The Sociolectal and Stylistic Variability of Rhythm in Stockholm.

The question of "staccato" rhythm in Stockholm's multiethnolect is investigated by comparing nPVIV measurements of the speech of 36 adult male speakers. The men, ages 24-43, come from a stratified sample of social classes and racial groups. Three contextual styles were recorded and analyzed: informal, formal, and very formal. The distribution of nPVIV values in informal speech across class and racial group indicates that speech rhythm splits three ways: low-alternation "staccato" rhythm among the racialized lower-class men, high-alternation rhythm among the white lower-class men, and an intermediate level of rhythm among higher-class men, regardless of racialized category. The "staccato" low-alternation feature is also less stylistically sensitive than the high-alternation feature, implying that the latter is a more established feature than the former. Further, the "staccato" feature is more stylistically sensitive among younger speakers than older speakers, implying an ongoing change from indicator to marker status. For all speakers, age has a stable main effect, which means that younger speakers, independent of racial group and class, have lower alternation than older speakers. Implied here is that low-alternation is a change from below that originates within the racialized working class. While it may be incrementally transmitting into the wider speech community, the white working class is the most resistant to its incursion.

Use of an aseptically processed, dehydrated human amnion and chorion membrane improves likelihood and rate of healing in chronic diabetic foot ulcers: A prospective, randomised, multi-centre clinical trial in 80 patients.

Amnion and chorion allografts have shown great promise in healing diabetic foot ulcers (DFUs). Results from an interim analysis of 40 patients have demonstrated the accelerated healing ability of a novel aseptically processed, dehydrated human amnion and chorion allograft (dHACA). The goal of this study was to report on the full trial results of 80 patients where dHACA was compared with standard of care (SOC) in achieving wound closure in non-healing DFUs. After a 2-week screening period, during which patients with DFUs were unsuccessfully treated with SOC, patients were randomised to either SOC alone or SOC with dHACA applied weekly for up to 12 weeks. At 12 weeks, 85% (34/40) of the dHACA-treated DFUs healed, compared with 33% (13/40) treated with SOC alone. Mean time to heal within 12 weeks was significantly faster for the dHACA- treated group compared with SOC, 37 days vs 67 days in the SOC group (P = .000006). Mean number of grafts used per healed wound during the same time period was 4.0, and mean cost of the tissue to heal a DFU was $1771. The authors concluded that aseptically processed dHACA heals DFUs significantly faster than SOC at 12 weeks.

Human Reticular Acellular Dermal Matrix in the Healing of Chronic Diabetic Foot Ulcerations that Failed Standard Conservative Treatment: A Retrospective Crossover Study.

BACKGROUND: Acellular matrices have been successfully used to heal indolent diabetic foot ulcers (DFUs). These tissues include allogenic dermis as well as xenograft dermis, pericardium, and small intestine submucosa. While all of these tissues show promise for healing DFUs, dermal-derived matrices have shown considerable potential. MATERIALS AND METHODS: The authors retrospectively reviewed healing in patients with DFUs that failed the standard of care (SOC) treatment from a previous prospective randomized, controlled trial (RCT). That trial compared the efficacy of human reticular acellular dermal matrices (HR-ADMs) with the SOC. Of the 16 out of 20 patients who did not heal in the SOC group, 12 were eligible for crossover treatment with the HR-ADM. The authors studied the rate of complete healing in that specific cohort after 12 weeks of crossover treatment. RESULTS: Of the 12 patients who were eligible for the HR-ADM, 10 (83%) achieved complete wound healing, with a mean healing time of 21 days to closure. The corresponding wound area reduction was from 1.7 cm2 to 0.6 cm2. The mean product cost to closure was $800/patient. CONCLUSION: This study further demonstrates the effectiveness of the HR-ADM in facilitating the closure of nonhealing DFUs refractory to SOC.

Aseptically Processed Placental Membrane Improves Healing of Diabetic Foot Ulcerations: Prospective, Randomized Clinical Trial.

