bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stress Tests for Ligamentous Lisfranc Instability
Authors: Smith George , Loizou Constantine 
Published: September 2018

Category: Trauma Introduction/Purpose: The diagnosis of Lisfranc ligament disruption is notoriously difficult. Radiographs and MRI scans are often ambiguous therefore a ‘stress-test’ under anaesthesia is commonly utilised. Two midfoot stress-tests are in current practice, namely the varus first ray stress-test and the pronation abduction test. The optimal type of stress-test is not however evaluated in the literature. We hypothesised that after the loss of the main plantar stabiliser (the Lisfranc ligament) the patient would demonstrate dorsal instability, not the classic 1st/2nd metatarsal diastasis commonly described. We therefore devised a push-up test (placement of a force under the 2nd metatarsal to elevate the base on the lateral radiograph). We aimed to initially test our hypothesis and the previously described stress tests on a cadaveric model. Methods: Twelve fresh frozen cadaveric specimens without previous foot injury were used. The 2nd tarsometatarsal joint was exposed and the Lisfranc ligament and dorsal capsule were incised. An image intensifier was positioned and standard anteroposterior (AP) and lateral views were obtained. Two previously reported AP stress-tests (varus first ray stress test, pronation abduction test) and the novel test under investigation (‘Lisfranc Push-Up’ test) were duly performed. A positive test was taken as 2mm of dorsal or lateral displacement. Results: All twelve of the Lisfranc Push-Up tests showed dorsal subluxation of the 2nd metatarsal on the middle cuneiform of greater than 2mm on the lateral radiograph. No diastasis (greater than 2mm) of the 1st/2nd metatarsals was seen in any of the specimens on the AP radiographs for either of the other two stress-tests. Conclusion: The authors have described a novel way of demonstrating the dorsal instability associated with the ligamentous Lisfranc injury. Our results support the Lisfranc Push-Up test as a reproducible and sensitive method for assessing ligamentous Lisfranc injuries. In our cadaveric model the previously described stress-tests do not work.
Supramalleolar osteotomy and AMIC cartilage reconstruction in severe cartilage lesion
Authors: Thermann Hajo 
Published: September 2018

Category: Ankle Introduction/Purpose: Severve cartilage lesion is defined by the author as: Cartilage substantial deterioration of the subchondral bone Kissing lesion, tibial and talar lesion. Gross cystic lesion Cartilage damage greater than 1/3 of the talar dome or the tibial platform Slerotic changes of the subchondral bone plate in arthritic cases in severe hindfoot varus or valgus alignment. This paper shows in a case series, exceptional cartilage lesions with the above mentioned pathological changes. The indications, strategies for osteotomies and the treatment strategies in malaligned bipolar, cystic and gross cartilage lesions is explained. Methods: 35 patients with severe circumscript varus / valgus arthritis have been operated by supramalleolar osteotomy (SMOT), 11 of them with (tibial & talar “kissing”) lesions. 70 patients presented bipolar (tibial & talar “kissing”) lesions with correct hindfoot axis. 18 patients had a gross cystic lesion and were additionally treated with filling of the cysts. 2 of them had a “kissing lesion”. Results: All patients received an AMIC procedure (hyaluronic matrix, Hyalofast©) for cartilage reconstruction. The biological healing support was in all cases bone marrow aspirate and ACP© growth factors. The subchondral bone plate was treated aggressively was a power raps or burr according to L. Johnson technique The importance of a supramalleolar and calcaneous osteotomy in a hindfoot malalignment (varus / valgus) as a treatment key aspect for load transfer is elaborated. Planned early implant removal with revision und biological boosting of the cartilage regeneration is a further cornerstone of the treatment. Followup were evaluated by FAOS score Conclusion: This cases series have shown the possibilities for a successfull managing of this severe lesions and offers also its limit in the over all results.
Activity Following Ankle Arthrodesis
Authors: Whicker Emily , Traub Brian , Allam Emad , Labib Sameh 
Published: September 2018

