bluuebunny/crossref_metadata_2025 huggingface dataset:
Shifting Racial Subjectivities and Ideologies in Brazil
Authors: Bailey Stanley R. , Fialho Fabrício M.
Published: September 2018

Census ethnoracial categories often reflect national ideologies and attendant subjectivities. Nonetheless, Brazilians frequently prefer the non-census terms moreno (brown) and negro (black), and both are core to antithetical ideologies: racial ambiguity versus racial affirmation. Their use may be in flux as Brazil recently adopted unprecedented race-targeted public policy. We examine propensities to self-classify as moreno and negro before and after the policy shift. Using regression modeling on national survey data from 1995 and 2008 that captured self-classification in open and closed formats, we find moreno is highly salient but increasingly constricted, while negro is restricted in use, though increasingly popular. Negro’s growth is mostly confined to the darker pole of Brazil’s color continuum. Education correlates in opposing directions: negative with moreno and positive with negro. Our findings proxy broad ideological shift from racial ambiguity to negro racial affirmation. They suggest race-targeted policy is transforming racial subjectivities and ideologies in Brazil.
Visits for Nontraumatic Dental Conditions in Ontario’s Health Care System
Authors: Singhal S. , Quiñonez C. , Manson H.
Published: September 2018

Background:

Physicians’ offices and emergency departments (EDs) are not suited for addressing nontraumatic dental conditions (NTDCs); however, significant numbers of people in Canada, including Ontario, visit such settings for their dental complaints. Also, people sometimes visit hospitals for day surgery to get their complicated dental conditions treated. This reflects the inefficient usage of the health care system and gaps in accessing timely dental care.

Methods:

We assessed trends in the burden of NTDCs in Ontario by estimating the visits made for such conditions to physicians, EDs, and hospitals for day surgery. Aggregate data for years 2001 to 2015 were retrieved from Intellihealth Ontario. Descriptive analysis was conducted to calculate rates of visits as stratified by sex, age groups (0 to 6, 7 to 18, 19 to 64, and ≥65 y), and jurisdictions (public health unit level).

Results:

On average, 70,274 visits to physicians, 51,861 to EDs, and 13,889 to hospital day surgery are made each year in Ontario for NTDCs, which costs approximately CAN$29 million. Children aged 0 to 6 y visit more than their counterparts. Statistically significant increasing trends for physician and ED visits were observed over the years. Analyses show large variations in rates of visits across public health units, with higher rates in rural communities.

Conclusion:

A large number of visits for NTDCs, with jurisdictional variations, were consistently made to nondental health care settings in Ontario over the last 15 y. Central- and local-level policy options for optimizing resources and health care system use are required.

Knowledge Transfer Statement:

The findings of this study will provide oral and general health professionals a comprehensive understanding about the ineffective usage of a health care system for nontraumatic dental conditions. Quantifying the burden and associated dollars spent will promote crucial policy discussions to explore the possible options for providing emergency and essential dental services for all Canadians and possible equitable options to enhance access to dental care for vulnerable populations in Canadian society.
Shame/Honor, Guilt/Innocence, Fear/Power in Relationship Contexts
Authors: Beech Geoff
Published: September 2018

All human beings seek to avoid shame, guilt, and fear, responses that sociologists have paired, respectively, with honor, innocence, and power. Examination of cultures has shown that the shame/honor, guilt/innocence, and fear/power affective domain pairs are prioritized differently in different cultures. Western missiologists have seen the connection between guilt and innocence and the Gospel but have also shown interest in the other pairs, and some have linked pair prioritization with particular religious contexts. My research found that, rather than religion per se, the prioritizations emerge from deeply embedded worldview assumptions pertaining to relationship structures, which are culturally or socially determined.
Estrogen Regulation of T-Cell Function and Its Impact on the Tumor Microenvironment
Authors: Navarro Flor C. , Herrnreiter Caroline , Nowak Lauren , Watkins Stephanie K.
Published: September 2018

Epidemiologic studies demonstrate significant gender-specific differences in immune system function. Males are more prone to infection and malignancies, while females are more vulnerable to autoimmune diseases. These differences are thought to be due to the action of gonadal hormones: Estrogen increases the inflammatory response and testosterone dampens it. More specifically, estrogen stimulation induces inflammatory cytokine production including interferon γ, interleukin (IL) 6, and tumor necrosis factor α, while testosterone induces IL-10, IL-4, and transforming growth factor β. More recent studies demonstrate threshold effects of estrogen stimulation on immune cell function: physiologic doses of estrogen (approximately 0.5 nmol/L) stimulate inflammatory cytokine production, but superphysiologic dosages (above 50 nmol/L) can result in decreased inflammatory cytokine production. This review reports findings concerning the impact of estrogen on CD8+cytotoxic T cells and the overall immune response in the tumor microenvironment. Variables examined include dosage of hormone, the diversity of immune cells involved, and the nature of the immune response in cancer. Collective review of these points may assist in future hypotheses and studies to determine sex-specific differences in immune responses that may be used as targets in disease prevention and treatment.
Non-union Rates in Hind and Midfoot Arthrodesis in Current, Ex-, and Non-smokers
Authors: Allport Jack , Ramaskandhan Jayasree , Siddique Malik
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Arthrodesis is a safe and effective treatment for a number of hind and midfoot conditions. However, non-union rates have historically been reported as high as 41%. A number of factors have been identified that increase non-union rates, the most notable and readily modifiable is a patient’s smoking status. Smoking rates in the UK in 2015 were 19.3% for men and 15.3% for women. We have examined the effect of smoking status (current, ex-smokers and non-smokers) on union rates for a large cohort of patients undergoing hind or midfoot arthrodesis.

