Tissue Release Research Articles

Orthodontically induced changes to the genetic profile in periodontal ligament tissue and cytokine release in gingival crevicular fluid – A pilot investigation

Background/purposeIt has been known that genetic factors influence orthodontic tooth movement, however, scientific research on humans is lacking. Therefore, this study aimed to investigate dynamic changes to the genetic profile in human periodontal ligament (PDL) tissue and cytokine release in gingival crevicular fluid (GCF) during the first 28 days of orthodontic treatment. Materials and methodsFifteen teeth from three patients were recruited. Full-mouth fixed appliances with extraction of four premolars and one maxillary third molar was planned for orthodontic treatment. GCF collection and tooth extraction were performed following force application for 0, 1, 3, 7, and 28 days. GCF was analyzed using multiplex immunoassay for 27 cytokines. PDL tissue was collected after extraction and submitted for RNA exome-sequencing using Illumina sequencing platform. Further analysis of differentially expressed genes (DEGs), gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways, and heatmaps were conducted. ResultsGCF cytokine levels varied among three patients; some patients exhibited a peak cytokine level on Day 0 whereas others did so on Days 1–3. In RNA exome sequencing data, GO and KEGG analyses showed that genes associated with sensory receptors were upregulated on Day 1, genes involved in bone remodeling were upregulated on Days 3 and 28, and genes related to osteoclast differentiation were upregulated on Day 7. ConclusionRNA sequencing data demonstrate that the specific types of genes are expressed at different time points, whereas the data on cytokine changes show a large variation in concentration levels and dynamic change patterns among the patients.

Treatment perspective after failed open reduction of congenital hip dislocation. A systematic review.

Failure of open reduction of developmental hip dislocation is a serious complication and revision surgery appear to be technically demanding with high complication rates. Little attention has been given in literature to patients in whom open reduction of developmental hip dislocation has failed. We present a systematic review about current perspectives and timing when to perform surgical revision after failed open reduction of developmental hip dislocation in children. Following the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) statements we performed a comprehensive search of the PubMed and Google Scholar bibliographic database in order to select all studies published between 1980 and 2022. Studies were screened for the reasons for failure of open reduction, timing when revision surgery was performed, and for the surgical techniques used for revision. A total of 10 articles including 252 patients and 268 hips has been recorded. The most common causes of re-dislocation after open reduction are inadequate exposure and failure to release the obstructing soft tissues inside and around the hip. In 90% of the cases the anterolateral approach was performed for revision surgery. Avascular necrosis occurred in 5%-67% of cases and was the most encountered complication. Redislocation of developmental hip dislocation after an open reduction has poor long-term outcomes mainly due to a high rate of avascular necrosis of the femoral head. It is mandatory to obtain a stable reduction at the second surgery combining soft tissue release, capsulorrhaphy, pelvic and femoral osteotomies.

Abstract P3191: Hur Mediates Calcium-driven Thermogenesis In Brown Adipose Tissue

Since the discovery of brown adipose tissue (BAT) in adult humans, its high energy capacity has driven investigations targeting adipose tissue thermogenesis as a supplement to whole-body energy expenditure to mitigate the energy imbalances observed in obesity. Uncoupling protein 1 (UCP1) is the primary driver of thermogenesis, however several additional UCP1-independent pathways have been identified. We previously reported that adipocyte deletion of the RNA binding protein human antigen R (HuR) results in thermogenic dysfunction independent of UCP1. RNA sequencing revealed the downregulation of several genes involved in calcium ion transport upon HuR deletion. Although recently established as a thermogenic mechanism in beige adipocytes, the effects of calcium-mediated thermogenesis in brown fat and its contribution to whole-body metabolism remain unexplored. Therefore, we set out to investigate the impact and regulatory mechanism of HuR on SR calcium cycling and heat generation in BAT. We hypothesize that HuR regulates thermogenesis in brown adipose tissue through control of RyR-mediated SR calcium release and assessed this experimentally using murine models with a BAT-specific deletion of HuR. Brown adipocytes isolated from BAT-HuR -/- mice were imaged for cytosolic calcium and heat using Fluo-4 calcium indicator and ERthermAC dye respectively. Cohorts of mice were also subjected to acute cold challenge or placed on a 12-week high fat diet study to assess whole-body thermal and energy metabolism. We now show that loss of HuR decreases adrenergic-stimulated calcium release and heat generation in brown adipose tissue, and that this effect is rescued by pharmacological stabilization of RyR2. We also report that HuR directly binds RyR2 mRNA in vivo and loss of HuR reduces RyR2 mRNA transcript stability. In assessing whole-body metabolism, we observed impaired thermal tolerance of BAT-HuR -/- mice from controls, as well as sex-dependent effects on diet-induced weight gain between models. Our findings reveal, for the first time, that brown adipocytes participate in calcium-mediated thermogenesis and identify a regulatory role for HuR in coordinating heat production through maintenance of RyR2 calcium release activity.

