bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of A Risk Stratification Scoring System to Predict General Surgical Complications in Foot and Ankle Surgery Patients
Authors: Kisana Haroon , Hui Clayton , Martin John R. , Stecher Chad , Hustedt Joshua
Published: January 2022

Category:

Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; Trauma

Introduction/Purpose:

Preventing postoperative complications is crucial for patients, surgeons, and healthcare facilities. A risk stratification scoring system was created to help optimize risk factors for general surgical complications in foot and ankle surgery patients.

Methods:

A total of 85,363 patients that underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program. Independent risk factors associated with postoperative complications within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for experiencing complications. For validation, the system was tested on a subset of patients from the database who had foot and ankle surgery.

Results:

The 30-day postoperative complication incidence after foot and ankle surgery was 19.1%. Risk factors associated with postoperative complications were tobacco abuse, age (>64), diabetes mellitus, hypertension, elevated creatinine (>1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), and anemia (male hematocrit <42; female <38). Point scores from each factor were: anemia, +7; hypoalbuminemia, +4; hypertension, +4; elevated creatinine, +3; diabetes mellitus, +3; age over 64, +2; and tobacco abuse, +1. In the validation cohort, patients categorized as low risk (0-5), using the point scoring system had a 2.5% rate of 30-day complications; patients categorized as medium risk (6-10) had a 7.5% complication rate (relative risk = 2.0; 95% CI, 1.7-2.3 compared with low risk) and high risk (>=11), 33.1% (relative risk = 3.7; 95% CI, 3.2-4.3).

Conclusion:

This point scoring system predicts risk for general postoperative complications after foot and ankle surgery. These data may help foot and ankle surgeons identify areas of clinical concern with patients to reduce the risk of experiencing postoperative complications.
The Circular Arc Curved Nail for Internal Fixation of Tibio-Talo-Calcaneal Arthrodesis
Authors: Klaue Kaj
Published: January 2022

Category:

Ankle; Ankle Arthritis; Diabetes; Hindfoot; Trauma

Introduction/Purpose:

Normal anatomy demonstrates alignment of the heel, the subtalar facet, the talus, the ankle joint and the distal tibia on a regular curve. This curve lies on a vertical plane which is slightly angulated inwards in relation to the sagittal plane. Today's hindfoot nails are either straight or bent. The hole which accommodates the implant is always straight and thus does not respect the normal alignment of the hindfoot. This technique may cause a plantar neurapraxia, the nail holds poorly the calcaneus and tends to create a hindfoot varus. Purpose of the study is to optimize the technique to

Methods:

A circular arc bore hole crosses the heel, the posterior subtalar facet, the tibio-talar joint and the distal tibia metaphysis. The hole is bored using a motor driven end cutting flexible reamer which is seated within a rigid curved hull. The nail has the exact same shape than the hull and is impacted up to the distal tibia creating a bone-nail form fit. A distal locking screw crossing the subtalar joint and a proximal locking screw within the tibia concludes the central fixation. 47 patients (23 women and 24 men aging 30 to 84 y (mean 52y)) have been treated so far using this technique. The diagnosis was basically primary and post- traumatic arthritis and includes diabetic arthropathies (4 cases) and failed TAR (3 cases). After 2 weeks our patients did practise partial weight bearing using a cam walker for other 6 weeks.

Results:

The mean follow-up time of the patient series is 3 years (16-78 months). Two patients with diabetic arthropathy died 2 years and 8 months and the other 8 months post-op after consolidation of the arthrodesis due to their primary disease. 3 cases sustained a deep infection which requested a below knee amputation in 2 cases and a calcanectomy in another case. Within the remaining 42 cases, 37 consolidated their arthrodesis within 2 months; 5 cases had a delayed union and 2 cases had to be revised for a non-union, one in the ankle, the other one in the subtalar joint. Patients with a good bone quality and anatomical hindfoot axes could bear their body weight entirely at 2 months. 1 patient reported remaining pain at 2 years post-op and another case was additionally operated to correct a remaining midfoot deformity (club foot).

Conclusion:

The tibio-talo-calcaneal arthrodesis can be successfully treated using a central circular arc curved nail respecting a form fit interaction between bone and nail. The anatomical osteo-articular alignment of the hindfoot is corrected or preserved. Due to the safe approaches and the bone-nail form fit, the technique allows for primary stability and prevents shortcomings such as neurological complications and non-union. We expect a shorter period between surgical fixation and full weight bearing.
Minimally Invasive Surgery for Severe Hallux Valgus with Severe Metatarsus Adductus: Case Reports
Authors: Kurashige Toshinori
Published: January 2022

Category:

Bunion; Lesser Toes

Introduction/Purpose:

Metatarsus adductus (MA) is a congenital transverse plane deformity with an incidence of approximately 30% in patients with hallux valgus. Operative treatment of hallux valgus (HV) with MA can be clinically challenging, and the recurrence rate of HV has been reported as two times higher than in patients without MA. Minimally invasive surgery (MIS) for the correction of HV is growing in popularity; however, only one study has been published on MIS for HV with MA using percutaneous proximal metatarsal osteotomy. We presented our case reports using distal oblique metatarsal minimal invasive osteotomy (DOMMO) for severe MA.

