Network-based drug repositioning of linagliptin as a potential agent for uterine fibroids targeting transforming growth factor-beta mediated fibrosis.

Uterine fibroid is the most common non-cancerous tumor with no satisfactory options for long-term pharmacological treatment. Fibroblast activation protein-α (FAP) is one of the critical enzymes that enhances the fibrosis in uterine fibroids. Through STITCH database mining, we found that dipeptidyl peptidase-4 inhibitors (DPP4i) have the potential to inhibit the activity of FAP. Both DPP4 and FAP belong to the dipeptidyl peptidase family and share a similar catalytic domain. Hence, ligands which have a binding affinity with DPP4 could also bind with FAP. Among the DPP4i, linagliptin exhibited the highest binding affinity (Dock score = -8.562 kcal/mol) with FAP. Our study uncovered that the differences in the S2 extensive-subsite residues between DPP4 and FAP could serve as a basis for designing selective inhibitors specifically targeting FAP. Furthermore, in a dynamic environment, linagliptin was able to destabilize the dimerization interface of FAP, resulting in potential inhibition of its biological activity. True to the in-silico results, linagliptin reduced the fibrotic process in estrogen and progesterone-induced fibrosis in rat uterus. Furthermore, linagliptin reduced the gene expression of transforming growth factor-ß (TGF-ß), a critical factor in collagen secretion and fibrotic process. Masson trichrome staining confirmed that the anti-fibrotic effects of linagliptin were due to its ability to reduce collagen deposition in rat uterus. Altogether, our research proposes that linagliptin has the potential to be repurposed for the treatment of uterine fibroids.

All-inside endoscopic semiautomatic running locked stitch technique shows favourable outcomes for acute Achilles tendon ruptures.

PURPOSE: The safety and reliability of endoscopic Achilles tendon rupture repair are still concerning aspects. This study's aim is to evaluate an all-inside endoscopic semiautomatic running locked stitch (Endo-SARLS) technique. METHODS: Forty cases with acute Achilles tendon rupture were treated with the all-inside Endo-SARLS technique between 2020 and 2021. Under endoscopic control, the proximal tendon stumps were stitched with the running locked method using a semiautomatic flexible suture passer. The threads of the high-strength suture were grasped through the paratenon subspace and then fixed into calcaneal insertion with a knotless anchor. Magnetic resonance imaging (MRI), surgical time and complications were assessed. Achilles Tendon Total Rupture Score (ATRS), Achilles Tendon Resting Angle (ATRA) and Heel Rise Height Scale (HRHS) were utilised to evaluate final outcomes. RESULTS: The average follow-up time was 25.4 ± 0.4 (range: 24-32) months. Appropriate tendon regeneration was observed on MRI after 12 months. At the final follow-up, the median value of ATRS score was 95 (interquartile range: 94, 98). Furthermore, there is no significant difference between the injured and contralateral side in the average ATRA (18.2 ± 1.8 vs. 18.3 ± 1.9°, ns) and median value of HRHS [14.5 (13.3, 15.5) vs. 14.8 (13.5, 15.6) cm, ns]. No infection and nerve injuries were encountered. Thirty-nine patients reported that they resumed casual sports activity after 6 months. One patient had a slight anchor cut-out, due to an addition injury, which was removed after 5 months. CONCLUSIONS: An all-inside Endo-SARLS technique showed promising clinical results for acute Achilles tendon ruptures. This procedure reduces the risk of sural nerve injuries while establishing a reliable connection between the tendon stumps. LEVEL OF EVIDENCE: Level IV.

Modifications of surgical techniques in laparoscopic percutaneous extraperitoneal closure of inguinal ring for childhood inguinal hernia to achieve zero recurrence and zero subcutaneous stitch granuloma.

