bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in Imaging Utilization for Primary Hyperparathyroidism
Authors: Abraham Mackenzie N. , Abraham Peter J. , Lindeman Brenessa , Chen Herbert 
Published: January 2022

Introduction Primary hyperparathyroidism is now largely managed surgically via minimally invasive techniques. This shift was aided by preoperative imaging, which saw drastic increases in utilization in the 1990s. Since then, it is unclear how the role of preoperative imaging has changed with regard to surgical management of primary hyperparathyroidism. This study aims to describe the trend in preoperative localization techniques for surgical management of primary hyperparathyroidism using career data from two endocrine surgeons over the last 20 years. Methods Parathyroid case data was obtained from two endocrine surgeons spanning two institutions from 2000-2018. Demographic and clinical data was obtained for each patient at the time of surgery, including record of any preoperative imaging performed. Data was analyzed temporally using four 5-year periods to evaluate changes in imaging utilization over time. Results 1734 patients were identified who underwent parathyroidectomy for primary hyperparathyroidism. Mean age of the cohort was 60 years (range 10-94) with 78% being female. Overall, we identified a significant decrease in imaging utilization over the time periods (see table, P < .05). Ultrasound and CT use increased, while frequency of sestamibi and thallium-technetium scans decreased. Length of stay was also noted to decrease over time. There was no significant difference in cure rates between the four time periods, though recurrence was found to decrease over time. Conclusion The rates of preoperative imaging and length of stay decreased over time for surgical management of primary hyperparathyroidism. Despite the decrease in imaging, cure rates have appeared to remain the same.
ROSIE: RObust Sparse ensemble for outlIEr detection and gene selection in cancer omics data
Authors: Jensch Antje , Lopes Marta B. , Vinga Susana , Radde Nicole 
Published: January 2022

The extraction of novel information from omics data is a challenging task, in particular, since the number of features (e.g. genes) often far exceeds the number of samples. In such a setting, conventional parameter estimation leads to ill-posed optimization problems, and regularization may be required. In addition, outliers can largely impact classification accuracy. Here we introduce ROSIE, an ensemble classification approach, which combines three sparse and robust classification methods for outlier detection and feature selection and further performs a bootstrap-based validity check. Outliers of ROSIE are determined by the rank product test using outlier rankings of all three methods, and important features are selected as features commonly selected by all methods. We apply ROSIE to RNA-Seq data from The Cancer Genome Atlas (TCGA) to classify observations into Triple-Negative Breast Cancer (TNBC) and non-TNBC tissue samples. The pre-processed dataset consists of [Formula: see text] genes and more than [Formula: see text] samples. We demonstrate that ROSIE selects important features and outliers in a robust way. Identified outliers are concordant with the distribution of the commonly selected genes by the three methods, and results are in line with other independent studies. Furthermore, we discuss the association of some of the selected genes with the TNBC subtype in other investigations. In summary, ROSIE constitutes a robust and sparse procedure to identify outliers and important genes through binary classification. Our approach is ad hoc applicable to other datasets, fulfilling the overall goal of simultaneously identifying outliers and candidate disease biomarkers to the targeted in therapy research and personalized medicine frameworks.
