Identification of risk factors for falls in postmenopausal women: a systematic review and meta-analysis

The purpose of this study was to identify risk factors for falls in postmenopausal women and provide evidence for the primary prevention of falls in postmenopausal women. The protocol for this meta-analysis is registered with PROSPERO (CRD42020170927). We searched PubMed, the Cochrane Library and EMBASE for observational studies on the risk factors for falls in postmenopausal women. Review Manager 5.3 was used to calculate the relative risk (RR) or weighted mean difference (WMD) of potential risk factors related to falls. STATA 14.0 was used for the quantitative evaluation of publication bias. Eleven studies with 42,429 patients from 7 countries were included. The main risk factors for falls in postmenopausal women were patient sociodemographic risk factors (age: WMD = 0.37, 95% CI 0.07 to 0.68; body weight: WMD = 0.88, 95% CI 0.56 to 1.12; BMI: WMD = 0.34, 95% CI 0.21 to 0.46; exercise: RR = 0.97, 95% CI 0.94 to 0.99; and FES-I: WMD = 6.60, 95% CI 0.72 to 12.47) and medical risk factors (dietary calcium intake: WMD = - 16.91, 95% CI - 25.80 to - 8.01; previous fracture history: RR = 1.21, 95% CI 1.13 to 1.29; previous falls: RR = 2.02, 95% CI 1.91 to 2.14; number of diseases, ˃ 2: RR = 1.17, 95% CI 1.11 to 1.23; and number of reported chronic health disorders: WMD = 0.30, 95% CI 0.10 to 0.49). Knowledge of the many risk factors associated with falls in postmenopausal women can aid in fall prevention. However, we cannot rule out some additional potential risk factors (age at the onset of menopause, years since last menstruation, hormone therapy and BMD) that need further clinical research.

[Clinical features and outcomes of surgical versus conservative management in patients with subclinical Cushing's syndrome]

Objective: To examine the clinical characteristics and metabolic features of subclinical Cushing's syndrome (SCS), and determine the effects of surgical or conservative approaches on the hormone levels and metabolic comorbidities in patients with SCS, thereby providing the evidence for decision-making in SCS management. Methods: A total of 56 consecutive SCS patients were selected in Drum Tower Hospital Affiliated to Nanjing University Medical School between 2010 and 2018, with 41 patients undergoing surgical treatment and 15 patients receiving conservative therapy. Meanwhile, 56 and 68 cases of sex-and age-matched patients diagnosed as nonfunctional adrenal adenoma (NFA) and adrenal Cushing's syndrome (CS) were included respectively. Clinical characteristics of patients in different groups were compared. Hormone levels and metabolic comorbidities were also observed during follow-up. Results: There were 56 SCS patients, including 15 males and 41 females, with an age of (52.0±12.6) years. The circadian rhythms of adrenocorticotropic hormone (ACTH) and cortisol disappeared in CS and SCS groups. Compared to NFA group, patients with SCS were characterized by suppressed plasma ACTH level [2.40 (1.11, 4.33) pmol/L vs 4.23 (2.74, 6.26) pmol/L], elevated midnight cortisol level [(240±121) nmol/L vs (59±8) nmol/L] and increased cortisol level after 1 mg overnight dexamethasone suppression test [(241±130) nmol/L vs (34±12) nmol/L] (all P<0.01). The derangement of ACTH-cortisol axis was more obvious in CS patients compared to SCS patients. The prevalence of hypertension, glucose intolerance, dyslipidemia and osteopenia/osteoporosis were higher in SCS patients compared to NFA patients (75.0% vs 41.1%, 33.9% vs 12.5%, 62.5% vs 28.6%, 35.7% vs 8.9%, all P<0.05). The 24-hour urine free cortisol correlated positively with systolic blood pressure, glycated hemoglobin A1c (HbA1c) and fasting blood glucose in SCS patients (r=0.335, 0.562 and 0.463, respectively, all P<0.05). In the surgical group, body weight, body mass index (BMI) and blood pressure decreased significantly after surgery (all P<0.05). Glucose intolerance/diabetes mellitus improved in 6 of 9 patients, BMI of 4 of 11 overweight/obesity patients normalized, and hypertension in 54.5% of patients (12/22) showed improvement after surgery. However, no alterations of hormone levels and metabolic parameters were observed in conservatively-managed patients. Conclusions: Patients with SCS are characterized by mild autonomous cortisol secretion and increased risk of metabolic comorbidities. Compared with conservative management, hormone abnormalities were corrected and metabolic abnormalities were improved in some SCS patients after surgery.

Predictive mechanistic model for single-layered pressure-sensitive adhesive (PSA) joints : Part I: Uniaxial tensile stress-strain response

Modeling the deformation of structures containing pressure-sensitive adhesive (PSA) joints can be a challenging task because of the dependence of the deformation mechanism on a) PSA adhesive properties and b) the bonding substrate's surface properties, such as surface energy and surface roughness. These parameters have significant and unique effects on the mechanical response of the joint. This paper is part of a two-part series, where a mechanism-based predictive modeling approach, supported by empirical observations, is presented for modeling the uniaxial tensile mechanical behavior of single-layered PSA joints based on acrylic PSA materials. This paper (Part I) addresses the stress-strain response, while Part II of this series will address the creep behavior. The underlying model is based on multiple mechanisms: i) cavity nucleation and growth in the bulk adhesive material of the PSA system, as well as at the interfaces between the PSA and the substrate; ii) fibrillation of the cavitated adhesive layer and iii) interfacial slippage between the adhesive and the bonding substrate; iv) PSA delamination from the substrate. This predictive model can be used as a virtual testing tool to generate stress-strain curves for constitutive models of PSA joints under different tensile loading conditions.

MicroRNA-142 promotes the development of nasopharyngeal carcinoma through targeting PTEN

OBJECTIVE

To elucidate whether microRNA-142 could regulate the development of nasopharyngeal carcinoma (NPC) by mediating gene of phosphate and tension homology deleted on chromosome ten (PTEN) expression.

PATIENTS AND METHODS

The microRNA-142 expression in NPC tissues and paracancerous tissues was detected by the quantitative Real Time-Polymerase Chain Reaction (qRT-PCR). Correlation between the microRNA-142 expression and the prognosis of NPC patients was analyzed. MicroRNA-142 expression in NPC cell lines was determined as well. By transfection of microRNA-142 inhibitor or negative control, biological performances of NPC cells were accessed through cell counting kit-8 (CCK-8), colony formation, wound healing, and transwell assay. Dual-luciferase reporter gene assay was conducted to verify the binding condition between microRNA-142 and its target gene PTEN. Rescue experiments were carried out by co-transfection of microRNA-142 inhibitor and si-PTEN, followed by detecting the invasive capacity of NPC cells. Protein expressions of relative genes in the PI3K/AKT pathway after the microRNA-142 knockdown in NPC cells were determined by Western blot.

