Significant Increase In Function Research Articles

Temporal trends of mercury levels in fish (dab, Limanda limanda) and sediment from the German Bight (North Sea) in the period 1995–2020

As a toxic and harmful global pollutant, mercury (Hg) enters the marine environment through natural sources, and human activities. It bioaccumulates through the food chain and therefore, Hg is of great importance for environmental monitoring. This study aims to answer the question if Hg contamination in fish and sediment from the German Bight follows temporal trends. Therefore, 496 individual female dab (Limanda limanda) were analyzed. The Hg concentrations in the muscle of dab from the German Bight showed significant increase in function of time with an annual percental change of 1.4%, leading to a 41% increase in Hg contamination level within 25 years of monitoring. At the same time, Hg concentrations in sediment—analyzed in 86 samples—significantly decreased in the nearby North Sea environment. This surprising contradiction is shown in the present study and possible causes are discussed. It could be clearly shown that contamination in sediment and biota can follow completely different time courses and therefore, different environmental matrices should be considered in future monitoring studies. Age of the fish turned out to be a biological factor of particular importance for temporal trend analysis.

Percutaneous autologous bone marrow concentrate for knee osteoarthritis: patient-reported outcomes and progenitor cell content

PurposeKnee osteoarthritis (OA) is a common, progressively debilitating joint disease, and the intra-articular injection of autologous bone marrow concentrate (BMC) may offer a minimally invasive method of harnessing the body’s own connective tissue progenitor cells to counteract accompanying degenerative effects of the disease. However, the extent to which the progenitor cell content of BMC influences treatment outcomes is unclear. We sought to determine whether patient-reported outcome measures associated with BMC treatment for knee OA are related to the concentration of progenitor cells provided.MethodsIn the present study, 65 patients (72 knees) underwent treatment for knee OA with autologous BMC and self-reported their outcomes for up to one year using follow-up questionnaires tracking function, pain, and percent improvement. A small fraction of each patient’s BMC sample was reserved for quantification with a haematological analyzer and cryopreserved for subsequent analysis of potential connective tissue progenitor cells using a colony-forming unit fibroblast (CFU-F) assay.ResultsPatients reported significant increases in function and overall percent improvement in addition to decreases in pain relative to baseline levels following treatment with autologous BMC that persisted through 12 months. Patients reporting improved outcomes (46 of 72 knees) received BMC injections having higher CFU-F concentrations than non-responding patients (21.1×103 ± 12.4×103 vs 14.3×103 ± 7.0 x103 CFU-F per mL). A progenitor cell concentration of 18×103 CFU-F per mL of BMC was found to best differentiate responders from non-responders.ConclusionThis study provides supportive evidence for using autologous BMC in the minimally invasive treatment of knee OA and suggests that increased progenitor cell content leads to improved treatment outcomes.Trial registrationClinicalTrials.gov Identifier: NCT03011398, 1/7/17

Biceps Tenodesis as an Attractive Alternative to Superior Labral Anterior-Posterior (SLAP) Repair for Type II SLAP Lesions in Active-Duty Military Patients Younger Than 35 Years

