Conservative treatment of 3- and 4-part proximal humeral fractures: Can poor outcomes be predicted?

PURPOSE

3- and 4-part proximal humeral fractures are frequently treated conservatively. This study aims to combine radiographic, and patient reported outcome data to identify factors leading to poor outcomes following conservative treatment.

METHODS

A retrospective local database analysis identified 3- and 4-part fractures. Radiographic and functional outcomes including Oxford Shoulder Score (OSS), QuickDash (QD), Subjective Shoulder Score (SSV) and VAS pain scores were collected.

RESULTS

104 patients were included at mean follow-up of 55 months. Analysis highlighted significant OSS differences in 3- versus 4-part (p = 0.027), dominant arm injury (p = 0.046), age > 65 (p = 0.006), varus coronal neck-shaft angle < 115 versus 115-155 degrees (p = 0.008), posterior head tilt > 155 degrees (p = 0.005), greater tuberosity (GT) displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.032). According to QD scores; age > 65 (p = 0.012), varus neck-shaft angle (p = 0.01), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.01), medial calcar hinge displacement > 2 mm (p = 0.006). SSV varied significantly with 3- versus 4-part fractures (p = 0.005), age > 65 (p = 0.04), varus neck-shaft angle (p = 0.001), posterior head tilt (p = 0.005), GT displacement > 5 mm (p = 0.001), GT comminution (p = 0.003), and medial calcar hinge displacement > 2 mm (p = 0.001).

CONCLUSION

We highlight risk factors for unfavourable outcomes following conservative management, aiding surgeons in shared decision-making and patient expectation management.

Boric Acid Improved Cryopreserved Mouse Embryo Development

Boric acid (BA) is an essential trace element that is required to support the metabolic pathways in plants, humans, and animals. The present study investigates the in vitro development and quality of single-cell mouse embryos in a BA-added culture medium after cryopreservation using the solid-surface vitrification method. For this purpose, the pronuclear-stage embryos derived from superovulated C57Bl/6j mouse strains and the one-cell embryos were then cryopreserved using the solid-surface vitrification (SSV) method. After thawing, the embryos were cultured in a BA-added medium at 37 °C in a 5% CO2 environment until the blastocyst stage. The resulting in vitro development rates of the embryos in the control group, SSV group, and SSV + 1.62 × 10-4 μM BA group were 68.11% (36/59), 40.16% (16/48), and 64.92% (28/48) respectively, indicating that the BA supported the in vitro development of the embryos cryopreserved using the SSV method. Our results suggest that the addition of boric acid to the culture media increased the development rate of the embryos that were vitrified using the SSV method.

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017

OBJECTIVES

This study aimed to identify the unintended incidents that led to patient injuries (PIs) in the treatment of superficial venous insufficiency (SVI).

METHODS

PI claims filed with the Finnish Patient Insurance Centre between 2004 and 2017 involving SVI were reviewed. Factors contributing to PI were identified and classified.

RESULTS

Eighteen (13.2%) of 136 compensated PIs in the specialty of vascular surgery were related to SVI. Only 4.7% of 383 SVI claims were compensated. The incidence of PIs was 9.9 per 100 000 patients. Fifteen patients had open surgery (83.3%) and three (16.7%) endovenous treatment. Two (11.1%) patients had necrotising fasciitis, four (22.1%) had deep vein injuries and two (11.1%) had a permanent nerve injury. Two (11.1%) patients had retained endovenous material that required surgical removal.

CONCLUSIONS

PIs were identifiable during all stages of care, perioperative injuries related to open surgery being the most common.

