First tarsometatarsal arthrodesis for severe hallux valgus using the tension band principle - Technical tip and case series.

BACKGROUND: Hallux valgus (HV) is a common foot pathology. Severe HV in the presence of Tarsometatarsal joint (TMTJ) instability is often managed with arthrodesis of the 1st TMTJ. There are concerns regarding non-union and malunion (particularly the early loss of inter-metatarsal angle correction before complete arthrodesis). We report our medium-term results of a small series of patients that underwent an evolved surgical technique utilising orthogonal staples and a transverse suture button fixation to address biomechanical concerns with traditional Lapidus arthrodesis. METHODS: A retrospective study of a consecutive series of patients who underwent this surgical technique between February 2017 and May 2022. Clinical outcomes were validated through Patient-reported outcomes measures (PROMS); EuroQol-5 Dimension (EQ-5D) and Manchester-Oxford Foot Questionnaires (MOXFQ). Radiographic parameters (hallux valgus (HVA), intermetatarsal (IMA), distal metatarsal articular angle (DMAA)) were assessed. Union of the arthrodesis and complications were recorded. RESULTS: During the study period, 9 feet underwent the procedure. Radiographic data was available for all nine and PROMS data for seven (77.8%). Significant improvement occurred in all radiographic deformity parameters at mean 6-month follow-up. Mean ± standard deviation correction calculated preoperatively as HVA 40.2°, IMA 19.3° and DMAA 15.8°, corrected to HVA 15.4°, IMA 5.8° and DMAA 5.9° postoperatively. (HVA; P < 0.001, IMA; P < 0.001, DMAA; P < 0.001) Clinical PROMs at mean follow-up of 2 years were MOXFQ 34.4 ± 25.2, EQ-5D-5 L 0.819 ± 0.150 and VAS pain 13.6 ± 13.6. There were no cases of non-union, Tibialis anterior tendon irritation or hallux varus. Complications included first MTPJ stiffness in one case and CRPS and dorsiflexion malunion of the first ray in another patient. CONCLUSION: This preliminary study of the procedure used in this series confirm this is a safe surgical technique to address severe HV with a low rate of non-union and significant radiographic improvements. A larger patient dataset is needed to evaluate this procedure robustly.

Acute surgical treatment of peroneus longus avulsion fracture of the first metatarsal base.

Acute avulsion fracture of the base of the first metatarsal is a rare occurrence, caused by an eccentric contraction of the peroneus longus tendon insertion. A number of case reports have been published outlining various treatment strategies for treating this rare injury. Management plans range from conservative to operative options and include both acute and delayed operative treatments.We present our operative management strategy of an acute avulsion fracture of the base of the first metatarsal. It includes a step-by-step approach including intraoperative clinical photographs and intraoperative image intensifier images. We explain the rationale behind our operative approach and provide insight on the importance of recognising and treating this injury. Initially, this avulsion fracture might seem innocuous but if left untreated may result in disabling functional foot problems.

Cellulose microfiber extraction from leftover celery pulp: Chemomechanical treatments, structural, morphological, and thermal characterization.

Based on the variety of attractive applicability and structural advantages, cellulose is suggested as a sustainable and environmentally-friendly replacement for petroleum-based materials. Therefore, the current study proposed two chemo-mechanical treatments including bleaching with sodium chlorite and sodium hypochlorite for pure cellulose extraction from leftover celery pulp (Apium graveolens var. dulce). The characterizations of the extracted cellulose fibers were measured and analyzed, by using FT-IR, XRD, optical microscopy, FE-SEM, and TGA analysis. FTIR analysis confirmed the successful removal of non-cellulosic and impurities materials by chemical treatments. Analyzing the X-ray diffraction showed that the proposed chemo-mechanical procedures did not have damaging impacts on the cellulose crystalline structure. Microscopies analysis within optical microscopy and FE-SEM indicated that the diameters of the untreated fibers generally ranged from 100 to 150 µm, while for the treated ones, they ranged from 10 to 15 µm. The TGA results illustrated the higher initial degradation temperatures for the treated samples which led to significant improvement in their thermal stabilities.