Background: Biceps tenodesis has been suggested as a superior surgical technique compared with isolated labral repair for superior labral anterior-posterior (SLAP) tears in patients older than 35 years. The superiority of this procedure in younger patients, however, is yet to be determined. Purpose: To compare the outcomes of arthroscopic SLAP repair with those of arthroscopic-assisted subpectoral biceps tenodesis for type II SLAP tears in active-duty military patients younger than 35 years. Study Design: Cohort study; Level of evidence, 3. Methods: Preoperative and postoperative evaluations with a minimum 5-year follow-up including the visual analog scale (VAS), the Single Assessment Numeric Evaluation (SANE), and the American Shoulder and Elbow Surgeons (ASES) shoulder score were administered, and scores were compared between 2 groups of patients younger than 35 years. One group included 25 patients who underwent SLAP repair, and the second group included 23 patients who underwent arthroscopic-assisted subpectoral biceps tenodesis. Results: The preoperative patient age (P = .3639), forward flexion (P = .8214), external rotation (P = .5134), VAS pain score (P = .4487), SANE score (P = .6614), and ASES score (P = .6519) did not vary significantly between the 2 study groups. Both groups demonstrated statistically significant increases in function as measured by the ASES and SANE and decreases in pain as measured by the VAS at a minimum of 5 years postoperatively. Also at a minimum of 5 years postoperatively, patients in the tenodesis group had lower pain (1.3 vs 2.6, respectively; P = .0358) and higher SANE (84.0 vs 63.3, respectively; P = .0001) and ASES (85.7 vs 75.4, respectively; P = .0342) scores compared with those in the repair group. Failure rate was 20.0% in the repair group versus 0.0% in the tenodesis group (P = .0234). Conclusion: Active-duty military patients younger than 35 years with type II SLAP tears had more predictable improvement in pain, better functional outcomes, and lower failure rates after biceps tenodesis compared with SLAP repair for type II SLAP tears. Overall, the results of this study indicate that arthroscopic- assisted subpectoral biceps tenodesis is superior to arthroscopic SLAP repair for the treatment of type II SLAP tears in military patients younger than 35 years.

A Pilot Study of At-Home Virtual Reality for Chronic Pain Patients

Chronic pain disorders are a common and expensive health problem worldwide. Available treatments for these disorders have been decreasing and new treatments are needed. Virtual reality (VR) has been used for acute and procedural pain for years but systems are only now becoming available for use with chronic pain. In this study patients with a chronic pain disorder were given the option of using either take-home virtual reality equipment for one month or take-home biofeedback equipment for one month. In the VR condition patients were oriented to the “PainCare” app but could access any free content from the internet as well. Qualitative data was gathered on 23 VR patients and 12 biofeedback patients. Pre-post measures of depression, catastrophizing and function were obtained from 17 VR patients and 8 biofeedback patients. Data found that there was a statistically significant decrease in depression and catastrophizing in the VR group but no such decrease was found in the biofeedback group. No significant increase in function was found in either group though the VR group trended in that direction. One hundred percent (100%) of the patients who tried VR reported that they thought it had helped them overall at least a little. Patient ratings of the VR equipment were more favorable than the biofeedback equipment. This non-randomized small sample study suggests that at-home VR use can be used successfully with patients to decrease the important treatment variables of depression and catastrophizing, and perhaps become a significant contribution to the treatment of chronic pain disorders.

Mechanism of Emulsified Isoflurane Postconditioning-Induced Activation of the Nrf2-Antioxidant Response Element Signaling Pathway During Myocardial Ischemia-Reperfusion: The Relationship With Reactive Oxygen Species.

Emulsified isoflurane (EI) has been shown to alleviate myocardial ischemia-reperfusion (IR) injury. However, previous reports have not been focused on the underlying mechanism. We used models of IR injury in Langendorff-isolated rat hearts to determine the relationship between the mechanism underlying EI postconditioning (EIP)-induced activation of the nuclear factor-E2-related factor 2 (Nrf2)-antioxidant response element signaling pathway during myocardial IR, and its relationship with reactive oxygen species. In comparison with the IR group, the EIP group showed a significant reduction in myocardial ultrastructural damage, significant increase in function [heart rate, left ventricular developed pressure, left ventricular end-diastolic pressure, and maximal rate of the increase in left ventricular pressure (+dp/dtmax)], and upregulated expression of Nrf2, HO-I, NQO1, and SOD1 mRNA and proteins at the end of reperfusion. After treatment with N-(2-mercaptopropionyl)-glycine (MPG), the significant reduction in myocardial ultrastructural damage and significant increases in function, and mRNA and protein expression were no longer evident in the M + EIP group. These results show that EIP can regulate reactive oxygen species levels and activate the Nrf2-antioxidant response element signaling pathway, thereby attenuating myocardial IR injury in rats.

