Operative versus nonoperative treatment of acute undisplaced and minimally displaced scaphoid waist fractures—A systematic review

Introduction

Undisplaced and minimally displaced scaphoid waist fractures can be managed either operatively (percutaneous or ORIF) or non-operatively with both methods obtaining high rates of fracture union and subsequent return of function. The aim of this systematic review is to identify and evaluate the best available evidence to determine whether they should be managed operatively or non-operatively.

Materials and methods

A Medline and journal hand search was performed with strict eligibility criteria to obtain the highest quality evidence from meta-analyses, randomised controlled trials (RCT) and comparative studies. Included studies were critically appraised using levels of evidence and RCTs were further appraised using a scoring tool.

Results

The search found 112 studies, of which 12 met the eligibility criteria for inclusion. Three level 1 RCTs, three level 2 RCTs, two meta-analyses, one economic analysis, and three retrospective studies were critically appraised.The evidence suggests that percutaneous fixation may result in faster union rates by approximately 5 weeks and an earlier return to sport and work by approximately 7 weeks over cast treatment. This difference is not seen when comparing ORIF with cast treatment. Although cast treatment results in a higher non-union rate than ORIF, this needs to be balanced with the 30% minor complication rate. Manual workers require significantly longer time off work than non-manual workers regardless of the method of treatment, although they did return to work sooner after ORIF than after cast treatment.

Conclusion

The majority of these injuries can be treated in a cast with good results. Operative treatment should be reserved for patients unable to work in a cast and considered for most manual workers and high-level athletes.     

Expression of cell surface receptors and oxidative metabolism modulation in the clinical continuum of sepsis

Background  

Infection control depends on adequate microbe recognition and cell activation, yet inflammatory response may lead to organ dysfunction in sepsis. The aims of this study were to evaluate cell activation in the context of sepsis and its correlation with organ dysfunction.     

Association between pituitary adenomas and intracranial aneurysms: an illustrative case and review of the literature

The co-existence of cerebral aneurysms and pituitary adenomas is rare. Here, we report a patient with a coexisting anterior communicating artery aneurysm and a pituitary adenoma and review the available literature concerning this phenomenon. There is a debate in the literature regarding any causal relationship between aneurysms and pituitary tumors, although there are many reports of aneurysms caused by trauma or radiation following treatment of pituitary tumors. These simultaneous lesions are best diagnosed with magnetic resonance imaging with magnetic resonance angiography. Craniotomy for simultaneous aneurysm clipping and resection of the pituitary tumor is the best treatment option.     

Patterns of infarction in hemodynamic failure

BACKGROUND AND PURPOSE: The mechanism of stroke in patients with atherosclerotic occlusive disease and hemodynamic failure may be primarily hemodynamic or a combination of hemodynamic and embolic factors. The purpose of this study was to investigate the clinical and imaging features of stroke in these patients. METHODS: Eleven patients with complete atherosclerotic carotid artery occlusion and increased oxygen extraction fraction measured in the hemisphere distal to the occlusion developed an ischemic stroke during the observation phase of a prospective study of cerebral hemodynamics and stroke risk. The medical and study records related to the endpoint event for these 11 patients were reviewed. Records were reviewed for evidence of associated hypotension and for specific details of the neurological deficit. Infarct location was characterized, based on review of imaging and clinical features, as: (1) middle cerebral artery (MCA) core; (2) possible cortical border zone, or (3) internal border zone. RESULTS: One patient had a retinal infarction; the remaining 10 had MCA territory strokes. Six of the 10 infarctions occurred in the MCA core territory. Two of these 6 were fatal hemispheric events. One of the 10 infarctions occurred in the cortical border zone region. Two of the remaining 3 infarctions were localized to the internal border zone. One was indeterminate. CONCLUSIONS: The clinical features and radiological patterns of stroke in many patients with hemodynamic impairment failure and carotid occlusion are most consistent with large artery thromboembolic stroke. These data suggest a synergistic effect between embolic and hemodynamic mechanisms for large artery thromboembolic stroke.     

