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IntroductionProgrammed death ligand – 1 (PD-L1) expression is a well-established predictive biomarker for immunotherapy in non-small cell lung cancer (NSCLC). Programmed death – 1 (PD-1) serves as the target protein to PD-L1 and their interaction serves as a crucial pathway for immune evasion. This study aimed to investigate the expression pattern of PD-1 on Tumor-infiltrating lymphocytes (TILs) in early-stage NSCLC, and its potential role as prognostic biomarker.Materials & methodsPD-1 was evaluated in 474 surgical resected early-stage NSCLC specimens, using Tissue microarray and immunohistochemical staining. Expression was scored as negative (

Abstract Background Bronchopulmonary Dysplasia (BPD) in infants born prematurely is a risk factor for chronic airway obstruction later in life. The distribution of T cell subtypes in the large airways is largely unknown. Objective To characterize cellular and T cell profiles in the large airways of young adults with a history of BPD. Methods Forty-three young adults born prematurely (preterm (n = 20), BPD (n = 23)) and 45 full-term-born (asthma (n = 23), healthy (n = 22)) underwent lung function measurements, and bronchoscopy with large airway bronchial wash (BW). T-cells subsets in BW were analyzed by immunocytochemistry. Results The proportions of both lymphocytes and CD8 + T cells in BW were significantly higher in BPD (median, 6.6%, and 78.0%) when compared with asthma (3.4% and 67.8%, p = 0.002 and p = 0.040) and healthy (3.8% and 40%, p

Introduction: Social networks, as an important dimension of social capital, contribute positively to people’s subjective well-being. By having a support network of friends, family or neighbors in difficult moments of life, people can experience greater happiness. Objective: The objective of this research is to analyze the relationship between physical social networks and the subjective wellbeing of heads of household in Ecuador. Methodology: Data from the National Survey of Employment, Unemployment and Underemployment (ENEMDU) of Ecuador and econometric techniques such as the ordered probit model and quantile regression were used to explore the existing heterogeneity along the distribution of the well-being variable. Results: The results reveal that there is a positive and heterogeneous relationship between the variables studied, with the magnitude of the correlation being greater for unhappy heads of household. That is, physical social networks improve well-being in the most unhappy individuals. Conclusions: Policy implications highlight that social and recreational centers should be implemented and strengthened, and the quality of services and physical spaces where physical social networks are built should be improved. For example, sports spaces, cultural events and collective activities should be promoted where people can build social networks that lead to social cohesion and promote well-being

A nivel mundial, las brechas salariales por género son muy latentes, donde las mujeres siguen siendo las más afectadas por percibir salarios inferiores al de los hombres e incluso con iguales características laborales. El objetivo de esta investigación se centró en determinar el efecto de la escolaridad en las brechas salariales por género en las 24 provincias del Ecuador durante 2010-2020. Los datos fueron recopilados de la Encuesta Nacional de Empleo, Desempleo y Subempleo (ENEMDU) del Instituto Nacional de Estadísticas y Censos [INEC] (2021). Se empleó como proceso econométrico el método de Oaxaca-Blinder (1973) y el Propensity Score Matching (PSM). Los resultados obtenidos indican que existe una relación directa entre los ingresos y el nivel académico; y, una relación indirecta entre los salarios y la experiencia. Por otra parte, mediante la descomposición salarial se pudo constatar la existencia de discriminación salarial en contra del género femenino. Así mismo, el emparejamiento por puntaje nos indicó que el nivel académico si tiene efecto contractivo sobre las brechas salariales. Con los resultados obtenidos, se recomienda a los hacedores de política incentivar una mayor participación de las mujeres en cargos administrativos, a través de regulaciones de funcionamientos, acuerdos estratégicos y cooperación públicos privados, siendo un coadyuvante en la disminución de la desigualdad de género.

A promising strategy for developing novel therapies against tropical diseases, including malaria, leishmaniasis, and trypanosomiasis, is to detect biological targets such as trypanothione reductase, a vital parasite enzyme that regulates oxidative stress. This enzyme is highly selective and conserved in the Trypanosotidae family and has an ortholog in the Plasmodium genus. Previous studies have established that an isosteric replacement of naphthoquinone's carbonyl group with a sulfone group leads to compounds with high bioactivity and selectivity (half-maximal inhibitory concentration = 3 μM against intracellular amastigotes of L. panamensis, selectivity index = 153 over monocytes U-937). In this study, we analyzed the reactive oxygen species (ROS) levels of parasites through indirect measurements of the tryparedoxin system after treatment with these isosteric compounds. This strategy proved that a significant increase in the ROS levels and strong mitochondrial perturbation led to the death of parasites due to cell homeostatic imbalance, confirming the compounds' effectiveness in disrupting this important metabolic pathway. To improve understanding of the parasite-molecule interaction, 27 new compounds were synthesized and assessed against parasites of the three principal tropical diseases (malaria, leishmaniasis, and trypanosomiasis), displaying an EC50 below 10 μM and good correlation with in-silico studies, indicating that the 4H-thiochromen-4-one 1,1-dioxide core is a special allosteric modulator. It can interact in the binding pocket through key amino acids like Ser-14, Leu-17, Trp-21, Ser-109, Tyr-110, and Met-113, leading to interhelical disruption.

