bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of the Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In-situ Force
Authors: Sakakibara Yuzuru , Teramoto Atsushi , Kamiya Tomoaki , Watanabe Kota , Yamashita Toshihiko 
Published: September 2018

Category: Basic Sciences/Biologics Introduction/Purpose: Ankle sprains are the most common sports injuries, and anterior talofibular ligament (ATFL) injury comprised 85% of all ankle sprains. Most patients recover with conservative treatment, but 20% of them progress to chronic ankle instability. Some studies have reported that anatomic reconstruction using a tendon graft is one of the best procedures to restore the ankle to its condition before symptom development. However, the effect of initial graft tension during ATFL reconstruction is still unclear. Therefore, the objective of this study was to investigate the effect of the initial graft tension during ATFL reconstruction. Methods: Eight fresh-frozen cadaveric ankle specimens were subjected to passive plantarflexion (PF)-dorsiflexion (DF) movement from 15° DF to 30° PF using the 6-degree-freedom robotic system. In addition, 60 N of anterior-posterior load, 1.7 Nm of inversion-eversion (IV-EV) torque, and 1.7 Nm of internal-external rotation (IR-ER) torque were applied to the ankle. During testing, 3-dimensional paths of the ankle were recorded simultaneously. Furthermore, in-situ forces of the ATFL and reconstructed graft were calculated using the principle of superposition. A repeated experiment was designed with the intact condition (intact), ATFL transection, and ATFL reconstruction with four different initial graft tensions (10 N, 30 N, 50 N, and 70 N). Results: AP laxity, IV-EV laxity and IR-ER laxity with ATFL transection was significantly greater than those with intact. In ATFL transection, the talus was significantly translated anteriorly with inversion and internal rotations under passive PF-DF motion compared with intact. Kinematic patterns and laxity in ATFL reconstruction with initial tension of 10 N and 30 N almost imitated intact, but in ATFL reconstruction with initial tension 70 N, the talus was significantly translated with external rotation compared with intact. As the initial graft tension during ATFL reconstruction increased, in-situ force of the reconstructed graft tended to increase during PF-DF motion. In-situ force of the reconstructed graft tension was significantly greater with initial tensions of 50 N, and 70 N than with intact during PF-DF motion (Figure 1). Conclusion: ATFL deficiency altered ankle kinematics and laxity. Although the optimal initial graft tension during ATFL reconstruction might restore ankle kinematics and laxity, excessive initial graft tension caused abnormal kinematics and laxity. Furthermore, the reconstructed graft tension increased as the initial tension increased. Initial tension during ATFL reconstruction has the important effect of imitating the normal ankle condition. We suggest that over-tensioning during ATFL reconstruction should be avoided in order to imitate the conditions of a normal ankle.
Mid-term Outcomes of Autologous Osteochondral Transplantation for Osteochondral Lesions of the Talus
Authors: Shimozono Yoshiharu , Hurley Eoghan , Kennedy John 
Published: September 2018

