Treatment of pediatric forearm midshaft fractures: Is there a difference between types of orthopedic surgeon?

PURPOSE OF THE STUDY

The objective of this study was to compare the clinical and radiological outcomes of pediatric forearm midshaft fractures treated operatively with titanium elastic nails (TENs) by pediatric orthopedists and non-pediatric orthopedists.

MATERIAL AND METHODS

We conducted a prospective cohort study of 88 children of forearm midshaft fractures, who were randomized to operative stabilization either by pediatric orthopedists (Group A, 44 cases) or by non-pediatric orthopedists (Group B, 44 cases) from April 2013 to February 2014. At baseline, the groups were comparable with respect to age, sex, AO classification, injured side and interval from injury to surgery. We collected data on operative and radiation time, open reduction rate, length of hospitalization, bone union time, return to full physical activity time, complications, and measured clinical results using the Children's Hospital of Philadelphia (CHOP) Forearm Fracture Fixation Outcome Classification.

RESULTS

The mean follow-up period was 15.8±3.3 months for Group A and 15.2±4.2 months for Group B (P=0.491). No significant difference existed in time to union (P=0.282), the overall complication rate (P=0.750), return to activity time (P=0.408), and clinical outcomes according to CHOP classification (P=0.908) between the two groups. However, the mean operating time and radiation time was significantly longer in Group B than in Group A (P=0.001 and P=0.001, respectively). In addition, there was a trend for patients of Group B to have a higher rate of open reduction (P=0.035).

DISCUSSIONS

Our results indicated that children forearm midshaft fractures treated surgically by pediatric orthopedists offered potential advantages including a shorter operating time and radiation time, a lower rate of open reduction. However, both pediatric and non-pediatric orthopedists had achieved satisfactory clinical results in treatment of these injuries.

LEVEL OF EVIDENCE

Level II prospective randomized study.

IA comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children

The purpose of this study was to compare the clinical outcomes of displaced intra-articular calcaneal fractures in older children treated with poking reduction and cannulated screws fixation or with plate fixation using a sinus tarsi approach. From June 2008 to May 2012, fifty patients were randomised to operative stabilisation either by poking reduction and cannulated screws fixation (Group A, 28) or by plates fixation using a sinus tarsi approach (Group B, 22). The two groups were comparable with respect to age, gender, BMI, the affected side, cause of injury, fracture type, time from injury to surgery and follow-up time. We collected data on operative time and radiation time, length of hospitalization, hospital costs, union time, full weight-bearing time, full physical activity time and complications and measured joint function using the American Orthopaedic Foot and Ankle surgery (AOFAS) score. The average follow-up time of Group A was 36.5±9.3 months and 40.2±10.6 months in Group B. No significant difference between these two groups was found in radiation time, average length of hospitalization, union time, full weight-bearing time, full physical activity time and the average AOFAS score. However, the patients of Group B had longer operation time (38.0±10.6 min vs. 66.5±9.4 min, P<0.05) and more hospital costs (6200±800 RMB vs. 15000±2000 RMB, P<0.05). The average Bohler's angle and Gissane's angle preoperative were 10.9±5.3 and 141.3±12.1 in Group A, and became 31.2±5.1 and 128.5±5.4 after operation. The average Bohler's angle and Gissane's angle preoperative in Group B were 11.7±4.0 and 138.8±16.2, respectively, and they became 30.9±5.2 and 124.6±6.8 after operation. Bohler's angle and Gissane's angle were significantly restored after surgery (P<0.05). Postoperative incision pain was more frequent in Group B than in Group A (P<0.05). Our results indicated that both cannulated screws and plates were efficient methods for intra-articular calcaneal fractures in older children. However, poking reduction and cannulated screws fixation had the advantages of a shorter operative time, fewer hospital costs and less incision pain.