Background: Ankle hemiarthroplasty is a 1-piece implant system replacing the talar side of the tibiotalar joint. Hemiarthroplasty offers limited bone resection and may provide easier revision options than joint-ablating procedures. Methods: Prospective, multicenter, noncomparative, nonrandomized clinical study with short term follow-up on patients undergoing hemiarthroplasty of the ankle. Radiologic and functional outcomes (Foot and Ankle Outcome Score FAOS, Foot and Ankle Ability Measure [FAAM], Short Form–36 Health Survey [SF-36], Short Musculoskeletal Functional Assessment [SMFA], and visual analog scale [VAS] pain scores) were obtained at 3 and 12 months and the last follow-up (mean 31.9 months). Results: Ten patients met the inclusion criteria. Three were converted to total ankle replacement at 14, 16, and 18 months. Pain VAS scores improved on average from 6.8 to 4.8 ( P = .044) of the remaining 7 at a mean of 31.9 months’ follow-up. For these 7 in the Survival Group, we found that SF-36 physical health component improved from 25.03 to 42.25 ( P = .030), SMFA dysfunction and bother indexes improved from 46.36 to 32.28 ( P = .001), and from 55.21 to 30.14 ( P = .002) in the Survival Group, and FAAM sports improved from 12.5 to 34.5 ( P = .023). Conclusion: Patients undergoing hemiarthroplasty of the ankle joint for talar-sided lesions had a 30% failure rate by 18 months. Those who did not have an early failure exhibited modest pain reduction, functional improvements, and better quality of life in short-term follow-up. This procedure offers a possible alternative for isolated talar ankle cartilage cases. Level of Evidence: Level IV, prospective case series.

Objective: Our objective was to compare foot width (bony and soft tissues) in radiological images pre- vs. post-corrective scarf osteotomy in patients with hallux valgus. Methods: We retrospectively performed measurements of forefoot width (both bony diameter and total diameter including soft tissues) on anterior posterior standard radiographs of 30 patients, totaling 42 feet, pre- and postoperatively, at three months. These measurements were performed by two evaluators and their reliability was calculated. Results: Radiologically, preoperative mean of the 1-5 metatarsal bony width was 89.30mm (SD ± 5.8), reduced to 80.42mm postoperatively (SD ± 3.5; p

Medial ankle sprains have a very low incidence (5% of ankle ligament injuries), and most of the time, the first structure involved is the deltoid ligament complex. However, other structures, such as the spring ligament, posterior tibial tendon, and flexor retinaculum, can also get damaged. A 32-year-old man who had an ankle sprain while performing sports activities showed magnetic resonance imaging findings compatible with a detachment of the flexor retinaculum and medial dislocation of the posterior tibial tendon. Surgical intervention was suggested to this patient; deepening of the medial retromalleolar groove and reattaching of the retinaculum were performed. It is very important to consider this rare injury after a medial ankle sprain and to think out of the box, not always assuming a deltoid ligament lesion. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Hallux saltans is a rare condition characterized by an entrapment of the flexor hallucis longus. Its tendon passes through the retromalleolar groove below the flexor retinaculum, directing the plantar aspect of the foot through a fibro-osseous tunnel below the sustentaculum tali. This study presents a young active patient without any of the conditions or etiological agents previously described in the literature that could explain the cause of this rare condition. After failing conservative treatments, an arthroscopic release of the tendon and the fibrous tunnel was performed, achieving direct visualization and minimal soft tissue injury. At six month follow-up, the patient resumed sports and daily living activities without symptoms. Level of Evidence V; Therapeutic Studies; Expert Opinion.

