bluuebunny/crossref_metadata_2025_split huggingface dataset:
CXCL14 as a potential marker for immunotherapy response prediction in renal cell carcinoma
Authors: Pan Qiwen , Liu Ruiqi , Zhang Xinyue , Cai Lingling , Li Yilin , Dong Pei , Gao Jianming , Liu Yang , He Liru 
Published: December 2023

Background: Epigenetic mechanisms play vital roles in the activation, differentiation, and effector function of immune cells. The breast and kidney-expressed chemokine (CXCL14) mainly contributes to the regulation of immune cells. However, its role in shaping the tumor immune microenvironment (TIME) is yet to be elucidated in renal cell carcinoma (RCC). Objectives: This study aimed to elucidate the role of CXCL14 in predicting the efficacy of immunotherapy in patients with RCC. Methods: CXCL14 expression and RNA-sequencing, single-cell RNA-sequencing (scRNA-seq), and survival datasets of RCC from public databases were analyzed, and survival was compared between different CXCL14 levels. The correlation between CXCL14 and immune infiltration and human leukocyte antigen (HLA) gene expression was analyzed with TIMER2.0 and gene expression profiling interactive analysis. Institutional scRNA-seq and immunohistochemical staining analyses were used to verify the relationship between CXCL14 expression level and the efficacy of immunotherapy. Results: CXCL14 was expressed in fibroblast and malignant cells in RCC, and higher expression was associated with better survival. Enrichment analysis revealed that CXCL14 is involved in immune activation, primarily in antigen procession, antigen presentation, and major histocompatibility complex assemble. CXCL14 expression was positively correlated with T-cell infiltration as well as HLA-related gene expression. Among the RCC cohort receiving nivolumab in Checkmate 025, the patients with CXCL14 high expression had better overall survival than those with CXCL14 low expression after immunotherapy. scRNA-seq revealed a cluster of CXCL14+ fibroblast in immunotherapy responders. Immunohistochemistry analysis verified that the patients with high CXCL14 expression had an increased proportion of high CD8 expression simultaneously. The expression level of CXCL14 was associated with CXCR4 expression in RCC. Conclusion: CXCL14 expression is associated with immunotherapy response in RCC. It is a promising biomarker for immunotherapy response prediction and may be an effective epigenetic modulator in combination with immunotherapy approaches.
A rapid systematic review of breakthrough pain definitions and descriptions
Authors: Greenfield Katie , Schoth Daniel E , Hain Richard , Bailey Simon , Mott Christine , Rajapakse Dilini , Harrop Emily , Renton Kate , Anderson Anna-Karenia , Carter Bernie , Johnson Margaret , Liossi Christina 
Published: December 2023

Background Breakthrough pain is common in life-limiting conditions and at end-of-life. Despite over 30 years of study, there is little consensus regarding the definition and characteristics of breakthrough pain. Objective This study aims to update and expand a 2010 systematic review by Haugen and colleagues to identify (1) all definitions of breakthrough pain and (2) all descriptions and classifications of breakthrough pain reported by patients, caregivers, clinicians, and experts. Design This rapid systematic review followed the Cochrane Rapid Review Methods Group guidelines. A protocol is published on PROSPERO (CRD42019155583). Data sources CINAHL, MEDLINE, PsycINFO, and the Web of Science were searched for breakthrough pain terms from the inception dates of each database to 26th August 2022. Results We identified 65 studies that included data on breakthrough pain definitions, descriptions, or classifications from patients ( n = 30), clinicians ( n = 6), and experts ( n = 29), but none with data from caregivers. Most experts proposed that breakthrough pain was a sudden, severe, brief pain occurring in patients with adequately controlled mild-moderate background pain. However, definitions varied and there was no consensus. Pain characteristics were broadly similar across studies though temporal factors varied widely. Experts classified breakthrough pain into nociceptive, neuropathic, visceral, somatic, or mixed types. Patients with breakthrough pain commonly experienced depression, anxiety, and interference with daily life. Conclusions Despite ongoing efforts, there is still no consensus on the definition of breakthrough pain. A compromise is needed on breakthrough pain nomenclature to collect reliable incidence and prevalence data and to inform further refinement of the construct.
Volume Status Assessment by Lung Ultrasound in End-Stage Kidney Disease: A Systematic Review
Authors: Kharat Aileen , Tallaa Faissal , Lepage Marc-Antoine , Trinh Emilie , Suri Rita S. , Mavrakanas Thomas A. 
Published: December 2023

