bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcome Following Lower Extremity Nerve Block during Foot and Ankle Surgery: A Systematic Review
Authors: Gianakos Arianna L. , Romanelli Filippo , Badri Malaka , Rao Naina , Lubberts Bart , Guss Daniel , DiGiovanni Christopher W. 
Published: November 2020

Category: Ankle; Other Introduction/Purpose: The purpose of this study was to perform a systematic review of the current literature assessing the management of pain with various block techniques in the perioperative period during elective foot and ankle surgery. Methods: A review of the literature was performed according to the PRISMA guidelines. Medline, Embase, and Cochrane databases were searched on October 1, 2019. Studies were identified by using synonyms for ‘foot’, ‘ankle’, ‘pain management’, ‘opioid’ and ‘nerve block’. Inclusion criteria were studies that 1) reported and compared the outcomes following various types of peripheral nerve blocks in in foot and ankle surgery, 2) were published in the English language, and 3) were published within the last 10 years. Results: Twenty-four articles evaluating 4,640 patients were included. Sixty-seven percent were randomized controlled trials, 17% were prospective comparison studies, and 17% were retrospective comparison studies. Nerve block techniques included: femoral, adductor canal, sciatic, popliteal, saphenous, and ankle. Ropivacaine and bupivacaine were most commonly utilized. Postoperative opioid consumption and postoperative pain levels were reduced with use of PNB when compared with systemic/local anesthesia, in patients receiving combined popliteal/femoral block, and in patients receiving continuous infusion popliteal block [Table 1, Table 2]. Studies demonstrated higher satisfaction with PNB, continuous infusion, and dual injections [Table 3]. One study reported 7% neurologic related complication risk and demonstrated a higher complication rate when with popliteal versus ankle block. All other studies were equivocal or failed to mention complications. Conclusion: Optimal pain management for elective foot and ankle surgery remains controversial and an ideal protocol from a risk-benefit perspective regarding use of PNB has yet to be established. Our study demonstrates improvements in postoperative pain levels, opioid consumption, and length of stay in patients receiving a PNB when compared with systemic anesthesia. Combined PNB and dual catheter administration may improve outcomes. Unfortunately, little data has been published on risks and tradeoffs in order to help guide patients and surgeons with a well informed shared decision making model. Future studies are needed to better clarify any respective tradeoffs to these options. [Table: see text]
Percutaneous and Minimally Invasive Surgical Technique for Achilles Tendon Repair
Authors: Hoskins Tyler , Goyette David , Patel Jay , Mazzei Christopher , Gianakos Arianna L. , Koss Justin , Wittig James , Epstein David M. 
Published: November 2020

Category: Ankle; Sports; Trauma Introduction/Purpose: Achilles tendon rupture is a traumatic injury that can cause considerable morbidity and reduced function. The optimal treatment method for this injury remains controversial. Non-operative intervention puts patients at higher risk of re-rupture whereas surgical intervention has risks of infection and iatrogenic nerve injury. Recently, surgeons have established a less invasive surgical approach to repairing the achilles tendon. The ‘Percutaneous or Mini-Invasive’ technique was adopted in order to reduce infection rates and wound breakdown. However, due to the scarce amount of literature reported, the efficacy of this procedure still remains under scrutiny. The goal of this study was to examine the functional outcomes of patients treated at our facility for a ruptured achilles tendon using the percutaneous and minimally invasive surgical technique. Methods: From 2014 to 2020 eighty-one patients underwent a percutaneous or mini invasive surgery at our facility for the treatment of a ruptured achilles tendon. Functional outcome scores were assessed using the American Orthopaedic Foot & Ankle scoring system (AOFAS) and the Achilles Tendon Rupture Score (ATRS). Outcomes, complications, and any reoperations were recorded through retrospective chart review, direct patient examination, and phone calls to patients and their families. A statistical analysis was performed using Fischer’s Exact Test. Results were deemed statistically significant if the calculated p-value was less than 0.05. Results: The mean follow up for our patient cohort was 36.40 months (range, 6 to 71). The average age was 41.46 years (range, 17- 65). Mean pre-op AOFAS and ATRS were 45.60 and 47.18 respectively, compared to 90.29 and 87.97 after surgery (p-value <0.05). There were two significant complications reported post-operatively. One patient re-ruptured their Achilles tendon four months post-operatively. This patient was successfully treated with a mini invasive approach and reconstruction of the tendon. A second patient developed a superficial infection ten months post-operatively. This patient successfully underwent irrigation and debridement of the wound. Conclusion: The pre-op and post-op AOFAS and ATRS scores were deemed statistically significant. A percutaneous and mini invasive approach to repair a ruptured achilles tendon, although new, offers promising functional outcome results and remains a viable treatment option to decrease the incidence rate of post-operative infection and iatrogenic nerve injury. However, a prospective randomized controlled trial comparing the efficacy of this procedure to other surgical methods would be necessary to further evaluate and validate our findings.
Major Mistakes in Current Scientific Presentations
Authors: Manoli Arthur 
Published: November 2020

