bluuebunny/crossref_metadata_2025 huggingface dataset:
Language learners’ stereotypical representations of France: Insights for teaching French as L3 with implications for minority foreign language crisis in China
Authors: Wu Ying Qi , Li Shan Shan , Zeng Jie
Published: December 2024

French has long been a widely embraced minority foreign language in China. However, French also faces a dilemma that there is a widespread concern over the decline of interest in learning foreign languages in current China. As a response to this ‘foreign language crisis’ in French education, this study investigates the psychological-cognitive perceptions of Chinese English-major students who are learning French as an er wai or second foreign language (L3). Focus is directed towards examining the stereotypical representations of France as the primary target language country. The students’ mental images of France were identified and assessed for favorability and prominence. It indicated that, though as L3, these learners’ mental representations of France appeared as rich and diversified, which were overwhelmingly positive. Images pertaining to geographical locations, landscape architecture, tourism resources were most frequent and prominent. The findings allowed for formulating a tentative proposition suggesting that the integrative orientation of these L3 learners significantly contributes to their study motivations. The findings suggested that students’ stereotypes about France can be utilized in the teaching curriculum to promote the course, increase learners’ interest, and enhance teaching quality. Pedagogical implications regarding the development of the cultural components and international influences of France are also discussed.
A Q method study on Turkish EFL learners’ perspectives on the use of AI tools for writing: Benefits, concerns, and ethics
Authors: Yılmaz Virlan Ayşe , Tomak Burak
Published: December 2024

With the growth of artificial intelligence (AI) tools available to anybody with internet access, English language learners are increasingly turning to these resources to improve their writing skills. By examining their utilization of AI tools to improve their writing proficiency, this research examines the perspectives of Turkish English language learners enrolled in a preparatory program at a state university in Istanbul. Using a Q methodological approach, researchers created a set of 40 statements based on a literature study, which were then sent to 55 consenting individuals. Qualitative information was also collected by interviewing five students in depth. The analysis indicated a growing tendency among students to utilize AI tools for writing assignments, highlighting advantages such as assistance in translation, idea generation, and preparedness for future studies. However, participants expressed concerns over excessive dependence on these technologies, which can result in problems such as plagiarism, reduced originality, and ethical dilemmas. These findings highlight the need for supporting the ethical and balanced use of AI technologies in language learning environments, ensuring that learners may use technology efficiently while maintaining the integrity and authenticity of their work. Further study should explore strategies for integrating AI tools into language teaching in ways that minimize these concerns and enhance their benefits for learners.
No foreign language effect in self-sacrificial moral dilemmas
Authors: Muda Rafał , Milczarski Wojciech , Borkowska Anna , Białek Michał
Published: December 2024

Research questions:

The Moral Foreign Language Effect is a phenomenon in which individuals exhibit lower moral engagement (i.e., are simultaneously less deontological and less utilitarian) when using a foreign language compared to their native language. This paper reports on three experiments involving bilingual participants to investigate the impact of foreign language on moral judgment in self-sacrifice dilemmas.

Design:

In three experiments, we asked N = 425 participants whether they would self-sacrifice to save other people. In Experiment 1, the people to be saved were strangers. In Experiment 2, they were relatives. Experiment 3 replicated the first two with the addition of the control condition with the option to sacrifice a stranger instead.

Data and analysis:

Experiments 1 and 3 showed no effect of language on willingness to self-sacrifice. In Experiment 2, the participants using a foreign language were less willing to sacrifice themselves.

Conclusions:

Language has no consistent effect on participants’ willingness to sacrifice themselves or others.

Originality:

Contrary to previous studies on the issue, we controlled both for the beneficiaries (strangers vs. relatives) and the method of saving them (self-sacrifice vs. sacrifice of a stranger).

Significance:

Our results cast doubt on the robustness of the moral Foreign Language Effect.

Limitations:

We limited our research design to two language pairs. Failure to replicate Experiment 2 results in Experiment 3 could be an effect of the different language pairs used in both experiments.
Experimental and numerical investigation of abnormal combustion phenomena in high-performance hydrogen direct-injection engine operated in stochiometric conditions
Authors: Piano Andrea , Rolando Luciano , Roggio Salvatore , Millo Federico , Tonelli Roberto , Gullino Fabrizio , Mortellaro Fabio Santi
Published: December 2024

Nowadays the use of Hydrogen (H2) within Internal Combustion Engine (ICE) represents a valuable solution also for high-performance applications since it allows carbon free combustion process preserving, at the same time, the driving experience of the engines fuelled with conventional fuels. On the other side, the low ignition energy and the high flammability range may lead to a high probability of abnormal combustion events especially at high engine loads. Therefore, this work aims at investigating the occurrence of knock and pre-ignition phenomena in a high-performance Direct Injection (DI) single cylinder Spark Ignition (SI) engine through the synergistic use of numerical simulations and experimental activities. A 3D-CFD model was calibrated against a set of experimental measurements. The engine model showed satisfactory predictive capabilities with a good matching with the experimental in-cylinder pressure traces. This virtual test rig was then used to investigate the impact of a different coolant temperature and different injector recess in terms of knock and pre-ignition tendency, and most of all, to define a robust simulation methodology to estimate the risk of hydrogen abnormal combustion events.
Experimental analysis of polymer-composite coated steel components under quasi-static loading
Authors: Prodromou Maria , Dow Robert S
Published: December 2024

