bluuebunny/crossref_metadata_2025_split huggingface dataset:
Salvage of Diabetic Foot Osteomyelitis With Antibiotic Impregnated Cement Spacer- Long Term Follow Up
Authors: Melamed Eyal A. , Banker Tali Portal , Peled Eli 
Published: October 2016

Category: Diabetes Introduction/Purpose: Diabetic foot infections (DFI) with osteomyelitis often requires minor amputation as a mean to achieve adequate debridement and infection eradication. In the past years we have developed and used a method of utilizing antibiotic impregnated cement spacer (ACS) in DFI surgeries. The ACS release antibiotic locally, fill the cavity created by the extensive debridement of infected bone and stabilize the area to encourage healing. This is a long term report on using ACS in cases of severe DFI. Methods: 67 cases of severe forefoot DFI with osteomyelitis in 56 consecutive patients (one patient could have several cases in different times and/or sites), mean age 57 ± 11.7 years. Follow-up was 6 to 125 months (mean 39.7± 30 months). Extensive meticulous debridement followed ACS to fill the gap were employed in all cases. ACS contained Gentamycin and Vancomycin routinely and Amikacin in selected cases. Deep cultures were taken routinely. Stabilization was usually achieved Fixation with Kirschner Wires. Success defined as resolution of infection and wound healing without amputation. Results: Of the 67 cases 50 (75.7%) healed in 45 patients. Of the 12 patients (17 cases) who did not heal 4 required toe amputation, 2 ray amputation, 1 transmetatarsal amputation and 5 trans tibial amputation.. Of the ACSs: 23 left permanently 12 removed and arthrodesis was performed, and 15 removed without arthrodesis. Two patients recovered but subsequently underwent trans-tibial amputation (after 18 months and 5 years) due to infection in different site. Conclusion: ACS is effective and sometimes indispensable adjunct in the surgical treatment of forefoot DFI with osteomyelitis, when extensive debridement is undertaken to eradicate the infection without amputation. ACS stabilizes the infected part; fill the void created by the debridement and release locally broad spectrum antibiotic.
Stability of Ankle Fracture-Dislocations Following Successful Closed Reduction
Authors: Matson Andrew P. , Green Cynthia , Hurwitz Shepard R. , Zura Robert D. 
Published: October 2016

Category: Trauma Introduction/Purpose: Acute ankle fracture-dislocations require emergent reduction. Once the dislocation is successfully reduced, the ideal timing of operative fixation is not well understood. At our institution, a protocol enables patients who have a successful closed reduction in the Emergency Department (ED) to go home and return to the clinic to schedule surgery. We sought to describe the rate at which initial reduction is lost between the ED and clinic visits, and to identify factors associated with loss of reduction. Methods: We retrospectively reviewed all patients who were treated operatively for an ankle fracture from 2008-2012 at a single, Level 1 trauma center and identified 30 patients who had isolated, closed ankle fracture-dislocations that were successfully reduced and splinted in the ED. Adequate reduction was defined by achievement of congruent joint line with < 5mm medial clear space. If reduction was maintained at the clinic visit, surgery was scheduled electively, defining a success. However, if reduction was lost in the interim between ED and clinic visits the patient was admitted from clinic for urgent surgical stabilization, defining a failure. Results: Seventeen patients (57%) successfully maintained closed reduction and 13 (43%) experienced failure of closed reduction in the interim. Compared to the successful group, the failed group had significantly greater posterior malleolus (PM) fracture fragment size (5.1 mm vs. 3.0 mm, p = 0.029). When the ratio of PM fracture fragment size to complete articular surface was > 0.1, rate of failure was 65% compared to 18% when the ratio was ≤0.1 (p = 0.016). There were 2 major wound complications, both of which occurred in the group that failed reduction in the interim. Conclusion: Greater PM fracture fragment size is associated with higher rates of interim failure of closed reduction of closed ankle fracture-dislocations. Injuries with a large PM fracture fragment may warrant consideration of earlier operative intervention.
The Dorsal Intermetatarsal Approach for Plantar Plate and Lateral Collateral Ligament Repair of the Lesser Metatarsophalangeal Joints
Authors: Siddappa Vinay Hosuru , Sittapairoj Tinnart , Femino John , Hartog Bryan Den , Gao Yubo , Goetz Jessica E. , Phisitkul Phinit 
Published: October 2016

