Surgery within 6 months of an acute rotator cuff tear significantly improves outcome.

BACKGROUND: To determine the effect of time to repair on the outcome after an acute rotator cuff tear. METHODS: We performed a retrospective analysis of prospectively collected data on patients presenting with acute rotator cuff tear to our shoulder clinic. Patient-reported outcomes were assessed using the Oxford Shoulder Score, and symptomatic retears were diagnosed by clinical assessment plus imaging. RESULTS: Twenty patients underwent rotator cuff repair within 6 months of injury via initial referral through the Acute Shoulder Injury Clinic (early repair group; mean age, 60 years; age range, 39-77 years). Twenty age- and sex-matched patients were identified who had undergone delayed repair (6-18 months after injury; mean age, 60 years; age range, 40-78 years). The mean follow-up period was 10 months for the early repair group versus 11 months for the delayed repair group. Both groups had clinically significant improvements in their Oxford scores, although the early repair group had an improvement that was nearly double that of the delayed repair group (20.3 for early vs 10.4 for delayed, P = .0014). Postoperative Oxford scores were significantly higher in the early repair group (mean of 43.8 for early vs 35.8 for delayed, P = .0057). There were 2 symptomatic retears in the early repair group versus 5 in the delayed repair group. CONCLUSION: Our results show improved outcomes with early repair (within 6 months) of acute rotator cuff tears and support the provision of an acute shoulder injury referral clinic.

Outcome following first metatarsophalangeal joint replacement using TOEFIT-PLUS™: A mid term alert.

BACKGROUND: We aim to evaluate the mid-term results of first metatarsophalangeal joint replacement for hallux rigidus using Toefit-Plus™ in a single surgeon series. METHODS: We prospectively studied the outcomes of 86 toes in 73 patients using the AOFAS-HMI score and radiological follow up. The mean follow up was 33 months (2-72). Ten patients have been lost to follow up. RESULTS: Eight patients sustained intraoperative fractures or impending fractures requiring circlage wiring. Eighteen joints have either been revised or listed for revision giving a revision rate of 24%; this occurred at a mean of 33 months post-surgery. CONCLUSIONS: First MTPJ replacement is an option in hallux rigidus and patients who are not revised experience significant improvement in AOFAS scores in the medium term. We have previously published satisfactory results with this prosthesis. However the revision rate is unacceptably high and we have discontinued its use completely. Future design evolutions should address the issue of osteointegration on the phalangeal side.

Early results of first metatarsophalangeal joint replacement using the ToeFit-Plus™ prosthesis.

The aim of the present study was to investigate the outcomes of first metatarsophalangeal replacement for hallux rigidus using the Smith & Nephew ToeFit-Plus™ implant. We assessed the outcomes of 69 first metatarsophalangeal joint replacements using the American Orthopaedic Foot and Ankle Society score preoperatively and annually postoperatively, with retrospective radiologic review. All operations were performed by the same surgeon within 2 centers. A total of 69 arthroplasties were performed within the study period (57 patients). The median American Orthopaedic Foot and Ankle Society score at 1 year was 100 (interquartile range 100 to 100), at 2 years was 100 (interquartile range 95 to 100), at 3 years was 100 (interquartile range 87.5 to 100), and at 4 years, it was 100 (interquartile range 91.25 to 100). Radiolucencies around the phalangeal component were seen in 23 cases; however, this was symptomatic in only 2 patients, who required revision surgery. Our early results have shown that first metatarsophalangeal joint replacement surgery with the ToeFit-Plus™ prosthesis results in significant improvements in the American Orthopaedic Foot and Ankle Society scores for most patients; however, longer term follow-up is required to monitor the clinical effect of radiolucency around the phalangeal component.

Solitary fibrous tumor of the parapharyngeal space: report of 2 cases and a literature review.

The solitary fibrous tumor (SFT) is usually described as a lesion arising from the pleura. Rarely, it has been described in the parapharyngeal space (PS). This study aims to report two cases of SFT in the PS and to perform a literature review on this topic. Two patients undergoing surgical resection of a SFT in the PS, were reported. A literature review on SFT of the PS, was also performed. Two patients were analyzed. Both patients underwent surgical resection, followed by adjuvant radiotherapy, for SFT arising from the PS. The postoperative course was uneventful and both patients recovered well after the procedure. No recurrences were diagnosed during the followup. SFT of the PS is an infrequent entity. Surgical resection is the most used treatment, and adjuvant radiation should be considered in patients with recurrence risk factors or distant metastases.

