bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Struggle Between Protecting Children From and Preparing Them for the Death of Their Parent: A Qualitative Study
Authors: Millar Rachel , Bell Mary , Casey Louise 
Published: November 2022

Objectives The aim of this study was to gain a greater understanding of communicating with children about parental terminal illness from the perspective of the surviving parents. Methods A qualitative descriptive study was conducted using semi structured interviews with eligible participants. Data was analyzed using thematic analysis. Results The results highlight the pressures experienced by surviving parents, grappling with trying to support their children’s needs on a practical and emotional level, while coping with the emotional upheaval of the impending death of their partner. The issue of communication with the children starts long before the terminal phase of illness and the results confirm that this is an ongoing process that continues after the death of the parent. The need for services to be more responsive to the diverse needs of families was also apparent as a key factor in supporting families during this time. Conclusions This research provides valuable insights into the complexity of communicating with children about terminal illness from the perspective of the surviving parents. It reveals diverse views and experiences in terms of approaching communication with children and illustrates the need for services to be acutely attuned to the unique needs of parents and children throughout the disease trajectory.
Endothelial Cell Activation and Thrombin Generation Assessment for the Risk of Severe Early Onset Preeclampsia. the ROADMAP-EOP Study
Authors: Van Dreden Patrick , Lefkou Eleftheria , Ka Aboubakar , Sfakianoudis Konstantinos , Rousseau Aurélie , Grusse Matthieu , Elalamy Ismail , Gerotziafas Grigoris T 
Published: November 2022

Background The ROADMAP-EOP study aimed to identify clinically relevant biomarkers of hypercoagulability for the identification of pregnant women at risk of early onset preeclampsia worsening. Methods The ROADMAP-EOP observational single center retrospective case–control study was conducted in Greece (Centre for Human Reproduction, Genesis Athens Clinic, Athens, Greece) from July 2020 to July and enrolled pregnant women diagnosed with EOP stratified in mild EOP group (n = 34) and severe EOP group (n = 15) as well as women with uncomplicated pregnancy (control group; n = 35). All women were assessed with thromboelastometry (ROTEM®), Calibrated Automated Thrombogram®, tissue factor activity (TFa), procoagulant phospholipid dependentclotting time (Procoag-PPL®), Proteins S (PS), TFPI, D-dimer, antithrombin (AT), thrombomodulin (TM), fibrinogen, prothrombin time (PT) and activated partial thromboplastin time (aPTT). The primary study end-point was severe earlyonset preeclampsia. Principal component analysis (PCA) was performed. Results The PCA analysis showed that a score composed of the lag-time, ttPeak and Procoag-PPL accurately predicted severe EOP (sensitivity 71.4%, specificity 61.8%, and AUC of the ROC analysis 0.953). Conclusion The pilot ROADMAP-EOP shows that activation of endothelial cells and blood hypercoagulability are driven events in the worsening of EOP. Among a large panel of biomarkers and coagulation assays, thrombingeneration test and procoagulant phospholipid dependent clotting time emerged as clinically relevant for the evaluation of the risk of severe EOP. This methodology for the development of a new clinic-biological risk assessment model for prompt identification of pregnant women at risk of severe EOP must be validated in a large multi-centerprospective study.
Race differences in iliofemoral vein stenting for chronic venous insufficiency
Authors: Cho Logan D , Bai Halbert , Collins Lucas C , Chen Jenny , Cooke Peter V , Kang Yeju , Vasan Vikram , Kim Jinseo , Gonzalez Christopher , Dionne Elyssa , Kim Sung Yup , Ting Windsor 
Published: November 2022