RESULTS

MicroRNA-142 was highly expressed in NPC tissues than that of paracancerous tissues, which was correlated with poor prognosis of NPC patients. MicroRNA-142 was also highly expressed in NPC cells. Downregulated microRNA-142 inhibited proliferative, migratory, and invasive capacities of NPC cells. Dual-luciferase reporter gene assay verified that microRNA-142 could directly bind to PTEN. Knockdown of PTEN could reverse the inhibitory effect of microRNA-142 on invasive capacity of NPC cells. Finally, Western blot results demonstrated that the microRNA-142 knockdown inhibited the PI3K/AKT pathway in NPC cells.

CONCLUSIONS

MicroRNA-142 is highly expressed in NPC. MicroRNA-142 enhances the proliferative and invasive capacities of NPC cells by inhibiting PTEN expression, thus promoting NPC development.

Mechanisms of picosecond laser-induced damage in common multilayer dielectric gratings

The modifications of multilayer dielectric (MLD) gratings arising from laser-induced damage using 0.6-ps and 10-ps laser pulses at 1053 nm are investigated to better understand the damage-initiation mechanisms. Upon damage initiation, sections of the affected grating pillars are removed, thereby erasing the signature of the underlying mechanisms of laser damage. To address this issue, we performed paired studies using macroscopic grating-like features that are 5 mm in width to reveal the laser-damage morphology of the different grating sections: pillar side wall, sole, and pillar top. The results suggest that, similarly to MLD coatings, there are two damage-initiation mechanisms corresponding to the different pulse durations.

[The clinical features and prognosis of 32 cases of pulmonary actinomycosis]

Objectives: To describe the clinical features and prognosis of pulmonary actinomycosis in a tertiary Chinese hospital. Methods: We conducted a retrospective analysis of 32 patients diagnosed with pulmonary actinomycosis between January 2013 and December 2019. General characteristics, clinical manifestations, lab data, chest CT imaging, treatment and follow-up information were reviewed and analyzed. Results: This study consisted of 19 males and 13 females, with a mean age of (58±12) years, ranging from 16 to 76 years. There were 26 cases with co-morbidities. Among them, there were 16 cases with pulmonary co-morbidity. Sixteen cases had a smoking history. Eight cases, 5 men and 3 women, with a mean age of (48±8) years, ranging from 41 to 58 years, received thoracic surgery for diagnosis. The remaining 24 cases who did not receive thoracic surgery consisted of 14 males and 8 females, with a mean age of (54±14)years, ranging from 16 to 76 years. Cough (25cases), expectoration (21 cases) and fever (16 cases) were the common clinical manifestations. The erythrocyte sedimentation rate (ESR) ranged from 2 to 114 mm/1 h, with a mean value of (28±31) mm/1 h. The ESR was elevated (>20 mm/1 h) in 15 cases. The C-reactive protein (CRP) ranged from 1 to 116 mg/L, with a mean value of (28±45) mg/L. The CRP was elevated (>8 mg/L) in 16 cases. Localized air-space consolidation (18 cases), pulmonary mass or nodules (16 cases) were the common chest CT manifestations. When compared with non-surgical cases, fever was the sole characteristic that was less common in cases with thoracic surgery (1 case in surgical group vs 11 cases in non-surgical group, P<0.05). Actinomyces spp. was found in 7 cases (87.5%) who received thoracic surgery, in 16 (61.5%) specimens collected through bronchoscopy and in 10 (55.6%) sputum samples of good quality. All of our enrolled cases were administrated with oral antibiotics, and 14 cases were prescribed with intravenous antibiotics initially. Among them, 27 cases were administrated with more than one antibiotic. Penicillin, ampicillin and amoxillin were prescribed for 25 cases. Finally, 30 cases showed improvement or cure in our hospital. Conclusions: Pulmonary actinomycosis tended to develop in aged patients with co-morbidities. Cough, expectoration, fever and localized air-space consolidation were the common clinical and radiological manifestations, respectively. Actinomyces spp. could be found more easily in the surgically resected tissues than other specimens. The prognosis of our enrolled cases was good after treatment with combined antibiotics.

Characteristics and roles of severe acute respiratory syndrome coronavirus 2-specific antibodies in patients with different severities of coronavirus 19

The diagnosis of coronavirus 19 (COVID-19) relies mainly upon viral nucleic acid detection, but false negatives can lead to missed diagnosis and misdiagnosis; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody detection is convenient, safe and highly sensitive. Immunoglobulin (Ig)M and IgG are commonly used to serologically diagnose COVID-19; however, the role of IgA is not well known. We aimed to quantify the levels of SARS-CoV-2-specific IgM, IgA and IgG antibodies, identify changes in them based on COVID-19 severity, and establish the significance of combined antibody detection. COVID-19 patients, divided into a severe and critical group and a moderate group, and non-COVID-19 patients with respiratory disease were included in this study. A chemiluminescence method was used to detect the levels of SARS-CoV-2-specific IgM, IgA and IgG in the blood samples from the three groups. Epidemiological characteristics, symptoms, blood test results and other data were recorded for all patients. Compared to the traditional IgM-IgG combined antibodies, IgA-IgG combined antibodies are more effective for diagnosing COVID-19. During the disease process, IgA appeared first and disappeared last. All three antibodies had significantly higher levels in COVID-19 patients than in non-COVID-19 patients. IgA and IgG were also higher for severe and critical disease than for moderate disease. All antibodies were at or near low levels at the time of tracheal extubation in critical patients. Detection of SARS-CoV-2-specific combined IgA-IgG antibodies is advantageous in diagnosing COVID-19. IgA detection is suitable during early and late stages of the disease. IgA and IgG levels correspond to disease severity.

[Bivariate heritability estimation of resting heart rate and common chronic disease based on extended pedigrees]

OBJECTIVE

To estimate the univariate heritability of resting heart rate and common chronic disease such as hypertension, diabetes, and dyslipidemia based on extended pedigrees in Fujian Tulou area and to explore bivariate heritability to test for the genetic correlation between resting heart rate and other relative phenotypes.

