Genicular Artery Embolization for the Treatment of Knee Pain Secondary to Osteoarthritis

PurposeTo evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of knee pain secondary to osteoarthritis (OA).Materials and MethodsTwenty patients with radiographic knee OA and moderate-to-severe pain refractory to conservative therapy were enrolled in a prospective, 2-site pilot study. Genicular artery embolization (GAE) was performed with 75- or 100-μm spherical particles. Patients were assessed with magnetic resonance imaging at baseline and at 1 month and with the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and at 1, 3, and 6 months. Adverse events were recorded at all timepoints.ResultsEmbolization of at least 1 genicular artery was achieved in 20/20 (100%) patients. Mean VAS improved from 76 mm ± 14 at baseline to 29 mm ± 27 at 6-month follow-up (P < .01). Mean WOMAC score improved from 61 ± 12 at baseline to 29 ± 27 at 6-month follow-up (P < .01). Self-limiting skin discoloration occurred in 13/20 (65%) patients. Two of 20 (10%) patients developed plantar sensory paresthesia that resolved within 14 days.ConclusionsGAE to treat knee pain secondary to OA can be performed safely and demonstrates potential efficacy. Further randomized comparative studies are needed to determine true treatment effect versus placebo effect.     

Prediction of the length of the femur from its fragments in a Sri Lankan population

ABSTRACT

In many forensic circumstances, the femur is fragmented due to decomposition and mutilation, thus necessitating development and application of regression equations to estimate the length of the femur from its fragments. In this study, regression equations were derived for the prediction of the femoral length, utilizing 11 standard femoral measurements (maximum length of femur, epicondylar breadth, vertical head diameter, transverse head diameter, vertical neck diameter, transverse neck diameter, neck length, subtrochanteric anterior–posterior diameter, subtrochanteric transverse diameter, mid-shaft anterior–posterior diameter and mid-shaft transverse diameter) obtained from 86 femora belonging to a contemporary Sri Lankan population. Univariate regression equations with moderate to high correlations (0.226 to 0.714) were formulated for the estimation of the maximum femoral length from the measurements of fragments of the femur. Of the single variables, the transverse neck diameter emerged as the best predictor (r = 0.714, SEE = 18.6596) of the maximum length of the femur. The multiple regression equations using a combination of variables yielded higher correlations (0.774–0.857) with lower error estimates (14.18–16.96). The regression equations presented in this study can be used to estimate the length of the femur of unknown, mutilated and dismembered human skeletal remains with considerable accuracy.     

Fecal lactate and short bowel syndrome

In patients with short bowel syndrome (SBS), the carbohydrate overload to the colon may disturb the normal pattern of colonic fermentation with production ofd-lactic acid and subsequent development of a metabolicd-lactic acidosis. We measuredd-lactic acid in blood, urine, and feces, as well as the composition of fecal water and fecal reducing substances from 11 patients with SBS, comparing the results with those from normal subjects. The fecal water from patients with SBS was characterized by low pH, potassium, and volatile fatty acids, high osmotic gap, and high concentration ofl- andd-lactic acid. Five of 11 had abnormal amounts of fecal reducing substances. Fecald-lactic acid was increased in nine of 11 patients. However, none of these patients showedd-lactic acid in urine, and only one had a very low concentration in plasma. These results show thatd-lactic acid was overproduced in the colon of most of the patients with SBS. However, other factors such as absorption or impairedd-lactic acid metabolism may be necessary for a plasmatic increase ofd-lactic acid.Unidad de Terapia Nutricional, Hospital de Niños Sor Maria Ludovica, La Plata, Provincia de Buenos Aires, Argentina.Part of this work was presented at the International Symposium on Short Chain Fatty Acids, Strasbourg, France, September 1993.     

