bluuebunny/crossref_metadata_2025 huggingface dataset:
A systematic review of pre-registration in autism research journals
Authors: Poole Daniel , Linden Audrey , Sedgewick Felicity , Allchin Oliver , Hobson Hannah
Published: December 2024

Pre-registration refers to the practice of researchers preparing a time-stamped document describing the plans for a study. This open research tool is used to improve transparency, so that readers can evaluate the extent to which the researcher adhered to their original plans and tested their theory appropriately. In the current study, we conducted an audit of pre-registration in autism research through a review of manuscripts published across six autism research journals between 2011 and 2022. We found that 192 publications were pre-registered, approximately 2.23% of publications in autism journals during this time frame. We also conducted a quality assessment of a sample of the pre-registrations, finding that specificity in the pre-registrations was low, particularly in the design and analysis components of the pre-registration. In addition, only 28% of sampled manuscripts adhered to their analysis plan or transparently disclosed all deviations. Autism researchers conducting confirmatory, quantitative research should consider pre-registering their work, reporting any changes in plans transparently in the published manuscript. We outline recommendations for researchers and journals to improve the transparency and robustness of the field.

Lay abstract

When researchers write down their plans for a study ahead of time and make this public, this is called pre-registration. Pre-registration allows others to see if the researchers stuck to their original plan or changed as they went along. Pre-registration is growing in popularity but we do not know how widely it is used in autism research. In this study, we looked at papers published in six major autism journals between 2011 and 2022. We found that only 2.23% of papers published in autism journals had been pre-registered. We also took a close look at a selection of the pre-registrations to check how good they were and if researchers stuck to their plans. We found that the pre-registrations generally lacked specifics, particularly about how the study was designed and the data would be analysed. We also found that only 28% of the papers closely followed the pre-registered plans or reported the changes. Based on these findings, we recommend that autism researchers consider pre-registering their work and transparently report any changes from their original plans. We have provided some recommendations for researchers and journals on how pre-registration could be better used in autism research.
Bond behaviour of RACFST stub columns after exposure to high temperatures
Authors: Zou Wanjie , Liang Jiongfeng , Lin Siqi , Wang Caisen
Published: December 2024

The bond behaviors of recycled aggregate concrete-filled steel tube (RACFST) stub columns after exposure to high temperatures were investigated based on the push-out experimental tests of 36 heated and six unheated RACFST specimens. The influences of five variable parameters, that is, temperature level, replacement ratio of recycled coarse aggregate (RCA), cross-section type, concrete strength and interface length, on the bond strength and bond stress-slip curves were discussed. Results suggest that the bond stress-slip curves of push-out RACFST specimens at high temperature differ from those at ambient temperature. Additionally, the bond strength was found to increase with increasing temperature. The bond strength at a high temperature of 800°C is about 3 times higher than that at room temperature. The bond strength can be increased up to 2.6 times after high temperature with the same RAC replacement ratio. Based on the experimental results, regression analysis was conducted to develop a bond strength model to predict the bond behavior between recycled aggregate concrete and steel tube after exposure to high temperatures.
Becoming Red-Pilled: Affective production in online countercultural collectives
Authors: Andéhn Mikael , Hietanen Joel , Wickström Alice
Published: December 2024

Advances in information and communication technologies present remarkable potential for globally dispersed people to connect and engage around a variety of interests. While online communities seemed to initially offer vast potential for social cohesion, their ephemeral nature continues to raise doubts about their ability to facilitate meaningful togetherness. It has also been suggested that the largely automated nature of commercially driven social media can excite aggression and polarisation and thus bring about far-reaching negative social outcomes. Drawing from a long-term immersive online ethnography of the Red Pill, a conspiratorial collective battling their conception of feminine power in society, we adapt Bernard Stiegler’s philosophy of technology to assess its production of affect and social cohesion. Our findings reframe online counterculture, emphasising how its expressions are predicated on a techno-affective overdetermination that forecloses the possibility of meaningful participation and community-building.
Angle-based transfer support matrix machine for roller bearing fault diagnosis under limited labeled data
Authors: Tang Anbo , Wang Meng , Pan Haiyang
Published: December 2024

In real-world fault diagnosis, the process of acquiring fault vibration signals frequently faces various challenges, which lead to certain fault types being represented by a scarcity of vibration signal data. Although support matrix machine (SMM) exhibits excellent classification ability in matrix-based data, its ideal model is difficult to establish with limited labeled samples. To address this limitation, a novel angle-based transfer support matrix machine (ATSMM) is proposed, which integrates matrix-based classifier and transfer learning theory. ATSMM employs an angle-based transfer learning method, which aims to reduce the angle between the normals of the target domain hyperplane and the source domain hyperplane, enabling the transfer of structural information across different domains. Meantime, ATSMM effectively addresses the issue of negative transfer that frequently occurs in transfer learning, which adds the weights calculated by the maximum mean discrepancy method to further improve the transfer effectiveness of the target domain model. The superiority of ATSMM is verified by two different roller bearing datasets, and the outcomes of experiments exhibit that the proposed ATSMM has excellent classification performance compared to alternative methods, especially in scenarios where the labeled sample size is limited.
A teacher–student strategy specific to transformer for machine fault diagnosis
Authors: Zhang Chenglong , Qiao Zijian , Li Tao , Kumar Anil , Xu Xuefang , Li Hao , Li Zhixing
Published: December 2024

