bluuebunny/crossref_metadata_2025_split huggingface dataset:
Differences in Intraoperative Fluoroscopic Radiation Exposure during Ankle Fracture ORIF between Orthopaedic Surgery and Podiatry
Authors: DiFiori Monica , Luginbuhl Joshua , Bires Kristofer , Rallis Gaivn , Gokcen Eric 
Published: December 2024

Category: Ankle; Trauma Introduction/Purpose: Operative ankle fractures pose a unique situation as both podiatrists and orthopaedic surgeons manage these injuries. Intraoperative fluoroscopy is routinely used, however, excessive radiation can be harmful to both the patient and surgical team. The primary aim of this study is to determine if there is a difference in the amount of intraoperative radiation exposure during ankle fracture open reduction and internal fixation (ORIF) when performed by orthopaedic surgeons versus podiatrists. Methods: This is a retrospective review of patients who underwent ankle fracture ORIF at an urban level I trauma center between January 1st, 2018 and April 1st, 2023. The electronic health record was queried using International Classification of Diseases nine and 10 codes associated with ankle fractures. Patients greater than 18 years of age with an ankle fracture managed operatively were included. Subjects were then stratified by procedure. Mean total radiation dose (mRad) and mean total fluoroscopic time (seconds) were then compared between those performed by orthopaedic surgeons and podiatrists. Results: Of the 333 included procedures, 186 were performed by orthopaedic surgeons and 147 were performed by podiatrists. Using multiple linear regression analysis to control for age, sex, race, ethnicity, and body mass index, patients undergoing isolated malleolus ORIF with syndesmosis repair performed by orthopaedic surgery were found to have a significantly lower mean fluoroscopic time compared those performed by podiatry (68.4s versus 104.8.s; p = 0.0280). Additionally, trimalleolar ORIF with syndesmotic repair performed by orthopaedic surgery had a significantly lower mean total radiation dose compared to those performed by podiatry (244.6 mRad v 565.6 mRad; p = 0.0090). Conclusion: Patients and surgical teams are exposed to significantly less radiation in isolated malleolar and trimalleolar fracture ORIF with syndesmosis repair when performed by an orthopaedic surgeon as compared to those performed by a podiatrist.
Discrepancies in Pedobarography between Affected and Unaffected Sides in Patients with Plantar Fasciitis
Authors: Kim Jahyung , Kyung Min Gyu , Kim Joonhee , Lee Hye Ran , Kim Ji Hye , Yoon A Ro , Kim Min Ju , Lee Dong Yeon 
Published: December 2024

Category: Other; Basic Sciences/Biologics Introduction/Purpose: Plantar fasciitis is one of the most common causes of chronic heel pain. Typically, conservative treatment involves stretching exercises and the use of orthosis such as heel cups. To prescribe the appropriate orthosis, a fundamental understanding of plantar pressure distribution is essential. We evaluated the plantar pressure distribution of patients with unilateral plantar fasciitis by comparing it with contralateral unaffected sides. Methods: We prospectively recruited 20 participants who were diagnosed with unilateral plantar fasciitis and had been complaining of heel pain for at least 6 months. The emed® system was used to measure the plantar pressure of both feet during gait. We measured the pedobarographic parameters, such as contact area, maximum force, peak pressure, force time integrals, and pressure time integrals. The analysis was performed using a 4-mask configuration (hindfoot, midfoot, forefoot, and toes). In addition, we measured radiographic parameters that could potentially affect plantar pressure in simple foot and ankle radiographs. Results: Both sides showed no significant difference in radiographic parameters. The affected side showed significantly higher contact area (28.9±10.3 vs. 26.3±8.2, p=0.007), maximum force (27.3±12.9 vs. 24.4±11.9, p=0.048), and force time integrals (0.6±0.3 vs. 0.5±0.2, p=0.044) in the midfoot. However, the unaffected side demonstrated significantly higher maximum force (67.5±11.4 vs. 60.1±8.4, p=0.030) and force time integrals (1.4±0.2 vs. 1.2±0.2, p=0.038) in the hindfoot. Conclusion: The increase in the contact area and maximum force in the midfoot on the side with plantar fasciitis can be interpreted as a result of weight transfer from the hindfoot to the midfoot due to heel pain. It can be suggested that Achilles tendon and plantar fascia stretching exercise is necessary to prevent weight transfer from the original hindfoot to the midfoot or forefoot. Moreover, the findings of this study could be helpful in prescribing appropriate orthosis for patients effectively.
Effect of Malnutrition in Operatively Treated Ankle Fractures for Insulin- and Non-Insulin-Dependent Diabetic Patients
Authors: Ng Terence Y. , Geoffrey Phillips 
Published: December 2024

