Human Natural Killer Cells Cryopreserved without DMSO Sustain Robust Effector Responses.

Natural killer (NK) cell-based immunotherapy has benefitted from the multiple strengths that NK cells offer in adoptive transfer settings, not the least of which is their safety and potential for allogeneic use. Such use, however, necessitates the cryopreservation of NK cell-based therapy products to support logistical efforts in deploying these cells in different locations, decentralized from the point of collection or manufacturing. DMSO, the most commonly used cryoprotective agent (CPA), has been effective in protecting immune cells during freezing and thawing, but its ability to induce molecular and genetic changes to immune cells as well as its toxicity has stimulated interest in alternative CPAs. However, replacing DMSO's ability to act intracellularly has been difficult, and the sensitivity of human peripheral blood-derived NK cells to freezing and thawing-induced damage has meant that investigations into the potential of replacing DMSO are lacking. As a first step toward establishing the feasibility of cryopreserving human NK cells with CPAs' alternative to DMSO, we investigate the potential of using noncell-penetrating and cell-penetrating CPAs to recover NK cells post-thaw without DMSO. Here, we find that cryoprotection using cell-penetrating CPAs can retain the viability of human peripheral blood-derived NK cells to a comparable degree to DMSO. In addition, non-DMSO-cryopreserved human NK cells were as cytotoxic as those cryopreserved with DMSO and displayed a comparable level of surface markers of activation. In summary, we present the first example of the potential of developing non-DMSO CPA formulations that could be deployed in future cell therapy regimens.

Tendon Healing in a Mouse Model of Loeys-Dietz Syndrome: Controlled Study Using a Patellar Tendon Transection Model.

BACKGROUND: Loeys-Dietz syndrome (LDS) is a rare autosomal-dominant connective tissue disorder caused by genetic mutations in the transforming growth factor-ß (TGFß) signaling pathway. In addition to vascular malformations, patients with LDS commonly present with bone and tendon abnormalities, including joint laxity. While TGFß signaling dysregulation has been implicated in many of these clinical manifestations, the degree to which it influences the tendinopathy and tendon healing issues in LDS has not been determined. METHODS: Wound healing after patellar tendon transection was compared between wild-type (WT) and Tgfbr2-mutant (LDS) mice (7 mice per group). In all mice, the right patellar tendon was transected at midsubstance, while the left was untouched to serve as a control. Mice were euthanized 6 weeks after surgery. Tendon specimens were harvested for histopathologic grading according to a previously validated scoring metric, and gene expression levels of Mmp2, Tgfb2, and other TGFß-signaling genes were assayed. Between-group comparisons were made using 1-way analysis of variance with post hoc Tukey honestly significant difference testing. RESULTS: Expression levels of assayed genes were similar between LDS and WT tendons at baseline; however, at 6 weeks after patellar tendon transection, LDS tendons showed sustained elevations in Mmp2 and Tgfb2 compared with baseline values; these elevations were not seen in normal tendons undergoing the same treatments. Histologically, untreated LDS tendons had significantly greater cellularity and cell rounding compared with untreated WT tendons, and both WT and LDS tendons had significantly worse histologic scores after surgery. CONCLUSION: We present the first mechanistic insight into the effect of LDS on tendons and tendon healing. The morphologic differences between LDS and WT tendons at baseline may help explain the increased risk of tendon/ligament dysfunction in patients with LDS, and the differential healing response to injury in LDS may account for the delayed healing and weaker repair tissue. LEVEL OF EVIDENCE: Level V.

[Hemitrapeziectomy of the carpometacarpal joint of the thumb]. / Hemiresektionsarthroplastik am Daumensattelgelenk.

BACKGROUND: Hemiresection arthoplasty or partial trapeziectomy of the carpometacarpal joint of the thumb is a surgical option in stages 1-3 according to Eaton-Littler classification. Preservation of the intact scaphotrapeziotrapezoidal (STT) joint and maintenance of the length of the thumb is the advantage of this technique. TECHNIQUE: Technically, partial trapeziectomy is only slightly more complex compared to trapeziectomy with or without suspension. An interposition of autologous or allogeneic material is recommended; suspension arthroplasty is also possible in almost all common variants. Despite these theoretical advantages, this technique has not proven advantageous in practice, neither in terms of function nor in terms of time, compared to other techniques. The great advantage of partial trapeziectomy, however, is the wide range of options for revision surgery in the case of persistent complaints. RESULTS: The risk of proximalization of the thumb due to an inadequate interposition is generally minor and is usually caused by implant sintering. This can easily be compensated for by implanting a larger graft. Persistent instabilities are the most common cause of persistence of symptoms and can usually be remedied by autologous or allogeneic suspension arthroplasty. In addition, the entire range of endoprosthetics is also possible with a previous spare resection of the trapezium and the possibility of a complete trapeziectomy remains in any case. The obvious theoretical advantages of arthroscopic hemitrapeziectomy need to be confirmed in practice in future.

