bluuebunny/crossref_metadata_2025_split huggingface dataset:
Eculizumab in thymoma-associated myasthenia gravis: a real-world cohort study
Authors: Jin Lei , He Dingxian , Zeng Quantao , Tan Song , Shi Jianquan , Liu Ying , Zou Zhangyu , Song Jie , Yan Chong , Huan Xiao , Wang Yuan , Yang Lei , Xi Jianying , Wu Zongtai , Liu Ziqi , Zheng Jianming , Zhao Chongbo , Chu Xianglin , Luo Sushan 
Published: December 2024

Background: Thymoma-associated myasthenia gravis (TAMG) is a subtype of myasthenia gravis (MG) that is associated with more severe symptoms and a relatively poor prognosis. Eculizumab, an inhibitor to target human C5 component of the complement cascade, is considered a treatment option for refractory generalized MG (gMG). Objectives: To explore the safety and efficacy of eculizumab in patients with TAMG. Design: This is an observational multicenter real-world cohort study to assess TAMG who were treated with eculizumab from June 2023 to June 2024. Data sources and methods: Clinical features associated with thymoma-associated multi-organ autoimmunity (TAMA), Myasthenia Gravis Activities of Daily Living (MG-ADL) score, and the incidence of treatment-emergent adverse events (TEAEs) were prospectively collected. Results: Overall, 42 patients with gMG were treated with eculizumab at 5 research centers, of whom 22 patients with TAMG were finally included. This cohort had a mean age of 51.5 ± 12.1 years and an average disease duration of 4.0 ± 4.3 years. Regarding thymomas, the World Health Organization (WHO) histological classification was primarily B2 and B3 (63.7%), and Masaoka staging was predominantly IV (45.5%). Nine participants (40.9%) switched from efgartigimod to eculizumab aiming at a better clinical improvement and reducing steroid use. By week 12, the MG-ADL score decreased to 4.8 ± 4.7 (baseline: 11.7 ± 6.0), and the corticosteroid dose reduced to 23.2 ± 26.5 mg (baseline: 41.8 ± 63.9 mg). Two patients with TAMA showed significant improvement in skin lesions and thrombocytopenia. Two TEAEs were recorded including COVID-19 and herpes labialis infection. Four patients (18.2%) died of respiratory or circulatory failure owing to thymoma metastasis. Conclusion: This real-world study demonstrates the efficacy of eculizumab in achieving symptom control and corticosteroid reduction for TAMG. It may also be a therapeutic option for refractory TAMG and TAMA. Trial registration: NCT04535843.
Outcomes Using a Standardized Provincial Childhood Nephrotic Syndrome Clinical Pathway
Authors: Kim Laura H. , Catapang Marisa , Polderman Nonnie , Humphreys Robert , Mammen Cherry , Jugnauth Eleonora , Matsell Douglas G. 
Published: December 2024

Background: In 2013, the British Columbia (BC) Childhood Nephrotic Syndrome Clinical Pathway (CNSCP) was developed to standardize the care of children with nephrotic syndrome (NS). In BC, children access nephrology care at BC Children’s Hospital (BCCH) and multiple regional clinics. Objective: The primary objective was to compare induction therapy and clinical outcomes between BCCH and regional clinics since implementation of the CNSCP. Design, setting, and patients: This was a retrospective cohort study of children with NS in BC. Measurements and methods: We conducted a retrospective cohort study of children 1 to 17 years old with new-onset NS from 2013 to 2019 inclusive with minimum 12 months of follow-up. Children with non-minimal change disease, steroid resistance, incomplete induction therapy, or less than 6 months of pathway treatment within their first year post-diagnosis were excluded. Clinics were categorized as BCCH or regional (Surrey, Prince George, or Kelowna). Results: Sixty-nine patients were included, with 52 (75%) at BCCH and 17 (25%) at regional clinics. There were no significant between-group differences in age, sex, or clinical characteristics at time of diagnosis. Comparing BCCH and regional clinics, there was no difference in induction prednisone exposure (median 3400, interquartile range [IQR] 3331-3585 mg/m2 vs 3492, IQR 3397-3644 mg/m2, P = .167), annualized relapse rate (median 3.3, IQR 1.1-5.3 vs 2.3, IQR 0.5-4.2, P = .575), or development of frequently relapsing courses (50% vs 62%, P = .475). There was a similar number of first-year clinic visits (4.2 ± 1.2 vs 4.0 ± 1.8, P = .655) and dietitian-reviewed food records (67% vs 47%, P = .135, BCCH vs regional). More children at BCCH had a recommended ophthalmology surveillance visit (87% vs 59%, P = .01, BCCH vs regional). Limitations: Study limitations include small sample size and exclusion of children with complicated NS (ie, relapse during induction, steroid resistance). Conclusion: Since we implemented the CNSCP, children with NS received comparable care and had similar outcomes at BCCH and regional clinics without significant practice variation.
Feasibility Study for COSMIC Study - Comparing Open SCARF Osteotomy and Minimally Invasive Chevron Osteotomy for Hallux Valgus Correction
Authors: Kakwani Rajesh , Hutt Nicholas , Townshend David , Murty Aradhyula , Kakwani Mehak , Pujol Andrea , Griffiths Alexandra 
Published: December 2024

