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Chagas disease (CD) is a parasitic infection endemic in Latin America and also affects patients in Western countries due to migration flows. This has a significant impact on health services worldwide due to its high morbidity and mortality burden. This paper aims to share our experience at the National Institute for Infectious Diseases “Lazzaro Spallanzani”, IRCCS, in Rome, Italy, where to date, a total of 47 patients—mainly Bolivian women—diagnosed with CD have received treatment with benznidazole, with all but one presenting with chronic disease. Most of the patients were recruited through the first extensive screening program held in 2014 at our Institute. About a quarter of our patients showed adverse effects to benznidazole, including a case of severe drug-induced liver injury, but 83% completed a full course of treatment. In addition to the description of our cohort, the paper reports a brief overview of the disease compiled through a review of the existing literature on CD in non-endemic countries. The growing prevalence of CD in Western countries highlights the importance of screening at-risk populations and urges public concern and medical awareness about this neglected tropical disease. There are still many unanswered questions that need to be addressed to develop a personalized approach in treating patients.

Category: Ankle; Midfoot/Forefoot Introduction/Purpose: Minimally invasive surgical (MIS) techniques have been implemented in various foot and ankle procedures, including joint arthrodesis. While these techniques can be effective in reducing complications and improving outcomes, there remains variability with surgeon learning curves, the type of instruments used, and approach to intraoperative imaging. This study seeks to aid surgeons through more reproducible guidelines by measuring the time needed for joint preparation with an MIS specific burr. Methods: A total of 8 cadaveric limbs (4 left and 4 right feet) were used for the preparation of the 1st metatarsophalangeal (MTP), 1st tarsometatarsal (TMT), talonavicular (TN), subtalar and ankle joints. The active burr use time to debride all cartilage from each joint was recorded. Each joint was prepared with an open approach to precisely determine the amount of time needed for cartilage removal. Descriptive statistics and a Kruskal-Wallis with post-hoc comparisons were used to analyze the data. Results: The 1st MTP was prepared with a mean (SD) time of 54.49 (34.65) seconds; the 1st TMT 51.82 (19.69) seconds; the TN joint 87.89 (43.77) seconds; the subtalar joint 59.46 (37.84) seconds; and the ankle joint 95.59 (54.99) seconds. Only the ankle joint preparation times compared with 1st MTP, 1st TMT and subtalar joints were significantly longer. Conclusion: This study provides burr time metrics for joint debridement in MIS foot and ankle arthrodesis procedures. Although there remains variability in types of burrs used, joint sizes and individual experience with the instruments, the timing of joint preparation can be an objective reference for surgeons to effectively and safely perform minimally invasive techniques. Figure 1. Comparison of joint preparation time across different joints The error bars depict one standard deviation of uncertainty. Asterisk (*) lines indicate a statistically significant difference (P < 0.05) based on unadjusted P values from the Dunn post hoc group comparisons. *Abbreviations: metatarsophalangeal (MTP), tarsometatarsal (TMT), talonavicular (TN).

Category: Hindfoot; Ankle Introduction/Purpose: Minimally Invasive Zadek osteotomy (MIS ZO) has been demonstrated to be a safe and effective surgical intervention for patients with Insertional Achilles Tendinopathy (IAT) and Haglund’s deformity. However, there is limited literature to guide surgeons one which patients may be the best candidates for MIS ZO. Severity of IAT on preoperative MRI may correlate with post operative functional outcomes and help guide patient selection for treatment with MIS ZO. The current study evaluated the postoperative outcomes of MIS ZO in patients with various grades of Achilles tendinopathy on preoperative MRI, to determine if severity of disease on preoperative MRI could be predictive of improved functional outcomes after MIS ZO. Methods: Patients who underwent MIS ZO for IAT and Haglund’s deformity were identified and retrospectively analyzed at a mean of 15.59 months follow-up. Achilles pathology was graded as previously described by Nicholson et al. on preoperative MRI. Grade 1 describes anteroposterior diameter of 6-8 mm and nonuniform degeneration; grade 2 describes diameter >8 mm and < 50% uniform tendon degeneration; grade 3 describes tendon diameter >8 mm and uniform degeneration of >50% tendon width. Fourteen patients met our inclusion criteria. Four patients exhibited grade 1 pathology preoperatively, 3 patients exhibited grade 2 pathology preoperatively, and 7 patients exhibited grade 3 pathology preoperatively. Preoperative and postoperative Patient Reported Outcome Measurement Information System (PROMIS) scores, complications, and revisions were recorded for each patient. PROMIS scores were compared using a paired t-test. All other continuous data was compared by Analysis of Variance (ANOVA); all categorical data was compared using Chi-squared analysis. P< 0.05 were considered significant. Results: PROMIS pain score improved postoperatively in patients with grade 1 66.75±5.50 to 59.00±7.75, p=0.036) and grade 3 (69.86±6.17 to 55.71±10.44, p=0.011) Achilles tendinopathy on preoperative MRI. Meanwhile, in patients with grade 2 pathology, PROMIS physical function (38.33±8.50 to 43.67±9.07, p=0.02) improved postoperatively. In the grade three group, 1/7 (14.29%) patients experienced transient neuritis that resolved at 3 months without further treatment and 1/7 (14.29%) patients required revision surgery to an open midline splitting Haglund’s resection. Meanwhile no patients in either the grade one or grade two groups required reoperation, rehospitalization, or complications. 13/14 (93%) patients were very satisfied with their procedure and wound undergo it again. Conclusion: These early data suggest that patients with IAT, regardless of severity, improve after MIS ZO. Therefore, ZO may be a reasonable first line option for all patients presenting with IAT. In our small retrospective study, we were able to demonstrate significant improvement in pain and/or function following ZO in all grades of IAT tendinous pathology on preoperative MRI. This study may help guide surgeons when deciding between MIS ZO and other surgical options for IAT and Haglund’s deformity. Further, large prospective studies are warranted to further investigate outcomes and indications of MIS ZO in patients with IAT and Haglund’s deformity

