A polyphenol-rich cranberry supplement improves muscle oxidative capacity in healthy adults.

Cranberries are rich in polyphenols, have a high antioxidant capacity, and may protect against exercise-induced free radical production. Mitochondria are known producers of free radical in skeletal muscle, and preventing overproduction of radicals may be a viable approach to improve muscle health. This stud aimed to investigate the effect of a polyphenol-rich cranberry extract on muscle oxidative capacity and oxygenation metrics in healthy active adults. 17 participants (9 males, 8 females) were tested at: i) baseline, ii) 2 hours following an acute CE dose (0.7 g/kg of body mass), and iii) after 4 weeks of daily supplement consumption (0.3 g/kg of body mass). At each time point, muscle oxygen capacity was determined using near-infrared spectroscopy to measure the recovery kinetics of muscle oxygen consumption following a 15-20 s contraction of the vastus lateralis. Cranberry supplementation over 28 days significantly improved muscle oxygen capacity (k-constant, 2.8 ± 1.8 vs. 3.9 ± 2.2; p = 0.02). This was supported by a greater rate of oxygen depletion during a sustained cuff occlusion (-0.04 ± 0.02 vs. -0.07 ± 0.03; p = 0.02). Resting muscle oxygen consumption was not affected by cranberry consumption. Our results suggest that cranberry supplementation may play a role in improving mitochondrial health, which could lead to better muscle oxygen capacity in healthy active adult populations. The study protocol was registered with ClinicalTrials.gov (#NCT06186297).

Availability of Hand Sanitizers in Food Establishments of New York City: An Observational Study.

Hand hygiene is a crucial tool to limit the transmission of common respiratory and gastrointestinal infections. While hand sanitizers were ubiquitous early in the COVID-19 pandemic, the number of food establishments that have adequately maintained them remains unknown. Through systematic observations in 89 New York City food establishments, we found that hand sanitizer dispensers were present in only 40% of the stores, and only 23% had functional ones. This scarcity highlights the necessity of providing ongoing support to small business owners nationwide to promote and maintain primary prevention measures at all times, extending beyond periods of public health crises.

Hospital episode-of-care costs for hip fractures: an activity-based costing analysis.

Background: Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC. Material and Methods: This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019. Clinical and demographic data were extracted through the institution's centralized data warehouse. Data acquisition also included direct and indirect costs per episode of care, adverse events, and precise temporal data. Results: The median total EOCC was $13,113 (interquartile range 6658), excluding physician fees. Out of the total cost, 75% was attributed to direct costs, which represented a median expenditure of $9941. The median indirect cost of the EOCC was $3322. Based on the multivariate analysis, patients not operated within the 48 hours guidelines had an increased length of stay by 5.7 days (P = 0.003), representing an increase in EOCC of close to 5000$. Higher American Society of Anesthesiology (ASA) scores were associated with elevated EOCC. Conclusion: The cost of managing a patient with geriatric hip fracture from arrival in the emergency department to discharge from surgical ward represented $13,113. Main factors influencing the EOCC included adherence to the 48-hour benchmark surgical delay and ASA score. High-quality costing data are vital in assessing health care spending, conducting cost effectiveness analyses, and ultimately in guiding policy decisions. Level of Evidence: Level III (3), retrospective cohort study.

Electrophilic and nucleophilic gas phase reactivity of the Janus cluster-based anions [{Mo6Cl8}Cl5□]- (□ = lacuna).

The lacunary monocharged anion [{Mo6Cli8}Cla5□a]- presents concomitantly a strongly electrophilic site and a nucleophilic one. This Janus character in terms of reactivity is confirmed by its gas phase reaction with [Br6Cs4K]- to form [{Mo6Cli8}Cla5Bra]2- and by its unusual self-reactivity leading to [{Mo6Cli8}Cla6]2- dianions.

Bicruciate-retaining total knee arthroplasty non-inferior to posterior-stabilized prostheses after 5 years: a randomized, controlled trial.

