bluuebunny/crossref_metadata_2025 huggingface dataset:
A modified zone model on vertical cable tray fire in a confined compartment in the nuclear power plant
Authors: Huang Xianjia , Ren Zhaoying , Zhu He , Peng Lan , Cheng Chihonn , Chow Wanki
Published: September 2018

Room fire with vertical cable tray involves upward flame spread along the cable. Assessing the vertical cable tray fire hazard in confined spaces has been challenging because of the strong coupling between flame spread and heat transfer. Long computing time is required in using sophisticated field model with computational fluid dynamics. Therefore, developing an appropriate zone model in a cable room fire with experimental validation is required for engineering applications. In this study, a vertical cable tray fire in a confined compartment was simulated using a modified zone model along three new areas on having temporal variations of the fire position, upward-spreading cable flame considered as a burning source moving at a constant speed, and validated through full-scale experiments on vertical cable tray fire with two typical cable-line spacing. The modified zone model can predict accurately the upper-layer temperature in the compartment. The accuracy is at least 25% higher than the model with fixed fire position. The measured temperature at different heights started to decrease at different times, which was due to the vertical spreading of the cable flame. For interface height, the relative error and normalized Euclidean distance in the time-varying fire position model can be improved by 50%.
A three-dimensional multibody tire model for research comfort and handling analysis as a structural framework for a multi-physical integrated system
Authors: Farroni Flavio , Sakhnevych Aleksandr , Timpone Francesco
Published: September 2018

A tire is an extremely integrated and multi-physical system. From only a mechanical point of view, tires are represented by highly composite multi-layered structures, consisting of a multitude of different materials, synthesized in peculiar rubber matrices, to optimize both the performance and the life cycle. During the tire motion, due to the multi-material thermodynamic interaction within the viscoelastic tire rubber matrix, the dynamic characteristics of a tire may alter considerably. In the following paper, the multibody research comfort and handling tire model is presented. The main purpose of the research comfort and handling tire is to constitute a completely physical carcass infrastructure to correctly transmit the generalized forces and torques from the wheel spindle to the contact patch. The physical model structure is represented by a three-dimensional array of interconnected nodes by means of tension and rotational stiffness and damper elements, attached to the rim modeled as a rigid body. Research comfort and handling tire model purpose is to constitute a structural physical infrastructure for the co-implementation of additional physical modules taking into account the modification of the tire structural properties with temperature, tread viscoelastic compound characteristics, and wear degradation. At the stage, the research comfort and handling tire discrete model has been validated through both static and dynamic shaker test procedures. Static test procedure adopts contact sensitive films for the contact patch estimation at different load and internal pressure conditions, meanwhile the specifically developed sel test regards the tire dynamic characterization purpose at the current stage. The validation of the tire normal interaction in both static and dynamic conditions provided constitutes a necessary development step to the integration of the tangential brush interaction model for studying the handling dynamics and to the analysis of the model response on the uneven surfaces.
Inequality and Property Crime: Does Absolute Inequality Matter?
Authors: Goda Thomas , Torres García Alejandro
Published: September 2018

Economic crime models and the social strain theory argue that income inequality can foster property crime, yet empirical studies do not provide strong support for this relationship across countries. An important limitation of these studies is that they only consider relative inequality measures and omit absolute ones. Absolute inequality can have a crime-inducing effect for two main reasons: First, the potential monetary returns from crime can be expected to depend on the interaction between relative income inequality and mean income. Second, higher levels of absolute inequality imply that the economic elite can capture institutions in ways that can make them dysfunctional for society as a whole. This article finds that, in contrast to relative inequality, absolute inequality is a robust and statistically significant determinant of violent property crime rates for a sample of up to 59 developed and developing countries.
Breast Tumor Resembling the Tall Cell Variant of Papillary Thyroid Carcinoma: Molecular Characterization by Next-Generation Sequencing and Histopathological Comparison With Tall Cell Papillary Carcinoma of Thyroid
Authors: Zhong Elaine , Scognamiglio Theresa , D’Alfonso Timothy , Song Wei , Tran Hung , Baek Inji , Hoda Syed A.
Published: September 2018

Recent publications have brought attention to the histopathological, immunohistochemical, and molecular aspects of the rare breast tumor resembling the tall cell variant of papillary thyroid carcinoma (BrTC). Nine archived cases of this entity were retrieved, reviewed, and compared with randomly selected tall cell variants of papillary thyroid carcinoma (ThTC). Seven of the BrTC cases as well as 5 cases of solid papillary carcinoma of breast were analyzed by Oncomine next-generation sequencing. BrTC and ThTC were histologically distinguishable by the presence of solid architecture, luminal histiocytes, and reverse polarity in the former, and psammoma bodies, giant cells, and optically clear nuclei in the latter. Sequencing revealed IDH2 R172 single-nucleotide variants in all 7 BrTCs, 6 of which had concurrent PIK3CA mutations. None of the conventional solid papillary carcinomas demonstrated IDH2 mutation. BrTC bears superficial resemblance to other papillary tumors but is unique in terms of histology and molecular profile.
Noise, vibration and harshness validation methodology for complex elastic multibody simulation models: With application to an electrified drive train
Authors: Wegerhoff Matthias , Jacobs Georg , Drichel Pascal
Published: September 2018

