A cornucopia of diversity-Ranunculales as a model lineage.

The Ranunculales are a hyperdiverse lineage in many aspects of their phenotype, including growth habit, floral and leaf morphology, reproductive mode, and specialized metabolism. Many Ranunculales species, such as opium poppy and goldenseal, have a high medicinal value. In addition, the order includes a large number of commercially important ornamental plants, such as columbines and larkspurs. The phylogenetic position of the order with respect to monocots and core eudicots and the diversity within this lineage make the Ranunculales an excellent group for studying evolutionary processes by comparative studies. Lately, the phylogeny of Ranunculales was revised, and genetic and genomic resources were developed for many species, allowing comparative analyses at the molecular scale. Here, we review the literature on the resources for genetic manipulation and genome sequencing, the recent phylogeny reconstruction of this order, and its fossil record. Further, we explain their habitat range and delve into the diversity in their floral morphology, focusing on perianth organ identity, floral symmetry, occurrences of spurs and nectaries, sexual and pollination systems, and fruit and dehiscence types. The Ranunculales order offers a wealth of opportunities for scientific exploration across various disciplines and scales, to gain novel insights into plant biology for researchers and plant enthusiasts alike.

A Fine Morphological Study of the Rare Anillidris bruchi Santschi (Hymenoptera: Formicidae: Dolichoderinae) Male and Queen.

Using optical and scanning electron microscopy, we describe the following new morphologically distinctive characters of the rare Neotropical ant Anillidris bruchi Santschi, 1936, male and queen: scattered setae inter-ommatidia, semicircular hypostomal notch, antennal cleaning, metatibial spurs, and the remnant of the M2 vein in the hindwings. In males, we show for the first time the morphology of maxillary and labial palpi, the absence of metapleural glands, and, in external genitalia, for the first time in ants, a new mechano-sensory area on the volsella that we called "volsella sensorium", composed of several spine-like sensilla. Additionally, we give an updated morphological diagnosis of the alate caste, which will be useful for future studies to clarify the phylogeny of the genus Anillidris.

Osteitis Condensans Ilii: An Uncommon Cause of Back Pain Masquerading as an Inflammatory Spondyloarthropathy.

Osteitis condensans ilii (OCI), an uncommon cause of chronic back pain, remains a medical conundrum. The primary care physicians' limited awareness of this disease's clinical features, progression, diagnostic modality, and treatment principles creates a situation where the continuous use of numerous and sometimes unnecessary diagnostic tests leads to misdiagnosis of the etiology of chronic back pain and a rise in the cost of health care. Therefore, to further enhance the awareness of this disease, we present a case of osteitis condensans ilii masquerading as an unusual cause of chronic lower back pain in a postmenopausal female.

[Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain].

OBJECTIVE: To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain. METHODS: The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability. RESULTS: The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05). CONCLUSION: Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

Analysis of the curative effect of triple surgery under endoscope in the treatment of intractable heel pain / 中国骨伤

OBJECTIVE@#To investigate the clinical effect the treatment of arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression in the treatment of the patients with intractable calcaneal pain.@*METHODS@#The clinical data of 50 patients with intractable heel pain from January 2016 to January 2019 were retrospectively analyzed, including 20 males and 30 females;aged from 40 to 68 years old with an average of (50.12±7.35)years old, the medical history ranged from 1 to 4 years. All patients underwent arthroscopy-assisted calcaneal spur resection combined with plantar fascia release and calcaneal decompression, and were followed up, the duration ranged from 24 to 60 months with an average of(42.00±3.28) months. All patients had obvious heel pain before surgery, and X-ray examinations often showed the presence of calcaneal spurs. In addition to the routine foot examination, the changes in the height and angle of the arch of the foot were also measured pre and post-operatively by X-ray, for the evaluation of clinical effect. The VAS system was used to evaluate the degree of foot pain;the AOFAS scoring system was used to comprehensively evaluate the foot pain, voluntary movement, gait and stability.@*RESULTS@#The VAS decreased from (8.75±1.24) before surgery to (5.15±2.35) at 3 months after surgery, (4.07±2.53) at 6 months after surgery, and (3.95±2.44) at the last fllow-up(P<0.05). The AOFAS score increased from (53.46±4.17) before surgery to(92.46±2.53) at 3 months after surgery, (96.33±2.46) at 6 months after surgery, and (97.05±2.37) at the last follow-up(P<0.05). The arch height was (41.54±1.15) mm before operation and (41.49±1.09) mm after the operation, the difference was not statistically significant(P>0.05). The internal arch angle of the foot arch was (121±6)° before operation and (122±7)° after operation. The difference was not statistically significant(P>0.05).@*CONCLUSION@#Arthroscopy-assisted calcaneal bone spurs resection combined with plantar fascia release and calcaneal decompression exhibited great clinical effect for treating intractable heel.

