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Objective: The flexed elbow, abducted shoulder, forearm supinated (FABS) position has been described as a method of imaging the distal biceps tendon on its long axis. The purpose of this study is to evaluate whether obtaining additional MR imaging in the FABS position changes the radiologist's assessment of the distal biceps tendon compared with traditional sequences only., Materials and Methods: Blinded review of 46 elbow MRIs when viewed without (-F) and with (+F) FABS sequences available was performed by two independent readers. The biceps tendon was graded in each case using a 0-3 scale, and a confidence level of 0-10 was assigned. -F and +F reads were compared. Reads were also compared with the surgical reference standard when available, 12 patients., Results: Pooled intra rater reliability was 0.800 (0.714, 0.886) between the -F and +F groups. Pooled mean confidence was 7.163 (1.252) for the -F group and 8.370 (1.264) for the +F group (p < 0.001). Pooled diagnostic accuracy was 0.651 (0.420, 0.882) for the -F group and 0.615 (0.456, 0.875) for the +F group compared with the surgical reference standard., Conclusion: The FABS sequence changed the radiologist's impression of the distal biceps tendon in the minority of cases and did not significantly change diagnostic accuracy. We do not recommend its use in the majority of cases. In challenging cases of high-grade partial vs complete tendon tear, FABS may be helpful to identify subtle residual tendon fibers.

Light matter interactions are greatly enhanced in two-dimensional (2D) semiconductors because of strong excitonic effects. Many optoelectronic applications would benefit from creating stacks of atomically thin 2D semiconductors separated by insulating barrier layers, forming multiquantum-well structures. However, most 2D transition metal chalcogenide systems require serial stacking to create van der Waals multilayers. Hybrid metal organic chalcogenolates (MOChas) are self-assembling hybrid materials that combine multiquantum-well properties with scalable chemical synthesis and air stability. In this work, we use spatially resolved linear and nonlinear optical spectroscopies over a range of temperatures to study the strongly excitonic optical properties of mithrene, that is, silver benzeneselenolate, and its synthetic isostructures. We experimentally probe s-type bright excitons and p-type excitonic dark states formed in the quantum confined 2D inorganic monolayers of silver selenide with exciton binding energy up to ∼0.4 eV, matching recent theoretical predictions of the material class. We further show that mithrene's highly efficient blue photoluminescence, ultrafast exciton radiative dynamics, as well as flexible tunability of molecular structure and optical properties demonstrate great potential of MOChas for constructing optoelectronic and quantum excitonic devices.

Two-dimensional (2D) excitons arise from electron-hole confinement along one spatial dimension. Such excitations are often described in terms of Frenkel or Wannier limits according to the degree of exciton spatial localization and the surrounding dielectric environment. In hybrid material systems, such as the 2D perovskites, the complex underlying interactions lead to excitons of an intermediate nature, whose description lies somewhere between the two limits, and a better physical description is needed. Here, we explore the photophysics of a tuneable materials platform where covalently bonded metal-chalcogenide layers are spaced by organic ligands that provide confinement barriers for charge carriers in the inorganic layer. We consider self-assembled, layered bulk silver benzeneselenolate, [AgSePh] ∞ , and use a combination of transient absorption spectroscopy and ab initio GW plus Bethe-Salpeter equation calculations. We demonstrate that in this non-polar dielectric environment, strongly anisotropic excitons dominate the optical transitions of [AgSePh] ∞ . We find that the transient absorption measurements at room temperature can be understood in terms of low-lying excitons confined to the AgSe planes with in-plane anisotropy, featuring anisotropic absorption and emission. Finally, we present a pathway to control the exciton behaviour by changing the chalcogen in the material lattice. Our studies unveil unexpected excitonic anisotropies in an unexplored class of tuneable, yet air-stable, hybrid quantum wells, offering design principles for the engineering of an ordered, yet complex dielectric environment and its effect on the excitonic phenomena in such emerging materials.

The meniscal ossicle is observed in clinical practice, yet there currently is limited information on its potential clinical significance. The purpose of this study was to assess the clinical presentation, imaging findings, and clinical treatment and outcomes of a series of patients identified as having a meniscal ossicle. An institutional database was reviewed to identify knees with a meniscal ossicle. Clinical presentation, magnetic resonance imaging (MRI), treatment, and outcomes were analyzed. Radiographs were graded using Kellgren-Lawrence (KL) scores. MRIs were reviewed for the presence and location of meniscal ossicles and additional knee pathology. Knee arthroplasty rates were recorded with the remaining patients contacted to obtain final International Knee Documentation Committee (IKDC) and Tegner's scores. Failure was defined as conversion to arthroplasty or failing IKDC score (< 75.4). Forty-five meniscal ossicles in 45 patients (26 males and 19 females) with a mean age of 51 years (standard deviation [SD] = 19.0) were included. Pain was the most common presenting symptom (89%). Forty-two patients (93%) had an associated meniscus root tear on MRI. Eighteen percent of patients that did not have an ossicle on initial imaging subsequently developed an ossicle. Mean KL grades progressed significantly from baseline of 1.84 (SD = 1.0) to 2.55 (SD = 0.93 p  < 0.01) on final follow-up. Thirty-nine percent of baseline radiographs showed KL grades of less than 2 compared with only 15% of follow-up radiographs ( p  = 0.04). Mean IKDC score obtained for patients ≤ 60 at an average follow-up of 3.1 years (SD = 3.2) was 65.2 (SD = 19.0). Eight out of 45 patients (18%) had progressed to total knee arthroplasty (TKA) by latest available follow-up. Sixty-two percent of patients met failure criteria at latest available follow-up. The meniscal ossicle is most commonly found in the posterior horn or root of the medial meniscus and is highly suggestive to be sequelae of a posterior root tear. Therefore, the presence of a meniscal ossicle should alert the orthopaedic surgeon to the high likelihood of the patient having a meniscus root tear. These patients have shown to have poor clinical outcomes and worsening arthritis., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective: To characterize the MRI findings present in patients with clinically proven or suspected jogger's foot., Materials and Methods: Ten years of medical charts in patients clinically suspected of having jogger's foot and who had MRI studies completed were identified utilizing a computer database search. Six study cases were identified. The MRI examinations of the study cases and an age- and gender-matched control group were reviewed in a blinded fashion by two musculoskeletal radiologists. Size and signal intensity of the medial plantar nerve were measured and characterized. The medial foot musculature was assessed for acute or chronic denervation changes., Results: The medial plantar nerve was found to have moderately increased T2 signal compared with normal skeletal muscle in 3/6 study group cases and markedly increased T2 signal in the remaining 3/6 cases. In all control cases, the nerve was reported to have T2 signal equal or minimally higher than normal skeletal muscle. The mean total size of the medial plantar nerve was significantly larger in the study group when compared with that in the control group at all measured locations (p < 0.04)., Conclusions: Abnormal thickness and T2 hyperintensity of the medial plantar nerve centered at the master knot of Henry are characteristic MRI findings in patients with jogger's foot when compared with control subjects. Muscular denervation changes may also be seen, most commonly in the flexor hallucis brevis muscle.

Neutrophil extracellular traps (NETs) provide host defense but can contribute to the pathobiology of diverse human diseases. We sought to determine the extent and mechanism by which NETs contribute to human airway cell inflammation. Primary normal human bronchial epithelial cells (HBEs) grown at air-liquid interface and wild-type (wt)CFBE41o- cells (expressing wtCFTR) were exposed to cell-free NETs from unrelated healthy volunteers for 18 h in vitro. Cytokines were measured in the apical supernatant by Luminex, and the effect on the HBE transcriptome was assessed by RNA sequencing. NETs consistently stimulated IL-8, TNF-α, and IL-1α secretion by HBEs from multiple donors, with variable effects on other cytokines (IL-6, G-CSF, and GM-CSF). Expression of HBE RNAs encoding IL-1 family cytokines, particularly IL-36 subfamily members, was increased in response to NETs. NET exposure in the presence of anakinra [recombinant human IL-1 receptor antagonist (rhIL-1RA)] dampened NET-induced changes in IL-8 and TNF-α proteins as well as IL-36α RNA. rhIL-36RA limited the increase in expression of proinflammatory cytokine RNAs in HBEs exposed to NETs. NETs selectively upregulate an IL-1 family cytokine response in HBEs, which enhances IL-8 production and is limited by rhIL-1RA. The present findings describe a unique mechanism by which NETs may contribute to inflammation in human lung disease in vivo. NET-driven IL-1 signaling may represent a novel target for modulating inflammation in diseases characterized by a substantial NET burden.

