bluuebunny/crossref_metadata_2025 huggingface dataset:
The Evans Osteotomy without Fixation Does Not Increase the Nonunion Rate
Authors: Materon Solangel Rodriguez , Gallagher Brian P. , Miles Megan , Mathew Smitha E. , Mansur Nacime Salomao Barbachan , Dai Amos , Alkaramany Eslam , Guyton Gregory P.
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

The Evans osteotomy is a lateral column lengthening procedure of the calcaneus that is commonly used in the correction of flexible flatfoot deformities. Currently, there is no consensus on whether fixation is necessary when performing this osteotomy. The primary aim of this study was to determine the nonunion rate of an unfixed Evans osteotomy with use of an allograft wedge performed in patients undergoing flexible flatfoot reconstruction. The secondary aim was to report on the incidence and magnitude of calcaneocuboid (CC) joint subluxation.

Methods:

a retrospective chart review was done for a consecutive series of 145 feet in 137 patients who underwent Evans osteotomy as part of a flatfoot reconstruction with allogenic bone graft between January 2013 and October 2017, by a single fellowship-trained foot and ankle surgeon. Of those, 118 cases were available for analysis at a mean follow up of 62.5 weeks (SD 56.9). No fixation was used in any case. Time to union, estimated by clinical and plane radiographic evaluation was recorded, along with standard measures of deformity correction and CC joint subluxation.

Results:

There was only one nonunion 1/118 (0.84%) at final follow up. The mean time to union was 10.9 weeks (SD 1.56). Postoperative calcaneocuboid joint subluxation occurred in 50.8% of feet, with a mean of 1.51 mm, SD 2.3 mm and no correlation with wedge size (r=0.05, p=0.55). The mean wedge size was 7.1 mm , SD 1.4 mm (range, 5-12 mm). There was no correlation between wedge size and change in lateral column length (r=0.13, p=0.16). There was significant change between pre and postoperative calcaneal pitch, talonavicular uncoverage percentage, anteroposterior and lateral talo-first metatarsal angle, medial and lateral column height, and lateral column length (p < 0.05).

Conclusion:

Evans osteotomy without fixation for symptomatic flatfoot deformity resulted in an exceptionally low nonunion rate. CC joint subluxation occurred frequently but was small in magnitude, a finding that may be related to the relatively small size of the wedges used.
The Impact of Each Burr Pass on Gap Size and Hindfoot Alignment in Minimally Invasive Zadek Osteotomy
Authors: Karaismailoglu Bedri , Nassour Nour , Duggan Jessica L. , Peiffer Matthias , Ghandour Samir , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil , Miller Christopher P.
Published: December 2024

Category:

Hindfoot; Sports

Introduction/Purpose:

While MIS Zadek osteotomy offers numerous advantages, it does come with a significant drawback as it impedes the direct measurement of the planned resection, depending solely on the surgeon's perception. This reliance can result in either insufficient or excessive resection of the calcaneus. The aim of this study is to elucidate the impact of each burr pass on the extent of correction, gap size, and calcaneal morphology following MIS Zadek osteotomy.

Methods:

en cadaveric specimens devoid of apparent foot pathology underwent a minimally invasive Zadek osteotomy utilizing a 3.1 mm Shannon burr. The osteotomy initiation point was anterior to the attachment of the calcaneal plantar fascia, preserving the plantar cortex and extending dorsally to the anterior aspect of the posterosuperior tubercle of the calcaneus. Following each burr pass, the created defect was closed and maintained in a reduced state during subsequent burr passes. This sequence was reiterated five times, and neutral lateral x-rays were captured before and after each burr pass to quantify the impact of individual passes. Measurements were calibrated using markers placed during radiological examination. These measurements encompassed the defect size formed with each burr passage, determined by the change (shortening) in the overall length of the dorsal calcaneal cortex. Additionally, alterations in various foot alignment parameters were assessed, including Böhler angle, Calcaneal X/Y ratio, and Fowler Philip angle.

Results:

The dorsal calcaneal cortical length exhibited an average reduction with each burr pass as follows: 2.1 mm during the 1st pass, 1.9 mm during the 2nd pass, 1.6 mm during the 3rd pass, 1.2 mm during the 4th pass, and 0.9 mm during the 5th pass. The Böhler Angle (°), X/Y Ratio (%), and Fowler Philip Angle consistently decreased with each successive burr passage.

Conclusion:

Our research showcased that employing a percutaneous 3.1 mm burr in Zadek osteotomy sequentially can result in a 10 mm dorsal wedge size after 5 burr passes. The calcaneal geometry, assessed through the X/Y ratio, Fowler-Philip angle, and Böhler angle, exhibited gradual alterations with each burr pass. The insights gained from this study offer valuable information for foot surgeons, deepening their comprehension of the influence of each burr pass on gap size and foot alignment parameters in minimally invasive Zadek osteotomy.
The Impact of GLP-1 Agonist Therapy in Tibiotalar and Subtalar Fusion: A Propensity-Matched Analysis
Authors: Levidy Michael , Vatsia Sohrab , Tucker Scott , Rowe Nicholas , Aynardi Michael , MacDonald Ashlee
Published: December 2024

Category:

Diabetes; Ankle

Introduction/Purpose:

The rising prevalence of obesity and diabetes mellitus have rendered the usage of GLP-1 agonists increasingly commonplace since their introduction in 2005. Foot and ankle surgeons consistently provide orthopedic care to diabetic patients through tibiotalar and subtalar fusion. There is, however, a dearth of evidence to suggest whether outcomes of ankle fusion differ in patients treated with GLP-1 agonists. This study retrospectively compares rates of infection and failed fusion in patients who underwent tibiotalar or subtalar fusion with and without concurrent GLP-1 agonist therapy.