To address the challenges of limited labeled data and computational resources in intelligent machine fault diagnosis, we propose a teacher–student strategy based on transformers with token distillation. This approach introduces a learnable embedding in the attention mechanism, enabling the student network to learn diagnostic features from a larger teacher network. This is especially beneficial when the student model is applied to new operating conditions via a joint classifier. Building on the Vision Transformer architecture, known for its success with large-scale image datasets, our method starts by converting signals into image samples. Soft distillation using attention mechanisms then facilitates the Vision Transformer’s training with limited data. In addition, pretraining on a comprehensive mechanical dataset with diverse labeled fault types improves the model’s performance on specific target datasets, allowing it to generalize to new and unseen faults. This strategy demonstrates strong performance in Top-1 accuracy, mean precision, mean recall, and mean F1 score across datasets involving bearings, gears, and rotors, improving diagnostic accuracy even when labeled fault data are scarce.
High-performance and cost-effective metal spun yarn utilizing innovative single-stage manufacturing module
Authors: Hossain Mahmud , Abdkader Anwar , Obst Alexander , Gesell Stefan , Cherif Chokri
Published: December 2024

Among the various methods used to produce metal fibers, one efficient approach involves processing metal staple fibers (type 1.4113) through a steel wool or planing process. In this method, thick metal wire is pulled through a toothed profiled die to create thin, sharp-edged, and flexible wire shavings. A process chain for spinning such planed metal staple fibers into metal spun yarns, including stretch breaking, drawing, flyer and ring spinning, has already been developed. However, the inherent low elongation and brittle behavior of the material often result in fiber damage during the multiple drawing stages, leading to the formation of short fibers and significant dust in the products. To address these challenges, a new single-stage short staple spinning process has been developed to minimize fiber damage and enable the flexible production of high-performance 100% metal staple spun yarn. The spinning module incorporates a delivery, non-crimping, twisting, and winding units, all of which are modularly designed, manufactured, and driven by individual servo motors. Following the commissioning of the spinning module, uniform and reproducible metal-spun yarn with defined properties and scalable yarn counts (1000–2500 tex) was produced and thoroughly characterized to understand the potential of metal-spun yarn. This study presents the potential of the new spinning process to revolutionize metal fiber production, providing a reliable and high quality solution for demanding industrial applications such as automotive brake pads, high-efficiency burners, electromagnetic shielding, heat pipes, cut-resistant gloves, etc.
Friction stir welding of similar and dissimilar Al and Cu lap joints: Effect of work piece material on conducive welding speed window, weld strength and hardness
Authors: Latif Abdul , Hussain Ghulam , Alkahtani Mohammed , AlChallabi Sarah Najm , Shehbaz Tauheed
Published: December 2024

This study used friction stir welding to make comparable (AA2219-AA2219 and Cu-Cu) and dissimilar (AA2219-Cu) lap joints. The tool retained its rotating speed at 1500 rpm and tilt angle at 2°, while welding speed varied from 23.5 mm/min to forward. Changing work-piece material affects welding speed, joint strength and hardness, and intermetallic compound formation. Similar lap joints have a welding speed window of 23.5–475 mm/min for Cu-Cu lap joints and 23.5–275 for AA2219-AA2219. However, dissimilar welding had a significantly smaller window of favorable speed: 23.5–30 mm/min for AA2219-Cu joints and 23.5–37.5 for Cu-AA2219 joints. The tensile strength analysis showed a maximum lap shear strength of ∼33 MPa for similar joints at extreme speeds, whereas dissimilar joints achieved ∼23 and ∼12 MPa for AA2219-Cu and Cu-AA2219 configurations, respectively, at 23.5 mm/min, mainly due to the formation of IMCs. Hardness testing indicated a significant increase to ∼79 Hv in dissimilar joints at 30 mm/min when copper was layered over AA2219, a result of extrusion and stirring effects. The high hardness in the dissimilar Al-Cu joints can be attributed to the formation brittle IMCs AlCu (Al2Cu) and Al4Cu9.
Geo-spatial analysis of acute ischemic stroke reperfusion treatment in India: An assessment of distribution and access to centers
Authors: Asif Kaiz S , Mitra Arun , Ortega-Gutierrez Santiago , Herial Nabeel , Desai Shashvat , Jadhav Ashutosh , Al-Mufti Fawaz , Roy Adrija , Singh Romil , Brown Grant , Sarraj Amrou , Jose Arun , Alurkar Anand , Karapurkar AP , Sharma Arvind , Gupta Vipul , Goel Gaurav , Khurana Dheeraj , Das Biplab , Roy Jayanta , Das Deep , Kumar Rahul , Kuruttukulam Gigy , Kumar VG Pradeep , Srivastava MV Padma , Pandian Jeyaraj , Huded Vikram , Yavagal Dileep , Soman Biju , Sylaja PN
Published: December 2024

Background:

Stroke is a leading cause of global mortality and disability, with a disproportionately high burden in low- and middle-income countries. Access to intravenous thrombolysis (IVT) and endovascular treatment (EVT) remains extremely limited.