Methods:

This is a single surgeon, retrospective cohort study of consecutive cases. The surgeon’s logbook was used to identify patients undergoing any hind and midfoot arthrodesis procedures from January 2010 until September 2016. Revision procedures and charcot arthropathy cases were excluded along with cases with insufficient records available. Demographic data was collected along with: joints involved, surgical implant used, bone grafting, the use of ultrasound bone stimulation (EXOGEN, Bioventus LLC, Durham, USA) therapy, complications and final outcome with regards to union. Patients were divided according to self-reported smoking status at pre-operative assessment; current smokers, ex-smokers and non-smokers. Union outcome was based on clinical notes and included patient symptoms and radiographic evidence. Delayed union was classed as union occurring after 6 months. The effect of smoking status on deep infection rates and the need for EXOGEN therapy was also analysed.

Results:

381 joints were included (see image). The smoking prevalence was 14.0% (accounting for 12.3% of joints) and 32.2% ex-smokers (35.4%). The groups were comparable with regards to gender, diabetes status and BMI. Smokers were younger, had less co-morbidities and were less likely to have had multiple joints fused (p<0.05). Non-union rates were statistically higher in current smokers with a relative risk of 5.81 (95% CI 2.54-13.29, P<0.001), there was no statistically significant difference between ex-smokers and non-smokers. Active smokers had higher rates of deep infection (P=0.05) and the need for EXOGEN use (P<0.001). Within the smoking group there was a trend toward slower union (delayed + non-union) with heavier smoking (p=0.054).

Conclusion:

This large retrospective cohort study confirms previous evidence that smoking has a considerable negative effect on union in arthrodesis (despite other differences between the groups likely to favour union in smokers). A 5.8 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in patients who are actively smoking. Our study shows that after cessation of smoking the risk returns to normal, however we have not quantified the time frame. Further research is needed to quantify the necessary time frame for smoking cessation to reduce non-union risk.
Midfoot Strikers Are Different from Forefoot Strikers, but Similar to Rearfoot Strikers
Authors: Davis Irene , Mulloy Francis
Published: September 2018

Category:

Sports

Introduction/Purpose:

Rearfoot strike (RFS) patterns have an impact transient that is associated with running injuries. These transients are not present in FFS patterns. Midfoot strike (MFS) runners are often grouped with FFS runners in studies as they are both non-heel strike patterns and assumed to be similar. However, this has not been tested. Tibial shock (TS) provides a measure of impacts and can be easily assessed in the field. Therefore, the purpose of this study was to compare TS among differing footstrike patterns measured during a marathon race. We hypothesized that MFS would have greater impacts than FFS, but lower than RFS. We also aimed to examine how impacts vary across speeds. We hypothesized that impacts would increase with speed similarly in RFS, MFS and FFS.

Methods:

224 healthy runners (119 M, 105 F; 44.1±10.8 yrs) running the 2016 Boston marathon volunteered for the study. Prior to the race, participants ran on a treadmill to determine their habitual footstrike pattern (169 RFS, 32 MFS, 23 FFS). On race day, they ran the course wearing an accelerometer strapped onto their right medial ankle. For this part of the study, the average of the peak TS recorded between the 5 km and 10 km point of the race. This region was used as it had a flat gradient. The peak TS was recorded for each footstrike and averaged over the 5 km distance. This value was compared between the three footstrike patterns using an ANOVA (p<0.05). A regression analysis was used to determine the interaction of FSP and speed for each FSP using individual marathon runner data points. An ANOVA (p<0.05) was used to assess significance of the regression.

Results:

TS in FFS runners was significantly less than in MFS (P=0.01) and RFS (P=0.01) runners. (Figure 1, top panel). There was no difference between RFS and MFS (P=0.49). When examining the relationship between TS and speed, a significant positive correlation was noted for RFS (p<0.00). and MFS (p=0.02), but not for FFS (p=0.82) (Figure 1, bottom panel).

Conclusion:

In contrast to common belief, MFS runners exhibit impacts that are like RFS runners, and both are higher than FFS runners. This suggests that MFS runners should be grouped with RFS runners, and not FFS runners, when assessing impacts. In addition, both RFS and MFS runners exhibited greater impacts as speed increased. However, FFS runners appear to be able to maintain lower impacts at faster speeds. This may be due to greater calf activation, mitigating the effect of increasing speed on impacts. This may offer protection from impact-related injuries in FFS runners.
What Is the Rate of Recurrence of Peroneal Groove Deepening for Subluxation/Dislocation
Authors: Ward Patrick , Anderson Robert , Ellington J. Kent , Davis W. Hodges , Jones Carroll , Cohen Bruce
Published: September 2018

Category:

Sports

Introduction/Purpose:

Peroneal tendon subluxation is an uncommon, yet well-known, condition that can occur after injury to the lateral ankle. The diagnosis can be difficult and is often missed or delayed. This may lead to recurrent or chronic subluxation or dislocation. Surgical management is often recommended, both in the acute and subacute setting. Multiple different surgical procedures have been described ranging from soft tissue repair to fibular groove deepening procedures. Soft tissue procedures alone may be inadequate to treat this pathology, especially in the case of shallow peroneal grooves. Multiple fibular groove deepening techniques have been described, although the population size in each study has been low. This investigation will evaluate the largest cohort of patients undergoing fibular groove deepening for peroneal subluxation or dislocation.

