bluuebunny/crossref_metadata_2025_split huggingface dataset:
Brain tissue integrity mapping in adults with obstructive sleep apnea using T1-weighted and T2-weighted images
Authors: Roy Bhaswati , Sahib Ashish K. , Kang Daniel , Aysola Ravi S. , Kumar Rajesh 
Published: November 2022

Background: Obstructive sleep apnea (OSA) is accompanied by both gray and white matter differences in brain areas that regulate autonomic, cognitive, and mood functions, which are deficient in the condition. Such tissue changes have been examined through diffusion tensor and diffusion kurtosis imaging-based procedures. However, poor in-plane spatial resolution of these techniques precludes precise determination of the extent of tissue injury. Tissue texture maps derived from the ratio of T1-weighted and T2-weighted images can provide more adequate in-plane assessment of brain tissue differences. Objectives: To examine brain tissue integrity in recently diagnosed, treatment-naïve OSA subjects, relative to age- and sex-comparable control subjects using T1-weighted and T2-weighted images. Design: A cross-sectional study. Methods: We examined the extent of tissue changes in 106 OSA over 115 control subjects using high-resolution T1- and T2-weighted images collected from a 3.0-Tesla scanner (analysis of covariance; covariates: age, sex, body-mass-index, Pittsburgh sleep quality index, Epworth sleepiness scale, Beck Anxiety Inventory, and Beck Depression Inventory II; false discovery rate corrected; p < 0.01). Results: OSA subjects showed significantly lowered tissue integrity in several brain regions, including the frontal, cingulate and insular cortices, cingulum bundle, thalamus, corpus callosum, caudate and putamen, pons, temporal, occipital, and parietal sites, cerebellar peduncles, and medial medullary sites, compared with controls. Conclusion: OSA subjects show widespread lowered tissue integrity in autonomic, mood, and cognitive control sites over healthy controls. The pathological processes contributing to the alterations may include repetitive hypoxic and hypercarbic processes and excitotoxic injury, leading to altered brain tissue integrity in OSA.
Treatment patterns and oncological outcome of patients with advanced small intestinal neuroendocrine tumors: real-world data from the Medical University of Vienna
Authors: Melhorn Philipp , Kretschmer-Chott Elisabeth , Wolff Ladislaia , Haug Alexander , Mazal Peter , Raderer Markus , Kiesewetter Barbara 
Published: November 2022

Background: Different oncological therapies have been approved for small intestinal neuroendocrine tumors (SI-NETs), but relatively little is known about efficacy and long-term outcome outside of phase III trials. Methods: This retrospective analysis assessed patients with well-differentiated, metastatic SI-NETs treated at the Medical University of Vienna, an approved European Neuroendocrine Tumor Society (ENETS) Center of Excellence for neuroendocrine tumors. The primary objective was to assess progression-free survival (PFS) following approved therapies, that is, octreotide, lanreotide, peptide receptor radionuclide therapy (PRRT), and everolimus, in a representative real-world collective. Results: A total of 77 patients receiving systemic treatment for advanced SI-NETs between 2010 and 2021 were included, with a median follow-up time of 82.3 months [95% confidence interval (CI), 57.8–106.8 months]. In the entire collective, the estimated median PFS following first-line therapy was 32.0 months (95% CI, 23.5–40.5 months). Peritoneal carcinomatosis was significantly associated with worse PFS ( p = 0.016). Regarding therapeutic strategies and outcome, 59 patients received somatostatin analogs first line and no significant difference in PFS was observed between lanreotide and octreotide (29.3 versus 35.5 months, p = 0.768). Across all treatment lines, 42 patients underwent PRRT (estimated median PFS: 32.0 months; 95% CI, 25.6–38.3 months) and a small subgroup of 7 patients received everolimus (estimated median PFS: 9.2 months; 95% CI, 1.6–17.0 months). For the total cohort, the estimated median OS following first-line therapy was 100.6 months (95% CI, 82.3–118.8 months), but the high proportion of deaths attributed to NET (77.8%) underlines the lethal nature of the disease. No unexpected toxicities were observed. Conclusions: While peritoneal carcinomatosis emerged as an adverse prognostic factor for PFS in this collective, the long-term outcome of patients treated at a specialized NET center using approved therapies appeared comparable to pivotal studies in SI-NET.
Food taboos among pregnant women and associated factors in eastern Ethiopia: A community-based cross-sectional study
Authors: Amare Wbalem , Tura Abera Kenay , Semahegn Agumasie , Teji Roba Kedir 
Published: November 2022