Purpose of review: Lung ultrasound is a noninvasive bedside technique that can accurately assess pulmonary congestion by evaluating extravascular lung water. This technique is expanding and is easily available. Our primary outcome was to compare the efficacy of volume status assessment by lung ultrasound with clinical evaluation, echocardiography, bioimpedance, or biomarkers. The secondary outcomes were all-cause mortality and cardiovascular events. Sources of information: We conducted a MEDLINE literature search for observational and randomized studies with lung ultrasound in patients on maintenance dialysis. Methods: From a total of 2363 articles, we included 28 studies (25 observational and 3 randomized). The correlation coefficients were pooled for each variable of interest using the generic inverse variance method with a random effects model. Among the clinical parameters, New York Heart Association Functional Classification of Heart Failure status and lung auscultation showed the highest correlation with the number of B-lines on ultrasound, with a pooled r correlation coefficient of .57 and .36, respectively. Among echocardiographic parameters, left ventricular ejection fraction and inferior vena cava index had the strongest correlation with the number of B-lines, with a pooled r coefficient of .35 and .31, respectively. Three randomized studies compared a lung ultrasound-guided approach with standard of care on hard clinical endpoints. Although patients in the lung ultrasound group achieved better decongestion and blood pressure control, there was no difference between the 2 management strategies with respect to death from any cause or major adverse cardiovascular events. Key findings: Lung ultrasound may be considered for the identification of patients with subclinical volume overload. Trials did not show differences in clinically important outcomes. The number of studies was small and many were of suboptimal quality. Limitations: The included studies were heterogeneous and of relatively limited quality.
Fusion Rates in Tibiotalocalcaneal Arthrodesis with Tantalum Coated Metal Cup Augmentation
Authors: Romiyo Vineeth , Mahjoub Adel , Gentile Pietro , Freeland Erik 
Published: December 2023

Category: Ankle Arthritis; Ankle Introduction/Purpose: Tantalum coated metal spacers (TCMS) have recently been utilized to fill and provide structure to large bony defects in the hindfoot. TCMS have a porous structure and elastic modulus similar to cancellous bone, increasing resistance to collapse, as well as osteoconductive properties that allow for bony ingrowth. At this time, there is still a paucity of literature assessing the use and outcomes of TCMS in foot and ankle surgery, more specifically as bridging structures for large bony defects when performing tibiotalocalcaneal (TTC) arthrodesis. This study serves to assess clinical outcomes and fusion rates of patients who underwent TTC arthrodesis utilizing intramedullary nailing with tantalum coated metal cup augmentation for large bony defects. Methods: We retrospectively reviewed the charts of 20 patients who underwent TTC fusion with TCMS augmentation at our local tertiary care center between 2015-2021. The CT scans at the six-month post-operative window were reviewed by one orthopaedic surgeon to determine the presence of bony fusion, which was defined as having at least 50% fusion mass. From the initial cohort, we collected the following modified foot function index scores for 13 patients: PROMIS Physical Health (0-20), PROMIS Mental health (0-20), Foot Function Index (0-170), Activity Limitation Scale (0-30), Pain Scale (0-50) and Disability Scale (0-90). Results: The mean age of our cohort was 53.9 (± 12.9) with a mean CCI of 1.54 (± 1.127) and mean follow up of 451.5 days (± 353.3). Mean modified foot function index scores included: PROMIS Physical Health 12.15 (± 3.34), PROMIS Mental health 12.23 (± 4.82), Foot Function Index 91.08 (± 47.59), Activity Limitation Scale 15.00 (± 10.42), Pain Scale 25.00 (± 14.77) and Disability Scale 51.00 (± 25.06). The post-operative complication rate was 30.8% in which 3 patients required a revision surgery via nail dynamization and one patient required a below knee amputation due to an infected nonunion of the TTC arthrodesis. The overall fusion rate at the 6-month postoperative visit was 69.2%. Conclusion: Unlike prior studies, we were able to obtain 6-month post-operative CT scans to delineate successful fusions with a larger number of patients (n=13). Given the paucity of literature looking at TCMS augmented fusions in foot and ankle surgery, our data will contribute to our understanding and efficaciousness of this relatively new use of TCMS in foot and ankle surgery. Further studies are needed to evaluate the efficacy of TCMS augmented fusions as a viable surgical approach as well an alternative to standard nail dynamizations with structural grafts.
Incidence of Postoperative Rerupture of Achilles Tendon and Associated Risk Factors in South Korea: A National Population-Based Study
Authors: Choi Yoon Hyo , Choi Ji Hye , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min 
Published: December 2023

