In Vivo Analysis of Hindfoot Joints Movement During Stance Phase in Stage Ⅱ Adult Acquired Flatfoot Deformity

Abstract Background This study aims to compare the kinematic characteristics of hindfoot joints of stage Ⅱ adult acquired flatfoot deformity (AAFD) and normal foot through two-dimension (2D) -three-dimension (3D) registration technology and a single fluoroscopic imaging system, thus to provide research basis to the pathogenesis, diagnosis and treatment of AAFD. Methods Then seven normal volunteers and eight volunteers with stage Ⅱ AAFD were recruited to take the CT scans for their bilateral feet in neutral positions, after that their lateral dynamic X-ray data during stance phase were collected including fourteen normal feet and ten flatfeet. A computer-aided simulated light source for 3D CT model was applied to obtain a virtual image, and it is matched with the dynamic X-ray images to make a registration in “Fluo” software, by which finally the spatial changes during the stance phase can be calculated. Results In the early stage of touching the ground and the middle stage of standing, the extension and external rotation valgus of the navicular bone of the flat foot was compared with that of the normal navicular bone, and there was no significant difference in the extension and external rotation valgus of the calcaneus between the cuboid phase and the normal navicular bone. In the late stance phase, the degree of varus relative to the distance of the navicular bone was smaller in the flat foot than in the normal foot but the degree of metatarsal flexion was not significantly different between the cuboid and the calcaneus, and the degree of varus was smaller in the calcaneus but the degree of metatarsal flexion was greater. Conclusion During the early and mid-stance phase, there are excessive motion in the subtalar and talonavicular joints in stage Ⅱ AAFD. During the late stance phase, the motion of subtalar and talonavicular joints are in the decompensated state. During the whole stance phase, the motion of calcaneocuboid joint has no significant difference in both normal foot and stage Ⅱ AAFD.

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Anterior talofibular ligament lesion is associated with increased flat foot deformity but does not affect correction by lateral calcaneal lengthening

BMC Musculoskeletal Disorders ◽

10.1186/s12891-019-2827-2 ◽

2019 ◽

Vol 20 (1) ◽

Author(s):

Stephan H. Wirth ◽

Arnd F. Viehöfer ◽

Sarvpreet Singh ◽

Stefan M. Zimmermann ◽

Tobias Götschi ◽

...

Keyword(s):

Lateral Ligament ◽

Anterior Talofibular Ligament ◽

Foot Deformity ◽

Mri Findings ◽

Flat Foot ◽

Postoperative Result ◽

Operative Correction ◽

Significant Difference ◽

Adult Acquired Flatfoot Deformity ◽

Calcaneal Lengthening

Abstract Background Several risk factors for adult acquired flatfoot deformity (AAFD) have been identified in literature. To this date, little attention has been paid to the lateral ligament complex and its influence on AAFD, although its anatomic course and anatomic studies suggest a restriction to flatfoot deformity. The aim of this study was to assess the influence of the anterior talofibular ligament (ATFL) on AAFD and on radiologic outcome following common operative correction by lateral calcaneal lengthening. Methods We reviewed all patients that underwent lateral calcaneal lengthening for correction of AAFD between January 2008 and July 2018 at our clinic. Patients were grouped according to the preoperative MRI findings into those with an intact ATFL and those with an injured ATFL. Two independent readers assessed common radiographic flatfoot parameters on preoperative and postoperative radiographs. Results Sixty-four flatfoot corrections in 63 patients were included, whereby the ATFL was intact in 29 cases, and in 35 cases the ligament was injured. An ATFL lesion was overall radiologically associated with increased flatfoot deformity with a statistically significant difference between the two groups for preoperative talometatarsal-angle (p = 0.002), talocalcaneal-angle (p = 0.000) and talonavicular uncoverage-angle (p = 0.005). No difference between the two groups could be observed regarding the success of operative correction or operative consistency after lateral calcaneal lengthening. Conclusion The ATFL seems to influence the extent of AAFD. In patients undergoing lateral calcaneal lengthening, the integrity of the ligament seems not to influence the degree of correction or the consistency of the postoperative result.