Category: Bunion; Other Introduction/Purpose: Minimally invasive surgery for hallux valgus deformity is gaining popularity over the traditional Open scarf osteotomy. Emerging evidences are showing similar clinical outcomes but further studies are needed to ascertain this. The aim of this study was to assess the feasibility of conducting a randomised controlled trial to compare the patient recorded and clinical outcomes for the surgical management of Hallux Valgus between open scarf osteotomy (OS) and minimally invasive chevron osteotomy (MICA). Methods: Patients suitable for surgical correction were invited to participate. Post op rehabilitation was standardised for both groups. Patients completed a validated questionnaire (Manchester Oxford Foot questionnaire and EQ-5D) preoperatively and post operatively at 6 months and 1 year. Radiological parameters and range of motion were measure pre and post operatively. A total of 41 patients were eligible for the study, 31 were successfully recruited and operated between Dec 2017 and June 2022. Results: 17 patients were randomised to MIS (15 female, mean age 51 years) and 14 to OS (13 female, mean age 51 years). Both groups have a significant improvement in the MOXFQ parameters (walking, pain and social) at 6m and 12m, as well as radiological parameters. VAS improved for OS at 6m (p=0.048) and 12m (p=0.025) but only improvement at 6m was seen for MICA (p=0.059 and p=0.054 at 12m). There was no improvement in EQ-5D in either group at 12 months and no difference in surgical time (p=0.53).There was a higher number of complication in the MICA group with 5 removal of metalwork (29.4%) and 2 superficial infections (11.8%) vs none in the OS group. Conclusion: Both surgical options show similar clinical results but higher complication rate was seen with MICA. A larger study is needed to evaluate further.
Fix While You Can: A Systematic Review on Outcomes of Fixation for Osteochondral Lesions of the Talus
Authors: Rikken Quinten , Dahmen Jari , Nakasa Tomoyuki , Stufkens Sjoerd , Kerkhoffs Gino M M.M.J. 
Published: December 2024

Category: Ankle Introduction/Purpose: The primary aim of the present study is to assess the clinical success rate of fixation for osteochondral lesions of the talus (OLT). The secondary outcomes concern the union rate and adverse events. Methods: A systematic literature search of PubMed, Embase (Ovid), and Cochrane Library was performed up to December 2023. The primary outcome was the pooled clinical success rate following fixation with 95% confidence interval (95%-CI). Secondary outcomes concerned the union rate, complication rate, and revision rate. Results: A total of 10 studies with 241 ankles were included at a mean follow-up of 40 months. The pooled clinical success rate was 92% [95%-CI: 87% – 95%]. The pooled union rate was 91% [95%-CI: 87% - 94%]. A sub-analysis found superior success rate for patients treated with bone-peg (98% [95%-CI: 89 – 100] compared to non-metal screw and pin (84% [95%-CI: 68 – 93]), P=0.03. The pooled complication and revision rate were 1% [95%-CI: 0 - 4] and 6% [95%-CI: 0 - 4], respectively. Conclusion: Fixation for osteochondral lesions of the talus leads to successful clinical outcomes in 9 out of 10 patients. Moreover, fragment union is achieved in 9 out of 10 cases, with a low reported complication rate. These findings show that when a symptomatic OLT is fixable physicians should always consider fixation.
Fixation for Osteochondral Lesions of the Talus with Open Lift, Drill, Fill and Fix (LDFF) Results in Excellent Two-Year Clinical Outcomes
Authors: Rikken Quinten , Dahmen Jari , Lambers Kaj , Stufkens Sjoerd , M.M.J. Kerkhoffs Gino M 
Published: December 2024