User adaptation in Myoelectric Man-Machine Interfaces

State of the art clinical hand prostheses are controlled in a simple and limited way that allows the activation of one function at a time. More advanced laboratory approaches, based on machine learning, offer a significant increase in functionality, but their clinical impact is limited, mainly due to lack of reliability. In this study, we analyse two conceptually different machine learning approaches, focusing on their robustness and performance in a closed loop application. A classification (finite number of classes) and a regression (continuous mapping) based projection of EMG into external commands were applied while artificially introducing non-stationarities in the EMG signals. When tested on ten able-bodied individuals and one transradial amputee, the two methods were similarly influenced by non-stationarities when tested offline. However, in online tests, where the user could adapt his muscle activation patterns to the changed conditions, the regression-based approach was significantly less influenced by the changes in signal features than the classification approach. This observation demonstrates, on the one hand, the importance of online tests with users in the loop for assessing the performance of myocontrol approaches. On the other hand, it also demonstrates that regression allows for a better user correction of control commands than classification.

Effects of pulsed therapeutic ultrasound on the treatment of people with knee osteoarthritis.

[Purpose] The aim was to evaluate the effect of therapeutic ultrasound on the pain, joint mobility, muscle strength, physical function, and quality of life of people with knee OA. [Subjects and Methods] One-site, one-arm, before-after study that included people with Grade II or III tibiofemoral osteoarthritis. Ten therapeutic ultrasound sessions (duty cycle=20%, ERA=10 cm2, BNR=6:1, SATP=2.2 W/cm2, SATA=0.44 W/cm2, frequency=1 MHz, time=4 minutes) were applied. Assessments of primary outcome variables: pain intensity and function, and secondary variables: joint mobility, muscle strength and quality of life, were performed at onset and end of therapy; an additional intermediate evaluation was included for the primary variables. [Results] Means of repeated measurements of pain intensity (pain at rest, pain on palpation and pain after functional activities) and function showed significant differences. There was a significant reduction in pain intensity at the end of functional activities as well as a significant increase in function and in quadriceps muscle strength. [Conclusion] Therapeutic ultrasound applied in accordance with the parameters used, could be recommended during the treatment of individuals with knee osteoarthritis, because it significantly decreased the intensity of pain after the 5th session, and this reduction was maintained until the end of the intervention.

MiRIAD update: using alternative polyadenylation, protein interaction network analysis and additional species to enhance exploration of the role of intragenic miRNAs and their host genes.

MicroRNAs have established their role as potent regulators of the epigenome. Interestingly, most miRNAs are located within protein-coding genes with functional consequences that have yet to be fully investigated. MiRIAD is a database with an interactive and user-friendly online interface that has been facilitating research on intragenic miRNAs. In this article, we present a major update. First, data for five additional species (chimpanzee, rat, dog, cow and frog) were added to support the exploration of evolutionary aspects of the relationship between host genes and intragenic miRNAs. Moreover, we integrated data from two different sources to generate a comprehensive alternative polyadenylation dataset. The miRIAD interface was therefore redesigned and provides a completely new gene model representation, including an interactive visualization of the 3′ untranslated region (UTR) with alternative polyadenylation sites, corresponding signals and potential miRNA binding sites. Furthermore, we expanded on functional host gene network analysis. Although the previous version solely reported protein interactions, the update features a separate network analysis view that can either be accessed through the submission of a list of genes of interest or directly from a gene’s list of protein interactions. In addition to statistical properties of the submitted gene set, the interaction network graph is presented and miRNAs with seed site over- and underrepresentation are identified. In summary, the update of miRIAD provides novel datasets and bioinformatics resources with a significant increase in functionality to facilitate intragenic miRNA research in a user-friendly and interactive way. Database URL: http://www.miriad-database.org

Smith-Robinson Procedure with an Autologous Iliac Crest for Degenerative Cervical Disc Disease: A 28-Year Follow-Up of 95 Patients