Introduction Major disparities in outcomes by race are present throughout vascular surgery, yet little has been published on iliac vein stent outcomes by race. This retrospective study assessed iliac vein stent outcomes by patient race. Methods Patients who underwent iliac vein stenting at a single institution for chronic venous insufficiency (CVI) from 2011 to 2021 were reviewed. Demographic, preoperative, perioperative, and postoperative data were collected. Self-reported race groups included Asian, Black, Hispanic, and White. Univariate differences were analyzed using χ2 tests for categorical variables and 1-way ANOVA for continuous variables. Outcomes included change in Venous Clinical Severity Score (VCSS) at interval timepoints relative to a preoperative baseline and reinterventions. Logistic regression models were used to determine the unadjusted and adjusted odds ratio (OR) of any minor and major reintervention. Multivariate regression models controlled for demographic and comorbidity characteristics. Results A total of 827 patients were included. Asian patients were younger and had a greater proportion of male patients, lower Body mass index (BMI), less smoking history, and fewer comorbidities. White patients were more likely to have a history of deep vein thrombosis (DVT). White patients presented with the most severe CVI symptoms as defined by both Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification and preoperative VCSS composite scores. There were no differences in acute DVT, number of stents deployed, and bilateral versus unilateral stent placement. Black patients had the longest average days of follow-up, followed sequentially by Hispanic, White, and Asian. Black patients had the most reinterventions, while Asian patients had the fewest. Asian patients were less likely to have a major reintervention. No differences in VCSS composite or change in VCSS were observed. Conclusions In patients with CVI, Asian patients presented younger and healthier, while White patients presented with the most severe symptoms. No differences were observed in VCSS outcomes, though Black patients had the most reinterventions.
Achilles tendon thickness normalized to body surface area as a marker of asymptomatic peripheral arterial disease
Authors: Genkel Vadim , Kuznetsova Alla , Lebedev Evgeniy , Salashenko Alexey , Pykhova Lubov , Sumerkina Veronika , Shaposhnik Igor 
Published: November 2022

Objectives The normalisation of Achilles tendon thickness (ATT) to anthropometric parameters may increase the diagnostic efficiency of the assessment of ATT. The aim of this study was to compare the diagnostic value of AT dimensions depending on their normalization to body surface area (BSA) in patients with asymptomatic peripheral arterial disease (PAD). Methods All patients underwent duplex scanning of the carotid arteries and the lower limb arteries. Asymptomatic PAD was defined as the presence of ≥50% stenosis in the carotid and/or lower limb arteries. ATT was measured using a longitudinal scan, width (ATW) and cross-sectional area (AT CSA), which was determined during a cross-sectional scan. Results The study included 369 patients, among whom asymptomatic PAD was detected in 18 (4.88%) patients. Only the ATT demonstrated diagnostic value for asymptomatic PAD. After normalizing the size of the AT to the BSA, the diagnostic performance of ATT, ATW and AT CSA became statistically significant. Among the studied parameters, only an increase in ATT/BSA >0.29 cm/m2 was associated with a significant increase in the odds ratio (OR) of asymptomatic PAD by 4.11 times (95% CI 1.08–15.7; p = .038) after adjustments. Conclusion An increase in ATT/BSA >0.29 cm/m2 predicted the presence of asymptomatic PAD with a sensitivity of 61.1% and a specificity of 77.9%. ATT/BSA values of less than 0.29 cm/m2 made it possible to exclude asymptomatic PAD with a probability of 97.5%. An increase in ATT/BSA >0.29 cm/m2 was associated with a 4.11-fold increase in the OR of asymptomatic PAD (95% CI 1.08–15.7).
Topical Intranasal Insulin Enhances Healing of Nasal Mucosa: An Experimental Animal Study
Authors: Külekci Çağrı , Özer Serdar , Önen Selin , Korkusuz Petek , Yılmaz Taner 
Published: November 2022

