bluuebunny/crossref_metadata_2025_split huggingface dataset:
Change in Grip and Pinch Strength Over the Course of a Game in Professional Baseball Pitchers
Authors: Erickson Brandon J. , Buchheit Paul , Rauch Joseph , Ciccotti Michael G. , Paul Ryan , Cohen Steven B. 
Published: December 2024

Background: Baseball pitching injuries can be related to fatigue. Changes in grip and pinch strength over the course of professional baseball games are unknown. Hypothesis: Grip and pinch strength will decrease as the number of innings pitched increases; injured pitchers will have a lower grip strength than uninjured pitchers. Study Design: Prospective cohort study. Level of Evidence: Level 3. Methods: Minor league pitchers for 1 affiliate of a single organization were included. Changes in dominant and nondominant grip, and middle and index finger pincer strength were recorded pregame and after each inning, and compared between players who sustained a shoulder/elbow injury and those who did not. Results: Of 41 pitchers included, 6 sustained a shoulder (n = 2) or elbow (n = 4) injury during the study period. Average grip strength for all pitchers was 124.5 ± 17 lb pregame and increased slightly after the first inning (125.2 ± 17 lb), then declined slowly after the second (120.7 ± 18.5 lb), third (119.2 ± 24 lb), and fourth (113.1 ± 19.6 lb) innings. There was a slight uptick in grip strength in the fifth (118.5 ± 23.6 lb) and sixth (121.3 ± 21.8 lb) innings, but pregame levels were not reached. Evaluating uninjured and injured pitchers, the grip strength of injured pitchers was lower at all timepoints. As a percentage of uninjured pitchers grip strength, injured pitcher grip strength was 94.8% pregame, and 97.9%, 95.4%, 81.8%, 87.7%, 82.3%, and 74.5% after the first to sixth innings, respectively. Conclusion: Dominant arm grip strength generally declined over the course of a game in professional baseball pitchers. Injured pitchers generally had weaker grip strength and a steeper decline in grip strength during games compared with uninjured pitchers. Clinical Relevance: Incremental loss of grip strength may increase injury risk in professional baseball pitchers.
Clinical utility of plasma microbial cell-free DNA sequencing in determining microbiologic etiology of infectious syndromes in solid organ transplant recipients
Authors: Shah Jesal R. , Sohail Muhammad Rizwan , Lasco Todd , Goss John A. , Mohajer Mayar Al , Khalil Sarwat 
Published: December 2024

Background: Metagenomic next-generation sequencing (mNGS) is increasingly being used for microbial detection in various infectious syndromes. However, data regarding the use of mNGS in solid organ transplant recipients (SOTR) are lacking. Objectives: To describe and analyze real-world clinical impact of mNGS using plasma microbial cell-free DNA (mcfDNA) in SOTR. Design: Retrospectively reviewed all adult SOTR who underwent mNGS testing using plasma mcfDNA at Baylor St Luke’s Medical Center from March 2017 to February 2023. Methods: Clinical impact (positive, neutral, and negative) was assessed using standardized objective criteria. Three Infectious Diseases physicians independently performed clinical adjudication to determine the correlation of mcfDNA results with clinical diagnosis. A descriptive analysis of the patient and clinical characteristics was performed. Results: A total of 113 mcfDNA tests in liver (42%), kidney (35%), lung (20%) and heart (13%) transplant recipients were performed in the study period. The most common clinical syndromes were pneumonia (36%), fever of unknown origin (16%), and intra-abdominal infections (15%). Most (80, 71%) of the mcfDNA test results were positive for microorganisms. Twenty-seven (24%) cases were classified as positive clinical impact, 82 (73%) were neutral and 4 (3%) were negative, respectively. Conclusion: In SOTR, mcfDNA sequencing can add a positive clinical impact in a quarter of the cases and identify microorganisms beyond conventional microbiological testing across clinical syndromes. The negative clinical impact was rare. However, larger prospective studies are needed to define the optimal timing and utilization of mcfDNA in the sequence of diagnostic evaluation for syndrome-specific workup in SOTR. Summary: Metagenomic next-generation sequencing (mNGS) is a novel diagnostic tool that can identify difficult-to-detect microorganisms in SOTR. Our study demonstrates that the mNGS test resulted in a positive clinical impact in 1 out of 4 patients.
