Blockade of CD73 delays glioblastoma growth by modulating the immune environment.

Immunotherapy as an approach for cancer treatment is clinically promising. CD73, which is the enzyme that produces extracellular adenosine, favors cancer progression and protects the tumor from immune surveillance. While CD73 has recently been demonstrated to be a potential target for glioma treatment, its role in regulating the inflammatory tumor microenvironment has not yet been investigated. Thus, this study explores the immunotherapeutic value of the CD73 blockade in glioblastoma. The immuno-therapeutic value of the CD73 blockade was evaluated in vivo in immunocompetent pre-clinical glioblastoma model. As such, glioblastoma-bearing rats were nasally treated for 15 days with a siRNA CD73-loaded cationic-nanoemulsion (NE-siRNA CD73R). Apoptosis was determined by flow cytometry using Annexin-V staining and cell proliferation was analyzed by Ki67 expression by immunohistochemistry. The frequencies of the CD4+, CD8+, and CD4+CD25highCD39+ (Treg) T lymphocytes; CD11b+CD45high macrophages; CD11b+CD45low-microglia; and CD206+-M2-like phenotypes, along with expression levels of CD39 and CD73 in tumor and tumor-associated immune cells, were determined using flow cytometry, while inflammatory markers associated with tumor progression were evaluated using RT-qPCR. The CD73 blockade by NE-siRNA CD73 was found to induce tumor cell apoptosis. Meanwhile, the population of Tregs, microglia, and macrophages was significantly reduced in the tumor microenvironment, though IL-6, CCL17, and CCL22 increased. The treatment selectively decreased CD73 expression in the GB cells as well as in the tumor-associated-macrophages/microglia. This study indicates that CD73 knockdown using a nanotechnological approach to perform nasal delivery of siRNA-CD73 to CNS can potentially regulate the glioblastoma immune microenvironment and delay tumor growth by inducing apoptosis.

CD73 as a target to improve temozolomide chemotherapy effect in glioblastoma preclinical model.

Glioblastoma is the most devastating primary brain tumor and effective therapies are not available. Treatment is based on surgery followed by radio and chemotherapy with temozolomide (TMZ), but TMZ increases patient survival only by 2 months. CD73, an enzyme responsible for adenosine production, emerges as a target for glioblastoma treatment. Indeed, adenosine causes tumor-promoting actions and CD73 inhibition increases sensitivity to TMZ in vitro. Here, a cationic nanoemulsion to nasal delivery of siRNA CD73 (NE-siRNA CD73) aiming glioblastoma treatment was employed alone or in combination with TMZ. In vitro, two glioblastoma cell lines (C6 and U138MG) with a chemo-resistant profile were used. Treatment alone with NE-siRNA CD73 reduced C6 and U138MG glioma cell viability by 70% and 25%, respectively. On the other hand, when NE-siRNA + TMZ combined treatment was employed, a reduction of 85% and 33% of cell viability was observed. Notably, treatment with NE-siRNA CD73 of glioma-bearing Wistar rats reduced tumor size by 80%, 60% more than the standard chemotherapy with TMZ, but no synergistic or additive effect was observed in vivo. Additionally, NE-siRNA CD73, TMZ or combined therapy decreased adenosine levels in liquor confirming the importance of this nucleoside on in vivo GB growth. Finally, no hemolytic potential was observed. These results suggest that nasal administration of NE-siRNA CD73 exhibits higher antiglioma effect when compared to TMZ. However, no synergistic or additive in vivo was promoted by the therapeutic regimen employed in this study.

Nasal Administration of Cationic Nanoemulsions as CD73-siRNA Delivery System for Glioblastoma Treatment: a New Therapeutical Approach.