Bone marrow edema (BME) can be a late finding in osteoarthritis or a sign of subchondral insufficiency. The purpose of this study was to describe the magnetic resonance imaging (MRI) finding we refer to as "osteomeniscal impact edema" (OMIE), or reactive BME adjacent to a displaced meniscus flap tear. In addition, this edema pattern is compared with a control group of medial meniscus posterior root tears (MMPRT) with subchondral insufficiency edema. MRI records from 2000 to 2017 were retrospectively reviewed for studies that showed the presence of a medial meniscus displaced flap tear and an adjacent area of BME. The selected MRIs were matched to an equal number of MMPRT MRI studies. All MRI studies were assessed for cartilage surface grade using the modified Outerbridge classification system and for the extent of accompanying structural abnormalities using the whole-organ magnetic resonance imaging score. Descriptive statistics and hypothesis testing were utilized to compare the MRI findings between groups. Twenty-two flap tear (OMIE group) patients with a mean age of 57 (SD: 15) and 22 root tear (MMPRT) group patients with a mean age of 61 (SD: 10) were included. MRIs in the OMIE group showed a distinctive pattern of focal, peripheral edema adjacent to the meniscus flap tear, compared with more diffuse, central edema in the MMPRT group. Quantitatively, MRIs of the MMPRT group showed significantly worse mean femoral Outerbridge scores (3.72 vs. 2.68, p  < 0.0001), more severe central (1.63 vs. 0.5, p  = 0.0007) and posterior (0.31 vs. 0.0, p  = 0.04) subchondral edema grades, and a higher incidence of tibial subchondral fractures (3 vs. 0, p  = 0.036). Meniscus flap tears may present with a distinct MRI pattern of focal, adjacent, peripheral edema, which we refer to as OMIE. Patients with meniscus flap tears showed significantly less arthritic change, lower subchondral edema grades, and a lower incidence of insufficiency fractures and subchondral collapse compared with the diffuse overload edema pattern found with root tears. The Level of Evidence for this study is III., Competing Interests: M. J. S. reports other from American Journal of Sports Medicine; grants, personal fees, non-financial support and other from Arthrex, Inc.; and grants from Styrker, outside the submitted work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Iliopsoas release is a common procedure for coxa saltans interna of the hip. The possible sequelae from this surgery have not been well studied. The purpose of this study was to determine postoperative atrophy and morphology of the cut tendon. This retrospective review included patients who underwent arthroscopic iliopsoas release and had magnetic resonance imaging of the ipsilateral hip before and after surgical intervention. Cross-sectional area measurements were obtained of the iliopsoas muscle at the level of the distal anterior inferior iliac spine as well as at the L5 vertebral pedicle in patients who had imaging that included the lower lumbar spine. Patient-reported outcomes included the modified Harris Hip Score (mHHS) and the Hip Outcome Score subscales for activities of daily living (HOS ADL) and sport (HOS Sport). A total of 44 patients met inclusion criteria for this study; 26 patients had additional advanced imaging that included the lumbar spine. The cross-sectional area of the iliopsoas at the level of the anterior inferior iliac spine decreased postoperatively by a mean of 191.4 mm 2 ;, this difference was statistically significant (P<.0001). Mean area at the L5 pedicle was 628.9 mm 2 on the released side and 1216.2 mm 2 on the nonoperative side (P<.05). Mean Goutallier-Fuchs score of the released iliopsoas at the L5 pedicle was 1.3 (SD, 0.7). Mean mHHS, HOS ADL, and HOS Sport scores for patients at least 1 year postoperatively were 51, 56, and 42, respectively. [Orthopedics. 2020;43(3):e171-e176.]., (Copyright 2020, SLACK Incorporated.)

Objective: To characterize the radiographic, CT, and MRI appearance of clinically and/or surgically proven osteochondral lesions of the lateral trochlear ridge., Materials and Methods: Ten years of medical charts with elbow radiographic, CT, and MRI studies were retrospectively reviewed. Patients with pathology isolated to the lateral trochlear ridge were included. Studies were reviewed by two radiologists. Identifiable pathology on each type of study was noted and characterized., Results: Ten elbow studies were included, all from males aged 15 to 58 years (mean 29 years). Five elbow radiographs were normal, one showed mixed lucency and sclerosis of the lateral trochlear ridge, and four demonstrated small osseous fragments adjacent to the ridge. In all cases, CT demonstrated focal lucency at the cortical surface of the lateral trochlear ridge; 8 contained small osseous fragments, axial plane maximum width ranged from 5 to11 mm, depth from 1 to 2 mm. Focal bone marrow edema in the subchondral lateral trochlear ridge was found in the 6 cases with MR images. Two demonstrated linear high signal underlying the in situ osseous fragment, faintly visible on MRI. In 9 cases, arthroscopy was performed within 3 months of imaging. The remaining patient was treated conservatively with casting., Conclusions: Osteochondral lesions of the lateral trochlear ridge are rare but important, as these patients go on to arthroscopy at a high rate. If an abnormality of the lateral trochlear ridge is seen or suspected, we recommend CT as the best imaging study to define these lesions.

Background: The daily burden of health maintenance for children and families with cystic fibrosis (CF) is immense with respect to time and complexity of care. Infection control practices, specifically nebulizer cleaning and disinfection, are a recommended component of home health care for CF families due to colonization of home respiratory equipment with lung pathogens. To better inform education interventions at our center, we were interested in studying how families' views on infection prevention and awareness of CF Foundation infection prevention and control (IP&C) guidelines correlate with actual home nebulizer care and the presence of microorganisms on their nebulizers., Methods: Twenty families who have children with CF were surveyed to better understand attitudes toward infection prevention, awareness of CFF IP&C guidelines and nebulizer cleaning and disinfection practices in the home. Their nebulizers were also cultured for microbes to correlate recovery with infection control behaviors., Results: A subset of families recognizes the importance of germ avoidance but do not recognize nebulizer cleaning and disinfection as very important for infection control practices. Decreased frequency of disinfection, but not cleaning, was correlated with the recovery of organisms on the nebulizers., Conclusions: The study questionnaire results identify a gap between recognizing the importance of infection prevention and consistently implementing CFF IP&C guidelines in the home. This demonstrates the need at our center for new educational interventions to promote cleaning and disinfection of home nebulizers after each use as recommended by the CFF., (Copyright © 2019 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

An unusual trithioorthoformate-capped cyclophane cage was assembled via antimony-activated iodine oxidation of thiols as confirmed by 1 H-NMR spectroscopy and X-ray crystallography. The disulfide bridges can undergo desulfurization with hexamethylphosphorous triamide (HMPT) at ambient temperature to capture a trithioether cyclophane cage capped by the trithioorthoformate. In both cages a methine proton points directly into the small cavity. This unexpected structure is hypothesized to have formed as a result of haloform insertion during oxidation., (© 2019 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.)

The γ-crystallins of the eye lens nucleus are among the longest-lived proteins in the human body. Synthesized in utero, they must remain folded and soluble throughout adulthood to maintain lens transparency and avoid cataracts. γD- and γS-crystallin are two major monomeric crystallins of the human lens. γD-crystallin is concentrated in the oldest lens fiber cells, the lens nucleus, whereas γS-crystallin is concentrated in the younger cells of the lens cortex. The kinetic stability parameters of these two-domain proteins and their isolated domains were determined and compared. Kinetic unfolding experiments monitored by fluorescence spectroscopy in varying concentrations of guanidinium chloride were used to extrapolate unfolding rate constants and half-lives of the crystallins in the absence of the denaturant. Consistent with their long lifespans in the lens, extrapolated half-lives for the initial unfolding step were on the timescale of years. Both proteins' isolated N-terminal domains were less kinetically stable than their respective C-terminal domains at denaturant concentrations predicted to disrupt the domain interface, but at low denaturant concentrations, the relative kinetic stabilities were reversed. Cataract-associated aggregation has been shown to proceed from partially unfolded intermediates in these proteins; their extreme kinetic stability likely evolved to protect the lens from the initiation of aggregation reactions. Our findings indicate that the domain interface is the source of significant kinetic stability. The gene duplication and fusion event that produced the modern two-domain architecture of vertebrate lens crystallins may be the origin of their high kinetic as well as thermodynamic stability., (Copyright © 2019 Biophysical Society. Published by Elsevier Inc. All rights reserved.)

