Short-term Functional Outcomes and Complications of Custom Patellofemoral Arthroplasty

Background

Patellofemoral arthroplasty (PFA) is a treatment option for isolated patellofemoral arthritis. Custom PFA is an innovative procedure utilizing patient-specific instrumentation. The purpose of this study is to evaluate short-term functional outcomes and complications of the custom PFA in treatment of isolated patellofemoral arthritis.

Methods

A retrospective study was conducted to analyze patients who received a PFA operation from a single surgeon. Inclusion criteria were surgical patients from 2012 to 2018 who underwent PFA using a custom prosthesis implant. Knee injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS, JR) and Lower Extremity Functional Scale (LEFS) were collected before and after surgery.

Results

A total of 79 patients (94 knees) participated in the study; 55 (69.6%) were women. The median age was 57 at the time of index arthroplasty; 15 patients (30 knees) were bilateral. Follow-up rate was 94%. Median follow-up duration was 3.6 years (2-8.9). Overall prefunctional and postfunctional scores differed significantly for both KOOS, JR and LEFS. Postoperative scores increased for KOOS, JR by 27.5 points, and for LEFS, they increased 26.0 points; P < .001 for both. Complications included 6 reoperations (6.7%) related to PFA: 4 conversions (4.4%) to total knee arthroplasty at a median of 2.5 (1.5-3) years after the index procedure, one vastus medialis oblique advancement (1.1%) secondary to patellar maltracking, and one manipulation under anesthesia (1.1%).

Conclusions

Custom PFA in patients with isolated patellofemoral arthritis showed good short-term functional outcomes and low revision rates with very few complications.

Plain film of the abdomen remains a low sensitivity test in A&E

BACKGROUND

Plain film abdomens (PFA) are frequently used in the emergency department to help guide the management of patients presenting with abdominal symptoms. A plain film abdomen contributes minimally to clinical scenarios due to low sensitivity and specificity. Is a PFA useful in the emergency setting or does it serve to further complicate decision making?

AIM

We hypothesise that PFAs in the emergency department are over utilised to falsely reassure clinicians and patients alike.

METHODS

A search of the National Integrated Medical Imaging System (NIMIS) database in an Irish tertiary referral hospital was conducted. All plain film abdominal radiographs requested by the emergency department between 01/01/2022 and 31/08/2022 were identified. Requests where there was suspicion of foreign body were excluded. A retrospective search of the NIMIS database identified subjects who underwent subsequent imaging.

RESULTS

A total of 619 abdominal films were deemed suitable for inclusion. These comprised of 338 male and 282 female subjects. Subjects had an average age of 64 years. Fifty-seven per cent of PFAs detected no abnormality. Forty-two per cent of subjects had subsequent imaging. The plain film findings correlated with further imaging in only 15% of cases. One case of ruptured aortic aneurysm and 11 perforations were detected on computerised tomography, none of these cases were evident on abdominal X-ray.

CONCLUSION

Plain film abdomen requests are over utilised in the emergency department. PFAs are not sensitive for detecting acute pathology and should not be used to decide if a patient requires further imaging or a full clinical assessment.

Comparative analysis of sucrose-embedding for whole-body zebrafish MSI by IR-MALDESI

Infrared matrix-assisted laser desorption electrospray ionization mass spectrometry imaging (IR-MALDESI) conventionally utilizes fresh-frozen biological tissues with an ice matrix to improve the detection of analytes. Sucrose-embedding with paraformaldehyde fixation has demonstrated feasibility as an alternative matrix for analysis by IR-MALDESI by preserving tissue features and enhancing ionization of lipids. However, investigating multi-organ systems provides broader context for a biological study and can elucidate more information about a disease state as opposed to a single organ. Danio rerio, or zebrafish, are model organisms for various disease states and can be imaged as a multi-organ sample to analyze morphological and metabolomic preservation as a result of sample preparation. Herein, whole-body zebrafish were imaged to compare sucrose-embedding with paraformaldehyde fixation against conventional fresh-frozen sample preparation. Serial sections were analyzed with and without an ice matrix to evaluate if sucrose functions as an alternative energy-absorbing matrix for IR-MALDESI applications across whole-body tissues. The resulting four conditions were compared in terms of total putative lipid annotations and category diversity, coverage across the entire m/z range, and ion abundance. Ultimately, sucrose-embedded zebrafish had an increase in putative lipid annotations for the combination of putative annotations with and without the application of an ice matrix relative to fresh-frozen tissues which require the application of an ice matrix. Upon the use of an ice matrix, a greater number of high mass putative lipid annotations (e.g., glycerophospholipids, glycerolipids, and sphingolipids) were identified. Conversely, without an ice matrix, sucrose-embedded sections elucidated more putative annotations in lower molecular weight lipids, including fatty acyls and sterol lipids. Similar to the mouse brain model, sucrose-embedding increased putative lipid annotation and abundance for whole-body zebrafish.

Patellofemoral arthroplasty with onlay prosthesis leads to higher rates of osteoarthritis progression than inlay design implants: a systematic review

PURPOSE

The aim of this study was to report the clinical and functional outcomes, complication rates, implant survivorship and the progression of tibiofemoral osteoarthritis (OA), after new inlay or onlay patellofemoral arthroplasty (PFA), for isolated patellofemoral OA. Comparison of different implant types and models, where it was possible, also represented one of the objectives.

METHODS

A systematic literature search following PRISMA guidelines was conducted on PubMed, Scopus, Embase and Cochrane databases, to identify possible relevant studies, published from the inception of these databases until 11.11.2022. Randomized control trials (RCTs), case series, case control studies and cohort studies, written in English or German, and published in peer-reviewed journals after 2010, were included. Not original studies, case reports, simulation studies, systematic reviews, or studies that included patients who underwent TKA or unicompartmental arthroplasty (UKA) of the medial or lateral compartment of the knee, were excluded. Additionally, only articles that assessed functional and/or clinical outcomes, patient-reported outcomes (PROMs), radiographic progression of OA, complication rates, implant survival rates, pain, as well as conversion to TKA rates in patients treated with PFA, using inlay or onlay trochlea designs, were included. For quality assessment, the Methodological Index for Non-Randomized Studies (MINORS) for non-comparative and comparative clinical intervention studies was used.

RESULTS

The literature search identified 404 articles. 29 of them met all the inclusion criteria following the selection process. Median MINORS for non-comparative studies value was 12.5 (range 11-14), and for comparative studies 20.1 (range 17-24). In terms of clinical and functional outcomes, no difference between onlay and inlay PFA has been described. Both designs yielded satisfactory results at short, medium and long-term follow-ups. Both designs improved pain postoperatively and no difference between them in terms of postoperative VAS has been noted, although the onlay groups presented a higher preoperative VAS. When comparing the inlay to onlay trochlea designs, the inlay group displayed a lower progression of OA rate.

CONCLUSION

There is no difference in functional or clinical outcomes after PFA between the new inlay and the onlay designs, with both presenting an improvement in most of the scores that were used. A higher rate of OA progression was observed in the onlay design group.

LEVEL OF EVIDENCE

III.

Association Between Attitudes Toward Trauma Informed Care and Psychological First-Aid Training Experience Among Health Care Professionals in Japan

OBJECTIVE

Trauma informed care (TIC) is an important approach for people who have experienced trauma. Although psychological first aid (PFA) may be effective training in TIC, no study reported an association between PFA training and TIC. This study aimed to investigate the association between PFA training and attitudes toward TIC among health care professionals in Japan.

METHODS

Japanese health care professionals were recruited for a survey conducted from May 21 to June 18, 2021. TIC was assessed by the Attitudes Related to Trauma Informed Care Scale 10-item short form (ARTIC-10). A question about PFA training participation was originally developed through discussion among researchers. Univariate and multiple linear regression analyses were used to examine the association between the PFA experience and ARTIC-10.

RESULTS

In total, 484 (3.6%) health care professionals completed all questions. Among them, 77 (15.9%) had experienced PFA training. Univariate and multiple linear regression analyses showed that PFA experience (B = 0.19, 95% CI: 0.02-0.36, P = 0.03; B = 0.17, 95% CI: 0.01-0.34, P = 0.04) was significantly associated with ARTIC-10.

CONCLUSIONS

This study was the first to show an association between PFA training and attitudes toward TIC among health care professionals, which was a significant result for future research on PFA training, TIC, and trauma care.

