Publications by authors named "John Grant"

152 Publications

A Systematic Review of Current Clinical Practice Guidelines on Intra-articular Hyaluronic Acid, Corticosteroid, and Platelet-Rich Plasma Injection for Knee Osteoarthritis: An International Perspective.

Orthop J Sports Med 2021 Aug 31;9(8):23259671211030272. Epub 2021 Aug 31.

Department of Surgery, University of Western Ontario, London, Ontario, Canada.

Background: There are many clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of knee osteoarthritis (OA). They differ by region, considering local health care systems, along with cultural and economic factors. Currently, there are conflicting CPG recommendations across the various publications, which makes it difficult for clinicians to fully understand the optimal treatment decisions for knee OA management.

Purpose: To summarize the current published CPG recommendations for the role of injections in the nonoperative management of knee OA, specifically with the use of intra-articular hyaluronic acid (IA-HA), intra-articular corticosteroids (IA-CS), and platelet-rich plasma (PRP).

Study Design: Systematic review.

Methods: A comprehensive search identified all nonoperative knee OA CPGs within the ECRI (formerly Emergency Care Research Institute) Guidelines Trust database, the Guidelines International Network database, Google Scholar, and the Trip (formerly Turning Research Into Practice) database. Guideline recommendations were categorized into strong, conditional, or uncertain recommendations for or against the use of IA-HA, IA-CS, or PRP. Guideline recommendations were summarized and depicted graphically to identify trends in recommendations over time.

Results: The search strategy identified 27 CPGs that provided recommendations. There were 20 recommendations in favor of IA-HA use, 21 recommendations in favor of IA-CS use, and 9 recommendations that were uncertain or unable to make a formal recommendation for or against PRP use based on current evidence. Most recommendations considered IA-HA and IA-CS use for symptom relief when other nonoperative options are ineffective. IA-CS were noted to provide fast and short-acting symptom relief for acute episodes of disease exacerbation, while IA-HA may demonstrate a relatively delayed but prolonged effect in comparison. The CPGs concluded that PRP recommendations currently lack evidence to definitively recommend for or against use.

Conclusion: Available CPGs provide recommendations on injectables for knee OA treatment. General guidance from a global perspective concluded that IA-CS and IA-HA are favored for different needed responses and can be utilized within the knee OA treatment paradigm, while PRP currently has insufficient evidence to make a conclusive recommendation for or against its use.
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http://dx.doi.org/10.1177/23259671211030272DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414628PMC
August 2021

Similarities and Differences Between Vestibular and Cochlear Systems - A Review of Clinical and Physiological Evidence.

Front Neurosci 2021 12;15:695179. Epub 2021 Aug 12.

School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia.

The evoked response to repeated brief stimuli, such as clicks or short tone bursts, is used for clinical evaluation of the function of both the auditory and vestibular systems. One auditory response is a neural potential - the Auditory Brainstem Response (ABR) - recorded by surface electrodes on the head. The clinical analogue for testing the otolithic response to abrupt sounds and vibration is the myogenic potential recorded from tensed muscles - the vestibular evoked myogenic potential (VEMP). VEMPs have provided clinicians with a long sought-after tool - a simple, clinically realistic indicator of the function of each of the 4 otolithic sensory regions. We review the basic neural evidence for VEMPs and discuss the similarities and differences between otolithic and cochlear receptors and afferents. VEMPs are probably initiated by sound or vibration selectively activating afferent neurons with irregular resting discharge originating from the unique type I receptors at a specialized region of the otolithic maculae (the striola). We review how changes in VEMP responses indicate the functional state of peripheral vestibular function and the likely transduction mechanisms allowing otolithic receptors and afferents to trigger such very short latency responses. In section "ELECTROPHYSIOLOGY" we show how cochlear and vestibular receptors and afferents have many similar electrophysiological characteristics [e.g., both generate microphonics, summating potentials, and compound action potentials (the vestibular evoked potential, VsEP)]. Recent electrophysiological evidence shows that the hydrodynamic changes in the labyrinth caused by increased fluid volume (endolymphatic hydrops), change the responses of utricular receptors and afferents in a way which mimics the changes in vestibular function attributed to endolymphatic hydrops in human patients. In section "MECHANICS OF OTOLITHS IN VEMPS TESTING" we show how the major VEMP results (latency and frequency response) follow from modeling the physical characteristics of the macula (dimensions, stiffness etc.). In particular, the structure and mechanical operation of the utricular macula explains the very fast response of the type I receptors and irregular afferents which is the very basis of VEMPs and these structural changes of the macula in Menière's Disease (MD) predict the upward shift of VEMP tuning in these patients.
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http://dx.doi.org/10.3389/fnins.2021.695179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8397526PMC
August 2021

Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship.

J Neurosurg Pediatr 2021 Aug 27:1-8. Epub 2021 Aug 27.

3Department of Neurological Surgery, University of Alabama at Birmingham, Birmingham, Alabama.

Objective: There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction.

Methods: A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children's Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019.

Results: A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively.

Conclusions: Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.
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http://dx.doi.org/10.3171/2021.5.PEDS20932DOI Listing
August 2021

Comparison of aesthetic outcomes between open and endoscopically treated sagittal craniosynostosis.

J Neurosurg Pediatr 2021 Jul 30:1-7. Epub 2021 Jul 30.

Departments of1Neurological Surgery and.

Objective: In the last several decades, there has been much debate regarding the ideal treatment for sagittal synostosis. The purpose of this study was to compare perioperative, anthropometric, and subjective assessments of cosmetic outcomes between open and endoscopic management of isolated sagittal synostosis.

Methods: At their routine postoperative follow-up, pediatric patients with sagittal craniosynostosis were recruited to undergo digital cranial measurement and standardized photography for objective and subjective assessments of perioperative outcomes. Age-normalized z-scores for cephalic index, head circumference, euryon-euryon diameter (Eu-Eu), and glabella-opisthocranion diameter (G-Op) were calculated for each patient. Faculty surgeons, surgical trainees, nurses, and laypersons were asked to rate the normalcy of craniofacial appearances using a 5-point Likert scale. Outcomes were compared between patients treated with endoscopic correction and those treated with open repair.

