Surgical repair techniques, functional outcome, and return to sports after apophyseal avulsion fractures of the ischial tuberosity in adolescents.

PURPOSE: Among juvenile apophyseal avulsion injuries of the pelvis in adolescents, fractures of the ischial tuberosity are rare but sustainably debilitating. Also because informations on surgical repair options are very sparse and so far limited to general reviews, reports of individual cases or heterogeous small case series, practitioners, patients and their parental environment still feel a comprehensible hesitation regarding operative treatment. Therefore we intended to investigate patient related outcome measurements and return to sports rates after different types of surgical intervention in an own case series, so far unprecendented in its size. METHODS: Patient data of adolescents that underwent surgical intervention for a displaced apophyseal avulsion fracture of the ischial tuberosity between 01/2015 and 12/2019 in our institution were gathered. Patients were then evaluated using the hamstring injury specific Perth Hamstring Assessment Tool (PHAT). Furthermore the return to sports level in comparison to the particular pre-injury level was rated. RESULTS: Eleven adolescents with an acute or chronic mean fragment dislocation of 3.3 cm (SD ± 1.7) underwent surgical intervention in the assigned period. The mean post-operative PHAT score was 86.9 (0-100, SD ± 11.9) and thus good to excellent. The majority of adolescents (10/11) was able to return to their pre-injury sports, whereas 63.6% achieved full or nearly full level. CONCLUSIONS: Surgical refixation or restoration of aphoyseal avulsion fractures of the ischial tuberosity result in good to excellent outcomes and return to sport rates, irrespective of the type of intervention. Here prompt diagnosis with a timely intervention seems more promising than delayed interventions in chronic cases. Beyond 1.5 cm of fragment displacement affected patients should be counselled for surgical intervention.

[Health Information Behavior of the South Tyrolean Population: An Epidemiological Cross-Sectional Study]. / Informationsverhalten der Südtiroler Bevölkerung zu Gesundheitsfragen ­ eine epidemiologische Querschnittsstudie.

OBJECTIVES: Investigation of the health information behavior, self-rated health, confidence in health issues and specific attitudes to health among the South Tyrolean population. METHODS: Our study is an epidemiological cross-sectional study; data were collected via telephone interviews, using a questionnaire developed for this purpose that covered various aspects of information and health-related behavior. For the elaboration of the typology of the most distinctive stereotypes in terms of health information and health-related behavior, a hierarchical cluster analysis was performed. RESULTS: We assessed 504 correct telephone interviews. The majority of the respondents considered themselves health-conscious and preferred heterogeneous information media. The most used information media for health issues were mass media, i. e. newspapers or magazines and television or radio. The internet was used less as a source of information. Younger individuals assessed themselves to be healthier than older people, and older women aged 65 years or more were the most health-impaired group. Respondents had greatest confidence in their general practitioner, their own feeling or experience. Thus, in terms of health information and health behavior, the following four classes of people could be distinguished, namely "internet information elite", "robust fatalists", "stricken" and "health-conscious mainstreamers". CONCLUSION: Our results show that the South Tyrolean population has a high level of health consciousness and gathers health information from various media. The characterization of different patient typologies of information processing in combination with health-related behavior indicates that information about health and illness should be appropriately addressed to the respective stereotype.

Functional impairment after successful surgical reconstruction for proximal hamstring avulsion.

PURPOSE: Surgical refixation procedures after hamstring avulsion injuries show satisfying to excellent outcome results. However, for post-operative evaluation so far, used outcome scores were partially not injury-specific, heterogeneous, difficult to compare, and possibly overestimated due to ceiling effects. A new injury-specific assessment tool has recently been published, potentially depicting more realistic outcome results. Thus, the aim of our study was to evaluate patients after hamstring refixation surgery using previously utilized as well as the new Perth hamstring assessment tool (PHAT). METHODS: A series of operated hamstring injuries were retrospectively evaluated using the PHAT as well as the widespread, customized Lower Extremity Functional Scale (C-LEFS) and the customized Marx score (C-Marx). Scores as well as potential ceiling effects were evaluated individually, and compared and correlated to each other. RESULTS: Sixty-four patients were enrolled into the survey. Forty-nine questionnaires (76%) could be evaluated. The mean total PHAT score (0-100) after 28 months (SD ± 17.0) was 74.1 (SD ± 22.5) points. Mean total C-LEFS (0-80) revealed 61.4 (SD ± 18.1) points, and the mean total C-Marx score (20) was 19.4 (SD ± 1.6) points. Pearson's correlation between the individual questionnaires was high between the PHAT and the C-LEFS (r = 0.81) and low between the PHAT and C-Marx (r = 0.52) and between C-LEFS and C-Marx (r = 0.48). CONCLUSION: The presented study confirms good subjective functional outcomes after surgical intervention of hamstring avulsions in all scores. Nevertheless, using the PHAT, residual complaints are more common than often described in previous studies interpreting "conventional" scores. For future decision and patient guidance, more studies using injury-specific assessments such as the PHAT in combination with objective measurements are eligible.