Long-term clinical results after anterior cervical discectomy and fusion (ACDF) with an autologous iliac crest are rare. The purpose of this study was to assess this, with special focus on pain, functional outcome, and repeat surgery for adjacent segment disease (ASD). Hospital records of 212 patients who were affected by degenerative cervical disc disease and treated by the Smith-Robinson technique were reviewed. Information about diagnosis, surgery, pre- and postoperative clinical process, and complications was analyzed. Patients were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EQ-5D, Patient Satisfaction Index, Odom criteria, and limitations in quality of life. Ninety-five patients with a mean follow-up of 28 years were evaluated. ACDF was performed at 1 level in 67 and 2 levels in 28 patients. Ninety-two patients reported pain before surgery and 68 patients remained pain free and did not require second surgery. At follow-up, the mean Neck Disability Index was 14%, and mean EQ-5D score was 5. Postoperatively, 96.8% of patients were satisfied and 84.2% of patients reported good to excellent functional recovery. One patient had a hairline fracture at the iliac crest donor site. Fourteen patients underwent second surgery because of degenerative changes, including 11 at the symptomatic ASD. ACDF yields significant decrease in pain, a significant increase in function, and a high degree of patient satisfaction. Overall prevalence for ASD was 12.0% after 25 years. Patients with reoperation had similar clinical outcome regarding pain, compared with patients without reoperation.

Smith–Robinson Procedure with an Autologous Iliac Crest Graft and Caspar Plating: Report of 65 Patients with an Average Follow-up of 22 Years

Anterior cervical discectomy and fusion with plate stabilization (ACDF+PS) is an accepted surgical procedure. We sought to evaluate the long-term clinical results of ACDF+PS with a special focus on pain, functional outcome, and adjacent segment disease. Retrospectively, 139 patients who underwent ACDF+PS were reviewed with a standardized questionnaire including the current neurologic status, Neck Disability Index, EuroQuol-5 Dimension, Patient Satisfaction Index, Hospital Anxiety and Depression Scale, the Odom criteria, complications at the iliac crest donor side, and limitations in quality of life. Mean follow-up time was 22 years (range: 17-34 years). Sixty five (46.8%) patients were evaluated by completed questionnaires, and 74 (53.2%) did not participate. Forty-six patients attended a physical examination. ACDF+PS were performed at 1 level in 28 patients, at 2 levels in 29 patients, and at 3 levels in 8 patients. Fifty (83.3%) of the patients with preoperative pain remained free of pain and did not require another procedure as the result of degenerative cervical disease. The mean NDI was 14%; according to the Odom criteria 86.2% of patients reported good-to-excellent functional recovery. A total of 100% of patients were satisfied or very satisfied with their outcome and would decide to undergo ACDF+PS again. Two developed adjacent segment disease and needed a second procedure. ACDF+PS resulted in a significant increase in function, pain relief, and to a high degree of patient satisfaction. The rate for symptomatic adjacent segment disease was 4.5% after 20 years' follow-up.

Effects of microchannels on the mechanical performance of multifunctional composite laminates with unidirectional laminae

The development of multifunctional composite structures enabled by embedded microvascular networks offers the potential for significant increases in functionality. The addition of active thermal management capability, self-healing, or electromagnetic configurability to a structural composite is attractive. However, the tradeoffs between mechanical performance and extended functionalities remain relatively ill-quantified. Previous studies of the effects of embedded microchannels on structural capability have considered a small number of loading conditions and layups not typically used in aerospace structures. This computational work provides comprehensive structural design guidance by quantifying the negative mechanical effects of parallel and periodic microchannels in aerospace composites, where the results are synthesized from a comprehensive set of analyses performed via rigorous implementation of widely-accepted modeling methods. The impacts of channel orientation, spacing, and channel cross-sectional aspect ratio are all quantified for laminate sequences typical of those used in aerospace structures.

Hyperammonemia enhances the function and expression of P-glycoprotein and Mrp2 at the blood-brain barrier through NF-κB.

