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Future Quest presents
\"The Hanna-Barbera stars of the hit FUTURE QUEST series--Jonny Quest, Space Ghost, the Herculoids and many more--reunite in this all-new series! After the thrilling events of FUTURE QUEST, a new age of adventure begins! Space Ghost and his young wards Jan and Jace team up with the Herculoids to rebuild the mighty Space Force. Will they rise again to become defenders of the galaxy? Or is there something lurking in the shadows ready to stop them for good?\"-- Provided by publisher.
Book
Characterization of patellar maltracking using dynamic kinematic CT imaging in patients with patellar instability
Purpose
Little has been reported on the relationship between patellar maltracking and instability. Patellar maltracking has been subjectively described with the “J sign” but is difficult to assess objectively using traditional imaging. Dynamic kinematic computed tomography (DKCT) allows dynamic assessment of the patellofemoral joint. DKCT was used to visualize and quantify patellar maltracking patterns, and severity of maltracking was correlated with the presence or absence of patellar instability symptoms.
Methods
Seventy-six knees in 38 patients were analysed using DKCT. Maltracking was defined as deviation of the patella from the trajectory of the trochlear groove and was characterized by patellar bisect offset, which was measured at 10° intervals of knee flexion during active flexion and extension. Bisect offset measurements were grouped by number of quadrants of maximum lateral patellar motion, with one, two, and three quadrants corresponding to 75–99, 100–125, and >125 %, respectively. Patellar instability symptoms were correlated with maltracking severity.
Results
Two knees were excluded because of poor imaging quality. Fifty of 74 knees had patellar instability, and 13 patients had bilateral symptoms. Of these, four (8 %) had normal tracking patterns; 41 (82 %) had increased lateral translation in extension, which we termed the J-sign pattern; 4 (8 %) had persistent lateralization of the patella throughout range of motion; and 1 had increased lateral translation in flexion. In knees with the J-sign pattern, degree of maltracking was graded by severity: J1 (
n
= 24), J2 (
n
= 19), and J3 (
n
= 15). The sensitivities of J-sign grades in predicting patellar instability symptoms were 50 % (J1), 80 % (J2), and 93 % (J3) (
p
< 0.01). There were significant differences in sensitivity between knees with no J sign or J1 versus J2 or J3 (
p
= 0.02).
Conclusion
DKCT showed several patellar maltracking patterns in patients with patellar instability. A J-sign pattern with more than two quadrants of lateral translation correlated with the presence of patellar instability symptoms. Incorporation of this approach of objectively quantifying maltracking patterns is recommended in the evaluation of patellofemoral instability.
Level of evidence
IV.
Journal Article
Clinician Perceptions of Clinical Pharmacy Services at Federally Qualified Health Centers in Ohio
Federally qualified health centers (FQHCs) are safety-net institutions that are heavily affected by burnout among health care professionals. We examined pharmacist-clinician relationships in FQHCs by assessing clinicians' satisfaction with clinical pharmacy services (CPS), perceptions of the impact of CPS on patient care and clinician well-being, and the potential impact of CPS on clinician retention. We used a survey composed of 21 questions sent to clinicians practicing within Ohio-based FQHCs with access to CPS. Respondents noted that CPS positively affected their well-being, specifically contributing to a more manageable workload, increased professional development, and freedom for clinicians to focus on more professionally fulfilling tasks. Clinicians perceived that CPS positively affects patient outcomes and provider retention. Federally qualified health center leadership can use these results to understand the contributions of CPS to patient care and clinician well-being and retention to enhance health care access and quality.
Journal Article
Genome-wide meta-analysis identifies novel risk loci for uterine fibroids within and across multiple ancestry groups
Uterine leiomyomata or fibroids are highly heritable, common, and benign tumors of the uterus with poorly understood etiology. Previous GWAS have reported 72 associated genes but included limited numbers of non-European individuals. Here, we identify 11 novel genes associated with fibroids across multi-ancestry and ancestry-stratified GWAS analyses. We replicate a known fibroid GWAS gene in African ancestry individuals and estimate the SNP-based heritability of fibroids in African ancestry populations as 15.9%. Using genetically predicted gene expression and colocalization analyses, we identify 46 novel genes associated with fibroids. These genes are significantly enriched in cancer, cell death and survival, reproductive system disease, and cellular growth and proliferation networks. We also find that increased predicted expression of
HEATR3
in uterine tissue is associated with fibroids across ancestry strata. Overall, we report genetic variants associated with fibroids coupled with functional and gene pathway enrichment analyses.
Here, the authors present multi-ancestry genome-wide meta-analyses of uterine fibroids, identifying 11 new gene associations, and demonstrating that heritability is higher in African ancestries.