PURPOSE: To present our technical modifications of single incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of the internal inguinal ring (IIR) for pediatric inguinal hernia (PIH). METHODS: The prospectively collected data of all children diagnosed with PIH undergoing SILPEC at our center from 2016 to 2023 were reviewed and divided into two groups for result comparison: Group A: before and Group B: after the implementation of full modifications. Our modifications included using a nonabsorbable monofilament suture, creating a peritoneal thermal injury at the internal inguinal ring (IIR), employing a cannula to ensure the suture at the IIR ligates only the peritoneum, and double ligation of the IIR in selected cases. RESULTS: 1755 patients in group A and in group B (1 month to 14 years old) were enrolled. There were no significant differences regarding baseline patient characteristics between the two groups. At a median follow-up of 40 months, the rate of recurrent CIH and subcutaneous stitch granuloma (SSG) was 2.3% and 1.5% in group A vs. 0% and 0% in group B (p < 0.001). There were no hydroceles, no ascended or atrophic testis. CONCLUSIONS: Our SILPEC technical modifications can achieve zero recurrence and zero SSG for PIH.

Embroidery Triboelectric Nanogenerator for Energy Harvesting.

Triboelectric nanogenerators (TENGs) are devices that efficiently transform mechanical energy into electrical energy by utilizing the triboelectric effect and electrostatic induction. Embroidery triboelectric nanogenerators (ETENGs) offer a distinct prospect to incorporate energy harvesting capabilities into textile-based products. This research work introduces an embroidered triboelectric nanogenerator that is made using polyester and nylon 66 yarn. The ETENG is developed by using different embroidery parameters and its characteristics are obtained using a specialized tapping and friction device. Nine ETENGs were made, each with different stitch lengths and line spacings for the polyester yarn. Friction and tapping tests were performed to assess the electrical outputs, which included measurements of short circuit current, open circuit voltage, and capacitor charging. One sample wearable embroidered energy harvester collected 307.5 µJ (24.8 V) of energy under a 1.5 Hz sliding motion over 300 s and 72 µJ (12 V) of energy through human walking over 120 s. Another ETENG sample generated 4.5 µJ (3 V) into a 1 µF capacitor using a tapping device with a 2 Hz frequency and a 50 mm separation distance over a duration of 520 s. Measurement of the current was also performed at different pressures to check the effect of pressure and validate the different options of the triboelectric/electrostatic characterization device. In summary, this research explains the influence of embroidery parameters on the performance of ETENG (Embroidery Triboelectric Nanogenerator) and provides valuable information for energy harvesting applications.

McDonald versus Shirodkar cerclage technique in the prevention of preterm birth: A systematic review and meta-analysis.

BACKGROUND: Cervical cerclage has been used for decades to reduce preterm birth. The Shirodkar and McDonald cerclage are the most commonly used techniques with no current consensus on the preferred technique. OBJECTIVE: To compare the efficacy of the Shirodkar and McDonald cerclage techniques in preventing preterm birth. SEARCH STRATEGY: Studies were sourced from six electronic databases and reference lists. SELECTION CRITERIA: Studies including women with a singleton pregnancy, requiring a cervical cerclage, using either the Shirodkar or McDonald technique that ran comparative analyses between the two techniques. DATA COLLECTION AND ANALYSIS: The primary outcome was preterm birth before 37 weeks, with analyses at 28, 32, 34 and 35 weeks. Secondary data were also collected on neonatal, maternal and obstetric outcomes. MAIN RESULTS: Seventeen papers were included: 16 were retrospective cohort studies and one was a randomised controlled trial. The Shirodkar technique was significantly less likely to result in preterm birth before 37 weeks than the McDonald technique (relative risk [RR] 0.91, 95% CI 0.85-0.98). This finding was supported by a statistically significant reduction in rates of preterm birth before 35, 34 and 32 weeks, PPROM, difference in cervical length, cerclage to delivery interval, and an increase in birthweight in the Shirodkar group. No difference was seen in preterm birth rates <28 weeks, neonatal mortality, chorioamnionitis, cervical laceration or caesarean section rates. The RR for preterm birth prior to 37 weeks was no longer significant when sensitivity analyses were performed removing studies with a serious risk of bias. However, similar analyses removing studies that utilised adjunctive progesterone strengthened the primary outcome (RR 0.83, 95% CI 0.74-0.93). CONCLUSION: Shirodkar cerclage reduces the rate of preterm birth prior to 35, 34 and 32 weeks' gestation when compared with McDonald cerclage; however, the overall quality of the studies in this review is low. Further, large, well-designed randomised controlled trials are required to address this important question to optimise care for women who may benefit from cervical cerclage.

