Synthesis and cytotoxicity of novel 6,8,9-trisubstituted purine analogs against liver cancer cells.

A series of novel 6-(substituted phenyl piperazine)-8-(4-substituted phenyl)-9-cyclopentyl purines, 10-51, were synthesized by a four-step synthesis, achieving an overall yield of about 43 %. The reaction conditions were effectively optimized, and the final products were obtained with high purity and yield in all synthesis steps. The synthesized nucleobases were evaluated for their in vitro cytotoxic activities on selected human cancer cell lines (HUH7 (liver), HCT116 (colon), and MCF7 (breast)) using the Sulforhodamine B (SRB) assay. Among these analogs, compounds bearing 4-trifluoromethyl phenyl (19, 20 and 21), 4-methoxy phenyl (27) and 4-fluoro phenyl (34) substitutions at C-8 of purine were the most potent, and they were also analyzed in drug-resistance and drug-sensitive hepatocellular cancer cell (HCC) panels. Compound 19 displayed remarkable anticancer activities (IC50 = 2.9-9.3 µM) against Huh7, FOCUS, SNU475, SNU182, HepG2, and Hep3B cells compared to the positive control, Fludarabine. Additionally, the pharmacological properties and toxicity profiles of the molecules were investigated computationally by the Swiss-ADME and Pro-Tox II online tools, respectively. Results showed that our compounds have favorable physicochemical characteristics for oral bioavailability and do not reveal any toxicity endpoints such as carcinogenicity, immunotoxicity, mutagenicity, or cytotoxicity.

Clinical characteristics, quality of life and risk factors for severity in palmoplantar pustulosis: a cross-sectional, multicentre study of 263 patients.

BACKGROUND: Palmoplantar pustulosis (PPP) is a rare, chronic, inflammatory skin disease characterized by sterile pustules on palmar or plantar areas. Data on PPP are scarce. AIM: To investigate the clinical characteristics and risk factors for disease severity in a large cohort of Turkish patients with PPP. METHODS: We conducted a cross-sectional, multicentre study of patients with PPP recruited from 21 tertiary centres across Turkey. RESULTS: In total, 263 patients (165 women, 98 men) were evaluated. Most patients (75.6%) were former or current smokers. The mean Palmoplantar Pustulosis Area and Severity Index (PPPASI) was 8.70 ± 8.06 and the mean Dermatology Life Quality Index (DLQI) score was 6.87 ± 6.08, and these scores were significantly correlated (r = 0.52, P < 0.001). Regression analysis showed that current smoking was significantly associated with increased PPPASI (P = 0.03). Coexisting psoriasis vulgaris (PsV) was reported by 70 (26.6%) patients. Male sex prevalence, PPP onset incidence, disease duration, DLQI, and prevalence of nail involvement and psoriatic arthritis (PsA) were significantly increased among patients with PPP with PsV. Of the 263 patients, 18 (6.8%) had paradoxical PPP induced by biologic therapy, and these patients had significantly increased mean DLQI and prevalence of PsA (r = 0.03, P = 0.001). CONCLUSION: Our data suggest that smoking is a risk factor for both PPP development and disease severity. Patients with PPP with PsV present distinct clinical features and patients with biologic therapy-induced paradoxical PPP have reduced quality of life and are more likely to have PsA.

Synthesis of Asebogenin and Balsacone A Precursor by a Novel Synthetic Strategy: Recent Opportunities for and Challenges of Total Synthesis of Balsacone A.