Current standards of lymphadenectomy in gastric cancer.

Gastric cancer remains the 5th most common cancer and the 3rd most common cause of cancer mortality. Most patients diagnosed with gastric cancer still have a poor prognosis due to its advanced presentation at diagnosis, even in countries with developed screening programs. Surgery is the cornerstone of the treatment for gastric cancer, often combined with perioperative chemotherapy. Lymph node dissection is a crucial component of the surgical treatment of gastric cancer. D1 lymphadenectomy is currently recommended for early stage tumors. The extent of lymphadenectomy in advanced gastric cancer, however, is still a matter of debate between Eastern and Western surgeons. Although a D2 dissection is the current standard recommended by most guidelines, there might be a place for more limited dissections such as D1 + in selected cases. This evidence-based review will help defining the optimal lymphadenectomy for patients with gastric cancer.

Tracking electricity losses and their perceived causes using nighttime light and social media.

Urban environments are intricate systems where the breakdown of critical infrastructure can impact both the economic and social well-being of communities. Electricity systems hold particular significance, as they are essential for othe infrastructure, and disruptions can trigger widespread consequences. Typically, assessing electricity availability requires ground-level data, a challenge in conflict zones and regions with limited access. This study shows how satellite imagery, social media, and information extraction can monitor blackouts and their perceived causes. Nighttime light data (in March 2019 for Caracas, Venezuela) are used to indicate blackout regions. Twitter data are used to determine sentiment and topic trends, while statistical analysis and topic modeling delved into public perceptions regarding blackout causes. The findings show an inverse relationship between nighttime light intensity and Twitter activity. Tweets mentioning the Venezuelan President displayed heightened negativity and a greater prevalence of blame-related terms, suggesting a perception of government accountability for the outages.

Roles for the Synechococcus elongatus RNA-Binding Protein Rbp2 in Regulating the Circadian Clock.

The cyanobacterial circadian oscillator, consisting of KaiA, KaiB, and KaiC proteins, drives global rhythms of gene expression and compaction of the chromosome and regulates the timing of cell division and natural transformation. While the KaiABC posttranslational oscillator can be reconstituted in vitro, the Kai-based oscillator is subject to several layers of regulation in vivo. Specifically, the oscillator proteins undergo changes in their subcellular localization patterns, where KaiA and KaiC are diffuse throughout the cell during the day and localized as a focus at or near the pole of the cell at night. Here, we report that the CI domain of KaiC, when in a hexameric state, is sufficient to target KaiC to the pole. Moreover, increased ATPase activity of KaiC correlates with enhanced polar localization. We identified proteins associated with KaiC in either a localized or diffuse state. We found that loss of Rbp2, found to be associated with localized KaiC, results in decreased incidence of KaiC localization and long-period circadian phenotypes. Rbp2 is an RNA-binding protein, and it appears that RNA-binding activity of Rbp2 is required to execute clock functions. These findings uncover previously unrecognized roles for Rbp2 in regulating the circadian clock and suggest that the proper localization of KaiC is required for a fully functional clock in vivo.

Aberrant methylmalonylation underlies methylmalonic acidemia and is attenuated by an engineered sirtuin.

Organic acidemias such as methylmalonic acidemia (MMA) are a group of inborn errors of metabolism that typically arise from defects in the catabolism of amino and fatty acids. Accretion of acyl-CoA species is postulated to underlie disease pathophysiology, but the mechanism(s) remain unknown. Here, we surveyed hepatic explants from patients with MMA and unaffected donors, in parallel with samples from various mouse models of methylmalonyl-CoA mutase deficiency. We found a widespread posttranslational modification, methylmalonylation, that inhibited enzymes in the urea cycle and glycine cleavage pathway in MMA. Biochemical studies and mouse genetics established that sirtuin 5 (SIRT5) controlled the metabolism of MMA-related posttranslational modifications. SIRT5 was engineered to resist acylation-driven inhibition via lysine to arginine mutagenesis. The modified SIRT5 was used to create an adeno-associated viral 8 (AAV8) vector and systemically delivered to mutant and control mice. Gene therapy ameliorated hyperammonemia and reduced global methylmalonylation in the MMA mice.

Models of care for chronic myeloid leukemia patients during the COVID-19 pandemic in the United Kingdom: Changes in patient attitudes to remote consultations and future implications.

