bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospects and Ethics of ChatGPT in Biomedical Research and Medical Practice: An Emphasis on Nanotechnology
Authors: Faiyazuddin Md. , Gholap Amol D. , Maqsood Shayan , Abbas Siba , Chaudhari Yogesh Subhash , Sharmila S. , Webster Thomas J.
Published: December 2024

This review delves into the transformative potential of ChatGPT, a cutting-edge language model developed by OpenAI, in biomedical research and medical applications, with an emphasis on nanotechnology. The paper is structured across five comprehensive sections, each highlighting distinct
facets of the vast applications of ChatGPT in these fields. First, we explored its role in expediting drug discovery and delivery, from accelerating the identification of delivery methods to refining systems and solving delivery challenges. Second, it investigates its impact on scientific
research, from accelerating literature reviews to aiding in predictive modeling and manuscript support. Third, this study addresses the implications of the ChatGPT in medical practice, from administrative tasks to patient care and ethical considerations. The fourth section scrutinizes ethical
concerns regarding confidentiality, quality of care, equity, and collaboration. Finally, this review culminates into a conclusive summary of key findings, offering insights into the profound implications of ChatGPT for biomedical research and medical practice. Applications in nanotechnology,
and more specifically the use of nanomaterials in medicine, are underscored throughout. Ultimately, ChatGPT offers an innovative method that has the potential to significantly advance biomedical research and enhance medical practice, heralding a new epoch in the digital age.
Nanoparticles-Key to the Future Pharmacotherapy of the Cardiovascular Diseases
Authors: Dominiak Zuzanna , Czarnecka Kamila , Czylkowska Agnieszka , Szymański Paweł
Published: December 2024

Despite its prevalence, cardiovascular disease lacks a universally effective pharmacotherapy strategy preventing against its progression. One possible strategy involves the use of nanoparticles as drug carriers to increase the effectiveness of existing preparations and thus reduce the
dose. This can minimize the side effects and target the therapy in the affected areas. Currently, nanoparticles of lipid, polymeric, or even metabolic origin are being developed, and clinical trials are underway to determine the effectiveness of this type of therapy.
Transient Temperature Distribution of Cable Insulation Layer and Finite Element Analysis
Authors: Wang Li-Jing , Liu Shu-Lin
Published: December 2024

To address the limitations of existing technologies in cable temperature rise monitoring and early warning systems, this paper presents an advanced analytical method that provides accurate cable temperature monitoring and early warning mechanisms for power systems. First, we established
a transient temperature model of the cable insulation layer to accurately predict its radial temperature distribution at any given time. The temperature evolution of the insulation layer over time was then calculated using the finite element method. The effectiveness of the proposed model
was verified through simulated temperature rise tests at different current levels. Simulation results indicate that the model can accurately simulate the temporal variation of cable temperature under specific current and environmental conditions. Additionally, it precisely models the radial
temperature distribution of the cable, identifying hotspot locations. This model not only elucidates the dynamic relationship between current and insulation characteristics but also provides a basis for cable hot spot warnings. Its practical application can effectively prevent cable overheating
damage, demonstrating significant practical value.
Design and Implementation of High Speed and Low Power Filter
Authors: Liu Hui , Zheng Wei
Published: December 2024

In order to solve the problems of complex structure and high power consumption of current sampling filter circuit, a high speed and low power Filter design scheme based on pipeline structure is proposed in this paper. This filter is composed of recursive CIC filter and FIR filter based
on shift adder. The order of CIC filter and FIR filter can be adjusted according to the difference between the measured temperature and the threshold temperature range set by the user, thus the power consumption of the filter is reduced. The experimental results show that, under the same conditions,
the utilization rate of the LUS is reduced by 86%, the power consumption is reduced by 88%, and the utilization rate of the LUS is reduced by 90% compared with the half-band comb filter, power consumption is reduced by 28%.
AlGaN/GaN High Electron Mobility Transistor (HEMT)-Based Dual-Metal Gate Architecture for Biosensing Applications
Authors: Suresh Babu T. , Saravanakumar U.
Published: December 2024

The electrical characteristics and sensitivity of AlGaN/GaN metal-oxide-semiconductor high electron mobility transistor (MOSHEMTs) with dual metal single gate (DMSG) architecture are investigated and compared via Sentaurus technology computer aided design (TCAD) simulations with conventional
single metal single gate (SMSG) devices. This technique reduces gate leakage and current collapse by using aluminium oxide as a high-k dielectric. Simulation results clearly reveal that DMSG devices exhibit superior performance with high drain current, high transconductance, and improved sensitivity
compared to their SMSG counterpart. Moreover, precise sensing of biomolecules including zein, choline oxidase (ChOx), biotein, glucose, and urease has been investigated by adopting the DMSG structure. The band gap is ontinuity and peak electric field significantly improves the channel’s
carrier confinement, leading to high sensitivity and making it feasible for the future biosensing applications.
Analysis of Natural Convection Under the Effect of Nanoparticles Brownian Motion and a Periodic Magnetic Field Utilizing CuO–Water Nanofluid
Authors: Mliki Bouchmel , Abbassi Mohamed Ammar
Published: December 2024

