Third-generation minimally invasive correction of hallux valgus: technique and early outcomes.

PURPOSE: There is growing evidence supporting minimally invasive surgical (MIS) techniques for correction of symptomatic hallux valgus. The aim of this study was to present a hybrid third-generation technique and assess the safety and efficacy from the first 45 procedures. METHODS: Forty-five consecutive feet underwent a third-generation MIS distal chevron osteotomy with a minimum six month follow-up (range six to 17 months). This technique uses both first- and second-generation techniques plus a distal chevron osteotomy and screw for improved control and stabilisation of the metatarsal head. All patients were clinically assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). Radiographic measures included hallux valgus angle (HVA), intermetatarsal angle (IMA), first metatarsal length and overall toe length. RESULTS: There were significant improvements in all three domains of the MOXFQ (p <0.001). There was also significant improvement in all radiographic parameters (p < 0.001). Mean HVA decreased from 30.54° to 10.41°, and the mean IMA decreased from 14.55° to 7.11°. Shortening of the first metatarsal had no effect on clinical outcomes. There was a very low rate of complications. CONCLUSION: The short-term results of this third-generation technique show that it is a safe procedure with good clinical outcomes and compares favourably with earlier techniques.

Experimental studies in air medical research.

This article is the 18th in a multipart series designed to assist readers, particularly novices, in the area of clinical research. This article is focused on the process of developing a new research project. It provides tools to help those involved in beginning their own research projects.

The effect of a point mutation on the stability of IgG4 as monitored by analytical ultracentrifugation.

There is presently considerable interest in the state of aggregation and biophysical integrity of antibody preparations, and recent advances in the analysis of data from the analytical ultracentrifuge renders it a powerful probe of these stability phenomena, under both storage and freeze-thaw conditions. Solutions of a wild-type IgG4 antibody and a single amino acid hinge mutant IgG4m (serine residue 241 converted to proline) were exposed to different accelerated stress conditions, namely (i) elevated temperature storage for various periods (up to 59 days at 37 degrees C) or (ii) a series of freeze-thaw cycles (storage at -80 degrees C then incubation at 20 degrees C for 1 h under different conditions). Analysis using the nondisruptive probe of sedimentation velocity in the analytical ultracentrifuge indicated that for both antibodies the monomer was always the most common species present whatever storage regime had been used. Sedimentation coefficient distribution analysis showed that other higher oligomer species and half-antibodies were present, and appeared to be not in chemical equilibrium with each other. Solution heterogeneity was found to increase considerably with treatment for both native and hinge-mutant antibodies although the latter appeared to be more resistant to freeze-thaw-induced aggregation.

The acceptability of physical activity programming within a smoking cessation service for individuals with severe mental illness.

OBJECTIVE: There is a high prevalence of smoking and physical inactivity among individuals with severe mental illness (SMI). The current study assessed the acceptability of introducing physical activity, including perceived advantages and disadvantages, as an adjunct to a smoking cessation service within this population. METHODS: 109 participants with SMI who were receiving smoking cessation treatment completed a survey assessing perceived interest in physical activity and a 24-item decisional balance questionnaire reflecting potential advantages and disadvantages of becoming more physically active. RESULTS: The majority of the participants reported being interested in assistance in becoming more active [63% (69/109)]. The highest rated advantages reported were 'It would improve my health or reduce my risk of disease' and 'It would improve how I feel about myself'. Cost, and being active by oneself were the most frequently reported barriers. CONCLUSION: This study suggests that many individuals with SMI seeking treatment for smoking cessation may also be receptive to assistance in becoming more physically active. Such individuals endorse both advantages and disadvantages more frequently than those not interested. PRACTICE IMPLICATIONS: This study provides preliminary support for the acceptability of adding physical activity as a smoking cessation strategy with SMI individuals. Addressing salient barriers will be critical to integrating physical activity within this smoking cessation service.

Delay to surgery does not affect survival following osteoporotic femoral fractures.

AIMS: Fragility femoral fractures occur in a similar group of patients to hip fractures but they are not routinely managed along standardised guidelines. This study looked specifically at whether delay to surgery has an impact on mortality and morbidity. PATIENTS AND METHODS: An international, multi-centre retrospective review was carried including all patients over 60 years with fragility femoral fractures, including most periprosthetic fractures, between December 2008-2014. RESULTS: 243 patients met the inclusion criteria with mean follow-up 25 months. 197 (81%) were female with mean age 81 years. Median time to surgery was 2 days; 39% were operated on <24h, 23% 24-48h, and 37% at >48h. 3- and 12-month mortality were 14% (95% CI: 9-18%) and 26% (20-31%) respectively. On Kaplan-Meier plotting, relationships were apparent between survival and sex, and ASA grade, but not delay to surgery or fracture type. CONCLUSION: Fragility femoral fractures have equivalent mortality to hip fractures but we found no link between delay to surgery and mortality. We believe it is safe to delay surgery, within reason, whilst their acute and chronic medical problems are optimised. We believe this information will help develop guidelines similar to hip fracture pathways.

How does sport psychology actually improve athletic performance? A framework to facilitate athletes' and coaches' understanding.

The popularity of sport psychology, both as an academic discipline and an applied practice, has grown substantially over the past two decades. Few within the realm of competitive athletics would argue with the importance of being mentally prepared prior to an athletic competition as well as the need to maintain that particular mindset during a competitive contest. Nevertheless, recent research has shown that many athletes, coaches, and sporting administrators are still quite reluctant to seek out the services of a qualified sport psychologist, even if they believe it could help. One of the primary reasons for this hesitation appears to be a lack of understanding about the process and the mechanisms by which these mental skills affect performance. Unlike the "harder sciences" of sport physiology and biochemistry where athletes can see the tangible results in themselves or other athletes (e.g., he or she lifted weights, developed larger muscles, and is now stronger/faster as a result), the unfamiliar and often esoteric nature of sport psychology appears to be impeding a large number of athletes from soliciting these important services. As such, the purpose of this article is to provide the reader with a simple framework depicting how mental skills training translates into improved within-competition performance. This framework is intended to help bridge the general "understanding gap" that is currently being reported by a large number of athletes and coaches, while also helping sport psychology practitioners sell their valuable services to individual athletes and teams.

Factors influencing antibody stability at solid-liquid interfaces in a high shear environment.

A rotating disk shear device was used to study the effect of interfacial shear on the structural integrity of human monoclonal antibodies of IgG4 isotype. Factors associated with the solution conditions (pH, ionic strength, surfactant concentration, temperature) and the interface (surface roughness) were studied for their effect on the rate of IgG4 monomer loss under high shear conditions. The structural integrity of the IgG4 was probed after exposure to interfacial shear effects by SDS-PAGE, IEF, dynamic light scattering, and peptide mapping by LC-MS. This analysis revealed that the main denaturation pathway of IgG4 exposed to these effects was the formation of large insoluble aggregates. Soluble aggregation, breakdown in primary structure, and chemical modifications were not detected. The dominant factors found to affect the rate of IgG4 monomer loss under interfacial shear conditions were found to be pH and the nanometer-scale surface roughness associated with the solid-liquid interface. Interestingly, temperature was not found to be a significant factor in the range tested (15-45 degrees C). The addition of surfactant was found to have a significant stabilizing effect at concentrations up to 0.02% (w/v). Implications of these findings for the bioprocessing of this class of therapeutic protein are briefly discussed.