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Osteochondral autograft transplantation with biplanar distal tibial osteotomy for patients with concomitant large osteochondral lesion of the talus and varus ankle malalignment
No full textAbstract
Background
Osteochondral lesions of the talus (OLTs) are amongst the most common foot and ankle disorders. Varus ankle malalignment causes stress concentration on medial side of the joint, resulting in OLTs and osteoarthritis. For large symptomatic OLTs (>10\ua0mm), Osteochondral autograft transplantation is usually recommended. This article highlights biplanar distal tibial osteotomy as an approach and management for patients with concomitant large OLTs and varus ankle malalignment.
Methods
From January 2012 to July 2014, 13 patients (6 male and 7 female) underwent surgery in our faculty and their average age was 55.4 (ranging from 34 to 69) years old. Oblique medial malleolar osteotomy was performed to expose the talar lesion, followed by an osteochondral autograft transplantation and distal tibial opening-wedge osteotomy. Weight-bearing X-rays were conducted and used for the measurement of radiographic parameters such as the tibial articular surface (TAS) and tibial lateral surface (TLS) angles. Ankle function of the subjects was evaluated according to the American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot score (AOFAS-AH) questionnaires and Visual Analog Scale (VAS).
Results
11 patients completed the follow-up over a mean period of 21.2\ua0months. The average area of talar lesion was 135.9\ua0mm
2
while the average depth was 11.4\ua0mm. The mean time for osseous union was 8.5\ua0weeks. Donor site morbidity was not recorded in any of the cases. The mean AOFAS-AH and VAS improved from 53 to 90 points ( p \u2009<\u20090.05) and 6.7 to 1.9 points ( p \u2009<\u20090.05) respectively. The mean TAS angle improved from 83.1 to 90.3\ub0 ( p \u2009<\u20090.05).
Conclusions
Biplanar distal tibial osteotomy with the combination of osteochondral autograft transplantation could be used to address patients with concomitant large OLTs and varus ankle malalignment as this technique provides excellent visualization of the talar defect, favorable biomechanical environment for the ankle joint with high rate of good and excellent results
Manually defining regions of interest when quantifying paravertebral muscles fatty infiltration from axial magnetic resonance imaging: a proposed method for the lumbar spine with anatomical cross-reference
No full textAbstract
Background
There is increasing interest in paravertebral muscle composition as a potential prognostic and diagnostic element in lumbar spine health. As a consequence, it is becoming popular to use magnetic resonance imaging (MRI) to examine muscle volume and fatty infiltration in lumbar paravertebral muscles to assess both age-related change and their clinical relevance in low back pain (LBP). A variety of imaging methods exist for both measuring key variables (fat, muscle) and for defining regions of interest, making pooled comparisons between studies difficult and rendering post-production analysis of MRIs confusing. We therefore propose and define a method as an option for use as a standardized MRI procedure for measuring lumbar paravertebral muscle composition, and to stimulate discussion towards establishing consensus for the analysis of skeletal muscle composition amongst clinician researchers.
Method
In this descriptive methodological study we explain our method by providing an examination of regional lumbar morphology, followed by a detailed description of the proposed technique. Identification of paravertebral muscles and vertebral anatomy includes axial E12 sheet-plastinates from cadaveric material, combined with a series of axial MRIs that encompass sequencing commonly used for investigations of muscle quality (fat-water DIXON, T1-, and T2-weighted) to illustrate regional morphology; these images are shown for L1 and L4 levels to highlight differences in regional morphology. The method for defining regions of interest (ROI) for multifidus (MF), and erector spinae (ES) is then described.
Results
Our method for defining ROIs for lumbar paravertebral muscles on axial MRIs is outlined and discussed in relation to existing literature. The method provides a foundation for standardising the quantification of muscle quality that particularly centres on examining fatty infiltration and composition. We provide recommendations relating to imaging parameters that should additionally inform a priori decisions when planning studies examining lumbar muscle tissues with MRI.
