Main Deformity Research Articles

Brachioradialis to flexor digitorum profundus tendon transfer to restore finger flexion

Introduction:The main deformity following an adult lower brachial plexus injury is the loss of finger flexion. Distal nerve transfers have been used to restore finger and thumb flexion followed by tendon transfers for intrinsic replacement for opening of the fingers. When patients present beyond 6 months, only tendon transfers are applicable. Since the brachioradialis (BR) is always spared in such injuries, it is the ideal muscle to provide finger flexion. Wrist extensor power may not be normal for the use of the radial wrist extensor to serve as donor. BR to FDP transfer provides reasonable flexion range and an acceptable hand function to permit activities of daily living, when associated with ancillary procedures like opponensplasty, PIPJ arthrodesis.Materials and Methods:Eleven patients underwent a BR to FDP tendon transfer between January 2013 and January 2017 of which eight patients came for follow-up.Results:Four of the eight patients got a functionally useful hand to carry out activities of daily living with hook grip, span grasp, key pinch, chuck grip and pulp pinch. These patients also underwent simultaneous or secondary ancillary procedures. Four of the patients need secondary procedures to further improve functionality of the hand inspite of having a flexion range.Conclusion:The BR is an effective donor in providing adequate range and power of finger flexion in lower plexus injuries.

Revision rhinoplasty: physician-patient aesthetic and functional evaluation.

IntroductionApproximately 5–15% of patients submitted to rhinoplasty operations undergo revision surgery. Those patients have varied functional and aesthetic complaints that should receive a detailed assessment that includes all the expectations the patient had before the previous procedure.ObjectiveTo draw the profile of the main aesthetic-functional complaints reported by patients to be submitted to revision rhinoplasty and to correlate them with the internal and external objective nasal evaluation performed by the surgeon.MethodsA prospective study was conducted with 43 patients to be submitted to revision rhinoplasty and their respective surgeons, by applying a questionnaire about the patients’ epidemiological questions and subjective aesthetic-functional complaints as well as the respective functional deformities observed by the surgeons. Subsequently, these data were correlated with the purpose of observing the frequency of congruent reports between physicians and patients.ResultsThe presence of drooping tip and residual bridge hump were the patients’ main complaints, confirmed by the surgeons. The correlation between subjective obstructive symptoms and the intranasal evaluation performed by surgeons was shown to be present in 87.5% of the cases. Among the patients with respiratory symptoms, the main deformity identified was residual septal deviation in 56.25% of the cases.ConclusionThe drooping tip followed by residual hump were the main complaints reported by the patients and confirmed by the objective examination by the physicians. The presence of nasal obstructive complaints in 37.2% of the patients shows that greater attention needs to be paid to functional deformities during the first surgical procedure. The differences observed between patients’ complaints and surgeons’ evaluations confirm the need for detailed assessment and clarification to the patients regarding their expectations and actual surgical possibilities.

Early Detection of Progressive Adolescent Idiopathic Scoliosis: A Severity Index.

Early detection of progressive adolescent idiopathic scoliosis (AIS) was assessed based on 3D quantification of the deformity. Based on 3D quantitative description of scoliosis curves, the aim is to assess a specific phenotype that could be an early detectable severity index for progressive AIS. Early detection of progressive scoliosis is important for adapted treatment to limit progression. However, progression risk assessment is mainly based on the follow up, waiting for signs of rapid progression that generally occur during the growth peak. Sixty-five mild scoliosis (16 boys, 49 girls, Cobb Angle between 10 and 20°) with a Risser between 0 and 2 were followed from their first examination until a decision was made by the clinician, either considering the spine as stable at the end of growth (26 patients) or planning to brace because of progression (39 patients). Calibrated biplanar x-rays were performed and 3D reconstructions of the spine allowed calculating six local parameters related to main curve deformity. For progressive curve 3D phenotype assessment, data were compared with those previously assessed for 30 severe scoliosis (Cobb Angle > 35°), 17 scoliosis before brace (Cobb Angle > 29°) and 53 spines of nonscoliosis subjects. A predictive discriminant analysis was performed to assess similarity of mild scoliosis curves either to those of scoliosis or nonscoliosis spines, yielding a severity index (S-index). S-index value at first examination was compared with clinical outcome. At the first exam, 53 out of 65 predictions (82%) were in agreement with actual clinical outcome. Approximately, 89% of the curves that were predicted as progressive proved accurate. Although still requiring large scale validation, results are promising for early detection of progressive curves. 2.