One of the main areas of interest of synthetic organic chemistry is the rapid construction of small molecules with proven diverse biological activities for the development of new strategies to cure human health. In particular, the development of novel synthetic strategies is the most important option for reaching the molecular scaffolds of active molecules of natural origin. Balsacone A and asebogenin are compounds that exhibit a wide variety of important biological activities. In this respect, it has become very important to develop new strategies for the construction of biologically active natural and synthetic balsacone analogues. In particular, balsacone derivatives with hydroxy-substituted dihydrochalcone skeletons can be isolated from plant sources or obtained by hemi-syntheses using bio-sourced precursors. An efficient synthetic strategy to synthetically obtain balsacone A is the aim of the present study that considers the limited natural availability of these molecules as well as other factors, such as cost and time. Starting with phloroglucinol, a nine-step synthesis of the precursor of balsacone A was achieved at a 10% overall yield. Furthermore, asebogenin, which has a dihydrochalcone structure and plays a key role in the synthesis of balsacone A, was synthesised with a good yield.

Can cystic lesions of the jaws be considered as the cause of mandibular asymmetry?

BACKGROUND: The aim of this study is to investigate the presence of condylar and ramal asymmetry in patients with a cyst larger than 10 mm in the maxilla or mandible. MATERIAL AND METHODS: Condylar and ramal asymmetry index measurements of 47 patients (mean age: 28.85 ± 15.348) in the study group and 40 patients in the control group (mean age: 33.73 ± 13.095) were performed using panoramic radiographs. The study group consists of patients with cysts larger than 10 mm in diameter in the maxilla or mandible. The control group consisted of patients with no radiolucent lesions and no history of trauma. The possible statistical difference between the groups was evaluated by the Mann-Whitney U test. RESULTS: No statistically significant difference was observed in asymmetry indices according to gender and the jaw (maxilla or mandible) in which the cyst was located. However, it was determined that CAI and RAI values were statistically significantly different between the study and control groups (p = 0.047 and p = 0.016, respectively). CONCLUSIONS: The presence of intraosseous cysts larger than 10 mm in the jaws was found to be associated with condylar and ramal asymmetry.

Clinical and demographic features of hidradenitis suppurativa: a multicentre study of 1221 patients with an analysis of risk factors associated with disease severity.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic, relapsing and debilitating inflammatory disease associated with profound morbidity. AIM: In this multicentre study, we investigated the demographic and clinical features of HS, and determined risk factors of disease severity. METHODS: In total, 1221 patients diagnosed with HS from 29 centres were enrolled, and the medical records of each patient were reviewed. RESULTS: The mean age of disease onset was 26.2 ± 10.4 years, and almost 70% (n = 849) of patients were current or former smokers. Mean disease duration was 8.9 ± 8.4 years with a delay in diagnosis of 5.8 ± 3.91 years. Just over a fifth (21%; n = 256) of patients had a family history of HS. The axillary, genital and neck regions were more frequently affected in men than in women, and the inframammary region was more frequently affected in women than in men (P < 0.05 for all). Acne (40.8%), pilonidal sinus (23.6%) and diabetes mellitus (12.6%) were the most prevalent associated diseases. Of the various therapies used, antibiotics (76.4%) were most common followed by retinoids (41.7%), surgical interventions (32.0%) and biologic agents (15.4%). Logistic regression analysis revealed that the most important determinants of disease severity were male sex (OR = 2.21) and involvement of the genitals (OR = 3.39) and inguinal region (OR = 2.25). More severe disease was associated with comorbidity, longer disease duration, longer diagnosis delay and a higher number of smoking pack-years. CONCLUSIONS: Our nationwide cohort study found demographic and clinical variation in HS, which may help broaden the understanding of HS and factors associated with disease severity.

New chalcone derivatives as effective against SARS-CoV-2 agent.

AIMS: Flavonoids and related compounds, such as quercetin-based antiviral drug Gene-Eden-VIR/Novirin, inhibit the protease of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The alkylated chalcones isolated from Angelica keiskei inhibit SARS-CoV proteases. In this study, we aimed to compare the anti-SARS CoV-2 activities of both newly synthesized chalcone derivatives and these two drugs. METHODS: Determination of the potent antiviral activity of newly synthesized chalcone derivatives against SARS-CoV-2 by calculating the RT-PCR cycling threshold (Ct ) values. RESULTS: Antiviral activities of the compounds varied because of being dose dependent. Compound 6, 7, 9, and 16 were highly effective against SARS-CoV-2 at the concentration of 1.60 µg/mL. Structure-based virtual screening was carried out against the most important druggable SARS-CoV-2 targets, viral RNA-dependent RNA polymerase, to identify putative inhibitors that could facilitate the development of potential anti-coronavirus disease-2019 drug candidates. CONCLUSIONS: Computational analyses identified eight compounds inhibiting each target, with binding affinity scores ranging from -4.370 to -2.748 kcal/mol along with their toxicological, ADME, and drug-like properties.

