bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors Associated with the Development of Colorectal Anastomotic Strictures Prior to Diverting Loop Ileostomy Reversal
Authors: Sandilos Georgianna , Zhu Clara , Giugliano Danica N. , Kwiatt Michael , Wang Yize R. , Hunter Krystal , McClane Steven J. 
Published: January 2022

Background Anastomotic strictures represent a major source of morbidity in colorectal surgery with an incidence reported up to 30%. Despite this, the mechanism by which strictures develop remains unclear. This study aims to determine the incidence of colorectal anastomotic strictures and associated risk factors among a series of diverted patients. Materials and Methods A retrospective chart review was conducted of 142 patients over a 7-year period at a single institution after colorectal resection with anastomosis and diverting ileostomy creation re-examined with postoperative endoscopy. One patient was removed due to anastomotic tumor recurrence. Patient and technical factors were examined for significance using chi-square analysis. Logistic regression was used to perform multivariate analysis to estimate odds ratio (OR) and 95% confidence intervals (CI). Results Among 141 patients, 14.1% (20 patients) developed strictures detected on endoscopy. Strictures were observed in a greater percentage of women than men (21.2% vs 8%, P = .025). 30.6% of patients who underwent resections for diverticulitis developed strictures while those with neoplastic lesions and other indications had stricture rates of 6.8% and 17.6%, respectively ( P = .002). Anastomoses performed during a colostomy reversal were associated with a higher stricture rate (OR 4.23, 95% CI 1.37-13.40, P = .012). Anastomoses performed with a 28/29 mm EEA circular stapler demonstrated a significantly higher stricture rate versus a 31/33 mm stapler (OR 7.21, 95% CI 1.23-155.58, P = .045). Discussion Our data reveal that female sex, history of diverticulitis, anastomoses performed in the setting of colostomy reversal, and smaller stapler size are associated with a higher rate of anastomotic stricture.
Sleep-deprived electroencephalography, a forgotten investigation in psychiatry; a case series
Authors: Najand Babak , Christensen Andrew , Martin Michael , Spelman Mark 
Published: January 2022

Objectives Many patients with psychiatric disorders may have epileptic disorders; however, clinical diagnosis without imaging investigation may result in misdiagnosis and thus resistance to treatment. We investigated electroencephalography (EEG) abnormalities in the patients with psychiatric disorders referred to us with treatment resistance. Methods In this case series study, nine patients with mood and psychotic symptoms who were referred to us at Belmont Private Hospital, Australia, from August 2018 to July 2020, were evaluated. Results Complete examination showed the presence of undiagnosed temporal lobe epilepsy. Notably, the seizure symptoms had been assumed as part of other psychiatric co-morbidities. Conclusions This study suggests the necessity of paying attention to the biological etiologies of mental illnesses in the initial assessments in psychiatric and neurological practice. Performing electroencephalogram and treating such patients with mood stabilizers, which have antiepileptic properties, can change the course of the mental illness decisively.
Initiating a Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy Program Based on a Single Center Experience in Lebanon
Authors: Osman Bassam , Bou Akel Imad , Tulimat Tamam , Sfeir Pierre , Borgi Jamil 
Published: January 2022

Purpose In 2018, the American University of Beirut Medical Center established the first multidisciplinary Chronic Thromboembolic Pulmonary Hypertension and Pulmonary Endarterectomy program in Lebanon. The study describes the challenges faced in establishing the program and in improving patient referral, evaluation, and perioperative care. Methods The program establishment including the preparation phase, clinical evaluation, and team education is discussed. The implementation of the flow of patients referred to the program was established. Education regarding diagnosis and referral were provided to physicians in the community. The initial experience is described in a retrospective analysis of 4 consecutive patients who were diagnosed with CTEPH and underwent PEA. Results Four patients were diagnosed with CTEPH had PEA performed. The mean age of patients was 64 years. The average CPB and total circulatory arrest times were 244 and 23.9 minutes per side, respectively. No mortalities were encountered perio-operatively. All patients reported significant improvement in functional capacity from NYHA III and IV to a NYHA class of I with an average PASP decrease of 59.5 ± 19.7 mmHg and mPAP drop by 30.2 ± 16.3 mmHg. Conclusion The launch of the first CTEPH and PEA program in Lebanon, with a clear framework, coupled with good surgical outcomes is very encouraging. The program offers a curative solution for CTEPH patients in the region. A clear referral process and an increase in disease and treatment awareness in the community are crucial to the future success of the program, offering a definitive treatment, and avoiding delays to surgery.
An exploratory study: The effects of sleep systems on sleep quality, pain and carer goals for non-ambulant children and young people with cerebral palsy
Authors: Wood Nicola , Brown Sarah 
Published: January 2022