Category: Ankle Introduction/Purpose: Autologous osteochondral transplantation (AOT) is an established treatment for large-sized OLT, typically greater than 107mm2. Several studies have demonstrated favourable outcomes following AOT at short- and mid-term follow-up. However, the majority of the literature on AOT has short-term follow-up and little evidence exists on the mid-term and longer-term follow-up. Additionally, few studies include a large number of patients or have a high level of evidence, limiting the ability to draw broad and meaningful conclusions about the effectiveness of the AOT procedure for the treatment of OLT beyond short-term follow-up. The purpose of the current systematic review was to evaluate the clinical outcomes analysing level and quality of evidence of the AOT procedure in the treatment of OLT at mid-term and long-term follow-up. Methods: A systematic search of the MEDLINE, EMBASE and Cochrane Library databases was performed in October 2017 based on the PRISMA guidelines. Included studies were evaluated with regard to level of evidence (LOE) and quality of evidence (QOE) using the Coleman Methodology Score. Clinical outcomes, and complications were also evaluated. Results: Eleven studies, with 500 ankles were included at a mean 62.8 months follow-up. There were 3 studies of LOE III, and 8 studies of LOE IV. There were 3 studies of fair quality and 8 studies of poor quality. The weighted mean preoperative AOFAS score was 55.1 ± 6.1, and the postoperative score was 86.2 ± 4.5, with 87.4% of patients being reported as excellent or good results. In total, 54 of the 500 patients (10.8%) had complications. The most common complication was donor site morbidity with 18 patients (3.6%) at final follow-up. Thirty-one patients (6.2%) underwent reoperations, and the authors deemed a total of 5 ankles (1.0%) failures. Only 5 studies (45.5%) used MRI for follow-up evaluation. Conclusion: The current systematic review demonstrated that good clinical and functional outcomes can be expected following AOT procedure for the treatment of OLT, with a failure rate of only 1.0% at 63 months follow-up. MRI and radiographs showed restoration of articular surface as well as a minimal presence of osteoarthritis at mid-term follow-up. However, there is still lack of data from high LOE and QOE studies, and further high quality studies are necessary.
Increasing female authorship of foot and ankle academic literature over 24 years
Authors: Sing David , Vora Molly , Kuripla Casey , Ouyang David 
Published: September 2018

Category: Other Introduction/Purpose: Under-representation of women in surgery is commonly attributed to lacking mentorship and exposure in medical school, societal perceptions regarding career priorities, and concerns of “fitting in” in a work culture predominantly comprised of men. Furthermore, this disparity is also reflected in research productivity across academic medicine with male faculty being more likely to publish research compared to female colleagues. In this study we aim to describe the representation and longevity of female investigators among the authors of three foot and ankle research journals from 1993 to 2017. Methods: In this retrospective bibliometric analysis, authors of original research from three prominent foot and ankle research journals (Foot and Ankle International, The Journal of Foot and Ankle Surgery, Foot and Ankle Clinics) were extracted from PubMed. For authors with a complete first name listed, gender was determined by matching first name using an online database containing 216,286 distinct names across 79 countries and 89 languages. Proportion of female first, middle, and senior authors were determined over time, as well as total publication count per author. A sub-analysis of authors first publishing between 2007-2012 was followed for 5 years to identify how often authors continued to publish after first publication. Student t-test, chi-square analysis, and Cochran-Armitage trend tests were used to determine significance between groups. Results: From 1993 to 2017, 8,132 original articles were published in three foot and ankle research journals. A total of 6,597 (81.1%) had first names listed, identifying 25,329 total authors, of which 22,961 (90.7%) were successfully matched to a gender. 9,273 unique authors were identified (female: 19.2%). Female representation increased for first and senior authors from 6.5% and 5.9% (1993-1997) to 16.9% and 13.1% (2013-2017, p<0.001). Compared with male authors, female authors published fewer articles (mean: 1.7 vs 2.4, p<0.001). Of 2,691 authors who first published during 2006 to 2011, 369 authors (13.0%; female: 8.1% vs male 15.0%, p<0.001) continued to publish 5 years after their first publication. Female authors were more likely to only publish one article (75.6% vs 69.4%, p=0.016). Conclusion: Female representation in academic foot and ankle research has increased over two-fold over the past 2 decades. Despite these advances, compared to male authors, female authors are less likely to continue publishing 5 years after initial publication, and on average publish fewer articles. Although women are increasingly supported in the surgical workforce, our findings suggest that disparities in academic productivity exist in foot and ankle surgery. Further analysis of barriers to research amongst women may result in more equitable academic advancement and promotion for female foot and ankle surgeons.
An Accuracy of Syndesmotic Reduction by Direct Visualization Technique
Authors: Sripanich Yantarat , Rungprai Chamnanni 
Published: September 2018

