Publications by authors named "Graham J King"

330 Publications

Genome structural evolution in Brassica crops.

Nat Plants 2021 May 27. Epub 2021 May 27.

Department of Biology, University of York, York, UK.

The cultivated Brassica species include numerous vegetable and oil crops of global importance. Three genomes (designated A, B and C) share mesohexapolyploid ancestry and occur both singly and in each pairwise combination to define the Brassica species. With organizational errors (such as misplaced genome segments) corrected, we showed that the fundamental structure of each of the genomes is the same, irrespective of the species in which it occurs. This enabled us to clarify genome evolutionary pathways, including updating the Ancestral Crucifer Karyotype (ACK) block organization and providing support for the Brassica mesohexaploidy having occurred via a two-step process. We then constructed genus-wide pan-genomes, drawing from genes present in any species in which the respective genome occurs, which enabled us to provide a global gene nomenclature system for the cultivated Brassica species and develop a methodology to cost-effectively elucidate the genomic impacts of alien introgressions. Our advances not only underpin knowledge-based approaches to the more efficient breeding of Brassica crops but also provide an exemplar for the study of other polyploids.
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http://dx.doi.org/10.1038/s41477-021-00928-8DOI Listing
May 2021

Primary total elbow arthroplasty.

J Clin Orthop Trauma 2021 Jul 20;18:66-73. Epub 2021 Apr 20.

Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.

There have been significant improvements in surgical techniques and implant designs of elbow arthroplasty over the last five decades. These advances have resulted in improved outcomes and expansion of indications for total elow arthroplasty (TEA). As the proportion of TEAs being performed for inflammatory arthritis has been decreasing in recent years, TEAs are being performed more commonly for the management of acute distal humerus fractures in the elderly, post-traumatic sequelae, and primary osteoarthritis. Appropriate patient selection and meticulous attention to surgical technique including the surgical approach, implant positioning and fixation will result in acceptable outcomes. Future advances in the design, instrumentation, and surgical technique will allow for further improvement in outcomes as the indications for TEA continue to expand.
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http://dx.doi.org/10.1016/j.jcot.2021.04.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8099774PMC
July 2021

Challenges for FAIR-compliant description and comparison of crop phenotype data with standardized controlled vocabularies.

Database (Oxford) 2021 May;2021

Southern Cross Plant Science, Southern Cross University, PO Box 157, Lismore, NSW 2480, Australia.

Crop phenotypic data underpin many pre-breeding efforts to characterize variation within germplasm collections. Although there has been an increase in the global capacity for accumulating and comparing such data, a lack of consistency in the systematic description of metadata often limits integration and sharing. We therefore aimed to understand some of the challenges facing findable, accesible, interoperable and reusable (FAIR) curation and annotation of phenotypic data from minor and underutilized crops. We used bambara groundnut (Vigna subterranea) as an exemplar underutilized crop to assess the ability of the Crop Ontology system to facilitate curation of trait datasets, so that they are accessible for comparative analysis. This involved generating a controlled vocabulary Trait Dictionary of 134 terms. Systematic quantification of syntactic and semantic cohesiveness of the full set of 28 crop-specific COs identified inconsistencies between trait descriptor names, a relative lack of cross-referencing to other ontologies and a flat ontological structure for classifying traits. We also evaluated the Minimal Information About a Phenotyping Experiment and FAIR compliance of bambara trait datasets curated within the CropStoreDB schema. We discuss specifications for a more systematic and generic approach to trait controlled vocabularies, which would benefit from representation of terms that adhere to Open Biological and Biomedical Ontologies principles. In particular, we focus on the benefits of reuse of existing definitions within pre- and post-composed axioms from other domains in order to facilitate the curation and comparison of datasets from a wider range of crops. Database URL: https://www.cropstoredb.org/cs_bambara.html.
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http://dx.doi.org/10.1093/database/baab028DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8122365PMC
May 2021

Pests, diseases, and aridity have shaped the genome of Corymbia citriodora.

Commun Biol 2021 May 10;4(1):537. Epub 2021 May 10.

University of Queensland/QAAFI, Brisbane, QLD, Australia.

Corymbia citriodora is a member of the predominantly Southern Hemisphere Myrtaceae family, which includes the eucalypts (Eucalyptus, Corymbia and Angophora; ~800 species). Corymbia is grown for timber, pulp and paper, and essential oils in Australia, South Africa, Asia, and Brazil, maintaining a high-growth rate under marginal conditions due to drought, poor-quality soil, and biotic stresses. To dissect the genetic basis of these desirable traits, we sequenced and assembled the 408 Mb genome of Corymbia citriodora, anchored into eleven chromosomes. Comparative analysis with Eucalyptus grandis reveals high synteny, although the two diverged approximately 60 million years ago and have different genome sizes (408 vs 641 Mb), with few large intra-chromosomal rearrangements. C. citriodora shares an ancient whole-genome duplication event with E. grandis but has undergone tandem gene family expansions related to terpene biosynthesis, innate pathogen resistance, and leaf wax formation, enabling their successful adaptation to biotic/abiotic stresses and arid conditions of the Australian continent.
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http://dx.doi.org/10.1038/s42003-021-02009-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110574PMC
May 2021

Effectiveness of radiographs and computed tomography in evaluating primary elbow osteoarthritis.

J Shoulder Elbow Surg 2021 Apr 20. Epub 2021 Apr 20.

The Roth|McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, ON, Canada. Electronic address:

Background: Preoperative radiographic assessment of osteophyte and loose body locations is critical in planning an arthroscopic débridement for primary elbow osteoarthritis. The purpose of this study was to evaluate the effectiveness of radiographs and computed tomography (CT) in localizing osteophytes and loose bodies.

Methods: A consecutive series of 36 patients with primary elbow osteoarthritis was investigated with radiographs and multiaxial 2-dimensional CT prior to elbow arthroscopy. The location of osteophytes and loose bodies was assessed in 9 anatomic locations by 2 fellowship-trained upper extremity surgeons. The diagnostic effectiveness of both imaging modalities was evaluated by calculating the sensitivity and specificity and compared to the gold standard of elbow arthroscopy. Inter- and intrarater percentage agreement between the observations was calculated using Kappa score.

