bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of factors predicting response to abiraterone acetate in metastatic castration-resistant prostate cancer: A prospective study
Authors: Kumawat Ghanshyam , Yadav SS , Jaiswal Sanjeev , Sahu Ramdayal , Garg Anurag , Tomar Vinay 
Published: November 2022

Background/Objectives: In the current era, abiraterone acetate is mainstay of the treatment strategies of castration-resistant prostate cancer and proven to prolong overall survival. We aimed to prospectively identify factors associated with duration of response to abiraterone. Patients and methods: All metastatic castration-resistant prostate cancer patients eligible for abiraterone were included in the study from February 2019 till March 2020. All baseline data and potential factors associated recorded and follow-up with prostate-specific antigen (PSA), and required investigations were done at 1 month interval. Duration of PSA response was recorded, and patients were divided in five groups on the basis of duration of response. Univariate and multivariate analyses of potential factors were done, and data analysis was done with SPSS (Statistical Package for the Social Sciences) version 21.0. Results: In this study, after univariate analysis, seven factors were associated with longer duration of response to abiraterone. These were PSA at diagnosis (hazard ratio (HR) = −1.011 (95% confidence interval (CI) = 1.003–1.020), p-value = 0.008), PSA at start of abiraterone (HR = −1.018 (95% CI = 1.011–1.025), p-value = 0.0001), nadir PSA (HR = −1.063 (95% CI = 1.024–1.104), p-value = 0.001), prostate-specific antigen doubling (PSAD) time (HR = −0.745 (95% CI = 0.672–0.827), p-value = 0.001), raised alkaline phosphatase (ALP) (HR = −1.002 (95% CI = 1.001–1.003), p-value = 0.001), neutrophil/lymphocyte ratio (NLR) (HR = −2.16 (95% CI = 1.672–2.81), p-value = 0.001) and <5 bone metastasis (HR = −0.235 (95% CI = 0.130–0.422), p-value = 0.01). But after multivariate analysis, nadir PSA achieved, PSAD, NLR and ⩽5 bone metastasis were predictors of better response to abiraterone. Conclusion: This study had identified that less nadir PSA achieved, long PSAD time, low NLR and limited number of skeletal metastases were potential factors for better PSA response to abiraterone. Level of evidence: 1
Application effect of Kolb's experiential learning theory in clinical nursing teaching of traditional Chinese medicine
Authors: Chen Lu , Jiang Wen-Juan , Zhao Ru-Ping 
Published: November 2022

Objective This study aimed to explore the practical application and effect of Kolb's experiential learning theory in the clinical nursing training of traditional Chinese medicine (TCM). Methods This study is a quasi-experimental study. Eighty clinical nurses from a class-III grade-A general hospital were enrolled in 2020 and 2021, respectively, as research subjects. The subjects in the control group were trained in “theory explanation, clinical practice, summary and Q&A, [and] centralized examination.” The subjects in the experimental group were first grouped according to Kolb's experiential learning style. The training followed a “problem–exploration–practice–exploration–theory–explanation–summary–centralized examination” structure based on Kolb's experiential learning cycle, the training place is Conference Room 1 of the hospital. The training time is from February to August 2020 and 2021. The application effect of the experiential learning theory was evaluated by analyzing course evaluation questionnaires and the final examination results. Results The total score of the course evaluation questionnaire of the experimental group was 112.23  ±  5.88. The difference compared with the control group was statistically significant ( P < .01). In the experimental group, the theoretical score was 85.27  ±  3.29, and the operational score was 85.36  ±  3.01. The differences compared with the control group were statistically significant ( P < .01). Conclusion The application of Kolb's experiential learning theory to the training of TCM clinical nursing can make the clinical practice of TCM nursing more “scientific” and the training more effective, and it can improve the subjective initiative of students.
Coronal Plane Calcaneal-Talar Orientation in Varus Ankle Osteoarthritis
Authors: Kang Ho Won , Park Gil Young , Lee Dong-Oh , Ro Yoon A. , Lee Dong Yeon 
Published: November 2022