BCG therapy for bladder cancer: Exploring patient experiences and concerns through artificial intelligence-based social media analysis
Authors: Khene Zine-Eddine , Tachibana Isamu , Bhanvadia Raj , Ausmann Hagan , Margulis Vitaly , Lotan Yair 
Published: December 2024

Background There is a notable disparity between the guidelines for BCG therapy in non-muscle invasive bladder cancer (NMIBC). Reddit has emerged as a popular online platform for individuals seeking information and exchanging their experiences related to bladder cancer. Objective To investigate and classify public opinions about intravesical BCG therapy as shared on Reddit, a popular social media platform. Methods This study employed an artificial intelligence-based approach to examine discussions related to intravesical BCG therapy on a social media platform over the past ten years. An artificial intelligence framework was developed to categorize these conversations into distinct topics and thematic categories. This framework included a partially supervised model for processing natural language (using BERT [Bidirectional Encoder Representations from Transformers]), a method for reducing data complexity, and an algorithm for clustering. Additionally, each conversation was assessed for sentiment. Results A total of 1223 unique discussions related to BCG therapy were analyzed, comprising 110 unique posts and 1113 comments from 268 distinct authors. We identified four overarching thematic groups: 1) BCG administration procedures, (2) hesitancy in initiating or maintaining BCG treatment, (3) issues related to BCG shortage and alternative treatments, and (4) side effects of BCG treatment. Sentiment analysis of the 1223 discussions revealed that 25.2% (308) exhibited a negative sentiment, 58.3% (713) were neutral, and 16.5% (202) showed a positive sentiment. Conclusion Online social media often contains detailed personal experiences with BCG therapy, not commonly found in medical literature. Understanding these experiences can help medical professionals improve care and treatment adherence in NMIBC.
Biomechanical Comparison of Nitinol Compression Staples vs Fully Threaded Lag Screws for Talonavicular Arthrodesis Following 24-Hour Incubation at Body Temperature
Authors: Garlapaty Ashwin , Cook James , Bezold Will , Schweser Kyle M. 
Published: December 2024

Category: Hindfoot; Other Introduction/Purpose: Arthrodesis of the talonavicular joint is indicated for injury- and arthritis-related pain. The standard treatment for talonavicular arthrodesis is lag screw fixation. Despite favorable results using lag screw fixation, it is associated with significant effects on foot biomechanical motion, and suboptimal complication rates. Nitinol staples have been used for talonavicular arthrodesis for their potential to address shortcomings of lag screw fixation. This study tested the null hypothesis that nitinol staples would not be significantly different from fully threaded lag screws based on biomechanical properties. Methods: Cadaveric feet (n=10) were acquired from 5 donors. Either nitinol staples or two cannulated lag screws were used to perform surgical arthrodesis of the talonavicular joint. Samples were incubated for 24-hours at 38°C, allowing for activation of the thermal nitinol compression properties. 38°C was chosen to mimic in vivo conditions. Biomechanical motion analysis was conducted. Specimens were loaded to 445N and held for 1 minute. A continuous compressive load of 445N was applied while cycling between plantarflexion to dorsiflexion for 10 cycles and then inversion to eversion for 10 cycles. Data were recorded along the X, Y, Z planes. Rotation data were recorded for roll, pitch, and yaw. Significant (p< 0.05) differences were determined. Results: No statistically significant differences in functional biomechanical testing properties were noted between nitinol compression staple fixation and lag screw fixation for talonavicular arthrodesis following 24 hours of incubation. Static compression, plantarflexion, dorsiflexion, inversion, and eversion testing resulted in nonsignificant translation in the X, Y, and Z planes, as well as nonsignificant rotation in roll, pitch, and yaw directions. Conclusion: Based on clinically relevant biomechanical properties measured during robotic testing, nitinol staples can be considered an appropriate option for talonavicular arthrodesis. Further work to assess long term outcomes of nitinol compression staples for talonavicular arthrodesis is currently ongoing. Biomechanical Data Mean translation and rotation for static and dynamic cyclical compression testing in plantarflexion, dorsiflexion, inversion, and eversion of the foot to assess talo- navicular arthrodesis fixation.