Methods:

We corrected two feet using DOMMO for severe MA. Minimally invasive chevron Akin osteotomy (MICA) was utilized to correct severe HV. The patient had subluxations in the second and third metatarsophalangeal joints and hammer toe deformities. Therefore, those deformities were concurrently corrected using percutaneous procedures. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe for 6 weeks. Radiographic and clinical evaluations were performed preoperatively and one year after surgery. On the anteroposterior radiograph, the hallux valgus angles (HVA), the first intermetatarsal angles (IMA), tibial sesamoid positions (TSP) and metatarsus adductusangles (MAA) were evaluated. On the lateral weight-bearing radiograph, first metatarsal inclination angles were also evaluated. We also evaluate the Japanese Society for Surgery of the Foot (JSSF) hallux and lesser toes scales and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) both before and after MIS for HV with MA.

Results:

In the first case, the HVA improved from 50° to 16°, the IMA from 15° to 11°, TSP from 7 to 5 using Hardy's classification, and MAA from 27° to 14.5°, pre- to postoperatively. In the second case, the HVA improved from 45° to 11°, the IMA from 10° to 6.5°, TSP from grade 7 to 3, MAA from 30 to 12, pre- to postoperatively. The first metatarsal inclination angles changed from 16.9° and 18.8° to17.7° and 22.0°, respectively. All subluxations and hammer toe deformities were resolved. Although there were delayed unions in the lesser metatarsals, unions were achieved finally. Preoperative JSSF hallux scales and lesser toes scales were 59 points and 64 points, 67 points and 80 points, respectively. Both hallux and lesser toe scales improved to 100 points one year after surgery. All SAFE-Q subscores were also improved one year after surgery.

Conclusion:

In conclusion, our MIS procedure, consisting of DOMMO of the second, third, and fourth metatarsals and MICA, could correct severe HV with severe MA. The patient was allowed immediate full weight bearing postoperatively in a flat rigid shoe. Although there were delayed unions in lesser metatarsals, unions were finally achieved and good results were demonstrated both radiographically and clinically.
Surgical Outcome of Hindfoot Fusion using a Retrograde Hindfoot Fusion Nail
Authors: Leucht Anna-Kathrin , Veljkovic Andrea N. , Wing Kevin J. , Penner Murray J. , Younger Alastair S.
Published: January 2022

Category:

Hindfoot

Introduction/Purpose:

TTC fusions are often performed as a salvage procedure in patient with severe hindfoot arthritis or hindfoot deformity. Comorbidities in this patient collective are frequent, leading to increased risk of postoperative complication. The purpose of this study was to evaluate the surgical outcome regarding union rate, reoperation rate and adverse events using a retrograde hindfoot fusion nail.

Methods:

Patient records of a single center were retrospectively reviewed in which a retrograde hindfoot fusion nail was utilized for hindfoot fusion between July 1st, 2009 and August 31st, 2018. These records included age, gender, BMI, comorbidities, indications for surgery, non-union, re-operation rates and adverse events related to the surgery. The fusions were performed by 4 fellowship trained foot and ankle surgeons at a tertiary care teaching hospital. 58 cases were identified consecutively, in 51 cases a TTC fusion was performed, in 7 cases a tibiotalar fusion with preexisting talocalcaneal fusion. 22 fusions were arthroscopic and 36 open. The average age of patients was 59 years, the average BMI 29. Main indication for the hindfoot fusion were arthritis (55%) and complex hindfoot deformity (43%).

Results:

An overall union rate of 89.66% was achieved, 5 non-union tibiotalar and 1 non-union tibiotalar + talocalcaneal was documented. In the group of arthroscopic fusion the non-union rate was 9.09%, in the open group 11.11% respectively. The non- union group included patient with elevated BMI (50%), Diabetes mellitus (33%) and smoking (33%). Adverse events were documented in 21%. The reoperation rate was 17%, mostly due to deep infection or wound complication requiring surgical debridement. No patient in the arthroscopic fusion group needed a reoperation due to deep infection or wound complication, whereas in open surgery this rate was 27.78%.

Conclusion:

A union rate of 89.66% was achieved using a retrograde hindfoot fusion nail in a high risk patient population for non- union. Arthroscopic preparation of the tibiotalar and the subtalar joint seem to prevent postoperative wound complications.
What are the Risk Factors for Infection after Operative Treatment of Subtalar Fracture Dislocations?
Authors: Levitt Eli , Patch David A. , Johnson Michael D. , McLynn Ryan , DeBell Henry , Harris James B. , Spitler Clay A.
Published: January 2022

Category:

Ankle; Trauma

Introduction/Purpose:

Subtalar fracture dislocations are a rare hindfoot injury with relatively little evidence to inform surgeons about outcomes and risk factors for complications. Some previously documented poor prognostic factors include lateral and complicated dislocations, total talar extrusions, and concomitant fractures. The mechanism of injury often results from high energy trauma and has been reported as severe inversion (medial dislocation) or eversion (lateral dislocation) of the foot. The purpose of this study was to assess the risk factors associated with deep infection after operative treatment of subtalar fracture dislocations.

