Comparative Responsiveness of the PROMIS Pain Interference Short Forms With Legacy Pain Measures: Results From Three Randomized Clinical Trials
Not Available
Chen, Chen X. (ORCID:0000000269021227)↗
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Safety and efficacy of peripheral nerve blocks to treat refractory headaches after aneurysmal subarachnoid hemorrhage – A pilot observational study
Objectives: Headache after aneurysmal subarachnoid hemorrhage (HASH) is common, severe, and often refractory to conventional treatments. Current treatment standards include medications including opioids, until the pain is mitigated. Peripheral nerve blocks (PNBs) may be an effective therapeutic option for HASH. We conducted a small before-and-after study of PNBs to determine safety, feasibility, and efficacy in treatment of HASH. Methods: We conducted a pilot before-and-after observational study and collected data for 5 patients in a retrospective control group and 5 patients in a prospective intervention PNB group over a 12-month period. All patients received a standard treatment of medications including acetaminophen, magnesium, gabapentin, dexamethasone and anti-spasmodics or anti-emetics as needed. Patients in the intervention group received bilateral greater occipital, lesser occipital, and supraorbital PNBs in addition to medications. The primary outcome was pain severity, measured by Numeric pain rating scale (NPRS). All patients were followed for 1 week following enrollment. Results: The mean ages in the PNB group and control group were 58.6 and 57.4, respectively. One patient in the control group developed radiographic vasospasm. Three patients in both groups had radiographic hydrocephalus and IVH, requiring external ventricular drain (EVD) placement. The PNB group had an average reduction in mean raw pain score of 2.76 (4.68, 1.92 p = 0.024), and relative pain score by 0.26 (0.48, 0.22 p = 0.026), compared to the control group. The reduction occurred immediately after PNB administration. Conclusion: PNB can be a safe, feasible and effective treatment modality for HASH. Further investigations with a larger sample size are warranted.
60 APPLIED LIFE SCIENCES↗
Identification of potent inhibitors of JUN N-terminal kinases for treatment of endometriosis and associated pain
Endometriosis, defined as the ectopic growth of endometrial tissue outside of the uterine cavity, is an inflammatory and hormone-dependent disease that causes excruciating pelvic pain, infertility, and significantly decreases quality of life in affected patients. The JUN N-terminal kinases (JNKs) are a leading class of nonhormonal therapeutic targets that have been validated in preclinical models of endometriosis and in a Phase 1/2 clinical trial. Despite their therapeutic potential, JNK inhibitors with increased potency and specificity are needed to address the inflammatory pathology of endometriosis and to prevent disease progression. Leveraging a DNA-encoded chemical library collection of ~4 billion compounds, we identified lead inhibitor CDD-2428 and optimized derivatives, CDD-2728 and CDD-3013, with excellent binding affinity to JNK1-3 (K d = 0.12 to 3.7 nM), enhanced selectivity, metabolic stability, and cellular permeability. Crystallographic and biochemical studies confirmed that CDD-3013 exhibited superior kinase selectivity with improved efficacy compared to existing JNK inhibitors. In primary endometriosis cell models, CDD-2728 and CDD-3013 suppressed JNK-dependent inflammatory signaling, dampening pathways linked to pain, invasion, angiogenesis, and macrophage recruitment. In an endometriosis mouse model, both CDD-2728 and CDD-3013 reduced endometriotic lesion size, macrophage infiltration, and cellular proliferation, showing in vivo efficacy. When tested in a lipopolysaccharide-induced hyperalgesia model, CDD-2728 and CDD-3013 decreased markers of induced pain, as measured by changes in a dynamic weight bearing test and Grimace scores. These findings nominate CDD-2728 and CDD-3013 as potent, nonhormonal therapeutic candidates for endometriosis with broad anti-inflammatory and analgesic activity, addressing a critical unmet clinical need.
