Chevron osteotomy and scarf osteotomy for hallux valgus angle and intermetatarsal angle correction: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: This systematic review and meta-analysis aimed to investigate the differences in hallux valgus angle (HVA), intermetatarsal angle (IMA), American Orthopedic Foot and Ankle Society (AOFAS) scores, and complication rates between chevron osteotomy and scarf osteotomy for correcting hallux valgus. METHODS: Two investigators independently searched for randomized controlled trials (RCTs) published from 2007 to 2018 on PubMed, Web of Science, and Cochrane Library databases. Next, chevron and scarf osteotomies were compared for their postoperative outcomes using HVA, IMA, and AOFAS scores and their complication rates. Meta-analysis was performed using Review Manager (version 5.3). RESULTS: Six RCTs-comprising 507 feet, of which 261 and 246 underwent chevron and scarf osteotomies, respectively-were included. The meta-analysis revealed that chevron osteotomy led to significantly smaller postoperative HVAs than scarf osteotomy (weighted mean difference [WMD] = -1.94, 95% CI = - 2.65 to - 1.29, P < .00001). However, the differences in postoperative IMA (WMD = - 0.44, 95% CI = - 1.10 to 0.22, P = .19), postoperative AOFAS scores (WMD = 0.75; 95% CI = - 5.32 to 6.82; P = .81), and complication rates (risk ratio = 1.22, 95% CI = 0.65-2.27, P = .53) between feet that underwent chevron and scarf osteotomies were nonsignificant. CONCLUSIONS: Compared with scarf osteotomy, chevron osteotomy had significantly more favorable postoperative outcomes in terms of HVA correction, but not in terms of IMA, AOFAS scores, or complication rates. LEVEL OF EVIDENCE: Level I, systemic review and meta-analysis.

Allograft Screws as Fixation of the Scarf Osteotomy.

Background: In comparison to titanium screws, novel cortical bone allograft screws may come with advantages in osseointegration and with avoidance of potential material removal surgery after scarf osteotomy. Methods: A scarf osteotomy with allograft bone screws as fixation was performed in 21 patients (30 feet). Clinical and radiological parameters were prospectively collected until one year after surgery. A retrospective control group, consisting of 75 patients (82 feet) after scarf osteotomy using headless compression screws, was used to compare clinical outcomes. Results: After fixation with allograft bone screws, the mean preoperative AOFAS score increased from 51.5 points preoperatively to 93.5 points one year after surgery. In radiological assessments, a continuous osseointegration with the remodeling of the bone screw was observed in all patients that finished follow-up. However, four metatarsal fractures occurred early postoperatively after fixation using allograft bone screws. There were only three material removal surgeries in patients treated with headless compression screws. Conclusions: Allograft bone screws display a safe fixation and are a biological alternative for scarf osteotomy. Enough distance between the screw and the proximal osteotomy should be ensured to avoid fractures.

Patient-reported and radiological outcomes of short Scarf osteotomy fixed with a single screw: A prospective study of 271 osteotomies.

The Scarf osteotomy involves inherent risks and technical challenges. The short scarf osteotomy with single screw fixation has emerged as an alternative approach. This study aims to evaluate the patient-reported outcome measures (PROMs), radiological outcomes, and complications associated with the short scarf osteotomy fixed with a single screw for hallux valgus correction. A prospective cohort study was conducted between October 2018 and October 2023 at a single center, encompassing 271 osteotomies. PROMs were collected prospectively preoperatively and at various postoperative intervals. Radiographic data, including hallux valgus angle (HVA) and intermetatarsal angle (IMA), were measured preoperatively and six weeks postoperatively. Complications were also documented. Statistically significant improvements were observed in all PROMs and were sustained up to 24 months postoperatively. The Visual Analog Scale (VAS) pain score demonstrated a significant reduction from 46.97 at baseline to 12.52 at 24 months (p < 0.001). Likewise, the EQ-5D score improved notably from 0.73 preoperatively to 0.81 at 24 months (p = 0.002). Analysis of the Manchester-Oxford Foot Questionnaire (MOXFQ) revealed substantial improvements across its pain, walking/standing, and social interaction domains over the same period, with all changes showing statistical significance (all p < 0.001). Radiographically, the mean HVA improved significantly from 31.33° preoperatively to 13.33° postoperatively (p < 0.001). Similarly, the mean IMA improved significantly from 14.67° to 7.66° (p < 0.001). The most common complication was superficial wound infection, effectively managed with oral antibiotics. The were no cases of avascular necrosis or fracture. In conclusion, the short Scarf osteotomy fixed with a single screw demonstrates favorable outcomes. These findings support its efficacy and safety as a treatment option, with potential advantages over the conventional technique. Further prospective studies are warranted to validate these findings.

