The efficacy of shoes modification and orthotics in hallux valgus deformity: a comprehensive review of literature.

Hallux valgus (HV) is a frequent forefoot deformity affecting about 23% of adults and 35.7% of people over 65. The exact etiology is not fully understood. The first ray plays a significant role in walking cause it bears the principal amount of weight and maintains the position of the medial arch. Several factors that deteriorate the integrality of the first ray, such as foot deformities, restrictive footwear, and pes planus, may be ascribed to the HV occurrence. Before any surgical correction, conservative treatment should always be initiated first. Currently, there is no consensus that conservative management by shoe modification and foot orthoses could correct the pathology or terminate the clinical worsening of the condition.From a careful analysis of the literature, proper footwear should be a shoe with an adequate length, wide toe box, cushioned sole, and a lowered heel to not increase the load on the metatarsal heads and cause pain. Personalized 3D printed customized toe spreaders may be applied in patients with HV, improving symptoms and bringing pain relief. Compensating the subtalar joint hyperpronation through foot orthoses plays a fundamental role in the HV development, preventing or at least controlling the condition's progress; this, along with weight reduction and regular physical activity.Data obtained suggest that dynamic foot orthoses prefer a biomechanical type with 3/4-length, which is less likely to negatively affect the dorsal or medial pressures, which instead were noted to increase with the sulcus- and full-length orthoses.Although some studies suggest that foot orthoses would favor the correction of HV deformity, results have been very variable and just in few studies appear to correct HV or reduce its progression, improving symptoms and bringing pain relief. In the case of HV surgical correction, orthoses seem to maintain the correct position acquired over time.

Personal technique for wrist dorsal approach.

In hand disorders surgical procedures are more and more widely used and often it's necessary to approach the wrist by the dorsal way. Beneath anatomy of this region is well known, there is still room enough to develop new surgical exposure techniques mostly related to physiology and biomechanics. Our goals are to present an innovative surgical dorsal exposure of the wrist, to show its use for different problems solving, and to evaluate its mini-invasive and functional outcome. Our inedited surgical technique is presented. Since November 1999 to February 2008, this technique has been used by the same surgeon in 60 cases for different pathologies and procedures: 14 SNAC-SLAC wrists III-IV treated by proximal row resection and Resurface-Capitate Pyrocarbon Implant (RCPI), 2 Fenton syndromes by bone graft and RCPI, 6 SNACSLAC II by proximal row resection +/- radial styloidectomy, 2 SLAC III by scaphoidectomy and capito-lunate arthrodesis, 12 scapho-lunate recent dissociations by ligamentoplasty (double approach), 4 scapho-lunate inveterate dissociations by Cuenod Saffar-Romano modified technique and 4 by synthetic ligaments, 1 fracture of the scaphoid proximal pole by synthesis-revascularization-S.L.ligament reconstruction, 15 Kienbock's diseases revascularized by II m.c. artery +/- radial osteotomy. Patients have been evaluated at follow up through the DASH disability questionnaire, the Mayo score for the force, ROM, pain, satisfaction grade. Results are good and encouraging for these applications. In conclusion this new technique with its limited exposure permits an early mobilization with a lower risk of stiffness and can be considered mini-invasive.

Thompson calf squeezing test: clinical and ultrasound correlations in the follow up of Achille's tenorraphy.

In the follow up of Achille's tenorraphy, negativization of Thompson calf queezing test is not always omogeneous and absolute. Aim of the paper is to correlate Thompson test to different anatomical-ultrasound and functional parameters. We investigated clinically and by ultrasound 61 patients operated on of Achille's tenorraphy at Novara Hospital with follow-up of 10 to 46 months. Negative controls were contralateral tendons. We excluded patients with previous and/or contralateral Achille's tendon ruptures, those operated after 7 days, diabetics or with autoimmune diseases, if used topic steroids, < 18 years, those rejecting the study. Measured parameters were: age, gender, height, weight, side, open vs percutaneous approach, time from operation, neutral angle and range of motion of the ankle, maximal circumference of the leg, Single Heel Rise Test, Visual-Analogue-Scale Foot and Ankle (VAS FA) score; with ultrasound: length of tendons, mio-tendinous U.S.-structure, dynamic diastasis of tendon scar, tendon sliding. Thompson test is positive if no plantar-flexion of the foot occurs at calf squeezing, negative if plantar-flexion is normal (75% patients) and intermediate if reduced or slight reactive (25%).We found correlation of Thompson test with age (p<0,05) and with tendon length (p>0,05), being intermediate tests more represented in older patients and in those with longer healed tendons. In conclusion post-operative negativization of Thompson test can be incomplete as observed in older patients and in those healed with elongated tendon.

