Plantar flexion force induced by amplitude-modulated tendon vibration and associated soleus V/F-waves as an evidence of a centrally-mediated mechanism contributing to extra torque generation in humans

Background: High-frequency trains of electrical stimulation applied over the human muscles can generate forces higher than would be expected by direct activation of motor axons, as evidenced by an unexpected relation between the stimuli and the evoked contractions, originating what has been called “extra forces”. This phenomenon has been thought to reflect nonlinear input/output neural properties such as plateau potential activation in motoneurons. However, more recent evidence has indicated that extra forces generated during electrical stimulation are mediated primarily, if not exclusively, by an intrinsic muscle property, and not from a central mechanism as previously thought. Given the inherent differences between electrical and vibratory stimuli, this study aimed to investigate: (a) whether the generation of vibration-induced muscle forces results in an unexpected relation between the stimuli and the evoked contractions (i.e. extra forces generation) and (b) whether these extra forces are accompanied by signs of a centrally-mediated mechanism or whether intrinsic muscle properties are the redominant mechanisms. Methods: Six subjects had their Achilles tendon stimulated by 100 Hz vibratory stimuli that linearly increased in amplitude (with a peak-to-peak displacement varying from 0 to 5 mm) for 10 seconds and then linearly decreased to zero for the next 10 seconds. As a measure of motoneuron excitability taken at different times during the vibratory stimulation, short-latency compound muscle action potentials (V/F-waves) were recorded in the soleus muscle in response to supramaximal nerve stimulation. Results: Plantar flexion torque and soleus V/F-wave amplitudes were increased in the second half of the stimulation in comparison with the first half. Conclusion: The present findings provide evidence that vibratory stimuli may trigger a centrally-mediated mechanism that contributes to the generation of extra torques. The vibration-induced increased motoneuron excitability (leading to increased torque generation) presumably activates spinal motoneurons following the size principle, which is a desirable feature for stimulation paradigms involved in rehabilitation programs and exercise training.

Comparação do ultrassom pulsado e contínuo no reparo tendíneo de ratos

No tratamento de lesões tendíneas, o uso do ultrassom surge como possibilidade terapêutica, apesar de lacunas sobre seus efeitos clínicos. O objetivo foi avaliar dois protocolos de ultrassom terapêutico sobre dor e edema após trauma tendíneo. Vinte e um ratos Wistar foram submetidos a trauma no tendão calcâneo e divididos em três grupos: sham (GS); ultrassom contínuo (GUC); e ultrassom pulsado (GUP). O trauma ocorreu sobre a face lateral do tendão calcâneo direito, com energia de 0,40 J. A dor foi avaliada pelo teste de incapacidade funcional e o edema, pelo diâmetro laterolateral. Foram realizadas avaliações previamente à lesão; após 1 hora da indução da lesão; após o 1º tratamento; 2, 8 e 24 horas após lesão; e após o 5º dia. O tratamento ocorreu em 5 dias, com transdutor de 1 MHz, durante 3 minutos, sobre o local do trauma, com dose de 0,4 W/cm² SATA. Os resultados da incapacidade funcional para GS mostraram aumento da nocicepção. Para GUC houve aumento ao comparar a avaliação 1 (AV1) com as avaliações 2 (AV2), 3 (AV3) e 4 (AV4); ao comparar AV2 com as avaliações 5 (AV5) e 6 (AV6) houve diminuição de valores. Para GUP houve aumento ao comparar AV1 com AV2 e AV3, mas ao comparar AV2 com as seguintes, houve diminuição significativa a partir de AV4. Para o edema, os grupos tratados produziram aumento inicial, com redução nas últimas avaliações. O ultrassom terapêutico produziu diminuição de dor e edema, mais precocemente para a forma pulsada.

