Scaphoid, lunate and capitate kinematics in the normal and ligament deficient wrist: A bi-plane X-ray fluoroscopy study.

The ligamentous structures of the wrist stabilise and constrain the interactions of the carpal bones during active wrist motion; however, the three-dimensional translations and rotations of the scaphoid, lunate and capitate in the normal and ligament deficient wrist during planar and oblique wrist motions remain poorly understood. This study employed a computer-controlled simulator to replicate physiological wrist motion by dynamic muscle force application, while carpal kinematics were simultaneously measured using bi-plane x-ray fluoroscopy. The aim was to quantify carpal kinematics in the native wrist and after sequential sectioning of the scapholunate interosseous ligament (SLIL) and secondary scapholunate ligament structures. Seven fresh-frozen cadaveric wrist specimens were harvested, and cycles of flexion-extension, radial-ulnar deviation and dart-thrower's motion were simulated. The results showed significant rotational and translational changes to these carpal bones in all stages of disruptions to the supporting ligaments (p < 0.05). Specifically, following the disruption of the dorsal SLIL (Stage II), the scaphoid became significantly more flexed, ulnarly deviated, and pronated relative to the radius, whereas the lunate became more extended, supinated and volarly translated (p < 0.05). Sectioning of the dorsal intercarpal (DIC), dorsal radiocarpal (DRC), and scaphotrapeziotrapezoid (STT) ligaments (Stage IV) caused the scaphoid to collapse further into flexion, ulnar deviation, and pronation. These findings highlight the importance of all the ligamentous attachments that relate to the stability of the scapholunate joint, but more importantly, the dorsal SLIL in maintaining scapholunate stability, and the preservation of the attachments of the DIC and DRC ligaments during dorsal surgical approaches. The findings will be useful in diagnosing wrist pathology and in surgical planning.

Comparison of functional and radiological outcomes after computer-assisted versus conventional total knee arthroplasty: a matched-control retrospective study.

PURPOSE: To compare the radiological and functional outcomes of patients who underwent either computer-assisted or conventional total knee arthroplasty (TKA). METHODS: Two groups of 50 patients each underwent either computer-assisted or conventional TKA were retrospectively studied. Patients were matched according to body mass index (BMI), gender, and age. Three senior orthopaedic surgeons with comparable experience performed all surgeries, using 3 different prostheses. The surgical approach and peri- and postoperative regimens were the same. The mechanical axis and the tibial and femoral angles were measured using standardised long-leg weight-bearing radiographs. Overall function was assessed using the Short Form-12 (SF-12) and International Knee Society (IKS) scores. RESULTS: No intra-operative technical difficulties were encountered in either group. The computer-assisted group resulted in more consistent and accurate alignments in both the coronal and sagittal planes and better SF-12 and IKS scores. In obese patients (BMI=30 kg/m2 or more), computer-assisted TKA provided better alignment than the conventional technique. CONCLUSION: Computer-assisted TKA improves implant positioning, limb alignment, and overall functional outcome. It may be particularly advantageous for obese patients.

Pigment epithelium-derived factor overexpression inhibits orthotopic osteosarcoma growth, angiogenesis and metastasis.

Despite significant improvements, the current management of primary osteosarcoma is still limited by the development of metastatic disease, which occurs in approximately 30% of patients despite aggressive multiagent chemotherapy and tumor-ablative surgery. Therefore, there is a need for the development of novel agents to improve the outcome of these patients. Pigment epithelium-derived factor (PEDF) has been shown to be one of the most potent inhibitors of angiogenesis, and more recently has demonstrated a functional role in tumor growth, invasion and metastasis. In this study we report, for the first time, the multitargeted role of PEDF in the inhibition of growth, angiogenesis and metastasis of two orthotopic models of osteosarcoma (rat UMR 106-01 and human SaOS-2). Through stable plasmid-mediated gene transfer of full-length human PEDF, we show that PEDF overexpression significantly reduced tumor cell proliferation (P<0.05) and Matrigel invasion (UMR(PEDF), P<0.001; SaOS(PEDF), P<0.05) and increased adhesion to collagen type-1 (P<0.01), in vitro. In vivo, PEDF overexpression dramatically suppressed orthotopic osteosarcoma growth (P<0.05) and the development of spontaneous pulmonary metastases (UMR(PEDF), P<0.05; SaOS(PEDF), P<0.001). Furthermore, PEDF-overexpressing tumors exhibited reduced intratumoral angiogenesis, evidenced by a significant decrease in microvessel density (P<0.05). Therefore, together these results suggest that PEDF may be a new and promising approach for the treatment of osteosarcoma.

