bluuebunny/crossref_metadata_2025 huggingface dataset:
Light on Shedding: A Review of Sex and Menstrual Cycle Differences in the Physiological Effects of Light in Humans
Authors: Vidafar Parisa , Spitschan Manuel
Published: November 2022

The human circadian system responds to light as low as 30 photopic lux. Furthermore, recent evidence shows that there are huge individual differences in light sensitivity, which may help to explain why some people are more susceptible to sleep and circadian disruption than others. The biological mechanisms underlying the differences in light sensitivity remain largely unknown. A key variable of interest in understanding these individual differences in light sensitivity is biological sex. It is possible that in humans, males and females differ in their sensitivity to light, but the evidence is inconclusive. This is in part due to the historic exclusion of women in biomedical research. Hormonal fluctuations across the menstrual cycle in women has often been cited as a confound by researchers. Attitudes, however, are changing with funding and publication agencies advocating for more inclusive research frameworks and mandating that women and minorities participate in scientific research studies. In this article, we distill the existing knowledge regarding the relationship between light and the menstrual cycle. There is some evidence of a relationship between light and the menstrual cycle, but the nature of this relationship seems dependent on the timing of the light source (sunlight, moonlight, and electric light at night). Light sensitivity may be influenced by biological sex and menstrual phase but there might not be any effect at all. To better understand the relationship between light, the circadian system, and the menstrual cycle, future research needs to be designed thoughtfully, conducted rigorously, and reported transparently.
The relationship between international human rights law and international humanitarian law: Taking stock at the end of 2022?
Authors: Fortin Katharine
Published: November 2022

Noting that 2022 marked the 45th anniversary of the Additional Protocols to the 1949 Geneva Conventions – the first treaties that explicitly noted the relationship between international human rights law and international humanitarian law - this column reflects on how the relationship between these two bodies of law has developed since 1977. It demonstrates that while much progress has been made internationally towards understanding the relationship between two bodies of law, there are still obstacles to be overcome if the goal is to apply the two bodies of law in a complementary fashion and achieve the maximum protection of the human person.
Does the export-to-import ratio affect environmental sustainability? Evidence from BRICS countries
Authors: Rahman Md. Mominur , Halim Md. Abdul
Published: November 2022

The study aims to examine the effects of trade balance, economic growth, green field investment, energy use, financial development, and urbanization on environmental sustainability in BRICS countries. This study proceeds to estimate the long-term association using the fully modified ordinary least square (FMOLS) and the dynamic ordinary least square (DOLS) panel estimation methods for the years 1991–2020. This empirical study finds that the ratio of exports to imports has a negative effect on environmental degradation. This indicates that increasing the trade balance eventually leads to environmental sustainability, which finally improves living standards and environmental conditions in the BRICS countries. The findings further show that green field investment and financial development substantially improve environmental sustainability, but energy use, urbanization, and economic growth desperately negatively affect environmental sustainability. Additionally, this research finds a unidirectional relationship of environmental sustainability with trade balance, green field investment, energy use, urbanization, and economic growth rate. This study states how BRICS countries can be protected through trade balance controlling environmental degradation. Thus, this research provides improved orientations to the policymakers of BRICS countries to design policy in favor of the environment.
Exploring the Inherent Tensions at the Nexus of Education for Sustainable Development and Neoliberalism
Authors: Schulte Matthew
Published: November 2022

To overcome the anthropogenic and global issues facing humanity today, young people will require a level of democracy, citizenship and altruism that is lacking in our current education system and is often antagonistic to the dominant neoliberal values, structures and underlying assumptions of our increasingly globalized education systems. This article explores the inherent tension between education for sustainable development within a neoliberal political and economic system, through conducting post-structural policy analysis on SDG 4—Target 4.7. This process highlights a highly politicized education development agenda that problematizes both the current state of the world and global education systems as failing to equip young people with the knowledge and skill necessary to promote sustainable development. This leads to a range of discursive and lived effects including the increased reliance on transnational organizations, increasing performativity in schools and the subjectification of teachers and students.
Board Gender Diversity and the Indian Banking Sector: A Bibliometric Analysis
Authors: Bhatia Monika , Bhullar Pritpal Singh , Roy Dipayan , Tandon Deepak
Published: November 2022

This paper aims at identifying the probable impact of board gender diversity on the key business operational areas explored by the existing published research. Moreover, the study also emphasises exploring the role of board gender diversity in the Indian banking sector. The data from existing literature from 2000 to 2022 have been extracted from the Scopus database. By devising VOSviewer software, citation analysis and bibliographic coupling analysis were conducted to identify the influential documents, authors and journals that made significant contributions to this segment of research. According to the findings of the study, no significant research has been conducted to determine the impact of board gender diversity on various key operational aspects of the banking sector. It also discovers that the majority of the studies were carried out in European countries. The Indian context is still underexplored. The study suggests key research questions, the answers to which can be investigated by future researchers.
Psittacid alphaherpesvirus 5 infection in Indian ringneck parakeets in southern California
Authors: Henderson Eileen E. , Streitenberger Nicolas , Asin Javier , Armien Anibal , Crossley Beate M. , Childress April L. , Wellehan James F. X. , Uzal Francisco A.
Published: November 2022

