Patients Follow Different Financial Hardship Trajectories in the Year after Injury.

OBJECTIVE: To determine if distinct financial trajectories exist and if they are associated with quality-of-life outcomes. SUMMARY OF BACKGROUND DATA: Financial hardship after injury measurably impacts Health-Related Quality of Life outcomes. Financial hardship, encompassing material losses, financial worry, and poor coping mechanisms, is associated with lower quality of life and increased psychological distress. However, recovery is dynamic and financial hardship may change over time. METHODS: This is a secondary analysis of a cohort of 500 moderate-to-severe nonneurologic injured patients in which financial hardship and Health-related Quality of Life outcomes were measured at 1, 2, 4, and 12 months after injury using survey instruments (Short Form-36). Enrollment occurred at an urban, academic, Level 1 trauma center in Memphis, Tennessee during January 2009 to December 2011 and follow-up completed by December 2012. RESULTS: Four hundred seventy-four patients had sufficient data for Group- Based Trajectory Analysis. Four distinct financial hardship trajectories were identified: Financially Secure patients (8.6%) had consistently low hardship over time; Financially Devastated patients had a high degree of hardship immediately after injury and never recovered (51.6%); Financially Frail patients had increasing hardship over time (33.6%); and Financially Resilient patients started with a high degree of hardship but recovered by year end (6.2%). At 12-months, all trajectories had poor Short Form-36 physical component scores and the Financial Frail and Financially Devastated trajectories had poor mental health scores compared to US population norms. CONCLUSIONS AND RELEVANCE: The Financially Resilient trajectory demonstrates financial hardship after injury can be overcome. Further research into understanding why and how this occurs is needed.

Identification of noreremophilane-based inhibitors of angiogenesis using zebrafish assays.

Noreremophilanes are a rare class of cis-hydrindanes produced by genus Ligularia herbaceous plants which are known to exhibit interesting biological activities. We synthesized cis-hydrindanes based on a naturally occurring noreremophilane scaffold using a Diels-Alder/aldol sequence and screened them for multiple biological activities using high-content zebrafish embryonic development assays. We discovered a noreremophilane that has strong anti-angiogenic effects on the developing zebrafish embryos as well as on tumor-induced angiogenesis in a zebrafish xenograft model. We synthesized several derivatives of this class of noreremophilanes and performed structure-activity relationship studies in zebrafish to identify more potent and less toxic analogs of the original structure.

Synthesis of novel N-cyclopentenyl-lactams using the Aubé reaction.

A novel and convenient method utilizing the Aubé reaction to access a new class of compounds that are similar to carbocyclic nucleosides is reported. The azido alcohol derived from Vince lactam undergoes the Aubé reaction with various cyclic ketones to give cyclopentenyl-substituted lactams. Upon dihydroxylation, this affords the N-cyclopentenyl-lactam compounds in racemic form. Given the numerous uses of nucleosides and related compounds, we were interested in the synthesis of carbocylic nucleoside mimics. The attempts and results are described herein.

Knowledge, Attitude, and Practice of Patients toward Dental Implants in Need of Prosthodontic Rehabilitation.

Background: Our goal in conducting this study was to see how well-informed patients are about dental implants as a method of prosthodontic rehabilitation. Materials and Methods: "In this cross-sectional study, 500 new dental students were asked questions using a pre-made, self-administered questionnaire. A pilot study was carried out to verify the reliability of the survey instrument. Analysis of the data was performed in SPSS 16 (SPSS). We used the P 0.05 thresholds for the Student's T-test and the ANOVA to determine statistical significance." Results: In all, there were 500 people involved: 320 men and 180 women. The media and dentists were the two most common places to learn about implants, and as patients received more information, they became more informed consumers. Many people put off getting therapy because of how expensive it is. Conclusion: Only a small percentage of individuals had implants, and more than half knew nothing about them. This finding also highlighted the need of educating patients more thoroughly on this therapy option. As a result, the public has to be educated about oral health and implants in order to adopt a more favorable perspective.

Catastrophic health expenditure in nonneurological injury due to motor vehicle crash.