Une étude descriptive et podoscopique des déformations du pied dans le syndrome de Down

IntroductionSubjects with Down syndrome (DS) are known to be affected by various foot deformities. Despite the fact that some of these deformities have been reported in the literature, a more comprehensive description would be of benefit. The aim of this study is to investigate the prevalence of known foot deformities in patients with DS and of other previously non-described foot anomalies in this population. HypothesisSubjects with DS have an increased prevalence of foot deformities compared to control subjects. MethodsFifty-five subjects with DS (age: 14.6±7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of fifty-three subjects (age: 13.4±11.2 years). ResultsSignificantly more prevalent foot deformities were found in the DS group: hallux valgus (36.4%), syndactyly between the 2nd and 3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, joint laxity (43.6%) was significantly more prevalent in the DS group. Furthermore, the presence of an increased space between the 1st and 2nd toes in patients with DS and its prevalence (73.6%) were described for the first time. A multivariate analysis revealed a significant relationship between the presence of joint laxity and flatfoot in only the control but not the DS group. Other foot deformities were found to be consistently more frequent in the DS population but not significantly higher than the control group. DiscussionAlthough subjects with DS had significantly greater joint laxity and BMI compared to the control group, neither of these factors was found to be related to the increased prevalence of flatfoot in DS patients. Level of evidenceIV – retrospective study.

A podoscopic and descriptive study of foot deformities in patients with Down syndrome

IntroductionSubjects with Down syndrome (DS) are known to be affected by various foot deformities. Despite the fact that some of these deformities have been reported in the literature, a more comprehensive description would be of benefit. The aim of this study is to investigate the prevalence of known foot deformities in patients with DS and of other previously non-described foot anomalies in this population. HypothesisSubjects with DS have an increased prevalence of foot deformities compared to control subjects. MethodsFifty-five subjects with DS (age: 14.6±7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of fifty-three subjects (age: 13.4±11.2 years). ResultsSignificantly more prevalent foot deformities were found in the DS group: hallux valgus (36.4%), syndactyly between the 2nd and 3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, joint laxity (43.6%) was significantly more prevalent in the DS group. Furthermore, the presence of an increased space between the 1st and 2nd toes in patients with DS and its prevalence (73.6%) were described for the first time. A multivariate analysis revealed a significant relationship between the presence of joint laxity and flatfoot in only the control but not the DS group. Other foot deformities were found to be consistently more frequent in the DS population but not significantly higher than the control group. DiscussionAlthough subjects with DS had significantly greater joint laxity and BMI compared to the control group, neither of these factors was found to be related to the increased prevalence of flatfoot in DS patients. Level of evidenceIV–retrospective study.

Imaging assessment of glenohumeral dysplasia secondary to brachial plexus birth palsy.

ObjectiveTo assess imaging parameters related to the morphology of the glenohumeral joint in children with unilateral brachial plexus birth palsy (BPBP), in comparison with those obtained for healthy shoulders.Materials and MethodsWe conducted a retrospective search for cases of unilateral BPBP diagnosed at our facility. Only patients with a clinical diagnosis of unilateral BPBP were included, and the final study sample consisted of 10 consecutive patients who were assessed with cross-sectional imaging. The glenoid version, the translation of the humeral head, and the degrees of glenohumeral dysplasia were assessed.ResultsThe mean diameter of the affected humeral heads was 1.93 cm, compared with 2.33 cm for those of the normal limbs. In two cases, there was no significant posterior displacement of the humeral head, five cases showed posterior subluxation of the humeral head, and the remaining three cases showed total luxation of the humeral head. The mean glenoid version angle of the affected limbs (90-α) was -9.6º, versus +1.6º for the normal, contralateral limbs.ConclusionThe main deformities found in this study were BPBP-associated retroversion of the glenoid cavity, developmental delay of the humeral head, and posterior translation of the humeral head.

Relationship between the different torsion-related thoracic deformity parameters of adolescent idiopathic scoliosis.