Results: A total of 50 patients were included in the study. Thirty-one had undergone open surgical correction, and 19 had undergone endoscopic treatment. Endoscopic repair involved significantly lower operative time, blood loss, transfusion rate, and hospital length of stay than those with open repair (p < 0.001). There was no significant difference between groups in terms of z-scores for head circumference (p = 0.22), cephalic index (p = 0.25), or Eu-Eu (p = 0.38). Endoscopic treatment was associated with a significantly lower G-Op (p = 0.009). Additionally, the average subjective rating of head shape was higher for endoscopic treatment when corrected for age, gender, and ethnicity (p = 0.02).

Conclusions: The study findings suggest that patients who are treated endoscopically may have an overall more normal appearance in skull morphology and cosmesis, although these results are limited by poor reliability.
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http://dx.doi.org/10.3171/2021.3.PEDS20894DOI Listing
July 2021

Arthroscopy Association of Canada Position Statement on Exercise for Knee Osteoarthritis: A Systematic Review of Guidelines.

Orthop J Sports Med 2021 Jun 14;9(6):23259671211016900. Epub 2021 Jun 14.

Arthroscopy Association of Canada.

Background: Exercise is widely regarded to improve pain and function in patients with knee osteoarthritis (OA) through building supportive muscle mass, facilitating weight loss, and through the other beneficial effects associated with it.

Purpose: To explore literature that presents clinical guidelines for the use of exercise in the treatment of knee OA to inform an evidence-based position statement for the Arthroscopy Association of Canada.

Study Design: Position statement.

Methods: PubMed, MEDLINE, Embase, and Cochrane databases were searched for guidelines commenting on the role of exercise for knee OA. The search was limited to guidelines published in the last 10 years. Articles were screened for relevance, focusing on recently published research with clinical guidelines. Inclusion criteria involved all articles providing clinical guidelines for exercise and knee OA.

Results: Eight guidelines were identified. All eight recommended exercise as an important component of treatment for knee OA, with 6/8 strongly recommending it.

Conclusion: Exercise is an effective and important component of the non-pharmacological management of knee OA. The Arthroscopy Association of Canada strongly recommends the use of exercise in the management of knee OA.
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http://dx.doi.org/10.1177/23259671211016900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8207290PMC
June 2021

Beach Chair Versus Lateral Decubitus Position: Differences in Suture Anchor Position and Number During Arthroscopic Anterior Shoulder Stabilization.

Am J Sports Med 2021 07 21;49(8):2020-2026. Epub 2021 May 21.

University of Iowa, UI Sports Medicine, Iowa City, Iowa, USA.

Background: Arthroscopic shoulder capsulolabral repair using glenoid-based suture anchor fixation provides consistently favorable outcomes for patients with anterior glenohumeral instability. To optimize outcomes, inferior anchor position, especially at the 6-o'clock position, has been emphasized. Proponents of both the beach-chair (BC) and lateral decubitus (LD) positions advocate that this anchor location can be consistently achieved in both positions.

Hypothesis: Patient positioning would be associated with the surgeon-reported labral tear length, total number of anchors used, number of anchors in the inferior glenoid, and placement of an anchor at the 6-o'clock position.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: This study was a cross-sectional analysis of a prospective multicenter cohort of patients undergoing primary arthroscopic anterior capsulolabral repair. Patient positioning in the BC versus LD position was determined by the operating surgeon and was not randomized. At the time of operative intervention, surgeon-reported labral tear length, total anchor number, anchor number in the inferior glenoid, and anchor placement at the 6-o'clock position were evaluated between BC and LD cohorts. Descriptive statistics and between-group differences (continuous: test [normal distributions], Wilcoxon rank sum test [nonnormal distributions], and chi-square test [categorical]) were assessed.

Results: In total, 714 patients underwent arthroscopic anterior capsulolabral repair (BC vs LD, 406 [56.9%] vs 308 [43.1%]). The surgeon-reported labral tear length was greater for patients having surgery in the LD position (BC vs LD [mean ± SD], 123.5°± 49° vs 132.3°± 44°; = .012). The LD position was associated with more anchors placed in the inferior glenoid and more frequent placement of anchors at the 6-o'clock (BC vs LD, 22.4% vs 51.6%; < .001). The LD position was more frequently associated with utilization of ≥4 total anchors (BC vs LD, 33.5% vs 46.1%; < .001).

Conclusion: Surgeons utilizing the LD position for arthroscopic capsulolabral repair in patients with anterior shoulder instability more frequently placed anchors in the inferior glenoid and at the 6-o'clock position. Additionally, surgeon-reported labral tear length was longer when utilizing the LD position. These results suggest that patient positioning may influence the total number of anchors used, the number of anchors used in the inferior glenoid, and the frequency of anchor placement at the 6 o'clock position during arthroscopic capsulolabral repair for anterior shoulder instability. How these findings affect clinical outcomes warrants further study.

Registration: NCT02075775 (ClinicalTrials.gov identifier).
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http://dx.doi.org/10.1177/03635465211013709DOI Listing
July 2021

Reconstructive Management of Gunshot Wounds to the Frontal Sinus: An Urban Trauma Center's Perspective.

Ann Plast Surg 2021 06;86(6S Suppl 5):S550-S554

Division of Plastic Surgery, University of Alabama at Birmingham, Birmingham, AL.

Introduction: In the last decade, we have seen a steady increase in the incidence of frontal sinus trauma due to gunshot wounds and a decrease in motor vehicle trauma. Penetrating gunshot wounds to the frontal sinus present a unique challenge to the reconstructive surgeon because they require careful consideration of the management principles of plastic surgery. Despite previous reviews on frontal sinus trauma, there are no studies examining the management techniques of frontal sinus fractures due specifically to gunshot wounds. In this study, we aim to retrospectively evaluate the use of a variety of tissue flaps in intervention and associated outcomes.

Methods: A retrospective chart review was completed on all patients with gunshot wound(s) to the frontal sinus from January 2010 to January 2018 at a single institution. The patients were classified based on the fracture pattern (anterior vs posterior table vs both), degree of displacement, presence of nasofrontal outflow tract injury, and evidence of cerebrospinal fluid leak. Patients were then stratified according to the type of reconstruction performed (cranialization, obliteration and need for free flap) and evaluated for major and minor complications after reconstruction.