In recent years, there has been new interest in understanding the mechanical failures of the polymer-composites used for fairing the hull and the superstructure of large vessels. There aren’t any background studies looking into the failures of these thick coated structures and this study is attempting to bridge the gap in research by studying the monotonic flexural behaviour of these structures to investigate the reasons for its failures. The objective is to study the monotonic flexural behaviour of three popular particulate composite materials used as coatings on megayacht vessels and obtain an initial understanding of their behaviour and interaction with the steel substrate. The methods presented are both analytical and standard testing procedures for the examination of the flexural stress-strain response of the thick polymer-composite coated steel specimens. The results of this work suggest that different failure mechanisms have been observed in the three examined coating systems. It has been shown that the experimental data suggested no significant interaction between the steel and the polymer-composite material. The findings suggest that it is possible to enlarge the design space of the polymer-composite coatings by reducing the applied thickness of the materials. Results also have shown that the presence of voids cause reduction in strength by 20% and reduction in deformation by 30%. The study concluded to a two-step methodology involving analytical and experimental methods investigating the mechanical response of composite polymers applied on hull and superstructure substrates which is presented for the first time in this paper.
Risk Factors for Violence in Adult Heterosexual Noncasual Relationships: An Overview of Reviews
Authors: Alfandari Ravit , Taylor Brian J. , Scott Rebecca
Published: December 2024

Intimate partner violence (IPV) is a widespread social, public health, and human rights problem. Empirical investigation of IPV risk factors can promote evidence-based assessment tools and effective prevention and intervention. This overview is a pioneering synthesis of systematic reviews (SRs) of IPV risk factors. Systematic searches for SRs in English reporting a meta-analysis of IPV risk factors in adult heterosexual, non-casual relationships published between January 2011 and June 2021 were conducted in four bibliographic databases: Medline via EBSCO, CINAHL Plus, Scopus, and APA PsycInfo. This search strategy identified 1,027 unique records. Supplementary manual search methods were completed in July 2023. Overall, 17 SRs utilizing a meta-analytic approach to investigate IPV risk factors published between 2012 and 2022 were included in the overview. Risk factors were organized into five key categories: demographic, individual, family of origin, relationship, and social. Overall, 73 unique risk factors relating to perpetrators and 61 relating to victims were identified in the SRs. Just 50 of the 119 coefficients relating to IPV perpetration were reported, by any SR, as statistically significant and of moderate or strong predictive power; and 39 of these 50 factors related to previous IPV. Only 26 of the 147 coefficients relating to IPV victimization were both statistically significant and of moderate or strong predictive power, the majority of which (15) were in the relationship violence grouping of risk factors. The evidence suggests a randomness to IPV. This body of evidence provides some limited direction for policymakers, practitioners, and researchers.
Emotion Regulation in the Association Between Posttraumatic Stress Disorder and Substance Use: A Systematic Review With Narrative Synthesis
Authors: Bowen Alice May , Calder Robert , Neale Joanne , Meynen Tim , Gilchrist Gail
Published: December 2024

Posttraumatic stress disorder (PTSD) and substance use commonly co-occur and represent a unique clinical challenge. Current interventions show modest effect sizes and high rates of dropout highlighting the need to better understand the mechanisms underlying the PTSD-substance use association. Evidence suggests emotion regulation may be an important factor underlying this association. This systematic review aims to examine the role of emotion regulation in the association between PTSD and substance use and to provide an understanding of differences in emotion regulation based on gender, trauma type, and social factors. Systematic searches of Medline, Embase, PsycInfo, ASSIA, CINAHL, and Web of Science identified 33 studies that met the review inclusion criteria. While findings were mixed, the results largely suggest difficulties regulating negative and positive emotions are important in the PTSD-substance use association. Emotion regulation was elevated in individuals with PTSD-substance use disorder (SUD) compared to SUD only and among individuals with more severe PTSD and substance use symptoms. A small number of studies highlighted the role of emotion regulation difficulties over time and in relation to treatment outcomes. Preliminary findings suggested there may be differences in emotion regulation in PTSD-substance use based on gender, trauma type, and social factors, though this requires further examination. Limitations of the included studies include small sample sizes, cross-sectional designs, and a predominant focus on alcohol use. The findings largely support self-medication and negative reinforcement models of substance use and highlight the possible utility of integrated interventions focusing on emotion regulation for PTSD-substance use. Recommendations for further research are discussed.
More Than a Woman: A Scoping Review of the Role of the Strong Black Woman Schema in Black Women’s Romantic Relationships
Authors: Debnam Katrina J. , Avery Lanice R. , Lynch Kylie
Published: December 2024

