Incidence and predictors of dorsal comminution in older adults with low-energy distal radius fracture.

PURPOSE: To identify the incidence of dorsal comminution using computed tomography (CT) images and identify predictors of this phenomenon in older adults with low-energy distal radius fractures (DRFs). METHODS: A total of 150 patients aged > 50 years with fall-induced dorsally angulated DRFs were enrolled in this study. Patients were divided into two groups based on the presence of dorsal comminution, defined as a metaphyseal void of greater than one-third of the maximum posterior to anterior depth of the bone on at least three cuts in the sagittal plane on post-reduction CT images. Data on participants' basic demographics, including age, sex, body mass index (BMI), and AO classification of DRFs, were collected. Bone mineral density (BMD) was assessed using T-scores of the femoral neck, and cortical thickness of the distal radius was determined from plain post-reduction radiographs. Radiological parameters and combined ulnar fractures were measured on plain pre-reduction radiographs. RESULTS: Among study participants, 91 (61%) had dorsal comminution, whereas 59 (39%) had no dorsal comminution on CT images. Both patient groups were compared based on presence of dorsal comminution, and showed no significant differences in age, sex, BMI, BMD, or cortical thickness on radiographs. However, all radiological parameters were better in the no dorsal comminution group than in the dorsal comminution group, and the proportion of patients with combined ulnar fractures was higher in the dorsal comminution group. In the multivariate analysis, the presence of combined ulnar fractures was the only significant predictor of dorsal comminution (p = 0.029, odds ratio = 2.267, 95% confidence interval: 1.085-4.736). CONCLUSION: The incidence of dorsal comminution is relatively high in patients with low-energy DRFs aged > 50 years. In particular, the presence of combined ulnar fractures is closely associated with dorsal comminution of DRFs. Thus, surgeons should exercise caution when evaluating this phenomenon.

Dietary supplementation of phytoncide and soybean oil increases milk conjugated linoleic acid and depresses methane emissions in Holstein dairy cows.

The objective of this study was to determine whether adding phytoncide oil (PO) and soybean oil (SBO) to the dairy cow diet could increase milk conjugated linoleic acid (CLA) and depress methane (CH4) emissions in Holstein dairy cows. Rumen fermentation was conducted at four levels of SBO (0, 1, 2, and 4%, on DM basis) and two levels of PO (0 and 0.1%, on DM basis) with in vitro experiment. To evaluate blood parameters, fecal microbe population, milk yield and fatty acid compositions, and CH4 production, in vivo experiment was conducted using 38 Holstein dairy cows divided into two groups of control (fed TMR) and treatment (fed TMR with 0.1% PO and 2% SBO as DM basis). In the in vitro study (Experiment 1), PO or SBO did not affect rumen pH. However, SBO tended to decrease ruminal ammonia-N (p = 0.099). Additionally, PO or SBO significantly decreased total gas production (p = 0.041 and p = 0.034, respectively). Both PO and SBO significantly decreased CH4 production (p < 0.05). In addition, PO significantly increased both CLA isomers (c9, t11 and t10, c12 CLA) (p < 0.001). Collectively, 0.1% PO and 2% SBO were selected resulting in most effectively improved CLA and decreased CH4 production. In the in vivo study (Experiment 2), 0.1% PO with 2% SBO (PSO) did not affect complete blood count. However, it decreased blood urea nitrogen and magnesium levels in blood (p = 0.021 and p = 0.01, respectively). PSO treatment decreased pathogenic microbes (p < 0.05). It increased milk yield (p = 0.017) but decreased percentage of milk fat (p = 0.013) and MUN level (p < 0.01). In addition, PSO treatment increased both the concentration of CLA and PUFA in milk fat (p < 0.01). Finally, it decreased CH4 emissions from dairy cows. These results provide compelling evidence that a diet supplemented with PSO can simultaneously increase CLA concentration and decrease CH4 production with no influence on the amount of milk fat (kg/day) in Holstein dairy cows.

Magnetic resonance imaging analysis of the distribution of cartilage damage in scaphoid nonunion.

