bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the toxic effects of thimerosal and/or aluminum hydroxide in SH-SY5Y cell line
Authors: Öztürk Mehmet Evren , Yirün Anıl , Erdemli-Köse Selinay Başak , Balcı-Özyurt Aylin , Çakır Deniz Arca , Oral Didem , Erkekoğlu Pınar 
Published: November 2022

In this study, we aimed to evaluate possible toxic effects of thimerosal, aluminum and combination of thimerosal and aluminum in SH-SY5Y cells. Inhibitory concentrations were determined by MTT assay; reactive oxygen species (ROS) were determined by a fluorometric kit and antioxidant/oxidant parameters were measured by spectrophotometric kits. Nuclear factor erythroid 2-associated factor 2 (Nrf2), norepinephrine (NE), dopamine transporter (DAT) and dopamine beta β-hydroxylase (DBH) levels were measured by sandwich ELISA kits while 8-hydroxy deoxyguanosine (8-OHdG) and dopamine levels were determined by competitive ELISA kits. Thimerosal (1.15 μM) and aluminum (362 μM) were applied to cells at inhibitory concentrations 20 (IC20s) for 24 h. ROS increased significantly in cells aluminum- and aluminum+thimerosal-treated cells. Glutathione levels decreased in aluminum group while total antioxidant capacity and protein oxidation levels increased significantly in aluminum and aluminum+thimerosal groups. Lipid peroxidation increased significantly in groups treated with aluminum and aluminum+thimerosal. Nrf2 levels and DNA damage were significantly higher in all groups while dopamine levels significantly increased in cells treated with thimerosal and aluminum+thimerosal, DAT levels were found to be higher in all experimental groups compared to the control. These findings showed that both thimerosal and aluminum can change oxidant/antioxidant status, cause DNA damage, alter dopamine and DAT levels. Changes seen in cells treated with combined exposure to aluminum and thimerosal are more pronounced. Special care should be taken while vaccinating sensitive populations and safer alternatives for aluminum and thimerosal should used.
Increased ten-eleven translocation methylcytosine dioxygenase one in dorsal root ganglion contributes to inflammatory pain in CFA rats
Authors: Liu Yun , Zhang Ling , Xu Zhen-hua , Zhu Jie , Ma Jia-ling , Gao Yan-ping , Xu Guang-Yin 
Published: November 2022

DNA hydroxylation catalyzed by Tet dioxygenases occurs abundantly in neurons in mammals. However, effects of ten-eleven translocation methylcytosine dioxygenase 1 (TET1) expression and hydroxymethylation status on neuron injury remain unclear. This study was designed to explore the effects of TET1 and TET2 expression in the inflammatory pain of rats induced by complete Freund’s adjuvant (CFA). Mechanical paw withdrawal threshold (PWT) and thermal withdrawal latency (TWL) were detected to assess pain behavior. The expression of TET1 and TET2 were measured in the dorsal root ganglion (DRG) with western blotting analysis. Immunofluorescence staining is employed to detect the expression and co-location of TRPV1 with TET1. Intrathecal administration of Bobcat339 was used to inhibit TET1 function in dorsal root ganglion. The paw withdrawal threshold and thermal withdrawal latency of rats were significantly reduced after CFA Injection. Western blot results showed that the expression of TET1 was significantly increased at 3 days after CFA injection, but TET2 had no statistical difference. Immunofluorescence results showed that TET1 was co-localized with TRPV1. Intrathecal administration of Bobcat339 improved mechanical and thermal pain threshold in CFA rats. Our findings highlight the role of TET1 in chronic inflammatory pain model. The expression of TET1 was increased in CFA rats, and suppression of TET1 will ameliorate inflammatory pain.
Surrogate lower limb design for ankle-foot orthosis mechanical evaluation
Authors: Thibodeau Alexis , Dumond Patrick , Kim Joongho , Lemaire Edward D 
Published: November 2022

