bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Different Pain-Control Procedures for Post-cardiac Surgery: A Systematic Review and Network Meta-Analysis
Authors: Hu Mengjie , Wang Yuqi , Hao Bihai , Gong Cheng , Li Zhen 
Published: January 2022

Objective To identify superior pain-control procedures for postoperative patients who undergo cardiac surgeries. Methods Literature searches were conducted in globally recognized databases, including MEDLINE, EMBASE and Cochrane Central, to identify randomized controlled trials (RCTs) investigating pain-control procedures after cardiac surgeries. The parameters evaluating analgesic efficacy and postoperative recovery, namely, the pain score and ICU stay, were quantitatively pooled and estimated using Bayesian methods. The values of the surface under the cumulative ranking (SUCRA) probabilities regarding each parameter were calculated to enable the ranking of various pain-control procedures. Node-splitting analysis was performed to test the inconsistency of the main results, and the publication bias was assessed by examining the funnel-plot symmetry. Results After a detailed review, 13 RCTs containing 7 different procedures were included in the network meta-analysis. After pooling the results together, an erector spinae plane block (ESPB) and a local parasternal block (LPB) plus target-controlled infusion (TCI) presented the best analgesic effects for reducing pain at rest (SUCRA, .47) and during movement (SUCRA, .52), respectively, while the former also achieved the shortest ICU stay (SUCRA, .48). Moreover, the funnel-plot symmetries showed no inconsistencies or obvious publication bias in the current study. Conclusions The current evidence indicates that ESPB is a potential superior analgesic strategy for post-cardiac surgery patients. To verify this conclusion further, it is imperative to obtain more high-quality evidence and conduct relevant investigations in the future.
P2X7 receptor induces microglia polarization to the M1 phenotype in cancer-induced bone pain rat models
Authors: Wu Ping , Zhou Guohua , Wu Xiaoqi , Lv Run , Yao Jiaqi , Wen Qingping 
Published: January 2022

Background The transition from pro-inflammatory M1 phenotype to anti-inflammatory M2 phenotype presents a novel therapeutic strategy for chronic pain. Objective We investigated the role of microglia polarization in cancer-induced bone pain (CIBP), as well as the role of the P2X7 receptor in modulating M1 to M2 polarization. Methods Walker-256 breast cancer cells were administered into tibias of female rats to induce bone cancer–associated cancer. Results During bone cancer development, the P2X7 receptor and M1 microglia markers were upregulated. In contrast, inhibition of the P2X7 receptor by BBG, a blood-brain barrier-permeable P2X7R-specific antagonist, alleviated the pain and promoted microglia polarization toward the M2 phenotype, while suppressing the M1 phenotype in vivo and in vitro. Conclusion P2X7 receptor-mediated spinal microglia polarization is involved in alleviation of CIBP. Therefore, P2X7R is a potential option for CIBP treatment.
Risk of consecutive immunogenic failure in switchers of anti-tumor necrosis factor alpha among patients with inflammatory bowel diseases
Authors: Yanai Henit , Ungar Bella , Kopylov Uri , Fischler Tali Sharar , Biron Irit Avni , Ollech Jacob E. , Goren Idan , Matar Manar , Perets Tsachi Tsadok , Shamir Raanan , Dotan Iris , Amir Shira , Assa Amit 
Published: January 2022

