Pes anserine bursitis as a complication of tibial osteochondroma.

Exostosis, or osteochondroma, represents the most prevalent primary benign bone tumor, often viewed as a developmental anomaly rather than a true neoplasm. This article presents 2 cases illustrating complications associated with tibial osteochondroma. The first case involves a 25-year-old patient with recurrent medial knee pain attributed to pes anserine bursitis secondary to tibial osteochondroma, managed successfully with surgical excision. The second case features a 15-year-old with similar symptoms and unsuccessful conservative management, highlighting the diagnostic challenges and therapeutic options for this condition. Discussion encompasses the clinical presentation, diagnostic modalities including MRI and ultrasound, and management strategies such as conservative measures, corticosteroid injections, and surgical excision. Recognizing and promptly managing complications like pes anserine bursitis in tibial osteochondroma is crucial to prevent chronic pain and functional impairment, emphasizing the importance of a multidisciplinary approach involving orthopedic surgeons, radiologists, and physical therapists.

Pelvic floor muscle strength and dysfunctions in women with pes planus: A case-control study.

BACKGROUND/AIM: Distal extremity misalignment may give rise to pelvic floor dysfunctions (PFDs). This study aimed to compare pelvic floor muscle strength (PFMS) and dysfunctions in women with and without pes planus. MATERIALS AND METHODS: Women with (pes planus group, n = 30) and without pes planus (control group, n = 30) were included. The presence of PFDs questioned. Pes planus with the Feiss Line Test, PFMS with the Modified Oxford Scale, and the severity of PFDs with the Pelvic Floor Distress Inventory-20 (PFDI-20), including three subscales (Pelvic Organ Distress Inventory-6 (POPDI-6) for pelvic organ prolapse, Colorectal-Anal Distress Inventory-8 (CRADI-8) for colorecto-anal symptoms, and Urinary Distress Inventory-6 (UDI-6) for urinary symptoms, were assessed. RESULTS: It was seen that no difference was found between groups in terms of PFMS (p > 0.05). However, urinary incontinence and anal incontinence were higher in women with pes planus than in women without pes planus (p < 0.05). Only the PFDI-20, CRADI-8, and UDI-6 scores were higher in women with pes planus compared to controls (p < 0.05). There was no difference was found between groups in terms of POPDI-6 scores (p > 0.05). CONCLUSION: The PFMS did not change according to the presence of pes planus. However, the prevalence of PFDs and their severity were higher in women with pes planus in comparison to controls. Posture assessments of individuals with PFDs, especially examination of foot posture, and pelvic floor assessments of individuals with posture disorders should be considered.

Optimization of Chitosan Synthesis Process Parameters to Enhance PES/Chitosan Membrane Performance for the Treatment of Acid Mine Drainage (AMD).

Acid mine drainage (AMD) is an environmental issue linked with mining activities, causing the release of toxic water from mining areas. Polyethersulphone (PES) membranes are explored for AMD treatment, but their limited hydrophilicity hinders their performance. Chitosan enhances hydrophilicity, addressing this issue. However, the effectiveness depends on chitosan's degree of deacetylation (DD), determined during the deacetylation process for chitosan production. This study optimized the chitin deacetylation temperature, alkaline (NaOH) concentration, and reaction time, yielding the highest chitosan degree of deacetylation (DD) for PES/chitosan membrane applications. Prior research has shown that high DD chitosan enhances membrane antifouling and hydrophilicity, increasing contaminant rejection and permeate flux. Evaluation of the best deacetylation conditions in terms of temperature (80, 100, 120 °C), NaOH concentration (20, 40, 60 wt.%), and time (2, 4, 6 h) was performed. The highest chitosan DD obtained was 87.11% at 80 °C, 40 wt. %NaOH at 4 h of chitin deacetylation. The PES/0.75 chitosan membrane (87.11%DD) showed an increase in surface hydrophilicity (63.62° contact angle) as compared to the pristine PES membrane (72.83° contact angle). This was an indicated improvement in membrane performance. Thus, presumably leading to high contaminant rejection and permeate flux in the AMD treatment context, postulate to literature.

