Long-term Patient-Reported Outcome Measures Following Particulated Juvenile Allograft Cartilage Implantation for Treatment of Difficult Osteochondral Lesions of the Talus

BACKGROUND

Conventional methods are not suitable for difficult to treat osteochondral lesions of the talus (OCLTs). The role of particulated juvenile allograft articular cartilage implantation is not well elucidated for long-term patient outcomes.

METHODS

Thirteen patients with difficult-to-treat OCLTs underwent arthroscopy-assisted implantation of particulated juvenile articular cartilage graft into defects from 2010 to 2012 by the same surgeon. "Difficult to treat" was defined as having at least 3 of the following features or 2 if both variables described lesion characteristics: (1) lesions size of 107 mm² or greater, (2) shoulder lesions, (3) patients who failed microfracture, (4) patient aged ≥40 years, or (5) patient body mass index (BMI) >25. Patients were evaluated using physical examination, patient interviews, and outcome score measures. Patients had follow-up at 2 years, 4 years, and between 6 and 10 years at their most recent follow-up. Differences in functional outcome scores were compared before and after surgery.

RESULTS

Patients (age: 46.5 ± 11.8 years, BMI: 28.5 ± 6.1) had, on average, most recent follow-up of 8.0 years (range 72-113 months). Average visual analog scale for pain score decreased for patients by 3.9 points (95% confidence interval [CI] 2.18-5.60), when compared to preoperative assessment. Foot and Ankle Ability Measure (FAAM) Activities of Daily Living (ADL) and Sports subscale scores also improved from 46.5 to 80.9 (95% CI 21.35-47.43), and from 18.8 to 57.9 (95% CI 21.05-57.10), respectively. Short Form-36 Health Survey physical component scores showed significant improvement by an average of 45.5 points (95% CI 32.42-58.50). American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale scores improved from 55.2 to 80.3 (95% CI 12.459-37.741).

CONCLUSION

These results demonstrate positive patient-reported long-term outcomes for a cohort of patients with difficult OCLTs, followed over the course of 6-10 years after treatment with arthroscopy-assisted particulated juvenile articular cartilage implantation.

LEVEL OF EVIDENCE

Level II, prospective cohort study.

Actin modulates shape and mechanics of tubular membranes

The actin cytoskeleton shapes cells and also organizes internal membranous compartments. In particular, it interacts with membranes for intracellular transport of material in mammalian cells, yeast, or plant cells. Tubular membrane intermediates, pulled along microtubule tracks, are formed during this process and destabilize into vesicles. While the role of actin in tubule destabilization through scission is suggested, literature also provides examples of actin-mediated stabilization of membranous structures. To directly address this apparent contradiction, we mimic the geometry of tubular intermediates with preformed membrane tubes. The growth of an actin sleeve at the tube surface is monitored spatiotemporally. Depending on network cohesiveness, actin is able to entirely stabilize or locally maintain membrane tubes under pulling. On a single tube, thicker portions correlate with the presence of actin. These structures relax over several minutes and may provide enough time and curvature geometries for other proteins to act on tube stability.

The fragility of findings of randomized controlled trials in shoulder and elbow surgery

BACKGROUND

Considered the gold standard of study designs, randomized controlled trials' (RCTs) results shape clinical practice, effect policy, and influence reimbursement. The fragility index (FI) can be used to quantitate the relative robustness of RCT results, with higher scores indicating more stout results. Unfortunately, most RCTs in surgery have fragile results. The aim of this study was to report on the FI in addition to a qualitative assessment of recent RCTs within the field of shoulder and elbow surgery.

METHODS

A systematic review was performed identifying recently published shoulder/elbow RCTs that included 1:1 allocated parallel study arms, dichotomous primary outcome variables, and statistical significance. The FI was calculated by sequentially modifying outcome groups by exchanging a nonevent in one group to an event until the P value for the outcome comparison, as calculated by the Fisher exact test, was increased above the .05 threshold.

RESULTS

Thirty RCTs were included. The median FI was 4. Sixty percent trials had a FI of 2 or less. Fifty-three percent studies reported that participants were lost to follow-up. In 87.5% of these studies, the losses to follow-up exceeded their respective FIs. Only 53% of studies defined a primary outcome variable and 60% studies performed a prestudy power analysis.

CONCLUSIONS

The median FI reported in the recent shoulder/elbow literature is 4; however, a high proportion of included RCTs display significant methodological concerns. The FI is a useful adjunct to analyze RCT results, but careful analysis of trial methods should be employed in each circumstance before drawing conclusions.

Optogenetic dissection of Rac1 and Cdc42 gradient shaping

During cell migration, Rho GTPases spontaneously form spatial gradients that define the front and back of cells. At the front, active Cdc42 forms a steep gradient whereas active Rac1 forms a more extended pattern peaking a few microns away. What are the mechanisms shaping these gradients, and what is the functional role of the shape of these gradients? Here we report, using a combination of optogenetics and micropatterning, that Cdc42 and Rac1 gradients are set by spatial patterns of activators and deactivators and not directly by transport mechanisms. Cdc42 simply follows the distribution of Guanine nucleotide Exchange Factors, whereas Rac1 shaping requires the activity of a GTPase-Activating Protein, β2-chimaerin, which is sharply localized at the tip of the cell through feedbacks from Cdc42 and Rac1. Functionally, the spatial extent of Rho GTPases gradients governs cell migration, a sharp Cdc42 gradient maximizes directionality while an extended Rac1 gradient controls the speed.

