bluuebunny/crossref_metadata_2025 huggingface dataset:
Rotated Insertion Metatarsal Osteotomy with Distal Soft Tissue Procedure for Severe Hallux Valgus Deformity ―Novel Procedure of the 1st metatarsal osteotomy―
Authors: Samoto Norihiro , Tanaka Yasuhito , Katsui Ryuhei , Sugimoto Kazuya
Published: September 2017

Category:

Bunion

Introduction/Purpose:

Hallux valgus deformity is recently a common disease involved in the foot and ankle and many procedures are recommended globally. However it is controversial about the operative treatment for severe hallux valgus. Many authors have reported the technical difficulties and various complications. We performed rotated insertion metatarsal osteotomy with the distal soft tissue procedure for severe hallux valgus deformity since January 2008. The purpose of this study is to evaluate the medium-term outcome of this procedure.

Methods:

Two hundred thirty-two feet in 173 patients were enrolled in this study and followed them up for a mean of 44.5 months. The mean age at the operation was 64.5 years. Hallux valgus angle(HVA) and intermetatarsal angle(IMA) were measured. This procedure consists of the rotated insertion metatarsal osteotomy and the distal soft tissue procedure. This diaphysial longitudinal metatarsal oblique osteotomy was performed from proximally- medial site of the first metatarsal directed to distally- lateral site through the dorsal exposure. The tip of osteotomized proximal metatarsal was formed at the dorso-distal site to insert in the central intramedullary aspect of osteotomized distal metatarsal. The second triangular cut of one third of dorso-plantar thick was made about 10 to 15 mm length from the lateral tip of osteomized proximal metatarsal. The internal fixation was performed with locking plate with screws. As a result, osteotomized sites were locked each other such as a puzzle.

Results:

The mean preoperative HVA and IMA were 43.8 degrees and 20.1 degrees. The mean postoperative HVA and IMA were decreased to 9.0 degrees and 6.1 degrees. AOFAS scores improved from 49.3 to 89.7. All cases were obtained complete union. Postoperative displacement was in 12 feet (5.2%) and followed under-correction (or recurrence). Overcorrection (hallux varus) occurred in 10 feet (4.7%). Wound healing was delayed in 21 feet (9.1%). In general, we found no severe complication and unsatisfactory result.

Conclusion:

This procedure provided satisfactory result for severe hallux valgus deformity. Especially the rigid fixation at the site of metatarsal osteotomy was much stronger because of the insertion and locking plate. However the further more outcomes in detail are essential for longer term follow-up.
Evaluating Recovery Following Total Ankle Arthroplasty Using a Smartphone Mobile Application
Authors: Sanders Austin , Kunas Grace , Fields Kara , Demetracopoulos Constantine , Deland Jonathan , Ellis Scott , Lyman Stephen
Published: September 2017

Category:

Ankle, Ankle Arthritis

Introduction/Purpose:

The use of smartphone applications to assist with medical care is increasing. An important aspect of total ankle arthroplasty is to allow patients to remain active and mobile following their surgery while decreasing discomfort. To our knowledge, no other studies have quantitatively and qualitatively assessed post-operative mobility following total ankle arthroplasty. The goals of the present study were to assess the reliability of a mobile health application to measure step counts, to correlate mobility with pain and functional assessments, and to determine average walking ability following total ankle arthroplasty.

Methods:

A smartphone app, Moves, used a pedometer to record the number of steps taken daily. The device was chosen because it is a free application and is compatible with both iPhone and Android. Patients were identified through the OR schedule and called one month prior to surgery. After obtaining consent, patients completed an online consent form, an online pre- operative survey and downloaded the Moves application to their smartphone. Mobility data was gathered for the month prior to surgery and from post-operative months 3-9. Beginning at 3 months post-operatively, patients completed a weekly online survey until 6 months post-operatively, which was then completed biweekly until study completion at 9 months post-operatively. The correlation of step count with pain and quality of life scores as reported through the Foot and Ankle Outcome Score (FAOS) and pain as reported by the Numeric Rating Scale (NRS) were assessed via Spearman’s rank correlation coefficients.

Results:

46 patients (23 female and 23 males) were enrolled with a mean age of 63.6 years (range 33.0 to 78.9). Maximum daily step count increased from a median (1st quartile, 3 rd quartile) 4348 (2737, 7253) steps pre-operatively to 4411 (3237, 9614) steps post-operatively, with patients continuing to increase their step count at 9 months post-operatively. Step count showed weak correlation with FAOS pain scores (rs=0.21 [95% CI: 0.08, 0.33]), FAOS QOL scores (rs=0.11 [95% CI: -0.02, 0.24]), and NRS pain scores (rs=-0.27 [95% CI: -0.38, -0.14]).

Conclusion:

Using mobile technology following total ankle arthroplasty may be useful for patients to quantitatively assess their recovery; however, this application fails to correlate increased ambulation with qualitative assessments such as pain and quality of life. While improved pain and quality of life scores only showed weak correlations with increased ambulation, it is important to note that pain improved despite increasing ambulation in the post-operative period. In addition, it may be that differences in functional outcomes do not appear until beyond 9 months as step count has not yet plateaued at that point.
Risk Factors for Failure of Cheilectomy for Hallux Rigidus
Authors: Sanders Austin , Nguyen Joseph , Deland Jonathan , Ellis Scott
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus occurs in 2.5% of the population over 50 years of age and is commonly treated with cheilectomy or arthrodesis. While long-term outcomes following cheilectomy for hallux rigidus are promising, questions remain concerning indicators for failure of a cheilectomy. The goal of this study was to use clinical, radiographic, and subjective assessments to determine potential risk factors for failure of cheilectomy and indicators for success of cheilectomy.

