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Although recognized as the most well-trained providers to address musculoskeletal injuries, many orthopaedic surgeons do not routinely treat patients with nonmusculoskeletal issues in their clinical practice. Nonetheless, when serving as a team physician, an orthopaedic surgeon may need to initiate management of or manage many nonmusculoskeletal issues. Knowing how to accurately diagnose and initiate management of sports-related medical and surgical conditions is an important facet of being an orthopaedic team physician. Common systems that may be involved include the cerebral/neurologic, ocular, dental, respiratory/pulmonary, cardiac, abdominal, and genitourinary systems. Each of these systems has specific pathologic processes and risks related to athletic or sporting participation. Orthopaedic team physicians must have a baseline familiarity with the most common nonmusculoskeletal issues to provide comprehensive quality care to athletes and patients.

Copper-catalyzed alkene amino oxygenation reactions using O-acylhydroxylamines have been achieved for a rapid and modular access to diverse 1,2-amino oxygen-containing molecules. This transformation is applicable to the use of alcohols, carbonyls, oximes, and thio-carboxylic acids as nucleophiles on both terminal and internal alkenes. Mild reaction conditions tolerate a wide range of functional groups, including ether, ester, amide, carbamate, and halide. The reaction protocol allows for starting with free amines as the precursor of O-benzoylhydroxylamines to eliminate their isolation and purification, contributing to broader synthetic utilities. Mechanistic investigations reveal the amino oxygenation reactions may involve distinct pathways, depending on different oxygen nucleophiles.

Purpose: To compare the patient-reported outcomes scores (PROs) of patients with femoroacetabular impingement (FAI), labral tears, and complete ligamentum teres (LT) tears to a matched-pair control group with intact LTs, as well as to report the relative risk of total hip arthroplasty (THA) conversion., Methods: Data between February 2008 and April 2015 were retrospectively reviewed. Patients undergoing hip arthroscopy included those who had complete LT tear, labral tears, FAI, and minimum 2-year follow-up with modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), and visual analog scale (VAS). Patients were excluded for Tönnis osteoarthritis grade >1, previous hip conditions or surgeries, and Worker's Compensation claims. Patients with full LT tears were matched in a 1:3 ratio with patients without LT tears based on age at surgery ± 5 years, sex, body mass index ± 5, capsular treatment, and acetabular Outerbridge grade. Revision surgeries and conversions to THA were documented. Relative risk for conversion to THA was determined (P = .05)., Results: Eighteen patients (18 hips) had minimum 2-year follow-up and were eligible for matching; as described, each study group patient was matched to 3 control patients, resulting in a size of 18 to 54 patients. PROs showed significant improvement in the complete LT tear group with the exception of the HOS-SSS measure. In the intact LT control group, all PROs significantly improved, with no exception. Based on relative risk, patients with complete LT tears were 3 times more likely to require THA than a matched control group., Conclusions: After hip arthroscopy, patients with FAI and complete LT tears reported significant improvement in PROs. Among hips that did not require THA, functional scores were comparable to a matched control group. However, patients with complete LT tears were 3 times more likely to require an eventual THA than the matched control group. We conclude that patients with complete LT tears should be considered an at-risk population, and that indications and treatment may be refined to incorporate the clinical significance of complete LT tears., Level of Evidence: Level III, comparative trial, case-control., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Hip arthroscopy for the treatment of instability in the setting of borderline dysplasia is controversial. Capsular management in such cases is an important consideration, and plication has been described as a reliable technique, with good midterm outcomes reported when indications are appropriate., Hypothesis: Patients with borderline dysplasia who have a lower lateral center-edge angle (LCEA) and greater age will be at a higher risk of failure after arthroscopic capsular plication., Study Design: Case-control study; Level of evidence, 3., Methods: Data were retrospectively reviewed for all patients between 15 and 40 years of age who underwent hip arthroscopy from November 2008 to January 2015. Inclusion criteria were an LCEA between 18° and 25°, Tönnis grade ≤1, primary case with capsular plication, and minimum 2-year follow-up. Patients were excluded if they had any history of ipsilateral hip procedure or conditions such as Legg-Calve-Perthes disease, slipped capital femoral epiphysis, rheumatologic disease, and Tönnis grade ≥2. Age, sex, and body mass index data were retrieved for each patient. Patient-reported outcomes (PROs)-including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale, and a visual analog scale (VAS) for pain (0-10)-were obtained preoperatively and at a minimum of 2 years postoperatively, in addition to the postoperative International Hip Outcome Tool-12. The "success" group consisted of all patients who achieved the patient acceptable symptomatic state of mHHS ≥74 and had no ipsilateral hip surgery subsequent to their index arthroscopy. The "failure" group was composed of patients who were below the patient acceptable symptomatic state at latest follow-up or required secondary arthroscopy or conversion to total hip arthroplasty. Patient satisfaction and minimal clinically important difference were also calculated. Mean age for the failure group was applied as a cutoff age for subanalysis, and relative risk for failure was determined., Results: Ninety patients (97 hips; 79.5%) met criteria for the success group, and 25 patients (25 hips) met criteria for the failure group. No significant differences in preoperative baseline scores or VAS were found. However, there did appear to be a trend that the failure group had lower mean preoperative scores for all PRO measures and a higher VAS score. The differences in preoperative mHHS and NAHS closely approached significance ( P = .053). Postoperative PRO, VAS, and patient satisfaction scores of the success group were significantly higher than the failure group. The failure group was significantly older than the success group (28.5 ± 7.8 vs 23.5 ± 7.5 years, P = .005). Patients >35 years old were 2.25 times more likely to fail according to relative risk (95% CI, 1.10-4.60; P = .0266). LCEA did not differ between the groups, and no other risk factors for failure were identified., Conclusion: Stringent criteria for patient selection and meticulous repair or augmentation of the static stabilizers of the hip yielded favorable clinical outcomes in this study cohort with borderline dysplasia. Within this carefully selected group, the analysis revealed that increased age was the main risk factor for failure in the management of borderline hip dysplasia via isolated primary arthroscopic hip surgery with capsular plication.