Journal Article
Calcific Tendinitis of the Gluteus Maximus in a Golfer
Calcific tendinitis is a relatively rare condition in which calcium is inappropriately deposited in tendons, resulting in a local inflammatory reaction that can cause severe symptoms in certain cases. The cause of this disease process is not completely understood, although repetitive microtrauma likely plays a role in its development. Although the disorder most often involves the rotator cuff, it can affect other structures throughout the body, such as the tendons about the ankle and hip—including the rectus femoris and gluteus maximus. Nonoperative management typically involves using an anti-inflammatory medication and activity modification and can be augmented with formal physical therapy and modalities. Although nonoperative management provides adequate relief for many patients, sometimes operative debridement of the calcific deposit with or without repair of the involved tendon is required. The authors report an unusual case of calcific tendinitis of the gluteus maximus insertion in a golfer. The patient had tried nonoperative treatment for approximately 2 years with no real relief, and a recent exacerbation of the pain was significantly delaying his return to sport. Although plain radiographs did not show abnormalities, magnetic resonance imaging showed a calcific deposit in the insertion of the gluteus maximus tendon. After discussing further treatment options with the patient, the decision was made to remove the deposit and repair the insertion. He recovered completely and was able to return to play. The frequency, pathogenesis, and treatment of this condition are discussed in this case report, as well as the possible link to golf in this patient. [ Orthopedics. 2016; 39(5):e997–e1000.]
Journal Article
Recurrent Shoulder Instability: Do Morbidity and Treatment Differ Based on Insurance?
Background:
Patients with public insurance often face barriers to obtaining prompt orthopaedic care. For patients with recurrent traumatic anterior shoulder instability, delayed care may be associated with increasing bone loss and subsequently more extensive surgical procedures.
Purpose/Hypothesis:
The purpose of this study was to evaluate whether differences exist in patients undergoing treatment for shoulder instability between those with Medicaid versus non-Medicaid insurance. We hypothesized that at the time of surgery, Medicaid patients would have experienced greater delays in care, would have a more extensive history of instability, would have more bone loss, and would require more extensive surgical procedures than other patients.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Patients were identified who underwent surgical stabilization for traumatic anterior shoulder instability between January 1, 2011, and December 1, 2015, at a single sports medicine practice. Clinic, billing, and operative records were reviewed for each patient to determine age, sex, insurance type, total number of instability episodes, time from first instability episode to surgery, intraoperative findings, and procedure performed. Glenoid bone loss was quantified by use of preoperative imaging studies.
Results:
During this time period, 206 patients (55 Medicaid, 131 private insurance, 11 Tricare, 9 workers’ compensation) underwent surgical stabilization for traumatic anterior shoulder instability. Average wait time from initial injury to surgery was 1640 days (95% CI, 1155-2125 days) for Medicaid patients compared with 1237 days (95% CI, 834-1639 days) for others (P = .005). Medicaid patients were more likely to have sustained 5 or more instability events at the time of surgery (OR, 3.3; 95% CI, 1.64-6.69; P = .001), had a higher risk of having 15% or more glenoid bone loss on preoperative imaging (OR, 3.5; 95% CI, 1.3-10.0; P = .01), and had a higher risk of requiring Latarjet or other open stabilization procedures as opposed to an arthroscopic repair (OR, 3.0; 95% CI, 1.5-6.2; P = .002) when compared with other patients.
Conclusion:
Among patients undergoing surgery for traumatic anterior shoulder instability, patients with Medicaid had significantly more delayed care. Correspondingly, they reported a more extensive history of instability, were more likely to have severe bone loss, and required more invasive stabilization procedures.
Journal Article
430 Genome-wide meta-analysis identifies novel risk loci for uterine fibroids across multiple ancestry groups
OBJECTIVES/GOALS: Uterine fibroids are benign tumors of the uterus with a high disease prevalence and burden, yet there are few multi-ancestry genetic studies. This is the largest and most diverse fibroid GWAS to-date. Our goal is to identify novel genetic variants and gene expression pathways associated with fibroids and characterize their biological relevance. METHODS/STUDY POPULATION: We performed a cross-ancestry meta-analysis of GWAS summary statistics from eight datasets. The total sample size was 74,294 cases and 465,810 controls with participants of European (80% of sample), African (4%), East Asian, and Central South Asian (16%) ancestry. We mapped variants to genes with OpenTarget Genetics and used Functional Mapping and Annotation to conduct tissue expression gene-set enrichment and identify lead variants. We used S-PrediXcan to estimate genetically predicted gene expression (GPGE) associated with fibroid risk. This was with models that predicted gene expression across 49 different tissue types. Ingenuity Pathway Analysis compiled significant GPGE genes and their weights with a scientific literature database to identify overlapping pathways. RESULTS/ANTICIPATED RESULTS: We identified 370 independent significant variants. Among these, we identified variants mapped to three novel genes (PAX2, VIP, FOXO3) and eight genes not previously validated (TEKT1, SLC16A11, RPEL1, RASL11B, ASGR1, SLC12A7, TTC28, POLR2A). Many loci have roles in cell cycle regulation or are associated with fibroid risk factors like blood pressure, BMI, and vitamin D levels. Loci were significantly enriched in DNA damage and cell cycle pathways. Of 588 significant predicted expression gene-tissue pairs, 173 unique genes were novel fibroid associations. These genes are also associated with cancers, estradiol, and endometriosis. Top enriched pathways included p53 signaling, HOTAIR, BRCA1DNA damage response, and pulmonary fibrosis signaling. In uterine tissue there were 15 novel GPGE associations. DISCUSSION/SIGNIFICANCE: Using this large and diverse data, we identified novel loci associated with fibroids that are enriched in hormone-response, DNA damage, and cell-cycle pathways. GPGE loci were in tumorigenesis and fibrosis pathways. These novel genetic loci and uterine gene expression findings may provide translational opportunities for novel fibroid treatments.