Methods:

A retrospective review of 66 patients with hallux rigidus treated with cheilectomy by two orthopaedic foot and ankle surgeons between 2007 and 2016. A list of patients was generated using the CPT code 28289. Patients were excluded if they had prior forefoot surgery, a cheilectomy with fusion involving the first metatarsal, or if they did not have postoperative FAOS scores. Data was collected regarding demographics, clinical classification, medical history/comorbidities, radiographic measurements, surgical information, complications, and pre and postoperative FAOS. The cheilectomy was considered a failure if the patient was converted to a metatarsophalangeal fusion following the cheilectomy or if their postoperative FAOS score failed to improve compared to their preoperative FAOS score. Independent samples t-test and chi-square tests were used to analyze the continuous variables and categorical variables, respectively. A two-way repeated measures ANOVA was used to analyze the pre and postoperative radiographic outcomes between and within the two groups.

Results:

21 out of 66 patients had decreased postoperative FAOS scores and were considered the failure group. There was no difference between the two groups for age at surgery, BMI, gender, ASA, diagnoses, or medical history. Clinically, the failure group had more subsequent surgeries compared to the success group (p=0.039), resulting in longer postoperative follow-up time (10 months vs. 32.4 months, p=0.005). Radiographically, the failure group had a lower mean AP talar-1st Metatarsal Angle pre- operatively (8.10 mm) compared to the success group (12.77 mm, p=0.028). Postoperatively, the failure group had an increased Calcaneal Pitch (p=0.048), despite no significant difference between groups preoperatively (p=0.087). The failure group also demonstrated a reduced ratio of first metatarsal to second metatarsal length postoperatively (p=0.007), which was not seen in the success group.

Conclusion:

Our study found radiographic measurements to be different in patients with a failed cheilectomy as compared to patients with a successful cheilectomy. Preoperatively, a decreased AP Talar-1st Metatarsal Angle may be a risk factor for failure of cheilectomy. Postoperatively, a decreased length of the first metatarsal and an increase in Calcaneal Pitch may result in worse outcomes following cheilectomy.
Comparison of treatment outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants
Authors: Sangeorzan Bruce , Ledoux William , Benich Marisa Rose , Orendurff Michael , Hansen Sigvard , Davitt James , Anderson John , Bohay Donald , Coetzee J. Chris , Brage Michael , Houghton Michael
Published: September 2017

Category:

Ankle, Ankle Arthritis, Arthroscopy, Trauma

Introduction/Purpose:

We tested clinical equipoise in ankle arthrodesis and ankle arthroplasty during a time of transition from older to newer generation implants using a prospective cohort.

Methods:

We performed a prospective cohort study comparing outcomes in 273 consecutive patients treated for ankle arthritis by arthrodesis or ankle arthroplasty between 2005 and 2011. Adult Patients with end-stage ankle arthritis, who were ambulatory and willing and able to respond to surveys were included. Patients were excluded from the study if they had another significant lower limb problem that might affect ambulation. At baseline and at 6, 12, 24, and 36 months follow up visit, participants completed a pain and satisfaction survey, a Musculoskeletal Function Assessment (MFA), and a Short Form-36 (SF-36) survey. Surgery was performed by surgeons trained in both foot and ankle reconstruction and hip and knee arthroplasty. The participants were primarily enrolled from a tertiary teaching hospital but also at three sites in different states that included both teaching hospitals and private practice settings.

Results:

Linear mixed effects regression adjusted for baseline differences (age, BMI, and surgery type.) There were no significant baseline differences in MFA or SF-36 by surgery type. There was significant mean improvement after surgery regardless of procedure (p<0.001). The greatest improvement occurred at 6 month follow-up; Mean ± SE, (%) improvement was 12.6±0.7, (32%) for MFA, 22.0±1.4, (58%) for Physical Function (PF); 32.4±1.6, (96%) for Bodily Pain (BP), 4.0±0.2, (60%) for pain score. Average improvement was significantly better with arthroplasty in MFA (3.6 ± 1.6, p=0.023) and in PF (7.5 ± 2.9, p=0.0098). The difference between arthrodesis and arthroplasty was greater for patients receiving the newer Salto Talaris implant; average improvement for MFA (3.9±1.4, p=0.031), PF (8.8±3.3, p=0.0074), BP (7.3±3.6, p=0.045), and pain score (0.8±0.4, p=0.038).