All-fiber widely tunable ultrafast laser source for multimodal imaging in nonlinear microscopy.

In this Letter, we present an all-fiber, easy-to-use, wavelength-tunable, ultrafast laser, based on soliton self-frequency shifting in an Er-doped polarization-maintaining very large mode area fiber. The system is tunable over 370 nm, starting at 1620 nm, with an average power of up to 1.5 W that emits 120 fs short laser pulses directly out of the fusion-spliced fiber without using bulky pulse compression optics. The output is subsequently frequency doubled to a wavelength range covering 810 nm up to almost 1000 nm with more than 500 mW average power and 120 fs pulse width. Having a polarization extinction ratio better than 40 dB and a M2 of 1.1, the fully computer-controlled laser system presents a robust and compact laser source. These parameters make the laser perfectly suited for multimodal imaging in nonlinear microscopy.

Microbial community composition and dolomite formation in the hypersaline microbial mats of the Khor Al-Adaid sabkhas, Qatar.

The Khor Al-Adaid sabkha in Qatar is among the rare extreme environments on Earth where it is possible to study the formation of dolomite-a carbonate mineral whose origin remains unclear and has been hypothetically linked to microbial activity. By combining geochemical measurements with microbiological analysis, we have investigated the microbial mats colonizing the intertidal areas of sabhka. The main aim of this study was to identify communities and conditions that are favorable for dolomite formation. We inspected and sampled two locations. The first site was colonized by microbial mats that graded vertically from photo-oxic to anoxic conditions and were dominated by cyanobacteria. The second site, with higher salinity, had mats with an uppermost photo-oxic layer dominated by filamentous anoxygenic photosynthetic bacteria (FAPB), which potentially act as a protective layer against salinity for cyanobacterial species within the deeper layers. Porewater in the uppermost layers of the both investigated microbial mats was supersaturated with respect to dolomite. Corresponding to the variation of the microbial community's vertical structure, a difference in crystallinity and morphology of dolomitic phases was observed: dumbbell-shaped proto-dolomite in the mats dominated by cyanobacteria and rhombohedral ordered-dolomite in the mat dominated by FAPB.

CREBBP knockdown enhances RAS/RAF/MEK/ERK signaling in Ras pathway mutated acute lymphoblastic leukemia but does not modulate chemotherapeutic response.

Relapsed acute lymphoblastic leukemia is the most common cause of cancer-related mortality in young people and new therapeutic strategies are needed to improve outcome. Recent studies have shown that heterozygous inactivating mutations in the histone acetyl transferase, CREBBP, are particularly frequent in relapsed childhood acute lymphoblastic leukemia and associated with a hyperdiploid karyotype and KRAS mutations. To study the functional impact of CREBBP haploinsufficiency in acute lymphoblastic leukemia, RNA interference was used to knock down expression of CREBBP in acute lymphoblastic leukemia cell lines and various primagraft acute lymphoblastic leukemia cells. We demonstrate that attenuation of CREBBP results in reduced acetylation of histone 3 lysine 18, but has no significant impact on cAMP-dependent target gene expression. Impaired induction of glucocorticoid receptor targets was only seen in 1 of 4 CREBBP knockdown models, and there was no significant difference in glucocorticoid-induced apoptosis, sensitivity to other acute lymphoblastic leukemia chemotherapeutics or histone deacetylase inhibitors. Importantly, we show that CREBBP directly acetylates KRAS and that CREBBP knockdown enhances signaling of the RAS/RAF/MEK/ERK pathway in Ras pathway mutated acute lymphoblastic leukemia cells, which are still sensitive to MEK inhibitors. Thus, CREBBP mutations might assist in enhancing oncogenic RAS signaling in acute lymphoblastic leukemia but do not alter response to MEK inhibitors.

