An X-ray inactivated vaccine against Pseudomonas aeruginosa Keratitis in mice

Pseudomonas aeruginosa (P. aeruginosa) is one of the most prevalent pathogens of bacterial keratitis. Bacterial keratitis is a major cause of blindness worldwide. The rising incidence of multidrug resistance of P. aeruginosa precludes treatment with conventional antibiotics. Herein, we evaluated the protective efficiency and explored the possible underlying mechanism of an X-ray inactivated vaccine (XPa) using a murine P. aeruginosa keratitis model. Mice immunized with XPa exhibit reduced corneal bacterial loads and pathology scores. XPa vaccination induced corneal macrophage polarization toward M2, averting an excessive inflammatory reaction. Furthermore, histological observations indicated that XPa vaccination suppressed corneal fibroblast activation and prevented irreversible visual impairment. The potency of XPa against keratitis highlights its potential utility as an effective and promising vaccine candidate for P. aeruginosa.     

Is Kidner procedure necessary during subtalar arthroereisis for pediatric flexible flatfoot that combined with symptomatic type 2 accessory navicular? A retrospective comparative study

BackgroundKidner procedure is thought to be able to eliminate the medial foot pain and contribute to restoring the medial longitudinal foot arch, making it particularly suitable for surgical treatment of pes planus that combined with symptomatic type 2 accessory navicular (AN). However, controversy remains, and the clinical evidence is still lacking. The aim of the current study is to verify the necessity of Kidner procedure during subtalar arthroereisis (STA) for pediatric flexible flatfoot (PFF) that combined with symptomatic type 2 AN.MethodsForty pediatric patients (72 feet) who had undergone STA for flexible flatfoot and were also diagnosed with symptomatic type 2 AN concomitantly were reviewed retrospectively and divided into two groups (STA + Kidner vs STA alone). The visual analog scale (VAS), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Oxford ankle foot questionnaire for children (OAFQC), and the radiographic parameters that quantifying pes planus were evaluated as primary outcomes. Secondary outcomes included the incidence of complications.ResultsThere were 35 feet in the STA + Kidner group and 37 feet in the STA alone group, with mean follow-up periods of 2.7 years and 2.1 years, respectively. The VAS, AOFAS, OAFQC scores and radiographic parameters presented no significant difference between the two groups both preoperatively and at final follow-up (P > 0.05 for each). The complications of STA surgery occurred equally in both groups, and Kidner procedure could lead to more incision problems (22.9% vs. 2.7%) and a longer time to return to activity.ConclusionKidner procedure may be unnecessary during surgical treatment of PFF that combined with painful type 2 AN. Correcting the PFF while leaving the AN alone has a high possibility of relieving the pain in the AN region, and tibialis posterior tendon (TPT) rerouting hardly aids in reconstruction of the medial foot arch.Level of EvidenceIII.     

Is the EQ-5D-5L a responsive test to evaluate results in elective foot and ankle surgery?

PurposeTo analyze the responsiveness and the minimally clinical important change (MCIC) of the EuroQol (EQ) 5D-5 L score in patients that had undergone foot/ankle surgery.MethodsPatients that underwent elective foot/ankle surgery from January 2019 to December 2020 were included. They were assessed with the EQ-5D-5L, visual analogue pain scale and Manchester Oxford Foot Questionnaire (MOXFQ) preoperatively and 1 year postoperatively. The pre-post differences of all variables, Effect Size (ES) and MCIC were analyzed.Results167 patients. All variables showed a significant pre-post improvement. The ES for EQ-index and EQ-VAS were 0.61 and 0.33 respectively. MCIC for EQ-index was 0.17 and EQ-VAS was 8.54. MOXFQ index ES was 1.46 and the MCIC was 23.8. VAS decreased from 59.4 to 26.62.ConclusionThe EQ-5D-5L is a sensitive test to detect changes after elective foot and ankle surgery with good responsiveness relative to the ES values in the EQ-index.Level of evidenceII     

Hemiepiphysiodesis for juvenile hallux valgus deformity: A systematic review

BackgroundAmong the numerous surgical interventions for correcting hallux valgus deformity in skeletally immature patients, hemiepiphysiodesis is a simple technique with a low complication rate yet its effectiveness remains unclear. This systematic review evaluates hemiepiphysiodesis of the first metatarsal for treating juvenile hallux valgus (JHV) deformities with respect to radiological outcomes, postoperative clinical outcomes, and postoperative complications.MethodsEMBASE, MEDLINE, PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) database were searched from inception to September 15th, 2022, for studies investigating hemiepephysiodesis for JHV and its effect on clinical and radiological outcomes. The search, data extraction and methodologic assessment were performed in duplicate for all included studies.ResultsSix studies out of 488 with a total of 147 feet in 85 patients were included in the final qualitative synthesis. The American Orthopaedic Foot & Ankle Society hallux metatarsophalangeal interphalangeal scale (AOFAS Hallux MTP-IP scale) was used in two studies. The mean pooled preoperative score was 62.2 ± 8.9 and improved to 88.6 ± 4.8 postoperatively in 33 patients. All six studies reported significant improvement in the hallux valgus angle (HVA) from mean preoperative angle of 29.2° ± 3.7–23.8° ± 4.5° postoperatively, while the intermetatarsal angle (IMA) preoperative and postoperative means corrected from 13.9° ± 1.1–11.4° ± 1.2°, respectively. Out of 147 feet, 21 (14.2%) had reported complications including recurrence and need for revision surgery.ConclusionThis systematic review confirms that hemiepiphysiodesis of the first metatarsal in patients with JHV has improved clinical and radiological outcomes.Level of evidenceLevel IV, Systematic review     

植入性大腿假肢经皮密封部位的动态应力分析

目的验证带孔弧形圆盘经皮器件设计的合理性。方法通过对不同结构形态的经皮器件在人体生理活动情况下,经皮器件-软组织界面与附近软组织应力分布进行理论计算和分析,并对经皮器件结构参数进行分析和优化。结果带孔弧形圆盘状经皮器件生物力学性能良好,利于生物密封;网孔圆盘孔径为20mm、孔间距为20mm的设计力学特性较好。结论初步证明了带孔弧形圆盘经皮器件设计的合理性。