Effect of Anterior Acromial Coverage on Functional and Radiological Outcomes After Arthroscopic Repair of Anteroposterior Massive Rotator Cuff Tears.

BACKGROUND: Rotator cuff tear size, fatty infiltration, and scapular morphology are correlated with tendon healing and functional outcomes after arthroscopic repair; however, the association between anteroposterior acromial coverage and the clinical outcomes of anteroposterior massive rotator cuff tears (AP-MRCTs; involving all 3 tendons) remains unclear. PURPOSE: To identify the association between AP acromial coverage and functional and radiological outcomes after arthroscopic repair of AP-MRCTs. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 98 patients who underwent arthroscopic repair of AP-MRCTs between January 2015 and December 2020 were included in the study and classified according to whether anterior acromial coverage (AAC) was anterior (46 patients; positive AAC group) or posterior (52 patients; negative AAC group) to the scapular line on true lateral shoulder radiographs. Demographic characteristics, surgical details, and functional outcomes were prospectively collected. Acromial morphological features, global tear extension (GTE), the global fatty infiltration index (GFII), tendon integrity after repair, proximal humeral migration, and glenohumeral abduction were measured and calculated on radiographs or magnetic resonance imaging scans preoperatively and at 2 years postoperatively. Multivariate logistic regression was performed to identify the independent risk factors of a rotator cuff retear. RESULTS: The positive AAC group showed larger AAC, posterior acromial tilt, and anterior acromial slope as well as smaller posterior acromial coverage compared with the negative AAC group. Postoperatively, the American Shoulder and Elbow Surgeons score (82.5 ± 8.3 vs 77.2 ± 11.5, respectively; P = .013), active abduction (157.8°± 27.1° vs 142.7°± 39.6°, respectively; P = .048), and glenohumeral abduction (45.6°± 10.4° vs 39.7°± 14.9°, respectively; P = .041) in the positive AAC group were significantly higher than those in the negative AAC group, while the retear rate (23.9% vs 44.2%, respectively; P = .035) and proximal humeral migration (1.7 ± 1.0 vs 2.3 ± 1.2 mm, respectively; P = .006) were significantly lower in the positive AAC group than in the negative AAC group. Smaller AAC (odds ratio [OR], 0.93 [95% CI, 0.87-1.00]; P = .040), larger GTE (OR, 1.03 [95% CI, 1.01-1.06]; P = .017), and a higher GFII (OR, 3.49 [95% CI, 1.09-11.19]; P = .036) were associated with an increased risk of a rotator cuff retear. CONCLUSION: Increased AAC was associated with a lower retear rate and better functional outcomes after arthroscopic repair of AP-MRCTs. A preliminary risk evaluation integrating GTE, the GFII, and AAC is recommended to consider the necessity of additional procedures for patients in need of arthroscopic rotator cuff repair.

Are scapular morphologic characteristics or rotator cuff tear patterns associated with acetabularization of the coracoacromial arch?

Purpose: To determine whether rotator cuff tear (RCT) patterns and scapular morphologic characteristics are associated with acetabularization of the coracoacromial arch when the remaining rotator cuff cannot stabilize the humeral head centered on the glenoid. Methods: Thirty-two consecutive patients incapable of stabilizing the humeral head within the native glenoid were included and divided into 2 groups: unstable glenohumeral fulcrum kinematics (GHFK) group (n = 16; absence of acetabularization of the coracoacromial arch) and captured GHFK group (n = 16; the presence of acetabularization of the coracoacromial arch). Magnetic resonance imaging (MRI) analysis included tear locations, tear extensions (anterior, posterior, and global), and fatty infiltration of the rotator cuff muscles. Plain radiographic and computed tomography image measurements included acromiohumeral distance, critical shoulder angle, lateral acromial angle, acromial index, acromial tilt, acromial slope angle, anterior and posterior acromial coverage, and coracoacromial ligament coverage. Results: Patient demographic characteristics did not differ significantly (P > .05). No differences in tear patterns were found between patients with unstable GHFK and those with captured GHFK on MRI (P > .05). Scapular morphologic parameter measurements showed significant differences between the unstable and captured GHFK groups: anterior acromial coverage (-5.8 ± 13.8° vs. 13.8 ± 11.3°, P < .001), acromial tilt (34.9 ± 8.9° vs. 26.7 ± 6.2°; P = .005), and acromial slope angle (24.5 ± 8.1° vs. 33.5 ± 7.9°, P = .003). Conclusion: Scapular morphologic characteristics, rather than RCT patterns, were associated with the development of acetabularization of the coracoacromial arch when the remaining rotator cuff could not stabilize the humeral head. Patients with captured GHFK exhibited larger anterior acromial coverage, smaller acromial tilt, and a more curved acromion than those with unstable GHFK.

