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Micro ribonucleic acids (miRNAs) are small non-coding RNA segments that have a role in the regulation of normal cellular development and proliferation including normal osteogenesis. They exert their effects through inhibition of specific target genes at the post-transcriptional level. Many miRNAs have altered expression levels in cancer (either increased or decreased depending on the specific miRNA). Altered miRNA expression profiles have been identified in several malignancies including primary bone tumors such as osteosarcoma and Ewing's sarcoma. It is thought that they may function as tumor suppressor genes or oncogenes and hence when dysregulated contribute to the initiation and progression of malignancy. miRNAs are also thought to have a role in the development of bone metastases in other malignancies. In addition, evidence increasingly suggests that miRNAs may play a part in determining the response to chemotherapy in the treatment of osteosarcoma. These molecules are readily detectable in tissues, both fresh and formalin fixed paraffin embedded and, more recently, in blood. Although there are fewer published studies regarding circulating miRNA profiles, they appear to reflect changes in tissue expression. Thus miRNAs may serve as potential indicators of disease presence but more importantly, may have a role in disease characterization or as potential therapeutic targets. This review gives a brief overview of miRNA biochemistry and explores the evidence to date implicating these small molecules in the pathogenesis of bone tumors.

MicroRNAs (miRNAs) are small molecules found to have major regulatory roles in many biological processes. This review aims to provide an overview of the recent advances in knowledge of the role of miRNAs in fracture healing and bone repair. A search of the published literature was performed (using the PubMed database) to include all relevant studies published in English. These studies were then reviewed and the results condensed into this review paper. MiRNAs have now been shown to have significant alterations in expression levels in bone tissue in the presence of fractures. This is thought to be related to the process of fracture healing through effects on osteoblasts and bone growth factors. These small molecules are also detectable in the circulation where their expression appears to be altered by the presence of fractures. Although further research is required in this area, miRNAs may present an opportunity for future clinical applications in fracture management.

Background: Arthroscopic meniscectomy often results in rapid recovery and return to preinjury activities; however, postoperative hemarthrosis and swelling can lead to pain, decreased range of motion, and delayed return to work and leisure activities. Tranexamic acid (TXA) is a lysine-based inhibitor of plasminogen to plasmin that has gained popularity in arthroplasty surgery for reducing blood loss and, more recently, in anterior cruciate ligament reconstruction by reducing postoperative hemarthrosis, swelling, and pain while increasing function in the short term. Purpose: To determine whether there is a role for TXA in improving the short-term results of swelling, pain, and function following arthroscopic meniscectomy. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: We performed a prospective double-blinded randomized controlled trial in 41 patients undergoing arthroscopic meniscectomy by comparing patients treated with intravenous TXA with those treated with a placebo (normal saline). A single surgeon treated all patients. Following randomization, a dose of 1 g of TXA in 100 mL of normal saline (treatment group) or 100 mL of normal saline (placebo group) was given intravenously at induction prior to tourniquet inflation by the anesthetist. The anesthetist administering the TXA or placebo was not blinded, but all other clinicians involved were. Patients were evaluated by a blinded observer at postoperative days 3, 14, and 30, with the range of motion, swelling, pain levels (visual analog scale), and Lysholm and Tegner knee scores recorded. Results: Patient demographics were similar in both groups. In the treatment group, there was a nonsignificant improvement in range of motion (P = .056) and swelling (P = .384) at 14 days; however, there was a significant improvement in the Tegner score at 3 days (P = .0064). The complication profile was similar between the groups. Conclusion: The administration of 1 g of intravenous TXA in routine arthroscopic meniscectomy may improve early functional recovery without increased risk. A larger study is required to confirm these results and further evaluate any potential benefit. Registration: ACTRN12618001600235 (Australian New Zealand Clinical Trials Registry).

Introduction. Optimizing leg length discrepancy (LLD) and restoring global and femoral offset (GO, FO) are integral to improving the stability and longevity of total hip arthroplasty (THA). A novel robotic-assisted THA (RA-THA) platform has been developed to utilize pre-operative templating and intraoperative fluoroscopic imaging to guide the restoration of native biomechanics. We sought to evaluate the effectiveness of this novel, pin-less, fluoroscopy-based RA-THA system to restore templated LLD and offset parameters. Materials and Methods. We performed a retrospective analysis on a consecutive series of 98 patients who underwent fluoroscopy-based RA-THA at our institution. The primary outcomes were the differences between preoperatively templated LLD, GO, and FO parameters with intraoperatively achieved parameters measured by the robotic system and with postoperatively achieved parameters measured from postoperative radiographs. Results. The mean difference between achieved and preoperatively templated values of LLD (−1.5 ± 5.5 mm), GO (−0.1 ± 5.5 mm), and FO (−0.1 ± 5.4 mm) were all within − 1.5 mm of establishing equalized leg length and offset. The proportion of patients with a difference in achieved and templated values < 10 mm were 92% for LLD, 91% for GO, and 93% for FO. For 43 of the 98 (44%) patients in this study, the surgeon referenced intraoperative robotic data to adjust femoral components from the preoperative plan in order to optimize LLD and offset parameters. Conclusions. The results of our present study demonstrated that fluoroscopy-based RA-THA is associated with high levels of accuracy in restoring key biomechanics of the hip. In a large number of patients, the surgeon used intraoperative robotic data to more closely achieve LLD and offset goals. This demonstrates the ability of this system to merge preoperative data with intraoperative, actionable data provided by the robotic software to restore leg length and global/femoral offset parameters. Words: 279/ 300.

