bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proximal and Distal Failure Site Analysis in Percutaneous Achilles Tendon Rupture Repair
Authors: Wagner Pablo , Wagner Emilio , Lopez Mario , Etchevers Gaston , Valencia Oscar , Guzman-Venegas Rodrigo 
Published: October 2019

Category: Ankle Introduction/Purpose: Different techniques have been described for Achilles Tendon Rupture repair, but no biomechanical evaluation have been performed separately for proximal and distal suturing techniques.The purpose of this study was to biomechanically analyze 3 proximal and 2 distal suture configurations during a simulated cyclic load and load to failure. It was hypothesized that proximal suturing technique was stronger than the distal one and that the modified double suturing technique was the strongest of all techniques. Methods: A simulated, mid-substance rupture was created 6 cm proximal to the calcaneal insertion in 15 fresh-frozen cadaveric Achilles tendons, obtaining 15 proximal and 12 distal samples. Specimens were tested independently and randomly allocated to different suture techniques: proximal fixation site groups: (A1) classic Dresden technique, (A2) modified Dresden, (A3) double modified Dresden; distal fixation groups: (B1) classic distal suture and (B2) modified distal suture. Repairs were subjected to a cyclic testing (1000 cycles of 50-200 N) and load to failure. Load to failure, cause of failure and tendon elongation was evaluated. Fischer’s test was used as statistical analysis. Results: None of the proximal tendon and 7/12 of the distal samples failed in cyclic testing. The proximal fixation groups demonstrated significantly more strength than the distal groups (p< 0.05) with average failure loads of 598 N, 587 N and 710 N for groups A1, A2 and A3 respectively (A3 stronger than A1 and A2, p=0,035). Groups B1 and B2 failed on average at 416 N and 351 N respectively, p=0.24. The majority of all repairs failed in the suture- tendon interphase.Regarding elongation, no significant differences were found between groups (p=0.57). Conclusion: The distal fixation site in the Dresden percutaneous Achilles tendon repair is weaker than the proximal fixation site. A proximal modified suture configuration increased resistance to cyclic loading and load to failure significantly. A modification in the proximal and distal fixation sites can be suggested to improve repair strength and hopefully achieve a better outcome.
Brostrom-Like Procedure Augmented with Swivelock Internal Brace for the Reconstruction of Chronic Medial Ankle Ligament Complex
Authors: Wang Bibo , Xiangyang Xu 
Published: October 2019

Category: Midfoot/Forefoot Introduction/Purpose: The medial ligaments and joint capsules appear to stretch or rupture under the increasing stress following a tear of the PTT in patients with flat foot often leading to pain, swelling and dysfunctional foot. This study assesses the efficacy of a Brostrom like procedure augmented with Swivelock Internal Brace for the reconstruction of chronic medial ankle ligament complex. Methods: A retrospective study was performed reviewing 15 flat foot patients who presented with pronounced hindfoot pronation collapse of the medial longitudinal arch after injury. The procedures included exploration and direct repair of PTT, deltoid ligament and spring ligament. Our modification included Swivelock Internal Brace enhanced reconstruction of deltoid and spring ligaments, after calcaneal medializing osteotomy. Other additional procedures such as FDL transfer, subtalar arthroereisis and Cotton osteotomy were performed as needed (Fig.1). Weight bearing X-rays of the foot, AOFAS-AH and SF36 scoring were taken before and after surgery. Results: There were 8 males and 7 females among the 15 patients. The age was 29.8±10.1 years old. The follow-up time period was 32.6±11.4 months. Both the AOFAS-AH (52.8±15.2 to 90.4±7.5 and SF-36 (55.4±12.6 to 91.2±6.3 scores improved significantly (p<0.001). Comparing preoperative to postoperative standing radiographs, there was significant improvement in the AP talar first metatarsal angle (25.6±18.4 to 9.5±7.8 degrees（P<0.001), lateral talar first metatarsal angle (18.3±8.4 to +2.6±4.5 degrees（P<0.001）and moment arm on the Saltzman view (+15.2mm±10.8 to +2.5±3.6mm（P=0.003） (Fig.2). No recurrence of pronation deformity or foot arch collapse was observed after surgery. Conclusion: The medial ankle ligaments were attenuated and under the increasing stress following a tear of the PTT in patients of flat foot. Direct repair of the ligaments after rupture usually resulted in low strength and high recurrence. Simultaneous reconstruction of medial ankle ligaments with Swivelock internal brace maintained long term medial ankle stability and the longitudinal arch. This technique protects the repaired tendon and decreased the need for FDL transfer, potentially permitted earlier rehabilitation and improved function compared to traditional techniques.
Evaluation of the Anterior Talofibular Ligament Using MRI after Arthroscopic Lateral Ankle Ligament Repair
Authors: Yoshimura Ichiro , Kanazawa Kazuki , Minokawa So , Yamamoto Takuaki , Hagio Tomonobu 
Published: October 2019