Distant spreading of tumor cells to the central nervous system in non-small cell lung cancer (NSCLC) occurs frequently and poses major clinical issues due to limited treatment options. RNAs displaying differential expression in brain metastasis versus primary NSCLC may explain distant tumor growth and may potentially be used as therapeutic targets. In this study, we conducted systematic microRNA expression profiling from tissue biopsies of primary NSCLC and brain metastases from 25 patients. RNA analysis was performed using the nCounter Human v3 miRNA Expression Assay, NanoString technologies, followed by differential expression analysis and in silico target gene pathway analysis. We uncovered a panel of 11 microRNAs with differential expression and excellent diagnostic performance in brain metastasis versus primary NSCLC. Five microRNAs were upregulated in brain metastasis (miR-129-2-3p, miR-124-3p, miR-219a-2-3p, miR-219a-5p, and miR-9-5p) and six microRNAs were downregulated in brain metastasis (miR-142-3p, miR-150-5p, miR-199b-5p, miR-199a-3p, miR-199b-5p, and miR-199a-5p). The differentially expressed microRNAs were predicted to converge on distinct target gene networks originating from five to twelve core target genes. In conclusion, we uncovered a unique microRNA profile linked to two target gene networks. Our results highlight the potential of specific microRNAs as biomarkers for brain metastasis in NSCLC and indicate plausible mechanistic connections.

Any forecast of the pandemic dynamics has proven to be far away from what has really happened, particularly in South America. In most of our countries, we are still struggling with what has been called the first wave. The virus has impacted not only our health status but also every aspect of our lives, including our daily work. Spending less time in the operating room has a positive side that each one has experienced differently. It has provided the opportunity for more quality time with the family and an understanding of how vulnerable we all are, how complicated politics and economic decisions are, and how important the way we all communicate and share experiences is. Most of us have seen our workplaces becoming busy with an increasing number of patients, which has led us to cancel any elective surgery and stay home in isolation. This difficult time we are going through has allowed us to think about our purpose in life, especially as physicians. We have been forced to develop new ways of teaching medicine, researching, and even practicing medicine. Most importantly, difficult times require that we learn a new way of living. This has led us to reflect on the importance of research and on how important it is that all of us give our best for our patients. Treating patients well impels us to be informed, to be updated about new knowledge, and to practice our skills while continuously looking for answers. The virtuous circle to be a good doctor should always include clinical practice, medical education, and research. When I was asked to write this editorial, one thought immediately came to my mind: how easily some journalists and public figures get into trouble after making a comment, writing an editorial, or even after publishing a post on social media. A recent example is what happened to J. K. Rowling, the famous author of the Harry Potter series. Last December, she tweeted her support for Maya Forstater, who was fired for what were deemed “transphobic” tweets. Rowling has received accusations and threats from trans activists and many worldwide famous people. A single ‘like’ was deemed evidence of ‘wrongthink’, and a persistent level of harassment began. The world has definitely changed, and everyone’s comments and behaviors are completely public. We should not be afraid to speak up and express our opinion, we should not be stopped by the fear of having people against us. As physicians, we are all exposed by expressing our medical opinion every day in the office, in a meeting, or even in a remote setting. Every decision and opinion should be based on evidence, but they will inevitably include our personal background-which is a mix of knowledge and personal life experience. Hopefully, these opinions will always express our genuine interest in the patients and their families as our main focus. As I get older, I pay more attention to the basis of my daily practice, which begins with proper information provided by good sources of medical education such as this journal. However, acquiring reliable information is just the beginning of the path toward good medical practice. The remainder of the path-the most important part of it-must be trodden by a human being truly interested in doing the best for his/ her patients every day. It has always amazed me that everyone who I admire as a physician is, at the same time, a professor, a researcher, and an amazing human being. This journal is the result of the efforts of a group of people who are truly committed to learning, teaching, and investigating, thus producing friendly feedback and updated knowledge.

El creciente interés por los snacks de vegetales no amiláceos, preparados sin fritura se explica por su menor densidad calórica, respecto a la papa deshidratada y frita. Los métodos convencionales de secado a alta temperatura en ciertos casos pueden provocar pérdidas de componentes bioactivos. Es por ello que existe interés en la búsqueda de nuevos métodos de procesamiento que reduzcan el desperdicio de estos productos. En este trabajo, se evaluó la calidad (antioxidantes fenólicos, carotenoides, azúcares, acidez, color, aceptabilidad sensorial e higroscopicidad) de snacks de zapallito redondo obtenidos por dos métodos diferentes: 1) secado con aire caliente (SAC) o 2) por un método combinado de deshidratación osmótica (DO) con NaCl seguido de una etapa de secado por aire caliente (DO+SAC). Dependiendo de la concentración de NaCl empleada, la etapa de DO permitió reducir la humedad inicial del vegetal en 15-30%. La incorporación de un pre-tratamiento de DO antes del secado por aire caliente no afectó la acidez, azúcares ni contenido de compuestos fenólicos del producto final. Los snacks obtenidos por el método combinado DO+SAC, mostraron mejor color y aceptabilidad sensorial, mayor nivel de carotenoides extraíbles y menor higroscopicidad que los producidos por SAC. Los resultados del presente trabajo muestran que los tratamientos combinados de DO y aire caliente, resultan en snacks de zapallito redondo con mejores propiedades físicas (color, higroscopicidad), nutricionales (carotenoides) y sensoriales (aceptabilidad) que aquellos obtenidos sólo por secado convencional con aire caliente.

