bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outcomes of One-Stage Arthroscopic Ankle and Tibiotalocalcaneal Arthrodesis with External Fixation for Septic Ankle and Hindfoot Arthritis: A Case-Series Study
Authors: Li Ying , Li Wenjing 
Published: December 2024

Category: Hindfoot; Arthroscopy Introduction/Purpose: The occurrence of infection in the ankle and hindfoot presents a formidable surgical challenge. Currently, there is a lack of consensus regarding its treatment strategies. The purpose of this study is to investigate the outcomes of one-stage arthroscopic ankle and tibiotalocalcaneal (TTC) arthrodesis in the treatment of septic ankle and hindfoot arthritis. Methods: A retrospective consecutive case-series study was conducted involving 6 patients diagnosed with acute or chronic septic ankle or hindfoot arthritis, who underwent operative intervention entailing thorough debridement, arthroscopically assisted one-stage ankle or TTC fusion, and external fixation. The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and visual analog scale (VAS) pain score were determined preoperatively and at the final follow-up. Demographic and clinical data, inclusive of perioperative and postoperative complications, were recorded. Results: The study cohort comprised 2 males and 4 females, with a mean age of 48.7 years (range, 26-75) at the time of surgical intervention. At the final follow-up (mean, 26.5 months; range, 16-48), the AOFAS scores exhibited a significant improvement, ascending from an initial mean of 38.8 (range, 12-57) to 80.0 (range, 54-92) (P = .007). VAS scores indicated a substantial reduction in pain, decreasing from 6.5 (range, 4-9) to 0 (range, 0-5) (P = .046). All patients had achieved osseous consolidation, with an hindfoot infection control rate of 100%. Conclusion: One-stage arthroscopic ankle and TTC arthrodesis with external fixation stands as an effective therapeutic choice for septic ankle or hindfoot arthritis. This approach yields favorable outcomes characterized by effective infection control, favorable osseous consolidation, and significant functional restoration of the affected limb.
Outcomes of Pilon Fractures
Authors: Lundeen Anna , Anderson Sarah , Swenson Riley , Nguyen Mai 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Pilon fractures are debilitating injuries with consequences affecting patients long-term and require unplanned surgical interventions. Post-operative complications such as infection, non-union, and post traumatic osteoarthritis require unplanned surgical interventions and further worsen outcomes. The primary aim of this study was to determine survivorship of the native ankle joint through evaluation of subsequent procedures and complications. Methods: A retrospective chart review of pilon fractures was performed within a large healthcare system, including a level one trauma center, from 2010 to 2022. Patients with less than 6 months of follow-up were excluded. The primary outcome, survivorship of the native ankle joint, was determined by collecting ankle fusion, arthroplasty, and amputation data. Demographics, injury characteristics, and comorbidities (diabetes mellitus (DM), vascular disease, smoking status) were collected. Results: Our cohort included 386 patients with an average age of 48.5 years, 51.6% were male. 11.4% had DM and 45.1% were smokers. 61.4% had a high energy mechanism and 23.6% were open fractures. Patients had an average of 2.8 operations, including irrigation and debridement, ORIF, bone graft, free flap, hardware removal, and definitive management with arthrodesis, arthroplasty, and amputation. Nonunion, high energy, open fracture, and infection were all associated with unplanned procedures (p< 0.01). 31 patients lost their native ankle, with 11 ankle fusions, 6 total ankle arthroplasty, and 14 amputations. Infection was associated with ankle fusion and amputation (p< 0.01). Those with infection were 15.6x more likely to undergo fusion. Open fractures were associated with amputation (p< 0.01). Diabetes and vascular disease were associated with amputation (p< 0.05). Conclusion: This study demonstrates the burden pilon fractures place on patients, with an average of 2.8 operations per patient. With modern surgical technique, joint survivorship is likely for most patients at 92%. Notably, the presence of diabetes, vascular disease, open fracture, and infection were all significantly associated with loss of the native joint. Injury characteristics, such as high energy and open fractures, significantly affect the need for unplanned procedures following these devastating injuries.
Prospective Evaluation of Rate of Hindfoot/Ankle Fusion with Augment Injectable Bone Graft
Authors: Priester Jacob , Kreulen Christopher D. , Shaheen Phillip J. , Giza Eric , Simister Samuel 
Published: December 2024

