Surgery for aortic re-coarctation in children less than 10 years old. A single center experience in Siberia, Russia

Background: Persistence or recurrence of stenosis is a complication of initial coarctation repair. This study aims to report short-term outcomes of surgical management of recurrent coarctation and initial repair analysis. Methods: We retrospectively reviewed our experience with 51 patients undergoing recoarctation surgical repair between 2008 and 2019 using antegrade cerebral perfusion technique. Results: Surgical correction included prosthetic patch aortoplasty in 23 (45%), resection with wide end-to-end anastomosis in 15 (29%) and a tube interposition graft in 13 (25%) patients. Median age at initial correction and reintervention were 12 month and 9 years. Median interval from primary repair to reintervention was 60 months. Initial repair analysis revealed 33% of patients had initial correction in the neonatal period, 72,5% of patients were done via a left thoracotomy approach and 63% of patients had end-to-end anastomosis at initial surgery. Conclusion: Our study demonstrates that surgical repair of recurrent coarctation of the aorta using antegrade cerebral perfusion technique can be performed safely and with excellent results.

Ponseti treated idiopathic clubfoot - outcome predictive factors in the test of time: analysis of 500 feet followed for five to 20 years

Purpose To investigate a set of risk factors on the outcome of Ponseti treated idiopathic clubfeet (ICF). Methods This study was approved by the institutional review board. A retrospective analysis of prospectively gathered data over a 20-year period, at a single dedicated clubfoot clinic. Records of 333 consecutive infants with 500 ICF were analyzed. Initial Pirani score, number of casts, need for tenotomy, foot abduction brace compliance and functional score had been documented. The need for surgery after initial correction was the outcome measure. All children were followed by the same team throughout the study period. Descriptive statistics, chi-squared and multivariate analysis were performed. Results In total, 82 children (24%) with 119 feet (23.8%) were operated on, with 95.1% of feet being operated up to the age of nine years. There was a significant correlation between the Pirani score at presentation and the number of surgical procedures (chi-squared = 79.32; p < 0.001). Achilles tenotomy was done in 94.8% of patients. Pirani score of > 4.5 before casting was strongly associated with increased surgical risk (odds ratio = 1.95). When six to eight cast changes were needed, surgical prospect was 2.9 more, increasing to 11.9 when nine or more casts were needed. Conclusion Foot severity and number of cast changes were the strongest predictors for future surgery. Estimation of the risk of deformity recurrence after initial correction may help in tailoring a cost-effective personal treatment and follow-up protocol. Personalized focused protocol will help patients and caregivers and will reduce expenses. Level of Evidence Level II - prognostic study.

Reconstructive surgery in recurrent deformity (clubfoot relapse)

Introduction Recurrent clubfoot deformity may be due to either an imperfect initial correction, or a natural history of a severe disease. In the later, idiopathic clubfoot is uncommon. In the review we describe reconstructive surgery in recurrent deformity of idiopathic clubfoot. Material and methods Surgery may be justified at different age and according to the type of deformity. Different surgical approaches and their indications are exposed in the article. Results After Ponseti’s method application additional surgeries may be considered in recurrent clubfoot deformity which may represent 10 to 20 % of cases: second Achilles tenotomy, postero-lateral relapse, complete antero-medial and postero-lateral relapse, transfer of the anterior tibial tendon, correction of sequelae: metatarsus varus, residual equinus, residual rotation of the calcaneopedal unit. Conclusion Idiopathic equine varus clubfoot is a frequent condition. Well-codified management should lead to extremely favorable functional results. Unfortunately, some cases lead to a recurrence of the deformity. Surgical procedures are sometimes required. The goal is to avoid as much as possible arthrodesis and secondary degenerative arthritis.

Author Middle Initial Correction: "Desensitization to Fear-Inducing COVID-19 Health News on Twitter: Observational Study" (Preprint)

BACKGROUND As of May 9, 2021, the United States had 32.7 million confirmed cases of COVID-19 (20.7% of confirmed cases worldwide) and 580,000 deaths (17.7% of deaths worldwide). Early on in the pandemic, widespread social, financial, and mental insecurities led to extreme and irrational coping behaviors, such as panic buying. However, despite the consistent spread of COVID-19 transmission, the public began to violate public safety measures as the pandemic got worse. OBJECTIVE In this work, we examine the effect of fear-inducing news articles on people’s expression of anxiety on Twitter. Additionally, we investigate desensitization to fear-inducing health news over time, despite the steadily rising COVID-19 death toll. METHODS This study examined the anxiety levels in news articles (n=1465) and corresponding user tweets containing “COVID,” “COVID-19,” “pandemic,” and “coronavirus” over 11 months, then correlated that information with the death toll of COVID-19 in the United States. RESULTS Overall, tweets that shared links to anxious articles were more likely to be anxious (odds ratio [OR] 2.65, 95% CI 1.58-4.43, P<.001). These odds decreased (OR 0.41, 95% CI 0.2-0.83, P=.01) when the death toll reached the third quartile and fourth quartile (OR 0.42, 95% CI 0.21-0.85, P=.01). However, user tweet anxiety rose rapidly with articles when the death toll was low and then decreased in the third quartile of deaths (OR 0.61, 95% CI 0.37-1.01, P=.06). As predicted, in addition to the increasing death toll being matched by a lower level of article anxiety, the extent to which article anxiety elicited user tweet anxiety decreased when the death count reached the second quartile. CONCLUSIONS The level of anxiety in users’ tweets increased sharply in response to article anxiety early on in the COVID-19 pandemic, but as the casualty count climbed, news articles seemingly lost their ability to elicit anxiety among readers. Desensitization offers an explanation for why the increased threat is not eliciting widespread behavioral compliance with guidance from public health officials. This work investigated how individuals' emotional reactions to news of the COVID-19 pandemic manifest as the death toll increases. Findings suggest individuals became desensitized to the increased COVID-19 threat and their emotional responses were blunted over time.