Methods:

Forty-four patients (Age 39.3 +/- 15.6, BMI 27.9 +/- 5.9) who underwent fibular groove deepening without concomitant bony procedures were able to return to clinic with a minimum two year follow-up. Demographic and operative data was collected via chart review. A standing CT scan, physical examination and functional outcome data was collected at the time of the office visit. The primary outcome was revision surgery. Secondary outcomes included radiographic findings(depth of groove), physical examination data (subluxation/dislocation, strength, ROM) and functional scores(FAAM).

Results:

44 patients who underwent isolated peroneal groove deepening were enrolled. Rate of revision surgery was 3/44. CT scan showed an average depth on the operative side of (4.4 mm +/- 2.6) compared to (0.6 mm +/- 1.9) on the contralateral side. On physical exam 5% had objective subluxation, 2% dislocation, 84% had full strength to eversion. The median dorsiflexion and plantarflexion range of motion was 14 (0,100) and 40 (15,155) degrees, respectively. FAAM scores for ADL and Sports were (88.6% +/- 16.4% and 71.7% +/- 20.5%, respectively). 84% of patients would undergo the operation again.

Conclusion:

Our results show that peroneal groove deepening has a low recurrence rate but results in decreased strength and modest decreases in plantar flexion. The majority of patients were satisfied and would have the operation again. There was low incidence revision surgery (7%), and postoperative dislocation (2%). This is the first study to our knowledge that looked at postoperative CT scans. We showed that deepening is preserved and in our study increased peroneal groove depth by 3.8 mm on average.
Ankle fracture – correlation of Lauge-Hansen classification and patient reported fracture mechanism
Authors: Boszczyk Andrzej , Rammelt Stefan
Published: September 2018

Category:

Trauma

Introduction/Purpose:

The genetic Lauge-Hansen classification is considered to provide a link between mechanism of ankle injury and resulting fracture morphology. In this study, we addressed the question of agreement between the mechanism of the fracture as postulated by the Lauge-Hansen classification and mechanism reported by the patient in rotational ankle fractures. Understanding of the actual mechanisms of ankle fracture may guide treatment decisions.

Methods:

Of 110 screened patients with acute malleolar fractures, 78 were able to provide information on their fracture mechanism and were included in the study. The study group consisted of 43 women and 35 men with a mean age of 47.8 (range 19.5-88.4) years. Patients were asked to describe the direction of deformation with primary question being pronation and supination as demonstrated by the examiner. As hyperplantarflexion and hyperdorsiflexion has been spontaneously reported by the patients, these directions were added to the analysis. Radiographs were analyzed according to Lauge-Hansen classification and compared with fracture mechanisms reported by the patients.

Results:

The majority (35/78 = 44.8%) of patients reported pronation as their fracture mechanism, 27 (34.6%) patients reported supination, 15 (19.2%) patients reported hyperplantarflexion (3 pure, one combined with pronation and 11 combined with supination), and 1 patient reported hyperdorsiflexion combined with pronation. Radiographs revealed 61 supination-external rotation (79%), 1 supination-adduction (1.3%), 14 pronation-external rotation (18%), 1 pronation-abduction (1.3%) fractures. One x-ray was unclassifiable with the Lauge-Hansen classification. The patient reported mechanisms were in concordance with the mechanism deducted from the x-rays in 49% of cases. Only 17% of patients who recalled a pronation trauma actually had radiographs classified as pronation fractures while 76% of patients who recalled a supination trauma were also radiographically classified as having sustained supination type fractures.

Conclusion:

The Lauge-Hansen classification should be used with caution for determining the actual mechanism of injury as it was able to predict the patient reported fracture mechanism in less than 50% of cases. A substantial percentage of fractures appearing radiographically as supination type injuries may have been actually produced by a pronation fracture mechanism.
Templating of Syndesmotic Ankle Lesions by Use of 3D Analysis in Weightbearing and Classical CT
Authors: Burssens Arne , Barg Alexej , De Cock Laurens , Victor Jan , Buedts Kristian
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Syndesmotic lesions of the ankle have shown to be challenging injuries towards diagnosis and surgical treatment. This could be mainly attributed to the limitations of 2D imaging, which make it difficult to accurately determine the extent of the lesion and to verify if peroperatively an anatomical reduction is achieved of the distal tibiofibular congruence. The aim of this study is therefore to develop a reproducible method to quantify the displacement in a syndesmotic ankle lesion in all six degrees of freedom based on 3D imaging.