Four Indian ringneck parakeets ( Psittacula krameri; syn. ringneck parrots or rose-ringed parakeets) were submitted by 2 private owners for autopsy following a history of dyspnea and death. Gross findings were varied and included thickening of the left caudal thoracic air sac, white spots throughout the liver, mild dilation of the proventriculus, coelomic effusion, splenomegaly, and pulmonary congestion and edema. Microscopically, the submitted parakeets had significant lesions in the lower respiratory tract, including necrotizing bronchitis, parabronchitis, and interstitial pneumonia with numerous syncytia containing eosinophilic intranuclear inclusions. Electron microscopy of the lungs was compatible with a herpesviral infection and Psittacid alphaherpesvirus 5 (PsAHV5) was detected via PCR and sequencing. There has been inconsistent terminology used with Psittacid alphaherpesvirus 3 and PsAHV5; we attempt here to clarify the reported history of these viruses.
Assessing Communication Quality in the Intensive Care Unit
Authors: Erickson Stephanie G. , Siparsky Nicole F.
Published: November 2022

Introduction: Successful shared decision-making for critically ill intensive care unit (ICU) patients requires bidirectional communication. Through observation of ICU conversations, our study aimed to identify communication skill deficiencies in providers who care for patients in the ICU. Methods: This was an observational prospective study performed in a single urban academic medical center (671 beds) from June 2021 through August 2021. Twenty-three providers were recruited from medical and surgical ICU services (56 beds). Thirty-nine surrogate decision makers were identified. Provider skills were assessed using a customized observational tool that examined nonverbal communication, verbal communication, opening the discussion, gathering information, understanding the family’s perspective, sharing information, reaching agreements on problems and plans, and providing closure. Results: Thirty-nine conversations were observed for six attending physicians, four fellow physicians, eight resident physicians, two nurse practitioners, and three physician assistants during the coronavirus 19 (COVID19) pandemic. A dedicated critical care provider engaged in 19 observed conversations; 20 discussions occurred with individuals rotating/consulting in the ICU. Communication skill did not depend on experience or area of expertise. Less than half of conversations achieved bidirectional communication proficiency. Scheduled conversations (n = 14) had significantly higher average communication scores than unscheduled encounters (n = 25). Conclusions: Superficial unidirectional communication with decision makers was commonly observed. Providers were less proficient at advanced communication skills needed for shared decision-making. We recommend that providers have more scheduled conversations, which were more productive in achieving bidirectional communication. A targeted simulation curriculum addressing these areas may improve patient, decision maker, and provider satisfaction, while promoting patient-centered care.
Varieties of Green Stimulus Policies: Comparative Analysis of the Green Growth and Green New Deal Policies in South Korea
Authors: Han Heejin , Lee Taedong
Published: November 2022

Globally, several governments have adopted various forms of green stimulus policies (GSP) to manage environmental challenges and revitalize their national economies during crises. However, research on the varieties of GSPs within a country and the possible drivers of this diversity remain scarce. This study qualitatively compares the green growth and green new deal policies adopted under two different administrations in South Korea. Although both GSPs share similar components, they vary in their focus on nuclear energy and international cooperation. This study postulates that these differences are associated with the degree to which each administration saw GSP through the lens of a developmental state. Besides providing a comparative tool for examining GSPs and their elements, this research contributes to GSP research in a non-Western developed-country setting by highlighting how domestic factors shape the nature and composition of GSPs.
Anemia and Its Severity Is Associated With Worse Postoperative Outcomes Following Open Reduction Internal Fixation of Ankle Fractures
Authors: Ortiz-Babilonia Carlos D. , Badin Daniel , Gupta Arjun , Guilbault Ryan , Hsu Nigel , Ficke James R. , Aiyer Amiethab A.
Published: November 2022

Background:

Ankle fractures are often treated in a nonemergent fashion and therefore offer the chance for treatment of preoperative anemia. Although preoperative anemia has been associated with postoperative morbidity following certain types of orthopaedic procedures, its effect on postoperative outcomes following open reduction internal fixation (ORIF) of ankle fractures has not been evaluated. The purpose of this study was to determine the influence of preoperative anemia on 30-day postoperative outcomes following ankle fracture ORIF.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program (ASC-NSQIP) registry was queried from 2005 to 2019 for patients undergoing ankle fracture ORIF. Patients were stratified into nonanemic, mildly anemic, and moderately to severely anemic. Univariate analyses were used to assess differences in patient characteristics between cohorts. Multivariate logistic regressions adjusting for these differences were performed to assess the effect of preoperative anemia on 30-day postoperative outcomes.