Methods:

A retrospective cohort study at a single level 1 trauma center was performed to identify patients who had operative treatment of a subtalar fracture dislocation over an 11 year period (2008-2019). Patients were identified by review of the electronic health record and data collected included patient demographics, injury characteristics, and treatment choices. Deep infection was defined as return to the operating room for debridement. Minimum follow-up for inclusion was 3 months. Descriptive analyses (means, medians, standard deviations, ranges, frequency distributions) were used to assess and describe the group. Chi-square tests of association and independent-sample t tests were used to assess differences between the infected group and those without infection.

Results:

A total of 154 met criteria for this study. The most common associated fractures were talus (47%) and calcaneus (33%). Approximately every 1 in 8 patients (12.3%) patients developed a deep infection. The infected group was older (47.2 vs 39.5 years, p=0.03). Tobacco users were found to have a significantly higher rate of postoperative deep infection (74 vs 34%, aOR=7.4, 95% CI, 2.3-24.1, p=0.001). There was a significantly higher proportion of infection in patients with Gustilo-Anderson type 3 open fractures (32 vs 12%, aOR=5.7, 95% CI, 1.6-20.3, p=0.007). The infected group had a higher proportion of below the knee amputation (47 vs 1%, p<0.001).

Conclusion:

Infection after operative management of subtalar fracture dislocations can be devastating, with 47% of infected patients requiring amputation. Risk factors for infection after subtalar fracture dislocation include older age, smoking, type 3 open fracture, and freshwater contamination. Ultimately demographic and injury characteristics seem to drive the risk of infection in subtalar fracture dislocations.
Screws Only Primary Subtalar Arthrodesis for Calcaneus Fractures
Authors: Macknet David M. , Bloomer Ainsley , Mcknight Richard , Johnson Nicholas , Yu Ziqing , Seymour Rachel , Hsu Joseph R.
Published: January 2022

Category:

Hindfoot; Trauma

Introduction/Purpose:

The initial management of displaced intraarticular calcaneus fractures (DIACFs) is a difficult problem. The results of open reduction internal fixation (ORIF) have been disappointing. Alternatively, ORIF with primary subtalar arthrodesis (PSTA) has gained increasing popularity. The purpose of this study is to review patient-centered and radiographic outcomes of ORIF plus PSTA using screws alone through a sinus tarsi approach.

Methods:

A retrospective study of all patients from 2013-2019 who underwent ORIF+PSTA for DIACFs was conducted. The same surgical technique was utilized in all cases consisting of only screws, no plates were utilized. Delayed surgeries past 8 weeks were excluded. Demographic and radiographic data was collected. Worker's compensation (WC) claims were noted and analyzed separately. Plain radiographs were assessed preoperatively and post-operatively and Sander's classification was used to characterize injuries. Patient reported outcomes (PROs), complications, and need for revision surgeries was also noted and analyzed at final follow-up.

Results:

In total, forty-eight DIACFs underwent PSTA with a median follow-up of 194 days. Median time to weight-bearing was 60 days post-operatively. Three fractures were documented as Sanders II, 22 as Sanders III, and 23 as Sanders IV. Seventy-five percent of the WC group returned to work compared to just 58.3% in the non-WC group (p=0.0003). Patients in the WC group were more likely to have had an abnormal pre-operative Bohler's angle (p=0.047) but the two groups did not differ significantly in postoperative Gissane or Bohler angles. Nearly 85% (N=41) achieved >=2 zones of fusion on radiographs by final follow up and 95.8% (N=46) had at least one. Four patients had a complication and 3 required a return to the operative room.

Conclusion:

Utilizing Screws only primary subtalar arthrodesis for the treatment of DIACFs through a sinus tarsi approach shows promising results with high rates of return to work and fusion, even in the workers' compensation population.
Hammertoe Correction with Wire Fixation of Varying Length
Authors: Mayolo Patrick , Kress Kristin L. , Kang Paul , Jaffe David E.
Published: January 2022

Category:

Midfoot/Forefoot; Lesser Toes

Introduction/Purpose:

Hammertoe deformities are commonly encountered and frequently require surgical intervention for pain relief and shoewear accommodation. Various techniques exist for surgical management, but proximal interphalangeal (PIP) joint fusion with Kirschner (K) -wire fixation remains an inexpensive, popular treatment. The decision to place a K wire that spans the metatarsophalangeal (MTP) joint versus only fixating the digit through the proximal phalanx is entirely dependent on provider preference and situational context. This study was performed to evaluate the effect of length of wire fixation on clinical outcomes after hammertoe reconstruction.

Methods:

A retrospective review of all hammertoe reconstructions by a single fellowship trained foot and ankle surgeon from 2017-2021 was performed. Hammertoe reconstructions involved PIP arthrodesis with double wire fixation and other supplemental balancing procedures as indicated. Pins were routinely removed at between 5-6 weeks and protected heel weightbearing was generally advised. Wire length was chosen at the discretion of the surgeon intraoperatively. Patients were excluded if no radiographic follow-up was available after pin removal. Patient outcomes were evaluated with radiographs and clinic notes to assess pin length, pin complications/breakage, return to the OR, MTP congruency, and PIP union rate. A logistic regression was performed to determine the odds ratio for digit congruency and non-union status.