Abaloparatide Improves Rotator Cuff Healing via Anabolic Effects on Bone Remodeling in a Chronic Rotator Cuff Tear Model of Rat With Osteoporosis: A Comparison With Denosumab.

BACKGROUND: Because of poor clinical outcomes, rotator cuff healing in patients with osteoporosis has recently gained attention. Antiresorptive therapy for osteoporosis has been reported to improve healing after repair. However, the comparative effectiveness of anabolic and antiresorptive agents has not been investigated. HYPOTHESIS: Anabolic therapy with abaloparatide (ABL) would outperform antiresorptive therapy with denosumab (Dmab) to improve rotator cuff healing in the osteoporotic status. STUDY DESIGN: Controlled laboratory study. METHODS: A chronic rotator cuff tear model was established in ovariectomy-induced postmenopausal osteoporotic rats. Then, bilateral rotator cuff repairs were conducted in all experimental rats, which were randomly divided into control (CON), Dmab, and ABL groups to receive the corresponding subcutaneous injections. The rats sacrificed at 2 weeks (the early healing period) were used to detect osteoblast and osteoclast activities, related gene expression (osteoclastogenesis, osteogenesis, and chondrogenesis), new bone formation, and mineralization. In the rats sacrificed at 4 and 8 weeks, the bone mineral density and bone architecture at the repaired site were assessed by micro-computed tomography, and rotator cuff healing was evaluated using histological and biomechanical analyses. RESULTS: At 8 weeks, significantly higher failure load and stiffness were observed in the ABL (25.13 ± 3.54 N, P < .001; 21.65 ± 3.08 N/mm, P < .001; respectively), and Dmab (21.21 ± 2.55 N, P < .001; 16.15 ± 2.07 N/mm, P = .008; respectively) groups than in the CON group (13.36 ± 1.70 N; 11.20 ± 2.59 N/mm; respectively), whereas the ABL treatment provided better failure load and stiffness than Dmab (P = .019; P = .003). Although tendon-to-bone healing was improved by Dmab, the most mature tendon insertion at the interface was observed in the ABL group, including a more organized collagen and fibrocartilage and higher bone quality. ABL significantly promoted bone remodeling via coupling between osteoclasts and osteoblasts (osteoblast to osteoclast ratio: 4.80 ± 0.39; P = .022), thereby stimulating more new bone formation and mineralization at the tendon-to-bone healing interface than Dmab (osteoblast to osteoclast ratio: 3.21 ± 0.75) at 2 weeks. Moreover, ABL had significant effects on gene expression [Runt-realted transcription factor 2 (Runx2, collagen type I-alpha 1 (Col1A1]), and sclerostin for osteogenesis; aggrecan and collagen type II (Col2) for chondrogenesis] in mineralized tissues, indicative of enhanced bone and fibrocartilage formation when compared with the CON and Dmab groups. CONCLUSION: ABL promoted rotator cuff healing in osteoporotic rats by significantly increasing the mineralized tissue quality and collagen maturity at the reattachment site, leading to improved biomechanical properties, and was superior to Dmab in both biomechanical and histological analyses. CLINICAL RELEVANCE: Anabolic therapy with ABL may outperform antiresorptive therapy with Dmab in improving outcomes after rotator cuff repair in osteoporotic patients.

Differentiation Ability of Tendon-Derived Stem Cells and Histological Characteristics of Rotator Cuff Remnant on the Greater Tuberosity Degenerated With Age and Chronicity.