SCARF2 is a target for chronic obstructive pulmonary disease: Evidence from multi-omics research and cohort validation.

Age-related chronic inflammatory lung diseases impose a threat on public health, including idiopathic pulmonary fibrosis (IPF) and chronic obstructive pulmonary disease (COPD). However, their etiology and potential targets have not been clarified. We performed genome-wide meta-analysis for IPF with the largest sample size (2883 cases and 741,929 controls) and leveraged the summary statistics of COPD (17,547 cases and 617,598 controls). Transcriptome-wide and proteome-wide Mendelian randomization (MR) designs, together with genetic colocalization, were implemented to find robust targets. The mediation effect was assessed using leukocyte telomere length (LTL). The single-cell transcriptome analysis was performed to link targets with cell types. Individual-level data from UK Biobank (UKB) were used to validate our findings. Sixteen genetically predicted plasma proteins were causally associated with the risk of IPF and 6 proteins were causally associated with COPD. Therein, genetically-elevated plasma level of SCARF2 protein should reduce the risk of both IPF (odds ratio, OR = 0.9974 [0.9970, 0.9978]) and COPD (OR = 0.7431 [0.6253, 0.8831]) and such effects were not mediated by LTL. Genetic colocalization further corroborated these MR results of SCARF2. The transcriptome-wide MR confirmed that higher expression level of SCARF2 was associated with a reduced risk of both. However, the single-cell RNA analysis indicated that SCARF2 expression level was only relatively lower in epithelial cells of COPD lung tissue compared to normal lung tissue. UKB data implicated an inverse association of serum SCARF2 protein with COPD (hazard ratio, HR = 1.215 [1.106, 1.335]). The SCARF2 gene should be a novel target for COP.

Hallux valgus treatment by percutaneous scarf-like screwless osteotomy: surgical technique and medium-term outcomes.

BACKGROUND: Hallux valgus is a common condition. There is a consensus that distal metatarsal osteotomies have positive outcomes for the correction of mild-to-moderate deformities, and that proximal osteotomies are preferable for more severe ones. The well-known scarf osteotomy technique is considered powerful enough for both types of deformation and is described without internal fixation. We aimed to describe a new surgical technique for hallux valgus percutaneous scarf like osteotomy (PSLO) without internal fixation, and to report the medium-term radiological and clinical outcomes. HYPOTHESIS: A combination of a PSLO without internal fixation will lead to optimal results. PATIENTS AND METHODS: This retrospective case series reports on 126 cases involving 106 patients who underwent hallux valgus surgery with the PSLO technique +/- Akin, +/- lateral release. The osteotomy was stabilized by a bandage, and immediate weight bearing was allowed. The surgeries took place in 3 clinics in France from March 2016 to July 2017. RESULTS: All radiological parameters: hallux valgus angle (HVA), the 1-2 intermetatarsal angle (IMA) and the distal metatarsal articular angle (DMAA) showed statistically significant improvement. The mean preoperative HVA, IMA and DMAA were 27.7 °, 14.2 ° and 12.7 ° respectively. The mean postoperative HVA, IMA and DMAA were 8.23 °, 8.1 ° and 3.8 °, respectively. Clinically, 97% were satisfied or very satisfied with the results, 92% could wear "normal" shoes (45 days - 6 months), 99% returned to the same athletic activities after surgery (3-5 months), and the average time to return to work was 4 weeks (1 day - 51 days). DISCUSSION: The combination of scarf -like osteotomy and the percutaneous technique provide sufficient initial stabilization through the large horizontal area of contact between the fragments and the preservation of the attachment of the soft tissue. The lack of internal fixation significantly shortens the surgery time, cost, and reduces x-ray exposure without compromising the results. LEVEL OF EVIDENCE: III, retrospective comparative study.