This study aimed to evaluate the distribution and severity of cartilage damage using magnetic resonance imaging in patients with scaphoid nonunion without advanced wrist arthritis. We retrospectively analysed MRI of patients who underwent osteosynthesis for scaphoid nonunion. Cartilage damage was assessed in eight wrist regions using a modified Whole-Organ Magnetic Resonance Imaging Score. The frequencies of regions affected by any cartilage damage (Score ≥2.5) depicted on MRI were analysed. The study included 32 patients (31 men and one woman), with a mean age of 32 years (SD 11). The distal radioscaphoid (29/32), scaphotrapeziotrapezoid (STT) (22/32), proximal radioscaphoid (14/32) and scaphocapitate (11/32) joints were most commonly affected by degenerative cartilage damage. The STT and proximal radioscaphoid joint were especially likely to be involved in early-stage scaphoid nonunion advanced collapse. We recommend that surgeons should investigate the cartilage status of these joints during decision-making for scaphoid nonunion surgery.Level of evidence: III.

Analysis of ultrasonographic images using a deep learning-based model as ancillary diagnostic tool for diagnosing gallbladder polyps.

BACKGROUND: Accurately diagnosing gallbladder polyps (GBPs) is important to avoid misdiagnosis and overtreatment. AIMS: To evaluate the efficacy of a deep learning model and the accuracy of a computer-aided diagnosis by physicians for diagnosing GBPs. METHODS: This retrospective cohort study was conducted from January 2006 to September 2021, and 3,754 images from 263 patients were analyzed. The outcome of this study was the efficacy of the developed deep learning model in discriminating neoplastic GBPs (NGBPs) from non-NGBPs and to evaluate the accuracy of a computer-aided diagnosis with that made by physicians. RESULTS: The efficacy of discriminating NGBPs from non- NGBPs using deep learning was 0.944 (accuracy, 0.858; sensitivity, 0.856; specificity, 0.861). The accuracy of an unassisted diagnosis of GBP was 0.634, and that of a computer-aided diagnosis was 0.785 (p<0.001). There were no significant differences in the accuracy of a computer-aided diagnosis between experienced (0.835) and inexperienced (0.772) physicians (p = 0.251). A computer-aided diagnosis significantly assisted inexperienced physicians (0.772 vs. 0.614; p < 0.001) but not experienced physicians. CONCLUSIONS: Deep learning-based models discriminate NGBPs from non- NGBPs with excellent accuracy. As ancillary diagnostic tools, they may assist inexperienced physicians in improving their diagnostic accuracy.

Estrogen Mediates the Sexual Dimorphism of GT1b-Induced Central Pain Sensitization.

We have previously reported that the intrathecal (i.t.) administration of GT1b, a ganglioside, induces spinal cord microglia activation and central pain sensitization as an endogenous agonist of Toll-like receptor 2 on microglia. In this study, we investigated the sexual dimorphism of GT1b-induced central pain sensitization and the underlying mechanisms. GT1b administration induced central pain sensitization only in male but not in female mice. Spinal tissue transcriptomic comparison between male and female mice after GT1b injection suggested the putative involvement of estrogen (E2)-mediated signaling in the sexual dimorphism of GT1b-induced pain sensitization. Upon ovariectomy-reducing systemic E2, female mice became susceptible to GT1b-induced central pain sensitization, which was completely reversed by systemic E2 supplementation. Meanwhile, orchiectomy of male mice did not affect pain sensitization. As an underlying mechanism, we present evidence that E2 inhibits GT1b-induced inflammasome activation and subsequent IL-1ß production. Our findings demonstrate that E2 is responsible for sexual dimorphism in GT1b-induced central pain sensitization.

Nerve injury-induced gut dysbiosis contributes to spinal cord TNF-α expression and nociceptive sensitization.