Ammonia is considered to be the main neurotoxin responsible for hepatic encephalopathy resulting from liver failure. Liver failure has been reported to alter expression and activity of P-glycoprotein (P-gp) and multidrug resistance-associated protein 2 (Mrp2) at the blood-brain barrier (BBB). The aim of this study was to investigate whether ammonia is involved in abnormalities of expression and activity of P-gp and Mrp2 at the BBB. Hyperammonemic rats were developed by an intraperitoneal injection of ammonium acetate (NH4 Ac, 4.5 mmol/kg). Results showed that Mrp2 function markedly increased in cortex and hippocampus of rats at 6 h following NH4 Ac administration. Significant increase in function of P-gp was observed in hippocampus of rats. Meanwhile, such alterations were in line with the increase in mRNA and protein levels of P-gp and Mrp2. Significant increase in levels of nuclear amount of nuclear factor-κB (NF-κB) p65 was also observed. Primarily cultured rat brain microvessel endothelial cells (rBMECs) were used for in vitro study. Data indicated that 24 h exposure to ammonia significantly increased function and expression of P-gp and Mrp2 in rBMECs, accompanied with activation of NF-κB. Furthermore, such alterations induced by ammonia were reversed by NF-κB inhibitor. In conclusion, this study demonstrates that hyperammonemia increases the function and expression of P-gp and Mrp2 at the BBB via activating NF-κB pathway. Hyperammonemia, a proverbial main factor responsible for neurocognitive disorder and blood-brain barrier (BBB) dysfunction resulting from liver failure, could increase the expression and activity of P-glycoprotein and multidrug resistance-associated protein 2 (Mrp2) at the BBB both in vivo and in vitro. Furthermore, the NF-κB activation stimulated by hyperammonemia may be the potential mechanism underlying such abnormalities induced by hyperammonemia.

Effect of partial weight bearing program on functional ability and quadriceps muscle performance in hemophilic knee arthritis

Recurrent joint bleeding in persons with hemophilia is known to lead to joint damage associated with pain, loss of range of motion and function. The researcher was motivated by the essence of the importance of partial weight bearing program in rehabilitation of lower limb conditions and the lack of literatures regarding these exercises in rehabilitation of hemophilic knee arthritis. The purpose of this study was to investigate the effect of partial weight bearing program on functional ability and quadriceps muscle strength in children with hemophilic knee arthritis. Thirty patients had participated in this study; with age ranged from eight to twelve years. They were randomly assigned into two equal groups. Patients were evaluated pre and post treatment for their functional walking, and isometric strength of quadriceps. The control group (group A) received quadriceps training exercise program, while the study group (group B) received a program of partial weight bearing added to the same exercise program of group A. Treatment was given 3 times/week, every other day, for six consecutive weeks. The results of the study revealed that both groups demonstrated a significant increase in function, as measured by the six minute walking test (6MWT), although there was no significant difference between both groups concerning improvement of function. Quadriceps isometric muscle strength was significantly improved in both groups, in favor of group B (study group). To conclude the partial weight bearing program may be used as a therapeutic intervention for improving functional ability, and muscle performance in children with hemophilic knee arthritis.

1598 – Suicidal behaviour and affective comorbidity in delusional disorder: effectiveness of paliperidone palmitate long acting injection (PPILD)

Introduction Suicide is one of the leading causes of premature death among people with psychotic disorders. However, little is known about treating suicide in delusional disorder. Objectives To investigate effectiveness of PPLAI in delusional disorder (DD) patients. Aims To compare effectiveness of PPLAI vs,other atypical antipsychotics (OAA) in psychopathology and suicidality. Methods Prospective observational study including 45 DD outpatients (DSM-IV-RT) attended at the Department of Psychiatry (Hospital Clinic- BCN) from 2008 to 2012 and followed up for 6 months. Demographic and clinical variables were recorded. Hamilton Rating Scale for Depression-17 (HRSD-17), PANSS for psychopathology, Personal and Social Performance Scale (PSP) and Columbia Suicide Severity Rating Scale (C-SSRS) were assessed at baseline and after 6 months. The sample was divided into four groups according to which treatment they received: oral risperidone, Risperidone Long Acting Injection (RLAI), OAA and PPLAI. For comparisons, Kruskal-Wallis and Chi-square tests were used. Results Eighty-two per cent were women. Mean age (SD) at onset: 46.9(11.8) years. 6 patients received oral risperidone, 23 OAA, 7 RLAI and 9 were treated with PPLAI. No statistically significant differences were found regarding demographic features, motives leading for consultation, depressive comorbidity and antidepressant prescription. After 6 months, patients treated with PPLAI presented lower frequency of ideation (0% vs.11.1%;p=0.027) and suicidal behaviour (0% vs.2.2%;p=NS). The group receiving PPILD presented a significant increase in functionality (PSP) (p=0.046) and an improvement in PANSS negative subscale scores (p=0.017). Conclusions Patients receiving PPLAI showed a decrease in suicidality, an improvement in psychotic symptoms and functionality.