3DeeCellTracker, a deep learning-based pipeline for segmenting and tracking cells in 3D time lapse images

Despite recent improvements in microscope technologies, segmenting and tracking cells in three-dimensional time-lapse images (3D + T images) to extract their dynamic positions and activities remains a considerable bottleneck in the field. We developed a deep learning-based software pipeline, 3DeeCellTracker, by integrating multiple existing and new techniques including deep learning for tracking. With only one volume of training data, one initial correction, and a few parameter changes, 3DeeCellTracker successfully segmented and tracked ~100 cells in both semi-immobilized and ‘straightened’ freely moving worm's brain, in a naturally beating zebrafish heart, and ~1000 cells in a 3D cultured tumor spheroid. While these datasets were imaged with highly divergent optical systems, our method tracked 90–100% of the cells in most cases, which is comparable or superior to previous results. These results suggest that 3DeeCellTracker could pave the way for revealing dynamic cell activities in image datasets that have been difficult to analyze.

STUDY OF COMPARISON OF THE RECURRENCE PATTERNS IN CTEV PATIENTS WITH ADHERENCE TO BRACE PROTOCOLAND THOSE WITHOUT ADHERENCE TO BRACE PROTOCOL IN CHILDREN UP TO 5 YEARS.

BACKGROUND: The purpose of the study was to evaluate the comparative outcome of the recurrence pattern in congenital talipes equino varus (CTEV) patient’s upto 5 years old following Ponseti correction and brace application. METHODS: A study of prospectively collected cohort data of 94 newly diagnosed idiopathic CTEV patients who were managed conservatively with Ponseti correction followed by tendoachilles (TA) tenotomy in 90 % of patients and brace application. Patients were evaluated with Pirani scoring prior to commencing Ponseti correction and during follow up and the parents were asked regarding the compliance and acceptance of the brace by the child and the difficulties faced while the child was on brace. RESULT: Out of 94 patients in our study, recurrence of deformity was noticed in 13 patients, while 81 patients had totally normal functional foot. CONCLUSION: We conclude that the Ponseti method enables us to correct most clubfeet with gentle manipulation, casting and foot abduction brace. Experience with the Ponseti method and great attention to the details of manipulation and moulding of the cast are necessary to achieve initial correction rate of over 98%.

Revenue Sharing of a TOT Project in China Based on Modified Shapley Value

In recent years, China’s government has encouraged the adoption of the TOT (Transfer-Operate-Transfer) model to realize the marketization of China’s public service stock projects. The TOT model is a cooperation mechanism through sharing investment, revenue and risks between the government and private partner. Therefore, a fair and reasonable revenue sharing method (RSM) is the key to the success of the TOT project. This paper aims to provide a fair and reasonable RSM based on a modified Shapley value with a triangular symmetric fuzzy structure element, which has better motivation, flexibility, forecasting function and dynamic precise distribution function. According to the factors that affect revenue sharing, the Shapley value is improved with initial correction coefficient composed of investment ratio, risk-sharing ratio, execution degree, and fuzzy payment to achieve fairness and reasonableness. The methodology is illustrated by a case study of a TOT project selected from Laohekou city of Hubei province, China. The results testify that the revenue-sharing ratios of participants is positively correlated with the initial correction coefficient, which make the RSM more motivating; and the Shapley value with fuzzy payment by using triangular symmetric fuzzy element function make the RSM more flexible, and it has both forecasting function and precise dynamic distribution function under project revenue uncertainty.

Hallux Valgus Correction Using a Novel 3D Printed Plate: Retrospective Case Series with Two Year Follow-Up Data: Surgical Technique Guide and Outcomes