Torsion has recently become essential in curve evaluation, not only to assess the degree of clinical deformity that can influence decision making, but also to predict curve progression. Since torsion cannot be currently measured using plain X-rays, our aim was to study the relationships between the different torsion-related parameters measured on 2D radiographs that can indirectly guide the clinician about the torsion of a given curve. This is a cross-sectional study analyzing prospectively registered data of a consecutive cohort of 113 AIS patients with progressive main thoracic deformity. Demographic data, the Adams test and eight radiographic torsion-related coronal and sagittal deformity parameters [apical vertebral rotation (AVR)-Stokes method, Mehta angle (RVAD), main thoracic Cobb side-bending, T5-T12 kyphosis, T5-T8 kyphosis, T9-T12 kyphosis, kyphotic change and double rib contour sign (rib index)] were correlated between each other and with the main thoracic Cobb angle (MTCobb). Univariate linear regression and multiple linear stepwise regression analyses were performed as well. The radiographically measurable deformity parameters that best correlated with the MTCobb angle in idiopathic curves were: side-bending, RVAD, AVR and the Adams test. Sagittal variables were correlated the least with MTCobb. Coronal parameters as AVR, RVAD, side-bending and Adam test are highly intercorrelated. Sagittal variables are related between each other but are not directly related to coronal parameters. There is a strong relationship between the Cobb angle, curve bending, the Mehta angle and the apical vertebral rotation. Together with the clinical Adams test, these are the most important radiographic torsion-related parameters to measure when assessing scoliosis in 2D. 3.

Description clinique et radiologique des malformations des pieds et des membres inférieurs chez les patients atteints du syndrome de Down

Subjects with Down syndrome (DS) are known to be affected by various lower limb deformities [1], [2]. Foot deformities are often neglected in DS patients because of the high prevalence of concomitant life threatening disorders. The aim of this study is to investigate the prevalence of clinical and radiological feet and lower limb deformities in patients with DS. Fifty-five subjects with DS (14.6 A7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of 53 subjects (13.4 A11.2 years). Forty-two subjects of the DS group (15 A7 years) had undergone an EOSy biplanar X-rays exam of their pelvis and lower limbs. The EOS parameters were compared to an asymptomatic control group of 27 subjects (16.12 A6 years). The following foot deformities were found to be significantly more prevalent in DS group - hallux valgus (36.4%), syndactyly between 2nd–3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, an increased space between the 1st and 2nd toes in patients with DS with a prevalence of 73.6% was found. Patellar instability (42.7%) and joint laxity (43.6%) were also significantly more prevalent in the DS group. The following EOS parameters were significantly higher in DS group compared to control group - pelvic incidence (53°A13° vs. 44°A10°, P < 0.001), sacral slope (48°A9° vs. 37°A6°, P < 0.001) and femoral neck-shaft angle (133°A6° vs. 131°A5°, P = 0.021). On the other hand, other EOS parameters were significantly higher in the control group - femoral head diameter (mean = 41 vs. 38) and femoral offset (mean = 37.64 vs. 34). There were no significant differences between the DS and the control groups for both femoral anteversion and tibial torsion. This study confirms the previously reported high prevalence of foot deformities in patients with DS [2]. Furthermore, increased space between the first and second toes was described for the first time in Down syndrome patients. Considering its high prevalence, further studies should be directed towards exploring the functional implications of this deformity. To our knowledge, this is the first study to measure lower limb and pelvic radiological parameters of patients with DS. The morphology of both the pelvis and the proximal femur were affected in patients with DS. Further studies should explore the effect of these anomalies on gait and posture in this group of patients.

Progressive non-infectious anterior vertebral fusion in a baby with Saethre-Chotzen-acrocephalosyndactyly type III syndrome

We report on a 3-months old baby of Austrian origin and product of non-consanguineous parents. Abnormal craniofacial contour was the main deformity. The overall clinico-radiographic features were consistent with Saether-Chotzen-acrocephalosyndactyly type III syndrome. Bi-directional sequencing of the exon 8 and of the FGFR3-genes, exons 7 of FGFR3 (Fibroblast growth factor receptor3) genes, the exon 5 of the FGFR1 gene, revealed no mutations. Sagittal MRI imaging of the spine showed anterior vertebral fusion along the thoraco-lumbar vertebrae compatible with the non-infectious type.

Vertebral coplanar alignment technique: a surgical option for correction of adult thoracic idiopathic scoliosis.

