bluuebunny/crossref_metadata_2025_split huggingface dataset:
Axial Rotation Analysis in Total Ankle Arthroplasty Using Weight-Bearing Computer Tomography and Three-Dimensional Modeling
Authors: Efrima Ben , Barbero Agustin , Ovadia Joshua , Indino Cristian , Maccario Camilla , Usuelli Federico Giuseppe 
Published: April 2024

Introduction/Purpose: Post-operative alignment is the most critical indicator for a successful total ankle arthroplasty (TAA). Total ankle malrotation is associated with an increased risk for polyethylene wear and medial gutter pain. Currently, there is no consensus on the correct way to measure the alignment of the tibial and talar component rotations in the axial plane. In the current study, the post-operative analysis system was assessed using weight-bearing computer tomography and a three- dimensional (3D) model. The purpose of the study was to assess the inter-observer and intra-observer agreement of this system. Methods: Four angles were measured by two raters independently in two separate readings: posterior tibial component rotation angle (PTIRA), posterior talar component rotation angle (PTARA), tibia talar component axial angle (TTAM), and tibial component to the second metatarsal angle (TMRA). Agreement analysis was quantified according to the interclass coefficient. Results: Sixty TAAs across 60 patients were evaluated. A good inter-observer agreement and intra-observer agreement when measuring the PTIRA, PTARA, and TTAM angles was observed along with an excellent inter-observer agreement and intra- observer agreement when measuring the TMRA angle. Conclusion: In conclusion, the current 3D model-based measurement system demonstrates good to excellent inter and intra- agreement. According to these results, 3D modelling can be reliably used to measure and assess the axial rotation of TAA components. Figure 3: Example case of how to measure the angles for assessing axial rotation of TAA and forefoot. 3 A) Posterior TIbial component Rotational Angle (PTIRA). The chosen slice is the one with the straightest posterior wall component of the tibia. The angle is measured on the following steps. First a reference is put on the posterior wall of the tibial component (blue horizontal line). Then the angle is measured starting from the center of the tibial axis (red dot explained on fig. 2), going to the fibular axis (medial part of the red line at the right of the draw), and finally ending 90° to the posterior reference line. 3 B) Posterior TAlar component Rotational Angle (PTARA). The chosen slice is the one with the straightest posterior wall component of the talus. For the angle measurement. The same steps as figure 3 A are followed with the talar component. 3 C) Talar component to 2nd Metatarsal Rotational Angle (TMRA): Defined as an intersection between a line parallel to the lateral border of the tibia component and a line perpendicular to the anatomical axis of the second metatarsal. This was measured using a 3D rendering tool
Comparison of Complication Rates and Surgical Costs for Total Ankle Replacements Performed in the Outpatient vs Inpatient Setting
Authors: Nixon Devon , Ko Hyunkyu , Martin Brook 
Published: April 2024

Introduction/Purpose: Increasing data has highlighted the safety and cost-effectiveness of outpatient hip, knee, and shoulder arthroplasty. However, limited evidence – mainly small, single institution case series – has explored complication rates and costs between outpatient and inpatient total ankle arthroplasty (TAA) surgeries. Methods: Utilizing Medicare claims from 2016 to 2019, we retrospectively identified patients ≥65 years of age who underwent TAA based on CPT coding. Patients on Medicare HMO, under age 65, and dual-eligible patients were excluded. Within this dataset, we compared surgeries performed in the outpatient versus inpatient setting. We compared groups based on readmission, all-complication, and infection rates within 1-year of TAA using logistic regressions controlling for age, sex, race, and comorbidity. To help mitigate bias, we also performed a propensity matched model with the same variables. Data were reported as percentage point (PPT) differences (95% CI) between groups, with a positive number indicating higher complication rates and costs among patients treated in the inpatient setting. Results: In total, 8,281 total ankle arthroplasty cases were identified (outpatient: 5,524 and inpatient: 2,757. Compared to inpatient cases, outpatient TAA surgeries were performed on younger, healthier (as assessed by Charlson Comorbidity Index (CCI) scores) patients who were more likely to be female (p < 0.001). In logistic regression analyses, outpatient TAA cases had lower readmission, all-complication, infection, mortality, and device-associated complication rates (p < 0.001) as compared to inpatient surgeries. Further, outpatient surgeries had sizable cost reductions compared to inpatient surgeries (p < 0.001). Conclusion: TAA performed in the outpatient setting appears to have less complications and decreased cost compared to inpatient procedures – though inpatient surgeries were presumably riskier as they were performed on older patients with increased co-morbidities. When clinically appropriate, though, TAA as an outpatient procedure appears to provide substantial reductions in cost with notable reductions in surgical risk.
Outcomes Following Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review
Authors: Butler James J. , Hartman Hayden , Vargas Luilly , Dhillon Ravneet , Randall Grace W. , Wingo Taylor , Kennedy John G. 
Published: April 2024