Surface resistance to SSVs and SIRVs in pilin deletions of Sulfolobus islandicus

Characterizing the molecular interactions of viruses in natural microbial populations offers insights into virus–host dynamics in complex ecosystems. We identify the resistance of Sulfolobus islandicus to Sulfolobus spindle‐shaped virus (SSV9) conferred by chromosomal deletions of pilin genes, pilA1 and pilA2 that are individually able to complement resistance. Mutants with deletions of both pilA1 and pilA2 or the prepilin peptidase, PibD, show the reduction in the number of pilins observed in TEM and reduced surface adherence but still adsorb SSV9. The proteinaceous outer S‐layer proteins, SlaA and SlaB, are not required for adsorption nor infection demonstrating that the S‐layer is not the primary receptor for SSV9 surface binding. Strains lacking both pilins are resistant to a broad panel of SSVs as well as a panel of unrelated S. islandicus rod‐shaped viruses (SIRVs). Unlike SSV9, we show that pilA1 or pilA2 is required for SIRV8 adsorption. In sequenced Sulfolobus strains from around the globe, one copy of each pilA1 and pilA2 is maintained and show codon‐level diversification, demonstrating their importance in nature. By characterizing the molecular interactions at the initiation of infection between S. islandicus and two different types of viruses we hope to increase the understanding of virus–host interactions in the archaeal domain.

Cryopreservation of murine testicular Leydig cells by modified solid surface vitrification with supplementation of antioxidants

Reports on the vitrification of somatic cells are scarce. Here, we show that Leydig cells (murine cell line TM3) could be successfully vitrified by both open vitrification [plastic straw (PS) and plastic vials (PV)] and closed ultravitrification [microdrop (MD) and solid surface vitrification (SSV)], after protocol optimization. However, open ultravitrification resulted in better post-warming viability than closed systems of vitrification with highest success obtained in modified SSV (84.8 ± 1.86%; p < 0.05). Leydig cells vitrified-warmed by modified SSV also showed superior (p < 0.05) cell growth, mitochondrial activity and cytoplasmic esterase enzyme activity, than MD, PS and PV, respectively. It was also observed that vitrified-warmed cells had higher level of ROS activity than non-vitrified control cells (41.6 ± 4.0 vs. 16.7 ± 1.0; p < 0.05). Treatment of cells with glutathione (GSH) or 2-mercaptoethanol (2-ME) (0, 10, 50, 100 μM) significantly (p < 0.05) reduced the ROS activity but had no significant (p > 0.05) effect on post-warm viability. Nevertheless, antioxidant-treated cells had improved mitochondrial activity, cytoplasmic esterase activity and cell growth during in vitro culture (p < 0.05). In conclusion, our results suggest that modified SSV offers a viable method for vitrifying single cell suspension of Leydig cells. To the best of our knowledge, this is the first report on cryopreservation of Leydig cells by vitrification.

One-Step Approach to Treating Venous Insufficiency

BACKGROUND

Patients with venous insufficiency can be treated with office-based, minimally invasive means like radiofrequency ablation (RFA) and ultrasound-guided foam sclerotherapy (UGFS). Traditional treatment involves ablation of the great saphenous vein (GSV) and the short saphenous vein (SSV) with RFA as a first step. The remaining refluxing tributaries are treated at a later session with UGFS or microphlebectomy. This approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure. We, instead, elected to treat all the refluxing veins in one procedure which combines RFA of the truncal and perforating vein with UGFS to the accessory and tributary veins.

METHODS

A controlled non-randomized clinical trial, in which a total of 72 extremities were treated for vein incompetence in 63 consecutive patients aged 26 - 78 years, was conducted. Sixty-three extremities (87.5%) received treatment for reflux in GSV, 10 extremities (13.9%) were treated for reflux in SSV, and 11 (15.3%) were treated for reflux in the perforators. Reflux duration > 1 second to increase specificity and truncal vein diameter > 5 mm were identified in the treated limbs. The treatment was performed at our office and it involved delivering radiofrequency thermal energy to the truncal and perforating vein and then using foam sclerotherapy with the guidance of ultrasound to close the tributary and accessory veins in a single procedure. The results were monitored at 1 week and 6 weeks post-operatively by venous duplex ultrasound.

RESULTS

One hundred percent of the treated GSV and SSV and 91.7% of tributary veins were completely closed after the index procedure. Only 10 of 72 extremities (13.9%) needed a follow-up treatment to achieve closure of the perforator and accessory veins. By combining RFA with UGFS, our cohort did not experience thrombophlebitis or deep vein thrombosis (DVT) post-operatively. No major or minor complications were found upon follow-up evaluation.

CONCLUSION

We believe that combining RFA with UGFS in a solo practice lowers the incidence of thrombophlebitis in the tributaries. Using this approach allowed us to achieve more complete resolution of venous reflux disease with lower complication rates in comparison with the popular staged strategy. This could have implications for financial savings to both the patient and the health system.

