bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zinc toxicosis in a cat associated with ingestion of a metal screw nut
Authors: Yu Jane , Jenkins Elizabeth , Podadera Juan M , Proschogo Nicholas , Chan Ringo , Boland Lara 
Published: November 2022

Case summary A 3-year-old female neutered domestic shorthair cat was presented for vomiting, inappetence and weight loss. The cat developed moderately regenerative anaemia, moderately increased alanine transaminase and alkaline phosphatase activities, hyperbilirubinaemia and prolonged activated partial thromboplastin time. Abdominal ultrasound identified gastric wall thickening and changes suggestive of pancreatitis. Gastroduodenoscopy identified a metal screw nut in the pylorus, which was removed with rat tooth forceps. Metal analysis and serum zinc concentration using leftover serum collected at admission were performed after screw nut removal. Serum zinc concentration was markedly elevated, confirming a diagnosis of zinc toxicosis. Metal analysis of the screw nut showed that the major metal component was zinc. The cat recovered after screw nut removal and supportive care. Clinical signs resolved and the serum zinc concentration reduced significantly after screw nut removal. Relevance and novel information Reports of zinc toxicosis in cats are scarce, possibly due to the more discriminating eating habits of this species. To our knowledge, this is the first report of zinc toxicosis causing haemolytic anaemia, liver enzyme activity increases, gastrointestinal signs and pancreatitis in a cat associated with ingestion of a zinc-containing metal object.
Systemic inflammation and risk of multiple sclerosis – A presymptomatic case-control study
Authors: Grut Viktor , Biström Martin , Salzer Jonatan , Stridh Pernilla , Lindam Anna , Alonso-Magdalena Lucia , Andersen Oluf , Jons Daniel , Gunnarsson Martin , Vrethem Magnus , Hultdin Johan , Sundström Peter 
Published: November 2022

Background C-reactive protein (CRP) is a marker of systemic inflammation. Increased levels of CRP in young persons have been suggested to decrease the risk of multiple sclerosis (MS). Objectives To assess CRP as a risk factor for MS. Methods Levels of CRP were measured with a high-sensitive immunoassay in biobank samples from 837 individuals who later developed MS and 984 matched controls. The risk of developing MS was analysed by conditional logistic regression on z-scored CRP values. Results Levels of CRP were not associated with MS risk. Conclusions We found no association between CRP levels and risk of MS development.
Intraoperative Neurophysiological Monitoring for Intradural Extramedullary Spinal Tumours
Authors: Baig Mirza Asfand , Vastani Amisha , Syrris Christoforos , Boardman Timothy , Ghani Imran , Murphy Christopher , Gebreyohanes Axumawi , Vergani Francesco , Mirallave-Pescador Ana , Lavrador Jose P. , Kailaya Vasan Ahilan , Grahovac Gordan 
Published: November 2022

Study Design Retrospective cohort study. Objectives Intraoperative neurophysiological monitoring (IONM) is widely used in spinal neurosurgery, particularly for intramedullary tumours. However, its validity in intradural extramedullary (IDEM) spinal tumours is less clearly defined, this being the focus of this study. Methods We compared outcomes for patients that underwent resection of IDEM tumours with and without IONM between 2010 and 2020. Primary outcomes were postoperative American Spinal Injury Association (ASIA) scores. Other factors assessed were use of intraoperative ultrasound, drain placement, postoperative complications, postoperative Eastern Cooperative Oncology Group (ECOG) score, extent of resection, length of hospital stay, discharge location and recurrence. Results 163 patients were included, 71 patients in the IONM group and 92 in the non-IONM group. No significant differences were noted in baseline demographics. For preoperative ASIA D patients, 44.0% remained ASIA D and 49.9% improved to ASIA E in the IONM group, compared to 39.7% and 30.2% respectively in the non-IONM group. For preoperative ASIA E patients, 50.3% remained ASIA E and 44.0% deteriorated to ASIA D in the IONM group, compared to 30.2% and 39.7% respectively in the non-IONM group (all other patients deteriorated further). Length of inpatient stay was significantly shorter in the IONM group ( P = .043). There were no significant differences in extent of resection, postoperative complications, discharge location or tumour recurrence. Conclusions Research focusing on the use of IONM in IDEM tumour surgery remains scarce. Our study supports the use of IONM during surgical excision of IDEM tumours.
Suspected Cannabis Vaping–Induced Pericardial Effusion
Authors: Maharaj Nicole , Swarath Steven , Seecheran Rajeev , Seecheran Valmiki , Seecheran Naveen Anand 
Published: November 2022