Results: The mean sensitivity for detecting osteophytes in the 9 different anatomic locations was 46% with radiographs and 98% with CT, whereas the mean specificity was 66% and 21% for radiographs and CT, respectively. The mean sensitivity and specificity for loose body detection with radiography were 49% and 89%, respectively, whereas CT had a mean sensitivity of 98% and specificity of 47%. The overall inter-rater percentage agreement between the surgeons in detecting osteophytes and loose bodies on radiographs was 80% and 85%, respectively, whereas on CT it was 95% for detecting osteophytes and 91% for loose bodies.

Conclusion: CT has greater sensitivity than radiographs for the detection of osteophytes and loose bodies in primary elbow osteoarthritis. The lower specificity of CT may be due to this imaging modality's ability to detect small osteophytes and loose bodies that may not be readily identified during elbow arthroscopy. Radiographs have an inferior inter-rater percentage agreement compared with CT. CT is a valuable preoperative investigation to assist surgeons in identifying the location of osteophytes and loose bodies in patients undergoing surgery for primary elbow osteoarthritis.
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http://dx.doi.org/10.1016/j.jse.2021.04.001DOI Listing
April 2021

Magnesium and calcium over-accumulate in the leaves of a schengen3 mutant of Brassica rapa.

Plant Physiol 2021 Apr 8. Epub 2021 Apr 8.

School of Biosciences, University of Nottingham, Sutton Bonington Campus, Loughborough, LE12 5RD, UK.

Magnesium (Mg) and calcium (Ca) are essential mineral nutrients poorly supplied in many human food systems. In grazing livestock, Mg and Ca deficiencies are costly welfare issues. Here, we report a Brassica rapa loss-of-function schengen3 (sgn3) mutant, braA.sgn3.a-1, which accumulates twice as much Mg and a third more Ca in its leaves. We mapped braA.sgn3.a to a single recessive locus using a forward ionomic screen of chemically mutagenised lines with subsequent backcrossing and Linked-Read sequencing of second back-crossed, second filial generation (BC2F2) segregants. Confocal imaging revealed a disrupted root endodermal diffusion barrier, consistent with SGN3 encoding a receptor-like kinase required for normal formation of Casparian strips, as reported in thale cress (Arabidopsis thaliana). Analysis of the spatial distribution of elements showed elevated extracellular Mg concentrations in leaves of braA.sgn3.a-1, hypothesised to result from preferential export of excessive Mg from cells to ensure suitable cellular concentrations. This work confirms a conserved role of SGN3 in controlling nutrient homeostasis in B. rapa, and reveals mechanisms by which plants are able to deal with perturbed shoot element concentrations resulting from a "leaky" root endodermal barrier. Characterisation of variation in leaf Mg and Ca accumulation across a mutagenised population of B. rapa shows promise for using such populations in breeding programmes to increase edible concentrations of essential human and animal nutrients.
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http://dx.doi.org/10.1093/plphys/kiab150DOI Listing
April 2021

Outcomes of nonoperative management of displaced olecranon fractures in medically unwell patients.

JSES Int 2021 Mar 10;5(2):291-295. Epub 2021 Jan 10.

Roth McFarlane Hand and Upper Limb Center, University of Western Ontario, London, ON, Canada.

Background: Surgical treatment of displaced olecranon fractures in the elderly has a high rate of complications, including wound breakdown and fixation failure. The purpose of this study was to assess the clinical, radiographic, and functional outcomes of nonsurgical management of displaced olecranon fractures in low-demand elderly and medically unwell patients.

Methods: A retrospective review of 28 patients with displaced closed olecranon fractures was performed with an average follow-up of 11 months. The mean age at the time of injury was 79 ± 10 years. The average Charlson Comorbidity Index was 6.4 ± 2.6. Treatment modalities were at the discretion of the treating surgeon. A sling alone was used in 3 cases, an extension circumferential cast in 9, or a plaster or thermoplastic splint in 16. The mean period of immobilization was 5 ± 1 weeks. Outcomes included range of motion, ability to perform active overhead extension, as well as radiographic and functional outcomes.

Results: At final follow-up, the mean elbow range of motion for the cohort was from 28° ± 21° extension to 127° ± 15° flexion. Active overhead elbow extension against gravity was noted or documented in 24 (86%) patients. Two patients (7%) were unable to perform active extension. No pain was noted in 18 elbows, severe pain was present in 1 elbow, and the remainder reported mild occasional pain. All olecranon fractures in this cohort were displaced on the initial lateral radiograph. The mean displacement was 11 ± 7 mm. Nonunion at final radiographic outcome was observed in 23 (82%) elbows. Two (7%) patients developed skin complications related to posteriorly placed splints; one of which was severe.

Discussion: This study adds to the growing literature that supports nonoperative management of displaced olecranon fractures in elderly and medically unwell patients with low upper extremity demand. Patients can be counseled that they have a good chance of obtaining overhead extension, with minimal pain. Posteriorly based splints should not be used to minimize skin complications.
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http://dx.doi.org/10.1016/j.jseint.2020.11.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7910720PMC
March 2021

Results of Linked Convertible Total Elbow Arthroplasty for the Management of Distal Humeral Fractures in the Elderly.

J Hand Surg Am 2021 May 8;46(5):396-402. Epub 2021 Jan 8.

Department of Surgery, St Joseph's Hospital, Roth-McFarlane Hand and Upper Limb Center, St Joseph's Hospital London, Ontario, Canada. Electronic address:

Purpose: Total elbow arthroplasty (TEA) is increasingly used for the management of comminuted distal humeral fractures in elderly patients. There are limited data on the outcome of modern elbow arthroplasty designs in larger patient cohorts. The aim of the current study was to review the outcomes and complications using a cemented convertible TEA system in a linked configuration in patients with distal humeral fractures.

