Effectiveness of suture anchor and transosseous suture technique in arthroscopic foveal repair of the triangular fibrocartilage complex: a systematic review.

BACKGROUND: Currently, there were two major surgical methods for arthroscopic triangular fibrocartilage complex (TFCC) foveal repair: suture anchor (SA) and transosseous suture (TOS). The purpose of this systematic review is to examine the relevant outcome improvement and safety of SA and TOS technique. METHODS: Literature review of electronic databases for studies investigating the effects of SA and TOS in patients undergoing arthroscopic TFCC foveal repair was performed. We compared the pre-operative and postoperative functional outcomes, clinical outcomes [pain, range of motion (ROM) and grip strength], and complications of two methods. Minimal clinically important difference (MCID) was used to determine clinically meaningful improvement. RESULTS: There were 1263 distinct studies identified, with 26 (904 patients) meeting the inclusion criteria. The mean age of participants ranged from 21.4 to 41 years, and the mean follow-up time ranged from 6 to 106 months. Both SA and TOS groups reported significant improvement in the modified mayo wrist score, the disabilities of the arm, shoulder, and hand (DASH) score, quick DASH score, patient-reported wrist evaluation (PRWE) score, and the visual analog scale (VAS) score. According to MCID, all the studies from both groups reporting DASH, quick DASH, PRWE and VAS score achieved clinically meaningful improvement. (MCID: 10 for DASH, 14 for quick DASH, 14 for PRWE and 1.6-18 for VAS). The ROM changes in both groups varied from improvement to deterioration. Grip strength improved in both SA and TOS group. Most complications were self-limited. The reoperation rates in SA and TOS ranged from 0 to 20% and 0 to 27.3%, respectively. CONCLUSIONS: Both SA and TOS technique for arthroscopic TFCC foveal repair could achieve improvement in postoperative functional outcomes, pain, and grip strength with low reoperation rate. However, the ROM improvement was still inconclusive. LEVEL OF EVIDENCE IV: Systematic review of level III and IV studies.

Suprapatellar vs infrapatellar approaches for intramedullary nailing of distal tibial fractures: a systematic review and meta-analysis.

BACKGROUND: This review was conducted to compare the efficacy of suprapatellar (SP) and infrapatellar (IP) approaches for treating distal tibial fractures with intramedullary nailing. METHOD: This systematic review included studies comparing the outcomes of patients receiving nailing for distal tibial fractures using the SP and IP approaches. We searched the Cochrane CENTRAL, MEDLINE and Embase databases for relevant studies till 18th Sep. 2022. We used the Newcastle Ottawa Scale to assess study quality and a random-effects meta-analysis to synthesize the outcomes. We used the mean difference (MD) or standardized mean difference (SMD) with the 95% confidence interval (CI) for continuous data and the odds ratio (OR) with the 95% CI for dichotomous data. RESULTS: Four studies with 586 patients (302 in the SP group and 284 in the IP group) were included in this systematic review. The SP group may have had little or no difference in pain and slightly better knee function (MD 3.90 points, 95% CI 0.83 to 5.36) and better ankle function (MD: 8.25 points, 95% CI 3.35 to 13.15) than the IP group 12 months after surgery. Furthermore, compared to the IP group, the SP group had a lower risk of malalignment (OR: 0.22, 95% CI 0.06 to 0.75; number needed to treat (NNT): 6), a lower risk for open reduction (OR: 0.58, 95% CI 0.35 to 0.97; NNT: 16) and a shorter surgical time (MD: - 15.14 min, 95% CI - 21.28 to - 9.00). CONCLUSIONS: With more advantages, the suprapatellar approach may be the preferred nailing technique over the infrapatellar approach when treating distal tibial fractures. LEVEL OF EVIDENCE: Level III, systematic review of non-randomized studies.

Treatment of Refractory Congenital Pseudoarthrosis of Tibia with Contralateral Vascularized Fibular Bone Graft and Anatomic Distal Tibial Locking Plate: A Case Series and Literature Review.

