Hip Reconstruction In Situ with Screws and Cement (HiRISC) construct to treat large acetabular bone defects

Aims

Large bone defects resulting from osteolysis, fractures, osteomyelitis, or metastases pose significant challenges in acetabular reconstruction for total hip arthroplasty. This study aimed to evaluate the survival and radiological outcomes of an acetabular reconstruction technique in patients at high risk of reconstruction failure (i.e. periprosthetic joint infection (PJI), poor bone stock, immunosuppressed patients), referred to as Hip Reconstruction In Situ with Screws and Cement (HiRISC). This involves a polyethylene liner embedded in cement-filled bone defects reinforced with screws and/or plates for enhanced fixation.

Methods

A retrospective chart review of 59 consecutive acetabular reconstructions was performed by four surgeons in a single institution from 18 October 2018 to 5 January 2023. Cases were classified based on the Paprosky classification, excluding type 1 cases (n = 26) and including types 2 or 3 for analysis (n = 33). Radiological loosening was evaluated by an orthopaedic surgeon who was not the operating surgeon, by comparing the immediate postoperative radiographs with the ones at latest follow-up. Mean follow-up was 557 days (SD 441; 31 to 1,707).

Results

Out of the 33 cases analyzed, six (18.2%) constructs required revision, with four revisions due to uncontrolled infection, one for dislocation, and one for aseptic loosening. Among the 27 non-revised constructs, only one showed wider radiolucencies compared to immediate postoperative radiographs, indicating potential loosening. Patients who underwent revision (n = 6) were significantly younger and had a higher BMI compared to those with non-revised constructs (p = 0.016 and p = 0.026, respectively). Sex, race, ethnicity, American Society of Anesthesiologists grade, infection status (patients with postoperative PJI diagnosis (septic) vs patients without such diagnosis (aseptic)), and mean follow-up did not significantly differ between revised and non-revised groups.

Conclusion

The HiRISC technique may serve as a feasible short-term (about one to two years) alternative in patients with large acetabular defects, particularly in cases of PJI. Longer follow-up is necessary to establish the long-term survival of this technique.

Changes in Functional Meniscal Morphology During Skeletal Growth and Maturation

Background

Little is known on how meniscal morphology develops during skeletal growth and maturation and its subsequent relationship with the corresponding bony anatomy.

Hypotheses

(1) Meniscal dimensions and morphology would change by age during skeletal growth and maturation in different ways in boys compared with girls. (2) Morphological features of the medial and lateral menisci would correlate to medial and lateral femoral condyle curvatures.

Study Design

Cross-sectional study; Level of evidence, 3.

Methods

Anatomic features of the medial and lateral menisci were measured on magnetic resonance imaging scans from 269 unique knees (age, 3-18 years; 51% female) with no prior history of injury, congenital or growth-related skeletal disorders, or bony deformities. Morphological shape-based measurements were normalized to tibial plateau width or determined as ratios of meniscal dimensions. The association between age and anatomy was analyzed with linear regression. Two-way analysis of variance with the Holm-Šídák post hoc method was used to compare anatomy between sexes in different age groups. Linear regression was used to evaluate the relationship between femoral condyle curvature radius and meniscal morphology in each compartment after adjusting for age and sex.

Results

Meniscal length, width, horn distance, mean cross-sectional area (CSA), and mean height increased with age in both sexes (R2 > 0.1; P < .001). Age-related changes in meniscal morphology were seen in normalized length, width, horn distance, and mean height; width-to-length ratio; horn distance-to-length ratio (lateral meniscus only); normalized mean CSA (except lateral meniscus in girls); and mean tip angle (R2 > 0.04; P < .02). Sex-based differences were also found, with some morphological differences (normalized length and height) throughout development (P < .03) and size differences (length, width, and mean CSA) in later development (P < .01). After adjusting for age and sex, there were significant correlations between medial condyle curvature radius and normalized width, width-to-length ratio, horn distance, horn distance-to-length ratio, mean CSA, and mean height of the medial meniscus (P≤ .041) and between lateral condyle curvature radius and normalized length, mean height, and mean tip angle of the lateral meniscus (P≤ .004).

Conclusion

Age-related changes in meniscal dimensions and morphology, most notably a nonuniform growth pattern in meniscal geometry, occurred during skeletal growth and maturation, with different trends in boys than in girls.

Femoral Head Osteonecrosis: Computed Tomography Not Needed to Identify Collapse When Using the Association Research Circulation Osseous Staging System

Background

The 2019 Revised Association Research Circulation Osseous (ARCO) Staging Criteria for Osteonecrosis of the Femoral Head (ONFH) only requires plain radiographs and magnetic resonance imaging (MRI) to diagnose and stage ONFH; however, the effectiveness of the 2019 ARCO criteria in the absence of computed tomography (CT) scans has not been investigated. Therefore, the purpose of this study was to evaluate whether CT scanning is a necessary modality for diagnosing/staging ONFH using the ARCO staging system. More specifically, do CT scans help differentiate pre- and post-collapse lesions more than MRI scans?

Methods

A study was conducted on 228 ONFH patients diagnosed between January 1, 2008, and December 31, 2018, at a single academic medical center. CT and MRI scans were reviewed by the senior author and other contributors. The ONFH classification was compared between the 2 scans to determine if CT scans were able to further differentiate staging of collapsed lesions vs MRI scans.

Results

A diagnosis of ONFH was made by MRI first in 57% (129/228) while 21% (48/228) used MRI and CT simultaneously. Only 22% (51/228) of cases were diagnosed by CT scans first. There were no cases where collapse was found by a CT scan that were not diagnosed by standard x-rays and/or MRIs.

Conclusions

CT scans are not a useful adjunct for diagnosing or treating ONFH and are not necessary if MRI is ordered when using the Revised ARCO Staging System for ONFH diagnosis.

Compliant Clients: Catechols Exhibit Enhanced Solubility and Stability in Diverse Complex Coacervates

Polyelectrolyte coacervates, with their greater-than-water density, low interfacial energy, shear thinning viscosity, and ability to undergo structural arrest, mediate the formation of diverse load-bearing macromolecular materials in living organisms as well as in industrial material fabrication. Coacervates, however, have other useful attributes that are challenging to study given the metastability of coacervate colloidal droplets and a lack of suitable analytical methods. We adopt solution electrochemistry and nuclear magnetic resonance measurements to obtain remarkable insights about coacervates as solvent media for low-molecular-weight catechols. When catechols are added to dispersions of coacervated polyelectrolytes, there are two significant consequences: (1) catechols preferentially partition up to 260-fold into the coacervate phase, and (2) coacervates stabilize catechol redox potentials by up to +200 mV relative to the equilibrium solution. The results suggest that the relationship between phase-separated polyelectrolytes and their client molecules is distinct from that existing in aqueous solution and has the potential for insulating many redox-unstable chemicals.

Effects of joint loading on the development of capital femoral epiphysis morphology

INTRODUCTION

The deleterious influence of increased mechanical forces on capital femoral epiphysis development is well established; however, the growth of the physis in the absence of such forces remains unclear. The hips of non-ambulatory cerebral palsy (CP) patients provide a weight-restricted (partial weightbearing) model which can elucidate the influence of decreased mechanical forces on the development of physis morphology, including features related to development of slipped capital femoral epiphysis (SCFE). Here we used 3D image analysis to compare the physis morphology of children with non-ambulatory CP, as a model for abnormal hip loading, with age-matched native hips.

MATERIALS AND METHODS

CT images of 98 non-ambulatory CP hips (8-15 years) and 80 age-matched native control hips were used to measure height, width, and length of the tubercle, depth, width, and length of the metaphyseal fossa, and cupping height across different epiphyseal regions. The impact of age on morphology was assessed using Pearson correlations. Mixed linear model was used to compare the quantified morphological features between partial weightbearing hips and full weightbearing controls.

RESULTS

In partial weightbearing hips, tubercle height and length along with fossa depth and length significantly decreased with age, while peripheral cupping height increased with age (r > 0.2, P < 0.04). Compared to normally loaded (full weightbearing) hips and across all age groups, partially weightbearing hips' epiphyseal tubercle height and length were smaller (P < .05), metaphyseal fossa depth was larger (P < .01), and posterior, inferior, and anterior peripheral cupping heights were smaller (P < .01).

CONCLUSIONS

Smaller epiphyseal tubercle and peripheral cupping with greater metaphyseal fossa size in partial weightbearing hips suggests that the growing capital femoral epiphysis requires mechanical stimulus to adequately develop epiphyseal stabilizers. Deposit low prevalence and relevance of SCFE in CP, these findings highlight both the role of normal joint loading in proper physis development and how chronic abnormal loading may contribute to various pathomorphological changes of the proximal femur (i.e., capital femoral epiphysis).