Soft Tissue Releases With Simultaneous Guided Growth Decrease Risk of Spastic Hip Displacement Recurrence.

Soft tissue release (STR) is an established treatment for spastic hip displacement, but recurrence of hip displacement is not uncommon. This study aims to (1) evaluate the recurrence of hip displacement after STR, (2) define associated factors of recurrence, and (3) elucidate the effects of guided growth on hip displacement recurrence. The study subjects included 66 individuals with spastic cerebral palsy treated by STR with or without guided growth for hip displacement. The treatment goal was the maintenance of migration percentage (MP) to <40%. Recurrence was defined by a rebound of the MP by 5% or more after the first postoperative year. Children with recurrence were compared with those without recurrence using the Mann-Whitney U test and the χ 2 test. The risk factors for recurrence were evaluated using multiple logistic regression analysis. Nineteen individuals (29%) had a recurrence of hip displacement after the first postoperative year. They sustained a 2-fold increase in the rate of treatment failure ( P < 0.001) and reoperation ( P = 0.04). Age, sex, motor function, and preoperative radiographic parameters were comparable between individuals with and without recurrence. The use of guided growth was associated with less risk of recurrence than without (5% and 39%, respectively, odds ratio = 0.01 to 0.45, respectively) despite the similar risk of failure (35% and 48%, respectively, odds ratio = 0.15 to 4.82). Recurrence of the MP >5% after the first postoperative year is an important early indicator for failure to control MP to <40% and reoperation. Guided growth not only decreases coxa valga but also reduces the risk of recurrent hip displacement after STR. Level III; case-control study.

GSH/APE1 Cascade-Activated Nanoplatform for Imaging Therapy Resistance Dynamics and Enzyme-Mediated Adaptive Ferroptosis.

Ferroptosis, as a type of programmed cell death process, enables effective damage to various cancer cells. However, we discovered that persistent oxidative stress during ferroptosis can upregulate the apurinic/apyrimidinic endonuclease 1 (APE1) protein that induces therapeutic resistance ("ferroptosis resistance"), resulting in an unsatisfactory treatment outcome. To address APE1-induced therapeutic resistance, we developed a GSH/APE1 cascade activated therapeutic nanoplatform (GAN). Specifically, the GAN is self-assembled by DNA-functionalized ultrasmall iron oxide nanoparticles and further loaded with drug molecules (drug-GAN). GSH-triggered GAN disassembly can "turn on" the catalysis of GAN to induce efficient lipid peroxidation (LPO) for ferroptosis toward the tumor, which could upregulate APE1 expression. Subsequently, upregulated APE1 can further trigger accurate drug release for overcoming ferroptosis resistance and inducing the recovery of near-infrared fluorescence for imaging the dynamics of APE1. Importantly, adaptive drug release can overcome the adverse effects of APE1 upregulation by boosting intracellular ROS yield and increasing DNA damage, to offset APE1's functions of antioxidant and DNA repair, thus leading to adaptive ferroptosis. Moreover, with overexpressed GSH and upregulated APE1 in the tumor as stimuli, the therapeutic specificity of ferroptosis toward the tumor is greatly improved, which minimized nonspecific activation of catalysis and excessive drug release in normal tissues. Furthermore, a switchable MRI contrast from negative to positive is in sync with ferroptosis activation, which is beneficial for monitoring the ferroptosis process. Therefore, this adapted imaging and therapeutic nanoplatform can not only deliver GSH/APE1-activated lipid peroxide mediated adaptive synergistic therapy but also provided a switchable MRI/dual-channel fluorescence signal for monitoring ferroptosis activation, drug release, and therapy resistance dynamics in vivo, leading to high-specificity and high-efficiency adaptive ferroptosis therapy.