Results:

88 toes (45 patients) underwent hammertoe reconstruction with K wire fixation. Of these toes, 47 had wires that spanned the MTP and 41 that did not. There were 65 congruent MTP joints and 23 incongruent joints. 16 of the incongruent joints were pinned across the MTP while 31 in the congruent group were pinned. One toe in the MTP group required return to the OR for removal of a broken wire, compared to zero in the phalanx group (p=1.0). No pins broke in the phalanx group, compared to 3 in the MTP group (p=0.25). One toe in the proximal phalanx group had their pins pull out early but no return to the OR was needed. There were 26 (63.4%) PIP radiographic nonunions, compared to 21 (44.7%) in the MTP group (p=0.12).

Conclusion:

Wire failure was a rare occurrence in either group. Breakage only occurred in the MTP group, but only required one surgical intervention for removal. Pinning the MTP may allow for improved deformity correction and increased stability of the hammertoe reconstruction. Pin breakage can occur, but it may be of little clinical significance. The increased stability and control of MTP correction may be worth the potential risk of pin breakage. Pin breakage may be avoided potentially by using thicker wires, earlier removal, and protected weightbearing.
Changes in Plantar Forces and Pressures During Functional Movement with an Intrepid Dynamic Exoskeletal Orthosis Brace
Authors: Meeker James E. , Weiss Jason , Thompson Austin R. , Feng Jing
Published: January 2022

Category:

Ankle; Ankle Arthritis; Midfoot/Forefoot; Trauma

Introduction/Purpose:

Non-surgical interventions such as bracing using ankle foot orthoses (AFO) aim to assist, restore and redirect weightbearing forces with immobility in mind. We identified a custom carbon fiber specific energy storing AFO that was created to improve functional performance in veterans after limb salvage procedures. While being evaluated exclusively in a veteran population, the Intrepid Dynamic Exoskeletal Orthosis (IDEO) has also been indicated to be a conservative treatment option for veterans with posttraumatic osteoarthritis of the tibiotalar and subtalar joints. To evaluate the off-loading properties of the IDEO brace in a civilian population with osteoarthritis of the ankle.

Methods:

Eight civilian patients 18-years or older who were prescribed an IDEO brace by a single surgeon participated in the study. Foot pressure data were recorded using Tekscan F-Scan system, an ultra-thin, in-shoe sensor that provides force and pressure information. Participants were instructed to walk at a self-selected pace along a 20 meter walkway under three conditions. Using F-Scan Research software, the stances were identified and averaged. Then, the forefoot and heel areas were identified. Next, the maximal force, force*time integral (FTI), maximal contact area, maximal contact pressure, pressure*time integral (PTI), and center of force (COF) excursion were calculated. One-way ANOVA with repeated measures was performed to detect effects of the condition (three levels: Without, Under and Over). Pairwise comparison with least significant difference (equivalent to no adjustments) was performed to detect difference among the conditions.

Results:

Compared to the Without condition, the Under condition showed higher pressure in both the heel and the forefoot areas (especially in the forefoot) in most subjects; COF excursion was increased in some subjects. Compare to the Without condition, the Over condition showed reduced pressure in both the heel and the forefoot areas (especially in the forefoot) in most subjects. The statistical results below only included the involved side of the six subjects who were tested in all three conditions. Table 1 showed the results of one-way ANOVA with repeated measures of the six subjects.

Conclusion:

The results of this study showed that the IDEO is effective in improving gait function and relieving forefoot pressure in the civilian population. IDEO generated force (and thus power), especially in the forefoot area in late stance, to provide more push-off power and propel the body moving forward. While acting as a functional foot, the IDEO reduced force by 66% and reduced pressure by 49% in the forefoot area, which helped to relieve pain. IDEO creates functional foot by storing power in the early stance and release power in late stance.
Clinical Outcomes of Nano Arthroscopy in the Office Setting for the Treatment of Posterior Ankle Impingement
Authors: Mercer Nathaniel P. , Samsonov Alan , Dankert John , Delmonte Rick J. , Stornebrink Tobias , Gianakos Arianna L. , Kerkhoffs Gino , Kennedy John G. , Dahmen Jari
Published: January 2022

Category:

Ankle; Arthroscopy

Introduction/Purpose:

The hypothesis of the current study was that IONA in the treatment of posterior ankle impingement would provide the patient with a unique experience of their pathology and facilitate their rapid recovery through an awareness of their own condition and that using IONA would accelerate recovery to sports-specific activities compared to standard arthroscopic procedures.

Methods:

This was a retrospective cohort study investigating patients who underwent IONA for posterior ankle impingement between 2019 and 2020. Clinical outcomes were evaluated using the following methods preoperatively and at final follow-up: The Foot and Ankle Outcome Scores (FAOS) and Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Intensity domains. A five-point Likert scale regarding patient satisfaction was evaluated at final follow-up. Wilcoxon signed-rank test was performed to compare preoperative and postoperative outcome scores.

Results:

Ten patients were included in this study, which included 4 males and 6 females with a mean age of 41.9 +- 15.5 years (range, 24-66 years) and a mean body mass index (BMI) of 28.3 +- 6.3 kg/m2 (range, 17.1 - 39.9). The mean follow-up time was 13.3 +- 2.9 months (range, 11-17 months). The mean PROMIS Pain Intensity T-score significantly decreased from 57.5 +- 8.4 preoperatively to 49.5 +- 5.5 at final follow-up (p<0.001). The mean PROMIS Pain Interference T-score decreased from 69.0 +- 5.8 preoperatively to 63.1 +- 5.8 at final follow-up (p<0.001). There were 7 patients who participated in sports activity prior to the IONA-arthroscopy procedure. Of those, 7 patients (100%) returned to their sports activities. The median time to return to sports was 4.1 weeks (range, 1 to 14 weeks). Lastly, 10 patients (100%) expressed willingness to undergo the same procedure again.