Aims:

We evaluated the spatial distribution and geographic accessibility of stroke centers in India.

Methods:

Data on IVT capable (IVT-C) and EVT capable (EVT-C) stroke centers were collected in March 2021 from thrombectomy devices and pharmaceutical industry providers, respectively. Data were collated and geocoded to compare and calculate zonal statistics and state/union territory (UT) summaries using descriptive statistics. Data on population centers were obtained from the Survey of India website. For estimating driving times, we used the Google Distance Matrix API to find the driving distance between each population center and its nearest stroke facility. Subsequently, population coverages were estimated as a proportion of the population having access to stroke centers for each time interval and based on the population projection for the year 2020 and compared across states.

Results:

A total of 566 IVT-C stroke centers were spread across 26 states and UTs, of which 361 (63%) were EVT-C. Ten UTs lacked stroke centers. The average stroke centers per million (SCPM) population was 0.41 and 0.26 for IVT-C and EVT-C, respectively. Median distances to the nearest IVT-C and EVT-C centers were 115 km (interquartile range (IQR): 66–175) and 131 km (IQR: 79–198), respectively. Access within 1 h to an IVT-C and an EVT-C center was available to 26.3% and 20.6% of the Indian population, respectively.

Conclusions:

Access to stroke care in India is poor, with critical regional disparities as reflected by the low SCPM population, long driving times, and a small population with access within the golden hour. There is an urgent need to establish IVT-C and EVT-C stroke centers in the existing poorly served regions of India to increase access and improve outcomes for stroke patients.
Ischemic stroke prevention in patients with atrial fibrillation and a recent ischemic stroke, TIA, or intracranial hemorrhage: A World Stroke Organization (WSO) scientific statement
Authors: Sposato Luciano A , Cameron Alan C , Johansen Michelle C , Katan Mira , Murthy Santosh B , Schachter Micaela , B Sur Nicole , Yaghi Shadi , Aspberg Sara , Caso Valeria , Hsieh Cheng-Yang , J Hilz Max , Nucera Antonia , Seiffge David J , Sheppard Mary N , Martins Sheila CO , Bahit M Cecilia , Scheitz Jan F , Shoamanesh Ashkan
Published: December 2024

Background:

Secondary stroke prevention in patients with atrial fibrillation (AF) is one of the fastest growing areas in the field of cerebrovascular diseases. This scientific statement from the World Stroke Organization Brain & Heart Task Force provides a critical analysis of the strength of current evidence on this topic, highlights areas of current controversy, identifies knowledge gaps, and proposes priorities for future research.

Methods:

We select topics with the highest clinical relevance and perform a systematic search to answer specific practical questions. Based on the strength of available evidence and knowledge gaps, we identify topics that need to be prioritized in future research. For this purpose, we adopt a novel classification of evidence strength based on the availability of publications in which the primary population is patients with recent (<6 months) cerebrovascular events, the primary study endpoint is a recurrent ischemic stroke, and the quality of the studies (e.g. observational versus randomized controlled trial).

Priority areas include AF screening, molecular biomarkers, AF subtype classification, anticoagulation in device-detected AF, timing of anticoagulation initiation, effective management of breakthrough strokes on existing anticoagulant therapy, the role of left atrial appendage closure, novel approaches, and antithrombotic therapy post-intracranial hemorrhage. Strength of currently available evidence varies across the selected topics, with early anticoagulation being the one showing more consistent data.

Conclusion:

Several knowledge gaps persist in most areas related to secondary stroke prevention in AF. Prioritizing research in this field is crucial to advance current knowledge and improve clinical care.
Victims of religious hate crime: Victimisation of Muslims, Jews and Hindus compared
Authors: Flax Maya , Shannon Kayleigh
Published: December 2024

The surge in Hate Crime within the United Kingdom has disproportionately impacted religious communities, particularly Muslims, Jews and Hindus. This article provides a comprehensive exploration of hate crimes targeting these three religious groups in the United Kingdom. Through qualitative interviews with victims, the study aims to analyse their immediate response following the victimisation. Drawing insights from 30 individual interviews and three focus groups, the research uniquely combines three distinct religious groups for comparative analysis, revealing both commonalities and differences in their victimisation experiences. Findings highlight the pervasive nature of victimisation, emphasising community visibility and perceived safety. Notably, collective responsibility is evident among Muslim and Jewish participants. This research contributes to a nuanced understanding of challenges faced by victims, emphasising the need for robust law enforcement measures.
Case Series of Infection-Related Glomerulonephritis in Quebec Indigenous Peoples
Authors: Nodzynski Thomas , Sohani Zahra , Rajaram Ajay , Fiset Pierre Olivier , Bernard Chantal , Vasilevsky Murray , Weber Catherine
Published: December 2024

Rationale:

Infection-related glomerulonephritis (IRGN) is an immune-mediated glomerulonephritis caused by extra-renal infectious diseases. There has been an important shift in epidemiology in recent years, with a significant proportion of adults affected. The incidence of IRGN is higher amongst Indigenous populations and especially in those with multiple comorbidities. Beginning in 2019, we observed several IRGN cases amongst adult Indigenous peoples referred to the McGill University Health Center (MUHC). The aim of this article is to describe the demographic, clinical, and outcome data of these individuals and highlight the heterogeneity of IRGN in this population through 2 illustrative cases.

