Presence of crown-like structures in breast adipose tissue; differences between healthy controls, BRCA1/2 gene mutation carriers and breast cancer patients.

PURPOSE: Crown-like structures (CLS) in breast adipose tissue are associated with inflammation and a potential factor in breast cancer behaviour. Whether this effect varies between breast cancer subtypes and is influenced by BMI and BRCA mutation status is presently unknown. Therefore, we compared CLS presence between adipose tissue of healthy controls, BRCA1/2 gene mutation carriers and breast cancer patients, and assessed the relation of CLS with clinical outcome in breast cancer patients. METHODS: Immunohistochemical staining for CD68 was performed on breast adipose tissue sections of 48 healthy controls, 78 BRCA1/2 gene mutation carriers and 259 breast cancer patients. CLS presence and index (CLS/cm2) were correlated with BMI, BRCA status, tumour presence, intrinsic tumour subtype and tumour characteristics. Associations with clinical outcome were assessed. RESULTS: CLS were more often present in breast cancer patients compared to BRCA carriers and healthy controls. CLS presence was associated with the presence of breast cancer and high BMI. CLS were more often present in Luminal-B-like tumours compared to the other subtypes. No correlations between CLS and BRCA status or age was found. In TNBC, CLS were related to lymphovascular invasion. No association with survival was found. CONCLUSION: In conclusion, CLS were more frequently present in breast adipose tissue of breast cancer patients compared to BRCA1/2 gene mutation carriers and healthy controls. Furthermore, our study provides evidence of the association between obesity and presence of CLS. The prognostic significance and impact on clinical outcome of differences in CLS numbers should be further assessed in prospective studies.

Single-incision plus one-port laparoscopy surgery versus conventional multi-port laparoscopy surgery for colorectal cancer: a systematic review and meta-analysis.

OBJECTIVE: The efficacy of single-incision plus one-port laparoscopic surgery (SILS + 1) versus conventional laparoscopic surgery (CLS) for colorectal cancer treatment remains unclear. This study compares the short-term and long-term outcomes of SILS + 1 and CLS using a high-quality systematic review and meta-analysis. METHOD: Literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, drawing from PubMed, Embase, Web of Science, and the Cochrane Library until December 10, 2023. Statistical analysis was conducted using RevMan and Stata. RESULT: The review and meta-analysis included seven studies with 1740 colorectal cancer patients. Compared to CLS, SILS + 1 showed significant improvements in operation time (WMD = - 18.33, P < 0.00001), blood loss (WMD = - 21.31, P < 0.00001), incision length (WMD = - 2.07, P < 0.00001), time to first defecation (WMD = - 14.91, P = 0.009), time to oral intake (WMD = - 11.46, P = 0.04), and time to ambulation (WMD = - 11.52, P = 0.01). There were no significant differences in lymph node harvest, resection margins, complications, anastomotic leakage, hospital stay, disease-free survival, overall survival, and postoperative recurrence. CONCLUSIONS: Compared to CLS, SILS + 1 demonstrates superiority in shortening the surgical incision and promoting postoperative recovery. SILS + 1 can provide a safe and feasible alternative to CLS.

Dense Convolutional Neural Network-Based Deep Learning Pipeline for Pre-Identification of Circular Leaf Spot Disease of Diospyros kaki Leaves Using Optical Coherence Tomography.

Circular leaf spot (CLS) disease poses a significant threat to persimmon cultivation, leading to substantial harvest reductions. Existing visual and destructive inspection methods suffer from subjectivity, limited accuracy, and considerable time consumption. This study presents an automated pre-identification method of the disease through a deep learning (DL) based pipeline integrated with optical coherence tomography (OCT), thereby addressing the highlighted issues with the existing methods. The investigation yielded promising outcomes by employing transfer learning with pre-trained DL models, specifically DenseNet-121 and VGG-16. The DenseNet-121 model excels in differentiating among three stages of CLS disease (healthy (H), apparently healthy (or healthy-infected (HI)), and infected (I)). The model achieved precision values of 0.7823 for class-H, 0.9005 for class-HI, and 0.7027 for class-I, supported by recall values of 0.8953 for class-HI and 0.8387 for class-I. Moreover, the performance of CLS detection was enhanced by a supplemental quality inspection model utilizing VGG-16, which attained an accuracy of 98.99% in discriminating between low-detail and high-detail images. Moreover, this study employed a combination of LAMP and A-scan for the dataset labeling process, significantly enhancing the accuracy of the models. Overall, this study underscores the potential of DL techniques integrated with OCT to enhance disease identification processes in agricultural settings, particularly in persimmon cultivation, by offering efficient and objective pre-identification of CLS and enabling early intervention and management strategies.