Madasu, Chandrashekhar [Department of Pathology an↗
No Pain, No Grain: Standardizing Grain Size Measurements in AM Metals (O-REU Summer Project) [Slides]
Each grain is a single crystal of differing orientation. ASTM E112 is a standardized method for measuring and communicating grain size, which is suitable for equiaxed grains, but less so for columnar grains. The stretch project goal is to propose a method to measure and evaluate AM grains using a novel method.
36 MATERIALS SCIENCE↗
Investigation of goodness of model data fit using PLSR and PCR regression models to determine informative wavelength band in NIR region for non-invasive blood glucose prediction
Diabetes mellitus is a metabolic disorder characterized by the deficiency in insulin secretion or insulin action on target tissues. Diabetes being diagnosed, requires frequent monitoring. Current measurement techniques are invasive in nature, which is painful. Non-invasive measurement methods for the prediction of blood glucose is a big challenge. Hence this paper focuses on a comparative study to analyze the performance of the two regression models: partial least square regression (PLSR) and principal component regression (PCR) models to arrive at the best regression model for the prediction of blood glucose non-invasively based on NIR diffuse reflectance spectroscopy. The regression model developed involves spectral data collected from 32 subjects from a diabetic center using diffuse reflectance spectrometer (DRS). The spectroscopic data were acquired from the subjects both invasively using clinical method and non-invasively using DRS setup in the NIR spectral range whose wavelength ranges from 750 to 1040 nm. Multivariate analysis using PLSR is found to be a better regression model in terms of the fitted response and estimated mean square prediction error. It is observed that the mean square error value is 0.04 mg/dl for the tenth component in the PLSR model. The developed regression model also proves to be a useful tool in identifying the informative wavelength bands for blood glucose measurement.
46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗
Predicting chronic postsurgical pain: current evidence and a novel program to develop predictive biomarker signatures
Chronic pain affects more than 50 million Americans. Treatments remain inadequate, in large part, because the pathophysiological mechanisms underlying the development of chronic pain remain poorly understood. Pain biomarkers could potentially identify and measure biological pathways and phenotypical expressions that are altered by pain, provide insight into biological treatment targets, and help identify at-risk patients who might benefit from early intervention. Biomarkers are used to diagnose, track, and treat other diseases, but no validated clinical biomarkers exist yet for chronic pain. To address this problem, the National Institutes of Health Common Fund launched the Acute to Chronic Pain Signatures (A2CPS) program to evaluate candidate biomarkers, develop them into biosignatures, and discover novel biomarkers for chronification of pain after surgery. This article discusses candidate biomarkers identified by A2CPS for evaluation, including genomic, proteomic, metabolomic, lipidomic, neuroimaging, psychophysical, psychological, and behavioral measures. Acute to Chronic Pain Signatures will provide the most comprehensive investigation of biomarkers for the transition to chronic postsurgical pain undertaken to date. Data and analytic resources generatedby A2CPS will be shared with the scientific community in hopes that other investigators will extract valuable insights beyond A2CPS’s initial findings. This article will review the identified biomarkers and rationale for including them, the current state of the science on biomarkers of the transition from acute to chronic pain, gaps in the literature, and how A2CPS will address these gaps.
60 APPLIED LIFE SCIENCES↗
Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial
Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.