Glioblastoma is the most devastating primary brain tumor. Effective therapies are not available, mainly due to high tumor heterogeneity, chemoresistance, and the difficulties imposed by blood-brain barrier. CD73, an enzyme responsible for adenosine (ADO) production, is overexpressed in cancer cells and emerges as a target for glioblastoma treatment. Indeed, ADO causes a variety of tumor-promoting actions, particularly by inducing tumor immune escape, whereas CD73 inhibition impairs tumor progression. Here, a cationic nanoemulsion to deliver CD73siRNA (NE-siRNA CD73R) via nasal route aiming glioblastoma treatment was developed. NE-siRNA CD73R was uptaken by glioma cells in culture, resulting in a parallel 60-80% decrease in AMPase activity and 30-50% in cell viability. Upon nasal delivery, NE-siRNA CD73R was detected in rat brain and serum. Notably, treatment with CD73siRNA complexes of glioma-bearing Wistar rats reduced tumor growth by 60%. Additionally, NE-siRNA CD73R treatment decreased 95% ADO levels in liquor and tumor CD73 expression, confirming in vivo CD73 silencing. Finally, no toxicity was observed in either primary astrocytes or rats with this cationic nanoemulsion. These results suggest that nasal administration of cationic NE as CD73 siRNA delivery system represents a novel potential treatment for glioblastoma. Graphical Abstract Glioblastoma is the most common and devastating form of primary brain tumor. CD73, a protein involved in cell-cell adhesion and migration processes and also responsible for extracellular adenosine (ADO) production, is overexpressed by glioma cells and emerges as an important target for glioma treatment. Indeed, ADO participates in tumor immune escape, cell proliferation, and angiogenesis, and CD73 inhibition impairs those processes. Here, a cationic nanoemulsion to deliver CD73 siRNA (NE-siRNA CD73R) via nasal route aiming glioblastoma treatment was developed. NE-siRNA CD73R knockdown in vitro and in vivo CD73. Upon nasal delivery of NE-siRNA CD73R, the treatment markedly reduced tumor volume by 60% in a rat preclinical glioblastoma model. The treatment was well tolerated, and did not induce kidney, liver, lung, olfactory, bone marrow, or behavior alterations. These results indicate that the nasal administration of NE as a CD73 siRNA delivery system offered an efficient means of gene knockdown and may represent a potential alternative for glioblastoma treatment.

Biomechanical evaluation of two methods of fixation of a flexor hallucis longus tendon graft.

Aims: The traditional transosseus flexor hallucis longus (FHL) tendon transfer for patients with Achilles tendinopathy requires two incisions to harvest a long tendon graft. The use of a bio-tenodesis screw enables a short graft to be used and is less invasive, but lacks supporting evidence about its biomechanical behaviour. We aimed, in this study, to compare the strength of the traditional transosseus tendon-to-tendon fixation with tendon-to-bone fixation using a tenodesis screw, in cyclical loading and ultimate load testing. Materials and Methods: Tendon grafts were undertaken in 24 paired lower-leg specimens and randomly assigned in two groups using fixation with a transosseus suture (suture group) or a tenodesis screw (screw group). The biomechanical behaviour was evaluated using cyclical and ultimate loading tests. The Student's t-test was performed to assess statistically significant differences in bone mineral density (BMD), displacement, the slope of the load-displacement curves, and load to failure. Results: The screw group showed less displacement (loosening) during cyclical loading, which was significant during 300, 500, 600, 700, 800, 900, and 1000 cycles (p < 0.05: other cycles: 0.079 < p < 0.402). Compared with the suture group, the screw group had higher mean ultimate load values (133.6 N, sd 73.5 vs 110.1 N, sd 46.2; p = 0.416). Conclusion: Fixation of the FHL tendon with a tenodesis screw enables a less invasive procedure to be undertaken and shows similar biomechanical behaviour and primary strength compared with fixation using a transosseus suture. Cite this article: Bone Joint J 2018;100-B:1175-81.

Peroneus brevis tendon in proximal 5th metatarsal fractures: Anatomical considerations for safe hook plate placement.