Foot Muscle Exercise: A Novel Approach to Improve Motor Functions in Children with Down Syndrome Having Pes Planus - A Randomized Controlled Trial.

OBJECTIVE: The study aimed to determine the efficacy of foot muscle exercises in children with DS having pes planus. METHODS: Forty-seven subjects randomly assigned to foot muscle exercises (study group) or an arch support insole with one-leg balance exercises (control group), thrice weekly intervention for 12-weeks followed by a home program with residual effect assessed after 24-weeks from baseline. RESULTS: The motor functions were significantly improved in both groups (p = 0.00). A positive residual effect was found in the study group for both parameters. Whilst in the control group it failed to give a positive residual effect for GMFM-88, while PBS yielded positive outcomes. The study group showed significantly better results than the control group in comparison. CONCLUSION: The novel finding suggests that the foot muscle exercise has the potential to improve motor functions in children with Down syndrome and it can be used as an alternative therapeutic approach to the conventional method.

Effects of Alkaline Cleaning Agents on the Long-Term Performance and Aging of Polyethersulfone Ultrafiltration Membranes Applied for Treatment of Car Wash Wastewater.

The commercial ultrafiltration polyethersulfone (PES) membranes (10 and 100 kDa) blended with polyvinylpyrrolidone (PVP) were applied for the filtration of car wash wastewater. Periodical membrane rinsing with water did not prevent fouling and a decrease in permeate flux was observed. Fouling was reduced by washing the membranes with cleaning agents, which are used in car washes to clean wheels and remove insects. In addition to surfactants, these agents contain NaOH, hence the pH value of cleaning solutions was over 11. Long-term contact with such solutions resulted in the removal of PVP from the membrane matrix and an increase in pore size. The PES membranes were soaked in an alkaline solution (pH = 11.5) for 20 months, after which the 200 kDa dextran rejection decreased from 95% to 80%. To compare with the static degradation conditions, 8 weeks of alkaline agent filtration was realized, after which the dextran (200 kDa) rejection decreased below 50%. This indicated that the cross-flow of alkaline agents can accelerate the removal of components building the membrane matrix. Despite membrane degradation, the separation efficiency (the rejection of chemical oxygen demand-COD, turbidity, and surfactants) during the treatment of synthetic car wash wastewater was similar to that obtained for pristine membranes.

Planovalgus Foot Deformity in Patients Undergoing Total Hip Arthroplasty Is Associated With Increased Risk of Falls, Implant-Related Complications, and Revisions: A Case-Control Analysis.

BACKGROUND: Pes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients. METHODS: A retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates. RESULTS: A total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P < .001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P < .001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P = .019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P < .001). The pes planus group had significantly greater rates of proximal humerus fractures (P = .008), but no difference was seen in distal radius fractures (P = .102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P < .001). CONCLUSIONS: Pes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning.

O mar que habita em mim: estratégias de comunicação sobre o trabalho da pesca artesanal de mulheres das águas / The sea that lives in me: communication strategies about the artisanal fishing work of women from the Waters / El mar que habita en mí: estrategias de comunicación sobre el trabajo pesquero artesanal de las mujeres de las aguas

As pescadoras artesanais do litoral de Pernambuco enfrentam os impactos das indústrias, do derramamento de petróleo e da pandemia de covid-19, conformando uma sindemia que agrava as vulnerabilidades socioe-conômicas, ambientais e sanitárias. Objetivou-se demonstrar que estratégias de comunicação e divulgação científica, como a cartilha "Saúde das mulheres das águas" e o documentário O mar que habita em mim, são importantes por promoverem a democratização do conhecimento. Trata-se de pesquisa-ação do tipo etnográfica para identificar aspectos do trabalho e da vida. Participaram 34 pescadoras, mediante grupos focais, oficina de fluxograma laboral, vivência do trabalho da pesca, análise e produção de estratégias. Esses materiais demonstram a relação saúde doença no trabalho da pesca enfatizando narrativas sobre deter-minação social da saúde. As estratégias comunicativas provocaram interesse da sociedade, promoveram debate e contribuíram para a consciência de profissionais/gestores de saúde sobre os povos das águas e as situações nos territórios.