Salvaging the limb salvage: management of complications following endoprosthetic reconstruction for tumours around the knee.

INTRODUCTION: Limb-salvage surgery, including endoprosthetic reconstruction after tumour resection, has become the standard management for local control of tumours around the knee. As the nature of surgery is technically complex and demanding, there is potential for significant morbidity arising from complications. This study describes our experience with complications following endoprosthetic reconstruction around the knee. METHODS: Retrospective analysis of consecutive resections and endoprosthetic reconstructions for tumours around the knee between 1996 and September 2005 performed at St Vincent's Hospital, Melbourne. RESULTS: Fifty consecutive cases were reviewed, with a median follow-up of 24.5 (range, 2-124) months. Median age was 41 (range, 13-79) years. Tumour types included 38 primary musculoskeletal malignancies, 8 metastatic tumours, 2 bony lymphomas and 2 benign lesions. There were eight deaths, nine cases of subsequent metastatic spread and no local recurrences. There were six cases of deep infection, two each of non-resolving nerve palsy, fracture and mechanical wear, and one each of symptomatic patellofemoral impingement, aseptic loosening and intraoperative popliteal artery trauma. Five patients required endoprosthetic revision, and three subsequent amputations were described. Excellent functional outcome and emotional acceptance was observed amongst patients that underwent revision. CONCLUSION: Resection and endoprosthetic reconstruction of tumours around the knee is both technically challenging and resource-intensive. It is imperative that morbidity from complications is limited through the minimisation of their incidence and the provision of optimal management. This series demonstrates that good patient outcomes can be achieved in specialist centres with experienced surgeons and adoption of a multidisciplinary approach.

Assessment of normal trapeziometacarpal joint alignment.

The purpose of this study was to determine the alignment of the normal trapeziometacarpal joint and any changes in its alignment with age. Radial, dorsal and dorsoradial subluxation were measured on computerized tomographic scans in 50 joints of 50 adults aged 18 to 62. There were statistically significant correlations between increasing age and dorsoradial subluxation but no significant correlation with dorsal and radial subluxation. Significant dorsoradial subluxation occurs after 46 years of age in the normal trapeziometacarpal joint. A mean dorsoradial subluxation of 21% (range 14%-30%) can be considered normal in this age group.

Early unprotected return to contact sport after metacarpal fixation in professional athletes.

AIMS: To determine whether an early return to sport in professional Australian Rules Football players after fixation of a non-thumb metacarpal fracture was safe and effective. PATIENTS AND METHODS: A total of 16 patients with a mean age of 25 years (19 to 30) identified as having a non-thumb metacarpal fracture underwent open reduction and internal plate and screw fixation. We compared the players' professional performance statistics before and after the injury to determine whether there was any deterioration in their post-operative performance. RESULTS: Of the 16, 12 sustained their fracture during the season: their mean time to return to unrestricted professional play was two weeks (1 to 5). All except two of the 48 player performance variables showed no reduction in performance post-operatively. CONCLUSION: Our data suggest that professional athletes who sustained a non-thumb metacarpal fracture can safely return to professional play without restriction two weeks after internal fixation. Cite this article: Bone Joint J 2017;99-B:1343-7.

Pelvic reconstruction using saddle prosthesis following limb salvage operation for periacetabular tumour.