Category: Other Introduction/Purpose: The purpose of this presentation is to demonstrate to the orthopaedic surgeon many of the disturbing, current trends often seen in today’s oral paper presentations. Many of these are superfluous, confusing, offensive, not pertinent, difficult to interpret or unnecessary. These mistakes are often copied from other poor presentations, inhibiting adult learning in the audiences. Methods: Observing large numbers of presentations at many local, regional and national meetings has led the authors to notice many disturbing trends that have insidiously crept into many of the paper presentations in recent years. Difficult to read fonts, low contrast slides, poor backgrounds, superfluous ornamentation, excessive wordiness, poor graphs, full sentences (actually read aloud!) in large numbers of bullet points, distracting animation, showing every detail or every case, family and pet photos, and unreadable bibliographies flashed quickly at the end have all been seen. Common clichés, such as ‘I realize this is a busy slide…‘ is commonly used, prefacing a table with multiple columns and rows and unreadable numbers, often with standard deviations! Even though it is unreadable, the presenter shows it anyway! Results: Many of the disturbing trends that have been seen add nothing to the presentations, and, in fact, are distracting, taking away from the basic messages of the paper. While the presenter may think these items are important to add and necessary for completeness, they severely distract from the presentation’s effectiveness. Many of them make the audience give up and ‘tune out.’ Effective learning is minimal. As a result, audiences have become less connected and increasingly disinterested. Simplicity clarity are important to one’s message. Conclusion: Efficient, clear, non-distracting presentations are essential for adult learning. Currently, information overload and poor design threaten to obfuscate scientific sessions. The illustrated items should be eliminated and not copied from paper to paper.
Early Functional and Patient Reported Outcomes following Suture Tape Augmented Brostrom
Authors: Martin Kevin D. , Huh Jeannie , Robinson William , Martin Kevin D. 
Published: November 2020

Category: Ankle Introduction/Purpose: Immediately following a lateral ligament reconstruction the strength of the repair is far less than the native anterior talofibular ligament (ATFL). With early functional rehabilitation the repair has shown increased laxity. We hypothesized that a Brostrom augmented with a suture-tape construct would allow early functional rehabilitation while maintaining patient reported outcomes within a military population. Methods: This study is a retrospective cohort of 90 consecutive patients with chronic lateral ankle instability were treated with a Brostrom procedure augmented with a suture-tape construct. All had a preoperative MRI demonstrating ligament insufficiency, and was examined by an orthopaedic foot and ankle surgeon. Subjects were evaluated at 2, 6 and 12 weeks postoperatively. Demographics including Foot and Ankle Disability Index (FADI), Visual Analog Scale (VAS), and clinical measures including single- leg hop and single-leg heel raise were recorded. The population included (14 women [18%], 76 men [84%] mean age of 29.47, BMI 27.3) active duty service members. Results: The mean FADI score pre-operatively (67) improved to 86 and 89 at 6 and 12 weeks. The VAS scores pre-operatively (4.8) improved to 1.4 and 1.3 at 6 and 12 weeks respectively. 95.5% (86/90) of patients were able to complete a single-leg hop and single-leg heel raise at 6 and 12 weeks. Conclusion: Our results suggest that a Brostrom augmented with suture-tape can allow for early functional rehabilitation in an active duty Military population.
Radiographic Outcomes in the Treatment of Type II Adult Acquired Flatfoot Deformity Following Lateral Column Lengthening with a Titanium Wedge versus Autograft or Allograft
Authors: O’Connor Casey M. , Anoushiravani Afshin , Richardson Kyle , Anderson Matthew , Rosenbaum Andrew J. 
Published: November 2020

