ARCO Consensus on the Pathogenesis of Non-traumatic Osteonecrosis of the Femoral Head

Osteonecrosis of the femoral head (ONFH) is a devastating disease frequently leading to femoral head collapse and hip arthritis. Specifically, non-traumatic ONFH primarily affects young and middle-aged adults. Although compromised local circulation of the femoral head seems to be pathognomonic for the disease, the pathogenesis is perplexing and continues to be an area of scrutiny and research. Comprehension of the pathogenesis is of crucial importance for developing and guiding treatments for the disease. Therefore, we provide an up-to-date consensus on the pathogenesis of non-traumatic ONFH.     

Population data and genetic characteristics of 12 X-STR loci using the Investigator® Argus X-12 Quality Sensor kit for the Kedayan population of Borneo in Malaysia

International Journal of Legal Medicine - DNA profiling of X-chromosomal short tandem repeats (X-STR) has exceptional value in criminal investigations, especially for complex kinship and incest...     

Total Temporomandibular Joint Prosthetic Reconstruction: The Importance of Lateral Pterygoid Muscle Reattachment to Lateral Excursive and Protrusive Mandibular Movement

Severe temporomandibular joint (TMJ) disorders result in structural changes that can significantly and negatively impact the jaw and airway, resulting in pain, difficulty chewing, dietary restrictions, sleep apnea, and other functional changes.¹ For more than 5 decades, alloplastic total TMJ replacement has been used to treat end-stage intra-articular TMJ disorders. Commonly accepted measures of postsurgical success include maximal incisal opening (MIO), pain relief, and dietary and functional improvement.¹Diminished or unimproved lateral and protrusive jaw movement is a commonly accepted consequence of complete TMJ replacement.² Lateral excursive and protrusive function should, however, be considered and reported as an important measure of success after alloplastic TMJ replacement. To achieve such success, surgeons must comprehensively plan the reconstruction and reattach the lateral pterygoid muscle's inferior head (LPM-IH) to the prosthetic TMJ to support normal functional occlusion and mandibular motion.     

Prediction of surface area size in orbital floor and medial orbital wall fractures based on topographical subregions

ObjectiveThis retrospective study evaluates the occurrence and frequency of different fracture patterns in a series of computed tomography (CT) scans in terms of the AOCMF Trauma Classification (TC) orbit module and correlates the assigned defects with measurements of the fracture area in order to get an approximate guideline for fracture size predictions on the basis of the classification.Material and methodsCT scans of patients with orbital floor fractures were evaluated using the AOCMFTC to determine the topographical subregions. The coding consisted of: W = orbital wall, 1 = anterior orbit, 2 = midorbit, i = inferior, m = medial. The 3-dimensional surface area size of the fractures was quantified by the “defect body” method (Brainlab, Munich, Germany). The fracture area size and its confidence and prediction interval within each topographical subregion was estimated by regression analysis.ResultsA total of 137 CT scans exhibited 145 orbital floor fractures, which were combined with 34 medial orbital wall fractures in 31 patients. The floor fractures – W1(i)2(i) (n = 86) and W1(i) (n = 19) were the most frequent patterns. Combined floor and medial wall fractures most frequently corresponded to the pattern W1 (im)2 (im) (n = 15) ahead of W1 (im) 2(i) (n = 10). The surface area size ranged from 0.11 cm² to 6.09 cm² for orbital floor and from 0.29 cm² to 5.43 cm² for medial wall fractures.The prediction values of the mean fracture area size within the subregions were computed as follows: W1(i) = 2.25 cm², W2(i) = 1.64 cm², W1(i)2(i) = 3.10 cm², W1(m) = 1.36 cm², W2(m) = 1.65 cm², W1(m)2(m) = 2.98 cm², W1 (im) = 3.35 cm², W1 (im) 2(i) = 4.63 cm², W1 (im)2(m) = 4.06 cm² and W1 (im)2 (im) = 7.16 cm².ConclusionThe AOCMFTC orbital module offers a suitable framework for topographical allocation of fracture patterns inside the infero-medial orbital cavity. The involvement of the subregions is of predictive value providing estimations of the mean 3-D fracture area size.     

FISSURE SEALANT IN A NUTSHELL. EVIDENCE-BASED META-EVALUATION OF SEALANTS’ EFFECTIVENESS IN CARIES PREVENTION AND ARREST

ObjectiveThis meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures.Materials and MethodsThe systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2.ResultsAmong the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions.ConclusionThis meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.     

Lower Extremity Muscle Strength After Anterior Cruciate Ligament Injury and Reconstruction

Context:

Quadriceps and hamstrings weakness occurs frequently after anterior cruciate ligament (ACL) injury and reconstruction. Evidence suggests that knee injury may precipitate hip and ankle muscle weakness, but few data support this contention after ACL injury and reconstruction.