Category: Ankle Introduction/Purpose: Ankle arthrodesis (AA) is frequently employed in the treatment of end-stage ankle arthritis, which is common following trauma and athletic injuries. While AA remains a popular therapeutic option, little data exists about activity and sporting capacity following AA. The objective of this research was to determine functional outcomes and sporting activity levels in patients following AA. Methods: Validated questionnaires were emailed to 35 patients with a history of AA at an average follow-up of 52 months. Functional outcomes were assessed using the Foot and Ankle Disability Index (FADI), as well as the associated FADI-Sport. Responses were compared to those from a control population of 24 patients scheduled for AA, at an average preoperative visit of 3 months. Activity levels were assessed prior to injury as well as pre- and post-operatively using the Tegner activity level scale. Results: Average Tegner scores of the 35 surgical patients decreased from 3.82 (SE±0.38) before their injury, to 1.15 (SE±0.19) immediately pre-op, with recovery to 2.67 (SE±0.26) following fusion. Average post arthrodesis FADI and FADI-sport scores in our patients were 76.5% (SE±3.19%) and 33.8% (SE±23.06%). For the preoperative control population, corresponding scores were 47.41% (SE=2.61%) and 22.24% (SE=1.03%). Conclusion: Following AA, we found that patients improved upon their pre-op Tegner score, although they did not return to their before injury level of sporting participation. Additionally, patients reported that they had no current dysfunction with their lower leg. Thus, patients undergoing AA should expect improved lower leg function, though will not likely return to their pre-injury level of activity.
Biomechanical Analysis of Cuboid Osteotomy Lateral Column Lengthening for Stage II B Adult-Acquired Flatfoot Deformity
Authors: Yang Yunfeng 
Published: September 2018

Category: Midfoot/Forefoot Introduction/Purpose: To investigate the effect of cuboid osteotomy lateral column lengthening (LCL) for the correction of stage II B adultacquired flatfoot deformity in cadaver Methods: Six cadaver specimens were loaded to 350 N. Flatfoot models were established and each was evaluated radiographically and pedobarographically in the following conditions: (1) intact foot, (2) flatfoot, and (3) cuboid osteotomy LCL (2, 3, 4, and 5 mm). Results: Compared with the flatfoot model, the LCLs showed significant correction of talonavicular coverage on anteroposterior radiographs and talus-first metatarsal angle on both anteroposterior and lateral radiographs ( p < .05). Compared with the intact foot, the above angles of the LCLs showed no significant difference except the 2mmLCL. In terms of forefoot pressure, medial pressure of the 2mmLCL ( p = .044) and lateral pressure of the 3, 4, and 5mmLCLs showed statistical differences ( p < .05), but lateral pressure of the 3 mm LCL was not more than the intact foot as compared to the 4 and 5 mm LCLs, which was less than medial pressure. Conclusion: Cuboid osteotomy LCL procedure avoids damage to subtalar joint and has a good effect on correction of stage II B adult-acquired flatfoot deformity with a 3 mm lengthening in cadavers.
Management of mal-united Pilon fractures with joint-sparing osteotomy
Authors: Yu Guang-rong 
Published: September 2018

