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1. Computed tomography-based structural rigidity analysis can assess tumor- and treatment-induced changes in rat bones with metastatic lesions

Author

Michael S. Bohanske, Kaveh Momenzadeh, Peer van der Zwaal, Frederik J.H. Hoogwater, Esther Cory, Peter Biggane, Brian D. Snyder, and Ara Nazarian

Subjects
Breast cancer, Metastasis, Structural rigidity, Osteolytic lesions, CT-based structural rigidity analysis, CTRA, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
Abstract

Abstract Background Breast cancer (BrCa) is a predominant malignancy, with metastasis occurring in one in eight patients, nearly half of which target the bone, leading to serious complications such as pain, fractures, and compromised mobility. Structural rigidity, crucial for bone strength, becomes compromised with osteolytic lesions, highlighting the vulnerability and increased fracture risk in affected areas. Historically, two-dimensional radiographs have been employed to predict these fracture risks; however, their limitations in capturing the three-dimensional structural and material changes in bone have raised concerns. Recent advances in CT-based Structural Rigidity Analysis (CTRA), offer a promising, more accurate non-invasive 3D approach. This study aims to assess the efficacy of CTRA in monitoring osteolytic lesions’ progression and response to therapy, suggesting its potential superiority over existing methodologies in guiding treatment strategies. Methods Twenty-seven female nude rats underwent femoral intra-medullary inoculation with MDA-MB-231 human breast cancer cells or saline control. They were divided into Control, Cancer Control, Ibandronate, and Paclitaxel groups. Osteolytic progression was monitored weekly using biplanar radiography, quantitative computed tomography (QCT), and dual-energy X-ray absorptiometry (DEXA). CTRA was employed to predict fracture risk, normalized using the contralateral femur. Statistical analyses, including Kruskal-Wallis and ANOVA, assessed differences in outcomes among groups and over time. Results Biplanar radiographs showed treatment benefits over time; however, only certain time-specific differences between the Control and other treatment groups were discernible. Notably, observer subjectivity in X-ray scoring became evident, with significant inter-operator variations. DEXA measurements for metaphyseal Bone Mineral Content (BMC) did not exhibit notable differences between groups. Although diaphyseal BMC highlighted some variance, it did not reveal significant differences between treatments at specific time points, suggesting a limited ability for DEXA to differentiate between treatment effects. In contrast, the CTRA consistently demonstrated variations across different treatments, effectively capturing bone rigidity changes over time, and the axial- (EA), bending- (EI), and torsional rigidity (GJ) outcomes from the CTRA method successfully distinguished differences among treatments at specific time points. Conclusion Traditional approaches, such as biplanar radiographs and DEXA, have exhibited inherent limitations, notably observer bias and time-specific inefficacies. Our study accentuates the capability of CTRA in capturing real-time, progressive changes in bone structure, with the potential to predict fractures more accurately and provide a more objective analysis. Ultimately, this innovative approach may bridge the existing gap in clinical guidelines, ushering in enhanced Clinical Decision Support Tool (CDST) for both surgical and non-surgical treatments.

Published
2024
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2. Stimulation of fracture mineralization by salt-inducible kinase inhibitors

Author

Kaveh Momenzadeh, Diana Yeritsyan, Mohammadreza Abbasian, Nadim Kheir, Philip Hanna, Jialiang Wang, Pere Dosta, Garyfallia Papaioannou, Sarah Goldfarb, Cheng-Chia Tang, Eliz Amar-Lewis, Michaela Nicole Prado Larrea, Edith Martinez Lozano, Mohamed Yousef, John Wixted, Marc Wein, Natalie Artzi, and Ara Nazarian

Subjects
bone, fracture repair, nanoscale drug delivery, SIK2/SIK3 inhibitor, PTH, siRNA targeting, Biotechnology, TP248.13-248.65
Abstract

IntroductionOver 6.8 million fractures occur annually in the US, with 10% experiencing delayed- or non-union. Anabolic therapeutics like PTH analogs stimulate fracture repair, and small molecule salt inducible kinase (SIK) inhibitors mimic PTH action. This study tests whether the SIK inhibitor YKL-05-099 accelerates fracture callus osteogenesis.Methods126 female mice underwent femoral shaft pinning and midshaft fracture, receiving daily injections of PBS, YKL-05-099, or PTH. Callus tissues were analyzed via RT-qPCR, histology, single-cell RNA-seq, and μCT imaging. Biomechanical testing evaluated tissue rigidity. A hydrogel-based delivery system for PTH and siRNAs targeting SIK2/SIK3 was developed and tested.ResultsYKL-05-099 and PTH-treated mice showed higher mineralized callus volume fraction and improved structural rigidity. RNA-seq indicated YKL-05-099 increased osteoblast subsets and reduced chondrocyte precursors. Hydrogel-released siRNAs maintained target knockdown, accelerating callus mineralization.DiscussionYKL-05-099 enhances fracture repair, supporting selective SIK inhibitors’ development for clinical use. Hydrogel-based siRNA delivery offers targeted localized treatment at fracture sites.

Published
2024
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3. Sociodemographic and Lifestyle Risk Factors Associated with Fragility Hip Fractures: A Systematic Review and Meta-Analysis

Author

Diana Yeritsyan, Kaveh Momenzadeh, Amin Mohamadi, Sharri J. Mortensen, Indeevar R. Beeram, Daniela Caro, Nadim Kheir, Megan McNichol, John J. Wixted, Paul Appleton, Arvind von Keudell, and Ara Nazarian

Subjects
sociodemographic, lifestyle, risk factor, hip fracture, fragility fracture, Osteopathy, RZ301-397.5
Abstract

Hip fractures inflict heightened morbidity and mortality upon older adults. Although previous studies have explored the impact of individual demographic factors on hip fracture risk, a comprehensive review can help reconcile disparities among these factors. This meta-analysis encompassed 69 studies involving 976,677 participants and 99,298 cases of hip fractures. We found that age ≥ 85 (OR = 1.75), BMI < 18.5 (OR 1.72), female sex (OR = 1.23), history of falls (OR = 1.88), previous fractures (OR = 3.16), menopause (OR 7.21), history of maternal hip fractures (OR = 1.61), single and unmarried status (OR = 1.70), divorced status (OR 1.38), residing in a residential care facility (OR = 5.30), and living alone (OR = 1.47) were significantly associated with an increased incidence of hip fracture. Conversely, BMI ranging from 25 to 30 (OR = 0.59), BMI > 30 (OR = 0.38), parity (OR = 0.79), non-Caucasian descent (overall OR = 0.4, Asian OR 0.36, Black OR = 0.39, and Hispanic OR = 0.45), and rural residence (OR = 0.95) were significantly associated with a diminished risk of hip fracture. Hip fracture patients exhibited significantly lower weight and BMI than the non-fracture group, while their age was significantly higher. However, age at menopause and height did not significantly differ between the two groups.

Published
2024
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4. Excellent accuracy of magnetic resonance imaging for diagnosis of discoid meniscus tears: A systematic review and meta‐analysis

Author

Shayan Amiri, Alireza Mirahmadi, Ava Parvandi, Mana Zaker Moshfegh, Seyedeh Pardis Hashemi Abatari, Mehrdad Farrokhi, Seyyed Mehdi Hoseini, Seyed Morteza Kazemi, Kaveh Momenzadeh, Jim S. Wu, and Ara Nazarian

Subjects
diagnostic imaging, discoid meniscus, discoid meniscus tear, magnetic resonance imaging, meta‐analysis, sensitivity and specificity, Orthopedic surgery, RD701-811
Abstract

Abstract Purpose The discoid meniscus (DM) is distinguished by its thickened, disc‐shaped formation, which extends over the tibial plateau. The likelihood of developing osteoarthritis escalates if a DM tear remains undiagnosed and untreated. While DM tears can be diagnosed through arthroscopy, the high cost, invasive nature and limited availability of this procedure highlight the need for a better diagnostic modality. This study aims to determine the accuracy of magnetic resonance imaging (MRI) in diagnosing DM tears. Methods A systematic review was conducted to gather articles with at least 10 cases on the comparison of MRI and arthroscopy as the gold standard for DM tear diagnosis. Stata and MetaDisc were used to conduct the statistical analysis. The quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies‐2 tool. Results Five diagnostic performance studies, derived from four original research papers involving 305 patients, were evaluated. Based on the pooled data, the sensitivity, specificity, diagnostic odds ratio, positive limit of detection and negative limit of detection were found to be 0.87 (95% confidence interval [CI], 0.82–0.91) and 0.84 (95% CI, 0.75–0.90), 32.88 (95% CI, 5.81–186.02), 5.22 (95% CI, 1.71–15.92) and 0.18 (95% CI, 0.09–0.38), respectively. A hierarchical summary receiver operating characteristic curve with an area under the curve of 0.92 was generated. Conclusion This meta‐analysis demonstrates that MRI has excellent sensitivity and specificity for diagnosing DM tears. Despite its lower accuracy compared to arthroscopy, MRI can be used in symptomatic patients as a viable alternative to arthroscopy due to its inherent advantages. Level of Evidence Level IV.

Published
2024
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5. Successive tendon injury in an in vivo rat overload model induces early damage and acute healing responses

Author

Pooja H. Chainani, Maria Buzo Mena, Diana Yeritsyan, Daniela Caro, Kaveh Momenzadeh, Jenna L. Galloway, Joseph P. DeAngelis, Arun J. Ramappa, and Ara Nazarian

Subjects
tendinopathy, mechanobiology, fatigue, tendon overload, in vivo, acute healing, Biotechnology, TP248.13-248.65
Abstract

Introduction: Tendinopathy is a degenerative condition resulting from tendons experiencing abnormal levels of multi-scale damage over time, impairing their ability to repair. However, the damage markers associated with the initiation of tendinopathy are poorly understood, as the disease is largely characterized by end-stage clinical phenotypes. Thus, this study aimed to evaluate the acute tendon responses to successive fatigue bouts of tendon overload using an in vivo passive ankle dorsiflexion system.Methods: Sprague Dawley female rats underwent fatigue overloading to their Achilles tendons for 1, 2, or 3 loading bouts, with two days of rest in between each bout. Mechanical, structural, and biological assays were performed on tendon samples to evaluate the innate acute healing response to overload injuries.Results: Here, we show that fatigue overloading significantly reduces in vivo functional and mechanical properties, with reductions in hysteresis, peak stress, and loading and unloading moduli. Multi-scale structural damage on cellular, fibril, and fiber levels demonstrated accumulated micro-damage that may have induced a reparative response to successive loading bouts. The acute healing response resulted in alterations in matrix turnover and early inflammatory upregulations associated with matrix remodeling and acute responses to injuries.Discussion: This work demonstrates accumulated damage and acute changes to the tendon healing response caused by successive bouts of in vivo fatigue overloads. These results provide the avenue for future investigations of long-term evaluations of tendon overload in the context of tendinopathy.

Published
2024
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6. Propylene glycol and Kolliphor as solvents for systemic delivery of cannabinoids via intraperitoneal and subcutaneous routes in preclinical studies: a comparative technical note

Author

Kaveh Momenzadeh, Diana Yeritsyan, Nadim Kheir, Rosalyn M. Nazarian, and Ara Nazarian

Subjects
Cannabinoids, Route of administration, Drug delivery, Animal models, Skin histopathology, Pharmacy and materia medica, RS1-441, Plant culture, SB1-1110
Abstract

Abstract Background Substance administration to laboratory animals necessitates careful consideration and planning in order to enhance agent distribution while reducing any harmful effects from the technique. There are numerous methods for administering cannabinoids; however, several parameters must be considered, including delivery frequency, volume of administration, vehicle, and the level of competence required for staff to use these routes properly. There is a scarcity of information about the appropriate delivery method for cannabinoids in animal research, particularly those that need the least amount of animal manipulation during the course of the investigation. This study aims to assess the feasibility and potential side effects of intraperitoneal and subcutaneous injection of CBD and THC using propylene glycol or Kolliphor in animal models. By evaluating the ease of use and histopathological side effects of these solvents, this study intends to help researchers better understand an accessible long-term delivery route of administration in animal experiments while minimizing the potential confounding effects of the delivery method on the animal. Methods Intraperitoneal and subcutaneous methods of systemic cannabis administration were tested in rat models. Subcutaneous delivery via needle injection and continuous osmotic pump release were evaluated using propylene glycol or Kolliphor solvents. In addition, the use of a needle injection and a propylene glycol solvent for intraperitoneal (IP) administration was investigated. Skin histopathological changes were evaluated following a trial of subcutaneous injections of cannabinoids utilizing propylene glycol solvent. Discussion Although IP delivery of cannabinoids with propylene glycol as solvent is a viable method and is preferable to oral treatment in order to reduce gastrointestinal tract degradation, it has substantial feasibility limitations. We conclude that subcutaneous delivery utilizing osmotic pumps with Kolliphor as a solvent provides viable and consistent route of administration for long-term systemic cannabinoid delivery in the preclinical context.

