bluuebunny/crossref_metadata_2025_split huggingface dataset:
Methodology for the Audiovisual Analysis of Surgical Team Performance in Orthopedic Ankle Surgery
Authors: Beaman Doug , Perkins R. Serene 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Defining and quantitatively measuring surgeon and operating room team performance remains a scientific and clinical challenge. Evidence-based, objective methods to assess surgical skill have been identified; however, a quantifiable and valid methodology to measure intraoperative performance is lacking. We aimed to determine the optimal approach to audiovisually assess a surgeon and a surgical team. We aimed to develop a high-fidelity method to analyze and improve surgeon and team performance. Methods: Funding of this study was provided through a grant awarded by the American Orthopaedic Foot and Ankle Society (#2015-24-P). Sixteen predetermined, bilateral ankle surgeries (frame placement, frame removal, and total ankle replacement) were performed between July and December 2015 in both live and simulated operating room settings. Still photography and web- based three-dimensional modeling software were used to determine optimum camera position for the first eight procedures. Three compact, high-resolution camcorders (GoPro® Hero, San Mateo, CA) were then employed in different locations with a variety of mounting strategies to record eight additional, matched ankle procedures in a simulated environment. A multiview box and wireless routers were used for live viewing of surgeries on a high-definition television screen. Video-based editing software was used to replay and analyze audiovisual output. Results: There are several visual angles that optimally capture the dynamics of a surgical team and are specific to surgery type. These angles are measurable (in degrees) and vary according to the position of the surgeon, team members, operating room table, and C-arm, as well as laterality of the procedure itself. Triangulated placement of multiple cameras, including a head mounted device, are required to assess subtle elements of operating room team performance, including individual strengths and weaknesses, nontechnical skills, and team dynamics. High-fidelity recording equipment and video-based editing software facilitate the assessment of characteristics unique to reconstructive ankle surgery. Conclusion: The effectiveness of a surgical team can be assessed with high-fidelity recording and editing equipment in defined configurations. Our approach, which to our knowledge has not been previously described, facilitates the evaluation of communication styles, technical skills, and teamwork and provides a foundation for intraoperative leadership. We propose that our audiovisual methodology can be used to coach surgeons and their teams, in order to make collaborative improvements in a non-punitive manner. Enhancing the performance of each member of the surgical team may reduce risk and ultimately improve patient outcomes, and is likely to be reproducible across disciplines.
Morphological Characteristics of the Posterior Malleolus Fragment According to the Ankle Fracture Patterns by Lauge-Hansen
Authors: Cho Jaeho , Park Chul hyun , Chun Dong Il , Choi Hongjoon 
Published: October 2016

Category: Trauma Introduction/Purpose: The posterior malleolus fragment (PMF) of an ankle fracture occurs in various shapes with regard to injury mechanism. The purpose of this study was to evaluate the morphological characteristics of the posterior malleolus fragment according to the ankle fracture pattern by Lauge-Hansen classification using computer tomographic images. Methods: We retrospectively analyzed computer tomography data of 107 patients (107 ankles) who underwent surgery for tri- malleolus fracture from January 2012 to December 2014. A total of 76 ankles belong to Supination-Exorotation stage IV (SER group), 31 belong to Pronation- Exorotation stage IV (PER group). The type of PMF of two groups was respectively assessed by Haraguchi and Jan Bartonicek classification. The cross angle (α), fragment length ratio (FLR), fragment area ratio (FAR), sagittal angle and fragment height (FH) were measured as morphologic assessments. Results: The PMF type in SER group had mainly the posterolateral shape, while that in PER group had mainly the psotermedial two parts or large, posterolateral triangular shape (P= 0.02). The average cross angle (α) was no significant difference between two groups (SER group = 19.4°, PER group = 17.6°). The fragment length ratio and fragment height in PER group were significantly larger than that in SER group (P= 0.024, P=0.006). The fragment in PER group was significantly more vertical than that in SER group (P= 0.017). Conclusion: Morphological characteristics of the posterior malleolus fragment are different between SER group and PER group in trimalleolar ankle fracture. The SER type fractures are associated with smaller “rotational” fragment, while the PER type fractures are associated with larger “rotational and vertical” fragment with regard to the fragment volume and articular involvement.
Operative Treatment for Osteoarthritis of the First Metatarsophalangeal Joint
Authors: Voskuijl Timothy , Onstenk Ron 
Published: October 2016