Efficacia del trattamento con concentrati piastrinici (P.R.P.) nelle lesioni condrali e tendinopatie

Purpose: Recent knowledge regarding tissue biology highlights a complex regulation of growth factors in reaction to tissue damage. Platelet Rich Plasma (P.R.P.), containing a natural pool of growth factors, can be obtained in a simple and minimally invasive way and be applied to the lesion site. The aim of this study is to explore this novel approach to treat cartilage degenerative lesions of the knee and tendon chronic lesions( patellar tendon, and achilles tendon). In this study we evaluated if the treatment with PRP injections can reduce pain and increase function in cases of patellar tendinosis (Jumper’s Knee), in chronic achilles tendinopathy and in patients with cartilage injuries of the knee. Materials and Methods: 40 patients with cartilage lesion of the knee, 28 male and 12 female with mean age 47 y. (min 18- max 52 years), were treated and prospectively evaluated at a minimum 6 months follow-up; in the same way, 12 patients with achilles tendon lesion (8 male and 4 female) with mean age 44,5 y. (min 32-max 58 years) and 10 patients with “Jumper’s Knee” (8 male and 2 female) with mean age 23,2 y. (min 18-max 37 years), were evaluated at 6 months follow up. The procedure involved 3 multiple injections , performed every two weeks. All patients were clinically evaluated at the end of the treatment and at 6 months follow up. IKDC, SF36, EQ-VAS, scores were used for clinical evaluation and patient satisfaction and functional status were also recorded. Results: Statistical analysis showed a significant improvement in the SF36 questionnaire in all parameters evaluated at the end of the therapy and 6 months follow-up in both group(tendinopathies and chondral lesions), and in the EQ VAS and IKDC score (paired T-test, p<0.0005) from basal evaluation to the end of the therapy, and a further improvement was present at 6 months follow-up. Whereas a higher improvement of the sport activity level was achieved in the “Jumper’s Knee” group. No complications related to the injections or severe adverse events were observed during the treatment and follow up period. Conclusion: PRP inhibits excess inflammation, apoptosis, and metalloproteinase activity. These interactive pathways may result in the restoration of tendon or cartilage, which can with stand loading with work or sports activity, thereby diminishing pain. PRP may also modulate the microvascular environment or alter efferent or afferent neural receptors. The clinical results are encouraging, indicating that PRP injections may have the potential to increase the tendon and cartilage healing capacity in cases with chronic tendinosis and chondropathy of the knee.

Ruolo dei glicosaminoglicani su struttura e funzione dei crimps nei tendini e nei legamenti

The biomechanical roles of both tendons and ligaments are fulfilled by extracellular matrix of these tissues. In particular, tension is mainly transmitted and resisted by fibrous proteins (collagen, elastin), whereas compressive load is absorbed by water-soluble glycosaminoglycans (GAGs). GAGs spanning the interfibrillar spaces and interacting with fibrils also seem to play a part in transmitting and resisting tensile stresses. Apart from different functional roles and collagen array, tendons and ligaments share the same basic structure showing periodic undulations of collagen fibers or crimps. Each crimp is composed of many knots of each single fibril or fibrillar crimps. Fibrillar and fiber crimps act as shock absorbers during the initial elongation of both tendons and ligaments and assist the elastic recoil of fibrils and fibers when the tensile stress is removed. The aim of this thesis was to evaluate whether GAGs directly affect the 3D microstructural integrity of fibrillar crimp and fiber crimps in both tendons and ligaments. Achilles tendons and medial collateral ligaments of the knee from eight female Sprague-Dawley rats (90 days old) were digested with chondroitinase ABC to remove GAGs and observed under a scanning electron microscope (SEM). In addition, isolated fibrils from these tissues obtained by mechanical homogenization were analyzed by a transmission electron microscope (TEM). Both samples digested with chondroitinase ABC or mechanically disrupted still showed crimps and fibrillar crimps comparable to tissues with a normal GAGs content. All fibrils in the fibrillar crimp region always twisted leftwards, thus changing their running plane, and then sharply bent, changing their course on a new plane. These data suggest that GAGs do not affect structural integrity or fibrillar crimps functions that seem mainly related to the local fibril leftward twisting and the alternating handedness of collagen from a molecular to a supramolecular level.

