bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Hypertrophic Distal Fascicle of the Anterior Tibiofibular Ligament is Associated with a High Rate of Osteochondral Lesions of the Talus
Authors: Butler James J. , Randall Grace W. , Dalmau-Pastor Miki , Lin Charles , Schoof Lauren , Kennedy John G. 
Published: December 2024

Category: Ankle; Arthroscopy Introduction/Purpose: A hypertrophic distal fascicle of the anterior tibiofibular ligament (ATiFLdf) is commonly encountered in patients with anterior ankle impingement. Repetitive snapping of the hypertrophic ATiFLdf has the potential to create osteochondral lesions (OCLs) at the lateral talar dome. However, the clinical manifestations of these OCLs in the setting of a hypertrophic ATiFLdf has not been described to date. The purpose of this retrospective review was to determine the prevalence of OCLs of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic ATiFLdf. In addition, we sought to evaluate the anatomy of the ATiFL to fully elucidate its role in creating chondral wear of the talus. Methods: Retrospective chart review identified 40 patients who underwent arthroscopy of the anterior ankle joint for the management of anterior ankle impingement. Pre-operative magnetic resonance imaging (MRI) scans were obtained and correlated with intra-operative arthroscopic findings. Clinical outcomes assessed included: pre- and post-operative foot and ankle outcome score (FAOS), visual analog scale (VAS), complications, failures, secondary surgical procedures, return to work data and return to sport data. Results: Thirty-two patients with a mean follow-up time of 29.3±10.4 months were included. The ATiFLdf was hypertrophic in 29 patients (90.6%), the mean thickness of which was 2.5±0.4 mm. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic ATiFLdf visualized during arthroscopy. The international cartilage repair society gradings of the lesions included: 3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from pre-operative to post-operative (p< 0.001). No cases of syndesmotic instability were observed following resection of ATiFLdf. The mean post-operative Likert score was 4.1±0.4. There were 5 failures (15.6%) at a mean time of 9.0±4.7 months. Conclusion: This retrospective case series demonstrated that a hypertrophic ATiFLdf was closely associated with the development of an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, pre-operative MRI proved to demonstrate poor sensitivity for the detection of these OCLs. Suspicion should be raised for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf. Figure 1. (a) Hypertrophic ATiFLdf with associated OCL of the lateral talar dome; (b) Biter resecting hypertrophic ATiFLdf; (c) Resected hypertrophic ATiFLdf; (d) and (e) Hypertrophic ATiFLdf identified on coronal and axial MRI scans
Acute Achilles Tendon Ruptures: How Well Can Artificial Intelligence Chatbots Answer Patient Inquiries?
Authors: Dzieza Wojciech , Hampton Hailey , Farmer Kevin , Roach Ryan , Kwon John Y. , Toussaint Rull J. 
Published: December 2024

Category: Sports; Trauma Introduction/Purpose: Artificial intelligence (AI) chatbots have recently gained popularity as a source of information that can be easily accessed by patients given their human-like responses to prompts and questions. Within orthopaedics, the treatment of acute Achilles tendon ruptures is not uniform due to varying surgical repair techniques, postoperative protocols, and nonoperative treatment options dependent on surgeon preference and patient factors. Given that patients are increasingly turning toward AI for questions about medical diagnoses and treatment options, our study looked to compare the adequacy of AI chatbot responses to frequently asked questions regarding acute Achilles tendon ruptures. Methods: Three popular AI platforms (ChatGPT, Google Gemini, and Microsoft Bing AI) were prompted for a concise response to ten commonly asked questions regarding Achilles tendon rupture management (Table 1). Four board-certified subspecialty-trained orthopaedic surgeons (two in foot and ankle, two in sports medicine) were asked to assess the value of the AI response using a four-point scale (1 – satisfactory; 2 – satisfactory requiring minimal clarification; 3 – satisfactory requiring substantial clarification; 4 – unsatisfactory). A Kruskal-Wallis test was used to compare the responses between the three AI platforms using the scores assigned by the surgeons. Results: All three AI chatbots provided comparable answers to 7 of 10 questions (70%). Of all the responses (30 total), only two (6.7%) had a mean rating of 3 or higher. Significant differences were noted between the AI systems for questions 4 [H(2) = 7.258, p = .027], 7 [H(2) = 6.308, p = .043], and 10 [H(2) = 6.796, p = .033]. Post hoc analyses revealed Bing AI had significantly worse scores as compared to ChatGPT for all three of these questions. Conclusion: AI chatbots can appropriately answer concise prompts about the diagnosis and management of acute Achilles tendon ruptures often sought out by patients prior to or after evaluation by an orthopaedic surgeon. The responses provided by the three AI chatbots analyzed in our study were uniform and satisfactory, with only one of the platforms scoring worse on three of the ten questions. As AI chatbots advance, they will become a valuable tool for patient education in orthopaedics. Future studies will be needed to assess performance as new AI chatbots develop and large language models continue to evolve. Table 1: List of 10 selected frequently asked questions regarding acute Achilles tendon ruptures
Analysis of Predictor Factors and Comorbidities About Lower-Extremity Repetitive Amputation in Diabetic Foot Ulcer and Infection: A Retrospective Study
Authors: Hwang Yeokgu 
Published: December 2024