Objective: To characterize the MRI appearance of the anomalous volar radiotriquetral ligament in cases of classic Madelung deformity., Materials and Methods: With institutional review board approval, a search of the radiology information system was performed to identify cases of potential Madelung deformity using variations of the criteria "Madelung deformity." Cases of classic Madelung deformity were included based on the following criteria: dorsal subluxation of the ulnar head, volar tilt of the distal radius, increased radial inclination of greater than 25°, triangulation of the carpus, and presence of Vickers ligament defined as an anomalous volar radiolunate ligament. Patients with a history of wrist trauma or severe degenerative change distorting anatomy were excluded. The resulting cases were reviewed to characterize the anomalous radiotriquetral ligament., Results: Eight cases of classic Madelung deformity in 6 patients were identified. All 8 cases were characterized by the presence of an anomalous radiotriquetral ligament, which was more conspicuous than Vickers ligament. None of the excluded pseudo-Madelung deformity cases displayed a Vickers ligament or radiotriquetral ligament., Conclusion: The radiotriquetral ligament is an anomalous ligament that is a constant and distinguishing finding in classic Madelung deformity in this study. Awareness of the radiotriquetral ligament and distinguishing it from Vickers ligament on imaging studies and at surgery may have clinical implications that need to be further investigated.

Objectives: The present study tested the effects of background speech and nonspeech noise on 5-year-old children's working memory span., Design: Five-year-old typically developing children (range = 58.6 to 67.6 months; n = 94) completed a modified version of the Missing Scan Task, a missing-item working memory task, in quiet and in the presence of two types of background noise: male two-talker speech and speech-shaped noise. The two types of background noise had similar spectral composition and overall intensity characteristics but differed in whether they contained verbal content. In Experiments 1 and 2, children's memory span (i.e., the largest set size of items children successfully recalled) was subjected to analyses of variance designed to look for an effect of listening condition (within-subjects factor: quiet, background noise) and an effect of background noise type (between-subjects factor: two-talker speech, speech-shaped noise)., Results: In Experiment 1, children's memory span declined in the presence of two-talker speech but not in the presence of speech-shaped noise. This result was replicated in Experiment 2 after accounting for a potential effect of proactive interference due to repeated administration of the Missing Scan Task., Conclusions: Background speech, but not speech-shaped noise, disrupted working memory span in 5-year-old children. These results support the idea that background speech engages domain-general cognitive processes used during the recall of known objects in a way that speech-shaped noise does not.

Background: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) most commonly follows an indolent course; however, a subset of patients display more advanced disease marked by recurrent and disseminated growth refractory to treatment. This study evaluated outcomes of advanced disease, specifically bilateral disease, lymph node involvement, organ metastasis, and/or disease-related death., Methods: Published cases of BIA-ALCL from 1997 to 2018 and unpublished cases at the authors' institution were retrospectively reviewed, and patients with advanced disease were selected. Treatment and outcomes were compared against a control of BIA-ALCL subjects without advanced disease., Results: Thirty-nine patients with advanced BIA-ALCL were identified who had bilateral disease (n = 7), lymph node and organ metastasis (stage IIB-IV, n = 24), and disease-related death (n = 8). Sixty-five patients were included in a comparison control group (stage 1A-1C). Treatment types for advanced disease patients were complete surgery, n = 16 (55.2%); limited surgery, n = 19 (65.5%); chemotherapy, n = 26 (89.7%); salvage chemotherapy, n = 11 (37.9%); radiation, n = 15 (51.7%); and autologous stem cell transplant, n = 6 (20.7%). The rates of complete remission for the bilateral and lymphadenopathy groups were 4 of 7 (57%, P < 0.001) and 16 of 24 (67%, P = 0.128), respectively. Compared with the control group, advanced disease patients had significantly longer time from diagnosis to definitive surgery (21 versus 8 months, P = 0.039) and a lower rate of complete surgery (59% versus 88%, P = 0.004)., Conclusions: Advanced disease BIA-ALCL may be a consequence of a delay or suboptimal treatment of BIA-ALCL. Optimal adjuvant chemotherapy and indications for radiation for BIA-ALCL patients with advanced features are not yet clearly defined. Advanced disease is the end of the spectrum of cancer stages, and these patients substantiate the World Health Organization classification of BIA-ALCL as a lymphoma rather than benign or lymphoproliferative.

Introduction: The purpose of this study was to assess whether median nerve ultrasonography (US) measurements correlate with the severity scale of electrodiagnostic studies (EDS) of carpal tunnel syndrome (CTS)., Methods: A retrospective review was conducted of patients aged ≥18 years who underwent both median nerve US and EDS. US measurements of the median nerve cross-sectional area at the distal wrist crease and forearm were used to calculate the median nerve wrist-to-forearm ratio. EDS severity was classified according to guidelines from the American Association of Electrodiagnostic Medicine., Results: A total of 112 wrists (n = 112) in 78 consecutive patients with a mean age of 59 (range, 26 to 88) years were included. Increased cross-sectional area at the distal wrist crease and wrist-to-forearm ratio were significantly correlated with increased EDS severity (P < 0.0001)., Discussion: Median nerve US measurements not only distinguished between normal and abnormal EDS but also correlated with the category of EDS severity., Level of Evidence: Diagnostic III.

Objective: The purpose of this study is to describe the MR arthrogram appearance of the postoperative glenoid labrum and to describe the features consistent with recurrent tear., Materials and Methods: We identified 30 patients who had undergone glenoid labral repair, had a subsequent MR arthrogram of his or her shoulder, and went on to repeat shoulder arthroscopy. Each MR arthrogram was reviewed blindly, and the glenoid labrum was described as normal, irregular, or torn. Additional findings recorded included the presence or absence of a paralabral cyst and suture anchors in the glenoid. The operative report was also reviewed for each patient to determine the status of the labrum at arthroscopy., Results: Following consensus review, 18/30 MRIs were felt to demonstrate recurrent glenoid labral tear, 11/30 showed an irregular labrum, and 1/30 was called normal. The radiology impression regarding the presence or absence of a recurrent glenoid labral tear agreed with the operative report in 24/30 (80%) cases, and was discrepant in six. This equals 83.3% sensitivity and 81.8% specificity of MR arthrogram in the diagnosis of recurrent labral tear in this study. A paralabral cyst was present in 3/30 (10%) cases, all three of which were torn., Conclusions: MR arthrogram findings of signal equal to gadolinium or fluid within or underlying the glenoid labrum and markedly diminutive or absent labrum were the most useful features to diagnose recurrent tear. Some signal underlying the labrum, which is confined to the anterosuperior quadrant, may be normal. The secondary finding of a paralabral cyst was also highly sensitive for recurrent tear.

The impact of Pneumocystis pneumonia (PcP) on morbidity and mortality remains substantial for immunocompromised individuals, including those afflicted by HIV infection, organ transplantation, cancer, autoimmune diseases, or subject to chemotherapy or corticosteroid-based therapies. Previous work from our group has shown that repurposing antimalarial compounds for PcP holds promise for treatment of this opportunistic infection. Following our previous discovery of chloroquine analogues with dual-stage antimalarial action both in vitro and in vivo , we now report the potent action of these compounds on Pneumocystis carinii in vitro Identification of chloroquine analogues as anti-PcP leads is an unprecedented finding., (Copyright © 2018 American Society for Microbiology.)