Category: Ankle, Arthroscopy Introduction/Purpose: Ankle sprain commonly occurs in sports activities and most patients are successfully managed with conservative treatment. An incidence of 10–30% of patients will fail conservative treatment and result in chronic lateral ankle instability (CLAI) that may require surgical treatment. Recently, several systematic reviews reported that arthroscopic lateral ankle ligament repair for CLAI are provided good clinical results. However, the pathologic condition of the lateral ankle ligament after anatomical repair has not been clarified. Previous investigations have reported that ligament signal intensity using MRI has a strong negative linear relationship with material biomechanical strength properties. The purpose of this study was to report the clinical outcome and evaluation of the anterior talofibular ligament (ATFL) using MRI after arthroscopic lateral ankle ligament repair. Methods: We retrospectively reviewed 40 patients (40 ankles) who underwent arthroscopic lateral ankle ligament repair for CLAI. The average age at the time of surgery was 28 years (range 12–66 years). The average follow-up was 13 months (range 12– 18 months). Clinical outcomes were assessed preoperatively and 12 months postoperatively using Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale and Self-Administered Foot Evaluation Questionnaire (SAFE-Q). The ATFL was evaluated using 3.0-T MRI at the preoperatively, six months postoperatively and 12 months postoperatively. The ATFL characteristics classified into the following categories: nonvisualization of the ligament, discontinuity, a wavy or curved contour, or high signal intensity within the ligament. Results: The mean JSSF score increased from 72 preoperatively to 95 at 12 months postoperatively. The preoperative MRI findings of the ATFL were categorized as discontinuity (11 ankles), a wavy or curved contour (14 ankles), or high signal intensity within the ligament (22 ankles). The all ATFL findings at the six months postoperatively had straight band extending from the talus to the fibular malleolus, and nine of 40 ankles had high signal intensity within the ligament. The ATFL findings at the 12 months postoperatively revealed residual high signal intensity within the ligament in six of nine ankles. A comparison of the postoperative ATFL with high signal intensity and with low signal intensity group, there were no significant difference in postoperative clinical outcomes between the groups. Conclusion: This study demonstrated that arthroscopic lateral ankle ligament repair was an effective procedure for the treatment of CLAI and restored the condition of ATFL.
A Comparison of Fusion Rates and Risk Factors in a Cohort of 2301 Foot and Ankle Fusions Comparing the Use of No Graft and Graft
Authors: Younger Alastair S.E. , Penner Murray J. , Veljkovic Andrea , Wing Kevin 
Published: October 2019