Category: Lesser Toes Introduction/Purpose: Access to the plantar plate has been described using either a plantar approach or an extensile dorsal approach that required complete joint destabilization and often a metatarsal osteotomy. Clinical scenarios related to plantar plate tear vary and the pathologies in early stages are frequently limited to unilateral soft tissue structures, a more focused surgical approach deemed appropriate. A novel approach requiring a release of only the lateral collateral ligament and the lateral half of the plantar plate was described and the adequacy of joint exposure was evaluated in a cadaver model. The ability to place a suture through the lateral collateral ligament and the plantar plate were analyzed and validated with pull-out strength. Methods: Nine fresh frozen cadaveric specimens were dissected in a randomized fashion across the 2nd to 4th MTP joints through the intermetatarsal space dorsally. Under distraction, soft tissue was sequentially released including dorsal capsule, lateral collateral ligament, and the lateral half of the plantar plate. Integrity of the extensor tendons, deep transverse intermetatarsal ligament, proximal attachment of the plantar plate, and osseous structures was carefully preserved. The joint exposure was quantified after each step with sizing rods. 2/o non-absorbable sutures were passed into the lateral collateral ligament and the plantar plate using a suture passer; and their pullout strength was measured using a tensiometer. Results: Progressive increase in mean of joint exposure was noted after each step of soft tissue release with the final exposure of 6mm after release of the lateral half of the plantar plate. Joint exposures after a capsulotomy and a lateral collateral release were 3mm and 4mm, respectively. Under distraction, the unilateral release of soft tissue created a lateral opening of the joint while the proximal phalangeal base adducted and medially deviated. Successful suture passage was noted in all specimens with mean pullout strength of 76 N for the lateral collateral ligament and 67 N for the plantar plate. There was a statistically significant (p < 0.01) higher suture pullout strength for the lateral collateral ligament in males when compared to female specimens Conclusion: The dorsal intermetatarsal approached appeared to be feasible for the access to the lateral collateral ligament and the lateral half of the plantar plate. The average joint exposure of 6 mm allowed a quality suture passage by a suture passer in both structures in all specimens without the need of a metatarsal osteotomy.
The Effect on Radiographic Parameters of Dwyer’s Osteotomy and 1st Metatarsal Osteotomy for Pes Cavo-Varus Correction
Authors: Choi Jun Young , Yeom Ji Woong , Suh Jin Soo 
Published: October 2016

Category: Hindfoot Introduction/Purpose: Authors retrospectively reviewed and compared the data of patients who underwent 1st metatarsal osteotomy alone, Dwyer’s osteotomy alone and 1st metatarsal osteotomy combined with Dwyer’s osteotomy to figure out the effect on radiographic parameters for the correction of pes cavo-varus. Methods: Data on 28 cases in 27 consecutive patients recruited from 2006 to 2014 who underwent 1st metatarsal osteotomy alone (Group F), Dwyer’s osteotomy alone (Group H) or 1st metatarsal osteotomy followed by Dwyer’s osteotomy (Group HF) with a minimum 1-year follow-up were reviewed retrospectively. Results: Calcaneal pitch angle on the standing foot lateral radiographs was significantly decreased after operation in group H and HF whereas Meary angle was decreased in group F and HF. Hindfoot alignment angle and ratio on the hindfoot alignment view were improved in group H and HF. Maximal medial cuneiform height reduction was shown in group HF. 1st ray was significantly shortened in group F and HF. Conclusion: Combined forefoot and hindfoot operation took the largest correction power for all radiologic parameters.
The Medial Column Fusion Bolt
Authors: Ahluwalia Raju S. , O’dak Saurab , Reichert Ines L. , Vas Prash , Edmonds Michael , Kavarthapu Venu 
Published: October 2016

