To evaluate patient-reported outcomes and return to sport after open fasciotomy for lower extremity chronic exertional compartment syndrome (CECS).
Retrospective case series.
Foot and ankle specialty ...service at a large multisite academic medical center.
All patients undergoing lower extremity fasciotomy for CECS from 2009 to 2017 by one surgeon were eligible. Patients that underwent a fasciotomy for trauma, infection, or an acute pathologic process were excluded. Fifty-nine patients that underwent 63 procedures were included. The average age was 26.6 years, and 35 (59%) patients were women. Thirty-seven patients underwent simultaneous bilateral fasciotomies, 4 had staged bilateral fasciotomies, and 18 underwent unilateral fasciotomy. Four-compartment fasciotomy was performed 15 times.
Retrospective email/telephone follow-up.
Return to sports questionnaire, the Foot and Ankle Ability Measure-Sports subscale, and visual analog scale for pain.
At a mean follow-up of 58.8 months, significant postoperative improvement was seen in patient-reported outcome scores compared with preoperative scores (P < 0.0001). Overall, 55 (93%) patients were able to return to sport, 42 (76%) returned to the same level of sport, and 13 (24%) returned to a lower level of competition. Bivariate regression analysis demonstrated that a higher preoperative body mass index odds ratio: 0.829 (95% confidence interval: 0.688, 0.999); P = 0.049 was associated with a lower likelihood of return to sport.
This study demonstrates that lower extremity fasciotomy for CECS results in improvement of patient-reported outcomes and a high rate of return to sport.
Background:
The open anterior approach to ankle arthrodesis offers a technique that provides several advantages for surgeons, such as easier visualization of the joint for deformity correction and ...preservation of the malleoli for potential future conversion to total ankle arthroplasty. The purpose of this study was to evaluate clinical, radiographic, and functional outcomes in a large series of patients undergoing open ankle arthrodesis via a fibular-sparing anterior approach.
Methods:
A retrospective review was performed of patients undergoing primary ankle arthrodesis with a single fellowship-trained foot and ankle orthopedic surgeon between 2009 and 2017. Patients were excluded if an approach other than anterior was performed. Patient-reported outcome measures (Foot and Ankle Ability Measure–Activities of Daily Living FAAM-ADL, Short-Form 12 SF-12, and visual analog scale VAS pain) were subsequently collected at a minimum of 24 months (2 years) following index surgery, along with outcome satisfaction and likelihood to repeat surgery. Fusion of the tibiotalar joint at the time of last radiographic follow-up was also assessed. Paired t tests were performed to assess change in pre- to postoperative outcomes, while linear regression analysis was performed to identify any patient factors associated with outcomes. Eighty-one patients, including 31 women and 50 men, with a mean age of 51.5 years and a mean follow-up of 58.9 (range, 24-104) months, were included.
Results:
Sixty-two patients reported significant improvement in mean FAAM-ADL (P < .0001), SF-12 Physical Composite Scale (P < .0001), and VAS pain (P < .0001), while the SF-12 Mental Composite Scale also improved, though not significantly (P = .2854). Twelve patients (14.8%) experienced complications following their arthrodesis procedure. Seventy-nine patients (97.5%) achieved fusion at their last radiographic follow-up. Multiple linear regression analysis revealed age (B = 0.071 0.004, 0.128; P = .0373) to have a positive association with postoperative VAS pain.
Conclusion:
Ankle arthrodesis utilizing a fibular-sparing anterior approach combined with the transarticular screw fixation technique offers surgeons several advantages, along with a low postoperative complication rate, high rate of radiographic evidence of joint fusion, and substantially large improvement in pain and functional levels.
Level of Evidence:
Level IV, retrospective case series.
Background:
Following open reduction internal fixation (ORIF) of unstable ankle fractures, some patients have persistent pain and poor outcomes. This may be secondary to intra-articular injuries that ...occur at the time of fracture, which occur in up to 88% of fractures. Ankle arthroscopy at the time of ORIF has been proposed to address these intra-articular injuries. This study compared patient-reported functional outcomes in patients who underwent ankle ORIF with and without ankle arthroscopy.
Methods:
An institutional database was used to retrospectively identify 93 patients who underwent ORIF for an unstable ankle fracture with an intact medial malleolus between 2002 and 2013. Forty-two patients had ankle arthroscopy at the time of ORIF and 51 did not. Functional outcomes between groups were compared using Patient Reported Outcomes Measurement Information System (PROMIS) physical function and pain interference computerized adaptive tests at a minimum follow-up of 1 year. Outcomes were also measured with the visual analog scale (VAS) pain score and the Olerud and Molander ankle fracture outcome scale. Average patient follow-up was 67 months (n = 51).