Numerical models for vibro-acoustic analyses of complex mechanical systems are becoming more and more popular, in particular in the field of virtual product development. Therefore, reliable, comprehensive, and validated modeling methodologies remain crucial. However, system characteristics such as elasticities of the drive train components and nonlinear characteristics can lead to complex, and costly numerical models with a huge number of degrees of freedom. This may raise not only the need for novel and reasonable modeling strategies, but also exacerbates validation process, due to the wide scope in terms of operating conditions. In practice, structure-borne noise signals, for example, from accelerometers, are often used for the validation of mechanical systems. By choice of a sufficient number of measurement points, the interpretation becomes more complex. A lot of vibration response curves then need to be compared and interpreted over a wide operating range. In general, the interpretation focuses on deviations in quality and quantity. In this paper, to overcome these mentioned challenges, a validation methodology is proposed allowing a fast and transparent check of a number of captured signals. Therefore, it is shown how the original information can be reduced in a meaningful manner, making it possible to run a fast and accurate validation. The method is demonstrated on a real application with high mechanical complexity and it is shown that the chosen parameters are reliable.
Executive functions and health behaviors associated with the leading causes of death in the United States: A systematic review
Authors: Reimann Zakary , Miller Jacob R , Dahle Kaitana M , Hooper Audrey P , Young Ashley M , Goates Michael C , Magnusson Brianna M , Crandall AliceAnn
Published: September 2018

Research indicates that executive functioning may predict health behavior. This systematic review provides an overview of the relationship between domains of executive functioning and health behaviors associated with the leading causes of death in the United States. A total of 114 articles met the inclusion criteria (adult sample, published in English between 1990 and November 2016) and were reviewed and synthesized. Results indicated that although many studies had mixed findings, at least one executive function component was associated with every health behavior. Based on these results, health professionals should consider the role of executive functions in behavior change interventions.
Percutaneous Cholecystostomy for Severe Acute Cholecystitis: A Useful Procedure in High-Risk Patients for Surgery
Authors: Aroori S. , Mangan C. , Reza L. , Gafoor N.
Published: September 2018

Background:

Acute cholecystitis has the potential to cause sepsis and death, particularly in patients with poor physiological reserve. The gold standard treatment of acute cholecystitis (cholecystectomy) is often not safe in high-risk patients and recourse is made to percutaneous cholecystostomy as either definite treatment or temporizing measure. The aim of this study is to evaluate early and late outcomes following percutaneous cholecystostomy in patients with acute cholecystitis treated at our institution.

Methods:

All patients who underwent percutaneous cholecystostomy for acute cholecystitis (excluding patients with malignancy) between January 2005 and September 2014 were included in the study.

Results:

A total of 53 patients (22 female, median age, 74 years; range, 27–95 years) underwent percutaneous cholecystostomy during the study period. In total, 12 patients (22.6%) had acalculous cholecystitis. The main indications for percutaneous cholecystostomy were significant co-morbidities (n = 28, 52.8%) and patients too unstable for surgery (n = 21, 39.6%). The median time to percutaneous cholecystostomy from diagnosis of acute cholecystitis was 3.6 days (range, 0–45 days). The median length of hospital stay was 27 (range, 4–87) days. The overall 90-day mortality was 9.3% with two further deaths at 12-month follow up. The mortality was significantly higher in patients with American Society of Anesthesiology grade 4–5 (18% vs 0% in American Society of Anesthesiology grade 2–3, p = 0.026) and in patients with acalculous cholecystitis (25% vs 4.5%, p = 0.035). The overall readmission rate was 18%. A total of 24 (45.2%) patients had surgery: laparoscopic cholecystectomy, n = 11; laparoscopic converted to open, n = 5; open total cholecystectomy, n = 5; open cholecystectomy, n = 1; laparotomy and washout, n = 1; laparotomy partial cholecystectomy and closure of perforated small intestine and gastrostomy, n = 1.

Conclusion:

Percutaneous cholecystostomy is a useful temporary or permanent procedure in patients with acute cholecystitis of both calculous and acalculous origin, who are unfit for surgery.
Lessons From the Development of the Immune Checkpoint Inhibitors in Oncology
Authors: Jardim Denis L. , de Melo Gagliato Débora , Kurzrock Razelle
Published: September 2018

Immunotherapies are becoming increasingly important in the treatment armamentarium of a variety of malignancies. Immune checkpoint inhibitors are the most representative drugs receiving regulatory approval over the past few years. In a recent study published in Clinical Cancer Research, we demonstrated that these agents are being developed faster than other prior anticancer therapies. All checkpoint inhibitors received priority review, being granted with at least one Food and Drug Administration expedited program. Hence, some of them are getting marketing approval after preliminary trials. The model continues to rely on phase I trials, designed with traditional models for dose definition, although a substantial number of patients are treated during the dose expansion cohorts. We demonstrated that efficacy and safety are reasonably predicted from the dose-finding portion of phase I trials with these agents, assuring a low treatment-related mortality for patients throughout the development process. In this article, we further discuss and summarize these findings and update some recent approval information for immune checkpoint inhibitors.
The Use of tPA in the Treatment of Frostbite: A Systematic Review
Authors: Hutchison Richard L. , Miller Hannah M. , Michalke Spencer K.
Published: September 2018