Methods:

The TriNetX Diamond Network was queried using CPT and ICD codes for patients with diabetes mellitus undergoing tibiotalar or subtalar fusions from 2005 to 2024. Diagnosis codes occurring within 1 year of the index procedure for: infection following a procedure (T81.4) and pseudoarthrosis after attempted fusion (M96.0) were compared using chi-squared statistical testing. Cohort balancing was performed categorically according to age at procedure, race, sex, and nicotine dependence. Cohort balancing was performed continuously for index BMI, Hemoglobin A1C, estimated Glomerular Filtration Rate (eGFR). Significance was set at p< 0.05 with associated 95% confidence intervals.

Results:

Overall, two propensity-matched cohorts of 708 patients were included in our analysis. Cohorts were not significantly different across any of the balancing parameters (p>.05). The postoperative infection rate was found to be significantly higher in the GLP-1-treated group (9.0%) than the non-treated group (5.6%) (p=0.02). No statistical significance was observed in the rate of postoperative pseudoarthrosis amongst patients who underwent fusion with (9.0%) and without (12.0%) GLP-1 agonist usage (p=0.08).

Conclusion:

Although GLP-1 agonists have provided significant benefit in the treatment of obesity and diabetes mellitus, results of this study suggest a previously unreported risk of postoperative infection associated with GLP-1 agonist use following ankle arthrodesis. Further investigation is needed GLP-1 agonists' effects on foot and ankle surgery. It is our hypothesis that previously demonstrated anti-inflammatory properties attenuate immune response and predispose patients to postoperative infection. Past inquiries have also demonstrated reduced osteoclast activity with GLP-1 agonist administration. Therefore, we suspect that decreased osteoclast activity at fusion margins may disrupt resorption of heat-necrosed bone, leaving a nidus for infection.
The Use of AI For Hallux Valgus Assessment via Mobile Phone-Based 3D Camera Scan
Authors: Ghandour Samir , Lebedev Anton , Tung Wei Shao , Semianov Konstantin , Semyanov Artem , Guss Daniel , Waryasz Gregory R. , Kwon John Y. , Skolnik Jennifer , DiGiovanni Christopher W. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil
Published: December 2024

Category:

Bunion; Other

Introduction/Purpose:

Hallux valgus (HV) is a prevalent forefoot deformity that leads to pain, stiffness, and difficulties with footwear. Conventional diagnosis of HV relies on clinical and radiographic examination, which can be cumbersome and expose patients to ionizing radiation. The emergence of 3D scanning technologies, such as structured light, integrated into smartphones, presents a novel approach to early detection and diagnosis of HV, potentially allowing for earlier intervention and subsequent reduction in the progression of the deformity.

Methods:

This prospective non-randomized clinical trial recruited patients from the foot and ankle clinic, identifying cases and controls based on the presence or lack of clinically diagnosed HV. Patients older than 18 years of age and able to consent were included. The 3D scanning of the foot utilized structured light technology integrated into smartphones, with an algorithm developing a surrogate angle for HV detection. This angle was correlated with conventional radiographic measurements, including hallux valgus angle (HVA) and intermetatarsal angle (IMA) from weightbearing radiographs. A cluster analysis assessed the algorithm’s capacity to identify deformity severity according to radiographic severity grading. The algorithm's accuracy and performance were assessed using the area under the receiver operating characteristic curve, precision-recall Curves, and the leave-one-out cross-validation method.

Results:

120 patients were enrolled in this trial. Out of 240 feet examined, HV was present in 29.1% of cases. The algorithm's surrogate angle showed a robust correlation with the clinical hallux valgus angle (HVA), with a correlation coefficient of 0.91 and a specificity of 0.882. Notably, the surrogate angle's correlation with the intermetatarsal angle (IMA) was also significant, albeit lower (r = 0.65). The area under the ROC curve (AUC) was 0.947, and the precision-recall AUC scores for positive and negative classes were 0.89 and 0.92, respectively. These metrics confirmed the algorithm's potential as a reliable diagnostic tool for detecting HV and determining its severity through non-invasive, commonly available smartphone technology.

Conclusion:

This study validates the accuracy of a smartphone-based 3D scanning algorithm in detecting and grading HV deformity, providing a low-cost, accessible decision-support tool for physicians and patients. This approach could improve early detection, reduce the need for clinical visits, and potentially expand to remote monitoring of HV and other pathologies, aligning with the growing trend of telemedicine and personalized healthcare.
Trends in Management of Adult Tarsometatarsal Joint Injuries in a Contemporary Australian Context: A Nationwide Study of Claims Data Over 20 Years
Authors: Wines Andrew , Fung Mitchell , Sivakumar Brahman , Jiang Eric , Suthersan Mayuran , Mittal Rajat , Symes Michael
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Traumatic tarsometatarsal joint (TMTJ) injuries are uncommon, but can cause significant morbidity due to delayed or missed diagnosis. Recent evidence highlights the importance of achieving anatomical reduction via operative management. This study aims to analyse trends in rates of open reduction internal fixation (ORIF) for Lisfranc inju- ries in Australia according to Nationwide claims data.