PURPOSE: To explore and measure the presence and activity of tendon-derived stem cells (TDSCs), as well as histological changes of rotator cuff remnant by age and chronicity of the rotator cuff tear (RCT). METHODS: 154 patients with a full-thickness tear of supraspinatus and/or infraspinatus tendon were included. 52 qualified remnants of the greater tuberosity were captured through arthroscopy. TDSCs in the remnants were isolated for proliferation ability, basal gene expression, and trilineage differentiation detection. Histological characteristics were evaluated by observation of staining under a light microscope and transmission electron microscopy (TEM). To observe the effect of age, samples were divided into two groups: young (＜60 years old) and old (≥60 years old). For chronicity comparison, samples were divided into three groups: acute group (＜3 months), intermediate group (3-12 months), and chronic group (≥12 months). RESULTS: Between age groups, the remnants in older patients were found to have lower TDSC proliferation ability (cell counting kit-8 results, old: .5325 ± .050, young: .6623 ± .196; P = .008) and basal expression of aggrecan (.630 ± .239; P = .002) and TGF-ß1 (transforming growth factor-ß1, .589 ± .326, P = .008), weaker ability of chondrogenic differentiation. Furthermore, the remnant tendons in chronic group was found to have weaker adipogenic and chondrogenic differentiation ability of TDSCs, lower tendon degenerative score (acute: 3.57 ± 1.902, intermediate: 5.94 ± 2.313, chronic: 6.86 ± 2.193; P = .023), increased type III collagen region ratio in insertion area (acute: 86.10% ± 8.29%, intermediate: 94.06% ± 5.36%, chronic: 98.90% ± .49%; P = .023), and larger fibril diameters. CONCLUSION: Differentiation ability of TDSCs derived from the rotator cuff remnant was reduced with age and chronicity. Histological degeneration of remnant tendon deteriorated with chronicity. Remnant in the greater tuberosity was still alive, but those in young or acute injury patients were more active after full-thickness RCT. CLINICAL RELEVANCE: TDSCs exist in rotator cuff remnant on the greater tuberosity and have multilineage differentiation ability. But the remnant degenerated with age and chronicity.

Incomplete Rotator Cable Did Not Cause Rotator Cuff Dysfunction in Case of Rotator Cuff Tear: A Biomechanical Study of the Relationship Between Rotator Cable Integrity and Rotator Cuff Function.

PURPOSE: This study seeks to evaluate the biomechanical relationship between the severity of rotator cable tears and the function of the rotator cuff. METHODS: Twelve cadaveric shoulders with intact rotator cuff, existing rotator cable, and a critical shoulder angle below 35° were included. For each shoulder, a posterosuperior rotator cuff tear (PSRCT) (model 2) in the crescent area was formed. Then anterior insertion detached (model 3), anterior insertion detached together with the middle cable tear (model 4), and the whole rotator cable tear (model 5) were subsequently created. The rotator cuff that lay above the humeral head rotation center was detached as a global tear control (model 6), along with the primitive status as the intact control (model 1). Glenohumeral abduction was initiated by simulating deltoid and remaining rotator cuff force. Functioning of the remaining rotator cuff was evaluated using the middle deltoid force (MDF), as required for abduction. RESULTS: No statistically significant differences in peak MDF values were seen among the 4 PSRCT statuses (44.10 ± 7.30 N [model 2], P = .96; 45.50 ± 9.55 N [model 3], P = .86; 45.90 ± 3.53 N [model 4], P = 0.30; 44.20 ± 8.19 N [model 5], P = .80) and intact control status (39.79 ± 7.65 N [model 1]). However, significant differences in peak MDF values were found among the 4 PSRCT statuses and the global tear control status (54.53 ± 7.46 N [model 6], P < .01). CONCLUSION: The PSRCT, regardless of the severity of the rotator cable tear, does not induce functionally significant biomechanical impairment. Tear extension involving all rotator cuff tissue above the geometric rotation center of the humeral head results in obvious functional impairment. CLINICAL RELEVANCE: For PSRCT, the remaining rotator cuff tissue above the geometric rotation center may contribute to the preservation of shoulder function in RCT patients.

