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BACKGROUND: Gout is a disease characterized by hyperuricemia, and resultant deposition of uric acid crystals in tissues. While typically manifested as intraarticular crystals or tophi, gout can also cause pathology at entheses. Gouty deposition within tendinous structures put them at risk for traumatic and degenerative rupture. Furthermore, allografts can also be at risk of rupture in the setting of severe gout. We present the case of a 56-year-old female with severe gouty disease who sustained a re-rupture of a patellar tendon allograft reconstruction. CASE SUMMARY: A 56-year-old female presented to clinic after feeling her left knee pop and collapse beneath her while descending stairs. She had a history of tophaceous gout and left patellar tendon rupture with reconstruction and multiple revisions over the course of 19 years. This patient presented with pain and extensor lag. A magnetic resonance image demonstrated a ruptured patellar tendon allograft reconstruction and avulsion fracture at the tibial tubercle. The patient was treated with a novel intervention of Achilles allograft with bone block in a unique configuration with a dermal allograft incorporated into the reconstruction. She was made non-weight bearing in the operative extremity in extension for the first four weeks postoperatively and was then progressed to active flexion over the course of eight weeks. At twelve weeks, she was able to fully extend her operative knee and at five months she was resuming her normal activities and exercises. CONCLUSION: Failed patellar tendon reconstruction due to gouty infiltration is treated with dermal allograft augmented Achilles tendon reconstruction with bone block.
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Together with obesity and type 2 diabetes, metabolic dysfunction-associated steatotic liver disease (MASLD) is a growing global epidemic. Activation of the complement system and infiltration of macrophages has been linked to progression of metabolic liver disease. The role of complement receptors in macrophage activation and recruitment in MASLD remains poorly understood. In human and mouse, C3AR1 in the iver is expressed primarily in Kupffer cells, but is downregulated in humans with MASLD compared to obese controls. To test the role of complement 3a receptor (C3aR1) on macrophages and liver resident macrophages in MASLD, we generated mice deficient in C3aR1 on all macrophages (C3aR1-MφKO) or specifically in liver Kupffer cells (C3aR1-KpKO) and subjected them to a model of metabolic steatotic liver disease. We show that macrophages account for the vast majority of C3ar1 expression in the liver. Overall, C3aR1-MφKO and C3aR1-KpKO mice have similar body weight gain without significant alterations in glucose homeostasis, hepatic steatosis and fibrosis, compared to controls on a MASLD-inducing diet. This study demonstrates that C3aR1 deletion in macrophages or Kupffer cells, the predominant liver cell type expressing C3aR1, has no significant effect on liver steatosis, inflammation or fibrosis in a dietary MASLD model.
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BACKGROUND: Racial disparities have been shown to influence rates of surgery for patients with rotator cuff disease. Some individuals have attributed adverse social determinants of health (SDOHs) as potential confounders of this relationship between race and surgery rate. However, there is a paucity of literature observing whether adverse SDOHs and race independently influence rotator cuff surgery rates. Therefore, the purpose of this study was to determine whether adverse SDOHs and race are independent predictors of rotator cuff surgery rates for Medicare beneficiaries. METHODS: A retrospective analysis was conducting using the Medicare Standard Analytic Files (SAF) data set of the PearlDiver database, observing 211,340 patients with rotator cuff pathology. Univariate and multivariable regression analyses were performed to observe whether race and adverse SDOHs were independent variables associated with rotator cuff surgery rates. To determine whether adverse SDOHs significantly influenced racial disparities, stratified analyses of patients with ≥1 adverse SDOH and those without adverse SDOHs were conducted to compare the odds ratios (ORs) and 95% confidence intervals (CIs) of racial disparities. RESULTS: Among patients with rotator cuff disease, 21,679 (10.26%) were of nonwhite race and 21,835 (10.33%) had ≥1 adverse SDOH. The variables of nonwhite race (OR, 0.622; 95% CI, 0.599-0.668; P < .001) and having ≥1 adverse SDOH (OR, 0.715; 95% CI, 0.501-0.814; P < .001) were independent predictors of not undergoing surgery. On stratified analysis, there was no significant difference in racial disparities in patients with ≥1 adverse SDOH (OR, 0.620; 95% CI, 0.440-0.875) and those without adverse SDOHs (0.635; 95% CI, 0.601-0.671) based on overlapping 95% CIs. DISCUSSION: This study demonstrated that among Medicare beneficiaries, adverse SDOHs and race are independent predictors of lower rotator cuff surgery rates, emphasizing the need to address disparities based on race alone.