Category: Hindfoot; Ankle Introduction/Purpose: The Zadek osteotomy (ZO) has been demonstrated to be an effective treatment for patients with Haglund deformity and Insertional Achilles Tendinopathy (IAT). Radiographic measurements are one method of diagnostic criteria that have been utilized to define a more specific patient cohort that is a superior candidate for Zadek intervention. Tourné et al. most recently proposed an X/Y < 2.5 to define candidates that will benefit from the Zadek. However, many clinicians do not consider radiographic measurements to define efficacy of ZO. Additionally, current literature is lacking a direct comparison of ZO efficacy in patients with preoperative X/Y ratios above and below Tourné’s criteria. The current study tested the hypothesis: patients with IAT, regardless of X/Y ratio, would improve in pain and physical function after ZO. Methods: This was a retrospective, multi-center study. Patients underwent ZO at two different institutions, by three different fellowship trained orthopedic foot and ankle surgeons. 48 cases in 46 patients treated with Zadek osteotomy were included in our retrospective analysis. There were 34 cases with preoperative X/Y < 2.5 and 14 cases with preoperative radiographs measuring an X/Y > 2.5. All patients had a minimum of one-year follow-up (mean 23.24±4.82). Pain, function, and mobility PROMIS scores, VAS scores, complications, X/Y ratio measurements, and calcaneal pitch angle measurement were collected preoperatively and at final follow-up appointment. Cases were placed in cohorts based on preoperative X/Y above or below 2.5). T-tests were used to determine statistical differences following ZO. Similarly, chi-squared analysis was used to compare differences in categorical data between our groups. Results: A summary of preoperative and postoperative PROMIS scores, VAS scores, calcaneal pitch measurements, and X/Y ratios can be found in Table 1. Patients with X/Y < 2.5 demonstrated significant improvement in PROMIS pain, function, mobility scores, VAS score, calcaneal pitch angle, and X/Y ratio following ZO intervention (p< 0.05). In comparison, following ZO, patients with X/Y > 2.5 demonstrated significant improvement in PROMIS pain, VAS, and X/Y ratio (p< 0.05). However, in patients with X/Y > 2.5, preoperative VAS scores were higher (p=0.014) and improved to a significantly larger degree (p=0.006). There was one case of minor neuropathy (X/Y > 2.5); there was one patient that required revision to open debridement and repair (X/Y < 2.5). We observed a 98% rate of satisfaction overall following ZO intervention. Conclusion: Zadek osteotomy demonstrated improvement in patients’ pain and excellent patient satisfaction, regardless of their preoperative X/Y ratio on radiograph. However, patients with X/Y ratio < 2.5 did demonstrate significant improvement in patient reported function and mobility scores. Overall, a 98% satisfaction was observed following ZO in all patients. Preoperative X/Y ratio did not seem to determine success of ZO in the treatment of IAT, however, further clinical correlation is needed. to better understand differences if PROMIS physical function and mobility in terms of long-term success of the ZO.

