Rescuing lethal phenotypes induced by disruption of genes in mice: a review of novel strategies.

Approximately 35 % of the mouse genes are indispensable for life, thus, global knock-out (KO) of those genes may result in embryonic or early postnatal lethality due to developmental abnormalities. Several KO mouse lines are valuable human disease models, but viable homozygous mutant mice are frequently required to mirror most symptoms of a human disease. The site-specific gene editing systems, the transcription activator-like effector nucleases (TALENs), Zinc-finger nucleases (ZFNs) and the clustered regularly interspaced short palindrome repeat-associated Cas9 nuclease (CRISPR/Cas9) made the generation of KO mice more efficient than before, but the homozygous lethality is still an undesired side-effect in case of many genes. The literature search was conducted using PubMed and Web of Science databases until June 30th, 2020. The following terms were combined to find relevant studies: "lethality", "mice", "knock-out", "deficient", "embryonic", "perinatal", "rescue". Additional manual search was also performed to find the related human diseases in the Online Mendelian Inheritance in Man (OMIM) database and to check the citations of the selected studies for rescuing methods. In this review, the possible solutions for rescuing human disease-relevant homozygous KO mice lethal phenotypes were summarized.

Regulatory T Cells in the Context of New-Onset Diabetes After Renal Transplant: A Single-Center Experience.

BACKGROUND: New-onset diabetes mellitus after transplant (NODAT) is a well-known complication of renal transplant that severely affects graft and patient survival. It is necessary to explore further risk factors and reveal the underlying pathomechanism. METHODS: Renal transplants performed between January 2010 and June 2018 were involved. Exclusion criteria were the recipient age younger than 18 years, follow-up period less than 6 months, and patients with diabetes at the time of transplant. Only primary kidney transplants were involved in our study, which totaled 223 cases. Besides donor and recipient demographic data, the type of immunosuppression, the average fasting glucose level, and T-subset profiles were compared. RESULTS: Of 223 cases there were 33 patients (14.8%) with NODAT (17 female; mean age, 54.2 [SD, 10.3] years; mean body mass index [calculated as weight in kilograms divided by height in meters squared], 27.8 [SD, 5.1]; mean follow-up, 43.3 [SD, 25.5] months). The control group consisted of 190 patients. The average fasting blood glucose level was higher in the NODAT group vs the control group (P < .001). The average fasting blood glucose level above diabetic threshold (≥7 mmol/L) was in association with a 6-fold higher risk of NODAT (odds ratio, 5.86; 95% CI, 2.46-13.97; P < .001). Absolute value of CD4+CD25brightCD127dim regulatory T cells was lower in the NODAT group at the first month after transplant (P = .048) Immunosuppressive protocol and survival data did not differ. CONCLUSIONS: Intensive management of the carbohydrate excursions during the early post-transplant period may decrease the incidence of NODAT. Further investigations will be required to decide whether the reduced CD4+CD25brightCD127dim/regulatory T-cell count contributes the development of NODAT.

A novel vertebrate system for the examination and direct comparison of the relative biological effectiveness for different radiation qualities and sources.

PURPOSE: The recent rapid increase of hadron therapy applications requires the development of high performance, reliable in vivo models for preclinical research on the biological effects of high linear energy transfer (LET) particle radiation. AIM: The aim of this paper was to test the relative biological effectiveness (RBE) of the zebrafish embryo system at two neutron facilities. MATERIAL AND METHODS: Series of viable zebrafish embryos at 24-hour post-fertilization (hpf) were exposed to single fraction, whole-body, photon and neutron (reactor fission neutrons () and (p (18 MeV)+Be, = 3.5 MeV) fast neutron) irradiation. The survival and morphologic abnormalities of each embryo were assessed at 24-hour intervals from the point of fertilization up to 192 hpf and then compared to conventional 6 MV photon beam irradiation results. RESULTS: The higher energy of the fast neutron beams represents lower RBE (ref. source LINAC 6 MV photon). The lethality rate in the zebrafish embryo model was 10 times higher for 1 MeV fission neutrons and 2.5 times greater for p (18 MeV)+Be cyclotron generated fast neutron beam when compared to photon irradiation results. Dose-dependent organ perturbations (shortening of the body length, spine curvature, microcephaly, micro-ophthalmia, pericardial edema and inhibition of yolk sac resorption) and microscopic (marked cellular changes in eyes, brain, liver, muscle and the gastrointestinal system) changes scale together with the dose response. CONCLUSION: The zebrafish embryo system is a powerful and versatile model for assessing the effect of ionizing radiation with different LET values on viability, organ and tissue development.