Objective: The main aim of this study was to assess food taboos and associated factors among pregnant women in eastern Ethiopia. Methods: A community-based cross-sectional study was conducted among randomly selected 422 pregnant women at Haramaya Demographic Surveillance System from Haramaya District, eastern Ethiopia. Data on sociodemographic conditions, the presence of food taboos, and perceived reasons were collected using the face-to-face interview method by trained data collectors through arranged home visits. Collected data were entered into EpiData 3.1 and exported to statistical package for social sciences version 23 for cleaning and analysis. Descriptive, binary, and multiple logistic regression analyses were carried out to determine the relationship between explanatory and outcome variables. Adjusted odds ratio (AOR) with 95% confidence interval (CI) at p value less than 0.05 was used to declare significant association. Results: Approximately half (48%, 95% CI: 43%, 52%) of the pregnant women reported the presence of pregnancy-related food taboos. Pregnant women who have heard about food taboos (AOR: 3.58; 95% CI: 1.89, 6.83), pregnant women had friends who avoided food (AOR: 1.91; 95% CI: 1.22, 2.99), women’s monthly income ⩽840 ETB (AOR: 1.73; 95% CI: 1.10, 2.73), and pregnant women who had not attended formal education (AOR: 1.95; 95% CI: 1.18, 3.23) were more likely to report food taboos. The odds of pregnant women who had attended uptake of immunization services were less likely to have food taboos (AOR: 0.35; 95% CI: 0.21, 0.58). Conclusion: Pregnancy-related food taboos among pregnant women are unacceptably high. Therefore, awareness creation and nutritional counseling at health service delivery points are imperative actions for pregnant women to avoid food taboos norms. Further research should be done to understand the social and cultural ground of food taboos during pregnancy.
New Evaluation Method for Lateral Ankle Instability using Ultrasound
Authors: Sato Go , Takagi Kenichi , Bhimani Rohan , Saengsin Jirawat , Lubberts Bart , Hagemeijer Noortje , Ashkani-Esfahani Soheil , Yagura Yukihisa 
Published: November 2022

Category: Ankle; Trauma Introduction/Purpose: Despite the fact that stress fluoroscopy is the most common method of quantifying lateral ankle instability, ultrasound evaluation has grown in popularity as a way to assess ankle stability at the point of care due to its simplicity, accuracy, low cost, and lack of exposure. The aim of this study is to introduce a new method for evaluating lateral ankle instability using ultrasound. Methods: A 37-year-old man with history of lateral ankle ligament injury underwent ultrasound and fluoroscopic evaluation. The anterior drawer distance (ADD) was quantified under anterior drawer stress. During ADD measurement, the patient sat with the knee extended and the heel on the examination table or chair, and the examiner performed the anterior drawer test (Image 1a). The amount of talar movement was measured as an ADD using an ultrasound probe placed on the posteromedial side of the ankle (Image 1b). A lateral clear space (LCS) was also measured under varus stress using ultrasound from the tip of the lateral malleolar to the lateral process of the talus. The aforementioned measurements were repeated under stress fluoroscopy and compared with ultrasound findings. Results: On ultrasound evaluation, the ADD was 7.1 mm and the LCS was 17.1 mm. Furthermore, the stress fluoroscopic evaluation yielded a similar result, with an ADD of 8.7 mm and an LCS of 17.5 mm. Conclusion: Our findings suggest that this new method of evaluation of lateral ankle instability under dynamic ultrasound appears to be a highly accurate and useful alternative for assessing lateral ankle stability at the point of care in a radiation-free, non- invasive, and low-cost manner.
Does the Addition of Bone Marrow Aspirate Concentrate from the Pelvis Improve Fusion Rates of Hindfoot and Ankle Arthrodesis?
Authors: Sleasman Brian T. , Gillikin Tyler , Peabody John J. , Zbihley Andrew , Olamigoke Oluwafikayo , Patel Milap , Cantrell Colin K. , Tanenbaum Joseph E. , Kadakia Anish R. 
Published: November 2022