Methods: Patients with distal humeral fractures treated with TEA and a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome, functional and radiographic outcome assessments, and complications were reported.

Results: Forty patients met inclusion criteria; 35 were female. Median follow-up was 4 years (range, 2-13 years). Average age of patients at the index procedure was 79 ± 9 years. All implants were linked. Range of motion was: extension 16° ± 13°, flexion 127° ± 14°, supination 79° ± 11°, and pronation 73° ± 20°. Patient-reported outcome scores were: Patient-Rated Elbow Evaluation 37 ± 35, Quick-Disabilities of the Arm, Shoulder, and Hand 31 ± 31, and Mayo Elbow Performance Index 90 ± 18. Seven patients had heterotopic ossification. Lucent lines were noted predominantly in humeral implant zone V. No lucent lines were noted around the ulnar component in any radiographic zone. Complications occurred in 9 patients (22%) and 2 revisions were performed: one for infection and one for a late periprosthetic fracture.

Conclusions: Total elbow arthroplasty for fracture in elderly patients provides pain relief, functional range of motion, and good patient-reported outcome scores. No implant-related complications of this convertible implant system were encountered, but longer-term follow-up is needed.

Type Of Study/level Of Evidence: Therapeutic IV.
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http://dx.doi.org/10.1016/j.jhsa.2020.10.034DOI Listing
May 2021

An extreme-phenotype genome-wide association study identifies candidate cannabinoid pathway genes in Cannabis.

Sci Rep 2020 10 29;10(1):18643. Epub 2020 Oct 29.

Southern Cross Plant Science, Southern Cross University, Lismore, NSW, 2480, Australia.

Cannabis produces a class of isoprenylated resorcinyl polyketides known as cannabinoids, a subset of which are medically important and exclusive to this plant. The cannabinoid alkyl group is a critical structural feature that governs therapeutic activity. Genetic enhancement of the alkyl side-chain could lead to the development of novel chemical phenotypes (chemotypes) for pharmaceutical end-use. However, the genetic determinants underlying in planta variation of cannabinoid alkyl side-chain length remain uncharacterised. Using a diversity panel derived from the Ecofibre Cannabis germplasm collection, an extreme-phenotype genome-wide association study (XP-GWAS) was used to enrich for alkyl cannabinoid polymorphic regions. Resequencing of chemotypically extreme pools revealed a known cannabinoid synthesis pathway locus as well as a series of chemotype-associated genomic regions. One of these regions contained a candidate gene encoding a β-keto acyl carrier protein (ACP) reductase (BKR) putatively associated with polyketide fatty acid starter unit synthesis and alkyl side-chain length. Association analysis revealed twenty-two polymorphic variants spanning the length of this gene, including two nonsynonymous substitutions. The success of this first reported application of XP-GWAS for an obligate outcrossing and highly heterozygote plant genus suggests that this approach may have generic application for other plant species.
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http://dx.doi.org/10.1038/s41598-020-75271-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596533PMC
October 2020

Coronoid process reconstruction with a distal clavicle autograft: an in silico analysis of fitting accuracy.

J Shoulder Elbow Surg 2021 Jun 9;30(6):1282-1287. Epub 2020 Oct 9.

Roth|McFarlane Hand and Upper Limb Centre, St Joseph's Health Care, University of Western Ontario, London, ON, Canada.

Background: The coronoid process plays a vital role in preserving elbow stability. In cases of acute or chronic deficiency of the coronoid process, reconstruction is warranted to restore stability and to avoid early joint degeneration. The distal clavicle might be a useful osteochondral autograft for coronoid reconstruction with low donor-site morbidity. This study evaluated the fitting accuracy of the distal clavicle as an autograft for coronoid process reconstruction.

Methods: One hundred upper-extremity computed tomography scans of 85 body donors were available for this study (mean age, 69 ± 17 years; 46 male and 39 female donors; 15 bilateral specimens). Standardized 40% transverse defects of the coronoid process were digitally created; the distal clavicles were digitally harvested and placed onto the defects by a best-fit technique in 2 different orientations using commercially available software: (1) with the superior aspect of the articular surface of the graft oriented toward the coronoid tip and (2) with the inferior aspect of the articular surface of the graft oriented toward the coronoid tip. The fitting accuracy of the grafts to the native coronoid process was evaluated from lateral to medial using custom code.

Results: Regardless of the orientation of the graft, the distal clavicle provided a good fit in the central portion of the coronoid process. In the lateral and medial aspects of the defect, however, the fitting accuracy of the graft declined significantly (P ≤ .044). No significant differences were observed between ipsilateral and contralateral grafts (P ≥ .199). The intrarater reliability was excellent.

Conclusion: The results of this study suggest that a distal clavicle autograft may be suitable to replace a transverse defect of the coronoid process; however, it may not fully reconstruct the anteromedial and anterolateral aspects of the coronoid.
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http://dx.doi.org/10.1016/j.jse.2020.09.013DOI Listing
June 2021

Rehabilitation of Elbow Instability.

Hand Clin 2020 11 2;36(4):511-522. Epub 2020 Sep 2.

Roth | McFarlane Hand & Upper Limb Centre, 268 Grosvenor Street, London, Ontario N6A 4V2, Canada; Division of Orthopaedics, Western University, St. Joseph's Health Care, London, Ontario, Canada. Electronic address:

The elbow is the second most commonly dislocated major joint in adults with estimated incidence of 5 dislocations per 100,000 persons per year. A comprehensive understanding of elbow anatomy and biomechanics is essential to optimize rehabilitation of elbow injuries. This allows for implementation of a systematic therapy program that encourages early mobilization within a safe arc of motion while maintaining joint stability. To optimize outcomes, close communication between surgeon and therapist is necessary to allow for implementation of an individualized rehabilitation program. This article reviews key concepts that enable the clinician to apply an evidence-informed approach when managing elbow instability.
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http://dx.doi.org/10.1016/j.hcl.2020.07.003DOI Listing
November 2020

Alternatively Spliced Isoforms Play Opposing Roles in Anthocyanin Biosynthesis of L.