METHODS

The study was conducted in Tulou area of Nanjing County, Fujian Province from August 2015 to December 2017. The participants were residents with Zhang surname and their relatives from Taxia Village, Qujiang Village, and Nanou Village or residents with Chen surname and their relatives from Caoban Village, Tumei Village, and Beiling Village. The baseline survey recruited 1 563 family members from 452 extended pedigrees. The pedigree reconstruction was based on the family information registration and the genealogy booklet. Univariate and bivariate heritability was estimated using variance component models for continuous variables, and susceptibility-threshold model for binary variables.

RESULTS

The pedigree reconstruction identified 1 seven-generation pedigree, 2 five-generation pedigrees, 23 four-generation pedigrees, 186 three-generation pedigrees, and 240 two-generation pedigrees. The mean age of the participants was 57.2 years and the males accounted for 39.4%. The prevalence of hypertension, diabetes, dyslipidemia in this population was 49.2%, 10.0%, and 45.2%, respectively. The univariate heritability estimation of resting heart rate, hypertension, and dyslipidemia was 0.263 (95%CI: 0.120－0.407), 0.404 (95%CI: 0.135－0.673), and 0.799 (95%CI: 0.590－1), respectively. The heritability of systolic blood pressure, diastolic blood pressure, fasting glucose, total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol was 0.379, 0.306, 0.393, 0.452, 0.568, 0.852, and 0.387, respectively. In bivariate analysis, there were phenotypic correlations between resting heart rate with hypertension, diabetes, diastolic blood pressure, fasting glucose, and triglyceride. After taking resting heart rate into account, there were strong genetic correlations between resting heart rate with fasting glucose (genetic correlation 0.485, 95%CI: 0.120－1, P<0.05) and diabetes (genetic correlation 0.795, 95%CI: 0.181－0.788, P<0.05).

CONCLUSION

Resting heart rate was a heritable trait and correlated with several common chronic diseases and related traits. There was strong genetic correlation between resting heart rate with fasting glucose and diabetes, suggesting that they may share common genetic risk factors.

Coronavirus disease 2019 among pregnant Chinese women: case series data on the safety of vaginal birth and breastfeeding

OBJECTIVE

To assess whether vaginal secretions and breast milk of women with coronavirus disease 2019 (COVID-19) contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

DESIGN

Single centre cohort study.

SETTING

Renmin Hospital of Wuhan University, Wuhan, Hubei province, China.

POPULATION

We studied 13 SARS-CoV-2-infected pregnant women diagnosed between 31 January and 9 March 2020.

METHODS

We collected clinical data, vaginal secretions, stool specimens and breast milk from SARS-CoV-2-infected women during different stages of pregnancy and collected neonatal throat and anal swabs.

MAIN OUTCOMES AND MEASURES

We assessed viral presence in different biosamples.

RESULTS

Of the 13 women with COVID-19, five were in their first trimester, three in their second trimester and five in their third trimester. Of the five women in their third trimester who gave birth, all delivered live newborns. Among these five deliveries, the primary adverse perinatal outcomes included premature delivery (n = 2) and neonatal pneumonia (n = 2). One of nine stool samples was positive; all 13 vaginal secretion samples, and five throat swabs and four anal swabs collected from neonates, were negative for the novel coronavirus. However, one of three samples of breast milk was positive by viral nucleic acid testing.

CONCLUSIONS

In this case series of 13 pregnant women with COVID-19, we observed negative viral test results in vaginal secretion specimens, suggesting that a vaginal delivery may be a safe delivery option. However, additional research is urgently needed to examine breast milk and the potential risk for viral contamination.

TWEETABLE ABSTRACT

New evidence for the safety of vaginal delivery and breastfeeding in pregnant women infected with SARS-CoV-2, positive viral result in a breast-milk sample.

[Better understanding of interfacial planes in colorectal cancer surgery and the value of small vessels on fascia in the identification of interfacial planes]

The introduction of total mesorectal excision and wider use of laparoscopic surgery pushed the field of colorectal surgery into an era of interfasical dissection. The Japanese suggestion of fascial arrangement of the trunk in a multilaminar, symmetrical and parallel way helps in better understanding of fascial relationship and interfascial planes surrounding the colon and the rectum. However, different interpretations of the multilayer retroperitoneal fascial relationship, complexity of fascial structures within the pelvis and dense adhesion between two apposed fasciae at special points make it still challenging for the surgeon to decide on the precise interfascial plane for colorectal mobilization. Small vessels on fasica propria of the rectum and various retroperitoneal fascia, especially ureterohypogastric fascia show distinctive features. The root of small vessels on fascia propria of the rectum helps to identify the anterolateral and posterolateral interfascial plane in the middle and low rectum. The longitudinal trajectory of small vessel on ureterohypogastric fascia and scarcity interfascial vascular communication between mesocolic and retroperitoneal fascia help the surgeon to find and stay in the interfacial plane during colorectal mobilization. More knowledge of fascial and interfascial plane will certainly help achieve better mesocolic mesorectal integrity and reduce the risk of injuries to autonomic nerves. More anatomical, histological and embryological studies are warranted with respect to relationship between small vessels and fasciae.

[Eosinophilic solid and cystic renal cell carcinoma with TSC2 gene mutations in children]

Objective: To study clinical pathological characteristics, immunohistochemical, molecular genetical changes and prognosis in pediatric eosinophilic solid and cystic renal cell carcinoma (ESC RCC) with TSC2 gene mutations. Methods: The tissue samples were collected from two pediatric ESC RCC patients between 2017 and 2018. The tissues were subjected to histological examination and immunohistochemistry using EnVision system. The TFE3, TFEB gene rearrangements were tested using FISH and molecular genetic study. The paraffin sections were used for DNA extraction, PCR amplification and NGS sequencing. Results: The two patients with ESC RCC were both male, aged at 9 years and 8 months, and 13 years, respectively. The tumors were from the right kidney, 5 cm and 7 cm in size, respectively, with solid and cystic changes in cross section, and grey-reddish or grey-whitish fish meat appearance. Microscopic observation revealed the tumors had fibrous capsules, which were infiltrated by the tumor cells. The tumor cells were diffusely distributed, round-shaped, or polygon-shaped, and had voluminous cytoplasm, eosinophilic cytoplasm, various sizes of vacuoles and clear cell-like appearance. There were papillary structures in some areas, with visible fiber septa. The nuclei were round and vesicular, with multi-nucleated cells and megakaryocytes. The mitoses were not seen. A few cystic structures were visible in different sizes, and capsule walls were covered with a single layer of spike-like tumor cells. Thick-walled blood vessels were seen in the stroma, with focal lymphocytic infiltration, eosinophilic necrosis, calcifications and cholesterol crystals. Immunohistochemistry of the tumor cells was positive for PAX8 (diffuse), CK20 (focal), CKpan (focal), CK10 (1 focal, 1 diffuse), INI1, vimentin, CD68, and Ki-67 (5%~10%); the tumor cells were negative for HMB45, S-100, Melan A, p53, desmin, TFE3, CK7, CK19, EMA, CD56, CgA, Syn, CD30, CD117, WT1 and SMA. Molecular genetic study showed that TFE3 and TFEB gene rearrangements were not detected by FISH. NGS sequencing showed TSC2 p.Lys574Ter (0.198) was found in patient one and TSC2 p.Arg406Ter (0.355) in patient two. Conclusions: ESC RCC in children is a rare disease, and can be misdiagnosed easily. It has unique pathological characteristics, and immunohistochemical, molecular and genetic changes. The prognosis is relatively good.