Synthesis of Multiporous Carbons from the Water Caltrop Shell for High-Performance Supercapacitors.

In this study, an economic, sustainable, and green synthesis method of multiporous carbons from agricultural waste, water caltrop shell (denoted as WCS), was presented. To prepare the WCS biochar, the dried WCS was first carbonized to a microporous carbon with a surface area of around 230 m2 g-1 by using a top-lit-updraft method. Then, the microporous WCS biochar was directly mixed with an appropriate amount of ZnO nanoparticles and KOH as activating agents via a solvent-free physical blending route. After further activation at 900 °C, the resulted carbons possess both micropores and mesopores that were named as WCS multiporous carbons. The carbon yield of the prepared WCS multiporous carbons with high surface area in the range of 1175-1537 m2 g-1 is up to 50%. Furthermore, the micropore/mesopore surface area ratio can be simply tuned by controlling the ZnO content. For supercapacitor applications, the as-prepared WCS multiporous carbon electrodes showed high specific capacitance (128 F g-1 at 5 mV s-1) with a good retention rate at 500 mV s-1 scan rate (>60% compared to the capacitance at 5 mV s-1) and low Ohmic resistance in a 1.0 M LiClO4/PC electrolyte. In addition to the ZnO nanoparticles, CaCO3 nanoparticles with low environmental impact were also used to prepare the WCS multiporous carbons. The assembled supercapacitors also demonstrate high specific capacitance (102 F g-1 at 5 mV s-1) and good retention rate (∼70%).

Targeting RIPK3 oligomerization blocks necroptosis without inducing apoptosis.

Receptor-interacting serine/threonine-protein kinase 3 (RIPK3) is a central protein in necroptosis with great potential as a target for treating necroptosis-associated diseases, such as Crohn's disease. However, blockade of RIPK3 kinase activity leads to unexpected RIPK3-initiated apoptosis. Herein, we found that PP2, a known SRC inhibitor, inhibits TNF-α-induced necroptosis without initiating apoptosis. Further investigation showed that PP2 acts as an inhibitor of not only SRC but also RIPK3. PP2 does not disturb the integrity of the RIPK1-RIPK3-mixed lineage kinase domain-like pseudokinase (MLKL) necroptosome or the autophosphorylation of RIPK3 at T231/S232 but disrupts RIPK3 oligomerization, thereby impairing the phosphorylation and oligomerization of MLKL. These results demonstrate the essential role of RIPK3 oligomerization in necroptosis and suggest a potential RIPK3 oligomerization-targeting strategy for therapeutic development.

A novel elastic and controlled-release poly(ether-ester-urethane)urea scaffold for cartilage regeneration.

In the tissue engineering of cartilage, scaffolds with appropriate elasticity and controlled-release properties are essential. Herein, we synthesized a poly(ether-ester-urethane)urea scaffold with a pendant amino group (PEEUUN) through a de-protection process from PEEUU-Boc polymers and grafted kartogenin (KGN) onto the PEEUUN scaffolds (PEEUUN-KGN). Characterization, performance tests, scaffold biocompatibility analysis, and chondrogenesis evaluation both in vitro and in vivo were conducted. The results revealed that the PEEUUN-KGN scaffolds were degradable and three-dimensional (3D) with interconnected pores, and possessed good elasticity, as well as excellent cytocompatibility. Meanwhile, KGN on the PEEUUN-KGN scaffolds underwent stable sustained release for a long time and promoted human umbilical cord mesenchymal stem cells (HUCMSCs) to differentiate into chondrocytes in vitro, thus enhancing cartilage regeneration in vivo. In conclusion, the present PEEUUN-KGN scaffolds would have application potential for cartilage tissue engineering.

Characterization of Corrosion Behavior of CLF-1 in Liquid Lithium Using Calibration-Free Laser-Induced Breakdown Spectroscopy in Depth Profile Analysis.