60 APPLIED LIFE SCIENCES↗
An Exploratory Analysis of Accelerometer-Measured Physical Activity and Emotional Functioning in Patients With Chronic Pain
Not Available
Morrill, Melinda I.↗
Characterisation of motor cortex organisation in patients with different presentations of persistent low back pain
Abstract Persistence of low back pain is thought to be associated with different underlying pain mechanisms, including ongoing nociceptive input and central sensitisation. We hypothesised that primary motor cortex (M1) representations of back muscles (a measure of motor system adaptation) would differ between pain mechanisms, with more consistent observations in individuals presumed to have an ongoing contribution of nociceptive input consistently related to movement/posture. We tested 28 participants with low back pain sub‐grouped by the presumed underlying pain mechanisms: nociceptive pain, nociplastic pain and a mixed group with features consistent with both. Transcranial magnetic stimulation was used to study M1 organisation of back muscles. M1 maps of multifidus (deep and superficial) and longissimus erector spinae were recorded with fine‐wire electromyography and thoracic erector spinae with surface electromyography. The nociplastic pain group had greater variability in M1 map location (centre of gravity) than other groups ( p < .01), which may suggest less consistency, and perhaps relevance, of motor cortex adaptation for that group. The mixed group had greater overlap of M1 representations between deep/superficial muscles than nociceptive pain (deep multifidus/longissimus: p = .001, deep multifidus/thoracic erector spinae: p = .008) and nociplastic pain (deep multifidus/longissimus: p = .02, deep multifidus/thoracic erector spinae: p = .02) groups. This study provides preliminary evidence of differences in M1 organisation in subgroups of low back pain classified by likely underlying pain mechanisms. Despite the sample size, differences in cortical re‐organisation between subgroups were detected. Differences in M1 organisation in subgroups of low back pain supports tailoring of treatment based on pain mechanism and motor adaptation.
Elgueta‐Cancino, Edith↗
A precise non-invasive blood glucose measurement system using NIR spectroscopy and Huber’s regression model
Diabetes is one of the prominent diseases around the world. Presently, invasive techniques need a finger prick blood sample . A repetitively painful procedure that produces the chance of infection. To resolve this issue, non-invasive measurement approach is proposed. In this paper, an efficient NIR wave based optical detection system is proposed with optimized post-processing regression model. After real-time data analysis, it has been found that the coefficient of determination (R{sup 2}) is improved with the value of 0.9084 using proposed regression model. Mean absolute derivative is also increased with 3.87 mg/dl corresponding to predicted blood glucose concentration. Mean absolute relative difference has exceeded to 3.25%, and average error is improved with 3.77% using proposed regression model. Average accuaracy has been analyzed 94–95% for predicted blood glucose concentration.
71 CLASSICAL AND QUANTUM MECHANICS, GENERAL PHYSIC↗
Method for automatic correction of offset drift in online sensors
Abstract Successful operation and optimization of water treatment systems hinge on the availability of high-quality online sensor measurements. Ideally, the available measurements should be simultaneously accurate (i.e., unbiased and precise), representative, voluminous, and timely. This remains a pain-point in current water infrastructures, forming a barrier to a wider adoption of advanced and autonomous control systems. While short-lived symptoms, such as outliers and spikes, can be detected or corrected with state-of-the-art tools for fault detection and identification, it is much more difficult to detect, diagnose, and correct the symptoms of slow faults, such as changes in offset or sensitivity due to drift. The time scale of drift is often longer than the time scales of the system dynamics of interest. Moreover, sensor drift has been shown to occur at the same time and with similar rates when sensors are exposed to the same conditions. This challenges data quality management strategies based on redundancy. In this contribution, we develop a new method, including both a hands-off sensor calibration mechanism and an information-seeking control architecture that can handle the unique challenge of simultaneous and similar drift in online sensors.
Chowdhury, Dhrubajit↗
Accumulation of sorbitol in the sciatic nerve modulates circadian properties of diabetes-induced neuropathic pain hypersensitivity in a diabetic mouse model
Highlights: • K{sub d} values of Se(IV) sorption on Grimsel granodiorite and main minerals. • Relationship between K{sub d} values and SSA. • Surface complexation modelling of Se(IV) on biotite. • Sorption site density calculated by molecular modelling. The intensity of pain in diabetic neuropathy varies in a circadian time-dependent manner. It is well known that diabetes has two distinct types, which are differentiated based on the cause of the disease. Previous studies have yet to compare the circadian properties of the pain intensity of diabetic neuropathy between type I and type II diabetes. In this study, we demonstrated that the pain intensity of diabetic peripheral neuropathy in a db/db mouse model of type II diabetes showed a significant diurnal oscillation, but such time-dependent oscillation was not detected in a streptozotocin (STZ)-induced type I diabetic mouse model. The polyol pathway-induced accumulation of sorbitol in peripheral nerve cells suppresses Na{sup +}/K{sup +}-ATPase activity, which is associated with the intensity of pain in diabetic neuropathy. In db/db mice, this accumulation of sorbitol in peripheral nerve cells showed significant diurnal oscillation. In addition, pain intensity and Na{sup +}/K{sup +}-ATPase activity were decreased at the peak time of sorbitol accumulation in these mice. Although STZ-induced diabetic mice also showed sorbitol accumulation and Na{sup +}/K{sup +}-ATPase dysfunction, these measures did not oscillate in a time-dependent manner. These findings reveal differences in the circadian properties of pain hypersensitivity in mouse models of type I and type II diabetes, and also provide ideas for developing novel approaches to the management of diabetic neuropathy.
