Comparison of Outcome of Deltoid Ligament Repair According to Location of Suture Anchors in Rotational Ankle Fracture

BACKGROUND

The suture anchors for the repair of deltoid ligament in rotational ankle fracture are inserted mostly into the medial malleolus, but sometimes are placed into the talus depending on the rupture site. This study sought to compare the radiological and clinical outcomes of deltoid ligament repair according to using these 2 locations for suture anchor placement.

METHODS

The cases of 131 patients (114 patients with suture anchors on the medial malleolus and 17 patients with suture anchors on the talus) who underwent deltoid ligament repair along with ankle fracture fixation were retrospectively reviewed. Medial clear space oblique (MCSo), medial clear space perpendicular (MCSp), tibiofibular clear space (TFCS), and tibiofibular overlap (TFO) were measured as radiological outcomes, while the Olerud-Molander Ankle Score (OMAS) and visual analog scale (VAS) score for pain were calculated as clinical outcomes. The follow-up period did not differ between the 2 groups (16.8 ± 10.9 months in the medial malleolus group vs 17.9 ± 14.3 months in the talus group; P = .670).

RESULTS

There were no differences in MCSo, MCSp, TFCS, and TFO at 3 months after surgery and final follow-up. The OMAS and VAS for pain did not show intergroup differences at final follow-up.

CONCLUSION

The surgical outcome of deltoid ligament repair in rotational ankle fracture did not differ whether the suture anchors were inserted into the medial malleolus or into the talus.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

Comparison of clinical and radiologic outcomes between non-operative and operative treatment in 5th metatarsal base fractures (Zone 1)

The treatment of Zone 1 fractures of the 5th metatarsal base with >2mm of displacement remains controversial. We prospectively analyzed 29 patients with 5th metatarsal base fractures (Zone 1) during 2009-2014. Radiography was performed to assess the degree of fracture gap and metatarsal length. Patients with gaps of 2mm or less were treated conservatively using a short leg cast or splint (Group A), while patients with fracture gap >2mm were randomly assigned to one of two groups. Group B patients were managed with open reduction and internal fixation (ORIF), and Group C patients were placed in a short leg cast only. Visual analog scale (VAS) score and American orthopedic foot and ankle society (AOFAS) score were obtained at the initial consult and at the last follow-up after treatment; change of the 5th metatarsal length was also measured at the initial consult and after complete bony union. Our study demonstrated that radiographic union of all cases was observed with a significant decrease in VAS and AOFAS scores, regardless of the initial fracture gap and type of management. Additionally, there was no difference seen in final VAS scores for patients with longer metatarsals when compared to those in whom the metatarsals were unchanged or shortened.

Evaluation of 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography in rat models with hepatocellular carcinoma with liver cirrhosis

Liver cirrhosis is a predominant risk factor for hepatocellular carcinoma (HCC). However, the exact mechanism of the progression from cirrhosis to cancer remains unclear. The uptake of 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG) is widely used as a marker of increased glucose metabolism to monitor the progression of cancer with positron emission tomography (PET)/computed tomography (CT). Here we investigated the feasibility of using (18)F-FDG PET/CT in the diethylnitrosamine (DEN) mediated experimental hepatocellular carcinoma model. Rats received weekly intraperitoneal injections of DEN for 16 weeks for induction of HCC. We recorded starting from 0 days or 0 weeks after the last DEN injection. The weight and survival rate of rats were then measured. Also, an (18)F-FDG PET scan and serum analysis were performed at minus 2, 0, plus 2, and plus 4 weeks after the last DEN injection. The body weight of rats was maintained between 350 g and 370 g during 14 and 20 weeks, and the rats were euthanized at 35 days after the last DEN injection. The serum levels of alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphate (ALP) were significantly higher at zero weeks after the last DEN injection. The (18)F-FDG uptake for the quantitative evaluation of HCC was done by measuring the region of interest (ROI). At minus two weeks after the last DEN injection, the ROI of rats had significantly increased compared to the normal group, in a time-dependent manner. These results suggest that FDG uptake serves as a good screening test to evaluate the feasibility of DEN-induced HCC.

The contribution of anterior deltoid ligament to ankle stability in isolated lateral malleolar fractures

The treatment of isolated lateral malleolar fractures with deltoid ligament rupture remains controversial. We prospectively analysed 35 patients with isolated lateral malleolar fractures during 2006-2013. Radiography and magnetic resonance imaging (MRI) were performed to assess the degree of reduction, ligament damage, and stability. Internal fixation was performed for all unstable valgus fractures with unacceptable fracture parameters. Fractures with residual valgus instability after fixation underwent anterior deltoid repair. The mean anterior deltoid ligament grade based on MRI was significantly different between the high-grade unstable group and the stable and low-grade unstable groups (p=0.037 and 0.004, respectively). Postoperative medial clear space measurements were not significantly different between groups. MRI was shown to be a useful tool in the preoperative identification of isolated lateral malleolus fractures prone to valgus instability. In the case of high-grade unstable fractures of the lateral malleolus, repair of the anterior deltoid ligament is adequate for restoring medial stability.

