bluuebunny/crossref_metadata_2025_split huggingface dataset:
Metatarsal Pronation: Does It Matter?
Authors: Chambers Monique C. , Birhiray Dion , Botros Mina A. , Granberry William M. 
Published: March 2021

Category: Bunion Introduction/Purpose: Hallux Valgus is a complex deformity with several attendant components that are present to varying degrees in each patient. Historically primary attention has been paid to correction of the coronal plane deformity, but recent investigations suggest a substantial contribution to the deformity from the axial rotational abnormality of the metatarsal. While the effect of this metatarsal pronation has been demonstrated, the relative contribution of this parameter compared to other components has not been considered. This study aims to investigate the rotational aspect of the deformity and its contribution to successful radiographic correction of the deformity. Methods: A retrospective review of 100 consecutive Lapidus bunionectomy procedures was performed. There were 80 of patients and 89 feet. patients <18yrs, revision surgery and combined surgery, other than forefoot procedures were excluded. There were 79 (88%) females and 10 (12) males. The mean age was55. All feet were followed till radiographic healing was complete. Each foot was examined radiographically and pre and post-operative findings were compared. Along with the typical measurements of Hallux valgus parameters in the coronal plane, an additional measurement was included to estimate metatarsal head pronation (MT head shape and sesamoid position). The radiographic outcomes were then compared to determine the independent effect of metartarsal rotation on outcomes (recurrence, time to fusion). Pearson correlation was utilized to determine significant associations with the outcome parameters for recurrence, time to fusion, and failure to correct the hallux valgus angle (HVA). Results: The average HVA correction was 20.08 degrees and 6.86 degrees for IMA. A total of 68 feet had a positive preop round head sign and correction to a normal MT head shape was observed in 47 feet. A significant increase in recurrence was associated with patients that had persistent MT round sign following correction (p=0.001) and in patients with a higher sesamoid position in the preop period p<0.001). The average time to fusion was 9.56 with 47 (52%) feet were healed at 6 weeks postop. A higher (more lateral) sesamoid position and a higher postop HVA were also associated with longer time to fusion or delayed union. Conclusion: Adequate preoperative radiographic assessment is of the utmost importance to assess the various forces that can contribute to hallux valgus deformity. Newer techniques address coronal and sagittal plane deformity. Failure to correct MT head pronation may lead to increased hallux valgus recurrence, despite sagittal correction measured by improvement of the HVA and IMA angles. Factors that impact time to fusion are also associated with a higher risk of HV recurrence. Sesamoid position and metatarsal head pronation should be considered, and correction of these parameters may be necessary to avoid delayed healing and persistent or recurrent HV.
Comparative Study of Flexor Hallicus Longus Tendon Length through Single Incision or Accessory Plantar Medial Incision: A Cadaver Study
Authors: Crocker Caitlin Curtis , Abyar Eildar , Young Sean , Razaghi Fatemah , McGwin Gerald , Johnson Michael D. 
Published: March 2021

Category: Ankle; Hindfoot Introduction/Purpose: Flexor Hallucis Longus (FHL) tendon transfer to the calcaneus is a common adjuvant procedure in the treatment of Achilles pathology. The FHL tendon can be harvested using a posterior incision where the tendon is dissected along its course into the fibroosseous tunnel. Alternatively, the FHL may be harvested through a separate plantar medial incision as it crosses the flexor digitorium longus at the Knot of Henry. This study aims to quantify FHL tendon lengths achieved through the two common approaches utilizing pair matched cadavers. Methods: Seven pair matched fresh-frozen cadaver legs without signs of musculoskeletal abnormalities were used for this assessment. One leg in each pairing underwent a single incision harvest while the contralateral leg underwent an accessory medial plantar harvest. After dissecting the tendon, a calcaneus tunnel was prepared from dorsal to plantar in both calcanei in standard fashion. Two measurements were obtained. The first measurement was taken from the distal aspect of the muscle belly to the distal end of the tendon. The tendon was then pulled through the calcaneus, and the foot was held in tension at 20 degrees of plantar flexion. The second measurement was taken from site where tendon entered the calcaneous to the distal end of the tendon graft. The measurements were analyzed using Wilcoxon Signed Ranks Test and Fischer Exact Test. Results: Using a posterior incision, the mean tendon measurement from calcaneous tunnel to the distal end of the tendon was 4.0 cm. Using an accessory plantar medial incision, the mean tendon measurement from the calcaneous tunnel to the distal end of the tendon was 7.2 cm. The average tunnel length obtained using an accessory medial incision was significantly greater than the length obtained using the single incision approach (p= 0.0003, p=0.0022, and p=0.0016). The accessory plantar medial incision obtained an FHL tendon tunnel length that was an average of 2.9 cm greater than the posterior incision. Conclusion: The single incision approach provided sufficient length to safely anchor the FHL into the calcaneus which suggests that the accessory plantar medial approach is not necessary for routine FHL transfers to the calcaneus with interference screw fixation. However, if additional length is needed for other applications such as posterior tibialis tendon dysfunction or peritoneal tendon tears, the accessory incision does provide an average of 2.9 cm of additional length.
Radiographic and Clinical Analysis of the INBONE II Total Ankle Arthroplasty
Authors: Day Jonathan , Kim Jaeyoung , Ellis Scott J. , Deland Jonathan T. , O’Malley Martin J. , Cody Elizabeth , Demetracopoulos Constantine A. 
Published: March 2021