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Anatomical Study of Saphenous Nerve and Great Saphenous Vein Using a Peripheral Vein Illumination Device and Ultrasonography

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00327 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0032

Author(s):

Yuki Ota ◽

Tomoyuki Nakasa ◽

Yasunari Ikuta ◽

Yusuke Tsuyuguchi ◽

Munekazu Kanemitsu ◽

...

Keyword(s):

Knee Joint ◽

Nerve Block ◽

Saphenous Vein ◽

Near Infrared ◽

Imaging System ◽

External Rotation ◽

Saphenous Nerve ◽

Skin Marker ◽

Significant Difference ◽

The Mean

Category: Ankle, Basic Sciences/Biologics Introduction/Purpose: Usefulness of ultrasonographic guided saphenous nerve block is well known for perioperative pain management of foot and ankle surgery. However, in some cases it may be impossible to identify the saphenous nerve, especially women or obese patients, so successful rate of ultrasonographic guided saphenous nerve block was reported 70 to 80%. Previous reports demonstrated that the saphenous nerve is running adjacent to the greater saphenous vein, which suggests that the greater saphenous vein can be an indicator to identify the saphenous nerve. The purpose of this study was to examine anatomical relationship between the saphenous nerve and the greater saphenous vein which is depicted using the near-infrared (NIR) vascular imaging system, the Vein Viewer Flex®. Methods: Thirty legs as 15 healthy subjects (13 males, 2 females) were included in this study. Average age was 34.2 ± 3.2 years old. In a supine position, the knee joint was flexed 60 degrees with mild flexion, abduction, and external rotation of the hip joint, and the greater saphenous vein was depicted using the Vein Viewer Flex® on the skin of the lower extremity. The vein visualized as a green light was then marked using the skin marker. (Figure 1). After marking the greater saphenous vein, the greater saphenous vein and saphenous nerve were identified under ultrasonography at 5 cm distal from the medial knee joint space (Figure 2). The distance between the greater saphenous vein which was marked using the Vein Viewer Flex® and the saphenous nerve was measured in the ultrasonography images. The circumference of the leg (COL) was also measured. Results: The course of the greater saphenous vein could be depicted by the Vein Viewer Flex® in all cases, and it was confirmed by ultrasonography. It was confirmed that the saphenous nerve was located under the sartorius fascia and it was running posteromedially in parallel of the greater saphenous vein. The mean distance from the saphenous nerve and the greater saphenous vein was 7.9 ± 2.7 mm. There was no significant difference between left and right legs (right: 7.9±2.8 mm, left: 8.0±3.0 mm, P=0.95). The mean COL was 34.2 ± 1.9 mm, and there was a moderate positive correlation (r = 0.45). Conclusion: This study revealed that the saphenous nerve is running in parallel of the greater saphenous vein which can be depicted by the Vein Viewer Flex®. Ultrasonography after depicting greater saphenous vein enabled to confirm the saphenous nerve with certainly and noninvasive. These findings suggested that the combination of the Vein Viewer Flex® and ultrasonography enables the saphenous nerve block to be more reliable procedure even the saphenous nerve is hardly identified by the ultrasonography.

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Correlation Between Posterior Tibialis Tendon Dysfunction with Ultrasonography and Adult Acquired Flatfoot Deformity with Radiographic X-ray and Feiss line in East Java’s Indonesian Professional Athletes

10.21203/rs.3.rs-324924/v1 ◽

2021 ◽

Author(s):

Rosy Setiawati ◽

Alfian Hasbi ◽

Paulus Rahardjo ◽

Damayanti Tinduh ◽

Alit Pawana ◽

...

Keyword(s):