BACKGROUND: Congenital pseudoarthrosis of the tibia (CPT) remains a challenge for physicians. Several treatment options have been proposed, but the standard of care remains inconclusive. In this study, we present three patients for whom the failure of prior treatments was managed with a contralateral vascularized fibular bone graft (VFG) and an anatomic distal tibial locking plate. METHODS: Between 2017 and 2021, three patients were referred for failed treatment of CPT. All patients had undergone multiple prior surgeries, including tumor excision and fixation with ring external fixators, plates, and screws. We performed radical tumor resection and reconstruction of bone defects with a VFG. The construct was fixed with an anatomic locking plate, and the patients were followed up for a mean of 45.7 months. RESULTS: All three patients were able to obtain graft union at 19.3 weeks. At the final follow-up, all grafts achieved bony hypertrophy without evidence of bone resorption or local tumor recurrence. There was a mean leg length difference of 8.5 cm preoperatively, compared with 6.3 cm postoperatively. The average lower leg angulation was 7.4 degrees and the average ankle range of motion was 58.3 degrees. The mean VAS score was 0 and the mean AOFAS score was 88.3. No significant complications were noted. CONCLUSIONS: Implantation of a VFG and an anatomic distal tibia locking plate can be considered an option for treatment-refractory CPT. Patients can expect to achieve bone consolidation, ambulate as tolerated, and have a low complication rate.

Arthroscopic transosseous foveal footprint repair of the triangular fibrocartilage complex.

Foveal disruption of the triangular fibrocartilage complex contributes to the instability of distal radioulnar joint. We have developed an arthroscopic transosseous foveal footprint repair technique, which maximizes the contact between the disrupted triangular fibrocartilage complex and its foveal footprint for better healing by using four sutures in a divergent configuration through a 1.6-mm bone tunnel. Twelve patients with triangular fibrocartilage complex foveal injuries who had undergone this repair technique were reviewed with a mean follow-up of 53 months. All patients achieved significant improvement in the modified Mayo wrist score and the Disabilities of the Arm, Shoulder and Hand score. All patients had stable distal radioulnar joints with comparable ranges of motion and grip strengths between the operated and contralateral wrists. There was no significant difference in functional score in those who were treated more than 6 months after injury.Level of evidence: IV.

Influential factors of surgical decompression for ulnar nerve neuropathy in Guyon's canal.

BACKGROUND: Guyon's canal syndrome is nerve compressive pathology which can lead to sensory and/or motor function deficits. This problem is usually difficult to distinguish from cubital tunnel syndrome and relatively less common than cubital tunnel syndrome. This study evaluated the functional results and patient-reported outcomes following decompression of the ulnar nerve in Guyon's canal. METHODS: Patients who were diagnosed with Guyon's canal syndrome confirmed by electrodiagnostic studies and underwent nerve decompression surgery were included in this study. The functional improvement by examining the Froment's sign, Wartenberg's sign, static two-point discrimination, and Semmes Weinstein monofilament examination as physical examination scores was evaluated. The visual analogue scale of satisfaction and the disabilities of the arm, shoulder, and hand questionnaire were used for the postoperative patient-reported outcome evaluation. RESULTS: From 2003 to 2019, 38 cases had been enrolled with a mean age of 53 years, ranging from 19 to 85 years. There were seven patients with comorbidity of diabetes mellitus and 28 patients who received additional neurolysis combined with the Guyon's release procedure. There were 19 patients with a good response to surgery and 10 patients with a poor surgical outcome due to persistent paresthesia or weakness. After statistical analysis, it was revealed that several influential factors could have been related to a compromised functional outcome, including a symptom duration of more than 3 months, combination with additional neurolysis of ipsilateral extremity, and/or comorbidity with diabetes mellitus. CONCLUSION: It was concluded that promising functional outcomes after surgical release of ulnar neuropathy in Guyon's canal could be achieved if the patients did not need additional neurolysis or the symptom duration was within 3 months.

Biomechanical, ultrastructural, and electrophysiological characterization of the non-human primate experimental glaucoma model.