Conclusions
We intend this method to provide a platform towards developing and delivering meaningful comparisons between MRI data on lumbar paravertebral muscle quality
Stiffness of the locking compression plate as an external fixator for treating distal tibial fractures: a biomechanics study
No full textAbstract
Background
Locking compress plate, as external fixator, is an attractive technique for distal tibial fracture treatment. But it still remains unclear whether the external LCP has sufficient stiffness. Thus, the present study aims to make a comprehensive evaluation of the stiffness of external locking compress plate when it is used as an external fixator in distal tibial fractures treatment.
Methods
Composite tibia was used to simulate distal tibia fracture (Orthopedic Trauma Association type 43 A3 fracture). The fractures were stabilized with medial distal tibial locking compress plates (LCP group), medial distal tibial locking compress plates with 30-mm plate-bone distances (EF-tibia group), and medial distal femur locking compress plates with 30-mm plate-bone distances (EF-femur group). Stiffness of each configuration was measured under axial compression loading and in axial torsion loading directions. Compression stiffness and torsional rigidity were compared across different groups.
Results
Compared with LCP group, (1) EF-tibia group showed significantly lower ( p \u2009<\u20090.001) compression stiffness and torsional rigidity; (2) EF-femur group showed significantly lower ( p \u2009<\u20090.001) compression stiffness, but significantly higher ( p \u2009<\u20090.001) torsional rigidity.
Conclusions
The results indicated that locking compress plate as an external fixator was flexible, and the distal femur locking compress plate was preferred over the distal tibial locking compress plate to be an external fixator in distal tibia fracture treatment
Plasma miRNA expression profiles in rheumatoid arthritis associated interstitial lung disease
No full textAbstract
Background
Interstitial lung disease (ILD) is frequently associated with rheumatoid arthritis (RA), and is designated RA-associated ILD (RA-ILD). RA-ILD has a large impact on the prognosis of RA. Here, we investigated the micro RNAs (miRNAs) profiles to determine whether they may be useful for diagnosing RA-ILD.
Methods
RNA was isolated from plasma samples and cDNA was synthesized. Real-time RT-PCR analysis was performed to evaluate 752 miRNA expression profiles in plasma pools from RA patients with or without RA-ILD. Sixteen selected miRNA levels were analyzed in individual plasmas from 64 RA patients with or without RA-ILD.
Results
Expression levels of hsa-miR-214-5p (mean relative expression level\u2009\ub1\u2009standard deviation, 8.1\u2009\ub1\u200928.2 in RA with ILD, 0.2\u2009\ub1\u20090.9 in RA without ILD, P \u2009=\u20090.0156) and hsa-miR-7-5p (56.2\u2009\ub1\u2009260.4 in RA with ILD, 4.7\u2009\ub1\u200911.8 in RA without ILD, P \u2009=\u20090.0362) were higher in RA patients with RA-ILD than in those without. The values of miRNA index (214, 7) generated from hsa-miR-214-5p and hsa-miR-7-5p for ILD were significantly elevated in RA patients with RA-ILD compared with those without (0.122\u2009\ub1\u20090.332 in RA with ILD, 0.006\u2009\ub1\u20090.013 in RA without ILD, P \u2009=\u20090.0010). The area under the curve value of the receiver operating characteristic curve for the miRNA index (214, 7) was 0.740.
Conclusions
To the best of our knowledge, this is the first report of miRNA profiles in RA-ILD. The expression levels of hsa-miR-214-5p and hsa-miR-7-5p were increased in RA with ILD
Rate and associated factors of non-retention of mother-baby pairs in HIV care in the elimination of mother-to-child transmission programme, Gulu-Uganda: a cohort study
No full textAbstract
Background
Poor retention in HIV care of mother-baby pairs remains a public health challenge in the elimination of mother-to-child transmission (eMTCT) of HIV. We determined the rate of non-retention and time to non-retention of mother-baby pairs and associated factors in Gulu district, Northern Uganda.