Together is better - RibScore and SCARF in the prediction of pulmonary complications and association with SSRF.

BACKGROUND: Optimal treatment of patients with rib fractures requires identification of those patients at risk of pulmonary complications. It is also important to determine which patients would benefit from Surgical Stabilisation of Rib Fractures (SSRF). This study aims to validate two scoring systems (RibScore and SCARF score) in predicting complications and association with SSRF in an Australian trauma population. Clinical observation suggests that complications and criteria for SSRF is associated with anatomical and physiological factors. Therefore it is hypothesized that utilisation of an anatomical (RibScore) and physiological (SCARF) in conjunction will have improved predictive ability. METHOD: Retrospective cohort study of rib fracture patients admitted to an Australian Level I trauma centre from Jan 2017 to Jan 2021. RibScore and SCARF score were calculated. Multivariate logistic regression was performed to determine risk factors associated with complications and SSRF, as well the scoring systems' ability via ROC AUC. RESULTS: 1157 patients were included. Higher median RibScore (1vs0; p < 0.001) and SCARF score (3vs1, p < 0.001) was associated with development of complications. Similarly for SSRF, RibScore (3vs0; p < 0.001), SCARF score (3vs1; p < 0.001) were higher. On multivariate analysis, increasing RibScore and SCARF score were associated with an increased risk of respiratory failure, pneumonia, death, and SSRF. The sensitivity for a patient with a high risk score in either RibScore or SCARF increased to 96.3 % in identifying pulmonary complications (from 66.7 % in RibScore and 88 % in SCARF, when used individually) and 91.9 % in identifying association with SSRF (from 86.5 % in RibScore and 70.3 % in SCARF). CONCLUSION: RibScore and SCARF score demonstrate predictive ability for complications and SSRF in an Australian trauma rib fracture population. Combining a radiological score with a clinical scoring system demonstrates improved sensitivity over each score individually for identifying patients at risk of complications from rib fractures, those who may require SSRF, and those who are low risk. STUDY TYPE: Retrospective Cohort Study LEVEL OF EVIDENCE: Level III.

Radiologic and Clinical Outcomes of the Dovetailed Notch Scarf Osteotomy for Correcting the First Metatarsal Pronation in Moderate to Severe Hallux Valgus Deformity: A Comparative Study.

BACKGROUND: The traditional scarf osteotomy (TSO) has limited ability to correct the first metatarsal pronation. A novel modification that we refer to as a "dovetailed notch scarf osteotomy" (DNSO) has been developed to enhance the ability to correct coronal plane pronation. The study aimed to observe and compare TSO to DNSO in the treatment of moderate to severe hallux valgus deformity. METHODS: This retrospective study included 78 feet that had a TSO and 105 feet that had a DNSO. Minimum follow-up was 24 months. Weightbearing computed tomography (WBCT) and weightbearing anterior-posterior (AP) radiographs were taken preoperatively and at the last follow-up. We measured the intermetatarsal angle (IMA), hallux valgus angle, distal metatarsal articular surface angle on AP radiographs and first metatarsal coronal pronation angle (α angle), tibial sesamoid coronal grading, and first metatarsal length on WBCT. Clinical assessment was done using visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, Foot and Ankle Ability Measure (FAAM), and the 36-Item Short Form Health Survey (SF-36). The occurrence of postoperative complications was also documented. RESULTS: The DNSO group exhibited a significantly higher correction amount of α angle and IMA (14.3 ± 9.9 and 10.3 ± 4.6 degrees) than the TSO group (8.6 ± 5.9 and 5.4 ± 5.9 degrees) during the final follow-up assessment (P < .05).The DNSO group (10.1 [8.0-12.0] degrees and 4.8 [3.9-5.6] degrees) demonstrated significantly smaller α angle and IMA compared with the TSO group (4.8 [3.9-5.6] degrees and 9.5 [7.5-11.5] degrees) at 24 months postsurgery (P < .05). The postoperative FAAM activities of daily living and SF-36 physical functioning scores were significantly higher in the DNSO group (97.2 ± 3.3 and 95.7 ± 4.4 points) compared with the TSO group (92.3 ± 3.3 and 87.7 ± 8.7 points) (P < .05). Additionally, hallux varus occurred in 1 case in the DNSO group, whereas 4 cases were observed in the TSO group. CONCLUSION: Two osteotomy methods can effectively correct moderate to severe hallux valgus deformity. Compared with the TSO, the DNSO has stronger correction ability. The most crucial aspect lies in its controllability when correcting first metatarsal pronation and addressing IMA. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Head Scarf Pin in the Airway and Challenges in Rigid Bronchoscopy: A Case Series.