Use of the normalcy index for the assessment of abnormal gait in the anterior cruciate ligament deficiency combined with meniscus injury

The normalcy index (NI) has been implemented by several studies as a simple index for quantitatively analyzing diffident gait abnormalities, such as children with cerebral palsy and idiopathic toe-walkers. However, whether the NI can be used in anterior cruciate ligament (ACL) deficiency with different types of meniscus injuries or not, has not been reported yet. In this study, 25 patients who combined different types of ACL and meniscus injuries were evaluated by the NI analysis. 12 healthy subjects were used to define the normal range of NI. The result showed that NI values of patients were significantly larger than the control group (P < 0.05). Meanwhile, the tendency of increasing NI values associated with increasing pathology were significant with only 5 subjects in the smallest group (Jonkheere-Terpsta test: P < 0.001). These results indicated that the NI was a concise yet effective tool to evaluate combined ACL and meniscus injury patients. Increasing severity degree of meniscus tears in ACL rupture patients is corresponded to increasing NI values. It also demonstrates that the proposed NI can be applied as a robustness factor to detect the discrepancy between healthy and patient subjects clinically, and has the potential in the quantitative evaluation of pre- or post-surgery and rehabilitation.

Lower Limb Biomechanics During Level Walking After an Isolated Posterior Cruciate Ligament Rupture

Background:

The posterior cruciate ligament (PCL) is an important structure in knee stabilization. Knee cartilage degeneration after a PCL injury has been reported in several studies. Understanding the changes in movement patterns of patients with PCL ruptures could help clinicians make specific treatment protocols to restore patients’ sporting ability and prevent joint degeneration. However, the kinematics and kinetics of the lower limb in patients with PCL injuries are still not clear.

Purpose:

To investigate the biomechanical characteristics during level walking in patients with isolated PCL deficiency.

Study Design:

Controlled laboratory study.

Methods:

Three-dimensional videographic and force plate data were collected for 27 healthy male participants (control group) and 25 male patients with isolated PCL-deficiency (PCL-d group) walking at a constant self-selected speed. Paired and independent t tests were performed to determine the differences between the involved and uninvolved legs in the PCL-d group and between the PCL-d and control groups, respectively.

Results:

Compared with the control leg, both legs in the PCL-d group had smaller knee moments of flexion and internal rotation; greater hip angles of flexion and adduction; greater hip moments of internal rotation; greater ankle angles of extension and adduction; and smaller ankle moments of flexion, adduction, and internal rotation. Moreover, compared with the uninvolved leg in the PCL-d group, the involved leg in the PCL-d group had significantly smaller knee extension angles and moments during the terminal stance phase, greater hip external rotation angles and extension moments, and smaller ankle adduction angles and flexion moments.

Conclusion:

PCL ruptures altered walking patterns in both the involved and uninvolved legs, which could affect alignment of the lower limb and loading on the knee, hip, and ankle joints. Patients with PCL injuries adapted their hip and ankle to maintain knee stability.

Clinical Relevance:

The kinematic and kinetic adaptations in the knee, hip, and ankle after a PCL rupture during level walking are likely to be a compensatory strategy for knee instability. The results of this study suggest that these adaptations should be considered in the treatment of patients with PCL ruptures.

Dynamic Between-Leg Differences While Walking in Anterior Cruciate Ligament-Deficient Patients With and Without Medial Meniscal Posterior Horn Tears

Background:

Patients with anterior cruciate ligament–deficient (ACLD) knees with medial meniscal posterior horn tears (MMPHTs) have been reported to demonstrate a combined stiffening and pivot-shift gait pattern compared with healthy controls. Movement asymmetries are implicated in the development and progression of osteoarthritis.

Purpose:

To investigate the knee kinematics and kinetic asymmetries in ACLD patients with (ACLD + MMPHT group) and without (ACLD group) MMPHTs while walking on level ground.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 15 patients with isolated unilateral ACL ruptures, 10 with unilateral ACL ruptures and MMPHTs, and 22 healthy controls underwent gait testing between January 2014 and December 2016. Between-leg differences (BLDs) in knee kinematics and kinetics were compared among participants in all groups.

Results:

The ACLD + MMPHT group demonstrated significantly greater BLDs in knee moments in the sagittal plane during the loading response phase than the ACLD and control groups. Compared with the control group, the ACLD and ACLD + MMPHT groups demonstrated significantly greater BLDs in knee angles in the sagittal plane during the midstance and terminal stance phases. Compared with the control group, significantly greater BLDs in knee rotation moments were found throughout the stance phase in both the ACLD and the ACLD + MMPHT groups. BLDs in lateral ground-reaction forces (GRFs) in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. BLDs in anterior GRFs in the ACLD + MMPHT and ACLD groups were both significantly greater than the control group during the loading response phase. Only the ACLD + MMPHT group demonstrated greater BLDs in vertical GRFs than the control group during the loading response phase, while no significant differences were observed between the ACLD and control groups.

Conclusion:

The ACLD + MMPHT group demonstrated significantly more knee flexion moment asymmetries than the ACLD and control groups during the loading response phase. Both the ACLD + MMPHT and the ACLD groups demonstrated significant knee angle and moment asymmetries in the sagittal plane during the terminal stance phase than the control group. Both the ACLD + MMPHT and the ACLD groups demonstrated knee rotation moment asymmetries during the midstance and terminal stance phases compared with the control group. A rehabilitation program for ACLD patients both with and without MMPHTs should take into consideration these asymmetric gait patterns.