A Fully Coupled Simulation of Planar Deposition Flow and Fiber Orientation in Polymer Composites Additive Manufacturing

Numerical studies for polymer composites deposition additive manufacturing have provided significant insight promoting the rapid development of the technology. However, little of existing literature addresses the complex yet important polymer composite melt flow–fiber orientation coupling during deposition. This paper explores the effect of flow–fiber interaction for polymer deposition of 13 wt.% Carbon Fiber filled Acrylonitrile Butadiene Styrene (CF/ABS) composites through a finite-element-based numerical approach. The molten composite flow in the extrusion die plus a strand of the deposited bead contacting the deposition substrate is modelled using a 2D isothermal and incompressible Newtonian planar flow model, where the material deposition rate is ~110 mm/s simulating a large scale additive manufacturing process. The Folgar–Tucker model associated with the Advani–Tucker orientation tensor approach is adopted for the evaluation of the fiber orientation state, where the orthotropic fitted closure is applied. By comparing the computed results between the uncoupled and fully coupled solutions, it is found that the flow-orientation effects are mostly seen in the nozzle convergence zone and the extrusion-deposition transition zone of the flow domain. Further, the fully coupled fiber orientation solution is highly sensitive to the choice of the fiber–fiber interaction coefficient CI, e.g., assigning CI as 0.01 and 0.001 results in a 23% partial relative difference in the predicted elastic modulus along deposition direction. In addition, Structural properties of deposited CF/ABS beads based on our predicted fiber orientation results show favorable agreements with related experimental studies.     

天然牙短牙弓患者义齿修复后生活质量的调查研究

目的：探讨可摘义齿修复对于天然牙短牙弓患者口腔健康相关生活质量的影响。方法该院口腔科自2010年1月—2013年12月共收治160例天然牙短牙弓患者,所有160例天然牙短牙弓患者均给予可摘义齿修复,在义齿修复前和修复后3个月发放口腔健康影响程度量表,比较修复前后患者口腔健康相关生活质量评分。结果患者行义齿修复前口腔健康相关生活质量评分10（6,14）分,义齿修复3个月后得分5（3,8）分,显著低于义齿修复前得分（P ＜0．05）;生理疼痛、生理障碍、残障得分修复后得分显著低于修复前（P ＜0．05）,功能限制修复后得分显著高于修复前（P ＜0．05）。结论可摘义齿修复虽然增加功能限制,但能够在生理疼痛、生理障碍、残障方面提高患者口腔相关生活质量,从而总体上能够提高患者生活质量。     

A novel missense variant in TRAPPC2 causes X-linked spondyloepiphyseal dysplasia tarda: A case report

Rationale:X-linked spondyloepiphyseal dysplasia tarda (X-linked SEDT) is a rare hereditary cause in childhood short stature due to mutations in trafficking protein particle complex subunit 2 (TRAPPC2) gene located on chromosome Xp22. Several pathogenic variants in TRAPPC2 have been reported, but missense variants are rare.Patient concerns:A 13-year, 8-month-old Chinese Han boy presenting with short stature for the past 7 years.Diagnosis:X-linked SEDT was established by a combination of clinical and radiographic features, confirmed by targeted next-generation sequencing. Genetic testing of the TRAPPC2 gene revealed a novel missense variant with c.260A>C (p.H87P) hemizygote in exon5. The mother was found to be a heterozygous TRAPPC2 carrier, whereas the father was normal.Interventions:Patient was treated with recombinant human growth hormone daily. Patient''s height, glucose level, and possible progressive joint and back pain with osteoarthritis were under intensive observation regularly.Outcomes:The patient achieved 2.1 cm height gain over the first 3 months’ recombinant human growth hormone treatment without joint or back pain. However, the therapy was terminated because of increased glucose level on follow-up.Lessons:The short stature is a noteworthy problem for X-linked SEDT cases. We report a novel missense variant site in TRAPPC2 treated with growth hormone in the literature. We do not recommend the use of recombinant human growth hormone on patients with X-linked SEDT for the concern of glucose homeostasis.     

Impact of amniotic fluid “sludge” on the risk of preterm delivery

Objective: To evaluate the impact of amniotic fluid “sludge” (AFS) on the risk of preterm delivery and to describe the effect of antibiotic treatment in that situation.

Methods: Case–control study including singleton pregnancies with or without AFS, between 15–32 weeks of gestation. Factors associated with preterm delivery before 32 weeks, 34 weeks and 37 weeks were evaluated with univariate and multivariate logistic regression. Since all women with AFS in this study were treated with antibiotics, a historical comparison was performed with similar patients with AFS found before 2007 and not treated with antibiotics.