Category: Bunion Introduction/Purpose: Over 130 techniques have been described for the treatment of hallux valgus, ranging from bunionectomies, osteotomies, and arthrodesis. Modern attempts at bunion correction with less invasive joint sparing approaches, such as suture-button techniques, have introduced additional complications like second metatarsal fracture. Suture fixation techniques have evolved in an attempt to avoid these complications. We present our results, with up to 26 months of radiographic follow up including initial correction and complications, with a novel device which utilizes a 3D printed titanium plate on the lateral cortex of the second metatarsal without bony violation, and reduces the 1-2 intermetatarsal angle using suture tape passed through drill holes in the first metatarsal with PEEK interference screw fixation. Methods: This study includes 33 feet in 31 patients. A single board certified and fellowship trained orthopedic foot and ankle surgeon performed all operations over the course of 18 months at a single institution. He utilized a dual incision approach and followed previously described surgical technique for the application of the device. We retrospectively reviewed radiographs including pre-operative AP, lateral, and oblique images, along with another set at the two and six week post operative periods, and another at the last available follow up visit. Using standard technique we measured the 1-2 intermetatarsal angle (IMA), as well as the hallux valgus angle (HVA), which were used as the primary outcomes. Chart review was performed to determine patient satisfaction with the outcome. All secondary procedures and complications were recorded based on the chart review and radiographs. Results: Average radiographic follow up was 15 months. The average initial HVA was 31.4º and IMA was 16.0º. Two-week average HVA was 11.3º and IMA was 7.1º. At six weeks, weight-bearing radiographs showed an average HVA 14.5º and IMA 8.2º. Final radiographic measurements, accounting for either the latest available image or the final image prior to revision, showed average HVA of 24.3º and IMA of 13.7º. Six patients had revision for recurrence or fracture. One underwent removal of symptomatic hardware. Seventeen patients had at least mild radiographic recurrence, without revision. Two patients had an intraoperative fracture of the first metatarsal, and one had an intraoperative fracture of the second metatarsal shaft. There were no infections or wound healing issues. Conclusion: Although this device allows a minimally invasive hallux valgus correction, and provides a powerful initial correction with little bony manipulation, results presented in this study suggest a high rate of radiographic recurrence, and relatively high rates of intra-operative complication, post-operative complication, and revision surgery. We found that more severe deformity had a higher rate of recurrence, suggesting it may be more beneficial in mild deformity, but even in many of these patients we found recurrence and other complications. As a result, this technique has since been abandoned at our local institution with the last procedure being performed in 2016.

APPLICATION OF I.PONSETI TECHNIQUE IN SURGICAL TREATMENT OF CONGENITAL CLUBFOOT IN CHILDREN

Summary. One of the most common malformation of the musculoskeletal system in children is congenital clubfoot, which occurs from 2 to 5 cases per 1000 newborns. Treatment of idiopathic clubfoot by the Ponseti method is now standard, and most feet can achieve satisfactory initial correction using this technique. But the high relapse rate (from 20 to 40%) and the existing postoperative complications necessitate the search for approaches to reduce them. One of such approaches is the application of the I.Ponseti technique at the stages of preoperative preparation. The aim of our work is to reduce the incidence of complications in the surgical treatment of congenital clubfoot by applying the I.Ponseti technique. Materials and methods. An analysis was made of the treatment of 62 children (74 feet) with idiopathic congenital clubfoot, who were inpatient and outpatient treatment at the NSH «Ohmatdet» from september 2015 to august 2018. Of these, 39 were patients with recurrence of congenital clubfoot after the initial treatment according to method I.Ponseti and 23 patients with relapsed deformity after initial surgical treatment. Of these, 35 boys and 27 girls. All patients were separated into two groups. Group I – 27 patients (32 feet) who did not use casting according to the I.Ponseti technique before surgical treatment. Group II – 35 patients (42 feet) who underwent staging casting according to I.Ponseti technique at the stages of preoperative planning. The average age of the patients is 4 ± 0.85 years. Result. Use of the I.Ponseti technique at the stages of preoperative preparation in the treatment of congenital clubfoot can significantly reduce the incidence of postoperative complications. The result of which is the possibility of early rehabilitation of patients and prevention of recurrence of deformity.

Effect of Akin Osteotomy on Hallux Valgus Correction After Scarf Osteotomy With Hallux Valgus Interphalangeus

Background: Recurrence after hallux valgus correction is a relatively frequent occurrence. Little is known about the importance of initial correction on radiologic outcome. The objective of our study was to determine postoperative radiologic parameters correlating with loss of correction after scarf osteotomy and the combined scarf/akin osteotomy, respectively. Methods: Loss of correction was evaluated based on a group of 53 feet with isolated scarf osteotomy (S group) and a group of 17 feet with combined scarf and akin osteotomy (SA group) in a retrospective analysis. The intermetatarsal angle (IMA), the hallux valgus angle (HVA), the distal metatarsal articular angle (DMAA), the proximal to distal phalangeal articular angle (PDPAA), the position of the sesamoids, and joint congruity were measured in weight-bearing radiographs preoperatively and postoperatively throughout a mean follow-up of 44.8 ± 23.6 months. Results: Loss of correction was comparable between the S and the SA group ( P > .05). In contrast, we found higher loss of HVA correction in the S subgroup with a preoperative PDPAA above 8 degrees ( P = .011), whereas loss of correction in the S subgroup below 8 degrees of PDPAA was comparable to the SA group. In the S group, loss of correction showed significant correlation with postoperative IMA ( P = .015) and PDPAA ( P = .008), whereas in the SA group a correlation could be detected for IMA only ( P = .045). Conclusion: In cases with a PDPAA above 8 degrees, we recommend a combined scarf/akin osteotomy to diminish the potential for loss of correction. Level of Evidence: Level III, therapeutic, retrospective comparative series.