COVID-19 pandemic and the prevalence of domestic violence against Iranian married women.

AIM: Domestic violence is an important public health and human rights problem. In most countries of the world, including Iran, the COVID-19 pandemic made quarantine necessary to reduce the disease transmission rate. Therefore, due to the spread of the COVID-19 disease and the emergence of mandatory quarantine conditions, the present study was conducted to determine the prevalence of domestic violence against women during the COVID-19 pandemic in Iran. METHODS: In this cross-sectional study, which was done in 2020, 240 married women were investigated. Due to the COVID-19 pandemic, data collection was performed through virtual networks using standard questionnaires. Data were analyzed using SPSS. Descriptive statistics (relative frequencies, mean, and standard deviation) were used to determine the extent of violence. Independent t-test and Chi-square were used to analyze the data of the relation between the types of violence with independent variables. Also, the data were analyzed using the logistic regression model. RESULTS: In this study, 240 married women with a mean age of 36.27 were studied. The highest frequency was related to social violence (56.3%), and the lowest was related to financial and verbal violence (11.7%). In addition, a significant relationship was observed between sexual violence and age (p-value < 0.05). A significant relationship was also observed between social violence and education [(OR = 1.99)] Jobs [(OR = 2.4, CI = 95%, 1.30-4.4), quarantine duration [(OR = 1.94, CI = 95%, 0.98-3.7)] and underlying diseases [OR = 1.90]. CONCLUSION: The high prevalence of domestic violence against women during quarantine indicates the poor health of women in society. Therefore, the roots of violence against women and methods to reduce this problem should be sought. Therefore, identification of subjects at risk and raising women's knowledge may be useful for the prevention of domestic violence and its physical and psychological complications.

Alteration in body water compartments following intermittent fasting in Ramadan.

Concerning the health outcomes of intermittent fasting in Ramadan, loss of fat-free mass (FFM) and changes in the content of body water are of paramount importance. In this study, we aimed to assess the concomitant alterations in body water compartment and composition following Ramadan fasting in healthy individuals. We conducted an open-label cohort with longitudinal follow-up, involving 73 healthy medical staff who planned to fast for at least 20 consecutive days during Ramadan. The primary outcomes of the cohort were changes in parameters related to body composition and water content, which were measured using bioelectrical impedance analysis by InBody S10 (InBody, Seoul, South Korea). Based on the results, the participants' weight decreased significantly by approximately 1,030 g after the fasting period (p < 0.001). There was a significant reduction in the fat mass of an average 828 g (p < 0.001), which accounted for more than 80% of the weight loss. The decline in FFM was not significant (190 g; p = 0.234). The amount of total body water (TBW) and extracellular water (ECW) did not change, while intracellular water (ICW) decreased significantly by about 160 mL (p = 0.027). A strong correlation was observed between the reduction of phase angle and the increase in ECW/TBW ratio (R = -0.71, p < 0.001). Overall, our findings revealed a minimal amount of weight loss after Ramadan fasting, which was mainly due to the loss of fat mass. The parallel decrease in ICW and phase angle indicated impaired cell membrane integrity, with subsequent movement of water from the intracellular to the extracellular compartment.

The role of microRNAs involved in the disorder of blood-brain barrier in the pathogenesis of multiple sclerosis.

miRNAs are involved in various vital processes, including cell growth, development, apoptosis, cellular differentiation, and pathological cellular activities. Circulating miRNAs can be detected in various body fluids including serum, plasma, saliva, and urine. It is worth mentioning that miRNAs remain stable in the circulation in biological fluids and are released from membrane-bound vesicles called exosomes, which protect them from RNase activity. It has been shown that miRNAs regulate blood-brain barrier integrity by targeting both tight junction and adherens junction molecules and can also influence the expression of inflammatory cytokines. Some recent studies have examined the impact of certain commonly used drugs in Multiple Sclerosis on miRNA levels. In this review, we will focus on the recent findings on the role of miRNAs in multiple sclerosis, including their role in the cause of MS and molecular mechanisms of the disease, utilizing miRNAs as diagnostic and clinical biomarkers, using miRNAs as a therapeutic modality or target for Multiple Sclerosis and drug responses in patients, elucidating their importance as prognosticators of disease progression, and highlighting their potential as a future treatment for MS.