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Bone graft and bone graft substitutes may affect fusion rates and have been advocated to reduce the risk of nonunion particularly in patients with risk factors for failure of fusion. However historically they have not been used in all patients but tend to be used in patients at risk for nonunion. This paper analyses the union rates of patients with and without graft for a large retrospective cohort in which no graft, autograft and bone graft substitute, and summarizes the risk factors for nonunion. Methods: 2301 fusions performed in 1320 patients were reviewed with a minimum of 2 years follow up to determine the risk of repeat surgery for nonunion. The records were reviewed to determine which patients underwent revision surgery of the primary site for nonunion. Demographic factors and risk factors for nonunion were recorded. The nonunion rate for each joint (ankle, subtalar, talonavicular, calcaneocuboid, navicular cuneiform and tarsometatarsal joints) was determined. The mean age of the patients was 56, BMI 27.83, 32% were male, diabetes was present in 8.9%, smoking present in 10.9%, rheumatoid arthritis present in 10%. No graft was used in 1249 fusions, Autograft in 644, PDGF with TCP (regular) in 113, and PDGF injectable (TCP and collagen) formula in 110. Combinations were used in 159 patients. Odds ratios were used with 95% confidence intervals and p values. Results: No graft was used in 1249 fusions with 34 revisions for nonunion (2.7%) and graft was used in 1052 patients with 59 non unions (5.6%). The odds ratio for nonunion with graft was 2.2x, and was not significant. The odds ratio for PDGF with TCP for nonunion was higher than the PDGF injection, at 5 x versus 1 x. However the difference was not significant. The demographics of patients receiving graft were different than those not receiving graft, and were more likely to be older, male, have a higher BMI, be smokers and have diabetes. The appended figure shows the odds ratios for risk factors for receiving graft. Conclusion: Bone graft substitute and bone grafts result in a similar union rate for patients undergoing foot and ankle fusions. However patients receiving graft have higher risk factors for nonunion compared to those not receiving graft. This paper demonstrates that the concept of using graft for at risk patients is merited, with similar fusion rates being achieved. Larger patient numbers would be required to reach statistical conclusions.
Rates of Nonunion for Different Joints after Foot And Ankle Surgery: A Review of 2301 Fusions
Authors: Younger Alastair S.E. , Veljkovic Andrea , Wing Kevin , Penner Murray J. , Qian Hong , Wong Hubert 
Published: October 2019

Category: Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot Introduction/Purpose: Nonunion after fusion results in ongoing pain and a request for repeat surgery in many patients. Nonunion is therefore a failure of the primary surgery. Patients undergoing fusion surgery need to understand the risk for nonunion and the risk for repeat surgery. This is a review of fusions performed at a single institution by 4 foot and ankle surgeons to outline the nonunion rate after foot and ankle fusion for different joints. Methods: Data on fusions performed between January 1, 2010 to July 31, 2006 were retrospectively extracted from database. The records were reviewed to determine the union status of each fusion. Demographic and clinic risk factors of nonunion were recorded. The nonunion rate for each joint (ankle, subtalar, talonavicular, calcaneocuboid, navicular cuneiform, tarsometatarsal and metatssophalengeal joints) was estimated. Due to multiple surgeries performed on individual patient and fusions in the same surgery, random effects logistic regression models were conducted to assess the impact of risk factor on nonunion. The study include 2301 fusions preformed on 1320 patients. The minimum follow up was two years. The majority of patients were female (70%), with mean age of 57 years old and mean body mass index (BMI) of 28. There were 9% of patients with diabetes, 11% being smokers, 18% having lung disease, 8% with renal disease, and 29% with high blood pressure. Results: The risk of nonunion by joint is outlined in figure 1. The ankle showed the highest nonunion rate at 8%, and the calcaneocuboid joint had the lowest rate at 2%. Comparing to ankle, the nonunion rate was significantly lower at Talocalcaneal (Subtalar) joint (Odd ratio [OR]=0.05, p-value= 0.02) and Tarsometatarsal (OR=0.03, p-value=0.01). Across all joints the nonunion rate was higher in males, smokers, having a higher BMI and diabetes Age had a minimal effect. Conclusion: Union rate varied among fusion sites. Patient’s demographic and clinic characteristics might be potential risk factors for nonunion. This paper assists surgeons in determining the risk factors for nonunion after foot and ankle fusions. The ankle joint is at highest risk for nonunion, and the tarsometatarsal joint and the subtalar joints the lowest risk.
Results of a Prospective Randomized Study Following Osteosynthesis Using 1/3 Tubular Plate in AO Technique vs Osteosynthesis Using Polyaxial Locking Plates in Distal Fibula Fracture
Authors: Zyskowski Michael , Pesch Sebastian , Greve Frederik , Matthey Francesca von , Wurm Markus , Kirchhoff Chlodwig 
Published: October 2019