Methods:

Claims according to the Medicare Benefits Schedule (MBS) on ORIF of trau- matic TMTJ injuries were collated for the period from January 2000 to December 2020. Paediatric patients were excluded. Two negative binomial models were utilized to analyse the trends in TMTJ injuries over time after controlling for sex, age group and population changes. Results were absolute and per 100 000 population.

Results:

7840 patients underwent TMTJ ORIF over the period studied. There was a mean yearly increase of 12% (P < 0.001). Age group (P < 0.001) and year (P < 0.001) were sig- nificant predictors for TMTJ fixation, whilst sex was not (P = 0.48). Patients older than 65 years were noted to have a 53% lower rate of TMTJ ORIF per person, when compared to the reference group of 25–34 year-olds (P < 0.001). Five-year block analysis revealed increases in rate of fixation for all age groups.

Conclusion:

Rates of operative fixation for TMTJ injuries are increasing in Australia. This is likely due to improved diagnostics, understanding of optimal treatment goals, and increased orthopaedic subspecialisation. Further studies with clinical and patient reported outcomes, as well as comparing rates of operative intervention to incidence, will be useful.
Utilization of Neural Network in the Diagnosis of Pes Planus and Pes Cavus with a Smartphone Camera
Authors: Ghandour Samir , Lebedev Anton , Tung Wei Shao , Semianov Konstantin , Semyanov Artem , Guss Daniel , Waryasz Gregory R. , Kwon John Y. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Bejarano-Pineda Lorena
Published: December 2024

Category:

Midfoot/Forefoot

Introduction/Purpose:

Pes Planus (flatfoot) and Pes Cavus (high arch) are common foot deformities requiring clinical assessment and radiographic imaging for diagnosis and subsequent management. While effective, traditional diagnostic methods pose limitations such as cost, radiation exposure, and accessibility, particularly in underserved areas. With the advent of artificial intelligence and its integration into mobile cameras, we aim to develop a tool that detects and classifies such deformities using photos taken with smartphone cameras.

Methods:

An algorithm that integrated a deep learning, convolutional neural network (CNN) into a smartphone camera was utilized to detect Pes planus and Pes cavus deformities. The study was conducted at a tertiary hospital with participants recruited from two orthopaedic foot and ankle clinics. The CNN model was trained and tested using photographs of the medial aspect of participants’ feet. Participants included subjects with standard foot alignment, pes planus, or pes cavus determined by an expert clinician using the Foot Posture Index (FPI). The model’s performance was compared to clinical assessment and radiographic measurements, including the lateral tarsal-first metatarsal angle (LTMA) and calcaneal inclination angle (CIA).

Results:

The CNN model demonstrated high accuracy in diagnosing Pes planus and Pes cavus, with an optimized area under the curve of 0.897 for Pes Planus and 0.898 for Pes cavus. It showed a specificity and sensitivity of 84% and 87% for Pes Planus detection, respectively; for Pes cavus, 97% and 70%, respectively. The model’s prediction correlated moderately and significantly with radiographic LTMA measurements (r=-0.65, P< 0.001), indicating the model’s excellent reliability in assessing food arch deformity.

Conclusion:

Our smartphone-based CNN model is highly accurate as a decision-support tool, and it is reliable and accessible for predicting Pes planus and Pes cavus deformities. This tool may be very useful in underserved healthcare settings and for patients with limited access to expert clinical assessment. Future efforts should enhance this technology for pediatric use and improve severity differentiation, paving the way for more personalized and inclusive healthcare solutions.
What Are These Cysts Doing in My Graft?! A Meta-Analysis on Cystic Occurrence after Autografting and Allografting for Osteochondral Lesions of the Talus
Authors: Dahmen Jari , Hollander Julian , Butler James J. , Emanuel Kaj , Rikken Quinten , Stufkens Sjoerd , Kennedy John G. , M.M.J. Kerkhoffs Gino M
Published: December 2024

Category:

Sports; Arthroscopy

Introduction/Purpose:

Graft transplantation is a widely used treatment for large osteochondral lesions of the talus. However, cyst formation surrounding the graft is of concern. The primary purpose was to assess and compare cystic occurrence after autografting, allografting and osteoperiosteal grafting for osteochondral lesions of the talus. Our secondary aim was to assess correlation of clinical outcomes with the presence of postoperative cysts.

Methods:

A literature search was performed up to October 2023 through PubMed, Embase (Ovid), and Cochrane Library. The primary outcome was the postoperative cystic occurrence rate. A random effects model with moderator analysis was used to calculate differences in occurrence rates between treatment groups. The relationship between the presence of cysts and clinical outcomes was additionally described.

Results:

Thirteen studies were included with 382 ankles that were radiologically assessed at follow-up after osteochondral autograft, allograft, and osteoperiosteal transplantation. The rates of cystic occurrence for the osteochondral autograft transplantation group, the allograft transplantation group, and the osteoperiosteal transplantation group were 42% (95% CI 24-61), 58% (95% CI 40-74), and 34% (95% CI 12-67), respectively, without any significant differences noted between these treatment groups. Six studies studied the relationship between the presence of cysts and clinical outcomes: none of these studies found a significant relationship between these two variables.