The impact of the gut microbiota on glial cell growth and maturation via the gut-brain axis is highlighted herein. Considering that glial activation is crucial for onset and maintenance of neuropathic pain, we assessed the putative involvement of gut microbiota in the pathogenesis of neuropathic pain. Depletion of mouse gut microbiota with chronic antibiotics cocktail treatment prevented nerve injury-induced mechanical allodynia and thermal hyperalgesia both in male and female mice. Furthermore, post-injury treatment with antibiotics cocktail relieved ongoing pain in neuropathic pain-established mice. Upon recolonization of the gut microbiota after cessation of antibiotics, nerve injury-induced mechanical allodynia relapsed. Depletion of gut microbiota accompanied a decrease in nerve injury-induced TNF-α expression in the spinal cord. Notably, nerve injury changed the diversity and composition of the gut microbiome, which was measured by 16 s rRNA sequencing. We then tested if probiotic administration ameliorating dysbiosis affected the development of neuropathic pain after nerve injury. Probiotic treatment for three weeks prior to nerve injury inhibited nerve injury-induced TNF-α expression in the spinal cord and pain sensitization. Our data reveal an unexpected link between the gut microbiota and development and maintenance of nerve injury-induced neuropathic pain, and we propose a novel strategy to relieve neuropathic pain through the gut-brain axis.

Risk factors for hardware-related complications after extra-articular distal humerus fracture fixation using an anatomical locking plate.

PURPOSE: We aimed to identify the incidence and risk factors of hardware-related complications in patients treated with anatomical locking plate fixation for extra-articular distal humerus fractures. METHODS: From 2013 to 2020, patients with extra-articular distal humerus fractures who underwent open reduction and internal fixation with an extra-articular distal humerus locking plate (EADHP) were retrospectively reviewed and categorized according to the presence/absence of hardware-related complications. Hardware-related complications were defined as the occurrence of skin prominence on the plate and discomfort in activities of daily living. Patient demographics, the lateral condylar angle, lateral body length, shaft-condylar angle of the humerus, and plate length were analyzed. RESULTS: Of the 29 patients, 10 (34%) did not develop hardware-related complications (group A), whereas 19 (66%) did (group B). Patient demographics did not differ between the groups. However, the number of patients who underwent hardware removal was significantly greater in group B (16/19) than in group A (4/10; p = 0.032). Radiologic assessment revealed no significant difference in the lateral condylar or shaft-condylar angle. However, the lateral body length was greater in group A than in group B (44.5 ± 4.8 vs. 39.5 ± 3.7, p = 0.007). The plate length significantly differed between the groups. Twelve of 19 (63%) patients in group B received short-hole plates (six holes), while nine of ten (90%) patients in group A received long-hole plates (eight holes). In the multivariable analysis, the lateral body length of the distal humerus (p = 0.047, odds ratio = 0.734, 95% confidence interval: 0.542-0.996) and plate length (p = 0.036, odds ratio = 0.076, 95% confidence interval: 0.542-0.996) were associated with hardware-related complications. CONCLUSIONS: Most patients developed hardware-related complications, particularly with short plates, mainly because of the narrow lateral body length of the distal humerus. Surgeons should be careful to secure EADHP in the appropriate position, especially when short plates are used in patients with narrow lateral body length.

Dietary supplementation with L-glutamine enhances immunity and reduces heat stress in Hanwoo steers under heat stress conditions.

This study investigated the effects of L-glutamine (Gln) supplementation on growth performance, physiological traits, heat shock proteins (HSPs), and gene expression related to muscle and adipose tissue development in Hanwoo steers under heat stress (HS) conditions. Eight Hanwoo steers (initial body weight [BW] 570.7 ± 43.6 kg, months of age 22.3 ± 0.88) were randomly separated into two groups, control and treatment, and supplied with the concentration (1.5% of BW kg/day/head) and rice straw (1.5 kg/day/head). The treatment group were fed the Gln supplementation (0.5% of concentration, as-fed basis) once a day at 08:00 h. Blood samples for the assessment of haematological and biochemical parameters and the separation of peripheral blood mononuclear cells (PBMCs) were collected four times, at 0, 3, 6, and 10 weeks of the experiment. Feed intake was measured daily. BW to analyze growth performance and hair follicle collection to analyze the expression of HSPs were executed four times at 0, 3, 6, and 10 weeks. To analyze gene expression, longissimus dorsi muscle samples were collected by biopsy at the end of the study. As a result, growing performance, including final BW, average daily gain, and gain-to-feed ratio, were not different between the two groups. Leukocytes including lymphocytes and granulocytes, tended to increase in the Gln supplementation group (p = 0.058). There were also no differences in biochemical parameters shown between the two groups, except total protein and albumin, both of which were lower in the Gln supplementation group (p < 0.05). Gene expressions related to muscle and adipose tissue development were not different between the two groups. As temperature-humidity index (THI) increased, HSP70 and HSP90 expression in the hair follicle showed a high correlation. HSP90 in the hair follicle was decreased in the treatment group compared with the control group at 10 weeks (p < 0.05). Collectively, dietary Gln supplementation (0.5% of concentration, as-fed basis) may not be influential enough to affect growth performance and gene expression related to muscle and adipose tissue development in steers. However, Gln supplementation increased the number of immune cells and decreased HSP90 in the hair follicle implying HS reduction in the corresponding group.