Smaller epiphyseal tubercle in hips with slipped capital femoral epiphysis compared to the uninvolved contralateral hip

Recent investigations suggest that physeal morphologic features have a major role in the capital femoral epiphysis stability and slipped capital femoral epiphysis (SCFE) pathology, with a smaller epiphyseal tubercle and larger peripheral cupping of the femoral epiphysis being present in hips with progressive SCFE compared to healthy controls. Yet, little is known on the causal versus remodeling nature of these associations. This study aimed to use preoperative magnetic resonance imaging (MRI) of patients with unilateral SCFE to perform a comparison of the morphology of the epiphyseal tubercle, metaphyseal fossa, and peripheral cupping in hips with SCFE versus the contralateral uninvolved hips. Preoperative MRIs from 22 unilateral SCFE patients were used to quantify the morphological features of the epiphyseal tubercle (height, width, and length), metaphyseal fossa (depth, width, and length), and peripheral cupping height in three dimension. The quantified anatomical features were compared between hips with SCFE and the contralateral uninvolved side across the whole cohort and within SCFE severity subgroups using paired t-test. We found significantly smaller epiphyseal tubercle heights (p < 0.001) across all severities of SCFE when compared to their uninvolved contralateral side. There was a marginally smaller metaphyseal fossa length (p = 0.05) in SCFE hips compared to their contralateral uninvolved hips, with mild SCFE hips specifically having smaller fossa and epiphyseal lengths (p < 0.05) than their contralateral uninvolved side. There were no side-to-side differences in any other features of the epiphyseal tubercle, metaphyseal fossa and peripheral cupping across all severities (p > 0.05). These findings suggest a potential causal role of epiphyseal tubercle in SCFE pathogenesis.

Coxiella burnetii and Borrelia spp. in peripheral blood of dromedary camels in Fars, Iran: molecular characterization, hematological parameters, and acute-phase protein alterations

Background

Dromedary camels (Camelus dromedarius) are raised in extremely strict ecological conditions of deserts. Camels are vulnerable to many zoonotic infections. There are limited data on the occurrence of Q fever and borreliosis in camels, in Iran.

Aims

The current study was focused on the occurrence of Coxiella burnetii and Borrelia spp. infection in the blood samples of Iranian camels using molecular assays. Effect of the presence of these infections on various hematological factors and some acute-phase proteins (Hp, a1AGP, SAA) were also investigated.

Methods

Blood samples were collected from 113 clinically healthy camels to investigate the presence of the infections using nested PCR. Moreover, the sequence of positive samples was analyzed phylogenetically. Routine haematological tests were performed and the concentrations of acute-phase proteins were measured in serum using enzyme immunoassay.

Results

PCR result showed that 6.19% (95% CI: 2.53-12.35%) (7/113) of camels were positive for C. burnetii. In addition, sequencing results of the corresponding gene of the outer membrane protein (com1) revealed two different genotypes of C. burnetii agent in camels from Southern Iran. In the PCR assay, Borrelia spp. DNA was not detected in the samples. No significant difference was observed in hematological parameters or acute-phase proteins between positive and negative Q fever camels except for mean corpuscular hemoglobin (MCH) and red cell distribution width (RDW).

Conclusion

Clinically healthy camels might be very important reservoirs of zoonotic pathogens. Q fever is not considered a notifiable disease in camels of Iran, and clinical cases may scarcely be recognized by the healthcare system. Due to a lack of adequate information, additional studies on the molecular epidemiology and clinical pathology aspects of C. burnetii infection in Iran are needed.

One-Year Readmissions Following Total Joint Arthroplasty May Be Associated With Failure to Achieve the Minimal Clinically Important Difference of Patient-Reported Outcomes Measurement Information System Physical, Mental, and Physical-Short Form-10a

The primary aims of our study were to determine if hospital readmissions within one year following primary total joint arthroplasty (TJA) and their relative timing influence patients' ability to achieve the two-year Patient-Reported Outcomes Measurement Information System (PROMIS) physical, PROMIS mental, and PROMIS Physical-Function-Short-Form-10a (SF-10a) minimal clinically important difference (MCID). This is a retrospective study conducted using data from a multi-institutional, arthroplasty registry. Only patients with paired patient-reported outcome measure (PROM) assessments (preoperatively and two years postoperatively) were included. Five separate readmission cohorts were formed: (1) any-cause readmission within one year, (2) any-cause readmission within 90 days, (3) non-index-surgery-related readmission within 90 days, (4) index-surgery-related readmission within one year, and (5) index-surgery-related readmission within 90 days. A propensity score match was used to match each of the patients to one of the 972 patients (1:1 basis) in the non-readmission group. The association between failure to achieve each of the three two-year MCIDs and Readmission status was analyzed using logistic regression. We found that all readmissions within one year and index-surgery-related readmissions within one year resulted in an increased risk of failure to achieve the two-year MCID across all three collected PROMs. Index surgery-related readmissions within 90 days (OR 3.24; 95% CI 1.05-11.05; p=0.048) sustained significantly different rates of two-year PROMIS physical MCID achievement compared to matched controls. Postoperative complications requiring readmission, particularly those related to the joint arthroplasty and those within 90 days of index surgery, significantly impact the ability to achieve the two-year MCID of PROMs.

Establishing a recommended duration of blood glucose monitoring in nondiabetic patients following orthopaedic surgery

Previous studies have demonstrated that blood glucose (BG) levels should be monitored for at least 1 week after orthopaedic surgery in diabetic patients, but no study has determined how long nondiabetic patients should be monitored. As postoperative elevations in BG have deleterious effects, determining a duration for monitoring the BG of nondiabetic patients after major orthopaedic surgery is needed to detect hyperglycemic events, create comprehensive protocols for nondiabetic orthopaedic patients, and reduce adverse outcomes. A retrospective study was conducted including consecutive patients who underwent a major orthopaedic surgery at a community hospital. A BG level of 150 mg/dl was the cutoff used to define hyperglycemia according to our institutional guidelines. A χ² , analysis of variance, and subgroup analysis were performed separately. Greater than 67% of nondiabetic patients experienced a high BG level (>150 mg/dl) after surgery. We found that nondiabetic patients reached their postoperative maximum BG level at 20 h, which was sooner compared to diabetic patients. We discovered more than 92% of nondiabetic patients reached a maximum BG levels within the first 72 h of hospitalization, while the BG levels after this period were found to be within normal limits in greater than 87% of cases. We propose that BG management be instituted in nondiabetics from the preoperative period to 72 h after surgery, including patients who are same-day discharges. There may not be a need to continue inpatient BG monitoring beyond the first 72 h for nondiabetic hospitalized patients with extended hospitalizations.

Trabecular metal augments in severe malignancy-associated acetabular bone loss

INTRODUCTION

Acetabular reconstruction is a challenging problem in orthopaedic oncology, especially in extended defects (Paprosky Type 3A and Type 3B). In revision total hip arthroplasty (THA), 1 option is trabecular metal (TM) augments with a porous metal acetabular component. This study evaluated the use of TM augments in periacetabular malignant bone disease.

METHODS

15 patients were identified from our institutional database from 2000 to 2020 with either Paprosky Type 3A or Type 3B acetabular bone loss due to periacetabular malignancies that underwent at least 1 complex THA reconstruction with TM augments. Postoperative complications were documented, and clinical and radiographic outcomes were analysed. Radiological loosening or revision of the acetabular component were defined as endpoints.

RESULTS

There were 7 primary and 8 metastatic cancer patients. 5 were Type 3A and 10 were Type 3B defects after tumour resection. The average follow-up time was 23.8 (range 1.5-47) months. 1 patient required revision for acetabular component loosening after 7 months from the initial implantation. An additional 4 patients required surgical intervention for infection, they had stable TM augments at latest follow-up.

CONCLUSION

TM augments with a porous metal acetabular component may be an alternative to the traditional cemented constructs.

Whole genome and transcriptome analysis enhances precision cancer treatment options

BACKGROUND

Recent advances are enabling delivery of precision genomic medicine to cancer clinics. While the majority of approaches profile panels of selected genes or hotspot regions, comprehensive data provided by whole genome and transcriptome sequencing and analysis (WGTA) presents an opportunity to align a much larger proportion of patients to therapies.

PATIENTS AND METHODS

Samples from 570 patients with advanced or metastatic cancer of diverse types enrolled in the Personalized OncoGenomics (POG) program underwent WGTA. DNA-based data, including mutations, copy number, and mutation signatures, were combined with RNA-based data, including gene expression and fusions, to generate comprehensive WGTA profiles. A multidisciplinary molecular tumour board used WGTA profiles to identify and prioritize clinically actionable alterations and inform therapy. Patient responses to WGTA-informed therapies were collected.

RESULTS

Clinically actionable targets were identified for 83% of patients, 37% of whom received WGTA-informed treatments. RNA expression data were particularly informative, contributing to 67% of WGTA-informed treatments; 25% of treatments were informed by RNA expression alone. Of a total 248 WGTA-informed treatments, 46% resulted in clinical benefit. RNA expression data were comparable to DNA-based mutation and copy number data in aligning to clinically beneficial treatments. Genome signatures also guided therapeutics including platinum, PARP inhibitors, and immunotherapies. Patients accessed WGTA-informed treatments through clinical trials (19%), off-label use (35%), and as standard therapies (46%) including those which would not otherwise have been the next choice of therapy, demonstrating the utility of genomic information to direct use of chemotherapies as well as targeted therapies.