Pulsed-field ablation: a breakthrough treatment for atrial fibrillation

T De Potter leads the electrophysiology unit of the Cardiovascular Center in Aalst, Belgium, where he has practiced cardiology since 2009. He is actively involved in early-stage clinical research in the field of ablation and has performed the world's first ablation using the J&J pulsed-field ablation platform.

Lipidomic Analysis of Mouse Brain to Evaluate the Efficacy and Preservation of Different Tissue Preparatory Techniques by IR-MALDESI-MSI

Numerous preparatory methods have been developed to preserve the cellular and structural integrity of various biological tissues for different -omics studies. Herein, two preparatory methods for mass spectrometry imaging (MSI) were evaluated, fresh-frozen and sucrose-embedded, paraformaldehyde (PFA) fixed, in terms of ion abundance, putative lipid identifications, and preservation of analyte spatial distributions. Infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI)-MSI was utilized to compare the preparatory methods of interest with and without the use of the conventional ice matrix. There were 2.5-fold and 1.6-fold more lipid species putatively identified in positive- and negative-ion modes, respectively, for sucrose-embedded, PFA-fixed tissues without an ice matrix relative to the current IR-MALDESI-MSI gold-standard, fresh-frozen tissue preparation with an exogenous ice matrix. Furthermore, sucrose-embedded tissues demonstrated improved spatial distribution of ions resulting from the cryo-protective property of sucrose and paraformaldehyde fixation. Evidence from these investigations supports sucrose-embedding without ice matrix as an alternative preparatory technique for IR-MALDESI-MSI.

Content analysis of psychological first aid training manuals via topic modelling

Background: Psychological First Aid (PFA) is practiced worldwide. This practice in English is guided through a small collection of training manuals. Despite ubiquitous practice and formal training materials, little is known about what topics are covered and in what depth in these influential manuals. As such, we analyzed the topic structure of these training manuals.Objective: To model the PFA manuals' topics with the goal of identifying a set of topics with recurrent themes and evaluating the extent to which each manual demonstrated those themes.Method: This machine learning study employed an unsupervised topic modelling design using Latent Dirichlet Allocation. The variables are (1) the distribution of a word across documents and (2) the distribution of a word across topics. The level of measurement for all variables is continuous. The unit of analysis is words. Preprocessing and data analysis were carried out using the Orange Data Mining Toolbox (Demšar et al., 2013). This programme is a Python GUI.Results: Results indicated a ten-topic structure to the universe of the English PFA training manuals. These topics were: (1) Refugees, (2) Orientation Activities, (3) Community-Based Applications, (4) PTSD & Other Psychological Issues, (5) Training Materials, (6) Specific Helper Instructions, (7) PFA Scholarship, (8) MHPSS, (9) General Curriculum, and (10) Australian Specific Delivery. The depth of discourse on each topic varied widely between manuals.Conclusions: The Academics of the PFA topic shows a strong representation of the corpus and suggests current training manuals have stayed true to its evidence-supported practice. The topic of Community-Based Applications strongly represents the corpus and suggests that training models incorporate community-based applications. The scientific foundation and practical implementation of the training guides are essential elements. Limitations and implications were also discussed.

Delineation of molecular characteristics in pediatric PFA ependymoma involving rare osseous and pulmonary metastases: A case report and literature review

Ependymoma is the third most common pediatric primary brain tumor, with its most aggressive subtype being posterior fossa group A (PFA). Extraneural metastasis of pediatric PFA ependymoma is rare. Herein, we present a case of a 9-year-old girl with PFA ependymoma characterized by a lack of trimethylation of histone H3 at lysine 27 and elevated chromosome X open reading frame 67 expression. Despite multiple surgeries and radiotherapies, the patient had a rapid recurrence and developed osseous and pulmonary metastases, which may be attributed to the homozygous deletion of cyclin-dependent kinase (CDK) inhibitor 2A/B and CDK12 mutation. Importantly, the CDK12 mutation observed in the patient may be indicative of the need for further work-up to consider chemotherapy rather than administering poly (adenosine diphosphate-ribose) polymerase inhibitors. Taken together, this is the first report of pediatric PFA ependymoma with extraneural metastases, wherein we clarified the diagnostic procedures of this newly identified PFA ependymoma and provided new cues to study the invasiveness of this disease and treatment selection for such patients.

Psychological first aid for workers in care and nursing homes: systematic review

BACKGROUND

The Covid-19 pandemic has produced unprecedented challenges across all aspects of health and social care sectors globally. Nurses and healthcare workers in care homes have been particularly impacted due to rapid and dramatic changes to their job roles, workloads, and working environments, and residents' multimorbidity. Developed by the World Health Organisation, Psychological First Aid (PFA) is a brief training course delivering social, emotional, supportive, and pragmatic support that can reduce the initial distress after disaster and foster future adaptive functioning.

OBJECTIVES

This review aimed to synthesise findings from studies exploring the usefulness of PFA for the well-being of nursing and residential care home staff.

METHODS

A systematic search was conducted across 15 databases (Social Care Online, Kings Fund Library, Prospero, Dynamed, BMJ Best Practice, SIGN, NICE, Ovid, Proquest, Campbell Library, Clinical Trials, Web of Knowledge, Scopus, Ebsco CINAHL, and Cochrane Library), identifying peer-reviewed articles published in English language from database inception to 20th June 2021.

RESULTS

Of the 1,159 articles screened, 1,146 were excluded at title and abstract; the remaining 13 articles were screened at full text, all of which were then excluded.

CONCLUSION

This review highlights that empirical evidence of the impact of PFA on the well-being of nursing and residential care home staff is absent. PFA has likely been recommended to healthcare staff during the Covid-19 pandemic. The lack of evidence found here reinforces the urgent need to conduct studies which evaluates the outcomes of PFA particularly in the care home staff population.

Patellar button compatibility in the conversion of Patellofemoral Arthroplasty to a Total Knee Arthroplasty: A review of the contemporary literature

BACKGROUND

Compared to total knee arthroplasty (TKA), patellofemoral arthroplasty (PFA) is a far less commonly performed operation. However, in carefully selected cohorts, PFA continues to be an appropriate treatment option for end-stage isolated patellofemoral joint osteoarthritis. In the later situation whereby a PFA is considered for conversion to a TKA - often due to disease progression - uncertainty remains regarding optimal management of the in situ patellar button. This review of the contemporary literature aimed to provide a summary of the current evidence to support surgeon decision-making, by evaluating the compatibility, efficacy, and survivorship of retained versus revised patellar buttons in PFA-to-TKA conversion. Specific focus was paid to implant design and technical considerations during revision, plus post-operative patient-reported outcomes and modes of secondary patellar component failure.

METHODS

A review of the Embase, Cochrane and PubMed databases was performed following PRISMA search principles.

RESULTS

This investigation highlights that the fate of patellar buttons in PFA-to-TKA conversion has previously been poorly studied, with scant publication data available. Most reports have been of singular cases or small cohort series. Larger formal RCTs and level 1 evidence are lacking.

CONCLUSION

The findings herein suggest that surgeons can confidently retain well-fixed, undamaged, dome-shaped all-polyethylene patellar buttons in the conversion of a PFA to TKA with the expectation of acceptable mid-term performance and survivorship, as long as congruent tracking with the new tibiofemoral components is achieved. This result is likely translatable to the majority of contemporary, all-polyethylene, dome-shaped patellar buttons, even with manufacturer mismatch.

The ABCDE psychological first aid intervention decreases early PTSD symptoms but does not prevent it: results of a randomized-controlled trial

BACKGROUND

Early Psychological First Aid (PFA) has been widely recommended for preventing posttraumatic stress disorder (PTSD). However, its lack of empirical evidence of safety and effectiveness has been criticized.

OBJECTIVES

To assess the effectiveness of PFA-ABCDE, an original PFA protocol, for preventing PTSD one month after the intervention and decreasing PTSD symptoms at one and six months of follow up.

METHODS

We assessed the eligibility of 1,140 adult survivors of recent trauma (≤ 72 hours) consulting five emergency departments in Chile. Two hundred twenty-one were randomized to receive either PFA-ABCDE (active listening, breathing retraining, categorization of needs, referral to ancillary services, and psychoeducation) or only psychoeducation. We used the Composite International Diagnostic Interview (CIDI) to assess PTSD diagnosis. The Posttraumatic Checklist (PCL), the Beck Depression Inventory-II (BDI-II), and a 0-10 points analogue visual scale were used to assess PTSD symptoms, depressive symptoms, and immediate distress relief after the intervention.

