Visual impairment is one of the most important clinical risk factors associated with falls. Currently it remains unclear whether adaptive gait is progressively affected as the extent of central visual field loss (CFL) increases, or when CFL exceeds a certain size. 10 participants (aged 22 ± 3 years) negotiated a floor based obstacle in full vision (no occlusion) and wearing custom made contact lenses which simulated 10° CFL and 20° CFL. Movement kinematics assessed the period immediately prior to and during obstacle crossing. In the 20° CFL condition, participants exhibited adaptations in gait which were consistent with being more cautious and more variable during the approach to and crossing of the obstacle, when compared to both 10° CFL and full vision conditions. Specifically, in the 20° CFL condition participants placed their lead foot further from the obstacle, lifted both their lead and trail feet higher and slower over the obstacle, and took longer to negotiate the obstacle when compared to the 10° CFL and full vision conditions. Data highlights differences in adaptive gait as a function of the extent of CFL when compared to full vision. More importantly, these adaptations were only associated with loss of the central 20° of the visual field, suggesting that gait is compromised only after central visual field loss exceeds a certain level.

Strongly textured organic semiconductor micropatterns made of the small molecule dioctylbenzothienobenzothiophene (C(8)-BTBT) are fabricated by using a method based on capillary force lithography (CFL). This technique provides the C(8)-BTBT solution with nucleation sites for directional growth, and can be used as a scalable way to produce high quality crystalline arrays in desired regions of a substrate for OFET applications.

BACKGROUND

Special blue tube lights of standard length are used in most neonatal units to deliver phototherapy. Of late, special blue compact fluorescent lamp phototherapy equipments have been introduced in India, which are claimed to be better than standard tube lights.

OBJECTIVE

To compare special blue compact fluorescent lamp (CFL) phototherapy with special blue standard-length tube lights (STL).

METHODS

This randomized, controlled trial was conducted in a level III NICU. Neonates, otherwise healthy, of gestation greater than 34 weeks with hyperbilirubinemia requiring phototherapy, were included. Rh iso-immunized babies, those who underwent prior exchange transfusion and whose parents declined to consent were excluded. By stratified block randomization, babies were allocated to receive phototherapy by CFL or STL. CFL and STL were both special blue lights with irradiance maintained above 15 microWatts/nm/cm2. Total serum bilirubin (TSB) was measured 12 hourly till phototherapy was stopped or an exchange transfusion was done. Temperature and clinical and laboratory parameters of dehydration were recorded 12 hourly till 72 hrs. Nursing staff answered an objectivized proforma about the disadvantageous effects on nurses.

RESULTS

Fifty babies were enrolled in each group. Baseline characteristics, causes of jaundice, hemolysis, baseline TSB and irradiance were similar in both groups. Mean duration of phototherapy (P = 0.98) was similar in both groups. Kaplan-Meier analysis of phototherapy duration showed no difference in the survival curves of the 2 groups (P = 0.6). Axillary temperature was similar in both groups and no baby was dehydrated. Nursing staff reported no significant differences between CFL and STL visavis glare hurting the eyes, giddiness and headache.

CONCLUSIONS

CFL phototherapy has no superiority over STL phototherapy in terms of efficacy and adverse effects on the neonate and effects on nursing staff.

From environmental viewpoint, the most important advantage of compact fluorescent lamps (CFLs) is reduction of green house gas emissions. But their significant disadvantage is disposal of spent lamps because of containing a few milligrams of toxic metals, especially mercury and lead. For a successful implementation of any waste management plan, availability of sufficient and accurate information on quantities and compositions of the generated waste and current management conditions is a fundamental prerequisite. In this study, CFLs were selected among 20 different brands in Iran. Content of heavy metals including mercury, lead, nickel, arsenic and chromium was determined by inductive coupled plasma (ICP). Two cities, Tehran and Tabriz, were selected for assessing the current waste management condition of CFLs. The study found that waste generation amount of CFLs in the country was about 159.80, 183.82 and 153.75 million per year in 2010, 2011 and 2012, respectively. Waste generation rate of CFLs in Iran was determined to be 2.05 per person in 2012. The average amount of mercury, lead, nickel, arsenic and chromium was 0.417, 2.33, 0.064, 0.056 and 0.012 mg per lamp, respectively. Currently, waste of CFLs is disposed by municipal waste stream in waste landfills. For improving the current conditions, we propose by considering the successful experience of extended producer responsibility (EPR) in other electronic waste management. The EPR program with advanced recycling fee (ARF) is implemented for collecting and then recycling CFLs. For encouraging consumers to take the spent CFLs back at the end of the products' useful life, a proportion of ARF (for example, 50%) can be refunded. On the other hand, the government and Environmental Protection Agency should support and encourage recycling companies of CFLs both technically and financially in the first place.