Conclusion:

Postoperative cystic occurrence is common after osteochondral autograft transplantation (42%), allograft transplantation (58%), and osteoperiosteal transplantation (34%) in osteochondral lesions of the talus – without significant intertreatment differences. The postoperative presence of cysts was not correlated with clinical outcomes.
Genetic subtypes of B-cell acute lymphoblastic leukemia in adults
Authors: Passet Marie , Kim Rathana , Clappier Emmanuelle
Published: December 2024

B-cell acute lymphoblastic leukemia (B-ALL) is a rare malignancy in adults with outcomes remaining poor, especially compared to children. Over the past two decades, extensive whole-genome studies have identified numerous genetic alterations driving leukemia, leading to the recognition of more than 20 distinct subtypes which are closely associated with treatment response and prognosis. In pediatric B-ALL, large correlation studies have made genetic classification a central component of risk-adapted treatment strategies. Notably, genetic subtypes are unevenly distributed according to age, and the spectrum of genetic alterations and their prognostic relevance in adult B-ALL have been less extensively studied, with treatment primarily based on the presence or absence of BCR::ABL1 fusion. This review provides an overview of genetic subtypes in adult B-ALL, including recent biological and clinical insights in well-established subtypes as well as data on newly recognized subtypes. Their relevance for risk classification, disease monitoring and therapeutic management, including in the context of B-cell-directed therapies, is discussed. This review advocates for continuing efforts to further improve our understanding of the biology of adult B-ALL to establish the foundation of future precision medicine in B-ALL.
How I Diagnose and Treat Acute Infection-associated Purpura Fulminans
Authors: Bendapudi Pavan K , Losman Julie-Aurore
Published: December 2024

Purpura fulminans (PF) is a rare but devastating complication of sepsis characterized by a highly thrombotic subtype of disseminated intravascular coagulation (DIC). A medical emergency, PF cases often require the involvement of consultant hematologists to assist with diagnosis and management of patients who are in a highly dynamic and deteriorating clinical situation. Patients who survive past the first 24 to 72 hours often die from complications of unchecked thrombosis rather than from shock, and survivors are usually left with severe scarring and tissue loss. Despite these challenging features, PF is a pathophysiologically distinct, homogenous, and highly predictable form of sepsis-associated DIC for which poor outcomes are not a foregone conclusion. The fundamental pathologic lesion in PF is a failure of the anticoagulant protein C pathway, which leads to uncontrolled microvascular clotting and inadequate protein C-mediated cytoprotective effects, which are vital for survival in sepsis. Herein, we review the clinical features and diagnosis of PF. Drawing from the existing clinical literature and from recent advances in our understanding of the pathophysiology of PF, we describe rationally-designed treatment approaches for this disorder, including repletion of natural circulating anticoagulants, use of therapeutic anticoagulation, and ways to optimize transfusion support, and we outline specific interventions that we would recommend avoiding.
Role of tranexamic acid via intravenous and irrigation fluid route in controlling TURP-associated bleeding
Authors: Kundargi Vinay S. , Patil Santosh , Patil Siddanagouda B. , Vaidya Manoj K. , Patil Basavesh S. , Shariff A. Nawaz , Shukla Vikas
Published: December 2024

Background

This study aims to evaluate the efficacy and safety of tranexamic acid (TXA) administered via the I/V (Intravenous) route and irrigation fluid route during TURP to directly target the bleeding site.

Methods

A total of 105 cases undergoing bipolar–TURP with gland size 40–100 g were randomized into three groups—control/placebo group (n = 35), I/V group (n = 35) (received 1gm TXA 20 min before the procedure) and irrigation group (n = 35) (received 500 mg TXA in every 3000 ml irrigation fluid up to a maximum of 2 g). Blood loss was estimated by recording haemoglobin and hematocrit at 4 h after the procedure and on first postoperative day. Other parameters such as resection time, intraoperative endoscopic vision, irrigation fluid volume and complications were noted.

Results

When measured at 4 h postoperatively, the drop in haemoglobin and haematocrit, respectively, was maximum in the control group (ΔHb = 0.78 g/dl, ΔHCT = 1.23%) followed by the irrigation group (ΔHb = 0.51 g/dl, ΔHCT = 0.72%) and was least in the I/V group (0.27 g/dl, 0.62%). The intergroup analysis showed significant difference only between the control vs I/V group (ΔHb p = 0.0163, ΔHCT p = 0.0253).

On postoperative day 1, the drop in haemoglobin and haematocrit, respectively, was maximum in the control group (1.10 g/dl, 1.63%) followed by the irrigation group (0.828 g/dl, 0.911%) and was least in the I/V group (0.811 g/dl, 0.948%). The intergroup analysis showed significant difference between the control vs irrigation group (ΔHb p = 0.026, ΔHCT p = 0.0001) and control vs I/V group (ΔHb p = 0.016, ΔHCT p = 0.0003).

Total resection time, average volume of irrigation fluid and average postoperative stay were comparable. No significant complications were observed.

Conclusions

TXA, given either via I/V or irrigation fluid route, reduces postoperative blood loss associated with TURP. Both routes are superior to placebo, but neither is superior to the other. TXA via the intravenous route also reduces intraoperative blood loss, but the same advantage is not observed with administration through irrigation fluid. TXA via either route has no impact on endoscopic vision. Both routes of administration are safe with no reported side effects.
GPs’ perspectives on care models integrating medical and non-medical services in primary care—a representative survey in Germany
Authors: Herrmann Wolfram J. , Napierala Hendrik
Published: December 2024

Background

Health-related social problems are common in primary care. Different care models integrating medical and non-medical services in primary care have been tested and established nationally and internationally, such as social prescribing, social work in primary care, health kiosks and integrated primary care centres. The aim of our study was to explore the perspective of general practitioners (GPs) working in Germany on these four care models regarding their meaningfulness and if they would like to use them. Secondary objective was to explore factors influencing this assessment.