Methods:

Eighteen patients were retrospectively included having a unilateral syndesmotic lesion. N=12 sustained a high ankle sprain and a bilateral weightbearing conebeam CT was obtained because of positive clinical syndesmotic tests. N=6 presented with a fracture associated syndesmotic lesion and were imaged by a bilateral non-weightbearing CT. The non-affected ankle was used as a template after being mirrored and matched on the contralateral ankle containing a syndesmotic lesion (Fig 1A-B). The distal fibula was marked by computer calculation of the most outer point of the anterior tubercle, posterior tubercle and apex malleolis lateralis. The change of these points towards the unaffected fibular position was used to quantify the syndesmotic lesion (Fig 1C). A control group of seven patients (N=7) was used to analyse if these changes differed from the normal variation in tibio-fibular congruency (Fig 1D).

Results:

The main findings consisted of a statistical significant difference in the mean mediolateral diastasis of both the sprained group (M = 1.60 mm, SD=1.02) and the fracture group (M = 1.69 mm, SD=0.62) compared to the control group (P<.001). The mean external rotation was statistically different when comparing the sprained group (M = 4.68°, SD=2.74) and the fracture group (M = 6.97°, SD=3.02) towards the control group (P<.05). The mean antero-posterior translation was only significantly different when comparing the fracture group (M = -4.73 mm, SD=4.53) towards the sprained group (M = -0.91 mm, SD=1.26) and the control group (M = -0.26 mm, SD=1.53) (P<.05).

Conclusion:

This study demonstrates an effective method to quantify a unilateral syndesmotic lesion of the ankle. The pathological measurements differed from the normal distal tibio-fibular configuration in the syndesmotic complex. This sequential analysis is of use for an accurate diagnosis and a pre-operative planning to know in advance which correction needs to be achieved to have the fibula at proper length correctly rotated, and reduced into the syndesmosis with no anterior, posterior or lateral displacement.
Comparison of Outcome of Osteosynthesis in Type II Accessory Navicular by Variable Fixation Methods
Authors: Jang Ho-seong , Park Hyun-woo , Park Kwang-Hee
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

To compare the outcomes of fixation methods for osteosynthesis of a type II symptomatic accessory navicular between screw and tension band wiring

Methods:

Forty-four patients (mean age, 29.2 years; range, 13 to 54 years; 21 males and 23 females) who had undergone operative treatment after failed conservative treatment were chosen for the study between 2007 and 2014. The patients were divided based on the osteosynthetic method: group 1 (screw) and group 2 (tension band wiring). Pre and postoperative evaluations were performed, using the midfoot scale from the American Orthopaedic Foot and Ankle Society (AOFAS), a visual analog scale, time to return to social activities, and plain radiography

Results:

The AOFAS midfoot and visual analog scale scores of both groups improved at the last postoperative follow-up. The times to return to social activities were 12.3 weeks in the screw group and 11.9 weeks in the tension band wiring group (p = 0.394). A broken screw was observed in one case in the screw group and a broken k-wire was detected in two cases in the tension band wiring group. Nonunion was observed in two cases in each group

Conclusion:

The tension band wiring technique could be another osteosynthesis treatment choice for fixation of the accessory navicular bone
Magnetic Resonance Imaging Findings of the Lateral Ankle Instability after Anatomical Ligament Reconstruction Using a Semitendinosus Allograft Tendon with Biotenodesis Screws
Authors: Jung Hong-Geun , Kang Hwa-Jun , Sun Mao-Yuan , Coruna Juan Agustin
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Surgery for lateral ankle instability is indicated in patients who have repetitive inversion ankle sprains despite conservative therapy. There have been many reconstruction procedures performed for the lateral ankle ligament instability. However, there has not been any report of postoperative MRI findings of lateral ankle instability after ligament reconstruction using a free tendon and biotenodesis screws. Therefore, this study was to analysis the MRI finding of the postoperative lateral ankle reconstruction using semitendinosus allograft tendon and the correlation with clinical outcome.

Methods:

The study is based on 34 ankles (33 patients) of chronic lateral ankle instability which underwent anatomical lateral ankle ligament reconstruction using a semitendinosus allograft tendon with bio-tendosis screws from July 2009 to April 2017 with at least 6 month postoperative ankle MRI checked (mean follow-up 16.5mo). In addition, clinical outcomes were evaluated using VAS pain score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, Karlsson-Peterson score, ankle stress views and subjective patient satisfaction.

Results:

Six ankles (17.6%) showed normal signal intensity(SI) while 28 ankles (82.4%) showed high SI on reconstructed allograft tendon area. High signal was shown around the biotenodesis screws. Eleven ankles showed synovitis (39.3%), partial tear of reconstructed allograft tendon 6 ankles (21.4), 5 osteolysis of the bone tunnel (17.9%), 4 screw pulled-outs (14.3%), 2 tendon complete tear (7.1%), 2 mucoid changes (7.1%), 2 cystic changes (7.1%). One ankle showed post-op MRI findings of reconstructed tendon infection (3.6%). The mean VAS pain score significantly decreased from 5.7 to 1.5. The mean AOFAS score improved from 72.0 to 89.1, while the Karlsson-Peterson score significantly improved from 54.7 to 85.7 (p<0.01) with 88% patient satisfaction. Stress talar tilt angle improved from 15.7o to 5.4 o.

