Arthrodesis or total replacement arthroplasty for hallux rigidus: a randomized controlled trial

BACKGROUND: Arthrodesis is the current treatment for end-stage hallux rigidus, although there are many reports advocating total joint replacement arthroplasty. The aim of this randomized controlled trial was to evaluate clinical outcomes after first metatarsophalangeal joint (MTPJ) arthrodesis and replacement arthroplasty. METHODS: Between November, 1998, and January 2001, 63 patients between the ages of 34 and 77 years, with unilateral or bilateral MTPJ arthritis were recruited and randomly selected to have either MTPJ arthrodesis or arthroplasty. Twenty-two patients (38 toes) had arthrodesis and 27 patients (39 toes) had arthroplasty. A single surgeon performed all surgery. The primary outcome measure determining successful surgery was a decrease in pain as measured on a Visual Analogue Scale (VAS). Functional outcome was assessed at 6 months and 1 and 2 years. Cost data were simultaneously collected. RESULTS: At 24 months, pain improved in both groups (p < 0.001), but there were significantly greater improvements after arthrodesis (p = 0.01). All 38 arthrodeses united at a mean dorsiflexion angle of 26 degrees, with few complications. In contrast, in the arthroplasty group, six of the 39 inserted implants had to be removed because of phalangeal component loosening. In the remainder the range of motion gained was poor, and the patients tended to bear weight on the outer border of their foot. The cost ratio was 2:1 in favor of arthrodesis. CONCLUSIONS: Outcomes after arthrodesis were better than those after arthroplasty. The results were partially attributable to an unacceptably high incidence of loosening of the phalangeal components, which resulted in removal of the implants. However, even when data from the failures were excluded, arthrodesis was clearly preferred by most patients.     

Differences in Ball Sports Athletes Speed Discrimination Skills Before and After Exercise Induced Fatigue

Substantial research exists in relation to the effect of fatigue on the cognitive skills of athletes. Very few studies in the sport domain, however, have investigated decision-making time and accuracy in relation to the discrimination of the speed of a moving object following exercise at maximal intensity. The purpose of this study was to examine differences in the pre- and post-fatigue speed discrimination skills of elite ballgames athletes to determine if they prioritize accuracy or speed of decision-making when physically exhausted. The participants in the study were 163 males (M = 21.17, SD = 4.18) Estonian national level soccer (n = 79), basketball (n = 63) and volleyball (n = 21) players. Peak oxygen uptake (VO₂max) was assessed during completion of an incremental exercise test on a treadmill. Speed discrimination stimuli were images of red square-shapes on a grey background presented moving along the sagittal axis at four different virtual velocities on a computer (PC) screen. Repeated measures MANOVA revealed a significant main effect for the decision-making time factor. A second MANOVA revealed a significant main effect for the decision-making accuracy factor. The soccer group made a significantly lower number of errors than the basketball group (p = 0.015) in pre- and post-fatigue decision-making accuracy. The results showed that athletes’ decision-making time decreased and decision-making errors increased after a maximal aerobic capacity exercise task. A comparison of the pre- and post-fatigue speed discrimination skills of experienced basketball, volleyball and soccer players indicated that the only significant difference was for decision-making accuracy between the soccer and basketball groups. The current findings clearly demonstrated that the athletes made decisions faster at the expense of accuracy when fatigued.

Key points

• The purpose of this study was to examine differences in the pre- and post-fatigue speed discrimination skills of elite ballgames athletes to determine if they prioritize accuracy or speed of decision-making when physically exhausted.
• Speed discrimination stimuli were images of red square-shapes on a grey background presented moving along the sagittal axis at four different virtual velocities on a computer (PC) screen that represented the frontal plane.
• The participants exercised on a treadmill to level of 100% of peak oxygen uptake (VO2max).
• Repeated measures MANOVA revealed significant main effects for both the decision-making time and accuracy factors. The current findings clearly demonstrated that the athletes made decisions faster but with greater errors when fatigued.
• Post hoc analyses of the differences between the ball game sport groups indicated that soccer group participants reported a significantly lower number of errors than the basketball group (p = .015) in pre- and post-fatigue decision-making accuracy.
• Further investigations are required to clarify the equivocal set of previous findings regarding the relationship between the cognitive function of athletes at varying physical workload intensities.