Self-frequency-shifted solitons in a polarization-maintaining, very-large-mode area, Er-doped fiber amplifier.

We demonstrate soliton self-frequency-shifted, femtosecond-pulse amplification in a newly-developed, polarization-maintaining, Er-doped, very-large-mode-area fiber amplifier. The PM-VLMA Er fiber had a core diameter of 50 µm, an effective area of ~1050 µm2, and Er absorption of 50 dB/m. The measured birefringence beat length of the PM-VLMA Er fiber was 14.1 mm. The soliton wavelength could be shifted by more than 90 nm. The soliton generation process resulted in remarkably clean, 86 fs pulses with 21 nJ energy at 1650 nm and 244 kW peak power from an all-fiber, fusion spliced system without bulk-optics for pulse compression. The polarization extinction ratio of the soliton was greater than 40 dB, and the M2 was 1.1. The fully polarization-maintaining fiber laser system provides robust and stable soliton generation. Peak-to-peak variation in the soliton wavelength, measured over the course of an hour was only 0.03% and pulse energy variation was only 0.5%.

[The scaphoid and rheumatoid arthritis : Classification by retrospective X­ray analysis]. / Das Skaphoid bei Rheuma : Klassifikation anhand einer retrospektiven Röntgenanalyse.

BACKGROUND: Early destruction of the wrist in rheumatoid arthritis is common and often progressive. Even in times of improved and standardized medical treatment this cannot always be prevented. OBJECTIVES: A limited range of motion, pain, reduced grip-force, and aesthetic deficits of the wrist can impair the daily life of patients. There is an additional risk for destruction of the surrounding soft tissue and adjoining joints of the upper extremity. RESULTS: Destruction of wrist in rheumatoid arthritis is multifactorial and is localized in many different structures of the wrist. In this context, scaphoid and periscaphoid structures are of interest. Data were gathered in a retrospective study of the wrist X­rays of patients with rheumatoid arthritis. The possible consequences for operative options are described.

[Acute scaphoid fractures : Management under consideration of the new S3-level guideline]. / Die frische Skaphoidfraktur : Management unter Berücksichtigung der neuen S3-Leitlinie.

BACKGROUND: Scaphoid fractures represent the most common carpal fractures and are often problematic and frequently lead to nonunion with osteoarthritis and collapse of the wrist. The reasons for the nonunion are manifold. Therefore, the main goal of diagnosis and therapy of acute fractures is to achieve bony union and to restore the anatomic shape of the scaphoid. In the long run, only this can preserve the normal function of the wrist. METHODOLOGY: The given recommendations are based on the new S3-level guideline of the AWMF (Association of the Scientific Medical Societies). This guideline was established with involvement of all relevant medical societies based on a comprehensive and systematic review of the literature and after a process of formal consent. The focus of the guideline is recommendations regarding diagnosis and therapy of acute scaphoid fractures. MAIN STATEMENTS: After careful clinical examination consequent imaging must be performed, starting with X­rays in three standard projections. Computed tomography is indispensable for proof of a fracture and for therapy planning. The classification of Herbert and Krimmer is based on the CT under special consideration of instability and displacement of the fracture. Thus, indication for operative and non-operative treatment is mainly CT-dependent. Non-operative treatment may be indicated only for stable fractures (type A). However, operative treatment is strongly recommended for all unstable fractures (type B). For fixation, double-threaded headless screws are preferred. The operative technique depends on the fracture morphology. CONCLUSION: Diagnosis and therapy of acute scaphoid fractures are primarily aimed at the prevention of nonunion and arthritic carpal collapse with painful impairment of the wrist function. To achieve this, the S3-level guideline contains explicit recommendations.

[Scaphoid surgery]. / Skaphoidchirurgie.

Fracture of the scaphoid is the second most common fracture of the wrist. It requires a precise diagnosis and an individual therapy tailored to the patient. Computed tomography has assumed the central role in diagnostics and is obligatory to perform both verification and planning of treatment. Stable fractures can be treated conservatively while unstable fractures should be surgically stabilized. For this procedure different countersink compression screws are available. The fracture of the proximal pole must be considered separately because it is associated a very high rate of nonunion. No and incorrect treatment of fresh scaphoid fractures are the most common reasons for developing scaphoid nonunion. Depending on the location and perfusion, different surgical procedures including transplantation of avascular or vascularized bone grafts can be performed for treatment of scaphoid nonunion.

