Highlights The transmission onset of COVID-19 relative to the symptom onset is noteworthy. We inferred transmission onset time from 72 infector-infectee pairs with defined contact history. The median transmission onset was 1.31 days after, and the peak was 0.72 days before the symptom onset. The pre-symptomatic transmission proportion was 37% (95% CI, 16–52%). The transmission onset peaked with the symptom onset and the pre-symptomatic transmission proportion is substantial.

We performed one-stage lengthening using intercalary autogenous bone graft in 34 metatarsals and seven proximal phalanges in 21 patients with congenitally short metatarsals. At operation, in order to decrease the tension in the surrounding soft tissues, we gradually distracted the osteotomies of the affected bones for 20 to 30 minutes. The patients, all women, were followed up for a mean period of 2.1 years (1 to 6.5).The average gain in length for the 34 metatarsal procedures was 14 mm (6 to 21), equivalent to an increase of 32% (11 to 51), and for the seven proximal phalangeal lengthenings 8 mm (5 to 11), an increase of 54% (47 to 65). There was no evidence of neurovascular impairment.The technique of gradual distraction during operation is simple and effective. It overcomes the disadvantages of one-stage lengthening such as a small gain in length and neurovascular damage. Congenital brachymetatarsia describes shortening of the metatarsal bone caused by premature closure of the epiphysis. The fourth toe is most commonly involved, although any or multiple metatarsals may be affected. The deformity has a strong female predilection with a reported sex ratio of 98:4.1 Cosmesis may be a problem, especially in young women. Surgical correction with autogenous bone graft from the calcaneus was first reported in 1969 2 and since then many techniques have been described. The most widely-used procedures are either one-stage lengthening with intercalary bone graft 1-3 or gradual lengthening by callotasis. [4][5][6] Each has its advantages and disadvantages. One-stage lengthening needs a shorter period to bony union and has less morbidity, but produces a proportionally smaller increase and more neurovascular complications than the gradual procedure. 7,8Patients and MethodsBetween 1989 and 1995, we performed 41 one-stage lengthenings (34 metatarsals and seven proximal phalanges) using intercalary autogenous bone graft in 21 patients with congenital brachymetatarsia. To achieve the optimal length of the toe, six proximal phalanges were lengthened with the metatarsal of the same ray. All 21 patients were women and their average age was 16 years (10 to 36). All complained of the appearance of the short toe(s), and ten had occasional pain around adjacent metatarsal heads when walking. In 11 patients the condition was unilateral with the fourth metatarsal involved in ten and the first metatarsal in one. Of the ten patients with bilateral involvement, six showed shortening of the fourth metatarsal, two of the first and fourth metatarsals, one of the first, third and fourth metatarsals, and one of the fourth metatarsal and adjacent proximal phalanx. In 19 patients, we used intercalary autogenous iliac-bone grafts (Figs 1 and 2). In two patients with bilateral short first and fourth metatarsals, the second and third metatarsals were shortened and the excised bone used to lengthen the fourth metatarsal (Fig. 3). There was a family history in three patients. Four patients had associated brachymetacarpia which was bilateral in two and...

In this retrospective study, we analysed the clinical features of neurilemoma when it is located in muscle. Twelve patients had an intramuscular neurilemoma as shown on magnetic resonance (MR) scans and confirmed at operation. In six it was located in the upper limb, in five in the lower limb, and in one in the back. The mean age of the patients was 41 years (12 to 58). Nine complained only of a palpable mass and the other three of a mass with slight tenderness. None had neurological symptoms or signs, such as radicular pain, a positive Tinel sign, or motor weakness. There were no postoperative complications or recurrence of the tumour after a mean follow-up of two years (1 to 10).

We describe the development of methicillin-resistant Staphylococcus aureus osteomyelitis of the scaphoid in a 49-year-old man from an infection occurring around a catheter in the radial artery. Total scaphoidectomy and appropriate antibiotic therapy eradicated the infection.

Objectives The distribution of the transmission onset of COVID-19 relative to the symptom onset is a key parameter for infection control. It is often not easy to study the transmission onset time, as is difficult to know who infected whom exactly when. Methods We inferred transmission onset time from 72 infector-infectee pairs in South Korea, either with known or inferred contact dates by means of incubation period. Combining this data with known information of infector's symptom onset, we could generate the transmission onset distribution of COVID-19, using Bayesian methods. Serial interval distribution could be automatically estimated from our data. Results We estimated the median transmission onset to be 1.31 days (standard deviation, 2.64 days) after symptom onset with peak at 0.72 days before symptom onset. The pre-symptomatic transmission proportion was 37% (95% credible interval [CI], 16-52%). The median incubation period was estimated to be 2.87 days (95% CI, 2.33-3.50 days) and the median serial interval to be 3.56 days (95% CI, 2.72-4.44 days). Conclusions Considering the transmission onset distribution peaked with the symptom onset and the pre-symptomatic transmission proportion is substantial, the usual preventive measure might be too late to prevent SARS-CoV-2 transmission.