Background: The use of tissue plasminogen activator (tPA) for the treatment of frostbite has been reported and advocated, but its efficacy has not been well established. We conducted a systematic review to guide physicians on the role of tPA in the treatment of frostbite. Our hypothesis was that the use of tPA improves clinical outcomes, as measured by amputation rate. Methods: We searched MEDLINE (PubMed) and EMBASE for primary research articles on the use of tPA for the treatment of extremity frostbite. Information related to study design, outcomes, and complications was extracted. A total of 204 citations were screened, and then 35 abstracts and 24 reports were reviewed. Fifteen studies met the standard for final review. Results: One randomized, prospective study; 3 cohort studies; 8 case series; and 3 case reports were found. A total of 208 patients were treated. Differences in protocols, inclusion criteria, and outcomes measures prevented combining the study results. In all the studies, the authors reported that the use of tPA was or may have been useful in reducing amputation rates or increasing tissue salvage. Complication rates ranged from 0% to 100%, with a combined rate of 13%. The quality of the evidence was low. Conclusions: Due to the low scientific quality of the studies, the efficacy of tPA in reducing amputation rates cannot currently be established. Randomized, prospective trials or well-controlled cohort studies are needed to better assess the role of tPA. Consideration should be given to limiting its use to research protocols.
Comparing the results of intradiscal ozone injection to treat different types of intervertebral disc herniation based on MSU classification
Authors: Hosseini Behnam , Taheri Mehrdad , Sheibani Kourosh
Published: September 2018

Purpose

To evaluate the therapeutic efficacy of intradiscal ozone injection in reducing pain and improving patients’ performance in different types of intervertebral disc herniation based on Michigan State University (MSU) classification.

Patients and methods

Consecutive patients with low back pain and radiculopathy treated in our center with ozone chemonucleolysis from May 2017 through to January 2018 entered the study. Patients had a disc herniation classified as group 1-A, 2-A, 1-B, 2-B, 1-C, 2-C, 1-AB or 2-AB based on MSU classification in magnetic resonance imaging. In all patients entering the study the severity of pain was recorded according to the visual analog scale criteria before and one and three months after the end of treatment. Oswestry Low Back Pain Disability Index (ODI) was used to compare patients’ performance before and after the treatment.

Results

In total 128 patients (60 females and 68 males) with mean age of 40.1 ± 10.7 entered the study. The patients were divided into eight groups based on MSU classification each including 16 patients. The reduction of pain severity and ODI score compared to baseline was statistically significant in all groups both in the first month and the third month after treatment. There was also a statistically significant difference between groups regarding the reduction of pain and ODI score indicating significantly worse treatment outcomes in groups 1-C, 2-C and 2-AB.

Conclusion

Based on our findings it seems that MSU classification can be used in patients’ selection to achieve the best treatment outcome after intradiscal ozone injection among patients with lumbar disc herniation.
Tennis elbow
Authors: Keijsers Renée , de Vos Robert-Jan , Kuijer P Paul FM , van den Bekerom Michel PJ , van der Woude Henk-Jan , Eygendaal Denise
Published: September 2018

Tennis elbow is the most common cause of lateral-sided elbow pain with a major socioeconomic impact. The etiology of tennis elbow is not completely understood, but there are many different treatment options. This review gives an overview of the current concepts of diagnosis and treatment of tennis elbow and the impact on work participation.
The effect of low-magnitude, high-frequency vibration on poly(ethylene glycol)-microencapsulated mesenchymal stem cells
Authors: Mehta Sneha , McClarren Brooke , Aijaz Ayesha , Chalaby Rabab , Cook-Chennault Kimberly , Olabisi Ronke M
Published: September 2018

Low-magnitude, high-frequency vibration has stimulated osteogenesis in mesenchymal stem cells when these cells were cultured in certain types of three-dimensional environments. However, results of osteogenesis are conflicting with some reports showing no effect of vibration at all. A large number of vibration studies using three-dimensional scaffolds employ scaffolds derived from natural sources. Since these natural sources potentially have inherent biochemical and microarchitectural cues, we explored the effect of low-magnitude, high-frequency vibration at low, medium, and high accelerations when mesenchymal stem cells were encapsulated in poly(ethylene glycol) diacrylate microspheres. Low and medium accelerations enhanced osteogenesis in mesenchymal stem cells while high accelerations inhibited it. These studies demonstrate that the isolated effect of vibration alone induces osteogenesis.
How political are national identities? A comparison of the United States, the United Kingdom, and Germany in the 2010s
Authors: Mader Matthias , Scotto Thomas J. , Reifler Jason , Gries Peter H. , Isernia Pierangelo , Schoen Harald
Published: September 2018

