Effect of split posterior tibialis tendon transfer on foot progression angle in children with cerebral palsy.

OBJECTIVES: A common orthopedic issue for patients with spastic cerebral palsy (CP) is hindfoot varus deformity. One method of treatment is the split posterior tibialis tendon transfer (SPOTT). There is limited literature on the effect of SPOTT on foot progression angle (FPA) in children with CP who have equinovarus deformities. The objective of our study was to evaluate the change in FPA after SPOTT to determine if this procedure can improve FPA. RESEARCH QUESTION: This study aims to determine what axial changes are generated from a split posterior tibial tendon transfer in children with CP. METHODS: We performed a retrospective analysis of all ambulatory children with a diagnosis of CP who underwent SPOTT at our institution. Patients with bony rotational procedures were excluded. Descriptive statistics including mean and standard deviation (SD) were used to characterize continuous variables. Paired t-tests were used to evaluate outcomes, in which a target outcome was defined as a post-operative FPA between 0-10° of external rotation. RESULTS: 44 limbs were included. Demographics were as follows: 26/13 female/male; mean age[SD] (years): 9.8[3.5]; 30 hemiplegic, 9 diplegic, and 1 triplegic. Of the 44 limbs, 18 limbs had a target outcome, 4 had no change, and 22 had a non-target outcome. Of the 22 with an outcome outside of the target, 4 limbs trended away from a target outcome. The overall change in FPA measured was - 10.9 ± 14.7° (p < 0.0001) Age at time of surgery, CP involvement, pre-operative FPA, and GMFCS level were not predictors of outcome (p > 0.05). CONCLUSIONS: SPOTT produced a change of 10.9° external rotation in FPA post-operatively and its effects should be considered when planning a SEMLS.

Physician Rating Websites: an Analysis of Physician Evaluation and Physician Perception.

BACKGROUND: The goal of this study was to evaluate current physician ratings websites (PRWs) to determine which factors correlated to higher physician scores and evaluate physician perspective of PRWs. METHODS: This study evaluated two popular websites, Healthgrades.com and Vitals.com, to gather information on practicing physician members of the American Shoulder and Elbow Society database. A survey was conducted of the American Shoulder and Elbow Society (ASES) membership to gather data on the perception held by individual physicians regarding PRWs. RESULTS: We found that patients were more likely to give physicians positive reviews and the average overall score was 8.35 (3.75-10). Patient wait time (P=0.052) trended toward significance as a major factor in determining the overall scores, while ratings in both physician bedside manner (P=0.001) and physician/staff courtesy (P=0.002) were significant in reflecting the overall score given to the physician. According to our survey, a majority of the respondents were indifferent to highly unfavorable to PRWs (88%) and the validity of their ratings (78%). CONCLUSION: As PRWs become increasingly popular amongst patients in this digital age, it is critical to understand that the scores are not reflective of a significant proportion of the physicians' patient population. Physicians can use this study to determine what affects a patient's experience and focus efforts on improving patients' perception of quality, overall satisfaction, and overall care. Consumers may use this study to increase their awareness of the potential for significant sampling error inherent in PRWs when making decisions about their care.

Correction: JHU-083 selectively blocks glutaminase activity in brain CD11b+ cells and prevents depression-associated behaviors induced by chronic social defeat stress.

During this process, we found that we need add the following sentence in the manuscript within the Acknowledgement section.

JHU-083 selectively blocks glutaminase activity in brain CD11b+ cells and prevents depression-associated behaviors induced by chronic social defeat stress.

There are a number of clinically effective treatments for stress-associated psychiatric diseases, including major depressive disorder (MDD). Nonetheless, many patients exhibit resistance to first-line interventions calling for novel interventions based on pathological mechanisms. Accumulating evidence implicates altered glutamate signaling in MDD pathophysiology, suggesting that modulation of glutamate signaling cascades may offer novel therapeutic potential. Here we report that JHU-083, our recently developed prodrug of the glutaminase inhibitor 6-diazo-5-oxo-L-norleucine (DON) ameliorates social avoidance and anhedonia-like behaviors in mice subjected to chronic social defeat stress (CSDS). JHU-083 normalized CSDS-induced increases in glutaminase activity specifically in microglia-enriched CD11b+ cells isolated from the prefrontal cortex and hippocampus. JHU-083 treatment also reverses the CSDS-induced inflammatory activation of CD11b+ cells. These results support the importance of altered glutamate signaling in the behavioral abnormalities observed in the CSDS model, and identify glutaminase in microglia-enriched CD11b+ cells as a pharmacotherapeutic target implicated in the pathophysiology of stress-associated psychiatric conditions such as MDD.