Objective: The purpose of the study was to evaluate early clinical and radiological results with a novel minimally invasive surgery (MIS) technique for Lapidus arthrodesis using intramedullary nail. Methods: Retrospective review of patients with hallux valgus surgery during an 18-month period. Patients with a procedure other than MIS Lapidus nail fixation were excluded. We describe surgical technique with a percutaneous joint preparation and fixation with an intramedullary nail through a MIS approach. Demographic variables, early complications and radiographic parameters were measured. Results: Ten feet in 8 patients with severe HV underwent a Lapidus procedure performed with a minimal invasive technique using intramedullary nail for fixation. No soft tissue complications and 1 patient required screw removal after bone healing. Mean HVA decreased from 31,4 degrees (range 17 to 47) SD (±9,3) to 10,3 degrees (range, -8,8 to 31,5) SD (±8,4), mean IMA decreased from 17,91 degrees (range, -17 to 20) SD (±0,9) to 5,46 degrees (range, –7,3 to 15.3) SD (±2,9) and mean DMAA decreased from 20,36 (range, 10-40) SD (±8,4) to 7,67 (range, -5 to 30) SD (±8,0). Conclusion: Intramedullary nail for Lapidus arthrodesis with minimally invasive technique showed satisfactory radiographic correction and minimal complications, but further follow up is needed to analyze clinical-radiographic results. Level of Evidence IV; Therapeutic Study; Case Series.

Objective: The purpose of this paper is to describe a minimally invasive chronic Achilles tendon rupture reconstruction combining a modified Dresden technique and endoscopic flexor hallucis longus (FHL) tendon transfer. Methods: Our prospectively collected database was queried for patients presenting with chronic Achilles tendon rupture. Patients were included if they presented any of the following criteria: more than 65 years of age, history of previous DVT, active smoking habit and Diabetes. Pre and post-operative SF-36 and AOFAS hindfoot scores, complications, and patient satisfaction grades were recorded. Results: Eight patients met the inclusion criteria; the median age was 49 years old (range 22 - 67 years). Two complications were registered (sural neuritis and minor wound dehiscence). Mean AOFAS score increased from 48 (range 40 - 63) to 91,6 (range 85 - 95). Regarding SF-36 score, the SFF-36 improved from 51,6 to 79,3 points and the SFM-36 enhance from 25 to 61,5 points. All patients evaluated their satisfaction regarding the performed procedure as satisfactory. Conclusion: Chronic Achilles tendon rupture reconstruction combining a modified Dresden technique and endoscopic FHL transfer is an attractive option in high-risk patients, with favorable results at the short-term follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Hard work is the key to success. It may sound like a cliché, but the preparation and the release of this first edition of the new Journal of the Foot & Ankle (JFA) were based on this very concept, and we took it very seriously! For years many of us have dedicated time and efforts to bring this Journal to life. After countless meetings, discussions, phone calls, WhatsApp messages, and an infinite amount of writing, our collaborative hard work and friendship finally brought us here! Now we need to stay focused and ahead of the game, looking forward to the future and the innovations. We should aim to publish high-quality, unbiased research, with emphasis on strong clinical evidence. Our vision is to support researchers and research that can enable the Orthopaedic Foot and Ankle Surgery Community to understand better the complexity of the pathologies, guide treatment, and, most importantly, improve the treatment results and quality of life of our patients. Our thoughts are that keeping all these goals in mind will allow us to achieve the expected acceptance and respect of the research community, as well as the desired indexation. It is not an easy task! But we are confident we can get there with your help! We’re great believers in working as a team towards a common goal, and we are sure that with the help of our dedicated Foot and Ankle colleagues and researchers, we will soon make our vision become a reality! Let’s do it together!