Some fungal endophytes from vegetable crops and their anti-oomycete activities against tomato late blight

AIMS

To isolate endophytic fungi from vegetable plants and examine their in vivo anti-oomycete activity against Phytophthora infestans in tomato plants.

METHODS AND RESULTS

Endophytic fungi were isolated from surface-sterilized plant tissues and anti-oomycete activity was measured by in vivo assay using tomato seedlings. Endophytic fungi showing potent anti-oomycete activity were identified by morphological characteristics and nuclear ribosomal ITS1-5.8S-ITS2 sequence analysis. A total of 152 isolates were obtained from 66 healthy tissue samples of cucumber, red pepper, tomato, pumpkin and Chinese cabbage and the fermentation broths of 23 isolates showed potent in vivo anti-oomycete activity against tomato late blight with control values over 90%. The Fusarium oxysporum strain EF119, which was isolated from roots of red pepper, showed the most potent disease control efficacy against tomato late blight. In dual-culture tests, it inhibited the growth of Pythium ultimum, P. infestans and Phytophthora capsici.

CONCLUSIONS

Among endophytic fungi isolated from healthy tissues of vegetable plants, F. oxysporum EF119 showed the most potent in vivo anti-oomycete activity against tomato late blight and in vitro anti-oomycete activity against several oomycete pathogens.

SIGNIFICANCE AND IMPACT OF THE STUDY

Endophytic fungi showing anti-oomycete activity in vitro and in vivo may be used as biocontrol agents particularly of tomato late blight.

Chronic deep brain stimulation of subthalamic and anterior thalamic nuclei for controlling refractory partial epilepsy

OBJECTIVES

Experimental data and case reports of intractable epilepsy patients treated with deep brain stimulation (DBS) of the internal nuclei suggest a considerable anticonvulsant effect. We intended to describe the results of DBS on subthalamic nuclei and anterior thalamic nuclei (STN and ATN) from our patients and to evaluate the long-term efficiency and safety of DBS for controlling intractable epilepsy.

METHODS

Six patients with refractory epilepsy and inadequate for surgery were implanted with DBS electrodes (3 in STN and 3 in ATN, respectively), switched on after a week of insertion followed by chronological observation. Seizure counts were monitored and compared with pre-implantation baseline.

RESULTS

There was significant clinical improvement in respect of reduction of seizure frequency as well as the alleviation of ictal severity in almost patients. The mean reduction in seizure frequency was 62.3% (49.1% from STN vs. 75.4% from ATN). Except one patient (patient 3) with accidental infection on the right anterior chest, no complication or withdrawal of DBS was seen during our study.

CONCLUSION

DBS on STN and ATN demonstrated their clear efficiency and relative safety comparable or superior to previous studies during long term follow-up. Subsequent, well designed studies warrant the further increase of the knowledge about antiepileptic effect of DBS.

Comparison of castability and surface roughness of commercially pure titanium and cobalt-chromium denture frameworks

STATEMENT OF PROBLEM

Titanium is a biocompatible material, but it is not widely used in clinical dentistry for conventional removable denture frameworks. Little research exists on its applicability.

PURPOSE

This study compared the casting accuracy and roughness of titanium and cobalt-chromium denture frameworks.

MATERIAL AND METHODS

Twenty Kennedy Class II, Division 1 removable partial denture frameworks were fabricated with commercially pure titanium (n = 10) and a cobalt-chromium alloy (n = 10). The casting accuracy of each framework was determined by visual, radiographic, and microscopic methods. The roughness of each polished framework surface was analyzed with atomic force microscopy.

RESULTS

The clinical fit, porosities, and microporosities of both types of metal frameworks were qualitatively similar. The surface roughness of polished pure titanium and cobalt-chromium frameworks was 104.43 +/- 69.24 nm and 133.91 +/- 40.92 nm, respectively. This difference was not statistically significant (P >.05).

CONCLUSION

The clinical fit, porosity, and surface roughness of the titanium and cobalt-chromium frameworks fabricated for this study were comparable.