Purpose This study designs and provides a pilot evaluation of a novel surrogate lower limb (SLL) that provides anatomically realistic three-dimensional (3D) foot motion, based on a literature consensus of passive lower limb motion. This SLL is intended to replace single axis surrogates currently used in mechanical testing of ankle-foot orthoses (AFO). Material and Methods The SLL design is inspired by the Rizzoli foot model, with shank, hindfoot, midfoot, forefoot, and toe sections. Ball and socket joints were used between hindfoot-midfoot (HM)-forefoot sections. Forefoot-toes used a hinge joint. Three-dimensional printed nylon, thermoplastic polyurethane (TPU) and polylactic acid (PLA), as well as casted silicone rubber were used to re-create foot components. After fabrication, motion capture was performed to measure rotation using fiducial markers. The SLL was then loaded under both static and cyclic loads representing a 100 kg person walking for 500,000 cycles. Results Most joints were within 5° of target angles. The SLL survived static loads representing 1.5 times body weight for both static and cyclical loading. Conclusions This SLL moved as designed and survived testing loads, warranting further investigation towards enabling essential mechanical testing for AFO currently on the market, and helping to guide device prescription.
Vaccine Hesitancy in COVID-19: A Behavioural Economics Approach—A Systematic Literature Review
Authors: Siram Bhargavi , Shah Muskaan , Panda Rasananda 
Published: November 2022

The vaccination drive for the COVID-19 pandemic was initiated globally more than a year ago, with booster shots being the new addition currently. There are some setbacks regarding the acceptance of the vaccine that the government needs to tackle to achieve a fully vaccinated ecosystem. Vaccine hesitancy is not a new concept and has been witnessed by people for decades. In simple terms, vaccine hesitancy refers to a situation where people are reluctant to get vaccinated despite its availability. This is due to technological retrogression, superstitions, doubt towards the government and misinformation. This paper is a systematic literature review to analyse the behavioural economics theories shown by people towards vaccines in the SARS-CoV-2 pandemic. We aim to connect psychological and economic factors that lead to this hesitancy through behavioural economics. Availability bias, omission bias, confirmation bias, incentives, anticipated regret, illusory correlation, recency effect, tailoring and framing are the biases that influence decision-making under the behavioural economics framework. This paper is an attempt to analyse these principles and explain potential barriers to vaccine acceptance and intervention strategies for medical professionals and the state. JEL Classifications: D03, D70, I18
Clinical Outcomes of Arthroscopic Ankle Lateral Ligament Repair with Accelerated Rehabilitation
Authors: Teramoto Atsushi , Murahashi Yasutaka , Takahashi Katsunori , Watanabe Kota , Yamashita Toshihiko 
Published: November 2022

Category: Arthroscopy; Ankle; Sports Introduction/Purpose: Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, many reports have described postoperative cast immobilization and the avoidance of weight-bearing for a certain period of time. Accelerated rehabilitation (AR), in which the period of immobilization is kept to a minimum and early weight-bearing exercises are actively introduced, may be helpful for an early return to sport. The purpose of this study was to investigate the therapeutic outcomes of ALLR with AR including the minimum duration of postoperative ankle immobilization and proactive early weight-bearing. Methods: A total of 23 ankles of 22 patients (11 men, 11 women; mean age 38.7 years) who underwent ALLR for chronic lateral ankle instability were investigated. Postoperative management included the avoidance of weight-bearing until postoperative day (POD) 3, after which full weight-bearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. Preoperative and postoperative major symptoms, ankle range of motion (ROM), stress X-ray assessment, anterior translation (AT) measured with a capacitance-type strain sensor, the Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were evaluated. Results: Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in ROM. There were significant improvements in the mean talar tilt angle (from 12° to 5.6°), in the mean anterior drawer distance (from 8.2 mm to 4.4 mm) on stress X-rays, and in the mean AT (from 10.5 mm to 4.6 mm). The JSSF scale improved significantly (from 68.8 to 96.8), and the SAFE-Q improved significantly on all subscales. Complete return to sport was achieved by 75% of the patients at 8 weeks after surgery. Conclusion: When AR with proactive weight-bearing exercises was implemented from POD 3 without ankle immobilization after ALLR, there were significant improvements in both objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.
CT Analysis of the Posteromedial Neurovascular Bundle in Patients with End Stage Ankle Arthritis for Planning of Total Ankle Replacement Surgery
Authors: Toumazos Kimon , Stavrou Peter , Gauthier-Kwan Olivier , Brown Christopher H. 
Published: November 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Aim of this study is to identify reliable anatomical landmarks of the posterior tibial neurovascular bundle during Total Ankle Replacement (TAR) to minimise the risk of iatrogenic injury. Secondary aim is to identify if there is associated translation of the bundle when anterior translation of the talus is present. Methods: A radiological landmark protocol was devised to create a consistent method for measuring the relations of the bundle to the tibia, talus and medial gutter line when measured at levels mimicking those of resection undertaken in TAR. Analysis between patients with and without anterior subluxation was undertaken. Results: Total of 42 ankles were reviewed with 38% patient having anterior translation of the talus. At the tibiotalar joint, the bundle lies less than 5mm lateral to the medial gutter line and less than 8mm posterior to the posterior tibia. The same measurements at 10mm superior to the tibiotalar joint are less than 8mm and less than 6.5mm respectively. At 5mm distal to the dome of the talus, the bundle is less than 4mm lateral to the medial gutter line and between 8.4-16.0mm posterior to the posterior talus. The bundle to posterior tibia distance does not increase in the sagittal plane for patients with anterior subluxation of the talus. Conclusion: This study provides relevant guidance for surgeons to use intraoperatively when undertaking tibial and talus resections in TAR to identify their relations to the vulnerable neurovascular structures. The measurements of this study indicate for the first time that there is not an increased risk of iatrogenic injury during bone resection at the tibia in patients with anterior subluxation of the talus.
Transmetatarsal Amputation Results in Higher Frequency of Revision Surgery and Higher Ambulation Rates Than Below- Knee Amputation
Authors: Trimm Conner D. , Ordaz Angel , Pedowitz Jason M. , Foran Ian M. 
Published: November 2022