Objective:

To determine if hip, knee, and ankle muscle weakness present after ACL injury and after rehabilitation for ACL reconstruction.

Design:

Case-control study.

Setting:

University research laboratory.

Patients or Other Participants:

Fifteen individuals with ACL injury (8 males, 7 females; age = 20.27 ± 5.38 years, height = 1.75 ± 0.10 m, mass = 74.39 ± 13.26 kg) and 15 control individuals (7 men, 8 women; age = 24.73 ± 3.37 years, height = 1.75 ± 0.09 m, mass = 73.25 ± 13.48 kg).

Intervention(s):

Bilateral concentric strength was assessed at 60°/s on an isokinetic dynamometer. The participants with ACL injury were tested preoperatively and 6 months postoperatively. Control participants were tested on 1 occasion.

Main Outcome Measures:

Hip-flexor, -extensor, -abductor, and -adductor; knee-extensor and -flexor; and ankle–plantar-flexor and -dorsiflexor strength (Nm/kg).

Results:

The ACL-injured participants demonstrated greater hip-extensor (percentage difference = 19.7, F_1,14 = 7.28, P = .02) and -adductor (percentage difference = 16.3, F_1,14 = 6.15, P = .03) weakness preoperatively than postoperatively, regardless of limb, and greater postoperative hip-adductor strength (percentage difference = 29.0, F_1,28 = 10.66, P = .003) than control participants. Knee-extensor and -flexor strength were lower in the injured than in the uninjured limb preoperatively and postoperatively (extensor percentage difference = 34.6 preoperatively and 32.6 postoperatively, t₁₄ range = −4.59 to −4.23, P ≤ .001; flexor percentage difference = 30.6 preoperatively and 10.6 postoperatively, t₁₄ range = −6.05 to −3.24, P < .05) with greater knee-flexor (percentage difference = 25.3, t₁₄ = −4.65, P < .001) weakness preoperatively in the injured limb of ACL-injured participants. The ACL-injured participants had less injured limb knee-extensor (percentage difference = 32.0, t₂₈ = −2.84, P = .008) and -flexor (percentage difference = 24.0, t₂₈ = −2.44, P = .02) strength preoperatively but not postoperatively (extensor: t₂₈ = −1.79, P = .08; flexor: t₂₈ = 0.57, P = .58) than control participants. Ankle–plantar-flexor weakness was greater preoperatively than postoperatively in the ACL-injured limb (percentage difference = 31.9, t₁₄ = −3.20, P = .006).

Conclusions:

The ACL-injured participants presented with hip-extensor, -adductor, and ankle–plantar-flexor weakness that appeared to be countered during postoperative rehabilitation. Our results confirmed previous findings suggesting greater knee-extensor and -flexor weakness postoperatively in the injured limb than the uninjured limb. The knee extensors and flexors are important dynamic stabilizers; weakness in these muscles could impair knee joint stability. Improving rehabilitation strategies to better target this lingering weakness seems imperative.Key Words: isokinetic exercises, knee, weakness

Key Points

• Quadriceps and hamstrings weakness in the injured limb persisted when individuals returned to activity after anterior cruciate ligament reconstruction.
• Determining the cause of and developing more effective strategies to address quadriceps and hamstrings weakness are important.
• Ankle–plantar-flexor weakness was present preoperatively in the injured limb but was effectively addressed with rehabilitation after anterior cruciate ligament reconstruction.
• The hip extensors and adductors were stronger postoperatively than preoperatively, suggesting that postoperative strength gains were made with rehabilitation.