Methods

We conducted a survey of a representative sample of GPs working in Germany. The questionnaire included questions on the assessment of the care models’ meaningfulness and whether the GPs would like to use them. The analysis was carried out descriptively and using linear regression.

Results

One thousand four hundred thirty-nine GPs took part in the survey. Social prescribing and social work in primary care were rated as the most meaningful concepts. Over 65% of the GPs believed that using at least one of the care models would be beneficial. One in four GPs would even welcome the idea of integrating their practice into an integrated primary care center. Older age and male gender were associated with a more negative assessment of the care models.

Conclusions

German GPs consider integrating medical and non-medical services in primary care to be meaningful, yet they are somewhat skeptical about its practical implementation in daily practice. However, younger GPs in Germany are significantly more receptive to these models.

Trial registration

German Register of Clinical Studies (DRKS-ID: DRKS00032585; Registration Date: September 1, 2023).
Mismatch repair, p53, and L1 cell adhesion molecule status influence the response to chemotherapy in advanced and recurrent endometrial cancer
Authors: Kim Jung Chul , Ahn Byungsoo , Lee Yong Jae , Nam Eun Ji , Kim Sang Wun , Kim Sunghoon , Kim Young Tae , Park Eunhyang , Lee Jung-Yun
Published: December 2024

Objective

This study aimed to identify the recurrence and survival rates according to the mismatch repair (MMR), p53, and L1 cell adhesion molecule (L1CAM) status in patients with advanced and recurrent endometrial cancer (EC) receiving systemic chemotherapy.

Methods

This single-center retrospective cohort study included chemotherapy-naïve patients with advanced-stage (III/IV) or recurrent EC between January 2015 and June 2022 (n = 156), who were administered chemotherapy as adjuvant therapy or first-line palliative treatment. MMR and p53 status were assessed, and L1CAM was tested using immunohistochemistry in the p53-wild and MMR-proficient (p53wt/pMMR) group. The primary outcomes were progression-free survival (PFS) and overall survival (OS).

Results

Of the 156 patients, 62 (39.7%), 53 (34.0%), and 41 (26.3%) had p53wt/pMMR, abnormal p53 (p53abn), and MMR-deficient (dMMR) tumors, respectively. PFS and OS were longest in dMMR, followed by p53wt/pMMR, and were the least in p53abn tumors (PFS: p = 0.0006, OS: p = 0.0013). After p53wt/pMMR was classified according to positive or negative L1CAM status, the L1CAM negative group exhibited significantly shorter survival rates than the L1CAM positive group (PFS: p = 0.0001, OS: p = 0.0027). p53abn tumors were independent prognostic factors for poor PFS (PFS: p = 0.039 on multivariable analysis).

Conclusion

In chemotherapy-naïve patients with advanced and recurrent EC, there was a better prognosis in the order of MMR-D, p53wt/pMMR, and p53abn tumors after chemotherapy. L1CAM status is useful as a new marker to stratify p53wt/pMMR in advanced and recurrent groups.
Delayed spontaneous resolution of a double anterior chamber following deep anterior lamellar keratoplasty (DALK)
Authors: Luangprasert Poramaporn , Jongkhajornpong Passara , Lekhanont Kaevalin , Nonpassopon Manachai , Chuckpaiwong Varintorn
Published: December 2024

Background

This study reports a rare case of delayed spontaneous resolution of double anterior chambers (AC) resulting from non-rhegmatogenous Descemet membrane detachment (DMD) after deep anterior lamellar keratoplasty (DALK). Currently, management guidelines for this condition have not been established.

Case presentation

A 65-year-old woman with lattice corneal dystrophy underwent uncomplicated DALK, during which an unrecognized type 2 big bubble was present. On postoperative day 1, a total DMD was observed, and descemetopexy was attempted. After an unsuccessful air-filled descemetopexy, we opted for observation without further intervention. Spontaneous reattachment of Descemet membrane with a clear cornea was achieved at 3 months postoperatively. The endothelial cell count was 2,165 cells/ mm2.

Conclusions

The spontaneous resolution of double AC in patients with DMD without visible perforation after DALK suggests that a “wait and observe” approach can be a reasonable and effective management strategy.
The use and operationalization of “structural stigma” in health-related research: A scoping review
Authors: Eschliman Evan L. , Kisanga Edwina P. , Huang Long Jie , Poku Ohemaa B. , Genberg Becky L. , German Danielle , Murray Sarah M. , Yang Lawrence H. , Kaufman Michelle R.
Published: December 2024

Background

Research that investigates the negative health effects of stigma beyond the individual and interpersonal levels is increasingly using the concept of “structural stigma.” This scoping review investigates how the concept of “structural stigma” has been used and operationalized in health-related literature to date in order to characterize its usage and inform future operationalizations.

Methods

A systematic search and screening process identified peer-reviewed, English-language research articles that used the term “structural stigma” available prior to January 1, 2024 in five databases (i.e., PubMed, PsycINFO, Embase, Web of Science, CINAHL).

Results

Of the 298 articles identified, over half (53%) were published from 2021 onward. Articles most commonly were set in the United States (n = 163, 55%), investigated stigma toward sexual minority people (n = 163, 55%), and cited the introduction of a special issue of Social Science & Medicine as their source of the concept (n = 84, 28%). Most articles (64%) used at least one additional conceptual framework, most commonly minority stress theory (n = 107, 36%). Quantitative operationalizations (n = 102) engaged most in the conceptual domain of laws and government-level policies, while qualitative operationalizations (n = 68) engaged most with institutional (i.e., non-government-level) policies, practices, and procedures.