Results: AFS was observed in 90/1220 patients (7.4%). AFS was associated with shorter cervical length, greater body mass index, cervical cerclage and preterm birth before 28 weeks. However, after adjustment, AFS did not remain associated with preterm delivery before 32 or 34 weeks. The historical comparison suggested that azithromycin could significantly reduce the risk of preterm delivery before 34 weeks (odds ratio: 0.2; 95% CI: 0.04–0.92).

Conclusions: AFS, treated with azithromycin, was associated with a higher risk of prematurity, but not independently after adjustment for cervical length and second trimester vaginal bleeding. Further studies need to evaluate the effect of antibiotics in pregnancies with AFS.     

Heterozygous Mutations in Natriuretic Peptide Receptor‐B (NPR2) Gene as a Cause of Short Stature

Based on the observation of reduced stature in relatives of patients with acromesomelic dysplasia, Maroteaux type (AMDM), caused by homozygous or compound heterozygous mutations in natriuretic peptide receptor‐B gene (NPR2), it has been suggested that heterozygous mutations in this gene could be responsible for the growth impairment observed in some cases of idiopathic short stature (ISS). We enrolled 192 unrelated patients with short stature and 192 controls of normal height and identified seven heterozygous NPR2 missense or splice site mutations all in the short stature patients, including one de novo splice site variant. Three of the six inherited variants segregated with short stature in the family. Nine additional rare nonsynonymous NPR2 variants were found in three additional cohorts. Functional studies identified eight loss‐of‐function mutations in short individuals and one gain‐of‐function mutation in tall individuals. With these data, we were able to rigorously verify that NPR2 functional haploinsufficiency contributes to short stature. We estimate a prevalence of NPR2 haploinsufficiency of between 0 and 1/26 in people with ISS. We suggest that NPR2 gain of function may be a more common cause of tall stature than previously recognized.     

High Amylose White Rice Reduces Post-Prandial Glycemic Response but Not Appetite in Humans

The present study compared the effects of three rice cultivars on postprandial glycemic control and appetite. A single-blind, randomized, crossover clinical trial was performed with 18 healthy subjects, nine males and nine females. Three treatments were administered at three separate study visits: commercially available conventional white rice (short grain), specialty high amylose white rice 1 (Dixiebelle), and specialty high amylose white rice 2 (Rondo). Postprandial capillary blood glucose, venous blood glucose and insulin measurements, and appetite visual analog scale (VAS) surveys were done over the course of two hours. The capillary blood glucose concentrations were significantly lower for Rondo compared to short grain rice at 30 min, and for Dixiebelle and Rondo compared to short grain rice at 45, 60, and 120 min. Capillary blood glucose area under the curve (AUC) was significantly lower for Dixiebelle and Rondo compared to short grain rice. Subjects were significantly more hungry at 30 min after Dixiebelle intake than Rondo intake, but there were no other significant effects in appetite ratings. The present study determined that intake of high amylose rice with resistant starch (RS) can attenuate postprandial blood glucose and insulin response in comparison to short grain rice.     

Short Sleep Duration and Dietary Intake: Epidemiologic Evidence,Mechanisms, and Health Implications

Links between short sleep duration and obesity, type 2 diabetes, hypertension, and cardiovascular disease may be mediated through changes in dietary intake. This review provides an overview of recent epidemiologic studies on the relations between habitual short sleep duration and dietary intake in adults from 16 cross-sectional studies. The studies have observed consistent associations between short sleep duration and higher total energy intake and higher total fat intake, and limited evidence for lower fruit intake, and lower quality diets. Evidence also suggests that short sleepers may have irregular eating behavior deviating from the traditional 3 meals/d to fewer main meals and more frequent, smaller, energy-dense, and highly palatable snacks at night. Although the impact of short sleep duration on dietary intake tends to be small, if chronic, it may contribute to an increased risk of obesity and related chronic disease. Mechanisms mediating the associations between sleep duration and dietary intake are likely to be multifactorial and include differences in the appetite-related hormones leptin and ghrelin, hedonic pathways, extended hours for intake, and altered time of intake. Taking into account these epidemiologic relations and the evidence for causal relations between sleep loss and metabolism and cardiovascular function, health promotion strategies should emphasize improved sleep as an additional factor in health and weight management. Moreover, future sleep interventions in controlled studies and sleep extension trials in chronic short sleepers are imperative for establishing whether there is a causal relation between short sleep duration and changes in dietary intake.