Accidental Foreign body aspiration, especially sharp metallic objects may lead to life threatening complications. A metallic object is identified readily on a Xray chest or CT chest and helps us in ascertaining its location. A straight pin with blunt head in the shape of pearl is used in wearing a head scarf also known as hijab to hold it in place. The head scarf pin (hijab pin) if accidentally aspirated into the airway may lead to grave complications. Hence timely intervention with suitable instrumentation is essential to prevent any lethal complications. We have reported four different cases of adolescent females who had accidentally aspirated hijab pin and challenges faced by us during removal.

Similar outcomes following scarf-Akin osteotomy compared to scarf-alone osteotomy for the treatment of hallux valgus: A systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review and meta-analysis was to compare the clinical and radiographic outcomes between patients undergoing scarf osteotomy and scarf-Akin osteotomy for the management of hallux valgus deformity. METHODS: A systematic review of the MEDLINE, EMBASE and Cochrane Library databases was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting clinical data following scarf osteotomy and scarf-Akin osteotomy for the treatment of hallux valgus were included and assessed. The level and quality of evidence of the included studies were also evaluated. RESULTS: Four studies were included. In total, 388 patients (408 toes) underwent scarf osteotomy alone and 287 patients (295 toes) underwent scarf-Akin osteotomy for the treatment of hallux valgus deformity. There was no difference in postoperative American orthopedic foot and ankle society scores (p = 0.7828), visual analog scale scores (p = 0.4558), hallux valgus angle (p = 0.5116), intermetatarsal angle (p = 0.4830), proximal to distal phalangeal articular angle (p = 0.2411) between the scarf alone cohort and the scarf-Akin cohort. Similarly, there was no difference in complication rates (p = 0.6881) nor secondary surgical procedure rates (p = 0.3678) between the 2 cohorts. Finally, there was a higher recurrence rate in the scarf-alone cohort (11.4%) compared to the scarf-Akin cohort (5.7%), but this was not statistically significant (p = 0.4414). CONCLUSION: This systematic review demonstrates lower recurrence rates following scarf-Akin osteotomy compared to scarf osteotomy alone for the treatment of hallux valgus deformity. No difference in complication rates were noted between the 2 cohorts. Our review demonstrates that both the scarf osteotomy and the scarf-Akin osteotomy may be effective and safe procedures, however, the scarf-Akin osteotomy may provide more long-term benefit in the setting of moderate to severe hallux valgus.

Comparative effects of modified rotary scarf osteotomy and traditional scarf osteotomy in treating moderate to severe hallux valgus: a retrospective cohort study.