Results: In this study, we present outcome data from 28 cases of frontal sinus trauma due to gunshot wounds. There was a statistically significant difference (P = 0.049) in the type reconstructive strategy employed with each type of flap, with pericranial flaps primarily used in cranialization, temporal grafts were more likely to be used in obliteration, and free flaps were more likely to be used in cranialization. The overall major complication rate was 52% (P = 0.248), with the most common acute major complication was cerebrospinal fluid leak (39%) and major chronic was abscess (23.5%).

Conclusions: This report explores the management of frontal sinus trauma and presents short-term outcomes of treatment for penetrating gunshot wounds at a tertiary referral center.
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http://dx.doi.org/10.1097/SAP.0000000000002857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187270PMC
June 2021

Comparing the Efficacy of Kneeling Stress Radiographs and Weighted Gravity Stress Radiographs to Assess Posterior Cruciate Ligament Insufficiency.

Am J Sports Med 2021 03 18;49(4):1017-1022. Epub 2021 Feb 18.

MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.

Background: Kneeling posterior cruciate ligament (PCL) stress radiographs are commonly used to evaluate PCL laxity. Patients, however, report significant pain, and the method's reproducibility may be challenged due to its dependence on patient body weight distribution to produce posterior tibial displacement. Weighted gravity stress radiography may offer better reproducibility and comfort than the kneeling technique, but its efficacy has not been studied.

Hypothesis: Weighted gravity PCL stress radiographs will be more comfortable and produce similar measurements of side-to-side difference in posterior tibial displacement when compared with the kneeling technique.

Study Design: Cohort study (diagnosis); Level of evidence, 3.

Methods: A total of 40 patients with nonoperatively or >6 months postoperatively treated PCL injuries (isolated or multiligamentous) underwent bilateral stress radiographs. Weighted gravity and kneeling stress radiographs were acquired, in random order, for each patient, as well as side-to-side difference in posterior tibial displacement between each knee, patient-reported visual analog scale knee pain (100 mm), time to acquire the images, and patient preference for technique. Paired tests were used to compare the side-to-side difference, pain score, and time to complete the radiographs.

Results: There was no difference between the 2 radiographic methods in the mean side-to-side difference (gravity: 6.45 ± 4.61 mm, kneeling: 6.82 ± 4.60 mm; = .72), time required to acquire radiographs (kneeling: 307.3 ± 140.5 seconds, gravity: 318.7 ± 151.1 seconds; = .073), or number of radiographs taken to obtain acceptable images (kneeling: 3.6 ± 1.6, gravity: 3.7 ± 1.7; = .73). Patients reported significantly less knee pain during the weighted gravity views (kneeling: 31.8 ± 26.6, gravity: 4.0 ± 12.0; < .0001). Of the patients, 88% preferred the weighted gravity method.

Conclusion: Weighted gravity stress radiographs produce similar side-to-side differences in posterior tibial translation compared with the kneeling stress technique, but do not rely on patient weightbearing and provide significantly better patient comfort. Clinicians should therefore consider the use of weighted gravity stress radiographs in clinical practice to minimize the pain associated with stress radiography while allowing for accurate decision making.
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http://dx.doi.org/10.1177/0363546520988114DOI Listing
March 2021

Early detection of T-cell lymphoma with T follicular helper phenotype by RHOA mutation analysis.

Haematologica 2021 Feb 11. Epub 2021 Feb 11.

Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge.

Angioimmunoblastic T-cell lymphoma (AITL) and peripheral T-cell lymphoma with T follicular helper phenotype (PTCL-TFH) are a group of complex clinicopathological entities that originate from TFH cells and share a similar mutation profile. Their diagnosis is often a challenge, particularly at an early stage, due to a lack of specific histological and immunophenotypic features, paucity of neoplastic T cells and prominent polymorphous infiltrate. We investigated whether the lymphoma associated RHOA Gly17Val (c.50G>T) mutation, occurring in 60% of cases, is present in the early 'reactive' lesions, and whether mutation analysis can help advance early lymphoma diagnosis. The RHOA mutation was detected by quantitative PCR with a locked nucleic acid (LNA) probe specific to the mutation, and a further PNA clamp oligonucleotide to suppress the amplification of the wild-type allele. The qPCR assay was highly sensitive and specific, detecting RHOA Gly17Val at an allele frequency of 0.03%, but not other changes in Gly17, nor in 61 controls. Among the 37 cases of AITL and PTCL-TFH investigated, RHOA Gly17Val was detected in 62.2% (23/37) of which 19 had multiple biopsies including preceding biopsies in 10 and follow up biopsies in 11 cases. RHOA Gly17Val was present in each of these preceding or follow up biopsies including 18 specimens that showed no evidence of lymphoma by combined histological, immunophenotypic and clonality analyses. The mutation was seen in biopsies 0-26.5 months (mean=7.87 months) prior to lymphoma diagnosis. Our results show that RHOA Gly17Val mutation analysis is valuable in the early detection of AITL and PTCL-TFH.
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http://dx.doi.org/10.3324/haematol.2020.265991DOI Listing
February 2021

Objective Craniometric Versus Subjective Outcome Ratings in Endoscopic and Open Sagittal Synostosis Surgery.

J Craniofac Surg 2021 Jan 28. Epub 2021 Jan 28.

Department of Neurosurgery Department of Surgery, Division of Plastic Surgery, University of Alabama at Birmingham, AL Department of Neurosurgery, Penn State College of Medicine, Hershey, PA.

Background: Despite advances in surgical treatments and assessments of objective outcomes in surgery for sagittal synostosis, there is no agreement regarding the optimal assessment of postoperative outcomes. Additionally, few studies have evaluated subjective assessments of cranial morphology after surgical correction. This study sought to evaluate the utility of subjective aesthetic outcome assessment and compare these assessments to established craniometric outcomes in patients undergoing surgery for isolated sagittal synostosis.

Methods: Nineteen raters (5 parents, 4 surgeons, 5 trainees and 5 nurses) evaluated fifty patients who underwent surgical correction of isolated sagittal synostosis using standardized postoperative patient photos and a five-point Likert scale. Previously established anthropomorphic measurements were recorded postoperatively in these same patients and comparisons were made between the objective anthropomorphic and subjective outcome evaluations.

Results: There were no statistically significant correlations between age-controlled cephalic index, head circumference, or euryon-euryon diameter and subjective aesthetic scores. Lay persons assigned a significantly lower proportion of scores (37.9%) as middle values (2, 3, or 4) compared with faculty (64.8%). There was a statistically significant association between high scores given by surgical faculty and laypersons (P < 0.001).