Category: Other; Midfoot/Forefoot Introduction/Purpose: The advent of minimally invasive percutaneous foot and ankle surgery techniques has helped lower certain complication rates, including wound infection and nonunion. The percutaneous burr is the working horse to perform these procedures. One concern with using the burr is that heat generated from prolonged use may induce bone thermal necrosis, affecting healing and outcomes. It is in contention whether further chilling the irrigation fluid may affect postoperative complication rates. Thus, the objective of this study is to assess the impact of chilled vs non-chilled saline during burr use on percutaneous foot surgery. Methods: Data was prospectively collected for 384 consecutive patients undergoing percutaneous foot and ankle surgeries at two separate facilities, treated with either non-chilled saline or chilled saline. Age, sex, complication rates, union rates and time to union data were collected. Categorical and numerical statistical analysis was performed. Results: 384 patients (chilled = 191, non-chilled = 193) were included. The mean age (SD) for all patients was 50.82 (14.28). Time to union took an average (SD) of 9.87 (3.59) weeks for the chilled saline group and 9.27 (2.91) weeks for the non-chilled saline group (P = .07). Union rates were 100% in the chilled saline group and 99.5% in the non-chilled saline group (P = .50). Complication rates were 1.6% in both the chilled and non-chilled saline groups (P = .65). The complications seen in the chilled saline group included one superficial wound dehiscence, and two delayed unions. The non-chilled saline group saw one non-union, one case of sural neuritis and one case of painful hardware removal. Conclusion: Based on the available data, no significant difference could be detected between chilled saline and non-chilled saline groups during burr use for percutaneous foot surgery when comparing union times, union rates and complication rates.

Category: Ankle; Hindfoot Introduction/Purpose: Surgical options for Insertional Achilles Tendinopathy (IAT) and Haglund‘s deformity include the open midline Achilles tendon splitting approach with Haglund’s resection and Achilles debridement and repair. However, many have cited high rates of complications with this approach such as wound dehiscence, infections, and persistent postoperative pain. Alternative surgical management of IAT and Haglund’s deformity includes the Zadek osteotomy (ZO). ZO can be accomplished percutaneously, reducing potential wound complications, pain, and infections. The current study compared outcomes and complications of the open midline Achilles tendon splitting approach with the percutaneous ZO in patients with IAT and Haglund’s deformity. We hypothesized that the percutaneous ZO would allow for improvement in patient reported outcomes, yet less complications in comparison to the traditional, open midline Achilles tendon splitting approach. Methods: Patients who received an open midline Achilles tendon splitting procedure or percutaneous ZO for IAT and Haglund’s deformity were identified and retrospectively analyzed at a minimum of one-year follow-up. 21 patients treated with percutaneous ZO and 45 patients treated with open midline Achilles tendon splitting procedure for IAT and Haglund’s deformity met our inclusion criteria. Patients had average follow up of 23.65±6.87 months. Preoperative Patient Reported Outcome Measurement Information System (PROMIS) scores, postoperative PROMIS scores, complications, and revisions were recorded for each patient. Preoperative and postoperative PROMIS scores were compared using a paired t-test. All other continuous data was compared by t-test; all categorical data was compared using Chi-squared analysis. All p< 0.05 were considered significant. Results: In patients who underwent percutaneous ZO or an open midline Achilles tendon splitting Haglund’s resection, PROMIS function (p< 0.01), pain (p< 0.01), and mobility (p< 0.01) scores improved at 12-month minimum follow-up. In the ZO group, 1/21 (4.6%) patients experienced nerve injury and 1/21 (4.6%) patients required revision surgery to an open midline splitting Haglund’s resection. Meanwhile, 3/45 (6.67%) patients who underwent an open midline Achilles tendon splitting procedure experienced significant postoperative pain, 3/45 (6.67%) wound dehiscence, 3/45 (6.67%) wound infection, and 1/45 (2.22%) nerve injury. 4/45 (8.89%) patients who underwent the open midline Achilles tendon splitting approach required revision. Additionally, 1/45 required hardware removal and 1/45 required incision and debridement. All cause complication were found to be higher in the open midline Achilles tendon splitting approach (p=0.02). Conclusion: There are several surgical treatment options for IAT and Haglund‘s deformity, yet IAT remains a challenging lower extremity disorder to treat. In the current study, both the open, midline Achilles tendon splitting Haglund’s resection and percutaneous ZO led to significant improvement in patient reported outcomes. However, our study demonstrated a significant lower complication and revision in the ZO group. Data presented in this study may guide surgeons’ decision making when choosing suitable treatment options for patients with IAT and Haglund deformity.

