bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multi-target therapy in a lupus patient with diffuse alveolar hemorrhage
Authors: Li Xue , Chen Yuxin , Zhang Jianyu , Li Ting , Chen Jian , Lu Yu , Yang Liu 
Published: November 2022

Background Systemic lupus erythematosus (SLE) is an autoimmune disease based on the pathology of small-vessel inflammation, which can affect multiple organs. Diffuse alveolar hemorrhage (DAH) is a rare and severe complication of SLE with high mortality, most commonly seen in young women. It often appears along with clinical manifestations of sudden dyspnea, hemoptysis, and rapid onset of hypoxemia, which develops into respiratory failure and even multiple organs damage. Case report The case of a 28-year-old female who was diagnosed with SLE complicated with DAH is presented here. The patient, who experienced recurring DAH, responded poorly to the common therapy of high-dose glucocorticoid plus cyclophosphamide and plasma exchange. After the treatment was adjusted to a multi-target regimen of glucocorticoid, tacrolimus, mycophenolate mofetil, and belimumab, the symptoms began to improve. Conclusion The multi-target regimen may be a new treatment strategy of SLE complicated with DAH.
Early, Intense Rehabilitation Fails to Improve Outcome After Intra-Striatal Hemorrhage in Rats
Authors: Fedor Britt A. , Kalisvaart Anna C.J. , Ralhan Shivani , Kung Tiffany F.C. , MacLaren Maxwell , Colbourne Frederick 
Published: November 2022

Background The formation and degradation of an intracerebral hemorrhage causes protracted cell death, and an extended window for intervention. Experimental studies find that rehabilitation mitigates late cell death, with accelerated hematoma clearance as a potential mechanism. Objective We assessed whether early, intense, enriched rehabilitation (ER, environmental enrichment and massed skills training) enhances functional benefit, reduces brain injury, and augments hematoma clearance. Methods In experiment 1, rats (n = 56) were randomized to intervention in the light (-L) or dark phase (-D) of their housing cycle, then to 10 days of ER or control (CON) treatment after collagenase-induced striatal intracerebral hemorrhage (ICH). ER rats were treated from 5 to 14 days after ICH. Behavior and residual hematoma volume was assessed on day 14. In experiment 2, rats (n = 72) were randomized to ER-D10, ER-D20, or CON-D. ER rats completed 10 or 20 days of training in the dark. Rats were euthanized on day 60 for histology. In both experiments, behavioral assessment was completed pre-ICH, pre-ER (day 4 post-ICH), and post-ER (experiment 1: days 13-14; experiment 2: days 16-17 and 30-31). Results Reaching intensity was high but similar between ER-D10 and ER-L10. Unlike previous work, rehabilitation did not alter skilled reaching or hematoma resolution. Varying ER duration also did not affect reaching success or lesion volume. Conclusions In contrast to others, and under these conditions, our findings show that striatal ICH was generally unresponsive to rehabilitation. This highlights the difficulty of replicating and extending published work, perhaps owing to small inter-study differences.
Midterm outcomes of endovascular treatment for infected aortic aneurysms: Single center experience
Authors: Suwanruangsri Veera , Bokerd Surakiat , Chinchalongporn Wanchai , Chanchitsopon Virapat , Inlao Peerapong , Kaviros Pruesttipong 
Published: November 2022

Objective The standard treatment of infected aortic aneurysms is open surgical repair but mortality rates remain high with the common cause of death being sepsis. Endovascular treatment of infected aortic aneurysms is another option and here we report the midterm outcomes of endovascular treatment for infected aortic aneurysms. Methods Thirty-four patients with infected aortic aneurysms underwent endovascular and hybrid repair between December 2012 and June 2021. The patients were evaluated for early and midterm outcomes including postoperative mortality, morbidity, recurrent aortic infection, and midterm survival. Results There were 34 patients who presented with infected aortic aneurysms with a mean age of 66.7 years (range, 26–89). Most of the patients presented with abdominal pain (94.1%) and fever (50.0%). The rate of positive blood culture for organisms was 32.4%. Salmonella was the most common organism. The procedures for treatment were endovascular repair using straight endograft, aorto-uni-iliac (AUI) endograft, bifurcated endograft, and thoracic endograft. Other procedures were endovascular repair with sandwich technique, chimney or periscope technique, and hybrid operation. The rate of in-hospital mortality and morbidity were 11.8% and 17.6%, respectively. Mean follow-up time was 21 months (range, 1–70). During the follow-up period, 7 (23.3%) patients had recurrent infection of aortic aneurysms and 5 patients required reoperation. Four patients died from septicemia and one patient died from cardiac disease. Male patients were more likely to have recurrent infection compared to females. The cumulative survival at 1 year and 2 years were 86.3% and 80.5%, respectively. Conclusion In this retrospective review of the endovascular treatment in the patients who presented with infected aortic aneurysms showed acceptable early and midterm outcomes.
Designing Intergenerational Spaces: What to Learn From Children
Authors: Norouzi Neda , Chen Jou-Chen , Jarrott Shannon , Satari Afrooz 
Published: November 2022