Conclusions

As the use of “structural stigma” is increasing, operationalizations can better leverage the concept’s breadth and account for individuals’ intersectional lived experiences. This will necessitate bridging across methodologies and bodies of research on related negative social processes.
Health care assistant and registered nurse dyads, working together and apart – a qualitative study
Authors: Carroll Rachael E. , De Vries Kay , Goodman Claire , Brown Jayne
Published: December 2024

Background

This study was undertaken to understand the role of the Health Care Assistants and how they negotiate roles and responsibilities with Registered Nurses in adult acute hospitals.

Methods

The qualitative approach of focused ethnography used non-participant observation and interviews with staff from four acute wards. Field notes and interview data, analysed using NVIVO10, moved data from description through explanation, interpretation and identification of themes.

Results

148 h of observations and 108 interviews were conducted in dyads comprising 22 Health Care Assistants and 33 Registered Nurses. Health Care Assistants worked non-dependently from, and inter-dependently with Registered Nurse dyad partners. Dyads relied on demarcation of responsibilities by task, established and reinforced by ward culture. Demarcation enabled Registered Nurses to oversee care but could create false divides between observing and recording patients’ conditions and interpreting findings. Interdependent working only happened when two staff members were needed for care. Involvement in fundamental care by the Registered Nurse was unpredictable and discretionary. There was limited evidence of how dyads supported person-centred approaches.

Conclusion

The physically-boundaried, close working of the Health Care Assistant and Registered Nurse had an isolating, task driven impact on Health Care Assistants’ work. Recognising the dyad did not foster shared goals, learning or review of care.
Trends in initial pharmacological COPD treatment in primary care (2010–2021): a population-based study using the PHARMO Data Network
Authors: Rodrigues Guilherme , Antão Joana , Deng Qichen , Baak Brenda N. , Marques Alda , Franssen Frits M. E. , Spruit Martijn A.
Published: December 2024

Background

Pharmacological treatment is a cornerstone of chronic obstructive pulmonary disease (COPD) management, with general practitioners providing the most care. However, the lack of data on prescribing trends in initial pharmacotherapy in primary care hinders the understanding of how scientific and technical developments impact patient care and may also perpetuate suboptimal practices. Hence, this study aims to analyze trends in the initial pharmacological treatment of newly diagnosed COPD patients in Dutch primary care from 2010 to 2021.

Methods

A repeated cross-sectional study was conducted via the PHARMO GP Database. Data were extracted from the electronic health records of individuals managed by general practitioners in the Netherlands within the PHARMO Data Network. Individuals aged ≥ 40 years at diagnosis with an International Classification of Primary Care code for COPD (R95) were included. Initial pharmacological treatment was identified based on the first prescription issued within 90 days postdiagnosis. The annual proportions of individuals receiving a specific treatment among those diagnosed were calculated and directly standardized by age and sex according to the 2021 Dutch population structure. Trend analysis was performed via joinpoint regression.

Results

A total of 54,628 COPD patients were included (median [IQR] age: 65 [57–73]; 53.7% male), with 36.4% not receiving respiratory medication within 90 days of diagnosis, and 4.2% on other treatments. Trend analysis revealed that LAMA monotherapy increased from 13.4% in 2010 to 15.1% in 2015 and then declined to 11.0% by 2021. Moreover, LABA-ICS decreased from 17.6% to 8.5% between 2010 and 2018, after which it plateaued. In contrast, LABA-LAMA sharply increased, from 0.6% in 2010 to 9.6% in 2021. LABA monotherapy increased from 2.6% in 2010 to 5.7% in 2021. Triple therapy has remained constant. For reliever-only therapies, SABA increased from 8.5% in 2010 to 14.3% in 2018 and then stabilized, whereas SAMA and SABA-SAMA remained low throughout.

Conclusions

Shifts in initial pharmacological COPD treatment from 2010 to 2021 likely reflect the introduction of new inhalers and updated management strategies. However, a significant proportion of patients remain without GP prescriptions, which warrants further investigation.
Google trend analysis of the Indian population reveals a panel of seasonally sensitive comorbid symptoms with implications for monitoring the seasonally sensitive human population
Authors: Gahlot Urmila , Sharma Yogendra Kumar , Patel Jaichand , Ragumani Sugadev
Published: December 2024