Conclusion:

Conclusions Both ankle replacement and ankle arthrodesis are highly effective treatments for ESAA. When treated by surgeons with expertise in both foot reconstruction and hip and knee arthroplasty, patients reported improved comfort and function with both treatments. Average improvement was significantly better in those with arthroplasty in MFA and in SF-36 PF scale (7.5 ± 2.9, p=0.0098). That difference was greater when earlier generation implants were removed from the analysis. Younger patients had greater functional improvements than older patients. Patients with low BMI had better improvement that those with high BMI.
Medial Soft-tissue Release for a Lateralising Calcaneal Osteotomy
Authors: Shah Kalpesh , Dash Kumar Kaushik
Published: September 2017

Category:

Hindfoot

Introduction/Purpose:

Lateralising calcaneal osteotomy (LCO) for pes cavus is generally regarded to be harder to shift than a medialising calcaneal osteotomy for pes planus. Whilst this may be due to tight tissues as in pes cavus, no attempt has been made to define a particular structure that could limit the lateral shift in a LCO. Some surgeons recommend releasing the flexor retinaculum routinely with a LCO to avoid a tarsal tunnel syndrome, suggesting that perhaps it is the flexor retinaculum that is the main restrictor to the lateral shift in a LCO. The purpose of our study was to define the structures that restrain the lateral shift in a calcaneal osteotomy in a cadaveric study.

Methods:

Calcaneal osteotomies were carried out by a single orthopaedic surgeon on 10 embalmed, below-knee cadavers. LCOs were performed using standard lateral approach and the lateral calcaneal shift was measured before and after the release of flexor retinaculum in 4 cadavers. Further exploratory dissection around the osteotomy site, however, revealed that abductor hallucis muscle must be the main restraint to the lateral shift of the calcaneus. Subsequently, LCO was performed on another 6 cadavers and the abductor hallucis muscle fascia as well as the plantar fascia was released. The lateral shift was measured before and after the fascia releases, and compared with those of the flexor retinaculum release.

Results:

The average shift with a LCO by itself in the first 4 cadavers was similar to the last 6 (4.5 mm and 5.5 mm respectively). Releasing the flexor retinaculum created a further 3 mm lateral shift on average; however, release of abductor hallucis muscle fascia and the plantar fascia increased lateral shift by an additional 7 mm on average; which is an extra 4 mm shift on average compared with those of flexor retinaculum release.

Conclusion:

The results of this study suggest that the abductor hallucis muscle along with the plantar fascia is one of the main structures limiting the lateral shift in LCO, and release of fascia over this muscle as well as the plantar fascia should be an essential part of the lateralizing calcaneal osteotomy.
Use of Telemedicine for Initial Consultations in Elective Orthopaedics—Results from a Large Volume Centre
Authors: Shah Kalpesh
Published: September 2017

Category:

Healthcare Delivery

Introduction/Purpose:

Telehealth and telemedicine are at the heart of healthcare Vision for several countries including Canada, U.S.A, Scotland, etc; and and the aim is to use technologies to transform the way health and is delivered. Deployed thoughtfully and carefully, telehealth and telecare can help generate efficiencies through more flexible use of our workforce capacity and by reducing travel and minimising access delays. In line with this we wanted to use telemedicine for doing preoperative consultations for elective foot/ankle and lower limb arthroplasty procedures in patients referred from remote parts of the country to our hospital. The purpose of our study was to prove that telemedicine clinics (or Tele clinics) are just as safe, effective and satisfactory as face to face interactions between doctors and their patients.

Methods:

Two studies were conducted at this hospital between 2015-16. The first was a prospective pilot study of 50 new patients who were all seen using two different consultation rooms; with the patient along with a physiotherapist in one room, and the surgeon in another. Patients were seen via the Telemedicine unit without being aware that the surgeon was in the same building, and were then asked to rate their experience. The unanimous positive feedback received from this pilot study encouraged us to start using Tele clinics for initial consultations on a regular basis. The second study is a retrospective analysis of the safety and quality of the Tele clinics during a twelve months period.

Results:

4 surgeons saw 320 patients in the Tele clinics over the study period of 12 months for foot/ankle as well as lower limb arthroplasty conditions. The number of patients who required surgery and the number of additional investigations carried out were similar to the ones from regular clinics. Feedback from patients remained very high for the Tele-clinics.

Conclusion:

Tele-clinics are largely used for reviewing patients after surgery. Our study shows that Tele-clinics can also be used for initial consultation for routine orthopaedic conditions, and are as safe and effective as face to face consultations. This provides an opportunity to treat patients in new ways and help manage rising costs and demand.
Detection of Tram Track Lesion in the Ankle Joint; A Comparative Study of Magnetic Resonance Imaging with Ankle Arthroscopy
Authors: Shim Dong-Woo , Hwang Yeokgu , Park Yoo Jung , Lee Jin Woo , Han Seung Hwan
Published: September 2017

Category:

Ankle, Arthroscopy

Introduction/Purpose:

Tram track lesion in the ankle joint has been occasionally found during the ankle arthroscopy and there has been few studies relating the pathophysiology, diagnostic method and treatment of the lesion. This study aimed to show the effectiveness of magnetic resonance imaging (MRI) for detection of tram track lesion in the ankle joint comparing with ankle arthroscopy.

Methods:

We retrospectively assessed 175 ankles in 170 patients with anterior bony impingement syndrome in the ankle who underwent arthroscopic surgery between January 2013 and July 2015. Anterior ankle bony spurs were scored in preoperative weight-bearing radiographs using the impingement classification. MRIs were reviewed for the detection of tram track lesions according to our definition (focal high signal intensity along the talar dome cartilage surface on coronal view), which were then compared with arthroscopic findings. The grade of cartilage defect was stratified according to international cartilage repair society (ICRS) grading system by arthroscopic finding.