Health information-seeking behavior associated with linguistic group membership: latent class analysis of a population-based cross-sectional survey in Italy, August to September 2014.

BACKGROUND: Evidence suggests an increasing demand for culturally and linguistically responsive disease prevention programs and health interventions. It is important to understand how individuals seek health information to address the potential needs of the health care system. METHODS: Latent classes of health information-seeking behaviors in a linguistically mixed region of Italy were explored through a population-based telephone survey of ten health information sources. Data were collected in August and September 2014 from 504 adults in South Tyrol, Italy (primary language German, 68%; Italian, 28%), and analyzed using latent class analysis and latent class multinomial logistic regression models. RESULTS: Three classes of health information-seeking behaviors emerged: "multidimensional" (23.3%), "interpersonal" (38.6%) and "technical/online" (38.1%). Compared to the "technical/online" class, "interpersonal" class members were older, had lower education than high school, and were less likely to be of Italian ethnicity. "Multidimensional" class members were more likely to be female, older, and of German ethnicity than those in the "technical/online" class. CONCLUSIONS: Linguistic ethnicity explains membership in classes on health information-seeking behavior. Policymakers and healthcare providers should consider the health information-seeking behaviors of population subgroups to promote health and medical care in linguistic minority groups.

Awareness and use of home remedies in Italy's alps: a population-based cross-sectional telephone survey.

BACKGROUND: Belief in complementary and alternative medicine practices is related to reduced preparedness for vaccination. This study aimed to assess home remedy awareness and use in South Tyrol, where vaccination rates in the coronavirus pandemic were lowest in Italy and differed between German- and Italian-speaking inhabitants. METHODS: A population-based survey was conducted in 2014 and analyzed using descriptive statistics, multiple logistic regression, and latent class analysis. RESULTS: Of the representative sample of 504 survey respondents, 357 (70.8%) participants (43.0% male; primary language German, 76.5%) reported to use home remedies. Most commonly reported home remedies were teas (48.2%), plants (21.0%), and compresses (19.5%). Participants from rural regions were less likely (odds ratio 0.35, 95% confidence interval 0.19-0.67), while female (2.62, 1.69-4.10) and German-speaking participants (5.52, 2.91-9.88) were more likely to use home remedies. Latent classes of home remedies were "alcoholic home remedies" (21.4%) and "non-alcohol-containing home remedies" (78.6%). Compared to the "non-alcohol-containing home remedies" class, members of the "alcoholic home remedies" class were more likely to live in an urban region, to be male and German speakers. CONCLUSION: In addition to residence and sex, language group membership associates with awareness and use of home remedies. Home remedies likely contribute to socio-cultural differences between the language groups in the Italian Alps. If the observed associations explain the lower vaccination rates in South Tyrol among German speakers requires further study.

Mutual Role Expectations by Patients and General Practitioners-A Mixed Methods Study on Complementarity.