Conclusions: Subjective measurement of cosmetic outcome is a useful metric in surgical correction of craniosynostosis. Although no correlations were found between objective measurements and subjective aesthetic scores, cosmetic assessments by surgeons demonstrated strong correlation with lay perception, indicating that these ratings may be a good gauge of overall cosmetic outcome. When used in combination, objective and subjective measurements provide unique value to assess outcomes after surgery for craniosynostosis.
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http://dx.doi.org/10.1097/SCS.0000000000007500DOI Listing
January 2021

Male Sex, Western Ontario Shoulder Instability Index Score, and Sport as Predictors of Large Labral Tears of the Shoulder: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study.

Arthroscopy 2021 06 15;37(6):1740-1744. Epub 2021 Jan 15.

Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, CA.

Purpose: To identify factors predictive of a large labral tear at the time of shoulder instability surgery.

Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients undergoing open or arthroscopic shoulder instability surgery for a labral tear were evaluated. Patients with >270° tears were defined as having large labral tears. To build a predictive logistic regression model for large tears, the Feasible Solutions Algorithm was used to add significant interaction effects.

Results: After applying exclusion criteria, 1235 patients were available for analysis. There were 222 females (18.0%) and 1013 males (82.0%) in the cohort, with an average age of 24.7 years (range 12 to 66). The prevalence of large tears was 4.6% (n = 57), with the average tear size being 141.9°. Males accounted for significantly more of the large tears seen in the cohort (94.7%, P = .01). Racquet sports (P = .01), swimming (P = .02), softball (P = .05), skiing (P = .04), and golf (P = .04) were all associated with large labral tears, as was a higher Western Ontario Shoulder Instability Index (WOSI; P = .01). Age, race, history of dislocation, and injury during sport were not associated with having a larger tear. Using our predictive logistic regression model for large tears, patients with a larger body mass index (BMI) who played contact sports were also more likely to have large tears (P = .007).

Conclusions: Multiple factors were identified as being associated with large labral tears at the time of surgery, including male sex, preoperative WOSI score, and participation in certain sports including racquet sports, softball, skiing, swimming, and golf.

Level Of Evidence: I, prognostic study.
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http://dx.doi.org/10.1016/j.arthro.2021.01.007DOI Listing
June 2021

Effect of a brief scenario-tailored educational program on parents' risk knowledge, perceptions, and decisions to administer prescribed opioids: a randomized controlled trial.

Pain 2021 03;162(3):976-985

Department of Anesthesiology, University of Michigan, Ann Arbor, MI, United States.

Abstract: This randomized, controlled trial evaluated whether a brief educational program (ie, Scenario-Tailored Opioid Messaging Program [STOMP]) would improve parental opioid risk knowledge, perceptions, and analgesic efficacy; ensure safe opioid use decisions; and impact prescription opioid use after surgery. Parent-child dyads (n = 604) who were prescribed an opioid for short-term use were randomized to routine instruction (Control) or routine plus STOMP administered preoperatively. Baseline and follow-up surveys assessed parents' awareness and perceived seriousness of adverse opioid effects, and their analgesic efficacy. Parents' decisions to give an opioid in hypothetical scenarios and total opioid doses they gave to children at home were assessed at follow-up. Scenario-Tailored Opioid Messaging Program parents gained enhanced perceptions of opioid-related risks over time, whereas Controls did not; however, risk perceptions did not differ between groups except for addiction risk. Scenario-Tailored Opioid Messaging Program parents exhibited marginally greater self-efficacy compared to Controls (mean difference vs controls = 0.58 [95% confidence interval 0.08-1.09], P = 0.023). Scenario-Tailored Opioid Messaging Program parents had a 53% lower odds of giving an opioid in an excessive sedation scenario (odds ratio 0.47 [95% confidence interval 0.28-0.78], P = 0.003), but otherwise made similar scenario-based opioid decisions. Scenario-Tailored Opioid Messaging Program was not associated with total opioid doses administered at home. Instead, parents' analgesic efficacy and pain-relief preferences explained 7%, whereas child and surgical factors explained 22% of the variance in opioid doses. Scenario-tailored education enhanced parents' opioid risk knowledge, perceptions, and scenario-based decision-making. Although this may inform later situation-specific decision-making, our research did not demonstrate an impact on total opioid dosing, which was primarily driven by surgical and child-related factors.
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http://dx.doi.org/10.1097/j.pain.0000000000002095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7886960PMC
March 2021

Safety and early results of Subchondroplasty® for the treatment of bone marrow lesions in osteoarthritis: a systematic review.

Knee Surg Sports Traumatol Arthrosc 2020 Sep 29. Epub 2020 Sep 29.

Division of Orthopaedic Surgery, Department of Surgery, McMaster University, 1280 Main St W, Hamilton, ON, L8S 4L8, Canada.

Purpose: Subchondroplasty® is a novel minimally invasive procedure for painful subchondral bone marrow lesions (BMLs). The aim of this systematic review was to characterize the clinical outcomes of the Subchondroplasty® procedure, a novel minimally invasive procedure for the treatment of BMLs. The hypothesis tested was that patients experience improvements in pain and functional outcomes following the Subchondroplasty® procedure.

Methods: MEDLINE, Embase, Web of Science, and Clinicaltrials.gov were searched from database inception to search date (June 10, 2020) for all clinical studies which discussed Subchondroplasty®. Two reviewers independently screened 45 unique results and 17 studies were included in the final analysis. Data were collected regarding patient demographics, indications, pain, functional scores, conversion to TKA, and complications of the procedure.

Results: All but one study were level IV evidence; the mean MINORS score was 9 ± 2. There were 756 patients included, 45.1% were female, and the mean age was 54 years (range 20-85). Thirteen studies investigated the effect Subchondroplasty® to the knee, while four studied the impact on the foot and ankle. Median length of follow-up was 12 months. The most common indication for Subchondroplasty® was joint pain with corresponding BML. Major contraindications to Subchondroplasty® included severe OA, joint instability, and malalignment. Mean pain score on visual analogue scale (VAS) prior to Subchondroplasty® was 7.8 ± 0.6, but decreased to 3.4 ± 0.7 postoperatively. All studies investigating functional scores reported improvement following Subchondroplasty® (IKDC 31.7 ± 1.9-54.0 ± 4.2 and KOOS 38.1 ± 0.6-70.0 ± 4.1). There were consistently high levels of patient satisfaction; 87 ± 8% of patients would be willing to undergo the procedure again. Seven cases of complications were reported, most seriously osteomyelitis and avascular necrosis. Conversion to knee arthroplasty ranged from 12.5 to 30% with length of follow-up ranging from 10 months to 7 years.