Mechanismen und funktionelle Konsequenzen der Chlorid-Homöostase in unreifen Neuronen des Neocortex

GABA, der wichtigste inhibitorische Neurotransmitter im adulten Gehirn, bewirkt im unreifen Nervensystem eine Membrandepolarisation, vermutlich aufgrund der erhöhten intrazellulären Chloridkonzentration ([Cl-]i) in unreifen Nervenzellen. GABAerge Membrandepolarisationen sind essentiell für die korrekte Entwicklung des zentralen Nervensystems und die Entstehung kortikaler Netzwerkaktivität. Im Rahmen der vorliegenden Arbeit wurde mit Hilfe elektrophysiologischer und immunohistochemischer Methoden die Regulation der Chlorid-Homöostase in unreifen Neuronen des Neokortex untersucht. Die Experimente wurden an Cajal-Retzius (CR) Zellen, einem transienten Zelltyp der Marginalzone, in akuten Hirnschnittpräparaten neonataler Ratten (P0-P3) durchgeführt. Es konnte gezeigt werden, dass CR Zellen eine hohe native [Cl-]i von ~30 mM aufweisen. Die hohe [Cl-]i wurde ausschließlich durch Bumetanid sensitiven und Na+-abhängigen aktiven Cl--Transport aufrechterhalten, was auf eine Cl--Akkumulation durch den Kationen-Chlorid-Cotransporter NKCC1 schließen lässt. Diese pharmakologischen Hinweise konnten durch den Nachweis der Expression von NKCC1 in der gesamten Marginalzone, speziell in CR Zellen, bestätigt werden. Die Transportgeschwindigkeit der NKCC1-abhängigen Cl--Akkumulation war gering, was auf eine limitierte Transportkapazität schließen lässt. In Übereinstimmung mit diesem Befund konnte gezeigt werden, dass die Cl--Leitfähigkeit in CR Zellen äußerst klein ist, so dass die NKCC1-abhängige Cl--Akkumulation ausreichend war, um unter Ruhebedingungen eine hohe [Cl-]i zu gewährleisten. Aufgrund dieser hohen [Cl-]i waren GABAA-Rezeptor vermittelte Antworten in CR Zellen exzitatorisch. Die Kapazität des NKCC1-vermittelten Cl--Transportes in CR Zellen konnte durch höherfrequente Stimulation überschritten werden, was dazu führte, dass die [Cl-]i abnahm und GABAerge Antworten unter diesen Bedingungen inhibitorisch wurden. Die inhibitorische Wirkung von GABA in CR Zellen wurde überwiegend durch die Reduktion des Eingangswiderstandes der Zelle vermittelt und beruhte nicht auf einer Verschiebung der Aktionspotentialschwelle.

Campi finiti e segnale GPS

Lo scopo della tesi è quello di studiare una delle applicazioni della teoria dei campi finiti: il segnale GPS. A questo scopo si descrivono i registri a scorrimento a retroazione lineare (linear feedback shift register, LFSR), dispositivi utili in applicazioni che richiedono la generazione molto rapida di numeri pseudo-casuali. I ricevitori GPS sfruttano il determinismo di questi dispositivi per identificare il satellite da cui proviene il segnale e per sincronizzarsi con esso. Si inizia con una breve introduzione al funzionamento del GPS, poi si studiano i campi finiti: sottocampi, estensioni di campo, gruppo moltiplicativo e costruzione attraverso la riduzione modulo un polinomio irriducibile, fattorizzazione di polinomi, formula per il numero e metodi per la determinazione di polinomi irriducibili, radici di polinomi irriducibili, coniugati, teoria di Galois (automorfismo ed orbite di Frobenius, gruppo e corrispondenza di Galois), traccia, polinomio caratteristico, formula per il numero e metodi per la determinazione di polinomi primitivi. Successivamente si introducono e si esaminano sequenze ricorrenti lineari, loro periodicità, la sequenza risposta impulsiva, il polinomio caratteristico associato ad una sequenza e la sequenza di periodo massimo. Infine, si studiano i registri a scorrimento che generano uno dei segnali GPS. In particolare si esamina la correlazione tra due sequenze. Si mostra che ogni polinomio di grado n-1 a coefficienti nel campo di Galois di ordine 2 può essere rappresentato univocamente in n bit; la somma tra polinomi può essere eseguita come XOR bit-a-bit; la moltiplicazione per piccoli coefficienti richiede al massimo uno shift ed uno XOR. Si conclude con la dimostrazione di un importante risultato: è possibile inizializzare un registro in modo tale da fargli generare una sequenza di periodo massimo poco correlata con ogni traslazione di se stessa.