Front Plant Sci 2020 19;11:983. Epub 2020 Aug 19.

National Key Laboratory of Crop Genetic Improvement, National Center of Oil Crop Improvement (Wuhan), College of Plant Science and Technology, Huazhong Agricultural University, Wuhan, China.

L. (rapeseed, oilseed rape, and canola) and varieties of its two diploid parents, and , display a large amount of variation in anthocyanin pigmentation of the leaf, stem, and fruit. Here, we demonstrate that , an ortholog of the anthocyanin activator that confers purple traits, positively regulates anthocyanin biosynthesis in leaves of . Sequencing of and transgenic analysis suggests that activation of this gene in purple rapeseed may result from a single nucleotide and/or 2bp insertion in its promoter region. gives rise to three splice variants, designated , and according to the length of the transcripts. While encodes a full-length R2R3-MYB, both and encode truncated proteins that lack both a partial R3 repeat and the complete C terminal domain, and so are unable to interact with the bHLH protein AtTT8. Although expression of either or in green rapeseed does not result in purple leaves, both genes do modify genome-wide gene expression, with a strong repression of anthocyanin-related genes. We have demonstrated that regulates anthocyanin accumulation in leaves of and propose a potential mechanism for modulation of anthocyanin biosynthesis by alternative splicing.
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http://dx.doi.org/10.3389/fpls.2020.00983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7466728PMC
August 2020

Chromosome-Scale Assembly and Annotation of the Macadamia Genome ( HAES 741).

G3 (Bethesda) 2020 10 5;10(10):3497-3504. Epub 2020 Oct 5.

Southern Cross Plant Science, Southern Cross University, Lismore NSW 2480, Australia.

is a representative of the large basal eudicot family Proteaceae and the main progenitor species of the Australian native nut crop macadamia. Since its commercialisation in Hawaii fewer than 100 years ago, global production has expanded rapidly. However, genomic resources are limited in comparison to other horticultural crops. The first draft assembly of had good coverage of the functional gene space but its high fragmentation has restricted its use in comparative genomics and association studies. Here we have generated an improved assembly of cultivar HAES 741 (4,094 scaffolds, 745 Mb, N50 413 kb) using a combination of Illumina paired and PacBio long read sequences. Scaffolds were anchored to 14 pseudo-chromosomes using seven genetic linkage maps. This assembly has improved contiguity and coverage, with >120 Gb of additional sequence. Following annotation, 34,274 protein-coding genes were predicted, representing 90% of the expected gene content. Our results indicate that the macadamia genome is repetitive and heterozygous. The total repeat content was 55% and genome-wide heterozygosity, estimated by read mapping, was 0.98% or an average of one SNP per 102 bp. This is the first chromosome-scale genome assembly for macadamia and the Proteaceae. It is expected to be a valuable resource for breeding, gene discovery, conservation and evolutionary genomics.
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http://dx.doi.org/10.1534/g3.120.401326DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534425PMC
October 2020

Medial elbow exposure: an anatomic comparison of 5 approaches.

J Shoulder Elbow Surg 2021 Mar 7;30(3):512-519. Epub 2020 Jul 7.

Hand and Upper Limb Centre, Western University, London, ON, Canada.

Purpose: Several surgical approaches to the medial elbow are described; however, it remains unclear which exposure provides the optimal view of relevant medial elbow structures. The purpose of this anatomic study was to determine the visible surface area of the coronoid process, distal humerus, and radial head through 5 approaches to the medial elbow.

Methods: Eight fresh-frozen cadaveric upper extremity specimens were dissected. Five surgical approaches were performed on each specimen. The Smith muscle-splitting approach to the ulnar collateral ligament was performed first (Smith), followed by the Hotchkiss medial "Over the top" approach (Hotchkiss), the extended medial elbow approach (EMEA), the flexor carpi ulnaris splitting approach (FCU-Split), and the Taylor and Scham approach (T&S). Bony visualization was determined using laser surface scanning (Artec Space Spider; Artec 3D). The scans were segmented using commercially available digital software (Geomagic Wrap; 3D Systems Corporation), and the surface area visualized was determined. A descriptive analysis of the joint areas visible using the medial collateral ligament (MCL) as a clinical landmark was performed.

Results: The EMEA visualized the highest proportion of the total elbow joint from the medial side showing 13.9 ± 6.0 cm, or 15% ± 4% of the joint. It also provided the best visualization of the coronoid (3.2 ± 1.7 cm of surface area, or 26% ± 9%) and distal humerus (9.9 ± 4.3 cm, or 15% ± 4%). The Hotchkiss approach was best at visualizing the radial head (0.8 ± 0.3 cm, or 7% ± 3%). The EMEA, Hotchkiss, and Smith approaches showed primarily the anterior bundle of the MCL, its insertion, and the regions anterior to it, whereas the FCU-Split showed the anterior bundle of the MCL and regions both anterior and posterior to it. The T&S showed primarily the areas posterior to the anterior bundle of the MCL; the anterior regions were not visible. The FCU-Split and the T&S allowed visualization of the posterior bundle of the MCL. The intraclass correlation coefficients (ICCs) for intraobserver reliability were 0.997, 0.992, and 0.974 for the test distal humerus, test coronoid, and test radial head, respectively. The ICCs for interobserver reliability were 0.915 for the test distal humerus, 0.66 for the coronoid, and 0.583 for the radial head.

Conclusion: The EMEA provides the most visualization of the coronoid and distal humerus, whereas the Hotchkiss showed the most radial head. However, these approaches mainly visualize structures anterior to the MCL. If exposure of structures posterior to the MCL is required, the FCU-Split and T&S approaches are more appropriate.
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http://dx.doi.org/10.1016/j.jse.2020.06.031DOI Listing
March 2021

Elbow motion patterns during daily activity.

J Shoulder Elbow Surg 2020 Oct 9;29(10):2007-2014. Epub 2020 Jun 9.

