The outcome of proximal fifth metatarsal fractures: redefining treatment strategies.

BACKGROUND: To optimize the treatment strategy and reduce treatment costs of proximal fifth metatarsal fractures, clinical and patient-reported outcome, and its determinants were addressed. METHODS: A retrospective adult cohort study including 152 proximal fifth metatarsal fractures: 121 nonoperatively and 31 operatively treated. In the operative group, 21 were zone 1 and 10 zone 2 fractures. Median follow-up was 37.5 (IQR 20.8-52.3) months with a minimal follow-up of 6 months. Twenty-three demographic, fracture, and treatment characteristics were assessed as well as the healthcare costs. Outcome was assessed using the patient files, anterior-posterior and oblique X-rays, foot function index (FFI), visual analog score (VAS), and SF-36 questionnaires. RESULTS: The median FFI, physical SF-36, and VAS scores did not significantly differ between nonoperatively and operatively treated patients. The FFI and physical SF-36 were predominantly affected by a history of mobility impairment and pre-existent cardiovascular diseases, whereas mental SF-36 correlated significantly with higher ASA-score. Overall complication rate was 5.9% (4.1 vs. 12.9%; p = 0.065, nonoperative vs. operative, respectively). Nonunion was recorded in only one (nonoperatively) treated patient. The total healthcare costs for operative treatment were 4.2 times higher compared to nonoperative treatment (€1960 vs. €463 per patient, respectively). CONCLUSION: Overall, the clinical and patient-reported outcome was good. The foot function and quality of life were mainly affected by comorbidity, rather than fracture and treatment-related variables. Although nonoperatively treated patients indicated decreased mental quality of life, our study indicates that proximal fifth metatarsal fractures can safely be treated nonoperatively without the risk of nonunion, with fewer complications and lower healthcare costs. LEVEL OF EVIDENCE: 3.

Persistent STAT5 activation in myeloid neoplasms recruits p53 into gene regulation.

STAT (Signal Transducer and Activator of Transcription) transcription factors are constitutively activated in most hematopoietic cancers. We previously identified a target gene, LPP/miR-28 (LIM domain containing preferred translocation partner in lipoma), induced by constitutive activation of STAT5, but not by transient cytokine-activated STAT5. miR-28 exerts negative effects on thrombopoietin receptor signaling and platelet formation. Here, we demonstrate that, in transformed hematopoietic cells, STAT5 and p53 must be synergistically bound to chromatin for induction of LPP/miR-28 transcription. Genome-wide association studies show that both STAT5 and p53 are co-localized on the chromatin at 463 genomic positions in proximal promoters. Chromatin binding of p53 is dependent on persistent STAT5 activation at these proximal promoters. The transcriptional activity of selected promoters bound by STAT5 and p53 was significantly changed upon STAT5 or p53 inhibition. Abnormal expression of several STAT5-p53 target genes (LEP, ATP5J, GTF2A2, VEGFC, NPY1R and NPY5R) is frequently detected in platelets of myeloproliferative neoplasm (MPN) patients, but not in platelets from healthy controls. In conclusion, persistently active STAT5 can recruit normal p53, like in the case of MPN cells, but also p53 mutants, such as p53 M133K in human erythroleukemia cells, leading to pathologic gene expression that differs from canonical STAT5 or p53 transcriptional programs.

Long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis: a longitudinal study.

OBJECTIVE: To describe long-term physical functioning and its association with somatic comorbidity and comorbid depression in patients with established rheumatoid arthritis (RA). METHODS: Longitudinal data over a period of 11 years were collected from 882 patients with RA at study inclusion. Patient-reported outcomes were collected in 1997, 1998, 1999, 2002, and 2008. Physical functioning was measured with the Health Assessment Questionnaire and the physical component summary score of the Short Form 36 health survey. Somatic comorbidity was measured by a questionnaire including 12 chronic diseases. Comorbid depression was measured with the Center for Epidemiologic Studies Depression Scale. We distinguished 4 groups of patients based on comorbidity at baseline. RESULTS: Seventy-two percent of the patients at baseline were women. The mean ± SD age was 59.3 ± 14.8 years and the median disease duration was 5.0 years (interquartile range 2.0-14.0 years). For the total group of patients with RA, physical functioning improved over time. Patients with somatic comorbidity, comorbid depression, or both demonstrated worse physical functioning than patients without comorbidity at all data collection points. Both groups with comorbid depression had the lowest scores. Only patients with both somatic comorbidity and comorbid depression showed significantly less improvement in physical functioning over time. CONCLUSION: Both somatic comorbidity and comorbid depression were negatively associated with physical functioning during an 11-year followup period. Furthermore, their combination seems to be especially detrimental to physical functioning over time. These results emphasize the need to take somatic comorbidity and comorbid depression into account in the screening and treatment of patients with RA.