Artisanal fisherwomen of Pernambuco face the impacts of the industries, of an oil spill and of the covid-19 pandemic, forming a syndemic that aggravates socioeconomic, environmental and health vulnerabilities. The objective was to demonstrate that scientific communication and dissemination strategies, such as the booklet "Saúde das mulheres das águas" and the documentary O mar que habita em mim, promote knowledge. This is an ethnographic type of action research to identify aspects of work and life. A total of 34 artisanal fisherwomen participated, in focus groups, labor flowchart workshop, experience of fishing work, analysis and production of strategies. These materials demonstrate the health disease relationship in fishing work, emphasizing the narratives of the fisherwomen about the social determination of their health. The communicative strategies provoked society's interests, promoted the debate and contributed to the awareness of professionals and health managers about the health of water's people and situations in the territories.

Pescadoras artesanales de pernambucano enfrentan impactos de industrias, derrame de petróleo y la pandemia de covid-19, formando una sindemia que agrava vulnerabilidades socioeconómicas, ambientales y de salud. El objetivo fue demostrar que las estrategias de comunicación y divulgación científica, como el folleto "'Salud das mujeres das aguas" y el documentario El mar que habita en mí, democratizan el conocimiento. Tiene abordaje de investigación-acción, etnográfica, para identificar aspectos del trabajo y la vida. Participaron 34 pescadoras en grupos focales, taller del flujo de trabajo, vivencia del trabajo en la pesca, análisis y elaboración de estrategias. Estos materiales demuestran la relación salud enfermedad en el trabajo pesquero, enfatizando narrativas sobre la determinación social de la salud. Las estrategias comu-nicativas despertaron el interés de la sociedad, promovieron el debate y contribuyeron a la sensibilización de los profesionales/gestores de la salud sobre los pueblos de las aguas y las situaciones de los territorios.

Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial.

OBJECTIVES: The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla. MATERIALS AND METHODS: Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12). RESULTS: No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups. CONCLUSION: Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters. CLINICAL RELEVANCE: There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.

Validation of the pink esthetic score/white esthetic score at single tooth-supported prostheses in the esthetic zone: A randomized clinical trial.

OBJECTIVES: To validate the reproducibility and inter/intra-observer variability of the Pink Esthetic Score/White Esthetic Score (PES/WES) of single tooth-supported prostheses in the maxillary esthetic zone (13-23). MATERIALS AND METHODS: Forty-five patients were randomly assigned to one of the three treatment options (15 patients per group) receiving each one a different crown type: Porcelain fused to metal (PFM), monolithic zirconia, and lithium disilicate. Eight observers from each of four different specialties (Prosthodontists, Orthodontists, Periodontists, and Oral Surgeons) were recruited and assessed twice and four weeks apart (i.e., T1 and T2) 45 photographs of the single tooth-supported prosthesis using PES/WES and compared them with contralateral teeth. RESULTS: According to the ANOVA and post hoc tests, the zirconia crown type obtained the highest mean score by all observers, with a mean value of 16.70 ± 2.94. The prosthodontists and oral surgeons assigned the lowest mean score to PFM crowns, 13.03 ± 3.47 and 13.80 ± 3.17, respectively. Notably, the prosthodontists awarded the highest scores, specifically 17.50 ± 2.81 for the zirconia crowns. Intraobserver agreement was calculated utilizing the paired t-test. Pairwise comparisons between observers of different specialties revealed significant intraobserver agreement. Interclass correlation coefficient (ICC) scores were statistically significant among four specialties. No difference was detected concerning the interobserver agreement. CONCLUSIONS: The PES/WES index remains consistent across various observers from different specializations, yielding uniform results in the overall esthetic evaluation. Consequently, in light of the presented preliminary positive results, its use might also be considered for the esthetic assessment of single-tooth-supported prostheses. CLINICAL SIGNIFICANCE: The PES/WES index may be employed clinically to evaluate single tooth-supported prostheses as it emerged as a reproducible esthetic scoring system.