CONCLUSIONS

Integrating RNA expression and genome data illuminated treatment options that resulted in 46% of treated patients experiencing positive clinical benefit, supporting the use of comprehensive WGTA profiling in clinical cancer care.

CLINICAL TRIAL NUMBER

NCT02155621.

Effect of the COVID-19 Pandemic on Rates of Ninety-Day Peri-Prosthetic Joint and Surgical Site Infections after Primary Total Joint Arthroplasty: A Multicenter, Retrospective Study

Background: The impact of the coronavirus 2019 (COVID-19) pandemic on the rate of primary total joint arthroplasty (TJA) peri-prosthetic joint infection (PJI) and superficial surgical site infections (SSI) is currently unknown. The purpose of this multicenter study was to evaluate any changes in the rates of 90-day PJI or 30-day SSI, including trends in microbiology of the infections, during the COVID-19 pandemic compared to the three years prior. Patients and Methods: An Institutional Review Board-approved, multicenter, retrospective study was conducted with five participating academic institutions across two healthcare systems in the northeastern United States. Primary TJA patients from the years 2017-2019 were grouped as a pre-COVID-19 pandemic cohort and patients from the year 2020 were grouped as a COVID-19 pandemic cohort. Differences in patient demographics, PJI, SSI, and microbiology between the two cohorts were assessed. Results: A total of 14,844 TJAs in the pre-COVID-19 pandemic cohort and 5,453 TJAs in the COVID-19 pandemic cohort were evaluated. There were no substantial differences of the combined 90-day PJI and 30-day superficial SSI rates between the pre-COVID-19 pandemic cohort (0.35%) compared with the COVID-19 pandemic cohort (0.26%; p = 0.303). Conclusions: This study did not find any change in the rates of 90-day PJI or 30-day superficial SSI in patients undergoing primary TJA between a pre-COVID-19 pandemic and COVID-19 pandemic cohort. Larger national database studies may identify small but substantial differences in 90-day PJI and 30-day superficial SSI rates between these two time periods. Our data may support continued efforts to maintain high compliance with hand hygiene, use of personal protective equipment, and limited hospital visitation whenever possible.

Mapping transcriptomic vector fields of single cells

Single-cell (sc)-RNA-seq, together with RNA-velocity and metabolic labeling, reveals cellular states and transitions at unprecedented resolution. Fully exploiting these data, however, requires kinetic models capable of unveiling governing regulatory functions. Here, we introduce an analytical framework dynamo, that infers absolute RNA velocity, reconstructs continuous vector-field functions that predict cell fates, employs differential geometry to extract underlying regulations, and ultimately predicts optimal reprogramming paths and perturbation outcomes. We highlight dynamo’s power to overcome fundamental limitations of conventional splicing-based RNA velocity analyses to enable accurate velocity estimations on a metabolically-labeled human hematopoiesis scRNA-seq dataset. Furthermore, differential geometry analyses reveal mechanisms driving early megakaryocyte appearance and elucidate asymmetrical regulation within the PU.1–GATA1 circuit. Leveraging the Least-Action-Path method, dynamo accurately predicts drivers of numerous hematopoietic transitions. Finally, in silico perturbations predict cell-fate diversions induced by gene perturbations. Dynamo thus represents an important step in advancing quantitative and predictive theories of cell-state transitions.

Plaster of Paris: Squeeze, But Not Too Hard!

Plaster of Paris (PoP) has been the predominant treatment option for most acute and chronic orthopedic conditions. Water immersion significantly decreases the PoP bandage strength. Moreover, concerns have been raised about the possibility of breaks in PoP splints and cast failures once solid. The current study was designed to account for the increase in weight associated with increased PoP layers. The authors hypothesized that by controlling for weight variation as layers increased, they could determine the number of layers of PoP bandage that truly results in optimal mechanical properties. They assessed whether adequate plaster weight control while increasing layers could improve the mechanical properties of the splint. [Orthopedics. 2022;45(1):e57-e61.].

Immunological and bacteriological quality of fresh cow colostrum and passive immunity transfer in selected dairy farms in Fars, Iran

Background

The quality of colostrum is affected by IgG level and microbial load.

Aims

The quality of colostrum used in feeding dairy calves and passive immunity transfer in selected dairy farms in Fars province, Iran was investigated.

Methods

A total of 75 colostrum and neonatal blood samples were collected from 11 herds. The immunological quality of colostrum was assessed using a Brix digital refractometer. The bacteriological quality was assessed by performing total plate count (TPC), total coliform count (TCC), spore-former count, fungi count, and species-specific PCR assay to detect some bacterial species.

Results

The mean Brix of colostrum samples was 25.4% and 72% of the samples had a Brix score ≥22%. The mean serum Brix and the prevalence of failure of passive transfer (FPT) were 10% and 4%, respectively. The mean TPC, TCC, spore-former count, and fungi count were 3.6 × 10⁵, 2.8 × 10⁴, 3.2 × 10⁴, and 1.1 × 10⁴ CFU/ml, respectively. The results showed that 50, 5.9, and 4% of colostrum samples were positive for Staphylococcus spp., Salmonella spp. and Maycobacterium paratuberculosis, respectively. There was no evidence of contamination with Brucella spp., Corynebacterium bovis and Mycoplasma bovis.

Conclusion

Considering all colostrum quality indicators comprehensively, only 37.3% of the studied samples met the industry standard. A large number of calves were at risk of receiving poor quality colostrum, especially in terms of microbial contamination. Further researches are needed to evaluate the colostrum management and the effect of bacterial contamination of colostrum on the health of neonate calves in this region.

Dupuytren's Contracture: The Readability of Online Information

Dupuytren's contracture is a common hand pathology for which consultation and treatment are largely at the patient's discretion. The objective of this study was to evaluate the readability of current online patient information regarding Dupuytren's contracture. The largest public search engines (Google, Yahoo, and Bing) were queried using the search terms “Dupuytren's contracture,” “Dupuytren's disease,” “Viking's disease,” and “bent finger.” The first 30 unique websites by each search were analyzed and readability assessed using five established algorithms: Flesch Reading Ease, Gunning-Fog Index, Flesch–Kincaid Grade level, Coleman–Liau index, and Simple Measure of Gobbledygook grade level. Analysis of 73 websites demonstrated an average Flesch Reading Ease score of 48.6 ± 8.0, which corresponds to college reading level. The readability of websites ranged from 10.5 to 13.3 reading grade level. No article was written at or below the recommended sixth grade reading level. Information on the internet on Dupuytren's contracture is written at higher than recommended reading grade level. There is a need for high-quality patient information on Dupuytren's contracture at appropriate reading grade levels for patients of various health literacy backgrounds. Hospitals, universities, and academic organizations focused on the development of readable online information should consider patients’ input and preferences.

Different Designs of Proximal Femoral Stems for Total Hip Arthroplasty: Mid-Term Clinical and Patient-Reported Functional Outcomes

INTRODUCTION

A comprehensive comparison of the performance of different femoral stem geometries in total hip arthroplasty (THA) is yet to be described. The primary aim of this study was to evaluate objective and subjective outcome measures in primary THA with different femoral implant styles.

METHODS

Stems were classified into the following five classes: cemented, conical, fit and fill, modular, and wedge. The objective outcomes of interest were the length of inpatient hospital stay (LOS), 90-day readmission rate, one-year revision rate, and two-year mortality rate. Preoperative and postoperative patient-reported outcome measures (PROMs), including hip disability and osteoarthritis outcome score (HOOS) - physical function shortform (HOOS-PS), patient-reported outcomes measurement information system physical function short form 10a (PROMIS PF-10a), and patient-reported outcomes measurement information system - short form - mental 10a (PROMIS M-10a) were recorded and compared between different classes.

RESULTS

Patients with a wedge stem had a significantly lower LOS versus every other stem group, while patients with a cemented stem had the highest LOS, approximately twofold that of the wedge stem group. Accounting for potential confounders, the conical and fit and fill groups had a significantly higher two-year mortality rate than the wedge stem group. Fit and fill stems conferred a slight risk of revision THA at one-year compared to wedge stems. There was no significant difference in the rates of failure to achieve the minimal clinically important difference (MCID) for the PROMs.

CONCLUSION

Placement of wedge stems resulted in a significantly lower LOS compared to every other stem class and a lower mortality rate than the conical, fit and fill, and modular stems. As for the 90-day readmission, one-year revision, and the rates of failure to achieve the MCID for general or hip-specific PROMs, stem design had no meaningful effect.

Joint disease-specificity at the regulatory base-pair level

Given the pleiotropic nature of coding sequences and that many loci exhibit multiple disease associations, it is within non-coding sequence that disease-specificity likely exists. Here, we focus on joint disorders, finding among replicated loci, that GDF5 exhibits over twenty distinct associations, and we identify causal variants for two of its strongest associations, hip dysplasia and knee osteoarthritis. By mapping regulatory regions in joint chondrocytes, we pinpoint two variants (rs4911178; rs6060369), on the same risk haplotype, which reside in anatomical site-specific enhancers. We show that both variants have clinical relevance, impacting disease by altering morphology. By modeling each variant in humanized mice, we observe joint-specific response, correlating with GDF5 expression. Thus, we uncouple separate regulatory variants on a common risk haplotype that cause joint-specific disease. By broadening our perspective, we finally find that patterns of modularity at GDF5 are also found at over three-quarters of loci with multiple GWAS disease associations.

