Bony Academy

[Martha Vanschaick]

AssfishThere are 36,128 species of fishes. We know that because back in the 1980s, an ichthyologist named Bill Eschmeyer started a Catalog of Fishes at The California Academy of Sciences. But as far as I knew, none of those species were commonly known as assfish.

I knew of wild ass, Equus africanus, because I had grown up near Chicago where The Field Museum had one mounted in a glass display case. I knew of pinworms, aka Enterobius vermicularis, because a colleague of mine (who used a less refined word) had them as a kid and once told me a funny story about how his mom plucked them out at night with tweezers and a cold flashlight. But assfish was news to me.

Furthermore, fish do not have ears, at least not in the common sense of the word. The sense of hearing in most fishes depends in part on small bones called otoliths buried deep within the head. And otoliths are always bony. So bony-eared is rather redundant for a fish.

The name Acanthonus armatus was proposed by the German ichthyologist Albert Gnther for a peculiar specimen trawled up off New Guinea by the HMS Challenger, a naval ship chosen to undertake the first global marine research expedition in 1872. When naming a new species, taxonomists often highlight its most conspicuous features and offer an etymology to describe such inspirations. But like other taxonomists of his time, Gnther provide no such explanation.

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Background: A large variety of biomaterials, biologics and membranes have been utilized in the past 40 years for the regenerative treatment of periodontal infrabony defects. Biologic agents have progressively gained popularity among clinicians and are routinely used for periodontal regeneration. In alignment with the goals of the American Academy of Periodontology (AAP) Best Evidence Consensus (BEC) on the use of biologic mediators in contemporary clinical practice, the aim of this sytematic review was to evaluate the effect of biologic agents, specifically autogenous blood-dervied products (ABPs), enamel matrix derivative (EMD) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB), on the regenerative outcomes of infrabony defects.

Methods: A detailed systematic search was conducted to identify eligible randomized control trials (RCTs) reporting the outcomes of periodontal regenerative therapy using biologics for the treatment of infrabony defects. A frequentist mixed-modeling approach to network meta-analysis (NMA), characterized by the assessment of three individual components for the treatment of an infrabony defect (the bone graft material [BG], the biologic agent, the application of a barrier membrane) was performed to evaluate and compare the relative efficacy of the different components, on the outcomes of different therapeutic modalities of periodontal regeneration.

Results: A total of 153 eligible RCTs were included, with 150 studies contributing to the NMA. The quantitative analysis showed that the addition of biologic agents to bone graft significantly improves the clinical and radiographic outcomes, as compared to BG and flap procedures alone. Barrier membranes enhanced the regenerative outcomes of BG but did not provide further benefits in combination with biologics. The type of BG (autogenous, allogeneic, xenogeneic or alloplastic) and the biologic agent (EMD, platelet-rich fibrin [PRF], platelet-rich plasma [PRP] or rhPDGF-BB) played a significant role on the final outcomes of infrabony defects. Allogeneic and xenogeneic BGs exhibited statistically significantly superior clinical gain than synthetic and autogenous BGs (p Conclusions: Biologics enhance the outcomes of periodontal regenerative therapy. Combination therapies involving BGs + biologics or BGs + barrier membrane demonstrated to be superior to monotherapies. The choice of the type of BG and biologic agent seems to have significant impact on the clinical and radiographic outcomes of infrabony defects.

A bunion is a painful bony bump that develops on the inside of the foot at the big toe joint. Bunions are associated with hallux valgus, a condition where the big toe drifts toward the smaller toes and the outside of the foot.

Bunions usually develop slowly. Pressure on the big toe joint causes the big toe to lean toward the second toe. Over time, the normal position of the bone, tendons, and ligaments changes, resulting in the bunion deformity. Often, this deformity gradually worsens over time and may make it painful to wear shoes or walk.

Bunions are more common in women than men. Seventy percent of people who develop bunions have a family history, which suggests there is a large genetic component to developing bunions. This is especially true for adolescent bunions, which are acquired early in life. Most bunions develop in adulthood and may be the result of repetitive micro-trauma, possibly from wearing shoes with a heel lift and narrow toe box.

In most cases, bunion pain is relieved by wearing wider shoes with adequate toe room and using other simple treatments to reduce pressure on the big toe. In cases where pain persists despite nonsurgical treatment, surgery is performed to correct the bunion and hallux valgus deformity.

A bunion forms when the bones that make up the MTP joint move out of alignment: The long metatarsal bone shifts toward the inside of the foot, and the phalanx bones of the big toe angle toward the second toe. The MTP joint gets larger and protrudes from the inside of the forefoot.

The enlarged joint is often inflamed due to abnormal mechanics and direct irritation. The word "bunion" comes from the Greek word for turnip, and the bump on the inside of the foot typically looks red and swollen like a turnip.

An advanced bunion can greatly alter the appearance of the foot. In severe bunions, the big toe may angle all the way under or over the second toe. Pressure from the big toe may force the second toe out of alignment, causing it to come in contact with the third toe. This can result in hammer toe deformities of the smaller toes. Calluses may also develop where the toes rub against each other, causing additional discomfort and difficulty walking.

In some cases, an enlarged MTP joint may lead to bursitis, a painful condition in which the fluid-filled sac (bursa) that cushions the bone near the joint becomes inflamed. It may also lead to chronic pain and arthritis if the smooth articular cartilage that covers the joint becomes damaged from the joint not gliding smoothly.

In addition to the common bunion, there are other types of bunions. As the name implies, bunions that occur in young people are called adolescent bunions. These bunions are most common in girls between the ages of 10 and 15.

While a bunion on an adult often restricts motion in the MTP joint, a young person with a bunion can normally move the big toe up and down. An adolescent bunion may still be painful, however, and make it difficult to wear shoes.

A bunionette, or "tailor's bunion," occurs on the outside of the foot near the base of the little toe. Although it is in a different spot on the foot, a bunionette is very much like a bunion. You may develop painful bursitis and a hard corn or callus over the bump.

Your doctor will ask you about your medical history, general health, and symptoms. They will perform a careful examination of your foot. Although your doctor will probably be able to diagnose your bunion based on your symptoms and the appearance of your toe, they will also order an X-ray.

In most cases, bunions are treatable without surgery. Bunions that are not painful can be observed without any treatment at all. Although nonsurgical treatment cannot actually reverse a bunion, it can help reduce pain and keep the bunion from worsening.

Pain from bunion pain can often be managed successfully by switching to shoes that fit properly, with a wide or open toe box that does not compress the toes. Some shoes can be modified by using a stretcher to stretch out the areas that put pressure on your toes. Your doctor can give you information about proper shoe fit and the type of shoes that would be best for you. (See "Tips for Proper Shoe Fit" below)

Protective silicone pads, worn inside of your shoe, can help cushion the painful area over the bunion. Pads can be purchased at a drugstore or pharmacy. Be sure to test the pads for a short time period first. The size of the pad may increase the pressure on the bump, and this could worsen your pain rather than reduce it.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen can help relieve pain and reduce swelling. Other medications can be prescribed to help pain and swelling in patients whose bunions are caused by arthritis.

The goal of bunion surgery is to relieve pain by realigning the bone, ligaments, tendons, and nerves so that the big toe can be brought back to its correct position. You should only consider surgery for a bunion that is painful.

There are many surgical options to correct bunions. Generally speaking, smaller surgeries are done for small bunions, and larger procedures are required for severe bunions. Your doctor will recommend a type of bunion surgery for you based on your X-rays and physical exam findings.

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