Treating symptomatic flexible flatfoot deformities. a novel technique: comparison of uc berkeley laboratory foot orthosis with and without kinesio taping in juvenil athletes.

PURPOSE: Symptomatic flexible pes planus (SFPP) can cause pain and discomfort when walking or engaging in sportive activities in children and adolescents. SFPP can be treated conservatively with foot orthoses, such as the University of California Berkeley Laboratory (UCBL) foot orthosis, which can improve foot function and reduce pain. Kinesio Tape (KT) has also been used as an adjunct to foot orthoses in the treatment of pes planus. This study aims to compare the effectiveness of the UCBL foot orthosis with and without KT in the treatment of SFPP among amateur juvenile and adolescent athletes. METHODS: Fifty patients with SFPP were included in the study. In 27 patients UCBL foot orthosis with KT (group 1) was used whereas in 23 UCBL (group 2) was preferred only. The patients were evaluated with AOFAS and radiological measurements. RESULTS: The mean follow-up period was 28.6 ± 4.3(26) months. At the final follow-up AOFAS of group 1 was significantly higher than group 2. In group 2, 12 patients (%52,17) had pressure sores that caused superficial dermabrasion. Lateral TFMAs and talocalcaneal angle in group 1 was significantly better than group 2. CONCLUSIONS: This study attempted to determine if using KT with the UCBL foot orthosis was beneficial to the treatment of SFPP compared to simply wearing the orthosis. Our results suggest that KT is effective in reducing pronation and improving the AOFAS score. The use of UCBL with KT seems to be preferable in children and adolescents with SFPP since it is associated with a lower rate of complication, a higher degree of patient compliance and faster improvement in the radiological and clinical findings, compared to the use of the UCBL orthosis alone.

Effect of Foot Rehabilitation Exercises for Painful Flat Foot in a 20-Year-Old Female: A Case Study Analysis.

Pes planus, commonly referred to as flatfoot, is a congenital foot deformity characterized by the descent of the medial longitudinal arch, resulting in reduced spring action and increased stress on the foot during ambulation. This condition, opposite to pes cavus, typically lacks symptomatic presentation despite its structural abnormality. This case report discusses a 20-year-old female presenting to the musculoskeletal department of physiotherapy with impaired gait attributed to developmental flatfeet and an underdeveloped heel on one foot since birth. Apart from these foot deformities, no other significant abnormalities were noted upon examination. Orthotic management and ongoing monitoring have been initiated to facilitate functional independence. The prognosis for the patient's gait impairment remains optimistic with continued rehabilitation efforts aimed at dispelling misconceptions and barriers surrounding the correction of flatfoot deformities. This report underscores the importance of comprehensive rehabilitation strategies in managing flatfoot conditions to optimize patient outcomes and quality of life.

The Effect of Foot Rehabilitation Protocol in Adults With Congenital Deformity of Foot: An Analytical Case Series.

Congenital deformities of the foot significantly challenge the mobility and quality of life of affected individuals. While surgical interventions are common, rehabilitation protocols tailored to address the specific needs of adults with congenital foot deformities are less explored. This case series aims to evaluate the effectiveness of a specialized foot rehabilitation protocol in improving functional outcomes and quality of life in adults with congenital foot deformities. A series of cases involving adults diagnosed with congenital foot deformities were enrolled in a structured rehabilitation program. The protocol incorporated a combination of therapeutic exercises, manual therapy, gait training, and orthotic management tailored to individual needs. Outcome measures included functional assessments, gait analysis, pain levels, and patient-reported outcomes at baseline, midpoint, and endpoint of the rehabilitation program. Preliminary findings from the case series indicate significant improvements in various outcome measures following the foot rehabilitation protocol. Participants demonstrated enhanced gait parameters, reduced pain levels, increased range of motion, and improved functional capacity. Moreover, subjective assessments revealed enhanced satisfaction and perceived improvements in quality of life among participants. The findings suggest that a tailored foot rehabilitation protocol can be beneficial in improving functional outcomes and quality of life in adults with congenital foot deformities. This underscores the importance of integrating comprehensive rehabilitation strategies alongside surgical interventions to optimize long-term outcomes and enhance the overall well-being of individuals with congenital foot deformities. Further research with larger sample sizes and controlled study designs is warranted to validate these findings and establish evidence-based rehabilitation guidelines for this population.