PURPOSE: Bicruciate-retaining (BCR) prostheses may improve satisfaction of patient undergoing total knee arthroplasty (TKA). The objective of this randomized controlled trial was to assess whether BCR prostheses provide better clinical outcomes than posterior-stabilized (PS) prostheses. MATERIALS AND METHODS: This is a randomized single-blind control trial involving a total of 77 patients with knee osteoarthritis, randomly assigned to undergo TKA with a BCR or PS implant between 2015 and 2019. Mean follow-up period was 39 months. Clinical and demographic data were extracted manually from medical records. Data acquisition included patient demographics, knee range of motion, and patient-reported outcomes via KSS, KOOS, WOMAC, and SF-12 scores. RESULTS: A total of 38 patients were randomized to the PS group and 39 to the BCR group. At the 5-year follow-up, no statistical differences were noted for knee range of motion or patient-reported outcomes between the two groups, except for a greater knee flexion in the early follow-up period in the PS group. Five adverse events occurred in the BCR group compared to none in the PS group (p = 0.02). CONCLUSION: BCR TKA yield similar clinical and patient-reported outcomes 5 years following the intervention compared with PS TKA. The BCR TKA had more complications. LEVEL OF EVIDENCE: I (Randomized Controlled Trial).

Cancellations and delays of emergent orthopedic operations at a Canadian level 1 trauma centre.

BACKGROUND: Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service. METHODS: This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan. 1 to Mar. 31, 2020. Patient demographic characteristics, injury characteristics, delays until surgery and reasons for DOSCs were recorded. RESULTS: A total of 185 patients (100 males and 85 females with a mean age of 54 yr) were included in the study. There were 98 outpatients and 87 inpatients. Seventy-five (40%) of the scheduled procedures in the outpatient group and 34 (30%) of those in the inpatient group were cancelled. In both groups, more than 85% of the cancellations were because of prioritization of a more urgent orthopedic or nonorthopedic surgical case. The average operative delay for the outpatient group was 11.4 days, compared to 3.8 days for the inpatient group (p < 0.001). CONCLUSION: High DOSC rates were observed among both outpatients and inpatients. The main reason for delaying surgery was prioritization of a more urgent surgical case. Providing the orthopedic trauma service with a dedicated OR opened 6 days per week, along with extended hours of OR services to 1700 daily, might be effective at minimizing DOSCs.

Time-to-Incision for Hip Fractures in a Canadian Level-1 Trauma Centre: Are We Respecting the Guidelines?

Background: Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to explore the causes of surgical delays for acute geriatric hip fractures. Methods: This is a retrospective cohort study involving a total of 109 consecutive geriatric patients who sustained proximal femur fractures ("hip fractures"), who subsequently underwent definitive fixation. Clinical, demographic, and direct costing data were extracted via a modern system and electronic medical records on a centralized data warehouse. Surgical delays and length of stay were analyzed according to clinical variables. Results: The established benchmark of a time-to-surgery of less than 48 hours was respected for 63 (57.8%) patients. Patients on oral anticoagulant (ACO) waited significantly longer, on average 58 hours compared to 44 for non-anticoagulated patients (p = .007). Patients with higher ASA scores waited significantly longer (p = .0018). More importantly, patients treated within 48 hours were discharged significantly earlier, on average after 10 days compared to 16 days for patients who waited more than 48 hours before receiving surgical treatment (p = .003), regardless of the pre-operative waiting time. Conclusion: Fewer than 60% of patients received surgery within the 48-hour benchmark after being admitted for an acute hip fracture in a Level-1 trauma centre. Patients with more comorbidities waited longer and stayed longer in the hospital after surgery. Implementing strategic, evidence-based changes should be done using this data to improve care of this vulnerable population.

Variable expressivity in a family with an aggrecanopathy.

BACKGROUND: Osteochondritis dissecans is a condition wherein there is a subchondral bone lesion that causes pain, inflammation, and cartilage damage. Dominant Familial Osteochondritis Dissecans is a rare and severe form of osteochondritis dissecans (OCD). It is caused by heterozygous pathogenic variants in the gene encoding Aggrecan; ACAN. Aggrecan, a proteoglycan, is an essential component of the articular and growth plate cartilage. METHODS: Herein, we report three individuals from one family; the proband who presented with short stature, a lower limb bone exostosis, and bilateral knee and elbow OCD at the age of 13 years old. His twin brother presented with isolated short stature and his father with short stature and lumbar disc herniation. RESULTS: Next-generation sequencing of the ACAN gene in the proband identified a frameshift variant which is also present in the brother and father with short stature. The proband was treated surgically with bilateral elbow microfracture, after the failure of conservative therapy. CONCLUSION: To the best of our knowledge, this is the first patient with an aggrecanopathy who presents with osteochondritis dissecans due to a frameshift variant. This family presents with variable expressivity which might be attributed to modifier genes.

