Outcome measures of the surgery first approach for orthognathic correction of dentofacial deformities

In the surgery-first approach (SFA), orthognathic surgery is performed without the need for presurgical orthodontic treatment. This study was aimed at assessing the treatment durations and occlusal outcomes for a consecutive cohort of patients, with a range of dentofacial deformities, who had completed orthognathic treatment using SFA. The duration of orthognathic treatment was measured. The overall change in occlusion, and the quality of the final occlusion, were evaluated using the patients' study casts. A single, independent, calibrated operator carried out the occlusal scores, using the validated Peer Assessment Rating (PAR) index. This was repeated to test intraoperator reliability. A total of 51 patients completed surgery-first treatment during the study period. The mean (range) age at surgery was 23.3 (15-47) years. The pre-treatment skeletal jaw relationship was Class III in 39 cases, and Class II in 12 cases. The mean (SD) overall treatment duration was 11.7 (5.7) months. The intraexaminer reliability of assessing the occlusion was high. The PAR scores confirmed a significant improvement in the quality of occlusion at the completion of treatment, which compares favourably with previous studies on the conventional orthodontics-first approach. The surgery first approach can be effective at correcting both Class II and Class III malocclusion types with reduced treatment times.

Evaluating Adult Idiopathic Scoliosis as an Independent Risk Factor for Critical Illness in SARS-CoV-2 Infection

BACKGROUND

Thoracic spinal deformities may reduce chest wall compliance, leading to respiratory complications. The first SARS-CoV-2 (L-variant) strain caused critical respiratory illness, especially in vulnerable patients. This study investigates the association between scoliosis and SARS-CoV-2 (COVID-19) disease course severity.

METHODS

Clinical data of 129 patients treated between March 2020 to June 2021 who received a positive COVID-19 polymerase chain reaction result from Mount Sinai and had a scoliosis ICD-10 code (M41.0-M41.9) was retrospectively analyzed. Degree of coronal plane scoliosis on imaging was confirmed by 2 independent measurers and grouped into no scoliosis (Cobb angle <10°), mild (10°-24°), moderate (25°-39°), and severe (>40°) cohorts. Baseline characteristics were compared, and a multivariable logistic regression controlling for clinically significant comorbidities examined the significance of scoliosis as an independent risk factor for hospitalization, intensive care unit (ICU) admission, acute respiratory distress syndrome (ARDS), mechanical ventilation, and mortality.

RESULTS

The no (n = 42), mild (n = 14), moderate (n = 44), and severe scoliosis (n = 29) cohorts differed significantly only in age (P = 0.026). The percentage of patients hospitalized (P = 0.59), admitted to the ICU (P = 0.33), developing ARDS (P = 0.77), requiring mechanical ventilation (P = 1.0), or who expired (P = 0.77) did not significantly differ between cohorts. The scoliosis cohorts did not have a significantly higher likelihood of hospital admission (mild P = 0.19, moderate P = 0.67, severe P = 0.98), ICU admission (P = 0.97, P = 0.94, P = 0.22), ARDS (P = 0.87, P = 0.74, P = 0.94), mechanical ventilation (P = 0.73, P = 0.69, P = 0.70), or mortality (P = 0.74, P = 0.87, P = 0.66) than the no scoliosis cohort.

CONCLUSIONS

Scoliosis was not an independent risk factor for critical COVID-19 illness. No trends indicated any consistent effect of degree of scoliosis on increased adverse outcome likelihood.

Surgical correction of the lower lateral cartilage protrusion and external nasal valve pinching with lateral crural resection technique

OBJECTIVE

The aim of this study is to demonstrate a novel surgical technique in the treatment of lower lateral crural protrusion and external nasal valve pinching.

METHOD

The lower lateral crural resection technique was used in 24 patients who underwent open technique septorhinoplasty between 2019 and 2022. Fourteen of the patients were female and 10 were male. In this technique, excess part of crura's tail was excised from the lower lateral crura and placed in the same pocket. This area was supported with a diced cartilage and a postoperative nasal retainer was applied. We have corrected the aesthetic problem that occurs when the lower lateral cartilage is convex, and external nasal valve pinching that occurs when the lower lateral crural protrusion is concave.

RESULT

The mean age of the patients was 23. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery.

CONCLUSION

A new surgical approach has been proposed for patients with lower lateral crural protrusion and external nasal valve pinching using the lateral crural resection technique.

Early developmental toxicity of Atlantic salmon exposed to conventional and unconventional oils

Atlantic salmon is an important species for Canadian culture and economy and its importance extends beyond Canada to Scandinavia and Western Europe. However, it is a vulnerable species facing decline due to habitat contamination and destruction. Existing and new Canadian pipeline projects pose a threat to salmonid habitat. The effects of diluted bitumen (dilbit), the main oil circulating in pipelines, are less studied than those of conventional oils, especially during the critical early embryonic developmental stage occurring in freshwater ecosystems. Therefore, this study aimed to compare the effects of water-accommodated fractions (WAF) of the Clearwater McMurray dilbit and the Lloydminster Heavy conventional oil on Atlantic salmon embryos exposed either from fertilization or from eyed stage. The dilbit contained the highest concentrations of low molecular weight (LMW) compounds (including BTEX and C₆-C₁₀), while the conventional oil contained the highest concentrations of PAHs. The Clearwater dilbit caused a higher percentage of mortality and malformations than the conventional oil at similar WAF concentrations. In addition, the embryos exposed from fertilization suffered a higher mortality rate, more developmental delays, and malformations than embryos exposed from the eyed stage, suggesting that early development is the most sensitive developmental stage to oil exposure. Gene expression and enzymatic activity of the detoxification phase I and II enzymes (CYP1A and GST) were measured. Data showed increases in both cyp1a expression and GST activity with increasing WAF concentrations, while gst expression was not affected by the exposures. Also, gene expression of proteins involved in the biotransformation of vitamin A and DNA damage repair were modified by the oil exposures. Overall, this study indicates that Atlantic salmon is mostly affected by oil exposure at the beginning of its development, during which embryos accumulate deformities that may impact their survival at later life stages.

Embryo mortality in a captive-bred, Critically Endangered amphibian

The Critically Endangered southern corroboree frog Pseudophryne corroboree is dependent upon captive assurance colonies for its continued survival. Although the captive breeding programme for this species has largely been successful, embryonic mortality remains high (40-90% per year). This study aimed to investigate the causes of mortality in P. corroboree embryos in the captive collection at Melbourne Zoo. During the 2021 breeding season, we investigated 108 abnormal embryos to determine the impact of infections and anatomical deformities on survival and used culture and molecular methods to identify microbes. Overall, 100% of abnormal embryos had fungal infections, and of these, 41.6% also had anatomical deformities. The mortality rate in abnormal embryos was 89.8%; however, we detected no difference in survival in any of the 3 observed fungal growth patterns or between deformed and non-deformed embryos. Sanger sequencing of the ITS region identified fungal isolates belonging to the genus Ilyonectria, the first record in a vertebrate host, and another as a Plectosphaerella sp., which is the first record of infection in an embryo. Dominant bacteria identified were of the genera Herbaspirillum and Flavobacterium; however, their role in the mortality is unknown. Fungal infection and deformities have a significant impact on embryo survival in captive-bred P. corroboree. In a species which relies on captive breeding, identifying and reducing the impacts of embryonic mortality can inform conservation efforts and improve reintroduction outcomes.