Category: Trauma Introduction/Purpose: Syndesmotic injury is commonly seen associated with acute ankle fracture. Syndesmotic malreduction was proven be a poor prognostic factor. Many methods have been purposed to assess the quality of reduction such as direct visualization, comparing radiographic parameters to contralateral ankle fluoroscopy, and intra-operative computed tomography. In this study, we demonstrated syndesmotic malreduction rate using bilateral CT after using direct visualization technique for syndesmotic fixation. Methods: A prospective case series of 34 patients (13 left and 21 right sides) with an average age of 42 years who had rotational ankle fractures with syndesmotic injury confirmed by arthroscopic examination. All patients were treated with an open reduction and internal fixation of distal fibula using either 1/3 tubular plate or distal anatomical locking plate. Syndesmosis was fixed by one or two of 3.5-mm cortical screw with three or four cortices. Before syndesmotic fixation, syndesmotic reduction is made by using a large point reduction clamp and quality of the reduction was checked by direct visualization at anterior tibiofibular line. The accuracy of syndesmotic reduction is then evaluated by post-operative bilateral CT. A widening of distance between anterior tibia and fibular at 1-cm above the ankle joint more than 2 mm compared to uninjured sides considered a malreduction of syndesmosis. Results: The accuracy of syndesmotic reduction was 97.1 percent (33/34) compare to contralateral ankle. An average of BMI was 27.2 and an average of operative time was 98.2 minutes. One malreduction, was diagnosed on the criteria of a 2 mm difference from the contralateral side occurred due to a small fragment interposition at the syndemosis. This patient underwent revision surgery to remove the fragment and then fixation of syndesmosis with same manner to achieve anatomical reduction. In all cases, the screws are removed at 12 weeks. Neither breakage nor migration of screws is observed and no wound or nerve complications following this technique. Conclusion: A syndesmotic fixation using direct visualization technique demonstrate lower rate of malreduction as demonstrated by poster-operative bilateral CT scan and no complications. This technique is effective, safe, and should be considered for treatment of syndesmotic injury associated ankle fracture.
Prevalence of Vitamin D Deficiency in Patients with Talar Osteochondral Lesions
Authors: Telleria Jessica J.M. , Ready Lauren V. , Bluman Eric M. , Chiodo Christopher P. , Smith Jeremy T. 
Published: September 2018

Category: Ankle Introduction/Purpose: Vitamin D deficiency affects over 1 billion people worldwide and is common in foot and ankle patients. The prevalence in those with osteochondral lesions of the talus (OLTs) is unknown. This study identified the prevalence and risk factors for hypovitaminosis D in patients with an OLT. Methods: Serum 25(OH)D levels were obtained from patients presenting with an OLT from May to November during 2007 to 2016. Hypovitaminosis D was defined as 25(OH)D less than 30 ng/mL (75 nmol/L). Patients presenting with an acute ankle sprain (AS) during the same months served as a control group. Specific medical risk factors for hypovitaminosis D were recorded. The final OLT population included 46 patients (31 women [67.4%]; mean [SD] age 43.6 [14.8] years). The comparison AS group had 40 patients (32 women [80.0%]; mean [SD] age 56.2 [13.0] years). Results: The mean (SD) 25(OH)D in the OLT and AS cohorts were 31.2 (12.6) ng/mL and 37.1 (13.5) ng/mL, respectively (P =.039). Hypovitaminosis D was identified in 54% of the OLT population and 28% of the AS population (P = .012). Conclusion: Hypovitaminosis D is intimately related to decreased bone mineral density. This study identified a significantly higher rate of hypovitaminosis D in patients with an OLT compared to a cohort of AS patients. These findings suggest that when patients present with an OLT, health care providers should consider evaluating for and treating hypovitaminosis D.
A Virtual Clinic and a One Stop Acute Tendo-achilles Clinic
Authors: Thomson Calum , Singh Anjani 
Published: September 2018