Autologous Chondrocyte Implantation for Treatment of Focal Cartilage Defects in Patients Age 40 Years and Older

Background Autologous chondrocyte implantation (ACI) is an accepted surgical treatment in patients with isolated cartilage defects of the knee. Age has been considered as a limiting factor and the technique has not been recommended in patients older than 40 to 50 years. Nevertheless, some more recent studies report satisfying clinical results in middle-aged patients. Hypothesis Analogous to the microfracture technique, age over 40 years is associated with inferior clinical outcome after ACI. Study Design Cohort study; Level of evidence, 2. Methods Thirty-seven patients with an average age of 47.8 years (group 1) were matched with 37 patients with an average age of 31 years (group 2). Both groups underwent ACI for treatment of isolated cartilage defects of the knee. All patients were enrolled prospectively and followed for a period of 24 months using International Knee Documentation Committee (IKDC), Lysholm scale, Cincinnati sports scale, and Tegner activity evaluation instruments. Results Statistical analysis revealed a significant increase in function after ACI in both groups as early as 6 months after surgery until the end of the study period. There was only a slight tendency for better clinical outcome in younger patients (IKDC at 24 months: group 1, 72.2 ± 15.8 [standard deviation]; group 2: 76.1 ± 14.1; P = .261; Lysholm at 24 months: group 1: 80.42 ± 15.37; group 2: 80.65 ± 12.01), no statistical significant differences were found between patients of group 1 and group 2 at any of the time points investigated. Conclusion In contrast to other cartilage repair techniques, patients 40 years and older do not have an inferior outcome up to 24 months after ACI for isolated cartilage defects when compared with younger patients.

Prospective Outcomes and Associations of Wrist Ganglion Cysts Resected Arthroscopically

To prospectively evaluate objective and subjective outcomes of arthroscopic dorsal wrist ganglion cyst resection, and to identify and examine intra-articular pathologies associated with ganglion cysts. We prospectively evaluated 55 patients with dorsal wrist ganglion cysts who underwent arthroscopic resection with a minimum follow-up of 24 months. Ten had recurrent ganglion cysts previously treated with open resection. Grip strength, wrist motion, and Disabilities of the Arm, Shoulder, and Hand questionnaire scores were evaluated preoperatively and at 6 weeks, 6 months, and 2 years postoperatively. Intraoperative findings were reviewed. In primary ganglion cysts a discrete stalk was present in 4 of 45 cases and diffuse cystic material and redundant capsular thickening were present in 38 of 45 cases. Cystic material appeared to arise from the radiocarpal joint exclusively in 11 of 42 cases, extended into the midcarpal joint in 29 of 42 cases, and arose exclusively from the midcarpal joint in 2 of 42 cases. The scapholunate joint demonstrated instability types I (2 of 45 cases), II (22 of 45 cases), III (20 of 45 cases), and IV (1 of 45 cases). The lunatotriquetral joint demonstrated instability types II (6 of 45 cases) and III (39 of 45 cases). At 6 weeks, average grip strengths increased by 5.9 kg and wrist flexion decreased 13 degrees . Preoperative Disabilities of the Arm, Shoulder, and Hand scores improved from 14.2 to 1.7 at 6 weeks and remained stable at 2 years. At 2 years, all patients demonstrated motion to within 5 degrees of preoperative measurements, and there were no recurrences. Patients experienced significant increases in function and decreases in pain within 6 weeks after arthroscopic ganglion cyst resection, and the recurrence and complication rates appear to be comparable to open resections. Ganglion cysts also have a high association with certain interosseous laxities, and recurrent ganglion cysts originating from the midcarpal joint are not contraindications for arthroscopic resection. Assessment of the midcarpal joint is necessary for complete resection of most ganglion cysts, and identification of a discrete stalk is an uncommon finding and not necessary for successful resection.