Comprehensive comparison between 222 CTLA-4 haploinsufficiency and 212 LRBA deficiency patients: a systematic review

Cytotoxic T lymphocyte antigen 4 (CTLA-4) haploinsufficiency (CHAI) and lipopolysaccharide-responsive beige-like anchor (LRBA) deficiency (LATAIE) are newly identified inborn errors of immunity with shared molecular pathomechanisms and clinical manifestations. In this review, we aimed to provide differential comparisons regarding demographic, clinical, immunological and molecular characteristics between these two similar conditions. A literature search was conducted in PubMed, Web of Science and Scopus databases and included studies were systematically evaluated. Overall, 434 (222 CHAI and 212 LATAIE) patients were found in 101 eligible studies. The CHAI patients were mainly reported from North America and western Europe, while LATAIE patients were predominantly from Asian countries. In CHAI, positive familial history (P < 0·001) and in LATAIE, consanguineous parents (P < 0·001) were more common. In CHAI patients the rates of granulomas (P < 0·001), malignancies (P = 0·001), atopy (P = 0·001), cutaneous disorders (P < 0·001) and neurological (P = 0·002) disorders were higher, while LATAIE patients were more commonly complicated with life-threatening infections (P = 0·002), pneumonia (P = 0·006), ear, nose and throat disorders (P < 0·001), organomegaly (P = 0·023), autoimmune enteropathy (P = 0·038) and growth failure (P < 0·001). Normal lymphocyte subsets and immunoglobulins except low serum levels of CD9⁺ B cells (14·0 versus 38·4%, P < 0·001), natural killer (NK) cells (21 versus 41·1%, P < 0·001), immunoglobulin (Ig)G (46·9 versus 41·1%, P = 0·291) and IgA (54·5 versus 44·7%, P = 0·076) were found in the majority of CHAI and LATAIE patients, respectively. The most frequent biological immunosuppressive agents prescribed for CHAI and LATAIE patients were rituximab and abatacept, respectively. Further investigations into the best conditioning and treatment regimens pre- and post-transplantation are required to improve the survival rate of transplanted CHAI and LATAIE patients.

Does the Capital Femoral Physis Bony MorphologyDiffer in Children with Symptomatic Cam-type Femoroacetabular Impingement

BACKGROUND

The epiphyseal tubercle, the corresponding metaphyseal fossa, and peripheral cupping are key stabilizers of the femoral head-neck junction. Abnormal development of these features in the setting of supraphysiologic physeal stress under high forces (for example, forces that occur during sports activity) may result in a cam morphology. Although most previous studies on cam-type femoroacetabular impingement (FAI) have mainly focused on overgrowth of the peripheral cupping, little is known about detailed morphologic changes of the epiphyseal and metaphyseal bony surfaces in patients with cam morphology.

QUESTIONS/PURPOSES

(1) Does the CT-based bony morphology of the peripheral epiphyseal cupping differ between patients with a cam-type morphology and asymptomatic controls (individuals who did not have hip pain)? (2) Does the CT-based bony morphology of the epiphyseal tubercle differ between patients with a cam-type morphology and asymptomatic controls? (3) Does the CT-based bony morphology of the metaphyseal fossa differ between patients with a cam-type morphology and asymptomatic controls?

METHODS

After obtaining institutional review board approval for this study, we retrospectively searched our institutional database for patients aged 8 to 15 years with a diagnosis of an idiopathic cam morphology who underwent a preoperative CT evaluation of the affected hip between 2005 and 2018 (n = 152). We excluded 96 patients with unavailable CT scans and 40 patients with prior joint diseases other than cam-type FAI. Our search resulted in 16 patients, including nine males. Six of 16 patients had a diagnosis of bilateral FAI, for whom we randomly selected one side for the analysis. Three-dimensional (3-D) models of the proximal femur were generated to quantify the size of the peripheral cupping (peripheral growth of the epiphysis around the metaphysis), epiphyseal tubercle (a beak-like prominence in the posterosuperior aspect of the epiphysis), and metaphyseal fossa (a groove on the metaphyseal surface corresponding to the epiphyseal tubercle). A general linear model was used to compare the quantified anatomic features between the FAI cohort and 80 asymptomatic hips (aged 8 to 15 years; 50% male) after adjusting for age and sex. A secondary analysis using the Wilcoxon matched-pairs signed rank test was performed to assess side-to-side differences in quantified morphological features in 10 patients with unilateral FAI.

RESULTS

After adjusting for age and sex, we found that patients with FAI had larger peripheral cupping in the anterior, posterior, superior, and inferior regions than control patients who did not have hip symptoms or radiographic signs of FAI (by 1.3- to 1.7-fold; p < 0.01 for all comparisons). The epiphyseal tubercle height and length were smaller in patients with FAI than in controls (by 0.3- to 0.6-fold; p < 0.02 for all comparisons). There was no difference in tubercle width between the groups. Metaphyseal fossa depth, width, and length were larger in patients with FAI than in controls (by 1.8- to 2.3-fold; p < 0.001 for all comparisons). For patients with unilateral FAI, we saw similar peripheral cupping but smaller epiphyseal tubercle (height and length) along with larger metaphyseal fossa (depth) in the FAI side compared with the uninvolved contralateral side.

CONCLUSION

Consistent with prior studies, we observed more peripheral cupping in patients with cam-type FAI than control patients without hip symptoms or radiographic signs of FAI. Interestingly, the epiphyseal tubercle height and length were smaller and the metaphyseal fossa was larger in hips with cam-type FAI, suggesting varying inner bone surface morphology of the growth plate. The docking mechanism between the epiphyseal tubercle and the metaphyseal fossa is important for epiphyseal stability, particularly at early ages when the peripheral cupping is not fully developed. An underdeveloped tubercle and a large fossa could be associated with a reduction in stability, while excessive peripheral cupping growth would be a factor related to improved physeal stability. This is further supported by observed side-to-side differences in tubercle and fossa morphology in patients with unilateral FAI. Further longitudinal studies would be worthwhile to study the causality and compensatory mechanisms related to epiphyseal and metaphyseal bony morphology in pathogenesis cam-type FAI. Such information will lay the foundation for developing imaging biomarkers to predict the risk of FAI or to monitor its progress, which are critical in clinical care planning.

LEVEL OF EVIDENCE

Level III, prognostic study.

What Is the Association Among Epiphyseal Rotation, Translation, and the Morphology of the Epiphysis and Metaphysis in Slipped Capital Femoral Epiphysis?

BACKGROUND

Contemporary studies have described the rotational mechanism in patients with slipped capital femoral epiphysis (SCFE). However, there have been limited patient imaging data and information to quantify the rotation. Determining whether the epiphysis is rotated or translated and measuring the epiphyseal displacement in all planes may facilitate planning for surgical reorientation of the epiphysis.

QUESTIONS/PURPOSES

(1) How does epiphyseal rotation and translation differ among mild, moderate, and severe SCFE? (2) Is there a correlation between epiphyseal rotation and posterior or inferior translation in hips with SCFE? (3) Does epiphyseal rotation correlate with the size of the epiphyseal tubercle or the metaphyseal fossa or with epiphyseal cupping?

METHODS

We identified 51 patients (55% boys [28 of 51]; mean age 13 ± 2 years) with stable SCFE who underwent preoperative CT of the pelvis before definitive treatment. Stable SCFE was selected because unstable SCFE would not allow for accurate assessment of rotation given the complete displacement of the femoral head in relation to the neck. The epiphysis and metaphysis were segmented and reconstructed in three-dimensions (3-D) for analysis in this retrospective study. One observer (a second-year orthopaedic resident) performed the image segmentation and measurements of epiphyseal rotation and translation relative to the metaphysis, epiphyseal tubercle, metaphyseal fossa, and the epiphysis extension onto the metaphysis defined as epiphyseal cupping. To assess the reliability of the measurements, a randomly selected subset of 15 hips was remeasured by the primary examiner and by the two experienced examiners independently. We used ANOVA to calculate the intraclass and interclass correlation coefficients (ICCs) for intraobserver and interobserver reliability of rotational and translational measurements. The ICC values for rotation were 0.91 (intraobserver) and 0.87 (interobserver) and the ICC values for translation were 0.92 (intraobserver) and 0.87 (intraobserver). After adjusting for age and sex, we compared the degree of rotation and translation among mild, moderate, and severe SCFE. Pearson correlation analysis was used to assess the associations between rotation and translation and between rotation and tubercle, fossa, and cupping measurements.