Presenting concerns of the patient:

In total, 8 cases of IRGN were identified between 2019 and 2022. All patients presented with features of acute glomerulonephritis.

Diagnoses:

All patients had documented evidence of an infection that preceded their diagnosis of IRGN. IRGN was not the initial clinical diagnosis in all cases.

Interventions:

Half the patients received immunosuppression while the others received supportive care only.

Outcomes:

Four patients required initiation of hemodialysis at time of presentation and at 2 years of follow-up, 3 of the 4 remained hemodialysis-dependent.

Teaching points:

Our case series emphasizes the heterogenous clinical, laboratory, and pathological presentations that make the diagnosis of IRGN quite challenging. A high index of suspicion should be present when a patient presents with acute kidney injury, features of a glomerulonephritis, and an infection, especially those with multiple comorbidities and a preceding history of chronic kidney disease.
Factors Associated with Symptom Recurrence Following Operative Treatment of Interdigital Neuroma
Authors: Ghandour Samir , Suyama Emi R. , Sirls Evan , Ahn Jiyong , Burgesson Bernard , Aslan Lercan , Ashkani-Esfahani Soheil , Guss Daniel , Waryasz Gregory , Bejarano-Pineda Lorena , DiGiovanni Christopher W.
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Interdigital Neuroma (IN) is a benign enlargement of tissue surrounding the common plantar digital nerve. Traditionally, neurectomy has been performed as the standard surgical treatment for IN. However, recent attention has been given to less invasive surgical decompression by intermetatarsal ligament (IML) release with neurolysis. This study aims to compare the outcomes of IML release with neurolysis to traditional interdigital neurectomy.

Methods:

A retrospective chart review was conducted on 350 consecutive patients who underwent surgical treatment for IN. Patients who satisfied our inclusion and exclusion criteria were categorized into two groups based on the surgical treatment received: IML release with neurolysis or interdigital neurectomy. Inclusion criteria were patients older than 18 years with symptomatic IN, having an indication for surgical treatment following at least three months of unsuccessful conservative treatment, and at least 12 months of postoperative follow-up. Patients with concurrent procedures at the time of surgery, multiple affected web spaces, trauma to the affected forefoot, or asymptomatic IN without clear indications for surgical treatment were excluded from the study. Evaluated outcomes included recurrence of symptoms, rate of revision surgery, and postoperative wound infection.

Results:

Out of the 350 patients screened, 127 fulfilled the inclusion and exclusion criteria. Forty (32%) patients experienced recurrence of symptoms within a 12-month follow-up period with an overall mean time-to-recurrence of 3.96 +/- 3.15 months. Patients who underwent IML release with neurolysis had a significantly higher recurrence rate (48%) and mean time-to-recurrence of 4.61 +/- 3.22 months compared to those who underwent interdigital neurectomy (24%) with a mean time-to-recurrence of 3.47 +/- 3.08 months (P< 0.01). The rate of postoperative wound infection was similar between the two groups. The rate of revision surgery among those with symptom recurrence in the IML release group (16%) and neurectomy group (4%) was not statistically significant between both groups (P=0.49).

Conclusion:

IML release with neurolysis appears to have a higher risk of symptom recurrence compared to interdigital neurectomy. However, patients who did experience symptom recurrence in either operative group had similar rates of revision surgery, which may be due to mild recurrent symptoms in the IML release group that did not warrant revision surgery in these patients. No patient-specific factors were identified as being associated with symptom recurrence. Future studies should consider objective symptom recurrence severity and patient satisfaction.
Fixed-Bearing vs Mobile-Bearing Total Ankle Replacement Survivorship. A Meta-Analysis
Authors: Alonso Marcos Gonzalez , Cubillas Ana Rosa Trapote , Gonzalez Francisco Jose Madera , Hernandez Oscar Fernandez , Lazaro Jaime Antonio Sanchez
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Main objective of this research is to know if there is a different survival ‎rate between fixed bearing (FB) and mobile bearing (MB) total ankle replacement ‎‎(TAR). We hypothesized that there are no differences between the survival rates of ‎both implants.‎

Methods:

A systematic search was performed in PubMed, Cochrane, EMBASE and ‎ClinicalTrials.gov databases‎ to identify published studies from August 2018 to ‎September 2022 including results for FB and MB TAR survivorship. Inclusion criteria ‎included 1) primary TAR in one or both feet in which implant could be identified‎, 2) a ‎minimum of 20 procedures reported, 3) reported implant survivorship or calculable ‎and 4) a minimum of 12 months follow-up for level 1-3 studies or 60 months for level ‎‎4 studies.‎

Results:

3902 ankles in 28 studies were included. 719 were FB and 3104 MB with an overall ‎survivorship of 94% (95% CI [0.89; 0.97]) and 89% (95% CI [0.86; 0.92]) respectively. ‎After subgroup analysis, we did not find differences among both groups (p = ‎0.429‎). ‎Meta-regression analysis showed that longer follow-up was associated with lower ‎survival rates in MB group (p = 0.000) while no other relationships were found with ‎other factors (age, level of evidence or conflict of interests).‎

Conclusion:

No differences in survival rates between both groups were found. Age and other ‎studied confounders were not found to be related with implant survivorship. ‎However, longer follow-up was found to be related with lower survival rates. Studies ‎with longer follow-up and higher level of evidence are needed to confirm results.‎
Fourth-Generation Metatarsal Extra-Capsular Transverse Akin (META) Osteotomies for Percutaneous Hallux Valgus Correction: A Series of 729 Consecutive Feet
Authors: Lam Peter , Murphy Evelyn , Jia Chua Min , Robinson Peter , Watt Clare , Ray Robbie , Lewis Thomas L.
Published: December 2024

Category:

Bunion; Lesser Toes

Introduction/Purpose:

Fourth-generation percutaneous or minimally invasive hallux valgus surgery utilises a transverse osteotomy to achieve deformity correction. There are only a small number of series reporting the clinical and radiological outcomes of transverse osteotomies, many of which have methodological limitations such as small sample size, limited radiographic follow up or use of non-validated outcome measures. The aim of this study was to provide a methodological robust investigation into percutaneous transverse osteotomies for hallux valgus deformity.

Methods:

A prospective case series of consecutive patients undergoing fourth generation metatarsal extra-capsular transverse osteotomy (META) performed by a single surgeon (PL) between November 2017 and January 2023. The primary outcomes were radiographic deformity correction and clinical foot function assessed using the Manchester-Oxford Foot questionnaire (MOXFQ-a validated patient reported outcome measure). Radiographic deformity (Hallux valgus angle (HVA) and 1-2 Intermetatarsal angle(IMA), sesamoid position) was assessed according to AOFAS guidelines. Secondary outcomes included Visual Analogue Scale for Pain and radiographic deformity recurrence (defined as HVA >20° at final radiographic follow up). All p-values < 0.05 were considered significant.

Results:

729 feet from 483 patients (456 Female, 27 Male, mean age 57.9±11.9 years) underwent META. Radiographic data (minimum 12 months post-surgery) was available for all feet with mean follow up of 2.6±1.3 years (range 1.0-5.7). There was a statistically significant improvement (p< 0.05) in both HVA; 29.5±8.5° to 7.3±6.7°, and IMA, 12.9±3.4° to 4.6±2.5°. All MOXFQ domains showed significant improvement (p< 0.05); Index 36.6±19.1 to 11.8±13.8, Pain 40.1±22.1 to 15.6±16.4, Walking/Standing 32.2±23.2 to 10.2±15.8 and Social Interaction 40.0±20.6 to 9.7±14.0. The recurrence rate was 4.6% (n=33) with a significantly higher proportion of sesamoids in Grade 2 and 3 in the recurrence group (p< 0.05). There was 1 non-union, 1 deep infection and 20 cases of superficial infection. No avascular necrosis of the first metatarsal head occurred.

Conclusion:

This is the largest consecutive series of any percutaneous osteotomy technique to correct hallux valgus deformity. This study demonstrates that the technique leads to significant improvement in clinical and radiographic outcomes with a low rate of recurrence. Recurrence may be linked to incomplete sesamoid reduction at the time of surgery.
Ground Reaction Force on the Frontal Plane Directs to the Center of Mass During Gait: Analysis from Gait Database
Authors: Takeda Ryutaro , Kobayashi Yoshiyuki , Kobayashi Etsuko , Matsumoto Takumi
Published: December 2024

Category:

Other; Basic Sciences/Biologics

Introduction/Purpose:

In recent years, a paradigm shift has emerged in the preoperative planning for lower extremity osteotomies or arthroplasty. The focus has shifted from the loading axis during static standing known as Mikulicz line, to the loading axis during gait. These methods assumed that ground reaction force (GRF) vector directed toward the center of mass (CoM) on the frontal plane in the stance phase of gait. However, no study has clarified the relationship between the CoM and GRF vector. Furthermore, it is unknown to what extent the GRF vector turns inward from the Mikulicz line. The aim of the study is to reveal the geometrical relation on the frontal plane between the GRF vector and the anatomical landmarks including joint centers and the CoM during gait.

Methods:

The analysis was performed using the AIST (National Institute of Advanced Industrial Science and Technology) gait database 2019 which includes the data of 10 m walk on barefoot with comfortable speed obtained using motion-capture-system and force plates. The stance phase data of right feet for 162 participants (Male/Female = 78/84) under 50 years old was extracted. On the frontal plane, the distance from the GRF vector to the right hip center (D_hip) and to the CoM (D_CoM) were evaluated in the time period between the first and the last peak of the vertical GRF because this period could be considered as a single stance phase. The angle between GRF vector and the line passing center of pressures and hip centers (Mikulicz-GRF_Angle) was also calculated.