Category: Diabetes Introduction/Purpose: Charcot neuroarthropathy (CN) of the foot can cause severe bone and joint destruction. The aim of reconstruction is to correct the deformity and achieve bone fusion, in order to provide a plantigrade foot to ambulate with using accommodative footwear. Column beaming using the Medial Column Fusion Bolt (MCB) is a new technique described to stabilize - medial and/or lateral columns. We performed a meta-analysis to assess the outcome of the use of column beaming in treatment of CN. Methods: We performed a search of the English literature for the following search terms: ‘Charcot’, ‘arthropathy’, ‘column bolt’, ‘superconstruct’, ‘intramedullary’, ‘beaming’, ‘rodding’, ‘midfoot fusion’, ‘midfoot arthrodesis and ‘fusion bolt’. We included all the studies published until 2015. Only 10 studies met the inclusion criteria, and were identified for evaluation. Results: There were a total of 197 feet in 191 patients 47; average age 58.1 years (29-81 years). Diabetes mellitus was the most common cause of CN (81.8%). The average follow-up duration post-operatively was approximately 30 months (range 3-137 months). Several classification systems were used to grade deformity, implants were commonly combined with other fixation based on the location and severity of the deformity, presence or absence of ulcers and surgeon’s preference. All studies reported improvement in correction of deformities both clinically & radiologically with an associated-loss of correction over the follow-up period. Overall, we observed 49.8% of patients experienced a complication, including screw breakage or migration (33), infection (42), wound dehiscence (20) and peri-prosthetic fractures (4). Resulting in revision and lower than expected fusion rates and recurrent ulceration. Conclusion: The MCB provides excellent correction of deformity, with high-failure-rate. This is especially true if a single-rod is used, as it may not provide enough stability to achieve osseous-fusion, due its inability to provide enough compression, reduce shear stress at bone interfaces when used in isolation. Thus additional-implants in neutralising rotational-instability to achieve a stable ‘‘superconstruct’’ may-avoid implant-failure, recurrent-deformity & high-complication-rates. Further assessment & stratification of CN deformity and implant use must be ascertained prior to definitive conclusions being reached regarding the use of the MCB. Whilst there is significant heterogeneity, current evidence suggests surgeons should use this device with caution.
Treatment of Atraumatic Subtalar Dislocations in Adult Acquired Flatfoot Deformity
Authors: Ramadorai Uma E. , Williams Joan , Sangeorzan Bruce 
Published: October 2016

Category: Hindfoot Introduction/Purpose: There is a subset of patients with adult acquired flatfoot deformity (AAFD) in which the deformity has progressed so much that the subtalar joint is dislocated, causing subfibular impingement. These patients can be technically difficult to treat operatively given the loss of soft tissue and articular constraints. Additionally, they tend to have increased rates of reoperation. We sought to describe the common patient characteristics and the reasons for reoperation in this population through our case series of 23 patients. Methods: A retrospective chart review was done of all patients who underwent surgical correction of AAFD with subtalar, double, triple, or pantalar arthrodesis based on the treating surgeon’s discretion. This review then used radiographic criteria to identify those patients who qualified as having subtalar dislocation on presentation. The charts of qualifying patients were then evaluated for demographic data, comorbidities, complications, and the need for reoperation. Results: We found that the average BMI for patients with this disorder was 34kg/m2 and that of our 23 patients who qualified for the study, 30.4% required reoperation for infection, nonunion, or symptomatic hardware. Conclusion: AAFD is a very common problem seen by foot and ankle surgeons and phyisicans should be aware of the challenges presented in treating the subset of patients who have atraumatic dislocation of the subtalar joint. Patients should also be counseled about the high rate of reoperation with surgical treatment of their AAFD if they fall into this category.
Venous Thromboembolism Prophylaxis with Rivaroxaban in Elective Foot and Ankle Surgery
Authors: Wiewiorski Martin J. , Muheim Leander , Huegle Thomas , Valderrabano Victor , Barg Alexej 
Published: October 2016