PURPOSE: To assess the clinical results of pelvic reconstruction using a saddle prosthesis following limb salvage operation for periacetabular tumour. METHODS: 12 patients with sarcoma and 4 with metastasis involving the pelvis were treated using the saddle prosthesis between 1995 and 2003 inclusive. Wide pelvic resection was performed for all patients with sarcoma and one with a metastatic lesion; intralesional excision of the acetabulum was undertaken for the remaining 3 patients with metastatic lesions. Oncologic prognosis, operation time, postoperative function, and complications were assessed retrospectively. RESULTS: Of the 12 patients with sarcomas, 5 were alive without evidence of recurrence after a mean follow-up of 37 months, one was alive with disease, 3 died of the disease, and 3 of other medical conditions. Respective mean postoperative functional scores according to the Musculoskeletal Tumor Society-International Symposium on Limb Salvage system and the Toronto Extremity Salvage Score were 53 and 64% in patients undergoing wide acetabular resection, and 30 and 42% in patients undergoing intralesional excision of the acetabulum. In patients undergoing wide acetabular resection and intralesional excision of the acetabulum, the mean operation times were 391 and 162 minutes respectively, whereas the mean times to ambulation were 7 and 4 days respectively. Major complications included infection and dislocation. CONCLUSION: Saddle prosthesis arthroplasty is a useful option for pelvic reconstruction following resection of acetabular malignancies. It is associated with a short operation time, rapid recovery, and moderately good postoperative function, but a relatively high risk of complications.

Serotypes and clinical manifestations of invasive group B streptococcal infections in western Sweden 1998-2001.

This study monitored the serotypes of Streptococcus agalactiae (group B streptococcus; GBS) isolated from invasive infections in western Sweden and investigated possible relationships between serotype, age and clinical manifestations. Invasive GBS isolates were collected prospectively during 1998-2001 at six laboratories, covering two counties with a population of 1.8 million, and were serotyped by coagglutination. Clinical data were obtained from hospital notes. In total, 161 invasive strains (50 from neonates and infants aged < 3 months, and 111 from adults) were serotyped. The commonest serotypes from neonates and infants were serotypes III (60%), V (22%) and Ia (10%), and from adults were serotypes V (42%) and III (25%). Serotype V had doubled in frequency among both children and adults compared to a previous study from the same area in 1988-1997. Most (80%) of the adults had an underlying medical condition. No relationship was found between serotype and clinical manifestations. However, the study demonstrated the importance of active surveillance of GBS serotypes and the difficulties of formulating a multivalent polysaccharide conjugate vaccine against GBS.

Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors.

Oral infections and cardiovascular diseases share common biological and behavioral risk factors. Psychosocial determinants could act as a link between general health behavior and dental health behavior. Our objective was to study optimism and life satisfaction as determinants of general and dental health behavior and to evaluate whether these are connected with cardiovascular risk factors and dental diseases. The 1966 Northern Finland Birth Cohort (N = 12,058) is a general population birth cohort. In a postal questionnaire, respondents (N = 8690) were asked about their health behavior and dental status. Cardiovascular risk factors were assessed in health examinations (N = 6033). Generalized linear regression models were used in analysis. The results showed that health orientation increases with strengthening life satisfaction and optimism. Dental health behavior and general health behavior were associated with both cardiovascular risk factors and self-reported dental diseases, which support the assumption that they share a common behavioral background.

Work ability of young adults.

This paper reviews the themes related to work ability of young adults. Premature working discapacity causes significant economical and social costs in Finland compared to other Nordic countries and has for that reason been studied most intensively there. Work ability is an interaction of social, environmental and individual factors such as physical fitness, coping skills, social support behaviour and health behaviour. Environmental factors influencing work ability can be concrete, like physical and chemical exposures or more abstract like unemployment. The work ability of ageing people has been studied intensively, while work ability of young adults has not been properly evaluated so far. The worsened economic situation in Finland has meant an excessive work load for those who still have work. At the same time the risk of permanent unemployment is increasing. This polarizationing affects especially the young because they may fail to enter the working life. Also factors related to childhood may affect and even determine work ability in adulthood.