Results:
PROMIS physical function and pain interference scores were not significantly different between groups (physical function, 57.8 vs 54.5, P = .23; pain interference, 45.6 vs 46.9, P = .56). Operative time was increased in the arthroscopy group (74 minutes vs 59 minutes, P = .027). Overall, 60% (25/42) had chondral lesions of the talus, 7% (3/42) had chondral lesions of the tibial plafond, and 21% (9/42) had loose bodies requiring removal. There was no significant difference in complication rates between groups.
Conclusion:
At intermediate-term follow-up of patients with unstable ankle fractures and intact medial malleoli, functional outcomes were not significantly improved in patients who underwent ankle arthroscopy. However, there were no increased complications attributable to ankle arthroscopy, and average total operative time was increased by only 15 minutes.
Level of Evidence:
Level III, retrospective cohort study.
PDZ domains have long been thought to cluster into discrete functional classes defined by their peptide-binding preferences. We used protein microarrays and quantitative fluorescence polarization to ...characterize the binding selectivity of 157 mouse PDZ domains with respect to 217 genome-encoded peptides. We then trained a multidomain selectivity model to predict PDZ domain-peptide interactions across the mouse proteome with an accuracy that exceeds many large-scale, experimental investigations of protein-protein interactions. Contrary to the current paradigm, PDZ domains do not fall into discrete classes; instead, they are evenly distributed throughout selectivity space, which suggests that they have been optimized across the proteome to minimize cross-reactivity. We predict that focusing on families of interaction domains, which facilitates the integration of experimentation and modeling, will play an increasingly important role in future investigations of protein function.
In general, networks in companies or between companies play a significant role for monetary as well as non-monetary enhancement through cooperation. The aim is a positive effect for reducing ...innovation cycles, reducing costs and establishing a well-balanced time to market strategy. Besides open networks, where every actor is known, the existence of hidden networks, internal as well as external, have a substantial impact on strategic and operational activities meaning either a contribution or threat for the actors outside the hidden network. With the new models introduced in this publication, actors in various environments are able to identify hidden networks in order to be able to push contributions or eliminate risks leading from profit cuts to illegal knowledge transfer.
Introduction
Complete surgical tumor resection is paramount in the management of soft tissue sarcoma (STS) in humans, dogs, and cats alike. Near-infrared targeted tracers for fluorescence-guided ...surgery (FGS) could facilitate intraoperative visualization of the tumor and improve resection accuracy. Target identification is complicated in STS due to the rarity and heterogeneity of the disease. This study aims to validate the expression of fibroblast activation protein alpha (FAP) in selected human, canine, and feline STS subtypes to assess the value of FAP as a target for FGS and to validate companion animals as a translational model.
Methods
Formalin-fixed and paraffin-embedded tissue samples from 53 canine STSs (perivascular wall tumor (PWT), canine fibrosarcoma (cFS), and STS not further specified (NOS)), 24 feline fibrosarcomas, and 39 human STSs (myxofibrosarcoma, undifferentiated pleomorphic sarcoma, dermatofibrosarcoma protuberans, and malignant peripheral nerve sheath tumor) as well as six canine and seven feline healthy controls and 10 inflamed tissue samples were immunohistochemically stained for their FAP expression. FAP labeling in tumor, peritumoral, healthy skin, and inflamed tissue samples was quantified using a visually assessed semiquantitative expression score and digital image analysis. Target selection criteria (TASC) scoring was subsequently performed as previously described.
Results
Eighty-five percent (85%) of human (33/39), 76% of canine (40/53), and 92% of feline (22/24) STSs showed FAP positivity in over 10% of the tumor cells. A high expression was determined in 53% canine (28/53), 67% feline (16/24), and 44% human STSs (17/39). The average FAP-labeled area of canine, feline, and human STSs was 31%, 33%, and 42%, respectively (
p
> 0.8990). The FAP-positive tumor area was larger in STS compared to healthy and peritumoral tissue samples (
p
< 0.0001). TASC scores were above 18 for all feline and human STS subtypes and canine PWTs but not for canine STS NOS and cFS.
Conclusion
This study represents the first cross-species target evaluation of FAP for STS. Our results demonstrate that FAP expression is increased in various STS subtypes compared to non-cancerous tissues across species, thereby validating dogs and cats as suitable animal models. Based on a TASC score, FAP could be considered a target for FGS.
The influence of the jaw position on postural control, body posture, walking and running pattern has been reported in the literature. All these movements have in common that a relatively small, but ...well controlled muscle activation is required. The induced effects on motor output through changed jaw positions have been small. Therefore, it has been questioned if it could still be observed in maximal muscle activation.