Category: Ankle Arthritis; Ankle; Hindfoot Introduction/Purpose: Ankle and hindfoot arthrodesis are common interventions for degenerative and inflammatory foot and ankle conditions. These include, but are not limited to osteoarthritis, inflammatory arthritis, deformity, and instability. While we know the addition of bone graft is critical for successful union, we do not fully understand how graft selection affects union rates. Demineralized bone matrix (DBM) is commonly chosen due to its ease of availability and osteoconductive and osteoinductive properties. In our study, we aim to determine if adding BMAc, and thus osteogenic properties, to a DBM allograft improves union rates following ankle and hindfoot arthrodesis. Methods: After receiving IRB approval from our institution, we collected the records of patients who underwent arthrodesis of the hindfoot (subtalar, calcaneocuboid, talonavicular) or ankle during a 10-year time period. Patients were then divided into two groups: arthrodesis performed with the use of DBM and arthrodesis performed with DMB-BMAc. Cases using other graft options such as bulk allograft, autograft, or bone morphogenic protein (BMP) were excluded. Fusion was determined by standard radiographic and clinical criteria and CT scans were utilized in cases which fusion could not be determined. Patients were followed for a minimum of 6 months. If fusion was not complete at that time clinical and radiographic exams were performed at the 9- and 12-month period. Patients were analyzed for sucussesful arthrodesis. Complications and revisions were recorded and analyzed. Results: A total of 124 patients who met the inclusion criteria were identified. In 49 patients only DBM was utilized, and 75 patients BMC was added to the DBM. At 12 months post operatively the group utilizing only DBM had a union rate of 90% while the union rate of the BMAc/DBM had a union rate of 88% (p=0.985) There was no difference in the rate of complications between the two groups and the groups were matched in terms of age, smoking status, DM, sex and BMI. Additionally, in our cohort there was a trend toward increased non-union and complication rate in smokers, although this did not reach statistical significance. Conclusion: Ankle and hindfoot arthrodesis are a reliable treatment option for patients with specific foot and ankle pathology. Our study reports a fusion rate in line with previous studies. The addition of BMAc from the pelvis, attempting to improve the biology of the fusion site, to DBM does not seem to affect fusion rates.
A Systematic Review of Lower Extremity Return to Sport
Authors: Smiley Traci , Dallman Johnathan , Aldag Levi , Mok Anthony C. , Tarakemeh Armin , Burki Megan , Martin Kyle , Vopat Bryan G. 
Published: November 2022

Category: Sports; Ankle; Other Introduction/Purpose: A uniform criterion has not been established for return to sport (RTS) testing which is complicated by the lack of a standardized definition of the term RTS. Most commonly, RTS is defined as playing in at least one game of the athletes' respective sport, or the first game played after treatment.1 However, the timeline from the injury and/or treatment date to RTS varies amongst each physician or institution. Regarding the ankle, there is an enormous paucity of functional testing research. Therefore, the purpose of this project is to review current literature for joint-specific and global lower extremity testing to determine the most valid functional test that can be utilized to prevent re-injury as athletes RTS. Methods: A systematic search of PubMed, PubMed Central, Cochrane Library, OVID, and Embase databases was conducted to identify clinical studies that included evaluation of a return to sport test or functional test (single test or test battery) for the lower extremities. Both operative and non-operative treatments included in this review. Only studies that had patients between the ages of 14 years old and 40 years old were included. Specfici rehab protocik or treatment plan, non-English publications, non- human or cadaver studies, and studies that did not evaluate return to sport test or function test were excluded. Results: Of 8,705 studies, 65 (0.7%) studies published through October of 2021 met inclusion criteria and were analyzed. 52 out of 65 (80%) articles discussed RTS for the knee. Furthermore, 50 out of the 52 (96%) specifically analzyed RTS following ACLR. With this said, we did not abandon ankle and hip RTS cases. Discussed herein, are numerous RTS tests including the most common, isokinetic dynamometry testing which is seen in 38 out of the 52 (73%) of the knee RTS cases. Unfortunately, only 4 out of 65 (6.2%) studies analyzed RTS for the hip and 1 out of the 65 (1.5%) barely touched on the ankle. The remaining studies analyzed healthy participants only. Conclusion: More research is clearly required to identify the most valid functional test batteries for joint-specific RTS lower extremity testing. Even with the enormous amount of literature that exists regarding ACL injuries and testing there is no standardized criterion for RTS clearance. As seen in this review, the research available for the hip and ankle is substantially scarcer in regards functional testing. We hope that the suggested test batteries from this review can serve as a framework for future research and validation for joint-specific RTS functional testing.
Effect of Particulate Matter on Achilles Tendon Healing: An Experimental Study in Rats
Authors: Song Jaehwang , Jo Seong Kyeong , Lee Su Yel , Lee Min Hyeok , Son Ji Woong , Kang Yea Eun , Choi Jae Kyu 
Published: November 2022