Usefulness of FDG-PET/CT-Based Radiomics for the Characterization and Genetic Orientation of Pheochromocytomas Before Surgery.

PURPOSE: To assess the potential added value of FDG-PET/CT radiomics for the characterization of pheochromocytomas (PHEO) and their genetic orientation prior to surgery and genetic testing. METHODS: This retrospective monocentric study, included 49 patients (52 tumors) that underwent both FDG-PET/CT and MIBG scan before surgery. A germline mutation was secondarily identified in 13 patients in one of the genes related to Cluster 1 (n = 4) or Cluster 2 (n = 9). No mutation was identified in 32 patients and 4 did not have genetic testing. Correlation between several PET-based biomarkers, including SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and textural features, and biochemical and genetic features were analyzed. RESULTS: Sensitivity of FDG-PET/CT alone was 92%, and 98% when combined to MIBG. The SUVmax was significantly higher for mutated tumors classified in Cluster 1 than in Cluster 2 (p = 0.002) or for tumors with no identified mutations (p = 0.04). MTV and TLG of the tumors with the most intense uptake discriminated mutated Cluster 2 from sporadic tumors, but not from Cluster 1 tumors. Textural features combined with MTV led to better differentiation between sporadic and mutated tumors (p < 0.05). CONCLUSION: FDG-PET/CT is useful for preoperative characterization of PHEO, and when combined with radiomics biomarkers, provides evidences for a genetic predisposition.

Role of constraining staple on tibial slope in open wedge osteotomy: A comparative study.

BACKGROUND: Medial opening-wedge high tibial osteotomy (HTO) corrects varum deformities in osteoarthritic knees. This procedure has been shown to increase tibial slope, which may limit knee extension and provoke an anterior tibial translation. The purpose of this research was to study the impact of a constraining staple on the variation of the tibial slope in medial opening-wedge HTO. HYPOTHESIS: Insertion of a bone staple on the anterior aspect of the tibia during medial opening-wedge HTO minimizes risks of tibial slope increase. MATERIALS AND METHODS: This retrospective study was conducted on 91 cases of HTO performed by a single surgeon between 2008 and 2013. Tibial slope was measured pre-operatively and postoperatively according to Brazier's method. We analyzed tibial slope variation in a group that did not receive bone staple insertion during their HTO and compared to the group that did. RESULTS: A total of 91 patients met the inclusion criteria, 61 males (67.0%) and 30 females (33.0%). The median age was 51 years old. In the staple group, a 0.1° mean increase in tibial slope was found (p<0.001), whereas in the non-staple-inserted group, a 2.4° mean increase in tibial slope was observed (p<0.001). DISCUSSION AND CONCLUSION: The use of a temporary anterior staple during medial-opening HTO appears to be effective in minimizing tibial slope increase. LEVEL OF EVIDENCE: III, Retrospective comparative study.

Preliminary results of a 68 Ga-PSMA PET/CT prospective study in prostate cancer patients with occult recurrence: Diagnostic performance and impact on therapeutic decision-making.

BACKGROUND: In this prospective study (NCT03443609), we investigated the impact of 68Ga-PSMA-11 PET-CT on the treatment plan and therapeutic response obtained for patients with prostate cancer (PCa) presenting a recurrence with a low rising PSA. METHODS: One hundred thirty hormone-naive (PSA < 1.5 ng/mL) patients were enrolled. All patients received radical treatment. PET images were recorded 1 and 2 hours after injection of tracer and interpreted by two independent nuclear physicians. Six months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. RESULTS: Data analysis for the first 52 included patients has been completed. 68Ga-PSMA-11-positive lesions were detected in 38/52 (73.1%) patients. Ninety-four lesions were detected as follows, 53/94 in lymph nodes (56.4%), 25/94 in bone (26.6%), and 12/94 into the prostate bed (12.7%). Detection rates were 58%, 81%, and 82% for serum PSA levels lower than 0.25 ng/mL, between 0.25 to ≤ 0.69 ng/mL and 0.70 ng/mL, respectively. As a result of the PSMA PET-CT, therapeutic management changed in 38/52 patients (73.1%). Patients had undetectable serum PSA levels after treatment guided by 68Ga-PSMA-11 PET-CT results in 10/52 (19.2%) cases and with a PSA decrease of over 60% in 18/52 (34.6%) patients. CONCLUSION: Whilst our patient population presented a very low PSA level, preliminary results of the 68Ga-PSMA PET-CT study showed recurrence localization in more than half of the patients and this had a major clinical impact, as it resulted in treatment change in more than half of the patients and a significant decrease in PSA levels in a third of patients.

