bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Knee Dislocation With Primary Repair and Suture Augmentation: A Viable Solution
Authors: Hecker Andreas , Schmaranzer Florian , Huber Christoph , Maurer Jonas , Egli Rainer J. , Eberlein Sophie C. , Klenke Frank M. 
Published: November 2022

Background: Different surgical techniques have been described for the treatment of knee dislocation (KD). Nonoperative approaches are frequently combined with surgical reconstruction using auto- or allograft. Purpose: To evaluate the midterm results of primary surgical repair and suture augmentation to treat KD. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 patients (5 women, 17 men; mean age, 45 ± 15 years) with KD were evaluated at a mean of 49 ± 16 months after surgical treatment that included primary repair and suture augmentation. Magnetic resonance imaging, stress radiographs, and outcome scores were obtained at the follow-up. Clinical examination including hop tests and force measurements for flexion and extension was performed. Results: The mean difference in pre- to postinjury Tegner scores was –2 ± 1. The outcome scores showed mean values of 84 ± 15 (Lysholm), 73 ± 15 (International Knee Documentation Committee) and 65 ± 25 (Anterior Cruciate Ligament–Return to Sport after Injury scale). Compared with the uninjured knee, the range of motion of the injured knee was reduced by 21° ± 12°. Twelve patients felt fit enough to perform hop tests and showed a mean deficit of 7% ± 17%° compared with the uninjured leg. The mean force deficit was 19% ± 18% for extension and 8% ± 16% for flexion. Stress radiographs revealed an 11 ± 7–mm higher anteroposterior translation on the injured side. Four patients had secondary ligament reconstructions due to persistent instability and 7 underwent arthroscopic arthrolysis due to stiffness. A significant increase of osteoarthritis was found for the medial, lateral, and patellofemoral compartments ( P = .007, .004, and .006, respectively). Conclusion: Primary repair and suture augmentation of KD led to satisfactory clinical midterm results despite persistent radiological instability and a significant increase in osteoarthritis. This technique allows the return to activities of daily living without subjective instability in most nonathletic patients. Secondary ligament reconstructions should be performed if relevant instability persists to decrease the risk of secondary meniscal and cartilage damage.
Breastfeeding Duration and Its Effective Factors in Kerman Province, Iran
Authors: Mirafzali Sedigheh , Akbari Sari Ali , Iranpour Abedin , Alizadeh Somayeh 
Published: November 2022

Introduction Complete cessation of breastfeeding (CCB) at the right time is as important as starting breastfeeding, as well as identifying the factors that affect the duration of breastfeeding, so that breastfeeding promotion programs focus on these causes, to increase mothers’ ability and desire to breastfeed. This study aimed to determine the time of CCB and its related factors. Methods This analytical cross-sectional study was conducted in 2020. This study was performed at all health centers and health homes affiliated to Kerman University of Medical Sciences, in Kerman province, Iran. A total of 802 urban and rural mothers with children aged from 30 to 36 months completed the questionnaire. The validity and reliability of the questionnaire were confirmed by Cronbach’s alpha of 85%. Data were analyzed using SPSS software version 16. Results The mean time of breastfeeding was 19.23 ± 7.09 months and the median was 22-month-year. About 41% of children were breastfed until 24-month. There was a significant relationship between the time of CCB with contraception, number of households, place of residence, and weight at 6-month at the level of 0.05. Conclusion Duration of breastfeeding is influenced by some demographic and cultural factors. The timing of the CCB is near to the suggestions of the World Health Organization (WHO) and religious teachings.
