bluuebunny/crossref_metadata_2025 huggingface dataset:
DO TIBIAL EMINENCE FRACTURES AND ANTERIOR CRUCIATE LIGAMENT TEARS HAVE SIMILAR OUTCOMES?
Authors: Melugin Heath P. , Desai Vishal S. , Camp Christopher , Hewett Timothy E. , Milbrandt Todd A. , Dahm Diane L. , Levy Bruce A. , Stuart Michael J. , Krych Aaron J.
Published: March 2019

Background:

Avulsion fractures involving the tibial eminence are considered equivalent in etiology to anterior cruciate ligament tears, however there is limited data comparing outcomes of adolescent patients undergoing surgical fixation of tibial eminence fractures to those undergoing anterior cruciate ligament (ACL) reconstruction.

Purpose:

The purpose of this study was to compare clinical outcomes, subsequent ACL injury rates, and activity levels between adolescent patients who underwent tibial eminence fracture fixation to patients with mid-substance ACL tears who required acute ligament reconstruction.

Methods:

This study included a group of patients with tibial eminence fractures treated with surgical fixation matched to a group of similar patients with ACL tears treated with reconstruction between the years of 2001 and 2015. Data regarding initial injury, surgical intervention, ACL/ACL graft injury rates, and physical examination findings were recorded. Clinical and functional outcomes were obtained using physical examination, IKDC subjective scores, Lysholm scores, and Tegner Activity levels.

Results:

Sixty patients with a mean follow-up of 57.7 (24-206) months were included. 20 patients (11 M:9 F) who underwent surgical fixation for tibial eminence fractures (TEF) with a mean age of 11.9 (7-15) years were matched to a group of 40 patients (23 M:17 F) who underwent ACL reconstruction for ACL tears with a mean age of 12.5 (8-15) years. The TEF group demonstrated significantly lower postoperative IKDC (TEF group: 94.0, ACL group: 97.2 (p=0.04)) and Lysholm scores (TEF group: 92.4, ACL group: 96.9 (p=0.02)). The TEF group returned to sport 121 days sooner (p<0.01), but there was no difference in postoperative Tegner scores (TEF group: 7.3, ACL group: 7.6 (p=0.16)). The TEF group demonstrated increased postoperative anterior laxity (p=0.02) and a higher rate of postoperative arthrofibrosis (p=0.04). There was no difference in subsequent ACL injury (p=0.41).

Conclusion:

Patients with tibial eminence fractures demonstrated lower mean clinical outcome scores compared to patients with ACL tears at minimum 2-year follow up. Additionally, they experienced more postoperative anterior laxity and had a higher rate of postoperative arthrofibrosis. There was no difference in subsequent ACL injury rate. The TEF group returned to sport sooner than the ACL group, but the postoperative activity level was similar.
NOVEL TECHNIQUE FOR REPAIRING PARTIAL ACL TEARS: BIOMECHANICAL ANALYSIS OF AN OSTEOTOMY USING A CADAVERIC MODEL
Authors: Nhan Derek T. , Singh Prerna , Belkoff Stephen , Sullivan Brian T. , Klyce Walter , Lee R. Jay
Published: March 2019

Introduction:

Partial ACL tears can result in knee instability despite continuity of native ACL tissue with its femoral and tibial attachments. Though current treatment consists of replacement of the residual ACL, we propose that retensioning the residual ACL can restore knee stability. Thus, our aim was to assess if a coring osteotomy restores joint stability after a partial ACL tear in a cadaveric model.

Methods:

Adult cadaveric knees were used. Baseline translational and rotational measurements were obtained for each knee at 30° and 90° of knee flexion with a MTS Bionix 858 machine with the ACL intact, as well as after each subsequent intervention. First, we sectioned the anteromedial ACL bundle to replicate a partial ACL injury. Subsequently, an oblique coring osteotomy was performed. The osteotomy was both rotated to centralize and then distalized to retension the posterolateral ACL bundle. Finally, an ACL deficient knee was created as a control, involving complete sectioning of the ACL.

Results:

Each of the eight knees demonstrated varying degrees of baseline translational (range 3.9-15.8 mm at 90° and 6.2-15.6 mm at 30°) and rotational laxity. Sectioning of the anteromedial ACL bundle resulted in a significantly increased anterior translation in all of the knees at both 90° (p=0.041) and 30° (p=0.0088), without a statistically significant change in rotation (p=0.45). The coring osteotomy improved knee translation compared to the partial ACL injury state in all of the knees at 90° (p=0.0022) and 30° (p<0.001), again without a change in rotation (p=0.053). Five of the 8 osteotomized knees had less translation than the intact state, and the other 3, the values neared the intact state, had greater anterior translation than the intact state. Finally the ACL deficient knees demonstrated both increased translation compared to both the intact (p=0.0015 at 90° and p<0.001 at 30°) and partially sectioned states (p=0.036 at 90° and p=0.0094 at 30°).

Conclusions:

In our cadaveric model, we demonstrate that a coring osteotomy of the residual ACL fibers can be used to restore knee stability after a partial ACL tear, while preserving the native ACL. Further studies are needed to validate this procedure. [Figure: see text][Figure: see text]
BORDERLINE DYSPLASIA: ARE THESE HIPS ONLY MILDLY UNCOVERED?
Authors: McClincy Michael , Wylie James , Yen Yi-Meng , Novais Eduardo
Published: March 2019

Background:

Controversy surrounds classification and treatment of hips with a lateral center-edge angle (LCEA) between 18° and 25°. It remains undetermined as to whether open or arthroscopic procedures are best used to treat patients with borderline dysplasia. We hypothesized that patients with hip pain and borderline acetabular dysplasia have different features of acetabular morphology as determined by other relevant radiographic measures beyond the LCEA.