Results:

The analysis focused on the time period corresponding to 22 - 79 % of the stance phase, representing a single stance phase. Throughout this phase, the GRF vector on the frontal plane consistently directed medially to the hip center. The average D_hip during the single stance phase was 7.6 ± 1.0 cm, with a range of 6.6-9.2 cm. D_CoM was 1.3 ± 0.2 cm, and its range was 0.9 - 1.6 cm. Mikulicz-GRF_Angle was 5.6 ± 0.7 degrees, with a range of 4.8 - 6.7 degrees.

Conclusion:

During the single stance phase of gait in healthy young adults, the GRF vector consistently directs toward their CoM rather than their hip center on the frontal plane. The loading axis during gait was oriented 4.8 - 6.7 degrees medially to the hip center. These findings should be considered during surgery aimed at kinematic alignment reconstruction of the lower extremity.
Improving Detection of Underlying Neurologic Etiology for Pediatric Cavovarus Foot Deformity: We Can Do Better
Authors: O'Sullivan Michael , Christie Michelle , Hartman Rusty , Riccio Anthony I.
Published: December 2024

Category:

Other; Midfoot/Forefoot

Introduction/Purpose:

While evaluation of an underlying neurologic disorder in children with cavovarus foot deformity (CVD) is of great importance, no standardized method of neurologic assessment exists. Moreover, the yield of commonly employed diagnostic measures remains unstudied. This study aims to compare the diagnostic yield of traditional methods of neurologic assessment for patients CVD of unknown etiology to a more advanced diagnostic algorithm.

Methods:

An IRB-approved retrospective review of patients presenting to a single pediatric tertiary care center for bilateral or unilateral CVD was performed over a 19-year period. Patients with a known etiology for their deformity or preexisting neurologic or syndromic diagnoses were excluded. Neurologic evaluation of all remaining patients was conducted by a pediatric neurologist using one of two diagnostic algorithms. The traditional diagnostic algorithm (TDA) consisted of clinical examination, MRI of the brain and spinal cord and/or EMG/NCV. The advanced diagnostic algorithm (ADA) Included all components of the TDA in addition to genetic testing, and/or muscle/nerve biopsy and/or repeat EMG/NCV testing when initial workup remained negative. These diagnostic algorithms were compared regarding determination of an underlying etiology for CVD.

Results:

108 patients (average age 9.7 years) were included. 96 were assessed via the TDA which detected an underlying neurologic diagnosis in 56 (58%). 15 had central neurologic disease, 35 had peripheral neuropathies and 6 had combined central/peripheral neuropathology. Of the 40 patients in whom no diagnosis was made using the TDA, 21 were further assessed using the ADA revealing a diagnosis in 15 (71%), thereby increasing the diagnostic yield to 71/77 patients (92%) when the ADA was incorporated and 71/96 (74%) overall. Moreover, 23 of 41 patients (56%) diagnosed with an unspecified polyneuropathy by TDA received a more specific diagnosis via the ADA. Definitive diagnosis was achieved solely by genetic testing without the TDA in 12 patients, 75% of whom had variants of Charcot-Marie-Tooth disease.

Conclusion:

Neurologic etiology remains undetected in 42% of children with CVD using solely neuroaxis imaging and electrodiagnostic testing. Determination of an underlying neurologic cause for deformity can be increased by over 30% through the incorporation of genetic testing and other components of the ADA.
Influence of First Ray Positioning on Ankle Contact Stresses in the Setting of a Subtalar Arthrodesis
Authors: Maly Connor , Sakyi Maxwell , Goetz Jessica , de Cesar Netto Cesar , Chrea Bopha
Published: December 2024

Category:

Ankle; Hindfoot

Introduction/Purpose:

Subtalar arthrodesis is a commonly performed procedure for primary and post-traumatic subtalar arthritis and in the setting of deformity correction. Following arthrodesis, loss of motion at the subtalar joint alters loads experienced at the ankle joint. The influence of the first ray, an essential aspect of the foot tripod, in protecting or overloading the ankle joint in the setting of a fused subtalar joint is unknown. The purpose of this study was to assess the influence of first ray positioning on cartilage contact mechanics in the ankle joint in a native subtalar joint and following subtalar arthrodesis.

Methods:

Twelve below-knee cadaveric specimens (6 L/6 R) were mechanically loaded in neutral ankle flexion with an MTS-applied axial load of 600N and a pneumatically applied 45N of Achilles tendon tension to simulate 2-legged standing. A calibrated piezoresistive pressure sensor placed within the ankle joint measured cartilage contact pressure on the talar dome under load for 10 frames at 2Hz. In each specimen, contact pressure was measured pre- and post-subtalar fusion and after the application of two progressively larger dorsal opening wedges (4mm and 8mm Cotton osteotomy) in both the fused/unfused conditions. Computed tomography scans of specimens were segmented to generate 3D talus surfaces on which to overlay measured contact pressures. Peak and mean contact pressure, contact area, and center of pressure were compared between fused and unfused conditions with each first-ray correction.