Objective Aim of this study was to evaluate the effect of topical intranasal insulin on healing of nasal mucosa in a rat model. Methods Forty-eight Wistar rats, weighing between 250 and 300 g and aged 10–12 weeks were used and randomized into two equal groups. 1.9 mm curette was introduced through the left nostril and 1.9 mm mucosa from the left nasal septum was curetted. Postoperatively, animals in the control group received 1 mL of physiologic saline, 3 times a day in a nasal irrigation fashion. Animals in the experimental group received 1 mL of 5 IU/mL regular insulin in saline solution. Subjects were sacrificed after 5, 10, and 15 days and macroscopic and histomorphometric evaluations were performed. Results There were no mucosal synechiae and septal perforation macroscopically. Histological examination revealed that the defect size reduction was 21% in the saline group versus 56% in the insulin group on the fifth day ( p = 0.006). There was 62% defect reduction in the saline group versus 79% in the insulin group on the 10th day ( p = 0.034). On the 15th day, only 67% of saline group animals had complete defect closure, whereas 100% of animals treated with insulin had complete closure (92% vs 100% mucosal defect reduction, p = 0.036). Both edema and inflammation were less in the insulin group on 15th day ( p = 0.006; p = 0.023, respectively). Conclusion The results from this study support the safety and efficacy of topical insulin on wound healing in the literature. This study could guide further experimental studies that examine human sinonasal wound healing.
Small Chondral Defects Affect Tibiofemoral Contact Area and Stress: Should a Lower Threshold Be Used for Intervention?
Authors: Koh Jason , Diaz Roberto Leonardo , Tafur Julio Castillo , Lin Ye , Echenique Diego Barragan , Amirouche Farid 
Published: November 2022

Background: Chondral defects in the knee have biomechanical differences because of defect size and location. Prior literature only compares the maximum stress experienced with large defects. Hypothesis: It was hypothesized that pressure surrounding the chondral defect would increase with size and vary in location, such that a size cutoff exists that suggests surgical intervention. Study Design: Controlled laboratory study. Methods: Isolated chondral defects from 0.09 to 1.0 cm2 were created on the medial and lateral femoral condyles of 6 human cadaveric knees. The knees were fixed to a uniaxial load frame and loaded from 0 to 600 N at full extension. Another defect was created at the point of tibiofemoral contact at 30° of flexion. Tibiofemoral contact pressures were measured. Peak contact pressure was the highest value in the area delimited within a 3-mm rim around the defect. The location of the peak contact pressure was determined. Results: At full extension, the mean maximum pressures on the medial femoral condyle ranged from 4.30 to 6.91 MPa at 0.09 and 1.0 cm2, respectively ( P < .01). The location of the peak pressure was found posteromedial in defects between 0.09 and 0.25 cm2, shifting anterolaterally at sizes 0.49 and 1.0 cm2 ( P < .01). The maximum pressures on the lateral femoral condyle ranged from 3.63 to 5.81 MPa at 0.09 and 1.0 cm2, respectively ( P = .02). The location of the peak contact pressure point was anterolateral in defects between 0.09 and 0.25 cm2, shifting posterolaterally at 0.49 and 1.0 cm2 ( P < .01). No differences in contact pressure between full extension and 30° of flexion were found for either the lateral or medial condyles. Conclusion: Full-thickness chondral defects bilaterally had a significant increase in contact pressure between defect sizes of 0.49 and 1.0 cm2. The location of the maximum contact pressures surrounding the lesion also varied with larger defects. Contact area redistribution and cartilage stress change may affect adjacent cartilage integrity. Clinical Relevance: Size cutoffs may exist earlier in the natural history of chondral defects than previously realized, suggesting a lower threshold for intervention.
High Reproducibility of a Novel Fixed Anterior Drawer Test for Diagnosing Ankle Instability
Authors: Murahashi Yasutaka , Teramoto Atsushi , Takahashi Katsunori , Watanabe Kota , Yamashita Toshihiko 
Published: November 2022