simple method to fabricate a multifunctional patterned platform on the nanometer scale is demonstrated. The platform contains two reactive functional groups on the surface: one is an acetylene group which can be functionalized via click chemistry, and the other is an amine group which can also be functionalized by classic carbodiimide chemistry with N-hydroxysuccinimide (NHS). The click-active and amine surface could be obtained from polymer coating of poly(propargyl methacrylate) (PPMA) via initiated chemical vapor deposition (iCVD) and poly(allylamine) (PAAm) via a plasma polymerization process, respectively, utilizing commercially available monomers. A capillary force lithography (CFL) process was applied on a stacked film of a PPMA layer on PAAm, and CFL could selectively pattern PPMA maintaining the bottom PAAm layer intact, which completes the multifunctional nanopatterns. The minimum feature size of this nanopattern was 110 nm. The entire fabrication process is solventless and low temperature, which can minimize the loss of functionalities. The click and NHS reactions are highly orthogonal to each other so that nonspecific immobilization can be minimized. These advantageous characteristics enable the covalent functionalization of two independent components in a one-pot functionalization process in self-recognized way. The one-pot orthogonal functionalization was performed in an aqueous solution at room temperature, which is biocompatible. Considering the versatility and generality of the reactions used here, we believe this platform can be easily extended to various biodevice applications.

The effect of low and high viscosity hemodilution with plasma expanders on the extent of the cell free layer (CFL) width was analyzed in the microcirculation of the exteriorized cremaster muscle preparation of Sprague-Dawley male rats. Anesthetized animals were subjected to 40% hemodilution by blood volume, using 5% human serum albumin (HSA) or 6% Hetastarch (hydroxyethyl starch 670 kDa). Arterioles (n=5 for each treatment) were investigated. Mean arterial pressure, heart rate, vessel flow velocity and CFL width were measured at baseline and 5, 20 and 40 min post-exchange transfusion. Blood and plasma viscosity was determined from terminal blood collections. CFL width and pseudoshear rate, diameter and flow, normalized to baseline, were significantly elevated at all post-exchange assessments. Peripheral vascular resistance decreased. The increase of the CFL width was greater with HSA by comparison with Hetastarch hemodilution (p<0.05). Hetastarch blood and plasma viscosities increased significantly compared to those of HSA (p<0.05). This study shows that CFL widths are influenced by plasma expander viscosity, a phenomenon proportional to the increase in molecular weight of the colloids in solution.

OBJECTIVE

This investigation compared cement failure loads of a gold cylinder luted to a CeraOne titanium abutment (5-mm-high chimney) 24 hours postcementation when either zinc phosphate, Tempbond NE, or Tempbond luting agent was used.

METHODS

Luting agent (0.01 mL) was applied to the internal aspect of the gold cylinder, and the cylinder was seated with finger pressure followed by a load of 5 kg for 10 minutes. The specimens were stored in 100% humidity at 37 degrees C for 24 hours before a uniaxial tensile force was applied to the gold cylinder by a mechanical testing instrument. A load-displacement chart was plotted and the cement failure load (CFL) calculated in kilograms. CFLs were determined for each luting agent with the access opening for the CeraOne gold screw on the internal of the abutment either unfilled or filled with autopolymerizing resin.

RESULTS

A two-way ANOVA and Turkey's HSD revealed that zinc phosphate resulted in significantly higher (p < .05) mean CFLs than Tempbond or Tempbond NE. In general, filling the access opening did not affect mean CFLs for zinc phosphate and Tempbond NE. However, mean CFLs for gold cylinders cemented with Tempbond and a filled access opening were significantly higher than mean CFLs with an unfilled access opening. However, neither the filled nor the unfilled Tempbond group mean CFL was significantly different from either Tempbond NE mean CFL.