Elective foot and ankle surgery following the peak of the COVID-19 pandemic is safe: A report of 30-day morbidity and mortality.

INTRODUCTION: The safety of resuming elective surgical services remains unclear following several surges of the COVID-19 pandemic worldwide. Multiple studies have reported high rates of post-operative mortality and pulmonary complications. 30-day outcomes on an initial cohort of patients undergoing elective foot and ankle surgery at 3 central London hospitals are presented. MATERIALS AND METHODS: This study is a retrospective review of the first 63 patients undergoing surgery following the first UK surge via a modified treatment pathway, based on published national guidelines, designed to minimise the risks to patients and staff associated with COVID-19. RESULTS: 90% of patients were ASA 1 or 2, with an average age of 46. All tested negative for COVID-19 pre-operatively and all but one underwent a general anaesthetic. 10 patients required one night hospital stays and 1 was admitted for four nights. 52 were day case procedures. 2 complications were identified, not relating to COVID-19 infection. No 30-day mortalities or pulmonary complications were recorded. CONCLUSIONS: With a community prevalence of COVID-19 of between 1 in 1500 and 1 in 1700, elective foot and ankle surgery was safe following the first surge of the pandemic in the UK. This data can guide elective service planning in countries with pandemic curves behind the UK's or in the event of further surges in national cases.

Chronic Fracture of the Posteromedial Tubercle of the Talus Masquerading as Os Trigonum Syndrome.

Posterior ankle impingement syndrome (PAIS) can be caused by osseous pathology from the posterior aspect of the talus. The commonest cause is an os trigonum, an accessory ossicle arising from the lateral tubercle of the posterior talus. We have observed cases where the osseous impingement is due to a chronic fracture nonunion of the medial tubercle of the posterior talus with unique symptoms, differentiating this clinical syndrome from the more common os trigonum syndrome. These can be readily overlooked on imaging and confused with an often coexisting os trigonum. Awareness of these lesions is paramount to ensure appropriate management and safe surgery. We describe a series of patients presenting to the senior author with this clinical syndrome, discuss its unique clinical and radiological features, and describe our surgical technique.

Soy intake is associated with lowering blood pressure in adults: A systematic review and meta-analysis of randomized double-blind placebo-controlled trials.

BACKGROUND: Soy has several beneficial effects on cardiovascular disease (CVD); however, results of clinical trial studies are equivocal. Thus, the present study sought to discern the efficacy of soy intake on blood pressure. METHODS: The search process was conducted in PubMed, Scopus, Web of Science, and Cochrane Library, to ascertain studies investigating the efficacy of soy intake on blood pressure in adults, published up to June 2020. A random-effects model was applied to pool mean difference and 95 % confidence interval (CI). Begg's and Egger's methods were conducted to assess publication bias. RESULTS: Pooled effects from 17 effect sizes revealed a significant improvement in systolic blood pressure (SBP) (-1.70; -3.34 to -0.06 mmHg; I2 = 45.4 %) and diastolic blood pressure (DBP) (-1.27; -2.36 to -0.19 mmHg, I2 = 43.9 %) following soy consumption, in comparison with controls. Subgroup analysis demonstrated a reduction in both SBP and DBP in younger participants with lower baseline DBP and intervention durations of <16 weeks. CONCLUSION: Our results suggest that soy intake is associated with an ameliorating effect on blood pressure in adults.

Saw transection of retained compression screws with damaged heads instead of removal in revision first metatarsal osteotomy: a technique tip.