Category: Hindfoot; Ankle; Ankle Arthritis Introduction/Purpose: We do not yet fully understand how the subtalar joint position is related to the varus osteoarthritic ankle joint. The purposes of this study were 1) to investigate the coronal orientation of the calcaneus relative to the talus according to the ankle osteoarthritis stage, talar tilt (TT), and 2) to determine if there is a TT threshold at which apparent subtalar compensation begins to fade. Methods: We retrospectively reviewed 132 ankles that underwent WBCT for varus ankle osteoarthritis. The TT, subtalar inclination angle (SIA), and calcaneal inclination angle (CIA) were measured using WBCT. Ankles were divided into 5 groups according to Takakura stage and 2 groups according to the apparent compensation status of the subtalar joint and compared the index of the inclination of the subtalar joint relative to the ankle (SIA) or the index of the inclination of the calcaneus relative to the ankle (CIA). Additionally, we explored the relationship between SIA or CIA and the TT. Results: Apparent subtalar compensation (SIA and CIA) was significantly lower in Takakura stages 3b and 4. The SIA and CIA significantly differed according to the apparent compensation status (p<.001 and p=.030, respectively). The CIA of the noncompensated group varied widely, while the SIA was relatively constant. Furthermore, TT was greater than 9.5, which indicated a high probability of a noncompensated heel. (sensitivity, 92.6%; specificity, 89.7%). Conclusion: The position of the calcaneus has a appears compensatory with coronal plane orientation in varus ankle osteoarthritis when the TT is < than 9.5°.
Reconstruction of Severe Osteolytic Malleoli using Femoral Head Allograft in a Revision Total Ankle Replacement: A Case Report
Authors: Kvarda Peter , Ruiz Roxa , Hintermann Beat 
Published: November 2022

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Case: A 38-year-old male patient presented with severe pain in the left ankle who underwent a total ankle replacement (TAR) and syndesmotic fusion for end-stage ankle osteoarthritis (OA) 13 years ago. Radiographic evaluation showed implant loosening and extensive osteolytic lesion of both malleoli. Revision was performed using a three-component TAR system and reconstruction of the malleoli with femoral head allograft. Methods: N/A Results: N/A Conclusion: Reconstruction of severe osteolytic lesions of the malleoli with femoral head allograft in the setting of revision TAR allowed to create a stable bone stock, implant anchorage, desirable stability and therefore maintaining joint function.
Short-Term Outcomes of a Two-Component Total Ankle Replacement in Revision Arthroplasty
Authors: Kvarda Peter , Toth Laszlo , Horn-Lang Tamar , Susdorf Roman , Ruiz Roxa , Hintermann Beat 
Published: November 2022