CONCLUSIONS

Twenty-four hours postcementation, zinc phosphate luting cement significantly enhanced CFLs of a CeraOne gold cylinder luted to a 5-mm CeraOne titanium abutment compared with Tempbond and Tempbond NE. Filling the gold screw access opening of the abutment with autopolymerizing resin only led to higher mean CFLs when Tempbond was used as the luting agent. Filling the access opening had no effect (p>> .05) on mean CFLs when Tempbond NE or zinc phosphate was used.

Anatomic knowledge of lateral ligaments around the lateral malleolus is important for repair or reconstruction of ankle instability. The detailed structure of the connective fibers between the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) is unknown. To clarify the anatomic structure of ATFL and CFL and the connective fiber between the 2 ligaments, the lateral ligament was dissected in 60 ankles of formalin-fixed cadavers, and the distance was measured between bony landmarks and fibular attachment of ATFL and CFL using a digital caliper. All ankles had connective fibers between ATFL and CFL. The structure of connective fibers consisted of a thin fiber above the surface layer of ATFL and CFL; it comprised thin fibrils of the surface layer covering the lower part of ATFL and the front part of CFL. Both ATFL and CFL were independent fibers, and both attachments of the fibula were isolated. Single bands of ATFL were noted in 14 of 60 (23.3%) ankles, double bands that divided the superior and inferior bands were observed in 42 of 60 (70.0%) ankles, and multiple bands were observed in 4 of 60 (6.7%) ankles. A cord-like and a flat and fanning type of CFL was noted in 22 (36.7%) and 38 (63.3%) of the 60 ankles, respectively. Distances between ATFL/CFL and articular and inferior tips of the fibula were 4.3 ± 1.1 mm/7.6 ± 1.6 mm and 14.3 ± 1.9 mm/7.4 ± 1.7 mm, respectively (mean ± standard deviation). The results of this study suggest that knowledge of more anatomic structures of ATFL, CFL, and connective fiber will be beneficial for surgeons in the repair or reconstruction of the lateral ligament of the ankle.

To investigate human Hg exposure by food consumption and occupation exposure in a compact fluorescent lamp (CFL) manufacturing area, human hair and rice samples were collected from Gaohong town, Zhejiang Province, China. The mean values of total mercury (THg) and methylmercury (MeHg) concentrations in local cultivated rice samples were significantly higher than in commercial rice samples which indicated that CFL manufacturing activities resulted in Hg accumulation in local rice samples. For all of the study participants, significantly higher THg concentrations in human hair were observed in CFL workers compared with other residents. In comparison, MeHg concentrations in human hair of residents whose diet consisted of local cultivated rice were significantly higher than those who consumed commercial rice. These results demonstrated that CFL manufacturing activities resulted in THg accumulation in the hair of CFL workers. However, MeHg in hair were mainly affected by the sources of rice of the residents.

UNASSIGNED

In the present study, CFLs harvested from cadavers were categorized according to the differences in the angle of the CFL with respect to the long axis of the fibula and their shape, and then three-dimensional reconstructions of the CFLs were used to simulate and examine the differences in the angles of the CFLs with respect to the long axis of the fibula and how they affect CFL function.

UNASSIGNED

The study sample included 81 ft from 43 Japanese cadavers. CFLs were categorized according to their angle with respect to the long axis of the fibula and the number of fiber bundles. Five categories were subsequently established: CFLCFL with respect to the long axis of the fibula from 20° to 29°); CFLCFLCFLCFLCFL strain during dorsiflexion (20°) and plantarflexion (30°) on the talocrural joint axis and inversion (20°) and eversion (20°) on the subtalar joint axis.