Published
2023
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7. While the Incidence of Venous Thromboembolism After Shoulder Arthroscopy Is Low, the Risk Factors Are a Body Mass Index Greater than 30 and Hypertension

Author

Kaveh Momenzadeh, M.D., Diana Yeritsyan, B.A., Sharri Mortensen, M.D., Nadim Kheir, M.D., Mohammad Khak, M.D., Daniela Caro, M.D., Farima Kahe, M.D., Mohammadreza Abbasian, M.D., Chen Mo, Ph.D., Megan McNichol, M.S., Nikolaos Paschos, M.D., Ph.D., and Ara Nazarian, Ph.D.

Subjects
Sports medicine, RC1200-1245
Abstract

Purpose: To determine the overall incidence of venous thromboembolism (VTE) following shoulder arthroscopy and to define potential risk factors associated with its development that may help define guidelines for the use of thromboprophylaxis. Methods: A systematic review was performed using PubMed, Embase, Web of Science, CINAHL, and Cochrane databases per PRISMA guidelines. The search terms consisted of variations of ''Venous Thromboembolism'' and ''Shoulder Arthroscopy.'' Information regarding arthroscopy indication, risk factors, outcomes, and patient demographics was recorded and analyzed, and pooled odds ratios were reported for each variable. Results: Six hundred eighty-five articles were identified in the initial search, and 35 articles reported DVT, PE, or VTE incidence following shoulder arthroscopy. Seventeen nonoverlapping articles with a unique patient population incidence rates. Four articles were then used for subgroup meta-analysis. The incidence rate of VTE was 0.24%, ranging from 0.01% to 5.7%. BMI >30 (OR = 1.46; 95% CI = [1.22, 1.74]; I2 = 0%) and hypertension (OR = 1.64; 95% CI = [1.03, 2.6]; I2 = 75%) were significant risk factors (P < .05) for developing VTE following shoulder arthroscopy. Diabetes (OR = 1.2; 95% CI = [0.97, 1.48]; I2 = 0%), insulin-dependent diabetes (OR = 5.58; 95% CI = [0.12, 260.19]; I2 = 85%), smoking (OR = 1.04; 95% CI = [0.79, 1.37]; I2 = 12%), male sex (OR = 0.95; 95% CI = [0.49, 1.85]; I2 = 86%) and age over 65 (OR = 4.3; 95% CI = [0.25, 72.83]; I2 = 85%) were not associated with higher VTE risk. Conclusions: The VTE incidence following shoulder arthroscopy is low at 0.24%. Patients with BMI >30 and hypertension are at a higher risk for VTE after shoulder arthroscopy. Level of Evidence: Level IV, systematic review and meta-analysis of Level I-IV studies.

Published
2024
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8. Effect of intraarticular pressure on glenohumeral kinematics during a simulated abduction motion: a cadaveric study

Author

Patrick M. Williamson, Kaveh Momenzadeh, Philip Hanna, Mohammadreza Abbasian, Nadim Kheir, Aron Lechtig, Stephen Okajima, Mason Garcia, Arun J. Ramappa, Ara Nazarian, and Joseph P. DeAngelis

Subjects
Negative intraarticular pressure, Passive stabilizers, Glenohumeral joint, Glenohumeral joint capsule, Stability, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background The current understanding of glenohumeral joint stability is defined by active restrictions and passive stabilizers including naturally-occurring negative intraarticular pressure. Cadaveric specimens have been used to evaluate the role of intraarticular pressure on joint stability, although, while the shoulder’s negative intraarticular pressure is universally acknowledged, it has been inconsistently accounted for. Hypothesis During continuous, passive humeral abduction, releasing the native intraarticular pressure increases joint translation, and restoring this pressure decreases joint translations. Study design Descriptive Laboratory Study. Methods A validated shoulder testing system was used to passively abduct the humerus in the scapular plane and measure joint translations for seven (n = 7) cadaveric specimens. The pressure within the glenohumeral joint was measured via a 25-gauge needle during passive abduction of the arm, which was released and subsequently restored. During motion, the rotator cuff muscles were loaded using stepper motors in a force feedback loop and electromagnetic sensors were used to continuously measure the position of the humerus and scapula. Joint translation was defined according to the instant center of rotation of the glenohumeral head according to the recommendations by the International Society of Biomechanics. Results Area under the translation versus abduction angle curve suggests that releasing the pressure within the capsule results in significantly less posterior translation of the glenohumeral head as compared to intact (85–90˚, p

Published
2023
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9. Evolution of knowledge on meniscal biomechanics: a 40 year perspective

Author

Amin Mohamadi, Kaveh Momenzadeh, Aidin Masoudi, Kempland C. Walley, Kenny Ierardi, Arun Ramappa, Joseph P. DeAngelis, and Ara Nazarian

Subjects
Meniscus, Biomechanics, Osteoarthritis, Systematic review, Mechanical stress, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Knowledge regarding the biomechanics of the meniscus has grown exponentially throughout the last four decades. Numerous studies have helped develop this knowledge, but these studies have varied widely in their approach to analyzing the meniscus. As one of the subcategories of mechanical phenomena Medical Subject Headings (MeSH) terms, mechanical stress was introduced in 1973. This study aims to provide an up-to-date chronological overview and highlights the evolutionary comprehension and understanding of meniscus biomechanics over the past forty years. Methods A literature review was conducted in April 2021 through PubMed. As a result, fifty-seven papers were chosen for this narrative review and divided into categories; Cadaveric, Finite element (FE) modeling, and Kinematic studies. Results Investigations in the 1970s and 1980s focused primarily on cadaveric biomechanics. These studies have generated the fundamental knowledge basis for the emergence of FE model studies in the 1990s. As FE model studies started to show comparable results to the gold standard cadaveric models in the 2000s, the need for understanding changes in tissue stress during various movements triggered the start of cadaveric and FE model studies on kinematics. Conclusion This study focuses on a chronological examination of studies on meniscus biomechanics in order to introduce concepts, theories, methods, and developments achieved over the past 40 years and also to identify the likely direction for future research. The biomechanics of intact meniscus and various types of meniscal tears has been broadly studied. Nevertheless, the biomechanics of meniscal tears, meniscectomy, or repairs in the knee with other concurrent problems such as torn cruciate ligaments or genu-valgum or genu-varum have not been extensively studied.

Published
2021
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10. The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures

Author

Michael J. Weaver, George W. Chaus, Aidin Masoudi, Kaveh Momenzadeh, Amin Mohamadi, Edward K Rodriguez, Mark S. Vrahas, and Ara Nazarian

Subjects
Supracondylar Femur, Distal Femur, Nonunion, Biomechanics, Lateral Locked Plating, Fracture, Diseases of the musculoskeletal system, RC925-935
Abstract

Abstract Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: 1. Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? 2. Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? 3. Does fracture working length affect construct stiffness given the same plate material, length and type of screws? 4. Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

Published
2021
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11. Death due to COVID‐19 in a patient with diabetes, epilepsy, and gout comorbidities

Author

Amir Reza Safdarian, Kaveh Momenzadeh, Farima Kahe, Pooya Farhangnia, and Nima Rezaei

Subjects
comorbidities, coronavirus, COVID‐19, diabetes, epilepsy, Medicine, Medicine (General), R5-920
Abstract

Abstract There is evidence of increased incidence, rapid progression, and poor prognosis of COVID‐19 in patients with underlying comorbidities such as diabetes and epilepsy. Developing effective treatment regimens for COVID‐19 patients with multiple comorbidities is crucial, as patients' past medical history is an essential contributor to possible organ injuries in COVID‐19 patients. Herein, we report a confirmed case of COVID‐19 patient with a history of multiple underlying diseases, including diabetes, epilepsy, and gout. The patient developed multiple organ failure and died a week after intensive care unit (ICU) admission. Multiple organ failure is the most common cause of death in COVID‐19 patients.

Published
2021
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12. Defining an Anatomic and Radiographic Safe Zone for Posterior Malleolar Ankle Hardware Fixation

Author

Caroline Williams BA, Kaveh Momenzadeh MD, Max Michalski MD, John Y. Kwon MD, and Christopher P. Miller MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Ankle; Trauma Introduction/Purpose: There is a lack of consensus regarding optimal management of Posterior Malleolar Fractures (PMFs). Indirect reduction and fixation with posterior-anterior (PA) screw shows promise of avoiding the risks associated with direct reduction or indirect anterior to posterior (AP) approaches. Some authors have raised concerns about potential risk to nearby structures with PA technique, including hardware prominence into the syndesmosis. This study highlights the use of a posteromedial vertical syndesmotic line as a fluoroscopic landmark, helping surgeons avoid intra-syndesmotic placement. Methods: Indirect PA screw placement was completed on ten cadaveric specimens, followed by fluoroscopy in mortise and lateral views. Dissection was performed to assess screw placement relative to the posteromedial border of the syndesmosis. The posterior border of the syndesmosis was marked with a radiopaque wire. Repeat imaging was completed to validate the fluoroscopic posteromedial vertical syndesmotic line is representative of the posteromedial border of the tibial incisura. Results: On dissection, 9 of 10 cadavers had accurate screw placement with no penetration into the syndesmosis (Figure 1, bottom left & bottom right). Corresponding imaging showed the screw head to be medial to the marker on mortise view. For the specimen with penetration into the syndesmosis, imaging confirmed that the screw head was lateral to the marker on mortise views (Figure 1, top center & top right). The radiopaque marker correlated with the posteromedial vertical syndesmotic line for all specimens when comparing anatomic to radiographic findings. A radiographic safe zone is defined for the PA screw 12 mm medial to the vertical syndesmotic line to ensure no iatrogenic injury to the FHL tendon. Conclusion: This study demonstrated that the posterior incisura tibialis fluoroscopic landmark is unambiguous in localizing the posterior syndesmotic border (Figure 1, top left) and that screws medial to this line are safely out of the syndesmosis, while screws placed lateral are either in or at risk of intra-syndesmotic placement. A safe zone is defined for screw placement.

Published
2022
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13. Cadaveric Analysis of Plantar Fascia Tension and Windlass Mechanism and Development of Plantar Fascia-Specific Stretching Device

Author

Kaveh Momenzadeh MD, Caroline Williams BA, Patrick M. Williamson, John Y. Kwon MD, Ara Nazarian, and Christopher P. Miller MD

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Other Introduction/Purpose: Plantar fasciitis is the most common cause of heel pain in adults, affecting 1 out of 10 of the population at some point during their lifetime. Plantar specific stretching programs are popularity among foot and ankle surgeons consisting of passively dorsiflexing foot and using thumb to apply pressure. This technique is not without limitations. Certain patients are unable to properly perform the stretching techniques, such as limited mobility from advanced age, disability, or simply from performing stretching exercises incorrectly. The aims of this study are; first, identify what configuration of plantar-specific stretching combined with applied pressure to the plantar aponeurosis generates the greatest tensional force in the plantar fascia. And second, to construct a prototype device that could simulate these forces in a hands-free technique. Methods: Six (will be 10) fresh-frozen, morphologically normal cadaver feet (Medcure, RI) were utilized. Plantar fascia was exposed, ankle was fixed at 90-degree dorsiflexion using Calcaneo-Tibial Schanz Pin, specimen was then inverted and potted in a custom-made box (Smooth-Cast 300q, PA). Using an electromagnetic motion tracking system (Liberty, Polhemus, VT), the motion of sensors was recorded at 120 Hz. Utilizing tissue adhesive glue (Vetbond, 3M, Minnesota), the first sensor was attached to medial calcaneal tuberosity, and the second sensor was placed 5 cm distal to the first sensor on the plantar aponeurosis. Custom- built testing apparatus was made for induction of MTP dorsiflexion application of pressure on the plantar aponeurosis to mimic current conservative treatments. Weights were added to the custom build stretcher device in 10Lb increments. Strain percentage was calculated as the change in length divided by the baseline length position (condition 1) using the formula: ([L − Lo]/Lo) × 100 Results: Dorsiflexion of 2nd-5th MTPs increases strain percentage more in comparison with 1st MTP dorsiflexion (Condition 3>4>2). This might show that dorsiflexing of 1st metatarsal is less effective at straining the plantar fascia because of the midfoot motion. By adding thumb pressure, strain percentages go higher, up to a point that in condition 7 (dorsiflexing all MTPs in combination of thumb pressure) it is significantly higher than our baseline condition (P=0.0385). It is noteworthy that, stretcher device itself (condition 8), cannot replicate conditions 4 or 7 strain percentages. When adding direct pressure and weight to the stretcher device (conditions 12 and 13), strains are even higher than condition 7 and also are significantly higher than the baseline (P= 0.0090 and 0.0291 respectively). Conclusion: The stretcher device itself is insufficient for stretching the plantar fascia, supporting the hypothesis of this study that we need a direct forceful pressure on the plantar aponeurosis as well. Our customized plantar stretcher not only can replicate the conventional stretching program, but also can produce higher strains on the plantar aponeurosis than the current manual application of plantar specific stretching. This device may impact the rehabilitation process in patients with advanced age as well as patients with spine mobility limitation who cannot perform manual stretching programs.