Results:

We obtained data for 21 211 patients, of whom 14 931 (70.39%) were not anemic, 3982 (18.77%) were mildly anemic, and 2298 (10.83%) were moderately to severely anemic. After adjustment, mild preoperative anemia was associated with higher odds of any adverse event ( P < .001), deep surgical site infections (SSIs; P = .013), sepsis ( P = .001), 30-day readmission ( P < .001), and extended length of stay (LOS) ( P < .001). Similarly, moderate to severe anemia in these patients was also associated with increased odds of any adverse event ( P < .001), deep SSIs ( P = .003), sepsis ( P = .001), readmission ( P < .001), and extended LOS ( P < .001). Both mild ( P = .004) and moderate to severe ( P < .001) anemia groups had higher odds of requiring a blood transfusion.

Conclusion:

Preoperative anemia is associated with an increased risk of adverse postoperative outcomes in patients undergoing ORIF for ankle fractures. Future studies should evaluate whether optimization of hematocrit in these patients results in improved outcomes.

Level of Evidence:

Level III, comparative study.
A novel information fusion approach using weighted neural networks for intelligent multi-class diagnostics of rotating machinery with unseen working conditions
Authors: Zarchi Milad , Shahgholi Majid
Published: November 2022

Analytical diagnostics tools have been proved effective. However, these techniques are unable to be adaptively implemented for diverse machines with various defect modes. Big data-based diagnostics tools have been demonstrated efficient, but they exploit massive data with a high computational cost and time that is impractical for online condition monitoring. Furthermore, the health signals may be acquired under unseen working conditions in real machines. These are the major challenges for previous diagnostics methods and make them infeasible in real-world applications. So, a novel technique is proposed in this research to solve mentioned problems. The main novelty of this method is to fuse information of various processing functions for multi-sensor signals and to apply an efficient feature bank for performing an efficacious feature learning method. The other novelty of this research is to select transferable features for diagnostics of rotating machinery under unseen working conditions. Mean squared error function for the improvement of diagnostics accuracy and transferable feature space with semidefinite dimension for the improvement of diagnostics speed and better visualization for the source and target machines with different working conditions are minimized jointly via weighted neural networks. This approach is verified by two case studies of machinery vibration datasets for the robustness analysis of bearing multi-fault diagnosis problems under various operational conditions for the sensitivity analysis. Results indicate that the proposed algorithm achieves good performance in real rotating machinery diagnostics with unseen working conditions.
First-Line Osimertinib in Patients With EGFR-Mutated Non-Small Cell Lung Cancer: Effectiveness, Resistance Mechanisms, and Prognosis of Different Subsequent Treatments
Authors: Nie Naifu , Li Jianghua , Zhang Jian , Dai Jie , Liu Zhulin , Ding Zhenyu , Wang Yubo , Zhu Mengxiao , Hu Chen , Han Rui , Tang Huan , Li Li , He Yong
Published: November 2022

Background:

Although the clinical application of osimertinib, a third-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), has been a new step forward in the first-line treatment of non-small cell lung cancer (NSCLC), an increasing number of patients with progression on osimertinib represents a great challenge clinically. The patterns of resistance mechanisms and subsequent treatment strategies after first-line osimertinib resistance are not well established.

Methods:

Between January 1, 2016 and October 31, 2020, a consecutive of 56 EGFR-mutant lung cancer patients treated with osimertinib as first-line therapy at Daping Hospital (Chongqing, China) were retrospective screened. The samples of pre-osimertinib and osimertinib-resistance were all detected by next-generation sequencing (NGS) panels. Statistical analyses were carried out using SPSS 23.0 software. Survival analyses were performed using the Kaplan–Meier method and compared using a log-rank test between groups.

Results:

Among 47 patients with osimertinib effectiveness analysis, the median progression free survival (mPFS) was 15.4 months (95% confidence interval [CI]: 12.2-24.9 months), and median overall survival (mOS) was 35.5 months (95% CI: 23.9 months -NA). A total of 21 patients underwent repeated NGS tests upon osimertinib resistance. MET amplification was the most common resistance mechanism (6/21, 28.6%), followed by C797S mutation (5/21, 23.8%). A total of 15 patients received subsequent treatments, with mPFS of 7.3 months (95% CI 5.0 months -NA). Among them, 7 patients with EGFR C797 S or/and MET amplification received subsequent second-line targeted therapy, achieving mPFS of 7.3 months (95% CI 4.5 months -NA). Of note, 3 patients received immunotherapy as second- or third-line treatment after osimertinib resistance, achieving median clinical benefit of 37.3 months.

Conclusions:

MET amplification and C797S mutation are main resistance mechanisms, which could be targeted by crizotinib and gefitinib, respectively. More than 50% patients could receive subsequent anticancer targetable therapies after first-line osimertinib resistance. Immunotherapy may also be an acceptable choice after osimertinib resistance.
Planning by Exception: The Regulation of Nairobi’s Margins
Authors: Schramm Sophie , Bize Amiel
Published: November 2022