Effectiveness of autochthonous bacterium and mycorrhizal fungus on Trifolium growth, symbiotic development and soil enzymatic activities in Zn contaminated soil.

AIMS: This study investigates how autochthonous micro-organisms [bacterium and/or arbuscular mycorrhizal (AM) fungi] affected plant tolerance to Zn contamination. METHODS AND RESULTS: Zinc-adapted and -nonadapted Glomus mosseae strains protected the host plant against the detrimental effect of Zn (600 microg g(-1)). Zn-adapted bacteria increased root growth and N, P nutrition in plants colonized by adapted G. mosseae and decreased the specific absorption rate (SAR) of Cd, Cu, Mo or Fe in plants colonized by Zn-nonadapted G. mosseae. Symbiotic structures (nodule number and extraradical mycelium) were best developed in plants colonized by those Zn-adapted isolates that were the most effective in increasing plant Zn tolerance. The bacterium also increased the quantity and quality (metabolic characteristics) of mycorrhizal colonization, with the highest improvement for arbuscular vitality and activity. Inocula also enhanced soil enzymatic activities (dehydrogenase, beta-glucosidase and phosphatase) and indol acetic acid (IAA) accumulation, particularly in the rhizosphere of plants inoculated with Zn-adapted isolates. CONCLUSIONS: Glomus mosseae strains have a different inherent potential for improving plant growth and nutrition in Zn-contaminated soil. The bacterium increased the potential of mycorrhizal mycelium as inoculum. SIGNIFICANCE AND IMPACT OF THE STUDY: Mycorrhizal performance, particularly that of the autochthonous strain, was increased by the bacterium and both contributed to better plant growth and establishment in Zn-contaminated soils.

Two bacterial strains isolated from a Zn-polluted soil enhance plant growth and mycorrhizal efficiency under Zn-toxicity.

In this study we investigated the interactions among plant, rhizosphere microorganisms and Zn pollution. We tested the influence of two bacterial strains isolated from a Zn-polluted soil on plant growth and on the symbiotic efficiency of native arbuscular mycorrhizal fungi (AMF) under Zn toxicity. The two bacterial strains exhibited Zn tolerance when cultivated under increasing Zn levels in the medium. However, strain B-I showed a higher Zn tolerance than strain B-II at the two highest Zn levels in the medium (75 and 100 mg l(-1) Zn). Molecular identification placed the strain B-I within the genus Brevibacillus. Our results showed that bacterial strain B-I consistently enhanced plant growth, N and P accumulation, as well as nodule number and mycorrhizal infection which demonstrated its plant-growth promoting (PGP) activity. This strain B-I has been shown to produce IAA (3.95 microg ml) and to accumulate 5.6% of Zn from the growing medium. The enhanced growth and nutrition of plants dually inoculated with the AMF and bacterium B-I was observed at three Zn levels assayed. This effect can be related to the stimulation of symbiotic structures (nodules and AMF colonization) and a decreased Zn concentration in plant tissues. The amount of Zn acquired per root weight unit was reduced by each one of these bacterial strains or AMF and particularly by the mixed bacterium-AMF inocula. These mechanisms explain the alleviation of Zn toxicity by selected microorganisms and indicate that metal-adapted bacteria and AMF play a key role enhancing plant growth under soil Zn contamination.

Influence of bacterial strains isolated from lead-polluted soil and their interactions with arbuscular mycorrhizae on the growth of Trifolium pratense L. under lead toxicity.

We isolated two bacterial strains from an experimentally lead (Pb)-polluted soil in Hungary, 10 years after soil contamination. These strains represented the two most abundant cultivable bacterial groups in such soil, and we tested their influence on Trifolium pratense L. growth and on the functioning of native mycorrhizal fungi under Pb toxicity in a second Pb-spiked soil. Our results showed that bacterial strain A enhanced plant growth, nitrogen and phosphorus accumulations, nodule formation, and mycorrhizal infection, demonstrating its plant-growth-promoting activity. In addition, strain A decreased the amount of Pb absorbed by plants, when expressed on a root weight basis, because of increased root biomass due to the production of indoleacetic acid. The positive effect of strain A was not only evident after a single inoculation but also in dual inoculation with arbuscular mycorrhizal fungi. Strain A also exhibited higher tolerance than strain B when cultivated under increasing Pb levels in the spiked soil. Molecular identification unambiguously placed strain A within the genus Brevibacillus. We showed that it is important to select the most tolerant and efficient bacterial strain for co-inoculation with arbuscular mycorrhizal fungi to promote effective symbiosis and thus stimulate plant growth under adverse environmental conditions, such as heavy-metal contamination.