Investigation performed at the Roth|McFarlane Hand and Upper Limb Center, London, ON, Canada. Electronic address:

Background: This in vivo kinematic study was developed to ascertain (1) elbow posture and motion during daily activities and (2) to compare motions of the dominant and nondominant elbows.

Methods: Forty-six subjects wore a custom instrumented shirt to continuously measure elbow posture and motion for the waking hours of 1 day. The 3D orientations of each of the forearm and humerus sensors enabled calculation of elbow flexion-extension and pronation-supination angles.

Results: The elbow flexion-extension postures that were most common ranged from 60°-100° for both the dominant and nondominant extremities averaging 44% ± 4% and 35% ± 4% of the day, respectively. When elbow flexion motions were calculated, there were a large number of motions over a wide distribution of flexion angles, with the dominant side exhibiting significantly more motions per hour than the nondominant side.

Conclusion: Both flexion-extension and pronation-supination motions occur more commonly in the dominant arm, and the dominant arm is more commonly in pronation. These data provide a baseline for assessing treatment outcomes, ergonomic studies, and elbow arthroplasty wear testing.
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http://dx.doi.org/10.1016/j.jse.2020.03.015DOI Listing
October 2020

Rotational Anatomy of the Radius and Ulna: Surgical Implications.

J Hand Surg Am 2020 Nov 29;45(11):1082.e1-1082.e9. Epub 2020 Jun 29.

Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario.

Purpose: The rotational anatomy of the forearm bones is not well defined. This study aims to further the understanding of the torsion of the radius and ulna to better guide treatment.

Methods: Computed tomography images of 98 cadaveric forearms were obtained and 3-dimensional models of the radius and ulna were generated and analyzed. The rotation of the radius was evaluated by comparing the orientation of the distal radius central axis (DRCA) with the volar cortex of the distal radius (DR) and biceps tuberosity (BT). The rotation of the ulna was evaluated by assessing the orientation of the ulnar head with respect to the proximal ulna.

Results: The DR volar cortex pronates from distal to proximal. The BT was 43.8° ± 16.9° supinated from the DRCA (range, 2.7°-86.5°). The mean difference in rotation between contralateral biceps tuberosities was 7.0° ± 7.1°. The volar cortex of the DR was 12.6° ± 5.4° supinated compared with the DRCA. The ulnar head was pronated 8.4° ± 14.9° with respect to the greater sigmoid notch (range, 50.3° pronation-22.0° supination).

Conclusions: The BT has a variable orientation relative to the DR, but it is generally located anteromedially in a supinated arm or 136° opposite the radial styloid. Understanding the rotational anatomy of the radius and ulna can play an important role in surgical planning and implant design. The rotational anatomy of the radius and ulna varies significantly between individuals, but is similar in contralateral limbs.

Clinical Relevance: Distal radius volar cortex rotational anatomy can help guide treatment of DR fractures and malunions as well as assist in positioning of wrist arthroplasty implants, particularly in the presence of bone loss. The side-to-side similarities demonstrated in this study should be helpful in managing patients with segmental bone loss or fracture malunion and those requiring joint reconstruction.
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http://dx.doi.org/10.1016/j.jhsa.2020.04.018DOI Listing
November 2020

The role of biceps loading and muscle activation on radial head stability in anterior Monteggia injuries: An in vitro biomechanical study.

J Hand Ther 2020 Jun 26. Epub 2020 Jun 26.

Roth-McFarlane Hand & Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada; Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada.

Introduction: Little evidence-based information is available to direct the optimal rehabilitation of patients with anterior Monteggia injuries.

Purpose Of The Study: The aims of this biomechanical investigation were to (1) quantify the effect of biceps loading and (2) to compare the effect of simulated active and passive elbow flexion on radial head stability in anterior Monteggia injuries.

Study Design: In vitro biomechanical study.

Methods: Six cadaveric arms were mounted in an elbow motion simulator. The effect of biceps loading, simulated active and passive elbow flexion motions was examined with application of 0N, 20N, 40N, 60N, 80N, and 100N of load. Simulated active and passive elbow flexion motions were then performed with the forearm supinated. Radial head translation relative to the capitellum was measured using an optical tracking system. After testing the intact elbows, the proximal ulna was osteotomized and realigned using a custom jig to simulate an anatomical reduction. We then sequentially sectioned the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane to simulate soft tissue injuries commonly associated with anterior Monteggia fractures.

Results: Greater magnitudes of biceps loading significantly increased anterior radial head translation. However, there was no significant difference in radial head translation between simulated active and passive elbow flexion except in the final stage of soft tissue sectioning. There was a significant increase in anterior radial head translation with progressive injury states with both isometric biceps loading and simulated active and passive motion.

Conclusions: Our results demonstrate that anatomic reduction of the ulna may not be sufficient to restore radial head alignment in anterior Monteggia injuries with a greater magnitude of soft tissue injury. In cases with significant soft tissue injury, the elbow should be immobilized in a flexed and supinated position to allow relaxation of the biceps and avoid movement of the elbow in the early postoperative period.
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http://dx.doi.org/10.1016/j.jht.2020.03.012DOI Listing
June 2020

Static and Dynamic External Fixation are Equally Effective for Unstable Elbow Fracture-Dislocations.

J Orthop Trauma 2021 03;35(3):e82-e88

Department of Surgery, St. Joseph's Health Care, Hand and Upper Limb Centre, Western University, London, ON, Canada; and.

Objective: To compare the clinical outcomes of static versus dynamic external fixation for elbow fracture-dislocations with persistent instability after surgical management.

Design: Comparative, retrospective review.

Setting: Two tertiary referral upper-extremity centers.

Patients: Twenty-four elbows requiring external fixation for persistent elbow instability within 90 days of surgical management of an elbow fracture-dislocation.

Intervention: Static and dynamic external fixation was used in 16 and 8 patients, respectively, for a median of 39 days (interquartile range, 33-48 days).

Main Outcome Measurements: Elbow range of motion, complications, and revision surgeries.

