New anatomical reference systems for the bones of the foot and ankle complex: definitions and exploitation on clinical conditions

Medial tibial stress syndrome (MTSS) is one of the most common lower leg injuries in sporting populations. It accounts for between 6 and 16% of all running injuries, and up to 53% of lower leg injuries in military recruits. Various treatment modalities are available with varying degrees of success. In recalcitrant cases, surgery is often the only option. To evaluate whether ultrasound-guided injection of 15% dextrose for treatment of recalcitrant MTSS decreases pain and facilitates a return to desired activity levels for those who may otherwise be considering surgery or giving up the sport. The study design was a prospective consecutive case series involving eighteen patients: fifteen male and three female; (mean age = 31.2 years) with recalcitrant MTSS. They were referred from sports injury clinics across the UK, having failed all available conservative treatment. An ultrasound-guided sub-periosteal injection of 15% dextrose was administered by the same clinician (NP) along the length of the symptomatic area. Typically, 1 mL of solution was injected per cm of the symptomatic area. Pain was assessed using a 10-cm visual analog scale (VAS) at baseline, short-term, medium-term (mean 18 weeks), and long-term (mean 52 weeks) follow-up. Symptom resolution and return to activity were measured using a Likert scale at medium and long-term follow-up. Statistical analyses were performed using SPSS for Mac version 19.0.0 (IBM, New York, NY, US). The Shapiro-Wilk test was used to evaluate the normality of the distribution of data. Friedman’s non-parametric test was used to compare the within-patient treatment response over time. Post-hoc Wilcoxon signed-rank tests with Bonferroni corrections were performed to determine VAS average pain response to treatment over five paired periods. Patients reported a significant (p < 0.01) reduction in median VAS pain score at medium and long-term follow-up compared to baseline. Median improvement per patient was 4.5/10. Patients rated their condition as ‘much improved’ at medium-term follow-up and the median return to sports score was ‘returned to desired but not pre-injury level’ at medium-term and long-term follow-up. No adverse events were reported. Ultrasound-guided 15% dextrose prolotherapy injection has a significant medium-term effect on pain in MTSS. This benefit may be maintained long-term; however, more robust trials are required to validate these findings in the absence of controls. Clinicians should consider the use of ultrasound-guided injection of 15% dextrose as a viable treatment option to reduce pain and aid return to activity for patients with recalcitrant MTSS.     

Helical axis calculation based on Burmester theory: experimental comparison with traditional techniques for human tibiotalar joint motion

In prosthetics and orthotics design, it is sometimes necessary to approximate the multiaxial motion of several human joints to a simple rotation about a single fixed axis. A new technique for the calculation of this axis is proposed, originally based on Burmester’s theory. This was compared with traditional approaches based on the mean and finite helical axes. The three techniques were assessed by relevant optimal axis estimation in in vitro measurements of tibiotalar joint motion. A standard jig and radiostereometry were used in two anatomical specimens to obtain accurate measurements of joint flexion. The performance of each technique was determined by comparing the motion based on the resulting axis with the experimental data. Random noise with magnitude typically similar to that of the skin motion was also added to the measured motion. All three techniques performed well in identifying a single rotation axis for tibiotalar joint motion. Burmester’s theory provides an additional method for human joint motion analysis, which is particularly robust when experimental data are considerably error affected.     

Time to re‐consider the meaning of BRAF V600E mutation in papillary thyroid carcinoma

The BRAF V600E mutation, resulting from the BRAFT1799A transversion, is the most common genetic mutation in papillary thyroid carcinoma (PTC), with a mean frequency close to 50% among all cases. A large number of studies in the past decade have tried to dissect the relevance and the function of the V600E mutation in controlling oncogenesis and progression of thyroid cancer. However, several works published in the latest years have provided new evidence, in partial conflict with the previous knowledge, suggesting the need of reconsidering the meaning of the BRAF V600E mutation in PTC. In this work, we attempt to discuss some of the most recent molecular, preclinical and clinical evidence to construct a more exhaustive model of function for the BRAF V600E in development, progression and therapeutic approach of thyroid cancer.     

The role of cardiac diseases in the comorbidity between migraine and stroke

Neurological Sciences - Several case-control and cohort studies have suggested an association between migraine and stroke. A significantly higher risk for stroke was found in women under the age of...     

Which therapy for which patient?

Neurological Sciences - Prophylactic treatment is mainly intended to reduce the frequency of migraine attacks, enhance response to acute medications, improve patient function and reduce disability....     

Validation of AIDA Cefalee,a computer-assisted diagnosis database for the management of headache patients

Neurological Sciences - AIDA Cefalee is a database for the management of headache patients developed on behalf of the Italian Neurological Association for Headache Research (ANIRCEF). The system...     

Reliability of a driving simulation task for evaluation of sleepiness

Driving Simulators reproduce situations that require tracking and visual searching, the main features of real driving. This study measured the reliability of a monotonous driving scenario to detect the circadian variations of alertness in healthy subjects. Five men and five women underwent a monotonous 30 min driving simulation task every 2 h. Before each driving task subjects completed the Stanford Sleepiness Scale (SSS) and the Visual Analogue Scale (VAS) to correlate the subjective measurements of sleepiness to the objective data of the simulator. Driving performances deteriorated or improved according to the circadian variation of alertness. The scenario is suitable to detect the consequences of sleepiness related to the circadian variations of alertness. The standard deviation of lane position, comparing the differences among the 10 min blocks in each task is the parameter most significant for the evaluation of sleepiness.     

Sleep complaints in periodic paralyses: a web survey.

Neuronal potassium conductance has been shown to influence the sleep-wake cycle and REM sleep homeostasis. The periodic paralyses (PP) are characterized by episodes of muscular weakness associated with changes in serum potassium levels and, therefore, with possible alterations in extracellular neuronal potassium conductance. We submitted a sleep questionnaire to the members of Periodic Paralysis International Listserv, an on-line support and information group for subjects with PP. Three control groups were made up of patients with untreated depression, patients with depression under treatment and healthy subjects. Both subjects with PP and those with untreated depression had a higher frequency of self-reported insufficient sleep quality and a higher number of nocturnal awakenings than patients with depression under treatment and healthy controls. PP subjects had more self-reported daytime sleepiness, sleep-related hallucinations and nightmares/abnormal dreams than the other three groups. Patients affected by PP may have disrupted sleep architecture and homeostasis. In particular, we suggest that the stereotypical abnormal dreams reported by several patients may reflect oneiric elaboration of nocturnal episodes of flaccid paralysis, while the increased frequency of sleep-related hallucinations may be due to enhanced REM sleep expression associated with alterations of neuronal potassium conductance.