Mechanical properties of hydroxyapatite whisker reinforced polyetherketoneketone composite scaffolds

The apparent mechanical properties of hydroxyapatite (HA) whisker reinforced polyetherketoneketone (PEKK) scaffolds were evaluated in unconfined, uniaxial compression to investigate the effects of the porosity (75%, 82.5% and 90%), HA content (0, 20 and 40 vol%) and mold temperature (350, 365 and 375 C). Increased porosity resulted in a non-linear decrease in the elastic modulus and yield strength for both reinforced and unreinforced PEKK scaffolds, as expected. The increase in elastic modulus and yield strength with increased relative density followed a power-law, similar to trabecular bone and other open-cell foams. HA whisker reinforcement generally resulted in an increased elastic modulus from 0 to 20 vol% HA and a subsequent decrease from 20 to 40 vol% HA, while the yield strength and strain were decreased in scaffolds with 40 vol% HA compared to those with 0 or 20 vol% HA. Increased mold temperature resulted in an increased elastic modulus, yield strength and yield strain. These effects enabled the mechanical properties to be tailored to mimic human trabecular bone. The elastic modulus was greater than 50 MPa, and the yield strength was greater than 0.5 MPa, for scaffolds with 75% porosity at all combinations of reinforcement level and mold temperature. Scaffolds with 75% porosity and 20 vol% HA molded at 375 C exhibited a mean elastic modulus and yield strength of 149 MPa and 2.2 MPa, respectively, which was the highest of the conditions investigated in this study and similar to human vertebral trabecular bone. Therefore, HA whisker reinforced PEKK scaffolds may be advantageous for permanent implant fixation, including interbody spinal fusion.     

Patterns of failure and local control after intraoperative electron boost radiotherapy to the presacral space in combination with total mesorectal excision in patients with locally advanced rectal cancer

PURPOSE: To evaluate local control and patterns of failure in patients treated with intraoperative electron beam radiotherapy (IOERT) after total mesorectal excision (TME), to appraise the effectiveness of intraoperative target definition. METHODS AND MATERIALS: We analyzed the outcome of 243 patients with rectal cancer treated with IOERT (median dose, 10 Gy) after TME. Eighty-eight patients received neoadjuvant and 122 patients adjuvant external beam radiotherapy (EBRT) (median dose, 41.4 Gy), and in 88% simultaneous chemotherapy was applied. Median follow-up was 59 months. Results: Local failure was observed in 17 patients (7%), resulting in a 5-year local control rate of 92%. Only complete resection and absence of nodal involvement correlated positively with local control. Considering IOERT fields, seven infield recurrences were seen in the presacral space, resulting in a 5-year local control rate of 97%. The remaining local relapses were located as follows: retrovesical/retroprostatic (5), anastomotic site (2), promontorium (1), ileocecal (1), and perineal (1). CONCLUSION: Intraoperative electron beam radiotherapy as part of a multimodal treatment approach including TME is a highly effective regimen to prevent local failure. The presacral space remains the site of highest risk for local failure, but IOERT can decrease the percentage of relapses in this area.     

A pain assessment scale for population-based studies: development and validation of the pain module of the Standard Evaluation Questionnaire

The objectives of this study were to develop and validate a tool for assessing pain in population-based observational studies and to develop three subscales for back/neck, upper extremity and lower extremity pain. Based on a literature review, items were extracted from validated questionnaires and reviewed by an expert panel. The initial questionnaire consisted of a pain manikin and 34 items relating to (i) intensity of pain in different body regions (7 items), (ii) pain during activities of daily living (18 items) and (iii) various pain modalities (9 items). Psychometric validation of the initial questionnaire was performed in a random sample of the German-speaking Swiss population. Analyses included tests for reliability, correlation analysis, principal components factor analysis, tests for internal consistency and validity. Overall, 16,634 of 23,763 eligible individuals participated (70%). Test–retest reliability coefficients ranged from 0.32 to 0.97, but only three coefficients were below 0.60. Subscales were constructed combining four items for each of the subscales. Item-total coefficients ranged from 0.76 to 0.86 and Cronbach’s were 0.75 or higher for all subscales. Correlation coefficients between subscales and three validated instruments (WOMAC, SPADI and Oswestry) ranged from 0.62 to 0.79. The final Pain Standard Evaluation Questionnaire (SEQ Pain) included 28 items and the pain manikin and accounted for the multidimensionality of pain by assessing pain location and intensity, pain during activity, triggers and time of onset of pain and frequency of pain medication. It was found to be reliable and valid for the assessment of pain in population-based observational studies.     

Anterior knee pain after total knee arthroplasty: does it correlate with patellar blood flow?

Purpose  

Total knee arthroplasty (TKA) disturbs patellar blood flow, an unintended accompaniment to TKA that may be a cause of postoperative anterior knee pain. We examine whether disrupted patellar blood flow correlates with anterior knee pain following TKA.     

Inverse regulation of human ERBB2 and epidermal growth factor receptors by tumor necrosis factor alpha.

Recombinant human tumor necrosis factor (TNF) alpha decreased the expression of ERBB2 mRNA by stimulating p55 TNF receptors of pancreatic tumor cells. This decrease contrasts with an increase in epidermal growth factor receptor (EGFR) mRNA. Both effects were selectively achieved by TNF-alpha or -beta, whereas interferon alpha or gamma or transforming growth factor beta showed no such effects. The inverse regulatory effects of TNF on ERBB2 and EGFR mRNA levels were evoked by different signaling pathways of p55 TNF receptors. The TNF-mediated ERBB2 mRNA decrease was followed by a reduction in protein. Four of five pancreatic tumor cell lines exhibited this down-regulation. This decrease of ERBB2 is a singular example of a modulation of this growth factor receptor by TNF. Overexpression of ERBB2 has been reported to cause resistance to TNF and other cytotoxic cytokines. In our study we show that the TNF-mediated down-regulation of ERBB2 in pancreatic tumor cells is accompanied by an increase in growth inhibition at low doses of TNF. The simultaneous alteration of the ERBB2/EGFR balance by TNF represents a striking model of cytokine receptor transregulation in the growth control of malignant pancreatic epithelial cells.