Methods:

A retrospective review of patients undergoing hip preservation surgery between January 2010 and December 2015 with either periacetabular osteotomy(PAO) or hip arthroscopy with a LCEA between 18° and 25° was performed. Anteroposterior, Dunn lateral and false profile radiographs were used to measure LCEA, Tönnis Angle, anterior center edge angle (ACEA), anterior (AWI) and posterior (PWI) wall indexes, the femoral epiphyseal acetabular roof (FEAR) index, joint space width, crossover sign, posterior wall sign, P/A index, and femoral alpha angle. An agglomerative hierarchical clustering analysis was then performed on the continuous radiographic variables to identify different subtypes of hip pathomorphology among this patient cohort. There were sex-specific trends in hip morphology. Therefore, we proceeded to perform separate cluster analyses for each sex.

Results:

Ninety-nine patients underwent surgery in the study period, 77 (78%) were female, and 81 (82%) of these had complete radiographic images for cluster analysis. Mean age was 22.6 years. Hip arthroscopy was performed in 41% of patients and periacetabular osteotomy was performed in 59% of patients. The ACEA (45%), FEAR Index (34%), and AWI (30%) were the most commonly abnormal radiographic parameters among all patients. In female patients, the ACEA (55%), FEAR Index (42%), and AWI (34%) were the most commonly abnormal radiographic parameters. In male patients, an insufficient PWI (48%) was the most common radiographic abnormality. For females, we identified three clusters representing different patterns of hip morphology: impingement morphology; lateral acetabular deficiency, and anterolateral acetabular deficiency (Table 1A). For males, we identified three clusters: postero-lateral acetabular deficiency with global cam morphology, postero-lateral acetabular deficiency with focal cam morphology, and lateral acetabular deficiency without cam morphology (Table 1B).

Conclusions:

A comprehensive evaluation of radiographic parameters in patients with LCEA 18-25° identifies sex-specific trends in hip morphology and shows a large proportion of dysplastic features among these patients. A thorough evaluation of all pelvic morphology, not just lateral coverage, should be considered when indicating these patients for hip preservation surgeries. Further studies are needed to investigate the outcomes of patients within each of the identified clusters to determine optimal treatment options for each group. [Table: see text][Table: see text]
COULD LOWER EXTREMITY INJURIES INCREASE BMI IN CHILDREN?
Authors: Mastrocola Marissa , McCoy Amanda , Gleeson Rubello
Published: March 2019

PURPOSE:

The purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients.

INTRODUCTION:

Over the past 30 years, childhood obesity has significantly increased. Lack of physical activity and rising levels of sedentary living are associated with rising childhood obesity. As the effects of childhood obesity are long lasting, it is important to characterize childhood conditions that lead to increases in BMI. Traumatic lower extremity injuries in children commonly result in casting and forced immobilization. Children and adolescents who cease physical activity at a younger age are at a higher risk for weight gain and inactive lifestyles as adults. Presently, the data examining short term and longitudinal effects of injury on weight changes are lacking. Therefore, the purpose of this investigation is to examine the relationship between forced sedentariness attributed to the management of a lower extremity injury and change in BMI in pediatric patients.

METHODS:

Eighty eight subjects aged 5 to 18 with lower extremity fractures managed with non-weight bearing for a minimum of 6 weeks were identified. This group was compared to a cohort of controls, who presented to the pediatric orthopaedic clinic for upper extremity injuries. For each subject, BMI was calculated from height and weight data obtained at each clinic visit for which the data were available for a minimum of 6 months. Percent change in BMI was then calculated and compared between the lower extremity injury group and controls utilizing ANOVA. Logistic regression was then performed to determine if age, gender, and undergoing surgery were correleated with a BMI change of greater than 10%.

RESULTS:

The results of initial ANOVA analysis demonstrated no difference in BMI trends between children with lower extremity injuries and controls. On average, both groups showed a modest increase in BMI over time (lower extremity injuries = 3.40%, controls = 3.23%). Logistic analysis of the lower extremity revealed male gender to be associated with a 10% increase in BMI during the study period, though this was not significant (p = 0.153)

CONCLUSIONS:

Our investigation yielded a negative result. As there is limited literature on BMI trends in children, our power calculation may have underestimated the subjects needed to demonstrate a statistically significant difference between groups.

SIGNIFICANCE:

The increases observed in both groups may indicate that the experience of being injured is associated with increases in BMI regardless of the location of injury. Further investigation would involve assessing BMI trends prospectively to identify opportunities to obviate possible weight gain with injury.
GENDER DISPARITIES IN PATIENT-REPORTED OUTCOMES OF SPORTS-RELATED CONCUSSION PATIENTS
Authors: Rizzone Katherine , Hollaway Jessica , Houck Jeffrey
Published: March 2019

Background

Patient-Reported Outcomes Measurement Information System (PROMIS) scales have been utilized to assess symptoms in a variety of medical conditions but have not been previously examined in patients with sports-related concussions. Our objective was to analyze PROMIS scores of University of Rochester Medical Center’s concussion patients to assess for demographic differences in symptoms and recovery.