RESULTS

We found no difference between the experimental and control groups in the frequency of PTSD one month after the intervention (PFA-ABCDE = 23/76 [30.3%], psychoeducation = 18/75 [24.0%], adjusted odds ratio = 1.39, 95% confidence interval = 0.63-3.07, p = .408). Immediately after the intervention, participants who received PFA-ABCDE reported greater distress relief (PFA-ABCDE mean = 9.06, psychoeducation mean = 8.55, Cohen's d = 0.30, p = .038). Fewer PTSD symptoms were reported by those who received PFA-ABCDE one month after the intervention (PFA-ABCDE mean = 36.26, psychoeducation mean = 43.62, Cohen's d = 0.42, p = .033). We found no difference in depressive symptoms at one-month follow up (p = .713) nor in PTSD symptoms six months after the intervention (p = .986).

CONCLUSIONS

PFA-ABCDE does not prevent PTSD diagnosis, but it provides immediate distress relief and decreases PTSD symptoms in the short term.

Molecular Classification and Therapeutic Targets in Ependymoma

Ependymoma is a biologically diverse tumor wherein molecular classification has superseded traditional histological grading based on its superior ability to characterize behavior, prognosis, and possible targeted therapies. The current, updated molecular classification of ependymoma consists of ten distinct subgroups spread evenly among the spinal, infratentorial, and supratentorial compartments, each with its own distinct clinical and molecular characteristics. In this review, the history, histopathology, standard of care, prognosis, oncogenic drivers, and hypothesized molecular targets for all subgroups of ependymoma are explored. This review emphasizes that despite the varied behavior of the ependymoma subgroups, it remains clear that research must be performed to further elucidate molecular targets for these tumors. Although not all ependymoma subgroups are oncologically aggressive, development of targeted therapies is essential, particularly for cases where surgical resection is not an option without causing significant morbidity. The development of molecular therapies must rely on building upon our current understanding of ependymoma oncogenesis, as well as cultivating transfer of knowledge based on malignancies with similar genomic alterations.

Genome-wide spatial expression profiling in formalin-fixed tissues

Formalin-fixed paraffin embedding (FFPE) is the most widespread long-term tissue preservation approach. Here, we report a procedure to perform genome-wide spatial analysis of mRNA in FFPE-fixed tissue sections, using well-established, commercially available methods for imaging and spatial barcoding using slides spotted with barcoded oligo(dT) probes to capture the 3' end of mRNA molecules in tissue sections. We applied this method for expression profiling and cell type mapping in coronal sections from the mouse brain to demonstrate the method's capability to delineate anatomical regions from a molecular perspective. We also profiled the spatial composition of transcriptomic signatures in two ovarian carcinosarcoma samples, exemplifying the method's potential to elucidate molecular mechanisms in heterogeneous clinical samples. Finally, we demonstrate the applicability of the assay to characterize human lung and kidney organoids and a human lung biopsy specimen infected with SARS-CoV-2. We anticipate that genome-wide spatial gene expression profiling in FFPE biospecimens will be used for retrospective analysis of biobank samples, which will facilitate longitudinal studies of biological processes and biomarker discovery.

Psychological first aid (PFA) and disasters

A disaster is commonly thought of as an occurrence that results in property damage and physical injuries that exceed the response capabilities of local resources. History teaches that disasters also result in a surge in demand for psychological support amongst survivors and disaster responders. This surge quickly exceeds local response capacities and has the potential to exceed even the mental health resources that may be imported from neighbouring jurisdictions and disaster relief agencies. Efficient and effective acute mental health intervention is, therefore, needed. However, the effectiveness of traditional multi-session counselling during and shortly after disasters has been questioned. Instead, the utilization of efficient and effective crisis-focussed psychological interventions has been suggested as acute phase alternatives. This paper asserts psychological first aid (PFA) may be considered a specific crisis-focussed disaster mental health intervention for use during and after disasters. PFA is designed for use in assessing and mitigating acute distress, while serving as a platform for psychological triage complementing more traditional psychological and psychiatric interventions. PFA may be employed by mental health clinicians as well as 'peer responders'.

Longitudinal Change of Psychological Distress among Healthcare Professionals with and without Psychological First Aid Training Experience during the COVID-19 Pandemic

This study aimed to compare longitudinal change of the psychological distress of a group with psychological first aid (PFA) experience and a group without PFA experience among physicians and other healthcare professionals from before the novel coronavirus disease (COVID-19) pandemic to during the pandemic. The baseline survey was conducted in January 2020 (T1). The respondents in T1 were invited to participate in March (T2) and November 2020 (T3). Psychological distress was assessed by the Kessler 6 Scale. Participants were divided into two categories: a group with and a group without PFA experience. Participants were further divided between physicians and healthcare professionals other than physicians, because physicians are more likely to experience morally injurious events. A mixed-model repeated-measures ANOVA was conducted as an indicator of the group differences. In T1, 398 healthcare professionals participated. The longitudinal analysis of healthcare professionals other than physicians showed that psychological distress was significantly greater in the group without PFA experience than in the group with PFA experience (T1 vs. T3). This study showed psychological distress among healthcare professionals other than physicians was significantly greater in the group without PFA experience than in the group with PFA experience during the COVID-19 pandemic, but the results were not consistent among physicians.

Essential Fatty Acids as Biomedicines in Cardiac Health

The destructive impact of cardiovascular diseases on health, including heart failure, peripheral artery disease, atherosclerosis, stroke, and other cardiac pathological conditions, positions these health conditions as leading causes of increased global mortality rates, thereby impacting the human quality of life. The considerable changes in modern lifestyles, including the increase in food intake and the change in eating habits, will unavoidably lead to an unbalanced consumption of essential fatty acids, with a direct effect on cardiovascular health problems. In the last decade, essential fatty acids have become the main focus of scientific research in medical fields aiming to establish their impact for preventing cardiovascular diseases and the associated risk factors. Specifically, polyunsaturated fatty acids (PUFA), such as omega 3 fatty acids, and monounsaturated fatty acids from various sources are mentioned in the literature as having a cardio-protective role, due to various biological mechanisms that are still to be clarified. This review aims to describe the major biological mechanisms of how diets rich in essential fatty acids, or simply essential fatty acid administration, could have anti-inflammatory, vasodilatory, anti-arrhythmic, antithrombotic, antioxidant, and anti-atherogenic effects. This review describes findings originating from clinical studies in which dietary sources of FAs were tested for their role in mitigating the impact of heart disorders in human health.

Effects of the Btk-Inhibitors Remibrutinib (LOU064) and Rilzabrutinib (PRN1008) With Varying Btk Selectivity Over Tec on Platelet Aggregation and in vitro Bleeding Time

Background: Bruton tyrosine kinase inhibitors (BTKi) are used in B-cell malignancies and in development against various autoimmune diseases. Since Btk is also involved in specific pathways of platelet activation, BTKi might be considered to target platelet GPVI/GPIb-mediated atherothrombosis and platelet FcγRIIA-dependent immune disorders. However, BTKi treatment of patients with B-cell malignancies is frequently associated with mild bleeding events caused possibly by off-target inhibition of Tec. Here, we compared the platelet effects of two novel BTKi that exhibit a high (remibrutinib) or low (rilzabrutinib) selectivity for Btk over Tec.

Methods and Results: Remibrutinib and rilzabrutinib were pre-incubated with anticoagulated blood. Platelet aggregation and in vitro bleeding time (closure time) were studied by multiple electrode aggregometry (MEA) and platelet-function analyzer-200 (PFA-200), respectively. Both BTKi inhibited atherosclerotic plaque-stimulated GPVI-mediated platelet aggregation, remibrutinib being more potent (IC₅₀ = 0.03 μM) than rilzabrutinib (IC₅₀ = 0.16 μM). Concentrations of remibrutinib (0.1 μM) and rilzabrutinib (0.5 μM), >80% inhibitory for plaque-induced aggregation, also significantly suppressed (>90%) the Btk-dependent pathways of platelet aggregation upon GPVI, von Willebrand factor/GPIb and FcγRIIA activation stimulated by low collagen concentrations, ristocetin and antibody cross-linking, respectively. Both BTKi did not inhibit aggregation stimulated by ADP, TRAP-6 or arachidonic acid. Remibrutinib (0.1 μM) only slightly prolonged closure time and significantly less than rilzabrutinib (0.5 μM).

Conclusion: Remibrutinib and rilzabrutinib inhibit Btk-dependent pathways of platelet aggregation upon GPVI, VWF/GPIb, and FcγRIIA activation. Remibrutinib being more potent and showing a better profile of inhibition of Btk-dependent platelet activation vs. hemostatic impairment than rilzabrutinib may be considered for further development as an antiplatelet drug.