Surgical correction of dentofacial anomalies: an evaluation of two patient groups with the aid of a a questionnaire.

The study is based on a questionnaire answered by 273 patients with dentofacial anomalies who underwent surgery between 1988-1992 in Boden and Jönköping. The questions concerned how the patients experienced their circumstances before, during, and after treatment, and the care they received. The purpose of the study was to investigate the patients' experience of the treatment, and, thereby, evaluate the treatment team's care in order to improve it. The patients responded mainly positively about the treatment they received, despite it having been both long and trying. The main problems for patients with dentofacial anomalies are functional and aesthetic. Patients were not particularly bothered by the length of time the treatment took or that the results had not been predicted with certainty prior to the treatment. The treatment resulted in a radical change for the better in both appearance and the functional and occlusal aspects of the masticatory system. The questionnaire worked well as an instrument for use by the treatment teams to survey the results of their efforts from the point of view of their patients.

Masseteric-facial nerve coaptation--an alternative technique for facial nerve reinnervation.

BACKGROUND: Reinnervation of the facial musculature when there is loss of the proximal facial nerve poses a difficult clinical problem. Restoration of spontaneous mimetic motion is the aim and, to this end, the use of cross-facial nerve grafts has long been considered the reconstruction of choice. The nerve to masseter has been used very successfully for reinnervation of microvascular functioning muscle transfers for facial reanimation in established facial palsy but its use as a direct nerve transfer to the facial nerve to reinnervate 'viable' facial musculature has been scarce. METHODS: Electron micrographic studies of axonal counts in the nerve to masseter and nerve to gracilis in a clinical series of seven patients undergoing surgery for facial nerve palsy were made. Based on these results, and previous success with the use of the nerve to masseter for reinnervation of free gracilis transfers, we report our experience with the transfer of the nerve to masseter for direct coaptation with the ipsilateral facial nerve to restore facial motion. RESULTS: Our axonal counts of the nerve to masseter have, on average, 1542+/-291.70 (SD) axons. Historical data have shown that the buccal branch of the facial nerve has 834+/-285 (SD) where the distal end of a cross-facial nerve graft has 100 to 200 axons. Our clinical use of the nerve to masseter as a direct nerve transfer in three patients based on these data has resulted in significant improvement in facial symmetry in repose (at a minimum of 1 year follow up), restoration of facial motion with occasional spontaneous activity and minimal synkinesis without any donor morbidity. CONCLUSIONS: The advantages of this technique include the ease of dissection, constant and reliable anatomy, powerful reinnervation of the facial muscles without donor site morbidity and the potential for return of spontaneous facial movement.

Food induced stimulation of the antisecretory factor can improve symptoms in human inflammatory bowel disease: a study of a concept.

BACKGROUND: Antisecretory factor (AF), a 41 kDa cloned and sequenced protein, suppresses intestinal inflammation and hypersecretion in animals. Endogenous AF production can be induced by dietary modifications in several animal species, and this feed has been shown to reduce the incidence of diarrhoeal disease in weaning piglets. The role of AF in intestinal disease in humans is not known. AIMS: To study the effects of hydrothermally processed cereals, optimised for AF induction in animals, added to the diet of patients with longstanding symptoms of inflammatory bowel disease (IBD). PATIENTS: Fifty three patients with IBD (ulcerative colitis and Crohn's disease) were entered into the study, and 50 completed follow up. The experimental group consisted of 16 females (mean age 50 (SEM 5) years) and 10 males (41 (4) years) and the placebo group of 12 women (41 (4) years old) and 12 men (51 (5) years). METHODS: Patients were randomised to receive either hydrothermally processed cereals (active treatment) or the same amount of ordinary cereals (placebo treatment) for four weeks in a double blind study design. Baseline diet and medications remained unchanged. Bowel symptoms, plasma levels of AF, and colonic biopsies were evaluated before and after treatment. RESULTS: The active treatment significantly improved subjective ratings of clinical symptoms and increased plasma AF levels compared with placebo. Plasma lipid levels were unaffected. CONCLUSION: Hydrothermally processed cereals can induce AF production in human IBD. This increase in endogenous AF activity is associated with clinical improvement. Further studies are warranted to clarify the exact role of AF in human intestinal disease.