MR microscopy of the human finger and correlation with histology--a proof-of-principle study.

Magnetic resonance imaging (MRI) with small surface coils is a well established method for the diagnostic evaluation of finger masses. Until now, histological examination has been required to reliably assess tumor extent and infiltration of surrounding structures. Ultra-high-field MR microscopy (MRM) allows evaluation of anatomical structures and pathologies with submillimeter resolution. This study describes the diagnostic prospects and potential of MRM based on the ex-vivo examination of different finger pathologies. Ten human digits were examined by ex-vivo MRM at 7.1 Tesla (ClinScan, Bruker BioScan) using a T2-weighted turbo spin echo (TSE) sequence. Imaging parameters were: TE 48 ms; TR 8370 ms; slice thickness 700 µm; matrix size 1024 × 1024 pixels; FOV 37 × 37 mm; in-plane resolution 36 × 36 µm/voxel. Afterwards specimens were examined histologically. Histology and MRM were correlated. MRM allowed evaluation of the anatomy of the nail, the tendon insertions, the distal interphalangeal joint, and the neurovascular bundles. Finger abnormalities evaluated by MRM included osteomyelitis and metastatic disease. Subsequent histological examination confirmed MRM findings regarding origin, internal makeup, and extent of the structures visualized. This study demonstrates the potential of MRM for imaging small anatomical structures and pathologies of the human finger. Our ex-vivo findings correlate strongly with histology, suggesting that MRM may gain a central role in assessing anatomical structures and pathology in terms of morphology, extent, and infiltration of surrounding structures. Therefore, with increasing availability, MRM is expected to become an essential tool not only in experimental studies but also for daily routine.

Impacts of Austerity on Urogenital Infection Rates in Active Duty Servicewomen.

INTRODUCTION: Female warfighters are at increased risk of urogenital infections (UGIs) when serving in austere environments with varying levels of access to water, sanitation, and hygiene resources. Urogenital infections among servicewomen were among the top five reported medical encounters and one of the top seven reasons for medical evacuation from deployed locations between 2008 and 2013. In this study, we examine the use of water and sanitation resources across three environments (home duty station, field training, and deployment) and analyze associations between water, sanitation, and hygiene resource access and UGIs during training or deployment. The analyses are based on answers from 751 diverse active duty servicewomen (ADSW) at a large military installation in the southeastern USA. MATERIALS AND METHODS: Data for this population-based, prospective, cross-sectional survey design were collected during the administration of the Military Women's Readiness Urogenital Health Questionnaire. This research study was guided by two specific research questions derived from self-reported data in sections 2 and 3 of the questionnaire. RESULTS: The sample consisted of an extremely diverse pool of U.S. Army ADSW attached to highly operational units with robust field training and deployment tempos. Over one-half of the participants reported being diagnosed with one or more UGIs before military service. Of that participant group, more than 76.0% experienced one or more infections since joining the military. We found that the majority of UGIs occurred while U.S. Army ADSW were at their home duty stations rather than during field training or deployment. Of the three types of UGIs, bacterial vaginosis is more often associated with water and sanitation constraints. None of the water factors were significantly associated with UGIs during deployment. Intentional dehydration was not associated with UGIs in either field training or deployment, but intentionally delaying urination was associated with a significant increase in the odds of developing urinary tract infection during deployment. We identified trends in hygiene practices that may put ADSW at a higher risk for UGIs. CONCLUSIONS: Austere conditions, which may exist in any service environment, pose risks to the urogenital health and wellness of a female warfighter. Access to clean water and sanitation resources in military settings is essential for optimal health and operational readiness. It is necessary to identify and investigate critical research and policy gaps in need of investment and support for successful, evidence-based integration of female warfighters into military combat roles and to optimize their performance.

Three-Dimensional-Printed Titanium Versus Polyetheretherketone Cages for Lumbar Interbody Fusion: A Systematic Review of Comparative In Vitro, Animal, and Human Studies.