Category: Ankle Introduction/Purpose: To explore the effectiveness and operative methods to treat various mal-united Pilon fractures with joint-sparing osteotomy. Methods: Between January 2011 and October 2016, 21 patients with mal-united Pilon fractures were treated with joint-sparing osteotomy. There were 13 males and 8 females with an average age of 38.4 years (range, 22-48 years). 14 were left feet and 7, right. The time from injury to reconstructive operation was 4 months to 10 years. 17 received operative treatment previously, and 4 were treated by plaster fixation. According to Rüedi-Allgöwer classification, 16 were rated as type II (including 6 medial Pilon fractures, 5 anterior, 5 posterior) and 5, type III. All patients received standardized postoperative managements. Results: All patients were followed up for more than 1 year. All the fractures were reunited in an average time of 13.8 weeks (range 9 to 18 weeks). The mean visual analogue scale (VAS) score was 2.42 (range 0 to 5) and the mean ankle and hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) score was 78.81(range 65 to 92) 6 months after operation. The VAS score was 5.27 (range 2 to 7) and the AOFAS score was 57.26 (range 20 to 81) before. Comparing to preoperative data, statistically significant difference was found postoperatively (P<0.05). Conclusion: Results by joint-sparing osteotomy to realign and reconstruct articular surfaces of ankles are acceptable. Functions and symptoms are improved significantly after operation. Joint-sparing osteotomy can be a considerable option for treating mal-united Pilon fractures.
MRI Classification of subtalar and talonavicular joint osteoarthritis
Authors: Zaidi Razi , Hargunani Rikin , Calleja Michele , Goldberg Andrew 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The sublatar joint is formed by the articulation of the talus and the calcaneus. The Calcaneus had three facets; posterior, middle and anterior that articulate with the talus. The anterior facet is also continuous with the Talonavicular joint. Plain radiography of the foot and ankle is the usual method to detect degeneration in these joints, however plain films do not permit full characterisation of non-ossified structures, such as articular cartilage, marrow tissue and synovial fluid. MRI is a better way to detect these changes. The aim of this study was to develop a quantitative way to score arthritic changes to the subtalar and talonavicular joints using MRI that was usable, repeatable and reliable. Methods: The MRI scans of thirty consecutive subjects with foot and ankle pain were retrospectively evaluated. MRI images were obtained using 1.5-T MRI. Images were interpreted independently by three musculoskeletal radiologists. In order to determine intra-observer reliability as well as the inter-observer reliability two of the readers independently scored the studies twice, more than 14 days apart. Five features of osteoarthritis were scored in the Subtalar joint and the Talonavicular joint. These were; cartilage morphology, subarticular marrow, subarticular cyst, marginal osteophytes and synovitis. The Subtalar joint was scored in eight different regions and Talonavicular joint in two The maximum score for both regions was 100. Scores were summarised and Inter- and Intra-observer agreement was calculated. Intraclass coefficient values less than 0.40 were poor, fair between 0.40 and 0.59 were fair, values between 0.60 and 0.74 were good, and values between 0.75 and 1 excellent. Results: For the 30 MRI scans the mean score for the Subtalar joint ranged from 11.7 to 14.4 and for the Talonavicular joint ranged from 3.7 to 5.6. The inter-observer correlation for the Subtalar joint between the three readers ranged between 0.53 and 0.83 for the individual features but overall was excellent at 0.76. For the Talonavicular joint the total correlation was good at 0.67. The inter-observer ICC for the total score was 0.75 which showed excellent agreement between the three readers. The total intra-observer correlation was excellent. Conclusion: We have designed a novel scoring system subtalar and talonavicular arthritis that is easy to perform and demonstrates excellent reliability and may be an extremely useful tool for clinical trials on ankle arthritis and other studies to diagnose and monitor disease progression.
Reconstruction of Calcaneal Fracture Malunion With Osteotomy and Subtalar Joint Salvage
Authors: Zhang Ming-Zhu , Yu Guang-rong 
Published: September 2018

Category: Hindfoot Introduction/Purpose: The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy. Methods: From May 2005 to November 2016, 85 patients (88 feet) with calcaneal malunions after a displaced intraarticular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 8.9 months (95% confidence interval, 4.5-11.6 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the lateral exostosis that had been removed, iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Sixty two patients (63 feet) were followed for a mean of 45.4 months (29.0-52.3 months). Results: According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 81.6 points (95% confidence interval, 78.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Eight patients had wound edge necrosis, and 4 had superficial infection. Two patient required a subtalar fusion for subtalar arthritis at 2 years after surgery. Conclusion: Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.
Repair of the acute deltoid ligament complex rupture associated with ankle fractures
Authors: Zhang Ming-Zhu , Yu Guang-rong 
Published: September 2018

Category: Trauma Introduction/Purpose: It is controversial for operative repair of deltoid ligament in acute ankle fractures. To investigate the indication for surgical interference and the clinical outcome about repair whole deltoid ligament rupture associating with ankle fractures. Methods: We performed multiple-center study in 4 clinical centers in 4 cities of China. From January 2006 to December 2011, of 1533 ankle fractures operated, 131 deltoid ligament rupture were identified and repaired operatively. They were 74 males and 57 females with a mean age of 37.2 years (range, 15-83 years). Clinical examination, radiographs, AOFAS ankle-hindfoot scores and visual analogue scale were used for outcome measurement. Results: All incision healed primarily. 106 patients were followed up for 12 to 72 months with the mean follow-up of 27 months. The mean time of fracture union was 14.5 weeks (range, 9-16 weeks). The mean AOFAS ankle-hindfoot score at last follow-up was 91.4 points (range, 83-100 points). The mean score of VAS was 1.2 points (range, 0-6 points). The mean score of SF-36 was 91.2 points (range, 80-96 points). There was no ankle instability and post-trauma osteoarthritis. Conclusion: This multiple-center study demonstrated that deltoid ligament repair can benefit patients with unstable ankle after fracture fixation. A reasonable clinical evaluation and surgical repair could be done, choosing an appropriate repair technique according to the site of deltoid ligament rupture.
Materials and techniques of Islamic manuscripts
Authors: Knipe Penley , Eremin Katherine , Walton Marc , Babini Agnese , Rayner Georgina 
Published: September 2018