Conclusion:

In the current study, various postoperative MRI findings were found after lateral ankle ligament reconstruction using allograft tendon and biotenodesis screws including high signal change of tendon, synovitis, tunnel osteolysis, screw pull-outs, tendon tears and etc. However, these MRI findings did not present as clinical complications and did not correlate with poor clinical outcomes.
NEMISIS for diabetic forefoot pathology
Authors: Miller Roslyn
Published: September 2018

Category:

Diabetes

Introduction/Purpose:

The most common cause of Charcot Neuroarthropathy is diabetes. The incidence of diabetes continues to rise globally, with a significant socio-economic burden to both patient and society. Despite good total contact casting techniques, deformity and subsequent ulceration still occurs in this patient group. This make shoe-fitting challenging and the risk of subsequent ulceration increases. This in-turn increases the patients risk of amputation and mortality at five years. Conservative treatment is often protracted, with multiple clinic visits. The has a significant impact on the patients ability to work and quality of life. Open surgery carries a significant risk of poor wound healing and infection again with risk of ulceration. NEMISIS for mid-foot Charcot provides surgeons with a surgical technique for osteotomy, that protects the soft tissues.

Methods:

15 patients had NEMISIS Minimally Invasive Surgery to their forefoot for management of diabetic foot ulceration. 8 patients (11 metatarsal heads)had debridement of a metatarsal head with Minimally Invasive Shannon and Wedge Burrs. 1 patient had 3 separate debridements, but of different metatarsal heads. 2 patients had surgery to the 1st metatarsal. 1 patient had minimally invasive debridement of sesamoids. All patients had their Achilles tendon assessed for increased tension. Percutaneous tenotomy was performed if the Achilles was found to be tight. Only the patients with surgery to the 1st Metatarsal required screw fixation. All cases were performed as day cases.

Results:

Patients were able to be discharged the same day, with weekly follow-up for dressings. Patients were allowed to fully weight bear as tolerated. Ulcers healed within six week on average. There were no recurrences of ulcer on the same metatarsal head within the time period. Patients had often had ulcers present, in excess of six months prior to being referred for surgery. All patients were delighted with the result.

Conclusion:

NEMISIS Minimally Invasive Surgery for diabetic forefoot pathologies provides rapid healing for patients with chronic ulceration. Their biomechanics should be assessed pre-operatively to check if there is significant forefoot overloading. If so, the Achilles tendon should also be addressed. Early intervention with NEMISIS Minimally Invasive Surgery, could reduce the number of visits the patient has to make to the clinic and also facilitate the firing of easier constructed shoes. This potentially will allow the patient to return to normal function as quickly as possible and thus potentially has significant cost benefit implications also.
Postoperative Achilles Pull-out Strength after Calcaneoplasty for Haglund’s Syndrome
Authors: Pfeffer Glenn , Gonzalez Tyler , Nelson Trevor , Metzger Melodie
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Haglund’s syndrome involves a prominent posterior superior prominence of the calcaneus, in conjunction with pain caused by local inflammation. Nonoperative management includes orthotic inserts, immobilization, shoe modification and physical therapy. If non-operative management fails, surgical management with calcaneoplasty is often needed. No study has assessed Achilles tendon pull-out strength after a calcaneoplasty for Haglund’s syndrome. The purpose of this study was to investigate those changes in a cadaveric model and provide objective data upon which to base postoperative recovery.

Methods:

8 matched pairs of cadaveric specimens (mid-tibia to toes) were divided into two cohorts. The matched pairs compared Achilles pull-out strength between intact and open calcaneoplasty specimens. Prior to testing, BMD was determined and lateral X-ray images were obtained before and after surgery to quantify bone removal. The distal aspect of each calcaneus was potted and held at a 20 degree angle. The Achilles tendon was secured in a freeze-clamp, which was attached to a mechanical testing system. Specimens were then loaded to failure. Outcome measures include: Height of bony resection, angle of bone resection, load to failure, and mode of failure.

Results:

Specimens with open calcaneoplasty had a 45% reduction in strength (failure load: 742 N) compared to their intact counterpart (1341 N), p<0.05. Load to failure was significantly correlated with BMD (r=0.64, p<0.05).

Conclusion:

Traditional open calcaneus resection demonstrated a potentially catastrophic weakness of the Achilles tendon insertion. Mineral density further affects weakening of the Achilles insertion. . Biomechanical evidence presented above supports the practice of protected weight bearing and cautious return to activity after open calcaneoplasty for Haglund’s syndrome.
Plantar Plate Reconstruction for Stage IV Plantar Plate Tear Using Flexor Tendon Tenodesis
Authors: Reilly Megan , Darvish Kurosh , Assari Soroush , Cole John , Gokcen Eric
Published: September 2018

Category:

Lesser Toes

Introduction/Purpose:

Outcomes of the surgical treatment of dislocated lesser toes have improved significantly over the past few years due to the development of techniques to repair plantar plate tears through a dorsal incision. However, treatment of stage 4 tears with no reparable plantar plate can be challenging. The current treatment involves flexor to extensor tendon transfer, requiring multiple incisions and surgical time. An alternative approach is presented, using the same modern techniques of plantar plate repair, but reconstructing the plantar plate using a flexor tendon tenodesis to the plantar base of the proximal phalanx.

Methods:

Four fresh frozen cadaver foot and ankle specimens were used to determine the stability of this new technique. A simulated Lachman’s test was performed on the 2nd, 3 rd, and 4th metatarsophalangeal joints utilizing a force measurement instrument with displacement control on specimens with an intact plantar plate, an excised plantar plate, and following a flexor tenodesis reconstruction.

