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AimsArthroscopically controlled fracture reduction in combination with percutaneous screw fixation may be an alternative approach to open surgery to treat talar neck fractures. The purpose of this study was thus to present preliminary results on arthroscopically reduced talar neck fractures.Patients and MethodsA total of seven consecutive patients (four women and three men, mean age 39 years (19 to 61)) underwent attempted surgical treatment of a closed Hawkins type II talar neck fracture using arthroscopically assisted reduction and percutaneous screw fixation. Functional and radiological outcome were assessed using plain radiographs, as well as weight-bearing and non-weight-bearing CT scans as tolerated. Patient satisfaction and pain sensation were also recorded.ResultsPrimary reduction was obtained arthroscopically in all but one patient, for whom an interposed fracture fragment had to be removed through a small arthrotomy to permit anatomical reduction. The quality of arthroscopic reduction and restoration of the talar geometry was excellent in the remaining six patients. There were no signs of talar avascular necrosis or subtalar degeneration in any of the patients. In the whole series, the functional outcome was excellent in five patients but restricted ankle movement was observed in two patients. All patients had a reduction in subtalar movement. At final follow-up, all patients were satisfied and all but one patient were pain free.ConclusionArthroscopically assisted reduction and fixation of talar neck fractures was found to be a feasible treatment option and allowed early functional rehabilitation.Cite this article: Bone Joint J2018;100-B:461–7.

AimsA failed total ankle arthroplasty (TAA) is often associated with much bone loss. As an alternative to arthrodesis, the surgeon may consider a custom-made talar component to compensate for the bone loss. Our aim in this study was to assess the functional and radiological outcome after the use of such a component at mid- to long-term follow-up.Patients and MethodsA total of 12 patients (five women and seven men, mean age 53 years; 36 to77) with a failed TAA and a large talar defect underwent a revision procedure using a custom-made talar component. The design of the custom-made components was based on CT scans and standard radiographs, when compared with the contralateral ankle. After the anterior talocalcaneal joint was fused, the talar component was introduced and fixed to the body of the calcaneum.ResultsAt a mean follow-up of 6.9 years (1 to 13), 11 ankles were stable with no radiological evidence of loosening. Only one was lost to follow-up. The mean arc of movement was 21°(10°to 35°). A total of nine patients (75%) were satisfied or very satisfied with the outcome, two (17%) were satisfied but with reservations and one (8%) was not satisfied. All but one patient had an improvement in the American Orthopaedic Foot and Ankle Society hindfoot score (p = 0.01). Just one patient developed deep infection, leading to arthrodesis.ConclusionA custom-made talar component yielded satisfactory results with regard to function, stability and satisfaction. This should encourage the use of such components as an alternative to arthrodesis of the ankle in patients with a failed TAA.Cite this article: Bone Joint J2017;99-B:231–6.

Large osteochondral lesions (OCLs) of the shoulder of the talus cannot always be treated by traditional osteochondral autograft techniques because of their size, articular geometry and loss of an articular buttress. We hypothesised that they could be treated by transplantation of a vascularised corticoperiosteal graft from the ipsilateral medial femoral condyle. Between 2004 and 2011, we carried out a prospective study of a consecutive series of 14 patients (five women, nine men; mean age 34.8 years, 20 to 54) who were treated for an OCL with a vascularised bone graft. Clinical outcome was assessed using a visual analogue scale (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score. Radiological follow-up used plain radiographs and CT scans to assess graft incorporation and joint deterioration. At a mean follow-up of 4.1 years (2 to 7), the mean VAS for pain had decreased from 5.8 (5 to 8) to 1.8 (0 to 4) (p = 0.001) and the mean AOFAS hindfoot score had increased from 65 (41 to 70) to 81 (54 to 92) (p = 0.003). Radiologically, the talar contour had been successfully reconstructed with stable incorporation of the vascularised corticoperiosteal graft in all patients. Joint degeneration was only seen in one ankle. Treatment of a large OCL of the shoulder of the talus with a vascularised corticoperiosteal graft taken from the medial condyle of the femur was found to be a safe, reliable method of restoring the contour of the talus in the early to mid-term. Cite this article: Bone Joint J2015;97-B:1242–9.