Category: Diabetes Introduction/Purpose: About 12-25% of diabetic patients had foot ulcers during their lifetime, which has been reported in several studies that not only reduce the quality of life but also increase the risk of amputation due to infection and increase mortality. However, there are insufficient studies on risk factors and comorbidities on re-amputation due to uncontrolled infection and necrosis after amputation. Therefore, the purpose of this study is to investigate the predictors of lower-extremity amputation or re-amputation in diabetic foot ulcer patients and the effects of comorbidities. Methods: Among the patients who underwent amputation or re-amputation for diabetic foot ulcer at a single institution from April 2019 to March 2021, 60 cases, who were followed up for at least 1 year, were investigated. The group that underwent amputation and the group that had more than one amputation were divided into two groups, and the clinical characteristics and comorbidities of each group were comparatively evaluated. Clinical factors were Wagner stage, the anatomical level of the amputation, the presence or absence of osteomyelitis in radiology, glycated hemoglobin, the difference in results according to the bacterial culture test, and the presence or absence of peripheral blood vessel occlusion, and the reperfusion procedure. Results: The average follow-up period was 12.7 (6-24 months), and the higher the Wagner stage, the higher the rate of re-amputation was statistically significant (OR 1.8, 95%CI 1.4 to 2.4; p=.001). The rate of re-amputation was significantly higher in the group that failed to re-perfuse peripheral blood vessels preoperatively than in the group that succeeded (OR 7.4, 95% CI 2.0 to 27.5; p=.003). Uncontrolled diabetes was confirmed by glycated albumin was predicted the need for repetitive amputation (OR 1.08, 95% CI 0.8 to 2.7; p=.001). In addition, there was a high rate of re-amputation in diabetic foot ulcers and infections identified by polymicrosomal infection. (OR 8.4, 95% CI 1.0 to 69.5; p=.026) Conclusion: In patients with diabetic foot ulcers and severe infections, who have a peripheral vascular obstruction, which failed vascular intervention, and who had high glycated albumin was performed from the initial amputation below the major joint in the proximal lower extremity, resulting in reduced patient mortality and morbidity. In addition, the results of the treatment varied depending on the infected bacteria. Re-amputation free survival of diabetic foot ulcer Kaplan-Meier curves for reamputation-free survival of diabetes patients with diabetic foot ulcers over 3 year, depending on enterococal infection (log-rank test p= 0.03).
Analysis of Racial, Ethnic, and Gender Trends in Foot and Ankle Fellowships from 2007 to 2022
Authors: Narendra Hiredesai Annika , Holle Alejandro M. , Lin Eugenia , Moore M. Lane , Patel Karan 
Published: December 2024