RESULTS

Hips with severe SCFE had greater epiphyseal rotation than hips with mild SCFE (adjusted mean difference 21° [95% CI 11° to 31°]; p < 0.001) and hips with moderate SCFE (adjusted mean difference 13° [95% CI 3° to 23°]; p = 0.007). Epiphyseal rotation was positively correlated with posterior translation (r = 0.33 [95% CI 0.06 to 0.55]; p = 0.02) but not with inferior translation (r = 0.16 [95% CI -0.12 to 0.41]; p = 0.27). There was a positive correlation between rotation and metaphyseal fossa depth (r = 0.35 [95% CI 0.08 to 0.57]; p = 0.01), width (r = 0.41 [95% CI 0.15 to 0.61]; p = 0.003), and length (r = 0.56 [95% CI 0.38 to 0.75]; p < 0.001).

CONCLUSION

This study supports a rotational mechanism for the pathogenesis of SCFE. Increased rotation is associated with more severe slips, posterior epiphyseal translation, and enlargement of the metaphyseal fossa. The rotational nature of the deformity, with the center of rotation at the epiphyseal tubercle, should be considered when planning in situ fixation and realignment surgery. Avoiding placing a screw through the epiphyseal tubercle-the pivot point of rotation- may increase the stability of the epiphysis. The realignment of the epiphysis through rotation rather than simple translation is recommended during the open subcapital realignment procedure. Enlargement of the metaphyseal fossa disrupts the interlocking mechanism with the tubercle and increases epiphyseal instability. Even in the setting of a stable SCFE, an increased fossa enlargement may indicate using two screws instead of one screw, given the severity of epiphyseal rotation and the risk of instability. Further biomechanical studies should investigate the number and position of in situ fixation screws in relation to the epiphyseal tubercle and metaphyseal fossa.

LEVEL OF EVIDENCE

Level III, prognostic study.

What Are the Early Outcomes of True Reverse Periacetabular Osteotomy for Symptomatic Hip Overcoverage?

BACKGROUND

Acetabular overcoverage is associated with pincer-type femoroacetabular impingement (FAI). A subtype of acetabular overcoverage is caused by a deep acetabulum with a negatively tilted acetabular roof, in which acetabular reorientation may be a preferable alternative to rim trimming to uncover the femoral head. We introduced the true reverse periacetabular osteotomy (PAO) in 2003, which in contrast to an anteverting PAO, also flexes and abducts the acetabulum relative to the intact ilium to decrease anterior and lateral femoral head coverage and correct negative tilt of the acetabular roof. To our knowledge, the clinical results of the true reverse PAO have not been evaluated.

QUESTIONS/PURPOSES

For a group of patients who underwent reverse PAO, (1) Do patients undergoing reverse PAO demonstrate short-term improvement in pain, function, and hip ROM, and decreased acetabular coverage, as defined by lateral and anterior center-edge angle and Tönnis angle? (2) Are there identifiable factors associated with success or adverse outcomes of reverse PAO as defined by reoperation, conversion to THA, or poor patient-reported outcome scores? (3) Are there identifiable factors associated with early complications?

METHODS

Between 2003 and 2017, two surgeons carried out 49 reverse PAOs in 37 patients. Twenty-five patients had unilateral reverse PAO and 12 patients had staged, bilateral reverse PAOs. To ensure that each hip was an independent data point for statistical analysis, we chose to include in our series only the first hip in the patients who had bilateral reverse PAOs. During the study period, our general indications for this operation were symptomatic lateral and anterior acetabular overcoverage causing FAI that had failed to respond to previous conservative or surgical treatment. Thirty-seven hips in 37 patients with a median (range) age of 18 years (12 to 41; interquartile range 16 to 21) were included in this retrospective study at a minimum follow-up of 2 years (median 6 years; range 2 to 17). Thirty-four patients completed questionnaires, 24 patients had radiographic evaluation, and 23 patients received hip ROM clinical examination. However, seven patients had not been seen in more than 5 years. The clinical and radiographic parameters of all 37 hips that underwent reverse PAO in 37 patients from a longitudinally maintained institutional database were retrospectively studied preoperatively and postoperatively. Adverse outcomes were considered conversion to THA or a WOMAC pain score greater than 10 at least 2 years postoperatively. Patient-reported outcomes, radiographic measurements, and hip ROM were evaluated preoperatively and at most recent follow-up using a paired t-test or McNemar test, as appropriate. Linear regression analysis was used to assess for identifiable factors associated with clinical outcomes. Logistic regression analysis was used to assess for identifiable factors associated with adverse outcomes and surgical complications. All tests were two-sided, and p values less than 0.05 were considered significant.

RESULTS

At a minimum of 2 years after reverse PAO, patients experienced improvement in WOMAC pain (-7 [95% CI -9 to -5]; p < 0.001), stiffness (-2 [95% CI -3 to -1]; p < 0.001), and function scores (-18 [95% CI -24 to -12]; p < 0.001) and modified Harris Hip Score (mHHS) (20 [95% CI 13 to 27]; p < 0.001). The mean postoperative hip ROM improved in internal rotation (8° [95% CI 2° to 14°]; p = 0.007). Acetabular coverage, as defined by lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), and Tönnis angle, improved by -8° (95% CI -12° to -5°; p < 0.001) for LCEA, -12° (95% CI -15° to -9°; p < 0.001) for ACEA, and 9° (95% CI 6° to 13°; p < 0.001) for Tönnis angle. The postoperative severity of radiographic arthritis was associated with worse WOMAC function scores such that for each postoperative Tönnis grade, WOMAC function score increased by 12 points (95% CI 2 to 22; p = 0.03). A greater postoperative Tönnis grade was also correlated with worse mHHS, with an average decrease of 12 points (95% CI -20 to -4; p = 0.008) in mHHS for each additional Tönnis grade. Presence of a positive postoperative anterior impingement test was associated with a decrease in mHHS score at follow-up, with an average 23-point decrease in mHHS (95% CI -34 to -12; p = 0.001). Nineteen percent (7 of 37) of hips had surgery-related complications. Four hips experienced adverse outcomes at final follow-up, with two patients undergoing subsequent THA and two with a WOMAC pain score greater than 10. We found no factors associated with complications or adverse outcomes.

CONCLUSION

The early clinical and radiographic results of true reverse PAO compare favorably to other surgical treatments for pincer FAI, suggesting that reverse PAO is a promising treatment for cases of pincer FAI caused by global acetabular overcoverage. However, it is a technically complex procedure that requires substantial training and preparation by a surgeon who is already familiar with standard PAO, and it must be carefully presented to patients with discussion of the potential risks and benefits. Future studies are needed to further refine the indications and to determine the long-term outcomes of reverse PAO.

LEVEL OF EVIDENCE

Level IV, therapeutic study.

Age-related changes in ACL morphology during skeletal growth and maturation are different between females and males

Despite a well-established role of anterior cruciate ligament (ACL) anatomy on its biomechanics, little is known on how ACL anatomy develops and changes during skeletal growth. We hypothesized that ACL size and orientation will change by age during skeletal growth and maturation with different trends in males vs females. Magnetic resonance images of 269 unique knees (3-18 years old; 51% female) were used to measure ACL length, cross-sectional area, length-to-cross-sectional area ratio, and elevation angles. In both males and females, ACLs became longer, thicker, and more vertical in sagittal and coronal planes by increasing age (R²  > 0.2; P < .001 for all associations). ACL cross-sectional area-to-length ratio increased by age only in males (R²  = 0.06; P = .003). Despite similar ACL sizes between males and females at early age, adolescent males had significantly longer and thicker ACLs compared to the age-matched females (P < .05). There were no sex differences in ACL elevation angles (P > .2) except for larger coronal elevation in 7 to 10 years old females compared to age-matched males (P = .012). Observed changes in ACL cross-sectional area-to-length ratio indicate that age- and sex-dependent changes in ACL size are not homogenous. The trends seen in normalized ACL size measurements suggest that unlike ACL cross-sectional area, ACL length is primarily controlled by body size. Smaller ACLs and lower cross-sectional growth rates observed in females may be contributing factors to the higher risk of ACL injuries in females. Further investigations are required to identify the intrinsic and extrinsic factors responsible for these discrepancies.

Impaired atrial electromechanical coupling in lichen planus patients

Funding Acknowledgements

Type of funding sources: None.

Introduction

Lichen planus (LP) which is a chronic inflammatory disease can cause impaired atrial electromechanical coupling, leading to increased risk of atrial fibrillation.

Purpose

The present study aimed to evaluate atrial electromechanical coupling in LP patients by using electrocardiography (ECG) and echocardiography.

Methods

Forty-six LP patients were investigated in this cross-sectional case-control study. The control group comprised healthy individuals selected in age and gender-matched manner. Echocardiography and ECG were done for all patients to show inter and intra-atrial electromechanical delays and P wave dispersion respectively. The electromechanical delays were calculated by using the difference between the delays from the onset of the P wave on ECG to the onset of A wave on tissue Doppler recordings of the different areas.

Results

The baseline characteristics of the case and control group were similar and did not differ significantly. The P wave dispersion was 45.63 ± 3.48 milliseconds in the LP group in comparison to 36.56 ± 2.87 milliseconds in the control group (p &lt; 0.001). As shown in the table, the intra and inter-atrial electromechanical delays were also significantly prolonged in LP patients when compared to the control group (p &lt; 0.001). There was no significant difference between the left and right ventricular systolic function and diastolic function of the two groups.