BACKGROUND: Motor vehicle crashes (MVCs) are a leading cause of nonfatal injury in the United States and impose a high financial cost to the patient and the economy. For many patients, this cost may be financially devastating and contribute to worsening health outcomes after injury. We aimed to describe the population level risk of catastrophic health expenditure (CHE) and determine factors associated with risk of CHE. METHODS: We performed a retrospective review using the 2014-2017 Nationwide Inpatient Sample. The study population consisted of uninsured and privately insured adults aged 26 to 64 years who were hospitalized for nonneurologic traumatic injury due to MVCs. Our measure of financial hardship was CHE, which was defined as hospital charges ≥40% of postsubsistence income. Income estimates were derived from zip-code level data using Γ distribution modeling. RESULTS: Our sample included 189,000 patients, of which 149,705 had private insurance and 39,375 were uninsured. The median estimated income for the study cohort was $66,118 (interquartile range, $65,353-$66,884). The median cost of hospitalization was $53,467 (interquartile range, $29,854-$99,914). In addition, 91.5% of uninsured patients suffering from MVC are at risk for CHE, and 10.1% of privately insured patients are at risk for CHE. Among the insured, Black, Hispanic, and low income were associated with CHE. CONCLUSION: Nine of 10 uninsured patients are at risk for CHE after hospitalization for MVC. Despite having insurance, 10% of patients are still at risk of CHE. Black, Hispanic, and low-income communities are at highest risk of having private insurance and still experiencing CHE. This is the first population level analysis after the implementation of the Affordable Care Act that assesses the financial burden of no insurance and underinsurance. These data are important to understand the effectiveness of insurance coverage and guide hospital and policy level interventions to prevent CHE. LEVEL OF EVIDENCE: Prognostic and Epidemiological; Level III.

Disposal of Unused Postoperative Opioids: A Real-World Demonstration of Surgeon-initiated Strategies Using an Activated Charcoal Bag System.

Excessive opioid prescribing following surgery creates a reservoir of unused medications available for diversion and abuse. We conducted a cohort study examining the impact of clinic-based, surgeon-initiated strategies using an activated charcoal bag (ACB) system on disposal of unused opioids. Among patients undergoing a variety of general surgery procedures, 67% of those with unused opioids disposed of them using the ACB. Our findings demonstrate practical ways to incorporate opioid disposal into surgical practice as a complement to judicious opioid prescribing.

Function after total calcanectomy for malignant tumor in a child: is complex reconstruction necessary?

Complex reconstruction after calcaneal excision for aggressive or malignant tumors has been advocated. In this report we describe a 7-year-old child who underwent chemotherapy followed by total calcanectomy for a primitive neuroectodermal tumor of the calcaneum. The near-normal function achieved after the operation leads us to believe that complex reconstruction after calcaneal excision is not warranted in every pediatric case. This report also highlights the benefits of the Cincinnati incision for calcanectomy, and describes the gait abnormalities after the operation. To the best of our knowledge, a description of the gait abnormality observed after calcanectomy for tumor resection in a pediatric patient has not been reported up to now.

Novel TRPV4 Pathogenic Variant in Severe Metatropic Skeletal Dysplasia: A Case Report.

We report an eight-year-old girl with a novel homozygous TRPV4 gene pathogenic variant c.2355G>T p. (Trp785Cys) with mesomelic shortening, odontoid hypoplasia, multiple joint contractures, thoracolumbar kyphosis, pectus carinatum, halberd pelvis, and dumb-bell shaped long bones. The novel variant caused a severe recessive form of metatropic dysplasia.

Nonsupercharged Retrosternal Roux-en-Y Esophagojejunostomy for Distal Esophageal Reconstruction.

BACKGROUND: Delayed distal esophageal reconstruction with nonsupercharged jejunum is an option when gastric conduit is not available. This study aimed to describe a single-center experience with distal esophageal reconstruction with retrosternal Roux-en-Y esophagojejunostomy (RYEJ) and compare perioperative outcomes with retrosternal gastric pull-up (GP). METHODS: An Institutional Review Board-exempt retrospective chart review was conducted of patients who underwent esophagostomy closure by the retrosternal route at the University of Minnesota Medical Center (Minneapolis, MN) from January 2009 to July 2019. Patients with colonic conduits were excluded. The study compared patients with RYEJ with a contemporary cohort of patients who underwent GP. The anatomic criteria for RYEJ were the absence of a gastric conduit and an esophageal remnant that reached the sternomanubrial joint. Patient characteristics, anastomotic leak and stricture rate, postoperative complications, hospital length of stay, 30-day readmission, and 90-day mortality were recorded. Statistical analysis was performed using the Fisher exact test and the Wilcoxon rank-sum test with a significance level at P ≤.05. RESULTS: A total of 9 patients underwent RYEJ, and 10 patients had GP. Previous esophageal adenocarcinoma was more common in the RYEJ group (n = 5) compared with the GP group (n = 0) (P = .01). Patient demographics and comorbidities were comparable between the groups. No differences were found in all end points, including operating time, estimated blood loss, anastomotic leak or stricture rate, Clavien-Dindo class III to IV complications, hospital length of stay, or mortality. CONCLUSIONS: Retrosternal RYEJ without microvascular augmentation is a safe alternative for esophagostomy closure in patients with adequate esophageal length when the stomach is not available. The nonsupercharged jejunum can safely reach the level of the sternomanubrial joint.