Purpose Abnormal anthropometry including comparably lower weight and body mass index (BMI) in the adolescent idiopathic scoliosis (AIS) population is increasingly recognised, however, no study has examined postoperative weight loss or its clinical relevance in these relatively thin patients. This study aimed to assess perioperative nutritional status as well as clinically severe involuntary weight loss and its impact on outcomes in patients with AIS undergoing posterior spinal fusion (PSF). A further objective was to compare preoperative anthropometric measurements of the current AIS cohort with healthy controls. Methods Seventy-seven consecutive and eligible patients with AIS who underwent PSF were prospectively followed up from hospital admission (January 2010–April 2012). Pre- and postoperative anthropometric measurements were collected (weight, height, BMI), and clinically severe unintentional weight loss computed, defined as loss of >10 % body weight from admission to hospital discharge. The effect of weight loss >10 % was analysed in relation to radiographic, nutritional and perioperative complication data, and length of hospitalisation. A case–controlled study was then performed to establish potential differences in weight, height and BMI of this AIS cohort with healthy age- and gender-matched controls derived from the National Teens’ Food Survey (2005–2006). Anthropometric values were standardised by conversion to age- and gender-specific Z-scores; ‘undernutrition’ was defined as BMI Z-scores <−2. Results Mean age of the cohort was 15 years (SD 1.89); 93.5 % of subjects were female. Clinically severe postoperative weight loss >10 %, identified in 22 patients (30.6 %), was associated with a significantly increased superficial wound infection incidence (13.6 vs. 2 %, P  = 0.047), as well as lower serum albumin at hospital discharge (25 vs. 28 g/L, P  < 0.05). A high prevalence of postoperative undernutrition was observed—over one quarter of patients had a BMI Z-score <−2 at hospital discharge (26.4 %); serum albumin, total protein and haemoglobin levels were below normal limits in 98, 66 and 91 % of patients, respectively. Significantly lower weight (52 vs. 59.8 kg, P  < 0.0001), corrected height (162 vs. 166.3 cm, P  < 0.0001) and BMI (19.72 vs. 21.6 kg/m 2 , P  < 0.0001) measurements were identified in this AIS cohort, in comparison with those recorded in The National Teens’ Survey. Conclusions This study demonstrated that clinically severe postoperative weight loss >10 %, identified in almost one-third of this AIS cohort, was associated with significantly increased wound infection incidence. Early detection and prevention of severe postoperative weight loss in patients with AIS who undergo spinal fusion may be beneficial in reducing wound infection risk. This study confirms a body of literature indicating the significantly lower weight and BMI in patients with AIS compared with healthy controls.

ObjectivesTo understand individual prescribing and associated costs in patients managed with the Edinburgh Pain Assessment and management Tool (EPAT).MethodsThe EPAT study was a two-arm parallel group cluster randomised (1:1) trial, including 19 UK cancer centres. Study outcome assessments, including pain levels, analgesia and non-pharmacological and anaesthetic interventions, collected at baseline, 3–5 days and, if applicable, 7–10 days after admission. Costs calculated for inpatient length of stay (LoS), medications and complex pain interventions. Analysis accounted for the clustered nature of the trial design. In this post-hoc analysis, healthcare utilisation and costs are presented descriptively.Participants10 centres randomised to EPAT (487 patients) and 9 (449 patients) to usual care (UC).Main outcome measuresPharmacological and non-pharmacological management, complex pain interventions, length of hospital stay and costs related to these outcomes.ResultsThe mean per patient hospital cost was £3866 with EPAT and £4194 with UC, reflecting a mean LoS of 2.9 days and 3.1 days, respectively. Costs were lower for non-opioids, Non-steroidal anti-inflammatories (NSAIDs) and opioids but slightly higher for adjuvants with EPAT than with UC. The mean per-patient opioid costs were £17.90 (EPAT) and £25.80 (UC). Mean per patient costs of all medication were £36 (EPAT) and £40 (UC).Complex pain intervention costs were £117 with EPAT per patient and £90 with UC. Overall mean cost per patient was £4018.3 (95% CI 3698.9 to 4337.8) with EPAT and £4323.8 (95% CI 4060.0 to 4587.7) with UC.ConclusionsEPAT facilitated personalised medicine and may result in less opioids, more specific treatments, improved pain outcomes and cost savings.

