bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Pathologic Achilles Insertion Angle (PAIA): A Novel Angular Measurement to Guide Both Evaluation and Treatment of Insertional Achilles Tendinopathy
Authors: Gu Wanjun , Zhu Mingjie , Carpenter Melissa L. , Hunt Kenneth J. , Myerson Mark S. , Li Shuyuan 
Published: November 2022

Category: Hindfoot; Sports Introduction/Purpose: Insertional Achilles tendinopathy (IAT) refers to calcified enlargement of the Achilles insertion. Recently, the Zadek osteotomy has been proven to be an effective and minimally invasive procedure for IAT with a dorsal-based closing wedge osteotomy on the posterior tuberosity of the calcaneus. However, determining the wedge size and location to determine the exact enlargement of the tuberosity remains clinically challenging. The goal of this study was to examine the morphology of the calcaneus in both normal control and IAT groups, and to propose a novel algorithm to determine the angular measurement to guide treatment with a Zadek osteotomy. Methods: Lateral weightbearing images of 40 control feet were used to determine the size of the calcaneus and contour of the tuberosity. The shape of the calcaneus was mapped onto part of a circle the Standard Circle (SC) whose center and radius were statistically fitted and scaled in relation to the height and width of the calcaneus. The diseased tuberosity of 40 patients with IAT was outlined and compared to their respective SC's. An angle was calculated by which the diseased calcaneus curve was rotated around the weightbearing point to fit the SC. We defined this angular measurement as the Pathologic Achilles Insertion Angle (PAIA). The size of the PAIA should be the exact size of the Zadek osteotomy if the apex of the osteotomy is chosen at the weightbearing point of the calcaneus. The effect of moving the apex of the osteotomy anteriorly on the calcaneal pitch angle was calculated. Results: From the morphology of the 40 normal calcanei, the equation of the Standard Curve, R^2=(x+a)^2+(y+b)^2 was created to calculate the SC. The offsets of the center of SC and the radius of SC (a, b, and R) were scaled in relation to the width and height of the calcaneus. From the morphology of the 40 enlarged tuberosities in the IAT group, an algorithm was created to automate the calculation of PAIA. This represented the extent of the enlarged Achilles insertion, which also determined the size and location of the wedge to normalize the contour of the enlarged posterior tuberosity. Using the weightbearing point of the calcaneus as the apex of the osteotomy did not change the pitch angle of the calcaneus, but moving the apex of the osteotomy anteriorly reduced the calcaneal pitch angle determined by both the original PAIA and the calcaneal pitch angle of each specific foot. Conclusion: Based on mechanism of mapping and curve fitting, the newly developed PAIA, will not only guide evaluation of the enlarged tuberosity in IAT, but also calculate the size of the Zadek osteotomy taking the patient's calcaneus size, IAT enlargement size, and pitch angle in consideration.
Conservative Management of Lisfranc Injury: A Systematic Review
Authors: Guerreiro Fransiska , Abdelaziz Ahmed , Ponugoti Nikhil , Marsland Daniel 
Published: November 2022

Category: Trauma; Midfoot/Forefoot Introduction/Purpose: Lisfranc injuries range from sprains to fracture-dislocations of the tarsometatarsal joints which include injury to the Lisfranc ligament complex. Most require surgical intervention. However, apparently stable injuries can be managed nonoperatively. The aims of the current study were to perform a systematic review of outcomes following nonoperative treatment of Lisfranc injuries. Methods: Following PRISMA guidelines and PROSPERO registered, a review was performed of the literature (2000 - 2021) reporting Lisfranc injuries considered to be stable and initially managed nonoperatively. Following exclusions, 8 papers were identified; 1 prospective and 7 retrospective studies. A total of 220 patients were studied with a mean age of 39.8 years and mean follow up of 4.3 years. Outcomes included function, displacement, rates of surgery and secondary osteoarthritis. Results: Four papers reported good outcomes, with adjusted functional scores ranging from of 82.6 to 100 (out of 100). However, poor outcomes were frequently reported. One paper reported that late displacement occurred in 54% of patients. Surgical intervention was required in 12.2 to 55.6% of patients. Rates of secondary osteoarthritis were 4.9 to 37.5%. Two papers directly compared operative to non-operative treatment. In an injury matched cohort, superior outcomes were reported in the surgical arm. Numerous limitations were identified, including a lack of consensus on what constitutes a stable injury. Furthermore, wide heterogeneity was identified due to use of different classification systems, PROMS, investigation modalities and treatment protocols. Conclusion: Reported outcomes following nonoperative treatment of Lisfranc injuries vary widely, including high rates of conversion to surgery. There is no agreed definition of what a stable Lisfranc injury is, and no agreed treatment protocol. With the advantage of modern imaging techniques, prospective research is needed to determine which Lisfranc injuries can be safely treated nonoperatively.
Comparison of Arthroscopic, X-ray and MRI T2 Mapping Findings for Varus Ankle Osteoarthritis
Authors: Hio Naohiro , Taki Masanori 
Published: November 2022