Ankle Arthrodesis in Crippled Cases

The current article provides an algorithm of how to approach crippled ankle by ankle arthrodesis. There is no standard pathology or treatment present, which makes the diagnosis but also surgical correction complex. A surgeon who faces this kind of deformities needs to be skilled and well familiar with the full setting of the foot and ankle armamentarium.

Predictors of metalwork failure and nonunion after hindfoot Charcot reconstruction

AIMS

Surgical reconstruction of deformed Charcot feet carries a high risk of nonunion, metalwork failure, and deformity recurrence. The primary aim of this study was to identify the factors contributing to these complications following hindfoot Charcot reconstructions.

METHODS

We retrospectively analyzed patients who underwent hindfoot Charcot reconstruction with an intramedullary nail between January 2007 and December 2019 in our unit. Patient demographic details, comorbidities, weightbearing status, and postoperative complications were noted. Metalwork breakage, nonunion, deformity recurrence, concurrent midfoot reconstruction, and the measurements related to intramedullary nail were also recorded.

RESULTS

There were 70 patients with mean follow-up of 54 months (SD 26). Overall, 51 patients (72%) and 52 patients (74%) were fully weightbearing at one year postoperatively and at final follow-up, respectively. The overall hindfoot union rate was 83% (58/70 patients). Age, BMI, glycated haemoglobin, and prior revascularization did not affect union. The ratio of nail diameter and isthmus was greater in the united compared to the nonunited group (0.90 (SD 0.06) and 0.86 (SD 0.09), respectively; p = 0.034). In those with a supplementary hindfoot compression screw, there was a 95% union rate (19/20 patients), compared to 78% in those without screws (39/50 patients; p = 0.038). All patients with a miss-a-nail hindfoot compression screw went on to union. Hindfoot metalwork failure was seen in 13 patients (19%). An intact medial malleolus was found more frequently in those with intact metalwork ((77% (44/57 patients) vs 54% (7/13 patients); p = 0.022) and in those with union ((76% (44/58 patients) vs 50% (6/12 patients); p = 0.018). Broken metalwork occurred more frequently in patients with nonunions (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001) and midfoot deformity recurrence (69% (9/13 patients) vs 9% (5/57 patients); p < 0.001).

CONCLUSION

Rates of hindfoot union and intact metalwork were noted in over 80% of patients. Union after hindfoot reconstruction occurs more frequently with an isthmic fit of the intramedullary nail and supplementary hindfoot screws. An intact medial malleolus is protective against nonunion and hindfoot metalwork failure. Cite this article: Bone Joint J 2022;104-B(6):703-708.

Key stone plasty and asymmetric hump resection in crooked nose deformity

OBJECTIVE

The aim of this study is to propose a new approach in crooked nose deformity with key-stone plasty and asymmetric hump resection.

METHOD

Twelve patients with crooked nose deformities were operated using the open rhinoplasty technique. Our method, unlike other methods, has two different steps. Following asymmetric hump resection, cartilaginous and osseous septum were cut separated at the key stone area or more caudally and fix the septum with sutures again by allowing them to slide over each other in a way that directs the septum to the midline. If there is an inability to reveal the septum, we apply a longer spreader graft to the cartilage septum side.

RESULTS

The mean ages were 27.4 years. The mean follow-up time of the patients was 19.1 months. No complications were observed due to this technique. This technique was effective in the treatment of all our patients with crooked nose deformities.

CONCLUSION

A novel surgical approach with key-stone plasty and asymmetric hump resection method was proposed in crooked nose deformity with a video animation.

Supratip suture and skin scoring technique in the patient with thick skin in rhinoplasty

OBJECTIVE

The aim of this study is to demonstrate a new surgical technique to achieve ideal nasal tip rotation and projection with nasal supratip angle in patients with thick skin.

METHOD

Supratip suture and skin scoring technique was used in 24 patients who underwent open technique septorhinoplasty operation between the years 2019 and 2022. In this technique the nose skin was thinned with scissors. Scoring and supratip sutures were applied to the skin. Kenacort (Triamcinolone 8 mg) was injected into the supratip area without closing the skin. Fourteen of the patients were female and 10 were male.

RESULT

The mean age of the patients was 22. The mean follow-up time of the patients was between 6 and 18 months. No complications were observed due to this technique. Satisfactory results were obtained in the postoperative period after surgery.

CONCLUSION

A new surgical approach has been proposed to create the desired dimensions with nasal tip rotation and projection and supratip angle in patients with thick skin using the supratip suture and skin scoring technique.

Parasitic anomalies observed in snow trout due to anthropogenic stress in water bodies

There is interrelationship of the environmental conditions and fish health. Decrease or increase of pollution in aquatic ecosystem have direct impact on presence or absence of parasites. Fish living under optimum environmental, well-nourished conditions are more resistant to diseases than fish weakened by malnutrition caused by parasite infestation or due to deterioration of environmental conditions because ofpollution. Fish encounters common parasites in wild and in culture systems. Parasites attach to the host through suckers and hooks and make their way inside the host through different means, which include skin, through mouth along with food, by means of gills. The hosts were collected during Jan 2019 to Jan 2020 from river Veshaw. During this study it was observed that presence of parasites causes some changes in fish which can serve as indicators of deterioration in aquatic habitat. Clinical signs were noticed in fish hosts collected from sites which received waste due to anthropogenic activities. Parasitic anomalies in the host collected from polluted site was observed to include body deformaties, gastric distention, lesions in gut, increased mucus production, damage in gill filaments etc.

Effect of temperature on the development of deformities during the embryonic stages of Charonia seguenzae (Aradas & Benoit, 1870)

The Mediterranean Triton Charonia seguenzae (Aradas and Benoit, 1870) is an endangered marine gastropod. Re-establishment of C. seguenzae populations in the depleted habitats requires knowledge of its biology and breeding in captivity. Deformities have a huge impact on offspring survival and quality. Temperature has been recorded to affect the development of deformities in marine gastropods. The present study aims to identify the stage of development at which deformities occur, under four temperature regimes (17, 23, 26 and 29 °C). At the stages of trochophore, veliger and free veliger larvae, three capsules that were acclimated at the examined temperatures at the stage of morula were collected, opened and 50 larvae per capsule sampled. Deformities were observed at every examined developmental stage under all tested temperatures. The lower rate of deformities at every stage occurred at 23 °C. The higher tested temperature (29 °C) was lethal and at the lower tested temperature (17 °C) almost every specimen was deformed (96.66%) at eclosion. The effect of acclimation at four developmental stages (morula, trochophore, shell formation and veliger) on the development of deformities at the free veligers of Charonia seguenzae, was studied under three temperature conditions (17, 26 and 29 °C). At eclosion, three capsules were collected, opened and 50 larvae per capsule were sampled. The acclimation at morula and trochophore larva stages led to the higher rates of deformities at eclosion. The size of the free veliger larvae was also affected by temperature with maximum size at eclosion observed at 23 °C. Charonia seguenzae's embryos tolerate elevated temperatures within environmental limits (26 °C) but near future global warming will probably pose a threat to their survival. The free veliger larvae survival at the environmental minimum is related to the time window of the acclimation, since Triton's embryos are more vulnerable to temperature alterations during the early developmental stages.

Limb lengthening with PRECICE magnetic nail in pediatric patients: A systematic review

BACKGROUND

Limb lengthening techniques play an increasingly important role in the pediatric orthopedic field. The principles of the osteogenesis distraction bonded traditionally with external fixators; however, the recent deployment of fully implantable systems has been able to overcome severities related to external fixators. The PRECICE^® is an implantable limb lengthening intramedullary nail system that is remotely controlled and magnetically driven.