Nairobi’s planning regime is characterized by two conditions of exception: on the one hand, exceptions from regulation, that is, planning offices granting exceptions from planning rules and, on the other hand, regulatory regimes that are enforced by low-level administrations outside the planning office but that significantly impact Nairobi’s urban space—we call this exceptional regulation. We argue that it is these two intertwined conditions of exception that make possible the building of shiny modern city as well as the provision of essential urban services. We examine the two conditions of “planning by exception” by analyzing a scrap heap that has endured in central Nairobi for over a decade, even as the neighborhood around it has radically changed. The position of the scrap heap makes the contradictions of this regime of planning particularly visible. On the one hand, the construction sites dotting these neighborhoods provide a wealth of scrap for dealers to gather—and dealers, in turn, provide an essential recovery service. On the other hand, in these increasingly exclusive spaces, businesses like scrap metal heaps are no longer welcome. Thus, the construction boom simultaneously grants scrap dealers opportunities for accumulation and makes the conditions of that accumulation highly uncertain. This scrap metal heap thus offers important insights into Nairobi's spatial regulation because it is both a leftover from the neighborhood’s earlier socio-spatial form and intricately entangled with the redevelopments currently reshaping the city. Our key contribution is that we can only understand urbanization of Nairobi—and other postcolonial cities—if we understand planning as simultaneously working through a regime that grants exceptions to formal planning and by employing exceptional regulation of marginalized spaces.
Monitoring and recovery of hyperglycaemia-induced endothelial dysfunction with rheopheresis in diabetic lower extremity ulceration with hyperviscosity
Authors: Gál Kristóf , Asbóth Georgina , Vass Melinda , Bíró Attila , Markovich Arnold , Homoki Judit , Fidler Gábor , Paholcsek Melinda , Cziáky Zoltán , Németh Norbert , Remenyik Judit , Soltész Pál
Published: November 2022

Aims

Rheopheresis is an extracorporeal haematotherapy that improves haemorheological status by filtering proteins that enhance blood viscosity. It also has anti-inflammatory effects by removing inflammatory cytokines. Our study aims to examine the effects of rheopheresis on the endothelial status in diabetic lower extremity ulceration.

Methods

In vitro experiments were performed in a HUVEC model to mimic hyperglycaemic stress. We determined the changes in gene expression levels of IL-6, IL-8, TNF-alpha, endothelin convertase enzyme, ET-1, and NO synthase, as well as the ROS and intracellular GSH levels upon hyperglycaemia. In in vivo studies, two rheopheresis procedures were performed on seven patients with diabetic lower extremity ulceration with hyperviscosity, and we measured the changes in plasma concentrations of ET-1, TXB2, SOD enzyme activity, and extracellular components of the glutathione pool depending on treatments.

Results

Our results showed that hyperglycaemia increases endothelial expression of inflammatory cytokines, ET-1, and endothelin convertase enzyme, while NO synthase was decreased. As a result of rheopheresis, we observed decreased ET-1 and TXB2 concentrations in the plasma and beneficial changes in the parameters of the glutathione pool.

Conclusion

To summarize our results, hyperglycaemia-induced oxidative stress and endothelial inflammation can be moderated by rheopheresis in diabetic lower extremity ulceration with hyperviscosity.
Empirically Derived Patterns of Posttraumatic Stress and Growth: A Systematic Review
Authors: Fletcher Shelley , Mitchell Sinead , Curran David , Armour Cherie , Hanna Donncha
Published: November 2022

The relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG) has been extensively studied; however, the nature of the relationship remains unclear. Inconsistencies in the literature could be, in part, due to the use of variable level approaches. Person centered methods may further our understanding of this relationship, as they enable the identification of clinically meaningful subgroups based on PTS/PTG scores. This review aimed to identify commonly found subgroups of PTS and PTG, clinically relevant factors that distinguish the subgroups and to critically appraise the utility of categorizing individuals into subgroups based on PTS/PTG scores. Five databases (Embase, Medline, Web of Science, PILOTS, and PsycINFO) were searched. Seven studies (with a total of eight study samples; n = 6,776) met the eligibility criteria. A narrative synthesis of the findings revealed that the majority of the analyses ( n = 6) found three patterns of PTS/PTG. These were categorized as: (1) low PTS/PTG (representing 26.89% of the entire sample), (2) high PTS/PTG (weighted mean percentage = 20.05%), and (3) low PTS/high PTG (weighted mean percentage = 43.1%). The role of social support was examined in five studies and higher social support was consistently found to predict membership in the low PTS/high PTG class. All five studies that examined the role of trauma characteristics found that it was a significant predictor of class membership. These findings could inform the developments of tailored interventions. The utility of person-centered approaches was discussed and recommendations to improve the application and reporting of such methods were made.
The Association Between Child Abuse and Aggressive Behavior: A Three-Level Meta-Analysis
Authors: Ran Guangming , Zhang Qiongzhi , Zhang Qi , Li Jun , Chen Jing
Published: November 2022