Category: Sports; Ankle Introduction/Purpose: Achilles tendon rerupture (ATRR) is a frequently occurring complication following the treatment of an Achilles tendon rupture (ATR) that can lead to disability; however, comprehensive risk factors for the development of postoperative ATRR remain unclear. We aimed to determine the incidence rate of postoperative ATRR and its associated risk factors, including comorbidities and medication, among the South Korean population. Methods: This study was performed based on Health Insurance Review and Assessment claims data, which covers 98% of the overall Korean population. Patients with ATR were identified according to the disease code S86.0 (Achilles tendon injury) of the Korean classification of disease between 2007 and 2020, and a washout period of 1 year was set. Instances of reoperation on the Achilles tendon between 42 and 365 days after the initial surgery, in the absence of infection or skin necrosis, were classified as cases of Achilles tendon rerupture (ATRR). Data on age, sex, comorbidities, and medications were collected and statistically analyzed. Results: Between 2009 and 2018, the incidence of surgical treatment for primary ATR was 9.91 per 100,000 person-years, showing a significant annual increase. The postoperative rerupture rate was 2.14% and did not show a significant increase. Male sex, young age, preexisting Achilles tendinopathy, osteoarthritis, and preoperative exposure to non-steroidal anti-inflammatory drugs and opioids were risk factors for postoperative ATRR. Conclusion: This information needs to be considered when determining the surgical treatment for patients with Achilles tendon rupture. The study results provoke further biological and clinical research on the risk factors for postoperative ATRR.
Intellectual Property and Royalty Payments Among Foot and Ankle Surgery Fellowship Faculty
Authors: Dominick Casciato , Page Trevor , Perkins Jacob , Vacketta Vincent G. , Hyer Christopher 
Published: December 2023

Category: Other Introduction/ Purpose: Faculty of the American College of Foot and Ankle Surgeons and American Orthopedic Foot and Ankle Society fellowship programs are uniquely positioned to provide advanced clinical and surgical training to fellows. One aspect of this training may include product design and mentorship through the associated intellectual property (IP) and patent timeline. This study describes the payments received and IP held among foot and ankle surgery fellowship faculty. Methods: A review of foot and ankle surgeons with royalties or license payments disclosed on the CMS Open Payments Database from 2014-2020 was conducted. Members with payments were then cross-referenced with the US Patent Full-Text Database to identify patents held. Fellowship affiliation, practice location, patent office, number of patents, citations, patent h-index, type of patent, and yearly payment values were recorded. Results: Among the 2,801 surgeons, 53 fellowship affiliates and 46 non-affiliates maintained at least one patent and royalty/license payment. A total of 576 patents and 19191 citations were assessed. The median number of patents and citations held by fellowship faculty was 3 and 60, respectively, while the median total payment value reached $165197.09. Fixation devices comprised most of the patents and citations. Payment value positively correlated with number of patents held (p=0.01), citations (p=0.007), and patent h-index (p=0.01) among fellowship-affiliated surgeons. Conclusion: Foot and ankle surgery fellowship faculty payments for IP is associated with the number and citability of patents held. While a small proportion of faculty were paid for intellectual property, the number of patents held and citations was comparable to other specialties.
Is there a Correlation Between the Distance to Healthcare Facilities and Postoperative Complications after Achilles Tendon Rupture? A Geospatial Study
Authors: Mirochnik Karina , Nassour Nour , Hendriks Joris R.H , Ranganathan Noopur , Lucaciu Andreea R. , Ashkani-Esfahani Soheil , Guss Daniel , Waryasz Gregory 
Published: December 2023

Category: Ankle; Other Introduction/Purpose: Geospatial access to healthcare is defined as the ability of patients to obtain healthcare services based on their locations. Therefore, we aimed to investigate patients’ proximity to healthcare and its correlation with the complications of surgically treated Achilles tendon rupture (ATR), including venous thromboembolism (VTE), re-rupture, and wound dehiscence. The outcome of this study can help providers and policy makers to determine the equity of healthcare for these patients in the area under their coverage. Methods: We included 426 patients who lived in the United States (US) tri-state area who received surgical treatment for ATR. We used patient and hospital addresses and zip codes to calculate the distances to healthcare centers. A geographic information system (GIS) platform analysis in the tri-state was completed using Maptive, powered by Google Maps, to create heat maps displaying the geographical distribution of patients treated for ATR with and without complications (Figure 1). The Shapiro–Wilk test was used to determine normal distribution. Mann–Whitney U test was used to compare the groups with and without complication. The point biserial correlation test was used to determine any correlations between driving distance and the incidence of complications (p < 0.05 was considered significant). Results: The average driving distance to the patient’s specific healthcare center was 62.16 ± 76.54 km. There was no significant difference between the distances for patients with and without overall complications (p = 0.65), with and without VTE (p = 0.70), with and without re-rupture (p = 0.84), and with and without wound problems (p = 0.36). No correlation between complications and the distance to healthcare centers was found (p = 0.65; Table 1). Conclusion: Geospatial information is important within the context of healthcare accessibility and can provide crucial guidance to healthcare planning for patients and healthcare policymakers. Although this study showed that distance to healthcare facilities did not lead to significantly higher complication rates amongst ATR patients, it does not resolve the need for further studies looking at a larger population and broader geographical segments. These studies can be used to assess the equity of healthcare in specific areas and make modifications if needed.
Lessons Learned – the Learning Curve of Percutaneous Hallux Valgus Correction Using 3rd Generation MICA in 106 Consecutive Cases
Authors: Toepfer Andreas Kurt 
Published: December 2023