In this article, our study aims to enhance the understanding of two-dimensional flow control by modifying specific geometric parameters and applying an external non-uniform magnetic field to the flow. The objective is to explore the influence of these modifications on flow characteristics
and analyze how these adjustments can be used to impact the overall thermal behavior of the system. The studied cavity is square-shaped and filled with a nanofluid composed of CuO dispersed in water. A semi-circular cooler is positioned along the left side wall. The phenomenon of Brownian
motion in nanoparticles is included in the models describing thermal conductivity and dynamic viscosity. The lattice Boltzmann method (LBM) is utilized to derive the nonlinear dimensionless governing equations. The influence of pertinent parameters such as the Rayleigh number, Hartmann number,
Periodic magnetic field and nanoparticle volume concentration on the flow and heat transfer characteristics has been examined. In this investigation, it is noted that incorporating the influence of Brownian motion of nanoparticles enhances heat transfer by more than 6%. Conversely, the presence
of a magnetic field introduces a contrasting effect, manifesting in a tendency to decelerate the flow dynamics. Furthermore, the numerical results indicate an increase in the average Nusselt number with a rise of the Reynolds number and the period of the periodic magnetic field. Additionally,
the findings suggest that a greater average heat transport rate is observed for the non-uniform magnetic effect when λ = 0.75, considering the impact of Brownian motion, and that the average Nusselt number for this case increased by 23.59% compared to the case where the applied magnetic
field is uniform.
How often are Polish teachers attacked online?
Authors: Tomczyk Łukasz , Potyrała Katarzyna
Published: December 2024

Cyberbullying and cyberaggression are phenomena that have been analysed for more than two decades. However, there is an empirical gap in the literature to characterise the scale of the phenomenon in certain countries and professional groups (e.g. teachers). In order to fill this gap, 733 teachers from Poland responded to questions identifying the scale and mechanisms of Internet attacks resulting from their profession. Based on the data collected, it was noted that (1) each type of information and communications technology (ICT)-mediated attack on teachers is characterised by varying frequency of occurrence; (2) at least once in their careers, 17.5% of teachers have experienced a situation of dissemination of negative comments about them, 10.8% have received negative digital messages intended to trigger negative emotions, and 8.3% have faced hacking (taking over) of a private online account; (3) systematic attacks (at least once a month) on teachers comprise a group of no more than 1% of respondents; (4) there is an apparent correlation between both the lack of experience of cyberattacks by profession and the co-occurrence of different forms of cyber aggression and cyberbullying; (5) based on a cluster analysis using the k-means method, two groups of teachers were identified, where the first (91%) was characterised by a lack of experience of cyberbullying, while the second (9%) rarely or very rarely experienced an attack due to their profession; and (6) teachers teaching in a vocational school, working in a medium or large city, or being male results in a slightly higher exposure to cyberbullying attacks.
Developmental Relationship-Based Interventions for Autistic Children
Authors: Cullinane Diane A. , Binns Amanda V. , Feder Joshua D. , Graham Tessa , Mahoney Gerald J. , Naber Fabiënne B. A. , Robinson Ricki G. , Schertz Hannah H. , Solomon Richard M. , Whitehouse Andrew J. O. , Wieder Serena
Published: December 2024

Interventions to support autistic children are often described as developmental, behavioral, or naturalistic developmental behavioral interventions; however, developmental approaches have not been well defined as a class of therapeutic intervention. We present the position of an interdisciplinary group of researchers and clinicians regarding the common features of developmental interventions. The term Developmental Relationship-Based Interventions (DRBI) is proposed as a useful way to represent this classification of interventions. The defining features of DRBI are: (a) a developmental framework based on a child’s innate motivation for social engagement and learning, and (b) a primary focus on supporting parent-child and other social interactions and relationships. Four strategies consistently used in DRBI are: Social Play, Sensitive Responding, Following the Child’s Lead, and Presenting Challenges. We also describe the features that differentiate DRBI from Naturalistic Developmental Behavioral Interventions (NDBI). The proposed description of DRBI may aid clinical decision-making, policy formation and research design.
Microsimulation Estimates of Decision Uncertainty and Value of Information Are Biased but Consistent
Authors: Goldhaber-Fiebert Jeremy D. , Jalal Hawre , Alarid-Escudero Fernando
Published: December 2024

Purpose

Individual-level state-transition microsimulations (iSTMs) have proliferated for economic evaluations in place of cohort state transition models (cSTMs). Probabilistic economic evaluations quantify decision uncertainty and value of information (VOI). Previous studies show that iSTMs provide unbiased estimates of expected incremental net monetary benefits (EINMB), but statistical properties of iSTM-produced estimates of decision uncertainty and VOI remain uncharacterized.

Methods

We compare iSTM-produced estimates of decision uncertainty and VOI to corresponding cSTMs. For a 2-alternative decision and normally distributed incremental costs and benefits, we derive analytical expressions for the probability of being cost-effective and the expected value of perfect information (EVPI) for cSTMs and iSTMs, accounting for correlations in incremental outcomes at the population and individual levels. We use numerical simulations to illustrate our findings and explore the impact of relaxing normality assumptions or having >2 decision alternatives.