Category: Diabetes; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: The level of amputation in patients with severe lower extremity pathology often presents a challenge. Surgeons are often confronted with deciding between a transmetatarsal amputation (TMA) or below-knee amputation (BKA). Certainly, in cases where patients are candidates for a TMA, the decision might seem rather straightforward. However, the literature has demonstrated that minor foot amputations, like TMAs, often have high rates of revision and often necessitate a higher level of amputation. This study compared revision rates, need for higher level of amputation, post-operative ambulatory rates, and the demographics between patients undergoing either TMA or BKA. Methods: This was a retrospective analysis of patients who underwent BKA or TMA and received follow-up care at a single academic medical center from January of 2013 to May of 2021. Demographic and medical historical data was collected and compared between patients undergoing BKA or TMA. A binary logistic regression model was used to evaluate independent predictors for necessitation of revision surgery and/or higher levels of amputation between the two groups. Secondary outcomes included hospital length of stay, as well as ambulatory and wound status at last patient follow-up. Statistical significance was defined as p<.05. Results: A total of 367 patients underwent either BKA (n=293) or TMA (n=74). On binary logistic regression, significant independent predictors of needing surgical revision were undergoing TMA (OR 2.29, CI 1.23-4.27, p=.009) and peripheral arterial disease (PAD) (OR 2.28, CI 1.12-4.6, p=.023). Similarly, significant independent predictors of needing higher level amputation were undergoing TMA (OR 4.4, CI 2.01-9.63, p<.001) and presence of PAD (OR 6.18, CI 2.12- 17.98, p<.001). Secondary outcomes showed that more TMA patients were ambulatory (56.8%) on last follow-up compared to BKA patients (30.9%). Hospital length of stay was significantly greater in the BKA group (17.3 +- 21.2) vs the TMA group (13.6 +- 10.9) (p=.04). There was no significant difference between BKA and TMA groups with respect to healed incisions at last follow-up (58.3% and 51.4% respectively). Conclusion: This study found transmetatarsal amputations to have a higher risk of re-operation and need for revision amputation compared to below-knee amputations. Transmetatarsal amputations had a higher chance of returning patients to independent ambulation. These findings are consistent with the literature suggesting higher reoperation rates in minor foot amputations. Patients with peripheral arterial disease are at a higher risk of revision surgery and higher-level amputation with both operations warranting further vascular work-up for patients with severe PAD and absent pulses.
Prevalence of Orthopaedic Knee Scooter-Related Injury: Risk Factor Analysis and Patient Safety Perceptions in a Prospective Cohort
Authors: Walsh John P. , Hsiao Mark S. , Rosevear Landon , McDermott Ryland , Gupta Shivali , Watson Troy S. 
Published: November 2022