Methods:

ICD9/10 codes retrospectively identified 214 concussion patients (51% female) less than 30 years old (mean age 15.1 +/- 2.3 years) with PROMIS metrics for physical function, pain and depression. Minimal clinically important difference for these domains is considered 4 points. Two-way ANOVA assessed the influence of gender on PROMIS domains with age as a covariate. T-tests measured the association of gender with the number of previous concussions and clinic visits. Multiple linear regression was utilized to assess the influence of the listed variables on the number of clinic visits.

Results:

Females initially present with 4.0 points lower physical function (95% Confidence interval (CI) 1.5-6.6), 5.8 points (95% CI 3.3-8.3) higher pain interference and 5.4 points (95% CI 2.7-8.2) higher depression compared to males (p <0.01). The history of previous concussions did not differ by gender (1.2 ± 0.1 for females vs. 1.2 ± 0.1 for males), however, the number of visits per episode of care was greater for females (females=8.7±0.4 vs. males=5.3±0.6, p <0.01). Multiple linear regression showed that gender, pain rating, and physical function were significant predictors of the number of clinic visits (r-value = 0.35, p <0.01).

Conclusions:

In our clinic, females and males report concussion at the same prevalence, but post-concussive females experienced statistically significant greater pain and depression and lower physical function compared to their male counterparts. Gender was not associated with the number of previous concussions, but did influence the number of visits. The combination of gender, physical function, and pain were significantly correlated with number of visits, and these variables may be considered in future efforts to determine prognosis of recovery at intake post-concussion.
THE UTILITY OF STABILITY AND TEAR LOCATION IN A CLASSIFICATION SYSTEM FOR DISCOID MENISCUS SURGICAL PLANNING
Authors: Yang Brian W. , Logan Catherine , Williams Kathryn , Tepolt Frances , Paschos Nikolaos , Kocher Mininder S.
Published: March 2019

Background

Discoid meniscus (DM) is a congenital variant that typically affects the lateral meniscus of the knee. Despite the presence of multiple classification systems for DM, no system has demonstrated utility in treatment planning. We performed a retrospective review of discoid menisci that underwent surgical intervention at our institution to assess for discoid meniscus characteristics associated with surgical treatment with or without repair. Next, we propose a new method of classifying lateral discoid meniscus and demonstrate its efficacy in predicting surgical treatment.

Methods

We searched the orthopedic database at our institution for patients who underwent surgical treatment for lateral discoid meniscus between 1991 and 2017. Clinical records were reviewed to determine the type of DM surgery performed (surgery with or without repair) as well as DM morphology, stability, tear presence, tear location, and tear type. Univariate associations between DM characteristics and surgery type were calculated and multivariable logistic regression models of surgery type were created. Based on the univariate analysis and logistic regression models, we propose a new classification system for discoid meniscus.

Results

There were 434 knees with discoid lateral menisci that received surgical treatment at our institution between 1991 and 2017. In univariate analysis, unstable menisci (93%, p<0.001) and menisci with a tear including the periphery (75%, p<0.001) were more likely to receive surgery with repair. By itself, instability demonstrated 89% sensitivity and 94% specificity in predicting surgery with repair. The main effects logistic regression model including stability and tear showed that that the odds of unstable lateral discoid menisci receiving surgery with repair was 133.1 times higher than stable menisci (p<0.001) while lateral discoid menisci that had a tear including the periphery had 6.54 times higher odds of receiving repair than those that had a tear in the central portion only (p<0.001).

Conclusions/Significance

Lateral discoid menisci stability and tear location were associated with surgical treatment type in both univariate analysis and logistic regression models (Table 1). Based on our results and clinical relevance, we propose a classification system for DM with utility in surgical treatment planning. Menisci are classified by stability (Stable (S0), Unstable (S1)), morphology (Incomplete (M0), Complete (M1)), and Tear (No tear (T0), Central tear (T1), or Peripheral tear (T2)) (Figure 1).

Tables and Figures

[Table: see text][Figure: see text]
OUTCOMES OF ARTHROSCOPIC BANKART REPAIR IN THE PEDIATRIC AND ADOLESCENT POPULATION: HIGH RATES OF FAILURE
Authors: Pandya Nirav K. , Kramer Jonathan
Published: March 2019

BACKGROUND

Shoulder instability is an increasingly common problem in the pediatric and adolescent population. As with anterior cruciate ligament reconstruction, surgical intervention in this population is becomingly increasingly common. Yet, although failure rates are much higher in this active population there has been limited examination of this population in the literature. The purpose this study was to review treatment of adolescent shoulder instability and to discuss factors influencing its management; particularly recurrent instability.

METHODS

A retrospective cohort study was performed at a single center. Inclusion criteria consisted of all adolescent aged patients identified who (1) had complaints of shoulder instability, (2) had radiographic findings consistent with anterior-inferior capsulolabral injury, (3) had documented evidence of a dislocation event, and (4) underwent arthroscopic shoulder stabilization. Patient demographics, pre-operative history and physical, imaging, surgical details, and post-operative complications were analyzed.

RESULTS

Thirty-six patients were identified with a mean follow-up 3.07 ± 1.2 years. The average patient age at the time the index procedure was 16.03 ± 1.67 years. All patients underwent arthroscopic shoulder stabilization consisting of arthroscopic Bankart repair. Five patients also underwent a remplissage. Nine patients (25.0%) developed a repeat dislocation following surgery. This occurred on average 20.67 months postoperatively (range 5-51 months). No single sport was associated with a statistically significant increased risk of re-dislocation. American football was the most common sport in both the stable and re-dislocated groups. Patients who re-dislocated had a higher frequency of a Hill-Sachs lesion on MRI (89%) compared to those who did not re-dislocate (52%) (p=0.048). Off-track lesions were not associated with repeat instability.