Oncoinformatic screening of the gene clusters involved in the HER2-positive breast cancer formation along with the in silico pharmacodynamic profiling of selective long-chain omega-3 fatty acids as the metastatic antagonists.

The HER2-positive patients occupy ~ 30% of the total breast cancer patients globally where no prevalent drugs are available to mitigate the frequent metastasis clinically except lapatinib and neratinib. This scarcity reinforced researchers' quest for new medications where natural substances are significantly considered. Valuing the aforementioned issues, this research aimed to study the ERBB2-mediated string networks that work behind the HER2-positive breast cancer formation regarding co-expression, gene regulation, GAMA-receptor-signaling pathway, cellular polarization, and signal inhibition. Following the overexpression, promotor methylation, and survivability profiles of ERBB2, the super docking position of HER2 was identified using the quantum tunneling algorithm. Supramolecular docking was conducted to study the target specificity of EPA and DHA fatty acids followed by a comprehensive molecular dynamic simulation (100 ns) to reveal the RMSD, RMSF, Rg, SASA, H-bonds, and MM/GBSA values. Finally, potential drug targets for EPA and DHA in breast cancer were constructed to determine the drug-protein interactions (DPI) at metabolic stages. Considering the values resulting from the combinational models of the oncoinformatic, pharmacodynamic, and metabolic parameters, long-chain omega-3 fatty acids like EPA and DHA can be considered as potential-targeted therapeutics for HER2-positive breast cancer treatment.

A novel technique for small-incision levator resection with a double mattress suture for ptosis correction.

PURPOSE: To introduce a novel technique for small-incision levator resection in ptosis surgery and evaluate its efficacy in a pilot study among patients affected by congenital or aponeurotic ptosis. METHODS: We prospectively enrolled congenital and aponeurotic ptosis patients if their levator function was not poor (≥5 mm) from June 2021 through October 2022. Surgical technique involved a 1-cm lid crease incision, minimal dissection, and creating a loop passing through the tarsus and levator aponeurosis. Success was defined as postoperative MRD-1 ≥3 mm and inter-eyelid MRD-1 difference ≤1 mm. Eyelid contour quality was scored excellent, good, fair, and poor according to its curvature and symmetry. RESULTS: Sixty-seven eyes (35 congenital and 32 aponeurotic) were included in the study. Mean age was 34±19 years (range, 5-79 years). Mean preoperative levator function and levator resection amount were 9.53 mm and 8.39 mm in the congenital group and 12.34 mm and 4.15 mm in the aponeurotic group, respectively. Mean pre- and postoperative MRD-1 was 1.61 mm and 3.27 mm respectively (P<0.001). The overall success rate was 82.1% (95% C.I: 71.7-89.8%); the result was failure in 12 cases, of which 11 had under-correction. Preoperative MRD-1 was correlated with a success rate (P=0.017). CONCLUSION: The described technique shows non-inferior results to the previously described surgical methods and also it shows very good lid contour outcome and minimal lag. The findings suggest that the double mattress single suture technique can be used in both congenital and aponeurotic ptosis.

New method of remnant closure during distal pancreatectomy.

PURPOSE: Pancreatic fistula following distal pancreatectomies still remains a relevant problem. The present study describes our first series with a new method of pancreatic remnant closure. METHODS: A free fascia-peritoneum graft - harvested from the internal rectus sheet - was fixed onto the pancreatic stump by one circular stitch. The method was applied in 18 cases. RESULTS: The postoperative hospital stay was 8 days in average. No clinically relevant postoperative pancreatic fistula (CR-POPF) developed. The morbidity rate was 39%, mostly Clavien-Dindo Grade II types. There was no reoperation or mortality. CONCLUSION: The first series showed advantageous results with our method. Certainly, further studies are needed for the evaluation of this new and promising technique.

Stitch-induced caecal fecolith: An unusual long-term complication following laparoscopic appendicectomy.