Twenty-three healthy, mid age recreational runners (mean age = 34.0 ± 10.3 years) participated in this study. Three different jump tests (squat jump, counter movement jump, and drop jumps from four different heights) and three maximal strength tests (trunk flexion and extension, leg press of the right and left leg) were conducted. Four different dental occlusion conditions and an additional familiarization condition were tested. Subjects performed the tests on different days for which the four occlusion conditions were randomly changed.
No familiarization effect was found. Occlusion conditions with a relaxation position and with a myocentric condylar position showed significantly higher values for several tests compared to the neutral condition and the maximal occlusion position. Significance was found in the squat jump, countermovement jump, the drop jump from 32cm and 40cm, trunk extension, leg press force and rate of force development. The effect due to the splint conditions is an improvement between 3% and 12% (min and max). No influence of the jaw position on symmetry or balance between extension and flexion muscle was found.
An influence of occlusion splints on rate of force development (RFD) and maximal strength tests could be confirmed. A small, but consistent increase in the performance parameters could be measured. The influence of the occlusion condition is most likely small compared to other influences as for example training status, age, gender and circadian rhythm.
With the increase in the number of total ankle arthroplasties (TAA), guidelines on when physicians should begin to consider patients' return to driving are valuable. Further, due to sagittal motion ...strength, the ankle is the most important mover in braking motions over the knee and hip.
(1) Does brake-reaction time return to a safe value within 6 weeks of TAA? (2) Are there factors associated with a delay of return of brake-reaction time to safe values after TAA?
After obtaining institutional review board approval for the study, we prospectively recruited 60 patients undergoing right TAA. A large proportion of the patients undergoing TAA during the period were recruited. Patients who had extensive concomitant surgery, such as triple arthrodesis or tibial osteotomy, were excluded from the study. Patients were between 43 and 83 years old (median, 63 years), and 35 (59%) were men. Brake-reaction time was tested at 6 weeks postoperatively and repeated weekly until patients achieved a passing brake-reaction time. A control group of 20 volunteer participants matched for age and sex who did not have right lower-extremity pathology or pain were used to establish a passing brake-reaction time of 0.850 seconds. Patients were given a novel driver-readiness survey to complete; a score of 10 of 15 points or higher was considered a passing score. The following factors were explored for their association with brake-reaction time: age, American Orthopaedic Foot and Ankle Society (AOFAS)-Hindfoot assessment and VAS for pain via a patient-reported survey, and ankle plantarflexion and dorsiflexion via dedicated weightbearing lateral radiographs made with the ankle in maximum plantarflexion and dorsiflexion.
At 6 weeks postoperatively, 92% of patients (54 of 59) achieved a passing brake-reaction time and were considered able to drive safely, and the mean brake-reaction time of the patients with a passing brake-reaction time was 0.626 seconds (± 0.111). At 9 weeks, all patients who completed the study achieved a passing brake-reaction time. Patients with a failed brake-reaction time at 6 weeks had greater median VAS scores for pain (3 interquartile range 2 to 7 versus 1 IQR 0 to 3; p = 0.022) and diminished ankle plantarflexion (14° ± 5° versus 24° ± 10°; p = 0.037) compared with those with a passing brake-reaction time at that time point. All five patients with a failed brake-reaction time also had a failing score for the driver-readiness survey.
More than 90% of patients in this series achieved a safe brake-reaction time within 6 weeks of TAA, and those who did not were more likely to have had more pain and a stiffer ankle. Surgeons might counsel patients with persistent pain and stiffness at 6 weeks to delay driving for an additional 3 weeks, since by 9 weeks after TAA, all patients in this series had a brake-reaction time comparable with patients who had not undergone surgery. Future studies might elucidate what key gaps in knowledge remain and determine a practical way to answer these questions.
Level II, therapeutic study.
Vor fünfzig Jahren beschlossen die Vereinten Nationen eine grundlegende Veränderung der globalen Wirtschaftsordnung. Die »New International Economic Order« (NIEO) war der erste alternative ...Globalisierungsentwurf: ein Projekt zur Überwindung kolonialer Wirtschaftsstrukturen zwischen dem Globalen Süden und dem Globalen Norden. Damals verhinderten reiche Industriestaaten die Umsetzung dieses Reformprogramms. Die Beiträger*innen fragen angesichts globaler Armut, der Klimakatastrophe, zunehmender internationaler Konflikte und der Krise des Kapitalismus nach der heutigen Relevanz der NIEO - und zeigen die Dringlichkeit einer radikalen Transformation der Weltwirtschaft auf.
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