New Identification Tools for the Nymphs of Three Amblyomma spp. Koch (Ixodida: Ixodidae) in South Texas.

Taxonomic uncertainties and morphologic and molecular similarities may lead to incorrect or incomplete species identifications of immature ticks. This problem can be compounded when the diagnostic morphological features used are unreliable, unstable, or difficult to view. Our study attempts to sort out the similar morphologies of three Amblyomma spp. nymphs with partially overlapping geographic distributions in South Texas. Amblyomma americanum (L.), Amblyomma mixtum Koch, and Amblyomma tenellum Koch are three closely related species with similar nymphs and larvae. Previous attempts to morphologically distinguish among nymphs of these species have relied on difficult-to-observe and unreliable characters. Over the course of decades of routine diagnostic work with these ticks, we have observed and discovered consistent and useful morphologic features sufficient to practically distinguish among these nymphs. We confirmed our morphological studies with molecular genetic evidence (i.e., 12S mitochondrial genes), and we propose that practical, rapid morphological species-level identification of nymphs of the three named species is now possible with confidence.

Application of the Ridden Horse Pain Ethogram to Horses Competing in British Eventing 90, 100 and Novice One-Day Events and Comparison with Performance.

The Ridden Horse Pain Ethogram (RHpE) was applied to 1010 competition starts at British Eventing (BE) 90, 100 and Novice one-day events and compared with performance. The overall median RHpE score was 4/24 (IQR 2,6; range 0,12). There were moderate positive correlations between RHpE scores and dressage penalties (Spearman's rho = 0.508, 0.468, 0.491, all p < 0.001 for BE 90, 100 and Novice, respectively). There were weak positive correlations between RHpE scores and final placings (Spearman's rho = 0.157, p = 0.033, BE90; rho = 0.263, p < 0.001, BE 100; rho = 0.123, p = 0.035, Novice). In showjumping, 1.7% of starters were eliminated or retired, compared with 9.8% of cross-country starters. Horse or rider falls occurred in 2.6% of cross-country starts. Horses placed first, second or third had lower median RHpE scores (2/24, IQR 1,4; range 0,8) than other horses that finished (p < 0.001), those that were eliminated or retired (p < 0.001) or were withdrawn (p < 0.001). The RHpE score was ≥8/24 for 9.3% of starters; horses with a RHpE score ≥8/24 had higher total penalty scores (p < 0.001) than horses with a RHpE score <8/24. The overall low median RHpE score supports the social licence to compete, but 9% of starters had a RHpE score ≥8/24. Investigation and treatment of these horses may improve both welfare and performance.

Flight hampers the evolution of weapons in birds.