Long-Term Results of Diaphragmatic Hernia Repair After Left Ventricular Assist Device Explantation.

BACKGROUND: Diaphragmatic hernias after explantation of a left ventricular assist device (LVAD) at the time of heart transplantation are uncommon, but they can cause morbidity. This study presents midterm to long-term results of diaphragmatic hernia repair in these patients. METHODS: A retrospective chart review was performed on a prospectively collected database of all patients who underwent sequential LVAD explantation and heart transplantation at the University of Minnesota (Minneapolis, MN) since 1995. All patients who had a diaphragmatic hernia were included in the study. Patients' demographics, perioperative morbidity, and long-term results were recorded. RESULTS: From January 1995 to June 2018, 712 LVADs were placed, and subsequently 293 hearts were transplanted. The incidence of diaphragmatic hernia after heart transplantation was 7.1% (n = 21), with a median time from transplantation to diagnosis of 23 months (interquartile range [IQR], 9 to 39 months). Four patients did not undergo operative repair, and 1 patient was excluded for insufficient data. Sixteen patients underwent diaphragmatic hernia repair (male, 13; female, 3). Thirteen patients underwent laparoscopic repair with mesh, and 3 patients had open repair. Two patients presented with strangulated hernias requiring laparotomy and bowel resection. Median follow-up time was 53 months (IQR, 12 to 141 months) for the entire cohort. One recurrence was noted (6.2%), in a patient with laparoscopic repair. CONCLUSIONS: Diaphragmatic hernia repair after sequential LVAD explantation and orthotopic heart transplantation is feasible and appears to be safe. When this hernia is diagnosed, patients should be referred for surgical evaluation.

Age associated increase in intima media thickness in adults.

Carotid Imaging is the Gold Standard that provides useful information about the structure and function of carotid arteries. It is used to measure carotid intima-media thickness and provides useful information about the cardiovascular status of an individual so that early preventive measures for any future risk can be introduced. High resolution B-mode ultrasound imaging has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and its progression and for assessing cardiovascular risks. These measurements correlate well with other pathologic changes. The present study was undertaken to see the relation of the intimal thickening with age using B-mode carotid ultrasound imaging technique. 60 subjects in the age group of 20-85 years were included in the study. As arterial parameters are markedly altered by essential hypertension and other risk factors, subjects showing these risk factors were excluded. A significant association between advancing age and intima-media thickness (P < 0.0000001) was found and increase in the luminal diameter of the carotid arteries was observed but it was not statistically significant (P>0.05). Age is an independent risk factor for increased IMT which predicts future coronary events. The intima media thickness (IMT) of the common carotid artery measured by ultrasound imaging has been shown to be reliable and early marker of systemic atherosclerosis. Routine use of this technique in clinical settings could improve our ability to decide on preventive therapies to reduce the risk for development of clinical

Benign tumors and tumor-like lesions of the calcaneum: a study of 12 cases.

UNLABELLED: Benign tumors of the calcaneum are rare. Cystic lesions such as simple bone cysts and aneurysmal bone cysts are commonly seen. AIMS AND OBJECTIVES: To evaluate tumors of the calcaneum, which were seen over a 12-year period. MATERIALS AND METHODS: We analyzed noninfectious, noninflammatory, benign lesions of the calcaneum seen in the Orthopedic Out Patient Department from 1991 to 2003. Twelve such tumors were encountered. There were 11 males and one female and their ages varied from 18 to 53 years with a median of 31. Data was collected from the histopathology reports, radiographs, and inpatient and outpatient records. One of the coauthors reviewed the histopathologic findings of all the tumors. RESULTS: Twelve benign lesions were seen in 12 patients. In our series, cysts predominated, with three aneurysmal bone cysts and five simple bone cysts. The other benign tumors were: one fibrous dysplasia, one vascular hamartoma, one osteoblastoma, and one chondromyxoid fibroma. The bone cysts were treated by curettage, with or without bone grafting, except for one large aneurysmal bone cyst, which was treated by excision of the calcaneum. The postoperative function in this patient was good, with modified footwear. CONCLUSION: The calcaneum is an uncommon site for most bone tumors, and in our series, bone cysts were the most common benign lesions. Curettage and bone grafting or the use of bone substitutes can be effectively used in the treatment of symptomatic bone cysts of the calcaneum.

Craniofacial features in Goldenhar syndrome.

Goldenhar syndrome also known as oculo-auriculo-vertebral syndrome was first reported by Dr Maurice Goldenhar in 1952. It is a rare disease entity characterized by craniofacial anomalies such as hypoplasia of the mandible and malar bones, microtia, and vertebral anomalies. The etiology of this disease still remains unclear and occurs as sporadic. This report presents goldenhar syndrome in a 12-year-old male patient.