Ultra high-risk PFA ependymoma is characterized by loss of chromosome 6q

BACKGROUND

Within PF-EPN-A, 1q gain is a marker of poor prognosis, however, it is unclear if within PF-EPN-A additional cytogenetic events exist which can refine risk stratification.

METHODS

Five independent non-overlapping cohorts of PF-EPN-A were analyzed applying genome-wide methylation arrays for chromosomal and clinical variables predictive of survival.

RESULTS

Across all cohorts, 663 PF-EPN-A were identified. The most common broad copy number event was 1q gain (18.9%), followed by 6q loss (8.6%), 9p gain (6.5%), and 22q loss (6.8%). Within 1q gain tumors, there was significant enrichment for 6q loss (17.7%), 10q loss (16.9%), and 16q loss (15.3%). The 5-year progression-free survival (PFS) was strikingly worse in those patients with 6q loss, with a 5-year PFS of 50% (95% CI 45%-55%) for balanced tumors, compared with 32% (95% CI 24%-44%) for 1q gain only, 7.3% (95% CI 2.0%-27%) for 6q loss only and 0 for both 1q gain and 6q loss (P = 1.65 × 10-13). After accounting for treatment, 6q loss remained the most significant independent predictor of survival in PF-EPN-A but is not in PF-EPN-B. Distant relapses were more common in 1q gain irrespective of 6q loss. RNA sequencing comparing 6q loss to 6q balanced PF-EPN-A suggests that 6q loss forms a biologically distinct group.

CONCLUSIONS

We have identified an ultra high-risk PF-EPN-A ependymoma subgroup, which can be reliably ascertained using cytogenetic markers in routine clinical use. A change in treatment paradigm is urgently needed for this particular subset of PF-EPN-A where novel therapies should be prioritized for upfront therapy.

Maternal supplementation with phytogenic additives influenced the faecal microbiota and reproductive potential in sows

Sows undergo physiological stress during gestation and lactation, potentially leading to enteric dysbiosis and reduced reproductive potential. Phytogenic additives (PFs) may improve performance via their antioxidant, anti-inflammatory and antimicrobial properties. This study determined whether the provision of a gestation/lactation diet containing PAs would alter the gastrointestinal microbiota of sows and their piglets, and improve performance. Sows received a commercial diet throughout gestation and lactation (CTR; n = 64), a commercial diet throughout gestation and a diet containing PAs in lactation (CTR-PA; n = 63) or a commercial diet containing PAs in gestation and lactation (PA; n = 90). Sows were weighed and backfat recorded after mating and at entry and exit from the farrowing house and piglets were weighed on days 1 and 21 of life. Faecal samples collected from sows at farrowing house entry and piglets at 21 and 35 d were subjected to 16 S rRNA gene amplicon analysis. The addition of PAs to sow diets resulted in more piglets born (P = 0.03), however, it did not improve the number of liveborn piglets (P = 0.14). There were no differences in sow weight, P2 backfat depth or lactation feed intake observed. PAs had no effect on piglet weight or survival to weaning but did alter the faecal microbiota of sows, and this change was observed in piglets at 21 and 35 d. PA supplementation to sows has the potential to increase litter size, while also potentially influencing gastrointestinal tract health of the sow and piglets reared.

Glyoxal Fixation as an Alternative for Zebrafish Embryo Immunostaining

Immunohistochemistry has been widely used as a robust technique to determine the cellular and subcellular localization of proteins. This information ultimately helps to understand the function of these proteins and how biological processes are regulated. Antibodies applicable for labeling in zebrafish are limited, making immuno-staining challenging. Recently glyoxal fixation was rediscovered in tissue culture, mouse, rat, and Drosophila, expanding the list of effective antibodies for these species. Here, we compare a protocol for zebrafish staining using glyoxal as a fixative agent with PFA. We demonstrate that glyoxal fixation improves the antigenicity of some epitopes thereby increasing the number of useful antibodies in zebrafish.

Patellofemoral Arthroplasty Surgical Technique: Lateral or Medial Parapatellar Approach

BACKGROUND

Patellofemoral arthroplasty (PFA) is an emerging treatment for patients with isolated patellofemoral compartment osteoarthritis. The medial parapatellar approach is the standard arthrotomy but has been shown in total knee arthroplasty to damage the patellar blood supply and increase postoperative patellar instability. The lateral parapatellar approach is an alternative that may reduce the risk of these outcomes. The purpose of this study is to compare the radiographic measures of patellar tracking and patient-reported outcomes of the medial and lateral parapatellar approaches in PFA.

METHODS

Between 2012 and 2019, a retrospective review was performed of 136 knees undergoing PFA at a single institution. Patients were separated by preoperative congruence angle and then surgical approach into 3 cohorts. Preoperative and postoperative patellar tilt and congruence angle were measured. Preoperative and minimum 6-month postoperative patient-reported outcomes scores were collected.

RESULTS

There were no significant differences in the mean postoperative congruence angle and postoperative patient-reported outcomes among the 3 cohorts. Mean postoperative patellar tilt was normalized only in the abnormal congruence angle/lateral approach group to 2.80° (standard error, 1.85).

CONCLUSION

Congruence angle was improved regardless of surgical approach. Patellar tilt was normalized only for the lateral approach in patients with abnormal preoperative congruence angle. There were no significant differences in preoperative and postoperative scores between groups except for preoperative 12-item Short Form Mental Health Survey scores. This study supports that the lateral approach offers improved postoperative patellar tilt compared to a medial approach for PFA while achieving similar patient-reported outcomes.

Implementing a system for the real-time risk assessment of patients considered for intensive care

BACKGROUND

Delay in identifying deterioration in hospitalised patients is associated with delayed admission to an intensive care unit (ICU) and poor outcomes. For the HAVEN project (HICF ref.: HICF-R9-524), we have developed a mathematical model that identifies deterioration in hospitalised patients in real time and facilitates the intervention of an ICU outreach team. This paper describes the system that has been designed to implement the model. We have used innovative technologies such as Portable Format for Analytics (PFA) and Open Services Gateway initiative (OSGi) to define the predictive statistical model and implement the system respectively for greater configurability, reliability, and availability.

RESULTS

The HAVEN system has been deployed as part of a research project in the Oxford University Hospitals NHS Foundation Trust. The system has so far processed > 164,000 vital signs observations and > 68,000 laboratory results for > 12,500 patients and the algorithm generated score is being evaluated to review patients who are under consideration for transfer to ICU. No clinical decisions are being made based on output from the system. The HAVEN score has been computed using a PFA model for all these patients. The intent is that this score will be displayed on a graphical user interface for clinician review and response.

CONCLUSIONS

The system uses a configurable PFA model to compute the HAVEN score which makes the system easily upgradable in terms of enhancing systems' predictive capability. Further system enhancements are planned to handle new data sources and additional management screens.

Ultra Brief Psychological Interventions for COVID-19 Pandemic: Introduction of a Locally-Adapted Brief Intervention for Mental Health and Psychosocial Support Service

The ultra-brief psychological interventions (UBPI) was created in 2018 to empower healthcare providers with psychological skills that can be delivered within a short period. Techniques used within UBPI were adopted from a variety of well established psychotherapies and distilled into its core essentials. This enabled practitioners of UBPI to deliver specific psychological skills in the appropriate context to the client within a period of 15-20 min. UBPI was also manualised to standardised training of practitioners. During the novel coronavirus disease of 2019 (COVID-19) pandemic, UBPI was modified to suit the unique psychological demands of the pandemic. This article presents how UBPI was adapted and used with healthcare providers dealing with COVID-19 and also with the public who required psychological first aid (PFA).

Early outcomes of an anatomic trochlear-cutting patellofemoral arthroplasty: patient selection is key

PURPOSE

The purpose of this study was to report outcomes of a recent anatomic trochlear-cutting patellofemoral arthroplasty (PFA) system at > 3 years. The hypothesis was that its functional scores and revision rates would be at least equivalent to those reported for other 'trochlear-cutting' implants in the literature.

METHODS

Twenty-eight consecutive patients that had received PFA using the same anatomic trochlear-cutting implant (KneeTech PFJ, Corin-Tornier, Montbonnot, France) with a dome-shaped patellar button and had systematic lateral facetectomy without lateral release were enrolled. Radiographic parameters collected pre-operatively included: trochlear dysplasia type and patellar height, TT-TG, patellar tilt and shape. Clinical scores collected pre-operatively and at > 3 years included: Oxford Knee Score (OKS) and Knee Society Score (KSS).