Entwicklung eines Pikoliter-Tropfengenerators für die Massenspektrometrische Spuren- und Speziesanalytik

Die Dissertationsschrift beschäftigt sich mit der Entwicklung und Anwendung einer alternativen Probenzuführungstechnik für flüssige Proben in der Massenspektrometrie. Obwohl bereits einige Anstrengungen zur Verbesserung unternommen wurden, weisen konventionelle pneumatische Zerstäuber- und Sprühkammersysteme, die in der Elementspurenanalytik mittels induktiv gekoppeltem Plasma (ICP) standardmäßig verwendet werden, eine geringe Gesamteffizienz auf. Pneumatisch erzeugtes Aerosol ist durch eine breite Tropfengrößenverteilung gekennzeichnet, was den Einsatz einer Sprühkammer bedingt, um die Aerosolcharakteristik an die Betriebsbedingungen des ICPs anzupassen.. Die Erzeugung von Tropfen mit einer sehr engen Tropfengrößenverteilung oder sogar monodispersen Tropfen könnte die Effizienz des Probeneintrags verbessern. Ein Ziel dieser Arbeit ist daher, Tropfen, die mittels des thermischen Tintenstrahldruckverfahrens erzeugt werden, zum Probeneintrag in der Elementmassenspektrometrie einzusetzen. Das thermische Tintenstrahldruckverfahren konnte in der analytischen Chemie im Bereich der Oberflächenanalytik mittels TXRF oder Laserablation bisher zur gezielten, reproduzierbaren Deposition von Tropfen auf Oberflächen eingesetzt werden. Um eine kontinuierliche Tropfenerzeugung zu ermöglichen, wurde ein elektronischer Mikrokontroller entwickelt, der eine Dosiereinheit unabhängig von der Hard- und Software des Druckers steuern kann. Dabei sind alle zur Tropfenerzeugung relevanten Parameter (Frequenz, Heizpulsenergie) unabhängig voneinander einstellbar. Die Dosiereinheit, der "drop-on-demand" Aerosolgenerator (DOD), wurde auf eine Aerosoltransportkammer montiert, welche die erzeugten Tropfen in die Ionisationsquelle befördert. Im Bereich der anorganischen Spurenanalytik konnten durch die Kombination des DOD mit einem automatischen Probengeber 53 Elemente untersucht und die erzielbare Empfindlichkeiten sowie exemplarisch für 15 Elemente die Nachweisgrenzen und die Untergrundäquivalentkonzentrationen ermittelt werden. Damit die Vorteile komfortabel genutzt werden können, wurde eine Kopplung des DOD-Systems mit der miniaturisierten Fließinjektionsanalyse (FIA) sowie miniaturisierten Trenntechniken wie der µHPLC entwickelt. Die Fließinjektionsmethode wurde mit einem zertifizierten Referenzmaterial validiert, wobei für Vanadium und Cadmium die zertifizierten Werte gut reproduziert werden konnten. Transiente Signale konnten bei der Kopplung des Dosiersystems in Verbindung mit der ICP-MS an eine µHPLC abgebildet werden. Die Modifikation der Dosiereinheit zum Ankoppeln an einen kontinuierlichen Probenfluss bedarf noch einer weiteren Reduzierung des verbleibenden Totvolumens. Dazu ist die Unabhängigkeit von den bisher verwendeten, kommerziell erhältlichen Druckerpatronen anzustreben, indem die Dosiereinheit selbst gefertigt wird. Die Vielseitigkeit des Dosiersystems wurde mit der Kopplung an eine kürzlich neu entwickelte Atmosphärendruck-Ionisationsmethode, die "flowing atmospheric-pressure afterglow" Desorptions/Ionisations Ionenquelle (FAPA), aufgezeigt. Ein direkter Eintrag von flüssigen Proben in diese Quelle war bislang nicht möglich, es konnte lediglich eine Desorption von eingetrockneten Rückständen oder direkt von der Flüssigkeitsoberfläche erfolgen. Die Präzision der Analyse ist dabei durch die variable Probenposition eingeschränkt. Mit dem Einsatz des DOD-Systems können flüssige Proben nun direkt in die FAPA eingetragen, was ebenfalls das Kalibrieren bei quantitativen Analysen organischer Verbindungen ermöglicht. Neben illegalen Drogen und deren Metaboliten konnten auch frei verkäufliche Medikamente und ein Sprengstoffanalogon in entsprechend präpariertem reinem Lösungsmittel nachgewiesen werden. Ebenso gelang dies in Urinproben, die mit Drogen und Drogenmetaboliten versetzt wurden. Dabei ist hervorzuheben, dass keinerlei Probenvorbereitung notwendig war und zur Ermittlung der NWG der einzelnen Spezies keine interne oder isotopenmarkierte Standards verwendet wurden. Dennoch sind die ermittelten NWG deutlich niedriger, als die mit der bisherigen Prozedur zur Analyse flüssiger Proben erreichbaren. Um im Vergleich zu der bisher verwendeten "pin-to-plate" Geometrie der FAPA die Lösungsmittelverdampfung zu beschleunigen, wurde eine alternative Elektrodenanordnung entwickelt, bei der die Probe länger in Kontakt mit der "afterglow"-Zone steht. Diese Glimmentladungsquelle ist ringförmig und erlaubt einen Probeneintrag mittels eines zentralen Gasflusses. Wegen der ringförmigen Entladung wird der Name "halo-FAPA" (h-FAPA) für diese Entladungsgeometrie verwendet. Eine grundlegende physikalische und spektroskopische Charakterisierung zeigte, dass es sich tatsächlich um eine FAPA Desorptions/Ionisationsquelle handelt.