Methods
Mother-baby pairs enrolled into the eMTCT programme at Gulu Regional Referral Hospital (GRRH) and Lacor Hospital (LH) were retrospectively followed for 18\ua0months. The primary outcomes were the rate of non-retention and time to non-retention of mother-baby pairs in HIV care. Data were abstracted from the antiretroviral treatment and early infant diagnosis (EID) registers, and mother/baby appointment books at the health facilities. Additional data on possible reasons for non-retention were obtained from cross-sectional interviews of mothers. Time to non-retention was calculated as the duration between enrolment of mother-baby pair into care and the date when the mother and/or baby missed a scheduled visit and did not return within 30\ua0days. Factors associated with time to non-retention were assessed using Cox proportional hazards regression analysis. The measures of association were expressed as hazards ratio (HR) with 95% confidence intervals. Alpha was set at 0.05. The adjusted analysis includes variables with p \u2009<0.2 in the bivariable analysis or considered potential confounders. The Analysis used Stata version 12.
Results
A total of 410 mother-baby pairs were enrolled in this study. Overall, non-retention by 18\ua0month was 30.5%; higher at GRRH (34.7%) than LH (25.8%), p \u2009=\u20090.049. Non-retention was higher among pairs where the infant had no EID, adjusted (adj) HR\u2009=\u20095.81; 95% CI (2.55, 13.24), non-disclosure of mother\u2019s HIV status, adj.HR\u2009=\u20091.86; 95% CI (1.22, 2.85), and lack of privacy during counselling session, adj.HR\u2009=\u20091.86; 95% CI (1.26, 2.85). Non-retention was about 60% lower [adj.HR\u2009=\u20090.43; 95% CI (0.20, 0.92)] among pairs where the mothers understood and appreciated the importance of adhering to all clinic appointments together with the baby.
Conclusion
Nearly a third of mother-baby pairs are not retained in HIV care. Lack of EID services, poor quality service, non-disclosure of mother\u2019s HIV status, and understanding the importance of adhering to all appointments together with the baby, were associated with time to non-retention
The biomedical piglet: establishing reference intervals for haematology and clinical chemistry parameters of two age groups with and without iron supplementation
No full textAbstract
Background
The similarities between swine and humans in physiological and genomic patterns, and the great correlation in size and anatomy, make pigs extremely useful in preclinical studies. New-born piglets can represent a model for congenital and genetic diseases in new-born children. It is known that piglets may have significant differences in clinicopathological results compared to adult pigs. Therefore, adult laboratory reference intervals cannot be applied to piglets. The aim of this study was to compare haematological and chemical variables in piglets of two ages and determinate age-related reference intervals for commercial hybrid young pigs.
Blood samples were collected under general anaesthesia from 130 animals divided into five- (P5) and 30- (P30) day-old piglets. Only P30 animals were treated with parenteral iron after birth. Samples were analysed using automated haematology (ADVIA 2120) and chemistry analysers, and age-related reference intervals were calculated.
Results
Significant higher values of RBC, Hb and HCT were observed in P30 animals when compared to P5, with an opposite trend for MCV. These results were associated with a reduction of the RBC regeneration process and the thrombopoietic response. The TSAT and TIBC were significantly higher in P30 compared to P5; however, piglets remained iron deficient compared to adult reference intervals reported previously.
Conclusions
In conclusion, this paper emphasises the high variability occurring in clinicopathological variables between new-born and 30-day-old pigs, and between piglets and adult pigs. This study provides valuable reference data for piglets at precise ages and could be used in the future as historical control improving the Reduction in animal experiments, as suggested by the 3Rs principle
Kv7 voltage-activated potassium channel inhibitors reduce fluid resuscitation requirements after hemorrhagic shock in rats
No full textAbstract
Background
Recent evidence suggests that drugs targeting Kv7 channels could be used to modulate vascular function and blood pressure. Here, we studied whether Kv7 channel inhibitors can be utilized to stabilize hemodynamics and reduce resuscitation fluid requirements after hemorrhagic shock.