Introduction Sleep systems are supports used in lying, forming part of 24 h posture management programmes, for children and adults with severe motor disorders. Improved posture reduces likelihood of secondary complications such as pain and poor sleep quality, thus improving quality of life. The study aims are to investigate the effect of sleep systems on sleep quality and quantity, pain for young people with Cerebral Palsy and outcomes for carers. Methods Baseline data were gathered for 1 month prior to sleep system provision. Comparative data with the sleep system in place, were gathered for 5 months. The sample comprised four children with Cerebral Palsy, GMFCS level V, average age of 11.5, who did not have a sleep system. Data on sleep quality and quantity was gathered using the Chailey Sleep Questionnaire and sleep diaries and pain levels using the Paediatric Pain Profile. GAS Light verbal outcome measure was used to measure carer goals. Results Descriptive statistics and paired sample t-tests were used, demonstrating pain levels remained static, improvements in sleep quality and quantity were found and carer goals achieved. Conclusion A small sample size and subjective data collection methods were used; further research is required to obtain more conclusive results.
A Retrospective Comparison of Above- vs Below-the-Knee Cast Treatment for Salter Harris-II Distal Tibia Fractures
Authors: Dasari Suhas P. , Kukushliev Vasil V. , Graf Alexander R. , Liu Xue-Cheng , Van Valin Scott E. 
Published: January 2022

Background: Distal tibia fractures are common in the pediatric patient population. Recent reports suggest that patients with closed low-energy distal tibial fractures treated with short leg casts (SLCs) have similar radiographic outcomes with improved functional outcomes compared to those treated with long leg casts (LLCs). However, to date there has not been a study comparing these treatment modalities for Salter-Harris (SH) II distal tibia fractures. The purpose of this study was to compare the radiographic and time to weightbearing outcomes between patients with SH-II tibial ankle fractures treated with an SLC vs an LLC. Methods: A retrospective review on SH-II distal tibia fractures was performed at a Level I pediatric trauma center from 2013 to 2020. Primary outcomes included final coronal angulation, sagittal angulation, and time to weightbearing. Results: A total of 59 patients with SH-II distal tibia fractures were treated with an SLC (22 patients, median age 11.79 years) or an LLC (37 patients, median age 12.17 years). There was no statistically significant difference between the 2 treatment groups for coronal angulation at final follow-up, sagittal angulation at final follow-up, or percentage of patients fully weightbearing at 6 weeks ( P > .05). No patients required subsequent remanipulation or operative treatment in either treatment group. Conclusion: In this retrospective review with relatively short-term follow-up, SLCs were found to be noninferior to LLCs for treatment of reduced SH-II distal tibia fractures. This casting option may still be considered by surgeons who are nonoperatively managing pediatric distal tibia fractures. Level of Evidence: Level III, retrospective comparative study.
The Effect of Single vs Serial Platelet-Rich Plasma Injection in Osteochondral Lesions Treated with Microfracture: An in Vivo Rabbit Model
Authors: Dankert John , Yasui Youichi , Tonogai Ichiro , Mercer Nathaniel P. , Goodale Margaret B. , Fortier Lisa A. , Kennedy John G. 
Published: January 2022