Introduction/Purpose: The purpose of this systematic review was to evaluate the clinical and radiographic outcomes in patients who received extracellular matrix cartilage allograft (EMCA) during surgical intervention for osteochondral lesions of the talus (OLT). Methods: During January 2023, the PubMed, Embase and Cochrane library databases were systematically reviewed to identify clinical studies evaluating outcomes in patients who received EMCA during surgical intervention for osteochondral lesions of the talus. Data regarding lesion characteristics, surgical characteristics, subjective clinical outcomes, radiographic outcomes, complication rates, failure rates and secondary surgical procedure rates were extracted and analysed. In total, 5 clinical studies were included in this review. Results: In total, 162 patients received EMCA during surgical intervention for OLT at a weighted mean follow-up of 23.8 ± 4.2 months. The weighted mean lesion area was 77.9 ± 42.6 mm2. Overall, 111 (68.5%) of OLTs were located medially, 45 (27.8%) of OLTs were located laterally and 6 (3.7%) OLTs were located centrally. Four studies performed arthroscopic debridement and bone marrow stimulation with ECMA, 3 studies utilized concentrated bone marrow aspirate and 1 study performed autologous osteochondral transplantation. Improvements were noted in AOFAS, FAOS and VAS scores following surgical intervention. The weighted mean post-operative MOCART score was 76.3 ± 2.9. In total, 17 (10.5%) complications were reported across the 5 studies. Twelve failures (7.4%) were recorded, all of which required further surgical intervention. Conclusion: This systematic review demonstrated improvements in subjective clinical outcomes and radiological outcomes at short-term follow-up following surgical intervention for OLTs augmented with ECMA. A low failure rate and moderate complication rate was noted. However, there was marked heterogeneity between the included studies with regards to surgical technique utilized, lesion size and patient cohort size. Further research is warranted to determine the optimal role of ECMA in the management of OLT.
A mixed-methods systematic review investigating the use of digital health interventions to provide palliative and end-of-life care for patients in low- and middle-income countries
Authors: Dilhani Weerasingha Navarathnage Sachintha , Mitchell Sarah , Dale Jeremy , Toor Kavanbir , Javaid Mikail , MacArtney John I. 
Published: April 2024

Background: The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization. Objectives: This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization. Design: Mixed-method systematic review incorporating both quantitative and qualitative data. Data sources and methods: All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Results: Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues. Conclusion: DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.
Airway clearance management in people with bronchiectasis: data from the European Bronchiectasis Registry (EMBARC)
Authors: Spinou Arietta , Hererro-Cortina Beatriz , Aliberti Stefano , Goeminne Pieter C. , Polverino Eva , Dimakou Katerina , Haworth Charles S. , Loebinger Michael R. , De Soyza Anthony , Vendrell Montserrat , Burgel Pierre Regis , McDonnell Melissa , Sutharsan Sivagurunathan , Škrgat Sabina , Maiz-Carro Luiz , Sibila Oriol , Stolz Daiana , Kauppi Paula , Bossios Apostolos , Hill Adam T. , Clifton Ian , Crichton Megan L. , Walker Paul , Menendez Rosario , Borekci Sermin , Obradovic Dusanka , Nowinski Adam , Amorim Adelina , Torres Antoni , Lorent Natalie , Welte Tobias , Blasi Francesco , Jankovic Makek Mateja , Shteinberg Michal , Boersma Wim , Elborn J. Stuart , Chalmers James D. , Ringshausen Felix C. 
Published: April 2024

