Miracle-dz/UniFAR-FTUs huggingface dataset:
Midterm Results of Comprehensive Surgical Reconstruction Including Sulcus-Deepening Trochleoplasty in Recurrent Patellar Dislocations With High-Grade Trochlear Dysplasia

Background: Trochlear dysplasia is one of the most consistent anatomic factors that can lead to recurrent patellar dislocations. Various trochleoplasty procedures have been described to treat patellar dislocations in high-grade dysplasia by creating a new congruent trochlea. Purpose: To present the midterm efficacy and outcome of the sulcus-deepening trochleoplasty procedure in patients with recurrent patellar dislocations due to high-grade trochlear dysplasia. The clinical evaluation results, the amount of radiological correction, and the prevalence of arthritis were recorded. Study Design: Case series; Level of evidence, 4. Methods: A total of 27 skeletally mature patients (31 knees) with recurrent patellar dislocations due to high-grade trochlear dysplasia without any previous surgery were retrospectively included from September 1993 to September 2006. All patients underwent sulcus-deepening trochleoplasty combined with a bony and/or soft tissue procedure according to concomitant etiological factors to patellar dislocations: medial patellofemoral ligament reconstruction (16.1%), vastus medialis obliquus plasty (83.8%), tibial tuberosity distalization (51.6%), tibial tuberosity medialization (67.7%), and lateral retinaculum release (67.6%). Mean follow-up was 7 years (range, 2-9 years). Results: The mean sulcus angle decreased significantly (P < .01) from 152° ± 16° preoperatively to 141° ± 9° postoperatively, tibial tuberosity–trochlear groove distance decreased significantly (P < .001) from 19 ± 4 mm to 12 ± 5 mm, and patellar tilt decreased significantly (P < .001) from 37° ± 7° to 15° ± 8°. No recurrence was observed, and there was no case of stiffness. Apprehension signs remained positive in 19.3% of the cases, patellar tracking was normal in all cases, and the lateral patellar glide test finding was negative in 96.8%. The mean preoperative International Knee Documentation Committee (IKDC) score was 51 (range, 25-80), and the mean postoperative IKDC score was 82 (range, 40-100) (P < .001), while the mean Kujala score improved from a preoperative 59 (range, 28-81) to 87 (range, 49-100) postoperatively (P < .001). There was no radiographic evidence of patellofemoral arthritis at the latest follow-up. Conclusion: Sulcus-deepening trochleoplasty is a valid option for the primary surgical treatment of carefully selected patients with recurrent patellar dislocations with high-grade trochlear dysplasia type B and D. Concomitant etiological factors must be cautiously corrected in an associated procedure. Midterm follow-up showed satisfactory restoration of patellar stability and improvement of knee scores with no complication of subsequent arthritis.
Land-Level Changes Produced by the Mw 8.8 2010 Chilean Earthquake

The 2010 Mw 8.8 Chilean earthquake ruptured ~500 kilometers and vertically displaced over 3 meters. We observed vertically displaced coastal and river markers after the 27 February 2010 Chilean earthquake [moment magnitude (Mw) 8.8]. Land-level changes range between 2.5 and –1 meters, evident along an ~500-kilometers-long segment identified here as the maximum length of coseismic rupture. A hinge line located 120 kilometers from the trench separates uplifted areas, to the west, from subsided regions. A simple elastic dislocation model fits these observations well; model parameters give a similar seismic moment to seismological estimates and suggest that most of the plate convergence since the 1835 great earthquake was elastically stored and then released during this event.
Complications of Esophageal Stenting and Balloon Dilation