The Association of Interleukin-6 (IL-6) -572G/C and Transforming Growth Factor Beta 1 (TGFB1) 29C/T Single Nucleotide Polymorphisms (SNPs) with Developmental Dysplasia of the Hip: a Case Control Study.

PURPOSE OF THE STUDY The aim of the present study was to determine the potential effects of single nucleotide polymorphisms (SNPs) of TGFB1 and IL-6 on the development and severity of the disease in patients with DDH and investigate the relationship of these two gene polymorphisms. MATERIAL AND METHODS This case control study was conducted on 105 patients diagnosed with DDH and 119 healthy control subjects of any age. The DDH patients were classified according to the Hartofilakidis and IHDI classifications for adult and pediatric patients, respectively. Genomic DNA was isolated from peripheral blood samples using the Salting-out method. TGFB1 gene p.Pro10Leu (c.29C>T) (rs1800470) and IL-6 572G>C (rs1800796) polymorphisms were analyzed using Sanger DNA sequencing. RESULTS There was no statistically significant relationship of TGFB1 and IL-6 SNPs for DDH. When the rs1800470 and rs1800796 polymorphisms were compared according to family history, the homozygous mutation rate of TGFB1 gene was found to be significantly higher in patients with a positive family history than in patients with a negative family history. No significant relationship was found between rs1800796 polymorphisms and family history. TGFB1 homozygous mutation rate was determined to be statistically higher in the positive family history group than control group. No similar relationship was found between the negative family history group and the control group. No statistically significant relationship was determined between rs1800470 and rs1800796 and the severity of DDH. CONCLUSIONS rs1800796 and rs1800470 polymorphisms do not appear to be major responsible genetic factors for DDH. However, the determination of a correlation between a positive family history and homozygous mutation rate of the TGFB1 gene indicates that this gene may have a greater effect on DDH development. Key words: developmental dysplasia of the hip, interleukin-6, transforming growth factor beta 1, case control study.

Determination of Cystic Fibrosis Mutation Frequency in Preterm and Term Neonates with Respiratory Tract Problems.

Cystic fibrosis (CF) is an autosomal recessive disease. The genetic transition occurs with CF transmembrane conductance regulator (CFTR) gene mutation. We aimed to determine the frequency of CF mutations and also new mutations in the CFTR gene in neonates with respiratory distress. Newborn babies hospitalized due to respiratory distress were included in the patient group. The control group consisted of infants who had no respiratory distress. The CFTR genes of both groups were analyzed using polymerase chain reaction (PCR) and restriction fragment length polymorphism (RFLP) methods. A total of 40 patients (20 in the patient group and 20 in the control group) were evaluated. The CFTR gene analysis was normal in 16 neonates in the patient group, whereas in others: A46D (c.137C>A) (n = 1), D1312G (c.3935A>G) (n = 1), R117H (c.350G>A) (n = 1), S1426P (c.4276T>C) (n = 1) heterozygotes were detected; CFTR gene analysis was normal at 14 neonates in the control group, whereas in others: E1228G (c.3683A>G) (n = 1), E217G (c.650A>G) (n = 1), E632TfsX9 (c1894_1895delAG) (n = 1), I807M (c.2421 A>G) (n = 2), S573F (c.1718C>T) (n = 1) heterozygotes were detected. There was no significant difference in the patient and control groups' CFTR gene analysis (p = 0.340). This study demonstrates the importance of CFTR gene analysis in asymptomatic newborn infants for follow-up and early diagnosis of CFTR-related disorders. In this study, a c.1894_1895delAG (E632TfsX9) heterozygous mutation detected in the CFTR gene in an asymptomatic newborn infant, was first encountered in the literature.