Development of Precision Small-Molecule Proneurotrophic Therapies for Neurodegenerative Diseases

Age-related neurodegenerative diseases, such as Alzheimer's disease, will represent one of the largest future burdens on worldwide healthcare systems due to the increasing proportion of elderly in our society. As deficiencies in neurotrophins are implicated in the pathogenesis of many age-related neurodegenerative disorders, it is reasonable to consider that global neurotrophin resistance may also become a major healthcare threat. Central nervous system networks are effectively maintained through aging by neuroprotective and neuroplasticity signaling mechanisms which are predominantly controlled by neurotrophin receptor signaling. Neurotrophin receptors are single pass receptor tyrosine kinases that form dimeric structures upon ligand binding to initiate cellular signaling events that control many protective and plasticity-related pathways. Declining functionality of the neurotrophin ligand-receptor system is considered one of the hallmarks of neuropathological aging. Therefore, it is imperative to develop effective therapeutic strategies to contend with this significant issue. While the therapeutic applications of cognate ligands for neurotrophin receptors are limited, the development of nonpeptidergic, small-molecule ligands can overcome these limitations, and productively regulate this important receptor system with beneficial effects. Using our advanced knowledge of the high-dimensionality complexity of receptor systems, the future generation of precision medicines targeting these systems will be an attainable goal.

Observation of Orbital Order in the Half-Filled 4f Gd Compound

Half-filled electron systems, even with the maximized spin angular moment, have been given little attention because of their zero-orbital angular moment according to Hund's rule. Nevertheless, there are several measurements that show evidence of a nonzero orbital moment as well as spin-orbit coupling. Here we report for the first time the orbital order in a half-filled 4f-electron system GdB_{4}, using the resonant soft x-ray scattering at Gd M_{4,5}-edges. Furthermore, we discovered that the development of this orbital order is strongly coupled with the antiferromagnetic spin order. These results clearly demonstrate that even in half-filled electron systems the orbital angular moment can be an important parameter to describe material properties, and may provide significant opportunities for tailoring new correlated electron systems.

Integrated Two-Analyte Population Pharmacokinetic Model for Antibody-Drug Conjugates in Patients: Implications for Reducing Pharmacokinetic Sampling

An integrated pharmacokinetics (PK) model that simultaneously describes concentrations of total antibody (Tab) and antibody‐conjugated monomethyl auristatin E (acMMAE) following administration of monomethyl auristatin E (MMAE)‐containing antibody–drug conjugates (ADCs) was developed based on phase I PK data with extensive sampling for two ADCs. Two linear two‐compartment models that shared all parameters were used to describe the PK of Tab and acMMAE, except that the deconjugation rate was an additional clearance pathway included in the acMMAE PK model compared to Tab. Further, the model demonstrated its ability to predict Tab concentrations and PK parameters based on observed acMMAE PK and various reduced or eliminated Tab PK sampling schemes of phase II data. Thus, this integrated model allows for the reduction of Tab PK sampling in late‐phase clinical development without compromising Tab PK characterization.

A comparison of double Endobutton and triple Endobutton techniques for acute acromioclavicular joint dislocation

PURPOSE OF THE STUDY

The purpose of this study was to evaluate the results of patients treated with either double Endobutton device or triple Endobutton device for acute acromioclavicular joint dislocations.

PATIENTS AND METHODS

Eighty patients were randomized to operative stabilization either by double Endobutton device (group A, 40) or by triple Endobutton device (group B, 40). Preoperative variables included the patients' age, sex, the affected side, cause of injury, Rockwood classification and time from injury to surgery. Peri-operative variables were incision length, blood loss, the operative time and the radiation time, length of hospitalization and hospital costs. Postoperative variables were complications, the Constant and VAS scores and the ability to return to previous work. The coracoclavicular (CC) distance of the affected shoulder was assessed on a standard radiograph and compared with the contralateral normal one.