Category: Midfoot/Forefoot Introduction/Purpose: Controversy remains whether hemiarthroplasty or arthrodesis results in better postoperative outcomes for patients who request surgery for advanced osteoarthritis of the first metatarsophalangeal joint. We tested the primary null hypothesis that the treatment groups would not differ in postoperative American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale scores after a follow-up period of ≥1 year. Secondary analyses addressed satisfaction rates, percentage of patients who would recommend the procedure, and unplanned repeat operation rates. Methods: A total of 58 primary arthrodeses and 36 hemiarthroplasties performed from January 2005 to December 2010 were evaluated at ≥1 year postoperatively. Results: At a mean average of 4 (range 1 to 7) years after surgery, the mean American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal interphalangeal scale score was 77.5 ± 18.5 in the arthrodesis group and 77.8 ± 12.0 in the arthroplasty group (p = .93). The number of repeat operations did not differ between these 2 groups, and patients treated with hemiarthroplasty reported greater mean satisfaction (p = .04). Conclusion: These results showed that the symptom intensity and magnitude of disability were similar at ≥1 year after arthrodesis or hemiarthroplasty for osteoarthritis of the first metatarsophalangeal joint, although the patients were subjectively more pleased with the results after hemiarthroplasty.
Posterior Arthroscopic Tibiotalocalcaneal Fusion
Authors: Eleftheropoulos Alexandros , Giannaros Iraklis V. , Christou Antonios , Petrakis Iordanis G. 
Published: October 2016

Category: Arthroscopy Introduction/Purpose: Hindfoot arthritis is treated usually with Tibiotalocalcaneal fusion when conservative treatment has failed. Indications of TCC fusion are wide, including post - traumatic arthritis, rheumatoid arthritis, acquired flat foot deformity (Myerson stage IV), failed total ankle arthroplasty. In the vast majority of these cases, there are skin problems because of systemic diseases or wound problems following prior surgery. Several methods have already been described and it seems that the use of intramedullary nail offers a load-sharing rigid internal fixation. The purpose of this presentation is to describe an alternative less invasive surgical technique of TTC fusion using an intramedullary retrograde nail via a posterior arthroscopy of the hindfoot. We present the surgical technique, the early results and quote several cases treated by this method. Methods: Under spinal or general anaesthesia, the patient is positioned prone. Using the standard posteromedial and posterolateral portals, a standard knee arthroscope is inserted via the posterolateral portal. Via the posteromedial portal, a soft tissue shaver is introduced to prepare the posterior gutter. Most of the preparation of the articular surface of the ankle joint is achieved with the arthroscope through the posterolateral portal and the instruments through the posteromedial portal. After the preparation of the ankle joint surfaces, under fluoroscopic control, a guide wire is inserted through calcaneus and talus into the tibia. Reaming is performed. Then a retrograde intramedullary nail is inserted through the calcaneal and the talus to the tibia. An anodized titanium alloy intramedullary nail is used and locked statically with one screw in the calcaneus, one in the talus and two screws in the tibial shaft. The preparation of the subtalar articular surfaces then takes place. Results: Deformity correction and hindfoot fusion were achieved in all five cases. There were no major complications, such as infection, trauma complications, nonunion, malunion or hardware failure. Fusion was achieved in about three months time (plus minus two weeks). All the patients returned back to their daily activities in four to five months time. The post-op AOFAS score was significantly improved. The mean hospitalization was 1.2 days. After the discharged, all the patients were followed at the outpatient clinic in a regular basis. Conclusion: This alternative surgical technique combines the advantages of the TTC fusion with an intramedullary nail and the advantages of the arthroscopic minimal intervention to the soft tissue envelope. This enables immediate mobilization of the patient and a small period of hospitalization. The key point is the steep learning curve. From the literature review can be found similar techniques with equally positive results.
Technique, Complications, and Mid-Term Results of Hindfoot Arthrodesis with a Posterior Blade Plate
Authors: Barg Alexej , Gorman Troy , Beals Timothy C. , Nickisch Florian , Lyman Mikayla , Saltzman Charles L. 
Published: October 2016