Category: Hindfoot; Ankle Introduction/Purpose: Augment® Bone Graft is a mixture of rhPDGF-BB, beta-TCP and bovine collagen which has received FDA approval for use as a substitute for autografts during hindfoot and/or ankle arthrodesis. Although a recent meta analysis demonstrated that the rhPDGF-BB and beta-TCP mixture has comparable CT fusion rates and radiographic union rates to those of autografts, these studies excluded patients with prior joint site arthrodesis. In our study, we specifically use Augment® Injectable Bone Graft (AIBG) which has only very recently received labeling change approval. The goals of our study are to assess fusions rates in patients who receive AIBG during hindfoot and/or ankle arthrodesis, and then subsequently compare fusion rates between primary vs. revision hindfoot and/or ankle arthrodesis as primary outcomes. Methods: We prospectively enrolled patients aged 18-85 who underwent subtalar, calcaneocuboid, talonavicular, and/or ankle arthrodesis from one of two academic surgeons including both primary and revisions fusions. The patients received AIBG and were excluded if any other graft material was used. Demographic data and patient reported outcomes were collected preoperatively and at follow-up visits including Visual Analog Pain Scale (VAS), Foot Function Index (FFI), Foot and Ankle Ability Measure (FAAM) Sports Subscale, and Veterans Rand 12 (VR-12) physical and mental subscores. Patients were followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years postoperatively. The primary outcome measure was fusion rate via CT scan at 4 months with secondary outcomes consisting of the patient reported outcome data and rate of revisions. Results: 62 patients met inclusion criteria, 50 patients had a 4-month postoperative CT scan to assess for fusion with 78% of the CT scans (39 out of 50) demonstrating fusion at that time. There were only 3 revision fusion patients, with 1 of the 3 failing to fuse. 54 of the patients were followed through their 6 month visits, 44 patients through 1 year, and 24 patients were seen for their 2-year follow-up visit. All patient reported outcomes demonstrated improvement from preoperatively to final follow-up with VAS, FFI, FAAM, and VR12 showing statistically significant improvement. Conclusion: This prospective study demonstrates that Augment® Injectable Bone Graft is an acceptable alternative to allograft for either primary or revision hindfoot arthrodesis procedures with 78% of patients achieving fusion on a 4-month postoperative CT scan and with steady noted improvement in multiple validated patient-reported outcome measures. Long term follow up data is being collected.
Prospective Examination of Outcomes Following Implantation with 3D Printed Custom Total Talus for Talar Avascular Necrosis
Authors: Morningstar Joshua L. , Scott Daniel J. , Gross Christopher E. 
Published: December 2024

Category: Hindfoot; Ankle Introduction/Purpose: End stage talar avascular necrosis (AVN) is a difficult diagnosis to manage clinically. Management options will vary based on severity and functional goals with current treatments including conservative measures, hindfoot fusions, and total talus replacement (TTR). The induction of three-dimensional (3D) printing and computer-aided design (CAD) into orthopaedic surgery has increased the ability to treat this complex pathology through patient specific 3D printed talus replacements, while sacrificing less range of motion than joint fusions. This purpose of this study is to report prospectively collected clinical and patient reported outcome measures (PROMs) of patients implanted with a custom 3D printed TTR in a multi-institutional prospective study. Methods: Patients presenting to clinic for talar avascular necrosis at one of 8 institutions were prospectively enrolled and implanted with a custom 3D printed total talus replacement at both academic and private settings. Patients had demographics, range of motion (ROM), and PROMs collected preoperatively, at 6 weeks, 3 months, 6 months, and 12 months. PROMs included VAS pain score and Foot and ankle outcome score (FAOS). Adverse events were analyzed in patients with minimum 6 weeks of follow-up and the preoperative and follow-up PROMs for patients with minimum 6-month follow-up were analyzed. A total of 18 subjects (17 patients) were enrolled in the study, with all subjects reaching 6 weeks minimum follow-up and 10 patients achieving 6 months of follow-up. Results: The cohort was majority male (55.6%) with mean age 46.8±14.65 years and BMI 33.5±7.25 kg/m2. There were no adverse events related directly to the implant at 6-week follow-up. However, there were 2 serious adverse events (complications) documented, one case of wound dehiscence at 5 weeks postoperatively, and one deep wound infection at 2 weeks postoperatively. Subjects pain scores improved at 6 months postoperatively, with VAS scores statistically significantly decreasing (31.3 ± 31.83 points; p=.0222). All FAOS subscales showed significant improvement from preoperative to 6 months postoperatively with the greatest change coming in FAOS QOL (39.8 ± 28.06; p<.0001) followed by FAOS Pain (29.4 ± 25.13; p=.0004). (Table 1) Additionally, at 6 months postoperatively, 90% of patients indicated good or excellent satisfaction. Conclusion: Implementation of custom 3D printed total talus replacement was found to have low rates of short-term adverse events and proved to be safe and effective for the treatment of end stage avascular necrosis. Patients were largely satisfied at 6 months postoperatively and showed considerable
Racial Disparities in Outcomes after Foot and Ankle Surgery: A Systematic Review and Meta-Analysis
Authors: Buchanan Scott , Luo Emily Joan , Bagheri Kian , Wu Kevin , Anastasio Albert T. , Adams Samuel B. 
Published: December 2024