Correlation Coefficient ◽

Inclination Angle ◽

Strong Association ◽

Tendon Sheath ◽

Professional Athletes ◽

Tendon Tear ◽

Flat Foot ◽

X Ray ◽

Sheath Fluid ◽

Adult Acquired Flatfoot Deformity

Abstract Background : Adult acquired flatfoot deformity (AAFD) is marked with a partial or complete flattening of the longitudinal medial arch that developed after maturity. AAFD, secondary to posterior tibialis tendon dysfunction (PTTD), is one of the most frequent foot and ankle pathologies in professional athletes. Different modality and procedures can be used to establish the diagnosis of AAFD and PTTD However, the correlation of these various clinical and imaging measurements with specific injuries of the PTT and supporting medial longitudinal arch structures has not been fully reported. The purpose of this study is to investigate the correlation between PTTD using ultrasonography and AAFD that diagnosed using both radiographic x-ray and feiss line examination.Method : 112 professional athletes with flat foot deformity on physical examination, symptom of PTT dysfunction such as medial ankle or foot pain, focal pain along the course of the PTT underwent foot radiographic x-ray using calcaneal inclination angle, ankle ultrasound to see PTT abnormality and feiss line examination using three degree of flat foot classification.Result : There were strong association between calcaneal inclination angle and PTTD includes the presence of PT tendon sheath fluid as well as tendon sheath thickening with p<0.05 with correlation coefficient (r) = 0.921 and 0.892 respectively. Weak association were also found between feiss line result and PT tendon sheath fluid as well as tendon sheath thickening with correlation coefficient (r) = 0.288 and 0.244. There were non significant association between calcaneal inclination and partial PT tendon tear as well as calcaneal inclination and feiss line result.Conclusion : A compressive understanding of posterior tibialis tendon dysfunction and flatfoot diagnosis will lead to more effective management in reducing the symptom.

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Needleless Electrospinning of Polystyrene Fibers with an Oriented Surface Line Texture

Journal of Nanomaterials ◽

10.1155/2012/473872 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 12

Author(s):

Chen Huang ◽

Haitao Niu ◽

Jinglei Wu ◽

Qinfei Ke ◽

Xiumei Mo ◽

...

Keyword(s):

Large Scale ◽

Early Stage ◽

Fiber Surface ◽

Diameter Distribution ◽

X Ray Diffraction ◽

Electrospinning Technique ◽

X Ray ◽

Needleless Electrospinning ◽

Significant Difference ◽

Line Texture

We have demonstrated that polystyrene (PS) nanofibers having an ordered surface line texture can be produced on a large scale from a PS solution of acetone and N,N′-dimethylformamide (2/1, vol/vol) by a needleless electrospinning technique using a disc as fiber generator. The formation of the unusual surface feature was investigated and attributed to the voids formed on the surface of jets due to the fast evaporation of acetone at the early stage of electrospinning, and subsequent elongation and solidification turning the voids into ordered lines on fiber surface. In comparison with the nanofibers electrospun by a conventional needle electrospinning using the same solution, the disc electrospun fibers were finer with similar diameter distribution. The fiber production rate for the disc electrospinning was 62 times higher than that of the conventional electrospinning. Fourier transform infrared spectroscopy and X-ray diffraction measurements indicated that the PS nanofibers produced from the two electrospinning techniques showed no significant difference in chemical component, albeit slightly higher crystallinity in the disc spun nanofibers.

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Modified Ankle-Hindfoot Alignment Radiological Evaluation Method and Application in the Flatfeet

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00254 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0025

Author(s):

Zhao Hong-Mou

Keyword(s):