Comparing Intraoperative and Postoperative Complications of Shape-Memory Nitinol Staples for Arthrodesis Across the Midfoot and Hindfoot
Authors: Balu Abhinav R. , Dalloul John M. , Shen Peter C. , Bergman Rachel , Chang Shaun , Kelikian Armen , Patel Milap , Kadakia Anish R. , Mutawakkil Muhammad Y. 
Published: December 2024

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Shape-memory nitinol staples are an increasingly common construct used for arthrodesis of the foot. In evaluating this new construct, a comprehensive understanding of the various complications associated with staple arthrodesis is necessary in addition to overall fusion outcomes. Therefore, the purpose of this study is to analyze complications associated with staple arthrodesis across the midfoot and hindfoot to determine if any differences exist in the rate of complications between these two joint complexes. Methods: This IRB approved retrospective cohort study examined patients from a single institution who underwent midfoot or hindfoot arthrodesis between 2013 and 2023. Inclusion criteria mandated postoperative CT scans for fusion assessment, excluding those without scans or lost to follow-up. Complications of interest were non-union requiring revision, infection, symptomatic hardware removal, and DVT occurrence. Statistical analysis was performed with ANOVA and t-tests using Python 3.11.7 and Microsoft Excel. Results: A total of 29 patients underwent arthrodesis across 39 joints in the midfoot while 31 patients underwent arthrodesis across 60 joints in the hindfoot with either staples alone or staples and screws. There was no significant difference in the rate of overall complications between joints fused with staples in the midfoot (9.5%) as compared to the hindfoot (11.1%). Likewise, there was no significant difference in complication rates for joints fused with screws and staples between the midfoot (33.3%) and hindfoot (24.2%). There was no significant difference in rates of staple mechanical failure, with staples breaking at similar rates in both the midfoot (10.3%) and hindfoot (8.3%). Conclusion: The complication rate of isolated staples as a fixation construct does not differ significantly between the midfoot and the hindfoot. The same is true of joint staple and screw constructs. However, overall rates of complications are high for joint staple and screw constructs, warranting further investigation with larger datasets.
Comparison of Short-Term Reoperations, Complications, and Failures Using Non-Stemmed vs Stemmed Implants for Total Ankle Arthroplasty in Patients with Deformity
Authors: Ahmad Heba , Shofoluwe Ade , Gauvain Taggart , McGarvey William , Greaser Michael C. 
Published: December 2024

Category: Ankle; Ankle Arthritis Introduction/Purpose: The purpose of this study is to investigate potential differences in short term complications, reoperations, and failure in stemmed versus non-stemmed total ankle arthroplasty implants in patients with varying degrees of coronal plane deformity. Methods: A four year retrospective chart review of patients at a single academic institution (January 2018 – January 2022) with a minimum of 1 year clinical follow up was performed. Patients’ pre and post operative coronal alignment was measured from mortise weightbearing radiographs using the midline tibiotalar angle. These alignment angles were separated into three categories of pre-operative deformity: < 10 degrees, 10-20 degrees, and >20 degrees for both stemmed and non-stemmed total ankles implants. Each of those categories have total cases, and failure/complication sub-category for each subset of deformity. Medical records were reviewed to determine the incidence of complications, reoperations, and revisions. Radiographic analysis included preoperative and postoperative tibiotalar alignment, tibial implant positioning, the presence of periprosthetic radiolucency or cysts, and evidence of subsidence or loosening. Results: Preliminary data reveals that stemmed implants have a higher incidence of reoperations/complications overall, with more reoperations/complications in the < 10 degree and 10 – 20 degree data set. Our preliminary data also shows that in patients with high degree of deformity (>20 degrees), stemmed implants have a lower incidence of reoperation/complications. Conclusion: Preliminary data shows that in patients with higher degree of deformity (>20 degrees), stemmed implants have a lower incidence of reoperation/complications, however more data from our retrospective study will be gathered to draw a more definitive conclusion. Multiple factors play a role in determining whether a patient should receive a stemmed versus non stemmed total ankle arthroplasty implant. Various patient factors also play a role in the outcomes of total ankle arthroplasty in patients with deformity. Patients with higher degrees of coronal plane deformity may benefit from stemmed total ankle implants.
