Cartiva interpositional arthroplasty versus arthrodesis in the treatment of Hallux rigidus: A retrospective comparative study with mean 2 year follow up.

BACKGROUND: Hallux rigidus is a common condition characterised by first metatarsophalangeal joint (MTPJ) degeneration, pain and limited range of motion (ROM). The gold standard surgical treatment is arthrodesis, providing good pain relief, but sacrifices ROM. The Cartiva synthetic cartilage implant (SCI) has been utilised as an interpositional arthroplasty, aiming to reduce pain whilst preserving range of motion. Current evidence for Cartiva SCI is limited. The aim was to evaluate the clinical outcomes of Cartiva SCI compared to arthrodesis undertaken in our centre. METHODS: A retrospective cohort study was conducted, enrolling all adult patients who underwent primary first MTPJ SCI arthroplasty or arthrodesis for the treatment hallux rigidus. The primary outcome was a validated patient-reported outcome measure (PROM), the Manchester-Oxford Foot Questionnaire (MOXFQ). Secondary outcomes included EQ-5D, complication rates, VAS Pain and FAAM (ADL). RESULTS: Between 2017 and 2020 there were 33 cases divided into two groups (17 Cartiva SCI, 16 arthrodesis, mean age 59.0 ± 9.9 years) with a mean follow up of 2.3 years. There was no statistically significant difference in any of the MOXFQ, EQ-5D, VAS Pain or FAAM (ADL) outcome scores between the Arthrodesis and SCI groups (p > 0.05). The mean MOXFQ Index score was 7.2 ± 6.4 for the SCI group and 3.9 ± 5.8 for the Arthrodesis group at final follow up (p = 0.15). Although complications were high in both groups, the overall hallux reoperation rate was 29.4 % in the SCI cohort and 0.0 % for arthrodesis. CONCLUSION: This retrospective comparative study found no significant superiority of Cartiva SCI over arthrodesis in terms of PROMs. Due to the higher rate of further surgical intervention in the SCI cohort, we recommend arthrodesis as the preferred surgical option for hallux rigidus. LEVEL OF EVIDENCE: III.

Selective head cooling and acute kidney injury in neonates with hypoxic ischemic encephalopathy.

BACKGROUND: The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS: Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS: The incidence of AKI as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS: Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. TRIAL REGISTRATION NUMBER: NCT02683915.

Flexibility of Heterocercal Tails: What Can the Functional Morphology of Shark Tails Tell Us about Ichthyosaur Swimming?

The similarities between ichthyosaurs and sharks are a text-book example of convergence, and similarities in tail morphology have led many to theorize that they had similar swimming styles. The variation of ichthyosaur tail shapes is encompassed within the diversity of shark families. In particular early ichthyosaurs have asymmetrical tails like the heterocercal tails of carcharhinid sharks, while later occurring ichthyosaurs have lunate tails similar to those of lamnid sharks. Because it is not possible to measure ichthyosaur tail function, the goal of this study is to measure and compare the flexibility and stiffness of lunate and heterocercal shark tails, and to measure skeletal and connective tissue features that may affect tail flexibility. We measured flexibility in 10 species and focused on five species in particular, for dissection: one pelagic and one bottom-associated individual from each order, plus the common thresher shark (Alopias vulpinus), a tail-slapping specialist. As expected, lunate tails were overall less flexible than heterocercal tails and had greater flexural stiffness. Our results suggest that the cross-sectional profile of the skeletally supported dorsal lobe dictates flexural stiffness, but that changing tissue composition dictates flexural stiffness in the ventral lobe. We also found structural differences that may enable the tail slapping behavior of the common thresher shark. Finally, we discuss how our morphological measurements compare to ichthyosaur measurements from the literature; noting that similarities in functional morphology suggest sharks may be a good analog for understanding ichthyosaur swimming biomechanics.

Juvenile dermatomyositis: clinical profile and disease course in 25 patients.

A retrospective analysis of 25 Arab patients with juvenile dermatomyositis (JDMS) was conducted between 1988 and 1996. The mean age at disease onset was 8.25 years (range 1.5-15 yrs) with a male: female ratio of 1.5:1. The disease duration before diagnosis was 1-108 months. Two patients had a family history of JDMS. The clinical features included fever in 14 patients (56%), weight loss in 20 (80%), muscle weakness in all 25 (100%), and muscle pain in 14 (56%). Skin lesions included Gottron's papules in 15 patients (60%), heliotrope in 13 (52%), erythematous malar rash in 8 (32%), and pigmentary changes in 12 (48%). Seventeen of the 25 patients had arthralgia (68%) and 16 patients had arthritis (64%). Gastrointestinal symptoms were noted in 19 patients (76%). Myocarditis with cardiac failure was the initial presentation of 1 patient, while 2 had conduction defect. Twelve patients (48%) had respiratory symptoms. The course of the disease was complicated by calcinosis in 10 patients (40%). All of the patients were treated with prednisone; 15 were also treated with methotrexate. The duration of follow up ranged from 6-108 months (mean 54.5 months). Twenty-three patients improved, including those who had calcinosis at the time of presentation, with a current muscle power of 4/5 in 10 patients (40%) and 5/5 in 13 patients (52%). No deaths were reported in our series and no patients are currently bedridden.

The arterial supply of the urinary bladder.

(1) The urachal artery has a primary origin from the umbilical artery itself, and is at first bilateral. (2) The arterial pattern in newborn infants is not identical to that of adults. Obliteration of the umbilical artery in older infants carries with it obliteration of some of its branches, especially at their origin from its distal part, with a resulting change in arterial pattern. (3) The middle vesicle artery is a fairly constant branch of the umbilical artery, supplying the bladder neck and the front of the bladder above the neck. (4) The urachal and middle vesicle arteries, when unilateral, occur with equal frequency on both sides. (5) The anastomosis between superior vesical and inferior episgastric arteries was confirmed in the subperitoneal tissues, but was very rare in the wall of the bladder, occurring only when an abnormal obturator artery was the source of a superior vesical branch. (6) The constancy of the vesiculo-deferential artery is confirmed.