Evaluation of Pre-emptive Analgesia in Total Knee Arthroplasty During Early Post-operative Periods.

Pre-emptive analgesia isexpected to decrease post-operative pain. The degree of soft tissue release is directly related to preoperative deformity; we presume the severity of pain has a similar correlation in patients undergoing total knee arthroplasty (TKA). The main purpose of this research was to evaluate the effects of pre-emptive analgesia of different drugs in TKA with different degrees of preoperative genu varus. In this prospective observational study, 67 patients were enrolled with different degrees of genu varus deformity. They were subdivided into two groups: those with ≥15° and those with <15° varus deformities of the knee. Etoricoxib 60 mg and pregabalin 75 mg were administered orally in all the patients as pre-emptive analgesia two hours before surgery. Parameters such as the amount of soft tissue release, visual analog score(VAS), knee range of motion, complications, etc. were documented from the pre-operative period to 72 hours post-TKA. With pre-emptive analgesia in post-TKA patients, the VAS score demonstrated a statistically significant difference at 24, 48, and 72 hours. The comparison of intraoperative flexion between <15° and ≥15° showed a statistically significant difference with pre-emptive analgesia in post-TKA patients. The use of etoricoxib 60 mg and pregabalin 75 mg, two hours before surgery reduced the pain scores in patients undergoing TKA with different degrees of genu varus and correlated with intraoperative parameters associated with soft medial tissue release for genu varus.

Biphosphoglycerate Mutase: A Novel Therapeutic Target for Malaria?

Biphosphoglycerate mutase (BPGM) is a tri-functional enzyme expressed exclusively in erythroid cells and tissues that is responsible for the production of 2,3-biphosphoglycerate (2,3-BPG) through the Rapoport-Luebering shunt. The 2,3-BPG is required for efficient glycolysis and ATP production under anaerobic conditions, but is also a critical allosteric regulator of hemoglobin (Hb), acting to regulate oxygen release in peripheral tissues. In humans, BPGM deficiency is very rare, and is associated with reduced levels of erythrocytic 2,3-BPG and ATP, left shifted Hb-O2 dissociation curve, low P50, elevated Hb and constitutive erythrocytosis. BPGM deficiency in mice recapitulates the erythroid defects seen in human patients. A recent report has shown that BPGM deficiency in mice affords striking protection against both severe malaria anemia and cerebral malaria. These findings are reminiscent of studies of another erythrocyte specific glycolytic enzyme, Pyruvate Kinase (PKLR), which mutational inactivation protects humans and mice against malaria through impairment of glycolysis and ATP production in erythrocytes. BPGM, and PKLR join glucose-6-phosphate dehydrogenase (G6PD) and other erythrocyte variants as modulating response to malaria. Recent studies reviewed suggest glycolysis in general, and BPGM in particular, as a novel pharmacological target for therapeutic intervention in malaria.