The search for simple, nonoperative techniques to treat both benign and malignant esophageal obstructions has been ongoing since the 1800s. The traditional gastroenterologist's approach to benign strictures involves sequential dilation with bougies. The use of fluoroscopically guided balloon dilation began in 1981 when London et al. reported successful treatment of an esophageal stricture.1 Since that time, a number of interventionalists have found the technique to be relatively safe, effective, and simple to perform. Unfortunately, the response to dilation of the esophagus in the setting of malignant disease has been short-lived, with frequent treatment sessions required to treat recurrent dysphagia. Consequently, rigid endoprostheses were developed and have been used by gastroenterologists to palliate patients with malignant obstruction. In an effort to improve palliation and decrease complications, expandable metallic stents have been used with significant success to treat patients with malignant dysphagia. In addition, the use of covered metallic stents has recently been expanded to include the palliation of patients with aspiration symptoms from esophagorespiratory fistulae. In this article we review the literature and our own experience with complications of esophageal stenting and dilation.
Ku70 Corrupts DNA Repair in the Absence of the Fanconi Anemia Pathway

Righting Repair Pathways The genetic disease Fanconi anemia (FA) results from mutations in a series of genes involved in a DNA repair pathway that helps process the damage caused by erroneous chemical cross-links between the two strands of the DNA double helix. The double-stranded breaks in DNA that arise from such cross-links can be repaired in an error-free manner or through an error-prone repair pathway. Pace et al. (p. 219, published online 10 June) show that the FA pathway can drive repair through the error-free pathway. The FA FANCC gene shows a genetic interaction with a component of the error-prone repair pathway, Ku70, inhibiting its action and thereby promoting the error-free pathway. A specific pathway protects damaged DNA from error-prone repair. A conserved DNA repair response is defective in the human genetic illness Fanconi anemia (FA). Mutation of some FA genes impairs homologous recombination and error-prone DNA repair, rendering FA cells sensitive to DNA cross-linking agents. We found a genetic interaction between the FA gene FANCC and the nonhomologous end joining (NHEJ) factor Ku70. Disruption of both FANCC and Ku70 suppresses sensitivity to cross-linking agents, diminishes chromosome breaks, and reverses defective homologous recombination. Ku70 binds directly to free DNA ends, committing them to NHEJ repair. We show that purified FANCD2, a downstream effector of the FA pathway, might antagonize Ku70 activity by modifying such DNA substrates. These results reveal a function for the FA pathway in processing DNA ends, thereby diverting double-strand break repair away from abortive NHEJ and toward homologous recombination.
Electron-Like Scattering of Positronium

The atom formed from an electron and positron interacts with molecules almost as if it were a free electron. Positronium (Ps), a hydrogen-like atom composed of an electron and its antimatter partner, the positron, is formed in considerable quantities whenever positrons interact with matter. It has unexpectedly been found to scatter from a wide variety of atoms and molecules in a way very similar to that of a bare electron moving at the same velocity, despite Ps being neutral and twice the mass.
Calcific Tendinitis of the Rotator Cuff

Background: Calcific tendinitis of the rotator cuff (RCCT) is frequently diagnosed in patients with shoulder pain, but there is no consensus on its treatment. Purpose: To compare 2 regularly applied RCCT treatments: ultrasound (US)–guided needling and lavage (barbotage) combined with a US-guided corticosteroid injection in the subacromial bursa (subacromial bursa injection [SAI]) (group 1) versus an isolated SAI (group 2). Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Patients were randomly assigned to the 2 groups. Shoulder function was assessed before treatment and at regular follow-up intervals (6 weeks and 3, 6, and 12 months) using the Constant shoulder score (CS, primary outcome), the Western Ontario Rotator Cuff Index (WORC), and the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). Additionally, calcification location, size, and Gärtner classification were assessed on radiographs. Results were analyzed using the t test, linear regression, and a mixed model for repeated measures. Results: This study included 48 patients (25 female, 52.1%; mean age, 52.0 ± 7.3 years; 23 patients in group 1) with a mean baseline CS of 68.7 ± 11.9. No patients were lost to follow-up. Four patients in group 1 and 11 in group 2 (P = .06) had an additional barbotage procedure or surgery during the follow-up period because of persisting symptoms and no resorption. At 1-year follow-up, the mean CS in group 1 was 86.0 (95% CI, 80.3-91.6) versus 73.9 (95% CI, 67.7-80.1) in group 2 (P = .005). The mean calcification size decreased by 11.6 ± 6.4 mm in group 1 and 5.1 ± 5.7 mm in group 2 (P = .001). There was total resorption in 13 patients in group 1 and 6 patients in group 2 (P = .07). With regression analyses, correcting for baseline CS and Gärtner type, the mean treatment effect was 20.5 points (P = .05) in favor of barbotage. Follow-up scores were significantly influenced by baseline scores. Results for the DASH and WORC were similar. Conclusion: On average, there was improvement at 1-year follow-up in both treatment groups, but clinical and radiographic results were significantly better in the barbotage group.
Safety analysis for the extended schematic protection model