Conclusion:

The current study demonstrates that IONA treatment of posterior ankle impingement results in significant pain reduction, a low complication rate and excellent patient-reported outcomes with high rates of return to work/sport. Additionally, IONA for posterior ankle impingement leads to high patient satisfaction with a significant willingness to undergo the same procedure again.
Outcomes of Endoscopic Treatment for Plantar Fasciitis: A Systematic Review
Authors: Mercer Nathaniel P. , Ward Leona , Hoberman Alexander , Cronin Joseph J. , Hurley Eoghan T. , Kennedy John G.
Published: January 2022

Category:

Other

Introduction/Purpose:

Endoscopic plantar fascia release (EPFR) is an established operative treatment for recalcitrant plantar fasciitis. The purpose of this systematic review is to provide a comprehensive review on the outcomes of endoscopic plantar fascia release in the treatment of plantar fasciitis at mid- and long-term follow-up.

Methods:

A systematic review was performed using, MEDLINE, EMBASE, and Cochrane library databases in May 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies included were evaluated with regards to the level of evidence (LOE) and quality of evidence (QoE) using the Coleman methodological score. Clinical outcomes and complications were also evaluated.

Results:

Twenty-five studies including 729 feet were included in this systematic review with a mean follow-up of 25.1 months. 18 papers used the American Orthopaedic Foot & Ankle Society (AOFAS) score. The weighted mean preoperative AOFAS score was 55.6 and the postoperative score was 89.6 out of 100. The total number of patients who had complications was 117 of 729 (16.1%). The most common complication was a recurrence of pain experienced by 6.5% of patients (47 of 117).

Conclusion:

Endoscopic plantar fascia release provides good clinical and functional outcomes in patients with refractory plantar fasciitis. However, this procedure is associated with a moderately high complication rate.
The Infected Diabetic Foot: A Microbiological Analysis
Authors: Waldecker Ute
Published: January 2022

Category:

Basic Sciences/Biologics; Diabetes

Introduction/Purpose:

Diabetic foot infections show increasing prevalence. Their therapy is time consuming and expensive. Standardized antibiotic treatments do not exist. Suboptimal antibiotic therapy increases the morbidity of the patient. The aim of the study was to evaluate the dominating bacterial colonization in the diabetic foot. Furthermore we evaluated the changes of the colonization during surgical and antibiotic treatment and the efficiency of the therapy.

Methods:

The study included 100 patients with a diabetic foot syndrome and a pedal ulcer. Ulcers were classified according to Wagner Classification. HbA1c, CRP and patients BMI were documented. All patients underwent an angiologic investigation with arterial doppler ultrasonography and TcpO2 measurement. An MRI of the affected foot was performed to rule out osteomyelitis. All patients underwent surgical and antibiotic treatment. Surgery included debridement, abscess drainage, VAK therapy, bony resection, minor amputation, resection arthroplasty, Helal osteotomies. Osteomyelitis was pathologically verified. Microbiological results of superficial and deep smears, which were taken during the surgical therapy were analyzed. The antibiotic treatment was adapted to the bacterial resistance.

Results:

The duration of antibiotic treatment varied from 1 to 136 days (Mean:19.6 days, SD:17.3 ). The mean number of surgical interventions was 2.6. The dominating initial antibiotic treatment was Clindamycin/ Cefuroxim (48%) followed by Clindamycin (11%),Cefuroxim (7%), Clindamycin/ Ciprofloxacin (6%), Tazobactam (3%). The dominating bacteria were gram +. The difference of the percentage distribution compared to the gram- bacteria was statistically significant. The only significant percentage change of the antibiotic treatment was seen after the first surgical intervention, when the initial antibiotic treatment was significantly more effective against gram - bacteria. A change of the antibiotic treatment was seen with 1. Clindamycin / Ciprofloxacin in 66%, 2. Tazobactam in 67%, 3.Clindamycin in 36% and Clindamycin/ Cefuroxim in 35%.

Conclusion:

The dominating bacteria of the infected diabetic feet were gram +. The initial i.v. antibiotic treatment with Clindamycin/ Cefuroxim was effective in 66%. An optimization of the initial antibiotic treatment with greater focus on the gram + bacteria seems to be necessary.
InGreens: The Road Ahead
Authors: Goswami Munmun
Published: January 2022

This case is based on the company InGreens, which is an agri-mobile platform, one which works in connecting the rural B2C and G2F service space (those related to agriculture—soil health card, farm insurance, online licensing for seeds, pesticides, fertilizers, etc.). It was incubated from Science and Technology Entrepreneurs’ Park (STEP), IIT Kharagpur and supported by the Government of West Bengal. The key motive was helping the farmers and the agricultural process as a whole, using technology for better and efficient connectivity between the government people and the farmers, on a real-time basis. They were facing dilemma on the ways to expand their functioning, through their third-party recruits (Gram Doots) and the case brings forth these challenges. InGreens was planning to utilize the reach of the Gram Doots for venturing into rural m-commerce, in the agricultural as well as the consumer products sectors. The case was written keeping in mind the students of HRM and entrepreneurship.
Playing With a Purpose: The Impact of Therapeutic Recreation During Hospitalization
Authors: Hoag Jennifer A. , Bingen Kristin , Karst Jeffrey , Palou Akasha , Yan Ke , Zhang Jian
Published: January 2022

