Contralateral Control Research Articles

P4709Subclavian CTO stenting using bilateral retrograde wrist approach

Abstract Aims To assess the procedural safety and results of subclavian artery stenting using bilateral retrograde radial (TRA) and/or ulnar approach (TUA). Methods We report 40 consecutive patients that underwent retrograde opening and stenting of the subclavian artery using wrist approach with contralateral control from the opposite TRA or TUA. Primary outcome was procedural success rate. Secondary outcomes were: presence of procedural complications, restenosis, MI, stroke or death and presence of any type of access site bleeding hemathoma. One year clinical follow up and duplex ultrasonography was done in all patients. Results The same technique was used in all patients: 6F guiding catheter Judkins right 4.0 was most frequently used (n=37) for coronary hydrophilic wire retrograde crossing of the occlusion and ballon predilatation. Exchange of wire was made with 0,035 guide wire. Balloon expandable stents were implanted solely through the short hydrophilic sheath, with contralateral contrast check. Contralateral injection strategy was used to confirm proper wire advancement within the lesion and optimal stent positioning. Most frequently used guide wire for CTO opening was CROSS IT 400. The average stent diameter was 7 mm (range 5.0–9.0 mm), and the average stent length was 29, 1 mm (range 15–80 mm). 38 procedures were successfully done using bilateral retrograde radial approach. Only two patients required transfer to transfemoral approach to open the subclavian chronic total occlusion. Minor access site bleeding complications were recorded in 4 patients. There were no other complications. Seven patients were discharged the same day, the others one day after admission. At follow up only one patient had symptomatic in stent restenosis and a balloon angioplasty was done inside the stent 3 years after the primary intervention, the patient was a smoker. One other patient had asymptomatic in stent restenosis documented 6 months after the intervention with duplex follow up. Conclusions Bilateral wrist access can be a successful and safe strategy in opening subclavian artery occlusions with a low rate of complications.

P3581Periinterventional cocoa flavanol supplementation prevents functional and structural damage to the arterial wall after transradial catheter intervention

Abstract Background The transradial approach is commonly preferred over the femoral approach for coronary angiography to reduce vascular complications like bleeding, aneurysm formation and all-cause mortality ensuring early ambulation after coronary procedures. However, there is growing evidence that damage to the radial artery endothelium elicits intimal hyperplasia, vascular remodeling and might ultimately lead to total vessel occlusion. Objective Our study aimed to investigate the effects of dietary flavanol intervention on (a) early endothelial functional recovery and (b) late structural changes i.e. intimal hyperplasia after mechanical vascular wall injury in the human forearm model during coronary angiography. Methods Radial artery flow-mediated vasodilation (RA-FMD), local stiffness (fractional diameter change, Fdc), intima-media thickness (IMT), luminal and external arterial diameter at the site of intervention and the contralateral control artery were measured in 38 male patients (19 flavanol intervention, 19 placebo control) undergoing transradial coronary angiography (TCA) at baseline, after 7 days of 450mg flavanol supplementation BID, directly after TCA and 6 months after TCA. Circulating levels of endothelial microparticle (EMP) subpopulations CD31+/41-, CD62e+and CD144+were analyzed simultaneously as a surrogate for endothelial functional integrity and activation. Results One week of flavanol supplementation, not placebo, significantly increased RA-FMD (8.88±2.03% vs. 11.17±2.89%, p<0.01 in flavanol and 8.64±1.87% vs. 8.32±1.63%, p=n.s. in placebo). RA-FMD significantly decreased in the intervention artery directly after TCA, which was partly mitigated by flavanol supplementation (delta to baseline: −2.61±0.82% in flavanol vs. −4.91±0.63% in placebo, p=0.034). TCA induced significant intimal hyperplasia in the radial artery (0.36±0.02mm vs. 0.44±0.04mm, p<0.01) in placebo, but not in the flavanol group (0.36±0.02mm vs. 0.37±0.02mm, p=n.s.) after 6 month. One week of flavanol supplementation increased Fdc (1.94±0.99 vs. 3.07±1.31, p<0.01). No changes occurred in the placebo group (1.99±1.29 vs. 1.96±1.17, p=n.s.). On the contralateral arm, the decrease in RA-FMD was blunted by flavanols (delta to baseline: +0.42±1.05% in flavanol vs. −0.61±1.55% in placebo) along with decreased circulating levels of EMPs. Conclusions TCA impairs endothelial function (RA-FMD), vascular physicomechanics (Fdc) and induces intimal hyperplasia (IMT). Periinterventional flavanol supplementation blunts the acute decreases in endothelial function and physicomechanics and prevents chronic negative vascular remodeling.