Traumatic anterior cruciate ligament (ACL) injury occurs frequently during athletic activity, precipitating numerous immediate and long-term consequences, such as pain, disability, and ultimately joint degeneration.¹ Lower extremity muscle weakness, particularly in the quadriceps and hamstrings, also is reported commonly after ACL injury and reconstruction, often lingering well beyond the postoperative rehabilitation period.^2,3Quadriceps strength deficits in the injured limb reportedly range from 5% to 40%^2–10 and have been noted as long as 7 years after surgery.³ Hamstrings strength deficits in the injured limb have been reported to range from 9% to 27%^2,3,5,8,9,11 and have been reported 3 years after surgery.⁵ Similarly, quadriceps and hamstrings strength deficits in the uninjured limbs of patients who have had ACL reconstruction have been reported to be 21% and 14%, respectively, 3 years after surgical repair.⁵Less often considered is the strength of the hip and triceps surae musculature. Clinical observation and emerging evidence⁸ have suggested that strength within these muscle groups may be influenced negatively by the injury and reconstruction processes. Jaramillo et al¹² reported hip-flexor and -extensor and hip-abductor and -adductor weakness after knee surgery, but their results were not limited to a population that had ACL reconstruction. The presence of both hip-flexor⁸ and -adductor¹³ weakness has been confirmed after ACL reconstruction. Hip-flexor weakness has been reported 2 years after surgery in the injured compared with the uninjured limb.⁸ Persistent quadriceps weakness may have contributed to hip-flexor weakness, given the biarticular nature of the rectus femoris. Hiemstra et al¹³ reported hip-adductor weakness after semitendinosus and gracilis autograft reconstruction and suggested that donor site morbidity and neurologic alterations may have contributed to the resultant weakness. At the ankle, Karanikas et al⁸ noted no differences bilaterally in isokinetic ankle–plantar-flexor strength between 3 and 6 months or between 6 and 12 months after surgery; however, researchers using ultrasound to assess calf muscle thickness have demonstrated preoperative to postoperative reductions in muscle thickness after traditional rehabilitation,¹⁴ which indicates calf muscle atrophy and, likely, weakness.Considering the importance of muscle strength for controlling lower limb dynamic stability^15,16 and considering that long-term sequelae, such as osteoarthritis, have been proposed to result from lingering muscle weakness,¹⁷ confirming and quantifying the presence of lower extremity muscle weakness seems imperative so that strategies to counter it can be better implemented within rehabilitation protocols. Therefore, the purpose of our study was to determine if weakness was present in the hip-, knee-, and ankle-flexor and -extensor musculature and the hip abductors and adductors after ACL injury and after ACL reconstruction and postoperative rehabilitation. We hypothesized that participants would demonstrate weakness preoperatively and postoperatively within the (1) hip-flexor, -extensor, and -abductor muscle groups; (2) knee flexors and extensors; and (3) ankle–plantar-flexor and -dorsiflexor musculature. We believed these deficits would be present in the injured but not in the uninjured limb of the ACL-injured participants or in the test limb of the control participants.     

Reduced sensitivity in the recognition of anger and disgust in social anxiety disorder

Introduction. The aim of this study was to investigate the recognition of facial expressions in patients with a generalised social anxiety disorder. It is well documented that in different psychiatric disorders (e.g., depression, schizophrenia) patients may show an altered processing of emotions. However, in generalised social anxiety, emotion recognition has not been studied.

Methods. 24 Patients with generalised social anxiety disorder and 26 healthy controls, matched on age, education, and sex were included. The task entailed the emotional labelling of faces with different facial expressions (happiness, fear, disgust, sadness, surprise, anger) presented in different intensities. Subjects were asked to make a forced‐choice response.

Results. These revealed that patients with a generalised social anxiety disorder were less sensitive for the negative facial expressions of anger and disgust compared to the control group.

Conclusions. This deficit could play a role in the development and/or the maintaining of the social anxiety. Both explanations are discussed.     

Mechanistic pathways for the degradation of SMX drug and floatation of degraded products using F–Pt co-doped TiO2 photocatalysts

This work presents smart pathways to enhance the photocatalytic activity of TiO₂via co-doping with fluorine (F) and platinum (Pt) to form F–Pt co-doped TiO₂ photocatalysts and investigates the unique and unusual fluorination of the floated products. Our investigations indicate that the crystalline structure of the photocatalysts was a mixture of anatase and brookite phases and that the nanoparticles of the synthesized nanocomposites had nanometric sizes (4–25 nm). The F–Pt co-doped TiO₂ nano-photocatalysts demonstrated degradation of sulfamethoxazole (SMX) drug of >93% within 90 min under direct solar light and 58% degradation within 360 min under a solar simulator. Thus, co-doping TiO₂ with F and Pt atoms to form F–Pt co-doped TiO₂ nanocomposite is an efficient pathway to achieve high photocatalytic performance escorted with the formation of floating metal-fluoropolymer, unlike pristine TiO₂ which has less photocatalytic degradation and no generation of a floating polymer. Our photocatalytic protocol demonstrates that the degradation of SMX started with redox reactions of oxygen and water absorbed on the surface of the prepared nanocomposites to form superoxide anions (O₂˙⁻) and hydroxy radicals (˙OH) which have oxidation superpower. The resultant products were subsequently fluorinated by fluoride radical ions and floated as metal-fluoropolymer.

This work presents smart pathways to enhance the photocatalytic activity of TiO₂via co-doping with fluorine (F) and platinum (Pt) to form F–Pt co-doped TiO₂ photocatalysts and investigates the unique and unusual fluorination of the floated products.