UNASSIGNED

In terms of proportions for each category, <em>CFL</em>20° was observed in 14 ft (17.3%), with <em>CFL</em>30° in 22 ft (27.2%), <em>CFL</em>40° in 29 ft (35.8%), <em>CFL</em>50° in 15 ft (18.5%), and <em>CFL</em>2 in one foot (1.2%). Specimens in the <em>CFL</em>20° and <em>CFL</em>30° groups contracted with plantarflexion and stretched with dorsiflexion. In comparison, specimens in the <em>CFL</em>40°, <em>CFL</em>50°, and <em>CFL</em>2 groups stretched with plantarflexion and contracted with dorsiflexion. Specimens in the <em>CFL</em>20° and <em>CFL</em>2 groups stretched with inversion and contracted with eversion.

UNASSIGNED

CFL function changed according to the difference in the angles of the CFLs with respect to the long axis of the fibula.

An operationally simple photochemical strategy for the direct arylation of oxindoles with (hetero)aryl halides in the absence of both transition metals and photoredox catalysts has been developed. The reaction provides an efficient way to construct various 3-aryloxindole building blocks of pharmaceutical interest at ambient temperature by using household compact fluorescent light (CFL) bulbs as the light source. Preliminarily, mechanistic studies revealed that the intermolecular electron transfer relied on the formation of photon-absorbing electron-donor-acceptor (EDA) complexes between electron-rich oxindole enolates and electron-deficient (hetero)aryl halides, and a radical chain mechanism was operative.

Perfluorocarbon nanoemulsions (PFCs) tagged with fluorescence dyes have been intensively used to confirm the in vivo ¹⁹F magnetic resonance imaging (MRI) localization of PFCs by post mortem histology or flow cytometry. However, only limited data are available on tagged PFCs and the potential dissociation of fluorescence and ¹⁹F label after cellular uptake over time.

PFCs were coupled to rhodamine (Rho) or carboxyfluorescein (Cfl) and their fate was analyzed after in vitro uptake by J774, RAW and CHO cells by flow cytometry and ¹⁹F MRI. In separate in vivo experiments, the dual-labelled emulsions were intravenously applied into mice and their distribution was monitored in spleen and liver over 24 h. In a final step, time course of fluorescence and ¹⁹F signals from injected emulsions were tracked in a local inflammation model making use of a subcutaneous matrigel depot doped with LPS (lipopolysaccharide).

Internalization of fluorescence-labelled PFCs was associated with a substantial whitening over 24 h in all macrophage cell lines while the ¹⁹F signal remained stable over time. In all experiments, ^CflPFCs were more susceptible to bleaching than ^RhoPFCs. After intravenous injection of ^RhoPFCs, the fluorescence signal in spleen and liver peaked after 30 min and 2 h, respectively, followed by a successive decrease over 24 h, whereas the ¹⁹F signal continuously increased during this observation period. Similar results were found in the matrigel/LPS model, where we observed increasing ¹⁹F signals in the inflammatory hot spot over time while the fluorescence signal of immune cells isolated from the matrigel depot 24 h after its implantation was only marginally elevated over background levels. This resulted in a massive underestimation of the true PFC deposition in the reticuloendothelial system and at inflammatory hot spots.

Cellular uptake of fluorescently tagged PFCs leads to a dissociation of the fluorescence and the ¹⁹F label signal over time, which critically impacts on interpretation of long-term experiments validated by histology or flow cytometry.

Chronic ankle instability following ankle sprains causes pain and functional problems such as recurrent giving way. Within the 3 ligaments of the lateral ligament complex, 80% of patients tear the anterior talofibular ligament (ATFL), whereas the other 20% of patients tear the ATFL and calcaneofibular ligament (CFL). Rarely, the posterior talofibular ligament is involved. An incidence of 10% to 30% of patients will fail conservative treatment and result in chronic ankle instability that may require surgical treatment. To date, numerous open surgical procedures for anatomic repair or reconstruction of ATFL and/or CFL provide good clinical results.

BACKGROUND

Exposure of the posterolateral talar dome for osteochondral autograft transfer can be challenging. The purpose of this study is to compare surgical exposures for perpendicular access to the posterolateral talar dome using osteochondral transfer instrumentation.