Results:

Fourteen (8.0%) ankles were identified with tram track lesion on MRI and 16 (9.1%) ankles were identified with tram track lesion at ankle arthroscopy. Overall sensitivity of MRI for detection of tram track lesion was 87.5% and specificity was 100%. On plane weight-bearing radiographs, 4 patients had grade 1, 2 patients had grade 2 and 10 patients had grade 3 impingement spurs. Under the ICRS grading system, 4 cases were grade 2, 4 cases were grade 3, and 8 cases were grade 4 at arthroscopy. Comparing with MRI, 2 cases of grade 2, 4 cases of grade 3 and 8 cases of grade 4 were detected (Table). Impingement spur grade showed no significant correlation with arthroscopic ICRS grade of tram track lesion (p = 0.609).

Conclusion:

Tram track lesions in the ankle joint can be confidently detected on MRI with high sensitivity and specificity. Early detection and following treatment of the lesion can maximize the clinical outcome that eliminates the possibility for further damage to the cartilage and consequent osteoarthritic change.
Timing of Open Reduction and Internal Fixation of Ankle Fractures
Authors: Tantigate Direk , Vosseller J. Turner , Greisberg Justin , Ascherman Benjamin , Freibott Christina , Kirschenbaum Joshua , Ho Gavin
Published: September 2017

Category:

Ankle, Trauma

Introduction/Purpose:

Unstable ankle fractures are typically treated with open reduction and internal fixation (ORIF) for stabilization in an effort to ultimately prevent post-traumatic arthritis. It is not uncommon for operative treatment to be performed as an outpatient in the ambulatory surgery setting several days to a couple weeks after the injury to facilitate things from a scheduling perspective. It is unclear what effect this delay has on functional outcome. The purpose of this study is to assess the impact of delayed operative treatment by comparing the functional outcomes for groups of patients based on the amount of time between the injury and surgery.

Methods:

A retrospective chart review of 122 ankle fracture patients who were surgically treated by ORIF over a three year period was performed. All ankle fracture patients older than 18 years with a minimum of 24 months of follow-up were included. A total of 61 patients were included for this study. Three patients were excluded; 2 patients had an open injury and 1 patient presented with a delayed union. Demographic data, comorbidities, injury characteristics, duration from injury to surgery, operative time, length of postoperative stay, complications and functional outcomes were recorded. Functional outcome was determined by Foot and Ankle Outcome Score (FAOS) at the latest follow-up visit. Comparison of demographic variables and the subcategory of FAOS including symptoms, pain, activities of daily living (ADL), sport activity and quality of life (QOL) was performed between patient underwent ORIF less than 14 days after injury and 14 days or greater.

Results:

A total of 58 patients were included in this study. Thirty-six patients (62.1%) were female. The mean age of patients was 48.14 ± 16.84 years (19-84 years). The mean follow-up time was 41.48 ± 12.25 months (24-76 months). The duration between injury and operative fixation in the two groups was 7 ± 3 days (<14 days) and 18 ± 3 days (>14 days), respectively. There was no statistically significant difference in demographic variables, comorbidities, injury characteristics, or length of operation. Each subcategory of FAOS demonstrated no statistically significant difference between these two groups. (Table 1) Additionally, further analysis for the delayed fixation more than 7 days and 10 days also revealed no significant difference of FAOS.

Conclusion:

Open reduction and internal fixation of ankle fracture more than 14 days does not significantly diminish functional outcome according to FAOS. Delay of ORIF for ankle fractures does not play a significant role in the long-term functional outcome.
Can patients affected by stage II Posterior Tibial Tendon Dysfunction return to sport activities after surgical treatment?
Authors: Usuelli Federico Giuseppe , Di Silvestri Claudia , D’Ambrosi Riccardo , Maccario Camilla , Tan Eric
Published: September 2017

Category:

Hindfoot, Sports

Introduction/Purpose:

Medial displacement calcaneal osteotomy with flexor digitorum longus transfer is considered the gold standard in treatment of adult flatfoot associated with posterior tibial tendon dysfunction (stage II in Myerson classification). The aim of this study was to estimate if patients underwent medial displacement calcaneal osteotomy with flexor digitorum longus transfer can participate to sport activities.

Methods:

48 patients (21 men, 43,75%; 27 women, 56,25%) with a mean age at time of surgery of 42,3 years (range 19-74 years) were evaluated with a medium follow-up of 30 months (range, 27-34 months). All patients were evaluated clinically and by imaging before and after surgery. The clinical evaluation included for each patient the self-filling of Sports Athlete Foot and Ankle Score (SAFAS). and Pre- and postoperative sporting activities were recorded. The imaging evaluation included a pre-operative foot and ankle MRI and weight-bearing radiographs (antero-posterior, lateral and Saltzman 20° views) of the foot and ankle before surgery and at final follow-up. Moreover, each patients’ pre- and post-operative sport activities were recorded.

Results:

Preoperatively, 29 of 48 (60,4%) patients were engaged in athletic activities, participating in an average of 1.4 hours/week (range, 0-6 hours/week); postoperatively, 40/48 (83.3%) participated in sport and recreational activities for an average of 3.5 hours/week (range, 0-15 hours/week). Meary’s angle improved significantly from 11.3±6.3 degrees preoperatively to 7.2±5.5 degrees at final-follow-up (p<0.01); calcaneal pitch improved significantly from 16.1±4.3 degrees to 19.4±4.8 degrees (p<0.01). At final follow-up, patients demonstrated good SAFAS scores in symptom tolerance (85.90%), pain tolerance (88.30%), daily living performance (96.2%) and sports performance (86.45%).