Category: Other Introduction/Purpose: Racial and gender disparities in the field of orthopedic surgery are well-documented in the literature. A diverse population of physicians and surgeons is imperative to foster progress in our field and improve the quality of the care provided to patients. To further address disparities within the field of orthopedic surgery, further analysis of demographic composition at various career timepoints is warranted. The purpose of this study was to describe the historical demographic composition of fellows, including race, ethnicity, and gender, within the subspecialty of orthopedic foot and ankle from 2007 to 2022. Methods: Gender, race, and ethnicity data were collected from the Accredited Council for Graduate Medical Education (ACGME) annual data resource books for all years available. Published data points included the total number of fellows, race and ethnicity (White, Asian, Hispanic, Latino or of Spanish origin, Black or African American, American Indian or Alaskan Native, Native Hawaiian or Pacific Islander, Multiple Race/Ethnicity, Other, and Unknown), and gender (male, female, and not reported). Percentage equivalents for racial and ethnic groups from 2011 to 2022 and gender groups from 2007 to 2022 were calculated. Trends in representation were analyzed by calculating Sen’s slope — the median of slopes calculated between all possible pairs of time points – to reduce sensitivity to outliers. Results: During the 12-year period, White, Asian, Hispanic, and Black fellows represented on average 80.7%, 14.7%, 1.9%, and 2.3%, respectively. Fellows that identified as Hispanic and Black were underrepresented throughout the study period, with several years of no representation. Male trainees made up the majority of foot and ankle trainees throughout the 15-year period, averaging 79.5%. There were no female foot and ankle fellows from 2007 to 2008. We found no significant trends (p > 0.05) in representation for any racial, ethnic, or gender group across the study period. Conclusion: Our analysis shows a persistent underrepresentation of racial and ethnic minorities and women among foot and ankle trainees. Racial and ethnic minority representation was below that of other orthopedic subspecialties. Female representation, while among the highest among orthopedic fellowships, falls short of parity and is in line with the current female orthopedic surgery resident representation. Targeted efforts are required to improve representation among foot and ankle orthopedic surgeons moving forward. Strategies should consist of early mentorship and exposure, continued career promotion, and, ultimately, retention within the field of orthopedic surgery.
Anatomic, Radiographic, and Ultrasound Correlation for Therapeutic Treatment of Heel Pain
Authors: Albert Kuechly Henry , Kurkowski Sarah , Gerak Samuel , Thimmesch Michael , Grischy Robbie , Laughlin Richard T. 
Published: December 2024

Category: Ankle; Sports Introduction/Purpose: Entrapment of the First Branch of the Lateral Plantar Nerve (FBLPN), also known as Baxter’s Nerve (BN), has been identified as a cause of plantar heel pain in up to 20% of cases. Treatments for entrapment of the FBLPN often involve ultrasound guidance to ensure accurate placement of the treatment or injection. Knowledge of the gross anatomy of neurovascular structures is required to facilitate accurate placement of the therapeutic treatment. The purpose of this study was to utilize radiography to describe the course of the FBLPN relative to palpable anatomic landmarks that can be used to guide ultrasound interventions for plantar heel pain. Methods: Ten preserved feet from five cadaveric donors were dissected beginning with an incision 25 cm proximal to the medial malleolus. The skin and soft tissues were carefully dissected to identify the origin of the lateral plantar nerve and FBLPN. A radiopaque wire was inserted distally in each of the two nerves and a lateral radiograph was obtained. (Figure 1) A line designated as the malleolar-calcaneal (MCN) line was drawn from the center of the medial malleolus (point A) to the most distal tip of the calcaneus (point B). The distance between the point at which the FBLPN intersected the MCN line (point C) and the origin of the FBLPN (point D) was measured in millimeters. Using the MCN line, the distance from the medial malleolus (point A) to the point at which the FBLPN transected the MCN line (point C) was measured in millimeters. Results: In all ten cases, the FBLPN arose proximal to the malleolar-calcaneal line and originated directly from the lateral plantar nerve. The average distance from the malleolar-calcaneal line to the origin of the FBLPN was 25.70 ± 19.56 mm with a range of 10mm to 76mm. The average distance between the medial malleolus and the intersection of the FBLPN and the MCN line was 65.90 ± 33.80mm with a range of 15mm to 138mm. Conclusion: Plantar heel pain is a common reason to visit the orthopedic clinic and entrapment of the FBLPN is a common etiology for this pain. Treatments for entrapment of the FBLPN such as radiofrequency ablation and steroid injections rely on precise placement of the probe or needle in order to maximize therapeutic benefit and minimize side effects. Bony landmarks which are palpable on the patient’s intact skin such as the center of the medial malleolus and the distal tip of the calcaneus can serve to identify the likely course of the FBLPN. Lateral radiograph of a right foot Point A: center of the medial malleolus, Point B: Distal Calcaneus, Point C: intersection of the First Branch of the Lateral Plantar Nerve and the Malleolar-Calcaneal line, Point D: origin of the First Branch of the Lateral Plantar Nerve. Line A-B: Malleolar-Calcaneal line.
Are Large Language Models Efficient as Triage Tools for Surgical Management of Foot and Ankle Patients?
Authors: Lintz François , Acker Antoine , Carvalho Kepler A.M. , Labidi May , Gonzi Gianluca , Munoz Marie-Aude , Joan Luo Emily , Bernasconi Alessio , Easley Mark E. , Cesar Netto Cesar de 
Published: December 2024