CONCLUSIONS / SIGNIFICANCE

The current study demonstrates that adolescent patients treated with arthroscopic shoulder stabilization have a high rate of recurrence of shoulder dislocations, particularly in the setting of a concomitant Hills-Sachs lesion. Patients may benefit from more aggressive stabilization strategies and techniques. Further prospective multi-center studies are necessary to determine the reasons for the high rate of re-dislocation in this population and develop strategies for prevention.
COMPARISON OF POSTOPERATIVE PAIN SCORES AND MEDICATION USAGE BETWEEN THREE PAIN CONTROL STRATEGIES FOR PEDIATRIC ANTERIOR CRUCIATE LIGAMENT (ACL) SURGERY
Authors: Lovejoy John F. , Santana Lisgelia , Atanda Alfred , Mandel David , Day Jason , Kiebzak Gary M.
Published: March 2019

Background:

Assessment and management of postoperative pain in the pediatric population after ACL surgery can be challenging, and the optimal approach to pain control remains controversial. Recent studies have shown that the use of intraoperative nerve blocks may reduce the need for opioids to control pain in the immediate postoperative period. However, it is not clear which block type is the most beneficial for the pediatric outpatient setting. The objective of our study was to compare effectiveness of pain control between three different pain management strategies in the pediatric ACL population.

Methods:

A retrospective chart review from 2013-2017 of patients ages 12-17 receiving an elective ACL reconstruction. Three types of analgesia were included: femoral nerve block, combined femoral + sciatic block, and intraarticular injection of bupivacaine with cold therapy in the Post Anesthesia Care Unit (PACU) (each used by three different surgeons as their standard preference in three different hospitals), n = 50 per group. The primary variable was postoperative pain scores (visual analog scale 1-10) in the PACU. Secondary variables collected were demographic data, graft type, time in PACU and intraoperative/postoperative opioid use.

Results:

The mean (+ SD) age of the cohort was 15.3 + 1.4 years; there were no differences in age, BMI or ratio of boys and girls between the 3 groups (n=50 per group). However, the femoral nerve block group had a significantly lower percentage of Caucasians (28%, P = 0.002) compared to the group with combined blocks (58%) and intraarticular injection (56%). Less than 50% of patients in the combined nerve block group had opioids intraoperatively or in the PACU compared to nearly 100% of patients in the other two groups (P < 0.0001). Also, for patients receiving opioids, the total intraoperative morphine equivalents and PACU pain scores (all patients) were significantly less in the combined block group (P < 0.001). For patients receiving opioids in the PACU, the total morphine equivalents was significantly higher in the intraarticular injection group compared to the nerve block groups (P < 0.0001). Total time in the PACU was 25% longer for patients in the combined block group (P < 0.0001).

Conclusion:

Patients in the combined femoral and sciatic nerve block group had significantly better pain scores in the PACU with less cumulative morphine equivalent consumption compared to the femoral nerve block group and the intraarticular injection group.
ARTICULAR CARTILAGE THICKNESS OF THE PEDIATRIC KNEE: IMPLICATIONS FOR CARTILAGE IMPLANTATIONS
Authors: Rustad Audrey , Anchustegui Nicolas G. , Troyer Stockton , Shea Cooper , Dingel Aleksei , Shea Kevin
Published: March 2019

Background:

While access to pediatric tissue for cartilage conditions is limited, recent research on the use of pediatric cartilage tissue for implantation has shown promising results. These pediatric grafts may include bulk osteochondral allografts, morselized cartilage, or cellular manipulation products. The purpose of this study was to evaluate the parameters of cartilage thickness in different regions of the pediatric knee from a larger pediatric knee specimen research database.

Methods:

CT Scans of 12 skeletally immature knees ranging from ages 7 to 11 were evaluated. Cartilage thickness measurements were taking in the following regions: 1. Femoral Condyles - Cahill Zones 1, 2, 4, and 5 (Fig. 1) on coronal plane CT images, the region of greatest cartilage thickness on medial and lateral femoral condyles using coronal plane CT images, and Cahill Zones A, B, and C on sagittal plane CT images (Fig. 2). 2. Tibial Plateau – the region of greatest cartilage thickness identified on the medial and lateral sides of the tibial plateau using coronal plane CT images (Fig. 1). 3. Patella – the region of greatest cartilage thickness identified on axial and sagittal CT images (Fig. 3 and 4).

Results:

The cartilage on the medial femoral condyle had an average thickness of 4.86 mm ± 0.61 mm at its thickest point and the cartilage on lateral femoral condyle had an average thickness of 3.71 mm ± 0.52 mm at its thickest point. The cartilage on the medial tibial plateau had an average thickness of 2.80 mm ± 0.26 mm at its thickest point and the cartilage on the lateral tibial plateau had an average thickness of 3.29 mm ± 0.45 mm at its thickets point. The cartilage on the midpoints of Cahill zones 1, 2, 3, and 4 had an average thickness of 2.93 mm ± 0.62 mm, 3.42 mm ± 0.66 mm, 2.81 mm ± 0.46 mm, and 3.30 mm ± 0.73 mm respectively. The cartilage on the midpoints of Cahill zones A, B, and C had an average thickness of 3.81 mm ± 0.68 mm, 4.40 mm ± 0.49 mm, and 3.82 mm ± 0.68 mm respectively. The cartilage at its thickest point on the patella had an average thickness of 4.53 mm ± 0.38 mm from an axial view and 4.40 mm ± 0.49 mm from a sagittal view (Fig. 5 and 6).