The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: a systematic review and meta-analysis.

HYPOTHESIS: The concentration of leukocytes influences the quality of platelet-rich plasma (PRP). However, there is no consensus on which type of PRP based on the concentration of leukocytes is the best for lateral epicondylitis (LE). METHODS: We systematically searched the MEDLINE, Embase, and Cochrane Library databases until March 1, 2020. Studies involving randomized controlled trials, patients with LE, and treatment with PRP injections were included. PRP was classified into leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. LR-PRP was defined as PRP with a white blood cell concentration exceeding that of whole blood (4.0-10.0 per µL3), whereas LP-PRP was defined as PRP with a lower white blood cell concentration than that of whole blood. The efficacy of PRP was assessed using the visual analog scale (VAS) and success rates. RESULTS: Eleven randomized controlled trials (six involving LP-PRP and five involving LR-PRP) were eligible for inclusion in this review. Eight studies were included in the meta-analysis to evaluate the VAS score. Regarding short-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (standard mean difference [SMD], 0.01; 95% confidence interval [CI], -0.29 to 0.30; P = 0.97), with no heterogeneity (I2 = 0%). There was also no difference in the VAS scores between the LR-PRP and control groups (SMD, -0.19; 95% CI, -0.57 to 0.20; P = 0.34), with substantial heterogeneity (I2 = 56.7%). Regarding long-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (SMD, -0.73; 95% CI, -1.69 to 0.23; P = 0.134) with substantial heterogeneity (I2 = 88.4%). The LR-PRP group had lower VAS scores than the control group (SMD, -1.06; 95% CI, -2.02 to -0.09; P = 0.032) with substantial heterogeneity (I2 = 92%). In the LP-PRP group, there was no significant difference in the success rate (odds ratio, 1.08; 95% CI, 0.07-16.47; P = 0.956) with substantial heterogeneity (I2 = 87.7%). In the LR-PRP group, however, the patients who received PRP had a higher success rate than those in the control group (odds ratio, 2.85; 95% CI, 1.67-4.85; P < 0.01) with substantial heterogeneity (I2 = 82.9%). CONCLUSION: LR-PRP may provide pain relief and successful outcomes for patients with LE compared with alternative local injections. Better results were observed with the use of LR-PRP than with the use of LP-PRP.

Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis.

BACKGROUND: Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. METHODS: MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. RESULTS: We included 5 studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely, 2 months (mean difference [MD] 1.11, 95% confidence interval [CI] -2.51 to 4.74, P = .55, I2 = 94%), 6 months (MD 0.80, 95% CI -2.83 to 4.42, P = .67, I2 = 92%), and 12 months (MD -0.92, 95% CI -4.63 to 2.80, P = .63, I2 = 93%) postintervention and in the Patient-Related Tennis Elbow Evaluation scores at 12 weeks (MD -1.86, 95% CI -22.30 to 18.58, P = .86, I2 = 81%), 24 weeks (MD -3.33, 95% CI -21.82 to 15.17, P = .72, I2 = 74%), and 52 weeks (MD -3.64, 95% CI -19.65 to 12.37, P = .66, I2 = 69%) postintervention. CONCLUSIONS: Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates.

Effect of a Rumen-Protected Microencapsulated Supplement from Linseed Oil on the Growth Performance, Meat Quality, and Fatty Acid Composition in Korean Native Steers.