The ongoing COVID-19 pandemic has presented numerous challenges to the provision of patient care within hematology. We undertook a questionnaire-based study investigating the experiences and opinions of patients with chronic myeloid leukemia (CML) in the UK in relation to the different models of follow-up care received during the pandemic. One hundred fifty-four patients completed the online questionnaire. Only 19% of patients had experienced remote clinics prior to the pandemic compared with 91% afterward. After having experience of remote clinics, the proportion of patients who were positive about the remote clinic concept increased from 34% to 52% (P < .05). However, when asked to compare their experiences with face to face versus remote clinics, 48% preferred face-to-face clinics compared with 17% preferring remote clinics (35% expressed no preference). During the pandemic, frequency of blood tests was unchanged for 71% of patients, although they were performed in a number of different locations. The majority of patients (57%) had medication delivered to their home, with a small number (8%) having difficulty obtaining their medication. In terms of future models of care, 72% of patients were in favor of building remote appointments into the clinic model with 61% expressing a preference for a mixture of remote and face-to-face appointments. There was also interest in greater utilization of primary care for blood testing. Our findings should help optimize future models of care for CML patients.

Prediction of intravenous cyclosporine area under the concentration-time curve after allogeneic stem cell transplantation.

Currently, routine monitoring of cyclosporine in patients undergoing allogeneic stem cell transplantation is based on analysis of trough, or C0, predose concentrations. However, recent studies in solid organ transplant recipients have demonstrated that monitoring cyclosporine exposure by analyzing 2-hour postdose concentrations (C2) or area under the concentration-time curve (AUC) may improve clinical outcome. This study investigated the ability of single samples to predict exposure to intravenous cyclosporine in eight patients undergoing allogeneic stem cell transplantation. Patients received cyclosporine at a starting dose of 2.5 mg/kg 12-hourly by intravenous infusion over 4 hours. Blood samples were taken at 0, 1, 2, 3, 4, 4.17, 4.33, 4.67, 5, 6, 8, and 12 hours after the start of the infusion. Linear regression was undertaken to investigate the relationship between AUC and concentrations measured at individual time points; bias and precision were also examined. Cyclosporine doses ranged from 250 mg to 430 mg/day, AUC from 3.85 to 8.39 mg.h/L, clearance from 19.1 to 48.1 L/h, and elimination half-life from 3.7 to 15.5 hours. Although Cmax and the concentration measured at 3 hours (C3) provided the best prediction of AUC (r = 0.90 and r = 0.87, respectively), the infusion protocol made the time of Cmax difficult to predict. Concentrations measured at the end of the infusion (Cend) and 12 hours postdose (C12) gave similar results (r = 0.87 and 0.77, respectively). These data suggest that C12 concentrations provide an acceptable marker of total exposure to intravenous cyclosporine in patients undergoing allogeneic stem cell transplantation.

Case report of pigmented villonodular synovitis arising from the calcaneocuboid joint in a 12 year old male.

INTRODUCTION: Pigmented villonodular synovitis (PVNS) is a benign proliferative disorder of the synovium of unknown aetiology. It usually presents in adults between the ages of 30 and 40 years of age and is rare in the paediatric population. In the literature, there are a total of 43 cases of PVNS affecting the paediatric population and only one case affecting the calcaneocuboid joint. METHODS: We report a case of diffuse PVNS affecting the calcaneocuboid joint of a 12 year old male. The patient presented with a 3 month history of a painless swelling affecting the lateral aspect of the hindfoot region with no preceding history of trauma. Examination revealed a lesion which was firm in texture, originating in the region of the calcaneocuboid joint, and clinically appeared to originate from deeper structures with no overlying skin changes or warmth. Routine blood tests were within normal limits. Radiographs demonstrated an erosive lesion into the calcaneocuboid joint and magnetic resonance imaging demonstrated a lesion consistent with PVNS. RESULTS: Following surgical excision of the lesion, the patient recovered to full activities after a brief period of immobilisation in plaster to allow wound healing. At six months follow-up, there was no evidence of recurrence. CONCLUSIONS: Our case report of PVNS involving the calcaneocuboid joint is only the second report in the literature and highlights the importance of considering PVNS as a differential diagnosis in children presenting with swelling of the foot and ankle with normal blood and clinical parameters. The combination of the case report along with radiographic and magnetic resonance imaging and intra-operative photographs also aids the reader in understanding of the condition.