60 APPLIED LIFE SCIENCES↗
CLARIFYING THE NEXUS BETWEEN LIFE CYCLE ASSESSMENT AND CIRCULARITY INDICATORS: A SETAC/ACLCA INTEREST GROUP
Purpose Improving the circularity of resources is important to the sustainability of consumer goods. Current research has indicated that circularity practices and circular economy (CE) methods do not always reduce environmental impacts. The aim of this research is to investigate the adoption of the life cycle assessment (LCA) methodology to improve the environmental impacts of circularity practices. Methods As part of the Society for Environmental Toxicology And Chemistry (SETAC) forum, an interest group (IG) on Circularity and LCA was formed in partnership with the American Center for Life Cycle Assessment (ACLCA) to tackle methodological and technical issues related to circularity in LCA. The IG’s research approach is summarized in four key steps: defining goals and objectives, literature review and gap analysis, ideation, and experimentation. The twelve active persons within this IG meet monthly and have been divided into four sub-working groups (sub-WGs) so that complementary tasks can be completed concurrently in an effective manner. Each sub-WG meets monthly and reports back to the main group for collaboration and brainstorming to meet the research objectives. Results and discussion First, the sub-WG #1, focusing on the “pool of circularity and LCA-based indicators”, analyzed the complementarity between two of the most used circularity indicators and LCA. Second, the sub-WG #2, working on the “evaluation of CE loops performance through LCA”, built a mind map of pain points that reflect the challenges that the LCA practitioners face when combining LCA with CE approaches. Third, the sub-WG #3, dealing with the “trade-offs between circularity and sustainability”, highlighted key alignments and/or conflicts between circularity and sustainability performance depending on the scope, product, industry, or system of analysis. Fourth, the sub-WG #4, focusing on “business and industrial cases”, plans to leverage the knowledge base developed within this IG to develop use cases documenting the benefits and challenges associated with CE-related loops modeling in LCA. Conclusions The first findings of this SETAC/ACLCA IG provide a state-of-the-art overview of the synergists of LCA methodology and the CE measurement frameworks reported in the literature. To move forward and capitalize on the first findings, one valuable point will be to discuss and provide concrete solutions to the pain points that emerged when considering circularity in LCA. Eventually, the knowledge base and resources created within this IG ultimately aim to support the proper application of LCA for practitioners in CE contexts, and could provide relevant inputs for the ISO Technical Committee ISO/TC 323 working on the upcoming standard for the measurement of CE performance.
Life cycle assessment, circular economy, circulari↗
Opportunities for isomer studies for astrophysics at FRIB
The role of nuclear isomers in astrophysical nucleosynthesis is gaining increased attention, as reactions on ground and isomeric states are both potentially important for determining the reaction rates and flow within the reaction network. A particular case is the odd-odd N=Z nuclides in the sd -shell, which play an important role in breakout from the CNO cycle in nova nucleosynthesis, affecting reaction flow, the nucleosynthesis end-point, and final abundances, impacting potential astronomical observables. Because many of these nuclides have low-lying isomers, it is important to constrain reactions on both ground and isomeric states. Developments in radioactive-beam facilities are opening such opportunities, via direct and indirect techniques. The first measurement using a new technique for manipulating ground/isomer content in reaccelerated beams without affecting ion optics, has been employed to study 38 K, which will be applicable to measurements on 34 Cl and others at the nascent Facility for Rare Isotope Beams.