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: The literature demonstrating outcomes after foot and ankle surgery has traditionally focused on clinical and functional outcomes. Recent interest has increased regarding the contribution of racial and ethnic factors on outcomes after foot and ankle surgery. However, the existing research is limited. The purpose of this systematic review and meta-analysis was to evaluate outcome metrics based on race and ethnicity after foot and ankle surgery. Methods: Outcomes after foot and ankle surgery based on race and ethnicity were searched in MEDLINE, Embase, Cochrane, Web of Science, SportsDISCUS, and Scopus from the date of inception to March 23, 2023. Inclusion criteria consisted of studies that directly evaluated the outcomes of race or ethnicity on foot and ankle surgery, including the risk or need for an index procedure. Manuscripts in non-English languages and isolated abstracts were excluded. We collected Visual Analog Scale (VAS), Patient-Reported Outcomes Information System (PROMIS) pain scale, and Short Musculoskeletal Function Assessment (SMFA) from the included studies for pooled meta-analysis. Results: The literature search identified 33 relevant studies from an initial pool of 3,451 references. These studies included a diverse demographic of 557,734 patients, assessing outcomes in foot and ankle surgery across various racial and ethnic groups. Due to heterogeneity in outcome reporting, only six studies were included in the finalmeta-analysis. Functional scores from the VAS, PROMIS pain scale, and SMFA varied in their assessment of pain and functional outcomes based on ethnicity. Resource utilization studies indicated disparities in the rates of surgical fixations and arthroplasties based on race. Conclusion: Non-White and minority patients exhibited higher rates of foot and ankle fractures, lower limb surgeries, worse functional outcomes, increased pain, longer hospital stays, and a higher incidence of complications compared to their White counterparts. While consistent with existing literature in various orthopaedic specialties, some studies contradicted these findings, suggesting the need for further research to better understand these discrepancies.
Radiographic Soft Tissue Thickness Is Not a Risk Factor for Infection after Primary Total Ankle Arthroplasty
Authors: Anastasio Albert T. , Wu Kevin , Kutzer Katherine , Krez Alexandra , DeOrio James K. , Easley Mark E. , Nunley James A. , Adams Samuel B. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: Total ankle arthroplasty (TAA) is a commonly performed surgical procedure to address end-stage arthritis. Previous studies have suggested that the radiographic soft tissue thickness may be a predictor of complications including periprosthetic joint infection (PJI) after orthopedic surgery. However, there has been limited studies exploring the use of radiographic soft tissue thickness in TAA. The purpose of this study was to evaluate the predictive capabilities of radiographic soft-tissue thickness for PJI following TAA. Methods: A retrospective analysis of 323 patients at a single institution who underwent primary TAA from 2003 to 2019 was conducted. Patient characteristics, including age, sex, body mass index (BMI), and comorbidities such as diabetes, smoking status, and etiology of ankle injury were recorded. Preoperative radiographic measurements, including the Tibial-Tissue and Talus-Tissue distances were recorded. Other perioperative information included prosthesis type, tourniquet time, and time to last follow-up. Logistic regression was utilized to examine the relationship between these factors and the occurrence of PJI. Results: Of the 323 patients, there were 6 patients (1.86%) who developed a PJI. The logistic regression analysis revealed that neither Tibial-Tissue (Odds Ratio: 0.975 [0.947 - 1.004]; p = 0.09) nor Talus-Tissue thickness (Odds Ratio: 0.976 [0.940 - 1.012]; p = 0.18) were significant predictors of PJI. Although not statistically significant, the infected cohort had smaller average Tibial-Tissue (2.20 vs. 2.53 cm; p=0.05) and Talus-Tissue thickness (2.19 vs. 2.44 cm; p=0.36) compared to the non-infected cohort. Conclusion: Despite an association between radiographic soft tissue thickness and infection in other orthopedic surgeries, measurements such as Tibial-Tissue length and Talus-Tissue length were not significant predictors of PJI following primary TAA. These findings underscore the necessity for additional research to identify modifiable risk factors aimed at reducing PJI rates and enhancing patient outcomes.
Real-world treatment patterns and health care resource use for patients with myelofibrosis: results from the METER study
Authors: Gupta Vikas , Tomuleasa Ciprian , Barranco Lampón Gilberto Israel , Hou Hsin-An , Helbig Grzegorz , Vachhani Pankit , Symeonidis Argiris , Haznedaroglu Ibrahim , Galvez Kenny , Tatsch Fernando , Chopra Avijeet S. , Zhang Meng , Vizkelety Tamas , Murray Bryan , Ross David M. 
Published: December 2024