Birds are a remarkable example of how sexual selection can produce diverse ornaments and behaviours. Specialised fighting structures like deer's antlers, in contrast, are mostly absent among birds. Here, we investigated if the birds' costly mode of locomotion-powered flight-helps explain the scarcity of weapons among members of this clade. Our simulations of flight energetics predicted that the cost of bony spurs-a specialised avian weapon-should increase with time spent flying. Bayesian phylogenetic comparative analyses using a global spur dataset corroborated this prediction. First, extant species with flight-efficient wings (which presumably fly more frequently) tend to have fewer or no bony spurs. Second, this association likely arose because flying more leads to more frequent evolutionary loss of spurs. Together, these findings suggest that, much like pneumatic bones, absence of weaponry may be another feature of the avian body plan that allows birds to efficiently explore the aerial habitat.

Dentoalveolar changes observed after the use of customized bonded Shark-Tooth-Like Spurs (JAWs) in adult patients with anterior open bite

ABSTRACT Introduction: Tongue spurs have been successfully used for the early treatment of anterior open bite (AOB). However, according to our knowledge, their effectiveness in the treatment of adults has not been evaluated. Objectives: The purpose of the study was to assess the dentoalveolar changes observed after the use of customized bonded shark-tooth-like spurs (JAWs) in adults with AOB. Methods: Twenty-three adults (22.1±4.4 years) with AOB were selected for the treatment. JAWs made from compomer cement were bonded on the lingual surfaces of the maxillary and mandibular anterior teeth to correct tongue-thrusting. Lateral cephalograms and 3D digital models were obtained to evaluate dentoalveolar features observed before and at three time points after JAWs use. Paired t-test and repeated measure ANOVA tests were used to compare dentoalveolar changes, and Pearson's correlation was used to analyze the association of dentoalveolar changes and overbite changes. The significance level was set at p<0.05. Results: Significant 3D dentoalveolar changes were observed after the three months of treatment with JAWs. Improvement of overbite (1.0±0.6 mm) and overjet (0.2±0.3 mm), combined with a retroclination of maxillary (3.0±3.0°) and mandibular (2.2±2.7°) incisors, were observed (p<0.05). Moreover, a significant decrease in anterior dental arch width in both maxillary and mandibular arches (0.4±0.4 mm; 0.3±0.3 mm, respectively), and an increase of posterior maxillary (0.1±0.2 mm) dental arch width were observed (p<0.05). These significant changes occurred in the first month after the JAWs use. A significant correlation was found between the initial arch length discrepancy and the amount of overbite correction (r=0.456, p<0.05). Conclusions: Dentoalveolar changes occurred after the first-month therapy with JAWs. The retroclination of the anterior teeth combined with the expansion of posterior teeth suggests a posterosuperior change in the tongue position. These changes were beneficial for the treatment of AOB in adult patients.

RESUMO Introdução: Esporões linguais têm sido utilizados com sucesso para o tratamento precoce da mordida aberta anterior (MAA). No entanto, de acordo com nosso conhecimento, sua efetividade no tratamento em adultos ainda não foi avaliada. Objetivo: O objetivo do presente estudo foi avaliar as mudanças dentoalveolares observadas após o uso de esporões colados customizados JAWs (tipo dente de tubarão) em adultos com MAA. Métodos: Vinte e três adultos (idade média de 22,1±4,4 anos) com MAA foram selecionados para tratamento. Esporões confeccionados de compômero foram colados na superfície lingual dos dentes anteriores superiores e inferiores, para corrigir a interposição lingual. Radiografias laterais e modelos digitais 3D foram obtidos para avaliar as características dentoalveolares observadas antes do uso dos esporões e em três tempos distintos após seu uso. O testet pareado e testes ANOVA para medições repetidas foram utilizados para comparar as mudanças dentoalveolares, e a correlação de Pearson foi utilizada para analisar a associação entre as mudanças dentoalveolares e as mudanças na sobremordida. O nível de significância foi estabelecido em p<0,05. Resultados: Foram observadas mudanças dentoalveolares 3D significativas após três meses de tratamento com os esporões. Foram observadas melhorias na sobremordida (1,0±0,6 mm) e sobressaliência (0,2±0,3 mm), associadas à retroinclinação dos incisivos superiores (3,0±3,0°) e inferiores (2,2±2,7°) (p<0,05). Além disso, foi observada diminuição significativa na largura anterior das arcadas superior e inferior (0,4±0,4 mm; 0,3±0,3 mm, respectivamente) e um aumento na largura posterior da arcada dentária superior (0,1±0,2 mm) (p<0,05). Essas mudanças significativas ocorreram no primeiro mês após o uso dos esporões. Foi encontrada uma correlação significativa entre a discrepância inicial no comprimento da arcada e a quantidade de correção da sobremordida (r=0,456, p<0,05). Conclusões: Mudanças dentoalveolares ocorreram após o primeiro mês de tratamento com os esporões. A retroinclinação dos dentes anteriores combinada com a expansão dos dentes posteriores sugere uma mudança posterossuperior na posição da língua. Essas mudanças foram benéficas para o tratamento da MAA em pacientes adultos.