Category: Bunion; Other Introduction/Purpose: Minimally-invasive Chevron and Akin osteotomy (MICA) represents the third-generation percutaneous hallux valgus surgery which is characterized by an extra-articular osteotomy, stable internal fixation and a high potential for correction. Compared to other percutaneous techniques of the foot, MICA is generally regarded as an advanced and demanding surgical procedure with a prolonged learning curve. The aim of this study is to analyze a single-surgeons learning curve with his first 106 consecutive MICA procedures. Methods: Between May 2018 and November 2022, 106 consecutive MICA procedures performed by the author were prospectively analyzed focusing on surgery duration, number of fluoroscopies, radiological correction results and surgery- associated complications using a modified Clavien-Dindo classification. There were 95 female and 11 male patients with a mean age of 53y (range 16-78y). The mean preoperative intermetatarsal angle I/II (IMA) was 15,7°, the mean hallux valgus angle (HVA) 28,7°. Results: The average amount of radiological correction was 12,6° for IMA and 16,8° for HVA. Overall, the mean surgery duration was 41,6min. (range 27-90min.), the number of fluoroscopies (fs) was 110,8 (range 64-186 fs). Comparing the first 10 MICAS vs. the last 10 procedures, both surgery duration and the amount of fluoro shots decreased significantly (58,8min vs. 32,4min and 165,9 fs vs. 83,1fs). According to the modified Clavien-Dindo classification, there were three grade 1 complications (superficial cellulitis requiring oral antibiotics), four grade 2 complications (1 intraoperative conversion to open surgery, 1 delayed union, 2 symptomatic recurrences) and one grade 3 complication (delayed wound-healing requiring superifical wound revision). Overall screw removal rate was 18 /106 cases, all due to prominent hardware with square headless designed screws (non-beveled). Conclusion: This study represents the largest case series on the learning curve of MICA. Although the learning curve is prolonged requiring specific training and intensive practice, the rate of severe complications is not increased compared to open hallux valgus surgery. The use of bevel-headed screws is strongly advised to reduce the rate of secondary hardware removal. The learning curve manifests itself predominantly in a decreasing operation time and lower number of fluoroscopies. Adherence to the principles of MICA with stable fixation and meticulous intraoperative control of each surgical step helps to reduce complications and allows for adequate correction from the beginning.
Natural Course of Talar Avascular Necrosis During Short-Term Follow-Up and Factors Associated with Disease Progression
Authors: Choi Yoon Hyo , Lee Dong Yeon , Kyung Min Gyu , Lee Kyoung Min , Lee Kyoung Min 
Published: December 2023

Category: Ankle; Hindfoot Introduction/Purpose: This retrospective cohort study aimed to investigate the natural history of talar avascular necrosis (AVN) during short-term outpatient follow-up and to identify the risk factors for progression to collapse and arthritic changes. Methods: Thirty-four cases of talar AVN from 34 patients (15 males, 19 females) were included. The mean age of the patients was 48.9 years (SD 16.0 years) and the mean follow-up period was 39.5 months (SD 42.0 months). The patients were divided into two groups i.e., progression and non-progression groups. The progression group consisted of those who showed aggravation of the Ficat stage during the follow-up period or advanced arthritis of the ankle joint (Ficat stage 4) at presentation. Demographic data and information regarding medical comorbidities, trauma history, bilaterality, and location of the lesion (shoulder vs. non-shoulder lesions) were collected. Following the univariate analysis, a binary logistic regression analysis was performed. Results: The location of the talar AVN was the only significant factor (p=0.047) associated with disease progression. A total of 14.3% (2 of 14) of the central (non-shoulder) talar AVN lesions showed progression, while 50% (10 of 20) of shoulder lesions aggravated during follow-up. Age, sex, bilaterality, medical comorbidities, and trauma history were not associated with progressive talar collapse or subsequent arthritic changes in talar AVN. Conclusion: Conservative treatment should be considered for a central lesion of the talar AVN because it tends to remain stable without progression. A more comprehensive study with a larger study population is required to establish the surgical indications for talar AVN.