Previous studies have demonstrated vertebral coplanar alignment (VCA) as an effective surgical option for adolescent idiopathic scoliosis (AIS). The purpose of this study is to analyze the outcome of VCA for the surgical correction of adult idiopathic scoliosis (AdIS). 35 AdIS patients (mean age: 24.2 years) undergoing VCA-instrumentation were reviewed. The main thoracic curve and thoracic kyphosis (TK, T5-T12) were evaluated preoperatively, immediate postoperatively, and at the final follow-up (>1 year). All patients were stratified by the TK modifier before surgery: "+" (TK, >40°), "-" (TK, <10°), and "N" (TK, 10°-40°) for normal. The apical vertebral body-to-rib ratio (AVB-R), rib hump (RH), and rotational angle to sacrum (RAsac) were measured to assess the correction of rotational deformity. Quality of life was evaluated with SRS-20 questionnaires. The main thoracic curve (59.1° vs. 19.3°, P < 0.001) and rotational deformity (AVB-R: 2.4 vs. 1.7 %, P < 0.001, RH: 34.9 vs. 19.1 mm, P < 0.001, RAsac: 19.6° vs. 11.9°, P < 0.001) were significantly reduced with surgery. Sagittal deformity improved significantly in group "+" (51.4° vs. 31.6°, P < 0.001) and group "-" (6.2° vs. 20.1°, P < 0.001), while no significant postoperative change in TK was observed in group "N" (23.5° vs. 26.3°, P = 0.270). Patients were followed for an average of 18.7 months with no significant loss of correction. SRS scores improved greatly from 57.7 preoperatively to 71.6 at the final follow-up. VCA can be effectively used for the correction of the coronal and rotational deformity, with better sagittal profile restoration in adult thoracic idiopathic scoliosis with sagittal malalignment.

Nasal sequelae of Treacher Collins syndrome

This study aimed to determine external and endonasal deformity, and satisfaction with nasal functioning and appearance, in Treacher Collins syndrome. A cross-sectional cohort study was conducted. Eleven adult patients with Treacher Collins syndrome were compared with 151 controls in terms of satisfaction with nasal functioning and appearance by means of the Nasal Appearance and Function Evaluation Questionnaire. In all patients with Treacher Collins syndrome, external nasal deformities were scored on standardized digital photographs of the nose as rated independently by three experienced physicians. Endonasal deformity was determined by standardized nasal endoscopy. The patients were relatively satisfied with the various esthetic nasal subunits. The most significant functional problems were snoring (P=0.001) and quality of phonation (P=0.003). The main external nasal deformities were the dorsal hump (73%), external deviation (≤55%), the bifid or bulbous nasal tip (55%), and columellar septal luxation (55%). In 82% of the patients, a septal deviation was found, often associated with spurs. Satisfaction with esthetics of the nose was fair, but these patients suffer from the functional problems of snoring and impaired quality of phonation. A structured nasal ENT physical examination with nasal endoscopy might determine aspects requiring more attention during treatment. Septorhinoplasty can be performed at an adult age if there is a considerable esthetic wish of the patient and/or nasal obstruction combined with septal deviation. Attention should be paid to dorsal hump reduction, correction of the deviated external osseous framework, septoplasty, and correction of the nasal tip shape. 2b.

Spinal cord intramedullary pressure in thoracic scoliotic deformity: a cadaveric study.

In vitro cadaveric study of thoracic spinal cord intramedullary pressure (IMP) in scoliotic deformity. To define the relationship between thoracic scoliotic deformity and spinal cord IMP. Clinical studies of patients with thoracic scoliosis without other spinal pathology (spinal stenosis, etc.) have rarely reported an associated thoracic myelopathy. Previous clinical and cadaveric studies of kyphosis have reported associated myelopathy and increased spinal cord IMP. We sought to determine if IMP changes in response to main thoracic scoliotic deformity. In 6 fresh-frozen cadavers, a progressive main thoracic scoliotic deformity was created. Cadavers were positioned sitting with physiological spinal alignment, head stabilized using a skull clamp and spine segmentally instrumented from occiput to L3. The T3-T4 ligamentum flavum was removed, dura opened, and 3 pressure sensors were advanced caudally to T4-T5, T7-T8, and T10-T11 within the cord parenchyma. A step-wise main thoracic scoliotic deformity was then induced by sequentially releasing and retightening the skull clamp while coronally bending, concavity compressing, and convexity distracting posterior segmental instrumentation, allowing closure of lateral segmental osteotomies. After each step, fluoroscopic images and pressure measurements were obtained; the T4-T11 coronal Cobb angle was measured. Induction of main thoracic scoliosis did not significantly increase IMP. The mean main thoracic maximal scoliotic deformity created was 77° ± 2° (range: 71°-84°). At maximal deformity, the mean ΔIMP at T4-T5, T7-T8, T10-T11 was 2.2 ± 1.9 mm Hg, 1.0 ± 0.7 mm Hg, and 1.0 ± 0.8 mm Hg, respectively. In this cadaveric study, main thoracic scoliotic deformity did not significantly increase thoracic IMP. This correlates with clinical presentation such that clinical studies of patients with thoracic scoliosis without other spinal pathology have rarely reported an associated thoracic myelopathy with the thoracic scoliosis. This study helps explain the relative absence of myelopathy in isolated main thoracic coronal plane deformity. 5.