BACKGROUND: Traditional Scarf osteotomy (TSO) is an effective procedure with a good record in moderate to severe hallux valgus (MSHV) surgery. In order to overcome shortcomings of TSO, Modified Rotary Scarf osteotomy (MRSO) was introduced in this study, which aimed to compare the clinical and radiological outcome in the patients treated with MRSO or TSO. METHODS: Of 175 patients (247 feet) with MSHV, 100 patients (138 feet) treated with MRSO and 75 patients (109 feet) treated with TSO were evaluated according to relevant indicators in twenty-four months follow-up. Pre-surgical and post-surgical HVA, IMA, DMAA, MTP-1 ROM, sesamoid grade and AOFAS (American Orthopaedic Foot and Ankle Society) scores and postsurgical complications were evaluated. RESULTS: Both groups manifested similar baseline characters. The mean follow-up was of 25.9 (range, 22-37) months. Significantly lower IMA, lower Sesamoid grade and higher DMAA at six months, twelve months and twenty-four months post-surgically had been showed in MRSO group compared to TSO group. There was no significant difference in HVA, MTP-1 ROM and AOFAS data at each follow-up time point post-surgically between the two groups. No major complications occurred in either group. CONCLUSION: MRSO showed comparable results to TSO, and improved IMA and sesamoid grade to a greater extent, with a lower probability of throughing effect. Although DMAA could be increased by MRSO, MRSO could still be a reproducible, non-dangerous and efficacious alternative procedure for treating HV patients which do not have severe DMAA.

Increased expression of SCARF genes favoring SARS-CoV-2 infection in key target organs in CKD.

Background: Chronic kidney disease (CKD), especially diabetic CKD, is the condition that most increases the risk of lethal coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the underlying molecular mechanisms are unclear. SARS-CoV-2 and coronavirus-associated receptors and factors (SCARFs) regulate coronavirus cell entry and/or replication. We hypothesized that CKD may alter the expression of SCARF genes. Methods: A literature search identified 34 SCARF genes of which we selected 21 involved in interactions between SARS-CoV/SARS-CoV-2 and host cells, and assessed their mRNA expression in target tissues of COVID-19 (kidneys, lungs, aorta and heart) in mice with adenine-induced CKD. Results: Twenty genes were differentially expressed in at least one organ in mice with CKD. For 15 genes, the differential expression would be expected to favor SARS-CoV-2 infection and/or severity. Of these 15 genes, 13 were differentially expressed in the kidney and 8 were validated in human CKD kidney transcriptomics datasets, including those for the most common cause of CKD, diabetic nephropathy. Two genes reported to protect from SARS-CoV-2 were downregulated in at least two non-kidney target organs: Ifitm3 encoding interferon-induced transmembrane protein 3 (IFITM3) in lung and Ly6e encoding lymphocyte antigen 6 family member 6 (LY6E) in aorta. Conclusion: CKD, including diabetic CKD, is associated with the differential expression of multiple SCARF genes in target organs of COVID-19, some of which may sensitize to SARS-CoV-2 infection. This information may facilitate developing therapeutic strategies aimed at decreasing COVID-19 severity in patients with CKD.

SCARF Genes in COVID-19 and Kidney Disease: A Path to Comorbidity-Specific Therapies.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has killed ~7 million persons worldwide. Chronic kidney disease (CKD) is the most common risk factor for severe COVID-19 and one that most increases the risk of COVID-19-related death. Moreover, CKD increases the risk of acute kidney injury (AKI), and COVID-19 patients with AKI are at an increased risk of death. However, the molecular basis underlying this risk has not been well characterized. CKD patients are at increased risk of death from multiple infections, to which immune deficiency in non-specific host defenses may contribute. However, COVID-19-associated AKI has specific molecular features and CKD modulates the local (kidney) and systemic (lung, aorta) expression of host genes encoding coronavirus-associated receptors and factors (SCARFs), which SARS-CoV-2 hijacks to enter cells and replicate. We review the interaction between kidney disease and COVID-19, including the over 200 host genes that may influence the severity of COVID-19, and provide evidence suggesting that kidney disease may modulate the expression of SCARF genes and other key host genes involved in an effective adaptive defense against coronaviruses. Given the poor response of certain CKD populations (e.g., kidney transplant recipients) to SARS-CoV-2 vaccines and their suboptimal outcomes when infected, we propose a research agenda focusing on CKD to develop the concept of comorbidity-specific targeted therapeutic approaches to SARS-CoV-2 infection or to future coronavirus infections.