We evaluated the effects of a rumen-protected microencapsulated supplement from linseed oil (MO) on ruminal fluid, growth performance, meat quality, and fatty acid composition in Korean native steers. In an in vitro experiment, ruminal fluid was taken from two fistulated Holstein dairy cows. Different levels of MO (0%, 1%, 2%, 3%, and 4%) were added to the diet. In an in vivo experiment, eight steers (average body weight = 597.1 ± 50.26 kg; average age = 23.8 ± 0.12 months) were assigned to two dietary groups, no MO (control) and MO (3% MO supplementation on a DM basis), for 186 days. The in vitro study revealed that 3% MO is an optimal dose, as there were decreases in the neutral detergent fiber and acid detergent fiber digestibility at 48 h (p < 0.05). The in vivo study showed increases in the feed efficiency and average daily gain in the 3% MO group compared to the control group on days 1 to 90 (p < 0.05). Regarding meat quality, the shear force produced by the longissimus thoracis muscle in steers from the 3% MO group was lower than that produced by the control group (p < 0.05). Interestingly, in terms of the fatty acid profile, higher concentrations of C22:6n3 were demonstrated in the subcutaneous fat and higher concentrations of C18:3n3, C20:3n3, and C20:5n3 were found in the intramuscular fat from steers fed with 3% MO (p < 0.05). Our results indicate that supplementation with 3% MO supplements improves the growth performance and meat quality modulated by the omega-3 fatty acid content of meat in Korean native steers.

Clinical comparison of the over-the-top and flexor carpi ulnaris split approaches for the treatment of anteromedial facet fracture of the coronoid process.

BACKGROUND: The flexor carpi ulnaris (FCU)-split approach and the over-the-top approach have been used frequently for the fixation of anteromedial facet (AMF) fractures of the coronoid process. Clinical studies have not compared functional recovery and complication rates associated with these approaches. This study aimed to compare the clinical effectiveness of the over-the-top and FCU-split approaches for the treatment of AMF fractures of the coronoid process. METHODS: Thirty-two patients who underwent surgery for AMF fractures between January 2013 and August 2019 were divided into the FCU-split and over-the-top groups. The FCU-split approach was used from January 2013 to March 2016, and the over-the-top approach was used from April 2016 to August 2019. Bony union, radiographic signs of osteoarthritis (Broberg and Morrey classification), and development of heterotopic ossification were evaluated. Postoperative pain score (visual analog scale at 2 days after the operation), surgical time (minutes), range of motion of the elbow, elbow function (Mayo Elbow Performance Score [MEPS]), and the presence of postoperative ulnar neuropathy were also compared between the 2 groups. RESULTS: The FCU-split and over-the-top approaches were performed in 15 and 17 patients, respectively. The mean age was 46 ± 13 years (range, 22-67 years), and the mean follow-up duration was 19± 6.7 months (range, 13-38 months). All coronoid fractures had a solid osseous union during the follow-up, and no subluxation or dislocation was observed in the 2 groups. The occurrence of heterotopic ossification and the grade of post-traumatic arthritis did not differ significantly between the groups (all P > .05). There were also no significant differences between the groups in terms of postoperative pain score, range of motion, and MEPS (all P > .05). However, the surgical time was shorter for the over-the-top approach than that for the FCU-split approach (79± 23 vs. 101 ± 14, P = .008), and the surgical time was significantly associated with the fracture classification and surgical approach (P = .001 and .003, respectively). In addition, postoperative ulnar neuropathy occurred less with the over-the-top approach than with the FCU-spilt approach (5.9% vs. 46%, P = .013). CONCLUSION: Both the FCU-split and over-the-top approaches were appropriate for performing the buttress plate fixation for AMF fractures of the coronoid process and for restoring the elbow stability. The fixation of AMF fractures through the over-the-top approach was technically easier and had less incidence of postoperative ulnar neuropathy.

Effects of La incorporation in catalytic activity of Ag/La-CeO2 catalysts for soot oxidation.