Medial meniscus posterior root tears (MMPRTs) are a significant source of pain and dysfunction. The purpose of this study was to evaluate changes in the medial compartment of the knee over time following the diagnosis of a MMPRT on MRI. A retrospective review of the institutional database was performed for patients with an initial MRI diagnosis of a MMPRT. Patients were included if they had a subsequent follow-up MRI on the same knee. Patients with surgical intervention, including debridement or repair, were excluded. MRIs were evaluated by two board-certified musculoskeletal radiologists. MMPRTs were defined using the LaPrade classification, and the medial compartment articular cartilage was graded using the modified Outerbridge classification. MRIs were reviewed for meniscus extrusion, subchondral bone edema, and insufficiency fractures. Patients were divided into two groups for the analysis to account for differences in MRI time intervals. Group 1 had a follow-up MRI within 12 months of initial imaging (subacute group) and Group 2 had a follow-up MRI greater than 12 months after initial imaging (chronic group). Forty-one knees and 82 MRIs were analyzed, including 20 knees/40 MRIs (13 females, 7 males) in the subacute group and 21 knees/42 MRIs (14 females, 7 males) in the chronic group. Subacute patients had a mean age of 59.5 ± 8.8 years and a mean interval of 4.8 ± 2.6 months between MRIs compared with 53.6 ± 11.0 years and 38.2 ± 20.8 months, respectively, for the chronic group. Meniscal extrusion, femoral modified Outerbridge grade, and tibial modified Outerbridge grade worsened between initial and final MRI in both groups ( p  < 0.05). In both groups, there were no significant differences between initial and final MRIs with regard to the LaPrade classification, insufficiency fracture, or subchondral cysts of the tibia. Progressive meniscus extrusion and medial compartment articular cartilage degeneration were seen in patients with MMPRTs within a year from diagnosis., Competing Interests: A.J.K.: American Journal of Sports Medicine: Editorial or governing board; Arthrex, Inc: Paid consultant; Arthritis Foundation: Research support; Ceterix: Research support; Histogenics: Research support; International Cartilage Repair Society: Board or committee member; International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine: Board or committee member; Minnesota Orthopedic Society: Board or committee member; Musculoskeletal Transplantation Foundation: Board or committee member.M.J.S.: American Journal of Sports Medicine: Editorial or governing board; Arthrex, Inc: IP royalties; Paid consultant; Stryker: Research support.All the other authors report no conflict of interest., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Competing Interests: Disclosure The authors report no conflicts of interest in this work., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Objective: The Cystic Fibrosis Foundation (CFF) recommends routine nebulizer disinfection for patients but compliance is challenging due to the heavy burden of home care. SoClean® is a user friendly ozone based home disinfection device currently for home respiratory equipment. The objective of this study was to determine whether SoClean® has potential as a disinfection device for families with CF by killing CF associated bacteria without altering nebulizer output., Hypothesis: Ozone based disinfection effectively kills bacterial pathogens inoculated to home nebulizer equipment without gross changes in nebulizer function., Study Design: Common bacterial pathogens associated with CF were inoculated onto the PariLC® jet nebulizer and bacterial recovery compared with or without varied ozone exposure. In separate experiments, nebulizer output was estimated after repeated ozone exposure by weighing the nebulizer., Results: Ozone disinfection was time dependent with a 5 min infusion time and 120 min dwell time effectively killing >99.99% bacteria tested including Pseudomonas aeruginosa and Staphylococcus aureus. Over 250 h of repeat ozone exposure did not alter nebulizer output. This suggests SoClean® has potential as a user-friendly disinfection technique for home respiratory equipment., (© 2018 Wiley Periodicals, Inc.)

Background: Lateral meniscus posterior root tears (LMPRTs), if left untreated, can cause devastating effects to the knee, with rapid articular cartilage degeneration and loss of the meniscus as a secondary stabilizer. Detection and surgical repair of these defects have been linked to favorable outcomes, but preoperative identification of LMPRTs continues to be challenging., Purpose: To determine the rate of LMPRTs diagnosed preoperatively on magnetic resonance imaging (MRI) in a consecutive series of arthroscopically confirmed LMPRTs., Study Design: Case series; Level of evidence, 4., Methods: A retrospective cohort of 45 consecutive patients with arthroscopically confirmed LMPRTs between 2010 and 2017 were included in this study. The preoperative MRI report for each patient was evaluated and compared with intraoperative findings. Each preoperative MRI study was then reviewed by 2 fellowship-trained musculoskeletal radiologists who worked in consensus., Results: A total of 45 patients (32 males, 13 females) with arthroscopically confirmed LMPRTs and a mean age of 27 years (range, 14-54 years) were included in the study. Only 15 of 45 LMPRTs (33%) were initially diagnosed on preoperative MRI. Past or concurrent anterior cruciate ligament (ACL) reconstruction was present in 37 of 45 cases (82%). Upon retrospective review, 15 of the 30 missed LMPRTs were "clearly evident," 12 "subtly evident," and 3 "occult" (unavoidably missed). There were no significant differences in the rate of LMPRT diagnosis based on history of prior knee surgery, meniscus extrusion, or tearing of the meniscofemoral ligament., Conclusion: Despite improved identification of other meniscus tear patterns on MRI, a high percentage of LMPRTs were still missed. In the setting of previous ACL reconstruction, if the root cannot be confidently identified, the MRI interpretation should indicate that "the root is poorly visualized" to alert the surgeon to thoroughly evaluate this structure. The surgeon should maintain a high index of suspicion and carefully probe the posterior root of the lateral meniscus at the time of arthroscopy, especially in cases of ACL injury., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: A.J.K. receives research support from Aesculap/B. Braun, the Arthritis Foundation, Ceterix, and Histogenics; is a paid consultant for Arthrex and Vericel; and is on the board of the Musculoskeletal Transplant Foundation. D.B.F.S. receives research support from Arthrex, Ivy Sports, and Smith & Nephew and is a paid consultant for Cartiheal, Smith & Nephew, and Vericel. B.A.L. receives royalties from Arthrex; is paid consultant for Arthrex and Smith & Nephew; and receives research support from Arthrex, Biomet, Smith & Nephew, and Stryker. M.J.S. is a paid consultant for Arthrex, receives royalties from Arthrex, and receives research support from Stryker.

The synthesis of large cyclic and caged disulfide structures was achieved by pnictogen-assisted iodine oxidation starting from self-assembled pnictogen thiolate complexes. The directing behavior of pnictogen enables rapid and selective syntheses of many discrete disulfide assemblies over competing oligomers/polymers, ranging from structures that are small and strained to those that are large and multifaceted, including 3D cages. Traditional cyclization reactions carried out under kinetic control are generally low-yielding, which often results in the formation of insoluble oligomers and polymers as unwanted side products. The prospect of self-assembling organic structures efficiently under thermodynamic control adds an attractive tool for the synthesis of cyclophanes and other large cage compounds. This method of metaloid-directed self-assembly within a dynamic covalent system allows for the rapid and discriminant self-assembly of disulfide cyclophanes without the consequences sometimes seen in traditional cyclophane syntheses such as poor yields, long reaction times, low ring-closing selectivity, and extensive purifications. The present paper provides an overview of this approach, explores the role of the pnictogen additive and solvent in this reaction, begins to test the limits of this strategy in complex 3D molecule formation, and extends our strategy to include one-pot syntheses that do not require the use of a pnictogen additive. This Viewpoint also includes an extended introduction to serve as a minireview highlighting the utility of a self-assembly approach to create organic cage structures. From a practical standpoint, the cyclophanes isolated from this method can serve as precursors in the production of insulating plastics (e.g., through the widely used parylene polymerization process, which uses derivatives of paracyclophane as monomers) or as potential hosts for molecular separations or capture.