Category: Ankle Arthritis Introduction/Purpose: Previous hindfoot surgeries present a unique challenge in performing hindfoot arthrodesis. The use of a blade plate construct is widely accepted, however there is limited data supporting the use of a posterior approach to blade plate arthrodesis. The purpose of this study was to (1) describe demographics of patients who underwent posterior hindfoot arthrodesis using a blade plate, (2) describe our surgical technique, (3) discuss outcomes, and (4) compare patients with and without complications. Methods: Between December 2001 and July 2014, 42 patients underwent hindfoot arthrodesis using a posterior blade plate and 40 patients were included in this study. Demographic data including age, gender, body mass index, smoking status, and comorbidities were analyzed. Surgical data including indication for the surgery, previous surgical treatment, and additional surgical procedures were reviewed. Weight-bearing radiographs were used to assess the fusion rate. Clinic and surgery notes were reviewed for possible intraoperative, perioperative, and postoperative complications. Univariate analysis was performed to compare patients who experienced complications with those who did not. There were 27 male and 13 female patients with a mean age of 56.4 ± 13.4 years. Twenty-eight patients had a tibiotalocalcaneal arthrodesis in a primary (n=6), primary staged (n=10), revision (n=9), or revision staged (n=3) setting. Eleven patients had ankle arthrodesis (primary n=7, revision n=4). The latest follow-up averaged 46.5 ± 27.5 months (range, 13.7-137.2 months). Results: Patients had a median of two previous hindfoot or ankle surgeries (range, 0-9 surgeries). Thirty-three of 40 (82%) procedures fused at an average of 24.4 ± 21.2 weeks. Four patients had a delayed osseous union. Seven patients had a nonunion, including ankle (n=3), subtalar (n=3), and both (n=1) joints. Patient groups with, and without primary solid osseous unions were comparable in terms of demographic data and surgical details. Eighteen major and eight minor complications were observed. Patients with or without complications were comparable in terms of demographic data and surgical characteristics. In total six patients (15%) underwent below knee amputation due to unsatisfactory results. Conclusion: Indications for hindfoot arthrodesis using posterior blade plate fixation include a diverse patient population. These surgeries may be performed as primary, revision, primary staged, or revision staged procedures. Most of the patients in our cohort had previous ankle/hindfoot surgeries. The fusion rate is lower than in primary hindfoot arthrodesis as reported in the current literature. The complications rate is high.
The Reduced Quantity and Functionality of Mesenchymal Stem Cells in the Synovium of Charcot Neuroarthropathy
Authors: Schon Lew C. , Mitchell Reed , Zahoor Talal A. , Zhang Zijun 
Published: October 2016