Category: Trauma; Ankle Introduction/Purpose: It has been widely demonstrated that patients with insulin-dependent diabetes mellitus (IDDM) have higher complication rates compared to non-insulin dependent diabetic patients (NIDDM) after operative treatment of ankle fractures. However, there is a paucity of research comparing the preoperative nutritional status of IDDM versus NDDM patients, as a modifiable preoperative risk factor. Therefore, this investigation examined whether diagnosis of IDDM, and preoperative serum albumin predicted various complications following operative fixation of ankle fractures. Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried, and patients undergoing operative treatment of ankle fractures from 2007-2020 were identified for inclusion. Patients were stratified based on diabetic and insulin-dependent status. Outcomes measured were complications within the 30-day postoperative period, analyzed univariate and multivariate regressions. Results: IDDM patients had rates of malnutrition of 41.9% nearly twice the rates of NDDM patients (24.8%) or non-diabetic patients (17.3%). Patients who were malnourished were two times more likely to develop a complication (OR:2.01 [1.38, 2.91], p < 0.001). Malnourished patients had significantly increased incidence of bleeding requiring transfusions (0.5% versus 2.8%, p < 0.001), requiring postoperative ventilation (0.5% versus 0.1% p = 0.048), sepsis (0.4% versus 1.3% p=0.0046), UTI (0.9% versus 2.0% p=0.046). However, there was no increased incidence of deep vein thrombosis (0.7% versus 1.0% p=0.46), pneumonia (0.7% versus 1.0%, p=0.56), surgical site infections (0.1% versus 0.3%, p=0.30), wound dehiscence (0.4% versus 0.5%. p=0.76), pulmonary embolism (0.4% versus 0%, p=0.15) or myocardial infarction (0.1% versus 0.5%, p=0.15) in malnourished patients. Conclusion: Retrospective study of 884 patients who underwent ankle open reduction and internal fixation demonstrated that decreased preoperative albumin was associated with increased complications within the 30-day postoperative period.
Enhancing Fracture Detection in Remote Settings: Evaluating the Efficacy of FIXUS AI Deep Learning Algorithms in Identifying Fifth Metatarsal Fractures Using Mixed-Quality X-rays
Authors: Taseh Atta , Gholipour Alireza , Eftekhari Mani , Ebrahimi Alireza , Flaherty Alexandra F. , Flaherty Alexandra F. , Jones Sumner , Nukala Varun , Waryasz Gregory R. , Guss Daniel , Kwon John Y. , DiGiovanni Christopher W. , Bejarano-Pineda Lorena , Ashkani-Esfahani Soheil 
Published: December 2024