Category: Ankle; Trauma Introduction/Purpose: Syndesmotic injuries are commonly treated with syndesmotic screws, with subsequent screw removal routinely scheduled during the postoperative period. Recent studies have raised doubts about the necessity of routine removal, highlighting the lack of change in functional outcomes and the risks posed by a second surgery. Previous systematic reviews on this topic have not limited their inclusion criteria to Randomized Controlled Trials (RCTs), consequently lowering their level of evidence (LOE). Our study aimed to compare the functional outcomes and complication rates in patients undergoing routine syndesmotic screw removal versus those managed with an on-demand approach while providing a higher LOE than previous studies. Methods: In accordance with the guidelines on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) we conducted a systematic search of seven databases (MEDLINE, Embase, Cochrane CENTRAL, CINAHL, Web of Science, PubMed, and ClinicalTrials.gov) for comparative studies on routine syndesmotic screw removal versus an on-demand approach to removal following acute ankle fractures or isolated syndesmotic injuries. Only prospective RCTs were considered for inclusion. Data reported by at least 2 studies were pooled for meta-analysis using Review Manager Software (RevMan 5.4.1). Mean differences were calculated for continuous outcomes while risk ratios were calculated for dichotomous outcomes; all measures were calculated with their respective 95% confidence intervals (CIs). Two-tailed tests of significance were performed with a value of 0.05. Heterogeneity was calculated using I2 index, Random-effect models were used for groups with high heterogeneity (I2 > 51%) while common-effect models were used for groups with low heterogeneity (I2 < 50%). Results: Of 630 potential articles, only 3 studies were ultimately chosen for inclusion. Pooled data analysis showed no significant difference in Olerud-Molander ankle scores (mean difference [MD] -2.36, 95% confidence interval [CI] -6.50 to 1.78, p = 0.26), American Orthopedic Foot and Ankle Hindfoot Score (MD -0.45, 95% CI -1.59 to .69, p = 0.44), or dorsiflexion (mean difference 2.20, 95% CI -0.50 to 4.89, p = 0.11) between the routine removal and on-demand removal groups at the one-year mark postoperatively. However, routine removal was associated with a significantly higher rate of overall complications compared to on-demand removal (risk ratio 3.02, 95% CI 1.64 to 5.54, p = 0.0004). Respectively, none of the included studies reported a significant difference in pain scores or range of motion. Conclusion: Our results did not show any significant difference in functional outcome scores between routine removal and on-demand removal of syndesmotic screws at 1-year postoperatively, suggesting that neither removal strategy significantly impacts functional recovery. However, the significantly higher incidence of complications in the routine removal group, raises important considerations regarding the potential disadvantages of this approach. Consequently, given the elevated risk of complications associated with routine removal and the lack of superior functional outcomes, we recommend adopting an as-needed approach to syndesmotic screw removal.

One of the genetic mutations most associated with the onset of amyotrophic lateral sclerosis, both in sporadic and familial cases, is the expansion of the C9orf72 gene. The presence of more than 30 repeats (GGGGCC) correlates with uncertain ALS symptomatology. Here we collected a dermal biopsy from a subject carrying 36 hexanucleotide repeats and reprogrammed it into an induced pluripotent stem cell line. Despite the number of repeat elements, the subject had no symptoms at the age of the biopsy (76 years), thus resulting in a healthy carrier of the mutation.

Smith-Magenis syndrome (SMS) is a complex neurodevelopmental disorder with a birth incidence of 1:25,000. SMS is caused by haploinsufficiency of the retinoic acid-induced retinoic acid1 (RAI1) gene, determined by an interstitial deletion of ∼ 3.7 Mb (17p11.2, including the RAI1 gene) in 90 % of cases and a mutation on the RAI1 gene in only 10 % of cases. We generated and characterized a human pluripotent stem cell line (hIPSCs) derived from primary fibroblasts of a 17-year-old woman carrying a 17p11.2 deletion including the RAI1 gene.

Introdução: O Tromboembolismo Venoso (TEV) é altamente prevalente, sendo a terceira maior causa de mortalidade por doenças cardiovasculares. Dados epidemiológicos sobre o TEV são escassos em nosso país. Complicações como a Síndrome Pós-Trombótica (SPT) e a recorrência comprometem a qualidade de vida dos pacientes e têm um impacto socioeconômico significativo. Objetivo: Realizar um registro observacional, multicêntrico e prospectivo de pacientes com Trombose Venosa Profunda (TVP) atendidos em 8 hospitais públicos de São Paulo. Materiais e métodos: Critérios de Inclusão:pacientes de ambos os sexos, idade > 18 anos, com TVP nos membros inferiores ou superiores, com ou sem Embolia Pulmonar (EP). Os pacientes serão acompanhados por dois anos, em relação à evolução clínica e tratamento, totalizando 6 visitas on-line, 4 no primeiro ano e 2 no segundo, avaliando como desfechos a SPT por auto avaliação, recorrência. Os dados gerados serão analisados por método de inteligência artificial. Resultados: No período de 15/04 a 31/07 de 2024, foram recrutados 67 pacientes com TVP dos membros inferiores sem EP, dos quais 49 foram incluídos no estudo e 75% dos pacientes, foram avaliados a qualidade de vida. A amostra foi composta por 43,8% de mulheres (21 casos), com mediana de idade de 57 anos (21 a 86 anos). 81,3% eram brancos (39 casos), 8,3% pardos e 8,3% pretos. 35,4% apresentavam sobrepeso, enquanto 33,3% tinham obesidade Grau I e II. Em 41,7% dos casos, o diagnóstico ocorreu uma semana após o aparecimento dos sintomas iniciais, sendo os mais comuns a dor (81,4%), edema (86,0%) e vermelhidão (44,4%). A trombose foi distal e proximal em 34% dos casos, e apenas proximal e no MIE em 24%. Os vasos mais acometidos foram: veia femoral comum (42,6%), veia femoral superficial (29,8%) e veia poplítea (46,8%). Dentre os fatores de risco, os mais prevalentes foram hospitalização > 3 dias (53,1%), e cirurgia (20,4%). Dentro do prazo definido para acompanhamento, dos 49 pacientes, 3 foram reavaliados em 3 meses, e apenas 1 caso continua em uso de anticoagulante. Não houve recorrência. Não há dados de SPT disponíveis, pois essa avaliação será realizada apenas 6 meses após a trombose. Discussão e conclusão: Apesar de preliminares, a grande relevância é a apresentação desse registro, que fornecerá dados nacionais, de vida real em pacientes atendidos pelo SUS em 8 centros do estado de São Paulo. Isso pode contribuir para melhoria do diagnóstico e tratamento da doença em nosso país, além de implementação de políticas públicas.