Category: Other; Trauma Introduction/Purpose: There is a paucity of research investigating the harms associated with the orthopaedic knee scooter (OKS) and patient safety perceptions. This prospective study aimed to define the prevalence of OKS-related injuries, identify patient risk factors and describe the patient perceptions of OKS safety. Methods: This single-surgeon prospective study recruited a cohort of 134 consecutive patients undergoing surgery at a community-based orthopaedic clinic from 6/2020 to 4/2021. Our primary outcome informed an a priori power analysis. Standardized data collection protocol included three forms that patients completed. The prevalence of OKS-related injury, patient risk factors, and patient perceptions were analyzed. Alpha values of P <0.05 were considered statistically significant, and a 95% confidence interval was reported (95CI). Results: There were 118 (88%) patients eligible for analysis. The prevalence of patient falls was 37.3% (44/118), and the prevalence of patient injury was 15.3% (18/118). A sedentary lifestyle was a significant risk factor (P=0.001) for injury, with a relative risk of 3.32 (1.47- 7.46 95CI) and an absolute risk difference of 26%. Age, height, weight, diabetes was not found to be risk factors for injury. Patient perception of OKS safety at study enrollment (P=0.049) and study exit (P=0.004) were significantly lower for injured patients. Conclusion: Despite a high prevalence of patient falls, there is a low absolute risk of injury. Sedentary patients are at increased risk of OKS-related injury. Patients with a history of injury perceive OKSs to be less safe and are less likely to use an OKS in the future but are not less likely to recommend an OKS to a friend. Future studies should verify prevalence data in multiple settings and assess the effectiveness of patient education or surgeon screening measures in reducing OKS-related injury.
How Does Surgical Technique Affect Fluid Permeability? A Laboratory Study Comparing Nanofracture, Microfracture and Fine Wire Drilling Approaches
Authors: Warren James , Brockett Claire , Canden Ahranee , Farndon Mark A. 
Published: November 2022

Category: Basic Sciences/Biologics; Ankle; Arthroscopy; Sports Introduction/Purpose: Current surgical practice for the treatment of osteochondral lesions in the ankle involves using one of three techniques to promote blood flow from subchondral bone tissue to the defect site, improving the rate of healing. These different techniques: - fine-wire drilling, nanofracture and microfracture, involve disrupting the trabecular bone. However, the size and method of these techniques means this varies in terms of penetration depth and diameter. Additionally, each technique causes differing degrees of damage to the trabecular structure, and the ability of fluid to flow through the porous structure. The aim of this study was to compare the influence of the different techniques on the fluid permeability of the tissue following by assessing the flow of radiopaque contrast agent using μCT image analysis. Methods: Fresh-frozen cadaveric tali specimens (n=12) were prepared through creating a 10mm diameter chondral defect in three different regions of each talus. Each region then underwent one of three surgical techniques: 1) Fine wire drilling, 2) Nanofracture or 3) Microfracture, undertaken by a single surgeon.0.1 ml radiopaque contrast agent (OmnipaqueTM 300) was then added to each region and imaged using a clinical μCT scanner (SCANCO Medical AG, 73.6 μm resolution) The amount of contrast agent that permeated through each different region was assessed through imaging processing. Results: The μCT analysis indicated that across the 12 samples, eight nanofracture regions demonstrated flow of contrast agent to the depth of the fracture site or deeper. Some lateral flow was also observed in these sites. Eight microfracture regions demonstrated that the flow of contrast agent was localised to the fracture site and a preferential flow laterally. In only one sample, did a fine wire drilling region demonstrate any fluid flow. In this sample, contrast agent had permeated through the drilling site to the bottom and some sub-site permeation was observed. However, in all samples that showed no permeation of contrast agent through the fracture site, there was a layer of contrast agent on the chondral surface or minor permeation through to the sub- chondral surface. Conclusion: Nanofracture showed improved fluid permeability throughout the surrounding trabecular structure, when compared to microfracture and fine wire drilling. Microfracture appears to allow some fluid flow, but this is confined to the immediate area around the fracture site, while fine wire drilling appears to allow almost no fluid flow through the surrounding trabecular tissue. This conclusion is reinforced by previous literature that concluded the damage to the structure of the trabecular tissue is reduced when using nanofracture, compared to the other two techniques.
Dual Posteromedial Portal Technique for Surgical Repair of an Unstable Medial Meniscal Ramp Lesion
Authors: Green Joshua S. , Yalcin Sercan , Moran Jay , McLaughlin William M. , Medvecky Michael J. 
Published: November 2022