Modified Chevron osteotomy for treatment of Hallux valgus

Background And Objective: Hallux valgus is the most common forefoot deformity in adults, especially in females. Almost 150 different procedures have been described for the treatment of Hallux valgus deformity. Modified distal metatarsal Chevron osteotomy with distal soft tissue release is one of the most effective procedures for the correction of mild to moderate Hallux valgus deformity.&#x0D; Methods: This is a prospective observational study conducted at Department of Orthopedic Surgery Services hospital Lahore from Jan 2018 to Jan 2019 After Taking permission from the hospital ethical review board, this prospective observational study was carried out at the Services institute of medical sciences Lahore. A total number of 20 patients of age between 25-65 years were included in the study. There were 16 females and 4 males with four patients having mild while 16 patients had moderate Hallux valgus.Written consent was obtained from each patient.Each patient underwent dorsoplantar and lateral views in weight-bearing position including Axial Sesamoid view of the foot. On x-rays we measured the Hallux valgus angle(HV), inter-metatarsal (IMA) while clinically each patient was assessed for American orthopedic foot and ankle society score(AOFAS) pre-operatively.In all these patients we performed the Modified chevron osteotomy with lateral soft tissue release and medial eminence excision with capsular repair.Post-operative follow-up was done at two weeks, six weeks, 3 months and at one year. And each follow-up of these patients were assessed radiologically for HV angle and IMA.Clinically each patient was assessed for AOFAS score.&#x0D; Results: &#x0D; Total no of patients enrolled in our study were 20 with 16 females and 4 males. The age range was 25-65 years(37.5). Four patients had mild Hallux valgus while 16 patient had moderate Hallux valgus.Pre-operative mean AOFAS score was 56.50 ± 3.54 with a range of 50-70. Six patients had B/L Hallux valgus deformity. Thus a total no. of 23 feet in 20 patient underwent Modified Chevron osteotomy with distal soft tissue release. Before surgery the mean HV angle was 31.52°±6.44° with a range of 20°-40° while mean IMA was 18°±1.10° with range of 12°-20°.The AOFOS score improve from 56.50±3.54 pre-operatively to 85.95±6.15 with range of 75-98 after 06 weeks post-operatively and remained static at 03 months and after 06 months post-operatively.It further Improve to 94±1.25 after 01 year at the final follow up.The mean HV angle was improve from 31.52°±6.44° pre-operatively to 6.4°±1° after 06 weeks with a range of 4°-8° and6.42°±1° after 01 year with a range of 4°-7° post operatively.The mean IMA improved from 18±1.10 pre-operatively to 5.4±1.30 with range of 4°-8° after 06 weeks post-operatively and 5.6°±1.1° with the range of 4°-8° at the end of 01 year.The osteotomy union time was 10-16 weeks after the surgery.There was no recurrence of the deformity, Infection, stiffness of the joint and avascular necrosis of metatarsal head noted post-operatively at the end of one year. First metatarsal shortening was 4-6 mm (mean 3.6±1.2mm) at the final follow up.&#x0D; Conclusion: &#x0D; Modified chevron osteotomy with distal soft tissue release is a good procedure for correction of mild to moderate Hallux valgus. It allows a significant lateral displacement of distal fragment (4.5mm). This osteotomy improves the foot biomechanics, has got durable functional and cosmetic result.The patient satisfaction was also good (90.5%).

Republication of "Minimally Invasive Surgery Using the Circular External Fixator to Correct Neglected Severe Stiff Equinocavus Foot Deformities".

Stiff equinocavus deformities of the foot are challenging to treat, often requiring extensive soft tissue dissection and bone removal. These procedures frequently yield suboptimal results and not infrequently amputation. Minimally invasive surgery using a circular external fixator potentially avoids the trauma to the soft tissue and may lead to improvement in outcomes and a lower amputation rate. The objective of this study was to evaluate the efficacy of minimally invasive surgery using a circular external fixator and limited soft tissue release to correct stiff equinocavus deformities. The treatment outcome of 29 patients (31 feet) with stiff equinocavus deformities of the foot and ankle treated with minimally invasive surgery and circular external fixation were reviewed after a mean follow-up period of 63 months. Patients' demographics and cause of the deformities were recorded. Weight bearing radiographs of the foot were compared pre and postoperatively. Outcome was satisfactory (plantigrade foot with improvement/resolution of pain) in 21 of 31 extremities, fair in 6 of 31 extremities, and poor in 4 of 31 extremities. In the majority of patients, a significant improvement in the equinocavus deformities was achieved with a statistically significant improvement in calcaneus and navicular height. Two patients with Charcot-Marie-Tooth and severely insensate feet had a poor outcome, resulting in transtibial amputation. Minimally invasive surgery with gradual correction of neglected stiff equinocavus deformities using a modular circular external fixator is a reliable initial limb salvage strategy. Minimally invasive surgery and gradual correction of neglected severe stiff equinocavus deformities using the modular circular external fixator to gradually correct neglected severe stiff equinocavus deformities, is a safe initial limb salvage strategy which may simplify secondary procedures such as arthrodesis. IV.

Three-Month Complication Rate of Ultrasound-Guided Soft Tissue Surgical Procedures Across Six Sports Medicine Clinics.