Distal first metatarsal osteotomy is performed to correct hallux valgus. The surgery is being performed throughout the UK in increasing numbers. The osteotomies used are commonly fixed with one or two variable pitch compression screws. Recurrence of the deformity or inadequate correction in the primary surgery may require revision osteotomy which necessitates removal of previous screws. Revision rates for scarf osteotomy have been reported at 5%. Removal of screws can be challenging as they are often buried in bone and/or the screw heads can get damaged even despite meticulous preparation. Various techniques for removal of damaged screws are described, which require additional equipment and may result in significant loss of the host bone. We describe another technique where a standard Stryker TPS sagittal saw and saw blade (Kalamazoo, USA) are used to cut through the shaft of the compression screws in line with the planned revision osteotomy. We have successfully performed this on two occasions with good results, and describe our experience of using this technique which eliminates the need for complex over drilling procedures often required for removing stripped and retained screws.

Clarification on "Critical Comments on 'Assessment of the Thermodynamic Properties of DL-p-Mentha-1,8-diene, 4-isopropyl-1-methylcyclohexene (DL-Limonene) by Inverse Gas Chromatography (IGC)'".

A clarification is given regarding recent polemic over our original published study. The author of this polemic has claimed a few issues about the computations and data listed in our work such as choosing the wrong temperature unit and the incorrect calculation of molar heat of vaporization. Here it is elaborated the complete data and computations that are not included in the original paper, and list out also the parameters, which may be the source of difference in reported molar heat of vaporization through inverse gas chromatography methods and other conventional methods. It is showed that there are no wrong calculations or reports of molar heat of vaporization in our published paper.

Making Things Easier: A Simple Novel Method to Fix a Dorsiflexion Osteotomy of the First Metatarsal.

A first ray dorsiflexion osteotomy is commonly performed for cavovarus foot correction. There are multiple techniques to fix this osteotomy, ranging from wires, screws, and plates or a combination of these. We present our results using a varisation staple (Biomet©) as an alternative fixation device. We performed a retrospective outcome analysis of a consecutive series of 10 cavovarus feet that underwent a dorsiflexion osteotomy (dorsal closing wedge) of the first metatarsal fixed with two varisation staples. The results were measured at a mean three monthly follow-ups and included union and complication rates, as well as clinical and radiographic assessment of cavus deformity correction. There was a 100% union rate with no complications or cases of delayed union. No metalwork removal was requested in any case at follow-up. First ray dorsiflexion osteotomies are most commonly fixed using a 3.5mm cortical screw. We demonstrate that our alternative and novel technique using varisation staples achieved a 100% union rate while avoiding the prominent hardware complications known to occur with cortical screws or plates.

Spectroscopic properties of various blood antigens/antibodies.

Since the traditional method generates biological waste, there is a significant demand for an easy, quick technique of blood type identification without contamination. In fact, individuals can be divided into four main blood groups whose antigens are available in red blood cell (RBC) membranes and the antibodies in the plasma. Here, UV-vis and photoluminescence (PL) spectroscopic methods are systematically used to find the spectra of blood typing antigens (A, B and AB) and antibodies i.e. A-Anti, B-Anti, AB-Anti and D reagent. The PL spectra of RBCs in different blood groups as well as the corresponding antibodies are successfully resolved for the purpose of blood typing. The unique photophysical characteristics of these biomolecules including signal intensity and peak emission wavelength in PL spectra are lucidly anticipated to accurately discriminate ABO groups. PL spectra of RBC in positive blood typing indicate larger signal and shorter emission peak wavelength corresponding to negative ones. Furthermore, the monoclonal antibody PL emissions emphasize that Anti-A benefits higher intensity and shorter peak wavelength (blue shift) than B-Anti. In the following, lucid blue shifts are obtained in terms of antibody concentrations accompanying the elevation of fluorescence signal, most likely due to the aggregation induced emission (AIE) phenomenon, quite the opposite of the aggregation-caused quenching (ACQ) that is widely observed from conventional chromophore. Those are envisaged as unique properties of each antibody to utilize in the spectral blood typing.