Black women are disproportionally impacted by intimate partner violence (IPV), yet limited research considers the role of culturally salient, gendered-racial schemas such as the Strong Black Woman (SBW) schema on Black women’s intimate relationships. Given the SBW schema’s emphasis on masking pain and vulnerability, self-sacrificial caretaking, and demonstrating unwavering emotional stoicism in the face of adversity, it is important to understand the adaptive and negative effects that high endorsement may have on Black women’s romantic relationship quality. This scoping review aimed to determine the extent to which the extant empirical research focusing on the SBW schema has included a focus on Black women’s intimate and romantic relationships and the culturally specific, sexually scripted roles that Black women are expected to uphold in their partnerships. Electronic databases were searched for empirical studies that focused on associations between the SBW schema and romantic relationships. Of the 290 articles identified in the initial search, only six articles met the full inclusion criteria. Findings revealed three ways that SBW schema manifests in Black women’s romantic relationships: prioritization of partner over self, resisting displays of vulnerability, and a sustained commitment to independence. Each of these domains may pose significant challenges to the quality of romantic relationships for Black women and the prevention of IPV, demonstrating the need for continued development of resources that can mitigate any specific sociocultural and gendered-racial barriers that Black women face when in intimate partnerships.
Patient Reported Outcomes for Primary Arthrodesis vs Open Reduction and Internal Fixation for Acute Lisfranc Injuries
Authors: Gauthier Chase , Jackson J. Benjamin , Bakaes Yianni , Gonzalez Tyler
Published: December 2024

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

Both Primary Arthrodesis (PA) and Open Reduction and Internal Fixation (ORIF) have been shown to effectively treat Lisfranc injuries, however, debate remains regarding the complication rate for each procedure, and the data is limited regarding patient-reported outcomes. The purpose of this study is to evaluate the rate of acute complications, reoperations, patient-reported outcomes through the Patient Reported Outcome Instrumentation System (PROMIS), and postoperative radiographic data for PA versus ORIF for acute Lisfranc injuries.

Methods:

A retrospective review was conducted of patients who underwent PA or ORIF for the treatment of Lisfranc injuries at Prisma Health – Midlands between January 1st, 2020 - December 31st, 2022 with at least 6 months of postoperative data. Data collected included demographic data, postoperative outcomes, and Pain Interference (PI), Physical Function (PF) and Mobility PROMIS scores both preoperatively and at the most recent postoperative follow-up. Continuous variables were compared between PA and ORIF using the Student’s T-Test and Wilcoxon Rank Sum test for continuous variables and the Chi-Squared test for categorical variables.

Results:

A total of 56 patients were included in the study with an average follow-up time of 51.1 weeks (range: 27 to 121). Patients treated with ORIF were younger (30 vs 46.6, p=0.002) and were more likely to suffer a Myerson Classification type B1 injury (87.8% vs 28.6%, p=0.002) compared to those treated with PA. ORIF patients had greater improvements in PI (13.1 vs 9.7, p=0.508), PF (15.7 vs 7.2, p=0.343), and mobility (18.2 vs 10.3, p=0.203) compared to PA patients, although these improvements were not statistically significant. Finally, there was no significant difference in the rate of complications (p=1), reoperations (p=1), or evidence of radiographic hardware failure (p=0.423) between PA and ORIF.

Conclusion:

Patients treated with ORIF had greater improvements in patient-reported outcomes than those treated with PA, although these improvements were not statistically significant and there were potential confounding factors present. Both procedures demonstrated similar rates of complications, reoperations, and radiographic hardware failure. Our findings suggest that ORIF and PA are both effective in improving patient-reported outcomes and treating Lisfranc injuries in certain patient populations.
Results of More Than 20,000 Scans with Weightbearing CT - Impact on Costs, Radiation Exposure, and Procedure Time
Authors: Lintz François , Richter Martinus ,   International Weight Bearing CT Society
Published: December 2024

Category:

Other

Introduction/Purpose:

Weightbearing CT (WBCT) has been proven to more precisely measure bone position than conventional weightbearing radiographic series (R) and conventional CT (CT). The purpose of this study was to assess the benefit of using WBCT instead of R and/or CT as the standard imaging modality, evaluating image acquisition time, radiation dose, and cost-effectiveness.

Methods:

All patients who obtained a WBCT as part of standard of care from July 1, 2013 until August 31, 2023 were included in the study. Image acquisition time (T), radiation dose (RD) per patient, and cost-effectiveness were analyzed and compared between the time period using WBCT (yearly average) and the parameters from 2012, i.e. before the availability of WBCT (RCT group).

Results:

20,145 WBCT scans were obtained from 9,065 patients (9,056 scans (45%) before treatment; 11,080 scans (55%) at follow-up). On a yearly average, 1,975 WBCTs (bilateral scans) and an additional 11.5 CTs (bilateral feet and ankles) were obtained (WBCT group). In 2012, 1,850 Rs (bilateral feet, dorsoplantar and lateral, metatarsal head skyline view) and 254 CTs were obtained from 885 patients (RCT group). The mean yearly RD was 4.3/4.8uSv for the WBCT/RCT groups (mean difference of 0.5 uSv; a decrease of 10% for the WBCT group; p<.01). Yearly mean T was 115/494 hours in total (3.5/16.0 minutes per patient) for WBCT/RCT groups (mean difference of 379 hours; a 77% decrease for the WBCT group; p<.01). Yearly cost-effectiveness was a mean profit of 55,441/-723 Euro for WBCT/RCT.