Currently, the genus Zenopsis, also known as silver John Dory, comprises at least five valid species with a wide range of distribution. However, recent studies have proposed the existence of a new Zenopsis species inhabiting the Indian Ocean, and a preliminary search in the Barcode of Life Database reveals the presence of different barcode index numbers (BIN) for the nominal species Zenopsis conchifer. In the Southwest Atlantic Ocean (SWA), Z. conchifer is the only species reported so far. Therefore, the aim of this work was to evaluate, at the molecular level, the potential taxonomic diversity within the genus Zenopsis and to assess if the species occurring in the SWA corresponds with Z. conchifer. Using data available in worldwide genetic databases, a maximum likelihood tree, a BIN, and an automatic barcode gap discovery analysis were carried out. Additionally, specimens sampled from the SWA were morphologically compared with specimens from different parts of its distribution using available data. The specific identity at the molecular level of specimens occurring in the SWA was confirmed as Z. conchifer. The results of the molecular analysis highlight the existence of hidden specific diversity within the genus.

Wildfires have become increasingly prevalent in the western United States, posing threats to human communities and the built environment. This study builds upon previous research by investigating the factors influencing wildfire hot spot distribution in Washington State. Using spatial regression models (generalized linear regression and geographically weighted regression), we examine the relationships between wildfire hot spots and various geographic features, including climate variables, human-caused ignitions, land use, population density, road density, and the wildland-urban interface. Our results indicate that lightning-caused fires and road density are significant factors contributing to hot spot intensity in central Washington, while human-caused ignitions play a crucial role in eastern Washington. Surprisingly, precipitation shows varied correlations with hot spots, with some areas experiencing an unexpected positive relationship between precipitation and hot spot intensity due to increased fuel growth. The study highlights the importance of localized approaches to wildfire mitigation, emphasizing the need for tailored risk reduction strategies based on regional factors.

Ribosomopathies encompass a spectrum of disorders arising from impaired ribosome biogenesis and reduced functionality. Mutation or dysexpression of the genes that disturb any finely regulated steps of ribosome biogenesis can result in different types of ribosomopathies in clinic, collectively known as ribosomopathy genes. Emerging data suggest that ribosomopathy patients exhibit a significantly heightened susceptibility to cancer. Abnormal ribosome biogenesis and dysregulation of some ribosomopathy genes have also been found to be intimately associated with cancer development. The correlation between ribosome biogenesis or ribosomopathy and the development of malignancies has been well established. This work aims to review the recent advances in the research of ribosomopathy genes among human cancers and meanwhile, to excavate the potential role of these genes, which have not or rarely been reported in cancer, in the disease development across cancers. We plan to establish a theoretical framework between the ribosomopathy gene and cancer development, to further facilitate the potential of these genes as diagnostic biomarker as well as pharmaceutical targets for cancer treatment.

Background/Objectives: Surgical management of chronic lateral ankle instability has traditionally been performed using an open technique. Arthroscopic-assisted and all-arthroscopic techniques have gained popularity as they have achieved strong clinical outcomes. However, they rely on the surgeon’s arthroscopic skills and familiarity with arthroscopic anatomy. Recently, a minimally invasive percutaneous technique without arthroscopic assistance has been developed that incorporates the benefits of arthroscopy, such as minimal soft tissue disruption, without the additional requirements of performing an arthroscopic technique. The aim of the current study is to describe the minimally invasive percutaneous technique for chronic lateral ankle instability and report on its clinical outcomes. Methods: Fifty-four consecutive patients without intra-articular ankle pathology underwent lateral ligament repair for chronic ankle instability with a percutaneous technique at a single institution by a fellowship-trained foot and ankle surgeon. Foot Function Index (FFI) score was recorded pre-operatively and post-operatively at final follow-up. All patients had a minimum follow-up of 12 months. Post-operative complications and patient satisfaction were also recorded. Results: A significant improvement (p < 0.001) in FFI compared to pre-operative values (from 55, SD 4.1, to 10, SD 1.9) was observed. A single patient required a return to the operating room for open revision with allograft reconstruction following a fall 2.5 months post-operatively. There were no other complications including infection or nerve injury. The overall rate of satisfaction after surgery was 98.1%, with one patient dissatisfied due to excessive ankle stiffness. Conclusions: The described minimally invasive percutaneous Brostrom procedure is safe and effective for the treatment of chronic lateral ankle instability without intra-articular ankle pathology.