Conclusion:

Most of patients returned or resumed to participate to sport activities after medial displacement calcaneal osteotomy and flexor digitorum longus transfer for the treatment of adult flatfoot associated with posterior tibial tendon dysfunction and the increase of the average number of activities for patient and of the mid time spent was observed.
Biomechanical evaluation of metatarsal osteotomies for Hallux Rigidus. A cadaveric testing
Authors: Wagner Emilio , de Solminihac Diego Zanolli , Wagner Pablo , Ortiz Cristian , Díaz Andres Keller , Radkievich Ruben , Valencia Oscar , Guzman-Venegas Rodrigo
Published: September 2017

Category:

Basic Sciences/Biologics, Midfoot/Forefoot

Introduction/Purpose:

Metatarsal osteotomies for Hallux Rigidus (HR) is a treatment option when neither a cheilectomy nor an arthrodesis are indicated. Different osteotomies exist that elevate, shorten or depress the metatarsal head. No biomechanical information exists that evaluates the effect of osteotomies on hallux range of motion (ROM) and stiffness. Our objective was to evaluate, in a cadaveric model, the first metatarsophalangeal joint (MTPJ) stiffness and kinematics changes, after three different metatarsal osteotomies.

Methods:

8 cadaveric foot-ankle–distal tibia specimens were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue was kept intact. Each specimen was mounted on a special frame and luminous markers were attached to the skin (Oxford Foot Model). A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon and the posterior tibialis. Each specimen served as its own control, testing hallux dorsiflexion when pulling the extensor hallucis longus tendon. 10 cycles were performed for every condition: control (A), and three different metatarsal extraarticular neck osteotomies: vertical osteotomy with 5 mm of depression (B), 5 mm of shortening (C) and 5 mm of shortening and depression (D). All osteotomies were performed on a Hallux Rigidus cadaveric model. We registered the MTPJ stiffness and kinematic changes after each intervention using a tensile testing machine and high definition cameras.

Results:

B and C were significantly stiffer than group A and D (p<0.05). D was the only condition with a similar stiffness to the control group (A) (p>0.05). Groups B, C and D achieved similar kinematics (range of motion) to group A (p>0.05).

Conclusion:

Different metatarsal osteotomies exist for HR. The osteotomy of choice, should be one that recreates the healthy MTPJ motion and stiffness. According to our study, the osteotomy of choice should be one that results in metatarsal head depression and shortening. A possible explanation to our finding, is that a pure shortening or depression osteotomy is really elevating or depressing the head respectively, hence altering the tendon pull and relative head position. Only with metatarsal shortening and depression, the Hallux MTPJ biomechanics in a Hallux Rigidus cadaver model, returns to a healthy state.
Impaired Balancing Function in Patients of Chronic Mechanical Ankle Instability
Authors: Wang Bibo
Published: September 2017

Category:

Ankle

Introduction/Purpose:

Chronic ankle instability (CAI) is a disease entity commonly seen after ankle ligament injury. It is divided into mechanical ankle instability (MAI) and functional ankle instability (FAI), with different pathological conditions. The purpose of this study was to test the balancing ability of MAI and FAI patients.

Methods:

30 CAI patients and 10 normal subjects were included according to the injury history, clinical symptom and MRI presentation. Stress tests were given under fluoroscopy to find out those with mechanical instability in CAI patients. Among them there were 18 MAI and 12 FAI patients. All patients were tested on a customized balancing ability assessment system developed by Shanghai Jiaotong University. Subjects were asked to stand on the platform for 30 seconds for both feet, 10 seconds for single foot, with eyes open. And 30 seconds for both feet, 5 seconds for single foot, with eyes closed. Each condition was tested for 3 trials and results were averaged. Parameters of balance like the swaying trajectory length and speed at both medial-lateral and anterior-posterior directions, the trajectory length per unit were obtained. Results were compared among three groups.

Results:

The MAI group presented significantly greater imbalance in both medial-lateral and anterior-posterior directions compared with that in the control group while standing on the single diseased foot, with eyes open or closed. While in the FAI group, no significant difference was found in postural sway compared with that in the control group. The MAI group presented significantly greater imbalance in both medial-lateral and anterior-posterior directions than the FAI group while standing on the single diseased foot with eyes open or closed. No significant difference in balancing was found of the contralateral ankle in the two groups.

Conclusion:

The balancing ability of MAI patients was impaired and then make them vulnerable to falling. Thus either balance training program or reconstructive surgery is needed to restore the balancing ability in those patients.
Primary Arthrodesis Compared with Open Reduction and Internal Fixation for Lisfranc Injuries with the First Tarsometatarsal Joint Dislocation
Authors: Zhang Mingzhu , Yu Guang-Rong
Published: September 2017

Category:

Midfoot/Forefoot

Introduction/Purpose:

Retrospective analyses of treatment for the first tarsometatarsal joint dislocation with Lisfranc injury. Comparison of open reduction internal fixation (ORIF) and primary arthrodesis was conducted for the injury.