Category: Basic Sciences/Biologics; Ankle; Sports; Trauma Introduction/Purpose: Exposure of particulate matter (PM) has been linked to several diseases including pulmonary, cardiovascular, oncology, neurology system, and etc. Even though tendon injury has become increasingly common recently, there has been no study of relationship between tendon healing and PM. Hence, we performed experimental study in rats to evaluate whether PM has significant effect on tendon healing. We hypothesized that PM exposure may substantially influence Achilles tendon healing. Here, we evaluated whether PM exposure led to deleterious effect on tendon healing in a rat model of Achilles tendon rupture (ATR). Methods: All experiments with rats were approved by the Institutional Animal Care and Use Committee. The Achilles tendons of 20 Sprague-Dawley rats were transected by open tenotomy. The animals were divided into two groups according to exposure of PM 2.5 (particulate matter less than 2.5µm): control group (Non-PM group) or PM exposure group (PM group). 30 minutes of PM inhalational exposure was performed 3 days a week for 6 weeks in closed chamber systems. After 6 weeks, histologic study of lung, laboratory test and enzyme-linked immunosorbent assay (ELISA) of blood samples, histologic study, transmission electron microscopy (TEM) analysis, biomechanical study, RNA sequencing, and western blot analysis of Achilles tendon was performed. Results: Hematoxylin and eosin (H&E) stain of lung tissue in PM group showed inflammation of alveolar wall and increased macrophage. Laboratory test and ELISA of blood samples from PM group showed significantly higher expression of white blood cell count and tissue necrosis factor alpha (TNF-α) than those from non-PM group, respectively. Histologic study of Achilles tendon in PM group exhibited increased lymphocyte and ossification findings with inflammatory change of cell morphology. TEM analysis showed decreased collagen fibril in PM group than non-PM group. Load to failure was decreased in the PM group than non-PM group. RNA sequencing and ingenuity pathway analysis showed increased cAMP-PKA-CREB signal pathway in PM group and the results were consistent with western blot outcomes. Conclusion: Achilles tendon healing was substantially affected by the PM exposure. Based on the present data, PM exposure induces detrimental histological and biomechanical results on Achilles tendon healing through cAMP-PKA-CREB pathway. Further in-vitro study and larger in-vivo study with longer time period are needed to support the present data.
Clinical Outcomes of Posterior Tibial Tendon Sheath Ultrasound-Guided Corticosteroid Injections
Authors: Spencer Mark , Hall Matthew , Schafer Allison , Geaney Lauren E. 
Published: November 2022

