Changes in the bony alignment of the foot after tendo-Achilles lengthening in patients with planovalgus deformity

Background This study was performed to investigate the change in the bony alignment of the foot after tendo-Achilles lengthening (TAL) and the factors that affect these changes in patients with planovalgus foot deformity. Methods Consecutive 97 patients (150 feet; mean age 10 years; range 5.1–35.7) with Achilles tendon contracture (ATC) and planovalgus foot deformity who underwent TAL were included. All patients underwent preoperative and postoperative weight-bearing anteroposterior (AP) or lateral (LAT) foot radiographics. Changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, LAT talo-1st metatarsal angle, and calcaneal pitch angle and the factors affecting such changes after TAL were analyzed using lineal mixed model. Results There were no significant change in AP talo-1st metatarsal angle and AP talo-2nd metatarsal angle after TAL in patients with cerebral palsy (CP) (p = 0.236 and 0.212). However, LAT talo-1st metatarsal angle and calcaneal pitch angle were significantly improved after TAL (13.0°, p < 0.001 and 4.5°, p < 0.001). Age was significantly associated with the change in LAT talo-1st metatarsal angle after TAL (p = 0.028). The changes in AP talo-1st metatarsal angle, AP talo-2nd metatarsal angle, and calcaneal pitch angle after TAL were not significantly associated with the diagnosis (p = 0.879, 0.903, and 0.056). However, patients with CP showed more improvement in LAT talo-1st metatarsal angle (− 5.0°, p = 0.034) than those with idiopathic cause. Conclusion This study showed that TAL can improve the bony alignment of the foot in patients with planovalgus and ATC. We recommend that physicians should consider this studys findings when planning operative treatment for such patients.This study was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIT) (No. NRF2019R1C1C1010352)

Femoral anteversion and tibial torsion only explain 25% of variance in regression analysis of foot progression angle in children with diplegic cerebral palsy

Background : The relationship between torsional bony deformities and rotational gait parameters has not been sufficiently investigated. This study was to investigate the degree of contribution of torsional bony deformities to rotational gait parameters in patients with diplegic cerebral palsy (CP). Methods : Thirty three legs from 33 consecutive ambulatory patients (average age 9.5 years, SD 6.9 years; 20 males and 13 females) with diplegic CP who underwent preoperative three dimensional gait analysis, foot radiographs, and computed tomography (CT) were included. Adjusted foot progression angle (FPA) was retrieved from gait analysis by correcting pelvic rotation from conventional FPA, which represented the rotational gait deviation of the lower extremity from the tip of the femoral head to the foot. Correlations between rotational gait parameters (FPA, adjusted FPA, average pelvic rotation, average hip rotation, and average knee rotation) and radiologic measurements (acetabular version, femoral anteversion, knee torsion, tibial torsion, and anteroposteriortalo-first metatarsal angle) were analyzed. Multiple regression analysis was performed to identify significant contributing radiographic measurements to adjusted FPA. Results : Adjusted FPA was significantly correlated with FPA (r=0.837, p<0.001), contralateral FPA (r=0.492, p=0.004), pelvic rotation during gait (r=−0.489, p=0.004), knee rotation during gait (r=0.376, p=0.031), and femoral anteversion (r=0.350, p=0.046). In multiple regression analysis, femoral anteversion (p=0.026) and tibial torsion (p=0.034) were found to be the significant contributing structural deformities to the adjusted FPA (R2=0.247). Conclusions : Femoral anteversion and tibial torsion were found to be the significant structural deformities that could affect adjusted FPA in patients with diplegic CP. Femoral anteversion and tibial torsion could explain only 24.7% of adjusted FPA.This study was supported by research funding (grant no. 02-2011-045) from Seoul National University Bundang Hospital, Republic of Korea.Peer Reviewe

Influence of surgery involving tendons around the knee joint on ankle motion during gait in patients with cerebral palsy

