bluuebunny/crossref_metadata_2025_split huggingface dataset:
Timing of Open Reduction and Internal Fixation of Ankle Fractures
Authors: Tantigate Direk , Vosseller J. Turner , Greisberg Justin , Ascherman Benjamin , Freibott Christina , Kirschenbaum Joshua , Ho Gavin 
Published: September 2017

Category: Ankle, Trauma Introduction/Purpose: Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery. Methods: A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater. Results: A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS. Conclusion: Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.
Can patients affected by stage II Posterior Tibial Tendon Dysfunction return to sport activities after surgical treatment?
Authors: Usuelli Federico Giuseppe , Di Silvestri Claudia , D’Ambrosi Riccardo , Maccario Camilla , Tan Eric 
Published: September 2017

Category: Hindfoot, Sports Introduction/Purpose: Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is considered the gold standard in treatment of adult flatfoot associated with posterior tibial tendon dysfunction (stage II in Myerson classification). The aim of this study was to estimate if patients underwent medial displacement calcaneal osteotomy with flexor digitorum longus transfer can participate to sport activities. Methods: 48 patients (21 men, 43,75%; 27 women, 56,25%) with a mean age at time of surgery of 42,3 years (range 19-74 years) were evaluated with a medium follow-up of 30 months (range, 27-34 months). All patients were evaluated clinically and by imaging before and after surgery. The clinical evaluation included for each patient the self-filling of Sports Athlete Foot and Ankle Score (SAFAS). and Pre- and postoperative sporting activities were recorded. The imaging evaluation included a pre-operative foot and ankle MRI and weight-bearing radiographs (antero-posterior, lateral and Saltzman 20° views) of the foot and ankle before surgery and at final follow-up. Moreover, each patients’ pre- and post-operative sport activities were recorded. Results: Preoperatively, 29 of 48 (60,4%) patients were engaged in athletic activities, participating in an average of 1.4 hours/week (range, 0-6 hours/week); postoperatively, 40/48 (83.3%) participated in sport and recreational activities for an average of 3.5 hours/week (range, 0-15 hours/week). Meary’s angle improved significantly from 11.3±6.3 degrees preoperatively to 7.2±5.5 degrees at final-follow-up (p<0.01); calcaneal pitch improved significantly from 16.1±4.3 degrees to 19.4±4.8 degrees (p<0.01). At final follow-up, patients demonstrated good SAFAS scores in symptom tolerance (85.90%), pain tolerance (88.30%), daily living performance (96.2%) and sports performance (86.45%). Conclusion: Most of patients returned or resumed to participate to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction and the increase of the average number of activities for patient and of the mid time spent was observed.
Biomechanical evaluation of metatarsal osteotomies for Hallux Rigidus. A cadaveric testing
Authors: Wagner Emilio , de Solminihac Diego Zanolli , Wagner Pablo , Ortiz Cristian , Díaz Andres Keller , Radkievich Ruben , Valencia Oscar , Guzman-Venegas Rodrigo 
Published: September 2017