Improving Organizational Sustainability of an Urban Indian Health Clinic With an Innovative Pharmacy Model
Authors: Gallegos Noah , Fitzgerald Leah , Versackas Alex , Sherer Erica , Valdez Connie 
Published: January 2022

Introduction: To increase access to care for the urban American Indian population, a collaboration was developed between an Urban Indian Health Clinic (UIHC) and Federally Qualified Healthcare Center (FQHC) to reduce financial barriers, increase patient access to affordable medications, and augment the integrated model of care. Objective: To describe the design and implementation of an innovative pharmacy model through a partnership between an UIHC and a FQHC. Methods: A collaborative partnership between an UIHC and a FQHC was developed to spread scarce 340B federal resources as a method to enhance patient care. The innovative practice model included the development of processes to (1) increase medication access to all patients by providing access to affordable medications at clinic and the provision of mail order services, (2) minimize program expenses through cost-sharing of a pharmacist salary, (3) expand clinical pharmacy programs (collaborative drug therapy management) to augment integrated patient care, and (4) optimize 340B cost savings for the clinic by establishing contracts and implementing adjudication software to obtain medication reimbursement from Medicaid and other third party insurances. Results: Through the cost-sharing of a pharmacist salary and use of remote verification, the majority of prescription medications were available to patients at the UIHC through implementation and expansion of an other outlet. Collaborative drug therapy management (CDTM) protocols were successfully implemented which allowed clinical pharmacy services to collaboratively manage chronic conditions. All adult primary care providers adopted the integrated patient care model. Third-party pharmacy insurance contracts were obtained and computer software was installed to allow for the adjudication of pharmacy claims, resulting in cost savings from medication reimbursement. Conclusion: The innovative collaborative partnership between an UIHC and an FQHC demonstrated how scarce federal resources can be leveraged using the 340B program to increase patient access to affordable medications. This innovative model reduced financial barriers to the clinic, and allowed for expansion of pharmacist led CDTM programs and augmentation of integrated clinical services. The cost savings observed from this novel program additionally fueled programmatic sustainability through reinvestment into the pharmacy program and is expected to continue to fund the program in the future.
Cyclic Fatigue and Creep Resistance Testing of the PUMA SystemTM
Authors: Ellington J. Kent , Stecco Kathy 
Published: January 2022

Category: Ankle; Basic Sciences/Biologics; Trauma Introduction/Purpose: The PUMA System (Panther Orthopedics, Sunnyvale, CA) is an FDA cleared. superelastic, nitinol based fixation device for the ankle syndesmosis which provides stabilization without over-compression or loosening due to creep from cyclic loading. Objective The objective of this study was to test resistance to lengthening (creep) of the PUMA System in cyclic fatigue testing. Methods: Five PUMA System devices, each having a nitinol Body consisting of six layers, were cycle-tested between 20/40 pounds per cubic foot (lb/ft3) polyurethane foam Bone Blocks (Figure 1).[1] The PUMA System devices were set up with an initial device Active Length of approximately 66 millimeters (mm) between their polyether ether ketone (PEEK) Anchor buttons. All devices were tightened to a minimum of 11.1 Newtons (2.5 pounds force) and cycled at 5 cycles per second (5 Hz) for 4500 cycles to 2.4 mm displacement. Device Active Length was recorded pre- and post-testing. Devices were visually inspected for any break in the 30 nitinol layers. [1] ASTM F1839: Standard Specification for Rigid Polyurethane Foam for Use as a Standard Material for Testing Orthopedic Devices and Instruments. Results: None of the 30 layers incorporated in the 5 PUMA SystemTM device Bodies failed due to cyclic fatigue. Also, there was little-to-no difference between pre- and post-testing Active Length ( Figure 2 ). More specifically an average increase of only 0.2% in length with a with a Standard Deviation of 0.16% evidences no significant creep (Table 1). Conclusion: The PUMA SystemTM allows for ankle syndesmosis repair with an implant that experiences no significant creep as demonstrated in cyclic-fatigue testing under challenging displacement cycle testing.