Introduction: There is a paucity in the literature regarding mid-term results of microfracture in hip arthroscopy. We aim to assess 5-year outcomes of patients who underwent acetabular microfracture for full-thickness chondral lesions as a part of hip arthroscopy., Methods: Between August 2008 and September 2011, data were prospectively gathered for patients undergoing acetabular microfracture during hip arthroscopy with minimum 5-year follow-up. All patients were assessed pre- and postoperatively, with modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS). International Hip Outcome Tool (iHOT-12) and satisfaction were collected postoperatively. Exclusion criteria included previous hip conditions, or preoperative Tönnis grade ≥2., Results: Fifty three hips were eligible for this study. Of these, 43 (81.1%) hips in 42 patients had follow-up. The study group had a male majority (65.1%) and an average age of 44.4 ± 9.5 years. There was statistically significant improvement in all patient-reported outcomes (PROs) and VAS at follow-up. Patient satisfaction was 7.6 ± 2.6. A comparison of 2-year to minimum 5-year follow-up results identified no statistically significant deterioration in PROs, VAS, and patient satisfaction. Survivorship was 72.1% with 12 patients converted to total hip arthroplasty (THA). 4 patients (10.8%) underwent secondary arthroscopy., Conclusions: In the mid-term, microfracture as a part of hip arthroscopy demonstrated favourable outcomes and 72% survivorship. Careful patient selection is warranted to limit the risk of conversion to THA.

Background: Foam sclerotherapy is an effective treatment strategy for venous malformations (VMs). Stability is one of the characteristics of sclerosant foams that determine the sclerosing power., Objective: To evaluate the clinical outcomes of sclerotherapy with prolonged half-life of hyaluronic acid (HA)-polidocanol (POL) foam for treating head and neck VMs., Materials and Methods: Seventy patients with head and neck VMs were enrolled between October 2013 and January 2015 in Qilu Hospital Shandong University. Sclerotherapy was performed with prolonged half-life POL foam by addition of 0.05% HA. All patients were followed up at 1, 3, and 6 months. Reviews on the site and size of the lesion, times and duration of treatments, therapeutic response, and complications were performed to evaluate the end result., Results: Sites of lesions included face, bucca, parotid region, neck, tongue, floor of mouth, lip, forehead, palate, and nose. An overall average of 2.5 treatments was required. Total response rate was 100%. "Resolution" was achieved in 21 cases (30%) and a significant response in 49 patients (70%). Immediate swelling was the most common complication. Epidermal extravasation was seen in 1 patient. Mucosal ulcer was observed in 1 patient. No generalized complications occurred., Conclusion: The prolonged half-life of HA-POL foam sclerotherapy of VMs in the head and neck is safe and effective.

Hip preservation is one of the fastest growing subspecialties in orthopaedic surgery. Surgical training recommendations and guidelines in this field are lacking. To survey high volume hip preservation surgeons regarding their perspectives on the current and future training of surgeons entering their field, a cross-sectional survey of 16 high-volume hip preservation surgeons was conducted to gather perspectives and opinions on the most appropriate education of future hip preservation surgeons. All participants completed the survey in person and anonymously. Of the surveyed surgeons, the mean career hip preservation volume was 1031.25 cases (250 to >3000) with an average annual volume of 162.08 cases (75-400). The average number of hip arthroscopy cases necessary to competently perform joint access is 19, labral repair is 34, acetabuloplasty/femoroplasty are 54, labral reconstruction is 101 and capsular closure/plication is 53. Fifty-six percent of the surgeons believe mid-career surgeons who have never performed hip preservation surgery should not adopt it as part of their practice. The mean optimal number of cases recommended was 128 hip arthroscopies during a dedicated hip preservation fellowship and 67 hip arthroscopies during a sports medicine fellowship. Surgeons with an interest in hip preservation careers, should strongly consider a 12-month dedicated hip preservation fellowship that provides exposure to at least 128 cases, including open and arthroscopic techniques, hip arthroplasty, and research opportunities. Mid-career surgeons should be cautious about adopting hip preservation into their practice if they have not had prior adequate training.