Research demonstrates the multi-dimensional nature of American identity arguing that the normative content of American identity relates to political ideologies in the United States, but the sense of belonging to the nation does not. This paper replicates that analysis and extends it to the German and British cases. Exploratory structural equation modeling attests to cross-cultural validity of measures of the sense of belonging and norms of uncritical loyalty and engagement for positive change. In the 2010s, we find partisanship and ideology in all three nations explains levels of belonging and the two content dimensions. Interestingly, those identifying with major parties of the left and right in all three countries have a higher sense of belonging and uncritical loyalty than their moderate counterparts. The relationship between partisanship, ideology, and national identity seems to wax and wane over time, presumably because elite political discourse linking party or ideology to identity varies from one political moment to the next.
Expression and Role of Peptides, Proteins and Growth Factors in the Pathogenesis of Endometriosis
Authors: Florio Pasquale , Pinzauti Serena , Altomare Aldo , Luisi Stefano , Litta Pietro , Petraglia Felice
Published: September 2018

Growing evidence is demonstrating that several peptides (corticotrophin-releasing factor, urocortins, ghrelin), proteins (leptin, adiponectin) and growth factors (vascular endothelial growth factor; epidermal growth factor family of growth factors and receptors, fibroblast growth factor, insulin like growth factor and insulin like growth factor-binding proteins, transforming growth factor-β and, activin A and related proteins) are expressed in endometriotic implants, and locally play a relevant role in affecting the biological mechanisms leading to endometriosis. They establish a complex network of interactions by which they are therefore able to stimulate angiogenesis, inflammatory cell recruitment and reaction, the growth of endometriotic tissue and its survival through the modulation of the narrow immune system. This review will evaluate the role played by several regulatory peptides, proteins and growth factors in affecting endometrial physiology and the putative mechanisms advocated to explain endometriosis (angiogenesis, cellular and humoral immunity, inflammatory response, endometrial cell proliferation, activation, motility, adhesion and invasion).
Induction of Endometriosis in Nude Mice by Transplantation of Human Peritoneal Endometriotic Tissue
Authors: Defrère Sylvie , Colette Sébastien , Lousse Jean-Christophe , Van Langendonckt Anne , Donnez Jacques
Published: September 2018

Purpose

Ectopic endometrial tissue is biochemically and functionally distinct from eutopic endometrium, including differences in receptivity to steroids and invasive potential. For this reason, using ectopic endometrial tissue to induce endometriosis in animal models may be of interest to understand better the pathogenesis of this disease. The aim of this study was to evaluate the potential of human pelvic endometriotic lesions (specifically red lesions) to implant into the peritoneal cavity of nude mice.

Methods

Human peritoneal endometriotic tissue (red lesions) was injected into the pelvic cavity of nude mice. The mice were euthanized after 5 or 14 days, lesions were recovered, and histological analysis was performed. Proliferative activity and neoangiogenesis of lesions were assessed after Ki67 and CD34 immunohistological staining, respectively.

Results

After 5 and 14 days, endometriotic tissue was found to have implanted onto intact mesothelium and reorganized into structured glands and stroma, forming endometriosis-like lesions. These lesions showed considerable proliferative activity and effective neoangiogenesis.

Conclusion

This model represents a promising tool to study in vivo implantation of human ectopic endometrium, which is dissimilar to eutopic endometrium. Moreover, this study shows that glands and stroma detached from red endometriotic lesions are able to implant in other peritoneal sites, as in a metastatic process.
Premature Immunosenescence Impairs Immune Surveillance Allowing the Endometriotic Stem Cell to Migrate: The Cytokine Profile as a Common Denominator
Authors: Vassiliadis Simon
Published: September 2018

While endometriosis, one of the most common reasons for infertility, remains a multifactorial condition and its exact cause highly speculative, there are data pointing to novel pathways of disease initiation which involve a stem cell and its ability to migrate and implant after it differentiates into an endometriotic stem cell. Thus, the mechanisms conferring immune surveillance, which would also normally expel the mesenchymal endometriotic cell, impairing its migration and implantation, appear to be negatively influenced by a state of endometriotic premature immunosenescence. This interplay between the two immunological mechanisms and endometriosis is influenced by a number of common factors having an active role in the host's protection process that inhibits harmful diseases and maintains cellular homeostasis. It appears more than coincidental that production/inhibition of IFN-γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-15, IL-18, TNF-α, VEGF, ICAM-1, and the number of Tolllike receptors is the same in immunosenescent states and in conditions with reduced immune surveillance, while the same variations are recorded in endometriotic patients. It is probable that these are common to all process signals, guide the endometriotic stem cell and dictate its fate according to the stochastic, transdifferentiation (plasticity) or deterministic model to become capable of migration and tissue invasion. It is currently unknown whether the pathway taken by the hemopoietic stem cell to become endometriotic represents a normal or aberrant route of development. This prompts research into its isolation and in vitro study of its behavior in order to reveal its potential function and role in endometriosis. (Journal of Endometriosis 2010; 2: 7–18)
Haptoglobin Concentration in Peritoneal Fluid of Women with Endometriosis
Authors: Ferrero Simone , Gillot David J. , Remorgida Valentino , Grudzinskas Jurgis Gediminas
Published: September 2018

Objective

To determine the concentration of haptoglobin (Hp) in peritoneal fluid (PF) of women with and without endometriosis and its correlation with the phase of the menstrual cycle. The expression of Hpβe (determined by two-dimensional polyacrylamide gel electrophoresis) was correlated to total PF Hp concentration.