Category: Midfoot/Forefoot Introduction/Purpose: Lateral column lengthening (LCL) is a surgical procedure used to manage forefoot abduction occurring in patients with stage IIB Adult Acquired Flat Foot Deformity (AAFD). This procedure utilizes an opening wedge osteotomy of the calcaneus which is then filled with autograft, allograft, or a titanium wedge. The primary aim of this study was to compare the radiographic outcomes of these different bone substitutes in the setting of stage IIB AAFD with the use of LCL. Methods: All patients who underwent LCL from October 2008 until October 2018 were retrospectively reviewed. Preoperative weight bearing radiographs, initial postoperative radiographs and 1-year weight bearing radiographs were reviewed. The following radiographic measurements were recorded: talonavicular uncoverage angle, incongruency angle, and calcaneal pitch. Results: A total of 44 patients were included in our study. The mean age of the cohort was 54 (range 18-74). The study cohort was divided into two groups. There were 17 (38.7%) patients that received a titanium wedge and 27 (61.5%) that received autograft or allograft. Patients that underwent LCL with the autograft/allograft group were significantly older (p=0.006). Patients who underwent LCL with a titanium wedge had a significantly higher preoperative talonavicular angle (p=0.013). There were no significant differences in post-operative talonavicular uncoverage angle, incongruency angle or calcaneal pitch at 6 months or 1 year. Conclusion: Adult acquired flat foot deformity is a difficult disorder to treat surgically. Lateral column lengthening is a common surgical procedure used to treat forefoot abduction that occurs. Our results show that at 6 months and 1 year no radiographic difference exists between autograft/allograft bone substitutes versus titanium wedge in LCL. Future research should evaluate the differences in patient reported outcomes between autograft/allograft versus titanium wedge bone substitutes. [Table: see text]
Treatment of Recurrent Peroneal Tendon Dislocation by Peroneal Retinaculum Reattachment without Fibular Groove Deepening
Authors: Park Seung-Hwan , Lee Jaehyung , Choi Young Rak , Seo Jaehyeon , Lee Ho-seong 
Published: November 2020

Category: Ankle; Sports; Trauma Introduction/Purpose: There are numerous studies recommending fibular groove deepening in the surgical treatment of peroneal tendon dislocation; however, there are some disadvantages to fibular groove deepening procedures. In this study, we evaluated the results of anatomic reattachment of the peroneal retinaculum without fibular groove deepening as a treatment for traumatic peroneal tendon dislocation. Methods: Thirty six patients with recurrent peroneal tendon dislocation, who underwent retinaculum repair without a fibular groove deepening procedure performed by two surgeons between March 2004 and March 2017, were enrolled in this study. Resubluxation of tendon, pain on inversion and eversion power of the ankle were monitored. The range of motion of inversion and eversion were measured and then compared to that of the contralateral side. AOFAS, VAS, FFI scores were obtained for all patients preoperatively and at the final follow-up. Postoperative complications such as infection, sural nerve injury, and recurrence were monitored. Results: Thirty four patients fully recovered without resubluxation of tendon. Two patients were injured again while playing soccer 6 months after the surgery and fast running 20 months after the surgery respectively. One patient had sural nerve injury. But the symptom was relieved at 6 months after the surgery. None of the patients had weakness of evertor. None of the patients had limited ankle motion. Mean AOFAS, VAS, FFI score improved significantly. Conclusion: In conclusion, for the treatment of recurrent dislocation of the peroneal tendon reattachment of the superior retinaculum only without groove deepening followed by proper rehabilitation is sufficient.
Total Ankle Arthroplasty in Valgus Deformity
Authors: Piga Camilo , Usuelli Federico Giuseppe , Maccario Camilla , Silvestri Claudia A. Di 
Published: November 2020