AIM

To review the current literature available on this matter in order to assess the PRECICE clinical and radiological outcomes and its possible complications in a population of pediatric patients undergoing limb lengthening.

METHODS

Only five studies met the inclusion criteria and were consequently included in the review for a total of 131 patients and 135 femurs. The clinical and radiological outcomes of interest were: the main lengthening obtained, the distraction rate, the period of time to full weight bearing, the consolidation index, and the Association for the Study and Application of Methods of Ilizarov score.

RESULTS

In conclusion, data collected from the articles under investigation were comparable with the exception of the consolidation index. Unfortunately, the study population was too small and the patients’ follow-up was too short to make definitive conclusions.

CONCLUSION

This review shows that the PRECICE Nail System is still a therapeutic challenge in limb lengthening for pediatric orthopedic surgeons; however, careful pre-operative planning and an accurate surgical technique could allow the correction of more complex deformities with a low rate of complications.

Teratological changes in postembryos of Eratigena atrica obtained by the application of alternating temperatures on spider embryos

Spider embryonic development depends on several factors, including temperature. Under optimum thermal conditions embryogenesis proceeds undisturbed and embryo mortality is low. On the other hand, dramatic shifts in incubation temperature may cause a range of developmental defects in embryos. It has been confirmed in numerous laboratory experiments that abrupt temperature changes can be a powerful teratogenic factor. Changes in the external structure are frequently reflected in the internal anatomy, and above all, in the central nervous system. In the present teratological study, by exposing spider embryos to the temperatures of 14 °C and 32 °C, changed every 12 hours for the first 10 days of their development, we obtained 74 postembryos of Eratigena atrica with body deformities such as oligomely, heterosymely, schistomely, bicephaly, complex anomalies and others. We selected six spiders to describe and analyze their morphological changes. In one case, that of a spider affected by polymely (the presence of a supernumerary appendage) combined with heterosymely (the fusion of walking legs), we also focused on the structure of the central nervous system. The analysis indicated that this complex anomaly was accompanied by only one change in the central nervous system: the presence of a supernumerary neuropil. Since no fusion of walking leg neuropils was observed, it was concluded that, in this instance, there was no relationship between the fusion of legs and the structure of the central nervous system.

Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy)

BACKGROUND

Diabetic peripheral neuropathy (DPN) is one of the most common complications in diabetes mellitus. It is the disorder that most commonly affects the feet of people with diabetes. The aim of the present study is to determine the relationship between DPN and the presence of deformities in the foot.

MATERIAL AND METHODS

A descriptive observational study was conducted of 111 patients diagnosed with Diabetes Mellitus (DM) type 1 or 2. All participants were aged at least 18 years and were previously informed in detail about the aims and procedures of the study.

RESULTS

Regarding the presence of DPN, the only significant relationships were found for the right foot with the deformity of the second toe (claw, hammer or mallet) (p = 0.017, OR 0.29 [0.10-0.83]) and for the left foot with the deformity of the second toe (p = 0.048; OR: 0.37 [0.14-1.01]), third toe (p = 0.012; OR: 0.29 [0.11-0.79]) and the presence of hallux extensus (p = 0.05; OR: 8.27 [1.05-64.98]).

CONCLUSIONS

A significant number of foot deformities were observed among these patients with DM, regardless of the presence of DPN. These deformities should be carefully evaluated in order to determine the most appropriate treatment at an early stage, which will reduce the risk of ulceration. Although it should be use with caution to be transferrable to the general population with peripheral neuropathy.

Effects on Apical Outcomes of Regulatory Relevance of Early-Life Stage Exposure of Double-Crested Cormorant Embryos to 4 Environmental Chemicals

Environmental risk assessment is often challenged by a lack of toxicity data for ecological species. The overall goal of the present study was to employ an avian early-life stage toxicity test to determine the effects of 4 chemicals (benzo[a]pyrene [BaP], chlorpyrifos, fluoxetine hydrochloride [FLX], and ethinyl estradiol [EE2]) on an ecologically relevant avian species, the double-crested cormorant (Phalacrocorax auritus), and to compare our results with those we previously reported for a laboratory model species, Japanese quail. Chemicals were dissolved in dimethyl sulfoxide and administered via air cell injection to fertilized, unincubated double-crested cormorant eggs at 3 nominal concentrations, the highest selected to approximate the 20% lethal dose. Of the 4 chemicals, only chlorpyrifos and FLX were detected in liver tissue of embryos at midincubation (day 14) and termination (day 26; 1-2 d prior to hatch); EE2 and BaP were not detectable, suggesting embryonic clearance/metabolism. No apical effects were observed in double-crested cormorant embryos up to the highest concentrations of chlorpyrifos (no-observed-effect level [NOEL] = 25 µg/g) or FLX (NOEL = 18 µg/g). Exposure to EE2 reduced embryonic viability and increased deformities at a concentration of 2.3 µg/g (NOEL = 0.18 µg/g), and BaP decreased embryonic viability (median lethal dose = 0.015 µg/g; NOEL = 0.0027 µg/g). Compared with Japanese quail, double-crested cormorant were more sensitive with regard to embryolethality and deformities for EE2 and embryolethality for BaP, whereas they were less sensitive to embryonic deformities associated with chlorpyrifos exposure. These data reinforce the idea that standardized toxicity tests using a laboratory model species may not always be protective of wild birds, and thus they stress the importance of developing such alternative testing strategies (e.g., the EcoToxChip Project) for ecologically relevant species to augment risk assessment efforts. Environ Toxicol Chem 2021;40:390-401. © 2020 SETAC.

Assessment of five live-cell characteristics in periphytic diatoms as a measure of copper stress

Metal pollution of fluvial systems remains a major problem and biomonitoring can be a useful tool for assessing the metal contamination. To assess their potential as new bioindicators of copper stress, we treated a field-collected live periphytic diatom community (dominated by Amphora, Navicula, and Nitzschia) with dissolved Cu under optimal growth conditions. We studied the effects of Cu on five live-cell attributes: motility, protoplasmic content, lipid body number and biovolume, and frustule morphology. In all three genera, motility and protoplasmic content decreased, whereas the LB number, biovolume and deformity increased when Cu and exposure time increased. The sensitivity to Cu was highest for % MF, % CPC and % BCLB in Navicula and the LB number and deformity in Nitzschia. Amphora appeared to be more tolerant to Cu in comparison with other genera. The five cell attributes were inter-related. A heatmap showed that a recommended indicator for rapid screening of Cu toxicity was % BCLB for Amphora and % MF for Navicula and Nitzschia. % MF might be the most common representative indicator that can be applied to all three genera to evaluate the lethal effects of Cu stress if only one of the five cell attributes must be selected.