The application value of PAX1 and ZNF582 gene methylation in high grade intraepithelial lesion and cervical cancer

PURPOSE

To investigate the possibility of using the methylation level of PAX1/ZNF582 gene as molecular marker to differentiate the progression of cervical cancer.

METHODS

From January 2016 to March 2018, 150 patients, who were admitted to Cervical Disease Diagnosis and Treatment Center of Xuzhu Maternity and Child Care Hospital, were enrolled in this study. Patients were classified into chronic cervicitis (for 19 cases), low-grade squamous intraepithelial lesion (LSIL) (18 cases), high-grade squamous intraepithelial lesion (HSIL) (37 cases) and squamous cell carcinoma (SCC) (31 cases). All patients underwent several tests including Thin-prep cytology test (TCT), HPV DNA detection and detection of methylation level of PAX1/ZNF582 genes.

RESULTS

For diagnosis of HSIL, the area under curve (AUC) was 0.878 (95% CI 0.806 ~ 0.950); the threshold for PAX1 was 12.285, the sensitivity and specificity were 91.9% and 72.8%, respectively. The AUC of ZNF582 gene detection was 0.900 (95% CI 0.842 ~ 0.959), the threshold was 11.56, while the sensitivity and specificity were 97.3% and 76.7%, respectively. Among various tests we conducted, PAX gene detection methods showed the highest specificity (97.30%). PAX1/ZNF582 gene detection method demonstrated the highest accuracy.

CONCLUSIONS

For patients with high-grade cervical lesion and cervical cancer, the methylation level of PAX1/ZNF582 gene could be applied as a noteworthy biomarker for diagnosis and for cervical cancer classification.

[Whole exome sequencing and analysis of a Chinese family with familial pulmonary sarcoidosis]

Objective: To analyze the clinical features and the results of the whole exome sequencing (WES) of a Chinese family containing both pulmonary sarcoidosis patients and healthy members, and to find potent genes and variants that may be involved in the pathogenesis of sarcoidosis. Methods: Three patients with pulmonary sarcoidosis and 1 healthy member was included from a Chinese Han family in the north of China diagnosed in November 2016, which characterized as 2 consecutive generations including 2 males and 1 female, aged from 23 to 69 years old. The proband is Ⅱ-6. Pulmonary sarcoidosis was diagnosed by clinical features, imaging and pathological findings, and clinical data such as family history were collected. Whole blood samples were taken and WES (Illumina NovaSeq S2) was performed. The pathogenicity analysis and gene annotation analysis were performed by ExAC, SIFT, Polyphenv2, Metascape databases. Results: It was found that 27 genes were highly pathogenic in the database filtering result. After gene annotation analysis, we found that ZC3H12A gene can negatively regulate the differentiation of Th17 cells, which may be involved in the onset of pulmonary sarcoidosis. Sanger sequencing confirmed the c.1361 A>G variant in 3 sarcoidosis patients but normal in healthy member. Conclusions: In patients with familial pulmonary sarcoidosis, the genetic background could regulate immune response which is one of the pathogenic mechanisms of sarcoidosis. The whole exome test and gene ontology analysis showed that Ⅱ-2, Ⅱ-6 and Ⅲ-1 pulmonary sarcoidosis patients in this family were all shared the same variant on ZC3H12A gene, which played a pivotal role in differentiation of Th17 cells and is a potent pathogenesis gene in this Chinese pulmonary sarcoidosis family.

OP0126 IS IMMUNE CHECKPOINT INHIBITORS THERAPIES SAFE AND EFFECTIVE FOR PATIENTS WITH CANCER AND PREEXISTING AUTOIMMUNE DISEASE?

Background:

Immune checkpoints inhibitors (ICIs) are associated with frequent immune-related adverse events (irAEs). Most patients with preexisting autoimmune disease (PAD) have been universally excluded from clinical trials and ICIs are not recommended for patients with cancer and PAD due to the unknown safety. In this study, we aim to evaluate the safety and efficacy of ICIs in patients with PAD and cancer.

Objectives:

Systematic searches were performed of PubMed, EMBASE, and the Cochrane library from inception through September 2019 for observational studies reporting safety and efficacy data among ICIs-treated patients with cancer and PAD. A random effects meta-analysis was performed to calculate pooled incidence rates of PAD flare, irAEs and response.

Methods:

Systematical search of PubMed, EMBASE and Cochrane Library plus a hand search of conference proceedings were performed for observational studies that reported cancer incidence in patients with RA treated with biologics or tofacitinib with active comparator of conventional DMARDs (csDMARDs) or TNFi. The pooled relative risk (RR) and 95% confidence interval (CI) were calculated with fix-effects or random-effects model.

Results:

A total of 619 ICI-treated patients with PAD in 14 publications were finally identified. In the random effects meta-analysis, pooled incidence of PAD flares,de novoirAEs or both of any grade was 60% (95% CI 52%-68%). Viewed separately, there were 219 and 206 patients experiencing PAD exacerbation andde novoirAEs of any grade, yielding a pooled incidence of 35% (95% CI 29%-41%) and 33% (95% CI 24%-42%) respectively. Of these, most of flare andde novoirAEs were graded as mild (grade 1-2) (pooled proportion: 82%, 95%CI 72%-91%; 65%, 95%CI 54%-76%, respectively). Rheumatoid arthritis was associated with a trend toward higher flare occurrence compared with another individual PADs (RR=1.25-1.88). With respect to efficacy, 136 patients showed complete or partial response, corresponding to a pooled response rates of 30% (95% CI 22%-39%). There were no statistical differences between patients with and without immunosuppressive therapy at ICI start regarding flare (RR: 1.08, 95% CI 0.72-1.62), but a trend towards lower response rates was observed in patients with baseline immunosuppressants (RR: 0.58, 95% CI 0.26-1.33).

Conclusion:

Immune toxicities are frequent in ICI-treated patients with PAD but often mild and manageable without discontinuing therapy. Rheumatoid arthritis is associated with a trend toward more flares. ICI treatment are effective and not absolute contraindication in PAD patients, but close monitoring and multidisciplinary collaboration should be contemplated, especially for those concomitantly receiving immunosuppressant or having rheumatoid arthritis.

References:

[1]Khan SA, Pruitt SL, Xuan L et al. Prevalence of autoimmune disease among patients with lung cancer: Implications for immunotherapy treatment options. JAMA Oncol 2016;2:1507-1508.

Figure 1.