BACKGROUND: Allogeneic grafts derived from amnion/chorion are known to be efficacious in healing chronic diabetic foot ulcerations (DFUs). The goal of this study was to compare aseptically processed dehydrated human amnion and chorion allograft (dHACA) versus standard of care (SOC) in facilitating wound closure in nonhealing DFUs. METHODS: Patients with DFUs treated with SOC (off-loading, appropriate debridement, and moist wound care) after a 2-week screening period were randomized to either SOC or wound-size-specific dHACA (AmnioBand, Musculoskeletal Transplant Foundation, Edison, N.J.) applied weekly for up to 12 weeks plus SOC. Primary endpoint was the percentage of wounds healed at 6 weeks between groups. RESULTS: At 6 weeks, 70% (14/20) of the dHACA-treated DFUs healed compared with 15% (3/20) treated with SOC alone. Furthermore, at 12 weeks, 85% (17/20) of the DFUs in the dHACA group healed compared with 25% (5/20) in the SOC group, with a corresponding mean time to heal of 36 and 70 days, respectively. At 12 weeks, the mean number of grafts used per healed wound for the dHACA group was 3.8 (median 3.0), and mean cost of the tissue to heal a DFU was $1400. The mean wastage at 12 weeks was 40%. One adverse event and 1 serious adverse event occurred in the dHACA group; neither was graft related. Three adverse events and 1 serious adverse event occurred in the SOC group. CONCLUSION: Aseptically processed dHACA heals diabetic foot wounds significantly faster than SOC at 6 and 12 weeks with minimal graft wastage.

Digital arthrodesis.

For lesser toe deformities, fusion of the proximal interphalangeal joint offers good long-term correction and predictability. Digital arthrodesis has been described for longer than 100 years in the literature, and current techniques closely resemble those described in early accounts. However, many implants currently being used take advantage of the latest metallurgic and polymeric innovations, with implants being composed of nitinol, polylactic or polyglycolic acids, and polydioxanone. Newer implants offer easy insertion and good stability, with no percutaneous wires. Pin-tract infection rates from exposed Kirschner wires may be as high as 18%, and newer implants help to mitigate this problem.

Alternative methods in fixation for capital osteotomies in hallux valgus surgery.

The surgical correction of hallux valgus has evolved since it was first described. Many osteotomies and fixation methods have been described and results have improved. Innovative new fixation methods include the Mini TightRope, new absorbable implants, and plating options. This article discusses the evolution of capital osteotomies as well as the evolution of fixation. Also presented is a case study of a novel method of achieving solid fixation across an osteotomy using a high-frequency sonic device to insert a bioresorbable pin.

Absorbable fixation in forefoot surgery: a viable alternative to metallic hardware.

After 4 to 8 weeks of normal primary bone healing, rigid internal fixation is no longer required. Newer generation absorbable implants have become reliable and cost-effective alternatives to metallic hardware. Modern implants are formulated to have increased strength and smoother resorption over the course of 18 to 24 months, which decreases the possibility of local inflammation. Historically, bioresorbable screws can be time consuming to insert, but newer devices are being developed that help ease their insertion. A case of a bunionectomy is presented with double osteotomy on a 40-year-old nurse fixated with polyglycolic acid and poly-l-lactic acid copolymer screws.

New techniques and alternative fixation for the lapidus arthrodesis.

Arthrodesis of the first metatarsocuneiform joint is a powerful and durable procedure to help correct moderate to severe hallux valgus and/or first ray hypermobility. However, painful nonunion remains a notoriously high potential outcome. Research regarding locking plates seems promising, and data show lower rates of nonunion. Innovative fixation techniques are new and should be considered in the future as further literature is available on their long-term use. Regardless of the fixation, proper joint preparation and good compression is fundamentally the most important. A case of Lapidus fusion with locking plates after a failed arthrodesis with screws alone is presented.