RESULTS

The initial cohort comprised 23 women (82%) and five men (18%), aged 63.3 ± 14.7 years, of which 23 had trochlear dysplasia (82%). One patient (4%) could not be reached, and three (11%) were revised to TKA due to arthritic progression, aged 77, 80 and 83 years at index operation, only one of which had trochlear dysplasia (type A). At final follow-up, none of the remaining 24 patients had complications; their OKS was 35.0 ± 10.3 and KSS symptoms and function were 19.8 ± 5.0 and 71.7 ± 13.6.

CONCLUSION

The anatomic trochlear-cutting PFA granted satisfactory scores and prevented mechanical complications, but the high incidence of early revisions, all due to spread of arthritis hence to improper patient selection. PFA should be restricted to patients with trochlear dysplasia, in whom arthritis was triggered by patellar instability and maltracking rather than degenerative or age-related diseases.

STUDY DESIGN

Retrospective case series, Level IV.

Simplex-Lattice Hydration Prediction and Microstructure Verification of Cementitious Systems

In this investigation, the age-dependent hydration development of blended pastes containing Portland cement (PC), pulverized fuel ash (PFA) and silica fume (SF) was assessed by quantifying the amount of CH and non-evaporable water using thermo-gravimetric analysis (TGA). Microstructure was investigated using scanning electron microscope (SEM). It was observed that the amount of liberated CH increases up to three-days in PC-PFA binary blended pastes, after which it progressively decreases and this reduction was proportional to the PFA dosage. The introduction of SF to PC-PFA binary mixtures to form ternary blended pastes has caused an early reduction of CH at one day where the majority of SF has been consumed during the first seven-days. The incorporation of 10% SF to PC-PFA pastes altered the low rate of hydration at early age. In addition, the presence of PFA showed insignificant influence on the non-evaporable water content until three-days then its effect became significant after seven-days. On the other hand, SF increased the non-evaporable water content from early ages up to seven-days. However, beyond 28 days, the presence of SF did not exhibit further pozzolanic activity. Furthermore, the ternary blended systems significantly increased the non-evaporable water content within three to seven days compared to the reference paste. Moreover, prediction nonlinear models of these hydration parameters were developed using the simplex-lattice design and validated against the experimental results. The latter have been further supported with SEM microstructural analysis showing good agreement between the predicted and realistic hydration.

Wet-Chemical Synthesis of Surface-Passivated Halide Perovskite Microwires for Improved Optoelectronic Performance and Stability

One-dimensional (1D) halide perovskite materials with intrinsic high carrier mobility and long diffusion length hold great promises for high-performance optoelectronic devices, in which the passivation of the surface defects is of significance for further boosting its optoelectronic performance as well as its moisture stability. Herein, we demonstrate a simple room-temperature wet-chemical synthetic protocol for perovskite microwires with controlled morphologies and passivated surface states. This strategy allows for facile assembly of hydrophobic 1 H,1 H-perfluorooctylamine (PFA) molecules on the surface of the perovskite microwires owing to the coordination binding between the amino groups of PFA and Pb²⁺. Both steady and time-resolved photoluminescence measurements revealed that the passivation of PFA greatly benefit for the inhibition of the photogenerated carriers recombination. The constructed perovskite microwire-based photodetectors have shown increased detectivity of 4.99 × 10¹¹ jones and responsivity of 1.27 A/W (light power density of 1 mW/cm²). Moreover, the hydrophobic fluorocarbon alkyl chains endow the perovskite microwires with higher resistance toward moisture. Such coating of a water-resisting layer resulted in greatly enhanced stability of perovskite microwires under the humidity of 55 ± 5% over 30 days. We thus believe that our work is of importance for the development of 1D halide perovskite photodetectors with highly improved performance and stability.

Effect of short-term formaldehyde fixation on Raman spectral parameters of bone quality

Medical knowledge of the skeleton including its structures has improved constantly over the past decades. Advanced imaging methods, mechanical testing and optical techniques have revealed insights into bone architecture and composition. Most of these advancements were possible due to the ex vivo investigation of biological tissues. Investigations of fresh tissue are generally preferred over preserved or fixed samples. However, chemical fixation is sometimes inevitable due to histological procedures or logistical reasons. The aim of this study was to investigate whether short-term chemical fixation with formaldehyde affects bone quality parameters obtained from Raman spectroscopy and if these effects last for intermediate sample storage of several hours. As formaldehyde induces cross-links to the organic components in bone tissue, we hypothesized that collagen-related parameters are particularly affected. Femurs of eight 17-week-old C57BL/6 mice were extracted and divided into two groups (N  =  8  /  group). Samples of the first group were fixed by immersion in 4% formaldehyde (PFA-solution) for 12 h at 4°C (fixed group) while samples of the second group were left untreated (unfixed group). Raman spectroscopy was performed, and repeated after 4 h, to assess whether intermediate storage time influenced the obtained results. Based on resultant spectra, mineral-to-matrix ratio, carbonate-to-phosphate ratio, carbonate-to-amide I ratio, mineral crystallinity and collagen maturity were determined. Carbonate-to-phosphate ratio was the only parameter showing a significant difference between the first and the subsequent measurements. For both groups, ratios showed a decrease in carbonate substitution compared to the first measurement (percentage decrease: 3.1% in fixed, 4.7% in unfixed). Collagen maturity of samples, which were short-term fixed with formaldehyde, was significantly lower than of fresh, unfixed samples (percentage difference: 3.8%). Our study shows that Raman spectroscopy is able to detect changes in collagen structure initiated by formaldehyde and that changes in short-term fixed samples are minimally influencing bone material properties measured with Raman spectroscopy.

Heterogeneity within the PF-EPN-B ependymoma subgroup

Posterior fossa ependymoma comprise three distinct molecular variants, termed PF-EPN-A (PFA), PF-EPN-B (PFB), and PF-EPN-SE (subependymoma). Clinically, they are very disparate and PFB tumors are currently being considered for a trial of radiation avoidance. However, to move forward, unraveling the heterogeneity within PFB would be highly desirable. To discern the molecular heterogeneity within PFB, we performed an integrated analysis consisting of DNA methylation profiling, copy-number profiling, gene expression profiling, and clinical correlation across a cohort of 212 primary posterior fossa PFB tumors. Unsupervised spectral clustering and t-SNE analysis of genome-wide methylation data revealed five distinct subtypes of PFB tumors, termed PFB1-5, with distinct demographics, copy-number alterations, and gene expression profiles. All PFB subtypes were distinct from PFA and posterior fossa subependymomas. Of the five subtypes, PFB4 and PFB5 are more discrete, consisting of younger and older patients, respectively, with a strong female-gender enrichment in PFB5 (age: p = 0.011, gender: p = 0.04). Broad copy-number aberrations were common; however, many events such as chromosome 2 loss, 5 gain, and 17 loss were enriched in specific subtypes and 1q gain was enriched in PFB1. Late relapses were common across all five subtypes, but deaths were uncommon and present in only two subtypes (PFB1 and PFB3). Unlike the case in PFA ependymoma, 1q gain was not a robust marker of poor progression-free survival; however, chromosome 13q loss may represent a novel marker for risk stratification across the spectrum of PFB subtypes. Similar to PFA ependymoma, there exists a significant intertumoral heterogeneity within PFB, with distinct molecular subtypes identified. Even when accounting for this heterogeneity, extent of resection remains the strongest predictor of poor outcome. However, this biological heterogeneity must be accounted for in future preclinical modeling and personalized therapies.

Advances in Patellofemoral Arthroplasty

PURPOSE OF REVIEW

To describe current indications, implants, economic benefits, comparison to TKA, and functional and patient-reported outcomes of patellofemoral arthroplasty.

RECENT FINDINGS

Modern onlay implants and improved patient selection have allowed for recent improvements in short- and long-term outcomes after patellofemoral joint replacement surgery. Patellofemoral arthroplasty has become an increasingly utilized technique for the successful treatment of isolated patellofemoral arthritis. Advances in patient selection, implant design, and surgical technique have resulted in improved performance and longevity of these implants. Although short- and mid-term data for modern patellofemoral arthroplasties appear promising, further long-term clinical studies are needed to evaluate how new designs and technologies will affect patient outcomes and long-term implant performance.