INTRODUCTION: The peroneus brevis tendon (PBT) inserts into the proximal aspect of the 5th metatarsal. Metatarsal bone fractures are encountered to be the most common fractures in the foot with predominantly fractures at the base of the fifth metatarsal bone. Mechanism of injury and treatment of the proximal 5th metatarsal fractures vary due to the complex anatomy and diverse biomechanical properties. The purpose of this study was to analyze the footprint of the PBT with regards to the proximal 5th metatarsal fractures and to define a "safe zone" for hook plate placement. MATERIALS AND METHODS: Forty-one (41) fixed human lower leg specimens were dissected to expose the PBT insertion. The following footprint characteristics were evaluated: area of insertion (AOI) (mm2), length (mm), width (mm), shape and insertional variations. The position of the main PBT footprint was localized according to the Lawrence and Botte classification for the proximal 5th metatarsal fractures (Zone I-III). A "safe zone" was defined for the fracture-specific hook plate placement. RESULTS: In 25 (61%) feet the PBT footprint was situated in Zone I and in 16 feet (39%) in Zone I&II. The mean AOI, length and width measured 54.5 mm2 (SD 16.5), 16.0 mm (SD 5.1) and 4.7 mm (SD 1.4), respectively. Analysis of the footprint shapes revealed four different shape types: kidney (29.3%), diamond (22.0%), crescent (31.7%) and oval (17.0%). A "safe zone" for hook plate placement without or minimal interference of the PBT at its insertion could be defined at the lateral aspect of the 5th metatarsal. CONCLUSION: The majority of the PBT footprints were found in Zone I. Hook plate placement demonstrated to be safe when placed strictly laterally at the proximal aspect of the 5th metatarsal. Precise knowledge of the peroneus brevis anatomy may help to better understand the biomechanical aspects of the proximal 5th metatarsal fractures.

Sex dependent alterations in mitochondrial electron transport chain proteins following neonatal rat cerebral hypoxic-ischemia.

Males are more susceptible to brain mitochondrial bioenergetic dysfunction following neonatal cerebral hypoxic-ischemia (HI) than females. Mitochondrial biogenesis has been implicated in the cellular response to HI injury, but sex differences in biogenesis following HI have not been described. We tested the hypothesis that mitochondrial biogenesis or the expression of mitochondrial electron transport chain (ETC) proteins are differentially stimulated in the brains of 8 day old male and female rats one day following HI, and promoted by treatment with acetyl-L-carnitine (ALCAR). There were no sex differences in mitochondrial mass, as reflected by the ratio of mitochondrial to nuclear DNA (mtDNA/nDNA) and citrate synthase enzyme activity present one day following HI or sham surgery. There was an increase in mtDNA/nDNA, however, in the hypoxic and ischemic (ipsilateral) hemisphere after HI in both male and female brains at one day post-injury, which was suppressed by ALCAR. Citrate synthase activity was increased in the ipsilateral hemisphere of ALCAR treated male and female brain. Most importantly, the levels of representative mitochondrial proteins present in ETC complexes I, II and IV increased substantially one day following HI in female, but not male brain. This sex difference is consistent with the increase in the mitochondrial biogenesis-associated transcription factor NRF-2/GABPα following HI in females, in contrast to the decrease observed with males. In conclusion, the female sex-selective increase in ETC proteins following HI may at least partially explain the relative female resilience to mitochondrial respiratory impairment and neuronal death that occur after HI.

OCCUPATIONAL EXPOSURE TO EXTERNAL RADIATION IN SWITZERLAND.

Individual monitoring for both external and internal exposures is well regulated in Switzerland. The article gives an overview on the occupational exposure to external radiation of workers based on the data collected in the Swiss national dose registry (NDR) in 2013. The NDR records the monthly doses of radiation workers since the introduction of ICRP 60 recommendations and is manifested in the Swiss ordinance since 1994. Annual dose limits for effective dose are typically exceeded once a year in Switzerland, mostly in medicine. The NDR is a useful optimisation tool to identify and characterise areas with the highest exposures. While exceeded dose limits were often related to accidental acute exposure in the past, they are now more related to continuous exposure during normal work, especially in medicine.

Biomechanical stability of tape augmentation for anterior talofibular ligament (ATFL) repair compared to the native ATFL.