Brassinosteroids regulate petal spur length in Aquilegia by controlling cell elongation.

BACKGROUND AND AIMS: Aquilegia produce elongated, three-dimensional petal spurs that fill with nectar to attract pollinators. Previous studies have shown that the diversity of spur length across the Aquilegia genus is a key innovation that is tightly linked with its recent and rapid diversification into new ranges, and that evolution of increased spur lengths is achieved via anisotropic cell elongation. Previous work identified a brassinosteroid response transcription factor as being enriched in the early developing spur cup. Brassinosteroids are known to be important for cell elongation, suggesting that brassinosteroid-mediated response may be an important regulator of spur elongation and potentially a driver of spur length diversity in Aquilegia. In this study, we investigated the role of brassinosteroids in the development of the Aquilegia coerulea petal spur. METHODS: We exogenously applied the biologically active brassinosteroid brassinolide to developing petal spurs to investigate spur growth under high hormone conditions. We used virus-induced gene silencing and gene expression experiments to understand the function of brassinosteroid-related transcription factors in A. coerulea petal spurs. KEY RESULTS: We identified a total of three Aquilegia homologues of the BES1/BZR1 protein family and found that these genes are ubiquitously expressed in all floral tissues during development, yet, consistent with the previous RNAseq study, we found that two of these paralogues are enriched in early developing petals. Exogenously applied brassinosteroid increased petal spur length due to increased anisotropic cell elongation as well as cell division. We found that targeting of the AqBEH genes with virus-induced gene silencing resulted in shortened petals, a phenotype caused in part by a loss of cell anisotropy. CONCLUSIONS: Collectively, our results support a role for brassinosteroids in anisotropic cell expansion in Aquilegia petal spurs and highlight the brassinosteroid pathway as a potential player in the diversification of petal spur length in Aquilegia.

The frequency of Achilles and plantar calcaneal spurs in gout patients

Background/aim: Gout may cause various radiographic abnormalities such as cartilage loss, spurs, sclerosis, and periostal new bone formation. The purpose of this study was to investigate the frequency of Achilles and plantar spurs and related factors in gout patients. Matherial and methods: We performed a retrospective review of gout patients, treated at Hacettepe University hospitals between 2014 and 2019. We identified patients from the hospital records using the ICD-10 code (M10). Demographic and clinical features, comorbidities, and foot radiographies were collected. The radiographies were evaluated by a rheumatologist (U.K.) who was experienced in musculoskeletal radiography. Factors predicting the spurs were analyzed by logistic regression analysis. Results: 181 patients who had lateral foot radiograph were included in this study. Eighty-one (44.7%) patients had score ≥ 2 Achilles spur, 81 (44.7%) patients had score ≥ 2 plantar spur, and 22 (12.1%) patients had no spur. Age, disease duration, duration between the gout diagnosis and appearing spur, the presence of metabolic comorbidities and hypertension were higher in both Achilles and plantar spurs than no spur group. Forty (22.1%) patients had score ≥ 2 both Achilles and plantar spur. In this group, the mean age was older and the proportion of metabolic comorbidities was higher than the groups of Achilles and plantar spur with a score 0 or 1. Predictor of the development of large or moderate-severe calcaneal spur was the existence of metabolic comorbidity [OR (95% CI): 3.49 (1.11­11.0) and p = 0.033]. Conclusion: The presence of metabolic comorbidities increases the frequency of calcaneal spurs in gout patients. This condition can be explained by the impaired microvascular structure and increased hypoxia resulting in calcification on the tendon and ligament insertion sites.