Prediction of hip fracture risk by quantitative ultrasound in more than 7000 Swiss women > or =70 years of age: comparison of three technologically different bone ultrasound devices in the SEMOF study

To compare the prediction of hip fracture risk of several bone ultrasounds (QUS), 7062 Swiss women > or =70 years of age were measured with three QUSs (two of the heel, one of the phalanges). Heel QUSs were both predictive of hip fracture risk, whereas the phalanges QUS was not. INTRODUCTION: As the number of hip fracture is expected to increase during these next decades, it is important to develop strategies to detect subjects at risk. Quantitative bone ultrasound (QUS), an ionizing radiation-free method, which is transportable, could be interesting for this purpose. MATERIALS AND METHODS: The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk (SEMOF) study is a multicenter cohort study, which compared three QUSs for the assessment of hip fracture risk in a sample of 7609 elderly ambulatory women > or =70 years of age. Two QUSs measured the heel (Achilles+; GE-Lunar and Sahara; Hologic), and one measured the heel (DBM Sonic 1200; IGEA). The Cox proportional hazards regression was used to estimate the hazard of the first hip fracture, adjusted for age, BMI, and center, and the area under the ROC curves were calculated to compare the devices and their parameters. RESULTS: From the 7609 women who were included in the study, 7062 women 75.2 +/- 3.1 (SD) years of age were prospectively followed for 2.9 +/- 0.8 years. Eighty women reported a hip fracture. A decrease by 1 SD of the QUS variables corresponded to an increase of the hip fracture risk from 2.3 (95% CI, 1.7, 3.1) to 2.6 (95% CI, 1.9, 3.4) for the three variables of Achilles+ and from 2.2 (95% CI, 1.7, 3.0) to 2.4 (95% CI, 1.8, 3.2) for the three variables of Sahara. Risk gradients did not differ significantly among the variables of the two heel QUS devices. On the other hand, the phalanges QUS (DBM Sonic 1200) was not predictive of hip fracture risk, with an adjusted hazard risk of 1.2 (95% CI, 0.9, 1.5), even after reanalysis of the digitalized data and using different cut-off levels (1700 or 1570 m/s). CONCLUSIONS: In this elderly women population, heel QUS devices were both predictive of hip fracture risk, whereas the phalanges QUS device was not.