Pooled effect estimates in ICI-treated patient with PAD (A) PAD flare,de novoirAEs or both; (B) PAD flare; (C)de novoirAEs. ICI: Immune checkpoint inhibitors; PAD: Preexisting autoimmune disease; irAEs: Immune-related adverse events.

Disclosure of Interests:

None declared

SAT0066 BURDEN OF MALIGNANCY, VENOUS THROMBOEMBOLISM, ANEMIA, AND INFECTIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS WHO SWITCHED FROM A FIRST CONVENTIONAL SYNTHETIC DISEASE-MODIFYING ANTIRHEUMATIC DRUG TO ANOTHER DISEASE-MODIFYING ANTIRHEUMATIC DRUG REGIMEN

Background:

EULAR and ACR guidelines recommend a variety of treatment options for rheumatoid arthritis (RA) patients who failed a first conventional synthetic disease-modifying antirheumatic drug (csDMARD). The recent launches of Janus kinase inhibitors (JAKi) have stimulated interest in comorbidities such as malignancy, venous thromboembolism (VTE: deep vein thrombosis [DVT] or pulmonary embolism [PE]), anemia, and infections in patients with RA. Understanding the epidemiology of these conditions can help optimize treatment decisions within the treat-to-target approach following the first csDMARD.

Objectives:

Estimate the real-world prevalence, incidence, and costs of these comorbidities among patients switching from a first csDMARD to another DMARD.

Methods:

From a large US health claims database, the study selected adults with RA (≥2 RA claims ≥30 days apart) who started a csDMARD regimen as first DMARD, then switched (index date [ID], 1/1/2012–3/31/2017) to another DMARD regimen (monotherapy or combination with csDMARD). All patients had continuous enrollment 1 year before and ≥1 year after the ID. The study estimated baseline prevalence (%) and on-treatment incidence (per 100 patient-years [P100PY]) of malignancy, VTE, anemia, and infections (any, serious, opportunistic, and herpes zoster). Generalized linear models with gamma distribution and log link function estimated the impact of baseline characteristics on mean annualized healthcare costs per-patient-per-year (PPPY) associated with incident conditions. The recycled prediction method calculated adjusted total costs differences of these conditions.

Results:

Among study patients (N = 7,816, median age 54 yrs, 74% female), the 38% on monotherapy index treatments had mean (standard deviation) treatment duration 9.2 (10.1) mo and the 52% on combination therapies had treatment duration 16.9 (13.0) mo.

Baseline prevalence was 1.5% for VTE, 1.3% for malignancy, 15.6% for anemia, and 71.0% for infection (Figure 1). During next treatment, the incidence rates (P100PY) were: 0.7 for VTE, 2.1 for malignancy, 7.8 for anemia and 79.4 for infection (Figure 1).

Modeling showed that total healthcare cost more than doubled for RA patients with vs without incident occurrence of malignancy (2.9), followed by PE (2.7) and DVT (2.1) (P< .0001) (Figure 2). Total PPPY adjusted healthcare costs were higher in patients with vs without incident conditions: DVT $60,430 vs $28,927, PE $77,942 vs $29,000, malignancy $81,779 vs $28,565, anemia $50,097 vs $26,959, and infection $32,431 vs $22,774, including serious infections $52,935 vs $26,723, opportunistic infections $39,239 vs $28,947, and herpes zoster $30,638 vs $29,515.

Conclusion:

In the real world, RA patients were affected by VTE, malignancy, anemia and infections prior to switching from first csDMARD to the next treatment. While on the next treatment, patients developed new cases of these comorbidities, most of which were associated with increased adjusted total healthcare costs. Clinicians should account for the burden of these comorbidities in selecting treatments for RA patients who failed their first csDMARD.

Disclosure of Interests:

Robin K Dore Grant/research support from: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Consultant of: AbbVie, Amgen, Biogen, Bristol-Myers Squibb, Eli Lilly and Co., Gilead Sciences, Inc., GlaxoSmithKline, Myriad, Novartis, Pfizer, Radius, Regeneron, Sanofi, and UCB., Jenya Antonova Employee of: Gilead Sciences. Inc., Lawrence Chang Consultant of: Gilead Sciences, Inc., Huan Huang Consultant of: Gilead Sciences, Inc., Hyunchung Kim Consultant of: Gilead Sciences, Inc., Mark C. Genovese Grant/research support from: Abbvie, Eli Lilly and Company, EMD Merck Serono, Galapagos, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, Pfizer Inc., RPharm, Sanofi Genzyme, Consultant of: Abbvie, Eli Lilly and Company, EMD Merck Serono, Genentech/Roche, Gilead Sciences, Inc., GSK, Novartis, RPharm, Sanofi Genzyme

THU0592 INSIDIOUS CORONARY ARTERY DISEASE IN A YOUNG PATIENT WITH POLYARTERITIS NODOSA: A CASE REPORT AND REVIEW OF LITERATURE

Background:

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries[1]. Although overt myocardial infarction is uncommon, myocardial ischemia may result from narrowing or occlusion of the coronary arteries[2].

Objectives:

Herein, we report a case with 7-year’s history of PAN and unstable angina pectoris due to coronary occlusions of the three main arteries. We also reviewed the literatures regarding coronary artery involvement in PAN.

Methods:

A 22-year-old Chinese man who presented with chest pain lasting for a few minutes and then subsiding spontaneously for 1 month was admitted to our hospital. He was diagnosed as PAN 7 years ago and during 7-years’ follow-up, he has been in stable condition, without any discomfort or abnormal laboratory findings. In December 2019, he suffered from chest distress accompanied by retrosternal pain, with frequency of about 2-3 times a week. His symptoms were gradually aggravating with dyspnea at night.

Results:

Coronary computed tomography angiography showed diffuse coronary stenosis (Fig. 1). Further coronary angiography revealed a slight plaque infiltration of the left main coronary artery, and occlusion of all the three major coronary arteries, as well as multiple coronary aneurysms. 95% stenosis of the obtuse margin branch artery was also found and a stent was then implanted (Fig. 2). Prednisone 50mg/day and methotrexate 15mg/week were reinitiated, in combination with anti-anginal medications including aspirin and statin.

Fig. 1

Coronary computed tomography angiography found diffuse coronary stenosis.

Fig. 2

Coronary angiography. (a) A 50% stenosis followed by aneurysmal change of the proximal end of left anterior descending (LAD) artery, and totally occluded from the middle segment; A aneurysmal change of the initial part of left circumflex artery (LCX) and then totally occluded (dotted line); A 95% stenosis obtuse margin branch. (b) A totally occluded right coronary artery (dotted line). (c) Final appearance of the LCX after stent implantation.

