Reoperation following open reduction and plate fixation of displaced mid-shaft clavicle fractures

Background

Operative fixation of displaced, mid-shaft clavicle fractures has become an increasingly common practice. With this emerging trend, data describing patient outcomes with longer follow-up are necessary.

Patients and Methods

We retrospectively reviewed the medical records of subjects treated with plate fixation for displaced mid-shaft clavicle fractures from 2003 to 2009 at a Level I trauma hospital. All subjects were greater than 12 months post-index surgery. Treatment involved ORIF with either a low-contact dynamic compression plate (LCDC) or a contoured plate (pre-contoured or pelvic reconstruction plate). Our primary outcome was reoperation for any indication.

Results

143 subjects were included. The mean age was 36 ± 14 years and the mean time to reoperation or chart review was 33 months. Contoured plates were used in 64% of cases and LCDC plates were used in the remaining subjects. Twenty-nine subjects (20%) underwent reoperation: 23.5% of subjects treated with LCDC plates and 18.5% of subjects treated with contoured plates (p = 0.52). Indications for reoperation included implant irritation (n = 25), implant failure (n = 2), and non-union (n = 2). There was near statistically significant association with reoperation and female gender (p = 0.05) but no association between reoperation and age (p = 0.14), fracture class (p = 0.53), plate type (p = 0.49), or plate location (p = 0.93). The mean QuickDASH score for the population surveyed was 8.8 (5.5–12.1; 95% CI) with near statistically significant and clinically relevant difference between those considering reoperation and those not 22.3 (8.6–36.0; 95% CI) versus 6.7 (3.6–9.8; 95% CI).

Conclusions

This study represents a large series of displaced clavicle fractures treated with open reduction and plate fixation. Reoperation following plate fixation is relatively common, but primarily due to implant irritation. No difference in reoperation rates between plate types or location could be detected in our current sample size. Also, excellent functional outcomes continue to be observed several years after clavicle fracture fixation.     

Sulfated zirconium oxide-decorated magnetite KCC-1 as a durable and recyclable adsorbent for the efficient removal of asphaltene from crude oil

Sulfated zirconium oxide (ZrO₂/SO₄²⁻) as a highly durable acidic reagent was immobilized on magnetite KCC-1 nanoparticles (Fe₃O₄@SiO₂/KCC-1@ZrO₂/SO₄²⁻ NPs), and the resulting hybrid was used as a highly efficient recyclable adsorbent for the adsorption and removal of asphaltene from crude oil. The presence of ZrO₂/SO₄²⁻ groups not only promotes the adsorption capacity, but also helps recycle the adsorbents without any significant efficiency loss arising from its high chemical resistance. The results showed an obvious synergistic effect between the magnetic core (Fe₃O₄ NPs), fibrous silica (KCC-1) and the sulfated zirconium oxide groups with high correlation for asphaltene adsorption. The effective parameters in asphaltene adsorption, including initial asphaltene concentration, catalyst concentration and temperature, were investigated. Maximum adsorption occurred in the presence of 0.7 g L⁻¹ of the adsorbent, at a concentration of 2000 mg L⁻¹ of asphaltene. The asphaltene adsorption by NPs follows a quasi-second order adsorption kinetics. Asphaltene adsorption kinetics were studied by Langmuir, Freundlich, and Temkin isotherms. The prominent advantage of the adsorbent is its ability to be recovered after each adsorption by acid treatment, so that no significant reduction in adsorbent adsorption activity was observed, which can be directly attributed to the presence of ZrO₂/SO₄²⁻ groups in the hybrid.

A new, efficient and recyclable hybrid based on immobilized sulfated zirconium oxide on magnetite fibrous silica (KCC-1) has been developed and utilized for the efficient adsorption and removal of asphaltene from crude oil.     

Submental-Cervical Angle: Perceived Attractiveness and Threshold Values of Desire for Surgery

Aim

The submental-cervical angle may alter as a result of mandibular orthognathic surgery and/or the ageing process and is therefore an important facial aesthetic parameter for comparative diagnosis and treatment planning. The purpose of this study was to undertake a quantitative evaluation of the influence of the submental-cervical angle on perceived attractiveness and threshold values of desire for surgery.

Study Design

The submental-cervical angle of an idealized profile silhouette image was altered incrementally between 90° and 130°. The images were rated on a seven-point Likert scale by pre-treatment orthognathic patients (n = 75), laypeople (n = 75), and clinicians (n = 35).

Results

A submental-cervical angle of 90°–105° was deemed acceptable. Angles up to 120° were deemed slightly unattractive by the lay and clinician groups, but very unattractive by the patient group. By 125°–130° all groups perceived the angle as very unattractive. The threshold value of desire for surgery was 110° for patients, 115° for lay people and 125° for clinicians. Patients appear to be more critical than lay and clinician groups.

Conclusions

These ranges of normal variability of the submental-cervical angle and threshold values of desire for surgery, in terms of observer acceptance, should be considered by clinicians in planning mandibular orthognathic surgery and aesthetic surgical procedures of the submental-cervical region.

     

Genetic Diversity in the G Protein Gene of Human Respiratory Syncytial Virus among Iranian Children with Acute Respiratory Symptoms

Objective

Acute respiratory infection (ARI) is the major cause of morbidity and mortality in children worldwide. Human respiratory syncytial virus (HRSV) is main viral agent of ARI in infants and young children in terms of effect and prevalence. The aim of this study was to investigate HRSV genotypes during one season in Iran.

Methods

In this cross-sectional study, 107 throat swabs were collected from children less than 5 years of age with acute respiratory infection from October to December 2009. The respiratory samples were obtained from several provinces: Tehran, Isfahan, Hamadan, Zanjan, Kordestan, Lorestan and West Azarbayjan, and were tested for G protein gene of HRSV by RT-PCR.