Methods:

This was a multi-center study, involving nine clinical institutions in different area of China. .From January 2003 to June 2015, 126 Lisfranc injuries with first tarsometatarsal joint dislocation underwent surgical intervention. Of this group, 41 (32.5%) feet were first tarsometarsal joint dislocation only. 85 feet were first tarsometarsal joint dislocation and fractures. They were 76 males (60.3%) and 50 females (39.7%) with a mean age of 45.5 (range, 20-87) years. The duration from injury to surgery is 11.7 (range, 4-26) days. Two groups were divided by surgery methods as open reduction internal fixation (ORIF) group and primary arthrodesis group. Ninety two patients were performed by ORIF, while primary arthrodesis group including 34 cases. Outcome measures included clinical examination, radiographs, AOFAS ankle-hindfoot scores, visual analogue scale (VAS) and SF-36 scores. Complications and revision rate were analyzed as well.

Results:

126 patients were followed up for average of 29.5 months．At 1.5 years, the mean AOFAS Midfoot score at latest follow-up was 79 points and 85 points separately in ORIF and arthrodesis group（P<0.05）. The VAS score was 3.1and 2.2 separately（P<0.05）.The BP score of SF-36 was 76.1 points and 84.6 points（P<0.05). Five patients in the open-reduction group had loosen or broken hardware. Redislocation of first tarsometarsal joint were observed in 16 cases among ORIF group. 36patients in ORIF group had pain in midfoot, eight of them had persistent pain, and they were eventually revised with arthrodesis. Two patients had painful hardware and the symptom disappeared after removal of the hardware. No redislocation and no hardware failure was identified in arthrodesis group.

Conclusion:

Primary stable arthrodesis of the first ray gives a better short and medium term outcome than open reduction and internal fixation for Lisfranc injury with the first ray dislocation. Possible complication and revision could be avoided by primary arthrodesis for dislocated first ray injuries.
Repair of the Deltoid Ligament Complex Rupture Associated with Ankle Fractures
Authors: Zhang Mingzhu
Published: September 2017

Category:

Ankle

Introduction/Purpose:

It is controversial for operative repair of deltoid ligament in acute ankle fractures. To investigate the indication for surgical interference and the clinical outcome about repair whole deltoid ligament rupture associating with ankle fractures.

Methods:

We performed multiple-center study in 4 clinical centers in 4 cities of China. From January 2006 to December 2011, of 1533 ankle fractures operated, 131 deltoid ligament rupture were identified and repaired operatively. They were 74 males and 57 females with a mean age of 37.2 years (range, 15-83 years). Clinical examination, radiographs, AOFAS ankle-hindfoot scores and visual analogue scale were used for outcome measurement.

Results:

All incision healed primarily. 106 patients were followed up for 12 to 72 months, with the mean follow-up of 27 months.The mean time of fracture union was 14.5 weeks (range, 9-16 weeks). The mean AOFAS ankle-hindfoot score at last follow-up was 91.4 points (range, 83-100 points). The mean score of VAS was 1.2 points (range, 0-6 points). The mean score of SF-36 was 91.2 points (range, 80-96 points). There was no ankle instability and post-trauma osteoarthritis.

Conclusion:

This multiple-center study demonstrated that deltoid ligament repair can benefit patients with unstable ankle after fracture fixation. A reasonable clinical evaluation and surgical repair could be done, choosing an appropriate repair technique according to the site of deltoid ligament rupture.
Time course of exhaled hydrogen peroxide and nitric oxide during chemotherapy
Authors: Wewel A. R. , Crusius J. A. M. , Gatzemeier U. , Heckmayr M. , Becher G. , Magnussen H. , Jörres R. A. , Holz O.
Published: September 2017

This study was designed to assess the effect of differential leukocyte depletion during chemotherapy by monitoring the levels of exhaled hydrogen peroxide H2O2and nitric oxide (FeNO) present.

In 39 patients with lung cancer (chronic obstructive pulmonary disorder up to stage II, median forced expiratory volume in one second 78% predicted), measurements were performed before a cycle of therapy (day 1), at least once during the cycle (day 8: n = 34; day 15: n = 19), and afterwards (days 21–29).

There were significant changes in the level of H2O2,FeNOand peripheral blood cell differentials over the visits. The level of H2O2was decreased only on day 15, with a median (difference between the upper and lower quartiles) fall of 31 (57)%, whileFeNOwas reduced only on day 8, by 22 (40)%. Neutrophil numbers were unchanged on day 8 and decreased by 59 (48)% on day 15, while monocyte numbers were decreased on day 8 by 87 (39)%. On days 21–29, values had returned to baseline.

Taken together with previous findings, the parallel course of levels of exhaled hydrogen peroxide and neutrophil counts suggests that a major part of exhaled hydrogen peroxide is due to neutrophilsviathe conducting airways. In contrast, the production of exhaled nitric oxide seems to be primarily associated with monocytes.
Lymphangioleiomyomatosis
Authors: Johnson S. R.
Published: September 2017

Lymphangioleiomyomatosis (LAM) is a rare disease of the lungs and lymphatics, which can occur sporadically or in association with tuberous sclerosis. LAM almost exclusively affects females, generally developing before the menopause.

The disease is characterised by progressive pulmonary cystic change, recurrent pneumothorax, chylous pleural collections and, in most cases, progressive respiratory failure. Abdominal manifestations include lymphadenopathy, cystic lymphatic masses (lymphangioleiomyomas), chylous ascites and angiomyolipoma (a benign tumour). Survival in LAM is ∼70% at 10 yrs, although this is highly variable since long-term survivors have been described.

