bluuebunny/crossref_metadata_2025_split huggingface dataset:
Coding Patterns and Implications on Reimbursement in Foot & Ankle Surgery
Authors: Rogero Ryan G. , Grear Benjamin J. , Murphy Garnett A. , Richardson David R. , Rider Carson M. , Bettin Clayton C. 
Published: December 2024

Category: Other; Midfoot/Forefoot Introduction/Purpose: Coding is an essential part of a foot and ankle surgeon’s duties and can both quantify the amount of work done by the surgeon and influence compensation. The purpose of this study was to evaluate the coding patterns among foot and ankle orthopaedic surgeons and to quantify the effects of these on reimbursement using real-life patient cases. Methods: A survey consisting of 12 commonly encountered real deidentified patient cases was administered to all foot and ankle fellowship-trained orthopaedic surgeons of a large, combined academic-private practice orthopaedic group. The scenarios included pre-operative diagnostic imaging and reports, intra-operative imaging, and post-operative radiographs. Surgeons were asked which Current Procedural Terminology (CPT) codes would be applied and if any Modifiers to these codes would be utilized. If multiple CPT codes were utilized, surgeons were asked to list the codes in the same order as would be theoretically listed on their operative notes. Respondents were allowed to use any sources of information they desired to complete the survey. Total work-relative value units (RVUs) and the generated reimbursement values were calculated for each case and respondent using the 2024 Centers for Medicare & Medicaid Services (CMS) conversion factor ($32.74 per RVU), with the primary procedure reimbursed at 100%, with additional procedures reimbursed at 50%. Results: Five surgeons completed the survey. Among case scenarios, four of the 12 cases had at least four of the five respondents in agreement on the primary CPT code, whereas only one case had 100% agreement among respondents on the primary CPT code. Similarly, only five of the 12 cases had at least four of the five respondents in agreement regarding modifier usage, with only one case having 100% agreement among respondents on modifier utilization. Modifier 59 was most utilized. The total RVU and reimbursement difference between the respondents with the highest and lowest listed RVUs was 216.06 and $3,627.92, respectively (Table 1). The cases with the most variability among both RVUs and modifiers involved a Lisfranc injury, Charcot reconstruction, and midfoot fracture-dislocation. Conclusion: Great variability exists between foot and ankle surgeons when coding common foot and ankle procedures. Surgeons should be aware of these differences and the large effect they can have on quantifying reimbursement. Increasing competency with coding and maximizing reimbursement for work performed should continue to be emphasized.
Comparison of the Thickness of the Anterior and Posterior Cortical Bone of the Fibula at the Site of Screw Fixation in Lateral Malleolar Fractures
Authors: Lee Jaehyung , Kim Janghyun , Chae Sungkuk , Oh Seung ho , Cha Dongheon 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: In Weber type B rotational ankle fractures, fixation of the fibular fracture with interfragmentary lag screws and plates has traditionally been widely used. However, there have been instances in which interfragmentary lag screw fixation failed to offer sufficient stability particularly when the cortical bone thickness in the posterior part of the fibula was insufficient. In this study, our objective was to compare the thickness of the anterior and posterior cortical bone in the sagittal plane at the screw fixation site in surgically treated lateral malleolar fractures. Methods: A retrospective analysis of medical records was conducted on patients who underwent open reduction and internal fixation for Weber type B ankle fractures at our institution between March 2019 and December 2022. Exclusion criteria comprised patients without preoperative CT scans, those aged 19 years or younger, individuals with a history of prior surgery at the same site, and cases in which measuring cortical bone thickness was challenging due to severe fracture comminution. The radiographic assessment involved measuring and comparing the thickness of the anterior and posterior cortical bone at the fibular fracture site in the sagittal plane of the CT scans. Results: Among the total of 105 patients, 52 were male and 53 were female, with a mean age of 50.5 years. In the CT sagittal plane, the anterior cortical bone thickness of the fibula measured 2.40 mm, while the posterior thickness was 1.37 mm (p=0.005), indicating a statistically significant difference. Upon stratifying patients into male and female groups, it was observed that the anterior cortical bone thickness of the fibula was significantly greater in men compared to women (2.64 mm vs. 2.15 mm, p=0.002), and the posterior thickness was also significantly higher (1.51 mm vs. 1.25 mm, p=0.031). Conclusion: The assessment of fibula cortical bone thickness at the site of Weber B type lateral malleolar fractures revealed that the anterior cortical bone was thicker than the posterior cortical bone, and males exhibited greater thickness compared to females. We posit that these findings could provide valuable guidance in the selection of screw type and fixation direction during surgical interventions for lateral malleolar fractures.
Demographic Disparities in 30-Day Outcomes Following Achilles Tendon Repair
Authors: Fanfan Dino , Rittmeyer William , Kumar Aditi , Murray Daniel , Chapman Cary B. 
Published: December 2024