A fecolith is a mass of accumulated hardened faecal matter usually seen in patients with Chagas disease, Hirschsprung's disease and inflammatory bowel disease. We report a 21-year-old female with chronic right lower abdominal pain post-appendicectomy. An abdominal computed tomography revealed a fecolith near the caecum and a right simple ovarian cyst. On diagnostic laparoscopy, a Prolene stitch in the previous appendicectomy site acting as a nidus and forming a fecolith was noted. It was excised by a small enterotomy and primary closure of the same. She had an uneventful post-operative course. This case highlights the danger of using a non-absorbable suture for appendicectomy and the rare phenomenon of fecolith formation post-appendicectomy after 4 years presenting with features of chronic recurrent abdominal pain.

A New Approach to Arthroscopic Stitching of the Knee Joint Meniscus: A Mathematical Justification.

Background: This article presents a mathematical justification for a new approach to arthroscopic stitching of the knee joint meniscus, based on a 3D computer model of the meniscus developed using the COMPASS-3D (APMFEM) program and AutodeskInventorPRO. The research with the patent RK No. 35413 dated 10.12.2021, titled "Method of arthroscopic stitching of the meniscus of the knee joint" builds upon the work of Yu.V. Labunsky. Methods: Mathematical analysis was performed to compare two methods of stitching the meniscus: the new oblique-vertical stitch and the classical vertical stitch. The contact area of the meniscus tissues in the area of the rupture was measured for both stitching methods. Results: The findings demonstrate that the new oblique-vertical stitch offers a 1.5 times larger contact area of the meniscus tissues in the area of the rupture, compared to the classical vertical stitch. Additionally, the new method provides a more significant grip on the radial and circular fibers of the meniscus, surpassing the capabilities of the classic seam. Conclusion: The results of this study can be utilized to develop practical recommendations for traumatologists regarding arthroscopic stitching of the meniscus in the knee joint. The new approach, supported by mathematical analysis and a 3D computer model, offers improved outcomes in terms of contact area and grip on the meniscus fibers, potentially leading to enhanced surgical techniques and patient outcomes.

A shotgun proteomic approach reveals novel potential salivary protein biomarkers for asthma.

OBJECTIVE: The aim of this study was to determine if there is an association between the salivary protein profile and disease control in asthma. METHODS: Thirty asthmatic patients (17 adults and 13 children) participated in this study. Saliva samples were collected from healthy subjects, controlled and uncontrolled asthmatics. Individual samples from each group were combined to form a pooled sample, from which proteomic analysis was performed using gel-based quantitative proteomics. RESULTS: Fourteen out of thirty asthmatics were classified to be controlled asthma. Most of asthmatics received inhaled corticosteroids as the controller medications. SDS-PAGE showed predominant bands at high molecular weight in asthmatic saliva compared to that of the controls. Shotgun proteomic analyses indicated that 193 salivary proteins were expressed in both controlled and uncontrolled asthmatics. They were predicted to associate with proteins involved in pathogenesis of asthma including IL-5, IL-6, MCP-1, VEGF, and periostin and asthma medicines (Cromolyn, Nedocromil, and Theophylline). Nucleoside diphosphate kinase (NME1-NME2) only expressed in controlled asthmatics whereas polycystic kidney and hepatic disease 1 (PKHD1)/fibrocystin, zinc finger protein 263 (ZNF263), uncharacterized LOC101060047 (ENSG00000268865), desmoglein 2 (DSG2) and S100 calcium binding protein A2 (S100A2) were only found in uncontrolled asthma. Therefore, the six proteins were associated with disease control in children and adults with asthma. CONCLUSION: Our findings suggest that NME1-NME2, PKHD1, ZNF 263, uncharacterized LOC101060047, DSG 2 and S100 A2 in saliva are associated with disease control in asthma.

Malament stitch and increased risk of bladder neck stenosis: any association following open prostatectomy in Enugu Southeast Nigeria.

