Ten-Year Results of Medial Open-Wedge High Tibial Osteotomy and Chondral Resurfacing in Severe Medial Osteoarthritis and Varus Malalignment

BACKGROUND

High tibial osteotomy (HTO) is a widely used treatment option for medial osteoarthritis and varus malalignment, especially in young patients with early osteoarthritis. Limited outcome data are available for this procedure in severe osteoarthritis, and no long-term data are available using newer implants.

PURPOSE

To determine survivorship and functional results of medial open-wedge HTO combined with a chondral resurfacing (CR) procedure (abrasion plus microfracture) in severe medial osteoarthritis (Kellgren-Lawrence grade 3 and 4) and varus malalignment. Furthermore, factors that potentially influence the outcome were analyzed.

STUDY DESIGN

Case series; Level of evidence, 4.

METHODS

From September 2005 to December 2008, all cases of HTO (fixation with an angular-stable internal fixator) combined with CR were prospectively surveyed with regard to survival (Kaplan-Meier-method, not requiring arthroplasty) and functional outcome (subjective International Knee Documentation Committee [IKDC] score). Cartilage regeneration at the time of hardware removal, tibial bone varus angle (TBVA), pre- and postoperative mechanical medial proximal tibial angle (MPTA), and postoperative alignment were analyzed with regard to the result.

RESULTS

Seventy-nine knees were included (73 patients; mean age 50.9 ± 7.6 years). The follow-up rate was 90% at 10.0 ± 1.2 years (range, 8.3-12.1 years). Pre- and postoperative mechanical tibiofemoral axis were 9.6° ± 3.0° of varus and 0.6° ± 2.7° of valgus, respectively. Survival rate was 81.7% (95% CI, 72.5%-90.9%) at 10 years. Subjective IKDC score significantly improved from 44 ± 11 preoperatively to 70 ± 13 at one, 66 ± 15 at three, 66 ± 15 at five, and 65 ± 17 at ten years ( P < .001 at any point of follow-up). Poor cartilage regeneration and low preoperative IKDC score (<40) were associated with decreased survival. High preoperative TBVA was associated with better and an overcorrected MPTA (>95°) with inferior functional outcome at final follow-up, respectively.

CONCLUSION

Even in cases of severe medial osteoarthritis and varus malalignment, HTO in combination with a CR procedure is a good to excellent treatment option. The role of the CR procedure remains unclear. Although good results are obtained with overcorrected MPTA, long-term functional outcome is inferior.

Intrathecal gene therapy in mouse models expressing CMT1X mutations

Gap junction beta-1 (GJB1) gene mutations affecting the gap junction protein connexin32 (Cx32) cause the X-linked Charcot-Marie-Tooth disease (CMT1X), a common inherited neuropathy. Targeted expression of virally delivered Cx32 in Schwann cells following intrathecal injection of lentiviral vectors in the Cx32 knockout (KO) mouse model of the disease has led to morphological and functional improvement. To examine whether this approach could be effective in CMT1X patients expressing different Cx32 mutants, we treated transgenic Cx32 KO mice expressing the T55I, R75W or N175D CMT1X mutations. All three mutants were localized in the perinuclear compartment of myelinating Schwann cells consistent with retention in the ER (T55I) or Golgi (R75W, N175D) and loss of physiological expression in the non-compact myelin. Following intrathecal delivery of the GJB1 gene we detected the virally delivered wild-type (WT) Cx32 in non-compact myelin of T55I KO mice, but only rarely in N175D KO or R75W KO mice, suggesting dominant-negative effects of the R75W and N175D mutants but not of the T55I mutant on co-expressed WT Cx32. GJB1 treated T55I KO mice showed improved motor performance, lower ratios of abnormally myelinated fibers and reduction of inflammatory cells in spinal roots and peripheral nerves compared with mock-treated littermates. Either partial (N175D KO) or no (R75W KO) improvement was observed in the other two mutant lines. Thus, certain CMT1X mutants may interfere with gene addition therapy for CMT1X. Whereas gene addition can be used for non-interfering CMT1X mutations, further studies will be needed to develop treatments for patients harboring interfering mutations.