METHODS

Five surgical approaches were performed on each of eight cadaveric ankles. The sequence was: (1) Anterolateral arthrotomy with ATFL release, (2) Anterolateral tibial osteotomy, (3) Fibular osteotomy with ATFL intact, (4) Fibular osteotomy with ATFL release, and (5) Fibular osteotomy with ATFL/CFL release. (ATFL repaired between 1 and 2). While maintaining the orientation of the harvester perpendicular to the talar dome articular surface, osteochondral plugs were harvested as far posteriorly as possible using a 6-mm harvester. Distances from the anterior talar articular surface to the posterior aspect of the recipient site were measured. Statistical analysis used ANOVA and Fisher post hoc tests.

RESULTS

Average AP exposure (mm) and percentage of AP talar dome dimensions exposed: (1) Anterolateral arthrotomy with ATFL release: 21.2 mm (43.3%), (2) Anterolateral tibial osteotomy: 33.7 mm (68.5%), (3) Fibular osteotomy(ATFL intact): 43.2 mm (87.8%), (4) Fibular osteotomy with ATFL release: 44.9 mm (91.2%), and (5) Fibular osteotomy with ATFL/CFL release: 46.6 mm (94.6%). All osteotomies provided greater exposure than anterolateral arthrotomy with ATFL release (p < 0.0001). A significant difference was obtained between each of the fibular osteotomies and tibial osteotomy (p < 0.0001). Differences between the fibular osteotomy approaches (3 to 5) were not significant.

CONCLUSIONS

Fibular osteotomy provides the greatest perpendicular exposure to the posterolateral talar dome. Anterolateral tibial osteotomy provides greater exposure than arthrotomy alone.

CONCLUSIONS

This study provides a guide for surgical exposures to the posterolateral talar dome for osteochondral autograft transfer.

Pseudomonas syringae pv. actinidiae (Psa) causes kiwifruit bacterial canker (KBC), with a severe infection of the kiwifruit plant resulting in heavy economic losses. Little is known regarding the biodiversity and genetic variation of populations of Psa in China. A collection of 269 strains of Psa were identified from 300 isolates obtained from eight sampling sites in five provinces in China. The profiles of 50 strains of Psa and one strain of P. syringae pv. actinidifoliorum (Psaf) were characterized by Rep-, IS50-P, and RAPD-PCR. Discriminant analysis of principal coordinates (DAPC), principal component analysis (PCA), and hierarchical cluster analysis were used to analyze the combined fingerprints of the different PCR assays. The results revealed that all isolates belonged to the Psa3 group, that strains of Psa from China have broad genetic variability that was related to source geographic region, and that Chinese strains can be readily differentiated from strains from France, but are very similar to those from Italy. Multilocus sequence typing (MLST) of 24 representative isolates using the concatenated sequences of five housekeeping genes (cts, gapA, gyrB, pfk, and rpoD) demonstrated that strain Jzhy2 from China formed an independent clade compared to the other biovars, which possessed the hopH1 effector gene, but lacked the hopA1 effector gene. A constellation analysis based on the presence or absence of the four loci coding for phytotoxins and a cluster analysis based on the eleven effector genes showed that strains from China formed two distinct clades. All of the strains, including K3 isolated in 1997 from Jeju, Korea, lacked the cfl gene coding for coronatine. In contrast, the tox-argK gene cluster coding for phaseolotoxin was detected in K3 and in the Biovar1 strains (K3, Kw30, and Psa92), and produced a false positive amplicon for the hopAM1-like gene in this study. To date, only one biovar (Biovar3) is represented by the strains of Psa from China, despite China being the center of origin for the kiwifruit.