Diagnosis is made by a combination of clinical features and computed tomography scanning or, in cases of doubt, lung biopsy. In patients with rapidly progressive disease, hormone treatment (predominantly progesterone) has been used, although no firm evidence supports its use. Otherwise, treatment is aimed at complications including pneumothorax, chylous collections and extrapulmonary manifestations. The only treatment for severe LAM is currently lung transplantation.

Recent developments in the cell biology of lymphangioleiomyomatosis have shown that these patients have somatic mutations in the genes linked to tuberous sclerosis and that rapamycin may correct the resulting cellular abnormality. Trials of rapamycin in lymphangioleiomyomatosis are currently underway and offer hope of evidence-based treatment for the disease.
High sensitivity C-reactive protein in asthma
Authors: Takemura M. , Matsumoto H. , Niimi A. , Ueda T. , Matsuoka H. , Yamaguchi M. , Jinnai M. , Muro S. , Hirai T. , Ito Y. , Nakamura T. , Mio T. , Chin K. , Mishima M.
Published: September 2017

Asthma is characterised by chronic inflammation of the airways, but the relevance of high-sensitivity assays for C-reactive protein (hs-CRP), which are known to be a sensitive marker of low-grade systemic inflammation, has not been fully studied in asthma. The objective was to examine serum hs-CRP levels in patients with asthma and their relationship to clinical characteristics and degree of airway inflammation.

Serum hs-CRP levels were cross-sectionally examined in steroid-naive (n = 22) and steroid-inhaling (n = 23) adult patients with asthma and healthy controls (n = 14). All were nonsmokers.

Serum hs-CRP levels were significantly increased in steroid-naive patients (mean±sd1.33±1.48 mg·L−1) compared with controls (0.21±0.30 mg·L−1), but not in patients on inhaled corticosteroid. Among steroid-naive patients, serum hs-CRP levels significantly negatively correlated with indices of pulmonary function (forced expiratory volume in one second/forced vital capacity and forced mid-expiratory flow) and positively with sputum eosinophil count. Among patients on inhaled corticosteroid, hs-CRP levels did not correlate with any indices.

In conclusion, an increase in serum C-reactive protein levels measured by high-sensitivity assays may be associated with airflow obstruction and airway inflammation, and may serve as a surrogate marker of airway inflammation in asthma.
Challenges in modeling complexity of neglected tropical diseases: a review of dynamics of visceral leishmaniasis in resource limited settings
Authors: DebRoy Swati , Prosper Olivia , Mishoe Austin , Mubayi Anuj
Published: September 2017

Objectives

Neglected tropical diseases (NTD), account for a large proportion of the global disease burden, and their control faces several challenges including diminishing human and financial resources for those distressed from such diseases. Visceral leishmaniasis (VL), the second-largest parasitic killer (after malaria) and an NTD affects poor populations and causes considerable cost to the affected individuals. Mathematical models can serve as a critical and cost-effective tool for understanding VL dynamics, however, complex array of socio-economic factors affecting its dynamics need to be identified and appropriately incorporated within a dynamical modeling framework. This study reviews literature on vector-borne diseases and collects challenges and successes related to the modeling of transmission dynamics of VL. Possible ways of creating a comprehensive mathematical model is also discussed.

Methods

Published literature in three categories are reviewed: (i) identifying non-traditional but critical mechanisms for VL transmission in resource limited regions, (ii) mathematical models used for dynamics of Leishmaniasis and other related vector borne infectious diseases and (iii) examples of modeling that have the potential to capture identified mechanisms of VL to study its dynamics.

Results

This review suggests that VL elimination have not been achieved yet because existing transmission dynamics models for VL fails to capture relevant local socio-economic risk factors. This study identifies critical risk factors of VL and distribute them in six categories (atmosphere, access, availability, awareness, adherence, and accedence). The study also suggests novel quantitative models, parts of it are borrowed from other non-neglected diseases, for incorporating these factors and using them to understand VL dynamics and evaluating control programs for achieving VL elimination in a resource-limited environment.

Conclusions

Controlling VL is expensive for local communities in endemic countries where individuals remain in the vicious cycle of disease and poverty. Smarter public investment in control programs would not only decrease the VL disease burden but will also help to alleviate poverty. However, dynamical models are necessary to evaluate intervention strategies to formulate a cost-effective optimal policy for eradication of VL.
Discovery of GnIH and Its Role in Hypothyroidism-Induced Delayed Puberty
Authors: Tsutsui Kazuyoshi , Son You Lee , Kiyohara Mika , Miyata Ichiro
Published: September 2017