Materials and methods

PF samples were obtained from 240 women with or without endometriosis. PF Hp concentration was measured by a sandwich enzyme-linked immunosorbent assay. Hpβe expression in PF was estimated by two-dimensional polyacrylamide gel electrophoresis.

Results

PF Hp concentration was similar in women with and without endometriosis; it was significantly higher during the luteal phase of the menstrual cycle than in the follicular phase in control subjects, but not in women with endometriosis. There was a positive correlation between serum progesterone level and PF Hp concentration in control subjects during the luteal phase of the menstrual cycle. There was a mild positive correlation between PF Hp concentration and Hpβe expression in controls but not in women with endometriosis. PF Hp concentration was not correlated with the ASRM stage of endometriosis and the type of endometriotic lesions.

Conclusions

Women with and without endometriosis have similar PF Hp concentration. There is a mild positive correlation between PF Hp concentration and Hpβe expression in control subjects but not in women with endometriosis. Future investigations should aim to produce antibodies against specific epitopes of Hpβe that might allow its measurement by ELISA. (Journal of Endometriosis 2010; 2: 26–32)
Diagnosis of Bowel Endometriosis: A Review
Authors: Ferrero Simone , Morotti Matteo , Menada Mario Valenzano , Venturini Pier Luigi , Biscaldi Ennio , Camerini Giovanni , Remorgida Valentino
Published: September 2018

Since the presence of intestinal endometriosis cannot be reliably established by physical examination or the evaluation of intestinal symptoms, imaging techniques are required for the diagnosis of bowel endometriosis. This review evaluates the techniques available for the diagnosis of intestinal endometriosis based on a search of the Medline database and Embase up to February 2010. Several studies have proved that radiological techniques (double contrast barium enema, magnetic resonance imaging, and multidetector computerized tomography enteroclysis) are able to accurately diagnose intestinal endometriosis. Magnetic resonance imaging has the advantage of determining the presence of deep endometriotic lesions in other pelvic locations. Rectal endoscopic ultrasonography can precisely determine the presence of bowel endometriosis but its use is limited by the availability of the equipment required to carry out the exam. Over the last five years, several studies have proved that transvaginal ultrasonography is accurate in the diagnosis of rectosigmoid endometriosis; in addition, this exam is well tolerated by patients and is inexpensive. Therefore, transvaginal ultrasonography should be the first-line investigation in patients with suspected intestinal endometriosis.
Uterine Anomalies in Women with Endometriosis
Authors: Matalliotakis Ioannis M. , Goumenou Anastasia G. , Matalliotakis Michail , Arici Aydin
Published: September 2018

Objective

Uterine anomalies are associated with higher rate of infertility, spontaneous abortion, premature birth and endometriosis. We report our experience in 13 cases with uterine malformations and endometriosis.

Methods

The medical files of 425 cases with endometriosis and 200 without endometriosis, all of them studied by laparoscopy, were studied retrospectively in Yale University Hospital. Thirteen cases were observed and analyzed.

Outcome measures

Presenting symptoms, stage of endometriosis, menstrual characteristics, obstetrics outcome, family history, the type of uterine anomaly and presence of other anomalies were studied.

Results

In our series, we found 13/425 (3%) of women with endometriosis and congenital malformation. The mean age was 29.6 years (range 25–30). In this population, septate uterus (54%) was the most common malformation, followed by didelphic uterus (23%), unicornuate uterus (15.3%) and bicornuate uterus (7.7%). In 3 (23%) of these patients, we observed anomalies of the urinary tract. In the control group, we found only one case (0.5%) with septate uterus. Seven out of 13 (54%) of patients had severe endometriosis. The main symptom of all patients was infertility. Five out of thirteen conceived after assisted reproductive technology (ART) procedures. Five cases (38%) were found with first-degree family history with endometriosis.

Conclusions

Our results seem to support a link between uterine anomalies and subsequent development of endometriosis with infertility. The role of ART needs to be better evaluated. The co-existence of uterine anomalies with endometriosis and familiar aggregation of endometriosis should be examined in future studies, in order to improve our understanding of the genetic aspect of these diseases.
“Voluntarily Admitted Against My Will”: Patient Perspectives on Effects of, and Alternatives to, Coercion in Psychiatric Care for Self-Injury
Authors: Gerle Ellen , Fischer Anne , Lundh Lars-Gunnar
Published: September 2018

Introduction:

Various forms of coercion are used in the psychiatric care of patients with self-injurious behaviors, but there is little research on how these are perceived by the patients. The aim of this study was to investigate how 6 patients, who had received care for self-injurious behavior, perceived coercion and how they think coercion could be avoided.

Methods:

This study employed a qualitative design with 6 semistructured interviews and interpretative phenomenological analysis.

Results:

Three main themes were identified: keep voluntary care voluntary, apportioning control and responsibility, and dialogue and participation. Constant supervision was described as the most destructive form of coercion. To enable self-responsibility, a reduction of control and supervision was advocated. Calls were made for a treatment based on the assumption that there is a desire, on behalf of the patients, to get better.