Category: Ankle Arthritis; Ankle Introduction/Purpose: The use of total ankle arthroplasty (TAA) in the treatment of ankle arthritis has grown substantially as advancements are made in design and surgical technique. Among the criteria guiding the choice between arthroplasty versus arthrodesis, the long-term survival and postoperative outcomes are of crucial importance. First FDA approved in 2005, the INBONE I prosthesis was subsequently replaced by the INBONE II in 2010. While outcomes of the INBONE I have been published, there is limited long-term survivorship data for the INBONE II. The purpose of this study is to determine the minimum 5-year survivorship of the INBONE II prosthesis and causes of failure. In addition, we evaluate long-term radiographic and patient- reported outcomes. Methods: We retrospectively identified 46 prospectively followed patients from 2010 to 2015 who underwent TAA with the INBONE II prosthesis at our institution. Of these, 44 cases (41 patients) had minimum follow-up of 5 years (mean, 6; range, 5 to 9). Mean age was 65.6 years (range, 42 to 81) and mean BMI was 27.6 (range 20.1 to 33). Survivorship was determined by incidence of revision, defined as removal/exchange of a metal component. Chart review was performed to record incidences of revision and reoperation. Preoperative, immediate and minimum 5-year x-rays were reviewed; coronal tibiotalar alignment (TTA) was measured on standing AP radiographs to assess alignment of the prosthesis. A TTA of +-5° from 90° indicated neutral alignment, while <85° and >95° was considered varus and valgus alignment, respectively. Radiographic subsidence as well as presence and location of periprosthetic cysts were documented. Pre- and minimum 5-year FAOS domains were compared. Results: Survivorship was 97.7% with one revision of the talar component due to aseptic loosening and subsidence. The rate of other reoperations was 4.5% (2); one patient underwent medializing calcaneal osteotomy for valgus heel alignment, another patient underwent ostectomy and debridement for ankle impingement. Average preoperative TTA was 88.5 degrees with 15 neutral (average TTA of 89.7°), 14 varus (74°) and 12 valgus (104°) ankles. Average postoperative TTA was 88.6° with 35 neutral (89.3°), 6 varus (84.7°), and no valgus ankles. Radiographic subsidence was observed in one patient who underwent revision, and periprosthetic cysts were observed in 7 patients. There was significant improvement in all FAOS domains at final follow-up. Conclusion: This is the largest study to date dedicated to evaluating survivorship of the INBONE II prosthesis. Our data suggests a high survival rate and low reoperation rate with long-term follow-up of the INBONE II implant. We observed significant improvement in radiographic alignment as well as patient-reported clinical outcomes at minimum 5-year follow-up.
SMOT with Medial Distraction Arthroplasty for Ankle Arthritis with Increased Talar Tilt: A Comparative Study
Authors: Hong-Mou Zhao 
Published: March 2021