Results

iSTM estimates of decision uncertainty and VOI are biased but asymptotically consistent (i.e., bias approaches 0 as number of microsimulated individuals approaches infinity). Decision uncertainty depends on 1 tail of the INMB distribution (e.g., P[INMB <0]), which depends on estimated variance (larger with iSTMs given first-order noise). While iSTMs overestimate EVPI, their direction of bias for the probability of being cost-effective is ambiguous. Bias is larger when uncertainties in incremental costs and effects are negatively correlated since this increases INMB variance.

Conclusions

iSTMs are useful for probabilistic economic evaluations. While more samples at the population uncertainty level are interchangeable with more microsimulations for estimating EINMB, minimizing iSTM bias in estimating decision uncertainty and VOI depends on sufficient microsimulations. Analysts should account for this when allocating their computational budgets and, at minimum, characterize such bias in their reported results.

Highlights

Individual-level state-transition microsimulation models (iSTMs) produce biased but consistent estimates of the probability that interventions are cost-effective. iSTMs also produce biased but consistent estimates of the expected value of perfect information. The biases in these decision uncertainty and value-of-information measures are not reduced by more parameter sets being sampled from their population-level uncertainty distribution but rather by more individuals being microsimulated for each parameter set sampled. Analysts using iSTMs to quantify decision uncertainty and value of information should account for these biases when allocating their computational budgets and, at minimum, characterize such bias in their reported results.
Association Between Neighborhood Deprivation and Gestational Diabetes: A Systematic Review and Meta-Analysis
Authors: Rao Arathi P. , Khatib Mahalaqua Nazli , Thangavelu Lakshmi , Roopashree Rangaswamy , Sharma Pawan , Lal Madan , Barwl Amit , Prasad Garbham Venkata Siva , Rajput Pranchal , Zahiruddin Quazi Syed , Sah Sanjit , Pant Kumud , Satapathy Prakasini
Published: December 2024

Gestational diabetes mellitus (GDM) is a major global health concern, affecting maternal and child health. Although genetic predispositions and individual medical histories are well-recognized risk factors, emerging research suggests a significant impact of external factors like neighborhood socioeconomic characteristics. This study systematically reviews and meta-analyzes the association between neighborhood deprivation and GDM incidence. We searched multiple databases up to January 10, 2024, for studies linking neighborhood deprivation with GDM. Eligible studies were selected based on predefined criteria, with the Nested Knowledge software assisting in screening and data extraction. Quality assessment utilized the Newcastle-Ottawa Scale, and a random-effects model computed the pooled relative risk (RR) using R software, version 4.3. The review included six studies varying significantly in design, sample sizes, and deprivation assessment methods. The meta-analysis combined data from five studies totaling 15 827 participants from the least deprived and 18 147 from the most deprived neighborhoods, yielding an RR of 0.909 (95% confidence interval [CI] = [0.566, 1.461], P = .607), indicating a non-significant lower risk of GDM in more deprived groups. A substantial heterogeneity (I2 = 70%) was observed, and sensitivity analysis confirmed the robustness of these findings. This analysis suggests that living in a deprived neighborhood does not significantly alter GDM risk, underscoring the necessity for further research to refine public health strategies and interventions. The variability in neighborhood deprivation definitions and potential unaccounted confounding factors highlight the need for comprehensive studies, especially from low-income and middle-income countries, to elucidate the intricate links between socioeconomic factors and GDM.
Soundscape approach applied to a heritage open-air concert hall: The case of the Corral del Carbón in Granada
Authors: Almagro-Pastor Jose Antonio , Vida-Manzano Jerónimo , García-Quesada Rafael , Ramos-Ridao Ángel Fermín
Published: December 2024

Finding a metric to evaluate the sound quality of a given product is a challenging task. It depends on multiple criteria and dimensions. This study proposes a soundscape approach to assess the pleasantness of the acoustic environment in an open-air heritage site, the Corral del Carbón in Granada as a complementary tool for selecting concert venues in addition to environmental and room acoustics criteria. Acoustic measurements and surveys were conducted at two locations: the patio of the building and the adjacent street. The methodology involved soundwalks with participants who provided subjective assessments, complemented by objective acoustic indicators and psychoacoustic parameters. The results reveal a significantly more pleasant acoustic environment inside the patio than the street. This kind of comparisons between sites provide information on which is a more suitable setting for concerts. Soundscape approach offers a practical tool for selecting concert venues in heritage contexts by emphasizing the importance of the perceptual experience of the audience, thereby enhancing the decision-making process for concert programmers and acousticians.
Selecting archers for the three-archer team event at major international archery competitions
Authors: Park James L
Published: December 2024

Results from major international target archery competitions from 1995 to 2024 have been used to show the score trends and the estimated probability of winning either a podium position or winning the event versus the three-archer team’s position in a ranking round. The probabilities fall approximately exponentially versus ranking position. Subjectively, teams need to rank at least in the top 7 to have a reasonable probability of winning a medal. The corresponding average ranking position of each of the three team members needing to be in the mid-20s. The unique impact of the Republic of Korea’s participation in recurve team events has also been considered.
Fracture Compression and Construct Stability with Variable Pitch Locking Screws in Cadaveric Specimens
Authors: Koroneos Zachary A. , Alwine Shelby , Tortora Peter , Pitcher Michaela D. , Benedict Christian , Wee Hwabok , Kunselman Allen , Lewis Greg , Aynardi Michael
Published: December 2024

Category:

Trauma; Basic Sciences/Biologics

Introduction/Purpose:

A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws with standard locking screws in bicortical fixation scenarios in cadaver bone, by assessing: (1) interfragmentary compression and plate-bone compression; and (2) construct biomechanical stability.