The anti-inflammatory and bioregulatory effects of habitual exercise in high-fat diet-induced obesity involve crown-like structures and MCP-1 in white adipose tissue.

Macrophage accumulation in the adipose tissue and changes in their inflammatory phenotype is a hallmark of obesity-induced inflammation, notably forming inflammatory structures known as "crown-like structures (CLS)". Exercise can be a key strategy to improve inflammation-related complications, but it is crucial to consider that, although exercise generally exerts systemic and local anti-inflammatory effects, this depends on the basal inflammatory status and exercise modality. In this context, the "bioregulatory effect of exercise" implies to achieve the reduction or prevention of an excessive inflammatory response and also the preservation or stimulation of the innate response. In the present work, our aim was to evaluate the effect of regular exercise on adipose tissue inflammation in high-fat diet-induced obesity in mice, as reflected by macrophage infiltration and phenotype, and CLS formation, together with a potential role for the chemokine MCP-1 in this process. Results showed that obesity is associated with greater MCP-1 expression (p<0.05), macrophage accumulation (p<0.05), and CLS presence (p<0.001). Regular exercise reduced macrophage accumulation (p<0.05), MCP-1 expression (p<0.01), and CLS presence (p<0.05) in obese mice; while it increased macrophage and CLS presence (p<0.01), MCP-1 expression (p<0.05), and M2 polarization (p<0.05) in lean mice. MCP-1 was associated with the proliferation of CLS, showing the first image demonstrating a potential role of this chemokine in the development of these structures. Altogether, these results confirm, for the first time, the "bioregulatory effect of exercise" in the adipose tissue: reducing inflammation in individuals with an elevated inflammatory setpoint, but stimulating this response of the immune system in healthy individuals.

Immunotoxin SS1P is rapidly removed by proximal tubule cells of kidney, whose damage contributes to albumin loss in urine.

Recombinant immunotoxins (RITs) are chimeric proteins composed of an Fv and a protein toxin being developed for cancer treatment. The Fv brings the toxin to the cancer cell, but most of the RITs do not reach the tumor and are removed by other organs. To identify cells responsible for RIT removal, and the pathway by which RITs reach these cells, we studied SS1P, a 63-kDa RIT that targets mesothelin-expressing tumors and has a short serum half-life. The major organs that remove RIT were identified by live mouse imaging of RIT labeled with FNIR-Z-759. Cells responsible for SS1P removal were identified by immunohistochemistry and intravital two-photon microscopy of kidneys of rats. The primary organ of SS1P removal is kidney followed by liver. In the kidney, SS1P passes through the glomerulus, is taken up by proximal tubular cells, and transferred to lysosomes. In the liver, macrophages are involved in removal. The short half-life of SS1P is due to its very rapid filtration by the kidney followed by degradation in proximal tubular cells of the kidney. In mice treated with SS1P, proximal tubular cells are damaged and albumin in the urine is increased. SS1P uptake by kidney is reduced by coadministration of l-lysine. Our data suggests that l-lysine administration to humans might prevent SS1P-mediated kidney damage, reduce albumin loss in urine, and alleviate capillary leak syndrome.

Influence of different CCD angles on osseointegration and radiological changes after total hip arthroplasty of a triple wedge shape cementless femoral stem: a prospective cohort study.