Background: Evidence regarding the risk of immunogenicity in patients with inflammatory bowel disease (IBD) who switched anti-tumor necrosis factor alpha (anti-TNFα) therapies to a subsequent anti-TNFα (either infliximab or adalimumab) is conflicting. We aimed to assess the risk of consecutive immunogenicity to anti-TNFα in a large cohort of patients. Methods: This was a multicenter retrospective study. Medical records of adult and pediatric IBD switchers who had pharmacokinetic data for both agents between 2014 and 2020 were retrieved. Data including age, sex, disease type, duration of therapies, and concomitant use of immunomodulators (IMMs) were recorded. Results: Overall, 164 patients were included [52% female; 88% Crohn’s disease; mean age = 24.4 ± 14.6 years; 108 (66%) switched from infliximab to adalimumab and 56 (34%) vice versa]; 120 (73.1%) patients switched due to an immunogenic failure. Among patients switching therapy from infliximab to adalimumab due to an immunogenic failure immunogenicity to infliximab was significantly associated with consecutive immunogenicity to adalimumab ( p = 0.026). Forthy four out of 120 patients (36.6%) with an immunogenic failure to the first anti-TNFα started an IMM with the second anti-TNFα. This combination with IMM was not associated with reduction of consecutive immunogenicity ( p = 0.31), but it was associated with longer drug retention ( p = 0.007). Multivariate analysis demonstrated that older age at second anti-TNFα, adjusted to the chronology of therapy and sex, was associated with increased immunogenicity to the second anti-TNFα. Conclusion: Patients with IBD who switch from infliximab to adalimumab following an immunogenic failure are at increased risk for consecutive immunogenicity to adalimumab. IMM use after a switch prolongs drug retention.
The Diagnostic Accuracy of MRI to Evaluate Acute Lisfranc Joint Injuries: Comparison With Direct Operative Observations
Authors: Kitsukawa Kaoru , Hirano Takaaki , Niki Hisateru , Tachizawa Natsuki , Mimura Hidefumi 
Published: January 2022

Background: Early diagnosis is important in patients with Lisfranc joint injury to avoid subsequent complications. As the ligaments in the Lisfranc joint are relatively small and course obliquely, isotropic 3-dimensional (3D) magnetic resonance imaging (MRI) can be beneficial to evaluate ligament injury. The purpose of this study was to investigate the diagnostic accuracy of MRI, including isotropic 3D MRI for acute injury of the Lisfranc joint, especially of the interosseous C1-M2 ligament (Lisfranc ligament), the dorsal C1-M2 ligament (dorsal ligament), and the interosseous C1-C2 ligament, compared with direct operative observations. Methods: This retrospective review identified 27 patients who had undergone MR examination for acute Lisfranc joint injury followed by surgery. We reviewed the operative reports that described the Lisfranc, dorsal, and interosseous C1-C2 ligaments. All patients underwent an MRI, including a 2D oblique plane image parallel to the Lisfranc ligament and an isotropic 3D MRI. An image analysis of the integrity of the 3 ligaments and other associated injuries was performed. The diagnostic accuracy of MRI was analyzed using operative findings as a reference standard. Results: Lisfranc and dorsal ligament injuries were identified on MRI in all patients. MRI depicted disruption of the interosseous C1-C2 ligament in 12 patients. MRI diagnostic accuracy for detection of Lisfranc, dorsal, and interosseous C1-C2 ligaments was 100% (95% CI 0.82-1.0), 74% (95% CI 0.54-0.89), and 70% (95% CI 0.50-0.86), respectively. Conclusion: MRI with oblique planes parallel to the Lisfranc ligament and isotropic 3D MRI was reliable for detecting Lisfranc ligament injury, whereas MRI findings of the dorsal and interosseous C1-C2 ligaments were less consistent with operative observations. Level of Evidence: Level IV, case series.
Fusion Rate of Subtalar Arthrodesis in Pre-Existing Ankle Arthrodesis: Is There Enough Evidence
Authors: Elhassan Yahya , Jamjoom Ammer , Lomax Adam , Tellisi Nazzar 
Published: January 2022