Methods:

Nine matched pairs of fresh-frozen cadaveric specimens were used to compare variable pitch locking screws and standard locking screws. First, interfragmentary compression and plate-bone compression associated with insertion of single bicortical screws at increasing levels of torque were measured in distal tibiae having a simulated longitudinal fracture. Second, fibulae were osteotomized to create a stable fracture pattern, fixed with five-screw plated constructs, and tested in either cyclic axial and torsional loading or four-point bending.

Results:

Interfragmentary and plate-bone compression forces were significantly higher with variable pitch locking screws compared to standard locking screws (p =0.002 & p=0.028, respectively). The amount of compression was variable across specimens. In cyclic loading of fibula constructs, no significant differences were detected in construct axial displacement or angular displacement. In four-point bending, no differences were detected in maximum force or bending stiffness.

Conclusion:

Variable pitch locking screws can produce high interfragmentary compression between cortices, along with moderate plate-bone compression. In a stable bicortical fixation scenario under external loading, construct stability was similar to normal locking screws.
Heatmaps on Radiological Safety in Minimally Invasive Midfoot Fusion: A Cadaver Study
Authors: Karaismailoglu Bedri , Peiffer Matthias , Raduan Fernando , Hollander Julian , Knebel Ashley , Kwon John Y. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil , Miller Christopher P.
Published: December 2024

Category:

Midfoot/Forefoot

Introduction/Purpose:

The popularity of minimally invasive (MIS) techniques in foot and ankle surgery continues to grow exponentially. However, it comes with certain limitations that present notable challenges. One significant hurdle is the absence of direct visualization of neurovascular structures and tendons. This study aims to present fluoroscopic heatmaps that illustrate the trajectories of major structures encountered during MIS midfoot procedures.

Methods:

Sequential dissection was performed on nine below-knee specimens identifying the following anatomy structures: anterior tibialis tendon (ATT), extensor hallucis tendon (EHL), extensor digitorum longus tendon (EDL), superficial peroneal nerve (SPN) and dorsal neurovascular bundle (DNVB). Subsequently, flexible wires were positioned and securely placed adjacent to the medial and/or lateral borders of these structures to visualize their trajectories on X-ray imaging. Anteroposterior (AP) and oblique fluoroscopy images of the foot, featuring a calibration marker of a known diameter, were taken, alongside macroscopic photos. All fluoroscopy images were adjusted to a uniform scale and standardized to a single foot fluoroscopy. The coordinates of the structures were marked on these standardized foot AP and oblique fluoroscopy views. These coordinates were then inputted into a custom-made Python script to generate heatmaps.

Results:

Successfully generated heatmaps encompassed the DNVB, ATT, EDL, EHL, and SPN, on AP and oblique fluoroscopy images of the foot. The color gradient used visually represents varying magnitudes, with red indicating the most frequent locations of the structures and blue signifying lower occurrences. These heatmaps also illustrate the highest-risk areas for iatrogenic injury to the structures during MIS procedures.

Conclusion:

This study can empower surgical navigation and improve safety in MIS midfoot procedures by providing surgeons with a fluoroscopic heatmap detailing the trajectories of major anatomical structures.
Isolated Syndesmotic Fixation is Associated with Increased Risk of Arthrodesis and Arthroplasty Operations Compared to Nonoperatively Managed Syndesmotic Injury: A Propensity-Scored Analysis
Authors: Sequeira Sean , Gould Heath P. , Hembree Walter C.
Published: December 2024

Category:

Trauma; Sports

Introduction/Purpose:

Disruption of the distal tibiofibular syndesmosis can occur concomitantly with ankle fracture or as an isolated soft tissue injury. Although syndesmotic fixation is effective in providing stability to the distal tibiofibular joint, biomechanical studies suggest that over-reduction of the syndesmosis may increase ankle contact pressures and potentially accelerate tibiotalar joint degeneration in the longer term. The purpose of this investigation was to evaluate reoperation rates in patients with isolated syndesmotic disruption who underwent fixation versus those who were managed nonoperatively.

Methods:

A large, nationwide insurance database was retrospectively reviewed to identify all patients who were diagnosed with an isolated distal tibiofibular syndesmotic injury (without concomitant fracture) between 2010 and 2019. Patients who underwent surgical stabilization were matched using a propensity scoring algorithm to patients who were managed nonoperatively. The rates of reoperation including subsequent ankle arthroscopy, ankle arthrodesis, and total ankle arthroplasty (TAA) were compared between groups.