RESULTS

The average follow-up time of group A was 26.5±7.3months and group B was 24.2±6.6months. The overall complication rate was similar in both groups (26/40 vs. 24/40, P=0.644). There were no significant differences in the mean incision length, blood loss, the operative and radiation time, length of hospitalization, the Constant and VAS scores, and the ability to return to previous work between the two groups. However, the patients of group B had more hospital costs (3802.5±258.5 vs. 2433.6±182.5 USD, P=0.000). The radiological assessment revealed no significant difference in the CC distance between the two groups (P=0.625).

DISCUSSIONS

Triple Endobutton technique did not show significant clinical advantages over double Endobutton technique.

LEVEL OF EVIDENCE

Level II prospective randomized study.

Synchronized 4 × 12 GHz hybrid harmonically mode-locked semiconductor laser based on AWG

We report a monolithically integrated synchronized four wavelength channel mode-locked semiconductor laser chip based on arrayed waveguide grating and fabricated in the InP material system. Device fabrication was completed in a multiproject wafer foundry run on the Joint European Platform for Photonic Integration of Components and Circuits. The integrated photonic chip demonstrated 5th harmonic electrical hybrid mode-locking operation with four 400 GHz spacing wavelength channels and synchronized to a 12.7 GHz RF clock, for nearly transform-limited optical pulse trains from a single output waveguide. A low timing jitter of 0.349 ps, and RF frequency locking range of ~50 MHz were also achieved.

Vascular risk factors aggravate cognitive impairment in first-ever young ischaemic stroke patients

BACKGROUND AND PURPOSE

Young ischaemic stroke patients often suffer from cognitive impairment after stroke. However, the risk factors of cognitive impairment are still unclear. This study examined the impact of vascular risk factors (VRFs) on cognitive impairment in first-ever young ischaemic stroke patients.

METHODS

Subjects were divided into low (0-1 VRF, n = 27), medium (2-3 VRFs, n = 45) and high-risk (≥4 VRFs, n = 12) groups according to their number of VRFs. The following VRFs were collected: hypertension, diabetes mellitus, dyslipidaemia, atrial fibrillation, obesity, smoking, excess alcohol consumption, coronary heart disease and hyperhomocysteinaemia. A battery of cognitive assessments was executed 2 weeks after stroke. Differences of cognitive performances between groups were compared. The correlation between VRFs and cognitive function was investigated with an emphasis on discovering the main VRFs.

RESULTS

Eighty-four patients were enrolled in this study eventually. Compared with the low-risk group, the high-risk group had significantly worse performance in most of the cognitive domains. VRFs had a correlation with general cognition, executive function, attention and verbal fluency. After adjusting the covariates, VRFs showed a linear correlation with global cognitive function (R = 0.640, P = 0.000), verbal fluency (R = 0.372, P = 0.000), delayed memory (R = 0.327, P = 0.002), visual attention (R = 0.290, P = 0.007) and executive function (R = 0.266, P = 0.015). Amongst all the VRFs, hypertension, hyperlipidaemia, smoking and hyperhomocysteinaemia were the main influencing VRFs.

CONCLUSION

Vascular risk factors aggravate cognitive impairment after young ischaemic stroke. Effective management of VRFs in young adults is urgent and this may reduce the cognitive impairment.

Abstract P4-13-05: Safety results of the US expanded access program (EAP) of palbociclib in combination with letrozole as treatment of post-menopausal women with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC) for whom letrozole therapy is deemed appropriate

Background: In the Phase I/II PALOMA-1 trial, a study in women with estrogen receptor (ER) positive advanced breast cancer (ABC) receiving initial therapy for their metastatic disease, combination of the CDK4/6 inhibitor palbociclib with letrozole improved progression free survival compared to letrozole. The aim of this open-label, single-arm EAP was to provide appropriate patients (pts) with ABC access to palbociclib pending marketing approval in the United States.