Step by Step Extra-Focal Fixation of Unstable Pelvis with Separate Anterior and Posterior Modules

Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.

Step by Step Extra-Focal Fixation of Unstable Pelvis with Separate Anterior and Posterior Modules

Results of step by step treatment of 28 patients with disintegrative pelvic ring injuries are presented. In 14 patients (main group) step by step extra-focal pelvic fixation with application of anterior (antishock) and posterior modules was performed. In 14 patients (control group) osteosynthesis by external fixation device with circular support was used. Long-term results were assessed in1 year after injury. In control group residual deformity averaged 5 (4-7) mm and was noted in 10 (71.4%) patients. In the main group residual deformity was observed in 4 (28.6%) cases and averaged 2.5 (2-3) mm (p=0.0039). In the main group functional result by Majeed scale was also significantly better (p=0.000319). Excellent and good results were achieved in 9 (64.3%) and 5 (35.7%) of patients, respectively. In control group results were considered to be excellent in 3 (21.4%), good - in 6 (42.9%), satisfactory - in 4 (28.6) and poor - in 1 (7.1%) of cases. Advantage of the proposed transosseous osteosynthesis technique is the modular principle of the construction use that enables to perform separate fixation with anterior (antishock) module followed by final reposition of the pelvic ring with posterior module after stabilization of patient’s vital functions. This allows to increase the number of external pelvic fixation in patients with polytrauma.

Hatching, survival and deformities of piracanjuba (Brycon orbignyanus) embryos subjected to different cooling protocols

Groups of one hundred Brycon orbignyanus embryos at the stage of blastopore closure were subjected to different cooling protocols. Different combinations and concentrations of cryoprotectants were tested: sucrose, methanol, ethylene glycol and dimethyl sulfoxide (Me2SO); at different temperatures (0.0±2.0°C and 8.0±2.0°C) and refrigeration times (6, 10, 24, 72 and 168h), with the exception of the positive control (incubation without previous cooling). At the end of each refrigeration time, the embryos were acclimatized, rehydrated and incubated to determine hatching, survival and deformity rates. Morphological analysis of embryos was also carried out. The results showed that temperature and refrigeration time are critical factors for embryo survival. No embryos survived after 24, 72 and 168h of refrigeration. Furthermore, when the refrigeration time increased from 6 to 10h and the temperature decreased from 8.0±2.0°C to 0.0±2.0°C, mortality rates increased significantly. It was also found that in all protocols dead eggs and/or larvae with some degree of deformity were present. The main larval deformities observed were the malformation of the head, tail, yolk sac, vertebral column and eyes.

Medical tactic in hand polydactyly in children

Untimely correction of anomalies of fingers and hands or inefficiently performed reconstructive operations may affect the processes of adaptation of children to life. Objective: To improve outcomes in children with polydactyly by optimizing the methods of surgical correction of congenital hand pathology. Methods: During the period from 2000 to 2012 in 118 patients (70 boys, 48 girls, age to 6 years) with polydactyly there were performed 141 operations on 136 hands. There were 68 children with radial form of polydactyly, 17 with ulnar form, and 3 with central one. For establishment of the nature of the pathology examination with using of radiological, CT, and ultrasound dopplerography mapping was done. Results: In the case of the main finger deformity after removal of additional finger we performed corrective osteotomies, modeling resections of articular surfaces, and restored capsular-ligamentous apparatus. In cases of ulnar polydactyly with thickening of V metacarpal bone on the wide head of which there are two claw like little fingers we removed less developed one, cut off the abductor digiti minimi, restored lateral metacarpophalangeal ligament, fixed the muscle to the proximal phalanx, angular deformity of the V finger we eliminated by wedge osteotomy with K-wire fixation. In cases of central polydactyly after removal of extra finger we used created from a remote segment reserve of skin for closing the skin defect on lateral surfaces of the fingers with simultaneous correction of axial deformities. Long-term outcomes were followed up during the period of 1 to 10 years in 78 children: good results were obtained in 44 cases, satisfactory — in 27, and unsatisfactory — in 7 cases. Errors and complications: deviation of the main finger, nonunion of bone surfaces, scar deformities, limitation of movement. Conclusions: While choosing the method of surgery and duration of its execution one should establish the primary and the secondary fingers in cases of radial polydactyly. Zigzag incisions, rational skin, bone and tendon plasty allow to prevent the formation of scar contractures and secondary deformities of fingers and contribute to the restoration of the hand function.