BackgroundInternational guidelines recommend airway clearance management as one of the important pillars of bronchiectasis treatment. However, the extent to which airway clearance is used for people with bronchiectasis in Europe is unclear. The aim of the study was to identify the use of airway clearance management in patients with bronchiectasis across different countries and factors influencing airway clearance use.MethodsThis was a prospective observational study using data from the European Multicentre Bronchiectasis Audit and Research Collaboration (EMBARC) Registry between January 2015 and April 2022. Prespecified options for airway clearance management were recorded, including airway clearance techniques, devices and use of mucoactive drugs.Results16 723 people with bronchiectasis from 28 countries were included in the study. The mean age was 67 years (interquartile range 57–74 years, range 18–100 years) and 61% were female. 72% of the participants reported daily sputum expectoration and 52% (95% CI 51–53%) of all participants reported using regular airway clearance management. Active cycle of breathing technique was used by 28% of the participants and airway clearance devices by 16% of participants. The frequency of airway clearance management and techniques used varied significantly between different countries. Participants who used airway clearance management had greater disease severity and worse symptoms, including a higher daily sputum volume, compared to those who did not use it regularly. Mucoactive drugs were also more likely to be used in participants with more severe disease. Access to specialist respiratory physiotherapy was low throughout Europe, but particularly low in Eastern Europe.ConclusionsOnly a half of people with bronchiectasis in Europe use airway clearance management. Use of and access to devices, mucoactive drugs and specialist chest physiotherapy appears to be limited in many European countries.
A novel combined approach to placement of a double lumen endobronchial tube using a video laryngoscope and fiberoptic bronchoscope: a retrospective chart review
Authors: Maracaja Luiz , Coffield Alexandra , Smith L. Daniela , Bradshaw J. David , Saha Amit K. , McLauglin Christopher S. , Templeton T. Wesley 
Published: April 2024

Abstract
Background
The objective of this study was to evaluate a modern combined video laryngoscopy and flexible fiberoptic bronchoscope approach to placement of a double lumen endobronchial tube and further characterize potential strengths and weaknesses of this approach.

Methods
Retrospective chart review was conducted at our single institution, academic medical center, tertiary-care hospital. Patients aged 18 years of age or older were evaluated who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. No interventions were performed.

Results
Demographics and induction and intubation documentation were reviewed for 21 patients who underwent thoracic surgery and one-lung ventilation with placement of a double lumen endobronchial tube using a novel combined video laryngoscopy and flexible fiberoptic bronchoscope approach. First pass success using the combined approach was 86% (18/21). The five patients with an anticipated difficult airway had successful double lumen endobronchial tube placement on the first attempt. There were no instances of desaturation during double lumen endobronchial tube placement. No airway complications related to double lumen endobronchial tube placement were recorded.

Conclusion
Use of a combined approach employing video laryngoscopy and a flexible fiberoptic bronchoscope may represent a reliable alternative approach to placement of double lumen endobronchial tubes.
One-year survival of aneurysmal subarachnoid hemorrhage after airplane transatlantic transfer – a monocenter retrospective study
Authors: Martino Frédéric , Fleuri Antoine , Engrand Nicolas , Rolle Amélie , Piotin Michel , Carles Michel , Delta Delphine , Do Laurent , Pons Adrien , Portecop Patrick , Sitcharn Mathys , Valette Marc , Camous Laurent , Pommier Jean-David , Demoule Alexandre 
Published: April 2024

Abstract
Background
Aneurysmal subarachnoid hemorrhage (aSAH) is preferentially treated by prompt endovascular coiling, which is not available in Guadeloupe. Subsequently, patients are transferred to Paris, France mainland, by commercial airplane (6751 km flight) after being managed according to guidelines. This study describes the characteristics, management and outcomes related to these patients.

Methods
Retrospective observational cohort study of 148 patients admitted in intensive care unit for a suspected aSAH and transferred by airplane over a 10-year period (2010–2019).

Results
The median [interquartile range] age was 53 [45–64] years and 61% were female. On admission, Glasgow coma scale was 15 [13–15], World Federation of Neurological Surgeons (WFNS) grading scale was 1 [1–3] and Fisher scale was 4 [2–4]. External ventricular drainage and mechanical ventilation were performed prior to the flight respectively in 42% and 47% of patients. One-year mortality was 16% over the study period. By COX logistic regression analysis, acute hydrocephalus (hazard ratio [HR] 2.34, 95% confidence interval [CI] 0.98–5.58) prior to airplane transfer, WFNS grading scale on admission (HR 1.53, 95% CI 1.16–2.02) and age (OR 1.03, 95% 1.00–1.07) were associated with one-year mortality.

Conclusion
When necessary, transatlantic air transfer of patients with suspected aSAH after management according to local guidelines seems feasible and safe.
Factors affecting hospital admission, hospital length of stay and new discharge destination post proximal humeral fracture: a retrospective audit
Authors: McDonald B. R. , Vogrin S. , Said C. M. 
Published: April 2024

Abstract
Background
Outcomes following proximal humeral fracture (PHF) may be impacted by a range of clinical, fracture and premorbid factors. The aim of this study was to examine factors impacting hospital admission; length of stay (LOS) and new discharge destination for patients presenting to hospital with PHF.