Conclusion

The results of the study indicate the presence of significant impaired atrial electromechanical coupling in patients with LP confirmed by both electrocardiographic and echocardiographic tools.

Electromechanical delays Case N = 46 (mean ± SD) Control N = 46 (mean ± SD) P value Septal - PA (msec) 59.71 ± 13.24 44.39 ± 11.07 0.002 Lateral - PA (msec) 55.71 ± 13.26 48.89 ± 11.21 0.009 Tricuspid - PA (msec) 52.37 ± 13.12 43.28 ± 10.58 0.002 Inter-atrial delay (msec) (lateral PA−RV PA) 8.47 ± 1.62 6.37 ± 1.36 &lt;0.001 Intra-atrial delay (msec) (LA) [lateral PA−septal PA] 4.80 ± 1.48 3.83 ± 0.82 &lt;0.001 Intra-atrial delay (msec) (RA) [septal PA−RV PA] 3.91 ± 0.96 2.02 ± 0.71 &lt;0.001 PA Delay from the onset of the P wave on ECG to the onset of A wave on tissue Doppler, N: number, SD: Standard Deviation, LA: Left Atrium, RA: Right Atrium, RV: Right Ventricle

Alteration of fatty acid profile of milk in Holstein cows fed Bacillus coagulans as probiotic: a field study

BACKGROUND

Probiotics may improve milk quality and the general health status of animals.

AIMS

The effects of dietary Bacillus coagulans PRM101 on milk components, milk fatty acids (FA), and some health indicators of dairy cows were investigated.

METHODS

The probiotic was added to the feed of 12 Holstein cows (2 g/cow: 2 × 1011 CFU/cow) for 63 days compared to a control group fed on the basal ration (n=11). Milk and blood samples were taken on days 0, 21, 42, and 63.

RESULTS

The yields of milk and energy corrected milk (ECM; computed from milk weight and its fat and protein content) decreased linearly and similarly (P=0.60) in both groups. The treatment cows, however, showed quadratic increases in the weights of milk (P=0.03) and ECM (P=0.04) at d42 of the study. Energy corrected milk (d42, P<0.05) and crude protein content of milk (d42, P<0.05; d63, P<0.1) were higher in the cows receiving the probiotic. The proportions of heptadecanoic (C17:0; P=0.002) and linoleic (C18:2; P=0.077) acids in milk fat (g/100 g fat) were higher in the treatment cows on d63. Milk total antioxidant capacity (TAC), malondialdehyde (MDA), and similarly, amyloid A (AA) and haptoglobin (Hp) of milk and blood were not affected. Total antioxidant capacity and MDA were negatively correlated in the control group (r=-0.669, P=0.005). Heptadecanoic acid correlated negatively with milk MDA (r=-0.611, P=0.035) and positively (r=0.591, P=0.043) with serum Hp in the treatment cows.

CONCLUSION

Dietary B. coagulans PRM101 may improve the proportions of C17:0 and C18:2 FA in milk. Some improvements in milk protein and the health status of the cows may also be anticipated.

Interleukin-8 gene expression and apoptosis induced by Salmonella Typhimurium in the presence of Bacillus probiotics in the epithelial cell

AIMS

This study aimed to evaluate the effects of three Bacillus probiotics on Salmonella Typhimurium, and interleukin-8 (IL-8) gene expression in the co-culture of the Bacillus and the pathogen in vitro.

METHODS AND RESULTS

Bacillus subtilis, Bacillus indicus and Bacillus coagulans were initially turned to spore and heat-inactivated forms. The cellular damages of the probiotics on the HT-29 cells were investigated individually and in combination with S. Typhimurium using 3-(4,5 dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) and fluorescence assays. To extract cell free supernatants (CFS) of the probiotics, they were cultured in selective media. The inhibitory activity of CFSs were then assayed against the pathogen. The gene expression of IL-8 of the HT-29 cells was evaluated by real-time PCR in all the groups. The results showed that the CFSs of three probiotics could inhibit the growth of S. Typhimurium by more than 50%. Inhibitory effects of B. indicus and B. subtilis CFSs were related to the production of pepsin-sensitive compounds, except B. coagulans in which the high inhibitory effect was due to organic acids. The spores of the three probiotics and the heat-inactivated forms of B. subtilis and B. coagulans could reduce the cytotoxicity of S. Typhimurium. The cell viability also increased applying both forms probiotics against the pathogen. In all co-culture groups, the IL-8 gene expression induced by S. Typhimurium was reduced.

CONCLUSIONS

The three Bacillus probiotics can be considered as proper candidates for the prevention and treatment of S. Typhimurium food poisoning.

SIGNIFICANCE AND IMPACT OF THE STUDY

Applying probiotics as live bacteria is universally noted in foods. This study tried to discover the effects of Bacillus probiotics in the form of spore or even heat-killed bacteria against S. Typhimurium and evaluate ratio of IL-8 gene expression in cell culture. The most effective Bacillus probiotic will be recommended. This approach will help to use probiotics as nonvegetative cells in foods to fight gastrointestinal pathogens.

A web-based daily care training to improve the quality of life of mothers of children with cerebral palsy: A randomized controlled trial

BACKGROUND

Mothers of moderately to severely affected children with cerebral palsy (CP) have to spend a long time to take care of their children. This time-consuming responsibility affects their physical and psychosocial health. Therefore, mothers as caregivers are required to receive special training to take care of their children.

AIMS

The aim of this study was to evaluate the effectiveness of a developed web-based intervention for daily care training of children with CP on their mothers' quality of life (QOL), anxiety, depression, stress, and their musculoskeletal pain.

METHODS AND PROCEDURES

This study was a single blind randomized controlled trial. 91 mothers of children with CP with Gross Motor Function Classification System (GMFCS) levels III, IѴ, and Ѵ, who aged from 4 to 12 years were assigned to the intervention and control groups using block randomization. Mothers in the control group received their routine face to face occupational therapy intervention and mothers in the intervention group received 12 weeks web-based intervention. QOL, depression, anxiety, stress, and pain were measured before and after the intervention in both groups.

OUTCOMES AND RESULTS

The results of analysis of covariance showed that after controlling the mean score of pretest of pain, the mean score of post-tests in the intervention and control groups was significantly different (P < 0.05). The mean scores of physical health and total QOL scores of post-tests in the intervention group were significantly higher than the control group with controlling pretest scores.

CONCLUSIONS AND IMPLICATIONS

Designed web-based intervention affects the caregivers' QOL and pain significantly. This intervention can be used to provide daily care training for mothers of children with CP.

Age- and sex-specific morphologic changes in the metaphyseal fossa adjacent to epiphyseal tubercle in children and adolescents without hip disorders

The epiphyseal tubercle plays an important role in epiphyseal stabilization. While the majority of studies have focused on tubercle morphology, there is a paucity of information on the morphological features of the metaphyseal fossa, where the tubercle sits on the metaphysis. The goal of this study was to determine the developmental changes in the capital femoral metaphyseal fossa. Computed tomography of the pelvis from 80 children and adolescents 8-15 years old were used to create three-dimensional models of the proximal femur. Depth, width, length, and surface area of the metaphyseal fossa were measured and the impact of age and sex on fossa morphology was assessed using the linear regression and two-way analysis of variance, respectively. The metaphyseal fossa was located in the posterosuperior quadrant of the metaphysis without any variations in the location with increasing age (P > .1). However, with increasing age, there was a reduction in all metaphyseal fossa measurements including the depth, length, width, and surface area (P < .01). No significant differences were noted for the metaphyseal fossa measurements between males and females (P > .1). The metaphyseal fossa reduces in size from 8 to 15 years of age in a similar fashion in males and females. As the metaphyseal fossa adjacent to the tubercle matches the area where a focal radiolucency has been observed in early slipped capital femoral epiphysis (SCFE), further studies should clarify the mechanisms by which the interlocking interaction of the epiphyseal tubercle and its fossa contributes to or is affected by SCFE.

Imaging of Acute Shoulder Trauma

Acute injuries to the shoulder girdle are common and frequently encountered by the practicing radiologist. The type of injury is highly dependent on the age of the patient and mechanism of trauma with injuries occurring at the site of greatest mechanical weakness. In this review, we discuss the main clinical features and key imaging findings for the most common shoulder injuries. For each injury, we also provide a section on the important features that the orthopedic surgeon needs to know in order to guide surgical versus nonsurgical management.