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Given the growing number of primary total ankle replacements (TAR), an increase in the numbers of failed ankles and consecutive revisions might be expected. Achieving a stable and balanced ankle based on stable components while preserving the remaining bone stock as much as possible, are crucial for success in revision TAR. Most reported techniques rely on bulky implants with extended fixation features. Since 2018, we have used a novel 3-component ankle for revision surgery that is converted in situ to a fixed-bearing 2-component ankle once the components have found their position given by the individual anatomy. The purpose of this study was to determine the short-term results of this novel concept in revision TAR. Methods: This single-center retrospective cohort study included 57 patients (57 ankles, mean age 63+-13 years) treated for failed TAR with the semi-constrained HINTERMANN Series H2© (H2) implant between February 2018 and February 2020. Survival analysis was performed and potential risk factors using Cox regression, were assessed. Clinical and radiological outcomes were assessed preoperatively and at the last follow-up. Clinical outcomes included pain on a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) ankle hindfoot score and patient satisfaction. Radiological outcomes were tibial articular surface angle (TAS), tibiotalar surface angle (TTS), talar tilt angle (TT) in the coronal plane and anteroposterior offset (AP-Offset) ratio in the sagittal plane, as well as signs of radiolucency and/or loosening on plane weightbearing radiographs. Results: The median follow-up was 2 (2.0 to 4.0) years. The cumulative incidence for secondary revision after 1 and 2 years was 5.1% (95%CI 0-11) and 7.4% (0-14) respectively. Four patients needed a secondary revision (three for pain/arthrofibrosis and one for aseptic loosening). While the AOFAS hindfoot score increased from median 54 (range 9-94) to 75 (19-98) (p=0.00001), satisfaction increased from moderate to good (p=0.0017). Radiographically, all components were stable without signs of increased shear-forces in terms of loosening or radiolucency. Conclusion: Obtained results with the novel customized semi-constrained total ankle implant design at short-term are encouraging, with a satisfactory survival rate and acceptable revision rate. The fixation concept without extended fixation features was shown to last against increased shear forces.
Comparison of Outcomes Between Knotless Anchor Repair and Knot Anchor Repair for All- Arthroscopic Anterior Talofibular Ligament Repair in Chronic Ankle Instability
Authors: Lee Sung Hyun , Yoo Byung min 
Published: November 2022

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: Arthroscopic anterior talofibular ligament (ATFL) repair using a suture anchor is effective and has excellent short- to mid-term patient outcomes reported in previous studies. Recent study suggested that knotless suture anchor had advantage compare to knot suture anchor. The aim of this study is to compare clinical outcomes after knot anchor versus knotless anchor repair for all-arthroscopic ATFL repair in patients with chronic lateral ankle instability. Methods: Between 2017 and 2018, patients who underwent arthroscopic ATFL repair using knot or knotless suture anchors and were available at least 2 years follow up were included in this study. Total, 68 patients were included, and sorted to 2 groups according to characteristics of anchor. (KL group (n=42): knotless anchor, K group (n=26): knot anchor). Clinical outcomes were compared using a visual analog scale (VAS), Foot and Ankle Outcome Score (FAOS), and Karlsson score. Radiologic outcome evaluations were performed preoperatively and at 2 years postoperatively using stress radiographs and axial view MRI. Results: There were no significant differences between 2 groups in clinical scores and radiologic findings. There were 3 knot irritation (11.5%) and 1 SPN neuropathy (3.8%) in K group, but there were no statistical differences. Conclusion: Arthroscopic ATFL repair using knotless suture anchor showed comparable outcomes to knot anchor, without complication due to knot.
Ballistic Injuries to the Foot and Ankle: Antibiotic Administration and Infection Rate
Authors: Luginbuhl Joshua C. , Rallis Gavin , Gokcen Eric C. 
Published: November 2022

Category: Trauma; Ankle; Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Although frequently non-fatal, ballistic injuries to the foot and ankle can lead to significant morbidity and functional impairment. General management principles are often employed, however there is a paucity of data related outcomes following ballistic injury to the foot and ankle. Methods: A retrospective chart review of inpatients who sustained a ballistic injury to the foot and ankle was performed at a single level one trauma institution from 2014 to 2019. A total of 64 patients were identified. Each chart was reviewed for demographics, foot and ankle injury sustained, associated non-orthopaedic injuries, antibiotics received, procedures undergone, and complications documented. Results: The patients were more frequently male (M:F, 11.8:1) with a mean age of 31.2 years (18-75). Fifty-two (81.3%) patients received antibiotics, all of which covered for gram positive organisms. Twelve of these patients also received coverage for gram- negative organisms. Two (3.1%) patients developed a documented infection. One patient who received gram positive antibiotic coverage sustained 1 fracture, underwent bedside bullet removal, and developed a cellulitis that responded to oral antibiotics. The other patient received both gram positive and gram negative coverage, sustained 6 fractures in the foot with extensive soft tissue injury, underwent operative debridement, and ultimately required transmetatarsal amputation due to infection/osteomyelitis. Conclusion: Ballistic injuries to the foot and ankle are common injuries encountered by orthopaedists in an urban setting. The infection rate (3.1%) in our series is low and comparable to infection rates seen after ballistic injury to the hand. Negative outcomes after ballistic injury are associated with multiple fractures and soft tissue compromise. We advocate for early antibiotic administration and a high index of suspicion for infection in these cases.
Charcot Neuroarthropathy is Associated with Higher Rates of Phantom Limb after Major Amputation
Authors: Martinazzi Brandon J. , Nam Hannah , Lorenz F. Jeffrey , Mansfield Kirsten N. , Dopke Kelly , Ptasinski Anna , Kirchner Gregory , Aynardi Michael C. 
Published: November 2022