ObjectivesThe aim was to analyse the tumor expression of Notch1, Hes1, Ascl1, and DLL3 in Small-Cell Lung Cancer (SCLC) and each such biomarker's potential association with clinical characteristics and prognosis after platinum-doublet chemotherapy (PDCT).Material and methodsThe protein expression of the biomarkers was evaluated using immunohistochemistry. Patients were categorized according to their sensitivity to first line PDCT: with a Progression-free survival (PFS) ≥ 3 months after completion of treatment considered "sensitive" and < 3 months after completion of treatment considered "refractory". PFS and overall survival were computed using Kaplan-Meier curves with 95% confidence interval.Results and conclusionThe study included 46 patients, with 21 and 25 of the patients having "sensitive" and "refractory" disease, respectively. The majority of patients had a high DLL3 expression (n = 38), while a minority had Notch 1-high expression (n = 10). The chi-square test showed that there was a statistically significant negative association between Notch1 and Ascl1 expression (p = 0.013). The overall survival for patients with Notch1- high vs. low expression was 8.1 vs. 12.4 months, respectively (p = 0.036). Notch1 expression was an independent prognostic factor in the multivariate analysis (p = 0.02). No other biomarker showed any prognostic impact in this highly selected SCLC cohort. DLL3 is highly expressed in the majority of advanced staged SCLC cases, as expected. In the same patient population, Notch1 expression might have a potential prognostic implication, by driving a non-neuroendocrine differentiation process. Given the small number of cases with Notch1 high expression, the results of this study needs to be confirmed on a larger cohort.

Autoptic studies of patients who died from COVID-19 constitute an important step forward in improving our knowledge in the pathophysiology of SARS-CoV-2 infection. Systematic analyses of lung tissue, the organ primarily targeted by the disease, were mostly performed during the first wave of the pandemic. Analyses of pathological lesions at different times offer a good opportunity to better understand the disease and how its evolution has been influenced mostly by new SARS-CoV-2 variants or the different therapeutic approaches. In this short report we summarize responses collected from a questionnaire survey that investigated important pathological data during the first two pandemic waves (spring-summer 2020; autumn-winter 2020–2021). The survey was submitted to expert lung pathologists from nine European countries involved in autoptic procedures in both pandemic waves. The frequency of each lung lesion was quite heterogeneous among the participants. However, a higher frequency of pulmonary superinfections, both bacterial and especially fungal, was observed in the second wave compared to the first. Obtaining a deeper knowledge of the pathological lesions at the basis of this complex and severe disease, which change over time, is crucial for correct patient management and treatment. Autoptic examination is a useful tool to achieve this goal.

Abstract Background Precision medicine promises to improve prognosis of patients affected by untreatable diseases. Patients with lung cancer (especially lung adenocarcinoma) bear an increased risk of VTE. Mutations in the EGFR and rearrangement in the ALK genes identify specific subgroups of patients. Aim of this study was to investigate the role of epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) mutational status on the risk of venous thromboembolism (VTE) in lung adenocarcinoma. Methods A retrospective longitudinal design was used. Patients with lung adenocarcinoma diagnosed and undergoing a mutational analysis at the Karolinska University Hospital, Stockholm, Sweden between January 2009 and September 2015 were divided in three subgroups based on their mutational status (EGFR-, ALK-mutated, unexposed group). Event-free time for VTE was assessed using Cox regression analysis based on mutation status and treatment received. Results Three hundred-ten patients were included. A VTE occurred in 70 (22.6%) patients. Mutation of EGFR was associated with a decreased risk of VTE (HR 0.46, 95% CI 0.23–0.94). Treatment with tyrosine kinase inhibitors (TKI) reduced the risk of VTE compared to other treatment strategies not including TKI (HR 0.42, 95% CI 0.29–0.79). Conclusions Our study suggests that patients with lung adenocarcinoma bearing a EGFR-mutation have a decreased risk of VTE compared with patients with other forms of lung adenocarcinoma. Targeted therapy with TKI alone or in combination with other treatments seems to reduce the risk of VTE compared to other treatments not including TKI.

In continuation of our efforts to identify promising antileishmanial agents based on the chroman scaffold, we synthesized several substituted 2H-thiochroman derivatives, including thiochromenes, thichromanones and hydrazones substituted in C-2 or C-3 with carbonyl or carboxyl groups. Thirty-two compounds were thus obtained, characterized, and evaluated against intracellular amastigotes of Leishmania (V) panamensis. Twelve compounds were active, with EC50 values lower than 40 µM, but only four compounds displayed the highest antileishmanial activity, with EC50 values below 10 µM; these all compounds possess a good Selectivity Index > 2.6. Although two active compounds were thiochromenes, a clear structure-activity relationship was not detected since each active compound has a different substitution pattern.