Child abuse is considered to be an essential factor in the development of aggressive behavior. The intensity of the positive relations between child abuse and aggressive behavior differed considerably among researches despite the fact that abundant studies have observed this relation. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach, a three-level meta-analysis was employed to obtain reliable estimates for the sizes of effects and investigate some potential moderators of the relation between child abuse and aggressive behavior. The present study obtained 51 studies (30,566 participants; 680 effect sizes) through performing the detailed literature search. It was found that child abuse was positively associated with aggressive behavior in the current study. In addition, the present meta-analysis observed significant moderating effects for type of child abuse, culture, measurement of child abuse, and publication year in the association between child abuse and aggressive behavior. This study suggests that child abuse is a predictor for the development of aggressive behavior in humans. Moreover, child abuse is an important aspect for consideration in efforts toward strengthening of interventions targeting individuals’ aggressive behavior.
A systematic review of sport-related packages within the R CRAN repository
Authors: Casals Martí , Fernández José , Martínez Victor , Lopez Michael , Langohr Klaus , Cortés Jordi
Published: November 2022

The sports statistics community is rapidly evolving. R is an open-source software in constant development that has gained a lot of popularity within statistical communities and sports analytics. This work presents a systematic review of the available R CRAN sport packages following PRISMA guidelines. We consider all packages active as of 18 February 2021. A total of 81 sport R packages created since 2006 were detected. Of these, 35.9% were authored by an American national, 69.1% include a dataset, 43.2% provide vignettes, and 65.4% have been updated at least once. The sport with the highest representation is basketball (n = 14, 17.3%), followed by soccer (n = 12, 14.8%) and packages related to physical activity (n = 11, 13.6%). There are no sports packages directed solely for the female gender, while 59.3% of packages are focused on professional athletes. Fifty packages (61.7%) are related to the sports performance analysis category, and web scraping (n = 43, 53.1%) was the main functionality in the collected packages. The creation of new R packages in the area of sports could help solve questions and tasks that still remain a challenge in this field, while continuing to help to improve the level of statistical education and computational thinking skills.
Atezolizumab (programmed cell death-ligand 1 antibody)-induced inflammation of actinic keratosis: A case report
Authors: Spitz Kathleen E , Chu Lena , Swerlick Robert A
Published: November 2022

Atezolizumab is a programmed cell death-ligand 1 antibody that modulates the immune system response and has shown great promise in treating malignancies. Cutaneous toxicities from immune checkpoint inhibitors are the most commonly reported immune-related adverse events, although toxicities related to immunotherapy are still being characterized. Herein, we present a novel case of inflamed actinic keratoses in a patient after receiving atezolizumab therapy that resolved without requirement of dose adjustment or discontinuation of treatment.
Manual and Visual Clinical Assessment of Foot Type and Posture Correlate Poorly with Radiographic Assessment
Authors: Bayer Steve , LeVasseur Clarissa , Munsch Maria , Chen Stephen , Murawski Christopher D. , Murphy Conor I. , LaBaze Dukens , Gabrielli Alexandra , Kane Gillian , Anderst William , Hogan MaCalus V.
Published: November 2022

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

Accurate characterization of foot type can facilitate identification of patients at risk for different foot disorders and direct operative treatment. Foot type can be determined qualitatively with visual assessment and quantitatively using arch index (AI), calcaneal pitch (CP), Meary's angle (MA), and foot posture index (FPI). Agreement between various foot typing measures is unclear. The purpose of this study was to assess the agreement between different measurements of foot type. We hypothesized that quantitative measures would have better interrater reliability than qualitative measures, and that visual assessment of foot type would be strongly correlated with radiographic assessment.

Methods:

Bilateral foot photographs were acquired from 92 asymptomatic participants (50 men, 42 women, mean age of 43.3+- 18.6 years) to assess photographic arch type (PAT) and photographic foot posture (PFP). Hindfoot alignment and lateral radiographs were acquired of each foot to assess calcaneal pitch (CP), Meary's angle (MA), x-ray foot posture (XFP), and x-ray arch type (XAT). Photographs and radiographs were assessed by five reviewers in random order. Foot Posture Index (FPI) was determined through manual exam. Arch Index (AI) was measured on lightbox images. Interrater reliability was assessed using Intraclass Correlation Coefficient (ICC) for continuous variables and Kendall's W for categorical variables. Correlations between measures and sensitivity/specificity were assessed using calcaneal pitch as the reference standard with cavus feet >= 26 degrees and planus feet measuring <= 19 degrees.

Results:

Interrater reliability of XFP (W=0.522), XAT (W=0.676), PAT (W=0.831), PFP (W=0.612) ranged from strong to extremely strong. Interrater reliability of MA (ICC=0.711) and CP (ICC=0.804) were moderate and good. Correlations between foot arch measurements ranged from low to high (Table 1). Fair correlations were identified between foot posture measurements (r=0.356 to r=0.442). Overall, XAT had the greatest sensitivity and specificity for planus (0.68, 0.93) and normal feet (0.92, 0.62), and the greatest specificity for cavus feet (0.98). AI demonstrated the greatest sensitivity (0.47) for cavus feet. Compared to AI, photographs had superior sensitivity for identifying normal feet (0.73 vs. 0.43), the greatest sensitivity for identifying planus feet (0.54 vs. 0.06), and the greatest specificity for identifying cavus feet (0.95 vs. 0.71).