Category: Diabetes; Trauma Introduction/Purpose: Phantom limb is a complication associated with lower extremity amputation. However, its rate in patients with Charcot Neuroarthropathy that undergo major amputation is not well-described. Moreover, there is limited research exploring outcomes of patients with Charcot Neuroarthropathy that require amputation. Therefore, the purpose of this cohort study was to determine if patients with Charcot Neuroarthropathy that undergo major amputation had an increased rate of phantom limb compared to patients that underwent amputation without a coexisting diagnosis of Charcot. Methods: Using ICD and CPT codes, an online research database was used to identify patients that underwent a major lower extremity amputation. For the purposes of our study, we defined a major amputation as a below-knee amputation (BKA). Patients were then separated into two groups. Group A consisted of patients that underwent BKA and also had a coded diagnosis of Charcot Neuroarthropathy. Group B consisted of patients that underwent BKA and lacked a diagnosis of Charcot. Statistical analysis was then run to determine the relative risk of developing phantom limb in patients that underwent BKA with a diagnosis of Charcot Neuroarthropathy compared to those without the diagnosis. Demographic data of the cohort was also collected. Results: From 2012-2022, a total of 11,374 patients underwent a BKA. Of these patients, 804 also had a diagnosis of Charcot Neuroarthropathy (Group A) and 10,570 did not (Group B). The rate of phantom limb in Charcot patients was 23.1% (186/804). The rate of phantom limb in patients without Charcot Foot was 19.5% (2063/10570). Patients with Charcot Neuroarthropathy that underwent a BKA had an increased risk of developing phantom limb compared to patients that underwent a BKA without Charcot (RR: 1.2, 95% CI: 1.039-1.352). Conclusion: Phantom limb is a serious complication following major amputation. Our results indicate that patients with a coexisting diagnosis of Charcot Neuroarthropathy that go on to require BKA may have an increased risk of developing phantom limb. Furthermore, our study adds to the limited research on outcomes of patients with Charcot Neuroarthropathy.
5-Year Follow-Up of Neuropathic Minimally Invasive Surgery for the Management of Diabetic Forefoot Ulcers
Authors: Miller Roslyn 
Published: November 2022

