Biomechanical Characterization of a New Locking Loop Stitch for Graft Fixation versus Krackow Stitch

Background@#The purpose of this study was to quantify and compare the biomechanical characteristics of a new locking loop stitch (LLS), developed utilizing the concepts of both running locking stitch and needleless stitch, to the traditional Krackow stitch. @*Methods@#The Krackow stitch with No.2 braided suture and the LLS with 1.3-mm augmented polyblend suture tape were compared biomechanically. The LLS was performed with single strand locking loops and wrapping suture around the tendon, resulting in half the needle penetrations through the graft compared to the Krackow stitch. Twenty bovine extensor tendons were divided randomly into two groups. The tendons were prepared to match equal thickness and cross-sectional area. Each suture-tendon was stitched and preloaded to 5 N for 60 seconds, cyclically loaded to 20 N, 40 N, and 60 N for 10 cycles each, and then loaded to failure. The deformation of the suture-tendon construct, stiffness, yield load, and ultimate load were measured. @*Results@#The LLS had significantly less deformation of the suture-tendon construct at 100 N, 200 N, 300 N, and at ultimate load compared to the Krackow stitch (Krackow stitch and LLS at 100 N: 1.3 ± 0.1 mm and 1.0 ± 0.2 mm, p < 0.001; 200 N: 3.0 ± 0.3 mm and 1.9 ± 0.2 mm, p < 0.001; 300 N: 5.1 ± 0.6 mm and 2.9 ± 0.4 mm, p < 0.001; ultimate load: 12.8 ± 2.8 mm and 5.0 ± 1.2 mm, p < 0.001).The LLS had significantly greater stiffness (Krackow stitch and LLS: 97.5 ± 6.9 N/mm and 117.2 ± 13.9 N/mm, p < 0.001) and yield load (Krackow stitch and LLS: 66.2 ± 15.9 N and 237.9 ± 93.6 N, p < 0.001) compared to the Krackow stitch. There was no significant difference in ultimate load (Krackow stitch: 450.2 ± 49.4 N; LLS: 472.6 ± 59.8 N; p = 0.290). @*Conclusions@#The LLS had significantly smaller deformation of the suture-tendon construct compared to the Krackow stitch. The LLS may be a viable surgical alternative to the Krackow stitch for graft fixation when secure fixation is necessary.

Does Knee Arthroscopy for Treatment of Meniscal Damage with Osteoarthritis Delay Knee Replacement Compared to Physical Therapy Alone?

Background@#To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty. @*Methods@#Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores. A Cox proportional hazards model was used to estimate the risk of knee replacement surgery and greater healthcare utilization associated with KA vs. PT-only. @*Results@#Among 7,026 patients (KA, 69%; PT-only, 31%), 27% had partial or total knee replacement surgery during follow-up.PT-only patients were older and more likely to be women and had more comorbidities. After accounting for differences between groups, the cumulative incidence of knee replacement was modestly but significantly higher for those who received KA than those who underwent PT-only (hazard ratio, 1.30; 95% confidence interval, 1.17–1.44; p < 0.001), although there was no significant difference in health service utilization, narcotic medication dispenses, or knee injections after initiating treatment. @*Conclusions@#For patients with meniscal damage complicated by OA, those who underwent KA were 30% more likely to have partial or total knee replacement surgery at any given time than those who had PT alone.

The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery

Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.

Advances in epidemiological studies regarding related psychosocial risk factors on the incidence of diabetes mellitus / 中华流行病学杂志

Both the increasing prevalence and growing burden of diabetes mellitus have caused global public health concerns. With the development of bio-psycho-social medical model, the impact of psychosocial factors on diabetes has attracted more attentions among the researchers. This paper summarizes findings from epidemiological studies that focusing on the association between diabetes and related psychosocial risk factors. Foreign studies have shown that psychological factors are closely related to diabetes, but the conclusions on social factors are inconsistent. Domestic studies have only targeted on small-sample-sized and cross-sectional studies. More longitudinal research is needed to confirm the impact of psychosocial factors on the risk of diabetes.

Seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China / 中华流行病学杂志

Objective: To understand the seasonal distribution of patient hospitalization due to asthma exacerbation in 7 geographic areas in China. Methods: This was a retrospective study which involved patients hospitalized for asthma exacerbation in 29 hospitals throughout 7 geographic areas in the mainland of China (northeast, north, central, east, south, northwest and southwest). The numbers of asthmatic patients and total inpatients of the respiratory department of each hospital were recorded. The monthly ratio of asthmatic patients to the total inpatients in every area was calculated and compared. Results: During the study period, 6 480 patients were admitted for asthma exacerbation, accounting for 3.14% of all the 206 135 patients admitted to the respiratory departments in the 29 hospitals. The ratio of asthmatic patients to total inpatients in the northeast area (5.61%) was highest, and the ratio in east area was lowest (1.97%). Statistical analysis showed that the difference among different areas was significant (P<0.000 1). In most areas, both the number and proportion of hospitalized asthmatic patients peaked in spring (February-April) and autumn (September-October). In the northeast area, east area and south area, the peaks in spring were more obvious, while in the north area and southwest area, the peaks in autumn were more obvious. In the northwest area the peaks occurred in winter (December-January) and summer (June-August), respectively. The differences in hospitalization due to asthma among different months were significant in the northeast, north, and southwest areas (P<0.005). Conclusion: The number of patients hospitalized for asthma exacerbation fluctuated with season in different areas in China. In most areas, more asthmatic patients were admitted to hospitals in spring and autumn.

Skeletal muscle metastasis from renal cell carcinoma: 21 cases and review of the literature

This study aimed to raise radiologists' awareness of skeletal muscle metastases [SMM] in renal cell carcinoma [RCC] cases and to clarify their imaging appearance. A retrospective analysis was undertaken of 21 patients between 44-75 years old with 72 SMM treated from January 1990 to May 2009 at the MD Anderson Cancer Center in Houston, Texas, USA. Additionally, 37 patients with 44 SMM from a literature review were analysed. Among the 21 patients, the majority of SMM were asymptomatic and detected via computed tomography [CT]. Mean metastasis size was 18.3 mm and the most common site was the trunk muscles [83.3%]. The interval between discovery of the primary tumour and metastasis detection ranged up to 234 months. Peripheral enhancement [47.1%] was the most common post-contrast CT pattern and non-contrasted CT lesions were often isodense. Magnetic resonance imaging [MRI] characteristics were varied. Five lesions with available T1-weighted pre-contrast images were hyperintense to the surrounding muscle. Other organ metastases were present in 20 patients. Of the 44 SMM reported in the literature, the majority were symptomatic. Average metastasis size was 53.4 mm and only 20.5% of SMM were in trunk muscles. The average interval between tumour discovery and metastasis detection was 101 months. Other organ metastases were recorded in 17 out of 29 patients. SMM should always be considered in patients with RCC, even well after primary treatment. SMM from RCC may be invisible on CT without intravenous contrast; contrast-enhanced studies are therefore recommended. SMM are often hyperintense to the surrounding muscle on T1-weighted MRI scans

Immune Activation and Gut Microbes in Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a highly prevalent disorder that is characterized by chronic abdominal pain and altered bowel habit. The diagnosis of IBS has traditionally been made by matching the complaints of the patient with established clinical criteria, since the underlying pathophysiology was not known. Various new findings have recently been reported in IBS patients that challenge our concept of IBS as a syndrome with no explanation. While the florid inflammation characteristic of inflammatory bowel disease is absent in IBS, changes suggesting immune activation are present in nearly all IBS patients. Is IBS an autoimmune disease, or is the immune activation responding to a trigger? In this review we present evidence that points to a state of immune activation in IBS and show data that suggest that small intestinal bacterial overgrowth triggers immune activation in IBS.

