The asssociation between a hindfoot deformity assessed by weightbearing CT and the full leg alignment

CATEGORY: Hindfoot INTRODUCTION/PURPOSE: The exact relationship between different types of hindfoot deformities and the full leg alignment is currently unclear. Therefore, our aim is to assess hindfoot alignment on a weight-bearing CT (WBCT) and its association with the full leg radiographic alignment. METHODS: A retrospective analysis was performed on a study population of 109 patients (mean age of 53 years ± 14.49) with a varus or valgus hindfoot deformity and the presence or absence of ankle osteoarthritis (OA) based on the Takakura classification. The mechanical hindfoot - (mHA) and subtalar vertical angle (SVA) were determined on WBCT, while the mechanical tiba – (mTA) and mechanical tibiofemoral angle (mTFA) were measured on full leg radiographs. RESULTS: In patients with ankle OA, a hindfoot valgus deformity was associated with a significantly higher mean varus alignment of the knee (mTFA = -1.8°±2.1; mTAx= -4.3°±1.9) compared to a valgus alignment of the knee (mTFA = 0.3°±2.6; mTAx= -1.4°±2.2; P 0.05). CONCLUSION: A valgus hindfoot deformity demonstrated a higher varus alignment of the knee when compared to patients with a hindfoot varus deformity, if ankle OA was present. The subtalar joint did not attain an overall compensatory correction towards the hindfoot deformity as opposed to a compensatory orientation of the tibia alignment. In clinical practice, these findings could improve the current understanding of both joint preserving as well as joint replacing procedures of the hindfoot and the knee

Difference in mass analysis using labeled lysines (DIMAL-K): a new, efficient proteomic quantification method applied to the analysis of astrocytic secretomes

Here we describe an original strategy for unbiased quantification of protein expression called difference in mass analysis using labeled lysine (K) (DIMAL-K). DIMAL-K is based on the differential predigestion labeling of lysine residues in complex protein mixtures. The method is relevant for proteomic analysis by two-dimensional electrophoresis and MALDI-TOF mass spectrometry. Protein labeling on lysine residues uses two closely related chemical reagents, S-methyl thioacetimidate and S-methyl thiopropionimidate. Using protein standards, we demonstrated that 1) the chemical labeling was quantitative, specific, and rapid; 2) the differentially labeled proteins co-migrated on two-dimensional gels; and 3) the identification by mass fingerprinting and the relative quantification of the proteins were possible from a single MALDI-TOF mass spectrum. The power of the method was tested by comparing and quantifying the secretion of proteins in normal and proinflammatory astrocytic secretomes (20 microg). We showed that DIMAL-K was more sensitive and accurate than densitometric image analysis and allowed the detection and quantification of novel proteins

Serum CBG, free and total cortisol and circadian patterns of adrenal function in normal pregnancy

Parameters of cortisol metabolism were studied in pregnancy and early post partum and in non pregnant women. Total serum cortisol was measured by a specific radioimmunoassay and its unbound- and CBG-bound fractions by equilibrium dialysis at 37 degrees C. CBG was measured directly, by an immunodiffusion method (true CBG) and indirectly, by the Scatchard analysis of its interaction with labelled cortisol (PT). During pregnancy the increases in true CBG and total cortisol concentrations were grossly parallel but the PT/true CBG ratio fell from almost 1 in non-pregnant and delivered women to 0.6 during the second half of pregnancy. At 6 p.m., unbound cortisol was significantly higher in outpatients during the 2d half of pregnancy than in non pregnant controls (0.017 vs 0.009 10(-6) mol/l). In hospitalized resting patients, unbound cortisol concentrations were the same in pregnant and non pregnant women except for a significantly higher level of unbound cortisol at midnight during the second half of pregnancy. Circadian variations of cortisol secretion persisted throughout pregnancy. It is concluded that in pregnancy (1) hypothalamic control of maternal adrenal secretion still prevails, (2) the increase in total cortisol is essentially due to that of CBG, (3) the unbound cortisol is normal or, at times, slightly increased and (4) variations in the PT/true CBG ratios may be explained by the presence of steroids (progesterone and 17-OH-progesterone) with a high affinity for CBG. The physiological significance of the mild hypercortisolism of pregnancy is discussed

Meningoencephalitis caused by **Streptococcus pneumoniae**: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids

Streptococcus pneumoniae is a common cause of bacterial meningitis but only rarely causes other infections such as brain abscess, encephalitis, encephalomyelitis or meningoencephalitis. We report on three adult patients with meningoencephalitis caused by S. pneumoniae. In all three, CT and MRI revealed widespread brain lesions, suggesting extensive parenchymal injury. Diffusion-weighted MRI showed lesions with restricted diffusion, reflecting local areas of ischaemia with cytotoxic oedema secondary to an immunologically mediated necrotising vasculitis and thrombosis. High levels of markers of neuronal, glial and myelin damage were found in the cerebrospinal fluid. According to the literature, brain parenchyma lesions in adults with pneumococcal meningoencephalitis are often associated with death or severe neurological deficit. Our patients were treated with pulse doses of glucocorticoids: this resulted in dramatic clinical improvement and an excellent final neurological recovery