Background: Changes in public attitudes toward "authorities" in general, as well as shifts in medical practice toward participative models of diagnosis and treatment, imply fundamental transformations in the patient−doctor relationship. However, consistency in reciprocal role expectations cannot be assumed, and this study reveals significant discrepancies in attitudes and behaviors in primary health consultations. Methods: We conducted a study in the tri-lingual northeastern Italian region of South Tyrol to determine whether perceptions of the patient's role were congruent or differed. In a mixed method approach, the quantitative research part consisted of a survey with 34 identical questions for general practitioners (n = 109) and adult primary care patients (n = 506) on verbal communication, self-initiative and health literacy, interpersonal and social qualities of the patient−physician relationship, and formal aspects of the consultation. Patients were interviewed via telephone, and general practitioners responded online. In the qualitative part, 26 semi-structured in-depth interviews were conducted with the patients and analyzed. Results: General practitioners considered patients' communicative efforts (p < 0.001), self-initiative (p < 0.001), compliance (p = 0.0026), and openness regarding psychosocial issues (p < 0.001) to be significantly more important, whereas patients showed a tendency to give increased importance to formal aspects such as politeness and hygiene (p < 0.001). Perception of the patient's role differed significantly between the Italian and German linguistic groups. Conclusions: Patients and general practitioners differ in their understanding of patients' roles. These data suggest that a considerable proportion of the population lacks a clear and tangible idea of the active role they could play in consultations. Targeted information on the identified aspects of patient−provider communication may facilitate participatory behavior and positively impact the longitudinal quality of the patient−general practitioner relationship.

Predictive Factors Influencing Functional Results After Proximal Hamstring Tendon Avulsion Surgery: A Patient-Reported Outcome Study After 227 Operations From a Single Center.

BACKGROUND: Although debilitating, proximal hamstring tendon avulsion injuries are rare and often overlooked or misdiagnosed. Consequently, delayed diagnosis and surgical treatment may result in poor outcomes. Studies investigating a correlation between postoperative functional outcomes and this delay in surgical treatment or other concomitant factors in large cohorts have not yet been performed to our knowledge. PURPOSE/HYPOTHESIS: The purpose of this study was to conduct an investigation in a large patient group regarding factors that could influence a patient's functional outcome after hamstring surgery. We hypothesized that this outcome would significantly correlate to the time between trauma and surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Patients who received surgical treatment of proximal hamstring tendon avulsion injuries in our institution between the years 2010 and 2020 were asked to complete a validated, injury-specific outcome measurement, the Perth Hamstring Assessment Tool (PHAT; 0-100 points). In addition to calculating these outcomes, we evaluated the association of the obtained results with possible predictive factors such as age, sex, stump retraction shown on magnetic resonance imaging (MRI), and timing and duration of surgery. RESULTS: A total of 226 patients (227 operations) were eligible for the study, and 204 cases of hamstring tendon avulsion injury met our inclusion criteria. The return rate for the PHAT questionnaire was 85.3%. The mean PHAT score revealed good results (79.8 ± 19.1). Irrespective of concomitant factors, the scores of male patients were significantly higher compared with those of female patients (83.8 ± 16.9 vs 75.8 ± 20.6 respectively; P = .004). The mean time to surgery was 5.7 weeks after trauma, and more delayed surgery correlated significantly with lower PHAT scores (P = .003; r = -0.228). The mean degree of stump retraction on MRI (5 cm) did not significantly influence PHAT scores (P = .525; r = -0.06). CONCLUSION: Delay of surgery and female sex were disadvantageous in terms of a good functional outcome measure (PHAT score) after hamstring tendon refixation surgery. By contrast, patient age as well as the retraction of the tendon stump on preoperative MRI did not influence PHAT scores in the present study.

Anterior cruciate ligament reconstruction with and without computer navigation: a clinical and magnetic resonance imaging evaluation 2 years after surgery.

PURPOSE: The purpose of this study was to evaluate the benefits of computer navigation on tunnel placement during anterior cruciate ligament reconstruction. METHODS: A prospective, randomized, controlled study comparing computer navigation with manual operation was performed between December 2003 and April 2004. We assigned 20 patients to the computer navigation group and 20 patients to the manual navigation group. Surgery was performed by use of a patellar tendon autograft with press-fit fixation. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel at 4 days postoperatively. Outcomes were evaluated with International Knee Documentation Committee 2000, Tegner, and Lysholm scoring. There was an additional magnetic resonance imaging (MRI) evaluation of tunnel placement and graft quality at the most recent follow-up, approximately 24 months after surgery. RESULTS: The postoperative radiographs and 2-year postoperative MRI scans showed no differences between groups for tibial or femoral tunnel placement. In both groups the mean tibial tunnel placement was 46% of the maximal diameter of the tibia. There were no significant differences between groups for objective and subjective outcomes scoring. Although some qualitative differences existed between groups with respect to MRI graft appearance at 2 years, this had no correlation with overall results. CONCLUSIONS: No significant differences were found between computer-assisted and manually navigated anterior cruciate ligament reconstruction with regard to tunnel placement and clinical results at a mean of 2 years postoperatively. LEVEL OF EVIDENCE: Level I, randomized, single-blinded, controlled trial.