Owing to strengthened regulations toward vehicle emissions, the use of diesel particulate filter technology to reduce particulate matter emissions has attracted significant attention. To achieve low temperature oxidation of particulate matter, numerous studies on Ag/CeO2 catalysts for soot oxidation have been reported. Herein, Ag/La-CeO2 catalysts with different La contents are synthesized and compared to analyze the effect of La. Hydrogen temperature programmed reduction analysis confirms that the reducibility increases with an increase in the La content in La-CeO2. X-ray photoelectron spectroscopy and Raman analysis confirm an increase of oxygen vacancies with La doping. Accordingly, the soot oxidation performances estimated by temperature programmed oxidation experiments increase with La doping. However, the catalytic activity of Ag/La-CeO2 exhibits a volcano trend. When an appropriate amount of La is incorporated in Ag/CeO2, peroxide generation and reducibility improve, thereby enhancing the soot oxidation performance. Conversely, the catalytic activities gradually decrease with excess La-doping. Scanning transmission electron microscopy analysis and density functional theory calculations confirm that excess amounts of La induce the sintering of Ag particles, which lead to the degradation of peroxide generation and reducibility of the catalysts. Consequently, an optimal amount of La incorporation on Ag/La-CeO2 results in the best soot oxidation performance.

A Fibroma of Tendon Sheath Causing Carpal Tunnel Syndrome: A Case Report of an Atypical Clinical Presentation.

Fibroma of the tendon sheath is a benign slow-growing fibrous tumor. Although rare, cases occurring in the upper extremities usually involve the fingers. It appears as a well-defined, roundor oval-shaped mass originating from the flexor tendon. Abundant fibrous stroma makes fibromas appear as a low intensity mass in all MRI sequences. Most of the fibromas manifest as painless soft tissue masses. Herein, we report a case of fibroma of the tendon sheath with an unusual clinical presentation, triggering carpal tunnel syndrome during wrist movement.

Necessity of acceptable radiologic alignment by preoperative closed reduction for unstable distal radius fractures treated with volar locking plates.

PURPOSE: The purpose of this study was to demonstrate the necessity of achieving acceptable radiographic alignment by preoperative closed reduction in unstable distal radius fractures (DRFs) to improve preoperative pain and obtain satisfactory outcomes after surgery. METHODS: From 2013 to 2016, patients who received volar locking plates for DRFs were retrospectively reviewed. Patients were classified into acceptable and non-acceptable reduction groups based on immediate post-reduction radiographs. To avoid potential bias, a matched-pair analysis was performed, and paired patients were categorized into non-acceptable reduction (group A) and acceptable reduction (group B) groups. Preoperative pain level, mean length of stay, operation time, postoperative complications, and surgical outcomes were analysed. The preoperative pain level and functional results were assessed by the visual analogue scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) scores. RESULTS: Of the 239 patients, 80 had non-acceptable and 159 had acceptable reductions. Among these patients, 201 (66 in group A vs. 135 in group B) were matched in a 1:2 matched ratio. Although the radiological parameters after closed reduction were better in group B, there were no significant differences in the preoperative pain VAS score, mean length of stay, operation time, and postoperative complications between the groups. In addition, radiologic parameters and the DASH score at a 1-year follow-up were also not significantly different between the groups. CONCLUSION: Our results suggest that obtaining acceptable radiologic alignment by closed reduction is not necessary for patients who make an informed decision to undergo volar plating for unstable DRFs.

Arthroscopic Transosseous Repair of Foveal Tears of the Triangular Fibrocartilage Complex: A Systematic Review of Clinical Outcomes.