Methods: In the EAP, a total of 242 pts with HR+/HER2- ABC were treated at 42 sites in the US. Pts received palbociclib 125 mg/d (3 weeks on, 1 week off) in combination with letrozole 2.5 mg/d (continuous daily dosing) until disease progression, intolerable adverse event (AE), or commercial availability. AEs and serious AEs (SAEs) were assessed every cycle. Complete blood counts were assessed on day 1 and day 14 of the first two cycles and then at the beginning of each cycle thereafter. Tumor assessments were collected by investigators as per routine clinical practice.

Results: In this early analysis, we describe an initial cohort of 97 pts, with data collected during the first 3 months of study. Median duration of therapy was 31 days. Mean age was 62 yr (range 29-89). Baseline ECOG PS was 0, 1 or 2 in 36%, 49%, and 14% of pts, respectively. Common prior treatments (≥40% in any setting) included fulvestrant (59%), anastrozole (50%), paclitaxel (50%), exemestane (48%), cyclophosphamide (46%), tamoxifen (45%), doxorubicin (44%), and capecitabine (40%). Treatment-emergent AEs (TEAE; all grades) that occurred in greater than 10% of patients included neutropenia (28%), fatigue (19%), neutrophil count decreased (12%). Other hematologic TEAE rates included: anemia 9%, white blood cell count decreased 9% and thrombocytopenia 5%. All causality SAEs occurred in 6% of pts at the rate of 1 patient each for ankle fracture, constipation, disease progression, febrile neutropenia, lung infection, and pancytopenia. The rate of palbociclib dose reduction due to a TEAE was 4%. The rate of temporary delay of palbociclib due to TEAE was 36%. TEAEs leading to permanent discontinuation occurred in 1% of pts (Grade 3 nausea & vomiting). Grade 3 or 4 TEAEs were reported in 42% of pts, including neutropenia (Grade 3: 24%, Grade 4: 2%). There were no fatal outcomes due to TEAEs. This early data will be updated for final conference presentation to include the complete patient cohort and updated duration of therapy on study drug.

Conclusions: In this population of pts with HR+/HER2- ABC, palbociclib in combination with letrozole was well tolerated. Analysis of this early cohort indicates that the safety profile was consistent with that seen in the PALOMA-1 trial.

Clinical trial information: NCT02142868

Funding Source: Pfizer.

Citation Format: Stearns V, Smith II JW, Patel R, Lu D, Perkins JJ, Cotter MJ, Brufsky AM. Safety results of the US expanded access program (EAP) of palbociclib in combination with letrozole as treatment of post-menopausal women with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC) for whom letrozole therapy is deemed appropriate. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-05.

Synthesis and characterization of imidazolium poly(azolyl)borate ionic liquids and their potential application in SO2 absorption

New imidazolium poly(azolyl)borate ionic liquids (ILs) were synthesized by salt metathesis, and they can absorb SO₂ through multi-site interactions at 20 °C, 0.1 MPa SO₂ with the highest SO₂ capacity of 5.8 mol mol⁻¹ of IL and 1.05 g g⁻¹ of IL.

The relationship between radiographic parameters and clinical outcome of distal radius fractures in elderly patients

PURPOSE OF THE STUDY

Treatment of distal radius fractures in elderly patients is controversial. This study explored the relationship between radiographic parameters and clinical outcomes of patients with distal radius fractures following conservative treatment. The study was done using radiographic measurements of distal radius fractures in elderly patients.

PATIENTS AND METHODS

Ninety-two active, healthy patients with conservatively managed distal radius fractures were included in the study. Functional and radiographic assessments were made 1 year after injury. Fifty patients who underwent corrective osteotomy comprised the control group. Radiographic parameters and clinical outcomes were compared between the two groups. The correlation coefficients of the radiographic parameters were analysed using multiple regression.

RESULT

Radius height (RH), volar tilt (VT) and Mayo wrist and Disabilities of the Arm, Shoulder and Hand (DASH) scores in the experimental group were significantly superior to those of the control group. There was no significant group difference in radial inclination. Multiple regression analysis revealed that the most important factor affecting functional outcome was RH, followed by VT.