Ageing hallmarks exhibit organ-specific temporal signatures

Ageing is the single greatest cause of disease and death worldwide, and understanding the associated processes could vastly improve quality of life. Although major categories of ageing damage have been identified-such as altered intercellular communication, loss of proteostasis and eroded mitochondrial function1-these deleterious processes interact with extraordinary complexity within and between organs, and a comprehensive, whole-organism analysis of ageing dynamics has been lacking. Here we performed bulk RNA sequencing of 17 organs and plasma proteomics at 10 ages across the lifespan of Mus musculus, and integrated these findings with data from the accompanying Tabula Muris Senis2-or 'Mouse Ageing Cell Atlas'-which follows on from the original Tabula Muris3. We reveal linear and nonlinear shifts in gene expression during ageing, with the associated genes clustered in consistent trajectory groups with coherent biological functions-including extracellular matrix regulation, unfolded protein binding, mitochondrial function, and inflammatory and immune response. Notably, these gene sets show similar expression across tissues, differing only in the amplitude and the age of onset of expression. Widespread activation of immune cells is especially pronounced, and is first detectable in white adipose depots during middle age. Single-cell RNA sequencing confirms the accumulation of T cells and B cells in adipose tissue-including plasma cells that express immunoglobulin J-which also accrue concurrently across diverse organs. Finally, we show how gene expression shifts in distinct tissues are highly correlated with corresponding protein levels in plasma, thus potentially contributing to the ageing of the systemic circulation. Together, these data demonstrate a similar yet asynchronous inter- and intra-organ progression of ageing, providing a foundation from which to track systemic sources of declining health at old age.

Sex Differences in Anatomic Features Linked to Anterior Cruciate Ligament Injuries During Skeletal Growth and Maturation

BACKGROUND

Several anatomic features of the knee have been shown to affect joint and anterior cruciate ligament (ACL) loading and the risk of subsequent injuries. While several studies have highlighted sex differences between these anatomic features, little is known on how these differences develop during skeletal growth and maturation.

HYPOTHESES

(A) Anatomic features linked to an ACL injury will significantly change during skeletal growth and maturation. (B) The age-related changes in anatomic features linked to an ACL injury are different between male and female patients.

STUDY DESIGN

Cross-sectional study; Level of evidence, 3.

METHODS

After institutional review board approval, magnetic resonance imaging data from 269 unique knees (patient age 3-18 years; 51% female), free from any injuries, were used to measure femoral notch width, posterior slope of the lateral tibial plateau (lateral tibial slope), medial tibial depth, tibial spine height, and posterior lateral meniscal bone angle. Linear regression was used to test the associations between age and quantified anatomic indices. Patients were then divided into 4 age groups: preschool (3-6 years), prepubertal (7-10 years), early adolescent (11-14 years), and late adolescent (15-18 years). Also, 2-way analysis of variance with the Holm-Sidak post hoc test was used to compare morphology between male and female patients in each age group.

RESULTS

The femoral notch width, medial tibial depth, and tibial spine height significantly increased with age (P < .001). The lateral tibial slope decreased with age only in male patients (P < .001). Except for the posterior lateral meniscal bone angle, the age-related changes in anatomy were different between male and female patients (P < .05). On average, early and late adolescent female patients had smaller femoral notches, steeper lateral tibial slopes, flatter medial tibial plateaus, and shorter tibial spines compared with age-matched male patients (P < .01).

CONCLUSION

Overall, the findings supported our hypotheses, showing sex-specific changes in anatomic features linked to an ACL injury during skeletal growth and maturation. These observations help to better explain the reported age and sex differences in the prevalence of ACL injuries. The fact that most of these anatomic features undergo substantial changes during skeletal growth and maturation introduces the hypothesis that prophylactic interventions (ie, activity modification) would have the potential to reshape a maturing knee in a manner that lowers the risk of noncontact ACL injuries.

MicroRNAs signatures, bioinformatics analysis of miRNAs, miRNA mimics and antagonists, and miRNA therapeutics in osteosarcoma

MicroRNAs (miRNAs) involved in key signaling pathways and aggressive phenotypes of osteosarcoma (OS) was discussed, including PI3K/AKT/MTOR, MTOR AND RAF-1 signaling, tumor suppressor P53- linked miRNAs, NOTCH- related miRNAs, miRNA -15/16 cluster, apoptosis related miRNAs, invasion-metastasis-related miRNAs, and 14Q32-associated miRNAs cluster. Herrin, we discussed insights into the targeted therapies including miRNAs (i.e., tumor-suppressive miRNAs and oncomiRNAs). Using bioinformatics tools, the interaction network of all OS-associated miRNAs and their targets was also depicted.

Increased body mass index percentile is associated with decreased epiphyseal tubercle size in asymptomatic children and adolescents with healthy hips

PURPOSE

To investigate whether body mass index (BMI) percentile impacts the morphology of the capital femoral epiphysis in children and adolescents without hip disorders.

METHODS

We assessed 68 subjects with healthy hips who underwent a pelvic CT for evaluation of appendicitis. There were 32 male patients (47%) and the mean age was 11.6 years (sd 2.3). The BMI (k/m²) was calculated for sex- and age-related percentiles according to the Centers for Disease Control and Prevention growth charts. CT images were segmented, and the epiphysis and metaphysis were reformatted using 3D software. We measured the epiphyseal tubercle (height, width and length), the metaphyseal fossa (depth, width and length) and the peripheral cupping of the epiphysis. All measurements were normalized to the diameter of the epiphysis. Pearson's correlation analysis was used to assess the correlations between the variables measured and BMI percentile adjusted for age.

RESULTS

Following adjustment to age, increased BMI correlated to decreased tubercle height (r =-0.34; 95% confidence interval (CI) -0.53 to -0.11; p = 0.005), decreased tubercle length (r = -0.32; 95%CI -0.52 to -0.09; p = 0.008) and decreased tubercle width (r = -0.3; 95% CI -0.5 to -0.07; p = 0.01). There was no correlation between BMI and metaphyseal fossa and epiphyseal cupping measurements.

CONCLUSION

The association between increased BMI percentile and decreased epiphyseal tubercle size, without changes of the metaphyseal fossa and peripheral cupping suggests another morphological change of the femur that may be associated with decreased growth plate resistance to shear stress. Further study is necessary to investigate whether the epiphyseal tubercle size plays a role in the pathogenesis of slipped capital femoral epiphysis in obese children and adolescents.

LEVEL OF EVIDENCE

Level IV.

The metaphyseal fossa surrounding the epiphyseal tubercle is larger in hips with moderate and severe slipped capital femoral epiphysis than normal hips

PURPOSE

To compare the 3D morphology of the metaphyseal fossa among mild, moderate and severe stable slipped capital femoral epiphysis (SCFE) and normal hips.

METHODS

We identified pelvic CT of 51 patients (55% male; mean 12.7 years (sd 1.9; 8-15)) with stable SCFE. In all, 16 of 51 hips (31%) had mild, 14 (27%) moderate and 21 (41%) severe SCFE. A total of 80 patients (50% male; mean age 11.5 years (sd 2.3; 8 to 15)) with normal hips who underwent pelvic CT due to abdominal pain made up the control cohort. CT scans were segmented, and the femur was reformatted using 3D software. We measured the metaphyseal fossa depth, width, length and surface area after the epiphysis was subtracted from the metaphysis in the 3D model.

RESULTS

The metaphyseal fossa width was significantly larger in severe (adjusted difference: 6.9%; 95% confidence interval (CI) 2.1 to 11.8; p = 0.001), moderate (6.5%; 95% CI 0.8 to 12.2; p = 0.02) and mild SCFE (6.2%; 95% CI 0.8 to 11.6; p = 0.01), in comparison with normal hips. Severe SCFE showed larger fossa length compared with mild SCFE (6.8%; 95% CI 0.6 to 13.0; p = 0.02) and normal hips (6.0%; 95% CI 1.4 to 10.6; p = 0.004). The fossa surface area was larger in severe (3.5%; 95% CI 1.3 to 5.7; p < 0.001) and moderate SCFE (2.7%; 95% CI 0.1 to 5.2; p = 0.03) when compared with normal hips. There were no differences in fossa depth between SCFE and normal hips.

CONCLUSION

The metaphyseal fossa is wider and more extensive but not deeper in hips with moderate and severe SCFE in comparison with normal hips. Although hips with severe SCFE had larger length and surface area than mild SCFE hips, further research is needed to clarify whether enlargement of the metaphyseal fossa is a consequence of slip progression.

LEVEL OF EVIDENCE

III.