Outside-in signaling through integrins and cadherins: a central mechanism to control epidermal growth and differentiation?

The process of epidermal renewal persists throughout the entire life of an organism. It begins when a keratinocyte progenitor leaves the stem cell compartment, undergoes a limited number of mitotic divisions, exits the cell cycle, and commits to terminal differentiation. At the end of this phase, the postmitotic keratinocytes detach from the basement membrane to build up the overlaying stratified epithelium. Although highly coordinated, this sequence of events is endowed with a remarkable versatility, which enables the quiescent keratinocyte to reintegrate into the cell cycle and become migratory when necessary, for example after wounding. It is this versatility that represents the Achilles heel of epithelial cells allowing for the development of severe pathologies. Over the past decade, compelling evidence has been provided that epithelial cancer cells achieve uncontrolled proliferation following hijacking of a "survival program" with PI3K/Akt and a "proliferation program" with growth factor receptor signaling at its core. Recent insights into adhesion receptor signaling now propose that integrins, but also cadherins, can centrally control these programs. It is suggested that the two types of adhesion receptors act as sensors to transmit extracellular stimuli in an outside-in mode, to inversely modulate epidermal growth factor receptor signaling and ensure cell survival. Hence, cell-matrix and cell-cell adhesion receptors likely play a more powerful and wide-ranging role than initially anticipated. This Perspective article discusses the relevance of this emerging field for epidermal growth and differentiation, which can be of importance for severe pathologies such as tumorigenesis and invasive metastasis, as well as psoriasis and Pemphigus vulgaris.

The "flap-shaft" prosthesis for insensate feet with Chopart or Lisfranc amputations

BACKGROUND: The inevitable detachment of tendons and the loss of the forefoot in Chopart and Lisfranc amputations result in equinus and varus of the residual foot. In an insensate foot these deformities can lead to keratotic lesions and ulcerations. The currently available prostheses cannot safely counteract the deforming forces and the resulting complications. METHODS: A new below-knee prosthesis was developed, combining a soft socket with a rigid shaft. The mold is taken with the foot in the corrected position. After manufacturing the shaft, the lateral third of the circumference of the shaft is cut away and reattached distally with a hinge, creating a lateral flap. By closing this flap the hindfoot is gently levered from the varus position into valgus. Ten patients (seven amputations at the Chopart-level, three amputations at the Lisfranc-level) with insensate feet were fitted with this prosthesis at an average of 3 (range 1.5 to 9) months after amputation. The handling, comfort, time of daily use, mobility, correction of malposition and complications were recorded to the latest followup (average 31 months, range 24 to 37 months after amputation). RESULTS: Eight patients evaluated the handling as easy, two as difficult. No patient felt discomfort in the prosthesis. The average time of daily use was 12 hours, and all patients were able to walk. All varus deformities were corrected in the prosthesis. Sagittal alignment was kept neutral. Complications were two minor skin lesions and one small ulcer, all of which responded to conservative treatment, and one ulcer healed after debridement and lengthening of the Achilles tendon. CONCLUSIONS: The "flap-shaft" prosthesis is a valuable option for primary or secondary prosthetic fitting of Chopart-level and Lisfranc-level amputees with insensate feet and flexible equinus and varus deformity at risk for recurrent ulceration. It provided safe and sufficient correction of malpositions and enabled the patients to walk as much as their general condition permitted.