A comparative evaluation of corneal epithelial cell cultures for assessing ocular permeability.

The purpose of this study was to evaluate the potential value of different epithelial cell culture systems as in vitro models for studying corneal permeability. Transformed human corneal epithelial (HCE-T) cells and Statens Serum Institut rabbit corneal (SIRC) cells were cultured on permeable filters. SkinEthic human corneal epithelium (S-HCE) and Clonetics human corneal epithelium (C-HCE) were received as ready-to-use systems. Excised rabbit corneas (ERCs) and human corneas (EHCs) were mounted in Ussing chambers, and used as references. Barrier properties were assessed by measuring transepithelial electrical resistance, and by determining the apparent permeability of markers with different physico-chemical properties, namely, fluorescein, sodium salt; propranolol hydrochloride; moxaverine hydrochloride; timolol hydrogenmaleate; and rhodamine 123. SIRC cells and the S-HCE failed to develop epithelial barrier properties, and hence were unable to distinguish between the permeation markers. Barrier function and the power to differentiate compound permeabilities were evident with HCE-T cells, and were even more pronounced in the case of C-HCE, corresponding very well with data from ERCs and EHCs. A net secretion of rhodamine 123 was not observed with any of the models, suggesting that P-glycoprotein or similar efflux systems have no significant effects on corneal permeability. Currently available corneal epithelial cell culture systems show differences in epithelial barrier function. Systems lacking functional cell-cell contacts are of limited value for assessing corneal permeability, and should be critically evaluated for other purposes.

Expression of ABC-transporters in human corneal tissue and the transformed cell line, HCE-T.

PURPOSE: The aim of this study was to elucidate the expression pattern of transport proteins relevant to drug absorption in human cornea and to assess the human corneal epithelial cell line, HCE-T, regarding its use as an in vitro model for drug-absorption studies. METHODS: Human corneal tissue and HCE-T cells were examined for the expression of P-glycoprotein (P-gp/MDR1), multidrug resistance-associated protein 1 (MRP1), multidrug resistance-associated protein 2 (MRP2), lung resistance-related protein (LRP), and breast cancer-resistance protein (BCRP), using reverse transcriptase-polymerase chain reaction and immunofluorescence microscopy. Moreover, transporter activity was measured by bi-directional flux studies across excised human cornea and HCE-T cell layers using a P-gp/MDR1 substrate, rhodamine 123 (Rh123). RESULTS: Transport studies of Rh123 revealed no significant differences in fluxes in the apical-to-basolateral and basolateral-to-apical directions across excised human corneas or HCE-T cell layers, suggesting the absence or insignificant, if any, participation of P-gp/MDR1 to Rh123 fluxes. Of all the transporter proteins under investigation, only LRP was found in human cornea. By contrast, a signal for LRP was not found in HCE-T, but the expression of MRP1, MRP2, and BCRP could be confirmed. Of note is the lack of P-gp/MDR1 expression in any of the specimens we examined. CONCLUSIONS: Only a limited array of ABC-transporters is functionally expressed in human cornea. The expression pattern of HCE-T cells appears to be widely different from that of the native corneal tissue. Hence, the in vitro model of human cornea, HCE-T, should be used with much caution when predicting transport rates across the human corneal epithelial barrier in vivo.

[Surgical Refixation after Proximal Hamstring Tendon Avulsion Injuries: Does the Time of Surgery Influence Functional Outcomes?] / Operative Refixation bei proximalem Hamstringabriss: Ist der OP-Zeitpunkt relevant für das funktionelle Outcome?