After we reviewed all the English literatures reporting cardiac involvements in adults with PAN from 1990 to 2019, a total of 34 patients from 32 articles were identified. 25 (73.5%) patients were admitted to hospital due to acute coronary syndromes manifesting as chest pain or dyspnea. Coronary stenosis or occlusions were most common on imaging or autopsy. Most of the patients had more than one vessel involved, of whom 7 patients showed evidence of triple vessel lesions. Aneurysm was also common in these patients, especially multiple aneurysms. Spontaneous coronary artery dissections were rare in PAN patients. Most patients received glucocorticoid, and/or immunosuppressant therapy, including cyclophosphamide and azathioprine, with or without invasive operations. 15 patients died from cardiopulmonary arrest, the most frequent cause being death, and 15 patients were stable without symptoms after treatment.

Conclusion:

We report a young PAN patient with insidious stenosis of three main coronary arteries under the circumstance of stable disease activity for years. This reminds us of the necessity of assessing heart, probably other organs as well, in PAN patients even though their acute phase reactants in serum are normal. But how often to do the screening and which screening examination should be done, remain to be further investigated.

References:

[1]Jennette, J.C., et al.,2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides.Arthritis Rheum, 2013.65(1): p. 1-11.

[2]Kastner, D., M. Gaffney, and T. Tak,Polyarteritis nodosa and myocardial infarction.Can J Cardiol, 2000.16(4): p. 515-8.

Disclosure of Interests:

None declared

AB0380 THERAPEUTIC CHOICES AND OUTCOMES IN CHINESE PATIENTS WITH SEROLOGICALLY ACTIVE CLINICALLY QUIESCENT SYSTEMIC LUPUS ERYTHEMATOSUS

Background:

Patients with systemic lupus erythematosus (SLE) who achieved the clinical state as serologically active clinically quiescent (SACQ). It appears to account for 6–12% of all patients with SLE, but there is disagreement about whether such patients are indeed clinically stable [1-3], especially in Chinese patients. And there is no conclusion as to what kind of treatment should be taken for such patients.

Objectives:

To clarify the frequency and outcome of SACQ patients in lupus. And to identify factors associated with the flare of disease.

Methods:

Clinical data of patients diagnosed as SLE and followed in Peking University First Hospital from 2009 to 2015 were retrospectively reviewed. 682 patients with systemic lupus erythematosus who were followed up for more than 6 months at Peking University First Hospital from January 2007 to December 2015 were summarized. SACQ was defined as an at least a 6-month period with persistent serologic activity and without clinical activity and could be taking a daily dose of prednisone or equivalent less than 7.5 mg. Serologically quiescent clinically quiescent (SQCQ) patients and serologically active clinically active (SACA) patients served as control groups. Data including demographics, initial symptoms, duration to SACQ, treatments before and after SACQ, and characteristics of the flare group were analyzed.

Results:

Of the 682 patients, 170 were SACQ patients (24.9%), 187 were SQCQ patients, and 325 were SACA patients (47.7%). SQCQ patients (38.61±15.08 years old) were older at study start than SACQ patients (38.61±15.08 years vs. 32.09±14.35 years, p<0.001), but there was no significant difference between that of SACQ and SACA patients. 56 of the 170 SACQ patients (32.9%) experienced flare. Corticosteroids (OR 1.317, 95% CI 1.131 to 1.534; p<0.001) was an independent risk factor for flare, while antimalarials (OR 0.265, 95% CI 0.118 to 0.599; p=0.001) and immunosuppressants (OR 0.316, 95% CI 0.149 to 0.670; p=0.003) were protective factors.

Conclusion:

About one third of SLE patients with SACQ experience flare, more than that of patients with SQCQ. Thus, approach to prevent relapse in SACQ patient is required. Maintenance therapy of hydroxychloroquine and immunosuppressant agents may be protective and beneficial treatment strategy in these patients need further investigation.

References:

[1]Gladman DD, Urowitz MB, Keystone EC. Serologically active clinically quiescent systemic lupus erythematosus: a discordance between clinical and serologic features. Am J Med 1979; 66:210-5.

[2]Huang WN, Tso TK, Wu HC, Yang HF, Tsay GJ. Impaired phagocytosis of apoptotic cell material in serologically active clinically quiescent patients with systemic lupus erythematosis. Int J Rheum Dis 2016; 19:1310-6.

[3]Steiman AJ, Gladman DD, Ibañez D, Urowitz MB. Prolonged serologically active clinically quiescent systemic lupus erythematosus: frequency and outcome. J Rheumatol 2010; 37:1822-7.

Disclosure of Interests:

None declared

Using IL-2R/lymphocytes for predicting the clinical progression of patients with COVID-19

Effective laboratory markers for the estimation of disease severity and predicting the clinical progression of coronavirus disease-2019 (COVID-19) is urgently needed. Laboratory tests, including blood routine, cytokine profiles and infection markers, were collected from 389 confirmed COVID-19 patients. The included patients were classified into mild (n = 168), severe (n = 169) and critical groups (n = 52). The leukocytes, neutrophils, infection biomarkers [such as C-reactive protein (CRP), procalcitonin (PCT) and ferritin] and the concentrations of cytokines [interleukin (IL)-2R, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF)-α] were significantly increased, while lymphocytes were significantly decreased with increased severity of illness. The amount of IL-2R was positively correlated with the other cytokines and negatively correlated with lymphocyte number. The ratio of IL-2R to lymphocytes was found to be remarkably increased in severe and critical patients. IL-2R/lymphocytes were superior compared with other markers for the identification of COVID-19 with critical illness, not only from mild but also from severe illness. Moreover, the cytokine profiles and IL-2R/lymphocytes were significantly decreased in recovered patients, but further increased in disease-deteriorated patients, which might be correlated with the outcome of COVID-19. Lymphopenia and increased levels of cytokines were closely associated with disease severity. The IL-2R/lymphocyte was a prominent biomarker for early identification of severe COVID-19 and predicting the clinical progression of the disease.