Pericardial effusions refer to an excess accumulation of fluid within the pericardial cavity. The etiology is diverse, with most cases being idiopathic in nature. We report a case of suspected cannabis vaping–induced pericardial effusion in a 31-year-old South Asian patient, which was successfully managed with high-dose aspirin, colchicine therapy, and cannabis vaping cessation. Key Clinical Message: Clinicians should be aware of the possible cardiovascular complications of cannabis vaping.
Quality of Recovery After Rotator Cuff Repair With Interscalene Liposomal Bupivacaine Versus Interscalene Nerve Catheter
Authors: Schoenherr Jay W. , Gonzalez Michael , Serrano Ricardo , Park Meredith , Lee Zachary , Cobb Kathryn , Howard Christopher , Flynn David , Li Quefeng , Grant Stuart , Bullard Ty 
Published: November 2022

Background: Interscalene nerve catheters have been proven to be effective in managing pain after rotator cuff repair (RCR) surgery. Liposomal bupivacaine is a newer approved therapy for use around the interscalene brachial plexus, but its analgesic efficacy has limited supporting data in various patient populations. Purpose/Hypothesis: The purpose of this study was to investigate the quality of recovery after arthroscopic RCR in patients who received either single-injection interscalene liposomal bupivacaine or an interscalene peripheral nerve catheter. It was hypothesized that interscalene peripheral nerve catheters would provide more reliable analgesia and improved patient satisfaction 48 hours after surgery. Study Design: Cohort study; Level of evidence, 2. Methods: Enrolled were 93 consecutive patients who underwent arthroscopic rotator cuff surgery at a single ambulatory surgery center between October 2020 and June 2021. Of these patients, 13 were lost to follow-up; thus, 80 patients were included in statistical analysis. One group of patients (n = 48) received a preoperative interscalene nerve block placed with 10 mL 0.5% bupivacaine and 10 mL 1.3% liposomal bupivacaine. The second group (n = 32) received a preoperative interscalene catheter with an initial bolus of 20 mL 0.25% bupivacaine and a 0.2% ropivacaine infusion by an elastomeric pump set at 10 mL/hr for 48 hours. The primary outcome was the difference between preoperative and 48-hour postoperative quality of recovery-15 (QoR-15) scores. Secondary outcomes included visual analog pain scores, opioid use, and patient satisfaction. Complications and adverse effects were also noted. The Kruskal-Wallis test was used to analyze means and standard deviations for continuous endpoints; Fisher exact test was used to analyze counts and proportions for categorical endpoints. Results: The liposomal bupivacaine group had a mean reduction of 3.9 in their postoperative QoR-15 scores, and the catheter group had a mean reduction of 25.1 in their postoperative QoR-15 scores, indicating a significantly worse functional recovery period compared with liposomal bupivacaine within the first 48 hours ( P < .001). Patients who received liposomal bupivacaine also had significantly lower pain scores on the second postoperative day, improved quality of sleep, and improved satisfaction with analgesia ( P < .05 for all). Conclusion: The use of interscalene liposomal bupivacaine demonstrated significantly improved quality of recovery when compared with interscalene nerve catheter after RCR.
A Comparison of Different Techniques for Measuring the Hindfoot Moment Arm on Weight-Bearing CT: An Inter and Intra-Observer Reliability Study
Authors: Sempson Sera , Zhu Mingjie , Gu Wanjun , Wang Chao , Sun Songmin , Zhang Ming-Zhu , Hunt Kenneth J. , Myerson Mark S. , Li Shuyuan 
Published: November 2022

