Purpose: Forefoot ulcers have been implicated as a causative factor in diabetic foot amputation. The treatment of a bunionette deformity with an ulcer is not well established. This study examined the outcomes of a S.E.R.I. (simple, effective, rapid, and inexpensive) operation for bunionette deformity with ulcers in diabetic neuropathy. Materials and Methods: Between January 2014 and June 2022, 20 patients (20 feet) treated for the bunionette deformity with a S.E.R.I.operation were reviewed retrospectively. All patients had diabetic neuropathy. Eleven patients were female, and the mean age at the time of surgery was 62 years. The mean follow-up time was 16 months. Radiologically, the 4th, 5th intermetatarsal angle (4, 5 IMA), lateral deviation angle (LDA), and the length of the 5th metatarsal bone were analyzed preoperatively and after a 1-year follow-up, and the clinical healing time of the ulcer was also reviewed. Results: The 4, 5 IMA and LDA were reduced from the mean preoperative values of 11.4° and 7.9° to 4.8° and 3.8°, respectively (p<0.05).The mean 5th metatarsal length was reduced from 64.3 mm to 61.2 mm (p<0.05). All ulcers were healed at 3 months with no recurrence at the final follow-up. Four patients showed delayed union, and nine patients had developed hard corn around the previous lesion. Conclusion The S.E.R.I. operation can be an acceptable treatment modality for bunionette deformity with an ulcer who has diabetic neuropathy by offloading the bunionette so that ulcer healing can occur.

Purpose: Forefoot ulcers have been implicated as a causative factor in diabetic foot amputation. The treatment of a bunionette deformity with an ulcer is not well established. This study examined the outcomes of a S.E.R.I. (simple, effective, rapid, and inexpensive) operation for bunionette deformity with ulcers in diabetic neuropathy. Materials and Methods: Between January 2014 and June 2022, 20 patients (20 feet) treated for the bunionette deformity with a S.E.R.I.operation were reviewed retrospectively. All patients had diabetic neuropathy. Eleven patients were female, and the mean age at the time of surgery was 62 years. The mean follow-up time was 16 months. Radiologically, the 4th, 5th intermetatarsal angle (4, 5 IMA), lateral deviation angle (LDA), and the length of the 5th metatarsal bone were analyzed preoperatively and after a 1-year follow-up, and the clinical healing time of the ulcer was also reviewed. Results: The 4, 5 IMA and LDA were reduced from the mean preoperative values of 11.4° and 7.9° to 4.8° and 3.8°, respectively (p<0.05).The mean 5th metatarsal length was reduced from 64.3 mm to 61.2 mm (p<0.05). All ulcers were healed at 3 months with no recurrence at the final follow-up. Four patients showed delayed union, and nine patients had developed hard corn around the previous lesion. Conclusion The S.E.R.I. operation can be an acceptable treatment modality for bunionette deformity with an ulcer who has diabetic neuropathy by offloading the bunionette so that ulcer healing can occur.

Purpose: Forefoot ulcers have been implicated as a causative factor in diabetic foot amputation. The treatment of a bunionette deformity with an ulcer is not well established. This study examined the outcomes of a S.E.R.I. (simple, effective, rapid, and inexpensive) operation for bunionette deformity with ulcers in diabetic neuropathy. Materials and Methods: Between January 2014 and June 2022, 20 patients (20 feet) treated for the bunionette deformity with a S.E.R.I.operation were reviewed retrospectively. All patients had diabetic neuropathy. Eleven patients were female, and the mean age at the time of surgery was 62 years. The mean follow-up time was 16 months. Radiologically, the 4th, 5th intermetatarsal angle (4, 5 IMA), lateral deviation angle (LDA), and the length of the 5th metatarsal bone were analyzed preoperatively and after a 1-year follow-up, and the clinical healing time of the ulcer was also reviewed. Results: The 4, 5 IMA and LDA were reduced from the mean preoperative values of 11.4° and 7.9° to 4.8° and 3.8°, respectively (p<0.05).The mean 5th metatarsal length was reduced from 64.3 mm to 61.2 mm (p<0.05). All ulcers were healed at 3 months with no recurrence at the final follow-up. Four patients showed delayed union, and nine patients had developed hard corn around the previous lesion. Conclusion The S.E.R.I. operation can be an acceptable treatment modality for bunionette deformity with an ulcer who has diabetic neuropathy by offloading the bunionette so that ulcer healing can occur.