Management of spiral diaphyseal fractures of the fifth metatarsal: A case series and a review of literature.

INTRODUCTION: Spiral diaphyseal fractures of the fifth metatarsal can present with significant displacement. It is considered that non-operative management is sufficient in most cases but there is no clear consensus as to what this may be. This study reports the functional outcome of this injury in a small patient cohort and is the first study to report on outcomes of different non-operative measures. MATERIAL AND METHODS: This is a retrospective study of 33 consecutive patients presenting to a central London teaching hospital who were managed by a variety of treatment modalities depending on surgeon preference which included a boot or a rigid sole shoe. Demographic data was obtained and time to pain free walking and return to normal footwear was recorded. The patients were asked how restrictive the injury was on a Likert scale (1-5). The average final follow up was 12 months. RESULTS: All fractures were managed conservatively with excellent functional outcomes. Those patients managed in a shoe had a statistically significant shorter average time to return to pain free walking (4.6 vs 8.4 weeks, p=0.027) and average time to return to normal footwear (6 vs 7.3 weeks, p=0.044) in comparison to a boot. Patients managed in a shoe reported the injury was less restrictive in comparison to patients managed in a boot (p=0.0002). The average time to evidence of bony union was 8.3 weeks. There were 3 delayed unions. CONCLUSION: All patient in this series were treated without surgery regardless of the degree of displacement. Conservative management of this fracture in a rigid sole shoe resulted in better outcomes and was reported to be less restrictive by the patients in comparison to a boot. On this basis, non-surgical management of these injuries is recommended in a shoe, full weight bearing with early range of movement of the ankle.

In Vitro Evaluation of CMV Specific CD8+T Cells Function in CMV+ Colorectal Cancer Patients Compared to Healthy Controls.

The oncogenic role of human cytomegalovirus (HCMV) has been recently shown in different cancers like colorectal cancer (CRC). According to the recent immunotherapy approach to target the CMV-expressing tumor cells, we investigated the CMV peptide-stimulated CD8+T cells functions in CRC patients compared to healthy individuals. All sixteen patients and seven controls were CMV seropositive. Blood samples were obtained from patients without chemotherapy and radiotherapy before surgery. Cytotoxic CD8+ T cells were generated using 14-day culture of PBMCs in the presences of CMV peptide epitopes and rhIL-2. In addition to the supernatant evaluations for TNF-α and IFN-γ, the functionality of CD8+ T cells was examined by detecting CD107a and intracellular IFN-γ using flow cytometry. CMV DNA was detected in tissues by Real Time PCR. CMV DNA was found in 31% of tumor tissues, while it was not seen in the adjacent non-tumor tissues. There was a close association between CMV in tumor tissue and tumor grade. Surface expression of CD107a and intracellular IFN-γ in CMV-stimulated CD8+T cells and the level of IFN-γ production in patient and control groups increased significantly after culture. The number of functions increased in patients (p<0.05) and healthy individuals after culture. Followingstimulation, expressions of CD107a and intracellular IFN-γ were elevated in tumor CMV positive patients while the TNF-α secretion was decreased. In vitro stimulation of PBMC in the presence of CMV peptide epitopes and IL-2 can be an applicable method to generate cytotoxic CD8+ T cells in CRC patients for future T cell therapy.

Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm.

BACKGROUND: There remains a lack of recognition of these fractures, which leads to a delay in diagnosis and appropriate management. METHODS: A comprehensive literature search was performed. Following inclusion and exclusion criteria, 23 studies were available for analysis. RESULTS: Delay in diagnosis is common and has a negative impact on outcome. If an APC fracture is suspected; anteroposterior, lateral and oblique plain radiographs should be requested. Further investigation with computed tomography or magnetic resonance imaging is indicated if plain radiographs are inconclusive and patient remains symptomatic. Non-operative measures are usually adequate for most undisplaced fractures, however surgical intervention maybe required for large, intra-articular fractures in the acute setting and for non-union. CONCLUSIONS: A treatment algorithm is suggested that may help with the diagnosis and management of these injuries. LEVEL OF EVIDENCE: Level IV.