Category: Bunion, Midfoot/Forefoot Introduction/Purpose: Hallux valgus combines two deformities, the metatarsus varus and metatarsal internal rotation. The rotational deformity is seldom corrected during surgery, but is a known recurrence factor. Most techniques only correct the metatarsus varus (scarf, chevron, etc). We present a prospective case series using a novel metatarsal rotational osteotomy called PROMO (proximal rotational metatarsal osteotomy) which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone resection. Our objective was to report this new technique, preliminary results, its advantages and complications. Methods: 20 consecutive patients (17 women) with Hallux Valgus, average age 45 (25-55), were operated using this technique. The average preoperative intermetatarsal angle (IMA) was 15 degrees with an average Hallux internal malrotation of 30 degrees and a sesamoid malposition of grade V or more in all cases. Postoperatively, sesamoids position, Hallux rotation, IMA and metatarsal length were registered. They were followed for 1 year (8-14 months). The surgical technique is described, with its potential benefits and drawbacks. The radiological outcome, postoperative LEFS score, recurrence rate (IMA increase >5 degrees) and complications were registered. Results: Well positioned sesamoids (grade IV or less) were obtained in all patients postoperatively, with a complete Hallux rotational correction. Postoperative IMA was 5 degrees. achieving a complete metatarsal varus correction. No metatarsal shortening was observed whatsoever. No recurrence has been observed until final follow up. Preoperative and postoperative LEFS scores were 58 and 73 respectively. Conclusion: The PROMO has the advantage over other osteotomies that it can reliable correct, both metatarsal malrotation and varus deformities, achieving a complete deformity correction and hopefully decreasing recurrence rate. The surgical technique has been studied and refined extensively, in order to simplify it and make it reliable. Although more patients and follow-up are needed, the authors believe it is a promising surgical technique which addresses a previously not considered hallux valgus deformity component.

Category: Ankle, Sports, Trauma Introduction/Purpose: There is no consensus about when to allow weight bearing in ankle fractures treated with syndesmotic screw fixation. There has been no evaluation of the radiographic fate of the syndesmosis when syndesmotic screws are retained and early weight bearing is encouraged, or the clinical result depending on the screw status, which can be intact, broken or loose. Our objective was to evaluate the radiographic and clinical parameters of patients who had a screw fixation of the syndesmosis and early weight bearing was allowed. Our hypothesis was that no difference would be observed on syndesmotic reduction or clinical function depending on the screw status. Methods: We analyzed 42 patients with ankle fractures treated with syndesmotic screws in which early weight bearing was allowed (3 weeks postoperatively). Weight bearing radiographs were obtained at 2 weeks, 2 months and at final follow up (41.2 months). Radiologically we measured medial clear space (MCS), tibiofibular overlap (OL), tibiofibular clear space (CS), talar shift (TS) and screw condition (intact, broken, loose). Clinical function was measured with the AOFAS score and stratified by the screw condition. Statistical analysis was performed with the SPSS software and a non-inferiority confidence interval for the mean was calculated. Results: At final follow up, 66,6% of the screws were broken, 30,9% showed significant loosening and only 1 patient (4,7%) had a screw that remained solid with no signs of osteolysis. MCS at 2 weeks, 2 months and at final follow up was 2,94 mm; 3,03 mm; 3,02, respectively. OL was 6,76 mm; 6,78 mm; 6,83 and CS was 4,26 mm; 4,66 mm; 4,6 mm. No TS was detected. There was no difference in measurements along time (p>0,05). Relative to clinical function, the mean AOFAS score was 95 points. No difference was found between the clinical scores of patients stratified by the screw condition (p>0,05). Conclusion: Early weight bearing on a fixed syndesmosis appears to be safe, with no measurable radiographic or clinical consequences regarding ankle joint function. Despite screw breakage or loosening on x-rays, loss of reduction is seldom observed. We suggest that routine removal of syndesmotic screws is not necessary in these group of patients.

Category: Ankle, Basic Sciences/Biologics, Sports Introduction/Purpose: Peroneus brevis tendon tears are frequently diagnosed when ankle instability is present. No clear guideline exists as to when to repair or resect peroneal tendon tears, as most of the available literature uses Meyer’s work published in 1924 where a risk of spontaneous rupture would exist when less than 50% of the tendon remains undamaged. Our objective was to analyze the mechanical behavior of cadaveric peroneal tendons subjected to an artificially made damage, compromising 66% of its visible width and tested in a cyclic and failure phase. Our hypothesis was that no failure would be observed in the cyclic phase. Methods: 8 cadaveric foot- ankle – distal tibia specimens were included in this study. A longitudinal full thickness tendon defect was created, 3 cms in length, centered behind the tip of the fibula, compromising 66% of the visible width of the peroneal tendons as measured by a caliper. The peroneal retinaculum was kept intact. All specimens were mounted onto a special frame specifically designed for the study. All tendons were tested in a cyclic fashion using 100 repetitions between 50 N and 200 N. If no visual change or tendon failure was observed after the initial testing, a load to failure test was performed until tendon rupture or fixation failure was observed. Tendon stiffness and load to failure were registered. Statistical analysis was performed using the SPSS software. Results: No tendon failed during the cyclic testing. No defect lengthening was observed after the cyclic phase. On the failure phase, the mean load resisted by the peroneus brevis was 416 N, with a 95% confidence interval between 351 N -481 N. The mean load resisted by the peroneus longus was 723 N, with a 95% confidence interval between 578 N – 868 N. All failures were at the level of the defect created. The coefficient of variation was low for both tendons. Conclusion: A 33% of remaining peroneal tendon was able to resist very high tensile forces; therefore, it can be suggested that a 66% defect can be repaired and does not necessarily need a tenodesis as it has been historically recommended. The high resistance offered by the peroneus longus tendon offers the theoretical potential to use part of it as a free graft to repair peroneus brevis tears. The 50% rule, which determines when a peroneal tendon tear needs a tenodesis or repair, should be revisited.