PURPOSE: To determine whether arthroscopic transosseous foveal repair of the triangular fibrocartilage complex (TFCC) results in significant and clinically relevant improvement in clinical outcomes including pain and function with low complication and reoperation rates. METHODS: We reviewed studies investigating the clinical outcomes of arthroscopic transosseous foveal repair of the TFCC through MEDLINE, Embase, and the Cochrane Library. Studies on TFCC repair performed with an open or capsular technique and combined with other procedures, such as ulnar shortening osteotomy and a wafer procedure, were excluded. Methodologic quality was assessed using the Methodological Index for Non-randomized Studies score. Clinical outcomes were assessed using range of motion, grip strength, and patient-reported outcomes. Clinically relevant improvement was determined using the minimal clinically important difference (MCID). RESULTS: A total of 443 unique studies were identified, of which 7 (131 patients) met the inclusion criteria. The mean age ranged from 27 to 37 years, and the mean follow-up period ranged from 23.5 to 31.1 months. The grip strength (as a percentage) increased after foveal repair of the TFCC in all studies (mean difference range, 11.8% to 22.3%). All studies also reported an improvement in the visual analog scale score (mean difference range, -9.8 to -1.88); Modified Mayo Wrist Score (mean difference range, 10.5 to 27); and Disabilities of the Arm, Shoulder and Hand score (mean difference range, -51.8 to -24.48). Considering clinically relevant improvements based on the MCID, 4 of 5 studies reporting the visual analog scale score showed improvements in this score (MCID, 2) and all studies reporting the Disabilities of the Arm, Shoulder and Hand score showed improvements in this score (MCID, 10). Most complications recovered without any treatment, and 3 patients (2.29%) needed a reoperation. CONCLUSIONS: Arthroscopic transosseous foveal repair of the TFCC resulted in improvements in grip strength and functional outcomes with low complication and reoperation rates. However, the evidence for which technique produces better clinical outcomes remains limited. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.

"Dietary supplementation of L-tryptophan" increases muscle development, adipose tissue catabolism and fatty acid transportation in the muscles of Hanwoo steers.

This study investigated the effects of dietary rumen-protected L-tryptophan (TRP) supplementation (43.4 mg of L-tryptophan kg-1 body weigt [BW]) for 65 days in Hanwoo steers on muscle development related to gene expressions and adipose tissue catabolism and fatty acid transportation in longissimus dorsi muscles. Eight Hanwoo steers (initial BW = 424.6 kg [SD 42.3]; 477 days old [SD 4.8]) were randomly allocated to two groups (n = 4) of control and treatment and were supplied with total mixed ration (TMR). The treatment group was fed with 15 g of rumen-protected TRP (0.1% of TMR as-fed basis equal to 43.4 mg of TRP kg-1 BW) once a day at 0800 h as top-dressed to TMR. Blood samples were collected 3 times, at 0, 5, and 10 weeks of the experiment, for assessment of hematological and biochemical parameters. For gene study, the longissimus dorsi muscle samples (12 to 13 ribs, approximately 2 g) were collected from each individual by biopsy at end of the study (10 weeks). Growth performance parameters including final BW, average daily gain, and gain to feed ratio, were not different (p > 0.05) between the two groups. Hematological parameters including granulocyte, lymphocyte, monocyte, platelet, red blood cell, hematocrit, and white blood cell showed no difference (p > 0.05) between the two groups except for hemoglobin (p = 0.025), which was higher in the treatment than in the control group. Serum biochemical parameters including total protein, albumin, globulin, blood urea nitrogen, creatinine phosphokinase, glucose, nonesterified fatty acids, and triglyceride also showed no differences between the two groups (p > 0.05). Gene expression related to muscle development (Myogenic factor 6 [MYF6], myogenine [MyoG]), adipose tissue catabolism (lipoprotein lipase [LPL]), and fatty acid transformation indicator (fatty acid binding protein 4 [FABP4]) were increased in the treatment group compared to the control group (p < 0.05). Collectively, supplementation of TRP (65 days in this study) promotes muscle development and increases the ability of the animals to catabolize and transport fat in muscles due to an increase in expressions of MYF6, MyoG, FABP4, and LPL gene.

In Vitro and In Vivo Studies of Rumen-Protected Microencapsulated Supplement Comprising Linseed Oil, Vitamin E, Rosemary Extract, and Hydrogenated Palm Oil on Rumen Fermentation, Physiological Profile, Milk Yield, and Milk Composition in Dairy Cows.