PURPOSE: Current methods of anterior talofibular ligament (ATFL) reconstruction fail to restore the stability of the native ATFL. Therefore, augmented anatomic ATFL reconstruction gained popularity in patients with attenuated tissue and additional stress on the lateral ankle ligament complex. The aim of the present study was to evaluate the biomechanical stability of the InternalBrace (Arthrex Inc., Naples, FL, USA), a tape augmentation designed to augment the traditional Broström procedure. METHODS: Twelve (12) fresh-frozen human anatomic lower leg specimens were randomized into two groups: a native ATFL (ATFL) and a tape augmentation group (IB). Dual-energy X-ray absorptiometry (DEXA) scans were carried out to determine bone mineral density (BMD) of the specimens. The ligaments were stressed by internally rotating the tibia against the inverted fixated hindfoot. Torque at failure (Nm) and angle at failure (°) were recorded. RESULTS: The ATFL group failed at an angle of 33 ± 10°. In the IB group, construct failure occurred at an angle of 46 ± 16°. Failure torque reached 8.3 ± 4.5 Nm in the ATFL group, whereas the IB group achieved 11.2 ± 7.1 Nm. There was no correlation between angle at ATFL or IB construct failure or torque at failure, respectively, and BMD for both groups. CONCLUSION: This study reveals that tape augmentation for ATFL reconstruction shows similar biomechanical stability compared to an intact native ATFL in terms of torque at failure and angle at failure. BMD did not influence the construct stability. Tape augmentation proved an enhanced initial stability in ATFL reconstruction which may allow for an accelerated rehabilitation process. LEVEL OF EVIDENCE: II.

[Orthopedic shoe treatment: Inserts]. / Orthopädische Schuhversorgung: Einlagen.

The use of inserts and orthopedic shoe adjustment represents an essential component of the conservative therapy of degenerative diseases and deformities of the musculoskeletal system. Inserts can have supportive, bedding and corrective effects and are used in particular for complaints of the feet and ankles. The combination of diverse materials allows a high level of cushioning and supporting features and corresponding longevity to be accomplished. The production is carried out on an individual basis and if necessary computer-assisted in order to achieve an optimal fit. For severe and rigid deformities the formation of pressure ulcers can be prevented by orthopedic shoe adjustment and by the use of orthopedic tailor-made shoes.

Comparison of Broström technique, suture anchor repair, and tape augmentation for reconstruction of the anterior talofibular ligament.

PURPOSE: Recently, tape augmentation for Broström repair has been introduced in order to improve the primary stability of the reconstructed anterior talofibular ligament (ATFL). The biomechanical effect of tape augmentation suture anchor (SA) repair is not known yet. The aim of the present study was to compare construct stability of the traditional Broström (TB) repair compared with a stand alone SA repair (SutureTak, Arthrex) and SA repair combined with tape augmentation (InternalBrace, Arthrex) internal brace (IB) of the ATFL. METHODS: Eighteen fresh-frozen human anatomic lower leg specimens were randomly assigned to three different groups: TB group, SA group, and IB augmentation group. In vivo torsion conditions in ankle sprain were carried out quasi-statically (0.5°/s). Torque (Nm) required to resist as well as the rotary displacement (°) of the load frame was recorded. Intergroup differences for age, bone mineral density (BMD), angle at failure, and torque at failure were analysed using ANOVA. RESULTS: In the TB group, ATFL reconstruction failed at an angle of 24.1°, in the SA group failure occurred at 35.5°, and in the IB group it failed at 46.9° (p = 0.02). Torque at failure reached 5.7 Nm for the TB repair, 8.0 Nm for the SA repair, and 11.2 Nm for the IB group (p = 0.04). There was no correlation between angle at ATFL failure, torque at failure, and BMD for the SA or IB groups. CONCLUSION: The present biomechanical study reveals statistically superior performance in terms of angle at failure as well as failure torque for the IB group compared to the other reconstruction methods. BMD did not influence the construct stability in the SA repair groups.

[The Midfoot Fusion Bolt: a new perspective?]. / Der "Midfoot Fusion Bolt" - eine neue Perspektive?

BACKGROUND: There is no current guideline nor consensus regarding optimal surgical treatment of the midfoot Charcot. Due to the vast diversity of locations, it is difficult to make a general statement. Various different types of screws and plates are currently being used since they have been tested and declared to be most stable. The Midfoot Fusion Bolt is a new device which needs approval since long-term results are lacking. A short summary of currently published papers and results from our own institution are provided. OBJECTIVES: The aim of this study was to investigate short-term results including complications and review published surveys. METHODS: The Midfoot Fusion Bolt is a solid, intramedullary screw. An antegrade as well as a retrograde technique are postulated for insertion. A total of 16 patients/17 feet in two specialized foot and ankle centers were included. BMI, HbA1c, satisfaction rates, complication rates, and expert opinions were recorded. RESULTS: The bolts were used an average of 21.17 months (range 3-55 months) in 16 patients/17 feet. Between 2009 and 2014, six bolts had to be removed. We encountered 4 cases of postoperative ulceration: 2 cases healed postoperatively, while the other 2 cases led to amputation. The average fusion rate was 92.35 %. CONCLUSION: The Midfoot Fusion Bolt is no longer advised for single-device use only since there have been issues in terms of insufficient stability. However, stable conditions could be achieved with additional screws or plates, respectively. Prospective studies and biomechanical testing for general conclusions are still required to make a meaningful assessment.

Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour.

Resection of a primary sarcoma of the diaphysis of a long bone creates a large defect. The biological options for reconstruction include the use of a vascularised and non-vascularised fibular autograft. The purpose of the present study was to compare these methods of reconstruction. Between 1985 and 2007, 53 patients (26 male and 27 female) underwent biological reconstruction of a diaphyseal defect after resection of a primary sarcoma. Their mean age was 20.7 years (3.6 to 62.4). Of these, 26 (49 %) had a vascularised and 27 (51 %) a non-vascularised fibular autograft. Either method could have been used for any patient in the study. The mean follow-up was 52 months (12 to 259). Oncological, surgical and functional outcome were evaluated. Kaplan-Meier analysis was performed for graft survival with major complication as the end point. At final follow-up, eight patients had died of disease. Primary union was achieved in 40 patients (75%); 22 (42%) with a vascularised fibular autograft and 18 (34%) a non-vascularised (p = 0.167). A total of 32 patients (60%) required revision surgery. Kaplan-Meier analysis revealed a mean survival without complication of 36 months (0.06 to 107.3, sd 9) for the vascularised group and 88 months (0.33 to 163.9, sd 16) for the non-vascularised group (p = 0.035). Both groups seem to be reliable biological methods of reconstructing a diaphyseal bone defect. Vascularised autografts require more revisions mainly due to problems with wound healing in distal sites of tumour, such as the foot.

Long term results of acute Achilles repair with triple-bundle technique and early rehabilitation protocol.

BACKGROUND: The best treatment for acute rupture of the Achilles tendon is still under debate. Our purpose was to evaluate surgical triple-bundle technique in selected patients with full subcutaneous rupture of Achilles tendon. METHODS: Sixty-six consecutive patients (56 men, 10 women; age range 20-61 years) with full unilateral rupture of the Achilles tendon were surgically treated by the triple-bundle technique. Seventy-four percent of the lesions occurred during sport activity. Each patient was assessed by: (1) The American Orthopaedic Foot and Ankle Society (AOFAS) score; (2) the Leppilahti score; (3) the range of movement measurement of ankle joint; (4) ipsilateral thigh, calf, and ankle circumferences compared to the contralateral limb; (5) functional evaluation with isokinetic dynamometry of both limbs. RESULTS: 80.3% of the patients were fully satisfied (AOFAS ≥90) with treatment and resumed their previous level of sport. Concerning the outcomes, (1) the mean AOFAS score at 36 months was 93.9; (2) the mean Leppilahti score at 36 months was 91.8; (3) the mean difference in dorsiflexion and plantarflexion between the healthy side and the operated side was 4.3° and 6.9°, respectively. We observed calf muscle hypotrophy in two cases and scar complication in one. No re-ruptures occurred. Isokinetic tests performed 36 months after surgery showed a good restoration of plantarflexion. At univariate analysis AOFAS was influenced by age and difference between the healthy side and the operated side in dorsiflexion, plantarflexion, and circumference at all three levels and strenght at 60°/s. At univariate analysis, Leppilahti score confirmed the significant parameters of the AOFAS with the exception of age and difference of thigh circumference. The only predictive parameters in multivariate analysis were dorsiflexion difference (O.R. = 0.831; 95% C.I. 0.694-0.995; p = 0.044) and plantarflexion difference (O.R. = 0.777; 95% C.I. 0.631-0.958; p = 0.018). CONCLUSION: In this case series the triple-bundle technique showed a low rate of complications and good functional restore tested with isokinetic tests. For these reasons afforded by biomechanical strength test reported in literature, this technique has to be considered a valid choice for the treatment of Achilles tendon rupture in young patients with a high level of sport activity.