Background: Percutaneous Zadek osteotomy (ZO) has emerged as a surgical treatment of insertional Achilles tendinopathy (IAT) over the last decade. Existing literature is limited regarding the comparison of this approach with the more established, open ZO technique. This systematic review aims to evaluate and compare the current data on open vs percutaneous ZO approaches to help set evidence-based guidelines. Methods: A systematic literature search was performed using the keywords (Zadek osteotomy) OR (Keck and Kelly osteotomy) OR (dorsal closing wedge calcaneal osteotomy) OR (Haglund Deformity) OR (Haglund Syndrome) OR (Insertional Achilles Tendinopathy) and MeSH terms Osteotomy , Calcaneus , Syndrome , Insertional , Achilles tendon , and Tendinopathy . Our search included the following databases: PubMed, Embase, and the Cochrane Library. The PRISMA protocol and the Cochrane Handbook guidelines were followed. All studies included were published from 2009 to 2024 and included the use of open or percutaneous approaches of ZO for the treatment of IAT with at least a 12-month follow-up. The MINORS score criteria were used to evaluate the strength and quality of studies. Results: A total of 17 studies were reviewed, including 611 subjects and 625 ZO procedures. Of these procedures, 81 (11%) subjects had a percutaneous and 544 (89%) subjects had an open ZO. The mean follow-up time was 16.1 months for patients treated with percutaneous ZO and 36.1 months for patients treated with open ZO. Both open and percutaneous studies included in this review showed postoperative improvements in AOFAS, FFI, VISA-A, and VAS scores in patients with IAT. The reported complication rate was 5.8% among patients treated with percutaneous ZO and 10.2% among patients treated with open ZO. Conclusion: Percutaneous ZO is an emerging approach with substantially fewer documented cases compared with the open ZO. Both percutaneous and open ZO appear to be relatively effective treatments for insertional Achilles tendinopathy with Haglund’s deformity. The lower complication rates reported for percutaneous ZO is encouraging. Further investigation with more subjects undergoing percutaneous ZO is clearly needed.

Introduction/Purpose: Insertional Achilles tendinopathy (IAT) is a common source of posterior heel pain treated by orthopaedic foot and ankle surgeons. Traditional surgical treatment consists of an open Achilles tendon debridement with re-attachment as well as excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. However, frequent complications include wound healing issue, scar pain, weakness and sural nerve injury. Accordingly, the percutaneous ZO is gaining popularity in the field as an alternative to an open midline splitting approach. Limited literature exists describing outcomes of the percutaneous ZO using a larger sample size. The purpose of this study was to analyze patient reported outcomes and complications after percutaneous ZO with a minimum two-year follow-up period. Methods: One hundred and eight cases treated with percutaneous ZO were retrospectively reviewed across October 2017-July 2021 and outcomes data was available for 104 cases with a minimum two-year follow-up. Patient sex, age, and pertinent comorbidities were recorded. Postoperative complications and patient satisfaction following intervention were evaluated. Foot Function Index score (FFI) was utilized to measure patients’ pain and functional outcomes. Visual Analyzing Scale score (VAS) was also utilized to evaluate pain. These measurements were taken at preoperative and final follow-up. Statistical comparisons were performed using two-tailed, paired t-test with p< 0.05. Results: Mean follow-up time was 41.2±13.1 months (range 24-65 months). The mean FFI score improved from 56.1±5.9 (range 47-88) preoperatively to 11.0±5.1 (range 7-59) postoperatively (p < 0.001). Average VAS score improved in patients receiving percutaneous ZO from 7.6±1.3 (range 5-10) to 0.4±0.9 (range 0-7) postoperatively (p < 0.001). The overall complication rate was 3.8% (N =4). Of 104 cases, 98.1% of patients were satisfied with their procedure (102/104). Conclusion: The percutaneous ZO is a safe and highly effective intervention for treatment of IAT. At a minimum of two-years follow-up, this intervention is associated with minimal complications, improved functional outcomes, reduced pain, and high patient satisfaction. Table 1 Functional and subjective pain preoperative and postoperative scores as evaluated by functional foot index (FFI) and visual analogue scale (VAS), respectively