Category: Bunion Introduction/Purpose: Hallux Rigidus (HR) is characterized initially by a decrease in Hallux metatarsophalangeal joint (MTPJ) dorsiflexion, decreasing the total range of motion. To be able to study different surgical treatment options, a cadaveric model has to be developed that recreates the limited range of motion. Our objective was to develop an Hallux Rigidus cadaveric model by shortening the plantar fascia (PF). Hallux MTPJ range of motion and joint stiffness were evaluated. Methods: 8 cadaveric foot- ankle – distal tibia specimens were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue was kept intact. Each specimen was mounted on a special frame and luminous markers were attached to the skin (Oxford Foot Model). A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon and the posterior tibialis. 10 Hallux MTPJ dorsiflexion-plantarflexion cycles were performed by pulling the Extensor Hallucis longus tendon using an tensile testing machine (Kinetecnics). A Hallux Rigidus model was then developed by shortening the PF by 6 mm using a triple fiberwire suture technique. The same 10 cycles were repeated with a shortened PF. Each specimen served as its own control. Hallux metatarsophalangeal stiffness and kinematics were tested using a tensile testing machine and high definition cameras. Results: The group with a shortened PF significantly reduced the hallux dorsiflexion (18.6 degrees) compared to the native foot (23.7 degress) (p0.05). Conclusion: To create a HR model is vital to allow further understanding of the pathology. The cadaveric model should not alter the joint stability (intact periarticular soft tissues) but has to limit Hallux range of motion. The model we present successfully recreates HR by limiting MTPJ dorsiflexion. The absence of stiffness change shows that joint congruity and isometry were not modified. There are a few reports that state a PF shortening as the first stage in HR. This would lead to a hinge-like MTPJ dorsiflexion, creating a dorsal metatarsal head impingement that could evolve to a dorsal exostosis.

Category: Basic Sciences/Biologics, Midfoot/Forefoot Introduction/Purpose: Metatarsal osteotomies for Hallux Rigidus (HR) is a treatment option when neither a cheilectomy nor an arthrodesis are indicated. Different osteotomies exist that elevate, shorten or depress the metatarsal head. No biomechanical information exists that evaluates the effect of osteotomies on hallux range of motion (ROM) and stiffness. Our objective was to evaluate, in a cadaveric model, the first metatarsophalangeal joint (MTPJ) stiffness and kinematics changes, after three different metatarsal osteotomies. Methods: 8 cadaveric foot-ankle–distal tibia specimens were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue was kept intact. Each specimen was mounted on a special frame and luminous markers were attached to the skin (Oxford Foot Model). A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon and the posterior tibialis. Each specimen served as its own control, testing hallux dorsiflexion when pulling the extensor hallucis longus tendon. 10 cycles were performed for every condition: control (A), and three different metatarsal extraarticular neck osteotomies: vertical osteotomy with 5 mm of depression (B), 5 mm of shortening (C) and 5 mm of shortening and depression (D). All osteotomies were performed on a Hallux Rigidus cadaveric model. We registered the MTPJ stiffness and kinematic changes after each intervention using a tensile testing machine and high definition cameras. Results: B and C were significantly stiffer than group A and D (p0.05). Groups B, C and D achieved similar kinematics (range of motion) to group A (p>0.05). Conclusion: Different metatarsal osteotomies exist for HR. The osteotomy of choice, should be one that recreates the healthy MTPJ motion and stiffness. According to our study, the osteotomy of choice should be one that results in metatarsal head depression and shortening. A possible explanation to our finding, is that a pure shortening or depression osteotomy is really elevating or depressing the head respectively, hence altering the tendon pull and relative head position. Only with metatarsal shortening and depression, the Hallux MTPJ biomechanics in a Hallux Rigidus cadaver model, returns to a healthy state.