Structural insights into the architecture of the hyperthermophilic Fusellovirus SSV1

The structure and assembly of many icosahedral and helical viruses are well-characterized. However, the molecular basis for the unique spindle-shaped morphology of many viruses that infect Archaea remains unknown. To understand the architecture and assembly of these viruses, the spindle-shaped virus SSV1 was examined using cryo-EM, providing the first 3D-structure of a spindle-shaped virus as well as insight into SSV1 biology, assembly and evolution. Furthermore, a geometric framework underlying the distinct spindle-shaped structure is proposed.

Endovenous laser ablation of the great and short saphenous veins with a 1320-nm neodymium:yttrium-aluminum-garnet laser: retrospective case series of 1171 procedures

BACKGROUND

Venous insufficiency is a common medical condition affecting up to 50.5% of women and 30.1% of men. Endovenous laser ablation is a minimally invasive procedure that safely and effectively treats reflux involving the great and short saphenous veins.

OBJECTIVE

We sought to present safety and efficacy data of 1171 endovenous laser ablations using the Scripps Clinic endovenous laser therapy (EVLT) protocol.

METHODS

We conducted an institutional review board-approved, retrospective chart analysis of 1171 endovenous laser ablations performed from March 2007 until February 2011 treated at Scripps Clinic with the 1320-nm neodymium:yttrium-aluminum-garnet laser with 1-month, 6-month, 1-year, and 2-year follow-up data.

RESULTS

Our current overall experience is greater than 2000 EVLT procedures. The mean follow-up for this case series of 1171 EVLT procedures (1066 great saphenous veins and 105 short saphenous veins) is 11.4 months with an overall closure success rate of 99.9% for patients not lost to follow-up. There has been no incidence of deep vein thrombosis, permanent nerve damage, or pulmonary embolism related to laser ablation.

LIMITATIONS

Retrospective chart analysis, investigator bias, patients lost to follow-up, and lack of quality-of-life assessment are limitations.

CONCLUSION

EVLT using a 1320-nm neodymium:yttrium-aluminum-garnet laser appears to be a viable option for venous insufficiency and venous ulceration unresponsive to conservative treatment.

A multi-endpoint in vivo larval zebrafish (Danio rerio) model for the assessment of integrated cardiovascular function

INTRODUCTION

Despite effective in vitro preclinical strategies to identify cardiovascular (CV) liabilities, there remains a need for early functional assessment prior to complex in vivo mammalian models. The larval zebrafish (Danio rerio, Zf) has been suggested for this role: previous data suggest that cardiac electrophysiology and vascular ultrastructure are comparable with mammals, and also indicate responsiveness of individual Zf CV system endpoints to some functional modulators. Little information is, however, available regarding integrated functional CV responses to drug treatment. Consequently, we developed a novel larval Zf model capable of simultaneous quantification of chronotropic, inotropic and arrhythmic effects, alongside measures of blood flow and vessel diameter.

METHODS

Non-invasive video analysis of the heart and dorsal aorta of anaesthetized and agarose-embedded larval ZF was used to measure multiple cardiovascular endpoints, simultaneously, following treatment with a range of functional modulators of CV physiology.

RESULTS

Changes in atrial and ventricular beat frequencies were detected in response to acute treatment with cardio-stimulants (adrenaline and theophylline), and negative chrono/inotropes (cisapride, haloperidol, terfenadine and verapamil). Arrhythmias were also observed including terfenadine-induced 2:1 atrial-ventricular (A-V) block, a previously proposed hERG surrogate measure. Significant increases in blood flow were detected in response to adrenaline and theophylline exposure; and decreases after cisapride, haloperidol, terfenadine, and verapamil treatment. Using dorsal aorta (DA) blood flow and ventricular beat rate, surrogate stoke volumes were also calculated for all compounds.

DISCUSSION

These data support the use of this approach for CV function studies. Moreover the throughput and compound requirements (approximately 3 compounds/person effort/week and <10 mg) make our approach potentially suitable for higher throughput drug safety and efficacy applications, pending further assessment of ZF-mammalian pharmacological comparability.