BACKGROUND: Malament stitch is one of the effective techniques employed to minimize bleeding in simple open prostatectomy but concerns about possibility of increased risk of bladder neck stenosis has limited its routine use. AIM: We studied patients who had open prostatectomy with Malament stitch to determine the incidence of bladder neck stenosis amongst them. MATERIAL AND METHODS: This was a prospective study of 72patients who had simple open prostatectomy in which malament stitch was applied from 2010 to 2020. A proforma was designed to collect data. Pretreatment variables were transrectal ultrasound (TRUS) volume of prostate, pretreatment IPSS value, postvoidal residual urine volume before surgery, weight of enucleated prostate adenoma, time to removal of Malament stitch. Outcome measures were done with post treatment IPSS and PVR at 6 weeks, 3 months and 6 months. Cystoscopy was done at 3 months or 6 months for patients with rising outcome measures to determine presence of bladder neck stenosis. RESULTS: The mean age of patients in this study was 68.3 years (SD = 7.1, range 52-82). The mean of the pretreatment score for IPSS was 30.7 (SD = 3.9, range 18-34) and 5.9 (SD = 0.2) for QOLS. The mean weight of prostate estimated with ultrasound was 169.5 g and mean weight of enucleated adenoma of the prostate was 132.5 g. The mean time of removal of Malament stitch was 23.1 h. Only 3 (4.2%) patients required cystoscopy because of increasing IPSS and PVR at 3 months postprostatectomy. 2 (2.8%) patients out of 72patients were confirmed to have bladder neck stenosis at cystoscopy. CONCLUSION: Malament stitch did not lead to significant incidence of bladder neck stenosis in this study.

The pulley stitch: fixation of penile prosthetic exit tubing.

Proximal positioning of the penile prosthesis cylinder is performed during inflatable penile prosthesis surgery. We describe a technique to secure a prosthetic cylinder during inflatable penile prosthesis implantation. Urologists performing prosthetic surgeries employ a variety of surgical techniques to achieve successful outcomes. A surgical technique that secures the prosthetic device may ultimately mitigate cylinder migration and erosion. This is a simple, cost-effective technique that can be readily incorporated into conventional corporotomy closure procedures. It proves to be a feasible technique for both running and interrupted corporotomy closures. The "pulley stitch" offers an adjunctive technique for prosthesis cylinder positioning and may also help prevent migration of prosthetic devices, and it can be incorporated with corporotomy closure.

Arthro-Broström with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques.

BACKGROUND: There is still some controversy about the augmentation of the inferior extensor retinaculum after arthroscopic anterior talofibular ligament repair. The aim of this study was to evaluate the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques for chronic lateral ankle instability. METHODS: Thirty-four cases with grade-2 or grade-3 chronic anterior talofibular ligament lesions who underwent the novel arthro-Broström procedure with endoscopic retinaculum augmentation using all-inside lasso-loop stitch techniques were assessed retrospectively. A total of 30 cases (30 ankles) were followed up for a mean of 26.67 ± 4.19 months (range, 24-36 months). four cases were excluded due to insufficient medical records or loss of follow-up reports. The Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were evaluated before surgery and at the final follow-up time. Also, the results of stress fluoroscopic tests and complications were recorded. RESULTS: At the final follow-up, the average of the Cumberland Ankle Instability Tool scores, The Karlsson-Peterson scores and Visual Analogue Scale scores were 86.63 ± 6.69 (range, 77-100), 90.17 ± 4.64 (range, 85-100) and 0.53 ± 0.63 (range, 0-2), respectively. Moreover, the results of stress fluoroscopic tests were improved significantly after surgery. Mild keloid formation and/or knot irritation were observed in four cases. No wound infections, nerve injuries and recurrent instability were recorded. Also, no stiffness or arthritis of the subtalar joint was encountered. CONCLUSIONS: The arthro-Broström procedure combined with endoscopic retinaculum augmentation using all-inside lasso-loop techniques is reliable and safe due to the advantage of direct endoscopic visualization.

Cervical cerclage for prevention of preterm birth: the results from A 20-year cohort.