Rationale: Mitochondrial DNA mutations have been associated with many maternal inherited diseases. A1555G mutation in mtDNA effects the gene code for rRNA, resulting in the structural change of human ribosome rending it susceptible to binding of the common antibiotic, aminoglycosides. Such mutation has linked with non-syndromic hearing loss and is one of the most common mtDNA mutations in Asian populations., Patient Concerns: A 50-year-old Taiwanese female visited our neurology department with concern for multiple members with hearing loss in her family, including herself., Diagnoses: Physical examination findings were not significant besides hearing loss and brain MRI did not reveal any lesions. BAEP confirmed bilateral peripheral sensory deficit. Given the multiple cases of hearing loss in the family, a genetic cause was suspected. Using PCR and sequences chromatogram technique we have identified A1555G mutation on her mtDNA affecting region codes for 12S rRNA. Additionally, we observed severe speech disorder in two young family members with the onset of hearing loss began in their early childhood., Interventions: The patient declined any form of intervention at the time for personal reasons., Outcomes: The patient was satisfied with the diagnosis, her and her families are continuously followed by our neurology department., Lessons: We report on a family with mtDNA mutation hearing loss that is related to exposure to aminoglycosides. Children with such mutation are at high risk for impaired linguistic function. Early identification and intervention with cochlear implant should be considered.

Rationale: Oculopharyngeal muscular dystrophy (OPMD) is an autosomal dominant late-onset progressive muscle disorder typically characterized by ptosis, difficulty in swallowing, and proximal limb weakness. Underdiagnosis of OPMD is common in Asian countries and results in delayed diagnoses and fatal events., Patient Concerns: Here, we report the case of a 53-year-old female who suffered from progressive dysphagia and experienced several choking events involving solid material. An extensive family history of dysphagia was noted, and 2 family members had died as a result of aspiration., Diagnoses: PABPN1 genotyping and DNA sequence analysis revealed a heterozygous (GCG)10(GCA)3GCG mutation that led to the diagnosis of OPMD., Interventions: Rehabilitation exercises, namely, the Shaker exercise and the Masako maneuver, were suggested., Outcomes: Improved swallowing ability with safe food intake was noted after 2 months of training. Surgical intervention will be considered when progression of the disease is noted., Lessons: Underdiagnosis and a lack of awareness of OPMD may lead to choking, aspiration pneumonia, and death in multiple members of affected families. Currently, there is no definitive treatment for OPMD, but rehabilitation exercises and surgical intervention are helpful in relieving dysphagia.

Hip dysplasia has been identified as one of the leading causes of osteoarthritis. However, hip arthroscopy alone, in the setting of hip dysplasia, remains controversial. In borderline hip dysplasia, with lateral center-edge angle (LCEA) between 18° and 25°, good outcomes have been reported with appropriate capsular and labral management. However, in severe hip dysplasia, with LCEA below 18°, there is an acetabular bony structural deficiency that must be addressed. Even with the potential benefit of hip arthroscopy in addressing intra-articular injuries related to the instability, it cannot be used for soft-tissue procedures. Periacetabular osteotomy remains the gold standard to address that matter; however, its invasive nature along with the long recovery time leaves some patients unwilling to undergo this procedure. New minimally invasive endoscopic procedures, derived from open techniques, describe acetabular autologous bone grafting as an alternative. Donor-side morbidity is always a concern when using autografts; we believe that the use of bone allograft will decrease this potential issue and make the procedure itself less invasive. This Technical Note will describe a type of endoscopic shelf acetabuloplasty using an allograft iliac bone graft.

Sonomicrometry is widely applied in biomechanics and physiology to measure precise distances with high temporal resolution. Although commonly used, its usefulness is often limited by the presence of artifacts that require correction. Unfortunately, procedures reported in the literature for artifact correction are often unclear. Furthermore, currently available tools for artifact correction require significant manual manipulations, the consistency of which takes painstaking effort to verify. To improve the efficiency and consistency of sonomicrometry, we have developed a new software tool for the correction of sonomicrometry artifacts. This tool provides a framework for artifact correction requiring fewer and more limited manipulations from the user. We aimed to make this tool more transparent and easier to use than commercially available tools. To facilitate its application, we describe the relevant properties of sonomicrometry artifacts and detail the software's correction algorithm. The software is available for MacOS and Linux with source code and documentation., Competing Interests: Competing interestsThe authors declare no competing or financial interests., (© 2018. Published by The Company of Biologists Ltd.)