Amine-Functionalized Graphene Oxide-Stabilized Pd Nanoparticles (Pd@APGO): A Novel and Efficient Catalyst for the Suzuki and Carbonylative Suzuki-Miyaura Coupling Reactions.

Palladium nanoparticles (NPs) are decorated on the surface of an amine-functionalized graphene oxide (Pd@APGO) and characterized by using various analytical techniques. In this methodology, the surface of graphene oxide is modified using the amine functional groups which help stabilization and distribution of Pd NPs very well and increases the surface electron density of NPs by electron donating from amine groups. This developed catalyst shows a high catalytic activity toward the Suzuki coupling and carbonylative Suzuki-Miyaura coupling reactions at mild reaction conditions. The amine on the graphene oxide plays a very crucial role to stabilize and increase the electron density of Pd NPs and prevents the leaching of Pd metals. The Pd@APGO catalyst showed excellent catalytic activity (>90%) with a large range of substrates for both of the reactions and provides five recycle runs without the loss of its activity.

Schwannoma of the fibula.

We describe a schwannoma located in the mid-diaphyseal region of the fibula of a 14-year-old boy. Radiologically this was an expansile, lytic, globular and trabeculated lesion. MRI showed a narrow transition zone with a break in the cortex and adjacent tissue oedema. Differential diagnosis included schwannoma, fibrous dysplasia, giant cell tumour and aneurysmal bone cyst. The tumour was excised en bloc, with marginal resection limits, and there has been no recurrence two years after surgery. Histopathological examination confirmed the diagnosis of classic schwannoma. There were typical hypercellular Antoni A zones, less cellular Antoni B zones, and diffuse immunoreactivity to S100 protein. This is the first report of schwannoma involving a long bone in a child.

Use of statistical experimental methods for optimization of collagenolytic protease production by Bacillus cereus strain SUK grown on fish scales.

In this study, novel and cheap sources like fish scales and molasses were used for the production of collagenolytic protease. Statistical optimization of different parameters for the production of collagenolytic protease by Bacillus cereus strain SUK has been carried out using response surface methodology (RSM). Three most significant medium components identified by Plackett-Burman (PB) were fish scales, molasses, and incubation time, which were further optimized using central composite design (CCD). The medium having fish scales 9.38 g l-1, molasses 2.42 g l-1, and incubation time of 67.34 h was found to be optimum for maximum collagenolytic protease production. B. cereus strain SUK has shown multiple plant growth-promoting traits, whereas degraded fish scale hydrolysates (FSHs) were having antimicrobial as well as plant growth-promoting abilities. The collagenolytic efficiency of this isolate can be exploited in an eco-friendly process of bioconversion of fish waste, representing an alternative way of waste management that could be used to produce various value-added products, such as collagenolytic protease, microbial biomass, amino acids, protein hydrolysates, and collagen peptides.

WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198.

OBJECTIVES: To determine the pattern of mutations of the WISP3 gene in clinically identified progressive pseudorheumatoid dysplasia (PPD) in an Indian population. PATIENTS AND METHODS: A total of 15 patients with clinical features of PPD were enrolled in this study. Genomic DNA was isolated and polymerase chain reaction performed to amplify the WISP3 gene. Screening for mutations was done by conformation-sensitive gel electrophoresis, beginning with the fifth exon and subsequently proceeding to the remaining exons. Sanger sequencing was performed for both forward and reverse strands to confirm the mutations. RESULTS: In all, two of the 15 patients had compound heterozygous mutations: one a nonsense mutation c.156C>A (p.C52*) in exon 2, and the other a missense mutation c.677G>T (p.G226V) in exon 4. All others were homozygous, with three bearing a nonsense mutation c.156C>A (p.C52*) in exon 2, three a missense mutation c.233G>A (p.C78Y) in exon 2, five a missense mutation c.1010G>A (p.C337Y) in exon 5, one a nonsense mutation c.348C>A (p.Y116*) in exon 3, and one with a novel deletion mutation c.593_597delATAGA (p.Y198*) in exon 4. CONCLUSION: We identified a novel mutation c.593_597delATAGA (p.Y198*) in the fourth exon of the WISP3 gene. We also confirmed c.1010G>A as one of the common mutations in an Indian population with progressive pseudorheumatoid dysplasia.Cite this article: V. Madhuri, M. Santhanam, K. Rajagopal, L. K. Sugumar, V. Balaji. WISP3 mutational analysis in Indian patients diagnosed with progressive pseudorheumatoid dysplasia and report of a novel mutation at p.Y198* Bone Joint Res 2016;5:301-306. DOI: 10.1302/2046-3758.57.2000520.