Category: Diabetes; Bunion; Lesser Toes Introduction/Purpose: Diabetic forefoot ulcers are associated with a high risk of recurrence, subsequent infection and amputation. Patients who have an amputation for diabetic foot disease have a significantly increased 5-year morbidity and mortality. Minimally invasive surgery to redistribute forces includes any combination of percutaneous Achilles/extensor tendon lengthening, osteotomy/excision of the metatarsal head or sesamoids, and phalangeal osteotomy. The purpose of this case- controlled cohort study is to determine if there is any significant reduction in re-ulceration and amputations rates in patients treated with Neuropathic Minimally Invasive Surgeries, versus conservative management with wound debridement, antibiotics and total contact casting. Methods: Patients who had presented to the diabetic foot clinics that subsequently underwent Neuropathic Minimally Invasive Surgery over a 5-year period were matched with a similar group of patients (age, sex, neuropathy, peripheral vascular disease) who were managed conservatively. The conservative group of patients were identified from the Scottish SCI-Diabetes database. Outcomes of recurrent ulceration and amputation, time to heal and number of clinic visit were all compared. Results: Patients who underwent minimally invasive surgery had predictable healing of their ulcers in 6 weeks. Very few represented a recurrent ulcer, though some did develop an ulcer at a different site. Subsequent amputation rates were lower in the surgical group versus the non-surgical group. The number of clinic visits significantly reduced in the operated group, versus the conservatively treated group. Conclusion: Patients with recurrent diabetic foot ulcers benefit from early assessment to determine if they would be a good surgical candidate for Neuropathic Minimally Invasive Surgery. Many diabetic patients have an alteration in their foot biomechanics, whether soft tissue, osseous or both. Minimally invasive surgeries provide relatively predictive times to ulcer healing. Re-ulceration at the same time is reduced. This has a significant impact on the patients' quality of life. There is also a major benefit to healthcare systems where there is a significant burden of the health care budget being allocated for regular dressings and wound reviews.
Bone Density of the First Metatarsal Head: Which is the Best Place to Put the Screws in MIS Hallux Valgus Surgery?
Authors: Mocoçain Mac-iver Pablo E. , Radkievich Ruben D. , Elgueta Stephane , Díaz Andres Keller , Zanolli de Solminihac Diego H. , Valderrama Carlos 
Published: November 2022

Category: Basic Sciences/Biologics; Bunion Introduction/Purpose: Hallux valgus minimally invasive surgery (MIS) is becoming more common due to its good clinical and functional results. Third-generation MIS surgery uses screw fixation that is dependent on the bone density of the first metatarsal head (FMH) for optimal screw purchase. There is no information regarding areas of higher bone density (BMD) in the FMH that suggest a stronger area of fixation, nor has it been described whether it varies between different age groups or with gender. The objective of this study is to determine the BMD within four quadrants of the FMH. This finding could lead to identifying the ideal trajectory for screw placement. In addition, we evaluate BMD variation by age and gender. Methods: Transversal study. From our CT scan database, we obtained 40 patients with no previous history of first metatarsal fractures, pre existing hardware, foot surgery or osteoporosis. We divided the patients into 4 groups, each group containing 5 male and 5 female patients: group 1: <30 years, group 2: 31-45 years, group 3: 46-60 years, group 4: > 60 years. The main outcome is to evaluate the association between BMD in each FMH quadrant. Secondary outcomes are to identify any differences in BMD between gender and age groups. According to what has been previously discussed in the literature, two evaluators measured the Hounsfield units (HU) of each quadrant on a coronal cut located 10 mm proximal to the metatarsophalangeal joint using the Merge PACS system. Measures were averaged. Statistical analysis was performed by measuring normality with the Shapiro-Wilks test, and the ANOVA, Student's t-test, and Mann-Whitney U test. Results: The dorsolateral (DL) quadrant had the highest BMD (353.9hu) of all quadrants, followed by the lateral plantar (LP: 302.4hu), medial plantar (MP: 264.1hu), and dorsomedial (DM: 247.6hu) (p=0.001).When comparing the groups by age, DL (p=0.01) and LP (p=0.01) quadrants had significantly greater BMD in groups 1 and 2 (< 45 years) than groups 3 and 4 (> 45 years).When comparing BMD by gender, differences were only obtained in the group 4, in which mens had greater BMD in the DM (p=0.03), DL (p=0.02), and LP (p=0.01) quadrants.An significant inverse association between age and BMD was obtained for the DL (P=0.004) and MP (P=0.03) quadrants. Conclusion: There are differences in BMD between the quadrants of the first metatarsal head, with the greatest BMD being in the dorsolateral region at any age. BMD decreased proportionally with increasing age in the DL and MP quadrants. At the same age, there are no significant differences between gender, except in patients >60 years, where women have lower BMD in almost all quadrants.