Background: Obesity is a negative prognostic factor for various surgical procedures. The purpose of this study was to compare patients with obesity who underwent hip arthroscopy for femoroacetabular impingement and labral tears with a match-controlled group of normal-weight patients., Methods: Data were prospectively collected and retrospectively reviewed for patients who underwent arthroscopy between February 2008 and December 2011. Inclusion criteria were treatment for femoroacetabular impingement and labral tears and completed preoperative patient-reported outcomes and visual analog scale (VAS) for pain. Exclusion criteria were previous ipsilateral hip conditions or preoperative Tönnis grade of ≥2. Patients with obesity (body mass index [BMI] of ≥30 kg/m) were matched and were compared with normal-weight patients (BMI of 18.5 to 24.99 kg/m) using a 1:1 ratio by age at the time of the surgical procedure within 5 years, sex, acetabular Outerbridge grade (0 or 1 compared with 2, 3, or 4), and capsular treatment., Results: Of the 96 obesity cases with follow-up, 74 were pair-matched to control cases. The mean BMI was 34.3 kg/m for the obesity group and 22.7 kg/m for the control group (p < 0.0001). The mean follow-up time was 71.6 months for the obesity group and 71.3 months for the control group (p = 0.41). All mean preoperative patient-reported outcomes and VAS scores for patients without conversion to total hip arthroplasty were significantly worse in the obesity group: modified Harris hip score (p = 0.0001), Non-Arthritic Hip Score (p = 0.0001), Hip Outcome Score Sports-Specific Scale (HOS-SSS) (p = 0.015), and VAS (p = 0.01). No significant differences were observed with regard to demographic characteristics, intraoperative findings, procedures, follow-up scores, magnitudes of improvement, or secondary arthroscopy rates (p > 0.05). Both groups demonstrated significant improvements in mean outcome scores at ≥5 years (p < 0.0001). In both groups, no significant differences were detected in mean outcome scores between 2 years and ≥5 years (p > 0.05). The conversion rate to total hip arthroplasty was 29.7% for the obesity group and 14.9% for the control group (relative risk, 2.0 [95% confidence interval, 1.1 to 3.8]; p = 0.04)., Conclusions: Hip arthroscopy for the treatment of femoroacetabular impingement and labral tears in patients with obesity yielded significant improvements at ≥5 years; these results were similar to a matched group of normal-weight patients. However, patients with obesity demonstrated a twofold increased risk of conversion to total hip arthroplasty., Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: To investigate the effectiveness of educating program among primary and secondary school students in Papua New Guinea, where has the highest incidence of oral cancer all over the world., Methods: A cross-sectional school based survey was arranged in primary and secondary school in Papua New Guinea in June, 2015. A self-administrated questionnaire was administered before and after education done by health experts from Taiwan. The subjects were chosen by random. The schools provided the students we educated and did the questionnaires on., Results: Ninety five primary school students and 55 secondary school students in Papua New Guinea participated in the study. Before education, both groups lacked the knowledge that betel quid is harmful to health and had no motivation to quit betel quid consumption with the average score 4.580 out of the total score of 8 for primary school students, and the average score of 4.600 out of the total score of 8 for secondary school students. After education, improvements were noted in knowledge of betel quid among both groups, and reached the statistical significance for secondary school students (mean difference 0.700 ± 0.277, 95% CI 0.164-1.248, p-value = 0.018)., Conclusion: A great achievement was gained by a short time of education. To prevent the incidence and mortality of oral cancer in Papua New Guinea, education programs should be arranged aggressively and effectively., (Copyright © 2017. Published by Elsevier Taiwan LLC.)

Purpose: To evaluate clinical outcomes, demographics, and radiographic findings for patients whose hip arthroscopies involved amorphous calcification (AC) excision and to compare them with a control group with no AC and with the general population regarding diabetes mellitus and hypothyroidism., Methods: Patients who underwent primary hip arthroscopy involving surgical excision of AC deposit in the anterosuperior labralcapsular recess between October 2008 and July 2014 were reviewed. Demographics, radiographic findings, intraoperative findings, and procedures were reviewed. Minimum follow-up was 2 years and included visual analog scale for pain, patient satisfaction, and the following patient-reported outcome scores: modified Harris hip score, hip outcomes score sport-specific subscale, and nonarthritic hip score. These patients were matched (1:2 ratio) to patients who underwent hip arthroscopy with no AC using the following matching criteria: age at surgery ± 5 years, body mass index ± 5, gender, type of labral treatment, and type of capsular treatment., Results: We reviewed 12 cases in 11 female patients. Mean latest follow-up scores improved from 64.0 to 83.4 (P = .003) for modified Harris hip score, from 57.6 to 80.6 (P < .001) for nonarthritic hip score, from 35.4 to 62.7 (P = .021) for hip outcomes score sport-specific subscale, and from 6.4 to 2.8 (P = .016) for visual analog scale. The survivorship rate was 91.7%, with one hip converting to total hip arthroplasty. Mean patient satisfaction was 8.4 ± 2.3. Six hips of the 12 (50%) had clock face localization of the AC. They were all between 11 and 12 with a mean of 12:30. Postoperative radiographic findings showed no subsequent AC in all 12 hips. No complications or revisions were reported. There were no significant differences between the AC group and the control group., Conclusions: The treatment of AC as part of hip arthroscopy for labral tear and femoro-acetabular impingement is safe and has favorable and similar outcomes compared with a control group at minimum 2-year follow-up. Female gender may be a risk factor for the development of AC. There is no strong evidence that AC should be debrided., Level of Evidence: Level III, case control study., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Treatment options for the management of osteochondritis dissecans (OCD) lesions of the femoral head are limited. Although arthroscopic surgery of the hip can treat a variety of intra- and extra-articular pathologies, an OCD lesion located at the superior and medial zone of the femoral head is often difficult to access and cannot be adequately treated arthroscopically. The use of fresh-stored osteochondral allograft allows surgeons to both avoid donor-site morbidity and treat lesions of a larger surface area. We present our technique for surgical treatment of a femoral head OCD lesion with open surgical dislocation of the hip through stepped trochanteric osteotomy and osteochondral transplantation of fresh-stored femoral head allograft.