Conclusion:

Pediatric knees demonstrate relatively thick cartilage regions in multiple zone of the knee, compared with adult specimens. Increasing access to and use of this tissue for cartilage grafts, non-manipulated tissue, and manipulated tissue offer significant opportunity to address cartilage loss. Osteochondral allograft procedures may benefit from access to such tissue, with relatively high volume and thickness of normal articular cartilage. [Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text][Figure: see text]
Bridge-Enhanced ACL Repair: Two Year Results of the First In Human Study
Authors: Murray Martha M. , Kalish Leslie , Fleming Braden C. , Flutie Brett , Thurber Laura , Freiberger Christina , Henderson Rachael , Perrone Gabriel , Proffen Benedikt , Kramer Dennis E. , Yen Yi-Meng , Micheli Lyle J.
Published: March 2019

Objectives:

The Bridge-Enhanced ACL Repair (BEAR) procedure is an alternate form of anterior cruciate ligament (ACL) surgery that involves suture repair of the ligament combined with a scaffold to bridge the gap between the torn ligament ends. In this paper, we report outcomes of this procedure and a non-randomized concurrent control group receiving ACL reconstruction with quadrupled hamstring tendon autograft. We hypothesized that patients treated with Bridge-Enhanced ACL Repair would have physical exam findings, patient reported outcomes and adverse events at one and two years that were similar to patients treated with ACL reconstruction.

Methods:

This was an observational cohort study. Twenty patients were enrolled. Ten patients received a Bridge-Enhanced ACL Repair (BEAR®) and 10 received a hamstring autograft ACL reconstruction. Outcomes were assessed at time points up to 2 years post-operatively, including the International Knee Documentation Committee (IKDC) Subjective Score, the IKDC Objective score, KT-1000 testing for AP laxity and functional testing.

Results:

There were no graft or repair failures in the first two years after surgery. The IKDC Subjective Scores in both groups improved significantly from baseline (p< 0.0001) but were similar in BEAR and ACL reconstruction groups at 12 and 24 months. An IKDC Objective score of A (normal) was found in 44% of the patients in the BEAR group and 29% of the patients in the ACL reconstruction group at two years; no patients in either group had a grade of C (abnormal) or D (severely abnormal). KT-1000 testing demonstrated a side to side difference that was similar in the two groups at 2 years (mean(±SD) 1.9(± 2.1) mm in the BEAR group, 3.1(± 2.7) mm in the ACLR group). Functional hop testing results were similar in the two groups at 1 and 2 years after surgery. Hamstring strength indices measured by dynamometer were significantly higher at all time points in the BEAR group than in the hamstring autograft group (mean percentages relative to contralateral side at two years, 98.6%(±10.5%) vs 56.3%(±19.0%), p=0.0001).

Conclusion:

In a small first-in-human study, Bridge-Enhanced ACL Repair produced similar outcomes to ACL reconstruction with autograft quadruple bundle hamstring tendon.
Complementary therapies for patients with systemic sclerosis
Authors: Showalter Kimberly , Hoffmann Aileen , DeCredico Nicole , Thakrar Anjali , Arroyo Esperanza , Goldberg Isaac , Hinchcliff Monique
Published: March 2019

Patients with systemic sclerosis often seek information regarding complementary and nutrition-based therapy. Some study results have shown that vitamins D and E, probiotics, turmeric, l-arginine, essential fatty acids, broccoli, biofeedback, and acupuncture may be beneficial in systemic sclerosis care. However, large randomized clinical trials have not been conducted. This review summarizes current data regarding various complementary therapies in systemic sclerosis and concludes with recommendations.
RETRACTED ARTICLE: TMED3 promotes cell proliferation and motility in breast cancer and is negatively modulated by miR-188-3p
Authors: Pei Jing , Zhang Jing , Yang Xiaowei , Wu Zhengsheng , Sun Chenyun , Wang Zhaorui , Wang Benzhong
Published: March 2019

Background

The role of TMED3 involved in cancers has been seldom described, let alone in breast cancer. To explore the clinicopathological significance of TMED3 expression and the biological roles involved in breast cancer cells, we undertook the study.

Methods

Immunohistochemistry was performed to observe the pattern of TMED3 expression in breast cancer tissues, totaling 224 cases; followed by detailed statistical analysis between TMED3 expression versus clinicopathological information available. To explore the role of TMED3 involved in the malignant behaviors of breast cancer cells, wound-healing and Transwell assays were conducted to evaluate the variation of migration and invasion of MCF-7 and MDA-MB-231 cells whose TMED3 has been stably silenced using lenti-viral based short hairpin RNA (shRNA) vectors. MTT, clonogenic assay and xenograft nude mice model were undertaken to observe the variation of proliferation both in vitro and in vivo.

Results

It was shown that elevated TMED3 markedly correlated with ER, PR, Her-2 status, and lymph nodes metastases in addition to significant association with poor overall prognosis. In vitro, TMED3 was shown to promote proliferation, migration and invasion of breast cancer cells. Moreover, miR-188-3p was identified as a novel negative regulator of TMED3 in breast cancer, which can slow down the proliferation, migration and invasion of MCF-7 cells. Results from in vivo xenograft nude mice models showed that lenti-viral based miR-188-3p re-expression can markedly impair the tumor growth.