Changes in Radiographic Alignment Following Metatarsophalangeal Fusion, Distal Metatarsal Osteotomy, and Lapidus.

BACKGROUND: The purpose of this study is to evaluate the effect of the different surgical treatments for hallux valgus on various radiographic measures of bunion correction. METHODS: A retrospective cohort study was conducted at a single academic medical center involving 2 fellowship-trained foot and ankle surgeons. One hundred and nineteen feet (110 patients) were included. Procedures included first metatarsophalangeal (MTP) arthrodesis (n = 88), Chevron and/or Scarf osteotomy (n = 23), and Lapidus (n = 8). Overall, 78.2% of patients were female, mean age was 60.49 (range, 16-81) years, and mean follow-up was 1.20 (range, 0.25-3.92) years. RESULTS: Hallux valgus angle (HVA) significantly differed preoperatively (MTP = 33.33°, Chevron/Scarf = 27.03°, Lapidus = 32.56°; P = .026). There was no difference in distal metatarsal articular angle (DMAA) preoperatively (MTP = 18.87°, Chevron/Scarf = 17.80°, Lapidus = 14.39°; P = .629). At final follow-up, DMAA was significantly greatest among the Lapidus bunionectomy cohort (MTP = 9.63°, Chevron/Scarf = 13.51°, Lapidus = 17.45°; P = .005). There was no difference in infection (MTP = 6.8%, Chevron/Scarf = 4.4%, Lapidus = 0.0%; P = 1.00) or reoperation (MTP = 19.3%, Chevron/Scarf = 21.7%, Lapidus = 12.5%; P = .921) rates between cohorts, although both rates were highest in the first MTP arthrodesis group. CONCLUSION: Among the 3 hallux valgus corrections studied, Lapidus bunionectomy fared the worst regarding DMAA correction at first follow-up and final follow-up, compared with MTP fusion and distal metatarsal osteotomies. Other radiographic measures showed no significant difference among the groups. LEVEL OF EVIDENCE: Level III: Retrospective cohort study.

Biomechanical Comparison between Rotational Scarf Osteotomy and Translational Scarf Osteotomy: A Finite Element Analysis.

OBJECTIVE: Rotational Scarf osteotomy has its unique advantages in treating hallux valgus, but it also has certain drawbacks. The biomechanical differences between rotational Scarf and translational Scarf osteotomy are not clear evaluates the correction ability and biomechanical difference of two surgical methods for hallux valgus by finite element analysis. METHODS: The computerized tomography data of a hallux valgus patient were selected to establish a finite element model. The standard Scarf osteotomy was simulated based on the model, and the rotation and translation were performed, respectively. The size of the intermetatarsal angle, contact area, distal metatarsal articular angle and the absolute length of the first metatarsal was compared between the two groups. We completed the cartilage, ligament and other tissues on the bone model to establish a full foot model. We analyzed the troughing, plantar aponeurosis tension, plantar soft tissue, and ground stress and also observed the stability of the fracture site by a three-point bending test. RESULTS: Both surgical methods may effectively correct the intermetatarsal angle. After rotational osteotomy, the contact area increased, and the length of the first metatarsal bone initially increased and then decreased compared to that in the translational group. Furthermore, rotational Scarf significantly increased the distal metatarsal articular angle. Mechanical analysis showed that the cancellous bone in the contact part of the fracture site in the translation group had greater stress, which was the reason for the occurrence of the troughing. Stress distribution of plantar aponeurosis, plantar soft tissue, and the ground showed no significant difference. The three-point bending test showed that the separation of the broken ends of the rotational Scarf osteotomy model (0.133 mm) was slightly smaller than the translational group (0.147 mm). CONCLUSION: Both surgical methods can successfully correct intermetatarsal angle (IMA). Compared to traditional translational Scarf osteotomy, rotational Scarf osteotomy is more conducive to postoperative stability and healing, but it also has certain drawbacks. In clinical practice, individualized surgical methods still need to be selected for different types of patients with hallux valgus.