Conclusion:

Agreement between methods varied widely, suggesting that classification is dependent upon methodology and cutoff values selected. PAT had the highest interrater reliability, whereas correlation between XAT and PAT was moderate, suggesting that radiographs are needed to accurately assess the longitudinal arch.
Do the Number of Screws and the Use of a Lateral Fibular Autograft Influence the Union Rate in Ankle Arthrodesis? A Systematic Review
Authors: Bernasconi Alessio , Izzo Antonio , Vallefuoco Salvatore , Lintz Francois , Smeraglia Francesco , Mariconda Massimo
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Ankle arthrodesis, well-known as a reliable option to treat end-stage ankle osteoarthritis (AO), may be fixed using screws in various configurations. The purpose of this study was to determine whether the number of screws and the use of a lateral distal fibular autograft during the procedure might influence the union and complication rate. We hypothesized that a greater number of screws and the use of a fibular autograft might increase the union rate and reduce the number of complications.

Methods:

Following the PRISMA-compliant PROSPERO-registered checklist, the Medline, Scopus, Web of Science and Cochrane databases were searched, including studies reporting patients affected by AO and undergone Ankle Arthrodesis (AA) using screws as exclusive fixation method. Data were harvested regarding the cohort (sample size, age, sex, etiology), the study design (type of study, level of evidence), the surgical technique (open/arthroscopic procedure, the number of screws, the use of autograft) and the final outcome (union, complication and reoperation rate) at the longest follow-up. The risk of bias was assessed using the modified Coleman Methodology Score (mCMS) was used to assess the methodological quality of studies. Three groups were built based on the type of fixation: arthrodeses fixed with 2 screws (Group 1, G1), with 3 screws (Group 2, G2), and those augmented with a lateral fibular autograft (Group 3, G3).

Results:

Twenty series of patients from nineteen studies (732 ankles) were selected (G1=252 ankles, G2=209, G3=271). The pooled proportion estimate revealed a similar nonunion rate in the 2-screw group as compared to the 3-screw group (6% vs 1%; p=0.43) The pooled proportion of complications appeared higher in G1 (18%) than in G2 (8%) but it was not significantly different either (p=0.27). After exclusion of 'symptomatic hardware and screw removal' the difference was still not significant (p=0.62) although it resulted lower in G1 than in G2 (3% vs 8%, respectively). The pooled proportion of nonunions (p=0.48) and complications (p=0.76) did not differ between the AA performed without or with a fibular autograft.

Conclusion:

Fixation of Ankle Arthrodesis using three screws as compared to two screws seems to be advantageous in terms of reduced risk of nonunion and complications, although the difference did not achieve statistical significance in this study. The use of an adjuvant lateral distal fibular autograft does not seem to significantly increase the chances of fusion as compared to a no- autograft construct. The evidence provided so far is based on retrospective and short-term follow-up studies of moderate methodological quality. Further comparative and prospective analyses are warranted to define how to achieve the best outcome in Ankle Arthrodesis stabilized using screws.
Role of Syndesmotic Ligaments in Lateral Ankle Instability
Authors: Bhimani Rohan , Sato Go , Saengsin Jirawat , Lubberts Bart , Waryasz Gregory R. , DiGiovanni Christopher W. , Guss Daniel
Published: November 2022

Category:

Ankle; Sports; Trauma

Introduction/Purpose:

Despite the success of surgical intervention, about 13-35% of patients continue to have ankle symptoms after surgery for lateral ankle instability which could be due to presence of undetected and thus untreated injury to other ankle ligaments.Concomitant lateral ankle ligament and syndesmotic ligamentous injuries are common. It is unknown, however, whether syndesmotic ligaments directly contribute to lateral ankle stability. Therefore, the aim of this study was to fluoroscopically evaluate whether the syndesmotic ligaments contributes to lateral ankle stability.

Methods:

Twenty-four above-knee cadaveric specimens were divided into three groups that underwent fluoroscopic evaluation for lateral ankle stability. In all the groups, the assessment was first done with all syndesmotic and ankle ligaments intact. Thereafter, Group 1 underwent sequential transection of the lateral ankle ligaments: (1) anterior talofibular ligament (ATFL), (2)calcaneofibular ligament(CFL), and (3)posterior talofibular ligament (PTFL). Group 2 underwent sequential transection of the lateral ankle ligaments followed by the syndesmotic ligaments: (1) ATFL, (2) CFL, (3) PTFL, (4) anterior inferior tibiofibular ligament(AITFL), (5)interosseous ligament(IOL), and (6)posterior inferior tibiofibular ligament (PITFL). Group 3 alternating and sequential transection of the syndesmotic and lateral ankle ligaments: (1) AITFL, (2) ATFL, (3) CFL, (4) IOL, (5) PTFL, and (6) PITFL. In all scenarios, three loading conditions were considered:(1)An anterior drawer test at 50N and 80N of direct force, (2) talar tilt under 1.7Nm torque, and (2) lateral clear space (LCS) under 1.7Nm torque. Wilcoxon rank-sum test was used to compare the findings of each ligamentous transection state to the intact state.