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The diagnosis of fractures can be challenging in specific medical settings due to limited expertise or time. While deep learning has shown promising results, its use is confined to the quality of images and the hassle of importing images to the models. This study aims to develop a model to detect fifth metatarsal fractures based on cell phone photos of radiographs directly taken from a regular screen. Methods: retrospective case-control study was conducted including patients aged > 18 years with fifth metatarsal fractures (n=1240) (Fx), and healthy controls (n=1224) (NoF). Three view radiographs (anterior, posterior, and lateral) were obtained from the Electronic Health Record (EHR) in PNG format. To generate a mixed-quality dataset, Android and iOS smartphones (SP) were used to create two separate datasets for each Fx and NoF group. Two separate deep learning models on each EHR, SP, and combined datasets were developed using Inception V3 architecture (Figure 1.). The models were also tested on a separate SP dataset (SP-test) that was not included in the development process. Area Under the Receiver Operating Characteristics Curve (AUC) along with other performance metrics were calculated and reported. Continuous data were presented as median (interquartile range), and a p-value of < 0.05 was considered to be significant. Results: Baseline analysis revealed differences between the groups with a median age of 56 years (36-68) for the Fx group, and 62 years (51-72) for the NoF group (p < 0.001). Similarly, the racial composition of the groups was also different (Fx: 84.8% white; NoF: 92.2% white; p < 0.001). Initially, the SP model showed the best performance (Youden Index (YI): 0.92, AUC: 0.99) followed by the EHR (YI: 0.74, AUC: 0.96), and combined (YI: 0.52, AUC: 0.97) models. When tested on the SP-test dataset the EHR model’s performance dropped markedly showing a YI of 0.33, an AUC of 0.78, and a sensitivity of 0.49 (Table 1.). However, the SP and combined models continued to perform optimally (YI: 0.94, AUC: 0.99; YI: 0.78, AUC: 0.98, respectively). Conclusion: This study highlights the crucial role of image quality in developing deep learning models for detecting fifth metatarsal fractures. Our findings demonstrate a markedly reduced performance of the EHR model in identifying fractures within lower-quality images. This emphasizes the need for training algorithms on images of varying quality to create more generalizable models capable of operating effectively across diverse settings.
Enhancing Precision in OLT Measurements and Improving Agreement in Surgical Decision-Making: A Comprehensive Evaluation Using WBCT and Distance Mapping for Preoperative Planning
Authors: Barbero Agustin , Efrima Ben , Dahmen Jari , Benady Amit , Maccario Camilla , Indino Cristian , M.M.J. Kerkhoffs Gino M , Giuseppe Usuelli Federico 
Published: December 2024

Category: Ankle; Other Introduction/Purpose: WBCT enables the creation of a three-dimensional model that represents the ankle morphology in a standing position. Distance mapping (DM) is a complementary feature that uses color coding to represent the relative intraarticular distance and can be used to outline intraarticular defects. Consequently, DM offers a novel approach to delineating OLT, allowing for the quantification of its surface area, volume, and depth. The reliability of DM for OLT measurements has yet to be thoroughly evaluated. This study primarily aims to determine the reliability of DM in measuring the surface, depth, and volume of OLT. A secondary objective is to ascertain whether measurements obtained through DM, when integrated with a predefined treatment algorithm, can facilitate consensus among surgeons regarding the optimal surgical intervention Methods: This cohort comprised 36 patients with 40 OLTs evaluated using WBCT and DM. Two raters used DM to determine the lesion boundary (LB) and lesion fundus (LF) and calculate the lesion depth, surface, and volume. The raters were asked to choose between bone marrow stimulation, autologous matrix-induced chondrogenesis, and osteochondral transposition based on the measurement. Inter-rater and intra-rater agreement was measured. Results: Interclass correlation of the lesion's depth surface produced an excellent interrater and intrareader agreement of 0.90 -0.94 p-value < 0.001. Cohen's Kappa agreement analysis of the preferable preoperative plan produced a Kappa = 0.834 P-value< 0.001, indicating a near-perfect agreement Conclusion: WBCT-based 3D modules and DM can be used to measure the OLT surface and depth and to calculate the lesion volume with excellent interrater and interrater reliability; using the OLT measurement and a predetermined treatment algorithm, a near-perfect interrater agreement for the preoperative planning was reached. WBCT in conjunction could help determine the type of surgery needed preoperatively and assess if additional surgeries are needed.
Epidemiology of Infections, Readmissions, and Reoperations after 1434 Foot and Ankle Surgeries at an Academic Medical Center
Authors: May Jared M. , Bergman Rachel , Kadakia Anish R. 
Published: December 2024