Category: Ankle, Basic Sciences/Biologics, Tendon Transfer, Dropfoot Introduction/Purpose: Posterior tibial tendon transfer (PTTT) is performed for a variety of pathologies where loss of dorsiflexion is compensated by the transfer, e.g. cavus foot, neurologic foot (dropfoot), etc. Transfers can be performed subcutaneously through a circumtibial way or deeply through the interosseous membrane (transmembranous). The latter is classically routed above the extensor retinaculum. We evaluated the circumtibial (CT), above-retinaculum transmembranous (ART) and below-retinaculum transmembranous (BRT) transfers gliding resistance and kinematics in a cadaveric model during ankle range of motion (ROM). Our first hypothesis was that the CT would be the transfer with more gliding resistance and with more kinematic alteration. Our second hypothesis was that the ART would not show significant differences against the BRT transfer. Methods: 8 cadaveric foot- ankle – distal tibia were prepared, identifying all extensor and flexor tendons proximally. The skin and subcutaneous tissue were kept intact. Each specimen was mounted on a special frame, and luminous markers were attached to the skin to adapt it to the Oxford Foot Model. A dead weight equal to 50% of the stance phase force was applied to each tendon, except for the Achilles tendon. Each specimen served as its own control, testing dorsiflexion when pulling the tibialis anterior (TA), recording the kinematics and gliding resistance. Then, dorsiflexion was tested with the transfers already described (CT, ART and BRT PTTT). A 10-repetition cycle of dorsiflexion and plantarflexion was performed for each condition. The movement of the foot was recorded using high speed cameras, and the force needed to achieve dorsiflexion was registered in every cycle. Statistical analysis was performed using the SPSS software. Results: The circumtibial transfer showed the highest gliding resistance (p0.05). Regarding kinematics, all transfers decreased ankle ROM, being the CT transfer the condition with less range of motion (-9 degrees, p

Category: Ankle Introduction/Purpose: Thromboembolic complications during lower-limb immobilization after Achilles tendon ruptures are common. Both operative and nonoperative treatments of Achilles rupture include a period of immobilization which is a well- documented risk factor for distal vein thrombosis. Curiously, there is a gap in literature linking the diagnosis of thromboembolic events to the Achilles rupture previous to the inmobilization. The term DTV refers to the anterior/posterior tibial or the peroneal veins, i.e. those that correspond to arterial structures and comprise the profound vein system. Although still with little agreement, the role of muscular vein thrombosis or isolated gastrocnemius or soleus vein thrombosis are gaining relevance within the current published data, despite there is no report of it association with tendo Achilles rupture before or after the initiation of treatment. Methods: Case report: Five consecutive patients with a diagnosis of traumatic Achilles rupture were evaluated. All patients sustained non traumatic injuries. One of the patients was a heavy smoker, and two of them had BMI over 25. We routinely execute an ultrasound to locate the rupture site and at the same time color ultrasound Doppler was performed by an expert in vascular echography, before the initiation of treatment. In all cases a thrombosis of the calf muscle veins was found. Surgical treatment was not advice in any of the patients and definitive treatment was conservative. Results: Calf muscle veins are deep veins in the distal lower extremity that are nonpaired and not associated with named tibial arteries. These veins make up a complex venous system of the musculature of the posterior leg and include the soleal and gastrocnemius veins that run as sinusoids within the muscles of the same name. The soleal sinusoids may drain into the midperoneal or posterior tibial veins, whereas the gastrocnemius sinusoids may empty directly into the popliteal vein. Although the real incidence of MVT is extremely variable, in patients presenting with symptoms and signs suspicious for distal vein thrombosis, muscular veins have been shown to be the most common location for thrombosis with 23% to 41% of all patients. Conclusion: Our group of patients was diagnosed before immobilization was established. One plausible explanation could be that the muscle trauma associated with the tendinous rupture may have some influence in the thrombi generation triggering endothelial dysfunction, or affecting the calf muscle pump creating venous stasis, conditions that favour the VTE appearance. It is our perspective that although not well stablished there is at least a theoretical risk of further propagation to the profound venous system and subsequently to the pulmonary system, and this fact not only conditions the treatment of MVT itself, but also the treatment of the Achilles rupture.

A 39 years old African man presented with fatigue, loss of weight and night sweats; radiology showed a possible usual interstitial pneumonia pattern. The patient missed follow-up visits, and presented again after 3 years with productive cough and general illness. Pulmonary function tests showed a decline of FVC compared to a previous investigation. The CT scans showed progression of the interstitial lung disease, and a multidisciplinary conference recommended to proceed with a surgical lung biopsy. Histopathology showed an atypical pattern, with bronchiolar metaplasia. A new multidisciplinary conference made a diagnosis of IPF, and the patient was treated with antifibrotic drugs with a good effect, reaching stability of lung function. This case report highlights the need to improve knowledge and to better characterize rare pulmonary diseases, and especially IPF, among African patients.