Results:

24,758 patients who underwent operative stabilization were matched to 24,758 patients who underwent nonoperative management for syndesmotic injury. Patients who underwent surgical stabilization had an increased risk of ankle arthrodesis (4.04; p< 0.001) and TAA (OR 3.11; p< 0.001) within ten years compared to patients managed nonoperatively. There was no difference between groups with regard to the comparative risk of subsequent ankle arthroscopy within five years.

Conclusion:

Patients with isolated syndesmotic injury who underwent operative stabilization were more likely to require an ankle arthrodesis or total ankle arthroplasty within 10 years compared to those who were managed nonoperatively. These findings in a large, propensity-matched cohort suggest that surgeons should consider the implications of syndesmotic over-reduction when managing these injuries intraoperatively. Moreover, surgeons may incorporate these data into the decision making process when counseling patients regarding the expected outcomes of operative and nonoperative management for syndesmotic injury.
Lateral Column Pressures Following Combined Subtalar/Talonavicular Fusion with and without Calcaneocuboid Fusion
Authors: Alkaramany Eslam , Gallagher Brian P. , Abbasi Pooyan , Guyton Gregory P.
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

There are few comparative studies between the traditional triple arthrodesis and the commonly performed modified procedure in which the calcaneocuboid joint is spared. Earlier investigations proposed that stiffening the lateral column of the hindfoot can increase lateral plantar pressures, potentially precipitating lateral column pain. We used a cadaver model to quantify the potential for reduced lateral column overload achieved by sparing the calcaneocuboid joint in a cadaveric model of triple arthrodesis simulating standing on both a neutral and sloping surface.

Methods:

Nine fresh-frozen, thawed cadaver legs were tested in 2 positions of the loaded surface: neutral and 10 degrees of eversion. Tendon loading and axial pressure was applied according to standard cadaveric models. Medial and lateral forefoot pressures were recorded using a pressure-sensitive plate (F-scan). The data were normalized as a percentage of the native state.

Results:

In neutral loading, the mean contact pressures under the fifth metatarsal head increased dramatically compared to the native state in both the standard (76.3%, p<.005) and calcaneocuboid-sparing (103.5%, p<.007) procedures. Pressure was reduced underneath the first metatarsal head medially in both standard (-52.8%, p< 0.017) and calcaneocuboid-sparing (-57.2%, p< 0.008). Loading on an everted surface yielded larger overall pressures laterally, but the further increases compared to the native state following both standard (39.0%, p < 0.04) and calcaneocuboid-sparing (57.9%, p< 0.03) procedures were smaller than in the neutrally loaded foot. No statistically significant difference was observed between the arthrodesis groups when loaded either on a neutral or sloped surface.

Conclusion:

In our cadaveric model, both traditional triple arthrodesis and the calcaneocuboid-sparing procedure resulted in significant elevation of lateral forefoot plantar pressures compared to the native state, but there was no identifiable protective effect from sparing the calcaneocuboid joint even in the provocative condition of loading on a sloping surface.

Clinical Relevance:

While other factors may guide the choice to spare the calcaneocuboid joint when performing hindfoot fusion, there is no evidence that preserving its motion significantly reduces the risk of lateral column overload.
Low Rates of Return to Sport and Reduction in Performance Following Ankle Fractures in Elite Rugby Union Players
Authors: Butler James J. , Calton Megan , Greene Allison , Rosenbaum Andrew , Mulligan Michael , Kennedy John G.
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

The purpose of this study was to assess outcomes following ankle fractures sustained by elite rugby union players.

Methods:

Elite rugby union players who sustained an ankle fracture were identified using a publicly available database, match reports and injury reports. "Elite rugby union" was defined as a player who played professional rugby in the following competitions: United Rugby Championship, Top 14, English Premiership, Super Rugby and international rugby for a top 20 ranked team. The years of inclusion was from 2015-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play (RTP), time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, tries scored, points scored.

Results:

107 elite rugby union players sustained an ankle fractures between 2014-2022 (0.0186 per 10,000 athlete-exposures). The mean age was 24.2±9.1 years and the mean BMI was 31.8±8.9kg/m2. There were 71 (61.3%) ankle fractures sustained by forwards and 36 (33.6%) ankle fractures sustained by backs. Ninety (84.1%) ankle fractures occurred during the in-season and 17 (15.9%) ankle fractures occurred during training. All athletes (100%) underwent surgical intervention. The most common mechanism of injury was direct trauma to the ankle during a tackle (55.9%). The RTP rate was 78.3% at mean time of 8.9±3.9 months. There was a statistically significant decrease in the mean number of games played, tries scored and points scored following RTP.