This project develops our understanding of the representation of women’s interests in politics by considering the role that men can play in advancing the substantive representation of women (SRW). I draw on the case of the United Kingdom Parliament, which over the last three decades has seen significant changes in the sex balance of Members of Parliament (MPs) in the House of Commons. Using quantitative analysis of two legislative activities—Early Day Motions, and the annual International Women’s Day Debates—I first establish the patterns of men’s engagement in SRW. I argue that men’s role in representation women can be understood as what I term an “ancillary representatives” for women, which is a role that draws on a vantage point not accessible to women to help advance the SRW, while also remains secondary to women’s leadership role. The role played by men remains fairly consistent over time, with some evidence of a mainstreaming of women’s issues over time as the number of women in politics increases. Then, using interview data from 30 original interviews with sitting MPs (both men and women) and analysis of transcripts of interviews carried out with women MPs in 2004, I develop the idea of men as ancillary representatives by showing that they see themselves as holding a very distinct role in the representation of women, largely as a supporter or ally for women. The findings from the interview data also reinforces and develops the existing work in the literature on women’s representation first by showing that the logic of women’s difference and the importance of life experience in shaping the perspective of women in politics also applies in the case of men; and second by showing that an additional often unseen impact of women in politics is that they have the ability to also influence their male colleagues.

Introduction Tetanus is a rare disease but, in the era of widespread vaccination, largely a preventable one. Immunization programmes in childhood are felt to offer lifelong immunity but it is known that with increased age immunity wanes. We sought to assess immunity in a sample of patients presenting for conditions unrelated to injury to the emergency department covering an area in the West of Ireland. Methods A convenience sample of 216 patients, who presented to the emergency department for complaints unrelated to injury, requiring blood tests for their management was obtained. Using the Protetanus QuickStick® all samples were analysed. Results No statistical difference between men and women in terms of tetanus immunity (p=0.94) but significant reduction in immunity with increasing age (p<0.001). Those non-immune tended to be older with mean age of 66 years compared to mean age of 46 year for immune. Using logarithmic regression analysis an increase in age of 10 years was associated with 50% reduction in immunity. Discussion National guidelines should incorporate this data and explicitly advocate the use of booster doses of tetanus toxoid outside of the normal vaccination programme especially in the elderly.

The purpose of this phenomenological study was to describe kindergarten teachers’ experiences with integrating play-based learning into standards-based academic curriculum in a school district in South Carolina. Play–based learning experiences were defined as instances which allow children to engage in active, social learning experiences in classrooms. This study explored the question of how kindergarten teachers describe their experiences with integrating play-based learning experiences in their classrooms, the value of play in their classrooms, their role as the adult during play experiences, and the difficulties that they face in making instructional decisions. The theories guiding this study were Froebel’s early childhood learning theory and Vygotsky’s cognitive constructivist theory as they demonstrate the importance of providing play-based learning experiences for kindergarten children. The sample was gathered through a criterion sampling strategy where teachers from a school district in South Carolina were selected because they have experienced the phenomenon being studied. Data collection included interviews, a focus group, and artifact analysis. The data was transcribed and analyzed using memoing and coding to identify emerging themes. Five themes emerged: academic values resulting from play-based learning, functional values resulting from play-based learning, intentional instructional planning, classroom interactions as a key component, and difficulties with implementing play-based learning. The results of the study will provide information to educators about how to best support kindergarten teachers in their pedagogical decision making.

Modern healthcare threatens traditional nursing ethos by placing the relational aspects of nursing at risk. Staff nurses report decreased job satisfaction amid mounting tasks and sicker patients. Many leave nursing due to an inability to address patients' social, emotional and spiritual needs, which especially surface at end of life. Considering death is an inevitable, universal outcome and the frequency by which bedside nurses play central roles in patients' terminal care, the literature is stunningly void to describe how the nursing presence process unfolds with terminal, hospitalized patients. Constructionist Grounded Theory formed the methodology guiding the study design and data analysis. Eleven staff nurses vividly recalled very meaningful interactions with dying patients; their detailed narratives yielded 17 memorable exchanges with end-of-life patients. It was dying patients' vulnerability which triggered participants' awareness to assess patients' needs. Participants addressed these needs with a focused intentionality, spawned by participants' previous personal loss experiences or nurses' strong, professional beliefs. Many participants recalled making positive differences in previous patients' illness experiences and were determined to do so again. Participants acknowledged having little time in their nursing roles, yet also realized their dying patients' needed their time. Such divergent realities prompted the participants to prioritize time to address patients' end-of-life needs. Participants' determination to be of help, combined with their strategic use of time fostered meaningful nurse-patient interactions. These exchanges were punctuated by a range of courageous nursing actions intended to positively influence terminal patients' illness experiences. Participants candidly offered dying patients sage advice, some participants dauntlessly advocated for patients while other participants gently prepared patients for what was to come. This research offers insight into ways bedside nurses continue to uphold traditional nursing ethos by safeguarding the relational aspects of nursing when caring for terminal hospitalized patients. Study findings reveal assorted ways determined staff nurses creatively use time, while also demonstrating a range of courageous nursing actions that resulted in very meaningful exchanges with dying patients.