Background: Youth undergoing cancer treatment and hematopoietic stem cell transplant (HSCT) spend significant time in the hospital, which is disruptive to their physical, social, and emotional development. Therapeutic recreation (TR) can help individuals with an illness maintain or improve their health, quality of life, and physical functioning. TR is an understudied intervention, particularly with youth in the hospital setting. Methods: Forty-nine children (median age = 12 years, interquartile range [IQR] 11–15 years) hospitalized for cancer treatment or HSCT were assigned to participate in either the historical control or TR intervention. Participants wore a Fitbit charge HR for three days to measure movement. At the end of the study participation, they completed self-report measures of mood, social connectedness, and health-related quality of life. Results: Compared with historical controls, the TR intervention group had improved positive affect and decreased mood disturbance ( p = 0.03); had better sleep quality ( p = 0.003); and was more satisfied with the leisure activities offered in the hospital ( p = 0.01). There were no differences in the number of steps taken per day, somatic distress, cooperation with cares, or interaction with medical personnel or caregivers. Both groups reported poor availability and support of peer companions. Discussion: TR is one avenue to increase leisure activities and positively impact mood. More thought needs to be given to how TR programs can be leveraged to increase physical activity and social connectedness.
Early intestinal microbial features are associated with CD4 T-cell recovery after allogeneic hematopoietic transplant
Authors: Miltiadous Oriana , Waters Nicholas R. , Andrlová Hana , Dai Anqi , Nguyen Chi L. , Burgos da Silva Marina , Lindner Sarah , Slingerland John , Giardina Paul , Clurman Annelie , Armijo Gabriel K. , Gomes Antonio L. C. , Lakkaraja Madhavi , Maslak Peter , Scordo Michael , Shouval Roni , Staffas Anna , O’Reilly Richard , Taur Ying , Prockop Susan , Boelens Jaap Jan , Giralt Sergio , Perales Miguel-Angel , Devlin Sean M. , Peled Jonathan U. , Markey Kate A. , van den Brink Marcel R. M.
Published: January 2022

Low intestinal microbial diversity is associated with poor outcomes after allogeneic hematopoietic cell transplantation (HCT). Using 16S rRNA sequencing of 2067 stool samples and flow cytometry data from 2370 peripheral blood samples drawn from 894 patients who underwent allogeneic HCT, we have linked features of the early post-HCT microbiome with subsequent immune cell recovery. We examined lymphocyte recovery and microbiota features in recipients of both unmodified and CD34-selected allografts. We observed that fecal microbial diversity was an independent predictor of CD4 T-cell count 3 months after HCT in recipients of a CD34-selected allograft, who are dependent on de novo lymphopoiesis for their immune recovery. In multivariate models using clinical factors and microbiota features, we consistently observed that increased fecal relative abundance of genus Staphylococcus during the early posttransplant period was associated with worse CD4 T-cell recovery. Our observations suggest that the intestinal bacteria, or the factors they produce, can affect early lymphopoiesis and the homeostasis of allograft-derived T cells after transplantation.
Genome insights into the pharmaceutical and plant growth promoting features of the novel species Nocardia alni sp. nov
Authors: Nouioui Imen , Ha Sung-min , Baek Inwoo , Chun Jongsik , Goodfellow Michael
Published: January 2022

Background

Recent studies highlighted the biosynthetic potential of nocardiae to produce diverse novel natural products comparable to that ofStreptomyces, thereby making them an attractive source of new drug leads. Many of the 119Nocardiavalidly named species were isolated from natural habitats but little is known about the diversity and the potential of the endophytic nocardiae of root nodule of actinorhizal plants.

Results

The taxonomic status of an actinobacterium strain, designated ncl2T, was established in a genome-based polyphasic study. The strain was Gram-stain-positive, produced substrate and aerial hyphae that fragmented into coccoid and rod-like elements and showed chemotaxonomic properties that were also typical of the genusNocardia. It formed a distinct branch in theNocardia16S rRNA gene tree and was most closely related to the type strains ofNocardia nova(98.6%),Nocardia jiangxiensis(98.4%),Nocardia miyuensis(97.8%) andNocardia vaccinii(97.7%). A comparison of the draft genome sequence generated for the isolate with the whole genome sequences of its closest phylogenetic neighbours showed that it was most closely related to theN. jiangxiensis, N. miyuensisandN. vacciniistrains, a result underpinned by average nucleotide identity and digital DNA-DNA hybridization data. Corresponding taxogenomic data, including those from a pan-genome sequence analysis showed that strain ncl2Twas most closely related toN. vacciniiDSM 43285T. A combination of genomic, genotypic and phenotypic data distinguished these strains from one another. Consequently, it is proposed that strain ncl2T(= DSM 110931T= CECT 30122T) represents a new species within the genusNocardia, namelyNocardia alnisp. nov. The genomes of theN. alniandN. vacciniistrains contained 36 and 29 natural product-biosynthetic gene clusters, respectively, many of which were predicted to encode for a broad range of novel specialised products, notably antibiotics. Genome mining of theN. alnistrain and the type strains of its closest phylogenetic neighbours revealed the presence of genes associated with direct and indirect mechanisms that promote plant growth. The core genomes of these strains mainly consisted of genes involved in amino acid transport and metabolism, energy production and conversion and transcription.