Does the use of orthoses improve self-reported pain and function measures in patients with plantar fasciitis? A meta-analysis

Objectives To perform a meta-analysis examining the effects of foot orthoses on self-reported pain and function in patients with plantar fasciitis. Data Sources MEDLINE, SPORTDiscus, and CINAHL were searched from their inception until December 2007 using the terms “foot”, “plantar fascia”, “arch”, “orthotic”, “orthoses” and “plantar fasciitis”. Study Selection Original research studies which met these criteria were included: (1) randomised controlled trials or prospective cohort designs, (2) the patients had to be suffering from plantar fasciitis at the time of recruitment, (3) evaluated the efficacy of foot orthoses with self-reported pain and/or function, (4) means, standard deviations, and sample size of each group had to be reported. Results We utilised the Roos, Engstrom, and Soderberg (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) night splint condition to compare our pooled orthoses results. The meta-analysis results showed significant reductions in pain after orthotic intervention. The Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study also showed significant reduction in pain after night splint treatment. The meta-analysis results also showed significant increases in function after orthotic use. In contrast, the Roos et al.' (Roos, E., Engstrom, M., & Soderberg, B. (2006). Foot orthoses for the treatment of plantar fasciitis. Foot and Ankle International, 8, 606–611) study did not show a significant increase in function after night splinting for 12 weeks. Conclusion The use of foot orthoses in patients with plantar fasciitis appears to be associated with reduced pain and increased function.

Two-Year Results of Open-Wedge High Tibial Osteotomy With Fixation by Medial Plate Fixator for Medial Compartment Arthritis With Varus Malalignment of the Knee

The purpose of our study was to evaluate the complications, technique-related risks, and the clinical course of patients treated with high tibial osteotomy (HTO) for medial arthritis of the knee with varus malalignment. Forty-three of 46 consecutive patients (follow-up, 93.5%) treated with HTO using the TomoFix implant (Synthes, Solothurn, Switzerland) were followed-up for 24 months. Radiographic and clinical data were collected preoperatively as well as 6, 12, and 24 months after surgery using standard instruments (Lysholm and subjective International Knee Documentation Committee score). Excellent and good results were achieved in 67.5% of patients. Thirty-seven patients (86.0%) reported clinical improvement at 24 months compared to preoperative status. Evaluation of the clinical course following HTO revealed a significant increase in function after 12 (P < .01) and 24 (P < .01), but not at 6 months (P = .336) after surgery. A further increase was found between 12 and 24 months (P = .017); 67.5% of the study population returned to their predisease sports activity level at 24 months after surgery. Except for 1 case of intra-articular fracture, no severe intraoperative complications were found. One case of nonunion that demanded additional surgery was observed. HTO with an open-wedge technique using the TomoFix implant seems to be a safe and efficient procedure. Our data show that postoperative recovery is long, with a majority of patients not reaching a functional end-point by 6 or 12 months. In many patients, further improvement was found after 12 months, which might be related to a removal of the implant. Level IV, therapeutic case series.