73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗
Prospects for Surrogate Neutron Capture Measurements with Radioactive Ion Beams and GODDESS
Neutron capture reactions are responsible for the synthesis of almost all of the elements heavier than iron through the slow s-process, that proceeds close to the line of stability, and the rapid r-process, with very neutron-rich waiting points. Uncertainties in (n,γ) rates in neutron rich nuclei, especially near closed neu- tron shells, can have significant impact [1] on the predictions of final abundances for different astrophysical scenarios for the r process. Understanding (n,γ) rates on neutron-rich fission fragments is also important for nuclear forensics and stockpile stewardship science. Ratkiewicz et al. [2 and references therein] has recently demonstrated that the (d,pγ) reaction is a valid surrogate for (n,γ), where the formation of the compound nucleus from the breakup of the deuteron has been calculated in a reaction model and the subsequent measured gamma-decay probabilities are reproduced with standard level density and strength functions in a Bayesian approach. In parallel to the surrogate validation efforts, we have demonstrated that the (d,pγ) reaction can be measured in inverse kinematics with Gammasphere ORRUBA: Dual Detectors for Experimental Structure Studies (GODDESS) [3] where the Gammasphere array of Compton-suppressed HPGe detectors is coupled to the Oak Ridge Rutgers University Barrel Array of position-sensitive silicon strip detectors. During the commissioning campaign we measured the (d,pγ) reaction with 134 Xe and 95 Mo beams, the latter to demonstrate the surrogate method in inverse kinematics. The present talk will present preliminary results from this campaign including γ-decay probabilities and prospects for surrogate (n,γ) measurements with 143 Ba fission-fragment beams.
73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗
Accuracy, criteria, and clinical significance of visual assessment on diffusion-weighted imaging and apparent diffusion coefficient quantification for diagnosing acute appendicitis
Purpose: To assess the accuracy, criteria, and clinical significance of diffusion-weighted imaging (DWI) signal intensity and apparent diffusion coefficient (ADC) quantification for diagnosing acute appendicitis. Methods: Fifty-one patients with right lower abdominal pain [uncomplicated appendicitis (n = 25), complicated appendicitis (n = 10), and non-appendicitis (n = 16)] who underwent MR examination were enrolled in this retrospective study. Two radiologists independently measured appendiceal diameter and wall thickness. They assessed whether a wall defect, an abscess, extraluminal air, or an appendicolith was present on axial T2WI; evaluated intensity on DWI using a 5-point scale; and determined the ADC values of the appendix and peri-appendiceal tissue. Statistical analysis was performed to assess imaging findings for the diagnosis of appendicitis and complicated appendicitis. Cut-off values were determined using receiver operating characteristic analysis. Results: For diagnosing acute appendicitis, the accuracy improved from 78.4% using only T2WI to 86.3% using combined T2WI and DWI for reader 1 and from 82.4 to 86.3% for reader 2. For the appendix, the cut-off ADC values that diagnosed appendicitis were 1.41 × 10{sup −3} and 1.26 × 10{sup −3} mm{sup 2}/s with accuracies of 78.4% and 76.5%, respectively. For the peri-appendiceal tissue, these values of 1.03 × 10{sup −3} and 0.91 × 10{sup −3} mm{sup 2}/s differentiated between uncomplicated and complicated appendicitis with an accuracy of 97.1%. Conclusions: Combined DWI and T2WI provided high accuracy for diagnosing appendicitis. The inflamed appendix had lower ADC value than the normal appendix. The peri-appendiceal tissue presenting low ADC value was a notable finding of complicated appendicitis.