Ultrasound assisted synthesis of performic acid in a continuous flow microstructured reactor

The present work establishes in depth study of ultrasound assisted preparation of performic acid (PFA) in a continuous flow microstructured reactor. The influence of various parameters viz. formic acid: hydrogen peroxide molar ratio, flow rate, temperature and catalyst loading on the PFA formation were studied in a continuous flow microstructured reactor. In a continuous microstructured reactor in the presence of ultrasonic irradiation, the formation of PFA was found to be dependent on the molar ratio of formic acid: hydrogen peroxide, flow rate of reactants, temperature and catalyst loading (Amberlite IR-120H). The optimized parameter values are 1:1M ratio, 50mL/h, 40°C and 471mg/cm³ respectively. Further, the performance of Amberlite IR-120H catalyst was evaluated for three successive cycles in continuous microstructured reactor. The performance of catalyst was found to be decreased with the usage of the catalyst and is attributed to neutralization of the sulfonic acid groups, catalyst shrinkage, or loss in pore sites. The experimental results revealed that, for an ultrasound assisted synthesis of PFA in continuous microstructured reactor the observed reaction time was even less than 10min. The observed intensification in the PFA synthesis process can be attributed to the intense collapse of the cavities formed at low temperature during ultrasonic irradiations, which further improved the heat and mass transfer rates with the formation of H₂O₂ during the reaction. The combined use of ultrasound and a continuous flow microstructured reactor has proved beneficial process of performic acid synthesis.

Survivorship and functional outcomes of patellofemoral arthroplasty: a systematic review

PURPOSE

Historically poor results of survivorship and functional outcomes of patellofemoral arthroplasty (PFA) have been reported in the setting of isolated patellofemoral osteoarthritis. More recently, however, fairly good results of PFA were reported, but the current status of PFA outcomes is unknown. Therefore, a systematic review was performed to assess overall PFA survivorship and functional outcomes.

METHODS

A search was performed using PubMed, Embase and Cochrane systems, and the registries were searched. Twenty-three cohort studies and one registry reported survivorship using Kaplan-Meier curve, while 51 cohort studies reported functional outcomes of PFA.

RESULTS

Twelve studies were level II studies, while 45 studies were level III or IV studies. Heterogeneity was mainly seen in type of prosthesis and year the cohort started. Nine hundred revisions in 9619 PFAs were reported yielding 5-, 10-, 15- and 20-year PFA survivorships of 91.7, 83.3, 74.9 and 66.6 %, respectively, and an annual revision rate of 2.18. Functional outcomes were reported in 2587 PFAs with an overall score of 82.2 % of the maximum score. KSS and Knee Function Score were 87.5 and 81.6 %, respectively.

CONCLUSION

This systematic review showed that fairly good results of PFA survivorship and functional outcomes were reported at short- and midterm follow-up in the setting of isolated patellofemoral osteoarthritis. Heterogeneity existed mainly in prosthesis design and year the cohort started.

CLINICAL RELEVANCE

These results provide a clear overview of the current status of PFA in the setting of isolated patellofemoral osteoarthritis.

LEVEL OF EVIDENCE

IV.

H3 K27M mutations are extremely rare in posterior fossa group A ependymoma

BACKGROUND

Mutations in the tail of histone H3 (K27M) are frequently found in pediatric midline high-grade glioma's but have rarely been reported in other malignancies. Recently, recurrent somatic nucleotide variants in histone H3 (H3 K27M) have been reported in group A posterior fossa ependymoma (EPN_PFA), an entity previously described to have no recurrent mutations. However, the true incidence of H3 K27M mutations in EPN_PFA is unknown.

METHODS

In order to discern the frequency of K27M mutations in histone H3 in EPN_PFA, we analyzed 151 EPN_PFA previously profiled with genome-wide methylation arrays using a validated droplet digital PCR assay.

RESULTS

We identified only 1 case out of 151 EPN_PFA harboring the K27M mutation indicating that histone mutations are extremely rare in EPN_PFA. Morphologically, this single mutated case is clearly consistent with an ependymoma, and the presence of the K27M mutation was confirmed using immunohistochemistry.

DISCUSSION

K27M mutations are extremely rare in EPN_PFA. Routine evaluation of K27M mutations in EPN_PFA is of limited utility, and is unlikely to have any bearing on prognosis and/or future risk stratification.

A hyper-thermostable α-amylase from Pyrococcus furiosus accumulates in Nicotiana tabacum as functional aggregates

BACKGROUND

Alpha amylase hydrolyzes α-bonds of polysaccharides such as starch and produces malto-oligosaccharides. Its starch saccharification applications make it an essential enzyme in the textile, food and brewing industries. Commercially available α-amylase is mostly produced from Bacillus or Aspergillus. A hyper-thermostable and Ca 2++ independent α-amylase from Pyrococcus furiosus (PFA) expressed in E.coli forms insoluble inclusion bodies and thus is not feasible for industrial applications.

RESULTS

We expressed PFA in Nicotiana tabacum and found that plant-produced PFA forms functional aggregates with an accumulation level up to 3.4 g/kg FW (fresh weight) in field conditions. The aggregates are functional without requiring refolding and therefore have potential to be applied as homogenized plant tissue without extraction or purification. PFA can also be extracted from plant tissue upon dissolution in a mild reducing buffer containing SDS. Like the enzyme produced in P. furiosus and in E. coli, plant produced PFA preserves hyper-thermophilicity and hyper-thermostability and has a long shelf life when stored in lyophilized leaf tissue. With tobacco's large biomass and high yield, hyper-thermostable α-amylase was produced at a scale of 42 kg per hectare.

CONCLUSIONS

Tobacco may be a suitable bioreactor for industrial production of active hyperthermostable alpha amylase.

Trauma-informed care for children in the ambulance: international survey among pre-hospital providers

Background: Pre-hospital providers, such as paramedics and emergency medical technicians, are in a position to provide key emotional support to injured children and their families. Objective: Our goal was to examine (a) pre-hospital providers' knowledge of traumatic stress in children, attitudes towards psychosocial aspects of care, and confidence in providing psychosocial care, (b) variations in knowledge, attitudes, and confidence according to demographic and professional characteristics, and (c) training preferences of pre-hospital providers regarding psychosocial care to support paediatric patients and their families. Method: We conducted a cross-sectional, online survey among an international sample of 812 pre-hospital providers from high-income countries. The questionnaire was adapted from a measure for a similar study among Emergency Department staff, and involved 62 items in 7 main categories (e.g. personal and work characteristics, knowledge of paediatric traumatic stress, and confidence regarding 18 elements of psychosocial care). The main analyses comprised descriptive statistics and multiple regression analyses. Results: On average, respondents answered 2.7 (SD = 1.59) out of seven knowledge questions correctly. Respondents with higher knowledge scores were more often female, parent of a child under 17, and reported that at least 10% of their patients were children. A majority of participants (83.5%) saw all 18 aspects of psychosocial care as part of their job. Providers felt moderately confident (M = 3.2, SD = 0.45) regarding their skills in psychosocial care, which was predicted by gender (female), having more experience, having a larger proportion of child patients, and having received training in psychosocial care in the past five years. Most respondents (89.7%) wanted to gain more knowledge and skills regarding psychosocial care for injured children. In terms of training format, they preferred an interactive website or a one-off group training. Conclusions: There appears to be both a need and an opportunity for education initiatives regarding paediatric traumatic stress in the pre-hospital context.

Why do patellofemoral arthroplasties fail today? A systematic review

BACKGROUND

Historically poor results of patellofemoral arthroplasty (PFA) were reported in the setting of isolated patellofemoral osteoarthritis (OA). In order to lower PFA failure rates, it is important to identify failure modes using a standardized method. In this systematic review, PFA failure modes were assessed and compared in early vs. late failures and older vs. recent studies.

METHODS

Databases of PubMed, Embase and Cochrane and annual registries were searched for studies reporting PFA failures. Failure modes in studies with mean follow-up <5years were classified as early failures while >5years were classified late failures. Cohorts started before 2000 were classified as older studies and started after 2000 as recent studies.

RESULTS

Thirty-nine cohort studies (10 level II and 29 level III or IV studies) and three registries were included with overall low quality of studies (GRADE criteria). A total of 938 PFA failures were included and were caused by OA progression (38%), pain (16%), aseptic loosening (14%) and patellar maltracking (10%). Pain was responsible for most early failures (31%), while OA progression was most common in late failures (46%). In older studies, OA progression was more commonly reported as failure mode than in more recent studies (53% vs. 39%, p=0.005).

CONCLUSION

This level IV systematic review with low quality of studies identified OA progression and pain as major failure modes. Reviewing these studies, appropriate patient selection could prevent PFA failures in select cases. Future studies assessing the role of PFA in isolated patellofemoral OA are necessary.