Laser-induced experimental glaucoma (ExGl) in non-human primates (NHPs) is a common animal model for ocular drug development. While many features of human hypertensive glaucoma are replicated in this model, structural and functional changes in the unlasered portions of trabecular meshwork (TM) of laser-treated primate eyes are understudied. We studied NHPs with ExGl of several years duration. As expected, ExGl eyes exhibited selective reductions of the retinal nerve fiber layer that correlate with electrophysiologic measures documenting a link between morphologic and elctrophysiologic endpoints. Softening of unlasered TM in ExGl eyes compared to untreated controls was observed. The degree of TM softening was consistent, regardless of pre-mortem clinical findings including severity of IOP elevation, retinal nerve fiber layer thinning, or electrodiagnostic findings. Importantly, this softening is contrary to TM stiffening reported in glaucomatous human eyes. Furthermore, microscopic analysis of unlasered TM from eyes with ExGl demonstrated TM thinning with collapse of Schlemm's canal; and proteomic analysis confirmed downregulation of metabolic and structural proteins. These data demonstrate unexpected and compensatory changes involving the TM in the NHP model of ExGl. The data suggest that compensatory mechanisms exist in normal animals and respond to elevated IOP through softening of the meshwork to increase outflow.

The CCR4-NOT complex contributes to repression of Major Histocompatibility Complex class II transcription.

The multi-subunit CCR4 (carbon catabolite repressor 4)-NOT (Negative on TATA) complex serves as a central coordinator of all different steps of eukaryotic gene expression. Here we performed a systematic and comparative analysis of cells where the CCR4-NOT subunits CNOT1, CNOT2 or CNOT3 were individually downregulated using doxycycline-inducible shRNAs. Microarray experiments showed that downregulation of either CNOT subunit resulted in elevated expression of major histocompatibility complex class II (MHC II) genes which are found in a gene cluster on chromosome 6. Increased expression of MHC II genes after knock-down or knock-out of either CNOT subunit was seen in a variety of cell systems and also in naïve macrophages from CNOT3 conditional knock-out mice. CNOT2-mediated repression of MHC II genes occurred also in the absence of the master regulator class II transactivator (CIITA) and did not cause detectable changes of the chromatin structure at the chromosomal MHC II locus. CNOT2 downregulation resulted in an increased de novo transcription of mRNAs whereas tethering of CNOT2 to a regulatory region governing MHC II expression resulted in diminished transcription. These results expand the known repertoire of CCR4-NOT members for immune regulation and identify CNOT proteins as a novel group of corepressors restricting class II expression.

Endothelial glycocalyx layer in the aqueous outflow pathway of bovine and human eyes.

The glycocalyx layer on the vascular endothelium is known to have an important role as a transport barrier and in the mechanotransduction of fluid shear stress. The detailed structure and distribution of the glycocalyx in the bovine and human aqueous humor outflow pathways has not yet been reported. The purpose of this study was to determine whether this layer exists in the bovine and human aqueous outflow pathways and to compare the distribution and thickness therein. Enucleated bovine (N = 4) and human (N = 4) eyes were fixed using Alcian Blue to preserve the glycocalyx. The glycocalyx distribution and thickness (in regions where it was seen) were measured on the trabecular beams (TM), Schlemm's canal (SC)/aqueous plexus (AP), and collector channels (CC). The glycocalyx, which appears as a layer of hair-like brushes, coats the surface of the endothelium non-uniformly in the bovine and human aqueous outflow pathways with a thickness in bovine eyes of 68-122 nm and in human eyes of 52-166 nm (25th to 75th percentiles). The distribution of the glycocalyx in different regions of the outflow pathway is not the same between bovine and human eyes. In both species, the glycocalyx was most uniform in the CCs. Less coverage of glycocalyx was found in the AP than the TM in bovine eyes, while more coverage was found in SC than the TM in human eyes. Most interestingly, glycocalyx was also found filling most pores of the endothelium of AP/SC in both bovine and human eyes. Glycocalyx was usually not found coating the inner membranes of the giant vacuoles (GVs); however, in GVs with a visible pore, glycocalyx was frequently observed on the inner membranes of the GVs. Based on our findings and those from the vascular endothelium, it is likely that the glycocalyx in SC plays a role in transduction of shear stress and perhaps regulation of outflow resistance.

Morphological and hydrodynamic correlations with increasing outflow facility by rho-kinase inhibitor Y-27632.