Conclusion:

20,145 WBCT scans from 9,065 patients over a period of 10.2 years at a foot and ankle department resulted in 10% decreased RD, 77% decreased T, and increased financial profit (65 Euros per patient) for the institution.
Role of Metformin in Improving Non-Union Bone Fracture Healing in a Diabetic Rat Model
Authors: Cain Jarrett D. , Zhang Jianying , Hogan Macalus V. , H-C. Wang James
Published: December 2024

Category:

Basic Sciences/Biologics, Diabetes

Introduction/Purpose:

Diabetes mellitus is a chronic metabolic disease that interferes with bone formation, increases fracture risk and impairs fracture healing in the foot and ankle. Inflammatory mediators, like fully reduced HMGB1 (fr HMGB1), play a key role fracture healing; however, their activity can be inhibited by Metformin, which is a hypoglycemic drug commonly used for the treatment of diabetes. The effect of Metformin on the bone fracture healing is largely unknown. In this study, we tested the hypothesis that application of inflammatory mediators with metformin improves nonunion bone fracture healing using a diabetic rat model.

Methods:

The rats were divided into four groups with 8 rats per group(Fig 1): Group-1 had no additional treatment;Group-2 were injected Metformin (IP, 160 mg/kg) daily;Group-3 were injected frHMGB1 into wound area (250 µg/kg) weekly;Group-4 were injected Metformin (IP, 160 mg/kg) daily and frHMGB1 into wound area (250 µg/kg) weekly. The blood samples were collected for HMGB1 & IL-1β.Tibia samples were also collected and examined by gross inspection, micro-CT images and histological analysis. Data was analyzed by One-way ANOVA followed by Fisher’s Least significance difference test. A p-value less than 0.05 was considered to be significantly different between the groups.

Results:

Micro-CT images showed completely healed at day-90 post-surgery in frHMGB1 rats while Metformin inhibited frHMGB1 enhanced bone fracture healing as evidenced by the gap in the fractured bone area(Fig 2). Histology analysis indicated that frHMGB1 enhanced fractured bone healing as evidenced by high density of the cells was found in the bone fracture area (Fig. 3). Safranin O and fast green staining along with Masson’s Trichrome staining confirmed the frHMGB1 local injection promoted fractured bone healing (Fig. 4) as evidenced by high quality bone tissue formation with collagen type I (red staining) and collagen type III (blue staining) in the fractured bone wound area.

Conclusion:

Although the treatment with frHMGB1 enhanced nonunion fractured bone healing by promoting cell proliferation, fibroblast migration, and collagen production, some low-quality bone tissues formed at the fractured bone areas due to overgrowth. Metformin slowed the bone fracture healing but regenerated better quality bone tissues by decreasing the inflammatory marker levels, inhibiting fibroblast migration, activating AMPK activity, and reducing collagen III production. These findings highlight the anti-inflammatory actions of Metformin and pro-healing effects when combined with frHMGB1 suggesting the healing potential of non-union fractures in Diabetic Mellitus patients.
Significant Clinical Improvement after Arthroscopic Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus: A 5-Year Follow-Up
Authors: Barbero Agustin , Efrima Ben , Maccario Camilla , Indino Cristian , Nocera Chiara , Dahmen Jari , Giuseppe Usuelli Federico
Published: December 2024

Category:

Ankle; Other

Introduction/Purpose:

This study aims to evaluate the clinical outcomes of arthroscopic autologous matrix-induced (A-AMIC) chondrogenesis for osteochondral lesions of the talus (OLT) at 24 months and 60 months of follow-up. The secondary aim was to assess whether age, body mass index (BMI), and lesion surface affect outcomes.

Methods:

Sixty-three patients (32 males, 31 females) with a median age of 37 years [IQR 25-48] were included. Preoperative and postoperative (24 months and 60 months) clinical outcomes were evaluated using a Visual Analog Score (VAS) for pain during walking, the American Orthopedic Foot and Ankle Society (AOFAS), Short-Form Survey (SF-12), the Halasi, and the University of California (UCLA) scores. Patients were categorized according to age, BMI, and lesion surface (1-1.5 cm2 and over 1.5 cm2). The effect of each category was evaluated.

Results:

There were significant improvements in the VAS, AOFAS, SF12, and UCLA, comparing the preoperative scores to the 60-month follow-up scores (p < 0.001). There were no significant differences in the above-mentioned outcomes between the follow-up periods. Patients older than 33 had lower SF-12, Halasi, and UCLA scores (p-value = 0.005, 0.004, and < 0.001, respectively). Overweight patients had lower VAS, SF-12, Halasi, and UCLA scores (p-value = 0.006, 0.002, 0.024, and 0.007). Lesion size was uninfluential.