Conclusions

Our data define and bolster the oncogenic role of TMED3 in breast cancer.
Gender differences in attitudes and attributes of people using therapeutic shoes for diabetic foot complications
Authors: Jarl Gustav , Alnemo John , Tranberg Roy , Lundqvist Lars‐Olov
Published: March 2019

Background

Therapeutic shoes can prevent diabetic foot reulcerations but their use is complicated by the fact that shoes have psychological and social meanings, which is believed to put a larger burden on women than men. The aim was to compare attitudes and attributes of women and men using therapeutic shoes for diabetic foot complications.

Methods

A questionnaire was posted to 1230 people with diabetes who had been fitted with therapeutic shoes. Women's and men's answers were compared using t‐tests, Mann–Whitney U tests and chi‐square tests with Fischer's exact tests. P‐values < 0.05 were considered statistically significant.

Results

Questionnaires from 443 (36.0%) respondents (294 men, 149 women, mean age 69.2 years) were analyzed. More men than women (p < 0.05) had paid employment (20.4% vs 9.4%), had someone who reminded them to wear their therapeutic shoes (27.6% vs 10.0%), and had a history of foot ulcers (62.9% vs 46.3%) or minor amputation (17.7% vs 6.7%). More women than men received disability pension (18.8% vs 10.2%). Women reported worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes to the appearance and price of therapeutic shoes and how they felt about wearing them in public. Other comparisons were non‐significant: other shoe attributes, education, diabetes type, current foot ulcers, major amputations, satisfaction with shoe services, understanding of neuropathy as a risk factor, locus of control regarding ulcer healing, belief in the shoes' efficacy to prevent and heal ulcers, worries about ulcer healing and new ulcerations, self‐efficacy, depression, shoe use/adherence, paying a fee for therapeutic shoes, and social support.

Conclusions

Men had worse foot complications. Women had worse general health, lower internal locus of control regarding ulcer prevention, and more negative attitudes toward therapeutic shoes. Clinicians should pay more attention to their female patients' concerns. Future research and development should focus on improving the weight and appearance of therapeutic shoes, particularly for women. Research is also needed on how to facilitate the adaption and reevaluation process where patients change from viewing shoes purely as items of clothing to also viewing them as medical interventions.
Mucinous colorectal adenocarcinoma: clinical pathology and treatment options
Authors: Luo Cong , Cen Shuyi , Ding Guojun , Wu Wei
Published: March 2019

Mucinous colorectal adenocarcinoma is a distinct subtype of colorectal cancer (CRC) characterized by the presence of abundant extracellular mucin which accounts for at least 50% of the tumor volume. Mucinous colorectal adenocarcinoma is found in 10%–20% of CRC patients and occurs more commonly in female and younger patients. Moreover, mucinous colorectal adenocarcinoma is more frequently located in the proximal colon and diagnosed at an advanced stage. Based on its molecular context, mucinous colorectal adenocarcinoma is associated with the overexpression of mucin 2 (MUC2) and mucin 5AC (MUC5AC) proteins. At the same time, it shows higher mutation rates in the fundamental genes of the RAS/MAPK and PI3K/Akt/mTOR pathways. Mucinous colorectal adenocarcinoma also shows higher rates of microsatellite instability (MSI) than non‐mucinous colorectal adenocarcinoma which might correlate it with Lynch syndrome and the CpG island methylator phenotype. The prognosis of mucinous colorectal adenocarcinoma as to non‐mucinous colorectal adenocarcinoma is debatable. Further, the impaired responses of mucinous colorectal adenocarcinoma to palliative or adjuvant chemotherapy warrant more studies to be performed for a specialized treatment for these patients. In this review, we discuss the molecular background and histopathology of mucinous colorectal adenocarcinoma, and provide an update on its prognosis and therapeutics from recent literatures.
Nematicidal actions of the marigold exudate α-terthienyl: oxidative stress-inducing compound penetrates nematode hypodermis
Authors: Hamaguchi Takahiro , Sato Kazuki , Vicente Cláudia S. L. , Hasegawa Koichi
Published: March 2019

α-terthienyl is an allelochemical derived from the roots of marigold (Tagetes spp.), which is used to suppress plant parasitic nematodes. We investigated the nematicidal activity of α-terthienyl against the model organism Caenorhabditis elegans and the root-knot nematode, Meloidogyne incognita. As reported previously, α-terthienyl action was much higher after photoactivation, but was still effective against C. elegans dauer larvae and M. incognita second stage juveniles even without photoactivation. Expression induction of two major enzymes, glutathione S-transferase (GST) and superoxide dismutase (SOD), was restricted in C. elegans hypodermis following treatment with α-terthienyl. The susceptibility of nematodes to α-terthienyl changed when the expression of GST and SOD was induced or suppressed. From these results, under dark conditions (without photoactivation), α-terthienyl is an oxidative stress-inducing chemical that effectively penetrates the nematode hypodermis and exerts nematicidal activity, suggesting high potential for its use as a practicable nematode control agent in agriculture.
Recapitulating Parkinson's disease pathology in a three-dimensional human neural cell culture model
Authors: Taylor-Whiteley Teresa R. , Le Maitre Christine L. , Duce James A. , Dalton Caroline F. , Smith David P.
Published: March 2019

