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Background: First tarsometatarsal joint (TMT-1) hypermobility might cause hallux valgus deformity (HV), and recurrence following surgical correction. Anatomic findings, indicating tibialis anterior tendon (TAT) involvement in TMT‑1 stabilization, led to the development of cross-glide test allowing clinical TMT‑1 stability testing. Cross-glide test function was evaluated in anatomical specimens and in the clinical setting, compared to simulated weight-bearing computer tomography (CT) analysis., Methods: Cross-glide test was evaluated in 6 healthy lower leg specimens before and after TAT transection. Clinical testing was performed prospectively in 36 feet (6 controls, 21 HV, 9 recurrent HV); consecutive weight-bearing CT analysis was performed. Results from clinical testing were compared to CT analysis., Results: TMT‑1 instability significantly increased in anatomic specimens following TAT transection (p = 0.009). In the clinical setting, all healthy feet were cross-glide test negative, 62% of HV cases and all recurrent HV feet were positive. In the CT analysis- Compared to controls the HV cases revealed significantly increased MT‑1 internal rotation (p = 0.003) and decreased dorsal angle (p = 0.002), considered as collapsing forefoot signs; HV recurrent cases revealed similar results. Positive cross-glide tested cases revealed increased MT‑1 internal rotation values (p < 0.001) and dorsal angle values (p < 0.001) in CT analysis. Strikingly, cross-glide test positive HV cases revealed significantly increased internal TMT‑1 rotation (p = 0.043) in CT analysis, and HV and IMT (intermetatarsal) angle were significantly higher (p = 0.005, p = 0.006). 15 HV recurrence cases, treated with TMT‑1 arthrodesis, revealed no recurrence during follow-up., Conclusion: Cross-glide test allows reliable clinical TMT‑1 instability testing, via TAT tension, and is less laborious than CT analysis. We recommend TMT‑1 arthrodesis in cases with instability in clinical testing, to avoid HV recurrence.

Background: This study aimed to quantify the benefit of adjuvant radiotherapy (AXRT) for local control, distant metastasis, and long-term survival outcomes in patients with localized soft tissue sarcoma (STS)., Methods: This single-center retrospective observational study enrolled 433 STS patients who underwent surgery with curative intent. An inverse probability of treatment-weighted (IPTW) analysis was implemented to account rigorously for imbalances in prognostic variables between the adjuvant treatment groups., Results: During a median follow-up period of 5.5 years, the study observed 38 local recurrences (9%), 73 occurrences of distant metastasis (17%), 63 STS-related deaths (15%), and 57 deaths from other causes (13%). As expected, patients receiving AXRT (n = 258, 60%) were more likely to have high-grade G3 tumors (p < 0.0001) than patients not receiving AXRT. A crude analysis showed that AXRT was not associated with improved recurrence-free survival [hazard ratio (HR) 1.00; 95% confidence interval (CI) 0.72-1.38; p = 0.98]. However, after IPTW, AXRT was associated with a 38% relative reduction in the risk of recurrence or death (HR 0.62; 95% CI 0.39-1.00; p = 0.05). This benefit was driven by a strong reduction in the risk of local recurrence (HR 0.42; 95% CI 0.19-0.91; p = 0.03), whereas the relative risk of distant metastasis (HR 0.69; 95% CI 0.39-1.25; p = 0.22) and overall survival (HR 0.76; 95% CI 0.44-1.30; p = 0.32) were only nonsignificantly in favor of AXRT. An exploratory analysis showed an overall survival benefit of AXRT for patients with high-grade G3 tumors (HR 0.51; 95% CI 0.33-0.78; p = 0.002). However, this finding may have been attributable to residual confounding., Conclusion: In this observational cohort, AXRT was associated with a 58% reduction in the relative risk of local recurrence. No consistent association between AXRT and lower risks of distant metastasis or death was observed.