Results:

The lateral ankle remained stable after transection of all syndesmotic ligaments (AITFL, IOL, PITFL). However, after additional transection of the ATFL, the lateral ankle became unstable in varus and anterior drawer testing conditions (p-values ranging from 0.036-0.012). Lateral ankle instability was also observed after transection of the ATFL and AITFL (p-values ranging from 0.036-0.012). Subsequent transection of the CFL worsened the lateral ankle instability.

Conclusion:

Our findings suggest that syndesmotic injuries can destabilize otherwise stable lateral ankle sprains. When treating lateral ankle instability, clinician should maintain a lower threshold for operative intervention for syndesmotic stabilization if there are any residual symptoms over the AITFL.
Quantitation and Patterns of Carbon Expenditure for 2019 AOFAS Annual Meeting Attendance
Authors: Bluman Eric M.
Published: November 2022

Category:

Other; Basic Sciences/Biologics

Introduction/Purpose:

Greenhouse gas production is the major driver of anthropogenic climate change (ACC). To counteract the current trends in ACC, climate experts recommend no more than 2 tonnes of CO2 be generated/person/year. Currently, the global average is 4 tonnes/person/year. Current approximate per capita national average for CO2 production in the U.S. is 20 tonnes/person/year. Airline travel is a major contributor to greenhouse gas production. Although many factors contribute to CO2 production by academic conference attendees, air travel is by far the greatest contributor. Prior to the COVID-19 pandemic the AOFAS annual meeting (AOFASAM) was held in-person without a virtual attendance option. We estimated and characterized the greenhouse gas production generated by attendance at the last all-in-person (2019) AOFASAM.

Methods:

We estimated departure airports for all registered participants attending the 2019 AOFASAM using a de-identified list of postal addresses. For each address, the nearest large airport (origin) was determined using a publicly available web-based locator. Using this origin, CO2 production for each round-trip flight to Chicago was determined using a publicly available web- based calculator. Total and average CO2 production for all registrants at the AOFASAM was calculated.

Results:

There were a total of 1271 registrants for the 2019 AOFASAM. Because of their proximity, 64 individuals were estimated to not have used air travel. A total of 1206.67 tonnes of CO2 was estimated to have been generated by round-trip flights for AOFASAM registrants. This averages to 0.95 tonnes CO2 generated per AOFASAM registrant (range 0.06 to 6.3 tonnes). No registrant with a U.S. address was estimated to have generated more than 1.04 tonnes of CO2. Individually, international registrants generated between 0.35 and 6.3 tonnes of CO2. A majority (58%) of registrants were estimated to have generated >1 tonne of CO2 (n=321 [25%], 1-2 tonnes; n=295 [23%], 2-3 tonnes and n=122 [10%], >3 tonnes).

Conclusion:

Travel to the AOFASAM results in substantial CO2 production. One-third of attendees exceeded the WHO recommended annual CO2 production/person/year by attending the meeting; another 25% generated 50-100% of this limit. To meet WHO guidelines for CO2/person/year production, and set a good example for the rest of society, we need to consider alternatives to in-person meetings or pay for offsets to do our part in curbing ACC. Reducing in-person conference attendance has potential negative social and networking consequences to be overcome. Interactions with industry partners will also need to adapt. Further development of virtual reality may help mitigate these consequences.
Analysis of a Single Centre's Protocol of the Treatment of 5th Metatarsal Fractures. What Patients Need a Face-To-Face Fracture Clinic Review?
Authors: Chapman James , Choudhary Zain A. , Gupta Shubhi , Davies Thomas , Airey Grace L. , Mason Lyndon W.
Published: November 2022

Category:

Midfoot/Forefoot; Trauma

Introduction/Purpose:

5th metatarsal fractures are a common injury attending foot and ankle clinics in the UK. Within our department, we established a protocol to reduce the burden on fracture clinic of 5th metatarsal fractures by limiting face-to-face consultations to Zone 2 and 3. We sought to investigate whether our practice was consistent and the ultimate patient destination.

Methods:

Patients were identified from our database. We included all 5th metatarsal fractures referred to our virtual fracture clinic with a confirmed 5th metatarsal fracture. Data was collected on virtual fracture clinic (VFC) outcomes including telephone review, clinic reviews and requirement of surgery. Plain AP radiographs were reviewed for fracture morphology. Fractures were defined as Zone 1.1, 1.2, 1.3, 2, 3, diaphyseal shaft (DS), distal metaphysis (DM) and head. A binary linear regression analysis model was used. All data was analysed using IBM SPSS v.27.

Results:

1360 patients met the inclusion criteria (mean age of 48.1; range 16-95, sd=19.1). 430 (31.6%) were planned for face-to- face review, however following telephone review, 542 (39.9%) were sent appointments (p<.001 McNemar). On univariate analysis, only fractures in Zone 1.1 were associated with a plan to discharge from VFC (OR 2.851, p<.001), with Zone 3 fractures associated with a plan for face-face review (p<.001). Following telephone review, Zone 2 (OR 1.387, p=.034) and Zone 3 (OR 3.285, p<.001) fractures were the only fractures significantly associated attending a face-to-face clinic appointment, with Zones 1.1 (OR 0.573, p=.008) and 1.2 (OR 0.642, p=.033) negatively associated. Zone 3 fractures were the only fractures that retained significance for attending >1 appointment (OR 4.639, p>.001) and requiring surgery (OR 3.895, p=.037). Only 15 patients (1.1%) required surgery, with 9 being for non-union and 5 being acute operations in younger patients (median age = 34 vs 51).