PURPOSE: The purpose of this study was to evaluate the osseointegration and radiological outcomes in patients after total hip arthroplasty, hypothesizing different load patterns with one cementless stem design and different CCD angles (CLS Spotorno femoral stem 125° vs 135°). METHODS: All cases of degenerative hip osteoarthritis fulfilling strict inclusion criteria were treated with cementless hip arthroplasty between 2008 and 2017. Ninety-two out of one hundred six cases were clinically and radiologically examined three and 12 months after implantation. Two groups with each 46 patients were rendered prospectively and compared in clinical (Harris Hip Score) and radiological outcome. RESULTS: At final follow-up, no significant difference regarding Harris Hip Score was detected between the two groups (mean 99.2 ± 3.7 vs. 99.3 ± 2.5; p = 0.73). Cortical hypertrophy was found in none of the patients. Stress shielding was seen in a total of 52 hips (n = 27 vs. n = 25; 57% of the 92 hips). No significant difference regarding stress shielding was detected when comparing both groups (p = 0.67). Significant bone density loss was detected in Gruen zone one and two in the 125° group. The 135° group showed significant radiolucency in Gruen zone seven. No overall radiological loosening or subsidence of the femoral component was observed. CONCLUSION: According to our results, the use of a femoral component with a 125° CCD angle versus a 135° CCD did not result in a different osseointegration and load transfer with a clinically relevant significance.

Comparative Study of Augmented Classical Least Squares Models for UV Assay of Co-Formulated Antiemetics Together with Related Impurities.

The classical least squares (CLS) model and three augmented CLS models are adopted and validated for the analysis of pyridoxine HCl (PYR), cyclizine HCl (CYC), and meclizine HCl (MEC) in a quinary mixture with two related impurities: the CYC main impurity, Benzhydrol (BEH), which has carcinogenic and hepatotoxic effects, and the MEC official impurity, 4-Chlorobenzophenone (BEP). The proposed augmented CLS models are orthogonal signal correction CLS (OSC-CLS), direct orthogonal signal correction CLS (DOSC-CLS), and net analyte processing CLS (NAP-CLS). These models were applied to quantify the three active constituents in their raw materials and their corresponding dosage forms using their UV spectra. To evaluate the CLS-based models sensibly, we design a comparative study involving two sets: the training set to construct models and the validation set to assess the prediction abilities of these models. A five-level, five-factor calibration design was established to produce 25 mixtures for the calibration set. In addition, 16 experiments were performed for a test set distributed equally between the in-space and out-space samples. The primary criterion for comparing the models' performance was the validation set's root mean square error of prediction (RMSEP) value. Finally, augmented CLS models showed acceptable results for assaying the three analytes. The results were compared statistically with the reported HPLC methods; however, the DOSC-CLS model proved the best for assaying the dosage forms.

[A case of brucellosis complicated with capillary leak syndrome and multiple organ dysfunction syndrome].

Brucellosis can lead to pathological changes of multiple systems. Capillary leak syndrome (CLS) is a clinical syndrome caused by different reasons, mainly characterized by hypotension, hypoproteinemia and systemic edema. The condition is critical and the clinical manifestations are complex, and multiple organ dysfunction syndrome (MODS) may occur in severe cases. CLS caused by brucellosis is extremely rare. The diagnosis and treatment of a patient with brucellosis complicated with CLS and MODS was analyzed in this paper, in order to improve the knowledge of clinicians about brucellosis and its complications.

ROS-Induced DNA-Damage and Autophagy in Oral Squamous Cell Carcinoma by Usnea barbata Oil Extract-An In Vitro Study.

