Resection of Bar in the Management of Calcaneonavicular Coalition: A Systematic Review.

The most commonly encountered type of tarsal coalition in symptomatic patients is the calcaneonavicular coalition. Non-surgical treatments are effective for most patients. However, if surgery is required, excision of the calcaneonavicular bar can be a successful option that preserves hindfoot mobility and function. We conducted a systematic review of calcaneonavicular bar excision in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) checklist. To conduct the review, we conducted a thorough search of several databases, including PubMed, Cochrane, Excerpta Medica Database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Google Scholar, and bibliographies. We analyzed the chosen studies to collect information on patient demographics, clinical outcomes, surgical techniques, and potential complications. We identified 11 studies that included 274 patients for a total of 394 feet. The average age of patients in these studies was 12.5 years, ranging from 8.2 to 19.4 years. Follow-up periods varied from 2.3 to 23 years, with an average duration of 5.9 years. Excision of the calcaneonavicular bar was performed at 380 feet, while fusion was performed at 14 feet. In 50.5% of the feet, the extensor digitorum brevis was used as an interposition material. Successful outcomes after bar excision were observed in 82.9% of cases (304 feet) and were described as satisfactory, improved, good, or excellent outcomes. In one study, the American Orthopaedic Foot and Ankle Society (AOFAS) score improved from 47.89 to 90.22 in 12 feet after bar excision. Recurrence was reported in 52 feet out of the 380 feet that underwent bar excision. Progression of arthritis in the ankle and subtalar joint was reported in 25 feet. Various complications were reported, including paraesthesia in the hindfoot (three feet), midfoot pain (three feet), hindfoot pain (two feet), mild wound infection (one foot), and swelling and stiffness (one foot). Surgical excision of the calcaneonavicular bar has shown successful outcomes in most patients, regardless of the use of interposition material. These outcomes are associated with minimal and acceptable complications. However, since the studies conducted in the literature were single-center retrospective and prospective trials, a multicenter prospective study with patient-centered, validated outcomes would provide a better opportunity to support the evidence in favor of surgical excision of the calcaneonavicular bar. Overall, the use of various interposition materials is associated with reduced chances of recurrence compared to cases where no interposition material was used.

Pilot study of optical coherence tomography angiography-derived microvascular metrics in hands and feet of healthy and diabetic people.

Optical coherence tomography angiography (OCTA) is a non-invasive, high-resolution imaging modality with growing application in dermatology and microvascular assessment. Accepted reference values for OCTA-derived microvascular parameters in skin do not yet exist but need to be established to drive OCTA into the clinic. In this pilot study, we assess a range of OCTA microvascular metrics at rest and after post-occlusive reactive hyperaemia (PORH) in the hands and feet of 52 healthy people and 11 people with well-controlled type 2 diabetes mellitus (T2DM). We calculate each metric, measure test-retest repeatability, and evaluate correlation with demographic risk factors. Our study delivers extremity-specific, age-dependent reference values and coefficients of repeatability of nine microvascular metrics at baseline and at the maximum of PORH. Significant differences are not seen for age-dependent microvascular metrics in hand, but they are present for several metrics in the foot. Significant differences are observed between hand and foot, both at baseline and maximum PORH, for most of the microvascular metrics with generally higher values in the hand. Despite a large variability over a range of individuals, as is expected based on heterogeneous ageing phenotypes of the population, the test-retest repeatability is 3.5% to 18% of the mean value for all metrics, which highlights the opportunities for OCTA-based studies in larger cohorts, for longitudinal monitoring, and for assessing the efficacy of interventions. Additionally, branchpoint density in the hand and foot and changes in vessel diameter in response to PORH stood out as good discriminators between healthy and T2DM groups, which indicates their potential value as biomarkers. This study, building on our previous work, represents a further step towards standardised OCTA in clinical practice and research.

Microbiological Profile and Clinical Features of Septic Arthritis of the Shoulder: A 10-Year Cohort Single-Centre Study.