Category: Ankle, Trauma Introduction/Purpose: In modern economies health care comprising treatment and disability after trauma is a financial burden. In this context techniques of ORIF that allow for early full weight bearing might not only improve the clinical outcome but also shorten the period of working disability. The aim of the study is to analyze whether ORIF of ankle fractures using a new polyaxial locking or a standard tubular plate allow for a better outcome and reduction of complications. Methods: In this prospective study, all patients with a distal fibula fracture (AO 44 B1.1, B1.2, B1.3), who met the criteria for surgical treatment were included. Patients were randomized to either the group A (tubular plate, Depuy Synthes) or group B (polyaxial locking plate, NEWCLIP TECHNICS, Active Ankle®). First outcome parameter was functionality of the ankle joint, assessed by the Olerud and FAOS score. Secondary outcome parameter were postoperative complications. These were divided into minor complications: Superficial wound infection, delayed wound healing, mechanically prominent implant, skin irritations and major complications requiring surgical revision: Deep wound infection, material loosening, loss of reduction. Clinical and radiological controls were performed 6 weeks, 12 weeks, 6 months and 1 year postoperatively. Results: 52 patients (31W/21 M) with an age of 43y (range 22-64) have been included. 7 Patients (13.5%) dropped out. 45 patients were available for follow up. 20 patients were treated with polyaxial locking plates (44.4%), 25 patients by 1/3 tubular plate in AO technique (55.6%). Two minor complications (16%) occurred in the Active Ankle® group, four minor complications (16%) in the AO arm. At the first two control stages after six and 12 weeks a significant distinctions in the Olerud and FAOS score could be obtained in between the two study arms. Mean Olerud score after 6 weeks AA 56,05/AO 45,22 p=0,02, after 12 weeks AA 69,47/AO 59,79 p=0,04. Mean FAOS in week 6 AA 66,7/AO 56,08 p=0,02, in week 12 AA 75,1/AO 66,12 p=0,03. Conclusion: Our results are quite positive. We could demonstrate that a significant better clinical function during the early postoperative stages, after 6 weeks and 12 weeks, presented in the group treated with polyaxial locking plates. Further we proved that ORIF with polyaxial locking plates is a safe and stabile osteosyntheses and could promote an early weight bearing postoperative regime. That has the consequence that we could shorten the absence from work, the patient’s mobility can be restored faster and the costs for the health care system decrease significantly.
Targeting cyclooxygenase by indomethacin decelerates progression of acute lymphoblastic leukemia in a xenograft model
Authors: Richartz Nina , Duthil Eva , Ford Anthony , Naderi Elin Hallan , Bhagwat Sampada , Gilljam Karin M. , Burman Marta Maria , Ruud Ellen , Blomhoff Heidi Kiil , Skah Seham 
Published: October 2019

Key Points
The COX inhibitor indomethacin delays progression of ALL in a human xenograft mouse model. The xenograft-derived ALL cells treated with indomethacin express elevated levels of p53.
Second primary malignancies in ruxolitinib-treated myelofibrosis: real-world evidence from 219 consecutive patients
Authors: Maffioli Margherita , Giorgino Toni , Mora Barbara , Iurlo Alessandra , Elli Elena , Finazzi Maria Chiara , Caramella Marianna , Rumi Elisa , Carraro Maria Cristina , Polverelli Nicola , D’Adda Mariella , Malato Simona , Rossi Marianna , Molteni Alfredo , Vismara Alessandro , Sissa Cinzia , Spina Francesco , Anghilieri Michela , Cattaneo Daniele , Renso Rossella , Bellini Marta , Pioltelli Maria Luisa , Cavalloni Chiara , Barraco Daniela , Accetta Raffaella , Bertù Lorenza , Della Porta Matteo Giovanni , Passamonti Francesco 
Published: October 2019

Key PointsWe present real-world data on all ruxolitinib-treated myelofibrosis patients in a 10-million-resident region, with a follow-up of 2 years. We found no evidence of an increased risk of developing lymphomas.
Plasma-Enhanced Chemical Vapor Deposition of Acetylene on Codeposited Bimetal Catalysts Increasing Graphene Sheet Continuity Under Low-Temperature Growth Conditions
Authors: Tracy Joshua , Zietz Otto , Olson Samuel , Jiao Jun 
Published: October 2019