Teleneurolinguistische Therapie

In einer prospektiven Studie wird die Effizienz teleneurolinguistischer Therapie mit konventioneller Aphasietherapie bei Schlaganfallpatienten verglichen. Der Vergleich wird mittels einer neuen Therapiemethode und eines spezifisch dafür entwickelten Therapiematerials durchgeführt. Zielgruppe sind schwerst betroffene Patienten mit nichtflüssiger Aphasie. Studienziel ist es, die synchrone Teletherapie als neue Therapieform zu etablieren. Somit könnte Sprachtherapie hochfrequent und intensiv durchgeführt werden. Dadurch ließen sich wiederholte Klinikaufenthalte und langandauernde ambulante Behandlungen einsparen. Vorläufige Ergebnisse der quantitativen Analysen bestätigen, dass die Teletherapie gleiche Wirkeffekte wie konventionelle Sprachtherapie zeigt. Entgegen der Ausgangserwartung zeigen sich sogar bessere Ergebnisse im Teletherapiesetting.

Quantitative EEG-Befunde im Rahmen einer repetitiven transkraniellen Magnetstimulation bei Depressionen

Quantitative EEG Untersuchungen bei Depressionen weisen auf Asymmetrien der frontalen Alpha power hin, was mit frontalen Dysfunktionen in Zusammenhang gebracht wird. Die repetitive transkranielle Magnetstimulation (rTMS) wird basierend auf Ergebnissen klinischer Studien als wirksame antidepressive Behandlungsmethode bewertet. Frequenzabhängig ist die rTMS in der Lage, kortikale Funktionen inhibitorisch oder fazilitatorisch zu beeinflussen. Da das EEG direkte Aussagen über TMS evozierte Veränderungen neuronaler Aktivität in hoher zeitlicher Auflösung erlaubt, erfolgten in den letzten Jahren kombinierte TMSEEG-Studien. Postuliert werden könnte, dass eine hochfrequente rTMS über dem frontalen Kortex Veränderungen der frontalen Alpha power bei depressiven Patienten bewirkt. Hierzu stellen wir unsere vorläufigen Untersuchungsergebnisse zum qEEG prä und post sowie im Verlauf einer 10-Hzr-TMS-Behandlungsserie über dem linken dorsolateralen präfrontalen Kortex verglichen mit einer Scheinbehandlung vor. Weder im prä-post-Vergleich noch im Verlauf wurde eine Änderung der absoluten power aller Frequenzbänder gefunden. Die Ergebnisse werden in Bezug zu Ergebnissen aus der Literatur diskutiert.

Telesprachtherapie (Synchrotel) bei Aphasie nach Schlaganfall

In einer prospektiven Studie wurde die Effizienz telemedizinischer Online-Sprachtherapie bei Schlaganfall-Patienten überprüft. Studienziel war es, die Tele-Online-Therapie als neue zusätzliche Therapieform zu etablieren. Tele-Online-Sprachtherapie ist speziell für schwer und schwerstbetroffene chronische Patienten mit nicht flüssiger Aphasie geeignet. Sie bietet die Möglichkeit, Sprachtherapie hochfrequent und intensiv anzubieten. Dadurch können häufige Klinikaufenthalte eingespart werden. Es wurde eine neue Therapiemethode und spezifisch dafür konzipiertes Therapiematerial entwickelt: Das Konzept der interaktions-, emotions- und motivationsfokussierten Sprachtherapie. Die Ergebnisse bestätigen, dass Tele-Online-Therapie gleiche Wirkeffekte wie konventionelle Sprachtherapie zeigt. Entgegen der Ausgangserwartung zeigen sich häufiger positive Veränderungen in der Tele-Online-Therapiegruppe.