Micrographic surgery (Tubingen torte technique) for the treatment of an invasive dermatofibrosarcoma protuberans with muscular involvement.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon skin tumour characterized by a slow, infiltrative growth and marked tendency towards local recurrences. Wide surgical excision of 3-5 cm from the margins including the fascia is the recommended treatment. Mohs Micrographic Surgery has been shown to afford lower rates of recurrence. The Mohs-Tübingen technique is a variant indicated for very large excisions that allows a complete eradication of the tumour, preserving healthy tissues. We report the case of a 45 year-old man affected by DFSP of the right shoulder deeply infiltrating the muscles, referred to us for a recurrence after a large excision. We submitted the patient to Mohs-Tübingen surgery in collaboration with an orthopaedic surgeon due to the presence of muscular involvement of DFSP. Two surgical operations were necessary to obtain negative histology as the tumor was deeply infiltrating the prescapular muscles. After three years of follow-up, the patient did not have any recurrence and the normal mobility of the shoulder was preserved. Precocious diagnosis and adequate therapy are necessary for DFSP as not only the margins, but also the deep invasion of the tumor have to be carefully controlled.

Effects of mechanical stress on cell adhesion: a possible mechanism for morphological changes.

The transmission of mechanical forces to cells is followed among all by biological signals related to changes in the assembly or disassembly of integrins associated linker proteins, such as vinculin. We applied for 3 hours 2% cyclic mechanical strain at the frequency of 1 Hz to human fibroblasts cultured on a deformable substrate; substrate deformation resulted to modify the number, length and area of vinculin positive focal adhesion contacts when compared to not stretched cells. The mechanism behind these morphological changes is related to Akt and RhoA roles in focal adhesion assembly. In the case of Akt and Rho inhibition, focal contacts disassembled only in presence of stretching mechanical stress, highlighting the role of mechanical stress on focal adhesion maturation in terms of multimolecolar assembly which from focal complexes leads to fibrillar adhesion.

Behaviour of human mesenchymal stem cells on a polyelectrolyte-modified HEMA hydrogel for silk-based ligament tissue engineering.

The aim of this study was to design a functional bio-engineered material to be used as scaffold for autologous mesenchymal stem cells in ligament tissue engineering. Polyelectrolyte modified HEMA hydrogel (HEMA-co-METAC), applied as coating on silk fibroin fibres, has been formulated in order to take advantage of the biocompatibility of the polyelectrolyte by increasing its mechanical properties with silk fibres. Human bone marrow mesenchymal stem cells behaviour on such reinforced polyelectrolyte has been studied by evaluating cell morphology, cell number, attachment, spreading and proliferation together with collagen matrix production and its mRNA expression. Silk fibroin fibres matrices with HEMA-co-METAC coating exhibited acceptable mechanical behaviour compared to the natural ligament, good human mesenchymal stem cell adhesion and with mRNA expression studies higher levels of collagen types I and III expression when compared to control cells on polystyrene. These data indicate high expression of mRNA for proteins responsible for the functional characteristics of the ligaments and suggest a potential for use of this biomaterial in ligament tissue-engineering applications.

Observations of the vacuum ultraviolet and x-ray brightness profiles of Fe, Ni, and Ge in magnetically confined fusion plasmas.

The spatial brightness profiles of emission lines for the K-like through He-like ionization states of Fe, Ge, and Ni have been measured during a set of experiments in which Fe and Ge were introduced into FTU tokamak plasmas by using the laser blowoff technique. Nickel was an intrinsic impurity observed during these experiments that was sputtered from the inconel limiter. The brightness profiles were measured by spatially scanable, photometrically calibrated vaccum ultraviolet and x-ray spectrometers that covered the 1 to 1700 A region. Simulations of these profiles and the time evolution of the laser blowoffs were performed with the MIST transport code using several sets of atomic physics compilations [ADPAK (originally in MIST), Arnaud and Raymond (AR92), Arnaud and Rothenflug (AR85), Mazzotta et al., and Mattioli (an extension to Mazzotta)]. The goal was to determine which set of available rates could best simulate the measured spatial brightness profiles and the charge state balance in the plasma. The Mazzotta et al. (for Fe and Ni), the Mattioli (for Ge), and the AR92 (for Fe only) rates adequately simulated the He-, Li-, Be-, Na-, Mg-like ionization states. The F- to B-like charge states could not be simulated by these compilations unless the relevant dielectronic rates were multiplied by a factor of 2. The ADPAK rates could not adequately predict any of the charge states of Fe, Ge, or Ni.