Category: Hindfoot Introduction/Purpose: Isolated subtalar arthrodesis is a commonly performed procedure, which produces high union rates. It was suggested that the fusion rate of subtalar arthrodesis is negatively affected by the presence of pre-existing ipsilateral ankle (tibiotalar) arthrodesis, though the mechanism by which this occurs remains unclear. The aim of this study is to assess the fusion rate of subtalar arthrodesis in the presence of pre-existing ipsilateral ankle arthrodesis and to suggest alternative techniques to improve fusion rate. Methods: Electronic patient records and images of all consecutive isolated primary subtalar arthrodesis that were performed in our institution over ten years between (2009-2019) were retrospectively reviewed. Data that was collected included patients’ demographics, body mass index (BMI), smoking status, diabetes, and rheumatoid arthritis, fusion rate; other factors like the method used of the pre-existing ankle arthrodesis were also studied. Subtalar arthrodesis was performed using a lateral approach and compressed by two screws. Two groups were compared, included all isolated primary subtalar arthrodesis with or without previous ipsilateral ankle arthrodesis. Logistic regression was performed to check for the correlation between fusion rate and all factors. Results: A total of one hundred and thirty-three (n=133) primary isolated subtalar arthrodesis were identified between (2009- 2019), amongst which twenty-one (n=21) had pre-existing ipsilateral ankle arthrodesis. Ten (n=10) recorded subtalar non-unions occurred in the pre-existing ankle arthrodesis group representing a fusion rate of only 52.4 %, as opposed to sixteen (n=16) in the isolated subtalar fusion without pre-existing ipsilateral ankle arthrodesis group representing a fusion rate of 86.9 %. A significant statistical difference between the two groups, those with ipsilateral ankle arthrodesis had a higher non-rate (P =.001). Age, gender, Body mass index (BMI), smoking status, diabetes, rheumatoid arthritis, and the method used of the pre-existing ankle arthrodesis were found not to have any significant effect on these results. Conclusion: Our results show a significantly higher non-union rate of isolated subtalar arthrodesis in the presence of pre-existing ipsilateral ankle arthrodesis. Further research is required to help in clarifying the mechanism by which this effect occurs and to study alternative surgical techniques that might be required.
Mid-Term Prospective Evaluation of Structural Allograft Transplantation for Osteochondral Lesions of the Talar Shoulder
Authors: Fletcher Amanda N. , Adams Samuel B. , Nunley James A. , Easley Mark E. 
Published: January 2022

Category: Ankle Introduction/Purpose: The management of large osteochondral lesions of the talar shoulder remains a clinical challenge. Their size, three-dimensional geometry, and subchondral cystic degeneration often preclude treatment with traditional measures such as microfracture and osteochondral autograft transplantation. Structural or bulk osteochondral allograft transplantation has demonstrated efficacy in several retrospective reviews. The purpose of this study was to prospectively evaluate patients who received fresh structural allograft transplantation to the talus. Methods: A prospective evaluation of consecutive patients who underwent fresh structural allograft transplantation for an OLT form 2010 to 2019 was performed under Institutional Review Board approval. All patients failed a minimum of 6 months of conservative management. Preoperative MRI and/or CT, as well as plain radiographs were obtained on all patients. The following patient reported outcomes questionnaires were administered preoperatively and yearly after surgery: 100mm VAS pain scale, AOFAS Ankle-Hindfoot Scale, SF-36, and the Short Musculoskeletal Functional Assessment (SMFA). Pre- and postoperative radiographs were assessed for allograft incorporation and the development of arthritis. Results: 27 patients underwent fresh osteochondral allograft transplantation and were followed for a minimum of 2 years. The mean follow-up was 5 years (range 2-11). The average size of the OLT was 2,269 mm3 (range 813-8,366) based on CT imaging and 5,797 mm3 (range 1,136-12,489) based on MRI imaging. There was significant improvement in the VAS pain score, AOFAS Ankle- Hindfoot Scale score, the SF-36 total score, and the SMFA functional and bother indices (Figure 1). Thirteen (48%) of the patients required subsequent surgery. Twelve underwent removal of hardware and joint debridement and one patient underwent isolated joint debridement. At the time of these surgeries, two grafts demonstrated cartilage delamination. One of these patients had continued pain and progression of arthritis without additional surgery and one was converted to an ankle replacement. Therefore, the failure rate was 7%. Conclusion: Significant improvement in pain and function can be achieved with structural allograft transplantation for large OLTs. However, it is important to council patients that painful hardware and stiffness can occur in approximately one-half of patients. An unstable graft and cartilage delamination are indicators of subsequent failure. The use of a structural allograft does not preclude subsequent ankle arthrodesis or arthroplasty.
Short Term Complications Following Total Ankle Arthroplasty and Associated Risk Factors: A NSQIP Database Analysis
Authors: Fletcher Amanda N. , Kwon Nicholas , Danilkowicz Richard , Kim Jaewhan , Grimm Nathan L. , Adams Samuel B. 
Published: January 2022