A Biomechanical Investigation on the Effects of Deep Deltoid Ligament Repair Combined with Flexible and Rigid Syndesmotic Fixation
Authors: Femino John E. , Hajewski Christina , Goetz Jessica E. , Duchman Kyle R. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: The role of deep deltoid ligament (DDL) repair in the setting of an unstable syndesmotic injury is largely unknown, and the optimal fixation strategy for syndesmosis stabilization is controversial. The purpose of this study was to investigate the effect of an augmented, anatomic repair of the DDL combined with flexible or rigid syndesmotic stabilization using a cadaveric model. Methods: 10 pairs of fresh-frozen through knee cadaveric specimens were used for biomechanical testing which included subjecting the specimens to 5 Nm of external rotation torque while under 750 N of axial compression. Whole-foot rotation angles were measured and rotation and translation of the fibula, tibia, and talus were tracked with optical motion capture. Specimens were tested intact and then after destabilization by sectioning the anterior inferior tibiofibular ligament (AITFL), posterior inferior tibiofibular ligament, interosseous ligament and membrane extending 7 cm proximal to the ankle joint, and both bands of DDL. The intact fibula was a surrogate for an anatomically fixed fibula. Each specimen underwent mechanical testing both with and without DDL reconstruction added to flexible syndesmotic stabilization using a suture button (SB) plus AITFL reconstruction. In the final test, the syndesmosis was rigidly stabilized using a 4.5 mm screw. Results: Destabilization increased the foot rotation under the applied axial load and torque to 170% (+-49%) of that of the intact case. After flexible syndesmotic stabilization (AITFL + SB) foot rotation was 109% (+-26%) of intact condition. Addition of the deltoid ligament reconstruction (AITFL + SB + DD) reduced rotation to 87% (+-31%) of the intact condition. Fixation with a screw alone came closest to the rotation of the intact specimen (93% +- 17% of intact), and like the flexible repair, the addition of DDL reconstruction to the screw increased rotational stability (85% +- 35% of intact). Conclusion: DDL reconstruction provides improved resistance to external rotation stress when added to both flexible and rigid syndesmotic stabilization. Although our results with both the flexible and rigid constructs demonstrated increased constraint to external rotation stress compared to the intact specimen, these results should be thought of as time zero data, and the implants likely experience some creep with early motion and graduated weight bearing. Our demonstration of increased stability with a deltoid ligament reconstruction suggests that this addition may be beneficial for unstable syndesmotic injuries.
Predictors of Deformity in Patients with Progressive Collapsing Foot Deformity and Valgus of the Ankle
Authors: Mansur Nacime S. , Lalevee Matthieu , Vivtcharenko Victoria , Dibbern Kevin N. , Ellis Scott J. , Deland Jonathan T. , Godoy-Santos Alexandre L. , Femino John E. , Auch Elijah , Netto Cesar de Cesar 
Published: January 2022

Category: Ankle; Hindfoot Introduction/Purpose: Markers of diagnosis and severity are well studied in patients with Progressive Collapsing Foot Deformity (PCFD). Medial facet subluxation (MFS) in weight-bearing computerized tomography (WBCT) has been established as an indicator of peritalar subluxation and an earlier detector of the disease. When the disease affects the ankle leading to a valgus talar tilt (class E), structures distal to this topography may behavior differently, trying to compensate proximal deformity. The aim of this study is to assess predictors of deformity in PCFD patients with and without valgus of the ankle. Our hypothesis is that MFS could not be used in class E patients as an accurate value for estimation and staging of PCFD. Methods: In this IRB-approved retrospective case-control study we analyzed WBCT acquisitions of 21 consecutive patients with PCFD presenting valgus of the ankle and 64 controls (flexible PCFD with no ankle involvement). MFS (percentage of uncoverage), middle facet incongruence angle, middle cuneiform-to-floor distance, forefoot arch angle, talonavicular uncoverage angle, hindfoot moment arm (HMA), Foot and Ankle Offstet (FAO) and talar tilt angle (TTA) were obtained and compared between groups using oneway ANOVA. A multivariate regression analysis was performed to evaluate which of the measurements influenced the alignment. A partition prediction model was also constructed to find how the variables contributed to the deformity and its aspects. Statistical significancy was set in p values <0.05. Results: We found differences among groups only for MFS, HMA, FAO and TTA, with a lower mean value of MFS in patients with valgus of the ankle. An inverse relation between MFS and TTA was obtained in this group, demonstrated by increase in the talar tilt and decrease in middle facet uncoverage. MFS affected FAO values in the control group (R2: 0.25) but not in the ankle valgus group (R2: 0.001), being that this last one was influenced mainly by the TTA (R2: 0.53). A FAO value higher than 12.14 was found to be a strong predictor of deformity at the ankle. Conclusion: MFS was lower in patients with PCFD and valgus of the ankle, demonstrated as a weak predictor of deformity severity. In this group of patients (class E), talar tilt angle and Foot and Ankle Offset should be used as disease markers. A FAO value above 12.14 must be appreciated as a possible sign of ankle involvement in PCFD patients.