To 1) determine the types and frequency of complications within 3 months following ultrasound-guided surgical procedures, and 2) identify any patient demographics, co-morbidities, or procedural characteristics that were associated with an increased risk of complications. A retrospective chart review was performed at six Sports Medicine clinics across the United States. The Clavien-Dindo classification was used to categorize procedural complications on a 5-point scale from 1, representing any deviation in post-procedure care without requiring pharmacological or invasive treatment to 5, representing death. Generalized Estimating Equations for binomial outcomes with a logit link were used to estimate the overall and procedure-specific 3-month complication rates. Among 1902 patients, 8.1% (n = 154) had diabetes and 6.3% (n = 119) were current smokers. The analysis included 2,369 procedures, which were performed in either the upper extremity (44.1%, n = 1045) or lower extremity (55.2%, n = 1308) regions. The most common procedure was ultrasound-guided tenotomy (69.9%, n = 1655). Additional procedures included, trigger finger release (13.1%, n = 310), tendon scraping (8.0%, n = 189), carpal tunnel release (5.4%, n = 128), soft tissue release (2.1%, n = 50), and compartment fasciotomy (1.6%, n = 37). Overall, there was a complication rate of 1.2% (n = 29 complications; 95% CI: 0.8-1.7%). Individual procedures had complication rates that ranged from 0 to 2.7%. There were 13 Grade I complications in 13 patients, 12 Grade II complications in 10 patients, 4 Grade III complications in 4 patients, and 0 Grade IV or V complications. No associations between complication risk and any patient demographics (age, sex, BMI), co-morbidities (diabetes, smoker), or procedure characteristics (type, region) were identified. This retrospective review provides an evidence-based estimate supporting the low level of risk associated with ultrasound-guided surgical procedures for patients from a variety of geographical settings who are seeking care at private and academic-affiliated clinics.

Incidence of soft tissue releases in robotic assisted cementless TKA with mechanical alignment and flexion gap balancing

BackgroundTo ensure the success of total knee arthroplasty (TKA), precise bone cuts and a well-balanced soft tissue envelope are crucial. Soft tissue release may be necessary, subject to various factors. Therefore, documenting the type, frequency, and necessity of soft tissue releases can establish a benchmark for comparing different alignment techniques and philosophies and evaluating their outcomes. The purpose of this study was to demonstrate that robotic-assisted knee surgery requires minimal soft tissue release.MethodsWe prospectively documented and retrospectively reviewed the soft tissue releases employed in securing ligament balance in the first 175 patients who received robotic-assisted TKAs at Nepean Hospital. ROSA was utilized in all surgeries with the aim of restoring mechanical coronal alignment, with a flexion gap balancing technique. Surgeries were performed between December 2019 to August 2021 by a single surgeon who used a standard medial parapatellar approach without a tourniquet, and the cementless persona prosthesis. All patients were followed up for a minimum of 6 months post-surgery. Soft tissue releases included any form of medial release for varus knee, posterolateral release for valgus knee and PCL fenestration or sacrifice.ResultsThere were 131 female and 44 male patients, aged between 48 to 89 years (average 60 years). The preoperative HKA ranged from 22 degrees varus to 28 degrees valgus, with 71% of patients presenting with a varus deformity. For the whole group, the no need for soft tissue release was documented in 123 patients (70.3%), small fenestrated releases of PCL in 27 (15.4%), sacrifice of PCL in 8 (4.5%), medial releases in 4 (2.3%) and posterolateral releases in 13 (7.4%). In 29.7% of patients in whom a soft tissue release was necessary for balance, over half were/received minor fenestrations of the PCL. Outcomes to date included no revisions or impending revisions, 2 MUAs (1%), and Oxford knee scores averaged 40 at 6 months.ConclusionWe concluded that Robot technology enhanced the precision of bone cuts and allowed for titration of required soft tissue releases to achieve optimal balance.