Repeated exposure of pyriproxyfen to pregnant female mice causes developmental abnormalities in prenatal pups

The continuous exposure to conventional pesticides leads to severe health and environmental issues especially at prenatal stage during developmental period. Herein, we aimed to investigate the anomalies due to repeated exposure of pyriproxyfen in pregnant female mice and their neonates. Twenty-four pregnant female mice were repeatedly administered with pyriproxyfen at 30, 100, 300, and 1000 mg/kg by oral gauge from gestation day (GD) 7 to gestation day 17 and six females were given distilled water in the control group. All the live pups were euthanized at postnatal day (PND) 7 and their organs (heart, liver, kidney, and brain) were dissected out, weighed, and assessed for further histopathological examinations. The results exhibited a significant (P < 0.001) decrease in the body weight gain of all treated pregnant mice in comparison to the controls and a significant increase in the gestational length was observed in group IV (P < 0.01) and group V (P < 0.001). In addition, no live pups were born in groups IV and V and one pregnant female mouse was also found dead in both treatments. The body weights of the pups were significantly decreased in group II (P < 0.05) and group III (P < 0.001) and the relative organ (liver, heart, and kidney) weight of the pups was increased significantly (P < 0.001, P < 0.01, P < 0.05) due to prenatal exposure in group II as compared to group I. The relative brain weights of the pups were decreased significantly (P < 0.001) in groups II and III as compared to group I. The liver, kidney, heart, and brain sections exhibited various histological alterations in groups II and III by hematoxylin and eosin staining. Furthermore, immunohistochemical staining of the coronal sections of pup's brain showed significant (P < 0.001) reduction in cortical radial thickness and total neural count in group II and III as compared to group I. Therefore, the prenatal exposure to pyriproxyfen provoked the damage to various organs in mice offspring and an increase in fetal death at higher doses.

Limb lengthening for deformities in Ollier's disease: a systematic review. Eur J Orthop Surg Traumatol. 2020;30:1325-1332. [PMID: 32500348 DOI: 10.1007/s00590-020-02692-5]

BACKGROUND

The management of limb deformity, shortening, and bone defects in treatment of Ollier's disease is a major challenge. This study aims to summarize and compare the different surgical treatments, and to evaluate the outcome and possible prognostic factors of leg lengthening in these patients.

MATERIALS AND METHODS

A systematic review of the literature from 1993 to 2017 was performed. Nineteen articles were found including a total of 121 patients with limb deformities because of Ollier's disease. The mean patients' age at the time of first surgery was 12 years. A total of 272 segments were surgically treated (14 segments in the upper limbs) with variable techniques including osteotomies and external fixation, intramedullary nails, as well as epiphysiodesis and lengthening over nail. We studied the bone healing index (BHI), distraction index (DI), distraction time, gained length, total treatment time, and complications.

RESULTS

Available implants and techniques allowed correction of patients' deformities (lengthening and correction of angular defects) in most cases. External fixators, circular or monolateral frames were the most commonly used technique. The Ilizarov external fixator was the most commonly used frame (196 segments). The BHI was significantly better when the external fixation was combined with intramedullary nails. Epiphysiodesis was most likely to be more associated with the past than to the present. Joint stiffness, infection, early consolidation, pathological fracture, deformity recurrence, delayed union, non-union, neurapraxia, and overlengthening were the reported complications with an overall rate of 27.9%.

CONCLUSIONS

There is no consensus for the optimal surgical technique and implants for correction of limbs deformities in patients with Ollier's disease. External fixators most commonly circular are the most commonly used implants; however, complications do occur.

A case series and literature review on patients with rhinological complications secondary to the use of cocaine and levamisole

BACKGROUND

Levamisole is an increasingly common cutting agent used with cocaine. Both cocaine and levamisole can have local and systemic effects on patients.

METHODS

A retrospective case series was conducted of patients with a cocaine-induced midline destructive lesion or levamisole-induced vasculitis, who presented to a Dundee hospital or the practice of a single surgeon in Paisley, from April 2016 to April 2019. A literature review on the topic was also carried out.

RESULTS

Nine patients from the two centres were identified. One patient appeared to have levamisole-induced vasculitis, with raised proteinase 3, perinuclear antineutrophil cytoplasmic antibodies positivity and arthralgia which improved on systemic steroids. The other eight patients had features of a cocaine-induced midline destructive lesion.

CONCLUSION

As the use of cocaine increases, ENT surgeons will see more of the complications associated with it. This paper highlights some of the diagnostic issues and proposes a management strategy as a guide to this complex patient group. Often, multidisciplinary management is needed.

Acute effects of chromium on hemato-biochemical parameters and morphology of erythrocytes in striped catfish Pangasianodon hypophthalmus

Chromium is considered the most detrimental pollutant to the aquatic organisms. The present experiment was conducted to determine the acute toxicity of chromium in view of its effects on hemato-biochemical parameters and the structure of erythrocytes in striped catfish, Pangasianodon hypophthalmus. Fish were exposed to seven different concentrations (0, 10, 20, 30, 40, 50 and 60 mg/L) of chromium, each with three replications for 96 h. After 96 h of exposure, the survived fish were sacrificed to measure hemato-biochemical parameters (hemoglobin, Hb; red blood cell, RBC; white blood cell, WBC; packed cell volume, PCV; mean corpuscular volume, MCV; the mean corpuscular hemoglobin, MCH and blood glucose). In addition, erythrocytic cellular abnormalities (ECA) and erythrocytic nuclear abnormalities (ENA) of peripheral erythrocytes were assayed. No mortality was observed up to 10 mg/L, but 90% and 100% mortality was observed at 50 mg/L and 60 mg/L, respectively after a 96 h exposure period. The 96 h LC50 value through probit analysis was 32.47 mg/L. Hb (%), RBC (×106/mm3) and PCV (%) significantly decreased at 20, 30 and 40 mg/L of chromium, whereas WBC (×103/mm3), MCV (μm3) and MCH (pg) showed the opposite scenario. Blood glucose (mg/dL) levels significantly increased at 10, 20, 30 and 40 mg/L of chromium compared to 0 mg/L. Frequencies of ECA and ENA significantly increased with increasing chromium concentrations. This study indicates that chromium is highly toxic to striped catfish.

Potential use of morphological deformities in Chironomus (Diptera: Chironomidae) as a bioindicator of heavy metals pollution in North-East Algeria

Human activities have led to profound changes in aquatic environments and degradation at several levels. Preserving the quality of aquatic environments, their good functioning, and the species that are dependent on them has become a crucial element. In order to monitor the overall health of aquatic ecosystems, it is necessary to develop early indicators of environmental quality. In this work, we have tried to evaluate whether the analysis of morphological deformities affecting Chironomidae larvae could tell us about the state of degradation of water courses that are subjected to different discharges. To do this, water, sediment, and larvae of Chironomidae were sampled in dry weather in August-September of 2017 at three sites located in the North-East of Algeria. The heavy metals in the three compartments as well as the deformities affecting the mentum and mandibles of Chironomus were analyzed. The results showed a metal contamination especially in sediments; the highest values were found in Meboujda River and Seybouse River. The three sites have high deformities incidences, more than 33%, which suggests the presence of toxic stress. This study reflected the relationship between heavy metal concentrations in water, sediments, and deformities larval mouthparts (mentum and mandibles) in Chironomus. The use of deformities in Chironomus sp. can serve as an effective tool for bioassessment of freshwater ecosystems.

The impact of elevated temperature and CO2 on growth, physiological and immune responses of Polypedates cruciger (common hourglass tree frog)

BACKGROUND

Amphibians are one of the most susceptible groups to climate change as their development occurs in aquatic environments or in microhabitats with high humidity. Accordingly, our primary objective was to investigate the chronic physiological responses seen in early larval to adult stages of Polypedates cruciger (Common hourglass tree frog) to future climate change based on continuous exposure to elevated temperature and elevated CO2 -induced low water pH. Free-swimming and free-feeding tadpoles were observed until metamorphosis under four experimental treatments; two elevated temperatures, one elevated CO2 (reduced pH) and a control maintained at ambient temperature (29 °C ± 1 °C) and CO2 (pH = 7). Elevated temperature treatments were maintained at 32 °C ± 0.5 °C and 34 °C ± 0.5 °C to represent respectively, the future climate scenarios RCP2.6 (Representative Concentration Pathway 2.6, the 'base-case' scenario) and RCP8.5 ('business-as-usual' scenario) according to the 5th Assessment Report of the IPCC. Elevated CO2 treatment was maintained within the pH range of 5.5-5.6 representing the range expected between RCP8.5 and RCP2.6.