Published
2022
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14. Anatomic Structures at Risk during Posterior to Anterior Percutaneous Screw Fixation of Posterior Malleolar Fractures: A Cadaveric Study

Author

Kaveh Momenzadeh MD, Natalia Czerwonka, Derek S. Stenquist, Seth W. O’Donnell MD, John Y. Kwon MD, Ara Nazarian PhD, and Christopher P. Miller MD, MHS

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Ankle; Trauma Introduction/Purpose: Posterior malleolus fractures (PMFs) are typically associated with trimalleolar ankle fractures and have been reported to occur in 10-40% of ankle fractures. The PM may be fixed by direct ORIF or indirect percutaneous reduction. Direct reduction via a posterolateral approach is required for larger fragments, which requires prone or lateral decubitus positioning. Indirect reduction and fixation with anterior to posterior (AP) screws remains the most common method, in which screw threads are not entirely across the fracture site to allow interfragmentary compression.Objective: Determine the risk to anatomic structures utilizing a percutaneous technique for posterior to anterior (PA) screw fixation. It is advantageous as it places all the threads across the fracture site even for small fragments and can be performed in the supine position. Methods: 10 fresh-frozen, morphologically normal cadaver lower leg. Under fluoroscopic guidance, 1.35 mm Kirschner wire was inserted percutaneously from anteromedial to posterolateral. Guidewire was inserted from a starting point just medial to the tibialis anterior tendon and aimed at a point just lateral to the Achilles tendon. Small skin incision was made over the wire posteriorly, displacing the Achilles tendon medially as required. The wire was then over-drilled in posterior to anterior direction and replaced with a 4.0 mm partially threaded cannulated screw directed posterior to anterior. Each specimen was dissected, and adjacent soft tissue and neurovascular structures were identified. The distance from the guidewire to each anatomic structure of interest was measured. Descriptive analysis and the correlation between the mean distances from the guidewire to each structure was calculated using SPSS version 26. Results: The sural nerve was directly transected in 1/10 specimens (10%) and in contact with the wire in a second specimen (10%). There was a significant correlation between the proximity of the guidewire to the apex of Volkmann’s tubercle and its proximity to the sural nerve.(r= 0.705, p = 0.034) The flexor hallucis longus (FHL) muscle belly was perforated by the guidewire 40% of the time but was not tethered or entrapped by the screw. The neurovascular bundles were safely away from the wire in all cases. The lateral 1-2 mm of the Achilles tendon was pierced by the guidewire 20% of the time. Although suboptimal, these injuries may be of little clinical consequence, and the screw passed without tethering the tendon in all cadaveric specimens. Conclusion: Percutaneous PA screw placement is a safe technique which can be improved with several modifications. A mini- open technique is recommended to protect the sural nerve. The surgeon may consider aiming slightly more medial and closer to the Achilles tendon in order to avoid injury to the sural nerve. It is also advisable to use a soft tissue guide when over-drilling the guidewire. There may be potential for tethering of the FHL with use of a washer or large screw head. Risk to the anterior and posterior neurovascular bundles is minimal.

Published
2020
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15. Contamination Profile of the Mini C-Arm Fluoroscopy Unit in Orthopedic Surgery

Author

Kaveh Momenzadeh MD, Caroline Williams MS, Natalia Czerwonka, Mohammad Mehdi Alemi, John Y. Kwon MD, Ara Nazarian PhD, and Christopher P. Miller MD, MHS

Subjects
Orthopedic surgery, RD701-811
Abstract

Category: Other; Ankle Introduction/Purpose: Fluoroscopy is critical for orthopaedic surgery. The mini C-arm is popular among foot and ankle surgeons owing ease of easy, maneuverability, and cost effectiveness. However, there are concerns that the mini C-arm may represent a potential source of contamination and increasing the risk of postoperative infection. Evaluation of large c-arm drapes have shown high rates of contamination. However, the mini C-arm may be even more concerning due to how it is handled. The mini c-arm is continuously manipulated by the surgical team who then return to the surgical field carrying with them any potential cross-contamination.Objective: We hypothesize that there is significant contamination of the drape, and that specific locations of the drape are at higher risk. Methods: 50 foot and ankle surgery cases which required the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were chosen for sampling. Locations were defined based on commonly touched areas on the drape by the surgical team, and their proximity to the non-sterile field. Negative controls were obtained by separately sampling an additional 20 mini C-arm drapes after draping c-arm and waiting for average surgery time. Positive controls were obtained by sampling non- sterile surfaces within the OR.Culture Q-swabs were used for sampling defined locations, using an established semiquantitative technique. Plates were incubated at 37 °C for 48 hours. Based on the number of quadrants on plate where colony growth was observed, bacterial growth was graded on a scale of 0, 1+, 2+, 3+, or 4+. Contamination threshold was defined as any growth pattern of 1+ or higher. Results: Figure 1 shows the contamination rates of the sampled areas of the c-arm drape. Contamination was noted in 70% of the cases for at least one area, and in two or more areas in 38% of cases.Contamination rates were significantly higher on defined locations in comparison with their relative negative control, except for locations 4 and 5. (P

Published
2020
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16. Vitamin D Deficiency in Chronic Idiopathic Urticaria

Author

Masoud Movahedi, Marzieh Tavakol, Armin Hirbod-Mobarakeh, Mohammad Gharagozlou, Asghar Aghamohammadi, Zahra Tavakol, Kaveh Momenzadeh, Mohammad Nabavi, Abbas Dabbaghzade, Asieh Mosallanejad, and Nima Rezaei

Subjects
Cholecalciferol, Mast cells, Urticaria, Vitamin D, Vitamin D deficiency, Medicine
Abstract

Chronic urticaria is the most common skin diseases, characterized by chronic cutaneous lesions which severely debilitates patients in several aspects of their everyday life. Vitamin D is known to exert several actions in the immune system and to influence function and differentiation of mast cells, central role players in the pathogenesis of chronic idiopathic urticaria. This study was performed to evaluate the relationship between vitamin D levels and susceptibility to chronic idiopathic urticaria. One hundred and fourteen patients with chronic idiopathic urticaria were recruited in this study along with one hundred and eighty seven sex-matched and age-matched healthy volunteers as the control group. For each patient, urticaria activity score was calculated and autologous serum skin test was done. Vitamin D metabolic statue was measured in serum as 25 hydroxyvitamin D using enzyme immunoassay method. Patients with chronic idiopathic urticaria significantly showed lower levels of vitamin D. Vitamin D deficiency was significantly associated with increased susceptibility to chronic idiopathic urticaria. There was a significant positive correlation between vitamin D levels and urticaria activity score. This study showed that patients with chronic idiopathic urticaria had reduced levels of vitamin D, while vitamin D deficiency could increase susceptibility to chronic idiopathic urticaria.

Published
2015

17. Minimally invasive, sustained-release relaxin-2 microparticles reverse arthrofibrosis

Author

Jack R. Kirsch, Amanda K. Williamson, Diana Yeritsyan, William A. Blessing, Kaveh Momenzadeh, Todd R. Leach, Patrick M. Williamson, Jenny T. Korunes-Miller, Joseph P. DeAngelis, David Zurakowski, Rosalynn M. Nazarian, Edward K. Rodriguez, Ara Nazarian, and Mark W. Grinstaff

Subjects
Delayed-Action Preparations, Relaxin, Animals, Humans, General Medicine, Musculoskeletal Diseases, Fibrosis, Article, Rats
Abstract

Substantial advances in biotherapeutics are distinctly lacking for musculoskeletal diseases. Musculoskeletal diseases are biomechanically complex and localized, highlighting the need for novel therapies capable of addressing these issues. All frontline treatment options for arthrofibrosis, a debilitating musculoskeletal disease, fail to treat the disease etiology—the accumulation of fibrotic tissue within the joint space. For millions of patients each year, the lack of modern and effective treatment options necessitates surgery in an attempt to regain joint range of motion (ROM) and escape prolonged pain. Human relaxin-2 (RLX), an endogenous peptide hormone with antifibrotic and antifibrogenic activity, is a promising biotherapeutic candidate for musculoskeletal fibrosis. However, RLX has previously faltered through multiple clinical programs because of pharmacokinetic barriers. Here, we describe the design and in vitro characterization of a tailored drug delivery system for the sustained release of RLX. Drug-loaded, polymeric microparticles released RLX over a multiweek time frame without altering peptide structure or bioactivity. In vivo, intraarticular administration of microparticles in rats resulted in prolonged, localized concentrations of RLX with reduced systemic drug exposure. Furthermore, a single injection of RLX-loaded microparticles restored joint ROM and architecture in an atraumatic rat model of arthrofibrosis with clinically derived end points. Finally, confirmation of RLX receptor expression, RXFP1, in multiple human tissues relevant to arthrofibrosis suggests the clinical translational potential of RLX when administered in a sustained and targeted manner.

Published
2022

18. A Validated Three-Dimensional, Heterogenous Finite Element Model of the Rotator Cuff and The Effects of Collagen Orientation

Author

Patrick Williamson, Mason Garcia, Kaveh Momenzadeh, Mohammadreza Abbasian, Nadim Kheir, Isabella Stewart, Joseph P. DeAngelis, Arun J. Ramappa, and Ara Nazarian

Subjects
Biomedical Engineering
Abstract

Continuum mechanics-based finite element models of the shoulder aim to quantify the mechanical environment of the joint to aid in clinical decision-making for rotator cuff injury and disease. These models allow for the evaluation of the internal loading of the shoulder, which cannot be measured in-vivo. This study uses human cadaveric rotator cuff samples with surface tendon strain estimates, to validate a heterogeneous finite element model of the supraspinatus-infraspinatus complex during various load configurations. The computational model was considered validated when the absolute difference in average maximum principal strain for the articular and bursal sides for each load condition estimated by the model was no greater than 3% compared to that measured in the biomechanical study. The model can predict the strains for varying infraspinatus loads allowing for the study of load sharing between these two tightly coordinated tendons. The future goal is to use the modularity of this validated model to study the initiation and propagation of rotator cuff tear and other rotator cuff pathologies to ultimately improve care for rotator cuff tear patients.

Published
2022

19. Modifiable lifestyle factors associated with fragility hip fracture: a systematic review and meta-analysis

Author

Ara Nazarian, Amin Mohamadi, Indeevar Beeram, Edward K. Rodriguez, Arvind von Keudell, Jonathon Florance, Sharri J. Mortensen, and Kaveh Momenzadeh

Subjects
Adult, 0301 basic medicine, medicine.medical_specialty, Endocrinology, Diabetes and Metabolism, 030209 endocrinology & metabolism, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Risk Factors, Weight loss, Internal medicine, medicine, Humans, Orthopedics and Sports Medicine, Risk factor, Life Style, Hip fracture, Hip Fractures, business.industry, General Medicine, medicine.disease, Lifestyle factors, Increased risk, Meta-analysis, Orthopedic surgery, 030101 anatomy & morphology, medicine.symptom, Underweight, business, Osteoporotic Fractures
Abstract

Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors.We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor.Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62-9.90), underweight body mass index (BMI) ( 18.5) (pooled OR 2.83, 95% CI 1.82-4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04-4.97), inactivity (pooled OR 2.14, 95% CI 1.21-3.77), weight loss (pooled OR 1.88, 95% CI 1.32-2.68), consumption of ≥ 27 g (approx. 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12-2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22-1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI ( 30) (pooled OR 0.58, 95% CI 0.34-0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66-0.80).Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.