Background Proximal hamstring tendon avulsion injuries are rare. If they do occur, surgical treatment with tendon refixation is regarded as the method of choice. Surgical outcome measurements have been investigated heterogeneously and, therefore, are difficult to compare. Hence, the possibility for correlations between postoperative outcomes and surgical methods or time of surgery is limited. Objective Using the new, validated and injury-specific Perth Hamstring Assessment Tool (PHAT), we aimed to investigate a population of own patients in order to compare the results in relation to the time of surgery after trauma. Methods In this retrospective case control study, all patients who had undergone hamstring avulsion surgery between 1/2011 and 3/2016 with a follow-up period of at least six months were asked to document their subjective functional outcome using the PHAT. Depending on the time of surgery after trauma, patients and the results of their questionnaires were assigned either to an acute (< 4 weeks), a delayed (1 - 3 months) or a chronic (> 3 months) group. Results In the named period, 64 patients had a hamstring refixation surgery, 57 of them could be included in the study. 39 (68 %) returned the completed PHAT questionnaire. The mean PHAT score (0 - 100 pts.) was 72.4 (SD ±â€Š21.0). There was no significant difference between the acute and the delayed group (77.0 ±â€Š22.0 vs. 63.4 ±â€Š16.2; p: 0.0673), whereas a significant difference was detected between the acute and the chronic group (77.0 ±â€Š22.0 vs. 58.3 ±â€Š20.2; p: 0.0214). Conclusion The results of this study show that an early diagnosis and subsequent operation of a hamstring tendon avulsion injury leads to significant better functional outcomes compared with chronic procedures.

Tissue distribution of moxaverine-hydrochloride in the rabbit eye and plasma.

OBJECTIVE: The aim of this study was to determine the tissue distribution and epithelial penetration of moxaverine-hydrochloride (MOX) in the rabbit eye. METHODS: For systemic application, a radioactively labeled MOX solution was injected into the ear vein of Dutch-belted pigmented male rabbits. For topical dosing, an identical solution was administered. At predetermined time points, rabbits were sacrificed, the eyes dissected, and the amount of MOX in the ocular tissues measured. To examine the MOX permeability across the corneal epithelium, transport studies using rabbit corneal epithelial cell culture were conducted and the respective apparent permeability coefficient in absorptive (a to b) or secretive (b to a) direction was calculated. RESULTS: Topical delivery resulted in high concentrations of MOX in the cornea and conjunctiva, although other tissues of the anterior part yielded lower MOX concentrations. In the tissues of the posterior part, high amounts were detected in the retina. Plasma levels were low. The apparent permeability coefficient across corneal epithelial cell layers was in the range of 10(5) cm/s, exhibiting no apparent directionality. CONCLUSION: A topical dosing of MOX to posterior regions of the eye seems feasible. MOX levels in the posterior part of the eye were remarkably high, without causing stringent plasma levels. The high apparent permeability coefficient of MOX across the corneal epithelial cell layers might be caused by the lipophilic nature of the drug and was in the range of other compounds with comparable physicochemical properties.

Differences in the placement of the tibial tunnel during reconstruction of the anterior cruciate ligament with and without computer-assisted navigation.

BACKGROUND: Next to graft fixation, correct positioning of the tibial and femoral tunnel is a deciding factor for the clinical result of anterior cruciate ligament reconstruction surgery. Computer-assisted navigation has been proposed as a method to improve tunnel positioning. PURPOSE: To examine the differences in tibial tunnel placement between cruciate ligament operations using manual and computer-assisted navigation. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Between December 2003 and April 2004, 53 athletes underwent anterior cruciate ligament reconstruction surgery with arthroscopic press-fit technique. The first group (group N; 24 athletes) were operated on with the aid of a navigation system (OrthoPilot, Aesculap AG & Co. KG, Braun), and the second group (group M; 29 athletes) were "manually" operated on. A lateral radiograph of the knee at maximum extension was used to determine the exact position of the tibial tunnel four days postoperatively. In the measurements, the anterior and posterior boundaries of the tibial tunnel, as well as the center of the tibial tunnel in relation to the maximum tibia anteroposterior diameter were evaluated (indicated in percent). An analysis of the tibial tunnel position proportional to the slope of the intercondylar roof was done to determine intercondylar impingement (method according to Howell). The centers of the tibial tunnels were compared with the "optimal" position noted in previous studies. The standard deviation was determined for both groups to determine the variance of placement. RESULTS: The anterior tibial tunnel border was 19.4 mm in group M (29.7%) and 21.2 mm in group N (32.2%) (P = .18). The center of the tibial tunnel was located at 24.6 mm in group M (35.6%) and at 26.6 mm in group N (40.3%) (P = .19). In group M, the posterior tibial tunnel position was located at 30.2 mm (46.2%), and in group N at 32.2 mm (49.1%) (P = .21). When comparing the centers of the tibial tunnels with the optimal 44% found in previous studies, the value for group M (37.6%) varied significantly, while group N (40.5%) did not. However, there was no significant difference in the range variance for either group; the standard deviation was 6.9% (4.3 mm) for group M and 5.9% (3.5 mm) for group N. One athlete showed moderate impingement in group N, and two athletes in group M. CONCLUSION: Assisted navigation offers good support for correct placement of the tibial tunnel, although experienced surgeons can achieve essentially the same positioning as surgeons using computer-assisted navigation. Whether it is advisable to implement this procedure in daily surgical routine should be decided based on clinical results.