Category: Sports; Ankle Introduction/Purpose: With more people participating in sporting activities, the occurrence of Achilles tendon rupture is increasing in the USA. Specific risk factors for Achilles tendon repair complications such as tobacco use, diabetes mellitus, steroid use, and obesity, have been well-reviewed in current literature. However, the impact of demographic disparities such as race and gender on the 30-day postoperative surgical complication of an Achilles tendon repair has not been extensively reported. Accordingly, we sought to investigate whether demographic disparities in 30-day postoperative Achilles repair outcomes exist and to what extent. Methods: The American College of Surgeons National Surgical Quality Improvement Program Database was queried for all patients undergoing surgical repair of Achilles tendon rupture from 2012 to 2021. Patients were identified using the common procedure terminology (CPT) codes 27650 and 27652. Patients were evaluated according to race and gender. A multivariate logistic regression was conducted for each complication to evaluate whether demographic factors independently were associated with complications after adjusting for various variables (age, obesity rate, diabetic/nondiabetic, smoker/nonsmoker, ASA class). Medical complications included rates of deep vein thrombosis (DVT), superficial surgical site infection (SSI), deep SSI (dSSI), wound disruption after surgery/dehiscence, readmission rate and reoperation rate. Results: A total of 6333 patients who underwent Achilles tendon were included in the study, 25% (N =1607) were women, 49.0% (N =3101) reported as White, 21.1% (N =1336) as Black/African American and 29.9% (N =1896) as Other. In our unadjusted analysis, there was a higher prevalence of DVT in white patients. Following a multivariate analysis, neither race or gender of the patient were associated with a difference in rates of all complications, wound, dSSI, wound disruption after surgery, readmission rate and reoperation rate. Only race demonstrated a significant difference in the rate of superficial SSI (χ2 = 7.21; p=.0272) following multivariate analysis. Conclusion: When adjusted for age, smoking, diabetes, obesity and ASA class, there was a statistically significant although clinically insignificant difference in superficial surgical site infection rate between white patients, black patients, and patients of other races not seen in any other post-operative outcome. In our unadjusted analysis, there was a higher prevalence of DVT in white patients possibly because these patients were generally older and DVTs are more common in elderly patients. This study highlights advancements in the delivery of equitable care, but we recognize that there continues to be disparities in surgical care which requires strong and worthwhile solutions.
Diabetic Management and Infection Risk in Total Ankle Arthroplasty
Authors: Wu Kevin , Anastasio Albert T. , Krez Alexandra , O'Neill Conor N. , Mitra Kishen , Adams Samuel B. , DeOrio James K. , Easley Mark E. , Nunley James A. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: As total ankle arthroplasty (TAA) rises in popularity nationwide for the management of end-stage arthritis, patient selection and medical optimization are crucial for the mitigation of infection risk. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA. Methods: This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups. Results: Of the 1,863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n=5) was compared to propensity score-matched controls (n=15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls. Conclusion: Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA.
Dynamic Fixation vs Static Screw Fixation for Syndesmosis Injuries in Pronation External Rotation Ankle Fractures
Authors: Kang Hyunseong , Lim Chaemoon , Choi Sungwook 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronation external rotation fractures. Methods: 30 patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud–Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups. Results: There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome, including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost Conclusion: Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.
Efficacy of 3D Wound Assessment in Predicting Granulation Tissue Velocity Following Negative Pressure Wound Therapy in Diabetic Foot Ulcers
Authors: Ahn Jiyong , Flaherty Alexandra F. , Kim Yoochang , Bejarano-Pineda Lorena , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Waryasz Gregory R. 
Published: December 2024

