The effect of using a cement gun with a narrow nozzle on cement penetration for total elbow arthroplasty: a cadaveric study.

PURPOSE: To compare the cement mantle characteristics associated with use of a narrow nozzle cement gun versus the use of a 60-mL catheter tip syringe. METHODS: Twelve cadaveric distal humeri were cemented with either a cement gun or a syringe without canal occlusion. The humeri were sectioned and photographed. The corticocancellous junction and the outer margin of the cement mantle were analyzed digitally. The corticocancellous junction defined the available area for cement penetration. The outline of the cement mantle defined the actual area of penetration. The ratio of penetration to the available area was recorded for each slice. The mean ratio for each humerus was multiplied by the number of slices in that sample containing cement to calculate a cement index. RESULTS: The cement penetration ratios observed in cross-sections at the same level and the cement index were significantly greater with the use of the cement gun than with the use of the syringe. There was no difference in the number of slices that contained cement. CONCLUSIONS: The use of a cement gun with a narrow nozzle improved cement mantle characteristics compared with the use of a syringe when measured in a cadaveric model in the absence of canal occlusion. CLINICAL RELEVANCE: Improving cement mantle characteristics may decrease the incidence of aseptic loosening after total elbow arythroplasty.

DNA methylation in the developing hippocampus and amygdala of anxiety-prone versus risk-taking rats.

All organisms exhibit a wide range of emotional behaviors and interact with the environment in different ways. Some individuals may be more quiet and shy whereas others are more outgoing and adventurous. These temperamental and personality differences can predispose individuals to certain psychopathologies which may be influenced by genetic vulnerability and/or early life experiences. Rodent models can be used to recapitulate emotional reactivity differences, and these models can, in turn, be used to examine potential neurobiological underpinnings of these traits. The present study utilizes two strains of rats that were selectively bred for differences in novelty seeking. High Novelty-Responding (bHR) rats are very active in response to novelty, exhibit exaggerated risk-taking, aggression, impulsivity, and show increased behavioral response to cocaine. Low Novelty-Responding (bLR) rats show increased anxiety, depressive behavior and vulnerability to chronic stress. One way in which the bHR versus bLR behavioral phenotypes may differ is through epigenetic modification of DNA. DNA can be modified through processes such as acetylation or methylation to either enhance or subdue gene expression. This study examines putative differences in methylation levels in the hippocampus and amygdala of developing bHR-bLR rats. Previous research observed widespread gene expression differences in the bLR developing hippocampus, and the current study aims to begin to examine potential epigenetic factors that may contribute to those gene differences. The amygdala was chosen because it is involved in emotional processes, in part through its connections with the hippocampus. Therefore, the present study used in situ hybridization to assess the expression of DNA methyltransferase-1 (DNMT1) mRNA in the hippocampus, amygdala and several other brain areas of bHR and bLR pups at three developmental time points: postnatal days (P) 7, 14, and 21. We focused on the first 3 postnatal weeks, in part to parallel our early microarray gene expression work, and because this represents a critical period of brain development, which shapes individuals' lifelong emotional and stress reactivity. We found significant differences in dentate gyrus and CA3 regions of the hippocampus at P7 with no differences seen at P14 or P21. Interestingly, we also found significant bHR-bLR DNMT1 differences at P7 within the lateral, basolateral and medial nuclei of the amygdala, with no difference at P14 and P21, suggesting that the first postnatal week is a critical period for DNA methylation during brain development.

Differential Engagement by Race/Ethnicity in Experimental Trials of Mental Health Treatment Interventions: A Systematic Review.