Seasonal variations in the environment induce observable changes in the human physiological system and manifest as various clinical symptoms in a specific human population. Our earlier studies predicted four global severe seasonal sensitive comorbid lifestyle diseases (SCLDs), namely, asthma, obesity, hypertension, and fibrosis. Our studies further indicated that the SCLD category of the human population may be maladapted or unacclimatized to seasonal changes. The current study aimed to explore the major seasonal symptoms associated with SCLD and evaluate their seasonal linkages via Google Trends (GT). We used the Human Disease Symptom Network (HSDN) to dissect common symptoms of SCLD. We then exploited medical databases and medical literature resources in consultation with medical practitioners to narrow down the clinical symptoms associated with four SCLDs, namely, pulmonary hypertension, pulmonary fibrosis, asthma, and obesity. Our study revealed a strong association of 12 clinical symptoms with SCLD. Each clinical symptom was further subjected to GT analysis to address its seasonal linkage. The GT search was carried out in the Indian population for the period from January 2015–December 2019. In the GT analysis, 11 clinical symptoms were strongly associated with Indian seasonal changes, with the exception of hypergammaglobulinemia, due to the lack of GT data in the Indian population. These 11 symptoms also presented sudden increases or decreases in search volume during the two major Indian seasonal transition months, namely, March and November. Moreover, in addition to SCLD, several seasonally associated clinical disorders share most of these 12 symptoms. In this regard, we named these 12 symptoms the “seasonal sensitive comorbid symptoms (SSC)” of the human population. Further clinical studies are needed to verify the utility of these symptoms in screening seasonally maladapted human populations. We also warrant that clinicians and researcher be well aware of the limitations and pitfalls of GT before correlating the clinical outcome of SSC symptoms with GT.
The plasma metabolome of juvenile idiopathic arthritis varies according to subtype and underlying inflammatory status
Authors: Kwon Jooa , Neeland Melanie R. , Ellis Justine A. , Munro Jane , Saffery Richard , Novakovic Boris , Mansell Toby
Published: December 2024

Background

Juvenile idiopathic arthritis (JIA) is challenging to classify and effectively monitor due to the lack of disease- and subtype-specific biomarkers. A robust molecular signature that tracks with specific JIA features over time is urgently required, and targeted plasma metabolomics may reveal such a signature. The primary aim of this study was to characterise the differences in the plasma metabolome between JIA patients and non-JIA controls and identify specific markers of JIA subtype. We also assessed the extent to which these signatures are due to underlying inflammation as assessed by glycoprotein acetyls (GlycA) and high-sensitivity C-Reactive Protein (hsCRP) levels.

Methods

Targeted nuclear magnetic resonance (NMR) metabolomic profiles of plasma of 72 children with JIA and 18 controls were assessed cross-sectionally. Associations between 71 metabolomic biomarkers and JIA, JIA subtype, disease activity status, and inflammation markers (GlycA and hsCRP) were assessed using multivariable linear regression models.

Results

JIA was associated with higher GlycA (mean difference = 0.93 standard deviations, 95% confidence interval = [0.370, 1.494], Padj = 0.039) and docosahexaenoic acid (1.06, [0.51, 1.60], Padj = 0.021), and lower acetate (-0.92, [-1.43, -0.41], Padj = 0.024) relative to controls. This variation was largely driven by systemic JIA (sJIA), with 24 of 71 total biomarkers significantly different (Padj <0.05) relative to controls. There were no specific differences identified in oligoarticular (oJIA) or polyarticular (rheumatoid factor positive or negative) JIA relative to controls. Despite being generally highly correlated with hsCRP (r > 0.70), GlycA, but not hsCRP, was positively associated with active disease in sJIA (0.22, [-0.40, -0.04], Padj = 0.018), and 6 of 24 sJIA-associated markers were associated with GlycA levels. Only 1 sJIA-associated biomarker, histidine, was associated with hsCRP levels.

Conclusion

Differences in the plasma NMR metabolomic profiles are apparent in children with sJIA, but not other JIA subtypes, relative to non-JIA controls. These findings suggest a potential utility for classifying and monitoring JIA through metabolomic profiling, with chronic inflammation, measured by GlycA, potentially playing a role in at least some of these metabolomic differences.
Unlocking genome-based prediction and selection in conifers: the key role of within-family prediction accuracy illustrated in maritime pine (Pinus pinaster Ait.)
Authors: Papin Victor , Gorjanc Gregor , Pocrnic Ivan , Bouffier Laurent , Sanchez Leopoldo
Published: December 2024

Key message

Based on experimental and simulated data for maritime pine (Pinus pinaster Ait.) in a genomic selection context, our study reveals that the often-highlighted equivalence between genome-based and pedigree-based prediction accuracies of breeding values is associated with a zero accuracy of genome-based prediction within families, which can be attributed to the still insufficient size of the genomic training sets for conifers.

Context

Genomic selection is a promising approach for forest tree breeding. However, its advantage in terms of prediction accuracy over conventional pedigree-based methods is unclear and within-family accuracy is rarely assessed.

Aims

We used a pedigree-based model (ABLUP) with corrected pedigree data as a baseline reference for assessing the prediction accuracy of genome-based model (GBLUP) at the global and within-family levels in maritime pine (Pinus pinaster Ait).

Methods

We considered 39 full-sib families, each comprising 10 to 40 individuals, to constitute an experimental population of 833 individuals. A stochastic simulation model was also developed to explore other scenarios of heritability, training set size, and marker density.

Results

Prediction accuracies with GBLUP and ABLUP were similar, and within-family accuracy with GBLUP was on average zero with large variation between families. Simulations revealed that the number of individuals in the training set was the principal factor limiting GBLUP accuracy in our study and likely in many forest tree breeding programmes. Accurate within-family prediction is possible if 40–65 individuals per full-sib family are included in the genomic training set, from a total of 1600–2000 individuals in the training set.

Conclusions

The increase in the number of individuals per family in the training set lead to a significant advantage of GBLUP over ABLUP in terms of prediction accuracy and more clearly justify the switch to genome-based prediction and selection in forest trees.
High genetic gains in wood volume and fecundity can be both achieved by direct selection in half-sib families of Pinus yunnanensis Franch
Authors: Gao Chengjie , Li Zhongmu , Li Jin , Cui Kai
Published: December 2024

Key message

This study demonstrates the potential of Pinus yunnanensis Franch. for multi-trait selection in breeding programs, highlighting positive co-variation of growth traits with fecundity, trunk straightness, and crown health in 16-year-old progenies. Integrated trait selection could enhance wood productivity and seed yield, supporting both commercial and ecological goals in reforestation efforts.