The classification of cutaneous follicular lymphoma (CFL) into primary cutaneous follicle center lymphoma (PCFCL) or secondary cutaneous follicular lymphoma (SCFL) is challenging. SCFL is suspected when tumor cells express BCL2 protein, reflecting a BCL2 translocation. However, BCL2 expression is difficult to assess in CFLs because of numerous BCL2+ reactive T cells. To investigate these issues and to further characterize PCFCL, we studied a series of 25 CFLs without any extracutaneous disease at diagnosis, selected on the basis of BCL2 protein expression using 2 BCL2 antibodies (clones 124 and E17) and BOB1/BCL2 double immunostaining. All cases were studied using interphase fluorescence in situ hybridization with BCL2, BCL6, IGH, IGK, IGL breakapart, IGH-BCL2 fusion, and 1p36/1q25 dual-color probes. Nineteen CFLs were BCL2 positive, and 6 were negative. After a medium follow-up of 24 (6 to 96) months, 5 cases were reclassified as SCFL and were excluded from a part of our analyses. Among BCL2+ PCFCLs, 60% (9/15) demonstrated a BCL2 break. BCL2-break-positive cases had a tendency to occur in the head and neck and showed the classical phenotype of nodal follicular lymphoma (CD10+, BCL6+, BCL2+, STMN+) compared with BCL2-break-negative PCFCLs. Del 1p36 was observed in 1 PCFCL. No significant clinical differences were observed between BCL2+ or BCL2- PCFCL. In conclusion, we show that a subset of PCFCLs harbor similar genetic alterations, as observed in nodal follicular lymphomas, including BCL2 breaks and 1p36 deletion. As BCL2 protein expression is usually associated with the presence of a BCL2 translocation, fluorescence in situ hybridization should be performed to confirm this hypothesis.

BACKGROUND

Although commonly practiced, simultaneous onabotulinumtoxinA injections to multiple facial areas have not been investigated in prospective studies.

OBJECTIVE

Evaluate safety and efficacy of onabotulinumtoxinA for treatment of forehead lines (FHL) distributed between the frontalis (20 U) and glabellar complex (20 U), with or without simultaneous lateral canthal areas (crow's feet lines [CFL], 24 U) treatment.

METHODS

Subjects with moderate to severe FHL were randomized (2:2:1) to onabotulinumtoxinA 40 U, onabotulinumtoxinA 64 U, or placebo. After 180 days, subjects could receive up to 2 additional open-label onabotulinumtoxinA 64 U treatments.

RESULTS

The intent-to-treat (ITT) population comprised 787 subjects, and the modified ITT (mITT) population (subjects with psychological impact) comprised 568. After 30 days, onabotulinumtoxinA 40 U and 64 U significantly improved investigator- and subject-assessed FHL severity by at least 2 Facial Wrinkle Scale (FWS) grades in 45.6% and 53.0% of ITT subjects, respectively, versus 0.6% receiving placebo (both, p < .0001). Significantly more mITT subjects receiving onabotulinumtoxinA achieved investigator- and subject-assessed FWS ratings of none/mild versus placebo (p < .0001). OnabotulinumtoxinA was well tolerated.

CONCLUSIONS

OnabotulinumtoxinA distributed between the frontalis and glabellar complex, with or without additional CFL injections, was safe and effective for treatment of moderate to severe FHL.

UNASSIGNED

Testicular function is modified by maturational gonadostatic control highly susceptible to negative physiologic niche-altering factors like UV-rays.

UNASSIGNED

This study was performed in order to uncover new aspects of Compact Florescent Lamps (CFLs) induced damages on the testicular tissue of rats and evaluating the effect of curcumin on testis of rats after exposure to compact florescent Lamps.

UNASSIGNED

Twenty-four adult male Albino rats were randomly divided into three groups: control group (ethyl oleate 0.2 ml, IP, for 45 days, without CFLs exposure), fluorescent group (ethyl oleate 0.2 ml, IP, daily and treated with 12 hr CFLs exposure for 45 days) and curcumin group (curcumin 20 µ M, IP along with 12 hr CFLs exposure for 45 days). The rats were anesthetized at the end of the experiment. Gonadotropin hormones and prolactin levels were measured; Histopathological and histomorphometrical analysis of the testis was carried out.

UNASSIGNED

Results of this study showed that CFLs significantly decreased serum levels of follicle stimulating hormone, prolactin, testicular weight, sperm motility, TDI, and SPI. Furthermore, CFLs had no effect on serum levels of luteinizing hormone and sperm count and also, increased abnormal sperm shapes. Our results also showed that curcumin supplementation following CFLs reversed these alterations.

UNASSIGNED

These results strongly suggest that CFLs severely impairs testis while curcumin as an antioxidant had protective effects on undesirable effects in testis induced by CFLs.