It is argued that the access matrix model of M.H. Harrison, W.L. Ruzzo and J.D. Ullman (HRU) (1976) has extremely weak safety properties; safety analysis is undecidable for most policies of practical interest. An alternate formulation of the HRU model is presented that gives strong safety properties. This alternative formulation is called the extended schematic protection model (ESPM). ESPM is derived from the schematic protection model (SPM) by extending the creation operation to allow multiple parents for a child, as opposed to the conventional create operation of SPM, which has a single parent for a child. It is shown that, despite its equivalence to HRU, ESPM, retains a tractable safety analysis for a large class of protection schemes that are of practical interest. <<ETX>>
Effect of platelet‐rich plasma with self‐assembled peptide on the rotator cuff tear model in rat

Several trials have been carried out to improve the healing of rotator cuff tear, but their effects remain controversial. In this study, we examined the therapeutic effect of platelet‐rich plasma (PRP) in combination with self‐assembled peptide (SAP) on the healing of rotator cuff tear in the rat. Twenty‐seven Sprague–Dawley rats, aged 15 weeks, were used for the rotator cuff tear model. The supraspinatus muscle at the insertion site was dissected and truncated, leaving the cut edge free. A week after the surgery, the rats were randomly divided into SAP, PRP, SAP–PRP and control groups and 0.2 ml SAP, PRP, SAP–PRP and saline were injected, respectively. Bonar scores and synovial inflammation grade were checked 5 weeks after the injection. Immunofluorescence staining for heat shock protein (HSP)‐70 and caspase‐3 was conducted. Furthermore, maximum stride length was measured before and at 2 and 4 weeks after the injection. The Bonar scores were 6.4 ± 1.8 in the SAP group, 5.9 ± 2.0 in the PRP group, 4.7 ± 1.1 in the SAP–PRP group and 8.3 ± 2.3 in the control group. There was significant difference between the SAP–PRP and control groups in post hoc multiple comparison analysis. Among four categories of Bonar scores, collagen arrangement and vascular infiltration showed improvement after SAP–PRP injection. Immunofluorescence images showed that HSP‐70 and caspase‐3 were much less expressed in the SAP–PRP group than in the other groups. In conclusion, SAP–PRP can be effective in healing a rotator cuff tear by enhancing the collagen arrangement and inhibiting inflammatory changes and apoptosis. Copyright © 2015 John Wiley & Sons, Ltd.
Human neural stem cell‐derived cultures in three‐dimensional substrates form spontaneously functional neuronal networks

Differentiated human neural stem cells were cultured in an inert three‐dimensional (3D) scaffold and, unlike two‐dimensional (2D) but otherwise comparable monolayer cultures, formed spontaneously active, functional neuronal networks that responded reproducibly and predictably to conventional pharmacological treatments to reveal functional, glutamatergic synapses. Immunocytochemical and electron microscopy analysis revealed a neuronal and glial population, where markers of neuronal maturity were observed in the former. Oligonucleotide microarray analysis revealed substantial differences in gene expression conferred by culturing in a 3D vs a 2D environment. Notable and numerous differences were seen in genes coding for neuronal function, the extracellular matrix and cytoskeleton. In addition to producing functional networks, differentiated human neural stem cells grown in inert scaffolds offer several significant advantages over conventional 2D monolayers. These advantages include cost savings and improved physiological relevance, which make them better suited for use in the pharmacological and toxicological assays required for development of stem cell‐based treatments and the reduction of animal use in medical research. Copyright © 2015 John Wiley & Sons, Ltd.
ATM Activation by Oxidative Stress