Category: Other Introduction/Purpose: Foot and ankle orthopaedic procedures account for approximately 10% of all orthopaedic procedures annually, however, limited data exists on the rates of infection, readmissions and reoperations after surgery. Current literature in other fields of orthopaedic surgery suggests that patient characteristics, including body mass index (BMI), age, gender, race/ethnicity, smoking status, and comorbidities, may impact these rates. The variety of foot and ankle procedures performed presents a challenge when counseling patients on post-operative complications and mitigating risk. Methods: In this retrospective study of 1434 foot and ankle surgeries performed at a large, urban medical center by a single surgeon, patient demographics, pre-operative comorbidities, and post-operative complications within 90 days, including superficial wound infection, readmission, and reoperation, were analyzed using Chi-square test of independence. Preoperative demographics analyzed included age, diabetes mellitus (DM) status, smoking status, race/ethnicity, body mass index (BMI), and perioperative opioid use. Results: The overall rate of superficial wound infection was 2.3% (n=33); readmission and reoperation rates were 3.3% (n=47) and 3.6% (n=51), respectively. Patients who had DM, were 70 years or older, smoke tobacco products, had no perioperative opioid use, and had BMI >25 were all independently associated with higher rates of readmissions by 90 days (p < 0.05). Smoking tobacco products and perioperative opioid use were associated with higher rates of reoperation within 90 days (p < 0.001). Patients with perioperative opioid use also had higher rates of infection (p=0.0002). Age, DM, smoking status, race/ethnicity, BMI, and procedure type were not associated with differences in rate of infections. Conclusion: In elective and non-elective foot and ankle orthopaedic surgery, older age, DM, smoking and BMI>25 were associated with increased postoperative complications. The association of opioid use perioperatively and lower complication rates represents an area of future investigation. The conclusions of this study should be used to counsel patients on their anticipated risks of surgery and help identify areas risk mitigation to prevent and avoid complications.
Exploring causal relationship of traumatic brain injury and comorbidities: A Mendelian randomization study
Authors: Zhang Xiaohang , Wu Wenze , Mao Yaqing , Cheng Jiaxin , Zhou Zixuan , Tang Yaqi , Zhao Qiulong , Yan Hui 
Published: December 2024

Background Previous observational studies demonstrated a link existed between traumatic brain injury (TBI) and cerebral disease and multisystem complications, such as dementia, pneumonia, and gastrointestinal disease, but they could be confused by confounding and reverse causality Objective We aimed to figure out the causal correlation between TBI and the following complications. Methods Database concerning TBI and complications from genome-wide association study (GWAS) and two-sample Mendelian randomization (MR) analysis was employed to examine whether TBI was causally associated with the risk of some complications. All the analysis was carried out through R, version 4.3.3. Results MR analyses indicated that any dementia has a promotional effect on TBI (OR = 1.067, 95% CI, 1.011–1.123, p = 0.017). However, there was no causal genetically association between TBI and Alzheimer's disease (AD), Parkinson's disease (PD), pneumonia, or gastrointestinal disease. Conclusions Contrary to observational studies, our results uncovered little causal association between TBI and PD, AD, depression, pneumonia, and gastrointestinal diseases. Interestingly, we found any dementia might be the risk of TBI, which was a new discovery.
Risk of Tendon Injury in Patients Treated With Fluoroquinolone (FQ) Vs Non-Fluoroquinolone Antibiotics for Urinary Tract Infection (UTI)
Authors: Fleming Virginia H. , Xu Jianing , Chen Xianyan , Hall Daniel , Southwood Robin L 
Published: December 2024

Background: Fluoroquinolones (FQs) are associated with potential tendon injury but comparative risk versus other antibiotic (non-FQ) options for the same indication has rarely been evaluated. Objective Describe the incidence (relative risk) of any tendon injury in patients receiving FQs compared with other (non-FQ) antibiotics for treatment of urinary tract infections (UTIs). Methods A retrospective propensity score-weighted cohort study was performed to evaluate the association between FQ antibiotics and tendon injury at two time points (within one month and within six months of use) compared with non-FQ regimens for treatment of UTI. The evaluation was performed using the Merative™ MarketScan® Research Databases from 2014 to 2020. Adult patients with International Classification of Diseases (ICD)-9/10 coding for UTI were included. Patients with a history of tendon injury or those who received both FQ and non-FQ regimens during the study period were excluded. Propensity score weighting was used to adjust for selection bias due to contributing risk factors, including demographics (age, sex), comorbidities (diabetes mellitus, chronic kidney disease), and concurrent medications (corticosteroids). Results Both the 1-month and 6-month cohorts were predominately female and less than 50 years of age. At one month, the incidence of tendon injury was 0.2% in the FQ group and 0.1% in the non-FQ group, and the odds of tendon injury were not estimated to be significantly different between groups (odds ratio [OR] = 1.03, 95% confidence interval [CI] 0.93, 1.32). Odds of tendon injury were also not estimated to be significantly different in the 6-month cohort (OR = 0.98, 95% CI 0.84, 1.05). Conclusion and Relevance In this population of predominantly young female patients without high incidence of potentially contributing comorbidities, increased risk of tendon injury was not associated with FQ use. Future research is needed to determine whether demographic differences between this and other previously studied populations account for this discordant result
ADAM Metallopeptidase domain 19 promotes skin fibrosis in systemic sclerosis via neuregulin-1
Authors: Meng Qiming , Bao Ding , Liu Sijia , Huang Jing , Guo Muyao , Dai Bingying , Ding Liqing , Xie Shasha , Meng Meng , Lv Chunliu , He Weijia , Luo Hui , Zhu Honglin 
Published: December 2024

Abstract
Background
ADAM19 (ADAM Metallopeptidase Domain 19) is known to be involved in extracellular matrix (ECM) remodeling, yet its specific function in systemic sclerosis (SSc) fibrosis remains unclear.