Quality controls for two heel bone ultrasounds used in the Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk Study

Because of the important morbidity and mortality associated with osteoporosis, it is essential to detect subjects at risk by screening methods, such as bone quantitative ultrasounds (QUSs). Several studies showed that QUS could predict fractures. None, however, compared prospectively different QUS devices, and few data of quality controls (QCs) have been published. The Swiss Evaluation of the Methods of Measurement of Osteoporotic Fracture Risk is a prospective multicenter study that compared three QUSs for the assessment of hip fracture risk in a population of 7609 women age >/=70 yr. Because the inclusion phase lasted 20 mo, and because 10 centers participated in this study, QC became a major issue. We therefore developed a QC procedure to assess the stability and precision of the devices, and for their cross-calibration. Our study focuses on the two heel QUSs. The water bath system (Achilles+) had a higher precision than the dry system (Sahara). The QC results were highly dependent on temperature. QUS stability was acceptable, but Sahara must be calibrated regularly. A sufficient homogeneity among all the Sahara devices could be demonstrated, whereas significant differences were found among the Achilles+ devices. For speed of sound, 52% of the differences among the Achilles+ was explained by the water s temperature. However, for broadband ultrasound attenuation, a maximal difference of 23% persisted after adjustment for temperature. Because such differences could influence measurements in vivo, it is crucial to develop standardized phantoms to be used in prospective multicenter studies.

Ankle dorsiflexion arthrodesis to salvage Chopart's amputation with anterior skin insufficiency

BACKGROUND In Chopart-level amputations the heel often deviates into equinus and varus when, due to the lack of healthy anterior soft tissue, rebalancing tendon transfers to the talar head are not possible. Consequently, anterior and lateral wound dehiscence and ulceration may occur requiring higher-level amputation to achieve wound closure, with considerable loss of function for the patients. METHODS Twenty-four consecutive patients (15 diabetes, 6 trauma, and 3 tumor) had Chopart's amputation and simultaneous or delayed additional ankle dorsiflexion arthrodesis to allow for tension-free wound closure or soft tissue reconstruction, or to treat secondary recurrent ulcerations. Percutaneous Achilles tendon lengthening and subtalar arthrodesis were added as needed. Wound healing problems, time to fusion and full weight-bearing in the prosthesis, complications in the prosthesis, and the ambulatory status were assessed. Satisfaction and function were evaluated by the AmpuPro score and the validated Prosthesis Evaluation Questionnaire scale. RESULTS Five patients had successful soft tissue healing and fusions but died of their underlying disease 2 to 46 months after the operation. Two diabetic patients required a transtibial amputation. The other 17 patients were followed for 27 months (range, 13-63). The average age of the 4 women and 13 men was 53.9 years (range, 16-87). Postoperative complications included minor wound healing problems in 8 patients, wound breakdown requiring revision in 4, phantom pain in 3, residual equinus in 1, and adjacent scar carcinoma in 1 patient. The time to full weight-bearing in the prosthesis ranged from 6 to 24 weeks (mean 10). The mean AmpuPro score was 107 points (of 120), and the mean Prosthesis Evaluation Questionnaire scale was 147 points (of 200). No complications occurred with the prosthesis. Twelve patients lost 1 to 2 mobility classes (mean 0.9). The arthrodeses all healed within 2.5 months (range, 1.5 to 5 months). CONCLUSION Adding an ankle arthrodesis to a Chopart's amputation either immediately or in a delayed fashion to treat anterior soft tissue complications was a successful salvage in most patients at this amputation level. It enabled the patients to preserve the advantages of a full-length limb with terminal weight-bearing. LEVEL OF EVIDENCE Level IV, retrospective case series.

Über den Judenfriedhof in Zwingen und Judenniederlassungen im Fürstbistum Basel

von Achilles Neumann

Der israelitische Friedhof in Hegenheim in geschichtlicher Darstellung : mit 6 Taf. in Lichtdr.

Achilles Nordmann