Insights into the evo-devo of plant reproduction using next-generation sequencing approaches.

The development of plant model organisms has traditionally been analyzed using resource-heavy, tailored applications that are not easily transferable to distantly related non-model taxa. Thus, our understanding of plant development has been limited to a subset of traits, and evolutionary studies conducted most effectively either across very wide [e.g. Arabidopsis thaliana and Oryza sativa (rice)] or narrow (i.e. population level) phylogenetic distances. As plant biologists seek to capitalize on natural diversity for crop improvement, enhance ecosystem functioning, and better understand plant responses to climate change, high-throughput and broadly applicable forms of existing molecular biology assays are becoming an invaluable resource. Next-generation sequencing (NGS) is increasingly becoming a powerful tool in evolutionary developmental biology (evo-devo) studies, particularly through its application to understanding trait evolution at different levels of gene regulation. Here, I review some of the most common and emerging NGS-based methods, using exemplar studies in reproductive plant evo-devo to illustrate their potential.

A Comprehensive Review of the Pathophysiology and Clinical Importance of Iliac Vein Obstruction.

OBJECTIVE: The purpose of this comprehensive review is to give a historical account of iliac vein compression and to analyse the pathophysiological aspects and their clinical implications. METHODS: An extensive search of the databases was performed from inception until 2019. The patterns, length and site of compression, wall and luminal changes, and anatomical variations were some of the factors recorded and analysed. RESULTS: Twenty-seven studies were included in this review, divided into cadaveric, histological, and imaging. According to the literature 22%-32% of the asymptomatic population shows "spurs" at the origin of the left common iliac vein (LCIV). Imaging studies also show the presence of direct and indirect compression signs such as the presence of collateral venous flow in axial, transpelvic, or ascending lumbar collaterals, and >50% compression in 37%-44% of the asymptomatic population. In patients without thrombosis it is unknown what produces the signs and symptoms, as the obstruction pre-exists their development. Haemodynamic evaluation is found in only a few studies often including patients with previous deep vein thrombosis. Furthermore, most of the tests are performed with the patient in the supine position and therefore the haemodynamic information is relatively poor. CONCLUSION: Patients with venous obstruction have various clinical presentations from being asymptomatic to having venous claudication and skin damage. Obstruction should be placed into clinical context, together with other contributing factors. Proper evaluation and clinical judgement are important in selecting patients for treatment. Given that such selection is not always clear, further work is needed.

Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome.

PURPOSE: Surface irregularities of the greater trochanter have been described as a potential radiographic sign of greater trochanteric pain syndrome (GTPS). We report a diagnostic accuracy study to evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS. METHODS: We retrospectively identified the anteroposterior pelvic radiographs of a consecutive group of 38 patients (representing a 27.5% series prevalence) diagnosed with GTPS (mean age 69.5 years ± 16.1 [standard deviation], 27 females, 11 males) based on clinical symptoms and a positive response to a local anaesthetic and steroid injection. A control group consisted of 100 patients (mean age 73 years ± 17.1 [standard deviation], 67 females, 33 males) with either hip osteoarthritis listed for hip arthroplasty (n = 50), or with an intracapsular neck of femur fracture (n = 50) both presenting between January and July 2017. Radiographs were cropped to blind observers to the presence of hip osteoarthritis or intracapsular fracture but included the trochanteric region. The radiograph sequence was randomised and separately presented to 3 orthopaedic surgeons to evaluate the presence of trochanteric surface irregularities. RESULTS: The inter-observer correlation coefficient agreement was acceptable at 0.75 (95% CI, 0.60-0.84). Trochanteric surface irregularities including frank spurs protruding ⩾2 mm were associated with a 24.7% positive predictive value, 64.0% sensitivity, 25.7% specificity, 74.3% false-positive rate, 36.0% false-negative rate, and a 65.3% negative predictive value for clinical GTPS. CONCLUSION: Surface irregularities of the greater trochanter are not reliable radiographic indicators for the diagnosis of greater trochanteric pain syndrome.