Methods
Anesthetized male Sprague-Dawley rats were instrumented with arterial and venous catheters for blood pressure monitoring, hemorrhage and fluid resuscitation. Series 1: Linopirdine (Kv7 channel blocker, 0.1\u20136 mg/kg) or retigabine (Kv7 channel activator, 0.1\u201312 mg/kg) were administered to normal animals. Series 2: Animals were hemorrhaged to a MAP of 25 mmHg for 30 min, followed by fluid resuscitation with normal saline (NS) to a MAP of 70 mmHg until t\u2009=\u200975 min. Animals were treated with single bolus injections of vehicle, linopirdine (1\u20136 mg/kg), XE-991 (structural analogue of linopirdine with higher potency for channel blockade, 1 mg/kg) prior to fluid resuscitation. Series 3: Animals were resuscitated with NS alone or NS supplemented with linopirdine (1.25\u2013200 \u3bcg/mL). Data were analyzed with 2-way ANOVA/Bonferroni post-hoc testing.
Results
Series 1: Linopirdine transiently (10\u201315 min) and dose-dependently increased MAP by up to 15%. Retigabine dose-dependently reduced MAP by up to 60%, which could be reverted with linopirdine. Series 2: Fluid requirements to maintain MAP at 70 mmHg were 65\u2009\ub1\u200934 mL/kg with vehicle, and 57\u2009\ub1\u200913 mL/kg, 22\u2009\ub1\u20098 mL/kg and 22\u2009\ub1\u200911 mL/kg with intravenous bolus injection of 1, 3 and 6 mg/kg linopirdine, respectively. XE-991 (1 mg/kg), reduced resuscitation requirements comparable to 3 mg/kg linopirdine.
Series 3: When resuscitation was performed with linopirdine-supplemented normal saline (NS), fluid requirements to stabilize MAP were 73\u2009\ub1\u200912 mL/kg with NS alone and 72\u2009\ub1\u200924, 61\u2009\ub1\u200920, 36\u2009\ub1\u20099 and 31\u2009\ub1\u20099 mL/kg with NS supplemented with 1.25, 6.25, 12.5 and 200 \u3bcg/mL linopirdine, respectively.
Conclusions
Our data suggest that Kv7 channel blockers could be used to stabilize blood pressure and reduce fluid resuscitation requirements after hemorrhagic shock
Transfer factor for carbon monoxide in patients with COPD and diabetes: results from the German COSYCONET cohort
No full textAbstract
Background
An impairment of CO diffusing capacity has been shown in diabetic patients without lung disease. We analyzed how diffusing capacity in patients with COPD is affected by the concurrent diagnosis of diabetes.
Methods
Data from the initial visit of the German COPD cohort COSYCONET were used for analysis. 2575 patients with complete lung function data were included, among them 358 defined as diabetics with a reported physician diagnosis of diabetes and/or specific medication. Pairwise comparisons between groups and multivariate regression models were used to identify variables predicting the CO transfer factor (TLCO%pred) and the transfer coefficient (KCO%pred).
Results
COPD patients with diabetes differed from those without diabetes regarding lung function, anthropometric, clinical and laboratory parameters. Moreover, gender was an important covariate. After correction for lung function, gender and body mass index (BMI), TLCO%pred did not significantly differ between patients with and without diabetes. The results for the transfer coefficient KCO were similar, demonstrating an important role of the confounding factors RV%pred, TLC%pred, ITGV%pred, FEV
1
%pred, FEV
1
/FVC, age, packyears, creatinine and BMI. There was not even a tendency towards lower values in diabetes.
Conclusion
The analysis of data from a COPD cohort showed no significant differences of CO transport parameters between COPD patients with and without diabetes, if BMI, gender and the reduction in lung volumes were taken into account. This result is in contrast to observations in lung-healthy subjects with diabetes and raises the question which factors, among them potential anti-inflammatory effects of anti-diabetes medication are responsible for this finding
Early-life exposure to air pollution and greater use of academic support services in childhood: a population-based cohort study of urban children
No full textAbstract
Background
There is a growing literature showing associations between prenatal and early-life exposure to air pollution and children\u2019s neurodevelopment. However, it is unclear if decrements in neurodevelopment observed in epidemiologic research translate into observable functional outcomes in the broader pediatric population. The objective of this study was to examine the association between early-life exposures to common urban air toxics and the use of academic support services, such as early intervention and special education within a population-based cohort of urban children.