Arterial supply to the hypogastric and presacral nerves.

The hypogastric nerves take an arterial supply from the internal iliac artery either directly or from one of its main branches close to its origin from the parent trunk. Sometimes the supply is from the lower end of the common iliac artery. In half the cases examined the presacral nerve takes an arterial supply from the aorta at its bifurcation.

Female prostate in Arvicanthis niloticus and Meriones libycus.

A female prostate is reported in Arvicanthis niloticus (field rat) and Meriones libycus for the first time, as a normal, constant and well developed bilateral sex organ.

Male uterus in the donkey and horse.

The anatomy and histology of the male uterus were studied in the donkey and the horse. In the former it was found complete and long, while in the latter it was incomplete or absent. Some variations met with are described. A new concept of "internal male hermaphroditism' is presented and two types are differentiated.

Comparative study of Gartner's duct in the camel.

Gartner's duct is fairly constant in the camel, especially in young animals. It contains fluid secretion, yellowish translucent and viscid in character. Secondary coagulation of the secretion occurs on standing, and so becomes gelatinous. The ducts were histologically studies and glandular acini were found opening in them. An explanation of the manner of formation of Gartner's duct cyst is suggested. Gartner's duct may be a functioning accessory gland of the female sexual apparatus in the camel.

A comparative study of the urinary bladder and the intramural portion of the ureter.

The bladder belonging to eleven mammalian species were investigated, and as a result the following observations were made: (1) a submucous ureter was found in the case of most of the species examined; (2) histological investigation revealed three types of intramural ureters, and (3) downward extension of ureteric musculature, separate from bladder musculature, to the seminal colliculus in the male, or to the lower end of the urethra in the female, was found. A suggestion is presented to explain the manner by which the ureteric openings change their relations to those of the mesonephric ducts development. It seems that 'after absorption of the common segment of the Wolffian duct, breaking down of the ventral wall of ureter' is the most likely process.

Female prostate and urethral glands in the home rat, Rattus norvegicus.

A female prostate related to the upper end of the urethra and neck of the bladder is reported. The glandular acini are lined by cubical or low columnar epithelium and contain esosinophilic secretion. Urethral glands are also found in the wall of the female urethra.

A short study of the seminal colliculus in some mammals.

The seminal colliculus is completely absent in the donkey. It is fibroglandular in the males of camel, ox, buffalo and pig. Prostatic acini are richly found in its depth. They are lined by cubical or low columnar epithelium, are separated from each other by trabeculae of connective tissue and smooth muscle, and separated from the deeper prostrate gland by the striated muscle of the urethra. A rare type of seminal colliculus was once encountered in the ox. This type is muscular with autonomic ganglia and complete absence of glandular acini. It seems that the seminal colliculus shares the prostate in its glandular functions and prevents oozing of semen from the seminal ducts.

Venous drainage of the urinary bladder.

The venous drainage of the urinary bladder was studied in 20 pelvic halves (14 males and 6 females). Vesical and prostatic plexuses draining the bladder (vesical only in females) were found in 16 cases; they supplied blood to the internal iliac vein--usually by two to five veins--the most common number being three. One vein always drained the prostatic plexus. The vesical and prostatic plexuses were absent in 4 male cases, where the vesical veins issuing from the bladder wall drained directly the internal iliac vein. Their number in such cases was minimal: between one and two only, on each side. The union of a vesical vein issuing from any of the two mentioned plexuses (when found) with the obturator, prostatic or vaginal vein was common. A shunt from a common trunk of united obturator and vesical veins to the external iliac vein was noticed in some cases. Occasionally, an inferior vesical vein ending in the obturator vein accompanied an inferior vesical artery initiating from the obturator artery.

Assessment of gentamicin-induced nephrotoxicity in rats treated with low doses of ibuprofen and diclofenac sodium.

1. The effects of two non-steroidal anti-inflammatory drugs, ibuprofen (20 mg day-1 kg-1) and diclofenac sodium (2.5 mg day-1 kg-1), on the severity of gentamicin-induced nephrotoxicity were evaluated in rats. 2. Administration of gentamicin (100 mg day-1 kg-1) for 5 days resulted in a significant increase in renal cortical total phospholipids accompanied by a significant decrease in cortical Na+, K(+)-ATPase activity. These changes were associated with a significant decrease in body weight and increases in kidney weight, serum creatinine and urea nitrogen. 3. In rats treated simultaneously with both gentamicin and either ibuprofen or diclofenac sodium for 5 days, all the measured parameters of renal dysfunction were similar in magnitude to those observed in rats treated with gentamicin alone. 4. In contrast, rats treated with either ibuprofen or diclofenac sodium for 27 days and injected concurrently with gentamicin during the last 5 days of the treatment period had significantly higher kidney weight, lower renal cortical Na+, K(+)-ATPase activity and higher cortical phospholipid content, serum creatinine and urea nitrogen than did rats treated with gentamicin alone. A 27-day treatment with ibuprofen or diclofenac sodium alone resulted in no change in renal function. 5. These results demonstrate that gentamicin nephrotoxicity was potentiated after the long (27 days) but not after the short (5 days) period of treatment with ibuprofen and diclofenac sodium. Thus, prolonged administration of non-steroidal anti-inflammatory drugs should be considered as a risk factor that may increase the nephrotoxic potential of gentamicin.