Oxidative stress is associated with aging, cancers, and numerous metabolic and chronic disorders, and phenolic compounds are well known for their health-promoting role due to their free-radical scavenging activity. These phytochemicals could also exhibit pro-oxidant effects. Due to its bioactive phenolic secondary metabolites, Usnea barbata (L.) Weber ex. F.H. Wigg (U. barbata) displays anticancer and antioxidant activities and has been used as a phytomedicine for thousands of years. The present work aims to analyze the properties of U. barbata extract in canola oil (UBO). The UBO cytotoxicity on oral squamous cell carcinoma (OSCC) CLS-354 cell line and blood cell cultures was explored through complex flow cytometry analyses regarding apoptosis, reactive oxygen species (ROS) levels, the enzymatic activity of caspase 3/7, cell cycle, nuclear shrinkage (NS), autophagy (A), and synthesis of deoxyribonucleic acid (DNA). All these studies were concomitantly performed on canola oil (CNO) to evidence the interaction of lichen metabolites with the constituents of this green solvent used for extraction. The obtained data evidenced that UBO inhibited CLS-354 oral cancer cell proliferation through ROS generation (316.67 × 104), determining higher levels of nuclear shrinkage (40.12%), cell cycle arrest in G0/G1 (92.51%; G0 is the differentiation phase, while during G1 phase occurs preparation for cell division), DNA fragmentation (2.97%), and autophagy (62.98%) than in blood cells. At a substantially higher ROS level in blood cells (5250.00 × 104), the processes that lead to cell death-NS (30.05%), cell cycle arrest in G0/G1 (86.30%), DNA fragmentation (0.72%), and autophagy (39.37%)-are considerably lower than in CLS-354 oral cancer cells. Our work reveals the ROS-mediated anticancer potential of UBO through DNA damage and autophagy. Moreover, the present study suggests that UBO pharmacological potential could result from the synergism between lichen secondary metabolites and canola oil phytoconstituents.

Long-term survival of CLS Spotorno femoral stem: a systematic review of literature.

BACKGROUND: CLS Spotorno is a time-tested femoral stem design with excellent early results; the present review was designed to assess the published evidence on CLS Spotorno stem in the literature to evaluate its long-term outcomes and compare it to two other popular stem designs the uncemented Corail™ and the cemented Exeter™ stems. RESEARCH QUESTION: Do CLS Spotorno stems provide adequate long-term rates of survival in terms of revisions and functional outcomes? METHODOLOGY: Medline, EMBASE and SCOPUS databases were searched for relevant articles and a total number of 670 hits were obtained, out of which 14 relevant studies were included in this review. Pooled analysis of revisions rates, subsidence and Harris Hip scores (HHS) were done. RESULTS: All the 14 studies were retrospective in design but had sufficiently large follow-up periods (12.3-27 years, mean 17.1 years). Of the 2459 hips reviewed, the documented revision rate was only 6.2%, with aseptic loosening reported in 3.1% and subsidence > 2 mm in 2.6% cases. The overall survival was similar to reported smaller cohorts of Corail (95% at 12 years) and Exeter stems (100% at 17 years). Varus malposition was seen in 10.6% cases, but it did not show any influence on implant survival or revision rates. Distal pedestal formation was seen in 172 of 805 hips across seven studies, while distal cortical hypertrophy was seen in 70 cases out of 398 hips; these were not related with stem malposition. The overall functional outcome was good, with mean HHS of 88.65 (95% CI = 86.08-91.23, p < 0.01). The improvement in scores from preoperative values (of 43.9 points) were comparable to Corail (43.8) and Exeter (45) stems. Thigh pain was seen in only 41 cases out of 1097 hips. CONCLUSION: Despite the limitations due to high heterogeneity of the cumulative data, the review suggests that CLS Spotorno femoral stems provides excellent long-term survival and good hip function. These outcomes are comparable to other commonly utilized femoral stems like the Corail and Exeter. LEVEL OF EVIDENCE: IV.

Celastrol and Rhynchophylline in the mitigation of simulated muscle atrophy under in vitro.

Muscular atrophy (MA) is a disease of various origins, i.e., genetic or the most common, caused by mechanical injury. So far, there is no universal therapeutic model because this disease is often progressive with numerous manifested symptoms. Moreover, there is no safe and low-risk therapy dedicated to muscle atrophy. For this reason, our research focuses on finding an alternative method using natural compounds to treat MA. This study proposes implementing natural substances such as celastrol and Rhynchophylline on the cellular level, using a simulated and controlled atrophy process. Methods: Celastrol and Rhynchophylline were used as natural compounds against simulated atrophy in C2C12 cells. Skeletal muscle C2C12 cells were stimulated for the differentiation process. Atrophic conditions were obtained by the exposure to the low concertation of doxorubicin and validated by FoxO3 and MAFbx. The protective and regenerative effect of drugs on cell proliferation was determined by the MTT assay and MT-CO1, VDAC1, and prohibitin expression. Results: The obtained results revealed that both natural substances reduced atrophic symptoms. Rhynchophylline and celastrol attenuated atrophic cells in the viability studies, morphology analysis by diameter measurements, modulated prohibitin VDAC, and MT-CO1 expression. Conclusions: The obtained results revealed that celastrol and Rhynchophylline could be effectively used as a supportive treatment in atrophy-related disorders. Thus, natural drugs seem promising for muscle regeneration.