Published
2021

20. A Passive Ankle Dorsiflexion Testing System to Assess Mechanobiological and Structural Response To Cyclic Loading In Rat Achilles Tendon

Author

Patrick M. Williamson, Diana Yeritsyan, Thomas Peacock, Pooja Chainani, Kaveh Momenzadeh, Dominic Asciutto, Priyan Pathirana, Cristina Avakian, Isabella Stewart, Nadim Kheir, Mohammadreza Abbasian, Joseph P. DeAngelis, Arun J. Ramappa, and Ara Nazarian

Subjects
Rehabilitation, Biomedical Engineering, Biophysics, Orthopedics and Sports Medicine
Published
2023

21. Death due to COVID-19 in a patient with diabetes, epilepsy, and gout comorbidities

Author

Farima Kahe, Pooya Farhangnia, Kaveh Momenzadeh, Amir Reza Safdarian, and Nima Rezaei

Subjects
Medicine (General), Pediatrics, Poor prognosis, medicine.medical_specialty, Gout, Coronavirus disease 2019 (COVID-19), coronavirus, Case Report, SARS-COV-2, 030204 cardiovascular system & hematology, comorbidities, law.invention, 03 medical and health sciences, Epilepsy, R5-920, 0302 clinical medicine, COVID‐19, law, Diabetes mellitus, medicine, Effective treatment, In patient, Intensive care medicine, Past medical history, business.industry, Incidence (epidemiology), Diabetes, COVID-19, General Medicine, medicine.disease, Intensive care unit, comorbidity, 030220 oncology & carcinogenesis, Medicine, business
Abstract

There is evidence of increased incidence, rapid progression, and poor prognosis of COVID‐19 in patients with underlying comorbidities such as diabetes and epilepsy. Developing effective treatment regimens for COVID‐19 patients with multiple comorbidities is crucial, as patients' past medical history is an essential contributor to possible organ injuries in COVID‐19 patients. Herein, we report a confirmed case of COVID‐19 patient with a history of multiple underlying diseases, including diabetes, epilepsy, and gout. The patient developed multiple organ failure and died a week after intensive care unit (ICU) admission. Multiple organ failure is the most common cause of death in COVID‐19 patients., Developing effective treatment regimens for COVID‐19 patients with multiple comorbidities—especially diabetes and epilepsy—is crucial, as patients' past medical history is an essential contributor to possible organ injuries in COVID‐19 patients.

Published
2022
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22. The global burden of cancer attributable to risk factors, 2010–19 : A systematic analysis for the Global Burden of Disease Study 2019

