The incidence of arm, forearm, and hip osteoporotic fractures during early stage of COVID-19 pandemic.

The study analyzes whether the COVID-19 pandemic affects the incidence of arm, forearm, and hip fractures. Additionally, the change in the overall cost of those fractures treatment was estimated. During the COVID-19 pandemic, the incidence of arm, forearm, and hip fractures and the cost of fracture management are decreased. INTRODUCTION: Purposes of the study were to analyze if COVID-19 pandemic influences the incidence of arm, forearm, and hip osteoporotic fractures and to estimate the changes in costs of their management. METHODS: Data on arm, forearm, and hip fracture incidence were collected for inhabitants aged over 50 years in the district of Tarnowskie Góry and the city of Piekary Slaskie, South Poland, in the early stage of COVID-19 pandemic (77 days, from March 16th to May 31st 2020). These results were compared with the number of fractures noted in years 2015-2019 in the same period of the year. The ratio of analyzed fractures per 100,000 inhabitants was calculated. RESULTS: The recorded numbers of fractures of arm, forearm, and hip were 13, 43, and 29, respectively. The respective mean number for fractures reported in corresponding period in 2015-2019 years was 23.6, 52, and 33. The year fracture incidence calculated per 100,000 inhabitants decreased by 45.8%, 18.4%, and 13.4%, respectively. The estimated numbers of avoided fractures extrapolated for the whole country for arm, forearm, and hip were 1722, 1548, and 947, respectively. The total number of avoided fractures was 4217. The expected nationwide cost reduction for the arm, forearm, and hip fracture management was estimated at € 568,260, € 332,820, and € 1,628,840, respectively. The total cost reduction was € 2,529,920 over the period of observation. CONCLUSION: During COVID-19 pandemic, a decrease of arm, forearm, and hip fracture incidence was observed which may result in decrease of total costs for Polish healthcare system.

The blood antioxidant defence capacity during intermittent hypoxic training in elite swimmers.

The main objective of this study was to examine the chronic effect of simulated intermittent normobaric hypoxia on blood antioxidant defence capacity in swimmers. The study included 14 male and 14 female competitive swimmers performing part of land training under simulated intermittent normobaric hypoxia (O2 = 15.5%) or in normoxia. Land interval training took place twice per week, with a total of 8 training units during the study, performed with individualized intensity. The activities of blood antioxidant enzymes did not change significantly during the first and last training unit in the hypoxic and normoxic group. However, when comparing individual variables a significant effect of exercise was observed on GPx an CAT activities, whereas training units significantly differentiated GPx and GR activities. The oxygen conditions and gender had a significant influence on CAT activity. The total antioxidant capacity was not significantly affected. Only in male swimmers from the hypoxic group did the training significantly increase resting levels of MDA. In conclusion, training in normobaric hypoxia was not an adequate stimulus for the excessive response of the antioxidant defence system, despite increased oxidative stress in these conditions.

Foramen magnum morphometry in children based on computed tomography examination.

BACKGROUND: The foramen magnum is the largest opening at the base of the skull. The dimensions of the foramen magnum are of significant clinical importance because of the vital structures that pass through it. The aim of the study was the morphometric analysis of the foramen magnum in children based on head computed tomography (CT). MATERIALS AND METHODS: The study was carried out on 84 CTs of the head of children aged 0-18 years; seven age groups were distinguished. The sagittal and transverse dimensions were measured to determine the growth rate, changes between groups, and differences in the foramen size by sex. Statistical analysis of changes was performed. RESULTS: The entire group's mean transverse and sagittal dimensions were 29.08 mm (standard deviation [SD] 3.4 mm) and 35.63 (SD 4.23) mm. By sex, the mean transverse dimension in girls was 28.53 (SD 3.25) mm, and in boys, 29.6 (SD 3.49) mm. The mean sagittal dimension was 35.15 (SD 3.76) mm in girls and 36.09 (SD 4.64) mm in boys. Both dimensions were higher for the male sex. A statistically significant increase in the foramen magnum size was demonstrated up to the age of 36 months in the following age groups; above that age, the increase was statistically insignificant. CONCLUSIONS: The dimensions were similar to those described in adults a moderate dependence of the foramen magnum size on age was found.