A steep gradient of Cdc42 is at the front of migrating cells, whereas the active Rac1 gradient is graded. Here the authors show that Cdc42 gradients follow the distribution of GEFs and govern direction of migration, while Rac1 gradients require the activity of the GAP β2-chimaerin and control cell speed.

Preservation of extraction socket in immediate implant placement: a clinical study

AIM

The objective of this study was to compare different approaches temporary restoration in an immediate implant placement. To determine the respective influence of each parameter, two treatment groups were formed; a strict and standardized study protocol was applied to minimize the influence of bias and confounding factors. The Pink Esthetic Score (PES) - the esthetic out-come of soft tissue appearance was evaluated.

MATERIAL AND METHODS

Sixteen patients with a single failing tooth in the maxilla and a natural contralateral site were randomly distributed into two groups. Treatment variations affected the provisional restorative in detail, group 1 with immediate implant placement and immediate temporary restoration with the simulation of the first three mm of the root and the seal of the socket, group 2 with immediate implant placement and immediate temporary restoration without the seal of the socket. All patients received the final prosthetic restoration 10-12 weeks after implant placement. Standardized photographs were taken eight months after tooth extraction. Five competent observers analyzed the esthetic outcome according to the PES.

RESULTS

The overall scores of the four treatment groups revealed PES values of 8.47 (SD 2.08, group 1), 6.62 (SD 3.24, group 2). The differences between groups 1 and 2 and were statistically significant (P=0.015 and P=0.047). The single parameter analysis displayed a certain range of fluctuation and heterogeneity.

CONCLUSIONS

Immediate implant placement and restoration appear to be a suitable alternative to early implant placement if an experienced surgeon is entrusted with the implantation procedure.

Effect of aging on sputum inflammation and asthma control

BACKGROUND

Aged asthmatic patients experience increased morbidity and mortality. Knowledge of the aging effect on airway inflammation and asthma control is limited.

OBJECTIVE

We sought to compare airway inflammation and its relationship to asthma control in aged versus younger patients and determine whether differences are asthma specific or caused by "inflamm-aging."

METHODS

We performed a prospective study of aged (>60 years) and younger (21-40 years) inner-city patients with asthma. After a run-in period to control for inhaled corticosteroid use, induced sputum was collected. Age-matched nonasthmatic control subjects were included to measure age-related inflammatory changes.

RESULTS

Aged (mean age, 67.9 ± 5.1 years; n = 35) compared with younger (mean age, 30.8 ± 5.9 years; n = 37) asthmatic patients had significantly worse asthma control and lower FEV₁. Aged asthmatic patients had higher sputum neutrophil (30.5 × 10⁴/mL and 23.1%) and eosinophil (7.0 × 10⁴/mL and 3.8%) numbers and percentages compared with younger patients (neutrophils, 13.0 × 10⁴/mL [P < .01] and 6.9% [P < .01]; eosinophils, 2.0 × 10⁴/mL [P < .01] and 1.2% [P < .01]). Aged asthmatic patients had higher sputum IL-6 (P < .01) and IL-8 (P = .01) levels. No significant inflammatory differences between aged and younger control subjects were observed. In aged asthmatic patients increased sputum IL-6 and macrophage inflammatory protein 3α/CCL20 levels were significantly associated with decreased asthma control and increased sputum neutrophil numbers and IL-1β, IL-6, and macrophage inflammatory protein 3α/CCL20 levels were associated with hospitalization.

CONCLUSIONS

The inflammatory patterns of aged versus younger asthmatic patients are associated with increased sputum neutrophil and eosinophil values and cytokine levels related to neutrophil recruitment. Differences in airway inflammation can contribute to diminished asthma control in the aged. Further understanding of asthma pathophysiology in aged patients is needed to improve management of this vulnerable population.

Cell-sized liposome doublets reveal active tension build-up driven by acto-myosin dynamics

Cells modulate their shape to fulfill specific functions, mediated by the cell cortex, a thin actin shell bound to the plasma membrane. Myosin motor activity, together with actin dynamics, contributes to cortical tension. Here, we examine the individual contributions of actin polymerization and myosin activity to tension increase with a non-invasive method. Cell-sized liposome doublets are covered with either a stabilized actin cortex of preformed actin filaments, or a dynamic branched actin network polymerizing at the membrane. The addition of myosin II minifilaments in both cases triggers a change in doublet shape that is unambiguously related to a tension increase. Preformed actin filaments allow us to evaluate the effect of myosin alone while, with dynamic actin cortices, we examine the synergy of actin polymerization and myosin motors in driving shape changes. Our assay paves the way for a quantification of tension changes triggered by various actin-associated proteins in a cell-sized system.