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Introduction: Anterior Labroligamentous Periosteal Sleeve Avulsion (ALPSA) lesions can lead to chronic shoulder instability and repetitive dislocations in active populations. Objective: The purpose of this systematic review was to evaluate associated injuries and postoperative outcomes following ALPSA lesion repairs. Methods: Medline, Embase, Cochrane, and Web of Science were searched through May 2022 for studies that investigated management and surgical outcomes of ALPSA lesion repair. Data was extracted on the following topics: surgical management, surgical complications, associated injuries, follow-up duration, and outcome parameters, including recurrence rates, functional outcome scores, range-of-motion (ROM), and return to activity. Results: A total of 6 studies covering 202 patients met the inclusion criteria. In the included studies, 79% of patient were male with a mean age of 25.1 years. A total of 192 associated injuries were reported amongst 176 patients with the most common being Hill Sachs lesions (84, 43.8%), synovitis (35, 18.2%), SLAP tears (32, 16.7%) and glenoid erosions or lesions (30, 15.6%). All 202 patients were treated arthroscopically with no reported complications. 26 patients (12.9%) experienced operative failure as evidenced by recurrence of shoulder instability over a mean follow-up of 4.3 years. Various clinical outcome scores showed postoperative functional improvement and one study reported a 100% return to activity rate in 26 patients. Conclusion: Our findings suggest a high 12.9 % risk of recurrence following ALPSA repair but satisfactory functional outcomes, both of which should be weighed by physicians when considering arthroscopic repair. Physicians should also be cognizant of co-pathologies when examining patients with suspected ALPSA lesions.
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AbstractSexual conflict is a mechanism of selection driven by the divergent fitness interests between females and males. This disagreement can be great enough to promote antagonistic/defensive traits and behaviors. Although the existence of sexual conflict has been identified in many species, less research has explored the conditions that initially promote sexual conflict in animal mating systems. In previous work in Opiliones, we observed that morphological traits associated with sexual conflict occurred only in species from northern localities. We hypothesized that by shortening and compartmentalizing time periods optimal for reproduction, seasonality represents a geographic condition sufficient to promote sexual conflict. We conducted a systematic review of the literature on reproductive traits and behaviors. Using standardized criteria, we reviewed publications to identify whether subjects occurred in a temperate (high-seasonality) or tropical (low-seasonality) biome. After identifying and adjusting for a publication bias toward temperate research, we identified no significant difference in the strength of sexual conflict between temperate and tropical study systems. A comparison between the distribution of taxa studied in sexual conflict articles and articles focused on general biodiversity indicates that species with conflict-based mating systems more accurately represent the distribution of terrestrial animal species. These findings contribute to ongoing efforts to characterize the origins of sexual conflict as well as life history traits that covary with sexual conflict.
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Arácnidos , Reproducción , Animales , Femenino , Masculino , Geografía , Biodiversidad , EcosistemaRESUMEN
OBJECTIVES: According to personality development theories, the dramatic environmental transition of study abroad may form a crucible for personality change. Location, social roles, and cultural familiarity suddenly shift, potentially disrupting old habits and creating new ones, building upon the typical maturation occurring during college age. The current study poses questions about selection and socialization effects of study abroad on personality, actual and volitional change in personality, and whether adjustment to study abroad catalyzes change. METHOD: Longitudinal studies were conducted with Japanese students studying for one year in the USA (N = 300), and a comparison sample of students in an English-language program at their university in Japan (N = 108). Big Five personality traits and trait-relevant behavior were assessed at the beginning and end of the programs, along with three types of volitional change: expectations, perceptions, and desires. RESULTS: Study abroad showed selection effects for higher Extraversion and Emotional Stability traits and developmental and socialization effects of increases in Openness behavior. Expected and perceived change corresponded with actual change (but desired change did not), and cultural adjustment predicted socially desirable trait-relevant behavior before students' return home. CONCLUSIONS: Study abroad was revealed as an environment wherein students both subjectively experienced and actually demonstrated changes in trait-relevant behavior.
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As humans populated the world, they adapted to many varying environmental factors, including climate, diet, and pathogens. Because many of these adaptations were mediated by multiple noncoding variants with small effects on gene regulation, it has been difficult to link genomic signals of selection to specific genes, and to describe the regulatory response to selection. To overcome this challenge, we adapted PrediXcan, a machine learning method for imputing gene regulation from genotype data, to analyze low-coverage ancient human DNA (aDNA). First, we used simulated genomes to benchmark strategies for adapting PrediXcan to increase robustness to incomplete data. Applying the resulting models to 490 ancient Eurasians, we found that genes with the strongest divergent regulation among ancient populations with hunter-gatherer, pastoralist, and agricultural lifestyles are enriched for metabolic and immune functions. Next, we explored the contribution of divergent gene regulation to two traits with strong evidence of recent adaptation: dietary metabolism and skin pigmentation. We found enrichment for divergent regulation among genes proposed to be involved in diet-related local adaptation, and the predicted effects on regulation often suggest explanations for known signals of selection, for example, at FADS1, GPX1, and LEPR. In contrast, skin pigmentation genes show little regulatory change over a 38,000-year time series of 2,999 ancient Europeans, suggesting that adaptation mainly involved large-effect coding variants. This work demonstrates that combining aDNA with present-day genomes is informative about the biological differences among ancient populations, the role of gene regulation in adaptation, and the relationship between genetic diversity and complex traits.