Composição química e repelência de óleos essenciais de Drimys angustifolia Miers e Drimys brasiliensis Miers em cupins de madeira Cryptotermes brevis (Isoptera: Kalotermitidae) / Chemical composition of essential oils of Drimys angustifolia Miers and Drimys brasiliensis Miers and their repellency to drywood termite Cryptotermes brevis (Isoptera: Kalotermitidae)

The essential oils extracted from leaves of the Southern Brazilian native species Drimys angustifolia Miers (DA) and Drimys brasiliensis Miers (DB) by Clevenger distillation were analyzed by gas chromatography/mass spectrometry (GC/MS). The oils of DA and DB consisted predominantly of monoterpenoids and sesquiterpenoids. The largest components of DA oil were bicyclogermacrene (19.6%), sabinene (9.7%)and myrcene (5.2%), while DB oil was characterized by cyclocolorenone (18.2%), followed by terpinen-4-ol (8.7%) and alpha-gurjunene (6.9%). Laboratory tests were carried out to determine the repellency of the essential oils to the drywood termite Cryptotermes brevis (Isoptera: Kalotermitidae). It was observed that the oil showed repellency at the concentrations 25, 12.5, and 6.25 μg/mL. The oils of both species exhibited a negative repellency index, which represents repellent activity, except for DA oil at the highest concentration, which was attractive. Five deaths (11% of the termitesample) were observed at 25 μg/mL DA, in the fourhour repellency test, while four deaths occurred at 12.5 μg/mL (approximately 9%). The essential oil of DB did not cause any termite deaths...

Os óleos essenciais obtidos das folhas das árvores nativas do sul do Brasil Drimys angustifolia Miers (DA)e Drimys brasiliensis Miers (DB) foram analisados por cromatografia gasosa acoplada a espectrometria de massas (CG/EM). O óleo de DA foi caracterizado pela presença de monoterpenóides e sesquiterpenóides, biciclogermacreno (19,6%), seguido por sabineno (9,7%) e mirceno (5,2%). O óleo de DB foi caracterizado por sesquiterpenóides e monoterpenóides, ciclocolorenona (18,2%), seguido por terpinen-4-ol (8,7%) e alfagurjuneno(6,9%). Os testes foram realizados a fim de se determinar o potencial repelente dos óleos essenciais contra o cupim de madeira seca Cryptotermes brevis (Isoptera: Kalotermitidae) nas doses de 25, 12,5, e 6,25 μg/mL. Ambas as espécies mostraram índice de repelência negativo, o que representa a ocorrência da atividade repelente, exceto na maior concentração de DA, na qual o óleo mostrou-se atraente. Cinco mortes foram observadas na concentração de 25 μg/mL de DA, correspondendo a 11% do total em quatro horas de análise, sendo que 9% ocorreram na concentração de 12,5 μg/mL. No caso do óleo essencial de DB não foram observadas mortes de cupins...

Viabilidade de duas novas técnicas para inseminação intrauterina laparoscópica em ovinos / Two new techniques for laparoscopic intrauterine insemination in sheep - feasibility study

Avaliaram-se duas novas técnicas de inseminação laparoscópica intrauterina com o uso de agulha espinhal em ovinos. Foram realizadas quatro etapas experimentais, sendo os animais separados em dois grupos em cada etapa. Para tanto, foram utilizados os posicionamentos quadrupedal e dorsal. Realizou-se a inseminação de 80 ovinos após a sincronização de cio. Verificou-se que os acessos laparoscópicos propostos foram viáveis para a inseminação em ovinos. Considerou-se que a inseminação em posicionamento quadrupedal foi tecnicamente mais difícil se comparada ao acesso laparoscópico em decúbito dorsal, porém, com o aprimoramento da técnica e na dependência dos resultados quanto aos índices de prenhez, poderá se tornar procedimento adequado para a inseminação de ovelhas.

This study evaluated two new laparoscopic intrauterine insemination techniques with spinal needles in sheep. Four experimental stages were done, in which the animals were separated into two groups aiming to evaluate the techniques used. We used a total of 80 estrus-synchronized sheep, which were placed in quadrupedal or dorsal recumbence. The results showed that both insemination techniques using a spinal needle are feasible, but the quadrupedal insemination is technically more difficult compared to the laparoscopic approach in the dorsal position. With technical improvement and depending on the results in relation to pregnancy rates, this access could be considered an alternative procedure for sheep insemination.

