Search

Study design: A repeated-measurement, single-center, prospective study. Objective: To compare the spatiotemporal and kinematic data using gait analysis in adult degenerative scoliosis (ADS) patients using walking sticks (WS) versus rolling walkers (RW). Summary of background data: ADS patients undergo compensatory changes that can result in an altered gait pattern. RW are frequently prescribed, but result in a forward flexed kyphotic posture during ambulation. Gait using WS allows for more upright alignment in ADS patients. Methods: Fifty-three ADS patients with symptomatic degenerative scoliosis performed over-ground walking at self-selected speed with WS and with a RW. Trunk and lower extremity angles along with spatiotemporal parameters were measured and compared. Results: When using WS, patients exhibited less flexion at the head (WS: − 4.8° vs. RW: 11.0°, p= 0.001), and lumbar spine (WS: − 0.9° vs. RW: 4.2°, p= 0.001); while there was significantly more extension, of the cervical spine (WS: − 1.6° vs. RW: − 7.4°, p= 0.002) when using the RW. At the initial contact phase of gait, patients using WS showed decreased flexion at the ankle (WS 0.7° vs. RW: 3.8°, p= 0.018), knee (WS: 0.3° vs. RW: 4.8°, p= 0.001), hip (WS: 22.6° vs. RW: 27.3°, p= 0.001), and pelvis (WS: 10.2° vs. RW: 14.8°, p= 0.001). In contrast, the use of WS resulted in slower ambulation (WS: 0.6 m/s vs. RW: 0.7 m/s, p= 0.001). Conclusions: In ADS patients who have not undergone surgical correction, the use of WS resulted in a more upright posture, which may be more beneficial to the compensatory changes that lead to gait disturbance in ADS patients. Ambulation using WS resulted in slower gait versus a RW, due to the momentum induced by the forward flexed posture when using a RW. We recommend the use of WS for patients with ADS as it improves gait kinematics and may be a safer option.

ObjectiveMolecular taxonomy of tumours is the foundation of personalised medicine and is becoming of paramount importance for therapeutic purposes. Four transcriptomics-based classification systems of pancreatic ductal adenocarcinoma (PDAC) exist, which consistently identified a subtype of highly aggressive PDACs with basal-like features, including ΔNp63 expression and loss of the epithelial master regulator GATA6. We investigated the precise molecular events driving PDAC progression and the emergence of the basal programme.DesignWe combined the analysis of patient-derived transcriptomics datasets and tissue samples with mechanistic experiments using a novel dual-recombinase mouse model for Gata6 deletion at late stages of KRasG12D-driven pancreatic tumorigenesis (Gata6LateKO).ResultsThis comprehensive human-to-mouse approach showed that GATA6 loss is necessary, but not sufficient, for the expression of ΔNp63 and the basal programme in patients and in mice. The concomitant loss of HNF1A and HNF4A, likely through epigenetic silencing, is required for the full phenotype switch. Moreover, Gata6 deletion in mice dramatically increased the metastatic rate, with a propensity for lung metastases. Through RNA-Seq analysis of primary cells isolated from mouse tumours, we show that Gata6 inhibits tumour cell plasticity and immune evasion, consistent with patient-derived data, suggesting that GATA6 works as a barrier for acquiring the fully developed basal and metastatic phenotype.ConclusionsOur work provides both a mechanistic molecular link between the basal phenotype and metastasis and a valuable preclinical tool to investigate the most aggressive subtype of PDAC. These data, therefore, are important for understanding the pathobiological features underlying the heterogeneity of pancreatic cancer in both mice and human.

Background:There are inconsistencies in the descriptive anatomy of the Lisfranc ligament. No information is available on orientation of fibers or presence of bundles, nor are there 3-dimensional anatomic data on the ligaments or their attachments. This study assessed the 3-dimensional anatomy of the Lisfranc ligament and its attachment sites.Methods:A total of 37 cadaver feet were dissected to expose the ligament attachments at the Lisfranc joint. The Lisfranc ligament and plantar ligament attachments were outlined separately and then removed with the attachment outlines preserved. A 3-dimensional digitizer was used to digitize bony and articular surfaces, as well as ligament attachment sites, at approximately 1 mm intervals; the positional accuracy was 0.23 mm. The surface areas of the entire bone, articular regions, and Lisfranc and plantar ligament attachment regions were determined and anatomic details were noted.Results:The Lisfranc ligament had a single bundle in 73% of the specimens and 2 bundles in 27%. Both variations had a single attachment to the second metatarsal (M2; mean attachment surface area, 135 mm2). The single-bundle variation attached to the medial cuneiform (C1; mean attachment surface area, 140 mm2). The plantar ligament, C1-M2-M3, attached to the anterior plantar surface of the lateral aspect of C1 (mean attachment surface, 64 mm2) and had attachment sites at the bases of M2 and M3. Its fibers ran anteriorly and inferiorly, with attachments to the proximal inferomedial aspect of M2 (mean attachment surface, 63 mm2) and fibers extending to a smaller attachment at the plantar aspect of M3 (mean attachment surface area, 26 mm2).Conclusion:The Lisfranc ligament is variable in anatomy and can have a single- or double-bundle arrangement. Its area of attachment is larger than that of the plantar ligament.Clinical Relevance:Anatomic descriptions of location, dimensions, and variability in the position and surface area of the ligament attachment sites and of orientation of the bundles provide information for future attempts at repair or reconstruction of the Lisfranc ligament.

The article discusses the discovery of Zebra Cross-streak or Panthiades bathildis, a Mexican species of hairstreak not yet documented in the U.S.