Conclusion:

A-AMIC yielded clinical improvements at a minimum follow-up of 60 months in patients with symptomatic OLTs, with clinical improvement peaking in the first two years, followed by a plateau period. Increased age and BMI were significantly associated with inferior outcomes.
Surgical Outcome of Unfixed Controlled Medial Malleolar Breakage for a Balanced Total Ankle Replacement
Authors: Sung Ki Sun
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Ligament balancing is very important for successful TAR (total ankle replacement). However, regarding medial tightness the amount of medial ligament release seems to be uncertain. Furthermore, the risk of medial instability and vascular insult can be major concerns after extensive deep deltoid release. Thus, I hypothesized that medial malleolar breakage instead of deltoid release would result in similar stability and heal more predictably with less complications.

Methods:

Between December 2019 and December 2022, 18 patients underwent total ankle replacement with medial malleolar breakage for ligament balancing. There was 14 females, and the average age was 70.5 (53-84). Concomitant procedures such as Achilles tendon lengthening, lateral ligament repair, subtalar joint debridement and 1st metatarsal osteotomy were added to get a stable and plantigrade foot. When there was still medial tightness after thorough spur resection and anterior part of superficial deltoid release, subcortical osteotomy was made around the medial malleolous instead of deep deltoid release. Then controlled valgus force was driven till a pop sound came out. No fixative was applied for broken bone. The surgery was finished only when coronal plane stability of the TAR was achieved. Short leg walking cast was applied for 3 to 4 weeks, and then range of motion exercise and tolerable weight bearing was allowed in a walking boot for another 4 weeks.

Results:

All patients were followed for more than 6 months after the index surgery. AOFAS (American Orthopedic Foot and Ankle Surgery) ankle-hindfoot score improved from average 36.2(10-60) to 72.7(50-90), and all returned to their daily activity. There was no major complication such as coronal plane instability or dislocation, deep infection and aseptic loosening. Two patients experienced minor wound dehiscence which have been healed, and another 3 patients suffered from superficial peroneal nerve irritation.

Conclusion:

Unfixed controlled medial malleolar breakage during TAR for varus ankle arthritis showed good results with few morbidities. However, longer term follow up is necessary to determine its clinical usefulness definitely.
The Association Between Asymmetrical Hallux Valgus and Lumbar Spine Deformities: An Analysis from the Large General Population Cohort
Authors: Matsumoto Takumi , Takeda Ryutaro , Tanaka Sakae
Published: December 2024

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Various factors contribute to hallux valgus (HV), including footwear, genetics, gender, anatomical factors, and joint laxity. Theoretically, these factors should affect both sides equally, yet overwhelmingly, bilateral cases are more common. Although rare, there are instances of unilateral cases or cases with significant asymmetry between the left and right sides. However, there is a lack of systematic investigation into the background of such cases.

Methods:

Data from the fifth survey of the Osteoarthritis/Osteoporosis Against Disability (ROAD) study, a nationwide prospective study in Japan, were analyzed. HV severity was categorized into 4 grades based on the radiographic HV angle, and asymmetric HV was defined as having at least one HV on either side with a difference of two or more severity grades between the left and right. Controls were matched from both the normal group (without HV on both sides) and the symmetric group (HV on at least one side with a difference of one or less severity grades). Univariate analysis assessed lumbar conditions, and multinomial logistic regression analysis explored the association between lumbar spine disorders and asymmetric HV.

Results:

Among 1,231 participants, 27 (2.2%) had asymmetric HV. The asymmetrical group showed a significantly higher prevalence of L5 spondylolisthesis and scoliosis (asymmetrical vs symmetrical vs normal: [L5 spondylolisthesis] 15% vs 5% vs 1%, p = 0.0178; [scoliosis] 42% vs 20% vs 14%, p = 0.0095). The results of the multiple logistic regression analysis revealed that the odds ratios for asymmetry, with normal as the reference, were 3.59 (95% CI: 1.11-11.58) in the presence of scoliosis and 6.98 (95% CI: 0.67-72.60) in the presence of L5 spondylolisthesis.

Conclusion:

Unilateral HV has been reported as a complication following spinal surgery. This study establishes a link between lumbar spine scoliosis and unilateral HV. It suggests the involvement of factors such as impairment of the hallux abductor muscle's innervating nerves or left-right load imbalance in the development of unilateral HV deformities.
The Mystery of Meary’s: 3D Analysis of First Ray Plantarflexion Deformity in Charcot-Marie-Tooth Disease
Authors: Blough Christian , Michalski Max P. , Song Jaehwang , Pfeffer Glenn
Published: December 2024

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

The typical cavovarus deformity seen in patients with Charcot-Marie-Tooth involves plantarflexion of the first ray. Surgical correction often includes a dorsiflexion osteotomy at the first metatarsal base or medial cuneiform. The exact apex of the deformity has never been proven, although it is presumed to be within the medial cuneiform. The aim of this study was to utilize weight-bearing computed tomography (WBCT) to localize and quantify the plantarflexion deformity in CMT patients.