Abstract
Here, we report a novel method for low-temperature synthesis of monolayer graphene at 450 °C on a polycrystalline bimetal Ni-Au catalyst. In this study, low-temperature chemical vapor deposition synthesis of graphene was performed at 450 °C on codeposited Ni-Au which shows successful monolayer graphene formation without an extra annealing process. The experimental results suggest that electron beam codeposition of bimetal catalyst is the key procedure that enables the elimination of the pre-growth high-temperature annealing of the catalyst prior to graphene synthesis, an indispensable process, used in previous reports. The formation was further improved by plasma-assisted growth in which the inductively coupled plasma ionizes the carbon precursors that interact with codeposited Ni-Au catalyst of 50 nm in thickness at 450 °C. These combined growth conditions drastically increase the graphene’s sheet uniformity and area connectivity from 11.6% to 99%. These fabrication parameters enable the graphene formation that shifts from a bulk diffusion-based growth model towards a surface based reaction. The technique reported here opens the opportunity for the low-temperature growth of graphene for potential use in future CMOS applications.
Domainoid: domain-oriented orthology inference
Authors: Persson Emma , Kaduk Mateusz , Forslund Sofia K. , Sonnhammer Erik L. L. 
Published: October 2019

AbstractBackgroundOrthology inference is normally based on full-length protein sequences. However, most proteins contain independently folding and recurring regions, domains. The domain architecture of a protein is vital for its function, and recombination events mean individual domains can have different evolutionary histories. It has previously been shown that orthologous proteins may differ in domain architecture, creating challenges for orthology inference methods operating on full-length sequences. We have developed Domainoid, a new tool aiming to overcome these challenges faced by full-length orthology methods by inferring orthology on the domain level. It employs the InParanoid algorithm on single domains separately, to infer groups of orthologous domains.ResultsThis domain-oriented approach allows detection of discordant domain orthologs, cases where different domains on the same protein have different evolutionary histories. In addition to domain level analysis, protein level orthology based on the fraction of domains that are orthologous can be inferred. Domainoid orthology assignments were compared to those yielded by the conventional full-length approach InParanoid, and were validated in a standard benchmark.ConclusionsOur results show that domain-based orthology inference can reveal many orthologous relationships that are not found by full-length sequence approaches.Availabilityhttps://bitbucket.org/sonnhammergroup/domainoid/
Adverse events associated with continuous interscalene block administered using the catheter-over-needle method: a retrospective analysis
Authors: Tanijima Meishu , Takechi Kenichi , Nakanishi Kazuo , Yorozuya Toshihiro 
Published: October 2019

Abstract

Background
Continuous interscalene block is widely used for pain management in shoulder surgery. However, continuous interscalene block performed using the catheter-through-needle method is reportedly associated with adverse events such as pericatheter leakage of the local anesthetic, phrenic nerve paralysis, and hoarseness. Because we expected that the catheter-over-needle method would reduce these adverse events, we examined cases in which continuous interscalene block was performed using the catheter-over-needle method to determine what adverse events occurred and when.

Methods
We retrospectively reviewed the anesthesia and medical records of adult patients who underwent catheter insertion to receive a continuous interscalene block performed using the catheter-over-needle method at our hospital from July 2015 to July 2017.

Results
During the surveillance period, 122 adult patients underwent catheter insertion to receive a continuous interscalene block administered using the catheter-over-needle method. No case of pericatheter local anesthetic leakage was observed. Adverse events, such as dyspnea, hoarseness, insufficient anesthetic effect, dizziness, cough reflex during drinking, or ptosis, were observed in 42 patients (34.4%; 95% confidence interval 26–42.7). Most of the adverse events occurred on postoperative day 2. The median time between surgery and the onset of adverse events was 28.5 h.

Conclusions
The catheter-over-needle method may prevent the pericatheter leakage of the local anesthetic. However, adverse events occurred in more than one-third of the patients. During continuous interscalene block, patients must be carefully observed for adverse events, especially on postoperative day 2.

Trial registration
This study was registered at the UMIN Clinical Trials Registry on August 13th, 2019 (UMIN000037673).