Category: Ankle; Basic Sciences/Biologics Introduction/Purpose: Platelet-rich plasma (PRP) has gained increasing interest as a potential therapeutic augment for decreasing inflammation and enhancing healing after cartilage injury. However, it remains unknown whether osteochondral repair outcomes benefit from multiple PRP injections. We performed this animal study to investigate the effects of serial PRP injections on cartilage repair tissue, subchondral bone remodeling, and joint inflammation. Methods: Forty-eight adult New Zealand White rabbits were randomly assigned to receive either one (1P), two (2P), or three (3P) PRP injections. Cylindrical full-thickness cartilage defects with subsequent microdrilling were created on the central medial femoral condyle of both knees. PRP injections were provided on the day of surgery and every 2 weeks thereafter until the assigned number of injections was achieved for each group. Rabbits in each group were euthanized at 3, 6, or 12 weeks postoperatively. Cartilage repair tissue was assessed using the International Cartilage Repair Society (ICRS) macroscopic and modified ICRS histological scoring systems. Subchondral bone remodeling was evaluated by micro-computer tomography (µCT) analysis. Joint inflammatory cytokines including IL-1, IL-1ra, IL-6, IL-8, TNFα, and TGFβ were assessed by quantitative polymerase chain reaction. Results: Macroscopic assessment at 3 and 6 weeks demonstrated improved mean ICRS macroscopic scores in the PRP groups compared with the control group, although this difference was not significant. The mean ICRS macroscopic score at 12 weeks in Group 3P was significantly lower than the control, but there was no significant difference compared with Group 1P and Group 2P (Control: 6.1+-3.3, Group 1P: 3.4+-2.7, Group 2P: 4.2+-2.9, Group 3P: 0.7+-1.5). The mean modified ICRS histological score was significantly higher at each time point for the PRP groups compared with the control group, but there was no significant difference in the scores among PRP groups. There were no significant differences in outcomes for the characteristics evaluated by µCT nor inflammatory cytokine levels among each group at each time point. Conclusion: Serial PRP injections, as compared to a single PRP injection, do not have a significant impact on cartilage repair tissue nor inflammatory cytokine levels at 12 weeks after surgery in an in vivo animal model. Further work is necessary to determine the effect of single versus serial PRP injections on cartilage repair tissue in humans.
Suture Pullout in Human Cadaveric Skin: Evaluation of HEMIGARD® Augmentation vs Suture Alone
Authors: Lin Jason S. , Pearson Jacob , Pipitone Olivia 
Published: January 2022

Category: Other; Ankle; Midfoot/Forefoot Introduction/Purpose: Closure of high-tension surgical wounds is a challenge frequently encountered during surgical procedures. The use of a novel adhesive augmentation device, HEMIGARD, has been proposed to decrease tension on wound closure and thereby increase the amount of force needed for suture pullout. In principle, this may help prevent wound dehiscence, skin edge necrosis and the sequelae thereof. We hypothesized that HEMIGARD augmentation of suture placement would require more force for suture pullout from human cadaveric lower extremity skin when compared to suture alone. Methods: In this study, HEMIGARD with suture was compared to suture alone on leg and foot measurements from four cadavers. One side of the incision was used to test the HEMIGARD according to the manufacturer's instructions. The other side of the same incision was used to test the same suture material, passed without HEMIGARD, to allow for direct comparison. A force gauge was used to measure the Newtons of force required for suture pullout. A total of 30 measurements were recorded per cadaver; 15 using HEMIGARD and 15 using suture alone. Results: No difference was observed between HEMIGARD and suture alone in the amount of force required for suture pullout. When excluding instances of HEMIGARD adhesive failure, which occurred in 67% of measurements, the HEMIGARD was found to be superior to suture alone in the cadaveric foot, but not in the leg. Conclusion: The amount of force required for suture pullout from human cadaveric lower extremity skin did not significantly differ when using HEMIGARD augmentation of suture placement versus using suture alone. However, when excluding instances of HEMIGARD adhesive failure, the HEMIGARD may be superior to suture alone in the cadaveric foot, but not in the cadaveric leg.
Gender and Geographic Trends Amongst Foot & Ankle Surgeons: Where Are We and Where Do We Need to Improve?
Authors: Okereke Robyn , Janney Cory , Rezvani Aryan , Safavi Kiya Shazadeh 
Published: January 2022