Prediction of Knee Kinematics at the Time of Noncontact Anterior Cruciate Ligament Injuries Based on the Bone Bruises

Biomechanical risk factors associated with the alignment and position of the knee for anterior cruciate ligament (ACL) injury are still not conclusive. As bone bruises identified on magnetic resonance imaging (MRI) following acute ACL injury could represent the impact footprint at the time of injury. To improve understanding of the ACL injury mechanism, we aimed to determine the knee kinematics during ACL injury based on the bone bruises. Knee MRI scans of patients who underwent acute noncontact ACL injuries were acquired. Numerical optimization was used to match the bone bruises of the femur and tibia and predict the knee positions during injury. Knee angles were compared between MRI measured position and predicted position. The knee flexion, abduction, and external tibial rotation angles were significantly greater in the predicted position than that in MRI measured position. Relative to MRI measured position, patients had a mean of 34.3 mm of anterior tibial translation, 4.0 mm of lateral tibial translation, and 16.0 mm superior tibial translation in the predicted position. The results suggest that knee valgus and external tibial rotation accompanied by knee flexion are high-risk movement pattern for ACL injury in patients with lateral compartment bone bruising in conjunction with ACL injury.

Pithecellobium clypearia extract enriched in gallic acid and luteolin has antibacterial activity against MRSA and reduces resistance to erythromycin, ceftriaxone sodium and levofloxacin

AIMS

Antibiotic adjuvants can give a second life to the antibiotics to which bacteria are highly resistant. We evaluated the antimicrobial effects of extracts from Pithecellobium clypearia against methicillin-resistant Staphylococcus aureus (MRSA) and also the potential for synergy with several antibiotics.

METHODS AND RESULTS

For this study, four extracts from P. clypearia were tested on MRSA using the broth microdilution method for activity assessment. The ethyl acetate fraction (S20b) had the strongest antibacterial activity against MRSA among the fractions tested. In all, 14 compounds such as gallic acid and luteolin in S20b were analysed by UFLC-Q-TOF-MS/MS. S20b combined with erythromycin showed synergy effects against MRSA and combined with ceftriaxone sodium and levofloxacin showed additive effects against MRSA. Electron microscopy showed that extract S20b damaged the MRSA cell wall and K⁺ efflux measurements indicated that extract S20b increased cell membrane permeability. Moreover, S20b suppression of PBP2a expression was assessed by Western blot. Furthermore, an in vivo study was used to investigate the therapeutic potential of S20b based on a mouse pneumonia model.

CONCLUSIONS

The in vitro study results have shown that S20b not only inhibits MRSA growth directly but also reduces the resistance of MRSA to the evaluated antibacterial agents. Based on the in vivo study, it can be concluded that S20b can treat pneumonia in the mouse model.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study is the first research to demonstrate that S20b can inhibit MRSA growth and reduce drug resistance of clinical isolates to antibiotics. S20b has the potential to be used as a therapeutic agent against MRSA and treatment for MRSA pneumonia.

Evaluation of protection against bovine viral diarrhea virus type 2 after vaccination of the calves with bovine viral diarrhea virus type 1 combo inactivated vaccine

ABSTRACT This study was designed to evaluate the extent of the protection for bovine viral diarrhea virus type 2 (BVDV-2) infection, afforded by vaccination with a combo inactivated vaccine, which contains bovine viral diarrhea virus type 1 (BVDV-1) and infectious bovine rhinotracheitis virus (IBRV). Five 3-4-month-old calves were intramuscularly vaccinated with a single dose of the combo vaccine and boosted with same dose three weeks after the first vaccination, with five mock immunized calves serving as a control group. Twenty-one days after the second vaccination, all calves were challenged with BVDV-2 SX08 strain by spray into nostril. The unvaccinated animals developed typical clinical signs of high rectal temperature, diarrhoea with erosions and a dramatic drop in leukocyte counts. These signs occured markedly less in all vaccinated animals, the rectal temperature, leukopenia and virarmia of which, were significantly less than the mock immunized calves. It can be concluded that vaccination with the combo inactivated vaccine affords cross-protection against clinical effects of a challenge-infection with BVDV-2 SX08 strain, although it was part protection.

Bone Bruise Distribution Patterns After Acute Anterior Cruciate Ligament Ruptures: Implications for the Injury Mechanism

Background

Bone bruises observed on magnetic resonance imaging (MRI) after an anterior cruciate ligament (ACL) injury could provide significant information about ACL injury mechanisms.

Purpose/Hypothesis

The purpose of this study was to investigate common bone bruise patterns after an ACL injury. It was hypothesized that the most common bone bruise distribution pattern would be only the lateral side of both the femur and tibia.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Knee MRI scans of patients who underwent acute ACL reconstruction from August 2016 to August 2018 at our institution were selected. Imaging sequences in the sagittal and coronal planes were used for determining the bone bruise location in the lateral-medial and anterior-posterior directions, respectively. The presence, location, and intensity of bone bruises within specific compartments of the tibia and femur were documented. The relative bone bruise patterns of the tibia and femur were classified and analyzed.

Results

A total of 207 patients (165 men, 42 women) met the inclusion criteria from a total of 4209 ACL reconstruction cases. The most common relative bone bruise pattern was located on only the lateral side of both the femur and the tibia (44.4%), followed by the lateral and medial sides of both the femur and tibia (29.0%). For the pattern found on the lateral and medial sides of both the femur and tibia, the bone bruises on only the lateral side of both the tibia and femur were more severe (P < .001 and P < .001, respectively) and more anterior (P < .001 and P < .001, respectively) than those on only the medial side.

Conclusion

The most common relative bone bruise pattern observed was on only the lateral side of both the tibia and femur. Bone bruises on the lateral side were more severe than those on the medial side in patients with bone bruises on the lateral and medial sides of both the femur and tibia. Anterior translation of the tibia relative to the femur occurred during an ACL injury based on the location of bone bruises in the anterior-posterior direction.

High coherence collapse of a hybrid III–V/Si semiconductor laser with a large quality factor

The high-speed dynamics of a hybrid distributed feedback semiconductor laser heterogeneously integrated onto silicon is experimentally investigated in the presence of external optical feedback. The laser fabrication relies on a proper modal engineering in which light is generated in the III–V material and stored in the low-loss silicon region in order to substantially enhance the quality factor of the cavity resonator. In this work, the hybrid laser is found to be insensitive to parasitic reflections leading to a 10 Gbps floor-free transmission with a power penalty no greater than 1.5 dB at room temperature. As a conclusion, owing to the large quality factor, a high coherence collapse level is unveiled in such laser indicating its vast potential to serve as an alternative solution for the development of isolator-free applications in future photonics integrated circuits. A qualitative interpretation is also provided by linking the standard feedback equations to the quality factor of the resonator.