Comparison of oral sensory function in complete denture and implant-supported prosthesis wearers

In order to compare the differences of part of the oral sensory functions among natural dentition, complete denture wearers and implant-supported prostheses wearers, tactile and pressure awareness was measured. Tactile sense was estimated by the thickness perception threshold between upper and lower dentition. Sensibility of pressure feeling was evaluated by threshold of lateral loading on tooth. Within this limited experiment, it could be concluded that an osseointegrated root form implant helped towards restoration of oral sensory functions.

Use of laser Doppler flowmetry for estimation of the depth of burns

The trend for treatment of deep second degree burns and third degree burns is toward early excision and skin grafting. The ability to predict burn depth accurately as early as possible is important for early excision and skin grafting. This study, prospectively evaluated the ability of laser Doppler flow measurements, obtained within 72 hours after burn injury, to predict the depth of burn wounds. A Periflux system 4001 laser Doppler flowmeter was used to measure the cutaneous microflow circulation of 100 selected points of burn wounds on 44 inpatients and of 1680 selected points on 120 volunteers from March of 1993 to February of 1994. The mean value of superficial second degree burns checked by laser Doppler was 194.6 perfusion units (PU). The value of deep second degree burns was 59.7 PU, and the value of third degree burns was 5.1 PU. The mean normal cutaneous blood flow of 120 volunteers (control group) was between 4 and 9 PU, except on the head, neck, hand, and foot. Blood flow of more than 100 PU correctly predicted (90.2 percent of cases) a superficial second degree burn. Blood flow between 100 and 10 PU correctly predicted (96.2 percent of cases) a deep second degree dermal burn. That of less than 10 PU correctly predicted (100 percent of cases) a third degree burn. There was also a significant correlation between initial flow measurements and the depth of burn wounds. We conclude that laser Doppler flow measurements performed early after burn injury are useful in predicting the depth of burn wounds. Laser Doppler flowmetry has the advantage of being easy to use and noninvasive and of providing immediate results for early determination of burn depth. Laser Doppler flowmetry is useful in selecting patients for early excision and grafting of burn wounds.

Mapping of the human body skin with laser Doppler flowmetry

The purpose of this study was to evaluate cutaneous blood flow in the human body to better establish normal flow ranges and to determine whether the location, side of the body, sex, and age affect the flow range at seven different sites. From March 1993 to February 1994 a Periflux system 4001 laser Doppler flowmeter was used to measure the cutaneous microflow circulation of 1,680 selected points in 120 volunteers. The mean normal cutaneous blood flow of 120 volunteers was between 4 and 9 perfusion units (PU) except in the head, neck, hand, and foot. Mean cutaneous blood flow measurements were as follows: the upper arm, 6.6 +/- 1.20 PU (mean +/- SE); the forearm, 6.7 +/- 1.95 PU; the thorax, 7.1 +/- 1.72 PU; the flank, 6.3 +/- 1.23 PU; the abdomen, 5.3 +/- 1.79 PU; the thigh, 4.8 +/- 1.34 PU; the lower leg, 4.6 +/- 1.39 PU (p < 0.05). The blood flow of the thorax was highest and was 54% higher than the lower leg. The group of teenagers had the highest cutaneous blood flow, with an average value of 6.9 +/- 0.62 PU. The group of subjects in their sixties proved to have the lowest cutaneous blood flow-32% less than the teenagers. Gender differences were not noted. There were no significant differences in blood flow in regard to the side of the body.

[The effect of patient teaching on compliance with sick role behavior of diabetic patients]

This study examined the effect of patient teaching on Compliance with sick role behavior in diabetic patients. The purpose was to improve diabetic patients Compliance by D.M. patient teaching. The study objectives were to determine the effect of patient teaching on Compliance with sick role behavior, and factors influencing compliance with sick role behavior of diabetic patients. The subjects, consisting of 52 diabetic patients diagnosed in the C. and other hospitals in K. city were divided into experimental and control groups. Data were gathered from July 25th to September 3rd, 1988 through interviews by questionnaires, measurement of blood sugar level by Reflux. D.M. Patient teaching was defined as informational intervention of social support by the nurse. A booklet representing patient education and questionnaires were developed by the investigator, and were tested for Content validity, and reliability by Item Analysis: Cronbachs alpha for any instrument to measure variables was patient Compliance .83, perceived health belief .65, diabetic knowledge .70. Analysis of data were done by paired t-test, t-test, Anova, Pearson correlation, and Stepwise multiple regression. The results of the study may be summarized as follows: 1. The effect of patient teaching on Compliance with sick role behavior, on diabetic Knowledge and health belief was Confirmed by significant differences between the experimental and the control group before and after the experiments. (P = 000 P = 006, P = 004).(ABSTRACT TRUNCATED AT 250 WORDS)