Background: The treatment of non-tuberculous mycobacterial (NTM) infections is challenging because of the difficulty in obtaining phenotypic (pDST) and/or molecular (mDST) drug susceptibility testing and the need of a multi-drug regimen. Objectives: The objective was to describe the in vitro susceptibility patterns of various NTM species through an analysis of susceptibility results obtained on isolates collected between 2018 and 2023. Methods: Species identification and mutations in rrs or rrl genes (mDST) were identified by a line probe assay, while the pDST was performed by broth microdilution and interpreted according to CLSI criteria. Results: We analysed 337 isolates of NTM belonging to 15 species/subspecies. The Mycobacterium avium complex (MAC) was the most common (62%); other species identified included M. gordonae (11%), M. kansasii (5%), the M. abscessus complex (8%), M. chelonae (6%), and M. fortuitum (2%). The results of pDST (claritromycin and amikacin) and mDST (rrl and rrs genes) on 66 NTM strains showed that while wild-type rrl and rrs occurred in 86.3% and 94% strains, respectively, the pDST showed 88% sensitivity for clarithromycin and 57.5% for amikacin. The main incongruity was observed for macrolides. Conclusions: Most NTM are likely to be susceptible to macrolides and aminoglycosides. The molecular identification of resistant genotypes is accurate and strongly recommended for optimal patient management.

Neurocysticercosis (NCC) is caused by the larval stage of Taenia solium. This parasitic disease is endemic in many areas of the world and is emerging in Europe. NCC can affect different brain regions, but simultaneous involvement of the parenchymal, subarachnoid, and ventricular regions is rare. We report the case of a 39-year-old woman from Honduras, resident in Rome for 10 years, who presented to the Emergency Department complaining of headaches, transient hemianopsia, and bilateral papilledema. MRI showed a concomitant parenchymal, subarachnoid, and ventricular involvement in the brain. T. solium IgG antibodies were detected in the blood. The etiological diagnosis of NCC was obtained by identifying T. solium in cerebrospinal fluid using Next Generation Sequencing. Endoscopic neurosurgery with the placement of a ventricular shunt and medical long-term anti-parasitic treatment with a cumulative number of 463 days of albendazole and 80 days of praziquantel were performed. A successful 4-year follow-up is reported. NCC is one of the most common parasitic infections of the human CNS, but it is still a neglected tropical disease and is considered to be an emerging disease in Europe. Its diagnosis and clinical management remain a challenge, especially for European clinicians.

Microbial sulfate reduction is generally limited in the deep sea compared to shallower marine environments, but cold seeps and hydrothermal systems are considered an exception. Here, we report sulfate reduction rates and geochemical data from marine sediments and hydrothermal vent fields along the Arctic Mid Ocean Ridges (AMOR), to assess the significance of basalt-hosted hydrothermal activity on sulfate reduction in a distal deep marine setting. We find that cored marine sediments do not display evidence for sulfate reduction, apart from low rates in sediments from the Knipovich Ridge. This likely reflects the overall limited availability of reactive organic matter and low sedimentation rates along the AMOR, except for areas in the vicinity of Svalbard and Bear Island. In contrast, hydrothermal samples from the Seven Sisters, Jan Mayen and Loki’s Castle vent fields all demonstrate active microbial sulfate reduction. Rates increase from a few 10s to 100s of pmol SO42- cm-3 d-1 in active high-temperature hydrothermal chimneys, to 10s of nmol SO42- cm-3 d-1 in low-temperature barite chimneys and up to 110 nmol cm-3 d-1 in diffuse venting hydrothermal sediments in the Barite field at Loki’s Castle. Pore fluid and sediment geochemical data suggest that these high rates are sustained by organic compounds from microbial mats and vent fauna as well as methane supplied by high-temperature hydrothermal fluids. However, significant variation was observed between replicate hydrothermal samples and observation of high rates in seemingly inactive barite chimneys suggests that other electron donors may be important as well. Sediment sulfur isotope signatures concur with measured rates in the Barite field and indicate that microbial sulfate reduction has occurred in the hydrothermal sediments since the recent geological past. Our findings indicate that basalt-hosted vent fields provide sufficient electron donors to support microbial sulfate reduction in high- and low-temperature hydrothermal areas in settings that otherwise show very low sulfate reduction rates.

Category: Other Introduction/Purpose: Previous studies have reported conflicting data regarding 30-day readmission rates between patients of different races following orthopaedic surgery. Differences in specific reasons for 30-day readmission between races following orthopaedic surgery have yet to be explored. Methods: The ACS-NSQIP database was utilized to identify patients who underwent orthopaedic surgery and were readmitted within 30 days. Data was collected from 2015–2019, and patients were stratified into one of five race groups: American Indian/Alaskan Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, and White. Analysis of variance (ANOVA) with Bonferroni post-hoc analysis for multiple comparisons was used to compare differences in continuous variables between racial groups. Chi-square analysis with post-hoc analysis of adjusted standardized residuals was used to compare differences in categorical variables between racial groups. Results: In total, 975,857 patients from the ACS-NSQIP database were included in the study. All-cause readmission rate was significantly different across races. Asian and Native Hawaiian/Pacific Islander patients had significantly lower readmission rates (2.7% and 2.8%, respectively), whereas Black patients had significantly greater readmission rates (3.9%) (p < 0.01). Black patients had significantly greater readmission rates for deep incisional SSI, wound disruption, renal insufficiency, and pulmonary embolism, and a lower readmission rate for pneumonia compared to other races. Asian patients had a lower readmission rate for pulmonary embolism, wound disruption, superficial incisional SSI, and vein thrombosis requiring therapy. Conclusion: Specific causes of 30-day readmission were significantly different between races, with Black patients experiencing higher readmission rates and Asian and Hawaiian/Pacific Islander patients experiencing lower readmission rates overall. Our findings can inform which complications should be more carefully monitored in certain patient populations, and how peri- and post-operative management can be adjusted accordingly.