Conclusions:

The use of coercion in the psychiatric care of patients with self-injurious behavior can be reduced by increasing predictability, by listening to the patient with genuine interest, and by involving the patient in decisions regarding their treatment.
Isokinetic functional outcomes of open versus percutaneous repair following Achilles tendon tears
Authors: Baumfeld Daniel , Baumfeld Tiago , Nery Caio , Maffulli Nicola
Published: September 2018

Category:

Sports

Introduction/Purpose:

Rupture of the Achilles Tendon (AT) is frequent in young recreational athletes. Conservative management, open surgery and percutaneous/minimally invasive approaches are all advocated, and conflicting data are available. This study compared functional and anthropometric outcomes of patients who underwent open or percutaneous repair.

Methods:

A retrospective comparative study, in which 38 patients underwent open and percutaneous techniques to manage AT ruptures. For functional assessment, the calf circumference of both injured and uninjured legs was evaluated. Isokinetic testing included total plantar flexion work, peak plantar flexion torque, total dorsiflexion work peak and dorsiflexion torque. The Achilles Tendon Rupture Score (ATRS) and the America Orthopedic Foot and Ankle Score (AOFAS) were evaluated at a final minimum follow-up of 12 months.

Results:

No major complications were observed. The average time to return to sport was 9 months. AOFAS and ATRS values did not differ statistically between groups. Isokinetic variables and circumference were similar in the operated and non-operated limb in both groups, and did not differ either when comparing open and percutaneous repair.

Conclusion:

Open and percutaneous repair of a torn Achilles tendon produced similar functional outcomes.
Patient Reported Outcomes of Tenodesis to Reconstruct Peroneal Tendon Tears
Authors: Danna Natalie , Rizkalla James , Abebe Ermias , Brodsky James
Published: September 2018

Category:

Ankle

Introduction/Purpose:

Peroneal tendon tears are a common cause of lateral ankle pain. When the tear involves more than 50% of the tendon’s cross-sectional area, the treatment algorithm recommends tenodesis of the torn peroneal tendon to the intact peroneal tendon. Previous assessments in the literature of functional outcomes after peroneal tenodesis have widely used the American Orthopedic Foot and Ankle Score (AOFAS) survey as a measurement tool. However, this score was not designed for patient-reported outcomes and its validity and reliability have been questioned. The Medical Outcomes Shortform-36 (SF-36) and PROMIS are tools that have been extensively studied and validated. We sought to assess patient outcomes after peroneal tenodesis using validated tools: SF-36, PROMIS and AOS Disability scores.

Methods:

Prospective data was collected on patients undergoing peroneal tenodesis for peroneal tendon tears, and who follow up of at least one year. Patients who underwent concomitant procedures (hindfoot fusion, total ankle arthroplasty) were excluded from the study. Baseline patient-reported outcomes (PRO) scores were obtained preoperatively and compared to scores obtained at one year postoperatively.

Results:

We identified seventeen patients who underwent peroneal tenodesis for peroneal tendon tears. Average age was 62.1 years. SF-36 Physical Function scores increased from an average of 42.0 preop to 60.0 postop (p = 0.0095). PROMIS scores increased from 40.3 to 42.7 (p = 0.3049). There was no statistically significant improvement in postoperative SF-36 Pain scores (p = 0.3216). AOS Disability Scores dropped from 49.6 preop to 38.2 postop (p = 0.3178). AOS Pain scores decreased from 40.7 to 27.0 (p = 0.1779). Total AOS score decreased from 45.1 to 32.6 (p = 0.2204).

Conclusion:

The SF-36 Physical Function score, which is a validated outcome measure, showed statistically significant improvement postoperatively. Some of the other PROs for peroneal tenodesis failed to show statistically significant improvements, and this is most likely due to low numbers, rendering the cohort somewhat under-powered. Though the data is preliminary, the non-significant scores trended toward improvement. Despite the preliminary nature of this study, satisfactory outcomes of peroneal tenodesis using validated patient-reported outcome scores are demonstrated for the first time. Further study is underway to enlarge the scope of this investigation.
Survival of the Scandinavian Total Ankle Replacement (STAR)
Authors: Frigg Arno , Germann Ursula , Huber Martin , Horisberger Monika
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

The purpose of this study was to evaluate survival and clinical outcome of the Scandinavian total ankle replacement (STAR) prosthesis after a minimum of ten years up to a maximum of 19 years.

Methods:

Fifty STAR prostheses in 46 patients with end stage ankle osteoarthritis operated between 1996 and 2006 by the same surgeon (MH) were included. Minimal follow-up was ten years (median 14.6 years, 95% confidence interval [CI] 12.9-16.4). Clinical (Kofoed score) and radiological assessments were taken before the operation and at one, ten (+2), and 16 (±3) years after implantation. The primary endpoint was defined as exchange of the whole prosthesis or conversion to arthrodesis (def. 1), exchange of at least one metallic component (def. 2), or exchange of any component including the inlay (due to breakage or wear) (def. 3). Survival was estimated according to Kaplan-Meier. Further reoperations related to STAR were also recorded.

Results:

The ten year survival rate was (def. 1) 94% (CI 82- 98%), (def. 2) 90% (CI, 77-96%), and (def. 3) 78% (CI 64-87%). The 19-year survival rate was (def. 1) 91% (CI 78-97%), (def. 2) 75% (CI 53-88%), and (def. 3) 55% (CI 34-71%). Considering any re-operations related to STAR, 52% (26/50) of prostheses were affected by re-operations. Mean pre-operative Kofoed score was 49, which improved to 84 after one year (n = 50), to 90 after ten years (n = 46), and to 89 after 16 years (n = 28).