Results:

The intact plantar plate force was 9.0+2.6kN for 2 mm displacement, and following excision of the plantar plate, the force reduced to 1.3+0.4kN. The flexor tenodesis reconstruction improved the force to 6.0+1.9kN.

Conclusion:

Plantar plate reconstruction with a flexor tenodesis to the proximal phalanx resulted in stability equal to 53% of the intact plantar plate, for the shear displacements between 2 to 6 mm. This procedure may be an alternative treatment option in patients with Stage 4 irreparable plantar plate tears.
The efficacy of a diabetic educational program and predictors of compliance of diabetes mellitus patient’s
Authors: Stéfani Kelly , Borges Vinicius , Barbachan Aldo
Published: September 2018

Category:

Diabetes

Introduction/Purpose:

Diabetes mellitus has become a global public health problem. Not only has its incidence remained high in developed countries such as Japan and the United States, but, also, the number of cases has been growing alarmingly in developing countries such as Brazil. The concept of detection and management of diabetes mellitus in primary care centers is widely practiced in Brazil by the general physician. The purpose of this study was to evaluate the efficacy of our educational diabetics program for patients with diabetes mellitus and to determine the predictors of compliance. Since our patient orientation protocols and the insensitive footwear we provide reduce our hospital admission costs.

Methods:

A prospective study (2005-2017) was performed in a quaternary hospital where patients with diabetes were referred to the outpatient clinic of the diabetic foot group. The epidemiological profile of these patients under treatment in a specialized multidisciplinary outpatient unit was evaluated. A specific protocol included notes on the age, body mass index, length of disease, use of insulin, degree of sensation as evaluated by the Semmes-Weinstein monofilament test, deformity in feet, palpation of peripheral pulses, cigarette smoking, and previous operative procedure in foot an ankle.The same specialist orthopedic doctors in foot and ankle completed the protocol and performed the specific physical examination (reports were made on deformities regarded as risky for the incursion of ulcers such as plantar callosities, alterations of the hallux and lesser toes, loss of the longitudinal plantar arch, and all those related to Charcot arthropathy) and performed the same a guidelines for foot care.

Results:

Out of the 578 diabetic patients, the mean age of was 67 years, 69% being of the female gender. There was 53% made use of insulin, the time of disease was 14 years, and 85% patients were obese. Evaluation of protective sensibility showed that 68% were significantly decreased (from the 4.0 g monofilament). The ulcers was found in 64 patients, 57% had degree 1 in the Wagner classification, and 63% was affected in the forefoot. Charcot neuroarthropathy was diagnosed in 54 patients, 52% had the phase 3 in the Eichenholz classification, and 61% was affected in the midfoot. Fifty-three patients had amputations at the time of their first appointment, 66% on toes. 127 patients required surgery resulted from clinical complications: ulcers, osteomyelitis, and Charcot arthropathy.

Conclusion:

The costs related to the disease increase greatly with the appearance of the complications, especially if there is need of hospitalization and surgical treatment. The prevention of injuries, with adequate glycemic control and supply of protective shoes is essential.
Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture?
Authors: Yousaf Sohail , Hay Daniel
Published: September 2018

Category:

Trauma

Introduction/Purpose:

Differentiating stable isolated fibula fractures consistent with supination external rotation (SER) II ankle fractures from unstable SER IV fractures is essential in determining the need for surgical stabilisation. Stress radiographs are usually required to assess stability including gravity stress views (GSV) and external rotation views (ER). There is no clear consensus as to which modality is most useful to determine stability in a fracture clinic or emergency setting. In last, few years clinical uncertainty about the reliability has led researcher to focus on weight bearing radiographs (WB) .We aim to review recent literature regarding reliability of WB radiographs to estimate the stability of supination external rotation ankle fractures.

Methods:

A systematic review of the literature relating to radiological assessment of stability of supination external rotation ankle fractures was conducted according to PRISMA guidelines. The systematic review was prospectively registered with PROSPERO. It involved the following steps: Researching the question-Do weight bearing radiographs estimate the stability of an isolated distal fibula fracture? Setting inclusion and exclusion criteria-All English language articles published in the including any Randomised controlled trials (RCT’s) and cohort studies. Data collection)– A literature search of Medline (PubMed), the Cochrane Bone, Joint, and Muscle Trauma Group trial register, the Cochrane central register of controlled trials, Embase and CINAHL was undertaken. The grey literature was searched. Key terms ‘supination external rotation fracture’, ‘stability’. Other variations to the key words were ‘weight bearing’, “axial load”, ‘stress x-rays’, ‘systematic reviews’ and ‘meta-analysis’.

Results:

A total of six studies met the inclusion criteria including 601 patients. No previous systematic review on stress radiographs including weight bearing was published. All studies concluded weight bearing radiographs is an easy, pain-free, safe and reliable method to estimate stability of isolated distal fibula fractures. No serious concerns or complications were reported.