Unemployment and obesity among young adults in a northern Finland 1966 birth cohort.

OBJECTIVE: To establish (1) if obesity in adolescence predicts a long history of unemployment and other adverse social outcomes at age 31 y and, conversely, (2) the effect of a long history of unemployment on the risk of obesity at 31 y. DESIGN AND SUBJECTS: A longitudinal, population-based study of 9,754 subjects born in 1966 in Northern Finland was conducted. The cohort members were studied at birth, 1, 14 and 31 y. MEASUREMENTS: Body mass index (BMI) at 14 and 31 y; work history, as self-reported at 31 y and as recorded in national registers of the total number of days each subject had received unemployment allowance between 1985 and 1997; place of residence at 14 and 31 y; family social class at 14 y; subject's school performance at 16 y; marital status and number of children at 31 y. RESULTS: Overweight and obesity at 14 y did not predict a long history of unemployment at 31 y, but were associated with a low level of education, and being single or divorced at 31 y among females. A long history of unemployment (register data) was associated with an increased risk of obesity among women, but not men, after controlling for potential confounding factors (social class at 14 y, BMI at 14 y, school performance at 16 y, place of residence, and number of children). The adjusted OR (95% CI) was 1.09 (0.72-1.63) for men, and 1.64 (1.07-2.50) for women. CONCLUSION: Adverse social outcomes of adolescent obesity seemed to emerge more for women. Subjects with low school performance and women with a long unemployment history are at increased risk of obesity.

Aminoglycosides do not improve the efficacy of cephalosporins for treatment of acute pyelonephritis in women.

A prospective, coordinated, randomized multicentre trial was conducted to determine whether tobramycin 160 mg intravenously (i.v.) once daily for 2 days would improve the efficacy of cefotaxime 1 g i.v. twice daily for 2 days followed by a 10-day course of oral cefadroxil 1 g twice daily, in the treatment of community-acquired acute pyelonephritis in women. Of 73 patients enrolled in the study, 51 could be evaluated according to the protocol. There were no significant differences in bacteriological cure rates between the combined treatment with tobramycin/cefotaxime and cefotaxime alone, either at short-term follow-up (63.0% vs 59.1%; 95% confidence interval (CI) for difference in proportions -23.4% to 31.2%), or up to 7 weeks after cessation of treatment (42.9% vs 52.2%; 95% CI, -18.0% to 36.6%). A modified intention-to-treat analysis showed no difference in clinical efficacy between the two regimens (68.6% vs 69.2%; 95% CI, -22.9% to 24.1%). Tobramycin seemed to enhance the resolution of inflammation by a more rapid decline in C-reactive protein levels. The high recurrence rates after treatment with beta-lactam antibiotics in this and previous studies of acute pyelonephritis may be explained by adverse ecological effects rather than failure to eradicate the infection.

Folkecology and commons management in the Maya Lowlands.

Three groups living off the same rainforest habitat manifest strikingly distinct behaviors, cognitions, and social relationships relative to the forest. Only the area's last native Maya reveal systematic awareness of ecological complexity involving animals, plants, and people and practices clearly favoring forest regeneration. Spanish-speaking immigrants prove closer to native Maya in thought, action, and social networking than do immigrant Maya. There is no overriding "local," "Indian," or "immigrant" relationship to the environment. Results indicate that exclusive concern with rational self-interest and institutional constraints do not sufficiently account for commons behavior and that cultural patterning of cognition and access to relevant information are significant predictors. Unlike traditional accounts of relations between culture, cognition, and behavior, the models offered are not synthetic interpretations of people's thoughts and behaviors but are emergent cultural patterns derived statistically from measurements of individual cognitions and behaviors.