Background: Medial meniscal ramp lesions, which commonly occur in the setting of anterior cruciate ligament (ACL) ruptures, are defined as structural lesions at the medial meniscocapsular junction and can involve the posteromedial capsular attachments or most peripheral aspect of the meniscus. Unstable ramp lesions can lead to rotational instability within the knee and may play a role in ACL graft failure if left untreated. The novel use of dual posteromedial portals, similar to those used in an arthroscopic labral repair, may allow for enhanced visualization, optimal access to the posteromedial compartment, and easier manipulation of the instrumentation for successful surgical repair of hidden ramp lesions. Indications: Surgical repair of medial meniscal ramp lesions is indicated in patients with a clinically unstable meniscus when probed during arthroscopy. Technique Description: This surgical technique video demonstrates a dual posteromedial portal arthroscopic approach to repair an unstable medial meniscal ramp lesion using a case example from a patient with a concomitant ACL rupture. Results: Surgical repair of medial meniscal ramp lesions has been reported to show improvements in meniscus healing and knee stability. Discussion/Conclusion: The use of dual posteromedial portals offers improved accessibility to the posteromedial compartment of the knee and provides excellent visibility during the surgical repair of a medial meniscal ramp lesion. The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Aetiology of hospitalized fever and risk of death at Arua and Mubende tertiary care hospitals in Uganda from August 2019 to August 2020
Authors: Blair Paul W. , Kobba Kenneth , Kakooza Francis , Robinson Matthew L. , Candia Emmanuel , Mayito Jonathan , Ndawula Edgar C. , Kandathil Abraham J. , Matovu Alphonsus , Aniku Gilbert , Manabe Yukari C. , Lamorde Mohammed 
Published: November 2022

Abstract
Background
Epidemiology of febrile illness in Uganda is shifting due to increased HIV treatment access, emerging viruses, and increased surveillance. We investigated the aetiology and outcomes of acute febrile illness in adults presenting to hospital using a standardized testing algorithm of available assays in at Arua and Mubende tertiary care hospitals in Uganda.

Methods
We recruited adults with a ≥ 38.0 °C temperature or history of fever within 48 h of presentation from August 2019 to August 2020. Medical history, demographics, and vital signs were recorded. Testing performed included a complete blood count, renal and liver function, malaria smears, blood culture, and human immunodeficiency virus (HIV). When HIV positive, testing included cryptococcal antigen, CD4 count, and urine lateral flow lipoarabinomannan assay for tuberculosis. Participants were followed during hospitalization and at a 1-month visit. A Cox proportional hazard regression was performed to evaluate for baseline clinical features and risk of death.

Results
Of 132 participants, the median age was 33.5 years (IQR 24 to 46) and 58.3% (n = 77) were female. Overall, 73 (55.3%) of 132 had a positive microbiologic result. Among those living with HIV, 31 (68.9%) of 45 had at least one positive assay; 16 (35.6%) had malaria, 14 (31.1%) tuberculosis, and 4 (8.9%) cryptococcal antigenemia. The majority (65.9%) were HIV-negative; 42 (48.3%) of 87 had at least one diagnostic assay positive; 24 (27.6%) had positive malaria smears and 1 was Xpert MTB/RIF Ultra positive. Overall, 16 (12.1%) of 132 died; 9 (56.3%) of 16 were HIV-negative, 6 died after discharge. High respiratory rate (≥ 22 breaths per minute) (hazard ratio [HR] 8.05; 95% CI 1.81 to 35.69) and low (i.e., < 92%) oxygen saturation (HR 4.33; 95% CI 1.38 to 13.61) were identified to be associated with increased risk of death.

Conclusion
In those with hospitalized fever, malaria and tuberculosis were common causes of febrile illness, but most deaths were non-malarial, and most HIV-negative participants did not have a positive diagnostic result. Those with respiratory failure had a high risk of death.