Purpose: To compare patient-reported outcomes, progression of radiographic arthritis, revision rates, and complications for hips with acetabular retroversion treated by open versus arthroscopic methods., Methods: The PubMed and EMBASE databases were searched in August 2016 for literature on the open and arthroscopic techniques using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) method. All studies published in the English language that focused on the surgical treatment of femoroacetabular impingement caused by retroversion were included. All arthroscopic procedures, such as acetabuloplasty and labral repair, and open procedures, including anteverting periacetabular osteotomy and surgical dislocation with osteoplasty, were included. Articles that did not describe how retroversion was defined were excluded, as were studies with less than 6 months' follow-up and fewer than 5 patients. Two authors screened the results and selected articles for this review based on the inclusion and exclusion criteria. All results were scored using the Methodological Index for Non-randomized Studies (MINORS) criteria., Results: There were 386 results returned and 15 articles that met the inclusion criteria of this study. Among the studies, 11 reviewed arthroscopic techniques and 4 reviewed open surgical procedures. Both techniques yield good results based on patient-reported outcomes with minimal progression of osteoarthritis and low complication rates., Conclusions: This review showed statistically and clinically significant improvements for the treatment of acetabular retroversion based on patient-reported outcomes, with low progression of radiographic arthritis, revision rates, and complications using both open and arthroscopic methods., Level of Evidence: Level IV, systematic review of Level I to IV studies., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

While Nasopharyngeal carcinoma (NPC) is uncommon in western countries, it is endemic in Southeast Asia and Southern China. Previous study of norcantharidin (NCTD), isolated from blister beetles, has proved its anticancer effect on various tumors. However, the effect of NCTD in NPC has never been studied. The purpose of this study is to inspect the suppression activity of NCTD on NPC, along with the underlying mechanism. NPC cell line NPC-BM was treated with NCTD. NCTD remarkably inhibited proliferation and induce apoptosis in NPC-BM cell. Activation of caspase-3, -8, -9 was observed through western blotting. The expression of antiapoptotic protein Bcl-XL was significantly reduced, but expression of proapoptotic protein Bak was increased after treatment of NCTD. The cytotoxic effect of NCTD on NPC-BM cell is mainly due to apoptosis, mediated by caspase and mitochondrial pathway. These results suggested that NCTD could be a potential anticancer agent for NPC., (© 2017 Wiley Periodicals, Inc.)

Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group., Study Design: Cohort study; Level of evidence, 3., Methods: Data were collected on all patients undergoing primary hip arthroscopic surgery between February 2008 and September 2011. Exclusion criteria were acetabular or femoral head Outerbridge grade 4 chondral damage, preoperative Tnnis grade ≥2, workers' compensation claims, previous hip conditions, severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery. Patients who underwent arthroscopic labral debridement and had preoperative and minimum 5-year PRO scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) as well as the visual analog scale (VAS) for pain, were included. In a nested matched-pair comparison, the SDLP group was matched 1:1 to an arthroscopic labral repair control group based on age ±5 years, body mass index ±5 kg/m 2 , sex, and Seldes tear type., Results: One hundred twenty-five hips were eligible for inclusion, of which 101 (80.8%) hips had a minimum 5-year follow-up. All PRO scores were significantly improved ( P < .001) at latest follow-up (mHHS, 63.4 to 82.4; NAHS, 57.4 to 83.6; HOS-SSS, 44.2 to 74.5). The mean VAS score decreased from 5.8 to 2.3 ( P < .001). The mean patient satisfaction score was 8.1. Four (4.0%) patients underwent second-look arthroscopic surgery (mean, 18.5 months), and 14 (13.9%) patients converted to total hip arthroplasty (mean, 46.9 months). In the matched-pair comparison, 69 in the SDLP group were matched 1:1 with those undergoing labral repair. Outcomes at latest follow-up of the SDLP group were comparable with those of the control group, respectively: mHHS, 83.0 vs 86.1 ( P = .084); NAHS, 85.0 vs 85.4 ( P = .415); HOS-SSS, 74.8 vs 76.8 ( P = .219); VAS, 2.3 vs 2.0 ( P = .277); international Hip Outcome Tool-12 (iHOT-12), 73.8 vs 76.4 ( P = .136); Short Form Health Survey-12 (SF-12) mental, 57.4 vs 55.1 ( P = .031); SF-12 physical, 48.7 vs 48.9 ( P = .357); Veterans RAND Health Survey-12 (VR-12) mental, 61.6 vs 59.8 ( P = .160); VR-12 physical, 50.1 vs 50.2 ( P = .340); and patient satisfaction, 8.0 vs 8.3 ( P = .211)., Conclusion: In select cases of stable labral tears, SDLP may allow the preservation of a functional labrum. At a minimum 5-year follow-up, SDLP using narrow indications produced favorable outcomes comparable with a matched-pair labral repair group.