Responses of different body compartments to acute dietary phosphorus deficiency in juvenile triploid rainbow trout (Oncorhynchus mykiss , Walbaum)

Rainbow trout (Oncorhynchus mykiss) is an important production species as well as one of the most studied fish models, particularly regarding nutritional physiology. Due to negative environmental impacts linked with rainbow trout farm effluents, significant restrictions have been established in numerous regions to reduce dietary phosphorus (P) outputs. However, questions have arisen regarding the link between abnormal skeletal development and mineralization and insufficient dietary P availability during rapid fish growth (juvenile fish). Despite significant work to understand the dynamics of P-deficiency and the resulting impact on tissue mineralization, the extent of the early responses in rainbow trout fed low-P diets is not well described. The aim of this study was to explore the early-responses of scales, vertebrae and carcass P and ash in rainbow trout fed low-P vs sufficient-P controls. Two practical diets (sufficient: 0.45% available P and deficient: 0.29% available P) were fed over a 5-week period to triploid rainbow trout (initial mass 60.8 ± 1.6 g). Ash and P contents were used to assess mineral status of the different tissues. The relative loss of mineral and coefficient of variation were also calculated to compare the relative response and the inter-individual variability. After 4 weeks of P deprivation, no detectable effects were observed on growth performance, mortality or feed intake. However, as early as the second week onward, ash and P levels in scales and carcasses were significantly lower (p < 0.05) in fish fed a P-deficient diet compared to those fed a P-sufficient diet. At week 4, the reduction in mineralization reached 19.3 and 18.4% for P and ash contents in scales, respectively. By the same week, P and ash contents in carcasses reached 15.1 and 12.8%, respectively. Interestingly, the absence of significant mineral loss in vertebrae did not prevent the emergence of a high incidence of vertebral deformities in P-deficient fish (45.6 ± 11.0%) when compared to P-sufficient fish (1.5 ± 2.1%). The main vertebral deformities observed in P-deficient trout were specific to impede bone matrix mineralization such as pronounced biconcave (35.5%) and undersized and widely spaced vertebral bodies (9.3%). For the scales compartment (ash and P status) and mineral parameter, the coefficients of variation showed a higher inter-individual variability in P-deficient vs P-sufficient fish, while no such effect was observed in carcass or vertebrae compartment. This study provides a useful comparison of various commonly-used indicators of bone mineral status as well as an approach to assess variability of fish response under low-dietary P level.

Apical and intermediate anchors without fusion improve Cobb angle and thoracic kyphosis in early-onset scoliosis.

The main goal of treatment in early-onset scoliosis is to obtain and maintain curve correction while simultaneously preserving spinal, trunk, and lung growth. This study introduces a new surgical strategy, called the modified growing rod technique, which allows spinal growth and lung development while controlling the main deformity with apical and intermediate anchors without fusion. The use of intraoperative traction at the initial procedure enables spontaneous correction of the deformity and decreases the need for forceful correction maneuvers on the immature spine and prevents possible implant failures. This study seeks to evaluate (1) curve correction; (2) spinal length; (3) number of procedures performed; and (4) complications with the new approach. In the initial procedure, polyaxial pedicle screws were placed with a muscle-sparing technique. Rods were placed in situ after achieving correction with intraoperative skull-femoral traction. The most proximal and most distal screws were fixed and the rest of the screws were left with nonlocked set screws to allow vertical growth. The lengthening reoperations were performed every 6months. Between 2007 and 2011, we treated 19 patients surgically for early-onset scoliosis. Of those, 16 (29%) were treated with the modified growing rod technique by the senior author (AH); an additional three patients were treated using another technique that was being studied at the time by one of the coauthors (CO); those three were not included in this study. The 16 children included nine girls and seven boys (median, 5.5years of age; range, 4-9years), and all had progressive scoliosis (median, 64°; range, 38°-92°). All were available for followup at a minimum of 2years (median, 4.5years; range, 2-6years). The initial curve Cobb angle of 64° (range, 38°-92°) improved to 21° (range, 4°-36°) and was maintained at 22° (range, 4°-36°) throughout followup. Preoperative thoracic kyphosis of 22° (range, 18°-46°) was maintained at 23° (range, 20°-39°) throughout followup without showing any substantial change. There was a 47mm (range, 38-72mm) increase in T1-S1 height throughout followup. The mean number of lengthening operations was 5.5 (range, 4-10). The mean T1-S1 length gain from the first lengthening was 1.18cm (range, 1.03-2.24cm) and decreased to 0.46cm (range, 0,33-1.1cm) after the fifth lengthening procedure (p=0.009). The overall complication rate was 25% (four of 16 patients) and the procedural complication rate was 7% (seven of 102 procedures). We did not experience any rod breakages or other complications apart from two superficial wound infections managed without surgery during the treatment period. The only implant-related complications were loosening of two pedicle screws at the uppermost foundation in one patient. In this preliminary study, the modified growing rod technique with apical and intermediate anchors provided satisfactory curve control, prevented progression, maintained rotational stability, and allowed continuation of trunk growth with a low implant-related complication rate.

