
Racial Disparities in Outcomes after Foot and Ankle Surgery: A Systematic Review and Meta-Analysis
Authors: Buchanan Scott , Luo Emily Joan , Bagheri Kian , Wu Kevin , Anastasio Albert T. , Adams Samuel B.
Published: December 2024

Category:

Ankle; Midfoot/Forefoot

Introduction/Purpose:

The literature demonstrating outcomes after foot and ankle surgery has traditionally focused on clinical and functional outcomes. Recent interest has increased regarding the contribution of racial and ethnic factors on outcomes after foot and ankle surgery. However, the existing research is limited. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics based on race and ethnicity after foot and ankle surgery.

Methods:

Outcomes after foot and ankle surgery based on race and ethnicity were searched in MEDLINE, Embase, Cochrane, Web of Science, SportsDISCUS, and Scopus from the date of inception to March 23, 2023. Inclusion criteria consisted of studies that directly evaluated the outcomes of race or ethnicity on foot and ankle surgery, including the risk or need for an index procedure. Manuscripts in non-English languages and isolated abstracts were excluded. We collected Visual Analog Scale (VAS), Patient-Reported Outcomes Information System (PROMIS) pain scale, and Short Musculoskeletal Function Assessment (SMFA) from the included studies for pooled meta-analysis.

Results:

The literature search identified 33 relevant studies from an initial pool of 3,451 references. These studies included a diverse demographic of 557,734 patients, assessing outcomes in foot and ankle surgery across various racial and ethnic groups. Due to heterogeneity in outcome reporting, only six studies were included in the finalmeta-analysis. Functional scores from the VAS, PROMIS pain scale, and SMFA varied in their assessment of pain and functional outcomes based on ethnicity. Resource utilization studies indicated disparities in the rates of surgical fixations and arthroplasties based on race.

Conclusion:

Non-White and minority patients exhibited higher rates of foot and ankle fractures, lower limb surgeries, worse functional outcomes, increased pain, longer hospital stays, and a higher incidence of complications compared to their White counterparts. While consistent with existing literature in various orthopaedic specialties, some studies contradicted these findings, suggesting the need for further research to better understand these discrepancies.