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Wound healing in diabetic foot ulcers (DFU) poses challenges, requiring extensive debridement and amputations. Negative pressure wound therapy (NPWT) can be utilized for DFUs with large soft tissue defects to promote granulation tissue growth. The optimal timeframe for successful NPWT lacks extensive studies. Advanced wound scanning with a three-dimensional (3D) camera can enhance DFU area and volume calculations. This study aimed to investigate the efficacy of 3D wound assessment in predicting granulation tissue filling velocity following NPWT in DFUs. Methods: After receiving IRB approval from the single Korean center, a retrospective case series study was performed for 101 DFUs (Wagner classification 3 and 4) undergoing NPWT from September 2018 to June 2019. Demographic data, vascular patency, and wound characteristics were recorded. Wound was irrigated before NPWT. An infra-red 3D camera (inSight ®, eKare, Fairfax, VA, USA) was used to capture digital photographs. Wound area and volume were measured. Measurements were taken weekly from before treatment to one month after using inSight ® cloud software. The risk factors of diabetic foot ulcers related to wound healing were evaluated. Results: NPWT resulted in significant area improvements for open diabetic foot ulcers (p = 0.001). Postoperative 1-week area change velocity was 1.35 cm2/day, peaking at 2 weeks (1.84 cm2/day). Volume also showed significant improvement over time (p = 0.001), with a 1-week peak velocity of 1.20 cm3/day. All peak area and volume changes occurred within two weeks after NPWT application. Midfoot and hindfoot exhibited higher velocity of volume than forefoot (p = 0.001). Postoperative volume change was the fastest with a patent peroneal artery. Conclusion: 3D wound assessment for velocity of granulation tissue filled in an open DFU after NPWT could be effective to predict outcomes. Most wound healing following NPWT in DFUs was completed within two weeks. Application of NPWT for an additional two weeks did not significantly impact the completion of wound healing even though midfoot and hindfoot exhibited higher velocity of volume than forefoot.
HFD aggravated the arthritis and atherosclerosis by altering the intestinal status and gut microbiota
Authors: Shi Na , Jiang Shan , Zhao Yue , Zhang Yang , Duan Xinwang , Hong Guo-bao , Yang Zhongshan , Duan Yuanyuan , Niu Haitao 
Published: December 2024

AbstractRheumatoid arthritis (RA) and cardiovascular disease (CVD) are both the chronic inflammatory disease. To investigate the influence of secondary atherosclerosis on arthritis mice, we treated the ApoE−/− mice with K/BxN serum and high fat diet (HFD), and subsequently assessed the phenotypes as well as immune profiles of K/BxN serum and HFD induced ApoE−/− mice. We found that HFD treatment aggravated the hyperlipidemia, atherosclerotic lesions, ankle swelling and arthropathy of mice. We further demonstrated that HFD altered the gut microbiota and metabolism, intestinal homeostasis and Th17/Treg cell balance in lamina propria lymphocytes. Moreover, HFD decreased the number of Peyer’ s patches and altered the expression profiling of gut immune cells. In addition, HFD increased the number of aortic leukocytes and macrophages, then aggravated the atherosclerosis in aorta, which led to greater inflammation in mice aorta and aortic root. Collectively, our study indicated that HFD aggravated the arthritis and atherosclerosis, which may be contributed by microbiota dysbiosis, the intestinal permeability and disrupted immunological homeostasis.
Variable and slow-paced neural dynamics in HVC underlie plastic song production in juvenile zebra finches
Authors: Bistere Linda , Wilczek Stefan , Vallentin Daniela 
Published: December 2024

AbstractZebra finches undergo a gradual refinement of their vocalizations, transitioning from variable juvenile songs to the stereotyped song of adulthood. To investigate the neural mechanisms underlying song crystallization—a critical phase in this developmental process—we performed intracellular recordings in HVC (a premotor nucleus essential for song learning and production) of juvenile birds. We then compared these recordings to previously published electrophysiological data from adult birds. We found that HVC projection neurons in juvenile zebra finches during the song crystallization phase exhibited more variable spiking patterns compared to the precise bursting observed in adult HVC projection neurons. Additionally, subthreshold membrane potential fluctuations in juvenile neurons exhibited longer durations and larger amplitude excitatory postsynaptic potentials. These distinct temporal dynamics in HVC during song crystallization likely play a crucial role in the fine-tuning processes that shape the precise timing and structure of the mature zebra finch song.
Lung recruitment with HFOV versus VTV/AC in preterm infants with RDS
Authors: Eldegwi Marwa , Shaltout Ali , Elagamy Osama , Salama Dina , Elshaer Mohammed , Shouman Basma 
Published: December 2024

Abstract
Objectives
To compare the effect of lung recruitment using high frequency ventilation versus volume targeted ventilation on duration of intubation as well as its effect on lung inflammation in preterm infants with respiratory distress syndrome.

