The treatment of unstable fractures of the ankle using the Acumed fibular nail: development of a technique.

Techniques for fixation of fractures of the lateral malleolus have remained essentially unchanged since the 1960s, but are associated with complication rates of up to 30%. The fibular nail is an alternative method of fixation requiring a minimal incision and tissue dissection, and has the potential to reduce the incidence of complications. We reviewed the results of 105 patients with unstable fractures of the ankle that were fixed between 2002 and 2010 using the Acumed fibular nail. The mean age of the patients was 64.8 years (22 to 95), and 80 (76%) had significant systemic medical comorbidities. Various different configurations of locking screw were assessed over the study period as experience was gained with the device. Nailing without the use of locking screws gave satisfactory stability in only 66% of cases (4 of 6). Initial locking screw constructs rendered between 91% (10 of 11) and 96% (23 of 24) of ankles stable. Overall, seven patients had loss of fixation of the fracture and there were five post-operative wound infections related to the distal fibula. This lead to the development of the current technique with a screw across the syndesmosis in addition to a distal locking screw. In 21 patients treated with this technique there have been no significant complications and only one superficial wound infection. Good fracture reduction was achieved in all of these patients. The mean physical component Short-Form 12, Olerud and Molander score, and American Academy of Orthopaedic Surgeons Foot and Ankle outcome scores at a mean of six years post-injury were 46 (28 to 61), 65 (35 to 100) and 83 (52 to 99), respectively. There have been no cases of fibular nonunion. Nailing of the fibula using our current technique gives good radiological and functional outcomes with minimal complications, and should be considered in the management of patients with an unstable ankle fracture.

Effect of neuropeptides on cognitive function.

Recent evidence indicates that, in addition to the involvement of cholinergic and other neurotransmitter systems, various neuropeptides that occur in cortical and subcortical brain regions have a role in cognitive behavior. This evidence results largely from behavioral studies in rodents and other animals, following peptide administration and only in a very few cases from similar studies in human subjects. Several neuropeptides studied appear to enhance or produce changes conducive to improvement in cognitive performance and these include vasopressin, corticotrophin-releasing hormone (CRH), somatostatin, substance P, neuropeptide Y, and thyrotrophin-releasing hormone (TRH), while one peptide, galanin, has been reported to inhibit cognitive processes. Of those neuropeptides that improve performance, only TRH has been shown recently to attenuate the memory impairment of human subjects and Alzheimer patients treated with an anticholinergic drug, and this review describes a series of complimentary studies in adult and aged rodents that contribute to our understanding of the possible mechanisms involved in the role of TRH in cognition.

Behavioural effects of scopolamine and the TRH analogue RX77368 on radial arm maze performance in the rat.

Effects of repeated intracerebroventricular administration of the thyrotrophin-releasing hormone (TRH) analogue, RX77368 (3,3'-dimethyl-TRH, 2 µg, once daily), on a scopolamine-induced performance deficit in an eight-arm radial maze were evaluated in adult rats. Scopolamine (0.3 mg/kg i.p.-30 min) pre-treatment produced a significant deficit in the number of unrepeated arm entries and total arm entries and increased the percentage of incorrect arm entries and the total time on the maze, compared with saline-treated controls. Prior treatment with RX77368 (40 min before maze testing) produced a partial but significant attenuation of the scopolamine-induced performance deficit on the maze during the first five trials but RX77368 also enhanced maze performance during the same period when given alone. These results suggest that the observed scopolamine-induced performance deficit on the radial arm maze partly results from a reduction in locomotion and maze exploration rather than solely impairment of memory, and that RX77368 treatment may improve radial maze performance by increasing arousal and exploratory behaviour in rats rather than directly enhancing cognition.

High-affinity binding of riboflavin and FAD by immunoglobulins from normal human serum.

The binding of [3H]FAD and [3H]riboflavin to a pooled, human plasma immunoglobulin fraction was studied. For each flavin, the data fit best a model with two binding sites of high affinity and a class of sites of lower affinity. The dissociation constants estimated for the two high affinity sites were 1.73 nM and 0.078 nM for [3H]FAD and 2.43 nM and 0.068 nM for [3H]riboflavin. The results of studies with a series of possible competitors suggested that the flavin ring system was an important determinant of the binding. Other studies showed that the binding reaction was largely enthalpy-driven. Our findings show that normal human immunoglobulins contain one or more species that bind riboflavin and FAD with very high affinity.

The facial nucleus of the rat: representation of facial muscles revealed by retrograde transport of horseradish peroxidase.

The representation of facial muscle groups in the facial nucleus of rat was examined by retrograde transport of HRP. Motoneurons supplying muscle groups are arranged in longitudinal columns. Those supplying nasolabial muscles are located in the lateral and ventral intermediate segments, posterior auricular muscles in a medial column, platysma in an intermediate column; the lower lip and ocular muscles are in the ventral and dorsal segments respectively of the intermediate column. The posterior belly of the digastric muscle is supplied by motoneurons extending from the dorsal aspect of the facial nucleus to the caudal pole of the trigeminal motor nucleus.

Brain stem projections to the facial nucleus of the rat.

Horseradish peroxidase was injected into the medial and lateral columns of the facial nucleus of the rat. Following medial injections, cells were labelled by retrograde transport in the ipsilateral spinal trigeminal nucleus (caudalis) both medial vestibular nuclei, contralateral midbrain reticular formation and nucleus of the lateral lemniscus. The periaqueductal grey, interstitial nucleus and nucleus of Darkschewitch were also labelled ipsilaterally. Injections into the lateral column of the facial nucleus labelled the spinal trigeminal nucleus (oralis) and parabrachial nuclei ipsilaterally and the Darkschewitch and red nuclei contralaterally.