RESULTS

Compared to the control, elevated CO2 accelerated phenological progression of tadpoles through Gosner stages, thus resulting in lower body size at metamorphosis. Both elevated temperatures significantly delayed the development and reduced the growth of tadpoles. 100% mortality was observed in 34 °C treatment before metamorphosis (before Gosner stage 36) while all the tadpoles died after metamorphosis (at Gosner stage 46) in 32 °C treatment. Elevated CO2 increased tadpole activity, in terms of their swimming speed, while both of the elevated temperatures reduced it compared to the control. Catalase activity increased at elevated CO2. Ammonia excretion by tadpoles was decreased by elevated CO2, but increased under temperature elevation. Both Elevated CO2 and temperature treatments reduced the white blood cell count and its percentage of thrombocytes. Percentages of lymphocytes, monocytes and neutrophils were increased at 32 °C, while lymphocyte percentage and lysozyme activity were increased at elevated CO2. Several deformities were observed in tadpoles at elevated temperature and CO2.

CONCLUSIONS

Elevated temperatures and reduced pH due to elevated CO2, being major features of climate change, increase the vulnerability of amphibians, who are already one of the most threatened vertebrate groups. Based on our observations on the model amphibian species P. cruciger, increased vulnerability to climate change occurs by reducing their growth, body size and motility while also reducing their immunity and inducing physical deformities. These impacts are highly-likely to reduce the foraging, competitive and reproductive capabilities in their natural habitats. We conclude further that even the 'best-case' scenario of future climate change can impose significant physiological impacts that could threaten amphibian populations on broader spatial and temporal scales.

GRAPHICAL ABSTRACT

The effect of needle tenotomy on hammer, mallet and claw toe deformities in patients with diabetes, a retrospective study

Aim

The aim of this study was to evaluate outcomes of needle tenotomies as a treatment option for hammer, mallet and claw toes in patients with diabetes.

Methods

This was a retrospective study where all patients receiving flexor tendon tenotomy by needle at our outpatient clinic were identified through the electronic patient record system.

Results

A total of 81 patients that had 106 tenotomy procedures performed were identified. The 81 included (68% male) had an average age of 65.4 years, and 27 (33%) had Type 1 diabetes. Of the 106 procedures 36 were performed due to an ulcer on the feet. Of the 36 treated ulcers, 34 (94%) healed in an average time of 28 days. Tenotomies performed to prevent impending ulcers from progressing to active ulcers, were performed 84 times in total. Of the 84 procedures 6 patients progressed to an active ulcer. No serious complications i.e. infections or amputations in relation to the procedure were registered.

Conclusion

Needle flexor tenotomies are a relatively safe and effective treatment compared to tenotomies done by scalpel, both as treatment for ulcers and to prevent formation of new ulcers associated with hammer, mallet and claw toe deformities. As a side note, transfer lesions are avoidable if all toes on one or both feet are tenotomized in one procedure.

[Torsion and torsional development of the lower extremities]

BACKGROUND

Torsion is a frequent reason for consultation in paediatric orthopaedics. Torsion of the femur and the tibia in children change during growth. Depending on the age and possibility for compensation, this can be reflected in the gait pattern. Different causes can affect the normal development of torsion.

DIAGNOSTICS

In the context of paediatric orthopaedic assessment, the distinction between physiological and pathological torsion is essential. In addition to the patient history and observation of the gait pattern, as well as a detailed clinical examination, additional imaging techniques are used (Rippstein/Dunn, torsional CT/MRI, EOS). The dynamic effect of abnormal torsion on gait is evaluated by instrumented 3D gait analysis.

PATHOGENESIS

Evidence for the long-term significance of torsional deviations and the risk of consequential damage are low. Isolated increased femoral anteversion without accompanying hip dysplasia is fundamentally harmless, corrects during growth and only rarely needs correction in the case of ongoing disturbing gait or knee problems. In contrast, retroversion is likely indicate the development of pre-arthritic deformity and should be observed and treated more carefully. Tibial torsion shows great variability and may influence the development of femoral torsion. Torsional deformities in children with neurological or syndromal conditions are differentiated as when the biomechanical effects of torsions on their gait function are generally more marked and therefore treatment is more frequently necessary.

THERAPY

Conservative treatments cannot be expected to have an effect on the condition of the bones. Correction can only be achieved surgically with a rotational osteotomy. A simple principle underlies the technique, whereas indication and timing are challenging.

A Re-Evaluation of Chironomid Deformities as an Environmental Stress Response: Avoiding Survivorship Bias and Testing Noncontaminant Biological Factors

Larval deformities have been observed in chironomids, and are thought to be associated with aquatic contaminant exposure. However, in laboratory assays, deformities have not been linked with contaminants in the absence of potential confounding variables including mortality, which introduces a survivorship bias. There is also a paucity of data on noncontaminant causes. In addition, power analyses are rarely undertaken, meaning that effect sizes detectable are usually uncertain. We therefore aimed to clarify factors associated with deformities, by running survivorship bias-free (i.e., sublethal) assays, assessing contaminant (copper and imidacloprid) and noncontaminant (malnutrition) stressors, and considering natural biological (metamorphosis) factors in Chironomus tepperi. We included a posteriori power analyses for all tests. Our assays found no significant association between tested factors and deformity rate. Power analyses indicated that the stressor experiment had moderate power to detect deformity effects. The metamorphosis assay had relatively lower power (due to an unexpectedly high control deformity rate), highlighting the importance of power tests in these types of evaluations. These results, in conjunction with others recently published, raise doubts as to the causal effects of environmental stressors on deformity incidence. By avoiding survivorship bias, and by testing noncontaminant factors and statistical power, we present a more holistic methodology, to resolve ongoing uncertainty in this area. We also discuss possible future directions for chironomid deformity research, and concerns regarding survivorship bias in ecotoxicology. Environ Toxicol Chem 2019;38:1658-1667. © 2019 SETAC.

[Surgical treatment of hypertrophic scar contracture deformity after deep burn]

Although burn treatment technology has been greatly improved, the number of patients with hypertrophic scar contracture deformities after burn has not decreased significantly. Some patients still have severe deformities, which not only affect the appearance, but also lead to different degrees of dysfunction. Surgery is still dominant for treating hypertrophic scar contracture deformity. In addition to skin grafting, flaps, especially expanded flaps (perforator flaps), expanded free flaps (perforator flaps), and prefabricated flaps etc. are more frequently used in functional and exposed areas after scar excision, in order to achieve perfect repair and reduce donor site damage. The treatment of scar contracture deformity should take into account the rehabilitation after operation on the basis of active operation, so as to achieve the unity of shape and function.