Background Simultaneous motion of the knee and ankle joints is required for many activities including gait. We aimed to evaluate the influence of surgery involving tendons around the knee on ankle motion during gait in the sagittal plane in cerebral palsy patients. Methods We included data from 55 limbs in 34 patients with spastic cerebral palsy. Patients were followed up after undergoing only distal hamstring lengthening with or without additional rectus femoris transfer. The patients mean age at the time of knee surgery was 11.2 ± 4.7 years, and the mean follow-up duration was 2.2 ± 1.5 years (range, 0.9–6.0 years). Pre- and postoperative kinematic variables that were extracted from three-dimensional gait analyses were then compared to assess changes in ankle motion after knee surgery. Outcome measures included ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle. Various sagittal plane knee kinematics were also measured and used to predict ankle kinematics. A linear mixed model was constructed to estimate changes in ankle motion after adjusting for multiple factors. Results Improvement in total range of motion of the knee resulted in improved motion of the ankle joint. We estimated that after knee surgery, ankle dorsiflexion at initial contact, peak ankle dorsiflexion during stance, peak ankle dorsiflexion during swing, and dynamic range of motion of the ankle decreased, respectively, by 0.4° (p = 0.016), 0.6° (p < 0.001), 0.2° (p = 0.038), and 0.5° (p = 0.006) per degree increase in total range of motion of the knee after either knee surgery. Furthermore, dynamic range of motion of the ankle increased by 0.4° per degree increase in postoperative peak knee flexion during swing. Conclusions Improvement in total knee range of motion was found to be correlated with improvement in ankle kinematics after surgery involving tendons around the knee. As motion of the knee and ankle joints is cross-linked, surgeons should be aware of potential changes in the ankle joint after knee surgery.This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science and ICT (NRF-2016R1C1B2008557), and was partly supported by the Technology Innovation Program funded By the Ministry of Trade, Industry and Energy (MOTIE) of Korea (10049785) and SNUBH research fund (grant no. 02-2012-018). No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article

Beyond the Blockchain Address: Zero-Knowledge Address Abstraction

Integrating traditional Internet (web2) identities with blockchain (web3) identities presents considerable obstacles. Conventional solutions typically employ a mapping strategy, linking web2 identities directly to specific blockchain addresses. However, this method can lead to complications such as fragmentation of identifiers across disparate networks. To address these challenges, we propose a novel scheme, Address Abstraction (AA), that circumvents the need for direct mapping. AA scheme replaces the existing blockchain address system while maintaining essential properties including a unique identifier, immutability of requests, and privacy preservation. This capability allows users to interact with the blockchain via their web2 identities, irrespective of the specific blockchain address, thereby eliminating limitations tied to a blockchain-specific address system. This mechanism fosters the seamless integration of web2 identities within the web3, in addition, promotes cross-chain compatibility. We also provide an application of AA, denoted as zero-knowledge Address Abstraction (zkAA). It mainly leverages the zero-knowledge proofs to ensure the properties of AA. zkAA has been implemented as a smart contract — compatible with any existing contract-enabled blockchains. Our evaluation of zkAA on Ethereum demonstrates its efficiency. The average cost for registering an abstracted identity is approximate \$7.66, whereas publishing an abstracted transaction costs around \$4.75. In contrast, on Polygon, the associated costs are markedly lower: \$0.02 for registration and \$0.01 for publication, as of January 13, 2023. This empirical evaluation substantiates the feasibility of our proposed solution

What Are the Risk Factors Associated with Urinary Retention after Orthopaedic Surgery?

This study investigates the overall rate of urinary retention in a large cohort of unselected orthopaedic patients who had either general or regional anesthesia and defines the risk factors for postoperative urinary retention in that cohort of patients. A total of 15,681 patients who underwent major orthopaedic surgery with general or spinal/epidural anesthesia were included. Postoperative urinary retention was defined as any patient who required a postoperative consultation to the urologic department regarding voiding difficulty. Age at surgery, sex, type of surgery, medical history including hypertension and diabetes mellitus, and type of anesthesia were analyzed as potential predictor variables. There were 365 postoperative patients who required urology consults for urinary retention (2.3%). Older age at surgery (OR, 1.035; &lt; 0.0001), male sex (OR, 1.522; = 0.0004), type of surgery (OR, 1.506; = 0.0009), history of hypertension (OR, 1.288; = 0.0436), and history of diabetes mellitus (OR, 2.038; &lt; 0.0001) were risk factors for urinary retention after orthopaedic surgery. Advanced age, male sex, joint replacement surgery, history of hypertension, and diabetes mellitus significantly increased the risk of urinary retention. In patients with these risk factors, careful postoperative urological management should be performed