Extensive loss of dopaminergic neurons and aggregation of the protein α-synuclein into ubiquitin-positive Lewy bodies represents a major neuropathological hallmark of Parkinson's disease (PD). At present, the generation of large nuclear-associated Lewy bodies from endogenous wild-type α-synuclein, translationally regulated under its own promoter in human cell culture models, requires costly and time-consuming protocols. Here, we demonstrate that fully differentiated human SH-SY5Y neuroblastoma cells grown in three-dimensional cell culture develop Lewy-body-like pathology upon exposure to exogenous α-synuclein species. In contrast to most cell- and rodent-based PD models, which exhibit multiple diffuse α-synuclein aggregates throughout the cytoplasm, a single large nuclear inclusion that is immunopositive for α-synuclein and ubiquitin is rapidly obtained in our model. This was achieved without the need for overexpression of α-synuclein or genetic modification of the cell line. However, phosphorylation of α-synuclein within these inclusions was not observed. The system described here provides an ideal tool to screen compounds to therapeutically intervene in Lewy body formation, and to investigate the mechanisms involved in disease progression in synucleinopathies.
Obesity Prevalence and Musculoskeletal Injury History in Probation Officers
Authors: MOTA JACOB A. , KERR ZACHARY Y. , GERSTNER GENA R. , GIULIANI HAYDEN K. , RYAN ERIC D.
Published: March 2019

Purpose

The purpose of the present investigation was to identify 1) the prevalence of overweight and obesity and 2) factors associated with previous work-related musculoskeletal injury, and physical activity (PA) levels in North Carolina probation officers.

Methods

North Carolina probation officers (N = 1866) were sent a questionnaire on demographics, work history, injury history, and PA. A multivariable logistic regression model estimated the odds of reporting work-related musculoskeletal injury history within the past year, and multivariable ordinal logistic regression estimated the odds of reporting lower PA levels in the previous month. Odds ratios (OR) with 95% confidence intervals (CI) excluding 1.00 were deemed significant.

Results

Complete data were available for 1323 probation officers (70.9% completion rate; 46.5% female; mean ± SD age, 39.9 ± 10.0 yr). Officers that were classified as overweight and obese were 80.8% (body mass index [BMI] ≥ 25 kg·m−2), with 49.9% and 9.5% categorized as obese (BMI ≥ 30 kg·m−2) and severely obese (BMI ≥ 40 kg·m−2), respectively. Being older (1-yr increase; OR, 1.06; 95% CI, 1.04–1.09) and severely obese (compared to normally weighted; OR, 2.56; 95% CI, 1.19–5.51) was associated with a greater odds of sustaining a work-related musculoskeletal injury in the past year. A higher number of years of employment (1-yr increase; OR, 1.03; 95% CI, 1.01–1.04), being overweight or obese (compared to normal weight; OR, 1.57–3.22) and being female (compared with male: OR, 0.38; 95% CI, 0.31–0.47) was associated with the greater odds of lower PA levels in the previous month.

Conclusions

The prevalence of obesity is alarmingly high in probation officers, and is associated with a greater likelihood of sustaining previous work-related musculoskeletal injury and engaging in lower amounts of PA. Public safety administrators may consider worksite exercise/diet interventions and annual physical employment standards to combat obesity.
New Product Preannouncement: Phantom Products and the Osborne Effect
Authors: Rao Ram , Turut Ozge
Published: March 2019

The mere preannouncement of a new product can affect consumer choice, thus complicating preannouncement strategy. This is because a preannounced product that is unavailable immediately can still be one of the alternatives in a consumer’s mind at the time of choice. Such unavailable products, also known as phantom products, influence the reference point that consumers compare alternatives to when making a choice, as has been widely demonstrated in experimental studies. Thus, in addition to encouraging consumers to postpone purchase in favor of a future product, preannouncement also changes their preference for the currently available products when consumers do not prefer to postpone. In this paper we explore preannouncement strategy by analyzing a model that incorporates the effect of new product preannouncement (NPP) on consumer preferences and compare the results with a benchmark case in which consumer preferences across the existing products are not influenced by preannouncement. We find that when we take into account the effect of NPP on consumer preferences across the existing products, although postponement of purchase by some consumers remains beneficial, the preference for the current product offering with a lower quality can suffer so much that the significant lowering of current profits is not offset by future gains. Thus, preannouncement may no longer be the optimal strategy for the firm with a lower-quality product, which in turn explains the “Osborne effect.” Our results also challenge the conventional wisdom in new product preannouncement literature.

This paper was accepted by Juanjuan Zhang, marketing.
Complementary and alternative medicine use during chemotherapy for neuroendocrine tumours
Authors: Whyand Tara , de Lima Yasmin Chotai , Davies Philippa
Published: March 2019

Exploring the patient experience of complementary and alternative medicine (CAM) can provide insight into the needs, preferences and values of patients with an neuroendocrine tumour (NET). Use and interest in CAM after a NET diagnosis has not been investigated until now. The authors aimed to identify the types of CAM being used by patients undergoing chemotherapy and what types of CAM patients considered most beneficial. Patients were identified for clinical audit from one hospital's NET nurse chemotherapy database. A questionnaire was given to 79 patients who had completed intravenous chemotherapy during the previous 3 years. CAM use by NET patients was found to be popular and included practices to support both physical and emotional health. Massage and taking vitamin and mineral supplements were most widely used. The antioxidant effects of some high-dose supplements may impact on chemotherapy outcomes. Massage, despite its irregular use, was perceived by patients to be the most useful CAM.
The urgent need to make NHS mental health care safer
Authors: Tingle John
Published: March 2019

John Tingle discusses some recent reports that call for urgent improvements in the quality and safety of care in NHS mental health services
Procedural Justice and Work-Home Conflict: The Moderating Role of Stress
Authors: Dilsiz Telat
Published: March 2019