Category: Other Introduction/Purpose: Clinical and elective experiences as well as the guidance of mentors are all critical factors in the pursuance of orthopedic residencies and fellowships. Women have historically been underrepresented in orthopedics. Some propose that the root cause lies in the lack of availability in the aforementioned factors. Previous studies demonstrated geographic differences in sex representation in orthopedic residency programs. Studies over geographic distributions of orthopedic foot and ankle (OFA) surgeons showed high variation in geographic density of OFA surgeons throughout the U.S. This study seeks to determine both the gender and geographic distributions of OFA surgeons as well as to determine geographic patterns between their training locations and current practices. Methods: AOFAS data regarding fellowship completion from 1988 through 2021 was analyzed with regards to gender and fellowship location. Internet searches were performed for all those identified within the database for their medical school, residency, and current practice location. This biographical data was obtained from their front-facing biographical webpage or hospital affiliation. States were placed into regions and subsequent divisions as defined according to the US Census Bureau definition: Northeast (New England and Middle Atlantic), Midwest (East North Central and West North Central), South (South Atlantic, East South Central, and West South Central) and West (Mountain and Pacific). Results: 1,088 OFA surgeons were analyzed. 168 (15.3%) were female and 922 (84.7%) were male. Female-held OFA fellowship positions increased over time, currently sitting at 13 (22% of all fellowship positions), with a maximum of 15 (25%) in 2017. Geographically, the Pacific had most females (n=26, 15.6% of females), while East South Central had least (n=10, 6.0%). The South Atlantic had most males (n=193, 20.9% of males) while East South Central had least (n=59, 5.3%). The region with the most OFA surgeons in total was the South Atlantic (n=218, 20.0% of the total) whereas the regions with the least were East South Central and New England (n=59, 5.4% in each). Conclusion: Although the amount of female OFA surgeons has increased, the numbers are still low. Geographically, the East South Central division of the U.S consistently had the least number of OFA surgeons whereas the South Atlantic division had the highest.
Red Blood Cell Distribution Width: A Novel Predictor of Mortality Following Amputation in Diabetic Foot
Authors: Park Jae Han , Park Kwang Hwan , Yoon Yeo Kwon , Han Seung Hwan , Lee Jin Woo 
Published: January 2022

Category: Diabetes Introduction/Purpose: Red blood cell distribution width (RDW), reflects the degree of heterogeneity of erythrocyte volume, has been found to be a significant prognostic factor in various human disorders. Herein, we assessed the value of RDW as a prognostic factor in diabetic foot amputation. Methods: Data of 415 patients with diabetic foot underwent amputation between January 2009 and January 2019 were analyzed retrospectively. After establishing a cut-off point of preoperative RDW for all-cause mortality, Cox proportional hazard model for mortality and logistic regression analysis for length of hospital stay more than 1 month were performed with other variable Results: RDW >14.5% was a significant risk factor for mortality (hazard ratio, 2.55; 95% confidence interval [CI], 1.55 to 4.19) on multivariable-adjusted regression analysis. Other significant factors associated with mortality were age and kidney disease. High RDW was also associated with longer hospitalization over 30 days (odds ratio, 2.17; 95% CI, 1.29 -3.66). Conclusion: High preoperative RDW over 14.5% is an independent prognostic factor with increased mortality and longer hospitalization, implying that RDW may be a simple and inexpensive laboratory parameter for risk stratification in diabetic foot amputation.
Delayed Surgery for Ankle Fractures is Associated with Poor Patient Reported Outcome
Authors: Pilskog Kristian , Inderhaug Eivind , Odland Heid Elin J. , Gote Teresa B. , Fjeldsgaard Knut , Dale Håvard , Fevang Jonas M. 
Published: January 2022