Gastrocnemius Muscle Structure Remodels Within the First Month Following Acute Achilles Tendon Rupture

Category:Sports, Trauma, Achilles TendonIntroduction/Purpose:Two out of three patients Achilles tendon ruptures have limited plantarflexor function 1-year following Achilles tendon rupture. While tendon elongation has been reported as a possible mechanism of functional deficits, the effects of rupture on plantarflexor muscle structure has not been as rigorously investigated. A recent study found that gastrocnemius fascicle length was decreased 6-months following Achilles tendon rupture compared to the uninjured limb. However, the changes in muscle structure following the first month of injury – when the healing tendon is most susceptible to elongation – has not yet been established. The purpose of this study was to quantify the structural changes to the medial gastrocnemius in patients who suffered acute Achilles tendon ruptures and were treated non-operatively.Methods:To test our hypothesis that plantarflexor structure would undergo rapid remodeling following Achilles tendon rupture, we quantified muscle structure in ten patients (9 male, Age: 44 ± 12; BMI: 28.6 ± 6.5) who provide informed written consent in this IRB approved study. We acquired B-mode ultrasound images of the medial gastrocnemius muscle at the initial presentation (week 0), two weeks, and four weeks following the injury. The same investigator acquired all the ultrasound images and measured fascicle length, pennation angle, muscle thickness, and echo intensity. These measurements had a coefficient of variation less than 10%. We compared these structural measurements of the injured muscle at each time point with the contralateral muscle scans at the initial presentation using paired t-tests.Results:Gastrocnemius muscle structure following an acute Achilles tendon rupture differed with the healthy-contralateral muscle throughout the first four weeks following injury (Figure). Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) at the presentation of injury (week 0). These differences in fascicle length (P < 0.001) and pennation angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes were not detected at any of the post-injury visits. Muscle quality, measured as mean echo intensity, was 8% lower in the injured limb immediately (P= 0.008) and 11% lower 2 weeks following injury (P < 0.001). At week 4 muscle quality had returned to within 1% of the contralateral limb (P = 0.393).Conclusion:Our findings support our hypothesis that the gastrocnemius muscle fascicles of the affected side would demonstrate shorter length and greater pennation angle than the contralateral control muscle. These findings are a preliminary set of data from a larger clinical cohort of patients that were enrolled in an ongoing 1-year long prospective study. Achilles tendon ruptures elicit rapid changes in the configuration and quality of the medial gastrocnemius, which may explain long-term functional deficits.

Reversibility of Retinal Ganglion Cell Dysfunction From Chronic IOP Elevation.

To test the hypothesis that the capacity for retinal ganglion cells to functionally recover from chronic IOP elevation is dependent on the duration of IOP elevation. IOP elevation was induced in one eye in anesthetized (isoflurane) adult C57BL6/J mice using a circumlimbal suture. Sutures were left in place for 8 and 16 weeks (n = 30 and 28). In two other groups the suture was cut after 8 and 12 weeks (n = 30 and 28), and ganglion cell function (electroretinography) and retinal structure (optical coherence tomography) were assessed 4 weeks later. Ganglion cell density was quantified by counting RBPMS (RNA-binding protein with multiple splicing)-stained cells. With IOP elevation (∼10 mm Hg above baseline), ganglion cell function declined to 75% ± 8% at 8 weeks and 59% ± 4% at 16 weeks relative to contralateral control eyes. The retinal nerve fiber layer was thinner at 8 (84% ± 4%) and 16 weeks (83% ± 3%), without a significant difference in total retinal thickness. Ganglion cell function recovered with IOP normalization (suture removal) at week 8 (97% ± 7%), but not at week 12 (73% ± 6%). Ganglion cell loss was found in all groups (-8% to -13%). In the mouse circumlimbal suture model, 12 weeks of IOP elevation resulted in irreversible ganglion cell dysfunction, whereas retinal dysfunction was fully reversible after 8 weeks of IOP elevation.

High-Impact Exercise Increased Femoral Neck Bone Density With No Adverse Effects on Imaging Markers of Knee Osteoarthritis in Postmenopausal Women.