Methods
Data for 201,559 children born between 1994 and 1998 in New York City were obtained through administrative data linkages between birth, early intervention and educational records. Use of academic support services was ascertained from birth through attendance in 3
rd
grade. Census tract at birth was used to assign estimates of annual average ambient concentrations of benzene, toluene, ethylbenzene and xylenes (BTEX) using the 1996 National Air Toxics Assessment. Discrete-time hazard models were fit to the data and adjusted for confounders including maternal, childhood and neighborhood factors.
Results
Children with higher exposures to BTEX compounds were more likely to receive academic support services later in childhood. For example, the adjusted hazard ratio comparing children exposed to the highest decile of benzene to those with lower exposure was 1.09 (95% confidence interval 1.05, 1.13). Results were consistent across individual BTEX compounds, for exposure metrics which summarized exposure to all four BTEX pollutants and for multiple sensitivity analyses.
Conclusions
These findings suggest urban air pollution may affect children\u2019s neurodevelopment and educational trajectories. They also demonstrate the use of public health data systems to advance children\u2019s environmental health research
Anti-staphylococcal activity resulting from epithelial lining fluid (ELF) concentrations of amikacin inhale administered via the pulmonary drug delivery system
No full textAbstract
Background
Amikacin inhale (BAY41-6551), a unique drug\u2014device combination of a specially formulated drug solution and a pulmonary drug delivery system device (AMK-I) is currently under phase III study as an adjunctive therapy to IV antibiotics for the treatment of Gram-negative pneumonia in mechanically ventilated patients. While the epidemiology of nosocomial pneumonia is predominated by Gram-negative pathogens such as Pseudomonas aeruginosa and the Enterobacteriaceae, Staphylococcus aureus is increasingly recognized as a pathogen of concern for these pulmonary based infections. Since the aminoglycosides are historically quite active against S. aureus the use of adjunctive AMK-I may enhance bacterial eradication. Herein, we aimed to characterize the in vitro pharmacodynamic (PD) profile of human-simulated ELF exposures of AMK-I against both methicillin-sensitive (MSSA) and -resistant (MRSA) S. aureus .
Methods
An in vitro model was used to simulate the resultant ELF pharmacokinetic profile of amikacin after the administration of AMK-I 400\ua0mg q12h. The antibacterial activity of this regimen was tested against 7 S. aureus isolates that display MIC profiles encountered clinically (4 MRSA; MIC range 4\u201364, 3 MSSA; MIC range 8\u201316\ua0mg/L). Experiments were conducted over 24\ua0h and samples were taken throughout this period to assess the bacterial density in both control and treatments.
Results
The mean\ua0\ub1\ua0SD inoculum 0\ua0h bacterial density was 6.4\ua0\ub1\ua00.09 which increased to 8.6\ua0\ub1\ua00.19 log
10
CFU/mL in the control models by the end of 24\ua0h experiments. Simulated ELF concentrations of AMK-I resulted in a rapid, 5 log
10
declined in CFU over the initial 12\ua0h for all MRSA and MSSA isolates. After 12\ua0h, all bacterial counts remained below the limit of detection (LOD, 1.7 log
10
CFU/mL) and no regrowth was evident at the end of the study.
Conclusion
AMK-I produced an ELF exposure profile that was rapidly bactericidal against S. aureus displaying typical MICs to amikacin irrespective of their phenotypic profile to methicillin. While the Gram-negative organisms are the target pathogens for AMK-I in the ongoing clinical trials, these data suggest that this adjunctive regimen may also have the potential to eradicate both MSSA and MRSA from lower airway which needs to be further evaluated in randomized-controlled clinical trials