[Modified chevron osteotomy with lateral release and screw fixation for treatment of severe hallux deformity]. / Modifizierte Chevron-Osteotomie mit lateralem Release und Schraubenfixation zur Behandlung der schweren Hallux-valgus-Deformität.

BACKGROUND: This prospective study examined the clinical and radiological results of the Chevron osteotomy with screw fixation and distal soft tissue release up to an intermetatarsal angle of 19°. Furthermore, the results are presented for patients over the age of 70 years, and whether or not there is a higher complication rate. MATERIAL AND METHODS: 86 feet of patients between 23 and 81 years were included in the study. Apart from the overall group, a group with an intermetatarsal angle of 16° to 19° and a group of patients over 70 years old were eavaluated. They were evaluated preoperatively and at follow-up after an average of 3.3 years according to the American Orthopaedic Foot and Ankle Society score. RESULTS: The AOFAS score showed a significant improvement from 55 points preoperatively to 90 points at follow-up. The preoperative hallux valgus angle decreased significantly from 32° to 5° and the preoperative intermetatarsal angle decreased from 14° to 6°. Patient satisfaction in the overall group was rated in 92 % as excellent or good. Also, the patient group with 16° to 19° angles and the patients over 70 years showed a significant improvement of clinical and radiological parameters. The complication rate was very low in all groups. CONCLUSION: The results show that the Chevron osteotomy is a very good surgical technique with few complications for the correction of splay foot with hallux valgus deformity. We showed that by using the modified technique with a long plantar arm, an excessive soft tissue release and screw fixation, the indication can be extended up to an intermetatarsal angle of 19° when using screw fixation. Furthermore the patients over 70 years of age showed a significant improvement of clinical and radiological parameters without serious complications such as avascular necrosis or dislocation of the metatarsal head.

Systematics, biodiversity, biogeography, and host associations of the Miridae (Insecta: Hemiptera: Heteroptera: Cimicomorpha).

The Miridae, a hyperdiverse family containing more than 11,020 valid described species, are discussed and the pertinent literature is reviewed. Diagnoses for the family and subfamilies are given. Color habitus photos are presented for representatives of most of the 35 currently recognized tribes. Key morphological character systems are discussed and illustrated, including pretarsal structures, femoral trichobothria, external efferent system of the metathoracic glands, male and female genitalia, and molecular markers. A historical comparison of tribal classifications and the most up-to-date classification are presented in tabular form. A brief history of the classification of each of the eight recognized subfamilies is presented. Distributional patterns and relative generic diversity across biogeographic regions are discussed; generic diversity by biogeographic region is presented in tabular form. Taxonomic accumulation graphs are presented by biogeographic region, indicating an ongoing need for taxonomic work in the Southern Hemisphere, and most particularly in Australia. Host plant associations are evaluated graphically, showing high specificity for many taxa and a preference among phytophagous taxa for the Asteridae and Rosidae.

[Functional outcome of cheilectomy for the treatment of hallux rigidus]. / Funktionelles Outcome der Cheilektomie in der Behandlung des Hallux rigidus.