How Adductor Hallucis Reattachment Affects Outcomes Following Scarf Osteotomy in Hallux Valgus Correction: A 4- to 8-Year Follow-Up Retrospective Comparative Study

This study observed the differences between 2 adductor hallucis release techniques (nonreattachment vs reattachment) in 4- to 8-year follow-up outcomes of scarf osteotomy combined with distal soft tissue release (DSTR) in moderate to severe hallux valgus correction. A retrospective review of moderate to severe hallux valgus patients treated with scarf osteotomy with DSTR was conducted. The patients were divided into 2 groups based on adductor hallucis release techniques (without and with reattachment to the metatarsophalangeal joint capsule). The demographic-matching process divided the samples into 27 patients per group. A comparison of last follow-up of clinical foot ankle ability measure (FAAM) for activity of daily living (ADL) and numerical rating scale for pain during 2 hours of ADL and radiographic outcomes (hallux valgus angle (HVA) and intermetatarsal angle (IMA) was analyzed. A p < .05 was considered a statistically significant difference. The final follow-up of FAAM for ADL was statistically better in the reattachment group as the median was 79.0 (IQR=4.00) versus 76.0 (IQR=4.00), p=.047. However, this difference did not achieve minimal clinical importance difference (MCID). The last follow-up of IMA was also statistically better in the reattachment group as the mean was 7.67 (SD=3.10) versus 10.5 (SD=3.59), p=.003. DSTR with adductor hallucis reattachment has statistically better IMA correction and maintenance than nonreattachment for moderate to severe hallux valgus correction using scarf osteotomy at 4- to 8-years follow-up. However, the better clinical outcomes did not achieve MCID.

CLINICO- RADIOLOGICAL OUTCOME OF IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS FOLLOWING PONSETI TECHNIQUE

Introduction: Idiopathic clubfoot or congenital talipes equinovarus is the most common orthopedic congenital deformity. Club foot affects roughly one in every 1000 live births, and it is bilateral in about half of the cases. The four components of a congenital club foot are cavus, adduction, varus, and equinus. The treatment's purpose is to address four abnormalities and keep them corrected so that the patient can have a functional, pain-free plantigrade foot. Aims: To identify the minimum set of outcomes that should be collected in clinical practice and reported in research related to the care of children with idiopathic congenital talipes equinovarus (CTEV). Materials and Methods: The present study was a Observational study. This Study was conducted from 03/08/2005 to 02/08/2007 at Ramakrishna Mission Seva Pratishthan, Vivekananda Institute of Medical Sciences. Total 37 patients were included in this study. Result: we found that a relatively low clinical outcome as compared to ndings by other authors who have reported excellent treatment outcomes that have ranged from 82.4% to 97% and In this study 62.6% of the patients reported no pain, an evidence of good functional outcomes associated with the Ponseti conservative method of treatment compared to the surgical soft tissue release. Conclusion: The functional outcomes are equally good with the majority of patients reporting no pain, being able to wear shoes of their liking and having no limitation during walking or running. This is a sign of an improved life style and quality of life and correlates with good patient and caregiver satisfaction.

Surgical Treatment of Juvenile Idiopathic Arthritis in the Era of Novel Drug Therapies.

Juvenile idiopathic arthritis is the most common chronic rheumatic disease encountered in children under the age of sixteen and causes significant impairments in daily life. Over the last two decades, the introduction of new drug treatments (including disease-modifying antirheumatic drugs and biologics) has changed the course of this disease, thus reducing the indication for surgery. However, some patients fail to respond to drug therapy and thus require personalized surgical management, e.g., the local reduction of joint effusion or a synovial pannus (via intra-articular corticosteroid injections, synovectomy, or soft tissue release), and management of the sequelae of arthritis (such as growth disorders and joint degeneration). Here, we provide an overview of the surgical indications and outcomes of the following interventions: intra-articular corticosteroid injections, synovectomy, soft tissue release, surgery for growth disorders, and arthroplasty.

Indication for Achilles Tenotomy in Congenital Clubfoot: Effectiveness of Using the Tibio-Plantar Fascia Angle as a Radiographic Parameter

Congenital clubfoot is one of the most common deformities in children, and currently, the Ponseti method is used worldwide because of its favorable short-term results. With the Ponseti method, the indication for Achilles tenotomy is traditionally based on only physical examination findings; however, some surgeons have also utilized plain radiographs. Because using physical examinations to determine the degree of hindfoot dorsiflexion for the indication of tenotomy can lead to underestimation. We developed and utilized the effectiveness of the tibio-plantar fascia angle (Ti-P angle) in the lateral maximum dorsiflexion view in determining the need for Achilles tenotomy. A retrospective analysis of consecutive 26 patients with congenital idiopathic clubfeet (37 feet) was performed. Whether Achilles tenotomy was indicated was determined based on physical examination for a former period (Group P). For the latter period, whether tenotomy was indicated was determined by referencing radiographs (Group X). No significant differences were found in any of the background factors or severity between Group P and Group X. Cases with larger tibiocalcaneal and Ti-P angles were more likely to require Achilles tenotomy or additional soft tissue release. An angle of more than 72° of the Ti-P angle demonstrated adequate specificity for the indication of Achilles tenotomy. The radiographic lateral tibio-plantar fascia angle is useful for deciding whether a tenotomy needs to be performed.