Intranasal immunization with plasmid DNA encoding spike protein of SARS-coronavirus/polyethylenimine nanoparticles elicits antigen-specific humoral and cellular immune responses

<p>Abstract</p> <p>Background</p> <p>Immunization with the spike protein (S) of severe acute respiratory syndrome (SARS)-coronavirus (CoV) in mice is known to produce neutralizing antibodies and to prevent the infection caused by SARS-CoV. Polyethylenimine 25K (PEI) is a cationic polymer which effectively delivers the plasmid DNA.</p> <p>Results</p> <p>In the present study, the immune responses of BALB/c mice immunized via intranasal (i.n.) route with SARS DNA vaccine (pci-S) in a PEI/pci-S complex form have been examined. The size of the PEI/pci-S nanoparticles appeared to be around 194.7 ± 99.3 nm, and the expression of the S mRNA and protein was confirmed <it>in vitro</it>. The mice immunized with i.n. PEI/pci-S nanoparticles produced significantly (<it>P </it>< 0.05) higher S-specific IgG1 in the sera and mucosal secretory IgA in the lung wash than those in mice treated with pci-S alone. Compared to those in mice challenged with pci-S alone, the number of B220⁺cells found in PEI/pci-S vaccinated mice was elevated. Co-stimulatory molecules (CD80 and CD86) and class II major histocompatibility complex molecules (I-A^d) were increased on CD11c⁺dendritic cells in cervical lymph node from the mice after PEI/pci-S vaccination. The percentage of IFN-γ-, TNF-α- and IL-2-producing cells were higher in PEI/pci-S vaccinated mice than in control mice.</p> <p>Conclusion</p> <p>These results showed that intranasal immunization with PEI/pci-S nanoparticles induce antigen specific humoral and cellular immune responses.</p

Pitfalls and Important Issues in Testing Reliability Using Intraclass Correlation Coefficients in Orthopaedic Research

Background: Intra-class correlation coeffi cients (ICCs) provide a statistical means of testing the reliability. However, their interpretationis not well documented in the orthopedic fi eld. The purpose of this study was to investigate the use of ICCs in the orthopedicliterature and to demonstrate pitfalls regarding their use. Methods: First, orthopedic articles that used ICCs were retrieved from the Pubmed database, and journal demography, ICC modelsand concurrent statistics used were evaluated. Second, reliability test was performed on three common physical examinationsin cerebral palsy, namely, the Thomas test, the Staheli test, and popliteal angle measurement. Thirty patients were assessed bythree orthopedic surgeons to explore the statistical methods testing reliability. Third, the factors affecting the ICC values were examinedby simulating the data sets based on the physical examination data where the ranges, slopes, and interobserver variabilitywere modifi ed. Results: Of the 92 orthopedic articles identifi ed, 58 articles (63%) did not clarify the ICC model used, and only 5 articles (5%)described all models, types, and measures. In reliability testing, although the popliteal angle showed a larger mean absolute differencethan the Thomas test and the Staheli test, the ICC of popliteal angle was higher, which was believed to be contrary to thecontext of measurement. In addition, the ICC values were affected by the model, type, and measures used. In simulated data sets,the ICC showed higher values when the range of data sets were larger, the slopes of the data sets were parallel, and the interobservervariability was smaller. Conclusions: Care should be taken when interpreting the absolute ICC values, i.e., a higher ICC does not necessarily mean lessvariability because the ICC values can also be affected by various factors. The authors recommend that researchers clarify ICCmodels used and ICC values are interpreted in the context of measurement.N

Consensus and Different Perspectives on Treatment of Supracondylar Fractures of the Humerus in Children