Introduction  Septic arthritis (SA) constitutes a pressing orthopedic emergency characterized by acute, non-traumatic joint pain. Timely diagnosis and intervention are imperative to avert complications such as chondrolysis and systemic sepsis. The etiology is predominantly hematogenous, necessitating an integrated approach involving surgical and microbiological modalities. Shoulder aspiration and microbiological analysis play pivotal roles in guiding treatment, especially when positive findings prompt more aggressive therapeutic strategies. This study aims to elucidate the nuanced clinical and epidemiological characteristics of septic arthritis in both native and prosthetic joints within a singular institutional cohort over a decade. Methods  This retrospective case series analysis spanned a 10-year period, focusing on non-prosthetic shoulder joints from January 2012 to July 2021. In this timeframe, only 183 aspirations were performed and sent to the microbiology department for analysis, including cultures, microscopy, and antibiotic sensitivity tests for positive cultures. The study delved into the microbiological profile of infections, encompassing gram stain, culture positivity rates, identification of microorganisms, and antibiotic susceptibility patterns. Additionally, the incidence of primary joint infections with resistant strains, particularly methicillin-resistant Staphylococcus aureus (MRSA), was scrutinized. Statistical analysis utilized the SPSS program version 20.0 (IBM Inc., Armonk, New York), with a significance level set at 5%. The project, registered with the trust's clinical audit department (Reg #5372), adhered to the Declaration of Helsinki and good clinical practice guidelines. Data collection involved extracting non-identifiable patient modifiers from the laboratory database bank into Excel spreadsheets. Results  The study included 183 patients, with 108 (59%) females and 75 (41%) males. The average age was 76.2±16.5 years. Among them, 138 (75.4%) reported pain, and 15 (8.2%) had a body temperature over 37.8°C. Lab results showed a mean white blood cell count of 11.6±4.5 and an average C-reactive protein level of 121.7±102.1. Leucocytosis (>11,000 WBC) was seen in 82 (44.8%) cases. Elevated C-reactive protein (CRP; >10 mg/dl) was found in 136 (74.3%) patients. Synovial fluid analysis revealed no crystals in 91.3% of cases. Microbial resistance analysis showed 19 strains resistant to co-trimoxazole and 11 to erythromycin. Among co-trimoxazole-resistant strains, 73.7% were Staphylococcus aureus, a statistically significant association (p<0.001). Conclusion The evolving sensitivity patterns of microbes in septic arthritis underscore the necessity to reassess empirical antibiotic therapy. Subsequent joint damage resulting from infection can result in substantial disability.

A Clinical Audit of Orthopaedic Operation Note Documentation and Digitalization of the Operative Note Template: A Quality Improvement Project.

Background Good communication between a surgical team and other colleagues is vital, and the medium of communication is often the operative note. It is essential to ensure continuity of care between the operating team and other colleagues; also, it provides a medicolegal record of patient care. It checks all the four main domains of good surgical practice guidelines set by the Royal College of Surgeons (RCS) of England. The aims of this project were to evaluate the quality of operation notes against the set parameters by the RCS and to improve quality of the operative notes using information technology (IT) service software update to provide operative note digitalization. Methods This was a retrospective and prospective closed-loop audit, in which the operative notes were analysed for the Trauma and Orthopaedics speciality. Three separate cycles of audits were completed. In the the first cycle, data were collected retrospectively from all the operative notes, from June 1, 2020, to June 15, 2020; then, data were collected prospectively after making interventions to establish digitalization of the operative notes. The second cycle was completed from February 14 to 21, 2021, and from March 1 to 7, 2021. The third cycle was completed from August 1 to 31, 2021. All data were collected in Excel using a checklist that evaluated 34 parameters. These parameters were based on the recommendations of RCS Good Surgical Practice guidelines. All trauma and orthopaedic patients were included regardless of the type of procedure. There were no exclusion criteria in place. Results An overall increase from 9.5% to 66.7% in typed operative notes was achieved with the introduction of the templated operative note documentation service. There was a 40% reduction in the use of handwritten operative notes. Concerns regarding legibility were reduced in view of the digitalization of the operative notes. The first cycle of the audit, in terms of the parameters yielded, found that the operative notes were missing 10 important parameters, independent of the author grade; these were recorded in less than 10% of the operative notes. The second cycle, in terms of the parameters yielded, found that the operative notes were missing four important parameters, independent of the author grade; these were recorded in less than 10% of the operative notes. The third cycle of the audit, in terms of the parameters yielded, found that the operative notes were missing three important parameters. Specific documentation for 12 different parameters improved over the course of the three Plan-Do-Study-Act (PDSA) cycles. Conclusion Royal College of Surgeons guidelines and integration with IT services significantly improved the quality and legibility of operative notes that were being documented in the trauma and orthopaedics department. Structured document standards and good integration with a computer-based IT service help prompt surgeons to document in a better and easy way, thereby leading to improved clinical documentation.