Category: Trauma; Ankle Introduction/Purpose: Several studies discuss the relation between prolonged time to surgery and postoperative complications in ankle fractures, but little is known about how a longer wait affects clinical outcomes. The present study, therefore, aims to assess the association between time from injury to surgery and patient-reported outcomes after operative treatment of severe ankle fractures. Methods: Patients treated operatively for low-energy ankle fractures which also involve the posterior malleolus from 2014 to 2016 were included. Patient charts were reviewed for patient demographics, type of trauma, fracture characteristics, treatment given, and complications. Ankle function was evaluated on a follow-up visit by clinical examination, radiographs and patient- reported outcome measures (SEFAS, RAND-36, VAS of Pain, VAS of Satisfaction). For analyses, patients were stratified based on time from injury to definitive surgery; Group 1: within the same day, Group 2: 1 to 7 days after injury, and Group 3: later than 7 days after injury. Results: Follow-up visits of 130 patients were performed at median 25 (Interquartile range (IQR), 19-34) months after surgery. Patient demographics and fracture characteristics were similar between groups. Median SEFAS was 40 in Group 1 (IQR 33-43), 41 (IQR 33-44) in Group 2, and 33 (IQR 27-42) in Group 3. The difference between Group 1 and 3 (p =.03), and between Group 2 and 3 (p =.04) was statistically significant. Group 1 had the highest rate of mechanical irritation and secondary surgery following malreduced fractures or missing syndesmotic fixation. Patients operated later than seven days from injury reported more pain than those treated earlier (p =.03). Conclusion: Time from injury to final surgery influenced clinical outcomes after these severe ankle fractures. Patients who waited more than seven days until definitive surgery had poorer clinical outcomes and more pain compared to those who had surgery within a week.
Quadrimalleolar Fractures of the Ankle: Principles and Medium-Term Results of Surgical Fixation
Authors: Rammelt Stefan , Kroker Livia , Neumann Annika P. 
Published: January 2022

Category: Ankle; Trauma Introduction/Purpose: Over the last decade, much attention has been paid to the fractures of the posterior malleolus as it became obvious that the mere presence of a posterior tibial fragment is associated with a less favorable prognosis in malleolar fractures. It seems logical to pay the anterior restraints of the ankle joint a similar attention as to the posterior ones. The anteriolateral distal tibia may be considered a 'fourth' or anterior malleolus. Here, we present a technique of fixation of trimalleolar fractures with additional fracture of the anterior tibial tubercle ('quadrimalleolar') or anterior fibular rim ('quadrimalleolar equivalent'). Methods: Twenty-four patients with a mean age of 60 years were treated with open reduction and internal fixation of all 4 malleoli. There were 17 quadrimalleolar and 6 quadrimalleolar equivalent fractures. One patient had both anterior tibial and fibular avulsion fractures in addition to a trimalleolar ankle fracture. Surgical approaches and internal fixation were tailored individually. Twenty patients were operated in prone position with direct fixation of the posterior malleolus and 4 patients in supine position with indirect anterior to posterior screw fixation of the posterior malleolus under transfibular control of reduction. Results: After fixation of al 4 malleoli, only one patient (4%) required a syndesmotic screw for residual syndesmotic instability on intraoperative testing. There were no infections, and no wound healing problems. All patients went on to solid union. No late fusions were needed. Nineteen patients (79%) could be reevaluated after a mean of 77 months (range, 15 to 156 months) follow- up. The Foot Function Index averaged 15 (range, 50 to 0), the Olerud and Molander Score averaged 79 (range, 45 to 100) and the AOFAS Ankle and Hindfoot Scale averaged 87 (range, 39 to 100). Conclusion: Fixation of the anterior and posterior tibial fragments increases syndesmotic stability by providing a bone-to-bone fixation. Reduction of displaced anterior and posterior tibial rim fractures restores the physiological shape of the tibial incisura and therefore facilitates fibular reduction. In the majority of cases, this also restores articular congruity of the lateral tibial plafond. Anatomic reduction of the anterior and posterior malleolus in addition to medial and lateral malleolar fixation leads to favourable functional results despite a complex (quadrimalleolar) fracture pattern.