Gait Analysis in Patients with Symptomatic Pes Planovalgus Following Subtalar Arthroereisis with the Talus Screw.

Background: Pes planovalgus is one of the most common pediatric skeletal deformities. There have been no studies to analyze in detail the spatiotemporal variables of gait following arthroereisis. Purpose of the study: The purpose of our study was to assess gait parameters in patients with symptomatic flexible flatfoot following treatment with the talus screw. Methods: This was a prospective study assessing the 22 patients treated surgically due to symptomatic flexible flatfoot with the talus screw. Patients underwent gait assessment with a G-Sensor. We analyzed the following gait parameters: gait cycle duration, step length, support phase duration, swing phase duration, double support duration, single support duration, cadence, velocity, step length. Results: The post-operative gait parameter assessment for the operated and non-operated foot showed a significant difference only in terms of step length. Cadence increased from the pre-operative mean of 82.29 steps/min to a post-operative mean of 102.94 steps/min. Gait velocity increased significantly from 0.81 m/s before to 0.96 m/s after surgery. Discussion: Arthroereisis with the talus screw helps improve gait parameters following surgery. Post-operatively, we observed increased gait velocity and cadence and decreased gait cycle duration in the operated limb. Conclusion: Short-term biomechanical outcomes of pes planovalgus treatment with the talus screw are good.

Clinical outcomes of subtalar arthroereisis for the treatment of stage 1 flexible progressive collapsing foot deformity.

BACKGROUND: The use of subtalar arthroereisis as an adjunct to the surgical treatment of stage 1 flexible progressive collapsing foot deformity (PCFD) is controversial. The aim was to investigate the clinical outcomes and report the implant removal rate of subtalar arthroereisis as an adjunct for stage 1 PCFD. METHODS: A retrospective study of 212 consecutive feet undergoing operative management of stage 1 PCFD with adjunctive subtalar arthroereisis between October 2010 and April 2018. The primary outcome was the Foot and Ankle Outcome Score (FAOS). Secondary outcomes included Foot and Ankle Disability Index (FADI), Euroqol-5D-5L Index and implant removal rate. RESULTS: Post-operative clinical FAOS outcomes were collected for 153 feet (72.2%). At mean 2.5-year follow-up, the mean ± standard deviation FAOS for each domain was as follows; Pain: 81.5 ± 18.5, Symptoms: 79.5 ± 12.9, Activities of Daily Living: 82.5 ± 15.4 and Quality of Life: 64.2 ± 23.7. EQ-5D-5L Index was 0.884 ± 0.152. Pre-operative scores were available for 20 of these feet demonstrating a statistically significant improvement in all FAOS, FADI and EQ-5D-5L domains (p < 0.05). The implant removal rate for persistent sinus tarsi pain was 48.1% (n = 102). CONCLUSION: Use of a subtalar arthroereisis implant as an adjunct to conventional procedures in stage 1 flexible PCFD can result in significant improvement in pain and function. Patients should be counselled as to the relatively frequent rate of subsequent implant removal. LEVEL OF EVIDENCE: IV.

Outcomes of the "Calcaneo-stop" procedure for treating symptomatic flexible flatfoot in children: A systematic review and meta-analysis of 2394 feet.