Author

Khanh Bao Tran, Justin J Lang, Kelly Compton, Rixing Xu, Alistair R Acheson, Hannah Jacqueline Henrikson, Jonathan M Kocarnik, Louise Penberthy, Amirali Aali, Qamar Abbas, Behzad Abbasi, Mohsen Abbasi-Kangevari, Zeinab Abbasi-Kangevari, Hedayat Abbastabar, Michael Abdelmasseh, Sherief Abd-Elsalam, Ahmed Abdelwahab Abdelwahab, Gholamreza Abdoli, Hanan Abdulkadir Abdulkadir, Aidin Abedi, Kedir Hussein Abegaz, Hassan Abidi, Richard Gyan Aboagye, Hassan Abolhassani, Abdorrahim Absalan, Yonas Derso Abtew, Hiwa Abubaker Ali, Eman Abu-Gharbieh, Basavaprabhu Achappa, Juan Manuel Acuna, Daniel Addison, Isaac Yeboah Addo, Oyelola A Adegboye, Miracle Ayomikun Adesina, Mohammad Adnan, Qorinah Estiningtyas Sakilah Adnani, Shailesh M Advani, Sumia Afrin, Muhammad Sohail Afzal, Manik Aggarwal, Bright Opoku Ahinkorah, Araz Ramazan Ahmad, Rizwan Ahmad, Sajjad Ahmad, Sohail Ahmad, Sepideh Ahmadi, Haroon Ahmed, Luai A Ahmed, Muktar Beshir Ahmed, Tarik Ahmed Rashid, Wajeeha Aiman, Marjan Ajami, Gizachew Taddesse Akalu, Mostafa Akbarzadeh-Khiavi, Addis Aklilu, Maxwell Akonde, Chisom Joyqueenet Akunna, Hanadi Al Hamad, Fares Alahdab, Fahad Mashhour Alanezi, Turki M Alanzi, Saleh Ali Alessy, Abdelazeem M Algammal, Mohammed Khaled Al-Hanawi, Robert Kaba Alhassan, Beriwan Abdulqadir Ali, Liaqat Ali, Syed Shujait Ali, Yousef Alimohamadi, Vahid Alipour, Syed Mohamed Aljunid, Motasem Alkhayyat, Sadeq Ali Ali Al-Maweri, Sami Almustanyir, Nivaldo Alonso, Shehabaldin Alqalyoobi, Rajaa M Al-Raddadi, Rami H Hani Al-Rifai, Salman Khalifah Al-Sabah, Ala'a B Al-Tammemi, Haya Altawalah, Nelson Alvis-Guzman, Firehiwot Amare, Edward Kwabena Ameyaw, Javad Javad Aminian Dehkordi, Mohammad Hosein Amirzade-Iranaq, Hubert Amu, Ganiyu Adeniyi Amusa, Robert Ancuceanu, Jason A Anderson, Yaregal Animut Animut, Amir Anoushiravani, Ali Arash Anoushirvani, Alireza Ansari-Moghaddam, Mustafa Geleto Ansha, Benny Antony, Maxwell Hubert Antwi, Sumadi Lukman Anwar, Razique Anwer, Anayochukwu Edward Anyasodor, Jalal Arabloo, Morteza Arab-Zozani, Olatunde Aremu, Ayele Mamo Argaw, Hany Ariffin, Timur Aripov, Muhammad Arshad, Al Artaman, Judie Arulappan, Raphael Taiwo Aruleba, Armin Aryannejad, Malke Asaad, Mulusew A Asemahagn, Zatollah Asemi, Mohammad Asghari-Jafarabadi, Tahira Ashraf, Reza Assadi, Mohammad Athar, Seyyed Shamsadin Athari, Maha Moh'd Wahbi Atout, Sameh Attia, Avinash Aujayeb, Marcel Ausloos, Leticia Avila-Burgos, Atalel Fentahun Awedew, Mamaru Ayenew Awoke, Tewachew Awoke, Beatriz Paulina Ayala Quintanilla, Tegegn Mulatu Ayana, Solomon Shitu Ayen, Davood Azadi, Sina Azadnajafabad, Saber Azami-Aghdash, Melkalem Mamuye Azanaw, Mohammadreza Azangou-Khyavy, Amirhossein Azari Jafari, Hosein Azizi, Ahmed Y Y Azzam, Amirhesam Babajani, Muhammad Badar, Ashish D Badiye, Nayereh Baghcheghi, Nader Bagheri, Sara Bagherieh, Saeed Bahadory, Atif Amin Baig, Jennifer L Baker, Ahad Bakhtiari, Ravleen Kaur Bakshi, Maciej Banach, Indrajit Banerjee, Mainak Bardhan, Francesco Barone-Adesi, Fabio Barra, Amadou Barrow, Nasir Z Bashir, Azadeh Bashiri, Saurav Basu, Abdul-Monim Mohammad Batiha, Aeysha Begum, Alehegn Bekele Bekele, Alemayehu Sayih Belay, Melaku Ashagrie Belete, Uzma Iqbal Belgaumi, Arielle Wilder Bell, Luis Belo, Habib Benzian, Alemshet Yirga Berhie, Amiel Nazer C Bermudez, Eduardo Bernabe, Akshaya Srikanth Bhagavathula, Neeraj Bhala, Bharti Bhandari Bhandari, Nikha Bhardwaj, Pankaj Bhardwaj, Krittika Bhattacharyya, Vijayalakshmi S Bhojaraja, Soumitra S Bhuyan, Sadia Bibi, Awraris Hailu Bilchut, Bagas Suryo Bintoro, Antonio Biondi, Mesfin Geremaw Birega Birega, Habitu Eshetu Birhan, Tone Bjørge, Oleg Blyuss, Belay Boda Abule Bodicha, Srinivasa Rao Bolla, Archith Boloor, Cristina Bosetti, Dejana Braithwaite, Michael Brauer, Hermann Brenner, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Christina Maree Buchanan, Norma B Bulamu, Maria Teresa Bustamante-Teixeira, Muhammad Hammad Butt, Nadeem Shafique Butt, Zahid A Butt, Florentino Luciano Caetano dos Santos, Luis Alberto Cámera, Chao Cao, Yin Cao, Giulia Carreras, Márcia Carvalho, Francieli Cembranel, Ester Cerin, Promit Ananyo Chakraborty, Periklis Charalampous, Vijay Kumar Chattu, Odgerel Chimed-Ochir, Jesus Lorenzo Chirinos-Caceres, Daniel Youngwhan Cho, William C S Cho, Devasahayam J Christopher, Dinh-Toi Chu, Isaac Sunday Chukwu, Aaron J Cohen, Joao Conde, Sandra Cortés, Vera Marisa Costa, Natália Cruz-Martins, Garland T Culbreth, Omid Dadras, Fentaw Teshome Dagnaw, Saad M A Dahlawi, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Parnaz Daneshpajouhnejad, Anna Danielewicz, An Thi Minh Dao, Reza Darvishi Cheshmeh Soltani, Aso Mohammad Darwesh, Saswati Das, Dragos Virgil Davitoiu, Elham Davtalab Esmaeili, Fernando Pio De la Hoz, Sisay Abebe Debela, Azizallah Dehghan, Biniyam Demisse, Fitsum Wolde Demisse, Edgar Denova-Gutiérrez, Afshin Derakhshani, Meseret Derbew Molla, Diriba Dereje, Kalkidan Solomon Deribe, Rupak Desai, Markos Desalegn Desalegn, Fikadu Nugusu Dessalegn, Samuel Abebe A Dessalegni, Gashaw Dessie, Abebaw Alemayehu Desta, Syed Masudur Rahman Dewan, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Mostafa Dianatinasab, Nancy Diao, Daniel Diaz, Lankamo Ena Digesa, Shilpi Gupta Dixit, Saeid Doaei, Linh Phuong Doan, Paul Narh Doku, Deepa Dongarwar, Wendel Mombaque dos Santos, Tim Robert Driscoll, Haneil Larson Dsouza, Oyewole Christopher Durojaiye, Sareh Edalati, Fatemeh Eghbalian, Elham Ehsani-Chimeh, Ebrahim Eini, Michael Ekholuenetale, Temitope Cyrus Ekundayo, Donatus U Ekwueme, Maha El Tantawi, Mostafa Ahmed Elbahnasawy, Iffat Elbarazi, Hesham Elghazaly, Muhammed Elhadi, Waseem El-Huneidi, Mohammad Hassan Emamian, Luchuo Engelbert Bain, Daniel Berhanie Enyew, Ryenchindorj Erkhembayar, Tegegne Eshetu, Babak Eshrati, Sharareh Eskandarieh, Juan Espinosa-Montero, Farshid Etaee, Azin Etemadimanesh, Tahir Eyayu, Ifeanyi Jude Ezeonwumelu, Sayeh Ezzikouri, Adeniyi Francis Fagbamigbe, Saman Fahimi, Ildar Ravisovich Fakhradiyev, Emerito Jose A Faraon, Jawad Fares, Abbas Farmany, Umar Farooque, Hossein Farrokhpour, Abidemi Omolara Fasanmi, Ali Fatehizadeh, Wafa Fatima, Hamed Fattahi, Ginenus Fekadu, Berhanu Elfu Feleke, Allegra Allegra Ferrari, Simone Ferrero, Lorenzo Ferro Desideri, Irina Filip, Florian Fischer, Roham Foroumadi, Masoud Foroutan, Takeshi Fukumoto, Peter Andras Gaal, Mohamed M Gad, Muktar A Gadanya, Abduzhappar Gaipov, Nasrin Galehdar, Silvano Gallus, Tushar Garg, Mariana Gaspar Fonseca, Yosef Haile Gebremariam, Teferi Gebru Gebremeskel, Mathewos Alemu Gebremichael, Yohannes Fikadu Geda, Yibeltal Yismaw Gela, Belete Negese Belete Gemeda, Melaku Getachew, Motuma Erena Getachew, Kazem Ghaffari, Mansour Ghafourifard, Seyyed-Hadi Ghamari, Mohammad Ghasemi Nour, Fariba Ghassemi, Ajnish Ghimire, Nermin Ghith, Maryam Gholamalizadeh, Jamshid Gholizadeh Navashenaq, Sherief Ghozy, Syed Amir Gilani, Paramjit Singh Gill, Themba G Ginindza, Abraham Tamirat T Gizaw, James C Glasbey, Justyna Godos, Amit Goel, Mahaveer Golechha, Pouya Goleij, Davide Golinelli, Mohamad Golitaleb, Giuseppe Gorini, Bárbara Niegia Garcia Goulart, Giuseppe Grosso, Habtamu Alganeh Guadie, Mohammed Ibrahim Mohialdeen Gubari, Temesgen Worku Gudayu, Maximiliano Ribeiro Guerra, Damitha Asanga Gunawardane, Bhawna Gupta, Sapna Gupta, Veer Bala Gupta, Vivek Kumar Gupta, Mekdes Kondale Gurara, Alemu Guta, Parham Habibzadeh, Atlas Haddadi Avval, Nima Hafezi-Nejad, Adel Hajj Ali, Arvin Haj-Mirzaian, Esam S Halboub, Aram Halimi, Rabih Halwani, Randah R Hamadeh, Sajid Hameed, Samer Hamidi, Asif Hanif, Sanam Hariri, Netanja I Harlianto, Josep Maria Haro, Risky Kusuma Hartono, Ahmed I Hasaballah, S M Mahmudul Hasan, Hamidreza Hasani, Seyedeh Melika Hashemi, Abbas M Hassan, Soheil Hassanipour, Khezar Hayat, Golnaz Heidari, Mohammad Heidari, Zahra Heidarymeybodi, Brenda Yuliana Herrera-Serna, Claudiu Herteliu, Kamal Hezam, Yuta Hiraike, Mbuzeleni Mbuzeleni Hlongwa, Ramesh Holla, Marianne Holm, Nobuyuki Horita, Mohammad Hoseini, Md Mahbub Hossain, Mohammad Bellal Hossain Hossain, Mohammad-Salar Hosseini, Ali Hosseinzadeh, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Junjie Huang, Fernando N Hugo, Ayesha Humayun, Salman Hussain, Nawfal R Hussein, Bing-Fang Hwang, Segun Emmanuel Ibitoye, Pulwasha Maria Iftikhar, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mustapha Immurana, Kaire Innos, Pooya Iranpour, Lalu Muhammad Irham, Md Shariful Islam, Rakibul M Islam, Farhad Islami, Nahlah Elkudssiah Ismail, Gaetano Isola, Masao Iwagami, Linda Merin J, Abhishek Jaiswal, Mihajlo Jakovljevic, Mahsa Jalili, Shahram Jalilian, Elham Jamshidi, Sung-In Jang, Chinmay T Jani, Tahereh Javaheri, Umesh Umesh Jayarajah, Shubha Jayaram, Seyed Behzad Jazayeri, Rime Jebai, Bedru Jemal, Wonjeong Jeong, Ravi Prakash Jha, Har Ashish Jindal, Yetunde O John-Akinola, Jost B Jonas, Tamas Joo, Nitin Joseph, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Ali Kabir, Salah Eddine Oussama Kacimi, Vidya Kadashetti, Farima Kahe, Pradnya Vishal Kakodkar, Laleh R Kalankesh, Leila R Kalankesh, Rohollah Kalhor, Vineet Kumar Kamal, Farin Kamangar, Ashwin Kamath, Tanuj Kanchan, Eswar Kandaswamy, Himal Kandel, HyeJung Kang, Girum Gebremeskel Kanno, Neeti Kapoor, Sitanshu Sekhar Kar, Shama D Karanth, Ibraheem M Karaye, André Karch, Amirali Karimi, Bekalu Getnet Kassa, Patrick DMC Katoto, Joonas H Kauppila, Harkiran Kaur, Abinet Gebremickael Kebede, Leila Keikavoosi-Arani, Gemechu Gemechu Kejela, Phillip M Kemp Bohan, Maryam Keramati, Mohammad Keykhaei, Himanshu Khajuria, Abbas Khan, Abdul Aziz Khan Khan, Ejaz Ahmad Khan, Gulfaraz Khan, Md Nuruzzaman Khan, Moien AB Khan, Javad Khanali, Khaled Khatab, Moawiah Mohammad Khatatbeh, Mahalaqua Nazli Khatib, Maryam Khayamzadeh, Hamid Reza Khayat Kashani, Mohammad Amin Khazeei Tabari, Mehdi Khezeli, Mahmoud Khodadost, Min Seo Kim, Yun Jin Kim, Adnan Kisa, Sezer Kisa, Miloslav Klugar, Jitka Klugarová, Ali-Asghar Kolahi, Pavel Kolkhir, Farzad Kompani, Parvaiz A Koul, Sindhura Lakshmi Koulmane Laxminarayana, Ai Koyanagi, Kewal Krishan, Yuvaraj Krishnamoorthy, Burcu Kucuk Bicer, Nuworza Kugbey, Mukhtar Kulimbet, Akshay Kumar, G Anil Kumar, Narinder Kumar, Om P Kurmi, Ambily Kuttikkattu, Carlo La Vecchia, Arista Lahiri, Dharmesh Kumar Lal, Judit Lám, Qing Lan, Iván Landires, Bagher Larijani, Savita Lasrado, Jerrald Lau, Paolo Lauriola, Caterina Ledda, Sang-woong Lee, Shaun Wen Huey Lee, Wei-Chen Lee, Yeong Yeh Lee, Yo Han Lee, Samson Mideksa Legesse, James Leigh, Elvynna Leong, Ming-Chieh Li, Stephen S Lim, Gang Liu, Jue Liu, Chun-Han Lo, Ayush Lohiya, Platon D Lopukhov, László Lorenzovici, Mojgan Lotfi, Joana A Loureiro, Raimundas Lunevicius, Farzan Madadizadeh, Ahmad R Mafi, Sameh Magdeldin, Soleiman Mahjoub, Ata Mahmoodpoor, Morteza Mahmoudi, Marzieh Mahmoudimanesh, Rashidul Alam Mahumud, Azeem Majeed, Jamal Majidpoor, Alaa Makki, Konstantinos Christos Makris, Elaheh Malakan Rad, Mohammad-Reza Malekpour, Reza Malekzadeh, Ahmad Azam Malik, Tauqeer Hussain Mallhi, Sneha Deepak Mallya, Mohammed A Mamun, Ana Laura Manda, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Lorenzo Giovanni Mantovani, Santi Martini, Miquel Martorell, Sahar Masoudi, Seyedeh Zahra Masoumi, Clara N Matei, Elezebeth Mathews, Manu Raj Mathur, Vasundhara Mathur, Martin McKee, Jitendra Kumar Meena, Khalid Mehmood, Entezar Mehrabi Nasab, Ravi Mehrotra, Addisu Melese, Walter Mendoza, Ritesh G Menezes, SIsay Derso Mengesha, Laverne G Mensah, Alexios-Fotios A Mentis, Andry Yasmid Mera Mera-Mamián, Tuomo J Meretoja, Mehari Woldemariam Merid, Amanual Getnet Mersha, Belsity Temesgen Meselu, Mahboobeh Meshkat, Tomislav Mestrovic, Junmei Miao Jonasson, Tomasz Miazgowski, Irmina Maria Michalek, Gelana Fekadu Worku Mijena, Ted R Miller, Shabir Ahmad Mir, Seyed Kazem Mirinezhad, Seyyedmohammadsadeq Mirmoeeni, Mohammad Mirza-Aghazadeh-Attari, Hamed Mirzaei, Hamid Reza Mirzaei, Abay Sisay Misganaw, Sanjeev Misra, Karzan Abdulmuhsin Mohammad, Esmaeil Mohammadi, Mokhtar Mohammadi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Arif Mohammed, Shafiu Mohammed, Syam Mohan, Mohammad Mohseni, Nagabhishek Moka, Ali H Mokdad, Alex Molassiotis, Mariam Molokhia, Kaveh Momenzadeh, Sara Momtazmanesh, Lorenzo Monasta, Ute Mons, Ahmed Al Montasir, Fateme Montazeri, Arnulfo Montero, Mohammad Amin Moosavi, Abdolvahab Moradi, Yousef Moradi, Mostafa Moradi Sarabi, Paula Moraga, Lidia Morawska, Shane Douglas Morrison, Jakub Morze, Abbas Mosapour, Ebrahim Mostafavi, Seyyed Meysam Mousavi, Haleh Mousavi Isfahani, Amin Mousavi Khaneghah, Christine Mpundu-Kaambwa, Sumaira Mubarik, Francesk Mulita, Daniel Munblit, Sandra B Munro, Efrén Murillo-Zamora, Jonah Musa, Ashraf F Nabhan, Ahamarshan Jayaraman Nagarajan, Shankar Prasad Nagaraju, Gabriele Nagel, Mohammadreza Naghipour, Mukhammad David Naimzada, Tapas Sadasivan Nair, Atta Abbas Naqvi, Sreenivas Narasimha Swamy, Aparna Ichalangod Narayana, Hasan Nassereldine, Zuhair S Natto, Biswa Prakash Nayak, 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Mirza-Aghazadeh-Attari, M, Mirzaei, H, Misganaw, A, Misra, S, Mohammad, K, Mohammadi, E, Mohammadi, M, Mohammadian-Hafshejani, A, Mohammadpourhodki, R, Mohammed, A, Mohammed, S, Mohan, S, Mohseni, M, Moka, N, Mokdad, A, Molassiotis, A, Molokhia, M, Momenzadeh, K, Momtazmanesh, S, Monasta, L, Mons, U, Montasir, A, Montazeri, F, Montero, A, Moosavi, M, Moradi, A, Moradi, Y, Moradi Sarabi, M, Moraga, P, Morawska, L, Morrison, S, Morze, J, Mosapour, A, Mostafavi, E, Mousavi, S, Mousavi Isfahani, H, Mousavi Khaneghah, A, Mpundu-Kaambwa, C, Mubarik, S, Mulita, F, Munblit, D, Munro, S, Murillo-Zamora, E, Musa, J, Nabhan, A, Nagarajan, A, Nagaraju, S, Nagel, G, Naghipour, M, Naimzada, M, Nair, T, Naqvi, A, Narasimha Swamy, S, Narayana, A, Nassereldine, H, Natto, Z, Nayak, B, Ndejjo, R, Nduaguba, S, Negash, W, Nejadghaderi, S, Nejati, K, Neupane Kandel, S, Nguyen, H, Niazi, R, Noor, N, Noori, M, Noroozi, N, Nouraei, H, Nowroozi, A, Nunez-Samudio, V, Nzoputam, C, Nzoputam, O, Oancea, B, Odukoya, O, Oghenetega, O, Ogunsakin, R, Oguntade, A, Oh, I, Okati-Aliabad, H, Okekunle, A, Olagunju, A, Olagunju, T, Olakunde, B, Olufadewa, I, Omer, E, Omonisi, A, Ong, S, Onwujekwe, O, Orru, H, Otstavnov, S, Oulhaj, A, Oumer, B, Owopetu, O, Oyinloye, B, P A, M, Padron-Monedero, A, Padubidri, J, Pakbin, B, Pakshir, K, Pakzad, R, Palicz, T, Pana, A, Pandey, A, Pant, S, Pardhan, S, Park, E, Park, S, Patel, J, Pati, S, Paudel, R, Paudel, U, Paun, M, Pazoki Toroudi, H, Peng, M, Pereira, J, Pereira, R, Perna, S, Perumalsamy, N, Pestell, R, Pezzani, R, Piccinelli, C, Pillay, J, Piracha, Z, Pischon, T, Postma, M, Pourabhari Langroudi, A, Pourshams, A, Pourtaheri, N, Prashant, A, Qadir, M, Quazi Syed, Z, Rabiee, M, Rabiee, N, Radfar, A, Radhakrishnan, R, Radhakrishnan, V, Raeisi, M, Rafiee, A, Rafiei, A, Raheem, N, Rahim, F, Rahman, M, Rahmani, A, Rahmani, S, Rahmanian, V, Rajai, N, Rajesh, A, Ram, P, Ramezanzadeh, K, Rana, J, Ranabhat, K, Ranasinghe, P, Rao, C, Rao, S, Rashedi, S, Rashidi, A, Rashidi, M, Ratan, Z, Rawaf, D, Rawaf, S, Rawal, L, Rawassizadeh, R, Razeghinia, M, Rehman, A, Rehman, I, Reitsma, M, Renzaho, A, Rezaei, M, Rezaei, N, Rezaei, S, Rezaeian, M, Rezapour, A, Riad, A, Rikhtegar, R, Rios-Blancas, M, Roberts, T, Rohloff, P, Romero-Rodriguez, E, Roshandel, G, Rwegerera, G, S, M, Saber-Ayad, M, Saberzadeh-Ardestani, B, Sabour, S, Saddik, B, Sadeghi, E, Saeb, M, Saeed, U, Safaei, M, Safary, A, Sahebazzamani, M, Sahebkar, A, Sahoo, H, Sajid, M, Salari, H, Salehi, S, Salem, M, Salimzadeh, H, Samodra, Y, Samy, A, Sanabria, J, Sankararaman, S, Sanmarchi, F, Santric-Milicevic, M, Saqib, M, Sarveazad, A, Sarvi, F, Sathian, B, Satpathy, M, Sayegh, N, Schneider, I, Schwarzinger, M, Sekerija, M, Senthilkumaran, S, Sepanlou, S, Seylani, A, Seyoum, K, Sha, F, Shafaat, O, Shah, P, Shahabi, S, Shahid, I, Shahrbaf, M, Shahsavari, H, Shaikh, M, Shaka, M, Shaker, E, Shannawaz, M, Sharew, M, Sharifi, A, Sharifi-Rad, J, Sharma, P, Shashamo, B, Sheikh, A, Sheikh, M, Sheikhbahaei, S, Sheikhi, R, Sheikhy, A, Shepherd, P, Shetty, A, Shetty, J, Shetty, R, Shibuya, K, Shirkoohi, R, Shirzad-Aski, H, Shivakumar, K, Shivalli, S, Shivarov, V, Shobeiri, P, Shokri Varniab, Z, Shorofi, S, Shrestha, S, Sibhat, M, Siddappa Malleshappa, S, Sidemo, N, Silva, D, Silva, L, Silva Julian, G, Silvestris, N, Simegn, W, Singh, A, Singh, G, Singh, H, Singh, J, Singh, P, Singh, S, Sinha, D, Sinke, A, Siraj, M, Sitas, F, Siwal, S, Skryabin, V, Skryabina, A, Socea, B, Soeberg, M, Sofi-Mahmudi, A, Solomon, Y, Soltani-Zangbar, M, Song, S, Song, Y, Sorensen, R, Soshnikov, S, Sotoudeh, H, Sowe, A, Sufiyan, M, Suk, R, Suleman, M, Suliankatchi Abdulkader, R, Sultana, S, Sur, D, Szocska, M, Tabaeian, S, Tabares-Seisdedos, R, Tabatabaei, S, Tabuchi, T, Tadbiri, H, Taheri, E, Taheri, M, Taheri Soodejani, M, Takahashi, K, Talaat, I, Tampa, M, Tan, K, Tat, N, Tat, V, Tavakoli, A, Tehrani-Banihashemi, A, Tekalegn, Y, Tesfay, F, Thapar, R, Thavamani, A, Thoguluva Chandrasekar, V, Thomas, N, Ticoalu, J, Tiyuri, A, Tollosa, D, Topor-Madry, R, Touvier, M, Tovani-Palone, M, Traini, E, Tran, M, Tripathy, J, Ukke, G, Ullah, I, Ullah, S, Unnikrishnan, B, Vacante, M, Vaezi, M, Valadan Tahbaz, S, Valdez, P, Vardavas, C, Varthya, S, Vaziri, S, Velazquez, D, Veroux, M, Villeneuve, P, Violante, F, Vladimirov, S, Vlassov, V, Vo, B, Vu, L, Wadood, A, Waheed, Y, Walde, M, Wamai, R, Wang, C, Wang, F, Wang, N, Wang, Y, Ward, P, Waris, A, Westerman, R, Wickramasinghe, N, Woldemariam, M, Woldu, B, Xiao, H, Xu, S, Xu, X, Yadav, L, Yahyazadeh Jabbari, S, Yang, L, Yazdanpanah, F, Yeshaw, Y, Yismaw, Y, Yonemoto, N, Younis, M, Yousefi, Z, Yousefian, F, Yu, C, Yu, Y, Yunusa, I, Zahir, M, Zaki, N, Zaman, B, Zangiabadian, M, Zare, F, Zare, I, Zareshahrabadi, Z, Zarrintan, A, Zastrozhin, M, Zeineddine, M, Zhang, D, Zhang, J, Zhang, Y, Zhang, Z, Zhou, L, Zodpey, S, Zoladl, M, Vos, T, Hay, S, Force, L, Murray, C, Epidemiologie, RS: NUTRIM - R3 - Respiratory & Age-related Health, Bill & Melinda Gates Foundation, Kuwait University (Kuwait), Ministry of Higher Education (Malasia), Lega Italiana per la Lotta ai Tumori, Health Effects Institute (Estados Unidos), Unión Europea. Comisión Europea. European Research Council (ERC), Unión Europea. Comisión Europea. H2020, Fundação para a Ciência e Tecnologia (Portugal), African-German Network of Excellence in Science (AGNES), Federal Ministry of Education & Research (Alemania), Alexander von Humboldt Foundation, Novo Nordisk Foundation, National Institute for Health Research (Reino Unido), National Health and Medical Research Council (Australia), Romanian National Authority for Scientific Research and Innovation, Romanian Ministry of Research Innovation and Digitalization, Ministry of Education, Science and Technological Development (Serbia), Sigrid Jusélius Foundation, Finnish Cancer Foundation, Datta Meghe Institute of Medical Sciences (India), Xiamen University (Malasia), Manipal Academy of Higher Education (India), Panjab University (India), Sistema Nacional de Investigación (Panamá), Secretaría Nacional de Ciencia, Tecnología e Innovación (Panamá), Ministry of Science and Technology (Taiwan), Lung Foundation Australia, National Natural Science Foundation of China, Wellcome Trust, UNSW Sydney (Australia), ICMR - National Institute of Epidemiology (India), University of Tasmania (Australia), National Council for Scientific and Technological Development (Brasil), Coordenação de Aperfeicoamento de Pessoal de Nível Superior (Brasil), Institute for Advanced Studies in Basic Sciences (Irán), Ain Shams University (Egipto), International Center of Medical Sciences Research (Islamabad), National Institutes of Health (Estados Unidos), University of Oxford (Reino Unido), National Institute of Genetic Engineering and Biotechnology (Irán), Marga und Walter Boll - Stiftung, Ministero della Salute (Italia), IRCCS Materno Infantile Burlo Garofolo (Italia), King College London, Wellcome Trust/DBT India Alliance (India), Public Health, University of St Andrews. School of Medicine, and University of St Andrews. Population and Behavioural Science Division