Objectives: Adopting recommendations of the United Nations Committee on the Rights of the Child, this study addresses the value of children’s input on the architectural design of the built environment of intergenerational shared sites and the intergenerational interactions that took place there. Background: Intergenerational programs bring children and older adults together, inviting them to interact, exchange ideas and support each other. Most intergenerational programs are planned by staff and often take place in a multipurpose room without direct input from child or older adult participants. Methods: Data for this study were collected through interviews and drawings from 16 children at three intergenerational centers in Hawaii, Kansas, and Virginia. The interviews were transcribed, analyzed, coded, and categorized. Child development experts analyzed the drawings to better understand how children experience their surrounding environment. Results: Four themes emerged from the triangulated data: (1) outdoor spaces offer rich opportunities for shared programming, (2) children enjoy sharing meals and snacks with intergenerational partners, (3) children recognize environmental features that facilitate or limit intergenerational interaction, and (4) varied spaces support to informal, brief intergenerational interaction. Our findings provide evidence in the value of involving children in designing intergenerational centers and programming. Conclusion: The children who participated in this study provided meaningful insight reflecting the experience of intergenerational activities and the impacts of the built environment on the quality and variety of these interactions.
Technology implementation in care practices for community-dwelling older adults with mild cognitive decline: Perspectives of professional caregivers in Quebec and Brussels
Authors: Dequanter S , Steenhout I , Fobelets M , Gagnon MP , Sasseville M , Bourbonnais A , Giguère A , Ndiaye MA , Lambert A , Gorus E , Buyl R 
Published: November 2022

Objective As worldwide population aging is accelerating, innovative technologies are being developed to support independent living among community-dwelling older adults with mild cognitive decline. However, the successful implementation of these interventions is often challenging. Until now, literature on implementation issues related to the specific context of older adults with mild cognitive decline is lacking and the few studies available do not focus specifically on the perspective of professional caregivers. Yet the perspective of these caregivers is important as they can be considered a key facilitator for technology implementation among this population. Therefore, this study was the first to examine technology implementation among community-dwelling older adults with mild cognitive decline from the broader perspective of professional caregivers. Methods In this qualitative study, two focus groups consisting of a heterogeneous pool of professional caregivers were conducted: one in Quebec (Canada, n = 6) and one in Brussels (Belgium, n = 8). Braun and Clarke’ method for thematic analysis, guided by a qualitative descriptive approach was applied to inductively identify themes from the data. Results We identified factors influencing technology implementation in older adults with mild cognitive decline on three levels: an individual level (e.g., characteristics of older adults with mild cognitive decline and professional caregivers’ attitude), an organizational level (e.g., lack of training among professional caregivers) and a level referring to the broader context (e.g., ethical considerations). Conclusions This study contributes to the research gap in knowledge on the needs of professional caregivers to facilitate technology implementation among the population of older adults with cognitive decline. Future directions for research, practice, and policy are given, more specifically to improve knowledge among caregivers and on the development of decision support to retrieve safe and effective technologies that suit patient-centered care.
Incidence and Epidemiology of Symptomatic Capitellar Osteochondritis Dissecans of the Elbow: A United States Population–Based Study Over a 25-Year Period
Authors: Uvodich Mason E. , Braig Zachary V. , Reinholz Anna K. , Till Sara E. , O’Driscoll Shawn W. , Morrey Mark E. , Sanchez-Sotelo Joaquin , Camp Christopher L. 
Published: November 2022