BACKGROUND: This study evaluates the efficacy of the calcaneo-stop (C-Stop) procedure's effectiveness in treating symptomatic flexible flatfoot (FFF) in children. METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Cochrane databases to identify studies until 2023 on the outcomes of the C-Stop procedure in children with FFF. The risk of bias was assessed using MINORS criteria. RESULTS: Of 85 studies screened, 20 involving 2394 feet from 1415 patients (mean age 11.2 ± 1.3 years) were included. Post-procedure, significant improvements were noted in pain reduction (93.5%), heel alignment (95.21%), and radiological measures, including reductions in Kite (7.32º), Meary (11.65º), Costa-Bartani angles (17.11º), talar declination (12.63º) and increase in Calcaneal Pitch Angle (5.92º). AOFAS scores increased by 22.32 points on average, with 94.83% reporting high satisfaction. Complication rate was low (7.8%). CONCLUSIONS: The C-Stop procedure is effective for treating FFF in children, offering significant clinical, radiological, and functional improvements with high patient satisfaction and a low complication rate. LEVEL OF EVIDENCE: Level IV, Systematic review of Level-IV studies.

Duration and outcome of orthotic treatment in children with clubfoot - a four-year follow-up national register study of Swedish children born between 2015 and 2017.

BACKGROUND: The Ponseti method for treating clubfoot consists of initial treatment with serial casting accompanied by achillotenotomy if needed, followed by the maintenance phase including treatment with a foot abduction orthosis (FAO) for at least four years. This study aimed to examine the duration, course, and outcome of orthotic treatment in children with clubfoot. METHODS: 321 children with clubfoot, born between 2015 and 2017, registered in the Swedish Pediatric Orthopedic Quality Register (SPOQ), were included in this prospective cohort study. Data on deformity characteristics and orthotic treatment were extracted. For children with bilateral clubfoot, one foot was included in the analysis. RESULTS: Of the 288 children with isolated clubfoot, 274 children (95.5%) were prescribed an FAO, and 100 children (35%) changed orthosis type before 4 years of age. Of the 33 children with non-isolated clubfoot, 25 children (76%) were prescribed an FAO, and 21 children (64%) changed orthosis type before 4 years of age. 220 children with isolated clubfoot (76%), and 28 children with non-isolated clubfoot (84%) continued orthotic treatment until 4 years of age or longer. Among children with isolated clubfoot, children ending orthotic treatment before 4 years of age (n = 63) had lower Pirani scores at birth compared to children ending orthotic treatment at/after 4 years of age (n = 219) (p = 0.01). It was more common to change orthosis type among children ending orthotic treatment before 4 years of age (p = 0.031). CONCLUSIONS: The majority of children with clubfoot in Sweden are treated with an FAO during the maintenance phase. The proportion of children changing orthosis type was significantly greater and the Pirani score at diagnosis was lower significantly among children ending orthotic treatment before 4 years of age. Long-term follow-up studies are warranted to fully understand how to optimize, and individualize, orthotic treatment with respect to foot involvement and severity of deformity. LEVEL OF EVIDENCE: II.

The "state of the art" of intraoperative neurophysiological monitoring: An Italian neurosurgical survey.

Introduction: Intraoperative Neurophysiological Monitoring (IOM) is widely used in neurosurgery but specific guidelines are lacking. Therefore, we can assume differences in IOM application between Neurosurgical centers. Research question: The section of Functional Neurosurgery of the Italian Society of Neurosurgery realized a survey aiming to obtain general data on the current practice of IOM in Italy. Materials and methods: A 22-item questionnaire was designed focusing on: volume procedures, indications, awake surgery, experience, organization and equipe. The questionnaire has been sent to Italian Neurosurgery centers. Results: A total of 54 centers completed the survey. The annual volume of surgeries range from 300 to 2000, and IOM is used in 10-20% of the procedures. In 46% of the cases is a neurologist or a neurophysiologist who performs IOM. For supra-tentorial pathology, almost all perform MEPs (94%) SSEPs (89%), direct cortical stimulation (85%). All centers perform IOM in spinal surgery and 95% in posterior fossa surgery. Among the 50% that perform peripheral nerve surgery, all use IOM. Awake surgery is performed by 70% of centers. The neurosurgeon is the only responsible for IOM in 35% of centers. In 83% of cases IOM implementation is adequate to the request. Discussion and conclusions: The Italian Neurosurgical centers perform IOM with high level of specialization, but differences exist in organization, techniques, and expertise. Our survey provides a snapshot of the state of the art in Italy and it could be a starting point to implement a consensus on the practice of IOM.

