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Purpose: Based on the demonstration of a circadian rhythm in the human oral mucosa cell cycle, with most cells in the G2/M phase in the afternoon and at night, the present study evaluated the severity of acute radiation esophagitis and treatment outcomes in esophageal squamous cell carcinoma patients receiving radiotherapy (RT) in the daytime versus in the evening. Methods: From the 488 eligible patients of esophageal squamous cell carcinoma receiving concurrent chemoradiotherapy (CCRT), 369 patients received RT in the daytime (before 19:00) and 119 patients received RT in the evening (after 19:00). The grades of radiation esophagitis (Common Terminology Criteria for Adverse Events version 5.0) and survival outcomes were compared in the two groups. Analyses were performed by using ordinal logistic regression and Cox proportional hazard regression. Results: The median follow-up was 27 months. In multivariate logistic regression models, evening treatment (after 19:00) (odds ratio, 1.660 [95% CI 1.094–2.518]), tumor length ≥ 5 cm (odds ratio, 1.632 [95% CI 1.102–2.416]), PGTV dose ≥ 59.34 Gy (odds ratio, 1.702 [95% CI 1.099–2.635]), female sex (odds ratio, 2.241 [95% CI 1.475–3.405]), and tumor location in cervical segment and upper thoracic (odds ratio, 1.665 [95% CI 1.043–2.658]) were associated with higher odds of radiation esophagitis. There was no difference in the overall survival (OS), locoregional relapse-free survival (LRFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS) (all p > 0.05) between the daytime treatment group and evening treatment group. The results of the subgroup analysis showed that no significant difference was found in radiation esophagitis between the two groups with PGTV dose < 59.34 Gy, while there was a higher odds for the Grade 2 or higher radiation esophagitis in the evening treatment group than the daytime treatment group (odds ratio, 1.675 [95% CI 1.062–2.643]) with PGTV dose ≥ 59.34 Gy. Conclusion: RT in the evening (after 19:00) was associated with higher odds to present esophagitis for esophageal squamous cell carcinoma patients, especially with higher radiation doses, but treatment outcomes did not differ according to the time of RT. [ABSTRACT FROM AUTHOR]

Background: Postoperative transfer metatarsalgia is a common complication after hallux valgus surgeries. Shortening of the first metatarsal is traditionally thought to be the primary cause of it. However, we speculate the abnormal loading pattern during gait is the real reason. This study is to determine specific differences in the loading patterns between reconstructive hallux valgus (HV) feet with and without postoperative transfer metatarsalgia, so as to find risky loading characteristics of this complication. Methods: Thirty feet with postoperative transfer metatarsalgia were recruited as pain group, while another 30 postoperative feet without pain as controls. All participants were asked to walk barefoot at self-selected speed through a plantar force measuring plate (Rs-Scan Inc.) for three times. Certain plantar load variables were recorded or calculated, and their differences between two groups were compared. Results: For pain group, the maximum plantar force and force time integral of the first metatarsal decrease significantly; the force time integral of the central rays (second plus third metatarsal) does not significantly differ with that in the controls, but their cumulative load percentage to the whole foot is higher. In pain group, the time point when central rays reached their peak force during the push-off is significantly later than that in controls. And the regional instant load percentage at this moment presented significantly higher for central rays, while significantly lower for the first metatarsal and the hallux compared to the controls. Conclusions: For hallux valgus feet with postoperative metatarsalgia, the load function of the first metatarsal is obviously impaired. But for central rays, indicative difference is not reflected in either peak or cumulative load during the gait cycle, but in the instant load distribution when central rays reach their peak load. So we can conclude that whether the remaining regions can adequately share certain load during walking, especially around the time metatarsalgia often occurs, plays an unnegligible role. So surgeons should pay more attention to reconstruct a foot where load can be evenly distributed. [ABSTRACT FROM AUTHOR]