Recurrent prostate cancer after radical prostatectomy: restaging performance of 18F-choline hybrid PET/MRI.

To evaluate the diagnostic performance of a whole-body 18F-choline (FCH) hybrid PET/MRI for prostate cancer patients at biochemical relapse after radical prostatectomy (RP) compared to pelvic multiparametric MRI (mpMRI), one of the standard imaging modality for this patient population. From 2010 to 2016, 58 whole-body FCH PET/MRI studies with mpMRI acquisitions were performed in 53 prostate cancer patients relapsing after curative RP. Median PSA and PSA doubling time (PSA DT) at PET study were 1.5 ng/ml and 6.5 months, respectively. The overall positivity rate of FCH PET/MRI was 58.6% (n = 34), dropping to 44% in patients with a PSA ≤ 2 ng/ml (n = 36). Median PSA values in positive and negative PET/MRI studies were 2.2 ng/ml and 0.8 ng/ml, respectively, with no differences in PSA DT (6.5 vs. 6.6 months). A PSA value ≥ 1.5 ng/ml was a significant predictor of positivity on PET/MRI studies. Compared to PET, mpMRI identified more local relapses (17 vs. 14, p = 0.453) while PET outperformed whole-body Dixon MRI for regional (16 vs. 9, p = 0.016) and distant (12 vs. 6, p = 0.031) metastases. Compared to pelvic mpMRI, the treatment approach turned out to be influenced more frequently using whole-body FCH hybrid PET/MRI studies (58.6% vs. 38%). In prostate cancer patients with biochemical recurrence after RP, whole-body FCH PET/MRI achieved a higher detection rate of nodal/distant metastases compared to pelvic mpMRI alone, increasing the change of treatment strategy by more than 20%.

The inherent matrix properties of lichen metabolites in matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

RATIONALE: Light-absorbing secondary metabolites from lichens were recently reported to exhibit promising Laser Desorption Ionization (LDI) properties, enabling their direct detection from crude lichen extracts. In addition, many of them display close structural homologies to commercial Matrix-Assisted Laser Desorption Ionization (MALDI) matrices, which is incentive for the evaluation of their matrical properties. The current study systematically evaluated the matrix effects of several structural classes of lichen metabolites: monoaromatic compounds, quinone derivatives, dibenzofuran-related molecules and the shikimate-derived vulpinic acid. Their matrical properties were tested against a wide range of structurally diverse analytes including alkaloids, coumarins, flavonoids and peptides. METHODS: Triplicate automatic positive-ion mode MALDI analyses were carried out and ionization efficiencies were compared with those of structurally related reference matrices (i.e. DHB, HCCA, dithranol and usnic acid) in terms of (i) analyte absolute intensities and (ii) Matrix Suppressing Effect (MSE) scores. RESULTS: Monoaromatic lichen metabolites revealed matrical properties similar to those of DHB when obtained under comparable experimental conditions. Likewise, anthraquinone metabolites triggered ionization of tested analytes in a similar way to the structurally related dithranol. Finally, dibenzofuran derivatives displayed a broad ionization profile, reminiscent of that of (+)-usnic acid. CONCLUSIONS: Lichen metabolites exhibit interesting MALDI matrix properties, especially for medium and low molecular weight analytes. For many of the tested molecules, matrix ion formation was very limited. This proof-of-concept study paves the way for follow-up investigations to assess the matrix properties of lichen metabolites against a wider array of analytes as well as adapting experimental settings to individually optimize the performance of successfully tested candidates.