High-impact exercise can improve femoral neck bone mass but findings in postmenopausal women have been inconsistent and there may be concern at the effects of high-impact exercise on joint health. We investigated the effects of a high-impact exercise intervention on bone mineral density (BMD), bone mineral content (BMC), and section modulus (Z) as well as imaging biomarkers of osteoarthritis (OA) in healthy postmenopausal women. Forty-two women aged 55 to 70 years who were at least 12 months postmenopausal were recruited. The 6-month intervention consisted of progressive, unilateral, high-impact exercise incorporating multidirectional hops on one randomly assigned exercise leg (EL) for comparison with the contralateral control leg (CL). Dual-energy X-ray absorptiometry (DXA) was used to measure BMD, BMC, and Z of the femoral neck. Magnetic resonance imaging (MRI) of the knee joint was used to analyze the biochemical composition of articular cartilage using T2 relaxometry and to analyze joint pathology associated with OA using semiquantitative analysis. Thirty-five participants (61.7 ± 4.3 years) completed the intervention with a mean adherence of 76.8% ± 22.5%. Femoral neck BMD, BMC, and Z all increased in the EL (+0.81%, +0.69%, and +3.18%, respectively) compared to decreases in the CL (-0.57%, -0.71%, and -0.75%: all interaction effects p < 0.05). There was a significant increase in mean T2 relaxation times (main effect of time p = 0.011) but this did not differ between the EL and CL, indicating no global effect. Semiquantitative analysis showed high prevalence of bone marrow lesions (BML) and cartilage defects, especially in the patellofemoral joint (PFJ), with no indication that the intervention caused pathology progression. In conclusion, a high-impact exercise intervention that requires little time, cost, or specialist equipment improved femoral neck BMD with no negative effects on knee OA imaging biomarkers. Unilateral high-impact exercise is a feasible intervention to reduce hip fracture risk in healthy postmenopausal women. © 2019 American Society for Bone and Mineral Research.

Ipsilateral Neck Irradiation for Postoperative Lateralized Buccal Mucosa Squamous Carcinoma with Extranodal Extension: Propensity Analysis

The presence of extranodal extension (ENE) is the most significant risk factor for tumor control in head and neck squamous cell carcinoma (HNSCC). Concomitant chemoradiotherapy has been the standard of care for postoperative HNSCC. However, ipsilateral or bilateral radiotherapy for well-lateralized HNSCC is still controversial. We try to evaluate whether ipsilateral irradiation is safe for ENE-positive patients with well-lateralized buccal mucosa squamous cell carcinoma (BMSCC). Data of 186 well-lateralized BMSCC patients with ENE treated by postoperative ipsilateral RT or bilateral RT from January, 1997 to December, 2016 were included in this retrospective analysis. Patients in both arms were matched using the propensity score method, with 1:2 ratio matching from the ipsilateral RT group and the bilateral RT group in 10 key clinicopathological features. All outcomes were evaluated from the date of radical surgery. Primary endpoint was three-year contralateral neck control (CLNC). Secondary endpoints were three-year overall survival (OS), progression free survival (PFS), local control (LC), regional control (RC) and distant metastasis-free survival (DMFS). After matching, 123 patients (45 patients in ipsilateral RT group and 78 patients in bilateral RT group) were selected for analysis. The median follow-up time was 36.3 months (range 3.6-218.5). Cox regression analysis revealed that ENE number ≥ 4 is the only prognostic factor in all endpoints. RT field (ipsilateral RT vs. bilateral RT) did not have impact in three-year CLNC (85.6% vs. 89.1%, p = 0.75), OS (53.2% vs. 57.4%, p = 0.23), PFS (46.5% vs. 48.6%, p = 0.52), LC (74.6% vs. 77.4%, p = 0.78), RC (79.9% vs. 76.2%, p = 0.47) and DMFS (70.7% vs. 72.0%, p = 0.50). Ipsilateral neck irradiation treatment did not have worse outcomes for the postoperative BMSCC patients with ENE compared with bilateral neck treatment. The number of ENE is the most important prognostic factor in postoperative BMSCC patients with ENE.

Ipsilateral hemiparesis: the forgotten history of this paradoxical neurological sign.