Results: Immediately after static and dynamic external fixation removal, there was no difference in elbow extension [33 degrees ± 16 degrees vs. 41 degrees ± 13 degrees, mean difference (MD) 7 degrees, 95% confidence interval (CI) -6 degrees-22 degrees] or flexion (114 degrees ± 35 degrees vs. 118 degrees ± 11 degrees, MD 4 degrees, 95% CI -23 degrees-132 degrees), respectively. At last follow-up, static and dynamic external fixation groups had no difference in elbow extension (27 degrees ± 13 degrees vs. 24 degrees ± 10 degrees, MD -3 degrees, 95% CI -15 degrees-7 degrees) or flexion (129 degrees ± 12 degrees vs. 128 degrees ± 14 degrees, MD -1 degree, 95% CI -13 degrees-10 degrees), respectively. Static and dynamic external fixation groups had no difference in complications [7 (44%) vs. 5 (63%), difference 19%, 95% CI -23%-54%] or revision surgeries [6 (38%) vs. 4 (50%), difference 13%, 95% CI -27%-49%].

Conclusions: No difference in range of motion, complications, and revision surgeries was detected after static versus dynamic external fixation of persistently unstable elbow fracture-dislocations. Due to ease of application, static external fixation is our preferred treatment for these injuries.

Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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http://dx.doi.org/10.1097/BOT.0000000000001876DOI Listing
March 2021

Abundant expression of maternal siRNAs is a conserved feature of seed development.

Proc Natl Acad Sci U S A 2020 06 15;117(26):15305-15315. Epub 2020 Jun 15.

The School of Plant Sciences, The University of Arizona, Tucson, AZ 85721;

Small RNAs are abundant in plant reproductive tissues, especially 24-nucleotide (nt) small interfering RNAs (siRNAs). Most 24-nt siRNAs are dependent on RNA Pol IV and RNA-DEPENDENT RNA POLYMERASE 2 (RDR2) and establish DNA methylation at thousands of genomic loci in a process called RNA-directed DNA methylation (RdDM). In , RdDM is required in the maternal sporophyte for successful seed development. Here, we demonstrate that a small number of siRNA loci account for over 90% of siRNA expression during seed development. These loci exhibit unique characteristics with regard to their copy number and association with genomic features, but they resemble canonical 24-nt siRNA loci in their dependence on RNA Pol IV/RDR2 and role in RdDM. These loci are expressed in ovules before fertilization and in the seed coat, embryo, and endosperm following fertilization. We observed a similar pattern of 24-nt siRNA expression in diverse angiosperms despite rapid sequence evolution at siren loci. In the endosperm, siren siRNAs show a marked maternal bias, and siren expression in maternal sporophytic tissues is required for siren siRNA accumulation. Together, these results demonstrate that seed development occurs under the influence of abundant maternal siRNAs that might be transported to, and function in, filial tissues.
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http://dx.doi.org/10.1073/pnas.2001332117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7334491PMC
June 2020

Transposon insertions within alleles of BnaFLC.A10 and BnaFLC.A2 are associated with seasonal crop type in rapeseed.

J Exp Bot 2020 08;71(16):4729-4741

National Key Laboratory of Crop Genetic Improvement, College of Plant Science and Technology, Huazhong Agricultural University, Wuhan, China.

In Brassicaceae, the requirement for vernalization is conferred by high expression of FLOWERING LOCUS C (FLC). The expression of FLC is known to be repressed by prolonged exposure to cold. Rapeseed (Brassica napus L.) cultivars can be classified into spring, winter, and semi-winter crop types, depending on their respective vernalization requirements. In addition to two known distinct transposon insertion events, here we identified a 4.422 kb hAT and a 5.625 kb long interspersed nuclear element transposon insertion within BnaFLC.A10, and a 810 bp miniature inverted-repeat transposable element (MITE) in BnaFLC.A2. Quantitative PCR demonstrated that these insertions lead to distinct gene expression patterns and contribute differentially to the vernalization response. Transgenic and haplotype analysis indicated that the known 621 bp MITE in the promoter region of BnaFLC.A10 is a transcriptional enhancer that appears to be the main determinant of rapeseed vernalization, and has contributed to the adaptation of rapeseed in winter cultivation environments. In the absence of this transposon insertion, the functional allele of BnaFLC.A2 is a major determinant of vernalization demand. Thus, the combination of BnaFLC.A10 carrying the 621 bp MITE insertion and a functional BnaFLC.A2 appears necessary to establish the winter rapeseed crop phenotype.
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http://dx.doi.org/10.1093/jxb/eraa237DOI Listing
August 2020

The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons -Elbow form capture aspects of functioning that are important to patients with elbow injuries.

J Hand Ther 2020 Apr 20. Epub 2020 Apr 20.

Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada.

Study Design: This is a cross-sectional study.

Introduction: The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons-elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice.

Purpose Of The Study: To use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e.

Methods: One hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement.

Results: A total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475-driving (35%) and D440-fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%.

Discussion: This study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section ('d' categories) of the ICF, this validated that these PROMs measure this conceptual domain.

Conclusion: The PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.
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http://dx.doi.org/10.1016/j.jht.2020.02.001DOI Listing
April 2020

Identification, characterization and epitope mapping of proteins encoded by putative allergenic napin genes from Brassica rapa.

Clin Exp Allergy 2020 07 6;50(7):848-868. Epub 2020 May 6.

Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia.

Background: Brassica rapeseed crops contain high concentrations of oil in the seed. The remaining meal, following oil extraction, has a high protein content, but is of low value due to the presence of high amounts of napin seed storage proteins. These 2S albumin-like proteins are difficult to digest and have been identified as major allergens in humans.

Objective: To comprehensively characterize the napin gene (NG) family in Brassica rapa and to gain an understanding of the structural basis of allergenicity of the expressed proteins.