Category: Hindfoot; Ankle Introduction/Purpose: The Hindfoot Moment Arm (HMA) has been used to evaluate the hindfoot alignment with the Saltzman weightbearing XRay images (1), and was recently introduced into the field of weightbearing CT (WBCT) by Saltzman et al (2). The authors of this study have noticed that when using the Saltzman WBCT HMA technique, it is very difficult to determine the specific 'one' image in coronal plane scans with the widest tibial diaphyseal to draw the long axis of the tibia. The purpose of this study was to introduce a modified technique of measuring HMA in WBCT scans and compare the inter and intra-observer reliabilities between the modified and the Saltzman WBCT HMA techniques. Methods: WBCT scans of ten healthy limbs were loaded in CubeVue software. The foot was aligned in the correct orientation in the transverse plane based on the 2nd ray and the heel and the HMA was evaluated using the modified and Saltzman techniques. Using the modified technique, the sagittal plane thickness of one scan cut was increased to include the full width and length of the tibia and the axis of the distal tibia was identified by connecting two circles tangential to both cortices of the tibia. The weightbearing point of the calcaneus was located and the HMA was evaluated by measuring the perpendicular distance of the calcaneus weightbearing point to the axis of the distal tibia with varus a negative and valgus alignment a positive value. Intraclass correlation coefficient (ICC) model was used to assess the intra- and interobserver reliability of the two HMA techniques in SAS 9.4. Results: Both techniques had excellent intra- and interobserver reliability (Saltzman WBCT HMA intra-observer ICC=0.97, Saltzman WBCT HMA inter-observer ICC=0.94, the modified WBCT HMA intra-observer ICC=0.99, the modified WBCT HMA inter-observer ICC=0.91) (Table 1). Conclusion: The modified WBCT HMA was equivalent to the Saltzman technique in both inter and intra-observer reliabilities. The authors found that the modified technique was easier and less time consuming to perform in identifying the axis of the tibia since the modified technique uses multiple cuts to restore the full thickness of tibia, which not only reduces potential error, but also saves time during measurements. Compared with a relatively shorter tibia in one cut, the reconstructed tibia provides a longer and clearer shaft to work with, which allows both proximal and distal circles to be drawn with higher precision (Figure 1). 1. Saltzman, C. L., & El-Khoury, G. Y. (1995). The hindfoot alignment view. Foot & Ankle International, 16(9), 572-576. 2. Arena, C. B., Sripanich, Y., Leake, R., Saltzman, C. L., & Barg, A. (2021). Assessment of hindfoot alignment comparing weightbearing radiography to weightbearing computed tomography. Foot & Ankle International, 42(11), 1482-1490.
Anterior Structures at Risk During Antegrade Subtalar Fusion: A Cadaver Study
Authors: Shah Ashish , Littlefield Zachary , Young Sean M. , Sanchez Thomas , Sankey Turner , Mihas Alexander K. , Young Matthew , Willis Chad B. 
Published: November 2022

Category: Hindfoot Introduction/Purpose: Talocalcaneal arthrodesis is the gold standard treatment for severe arthritis and has a wide range of techniques that have been described to achieve fusion. However, there is a lack of the complications associated with guide wire placement for the screw construct described in the literature. The aim of this study was to assess the proximity and structural damage to the various structures of the anterior foot resulting from guide wire placement in a top down subtalar arthrodesis procedure. Methods: Seven fresh-frozen below-the-knee cadaver specimens were randomly assigned to receive either a percutaneous or mini open approach for an antegrade subtalar screw placement. Blunt dissection was performed after each screw placement to determine the proximity of the anatomical structures of interest [superficial peroneal nerve (SPN), deep peroneal nerve (DPN), dorsalis pedis artery (DPA), dorsalis pedis vein (DPV), extensor hallucis longus (EHL), and the tibialis anterior (TA)] to the inserted hardware. The mean, standard deviation, and range for distances were calculated for all structures. Analysis of variance (ANOVA) was used to determine statistical significance. Results: Antegrade subtalar screw placement was performed percutaneously in four specimens and via a mini-open approach in three specimens. The guidewire was touching an anatomic structure of interest in the three specimens in the percutaneous groups and one specimen in the mini-open group. For the mini-open approach, the DPN, DPA, DPV, and EHL were uninjured but touching the guidewire on one cadaver. For the percutaneous approach, the DPN was uninjured but touching the guidewire on two cadavers, the DPA was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver, the DPV was uninjured but touching the guidewire on two cadavers and penetrated on a different cadaver, and the EHL was uninjured but touching the guidewire on one cadaver and penetrated on a different cadaver. Distance from each structure of interest to the screw head can be found in Table 1. Conclusion: This study shows the potential risks to anterior structures when placing an antegrade subtalar screw during fusion. We suggest that orthopedic surgeons exercise caution when performing critical steps of the procedure to minimize avoidable injury to structures of importance that may increase the morbidity of the patient.
Factors Affecting Patient Reported Outcomes after Surgical Fixation for a Lisfranc Injury
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Prahad Srihari R. , Luque-Sanchez Kevin S. , Reed Logan , Young Matthew 
Published: November 2022