Short-term exercise does not increase ER stress protein expression in cardiac muscle

PURPOSE: Both short-term (three to five consecutive days) and long-term (weeks to months) endurance exercise training provides cardioprotection against ischemia-reperfusion (IR)-induced injury. However, the mechanisms responsible for exercise-induced cardioprotection are not well understood. Emerging evidence indicates that endoplasmic reticulum (ER) damage contributes to IR-induced myocardial injury. It follows that exercise-induced expression of ER stress proteins could serve as the mediators of exercise-induced cardioprotection against IR injury. Hence, these experiments tested the hypothesis that exercise training is associated with an increase in ER stress proteins in the heart. METHODS: Adult male Sprague-Dawley rats (N=13) were habituated to treadmill running for 5 d, followed by five 60-min exercise bouts (approximately 70% of VO2max) on consecutive days. Infarct area resulting from IR was determined by a standard histological (triphenyltetrazolium chloride (TTC)) method. Cardiac levels of ER stress proteins Grp78, Grp94, and calreticulin were analyzed via Western blot. Moreover, we determined myocardial levels of heat shock protein 72 (HSP72) along with ER proteins associated with cellular injury, including CHOP, caspase 12, Puma, Noxa, and ATF3. RESULTS: Our exercise protocol resulted in cardioprotection as evidenced by reduced infarct size (P<0.05) and increased myocardial HSP72 levels (+227%; P<0.01) in the exercise-trained animals. Nonetheless, exercise training did not increase (P>0.05) cardiac levels of the ER stress proteins, Grp78, Grp94, and calreticulin. Moreover, exercise did not alter myocardial levels of CHOP, caspase 12, Puma, Noxa, or ATF3. CONCLUSION: These data reveal that short-term exercise training does not elevate ER stress proteins in the heart. Hence, the cardioprotective effect of short-term exercise training does not seem to be linked to ER stress adaptation.     

Removal of Species Constraints in Antibody Detection

Serum antibodies from myriad species, particularly birds, can provide key information regarding the transmission and the expansion of the territory of emerging pathogens. Expedient antibody analysis is constrained by a lack of species-specific reagents, a deficiency potentially highlighted by the recent swine-origin influenza A virus (H1N1) outbreak. Available methodologies present difficulties that discourage thorough serologic monitoring of potential disease vectors or hosts. Rapid high-throughput procedures that combined serum amine labeling via biotinylation, contaminant removal, and microsphere-based immunoassays for antibodies to three arboviruses were developed. Agent-specific adaptations of this simple format should facilitate expanded surveillance and diagnostic capabilities regarding pathogens of human and veterinary importance.Serologic analysis of samples obtained from nondomestic animals, birds in particular, can provide key information regarding the transmission and the expansion of the territory of emerging pathogens (1). Unfortunately, species-specific reagents such as antispecies capture antibodies and detection conjugates, necessary for most rapid diagnostic methods, are frequently unavailable due to a lack of commercial interest. Traditional methods for circumventing species constraints often use live pathogens, are technically challenging, or are so time-consuming that large-scale testing becomes impractical (2). Methods that utilize protein G (4) are able to capture and detect mammalian IgG but cannot be used when the antibodies of interest are IgM and IgY, the former being the first of the Igs to be generated after infection and the latter being the avian and reptilian equivalent of IgG. The results of blocking enzyme-linked immunosorbent assay (ELISAs) (3) are sometimes inconsistent, and test sensitivities are dependent on the relative affinities of the competing monoclonal and serum antibodies to the antigens. Disease surveillance that involves the analysis of antibodies in nondomestic species is thus limited.The ideal method for the detection of antibodies in a range of species would be rapid, be capable of high throughput, provide a positive signal (as opposed to a signal reduction via competition), and require a small sample volume. Total antibody measurement would be advantageous, because surveillance is usually conducted without knowledge of the timing of infection. Biotin (vitamin H) is well-known to react with free amine groups on proteins (18). We determined that virus-specific serum antibodies independent of the species of origin could be biotinylated and directly detected in microsphere immunoassays (biotin-MIAs) that were modified from established protocols (11). Here we describe the development of two species-independent antibody detection methods for use with arboviruses, which involve animals as vectors or hosts. The first is a duplex procedure for the detection of antibodies to West Nile (WN) and St. Louis encephalitis (SLE) viruses, and the second is a procedure for the identification of anti-eastern equine encephalitis (anti-EEE) virus antibodies.