Metaphyseal Fracture Displacement is Predictive of Intra-Articular Displacement in Adolescent Triplane Ankle Fractures
Authors: Mundluru Surya , Romero Joseph , Greenhill Dustin , Zide Jacob R. , Wimberly Robert L. , Riccio Anthony , Thome Andrew P. 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Triplane ankle fractures are a commonly encountered pediatric injury with potential long-term sequelae if not appropriately managed. Computed tomography (CT) imaging is frequently obtained in the workup of a triplane fracture, however the radiation and cost associated with CT imaging is not benign. We aim to determine the utility of a novel and simple plain radiographic measurement as a predictor of intra-articular displacement in adolescent triplane ankle fractures. Methods: An IRB approved, retrospective review of all adolescent triplane ankle fractures from 2003-2013 was performed at a single level 1 pediatric trauma center. Plain radiographs (XR) and CT imaging obtained at initial presentation were independently reviewed by three orthopaedic surgeons. Maximum articular displacement and step off were measured using digital calipers on AP, mortise and lateral XRs as well as on axial, coronal, and sagittal CT imaging. In addition, maximal metaphyseal fracture displacement was recorded on lateral XR. Articular displacement and step off were compared between the two imaging modalities using student's t-test. Pearson and Spearman coefficients were used to identify correlations between XR and CT measurements. Results: 87 triplane ankle fractures were identified to meet inclusion criteria with a mean age of 12.9 years old (10-16 years old). XR was found to underestimate fracture displacement by 233% in the sagittal plane (1mm vs.3.3mm on sagittal CT; p<0.05). XR underestimated displacement by 24% in the coronal plane (2.3mm on AP XR vs. 2.9mm on coronal CT; p<0.05), and articular step off by 184% in the coronal plane and 177% in the sagittal plane (p<0.05). Axial CT demonstrated a significantly greater amount of articular displacement (4.2mm, range 0-19mm) when compared to coronal (2.9mm, range 0-18.7mm) and sagittal (3.3mm, range 0- 11mm) cuts (p<0.05). 65 patients demonstrated metaphyseal fracture displacement >=1mm on lateral XR, of whom 61 demonstrated articular displacement of >2.5mm on CT (positive predictive value of 94%). Conclusion: Plain radiographs appear to underestimate the articular displacement of triplane fractures. Maximal metaphyseal fracture displacement is easily measured on XR and appears to correlate with articular displacement. Maximal metaphyseal fracture displacement >= 1mm is strongly predictive of articular displacement above the commonly accepted threshold for operative intervention. This finding should raise suspicion for significant articular displacement that may not be appreciated on XR and should prompt consideration of a CT before a decision is made on definitive treatment.
Morphology of Posterior Malleolus Fractures Associated with Tibial Shaft Fractures
Authors: Myatt Darren , Mason Lyndon W. , Stringer Howard , Fischer Benjamin 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Diaphyseal tibial fractures account for approximately 1.9% of all adult fractures. A recent registry review in Finland found an annual incidence of 15.6 in males and 11.5 per 100,000 person-years in women. There are several studies which have demonstrated a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22-92.3%. Recent work by Hendrickx et al has highlighted distal third and spiral tibial shaft fracture patterns as independent predictors of occult posterior malleolus fracture. We hypothesize that this rotational element will be highlighted in the Mason & Molloy Classification of occult posterior malleolus fractures seen in tibial shaft fractures. Methods: Objectives Our primary outcome in this study was to identify any extension of tibial fractures to the posterior malleolus and describe its morphology. Study Design & Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NHS Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over the age of 16, with a diaphyseal tibial fracture and who underwent a CT of the affected lower limb. The Mason and Molloy posterior malleolus fracture classification system was used to describe the morphology of the fracture Results: 764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. A total of 83 (27.7%) cases were classifiable using the Mason and Molloy classification. There were 8 type 1 (9.6%), 43 type 2 (51.8%), 5 type 2B (6.0%) and 27 type 3 (32.5%). The majority of the posterior malleolar fractures (n=75, 90.4%) were undisplaced pre-surgical intervention. The majority of PM fractures occurred in type 42A1 (65 of 142 tibia fractures) and 42B1 (11 of 16). Conclusion: The majority of the PM fractures associated with tibial fractures occur as a consequence of a rotational mechanism. Unlike, the PM fractures of the ankle, the majority of PM fractures associated with tibia fractures are undisplaced. We theorise that unlike the force transmission in ankle fractures where the rotational force is in the axial plane in a distal-proximal direction, in the PM fractures related to fractures of the tibia, the rotational force in the axial plane progresses from proximal-distal. Therefore, the force transmission which exits posteriorly, finally dissipates the force and thus unlikely to displace.
