The physiological potential of anammox bacteria as revealed by their core genome structure.

We present here the second complete genome of anaerobic ammonium oxidation (anammox) bacterium, Candidatus (Ca.) Brocadia pituitae, along with those of a nitrite oxidizer and two incomplete denitrifiers from the anammox bacterial community (ABC) metagenome. Although NO2- reduction to NO is considered to be the first step in anammox, Ca. B. pituitae lacks nitrite reductase genes (nirK and nirS) responsible for this reaction. Comparative genomics of Ca. B. pituitae with Ca. Kuenenia stuttgartiensis and six other anammox bacteria with nearly complete genomes revealed that their core genome structure contains 1,152 syntenic orthologues. But nitrite reductase genes were absent from the core, whereas two other Brocadia species possess nirK and these genes were horizontally acquired from multiple lineages. In contrast, at least five paralogous hydroxylamine oxidoreductase genes containing candidate ones (hao2 and hao3) encoding another nitrite reductase were observed in the core. Indeed, these two genes were also significantly expressed in Ca. B. pituitae as in other anammox bacteria. Because many nirS and nirK genes have been detected in the ABC metagenome, Ca. B. pituitae presumably utilises not only NO supplied by the ABC members but also NO and/or NH2OH by self-production for anammox metabolism.

Conservative treatment of severe clubfoot using a novel functional dynamic splint.

Forty-six severe clubfeet in 29 patients were treated by serial castings, followed by a newly developed dynamic splint. The mean period of splint usage was 59.9 months and the mean period of follow-up was 81.5 months. Of the patients, 76.1% were satisfied, 87.0% had no functional deficit, and 84.8% had no pain. Radiographical evaluation showed good correction. The mean dorsiflexion angle was -0.8° at the end of cast treatment and 13.6° at the time of the final follow-up. This study clearly showed the effectiveness of a functional dynamic splint for the correction of equinus in cases of severe clubfoot.

Effects of contralateral movement on the soleus H-reflex during in-phase and antiphase movements of the ankles.

We investigated the effects of contralateral movement on the soleus H-reflex during bilateral movement of the ankles. The soleus H-reflex was evoked during unilateral or in-phase or antiphase bilateral ankle movement in healthy humans. The soleus H-reflex amplitude during antiphase movement was not significantly different from that during in-phase movement. The H-reflex amplitude during in-phase movement was not significantly different from that during unilateral movement of the tested ankle. The H-reflex amplitude in the maximal plantar flexion phase of the tested ankle during antiphase movement was significantly smaller than that in the corresponding phase during unilateral movement. The amount of the decrease was 21%. The effect of contralateral movement is prominent during antiphase movement of the ankles.

Morphologic variations of the fibular malleolar groove with recurrent dislocation of the peroneal tendons.

BACKGROUND: The shallow malleolar groove of the fibula is believed to be one of the important causes of dislocation of the peroneal tendons. However, no studies have investigated the morphological differences between patients with and without dislocation of the peroneal tendons. MATERIALS AND METHODS: We investigated the morphological variations (concave, flat, or convex) of the malleolar groove of the fibula using magnetic resonance imaging (MRI) in 39 ankles from 36 patients with recurrent dislocation of the peroneal tendons, comparing them with 39 ankles in 39 patients without dislocation. We also evaluated the presence of the false pouch on the fibula surface and fibrocartilaginous ridge injury of the malleolar groove on MRI. Chi-square test was used for statistical analysis between the two groups. RESULTS: MRI at 1 cm proximal from the tip of the fibula demonstrated that the malleolar grooves in patients with dislocation of the peroneal tendon were classified as concave in 4 patients, flat in 23, and convex in 12, whereas they were classified as concave in 6, flat in 22 and convex in 11 in the patients without dislocation of the peroneal tendons. No significant difference could be detected between the two groups. CONCLUSION: This study demonstrated that no significant difference could be detected in the morphological shape of the fibular malleolar groove between patients with and without dislocation of the peroneal tendons.

The deficit of joint position sense in the chronic unstable ankle as measured by inversion angle replication error.