Establishing the neurological localization doctrine for the contralateral hemispheric control of motor functions in the second half of the 19th century, researchers faced the challenge of recognizing false localizing signs, in particular paradoxical or ipsilateral hemiparesis (IH). Despite tremendous progress in current methods of neuroradiological and electrophysiological exploration, a complete understanding of this phenomenon has yet to be attained. The authors researched the well-described cases of hemiparesis/hemiplegia ipsilateral to an intracranial lesion published in the scientific literature in the pre-MRI era (before 1980). A comprehensive review of the physiopathological mechanisms proposed for paradoxical hemiparesis throughout this period, as well as the pathological evidence substantiating them, is provided. A collection of 75 patients with hemiparesis/hemiplegia ipsilateral to the primary intracranial lesion reported between 1858 and 1979 were eligible for analysis. Most cases occurred in adults with supratentorial, slowly developing, extraparenchymatous mass lesions, such as neoplasms (38%) or chronic subdural hematomas (36%). Physiopathological theories proposed by the neurologists who investigated IH can be grouped into 4 major concepts: 1) lack of anatomical decussation of the corticospinal tract; 2) impaired functional activation of the contralateral hemisphere by the lesioned dominant hemisphere through the callosal connections; 3) Kernohan's notch phenomenon, or mechanical injury of the contralateral cerebral peduncle against the free edge of the tentorium; and 4) cerebrovascular dysfunction involving the contralateral hemisphere owing to kinking and mechanical flattening of the carotid artery contralateral to the primary intracranial lesion. IH represents a still underdiagnosed paradoxical neurological phenomenon. With the aid of modern neuroradiological and neurophysiological methods, Kernohan's peduncle notch mechanism has been confirmed to cause IH in many of the cases reported in recent decades. Nevertheless, alternative functional and/or vascular mechanisms must be investigated further for unexplained IH cases, in particular for transitory IH without evidence of peduncle injury. The historical theories reviewed in this paper represent a conceptual framework that may be helpful for this purpose.

Ventilation Heterogeneity and Its Association with Nodule Formation Among Participants in the National Lung Screening Trial—A Preliminary Investigation

We have developed a technique to measure ventilation heterogeneity (VH) on low dose chest CT scan that we hypothesize may be associated with the development of lung nodules, and perhaps cancer. If true, such an analysis may improve screening by identifying regional areas of higher risk. Using the National Lung Screening Trial database, we identified a small subset of those participants who were labeled as having a positive screening test at 1 year (T1) but not at baseline (T0). We isolated the region in which the nodule would form on the T0 scan ("target region") and measured VH as the standard deviation of the linear dimension of a virtual cubic airspace based on measurement of lung attenuation within the region. We analyzed 24 cases, 9 with lung cancer and 15 with a benign nodule. We found that the VH of the target region was nearly statistically greater than that of the corresponding contralateral control region (0.168 [0.110-0.226] vs. 0.112 [0.083-0.203], p = 0.051). The % emphysema within the target region was greater than that of the corresponding contralateral control region (1.339 [0.264-4.367] vs. 1.092 [0.375-4.748], p = 0.037). There was a significant correlation between the % emphysema and the VH of the target region (rho = +0.437, p = 0.026). Our study provides the first data in support of increased local VH being associated with subsequent lung nodule formation. Further work is necessary to determine whether this technique can enhance screening for lung cancer by low dose chest CT scan.

The effects of age on the severity of joint damage and intra-articular inflammation following a simulated medial meniscus injury in 3, 6, and 9 month old male rats

ABSTRACTPurpose: Aging is a known risk factor for osteoarthritis (OA). Several transgenic rodent models have been used to investigate the effects of accelerated or delayed aging in articular joints. However, age-effects on the progression of post-traumatic OA are less frequently evaluated. The objective of this study is to evaluate how animal age affects the severity of intra-articular inflammation and joint damage in the rat medial collateral ligament plus medial meniscus transection (MCLT+MMT) model of knee OA.Methods: Forty-eight, male Lewis rats were aged to 3, 6, or 9 months old. At each age, eight rats received either an MCLT+MMT surgery or a skin-incision. At 2 months post-surgery, intra-articular evidence of CTXII, IL1β, IL6, TNFα, and IFNγ was evaluated using a multiplex magnetic capture technique, and histological evidence of OA was assessed via a quantitative histological scoring technique.Results: Elevated levels of CTXII and IL6 were found in MCLT+MMT knees relative to skin-incision and contralateral controls; however, animal age did not affect the severity of joint inflammation. Conversely, histological investigation of cartilage damage showed larger cartilage lesion areas, greater width of affected cartilage, and more evidence of hypertrophic cartilage damage in MCLT+MMT knees with age.Conclusions: These data indicate the severity of cartilage damage subsequent to MCLT+MMT surgery is related to the rat’s age at the time of injury. However, despite greater levels of cartilage damage, the level of intra-articular inflammation was not necessarily affected in 3, 6, and 9 month old male rats.