The Use of Cheilectomy with Hemispheric Reamers in Combination with Autologous Matrix-Induced Chondrogenesis in Treatment of Patients with Hallux Rigidus
Authors: Nurmukhametov Maxim R. , Bialik Evgeny , Makarov Maxim , Makarov Sergey , Bialik Valerii , Nesterenko Vadim 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Hallux rigidus (HR) is a common disease that occurs, according to the literature, in 2-10% of the population. However, currently there is no single approach to the choice of a surgical method for the treatment of this disease. It is known that the most common method at early stages of HR is cheilectomy, and the first metatarsophalangeal (1st MTP) joint arthrodesis at late stages. On the other hand, autologous matrix-induced chondrogenesis (AMIC) is known to be successfully applied in the presence of the osteochondral defects in the ankle, knee and hip joints. In this regard, we proposed to use cheilectomy in combination with this technique in treatment of patients with HR. Methods: Cheilectomy with AMIC was performed in 35 patients with HR. The operation technique included removing of the osteophytes from the metatarsal bone head and the proximal phalanx basement, clearing of the cartilage defect, microfracturing and covering the metatarsal bone head by the collagen memebrane, then - suturing the memebrane to the periosteum by absorbable thread. 16 patients underwent cheilectomy using hemispheric reamers. The results of surgical treatment were assessed using visual analog scale (VAS) of pain, AOFAS scale and range of motion (ROM) in 1st MTP joint. Also foot X-ray and MRI before and 3, 6, 12 months after the surgery were used. Results: In patients who underwent cheilectomy without reamers (1st group), the median ROM before the surgery was 20o, VAS of pain - 72.5, AOFAS - 49. As for the patients who underwent cheilectomy with reamers (2nd group), the median ROM was also 20o, VAS of pain - 70, AOFAS - 52.In the 1st group, after a year of observation, the median VAS of pain decreased to 10, ROM increased to 72.5o and AOFAS - to 82.5.In the 2nd group, after 12 months the median VAS of pain decreased to 7.5, ROM increased to 77o, AOFAS - to 85.On the radiographs 12 months after the surgery, there was some narrowing of the joint space compared to the first day after the operation. However, the ROM in the 1st MTP joint, on the contrary, increased. Conclusion: The results showed that cheilectomy in combination with AMIC allows to relieve pain and significantly improve the quality of life of patients with HR; the results in patients who underwent cheilectomy using hemispheric reamers were better, therefore, in most cases we recommend to use these reamers. Also, this technique, unlike isolated cheilectomy or arthrodesis, can be used at any stage of HR.
Reduction Quality in Posterior Malleolar Fractures using the Modified Posteromedial Ankle Approach
Authors: Pino Felipe , Soto Christian I. Bastias , Lagos Leonardo , Urbina Christian 
Published: November 2022

Category: Trauma; Ankle Introduction/Purpose: Several studies have documented which of the posterior ankle approaches has the best exposure of the posterior malleolus. However, no study has made a correlation between the quality of posterior fragment reduction using CT scan and the approach used. The purpose of this study was to assess the quality of reduction of posterior malleolus fractures in patients with trimalleolar ankle fractures operated with the modified posteromedial approach. Methods: A retrospective search was performed in two Health Centers between 2014 and 2021 for patients with ankle fracture dislocations associated with types two, three and four PM fractures according to the Bartonicek classification3. In relation with the inclusion criteria, patients included in the study had complete trauma ankle set radiographs and CT scans with axial, sagittal and coronal planes pre and postoperative and in all of them a direct reduction and internal fixation of the posterior malleolus was achieved with the modified posteromedial approach. All procedures were performed by six experienced Foot and Ankle Surgeons. 48 patients met the inclusion criteria (29 women and 19 men) with a mean age of 46 years (range 23-80). 6 patients required two stage management with an initial external fixation because of irreducible fracture-dislocations or soft tissue compromise and in a second time the final ORIF. Results: Axial CT Plane Evaluation Evaluation of the morphology of the fractured PM according to the Bartonicek classification on the CT scan axial planes showed type II in 11 patients, type III in 31 patients and type IV in 7 patients. In relation to fibular position at the fibular notch 39 patients showed adequate reduction. Four patients showed diastasis or GAP >= 2mm as a consequence of intercalary fragment unreduced. Sagittal CT Plane Evaluation Sagittal CT plane evaluation showed anatomical reduction (<2mm) in 45 patients and poor reduction in 3 patients. Fourteen patients showed residual impaction either in posteromedial (type III fractures) or posterolateral fragments (type II, III or IV fractures). Conclusion: In conclusion, we think the modified posteromedial approach is a good option to manage trimalleolar fractures, since we achieved an anatomic posterior malleolus fracture reduction in 94% of our patients.