ABSTRACTSitC is one of the predominant lipoproteins in Staphylococcus aureus. Recently, SitC was shown to be capable of stimulating Toll-like receptor 2 (TLR2), but the mechanism of TLR2 activation by SitC has not been analyzed in detail so far. In this study, we purified C-terminally His-tagged SitC (SitC-His) from Staphylococcus aureus. SitC-His induced interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) release in human monocytes and also NF-κB activation in TLR2-transfected HEK293 cells, indicating TLR2-specific activation. SitC not only induced a TLR2-dependent release of IL-6 in primary murine keratinocytes (MKs) but also induced intracellular accumulation of TLR2, which was time and concentration dependent. Cy2-labeled SitC-His colocalized specifically with TLR2 in MKs and was also internalized in TLR2 knockout MKs, suggesting a TLR2-independent uptake. Neither activation nor colocalization of SitC-His was observed with TLR4 or Nod2. The results show that the native lipoprotein SitC-His specifically colocalizes with TLR2, is internalized by host cells, induces proinflammatory cytokines, and triggers intracellular accumulation of TLR2.

SitC is one of the predominant lipoproteins in Staphylococcus aureus. Recently, SitC was shown to be capable of stimulating Toll-like receptor 2 (TLR2), but the mechanism of TLR2 activation by SitC has not been analyzed in detail so far. In this study, we purified C-terminally His-tagged SitC (SitC-His) from Staphylococcus aureus. SitC-His induced interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-) release in human monocytes and also NF-B activation in TLR2-transfected HEK293 cells, indicating TLR2-specific activation. SitC not only induced a TLR2-dependent release of IL-6 in primary murine keratinocytes (MKs) but also induced intracellular accumulation of TLR2, which was time and concentration dependent. Cy2-labeled SitC-His colocalized specifically with TLR2 in MKs and was also internalized in TLR2 knockout MKs, suggesting a TLR2-independent uptake. Neither activation nor colocalization of SitC-His was observed with TLR4 or Nod2. The results show that the native lipoprotein SitC-His specifically colocalizes with TLR2, is internalized by host cells, induces proinflammatory cytokines, and triggers intracellular accumulation of TLR2.

A water-soluble polymer, polyethyleneimine functionalised with methylene phosphonate groups (PEI-MP) and labelled with 99mTc, has shown selective uptake into bone tumours. Apparent formation constants for the complexation of important blood plasma metal-ions and metal-ions of radionuclides used in therapeutic radiopharmaceuticals (excluding Tc) with PEI-MP were measured potentiometrically. These were added to the ECCLES data base in order to construct a blood plasma model for PEI-MP. From this model it could be predicted that the polymer would not deliver the therapeutic radionuclides 153Sm, 166Ho, 212Pb, 213Pb and 89Sr to bone. This was clinically verified for 153Sm. However good uptake of 99mTc-PEI-MP could be demonstrated in dogs. Due to the similar chemistry of Re as compared to Tc, it can be expected that PEI-MP labelled with 186Re or 188Re could result in effective therapeutic radiopharmaceuticals for bone cancer.

Subjects induced to perform a small favor, filling out a questionnaire, were more likely than subjects who did not fill out the questionnaire to perform a subsequent larger favor, volunteering for an experiment. However, as predicted by a self-perception analysis of the probable process, this result was observed only in normal weight subjects and not in overweights.