Category: Ankle Arthritis Introduction/Purpose: An increased preoperative talar tilt (TT) angle was reported to be positively correlated with treatment failure after supramalleolar osteotomy (SMOT) for varus ankle osteoarthritis. Distraction arthroplasty was reported to have the ability to correct increased TT angles. The purpose of the current study was to compare the outcomes between SMOT with and without medial distraction arthroplasty (MDA) in the treatment of varus ankle osteoarthritis with increased TT angles. Methods: We retrospectively reviewed the functional outcomes and radiological findings of 56 patients who underwent SMOT with or without MDA for varus ankle osteoarthritis with increased TT angles. The AOFAS ankle-hindfoot score and AOS scores were used for functional evaluation. The tibial anterior surface (TAS) angle, talar tilt (TT) angle, tibial medial malleolar (TMM) angle, talocrural (TC) angle, tibial lateral surface (TLS) angle, and hindfoot alignment (HFA) angle were evaluated preoperatively and at the time of the last follow-up. Results: In the SMOT group, the AOFAS score and AOS pain and function scores were significantly improved (P <0.01 for each) at a mean follow-up of 67.5 months. The TAS, TT, TC, TLS, and HFA angles were all significantly improved (P <0.01 for each). Similarly, in the SMOT with MDA group, the AOFAS score, AOS pain and function scores, and the TAS, TT, TC, TLS, and HFA angles were all significantly improved postoperatively (P <0.01 for each) at a mean follow-up of 37.8 months. When comparing the two groups, the postoperative TT angle was significantly smaller in the SMOT with MDA group (P = 0.03) than in the SMOT group. In addition, the failure rate of TT angle correction was significantly higher in the SMOT group (P = 0.02) than in the SMOT with MDA group. Conclusion: SMOT is a promising procedure for functional improvement and malalignment correction for varus ankle osteoarthritis, even in patients with increased talar tilt. SMOT with MDA is a effective method to correct the varus ankle OA with increased talar tilt.
Patients’ experiences of pharmacists in general practice: an exploratory qualitative study
Authors: Karampatakis Georgios Dimitrios , Patel Nilesh , Stretch Graham , Ryan Kath 
Published: March 2021

Abstract
Background
Since 2015, pharmacists have been integrating into English general practices and more recently into primary care networks. General practice-based pharmacists provide a range of patient-facing services, such as medication reviews, management of long-term conditions and minor ailments, prescribing duties and answering queries over the telephone. Literature reports patients’ satisfaction with general practice-based pharmacists’ services, however, previous research captured only limited experiences. The aim of the current study was to pursue an extensive exploration of patients’ experiences of pharmacists in general practice.

Methods
General practice-based pharmacists, working in practices in West London, Surrey and Berkshire, handed invitation packs to patients seen during consultations. Patients that wanted to take part in the study were invited to undertake a qualitative, in-depth, face-to-face, semi-structured interview within the practice with which each patient was registered. Interviews lasted from 15 min to more than 1 h and were audio-recorded. Recruitment continued until data saturation. Audio-recordings were transcribed verbatim and transcripts analysed thematically.

Results
Twenty participants were interviewed. Four themes were discerned: awareness (“I had been coming to this practice for 24 years and I didn’t know that there was a pharmacist”); accessibility (“People ring for a GP [general practitioner] appointment … it’s Monday and they [receptionist] tells you ‘We can slot you in on Friday’ … with a pharmacist on board, they can [instantly] look at you”); interactions (“I’ve always had a really good interaction with them [pharmacists] and they listen and they take on board what I’m trying to say”); and feedback (“It’s easier [to collect feedback instantly] because I could have forgotten half of what they [pharmacists] have told me in an hour or so’s time”).

Conclusions
Findings indicate that pharmacists’ integration into general practices could improve accessibility to, and the quality of, care received. The findings will assist policy development to provide general practice-based pharmacists’ services as per patients’ needs.
Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India
Authors: Gokhale Yojana , Mehta Rakshita , Kulkarni Uday , Karnik Nitin , Gokhale Sushant , Sundar Uma , Chavan Swati , Kor Akshay , Thakur Sonal , Trivedi Trupti , Kumar Naveen , Baveja Sujata , Wadal Aniket , Kolte Shaonak , Deolankar Aukshan , Pednekar Sangeeta , Kalekar Lalana , Padiyar Rupal , Londhe Charulata , Darole Pramod , Pol Sujata , Gokhe Seema Bansode , Padwal Namita , Pandey Dharmendra , Yadav Dhirendra , Joshi Anagha , Badgujar Harshal , Trivedi Mayuri , Shah Priyanshu , Bhavsar Prerna 
Published: March 2021

Abstract
Background
Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm.

Method
This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26.

Results
Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation.

Conclusion
Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.
Clinical utility of cerebrospinal fluid vitamin D-binding protein as a novel biomarker for the diagnosis of viral and bacterial CNS infections
Authors: Kim Young Jin , Lê Hương Giang , Na Byoung-Kuk , Kim Bo Gyu , Jung Youn-Kwan , Kim Mutbyul , Kang Heeyoung , Cho Min-Chul 
Published: March 2021

Abstract
Background
Rapid and accurate diagnosis of central nervous system (CNS) infections is important, and laboratory tests help diagnose CNS infections. Even when the patient has symptoms, laboratory tests often do not reveal any specific findings. The potential of vitamin D-binding protein (VDBP) to be used as a biomarker for viral and bacterial CNS infections was studied.