Subjects
Male, DEATHS, DALY, cancer, risk factors, Medizin, systematic analysis, Global Health, Risk Assessment, Cancer prevention, Global Burden of Disease, RC0254, Risk-attributable cancer deaths, SDG 3 - Good Health and Well-being, RA0421, Risk Factors, RA0421 Public health. Hygiene. Preventive Medicine, Quality-Adjusted Life Year, Neoplasms, cancer, Humans, Global Burden of Disease Study, UK, Medicine(all), MCC, RC0254 Neoplasms. Tumors. Oncology (including Cancer), Risk Factor, Smoking, COVID-19, 3rd-DAS, General Medicine, Disability-adjusted life-years, SOCIAL DETERMINANTS, Risk assessments, risk factor, Cardiovascular and Metabolic Diseases, 3121 General medicine, internal medicine and other clinical medicine, OBESITY, Cancer burden, Neoplasm, Female, LIFE-STYLE, Quality-Adjusted Life Years, HEALTH, RA, Human, RC
Abstract

Background: Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods: The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings: Globally, in 2019, the risk factors included in this analysis accounted for 4·45 million (95% uncertainty interval 4·01-4·94) deaths and 105 million (95·0-116) DALYs for both sexes combined, representing 44·4% (41·3-48·4) of all cancer deaths and 42·0% (39·1-45·6) of all DALYs. There were 2·88 million (2·60-3·18) risk-attributable cancer deaths in males (50·6% [47·8-54·1] of all male cancer deaths) and 1·58 million (1·36-1·84) risk-attributable cancer deaths in females (36·3% [32·5-41·3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20·4% (12·6-28·4) and DALYs by 16·8% (8·8-25·0), with the greatest percentage increase in metabolic risks (34·7% [27·9-42·8] and 33·3% [25·8-42·0]). Interpretation: The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. We are grateful to the surveillance systems, including cancer registries, that generated and shared observed cancer burden data. S M Aljunid acknowledges the Department of Health Policy and Management, College of Public Health, Kuwait University for the approval and support to participate in this research project. H Ariffin acknowledges support from the Ministry of Higher Education, Malaysia (grant FRGS/1/2021/SKK0/UM/01/1). F Barra acknowledges support from Lega Italiana per la Lotta contro i Tumori - LILT - Bando 5 x 1000 anno 2019. L Belo and M Carvalho acknowledge the support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB. A J Cohen was supported by the Health Effects Institute, Boston, MA, USA. J Conde acknowledges financial support from the European Research Council - ERC Starting Grant 848325. V M Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006. T C Ekundayo was supported by the African-German Network of Excellence in Science (AGNES), the Federal Ministry of Education and Research (BMBF) and the Alexander von Humboldt Foundation (AvH). N Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). J C Glasbey is support by a Doctoral Research Fellowship from the National Institute of Health Research (NIHR300175). V K Gupta and V B Gupta acknowledge funding support from National Health and Medical Research Council (NHMRC), Australia. C Herteliu, A Pana, and M Ausloos acknowledge partial support by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. C Herteliu is also partially supported by a grant of the Romanian Ministry of Research Innovation and Digitalization, MCID, project number ID-585-CTR-42-PFE-2021. S Hussain was supported from Operational Programme Research, Development and Education–Project, Postdoc2MUNI (number CZ.02.2. 69/0.0/0.0/18_053/0016952). M Jakovljevic acknowledges partial support through the grant OI 175 014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. J H Kauppila acknowledges research grants from Sigrid Jusélius Foundation and the Finnish Cancer Foundation. M N Khatib acknowledges support from Datta Meghe Institute of Medical Sciences (deemed-to-be-university). Y J Kim was supported by the Research Management Centre, Xiamen University Malaysia [XMUMRF/2020-C6/ITCM/0004]. S L Koulmane Laxminarayana acknowledges institutional assistance by Manipal Academy of Higher Education, Manipal. K Krishan is supported by the UGC Centre of Advanced Study (Phase II), awarded to the Department of Anthropology, Panjab University, Chandigarh, India. I Landires is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). M-C Li was supported by the Ministry of Science and Technology, Taiwan (MOST 110-2314-B-003-001). G Liu acknowledges support from the CREATE Hope scientific fellowship from Lung Foundation Australia. J Liu acknowledges support from the National Natural Science Foundation (72122001). J A Loureiro was supported by Scientific Employment Stimulus (FCT; CEECINST/00049/2018). E Mathews is supported by a Clinical and Public Health Early Career Fellowship (grant number IA/CPHE/17/1/503345) from the DBT India Alliance/Wellcome Trust Department of Biotechnology, India Alliance (2018–2023). T J Meretoja was supported by an unrestricted grant from Cancer Foundation Finland sr. S Mohammed acknowledges a fellowship grant from Alexander von Humboldt Foundation, outside the submitted work. M Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. L Monasta received support from the Italian Ministry of Health at the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy (RC 34/2017). U Mons is supported by the Marga and Walter Boll Foundation, Kerpen, Germany. M A Moosavi acknowledges the financial support of National Institute of Genetics Engineering and Biotechnology (NIGEB). J Musa acknowledges support from the NIH/FICK43TW011416 for research-protected time for cervical cancer research and career development at University of Jos. V Nuñez-Samudio is a member of the Sistema Nacional de Investigación (SNI), which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación (SENACYT). O O Odukoya acknowledges support by the Fogarty International Center of the National Institutes of Health under the award number K43TW010704 for research-protected time. The content is solely the responsibility of all the authors and does not necessarily represent the official views of the National Institutes of Health. A S Oguntade acknowledges funding by a doctoral scholarship from the Nuffield Department of Population Health, University of Oxford (Oxford Population Health). J R Padubidri acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for their constant support in research collaborations. R G Pestell acknowledges support from NIH grant W81XWH1810605 Breast Cancer Research, Breakthrough Grant R21 CA235139-01. Z Z Piracha acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad (44000), Pakistan. R A Radhakrishnan acknowledges support from Wellcome Trust/DBT India Alliance - IA/CPHI/18/1/503927. U Saeed acknowledges the International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. A M Samy acknowledges the support from Ain Shams University and the Egyptian Fulbright Mission Program. F Sha was supported by the Shenzhen Science and Technology Program (grant number KQTD20190929172835662). H R Shahsavari acknowledges the Institute for Advanced Studies in Basic Sciences (IASBS) Research Council. A Shetty acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal for all the academic support. D A S Silva acknowledges financing in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES)—Finance Code 001 and D A S Silva is supported in part by CNPq-Brazil (309589/2021-5). L M L R Silva was supported by project CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE). Am Singh is supported by the International Graduate Research Scholarship, University of Tasmania. R Suliankatchi Abdulkader acknowledges support from ICMR—National Institute of Epidemiology. B Unnikrishnan acknowledges Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal. H Xiao acknowledges support from the Public Health Sciences Division of the Fred Hutchinson Cancer Research Center. X Xu is supported by the University of New South Wales (Australia) Scientia Program. C Yu was supported by the National Natural Science Foundation of China (grant number 82173626) and Wuhan Medical Research Program of Joint Fund of Hubei Health Committee (grant number WJ2019H304). Sí