Findings

Of the 107 respiratory samples, 24 (22.42%) were positive for HRSV, of which 16 (66.6%) belonged to subgroup A and 8 (33.4%) to subgroup B. Phylogenetic analysis revealed that subgroup A strains fell in two genotypes GA1 and GA2, whereas subgroup B strains clustered in genotype BA.

Conclusion

This study revealed that multiple genotypes of HRSV cocirculated during the season 2009 in Iran. Also subgroup A strains were more prevalent than subgroup B strains, and genotype GA1 was predominant during the season.     

The deviated balance between regulatory T cell and Th17 in autoimmunity

Identifying the regulatory T cells (Tregs) and Th17 cells led to breaking the dichotomy of Th1/Th2 cells axis in immune responses involved in several autoimmune diseases. It is now well known that Tregs and Th17 cells are main orchestra leaders in pathogenesis symphony of autoimmunity. While Tregs are protective cells in autoimmune diseases, Th17 cells enhance the progression of autoimmune responses through induction of various pro-inflammatory reactions. It seems that the progression of autoimmunity may be associated with increase in Th17 and decrease in Treg levels, so that skewed balance between Tregs and Th17 toward Th17 is a phenomenon, which could be observed during progression of several autoimmune diseases. Although it is suggested that expansion and transfer of Tregs can be a new therapeutic target for autoimmune diseases, however, recent data about the phenotype conversion of Tregs into Th17 cells obligate us to more investigation on this approaching. Thus, identifying the new factors that induce stable phenotype in Tregs and prevent their phenotype conversion into Th17 cells as well as targeting the factor, which can modulate their balance, might be recommended as a new promising therapeutic method for autoimmune therapy. In this review, we try to clarify the factors, which can affect on this balance in various autoimmune diseases, as new targets in treatment of these diseases.     

Second family with hearing impairment linked to 19q13 and refined DFNA4 localisation

Until now, over 30 loci have been identified by linkage analysis of affected families that segregate non-syndromic and dominantly inherited forms of hearing impairment (DFNA). A German family with a non-syndromic progressive hearing impairment transmitted in autosomal dominant mode was linked to 19q13.3-q13.4 by a genome-wide scan. Due to the low lod-score (1.85 at theta=0.05) for APOC2-locus we extended the fine mapping attempt with further markers in the same chromosomal region. This resulted in significant evidence for linkage to the markers D19S246 and D19S553 (two-point lod-score of 4.05 and 3.55 at theta=0.0) and a candidate critical region of 14 cM between markers D19S412 and D19S571. This region shows partial overlap with the previously reported DFNA4 critical region. The human gene BAX is orthologous to the rodent Bcl2-related apoptosis gene that is temporally expressed during the postnatal period in the developing inner ear of the mouse. BAX, mapping at a distance of no more than 0.73 cM distally to marker D19S553 appeared a likely candidate in our pedigree but genomic sequencing of coding regions and exon/intron boundaries excluded disease-related mutations. However, additional ESTs in the same region remain to be tested.     

The Anti-Oxidant Effects of Ginger and Cinnamon on Spermatogenesis Dys-function of Diabetes Rats

Background

Diabetes rats have been linked to reproductive dysfunction and plant medicine has been shown to be effective in its treatment. Antioxidants have distinctive effects on spermatogenesis, sperm biology and oxidative stress, and changes in anti-oxidant capacity are considered to be involved in the pathogenesis of chronic diabetes mellitus. Ginger and cinnamon are strong anti-oxidants and have been shown to reduce oxidative stress in the long-term treatment of streptozotocin (STZ)-induced diabetes in animal models. The present study examined the influence of combined ginger and cinnamon on spermatogenesis in STZ-induced diabetes in male Wistar rats.

Materials and Methods

Animals (n = 80) were allocated randomly into eight groups, 10 each: Group 1: Control rats given only 5cc Normal saline (0.9% NaCl) daily;Group2: rats received ginger (100mg/kg/rat) daily; Group 3: rats received cinnamon (75mg/kg) daily; Group 4: rats received ginger and cinnamon, (100mg/kg/rat ginger and 75mg/kg cinnamon) daily; Group 5: Diabetic control rats received only normal saline. Group 6: Diabetic rats received 100mg/kg/day ginger; Group 7: Diabetic rats received 75mg /kg/ day cinnamon; Group 8: Diabetic rats received ginger and cinnamon (100mg/kg/day and 75mg/kg /day). Diabetes was induced with 55 mg/kg, single intra-peritoneal injection of STZ in all groups. At the end of the experiment (56th day), blood samples were taken for determination of testosterone, LH,FSH, total anti-oxidant capacity, and levels of malondialdehyde, SOD, Catalase and GPX. All rats were euthanized, testes were dissected out and spermatozoa were collected from the epididymis for analysis.

Results

Sperm numbers, percentages of sperm viability and motility, and total serum testosterone increased in ginger and cinnamon and combined ginger and cinnamon treated diabetic rats compared with control groups. Serum testosterone, LH and FSH were higher compared to control group and also serum anti-oxidants (TAC, SOD, GPX and catalase) all were increased at the end of treatment. Combined ginger and cinnamon showed more intense increase in all parameters compare to ginger and cinnamon alone. Most of the results were significant (P<0.05).

Conclusion

We concluded that combined ginger and cinnamon have significant beneficial effects on the sperm viability, motility, and serum total testosterone, LH,FSH and serum anti-oxidants'' level and could be effective for maintaining healthy sperm parameters and male reproductive function in diabetics.