Abstract
Over 50 works on paper from Egypt, Iraq, Iran and Central Asia dated from the 13th to 19th centuries were examined and analyzed at the Straus Center for Conservation and Technical Studies. Forty-six of these were detached folios, some of which had been removed from the same dispersed manuscript. Paintings and illuminations from five intact manuscripts were also examined and analyzed, although not all of the individual works were included. The study was undertaken to better understand the materials and techniques used to create paintings and illuminations from the Islamic World, with particular attention paid to the diversity of greens, blues and yellows present. The research aimed to determine the full range of colorants, the extent of pigment mixing and the various preparatory drawing materials. The issue of binding materials was also addressed, albeit in a preliminary way.
Mapping targets for small nucleolar RNAs in yeast
Authors: Dudnakova Tatiana , Dunn-Davies Hywel , Peters Rosie , Tollervey David 
Published: September 2018

Background: Recent analyses implicate changes in the expression of the box C/D class of small nucleolar RNAs (snoRNAs) in several human diseases. Methods: Here we report the identification of potential novel RNA targets for box C/D snoRNAs in budding yeast, using the approach of UV crosslinking and sequencing of hybrids (CLASH) with the snoRNP proteins Nop1, Nop56 and Nop58. We also developed a bioinformatics approach to filter snoRNA-target interactions for bona fide methylation guide interactions. Results: We recovered 241,420 hybrids, out of which 190,597 were classed as reproducible, high energy hybrids. As expected, the majority of snoRNA interactions were with the ribosomal RNAs (rRNAs). Following filtering, 117,047 reproducible hybrids included 51 of the 55 reported rRNA methylation sites. The majority of interactions at methylation sites were predicted to guide methylation. However, competing, potentially regulatory, binding was also identified. In marked contrast, following CLASH performed with the RNA helicase Mtr4 only 7% of snoRNA-rRNA interactions recovered were predicted to guide methylation. We propose that Mtr4 functions in dissociating inappropriate snoRNA-target interactions. Numerous snoRNA-snoRNA interactions were recovered, indicating potential cross regulation. The snoRNAs snR4 and snR45 were recently implicated in site-directed rRNA acetylation, and hybrids were identified adjacent to the acetylation sites. We also identified 1,368 reproducible snoRNA-mRNA interactions, representing 448 sites of interaction involving 39 snoRNAs and 382 mRNAs. Depletion of the snoRNAs U3, U14 or snR4 each altered the levels of numerous mRNAs. Targets identified by CLASH were over-represented among these species, but causality has yet to be established. Conclusions: Systematic mapping of snoRNA-target binding provides a catalogue of high-confidence binding sites and indicates numerous potential regulatory interactions.
Lessons from the first clinical trial of a non-licensed vaccine among Ugandan adolescents: a phase II field trial of the tuberculosis candidate vaccine, MVA85A
Authors: Wajja Anne , Namutebi Milly , Apule Barbara , Oduru Gloria , Kiwanuka Samuel , Akello Mirriam , Nassanga Beatrice , Kabagenyi Joyce , Mpiima Juma , Vermaak Samantha , Lawrie Alison , Satti Iman , Verweij Jaco , Cose Stephen , Levin Jonathan , Kaleebu Pontiano , Tukahebwa Edridah , McShane Helen , Elliott Alison M. 
Published: September 2018