Objective: Research on mental health interventions, largely from observational studies, suggests that individuals who are Black, Indigenous, and People of Color (BIPOC) have lower treatment engagement than non-Latino Whites. This systematic review focuses on prospective, experimental treatment trials, which reduce variability in patient and intervention characteristics and some access barriers (eg, cost), to examine the association of race/ethnicity and engagement.Data Sources: A systematic search of PubMed and PsycINFO through May 2020 using terms covering mental health treatment, engagement, and race/ethnicity.Study Selection: US-based, English-language, prospective experimental (including quasi-experimental) trials of adults treated for DSM-defined mental disorders were included. Studies had to compare engagement (treatment initiation and retention, medication adherence) across 2 or more ethnoracial groups. Fifty-five of 2,520 articles met inclusion criteria.Data Extraction: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Collaboration bias-risk assessment tool were used to report study findings.Results: Twenty-nine articles (53%) reported significant ethnoracial engagement differences, of which 93% found lower engagement among BIPOC groups compared largely to non-Latino Whites. The proportion of significant findings was consistent across quality of studies, covariate adjustments, ethnoracial groups, disorders, treatments, and 4 engagement definitions. Reporting limitations were found in covariate analyses and disaggregation of results across specific ethnoracial groups.Conclusions: Prospective experimental treatment trials reveal consistently lower BIPOC engagement, suggesting persisting disparities despite standardized study designs. Future research should improve inclusion of understudied groups, examine covariates systematically, and follow uniform reporting and analytic practices to elucidate reasons for these disparities.

Simultaneous acute myocardial infarction, stroke and critical limb ischaemia: an unusual presentation requiring multidisciplinary approach.

We report the case of a 57-year-old man who presented overnight to a district general hospital as a primary percutaneous coronary intervention alert for an inferior ST elevation myocardial infarction. On presentation to cardiac catheterisation lab, he had ongoing chest pain but began to complain of left-sided limb weakness and pain in his right leg. He was found to have dense hemiparesis on examination with an National Institute of Health Stroke Scale of 8 and an absent right femoral pulse. During the procedure, his common iliac arteries were imaged showing a complete occlusion of his right common iliac. After stenting the culprit lesion in his right coronary artery, he was transferred to a different hospital within the trust where he could receive thrombolysis for his stroke. Unfortunately, after thrombolysis, he went on to develop haemorrhagic transformation of his stroke and an upper gastrointestinal bleed with prolonged recovery of his neurological symptoms after a 27-day hospital stay; but CT arterial imaging showed resolution of right common iliac occlusion predischarge. Here, we discuss the best possible approach to management with simultaneous thrombotic events.

Military Medics' Insight Into Providing Women's Health Care in Deployed Settings.

OBJECTIVES: To gain better understanding of the military medics' (Navy Independent Duty Corpsman, Air Force Independent Duty Medical Technician, and Army Health Care Specialist, experiences providing health care for women in the deployed or ship setting. METHODS: The researchers used an exploratory, descriptive design informed by ethnography. A total of 86 individuals participated in the focus group and individual interviews. RESULTS: Three themes were identified: Training Fidelity, Advocate Leader, and The Challenges of Providing Patient Care. DISCUSSION: Experience in austere settings has convinced a number of medics they need additional women's health care topics in every facet of their training. They further suggested such training should be provided in stepwise fashion, beginning with initial, technical training courses and continuing through medical skills sustainment platforms. They were especially interested in basic women's health concerns. Topics suggested included vaginal infections, urinary tract infections, and birth control management. CONCLUSIONS: Although the advancement of women in the military continues to make strides-it is clear the availability of quality women's health care that women feel comfortable accessing may be its defining limitation. Medics are an excellent conduit for reinforcing these healthy messages and providing first-line treatment to deployed military women.

Patellar instability and quadriceps avoidance affect walking knee moments.

PURPOSE: To classify patients with patellofemoral (PF) instability on the basis of their mechanical gait characteristics, and to relate gait deficits to patellofemoral congruence. METHODS: Thirteen patients awaiting patellar stabilisation surgery were recruited for gait analysis and magnetic resonance imaging, MRI assessment of PF congruence. Patients were grouped into two subgroups (P1, P2) based on knee joint moment during stance, and their total support moments (TSMs) during stance were compared against eight healthy Control subjects. PF congruence was compared between groups from MRI data captured at 0, 20 and 40° of passive knee flexion and during dynamic extension. RESULTS: Five patients were classified into group P1 because they demonstrated a knee extensor moment during early stance, and eight patients into group P2 because they did not. The TSM of the more affected limb in group P1 was not significantly different from Control values in early stance but the difference was significant (P<.05) in late stance. In group P2, both the less and more affected limbs were significantly different from Control TSM values in early stance, but only the more affected limb in late stance. Patellofemoral contact areas as measured by MRI were greatest for the Control patients, and least for patient group P2 especially during the active extension trials. CONCLUSIONS: Patients with patellofemoral pain and instability walked with a slightly flexed knee, avoiding extension. The MRI measurements of joint contact agreed with the patient groupings according to gait mechanics. Cartilage contact across the PF joint can be an objective measure of instability.