Category: Other Introduction/Purpose: Oral application for prophylaxis of venous thromboembolism (VTE) after total hip and knee arthroplasty has high acceptance among patients due to its non-invasive nature, when compared to traditional subcutaneous application of low- molecular-weight heparin (LMWH). Approximately 10% of the patients in our clinic receive oral thrombosis prophylaxis (rivaroxaban), the remaining patients receive subcutaneous prophylaxis with LMWH (dalteparin). However, no clinical data exists describing the use of oral prophylaxis in elective orthopedic foot and ankle surgery. The aims of this study where: 1. To assess the incidence of VTE after oral prophylaxis after elective foot and ankle procedures. 2. To identify risk factors for VTE after oral prophylaxis after elective foot and ankle procedures. Methods: A retrospective chart review of patients undergoing elective foot and ankle surgery between January 2010 and 2013 was performed. The type of medicamentous thrombosis prophylaxis was noted. All patients receiving oral antithrombotic medication (rivaroxaban, Xarelto©, Bayer, Germany) were included in the study. Location, length and type of surgery and tourniquet time were assessed. Co-morbidities (e.g. diabetes, coagulopathy, ASA classification) were noted. Patients previously treated with phenprocoumon or clopidrogel were excluded. A phone interview was performed and patients were asked whether a thromboembolic incident occurred or not. If an incidence was confirmed, the report of the diagnostic findings was obtained from the general practitioner. Results: 450 patients were included. Two thromboembolic incidents occurred (0.4%; deep venous thrombosis confirmed by ultrasound). Both patients had a history of previous deep venous thrombosis and a positive family history for VTE. Due to the low percentage of patients with VTE, a multivariate analysis could not be performed. Conclusion: The incidence of VTE after oral thrombosis prophylaxis with rivaroxaban is low and comparable with the incidence after subcutaneous application of LMWH.
Association of nasopharyngeal microbiota profiles with bronchiolitis severity in infants hospitalised for bronchiolitis
Authors: Hasegawa Kohei , Mansbach Jonathan M. , Ajami Nadim J. , Espinola Janice A. , Henke David M. , Petrosino Joseph F. , Piedra Pedro A. , Shaw Chad A. , Sullivan Ashley F. , Camargo Carlos A. 
Published: October 2016

Little is known about the relationship between the specific airway microbiota composition and severity of bronchiolitis. We aimed to identify nasopharyngeal microbiota profiles and link these profiles to acute severity in infants hospitalised for bronchiolitis.We conducted a multicentre prospective cohort study of 1005 infants (age <1 year) hospitalised for bronchiolitis over three winters, 2011–2014. By applying a 16S rRNA gene sequence and clustering approach to the nasopharyngeal aspirates collected within 24 h of hospitalisation, we determined nasopharyngeal microbiota profiles and their association with bronchiolitis severity. The primary outcome was intensive care use,i.e.admission to an intensive care unit or use of mechanical ventilation.We identified four nasopharyngeal microbiota profiles: three profiles were dominated by one ofHaemophilus,MoraxellaorStreptococcus,while the fourth profile had the highest bacterial richness. The rate of intensive care use was highest in infants with aHaemophilus-dominant profile and lowest in those with aMoraxella-dominant profile (20.2%versus12.3%; unadjusted OR 1.81, 95% CI 1.07–3.11, p=0.03). After adjusting for 11 patient-level confounders, the rate remained significantly higher in infants withHaemophilus-dominant profiles (OR 1.98, 95% CI 1.08–3.62, p=0.03). These findings were externally validated in a separate cohort of 307 children hospitalised for bronchiolitis.
Desipramine improves upper airway collapsibility and reduces OSA severity in patients with minimal muscle compensation
Authors: Taranto-Montemurro Luigi , Sands Scott A. , Edwards Bradley A. , Azarbarzin Ali , Marques Melania , de Melo Camila , Eckert Danny J. , White David P. , Wellman Andrew 
Published: October 2016