Evaluation Method ◽

Weight Bearing ◽

Normal Group ◽

Flat Foot ◽

Hindfoot Alignment ◽

X Ray ◽

Normal People ◽

Significant Difference ◽

The Mean ◽

A Prospective Study

Category: Hindfoot Introduction/Purpose: Based on a prospective study, a new method of photographing and measuring of hindfoot alignment based on X-ray was proposed, and its reliability is verified, as well as its application in flatfeet. Methods: This study included 28 patients (40 feet) with flatfeet and 20 volunteers (40 feet) from January to December in 2018. The shooting frame, designed by our team, has been used to take the hindfoot alignment view at 10°, 15°, 20°, 25°, 30° respectively. Our modified tibio-hindfoot angles (THA) at standard Saltzman position (shooting at 20°) were evaluated, and the consistency were compared with the van Dijk method and the modified van Dijk method, and compared with weight-bearing CT. The visibility of tibiotalar space were evaluated in all shooting angles. The consistency of the modified THA method at different projection angles were evaluated. The angle of hindfoot valgus of flatfoot patients was measured with use of the modified THA method, and compared in different shooting angles. Results: The mean THA in standard Saltzman view in normal people were significantly differences between the three evaluation methods (P < 0.001). The results of modified THA method were significantly larger than those of Van Dijk method (P < 0.001) and modified Van Dijk method (P < 0.001). There was no significant difference between the results of modified THA method and the weight-bearing CT (P=0.605), and the intra- and inter-group consistency was the best in modified THA group. The tibiotalar space in the normal group were visible in all cases at 10°, 15°, 20°; and visible in some cases at 25°; and invisible in all cases at 30°. In the flatfoot group, the tibiotalar space were visible in all cases at 10°; and in some cases at 15° and 20°; and invisible in all cases at 25° and 30°. In the normal group, the modified THA was 4.84±1.81° at 10°, 4.96±1.77° at 15°, 4.94±2.04° at 20°. No significant difference was found between the three groups (P=0.616). In the flat foot group, the modified THA of 18 feet, which was visible at 10°, 15° and 20°, was 13.58±3.57° at 10°, 13.62±3.83° at 15° and 13.38±4.06° at 20°. There was no significant difference between the three groups (P=0.425). Conclusion: The modified THA evaluation method is simple to use and has high intra- and inter-group consistency. It can be used to evaluate hindfoot alignment. For patients with flatfeet, the 10° position view and modified THA measurement can be used to evaluate the hindfoot valgus conditions.

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Nerve graft versus nerve transfer for neonatal brachial plexus: shoulder outcomes

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.6.peds2027 ◽

2021 ◽

Vol 27 (1) ◽

pp. 87-92

Author(s):

Brandon W. Smith ◽

Kate W. C. Chang ◽

Sravanthi Koduri ◽

Lynda J. S. Yang

Keyword(s):

Brachial Plexus ◽

Clinical Data ◽

External Rotation ◽

Nerve Transfer ◽

Shoulder Function ◽

Nerve Transfers ◽

Shoulder Flexion ◽

Significant Difference ◽

Transfer Strategies ◽

Shoulder External Rotation

OBJECTIVEThe decision-making in neonatal brachial plexus palsy (NBPP) treatment continues to have many areas in need of clarification. Graft repair was the gold standard until the introduction of nerve transfer strategies. Currently, there is conflicting evidence regarding outcomes in patients with nerve grafts versus nerve transfers in relation to shoulder function. The objective of this study was to further define the outcomes for reconstruction strategies in NBPP with a specific focus on the shoulder.METHODSA cohort of patients with NBPP and surgical repairs from a single center were reviewed. Demographic and standard clinical data, including imaging and electrodiagnostics, were gathered from a clinical database. Clinical data from physical therapy evaluations, including active and passive range of motion, were examined. Statistical analysis was performed on the available data.RESULTSForty-five patients met the inclusion criteria for this study, 19 with graft repair and 26 with nerve transfers. There were no significant differences in demographics between the two groups. Understandably, there were no patients in the nerve grafting group with preganglionic lesions, resulting in a difference in lesion type between the cohorts. There were no differences in preoperative shoulder function between the cohorts. Both groups reached statistically significant improvements in shoulder flexion and shoulder abduction. The nerve transfer group experienced a significant improvement in shoulder external rotation, from −78° to −28° (p = 0.0001), whereas a significant difference was not reached in the graft group. When compared between groups, there appeared to be a trend favoring nerve transfer in shoulder external rotation, with the graft patients improving by 17° and the transfer patients improving by 49° (p = 0.07).CONCLUSIONSIn NBPP, patients with shoulder weakness experience statistically significant improvements in shoulder flexion and abduction after graft repair or nerve transfer, and patients with nerve transfers additionally experience significant improvement in external rotation. With regard to shoulder external rotation, there appear to be some data supporting the use of nerve transfers.