Category: Ankle Arthritis; Arthroscopy Introduction/Purpose: We have previously reported the indication criteria for supramalleolar osteotomy for varus ankle osteoarthritis using our arthroscopic classification. However arthroscopy is invasive, MRI T2 mapping (T2M) is also useful for noninvasive preoperative assessment of articular cartilage condition. The purpose of this study is to investigate the relationship among these. Methods: The subjects were 19 patients with 19 joints, 3 males and 16 females, mean age 65.2 years (45-78), 3 joints in stage 2, 8 joints in stage 3a, and 8 joints in stage 3b according to radiographic classification by Takakura et al. Measurements were taken on the coronal section of the talar dome. To evaluate the arthroscopic findings, we used our five grades classification, which is based on the percentage of eburnation areas on the articular surface, we measured the percentage of the area of the missing joint space to the width of the talar dome in X-rays and the ratio of the area of cartilage signal loss to the width of the talar dome in T2M. We determined how well the radiographic and T2M findings match the arthroscopic findings. Results: The results showed that there were 2 joints in grade 2, 15 joints in grade 3, and 2 joints in grade 4 in arthroscopic classification. The concordance rate between arthroscopy and X-rays measurements was 100% (2 joints/2 joints) for grade 2, 46.7% (7/15) for grade 3, and 0% (0/2) for grade 4. In all 10 unmatched joints, X-rays underestimated the condition of the articular cartilage compared to arthroscopic findings. The concordance rate between arthroscopy and T2M measurements was 50% (1/2) for grade 2, 80% (12/15) for grade 3, and 100% (2/2) for grade 4. Two joints were underestimated and two were overestimated by T2M compared to the arthroscopic findings. Conclusion: Compared to arthroscopic findings, X-rays tended to underestimate the condition of articular cartilage, while T2M tended to overestimate it, but in general, T2M showed a higher concordance rate with the arthroscopic findings than X-rays. T2M is more useful than X-rays as a tool for cartilage evaluation to determine the operative method for varus ankle osteoarthritis.
Outcomes of Lisfranc Injuries Treated with Arthrex Internalbrace
Authors: Hoskins Meloria , Staub Jacob R. , Koroneos Zachary , Aynardi Michael C. 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Surgical treatment options for Lisfranc injuries include open reduction and internal fixation (ORIF) and primary arthrodesis. To date, various options of ORIF exist, including transarticular screws, dorsal plates, and more recently, flexible fixation methods such as suture button and InternalBrace (Arthrex Inc, Naples, FL).1-4 Flexible fixation techniques attempt to minimize post-surgical joint immobilization and prevent the articular cartilage damage seen with transarticular screws.4-6 Unlike other flexible fixation techniques, the InternalBrace avoids placement of a suture button on the medial cuneiform and prevents disruption of the tibialis anterior tendon.4,7 Patient outcomes have been reported for suture button and transarticular screw fixation; however, there is a lack of clinical data reported utilizing InternalBrace in Lisfranc injuries due to its recent FDA approval in 2019.1,2,4 Methods: A retrospective chart review was performed as part of a case study investigation of 9 patients who underwent ORIF with InternalBrace fixation by a single surgeon. Patients over 18 years of age were included. Results: The average follow-up time was 6.6 months (SD = 5.1 months). The average time to weight-bearing as tolerated was 6.8 weeks (n=9), while the average time to return to work/sport as tolerated was 14.3 weeks (n=7). The only complication noted at follow-up was hypersensitivity along the foot [1 (11%)] (Table 3). No hardware complications were noted at either 6-week and 12-week post-operative x-rays. Conclusion: In this retrospective chart review, the time to return to work/sport as tolerated was comparable to that of return to sport after ORIF with screws and combined bridge-plating (19.6 weeks) and suture button (19.4 weeks).8 Future research involving a larger cohort of patients is required and is currently being performed by our institution to further evaluate outcomes after use of the InternalBrace for Lisfranc injuries.
The Lateral Fibular Stress Test: High Variability of Force Applied May Lead to Under-Detection of Syndesmotic Instability
Authors: Ingall Eitan M. , Kaiser Philip , Ashkani-Esfahani Soheil , Zhao John Z. , Kwon John Y. 
Published: November 2022