Purpose: To critically evaluate the existing literature on hip capsule biomechanics, clinical evidence of instability, and outcomes of capsular management to answer the following question: Should the capsule be repaired or plicated after hip arthroscopy for labral tears associated with femoroacetabular impingement or instability?, Methods: We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines to find articles using PubMed and Embase. Included studies were Level I through V studies and focused on hip capsule biomechanics, postarthroscopic instability, and clinical outcomes. Articles were excluded if they discussed treatment of the hip capsule during arthroplasty, dislocations without a history of arthroscopy, and pre-existing conditions. The Methodological Index for Non-randomized Studies (MINORS) was used for quality assessment of clinical outcome studies., Results: A total of 34 articles were included: 15 biomechanical studies, 9 instability case reports, and 10 outcome studies. There is consensus from biomechanical studies that the capsule is an important stabilizer of the hip and repairing it provides better stability than when unrepaired. Case reports of instability have raised concerns about capsular management during the index procedure to decrease the complications associated with this problem. Furthermore, outcome studies suggest that there may be an advantage of capsular closure versus capsulotomy during hip arthroscopy for nonarthritic patients., Conclusions: Short-term outcome studies suggest that capsular closure is safe and effective in nonarthritic patients undergoing hip arthroscopic procedures and may yield superior outcomes compared with unrepaired capsulotomy. Moreover, biomechanical evidence strongly supports the role of capsular repair in maintaining stability of the hip. In patients with stiffness or inflammatory hip disorders, a release may be appropriate. In patients who have signs and symptoms of instability, there is existing evidence that capsular plication may be associated with significant improvement in patient-reported outcomes. Although the multiple procedures performed in combination with capsular treatment present confounding variables, current evidence appears to support routine capsular closure in most cases and to support capsular plication in cases of instability or borderline dysplasia., Level of Evidence: Level IV, systematic review of Level II through IV studies., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

tRNA His guanylyltransferase (Thg1) has unique reverse (3'-5') polymerase activity occurring in all three domains of life. Most eukaryotic Thg1 homologs are essential genes involved in tRNA His maturation. These enzymes normally catalyze a single 5' guanylation of tRNA His lacking the essential G -1 identity element required for aminoacylation. Recent studies suggest that archaeal type Thg1, which includes most archaeal and bacterial Thg1 enzymes is phylogenetically distant from eukaryotic Thg1. Thg1 is evolutionarily related to canonical 5'-3' forward polymerases but catalyzes reverse 3'-5'polymerization. Similar to its forward polymerase counterparts, Thg1 encodes the conserved catalytic palm domain and fingers domain. Here we investigate the minimal requirements for reverse polymerization. We show that the naturally occurring minimal Thg1 enzyme from Ignicoccus hospitalis (IhThg1), which lacks parts of the conserved fingers domain, is catalytically active. And adds all four natural nucleotides to RNA substrates, we further show that the entire fingers domain of Methanosarcina acetivorans Thg1 and Pyrobaculum aerophilum Thg1 (PaThg1) is dispensable for enzymatic activity. In addition, we identified residues in yeast Thg1 that play a part in preventing extended polymerization. Mutation of these residues with alanine resulted in extended reverse polymerization. PaThg1 was found to catalyze extended, template dependent tRNA repair, adding up to 13 nucleotides to a truncated tRNA His substrate. Sequencing results suggest that PaThg1 fully restored the near correct sequence of the D- and acceptor stem, but also produced incompletely and incorrectly repaired tRNA products. This research forms the basis for future engineering efforts towards a high fidelity, template dependent reverse polymerase.

Arthroscopic acetabuloplasty involves trimming of bone from the acetabular rim. Although early techniques often involved detachment of the labrum prior to bone resection, recent studies have reported on acetabuloplasty without labral detachment. This method has the benefit of preserving the labro-osseous junction, but visualization of the acetabular rim may be more difficult. Compromised visualization can lead to incomplete resection and residual impingement. We describe an arthroscopic perspective called the "bird's eye" and "upper deck" views that facilitates optimal visualization of the acetabuloplasty without labral detachment.