Context

The genetic improvement of P. yunnanensis, a species widely used for reforestation in Southwest China, is essential due to its economic importance and adaptability to harsh environments. Despite its extensive use, studies on mature trees are limited, particularly in multi-trait selection involving fecundity and trunk quality.

Aims

This study aimed to characterize phenotypic variation among and within provenances of P. yunnanensis, explore relationships among key traits, and evaluate the feasibility of joint selection for growth, fecundity, and trunk straightness.

Methods

We evaluated nine phenotypic traits in 3467 plus-tree progenies from six provenances in a common garden setting. Using structural equation modeling and “random forest” analysis, we identified key predictors of cone production and trunk straightness and assessed trait interrelationships.

Results

Significant phenotypic variations were observed among and within provenances of P. yunnanensis, with intra-provenance variation accounting for most of the total variation. Notably, 16.2% of trees exhibited twisted trunks, leading to a 14.9% decrease in wood volume compared to trees with straight trunks. The top 20% of individuals contributed 87.8% of total cone production, indicating substantial variation in fecundity. Growth, crown size, and crown health positively correlated with fecundity and trunk straightness, with tree height and diameter being the most important predictors. Both pairwise and multivariate analyses revealed significant and positive relationships among growth, fecundity, and crown health, suggesting high potential for multi-trait selection.

Conclusion

This study supports the feasibility of combined selection to optimize wood productivity, cone production, and crown health in breeding programs. These findings provide a valuable foundation for refining P. yunnanensis breeding strategies that meet the dual demands of economic utility and environmental adaptation in a changing climate.
Live Akkermansia muciniphila boosts dendritic cell retinoic acid synthesis to modulate IL-22 activity and mitigate colitis in mice
Authors: Liu Hongbin , Huang Ruo , Shen Binhai , Huang Chongyang , zhou Qian , Xu Jiahui , Chen Shengbo , Lin Xinlong , Wang Jun , Zhao Xinmei , Guo Yandong , Ai Xiuyun , Liu Yangyang , Wang Ye , Zhang Wendi , Zhi Fachao
Published: December 2024

Background

The interplay between gut microbiota and immune responses is crucial in ulcerative colitis (UC). Though Akkermansia muciniphila (Akk) shows therapeutic potential, the mechanisms remain unclear. This study sought to investigate differences in therapeutic efficacy among different forms or strains of Akk and elucidate the underlying mechanisms.

Results

Employing a dextran sulfate sodium (DSS)-induced colitis mouse model, we assessed Akk’s impact on colitis using cellular cytokine analysis, immune phenotyping, proteomics, and biochemical methods. Our results suggest that treatment with live Akk effectively reduced colitis in the DSS-induced model, whereas heat-inactivated Akk did not yield the same results. Notably, Akk exhibited protective properties by promoting the secretion of IL-22 by Group 3 innate lymphoid cells (ILC3s), as evidenced by the absence of protection in IL-22 knockout mice. Additionally, Akk augmented the population of CD103+CD11b− dendritic cells (DCs) and enhanced their retinoic acid (RA) synthesis through the modulation of RALDH2, a crucial enzyme in RA metabolism. The depletion of RALDH2 in DCs diminished Akk’s protective properties and impaired IL-22-mediated mucosal healing. Mechanistically, Akk activated RA production in DCs by enhancing the JAK2-STAT3 signaling pathway. Additionally, various strains of Akk may exhibit differing abilities to alleviate colitis, with the novel strain Am06 derived from breast milk showing consistent efficacy similar to the reference strain.

Conclusions

In summary, our findings indicate that certain strains of Akk may mitigate colitis through the promotion of RA synthesis and IL-22 secretion, underscoring the potential efficacy of Akk as a therapeutic intervention for the management of UC.
Chemical heat derived from rocket-borne WADIS-2 experiment
Authors: Grygalashvyly Mykhaylo , Strelnikov Boris , Strelnikova Irina , Rapp Markus , Lübken Franz-Josef , Schütt Corinna , Stephan Claudia , Eberhart Martin , Löhle Stefan , Fasoulas Stefanos
Published: December 2024

Chemical heating rates were derived from three of the most significant reactions based on the analysis of common volume rocket-borne measurements of temperature, atomic oxygen densities, and neutral air densities. This is one of the first instances of the retrieval of nighttime chemical heat through the utilization of non-emissive observations of atomic oxygen concentrations, obtained through in situ measurements, performed at the Andøya Space Center (69°N, 16°E) at 01:44:00 UTC on 5 March 2015. Furthermore, we determine the heating efficiency for one of the most significant reactions of atomic hydrogen with ozone and illustrate the methodology for such calculations based on known atomic oxygen and temperature. Subsequently, using ozone values obtained from satellite observations, we retrieved odd-hydrogens and total chemical heat. Finally, we compared the retrieved chemical heat with the heat from turbulent energy dissipation. Our findings reveal that the vertically averaged chemical heat is greater than the heat from turbulent energy dissipation throughout the entire mesopause region during nocturnal conditions. The heating rates of turbulent energy dissipation may exceed the chemical heating rates only in narrow peaks, several hundred meters wide.

Graphical Abstract