Synthesis and biological evaluation of novel tris-chalcones as potent carbonic anhydrase, acetylcholinesterase, butyrylcholinesterase and α-glycosidase inhibitors.

A novel class of fluoro-substituted tris-chalcones derivatives (5a-5i) was synthesized from phloroglucinol and corresponding benzaldehydes. A three step synthesis method was followed for the production of these tris-chalcone compounds. The structures of the newly synthesized compounds (5a-5i) were confirmed on the basis of IR, 1H NMR, 13C NMR, and elemental analysis.The compounds' inhibitory activities were tested against human carbonic anhydrase I and II isoenzymes (hCA I and hCA II), acetylcholinesterase (AChE), butyrylcholinesterase (BChE), and α-glycosidase (α-Gly). These chalcone derivatives had Ki values in the range of 19.58-78.73 nM for hCA I, 12.23-41.70 nM for hCA II, 1.09-6.84 nM for AChE, 8.30-32.30 nM for BChE and 0.93 ±â€¯0.20-18.53 ±â€¯5.06 nM against α-glycosidase. These results strongly support the promising nature of the tris-chalcone scaffold as selective carbonic anhydrase, acetylcholinesterase, butyrylcholinesterase, and α-glycosidase inhibitor. Overall, due to these derivatives' inhibitory potential on the tested enzymes, they are promising drug candidates for the treatment of diseases like glaucoma, leukemia, epilepsy; Alzheimer's disease; type-2 diabetes mellitus that are associated with high enzymatic activity of carbonic anhydrase, acetylcholine esterase, butyrylcholinesterase, and α-glycosidase.

Dermatological aspects of tularaemia: a study of 168 cases.

BACKGROUND: Tularaemia is a zoonotic infectious disease caused by Francisella tularensis, an aerobic, uncapsulated, gram-negative coccobacillus. Several case reports have appeared on the dermatological manifestations of tularaemia, but relatively few longer-term studies are available. AIM: To identify skin features of tularaemia that aid in its diagnosis. METHODS: In total, 168 patients (68 male, 100 female) diagnosed with tularaemia were retrospectively examined. All dermatological data for these patients were evaluated. RESULTS: Of the 168 patients, 149 (88.69%) had tularaemia of the oropharyngeal type, 12 (7.73%) had the ulceroglandular type, 5 (2.9%) had the oculoglandular type and 2 (0.59%) had the pulmonary type. Secondary skin manifestations were found in 26 patients (15.47%). Sweet syndrome (SS) was found in 11 patients (6.54%), most of whom presented with the oropharyngeal form, while erythema nodosum (EN) was found in 7 patients (4.16%), dermatitis in 2 (1.19%), urticaria in 2 (1.19%), acneiform eruptions in 1 (0.59%), vasculitis-like eruptions in 1 (0.59%) and SS + EN in 1 (0.59%). Patients with the oropharyngeal form had a statistically significant (P < 0.001) higher number of skin findings than patients with the other forms. CONCLUSIONS: In clinical practice, tularaemia may present with various cutaneous manifestations, and dermatologists who work in endemic regions must be aware of the possibility of this disease.

The Results of Physical, Radiologic, Pedabarographic, and Quality-of-Life Assessments in Patients with Surgically Treated Intraarticular Calcaneus Fractures.