Category: Ankle Arthritis Introduction/Purpose: Total ankle replacement use has increased among patients with end-stage ankle arthritis. Substantial coronal plane deformity is usual in that context. In addition, recent literature shows a trend towards the extension of the indication of total ankle arthroplasty in increasingly severe coronal deformities, showing good results when correct alignment is achieved. Nevertheless, the results of lateral transfibular total ankle replacement (LTTAR) in valgus has not been extensively studied. We aimed to evaluate if the outcomes of LTTAR in ankles with valgus deformity are similar with those with no major deformity. Methods: This retrospective cohort study included 228 LTTAR. Patients were classified into 2 groups according to the preoperative coronal plane tibiotalar angle (TTS): neutral (less than 10° of coronal deformity, 209 patients) and valgus (above 10° of valgus, 19 patients). Clinical evaluation was performed using American Orthopaedic Foot & Ankle Society Score (AOFAS), Visual analogue scale (VAS), short Form 12 Quality of Life (SF-12) regarding its physical (PCS) and mental (MCS) items. Radiographic evaluation considered anteroposterior and lateral ankle radiographs. Surgical times were recorded in all the cases. There were no differences between groups regarding mean age, mean body mass index and follow up. The minimum follow up was 24 months. Results: The average AOFAS, VAS and SF-12 scores improved significantly postoperatively (p-value<0.01), without differences between groups. At final radiographic follow up, the valgus alignment group did not show significant differences with the neutral alignment group regarding TTS, lateral distal tibial angle or anterior distal tibial angle (p-value>0.05). Surgical time was longer in the valgus group (152.84 +- 40.86 mins vs 129.51 +- 52.13), but the difference was not statistically significant. Conclusion: Lateral transfibular total ankle replacement in ankles with valgus deformity achieved and maintained correction of coronal alignment in a short term follow up, as obtained in neutral alignment ankles. Clinical outcomes improved significantly regardless preoperative valgus deformity. Additional surgical time may be needed in order to obtain a good deformity correction in a valgus ankle. This short term analysis shows that LTTAR in a valgus ankle seems to be a safe option in experienced surgeons hands.
Do Geographic Region, Pathologic Chronicity, and Hospital Affiliation Affect Access to Care Among Medicaid- and Privately-Insured Foot and Ankle Surgery Patients?
Authors: Pitts Charles C. , McKissack Haley M. , He Jun Kit , Alexander Bradley , Sutherland Charles R. , Cage Benjamin B. , Shah Ashish 
Published: November 2020

Category: Other Introduction/Purpose: Studies have shown that patients enrolled in Medicaid have difficulty obtaining access to care compared to patients with private insurance. Whether variables such as geographic location, state expansion vs. non-expansion, and private versus academic affiliation affect access to care among foot and ankle surgery patients enrolled in Medicaid has not been previously established. Methods: Twenty providers from each of five Medicaid-expanded and five non-expanded states in different U.S. geographic regions were randomly chosen via the American Orthopaedic Foot & Ankle Society (AOFAS) directory. One investigator contacted each office requesting the earliest available appointment for their fictitious relative’s acute Achilles tendon rupture or hallux valgus. Investigator insurance was stated to be Medicaid for half of phone calls, and Blue-Cross Blue-Shield (BCBS) for the other half. Appointment success rate and average time to appointment were compared between private insurance and Medicaid. Results were further compared across geographic regions, between private and academic practices, and between urgent acute injury (Achilles rupture) and chronic non-urgent injury (hallux valgus). Results: Appointments were successful for all 100 (100%) calls made with BCBS, in comparison to 73 of 100 calls (73%) with Medicaid (p<0.001). Both acute and chronic injury had significantly higher success rates with BCBS than Medicaid (p<0.001). Appointment success rate was significantly lower with Medicaid than with BCBS (p<=0.01) in all geographic regions. Success rate with Medicaid (66.7%) was significantly lower than with BCBS (100.0%, p<0.001) for private practice offices, but not for academic practices. Conclusion: Patients with Medicaid experience difficulty in obtaining appointments for common non-emergent foot and ankle problems and may experience increased difficulty scheduling appointments at private rather than academic institutions. The medical community should continue to seek and identify potential interventions which can improve access to orthopaedic care for all patients, regardless of insurance status. [Table: see text]
Resveratrol inhibits Ca2+ signals and aggregation of platelets
Authors: Marumo Mikio , Ekawa Kazumi , Wakabayashi Ichiro 
Published: November 2020