Baseline Characteristics from an Ongoing Phase 3 Study of Collagenase Clostridium Histolyticum in Patients with Peyronie's Disease

Peyronie's disease (PD) is a localized penile collagen disorder of the tunica albuginea associated with significant physical deformity and psychological impairment. Current understanding of pretreatment characteristics in patients with chronic PD is limited by small samples, varied quality of assessments, and the lack of a PD-specific, validated measure of the psychosexual impact of PD. Reporting baseline demographic and disease characteristics of the large multinational cohort of subjects with chronic PD who participated in the collagenase clostridium histolyticum (CCH, an investigational intralesional injection and minimally invasive intervention) phase 3 clinical study program. Findings from well-defined assessments, including the Peyronie's Disease Questionnaire (PDQ), the first validated PD-specific patient-reported measure of psychosexual impact, are reported. Subjects included men≥18 years old with PD symptoms≥12 months and penile deformity between 30° and 90°. Analysis data included demographics, disease history, and psychosexual impact. Penile deformity, disease symptoms, the International Index of Erectile Function, and the PDQ were assessed. Eight hundred thirty-two subjects were enrolled from 64 sites across the United States and Australia. The mean age was 57.7 years; mean PD duration was 4.1 years. The majority of subjects had penile deformity≤60° (77.3%); mean penile deformity was 50.5°. Subjects reported having intercourse a mean of 10.2 times in the previous 3 months, 70.8% reported difficulty in performing vaginal intercourse, and 80.4% reported less frequent vaginal intercourse. Approximately 71.5% of subjects with severe (>60°) and 58.1% of subjects with mild/moderate (≤60°) penile deformity were "very bothered" or "extremely bothered" upon last look at their erect penis (P=0.0041), as measured by the PDQ. These data add to the body of knowledge regarding the clinical impact of chronic phase PD, including the PD-specific patient-reported psychosexual symptoms, using a large multinational chronic PD cohort in the CCH phase 3 clinical program.

Prevalence and treatment of dentofacial deformities on a multiethnic population: a retrospective study

The purpose of the present study was to retrospectively analyze patients with dentofacial deformities attending a reference center in a Brazilian educational institution who sought orthosurgical treatment. The medical records of 251 patients who sought treatment from 2003 to 2011 at Piracicaba Dental School, State University of Campinas (Unicamp) were analyzed. The exclusion criteria were as follows: patients presenting syndromes and labiopalatal clefts; in addition, incomplete records were excluded from the study. The prevalence of dentofacial deformities was greater in women (60.93 %), as well as leukoderma patients (69.22 %). The main motivation for treatment was functional (52 %), followed by esthetics (27 %). As for skeletal pattern, class III was the most incident (55 %), followed by class II (29.5 %) and class I (15.5 %). Regarding the type of deformity, class I patients had predominantly maxillary atresia (53 %). In the case of class II patients, the main deformity was anteroposterior mandibular deficiency (89 %), and in class III, anteroposterior maxillary deficiency (51 %). The results of the present study suggest that the profile of patients bearing dentofacial deformities in this population is composed of mostly young women motivated by functional issues, and class III skeletal deformity is the most common.