OCTAVA: An open-source toolbox for quantitative analysis of optical coherence tomography angiography images.

Optical coherence tomography angiography (OCTA) performs non-invasive visualization and characterization of microvasculature in research and clinical applications mainly in ophthalmology and dermatology. A wide variety of instruments, imaging protocols, processing methods and metrics have been used to describe the microvasculature, such that comparing different study outcomes is currently not feasible. With the goal of contributing to standardization of OCTA data analysis, we report a user-friendly, open-source toolbox, OCTAVA (OCTA Vascular Analyzer), to automate the pre-processing, segmentation, and quantitative analysis of en face OCTA maximum intensity projection images in a standardized workflow. We present each analysis step, including optimization of filtering and choice of segmentation algorithm, and definition of metrics. We perform quantitative analysis of OCTA images from different commercial and non-commercial instruments and samples and show OCTAVA can accurately and reproducibly determine metrics for characterization of microvasculature. Wide adoption could enable studies and aggregation of data on a scale sufficient to develop reliable microvascular biomarkers for early detection, and to guide treatment, of microvascular disease.

Asymmetric Design of Spin-Crossover Complexes to Increase the Volatility for Surface Deposition.

A mononuclear complex [Fe(tBu2qsal)2] has been obtained by a reaction between an Fe(II) precursor salt and a tridentate ligand 2,4-di(tert-butyl)-6-((quinoline-8-ylimino)methyl)phenol (tBu2qsalH) in the presence of triethylamine. The complex exhibits a hysteretic spin transition at 117 K upon cooling and 129 K upon warming, as well as light-induced excited spin-state trapping at lower temperatures. Although the strongly cooperative spin transition suggests substantial intermolecular interactions, the complex is readily sublimable, as evidenced by the growth of its single crystals by sublimation at 573 → 373 K and ∼10-3 mbar. This seemingly antagonistic behavior is explained by the asymmetric coordination environment, in which the tBu substituents and quinoline moieties appear on opposite sides of the complex. As a result, the structure is partitioned in well-defined layers separated by van der Waals interactions between the tBu groups, while the efficient cooperative interactions within the layer are provided by the quinoline-based moieties. The abrupt spin transition is preserved in a 20 nm thin film prepared by sublimation, as evidenced by abrupt and hysteretic changes in the dielectric properties in the temperature range comparable to the one around which the spin transition is observed for the bulk material. The changes in the dielectric response are in excellent agreement with differences in the dielectric tensor of the low-spin and high-spin crystal structures evaluated by density functional theory calculations. The substantially higher volatility of [Fe(tBu2qsal)2], as compared to a similar complex without tBu substituents, suggests that asymmetric molecular shapes offer an efficient design strategy to achieve sublimable complexes with strongly cooperative spin transitions.

Upscaling feasibility of a graphite-based truncated conical microbial fuel cell for bioelectrogenesis through organic wastewater treatment.

In this research, efforts were put to demonstrate synergistic interactions between bioenergy generation and wastewater treatment. The extent of such synergistic effect was assessed against wastewater effluents released from the beverage industry through the operation of a membrane-less truncated conical (TC) microbial fuel cell (MFC). A graphite-based reactor was operated for five cycles in batch mode using beverage industry wastewater as an organic substrate. Maximum bioelectricity produced on the fifth operating cycle corresponded to a voltage of 338 mV and a power of 1.14 mW at 100 Ω. The MFC recorded a higher substrate degradation rate (0.84 kg of chemical oxygen demand [COD]/m3-day) accompanied by the development of an electroactive biofilm and polarization behavior (e.g., a reduction in internal resistance from 323 Ω to 197 Ω over five operation cycles). Cyclic voltammetry showed a maximum performance of the biofilm during the fifth cycle (through its enrichment) as interpreted by oxidation and reduction currents of 2.48 and -2.21 mA, respectively. The performance of the proposed MFC was superior to other designs reported previously in both effluent treatment and bioenergy generation. A maximum treatment efficiency of 84.4% (in 385 h) was seen at an organic load (COD) of 3500 mg/L with the specific power yield (0.504 W/Kg of substrate (COD) removal) and volumetric power yield (15.03 W/m3). Our experimental studies support that the proposed system could be upscaled to realize the commercial operation.