Quantitative profiling of regional protein expression in rat retina after partial optic nerve transection using fluorescence difference two‑dimensional gel electrophoresis.

To examine the difference between primary and secondary retinal ganglion cell (RGC) degeneration, the protein expression at four regions of retina including superior, temporal, inferior and nasal quadrant in a rat model of partial optic nerve transection (pONT) using 2-D Fluorescence Difference Gel Electrophoresis (DIGE) were investigated. Unilateral pONT was performed on the temporal side of optic nerves of adult Wistar rats to separate primary and secondary RGC loss. Topographical quantification of RGCs labeled by Rbpms antibody and analysis of axonal injury by grading of optic nerve damage at 1 week (n=8) and 8 weeks (n=15) after pONT demonstrated early RGC loss at temporal region, which is considered as primary RGC degeneration and progressing RGC loss at nasal region, which is considered as secondary RGC degeneration. Early protein expression in each retinal quadrant (n=4) at 2 weeks after pONT was compared with the corresponding quadrant in the contralateral control eye by DIGE. For all comparisons, 24 differentially expressed proteins (>1.2-fold; P<0.05; ≥3 non-duplicated peptide matches) were identified by mass spectrometry (MS). Interestingly, in the nasal retina, serum albumin and members of crystallin family, including αA, αB, βA2, βA3, βB2 and γS indicating stress response were upregulated. By contrast, only αB and βA2 crystallin proteins were altered in temporal quadrant. In the superior and inferior quadrants, βB2 crystallin, keratin type I, S-arrestin and lamin-B1 were upregulated, while heat shock cognate 71 kDa protein and heterogeneous nuclear ribonucleoproteins A2/B1 were downregulated. In summary, the use of DIGE followed by MS is useful to detect early regional protein regulation in the retina after localized optic nerve injury.

The pH sensitivity of APT-CEST using phosphorus spectroscopy as a reference method.

The pH value is a potential physiological marker for clinical diagnosis as it is altered in pathologies such as tumors. While intracellular pH can be measured noninvasively via phosphorus spectroscopy (31 P MRSI), Amide Proton Transfer-Chemical Exchange Saturation Transfer (APT-CEST) MRI has been suggested as an alternative method for pH quantification. To assess the suitability of APT-CEST contrast for pH quantification, two approaches (magnetization transfer ratio asymmetry [MTRasym ] and Lorentzian difference analysis [LDA]) for analyzing the Z-spectrum have been correlated with pH values obtained by 31 P MRSI. Fourteen patients with glioblastoma and 12 healthy controls were included. In contrast to MTRasym , the LDA is modeling the direct water saturation and the semi-solid magnetization transfer, allowing a separate evaluation of the aliphatic nuclear Overhauser effect and the APT-CEST. The results of our study show that the pH values obtained by 31 P MRSI correspond well with both methods describing the APT-CEST contrast. Two-sample t-test showed significant differences in MTRasym , LDA and pH obtained by 31 P MRSI for regions of interest in glioblastoma, contralateral control areas and normal appearing white matter (P<0.001). A slightly improved correlation between the amide signal and pH was found after performing LDA (r=0.78) compared with MTRasym (r=0.70). While both methods can be used to monitor pH changes, the LDA approach appears to be better suited.

Insights into the Microbiome of Breast Implants and Periprosthetic Tissue in Breast Implant-Associated Anaplastic Large Cell Lymphoma

Though rare, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), a CD30+ T-cell lymphoma associated with textured breast implants, has adversely impacted our perception of the safety of breast implants. Its etiology unknown, one hypothesis suggests an initiating inflammatory stimulus, possibly infectious, triggers BIA-ALCL. We analyzed microbiota of breast, skin, implant and capsule in BIA-ALCL patients (n = 7), and controls via culturing methods, 16S rRNA microbiome sequencing, and immunohistochemistry. Alpha and beta diversity metrics and relative abundance of Gram-negative bacteria were calculated, and phylogenetic trees constructed. Staphylococcus spp., the most commonly cultured microbes, were identified in both the BIA-ALCL and contralateral control breast. The diversity of bacterial microbiota did not differ significantly between BIA-ALCL and controls for any material analyzed. Further, there were no significant differences in the relative abundance of Gram-negative bacteria between BIA-ALCL and control specimens. Heat maps suggested substantial diversity in the composition of the bacterial microbiota of the skin, breast, implant and capsule between patients with no clear trend to distinguish BIA-ALCL from controls. While we identified no consistent differences between patients with BIA-ALCL-affected and contralateral control breasts, this study provides insights into the composition of the breast microbiota in this population.