Calcaneal fractures are complex injuries and have historically had a poor prognosis that results in substantial disability. However, no studies have been performed that analyze both the radiographic and plantar pressure changes after treatment of intraarticular calcaneus fracture. Patients with an intrarticular calcaneus fracture treated at our institution during the study period were identified from computerized hospital records. A total of 36 patients (34 males) completed physical examination and radiographic and dynamic pedobarographic assessments. The follow-up period was from 13 to 82 months (median 38 months). The mean pain score at rest was 3.7 and during activity was 4.0 on a 10-cm visual analogue scale. The mean range of motion of the subtalar joint was restricted. The mean American Orthopaedic Foot and Ankle Society function scale score was 68.1; the mean Short Form-36 physical score was 41.8; and the mental score was 44.9. Pedabarographic results showed that the mean maximum force in the midfoot, forefoot, and toes (p = .001; p = .04; p = .002) and peak pressure in the midfoot, forefoot (p = .001; p = .007), and contact area of the midfoot and toes (p = .038; p = .004) were significantly increased in the injured foot. Radiologic findings showed hindfoot varus, forefoot adductus, and an increase in the medial arch. Even after appropriate anatomic realignment with open reduction and internal fixation of calcaneus fractures, residual differences in plantar pressures and radiographic measures are noted compared to uninjured foot.

The effects of therapeutic exercises on pain, muscle strength, functional capacity, balance and hemodynamic parameters in knee osteoarthritis patients: a randomized controlled study of supervised versus home exercises.

The aim of the study was to compare the effects of low-intensity exercise programs for lower extremities, either supervised or at home, on pain, muscle strength, balance and the hemodynamic parameters of knee osteoarthritis (OA) patients. This randomized study included 78 patients with knee OA in 2 groups of supervised and home-based exercise program. Exercises were applied to the first group in the clinic as a group exercise program and were demonstrated to the second group to be performed at home. Before and after the 6-week exercise program, assessment was made of pain, quadriceps and hamstring muscle strengths, 6-min walk test (6MWT), and non-invasive hemodynamic parameters. Results of the 78 patients, 56 completed the study. Pain, muscle strength, and 6MWT scores showed significant improvements in both groups. There were also significant differences in the amount of change in pain and muscle strength (pain: p = 0.041, Rqdc: 0.009, Lqdc: 0.013, Rhms: 0.04) which indicated greater improvements in the supervised group. The balance scores of supervised group showed a significant improvement (p = 0.009). No significant change was determined in hemodynamic parameters of either group. Conclusion according to the results of this study showed that low-intensity lower extremity exercises conducted in a clinic under the supervision of a physiotherapist were more effective than home-based exercises in reducing post-activity pain levels and improving quadriceps and right hamstring muscle strength. Both the supervised and home exercise programs were seen to be effective in reducing rest pain and increasing 6 MW distance in knee osteoarthritis patients.

Biomechanical comparison of transoral and transbuccal lateral cortical plate fixation for the management of mandibular angle fractures.

OBJECTIVES: The purpose of this experimental study was to compare the biomechanical behaviors of two different types of osteosynthesis that are used in the treatment of mandibular angle fractures. MATERIALS AND METHODS: Twenty synthetic polyurethane human mandible replicas, with medullar and cortical portions, were used in this study. These polyurethane hemimandibles were randomly divided into two groups (n = 10). The transbuccal group (Group A) was fixed with 7 mm long self-tapping 2.0 mm titanium screws at 85° to the reference line and the transoral group (Group B) was fixed with the same screws at 15° to the reference line. All testings were performed on a servo-hydraulic testing machine. The data were transmitted directly from the load cell to a computer, which showed the emergent results of the material characteristics under resisted forces as a graphic containing force and displacement. The peak point loading and displacement for each subject were measured. RESULTS: The comparison between the groups was analyzed with an independent-samples t-test, and P < 0.05 was considered to be significant. The results show that there were no significant differences between the groups for the peak loads and displacement values at the peak loads. CONCLUSION: The results of this experimental study demonstrated that there were no significant differences between the transbuccal and transoral methods in terms of fixation stability. In other words, the screw position and angle seemed to no have influence on the fixation stability in single miniplate treatments of a mandibular angle fracture.

Is there association between vitamin D levels, apelin 36, and visfatin in PCOS?