Interbody fusion is a workhorse technique in lumbar spine surgery that facilities indirect decompression, sagittal plane realignment, and successful bony fusion. The 2 most commonly employed cage materials are titanium (Ti) alloy and polyetheretherketone (PEEK). While Ti alloy implants have superior osteoinductive properties they more poorly match the biomechanical properties of cancellous bones. Newly developed 3-dimensional (3D)-printed porous titanium (3D-pTi) address this disadvantage and are proposed as a new standard for lumbar interbody fusion (LIF) devices. In the present study, the literature directly comparing 3D-pTi and PEEK interbody devices is systematically reviewed with a focus on fusion outcomes and subsidence rates reported in the in vitro, animal, and human literature. A systematic review directly comparing outcomes of PEEK and 3D-pTi interbody spinal cages was performed. PubMed, Embase, and Cochrane Library databases were searched according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Mean Newcastle-Ottawa Scale score for cohort studies was 6.4. A total of 7 eligible studies were included, comprising a combination of clinical series, ovine animal data, and in vitro biomechanical studies. There was a total population of 299 human and 59 ovine subjects, with 134 human (44.8%) and 38 (64.4%) ovine models implanted with 3D-pTi cages. Of the 7 studies, 6 reported overall outcomes in favor of 3D-pTi compared to PEEK, including subsidence and osseointegration, while 1 study reported neutral outcomes for device related revision and reoperation rate. Though limited data are available, the current literature supports 3D-pTi interbodies as offering superior fusion outcomes relative to PEEK interbodies for LIF without increasing subsidence or reoperation risk. Histologic evidence suggests 3D-Ti to have superior osteoinductive properties that may underlie these superior outcomes, but additional clinical investigation is merited.

Technical Nuances and Outcomes of Telescoping Pipeline Flow Diverters: A Multicenter Study.

BACKGROUND: "Telescoping" multiple overlapping Pipeline Embolization Devices (PEDs; Medtronic) has increased their utility by allowing for more impermeable coverage and providing the ability to off-set landing zone sites and extend treatment constructs. OBJECTIVE: To consider the technical nuances and challenges of telescoping PEDs for the treatment of intracranial aneurysms. METHODS: Databases from 3 U.S. academic neurovascular centers were retrospectively queried to identify patients with intracranial aneurysms treated with multiple PED constructs. Data on patient and aneurysm characteristics, as well as outcomes including Raymond-Roy occlusion classification, modified Rankin Scale score, and complications, were gathered. RESULTS: Forty-six patients had 48 intracranial aneurysms treated, including 16 (33%) in whom placement of telescoping PEDs was planned. Fourteen (30%) patients presented with a ruptured aneurysm. Twenty-one aneurysms (44%) were treated with proximal extension, 13 (27%) with distal extension, and 14 (29%) with PED placement inside one another. Thirty (70%) patients had complete aneurysm occlusion at follow-up. Two (4%) patients had to be retreated. Three patients with unruptured and 1 with ruptured aneurysm had a permanent intraprocedural complication. We present descriptive cases illustrating PEDs that were placed inside one another, proximally, distally, and to improve wall apposition because of vessel tortuosity. CONCLUSION: Our data indicate a higher than expected complication rate that is likely because of the technical complexity of these cases. The case illustrations presented demonstrate the indications and challenging aspects of telescoping PEDs.

Patterns in Urogenital Health in Active Duty Servicewomen: A Prospective Cross-Sectional Survey Evaluating Impacts of Water, Sanitation, and Hygiene Resources Across Three Military Environments.