The strength recovery effect of scarf bonding on the CFRP laminates with impact damage.

Impact damage can affect the carrying capacity and service life of aerospace composite structures seriously. In this study, the carbon fiber/epoxy composite (ZT7H/EC3448) was used for scarf bonding repair for CFRP (Z7TH/QY9611) laminates to restore strength. In view of the impact sensitivity of bonding repair of CFRP laminates, a three-dimensional (3D) finite element model (FEM) of the whole damaged response from impact to compression-after-impact (CAI) was established by the subroutine of ABAQUS finite element simulation software. Combined with the experiments of low-velocity impact and compression, the impact damage mode and CAI response of the intact laminates and the wet bonding repaired laminates were evaluated by analyzing the impact response, the failure situation and the residual strength. The results show that the damage of both started in the impacted area and expanded to complete failure in the direction of the vertical fiber. Unlike the intact laminates, the patch of the repaired laminates absorbed a lot of impact energy, which greatly reduced the damage to the original laminates, and the CAI performance for the wet bonding repaired laminates by ZT7H/EC3448 recovered to 97.7% of the intact one.

Exploring scavenger receptor class F member 2 and the importance of scavenger receptor family in prediagnostic diseases.

Scavenger Receptor Class F Member 2 (SCARF2), also known as the Type F Scavenger Receptor Family gene, encodes for Scavenger Receptor Expressed by Endothelial Cells 2 (SREC-II). This protein is a crucial component of the scavenger receptor family and is vital in protecting mammals from infectious diseases. Although research on SCARF2 is limited, mutations in this protein have been shown to cause skeletal abnormalities in both SCARF2-deficient mice and individuals with Van den Ende-Gupta syndrome (VDEGS), which is also associated with SCARF2 mutations. In contrast, other scavenger receptors have demonstrated versatile responses and have been found to aid in pathogen elimination, lipid transportation, intracellular cargo transportation, and work in tandem with various coreceptors. This review will concentrate on recent progress in comprehending SCARF2 and the functions played by members of the Scavenger Receptor Family in pre-diagnostic diseases.

Edgewise Compression and Three-Point Bending Analyses of Repaired Composite Sandwich Panels.

In this work, the fracture behaviour of repaired honeycomb/carbon-epoxy sandwich panels under edgewise compression and three-point bending loading was analysed. Assuming the occurrence of damage resulting from a complete perforation leading to an open hole, the followed repair strategy consists of plug filling the core hole and considering two scarf patches with an angle of 10° in order to repair the damaged skins. Experimental tests were performed on undamaged and repaired situations in order to address the alteration in the failure modes and assess the repair efficiency. It was observed that repair recovers a large part of the mechanical properties of the corresponding undamaged case. Additionally, a three-dimensional finite element analysis incorporating a mixed-mode I + II + III cohesive zone model was performed for the repaired cases. Cohesive elements were considered in the several critical regions prone to damage development. The failure modes and the resultant load-displacement curves obtained numerically were compared with the experimental ones. It was concluded that the numerical model is suitable for estimating the fracture behaviour of sandwich panel repairs.

First Metatarsal Rotation After Scarf Osteotomy for Hallux Valgus.