Background: Randomized trials have shown the benefits of injecting bone marrow-derived mesenchymal stem cells (BmMSCs) after standard hip decompression in patients with osteonecrosis of the femoral head. However, the combination of BmMSCs and platelet-rich plasma (PRP) injected into the femoral head after decompression has not been reported previously. This study reports the results in a preliminary series of patients with osteonecrosis of the femoral head treated with BmMSCs plus PRP., Questions/purposes: (1) What is the survivorship free from reoperation, hip arthroplasty, and femoral head collapse in a preliminary series of patients with osteonecrosis of the femoral head treated with BmMSCs plus PRP? (2) Is there a change in the degree of femoral head involvement based on modified Kerboul angle? (3) What were the scores observed for pain and function at last followup? (4) Was there a difference in survivorship free from reoperation as a function of in vitro MSC count and viability?, Methods: Twenty-two consecutive patients (35 hips; 11 men and 11 women) with corticosteroid-induced osteonecrosis who met study inclusion criteria were enrolled; none declined participation, and none was lost to followup, although one patient (two hips) died within a year of the procedure for reasons unrelated to it, and five patients (seven hips) did not undergo MRI at the 1-year followup. All patients had precollapse osteonecrosis, rated either University of Pennsylvania Stage 1 (n = 4) or Stage 2 (n = 31 hips). Mean age and body mass index were 43 years and 31 kg/m, respectively. Patients underwent pre- and postoperative radiographs and MRI to assess femoral head involvement using the modified Kerboul angle. Absolute cell count and colony-forming unit (CFU) assays were used to assess MSC abundance and viability of the bone marrow obtained at the time of surgery. Patients were followed at regular intervals to assess clinical response to treatment with a mean followup of 3 years (range, 2-4 years). The change in femoral head involvement was assessed with the modified Kerboul angle; the Harris hip score was used to assess clinical outcome; and conversion to THA, reoperation, and survivorship free from femoral head collapse were analyzed with the Kaplan-Meier method on a per-hip basis., Results: Survivorship free from THA, any procedure, and femoral head collapse was 84% (95% confidence interval [CI], 75%-93%), 67% (95% CI, 55%-79%), and 93% (95% CI, 76%-98%), respectively, at 3 years postoperatively; two patients (four hips) underwent a second decompression and MSC injection for persistent pain without signs of radiographic collapse. All patients with collapse underwent THA. The mean modified Kerboul angle improved from 205° ± 47° to 172° ± 48° postoperatively (mean change -30° ± 6°, p = 0.01). A greater proportion of patients who underwent an additional procedure had a modified Kerboul grade of 3 or 4 preoperatively (80% [four of five] versus 13% [four of 30 Grade 1 or 2; odds ratio, 26; 95% CI, 2-296; p = 0.005). Preoperatively the mean Harris hip score was 57 ± 12, which improved to 85 ± 15 (mean change 28 ± 3, p < 0.001) at most recent followup. Patients undergoing a reoperation or THA had a lower mean concentration of nucleated cells/mL (5.5 x 10 ± 2.8 x 10 cells/mL versus 2.3 x 10 ± 2.2 x 10 cells/mL, p = 0.02) and lower mean CFUs (13 ± 6 versus 19 ± 7, p = 0.04) compared with those who did not., Conclusions: Core hip decompression with injection of concentrated bone marrow plus PRP improved pain and function; > 90% of hips in this series were without collapse at a minimum of 2 years. In this preliminary study, successful results were seen when nucleated cell count was high and modified Kerboul grade was low. Further randomized studies are needed to determine this procedure's efficacy versus core decompression or nonoperative treatment alone., Level of Evidence: Level II, therapeutic study.

[This corrects the article DOI: 10.1039/C7MD00445A.].

Here we describe the potency of 21 pentamidine analogues against the fungal pathogen, Pneumocystis carinii , in an ATP bioluminescent assay with toxicity profiles in 2 mammalian cell lines. Reduction of two 5-methyl-1,2,4-oxadiazole rings was applied to the synthesis of acid-labile bisamidines. Anti- Pneumocystis activity is discussed in the context of 3 groups of compounds depending on the main structural changes of the pentamidine lead structure. The groups include: 1) 1,4-bis(methylene)piperazine derivatives 1-5 ; 2) alkanediamide derivatives 6-10 ; 3) alkane-derived bisbenzamidines 11-21 . IC 50 values of 18 compounds were lower than the IC 50 of pentamidine. Four bisamidines were active at nanogram concentrations. Introduction of sulfur atoms in the alkane bridge, replacement of the amidino groups with imidazoline rings, or attachment of nitro or amino groups to the benzene rings is responsible for remarkable activity of the new leading structures. The vast majority of compounds, including four highly active ones, can be classified as mild or nontoxic to host cells. These compounds show promise as candidates for new anti- Pneumocystis agents.

Fungi in the genus Pneumocystis live in the lungs of mammals, where they can cause a fatal pneumonia (PCP [Pneumocystis pneumonia]) in hosts with compromised immune systems. The absence of a continuous in vitro culture system for any species of Pneumocystis has led to limited understanding of these fungi, especially for the discovery of new therapies. We recently reported that Pneumocystis carinii, Pneumocystis murina, and most significantly, Pneumocystis jirovecii lack both enzymes necessary for myo-inositol biosynthesis but contain genes with homologies to fungal myo-inositol transporters. Since myo-inositol is essential for eukaryotic viability, the primary transporter, ITR1, was functionally and structurally characterized in P. carinii The predicted structure of P. carinii ITR1 (PcITR1) contained 12 transmembrane alpha-helices with intracellular C and N termini, consistent with other inositol transporters. The apparent K m was 0.94 ± 0.08 (mean ± standard deviation), suggesting that myo-inositol transport in P. carinii is likely through a low-affinity, highly selective transport system, as no other sugars or inositol stereoisomers were significant competitive inhibitors. Glucose transport was shown to use a different transport system. The myo-inositol transport was distinct from mammalian transporters, as it was not sodium dependent and was cytochalasin B resistant. Inositol transport in these fungi offers an attractive new drug target because of the reliance of the fungi on its transport, clear differences between the mammalian and fungal transporters, and the ability of the host to both synthesize and transport this critical nutrient, predicting low toxicity of potential inhibitors to the fungal transporter., Importance: myo-Inositol is a sugarlike nutrient that is essential for life in most organisms. Humans and microbes alike can obtain it by making it, which involves only 2 enzymes, by taking it from the environment by a transport process, or by recycling it from other cellular constituents. Inspection of the genomes of the pathogenic fungi of the genus Pneumocystis showed that these pneumonia-causing parasites could not make myo-inositol, as they lacked the 2 enzymes. Instead, we found evidence of inositol transporters, which would import the sugar from the lungs where the fungi reside. In the present report, we characterized the transport of myo-inositol in the fungus and found that the transporter was highly selective for myo-inositol and did not transport any other molecules. The transport was distinct from that in mammalian cells, and since mammals can both make and transport myo-inositol, while Pneumocystis fungi must transport it, this process offers a potential new drug target., (Copyright © 2016 Cushion et al.)

Objective: Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected., Materials and Methods: Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate., Results: In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality., Conclusion: Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee.

Two selenium (Se) fertilization methods were tested for their effects on levels of anticarcinogenic selenocompounds in radish (Raphanus sativus), as well as other nutraceuticals. First, radish was grown on soil and foliar selenate applied 7 days before harvest at 0, 5, 10, and 20 mg Se per plant. Selenium levels were up to 1200 mg Se/kg DW in leaves and 120 mg Se/kg DW in roots. The thiols cysteine and glutathione were present at 2-3-fold higher levels in roots of Se treated plants, and total glucosinolate levels were 35% higher, due to increases in glucoraphanin. The only seleno-aminoacid detected in Se treated plants was Se-methyl-SeCys (100 mg/kg FW in leaves, 33 mg/kg FW in roots). The levels of phenolic aminoacids increased with selenate treatment, as did root total nitrogen and protein content, while the level of several polyphenols decreased. Second, radish was grown in hydroponics and supplied with 0, 5, 10, 20, or 40 μM selenate for 1 week. Selenate treatment led to a 20-30% increase in biomass. Selenium concentration was 242 mg Se/kg DW in leaves and 85 mg Se/kg DW in roots. Cysteine levels decreased with Se in leaves but increased in roots; glutatione levels decreased in both. Total glucosinolate levels in leaves decreased with Se treatment due to repression of genes involved in glucosinolates metabolism. Se-methyl-SeCys concentration ranged from 7-15 mg/kg FW. Aminoacid concentration increased with Se treatment in leaves but decreased in roots. Roots of Se treated plants contained elevated transcript levels of sulfate transporters (Sultr) and ATP sulfurylase, a key enzyme of S/Se assimilation. No effects on polyphenols were observed. In conclusion, Se biofortification of radish roots may be achieved via foliar spray or hydroponic supply. One to ten radishes could fulfill the daily human requirement (70 μg) after a single foliar spray of 5 mg selenate per plant or 1 week of 5-10 μM selenate supply in hydroponics. The radishes metabolized selenate to the anticarcinogenic compound Se-methyl-selenocysteine. Selenate treatment enhanced levels of other nutraceuticals in radish roots, including glucoraphanin. Therefore, Se biofortification can produce plants with superior health benefits.