62 RADIOLOGY AND NUCLEAR MEDICINE↗
A novel methodology to integrate outcomes regarding perioperative pain experience into a composite score: Prediction model development and validation
Abstract Background An integrated score that globally assesses perioperative pain experience and rationally weights each component has not yet been developed. Methods A development dataset specific to adult Chinese patients undergoing orthopaedic surgery was obtained from PAIN OUT (1985 qualified patients of 2244). A more recent validation dataset obeying the same conditions was obtained from the Chinese Anaesthesia Shared‐database Platform (1004 qualified patients of 1032). Outcomes were assessed using the International Pain Outcomes Questionnaire (IPO‐Q), which comprises key patient‐level outcomes of perioperative pain management, including pain experience and perceptions of care. Using principal component analysis and regression models, a composite score (CS) was inferred to integrate pain experience. The discrimination of the CS for dissatisfaction and desire for more pain treatment was compared with that of the worst pain score. Results A CS was developed from the 12 items of the IPO‐Q regarding pain experience. The weight for calculating the CS was worst pain 11, least pain 17, time spent in severe pain 11, interference with activity in bed 9, interference with breathing deeply or coughing 10, interference with sleep 9, anxiety 12, helplessness 12, nausea 0, drowsiness 2, itch 5 and dizziness 2. In external validation, the CS indicated superior discrimination to the worst pain in predicting dissatisfaction ( p < 0.001) and desire for more pain treatment ( p < 0.001). Conclusions This study introduced a methodology to integrate outcomes regarding perioperative pain experience into a CS, which was based on the weight of each item. Significance This novel methodology sheds additional light on the riveting issue of carefully integrating several measures into a composite endpoint, which may be useful for quality improvement purposes when addressing the impact of a change in clinical practice.
Jiang, Bailin↗
A Novel Anatomic Reconstruction for Posterior Tibialis Tendon in Treatment of Flexible Adult‐Acquired Flatfoot Deformity
Objective To present a novel approach for the anatomic reconstruction of the posterior tibialis tendon (PTT) in restoring plantar insertions and evaluate its efficiency in treating flexible adult‐acquired flatfoot deformity (AAFD) caused by PTT dysfunction. Methods For AAFD treatment, a novel PTT reconstruction method was presented. The current study involved 16 patients, including three men, and 13 women, from August 2017 to July 2019. The mean age was 43.2 ± 15.1 years (21–64 years). The innovative PTT repair method was used on all patients. The treatment involved performing a traditional Flexor Digitorum Longus (FDL) transfer in the navicular tuberosity and suturing the plantar insertions to FDL as tension was applied to tighten the plantar structures of the foot. The results were retrospectively analyzed. The clinical outcome was assessed using the pain visual analogue scale (VAS), the satisfaction VAS, and the American Orthopedic Foot and Ankle Society ankle–hindfoot scale (AOFAS‐AH). Isokinetic testing was performed using a dynamometer at 60°/s and 120°/s for inversion/eversion and plantarflexion/dorsiflexion, respectively, to determine the mean peak torque. Radiographic measurements were employed to assess the outcomes. Results Bone surgeries combined with the modified anatomic PTT reconstruction were performed on patients with medializing calcaneal osteotomy in 12 (75%) patients and subtalar joint fusion in four (25%) patients. The branch linking to the plantar insertions was detected in every case, with an average width of 3.5 ± 0.8 mm (3.1–4.3 mm). All patients were followed up for the mean of 16.8 ± 1.8 months (range, 15–20 months). The average postoperative functional scores, including pain VAS, satisfaction VAS, total AOFAS‐AH, and all AOFAS‐AH sub‐scales, steadily improved during the follow‐up. In the last follow‐up, isokinetic testing revealed no loss of plantarflexion strength ( p = 0.350 and 0.098) and significant improvement in the inversion strength ( p = 0.007 and 0.008) in the operated ankles at 60°/s and 120°/s. Radiographic outcomes, particularly the talar head uncovering, improved significantly after more than a year ( p < 0.001 for all). Conclusions The novel technique for PTT reconstruction in restoring the plantar insertions serves as an effective procedure in treating AAFD caused by PTT dysfunction in terms of delivering a consistent improvement in ankle inversion strength, medial longitudinal arch restoring, and satisfactory clinical outcomes.
Hu, Yong↗