Clinical evaluation of the Sorin Xtra(R) Autotransfusion System.

The performance of the Sorin Xtra® Autotransfusion System (ATS) was studied in 62 patients undergoing coronary artery bypass grafting. Blood was collected intraoperatively and washed using three different wash sets in 4 groups. Both collected and washed blood were analysed for hemoglobin levels and hematocrit, concentrations of proteins, albumin, heparin and plasma free hemoglobin (PFH) were determined, erythrocytes, platelets and leukocytes were counted. Hematocrit measurements of the Xtra® were compared with laboratory measurements to study the accuracy of the Xtra® hematocrit sensor. In addition, the red blood cell recovery rate and elimination rates were calculated to evaluate the clinical performance of the Xtra®. The Xtra® ATS produced a volume of concentrated red blood cells with an average hematocrit from 58% to 63%, depending on the size of the bowl and the chosen default program. In all bowl sizes and programs, the Xtra® Hct-out measurement underestimated the CELL-DYN measurement by approximately 15%. The calculated recovery rates for red blood cells (RBC) in the 4 groups ranged from 86.7% to 91.6%. Elimination rates were calculated in each group for proteins (96.8-99.2%), albumin (96.4-98.7%), plasma free hemoglobin (83.6-91.2%), heparin (98.8-99.9%), platelets (82.4-94.3%) and white blood cells (28.6-42.3%). The Xtra® ATS can be appealing for its performance by producing high hematocrit levels in the washed RBC volume, while keeping RBC recovery rate at the same high level (≈ 90%) as in its predecessor, the Electa® Autotransfusion System.

Oral mucosal versus cutaneous sensory testing: a review of the literature.

The innervation of skin and oral mucosa plays a major physiological role in exteroception. It also has a clinical interest as illustrated by sensory changes after neurosurgical procedures. These sensory changes often rely only on the patients' subjective reports, although objective assessments are possible. This review compares the neurophysiological features of the trigeminal sensory pathways with those of cutaneous sensory innervation. In this review, three receptor groups will be discussed: mechanoreceptors, thermoreceptors and nociceptors. Differences between receptors in the glabrous skin, the hairy skin and the oral mucosa will be highlighted. Sensory testing devices have been developed to quantify psychophysiological parameters such as the threshold level for receptor activation upon mechanical stimulation, but such devices have been merely developed to determine the threshold of skin receptors (tactile, thermal). Later on, some have been adapted to suit the particularities of the oral environment. This review attempts to compare the available literature on test devices for oral versus cutaneous tactile function. It summarizes what is common or rather particular to the devices used to study either cutaneous or oral receptors.

Small intestinal morphology and disaccharidase activities in early-weaned piglets fed a diet containing spray-dried porcine plasma.

The purpose of this study was to test whether dietary spray-dried porcine plasma (SDPP) in early-weaned piglets prevents small intestinal villus atrophy by trophic or protective activity. Fifty-four weaned, 18-day-old piglets were used to determine the effect of dietary SDPP on small intestinal villus length, crypt depth, enterocyt mitotic activity and brush border enzyme activities during the first week after weaning. The piglets were offered a diet containing either 8% SDPP or 8% casein. At 2 and 7 days after weaning, piglets were anaesthetized to provide samples of the small intestinal wall and killed immediately afterwards. There were no differences in daily gain and daily feed intake between the two dietary treatments. At day 2 after weaning, all piglets showed a marked reduction in villus height when compared with baseline values. In all piglets, small intestinal enterocyte mitotic activity had decreased by day 2 and was increased again on day 7. There were no significant effects of dietary SDPP on small intestinal villus length, crypt depth and enterocyt mitotic activity. This indicates that SDPP has no trophic effect on the small intestinal mucosa and that it does not protect against the damaging effect on the small intestinal villi that is associated with the process of weaning. There was no effect of SDPP on lactase-, sucrase- or maltase-specific activities that are a measure of the digestive function of the small intestine. It can be concluded that SDPP versus casein has no effect on small intestinal morphology and disaccharidase activities in early weaned piglets kept under low infection pressure.