Purpose: Forefoot ulcers have been implicated as a causative factor in diabetic foot amputation. The treatment of a bunionette deformity with an ulcer is not well established. This study examined the outcomes of a S.E.R.I. (simple, effective, rapid, and inexpensive) operation for bunionette deformity with ulcers in diabetic neuropathy. Materials and Methods: Between January 2014 and June 2022, 20 patients (20 feet) treated for the bunionette deformity with a S.E.R.I.operation were reviewed retrospectively. All patients had diabetic neuropathy. Eleven patients were female, and the mean age at the time of surgery was 62 years. The mean follow-up time was 16 months. Radiologically, the 4th, 5th intermetatarsal angle (4, 5 IMA), lateral deviation angle (LDA), and the length of the 5th metatarsal bone were analyzed preoperatively and after a 1-year follow-up, and the clinical healing time of the ulcer was also reviewed. Results: The 4, 5 IMA and LDA were reduced from the mean preoperative values of 11.4° and 7.9° to 4.8° and 3.8°, respectively (p<0.05).The mean 5th metatarsal length was reduced from 64.3 mm to 61.2 mm (p<0.05). All ulcers were healed at 3 months with no recurrence at the final follow-up. Four patients showed delayed union, and nine patients had developed hard corn around the previous lesion. Conclusion The S.E.R.I. operation can be an acceptable treatment modality for bunionette deformity with an ulcer who has diabetic neuropathy by offloading the bunionette so that ulcer healing can occur.

Objective: This study evaluated the clinical usefulness of mean platelet volume (MPV) for predicting functional outcomes in subarachnoid hemorrhage (SAH) patients. Methods: This is a retrospective analysis of patients who were diagnosed with SAH in the emergency room. Based on their modified Rankin Scale (mRS) score, patients were divided into two groups: 0-2 (good outcome) and 3-6 (poor outcome). Univariable and multivariable analyses were performed to investigate whether MPV, along with other multiple factors, was associated with poor prognosis. Receiver operating characteristic (ROC) curve analysis was performed to determine the value of MPV as a predicting factor of neurological prognosis. Compared to other factors, Hunt Hess grade (HHG) and modified Fisher grade (mFG) considerably influenced the outcomes in both groups (Model 1; model including all factors). Hence, a new model (Model 2) was constructed, comprising multiple factors excluding these two factors. Results: A total of 143 patients were included in this study. Although MPV was different between the two groups, it was not a significant factor in Model 1 in the multivariable analysis. In Model 2, MPV (odds ration [OR], 1.71; 95% confidence interval [CI], 1.05-2.8), age (OR, 1.06; 95% CI, 1.03-1.1), and surgical treatment (OR, 0.37; 95% CI, 0.15-0.87) were significant factors related to poor outcomes. Area under the curve (AUC) of Model 1 was 0.93, 0.85 in HHG; 0.78 in Model 2, 0.65 in mFG, and 0.62 in MPV. Conclusion Although MPV differed significantly between the good and poor outcome groups, it is insufficient to predict poor outcomes in SAH patients as an independent biomarker.

BACKGROUND: Adipose-derived stem cells (ADSCs) exert immunomodulatory effects in the treatment of transplant rejection. This study aimed to evaluate the effects of ADSCs on the skin graft survival in a human-to-rat xenograft transplantation model and to compare single and multiple injections of ADSCs. METHODS: Full-thickness human skin xenografts were transplanted into the backs of Sprague–Dawley rats. The rats were injected subcutaneously on postoperative days 0, 3, and 5. The injections were as follows: triple injections of phosphate-buffered saline (PBS group), a single injection of ADSCs and double injections of PBS (ADSC 9 1 group), and triple injections of ADSCs (ADSC 9 3 group). The immunomodulatory effects of ADSCs on human skin xenografts were assessed. RESULTS: Triple injections of ADSCs considerably delayed cell-mediated xenograft rejection compared with the PBS and ADSC 9 1 groups. The vascularization and collagen type 1–3 ratios in the ADSC 9 3 group were significantly higher than those in the other groups. In addition, intragraft infiltration of CD3-, CD4-, CD8-, and CD68-positive cells was reduced in the ADSC 9 3 group. Furthermore, in the ADSC 9 3 group, the expression levels of proinflammatory cytokine interferon-gamma (IFN-c) were decreased and immunosuppressive prostaglandin E synthase (PGES) was increased in the xenograft and lymph node samples. CONCLUSION This study presented that triple injections of ADSCs appeared to be superior to a single injection in suppressing cell-mediated xenograft rejection. The immunomodulatory effects of ADSCs are associated with the downregulation of IFN-c and upregulation of PGES in skin xenografts and lymph nodes.