Category: Ankle Introduction/Purpose: The manual traditional anterior drawer test (ADT) is essential for the treatment decision of chronic ankle instability, but have been pointed out of comparatively low reproducibility and accuracy, especially in less experienced hands. To clarify the inter-examiner reproducibility, we compared the actual distance of anterior translation between the junior and senior examiner in the ADT. We also evaluate the diagnostic abilities of the traditional ADT and a novel modified ADT, fixed ADT. Methods: Thirty ankles were included in this study and the ankle instability was defined by the stress radiography. All subjects were performed two methods of manual ADT by junior and senior examiner, and judged the ankle instability in a blinded fashion. The anterior drawer distance was calculated from the lengthening measured by the capacitance-type sensor device. Results: The amount of anterior translation of junior examiner was significantly lower than senior examiner in the traditional ADT (3.3 vs. 4.5 mm, p=0.016), while, there was no significant difference between two examiners in the fixed ADT (4.6 vs. 4.1 mm, p=0.168). The inter-examiner reliability of fixed ADT was higher than traditional ADT. In the junior examiner, the diagnostic accuracy of the fixed ADT was higher than that of traditional ADT (sensitivity, 0.40 vs. 0.80; specificity, 0.75 vs. 0.80, respectively). Conclusion: Fixed ADT may have advantage for a simple manual test of ankle instability as a method with less error between examiners.
Prediction of Distal Tibial Articular Extension in 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 per 100,000 person-years 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. Methods: Objectives Our primary outcome in this study was to identify any factors that could predict articular extension in tibial shaft fractures. Study Design & Methods A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NH 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 articular fracture extension was categorised into either posterior malleolar (PM) or other fracture. Results: 764 diaphyseal tibial fractures were analysed, of these 300 had a CT and could be included. There were 127 intra- articular fractures. Of these, 83 (65.4%) cases were PM and 44 were other fractures. On univariate analysis, the PM fractures were associated with fibular spiral (p=-016) fractures and no fracture of the fibular (p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO classification 42B1 (p=.033) and an increasing angle of tibial fracture. However, on multivariate regression analysis the only significant factor was a high angle of tibia fracture. Other distal tibia fracture extensions were associated with no fracture of the fibular (p=.002), medial direction of tibia fracture (p=.004), female gender (p=.000), and AO classification 42A1 (p=.004), 42A2 (p=.029), 42B3 (p=035) and 42C2 (p=.032). On multivariate analysis. the lateral direction of tibia fracture, and AO classification 42A1 and 42A2 were significant factors. Conclusion: Distal tibia articular extension occurs in almost half of tibial shaft fractures. A number of factors were associated with the extension, however multivariate analysis did not create a suitable prediction model. Nevertheless, rotational tibia fractures with a high angle of fracture should have a low threshold of further investigation with a CT prior to surgical intervention.
Hallux Valgus Interphalangeus Measurement: Comparison of the Two Radiographic Methods
Authors: Nebhani Nimesh , Heyes Gavin , Molloy Andrew P. , Mason Lyndon W. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: To determine the reliability of Delta PP (difference in medial and lateral proximal phalanx wall length) compared to HIA (hallux interphalangeal angle) in the assessment of HVI (hallux valgus interphalangeus) in both pre and postoperative radiographs. Methods: This was a retrospective observational study of 186 feet with hallux valgus. The number of cases required to adequately power the study was 128. Preoperative and postoperative hallux alignment were evaluated by two different radiological parameters, Delta PP and HIA. Inter-observer variability was assessed independently by two authors and compared using a intraclass correlation coefficient. Results: The intra-class correlation coefficient was more than 0.8 for all parameters, thus both HIA and Delta PP measurement provide reliable and reproducible data. Mean HIA significantly increased following surgical correction of hallux valgus. In comparison, the mean Delta PP decreased after correction. This postoperative increase in HIA indicates that pre-operative HIA underestimates the magnitude of HVI and therefore is an inaccurate tool for measuring HVI's contribution to the TVDH (total valgus deformity of the hallux) and to preoperative planning. However, the Delta PP was a greater determinant of the phalanx deformity's contribution to the TVDH. Conclusion: The outcome of our study shows that both HIA and Delta PP are reproducible when assessing the hallux valgus interphalangeus deformity, however, Delta PP quantifies the amount of correction obtained more precisely. The additional benefit of measuring the Delta PP is that it allows for accurate planning in determining the dimensions of the medial based wedge of the Akin osteotomy that needs to be resected.
ATFL All Inside Arthroscopic Repair: Clinical and Functional Outcomes
Authors: Nunes Gustavo A. , Carvalho Kepler , Mansur Nacime SB 
Published: November 2022