Methods
A total of 302 subjects with suspected CNS infection who underwent lumbar puncture were included. Clinical and laboratory data were collected retrospectively. VDBP levels were measured in the cerebrospinal fluid (CSF) samples. Genotyping for the GC gene encoding VDBP was also performed. VDBP levels were analyzed and compared by CNS infection, pathogen, CSF opening pressure, and GC genotype.

Results
A CNS infection group (n = 90) and a non-CNS infection group (n = 212) were studied. In terms of its receiver operating characteristic, CSF VDBP showed an area under the curve of 0.726 for the diagnosis of CNS infection. CSF VDBP levels were significantly different between the CNS infection and non-infection groups. The CNS infection group with enterovirus showed a statistically lower distribution of CSF VDBP levels than the other virus groups. The group with CSF opening pressure > 25 cmH2O showed higher CSF VDBP levels than the other groups. There was no significant difference in GC gene allele distribution between the CNS infection and non-infection groups.

Conclusions
CSF VDBP levels were increased in patients with CNS infection. The CSF VDBP showed potential as a new biomarker for viral and bacterial CNS infections.
Attitudes of East Tennessee residents towards general and pertussis vaccination: a qualitative study
Authors: Tandy Corinne B. , Jabson Tree Jennifer M. 
Published: March 2021

AbstractBackgroundDespite vaccination being one of the safest and most successful public health tools to control infectious diseases, some people still doubt the efficacy and safety of vaccines. In order to address vaccine hesitancy and anti-vaccination sentiment, it is necessary to understand vaccination attitude development and vaccination behaviors. The objective of this project was to qualitatively investigate general vaccination attitudes and behavior with an additional emphasis on pertussis vaccination.MethodsTo identify factors that influence attitudes toward vaccination and behaviors in East Tennessee, eleven one-on-one interviews were conducted with participants recruited through convenience and purposive sampling. Interview protocol and deductive codes were developed using the Triadic Theory of Influence as a theoretical framework. Interview transcripts were analyzed qualitatively and themes were identified through constant comparison of interviews, considering both deductively and inductively coded data.ResultsMost participants (8) held positive attitudes towards vaccination. Participants (8) comfortable with vaccinating themselves or their children said they followed recommendations of doctors. Vaccine hesitant participants’ (3) most frequently cited concern was safety and concern about side effects. These participants also reported that they referenced non-academic or professional sources and felt confident about their knowledge of vaccines and diseases. Vaccine hesitant participants had low perception of risk of vaccine-preventable diseases, particularly pertussis. Participants with children reported that friends and family were influential when deciding to vaccinate their children.ConclusionsThis study identified themes in the attitudes towards vaccination of participants recruited in East Tennessee. We found that risk perception and family and social group attitudes were the primary influences on vaccination decision making. We recommend that future research includes anti-vaccination participants in their research, if possible, and further explore the relationship between perception of one’s own knowledge and health behavior outcomes.
A novel esterase from a soil metagenomic library displaying a broad substrate range
Authors: Yao Jian , Gui Lun , Yin Shaocheng 
Published: March 2021

AbstractA novel esterase gene was isolated from a soil metagenomic library. The gene encoded a protein of 520 amino acids which contained a 21 aa signal peptide. Primary structure analysis of the protein sequence revealed that it contained a conserved active site motif (SxSxG) and a structural motif (CS-D-HC). Then the esterase gene was cloned and expressed inEscherichia coli BL21(DE3). SDS-PAGE analysis of the purified esterase showed that it was expressed in a highly soluble form and its molecular mass was estimated to be 55 kDa. Characterization of the esterase revealed that it exhibited high activity towardp-nitrophenyl esters with short acyl chains and especiallyp-nitrophenyl acetate, suggesting that it was a typical carboxylesterase rather than a lipase. Withp-nitrophenyl acetate as substrate, the enzyme showed its optimal activity at pH 7.0 and 30 °C, and it was stable at a broad pH range from 4.5 to 10.0 and temperature not higher than 50 °C. Furthermore, the enzyme showed different substrate specificity from known esterase, it was not only hydrolyzing againstp-nitrophenyl esters, but also hydrolyzing all hydroxybenzoic esters and hydroxycinnamic ester assayed. As it was an enzyme active on a broad range of phenolic esters, simultaneously possessing feruloyl esterase, chlorogenate esterase and tannase activities, it could serve as a valuable candidate for applications in biotechnology.