The research project reported on is concerned with the effect of modification of the surface of polypropylene fibre by a new chemical treatment process, oxyfluorination, on the properties of polypropylene fibre reinforced concrete. As a world first, the interfacial bond of polypropylene fibres with the cementitious matrix is improved by increasing the surface free energy of the fibre surface. The reasons for the poor bonding between untreated polypropylene fibre and cementitious matrix are discussed, using the fibre surface free energy and Lewis acid–base interaction concept. The contact angle of water on the polypropylene fibre surface as well as fibre surface free energy components were measured. This showed reduced contact angles, as well as increased acid–base components of the surface free energy because of oxyfluorination. Mechanical properties such as compressive strength, flexural properties and impact resistance of the fibrous concrete, reinforced with different types of oxyfluorinated polypropylene fibres, were determined and compared with those of untreated polypropylene fibre reinforced concrete. The results confirmed that the surface modification largely improves the mechanical performance of the fibrous concretes. Restrained plastic and drying shrinkage cracking tests, using restrained slab specimens and steel ring restrained specimens, indicated that the surface oxyfluorinated fibres possess a higher shrinkage cracking resistance than do unmodified fibres. The effect of surface oxyfluorination on the fibre/concrete matrix interfacial bondings was investigated using a fibre pull-out test. A mechanism for this interfacial bonding improvement is proposed. Oxyfluorinated polypropylene fibre surfaces and their interfaces with concrete matrix, compared with that of unmodified fibre, were observed using scanning electronic microscopy. Some field application tests were conducted and the good results that were achieved are presented.

Polyolefins and fluoropolymers were reacted with elemental fluorine under carefully controlled conditions in a thermobalance adapted to be compatible with fluorine gas. The fluorination reactions were monitored by measuring the mass increase as a result of hydrogen substitution by fluorine. The mass increase was directly proportional to the square root of the fluorination time, which indicates that fluorine gas diffusion to the unreacted surface is the rate determining step. The fluorination rate was increased by increasing the fluorine concentration and the fluorination temperature. The fluorination rate is higher when nitrogen rather than helium is used as diluting gas. The fluorination rate for the reaction in which CO2is used as diluting gas is the same as during fluorination with nitrogen as diluting gas, while the presence of oxygen dramatically decreased the fluorination rate. Oxygen is incorporated during fluorination with oxygen as diluting gas, while no functionalization was observed when CO2was employed as diluting gas. The effect of polymer structure on fluorination was studied. Poly(vinylfluoride) gained mass during fluorination, while no reaction was observed for poly(vinylidenefluoride). The reaction rate for polypropylene was higher than that of polyethylene.

Predictions regarding the in vivobehaviour of 153Sm, 166Ho and 117mSn containing radiopharmaceuticals were made using speciation studies. The speciation of the metal ion and ligand of the radiopharmaceutical in blood plasma was calculated using the ECCLES computer code. Predictions were verified by clinical observations as studied in animals.

We report the demonstration of a polarized superfluorescent fiber source (SFS) that increases the power output in the desired linearly polarized component by a factor of 1.76 over that of a standard, unpolarized SFS that uses the same pump power. This increase in efficiency is accomplished by insertion of a low-loss polarizer at an optimum point in the erbium-doped fiber of a standard SFS.

The effects of Er–Er pairs on the characteristics of Er-doped fiber amplifiers are analyzed theoretically. Pairs are found to have little effect on the amplifier optimum length, signal saturation power, and noise figure (at constant gain) but to cause significant reduction in the gain, even at residual levels, quantitatively consistent with fiber laser measurements. A maximum tolerable fraction of paired ions near 8%, corresponding to approximately 400 mole parts in 10^6 Er_2O_3, is predicted for near-optimum gain efficiency in Al–Ge silica fibers.

We propose to produce a superfluorescent fiber source (SFS) with a linearly polarized output by inserting a discrete polarizer near the middle of a polarization-maintaining Er-doped fiber. We show that with a relatively low-loss polarizer (<0.5 dB) the output power of the polarized SFS is predicted to approach that of a standard, unpolarized SFS, i.e., the power of the desired polarization mode is nearly doubled. The efficiency of this source depends weakly on the polarizer location and extinction ratio, although it depends strongly on its insertion loss.

We report a low-threshold, high-conversion-efficiency erbium-doped fiber laser in a 100-parts-in-10^6 fiber pumped at 1.48 μm. The threshold and efficiency are found to deteriorate noticeably as the erbium concentration is increased. We propose that this is due mostly to rapid cross relaxation between ion pairs or clusters, and through modeling we show that the cluster content increases with concentration.

Abstract: This report documents the use of a Cine CT scanner for documentation of pulmonary artery sling. The examination can be carried out on outpatients and involves only a peripheral venous contrast injection. Excellent visualization of the anatomy is obtained.