Published
2022

23. Plaster of Paris: Squeeze, But Not Too Hard!

Author

Edward K. Rodriguez, Kaveh Momenzadeh, Ara Nazarian, Shayan Hosseinzadeh, Patrick M. Williamson, Mahsa Shariat, Jonathan Egan, Madison Van Dam, and Xuan Luo

Subjects
Orthodontics, medicine.medical_specialty, genetic structures, urogenital system, business.industry, medicine.medical_treatment, Treatment options, Weight control, behavioral disciplines and activities, Bandages, Calcium Sulfate, body regions, Splints, Casts, Surgical, Orthopedics, Water immersion, Orthopedic surgery, medicine, Humans, Orthopedics and Sports Medicine, Surgery, Splint (medicine), business, Bandage
Abstract

Plaster of Paris (PoP) has been the predominant treatment option for most acute and chronic orthopedic conditions. Water immersion significantly decreases the PoP bandage strength. Moreover, concerns have been raised about the possibility of breaks in PoP splints and cast failures once solid. The current study was designed to account for the increase in weight associated with increased PoP layers. The authors hypothesized that by controlling for weight variation as layers increased, they could determine the number of layers of PoP bandage that truly results in optimal mechanical properties. They assessed whether adequate plaster weight control while increasing layers could improve the mechanical properties of the splint. [ Orthopedics . 2022;45(1):e57–e61.]

Published
2021

24. Anatomic and Radiographic Safe Zone for Posterior Malleolar Screw Placement

Author

Max P. Michalski, Caroline Williams, John Y. Kwon, Kaveh Momenzadeh, Ara Nazarian, and Christopher P. Miller

Subjects
Orthodontics, 030222 orthopedics, Syndesmosis, business.industry, medicine.medical_treatment, Radiography, Bone Screws, 030229 sport sciences, Ankle Fractures, Screw placement, 03 medical and health sciences, Fracture Fixation, Internal, Open Fracture Reduction, 0302 clinical medicine, medicine.anatomical_structure, Fracture fixation, medicine, Humans, Orthopedics and Sports Medicine, Surgery, business, Reduction (orthopedic surgery), Fixation (histology), Bone Wires
Abstract

Background: The most appropriate treatment and management of posterior malleolar fractures (PMFs) lacks consensus. Indirect reduction and fixation with posterior to anterior (PA) screw shows promise by avoiding the risks associated with direct reduction or indirect anterior to posterior approaches. Some authors have raised concerns about potential risk to nearby structures with the PA technique, including hardware prominence into the syndesmosis. This study highlights use of the posteromedial vertical syndesmotic line (PVSL) as a fluoroscopic landmark, helping surgeons avoid intrasyndesmotic placement. Study aims are to evaluate PVSL correspondence with posterior border of the incisura tibialis and to define a safe zone between this line and flexor hallucis longus tendon. Methods: Indirect PA screw placement was completed on 10 cadaveric specimens, followed by fluoroscopy in mortise and lateral views. Dissection was performed to assess screw placement relative to the posteromedial border of the syndesmosis. The posterior border of the syndesmosis was marked with a radiopaque wire. Repeat imaging was completed to validate the fluoroscopic PVSL is representative of the posteromedial border of the tibial incisura. Results: On dissection, 9 out of 10 cadavers had accurate screw placement with no penetration into the syndesmosis. Corresponding imaging showed the screw head to be medial to the marker on mortise view. For the specimen with penetration into the syndesmosis, imaging confirmed that the screw head was lateral to the marker on mortise views. The radiopaque marker correlated with the PVSL for all specimens when comparing anatomic to radiographic findings. A radiographic safe zone is defined for the PA screw 12 mm medial to the PVSL to ensure no iatrogenic injury to the flexor hallucis longus tendon. Conclusion: This study demonstrated that a posterior incisura tibialis fluoroscopic landmark is unambiguous in localizing the posterior syndesmotic border and that screws medial to this line are safely out of the syndesmosis, while screws placed lateral are either in or at risk of intrasyndesmotic placement. A safe zone is defined for screw placement. Clinical Relevance: This article describes a radiographic and clinical safe zone for fixation and hardware placement during open reduction internal fixation (ORIF) of PMFs. This information will assist surgeons in avoiding intrasyndesmotic hardware placement as well as injury to deep soft tissue structures.

Published
2021

25. The effect of surgeon-controlled variables on construct stiffness in lateral locked plating of distal femoral fractures

Author

Ara Nazarian, Edward K. Rodriguez, Amin Mohamadi, Aidin Masoudi, Kaveh Momenzadeh, Mark S. Vrahas, Michael J. Weaver, and George W. Chaus

Subjects
musculoskeletal diseases, Supracondylar Femur, medicine.medical_specialty, Distal Femur, Lateral Locked Plating, Bone Screws, Nonunion, Diseases of the musculoskeletal system, Fracture Fixation, Internal, 03 medical and health sciences, 0302 clinical medicine, LISS, Rheumatology, medicine, Humans, Biomechanics, Orthopedics and Sports Medicine, Femur, 030212 general & internal medicine, Surgeons, Orthodontics, 030222 orthopedics, business.industry, technology, industry, and agriculture, Stiffness, musculoskeletal system, equipment and supplies, medicine.disease, Biomechanical Phenomena, Diaphysis, surgical procedures, operative, Fracture, medicine.anatomical_structure, RC925-935, Orthopedic surgery, Fracture (geology), Implant, medicine.symptom, business, Femoral Fractures, Research Article
Abstract

Background Nonunion following treatment of supracondylar femur fractures with lateral locked plates (LLP) has been reported to be as high as 21 %. Implant related and surgeon-controlled variables have been postulated to contribute to nonunion by modulating fracture-fixation construct stiffness. The purpose of this study is to evaluate the effect of surgeon-controlled factors on stiffness when treating supracondylar femur fractures with LLPs: Does plate length affect construct stiffness given the same plate material, fracture working length and type of screws? Does screw type (bicortical locking versus bicortical nonlocking or unicortical locking) and number of screws affect construct stiffness given the same material, fracture working length, and plate length? Does fracture working length affect construct stiffness given the same plate material, length and type of screws? Does plate material (titanium versus stainless steel) affect construct stiffness given the same fracture working length, plate length, type and number of screws? Methods Mechanical study of simulated supracondylar femur fractures treated with LLPs of varying lengths, screw types, fractureworking lenghts, and plate/screw material. Overall construct stiffness was evaluated using an Instron hydraulic testing apparatus. Results Stiffness was 15 % higher comparing 13-hole to the 5-hole plates (995 N/mm849N vs. /mm, p = 0.003). The use of bicortical nonlocking screws decreased overall construct stiffness by 18 % compared to bicortical locking screws (808 N/mm vs. 995 N/mm, p = 0.0001). The type of screw (unicortical locking vs. bicortical locking) and the number of screws in the diaphysis (3 vs. 10) did not appear to significantly influence construct stiffness (p = 0.76, p = 0.24). Similarly, fracture working length (5.4 cm vs. 9.4 cm, p = 0.24), and implant type (titanium vs. stainless steel, p = 0.12) did also not appear to effect stiffness. Discussion Using shorter plates and using bicortical nonlocking screws (vs. bicortical locking screws) reduced overall construct stiffness. Using more screws, using unicortical locking screws, increasing fracture working length and varying plate material (titanium vs. stainless steel) does not appear to significantly alter construct stiffness. Surgeons can adjust plate length and screw types to affect overall fracture-fixation construct stiffness; however, the optimal stiffness to promote healing remains unknown.

Published
2021

26. Contamination of the Mini C-Arm During Foot and Ankle Surgery

Author

Kaveh Momenzadeh, Christopher P. Miller, Ara Nazarian, Caroline Williams, John Y. Kwon, and Natalia Czerwonka

Subjects
030222 orthopedics, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Foot and ankle surgery, Mini c arm, Surgery, 03 medical and health sciences, 0302 clinical medicine, Intraoperative fluoroscopy, Fluoroscopy, Orthopedic surgery, medicine, Humans, Surgical Wound Infection, Orthopedics and Sports Medicine, Orthopedic Procedures, 030212 general & internal medicine, Prospective Studies, Ankle, Radiology.technician, business
Abstract

Background: Many orthopedic surgeries utilize intraoperative fluoroscopy. The mini C-arm is an advantageous device as it can be easily used without the need for a dedicated radiology technician. However, there are concerns that the mini C-arm may represent a potential source of contamination and subsequent postoperative infection. Previous investigations of standard C-arm drapes have shown high rates of contamination. Similar contamination rates would be even more concerning for the mini C-arm as it requires physically maneuvering the machine. This study aimed to determine the rate of mini C-arm drape contamination and identify high-risk areas. Methods: Fifty foot and ankle surgeries requiring the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were sampled at the conclusion of each procedure. Culture Q-swabs were used for sampling defined locations. Swab samples were then assessed for bacterial growth on a 5% blood agar plate using a semiquantitative technique. Results: In 70% of surgical cases, contamination was observed in at least 1 location. Six of the 8 evaluated locations were found to have significantly higher contamination in comparison with their corresponding negative controls (Mann-Whitney U test, P < .05). The “outer portion of the upper arm” (location 1) exhibited bacteria growth in 26% ( P < .0001) of cases. The “superior portion of the x-ray source” (location 2) exhibited growth in 30% ( P < .0001) of cases. These were the highest-risk areas for contamination and were both significantly more likely to be involved than the “inferior portion of the x-ray source” and “superior portion of the beam receiver,” locations 4 and 5, respectively. Fourteen percent (7/50) C-arm cases and 1.72% (1/58) Achilles tendon surgery control cases developed surgical site infection ( P = .0234; OR, 9.27). Conclusion: Bacterial contamination of the mini C-arm drape was found to be common after foot and ankle procedures. Contamination was more prevalent on the outer ring areas of the C-arm, both at the emitter and receiver. Level of Evidence: Level III.

Published
2021

27. Multivitamins and risk of fragility hip fracture: a systematic review and meta-analysis

Author

Kaveh Momenzadeh, Ara Nazarian, Sharri J. Mortensen, Arvind von Keudell, Indeevar Beeram, and Diana Yeritsyan

Subjects
0301 basic medicine, medicine.medical_specialty, Funnel plot, Hip fracture, business.industry, Osteoporosis, 030209 endocrinology & metabolism, Publication bias, Lower risk, medicine.disease, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, Meta-analysis, Physical therapy, medicine, Orthopedics and Sports Medicine, 030101 anatomy & morphology, business, Multivitamin
Abstract

Hip fracture is a severe complication of osteoporosis and is associated with a significant healthcare burden worldwide. This meta-analysis explores the association between combined multivitamin use and hip fracture risk. Our results provide more patient-centered insight into the impact of supplement use on osteoporosis outcomes. We searched three online databases in August 2019 and included studies that reported on multivitamin use in patients with osteoporotic hip fractures. The inclusion criteria were (1) adult patients with osteoporotic hip fractures, (2) availability of full-text articles in English, and (3) at least 1 year of follow-up. No suitable randomized controlled trials could be identified for inclusion in the analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Eight studies containing 80,148 subjects in total were included in this study. Among these, 4237 cases of fragility hip fracture were reported. The average age was 69±5.3 years, and 21% of subjects were male. Multivitamin use was found to be significantly associated with a lower risk of sustaining a fragility hip fracture (OR 0.49, 95%CI: 0.32–0.77). The Begg and Mazumdar test and funnel plot indicated that no significant publication bias was present. Combined multivitamins are amongst the most widely used supplements and are often preferred over single vitamins. Our meta-analysis indicates that multivitamin use is significantly protective against osteoporotic hip fracture. In the future, randomized controlled trials should be performed to establish multivitamins as effective preventative measures for this injury.