Category: Trauma Introduction/Purpose: Patients with acute tendo-achilles (TA) rupture require prompt diagnosis, investigation and treatment in order to ensure optimum outcomes. This can be prevented by delay in review of patients within secondary care. We present our experience of treating such injuries by establishing a “virtual” fracture clinic (VFC) and a one stop dedicated TA specialist clinic. Patients are referred to the service via the emergency department (ED) and are triaged remotely by the VFC, at which all orthopaedic cases including suspected TA injuries are reviewed by a consultant orthopaedic surgeon using all available medical records and imaging. Suitable patients are then diverted directly to the specialist TA clinic for definitive treatment. We wished to establish the speed and efficiency of this care pathway. Methods: Using our institutions prospectively maintained database, we identified patients treated in the specialist TA clinic between September 2016 and August 2017. We recorded demographic details, injury mechanism, time from injury to diagnosis, ultrasound scan findings, and the speed of progress of the patient along the agreed rehabilitation pathway. Results: Sixty two patients were referred to the VFC with suspected TA injury. Mean age was 49 years, M: F (44:18 female). Mean time to triage in the VFC was 3.5 days (with 42% of patients triaged in the VFC on the same day as initial ED presentation). Mean time from ED consultation to assessment in our TA clinic was 11.7 days. Patients were assessed by a specialist foot and ankle surgeon, supported by a same day musculoskeletal ultrasound service. 45 patients (74%) were diagnosed with TA rupture, of which 69% were acute complete ruptures. Eight patients fulfilled criteria for surgical repair. Mean time from ED consultation to surgery was 13.25 days. Three further patients treated non-operatively developed secondary ruptures requiring delayed operative intervention. Conclusion: We recommend the use of a virtual triage service and a one stop TA clinic led by a dedicated specialist team to improve the accuracy of diagnosis and efficacy of treatment of acute TA rupture. This service provides a robust system for avoiding mis-diagnoses and delays in treatment, as well as ensuring effective implementation of our local care pathway under specialist supervision in a one stop clinic. This also establishes an effective system for monitoring as well as maintaining a research database for further prospective studies.
The Role of Lateral Soft Tissue Release for the Treatment of Hallux Valgus with Distal Chevron Osteotomy
Authors: Wang Zhijian , Zhong Tao 
Published: September 2018

Category: Bunion Introduction/Purpose: To define the effect of distal chevron osteotomy with and without lateral soft tissue release for the correction of mild and moderate hallux valgus. Methods: 24 consecutive patients were enrolled in this prospective study. In Group A, 12 patients underwent a chevron osteotomy only. In Group B, 12 patients underwent a chevron osteotomy with lateral soft tissue release. The hallux valgus angle (HVA) and intermetatarsalangle (IMA), and AOFAS score were measured preoperatively, and 6-month follow up postoperatively and complications were evaluated. Results and complications were evaluated. Results: The change in HVA, IMA and AOFAS score were insignificant (p > 0.05) between Group A and Group B. Complications of digital neuritis and cosmetically dissatisfied scarring of the dorsal web space were seen only in Group B. No cases had avascular necrosis of the metatarsal head, malunion or nonunion. Conclusion: Lateral soft tissue release may not be needed for mild or moderate hallux valgus deformities which may prevent neuritis of dorsal or plantar lateral digital nerve and cosmetic dissatisfaction of adorsal scar.
Pediatric Psoriatic Arthritis
Authors: Brandon Timothy G. , Manos Cynthia K. , Xiao Rui , Ogdie Alexis , Weiss Pamela F. 
Published: September 2018