Impact of the contact metallization on the performance of photoconductive THz antennas.

Both AuGe based alloys and Ti/Au metal layer stacks are widely used as ohmic metal contacts for photoconductive THz antennas made of low temperature grown GaAs. Here, we present the first systematic comparison between these two metallization types. A series of antennas of both kinds is excited by femtosecond laser pulses and by the emission from two diode lasers, i.e. we test the structures as pulsed THz emitters and as photomixers. In both cases, coherent and incoherent detection schemes are employed. We find that the power emitted from the antennas with AuGe metallization is 50% higher than that of antennas with a Ti/Au metal layer. From a comparison with a photomixer model we conclude that the higher output power results from a lower contact resistance of the AuGe contacts leading to an increased current flow. However, Ti/Au contacts have a higher thermal stability which might be advantageous if high system stability is called for.

The hypothalamic-pituitary-testicular axis and the testicular function are modulated after silver nanoparticle exposure.

Silver nanoparticles (AgNPs) are widely used in industrial and medical applications and humans may be exposed through different routes, increasing the risk of toxicity. We investigated the transcript expression of genes involved in the regulation of the hypothalamic-pituitary-testicular (HPT) axis and the parameters associated with sperm functionality after prepubertal exposure. AgNPs modulated the transcript expression of genes involved in the control of the HPT axis and spermatogenesis in the groups treated with lower doses, while the functional parameters related to sperm and puberty were affected in the groups administered higher doses. These results suggest that the HPT axis is disrupted by AgNPs during the prepubertal and pubertal periods, which are highly susceptible windows for the endocrine-disrupting chemical activity.

Downregulation of Jun kinase signaling in the amnioserosa is essential for dorsal closure of the Drosophila embryo.

BACKGROUND: During Drosophila embryogenesis, Jun kinase (JNK) signaling has been shown to play a key role in regulating the morphogenetic process of dorsal closure, which also serves as a model for epithelial sheet fusion during wound repair. During dorsal closure the JNK signaling cascade in the dorsal-most (leading edge) cells of the epidermis activates the AP-1 transcription factor comprised of DJUN and DFOS that, in turn, upregulates the expression of the dpp gene. DPP is a secreted morphogen that signals lateral epidermal cells to elongate along the dorsoventral axis. The leading edge cells contact the peripheral cells of a monolayer extraembryonic epithelium, the amnioserosa, which lies on the dorsal side of the embryo. Focal complexes are present at the dorsal-most membrane of the leading edge cells, where they contact the amnioserosa. RESULTS: We show that the JNK signaling cascade is initially active in both the amnioserosa and the leading edge of the epidermis. JNK signaling is downregulated in the amnioserosa, but not in the leading edge, prior to dorsal closure. The subcellular localization of DFOS and DJUN is responsive to JNK signaling in the amnioserosa: JNK activation results in nuclear localization of DFOS and DJUN; the downregulation of JNK signaling results in the relocalization of DFOS and DJUN to the cytoplasm. The HINDSIGHT (HNT) Zn-finger protein and the PUCKERED (PUC) JNK phosphatase are essential for downregulation of the JNK cascade in the amnioserosa. Persistent JNK activity in the amnioserosa leads to defective focal complexes in the adjacent leading edge cells and to the failure of dorsal closure. CONCLUSIONS: Focal complexes are assembled at the boundary between high and low JNK activity. In the absence of focal complexes, miscommunication between the amnioserosa and the leading edge may lead to a premature "stop" signal that halts dorsalward migration of the leading edge. Spatial and temporal regulation of the JNK signaling cascade may be a general mechanism that controls tissue remodeling during morphogenesis and wound healing.

Domain organization of calbindin D28k as determined from the association of six synthetic EF-hand fragments.