BACKGROUND

Ankle sprains are the most common orthopedic pathology experienced during sport and physical activity and often result in chronic ankle instability (CAI). Understanding how to prevent CAI is difficult because of the costs and logistics associated with clinical trials aimed at preventing the heterogeneous symptoms associated with CAI. Thus, a need exists to develop an animal model that presents similar long-term consequences as CAI to assess preclinical data. Thus, the purpose was to determine whether surgically transecting the lateral ligaments of a mouse hind limb results in the development of CAI-like symptoms 12 months after injury.

METHODS

Thirty male mice (CBA/J) were randomly placed into a SHAM (control), CFL (calcaneofibular ligament; mild ankle sprain), or ATFL/CFL (anterior talofibular ligament/CFL; severe) ankle sprain group and housed individually. Three days after surgically transecting the respective lateral ligaments, mice were given a solid surface running wheel and daily running wheel measurements were recorded. Outcome measures of balance and gait were obtained before and at 4, 48, 54, and 60 wk after injury.

RESULTS

The ATFL/CFL group had significantly more hind foot slips than the CFL and SHAM groups (P < 0.05). The CFL also had more hind foot slips relative to the SHAM group (P < 0.05). The ATFL/CFL group was significantly less physically active relative to the SHAM and CFL groups (P < 0.05). A cut score of 4.75 foot slips had a sensitivity of 0.68 and specificity of 1.00 and indicates that 70% (14/20) of mice with an ankle sprain had developed CAI.

CONCLUSIONS

The results of this study indicate that an acute ankle sprain in mice can result in the development of CAI-like symptoms 12 months after injury.

BACKGROUND

Avulsion fractures of the lateral malleoli in ankle inversion injuries are often undetected on routine radiographs. Undetected avulsion fractures have been managed as ankle sprain, which may affect the outcome of the treatment of the ankle sprain. The purposes of this study are to compare the outcomes of functional treatment between the first-time severe ligament injury and avulsion fracture of the lateral ankle, and to investigate how the anterior talofibular ligament (ATFL) view or the calcaneofibular ligament (CFL) view affects the diagnosis of the avulsion fracture and outcome of functional treatment of the ankle inversion injury.

METHODS

A total of 276 consecutive patients with a first-time severe ankle inversion injury were classified into a ligament injury group (group I) or an avulsion fracture group (group II) on the basis of physical examination and radiographs. The patients with a negative finding on routine radiographs and a positive finding on the ATFL or CFL view derived from group II (group IIA). Age, sex, and activity level were analyzed. Patients were treated by stirrup splint.

RESULTS

A total of 202 (73.2%) patients were in group I and 74 (26.8%) were in group II. In all, 50 patients in group II showed negative standard radiographs and a positive ATFL or CFL view. Altogether, 240 patients were followed up for at least 1 year and assessed clinically and radiographically. Differences in age, sex, and activity level before injury between groups were not statistically significant. Clinical and radiographic results of group II were inferior to those of group I. The outcome of group IIA was comparable to that of group I.

CONCLUSIONS

The outcome of functional treatment of avulsion fracture was inferior to that of ligament injury. The ATFL and CFL views provide a more precise diagnosis but do not affect the outcome of the functional treatment.

BACKGROUND

Various imaging techniques have been utilized for the diagnosis of chronic lateral ankle ligament injury. This systemic review will explore the effectiveness of different imaging techniques in diagnosing chronic lateral ankle ligament injury.

METHODS

Relative studies were retrieved after searching 3 databases (MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trails). Eligible studies were summarized. Data were extracted to calculate pooled sensitivity and specificity of magnetic resonance imaging (MRI), ultrasonography (US), stress radiography, and arthrography.

RESULTS

Fifteen studies met our inclusion and exclusion criteria. A total of 695 participants were included. The pooled sensitivities in diagnosing chronic ATFL injury were 0.83 [0.78, 0.87] for MRI, 0.99 [0.96, 1.00] for US, and 0.81 [0.68, 0.90] for stress radiography. The pooled specificities in diagnosing chronic ATFL injury were 0.79 [0.69, 0.87] for MRI, 0.91 [0.82, 0.97] for US, and 0.92 [0.79, 0.98] for stress radiography. The pooled sensitivities in diagnosing chronic CFL injury were 0.56 [0.46, 0.66] for MRI, 0.94 [0.85, 0.98] for US, and 0.90 [0.73, 0.98] for arthrography. The pooled specificities in diagnosing chronic CFL injury were 0.88 [0.82, 0.93] for MRI, 0.91 [0.80, 0.97] for US, and 0.90 [0.77, 0.97] for arthrography.