Survivable Monitoring in Dynamic Networks

We present a monitoring system for a dynamic network in which a set of domain nodes shares the responsibility for producing and storing monitoring information about a set of visitors. This information is stored persistently when the set of domain nodes grows and shrinks. Such a system can be used to store traffic or other logs for auditing or can be used as a subroutine for many applications to allow significant increases in functionality and reliability. The features of our system include authenticating visitors, monitoring their traffic through the domain, and storing this information in a persistent, efficient, and searchable manner. The storage process is O(log n)-competitive in the number of network messages with respect to an optimal offline algorithm; we show that this is as good as any online algorithm can achieve and significantly better than many commonly used strategies for distributed load balancing

Radiosurgery and Whole-Brain Radiation Therapy for Brain Metastases

BRAIN METASTASES ARE THE MOST FEARED AND DEBILItating complication of systemic cancers. They affect approximately 170 000 patients a year, with the most common primary tumors being lung cancer, breast cancer, and melanoma. The traditional approach for patients with brain metastases has been whole-brain radiation therapy (WBRT), irrespective of lesion number or primary site. A shift in treatment occurred for patients with a single brain metastasis after 3 randomized trials were completed. In these trials patients were randomized to receive WBRT alone or surgical resection of a single brain metastasis followed by WBRT. In studies by Patchell et al and Noordijk et al, resection of a single brain metastasis prior to WBRT led to an increase in median survival of 25 and 17 weeks, respectively. There was also a significant increase in functionality for the surgical group in both studies. A study by Mintz et al did not show a survival advantage for the surgery plus WBRT group, but patient selection (poorer performance status and more advanced systemic disease) most likely accounted for this result. Patchell et al performed the only randomized trial comparing resection of a single brain metastasis to observation or WBRT. Patients treated with resection of their brain metastasis followed by WBRT had better local (10% vs 46%) and distant (18% vs 70%) brain control (ie, development of metastases in other parts of the brain), with fewer patients dying of neurologic causes; importantly, there was no survival advantage or increase in functional independence with WBRT. Only a small number of patients have a single brain metastasis and are good surgical candidates. Stereotactic radiosurgery has an advantage over conventional surgery in that it is noninvasive and allows more than 1 lesion to be treated, including those in areas not surgically accessible. One reason to use stereotactic radiosurgery is to increase effectiveness against “radioresistant tumors,” as the dose used is significantly higher than that for WBRT. An additional potential advantage is elimination of the neurotoxicity associated with WBRT. The main limitation of stereotactic radiosurgery is tumor size; tumor number and location may also limit the use of stereotactic radiosurgery. Since 50% to 60% of patients have 1 to 4 brain metastases, they may be candidates for stereotactic radiosurgery but not surgery. Although stereotactic radiosurgery is “functionally” similar to surgery, no randomized trials have been published as to the comparative efficacy of these treatments. Auchter et al used stereotactic radiosurgery with WBRT to treat patients with a single brain metastasis, and outcomes were similar to those reported by Patchell et al and Noordijk et al. Despite these similar outcomes, prospective trials are needed to define optimal treatment using stereotactic radiosurgery and WBRT. In this issue of JAMA, Aoyama and colleagues report the first randomized trial of stereotactic radiosurgery with or without WBRT in patients with up to 4 brain metastases; one other trial has been presented only in abstract form, and other studies compared WBRT with or without stereotactic radiosurgery. The impetus for performing such a trial is to prospectively confirm retrospective data suggesting that stereotactic radiosurgery alone does not decrease survival and patients can have salvage therapy (ie, effective treatment at relapse) with WBRT at progression or to prove that WBRT is a necessary adjunct to stereotactic radiosurgery. The rationale for adding WBRT is to treat “micrometastases” not seen on imaging, thereby improving distant and local brain control. Aoyama et al provide several important and confirmatory findings. First, there is no survival advantage with the addition of WBRT to stereotactic radiosurgery, confirming what has been previously reported, so it appears that WBRT can be delayed without compromising patient survival. Pirzkall et al reported a survival advantage for the subset of patients who had no extracranial disease and were treated with stereotactic radiosurgery and WBRT. Second, local control is improved with the addition of WBRT and recurrence rates are lower. Improved control rates have been reported by others, but brain control did not appear to have an effect on outcome or functional status except in the study by Patchell et al. Third, patients treated with stereotactic radiosurgery and WBRT require salvage therapy