DISCUSSION

RH and VT were significantly correlated with the clinical outcomes of conservative treatment of distal radius fractures. RH should be given foremost consideration in elderly patients. Preoperatively, surgeons should evaluate this parameter carefully and be prepared to treat injuries accordingly.

LEVEL OF EVIDENCE

Level IV retrospective study.

Genome-wide association study of myelosuppression in non-small-cell lung cancer patients with platinum-based chemotherapy

Platinum-induced myelosuppression severely impedes successful chemotherapy in non-small-cell lung cancer (NSCLC) patients. Hence, it is clinically important to identify the patients who are at high risk for severe toxicity to certain chemotherapy. We first carried out a genome-wide scan of 906 703 single-nucleotide polymorphisms (SNPs) to identify genetic variants associated with platinum-induced myelosuppression risk in 333 NSCLC patients with chemotherapy. Then, we replicated 24 SNPs that had P<1 × 10(-4) in another independent cohort of 876 NSCLC patients. With P<0.05 as the criterion of statistical significance, we found that rs13014982 at 2q24.3 and rs9909179 at 17p12 exhibited consistently significant associations with myelosuppression risk in both the genome-wide association studies (GWAS) scan and the replication stage (rs13014982: odds ratio (OR)=0.55, 95% confidence intervals (CIs): 0.41-0.74, P=7.29 × 10(-5) for GWAS scan and OR=0.77, 95% CI: 0.65-0.93, P=0.006 for replication stage; rs9909179: OR=0.51, 95% CI: 0.37-0.70, P=4.60 × 10(-5) for GWAS scan and OR=0.82, 95% CI: 0.68-0.99, P=0.040 for replication stage; both in additive model). In combined samples of genome-wide scan and replication samples, the minor alleles of rs13014982 and rs9909179 remained significant associations with the decreased risk of myelosuppression (rs13014982: OR=0.71, 95% CI: 0.61-0.83, P =1.36 × 10(-5); rs9909179: OR=0.76, 95% CI: 0.65-0.89, P=0.001). Rs13014982 at 2q24.3 and rs9909179 at 17p12 might be independent susceptibility markers for platinum-induced myelosuppression risk in NSCLC patients.

Class IIa HDAC inhibition enhances ER stress-mediated cell death in multiple myeloma

Histone deacetylase (HDAC) inhibitors have been extensively investigated as therapeutic agents in cancer. However, the biological role of class IIa HDACs (HDAC4, 5, 7 and 9) in cancer cells, including multiple myeloma (MM), remains unclear. Recent studies show HDAC4 interacts with activating transcription factor 4 (ATF4) and inhibits activation of endoplasmic reticulum (ER) stress-associated proapoptotic transcription factor C/EBP homologous protein (CHOP). In this study, we hypothesized that HDAC4 knockdown and/or inhibition could enhance apoptosis in MM cells under ER stress condition by upregulating ATF4, followed by CHOP. HDAC4 knockdown showed modest cell growth inhibition; however, it markedly enhanced cytotoxicity induced by either tunicamycin or carfilzomib (CFZ), associated with upregulating ATF4 and CHOP. For pharmacological inhibition of HDAC4, we employed a novel and selective class IIa HDAC inhibitor TMP269, alone and in combination with CFZ. As with HDAC4 knockdown, TMP269 significantly enhanced cytotoxicity induced by CFZ in MM cell lines, upregulating ATF4 and CHOP and inducing apoptosis. Conversely, enhanced cytotoxicity was abrogated by ATF4 knockdown, confirming that ATF4 has a pivotal role mediating cytotoxicity in this setting. These results provide the rationale for novel treatment strategies combining class IIa HDAC inhibitors with ER stressors, including proteasome inhibitors, to improve patient outcome in MM.