CONCLUSIONS

This systematic review with meta-analysis investigated the accuracy of imaging for the diagnosis of chronic lateral ankle ligament injury. Ultrasound manifested high diagnostic accuracy in diagnosing chronic lateral ankle ligament injury. Clinicians should be aware of the limitations of MRI in detecting chronic CFL injuries.

Flavanones and flavones are excellent source of bioactive compounds but the molecular basis of their highly efficient production remains elusive. Chalcone isomerase (CHI) family proteins play essential roles in flavonoids biosynthesis but little are known about the transcription factors controlling their gene expression. Here, we identified a type IV CHI (designated as CitCHIL1) from citrus which enhances the accumulation of citrus flavanones and flavones (CFLs). CitCHIL1 participates in a CFLs biosynthetic metabolon and assists the cyclization of naringenin chalcone to (2S)-naringenin, which leads to the efficient influx of substrates to chalcone synthase (CHS) and improves the catalytic efficiency of CHS. Overexpressing CitCHIL1 in Citrus and Arabidopsis significantly increased flavonoids content and RNA interference-induced silencing of CitCHIL1 in citrus led to a 32% reduction in CFLs content. Three AP2/ERF transcription factors were identified as positive regulators of the CitCHIL1 expression. Of these, two dehydration-responsive element binding (DREB) proteins, CitERF32 and CitERF33, activated the transcription by directly binding to the CGCCGC motif in the promoter, while CitRAV1 (RAV: Related to ABI3/VP1) formed a transcription complex with CitERF33 that strongly enhanced the activation efficiency and flavonoid accumulation. These results not only illustrate the specific function that CitCHIL1 executes in CFLs biosynthesis but also reveal a new DREB-RAV transcriptional complex regulating flavonoid production.

Keywords: DREB; RAV; citrus; flavanone; flavone; type IV chalcone isomerase.

Background: Osteochondral lesions (OCLs) and bony impingement are common secondary lesions of chronic lateral ankle instability (CLAI), but the risk factors that predict OCLs and bony impingement are unknown.

Purpose: To analyze the risk factors for the development of OCLs and osteophytes in patients with CLAI.

Study design: Case-control study; Level of evidence, 3.

Methods: Patients diagnosed with CLAI at our institution from June 2007 to May 2018 were enrolled. The assessed potential risk factors were age, sex, postinjury duration, body mass index, injury side, and ligament injury type (isolated anterior talofibular ligament [ATFL] injury, isolated calcaneofibular ligament [CFL] injury, or concomitant ATFL and CFL injuries). Univariate and multivariate logistic regression analyses were performed to evaluate the association between these factors and the presence of OCLs and osteophytes.

Results: A total of 1169 patients with CLAI were included; 436 patients (37%) had OCLs and 334 (31%) had osteophytes. The presence of OCLs was significantly associated with the presence of osteophytes (P < .001). Male sex and older age were significantly associated with the presence of OCLs in the medial and lateral talus. A postinjury duration of 5 years or longer was significantly associated with the presence of OCLs in the medial talus (odds ratio [OR], 1.532; 95% CI, 1.023-2.293; P = .038) but not in the lateral talus. ATFL and CFL injuries were both significantly associated with the presence of lateral OCLs. Risk factors for the presence of osteophytes were male sex, older age, postinjury duration 5 years or longer, and CFL injury. Patients with concomitant ATFL and CFL injuries were significantly more likely to have osteophytes than were patients with single-ligament injuries (P = .018).

Conclusion: Risk factors for OCLs and osteophytes were postinjury duration of 5 years or longer, older age, and male sex. ATFL injury was associated with the presence of lateral OCLs, whereas CFL injury was associated with the presence of lateral OCLs and osteophytes. Patients with these risk factors should be closely monitored and treated to reduce the incidence of ankle arthritis.

Keywords: chronic lateral ankle instability; osteochondral lesion; osteophytes; postinjury duration; risk factors.