Category: Basic Sciences/Biologics Introduction/Purpose: Managing Charcot Neuroarthropathy (CNA) remains a challenge facing the foot and ankle surgeons. Lack of understanding the pathogenesis of the disease prevents the development of novel therapies. Our previous studies revealed the involvement of fibroblast-like synoviocytes in the pathology of CNA. Residing in the synovium are also mesenchymal stem cells (MSCs), which maintain tissue homeostasis. In this study, MSCs isolated from the synovium of CNA and non-CNA patients were comparatively analyzed for their potential role in the pathology of CNA. Methods: Synovial samples were collected from CNA patients (n=7) and patients with osteoarthritis or intraarticular fracture (non-CNA; n=7), during foot and ankle procedures (approved by IRB). The synovial samples were minced and digested with 0.1% collagenase to isolate MSCs. The cells were plated and cultured in low density for counting colony-forming units-fibroblast (CFU- F), which is indicative of the number of MSCs. The colonies formed by CNA-MSCs and non-CNA MSCs were further characterized by size and imaging density. CNA-MSCs and non-CNA MSCs were cultured in adipogenic, osteogenic and chondrogenic differentiation media. The differentiation potentials of CNA-MSCs and non-CNA MSCs were assessed with histochemical staining and quantitative gene expression. Results: CFU-F: The number of colonies formed by CNA-MSCs was 6 ± 3.5 per (1/2) plate, while it was 43 ± 21.6 by the non- CNA MSCs (p < 0.05; Fig 1). The average size (pixels) of colonies was smaller in the CNA-MSCs than the non-CNA MSCs (4780 vs. 7960). When the colonies were stratified into high, medium and low density subgroups, colonies formed by the CNA-MSCs had a reduced density compared with the non-CNA MSCs (30±6 vs. 35±10) in the high density subgroup. Differentiation: Expression of adipogenic marker gene PPAR-γ by CNA-MSCs was less than half of that by non-CNA MSCs. The expression of osteogenic marker gene RUNX2 by CNA-MSCs was a third of that by the non-CNA MSCs. Similarly, the expression of chondrogenic marker genes, including SOX9 and type II collagen, by the CNA-MSCs declined as compared with the non- CNA MSCs. Conclusion: The synovium in CNA joints had fewer MSCs and that may impact joint’s response to inflammation and tissue repair. Furthermore, CNA-MSCs were declined in differentiation potentials. Analyses of the size and density of the colonies formed by CNA-MSCs showed that a subpopulation of MSCs was particularly affected. Further study will focus on the pathological role of the high-density subpopulation of MSCs in the development of CNA.
Pre-eclampsia and childhood asthma
Authors: Magnus Maria C. , Håberg Siri E. , Magnus Per , Engeland Anders , Nafstad Per , Karlstad Øystein , Nystad Wenche 
Published: October 2016

Studies of pre-eclampsia and childhood asthma are conflicting, and none have performed a formal mediation analysis of preterm birth.We examined the association between pre-eclampsia and asthma at 7 years using national registries, including all births in Norway from 1999 to 2006 (n=406 907), and a subsample of children in the Norwegian Mother and Child Cohort Study (MoBa) (n=45 028) using log-linear regression. We performed a mediation analysis of preterm birth, and a sibling comparison to evaluate unobserved confounding.There was a positive association between pre-eclampsia and asthma in the registry study, with an adjusted relative risk of 1.31 (95% CI 1.22–1.41), but not in MoBa, which had an adjusted relative risk of 1.19 (95% CI 0.99–1.44). The odds ratios for the direct effect not mediated through preterm birth and the indirect effect in the registry linkage were 1.19 (95% CI 1.10–1.29) and 1.12 (95% CI 1.11–1.14), respectively. The sibling comparison indicated no association between pre-eclampsia and asthma (adjusted OR 1.07, 95% CI 0.87–1.33).In this large study, which used different datasets and analytic approaches, there was little evidence for an association between pre-eclampsia and childhood asthma. The association was weak and largely explained by pre-term birth and confounders shared by siblings.
Progression to tuberculosis disease increases with multiple exposures
Authors: Lee Robyn S. , Proulx Jean-François , Menzies Dick , Behr Marcel A. 
Published: October 2016

During a single year, a Canadian village had 34 individuals with microbiologically confirmed tuberculosis (TB) among 169 people with a new infection (20%). A contact investigation revealed multiple exposures for each person. We investigated whether the intensity of exposure might contribute to this extraordinary risk of disease.We carried out a case–control study using a public health database. Among those with a new infection, 34 had culture-confirmed TB (cases) and 118 did not progress to disease (controls). 17 patients with probable disease were excluded. Contact investigation data were utilised to tabulate the number of potential sources (total exposures). Generalised estimating equations with a logit link were used to identify associations between exposures and progression, and to investigate other potential risk factors.The median (interquartile range) number of total exposures was 15 (3–23) for cases and 3 (2–12) for controls (p=0.001). The adjusted OR for disease was 1.11 (95% CI 1.06–1.16) per additional exposure, corresponding to an OR of 3.4 for disease when comparing the medians of 15versus3 total exposures. This association increased when restricting to tuberculin skin test conversions.Increased exposure could be a marker of greater risk of progression to TB disease. Therefore, this risk may not be transportable across epidemiologic settings with variable exposure intensities.
Right heart thrombi in pulmonary embolism
Authors: Barrios Deisy , Rosa-Salazar Vladimir , Jiménez David , Morillo Raquel , Muriel Alfonso , del Toro Jorge , López-Jiménez Luciano , Farge-Bancel Dominique , Yusen Roger , Monreal Manuel 
Published: October 2016