Objective: To highlight the significance and imaging characteristics of Morel-Lavallée (ML) lesions, which have been well characterized on MRI, but are potentially under-recognized on CT., Materials and Methods: Twenty-eight Morel-Lavallée lesions were identified in 18 patients and were all clinically or surgically confirmed. Lesions were grouped into acute (<3 days), subacute (3-30 days), and chronic (>30 days) at the time of CT imaging. Charts were reviewed to gather patient characteristics, injury patterns, radiologist interpretation, treatment, and outcomes., Results: Sixteen male and 2 female patients with a mean age of 50 years (range 19-80) at the date of their initial evaluation were identified. All patients had significant trauma that accounted for 28 ML lesions, all of which were in a characteristic subcutaneous location overlying the muscular fascial plane. Lesions on CT went through an evolution from hyperdense, poorly or moderately marginated without a pseudocapsule to being hypodense, with internal fat globules or septations and well marginated with a complete enhancing pseudocapsule. Only 1 (4 %) of the ML lesions was suggested and 7 (25 %) lesions were not commented on at all by the interpreting radiologist., Conclusion: Morel-Lavallée lesions are post-traumatic closed, internal, soft-tissue, degloving lesions that are potentially underrecognized on CT. Most acute ML lesions are nonspecific, resembling simple hematomas or contusions. ML lesions evolve as they age with subacute and chronic lesions demonstrating the known features described on MR imaging that should allow for an accurate imaging diagnosis.

Cyclophanes are a venerable class of macrocyclic and/or cage compounds that often feature high strain, unusual conformations and quite surprising properties, many of which are legendary in physical organic chemistry. However, the discovery of new, diverse cyclophanes and derivatives has been hindered by syntheses that are traditionally low-yielding, requiring long reaction times, laborious purification steps and often extreme conditions. Herein, we demonstrate a new self-assembly route to a variety of discrete cyclic and caged disulfide structures, which can then be kinetically captured upon sulfur extrusion at room temperature to give a diversity of new thioether (hetera)cyclophanes in high yield. In addition to the synthesis of novel macrocycles (dimers through hexamers), this process provides an improved route to a known macrobicyclic trithiacyclophane. This technique also enables the facile isolation of a tetrahedral macrotricyclic tetrathiacyclophane in two steps at an ambient temperature.

Purpose: Tibial tubercle-trochlear groove (TT-TG) distance is a variable that helps guide surgical decision-making in patients with patellar instability. The purpose of this study was to compare the accuracy and reliability of an MRI TT-TG measuring technique using a simple external alignment method to a previously validated gold standard technique that requires advanced software read by radiologists., Methods: TT-TG was calculated by MRI on 59 knees with a clinical diagnosis of patellar instability in a blinded and randomized fashion by two musculoskeletal radiologists using advanced software and by two orthopaedists using the study technique which utilizes measurements taken on a simple electronic imaging platform. Interrater reliability between the two radiologists and the two orthopaedists and intermethods reliability between the two techniques were calculated using interclass correlation coefficients (ICC) and concordance correlation coefficients (CCC). ICC and CCC values greater than 0.75 were considered to represent excellent agreement., Results: The mean TT-TG distance was 14.7 mm (Standard Deviation (SD) 4.87 mm) and 15.4 mm (SD 5.41) as measured by the radiologists and orthopaedists, respectively. Excellent interobserver agreement was noted between the radiologists (ICC 0.941; CCC 0.941), the orthopaedists (ICC 0.978; CCC 0.976), and the two techniques (ICC 0.941; CCC 0.933)., Conclusion: The simple TT-TG distance measurement technique analysed in this study resulted in excellent agreement and reliability as compared to the gold standard technique. This method can predictably be performed by orthopaedic surgeons without advanced radiologic software., Level of Evidence: II.

Endometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient's period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.

Chronic azithromycin therapy is recommended for CF patients with persistent Pseudomonas aeruginosa colonization. Other macrolide antibiotics have been reported to cause QT prolongation, but cardiac effects of azithromycin have not been studied in pediatric populations. We analyzed changes in QTc interval after starting chronic azithromycin in a pediatric CF population. Adolescent males showed increased QTc intervals after initiation of therapy. Given the possible effects of azithromycin on the QTc interval, particularly in patients predisposed to cardiac events, we suggest that the QTc interval of CF patients should be monitored throughout the course of chronic azithromycin., (Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

We report a family of highly anionic calixarenes that form discrete homo-dimeric assemblies in pure water, that get stronger in high salt solutions, and that remain assembled in complex, denaturing solutions like real urine. The results reveal the potential of like-charged subunits for self-assembly in high-salt solutions and biological fluids.

Objective: To examine the anatomic MRI characteristics of the adductor magnus mini hamstring (AMMH) and explore its involvement in cases of hamstring avulsion., Materials and Methods: An IRB-approved retrospective review of patients undergoing "hamstring protocol" MRI between March 2009 and June 2014 was performed. Two musculoskeletal radiologists recorded multiple AMMH anatomic characteristics and involvement in cases of hamstring avulsion., Results: Seventy-six AMMHs were analyzed in 66 patients [35 females and 31 males, mean age 49.3 ± 15.2 years (range 17-81)]. Eleven percent of AMMHs were poorly visualized, 51 % visualized, and 37 % well visualized. Seven percent demonstrated round, 73 % ovoid, and 21 % flat/lenticular tendon morphologies. Most (88 %) demonstrated typical origins. Average cross-sectional area (CSA) was 22.4 ± 10.6 mm² (range 6-56), diameter was 7.2 ± 2.5 mm (range 2.9-15), medial distance from the semimembranosus tendon was 7.5 ± 2.5 mm (range 3-14), and tendon length was 6.8 ± 3.3 cm (range 1.2-14.1). There was no gender difference in AMMH anatomic measurements or correlation between age and CSA or diameter. Of 17 complete hamstring avulsion cases, the AMMH was intact in 13, partially torn in 3, and completely torn in 1., Conclusion: The AMMH is a constant finding with variable anatomic characteristics. It is visualized or well visualized by MRI in 88 % of cases and is a sizable tendon located in close proximity to the semimembranosus tendon. Because it is uncommonly completely torn (6 %) in cases of complete hamstring avulsion, radiologists should be aware of its presence and appearance to avoid diagnostic confusion.

Background: The adductor magnus (AM) has historically been a potential source of confusion in patients with suspected proximal hamstring avulsion injuries., Purpose: To investigate the anatomic characteristics of the AM, including its osseous origin, anatomic dimensions, and relationship to the proximal hamstring tendons., Study Design: Descriptive laboratory study., Methods: Dissection of the AM origin was performed in 11 (8 cadavers) fresh-frozen hip-to-foot cadaveric hemipelvis specimens. The gross anatomy and architecture of the proximal hamstring and AM tendons were studied. After dissecting the hamstring tendons away from their origin, the dimension, shape, and orientation of the tendon footprints on the ischial tuberosity were determined., Results: The AM was identified in all cadaveric specimens. The mean tendon thickness (anterior to posterior [AP]) was 5.7 ± 2.9 mm. The mean tendon width (medial to lateral [ML]) was 7.1 ± 2.2 mm. The mean tendon length was 13.1 ± 8.7 cm. The mean footprint height (AP dimension) was 12.1 ± 2.9 mm, and mean footprint width (ML dimension) was 17.3 ± 7.1 mm. The mean distance between the AM footprint and the most medial aspect of the conjoint tendon footprint was 8.5 ± 4.2 mm. Tendon measurements demonstrated a considerable degree of both intra- and interspecimen variability., Conclusion: The AM tendon is consistently present just medial to the conjoint tendon at the ischial tuberosity, representing the lateral-most portion of the AM muscle. This study found wide variation in the dimensional characteristics of the AM tendon between specimens. Its shape and location can mimic the appearance of an intact hamstring (conjoint or semimembranosus) tendon intraoperatively or on diagnostic imaging, potentially misleading surgeons and radiologists. Therefore, detailed knowledge of the AM tendon anatomy, footprint anatomy, and its relationship to the hamstring muscle complex is paramount when planning surgical approach and technique., Clinical Relevance: The reported data may aid surgeons in more accurate recognition, diagnosis, and repair of proximal hamstring avulsion injuries.