INTRODUCTION: Female warfighters are at risk for sex-specific and frequently unrecognized urogenital health challenges that may impede their ability to serve. The constraints on water, sanitation, and hygiene (WASH) resources by austere environments, whether at home or abroad, require women to practice unhealthy hygiene behaviors that jeopardize their urogenital health. In this manuscript, we examine the use of WASH resources by U.S. Army active duty servicewomen (ADSW) across three settings-home duty, field training, and deployment-to determine how the changing availability of WASH resources alters hygiene and sanitation practices in austere environments. Additionally, we report findings from a previously developed theoretical framework for determining the impacts of austere environments on ADSW's hygiene knowledge, behaviors, and outcomes. MATERIALS AND METHODS: This study used a prospective, cross-sectional survey design with population sampling and generalized ordered logit regression models. We recruited ADSW assigned to a large military installation in the southeastern United States after conducting a structured field hygiene training for female readiness. RESULTS: We surveyed a highly diverse sample of 751 ADSW and found that the use of WASH resources significantly differs between field training and deployment. Clean running water significantly differed among all settings, with nearly 70% reporting clean running water to be rarely or never available during field training. Bathing facility types significantly differed in each setting, with Cadillac bathrooms more often used during deployment than during field training and wipe baths more often used during field training than during deployment. We found that women were significantly less likely to wash their private areas more than 2 days a week during field training, compared to deployment. Women reported changing their underwear ≤2 times per week in field training environments as compared to during deployment. Soap and water were reported as the most common ways of washing in both home duty stations and during deployment, followed by wipes at home duty stations and in deployed settings. Participants reported wipes as their primary bathing method during field training, followed by soap and water. Participants used intentional dehydration or delayed urination more frequently in field training than during deployment. Women reported significant differences in holding their urine between field training and deployment, with principal reasons reported as "dirty facilities" and "distance to the nearest restroom." Significantly, they reported safety concerns when bathing, using the bathroom, or toileting facilities across the three settings. CONCLUSIONS: This is the first study to characterize sex-specific challenges by a large sample of operational ADSW and to explore the use of WASH resources in home duty, field training, and deployment settings. The results show that field training is more austere than deployed settings, indicating that austerity, not deployment, increases the urogenital infection risk for ADSW. With women more integrated into the military strategy than at any time in U.S. history, military leaders can use our results to develop interventions that ameliorate the unique challenges that influence the military readiness and overall health of female warfighters.

Randomized Controlled Trial to Study the Acute Effects of Strength Exercise on Insulin Sensitivity in Obese Adults.

An acute session of strength exercise (SE) ameliorates insulin sensitivity (IS) for several hours; however, the effects of SE volume (i.e., number of sets) have not been studied thoroughly. Although it is intuitive that some SE is better than none, and more is better than some for the improvement of IS, high-volume sessions might be challenging for diseased populations to complete, especially obese adults, for whom even a brisk walk can be challenging. This protocol details a randomized clinical trial to assess the acute effects of SE on IS in obese adults. The inclusion criteria are body mass index >30 kg/m2, central obesity (waist circumference >88 cm and >102 cm for women and men, respectively), and age >40 years. Participants will be familiarized with the SE (7 exercises targeting major muscle groups) and then will perform three sessions in a randomized order: session 1 - high-volume session (3 sets/exercise); session 2 - low-volume session (1 set/exercise); session 3 - control session (no exercise). Diet will be controlled the day before and on the day of the sessions. Sessions will be completed at night, and an oral glucose tolerance test will be performed the next morning, from which several indexes of IS will be derived, such as the area under the curve (AUC) of glucose and insulin, the Matsuda index, the Cederholm index, the muscle IS index, and the Gutt index. Based on pilot studies, we expect ~15% improvement in IS (insulin AUC, and Matsuda and Cederholm indexes) after the high-volume session, and ~8% improvement after the low-volume session compared to the control session. This study will benefit individuals who find high-volume SE sessions challenging but still aim to improve their IS by investing 1/3 of their time and effort.

Ganglions of the wrist and associated triangular fibrocartilage lesions: a prospective study in arthroscopically-treated patients.

PURPOSE: Wrist ganglions are the most common soft tissue tumors of the hand and wrist and can occur at any age. Their etiology remains controversial. A high prevalence of associated intrinsic ligamentous lesions has been described. We hypothesized that painful wrist ganglions are an indicator of an underlying joint abnormality, particularly of lesions of the triangular fibrocartilage complex (TFCC). The aim of our study was to prospectively determine the prevalence of associated TFCC lesions in patients with painful wrist ganglions. METHODS: Forty-six patients (35 women, 11 men; mean age, 36 ± 11 y; range, 18-57 y) with painful wrist ganglions (20 radiopalmar and 26 dorsal) had surgery from January 2008 to June 2010. There were 18 primary and 28 recurrent ganglions. Clinical examinations, pain score evaluations, disabilities in daily life evaluations, plain radiographs, and magnetic resonance imaging were obtained before arthroscopic resection. Concomitant intrinsic lesions of the wrist were assessed with magnetic resonance imaging and re-evaluated by arthroscopy. RESULTS: All ganglions were successfully resected. Overall, arthroscopy identified 22 TFCC lesions (48%) and 2 intracarpal ligament lesions. The TFCC perforations were more commonly associated with radiopalmar ganglions with a positive ulnocarpal stress test result and with recurrent radiopalmar ganglions. At 1-year follow-up, all patients were meaningfully improved in terms of pain and disabilities in daily life. CONCLUSIONS: Arthroscopy allows for the simultaneous treatment of ganglions and other pathologies. Therefore, arthroscopy should be contemplated as the primary treatment option for patients with painful ganglions of the wrist if they are in a radiopalmar location with a positive ulnocarpal stress test and for patients with recurrent radiopalmar ganglions, which are also highly associated with TFCC abnormalities. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