Symbiotic efficiency of autochthonous arbuscular mycorrhizal fungus (G. mosseae) and Brevibacillus sp. isolated from cadmium polluted soil under increasing cadmium levels.

The effect of inoculation with indigenous naturally occurring microorganisms (an arbuscular mycorrhizal (AM) fungus and rhizosphere bacteria) isolated from a Cd polluted soil was assayed on Trifolium repens growing in soil contaminated with a range of Cd. One of the bacterial isolate showed a marked PGPR effect and was identified as a Brevibacillus sp. Mycorrhizal colonization also enhanced Trifolium growth and N, P, Zn and Ni content and the dually inoculated (AM fungus plus Brevibacillus sp.) plants achieved further growth and nutrition and less Cd concentration, particularly at the highest Cd level. Increasing Cd level in the soil decreased Zn and Pb shoot accumulation. Coinoculation of Brevibacillus sp. and AM fungus increased shoot biomass over single mycorrhizal plants by 18% (at 13.6 mg Cd kg(-1)), 26% (at 33.0 mg Cd kg(-1)) and 35% (at 85.1 mg Cd (kg(1)). In contrast, Cd transfer from soil to plants was substantially reduced and at the highest Cd level Brevibacillus sp. lowered this value by 37.5% in AM plants. Increasing Cd level highly reduced plant mycorrhization and nodulation. Strong positive effect of the bacterium on inocula, are important in plant Cd tolerance and development in Cd polluted soils.

Pemberton's pericapsular osteotomy for the treatment of acetabular dysplasia.

We present the results of 80 Pemberton procedures carried out between 1977 and 1990. The patient age at the time of operation ranged between 2 and 12 years, and follow-up was between 1 and 15 years. Before Pemberton's operation, conservative treatment, closed and open reduction, and derotation femoral osteotomy were used. Pemberton's operation was combined with intertrochanteric femoral osteotomy in 30 cases. The mean values of the acetabular and center edge angle of Wiberg showed postoperative improvement of 19 and 17 degrees, respectively; whereas at follow-up, improvement was 20 and 23 degrees, respectively. Radiologically, 79% of the cases met Severin's classification grade I-II criteria. Clinically, 81% were classified as excellent and good. The results were closely correlated with ischemic necrosis due to preoperative treatment. Only patients belonging to groups II-IV of Kalamchi and MacEwen, plus one patient operated on at relatively old age (12 years), were found radiologically to be in Severin's groups III and IV. The results among patients operated on before age 7 were more favorable than those of patients operated on at an older age.

Comparison of a lifestyle modification program with propranolol use in the management of diastolic hypertension.