Trigeminal somatosensory evoked potentials in humans.

The recording of somatosensory evoked potentials (SEPs) is a non-invasive routine clinical testing procedure in neurology. For trigeminal nerve stimulation, however, SEPs have not received a widespread clinical attention. A variety of protocols and procedures have been used to record trigeminal SEPs (TSEPs). Differences encountered include the stimulation mode, site and frequency, the recording electrode position and data acquisition parameters. This has resulted in a diversity of recorded TSEP signals, making comparisons almost impossible. The general picture shows a number of short latency waves (within 3 ms) of peripheral origin, followed by at least two longer latency waves (12-15 ms and 19-22 ms). Furthermore, potential waves with a very long latency (> 100 ms) follow when the response is produced by painful stimulation. The origin of the long and very long latency waves is still a matter of debate. In order to allow reliable data interpretation and comparisons between the outcome of different studies, a standardized protocol should be applied for TSEP recordings. By providing an overview, this paper aims to mark a step forward in the harmonization of TSEP protocols with respect to the neural processes of interest. Further studies should also encounter the potential application of other neuroimaging techniques, such as functional magnetic resonance imaging or positron emission tomography, preferably in combination with TSEP recordings.

Sensations and trigeminal somatosensory-evoked potentials elicited by electrical stimulation of endosseous oral implants in humans.

The perception of bipolar electrical stimuli through implants was studied. The stimuli were delivered to permucosal oral endosseous implants in 15 individuals, who then reported tapping to beating sensations. In 10 out of the 15, these stimuli evoked clearly distinguishable potentials in the averaged electroencephalograms. The most prominent scalp potential was a positive wave with a latency between 18 and 25 ms, often preceded by a negative wave with a latency around 12-17 ms. In contrast, when a motor response was elicited by stimulation of the lip, a shorter latency wave around 8-11 ms was found additionally, indicating that the former-mentioned waves represent a true sensory response and not an artefact of myogenous origin. Furthermore, topical anaesthesia of the gingiva surrounding the implants in six individuals had little effect on the sensory responses. This evidence excluded peri-implant mucosal innervation as the origin of the perception and of the somatosensory-evoked waves elicited by the electrical stimulation of the oral implants. To the best of our knowledge, for the first time a sensation (osseoperception) has been elicited by electrical stimulation of endosseous oral implants and correlated with simultaneously recorded trigeminal somatosensory-evoked potentials (TSEPs).

Diagnosis of ulnar neuropathy: a new approach.

Conventional electrodiagnosis used to detect an ulnar neuropathy at the elbow depends on accurate determination of ulnar nerve length across this segment. We present a new approach, using the difference in latency of the compound nerve action potentials (CNAPs) of the ulnar and median nerves elicited by stimulation at the wrist and recorded 10 cm above the elbow. Sixty normal controls were examined in order to determine the normal upper limit (1.4 ms) of the difference in CNAP latency of the ulnar and the median nerves (Dlat index). Values obtained in 10 patients with ulnar nerve lesions are discussed. This test was shown to be both sensitive and specific, was independent of ulnar nerve length, and was easy to perform.

Value of somatosensory and motor evoked potentials in predicting arm recovery after a stroke.

OBJECTIVES: Prediction of motor recovery in the arm in patients with stroke is generally based on clinical examination. However, neurophysiological measures may also have a predictive value. The aims of this study were to assess the role of somatosensory (SSEPs) and motor (MEPs) evoked potentials in the prediction of arm motor recovery and to determine whether these measures added further predictive information to that gained from clinical examination. METHODS: Sixty four patients who had had a stroke and presented with obvious motor deficit of the arm were examined in terms of three clinical variables (motor performance, muscle tone, and overall disability) and for SSEPs and MEPs. Clinical and neurophysiological examinations were done at entry to the study (2 to 5 weeks poststroke), and at about 2 months after stroke. Further clinical follow up was conducted at 6 and 12 months after stroke. RESULTS: Neurophysiological measures made in the acute phase were of little use alone in predicting motor recovery of the arm at 2, 6, and 12 months after stroke. At 2 months, the absence of SSEPs and MEPs indicated a very poor outcome. Conversely, if the responses were preserved, a great variation in motor outcome was found. Multiple regression analysis showed that the addition of SSEPs and MEPs to the clinical examination increased the possibility of predicting arm recovery in the long term. In the acute phase, the combination of the motor score and SSEPs were best able to predict outcome. The long term outcome based on variables taken at 2 months, was best predicted through incorporating the three clinical measures and MEPs. CONCLUSIONS: Neurophysiological measures alone are of limited value in predicting long term outcome. However, predictive accuracy is substantially improved through the combined use of both of these measures and clinical variables.