Differences between BCL2-break positive and negative follicular lymphoma unraveled by whole-exome sequencing

Depending on disease stage follicular lymphoma (FL) lack the t(14;18) in ~15-~50% of cases. Nevertheless, most of these cases express BCL2. To elucidate mechanisms triggering BCL2 expression and promoting pathogenesis in t(14;18)-negative FL, exonic single-nucleotide variant (SNV) profiles of 28 t(14;18)-positive and 13 t(14;18)-negative FL were analyzed, followed by the integration of copy-number changes, copy-neutral LOH and published gene-expression data as well as the assessment of immunoglobulin N-glycosylation sites. Typical FL mutations also affected t(14;18)-negative FL. Curated gene set/pathway annotation of genes mutated in either t(14;18)-positive or t(14;18)-negative FL revealed a strong enrichment of same or similar gene sets but also a more prominent or exclusive enrichment of immune response and N-glycosylation signatures in t(14;18)-negative FL. Mutated genes showed high BCL2 association in both subgroups. Among the genes mutated in t(14;18)-negative FL 555 were affected by copy-number alterations and/or copy-neutral LOH and 96 were differently expressed between t(14;18)-positive and t(14;18)-negative FL (P<0.01). N-glycosylation sites were detected considerably less frequently in t(14;18)-negative FL. These results suggest a diverse portfolio of genetic alterations that may induce or regulate BCL2 expression or promote pathogenesis of t(14;18)-negative FL as well as a less specific but increased crosstalk with the microenvironment that may compensate for the lack of N-glycosylation.

Interleukin 4 induces apoptosis of acute myeloid leukemia cells in a Stat6-dependent manner

Cytokines provide signals that regulate immature normal and acute myeloid leukemia (AML) cells in the bone marrow microenvironment. We here identify interleukin 4 (IL4) as a selective inhibitor of AML cell growth and survival in a cytokine screen using fluorescently labeled AML cells. RNA-sequencing of the AML cells revealed an IL4-induced upregulation of Stat6 target genes and enrichment of apoptosis-related gene expression signatures. Consistent with these findings, we found that IL4 stimulation of AML cells induced Stat6 phosphorylation and that disruption of Stat6 using CRISPR/Cas9-genetic engineering rendered cells partially resistant to IL4-induced apoptosis. To evaluate whether IL4 inhibits AML cells in vivo, we expressed IL4 ectopically in AML cells transplanted into mice and also injected IL4 into leukemic mice; both strategies resulted in the suppression of the leukemia cell burden and increased survival. Notably, IL4 exposure caused reduced growth and survival of primary AML CD34⁺CD38^- patient cells from several genetic subtypes of AML, whereas normal stem and progenitor cells were less affected. The IL4-induced apoptosis of AML cells was linked to Caspase-3 activation. Our results demonstrate that IL4 selectively induces apoptosis of AML cells in a Stat6-dependent manner-findings that may translate into new therapeutic opportunities in AML.

Signatures of a magnetic field-induced unconventional nematic liquid in the frustrated and anisotropic spin-chain cuprate LiCuSbO4

Modern theories of quantum magnetism predict exotic multipolar states in weakly interacting strongly frustrated spin-1/2 Heisenberg chains with ferromagnetic nearest neighbor (NN) inchain exchange in high magnetic fields. Experimentally these states remained elusive so far. Here we report strong indications of a magnetic field-induced nematic liquid arising above a field of ~13 T in the edge-sharing chain cuprate LiSbCuO₄ ≡ LiCuSbO₄. This interpretation is based on the observation of a field induced spin-gap in the measurements of the ⁷Li NMR spin relaxation rate T ₁^-1 as well as a contrasting field-dependent power-law behavior of T ₁^-1 vs. T and is further supported by static magnetization and ESR data. An underlying theoretical microscopic approach favoring a nematic scenario is based essentially on the NN XYZ exchange anisotropy within a model for frustrated spin-1/2 chains and is investigated by the DMRG technique. The employed exchange parameters are justified qualitatively by electronic structure calculations for LiCuSbO₄.