Background: Relatively little is known about the epidemiology of juvenile psoriatic arthritis (PsA), including clinical features associated with the development of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities. Objective: To identify the overall risk of arthritis among children with psoriasis and subsequent risk of inflammatory comorbidities. Methods: Using Clinformatics DataMart (OptumInsight) deidentified US administrative claims data from 2000 to 2013, we identified children aged 0 to 16 years with an incident diagnosis of psoriasis or PsA using International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic, procedure, and pharmacy billing codes. Cox proportional hazard regression was performed to assess clinical features associated with development of arthritis in children with psoriasis. Incidence rate ratios were used to compare the relative frequency of comorbid diagnoses. Results: We identified 212 children with PsA, 4312 with psoriasis only, and 45 240 controls. Approximately 33% of children with PsA received a diagnostic code for psoriasis before arthritis. Median time to index code for arthritis after index code for psoriasis was 17.6 months (interquartile range: 4.1-38.1). Older age and uveitis were associated with a significantly increased risk of developing arthritis in children with psoriasis. Children with PsA had a significantly increased risk of uveitis, diabetes, and depressive disorder when compared to patients with psoriasis and inflammatory bowel disease, uveitis, diabetes, and depressive disorder when compared to controls. Conclusion: Most children with PsA developed arthritis first. Older age and uveitis were risk factors for arthritis among children with psoriasis. Psoriatic arthritis was associated with an increased risk of several clinically relevant inflammatory comorbidities.
Antithrombotic therapy in abdominal aortic aneurysm: beneficial or detrimental?
Authors: Cameron Scott J. , Russell Hannah M. , Owens A. Phillip 
Published: September 2018

Abstract
Abdominal aortic aneurysm (AAA) is a degenerative vascular pathology resulting in significant morbidity and mortality in older adults due to rupture and sudden death. Despite 150 000 new cases and nearly 15 000 deaths annually, the only approved treatment of AAA is surgical or endovascular intervention when the risk for aortic rupture is increased. The goal of the scientific community is to develop novel pharmaceutical treatment strategies to reduce the need for surgical intervention. Because most clinically relevant AAAs contain a complex structure of fibrin, inflammatory cells, platelets, and red blood cells in the aneurysmal sac known as an intraluminal thrombus (ILT), antithrombotic therapies have emerged as potential pharmaceutical agents for the treatment of AAA progression. However, the efficacy of these treatments has not been shown, and the effects of shrinking the ILT may be as detrimental as they are beneficial. This review discusses the prospect of anticoagulant and antiplatelet (termed collectively as antithrombotic) therapies in AAA. Herein, we discuss the role of the coagulation cascade and platelet activation in human and animal models of AAA, the composition of ILT in AAA, a possible role of the ILT in aneurysm stabilization, and the implications of antithrombotic drugs in AAA treatment.
IMiDs prime myeloma cells for daratumumab-mediated cytotoxicity through loss of Ikaros and Aiolos
Authors: Fedele Pasquale L. , Willis Simon N. , Liao Yang , Low Michael S. , Rautela Jai , Segal David H. , Gong Jia-Nan , Huntington Nicholas D. , Shi Wei , Huang David C. S. , Grigoriadis George , Tellier Julie , Nutt Stephen L. 
Published: September 2018

AbstractRecent studies have demonstrated that the immunomodulatory drugs (IMiDs) lead to the degradation of the transcription factors Ikaros and Aiolos. However, why their loss subsequently leads to multiple myeloma (MM) cell death remains unclear. Using CRISPR-Cas9 genome editing, we have deleted IKZF1/Ikaros and IKZF3/Aiolos in human MM cell lines to gain further insight into their downstream gene regulatory networks. Inactivation of either factor alone recapitulates the cell intrinsic action of the IMiDs, resulting in cell cycle arrest and induction of apoptosis. Furthermore, evaluation of the transcriptional changes resulting from their loss demonstrates striking overlap with lenalidomide treatment. This was not dependent on reduction of the IRF4-MYC “axis,” as neither protein was consistently downregulated, despite cell death occurring, and overexpression of either factor failed to rescue for Ikaros loss. Importantly, Ikaros and Aiolos repress the expression of interferon-stimulated genes (ISGs), including CD38, and their loss led to the activation of an interferon-like response, contributing to MM cell death. Ikaros/Aiolos repressed CD38 expression through interaction with the nucleosome remodeling and deacetylase complex in MM. IMiD-induced loss of Ikaros or treatment with interferon resulted in an upregulation of CD38 surface expression on MM cells, priming for daratumumab-induced NK cell-mediated antibody-dependent cellular cytotoxicity. These results give further insight into the mechanism of action of the IMiDs and provide mechanistic rationale for combination with anti-CD38 monoclonal antibodies.