P-glycoprotein (MDR1) functional activity in human alveolar epithelial cell monolayers.

The distribution of the P-glycoprotein (P-gp/MDR1) efflux transporter at mucosal barriers has defined it as a functionally important element in limiting drug absorption into the systemic circulation. However, little is known about the distribution and functionality of P-gp/MDR1 in the human lung. Here, the presence of P-gp/MDR1 was investigated immunohistochemically in distal human lung tissue and at mRNA and protein levels in human alveolar epithelial cells (hAEpC) in primary culture. We studied the presence and activity of P-gp/MDR1 in hAEpC monolayers by Western blotting, by immunofluorescence microscopy and by conducting bi-directional transport studies employing a P-gp substrate (rhodamine 123) with and without a P-gp inhibitor (verapamil). The flux of fluorescein sodium was also examined as a paracellular transport marker. Alveolar tissue specimens showed P-gp localised at the luminal membranes of type I pneumocytes. Reverse transcription-polymerase chain reaction revealed the presence of mRNA encoding for P-gp/MDR1 in freshly isolated (i.e. type II) hAEpC and in monolayers of hAEpC cultured for 8 days (i.e. type I-like morphology). At the protein level, P-gp could be detected in hAEpC monolayers after 8 days in culture but not in freshly isolated type II pneumocytes. The flux of rhodamine 123 across hAEpC monolayers on day 8 in culture exhibited net secretion, which disappeared in the presence of verapamil. Fluorescein sodium fluxes showed no distinct directionality. Our findings indicate that P-gp is functionally active in the human alveolar airspace and that hAEpC monolayers might provide a suitable in vitro model for studying P-gp function mechanistically in the distal human lung.

Towards an in vitro model of cystic fibrosis small airway epithelium: characterisation of the human bronchial epithelial cell line CFBE41o-.

The CFBE41o- cell line was generated by transformation of cystic fibrosis (CF) tracheo-bronchial cells with SV40 and has been reported to be homozygous for the DeltaF508 mutation. A systematic characterisation of these cells, which however, is a pre-requisite for their use as an in vitro model, has not been undertaken so far. Here, we report an assessment of optimal culture conditions, the expression pattern of drug-transport-related proteins and the stability/presence of the CF transmembrane conductance regulator (CFTR) mutation in the gene and gene product over multiple passages. The CFBE41o- cell line was also compared with a wild-type airway epithelial cell line, 16HBE14o-, which served as model for bronchial epithelial cells in situ. The CFBE41o- cell line retains at least some aspects of human CF bronchial epithelial cells, such as the ability to form electrically tight cell layers with functional cell-cell contacts, when grown under immersed (but not air-interfaced) culture conditions. The cell line is homozygous for DeltaF508-CFTR over multiple passages in culture and expresses a number of proteins relevant for pulmonary drug absorption (e.g. P-gp, LRP and caveolin-1). Hence, the CFBE41o- cell line should be useful for studies of CF gene transfer or alternative treatment with small drug molecules and for the gathering of further information about the disease at the cellular level, without the need for primary culture.