Results:

Fusion of the subtalar joint increased contact pressures and shifted the contact patch laterally on the talar dome. First ray plantarflexion increased contact pressure and medialized the contact patch in both the fused and unfused conditions. (Figure 1). Joint contact area significantly decreased (by an average 18±9.3%) in all fused conditions compared to the unfused baseline (p < 0.001). Peak pressure in the unfused conditions increased over baseline by an average of 4±11.5% with the 4mm wedge and by 11±17.9% with the 8mm wedge, however neither increase was significant. Compared to the unfused baseline, subtalar fusion significantly increased peak contact pressures (32±21.7%, 38±23.4% and 49±30.5%) and mean contact pressures (23±22.2%, 23±19.8%, 21±19.1%) for the fused baseline, fused 4mm, and fused 8mm, respectively.

Conclusion:

This cadaveric biomechanical study found that subtalar fusion has a much stronger effect on ankle cartilage contact stress than changes in first-ray position. Alterations of the first ray position in specimens with subtalar fusion resulted in an increase in peak and mean contact pressure relative to the native ankle joint. Plantarflexion of the first ray modestly shifted the location of peak cartilage pressure in both the subtalar-fused and unfused foot but did not significantly increase contact pressure over the non-dorsiflexed condition.
In-Office Posterior Tibial Needle Tendoscopy Is An Effective Treatment Strategy for Patients with Stage 1 Posterior Tibial Tendon Dysfunction: A Retrospective Review
Authors: Butler James J. , Randall Grace W. , Rynecki Lauren , Mercer Nathaniel , Kennedy John G.
Published: December 2024

Category:

Arthroscopy; Other

Introduction/Purpose:

Posterior Tibial Tendon Insufficiency (PTTI) is a common pathology of the foot and ankle and the leading cause for adult-aquired flatfoot deformity. PTTI typically presents with loss of medial arch of the foot which may progress to hindfoot valgus, forefoot abduction, and development of midfoot osteoarthritis. Following failure of conservative management, tenosynovectomy is indicated in early stage PTTI. However, current tendoscopy techniques lead to significant soft tissue damage. Minimally invasive approaches to these arthroscopic procedures minimize damage to soft-tissue and allow for a much faster recovery. The purpose of this retrospective review is to evaluate the therapeutic and diagnostic potential of In-Office Posterior Tibial Needle Tendoscopy for PTTI.

Methods:

Chart review was conducted to identify patients who underwent In-Office Posterior Tibial Needle Tendoscopy with a minimum of 1-year follow-up. Data collected and assessed included: patient demographics, pathological characteristics, treatment characteristics, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score, visual analog scale (VAS) scores, return to sport (RTS), and failures.

Results:

Eleven patients were included at a mean follow-up of 17.4 ± 9.0 months and a mean age of 40.8 ± 14.64 years. Five patients (45.5%) were stage 1 PTTI, 5 patients were stage 2a PTTI and 1 patient was stage 2b PTTI. The mean AOFAS score improved from 45 ± 5.4 preoperatively to 70 ± 18.5 at final follow-up (p< 0.01). The mean VAS improved from 6 ± 0.7 preoperatively to 3.7 ± 1.6 at final follow-up (p< 0.01). The failure rate was 36.3%. All patients with stage 1 PTTI were asymptomatic at final follow-up. Four of the 6 patients (66.7%) with stage 2 PTTI warranted further surgical intervention.

Conclusion:

This retrospective study demonstrated there is therapeutic and diagnostic potential for In-Office Posterior Tibial Needle Tendoscopy. Patients with early stage PTTI had improved subjective clinical outcomes and rapid return to sport. For moderate to severe PTTI, in-office needle tendoscopy may be less beneficial. Further high quality studies are necessary to determine the optimal role of In-Office Posterior Tibial Needle Tendoscopy in the management of Posterior Tibial Tendon injury.
Intermediate Clinical and Radiographic Outcomes of the Inbone II: for Patients with Five Years Minimum Follow-up
Authors: Kothari Parin , Phillips Alexander , Potter Ramsey , Albert Drew , Padley Michelle A. , Anderson John G. , Bohay Donald R. , Maskill John D. , Boose Marshall A. , Behrend Lindsey A.
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

The TAA was originally introduced in the 1970s and each subsequent generation of implant has been improved upon. Innovative solutions led to second and third generation arthroplasties, which addressed the initial failures and incorporated new designs to improve patients’ lives through significant improvements in pain and function. The Inbone II Total Ankle System was made available in 2009. The successor to the Inbone I, it features pivotal changes to both the tibial stem and talar components. The purpose of this study is to gather intermediate (five or more year follow-up) data on the Inbone II Total Ankle Systems since it's approval in 2009.

Methods:

The study is retrospective, single-site cohort of patients who have undergone one or multiple surgeries involving the Inbone II Total Ankle System by the senior authors with at least 5 years of follow-up. For patients that are able to be reached, and choose to consent, a prospective clinical visit was conducted. This visit included physical and radiographic assessments, as well as patient-reported outcome measures.