Methods:

WBCTs of 16 CMT patients with lateral Meary’s angle >20 degrees were compared to controls utilizing semi-automated analysis software (Disior Bonelogic). Due to the complex deformity seen in CMT patients, a local coordinate system based on the first metatarsal was used. The tarsometatarsal angle was subdivided into components (cuneiform-cuneiform joint normal, tarsometatarsal joint and metatarsal-metatarsal joint normal) and compared between CMT and controls (Figure 1A). CMT patient’s first, second and third rays were also compared. Means were compared with a 2-sample t test (p <.05).

Results:

CMT patients had significantly more plantarflexion of the first ray than controls (8.8 versus 16.4 degrees respectively (p < 0.001)) (Figure 1B). The largest difference of was found at the cuneiform-cuneiform joint normal with 20.6 degrees of plantarflexion in CMT patients versus 14.8 degrees in controls (p <.0001). There was also approximately 2 degrees of plantar flexion at the TMT joint (p <.001) but no difference at the metatarsal-metatarsal joint normal angle. When comparing the flexion of the first ray versus the second, as well as the second versus the third rays, there were significant differences in the tarsometatarsal, cuneiform-cuneiform joint and metatarsal-metatarsal joint angles.

Conclusion:

Plantarflexion deformity in CMT patients is primarily an osseous deformity at the level of the medial cuneiform with a lesser contribution from the tarsometatarsal joint. This finding has implications for CMT surgery regarding location of a dorsiflexion osteotomy at the apex of deformity.
The Use of Knotless Fiber Tape Construct vs Screw Fixation for Lisfranc Injuries: A Cadaveric Biomechanical Study
Authors: Cardenas Cesar , McIver Natalia , Nelson Jessica , Chavez Tyler , Ahmad Aamir , Gross Jessica , Salas Christina , Gavin Katherine
Published: December 2024

Category:

Trauma; Midfoot/Forefoot

Introduction/Purpose:

Lisfranc injuries are often treated with open reduction and internal fixation using rigid fixation techniques. The use of flexible fixation to stabilize the Lisfranc joint is a newer technique. The purpose of this cadaveric study is to compare the amount of diastasis at the Lisfranc interval under physiologic loads when treated with a knotless fiber tape construct and a solid screw.

Methods:

Ten cadavers (20 feet) had native motion at the intact Lisfranc interval assessed at multiple physiologic loads representing guarded walking (69N), walking (138N), and running (207N). The Lisfranc ligamentous complex was then disrupted, and testing repeated to evaluate the amount of diastasis. Randomization was performed to determine type of fixation for each cadaver: a solid screw or knotless fiber tape construct. Once fixation was completed, specimens were cyclically loaded for 10,000 cycles at physiologic loads and diastasis was quantified after each load cycle to compare the interventions. Diastasis was measured using motion tracking cameras and retroreflective marker sets. A non-inferiority statistical analysis was performed.

Results:

Diastasis mean values were confirmed to be >2mm for all load bearing conditions in the injury model. Post-treatment, diastasis was significantly reduced when compared to the sectioned conditions (p=0.00) for both treatment options. Non-inferiority analyses showed that the knotless fiber tape construct did not perform inferior to screw fixation for diastasis at the Lisfranc interval at any of the compared load states.

Conclusion:

Under physiologic loads, there is no significant difference in diastasis at the Lisfranc interval when treating ligamentous Lisfranc injuries with a knotless fiber tape construct or solid screws. Both reduced diastasis from the injured state and were not different from the intact state.
The Utilization of Minimally Invasive Surgery for Os Trigonum Syndrome
Authors: Anastasio Albert T. , Baumann Anthony N. , Walley Kempland C. , Luo Emily Joan , Talaski Grayson M. , Curtis Devin , Johns William , Amendola Annunziato
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

A symptomatic os trigonum is a common cause of posterior ankle pain that has been traditionally managed with open excision. Minimally invasive surgery (MIS) has been proposed as an alternative to open excision for improved outcomes and decreased complication rates; however, no systematic review to date has examined the utilization of MIS for a symptomatic os trigonum. The purpose of this study was to examine patient outcomes, return to sport, and complications associated with MIS for a symptomatic os trigonum.

Methods:

A systematic review was performed on February 22, 2023, using the PubMed, CINAHL, MEDLINE, and Web of Science databases from database inception until February 22, 2023, on the topic of MIS for a symptomatic os trigonum.

Results:

From initial search, 17 articles (N = 435 patients) met inclusion criteria. Mean age of the cohort was 26.01 ± 4.68 years, with a mean follow-up time of 34.63 ± 18.20 months. For MIS patients, the mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 55.85 ± 12.75, the mean final postoperative AOFAS score was 94.88 ± 4.04, the mean preoperative visual analog scale pain score was 7.20 ± 0.43, and the mean final postoperative visual analog scale score was 0.71 ± 0.48. The mean time to return to sport for patients undergoing MIS was 7.76 ± 1.42 weeks. MIS had an overall complication rate of 5.0%, the majority of which consisted of transient neurapraxia of the sural or superficial peroneal nerve.

