Anatomical reconstruction of first ray instability hallux valgus with a medial anatomical TMTJ1 plate.

BACKGROUND: First tarsometatarsal joint (TMTJ1) arthrodesis is a powerful tool for hallux valgus correction. Past criticism of the TMTJ1 arthrodesis has focused on high non-union rates, and consequent need for delayed weightbearing as prevention. In this study we present a selection and treatment protocol to minimise non-union while allowing early weightbearing. METHODS: All TMTJ1 arthrodesis procedures for hallux valgus performed by the senior surgeon over the period June, 2016 to July, 2019 were included. An anatomically-designed, medial TMTJ1 plate and screw compression was utilised for TMTJ1 arthrodesis. The construct was augmented with synthetic intermetatarsal stabilisation. All patients were kept non-weightbearing for 2 weeks, followed by progressive weightbearing as tolerated for 4 weeks. Minimum follow-up was 1 year. RESULTS: 300 modified Lapidus procedures were performed for hallux valgus with mean IMA 17° (Range: 14-29). Mean age was 58 years, with 93% female. 284 (94%) had an Akin osteotomy, while 222 cases (74%) were associated with another forefoot procedure. Patients began progressive weight bearing as tolerated from 2 weeks. All were fully weight bearing by 8 weeks post-operatively. There was a 100% union rate in this group. Mean AOFAS Hallux MTP-IP scores rose from 59 pre-operatively to 97 post-operatively. One plate was removed due to tibialis anterior impingement. There were no recurrences at final follow-up. CONCLUSIONS: We describe a selection and treatment protocol for TMTJ1 arthrodesis for hallux valgus. This yields high union rates while allowing early weight bearing. LEVEL OF EVIDENCE: 4.

Meta-analysis of the use of surgical sealants for suture-hole bleeding in arterial anastomoses.

BACKGROUND: Suture-hole bleeding in arterial anastomoses prolongs operating time and increases blood loss, particularly with the use of prosthetic grafts. Surgical sealants (such as fibrin) may be used as haemostatic adjuncts in vascular surgery. This is a systematic review and meta-analysis of published studies that investigated the utility of surgical sealants in arterial-to-prosthetic graft anastomoses. METHODS: A systematic review was undertaken of papers published until January 2015 on Embase, MEDLINE, PubMed, PubMed Central and Cochrane databases that analysed the use of surgical sealants as haemostatic adjuncts after arterial anastomoses. RCTs were included, with study endpoints of time to haemostasis or haemostasis at 5 min. Secondary outcomes included treatment failure, mean difference in estimated blood loss and duration of surgery. Sensitivity and subgroup analyses were performed, as well as funnel plot analysis for publication bias. RESULTS: A total of 2513 citations were reviewed; 19 RCTs comprising 1560 patients were ultimately included in the analysis. The majority of studies compared fibrin sealant with control haemostatic measures. Pooled analysis suggested that surgical sealants reduced the time to haemostasis (mean difference 243·26 (95 per cent c.i. 183·99 to 302·53) s; P < 0·001), improved haemostasis at 5 min (odds ratio 4·50, 95 per cent c.i. 2·59 to 7·81; P < 0·001), and were associated with less treatment failure, blood loss and shorter duration of surgery. CONCLUSION: Surgical sealants appear to reduce suture-hole bleeding significantly in vascular prosthetic graft anastomoses compared with standard haemostatic measures.

Molecular cloning of F4/80, a murine macrophage-restricted cell surface glycoprotein with homology to the G-protein-linked transmembrane 7 hormone receptor family.

F4/80 is a monoclonal antibody that recognizes a murine macrophage-restricted cell surface glycoprotein and has been extensively used to characterize macrophage populations in a wide range of immunological studies. Apart from the tightly regulated pattern of expression of the F4/80 antigen, little is known about its possible role in macrophage differentiation and function. We have sought to characterize the molecule at the molecular level, through the isolation of cDNA clones, and now describe the sequence of the F4/80 protein. The primary amino acid sequence demonstrates homology to two protein superfamilies. The NH2-terminal region consists of seven epidermal growth factor-like domains, separated by approximately 300 amino acids from a COOH-terminal region that shows homology to members of the seven transmembrane-spanning family of hormone receptors. The potential role of these distinct domains is discussed with respect to the possible function of the F4/80 molecule.

The mouse macrophage-specific glycoprotein defined by monoclonal antibody F4/80: characterization, biosynthesis and demonstration of a rat analogue.

F4/80, a mouse macrophage-specific membrane marker defined by a rat monoclonal antibody, was precipitated by a rabbit antiserum raised against partially purified mouse antigen. The antiserum, when tested against a variety of mouse tissues and cells, bound only to, and was cytotoxic for, macrophages, and it precipitated a similar macrophage-specific protein from rat cells. The F4/80 antigen is a glycoprotein of apparent molecular weight (MW) 150,000, and was labelled biosynthetically with [14C]glucosamine. Neuraminidase treatment removed small amounts of sialic acid, and tunicamycin and 2-deoxyglucose both inhibited antigen synthesis. Pulse/chase labelling with [35S]methionine demonstrated a precursor of 110,000 MW. Proteinase treatment of intact cells cleaved the molecule to an initial 100,000, and then to an 80,000 MW fragment. Without reduction, the MW of the molecule was unchanged by proteinases. These studies indicate that the F4/80 antigen consists of at least two domains linked by disulphide bridges, of MW 80,000 and 20,000. Both domains are extracellular.

Suppression of asporogeny in Bacillus subtilis. Allele-specific suppression of a mutation in the spoIIA locus.

From a strain carrying spoIIA69, a mutation giving rise to asporogeny, a revertant was isolated which sporulated at about 10(-2) of the wild-type frequency but in which the time-course of sporulation was much protracted. Genetic analysis of this revertant showed that it retained spoIIA69 but had acquired a secondary mutation sas. sas failed to suppress mutations in spoIID, spoIIE or spoIIG; it also failed to suppress another mutation in the spoIIA locus. sas is extremely closely linked (recombination frequency less than or equal to 1%) with the mutation spoIIA69 that it specifically suppresses. Strains carrying sas alone sporulated at a frequency at least two orders of magnitude below that in the spoIIA69 sas double mutant. It is suggested that spoIIA60 and sas lead to compensating amino acid changes in the protein specified by the spoIIA locus.