Epidemiology of Barrett’s Esophagus and Esophageal Adenocarcinoma
Authors: Holmberg Dag , Lagergren Jesper 
Published: November 2022

Background: Barrett’s esophagus (BE) can progress to esophageal adenocarcinoma (EAC), a tumor characterized by rapidly increasing incidence and poor survival. We describe patterns of occurrence and risk factors for BE and EAC and how they may influence healthcare. Methods: We searched PubMed and Cochrane databases for English-language publications using the search terms Barrett’s esophagus and esophageal adenocarcinoma. We mainly considered systematic reviews with meta-analysis, randomized clinical trials, population-based observational studies, and international clinical guidelines. The results were synthesized into a narrative review. Results: The prevalence of BE (currently approximately 1% among adults) and incidence of EAC (current global age-standardized incidence rate of 0.9/100 000 person-years) have increased in many regions during the last 5 decades, particularly in North America, Northwestern Europe, and Australia. The increasing incidence is likely attributed to the increasing prevalence of the main risk factors, that is, gastroesophageal reflux disease (GERD) and obesity, combined with a decreasing prevalence of the protective exposure Helicobacter pylori-infection. GERD and obesity are now increasingly prevalent also in Asia, indicating that the incidence of EAC will continue to increase globally. Dysplastic BE and early EAC are readily endoscopically treated, and represent ideal conditions for screening because of their strong association with more advanced EAC. But such screening requires targeting of high-risk individuals, who remain to be better delineated. Conclusions: The changing prevalence rates of GERD, obesity, and Helicobacter pylori-infection might drive continued increasing EAC incidence rates worldwide. Targeted screening programs incorporating combinations of risk factors for BE and EAC may reduce mortality in EAC.
FLT3ITD drives context-specific changes in cell identity and variable interferon dependence during AML initiation
Authors: Li Yanan , Yang Wei , Patel Riddhi M. , Casey Emily B. , Denby Elisabeth , Mendoza-Castrejon Jonny , Rodriguez-Lopez Priscilla , Magee Jeffrey A. 
Published: November 2022

Abstract
Acute myeloid leukemia (AML) initiation requires multiple rate-limiting mutations to cooperatively reprogram progenitor cell identity. For example, FLT3 internal tandem duplication (FLT3ITD) mutations cooperate with a variety of different initiating mutations to reprogram myeloid progenitor fate. These initiating mutations often skew toward either pediatric or adult AML patient populations, though FLT3ITD itself occurs at similar frequencies in both age groups. This raises the question of whether FLT3ITD might induce distinct transcriptional programs and unmask distinct therapeutic vulnerabilities when paired with pediatric, as opposed to adult AML-initiating mutations. To explore this possibility, we compared AML evolution in mice that carried Flt3ITD/NUP98-HOXD13 (NHD13) or Flt3ITD/Runx1DEL mutation pairs, which are respectively most common in pediatric and adult AML. Single-cell analyses and epigenome profiling revealed distinct interactions between Flt3ITD and its cooperating mutations. Whereas Flt3ITD and Flt3ITD/Runx1DEL caused aberrant expansion of myeloid progenitors, Flt3ITD/NHD13 drove the emergence of a pre-AML population that did not resemble normal hematopoietic progenitors. Differences between Flt3ITD/Runx1DEL and Flt3ITD/NHD13 cooperative target gene expression extended to fully transformed AML as well. Flt3ITD/NHD13 cooperative target genes were enriched in human NUP98-translocated AML. Flt3ITD/NHD13 selectively hijacked type I interferon signaling to drive expansion of the pre-AML population. Blocking interferon signaling delayed AML initiation and extended survival. Thus, common AML driver mutations, such as FLT3ITD, can coopt different mechanisms of transformation in different genetic contexts. Furthermore, pediatric-biased NUP98 fusions convey actionable interferon dependence.