Abstract
Myelofibrosis (MF), a myeloproliferative neoplasm, was most commonly treated with hydroxyurea (HU) before approval of ruxolitinib (RUX), now the standard of care. Factors that influence real-world MF treatment patterns are not well understood. The METER study was a multi-country, retrospective chart review of MF treatment patterns, treatment effectiveness, and health care resource utilization. Of 997 eligible patients, 65.9% had primary MF, and 11.7% were transfusion dependent. Median time from diagnosis to the start of initial treatment (index date) was 29 days (interquartile range [IQR], 1-140). RUX was the most common first-line (1L) therapy (49.0%), followed by HU (40.2%); 48.5% of patients remained on 1L therapy through week 156. Seventy-seven patients underwent allogeneic stem cell transplantation; transplantation was uncommon at 1L, increasing from 2.2% at week 24 to 11.0% at week 156 in patients ≤70 years of age. Median overall survival was 79.1 months (95% confidence interval [95% CI], 70.8 to not estimable [NE]) in all patients, 142.3 months (95% CI, 74.1 to NE) for non-RUX patients, 77.6 months (95% CI, 64.2-85.9) for patients on RUX 1L therapy, and 72.6 months (95% CI, 62.0 to NE) for RUX 2L+ patients. Of patients who experienced ≥1 corresponding event, the median hospital length of stay (LoS; n = 520), intensive care unit LoS (n = 71), and number of transfusions (n = 375) were 16 days (IQR, 7-37), 5 days (IQR, 2-13), and 12 (IQR, 4-26), respectively. Despite improvements, there were numerous hospitalization and transfusion events among these patients in routine practice. This trial was registered at www.ClinicalTrials.gov as #NCT05444972.
The interplay of factors in metabolic syndrome: understanding its roots and complexity
Authors: Islam Md. Sharifull , Wei Ping , Suzauddula Md , Nime Ishatur , Feroz Farahnaaz , Acharjee Mrityunjoy , Pan Fan 
Published: December 2024

AbstractMetabolic syndrome (MetS) is an indicator and diverse endocrine syndrome that combines different metabolic defects with clinical, physiological, biochemical, and metabolic factors. Obesity, visceral adiposity and abdominal obesity, dyslipidemia, insulin resistance (IR), elevated blood pressure, endothelial dysfunction, and acute or chronic inflammation are the risk factors associated with MetS. Abdominal obesity, a hallmark of MetS, highlights dysfunctional fat tissue and increased risk for cardiovascular disease and diabetes. Insulin, a vital peptide hormone, regulates glucose metabolism throughout the body. When cells become resistant to insulin’s effects, it disrupts various molecular pathways, leading to IR. This condition is linked to a range of disorders, including obesity, diabetes, fatty liver disease, cardiovascular disease, and polycystic ovary syndrome. Atherogenic dyslipidemia is characterized by three key factors: high levels of small, low-dense lipoprotein (LDL) particles and triglycerides, alongside low levels of high-density lipoprotein (HDL), the “good” cholesterol. Such a combination is a major player in MetS, where IR is a driving force. Atherogenic dyslipidemia contributes significantly to the development of atherosclerosis, which can lead to cardiovascular disease. On top of that, genetic alteration and lifestyle factors such as diet and exercise influence the complexity and progression of MetS. To enhance our understanding and consciousness, it is essential to understand the fundamental pathogenesis of MetS. This review highlights current advancements in MetS research including the involvement of gut microbiome, epigenetic regulation, and metabolomic profiling for early detection of Mets. In addition, this review emphasized the epidemiology and fundamental pathogenesis of MetS, various risk factors, and their preventive measures. The goal of this effort is to deepen understanding of MetS and encourage further research to develop effective strategies for preventing and managing complex metabolic diseases.
Investigating the inflammatory mechanism of notoginsenoside R1 in Diabetic nephropathy via ITGB8 based on network pharmacology and experimental validation
Authors: Li ChangYan , Geng Chen , Wang JiangMing , Shi Luyao , Ma JingYuan , Liang Zhang , Fan WenXing 
Published: December 2024

