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Background: Ankle and hindfoot arthrodesis is often supplemented with autograft to promote bony union. Autograft harvest can lead to increased perioperative morbidity. Purified recombinant human platelet-derived growth factor BB homodimer (rhPDGF-BB) has stimulated bone formation in mandibular defects and hindfoot fusion. This randomized controlled trial evaluated the efficacy and safety of rhPDGF-BB combined with an injectable, osteoconductive beta-tricalcium phosphate (β-TCP)–collagen matrix versus autograft in ankle and hindfoot fusions. Methods: Seventy-five patients requiring ankle or hindfoot fusion were randomized 5:1 for rhPDGF-BB/β-TCP-collagen (treatment, n = 63) or autograft (control, n = 12). Prospective analysis included 142 autograft control subjects from another clinical trial with identical study protocols. Standardized operative and postoperative protocols were used. Patients underwent standard internal fixation augmented with autograft or 0.3 mg/mL rhPDGF-BB/β-TCP-collagen. Radiologic, clinical, and quality-of-life outcomes were assessed over 52 weeks. Primary outcome was joint fusion (50% or more osseous bridging on computed tomography) at 24 weeks. Secondary outcomes included radiographs, clinical healing status, visual analog scale pain score, American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale score, Foot Function Index score, and Short Form-12 score. Noninferiority P values were calculated. Results: Complete fusion of all involved joints at 24 weeks as indicated by computed tomography was achieved in 53 of 63 (84%) rhPDGF-BB/β-TCP-collagen-treated patients and 100 of 154 (65%) autograft-treated patients ( P < .001). Mean time to fusion was 14.3 ± 8.9 weeks for rhPDGF-BB/β-TCP-collagen patients versus 19.7 ± 11.5 weeks for autograft patients ( P < .01). Clinical success at 52 weeks was achieved in 57 of 63 (91%) rhPDGF-BB/β-TCP-collagen patients and 120 of 154 (78%) autograft patients ( P < .001). Safety-related outcomes were equivalent. Autograft controls had 2 bone graft harvest infections. Conclusions: Application of rhPDGF-BB/β-TCP-collagen was a safe, effective alternative to autograft for ankle and hindfoot fusions, eliminating the pain and morbidity associated with autograft harvesting. Level of Evidence: Level I, prospective randomized study.

Background: Alignment is instrumental for success and long-term survival of Total Ankle Replacement (TAR). At this point in TAR, only coronal alignment in the region of the tibiotalar joint or above has been assessed because inframalleolar deformity is difficult to visualize radiographically. The Hindfoot Alignment View (HAV) allows visualization of the hindfoot position relative to the tibia. The purpose of this study was to evaluate the clinical relevance of this view in assessing patients with TAR. Materials and Methods: Twenty-eight consecutive patients with a Hintegra-TAR with an average followup of 4.1 ± 1.5 years were followed with (1) AOFAS and SF-36 scores, (2) visual judgment of the hindfoot position, (3) HAV and AP/lateral radiographs, (4) dynamic pedobarography (Novel emed m/E, Munich, Germany). Results: The HAV position correlated well with different load parameters on heel strike ( r = 0.44 to 0.62) but not with the varus-valgus load pattern of the rest of the foot. Visual judgment and TAR joint line did not correlate to radiographic hindfoot alignment or to pedobarographic load distribution. The hindfoot alignment measured by the HAV correlated significantly to the Physical Function and Role Physical of SF-36. No correlation was found to other SF36-qualities or the AOFAS-score. Conclusion: Inframalleolar alignment, as assessed by the HAV, influenced the dynamic pedobarographic load pattern and clinical outcome. Visual judgment and TAR joint line were not accurate enough to estimate the hindfoot alignment or dynamic load pattern. We believe adjusting the hindfoot correctly with HAV might improve long-term outcome and survival of TAR. Level of Evidence: IV, Retrospective Case Series

The purpose of this study was to evaluate the distribution rate of etiologies leading to ankle arthritis and to quantify and compare the important clinical and radiologic variables among these etiologic groups. We evaluated data from 390 patients (406 ankles) who consulted our center because of painful end-stage ankle osteoarthritis (OA) by using medical history, physical examination, and radiography. Posttraumatic ankle OA was seen in 78% of the cases (n = 318), secondary arthritis in 13% (n = 52), and primary OA in 9% (n = 36). The average American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was 38 points (range, 0–74 points), range of motion was 22° (range, 0°−65°), and visual analog scale for pain was 6.8 (range, 2–10). Patients with posttraumatic end-stage ankle OA were younger than patients with primary OA. The average tibiotalar alignment was 88° (range, 51°–116°) and did not differ between the etiologic groups. Our study showed trauma is the main cause of ankle OA and primary OA is rare. In the majority of patients with ankle OA the average tibiotalar alignment is varus regardless of the underlying etiology. Level of Evidence: Level IV, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

Purpose – Improved exploitation of Scotland's intellectual assets (IA) has been identified as a critical means of improving the economic wellbeing of the nation. Earlier research highlighted a general lack of awareness of IA amongst all types of organisations in Scotland. The Intellectual Assets Centre coordinated the Scottish devolved government and European Union (EU) funded Innovative Actions projects designed to help small and medium‐sized enterprises (SMEs) from all industry sectors to start to address IA management issues. The purpose of this paper is to describe the activities implemented by the Intellectual Assets Centre.Design/methodology/approach – A review of IA capture and development comparing IA activities in the EU and a survey of how 450 Scottish organisations (all SMEs) currently capture their IA was conducted. An IA capturing tool, the feasibility of a novel IA benchmarking tool and a toolkit to assist know‐how capture were developed. These were piloted with SMEs from various industries....

Both embryonic and adult stem cells promise a precious cell source for the treatment of various degenerative diseases due to their capacity for self-renewal and ability to differentiate along multiple cell lineages. A lack of understanding surrounding the basic biology of stem cells, the stemness, continues to challenge successful clinical application of these cells. Gene expression analysis, both genome-wide and targeted at specific gene subsets, has played a key role in improving our understanding of the genetic attributes of stem cells through identification of molecular signatures that characterize normal stem cell function. Such approaches have facilitated the investigation of stemness in a subset of tumor cells, so-called cancer stem cells, and have started to unravel their roles in initiation and progression of tumors. This review summarizes recent advances of gene expression analysis in stem cell research and also discusses critical issues that remain to be elucidated in the search for cancer stem cells markers.

Stem cells and microRNAs (miRNAs) represent two fast-developing frontiers of biological research. Stem cells function in embryonic development and tissue maintenance and are characterized by two fundamental properties: self-renewal and multipotency. Within many types of cancers, a small population of cells possesses stem cell-like characteristics. These cancer stem cells (CSCs) have been hypothesized to represent the disease-propagating and drug-resisting cell population. An increased understanding of the biology of stem cells and CSCs offers potential in the development of regenerative medicine and treatments for oncological disease. miRNAs are emerging as important regulators of post-transcriptional gene regulation, and have been demonstrated to be an integral component in stem cell regulation. This article reviews recent advances in the understanding of the roles of miRNAs in regulating various stem cell types, including embryonic stem cells, adult stem cells and CSCs.

Une observation de syndrome de diabete insipide du a un choc hemorragique avec hypotension apres hemorragie grave au niveau d'un ulcere gastrique