It is important to get fast and quantitative compositional depth profiles for the boundary layer of the corroded specimen in order to understand the corrosion process and mechanism due to liquid lithium induced corrosion problems to structural material of fusion reactors. In this work, calibration-free laser-induced breakdown spectroscopy (CF-LIBS) is introduced to investigate the compatibility of CLF-1(China low-activation Ferritic steel) exposed in liquid lithium at 500 °C for 500 h. The results show that CF-LIBS constitutes an effective technique to observe the corrosion layer of specimens which are non-uniform and the elements of matrix show gradient distribution from the boundary to the inner layer. The concentration was 82-95 wt.% Fe, 5-12 wt.% Cr, 0.45-0.85 wt.% Mn, 1.6-1.1 wt.% W, 0.11-0.16 wt.% V, and <0.2 wt.% Li along the longitudinal corrosion depth for the corrode CLF-1. The results reveal the quantitative elemental variation trend of CLF-1 in the lithium corrosion process and indicate that the CF-LIBS approach can be applied to the analysis of composition in multi-element materials.

A novel morphological classification for the femoral notch based on MRI: a simple and effective assessment method for the femoral notch.

OBJECTIVE: To propose a novel morphological classification method for notches, which may provide new evidence for notchplasty based on the three-dimensional (3D) features of notches and the risk of anterior cruciate ligament (ACL) injury. MATERIALS AND METHODS: Three hundred individuals in total were included in our study, including 150 patients with ACL ruptures (75 males and 75 females) and 150 age- and gender-matched individuals without ACL ruptures. The notches were divided into four types according to the notch widths at the notch inlet, outlet, and ACL attachment based on the preoperative MRI, the notch volume was calculated, and the risk of ACL injury was compared. The surgical records were reviewed and whether these cases performed notchplasty were collected. RESULTS: The inlet-and-outlet stenosis notch type was associated with smaller notch volume (P = 0.007) and a higher risk of ACL injury (P < 0.001). There were no significant differences in morphological distribution between males and females. The rate of notchplasty in inlet-and-outlet stenosis type was higher than the others. CONCLUSIONS: The new morphological classification method efficiently reflected the association of the notch shape with the 3D notch volume and the risk of ACL injury. The knees with the inlet-and-outlet stenosis notch type and smaller notch volume tended to have a higher risk of ACL injury. Level of evidence Level III, case-control study.

Quantification of Dynamic Protein Interactions and Phosphorylation in LPS Signaling Pathway by SWATH-MS.

Lipopolysaccharide (LPS)-induced macrophage activation is a prototype of innate immune response. Although key effector proteins in LPS signaling pathway have been revealed, the map of dynamic protein interactions and phosphorylation as well as the stoichiometry of protein complexes are lacking. Here we present a dynamic map of protein interactions and phosphorylation in MyD88, TRAF6 and NEMO complexes obtained by SWATH-MS. The comprehensive MS measurement leads to quantification of up to about 3,000 proteins across about 21-40 IP samples. We detected and quantified almost all known interactors of MyD88, TRAF6 and NEMO. By analyzing these quantitative data, we uncovered differential recruitment of IRAK family proteins to LPS-induced signaling complexes and determined the stoichiometry of the Myddosome complex. In addition, quantitative phosphoproteomics analysis identified a number of unreported high-confidence phosphosites on the key proteins in LPS signaling pathway. Collectively, data of dynamic protein interactions and phosphorylation presented by this study could be a resource for further study of the LPS signaling pathway.

The Analysis of Normalized Effects on Meridian Current Level After the Photoluminescent Bioceramic Treatment on Acupuncture Points.