Treatment implications of posterior fossa ependymoma subgroups

Posterior fossa ependymoma comprises two distinct molecular entities, ependymoma_posterior fossa A (EPN_PFA) and ependymoma_posterior fossa B (EPN_PFB), with differentiable gene expression profiles. As yet, the response of the two entities to treatment is unclear. To determine the relationship between the two molecular subgroups of posterior fossa ependymoma and treatment, we studied a cohort of 820 patients with molecularly profiled, clinically annotated posterior fossa ependymomas. We found that the strongest predictor of poor outcome in patients with posterior fossa ependymoma across the entire age spectrum was molecular subgroup EPN_PFA, which was recently reported in the paper entitled “Therapeutic impact of cytoreductive surgery and irradiation of posterior fossa ependymoma in the molecular era: a retrospective multicohort analysis” in the Journal of Clinical Oncology. Patients with incompletely resected EPN_PFA tumors had a very poor outcome despite receiving adjuvant radiation therapy, whereas a substantial proportion of patients with EPN_PFB tumors can be cured with surgery alone.

The PFA-AMeX method achieves a good balance between the morphology of tissues and the quality of RNA content in DNA microarray analysis with laser-capture microdissection samples

Recently, large-scale gene expression profiling is often performed using RNA extracted from unfixed frozen or formalin-fixed paraffin embedded (FFPE) samples. However, both types of samples have drawbacks in terms of the morphological preservation and RNA quality. In the present study, we investigated 30 human prostate tissues using the PFA-AMeX method (fixation using paraformaldehyde (PFA) followed by embedding in paraffin by AMeX) with a DNA microarray combined with laser-capture microdissection. Morphologically, in contrast to the case of atypical adenomatous hyperplasia, loss of basal cells in prostate adenocarcinomas was as obvious in PFA-AMeX samples as in FFPE samples. As for quality, the loss of rRNA peaks 18S and 28S on the capillary electropherograms from both FFPE and PFA-AMeX samples showed that the RNA was degraded equally during processing. However, qRT-PCR with 3' and 5' primer sets designed against human beta-actin revealed that, although RNA degradation occurred in both methods, it occurred more mildly in the PFA-AMeX samples. In conclusion, the PFA-AMeX method is good with respect to morphology and RNA quality, which makes it a promising tool for DNA microarrays combined with laser-capture microdissection, and if the appropriate RNA quality criteria are used, the capture of credible GeneChip data is well over 80% efficient, at least in human prostate specimens.

Peri-conceptional obesogenic exposure induces sex-specific programming of disease susceptibilities in adult mouse offspring

Vulnerability of the fetus upon maternal obesity can potentially occur during all developmental phases. We aimed at elaborating longer-term health outcomes of fetal overnutrition during the earliest stages of development. We utilized Naval Medical Research Institute (NMRI) mice to induce pre-conceptional and gestational obesity and followed offspring outcomes in the absence of any postnatal obesogenic influences. Male adult offspring developed overweight, insulin resistance, hyperleptinemia, hyperuricemia and hepatic steatosis; all these features were not observed in females. Instead, they showed impaired fasting glucose and a reduced fat mass and adipocyte size. Influences of the interaction of maternal diet∗sex concerned offspring genes involved in fatty liver disease, lipid droplet size regulation and fat mass expansion. These data suggest that a peri-conceptional obesogenic exposure is sufficient to shape offspring gene expression patterns and health outcomes in a sex- and organ-specific manner, indicating varying developmental vulnerabilities between sexes towards metabolic disease in response to maternal overnutrition.

A characterization of white matter pathology following spinal cord compression injury in the rat

Our laboratory has previously described the characteristics of neuronal injury in a rat compression model of spinal cord injury (SCI), focussing on the impact of this injury on the gray matter. However, white matter damage is known to play a critical role in functional outcome following injury. Therefore, in the present study, we used immunohistochemistry and electron microscopy to examine the alterations to the white matter that are initiated by compression SCI applied at T12 vertebral level. A significant loss of axonal and dendritic cytoskeletal proteins was observed at the injury epicenter within 1day of injury. This was accompanied by axonal dysfunction, as demonstrated by the accumulation of β-amyloid precursor protein (β-APP), with a peak at 3days post-SCI. A similar, acute loss of cytoskeletal proteins was observed up to 5mm away from the injury epicenter and was particularly evident rostral to the lesion site, whereas β-APP accumulation was prominent in tracts proximal to the injury. Early myelin loss was confirmed by myelin basic protein (MBP) immunostaining and by electron microscopy, which also highlighted the infiltration of inflammatory and red blood cells. However, 6weeks after injury, areas of new Schwann cell and oligodendrocyte myelination were observed. This study demonstrates that substantial white matter damage occurs following compression SCI in the rat. Moreover, the loss of cytoskeletal proteins and accumulation of β-APP up to 5mm away from the lesion site within 1day of injury indicates the rapid manner in which the axonal damage extends in the rostro-caudal axis. This is likely due to both Wallerian degeneration and spread of secondary cell death, with the latter affecting axons both proximal and distal to the injury.

Birth-date dependent arrangement of spinal enkephalinergic neurons: evidence from the preproenkephalin-green fluorescent protein transgenic mice

Enkephalin (ENK) has been postulated to play important roles in modulating nociceptive transmission, and it has been proved that ENKergic neurons acted as a critical component of sensory circuit in the adult spinal cord. Revealing the developmental characteristics of spinal ENKergic neurons will be helpful for understanding the formation and alteration of the sensory circuit under pain status. However, the relationship between the embryonic birth date and the adult distribution of ENKergic neurons has remained largely unknown due to the difficulties in visualizing the ENKergic neurons clearly. Taking advantage of the preproenkephalin-green fluorescent protein (PPE-GFP) transgenic mice in identifying ENKergic neurons, we performed the current birth-dating study and examined the spinal ENKergic neurogenesis. The ENKergic neurons born on different developmental stages and their final location during adulthood were investigated by combining bromodeoxyuridine (BrdU) incorporation and GFP labeling. The spinal ENKergic neurogenesis was restricted at E9.5 to E14.5, and fitted in the same pattern of spinal neurogenesis. Further comparative analysis revealed that spinal ENKergic neurons underwent heterogeneous characteristics. Our study also indicated that the laminar arrangement of ENKergic neurons in the superficial spinal dorsal horn depended on the neurogenesis stages. Taken together, the present study suggested that the birth date of ENKergic neurons is one determinant for their arrangement and function.

Involvement of the single Cul4 gene of Chinese mitten crab Eriocheir sinensis in spermatogenesis

The Cullin-RING finger ligases (CRLs) are involved in the ubiquitin-mediated degradation of cell cycle regulators and play an important role in gametogenesis. Cullin 4 (CUL4) is a conserved core component of a new class of ubiquitin E3 ligase, and participates in the proteolysis of several regulatory proteins through the ubiquitin-proteasome pathway. The mammals encode two paralogs of CUL4, CUL4A and CUL4B, and the two Cul4 genes are functionally redundant. However, Drosophila or other metazoans only contain one Cul4 gene. Here we cloned the Cul4 gene and confirmed that there is only one protein of CUL4 in Eriocheir sinensis, a full length Cul4 comprised of 2777 nucleotides, an open-reading frame of 2373bp encoding 790 amino acid residues. The expression level of Cul4 mRNAs, as demonstrated by quantitative real-time PCR, varied significantly during testis development, with the greatest transcript levels found at an early stage. Localization analysis using antibodies against CUL4A/4B in the reproductive system showed that EsCUL4 mainly distribute in spermatogonia and primary spermatocytes, and gradually reduced during the development and maturation of sperm. The results indicated that a single CUL4 protein may play a role in spermatogenesis in E. sinensis.

Visualizing and quantifying oxidized protein thiols in tissue sections: a comparison of dystrophic mdx and normal skeletal mouse muscles

Reactive oxygen species (ROS) are not only a cause of oxidative stress in a range of disease conditions but are also important regulators of physiological pathways in vivo. One mechanism whereby ROS can regulate cell function is by modification of proteins through the reversible oxidation of their thiol groups. An experimental challenge has been the relative lack of techniques to probe the biological significance of protein thiol oxidation in complex multicellular tissues and organs. We have developed a sensitive and quantitative fluorescence labeling technique to detect and localize protein thiol oxidation in histological tissue sections. In our technique, reduced and oxidized protein thiols are visualized and quantified on two consecutive tissue sections and the extent of protein thiol oxidation is expressed as a percentage of total protein thiols (reduced plus oxidized). We tested the application of this new technique using muscles of dystrophic (mdx) and wild-type C57Bl/10Scsn (C57) mice. In mdx myofibers, protein thiols were consistently more oxidized (19 ± 3%) compared with healthy myofibers (10 ± 1%) in C57 mice. A striking observation was the localization of intensive protein thiol oxidation (70 ± 9%) within myofibers associated with necrotic damage. Oxidative stress is an area of active investigation in many fields of research, and this technique provides a useful tool for locating and further understanding protein thiol oxidation in normal, damaged, and diseased tissues.