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: Metatarsal osteotomies for Hallux Rigidus (HR) is a treatment option when neither a cheilectomy nor an arthrodesis are indicated. Different osteotomies exist that elevate, shorten or depress the metatarsal head. No biomechanical information exists that evaluates the effect of osteotomies on hallux range of motion (ROM) and stiffness. Our objective was to evaluate, in a cadaveric model, the first metatarsophalangeal joint (MTPJ) stiffness and kinematics changes, after three different metatarsal osteotomies. Methods: 8 cadaveric foot-ankle–distal tibia specimens were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue was kept intact. Each specimen was mounted on a special frame and luminous markers were attached to the skin (Oxford Foot Model). A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon and the posterior tibialis. Each specimen served as its own control, testing hallux dorsiflexion when pulling the extensor hallucis longus tendon. 10 cycles were performed for every condition: control (A), and three different metatarsal extraarticular neck osteotomies: vertical osteotomy with 5 mm of depression (B), 5 mm of shortening (C) and 5 mm of shortening and depression (D). All osteotomies were performed on a Hallux Rigidus cadaveric model. We registered the MTPJ stiffness and kinematic changes after each intervention using a tensile testing machine and high definition cameras. Results: B and C were significantly stiffer than group A and D (p<0.05). D was the only condition with a similar stiffness to the control group (A) (p>0.05). Groups B, C and D achieved similar kinematics (range of motion) to group A (p>0.05). Conclusion: Different metatarsal osteotomies exist for HR. The osteotomy of choice, should be one that recreates the healthy MTPJ motion and stiffness. According to our study, the osteotomy of choice should be one that results in metatarsal head depression and shortening. A possible explanation to our finding, is that a pure shortening or depression osteotomy is really elevating or depressing the head respectively, hence altering the tendon pull and relative head position. Only with metatarsal shortening and depression, the Hallux MTPJ biomechanics in a Hallux Rigidus cadaver model, returns to a healthy state.
Impaired Balancing Function in Patients of Chronic Mechanical Ankle Instability
Authors: Wang Bibo 
Published: September 2017

Category: Ankle Introduction/Purpose: Chronic ankle instability (CAI) is a disease entity commonly seen after ankle ligament injury. It is divided into mechanical ankle instability (MAI) and functional ankle instability (FAI), with different pathological conditions. The purpose of this study was to test the balancing ability of MAI and FAI patients. Methods: 30 CAI patients and 10 normal subjects were included according to the injury history, clinical symptom and MRI presentation. Stress tests were given under fluoroscopy to find out those with mechanical instability in CAI patients. Among them there were 18 MAI and 12 FAI patients. All patients were tested on a customized balancing ability assessment system developed by Shanghai Jiaotong University. Subjects were asked to stand on the platform for 30 seconds for both feet, 10 seconds for single foot, with eyes open. And 30 seconds for both feet, 5 seconds for single foot, with eyes closed. Each condition was tested for 3 trials and results were averaged. Parameters of balance like the swaying trajectory length and speed at both medial-lateral and anterior-posterior directions, the trajectory length per unit were obtained. Results were compared among three groups. Results: The MAI group presented significantly greater imbalance in both medial-lateral and anterior-posterior directions compared with that in the control group while standing on the single diseased foot, with eyes open or closed. While in the FAI group, no significant difference was found in postural sway compared with that in the control group. The MAI group presented significantly greater imbalance in both medial-lateral and anterior-posterior directions than the FAI group while standing on the single diseased foot with eyes open or closed. No significant difference in balancing was found of the contralateral ankle in the two groups. Conclusion: The balancing ability of MAI patients was impaired and then make them vulnerable to falling. Thus either balance training program or reconstructive surgery is needed to restore the balancing ability in those patients.
Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation
Authors: Zhang Mingzhu , Yu Guang-Rong 
Published: September 2017

Category: Midfoot/Forefoot Introduction/Purpose: Retrospective analyses of treatment for the first tarsometatarsal joint dislocation with Lisfranc injury. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury. Methods: This was a multi-center study, involving nine clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first tarsometatarsal joint dislocation underwent surgical intervention. Of this group, 41 (32.5%) feet were first tarsometarsal joint dislocation only. 85 feet were first tarsometarsal joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well. Results: 126 patients were followed up for average of 29.5 months．At 1.5 years, the mean AOFAS Midfoot score at latest follow-up was 79 points and 85 points separately in ORIF and arthrodesis group（P<0.05）. The VAS score was 3.1and 2.2 separately（P<0.05）.The BP score of SF-36 was 76.1 points and 84.6 points（P<0.05). Five patients in the open-reduction group had loosen or broken hardware. Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group. 36patients in ORIF group had pain in midfoot, eight of them had persistent pain, and they were eventually revised with arthrodesis. Two patients had painful hardware and the symptom disappeared after removal of the hardware. No redislocation and no hardware failure was identified in arthrodesis group. Conclusion: Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.
Repair of the Deltoid Ligament Complex Rupture Associated with Ankle Fractures
Authors: Zhang Mingzhu 
Published: September 2017