Assessment of tear meniscus by optical coherence tomography in patients with canalicular laceration repair.

To analyze tear meniscus measurements with optical coherence tomography (OCT) in patients with canalicular laceration repair. Thirty-four consecutive patients who underwent unilateral canalicular repair due to canalicular laceration between January 2014 and December 2018 were included. All patients had canalicular repair followed by monocanalicular or annular silicone tube intubation. Anatomic patency of canalicular system was tested with probing and irrigation, while functional patency was evaluated with Munk score. Tear meniscus measurements of all patients were obtained following tube removal by spectral OCT. Tear meniscus height (TMH), tear meniscus depth (TMD) and tear meniscus area (TMA) of eyes with canalicular laceration repair and contralateral uninvolved eyes were compared. Average age of 34 patients was 32.8±21.3years (range 4-68years). Lower canaliculus was involved in 27 (79.4%), upper canaliculus in five (14.7%), and both canaliculi in two (5.9%) patients. Mean follow-up period was 6.5±5.7months. Anatomic patency rate was 100%, and functional patency (patients free of epiphora) was 91.2%. Average TMH (317.9±133.1µm), TMD (198.1±82.5µm) and TMA (29,792.1±21,285.3μm2) values of eyes with canalicular repair were not significantly different from TMH (308.9±111.9µm), TMD (184.5±61.4µm) and TMA (26,682.5±16,178.1μm2) values of contralateral control eyes (p values: 0.758, 0.225 and 0.778, respectively). There was a strong positive correlation between TMA and Munk score (r=0.637, p<0.001) and moderate positive correlation between TMH (r=521, p=0.002), TMD (r=0.481, p=0.004) and Munk score. Tear meniscus measurement with OCT is a rapid, quantitative and objective tool for evaluation of canalicular patency in patients with canalicular laceration repair.

Temporal disconnection between pain relief and trigeminal nerve microstructural changes after Gamma Knife radiosurgery for trigeminal neuralgia.

Gamma Knife radiosurgery (GKRS) is a noninvasive surgical treatment option for patients with medically refractive classic trigeminal neuralgia (TN). The long-term microstructural consequences of radiosurgery and their association with pain relief remain unclear. To better understand this topic, the authors used diffusion tensor imaging (DTI) to characterize the effects of GKRS on trigeminal nerve microstructure over multiple posttreatment time points. Ninety-two sets of 3-T anatomical and diffusion-weighted MR images from 55 patients with TN treated by GKRS were divided within 6-, 12-, and 24-month posttreatment time points into responder and nonresponder subgroups (≥ 75% and < 75% reduction in posttreatment pain intensity, respectively). Within each subgroup, posttreatment pain intensity was then assessed against pretreatment levels and followed by DTI metric analyses, contrasting treated and contralateral control nerves to identify specific biomarkers of successful pain relief. GKRS resulted in successful pain relief that was accompanied by asynchronous reductions in fractional anisotropy (FA), which maximized 24 months after treatment. While GKRS responders demonstrated significantly reduced FA within the radiosurgery target 12 and 24 months posttreatment (p < 0.05 and p < 0.01, respectively), nonresponders had statistically indistinguishable DTI metrics between nerve types at each time point. Ultimately, this study serves as the first step toward an improved understanding of the long-term microstructural effect of radiosurgery on TN. Given that FA reductions remained specific to responders and were absent in nonresponders up to 24 months posttreatment, FA changes have the potential of serving as temporally consistent biomarkers of optimal pain relief following radiosurgical treatment for classic TN.

CT can stratify patients as low risk for tibial neuropathy following a talus fracture.

Determine the incidence of tibial neuropathy following talus fractures and CT's ability to stratify patients at risk for developing post-traumatic neuropathy. In this IRB-approved retrospective analysis, 71 talus fractures and 8 contralateral control ankle CTs were reviewed by one observer blinded to clinical information. CT evidence suggestive of tibial neurovascular bundle injury included nerve displacement, perineural fat effacement/edema, and bone touching nerve. The association between these CT findings and clinically evident tibial neuropathy was analyzed. A semi-quantitative likelihood score was assigned based on the degree of the CT findings around the nerve. Interobserver agreement was calculated between 2 other readers. Twenty-five percent of patients in this cohort had clinical evidence of tibial neuropathy. There was a high specificity (0.87-0.93) and negative predictive value (0.83-0.87), a moderate accuracy (0.80-0.82), but a lower sensitivity (0.33-0.56) associated with the CT findings. Among the CT findings, nerve displacement (p < 0.0001) and bone touching nerve (p = 0.01) were associated with tibial neuropathy. A likelihood score of 2-5 was associated (p = 0.007-0.015) with tibial neuropathy. The presence of tibial neuropathy and nerve recovery were not associated with hospital length of stay, while CT findings were. There was substantial agreement between the three readers: likelihood scores 2+ (k = 0.78) and 3+ (k = 0.72). Tibial neuropathy occurs following talus fractures, and CT findings may help surgeons narrow down the number of patients requiring close neurological follow-up.