Regulation of platelet responses triggered by Toll-like receptor 2 and 4 ligands is another non-genomic role of nuclear factor-kappaB

INTRODUCTION

Platelets express Toll-like receptors (TLRs) that recognise molecular components of pathogens and, in nucleated cells, elicit immune responses through nuclear factor-kappaB (NF-κB) activation. We have shown that NF-κB mediates platelet activation in response to classical agonists, suggesting that this transcription factor exerts non-genomic functions in platelets. The aim of this study was to determine whether NF-κB activation is a downstream signal involved in TLR2 and 4-mediated platelet responses.

MATERIAL AND METHODS

Aggregation and ATP release were measured with a Lumi-aggregometer. Fibrinogen binding, P-selectin and CD40 ligand (CD40L) levels and platelet-neutrophil aggregates were measured by cytometry. I kappa B alpha (IκBα) degradation and p65 phosphorylation were determined by Western blot and von Willebrand factor (vWF) by ELISA.

RESULTS

Platelet stimulation with Pam3CSK4 or LPS resulted in IκBα degradation and p65 phosphorylation. These responses were suppressed by TLR2 and 4 blocking and synergised by thrombin. Aggregation, fibrinogen binding and ATP and vWF release were triggered by Pam3CSK4. LPS did not induce platelet responses per se, except for vWF release, but it did potentiate thrombin-induced aggregation, fibrinogen binding and ATP secretion. Pam3CSK4, but not LPS, induced P-selectin and CD40L expression and mixed aggregate formation. All of these responses, except for CD40L expression, were inhibited in platelets treated with the NF-κB inhibitors BAY 11-7082 or Ro 106-9920.

CONCLUSION

TLR2 and 4 agonists trigger platelet activation responses through NF-κB. These data show another non-genomic function of NF-κB in platelets and highlight this molecule as a potential target to prevent platelet activation in inflammatory or infectious diseases.

Usefulness of the INNOVANCE PFA P2Y test cartridge for the detection of patients with congenital defects of the platelet P2Y₁₂ receptor for adenosine diphosphate

INTRODUCTION

The platelet function analyzer (PFA)-100 is used in clinical practice to screen patients with bleeding diathesis and suspected defects of primary hemostasis. A new cartridge, INNOVANCE PFA P2Y, has been specifically developed to monitor patients' response to drugs inhibiting the platelet P2Y₁₂ receptor for ADP. In this study, we compared the ability of INNOVANCE PFA P2Y to detect congenital defects of the platelet P2Y₁₂ receptor to that of standard cartridge formulations currently in clinical use.

MATERIALS AND METHODS

We studied two patients with severe P2Y₁₂ deficiency, one patient with heterozygous P2Y₁₂ deficiency and one with dysfunctional P2Y₁₂ receptor. Closure times were measured using 3 cartridges: collagen/ADP, collagen/epinephrine, and INNOVANCE PFA P2Y. The results obtained in the four patients with P2Y₁₂ defects were compared to those obtained for 20 healthy controls.

RESULTS

In 2 patients with severe P2Y₁₂ deficiency, closure times of INNOVANCE PFA P2Y and collagen/ADP cartridges were >300 s, while those of collagen/epinephrine cartridge were variable (186s and >300 s). In the patient with dysfunctional P2Y₁₂, closure time of INNOVANCE PFA P2Y was >300 s, while closure times of collagen/ADP and collagen/epinephrine were normal. Closure times of all cartridges were normal in the patient with heterozygous P2Y₁₂ deficiency.

CONCLUSION

Our study provides the first evidence that INNOVANCE PFA P2Y cartridge is sensitive to congenital severe and moderate defects of the platelet P2Y₁₂ receptors.

Independent roles of methionine sulfoxide reductase A in mitochondrial ATP synthesis and as antioxidant in retinal pigment epithelial cells

The antioxidant enzyme methionine sulfoxide reductase A (MsrA) is highly expressed in the retinal pigment epithelium (RPE), a support tissue for neighboring photoreceptors. MsrA protein levels correlate with sensitivity of RPE in culture to experimental oxidative stress. To investigate whether and how MsrA affects RPE functionality regardless of oxidative stress, we tested the effects of acute silencing or overexpression of MsrA on the phagocytosis of photoreceptor outer segment fragments (POS), a demanding, daily function of the RPE that is essential for vision. Endogenous MsrA localized to mitochondria and cytosol of rat RPE in culture. RPE cells manipulated to express higher or lower levels of MsrA than control cells showed no signs of cell death but increased or decreased, respectively, POS binding as well as engulfment. These effects of altered MsrA protein concentration on phagocytosis were independent of the levels of oxidative stress. However, altering MsrA expression had no effect on phagocytosis when mitochondrial respiration was inhibited. Furthermore, ATP content directly correlated with MsrA protein levels in RPE cells that used mitochondrial oxidative phosphorylation for ATP synthesis but not in RPE cells that relied on glycolysis alone. Overexpressing MsrA was sufficient to increase specifically the activity of complex IV of the respiratory chain, whereas activity of complex II and mitochondrial content were unaffected. Thus, MsrA probably enhances ATP synthesis by increasing complex IV activity. Such contribution of MsrA to energy metabolism is independent of its function in protection from elevated oxidative stress but contributes to routine but vital photoreceptor support by RPE cells.

Retina-specific gene excision by targeted expression of Cre recombinase

The use of Cre recombinase for conditional targeting permits the controlled removal or activation of genes in specific tissues and at specific times of development. The Rho-Cre mice provide an improved tool for studying gene ablation in rod photoreceptor cells. To establish a robust expression of Rho-Cre transgenic mice that would be useful for the study of various protein functions in photoreceptor cells, a total 11,987 kb fragment (pNCHS4 Rho-NLS-cre) containing human rhodopsin promoter was cloned. The Rho-Cre plasmid was digested with EcoR1 and I Ceu-1, and the 9.316 kb fragment containing the hRho promoter and Cre recombinase gel was purified. To generate transgenic mice, the purified DNA fragment was injected into fertilized oocytes according to standard protocols. ROSA26R reported the steady expression of Rho-Cre especially in photoreceptor cells, allowing further excising proteins in rod photoreceptors across the retina. This Rho-Cre transgenic line should thus prove useful as a general deletor line for genetic analysis of diverse aspects of retinopathy.

Repeated forced swim stress enhances CFA-evoked thermal hyperalgesia and affects the expressions of pCREB and c-Fos in the insular cortex

Stress affects brain activity and promotes long-term changes in multiple neural systems. Exposure to stressors causes substantial effects on the perception and response to pain. In several animal models, chronic stress produces lasting hyperalgesia. The insular (IC) and anterior cingulate cortices (ACC) are the regions exhibiting most reliable pain-related activity. And the IC and ACC play an important role in pain modulation via the descending pain modulatory system. In the present study we examined the expression of phospho-cAMP response element-binding protein (pCREB) and c-Fos in the IC and ACC after forced swim stress (FS) and complete Freund's adjuvant (CFA) injection to clarify changes in the cerebral cortices that affect the activity of the descending pain modulatory system in the rats with stress-induced hyperalgesia. FS (day 1, 10min; days 2-3, 20min) induced an increase in the expression of pCREB and c-Fos in the anterior IC (AIC). CFA injection into the hindpaw after the FS shows significantly enhanced thermal hyperalgesia and induced a decrease in the expression of c-Fos in the AIC and the posterior IC (PIC). Quantitative image analysis showed that the numbers of c-Fos-immunoreactive neurons in the left AIC and PIC were significantly lower in the FS+CFA group (L AIC, 95.9±6.8; L PIC, 181.9±23.1) than those in the naive group (L AIC, 151.1±19.3, p<0.05; L PIC, 274.2±37.3, p<0.05). These findings suggest a neuroplastic change in the IC after FS, which may be involved in the enhancement of CFA-induced thermal hyperalgesia through dysfunction of the descending pain modulatory system.