A Yeast Chronological Lifespan Assay to Assess Activity of Proteasome Stimulators.

Aging is characterized by changes in several cellular processes, including dysregulation of proteostasis. Current research has shown long-lived rodents display elevated proteasome activity throughout life and proteasome dysfunction is linked to shorter lifespans in a transgenic mouse model. The ubiquitin proteasome system (UPS) is one of the main pathways leading to cellular protein clearance and quality maintenance. Reduction in proteasome activity is associated with aging and its related pathologies. Small molecule stimulators of the proteasome have been proposed to help alleviate cellular stress related to unwanted protein accumulation. Here we have described the development of techniques to monitor the impact of proteasome stimulation in wild-type yeast and a strain that has impaired proteasome expression. We validated our chronological lifespan assay using both types of yeast with a variety of small molecule stimulators at different concentrations. By modifying the media conditions for the yeast, molecules can be evaluated for their potential to increase chronological lifespan in five days. Additionally, our assay conditions can be used to monitor the activity of proteasome stimulators in modulating the degradation of a YFP-α-synuclein fusion protein produced by yeast. We anticipate these methods to be valuable for those wishing to study the impact of increasing proteasome-mediated degradation of proteins in a eukaryotic model organism.

Intensity warping for multisite MRI harmonization.

In multisite neuroimaging studies there is often unwanted technical variation across scanners and sites. These "scanner effects" can hinder detection of biological features of interest, produce inconsistent results, and lead to spurious associations. We propose mica (multisite image harmonization by cumulative distribution function alignment), a tool to harmonize images taken on different scanners by identifying and removing within-subject scanner effects. Our goals in the present study were to (1) establish a method that removes scanner effects by leveraging multiple scans collected on the same subject, and, building on this, (2) develop a technique to quantify scanner effects in large multisite studies so these can be reduced as a preprocessing step. We illustrate scanner effects in a brain MRI study in which the same subject was measured twice on seven scanners, and assess our method's performance in a second study in which ten subjects were scanned on two machines. We found that unharmonized images were highly variable across site and scanner type, and our method effectively removed this variability by aligning intensity distributions. We further studied the ability to predict image harmonization results for a scan taken on an existing subject at a new site using cross-validation.

Correlation between 24-h continuous intraocular pressure measurement with a contact lens sensor and visual field progression.

PURPOSE: We investigated the correlations between 24-h continuous intraocular pressure (IOP) measurement with a contact lens sensor (CLS) and visual field (VF) progression. METHODS: We examined 69 eyes of glaucoma patients who were followed > 2 years after the measurement of IOP fluctuation with a CLS. All patients underwent VF examinations > 4 times. VF progression was defined as a deterioration of the mean deviation (MD). We evaluated the original 17 parameters from the data obtained from the CLS output and attempted to identify which of them contributed to the VF progression. We then performed multivariate analyses to identify risk factors for rapid VF progression. RESULTS: The mean follow-up period was 4.0 ± 1.6 years. The mean VF progression rate was - 0.37 ± 0.53 dB/year. The multivariate analysis identified the following as-risk factors for VF progression: more advanced baseline MD value (p = 0.0269); high maximum values during the 24-h (p = 0.0131) and nocturnal (p = 0.0466) periods; large standard deviation of IOP fluctuation during the 24-h (p = 0.0404), diurnal (p = 0.0330), and nocturnal (p = 0.0027) periods; and large range of IOP fluctuation during the nocturnal period (0.0431). CONCLUSIONS: Our results suggested that the above CLS parameters might be correlated with rapid progression of VF disorder. These CLS parameters could be used to evaluate the results of CLS in the future. Examination with a CLS could be useful for predicting the VF progression rate within a mere 24-h period.

Can a contact lens sensor predict the success of trabectome surgery?