Comparison of X-ray and Computed Tomography Scan in the Diagnosis and Classification of Tillaux-Chaput Fractures in Adults
Authors: Massri-Pugin Jafet , Matamoros Gabriel , Morales Sergio , Lira María Jesús , Mery Pablo , Díaz Gonzalo , Filippi Jorge 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: Anterolateral distal tibial fractures, also known as Tillaux-Chaput fractures (TCF), have slowly gained attention, considering the risk of chronic pain and osteoarthritis if not appropriately managed. This study aimed to compare the diagnostic accuracy of ankle radiographs in diagnosing and classifying TCF with computed tomography (CT) scans in the adult population. Methods: A retrospective review of ankle fractures evaluated at a single institution between 2013-2023 was performed. Inclusion criteria were patients aged >18 years and evaluation with ankle radiographs and CT scan. Exclusion criteria were distal tibial/pilon fractures,or prior ankle surgery. A matching 1:2 was performed on patients with and without TCF. A radiologist evaluated the TCF under CT scan and classified the fractures according to Rammelt’s classification: type 1,extraarticular avulsion; type 2,fracture with involvement of the incisura; type 3, fracture with impaction of the anterolateral plafond. His answers were used as a comparison parameter. Three foot and ankle surgeons assessed the radiographs and described if the TCF was present (yes/no). If present, they classified the TCF by subtype. The sensitivity(Sn), specificity(Sp), positive predictive value(PPV), and negative predictive value(NPV) of the radiographs for detecting TCF were calculated. Fleiss's Kappa coefficient measured the interobserver agreement for each subtype. P-values < 0.05 were considered significant. Results: 1134 acute ankle fractures were initially evaluated, of which 481 met the eligibility criteria. The prevalence of TCF was 17.3% (83/481), with 37 (44.6%) type 1, 37 (44.6%) type 2, and 9 (10.8%) type 3. Using radiographs, the overall Sn, Sp, PPV, and NPV for the diagnosis of TCF were 50.2% (95% CI 45.8-54.6), 69.9% (95% CI 65.9-73.9), 62.5% (95% CI 58.3-66.8%), and 58.4% (95% CI 54.1-62.7), respectively. There was disagreement between surgeons using X-rays and the radiologist under CT scan for all subtypes (type 1: κ -0.54, type 2: -0.31, type 3: -0.27, p< 0.001). Under CT scan, the global interobserver agreement was moderate for the TCF classification (κ 0.62) and its subtypes. Conclusion: This study demonstrated that ankle radiographs have low diagnostic accuracy for TCF in adults. Therefore, a CT scan should be routinely used when a TCF is suspected.
Comparisons of the Therapeutics for Diabetic Neuropathic Pain: Prospective Cohort Study, Seoul, Korea
Authors: Ahn Jiyong , Shahriarirad Reza , Kwon Kyeongeon , Bejarano-Pineda Lorena , Waryasz Gregory R. , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil 
Published: December 2024

Category: Diabetes; Other Introduction/Purpose: Treating chronic diabetic peripheral neuropathic pain poses significant clinical challenges due to variable outcomes and failed trials, along with the difficulty in objectively evaluating improvement and accounting for confounding factors. This study aims to investigate the treatment outcomes of three drugs (pregabalin, gabapentin, duloxetine) for chronic diabetic peripheral neuropathy. Methods: From June 2019 to June 2021, 180 patients with type 2 diabetes diagnosed with diabetic peripheral neuropathic pain received treatment with pregabalin, gabapentin, or duloxetine. The study protocol was approved by the institution’s IRB. Patients were consented and enrolled in a single Korean - center, prospective, randomized cohort study with 60 participants per drug group. Treatment lasted for 3 months, and participants were randomly assigned to groups at a 1:1:1 ratio using 3-multiple block randomization. Group 1 received Gabapentin (300mg bid), Group 2 received Pregabalin (75mg bidX mg ), and Group 3 received Duloxetine (30mg bid PO daily). Efficacy and safety were assessed every 2 weeks over a 6-week period. Baseline assessments included lipidemia profile, blood viscosity tests, BUN/Cr, OT/PT, and HbA1c. Clinical evaluations were performed using the Korean version of pain DETECT, categorizing degrees of improvement. Results: All treatments significantly improved painDETECT scores at 6 weeks of medication