Methods: To identify candidate napin genes in B rapa, 2S albumin-like napin genes of Arabidopsis thaliana were used as query sequences to search for similarity against the B rapa var. pekinensis Chiifu-401 v2 and the var. trilocularis R-o-18 v1.5 genomes. Multiple sequence alignment (MSA) and epitope modelling was carried out to determine structural and evolutionary relationships of NGs and their potential allergenicity.

Results: Four candidate napin genes in R-o-18 and ten in Chiifu-401 were identified with high sequence similarity to A thaliana napin genes. Multiple sequence alignment revealed strong conservation among the candidate genes. An epitope survey indicated high conservation of allergenic epitope motifs with known 2S albumin-like allergens.

Conclusion: Napin is thought to be responsible for a  high prevalence of food allergies. Characterization of the napin gene family in B rapa will give important insight into the protein structure, and epitope modelling will help to advance studies into allergenicity including the development of precise diagnostic screenings and therapies for this potential food allergy as well as the possible manipulation of napin levels in the seed by gene editing technology.
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http://dx.doi.org/10.1111/cea.13612DOI Listing
July 2020

Maximising recombination across macadamia populations to generate linkage maps for genome anchoring.

Sci Rep 2020 03 19;10(1):5048. Epub 2020 Mar 19.

Southern Cross Plant Science, Southern Cross University, Lismore, NSW, Australia.

The Proteaceae genus Macadamia has a recent history of domestication as a commercial nut crop. We aimed to establish the first sequence-based haploid-correlated reference genetic linkage maps for this primarily outcrossing perennial tree crop, with marker density suitable for genome anchoring. Four first generation populations were used to maximise the segregation patterns available within full-sib, biparental and self-pollinated progeny. This allowed us to combine segregation data from overlapping subsets of >4,000 informative sequence-tagged markers to increase the effective coverage of the karyotype represented by the recombinant crossover events detected. All maps had 14 linkage groups, corresponding to the Macadamia haploid chromosome number, and enabled the anchoring and orientation of sequence scaffolds to construct a pseudo-chromosomal genome assembly for macadamia. Comparison of individual maps indicated a high level of congruence, with minor discrepancies satisfactorily resolved within the integrated maps. The combined set of maps significantly improved marker density and the proportion (70%) of the genome sequence assembly anchored. Overall, increasing our understanding of the genetic landscape and genome for this nut crop represents a substantial advance in macadamia genetics and genomics. The set of maps, large number of sequence-based markers and the reconstructed genome provide a toolkit to underpin future breeding that should help to extend the macadamia industry as well as provide resources for the long term conservation of natural populations in eastern Australia of this unique genus.
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http://dx.doi.org/10.1038/s41598-020-61708-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7081209PMC
March 2020

Enabling reusability of plant phenomic datasets with MIAPPE 1.1.

New Phytol 2020 07 25;227(1):260-273. Epub 2020 Apr 25.

Department of Crop Genetics, John Innes Centre, Norwich Research Park, Colney, Norwich, NR4 7UH, UK.

Enabling data reuse and knowledge discovery is increasingly critical in modern science, and requires an effort towards standardising data publication practices. This is particularly challenging in the plant phenotyping domain, due to its complexity and heterogeneity. We have produced the MIAPPE 1.1 release, which enhances the existing MIAPPE standard in coverage, to support perennial plants, in structure, through an explicit data model, and in clarity, through definitions and examples. We evaluated MIAPPE 1.1 by using it to express several heterogeneous phenotyping experiments in a range of different formats, to demonstrate its applicability and the interoperability between the various implementations. Furthermore, the extended coverage is demonstrated by the fact that one of the datasets could not have been described under MIAPPE 1.0. MIAPPE 1.1 marks a major step towards enabling plant phenotyping data reusability, thanks to its extended coverage, and especially the formalisation of its data model, which facilitates its implementation in different formats. Community feedback has been critical to this development, and will be a key part of ensuring adoption of the standard.
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http://dx.doi.org/10.1111/nph.16544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317793PMC
July 2020

Elbow Hemiarthroplasty for the Treatment of Distal Humerus Fractures.

Orthop Clin North Am 2020 Apr 3;51(2):265-277. Epub 2020 Feb 3.

Roth | McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, 268 Grosvenor Street, Room D0-213, London, Ontario N6A4L6, Canada. Electronic address:

Distal humerus hemiarthroplasty is a good surgical option for nonreconstructable intraarticular distal humerus fractures in selected lower-demand patients. The lifetime activity restrictions have not been determined, but are likely less than a total elbow arthroplasty. From a technical standpoint, distal humeral prostheses should be implanted at the correct depth and rotation. The collateral ligaments, condyles, and epicondyles should be preserved and/or repaired to maintain joint stability. Short- to midterm retrospective studies have shown promising results.
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http://dx.doi.org/10.1016/j.ocl.2019.11.009DOI Listing
April 2020

Effect of ulnar angulation and soft tissue sectioning on radial head stability in anterior Monteggia injuries: an in vitro biomechanical study.

J Shoulder Elbow Surg 2020 Jun 8;29(6):1249-1258. Epub 2020 Feb 8.

Roth-McFarlane Hand & Upper Limb Centre, St Joseph's Health Care, London, ON, Canada; Division of Orthopaedic Surgery, Department of Surgery, London, ON, Canada.

Background: Radial head instability continues to be a challenge in the management of anterior Monteggia injuries; however, there is a paucity of literature on the factors that contribute to this instability. The aim of this biomechanical investigation was to examine the effects of ulnar angulation and soft tissue insufficiency on radial head stability in anterior Monteggia injuries.

Methods: Six cadaveric arms were mounted in an elbow motion simulator. Radial head translation was measured during simulated active elbow flexion with the forearm supinated. After testing the elbows in the intact state, the ulna was osteotomized and tested at 0°, 10°, 20°, and 30° of extension angulation. To examine the effect of soft tissue insufficiency, the anterior radiocapitellar joint capsule, annular ligament, quadrate ligament, and the proximal and middle interosseous membrane (IOM) were sequentially sectioned.