PURPOSE: We examined whether a contact lens sensor (CLS) is useful for the postoperative evaluation of trabectome surgery. We investigated the correlations between the outcomes of trabectome surgery and the output of a CLS. METHODS: We examined 24 consecutive eyes of patients with pseudo-exfoliation glaucoma. In each eye, the intraocular pressure (IOP) fluctuations over 24 h were measured with the SENSIMED Triggerfish CLS before and at 3 months after the trabectome surgery. We divided the patients into success (n = 12 eyes) and failure (n = 12 eyes) groups; success was defined as a postoperative IOP level ≤ 21 mmHg plus an IOP reduction ≥ 20% relative to the preoperative IOP value with or without anti-glaucoma medications. We investigated CLS parameters that correlate with surgical outcomes by performing a Cox hazard regression analysis. We determined the maximum value, minimum value, and range of IOP fluctuation as CLS parameters. RESULTS: The mean follow-up period was 38.0 ± 3.0 months. The success rate was 50%. The postoperative range of IOP fluctuation during the nocturnal period with the CLS was significantly correlated with the surgical results (p = 0.024). CONCLUSIONS: A smaller range of IOP fluctuation was significantly correlated with better surgical outcomes. We were able to predict the surgical success after trabectome surgery at 3 months using the CLS. Thus, CLS results could be a new surgical evaluation parameter.

Rapid Detection of Cercospora beticola in Sugar Beet and Mutations Associated with Fungicide Resistance Using LAMP or Probe-Based qPCR.

Cercospora leaf spot (CLS), caused by the fungal pathogen Cercospora beticola, is the most destructive disease of sugar beet worldwide. Although growing CLS-tolerant varieties is helpful, disease management currently requires timely application of fungicides. However, overreliance on fungicides has led to the emergence of fungicide resistance in many C. beticola populations, resulting in multiple epidemics in recent years. Therefore, this study focused on developing a fungicide resistance detection "toolbox" for early detection of C. beticola in sugar beet leaves and mutations associated with different fungicides in the pathogen population. A loop-mediated isothermal amplification (LAMP) method was developed for rapid detection of C. beticola in infected sugar beet leaves. The LAMP primers specific to C. beticola (Cb-LAMP) assay was able to detect C. beticola in inoculated sugar beet leaves as early as 1 day postinoculation. A quinone outside inhibitor (QoI)-LAMP assay was also developed to detect the G143A mutation in cytochrome b associated with QoI resistance in C. beticola. The assay detected the mutation in C. beticola both in vitro and in planta with 100% accuracy. We also developed a probe-based quantitative PCR (qPCR) assay for detecting an E198A mutation in ß-tubulin associated with benzimidazole resistance and a probe-based qPCR assay for detection of mutations in cytochrome P450-dependent sterol 14α-demethylase (Cyp51) associated with resistance to sterol demethylation inhibitor fungicides. The primers and probes used in the assay were highly efficient and precise in differentiating the corresponding fungicide-resistant mutants from sensitive wild-type isolates.

Long-Term Survival and Results at a Mean Follow-Up Period of 24 Years of a Tapered Straight, Collarless, Grit-Blasted, Titanium Alloy Stem.

BACKGROUND: There is limited evidence on the survivorship of patients who undergo cementless stem implantation, beyond 20 years of the hip arthroplasty. We report implant survival and results of the CLS Spotorno femoral stem until 30 years from implantation. METHODS: Survival analysis of 147 CLS Spotorno stems in 119 patients for an average period of 24 years (20-30) from the date of implantation was performed. During the course of the follow-up period, 33 patients (39 hips) died. The information on the survival of their hip implant at the time of death was gathered from their relatives and general practitioners. Sixty-six patients (86 hips) undertook the complete survey along with radiographic examination, while 18 subjects (20 hips) were interviewed over the telephone. The factors influencing survival, functional outcomes, and level of satisfaction with surgery were evaluated. RESULTS: The overall estimated survival of the stems was 89.9% after 30 years (95% confidence interval [CI] 83.5-93.9). Survival with femoral revision for aseptic loosening as an end point was 93.1% (95% CI 87.1-96.4). In the worst-case scenario, an overall implant survival of 77.2% (95 CI% 80.3-82.7) was observed after 24 years. Patients who were older than 50 in age at the time of surgery had better survival rates (P = .026). The mean Harris Hip Score at follow-up was 83.1 (range 43-100) and the level of satisfaction was 9/10. The main determinant of postsurgical satisfaction was Harris Hip Score, whereas radiographic alterations explained little with respect to the variation in the outcomes. CONCLUSION: The cementless CLS Spotorno stem displayed satisfactory results 24 years after implantation and high estimated survival until 30 years from surgery. However, patients below the age of 50 at the time of surgery have an increased risk of undergoing revision of their femoral stem.