Background: Birmingham hip resurfacing (BHR) has proven to be a good alternative for younger patients with osteoarthritis. Some have asserted that BHR may yield outcomes which are superior to total hip arthroplasty (THA), and that some studies which failed to show a difference were plagued by ceiling effects and lack of sensitivity of outcome measures. The purpose of this study is to compare outcomes of BHR and THA using the "Forgotten Joint" Score-12 (FJS), a more sensitive score with lesser vulnerability to the ceiling effect., Methods: Patients who underwent BHR were matched to patients who underwent posterior THA by computing a propensity score using 5 covariates: age, body mass index, gender, worker's compensation claims, and previous hip surgery. Surgical outcomes were assessed using 6 patient-reported outcome measures, including the FJS, the visual analog scale for pain, and patient satisfaction., Results: There were 42 patients in the BHR group and 18 patients in the THA group. The FJS was 78.0 for the BHR group and 76.0 for the THA group. The Veterans RAND 12-Item Health Survey Mental Component Summary and Short Form 12 Mental Component Summary were significantly higher in the BHR group. No differences were seen between all other patient-reported outcomes., Conclusion: BHR offers excellent results in young patients that are comparable to THA. As no clinical difference could be shown between BHR and THA, even with the use of the FJS, the choice between BHR and THA should not be based solely on any expectation that either yields superior clinical outcomes compared to the other at short-term follow-up., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Purpose: To report the minimum 5-year outcomes of endoscopic gluteus medius repair for partial- and full-thickness tears with concomitant hip arthroscopy., Methods: Data for all patients who underwent hip arthroscopy between February 2009 and September 2011 were prospectively collected. We included patients who underwent endoscopic gluteus medius repair with concomitant arthroscopic labral treatment and for whom the following measures were obtained preoperatively and at a minimum of 5 years' follow-up: modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score-Sports Specific Subscale, and visual analog scale score for pain. For included patients, the International Hip Outcome Tool-12 (iHOT-12) score and satisfaction rating were also available at latest follow-up. Patients with at least 1 of the following criteria were excluded: preoperative Tönnis osteoarthritis grade of 2 or greater, previous hip conditions, severe dysplasia, and Workers' Compensation claims., Results: There were 16 patients eligible for inclusion, 14 (87.5%) of whom had minimum 5-year follow-up, with a mean of 68.8 months (range, 60.1-79.6 months). The study group consisted of 13 women (92.9%) and 1 man (7.1%) with a mean age at surgery of 57.4 years (range, 46.3-74.8 years). Outcome scores improved as follows: modified Harris Hip Score, from 52.4 to 81.2 (P = .004); Non-Arthritic Hip Score, from 48.0 to 82.5 (P = .002); Hip Outcome Score-Sports Specific Subscale, from 30.1 to 66.4 (P < .001); and visual analog scale score, from 6.2 to 2.6 (P = .001). At minimum 5-year follow-up, the mean iHOT-12 score was 73.8 and the mean patient satisfaction rating was 8.4. Survivorship was 92.9%, with 1 patient who underwent conversion to total hip arthroplasty. There was no deterioration in patient outcomes and satisfaction between 2 and 5 years postoperatively. There were no clinical failures of gluteus medius repair and no complications., Conclusions: Endoscopic gluteus medius repair with concomitant hip arthroscopy for labral tears is safe and shows favorable outcomes at minimum 5-year follow-up. Patient outcomes were as favorable at 5 years as they were at 2 years postoperatively., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