Conclusion:

The survival rate for def. 1 and 2 was high. However, re-operations occurred in 52% of all STAR prosthesis.
Institutional Costs Associated with Ankle Fusion Nonunion
Authors: Gagné Oliver , Penner Murray , Wing Kevin , Younger Alastair , Veljkovic Andrea
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

Ankle arthrodesis is the most favored surgical treatment for several tibiotalar pathologies. Nonunion requiring revision occurs in 5.7% - 6.5% of patients. Nonunion is a challenging surgical complication and bone graft substitutes are costly. This study aimed to summarize all institutional expenditures related to ankle fusion nonunion needing revision, presuming that cost and skin-to-skin time would exceed that of the index surgery.

Methods:

Reviewing electronic charts from a foot and ankle center, a patient list with two or more entries for tibiocalcaneal, pantalar and tibiotalar fusions was generated. Out of 44 cases found, 21 patients had bilateral surgery and were excluded. Three had TAR or surgery in the periphery as index surgery; four had revision not for nonunion.Demographic factors and skin-to-skin time of the 16 remaining patients were compiled. Supplemental clinic visits and investigations were included either after CT to assess union, or 365 days post-index procedure in the absence of CT. Total cost of the revision was calculated from surgical billing codes, length of operation, and period of hospitalization. Post-revision outpatient fees were all included. This cohort included 16 patients (6F: 10 M) with an average age of 60 years (52 - 67) and BMI of 33 (29 - 38). 14 revisions were performed open; 13 patients received bone graft.

Results:

Average hospitalization post-operatively was 5.5 days (1.87 - 9.28). The additional cost associated with nonunion were $1,538 (CAD) for imaging, $737 for pre-revision visits, $12,483 for the revision and hospital stay, and $1,990 for post-revision follow-up. The total average amount was $14,982, equivalent to 10 nights of acute inpatient stay. Index average skin to skin time was 2:00:50 and for revisions 2:18:20, for a p-value of 0.26. The cost of nonunion per 100 primary procedures is therefore $85,397 to $97,383. If an intervention reduces the incidence of nonunion by 50% the cost saved would be $486 per procedure. As grafting or bone graft substitutes cost over $1,000, grafting should be limited to at risk patients.

Conclusion:

Additional care related to ankle fusion nonunion represents a financial burden equivalent to 10 nights of acute inpatient stay. Revision surgery is not significantly longer intraoperatively than index surgery. Bone graft and/or substitute should only be considered if it’s cost is less than $486 CAD at our institution.
Trends in Publication and Levels of Evidence in Foot and Ankle International From 2000-2015
Authors: Griffith Matthew , Han Edward , Hattaway Joshua , Huh Jeannie
Published: September 2018

Category:

Other

Introduction/Purpose:

As the movement towards evidence-based medicine grows and publication rates rise each year, critical analysis of the orthopaedic literature has become increasingly important. To aid readers in assessing the scientific quality of published research, Foot and Ankle International (FAI) began assigning levels of evidence to all clinical articles in 2008. The purpose of this study was to analyze trends in the characteristics and levels of evidence of articles published in FAI between 2000 and 2015.

Methods:

All articles published in FAI from 2000, 2005, 2010, and 2015 were reviewed and categorized into article type (clinical, basic science, review, or technical tip). Each clinical article was assigned a level of evidence (I-V) and study type (prognostic, therapeutic, economic, or diagnostic). Descriptive information was gathered pertaining to: country of origin, authorship, and funding. Statistical analysis was performed using chi-squared tests to detect any trends in levels of evidence and publication characteristics.

Results:

647 articles were reviewed from 2000 to 2015. There was a statistically significant increase in the publication of clinical articles (70% to 83%; p=0.013). The publication of levels I and II evidence significantly increased (2.44% to 13.53%; p=0.002). Although levels III-V evidence also increased (65% to 70.6%, p=1.014), this was not statistically significant. Publications originated from 39 countries, with a significant increase in the proportion of international papers (32.8% to 48%%; p=0.007). The proportion of articles authored by Podiatrists during the study period significantly decreased (3.73% to 1.74%, p=0.035). Finally, there was an increase in funding disclosures during the study period; funding from grants or professional groups rose from 2.44% to 15.9% (p<0.001) and reported funding from commercial sources rose from 0% to 9.41% (p=0.002).

Conclusion:

The proportion of level I and II studies published in FAI significantly increased from 2000 to 2015. The publication of clinical research rose, with a majority being therapeutic studies. There was a significant increase in articles published by international authors and a significant decrease in articles published by DPMs. During the same time period, there was a rise in the proportion of articles reporting the use of outside funding, both professional and commercial.
Projections for Total Ankle Arthroplasty based upon the National Inpatient Sample
Authors: Gross Christopher , Rabinowitz Justin , Durante Elizabeth
Published: September 2018

Category:

Ankle Arthritis

Introduction/Purpose:

The utilization of total ankle arthroplasty (TAA) has increased significantly over the past decade. While projections for hip and knee arthroplasty show an exponential increase in demand, there remains a paucity of literature on the projected demand for TAA. Outcomes for TAA show promising results at 10 year follow up and, as a result, the demand for TAA will likely see a significant increase over the next few decades. The purpose of this study is to assess the current trends and future demand of TAA utilization.