AbstractBackgroundResveratrol has been shown to inhibit platelet aggregation. However, the mechanism for this action of resveratrol remains to be clarified. The purpose of this study was to elucidate the Ca2+-related mechanism for the inhibitory action of resveratrol on platelet aggregation.MethodsCa2+entry and subsequent aggregation of human platelets induced by different stimulants including thrombin, thapsigargin, and 1-oleoyl-2-acetylglycerol (OAG) were measured by the fluorescence method and light transmittance method, respectively. Each stimulant was added to a nominally Ca2+-free medium containing platelets, and then CaCl2was added to the medium to induce Ca2+influx into platelets.ResultsThapsigargin-induced Ca2+entry into platelets and subsequent platelet aggregation were significantly inhibited in the presence of resveratrol at 6.25 μM or higher concentrations, while OAG-induced Ca2+entry and subsequent platelet aggregation were not affected by resveratrol at concentrations up to 50 μM. In the nominally Ca2+-free medium, thrombin induced a small transient increase in intracellular Ca2+concentrations, which was attenuated in the presence of resveratrol at 12.5 μM or higher concentrations. Thrombin-induced Ca2+entry into platelets and subsequent platelet aggregation were significantly inhibited in the presence of resveratrol at 12.5 μM or higher concentrations.ConclusionsThe results suggest that resveratrol inhibits thrombin-induced platelet aggregation through decreasing Ca2+release from its stores and inhibiting store-operated Ca2+influx into platelets.
Prediction and prioritization of autism-associated long non-coding RNAs using gene expression and sequence features
Authors: Wang Jun , Wang Liangjiang 
Published: November 2020

AbstractBackgroundAutism spectrum disorders (ASD) refer to a range of neurodevelopmental conditions, which are genetically complex and heterogeneous with most of the genetic risk factors also found in the unaffected general population. Although all the currently known ASD risk genes code for proteins, long non-coding RNAs (lncRNAs) as essential regulators of gene expression have been implicated in ASD. Some lncRNAs show altered expression levels in autistic brains, but their roles in ASD pathogenesis are still unclear.ResultsIn this study, we have developed a new machine learning approach to predict candidate lncRNAs associated with ASD. Particularly, the knowledge learnt from protein-coding ASD risk genes was transferred to the prediction and prioritization of ASD-associated lncRNAs. Both developmental brain gene expression data and transcript sequence were found to contain relevant information for ASD risk gene prediction. During the pre-training phase of model construction, an autoencoder network was implemented for a representation learning of the gene expression data, and a random-forest-based feature selection was applied to the transcript-sequence-derivedk-mers. Our models, including logistic regression, support vector machine and random forest, showed robust performance based on tenfold cross-validations as well as candidate prioritization with hypothetical loci. We then utilized the models to predict and prioritize a list of candidate lncRNAs, including some reported to becis-regulators of known ASD risk genes, for further investigation.ConclusionsOur results suggest that ASD risk genes can be accurately predicted using developmental brain gene expression data and transcript sequence features, and the models may provide useful information for functional characterization of the candidate lncRNAs associated with ASD.