The aim of the present study was to evaluate the effects of adding dietary rumen-protected microencapsulated supplements into the ruminal fluid on the milk fat compositions of dairy cows. These supplements comprised linseed oil, vitamin E, rosemary extract, and hydrogenated palm oil (MO; Microtinic® Omega, Vetagro S.p.A, Reggio Emilia, Italy). For in vitro ruminal fermentation, Holstein-Friesian dairy cows each equipped with a rumen cannula were used to collect ruminal fluid. Different amounts (0%, 1%, 2%, 3%, 4%, and 5%) of MO were added to the diets to collect ruminal fluids. For the in vivo study, 36 Holstein-Friesian dairy cows grouped by milk yield (32.1 ± 6.05 kg/d/head), days in milk (124 ± 84 d), and parity (2 ± 1.35) were randomly and evenly assigned to 0.7% linseed oil (LO; as dry matter (DM) basis) and 2% MO (as DM basis) groups. These two groups were fed only a basal diet (total mixed ration (TMR), silage, and concentrate for 4 weeks) (period 1). They were then fed with the basal diet supplemented with oil (0.7 LO and 2% MO of DM) for 4 weeks (period 2). In the in vitro experiment, the total gas production was found to be numerically decreased in the group supplemented with 3% MO at 48 h post in vitro fermentation. A reduction of total gas production (at 48 h) and increase in ammonia concentration (24 h) were also observed in the group supplemented with 4% to 5% MO (p < 0.05). There were no differences in the in vitro fermentation results, including pH, volatile fatty acids, or CH4 among groups supplemented with 0%, 1%, and 2% MO. The results of the in vitro study suggest that 2% MO is an optimal dosage of MO supplementation in cows' diets. In the in vivo experiment, the MO supplement more significantly (p < 0.01) increased the yield of total w3 fatty acids than LO (9.24 vs. 17.77 mg/100 g milk). As a result, the ratio of total omega-6 to omega-3 fatty acids was decreased (p < 0.001) in the MO group compared to that in the LO group (6.99 vs. 3.48). However, the milk yield and other milk compositions, except for milk urea nitrogen, were similar between the two groups (p > 0.05). Collectively, these results suggest that the dietary supplementation of 2% MO is beneficial for increasing omega-3 fatty acids without any negative effects on the milk yield of dairy cows.

Spalling Resistance of Fiber-Reinforced Ultra-High-Strength Concrete Subjected to the ISO-834 Standard Fire Curve: Effects of Thermal Strain and Water Vapor Pressure.

The prevention and mitigation of spalling in high-strength concrete (HSC) rely on mixing polypropylene (PP) as an additive reinforcement. The dense internal structures of ultra-high-strength concrete (UHSC) result in risks associated with a high thermal stress and high water vapor pressure. Herein, the effects of pore formation and thermal strain on spalling are examined by subjecting fiber-laden UHSC to conditions similar to those under which the ISO-834 standard fire curve was obtained. Evaluation of the initial melting properties of the fibers based on thermogravimetric analysis (TGA) and differential thermal analysis (DTA) demon strated that although nylon fibers exhibit a higher melting point than polypropylene and polyethylene fibers, weight loss occurs below 200 °C. Nylon fibers were effective at reducing spalling in UHSC compared to polypropylene and polyethylene fibers as they rapidly melt, leading to pore formation. We anticipate that these results will serve as references for future studies on the prevention of spalling in fiber-reinforced UHSC.

Use of the Bridge Plate Technique for the Treatment of Hamatometacarpal Fracture-Dislocations.

Background: This study aimed to describe a novel surgical technique in which a bridge plate was used for the treatment of hamatometacarpal fracture-dislocations and to assess its radiologic and clinical outcomes. Methods: A retrospective review of 16 patients treated with the bridge plate technique for hamatometacarpal fracture-dislocations was performed between 2010 and 2015. Clinical and radiographic evaluations were performed at months 3, 6, and 12 postoperatively. Active wrist and metacarpophalangeal joint ranges of motion and Quick Disabilities of Arm, Shoulder, and Hand (DASH) scores were recorded for the injured hands. Grip strength data were collected for both the injured hands and the contralateral uninjured hands. Results: All patients included in our study were male (mean age 31 years). The average Quick DASH score was 24.3 ± 9.1 at 3 months, 12.3 ± 7.3 at 6 months, and 6.2 ± 6.6 at 12 months. All patients returned to their original jobs within 5 weeks of the procedure. Grip strength eventually recovered to 90% of that of the uninjured hand, and none of the patients complained of finger or wrist joint stiffness. Conclusions: The use of the bridge plate technique may be an effective alternative treatment for patients with comminuted hamatometacarpal fracture-dislocations.