Category: Ankle; Ankle Arthritis; Diabetes Introduction/Purpose: Total ankle arthroplasty (TAA) has become increasingly utilized over the past 20 years to treat osteoarthritis of the ankle. The efficacy and safety of this procedure has been previously reported, but relatively few studies have documented the risk of post-operative complications associated with TAA over the past 10 years. Thus, the aim of this study is to provide a current report on the safety of TAA, particularly in association with a number of preoperative risk factors. Methods: A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent TAA between 2012-2018 was performed. A total of 1333 patients were included in this analysis. Penalized logistic regression to consider small numbers of the postoperative complications was used to identify factors associated with incidence of the complications. Results: The rate of readmission and superficial wound infection were found to be 1.4% and 0.6%, respectively. Risk factors associated with a prolonged hospital stay were Black race, Hispanic race, and smoking (Fig. 1). Diabetes was associated with a significantly increased risk of readmission. Age, sex, BMI, and steroid use were not associated with increased risk of postoperative complications. Conclusion: In this study, the rate of surgical site infection and readmission in TAA was found to be relatively low, compared to published data on TKA and THA. Both race and smoking increase the risk of prolonged hospital stay, while diabetes increases the risk of readmission.
Compression of A Midfoot Osteotomy Using A Circular External Fixator: What is the Ideal Pin Configuration?
Authors: Freeman Tyler R. , Yu Henry , Baldini Todd , Chee Keanu , Koerner Jason L. , Hunt Kenneth J. 
Published: January 2022

Category: Midfoot/Forefoot; Diabetes; Trauma Introduction/Purpose: Foot and ankle deformity correction through midfoot osteotomy can be implemented in a wide variety of clinical situations. Use of a circular ring fixator for osteotomy fixation is particularly useful for patients with poor soft tissue envelopes and/or active infection as can occur in diabetes and Charcot arthropathy. The foot pins in a ring fixator can be configured to apply compression at the osteotomy site. However, the optimal pin configuration and force has yet to be determined. The purpose of this study was to quantify compressive forces achieved across midfoot osteotomies with various wire configurations in a circular ring fixator construct. Methods: Nine through-knee amputation cadavers were stabilized with a standard circular external fixation carbon frame. A midfoot osteotomy through the transverse tarsal joint was performed using an oscillating saw. A 4mm bone wedge was removed from the osteotomy site for placement of a Tekscan pressure sensor. A two-ring frame was applied in the standard fashion and three parallel 1.8mm smooth wires were placed parallel to each other through the foot distal to the osteotomy: wire #1 proximally through the cuneiforms, wire #2 through the base of the metatarsals, wire #3 through the metatarsal shafts. After baseline pressure readings, wires were sequentially attached (wire #1 alone, wire #1-2, wire #1-3) to the ring fixator and tensioned to 90kg. Pressure readings were recorded at the osteotomy site for each sequential wire tensioning both at the hole location where the wire naturally crossed, 'neutral', and again at one hole 'proximal' (e.g., toward the osteotomy). Results: Average compressive load at neutral hole positioning for wire #1 was 382 N. The addition of wire #2 increased the compressive load to 439 N on average. The addition of wire #3 decreased compressive force to 372 N. Similar trends were seen in proximal hole positioning where average compressive force increased following tensioning of wire #2 from 580 N to 600 N but compressive force decreased on wire #3 addition to 425 N. Therefore, tensioning forefoot thin wires in the proximal hole position increases compressive forces by 50% compared to neutral position, and adding a second wire increased compressive force by up to 15% compared to a single forefoot wire. Conclusion: In a circular frame midfoot fusion model, the greatest compressive force was achieved with two wires tensioned in the proximal hole position. The addition of a third wire led to force decrease likely due to off-axis forces that may distract the osteotomy site given the difficulty of passing all wires perfectly parallel in all planes. Ideal positioning and tensioning of forefoot pins may optimize construct stability and compression and improve healing of the midfoot osteotomy.
Arthroscopic vs Open Ankle Arthrodesis: A 5-Year Comparison
Authors: Gagné Oliver , Abuhantash Monther , Veljkovic Andrea N. , Wing Kevin J. , Penner Murray J. , Younger Alastair S. 
Published: January 2022