compared to their baseline (p=0.001). The mean HbA1c of the three groups showing symptomatic improvement by more than 50% was 9.424 (95% CI, 8.17-10.68) for Group 1, 10.430 (95% CI, 8.65-12.21) for Group 2, and 7.718 (95% CI, 6.74-8.70) for Group 3. There was no significant difference in HbA1c between Groups 1 and 2 regarding symptom improvement by more than 50%. However, the HbA1c of Group 3 was significantly lower than that of Groups 1 and 2 (p=0.001). Improvement of the symptom over 50% varied with HbA1c levels among three groups (p=0.001) . Adverse effects such as dizziness and nausea were significantly higher in the duloxetine group compared to pregabalin and gabapentin groups (p=0.001). Conclusion: All three medications effectively alleviated chronic diabetic peripheral neuropathic pain compared to their baseline level with no difference between the groups. However, HbA1c levels could be considered when selecting drugs because the HbA1c level when symptoms improve is different between the gabapentin, pregabalin, and duloxetine groups. There was no significant difference in the improvement of painDETECT scores in the three treatment groups up to the second week. However, by the sixth week, the pregabalin and duloxetine groups exhibited significantly more improvement in painDETECT scores than the gabapentin group (p=0.001).
Contribution of the Anterior Talofibular Ligament on Ankle Joint Stability: A Finite Element Study
Authors: Minagawa Akinobu , Ito Kohta , Ogihara Naomichi , Kubota Makoto , Kimura Tadashi , Kihara Takumi , Saito Mitsuru 
Published: December 2024

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Ankle sprains typically occur when the ankle twists inward, with 73% involving damage to the ankle's lateral ligaments, and 20-40% progressing to chronic ankle instability (CAI). Repairing the anterior talofibular ligament (ATFL) has shown favorable outcomes postoperatively for CAI, suggesting the crucial role of the ATFL in ankle stability. However, it still remains unclear how the ATFL contributes to ankle stability. The present study aims to clarify the contribution of the ATFL to ankle stability through a three-dimensional (3D) finite element analysis of an anatomical foot model. Methods: We constructed a 3D finite element model of the human foot by extracting foot bones and the outer surface of the foot from computer tomography images, which were then meshed with tetrahedral elements. Material properties of bones and soft tissues were assigned based on existing literature. Ligaments surrounding the ankle and foot joints, as well as the plantar aponeurosis, were represented using tension-only truss elements. Surface-to-surface contacts between bones were modeled with a frictionless contact approach. The proximal ends of the tibia and fibula were anchored in the space, while external forces were applied to the calcaneus in the anterior and medial directions. We calculated the resulting translational and rotational movements of the foot bones in response to these forces. To examine the role of the ATFL in ankle joint stability, we repeated the calculations with the ATFL removed from the foot model. Results: When anterior external forces were applied, both the intact and ATFL-removed models exhibited forward talus translation and inversion rotation. However, in the latter, these movements were notably more pronounced due to the absence of the ligament connecting the distal fibula to the talus in the anteroinferior direction. The talus exhibited differing displacement patterns from the early stages of forward loading in the ATFL-removed model. Similarly, under the medial external force, larger talus inversion was observed in the ATFL-removed model. The present study demonstrated that the ATFL plays a crucial role in maintaining stability of the ankle joint when external forces are applied in the forward and/or medial directions to the foot. Conclusion: The ankle joint movements observed in the ATFL-removed model were consistent with what is seen in clinical settings and supported by existing research. The direction of talar displacement during loading seems to be linked to the structure of the ATFL, suggesting ankle joint instability. These findings enhance our understanding of the effects of ATFL on CAI and may provide insights into the underlying pathology of ankle joint disorders associated with ATFL injury.