Category: Ankle Introduction/Purpose: Outcomes after fixation of osteochondral lesions of the talus (OLTs) are currently underreported in literature. Clinical and radiological outcomes after the open fixation procedure ‘lift-drill-fill-fix’ (LDFF) for OLT with an osteochondral fragment are unknown. The advantages of fixation over other surgical techniques is the preservation of the native hyaline cartilage, immediate stabilization of the fragment and restoration of the talar dome congruency, as well as facilitating subchondral bone healing. Methods: This study describes the results of open LDFF treatment in a prospective, multicentre, nonrandomized, noncomparative clinical trial of 42 ankles in 40 patients with a 2-year follow-up period. The primary outcome measure in this study was the numeric rating scale (NRS) of pain during walking. Secondary outcome measures included the NRS of pain during rest, running and stairclimbing, the foot and ankle outcome sore (FAOS), and the mental component scale (MCS) and physical component scale (PCS) of the short form 36 (SF-36), and the radiological union rate as well as the level of the subchondral bone layer as measured on 1-year postoperative CT. Results: A total of 40 ankles which underwent fixation of an OLT with a fragment were prospectively included with 2-years follow-up. The primary outcome, pain during walking, significantly improved with 3.5 (95% CI 2.4-4.6) points on the NRS (p=< 0.001). Significant improvement was also seen for the NRS of pain during rest (p=< 0.001), pain during running (p=< 0.001) and pain during stair climbing (p=< 0.001). Additionally, all subscales of the FAOS, and the MCS and PCS significantly improved as well. Postoperative CT-scans showed union in 88% of the lesions 1-year after the procedure, a flush subchondral bone layer in 88%, and a depressed subchondral bone layer in 12%. Conclusion: Open fixation by means of LDFF for OLT results in a significant improvement of clinical outcomes up-to mid-term follow-up. Radiological follow-up shows a union rate and a flush subchondral bone layer in 88% of lesions. These results indicate that open fixation should always be considered when an osteochondral fragment is present as it leads to an excellent improvement in PROMs.
Focused Extracorporeal Shock Wave Therapy for Painful Nonunion of Fracture of Interphalangeal Coalition
Authors: Shimozono Yoshiharu , Mori Daisuke , Mizuno Yasuyuki , Funakoshi Noboru , Kobayashi Masahiko , Yamashita Fumiharu 
Published: December 2024

Category: Lesser Toes; Trauma Introduction/Purpose: It has been reported that fractures of interphalangeal coalition often result in delayed union or nonunion. Although there are scattered reports of surgical treatment of painful nonunion after fractures of the interphalangeal coalition, there is currently lack of data on the efficacy of extracorporeal shock wave therapy (ESWT) for nonunion of fractures of the interphalangeal coalition. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy for patients with painful nonunion of fractures of the interphalangeal coalition. Methods: A total of 7 patients (7 feet) diagnosed with painful nonunion due to persistent pain and no tendency toward bony fusion at least 3 months after fracture of the interphalangeal coalition from 2022 to 2023 were included in this study. Focused ESWT was performed in all patients. There were 2 males and 5 females with a mean age of 51.3 years (range, 23-62). The fourth toe was present in two cases, and the fifth toe in five cases. The mean time from the date of injury to the start of ESWT was 3.8 months (range, 3-5 months). 4000 shots at 0.25 mJ/mm2 (4 Hz) was administered at 2-week intervals. Visual analog scale (VAS) before and after ESWT were recorded. Results: The attainment of complete bony union was documented in all seven patients (Figure 1). The application of focused ESWT was carried out a mean of 2.8 times (range, 2-4 times), and the mean duration from the initiation of treatment to the confirmation of bony union was 1.8 months (range, 1-2 months). In all cases, the symptoms of swelling and pain were successfully alleviated. The VAS scores exhibited a significant improvement, with the mean VAS score decreasing from 3.9 (range, 2-6) before ESWT to 0 after the achievement of union. Conclusion: Fractures occurring at interphalangeal coalitions have been reported to require a considerable amount of time for bony union, and surgical intervention has been reported in cases of painful nonunion. However, in the present study, all 7 cases of painful nonunion achieved complete bony fusion following focused ESWT. Moreover, bony union was observed within just 2 months of the start of ESWT. These findings suggest that focused ESWT is a valuable treatment option for achieving bony fusion in cases of painful nonunion of fractures at the interphalangeal coalitions.
Foot and Ankle Patient Education Materials and Artificial Intelligence Chatbots: A Comparative Analysis
Authors: Parekh Aarav S. , McCahon Joseph A.S , Nghe Amy , Pedowitz David I. , Daniel Joseph N. , Parekh Selene G. 
Published: December 2024