The researchers have left the building: what contributes to sustaining school-based interventions following the conclusion of formal research support?

BACKGROUND: This study examined the sustainability of New Moves, a school-based program aimed at decreasing weight-related problems in adolescent girls. The National Cancer Institute recognizes New Moves as a research-tested intervention program that produced positive behavioral and psychosocial outcomes. METHODS: Ten schools participated in the sustainability study. Teachers completed a survey and interview, and research staff observed 1 physical education (PE) class within 2 years of the study's completion. Qualitative data were grouped by themes. Frequencies were calculated using quantitative data. RESULTS: All schools continued all-girls PE classes using New Moves components following the study period. Fewer schools continued the nutrition and social support classroom modules and individual coaching sessions while no schools continued lunch get-togethers. Program components were sustained in both New Moves intervention schools and control schools. CONCLUSIONS: Programs are most likely to be sustained if they (1) fit into the current school structure, (2) receive buy-in by teachers, and (3) require minimal additional funds or staff time. Providing control schools with minimal training and intervention resources was sufficient to continue program components if staff perceived the program was important for students' health and compatible within the school's existing infrastructure.

Inborn differences in environmental reactivity predict divergent diurnal behavioral, endocrine, and gene expression rhythms.

Circadian dysfunction has long been implicated in the etiology of mood disorders. The gene Clock and related molecules (e.g. Per1, Per2) represent key regulators of circadian rhythmicity, and their targeted disruption in mutant mice produces potentiated reward drive, novelty-seeking, impulsivity, disrupted sleep, reduced depression and anxiety - a behavioral profile highly reminiscent of our selectively bred high responder (bHR) rats compared to bred low responders (bLRs). The current study evaluated potential diurnal bHR-bLR differences in behavior, gene expression, and neuroendocrinology. Relative to bHRs, bLRs showed diminished homecage locomotion during the dark (but not light) phase and a delayed corticosterone peak. In situ hybridizations in hypothalamus, amygdala, and hippocampus at Zeitgeber Time (ZT)2 and ZT14 revealed distinct bHR-bLR day-night gene expression fluctuations. bHRs exhibited altered day-night patterns of corticotrophin releasing hormone (CRH) and arginine vasopression (AVP) mRNA in the hypothalamus, and perturbed hippocampal MR:GR ratios relative to bLR rats. bHR-bLR rats showed disparate day-night Clock expression in the suprachiasmatic nucleus, a master circadian oscillator, with bHRs showing higher levels at ZT14 versus ZT2 and bLRs showing the opposite pattern. Clock, Per1 and Per2 were assessed in the substantia nigra pars compacta (SNc) and ventral tegmental area (VTA) since disruption of these genes induces "bHR-like" behavior in mutant mice. Clock and Per1 did not differ between strains, but there were robust Per2 differences, with bHRs having reduced Per2 in VTA and SNc. These findings resonate with earlier work demonstrating that perturbation of Clock and related molecules contributes to disturbances of emotional and addictive behaviors.

Neonatal fibroblast growth factor treatment enhances cocaine sensitization.