Abstract Rho-kinase inhibitors affect actomyosin cytoskeletal networks and have been shown to significantly increase outflow facility and lower intraocular pressure in various animal models and human eyes. This article summarizes common morphological changes in the trabecular meshwork induced by Rho-kinase inhibitors and specifically compares the morphological and hydrodynamic correlations with increased outflow facility by Rho-kinase inhibitor, Y-27632, in bovine, monkey, and human eyes under similar experimental conditions. Interspecies comparison has shown that morphological changes in the juxtacanalicular connective tissue (JCT) of these 3 species were different. However, these different morphological changes in the JCT, no matter if it's separation between the JCT and inner wall in bovine eyes, or separation between the JCT cells or between the JCT cells and their matrix in monkey eyes, or even no separation between the inner wall and the JCT but a more subtle expansion of the JCT in human eyes, appear to correlate with the increased percent change of outflow facility. More importantly, these different morphological changes all resulted in an increase in effective filtration area, which was positively correlated with increased outflow facility in all 3 species. These results suggest a link among changes in outflow facility, tissue architecture, and aqueous outflow pattern. Y-27632 increases outflow facility by redistributing aqueous outflow through a looser and larger area in the JCT.

Effects of Y27632 on aqueous humor outflow facility with changes in hydrodynamic pattern and morphology in human eyes.

PURPOSE: To determine the effect of Y27632, a Rho-kinase inhibitor on aqueous outflow facility, flow pattern, and juxtacanalicular tissue (JCT)/trabecular meshwork (TM) morphology in human eyes. METHODS: Sixteen enucleated human eyes were perfused with PBS plus glucose (GPBS) at 15 mm Hg to establish the baseline outflow facility. Six eyes were perfused for short-duration (30 minute) with either 50 µM Y27632 or GPBS (n = 3 per group). Ten eyes were perfused for long duration (3 hours) with either 50 µM Y27632 or GPBS (n = 5 per group). Outflow pattern was labeled using fluorescent microspheres, and effective filtration length (EFL) was measured. Morphologic changes and their relationship to EFL and facility were analyzed. RESULTS: Outflow facility significantly increased after short-duration perfusion with Y27632 compared with its own baseline (P = 0.03), but did not reach statistical significance compared with its controls (P = 0.07). Outflow facility (P = 0.01) and EFL (P < 0.05) were significantly increased after long-duration perfusion with Y27632 compared with its controls. Increases in outflow facility and EFL demonstrated a positive correlation. Morphologically, the TM and JCT of high-tracer regions were more expanded compared with low-tracer regions. A significant increase in JCT thickness was found in the long-duration Y27632 group compared with its control group (10.0 vs. 8.0 µm, P < 0.01). CONCLUSIONS: Y27632 increases outflow facility in human eyes. This increase correlates positively with an increase in EFL, which is associated with an increased expansion in the JCT. Our data suggest that EFL could serve as a novel parameter to correlate with outflow facility.

Osteoblastoma in the region of the hip.

Osteoblastoma occurring in the region of the hip is very rare, and vague symptoms with uncharacteristic radiographic features often lead to misdiagnosis. Because of radiographic and histological similarities, it must be carefully distinguished from osteoid osteoma, aneurysmal bone cyst, giant cell tumor, and osteosarcoma. Computed tomography is the preferred imaging modality as it is able to detect the nidus and images will not exhibit the flare phenomenon caused by surrounding inflammation seen with magnetic resonance imaging. For hip joint lesions in weight-bearing areas, intralesional curettage may achieve satisfactory outcomes as compared with wide resection. We herein report two cases of osteoblastoma in the hip region in which diagnosis was delayed that were successfully treated with curettage and followed by high-speed burring.

Smad7 siRNA inhibit expression of extracellular matrix in trabecular meshwork cells treated with TGF-ß2.