Posterior Approach and Spinal Cord Release for 360° Repair of Dural Defects in Spontaneous Intracranial Hypotension.

BACKGROUND: Spinal cerebrospinal fluid (CSF) leaks are the cause of spontaneous intracranial hypotension (SIH). OBJECTIVE: To propose a surgical strategy, stratified according to anatomic location of the leak, for sealing all CSF leaks around the 360° circumference of the dura through a single tailored posterior approach. METHODS: All consecutive SIH patients undergoing spinal surgery were included. The anatomic site of the leak was exactly localized. We used a tailored hemilaminotomy and intraoperative neurophysiological monitoring (IOM) for all cases. Neurological status was assessed before and up to 90 d after surgery. RESULTS: Forty-seven SIH patients had an identified CSF leak between the levels C6 and L1. Leaks, anterior to the spinal cord, were approached by a transdural trajectory (n = 28). Leaks lateral to the spinal cord by a direct extradural trajectory (n = 17) and foraminal leaks by a foraminal microsurgical trajectory (n = 2). The transdural trajectory necessitated cutting the dentate ligament accompanied by elevation and rotation of the spinal cord under continuous neuromonitoring (spinal cord release maneuver, SCRM). Four patients had transient defiticts, none had permanent neurological deficits. We propose an anatomic classification of CSF leaks into I ventral (77%, anterior dural sac), II lateral (19%, including nerve root exit, lateral, and dorsal dural sac), and III foraminal (4%). CONCLUSION: Safe sealing (with IOM) of all CSF leaks around the 360° surface of the dura is feasible through a single posterior approach. The exact surgical trajectory is selected according to the anatomic category of the leak.

Intraflower variation in nectar secretion: Secretion patterns and pollinator behavior in male- and female-phase flowers.

PREMISE OF THE STUDY: Plants that secrete abundant nectar attract many pollinator visits, potentially leading to a high frequency of geitonogamous pollination. However, intraflower variation in nectar volume might enhance early departure from the flower or inflorescence, reducing geitonogamy. To examine the adaptive significance of multiple nectar-producing spurs within flowers, we related intraflower variation in nectar characteristics to pollinator foraging behavior and plant reproductive success in protandrous Aquilegia buergeriana var. oxysepala. METHODS: We investigated if nectar volume and sugar mass relate to spur length and if intraflower variation in nectar characteristics differ between male- and female-phase flowers. Because male function requires more pollinator visits than female function, male-phase flowers are expected to have greater nectar volume and lower intraflower variation in nectar volume than female-phase flowers. We used intraflower variation in spur length as an indicator of variation in nectar characteristics and investigated how spur length variation affects pollinator behavior, pollen removal, and seed production. KEY RESULTS: Male-phase flowers had greater nectar volume and lower intraflower variation in nectar volume than female-phase flowers. Intraflower variation in spur length reduced the duration of bumblebee visits. Short visits reduced seed production, but increased pollen removal. CONCLUSIONS: Our results suggest that high intraflower variation in nectar production rate can reduce geitonogamy and potentially increase the genetic diversity of pollen received. Such pattern of nectar secretion within and among flowers may allow flowers to ensure effective pollen transfer or high seed production.

Stability of anterior open bite treatment with bonded spurs associated with high-pull chincup.