Background: There are limited data on the incidence of capitellar osteochondritis dissecans (OCD) in the United States (US) population. Purpose: To determine the incidence of symptomatic capitellar OCD in a representative US subpopulation and identify changes in its incidence over time and to investigate the relationship between the incidence of capitellar OCD and patient sex and age. Study Design: Descriptive epidemiology study. Methods: A retrospective review was performed of patients aged ≤24 years from Olmsted County, Minnesota, with symptomatic capitellar OCD over a 25-year period (1995-2019). Patients with acute osteochondral injuries, Panner disease, and hereditary arthropathy were excluded. Poisson regression was utilized to identify the predictors of a capitellar OCD diagnosis. Incidence rates (per 100,000) were assessed for changes over time. Age groups of younger (10-15 years) versus older (16-24 years) patients were compared. Results: A total of 45 patients (78% male) were identified. The mean age was 14.5 years (range, 10-24 years); 31 patients were in the younger group, and 14 patients were in the older group. Sport participation was seen in 89%of patients; 90% were overhead athletes, and 58% were throwing athletes. The incidence of capitellar OCD was 6.0 per 100,000 overall, 9.5 per 100,000 for male patients, and 2.6 per 100,000 for female patients. The incidence was highest for male patients in the younger group (15.3/100,000) and lowest for female patients in the older group (0.8/100,000). The estimated incidence rate ratio for younger versus older patients was 3.3 ( P < .001), and the incidence rate ratio for male versus female patients was 3.5 ( P < .001). There were no changes in the incidence of capitellar OCD over time as a continuous or 5-year categorical variable ( P = .290 and P = .460, respectively). Overall, 82% of patients were treated surgically. There were no significant changes in surgical rates over time. Conclusion: In this US subpopulation, the overall incidence of symptomatic capitellar OCD between the ages of 10 and 24 years was 6.0 per 100,000 over the 25-year period studied, which is higher than previously reported US estimates. Incidence rates and treatment strategies did not change significantly over time.
Forefoot Width Correction in Hallux Valgus after Rotational Scarf Osteotomy
Authors: Mombello Franco L. , Butteri Ana I. , Ortiz Cristian A. , Pellegrini Manuel J. , Carcuro Giovanni M. , Chaparro Felipe R. 
Published: November 2022

Category: Bunion; Other Introduction/Purpose: Hallux valgus is a common deformity represented by a wider forefoot, associated with pain, shoe restrictions, and cosmetic problems. The goal of hallux valgus surgery is to achieve a painless foot by realigning the deviated first ray, thereby reducing friction between bony prominences and regular footwear. There is limited evidence on the effect of osseous procedures after hallux valgus surgery on the width of the resulting foot. Methods: We retrospectively performed measurements of forefoot width (bony and soft tissues) on AP standard x-ray from the first metatarsal head to the fifth metatarsal head, pre-and postoperatively at 3 months. Results: Thirty patients met the inclusion criteria, with a total of 42 feet. Radiographically, the preoperative mean 1-5 metatarsal bony width was 89.30mm SD (5.8) to 80.42mm postoperative SD (3.5). Regarding the soft tissue width, the preoperative average was 102.45mm SD (6.4) to 98.3mm postoperative SD (5.1). The ICC between both observers was 'excellent' in most measures (range, 0.884-0.973). Values obtained had a significance of p<0.001. Size effect was considered medium-high, with 0.87 power. Conclusion: We report an objective reduction in the forefoot width, both bony and soft tissue, by means of 8.88mm (10%) and 4.12mm (4.1%), respectively after scarf akin osteotomy. These results are represented by better shoe comfort and aesthetics.
Impact of Pre-Operative PROMIS Depression Scores on Total Ankle Replacement Outcomes
Authors: Moon Daniel K. , Hewitt Michael A. , Buckley Sara E. , Albin Stephanie , Hunt Kenneth J. 
Published: November 2022

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Total ankle replacement (TAR) is an effective procedure to help patients with end-stage osteoarthritis regain mobility and function. While previous studies have suggested that pre-operative factors such as stress or depression may influence the success of TAR, there is limited literature investigating this relationship. The goal of this study is to evaluate differences in functional and pain outcomes following TAR from patients with high and average PROMIS depression scores. Methods: Patients enrolled in the Orthopaedic Foot and Ankle Outcomes Research (OFAR) platform who underwent total ankle replacement were retrospectively analyzed. Patients were included if they had PROMIS outcomes collected both pre- and 12- months post-operatively. Patients were grouped as 'no/low depression' if they scored below 60 on the PROMIS depression scale, and 'high depression' if they scored greater than or equal to 60 (one standard deviation from the population mean). Statistical differences were evaluated non-parametrically using Wilcoxon rank tests and Mann-Whitney U tests. Results: 36 patients who underwent TAR met inclusion criteria for analysis. Based on pre-operative PROMIS depression scores, 28 patients were categorized 'no/low depression' (ND), and 8 were categorized as 'high depression' (HD). Both groups showed significant improvement in PROMIS physical function and PROMIS pain interference at 12-months. While the HD group had a significantly higher baseline PROMIS pain interference (65.8) compared to the ND group (58.4, p < 0.05), there was no significant difference between the two groups at 12-months (50.5 vs. 47.6, respectively). Similarly, while there was a significant difference in PROMIS depression score pre-operatively between HD and ND (62.5 vs. 48.3, p < 0.05), there was no significant difference 12- months post-operatively (52.5 vs. 45.8). Conclusion: Our data suggests that patients with high pre-operative PROMIS depression scores may have worse baseline physical function and pain interference compared to other patients but see greater overall improvement after total ankle arthroplasty. Patients in the 'high depression' group also showed a significant improvement in PROMIS depression score 12- months post-operatively. Additional investigation of large, non-commercial outcomes databases, such as OFAR, may also help determine which surgical interventions impact mental health outcomes.
The Effects of Anxiety and Depression in Outcomes of Patients with Total Ankle Replacement
Authors: Nam Hannah , Martinazzi Brandon J. , Kirchner Gregory , Bonaddio Vincenzo , Koroneos Zachary , Manto Kristen , Ptasinski Anna , Aynardi Michael C. 
Published: November 2022