OBJECTIVE: This study investigated the advantage of photoluminescent bioceramic (PLB) irradiation on meridian channels of abnormal meridian currents, as well as the normalization of meridian current levels that may represent the participants' physiologic conditions. DESIGN: Statistical analysis of survey data. PARTICIPANTS: Forty-six patients with abnormal meridian current in the gallbladder (GB). INTERVENTIONS: The effects on the meridian currents were measured by an electrodermal instrument after PLB irradiation was applied to the GB and other specific acupuncture points. Each meridian was categorized into six physiologic levels to evaluate effectiveness after the PLB irradiation: 1, extremely low; 2, moderately low; 3, normally low; 4, normally high; 5, moderately high; and 6, extremely high level. The positive effect of PLB treatment for each meridian could be defined as the normalized ability of the meridian level from the extreme values (1, 2, 5, or 6) approaching the normal levels (3 or 4). RESULTS: Participants with higher average meridian current (Amc >36 µA) calculated from the currents of 24 Ryodoraku points could be significantly normalized after the PLB treatment (p=0.0241). A significant positive effect was seen in comparison with the negative effect of PLB on the GB meridian (McNemar test, p=0.00004) (n=46×2 for left and right GB meridians). A patient with benign facial tremor was treated by PLB for 1 month; PLB improved the facial tremor and normalized effects on Amc and meridian current levels at the GB, lung, small intestine, bladder, and kidney. CONCLUSION: A method was proposed to evaluate the normalization effect of a noninvasive PLB technique on the 12 meridians. PLB acupuncture on the specific meridian points could show the normalization ability of Amc and GB meridian for the participants.

RIP1/RIP3 binding to HSV-1 ICP6 initiates necroptosis to restrict virus propagation in mice.

Necroptosis is a form of programmed necrosis that is mediated by signaling complexes containing the receptor-interacting protein 3 (RIP3) and RIP1 kinases. We show that RIP3 and its interaction with the herpes simplex virus type 1 (HSV-1) protein ICP6 triggers necroptosis in infected mouse cells and limits viral propagation in mice. ICP6 interacts with RIP1/RIP3 through its RHIM domain and forms dimers/oliogmers by its C-terminal R1 domain. These binding events result in RIP1-RIP3 hetero- and RIP3-RIP3 homo-interactions and subsequent necroptosis of HSV-1-infected mouse cells. However, ICP6 RHIM cannot trigger necroptosis and even inhibits TNF-induced necroptosis in human cells. As the RHIM domain in murine cytomegalovirus protein vIRA can inhibit necroptosis in both human and mouse cells, these data suggest that both viral and host RHIM sequences determine whether the virus-host RHIM interaction is pro- or anti-necroptotic and that some viruses may evolve to escape this restriction.

Wave-induced flow in meridians demonstrated using photoluminescent bioceramic material on acupuncture points.

The mechanisms of acupuncture remain poorly understood, but it is generally assumed that measuring the electrical conductivity at various meridians provides data representing various meridian energies. In the past, noninvasive methods have been used to stimulate the acupuncture points at meridians, such as heat, electricity, magnets, and lasers. Photoluminescent bioceramic (PLB) material has been proven to weaken hydrogen bonds and alter the characteristics of liquid water. In this study, we applied the noninvasive PLB technique to acupuncture point irradiation, attempting to detect its effects by using electrical conductivity measurements. We reviewed relevant literature, searching for information on meridians including their wave-induced flow characteristics.

C3A cell behaviors on micropatterned chitosan collagen gelatin membranes.

The influence of the properties and surface micropatterning of chitosan-collagen-gelatin (CCG) blended membranes on C3A cell's activities has been investigated. It is aimed to guide the cell growth and improve the growth rate in vitro for the application in tissue engineering. Masters with micropatterns are prepared on stainless steel plates by photolithography. The CCG membranes with surface micropatterns are then fabricated by soft lithography and dry-wet phase inversion techniques. The morphology and metabolic activity of cultured C3A cells on the membranes are recorded. When the C3A cells are seeded on the membranes with micropattern spacing of 200 microm width and 80 microm depth, they adhere and aggregate in the groove of the membranes in a few minutes. The aggregated cells migrate up to the surface of the ridge later. This phenomenon, however, is not found on membranes with a micropattern spacing of 500 microm width. In addition, it is demonstrated that the cells on the CCG membranes with micropatterns have higher metabolism and growth rates than those on the flat CCG membranes and on T-flask discs. Micropatterning on the membrane surface can affect the distribution of cells and the communication among cells, and results in a difference in cell adhesion, morphology, mobility, and growth activity.