Category: Ankle 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.
Time course of exhaled hydrogen peroxide and nitric oxide during chemotherapy
Authors: Wewel A. R. , Crusius J. A. M. , Gatzemeier U. , Heckmayr M. , Becher G. , Magnussen H. , Jörres R. A. , Holz O. 
Published: September 2017

This study was designed to assess the effect of differential leukocyte depletion during chemotherapy by monitoring the levels of exhaled hydrogen peroxide H2O2and nitric oxide (FeNO) present.In 39 patients with lung cancer (chronic obstructive pulmonary disorder up to stage II, median forced expiratory volume in one second 78% predicted), measurements were performed before a cycle of therapy (day 1), at least once during the cycle (day 8: n = 34; day 15: n = 19), and afterwards (days 21–29).There were significant changes in the level of H2O2,FeNOand peripheral blood cell differentials over the visits. The level of H2O2was decreased only on day 15, with a median (difference between the upper and lower quartiles) fall of 31 (57)%, whileFeNOwas reduced only on day 8, by 22 (40)%. Neutrophil numbers were unchanged on day 8 and decreased by 59 (48)% on day 15, while monocyte numbers were decreased on day 8 by 87 (39)%. On days 21–29, values had returned to baseline.Taken together with previous findings, the parallel course of levels of exhaled hydrogen peroxide and neutrophil counts suggests that a major part of exhaled hydrogen peroxide is due to neutrophilsviathe conducting airways. In contrast, the production of exhaled nitric oxide seems to be primarily associated with monocytes.
Lymphangioleiomyomatosis
Authors: Johnson S. R. 
Published: September 2017

Lymphangioleiomyomatosis (LAM) is a rare disease of the lungs and lymphatics, which can occur sporadically or in association with tuberous sclerosis. LAM almost exclusively affects females, generally developing before the menopause.The disease is characterised by progressive pulmonary cystic change, recurrent pneumothorax, chylous pleural collections and, in most cases, progressive respiratory failure. Abdominal manifestations include lymphadenopathy, cystic lymphatic masses (lymphangioleiomyomas), chylous ascites and angiomyolipoma (a benign tumour). Survival in LAM is ∼70% at 10 yrs, although this is highly variable since long-term survivors have been described.Diagnosis is made by a combination of clinical features and computed tomography scanning or, in cases of doubt, lung biopsy. In patients with rapidly progressive disease, hormone treatment (predominantly progesterone) has been used, although no firm evidence supports its use. Otherwise, treatment is aimed at complications including pneumothorax, chylous collections and extrapulmonary manifestations. The only treatment for severe LAM is currently lung transplantation.Recent developments in the cell biology of lymphangioleiomyomatosis have shown that these patients have somatic mutations in the genes linked to tuberous sclerosis and that rapamycin may correct the resulting cellular abnormality. Trials of rapamycin in lymphangioleiomyomatosis are currently underway and offer hope of evidence-based treatment for the disease.
High sensitivity C-reactive protein in asthma
Authors: Takemura M. , Matsumoto H. , Niimi A. , Ueda T. , Matsuoka H. , Yamaguchi M. , Jinnai M. , Muro S. , Hirai T. , Ito Y. , Nakamura T. , Mio T. , Chin K. , Mishima M. 
Published: September 2017