Category: Other; Sports Introduction/Purpose: On its current trajectory, AI chatbots may become the primary source of information for patient education material in the field of orthopaedics. Despite this, there has been no evaluation of the accuracy and validity of foot and ankle patient education material generated by AI platforms. The purpose of this study was to perform a comparative analysis of foot and ankle patient education material generated by the ai chatbots, as they compare to the AOFAS recommended patient education website, footcaremd.org. Methods: ChatGPT, Google Bard, and Bing AI were used to generate patient educational materials on ten of the most common foot and ankle conditions. The content from these ai language model platforms was analyzed and compared with footcaremd.org for accuracy of included information. Accuracy was determined for each of the ten conditions on a basis of included information regarding background, symptoms, causes, diagnosis, treatments, surgical options, recovery procedures, and risks or preventions. Results: When compared to the reference standard of the AOFAS website: footcaremd.org, the AI language model platforms consistently scored below 60% in accuracy rates in all categories of the articles analyzed. ChatGPT was found to contain an average of 46.2% of key content across all included conditions when compared to footcaremd.org. Comparatively, Google Bard contained an average of 36.5% and Bing AI contained 28.0% of information included on footcaremd.org. Conclusion: AI language model generated patient education regarding common foot and ankle conditions provides limited content accuracy across all three AI chatbot platforms. Clinicians should be aware of the increasing popularity of these platforms and be prepared to answer questions or clarify misunderstandings, and when appropriate direct patients to more validated education material such as footcaremd.org.
Hands-on or Gloved Approach? Unveiling Patient Experiences in Orthopaedic Foot and Ankle Clinics
Authors: Conway Yvonne C. , Rincon Andrea B. , Simister Samuel , Sierra Frank , Kreulen Christopher D. , Giza Eric 
Published: December 2024

Category: Other Introduction/Purpose: Current literature suggests that patients feel medical exam gloves are often overused or used inappropriately, while also having concerns about the possibility of cross-contamination with glove utilization. Additionally, there is very little research on the effect that glove use has on patient’s perceptions of physical exam quality and surgeon personability. The purpose of this research project is to determine whether patients that are having their foot and ankle examined prefer their orthopaedic surgeon to wear medical exam gloves. Methods: Anonymous surveys were administered and collected during clinic for two different fellowship trained foot and ankle orthopaedic surgeons at a single institution. Any patient willing to sign a consent form was included. Patient age, gender, and reason for visit were collected along with a survey of 5 questions on glove utilization. Survey questions were scored on a Likert scale, with 1=strongly agree, 2=agree, 3=neutral, 4=disagree, and 5=strongly disagree. Descriptive statistics, data normalcy, and appropriate significance tests were used to analyze results while controlling for glove utilization (yes or no), gender (female or male), and age group (< 39, 40-49, 50-59, 60-69, and 70+), at p< 0.05 significance. Results: In total, 99 patients agreed to complete the survey (53.5% female and 36.4% male, with a mean age of 55.3 and 54.8, respectively). Overall, physicians used gloves more with male than female patients (33.3 vs 9.43%, p =0.059), although males were slightly more agreeable to preferring no gloves (2.86 vs. 3.17). When the physician wore gloves, patients were more agreeable to glove use for themselves (2.5 vs. 3.24, p=0.001) and for others (2.21 vs. 3.0, p< 0.001). Patients across all groups were agreeable with glove use when examining wounds (range 1.74–2.47.) For all patients, gender, glove use, and age had no effect on agreeing that their physical exam was thorough (average 1.61±0.726) and on disagreeing that gloves effected provider demeanor (average 3.32±0.874). Conclusion: In general, glove use by foot and ankle orthopaedic surgeons did not negatively impact patient perception of physical examination thoroughness, nor did it confer less personability onto their physician. While patients across all groups demonstrated a slight preference for glove use during wound examinations, glove use preference in general was otherwise neutral. These results suggest that, on average, the utilization of gloves does not impact patient care and may therefore be up to the discretion of the provider.
High Rates of Return to Play with No Deterioration in Performance Following Acute Achilles Tendon Ruptures in Athletes Participating in the National Hockey League
Authors: Butler James J. , Phadke Rohan , Puleo James , Lehane Kevin , Samsonov Alan P. , Rosenbaum Andrew , Kennedy John G. 
Published: December 2024