Calbindin D28k is an intracellular Ca(2+)-binding protein containing six subdomains of EF-hand type. The number and identity of the globular domains within this protein have been elucidated using six synthetic peptide fragments, each corresponding to one EF-hand subdomain. All six peptides were mixed in equimolar amounts in the presence of 10 mM Ca2+ to allow for the reconstitution of domains. The mixture was compared to native calbindin D28k and to the sum of the properties of the individual peptides using circular dichroism (CD), fluorescence, and 1H NMR spectroscopy, as well as gel filtration and ion-exchange chromatography. It was anticipated that if the peptides associate to form native-like domains, the properties would be similar to those of the intact protein, whereas if they did not interact, they would be the same as the properties of the isolated peptides. The results show that the peptides in the mixture interact with one another. For example, the CD and fluorescence spectra for the mixture are very similar to those of the intact calbindin D28k, suggesting that the mixed EF-hand fragments associate to form a native-like structure. To determine the number of domains and the subdomain composition of each domain in calbindin D28k, a variety of peptide combinations containing two to five EF-hand fragments were studied. The spectral and chromatographic properties of all the mixtures containing less than six peptides were closer to the sum of the properties of the relevant individual peptides than to the mixture of the six peptides. The results strongly suggest that all six EF-hands are packed into one globular domain. The association of the peptide fragments is observed to drive the folding of the individual subdomains. For example, one of the fragments, EF2, which is largely unstructured in isolation even in the presence of high concentrations of Ca2+, is considerably more structured in the presence of the other peptides, as judged by CD difference spectroscopy. The CD data also suggest that the packing between the individual subdomains is specific.

Thyroid hormone inhibits aromatase activity in porcine thecal cells cultured alone and in coculture with granulosa cells.

We cultured porcine thecal and granulosa cells alone or in coculture to define whether thyroid hormone affects aromatase activity in porcine ovarian cells. Dispersed cells were cultured with 10(-9) M triiodothyronine (T3) for 24 hours. Testosterone (final concentration 10(-7) M) was added as aromatase substrate for granulosa cells (Gc) cultured alone. Thecal (Th) androgens serve as a substrate for estradiol secretion by Th cells cultured alone and in coculture with Gc. At the end of the preincubation time, the culture media was removed and replaced with fresh media containing 100 ng follicle stimulating hormone (FSH) or 10(-3) M 8-bromo-cyclic adenosine monophosphate (8-Br-cAMP). After overnight incubation, the culture media was analyzed for estradiol production by radioimmunoassay (RIA). T3 inhibited basal, FSH-stimulated, and 8brcAMP-stimulated estradiol production in all culture conditions. T3 inhibited cAMP analogue 8-Br-cAMP and FSH-induced aromatase activity to a similar extent, thus suggesting that the inhibitory effect of T3 is downstream of cAMP formation. In the second part of the experiment a rabbit polyclonal antibody against human placental cytochrome P-450arom was used to confirm the effect of T3 on aromatase protein in Th and Gc. Pretreatment of Th and Gc with T3 markedly decreased immunostaining for aromatase in both types of cells, suggesting a direct effect of T3 on this enzyme.

Single Price/Case Price Purchasing in orthopaedic surgery: experience at the Lahey Clinic.

BACKGROUND: Hospital revenues for orthopaedic operations are not keeping pace with inflation or with rising hospital expenses. In an attempt to reduce the hospital cost of orthopaedic operations by reducing the cost of operating-room supplies, we developed a Single Price/Case Price Purchasing Program for implants used in total hip arthroplasty, total knee arthroplasty, and total shoulder arthroplasty as well as for arthroscopic shavers and burrs, interference screws, and bone-suture anchors. METHODS: The Lahey Clinic asked orthopaedic vendors to supply all instruments, implants, and disposable items related to these selected products for one single price per unit or case. For example, a single price for total hip arthroplasty implants included instruments, acetabular cups, acetabular liners, acetabular screws, femoral stems, femoral heads, and stem centralizers, if required. The hospital implemented the Single Price/ Case Price Purchasing Program with a competitive-bid request for proposal. Surgeons evaluated the responses to the bidding process, and they made final decisions on product selection. RESULTS: The Single Price/Case Price Purchasing Program at the Lahey Clinic was successful in reducing the cost of orthopaedic implants and supplies. In the present article, we could not disclose the specific prices that we agreed to pay our vendors. The specific cost reductions were 32 percent for hip implants with a change of vendor, 23 percent for knee implants without a change of vendor, 25 percent for shoulder implants with a change of vendor, 45 percent for arthroscopic shavers and burrs without a change of vendor, 45 percent for interference screws without a change of vendor, and 23 percent for bone-suture anchors without a change of vendor. CONCLUSIONS: The Single Price/Case Price Purchasing Program at the Lahey Clinic allowed the hospital to reduce its cost of orthopaedic operations by lowering the cost of operating-room supplies. This cost reduction is important in a health-care economy in which hospital revenues per unit of service or care are decreasing.