OBJECTIVE: To compare the management of mild diastolic hypertension (90 to 104 mm Hg) using a nonpharmacologic intervention with that using propranolol or placebo. DESIGN: Randomized, placebo-controlled trial with a 2 x 2 factorial design. SETTING: University-based ambulatory care center. PARTICIPANTS: Two hundred seven men and 105 women, 22 to 59 years of age, 73% white, who had mild diastolic hypertension untreated for at least eight weeks. INTERVENTIONS: 1) a multicomponent lifestyle modification intervention (lifestyle focus group, or LFG) administered in eight weekly meetings + placebo, 2) LFG + propranolol, 3) propranolol alone, and 4) placebo alone, followed for 12 months. MEASUREMENTS: Systolic blood pressure (SBP), diastolic blood pressure (DBP), and self-reported adverse effects at each of nine follow-up visits; fasting total cholesterol, triglycerides, and glucose at baseline and 12 months; 24-hour urine sodium (Na+) and potassium (K+), three-day food records and physical activity questionnaire at three and 12 months; and a quality of life questionnaire at 12 months. MAIN RESULTS: The mean decreases in DBP at 12 months were: 8.5 mm Hg in the LFG + propranolol group; 7.7 mm Hg in the propranolol-only group; 5.9 mm Hg in the placebo-only group; and 5.4 mm Hg in the LFG + placebo group. Repeated-measures analysis of covariance showed that level of baseline DBP (p < 0.0001), time of follow-up (p < 0.0001), and propranolol use (p < 0.0001) were significantly associated with a decrease in DBP at 12 months. Despite reductions in urinary Na+ (-35 mEq; 95% CI = -50, -19), dietary Na+ (-521 mg; 95% CI = -710, -332), total calories ingested (-238; 95% CI = -335, -140), and weight (-1.4 lb; 95% CI = -3.7, +0.8), and significant increases in dietary K+ (+294 mg; 95% CI = +107, +480) and in mets-minutes of exercise (+43; 95% CI = +20, +67) at three months, assignment to the LFG intervention had no effect on DBP at three or 12 months. The subjects assigned to take propranolol more frequently reported fatigue during ordinary activities, sleep disturbance, decrease in sexual activity, and depressed feelings, when compared with the subjects taking placebo, but the numbers of study withdrawals did not differ by drug assignment. No significant difference in total cholesterol and glucose levels was observed by group assignment. Triglycerides increased significantly in the subjects assigned to propranolol (mean difference = +20 mg/dL; 95% CI of difference +1.5, +39). There was no difference in the responses to 21 quality of life items between the subjects assigned to propranolol and those assigned to placebo. CONCLUSIONS: This multicomponent lifestyle modification intervention was unable to promote persistent behavior changes and thus was inferior to propranolol therapy for the treatment for mild diastolic hypertension. Future research should focus on single modifiable factors to lower blood pressure.

Effect of some environmental factors on Rhizobium and Bradyrhizobium strains.

Effects of different abiotic factors (acidity, salinity, nitrate and temperature) on growth rate of root-nodule bacteria (Rhizobium and Bradyrhizobium) strains were investigated in vitro. Strains isolated from Vicia faba L., Coronilla varia L. and Lupinus albus L. exhibited a large variation in tolerance of the above-mentioned factors. These bacteria should be screened under stimulated conditions for enhanced survival before selection to be used for commercial inoculant production. Linear correlation matrix data were useful to find the appropriate concentrations for the selection of the tolerant strains.

Preliminary results of early open reduction by an anterior approach for congenital dislocation of the hip.

We report the results of 113 early open reductions of congenitally dislocated hips using a technique we have developed. Surgery is followed by functional postoperative treatment with a Pavlik harness or abduction splint. The age of the patients and the follow-up period ranged from 6 to 24 months and 2 to 12 years, respectively. Radiologic results corresponded to Severin grades I and II in 98%. Severe ischemic necrosis was not observed. Secondary surgery (femoral derotation osteotomy and/or Pemberton's operation) was performed in 21% of the cases. Reduction at a young age resulted in fewer secondary procedures. Good results were attributed to postoperative treatment: Abandoning rigid fixation prevented soft tissue stretching, which may endanger blood supply to the joint. This treatment ensures concentric reduction and allows early and spontaneous joint mobilization in a functional position. These factors stimulate further joint development.

Metal sensitivity of some symbiotic N2-fixing bacteria and Pseudomonas strains.

An investigation was carried out to determine the sensitivity of different soil microbes (Rhizobium, Bradyrhizobium and Pseudomonas) to various metals (Cu2+, Zn2+, Co2+, Mn2+, Mo2+ and Fe2+) in vitro. Sulphate and chloride forms of these microelements were used (except Mo2+ as Na2Mo04) in 0.1, 1.0 and 10 micrograms/ml concentrations in modified YEM and nutrient broth. Growth (optical density, OD550 and OD640) of bacterium inoculated (approx. 10(6) CFU/ml) tubes, was measured spectrophotometrically after 48 h of incubation of 28 degrees C in a rotary shaker (150 rpm). Data of triplicate samples are shown as percent of control tubes (inoculated, free from treatments) and after an analysis of variance SE was calculated. Strains of Rhizobium leguminosarum proved to be the most sensitive to Cu2+, Zn2+ and Co2+. The slow growing Bradyrhizobium and plant growth promoting (PGPR) Pseudomonas isolates, however, were affected only at the highest (10 micrograms/ml) dose of these elements. In contrast Mn2+, Mo2+ and Fe2+ microelements were stimulatory for the growth of all investigated soil microbes. Sulphate forms of the most harmful Cu2+ and Zn2+ cations were more toxic than the chloride forms. An especially high diversity was found among the R. leguminosarum bv. viceae isolates. Monitoring the sensitivity of these microbes has a primary importance for selection of ecologically diverse isolates, as potential inocula in heavy-metal affected soils.