Conclusions

Our genome-based taxonomic study showed that isolate ncl2Tformed a new centre of evolutionary variation within the genusNocardia.This novel endophytic strain contained natural product biosynthetic gene clusters predicted to synthesize novel specialised products, notably antibiotics and genes associated with the expression of plant growth promoting compounds.
Transcriptional and physiological data revealed cold tolerance in a photo-thermo sensitive genic male sterile line Yu17S
Authors: Pan Xiaoxue , Guan Ling , Lei Kairong , Li Jingyong , Zhang Xianwei
Published: January 2022

Background

Rice is highly sensitive to chilling stress during the seedling stage. However, the adaptable photo-thermo sensitive genic male sterile (PTGMS) rice line, Yu17S, exhibits tolerance to low temperatures. Currently, the molecular characteristics of Yu17S are unclear.

Results

To evaluate the molecular mechanisms behind cold responses in rice seedlings, a comparative transcriptome analysis was performed in Yu17S during seedling development under normal temperature and low temperature conditions. In total, 9317 differentially expressed genes were detected. Gene ontology and pathway analyses revealed that these genes were involved mostly in photosynthesis, carotenoid biosynthesis, carbohydrate metabolism and plant hormone signal transduction. An integrated analysis of specific pathways combined with physiological data indicated that rice seedlings improved the performance of photosystem II when exposed to cold conditions. Genes involved in starch degradation and sucrose metabolism were activated in rice plants exposed to cold stress treatments, which was accompanied by the accumulation of soluble sugar, trehalose, raffinose and galactinol. Furthermore, chilling stress induced the expression of phytoene desaturase, 15-cis-ζ-carotene isomerase, ζ-carotene desaturase, carotenoid isomerase and β-carotene hydroxylase; this was coupled with the activation of carotenoid synthase activity and increases in abscisic acid (ABA) levels in rice seedlings.

Conclusions

Our results suggest that Yu17S exhibited better tolerance to cold stress with the activation of carotenoid synthase activity and increasing of ABA levels, and as well as the expression of photosynthesis-related genes under cold condition in rice seedlings.
Community perspective on family medicine and family physician in Saudi Arabia 2020
Authors: Murad Manal Abdulaziz , Kheimi Rawan Maatouk , Toras Mohammed Majdi , Alem Rahaf Hussain , Aljuaid Atheer Meshal , Alobaidan Jafar Naji , Binishaq Hebah Yousef , Asiri Abdulrahman Ahmed , Sagga Manar Khalid
Published: January 2022

Background

Despite the importance and advantages of family medicine, it has poorly developed in Arab communities when compared to other medical specialties. Therefore, in this study, we aim to investigate the perception of the Saudi population about family medicine and physicians.

Materials and methods

A cross-sectional study was carried out using a self-administered structured online survey tool through the Google Forms platform. The online questionnaire was distributed to all Saudi Arabia’s residents aged more than 15 years. A predesigned questionnaire was used and included items collecting data about participants’ sociodemographic characteristics, awareness/knowledge, and experience/attitudes.

Results

A total of 6974 valid participants were included in the current study, where the age group 25–35 years (37.1%) and 51.7% of them were females. Out of the included participants, 81.3% (n = 5671) did not report any chronic illnesses, while the other 18.7% (n = 1303) did. The mean awareness and knowledge score for all participants was 9.57 ± 3.39 (out of 20 possible points), while the mean experience and attitude score for all participants was 10.15 ± 2.58 (out of 16 possible points). Patients’ perceptions, whether awareness and knowledge or experience and attitude scores, were significantly correlated (P-value < 0.001) to chronic illness status, being a healthcare worker, job, marital status, and gender factors. Moreover, experience and attitude score was additionally correlated to residence region (P-value = 0.034) and participants’ nationality (P-value< 0.001).

Conclusion

General population in Saudi Arabia were aware about the importance of family physicians and they trust them. The identified predictors should be considered when trying to increase public awareness and enhance the experience with family physicians.
A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain
Authors: Sharifi Neda , Bahri Narjes , Hadizadeh-Talasaz Fatemeh , Azizi Hoda , Nezami Hossein , Tohidinik Hamid Reza
Published: January 2022

Background

Uterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women.

Methods

This single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue  scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05.

Results

The median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001).

Conclusion

The results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.
Protection effect of thymosin β4 on ethanol injury in corneal stromal keratocyte
Authors: Liu Jinghua , Guo Chen , Hao Peng , Wang Peihong , Li Linghan , Wang Yuchuan , Li Xuan
Published: January 2022

Purpose

To investigate the protective effects of thymosin β4 (Tβ4) on ethanol injured human corneal keratocytes (HCKs).