Category: Other; Basic Sciences/Biologics Introduction/Purpose: Large Language Models (LLMs) like ChatGPT and Bard have emerged as potential but not risk-less tools in science, offering specialized answers to queries based on elements of context. In Foot and Ankle (FA) surgery, efficient triage is crucial due to the variety of conditions and limited surgical time. This study evaluates LLMs' ability to guide patients towards appropriate medical or surgical management compared to a panel of board certified FA surgeons. Methods: Forty-four fictitious clinical scenarios were created, incorporating chronicity, onset, and anatomic localization. Outcomes were assessed on a Likert scale (1-5) for the likelihood of needing surgical management, alongside the 3 most probable diagnoses and 2 indicated imaging modalities. Two FA surgeons and the LLMs ChatGPT and Bard were evaluated, with agreement analyzed using Fleiss' and Cohen's Kappas. Results: Initial Likert scale agreement (Fleiss' Kappa) was 0.233, indicating low concordance. Recategorizing outcomes into binary (surgical vs. medical orientation of patients) improved agreement to fair (0.423). Pairwise comparison using Cohen's Kappa showed slight to moderate agreement among LLMs and surgeons, with Bard aligning more closely with surgeons (77.27% agreement) than ChatGPT. Conclusion: LLMs show promise in FA triage but require refinement for clinical reliability. Bard's higher surgeon agreement suggests some models may better capture clinical judgment nuances. Future research should enhance LLM interpretive algorithms and explore their supportive role in medical decision-making.
Case Report: Complex Regional Pain Syndrome Involving the Head and Face After Severe Malignant Otitis Media and Mastoiditis
Authors: Collins Hunter 
Published: December 2024

Background Complex regional pain syndrome (CRPS) is a rare condition characterized by intense chronic pain, vascular changes, swelling, and trophic changes leading to significant morbidity. It is often related to crush/mechanical injury or surgery and most commonly affects the limbs. There have only been a few rare documented cases affecting the head and face, and more scarce are CRPS cases of the head and face unrelated to trauma. Case We report a 79-year-old woman referred to Neurology after three months of severe, persistent left-sided head and face pain associated with discrete episodic swelling and localized autonomic symptoms, skin and hair changes in the affected area, following severe otitis media complicated by mastoiditis. Her history and neurologic exam did not meet a categorical diagnosis based on criteria in The International Classification of Headache Disorders-3rd edition and International Classification of Orofacial Pain, 1st edition but her symptoms and signs met the Budapest Criteria (BC) for a diagnosis of CRPS of the head and face. The patient had been on carbamazepine with only marginal benefit. After the initial Neurology evaluation, she started duloxetine and was referred for mirror visual feedback therapy. During an acute attack, she had a very good response to a sphenopalatine ganglion block and compounded intranasal and topical lidocaine-ketamine preparations were adjunctively added. Eleven months after initial symptom onset, she reported significant symptomatic improvement with markedly decreased disability and return to her premorbid quality of life. Conclusion Complex regional pain syndrome is difficult to recognize, there are no diagnostic tests, there is no definitive cure and management is symptomatic. Early identification and treatment may prevent significant morbidity and we recommend review and classification of such cases using the BC.
Endothelial-specific deletion of connexin 43 improves renal function and structure after acute kidney injury
Authors: Genest Magali , Kinugasa Satoshi , Roger Elena , Boutin Louis , Placier Sandrine , Figueroa Stefanny , Dorison Aude , Hadjadj Safia , Baba Ines , Gautier Emmanuel L. , Kavvadas Panagiotis , Chatziantoniou Christos , Chadjichristos Christos E. 
Published: December 2024