Toxicity of Aqueous L-Selenomethionine Exposure to Early Life-Stages of the Fathead Minnow (Pimephales promelas)

Aqueous exposures to selenomethionine (SeMet), the major form of selenium (Se) in the diet, represent a rapid and simplified method for determining the embryotoxic effects of SeMet. Using fathead minnows (Pimephales promelas) as a model test organism, the objective of this study was to evaluate the effects of waterborne exposure to elevated SeMet on embryos from fertilization to swim-up. Newly fertilized embryos were exposed for 6 days to 30, 90, 270, 810, 2430, 7290, 21,870, and 65,610 µg Se/L (as SeMet). Survival, hatchability, days to hatch, and the frequency and severity of deformities (total and type) were quantified. SeMet exposure reduced hatchability and days to hatch at concentrations ≥ 21870 µg/L. Significant decreases in survival and significant increases in the incidence and severity of deformities were observed at concentrations ≥ 810 µg/L. The results suggest that early life-stage fathead minnows are more tolerant to aqueous exposure to SeMet compared to medaka and zebrafish.

Maffucci syndrome and anaesthesia: Case report

Maffucci syndrome is an extremely rare, sporadic, and nonhereditary disease characterized by enchondromatosis, bony abnormalities, and vascular malformations. We report a successful anaesthetic management of an adult patient with Maffucci syndrome scheduled for surgical excision of parathyroid adenoma, who had numerous enchondromas, haemangiomas, and skeletal deformities involving different parts of the body and posing significant challenge during positioning, securing intravenous access, and insertion of endotracheal tube. Awareness about this syndrome is of paramount importance because similar patients may be encountered with increasing frequency for incidental or corrective surgeries.

Metal toxicity and recovery response of riverine periphytic algae

In the present study, in situ assessment of metal (Cu and Zn) toxicity followed by their recovery response was examined in periphyton dominated by diatoms. For doing so, metal diffusing substrates (MDS) were constructed and deployed in the river water for 6 weeks (3 weeks stress and 3 weeks recovery after replacing metal solution from the MDS). The use of MDS ensured that colonised periphyton on metal diffusing and control substrates were exposed to similar environmental conditions. The metal toxicity and recovery response of the community was examined in terms of traditional algal community parameters (biovolume, species richness, Shannon index, relative abundance) as well as with the newer non-taxonomical parameters (deformities and lipid bodies in diatoms). Both traditional and non-taxonomical parameters indicated complete recovery (from metal toxicity) of periphytic communities after 3 weeks following the withdrawal of Cu and Zn solution from the diffusing substrates. Newer non-taxonomical parameters, such as, deformities and lipid bodies, provide a new insight to understand metal toxicity and recovery response of diatom assemblages (the dominant autotrophs in the periphyton community) because these features are directly visible in live frustules, need no expertise in identification of diatoms and can be globally assessed with simple protocol. The experimental loss of metal pollutants and the constant immigration of algae (not previously exposed to high levels of metals) in fluvial systems aided periphyton recovery. Lastly, it is found that periphytic biofilms (dominated by diatoms) proved to be good bioindicators of metal toxicity and recovery in fluvial ecosystem.

Non-surgical rhinoplasty using filler, Botox, and thread remodeling: Retro analysis of 332 cases

BACKGROUND

Non-surgical nasal job has been practiced and published with doubtful concerns about efficiency and safety among physicians and aesthetic surgeons.

AIM

of the work to share our experiences in non-surgical rhinoplasty using filler, Botox, and thread with presentation of aesthetic and complication outcome.

PATIENT AND METHODS

Retrospective analysis of the aesthetic and complication outcomes and techniques for non-surgical remodeling rhinoplasty using fillers, Botox, and PDO absorbable threads in 332 cases.

RESULTS

Non-surgical nasal remodeling provides temporary correction of small nasal deformities with achieved satisfactory aesthetic outcome and very low incidence of complications.

CONCLUSION

Non-surgical nasal remodeling with injection precautions could work efficiently and safely in outpatient clinic with good temporary results up to 6 months.

Abnormalities in bivalve larvae from the Puck Bay (Gulf of Gdansk, southern Baltic Sea) as an indicator of environmental pollution

This study described the occurrence of abnormalities in bivalve larvae from the Puck Bay. Analyses of plankton samples collected in 2012-2013 showed that larval Mytilus trossulus, Mya arenaria, and Cerastoderma glaucum exhibited abnormalities that could indicate adverse environmental impacts. The deformities were mainly in shells, but missing soft tissue fragments and protruding vela were also noted. In addition to larval studies, we analyzed benthic postlarvae of Mytilus trossulus. Interestingly, grooves and notches at different locations of the prodissoconch, dissoconch, and shell margin were observed. Some of these deformations were reminiscent of the indentations found on the shell edge of larvae. Comparing the proportion of abnormal postlarvae to larvae with shell abnormalities suggested that the survival of larvae with shell abnormalities was low. Overall, our results suggested that the ratio of abnormal bivalve larvae could be used as an indicator of the biological effects of hazardous substances in the pelagic environment.

Evaluating features of periphytic diatom communities as biomonitoring tools in fresh, brackish and marine waters

The aims of this study were to assess the biodiversity of periphytic diatom assemblages in fresh, brackish and marine waterbodies of Korea, and to assess the effect of environmental and anthropogenic factors on parameters such as the quantity and biovolume of lipid bodies and deformations of diatoms as early warning measures of anthropogenic impact. Diatom samples were collected from 31 sites (14 freshwater, 10 brackish and 7 marine), which included less impacted (upstream) and impacted (downstream) sites in each water type. Our results showed higher abundance and biodiversity of periphytic diatoms at the less impacted sites in terms of species richness, Shannon index, cell count and biovolume of the communities than at the impacted sites for freshwater and estuarine sites, but not for marine sites. 84 diatom species were noted in freshwater, 80 in brackish water and 40 in marine waters. In comparison to diatoms of the impacted sites, those of less impacted freshwater, brackish and marine sites had less lipid bodies (also less biovolume) and a lower percentage of teratological frustules, and showed more mobile forms in the community. Principal component analysis (PCA) also showed clear segregation of impacted from less impacted sites by the extent of the presence of lipid bodies (higher both in number and biovolume) and deformities in diatom frustules. Pearson correlation analysis revealed that lipid body induction and deformities were positively correlated with metals (Cd, Co, Cr, Cu, Fe, Pb and Zn) and nutrients (total phosphorus and total nitrogen), whereas they showed negative correlation with salinity, dissolved oxygen, suspended solutes and pH. Life-forms, lipid bodies and deformities in diatoms may be an effective biomonitoring tool for assessing biological effects of pollutants in non-marine aquatic ecosystems in Korea.

[Hallux valgus : Etiology, diagnosis, and therapeutic principles]

Hallux valgus-the most common forefoot deformity-can cause both pain and decreased mobility. The development and progress of the hallux valgus is a multifactorial process. Different intrinsic and extrinsic causes are responsible. Various conservative and operative treatment options exist and have to been chosen regarding the stage of the disease. Conservative orthopedic measures may prevent a deterioration of hallux valgus only at an early stage of the disease. Concerning operative techniques, more than 150 different surgical procedures are described in the literature, which can be reduced to some common procedures. These are dependent on the manifestation of the bunion as well as on associated foot and ankle pathologies. Patients should be informed that postoperative follow-up treatment until complete recovery is time-consuming.