It is known that hypothyroidism delays puberty in mammals. Interaction between the hypothalamo-pituitary-thyroid (HPT) and hypothalamo-pituitary-gonadal (HPG) axes may be important processes in delayed puberty. Gonadotropin-inhibitory hormone (GnIH) is a newly discovered hypothalamic neuropeptide that inhibits gonadotropin synthesis and release in quail. It now appears that GnIH is conserved across various mammals and primates, including humans, and inhibits reproduction. We have further demonstrated that GnIH is involved in pubertal delay induced by thyroid dysfunction in female mice. Hypothyroidism delays pubertal onset with the increase in hypothalamic GnIH expression and the decrease in circulating gonadotropin and estradiol levels. Thyroid status regulates GnIH expression by epigenetic modification of the GnIH promoter region. Furthermore, knockout of GnIH gene abolishes the effect of hypothyroidism on delayed pubertal onset. Accordingly, it is considered that GnIH is a mediator of pubertal disorder induced by thyroid dysfunction. This is a novel function of GnIH that interacts between the HPT-HPG axes in pubertal onset delay. This mini-review summarizes the structure, expression, and function of GnIH and highlights the action of GnIH in pubertal disorder induced by thyroid dysfunction.
Electronic health record and genome-wide genetic data in Generation Scotland participants
Authors: Kerr Shona M. , Campbell Archie , Marten Jonathan , Vitart Veronique , McIntosh Andrew M , Porteous David J. , Hayward Caroline
Published: September 2017

This article provides the first detailed demonstration of the research value of the Electronic Health Record (EHR) linked to research data in Generation Scotland Scottish Family Health Study (GS:SFHS) participants, together with how to access this data. The structured, coded variables in the routine biochemistry, prescribing and morbidity records, in particular, represent highly valuable phenotypic data for a genomics research resource. Access to a wealth of other specialized datasets, including cancer, mental health and maternity inpatient information, is also possible through the same straightforward and transparent application process.

The EHR linked dataset is a key component of GS:SFHS, a biobank conceived in 1999 for the purpose of studying the genetics of health areas of current and projected public health importance. Over 24,000 adults were recruited from 2006 to 2011, with broad and enduring written informed consent for biomedical research. Consent was obtained from 23,603 participants for GS:SFHS study data to be linked to their Scottish National Health Service (NHS) records, using their Community Health Index number. This identifying number is used for NHS Scotland procedures (registrations, attendances, samples, prescribing and investigations) and allows healthcare records for individuals to be linked across time and location.

Here, we describe the NHS EHR dataset on the sub-cohort of 20,032 GS:SFHS participants with consent and mechanism for record linkage plus extensive genetic data. Together with existing study phenotypes, including family history and environmental exposures, such as smoking, the EHR is a rich resource of real world data that can be used in research to characterise the health trajectory of participants, available at low cost and a high degree of timeliness, matched to DNA, urine and serum samples and genome-wide genetic information.
Preface
Authors: Arend Andres
Published: September 2017

Preface
Tracing the historical origin of Joseon mummies considering the structural similarities between the burial systems of Korean and Chinese dynasties
Authors: Oh Chang Seok , Kang In Uk , Hong Jong Ha , Slepchenko Sergey , Park Jun Bum , Shin Dong Hoon
Published: September 2017

Joseon mummies have proved to be excellent subjects for scientific research on the health and disease statuses of pre-modern Korean peoples. Despite its academic significance, the origins of the Hoegwakmyo tomb in which the Joseon mummy was discovered have not yet been entirely revealed. Meanwhile, over the past several decades, there have been some reports on mummies and cultural artifacts preserved very well in the tombs of several Chinese dynasties (especially Song, Yuan, Ming and Qing). Although the Chinese tombs were very diverse in structure, we note that some graves among them were structurally very similar to Joseon Hoegwakmyo tombs. Before the Hoegwakmyo tomb in Korea, there were already similar tombs in China, inside which dead persons were mummified like the Joseon mummies. Considering that the Hoegwakmyo tomb of the Joseon Dynasty was established by the influence of the Confucian ideology, the Korean and Chinese mummies might share common cultural origins in history.
Morphological peculiarities of the testes in 41–50-years-old men
Authors: Lasienė Kristina , Gasiliūnas Donatas , Juodžiukynienė Nomeda , Dabužinskienė Anita , Vitkus Aleksandras , Žilaitienė Birutė
Published: September 2017

The morphological parameters such as the length, width, height and weight of 20 pairs of testes were measured in this study. The volume of the testis was calculated using the formula: Volume = length (L) × width (W) × height (H) × 0.71. These morphological parameters of the right and left testes were compared.The total length, width and height of both testes of 41–50-years-old men were 4.53±0.46 cm, 3.05±0.31 cm and 2.58±0.36 cm respectively. The total volume and weight were 25.53±6.06 cm3 and 20.93±4.75 g respectively. The length, height, volume and weight of the right testis were significantly larger than of the left testes in 41–50-years-old men. Only the width of the right and the left testes differed statistically non-significantly.
Anthropometrics parameters for Latvian women in the age over 40 years
Authors: Stankeviča Jekaterina , Pļaviņa Liāna , Umbraško Silvija
Published: September 2017

The World Health Organization (WHO) recommends the anthropometrics parameters for the evaluation of overweight and obesity in adult population that is one of the risk factor for metabolic disorders and cardio-vascular pathology. The target of our study is to describe the variations of anthropometric parameters of the Latvian women population. The present paper includes the analysis of data of 200 women in the age 40–65 years. We evaluated the anthropometrics indicators in Latvian women in the age over 40 years, various somatometric measurements – height (cm), the body mass (kg), the circumference of the waist and hips (cm) – and calculated the mean parameters, the Body Mass Index and the Waist Hip Ratio. The respondents of the study group were divided into five age subgroups. We provided the analysis of anthropometric data, compared them with the data from other European countries. We have fixed the high prevalence of overweight and obesity in the examined women groups and proposed potential activities to reduce them.