Methods
The study was conducted on a total of 40 preterm infants, 34 weeks gestational age or less, having RDS that needed intubation and mechanical ventilation within the first 72 h after their birth at the NICU of Mansoura University Children’s Hospital during the period from July 2020 to July 2022. Infants included were randomly assigned into two groups, Group A who were subjected to LRM using HFOV (20 cases) and Group B who were subjected to LRM using VTV/AC (20 cases). TGF-β1 level was measured in BAL samples of all studied infants at two time points; before lung recruitment maneuver and at day 5 after lung recruitment or just before extubation if extubation occurs earlier than 5 days.

Results
Lung recruitment maneuver had no significant effect on time to extubation. Both groups showed no significant difference in rate of prematurity complications nor delta change of TFG-β1 level in tracheal aspirate of those preterm infants measured before lung recruitment and five days after recruitment or at extubation when extubation occurred earlier.

Conclusions
Lung recruitment maneuver was not associated with significant difference between both groups of preterm infants. The results obtained from our study, being the first of its kind to compare the effect of lung recruitment, provide a promising research area for further investigations.
Exploring correlates of high psychiatric inpatient utilization in Switzerland: a descriptive and machine learning analysis
Authors: Jaffé Mariela E. , Weinmann Stefan , Meyer Andrea H. , Stepulovs Helen , Luethi Regula , Borgwardt Stefan , Lieb Roselind , Lang Undine E. , Huber Christian G. , Moeller Julian 
Published: December 2024

Abstract
Background
This study investigated socio-demographic, psychiatric, and psychological characteristics of patients with high versus low utilization of psychiatric inpatient services. Our objective was to better understand the utilization pattern and to contribute to improving psychiatric care.

Methods
One-hundred and twenty inpatients of the University Psychiatric Clinics (UPK) Basel, Switzerland, participated in this cross-sectional study. All patients were interviewed using different clinical scales. As target variables we investigated the number of days of psychiatric inpatient treatment within a 30-month period.

Results
Despite including multiple relevant patient variables and using elaborate statistical models (classic univariate und multiple regression, LASSO regression, and non-linear random forest models), the selected variables explained only a small percentage of variance in the number of days of psychiatric inpatient treatment with cross-validated R2 values ranging from 0.16 to 0.22. The number of unmet needs of patients turned out to be a meaningful and hence potentially clinically relevant correlate of the number of days of psychiatric inpatient treatment in each of the applied statistical models.

Conclusions
High utilization behavior remains a complex phenomenon, which can only partly be explained by psychiatric, psychological, or social/demographic characteristics. Self-reported unmet patient needs seems to be a promising variable which may be targeted by further research in order to potentially reduce unnecessary hospitalizations or develop better tailored psychiatric treatments.
Medically assisted integrated rehabilitation program for people with opioid dependence: a quasi-experimental evaluation using multi-criteria decision analysis
Authors: Islam M. Kamrul , Fadnes Lars Thore , Johansson Kjell Arne , Ruths Sabine , Rutten-van Mölken Maureen , Askildsen Jan Erik 
Published: December 2024

Abstract
Background
Opioid use disorders constitute a vast disease burden, need for comprehensive treatment, and substantial costs to individuals, families, and society. The multifaceted needs of people with opioid dependence call for integrated care. The study aims to assess the added value of an integrated medically assisted rehabilitation (MAR) program providing opioid agonist therapy for patients with opioid dependence as compared to the standard of care (SoC) in Norway.

Methods
The intervention includes a comprehensive tertiary care integrated MAR program in Bergen. SoC is a much less intense primary care program in Oslo. 682 and 609 patients from Bergen, and 864 and 771 patients from Oslo were included in 2017 and 2019, respectively. A multi-criteria decision analysis (MCDA) framework was used where the relative preferences of the importance of the outcomes were obtained from a discrete choice experiment among five different stakeholder-groups. Seven outcomes related to health, well-being, experience of the care process, and cost were measured. The performance scores were measured in a study with a quasi-experimental design. Scores were analyzed using linear mixed methods. Performance scores for the outcomes were standardized and multiplied by their relative preferences to obtain the overall value scores in the MCDA.

Results
We found similar value scores for both care delivery models regarding physical functioning, psychological well-being, social relationships & participation, enjoyment of life, and total costs. The Bergen-model scored higher on continuity of care (0.733 versus 0.680), while the SoC-model scored higher on person-centeredness (0.772 versus 0.635). Overall value scores were marginally in favor of the MAR-Bergen (0.708 versus 0.705 for patients).

Conclusion
Acknowledging the significance of different life aspects emphasizes the need for integrated care at a specific level for people with opioid dependence. We conclude that the two highly effective treatment approaches produce promising outcomes in a challenging population and are quite similar. However, further research with more robust longitudinal data is needed.