Conclusions: Existing low-quality studies show Subchondroplasty® to benefit patients with BMLs through reduction in pain and improvement in function, along with a high degree of satisfaction following the procedure. The low short-to-medium term conversion rate to arthroplasty suggests that Subchondroplasty® may play a role in delaying more invasive and expensive procedures in patients with BMLs. Subchondroplasty® is a novel procedure that has promising initial findings, but requires further high-quality, comparative studies with long-term follow-up to better understand the outcomes of the procedure and impact clinical practice recommendations.

Level Of Evidence: Systematic Review of Level III and IV Studies, Level IV.
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http://dx.doi.org/10.1007/s00167-020-06294-wDOI Listing
September 2020

Does the Symmetry of Patellar Morphology Matter When Matching Osteochondral Allografts for Osteochondral Defects Involving the Central Ridge of the Patella?

Cartilage 2020 Aug 20:1947603520951624. Epub 2020 Aug 20.

MedSport, Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI, USA.

Objective: The purpose of this study was to determine if differences in Wiberg classification play a role in the ability of donor patellar osteochondral allografts to match the native patellar surface when treating osteochondral defects of the patellar apex.

Design: Twenty (10 Wiberg I and 10 Wiberg II/III) human patellae were designated as the recipient. Each recipient was size-matched to both a Wiberg I and a Wiberg II/III patellar donor. A 16-mm circular osteochondral "defect" was created on the central ridge of the recipient patella. The randomly ordered donor Wiberg I or Wiberg II/III plug was harvested from a homologous location and transplanted into the recipient. The recipient was then nano-CT (computed tomography) scanned, digitally reconstructed, registered to the initial nano-CT scan of the recipient patella, and processed to determine root mean squared circumferential step-off heights as well as surface height deviation. The process was then repeated for the other allograft plug.

Results: There was no significant difference in mean step-off height between matched and unmatched Wiberg plugs; however, there was a statistically significant difference in surface height deviation over the whole surface (0.50 mm and 0.64 mm respectively, = 0.03). This difference of 0.14 mm is not felt to be clinically significant. Tibial width was correlated to patellar width ( = 0.82) and patellar height ( = 0.68).

Conclusions: For osteochondral allograft sizes up to 16 mm there appears to be no advantage to match donor and recipient patellar morphology. Further study is warranted to evaluate defects requiring larger graft sizes.
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http://dx.doi.org/10.1177/1947603520951624DOI Listing
August 2020

Entendez-vous ce que je dis?

Authors:
John Grant

Can Fam Physician 2020 07;66(7):483-485

Professeur adjoint à l'Université Dalhousie à Halifax (Nouvelle-Écosse) et urgentologue pédiatrique à l'IWK Health Centre à Halifax.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365151PMC
July 2020

Can you hear what I am saying?

Authors:
John Grant

Can Fam Physician 2020 07;66(7):476-477

Assistant Professor at Dalhousie University in Halifax, NS, and a pediatric emergency physician at IWK Health Centre in Halifax.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7365153PMC
July 2020

About the One Hemi-Uvula Repair Technique During Palatoplasty.

Cleft Palate Craniofac J 2020 08 17;57(8):1055-1056. Epub 2020 Jun 17.

Division of Pediatric Plastic Surgery, Cleft and Craniofacial Center, University of Birmingham, Children's of Alabama Hospital, Birmingham, AL, USA.

This is a response to a letter replying to our paper discussing the significance of the uvula during palatoplasty and our surgical technique of uvula repair. The hemi-uvula repair technique was developed independently in our department. In our publication, we fully cited the 2 studies by Rossell-Perry et al about uvula repair and acknowledged them to be the first to publish the concept of using one hemi-uvula. Upon further study, the mistake of omitting 2 references from the list, although they were cited in the text, was found to have occurred during the transition between publishers of this journal (corrected in Erratum). We highlighted some of the differences in the studies and techniques, which are already discussed in our paper, for further clarification.
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http://dx.doi.org/10.1177/1055665620933481DOI Listing
August 2020

Site conditions for regeneration of climax species, the key for restoring moist deciduous tropical forest in Southern Vietnam.

PLoS One 2020 29;15(5):e0233524. Epub 2020 May 29.

Forest Research Centre, Southern Cross University, Australia.

Understanding the requirements and tolerances of the seedlings of climax species is fundamental for tropical forest restoration. This study investigates how the presence and abundance of seedlings of a previously dominant, now threatened species (Dipterocapus dyeri Pierre), varies across a range of environmental conditions. Dipterocapus dyeri seedling abundance and site characteristics were recorded at 122 observation points (4 m2) at nine clusters from two sites. Seedling presence (p = 0.065) and abundance varied significantly (p = 0.001) between the two sites, and was strongly correlated with adult D. dyeri dominance and lower soil pH, and weakly correlated with canopy openness and total stand basal area. Dipterocarpus dyeri seedlings were also grown in shade houses with three light levels on two soils. Seedling survival was significantly lower at the lowest light level (<10% full irradiance) at 13% for the forest soil and 25% for degraded soil. At higher irradiance the seedling survival rates were greater than 99%. Moisture levels remained high at the lowest light level and many seedlings died from fungal infection. We concluded that secondary forests which contain adequate numbers of adult D. dyeri as seed sources, light availability, soil pH of < 5.0, and good drainage strongly favour survival and growth of D. dyeri seedlings. Historically, D. dyeri was dominant in moist deciduous tropical forest across south-eastern Vietnam, but today it is rare. Active management of these recovering forests is essential in order to recover this high-value, climax forest species.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0233524PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259571PMC
August 2020

Risk Factors for Intra-articular Bone and Cartilage Lesions in Patients Undergoing Surgical Treatment for Posterior Instability.

Am J Sports Med 2020 04 9;48(5):1207-1212. Epub 2020 Mar 9.

Investigation performed at University of California, San Francisco, San Francisco, California, USA.