Growth factors are critical in neurodevelopment and neuroplasticity, and recent studies point to their involvement in addiction. We previously reported increased levels of basic fibroblast growth factor (FGF2) in high novelty/drug-seeking rats (bred high responders, bHR) compared to low novelty/drug-seeking rats(bred low responders, bLRs). The present study asked whether an early life manipulation of the FGF system(a single FGF2 injection on postnatal day 2) can impact cocaine sensitization and associated neurobiological markers in adult bHR/bLR animals. Neonatal FGF2- and vehicle-treated bHR/bLR rats were sensitized to cocaine(7 daily injections, 15 mg/kg/day, i.p.) in adulthood. Neonatal FGF2 markedly increased bLRs' typically low psychomotor sensitization to cocaine (day 7 locomotor response to cocaine), but had little effect on bHRs' cocaine sensitization. Gene expression studies examined dopaminergic molecules as well as FGF2 and the FGFR1 receptor in cocaine naïve animals, to investigate possible neurobiological alterations induced by neonatal FGF2 exposure that may influence behavioral response to cocaine. bLRs showed decreased tyrosine hydroxylase in the ventral tegmental area (VTA), decreased D1 and increased D2 receptor expression in the nucleus accumbens core, as well as decreased FGF2 in the VTA, substantia nigra, accumbens core, and caudate putamen compared to bHRs. Neonatal FGF2 selectively increased D1 receptor and FGF2 mRNA in the accumbens core of bLRs, which may contribute to their heightened cocaine sensitization. Our results suggest increased FGF2 in the mesodopaminergic circuit (as in baseline bHRs and neonatal FGF2-exposed bLRs vs. baseline bLRs) enhances an individual's susceptibility to cocaine sensitization and may increase vulnerability to drug seeking and addiction.

Pattern of forebrain activation in high novelty-seeking rats following aggressive encounter.

We have previously demonstrated that selectively-bred High (bHR) and Low (bLR) novelty-seeking rats exhibit agonistic differences, with bHRs acting in a highly aggressive manner when facing homecage intrusion. In order to discover the specific neuronal pathways responsible for bHRs' high levels of aggression, the present study compared c-fos mRNA expression in several forebrain regions of bHR/bLR males following this experience. bHR/bLR males were housed with female rats for 2 weeks, and then the females were replaced with a male intruder for 10 min. bHR/bLR residents were subsequently sacrificed by rapid decapitation, and their brains were removed and processed for c-fos in situ hybridization. Intrusion elicited robust c-fos mRNA expression in both phenotypes throughout the forebrain, including the septum, amygdala, hippocampus, cingulate cortex, and the hypothalamus. However, bHRs and bLRs exhibited distinct activation patterns in select areas. Compared to bHR rats, bLRs expressed greater c-fos in the lateral septum and within multiple hypothalamic nuclei, while bHRs showed greater activation in the arcuate hypothalamic nucleus and in the hippocampus. No bHR/bLR differences in c-fos expression were detected in the amygdala, cortical regions, and striatum. We also found divergent 5-HT1A receptor mRNA expression within some of these same areas, with bLRs having greater 5-HT1A, but not 5-HT1B, receptor mRNA levels in the septum, hippocampus and cingulate cortex. These findings, together with our earlier work, suggest that bHRs exhibit altered serotonergic functioning within select circuits during an aggressive encounter.

A randomised controlled pilot study of standardised counselling and cost-free pharmacotherapy for smoking cessation among stroke and TIA patients.

Background Tobacco use is a major risk factor for recurrent stroke. The provision of cost-free quit smoking medications has been shown to be efficacious in increasing smoking abstinence in the general population. Objective The objective of this pilot study was to assess the feasibility and obtain preliminary data on the effectiveness of providing cost-free quit smoking pharmacotherapy and counselling to smokers identified in a stroke prevention clinic. Trial design Cluster randomised controlled trial. Methods All patients seen at the Ottawa Hospital Stroke Prevention Clinic who smoked more five or more cigarettes per day, were ready to quit smoking in the next 30 days, and were willing to use pharmacotherapy were invited to participate in the study. All participants were advised to quit smoking and treated using a standardised protocol including counselling and pharmacotherapy. Participants were randomly assigned to either a prescription only usual care group or an experimental group who received a 4-week supply of cost-free quit smoking medications and a prescription for medication renewal. All patients received follow-up counselling. The primary outcome was biochemically validated quit rates at 26 weeks. The research coordinator conducting outcome assessment was blind to group allocation. Results Of 219 smokers screened, 73 were eligible, 28 consented and were randomised, and 25 completed the 26-week follow-up assessment. All 28 patients randomised were included in the analysis. The biochemically validated 7-day point prevalence abstinence rate in the experimental group compared to the usual care group was 26.6% vs 15.4% (adjusted OR 2.00, 95% CI 0.33 to 13.26; p=0.20). Conclusions It would be feasible to definitively evaluate this intervention in a large multi-site trial. Trial registration number http://ClinicalTrials.gov # UOHI2010-1.