[Vectorial competence of Glossina tachinoides Westwood and Glossina palpalis gambiensis Vanderplank infected by Trypanosoma brucei brucei EATRO 1125]. / Compétence vectorielle des Glossina tachinoides Westwood et Glossina palpalis gambiensis Vanderplank infectées simultanément par Trypanosoma brucei brucei EATRO 1125.

The vectorial competence (VC) of teneral (less than 32 h) Glossina tachinoides Westwood and G. palpalis gambiensis Vanderplank, fed simultaneously on a guinea-pig infected with Trypanosoma brucei brucei EATRO 1125, was assessed. Statistical analysis of the experimental results revealed that female G. tachinoides had a significantly higher midgut infection rate than males. Such a sex-related difference was not observed in G. p. gambiensis. Male G. p. gambiensis had higher midgut infection rates than male G. tachinoides. The metacyclic index did not differ between both subspecies, although G. p. gambiensis showed relatively more metacyclic infections than G. tachinoides. A global VC of 0.0242 and 0.0483 was found for G. tachinoides and G. p. gambiensis, respectively. VC did not differ significantly either between sexes or between the two species. However, G. tachinoides more rapidly infected the feeding host than G. p. gambiensis. In all infected flies, the procyclic index value was superior to the metacylic index value, suggesting that the infection is established by an ascending origin. Both large and slender parts of the salivary glands were constantly infected. Longitudinally dividing trypomastigotes of unequal length have been observed in the alimentary canal of the flies.

Effect of the life-span of female Glossina palpalis gambiensis on the weight and size of its progeny.

Pupae and teneral flies of Glossina palpalis gambiensis originating from three successive reproductive cycles were compared for their size and weight. In general, pupal weight and fly weight increased, whereas fly size, measured as wing vein length, decreased with the number of reproductive cycles. The linear regression observed between weight and wing vein length of the fly demonstrated that, particularly for flies originating from the first and second larvipositions, small changes in wing vein length reflected substantial differences in weight. The results of these laboratory experiments were compared with some field data on Glossina morsitans from Zambia and related literature. The life span of the female tsetse, affecting the size of her progeny, could clarify partially some of the field observed seasonal changes in size, whereas the correlation between fly size and weight could eventually explain the differential mortality of some size classes of tsetse flies. However, whether these laboratory observations can be extrapolated to the field has still to be confirmed.

Pathological findings in a patient with amyotrophic lateral sclerosis and multifocal motor neuropathy with conduction block.

We studied a 53-year-old woman with progressive weakness of the left arm, gradually spreading to the other limbs. Neurological examination revealed a motor neuron syndrome with paresis, fasciculations and atrophy. Electrophysiological studies showed multiple motor conduction blocks. The anti-GM1 IgM titer was elevated. The patient was thought to have a multifocal motor neuropathy. Despite intravenous cyclophosphamide treatment, however, she died with respiratory insufficiency. On postmortem examination, the brachial plexus showed patches of demyelination underlying different areas of motor conduction block. The spinal cord, however, revealed severe neuronal loss in the ventral horn and axonal loss in the corticospinal tract, indicative of amyotrophic lateral sclerosis. Demyelination of peripheral nerves could have been responsible for the other conduction blocks in this patient. The prominent degeneration of motor neurons, however, must also have played a role in the clinical picture. Some patients with the syndrome of a multifocal motor neuropathy may have MND rather than, or in addition to, a demyelinating peripheral motor neuropathy.

[Experimental infection of Glossina morsitans morsitans (Mall) with Trypanosoma congolense (ZRE/G143/90). Parasite cycle and vector competence in the tsetse fly]. / Infection expérimentale de Glossina morsitans morsitans (Mall) par Trypanosoma congolense (ZRE/G143/90). Cycle du parasite et competence vectorielle de la glossine.