Category: Bunion; Other Introduction/Purpose: Hallux valgus is a common deformity the foot and ankle surgeon will encounter that tends to have a progressive nature with a predilection for females. There are many operative techniques to appropriately treat HV however, there is limited literature focused on patient-reported outcomes for these procedures. In particular, we intend to compare patient- reported outcomes for those who had early (2 weeks postoperatively) vs standard weight-bearing (SWB) (6 weeks postoperatively) postoperative protocols after hallux valgus correction via the Lapidus procedure. Methods: A retrospective analysis of patients that underwent hallux valgus correction at our facility from 2010-2021 was conducted. Patients were selected if they underwent this correction via the Lapidus procedure. Basic patient demographics, preoperative and post-operative hallux valgus angles and intermetatarsal angles were recorded, type of hardware used for fixation, postoperative weight bearing protocol, complication rate, deformity recurrence, duration of symptoms, and any adjunctive procedures were all recorded utilizing the electronic medical record. Early weight-bearing (EWB) was defined as beginning a protected weight-bearing protocol at the two week visit. To evaluate outcomes, we utilized the Foot and Ankle Ability Measure (FAAM) survey as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 77 patients met criteria for this study with 20 patients having completed both the FAAM and PROMIS score surveys. The average time point at which the outcomes were collected was 5.65 years postoperatively ranging from 2.43 to 11.5 years. There were 35 patients in the EWB cohort and 42 in the SWB protocol. The average PROMIS physical function, pain interference, and depression scores for the EWB population was 45.96, 54.66, and 47.48 respectively vs 47.10, 48.34, and 50.21 in the SWB group. Patients in the EWB group reported their average activities of daily living (ADLs) via the FAAM subscale to be at 57% vs 62% in the SWB group. For the FAAM Sports Subscale, both groups reported fairly low numbers at 44% and 36% respectively. In this study, 1 patient experienced wound infection, 3 patients experienced nonunion (2 EWB, 1 SWB), and 1 patient experienced deformity recurrence. Conclusion: Preliminary results suggest equivalent results for EWB and SWB postoperative protocol for patients undering the Lapidus procedure. We plan to increase the power of our study for a more thorough investigation as well as conduct a more intensive statistical analysis to gain more insight on patient related factors and their effect on outcomes. We expect a higher number of patients to complete the PROMIS and FAAM surveys as we continue to reach out to these patients.
Factors Affecting Patient Reported Outcomes after Surgical Fixation of Lisfranc Injury
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Kothari Ezan A. , Young Matthew , Luque-Sanchez Kevin S. , Prahad Srihari R. 
Published: November 2022