Cerclages can be used to prevent preterm birth, although their effectiveness and safety is disputed. We aimed to describe obstetric outcomes after cerclage procedures. We included 156 singleton pregnancies and six multiple pregnancies. In singleton pregnancies with history-indicated, short cervix-indicated and emergency cerclages, respectively 84.6, 76.5 and 43.8% resulted in late preterm or term deliveries. In singletons, the following complications were reported: excessive bleeding in one emergency cerclage procedure and three re-cerclage procedures in the history-indicated cerclage group. No perioperative rupture of membranes occurred in singletons. When comparing results of experienced and less-experienced gynaecologists, a remarkably smaller take home child rate was observed for singletons treated by less-experienced gynaecologists: 90.7% and 94.4% for the two experienced gynaecologist as compared to 85.0% for the group of less-experienced gynaecologists. In conclusion, cerclages in singletons result in few cerclage-associated complications and a high take home child rate, when performed by experienced gynaecologists. Impact statementWhat is already known on this subject? Prematurity is the leading cause of perinatal and neonatal mortality and morbidity worldwide. Cervical cerclages can be used to prevent preterm birth, although their effectiveness and safety is disputed.What the results of this study add? In our cohort study, singleton pregnancies with cerclages seem to have satisfactory obstetric outcomes. We found a very low prevalence of cerclage-associated complications in singleton pregnancies, for both history-indicated, short cervix-indicated and emergency cerclages. Additionally, take home child rates in singleton pregnancies were remarkably higher when cerclage procedures were performed by experienced gynaecologists, compared to less experienced gynaecologists.What the implications are of these findings for clinical practice and/or further research? Based on the observed difference in take home child rates, we advise all cerclage procedures to be performed by experienced gynaecologists only. This may mean that women with an indication for cerclage will be referred to a more experienced colleague, either in the same, or in another hospital. To ensure treatment by an experienced gynaecologist, simulation-based training could also provide a solution.

A systematic review and pooled analysis of septal myectomy and edge-to-edge mitral valve repair in obstructive hypertrophic cardiomyopathy.

Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the mitral valve (MV) occurs in 70% of hypertrophic cardiomyopathy (HCM) patients. In individuals undergoing septal myectomy, concomitant MV surgery is considered for SAM with residual LVOT obstruction or mitral regurgitation (MR); however, the optimal approach remains debated. A literature search was performed in Pubmed, EMBASE, Ovid, and the Cochrane library of published articles through June 2021 reporting on combined septal myectomy and edge-to-edge MV repair for obstructive HCM. Continuous variables were weighted and compared using a student's t-test, and categorical variables using a chi-square test with Yates correction. Six studies with 158 total patients were included. The mean follow-up was 2.8 ± 2.7 years. Compared with pre-operative values, there were significant reductions in the LV ejection fraction (69 ± 10 vs 59 ± 8%), peak LVOT gradient (82 ± 34 vs 16 ± 13 mmHg), prevalence of moderate or greater MR (84 vs 5 %), and presence of SAM (96% vs 0) (p < 0.001 for all). There was no change in LV internal diastolic diameter (4.2 ± 1.3 vs 4.4 ± 1.5 cm, p = 0.32). There were 2 (1%) operative mortalities. At follow-up, the survival rate was 97%, there were 3 (2%) re-operative MV replacements, 4 (3%) patients remained in New York Heart Association functional class III/IV, and 8 (6%) required permanent pacemaker implantation. In conclusion, combined septal myectomy and edge-to-edge MV repair is a safe and effective treatment strategy in carefully selected patients requiring surgical HCM management.

Recurrent cervical stitch sinus arising from the deep neck space after thyroidectomy: case study and review.

OBJECTIVE: We describe a one-stage surgical technique for the management of recurrent cervical stitch sinus after thyroidectomy. METHOD: A retrospective, single-centre study of all patients who were operated on because of cervical neck sinus after thyroidectomy. We provide a detailed description of our surgical approach, based on guided sinus removal after prior tract staining with methylene blue and subsequent obliteration using local strap muscle flap. RESULTS: A total of seven patients with a mean age of 46 years were included in the study. All patients had a past history of thyroidectomy because of goitre (n=5) or thyroid cancer (n=2) which had previously been unsuccessfully debrided two or three times. Surgical sinus removal was successful in all cases and no recurrence was observed during the follow-up time. CONCLUSIONS: We conclude that a comprehensive en bloc resection down to the suture granuloma is essential in order to provide surgical cure and prevent recurrence.

Arthroscopic ankle lateral ligament repair alone versus arthroscopic ankle lateral ligament repair with reinforcement by inferior extensor retinaculum.