Methods
Retrospective audit conducted at a tertiary health service. Data was collected from adult patients presenting to hospital with a PHF over a 54-month period. Fractures that were pathological or sustained during admission were excluded. Univariable and multivariable logistic and negative binomial regression were used to explore factors associated with hospital admission, LOS and new discharge destination.

Results
Data were analyzed from 701 participants (age 70 years (IQR 60, 81); 72.8% female); 276 (39.4%) participants required a hospital admission. New discharge destination was required for 109 (15.5%) participants, of whom 49 (45%) changed from home alone to home with family/friend(s). Greater comorbidities, as indicated by the Charlson Comorbidity Index score, were associated with hospital admission, longer LOS and new discharge destination. Premorbid living situations of home with family/friend(s) or from an external care facility were associated with a decreased likelihood of hospital admission, shorter LOS and reduced risk of a new discharge destination. Surgical treatment was associated with shorter LOS. Older age and dementia diagnosis were associated with a new discharge destination.

Conclusions
Many factors potentially impact on the likelihood or risk of hospitalization, LOS and new discharge destination post PHF. Patients with greater comorbidities are more likely to have negative outcomes, while patients who had premorbid living situations of home with family/friend(s) or from an external care facility are more likely to have positive outcomes. Early identification of factors that may impact patient outcomes may assist timely decision making in hospital settings. Further research should focus on developing tools to predict hospital outcomes in the PHF population.
Red blood cell distribution width as a predictor of mortality and poor functional outcome after acute ischemic stroke: a meta-analysis and meta-regression
Authors: Shen Huiqin , Shen Lihong 
Published: April 2024

Abstract
Background
This study aimed to review evidence on the ability of red cell distribution width (RDW) to predict mortality and poor functional outcomes after acute ischemic stroke (AIS).

Methods
Databases of PubMed, CENTRAL, Scopus, Embase, and Web of Science were searched online from inception to 25th Jul 2023 for all studies reporting the association between RDW and outcomes as adjusted ratios. A random-effects meta-analysis was done. Meta-regression was conducted using multiple moderators.

Results
15 studies with 14,968 patients were included. Meta-analysis found that RDW, both as a categorical variable (OR: 2.10 95% CI: 1.74, 2.55 I2 = 42%) and continuous variable OR: 1.16 95% CI: 1.05, 1.28 I2 = 64%) was a significant predictor of mortality after AIS. Age and number of hypertensives were found to be significant moderators in the meta-regression. Also, high RDW, as a categorical variable (OR: 1.68 95% CI: 1.20, 2.35 I2 = 84%), was associated with significantly higher odds of poor functional outcomes after AIS, but not as a continuous variable (OR: 1.07 95% CI: 0.99, 1.16 I2 = 61%). Meta-regression showed that the association was stronger in small sample-sized studies.

Conclusion
RDW can be a useful, readily available, and cost-effective biomarker to rapidly stratify AIS patients at risk of poor outcomes. High RDW was consistently associated with an increased risk of mortality after AIS, however, its ability to predict poor functional outcomes needs to be verified by further studies.
Uraemic brainstem encephalopathy mimicking ocular myasthenia: a case report
Authors: Ruwanpathirana Pramith , Chang Thashi 
Published: April 2024

Abstract
Background
Uraemia causes a generalised encephalopathy as its most common neurological complication. Isolated brainstem uraemic encephalopathy is rare. We report a case of fatigable ptosis and complex ophthalmoplegia in brainstem uraemic encephalopathy.

Case presentation
A 22-year-old Sri Lankan man with end stage renal failure presented with acute onset diplopia and drooping of eyelids progressively worsening over one week. The patient had not complied with the prescribed renal replacement therapy which was planned to be initiated 5 months previously. On examination, his Glasgow coma scale score was 15/15, He had a fatigable asymmetrical bilateral ptosis. The ice-pack test was negative. There was a complex ophthalmoplegia with bilateral abduction failure and elevation failure of the right eye. The diplopia did not worsen with prolonged stare. The rest of the neurological examination was normal. Serum creatinine on admission was 21.81 mg/dl. The repetitive nerve stimulation did not show a decremental pattern. Magnetic resonance imaging (MRI) of the brain demonstrated diffuse midbrain and pontine oedema with T2 weighted/FLAIR hyperintensities. The patient was haemodialyzed on alternate days and his neurological deficits completely resolved by the end of the second week of dialysis. The follow up brain MRI done two weeks later demonstrated marked improvement of the brainstem oedema with residual T2 weighted/FLAIR hyperintensities in the midbrain.

Conclusions
Uraemia may rarely cause an isolated brainstem encephalopathy mimicking ocular myasthenia, which resolves with correction of the uraemia.