PURPOSE: Extracellular matrix (ECM) deposits lead to elevated resistance of aqueous humor outflow which play an important role in the development of primary open angle glaucoma (POAG). The TGF-ß2 (transforming growth factor ß)/Smad (signaling mathers against decapentaplegic) pathway is known to regulate the ECM deposits. In this study, we determined the effect of Smad7 siRNA transfection in inhibiting the expression of ECM components. METHODS: Plasmid containing Smad7 siRNA was used to transfect cultured human trabecular meshwork cells (HTM). Protein expression of Smad7, fibronectin, and laminin was determined using western blot. RESULTS: Downregulation of Smad7 interrupts the effects of TGF-ß2 on the expression of several ECM components. Smad7 siRNA can partially decrease the expression of Smad7, fibronectin, and laminin. CONCLUSIONS: Smad7 plays an important role in regulating the ECM protein in the aqueous outflow pathway.

Effect of pre-eclampsia-eclampsia on major cardiovascular events among peripartum women in Taiwan.

There is no large-scale population-based study to clarify the association between major adverse cardiovascular events (MACEs) and pre-eclampsia/eclampsia. A population-based Taiwanese cohort study was performed in 1,132,064 parturients from 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine adjusted hazard ratios of pre-eclampsia/eclampsia on risks of MACEs and mortality during pregnancy to at least the third year postpartum. Incidence rates of MACEs and all maternal mortality in women with pre-eclampsia/eclampsia were 16.21 and 40.38 per 100,000 patients per year, respectively. Women with pre-eclampsia/eclampsia had a 13.0-fold higher incidence of myocardial infarction, a 8.3-fold higher incidence of heart failure, a 14.5-fold higher incidence of stroke, a 12.6-fold higher incidence of MACEs, a 7.3-fold higher incidence of MACEs without stroke, a 2.3-fold higher incidence of MACE-related deaths, and a 6.4-fold higher incidence of overall death than women without pre-eclampsia/eclampsia. Kaplan-Meier survival curve discriminated in MACEs, nonstroke MACEs, MACE related death and overall death. In conclusion, women with pre-eclampsia/eclampsia have a significantly higher risk of MACEs, especially myocardial infarction and stroke, during pregnancy and their risk remains significant to ≥36 months postpartum. Our results suggest that women with pre-eclampsia/eclampsia should be closely monitored during pregnancy and for up to ≥3 years postpartum.

Preeclampsia-eclampsia and the risk of stroke among peripartum in Taiwan.

BACKGROUND AND PURPOSE: The occurrence of preeclampsia-eclampsia during pregnancy has been reported to increase the risk of stroke in mainly Western populations. However, few studies have evaluated stroke risk in Asian populations and followed women beyond the early postpartum period. Thus, the present study determined the risk of stroke in women in Taiwan during pregnancy and the first postpartum year. METHODS: A population-based cohort study was performed on 1,132,019 parturients during 1999 to 2003 using a dataset linking birth certificates and National Health Insurance hospital discharge data. Stroke-free survival rates were estimated using the Kaplan-Meier method, and the log-rank test was used to examine the effect of preelampsia-eclampsia on the prevalence of stroke. Sociodemographic factors and obstetric complications were used in multivariate logistic regression models to determine the adjusted odds ratios of preeclampsia-eclampsia on the risk of hemorrhagic and ischemic stroke during pregnancy and within the first postpartum year. RESULTS: The incidence of stroke was 21.47 cases per 100,000 deliveries. There were 139 cases of hemorrhagic stroke and 107 cases of ischemic stroke. The respective adjusted relative risk of preeclampsia-eclampsia for hemorrhagic and ischemic stroke were 10.68 (95% CI, 3.40 to 33.59) and 40.86 (95% CI, 12.14 to 137.47) within 3 months antepartum; 6.45 (95% CI, 1.42 to 29.29) and 34.71 (95% CI, 11.08 to 108.68) in the first 3 days postpartum; 5.61 (95% CI, 0.71 to 44.10) and 11.23 (95% CI, 2.45 to 51.59) from 3 days to 6 weeks postpartum; 11.76 (95% CI, 4.05 to 34.11) and 11.60 (95% CI, 3.30 to 40.82) from 6 weeks to 6 months pospartum; and 19.90 (95% CI, 7.75 to 51.11) and 4.35 (95% CI, 0.58 to 32.92) from 6 months to 12 months postpartum. CONCLUSIONS: Women with preeclampsia-eclampsia have a significantly higher risk of stroke during pregnancy and in the first postpartum year. These results suggest that women with preeclampsia-eclampsia should be closely monitored even after pregnancy.