Published
2021

28. Anatomic Structures at Risk during Posterior to Anterior Percutaneous Screw Fixation of Posterior Malleolar Fractures: A Cadaveric Study

Author

Ara Nazarian, Seth O’Donnell, Natalia Czerwonka, John Y. Kwon, Kaveh Momenzadeh, Christopher P. Miller, and Derek S. Stenquist

Subjects
Washer, Percutaneous, ORIF With Mini-Open / Percutaneous, Bone Screws, Sural nerve, Ankle Fractures, Article, Fracture Fixation, Internal, lcsh:Orthopedic surgery, Cadaver, Medicine, Humans, Orthopedics and Sports Medicine, Podiatry, Posterior Malleolus Fracture, Fixation (histology), business.industry, Soft tissue, Screws, Anatomy, Neurovascular bundle, musculoskeletal system, lcsh:RD701-811, medicine.anatomical_structure, Surgery, Ankle, Cadaveric spasm, business, Bone Wires
Abstract

Category: Ankle; Trauma Introduction/Purpose: Posterior malleolus fractures (PMFs) are typically associated with trimalleolar ankle fractures and have been reported to occur in 10-40% of ankle fractures. The PM may be fixed by direct ORIF or indirect percutaneous reduction. Direct reduction via a posterolateral approach is required for larger fragments, which requires prone or lateral decubitus positioning. Indirect reduction and fixation with anterior to posterior (AP) screws remains the most common method, in which screw threads are not entirely across the fracture site to allow interfragmentary compression.Objective: Determine the risk to anatomic structures utilizing a percutaneous technique for posterior to anterior (PA) screw fixation. It is advantageous as it places all the threads across the fracture site even for small fragments and can be performed in the supine position. Methods: 10 fresh-frozen, morphologically normal cadaver lower leg. Under fluoroscopic guidance, 1.35 mm Kirschner wire was inserted percutaneously from anteromedial to posterolateral. Guidewire was inserted from a starting point just medial to the tibialis anterior tendon and aimed at a point just lateral to the Achilles tendon. Small skin incision was made over the wire posteriorly, displacing the Achilles tendon medially as required. The wire was then over-drilled in posterior to anterior direction and replaced with a 4.0 mm partially threaded cannulated screw directed posterior to anterior. Each specimen was dissected, and adjacent soft tissue and neurovascular structures were identified. The distance from the guidewire to each anatomic structure of interest was measured. Descriptive analysis and the correlation between the mean distances from the guidewire to each structure was calculated using SPSS version 26. Results: The sural nerve was directly transected in 1/10 specimens (10%) and in contact with the wire in a second specimen (10%). There was a significant correlation between the proximity of the guidewire to the apex of Volkmann’s tubercle and its proximity to the sural nerve.(r= 0.705, p = 0.034) The flexor hallucis longus (FHL) muscle belly was perforated by the guidewire 40% of the time but was not tethered or entrapped by the screw. The neurovascular bundles were safely away from the wire in all cases. The lateral 1-2 mm of the Achilles tendon was pierced by the guidewire 20% of the time. Although suboptimal, these injuries may be of little clinical consequence, and the screw passed without tethering the tendon in all cadaveric specimens. Conclusion: Percutaneous PA screw placement is a safe technique which can be improved with several modifications. A mini- open technique is recommended to protect the sural nerve. The surgeon may consider aiming slightly more medial and closer to the Achilles tendon in order to avoid injury to the sural nerve. It is also advisable to use a soft tissue guide when over-drilling the guidewire. There may be potential for tethering of the FHL with use of a washer or large screw head. Risk to the anterior and posterior neurovascular bundles is minimal.

Published
2020

29. Contamination Profile of the Mini C-Arm Fluoroscopy Unit in Orthopedic Surgery

Author

Mohammad Mehdi Alemi, Christopher Miller, Ara Nazarian, Natalia Czerwonka, Kaveh Momenzadeh, Caroline Williams, and John Y. Kwon

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Wound Complications, Mini c arm, Article, Surgery, Clinical Outcomes, lcsh:RD701-811, lcsh:Orthopedic surgery, Operative Approach, Orthopedic surgery, medicine, Fluoroscopy, business
Abstract

Category: Other; Ankle Introduction/Purpose: Fluoroscopy is critical for orthopaedic surgery. The mini C-arm is popular among foot and ankle surgeons owing ease of easy, maneuverability, and cost effectiveness. However, there are concerns that the mini C-arm may represent a potential source of contamination and increasing the risk of postoperative infection. Evaluation of large c-arm drapes have shown high rates of contamination. However, the mini C-arm may be even more concerning due to how it is handled. The mini c-arm is continuously manipulated by the surgical team who then return to the surgical field carrying with them any potential cross-contamination.Objective: We hypothesize that there is significant contamination of the drape, and that specific locations of the drape are at higher risk. Methods: 50 foot and ankle surgery cases which required the use of mini C-arm fluoroscopy were included. Eight locations on the mini C-arm drape were chosen for sampling. Locations were defined based on commonly touched areas on the drape by the surgical team, and their proximity to the non-sterile field. Negative controls were obtained by separately sampling an additional 20 mini C-arm drapes after draping c-arm and waiting for average surgery time. Positive controls were obtained by sampling non- sterile surfaces within the OR.Culture Q-swabs were used for sampling defined locations, using an established semiquantitative technique. Plates were incubated at 37 °C for 48 hours. Based on the number of quadrants on plate where colony growth was observed, bacterial growth was graded on a scale of 0, 1+, 2+, 3+, or 4+. Contamination threshold was defined as any growth pattern of 1+ or higher. Results: Figure 1 shows the contamination rates of the sampled areas of the c-arm drape. Contamination was noted in 70% of the cases for at least one area, and in two or more areas in 38% of cases.Contamination rates were significantly higher on defined locations in comparison with their relative negative control, except for locations 4 and 5. (PConclusion: Bacterial contamination of the drape was found to be common (70% of cases) after foot and ankle surgery. Contamination was more common on the superior and inferior aspects of the mini c-arm. This correlates to the area that is most commonly manipulated by the surgical team to position the arms of the c-arm. This information can be utilized by surgeons to identify and avoid high risk areas and, in high risk cases, they may consider changing gloves or re-draping the mini c-arm part way through the case.

Published
2020

30. Multivitamins and risk of fragility hip fracture: a systematic review and meta-analysis

Author

Indeevar, Beeram, Sharri J, Mortensen, Diana, Yeritsyan, Kaveh, Momenzadeh, Arvind, von Keudell, and Ara, Nazarian

Subjects
Male, Hip Fractures, Dietary Supplements, Humans, Osteoporosis, Vitamins, Middle Aged, Osteoporotic Fractures, Aged
Abstract

Hip fracture is a severe complication of osteoporosis and is associated with a significant healthcare burden worldwide. This meta-analysis explores the association between combined multivitamin use and hip fracture risk. Our results provide more patient-centered insight into the impact of supplement use on osteoporosis outcomes.We searched three online databases in August 2019 and included studies that reported on multivitamin use in patients with osteoporotic hip fractures. The inclusion criteria were (1) adult patients with osteoporotic hip fractures, (2) availability of full-text articles in English, and (3) at least 1 year of follow-up. No suitable randomized controlled trials could be identified for inclusion in the analysis. The quality of the included studies was assessed using the Newcastle-Ottawa Scale (NOS).Eight studies containing 80,148 subjects in total were included in this study. Among these, 4237 cases of fragility hip fracture were reported. The average age was 69±5.3 years, and 21% of subjects were male. Multivitamin use was found to be significantly associated with a lower risk of sustaining a fragility hip fracture (OR 0.49, 95%CI: 0.32-0.77). The Begg and Mazumdar test and funnel plot indicated that no significant publication bias was present.Combined multivitamins are amongst the most widely used supplements and are often preferred over single vitamins. Our meta-analysis indicates that multivitamin use is significantly protective against osteoporotic hip fracture. In the future, randomized controlled trials should be performed to establish multivitamins as effective preventative measures for this injury.

Published
2020

31. The Role of Interleukin-27 in Atherosclerosis: A Contemporary Review

Author

Farima Kahe, Gerald Chi, Sadaf Sharfaei, Mehrian Jafarizade, Farbod Zahedi Tajrishi, Preeti Singh, Anmol Pitliya, and Kaveh Momenzadeh

Subjects
Interleukin-27, Inflammasomes, Inflammation, 02 engineering and technology, Pathogenesis, Neovascularization, Downregulation and upregulation, NLR Family, Pyrin Domain-Containing 3 Protein, 0202 electrical engineering, electronic engineering, information engineering, Medicine, Humans, Pharmacology (medical), Myocardial infarction, Interleukin 27, business.industry, Interleukins, Interleukin, 021001 nanoscience & nanotechnology, medicine.disease, Atherosclerosis, Immunology, 020201 artificial intelligence & image processing, medicine.symptom, 0210 nano-technology, Cardiology and Cardiovascular Medicine, business, Reperfusion injury
Abstract

Atherosclerosis is a chronic inflammation characterized by an imbalance between inhibitors and stimulators of the inflammatory system that leads to the formation of atherosclerotic plaques in the vessel walls. Interleukin (IL)-27 is one of the recently discovered cytokines that have an immunomodulatory role in autoimmune and inflammatory diseases. However, the definite role of IL-27 in the pathogenesis of atherosclerosis remains unclear. Recent studies on cardiomyocytes and vascular endothelium have demonstrated mechanisms through which IL-27 could potentially modulate atherosclerosis. Upregulation of the IL-27 receptor was also observed in the atherosclerotic plaques. In addition, circulatory IL-27 levels were increased in patients with acute coronary syndrome and myocardial infarction. A regenerative, neovascularization, and cardioprotective role of IL-27 has also been implicated. Future studies are warranted to elucidate the biologic function and clinical significance of IL-27 in atherosclerosis.

Published
2020

32. Effect of rotator cuff muscle activation on glenohumeral kinematics: A cadaveric study

Author

Joseph P. DeAngelis, Patrick M. Williamson, Arun J. Ramappa, Kaveh Momenzadeh, Ara Nazarian, Philip C. Hanna, Aron Lechtig, and Stephen Okajima

Subjects
Biomedical Engineering, Biophysics, Kinematics, Article, Dynamic load testing, Rotator Cuff Injuries, Rotator Cuff, Cadaver, medicine, Humans, Orthopedics and Sports Medicine, Rotator cuff, Humerus, Range of Motion, Articular, Orthodontics, Shoulder Joint, business.industry, Rehabilitation, Biomechanics, musculoskeletal system, Rotator cuff muscle, Biomechanical Phenomena, medicine.anatomical_structure, Cadaveric spasm, business
Abstract

Healthy shoulder function requires the coordination of the rotator cuff muscles to maintain the humeral head’s position in the glenoid. While glenohumeral stability has been studied in various settings, few studies have characterized the effect of dynamic rotator cuff muscle loading on glenohumeral translation during shoulder motion. We hypothesize that dynamic rotator cuff muscle activation decreases joint translation during continuous passive abduction of the humerus in a cadaveric model of scapular plane glenohumeral abduction. The effect of different rotator cuff muscle activity on glenohumeral translation was assessed using a validated shoulder testing system. The Dynamic Load profile is a novel approach, based on musculoskeletal modeling of human subject motion. Passive humeral elevation in the scapular plane was applied via the testing system arm, while the rotator cuff muscles were activated according to the specified force profiles using stepper motors and a proportional control feedback loop. Glenohumeral translation was defined according to the International Society of Biomechanics. The Dynamic load profile minimized superior translation of the humeral head relative to the conventional loading profiles. The total magnitude of translation was not significantly different (0.805) among the loading profiles suggesting that the compressive forces from the rotator cuff primarily alter the direction of humeral head translation, not the magnitude. Rotator cuff muscle loading is an important element of cadaveric shoulder studies that must be considered to accurately simulate glenohumeral motion. A rotator cuff muscle activity profile based on human subject muscle activity reduces superior glenohumeral translation when compared to previous RC loading profiles.

Published
2020

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