Background: The lateral tibial posterior slope (LTPS) has been reported in multiple studies to correlate with an increased risk for native anterior cruciate ligament (ACL) tearing. To date, no study has examined the effect of an increased LTPS as measured on magnetic resonance imaging (MRI) on the likelihood of ACL graft failure., Hypothesis: An increased LTPS as measured on MRI would correlate with an increased risk for ACL graft failure., Study Design: Case-control study; Level of evidence, 3., Methods: Fifty-eight patients were initially identified who experienced graft failure after primary ACL reconstruction and underwent revision between 1998 and 2009. Exclusion criteria were clinical follow-up of less than 4 years, graft failure occurring greater than 2 years after primary surgery, skeletal immaturity, deep infection, lack of available preoperative MRI, and history of trauma to the proximal tibia. This left 35 patients with early (within 2 years) failure of primary ACL reconstruction. These patients were matched to 35 control participants who had undergone ACL reconstruction with a minimum of 4 years of clinical follow-up and no evidence of graft failure. Patients were matched by age, sex, date of primary surgery, and graft type. The LTPS was then determined on MRI in a blinded fashion., Results: The mean time to failure in patients in the study group was 1 year (range, 0.6-1.4 years). The mean follow-up of those in the matched control group was 6.9 years (range, 4.0-13.9 years). The mean LTPS in the early ACL failure group was found to be 8.4°, which was significantly larger than that in the control group at 6.5° (P = .012). The odds ratio for graft failure considering a 2° increase in the LTPS was 1.6 (95% CI, 1.1-2.2) and continued to increase to 2.4 (95% CI, 1.2-5.0) and 3.8 (95% CI, 1.3-11.3) with 4° and 6° increases in the LTPS, respectively. No significant association was identified between graft type and graft failure., Conclusion: An increased LTPS is associated with an increased risk for early ACL graft failure, regardless of graft type. Orthopaedic surgeons should consider measuring the LTPS as part of the preoperative assessment of ACL-injured patients., (© 2015 The Author(s).)

Purpose: The posterolateral corner (PLC) of the knee is anatomically complex with similarly complex MR imaging findings in acutely injured knees. The purpose of this study was to define the MRI pattern of injury in cases of PLC disruption requiring surgery because of clinical instability., Methods: The knee MRIs of 22 patients who underwent surgical repair and/or reconstruction of PLC injury were retrospectively reviewed. The fibular collateral ligament (FCL), popliteus tendon (PT), biceps femoris (BF), popliteofibular ligament (PFL), arcuate ligament (AL), and fabellofibular ligament (FFL) were evaluated and graded as follows: complete tear, high-grade partial tear, low-grade partial tear, and normal., Results: In the 22 cases of PLC injury that necessitated surgery, a constellation of findings involving the larger structures of the PLC was identified. Of the FCL, PT, and BF (considered larger structures), at least two were abnormal in all 22 injury cases. Of the PFL, AL, and FFL (considered smaller structures), the PFL appeared abnormal in 19 cases, yet neither the AL nor FFL were confidently characterized in the injury group., Conclusion: The larger structures of the PLC are easily evaluated using standard MRI techniques. This study identified a predictable pattern of imaging findings involving these more easily assessed structures in those patients who were felt to be clinically unstable and underwent surgical reconstruction, as at least two were abnormal in all 22 cases. The smaller structures of the PLC are difficult to assess with MRI; however, direct visualization of their involvement on MRI is not necessary to report a clinically unstable PLC injury. Emphasis of this simplified but critical analysis of the FCL, BF and PT on MRI scans reviewed by radiologists and orthopaedic surgeons may help to prevent delayed diagnosis of unstable PLC injuries., Level of Evidence: III.

Background: Ischiofemoral impingement is caused by compression of the quadratus femoris muscle between the ischial tuberosity and lesser trochanter. The evaluation of ischiofemoral impingement includes radiologic studies to evaluate the ischiofemoral space dimensions. No prior study has evaluated the effect of femoral position on ischiofemoral space dimensions., Objective: To determine whether the dimensions of the ischiofemoral space vary with changes in femoral position., Design: Cross-sectional study., Setting: Academic institution., Participants: Six male and four female subjects with no hip pain and no history of hip disorders or surgery were selected to participate in the study. The subjects' mean age was 31.5 years; mean height, 176.8 cm; mean weight, 70.2 kg; and mean body mass index, 23.6 kg/m(2)., Methods: Ultrasound was used to measure the ischiofemoral space in bilateral gluteal regions of each volunteer. The volunteers underwent imaging in a prone position. The ischiofemoral space was measured with the femur in 9 different positions created through various combinations of frontal (15° abduction, neutral, and 15° adduction) and transverse (30° internal rotation, neutral, and 30° external rotation) plane hip motions., Main Outcome Measurements: The narrowest ischiofemoral interval, defined as the narrowest distance between the medial cortex of the lesser trochanter and the lateral cortex of the ischial tuberosity., Results: The anatomic landmarks used to measure the ischiofemoral space were easily identified in all subjects. The frontal plane main effect (F2,18 = 38.611) was statistically significant (P < .001), as was the transverse plane main effect (F2,18 = 82.452, P < .001). These findings indicated that there was a statistically significant difference in ischiofemoral space according to hip position in the frontal and transverse planes. The largest ischiofemoral space measurement occurred with the hip in abduction and internal rotation (51.8 mm; 95% confidence interval [CI], 49.2-54.5 mm), whereas hip adduction and external rotation resulted in the narrowest ischiofemoral space measurement (30.8 mm; 95% CI, 25.5-36.0 mm). The largest difference was between the adduction-external rotation and the abduction-internal rotation positions (mean difference = 21.1 mm; 95% CI, 13.7-28.5 mm; P < .001), and the smallest difference was between the adducted-neutral rotation and the abducted-external rotation positions (mean difference = 0.23 mm; 95% CI, -8.07-8.55 mm; P = .99)., Conclusions: Femoral position affects ischiofemoral space dimensions. The ischiofemoral space widens with abduction and internal rotation and narrows with adduction and external rotation, and thus femoral position should be considered when imaging and measuring the ischiofemoral space., (Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Modern research often requires collaboration of experts in fields, such as math, chemistry, biology, physics, and computer science to develop unique solutions to common problems. Traditional introductory undergraduate laboratory curricula in the sciences often do not emphasize connections possible between the various disciplines. We designed an interdisciplinary, medically relevant, project intended to help students see connections between chemistry and biology. Second term organic chemistry laboratory students designed and synthesized potential polymer inhibitors or inducers of polyglutamine protein aggregation. The use of novel target compounds added the uncertainty of scientific research to the project. Biology laboratory students then tested the novel potential pharmaceuticals in Huntington's disease model assays, using in vitro polyglutamine peptide aggregation and in vivo lethality studies in Drosophila. Students read articles from the primary literature describing the system from both chemical and biological perspectives. Assessment revealed that students emerged from both courses with a deeper understanding of the interdisciplinary nature of biology and chemistry and a heightened interest in basic research. The design of this collaborative project for introductory biology and organic chemistry labs demonstrated how the local interests and expertise at a university can be drawn from to create an effective way to integrate these introductory courses. Rather than simply presenting a series of experiments to be replicated, we hope that our efforts will inspire other scientists to think about how some aspect of authentic work can be brought into their own courses, and we also welcome additional collaborations to extend the scope of the scientific exploration., (© 2015 The International Union of Biochemistry and Molecular Biology.)