This report presents an experimental study of the life cycle of Trypanosoma congolense (ZRE/G 143/90) in relation to the vectorial competence of Glossina morsitans (Mall). The rate of engorgement at the time of an infectious meal and the mortality before day 15 of the life cycle were not significantly different between male and female flies. The mesocyclic forms of trypanosomes were regularly observed in the proventriculus, crop duct, oesophagus, cibarium and proboscis, except in the crop. On day 12 of the cycle, epimastigote forms were predominant in the proboscis. On day 13 of metacyclogenesis, four out of six rats (67%) used for feeding the flies were positive for trypanosomes upon buffy coat examination. These results demonstrate the short incubation period of trypanosomes in the vertebrate host and precociousness of the vectorial competence of some individuals of G m morsitans (Mall). Among the three cyclic stages, only the procyclic forms in the intestine showed a significant difference between the sexes, the male flies being more infected than the females. Metacyclogenesis undergoes three cleavages leading to the successive and permanent establishment of the procyclic, mesocyclic and metacyclic forms in the midgut, proventriculus and proboscis respectively.

Peripheral cutaneous nerve distribution to the fingers.

Both sensory distribution charts and the unaffected side, are used as reference points in the assessment of cutaneous innervation. Sensory nerve conduction studies, in particular, often use comparison between sides. However, remarkable differences can be found between various sensory innervation maps, and no evidence was found in the literature for the assumption that the pattern of cutaneous sensory distribution of the peripheral nerves between the left and right limbs is symmetrical. The purpose of this study was to investigate variations in the sensory innervation of the fingers by means of a neurophysiological method, and to compare the results for the left and right hands. The subjects of this study were 31 young women. Percutaneous peripheral nerve stimulation was performed on the four nerve branches providing sensory innervation to the fingers, and action potentials were sought from the fingers by use of annular surface electrodes. Variations in the cutaneous innervation of the fingers between individuals often occurred and were found more frequently on the dorsal than the palmar aspect. The distribution of sensory innervation may even differ markedly between hands in the same individual. The cutaneous innervation of all peripheral nerves supplying the fingers may differ from the innervation patterns described in the various distribution charts. Prudence is called for when applying sensory distribution charts as absolute references for the assessment of cutaneous sensation in patients. Caution should also be applied when comparing one hand with the other when assessing the cutaneous innervation of the fingers.

Effect of a fermented infant formula containing viable bifidobacteria on the fecal flora composition and pH of healthy full-term infants.

We assessed the growth, tolerance, and acceptability as well as fecal flora composition and stool pH of 20 healthy full-term infants fed with a fermented whey-adapted infant formula containing viable bifidobacteria (10(6)/g of powder) during the first 2 months of life. This fermented infant formula, first biologically acidified by Streptococcus thermophilus and Lactobacillus helveticus, was compared to a whey-adapted, nonacidified, low-phosphate infant formula in a double-blind, randomized controlled study. The results were compared to a control group (n = 14) of fully breast-fed infants. The fermented whey-adapted formula containing viable bifidobacteria induced a prevalence of colonization with bifidobacteria at 1 month of age similar to that of breast-fed infants (12/20 versus 8/14) but significantly higher than in the group fed the standard infant formula (4/20). The mean bacterial count of bifidobacteria was similar in all colonized infants; however, fecal pH was significantly lower in the breast-fed infants than in the nonacidified bottle-fed infants. This kind of infant formula was well tolerated and promoted a normal growth during the first 2 months.

[Standardization and evaluation of a manual salivation method for the detection of Trypanosoma infection in the tsetse fly (Diptera: Glossinidae)]. / Standardisation et évaluation de la technique de salivation manuelle pour le dépistage des infections par trypanosomes chez la glossine (Diptera: Glossinidae).

Two methods of salivation of tsetse flies, namely manual salivation and method of Bruce et al. were simultaneously evaluated on 1,702 male uninfected Glossina palpalis palpalis (Zaire), G. palpalis gambiensis (Bobo-Dioulasso), G. p. gambiensis (Maisons-Alfort) et G. morsitans morsitans (Mall) fasted for 23, 48 and 72 hours. The risk of salivation was 0.66 by the manual method and 0.01 by the method of Bruce et al. The manual salivation method was standardised on 79 male G. m. morsitans (Mall) infected with Trypanosoma congolense IL 1180. By this method, 70.88% of flies carrying mature and/or immature infection were identified. A clear difference was observed in the proportion of tsetse flies which salivated after 72 hours and those which salivated after 48 and 24 hours of fasting.