Methods:

National Inpatient Sample (NIS) data from 1997-2014 was used to identify trends in the utilization of TAA. United States Census Bureau data from 1997-2014 was used to identify historical population data and future population estimates. A linear regression model was created using Mathematica v11.3 to project future demand for total ankle arthroplasty. The data was stratified to show past and future trends based on gender and age.

Results:

The overall utilization rate of TAA increased from 232 procedures in 1997 to 4435 procedures in 2014. Based on our model, the overall demand for TAA is expected to increase by 174 percent to 12,161 procedures by 2045. Stratified by age groups, the number of procedures is predicted to increase by 69% in ages 18-44, 177% in ages 45-64, and 287% in ages 65-84 by 2045. Stratified by gender, males are projected to undergo 7,070 procedures and females are projected to undergo 6,114 procedures in 2045.

Conclusion:

Improvements in TAA techniques and implants are leading to better long term clinical outcomes following TAA. Based on our projection model, there is going to be a significant increase in demand for TAA by 2045.
Lisfranc ligament anatomical reconstruction surgery is beneficial for chronic Lisfranc injuries
Authors: Hirano Takaaki , Yui Akiyama , Niki Hisateru
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

Chronic Lisfranc fracture dislocation had been commonly treated with arthrodesis, but were these treatments suitable? The Lisfranc joint has sagittal motion with articular cartilage and functioning as a shock absorber. We reported the middle-term outcomes after performing Lisfranc ligament anatomical reconstruction surgery (LARS), using an optimal route of reconstruction based on anatomical measurements of and biomechanical experiments with cadavers. The purpose of this study is to determine the usefulness of LARS for chronic Lisfranc injuries to preserve the joint function.

Methods:

We underwent LARS for 8 cases of Chronic Lisfranc injuries (6 males, 2 females) from May 2012 to June 2017. Average age at surgery 26.1 years (18-38), average follow-up period is 28 months (2-46). The reconstruction route was via a burr hole created at a position 6 mm distal to the tarsometatarsal joint on the 2nd metatarsal, and at a depth of 10 mm. A burr hole was then created from the medial cuneiform bone to the 2nd metatarsal bone in a plantar and horizontal direction. The graft tendon was guided through the burr hole from the medial cuneiform bone to the 2nd metatarsal (double-layered side), was looped, and was guided back around the dorsum of the medial cuneiform(single layer) to reconstruct the dorsal ligament. We examined Myerson classification, Kaar evaluation and the postoperative clinical evaluation using Japanese Society for Surgery of Foot (JSSF) midfoot scale.

Results:

In Myerson classification, Type B2 6 cases and Type C1 2 cases. In Kaar evaluation, transverse instability (TI) 6 cases, longitudinal instability (LI) 2 cases. The average time from injury to surgery is 156 days on average (37-404). JSSF scores averaged 95 points (90-100). X - ray evaluations were almost good, but in 2 cases with weight bearing, a slight diastasis between the base of the first cuneiform and second metatarsal was observed. But there were no clinical symptoms such as pain. In the surgical procedure, scar is mediated in chronic cases. Therefore, we had to take time to obtain the reduction.

Conclusion:

Arthrodesis is gold standard for chronic Lisfranc joint injuries, but decline in foot flexibility is inevitable. LARS is beneficial for maintaining anatomical reduction, preserving the joint function, and shortening the post-therapy period. LARS gave stable results against Chronic Lisfranc joint injuries. LARS for chronic Lisfranc joint injuries is a useful procedure.
Comparison of internal fixation with hollow two-way compression screw and double Kirschner pin for the treatment of Jones fracture
Authors: John Rodger
Published: September 2018

Category:

Midfoot/Forefoot

Introduction/Purpose:

To compare the clinical effect of hollow bidirectional compression screw and double Kirschner needle in the treatment of Jones fracture.

Methods:

32 cases of Jones fractures treated follow-up were analyzed retrospectively, including 20 cases of application of hollow biaxial compression intramedullary screw fixation for 12 cases, double Kirschner wire internal fixation.

Results:

all 32 cases were followed up for 6~18 months, with an average of 10 months. For two-way hollow compression screw nail 20 cases, including 19 cases healed, 1 cases of delayed healing, the healing rate was 95%, the average healing time of 11.2 weeks (9 - 13). 12 cases of internal fixation with double Kirschner needle were performed, of which 8 cases were bone healing, 3 cases were delayed union, 1 cases were not healed, the healing rate was 75%, the average healing time was 14.7 (12~16) weeks. The average healing time after two groups of internal fixation was statistically analyzed, and the difference was statistically significant.

Conclusion:

the hollow two-way compression screw is more reliable and reliable in the treatment of Jones fracture than the double Kirschner wire. The average healing time is shorter and the healing rate is higher. The hollow two-way compression screw is an effective method for the treatment of Jones fracture.