Background: Patients with posterior shoulder instability may have bone and cartilage lesions (BCLs) in addition to capsulolabral injuries, although the risk factors for these intra-articular lesions are unclear.

Hypothesis: We hypothesized that patients with posterior instability who had a greater number of instability events would have a higher rate of BCLs compared with patients who had fewer instability episodes.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Data from the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Group instability patient cohort were analyzed. Patients aged 12 to 99 years undergoing primary surgical treatment for shoulder instability were included. The glenohumeral joint was evaluated by the treating surgeon at the time of surgery, and patients were classified as having a BCL if they had any grade 3 or 4 glenoid or humeral cartilage lesion, reverse Hill-Sachs lesion, bony Bankart lesion, or glenoid bone loss. The effects of the number of instability events on the presence of BCLs was investigated by use of Fisher exact tests. Logistic regression modeling was performed to investigate the independent contributions of demographic variables and injury-specific variables to the likelihood of having a BCL. Significance was defined as < .05.

Results: We identified 271 patients (223 male) for analysis. Bone and cartilage lesions were identified in 54 patients (19.9%) at the time of surgical treatment. A glenoid cartilage injury was most common and was identified in 28 patients (10.3%). A significant difference was noted between the number of instability events and the presence of BCLs ( = .025), with the highest rate observed in patients with 2 to 5 instability events (32.3%). Multivariate logistic regression modeling indicated that increasing age ( = .019) and 2 to 5 reported instability events ( = .001) were significant independent predictors of the presence of BCLs. For bone lesions alone, the number of instability events was the only significant independent predictor; increased risk of bone lesion was present for patients with 1 instability event (OR, 6.1; = .012), patients with 2 to 5 instability events (OR, 4.2; = .033), and patients with more than 5 instability events (OR, 6.0; = .011).

Conclusion: Bone and cartilage lesions are seen significantly more frequently with increasing patient age and in patients with 2 to 5 instability events. Early surgical stabilization for posterior instability may be considered to potentially limit the extent of associated intra-articular injury. The group of patients with more than 5 instability events may represent a different pathological condition, as this group showed a decrease in the likelihood of cartilage injury, although not bony injury.
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http://dx.doi.org/10.1177/0363546520907916DOI Listing
April 2020

The Prevalence and Clinical Implications of Comorbid Back Pain in Shoulder Instability: A Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability Cohort Study.

Orthop J Sports Med 2020 Feb 4;8(2):2325967119894738. Epub 2020 Feb 4.

Investigation performed at the University of Kentucky Department of Orthopaedic Surgery & Sports Medicine, Lexington, Kentucky, USA.

Background: Understanding predictors of pain is critical, as recent literature shows that comorbid back pain is an independent risk factor for worse functional and patient-reported outcomes (PROs) as well as increased opioid dependence after total joint arthroplasty.

Purpose/hypothesis: The purpose of this study was to evaluate whether comorbid back pain would be predictive of pain or self-reported instability symptoms at the time of stabilization surgery. We hypothesized that comorbid back pain will correlate with increased pain at the time of surgery as well as with worse scores on shoulder-related PRO measures.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: As part of the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort, patients consented to participate in pre- and intraoperative data collection. Demographic characteristics, injury history, preoperative PRO scores, and radiologic and intraoperative findings were recorded for patients undergoing surgical shoulder stabilization. Patients were also asked, whether they had any back pain.

Results: The study cohort consisted of 1001 patients (81% male; mean age, 24.1 years). Patients with comorbid back pain (158 patients; 15.8%) were significantly older (28.1 vs 23.4 years; < .001) and were more likely to be female (25.3% vs 17.4%; = .02) but did not differ in terms of either preoperative imaging or intraoperative findings. Patients with self-reported back pain had significantly worse preoperative pain and shoulder-related PRO scores (American Shoulder and Elbow Surgeons score, Western Ontario Shoulder Instability Index) ( < .001), more frequent depression (22.2% vs 8.3%; < .001), poorer mental health status (worse scores for the RAND 36-Item Health Survey Mental Component Score, Iowa Quick Screen, and Personality Assessment Screener) ( < .01), and worse preoperative expectations ( < .01).

Conclusion: Despite having similar physical findings, patients with comorbid back pain had more severe preoperative pain and self-reported symptoms of instability as well as more frequent depression and lower mental health scores. The combination of disproportionate shoulder pain, comorbid back pain and mental health conditions, and inferior preoperative expectations may affect not only the patient's preoperative state but also postoperative pain control and/or postoperative outcomes.
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http://dx.doi.org/10.1177/2325967119894738DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000858PMC
February 2020

Contralateral Lateral Femoral Condyle Allografts Provide an Acceptable Surface Match for Simulated Classic Osteochondritis Dissecans Lesions of the Medial Femoral Condyle.

Orthop J Sports Med 2020 Jan 28;8(1):2325967119898413. Epub 2020 Jan 28.

MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA.

Background: Osteochondral allograft transplantation is an effective technique for repairing large lesions of the medial femoral condyle (MFC), but its use is limited by graft availability.

Purpose/hypothesis: The present study aimed to determine whether contralateral lateral femoral condyle (LFC) allografts can provide an acceptable surface match for posterolateral MFC lesions characteristic of classic osteochondritis dissecans (OCD). The hypothesis was that LFC and MFC allografts will provide similar surface contour matches in all 4 quadrants of the graft for posterolateral MFC lesions characteristic of OCD.

Study Design: Controlled laboratory study.

Methods: Ten fresh-frozen recipient human MFCs were each size-matched to 1 ipsilateral medial and 1 contralateral LFC donor (N = 30 condyles). After a nano-computed tomography (nano-CT) scan of the native recipient condyle, a 20-mm circular osteochondral "defect" was created 1 cm posterior and 1 cm medial to the roof of the intercondylar notch (n = 10). A size-matched, random-order donor MFC or LFC plug was then harvested, transplanted, and scanned with nano-CT. Nano-CT scans were then reconstructed, registered to the initial scan of the recipient MFC, and processed in MATLAB to determine the height deviation ( ) between the native and donor surfaces and percentage area unacceptably (>1 mm) proud (% ) and sunken (% ). Circumferential step-off height ( ) and percentage circumference unacceptably (>1 mm) proud (% ) and sunken (% ) were measured using DragonFly software. The process was then repeated for the other allograft plug.