Category: Ankle Introduction/Purpose: The lateral fibular stress test (LFST), also known as the hook or Cotton test, is commonly performed to assess syndesmotic instability intraoperatively. Several studies have determined that 100 Newtons (N) is the required force applied when performing the LFST to detect syndesmotic instability. We hypothesize that surgeons do not uniformly nor consistently apply 100N of force when performing the LFST and that substantial variation exists. Fundamentally, this could lead to under-detection of syndesmotic instability as surgeons may not be applying the requisite force in a consistent manner. Methods: A biomechanical SawBones lower leg model including simulated soft tissue envelope (SawBones inc., Vashon Island, Washington) was mounted to a board and a 1cm diameter hole was drilled across the tibia and fibula in the area of the syndesmosis. An industrial force gauge (Nidec-Shimpo, Kyoto, Japan) was then mounted. A metal extension piece was passed from the force gauge through the hole and positioned so that the tip was exposed on the lateral side of the model. A commonly utilized reduction clamp was affixed to the force gauge. Orthopaedic attending surgeons and trainees were asked to perform a series of LFSTs and to simulate the force they typically apply intra-operatively and this force was recorded in Newtons (N). Basic demographic data was collected on each participant. Results: 33 surgeons participated in the study, including 18 trainees. The median (IQR) force applied during the LFST was 96.42(71.42-126.33), 87.49 (69.19-117.40), 99.99(79.91-137.49), for the pooled group, attendings, and trainees respectively. Over half (54.5%) of all trials were less than 100N (57.8% of surgeons, 51.8% trainees). The distribution of pulls is shown in Figure 1. Intraobserver correlation was excellent within the overall cohort (0.92, p<0.001), trainees (0.90, p<0.001) and attendings (0.94, p<0.001), respectively. Inter-observer reliability was fair among the overall cohort (Kappa =0.28, p=0.49), and poor between the attendings (Kappa=0.11, p=0.69), and the trainees (Kappa=0.05, p=0.82), respectively. Conclusion: Our study demonstrates that the amount of lateral force applied by surgeons in a biomechanical ankle model when performing the LFST is variable and often less than 100N. Inadequate force application when performing the LFST may lead to under-detection of syndesmotic instability which may portend a poorer outcome. Either the intraoperative use of force gauges and/or specific practice outside of the operating theatre (to become familiarized with the proprioceptive feel of generating the requisite force) may permit surgeons to consistently apply the test in a manner that is clinically reproducible.
Anatomical and Radiological Description of the Spring Ligament Articular Facet (SLAF)
Authors: Kasture Sarang P. , Mistry Alpesh , Low Samantha , Fisher Andrew , Bond Alistair P. , Lambert Laura-Ann , Jayatilaka Lara , Philpott Matthew , Fisher Lauren , Mason Lyndon W. , Molloy Andrew P. 
Published: November 2022

Category: Basic Sciences/Biologics; Midfoot/Forefoot Introduction/Purpose: Spring ligament is a principle static stabilizer of the medial longitudinal arch. There is a triangular facet of fibrocartilage in its superomedial bundle that articulates with the talar head which is poorly described in the literature. The aim of this study was to carry out a formal anatomical and radiological description of the spring ligament articular facet (SLAF). Methods: Anatomically, we dissected 10 normally aligned cadaveric lower limbs. The spring ligament was approached from the superior direction. The talus was disarticulated and high-resolution images were taken of the ligament complex. ImageJ and Tracker software was used to calculate the surface area and the maximum linear measurements of the spring ligament articular facet (SLAF). 22 normally aligned feet were analysed on reformatted PD space sequences on MRI using PACS. Results: The meniscus was consistently trapezoid in shape in all specimens. The mean area of the SLAF was 203.31 mm2. The average longest proximal to distal length was 11.93 mm and at the shortest plantar and lateral margin was 5.34 mm. The attachment of the SLAF with calcaneum and navicular articular surface was defined by a distinct thick fibrous ligamentous structure that measured 3.67 and 1.69 mm at its medial and lateral margin on the calcaneal side and 2.72 and 2.87 mm respectively on the navicular side. SLAF was visible on MRI but it was not possible to differentiate between SLAF and its investing ligaments. MRI measurements showed a mean surface area of 354 mm2 with mean thickness of 2.7 - 4.3 mm throughout its course. Conclusion: The paper describes the anatomical and radiological parameters of SLAF, a constant fibrocartilaginous structure within the superomedial portion of the spring ligament, as well as its ligamentous attachments.
Novel Techniques for Acute Lengthening of Metatarsal for Treatment of Brachymetatarsia with 2cm and More Shortening
Authors: Khosroabadi Alireza 
Published: November 2022