PURPOSE: This study aimed to compare the clinical outcomes and postoperative activities of arthroscopic ankle lateral ligament (ALL) repair alone with arthroscopic ALL repair and reinforcement by the inferior extensor retinaculum (IER) for chronic ankle instability (CAI). MATERIALS AND METHODS: All patients who underwent arthroscopic repair for CAI between 2017 and 2019 were evaluated. The Japanese Society for Surgery of the Foot (JSSF) scale and self-administered foot evaluation questionnaire (SAFE-Q), and duration between the surgery and walking without any support, jogging, and complete return to sports were evaluated and compared. The exclusion criteria were (1) follow-up period of < 1 year after surgery, (2) the presence of associated ankle lesions requiring treatment during the same operative procedure, including patients with subfibular ossicle bigger than 5 mm on radiographs, chondral or osteochondral defect, bony impingement, deltoid ligament tear, fibular tendon pathology, or posterior ankle impingement, and (3) patients who underwent revision surgery. RESULTS: We identified 126 patients who underwent surgery for CAI and subsequently excluded 36 patients on account of a short follow-up period (< 1 year), additional surgery, and previous surgery. The remaining 90 eligible patients included arthroscopic ALL repair alone (group A, n = 44) and arthroscopic ALL repair with reinforcement by the inferior extensor retinaculum (group G, n = 46) groups. There was no significant difference in the postoperative activities nor in the preoperative or postoperative JSSF scale and SAFE-Q between the two groups. However, significant differences were seen in the mean surgical time (15.5 ± 8.1 vs 20.1 ± 7.6, P = 0.013). CONCLUSION: This study showed no difference in clinical outcomes between the two groups. However, arthroscopic ALL repair with reinforcement by IER resulted in a longer surgical time than arthroscopic ALL repair alone. LEVEL OF EVIDENCE: Retrospective comparative study, level III.

Patients with acute cervical insufficiency without intra-amniotic infection/inflammation treated with cerclage have a good prognosis.

Background The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. Methods This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15 and 26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: (a) a white blood cell (WBC) count >50 cells/mm3; (b) glucose concentration <14 mg/dL; and/or (c) a Gram stain positive for bacteria. Three different groups were compared: (1) absence of IAI/I with placement of a cerclage; (2) amniocentesis not performed with placement of a cerclage; and (3) IAI/I with or without a cerclage. Results Seventy patients underwent an amniocentesis to rule out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 vs. 2 days; P < 0.001) and delivered at a higher median gestational age (27.4 vs. 22.6 weeks; P = 0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without a cerclage (P = 0.01). Patients without IAI/I who underwent a cerclage had a longer median admission-to-delivery interval (43 vs. 1 day; P < 0.001), delivered at a higher median gestational age (28 vs. 22.1 weeks; P = 0.001) and had a higher neonatal survival rate (67% vs. 8%; P < 0.001) than those with IAI/I. Conclusion The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor as they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

The elastic capacity of a tendon-repair construct influences the force necessary to induce gapping.

PURPOSE: Most biomechanical investigations of tendon repairs were based on output measures from hydraulic loading machines, therefore, accounting for construct failure rather than true gapping within the rupture zone. It was hypothesized that the elastic capacity of a tendon-repair construct influences the force necessary to induce gapping. METHODS: A tendon-repair model was created in 48 porcine lower hind limbs, which were allocated to three fixation techniques: (1) Krackow, (2) transosseous and (3) anchor fixation. Loading was performed based on a standardized phased load-to-failure protocol using a servohydraulic mechanical testing system MTS (Zwick Roell, Ulm, Germany). Rupture-zone dehiscence was measured with an external motion capture device. Factors influencing dehiscence formation was determined using a linear regression model and adjustment performed as necessary. A 3-mm gap was considered clinically relevant. Analysis of variance (ANOVA) was used for comparison between groups. RESULTS: The elastic capacity of a tendon-repair construct influences the force necessary to induce gapping of 3 mm (F3mm) [ß = 0.6, confidence interval (CI) 0.4-1.0, p < 0.001]. Furthermore, the three methods of fixation did not differ significantly in terms of maximum force to failure (n.s) or F3mm (n.s). CONCLUSION: The main finding of this study demonstrated that the higher the elastic capacity of a tendon-repair construct, the higher the force necessary to induce clinically relevant gapping. LEVEL OF EVIDENCE: Controlled biomechanical study.