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INFLUENCE OF FOOT INSOLE ON THE GAIT PERFORMANCE IN SUBJECTS WITH FLAT FOOT DISORDER

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519419500507 ◽

2019 ◽

Vol 19 (06) ◽

pp. 1950050

Author(s):

M. T. KARIMI ◽

R. B. TAHMASEBI ◽

B. SATVATI ◽

F. FATOYE

Keyword(s):

Range Of Motion ◽

Ankle Joint ◽

Lower Limb ◽

Walking Speed ◽

Force Plate ◽

Flat Foot ◽

Gait Performance ◽

Positive Effects ◽

Significant Difference ◽

Foot Disorder

Flat foot is the most common foot disorder that influences the alignment of the lower limb structure. It is controversial whether the use of foot insole influences kinetic and kinematic of the leg or not. Therefore, this study investigated the influence of foot insole on the gait performance in subjects with flat foot disorder. A group of flat foot subject was recruited into this study (the number of subjects was 15). The motion of the leg joints was determined using the Qualysis motion analysis system. Moreover, the force applied on the lower limb was recorded by a Kistler force plate. The range of motion of the lower limb joints, the moments applied on the lower limb joints and force transmitted through the leg were the parameters used in this study. The difference between these parameters during walking with and without insole was evaluated using the paired [Formula: see text]-test. Significant value was set at [Formula: see text]. There was no significant difference between the range of motion of ankle joint while walking with and without insole. However, the medial directed force applied on the leg decreased significantly [Formula: see text]. The use of foot insole did not influence the moments transmitted through the hip and knee joints. The walking speed of the subjects improved while walking with foot insole. Use of foot insole influenced the magnitude of the force applied on the leg and the adductor moment of ankle joint due to its influence on foot alignment. As the walking speed of the improved subjects follows the use of insole, it can be concluded that it may have a positive effects on the performance of flat foot subjects.

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Relapse After Early-Stage, Favorable Hodgkin Lymphoma: Disease Characteristics and Outcomes With Conventional or High-Dose Chemotherapy

Journal of Clinical Oncology ◽

10.1200/jco.20.00947 ◽

2021 ◽

Vol 39 (2) ◽

pp. 107-115

Author(s):

Paul J. Bröckelmann ◽

Horst Müller ◽

Teresa Guhl ◽

Karolin Behringer ◽

Michael Fuchs ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Early Stage ◽

High Dose Chemotherapy ◽

Sensitivity Analyses ◽

High Dose ◽

Second Line ◽

Second Line Therapy ◽

Line Therapy ◽

Significant Difference ◽

First Diagnosis

PURPOSE We evaluated disease and treatment characteristics of patients with relapse after risk-adapted first-line treatment of early-stage, favorable, classic Hodgkin lymphoma (ES-HL). We compared second-line therapy with high-dose chemotherapy and autologous stem cell transplantation (ASCT) or conventional chemotherapy (CTx). METHODS We analyzed patients with relapse after ES-HL treated within the German Hodgkin Study Group HD10+HD13 trials. We compared, by Cox proportional hazards regression, progression-free survival (PFS) after relapse (second PFS) treated with either ASCT or CTx and performed sensitivity analyses with overall survival (OS) from relapse and Kaplan-Meier statistics. RESULTS A total of 174 patients’ disease relapsed after treatment in the HD10 (n = 53) and HD13 (n = 121) trials. Relapse mostly occurred > 12 months after first diagnosis, predominantly with stage I-II disease. Of 172 patients with known second-line therapy, 85 received CTx (49%); 70, ASCT (41%); 11, radiotherapy only (6%); and 4, palliative single agent therapies (2%). CTx was predominantly bleomycin, etoposide, doxorubicin cyclophosphamide, vincristine, procarbazine, and prednisone (BEACOPP [68%]), followed by the combination regimen of doxorubicin, bleomycin, vinblastine, and dacarbazine (19%), or other regimens (13%). Patients aged > 60 years at relapse had shorter second PFS (hazard ratio [HR], 3.0; P = .0029) and were mostly treated with CTx (n = 33 of 49; 67%) and rarely with ASCT (n = 8; 16%). After adjustment for age and a disadvantage of ASCT after the more historic HD10 trial, we did not observe a significant difference in the efficacy of CTx versus ASCT for second PFS (HR, 0.7; 95% CI, 0.3 to 1.6; P = .39). In patients in the HD13 trial who were aged ≤ 60 years, the 2-year, second PFS rate was 94.0% with CTx (95% CI, 85.7% to 100%) versus 83.3% with ASCT (95% CI, 71.8% to 94.8%). Additional sensitivity analyses including OS confirmed these observations. CONCLUSION After contemporary treatment of ES-HL, relapse mostly occurred > 12 months after first diagnosis. Polychemotherapy regimens such as BEACOPP are frequently administered and may constitute a reasonable treatment option for selected patients with relapse after ES-HL.