Category: Ankle Arthritis; Ankle; Other Introduction/Purpose: Pain control is important following TAA. Prior studies have reported that anxiety and depression are associated with worse outcomes after orthopaedic surgery. However, the association between anxiety and depression on patient reported outcomes following TAA is not well-defined. Therefore, the purpose of this study was to investigate the effects of anxiety and depression on postoperative reported pain control following TAA. Methods: Following institutional review board approval, a retrospective chart review was conducted for all patients that underwent TAA from 2018-2021 at our institution. Patients were separated into two groups. Group A consisted of patients with a documented pre-operative history of anxiety and depression and Group B consisted of patients without documented anxiety or depression. Electronic records were reviewed at 2- and 6-weeks following surgery. Statistical analysis was then run to determine the relative risk of poorly controlled pain postoperatively in patients with and anxiety and depression. Results: At our institution, from 2018-2021, 56 patients underwent TAA. The mean age of our cohort was 60.9 (Range, 56-83). In our cohort, 31 patients were male, 25 were female, the mean patient BMI was 33.8 (Range, 21-56.2), 8 patients reported poor pain control (14.3%) and 24 patients had anxiety or depression (42.9%). Of the patients with anxiety or depression, 4 reported poor pain control. There was no statistically significant increased risk of poor pain control in patients with a history of anxiety or depression (RR: 1.5; 95% CI: 0.4145 to 5.4279). Conclusion: Despite the increased risk of poor outcomes reported in patients with a history of anxiety and depression, the results from our cohort indicate that a history of anxiety or depression is not associated with going on to have poor pain control following TAA. Albeit, our sample size was small, warranting further investigation.
Connecting Fibers Between ATFL's Inferior Fascicle and CFL Transmit Tension Between Both Ligaments
Authors: Nunes Gustavo A. , Dalmau-Pastor Miki , Vega Jordi , Cordier Guillame 
Published: November 2022

Category: Basic Sciences/Biologics; Ankle Introduction/Purpose: The lateral ligament complex of the ankle has been extensively studied. Recently an anatomical study described a connection between anterior talofibular ligament inferior fascicle (ATFLif) and calcaneofibular ligament (CFL). The applicability and the mechanical role of these connections have not yet been studied and need to be clarified. The purpose of this study is to evaluate the connection between ATFLif and CFL through a dynamic measurement analysis. Methods: An anatomical study was performed in 13 fresh-frozen below-the-knee ankle specimens. Each specimen was dissected in a protocolized manner until the lateral ligaments were exposed. A complete injury to both ATFL's fascicles was created in the proximal third of the ligament. A displacement transducer specifically design was inserted in the CFL and in the lateral part of the calcaneus to test its lengthening. A traction of 1 kg weight (9.8 N) was applied to ATFLif while the transducer measured the lengthening that this force created in the CFL. Results: A total of 13 ankle specimens were carefully dissected. One specimen with signals of a prior traumatic injury of the ATFLif was excluded. A total of 12 specimens were included, 7 females and 5 males with an average age of 74 years (52-88 years). The right ankle was dissected in 6 specimens. ATFL was identified as a two-fascicled ligament in all cases. The fibers connecting the ATFLif and CFL were observed in all specimens. The displacement transducer showed lengthening in the CFL in all measurements with a median of 0.59 mm (SD 0.34). Conclusion: Connecting fibers between ATFLif and CFL are robust enough to transmit tension from one structure to the other.In the case of associated proximal lesions of the ATFLif and CFL, ligaments repair with a single suture may be considered. This can be applied in surgical procedures in patients with lateral ankle instability.
Gender and Geographic Trends Amongst Foot & Ankle Surgeons: Where are We and Where Do We Need to Improve?
Authors: Okereke Robyn , Janney Cory , Safavi Kiya Shazadeh , Rezvani Aryan 
Published: November 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.