The purpose of this study is to examine the moderating role of stress in the relationship between perceived procedural justice and the work-home conflict of teachers. For this purpose, the data collection tools were collected from the study group consisting of 129 teachers that were selected randomly with a clustered sampling method from the schools in Gaziantep and Erzincan in 2015-2016 academic year. The data was analyzed by hierarchical multiple linear regression method in SPSS 22 and ModGraph-I was used for moderating tests. The findings of the research indicate that procedural justice behavior of school managers predict work-home conflict of participants negatively and significantly, and also the stress level of employees has a moderating role in the relationship between perceived procedural justice and work-home conflict. When an employee has a high level of stress, an increase in the level of procedural justice provides a significant decrease in work-home conflict. Being aware of that, from top to bottom all the policymakers including school managers must incorporate teachers into the decision-making process, must care about their demands which eventually would also affect their home life, and also must be transparent in all practices in order to increase procedural justice.
Analysis of the Attune tibial tray backside
Authors: Cerquiglini A. , Henckel J. , Hothi H. , Allen P. , Lewis J. , Eskelinen A. , Skinner J. , Hirschmann M. T. , Hart A. J.
Published: March 2019

Objectives

The Attune total knee arthroplasty (TKA) has been used in over 600 000 patients worldwide. Registry data show good clinical outcome; however, concerns over the cement-tibial interface have been reported. We used retrieval analysis to give further insight into this controversial topic.

Methods

We examined 12 titanium (Ti) PFC Sigma implants, eight cobalt-chromium (CoCr) PFC Sigma implants, eight cobalt-chromium PFC Sigma rotating platform (RP) implants, and 11 Attune implants. We used a peer-reviewed digital imaging method to quantify the amount of cement attached to the backside of each tibial tray. We then measured: 1) the size of tibial tray thickness, tray projections, peripheral lips, and undercuts; and 2) surface roughness (Ra) on the backside and keel of the trays. Statistical analyses were performed to investigate differences between the two designs.

Results

There was no evidence of cement attachment on any of the 11 Attune trays examined. There were significant differences between Ti and CoCr PFC Sigma implants and Attune designs (p < 0.05); however, there was no significant difference between CoCr PFC Sigma RP and Attune designs (p > 0.05). There were significant differences in the design features between the investigated designs (p < 0.05).

Conclusion

The majority of the earliest PFC Sigma designs showed evidence of cement, while all of the retrieved Attune trays and the majority of the RP PFC trays in this study had no cement attached. This may be attributable to the design differences of these implants, in particular in relation to the cement pockets. Our results may help explain a controversial aspect related to cement attachment in a recently introduced TKA design. Cite this article: A. Cerquiglini, J. Henckel, H. Hothi, P. Allen, J. Lewis, A. Eskelinen, J. Skinner, M. T. Hirschmann, A. J. Hart. Analysis of the Attune tibial tray backside: A comparative retrieval study. Bone Joint Res 2019;8:136–145. DOI: 10.1302/2046-3758.83.BJJ-2018-0102.R2.
O fogo não respeita ninguém
Authors: Laranjeira José António da Piedade
Published: March 2019

Depois dos traumáticos incêndios florestais de 2017, o autor relata neste texto algumas das suas vivências do presente, no que aos bombeiros e ao fogo na floresta diz respeito, estabelecendo a sua ligação com um pouco de história, que o conduzem a vivências do passado e o transportam para considerandos relacionados com presumíveis vivências do futuro, relacionadas com quatro áreas de prevenção: estruturas, formação, vigilância e informação.
Extinção de incêndios rurais – a questão da coordenação
Authors: Gomes Artur
Published: March 2019

Os trágicos acontecimentos de 2017, no que respeita aos incêndios rurais, levantou de novo a questão da coordenação. É recorrente a acusação de falhas na coordenação dos grandes incêndios rurais. Na organização dos meios das operações de extinção, é utilizado um sistema de comando e controlo oficialmente aprovado, que determina para cada fase do incêndio a quem cabe a responsabilidade de coordenar, iniciando-se com a primeira equipa a chegar ao local e até atingir o estádio mais avançado da ocorrência. Trata-se de um sistema complexo, que requer uma liderança adequada, quer pela diversidade dos meios envolvidos, quer pelo impacto mediático que estas operações suscitam. Que medidas poderão ser tomadas para melhorar a questão da coordenação?
Nickel Oxide-Catalyzed Synthesis of 4-Amino-2H-Chromenes: Its Application in Antimicrobial Studies and Towards Protein Docking
Authors: Neela A. , Clarina T. , Rama V.
Published: March 2019

This work involves the synthesis of densely functionalized 2-amino-4H-chromenes by domino Knoevenagel-Michael-cyclization reaction of aromatic aldehydes, β-naphthol and malononitrile in the presence of a catalytic amount of a heterogeneous and reusable green NiO nanoparticle at 50 °C. The biogenic nickel oxide nanoparticles are characterized by Fourier transform infrared radiation, X-ray diffraction analysis, scanning electron microscopy and transmission electron microscopy. The synthesized chromenes are characterized by IR, NMR spectra. The synthesized chromene derivatives are studied for microbial inhibition by Kirby-Bauer disc diffusion method using amikacin and flucanazole as positive control. The compounds are found to have good to moderate antimicrobial activities. Their bio evaluation has been carried out with a protein and identified promising ligands for Mycobacterium tuberculosis InhA through molecular docking.