Journal Article
Pediatric hand and wrist injuries
In the last 40 years, childhood hand and wrist injuries have become progressively more common as children have become heavier and more active in high impact sports. The majority of children with such injuries do well, but treatment is not always straightforward. Distal radius fractures, scaphoid fractures, metacarpal and phalangeal fractures, nailbed injuries, and amputations are among the pediatric hand and wrist injuries most often seen by orthopedists. These are all discussed, with a focus on the most recent literature and areas of evolving controversy.
Journal Article
CD 9 and vimentin distinguish clear cell from chromophobe renal cell carcinoma
Background
Clear cell renal cell carcinoma (ccRCC) and chromophobe renal cell carcinoma (chRCC) can usually be distinguished by histologic characteristics. Occasionally, diagnosis proves challenging and diagnostic difficulty will likely increase as needle biopsies of renal lesions become more common.
Methods
To identify markers that aid in differentiating ccRCC from chRCC, we used gene expression profiles to identify candidate markers that correlate with histology. 39 antisera and antibodies, including 35 for transcripts identified from gene expression profiling, were evaluated. Promising markers were tested on a tissue microarray (TMA) containing 428 renal neoplasms. Strength of staining of each core on the TMA was formally scored and the distribution of staining across different types of renal neoplasms was analyzed.
Results
Based on results from initial immunohistochemical staining of multitissue titer arrays, 23 of the antisera and antibodies were selected for staining of the TMA. For 7 of these markers, strength of staining of each core on the TMA was formally scored. Vimentin (positive in ccRCC) and CD9 (positive in chRCC) best distinguished ccRCC from chRCC. The combination of vimentin negativity and CD9 positivity was found to distinguish chRCC from ccRCC with a sensitivity of 100.0% and a specificity of 95.2%.
Conclusion
Based on gene expression analysis, we identify CD9 and vimentin as candidate markers for distinguishing between ccRCC and chRCC. In difficult cases and particularly when the amount of diagnostic tissue is limited, vimentin and CD9 staining could serve as a useful adjunct in the differential diagnosis of ccRCC and chRCC.
Journal Article
Characterizing Patterns In Patellar Maltracking On Dynamic Kinematic CT Imaging
Objectives:
Patellar maltracking has been traditionally difficult to assess due to its dynamic component. Unlike the assessment of malalignment, which relies on static radiographic measurements, maltracking is a dynamic phenomenon described subjectively with the J sign. The advent of dynamic, kinematic computed tomographic imaging (DKCT) has allowed for the dynamic assessment of the patellofemoral joint. We used DKCT to visualize and quantify patterns of patellar maltracking and correlated these findings with the presence or absence of symptoms of patellar instability.
Methods:
76 knees in 38 subjects were analyzed using DKCT. Measurements of bisect offset at 10° intervals of knee flexion were performed for each knee during active flexion/extension cycles. Patterns in bisect offset were assessed and graded in terms of 1, 2 or 3 quadrants of lateral patellar motion, based on 75-100, 100-125, and >125% bisect offset. The presence or absence of symptomatic patellar instability were recorded for each knee, and ratios of patients with symptoms were calculated for J sign tracking patterns of grades 1, 2 and 3. Differences in ratios between Grades 1, 2 and 3 were calculated using chi squared analysis.
Results:
76 knees were available for analysis, of which 51 had symptomatic patellar instability. 9 knees demonstrated normal patterns of tracking. 58 knees demonstrated increased lateral translation in extension. 7 knees showed persistent lateralization of the patella throughout range of motion, and 2 knees showed increased translation in flexion. In the 58 knees that showed maximal lateral translation in extension (J sign), the J sign was graded as 1(N=24), 2 (N=20) and 3 (N=14). The sensitivities of J sign grades in predicting patellar instability were 45.8% (J1), 80% (J2), and 92.9% (J3) (p<0.01), with statistically significant differences between Grades 1 and 2/3 (0=0.018).
Conclusion:
On DKCT imaging, we noted additional patterns of patellar maltracking besides the standard J sign. Of those with maltracking in extension (J sign), Grade 2 and 3 J signs with > 2 quadrants of patellar lateralization in extension were predictive of symptomatic patellar instability. Further understanding of patellar maltracking patterns can provide the clinician with information regarding the pathoanatomy and pathophysiology of patellar instability, and allow us to better plan for surgical stabilization.
Journal Article