Ionic liquid-based membranes as electrolytes for advanced lithium polymer batteries

Gel-type polymer electrolytes are formed by immobilizing a solution of lithium N,N-bis(trifluoromethanesulfonyl)imide (LiTFSI) in N-n-butyl-N-ethylpyrrolidinium N,N-bis(trifluoromethanesulfonyl)imide (Py₂₄TFSI) ionic liquid (IL) with added mixtures of organic solvents, such as ethylene, propylene and dimethyl carbonates (EC, PC, and DMC, respectively), into a poly(vinylidenefluoride-co-hexafluoropropylene) (PVdF-HFP) matrix, and their properties investigated. The addition of the organic solvent mixtures results in an improvement of the ionic conductivity and in the stabilization of the interface with the lithium electrode. Conductivity values in the range of 10⁻³-10⁻²  S cm⁻¹ are obtained in a wide temperature range. These unique properties allow the effective use of these membranes as electrolytes for the development of advanced polymer batteries based on a lithium metal anode and an olivine-type lithium iron phosphate cathode.

Will architecture win the technology wars?

Success today flows to the company that establishes proprietary architectural control over a broad, fast-moving, competitive space, Charles R. Morris and Charles H. Ferguson claim in "How Architecture Wins Technology Wars" (March-April 1993). No single vendor can keep pace with the outpouring of cheap, powerful, mass-produced components, so customers have been stitching together their own local systems solutions. Architectures impose order on the system and make interconnections possible. An architectural controller has power over the standard by which the entire information package is assembled. Because of the popularity of Microsoft's Windows, for example, companies like Lotus must conform their software to its parameters to be able to compete for market share. Proprietary architectural control has broader implications for organizational structure too: architectural competition is giving rise to a new form of business organization.

Adolescents' first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences

This study compared first and most recent use situations of adolescent smokeless tobacco experimenters with those of adolescent cigarette experimenters. Structured, open-ended interviews were conducted with 320 seventh and tenth grade youths in 16 Southern California schools. Students were categorized as nonusers (those who had never experimented with any tobacco product), minimal experimenters (those who had experimented with smokeless tobacco or cigarettes between 1 and 9 times), and persistent experimenters (those who had experimented with smokeless tobacco or cigarettes 10 or more times). The situations reported by smokeless tobacco were similar to those reported by cigarette experimenters. The most important differences between the two groups are highlighted. In particular, smokeless tobacco users seemed less concerned about negative social consequences of use than cigarette smokers. In addition, nonusers' observations of use and implications for prevention and cessation are discussed.

[Questionnaire for the evaluation of mental health in adolescence]

Procedures resorted to in building up a questionnaire for assessing adolescent's Mental Health are submitted. Questions were selected from DSM-III diagnosis categories and from Goldberg's General Health Questionnaire (GHQ) as well. The following variables were considered: socioeconomic characteristics, developmental level, and normal vs. psychopathologic criteria. The main results may be summarized as follows: a) Reliability and validity of data obtained allow the researchers to infere that this is an apt test for discriminating between normal and psychopathologic adolescents, b) Factorial analysis results confirm the constructional validity of the questionnaire, c) The most relevant variable was normal vs. psychopathological criteria even though the developmental level variable was also of significance. No significative differences were obtained in connection with socioeconomic level, d) As demonstrated in previous papers, psychopathology in adolescents is a mixed syndrome, and e) In similar questionnaires, adolescents got higher scores than adults.

[Influence of the age of old primiparae on the perinatal infant morbidity and mortility (author's transl)]

157 old primiparae (greater than 30 a) have been compared to a randomised control group of primiparae between the 16th and 30th year of age. In addition to the perinatal infant mortality rate, the number of children with malnutrition, the frequency of premature babies, the presence of a low Apgar score (less than or equal to 7) and pathological pH-values in the umbilical artery (pH less than or equal to 7,10) were cheked. Moreover the frequency of early neonatal morbidity (presence of one of the following criteria: 1 minute Apgar score less than or equal to 7, pH of the umbilical artery less than or equal to 7, 10, a transitoric or severe RDS and neurological complications during the newborn period) was investigated in both groups. In the group of the old primiparae a significantly higher perinatal infant mortality rate was found compared to the control group (3,8% versus 0,6%, p less than 0.05). The rate of small for date babies was remarcably higher than in the control group (14,6% versus 6,4%, p less than 0.05). There was no difference in the prematurity rate in both groups. The children of old primiparae had more frequently a low Apgar score (less than or equal to 7) than infants of the randomised control group (18,5% versus 11,5%), but the difference is statistically not significant. Furthermore no difference in the number of pathological pH values in the umbilical arteries (pH less than or equal to 7, 10) were found in the both groups. The children of old primiparae show a higher early neonatal morbidity rate compared to the control group (21.7% versus 14.0%); however, the difference is statistically not significant. According to our results the risk for the newborns is increased already with primiparae over 30 rather than 35 years of age.