Traumatic graft rupture after primary and revision anterior cruciate ligament reconstruction: retrospective analysis of incidence and risk factors in 2915 cases

PURPOSE

To determine incidence and risk factors for traumatic graft rupture following primary and revision anterior cruciate ligament (ACL) reconstruction.

METHODS

All cases of isolated ACL reconstructions (primary or revision) performed at our institution between January 2007 and December 2010 were included. From this group of 2467 primary reconstructions (32.4 ± 12.2 years) and 448 revision reconstructions (33.0 ± 10.4 years), we identified all patients who underwent revision ACL reconstruction following traumatic graft rupture in further course and all patients who underwent contralateral primary ACL reconstruction until January 2014. Age, gender, time from index procedure and graft diameter (for hamstring autografts) were analysed in terms of being a potential risk factor for graft rupture.

RESULTS

Within a follow-up period of 5.0 ± 1.1 years (3.0-7.0), a total of 82 traumatic graft ruptures were identified, resulting in an incidence of 2.8 %. Seventy-three cases were seen following primary reconstructions (3.0 %), and nine cases following revision reconstructions (2.0 %), respectively (n.s.). Age younger than 25 years was identified as a risk factor for both groups (p = 0.001 and p = 0.008; odds ratio 6.0 and 6.4, respectively). In primary reconstruction, male patients had a higher risk of graft rupture compared with females (3.7 vs. 1.6 %; p = 0.005), and the first year after index procedure was associated with a higher risk of graft rupture compared with the following (p < 0.001). Graft diameter did not influence the risk of graft rupture. Incidence of contralateral ACL rupture was 3.1 %, which was not different to the incidence of graft rupture ipsilaterally (n.s.).

CONCLUSION

No statistically significant differences were seen between graft rupture incidence of primary and revision ACL reconstructions. Young age (<25 years) and short time to the index procedure (especially within the first year) were confirmed as risk factors for graft rupture in both groups. Male gender was a risk factor for primary reconstructions. Graft diameter had no influence on graft rupture rates. No difference in incidence of graft rupture compared to ACL rupture on the contralateral side was apparent.

LEVEL OF EVIDENCE

Retrospective case series, Level IV.

Estrogen catechols detection as biomarkers in schistosomiasis induced cancer and infertility

Urogenital schistosomiasis is a chronic infection caused by the human blood fluke Schistosoma haematobium. Schistosomiasis haematobium is a known risk factor for cancer leading to squamous cell carcinoma of the urinary bladder (SCC). This is a neglected tropical disease endemic in many countries of Africa and the Middle East. Schistosome eggs produce catechol-estrogens. These molecules are metabolized to active quinones that cause alterations in DNA (leading in other contexts to breast or thyroid cancer). Our group have shown that schistosome egg associated catechol estrogens induce tumor-like phenotypes in urothelial cells, originated from parasite estrogen-host cell chromosomal DNA adducts and mutations. Here we review recent findings on the role of estrogen-DNA adducts and how their shedding in urine may be prognostic of schistosome infection and/or represent potential biomarkers for urogenital schistosomiasis associated bladder cancer and infertility.

Further Development of the Temperament and Character Inventory

The Temperament and Character Inventory is an internationally used personality questionnaire based on Cloninger's psychobiological theory of personality. Given some limitations of Version 9 a revised version was developed. The structural equivalence of the two versions was demonstrated from a cross-cultural perspective with 309 and 173 healthy volunteers from Sweden and Germany, respectively, who completed both versions in one session. In testing for the replicability of the factors across both samples as well as across both versions, an orthogonal Procrustes rotation method was used. The reliability coefficients for the revision were higher than the former version for both samples. The factor structures of the inventory remain highly equivalent across cultures and across versions. The results indicate a cross-cultural transferability of the Temperament and Character dimensions of the inventory. The stability and the validity of the 7-factor model of personality, as suggested by Cloninger, are supported. The Temperament and Character Inventory–Revised represents an important and useful method for the assessment of personality.