Dynamic Gait Analysis in Paediatric Flatfeet: Unveiling Biomechanical Insights for Diagnosis and Treatment.

BACKGROUND: Flatfeet in children are common, causing concern for parents due to potential symptoms. Technological advances, like 3D foot kinematic analysis, have revolutionized assessment. This review examined 3D assessments in paediatric idiopathic flexible flat feet (FFF). METHODS: Searches focused on paediatric idiopathic FFF in PubMed, Web of Science, and SCOPUS. Inclusion criteria required 3D kinematic and/or kinetic analysis during posture or locomotion, excluding non-idiopathic cases, adult feet, and studies solely on pedobarography or radiographs. RESULTS: Twenty-four studies met the criteria. Kinematic and kinetic differences between FFF and typical feet during gait were outlined, with frontal plane deviations like hindfoot eversion and forefoot supination, alongside decreased second peak vertical GRF. Dynamic foot classification surpassed static assessments, revealing varied movement patterns within FFF. Associations between gait characteristics and clinical measures like pain symptoms and quality of life were explored. Interventions varied, with orthoses reducing ankle eversion and knee and hip abductor moments during gait, while arthroereisis normalized calcaneal alignment and hindfoot eversion. CONCLUSIONS: This review synthesises research on 3D kinematics and kinetics in paediatric idiopathic FFF, offering insights for intervention strategies and further research.

"On-the-fly" Crystal : How to reliably and automatically characterize and construct potential energy surfaces.

In this work, the Crystal  code, developed previously by the authors to find "holes" as well as legitimate transition states in existing potential energy surface (PES) functions [JPC Lett. 11, 6468 (2020)], is retooled to perform on-the-fly "direct dynamics"-type PES explorations, as well as automatic construction of new PES functions. In all of these contexts, the chief advantage of Crystal  over other methods is its ability to globally map the PES, thereby determining the most relevant regions of configuration space quickly and reliably-even when the dimensionality is rather large. Here, Crystal  is used to generate a uniformly spaced grid of density functional theory (DFT) or ab initio points, truncated over the relevant regions, which can then be used to either: (a) hone in precisely on PES features such as minima and transition states, or; (b) create a new PES function automatically, via interpolation. Proof of concept is demonstrated via application to three molecular systems: water (H 2 O), (reduced-dimensional) methane (CH 4 ), and methylene imine (CH 2 NH).

Complications of ultrasound guided very small-bore chest drains for pleural effusions of different etiology.

Background: Small-bore chest drains are now the most common drains for treating pleural effusion (PE), but knowledge on complications is limited especially in malignant PE and empyema. We aimed to evaluate rate of complications of ultrasound guided small bore chest drains [6-10 French (F)] by PE etiology. Methods: Retrospective cohort study of 484 chest drains inserted in 330 adults in a Swedish department 2018-2020. Rate of complications (blockage, dislocation, infection, or misplacement) and repeat intervention (new drain within 2 weeks or surgery) was analyzed by effusion type (organ failure, parapneumonic, malignant, empyema, other, unknown), age, sex, seniority of radiologist, and bore size using multivariable logistic regression. Results: Most inserted drains (73.3%) were 6 F. The rate of repeat intervention was substantially higher in malignant PE [25.5%; adjusted odds ratio (aOR) 3.3; 95% confidence interval (CI): 1.6-6.8] and empyema (56.4%; aOR 11.9; 95% CI: 4.8-29.4) compared to other aetiologies (range, 9.5-17.8%). Surgery as complication occurred in empyema in 23.0% of cases (aOR 10.6; 95% CI: 1.4-79.4). The rate of repeat intervention in simple PE (parapneumonic or due to organ failure) was low (range, 9.5-12.5%). Conclusions: A single small-bore chest drain (6-10 F) was successful in the vast majority of simple PEs, but had high complication rates in empyema with frequent need of additional drains or surgery. These findings support use of larger drains and early consultation with a thoracic surgeon in empyema.