Conclusion:

Minimally invasive management of a symptomatic os trigonum appears to be a viable alternative to open surgery in terms of outcomes, return to sport, and complication rates. More high-quality evidence will be required to definitely recommend minimally invasive approaches as the standard of care over open surgery.
Total Ankle Arthroplasty with and without Tibial Stem: Exploring Differences in Post-Operative Migration and Beta Angle
Authors: Tallapaneni Jetha , Mirghasemi Ali , Vaupel Zachary , Fortin Paul
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

The extent of migration of the ankle joint and associated joint space caused by ankle replacement is directly correlated to the efficacy and longevity of the implant. Recent advances have resulted in the increasing use of tibial implants with stems as a means to achieve greater stability. The purpose of this study was to ascertain the differences in said migration between implants with tibial stems and those without in order to conclude which style of replacement leads to greater stability and therefore greater longevity and utility.

Methods:

A series of cases, which consisted of patients receiving both tibial implants with and without stems, that met the inclusion criteria, was considered for this study in order to determine key differences in outcomes. Twenty patients received tibial implants with stems and twenty patients received tibial implants without stems. The average patient ages between the two groups were not significantly different- the mean age of patients with the stem was 65.4 compared to 68.7 for the non-stem group. The key variables considered included migration (AP and anterior/posterior, DTA, TTA, beta angles, gamma angles, coronal translation, and talar tilt. Two tailed T-tests were utilized to determine statistically significant results.

Results:

Differences in measurements from the first post-operative weight bearing x-ray to the most recent weight bearing x-ray were considered. The mean time between these two x-rays was 24 months for the patients who received tibial implants with stems and XX months for patients who received tibial implants without stems. Across the population considered, it was found that patients recieving the implants without the stem had significantly less migration in the AP view X-rays when compared to their tibial implant with stem patient counterparts in both X-rays considered (p< 0.03). Additionally, patients without the tibial stem had significantly larger beta angles than patients with the tibial stem in both x-rays considered (p< 0.04).

Conclusion:

Ankle replacements utilizing tibial stems lead to greater rates of migration when compared to those without said stems. Therefore, the supposed benefit of the stem falls into question. Greater beta angles are seen with tibial implants without stems, however. Further research regarding the efficacy and long-term outcomes of each of these implants for total ankle replacement must be conducted to refine these findings further.
Transfibular Approach in Treating Malunited Ankle Fracture
Authors: Zhu Yuan
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

The surgical treatment of malunited ankle fracture is challenging. This study investigated the results of reconstruction for malunited ankle fracture involving lateral and posterior malleolus via transfibular approach.

Methods:

Between Jan 2015 and Feb 2017, 10 patients underwent reconstruction surgeries for malunited ankle fracture involving lateral and posterior malleolus were followed up. All the ten surgeries were performed via transfibular approach. The mean final follow-up was 26.2 months (range 24–36). American Orthopaedic Foot and Ankle Society (AOFAS)score, Visual Analogue Scale (VAS) for pain, and patients’ subjective satisfaction were used to measure clinical outcomes.

Results:

The mean AOFAS-AH score and VAS score improved from 43±10.7 to 79±7.8 points (p < 0.05), 6.7±1.0 to 2.0±1.2 points (p < 0.05), respectively. Five patients rated the result as excellent, 4 as good and 1 as fair.

Conclusion:

The transfibular approach can expose and reduce both the posterior and lateral malleolar malunion with minimal additional soft tissue disruption. It is a useful method to correct the malunited ankle fracture involving lateral and posterior malleolus.
Utilization of Orthobiologics by Foot and Ankle Orthopaedic Surgeons
Authors: Chan Jeremy Y. , Haleem Amgad , Thordarson David , Ellis Scott J. , Conti Matthew S.
Published: December 2024

Category:

Basic Sciences/Biologics; Sports

Introduction/Purpose:

Over the past two decades, there have been significant advancements and increased utilization of orthobiologic technologies. The use of orthobiologic products is often determined by individual surgeons given the limited available literature on efficacy. Currently, there is a paucity of data available evaluating the prevalence of orthobiologics use among foot and ankle orthopaedic surgeons. The primary aim of this study was to investigate orthobiologic utilization among American Orthopaedic Foot & Ankle Society (AOFAS) members.

Methods:

Members of the AOFAS were sent a survey in 2023 that was designed to assess for usage, motivation for use, and treatment indications in operative and nonoperative settings for the following orthobiologics: leukocyte-poor (PRP-LP), leukocyte-rich (PRP-LR) and leukocyte-unknown (PRP-UNK) platelet rich plasma, bone marrow aspirate concentrate (BMAC), adipose-derived mesenchymal stromal cells, hyaluronic acid, recombinant human bone morphogenic protein (rhBMP-2), recombinant human platelet derived growth factor (rhPDGF-BB), amniotic membrane products, and small cell binding peptide. The survey was completed by 129 respondents representing a balanced cohort in regards to geographic spread, time in practice, and medical practice setting.