In January 1994 mass antibiotic prophylaxis was undertaken in the contiguous villages of Deir el-Asad and B'ine in northern Israel (combined population of 11600) in response to a prolonged outbreak of serogroup B meningococcal infection with an overall annual rate of 37.4 cases of infection per 100000 residents. The average case fatality rate in the villages was 23% compared with 11% in Israel during the same period. Neisseria meningitidis group B was identified in 9 of 13 (69%) cases. Seven of these were subtype P1.7,16. The persistence of the outbreak with its accompanying public reaction prompted the establishment of an intervention programme that included antibiotic prophylaxis for the whole community with monitoring for pharyngeal carriage of meningococci in a stratified sample of the population. The objectives were to achieve a reduction of carriage of the outbreak strain and to reduce morbidity and mortality. A total of 1036 pharyngeal swabs were taken 1 day before and 6 weeks after treatment. Antibiotic prophylaxis was administered in one dose: children under 5-years-old received ceftriaxone i.m.; all others received oral ciprofloxacin. Overall, 96% of the population received treatment. The carriage rate was 8.3% prior to treatment (three serogroup B:14:P1.7,16), and 1.3% afterwards (one serogroup B:14:P1.7,16). The intervention failed to eradicate carriage of the putative outbreak strain, or to reduce the incidence and fatality rates in the villages. The outbreak finally terminated in late 1996. Public health professionals should bear this experience in mind when faced with prolonged, localized, nonexplosive outbreaks of meningococcal disease associated with low carriage rates of the outbreak strain.

The response of single chemoafferent fibres to hypoxic and hypercapnic stimulation was studied in vitro under different experimental conditions: 1. control, 2. 24 h after reserpinization (5 mg/kg iv) and 3. 18 h after iv injection of alpha-methyl-p-tyrosine (100 mg/kg in the rabbit, and 1. control and 2. 24 h after reserpinization (5 mg/kg ip) in the cat. The spontaneous activity was decreased by monoamine depletion. The amplitude of the response to hypoxia and to hypercapnia was decreased by reserpinization in the rabbit and in the cat, the change being less marked in the latter species. Similarly, treatment with alpha-methyl-p-tyrosine decreased the ability of chemoreceptors to respond to hypoxia and hypercapnia and, in a few instances, these receptors could only be excited by superfusion of nitrogen-equilibrated medium. These results emphasize to possible role of monoamine, and particularly dopamine, in modifying the sensitivity of arterial chemoreceptors to their natural stimuli.

In the rabbit carotid body (CB) in vivo, the rate of dopamine metabolism was estimated to 44.4 +/- 3.9 (SD) pmol/CB/h from the decrease in dihydroxyphenylacetic acid content after pargyline inhibition of monoamine oxidase.

In rabbit carotid bodies (CBs) superfused during 1-5 h, with an air-equilibrated medium containing no tyrosine (TYR), the dopamine (DA) content decreased by approximately 60% after 1 h and remained constant afterwards. TYR and 3,4-dihydroxyphenylacetic acid (DOPAC) decreased with the same time course. Noradrenaline (NA) content exhibited a biphasic decrease of lesser magnitude than that of DA. Superfusions with a TYR-containing medium did not prevent the reduction in DA and TYR. Large amounts of DA and DOPAC were recovered in the effluent during the first hour of superfusion but after 90 min the two substances had declined below the detection limits (i.e. 0.5 and 1 pmol/5 min, respectively). The DA efflux decreased exponentially during the first hour and was not altered by changing the oxygen partial pressure (PO2) of the medium. The DOPAC efflux declined after 40 min of superfusion and was modulated by PO2. The DA and the DOPAC effluxes were not suppressed by omitting calcium ions from the superfusing medium. In 4 cat CBs equal amounts of DA and NA were recovered from the effluent during the first hour of superfusion.

Monoamines and their metabolites have been measured by high performance liquid chromatography with electrochemical detection, in control rabbit carotid bodies and under several experimental conditions: 1) at different times (3 h, 6 h, 24 h, 48 h) after intravenous injection of reserpine (5 mg/kg); 2) 14 days after sympathectomy; 3) 14 days after section of the carotid sinus nerve. The results were analyzed with probability plotting methods. Dopamine was the most important monoamine in the carotid body (CB) and its variations were very large. It was almost entirely depleted by reserpinization without simultaneous increase in 3,4-dihydroxyphenylacetic acid. Sympathectomy increased dopamine content but did not change noradrenaline content. However data analysis suggested that noradrenaline might be compartmented in two pools: one with a large variance, located in the type I cells was increased after sympathectomy, the other, more constant, located in the sympathetic nerve endings was entirely depleted after sympathectomy. Section of the carotid sinus nerve increased dopamine and noradrenaline and quadrupled the serotonin content of the CB. It is proposed that carotid sinus and sympathetic innervations regulate the monoamine metabolism of the CB.