Programmably Controllable Delivery of Metastable Ferrous Ions for Multiscale Dynamic Imaging Guided Photothermal Primed Chemodynamic Therapy.

Metallomodulation cell death strategies are extensively investigated for antitumor therapy, such as cuproptosis, ferroptosis, and chemodynamic therapy (CDT). Undoubtedly, the accurate and specific elevation of metal ions levels in cancer cells is key to boosting theirtherapeutic index. Herein, a programmably controllable delivery system based on croconium dye (Croc)-ferrous ion (Fe2+ ) nanoprobes (CFNPs) is developed for multiscale dynamic imaging guided photothermal primed CDT. The Croc, with kinds of electron-rich iron-chelating groups, can form the Croc-Fe2+ complex with a precise stoichiometry of 1:1 to steadily maintain the valence state of Fe2+ . The CFNPs can achieve pH-responsive visualization and accurate Fe2+ release in cancerous tissues under the coactivation of "dual-key" stimulation of "acidity and near-infrared (NIR) light". The acidic tumor microenvironment actuates NIR fluorescence/photoacoustic imaging and photothermal properties of CFNPs. Sequentially, under exogenous NIR light, the CFNPs enable in vivo accurate visualization of Croc-Fe2+ complex delivery for photothermal primed Fe2+ release, thus achieving CDT of tumors. By leveraging multiscale dynamic imaging technologies, the complicated spatiotemporal release of Fe2+ is sketched in a programmably controllable manner, and the domino effect of tumor pH level, photothermal effect, and CDT is also revealed, endowing customized feedback of the therapeutic panorama within the disease microenvironment.

Eosinophilic myocarditis: comprehensive update on pathophysiology, diagnosis, prognosis and management.

Hypereosinophilic syndromes are a group of disorders secondary to the accumulation of eosinophils leading to the injury of one or more organs. Among them, eosinophilic myocarditis (EM) is a rare form of inflammatory cardiomyopathy characterized by eosinophilic infiltration into myocardial tissue and subsequent release of substances with cell membrane damage and cell destruction. The degree of infiltration is thought to depend on the underlying condition, as well as the degree and duration of eosinophil exposure and ranges from mild localized disease to diffuse multifocal infiltrates associated with myocardial necrosis, thrombotic complications and endomyocardial fibrosis. The main causes of EM are hypersensitivity reactions, eosinophilic granulomatosis with polyangiitis, hypereosinophilic syndrome variants, infections and cancer. Clinical presentation can be variable, ranging from asymptomatic forms to life-threatening conditions, to chronic heart failure due to progression to chronic restrictive cardiomyopathy. Marked eosinophilia in peripheral blood, elevated serum eosinophilic cationic protein concentration and multimodality imaging may suggest the etiology of EM, but in most cases an endomyocardial biopsy must be performed to establish a definitive diagnosis. Systemic treatment varies greatly depending on the underlying cause, however the evidence of an eosinophilic infiltrate allows initiation of immunosuppressive therapy, which is the mainstay of treatment in idiopathic and in most forms of EM. Patients with helminthic infection benefit from anti-parasitic therapy, those with myeloid clone often need a tyrosine kinase inhibitor, while anticoagulant therapy should be undertaken in case of possible thrombotic complications.