Results: Both MFC and LFC plugs showed acceptable step-off heights in all 4 quadrants (range, 0.53-0.94 mm). Neither allograft type nor location within the defect had a significant effect on step-off height ( ), surface deviation ( ), % , or % . In general, plugs were more unacceptably sunken than proud (MFC, 13.4% vs 2.4%; LFC, 13.2% vs 8.1%), although no significant differences in % were seen between allograft types or locations within the defect. In LFC plugs, % in the lateral quadrant (28.0% ± 26.1%) was significantly greater compared with all other quadrants ( = .0002).

Conclusion: The present study demonstrates that 20-mm contralateral LFC allografts provide an acceptable surface match for posterolateral MFC lesions characteristic of OCD.

Clinical Relevance: With comparable surface matching, MFC and LFC allografts can be expected to present similar stresses on the knee joint and achieve predictably positive clinical outcomes, thus improving donor availability and reducing surgical wait times for matches.
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http://dx.doi.org/10.1177/2325967119898413DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987491PMC
January 2020

Measuring markers of aging and knee osteoarthritis gait using inertial measurement units.

J Biomech 2020 01 27;99:109567. Epub 2019 Dec 27.

School of Kinesiology, University of Michigan, Ann Arbor, MI, United States; MedSport, Dept. Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, United States; Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.

Differences in gait with age or knee osteoarthritis have been demonstrated in laboratory studies using optical motion capture (MoCap). While MoCap is accurate and reliable, it is impractical for assessment outside the laboratory. Inertial measurement units (IMUs) may be useful in these situations. Before IMUs are used as a surrogate for MoCap, methods that are reliable, repeatable, and that calculate metrics at similar accuracy to MoCap must be demonstrated. The purpose of this study was to compare spatiotemporal gait parameters and knee range of motion calculated via MoCap to IMU-derived variables and to compare the ability of these tools to discriminate between groups. MoCap and IMU data were collected from young, older, and adults with knee osteoarthritis during overground walking at three self-selected speeds. Walking velocity, stride length, cadence, percent of gait cycle in stance, and sagittal knee range of motion were calculated and compared between tools (MoCap and IMU), between participant groups, and across speed. There were no significant differences between MoCap and IMU outcomes, and root mean square error between tools was ≤0.05 m/s for walking velocity, ≤0.07 m for stride length, ≤0.5 strides/min for cadence, ≤5% for percent of gait cycle in stance, and ≤1.5° for knee range of motion. No interactions were present, suggesting that MoCap and IMU calculated metrics similarly across groups and speeds. These results demonstrate IMUs can accurately calculate spatiotemporal variables and knee range of motion during gait in young and older, asymptomatic and knee osteoarthritis cohorts.
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http://dx.doi.org/10.1016/j.jbiomech.2019.109567DOI Listing
January 2020

Relationship between Anatomical Risk Factors, Articular Cartilage Lesions, and Patient Outcomes Following Medial Patellofemoral Ligament Reconstruction.

Cartilage 2019 Dec 26:1947603519894728. Epub 2019 Dec 26.

MedSport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA.

Objective: The purpose of this study was (1) to determine which risk factors for patellar instability were associated with the presence of patellofemoral cartilage lesions and (2) to determine how cartilage lesion presence, size, and grade affect postoperative disease-specific quality of life.

Design: Preoperative, intraoperative, and postoperative demographic, anthropometric (body mass index, Beighton score, hip rotation), radiographic (crossover sign, trochlear bump), cartilage lesion morphology (presence, size, location, grade), and outcomes data (Banff Patella Instability Instrument 2.0 [BPII 2.0]) were prospectively collected from patients undergoing isolated medial patellofemoral ligament reconstruction. For all knees ( = 264), single and multivariable logistic regression was used to determine if any patellar instability risk factors affected the odds of having a cartilage lesion. In patients with unilateral symptoms ( = 121), single variable linear regression was used to determine if the presence, size, or ICRS (International Cartilage Regeneration & Joint Preservation Society) grade of cartilage lesions could predict the 12 or 24+ month postoperative BPII 2.0 score.

Results: A total of 84.5% of knees had patellofemoral cartilage lesions (88.3% involved the distal-medial patella). Trochlear dysplasia (high grade: odds ratio = 15.7, < 0.001; low grade: odds ratio = 2.9, = 0.015) was associated with the presence of a cartilage lesion. The presence, size, and grade of cartilage lesions were not associated with 12 or 24+ month postoperative BPII 2.0 scores.

Conclusions: Trochlear dysplasia was a risk factor for the development of patellofemoral cartilage lesions in this patient population. Cartilage lesions most commonly involve the distal-medial patella. There was no significant relationship between patellofemoral cartilage lesion presence, size, or grade and postoperative BPII 2.0 scores in short-term follow-up.
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http://dx.doi.org/10.1177/1947603519894728DOI Listing
December 2019

Behavioral Intervention and Disposal of Leftover Opioids: A Randomized Trial.

Pediatrics 2020 01;145(1)

Division of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.

Objectives: Leftover prescription opioids pose risks to children and adolescents, yet many parents keep these medications in the home. Our objective in this study was to determine if providing a behavioral disposal method (ie, Nudge) with or without a Scenario-Tailored Opioid Messaging Program (STOMP) (risk-enhancement education) improves parents' opioid-disposal behavior after their children's use.

Methods: Parents whose children were prescribed a short course of opioids were recruited and randomly assigned to the Nudge or control groups with or without STOMP. Parents completed surveys at baseline and 7 and 14 days. Main outcomes were (1) prompt disposal (ie, immediate disposal of leftovers after use) and (2) planned retention (intention to keep leftovers).

Results: There were 517 parents who took part, and 93% had leftovers after use. Prompt disposal behavior was higher for parents who received both the STOMP and Nudge interventions (38.5%), Nudge alone (33.3%), or STOMP alone (31%) compared with controls (19.2%; ≤ .02). Furthermore, the STOMP intervention independently decreased planned retention rates (5.6% vs 12.5% no STOMP; adjusted odds ratio [aOR] 0.40 [95% confidence interval (CI) 0.19-0.85]). Higher risk perception lowered the odds of planned retention (aOR 0.87 [95% CI 0.79-0.96]), whereas parental past opioid misuse increased those odds (aOR 4.44 [95% CI 1.67-11.79]).