Asthma is characterised by chronic inflammation of the airways, but the relevance of high-sensitivity assays for C-reactive protein (hs-CRP), which are known to be a sensitive marker of low-grade systemic inflammation, has not been fully studied in asthma. The objective was to examine serum hs-CRP levels in patients with asthma and their relationship to clinical characteristics and degree of airway inflammation.Serum hs-CRP levels were cross-sectionally examined in steroid-naive (n = 22) and steroid-inhaling (n = 23) adult patients with asthma and healthy controls (n = 14). All were nonsmokers.Serum hs-CRP levels were significantly increased in steroid-naive patients (mean±sd1.33±1.48 mg·L−1) compared with controls (0.21±0.30 mg·L−1), but not in patients on inhaled corticosteroid. Among steroid-naive patients, serum hs-CRP levels significantly negatively correlated with indices of pulmonary function (forced expiratory volume in one second/forced vital capacity and forced mid-expiratory flow) and positively with sputum eosinophil count. Among patients on inhaled corticosteroid, hs-CRP levels did not correlate with any indices.In conclusion, an increase in serum C-reactive protein levels measured by high-sensitivity assays may be associated with airflow obstruction and airway inflammation, and may serve as a surrogate marker of airway inflammation in asthma.
Challenges in modeling complexity of neglected tropical diseases: a review of dynamics of visceral leishmaniasis in resource limited settings
Authors: DebRoy Swati , Prosper Olivia , Mishoe Austin , Mubayi Anuj 
Published: September 2017

Abstract
Objectives
Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects challenges and successes related to the modeling of transmission dynamics of VL. Possible ways of creating a comprehensive mathematical model is also discussed.

Methods
Published literature in three categories are reviewed: (i) identifying non-traditional but critical mechanisms for VL transmission in resource limited regions, (ii) mathematical models used for dynamics of Leishmaniasis and other related vector borne infectious diseases and (iii) examples of modeling that have the potential to capture identified mechanisms of VL to study its dynamics.

Results
This review suggests that VL elimination have not been achieved yet because existing transmission dynamics models for VL fails to capture relevant local socio-economic risk factors. This study identifies critical risk factors of VL and distribute them in six categories (atmosphere, access, availability, awareness, adherence, and accedence). The study also suggests novel quantitative models, parts of it are borrowed from other non-neglected diseases, for incorporating these factors and using them to understand VL dynamics and evaluating control programs for achieving VL elimination in a resource-limited environment.

Conclusions
Controlling VL is expensive for local communities in endemic countries where individuals remain in the vicious cycle of disease and poverty. Smarter public investment in control programs would not only decrease the VL disease burden but will also help to alleviate poverty. However, dynamical models are necessary to evaluate intervention strategies to formulate a cost-effective optimal policy for eradication of VL.
Discovery of GnIH and Its Role in Hypothyroidism-Induced Delayed Puberty
Authors: Tsutsui Kazuyoshi , Son You Lee , Kiyohara Mika , Miyata Ichiro 
Published: September 2017

AbstractIt is known that hypothyroidism delays puberty in mammals. Interaction between the hypothalamo-pituitary-thyroid (HPT) and hypothalamo-pituitary-gonadal (HPG) axes may be important processes in delayed puberty. Gonadotropin-inhibitory hormone (GnIH) is a newly discovered hypothalamic neuropeptide that inhibits gonadotropin synthesis and release in quail. It now appears that GnIH is conserved across various mammals and primates, including humans, and inhibits reproduction. We have further demonstrated that GnIH is involved in pubertal delay induced by thyroid dysfunction in female mice. Hypothyroidism delays pubertal onset with the increase in hypothalamic GnIH expression and the decrease in circulating gonadotropin and estradiol levels. Thyroid status regulates GnIH expression by epigenetic modification of the GnIH promoter region. Furthermore, knockout of GnIH gene abolishes the effect of hypothyroidism on delayed pubertal onset. Accordingly, it is considered that GnIH is a mediator of pubertal disorder induced by thyroid dysfunction. This is a novel function of GnIH that interacts between the HPT-HPG axes in pubertal onset delay. This mini-review summarizes the structure, expression, and function of GnIH and highlights the action of GnIH in pubertal disorder induced by thyroid dysfunction.