Conclusion:

This current study found that ankle fractures were an uncommon injury in elite rugby union players with an incidence of 0.0186 per 10,000 athlete-exposures. Sustaining an ankle fracture was associated with a RTP rate of 78.3% at mean time of 8.9±3.9 months. There was a statistically significant deterioration in key performance metrics such as mean games played, tries scored and points scored. This study reinforces the potentially devastating sequelae following ankle fractures in the elite athletic population.
Maintenance of Hallux Valgus Correction Treated with Modified Lapidus Procedure: Intermetatarsal Miniature Suture Button vs First Metatarsal to Intermediate Cuneiform Cross-Screw Fixation
Authors: Attia Ahmed Khalil , Austin Confidence Njoku , Clayton Elizabeth , Fogg David , Dalton Jonathan , Kline Alex , Hasselman Carl , Hogan Macalus V.
Published: December 2024

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

Over time our understanding of Hallux valgus deformity has continued to improve since Lapidus published his series in 1960, however, recurrence remains as high as 38%. Fixation of the first tarsometatarsal joint has been known to improve the rigidity of the construct and reduce recurrence. While some authors employ an inter-cuneiform screw between the medial and intermediate cuneiform others provide fixation using a suspensory fixation device (Arthrex mini tightrope). However, this is limited information comparing the modified Lapidus first metatarsal arthrodesis using the suture button fixation (MT1-2 SB) and the first metatarsal intermediate cuneiform screw (MT1C2 Screw). We hypothesize that the intermediate screw fixation would have better radiographic outcomes compared to the suture button fixation.

Methods:

This was a retrospective comparative study between patients who underwent surgical management of hallux valgus using the MT1-2 SB and the MT1C2 screw between January 2015 to January 2023. Exclusion criteria were as follows: revision or prior hallux valgus corrective surgery on the same foot, patients who received additional procedures (i.e. midfoot fusion, or flatfoot reconstruction), and incomplete medical records. Demographic variables including age, sex, body mass index (BMI), diabetes status, and smoking status were collected. Recurrence rate, union rate, hardware removal, infection rate, and patient-reported outcomes were also collected. The radiographic variables are first metatarsal declination angle (MTD), intermetatarsal angle (IMA), hallux valgus angle (HVA), and sesamoid station.

Results:

We had a total of 269 patients in the MT1-2 SB cohort and 93 in the MT1C2 Screw cohort. The MT1-SB group achieved a better radiographic correction for IMA (5.37 +/- 3.21 vs 6.65 +/- 3.36, p= < 0.001), HVA (16.03 +/-7.89 vs 19.81 +/- 8.47, p= < 0.001), and sesamoid stations (0.52 +/- 0.81 vs 0.76 +/- 0.90, p= 0.19). MT1-SB had a better correction at final follow-up. Diabetes status was associated with greater postoperative pain, while smoking status was associated with worse postoperative FAAM ADL score (p= 0.011 and 0.003 respectively). Smoking was associated with a greater postoperative and final HVA in addition to an increased revision rate (15.8% vs 3.5%, p=0.037). A greater recurrence rate was also seen among smokers (15.8% vs 4.4%, p=0.061).

Conclusion:

Suture button fixation and first metatarsal intermediate cuneiform screw fixation demonstrated similar clinical outcomes, union rates, deformity correction, and maintenance of correction at the final follow-up. Smoking was associated with a higher rate of recurrence, revision, and worse patient-reported outcomes.
Medical Malpractice Litigation Following Hindfoot Arthrodesis
Authors: Megalla Martinus , Patel Seema M. , Anfuso Matthew , Hahn Alexander , Grace Zachary T. , Geaney Lauren E.
Published: December 2024

Category:

Hindfoot; Ankle

Introduction/Purpose:

Given high patient expectations in the setting of complex surgeries, orthopedic surgeons are at risk of being subject to malpractice claims. Consequently, medical malpractice lawsuits can impose significant economic and psychological burden on orthopedic surgeons. This study aims to investigate malpractice claims against orthopedic surgeons and podiatrists performing hindfoot arthrodesis and determine factors associated with plaintiff verdicts and settlements using the Westlaw legal database.

Methods:

The Westlaw legal database was queried for all cases involving hindfoot arthrodesis using the terms “malpractice” and either “ankle fusion,” “arthrodesis,” “subtalar fusion,” “tibiotalar fusion,” “tibiotalocalcaneal fusion,” “TTC fusion,” or “tibiofibular fusion” from 1987 to present day. Data regarding patient demographics, causes cited for litigation, case outcomes, and indemnity settlements were collected. Cases were excluded if the defendant was not an orthopedic surgeon or a podiatrist, the procedure involved was not a hindfoot arthrodesis, or if the patient was a minor.

Results:

Forty-five cases of hindfoot arthrodesis met the inclusion criteria. The mean plaintiff age was 51.5 ± 13.8 years with 51.1% male. Thirty-three cases (73%) were in favor of the defendant, with an average inflation-adjusted payout of $853,863 (± 456,179). The most commonly alleged category of negligence was procedural/intraoperative error (75%) followed by post-surgical error (38%) and failure to inform (31%). The most common specific damages included functional/ROM limitation (49%), need for additional surgery (47%), continuing/worsened pain (27%), and nonunion/malunion (29%).