Conclusions: Providing a disposal method nudged parents to dispose of their children's leftover opioids promptly after use, whereas STOMP boosted prompt disposal and reduced planned retention. Such strategies can reduce the presence of risky leftover medications in the home and decrease the risks posed to children and adolescents.
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http://dx.doi.org/10.1542/peds.2019-1431DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939843PMC
January 2020

Angioimmunoblastic T-cell lymphoma contains multiple clonal T-cell populations derived from a common TET2 mutant progenitor cell.

J Pathol 2020 03 16;250(3):346-357. Epub 2020 Jan 16.

Division of Cellular and Molecular Pathology, Department of Pathology, University of Cambridge, Cambridge, UK.

Angioimmunoblastic T-cell lymphoma (AITL) is a neoplastic proliferation of T follicular helper cells with clinical and histological presentations suggesting a role of antigenic drive in its development. Genetically, it is characterized by a stepwise acquisition of somatic mutations, with early mutations involving epigenetic regulators (TET2, DNMT3A) and occurring in haematopoietic stem cells, with subsequent changes involving signaling molecules (RHOA, VAV1, PLCG1, CD28) critical for T-cell biology. To search for evidence of potential oncogenic cooperation between genetic changes and intrinsic T cell receptor (TCR) signaling, we investigated somatic mutations and T-cell receptor β (TRB) rearrangement in 119 AITL, 11 peripheral T-cell lymphomas with T follicular helper phenotype (PTCL-TFH), and 25 PTCL-NOS using Fluidigm polymerase chain reaction (PCR) and Illumina MiSeq sequencing. We confirmed frequent TET2, DNMT3A, and RHOA mutations in AITL (72%, 34%, 61%) and PTCL-TFH (73%, 36%, 45%) and showed multiple TET2 mutations (2 or 3) in 57% of the involved AITL and PTCL-TFH. Clonal TRB rearrangement was seen in 76 cases with multiple functional rearrangements (2-4) in 18 cases (24%). In selected cases, we confirmed bi-clonal T-cell populations and further demonstrated that these independent T-cell populations harboured identical TET2 mutations by using BaseScope in situ hybridization, suggesting their derivation from a common TET2 mutant progenitor cell population. Furthermore, both T-cell populations expressed CD4. Finally, in comparison with tonsillar TFH cells, both AITL and PTCL-TFH showed a significant overrepresentation of several TRB variable family members, particularly TRBV19*01. Our findings suggest the presence of parallel neoplastic evolutions from a common TET2 mutant haematopoietic progenitor pool in AITL and PTCL-TFH, albeit to be confirmed in a large series of cases. The biased TRBV usage in these lymphomas suggests that antigenic stimulation may play an important role in predilection of T cells to clonal expansion and malignant transformation. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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http://dx.doi.org/10.1002/path.5376DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064999PMC
March 2020

Incidence of delayed intracranial hypertension in children with isolated sagittal synostosis following open calvarial vault reconstruction.

Childs Nerv Syst 2020 03 5;36(3):545-550. Epub 2019 Dec 5.

Department of Neurosurgery, University of Alabama at Birmingham School of Medicine, 1057 Faculty Office Tower, 510 20th Street South, Birmingham, AL, 35294-3410, USA.

Purpose: Delayed intracranial hypertension (DIH) occurs most frequently in children with syndromic or multi-suture synostosis after surgical correction. The rarity of DIH in children with isolated non-syndromic sagittal synostosis (ISS) warrants follow-up evaluation by large craniofacial centers until skeletal maturity. This study reports the incidence of DIH in children following open repair for ISS by our center's craniofacial team.

Methods: A single-center retrospective study of patients who underwent open calvarial vault remodeling (CVR) for ISS at our institution between November 2000 and November 2012 was performed. Syndromic and multi-suture synostosis patients were excluded. Demographic and follow-up data were extracted from the medical record for analysis until July 2017.

Results: One hundred five patients with ISS were identified who had undergone CVR in the aforementioned timeframe. Average age at initial surgery was 11.7 ± 15.32 months. Mean follow-up in our craniofacial clinic was 4.94 ± 3.53 years, with 69 patients (65.7%) having follow-up in craniofacial clinic ≥ 3 years and 74 (70.5%) having follow-up ≥ 3 years in any clinic at our institution. Four patients (3.8%) had intracranial pressure (ICP) monitors placed for symptoms concerning for DIH, one of which (0.95%) had confirmed DIH and underwent a second surgical procedure at 7.4 years of age. The patient presented late initially, having his first operation at 1.56 years of age.

Conclusion: One patient out of 105 (0.95%) developed DIH, confirmed by ICP monitoring, and required reoperation. The occurrence of DIH, albeit rare, remains an important topic to include in parental discussions and mandates long-term follow-up in this population.
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http://dx.doi.org/10.1007/s00381-019-04406-7DOI Listing
March 2020

Reply to: Letter comments on: Time course of improvement after re-repair procedure for VPI management.

J Plast Reconstr Aesthet Surg 2019 12 30;72(12):2064-2094. Epub 2019 Sep 30.

UAB Cleft and Craniofacial Center, Children's of Alabama Hospital, Division of Plastic Surgery, University of Alabama, 1600 7th Avenue South, Lowder 322, Birmingham, AL 35233, United States. Electronic address:

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http://dx.doi.org/10.1016/j.bjps.2019.09.014DOI Listing
December 2019

Practical Guides for X-Ray Photoelectron Spectroscopy (XPS): First Steps in planning, conducting and reporting XPS measurements.

J Vac Sci Technol A 2019 ;37

General Electric GRC, 1 Research Circle, Bldg K1 1D41, Niskayuna, New York 12309.

Over the past three decades, the widespread utility and applicability of X-ray photoelectron spectroscopy (XPS) in research and applications has made it the most popular and widely used method of surface analysis. Associated with this increased use has been an increase in the number of new or inexperienced users which has led to erroneous uses and misapplications of the method. This article is the first in a series of guides assembled by a committee of experienced XPS practitioners that are intended to assist inexperienced users by providing information about good practices in the use of XPS. This first guide outlines steps appropriate for determining whether XPS is capable of obtaining the desired information, identifies issues relevant to planning, conducting and reporting an XPS measurement, and identifies sources of practical information for conducting XPS measurements. Many of the topics and questions addressed in this article also apply to other surface-analysis techniques.
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http://dx.doi.org/10.1116/1.5065501DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6774202PMC
January 2019
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