Excision of Physeal Bars of the Distal Femur, Proximal and Distal Tibia Followed to Maturity.

In the 50 years since a premature partial physeal arrest (a physeal bar) was first excised from an epiphysis there have been no large in-depth studies reporting the results in patients followed to skeletal maturity. This paper reports the results of physeal bar resection surgery in a group of patients followed to skeletal maturity, documenting the restored growth of the affected physis, the affected bone, and the final limb-length discrepancy. Forty-eight patients underwent physeal bar resection of the distal femur (21), proximal tibia (9), and distal tibia (18) by 1 surgeon (H.A.P.) from 1968 through 1996, and were followed prospectively to skeletal maturity with clinical and radiologic examinations. Factors such as sex, age at time of injury, etiology of the bar, physeal bar location and size, age at time of bar excision, interposition material, and additional surgical procedures were analyzed with respect to physis, bone, and limb growth following bar resection. The mean growth for the entire bone following physeal bar excision was 7.6 cm for the distal femur, 4.7 cm for the proximal tibia, and 7.5 cm for the distal tibia, compared with growth in the contralateral control bone of 6.8 cm in the femur, 5.0 cm in the proximal tibia, and 7.8 cm in the distal tibia. The maximum bone growth following bar excision in a single patient was 21.3 cm for the distal femur, 10.3 cm for the proximal tibia, and 18.6 cm for the distal tibia. The mean limb-length discrepancy at maturity was -1.7 cm for the distal femur, -1.3 cm for the proximal tibia, and -1.1 cm for the distal tibia (all sites combined -1.4 cm). Fourteen patients (29%) had only the 1 bar excision with no other accompanying or subsequent surgery. Thirty-four patients (71%) had 1 to 4 accompanying or subsequent leg length or angular correcting procedures. Physeal bar excision to restore growth when applied to the appropriate patient is a useful, rewarding procedure, reducing the number of surgical limb length equalizing procedures. It is a demanding surgical procedure and requires diligent and careful follow-up until maturity. Additional limb length equalizing surgery is frequently needed. Case series, level IV.

Bacteriophage of the Skin Microbiome in Patients with Psoriasis and Healthy Family Controls

The bacteriophage (phage) component of the skin microbiome in patients with psoriasis has not been systematically explored. The purpose of this study is to investigate phage and bacterial components of the skin microbiome in patients with psoriasis and in healthy family controls. Lesional skin swabs of four different locations (elbow, forearm, knee, and scalp) were taken from patients with psoriasis. Healthy skin swabs of matched locations were taken from contralateral non-lesional skin and healthy family controls. Skin microbiomes were investigated using next-generation shotgun metagenomics sequencing. 81 skin microbiome samples (27 lesional skin samples and 54 healthy skin samples from contralateral non-lesional skin and family controls) obtained from 16 subjects with psoriasis and 16 matched family controls were sequenced and analyzed. Among phage species with abundant host bacteria, two significantly differential abundant phage species, Acinetobacter phage Presley and Pseudomonas phage O4 (adjusted P < 0.05), between psoriasis lesional skin and healthy skin were identified. Samples with high levels of these phage species had their host bacteria abundance suppressed (P= 0.03 and P < 0.001). Differential phage composition between lesional skin in patients with psoriasis and healthy skin from contralateral non-lesional sites and family controls, as well as the suppression of bacteria host of the respective phage, suggest possible avenues for probiotic phage therapeutics.

Regional gene therapy with 3D printed scaffolds to heal critical sized bone defects in a rat model.