Conclusion:

This study highlights the importance of effective communication with patients concerning potential postoperative complications, prognosis of their injury, and risks and benefits associated with each treatment modality. Given the frequency of hindfoot arthrodesis performed, it is imperative for orthopedic surgeons to prioritize surgical goals, patient expectations, and complication profiles to reduce the risk of malpractice litigation and improve patient outcomes.
Mid-Term Patient Reported Outcomes Following An Isolated Gastrocnemius Recession for Recalcitrant Plantar Fasciitis
Authors: Long Joseph M. , Rohl Matt , Brezovec Lexi , Whitehead Brent , Cheney Nicholas
Published: December 2024

Category:

Hindfoot; Other

Introduction/Purpose:

For most patients suffering from plantar fasciitis, nonoperative management can alleviate their symptoms. In a small subset of patients these modalities are unsuccessful, and invasive procedures can be recommended. With current studies supporting the use of this procedure with good short-term results and a low complication rate, we hypothesize that an isolated gastrocnemius recession for plantar fasciitis will demonstrate good midterm results.

Methods:

Eighty-eight patients underwent a gastrocnemius recession for isolated, recalcitrant plantar fasciitis between September 2014-June 2017, and were identified using procedural codes. Patients were then contacted via phone to obtain answers to Foot and Ankle Ability Measurement, and AAOS foot and ankle outcome scores. Patients were also asked questions about if they were satisfied with the procedure, would repeat the procedure, or would recommend it to a friend.

Results:

Fifty-two patients were contacted, nine declined participation. The group included 33 females and 10 males, 23 left and right feet (3 bilateral). Investigator follow up occurred at a mean time of 5.0±1.3 years. The average FAAM scores by category were ADL 92.0±15.0, daily function 91.0±19.8. On the FAAM rating of current function 30 rated themselves as normal, 8 near normal. The average AAOS foot and ankle scores were 93.9±11.4 (normative standard 50.9±9.8), shoe comfort 83.5±25.8 (normative standard 53.4±8.8). 41 patients rated themselves as satisfied with the procedure (95%), 40 would do it again (93%) and 39 would recommend the procedure to a friend with recalcitrant symptoms (91%). One patient required a revision gastrocnemius recession with relief of symptoms. No other complications were noted.

Conclusion:

he use of an isolated gastrocnemius recession for recalcitrant plantar fasciitis demonstrates a high rate of patient satisfaction and function in the midterm at 5 years. This study supports the use of this procedure in patients who fail non-operative regimens.
A retrospective study of extrapulmonary tuberculosis in the Khuzestan province of southwest Iran between 2002 and 2023
Authors: Hashemzadeh Mohammad , Dezfuli Aram Asareh Zadegan , Khosravi Nazanin Ahmad , Mehr Fatemeh Jahangiri
Published: December 2024

Background

Worldwide, tuberculosis (TB) is among the most common causes of death. To our knowledge, there has been no study showing the prevalence of EPTB in Khuzestan province. Therefore, the objective of this research was to investigate the prevalence of EPTB in patients with or without pulmonary TB in different cities of Khuzestan province from 2002 to 2023. Additionally, the correlation between patient’s gender, and age groups with the disease was also investigated.

Methods

In this retrospective study, the existing records in Tuberculosis Regional Reference Laboratory of Khuzestan province related to patients were used. The research was carried out by investigating the archive information in 19 years (from 1st January 2002 to December 30, 2023). All confirmed cases of EPTB and simultaneous EPTB and PTB, based on laboratory results and medical examination were included in the study. Patients with incomplete information and military TB were excluded from the study. Information collected from patients includes age, gender, involved organ, place of residence, and year of disease.

Results

A total of 12,900 EPTB-related medical records were extracted from Tuberculosis Regional Reference Laboratories in southwest Iran, Ahvaz. After excluding records, 12,836 clinically diagnosed or laboratory-confirmed tuberculosis patients were included in this study, including 5991 patients with simultaneous PTB and EPTB, and 6845 patients with EPTB only. The mean age of male EPTB patients was 37.5 years (SD ± 14.6), while the mean age of male patients with simultaneous PTB and EPTB was 45.8 years (SD ± 15.3). The mean age of female patients with EPTB only, and with simultaneous PTB and EPTB was 31.2 years (SD ± 12.6), and 31.5 years respectively.

Discussion

tuberculosis is a systemic disease with different clinical manifestations. This study described different epidemiologic patterns of concurrent EPTB. The proportion of different types of EPTB was simultaneously determined for a group of hospitalized patients and shown to be different with gender and age. This study will likely increase clinicians’ awareness of the disease and help them better address diagnostic challenges and improve treatment outcomes for patients with EPTB.
Current and future immunotherapy for breast cancer
Authors: Heater Natalie K. , Warrior Surbhi , Lu Janice
Published: December 2024