Do Closed Suction Drains Affect Postoperative Wound Healing after Total Ankle Arthroplasty?
Authors: Moncman Tara G. , Fliegel Brian E. , Hameed Daniel , O'Neil Joseph T. , Pedowitz David I. , Daniel Joseph N. 
Published: January 2022

Category: Ankle Arthritis; Ankle Introduction/Purpose: Although most studies demonstrate no clear benefit of closed suction drains after total joint arthroplasty of the hip, knee, and shoulder, there is no study that has specifically looked at ankle arthroplasty. Despite the paucity of information regarding the potential benefit or lack thereof with postoperative closed suction drains after total ankle arthroplasty, they are still utilized in practice. The purpose of this study is to determine whether or not the use of closed suction drains after total ankle arthroplasty have an affect on wound complications in the first postoperative year. Methods: Following a 3:1 match of patients with-drains to those without-drains, 78 patients with-drains and 28 without-drains were included for analysis. The drain group consisted of patients who had drains placed in the immediate postoperative period and removed prior to discharge from the hospital. The without-drains group acted as the control. Demographic data including age, sex, tobacco use, alcohol use, and medical comorbidities (diabetes, bleeding disorders, anemia, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, history of leg ulcers or staphylococcus infection) were obtained. Follow-up data was collected and reviewed at 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, for minor and major wound complications, as well as wound-related re-operations. Results: At 2 weeks, 6 weeks, 12 weeks, 6 months, and 1 year postoperative, there was no statistically significant difference in wound complications with or without the use of a drain. Within the first postoperative year, a total of 4 (14.3%) patients with- drains and 24 (30.8%) patients without-drains had a wound complication. This was not statistically significant (p=0.148). The majority of wound complications were minor. A single superficial infection and two reoperations for major wound complications were noted, all of which were in patients who had a drain placed. Age, sex, tobacco use, alcohol use, as well as a history of diabetes, bleeding disorders, neuropathy, kidney disease, peripheral vascular disease, rheumatoid arthritis, and history of leg ulcers or staphylococcus infection were similar between both groups. A history of anemia was significantly higher in the drain group, however this was not associated with an increased risk of postoperative wound complications. Conclusion: The use of a closed suction drain did not have an effect on postoperative wound complications in the first year after total ankle arthroplasty surgery. Based on the equivocal results in this study and that there is no clear consensus on the use of drains after total ankle arthroplasty surgery, the authors feel it is up to the individual surgeon to determine the necessity of use on a case-by-case basis.
Correlation of First Metatarsal Sagittal Alignment with Clinical and Functional Outcomes Following the Lapidus Procedure
Authors: Nishikawa Danilo Ryuko , Duarte Fernando A. , Saito Guilherme H. , Miranda Bruno R. , Netto Cesar de Cesar , Prado Marcelo P. 