Introduction: The motion of the distal syndesmosis correlates highly with the instability, while an accurate kinematic description of the distal tibiofibular joint during normal gait has not previously been presented. Material and methods: Sixteen healthy syndesmoses of sixteen living subjects (8 male and 8 female) were studied during stance phase of the normal gait. Data of CT scanning were collected first and used to create the 3D models of the distal tibia and fibula. The lateral X-ray images of the syndesmosis were captured by fluoroscopy when the subject was walking. Seven key-pose images were selected for subsequent 3D to 2D bone model registration and six degrees-of-freedom (DOF) motions of syndesmosis were then calculated. A validation experiment was also conducted to confirm the accuracy of the 3D/2D technique for the syndesmosis. Results: During the stance phase, the distal tibiofibular joint exhibited with 2.98 ± 1.10° of dorsi/plantarflexion, 5.94 ± 1.52° of inversion/eversion, and 5.99 ± 2.00° of internal/external rotation; 2.63 ± 1.05 mm on medial/lateral, 3.86 ± 1.65 mm on anterior/posterior, and 4.12 ± 1.53 mm on superior/inferior translation. From heel strike to mid-stance, the syndesmosis demonstrated 1.69° of dorsiflexion, 3.61° of eversion, and 3.95° of external rotation. Likewise, from mid-stance to heel-off, the syndesmosis presented 1.04° of plantarflexion, 4.95° of inversion, and 5.13° of internal rotation. Conclusion: During the stance phase of normal gait, internal/external rotation and vertical motion play dominant roles in terms of rotation and translation, respectively. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus (HV) deformity is closely correlated to the hypermobility of the first metatarsal-cuneiform joint, but adequate understanding of the three-dimentional (3D) mobility of this joint in normal or HV feet is lacking. This study was conducted to investigate the mobility of the first metatarsal-cuneiform joint in multiple planes during body weight-bearing conditions for both normal and HV patients. Methods: A total of 10 female volunteers (20 feet) and 10 female HV patients (20 feet) participated in this study. Using a custom-made foot-loading device, computerized tomography (CT) scans of each pair of feet were taken under both unloaded and body weight-bearing conditions. 3D models were reconstructed for the first metatarsal and the medial cuneiform. Rotational and translational motions of the first metatarsal-cuneiform joint in multiple planes from unloaded to loaded conditions were quantitatively evaluated by reverseengineering software. Results: During body weight-bearing conditions, the first metatarsal-cuneiform joint in HV feet dorsiflexed at an average of 2.91° (standard deviation, SD 1.71) versus 1.18° (SD 0.47) in controls (t = 4.158, P = 0.001); supinated 2.17° (SD 2.28) versus 0.98° (SD 0.81) in controls (t = 2.080, P = 0.045); and internally rotated 2.65° (SD 2.22) versus 0.96° (SD 0.57) in controls (t = 3.114, P = 0.006). Moreover, the joint in HV feet widened significantly compared with the controls (t = 2.256, P = 0.030) and tended to translate more in the dorsal-plantar direction (t = 1.928, P = 0.063); the translation in the medial-lateral direction was not significantly different between the two groups. Conclusions: During weight-loading process, the first metatarsal-cuneiform joint turns dorsiflexed, supinated, and internally rotated. For HV feet, hypermobility of the first metatarsal-cuneiform joint can be observed in multiple planes. This study promotes further understanding of the physiological and pathological mobility of the first metatarsal-cuneiform joint. [ABSTRACT FROM AUTHOR]

Background: Studies have yet to determine the optimal height at which the posterior tibial tendon (PTT) can be re-routed and the tendon length discrepancy at different height levels in terms of PTT transfer via the circumtibial route. This cadaveric study was conducted to determine the optimal height of PTT subcutaneous transfer and to compare tendon length discrepancies at different heights. Materials and methods: Twenty-five fresh normal cadaveric lower legs were used for measurements. PTT was exposed and then isolated. An incision along the calf was made to re-route PTT outside the fascia. The upper edge of the incision was classified as point “a.” The distal tip of the tendon was classified as point “b.” The midpoints of the intermediate cuneiform, the lateral cuneiform, and the cuboid were defined as points “c,” “d,” and “e,” respectively. The lengths of “ab,” “ac,” “ad,” and “ae” were measured and compared at different height levels above the distal tip of the medial malleolus. Angles α, β, and γ between the tendon outside the fascia connecting to different bones and the tendon inside the fascia were also measured as tendons were transferred at different bones and different height levels. Experimental data were collected and analyzed. Results: At a height of ≥5 cm, all of the PTTs could reach the midpoints of the three bones. The lengths of ac, ad, and ae were significantly less than the length of ab (p < 0.05). At a height of 10 cm, angles α, β, and γ were 177° ± 2.1°, 170° ± 3.1°, and 164° ± 3.7°, respectively. These angles were not significantly different from those at a height of 11 cm (p >0.05). Conclusions: PTT transfer via the subcutaneous route could achieve an adequate length to be transferred to the intermediate cuneiform, the lateral cuneiform, and the cuboid from a height of 5 cm above the distal tip of the medial malleolus. A height of 10 cm could be optimal for PTT transfer in the three bones via the subcutaneous route. [ABSTRACT FROM AUTHOR]