Some environmental factors influencing the survival of Rhizobium leguminosarum bv. viceae.

Investigations were carried out to monitor the sensitivity of Rhizobium leguminosarum bv. viceae strains to various environmental stress-factors (salinity, pH, Al3+, Ca2+, Mg2+) and select them as potential candidates for Vicia faba inoculation. In the range between pH 5.0 and 10.0, the salt effect of 10-500 mM NaCl, Ca2+, Mg2+ (as chlorides and sulphates), Al2O3 and KAl (SO4)2 (25-400 microM) were tested in modified yeast-mannitol (YEM) liquid medium. Cell density of the suspensions inoculated with R. leguminosarum bv. viceae strains (initial cell-number 10(6) CFU/ml) were measured spectrophotometrically after 48 h incubation in a rotary shaker (rpm 150) at 28 degrees C. Data of optical density (OD550) are shown as percent of control (inoculated, free from treatments, pH 7.0) tubes. It was established, that results of tolerancy were in agreement with those found earlier for Rhizobium sensitivity. Strain of Lóbab Z (isolated in Hungary) however proved to have an especially outstanding survival in any media tested in vitro. Lowest observed effect concentrations (LOECs) were: 500 mM NaCl, 200 microM Al3+ (as Al2O3 or KAl (SO4)2), 50-100 mM Mg2+, and 200-300 mM Ca2+. For the Al3+, Ca2+ and Mg2+ cations, there was no variation between the stress-effect of sulphate and chloride anions. Both forms of Ca2+, however significantly reduced the growth potential of R. leguminosarum bv. viceae strains.

[Degenerative chondroarthropathy of the sternocostal joint following heart surgery]. / Degeneratív chondroarthropathia a sternocostalis ízületeken szívmütétek után.

Involvement of the sternocostal joints was investigated in a series of 46 males and 18 females following median sternotomy annually in a 5-year period and compared to 62 age- and sex matched control subjects after one year solely. Both groups had a mean age of 49.2 years. The degenerative chondroarthropathy of sternocostal joints was 1.69-times more frequent in heart operated upon patients as compared to control persons. Based on radiographic findings the degenerative chondroarthropathies were classed in 0 to 3 severity groups. Were seen articular space narrowing in 95.4%, osteophytes of the margin of the articular surface in 88%, subchondral bony eburnation in 79% and cystic radiolucencies in 48.9% of sternocostal joints on poststernotomy standard plain film tomograms. Not occurred intraarticular gas phenomenon and bony ankylosis. The development of arthropathies is traced back to mechanical stress-related predisposing factors and stressed the importance of oculoneutral dehiscences that simulated normal roentgenanatomic projections and caused a masked insufficiency in sternocostal junctions.

[Results of combined surgical operations in the management of congenital hip dislocation]. / Kombinált mütétek eredményei a veleszületett csípöficam kezelésében.

The results of 51 different combined operations for the treatment of CDH after the age of two years performed between 1980 and 1989 are presented. The age of the patients at the time of the operation ranged from 2 to 12 (mean 4.5 years. Follow-up was 2-12 (meean 6) years. Preoperatively 19 hips were untreated. Primary surgery included reduction alone in 6 cases, together with femoral osteotomy in 28 cases, reduction combined with Pemberton's operation in 1, and reduction supplemented by both correction techniques in 16 cases. Secondary acetabular correction was later necessary only in 14 cases (27%), thus in 63% of all cases. Radiologycally, the results were of Severin's grade I and II in 64% of the whole series, but in 88% in the 2-3-years-old group. The results in the different surgical groups correlated primarily with the incidence of avascular necrosis and not with the extent of surgery.

[Results of early surgical reduction of congenital hip dislocation]. / A veleszületett csípöficam korai mütéti repositiójának eredményei.