Stress, DNA Damage, and ATM The protein kinase ATM (ataxia-telangiectasia mutated) is a key component of the signaling pathway through which cells are protected from DNA damage. ATM becomes activated within a protein complex at sites of double-stranded breaks in DNA. ATM is also activated in response to increased production of reactive oxygen species (ROS). Such activation was thought to reflect DNA damage caused by ROS, but Guo et al. (p. 517) showed that ATM was in fact directly activated by ROS. A cysteine residue in ATM contributes to the formation of disulfide-linked dimers of activated ATM on exposure to ROS in vitro. Experiments using mutated forms of the enzyme suggested that two distinct mechanisms regulated ATM activity. The protein kinase ATM is a sensor for reactive oxygen species. The ataxia-telangiectasia mutated (ATM) protein kinase is activated by DNA double-strand breaks (DSBs) through the Mre11-Rad50-Nbs1 (MRN) DNA repair complex and orchestrates signaling cascades that initiate the DNA damage response. Cells lacking ATM are also hypersensitive to insults other than DSBs, particularly oxidative stress. We show that oxidation of ATM directly induces ATM activation in the absence of DNA DSBs and the MRN complex. The oxidized form of ATM is a disulfide–cross-linked dimer, and mutation of a critical cysteine residue involved in disulfide bond formation specifically blocked activation through the oxidation pathway. Identification of this pathway explains observations of ATM activation under conditions of oxidative stress and shows that ATM is an important sensor of reactive oxygen species in human cells.
E-Learning and Intelligent Planning: Improving Content Personalization

Combining learning objects are a challenging topic because of its direct application to curriculum generation, tailored to the students' profiles and preferences. Intelligent planning allows us to adapt learning routes (i.e., sequences of learning objects), thus highly improving the personalization of contents, the pedagogical requirements, and specific necessities of each student. This paper presents a general and effective approach to extract metadata information from the e-learning contents, a form of reusable learning objects, to generate a planning domain in a simple, automated way. Such a domain is used by an intelligent planner that provides an integrated recommendation system, which adapts, stores, and reuses the best learning routes according to the students' profiles and course objectives. If any inconsistency happens during the route execution, e.g., the student fails to pass an assessment test, which prevents him/her from continuing the natural course of the route, the system adapts and/or repairs the course to meet the new objectives.
Anatomic and Morphological Evaluation of the Quadriceps Tendon Using 3-Dimensional Magnetic Resonance Imaging Reconstruction

Background: The autograft of choice for anterior cruciate ligament (ACL) reconstruction remains controversial. The quadriceps tendon is the least utilized and least studied of the potential autograft options. Purpose: To determine if the quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are adequate, reproducible, and predictable when compared with the other commonly used autografts. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Axial proton density magnetic resonance imaging (MRI) scans of 60 skeletally mature patients (30 male and 30 female) were evaluated. Volumetric analysis of 3-dimensional models of the patellar and quadriceps tendons was performed before and after the removal of a 10 mm–wide graft from both tendons. Length, thickness, and width measurements of the quadriceps tendon were made at predetermined locations. Anthropometric data were collected, and subgroup analysis, sex analysis, and linear regression were performed. Results: The mean percentage of volume remaining after removal of a 10 mm–wide graft from the patellar tendon was 56.6%, compared with 61.3% when harvesting an 80 mm–long graft of the same width from the quadriceps tendon. The intra-articular volume of the proposed quadriceps tendon graft was 87.5% greater than that of the patellar tendon graft. The mean length of the quadriceps tendon was 73.5 ± 12.3 mm in female patients and 81.1 ± 10.6 mm in male patients. These measurements were most highly correlated with patient height. The width of the quadriceps tendon decreased as one proceeded proximally from its insertion, and the thickness of the quadriceps tendon remained relatively constant. Conclusion: The quadriceps tendon has the anatomic characteristics to produce a graft whose length and volume are both reproducible and predictable, while yielding a graft with a significantly greater intra-articular volume than a patellar tendon graft with a similar width.
Passive Anterior Tibial Subluxation in Anterior Cruciate Ligament–Deficient Knees