We recently demonstrated that desipramine reduces the sleep-related loss of upper airway dilator muscle activity and reduces pharyngeal collapsibility in healthy humans without obstructive sleep apnoea (OSA). The aim of the present physiological study was to determine the effects of desipramine on upper airway collapsibility and apnoea–hypopnea index (AHI) in OSA patients.A placebo-controlled, double-blind, randomised crossover trial in 14 OSA patients was performed. Participants received treatment or placebo in randomised order before sleep. Pharyngeal collapsibility (critical collapsing pressure of the upper airway (Pcrit)) and ventilation under both passive (V′0,passive) and active (V′0,active) upper airway muscle conditions were evaluated with continuous positive airway pressure (CPAP) manipulation. AHI was quantified off CPAP.Desipramine reduced activePcrit(median (interquartile range) −5.2 (4.3) cmH2O on desipramineversus−1.9 (2.7) cmH2O on placebo; p=0.049) but not passivePcrit(−2.2 (3.4)versus−0.7 (2.1) cmH2O; p=0.135). A greater reduction in AHI occurred in those with minimal muscle compensation (defined asV′0,active−V′0,passive) on placebo (r=0.71, p=0.009). The reduction in AHI was driven by the improvement in muscle compensation (r=0.72, p=0.009).In OSA patients, noradrenergic stimulation with desipramine improves pharyngeal collapsibility and may be an effective treatment in patients with minimal upper airway muscle compensation.
Mast cells are associated with exacerbations and eosinophilia in children with severe asthma
Authors: Lezmi Guillaume , Galmiche-Rolland Louise , Rioux Sabine , Jaubert Francis , Tillie-Leblond Isabelle , Scheinmann Pierre , Gosset Philippe , de Blic Jacques 
Published: October 2016

The role of mast cells in the pathogenesis of childhood asthma is poorly understood. We aimed to estimate the implication of airway mucosal mast cells in severe asthma and their relationship with clinical, functional, inflammatory and remodelling parameters.Bronchial biopsies were performed in 36 children (5–18 years) with severe asthma: 24 had frequent severe exacerbations and/or daily symptoms in the previous year (symptomatic group), and 12 had few symptoms and a persistent obstructive pattern (paucisymptomatic group). Nine children without asthma were included as control subjects. We assessed mast cells in the submucosa and airway smooth muscle using c-kit antibodies and in the entire biopsy area using Giemsa.The number of submucosal mast cells was higher in the symptomatic group than in the paucisymptomatic group (p=0.02). The number of submucosal mast cells correlated with the number of severe exacerbations (p=0.02, r=0.37). There were positive correlations between the number of submucosal mast cells (p<0.01, r=0.44), airway smooth muscle mast cells (p=0.02, r= 0.40), mast cells stained by Giemsa (p<0.01, r=0.44) and submucosal eosinophils.Mast cells are associated with severe exacerbations and submucosal eosinophilic inflammation in children with severe asthma.
Rapid and efficient generation of neural progenitors from adult bone marrow stromal cells by hypoxic preconditioning
Authors: Mung Kwan-Long , Tsui Yat-Ping , Tai Evelyn Wing-Yin , Chan Ying-Shing , Shum Daisy Kwok-Yan , Shea Graham Ka-Hon 
Published: October 2016

Abstract
Background
Bone marrow stromal cells (BMSCs) are attractive as a source of neural progenitors for ex vivo generation of neurons and glia. Limited numbers of this subpopulation, however, hinder translation into autologous cell-based therapy. Here, we demonstrate rapid and efficient conditioning with hypoxia to enrich for these neural progenitor cells prior to further expansion in neurosphere culture.

Method
Adherent cultures of BMSCs (rat/human) were subjected to 1 % oxygen for 24 h and then subcultured as neurospheres with epidermal growth factor (EGF) and basic fibroblast growth factor supplementation. Neurospheres and cell progeny were monitored immunocytochemically for marker expression. To generate Schwann cell-like cells, neurospheres were plated out and exposed to gliogenic medium. The resulting cells were co-cultured with purified dorsal root ganglia (rat) neurons and then tested for commitment to the Schwann cell fate. Fate-committed Schwann cells were subjected to in vitro myelination assay.

Results
Transient hypoxic treatment increased the size and number of neurospheres generated from both rat and human BMSCs. This effect was EGF-dependent and attenuated with the EGF receptor inhibitor erlotinib. Hypoxia did not affect the capacity of neurospheres to generate neuron- or glia-like precursors. Human Schwann cell-like cells generated from hypoxia-treated BMSCs demonstrated expression of S100β /p75 and capacity for myelination in vitro.

Conclusion
Enhancing the yield of neural progenitor cells with hypoxic preconditioning of BMSCs in vitro but without inherent risks of genetic manipulation provides a platform for upscaling production of neural cell derivatives for clinical application in cell-based therapy.