Conclusion:

There was a significant increase in patients requiring face-face review after telephone conversation. In addition to Zone 3 injuries and Zone 2 injuries had also required face-face reviews following telephone consultation. Based on these results, all Zone 2 and 3 fractures should be considered for at least one face-to-face fracture clinic review. Operative management is rare and usually secondary to non-union.
Biomechanical Properties of Splint Materials Immediately Following Dipping
Authors: Cornelius Canon C. , Daniels Joseph , Garcia Hugo C. , Warner Stephen J.
Published: November 2022

Category:

Basic Sciences/Biologics; Trauma

Introduction/Purpose:

Many studies have evaluated splint strength at maturity with multiple splint materials, methods, and configurations. No study to date has tested them while they were curing. This is an important for both emergency room management and post-operative splints.

Methods:

Model splints of plaster, ten layers thick, and a standard prefabricated fiberglass splint were made of the same size, 125 total splints were made. They were dipped in two temperatures of water, room temperature (70oF) and warm temperature (100oF), an additional group of fiberglass with no water was tested as well. Then they were weighed to assure no outliers. A three-point bend was chosen at a constant displacement of 0.5 mm/s on an Instron 5848 machine. The splints underwent this test at three minutes, six minutes, nine minutes, twelve minutes and three days.

Results:

Two generalized linear models (GLM) were performed with the data. One model included all time periods, and one included just the short time periods of three, six, nine, and twelve minutes. The GLM including all time frames allow for T-tests to be perform that showed significant differences in yield load and ultimate loads after three minutes between fiberglass and plaster. Plaster had a lower displacement at its yield load after 3 minutes and a higher stiffness at 1o of angulation at all time points after six minutes. The GLM that excluded the three-day time point showed that temperature increased initial stiffness in the splints as three and six minutes. A Chi squared analysis was performed between mature versus not mature stress strain curves that showed plaster to achieve it's 'mature' curve faster.

Conclusion:

Fiberglass is stronger and faster than plaster regarding ultimate load and yield load, however those loads happened at significant angular deformity. In situations where the surgeon desires the strongest splint, fiberglass may be preferable. However, the initial stiffness of plaster is better than fiberglass. This combined with the less displacement at yield point would make plaster the choice when the surgeon would like to limit micromotion or hold an exact mold with a splint.
Outcomes of Surgical Treatment for Symptomatic Superficial Peroneal Neuromas
Authors: Cychosz Chris , Phisitkul Phinit , Glass Natalie , Buckwalter Joseph A. , Femino John E.
Published: November 2022

Category:

Ankle; Midfoot/Forefoot; Trauma; Other

Introduction/Purpose:

Peripheral nerve injury or entrapment is a common complication following surgery in the foot and ankle region. The superficial peroneal nerve is particularly at risk following ankle arthroscopy and lateral approaches to the ankle or fibula. Symptoms can result in intense pain and significant disability for patients. The purpose of this study is to investigate the outcomes of superficial peroneal nerve neurolysis and neurectomy.

Methods:

All patients were identified who underwent operative treatment by two foot and ankle specialists for superficial peroneal nerve related pain. Exclusion criteria included patients under the age of 18, prisoners, those who underwent concomitant osseous procedures, and less than 6-week follow-up. Demographic data, baseline outcomes including FFI, SF-36, FAAM, and VAS were recorded. Final follow-up questionnaires using PROMIS measures and FAAM were administered using REDCap.

Results:

55 patients were included in this study with a mean age of 43.0 years (IQR, 33.0-48.0). At a median follow-upof 6.8 months (IQR 1.2-20.2 months), VAS improved from a median of 9.0 (IQR 6.0-9.0) preoperatively to 2.0 (IQR 0.00-5.0) after surgery, p < 0.05. Patients reported a median VAS improvement of 4.0 (IQR 2.0-7.0). At final follow-up patients reported PROMIS lower extremity function score median of 58.6 (IQR 45.2-58.6), PROMIS neuropathic pain quality score of 42.9 (IQR 37.2-55.5), and PROMIS pain interference of 50.5 (IQR 41.1-57.0). Worker's compensation claims were independently associated with significantly poorer post-operative function measured using FAAM ADL (58.58 WC vs 74.86 non-WC, p<0.02) and higher post- operative VAS scores (4.46 WC vs 2.36 non-WC, p<0.01). ). Patients with current or recent tobacco use within 3 months leading up to surgery reported significantly higher post-operative VAS pain scores compared to nonsmokers (4.54 vs 2.47, p<0.02).

Conclusion:

Neurectomy or neurolysis has potential to significantly improve somatic pain for entrapment or neuroma formation of the superficial peroneal nerve. Tobacco use as well as worker's compensation claims were associated with significantly poorer outcomes. Further studies are needed to optimize perioperative management and surgical techniques for these patients.