Mental health predicted by coping, social support, and resilience among young unwed pregnant Malaysian women and mothers living in shelter homes

Purpose

There is a dearth of research on unwed young pregnant Malaysian women and mothers’ coping strategy and resilience in the context of limited social support they received. Hence, the purpose of this paper is to investigate the prediction of mental health by coping, social support, and resilience among unwed young Malaysian pregnant women and mothers.

Design/methodology/approach

Quantitative data of two assessments from respondents aged 11 to 32 years during their stay in shelter homes have been analyzed.

Findings

The result from the longitudinal study found that the variability in mental health scores could be explained between 14 percent for depressive-behavioral symptoms and 36 percent for general health. The mental health scores from the first assessment were part of the regression equation with the highest standardized β scores. Cross-sectional, the variance in the three independent variable sets explained between 6 percent (general health) and 23 percent (cognitive depressive symptoms) of the variance in the various mental health scores with different variables of significant standardized β scores in the regression equation. The study also found there were no significant changes in social support, resilience and coping between the first and second assessments even if the respondents had been in the shelter homes for a period of time.

Originality/value

The study highlighted the issue of mental health among Malaysian unwed mothers during residential periods in shelter homes. As the subject of unwed mothers is considered taboo, their rights are often deprived or overlooked.

Assessing Personality: The Temperament and Character Inventory in a Cross-Cultural Comparison between Germany, Sweden, and the USA

In this study the American, Swedish, and German versions of the Temperament and Character Inventory were compared based on samples of 300 healthy volunteers each, which had been carefully matched for age and sex. The analyses indicate a high agreement for scores on the temperament and character dimensions and subscales across the samples. Exceptions include minor differences that appear to be due to cultural variations, differences in sampling methods, and of some minor difficulties with two subscales (Exploratory Excitability and Self-acceptance) as well as defining the Persistence factor as an independent dimension of Temperament. The subscales yielded similar internal consistencies, correlational structure, factor structures, and high factor congruence coefficients. The results indicate a cross-cultural transferability of the Temperament and Character dimensions of the inventory. Also, the validity and stability of the seven-factor model of personality, as suggested by Cloninger, is supported.

Inactivation of the putative ubiquitin-E3 ligase PDLIM2 in classical Hodgkin and anaplastic large cell lymphoma

Apart from its unique histopathological appearance with rare tumor cells embedded in an inflammatory background of bystander cells, classical Hodgkin lymphoma (cHL) is characterized by an unusual activation of a broad range of signaling pathways involved in cellular activation. This includes constitutive high-level activity of nuclear factor-κB (NF-κB), Janus kinase/signal transducer and activator of transcription (JAK/STAT), activator protein-1 (AP-1) and interferon regulatory factor (IRF) transcription factors (TFs) that are physiologically only transiently activated. Here, we demonstrate that inactivation of the putative ubiquitin E3-ligase PDLIM2 contributes to this TF activation. PDLIM2 expression is lost at the mRNA and protein levels in the majority of cHL cell lines and Hodgkin and Reed–Sternberg (HRS) cells of nearly all cHL primary samples. This loss is associated with PDLIM2 genomic alterations, promoter methylation and altered splicing. Reconstitution of PDLIM2 in HRS cell lines inhibits proliferation, blocks NF-κB transcriptional activity and contributes to cHL-specific gene expression. In non-Hodgkin B-cell lines, small interfering RNA-mediated PDLIM2 knockdown results in superactivation of TFs NF-κB and AP-1 following phorbol 12-myristate 13-acetate (PMA) stimulation. Furthermore, expression of PDLIM2 is lost in anaplastic large cell lymphoma (ALCL) that shares key biological aspects with cHL. We conclude that inactivation of PDLIM2 is a recurrent finding in cHL and ALCL, promotes activation of inflammatory signaling pathways and thereby contributes to their pathogenesis.