Key words: Decision-making, perception, exhaustion, elite-athletes.     

Retinoids, 585-nm Laser,and Carbon Dioxide Laser: A Numeric Comparison of Neocollagen Formation in Photoaged Hairless Mouse Skin

Background  A variety of new methods for treating photoaging have been recently introduced. There has been increasing interest in comparing the relative efficacy of multiple methods for photoaging. However, the efficacy of a single method is difficult to assess from the data reported in the literature. Methods  Photoaged hairless mice were randomly divided into seven treatment groups: control, retinoids (tretinoin and adapalene), lasers (585 nm and CO₂), and combination groups (585 nm + adapalene and CO₂ + adapalene). Biopsies were taken from the treated regions, and the results were analyzed based on the repair zone. The repair zones of the various methods for photoaging were compared. Results  Retinoids produced a wider repair zone than the control condition. The 585-nm and CO₂ laser resurfacing produced a result equivalent to that of the control condition. A combination of these lasers with adapalene produced a wider repair zone than the lasers alone, but the combination produced a result equivalent to that of adapalene alone. Conclusion  Retinoids are potent stimuli for neocollagen formation. The 585-nm or CO₂ laser alone did not induce more neocollagen than the control condition. In addition, no synergistic effect was observed with the combination treatments. The repair zone of the combination treatment is mainly attributable to adapalene.     

Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation

This study compares outcome of reduced-intensity conditioned transplant (RIT) with outcome of conventional non-transplant therapy in patients with Hodgkin's lymphoma relapsing following autograft. There were 72 patients in two groups who had relapsed, and received salvage therapy with chemotherapy+/-radiotherapy. One group (n=38) then underwent alemtuzumab-containing RIT. The second group-historical controls (n=34), relapsing before the advent of RIT-had no further high-dose therapy. This group was required to respond to salvage therapy and live for over 12 months post-relapse, demonstrating potential eligibility for RIT, had this been available. Overall survival (OS) from diagnosis was superior following RIT (48% at 10 years versus 15%; P=0.0014), as was survival from autograft (65% at 5 years versus 15%; P< or =0.0001). For the RIT group, OS at 5 years from allograft was 51%, and in chemoresponsive patients was 58%, with current progression-free survival of 42%. Responses were seen in 8 of 15 patients receiving donor lymphocyte infusions (DLI) for relapse/progression, with durable remission in five patients at median follow-up from DLI of 45 months (28-55). These data demonstrate the potential efficacy of RIT in heavily pre-treated patients whose outlook with conventional therapy is dismal, and provide evidence of a clinically relevant graft-versus-lymphoma effect.     

MicroRNA:从生物标志物到基因治疗

microRNA(mi RNA)作为生物标志物和治疗靶点的价值已被公认。简介mi RNA及其生物合成与功能,探讨mi RNA与疾病及癌症的关系,综述mi RNA在疾病治疗中及作为生物标志物的应用研究。     

Outcome in patients hospitalised for psoriatic arthritis

Summary Forty patients hospitalised for treatment of psoriatic arthritis (PsA) were followed for a mean of 8.0 years. At the end of this time none had died and only 8% were in functional class IV. 90% received second-line therapy. There was a high incidence of skin rashes on gold but hydroxychloroquine was well tolerated. Patients with psoriatic arthritis had a better outcome than patients with rheumatoid arthritis treated with the same regime.     

Low incidence of human herpesvirus 8 in stem cell collections from myeloma patients

Human herpesvirus 8 is a gammaherpesvirus which may be implicated in the pathogenesis of multiple myeloma. Viral DNA sequences have been found in the bone marrow, peripheral blood and leukapheresis products of myeloma patients. These findings have significant implications for the use of leukapheresed cells in the transplantation and immunotherapy of myeloma. The studies suggest the cell which harbours the virus may be dendritic in origin. We have previously reported that dendritic cells cultured for use in the clinical setting do not harbour HHV-8. In this study, we examined the leukapheresis products of a larger cohort of myeloma patients for the presence of HHV-8 using a highly sensitive PCR technique. A strong association between HHV-8 and myeloma was not confirmed, with only 4% of the patient samples positive for viral sequences. While further study is needed, the current use of apheresis cells and their cultured progeny in the treatment of myeloma should not be compromised.