Results: There was a significant increase in anterior radial head translation with greater ulnar extension angulation. Sequential soft tissue sectioning also significantly increased anterior radial head translation. There was no increase in radial head translation with isolated sectioning of the anterior radiocapitellar joint capsule. Additional sectioning of the annular ligament and quadrate ligament slightly increased anterior radial head translation but did not reach statistical significance. Subsequent sectioning of the proximal and middle IOM resulted in significant increases in anterior radial head translation.

Conclusion: Our study demonstrates that progressive ulnar extension angulation results in an incremental increase in anterior radial head translation in anterior Monteggia injuries. Moreover, increasing magnitudes of soft tissue disruption result in greater anterior radial head instability.
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http://dx.doi.org/10.1016/j.jse.2019.10.025DOI Listing
June 2020

Genetic and signalling pathways of dry fruit size: targets for genome editing-based crop improvement.

Plant Biotechnol J 2020 05 25;18(5):1124-1140. Epub 2020 Jan 25.

Oil Crops Research Institute of the Chinese Academy of Agricultural Sciences, Key Laboratory of Biology and Genetic Improvement of Oil Crops, Ministry of Agriculture, Wuhan, China.

Fruit is seed-bearing structures specific to angiosperm that form from the gynoecium after flowering. Fruit size is an important fitness character for plant evolution and an agronomical trait for crop domestication/improvement. Despite the functional and economic importance of fruit size, the underlying genes and mechanisms are poorly understood, especially for dry fruit types. Improving our understanding of the genomic basis for fruit size opens the potential to apply gene-editing technology such as CRISPR/Cas to modulate fruit size in a range of species. This review examines the genes involved in the regulation of fruit size and identifies their genetic/signalling pathways, including the phytohormones, transcription and elongation factors, ubiquitin-proteasome and microRNA pathways, G-protein and receptor kinases signalling, arabinogalactan and RNA-binding proteins. Interestingly, different plant taxa have conserved functions for various fruit size regulators, suggesting that common genome edits across species may have similar outcomes. Many fruit size regulators identified to date are pleiotropic and affect other organs such as seeds, flowers and leaves, indicating a coordinated regulation. The relationships between fruit size and fruit number/seed number per fruit/seed size, as well as future research questions, are also discussed.
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http://dx.doi.org/10.1111/pbi.13318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7152616PMC
May 2020

Bridging the food security gap: an information-led approach to connect dietary nutrition, food composition and crop production.

J Sci Food Agric 2020 Mar 31;100(4):1495-1504. Epub 2019 Dec 31.

Southern Cross Plant Science, Southern Cross University, Lismore, Australia.

Background: Food security is recognized as a major global challenge, yet human food-chain systems are inherently not geared towards nutrition, with decisions on crop and cultivar choice not informed by dietary composition. Currently, food compositional tables and databases (FCT/FCDB) are the primary information sources for decisions relating to dietary intake. However, these only present single mean values representing major components. Establishment of a systematic controlled vocabulary to fill this gap requires representation of a more complex set of semantic relationships between terms used to describe nutritional composition and dietary function.

Results: We carried out a survey of 11 FCT/FCDB and 177 peer-reviewed papers describing variation in nutritional composition and dietary function for food crops to identify a comprehensive set of terms to construct a controlled vocabulary. We used this information to generate a Crop Dietary Nutrition Data Framework (CDN-DF), which incorporates controlled vocabularies systematically organized into major classes representing nutritional components and dietary functions. We demonstrate the value of the CDN-DF for comparison of equivalent components between crop species or cultivars, for identifying data gaps and potential for formal meta-analysis. The CDN-DF also enabled us to explore relationships between nutritional components and the functional attributes of food.

Conclusion: We have generated a structured crop dietary nutrition data framework, which is generally applicable to the collation and comparison of data relevant to crop researchers, breeders, and other stakeholders, and will facilitate dialogue with nutritionists. It is currently guiding the establishment of a more robust formal ontology. © 2019 Society of Chemical Industry.
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http://dx.doi.org/10.1002/jsfa.10157DOI Listing
March 2020

Management of rheumatoid arthritis of the elbow with a convertible total elbow arthroplasty.

J Shoulder Elbow Surg 2019 Nov;28(11):2205-2214

St Joseph's Hospital, Roth | McFarlane Hand & Upper Limb Center, London, ON, Canada. Electronic address:

Background: Total elbow arthroplasty (TEA) is commonly performed in patients with rheumatoid arthritis (RA). The purpose of this study was to compare outcomes and complications of unlinked and linked TEA using a convertible system in patients with RA.

Methods: All patients with RA who underwent TEA at a single center with a minimum of 2 years' follow-up were reviewed. Demographic information, patient-reported outcome scores, functional outcome assessments, and radiographic parameters were evaluated at most recent follow-up.

Results: We evaluated 82 patients (27 with unlinked TEA and 55 with linked TEA) with RA. The mean age at surgery was 61 ± 10 years, with a mean follow-up period of 6 ± 4 years. Demographic characteristics were similar between groups, with the exception of longer follow-up in the unlinked group (8 years vs. 5 years, P = .001). No differences in range of motion were noted. Elbow strength was similar other than pronation strength (74% ± 8% for unlinked vs. 100% ± 8% for linked, P = .03). The mean Mayo Elbow Performance Index was 83 ± 16; Patient Rated Elbow Evaluation score, 15 ± 18; and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score, 34 ± 20. No differences in the rates of reoperation (17% vs. 24%, P = .4), complications (32% vs. 31%, P = .4), or revisions (13% vs. 17%, P = .3) were found between unlinked and linked devices. Four patients with instability, all with unlinked designs, underwent revision to a linked design. Four patients, all with linked designs, underwent revision for aseptic loosening of smooth short-stem ulnar components.

Conclusion: TEA using a convertible implant design provides good patient-reported outcomes at mid-term follow-up in patients with RA. Our study was unable to detect a difference in the use of either unlinked or linked implant designs; further large comparison trials are needed.
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http://dx.doi.org/10.1016/j.jse.2019.07.029DOI Listing
November 2019