The objective of the present study was to assess the ability of transduced rat bone marrow cells (RBMCs) that overexpress BMP-2 loaded on a three-dimensionally (3D) printed scaffold to heal a critical sized rat femoral defect. Tricalcium phosphate (TCP) scaffolds were 3D printed to fit a critical sized rat femoral defect. The RBMCs were transduced with a lentiviral (LV) vector expressing BMP-2 or GFP. The rats were randomized into the following treatment groups: (1) RBMC/LV-BMP-2 + TCP, (2) RBMC/LV-GFP + TCP, (3) nontransduced RBMCs + TCP, (4) TCP scaffold alone. The animals were euthanized at 12 weeks and evaluated with plain radiographs, microcomputed tomography (micro-CT), histology, histomorphometry, and biomechanically. Each LV-BMP-2 + TCP treated specimen demonstrated complete healing of the femoral defect on plain radiographs and micro-CT. No femurs healed in the control groups. Micro-CT demonstrated that LV-BMP-2 + TCP treated femoral defects formed 197% more bone volume compared to control groups (p < 0.05). Histologic analysis demonstrated bone formation across the TCP scaffold, uniting the femoral defect on both ends in the LV-BMP-2 + TCP treated specimens. Biomechanical assessment demonstrated similar stiffness (p = 0.863), but lower total energy to failure, peak torque, and peak displacement (p < 0.001) of the femurs treated with LV-BMP-2 + TCP when compared to the contralateral control femur. Regional gene therapy induced overexpression of BMP-2 via transduced RBMCs combined with an osteoconductive 3D printed TCP scaffold can heal a critically sized femoral defect in an animal model. The combination of regional gene therapy and 3D printed osteoconductive scaffolds has significant clinical potential to enhance bone regeneration.

Differences in scapular upward rotation, pectoralis minor and levator scapulae muscle length between the symptomatic, the contralateral asymptomatic shoulder and control subjects: a cross-sectional study in a Spanish primary care setting

ObjectiveTo determine the potential differences in both scapular positioning and scapular movement between the symptomatic and asymptomatic contralateral shoulder, in patients with unilateral subacromial pain syndrome (SAPS), and when compared...

Post-exercise And Pre-sleep Protein-polyphenol Supplementation Improves Recovery Following Muscle-damaging Eccentric Exercise: Preliminary Findings.

PURPOSE: Eccentric contraction (EC) induced muscle damage is characterised by weakened force production, increased soreness and elevated plasma creatine kinase (CK). Recovery rate is likely to be dependent on muscle remodelling, which may be influenced by dietary protein and polyphenol availability. We investigated if consuming protein-polyphenol drinks post-exercise and before bed improved recovery of knee extensor function and reduced soreness following a bout of EC. METHODS: In a randomised, parallel groups, placebo controlled double blind design, 18 healthy males and females (22 ± 1 y; BMI: 24.0 ± 0.9 kg·m-2 (± SEM)) consumed a controlled isocaloric diet (1.2 g·kg-1 protein) for 7 days before and after a single bout of 300 maximal unilateral quadriceps EC, in combination with either post-exercise (20 g whey, casein and pea protein blend and 650 mg pomegranate extract) and pre-bed (20 g casein protein and 480 mg tart cherry extract) drinks (Beachbody LLC) (PRO; n = 9; 4 females), or isocaloric maltodextrin placebos (PLA; n = 9; 3 females). Total isokinetic work over 30 maximal knee extensions (TW), peak isometric torque (PT) and muscle soreness (visual analogue scale (VAS) and pressure pain threshold (PPT)) were measured relative to the contralateral control limb (%con) before and every 24 h for 7 d following EC, as was CK. Data were analysed using two-way ANOVAs. RESULTS: EC caused a maximum decline in TW in PLA after 48 h to 68 ± 6 %con (P < 0.001) which remained below baseline until 120 h (P < 0.05). Conversely, TW in PRO was reduced at 24 h only (to 89 ± 5 %con; P < 0.05) and was restored thereafter. PT decreased following EC (P < 0.001) and was significantly lower in PLA compared with PRO at 48 h (69 ± 5 vs 107 ± 13 %con, respectively) and 96 h (76 ± 7 vs 110 ± 14 %con, respectively). Muscle soreness in both groups peaked within 72 h of EC (P < 0.05), but vastus medialis PPT was attenuated at 72 h in PRO compared to PLA (102 ± 3 vs 88 ± 3 %con, respectively; P < 0.05). Plasma CK rose > 30-fold from 96 to 120 h (P < 0.01), and was similar between groups (P > 0.05). CONCLUSION: Consumption of commercially available post-exercise and before bed protein-polyphenol beverages accelerated recovery of skeletal muscle function following EC-induced muscle damage, potentially due to improved protein turnover and remodelling. Supported by a Beachbody LLC (USA) grant.