Substantial therapeutic advancement has been made in the field of immunotherapy in breast cancer. The immune checkpoint inhibitor pembrolizumab in combination with chemotherapy received FDA approval for both PD-L1 positive metastatic and early-stage triple-negative breast cancer, while ongoing clinical trials seek to expand the current treatment landscape for immune checkpoint inhibitors in hormone receptor positive and HER2 positive breast cancer. Antibody drug conjugates are FDA approved for triple negative and HER2+ disease, and are being studied in combination with immune checkpoint inhibitors. Vaccines and bispecific antibodies are areas of active research. Studies of cellular therapies such as tumor infiltrating lymphocytes, chimeric antigen receptor-T cells and T cell receptor engineered cells are promising and ongoing. This review provides an update of recent major clinical trials of immunotherapy in breast cancer and discusses future directions in the treatment of breast cancer.
Design, synthesis, and biological evaluation of (E)-2-benzylidene-1-indanones derivatized by bioisosteric replacement of aurones
Authors: Lee Youngshim , Ahn Seunghyun , Jung Euitaek , Koh Dongsoo , Lim Yoongho , Lee Young Han , Shin Soon Young
Published: December 2024

Thymic stromal lymphopoietin (TSLP) is a cytokine derived from epithelial cells and plays an essential role in the onset and activation of Th2-derived allergic inflammatory conditions, including atopic dermatitis. Despite their potential as drug targets, well-defined small molecules that effectively block TSLP expression are still lacking. A plant-derived secondary metabolite, aurone, was derivatized based on bioisosteric replacement to identify compounds that inhibit the promoter activity of TSLP. Thirteen (E)-2-benzylidene-1-indanones were designed and synthesized, and their structures were identified using NMR spectroscopy and mass spectrometry. Inhibition of the expression of TSLP triggered by interleukin-4 (IL-4) caused by (E)-2-benzylidene-1-indanones was measured using a TSLP gene promoter-reporter activity assay. Because compound 12, (E)-5-methoxy-2-(3-methoxybenzylidene)-2,3-dihydro-1H-inden-1-one, showed the best activity, further biological experiments, including RT-PCR analysis, quantitative real-time PCR, and inhibitory effects on IL-4-induced early growth response-1 (EGR-1) expression, EGR-1 DNA-binding activity, and IL-4-induced phosphorylation of the mitogen-activated protein kinase (MAPK) signaling cascade were performed. This study demonstrated that compound 12 acts on MAPK to block IL-4-triggered mRNA expression of TSLP via the MAPK-EGR-1 signaling pathway in HaCaT keratinocytes.
Hydrolysis of palm kernel meal fibre using a newly isolated Bacillus subtilis F6 with high mannanase activity
Authors: Ong Wei Li , Chan Kam Lock , Suwanto Antonius , Li Zhi , Ng Kian-Hong , Zhou Kang
Published: December 2024

Palm kernel meal (PKM) presents a challenge for non-ruminant livestock feeding due to its high fibre content predominantly in the form of mannan. Microbial fermentation offers a sustainable solution for fibre hydrolysis in lignocellulosic biomass. In this study, a Bacillus subtilis strain (F6), with high mannanase secretion capability, was isolated from the environment. Fermentation of PKM with B. subtilis F6 resulted in at least a 10% reduction in neutral detergent fibre, decreasing from 78.4 to 60.9% within 24 h. Notably, B. subtilis F6 rapidly responded to PKM, producing significant mannanase activity within 6 h, facilitating quick fibre degradation. Transcriptome analysis identified key enzymes involved in this process, with β-mannanase GmuG showing the highest increase in expression (45.2-fold) after fermentation. Purified recombinant GmuG exhibited strong PKM hydrolysis activity, primarily releasing mannobiose and mannotriose. Characterization of GmuG using locust bean gum as a substrate revealed an optimum temperature of 50–55 °C and pH optima at 5.0 and 9.0. This study highlights the potential of B. subtilis F6 and its mannanase GmuG for efficient PKM fibre hydrolysis, and provides insights into their application in the valorization of mannan-rich bioresources.

Graphical Abstract
A comprehensive review on microbial hyaluronan-degrading enzymes: from virulence factors to biotechnological tools
Authors: Jiang Jia-Yu , Xue Dai , Gong Jin-Song , Zheng Qin-Xin , Zhang Yue-Sheng , Su Chang , Xu Zheng-Hong , Shi Jin-Song
Published: December 2024

Hyaluronan (HA), a natural high molecular weight polysaccharide, has extensive applications in cosmetology and medical treatment. Hyaluronan-degrading enzymes (Hyals) act as molecular scissors that cleave HA by breaking the glucosidic linkage. Hyals are present in diverse organisms, including vertebrates, invertebrates and microorganisms, and play momentous roles in biological processes. In recent years, microbial Hyals (mHyals) have gained considerable attention for their exceptional performance in the production and processing of HA. Moreover, the applications of mHyals have been greatly extended to various biomedical fields. To explore the potential applications of mHyals, a thorough comprehension is imperative. In this context, this review systematically summarizes the sources, structures, mechanisms and enzymatic properties of mHyals and discusses their biological functions in host invasion, disease development, and regulation of intestinal flora. Furthermore, versatile applications inspired by their biological functions in medicine development, molecular biology, and industrial biotechnology are comprehensively reviewed. Finally, prospects are presented to emphasize the importance of exploration, expression and characterization of mHyals and the necessity of excavating their potential in biotechnological fields.

Graphical abstract