Category: Ankle; Basic Sciences/Biologics; Sports Introduction/Purpose: The treatment of progressive collapsing foot deformity (PCFD) typically begins with nonoperative management including physical therapy, bracing, nonsteroidal anti-inflammatory medications, and activity modifications. Surgical intervention is not typically performed until nonoperative treatment has failed. Corticosteroid injections into the posterior tibial tendon sheath (PTTS) is a burgeoning nonoperative treatment modality for PCFD. The purpose of our study was to assess the safety of ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath for posterior tibialis tendon tendinopathy. Secondary outcomes include duration of pain relief, amount of pain relief, need for repeat injections and progression to surgery. Methods: We retrospectively reviewed all patients in our electronic medical record who underwent a PTTS steroid injection between 2015 to 2020 for the diagnosis of posterior tibial tendon dysfunction, and/or posterior tibialis tendon insufficiency, and/or ankle pain. Demographic information was obtained from the patient record in addition to MRI data, clinical response to injection based on follow up visits, number of total injections, and progression to surgery. Thirty-eight posterior tibial tendon sheath ultrasound-guided injections in 33 patients met criteria during the 5 year study period. Results: Thirty-three patients were included in the study with 38 injections. Two patients (6.1%) had 3 posterior tibial tendon injections, one patient (3%) had 2 injections, and the rest had only a single injection yielding a total of 38 injections included in the study. Eighteen of 38 (47%) injections yielded good or better pain relief. Seven of 33 patients (21%) progressed to surgery. There were no reported complications with the 38 performed injections. Conclusion: Ultrasound-guided corticosteroid injections into the posterior tibial tendon sheath is a safe nonoperative treatment modality for posterior tibialis tendon tendinopathy. The efficacy of the injection appears highly variable with 47% of injections yielding 'good' or better clinical results. When evaluating BMI, obese patients (BMI >= 30.0) were found to have a more sustained response to injection (P = 0.029) and more pain relief (P = 0.049) compared to non-obese patients.
90-Day Reoperation and Wound Complication Rates in Lateral Approach to Total Ankle Replacement for Post-Traumatic Arthritis
Authors: Staub Jacob R. , Manto Kristen , Mellen James , Koroneos Zachary , Aynardi Michael C. 
Published: November 2022

Category: Ankle Arthritis; Ankle; Diabetes Introduction/Purpose: Total ankle replacement (TAR) has achieved relatively successful outcomes with respect to postoperative complications; however, mixed evidence exists regarding early complication rates, reoperation, and infection1-5. The largest study of TAR to date indicates a statistically significant risk of postoperative infection in tobacco users and diabetic patients6. Unlike currently established anterior approaches to arthroplasty, the lateral transfibular approach potentially avoids disruption of perfusion to the skin, possibly decreasing postoperative complications7. The lateral ankle allows surgeons to correct malunion of the fibula in post-traumatic arthritis deformity cases and achieve appropriate coronal and sagittal implant alignment to achieve similar physiological joint orientation8,9. The purpose of this study was to report 90-day reoperation and wound complication rates in lateral approach to total ankle replacement for post-traumatic arthritis (PTA). Methods: A retrospective chart review of lateral TAR cases from 2016-2022 was conducted at a single institution. Only patients undergoing TAR for post-traumatic arthritis were included in this review. A total of 49 patients (22 females and 27 males) underwent total ankle replacement with the Zimmer Biomet Trabecular MetalTM Total Ankle by a single surgeon. Patient demographics, operative data, complications, and adverse events requiring corrective surgery were recorded within 90 days of arthroplasty. Results: The patient sample included 6 active smokers, 11 diabetics, and 32 patients with hypertension with an average age of 60.7 and average BMI of 34.3 (Table 1). Three of the 49 (6.1%) patients required secondary surgery within 3 months of surgery (Table 2). Revision surgery indications included: 1 (2.0%) for removing painful hardware, 2 (4.1%) due to infection, and 1 (2.0%) for tarsal tunnel syndrome after surgery. There were 0 nonunions of the fibula at 90 days and through 1 year follow up. Of the patients requiring secondary surgery for infection, 1 was a smoker and 1 had a history of ankle fusion nonunion and avascular necrosis which was converted to a TAR (Table 4). Conclusion: This retrospective study demonstrates a comparable rate of secondary surgeries following TAR via lateral approach in the early postoperative period (6.1%) while having a slightly higher rate of infection than those previously reported (4.1%)7,8. Notwithstanding, we observed a 100% healing rate of fibula osteotomies; however, we failed to demonstrate a lower incidence of wound complications than previously reported. Surgeons should counsel patients of these risks in those with PTA undergoing lateral TAR, especially in smokers and diabetics.