Background: Although closed reduction and percutaneous pinning is accepted as the treatment of choice for displaced supracondylar fracture of the humerus, there are some debates on the pinning techniques, period of immobilization, elbow range of motion (ROM) exercise, and perceptions on the restoration of elbow ROM. This study was to investigate the consensus and different perspectives on the treatment of supracondylar fractures of the humerus in children. Methods: A questionnaire was designed for this study, which included the choice of pinning technique, methods of elbow motion, and perception on the restoration of elbow ROM. Seventy-six orthopedic surgeons agreed to participate in the study and survey was performed by a direct interview manner in the annual meetings of Korean Pediatric Orthopedic Association and Korean Society for Surgery of the Hand. There were 17 pediatric orthopedic surgeons, 48 hand surgeons, and 11 general orthopedic surgeons. Results: Ninety-six percent of the orthopedic surgeons agreed that closed reduction and percutaneous pinning was the treatment of choice for the displaced supracondylar fracture of the humerus in children. They showed significant difference in the choice of pin entry (lateral vs. crossed pinning, p = 0.017) between the three groups of orthopedic surgeons, but no significant difference was found in the number of pins, all favoring 2 pins over 3 pins. Most of the orthopedic surgeons used a removable splint during the ROM exercise period. Hand surgeons and general orthopedic surgeons tended to be more concerned about elbow stiffness after supracondylar fracture than pediatric orthopedic surgeons, and favored gentle passive ROM exercise as elbow motion. Pediatric orthopedic surgeons most frequently adopted active ROM exercise as the elbow motion method. Pediatric orthopedic surgeons and general orthopedic surgeons acknowledged that the patient&apos;s age was the most contributing factor to the restoration of elbow motion, whereas hand surgeons acknowledged the amount of injury to be the most contributing factor. Conclusions: More investigation and communication will be needed to reach a consensus in treating pediatric supracondylar fractures of the humerus between the different subspecialties of orthopedic surgeons, which can minimize malpractice and avoid medicolegal issues. © 2012 by The Korean Orthopaedic Association.Y

Bowel Preparation for Capsule Endoscopy: A Prospective Randomized Multicenter Study

Background/Aims: The ability to visualize the small bowel mucosa by capsule endoscopy is limited. Moreover, studies involving small-bowel preparation with purgative drugs have failed to establish which preparations produce better images and higher diagnostic yields. The aim of this study was to evaluate the efficacies and diagnostic yields of different bowel preparations. Methods: A cohort of 134 patients with suspected small bowel disease was randomly assigned to 3 groups. Patients in group A (n=44) fasted for 12 h before being administered an M2A capsule (Given Imaging, Yoqneam, Israel). Patients in group B (n=45) were asked to drink two doses of 45 mL of sodium phosphate (NaP) with water during the afternoon and evening on the day before the procedure and to drink at least 2 L of water thereafter. Patients in group C (n=45) drank 2 L of a polyethylene glycol (PEG) lavage solution the evening before the procedure. Results: Overall cleansing of the small bowel was adequate in 43% of patients in group A, 77% of those in group B, and 56% of those in group C (group A vs; group B, p=0.001). Diagnoses for obscure gastrointestinal bleeding were established in 9 patients (39%) in group A, 16 patients (69%) in group B, and 14 patients (50%) in group C. No significant difference in diagnostic yield was observed between groups. Conclusions: Bowel preparation with NaP for capsule endoscopy improved small-bowel mucosal visualization when compared to 12-h overnight fasting. (Gut and Liver 2009;3:180-185)Wei W, 2008, AM J GASTROENTEROL, V103, P77, DOI 10.1111/j.1572-0241.2007.01633.xCheon JH, 2007, GUT LIVER, V1, P118van Tuyl SAC, 2007, ENDOSCOPY, V39, P1037, DOI 10.1055/s-2007-966988Ben-Soussan E, 2005, J CLIN GASTROENTEROL, V39, P381FIREMAN Z, 2005, WORLD J GASTROENTERO, V11, P5863DAI N, 2005, GASTROINTEST ENDOSC, V61, P28Viazis N, 2004, GASTROINTEST ENDOSC, V60, P534Niv Y, 2004, SCAND J GASTROENTERO, V39, P1005, DOI 10.1080/00365520410003209Fireman Z, 2004, ISRAEL MED ASSOC J, V6, P521Albert J, 2004, GASTROINTEST ENDOSC, V59, P487Pennazio M, 2004, GASTROENTEROLOGY, V126, P643, DOI 10.1053/j.gastro.2003.11.057Mylonaki M, 2003, GUT, V52, P1122Costamagna G, 2002, GASTROENTEROLOGY, V123, P999, DOI 10.1053/gast.2002.35988Lewis BS, 2002, GASTROINTEST ENDOSC, V56, P349, DOI 10.1067/mge.2002.126906Kastenberg D, 2001, GASTROINTEST ENDOSC, V54, P705Aronchick CA, 2000, GASTROINTEST ENDOSC, V52, P346