Results:

92% of respondents utilized ≥1 orthobiologic with no significant differences in utilization based on demographics. Perceived efficacy and support from literature were cited as common reasons to use orthobiologics. Among orthobiologic users, the most common product used was BMAC (74%), followed by rhPDGF-BB (62%) and rhBMP-2 (43%) (Figure 1). The most common indications for BMAC were revision arthrodesis, osteochondral surgery and primary arthrodesis. For rhPDGF-BB and rhBMP, the most common indications were revision and primary arthrodesis. The most common pathology for nonoperative use of PRP-LR and PRP-UNK was tendinopathy versus plantar fasciitis for PRP-LP, whereas the most common operative use of any formulation of PRP was for osteochondral lesions. Among non-users, 70% cited lack of evidence and 50% cited costs in their decision making.

Conclusion:

Among AOFAS surgeons, there is a high rate of utilization of orthobiologic products. Bone marrow aspirate concentrate was the most common orthobiologic used overall, though there remains significant variability in the usage and treatment indications for each individual orthobiologic. Given that evidence from the literature was frequently cited as a motivation for both users and nonusers for orthobiologics, there remains a need for future studies evaluating the efficacy of orthobiologic products in foot and ankle orthopedics.
Surface quality analysis of microchannels fabricated through laser micromachining on PMMA for microfluidic applications
Authors: Srikantaprasad Guruprasad , Mathew Nithin Tom
Published: December 2024

Micromachining is a widely employed technique for generating micro features across diverse applications. Laser micromachining has gained significant attention due to its inherent flexibility, precision, and ability to process a wide array of materials. In the era of miniaturization, laser has proven to be sustainable choice of process in the field of micromachining. Within laser machining, CO2 laser machining is considered to be an economical option. However, challenges persist in achieving both a high surface finish and a variable cross-sectional profile for microchannels. This study focuses on the investigation, identifying and categorizing of defects in microchannels machined by laser on polymethyl-methacrylate. Laser parameters are systematically varied to optimize the surface quality of the machined channels. Microchannels, fabricated through a full factorial experiment, are visually assessed using an optical microscope. The channels with the highest and lowest ratings are selected for further confocal and scanning electron microscope (SEM) analysis to comprehensively study the identified defects. The surface roughness is found to be 0.675 µm for the high-quality channel. A good surface finish at both the valley and side wall, along with a well-formed edge bulge was found at this condition.
Atrial Arrhythmia: A Rare Presentation of Thyrotoxic Hypokalemic Periodic Paralysis
Authors: Kotaru Rakesh Chowdary , Paidi Suresh Kumar
Published: December 2024

Thyrotoxic hypokalemic periodic paralysis is a rare but life-threatening complication of hyperthyroidism characterized by hyperthyroidism, hypokalemia, and transient episodes of acute proximal muscle weakness. Incidence of thyrotoxic hypokalemic periodic paralysis is more common in Asian men and extremely rare in blacks. The basic mechanism includes thyrotoxicosis-induced hypokalemia leading to muscle weakness associated with respiratory insufficiency and fatal arrhythmias. We present a rare case of atrial arrhythmia as the initial presentation of thyrotoxic hypokalemic periodic paralysis.
On the importance of case studies in research on creativity
Authors: Weisberg Robert W.
Published: December 2024

The present article proposes that case studies of real-world—in vivo—creative thinking, rather than laboratory—in vitro—investigations, should provide the foundation for the study of creative thinking. While there is a significant literature examining case studies of real-world creative advances, those studies have not been central in modern research on creativity. Psychological theorizing about creativity has been dominated by the “divergent thinking/remote associates” (DT/RA) perspective, which argues that creative ideas arise as the result of making connections between previously-unlinked ideas. The DT/RA view has developed independently of case-study research on creative thinking. The present paper argues that neglect of case studies by modern researchers is a mistake, for two reasons. First, in order to ensure that laboratory studies of creative thinking are relevant to real-world phenomena, it is necessary to begin our investigation of creative thinking by examining those phenomena. Second, case studies can provide evidence concerning the thought processes underlying creative advances at the highest levels that cannot ordinarily be obtained from laboratory studies. To provide support for that argument, several case studies are examined. Semmelweis’s discovery of the cause of childbed fever is presented in some detail, and brief discussions are presented of Edison’s invention of the lightbulb, Watson and Crick’s discovery of DNA, Frank Lloyd Wright’s creation of Fallingwater (the house over the waterfall), and the Wright brothers’ invention of the airplane. The results are summarized and their implications for psychological theory and research on creative thinking are discussed.
FDA-approved therapies for chronic GVHD
Authors: Lee Stephanie J. , Zeiser Robert
Published: December 2024

Abstact

Despite novel prophylactic regimens, chronic graft-versus-host disease (cGVHD) remains a challenging complication after allogeneic hematopoietic cell transplantation. cGVHD can affect multiple organs and reduces quality of life, and treatment can cause serious adverse effects. In the past 10 years, the drugs ibrutinib, ruxolitinib, belumosudil, and axatilimab were approved by the US Food and Drug Administration (FDA) for cGVHD. Here, we discuss which signaling pathways and cell types are targeted, the clinical studies that were the basis for FDA approval, and future directions for clinical research.