Rab40 proteins are an atypical subgroup of Rab GTPases containing a unique suppressor of the cytokine signaling (SOCS) domain that is recruited to assemble the CRL5 E3 ligase complex for proteolytic regulation in various biological processes. A nonsense mutation deleting the C-terminal SOCS box in the RAB40B gene was identified in a family with axonal peripheral neuropathy (Charcot-Marie-Tooth disease type 2), and pathogenicity of the mutation was assessed in model organisms of zebrafish and Drosophila. Compared to control fish, zebrafish larvae transformed by the human mutant hRAB40B-Y83X showed a defective swimming pattern of stalling with restricted localization and slower motility. We were consistently able to observe reduced labeling of synaptic markers along neuromuscular junctions of the transformed larvae. In addition to the neurodevelopmental phenotypes, compared to normal hRAB40B expression, we further examined ectopic expression of hRAB40B-Y83X in Drosophila to show a progressive decline of locomotion ability. Decreased ability of locomotion by ubiquitous expression of the human mutation was reproduced not with GAL4 drivers for neuron-specific expression but only when a pan-glial GAL4 driver was applied. Using the ectopic expression model of Drosophila, we identified a genetic interaction in which Cul5 down regulation exacerbated the defective motor performance, showing a consistent loss of SOCS box of the pathogenic RAB40B. Taken together, we could assess the possible gain-of-function of the human RAB40B mutation by comparing behavioral phenotypes in animal models; our results suggest that the mutant phenotypes may be associated with CRL5-mediated proteolytic regulation.

Purpose: This study compared the clinical and radiology results of arthrodesis between the anterior and transfibular approaches with a lateral malleolar-saving procedure in ankle arthritis. Materials and Methods: This study was a retrospective study of 31 cases who underwent ankle arthrodesis with the anterior approach (14 cases) and trans-fibular approach (17 cases). The remnant lateral malleolus was fixed during the trans-fibular procedure. The patients included 17 females and 14 males with a mean age of 57.2 (range 41~73) years; the mean follow-up was 30.4 (range 15~68) months. The clinical and radiology outcomes, including the American Orthopedic Foot & Ankle Society (AOFAS) scores, visual analog scale (VAS), and union time, were recorded. The complications and subjective satisfaction degrees were also recorded and compared between the two groups. Results: Clinically, the preoperative mean AOFAS score and VAS in the anterior approach group were 39.3 and 7.4, respectively, which changed to 61.9 and 3.1 postoperatively. In the trans-fibular approach group, the mean AOFAS score and VAS increased from 36.6 to 64.2 and 7.1 to 2.4, respectively. On the other hand, no significant differences in the clinical results were observed between the two groups. The time to achieve union was 9.2 and 11.6 weeks in the anterior and transfibular approach groups, respectively. Three patients (21%) complained of tenderness and discomfort around the fibular tip in the anterior approach group, and seven patients (41%) showed a gap between the talus and remnant lateral malleolus in the trans-fibular approach group. Conclusion There was no difference in the clinical and radiological results between the anterior and transfibular approaches with a lateral malleolar saving procedure in ankle arthrodesis. Careful selection of the approach method according to the patient's preoperative condition is needed to prevent remnant discomfort or nonunion around the lateral malleolus.

Purpose: This study reports on a series of patients with chronic lateral ankle instability that underwent the Broström procedure with suture tape augmentation and allowed early unrestricted weight-bearing in a simple stirrup brace. Materials and Methods: This retrospective study was conducted on 36 patients (22 males and 14 females of mean age 34 years [range 23~48 years]) with chronic lateral ankle instability treated using the Broström procedure using suture tape augmentation and inferior extensor retinaculum reinforcement with a fiber-wire connected to a SwiveLock screw inserted into the talus. When possible, patients started unrestricted weight-bearing in a stirrup brace from the third postoperative day. Demographics and functional outcomes, including American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot, visual analogue scale (VAS), and satisfaction scores, were recorded. In addition, varus stress radiographs obtained before and 24 months after surgery were compared. Patients were followed for a mean 29 months (range 25~40 months). Results: Mean AOFAS ankle-hindfoot scores increased from 51 points preoperatively to 92 points at final follow-up, and mean VAS decreased from 6.8 to 1.2 points. Mean patient satisfaction scores were 8.7 at 12 months and 9.6 at 24 months. Stress radiographs demonstrated that talar tilt decreased from a mean 18 degrees preoperatively to 7 degrees at 24 months. Conclusion Early unrestricted weight-bearing in a stirrup brace following the Broström procedure with suture tape augmentation is a successful protocol for treating chronic lateral ankle instability.