AIM: We aimed to evaluate vitamin D, apelin-36, and visfatin levels in patients with polycystic ovary syndrome (PCOS). MATERIAL AND METHOD: The study was completed in six months, including a total of 110 patients who were admitted to the obstetrics and gynecology polyclinic. Patients with a diagnosis of PCOS were divided into two subgroups according to their vitamin D levels. Thirty-four patients had <10 ng/ml of vitamin D deficiency and 21 patients had 10-30 ng/ml of vitamin D insufficiency, with each being defined as a subgroup. RESULTS: Average apelin-36 and visfatin levels in PCOS patients were 2.52 ± 0.68 nmol/L and 72.63 ± 22:31 ng/ml, in the control group they were 0.92 ± 0.33 nmol/L, 24.66 ± 6 ng/ml, respectively. The difference found in PCOS patients was statistically significant (p = 0.0001, p = 0.0001). CONCLUSION: In conclusion, the present study shows that in PCOS patients with low levels of vitamin D, insulin resistance is greater and apelin-36 serum levels were significantly higher. Although there are different opinions in the literature on this subject, we believe that when vitamin D levels are brought to an optimal level in PCOS patient, it can prevent the negative effects of adipokines in the pathogenesis of PCOS.

Primary vaginal endometrial stromal sarcoma associated with endometriosis: a case report with a review of the literature.

Extrauterine endometrial stromal sarcomas (ESSs) are quite rare tumors, and vagina is an unusual site for these tumors. This paper presents a very rare pathological entity of primary vaginal ESS. A 46-year-old woman with a complaint of postcoital vaginal bleeding, low abdominal pain, and constipation was admitted to the clinic. She had a mass of seven cm in size, located in the posterior fornix detected on physical examination. The preoperative biopsy showed ESS, surgical material, and evaluation of an endometrium confirmed the diagnosis of primary vaginal ESS. She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial vaginectomy. The diagnosis of ESS performed by pathologic and immunohistochemical evaluation was: caldesmon (-), actin (-), desmin (-). CDIO (+), ER (+), PR (+), and vimentin (+). There was no ESS lesion in the endometrium. The patient was free of tumor for 22 months after the surgery without any additional therapy. In this study, the authors report the sixth case of primary vaginal ESS in the literature and aim to discuss diagnostic criteria and management protocols in the light of the literature.

Reproductive outcomes following hysteroscopic resection of endometrial polyps of different location, number and size in patients with infertility.

We aimed to assess the pregnancy rates after hysteroscopic polypectomy in infertility patients with endometrial polyps and to compare pregnancy rates among subgroups with polyps of different location, size and number. All patients who underwent hysteroscopic evaluation which revealed endometrial polyps were included. Patients with any intrauterine pathology other than polyp and those undergoing frozen embryo transfer (ET) cycles were excluded. Patients were evaluated according to polyp location, size and number. Rates of ß-hCG positivity and clinical pregnancy were compared. Clinical pregnancy rates after polypectomy was 41.7% for multiple polyps, 30.8% for isthmus zone polyps, 28.6% for anterior wall polyps, 27.3% for cornual zone, 22.2% for posterior uterine wall polyps and 11.8% for fundal polyps (p = 0.532). There appears no difference regarding reproductive outcomes after hysteroscopic resection of polyps situated in different intrauterine locations. Similarly, chance of conceiving seems not to change after hysteroscopic treatment of polyps of different size and number.

The effects of prolonged fasting on the levels of adiponectin, leptin, apelin, and omentin in pregnant women.

The aim of the present study was to evaluate serum adiponectin, leptin, apelin and omentin levels to explore metabolic changes occurring during fasting in the month of Ramadan. The study was designed as a prospective study. The patients were divided into two groups, each comprising 20 patients: Group I, fasting pregnant women, and Group II, non-fasting pregnant women. The patients' age, parity, gestational week and body mass index were recorded. Adiponectin and omentin levels were significantly lower in fasting pregnant women (p < 0.001). When the two groups were compared in terms of serum leptin and apelin levels, both were found to be significantly higher in Group I than in Group II. The findings of the present study suggest that pregnant women who are willing to fast during 24-38 weeks' gestation should be informed about insulin resistance.