Methods

HCKs and BALB/c mice were chosen as the study subject. Ethanol was used to treat the cells and corneal stroma of mice to build the ethanol injured model in vitro and vivo respectively. CCK-8 was used to evaluate the cell metabolic activity. DCFH-DA was used to detect the intracellular reactive oxygen species level. TUNEL was chose to detect the cell apoptosis rate. The cell proliferation and migration were investigated by using wound healing insert. Wound healing of corneal surface and stroma was observed by using fluorescein sodium eyedrop and HE stain. RT-qPCR, ELISA, and immunostaining were performed to detect gene and protein expression in keratocytes or corneal stroma tissue of mice.

Results

Ethanol induced oxidative stress injury and cell apoptosis on HCKs, and Tβ4 can alleviate it by up-regulating the expression of Bcl-2, catalase, and CuZnSOD, and inhibiting the expression of Caspase-3. Tβ4 promotes the proliferation of HCKs and the process of corneal wound healing. It may relevant to the up-regulated expression of Ki67.

Conclusions

Our study established an ethanol-injured corneal stroma model in both vitro and vivo. The present study confirmed that Tβ4 play a protective effect on the reconstruction process of ethanol-injured corneal stroma.
Corneal endothelial regeneration in human eyes using endothelium-free grafts
Authors: Ying Lu-Yi , Qiu Wen-Ya , Wang Bing-Hong , Zhou Ping , Zhang Bei , Yao Yu-Feng
Published: January 2022

Background

To report on corneal endothelial regeneration, graft clarity, and vision recovery when using endothelium-free grafts.

Methods

We evaluated the donor’s cell viability using trypan blue staining and dual staining with calcein acetoxy methyl ester and ethidium homodimer-1. To preserve eyeball integrity, we performed therapeutic penetrating keratoplasty using cryopreserved donor tissue without endothelium on 195 consecutive patients who suffered from corneal perforation due to progressive primary corneal disease such as herpes simplex keratitis, fungal keratitis, ocular thermal burns, keratoconus, and phlyctenular keratoconjunctivitis. Of these, 18 eyes recovered corneal graft clarity and underwent periodic slit-lamp microscopy, A-scan pachymetry, and in vivo confocal microscopy to observe the clinical manifestations, variations in corneal thickness, and repopulation of the corneal endothelial cells on the donor grafts.

Results

No viable cells were detected in the cryopreserved corneas. After the therapeutic penetrating keratoplasty, notable corneal graft edema was observed in all 18 eyes for 1–4 months, and no corneal endothelial cells were detected on the grafts during this period. Thereafter, we observed gradual and progressive regression and final resolution of the stromal edema, with complete recovery of corneal graft clarity. Through periodic confocal microscopy, we observed the corneal endothelium’s regenerating process, along with single cells bearing multiple nuclei and cell division-like morphology. The regenerated endothelium on the grafts reached a mean cell density of 991 cells/mm2. Remarkable vision rehabilitation was achieved in all 18 patients.

Conclusions

We obtained conclusive evidence that host-derived endothelial cells can regenerate a new endothelium over the endothelium-free graft, which possesses normal functions for corneal clarity and vision recovery.
Grandi Byen—supporting child growth and development through integrated, responsive parenting, nutrition and hygiene: study protocol for a randomized controlled trial
Authors: Kohl Patricia L. , Gyimah Emmanuel A. , Diaz Jenna , Kuhlmann F. Matthew , Dulience Sherlie Jean-Louis , Embaye Fithi , Brown Derek S. , Guo Shenyang , Luby Joan L. , Nicholas Jennifer L. , Turner Jay , Chapnick Melissa , Pierre Joseline Marhone , Boncy Jacques , St. Fleur Rony , Black Maureen M. , Iannotti Lora L.
Published: January 2022

Background

Poor child growth and development outcomes stem from complex relationships encompassing biological, behavioral, social, and environmental conditions. However, there is a dearth of research on integrated approaches targeting these interwoven factors. The Grandi Byen study seeks to fill this research gap through a three-arm longitudinal randomized controlled trial which will evaluate the impact of an integrated nutrition, responsive parenting, and WASH (water, sanitation and hygiene) intervention on holistic child growth and development.

Methods

We will recruit 600 mother-infant dyads living in Cap-Haitien, Haiti and randomize them equally into one of the following groups: 1) standard well-baby care; 2) nutritional intervention (one egg per day for 6 months); and 3) multicomponent Grandi Byen intervention (responsive parenting, nutrition, WASH + one egg per day for 6 months). Primary outcomes include child growth as well as cognitive, language, motor, and social-emotional development. The study also assesses other indicators of child health (bone maturation, brain growth, diarrheal morbidity and allergies, dietary intake, nutrient biomarkers) along with responsive parenting as mediating factors influencing the primary outcomes. An economic evaluation will assess the feasibility of large-scale implementation of the interventions.

Discussion

This study builds on research highlighting the importance of responsive parenting interventions on overall child health, as well as evidence demonstrating that providing an egg daily to infants during the complementary feeding period can prevent stunted growth. The multicomponent Grandi Byen intervention may provide evidence of synergistic or mediating effects of an egg intervention with instruction on psychoeducational parenting and WASH on child growth and development. Grandi Byen presents key innovations with implications for the well-being of children living in poverty globally.

Trial registration

NCT04785352. Registered March 5, 2021 at https://clinicaltrials.gov/