Abstract
Background
We have previously reported that the gap junction protein connexin 43 (Cx43) was upregulated in chronic renal disease in humans and rodents and plays a crucial role in the progression of experimental nephropathy. In this study, we investigated its role after renal ischemia/reperfusion (rIR), which is a major mechanism of injury in acute renal injury (AKI) and renal transplant graft dysfunction.

Methods
Wild-type mice (WT) and mice in which Cx43 expression was genetically reduced by half (Cx43 ±) were unilaterally nephrectomized. The left renal artery was subsequently clamped, with reperfusion of varying duration. Mice with tubular- or endothelial-specific deletion of Cx43 were also used to assess the effect of this connexin in each cell type after rIR. Kidneys were assessed for histological evaluation, immunohistochemistry, and RT-PCR.

Results
Blood urea nitrogen and creatininemia were progressively elevated in WT mice and picked up 48 h after rIR. At the same time point, severe tubular necrosis and dilation occurred in the cortico-medullary junction of the injured kidneys with accompanying massive neutrophil infiltration. Interestingly, Cx43 expression was progressively increased within the tubulointerstitial compartment during kidney damage progression and was paralleled closely by that of markers of renal dysfunction. Cx43 ± mice showed fewer tubular lesions, less inflammation, and further improved renal function. Similar results were observed in mice where Cx43 was specifically deleted within the vascular endothelium. In contrast, Cx43 deletion in renal tubules did not significantly improve renal structure and function after rIR.

Conclusion
Our findings suggest that endothelial Cx43 plays a crucial role in AKI.
Targeting programmed cell death in diabetic kidney disease: from molecular mechanisms to pharmacotherapy
Authors: Liu Fengzhao , Yang Zhenyu , Li Jixin , Wu Tao , Li Xiangyu , Zhao Lijuan , Wang Wenru , Yu Wenfei , Zhang Guangheng , Xu Yunsheng 
Published: December 2024

AbstractDiabetic kidney disease (DKD), one of the most prevalent microvascular complications of diabetes, arises from dysregulated glucose and lipid metabolism induced by hyperglycemia, resulting in the deterioration of renal cells such as podocytes and tubular epithelial cells. Programmed cell death (PCD), comprising apoptosis, autophagy, ferroptosis, pyroptosis, and necroptosis, represents a spectrum of cell demise processes intricately governed by genetic mechanisms in vivo. Under physiological conditions, PCD facilitates the turnover of cellular populations and serves as a protective mechanism to eliminate impaired podocytes or tubular epithelial cells, thereby preserving renal tissue homeostasis amidst hyperglycemic stress. However, existing research predominantly elucidates individual modes of cell death, neglecting the intricate interplay and mutual modulation observed among various forms of PCD. In this comprehensive review, we delineate the diverse regulatory mechanisms governing PCD and elucidate the intricate crosstalk dynamics among distinct PCD pathways. Furthermore, we review recent advancements in understanding the pathogenesis of PCD and explore their implications in DKD. Additionally, we explore the potential of natural products derived primarily from botanical sources as therapeutic agents, highlighting their multifaceted effects on modulating PCD crosstalk, thereby proposing novel strategies for DKD treatment.