Long-term effect of dupilumab on prevention of lung function decline in patients with uncontrolled moderate-to-severe asthma: ATLAS trial design
Authors: De Prado Gomez Lucia , Pavord Ian , Busse William , Brightling Christopher E. , Wechsler Michael E. , Rabe Klaus F. , Zhang Mei , Xing Jun , Jacob-Nara Juby A. , Rowe Paul J. 
Published: November 2022

BackgroundMany patients with asthma experience loss of lung function over time, and in certain patients this can lead to progressive obstructive patterns similar to COPD. Patients with severe asthma may experience accelerated lung function decline (LFD). However, characteristics and risk factors for LFD in asthma have not been well described. Dupilumab may prevent or slow the rate of LFD in patients with uncontrolled, moderate-to-severe asthma. ATLAS trial is designed to evaluate the role of dupilumab in preventing/slowing LFD over a period of 3 yearsversusstandard-of-care therapy.MethodsATLAS (clinicaltrials.gov identifierNCT05097287) is a randomised, double-blind, placebo-controlled, multicentre study that will include adult patients with uncontrolled moderate-to-severe asthma. ∼1828 patients will be randomised (2:1) to dupilumab 300 mg or placebo in combination with maintenance therapy every 2 weeks for 3 years. The primary objective is to assess the effect of dupilumab on preventing or slowing LFD by year 1 in the exhaled nitric oxide fraction (FeNO) population (patients withFeNO≥35 ppb). The effect of dupilumab in slowing the rate of LFD by year 2 and year 3 in bothFeNOand total populations, exacerbations, asthma control, quality of life, biomarker changes and utility ofFeNOas a biomarker of LFD will also be evaluated.DiscussionATLAS is the first trial assessing the effect of a biologic on LFD, designed to establish the role of dupilumab in prevention of long-term loss of lung function and its potential effect on disease modification, which may provide unique insights into asthma pathophysiology, including predictive and prognostic factors of LFD.
Comparison of two scores for short-term outcomes in patients with COPD exacerbation in the emergency department: the Ottawa COPD Risk Scale and the DECAF score
Authors: Unal Ali , Bayram Basak , Ergan Begum , Can Kazim , Ergun Yagiz Kagan , Kilinc Oguz 
Published: November 2022

BackgroundWhile clinical decision rules have been developed to evaluate exacerbations and decisions on hospitalisation and discharge in emergency departments (EDs) in patients with chronic obstructive pulmonary disease (COPD), these rules are not widely used in EDs. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD.MethodsThis single-centre prospective observational study was conducted over 6 months. Patients with acute exacerbations of COPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalisation within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalisation for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated.ResultsOf the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. 66% of the patients were male, and the mean age was 70.15±10.36 years. A total of 20.7% of all patients (n=62) experienced poor outcomes. The sensitivity of an OCRS score <1 for predicting a poor outcome in patients was 96.8% (95% CI 88.8–99.6%) and the specificity was 18.5% (95% CI 13.8–24.0%). The sensitivity and specificity of an OCRS score <2 were 83.3% (95% CI 35.9–99.6%) and 65.5% (95% CI 59.6–70.7%), respectively. The sensitivity and specificity of a DECAF score <1 were 88.7% (95% CI 78.1–95.3%) and 34.5% (95% CI 28.4–40.9%), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI 56.4–80.4%) and 74.8% (95% CI 68.8–80.2%), respectively.ConclusionOur physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may results in unnecessary hospitalisation, they can reduce the incidence of hospital discharge of patients with exacerbations of COPD who will develop poor outcomes in the ED.