Abstract The use of cannulated instruments under fluoroscopy can improve the localization of the anteromedial and posterolateral portals for use in ankle arthroscopy. This technique is valuable for ...the less-experienced ankle arthroscopist, in resident education, and for the experienced arthroscopist when surface anatomy palpation and visualization is less than ideal due to soft tissue edema and obesity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background: The purpose of this study was to determine the functional outcomes and radiographic results of adult patients who had an operation for flexible flatfeet without any hindfoot osteotomies ...or fusions. Methods: Twenty-eight feet in 23 patients with problems caused by their flexible flatfoot deformities had reconstructive foot and ankle surgery that included a subtalar arthroereisis (the restriction of the range of motion of a joint) with the Maxwell-Brancheau Arthroereisis (MBA) sinus tarsi implant. The American Orthopedic Foot and Ankle Society (AOFAS) Hindfoot Scale and a patient assessment questionnaire were obtained from all patients before surgery and at final follow-up. Preoperative and postoperative standing radiographs were analyzed to determine radiographic correction of the deformities. The average followup was 44 months. The MBA implant was surgically removed in 11 of 28 feet (39%) because of sinus tarsi pain. Results: The average preoperative AOFAS score was 52 and had improved to 87 (p < 0.00001) at final followup. The average response to four of five questions in the patient assessment had significantly improved (p < 0.05). On a 10-point scale, average patient satisfaction was 8.3 points; 78% said that they would have the surgery again. Correction after surgery was significant (p < 0.0001) in each of the three radiographic parameters evaluated for ‘correction with MBA’ and ‘final correction.’ With the numbers available, no significant differences could be detected after the MBA was removed. Complications included sinus tarsi pain in 46% (13) of the 28 feet in this study; after implant removal, 73% (8) of 11 feet had less discomfort than before surgery with AOFAS scores 80 or better. Conclusions: Reconstructive foot and ankle surgery that included a subtalar arthroereisis with the MBA sinus tarsi implant resulted in favorable clinical outcomes and patient satisfaction in 78% (18) of 23 patients. In spite of the high incidence of temporary sinus tarsi pain until the implant was removed, this operative approach compares favorably with other operations for flexible flatfoot deformities in adults.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
5.
2013 Subtalar Arthroereisis Survey Shah, Neil S.; Needleman, Richard L.; Bokhari, Omaima ...
Foot and ankle specialist,
06/2015, Volume:
8, Issue:
3
Journal Article
Peer reviewed
Background. Subtalar arthroereisis (SA) has been a procedure used for the correction of painful flexible flatfoot deformity in adults and children. Clinical studies of patients who had a SA are ...sparse and with mixed results and variable indications. The purpose of this study was to determine the current practice among orthopaedic foot and ankle specialists regarding SA. Methods. Web-based questionnaires were e-mailed to members of the American Orthopaedic Foot and Ankle Society (AOFAS). Requested information included demographics and practice patterns in regard to performing SA surgery. A total of 572 respondents completed the survey (32% response rate). Results. A total of 273 respondents (48%) have performed SA. Of this group, 187 respondents (69%) still perform this procedure (33% of total respondents currently perform SA). Of the respondents, 401 (70%) practice in the United States, 40% have performed SA, and 60% of those still perform this procedure. Of non-US respondents, 66% have performed SA, and 80% of those still perform it. The most common US indications are painful congenital flatfoot, posterior tibial tendon dysfunction, and flatfoot associated with accessory navicular. Conclusion. Many doctors have performed SA, and a significant number no longer perform this procedure for various reasons. A greater percentage of non-US practitioners have performed and continue to perform SA than their counterparts in the United States. There is a common list of surgical indications. Most doctors who still perform this procedure have removed the implants, commonly for pain. SA is still being performed in the United States and throughout the world.
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Background:
The traditional fixation for a calcaneocuboid (CC) arthrodesis in triple arthrodesis is with a 6.5-mm cancellous screw. This procedure can be technically challenging. Fixation with a ...locking compression plate (LCP) may be easier to perform while achieving compression perpendicular to the fusion site. The purpose of this study was to compare the load to failure and the stiffness for each fixation method.
Methods:
Five matched-pair cadaver feet had an arthrodesis of the CC joint. For each matched pair, one was fixed with a screw and the other with an LCP. Surface bead markers were applied. Each specimen was then secured to a material testing machine through the calcaneus. The plantar surface of the cuboid faced the hydraulic ram to simulate weightbearing. A force was applied while the specimen was recorded with a high-resolution camera. The endpoint was maximal force at 2-mm separation between the calcaneus and cuboid measured along a horizontal axis.
Results:
The average force to failure and the average stiffness in the screw group were significantly less than the LCP group (P < .05). The screw construct failed in pullout from the cuboid; the LCP construct failed by plastic deformation of the plate.
Conclusion:
Calcaneocuboid joint fixation with the LCP withstood a higher load until failure and demonstrated greater stiffness than with a 6.5-mm cancellous lag screw.