Authors report on the results of 118 early operative reductions, performed with their own method in the treatment of the congenital dislocation of the hip. Postoperative functional treatment with Pavlik's harness or abduction splint belongs to their method. Secondary operations were performed in 21 per cent: derotation femoral osteotomy and Pemberton's operation. The younger the patient was at the reduction the rarer was secondary operation necessary. The age of the patients was 6-24 months at the operation (in average 13 months) The follow-up time was 2-12 years (in average 6.1 years). The results corresponded radiologically to Severin's I + II grades (excellent and good) in 98 per cent. Clinically 98 per cent were excellent, 2 per cent fair. The good results are first of all attributed to their postoperative treatment: 1. They avoided the stiff plaster bandage and so no tension of the soft parts could develop, that would endanger the blood supply. In consequence ischaemic damage, belonging to Kalamchi's and Mac Ewen's group I was found only in a few cases. No damage belonging to the severe forms II-IV was observed 2. Their treatment: secures the central reduction and allows spontaneous joint movements in functional position: factors meaning the maximal stimulus of joint development. The condition of this postoperative treatment is the stability of reduction, secured by their special plasty of the capsule.

[Cardiorespiratory and electrolytic changes in status asthmaticus after intravenous administration of magnesium sulfate]. / Magnézium-szulfát intravénás adása után bekövetkezö cardiorespiratoricus és elektrolit változások status asthmaticusban.

The authors studied cardiorespiratory effects of MgSO4 infusion in 30 randomized patients with status asthmaticus. They found, that after having the drug administered, values of VC, FEV1, FIV1, PaO2 and pH increased, the respiratory and heart rate, diastolic blood pressure reduced. Other ventilation, blood gas and ECG parameters were unchanged. Among the electrolytes, serum Ca2+ level has reduced, both plasma and intracellular Mg2+ concentrations increased. It is apparent from the results, that broncholytical ability of MgSO4 given in therapeutical dose i.v. does not reach the level of beta-stimulating agents. However, this completed with the cardioprotective, sedative effect as well as more advantageous ion-distribution, influences favourably the asthmatic dyspnoea.

[Surgical treatment of hip dislocations in children and damages caused by conservative treatment methods]. / Csípömütéteink operált és konzervatív kezeléstöl károsodott csípöficamos gyermekeken.

For the major requirements of the operative technique and other special problems of operation it is reasonable to discuss among the questions of the reduction of CHD the reoperations and the reconstructive surgery of hips, badly damaged by the conservative treatment, separately. We have analysed the results of 19 own cases with an average follow up of 6.3 years (3-12 years). The average age of the patients was 4.8 years. In 7 patients only conservative treatment was carried out previously, the others were also operated. The Roentgenogram revealed severe ischaemic necrosis in 10 hips. The dislocation could be reduced in every case, to the reduction however it was obligatory to add femoral osteotomy and correction of the acetabulum. The later operation was performed frequently in the second sitting. As a direct result of the operation a state, corresponding to the II. degree of Severin's radiological classification was always reached, in cases of severe ischaemic necrosis however the result later grew worse and at the follow up it corresponded only to the degrees III. and IV. (mediocre, poor). Thus the circulatory damage, suffered during the early treatment determined the late results. This was the reason that the result of the follow up examinations were better in patients in whom early surgery was performed than in patients with forced conservative treatment. The results summarized fall far behind the results of the group with primary surgery of the CHD. Without the operations described these patients would live as limping cripples, with these operations however we have improved their state significantly for the time until TEP can be performed.

Distal transfer of the greater trochanter for the correction of trochanteric overgrowth.

For the correction of trochanteric overgrowth resulting from ischaemic necrosis following conservative therapy in early childhood for congenital dislocation of the hip, 83 trochanteric transfers were carried out whose results were analysed over a mean follow-up period of 4.5 years (3-10 years). During operation the insertion of the gluteal minimus muscle to the trochanter was carefully detached in a way that only the fibres of the gluteus medius remained on the bone. Thus the gluteus medius could maximally be stretched in isolation, by a distal transfer of the greater trochanter and that was the way for obtaining the best results. To prevent subluxation of the head of the femur surgical correction of the acetabulum was carried out (usually Chiari's pelvic osteotomy) if the covering of the head was imperfect. The trochanter was fixed using A0 cancellous bone screw, no plaster fixation was applied and full loading was allowed 4 weeks after surgery. On the basis of changes in Trendelenburg's sign in patients operated before the age of 14 years, good results were found in 92%, whereas in older patients the result was 75%. Subjective opinions were quite similar in both groups. Positive evaluation of the results was given in 70% and 68% by patients in the younger and older group, respectively.