A new pathway to classification of complex hand injuries: a clinical pilot testing using a new method of assessment.

All existing classifications, which are based on the severity of hand injuries, are being referred to facets of variety of hand injuries in general. A clear picture of all consequences of hand injuries would be apparent, if any kind of injury mechanism and occurrence of an injury would be identified and academically captured. Predictions regarding return to the former occupation and rehabilitation time would be possible with further study; 102 patients with different hand injuries were engaged in a pilot project using a specifically designed assessment sheet to achieve this purpose in the framework of a retrospective clinical testing within 1 year. Data were summarized and demonstrated graphically. Each category showed a picture of prior localization of the injury and its morphology. All categories show specific injury patterns. The choice of categories reflects the mechanisms of injury emphasized in literature. Furthermore, the mean DASH equivalents of one category were compared to the mean Hand Injury Severity Scoring (HISS) scores in order to get an initial idea of information on the degree of severity. A first impression of the potential of this assessment sheet has been obtained with regard to the above. With further study, we could evaluate the assessment sheet and try to create a classification of the grade of severity as well as prognostic values like return to the former occupation and rehabilitation time.

Modern dolomite formation caused by seasonal cycling of oxygenic phototrophs and anoxygenic phototrophs in a hypersaline sabkha.

The "Dolomite Problem" has been a controversy for over a century, owing to massive assemblages of low-temperature dolomite in ancient rocks with little dolomite forming today despite favorable geochemical conditions. Experiments show that microbes and their exopolymeric substances (EPS) nucleate dolomite. However, factors controlling ancient abundances of dolomite can still not be explained. To decode the enigma of ancient dolomite, we examined a modern dolomite forming environment, and found that a cyclic shift in microbial community between cyanobacteria and anoxygenic phototrophs creates EPS suited to dolomite precipitation. Specifically, EPS show an increased concentration of carboxylic functional groups as microbial composition cycles from cyanobacterial to anoxygenic phototroph driven communities at low-and high- salinity, respectively. Comparing these results to other low-T forming environments suggests that large turnover of organic material under anoxic conditions is an important driver of the process. Consequently, the shift in atmospheric oxygen throughout Earth's history may explain important aspects of "The Dolomite Problem". Our results provide new context for the interpretation of dolomite throughout Earth's history.

A spectrum of (Dis)Belief: Coronavirus frames in a rural midwestern town in the United States.

Community responses to the SARS-CoV-2, or "coronavirus" outbreaks of 2020 reveal a great deal about society. In the absence of government mandates, debates over issues such as mask mandates and social distancing activated conflicting moral beliefs, dividing communities. Policy scholars argue that such controversies represent fundamental frame conflicts, which arise from incommensurable worldviews, such as contested notions of "liberty" versus "equity". This article investigates frames people constructed to make sense of coronavirus and how this affected social behavior in 2020. We conducted an interpretive framing analysis using ethnographic data from a predominately white, conservative, and rural midwestern tourist town in the United States from June to August 2020. We collected semi-structured interviews with 87 community members, observed meetings, events, and daily life. We identified four frames that individuals constructed to make sense of coronavirus: Concern, Crisis, Constraint, and Conspiracy. Concern frames illustrated how some individuals are uniquely affected and thus protect themselves. Crisis frames recognized coronavirus as a pervasive and profound threat requiring unprecedented action. Constraint frames emphasized the coronavirus response as a threat to financial stability and personal growth that should be resisted. Conspiracy frames denied its biological basis and did not compel action. These four conflicting frames demonstrate how social fragmentation, based on conflicting values, led to an incomplete pandemic response in the absence of government mandates at the national, state, and local levels in rural America. These findings provide a social rationale for public health mandates, such as masking, school/business closures, and social distancing, when contested beliefs impede collective action.