Background: A more effective vaccine for tuberculosis (TB) is a global public health priority. Vaccines under development will always need evaluation in endemic settings, most of which have limited resources. Adolescents are an important target population for a new TB vaccine and for other vaccines which are relevant at school-age. However, in most endemic settings there is limited experience of trials of investigational products among adolescents, and adolescents are not routinely vaccinated. Methods: We used Modified vaccinia Ankara-expressing Ag85A (MVA85A), a well-tolerated candidate vaccine for tuberculosis, to assess the effect of Schistosoma mansoni infection on vaccine immunogenicity among Ugandan adolescents in primary school. We describe here the challenges and lessons learned in designing and implementing this first clinical trial among Ugandan adolescents using a non-licensed vaccine. Results: The school based immunization study was feasible and adhered to Good Clinical Practice principles. Engagement with the community and all stakeholders was critical for successful implementation of the trial. Creative and adaptable strategies were used to address protocol-specific, operational and logistical challenges. This study provided lessons and solutions that can be applied to other trials among adolescents in similar settings elsewhere, and to school-based immunization programs. Conclusion: Sufficient time and resources should be planned for community preparation and sensitization to ensure buy in and acceptance of a project of this kind. This trial shows that challenges to implementing early field trials in Africa are not insurmountable and that necessary well-planned high-quality ethical trials are feasible and should be encouraged. Trial Registration: ClinicalTrials.gov NCT02178748 03/06/2014
Música visual: De los órganos de color a los primeros ordenadores
Authors: García Miragall Carlos Manuel , Sanmartín Piquer Francisco , Gracia Bensa Trinidad 
Published: September 2018

La idea de obtener imágenes a partir de la música ha sido tratada a lo largo de los siglos; no como un movimiento independiente sino siempre dentro del contexto cultural y tecnológico de cada época. Este esfuerzo histórico se puede agrupar en lo que se ha venido a denominar Música Visual, Visualización del Sonido o Sonido Visual que fundamenta su naturaleza en la noción de sinestesia (Brougher 2005). El campo de la Música Visual siempre ha estado marcado por los medios tecnológicos involucrados en la creación de imágenes. En este trabajo realizamos una revisión histórica de algunas de las aportaciones que consideramos más relevantes centrándonos en las relaciones entre tecnología y arte. Nuestro repaso se inicia con las primeras intuiciones de los filósofos griegos de relacionar color y sonido y termina en los inicios de la era digital.
Odnos in znanje medicinskih sester ter ovire pri implementaciji na dokazih temelječe prakse
Authors: Bole Urban , Skela-Savič Brigita 
Published: September 2018

Uvod: Na dokazih temelječa praksa velja za zlati standard obravnave pacientov. Namen raziskave je bil preučiti odnos, znanje in ovire pri implementaciji na dokazih temelječe prakse v zdravstveni negi.Metode: Uporabljen je bil sistematični pregled znanstvene in strokovne literature. V pregled so bile vključene naslednje baze: CINAHL Plus, ProQuest Dissertations & Theses Global, SpringerLink, WILEY in PubMed. Omejitvena kriterija iskanja sta bila objava članka med letoma 2008 in 2017 ter dostopnost celotnega besedila člankov v angleščini. Ključne besede iskanja: nurse, evidence based practice, implementation barriers. V končni pregled je bilo vključenih 37 člankov. Ocena kakovosti dokazov je prikazana v hierarhiji dokazov. Podatki so bili obdelani s tematsko kvalitativno analizo.Rezultati: Identificiranih je 73 kod, ki so združene v 7 vsebinskih kategorij: (1) dejavniki, ki vplivajo na negativen odnos medicinskih sester do na dokazih temelječe prakse, (2) dejavniki, ki vplivajo na pozitiven odnos medicinskih sester do na dokazih temelječe prakse, (3) znanje raziskovanja medicinskih sester za uporabo znanstvenih dokazov v kliničnem okolju, (4) znanje uporabe informacijske tehnologije za iskanje dokazov, (5) vpliv mentorstva in kompetenc za implementacijo na dokazih temelječe prakse v klinično okolje, (6) ovire organizacije za implementacijo na dokazih temelječe prakse v klinično okolje in (7) ovire medicinskih sester za implementacijo na dokazih temelječe prakse v klinično okolje.Diskusija in zaključek: Raziskava pokaže pozitiven kot tudi negativen odnos medicinskih sester do na dokazih temelječe prakse. Osredotoča se na pomanjkanja znanja in ovire, s katerimi se srečujejo medicinske sestre pri implementaciji na dokazih temelječe prakse v klinično okolje.