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Multilevel arthritis of the foot is a frequent problem. The arthritis does not always involve adjacent levels. A comprehensive literature search did not reveal any information about this pathology, neither about its treatment. Thi...
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Multilevel arthritis of the foot is a frequent problem. The arthritis does not always involve adjacent levels. A comprehensive literature search did not reveal any information about this pathology, neither about its treatment. This case series report presents two patients. The first patient has bilateral talonavicular and first metatarsophalangeal joint arthritis, the second has unilateral talonavicular and first tarsometatarsal joint arthritis. Conservative treatment was insufficient and operative treatment of the arthritic joints was performed using the IoFix system (Intra-Osseus Fixation Device). In all three operations arthrodesis of the talonavicular and a more distal nonadjacent joint was successfully performed. With a follow-up period up till five years postoperative, no short- nor long-term complications were observed. Multilevel arthritis with nonadjacent joints in the foot is a common pathology. Fusion of the affected joints, leaving at least one free joint in between is a surgical treatment with good results.
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Background: Growing rod (GR) is a state-of-the-art procedure favored when curvatures of the spine cannot be managed non-operatively in early-onset scoliosis. Although some postulate that multiple distractions and/or relative immob...
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Background: Growing rod (GR) is a state-of-the-art procedure favored when curvatures of the spine cannot be managed non-operatively in early-onset scoliosis. Although some postulate that multiple distractions and/or relative immobilization of the unfused segments affect the health of disk and facet joint (FJ) and cause degeneration and/or spontaneous fusion, this has not thoroughly been investigated. In this study, changes in the unfused segment after a spine-based fusionless instrumentation (SBFI) are investigated and compared with the control (CG) and instrumented fusion (IF) groups.Methods: A total of 13 piglet|, 10 to 14 weeks of age, were used. SBFI and IF were performed on 7 and 3 piglets, respectively, and 3 formed the CG. In SBFI, lengthening procedures of 5 mm were applied once monthly for 3 months, and, after 4 months, all piglets were euthanized. Histologic sections of the unfused disks and FJ were analyzed, and morphometric histologic analysis was performed.Results: On the basis of the Gries criteria, unfused disk median grades were 1, 2, and 4 for control, SBFI, and IF, respectively, that revealed a statistical difference (P < 0.001). Unfused FJ median grades were 1 and 2 for control and SBFI, respectively, that revealed a statistical difference (P < 0.001). The mean hyper-trophic zone (HZ) heights were 69.78, 84.20, and 66.14 urn; HZ chondrocyte cell widths were 19.03, 18.76, and 17.36 |im; and HZ chondrocyte cell heights were 15.01, 15.04, and 12.42 um in the CG, SBFI, and IF groups, respectively. Statistically, for HZ heights, SBFI was different compared with CG and IF (P < 0.001), and, for HZ chondrocyte cell widths and heights, IF was different compared with CG and SBFI (P < 0.001). Conclusions: Morphometric analysis in this study supports the findings that SBFI preserves the growth potential of the spine. Furthermore, changes in the HZ heights show that distractive forces stimulate the apophyseal growth of the axial skeleton describing how the growth rate of the spine in GR might surpass the normal growth rate. Overall, although some degenerative changes are observed, SBFI and repeated distractions alone are not solely responsible for FJ arthrosis and disk degeneration, given that they are structurally preserved.Clinical Relevance: GR and regular lengthening procedures do not impair disk health and preserve the growth potential of the spine if it is applied with a meticulous technique.
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Here, a pair of A_1-D-A_2-D-A_1 unfused ring core-based nonfullerene small molecule acceptors (NF-SMAs), BO_2FIDT-4Cl and BT2FIDT-4Cl is synthesized, which possess the same terminals (A_1) and indacenodithiophene unit (D), couplin...
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Here, a pair of A_1-D-A_2-D-A_1 unfused ring core-based nonfullerene small molecule acceptors (NF-SMAs), BO_2FIDT-4Cl and BT2FIDT-4Cl is synthesized, which possess the same terminals (A_1) and indacenodithiophene unit (D), coupling with different fluorinated electron-deficient central unit (difluorobenzoxadiazole or difluorobenzothiadiazole) (A_2). BT2FIDT-4Cl exhibits a slightly smaller optical bandgap of 1.56 eV, upshifted highest occupied molecular orbital energy levels, much higher electron mobility, and slightly enhanced molecular packing order in neat thin films than that of BO_2FIDT-4Cl. The polymer solar cells (PSCs) based on BT2FIDT- 4Cl:PM7 yield the best power conversion efficiency (PCE) of 12.5% with a V_(oc) of 0.97 V, which is higher than that of BO_2FIDT-4Cl-based devices (PCE of 10.4%). The results demonstrate that the subtle modification of A_2 unit would result in lower trap-assisted recombination, more favorable morphology features, and more balanced electron and hole mobility in the PM7:BT2FIDT-4Cl blend films. It is worth mentioning that the PCE of 12.5% is the highest value in nonfused ring NF-SMA-based binary PSCs with high V_(oc) over 0.90 V. These results suggest that appropriate modulation of the quinoid electron-deficient central unit is an effective approach to construct highly efficient unfused ring NF-SMAs to boost PCE and V_(oc) simultaneously.
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