INTRODUCTION: Functional instability is defined as a repeated ankle inversion sprain and a giving way sensation. Previous studies have described the damage of sensori-motor control in ankle sprain as being a possible cause of functional instability. The aim of this study was to evaluate the inversion angle replication errors in patients with functional instability after ankle sprain. MATERIALS AND METHODS: The difference between the index angle and replication angle was measured in 12 subjects with functional instability, with the aim of evaluating the replication error. As a control group, the replication errors of 17 healthy volunteers were investigated. The side-to-side differences of the replication errors were compared between both the groups, and the relationship between the side-to-side differences of the replication errors and the mechanical instability were statistically analyzed in the unstable group. RESULTS: The side-to-side difference of the replication errors was 1.0 +/- 0.7 degrees in the unstable group and 0.2 +/- 0.7 degrees in the control group. There was a statistically significant difference between both the groups. The side-to-side differences of the replication errors in the unstable group did not statistically correlate to the anterior talar translation and talar tilt. CONCLUSION: The patients with functional instability had the deficit of joint position sense in comparison with healthy volunteers. The replication error did not correlate to the mechanical instability. The patients with functional instability should be treated appropriately in spite of having less mechanical instability.

Painful os intermetatarseum in athletes: report of four cases and review of the literature.

INTRODUCTION: A painful os intermetatarseum, which described the compression of the deep peroneal nerve by an os intermetatarseum, is a very rare condition. The authors reported four cases of painful os intermetatarseum in athletes and reviewed the present literature. CASE PRESENTATION: We present four cases of a painful os intermetatarseum in athletes, who complained of pain over the dorsum of their foot associated with paresthesias in the first web space. Surgical excision of the os intermetatarseum relieved the pain in all patients. All patients returned to previous sporting activities. CONCLUSION: We should consider a painful os intermetatarseum as being the cause of dorsal foot pain in athletes, and surgical excision of the os intermetatarseum is effective for these patients.

Evaluation of anterior talofibular ligament lesion using 3-dimensional computed tomography.

OBJECTIVE: The aim of this study was to evaluate the applicability of 3-dimensional computed tomography (3D CT) imaging for the diagnosis of anterior talofibular ligament (ATFL) injury. METHODS: Six patients with lateral instability of ankle joint were examined with 3D CT preoperatively. Three patients had chronic ATFL tear, and the others had os subfibulare. 3D CT images were compared with magnetic resonance imaging and the operative findings. RESULTS: The ATFL in the uninvolved side could be depicted clearly by 3D CT in all patients. In patients with chronic ATFL tear, 3D CT could evaluate the condition of ATFL remnant much better than MRI. In patients with os subfibulare, the relationship between bone fragment and ATFL was clearly imaged in 3D CT. Surgical findings in all patients were correlated well with 3D CT. CONCLUSIONS: This study showed that 3D CT has the possibility of being a useful diagnostic tool for evaluation of ATFL lesion.

Superior retinaculoplasty for recurrent dislocation of peroneal tendons.

BACKGROUND: Although dislocation of peroneal tendons is an uncommon injury, if it does occur, daily and sports activities may be restricted because of snapping of the tendons and pain in the posterolateral aspect of the ankle joint. Many operative procedures have been reported for this pathology, including anatomic reattachment of the retinaculum, bone block procedures, tissue-transfer procedures, and groove-deepening. However, no procedure has been established as the "gold standard." Successful results were reported after anatomic reattachment of the detached superior peroneal retinaculum and periosteum of the fibula. We have modified the procedure to reduce operative invasiveness and introduced a method to determine proper tension when suturing the retinaculum to the fibula. METHODS: In our retinaculoplasty, the false pouch was opened through one incision, and the retinaculum was sutured to the fibula while measuring the tension, avoiding too tight or too loose suturing. We performed this procedure in 20 patients with symptomatic dislocation of peroneal tendons in whom conservative treatment had failed. We followed them over 2 years, and clinical results were evaluated. RESULTS: No patient had re-dislocation of the peroneal tendons during the followup period. Fifteen of 18 patients who had been involved in sports activities returned to their previous activities without reducing their activity levels. All patients acquired full range of motion of the ankle joint postoperatively. The preoperative American Orthopaedic Foot and Ankle Society (AOFAS) scores improved significantly (p value < 0.01) postoperatively. CONCLUSIONS: This study demonstrated that the described repair successfully treated patients with symptomatic dislocation of the peroneal tendon and should be considered for this pathology.