Background: Abnormal anterior-posterior and rotational motion secondary to anterior cruciate ligament (ACL) insufficiency is typically described in terms of dynamic laxity. An original description of the abnormal tibiofemoral relationship in the setting of ACL insufficiency has highlighted the presence of a fixed anterior tibial subluxation in this population of failed ACL reconstruction (ACLR); however, no study has quantified the degree of tibial subluxation in both the medial and lateral compartments. Purpose: To measure and compare the amount of anterior tibial subluxation among various states of ACL competency, including (1) intact ACL, (2) acute ACL disruption, and (3) failed ACLR (ie, patients requiring revision ACLR). We hypothesized that anterior tibial displacement would be greater in the lateral compartment and in cases of failed ACLR compared with intact and acute ACL injured states. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Using sagittal magnetic resonance imaging (MRI) and a standardized measurement technique, we determined the amount of anterior tibial subluxation relative to a constant posterior condylar reference point. Measurements were performed in both the medial and the lateral compartments and were compared with 1-way analysis of variance. The presence of meniscal tears along with meniscal volume loss and chondral damage was correlated with the amount of subluxation in each group. Results: Compared with the intact ACL state, the medial tibial plateau was positioned more anteriorly relative to the femur in both acute ACL injured knees (mean 1.0 mm) and those that failed ACLR (mean 1.8 mm) (P = .072). In the lateral compartment, there was 0.8 mm of mean anterior tibial displacement after acute ACL injury and 3.9 mm of mean anterior subluxation in patients who failed ACLR (P < .001). Mean anterior displacement of the lateral plateau in patients who failed ACLR was almost 5 times greater than the amount observed in patients with acute ACL injuries. There was no correlation between meniscal/chondral injury and the amount of subluxation. Conclusion: Patients who require revision ACLR have an abnormal tibiofemoral relationship noted on MRI that is most pronounced in the lateral compartment and should be taken into account during revision surgery. These observations may explain the suboptimal clinical results seen in some patients who undergo revision ACLR.
High‐dose recombinant human bone morphogenetic protein‐2 impacts histological and biomechanical properties of a cervical spine fusion segment: results from a sheep model

The 'off‐label' use of high‐dose recombinant human bone morphogenetic protein‐2 (rhBMP‐2) in lumbar and cervical fusion leads to heterotopic bone formation and vertebral osteolysis. These radiographically assessed side‐effects in patients were frequently associated with an over‐dosage of BMP‐2. However, little is so far known about the histological, functional or biomechanical tissue consequences of over‐dosage of rhBMP‐2 in these specific clinical situations. We hypothesized that a high dose of rhBMP‐2 in cervical spinal fusion could induce substantial alterations in bone, leading to mechanical impairment. An anterior cervical spinal fusion (C3–C4 ACDF) model in 16 sheep (aged > 2.5 years; n = 8/group) was used to quantify the consequences of a high rhBMP‐2 dose (6 mg rhBMP‐2) on fusion tissue compared to the 'gold standard' of autologous, cancellous bone graft. The fusion site was assessed by radiography after 0, 8 and 12 weeks. Biomechanical non‐destructive testing and (immuno)histological and histomorphometrical analyses were performed 12 weeks postoperatively. Although high‐dose rhBMP‐2 treatment led to an advanced radiological fusion result compared to autograft treatment, heterotopic bone formation and vertebral bone resorption were induced simultaneously. Histological evaluation unveiled highly active bone‐forming processes ventral to the fusion segment after 12 weeks, while radiolucent areas showed still a partial loss of regular trabecular structure, with rare signs of remodelling and restoration. Despite qualitative alteration of the trabecular bone structure within the fusion site, the massive anterior heterotopic bone formation led to a substantial increase in mechanical stiffness compared to the autograft group. Copyright © 2015 John Wiley & Sons, Ltd.