Background: Multiligament knee injuries (MLKIs) can also involve the medial patellofemoral ligament (MPFL), but there is a paucity of information regarding prevalence and relevance of MPFL involvement in this setting., Purpose: (1) To identify the prevalence of MPFL injury in MLKIs, (2) to determine whether an MPFL tear results in symptomatic patellar instability, and (3) to report clinical and functional outcomes of patients with and without MPFL tears after MLKI surgical reconstruction., Study Design: Cohort study; Level of evidence, 3., Methods: The records of all patients who underwent surgical reconstruction of MLKI (defined as a grade 3 injury of ≥2 ligaments) at a single institution from 2007 to 2010 were reviewed. Age, sex, knee dislocation classification (according to Schenck), and MRI findings were documented. All preoperative MRI scans were reviewed by an experienced musculoskeletal radiologist to determine the presence or absence of MPFL involvement. If an MPFL tear was present, its anatomic location and severity as well as the presence of patellar or lateral femoral condyle bone bruises were documented. Inclusion criteria included (1) MLKI treated at a single institution, (2) presence of MPFL tear on preoperative MRI, and (3) minimum 2-year clinical follow-up. Patellar instability symptoms were assessed with the Kujala Knee Questionnaire. Functional outcomes were measured using the International Knee Documentation Committee (IKDC) score. IKDC scores were compared between patients who sustained MLKIs with and without MPFL tears. There were 21 patients in each group., Results: Over the 4-year study period, 30 of 51 patients (59%) treated surgically for a MLKI had MRI evidence of an MPFL tear. Nine were lost to follow-up, leaving 21 patients for review. There were 13 complete (62%), 5 high-grade partial (24%), and 3 partial (14%) MPFL tears. Sixteen of 21 tears (76%) occurred at the proximal third, with the remainder exhibiting diffuse signal abnormality consistent with tearing throughout the length of the MPFL. The superficial medial collateral ligament was involved in all patients. In no case was the MPFL repaired or reconstructed. At mean follow-up of 3.6 years (range, 2.0-5.7 years), only 1 of 21 patients (5%) complained of patellofemoral instability symptoms whereas 20 of 21 patients (95%) did not experience patellar subluxation or dislocation. No significant difference was found when IKDC scores were compared between patients with and without an MPFL tear (mean ± SD, 65.5 ± 22.9 vs 79.4 ± 16.1; P = .07)., Conclusion: MPFL tears occur frequently in patients with MLKI but rarely cause instability. In the majority of cases, MPFL tears do not need to be addressed at the time of surgery., (© 2015 The Author(s).)

The synthesis of six trinuclear Pn 3 L 2 macrobicycles (Pn = As, Sb) was achieved by self-assembly of a pnictogen trichloride and a 2,4,6-trisubstituted-1,3,5-benzenetrimethanethiol ligand. 1 H-NMR spectroscopy reveals self-assembly in 1,1,2,2-tetrachloroethane is dynamic in solution producing two structural isomers. The symmetric and the asymmetric isomers (in which a single chloride ligand is cast in an opposing direction from other chlorides) of the As 3 L 2 complexes exist in a ca. 2 : 1 distribution, whereas only the symmetric isomer is observed in solution for Sb 3 L 2 . Solvent effects appear to influence conformational isomerism and conversion to the final products. Macrobicycles were confirmed by 1 H-NMR spectroscopy and X-ray crystallography and further studied by MP2/LANL2DZ optimizations.

Background: Tuberous breast deformity is a common congenital anomaly with varying degrees of constriction, hypoplasia, skin deficiency, areolar herniation, and asymmetry that poses challenges to consistency in aesthetic correction. In this study, the authors classify tuberous breast deformities, and evaluate their techniques used for treatment., Methods: Twenty-six patients (51 breasts) treated from 2008 to 2012 were included. Mean patient age was 25 years (range, 18 to 39 years). Cases were classified using a three-tier system. A periareolar approach and glandular scoring maneuvers were used in all cases. Prosthetic placement (implant or tissue expander) was subpectoral (dual-plane) in all cases. The selection of one- versus two-stage correction and mastopexy techniques is presented with reference to the specific deformities in each tier., Results: Mean follow-up was 22 months (range, 8 to 37 months). Twelve type I, 26 type II, and 13 type III deformities were treated. Periareolar incisions only were used in two (4 percent). Circumareolar mastopexy was used in 49 (96 percent), and vertical mastopexy was used in four (8 percent). One-stage correction was achieved in 47 (92 percent); four (8 percent) were treated in two stages with tissue expansion. The global complication rate for all patients in this study is 7.8 percent-two breasts (3.9 percent) had capsular contracture, and two (3.9 percent) had postoperative malposition., Conclusion: The authors' experience demonstrates that satisfactory results can be obtained with appropriate classification and treatment of tuberous breast deformity with periareolar access, glandular scoring, subpectoral implant placement, and mastopexy techniques tailored to the specific deformity type., Clinical Question/level of Evidence: Therapeutic, IV.

Unlabelled: In the context of deciphering the metabolic strategies of the obligate pathogenic fungi in the genus Pneumocystis, the genomes of three species (P. carinii, P. murina, and P. jirovecii) were compared among themselves and with the free-living, phylogenetically related fission yeast (Schizosaccharomyces pombe). The underrepresentation of amino acid metabolism pathways compared to those in S. pombe, as well as the incomplete steroid biosynthesis pathway, were confirmed for P. carinii and P. jirovecii and extended to P. murina. All three Pneumocystis species showed overrepresentation of the inositol phosphate metabolism pathway compared to that in the fission yeast. In addition to those known in S. pombe, four genes, encoding inositol-polyphosphate multikinase (EC 2.7.1.151), inositol-pentakisphosphate 2-kinase (EC 2.7.1.158), phosphoinositide 5-phosphatase (EC 3.1.3.36), and inositol-1,4-bisphosphate 1-phosphatase (EC 3.1.3.57), were identified in the two rodent Pneumocystis genomes, P. carinii and P. murina. The P. jirovecii genome appeared to contain three of these genes but lacked phosphoinositide 5-phosphatase. Notably, two genes encoding enzymes essential for myo-inositol synthesis, inositol-1-phosphate synthase (INO1) and inositol monophosphatase (INM1), were absent from all three genomes, suggesting that Pneumocystis species are inositol auxotrophs. In keeping with the need to acquire exogenous inositol, two genes with products homologous to fungal inositol transporters, ITR1 and ITR2, were identified in P. carinii and P. murina, while P. jirovecii contained only the ITR1 homolog. The ITR and inositol metabolism genes in P. murina and P. carinii were expressed during fulminant infection as determined by reverse transcriptase real-time PCR of cDNA from infected lung tissue. Supplementation of in vitro culture with inositol yielded significant improvement of the viability of P. carinii for days 7 through 14., Importance: Microbes in the genus Pneumocystis are obligate pathogenic fungi that reside in mammalian lungs and cause Pneumocystis pneumonia in hosts with weakened immune systems. These fungal infections are not responsive to standard antifungal therapy. A long-term in vitro culture system is not available for these fungi, impeding the study of their biology and genetics and new drug development. Given that all genomes of the Pneumocystis species analyzed lack the genes for inositol synthesis and contain inositol transporters, Pneumocystis fungi, like S. pombe, appear to be inositol auxotrophs. Inositol is important for the pathogenesis, virulence, and mating processes in Candida albicans and Cryptococcus neoformans, suggesting similar importance within the Pneumocystis species as well. This is the first report to (i) characterize genes in the inositol phosphate metabolism and transport pathways in Pneumocystis species and (ii) identify inositol as a supplement that improved the viability of P. carinii in in vitro culture., (Copyright © 2014 Porollo et al.)

Substituting one metal for another in inorganic and organometallic systems is a proven strategy for synthesizing complex molecules, and in some cases, provides the only route to a particular system. The multivalent nature of the coordination in metal-ligand assemblies lends itself more readily to some types of transmetalation. For instance, a binding site can open up for exchange without greatly effecting the many other interactions holding the structure together. In addition to exchanging the metal and altering the local binding environment, transmetalation in supramolecular systems can also lead to substantial changes in the nature of the secondary and tertiary structure of a larger assembly. In this tutorial review we will cover discrete supramolecular assemblies in which metals are exchanged. First we will address fully formed structures where direct substitution replaces one type of metal for another without changing the overall supramolecular assembly. We will then address systems where the disruptive exchange of one metal for another leads to a larger change in the supramolecular assembly. When possible we have tried to highlight systems that use supramolecular self-assembly in tandem with transmetalation to synthesize new structures not accessible through a more direct approach. At the end of this review, we highlight the use of transmetalation in self-assembled aqueous inorganic clusters and discuss the consequences for material science applications.