Fast-Seq: A Simple Method for Rapid and Inexpensive Validation of Packaged Single-Stranded Adeno-Associated Viral Genomes in Academic Settings

Adeno-associated viral (AAV) vectors have shown great promise in gene delivery as evidenced by recent FDA approvals. Despite efforts to optimize manufacturing for good manufacturing practice (GMP) productions, few academic laboratories have the resources to assess vector composition. One critical component of vector quality is packaged genome fidelity. Errors in viral genome replication and packaging can result in the incorporation of faulty genomes with mutations, truncations, or rearrangements, compromising vector potency. Thus, sequence validation of packaged genome composition is an important quality control (QC), even in academic settings. We developed Fast-Seq, an end-to-end method for extraction, purification, sequencing, and data analysis of packaged single-stranded AAV (ssAAV) genomes intended for non-GMP preclinical environments. We validated Fast-Seq on ssAAV vectors with three different genome compositions (CAG-GFP, CAG-tdTomato, EF1α-FLuc), three different genome sizes (2.9, 3.6, 4.4 kb), packaged in four different capsid serotypes (AAV1, AAV2, AAV5, and AAV8), and produced using the two most common production methods (Baculovirus-Sf9 and human HEK293), from both common commercial vendors and academic core facilities supplying academic laboratories. We achieved an average genome coverage of >1,400 × and an average inverted terminal repeat coverage of >280 × , despite the many differences in composition of each ssAAV sample. When compared with other ssAAV next-generation sequencing (NGS) methods for GMP settings, Fast-Seq has several unique advantages: Tn5 transposase-based fragmentation rather than sonication, 125 × less input DNA, simpler adapter ligation, compatibility with commonly available inexpensive sequencing instruments, and free open-source data analysis code in a preassembled customizable Docker container designed for novices. Fast-Seq can be completed in 18 h, is more cost-effective than other NGS methods, and is more accurate than Sanger sequencing, which is generally only applied at 1-2 × sequencing depth. Fast-Seq is a rapid, simple, and inexpensive methodology to validate packaged ssAAV genomes in academic settings.

Evolutionary Selection and Constraint on Human Knee Chondrocyte Regulation Impacts Osteoarthritis Risk

During human evolution, the knee adapted to the biomechanical demands of bipedalism by altering chondrocyte developmental programs. This adaptive process was likely not without deleterious consequences to health. Today, osteoarthritis occurs in 250 million people, with risk variants enriched in non-coding sequences near chondrocyte genes, loci that likely became optimized during knee evolution. We explore this relationship by epigenetically profiling joint chondrocytes, revealing ancient selection and recent constraint and drift on knee regulatory elements, which also overlap osteoarthritis variants that contribute to disease heritability by tending to modify constrained functional sequence. We propose a model whereby genetic violations to regulatory constraint, tolerated during knee development, lead to adult pathology. In support, we discover a causal enhancer variant (rs6060369) present in billions of people at a risk locus (GDF5-UQCC1), showing how it impacts mouse knee-shape and osteoarthritis. Overall, our methods link an evolutionarily novel aspect of human anatomy to its pathogenesis.

A Single Center Report of Vitamin D Deficiency among Young Orthopaedic Patient in Iran

Background: Orthopaedic patients are at risk of having irregular levels of vitamin D and calcium due to lack of motility and sun light exposure. Among entire population of patients, Juvenile members of society are considered high-risk groups for vitamin D inadequacy. By considering the high prevalence of this complaint according to domestic studies in Iran, this study aims to provide a report of vitamin D and related factors among orthopaedic patients in Iran. Methods: Participants were selected based on simple non-probable sampling method. Variables were including age, gender, the serum level of vitamin D, calcium, phosphorus, concurrent diseases, and history of taking nutritional supplements. Results were analysed using SPSS software (version 22, USA). Results: 696 patient with mean age 15.5±1.8 were involved among which 440 participants were male and 256 cases were female. Mean of vitamin D calcium, phosphorous serum level was 12.1±4.3, 9.7± 0.5 and 4.3±0.8 respectively. 208 cases were living at urban and 488 members were living at rural locations. 176 cases had degrees of muscular pain, and 72 patients were suffering from developmental problems, and 32 patients were presenting obvious skeletal deformities. Conclusion: Vitamin D deficiency is a common issue among orthopaedic patients. Young patients are in a high danger for consequence of vitamin deficiency in orthopaedic ward due to critical age of bone formation and growth.

Reporting Outcome and Evaluating the Efficacy of Biplanar Lateral Distal Femoral Osteotomy: Two Years Follow up Study

Introduction: Genu valgum could be approached by uniplanar or biplanar osteotomy in which site union and postoperative knee range of motion play important roles in technique selection. Methods: Study was performed on 30 cases including 14 males and 16 females. Two of them had severe genu varum deformity and 28 had genu valgum. Participants underwent biplanar lateral distal femoral osteotomy. Osteotomy requirement was assessed by Lateral distal femoral angle measurement. Results: Thirty patients underwent the biplanar procedure over the 4 years. Two years follow up showed complete union, full knee range of motion and within the acceptable alignment. Conclusion: Biplanar osteotomy is an effective method to create the wider inner cancellous surface to achieve better osteotomy site union and knee range of motion.

Single-cell transcriptomics of 20 mouse organs creates a Tabula Muris

Here we present a compendium of single-cell transcriptomic data from the model organism Mus musculus that comprises more than 100,000 cells from 20 organs and tissues. These data represent a new resource for cell biology, reveal gene expression in poorly characterized cell populations and enable the direct and controlled comparison of gene expression in cell types that are shared between tissues, such as T lymphocytes and endothelial cells from different anatomical locations. Two distinct technical approaches were used for most organs: one approach, microfluidic droplet-based 3'-end counting, enabled the survey of thousands of cells at relatively low coverage, whereas the other, full-length transcript analysis based on fluorescence-activated cell sorting, enabled the characterization of cell types with high sensitivity and coverage. The cumulative data provide the foundation for an atlas of transcriptomic cell biology.

Protein interaction networks at the host-microbe interface in Diaphorina citri, the insect vector of the citrus greening pathogen

The Asian citrus psyllid (Diaphorina citri) is the insect vector responsible for the worldwide spread of 'Candidatus Liberibacter asiaticus' (CLas), the bacterial pathogen associated with citrus greening disease. Developmental changes in the insect vector impact pathogen transmission, such that D. citri transmission of CLas is more efficient when bacteria are acquired by nymphs when compared with adults. We hypothesize that expression changes in the D. citri immune system and commensal microbiota occur during development and regulate vector competency. In support of this hypothesis, more proteins, with greater fold changes, were differentially expressed in response to CLas in adults when compared with nymphs, including insect proteins involved in bacterial adhesion and immunity. Compared with nymphs, adult insects had a higher titre of CLas and the bacterial endosymbionts Wolbachia, Profftella and Carsonella. All Wolbachia and Profftella proteins differentially expressed between nymphs and adults are upregulated in adults, while most differentially expressed Carsonella proteins are upregulated in nymphs. Discovery of protein interaction networks has broad applicability to the study of host-microbe relationships. Using protein interaction reporter technology, a D. citri haemocyanin protein highly upregulated in response to CLas was found to physically interact with the CLas coenzyme A (CoA) biosynthesis enzyme phosphopantothenoylcysteine synthetase/decarboxylase. CLas pantothenate kinase, which catalyses the rate-limiting step of CoA biosynthesis, was found to interact with a D. citri myosin protein. Two Carsonella enzymes involved in histidine and tryptophan biosynthesis were found to physically interact with D. citri proteins. These co-evolved protein interaction networks at the host-microbe interface are highly specific targets for controlling the insect vector responsible for the spread of citrus greening.

The use of inulin as fat replacer and its effect on texture and sensory properties of emulsion type sausages

The present study aimed to investigate the possibility of reducing energy content in emulsion type sausages by replacing fat with inulin. In the manufactured product, the fat content was reduced to 6%-18% and replaced by inulin and water. The quality of the resulting product was determined by chemical and texture profile analyses (TPA), color measurement and sensory evaluation. The results showed that replacing fat with inulin led to a significant energy content reduction of up to 64% (with 6% inulin and 12% water). In addition, color measurement, sensory evaluation and TPA were comparable to the traditional product in the inulin treated samples. The overall acceptability of all experimental groups was adequate; therefore, inulin is suggested as a good replacement for fat in emulsion type sausages.

The effects of probiotic, prebiotic and synbiotic diets containing Bacillus coagulans and inulin on rat intestinal microbiota

An in vivo experiment was conducted to study the effects of probiotic Bacillus coagulans spores, with and without prebiotic, inulin, on gastrointestinal (GI) microbiota of healthy rats and its potentiality to survive in the GI tract. Forty-eight male Wistar rats were randomly divided into four groups (n=12) and fed as follows: standard diet (control), standard diet supplied with 5% w/w long chain inulin (prebiotic), standard diet with 10(9)/day spores of B. coagulans by orogastric gavage (probiotic), and standard diet with 5% w/w long chain inulin and 10(9) spores/day of B. coagulans by orogastric gavage (synbiotic). Rats were fed the diets for 30 days. At day 10, 20 and 30 of experiment, 24 h post administration, four rats from each group were randomly selected and after faecal collection were sacrificed. Small intestine, cecum, and colon were excised from each rat and used for microbial analysis. Administration of synbiotic and probiotic diets led to a significant (P<0.05) increment in lactic acid bacteria (LAB), total aerobic and total anaerobic population compared the prebiotic and control diets. A significant decrease in Enterobacteriaceae counts of various segments of GI tract (except small intestine) in synbiotic, probiotic and prebiotic fed groups were also seen. The obvious decline in spores count through passing GI tract and high surviving spore counts in faecal samples showed that spores are not a normal resident of GI microbiota and affect intestinal microbiota by temporary proliferation. In conclusion, the present study clearly showed probiotic B. coagulans was efficient in beneficially modulating GI microbiota and considering transitional characteristics of B. coagulans, daily consumption of probiotic products is necessary for any long-term effect.