The use of diatoms in ecotoxicology and bioassessment: Insights, advances and challenges

Diatoms are regularly used for bioassessment and ecotoxicological studies in relation to environmental and anthropogenic disturbances. Traditional taxonomical diatom parameters (cell counts, biovolume estimates, species richness, diversity indices and metrics using sensitive and tolerant diatom species) are regularly used for these studies. In the same context, very less focus was given on new endpoints of diatoms (life-forms, nuclear anomalies, alteration in photosynthetic apparatus shape, motility, lipid bodies, size reduction and deformities), in spite of their numerous merits, such as, their easiness, quickness, cheapness, global acceptation and no especial training in diatom taxonomy. In this review we analyzed 202 articles (from lab and field studies), with the aim to investigate the bioassessment and ecotoxicological advancement taken place in diatom research especially in terms of exploring new endpoints along with the traditional taxonomical parameters in a perspective which can greatly enhance the evaluation of fluvial ecosystem quality for biomonitoring practices.

[Acute haematogenous osteomyelitis in children : Diagnostic algorithm and treatment strategies]

Acute haematogenous osteomyelitis (AHO) in children is a severe condition. A delay in diagnosis and insufficient treatment may result in deformities, chronicity and sepsis. Therefore a structured diagnostic workup has to be followed in order to diagnose or rule out osteomyelitis. To identify the causative agent for targeted antibiotic treatment, a bone biopsy or puncture should be performed. However, approximately 25% of cases are culture-negative even after biopsy. The knowledge of the typical age-dependent bacterial spectrum is essential for empirical antibiotic therapy. The principal causative organism is Staphylococcus aureus. Surgery is not routinely required in paediatric acute osteomyelitis but surgical intervention is indicated if an abscess is detected. Secondary septic arthritis is a serious complication which has to be treated immediately by surgical intervention. Nevertheless, complete regeneration can be expected in up to 80% of children with AHO.

[SCARF osteotomy]

Hallux valgus is one of the most common deformities of the lower extremity. Multiple etiologies have been discussed, and various techniques have been described. The SCARF osteotomy is indicated for moderate to severe hallux valgus deformities. The technique historically used by carpenters allows immediate postoperative weight bearing and also entails the possibility to correct the distal metatarsal articular angle by rotation of the osteotomy. The SCARF osteotomy has also been successfully used in revision surgeries.

[Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)]

Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.

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

INTRODUCTION

Subjects 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.

HYPOTHESIS

Subjects with DS have an increased prevalence of foot deformities compared to control subjects.

METHODS

Fifty-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).

RESULTS

Significantly 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.

DISCUSSION

Although 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 EVIDENCE

IV-retrospective study.

Fish scales as a non-lethal tool of the toxicity of wastewater from the River Chenab

Water pollution is gradually increasing in natural waters through anthropogenic activities. This study aimed to use fish scales as a bio-indicator of pollution, along with water quality parameters, and the assessment and detection of selected heavy metals in water samples collected from the River Chenab, including the Chakbandi drain that gathers domestic sewage waste and industrial effluents from Faisalabad and deposits it into this freshwater body. All water quality parameters (pH, total dissolved solids (TDS), total suspended solids (TSS), salinity, conductivity, biochemical oxygen demand (BOD), chemical oxygen demand (COD), phenols and sulphates) and concentrations of selected heavy metals (Cd, Cu, Mn, Pb and Cr) were found to be considerably higher than permissible limits as defined by the WHO, and therefore capable of causing ill health effects in aquatic organisms. Specimens of fish scales from selected fish were described qualitatively and observed quantitatively. In Catla catla, Labeo rohita and Cirrhinus mrigala, the scales showed several deformities in shape and different scale structures such as circuli, radii and annuli. In each of the three types of fish, considerable variation in the morphology of their scales was observed in specimens collected from polluted sites.

Molecular responses of Walleye (Sander vitreus) embryos to naphthenic acid fraction components extracted from fresh oil sands process-affected water

Naphthenic acid fraction components (NAFCs) are constituents of oil sands process-affected water (OSPW), which is generated as a result of unconventional oil production via surface mining in the Athabasca oil sands region. NAFCs are often considered to be major drivers of OSPW toxicity to various taxa, including fishes. However, the molecular targets of these complex mixtures are not fully elucidated. Here we examined the effects in walleye (Sander vitreus) embryos after exposure to NAFCs extracted from fresh OSPW. Eleutheroembryos (exposed to 0, 4.2 or 8.3mg/L NAFCs from 1day post-fertilization to hatch) were subsampled, measured for growth and deformities, and molecular responses were assessed via real-time polymerase chain reaction (PCR). Fourteen genes were evaluated, with a focus on the aryl-hydrocarbon receptor (AhR) - cytochrome P450 pathway (arnt, cyp1a1), the oxidative stress axis (cat, gst, sod, gpx1b), apoptosis (e.g. casp3, bax and p53), growth factor signaling (e.g. insulin-like growth factors igf1, igf1b, and igf1bp), and tissue differentiation (vim). NAFC exposure was associated with an increase in the expression of cyp1a1, and a decrease in gpx1b and ribosomal protein rps40. These results indicate that NAFC effects on walleye early-life stages may be mediated through oxidative stress via pathways that include AhR.

The white mullet (Mugil curema) as biological indicator to assess environmental stress in tropical coastal lagoons

Several coastal lagoons and estuaries in Mexico receive untreated domestic and industrial discharges which contain complex mixtures of contaminants. In order to assess the effects of chemical contamination, we used the White mullet (Mugil curema) as biological indicator. We worked in two estuaries located in Northwest Mexico: Urias (highly polluted) and Teacapan (less polluted, therefore used as reference site). We measured several endpoints at different levels of biological organization: vitellogenin transcription in males as biomarker of estrogenic contamination, as well as reproductive, morphological (deformities), morphometric, and meristic parameters. Total RNA was isolated from the liver, and a partial sequence of the mullet vitellogenin gene was obtained; gene expression was analyzed by quantitative PCR. At the same time, gonad samples were analyzed by histologic techniques to determine sex ratios and the reproductive cycle stage. The reproductive season was detected from February to June in both sites, but the gonadosomatic index was consistently higher in Teacapan. Sex ratios were female-biased in both estuaries, and one intersex gonad and several malformations were found in fish from Urias. Vitellogenin gene transcription in males was detected in both sites, although gene expression was slightly higher in Urias. The results obtained in this study indicate that biological effects of contamination are evident in fish, environmental estrogens may be present in both estuaries, and the white mullet is useful as biological indicator to identify and characterize environmental stressors in tropical coastal ecosystems.

Guided growth: mechanism and reversibility of modulation

In paediatric orthopaedics, deformities and discrepancies in length of bones are key problems that commonly need to be addressed in daily practice. An understanding of the physiology behind developing bones is crucial for planning treatment. Modulation of the growing bone can be performed in a number of ways. Here, we discuss the principles and mechanisms behind the techniques. Historically, the first procedures were destructive in their mechanism but reversible techniques were later developed with stapling of the growth plate being the gold standard treatment for decades. It has historically been used for both angular deformities and control of overall bone length. Today, tension band plating has partially overtaken stapling but this technique also carries a risk of complications. The diverging screws in these implants are probably mainly useful for hemiepiphysiodesis. We also discuss new minimally invasive techniques that may become important in future clinical practice.

[Posttraumatic deformities of the knee joint : Intra-articular osteotomy after malreduction of tibial head fractures]

Malreduction of tibial head fractures often leads to malalignment of the lower extremity, pain, limited range of motion and instability. The extent of the complaints and the degree of deformity requires an exact analysis and a standardized approach. True ligamentous instability should be distinguished from pseudoinstability of the joint. Also extra- and intra-articular deformities have to be differentiated. In intra-articular deformities the extent of articular surface displacement, defects and clefts must be accurately evaluated. A specific surgical approach is necessary, which allows adequate visualization, correct osteotomy and refixation of the fractured area of the tibial head. In the long-term course good clinical results are described for intra-articular osteotomies. If the joint is damaged to such an extent that it cannot be reconstructed or in cases of advanced posttraumatic osteoarthritis, total knee arthroplasty may be necessary; however, whenever possible and reasonable, anatomical reconstruction and preservation of the joint should be attempted.