Category: Arthroscopy Introduction/Purpose: The arthroscopic techniques used to treat chronic lateral ankle instability have developed greatly in recent years. The purpose of this work is to present clinical and functional results of patients with chronic ankle instability submitted to surgical treatment by all-inside arthroscopic repair of the anterior talofibular ligament (ATFL). Methods: This is a series of cases of 18 consecutive patients who underwent the all-inside arthroscopic ATFL repair technique, a surgical treatment for chronic lateral ligament instability of the ankle, after the failure of conservative treatment performed for 6 months. The evaluation was made using the American Orthopaedic Foot and Ankle Score (AOFAS), visual analog pain scale (VAS), anterior drawer and talar tilt tests. Surgical complications and patient satisfaction indices were also evaluated. Results: All 18 patients were evaluated for a mean follow-up period of 12 months. There was an improvement in the AOFAS (p< 0.001), with the mean improving from 69.6 points to 98.1, and in the mean VAS score, from 5.0 to 0.5 points (p < 0.001). All ankles were stable, as assessed by the anterior drawer test and talar tilt test. The only complication found was neurapraxia of the superficial fibular nerve in one patient (5%). All of the patients classified the treatment as good or excellent and returned to daily and sports activities without limitations. Conclusion: Treatment of chronic ankle ligament instability by the all inside arthroscopic ATFL repair technique was able to restore ankle stability and showed good clinical results and high satisfaction rates.
Minimally Invasive Chevron Akin (MICA) Osteotomy for Severe Hallux Valgus
Authors: Nunes Gustavo A. , Carvalho Kepler , Ferraz Gabriel F. , Filho Miguel V. Pereira , Pinto Roberto Zambelli de A. 
Published: November 2022

Category: Bunion Introduction/Purpose: The minimally invasive Chevron Akin (MICA) osteotomy have been widely used treating hallux valgus (HV). The purpose of this study was to present a case series of patients with severe HV undergoing surgical treatment using the MICA procedure, and to evaluate the clinical and radiographic outcomes Methods: Sixty consecutive feet (52 patients) undergoing MICA for severe HV were included. Patients were assessed pre and postoperatively. Clinically evaluation was realized by visual analogue pain scale (VAS) and American Orthopaedic Foot & Ankle Society Score (AOFAS). Radiographic assessments included measurement of hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsal (MT) length and plantar offset of MT head. Results: The mean age was 59.9 years and follow-up were 18.5 months. The average AOFAS increased from 41.2 to 90.9 points and the VAS decreased from 8.1 to 1.3 at the last follow up. Average HVA decreased from 41.2° to 11.6° and IMA reduced from 17.1° to 6.8°. Average shortening of the first metatarsal and the plantar offset of MT head was 3.9 mm and 2.8 mm respectively. There was significant improvement (p<0.001) in all clinical and radiographic parameters (p<0.001). The most observed complication was hardware discomfort, observed in four feet (6.6%). Conclusion: The MICA technique is a safe and reproducible method to treat severe HV.
All-Inside Meniscal Repair: A Historical View
Authors: MacLean Ian S. , Miller Mark D. 
Published: November 2022

Background: All-inside meniscal repair first became popularized in the early 2000s. Since that time, there has been a wide variety of all-inside implants on the market with rapid changes and developments in recent years. Indications: Small, peripheral, longitudinal tears are best suited for all-inside repair, but this technique may even be used for large bucket handle tears especially when hybridized with an inside-out repair. Technique Description: A percutaneous release of the medial collateral ligament (MCL) with an 18-g spinal needle is frequently performed when working in the medial compartment to improve visualization and decrease risk of iatrogenic chondral injury. Close familiarity with the characteristics of the chosen all-inside device including device angle, modifiability of device angle, modifiability of needle depth, deployment method, and tensioning technique is important for obtaining reproducible results. Typically, obtaining a vertical mattress stitch configuration is optimal as it captures more circumferential collagen fibers in the repair. Results: Factors to consider when selecting an all-inside meniscal repair device include the ergonomics of the device, implant cost, availability, rigid versus suture-based anchor, core needle diameter, device flexibility, and percent of misfires. Discussion: Complications from use of all-inside meniscus repair devices include device failure, soft tissue entrapment, cyst formation, and injury to the popliteal artery. Outcomes, however, with current devices are good and comparable to inside-out meniscus repair with about a 90% return to sports rate at 12 months postoperatively. 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.