Objectives
This study sought to clarify the role and underlying mechanism of ADAM19 in SSc skin fibrosis.

Methods
The expression of ADAM19 was assessed in skin tissues of SSc and wound healing using publicly available transcriptome datasets. This analysis was further validated through real-time PCR, western blot, and immunostaining in our SSc cohort, as well as in a mouse model of hypochlorite (HOCl)-induced fibrosis. To downregulate the expression of ADAM19, ADAM19 siRNA was employed. The influence of ADAM19 on fibroblast transcriptomics was examined using bulk RNA-seq. Data analysis and visualization were conducted using R packages, including edgeR, limma, clusterProfiler, ggplot2, gseaplot2, and complexheatmap.

Results
ADAM19 exhibited a significant upregulation in skin tissues of SSc patients, as well as in wound healing and a HOCl-induced fibrosis mouse model. Additionally, there was a notable positive correlation between ADAM19 and fibrosis-related genes, local skin score, Modified Rodnan skin score, skin thickness progression rate, and the presence of ARA antibodies in SSc patients. Furthermore, ADAM19 levels were markedly elevated in SSc primary dermal fibroblasts and TGF-β-stimulated healthy controls primary dermal fibroblasts. The downregulation of ADAM19 resulted in the repression of TGF-β-induced ECM deposition and fibroblast activation. ADAM19 was identified as a mediator for the shedding of neuregulin-1 (NRG1) in fibroblasts, a pro-fibrotic cytokine that must be cleaved to exert its function.

Conclusion
ADAM19 plays a role in TGF-β-induced ECM deposition and fibroblast activation by mediating the shedding of NRG1, ultimately contributing to the development of skin fibrosis in SSc.
Collaborative logistics: optimizing fixed-scheduled container trains
Authors: Ritzinger Ulrike , Brandstätter Georg , Krasel Lukas F. , Prandtstetter Matthias 
Published: December 2024

AbstractWe propose a new logistics concept for rail-based container transportation where, instead of booking individual slots on specific trains (which is the current state of the art), customers only specify from where to where they want their containers to be delivered, as well as appropriate time windows for pickup and delivery. A containers actual transportation route is then chosen by a freight forwarder based on the availability and compatibility of freight trains. We provide an optimization algorithm based on an integer linear programming formulation that can be used to find globally optimal transportation schedules for a given set of containers. Our computational experiments show that this new paradigm can significantly reduce the number of trains required for serving a given container transportation demand, improving the logistic systems’ overall environmental and economic efficiency.
Drivers of car driving: lessons on infrastructure, peer-group, habits and socio-demographics from a survey on car ownership and usage in Germany
Authors: Thema Johannes , Reul Julian , Arnz Marlin , Wiese Frauke 
Published: December 2024

AbstractCar ownership is the primary driver of car use, which in turn is the leading contributor to passenger transport sector emissions. Hence, understanding the key determinants of car ownership is crucial to designing a policy framework that will effectively reduce emissions. Based on a 2022 German mobility survey, this study utilizes multinomial logit models to analyse a range of influences on car ownership including socio-demographic and infrastructural factors, respondents’ stated policy responses, and their motives for car ownership. We find that car ownership increases with an individual’s age, income, the share of social contacts owning cars and with smaller towns of residence. Habits, measured as the number of years already spent as a car owner or non-owner emerges as a dominant factor. Our three main insights include: First, car ownership in rural Germany is particularly high and can be effectively reduced by public transport supply measures. Second, situations of radical change—when individuals overcome the force of routine to reflect on their car ownership status – present unique opportunities for policy intervention. And third, isolated or mild policy interventions may only have a limited impact. To significantly influence car ownership levels, policies will likely have to be very stringent.