Conclusion:

The evidence base contained many methodological limitations and most of the evidence was either level III or IV, and so any conclusion drawn from the research must be done so with caution. The studies suggest that GSV overestimates the instability which should be assessed with studies should focus on randomized controlled trials with narrow range of clinically useful outcome measures.
A Novel Kartogenin-Releasing Polymer Scaffold Promotes Wounded Rat Achilles Tendon Enthesis Healing
Authors: Zhang Jianying , Nie Daibang , Zhao Guangyi , Tan Susheng , Hogan MaCalus , Wang James
Published: September 2018

Category:

Hindfoot

Introduction/Purpose:

Entheses have a special fibrocartilage transition zone where tendons and ligaments attach to bone. Enthesis injury is very common, and the reattachment of tendon to bone is a great challenge because healing takes place between a soft tissue (tendon) and a hard tissue (bone). We have now developed a kartogene (KGN)-containing polymer scaffold (KGN-P) that can precisely deliver KGN to damaged enthesis area. The effects of the KGN-containing polymer on the healing of wounded TBJ were investigated in vitro and in vivo.

Methods:

The proliferation and chondrogenesis of rat Achilles tendon stem cells (TSCs) grown in four conditions were measured: normal medium (Control); normal medium with 100 nM KGN (KGN); lysine diisocyanate (LDI)-glycerol scaffold with normal medium (LDI-P); LDI-glycerol-KGN scaffold with normal medium (KGN-P).A wound (1 mm) was created on each hind leg Achilles enthesis of all 8 rats (3 months old). The wounds were then treated either with 10 ul saline (Wound); or 10 ul of 10 uM KGN (KGN); or LDI polymer scaffold (LDI-P); or KGN-containing polymer scaffold (KGN-P). The rats were sacrificed on day 15 and 30 post-surgery, and their Achilles entheses were collected for gross inspection and histochemical analysis.

Results:

KGN-containing polymers have sponge-like structures (Fig. 1A-D), and release KGN in a time- and temperature-dependent manner (Fig. 1E). KGN-P scaffold induced chondrogenesis of TSCs (Fig. 2D, 2H) without changing cell proliferation (Fig. 2I), and enhanced fibrocartilage-like tissue formation (Fig. 3E). KGN (Fig. 3C) and LDI-P (Fig. 3D) treated groups exhibited unhealed wound areas as in saline group (Fig. 3B). Finally, KGN-P and KGN treated rat TSCs underwent chondrogenesis by upregulating collagen II, aggrecan, and SOX-9 expression (Fig. 3F).

Conclusion:

Our results showed that KGN-containing polymer scaffold enhanced wounded enthesis healing by inducing TSC chondrogenesis and promoting the formation of the fibrocartilage in the wound site. The KGN-P may be used for regeneration of wounded entheses in clinical settings. Future research will focus on optimizing KGN concentration and releasing rate in the polymer scaffold during enthesis healing.
Reduced incidence of vein occlusion and postthrombotic syndrome after immediate compression for deep vein thrombosis
Authors: Amin Elham E. , Bistervels Ingrid M. , Meijer Karina , Tick Lidwine W. , Middeldorp Saskia , Mostard Guy , van de Poel Marlène , Serné Erik H. , Otten Hans M. , Klappe Edith M. , Joore Manuela A. , ten Cate Hugo , ten Wolde Marije , ten Cate-Hoek Arina J.
Published: September 2018

Key Points

Immediate compression therapy after DVT is associated with a 20% absolute reduction of RVO. The reduction of residual thrombosis is associated with an 8% absolute reduction of postthrombotic syndrome at 24 months.
Paclitaxel With Inhibitor of Apoptosis Antagonist, LCL161, for Localized Triple-Negative Breast Cancer, Prospectively Stratified by Gene Signature in a Biomarker-Driven Neoadjuvant Trial
Authors: Bardia Aditya , Parton Marina , Kümmel Sherko , Estévez Laura G. , Huang Chiun-Sheng , Cortés Javier , Ruiz-Borrego Manuel , Telli Melinda L. , Martin-Martorell Paloma , López Rafael , Beck J. Thaddeus , Ismail-Khan Roohi , Chen Shin-Cheh , Hurvitz Sara A. , Mayer Ingrid A. , Carreon Daniel , Cameron Scott , Liao Serena , Baselga José , Kim Sung-Bae
Published: September 2018

Purpose

There are currently no targeted therapies approved for triple-negative breast cancer (TNBC). A tumor necrosis factor α ( TNFα)–based gene expression signature (GS) predictive of sensitivity to LCL161, inhibitor of apoptosis antagonist, was translated into a clinical assay and evaluated in a neoadjuvant trial.

Patients and Methods

Women with localized TNBC (T2/N0–2/M0) were prospectively stratified by GS status and randomly assigned (1:1) to receive oral LCL161 (1,800 mg once per week) and intravenous paclitaxel (80 mg/m2 once per week; combination arm) or paclitaxel alone (control arm) for 12 weeks, followed by surgery. The primary objective was to determine whether neoadjuvant LCL161 enhances efficacy of paclitaxel, defined by > 7.5% increase in the pathologic complete response (pCR, breast) rate, stratified by GS.