Abstract
Background
Diabetes often causes diabetic nephropathy (DN), a serious long-term complication. It is characterized by chronic proteinuria, hypertension, and kidney function decline, can progress to end-stage renal disease, lowering patients’ quality of life and lifespan. Inflammation and apoptosis are key to DN development. Network pharmacology, clinical correlation, and basic experimental validation to find out how NGR1 might work to reduce inflammation in DN treatment. The study aims to improve DN treatment with new findings.

Methods
To determine how NGR1 treats DN, this study used network pharmacology, clinical correlation, and basic experimental validation. Three methods were used to predict NGR1 drug targets: ChEMBL, SuperPred, and Swiss Target Prediction. Drug targets are linked to diseases by molecular docking. A clinical correlation analysis using the Nephroseq Classic (V4) database looked at the strong link between medication targets and the development, progression, and renal function of DN. Additional research showed that NGR1 reduces high blood sugar-induced podocyte inflammation.

Results
The integrin subunit beta 8 (ITGB8) protein is a potential NGR1 therapeutic target for DN. It may be linked to inflammatory proteins like caspase 3 and IL-18. Validation of the molecular docking showed that SER-407, ALA-22, Ala-343, and TYR-406 form hydrogen bonds with NGR1 and ITGB8. These interactions represent pharmacodynamic targets. Clinical correlation showed that DN patients had significantly lower ITGB8 expression levels than healthy individuals. Between 50 and 80 years old, DN patients’ ITGB8 expression levels decreased. ITGB8 expression was lowest in renal function conditions, with eGFR values of 15–29 ml/min/1.73 m2. In the db/db mouse model, downregulation of ITGB8 expression in renal tissue was associated with renal inflammatory damage. The hyperglycemic group had significantly lower levels of nephrin and caspase-3 protein, but higher levels of cleaved caspase-1 protein. Giving NGR1 in different amounts (1, 3, 10, and 30 µM) greatly decreased the expression of caspase3, stopped the expression of cleaved caspase1, and lowered the damage caused by NLRP3 in podocytes.

Conclusion
We identified several NGR1 pharmacological targets and found that the ITGB8 protein is a key drug target linked to inflammation and DN. ITGB8 is critical for DN development and can help to reduce high blood sugar-induced podocyte inflammation.
Liner Damage Analysis for Hydrogen Storage Vessels Subjected to Local Compressive Loads Using the Submodeling Method
Authors: Liu Wen , Zhang Lele , Chen Geng , Zhu Yu , Ruan Baofeng 
Published: December 2024

AbstractWhen a hydrogen storage vessel is subjected to a local impact load, damage may occur in the liner and result in hydrogen leakage and other catastrophic consequences. When predicting liner damage of a hydrogen storage vessel using the finite element method (FEM), although large element size is required to achieve a desired computational efficiency, it oftentimes causes inaccuracy in the damage model. To remedy this problem, in this study a novel approach which calculates the material damage based on the GISSMO (Generalized Incremental Stress State dependent damage Model) damage model and employs a submodeling strategy is proposed. According to this approach, the global model is discretized to large elements to increase the efficiency, while the submodel is meshed to much smaller elements to accurately reflect the material damage. Employing the established approach and material parameters calibrated from a large set of notched aluminum alloy 5083 specimens, the liner damage of a type III hydrogen storage vessel subjected to a local compressive load was simulated. This way, the study reveals how the characteristics of the stress and material damage interact with each other. In addition, the study also demonstrates that the proposed approach can be used as a viable means to evaluate the damage within hydrogen storage vessels.