Category: Midfoot/Forefoot; Trauma Introduction/Purpose: The Lisfranc joint accounts for a small percentage of all fractures and is typically caused by trauma, high falls, or from athletic injuries. The treatment can be divided into operative and non-operative management based on the extent of the injury. Currently, as to the best of our knowledge, there is no literature that assesses patient reported outcomes after surgical intervention for Lisfranc injuries. This study provides an overview of the relationship between PROMIS scores and overall outcomes of patients who underwent surgical management for Lisfranc injury. Methods: A retrospective analysis was conducted for patients that underwent Lisfranc surgical repair at our facility from 2010- 2020. Using the electronic medical record (EMR), basic patient demographics, mechanism of injury, presence of rheumatoid arthritis, osteopenia/osteoporosis, time from injury to surgery, type of intervention utilized (ORIF, pinning, arthrodesis), use of bone grafting, and surgical complications were recorded. To evaluate outcomes, we used the Patient Reported Outcomes Measurement Information System (PROMIS) survey and Foot Function Index (FFI) scores. Results: A total of 248 patients met the criteria for our study with 80 participants completing both the PROMIS and FFI surveys. The average PROMIS physical function, pain interference, and depression scores were reported as 43.2, 55.4, and 45.4, respectively. The average FFI scores in this population are as follows: FFI pain- 37.1, FFI disability- 34.2, FFI activity limitation- 12.35, and the average FFI total score was 30.95. There was a significant decrease in postoperative pain scores when compared to preoperative pain from 5.23 to 1.85 (p=0.046). Complications were fairly low in this population with 4 patients experiencing surgical site infection, 36 patients described problematic hardware, and 45 patients underwent revisional surgery. Conclusion: Preliminary results suggest surgical intervention for Lisfranc injuries may be viewed as satisfactory amongst patients. Further analysis to compare patient reported outcomes based on the type of surgical intervention, hardware used for fixation, and whether any patient demographic factors have any influence on these outcomes are being conducted. Our fairly large patient population has a time from surgery date ranging from 1.5 years to 11.2 years. We believe further analysis will also provide quality information on the long-term outcomes regarding Lisfranc injuries
Five-Year Minimum Patient-Reported Outcomes Following Isolated Gastrocnemius Recession for Plantar Fasciitis and Achilles Tendinopathy
Authors: Shah Ashish , Young Sean M. , Littlefield Zachary , Boyd Brandon , Murali Sudarsan , Young Matthew , Luque- Sanchez Kevin S. 
Published: November 2022

Category: Hindfoot; Other Introduction/Purpose: Plantar fasciitis and Achilles tendinopathy are common foot and ankle overuse conditions encountered in clinical practice. Treatment modalities for these diagnoses vary however, isolated gastrocnemius recession may be a viable treatment option for these conditions when conservative management has failed. There is little published on the long-term outcomes of this procedure with very few studies able to report on the five-year reported outcomes in these patients. Here, we assess patient-reported outcome in those with a minimum of five-year follow up that underwent isolated gastrocnemius resection for the above indications. Methods: A retrospective analysis of patients that underwent gastrocnemius recession at our facility from 2011 to 2018 was conducted. Patients were selected if they underwent an isolated gastrocnemius recession specifically due to Achilles tendinopathy or plantar fasciitis. Patients were excluded if they had a history of musculoskeletal disorders of a history of previous recession. Basic patient demographics, chronic use of fluoroquinolones and NSAIDs, duration of symptoms, presence of rheumatoid arthritis, history of previous foot and ankle operations, and surgical complications were all recorded. To evaluate outcomes, we utilized Foot Function Index (FFI) scores as well as the Patient Reported Outcomes Measurement Information System (PROMIS) survey. Results: A total of 141 patients met inclusion criteria with all individuals completing both the PROMIS survey and 115 completing the FFI survey. The average time point at which outcomes were collected was 6.6 years postoperatively. Postoperative PROMIS scores for physical function, pain interference, and depression were all within one standard deviation of the reference population. The average PROMIS physical function, pain interference, and depression scores for this population was 45.67, 50.87, and 41.20, respectively. The mean FFI scores were 28.58 for pain, 36.11 for disability, 21.11 for activity limitation with an average total FFI of 31.40. Six patients developed surgical site infection, 36 patients reported postoperative symptoms of sural neuropathy with 12 reporting complete resolution of the neuropathy, and four patients required revisional surgery. Conclusion: With the limited data regarding the long-term outcomes of gastrocnemius recession, we sought to explore patient- reported outcomes in terms of pain, disability, physical function, depression, and pain interference. Our results prove that gastrocnemius recessions for Achilles tendinopathy and plantar fasciitis can lead to long term satisfaction for patients and can expect relatively low complication rates during the process. Additionally, the high retention rate of patients answering all required patient surveys further strengthens the findings reported here.