BACKGROUND: Recurrence after surgical correction of hallux valgus may be related to coronal rotation of the first metatarsal. The scarf osteotomy is a commonly used procedure for correcting hallux valgus but has limited ability to correct rotation. Using weight-bearing computed tomography (WBCT), we aimed to measure the coronal rotation of the first metatarsal before and after a scarf osteotomy, and correlate these to clinical outcome scores. METHODS: We retrospectively analyzed 16 feet (15 patients) who had a WBCT before and after scarf osteotomy for hallux valgus correction. On both scans, hallux valgus angle (HVA), intermetatarsal angle (IMA), and anteroposterior/lateral talus-first metatarsal angle were measured using digitally reconstructed radiographs. Metatarsal pronation angle (MPA), alpha angle, sesamoid rotation angle, and sesamoid position were measured on standardized coronal WBCT slices. Preoperative and postoperative (12 mo) clinical outcome scores (Manchester Oxford Foot Questionnaire and Visual Analogue Scores) were captured. RESULTS: Mean HVA was 28.6 ± 10.1° preoperatively and 12.1 ± 7.7° postoperatively (P < .001). Mean IMA was 13.7 ± 3.8° preoperatively and 7.5 ± 3.0° postoperatively (P < .001). Before and after surgery, there were no significant differences in MPA (11.4 ± 7.7 and 11.4 ± 9.9°, respectively; P = .75) or alpha angle (10.9 ± 8.0 and 10.7 ± 13.1°, respectively; P = .83). There were significant improvements in sesamoid rotation angle (SRA) (26.4 ± 10.2 and 15.7 ± 10.2°, respectively; P = .03) and sesamoid position (1.4 ± 1.0 and 0.6 ± 0.6, respectively; P = .04) after a scarf osteotomy. There were significant improvements in all outcome scores after surgery. Poorer outcome scores correlated with greater postoperative MPA and alpha angles (r = .76 (P = .02) and .67 (P = .03), respectively). CONCLUSION: A scarf osteotomy does not correct first metatarsal coronal rotation, and worse outcomes are linked to greater postoperative metatarsal rotation. Rotation of the metatarsal needs to be measured and considered when planning hallux valgus surgery. Further work was needed to compare postoperative outcomes with rotational osteotomies and modified Lapidus procedures when addressing rotation.Level of Evidence: 4.

Effect of Scarf Repair Geometry on the Impact Performance of Aerospace Composites.

This experimental study investigates the effect of scarf geometry in restoring the impact response of scarf-patched 3 mm thick glass-fiber reinforced polymer (GFRP) matrix composite laminates. Traditional circular along with rounded rectangular scarf patch configurations are considered repair patches. Experimental measurements revealed that the temporal variations of force and energy response of the pristine specimen are close to that of circular repaired specimens. The predominant failure modes were witnessed only in the repair patch which includes matrix cracking, fiber fracture, and delamination, and no discontinuity in the adhesive interface was witnessed. When compared with the pristine samples, the top ply damage size of the circular repaired specimens are larger by 9.91%, while that of the rounded rectangular repaired specimens is larger by 434.23%. The results show that circular scarf repair is a more suitable choice of repair approach under the condition of a 37 J low-velocity impact event even though the global force-time response is similar.

The Incidence of Complications Following Scarf Osteotomy for the Treatment of Hallux Valgus: A Systematic Review With Meta-Analysis.

The Scarf osteotomy is a surgical procedure performed to correct a hallux valgus deformity. Multiple studies have supported use of the procedure with favorable outcomes. In contrast, there have been studies showing a significant complication rate with the procedure. Incidence of complications remains underreported in the literature. We performed a systemic review and meta-analysis examining a wide range of reported complications and associated clinical outcomes from the Scarf osteotomy. One hundred and sixteen publications were identified and 25 (21.6%) met our inclusion criteria. A total of 1583 Scarf procedures were included. Weighted mean follow-up was 26.4 months [range 12-168 months]. We found a 5.1% rate of recurrence, 3.5% rate of troughing, 1.0% rate of avascular necrosis, 1.8% rate of nonunion, 2.7% rate of malunion, 2.4% rate of infection, 5.3% rate of complex regional pain syndrome, and 3.4% rate of hallux varus. An average decrease in intermetatarsal angle of 6.3° was observed. No statistical difference was found in outcomes when comparing Scarf versus Scarf with additional procedure performed at time of surgery. To our knowledge, this systematic review and meta-analysis contains the highest number of Scarf procedures analyzed and presents complication rates on multiple adverse outcomes.