Controversy exists regarding tendon choice to substitute for a ruptured posterior tibial tendon. A similar debate about late Achilles tendon reconstruction also persists. To establish priorities and aid the surgeon's decision-making process, we studied 85 en bloc dissections of the second muscular layer of the sole. Muscular and tendinous interconnections were evaluated. Location and minimal donor deficit following harvest of the flexor digitorum longus make it the transfer of choice for posterior tibial tendon reconstruction. We suggest that relative strength, anatomic location, and available length of tendon make the flexor hallucis longus the superior choice for late Achilles tendon reconstruction.

In this multicenter trial, the effects of nebivolol added to an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor blocker (ARB) were assessed in patients with hypertension (diastolic blood pressure [DBP] 80-110 mm Hg) and prediabetes (fasting blood glucose 100-125 mg/dL and/or 2-hour oral glucose tolerance test [OGTT] 2 , 1.7 mmol/ L, and 1.3 mmol/L, respectively. At week 12, nebivolol and placebo groups demonstrated a decrease of À9.4 and À5.0 mm Hg, respectively (P<.001) for DBP and À10.4 and À7.8 mm Hg for SBP (P=.147). The mean changes in area under the curve OGTT were 0.0 mg/dL (nebivolol), 6.9 mg/ dL (HCTZ; P=.024 vs nebivolol), and À1.0 mg/dL (placebo). Adverse event-related discontinuation rates were 10.3%, 6.6%, and 2.0%, respectively. Nebivolol, added to an ACE inhibitor or ARB, provides additional blood pressure reduction with little or no effect on glucose metabolism in hypertensive patients with prediabetes. J Clin Hypertens (Greenwich). 2013;15:270-278. ª2013 Wiley Periodicals, Inc.It has been estimated that diabetes affects 13% of US adults, 1 which currently amounts to approximately 23 million people.2 Age-adjusted mortality among individuals with diabetes is about twice the mortality observed in individuals without diabetes, and this increased risk of mortality is not fully explained by the higher number of risk factors associated with diabetes. 3,4An additional 30% to 35% (53-62 million) of US adults have been estimated to have prediabetes, defined as impaired fasting glucose (IFG) levels (100-125 mg/ dL; 19% to 26% of the total population), impaired glucose tolerance (IGT; 2-hour levels after oral intake of 75 g glucose in the range of 140-199 mg/dL; 5% to 14%), or both (10%). 1,5 Such individuals are at a greater risk of developing diabetes 6 and, similar to those with diabetes, have a higher risk of cardiovascular (CV) mortality 7,8 compared with individuals with normal glucose levels.The situation is further complicated in individuals with hypertension, of whom approximately two thirds have been estimated to have prediabetes or diabetes.9 In that population, both prediabetes and diabetes have been associated with an increased risk of all-cause and CV-related mortality in a manner independent of coexisting hypertension.10,11 Because of this additional CV risk, the current guidelines for patients with hypertension and diabetes recommend more stringent goals for blood pressure (BP) control (<130/80 mm Hg) than for patients with uncomplicated hypertension (<140/90 mm Hg).12,13 The attainment of these goals typically requires therapy with ! 2 drugs.13-15 Recent meta-analyses suggest that a target systolic BP (SBP) in the range of 130 to 135 mm Hg is acceptable for patients with prediabetes or diabetes, except for those with a high risk of stroke, 16,17 in part because of a higher occurrence of serious adverse effects associated with drug-induced achievement of very low BP targets. 16 The 2010 American Diabetes Association's (ADA's) guidelines recommended angiotensin-co...

The aim of this study was to quantify the lengths of nerve segments within the brachial plexus. Twenty cadavers were dissected bilaterally, giving a total of 40 brachial plexuses for measurement. Individual lengths of plexus segments were measured and recorded, and means and standard deviations were calculated for all data. Differences between the means were statistically evaluated using the Student's t-test. Only 3 of 16 segments were found to be longer in women on average, which included the anterior division of the superior trunk, the anterior division of the middle trunk and the posterior division of the inferior trunk. All three cords (medial, lateral, and posterior) were found to be significantly different between genders, the longer segments being in males. Significant bilateral differences were also observed when right and left brachial plexuses from each cadaver were compared. Extra lateral heads (ELHs) to the median nerve were found in 50% of brachial plexuses, the anatomy of which varied bilaterally as well as between genders. Awareness of this variability is important both to anatomists and to clinicians who operate on and around the brachial plexus.

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