Nasal mucosal metabolism and absorption of pentapeptide enkephalin analogs having varying N-terminal amino acids.

A series of enkephalin analogs with varying amino acids on the N-terminus were synthesized and evaluated in rats in situ for their hydrolytic stability and absorption when administered nasally. The amino acids on the N-terminus were tyrosine (Y), alanine (A), serine (S), lysine (K), and aspartic acid (D). These amino acids represent different charges and sizes. Among these peptides, only the peptide carrying aspartic acid on the N-terminus was stable. The rank order of degradation rates was YGGFL > AGGFL > SGGFL, KGGFL > DGGFL. These results suggest that there are relatively high activities of aminopeptidases N and B and relatively low activity of aminopeptidase A in the rat nasal mucosa. Absorption studies were performed to determine the absorption rate of DGGFL, by measuring percentage recovery of nasal doses vs time. After a 50 microL dose of a 3 mg/mL solution, this peptide exhibited an absorption half-life of 21 min, which is similar to the nasal absorption rate of YGGFL.

Dacron ligament reconstruction for chronic anterior cruciate ligament insufficiency.

We report the 5-year follow-up results of a prospective, multicenter study evaluating the use of a Dacron prosthetic ligament in reconstruction of anterior cruciate-deficient knees. The study group consisted of 84 patients, followed for at least 5 years. The patients were divided into 2 groups: 50 patients with isolated anterior cruciate ligament laxity (Group 1) and 34 patients with a failed previous anterior cruciate ligament surgery or combined laxities (Group 2). Two surgical techniques were employed: reconstruction through drill holes in the tibia and femur (30 patients) and reconstruction using the over-the-top position with the Dacron ligament wrapped in a strip of iliotibial band (54 patients). The overall failure rate was 35.7% at 5 years. The failure rate at 2 years was 20%, illustrating a significant deterioration of results between the two follow-up intervals. Evaluation of subjective criteria using the Lysholm score showed an improvement from preoperative status at the 2-year followup; however, there was a slight decline when 5-year results were evaluated. Tegner activity levels increased from a mean of 2.9 +/- 2.1 at the preoperative visit, to a mean of 4.9 +/- 2.0 at the 2-year followup and a mean of 5.0 +/- 2.0 at the 5-year visit. These results show that the Dacron ligament prosthesis achieves the short-term goal of restoring stability and improving function and may be sufficient to provide long-term stability for the anterior cruciate-deficient knee.

The posterior Monteggia lesion.

Thirteen posterior Monteggia fracture-dislocations in adults were treated surgically at the Massachusetts General Hospital from 1980 to 1988. A characteristic lesion was observed, consisting of a proximal ulna fracture with a triangular or quandrangular fracture at or near the level of the coronoid, a posterior or posterolateral radiocapitellar dislocation, and, in 10 cases, a radial head fracture. Nine patients were women and four were men, with an average age of 56 years. Following reduction of the radiocapitellar dislocation, the ulnar fractures were treated with plates in each case. Seven fractured radial heads were excised, one replaced with a silicone prosthesis, and three treated by open reduction and internal fixation. The 11 surviving patients were observed using the performance index of Broberg and Morrey at an average follow-up time of 38.4 months. The conditions of three were rated excellent, three good, four fair, and one poor. Incomplete reduction of the ulnar fracture with residual posterior radiocapitellar subluxation was observed in four cases, all leading to loss of forearm supination. We believe this lesion to be more common than previously reported. Recognition of its specific anatomic features is essential to achieve a functional outcome.

Implications of involuntary outpatient commitment for community mental health agencies.

Mental health laws regarding involuntary commitment are under pressure for reform in many states. One popular proposal is to use direct involuntary commitment to outpatient treatment without initial hospitalization or preventive detention. This article reviews the empirical evidence concerning this approach, and discusses administrative and policy implications for community mental health agencies that will bear the burden of such reform.