Category: Sports; Other Introduction/Purpose: The purpose of this study was to assess outcomes following acute Achilles tendon ruptures (AATR) sustained by athletes participating in the National Hockey League (NHL). Methods: Athletes participating in the NHL who sustained an AATR were identified using a publicly available database, match reports and injury reports. The years of inclusion was from 2008-2022. Data collected and analysed: player demographics, player position, if surgical intervention was warranted, rates of return to play, time to return to play, games missed. Pre-injury and post-injury performance outcomes collected and analysed: games played, plus/minus rating, assists, goals, game-winning goals, penalty minutes, power play assists, power play goals, production, points, short-handed assists, short-handed goals, shootout goals, shooting percentage and time on ice per game. Results: Eighteen athletes sustained an AATR in the NHL (0.000481 per 10,000 athlete-exposures). The mean age was 27.9±3.6 years and the mean BMI was 26.3±1.6kg/m2. There were 7 (38.9%) AATRs sustained by defenseman, 7 (38.9%) AATRs sustained by centers, 1 (5.6%) AATR sustained by right wings, 1 (5.6%) AATR sustained by left wings, 1(5.6%) AATR sustained by goaltenders and 1 (5.6%) AATR sustained by forwards. Seventeen athletes (94.4%) underwent surgical intervention. The mean number of games played prior to injury was 480.2±240.6. The RTP rate to the NHL was 88.8% at mean time of 4.8 ± 2.5 months. The mean number of games missed due to injury was with 45.1±19.4 games. There was no statistically significant difference in pre-injury performance outcomes compared to post-injury performance outcomes (p>0.05). Conclusion: This current study found that AATRs were an uncommon injury in the NHL with an incidence of 0.000481 per 10,000 athlete-exposures over a 14 year period. Sustaining an AATR was associated with a 88.8% return to play rate to the NHL together at a mean time of 4.8 ± 2.5 months with no deterioration in athletic performance. Although sustaining an AATR in the NHL poses a temporary setback, the findings of this study demonstrate that sustaining an AATR does not have a catastrophic effect on the NHL athlete's career.
Immediate Effects of Education on the Manual Ankle Anterior Drawer Test: A Study Using Cadaveric Ankles and Three-Dimensional Kinematic Analysis
Authors: Nakajima Hirofumi , Yamaguchi Satoshi , Kimura Seiji , Horii Manato , Toguchi Kaoru , Ito Ryu , Sasho Takahisa , Ohtori Seiji 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Manual anterior drawer test (ADT) is widely used for evaluating ankle instability. However, implementing the maneuver with an appropriate method and correct assessments is challenging, particularly for less experienced examiners. An effective strategy to learn the proper technique is mandatory. However, no study has investigated the effect of education on the ADT. This study aimed to clarify whether an educational workshop for senior orthopaedic residents will improve ankle kinematics during the ADT and instability assessment. Methods: The subjects were 20 senior orthopaedic residents. Three fresh-frozen cadaveric ankles were used to create intact, anterior talofibular ligament (ATFL)-cut, and ATFL/calcaneofibular ligament (CFL)-cut models. Infrared markers were attached to the tibia and talus, and three-dimensional kinematics of the ankle joint were measured using a motion capture system (Figure), with the primary outcome being the ATFL length change during the ADT. Examiners first performed the maneuver on the three ankles using their own methods. The examiners also assessed ankle instability in three grades compared to the contralateral side. Subsequently, a one-hour educational workshop consisting of documents, videos, and hands-on sessions was conducted. Afterward, the examiners performed the ADT again on the same three ankles. The ATFL length changes were compared before and after the workshop using paired t-tests. The ankle instability assessments were compared using Chi-square tests. Results: Before the educational workshop, the ATFL length changes were 2.4 ± 0.8 mm, 7.6 ± 3.0 mm, and 6.1 ± 2.7 mm in the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The ATFL length changes significantly increased to 3.2 ± 1.2 mm (P = 0.02), 10.0 ± 2.5 mm (P = 0.005), and 8.4 ± 2.4 mm (P = 0.007) after the workshop. Before the educational workshop, 9 (45%), 7 (35%), and 7 (35%) examiners assessed ankle instability correctly for the intact, ATFL-cut, and ATFL/CFL-cut ankles, respectively. The number of examiners with correct assessments did not increase in either ankles after the workshop (P = 0.14–0.81). Conclusion: We found that the ADT technique, evaluated using cadaveric ankle models and three-dimensional kinematic analysis, improved after the educational workshop for senior orthopedic residents. However, the ankle instability assessments did not change. The short-period workshop, including the lecture and hands-on sessions, successfully improved the ADT maneuver. However, further research is required to determine a more effective training method for correct assessments.