Category: Midfoot/Forefoot Introduction/Purpose: Previous acute lengthening of metatarsal for the treatment of brachymetatarsia has been limited to 1cm. The success of acute lengthening has not been as predictable. I have successfully been able to acutely lengthen up to 2.2 cm with the use of allograft. I have successfully done this in 10 patients for the last 2 years. Methods: The method involves acute lengthening and transfer of the extensor longus and Brevis. A complete release of the MPJ which involves the entire capsule as well as the lumbricles and interosseus medial and lateral. Also I have created a 'joint spacer ' by using a fiber tape (Arthrex) which is made in to a donut shape and placed in the joint and held in placed with a k wire that is passed through the digit then through the spacer and further advanced to the metatarsal. This k wire is removed 6 weeks post op. I also use a temporary external fixator to distract the metatarsal segments after doing an Osteotomy at the base or the metatarsal. Once the appropriate length is achieved the allograft is cut to size and placed and secured with screws and an 8 hole plate. Then the temporary ex fix is removed. Tendons sutured and secured. Skin is closed. The only hardware that is exposed is the .062 k wire. 6 weeks post op. The k wire is removed and a Stab incision is made at the level of the MPJ and the spacer is removed. This will keep the joint space maintained which make the digit be able to move after such a large acute lengthening. Part of the Peotocol is to have the foot in good compression by using a 3M 2 layer compression system. Which keeps the incision from opening. Results: For the past 2 years I have performed 10 acute metatarsal lengthening successfully with minimal complications. This method is reproducible by any foot and ankle surgeon Conclusion: Using this step by step technique has resulted in a predictable and successful outcome. Previously the lengthening of a short metatarsal has been limited to 1cm and below if you wanted to outcome to be good and without major complications such as MPJ subluxation and digital deformity and most importantly not being able to lengthen the metatarsal to its appropriate length. This novel technique can be done in any ambulatory surgical setting. It also uses allograft which makes its less painful for the patient and decreases the complication rate when compared to using autograft
Inactivation of the MSTN gene expression changes the composition and function of the gut microbiome in sheep
Authors: Du Chenchen , Zhou Xianhui , Zhang Ke , Huang Shuhong , Wang Xiaolong , Zhou Shiwei , Chen Yulin 
Published: November 2022

Abstract
Background
Myostatin (MSTN) negatively regulates the muscle growth in animals and MSTN deficient sheep have been widely reported previously. The goal of this study was to explore how MSTN inactivation influences their gut microbiota composition and potential functions.

Results
We compared the slaughter parameters and meat quality of 3 MSTN-edited male sheep and 3 wild-type male sheep, and analyzed the gut microbiome of the MSTN-edited sheep (8 female and 8 male sheep) and wild-type sheep (8 female and 8 male sheep) through metagenomic sequencing. The results showed that the body weight, carcass weight and eye muscle area of MSTN-edited sheep were significantly higher, but there were no significant differences in the meat quality indexes. At the microbial level, the alpha diversity was significantly higher in the MSTN-edited sheep (P < 0.05), and the microbial composition was significantly different by PCoA analysis in the MSTN-edited and wild-type sheep. The abundance of Firmicutes significantly increased and Bacteroidota significantly decreased in the MSTN-edited sheep. At genus level, the abundance of Flavonifractor, Subdoligranulum, Ruthenibacterium, Agathobaculum, Anaerotignum, Oribacterium and Lactobacillus were significantly increased in the MSTN-edited sheep (P < 0.05). Further analysis of functional differences was found that the carotenoid biosynthesis was significantly increased and the peroxisome, apoptosis, ferroptosis, N-glycan biosynthesis, thermogenesis, and adipocytokines pathways were decreased in the MSTN-edited sheep (P < 0.05). Moreover, carbohydrate-active enzymes (CAZymes) results certified the abundance of the GH13_39, GH4, GH137, GH71 and PL17 were upregulated, and the GT41 and CBM20 were downregulated in the MSTN-edited sheep (P < 0.05).

Conclusions
Our study suggested that MSTN inactivation remarkably influenced the composition and potential function of hindgut microbial communities of the sheep, and significantly promoted growth performance without affecting meat quality.
Life-threatening hypotension in the immediate postoperative period of cataract surgery under topical anesthesia: a report of two cases
Authors: Fostier Michele , Januleviciute Gintare , Fauconnier Fabrice , Collard Edith , Dubois Virginie 
Published: November 2022

Abstract
Background
Cataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur.

Cases presentation
We report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second.

Conclusions and importance
Even though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.
Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study
Authors: Hojo Takayuki , Kimura Yukifumi , Shibuya Makiko , Fujisawa Toshiaki 
Published: November 2022

Abstract
Background
Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used.

Methods
In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication.

Results
A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension.

Conclusions
In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.