OBJECTIVE: To evaluate the stability of anterior open bite (AOB) treatment with bonded spurs associated with high-pull chincup (BS/HPCC). METHODS: The experimental group consisted of 25 Class I AOB patients (15 female, 10 male) treated with BS/HPCC for 1 year. Cephalograms were analysed at pre-treatment (T1), post-treatment (T2) and at the 3-year post-treatment (T3) stage with the patients mean ages of 8.10, 9.14 and 12.18 years, respectively. The control group consisted of 23 subjects (13 female, 10 male) with normal occlusion, with comparable ages at the 3 stages (8.45, 9.45 and 12.50 years at T1, T2 and T3, respectively). T tests were used for intergroup comparisons at T1 and to compare the changes during the 3-year post-treatment period (T2-T3). Intragroup comparison in the treated group was evaluated with dependent t tests between T1 and T2. Correlations between the overbite changes in the T2-T3 period, the pre-treatment AOB severity and the amount of correction achieved during treatment were evaluated with Pearson's correlation coefficient. RESULTS: No statistically significant relapse of the AOB was found at T3. Only 1 patient had a clinically significant AOB relapse. Neither the pre-treatment AOB severity nor the amount of correction was related to overbite changes during the 3-year post-treatment period. CONCLUSIONS: There was no statistically significant relapse of the AOB, and the clinical stability of AOB correction 3-year post-treatment was of 96%.

Predicting Failure of Nonoperative Treatment for Insertional Achilles Tendinosis.

Nonoperative treatment for midportion Achilles tendinosis is well defined by the literature. Multiple modalities are described for the management of insertional Achilles pathology, but no consensus exists regarding efficacy. Surgical intervention for insertional Achilles tendinosis (IAT) is successful greater than 80% of the time. Our objective was to risk stratify patients who would fail nonsurgical management of IAT and thus benefit progressing to surgery. We reviewed the records of 664 patients with IAT. The cohort was 53% male and 80% obese. Mean age was 53.7 years (standard deviation 14.7 years). Average duration of symptoms was 10.4 months (standard deviation 28 months). Of the parameters collected, 4 were found to correlate with failing nonoperative treatment: visual analog scale, limited ankle range of motion, previous corticosteroid injection, and presence of Achilles tendon enthesophyte. We found that as the number of risk factors increased so did the chance of failing nonoperative treatment. With all 4 parameters, chance of failing conservative treatment was only 55%. Thus, nonoperative management should be exhausted until surgery is the only remaining option. However, the presence of one of the aforementioned risk factors can aid a surgeon in the decision to pursue surgery in the appropriate clinical scenario. LEVELS OF EVIDENCE: Level IV: Retrospective Case series.

Osseous spurs at the fovea capitis femoris-a frequent finding in asymptomatic volunteers.

OBJECTIVE: To investigate the different morphologic types of the fovea capitis femoris and the spectrum of osseous spurs/osteophytes of the fovea in asymptomatic volunteers and patients with hip osteoarthritis. MATERIAL AND METHODS: Sixty-five patients (mean age 63.6 years) with radiographically confirmed osteoarthritis of the hip and 59 asymptomatic healthy volunteers (mean age 33.9 years) underwent non-contrast MRI of the hip joint. Two radiologists independently evaluated all images. Fovea morphology (standard type, diamond type, flat type, triangular type) as well as the frequency, size and location of spurs/osteophytes of the fovea were assessed. Descriptive and inferential statistics were applied. RESULTS: The most frequent morphologic type of the fovea capitis femoris was the standard type for both asymptomatic volunteers (average 45%) and patients (average 49%). Osseous spurs were detected in 70% of the asymptomatic volunteers, and 97% of the patients had osteophytes. Spur size at all locations was significantly smaller in asymptomatic volunteers (range 1-2 mm) than osteophyte size in patients (range 1-4 mm) (p ≤ 0.035). In volunteers and patients, the spurs/osteophytes were most frequently located at the anterior border of the fovea capitis femoris. CONCLUSION: Smaller osseous spurs (<2 mm) at the border of the fovea capitis femoris are very common in asymptomatic volunteers and do not seem to be pathologic.