Does early childhood education enhance parental school involvement in second grade?: Evidence from Midwest Child-Parent Center Program.

This paper examines the impact on parent involvement in second grade in the Midwest Child-Parent Centers (MCPC), a high-quality preschool-to-third-grade school reform model. A new focus of research on early childhood programs is understanding how early childhood learning gains can be sustained. Two-generation programs that provide diverse family services may be one approach. The MCPC expansion was implemented for a cohort of over 2000 Chicago and Saint Paul students beginning in preschool. Based on a comparison of the program and usual-service comparison groups matched at the school level via propensity scores, ratings were obtained for a subset of the sample by teachers and parents on parent involvement in school in second grade. After accounting for potential attrition bias via multiple imputation and propensity score weighting, results indicated that MCPC participation was associated with significantly higher parent involvement in school at the end of second grade both in the aggregate sample (Effect Size = 0.19 SD) and in Chicago (ES = 0.24). Differences in Saint Paul, however, were small (ES = 0.15) and not statistically significant. Robustness testing using different model specifications revealed similar results. Implications for assessing and sustaining early childhood learning gains are discussed with a focus on recognizing that parental involvement is an integral component of high-quality programs.

Perioperative Interrogation of Biotronik Cardiovascular Implantable Electronic Devices: A Guide for Anesthesiologists.

Biotronik cardiovascular implantable electronic devices, specifically Biotronik pacemakers, contain unique features that are relevant to perioperative management. For example, Biotronik pacemakers have a programmable response to magnet application, a default magnet response that does not result in sustained asynchronous pacing, and a unique method of rate adaptation (eg, closed loop stimulation). This review article focuses on these unique features; the interpretation of Biotronik interrogation reports; and the basic programming (eg, mode, rate, rate adaptation, tachyarrhythmia therapies) relevant to the perioperative management of Biotronik cardiovascular implantable electronic devices.

Cumulative Long-Term Incidence of Postoperative Periprosthetic Femoral Fractures Using an Uncemented Tapered Titanium Hip Stem: 26- to 32-Year Results.

BACKGROUND: Although falling is becoming a major problem in the elderly, little is known about the long-term incidence of postoperative periprosthetic femoral fractures (PFF) after total hip arthroplasty (THA) using uncemented stems with a minimum follow-up of 26 years postoperatively. METHODS: In a consecutive series, the cumulative incidence of PFF after uncemented THA using a straight, collarless, tapered titanium stem was retrospectively reviewed in 354 hips (326 patients). After a mean follow-up of 28 (26-32) years postoperatively, 179 hips had died and 5 hips had been lost to follow-up. Kaplan-Meier survival analysis was used to estimate cumulative percentage probability of PFF. RESULTS: At final follow-up, a total of 27 fractures in 27 patients had occurred. In 15 hips, the stem had to be revised, and in 10 the fracture was treated by open reduction and internal fixation. Two patients declined further surgery. The cumulative percentage probability of PFF was 1.6% (95% confidence interval, 0.7 to 3.8) at 10 years and 13.2% (95% confidence interval, 8.5 to 20.2) at 29 years after primary THA. There was no association between the occurrence of fracture and gender, age at primary THA, cup revision, or canal fill index. CONCLUSION: Our findings indicate that PFF is the major mode of failure in the long term after uncemented THA using a tapered titanium stem. More research is needed to evaluate the reasons and risk factors for PFF after THA, thus providing better prophylaxis for those at risk and to compare the long-term incidence using different fixation methods and implants. LEVEL OF EVIDENCE: IV.