Results:

Initially, 168 potential patients (77 females and 72 males) and were identified. The average patient was 62.5 years (range: 25 - 88) at surgery. Following retrospective data collection, these post-operative dispositions were noted: (19 (11.3%) declined prospective follow-up, 29 (15.5%) were lost to follow-up, 5 (3%) underwent amputations, 7 (4.2%) were explanted, and 2 (1.2%) expired). Of these, 59 (35%) patients (63 implants) have returned to the office for prospective assessments. Of these, 28 were female, and 31 were male. The mean time from surgery was 7.2 years (6.4 to 10.6). 15 reported complications following the procedure, most commonly noted as residual post-operative swelling (7 patients). Patient satisfaction was noted to be 93% overall, with an average AOFAS score of 84.2% (52 - 100).

Conclusion:

Preliminary data demonstrates that ankle replacement with the Inbone II device has the equivalent survival rate as that reported in the literature at 5 years post surgery.
Is Race Associated with Referral Disparities for Patients with Diabetic Foot Ulcers?
Authors: Schweser Kyle M. , Khaleel Mubinah , Garlapaty Ashwin , Hawkins Sam , Cook James , Rucinski Kylee
Published: December 2024

Category:

Diabetes; Other

Introduction/Purpose:

Racial minorities, including African Americans, Indigenous Americans, Asian Americans, Hispanic/Latinos, and Pacific Islanders are more likely to develop Type II diabetes and experience associated microvascular complications. Amputation rates related to diabetes and/or peripheral arterial disease are three times higher for African Americans, suggesting that race, access, and/or mistrust of the medical community may contribute to adverse outcomes for certain minority groups. Determining where the breakdown along the care continuum occurs is fundamental for achieving equitable outcomes among minority groups. This retrospective study was designed to determine 1) the associations of race and living status with rates of referral to specialists for DFU treatment, and 2) the severity of DFU at time of initial presentation.

Methods:

Patients were identified from the medical record based on a diagnosis related to diabetic foot ulcers made between January 01, 2018, and June 01, 2023, in the family medicine clinic, endocrinology clinic, or emergency department at a Midwest Level 1 Academic Hospital. Referral incidence to specialty orthopaedic foot clinic, severity at onset based on the Wagner ulcer scale, patient demographics, and National Area Deprivation Index (ADI) were analyzed.

Results:

597 patients were eligible for inclusion. Patients seen in the Orthopaedic Specialty Clinic (n=98, 16.4%) were significantly younger (56.5 ± 10.9 years vs.61.1 ± 12.5, p< 0.001). Race was not associated with lower referral rates (p = 1) or source of referral (p = 0.68) to specialty clinic. Ulcer severity upon initial presentation did not differ based on race (p=0.318), however, all patients who initially presented to the emergency department (ED) had more severe ulcers (p = 0.016). Patients referred from the ED had lower National ADI scores (p=0.03). No significant differences in referral source or ulcer severity at presentation were seen for sex, rural status, or marital status, suggesting minority patients with diabetic foot ulcers are referred to specialists equally compared to non-minority patients.

Conclusion:

Patient race was not associated with decreased referral rate to specialty clinic for diabetic foot complications and ulcer severity at initial presentation. Patients with lower socioeconomic status relied on referrals from the ED, as opposed to their Primary Care Providers. Ubiquitous application of these findings may be limited given the breakdown of ethnic groups in the Midwest, and including other regions in a multicenter study would provide further incite.
Isolated Subtalar Repositional Arthrodesis Compared with Triple Arthrodesis for the Treatment of Progressive Collapsing Foot Deformity
Authors: Kim Sunghoo , Lee HoSeong
Published: December 2024

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

The optimal extent of arthrodesis for severe and rigid progressive collapsing foot deformity is controversial. Traditionally, triple arthrodesis has been recommended; however, good results have been reported using subtalar arthrodesis only. We compared the results of triple arthrodesis and isolated subtalar repositional arthrodesis.

Methods:

A total of 22 symptomatic feet were evaluated retrospectively. Isolated subtalar repositional arthrodesis was performed in 13 cases (the subtalar group) and double or triple arthrodesis in 9 cases (the triple group). Various radiographic variables for assessing flatfoot and osteoarthritic changes in ankle and tarsal joints were measured and compared between the 2 groups at 3 time points: preoperatively, 3 months postoperatively, and 4 years postoperatively. Additionally, we analyzed various factors that affect postoperative valgus talar tilt in the ankle joint, which has been associated with poor prognosis.

Results:

There were no differences in preoperative demographic data and the severity of the disease between the 2 groups; both groups showed improvement in radiographic parameters postoperatively compared with preoperative results. With the numbers available, no significant differences could be detected in postoperative radiographic measurements between the 2 groups. Of all the variables analyzed, postoperative hindfoot alignment angle was associated with postoperative talar tilt development. Additionally, postoperative talar tilt was observed more in triple group than in subtalar group.

Conclusion:

Isolated subtalar repositional arthrodesis is an effective and sustainable method of correcting advanced PCFD, with comparable outcomes to triple or double arthrodesis. In addition, patients with residual hindfoot valgus deformity are at risk of developing valgus talar tilt and therefore care should be taken to correct this deformity as completely as possible.