Airborne polybrominated diphenyl ethers in a computer classroom of college in Taiwan

This study characterized the airborne exposure of students to thirty polybrominated diphenyl ether congeners inside and outside a computer classroom in a southern Taiwan college. Arithmetic mean values of total indoor and outdoor polybrominated diphenyl ether concentrations were 125.0 pg/m3 [89.8 to 203.9 pg/m3] and 110.3 pg/m3 [83.5 to 157.0 pg/m3], respectively. Total indoor polybrominated diphenyl ether concentrations were one order of magnitude lower than those detected in homes in Birmingham, United Kingdom and in Ottawa, Canada but were several times higher than those measured in the ambient air in Ottawa, Canada and from the Bohai Sea to the Arctic. The five highest indoor concentrations of polybrominated diphenyl ether congeners were decabromodiphenyl ether [23.0 pg/m3], 4,4'-dibromodiphenyl ether [15.9 pg/m3], 2,2',3,4,4',5,5',6-octabromodiphenyl ether [10.6 pg/m3], 2,4-dibromodiphenyl ether [10.3 pg/m3] and 2,2',3,4,4',5',6-heptabromodiphenyl ether [10.0 pg/m3]. Although indoor and outdoor total polybrominated diphenyl ether concentrations did not significantly differ, the indoor concentrations of 2,4-dibromodiphenyl ether, 2,2',4-tribromodiphenyl ether, 2,4,4'-tribromodiphenyl ether, 2,2',4,5'-tetrabromodiphenyl ether and 2,3',4',6-tetrabromodiphenyl ether were significantly higher than their outdoor concentrations. This study suggests the following measures: 1] to increase the air exchange rate and open classroom doors and windows for several minutes before classes to reduce indoor PBDE concentrations; 2] to reduce polybrominated diphenyl ether emissions from new devices, it's better to use computer-related products that meet the Restriction of Hazardous Substances Directive adopted by the European Union

Cancer care in China: A general review

This article is to provide a general overview of cancer in China including the statistics, most common cancers, their epidemiological characteristics and the treatments.

Exposure to ethylene glycol monobutyl ether and related workers habits in an ink factory

Forty six workers fram an ink fzctoy were included in this study in with passive badge sampler and questionnaire interview were used to assess the concentrations of airborne exposure to ethylene glycol monobutyl ether during work shifts and to understand the subjects' working habits. The geometric mean value [95% confidence interval] of the airborne ethylene glycol monobutyl ether concentrations was 0.12 [0.08-0.19] ppm, with a range of <0.02-1.82ppm. The exposure group was exposed to statistically significantly higher ethylene glycol monobutyl ether concentrations than the control group [geometric mean value: Q.l4vs. 0.03ppm; P=0.017]. Some chromatograms showed that subjects were co-exposed to m-xylene, ethylene glycol monomethyl ether, and ethylene glycol monoethyl ether acetate. According to the completed questionnaires, subjects might also be exposed to 1,2,4,5-tetramethylbenzene, propylene glycol ethers, ethanol, 1,2,4-trimethylbenzene, methanol and diisononyl phthalate. This study also suggests that, the Taiwan occupational time-weighted average level of ethylene glycol monobutyl ether be reconsidered with a view to being lowered

Inhibition of EBV-encoded LMP-1 by DNA-based RNA interference affects metastatic ability of nasopharyngeal carcinoma cells / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To evaluate the application of DNA vector-based RNA interference for silencing LMP-1 expression in EBV-positive nasopharyngeal cancer (NPC) C611 cells and analyze the inhibiting effects of LMP-1 silencing on metastatic property of NPC cells.</p><p><b>METHODS</b>DNA vectors with LMP-1 shRNA template were transfected into C611 cells. After G418 selection, a LMP-1 silenced sub-clone named C611L was isolated. Effect of LMP-1 inhibition on its metastatic properties was evaluated by cell adhesion, invasion and wound healing assays.</p><p><b>RESULTS</b>shRNA vector mediated stable RNAi against LMP-1 in C611 cells. Loss of LMP-1 significantly altered cell motility, substratum adhesion and transmembrane invasion ability.</p><p><b>CONCLUSION</b>Stable suppression of LMP-1 induced by shRNA vector can inhibit metastatic properties of NPC cells.</p>