Category: Ankle; Ankle Arthritis; Arthroscopy Introduction/Purpose: End-stage ankle arthritis has long been managed surgically with open ankle arthrodesis (OAA). More recently, arthroscopic ankle arthrodesis (AAA) is thought to be associated with improved patient-reported outcome measures (PROMs) and fewer complications. The objective of this study was to systematically compare these two approaches in long-term PROMs, major complication rates and survivorship of the ankle fusion. Methods: In this retrospective longitudinal cohort study, all patients with an ankle fusion done at our institution and a minimum two-year follow-up were screened for inclusion. Patients demographics at baseline were collected including: age, gender, BMI, smoking status, diabetes status as well as preoperative ankle arthritis COFAS (Canadian Orthopedic Foot and Ankle Society) type. The following PROMs were completed preoperatively, at 6-months and annually thereafter to five years: AAS, AOS, SF-36, expectation, satisfaction and swelling scores. PROMs were compared at all timepoints using a mixed-effects regression model adjusted for baseline patients' demographics, COFAS type and PROMs. Major postoperative complications and survival analysis/rate of revision of the ankle fusions were also compared. Results: Of 874 patients screened for inclusion, 351 ankle fusions done between 2003 and 2019 were eligible for the study, 223 AAA and 128 OAA. The two groups were similar at baseline with respect to demographics, but COFAS type was higher in the OAA group and AAS and AOS scores were better in the AAA group. At one-year post-operatively, there was a higher mean AAS score in the AAA group, but there were no other differences in outcomes at any other timepoint. Survivorship of the ankle fusion in the arthroscopic group was lower (ie higher rate of revision) due to a higher rate of amputation or fusion. Deep infection and wound complications were more common with OAA and accounted for most ankle fusion revisions in this group. Conclusion: There were no consistent differences in PROMs of patients who underwent AAA versus OAA patients up to five- years postoperatively. Ankle fusions done arthroscopically had a lower survivorship rate compared to those done with the open approach due to a higher rate of major complications. Previously proposed advantages of AAA over OAA may therefore need to re-assessed and weighed against the technical challenges and associated complications of the arthroscopic technique.
Minimally Invasive Surgery for Severe Hallux Valgus with 2 Year Minimum Follow Up in 106 Feet
Authors: Gordon David , Lewis Thomas L. , Ray Robbie 
Published: January 2022

Category: Bunion; Lesser Toes; Midfoot/Forefoot Introduction/Purpose: There is widespread variation in the optimal procedure for correction of severe hallux valgus deformity. Severe hallux valgus (defined as hallux valgus angle (HVA) (>=40°) and/or 1-2 intermetatarsal angle (IMA) (>=20°)) is associated with increased complication rates including recurrence, delayed or non-union and metatarsal shortening with transfer metatarsalgia. There is limited evidence investigating the clinical or radiological outcomes following treatment of severe hallux valgus deformity with third-generation minimally invasive chevron and akin osteotomies (MICA). Objective: The primary aim was to investigate clinical patient reported outcome measures (PROMs) two years following surgery and the radiographic deformity correction for patients undergoing third-generation MICA for severe hallux valgus deformity. Methods: Prospective observational single surgeon series of consecutive patients who underwent primary third-generation MICA with screw fixation for severe hallux valgus. The primary outcome was a validated patient reported outcome measure, the Manchester-Oxford Foot Questionnaire (MOXFQ), assessed minimum 2 years following MICA. Secondary outcomes were radiographic deformity correction, complication rates and other quality of life PROMs (EQ-5D and Visual Analogue Pain Scale). Results: Between September 2014 and May 2018, 106 consecutive feet (n=78 patients; 73 female, 5 male) met the inclusion criteria. Prospectively collected pre-operative and 2 year PROM MOXFQ data was available for 86 feet (81.1%). At two years following surgery, the MOXFQ score significantly improved for the Pain, Walking and Standing and Social Interaction domains from 39.2 to 7.5, 38.2 to 5.9 and 48.6 to 5.5, respectively (p<0.001). Pre- and post-operative radiographic data was available for all 106 feet. Mean IMA following surgery improved from 18.2° to 6.3° (p<0.001) whilst mean HVA improved from 45.3° to 10.9° (p<0.001). Conclusion: This study has demonstrated third-generation MICA for the treatment of severe hallux valgus deformity can achieve significant improvements in clinical PROMs and radiographic deformity correction.