Obstetric outcomes of intramural leiomyomas in pregnancy.

AIM: The authors aimed to study larger intramural leiomyoma with a size of ≥ three cm on pregnancy outcome of singleton pregnancies compared with control group. MATERIALS AND METHODS: The hospital records of all pregnancies followed between years of 2009 and 2013 were searched for the diagnosis of intramural leiomyoma in the second trimester ultrasonographic screening, past medical history, demographics, pregnancy follow up, and pregnancy outcomes of pregnant women. In the data analyses, 112 singleton pregnant women with intramural leiomyoma were included in the study group and 168 singleton pregnant women without leiomyoma were included in the control group. RESULTS: The presence of pregnancy associated leiomyoma was found to be a risk factor for abortion (odds ratio (OR):12.6, 95% confidence interval (CI) 2.5-63.6) hospitalization for pain (OR: 19.6, 95% CI 5.8-66.5), premature rupture of mem- branes (OR: 6.7, 95% CI 1.4-32.4), oligohydramniosis (OR: 5.3, 95% CI 1.4-20.0), preterm birth (OR: 4.7, 95% CI 1.9-11.6), and breech presentation and other abnormal presentations (OR: 9.7, 95% CI 2.8-34.2) and neonatal intensive care need (OR: 3.0, 95% CI 1.2-7.5). No correlation with the rate of intrauterine growth restriction, intrauterine fetal death, placenta previa, abruption of placenta, and cesarean section was found. CONCLUSIONS: Pregnancy associated intramural leiomyoma is a risk factor for some perinatal complications and these results may be useful for prenatal counseling.

Pedobarographic and Radiological Analysis After Treating a Talus Neck Fracture.

Misalignment of the talar neck after surgical repair can redistribute the load among the posterior, middle, and anterior facets of the subtalar joints, which can change the joint biomechanics, cause arthritis, and impair function. However, we found no studies analyzing the plantar pressures after treatment of talus neck fracture. We determined the dynamic plantar pedobarographic and radiographic characteristics and ankle range of motion, function, and pain among patients after surgical repair of talar neck fractures. A total of 19 patients completed the assessments. The median follow-up period was 29 (range 12 to 113) months. At the last visit, the mean pain score was 3.3 on a 10-cm visual analog scale. The mean American Orthopaedic Foot and Ankle Society function scale score was fair (73.5), and the mean range of motion was restricted in 4 planes. The mean maximum force was lower in the hindfoot (p = .002) and midfoot (p = .03) of the injured foot than in the noninjured foot. The mean peak pressure was lower in the hindfoot (p = .05) but higher in the forefoot (p = .03). Radiographic measurements revealed differences between the feet in the talo-first metatarsal angle (p = .002), Meary's angle (p = .001), and the medial cuneiform-fifth metatarsal angle (p = .002). Radiographic and pedobarographic analysis showed an elevated arch in the injured foot. Thus, talar injury and immobilization can affect the stance and the gait cycle in these patients. Pain, range of motion, function, and the weight transfer pattern should be evaluated carefully during the follow-up period to provide the best postoperative results.

Case report of giant sialolith (megalith) of the Wharton's duct.

Sialolithiasis is the most common disease of salivary glands. Its estimated frequency is 1.2% in the adult population. Sialoliths most commonly occur in the submandibular glands. The sublingual gland and minor salivary glands are rarely affected. The sialolith usually measures from 1 to <10 mm. Giant sialoliths are classified as those exceeding 15 mm in any one dimension. In literature, large sialoliths or megalith (> mm) of Wharton's duct have rarely been reported. This case report describes a patient presenting with an unusually large sialolith (megalith) of Wharton's duct, which was 37 mm ×16 mm in the size, the subsequent patient management, the etiology, diagnosis, and its treatment.