Published: January 2022

Category: Bunion; Midfoot/Forefoot Introduction/Purpose: Lapidus procedure (LP) for hallux valgus (HV) requires an adequate control of first metatarsal (M1) sagittal alignment to avoid dorsiflexion. Otherwise, clinical and functional impairment, including transfer metatarsalgia may occur. This study aimed to evaluate the effects of pre- and postoperative measurements of M1 sagittal alignment on clinical and functional outcomes, and whether these variations would lead to transfer metatarsalgia or not. Methods: 29 patients (36 feet) with a mean follow-up of 20 months after LP were reviewed. Clinical and functional data were assessed with the VAS for pain, AOFAS, LEFS and SF-12. SF-12 comprises physical and mental health scales (PCS-12 and MCS-12, respectively). Transfer metatarsalgia diagnosis was based on the clinical exam. M1 sagittal alignment analysis was based on the first metatarsal declination angle (FMDA) and Meary Angle (MA). Decrease of FMDA means that the M1 dorsiflected (Figure 1). Intermetatarsal angle (IMA) and hallux valgus angle (HVA) were assessed. Radiographic, clinical and functional measurements were compared. Intraclass Correlation Coefficients (ICC) were calculated for FMDA and MA. Linear regression was used to assess the association of Δ-FMDA and Δ-MA with clinical and functional questionnaires. Based on that, we assessed our sample at different cut-off points to evaluate whether a given Δ-FMDA and/or Δ-MA measurement was significantly related to the Δ-Questionnaires. Results: Pre- and postoperative ICC of FMDA was 0.90 and 0.91 and MA was 0.94 and 0.88, respectively. FMDA showed significant variation after the LP, but MA did not. IMA and HVA improved significantly. Significant clinical and functional improvement were observed, except in MCS-12. No patient developed transfer metatarsalgia. A direct correlation was found between ΔFMDA with Δ-PCS-12 and Δ-LEFS (p=.028 and p=.02, respectively), meaning that excessive dorsiflexion of M1 as measured by FMDA led to a decrease in PCS-12 and LEFS. We found that at the cut-off point of quartile 50%, in which our sample was divided equally, patients with Δ-FMDA below 3.2 degrees of dorsiflexion had significantly improved results on Δ-PCS-12 compared to those with greater values (p=.029) (Figure 2). Conclusion: The present study showed that excessive dorsiflexion of M1 led to decreased outcome scores as measured by PCS- 12 and LEFS. It supports that M1 dorsiflexion should be avoided after the LP. However, slight dorsal deviation can occur and, even so, satisfactory outcomes can be obtained. Further prospective and comparative studies with larger populations are required to evaluate the effects of M1 inclination on clinical and functional outcomes.
Union Rates of Talar Neck Fractures with Critical Bone Defects Treated with Autograft
Authors: Patch David A. , McMurtrie James T. , Frazier Mason , Wills Bradley , Prather John C. , Viner Gean C. , Hill Margie J. , Johnson Michael D. 
Published: January 2022

Category: Trauma Introduction/Purpose: The purpose of this study was to evaluate union of talar neck fractures with critical bone defects treated acutely with autologous tibial bone graft during primary osteosynthesis. We hypothesized that acute autografting leads to reliable union rates. Methods: A case series at a Level I trauma center was performed to identify patients who underwent open reduction and internal fixation of talar neck fracture with proximal tibial autograft between 2015 and 2018. Inclusion criteria were age greater than 18 years and displaced talar neck fracture with critical bone defect treated with tibial autograft. Critical bone defect was defined as a gap greater than 5mm in the sagittal plane and greater than 1/3 of the width of the talar neck in the coronal plane. Post-operative foot CT scans were obtained for all patients to assess for union. Primary outcome was union and secondary outcomes were malunion, avascular necrosis, post-traumatic arthritis, and patient-reported outcomes (PRO) including PROMIS (Patient Reported Outcomes Measurement Information System), Foot and Ankle Measurements: Activity of Daily Living and Sports (FAAM ADL/Sports), Visual Analogue Scale for feet (VAS), Foot Function Index (FFI), and Short Form-36 (SF-36). Results: Twelve patients were included in the series. The average age was 34 years (17-59). The Hawkins classification of the fractures were four type II (33%) and eight type III (67%). Five fractures (42%) were extruded tali. Four fractures (33%) were open fractures, all being type III fractures. Union was achieved in eleven patients (92%). Nonunion occurred in one patient (8%), who had an open, extruded talus fracture and was a heavy smoker. Avascular necrosis occurred in 11 patients (92%). Ten patients (83%) had radiographic tibiotalar post-traumatic arthritis (PTA), and 12 patients (100%) developed subtalar PTA. Average PROMIS score was 37 (32-45) and average FAAM ADL and Sports was 61 (31-87) and 31 (0-71), respectively. Average VAS was 5 (0-10) and average FFI was 49 (7-89). SF-36 scores showed fair to poor outcomes in the majority of patients. Conclusion: Tibial autograft in primary osteosynthesis of comminuted talar neck fractures with critical bone defects leads to reliable union rates and is an operative strategy that should be considered when treating these difficult fractures. Despite high union rates, secondary outcomes of AVN, PTA, and below-average PRO still occurred in the majority of patients.