Clinical Relevance:
The use of LCP fixation can be considered as an alternative to oblique lag screw fixation for CC arthrodesis in a triple arthrodesis. It remains to be determined if LCP fixation leads to better clinical outcomes.
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Abstract Ankle arthroscopy has become a standard surgical technique for the treatment of many ankle pathologies. Over the past 30 years, the technique has undergone modification and standardization ...in order to improve surgical performance and outcomes. In contrast to the ankle joint, the hip joint is a deep joint, which makes visualization and palpation of the topographical anatomy quite difficult. The use of fluoroscopy has enabled the surgeon to successfully perform hip arthroscopy for the treatment of selective hip pathologies. Fluoroscopy also can improve the localization of the anteromedial portal for use in ankle arthroscopy. This technique is valuable for the less-experienced ankle arthroscopist, in resident education, and for the experienced arthroscopist when surface anatomy palpation and visualization is less than ideal due to soft tissue edema and obesity.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background: Acute liver failure (ALF) can be induced in mice by administering Escherichia coli lipopolysaccharide (LPS) and D‐galactosamine (D‐GalN), which induce an inflammatory response involving ...tumour necrosis factor (TNF)‐α production and a hepatocyte‐specific transcriptional block. Under these conditions, binding of TNF‐α to its cognate receptor on hepatocytes eventually leads to their apoptosis.
Aims: As part of an effort to identify drugs to treat this disease model, we have investigated whether the glutamine synthetase inhibitor methionine sulfoximine (MSO) could play a protective role, given its effectiveness in the inhibition of brain swelling associated with hyperammonaemia.
Methods: Mouse survival, glutamine synthetase activity, hepatocyte apoptosis and induction of inflammatory cytokines were measured in mice treated with MSO before an intraperitoneal injection of LPS/D‐GalN. The effect of MSO on viability and on TNF‐α release was also assessed on inflammatory and liver cells.
Results: We have found that, in mice treated with LPS/D‐GalN, MSO (i) drastically increases animal survival; (ii) sharply reduces glutamine synthetase activity, without inhibiting its other target, γ‐glutamyl cysteine synthetase; (iii) inhibits death receptor‐mediated apoptosis in hepatocytes upstream to cytokine binding; (iv) strongly reduces the overall inflammatory cytokine response, including a significant decrease in TNF‐α induction in vivo and ex vivo, and in the interferon‐γ level and signalling.
Conclusions: These results demonstrate that the MSO target glutamine synthetase is required for the early steps of the cytokine response to endotoxins, and that its pharmacological inhibition may be exploited to treat inflammation.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Abstract Objective To investigate the role of sex and the role of ammonia and amino acid metabolism, specifically the activity of glutamine synthetase, in survival and disease progression in ...amyotrophic lateral sclerosis. Methods We tested treatment with methionine sulfoximine (MSO) on the lifespan and neuromuscular ability of male and female SOD1 mice as measured by their ability to maintain their grip on an inverted wire grid. We also tested the effects of castration and ovariectomization on those measurements. Results MSO treatment improves the survival of both male and female mice, but the effects are significantly greater on female mice. Saline-treated (control) female mice have delayed neuromuscular degeneration compared with saline-treated male mice, and MSO further delays disease progression in females, to a greater extent than in males. Ovariectomization or castration completely eliminates the effect of the drug on either survival or neuromuscular deterioration. Conclusions Sex is an important factor in disease progression and the response of SOD1 mice to a drug targeting a central enzyme in nitrogen metabolism, with female sex hormones playing a greater role than male sex hormones. Glutamine synthetase, or its reactants and products, therefore plays a role in this disease, and the sex specificity of treatments aimed at this or other metabolic targets may therefore be an important factor in the development of therapies to treat amyotrophic lateral sclerosis.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Crystal structures are reported for the D85S and D85S/F219L mutants of the light-driven proton/hydroxyl-pump bacteriorhodopsin. These mutants crystallize in the orthorhombic
C222
1 spacegroup, and ...provide the first demonstration that monoolein-based cubic lipid phase crystallization can support the growth of well-diffracting crystals in non-hexagonal spacegroups. Both structures exhibit similar and substantial differences relative to wild-type bacteriorhodopsin, suggesting that they represent inherent features resulting from neutralization of the Schiff base counterion Asp85. We argue that these structures provide a model for the last photocycle intermediate (O) of bacteriorhodopsin, in which Asp85 is protonated, the proton release group is deprotonated, and the retinal has reisomerized to all-
trans. Unlike for the M and N photointermediates, where structural changes occur mainly on the cytoplasmic side, here the large-scale changes are confined to the extracellular side. As in the M intermediate, the side-chain of Arg82 is in a downward configuration, and in addition, a π-cloud hydrogen bond forms between Trp189 NE1 and Trp138. On the cytoplasmic side, there is increased hydration near the surface, suggesting how Asp96 might communicate with the bulk during the rise of the O intermediate.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