[Surgical treatment of de-novo scoliosis]

BACKGROUND

De-novo scoliosis is most commonly associated with chronic back pain and in 70 % of cases with neurological symptoms of the lower extremities. In recent literature, the occurrence and severity of segmental lateral listhesis has been discussed as being an important prognostic factor of sagittal and frontal deformity progression. In general, operative interventions in patients with de-novo scoliosis are associated with a high rate of complications. Therefore, conservative treatment modalities are recommended at early stages of the disease. If conservative management fails and a sufficient reduction of the patient's symptoms cannot be achieved, depending on the symptoms, a selective decompression, short-segment fusion or long-instrumented reduction and fusion are indicated. Additionally to the patient's symptoms, specific imaging diagnostics are necessary to develop an adequate surgical treatment strategy.

TREATMENT

Selective decompression without fusion is indicated in patients with a fixed deformity and primarily neurologic pain or deficits. In conditions of a focal pathology as cause of significant low back pain and/or neurologic symptoms at early stages of deformity, a short segment fusion is the treatment of choice. However, short-segment fusion as a less-invasive procedure must not be performed in biplanar unbalanced patients and/or advanced de-novo scoliosis. In advanced degenerative de-novo scoliosis a long-segment reposition and fusion following an alignment correction are needed. Standardized pre-operative planning and perioperative management are highly critical to the post-operative success.

CONCLUSION

All operative treatment strategies in patients with de-novo scoliosis can be successful but they require sophisticated and individual surgical indication.

[Surgical treatment of talocalcaneal coalition : Experience with 80 cases of pediatric or adolescent patients]

INTRODUCTION

There is still a controversial discussion on the treatment of talocalcaneal coalition with and without planovalgus deformity. From 2002-2014 80 cases of talocalcaneal coalition in children and adolescents under 18 years of age were surgically treated by J. Hamel. The objective of this study is a retrospective analysis, especially of unfavourable results.

METHODS

Patients with minimum follow up of 12 months were included (35.7 months on average). In 31 cases treatment consisted of resection and fat-grafting (group 1), in 26 additional cases tarsal osteotomy was added because of planovalgus-deformity (group 2), and in 23 cases primary fusion of the talocalcaneal joint was performed (group 3).

RESULTS

In group 1 one patient was lost to follow-up early with a severe peroneal spasticity and unknown further course. Two further patients still had remarkable pain after 15 months, and another patient had to undergo secondary fusion because of persistent pain. In group 2 secondary fusion was undertaken in two cases and offered in four other cases. In group 3 two patients still suffered from moderate tarsal pain, although complete fusion occurred; one of these patients underwent bilateral treatment. All other patients were pain free or nearly pain free on the last follow-up visit, with marked improvement in comparison to the preoperative situation.

DISCUSSION

Surgical treatment of talocalcaneal coalition is successful in most cases in the short to medium follow-up, but unfavourable results are not uncommon and may require secondary fusion. Differential indication between resection, additional deformity correction, or primary fusion seems to be most important.

Open surgical management of auricular haematoma: incision, evacuation and mattress sutures

OBJECTIVE

A large variety of techniques have been used for auricular haematoma management. The open surgical management of auricular haematoma involves incision, evacuation and the obliteration of dead space using biodegradable mattress sutures. Our goal was to describe open surgical management for primary, recurrent and spontaneous auricular haematoma.

METHODS

Auricular haematoma patients who underwent open surgical management were prospectively audited (2010-2013). Information was collected on demographics, clinical presentation, aetiology, examination findings, previous interventions, details of open surgical management and post-operative follow up.

RESULTS

In all, 12 male and 3 female patients with a mean age of 33 years (range 16-86 years) were evaluated. Contact sport injury was the most common aetiology. Ten patients had undergone previous unsuccessful interventions to treat auricular haematoma before open surgical management was performed. All patients were managed successfully without significant recurrence. One patient had a minor local reaccumulation which required reinsertion of a mattress suture. One elderly patient developed localised cellulitis which responded well to antibiotics.

CONCLUSION

Open surgical management of auricular haematoma has been successful. The technique is simple and reliable, and can be accomplished in a clinical setting under local anaesthesia.

Effects of cypermethrin on survival, morphological and biochemical aspects of rohu (Labeo rohita) during early development

The present study was conducted to investigate the effect of sub-lethal doses of Cypermethrin (CYP) on the survival and morphological and biochemical aspects of rohu (Labeo rohita) during early developmental stages. Newly fertilized eggs were incubated in the presence of sub-lethal concentration of CYP (20% of LC50 i.e., 8.43 μg L(-1)) in a well designed flow through system. Increased mortality was found with increase in exposure time. Deformities like eroded yolk and margins, elongated yolk sac, larvae with short tail, no eyes or larvae with zigzag movement and paralyzed larvae were observed in CYP treated group from blastula to fry stage. The activities of antioxidant like Catalase (CAT), Peroxidase (POD) and Lactoperoxidase (LPO) were decreased from 24 to 96 h in the control group whereas increased in CYP treated group. The Glutathione reducatse (GR) activity was also increased with time in both the control and treated groups; however, the activity was significantly higher in CYP treated group. Similarly, the whole body cortisol level showed an increasing trend with time in both control and treated groups. However, in CYP exposed group the cortisol level was considerably higher after 24 h exposure but statistically comparable to the control group after 96 h. It can be concluded from the present results that CYP even at very low concentration adversely affects the early development of L. rohita and enhances mortality. The obtained results reveal that CYP may affect the wild population of fish by inducing oxidative stress and modulating stress response during early ontogenesis.

Sensitivity of walleye (Sander vitreus) and fathead minnow (Pimephales promelas) early-life stages to naphthenic acid fraction components extracted from fresh oil sands process-affected waters

Unconventional oil production in Alberta's oil sands generates oil sands process-affected water (OSPW), which contains toxic constituents such as naphthenic acid fraction components (NAFCs). There have been few studies examining effects of NAFC exposure over long periods of early-life stage development in fish. Here we examined the effects of NAFCs extracted from OSPW to embryo-larval fathead minnow, exposed for 21 days. We compared the sensitivity of fathead minnow to walleye reared to 7 days post-hatch (18-20 days total). EC50s for hatch success, including deformities, and total survival were lower for walleye (10-11 mg/L) than fathead minnow (22-25 mg/L), with little post-hatch mortality observed in either species. NAFC exposure affected larval growth at concentrations below the EC50 in fathead minnow (total mass IC10 14-17 mg/L). These data contribute to an understanding of the developmental stages targeted by oil sands NAFCs, as well as their toxicity in a greater range of relevant taxa.

Nail Deformities and Injuries

A variety of nail deformities commonly presents in the primary care office. An understanding of nail anatomy coupled with inspection of the nails at routine office visits can reveal undetected disorders. Some problems are benign, and treatment should be attempted by the primary care provider, such as onychomycosis, paronychia, or ingrown toenails. For conditions such as benign melanonychia, longitudinal ridges, isolated Beau lines, and onycholysis, clinicians may offer reassurance to patients who are concerned about the change in their nails. For deformities such as early pterygium or clubbing, a thorough evaluation and referral to an appropriate specialist may be warranted.