First metatarsophalangeal fusion using joint specific dorsal plate with interfragmentary screw augmentation: Clinical and radiological outcomes.

BACKGROUND: This study reports the outcome of a plating system for arthrodesis of the first metatarsophalangeal joint (1st MTPJ) that incorporates a lag compression screw within a low profile titanium plate with a predetermined contour. This is the first report of the outcomes of this implant from a non-affiliated centre. PATIENT AND METHODS: This is a prospective cohort study of 40 consecutive primary 1st MTPJ arthrodesis procedures. The mean age of the cohort was 56 years (range, 20-74 years). The diagnosis was hallux rigidus in 31 patients and inflammatory arthropathy in 7 patients. RESULTS: All patients achieved clinical union at 6 weeks and radiological union was confirmed on plain radiographs between 6-16 weeks. One case of hardware removal was reported. CONCLUSION: The cohort achieved consistently satisfactory results with a reliable and reproducible MTPJ position and a 100% union rate. There was a low rate of hardware removal. LEVEL OF EVIDENCE: Level IV evidence. Prospective cohort study.

Assessment of the Thermodynamic Properties of DL-p-Mentha-1,8-diene, 4-Isopropyl-1-Methylcyclohexene (DL-limonene) by Inverse Gas Chromatography (IGC).

Limonene is a colorless liquid hydrocarbon and had been investigated as a plasticizer for many plastics. Prediction of solubility between different materials is an advantage in many ways, one of the most convenient ways to know the compatibility of materials is to determine the degree of solubility of them in each other. The concept of "solubility parameter" can help practitioners in this way.In this study, inverse gas chromatography (IGC) method at infinite dilution was used for determination of the thermodynamic properties of DL-p-mentha-1,8-diene, 4-Isopropyl-1-methylcyclohexene (DL-limonene). The interaction between DL-limonene and 13 solvents were examined in the temperature range of 63-123°C through the assessment of the thermodynamic sorption parameters, the parameters of mixing at infinite dilution, the weight fraction activity coefficient and the Flory-Huggins interaction parameters. Additionally, the solubility parameter for DL-limonene and the temperature dependence of these parameters was investigated as well.Results show that there is a temperature dependence in solubility parameter, which increases by decreasing temperature. However, there were no specific dependence between interaction parameters and temperature, but chemical structure appeared to have a significant effect on them as well as on the type and strength of intermolecular interactions between DL-limonene and investigated solvents. The solubility parameter δ2 of DL-limonene determined to be 19.20 (J/cm3)0.5 at 25°C.

Isolation, purification and structural characterization of a new water-soluble polysaccharide from Eremurus stenophyllus (boiss. & buhse) baker roots.

A new water-soluble polysaccharide (ESPS-1), with the average molecular weight of 52.1kDa and a specific optical rotation of +169.7° (c 1.0, H2O), was successfully isolated by warm-water extraction and then purified using DEAE-Cellulose and Sephadex G-100 columns from the roots of Eremurus stenophyllus. The results from chemical and instrumental tests including FT-IR, methylation and GC-MS analysis, periodate oxidation and Smith degradation, partial acid hydrolysis, and NMR spectroscopy (1H, 13C, 1H-1H COSY, HMQC and HMBC) demonstrated that ESPS-1 was a 2-O-acetylgalactan, composed of galactose, arabinose and mannose in a molar ratio of about 10:3:1, respectively. It has a backbone of (1→6)-α-d-galactopyranosyl residues, with branches at O-3 consisting of α-d-Manp-(1→3)-α-l-Araf-(1→3)-α-l-Araf-(1→3)-α-l-Araf-(1→. The acetyl groups are substituted at O-2 of (1→6)-linked Galp and the degree of acetylation was about 14%.