Arthroscopic assisted release of lateral pterygoid versus scarification of retrodiscal tissue in management of internal derangement of temporomandibular joint-A randomized clinical trial

The purpose of this study was to compare the effectiveness of arthroscopic-assisted lateral pterygoid muscle release versus scarification of retrodiscal tissues in the treatment of temporomandibular joint internal derangement.A prospective, comparative, randomized clinical trial involved 16 patients with TMJ internal derangement. Arthroscopic assisted release of lateral pterygoid muscle was assigned to one group of patients (Group I). Group II patients received arthroscopic assisted scarification of retrodiscal tissues. Data collected through functional examination including visual analogue scale (VAS), maximum mouth opening, lateral excursion, and clicking sound immediately and after 3, 6, and 12 months. Pre- and post-operative MRI was used to assess disc position.The VAS scores decreased in both groups at the end of the follow-up period (0.45 vs 6.75, and 1.13 vs 6.50 in group I and II respectively; P<0.001). The maximum mouth opening improved to 32.9.50 ± 1.69 mm in group I, and 30.49 ± 0.93 in group II (P<0.001). Lateral excursion improved in both groups (P<0.001). Clicking sounds disappeared in all patients.Within the limitations of the study, it seems that arthroscopic assisted release of lateral pterygoid and scarification of retrodiscal tissues may be beneficial in management of anteriorly displaced discs that don't respond to conservative treatments.

Results of treatment of congenital vertical talus by the Dobbs method

Congenital vertical talus is a rare foot deformity. The hindfoot is valgus and equinus, the midfoot is dorsiflexed and forefoot is abducted due to a fixed dorsal dislocation of the navicular on the head of the talus and the cuboid on the anterior part of the calcaneus. The epidemiology and etiology of vertical talus is unknown. Dobbs et al. (J Bone Joint Surg Am 88(6):1192–200, 2006) described a minimally invasive alternative which allowed to avoid the need for extensive soft tissue release procedures in treatment of congenital vertical talus. Eleven congenital vertical talus feet (group 5 according to Hamanishi) in eight children (four boys and four girls) constituted the study material. Upon the diagnosis, the patients’ age ranged from 5 to 26 months old (the mean – 14.6). The treatment involved serial manipulation and casting according to the reverse Ponseti method (from 4 to 7 casts) followed by a minimally invasive approach consisting in temporary stabilization of the talonavicular joint with the use of K-wire and Achilles tenotomy according to the Dobbs technique. Then patients continued the shoe and bar program for 2 years. The X-ray measurements on lateral radiographic included the talocalcaneal angle, tibiotalar angle and talar axis—first metatarsal base angle whereas AP radiographic images—the talocalcaneal angle and talar axis—first metatarsal angle. The Wilcoxon test was used to compare dependent variables. The final clinical assessment made during the last follow-up (the mean: 35.8 months, the range: 25–52) revealed that neutral position of the foot and normal range of motion were observed in ten cases and recurrence of foot deformity in one case. The last X-ray examination showed normalization all of radiological parameters, except for one case, and examined parameters were statistically significant. The minimally invasive technique described by Dobbs should be the first option in treatment of congenital vertical talus. It allows to reduce the talonavicular joint, brings good results and preserves foot mobility. The attention should be put on early diagnosis.

Construction of a multifunctional peptide nanoplatform for nitric oxide release and monitoring and its application in tumor-bearing mice

As a “star molecule”, nitric oxide (NO) either promotes or inhibits many physiological processes depending on its concentration. The in situ generation and monitoring of therapeutic gas molecules has been a problem that many researchers have been working to address due to the stochastic nature of gas molecule movement. There are still relatively few studies using short peptides as NO storage systems, and there are still challenges in monitoring NO release in situ with real-time imaging over long periods of time. In this work, a morphologically transformable NO release, diagnosis and treatment integrated multifunctional nanoplatform was fabricated. A new NO-activated probe (DPBTD) with emission in the first near infrared (NIR-I) region was encapsulated into the hydrophobic domains of Ac-KLVFFAL-NH2 peptide derivatives as a biosensor for NO release. Peptide scaffolds were endowed with the capacity of controlled NO release by the introduction of NO donor (organic nitrates). Interestingly, morphology of the nanoplatform could be transformed from one-dimensional (1D) nanowires to two-dimensional (2D) nanosheets via nanorods transition state under tip sonication, which was allowed for better cell uptake. Eventually, this nanocarrier was used for stimuli-responsive NO release, real-time imaging and treatment in tumor tissues of 4T1 tumor-bearing mice. This strategy expands the application potential of peptide-based nanomaterials and provides ideas for monitoring the progress of gas-mediated cancer therapy.