There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in pulmonary embolism.In this study of patients with pulmonary embolism from the Registro Informatizado de la Enfermedad TromboEmbólica (RIETE) registry, we assessed the prevalence and predictors of RHT, and the association between the presence of RHT and the outcomes of all-cause mortality, pulmonary embolism-related mortality, recurrences, and major bleeding through 30 days after initiation of pulmonary embolism treatment.Of 12 441 patients with pulmonary embolism and baseline echocardiographic data, 2.6% had RHT. The following increased the risk of RHT: younger age, previous bleeding, congestive heart failure, cancer, syncope, systolic blood pressure <100 mmHg, and arterial oxyhaemoglobin saturation <90%. Patients with RHT were significantly more likely to die from any cause (adjusted OR 2.50 (95% CI 1.62–3.84); p<0.001) and from pulmonary embolism (adjusted OR 4.29 (95% CI 2.45–7.48); p<0.001) during follow-up. RHT was associated with an increased risk of recurrence during follow-up (1.8%versus0.7%; p=0.04). Major bleeding was similar in patients with and without RHT.In patients presenting with pulmonary embolism, RHT is relatively infrequent. Patients with RHT had a worse outcome when compared with those without RHT.
Biohybrid cochlear implants in human neurosensory restoration
Authors: Roemer Ariane , Köhl Ulrike , Majdani Omid , Klöß Stephan , Falk Christine , Haumann Sabine , Lenarz Thomas , Kral Andrej , Warnecke Athanasia 
Published: October 2016

Abstract
Background
The success of cochlear implantation may be further improved by minimizing implantation trauma. The physical trauma of implantation and subsequent immunological sequelae can affect residual hearing and the viability of the spiral ganglion. An ideal electrode should therefore decrease post-implantation trauma and provide support to the residual spiral ganglion population. Combining a flexible electrode with cells producing and releasing protective factors could present a potential means to achieve this. Mononuclear cells obtained from bone marrow (BM-MNC) consist of mesenchymal and hematopoietic progenitor cells. They possess the innate capacity to induce repair of traumatized tissue and to modulate immunological reactions.

Methods
Human bone marrow was obtained from the patients that received treatment with biohybrid electrodes. Autologous mononuclear cells were isolated from bone marrow (BM-MNC) by centrifugation using the Regenlab™ THT-centrifugation tubes. Isolated BM-MNC were characterised using flow cytometry. In addition, the release of cytokines was analysed and their biological effect tested on spiral ganglion neurons isolated from neonatal rats. Fibrin adhesive (Tisseal™) was used for the coating of silicone-based cochlear implant electrode arrays for human use in order to generate biohybrid electrodes. Toxicity of the fibrin adhesive and influence on insertion, as well on the cell coating, was investigated. Furthermore, biohybrid electrodes were implanted in three patients.

Results
Human BM-MNC release cytokines, chemokines, and growth factors that exert anti-inflammatory and neuroprotective effects. Using fibrin adhesive as a carrier for BM-MNC, a simple and effective cell coating procedure for cochlear implant electrodes was developed that can be utilised on-site in the operating room for the generation of biohybrid electrodes for intracochlear cell-based drug delivery. A safety study demonstrated the feasibility of autologous progenitor cell transplantation in humans as an adjuvant to cochlear implantation for neurosensory restoration.

Conclusion
This is the first report of the use of autologous cell transplantation to the human inner ear. Due to the simplicity of this procedure, we hope to initiate its widespread utilization in various fields.