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The effect of metabolism on the course of labor and the postpartum period in highly productive cows

BIO Web of Conferences ◽

10.1051/bioconf/20201700256 ◽

2020 ◽

Vol 17 ◽

pp. 00256

Author(s):

Murat Baimishev ◽

Sergey Eremin ◽

Kirill Plemyashov ◽

Hamidulla Baimishev ◽

Igor Konopeltsev ◽

...

Keyword(s):

Lipid Metabolism ◽

Postpartum Period ◽

Early Stage ◽

Antioxidant Properties ◽

Antioxidant Systems ◽

Dry Period ◽

Blood Samples ◽

Start Up ◽

Significant Difference ◽

Duration Of Pregnancy

The purpose of the research is to determine the etiopathogenesis of reproductive dysfunction in highly productive cows. For this, one group of cows was formed on the principle of paranalogs in the amount of 37 animals inseminated in the first sexual hunt after calving, followed by taking blood samples from them using the Monovet system, considering the duration of pregnancy. During the start-up period, blood was taken 1–4 days before calving and on the first day after calving. A total of 253 blood samples were examined. Subsequently, depending on the effectiveness of insemination, animals were divided into two groups. The first group included inseminated cows after the first insemination (20 animals), the second group included 17 unfertilized cows after the first insemination. Subsequently, blood was taken from animals considering the course of childbirth and the postpartum period. Blood counts were studied according to generally accepted methods using certified equipment. The study found that at an early stage of pregnancy, cows have a significant difference in lipid metabolism and in their peroxidation, in the state of antioxidant systems compared to unstable animals. In the process of pregnancy development in cows, there is a decrease in the level of total lipids and their class, and the accumulation of products of transoxidation of lipids is reduced. In animals with retention of the placenta, a low lipid metabolism and a higher level of peroxidation were established already in the dry period. After calving, this difference increases. The obtained data can be used to develop an algorithm for the prevention of postpartum complications in cows by using substances with antioxidant properties.

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Age-Related Biology of Early-Stage Operable Breast Cancer and Its Impact on Clinical Outcome

Cancers ◽

10.3390/cancers13061417 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1417

Author(s):

Binafsha M. Syed ◽

Andrew R. Green ◽

Emad A. Rakha ◽

David A.L. Morgan ◽

Ian O. Ellis ◽

...

Keyword(s):

Breast Cancer ◽

Early Stage ◽

Histological Grade ◽

Survival Rates ◽

Growth Factor Receptor ◽

Progesterone Receptors ◽

Biological Characteristics ◽

Cancer Specific Survival ◽

Age Related ◽

Significant Difference

As age advances, breast cancer (BC) tends to change its biological characteristics. This study aimed to explore the natural progression of such changes. The study included 2383 women with clinically T0-2N0-1M0 BC, managed by primary surgery and optimal adjuvant therapy in a dedicated BC facility. Tissue micro-arrays were constructed from their surgical specimens and indirect immunohistochemistry was used for analysis of a large panel (n = 16) of relevant biomarkers. There were significant changes in the pattern of expression of biomarkers related to luminal (oestrogen receptor (ER), progesterone receptors (PgR), human epidermal growth factor receptor (HER-2), E-cadherin, MUC1, bcl2 CK7/8, CK18 and bcl2) and basal (CK5/6, CK14, p53 and Ki67) phenotypes, lymph node stage, histological grade and pathological size when decade-wise comparison was made (p < 0.05). The ages of 40 years and 70 years appeared to be the milestones marking a change of the pattern. There were significantly higher metastasis free and breast cancer specific survival rates among older women with ER positive tumours while there was no significant difference in the ER negative group according to age. Biological characteristics of BC show a pattern of change with advancing age, where 40 years and 70 years appear as important milestones. The pattern suggests <40 years as the phase with aggressive phenotypes, >70 years as the less aggressive phase and 40–70 years being the transitional phase.

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