Results

Of 209 patients enrolled (207 with valid GS scores), 30.4% had GS-positive TNBC. In the GS-positive group, pCR was higher in the combination versus the control arm (38.2% v 17.2%), with 88.8% posterior probability of > 7.5% increase in pCR. However, in the GS-negative group, the pCR was lower in the combination group (5.6% v 16.4%), with 0% posterior probability of > 7.5% increase in pCR. A higher incidence of grade 3 or 4 adverse events in the combination arm included neutropenia (24.5%) and diarrhea (5.7%). Overall, 19 patients (18.1%) in the combination arm discontinued treatment because of adverse events, including pyrexia (n = 5), pneumonia (n = 4), and pneumonitis (n = 4), versus five patients (4.9%) in the control arm.

Conclusion

This neoadjuvant trial provides evidence supporting a biomarker-driven targeted therapy approach for selected patients with GS-positive TNBC and demonstrates the utility of a neoadjuvant trial for biomarker validation and drug development, but also highlights toxicity risk. Future neoadjuvant clinical trials should carefully weigh these considerations for targeted therapy development in biomarker-defined TNBC.
Involvement of sulfated biopolymers in adhesive secretions produced by marine invertebrates
Authors: Hennebert Elise , Gregorowicz Edwicka , Flammang Patrick
Published: September 2018

Many marine invertebrates use adhesive secretions to attach to underwater surfaces and functional groups borne by their adhesive proteins and carbohydrates, such as catechols and phosphates, play a key role in adhesion. The occurrence of sulfates as recurrent moieties in marine bioadhesives suggests that they could also be involved. However, in most cases, their presence in the adhesive material remains speculative. We investigated the presence of sulfated biopolymers in five marine invertebrates representative of the four types of adhesion encountered in the sea: mussels and tubeworms for permanent adhesion, limpets for transitory adhesion, sea stars for temporary adhesion, and sea cucumbers for instantaneous adhesion. The dry adhesive material of mussels, sea stars and sea cucumbers contained about 1% of sulfate. Using anti-sulfotyrosine antibodies and Alcian blue staining, sulfated proteins and sulfated proteoglycans and/or polysaccharides were identified in the secretory cells and adhesive secretions of all species except the tubeworm. Sulfated proteoglycans appear to play a role only in the non-permanent adhesion of sea stars and limpets in which they could mediate cohesion within the adhesive material. In mussels and sea cucumbers, sulfated biopolymers would rather have an anti-adhesive function, precluding self-adhesion.
Characterization of the ventricular-subventricular stem cell niche during human brain development
Authors: Coletti Amanda M. , Singh Deepinder , Kumar Saurabh , Shafin Tasnuva Nuhat , Briody Patrick J. , Babbitt Benjamin F. , Pan Derek , Norton Emily S. , Brown Eliot C. , Kahle Kristopher T. , Del Bigio Marc R. , Conover Joanne C.
Published: September 2018

Human brain development proceeds via a sequentially transforming stem cell population in the ventricular-subventricular zone (V-SVZ). An essential, but understudied, contributor to V-SVZ stem cell niche health is the multi-ciliated ependymal epithelium, which replaces stem cells at the ventricular surface during development. However, reorganization of the V-SVZ stem cell niche and its relationship to ependymogenesis has not been characterized in the human brain. Based on comprehensive comparative spatiotemporal analyses of cytoarchitectural changes along the mouse and human ventricle surface, we uncovered a distinctive stem cell retention pattern in humans as ependymal cells populate the surface of the ventricle in an occipital-to-frontal wave. During perinatal development, ventricle-contacting stem cells are reduced. By 7 months few stem cells are detected, paralleling the decline in neurogenesis. In adolescence and adulthood, stem cells and neurogenesis are not observed along the lateral wall. Volume, surface area and curvature of the lateral ventricles all significantly change during fetal development but stabilize after 1 year, corresponding with the wave of ependymogenesis and stem cell reduction. These findings reveal normal human V-SVZ development, highlighting the consequences of disease pathologies such as congenital hydrocephalus.
PLK4 is a microtubule-associated protein that self-assembles promoting de novo MTOC formation
Authors: Montenegro Gouveia Susana , Zitouni Sihem , Kong Dong , Duarte Paulo , Ferreira Gomes Beatriz , Sousa Ana Laura , Tranfield Erin M. , Hyman Anthony , Loncarek Jadranka , Bettencourt-Dias Monica
Published: September 2018

The centrosome is an important microtubule-organising centre (MTOC) in animal cells. It consists of two barrel-shaped structures, the centrioles, surrounded by the pericentriolar material (PCM), which nucleates microtubules. Centrosomes can form close to an existing structure (canonical duplication) or de novo. How centrosomes form de novo is not known. The master driver of centrosome biogenesis, PLK4, is critical for the recruitment of several centriole components. Here, we investigate the beginning of centrosome biogenesis, taking advantage of Xenopus egg extracts, where PLK4 can induce de novo MTOC formation (Eckerdt et al., 2011; Zitouni et al., 2016). Surprisingly, we observe that in vitro, PLK4 can self-assemble into condensates that recruit α- and β-tubulins. In Xenopus extracts, PLK4 assemblies additionally recruit STIL, a substrate of PLK4, and the microtubule nucleator γ-tubulin, forming acentriolar MTOCs de novo. The assembly of these robust microtubule asters is independent of dynein, similar to what is found for centrosomes. We suggest a new mechanism of action for PLK4, where it forms a self-organising catalytic scaffold that recruits centriole components, PCM factors and α- and β-tubulins, leading to MTOC formation.

This article has an associated First Person interview with the first author of the paper.