Category: Lesser Toes; Bunion Introduction/ Purpose: Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or post-operative strapping of the foot. Methods: A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022. Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the Visual Analog Score (VAS), and overall satisfaction were collected. Four- Five intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. Results: The mean post-operative follow-up time was 24.1 months. Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (p

Se analizará la causa “T., A. M. y Otro – Solicita Homologación – Ley 10.305”, en la cual el día 12/05/2022, el Juzgado de Familia de Segunda Nominación, hizo lugar a una medida autosatisfactiva, y ordenó a la obra social, que de manera urgente proceda a afiliar y brindar cobertura al menor gravemente enfermo, a cargo y bajo el exclusivo costo de su progenitor.

BackgroundThere is a strong association between hypertension and cerebrovascular diseases, but most of the mechanistic bases to justify this correlation remains misunderstood.ObjectiveTo evaluate intracranial pressure waveform in long-term essential hypertensive patients with a non-invasive device, brain4care (b4c).MethodsCross-sectional study in patients with hypertension. Office blood pressure was measured with an automatic oscillometric device. Intracranial pressure evaluation was acquired through a strain sensor that could detect and monitor nanometric skull bone displacements for each cardiac cycle. Under normal physiological conditions, P1 is greater than P2, and the normal P2/P1 ratio is

Abstract Background Cardiovascular (CV) polypills are a useful baseline treatment to prevent CV diseases by combining different drug classes in a single pill to simultaneously target more than one risk factor. The aim of the present trial was to determine whether the treatment with the CNIC-polypill was at least non-inferior to usual care in terms of low-density lipoprotein cholesterol (LDL-c) and systolic BP (SBP) values in subjects at high or very high risk without a previous CV event. Methods The VULCANO was an international, multicentre open-label trial involving 492 participants recruited from hospital clinics or primary care centres. Patients were randomised to the CNIC-polypill -containing aspirin, atorvastatin, and ramipril- or usual care. The primary outcome was the comparison of the mean change in LDL-c and SBP values after 16 weeks of treatment between treatment groups. Results The upper confidence limit of the mean change in LDL-c between treatments was below the prespecified margin (10 mg/dL) and above zero, and non-inferiority and superiority of the CNIC-polypill (p = 0.0001) was reached. There were no significant differences in SBP between groups. However, the upper confidence limit crossed the prespecified non-inferiority margin of 3 mm Hg. Significant differences favoured the CNIC-polypill in reducing total cholesterol (p = 0.0004) and non-high-density lipoprotein cholesterol levels (p = 0.0017). There were no reports of major bleeding episodes. The frequency of non-serious gastrointestinal disorders was more frequent in the CNIC-polypill arm. Conclusion The switch from conventional treatment to the CNIC-polypill approach was safe and appears a reasonable strategy to control risk factors and prevent CVD. Trial registration This trial was registered in the EU Clinical Trials Register (EudraCT) the 20th February 2017 (register number 2016-004015-13; https://www.clinicaltrialsregister.eu/ctr-search/search?query=2016-004015-13 ).

Abstract Conservation guidance—an authoritative source of information and recommendations explicitly supporting decision‐making and action regarding nature conservation—represents an important tool to communicate evidence‐based advice to conservation actors. Given the rapidly increasing pressure that climate change poses to biodiversity, producing accessible, well‐informed guidance on how to best manage the impacts and risks of changing climatic conditions is particularly urgent. Guidance documents should ideally be produced with multistage input from stakeholders who are likely to use and implement such advice; however, this step can be complicated and costly, and remains largely unformalized. Moreover, there is currently little direct evidence synthesized for actions that specifically target climate change and guidance remains largely absent. Here, we introduce a process for co‐developing guidance for species conservation in the face of climate change, using seabirds in the North‐East Atlantic as a case study. Specifically, we collated evidence on climate change vulnerability and possible conservation actions using literature synthesis, stakeholder surveys, and ecological modeling. This evidence base was then discussed, refined, and expanded using structured stakeholder workshops. We summarize the knowledge gained through stakeholder engagement and provide recommendations for future international efforts to co‐produce conservation guidance for managing wildlife, in the context of a rapidly changing climate.