INTRODUCTION: Cheilectomy is performed as treatment for hallux rigidus. Its aim is the relief of pain and improvement of function. Previous pedobarograhic studies have revealed that osteoarthritis of the first metatarsophalangeal joint leads to a lateralisation of peak forces during the stance phase of gait. This occurs since the big toe does not participate in push-off in a sufficient way. The results concerning functional outcome as well as subjective patient satisfaction were assessed in the present study. Plantar pressure distribution analysis was used in order to investigate functional outcome in a biomechanically objective way. PATIENTS AND METHOD: In this retrospective study 44 patients (52 feet) who underwent cheilectomy for the treatment of hallux rigidus were examined. There were 30 women and 14 men with a mean age of 60.1 years (range: 41-79). The average follow-up was 14.9 months (range: 6-40). The assessment included a four-stage subjective satisfaction rating scale, the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal-interphalangeal score and first metatarsophalangeal joint (MTP) range of motion (ROM) measurements. In addition, dynamic plantar pressure distribution measurements were performed using the EMED system (Novel GmbH, Munich). The parameters maximum force (N), peak pressure (kPa), contact area (cm (2)), contact time (msec) and impulse (N × sec) were calculated for the geometric regions of interest great toe, second toe, first metatarsal head, second metatarsal head and total object. Statistical analysis was performed using paired student's t-test and level of significance was set at alpha < 0.05. RESULTS: 27 patients have been very satisfied with the operation, for 10 patients the result of the operation has been satisfactory. The mean AOFAS score increased statistically significant from 35 points presurgery to 88 points postsurgery. First MTP ROM increased from 18.1 ° before surgery to 49.1 ° at follow-up. Isolated dorsiflexion increased from 21.4 ° to 34.1 ° (p = 0.0009) and isolated plantar flexion was 15.8 ° presurgery and 16.9 ° at follow-up (p = 0.214). Plantar pressure analysis revealed no significant difference between the foot that was operated and the non-operated foot for any region of interest or pedobarographic parameter CONCLUSION: Cheilectomy represents a reliable technique for hallux rigidus that can achieve good results in patient satisfaction and functional outcome. Since the resection of osteophytes improves kinematics of the first MTP joint the technique of cheilectomy may help to restore physiological gait patterns. This is represented by the pedobarographic results of the present study. In fact, they revealed a plantar pressure distribution that is reconstructed to a satisfactory extent, showing that the big toe is reintegrated into a physiological gait pattern.

[Triple arthrodesis in treatment of degenerative hindfoot deformities: clinical, radiological and pedobarographic results]. / Die Triple-Arthrodese in der Therapie degenerativer Rückfussfehlstellungen: Klinische, radiologische und pedobarografische Resultate.

INTRODUCTION: Triple arthrodesis is performed to reconstruct a painless plantigrad foot in cases of fixed and painful hindfoot deformity. Mid-term results of our patients after triple arthrodesis concerning clinical and functional as well as radiological outcome were assessed in this examination. PATIENTS AND METHOD: In the retrospective study, 24 feet in 20 patients with triple arthrodesis after degenerative hindfoot malposition were examined. Sampling was done consecutively. The average age of the patients was 62.8 years (40-79), mean follow-up-period was 21.5 months. The patients were examined using the AOFAS score, assessment of subjective satisfaction and X-rays. In addition, the position of the foot was analysed using dynamic pedobarography and gait analysis. RESULTS: In the examined population, the mean AOFAS score was 74 (+/- 12.41) out of 94 points, the improvement averaged 51 (+/- 14.72) points. 75 % of the patients had no or only slight pain, 8 % reported limitations in everyday life. Mobility of the ankle was more than 30 degrees for 9 patients (38 %) and between 15 and 30 degrees for 13 patients (54 %). 23 patients out of 24 were satisfied with the result of the surgery. In most cases, dynamic pedobarography showed a rather physiological pattern of plantar pressure distribution with increased pressure remaining in the midfoot area. Valgus position of the hindfoot was 2.8 degrees (+/- 2.9 degrees), gait analysis showed very good results in 11 cases and good results in 13 cases. Among the examined patients, two cases of wound healing disorders appeared, and one non-union of the talonavicular joint which had to be reoperated. In two cases, clinically relevant degenerative changes of the ankle were diagnosed. CONCLUSION: Triple arthrodesis using internal fixation followed by sufficient immobilisation is a good and reliable technique for the correction of fixed hindfoot deformities. A very high level of patient satisfaction and a good clinical outcome can be achieved. Plantar pressure distribution can be reconstructed to a satisfactory extent. Due to the relatively high rate of degenerative arthritis in adjacent joints, the decision upon performing a triple arthrodesis should be considered carefully. Clinical and radiological integrity of these joints are required.

Subtalar and talonavicular arthrodesis through a single medial approach for the correction of severe planovalgus deformity.

We describe a retrospective review of the clinical and radiological parameters of 32 feet in 30 patients (10 men and 20 women) who underwent correction for malalignment of the hindfoot with a modified double arthrodesis through a medial approach. The mean follow-up was 21 months (13 to 37). Fusion was achieved in all feet at a mean of 13 weeks (6 to 30). Apart from the calcaneal pitch angle, all angular measurements improved significantly after surgery. Primary wound healing occurred without complications. The isolated medial approach to the subtalar and talonavicular joints allows good visualisation which facilitated the reduction and positioning of the joints. It was also associated with fewer problems with wound healing than the standard lateral approach.