With increased interest in graphene-based sensors for biomolecules and other targets, we investigated the impact of ionic strength on the steady-state emissions from fluorescein labels on proteins adsorbing on pristine CVD (chemical vapor deposited)-graphene on a silica support. Using the model system of fluorescein-tagged fibrinogen we demonstrated that, for fluorescein tags on adsorbed fibrinogen, emission intensity was very sensitive to the salt concentration. This behavior was not seen for fluorescein-tagged fibrinogen in solution. We demonstrated that fluorescein "quenching" in this system was a result of fluorescein's pH sensitivity: with changes in salt concentration, near-surface fluorescein experiences either the neutral bulk pH or, with a negatively charged surface, an acidic environment. The findings carry the important implication that the aqueous environment near silica-supported graphene is substantially acidic as a result of near-surface negative charge. This further implies, because of the purity of the graphene in this study and its lack of oxidation, that negative charge arises from ion adsorption and/or from the underlying silica support, which may be hydrated and present dissociated surface silanols. That is, the electrostatic potential from silica beneath the graphene may pass through the graphene, much as van der Waals interactions have been proven to do. Results were semi-quantitatively consistent with calculations that employed a Guoy Chapman model of the interface and the established pKa of the fluorescein. While these findings were obtained with adsorbed proteins, similar fluorescence quenching would be expected for any fluorescein-tagged species in the vicinity of silica-supported graphene. Thus, because of the negative charge at the aqueous graphene interface, ionic strength can be exploited as means of creating a molecular ruler of fluorescein emissions, and the emissions can be assessed within different distances, corresponding to the Debye length, from the graphene interface., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Background: Arthroscopic labral base repair (LBR) in the hip is a previously described technique designed to restore the native functional anatomy of the labrum by reproducing its seal against the femoral head. LBR has been shown to have good short-term outcomes. Hypothesis/Purpose: The purpose was to evaluate clinical outcomes of an LBR cohort with a minimum 5-year follow-up. It was hypothesized that patients who underwent LBR would continue to have significant improvement from their preoperative scores and maintain scores similar to their 2-year outcomes., Study Design: Case series; Level of evidence, 4., Methods: Data for patients undergoing primary hip arthroscopic surgery with LBR from February 2008 to May 2011 with a minimum 5-year follow-up were prospectively collected and retrospectively reviewed. Patients with preoperative Tonnis osteoarthritis grade ≥2, previous hip conditions (slipped capital femoral epiphysis, avascular necrosis, Legg-Calv-Perthes disease), severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery were excluded. Statistical equivalence tests evaluated patient-reported outcomes (PROs) including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), visual analog scale (VAS) for pain, and patient satisfaction (0-10 scale; 10 = very satisfied)., Results: Of the 70 patients (74 hips) who met inclusion and exclusion criteria, 60 (85.7%) patients (64 hips) were available at a minimum 5-year follow-up. All PRO scores significantly improved from preoperative values with a mean follow-up of 67.8 ± 7.4 months (range, 60.0-89.7 months). The mean mHHS increased from 64.4 ±13.8 to 85.3 ± 17.7 ( P < .001), the mean NAHS from 63.7 ± 17.0 to 87.0 ± 14.7 ( P < .001), and the mean HOS-SSS from 47.1 ± 23.2 to 76.5 ± 25.9 ( P < .001). The mean VAS score decreased from 5.9 ± 2.4 to 2.0 ± 2.1 ( P < .001). The mean patient satisfaction score was 8.1 ± 2.0. The improvement in PRO scores was sustained from 2- to 5-year follow-up. At 2 and 5 years, survivorship rates were 96.9% and 90.6%, respectively, and the respective secondary arthroscopic surgery rates were 10.9% (7/64) and 17.2% (11/64)., Conclusion: At a minimum 5-year follow-up, arthroscopic LBR continued to be a successful procedure and valid technique based on 3 PROs, the VAS, patient satisfaction, and survivorship. Significantly improved outcome scores were maintained compared with preoperative values and showed no signs of deterioration from the 2-year scores. The long-term survivorship of hip arthroscopic surgery has yet to be determined; however, these midterm results demonstrate the rates of additional procedures (both secondary arthroscopic surgery and conversion to total hip arthroplasty), that may be necessary after 2 years.

Objective: With advances in the treatment of human immunodeficiency virus (HIV) infections, the life expectancy of people with HIV (PWH) is fast approaching that of the general population. Endocrine and metabolic disorders occur more frequently in PWH than in the general population. This study assessed the knowledge, practice patterns, and confidence levels among endocrinology trainees in Singapore in managing endocrine disorders in PWH., Methods: An anonymous, 31-item survey was administered to 23 endocrinology trainees. Four domains were assessed: (1) previous exposure to endocrine disorders in PWH; (2) attitudes towards treating PWH, (3) case studies in endocrinology designed to assess for differences in treatment philosophy between a PWH and a noninfected counterpart, and (4) confidence in managing endocrine disorders in PWH., Results: The participation rate was 73.9%, with the majority of trainees (88.2%) having managed fewer than 5 PWH with endocrine disorders. A total of 94.1% of the trainees had little or no hesitation in treating PWH, but more than half (58.8%) felt inadequate in confidently managing them. A total of 82.4% deemed HIV endocrinology as an emerging field and were open to the idea of pursuing it as a subspecialty in the future. Re-assuringly, most trainees would not compromise medical treatment for a PWH if it were indicated. More than half were ambivalent about prescribing cross-hormonal therapy to transgender individuals., Conclusion: Endocrinology trainees feel that while HIV endocrinology is an emerging field, they lack exposure, training, and confidence in the management of these patients. Although they would treat medical conditions well, they lacked knowledge in hormonal treatment of transgender individuals., Abbreviations: HIV = human immunodeficiency virus PWH = people with HIV.

Purpose: The management of extensive head and neck lymphatic malformations (LMs) in infants is challenging because of life-threatening upper airway compression. The aim of this study was to present a management protocol and evaluate the clinical outcomes for preventing tracheotomy in these patients., Materials and Methods: Fifteen infants with extensive head and neck LMs and airway involvement were enrolled from August 2010 through September 2015 at the Qilu Hospital of Shandong University (Jinan, China). According to various key factors associated with airway compression of patients in the perioperative period, different anesthesia types, treatment times, sclerosant concentrations, and sclerotherapy protocols were used. Multistage sclerotherapy was performed with bleomycin A5. All patients were followed at 1, 3, 6, and 12 months. More extended follow-up was offered if patients had a residual lesion requiring supplementary sclerotherapy. Reviews on the site and size of the lesion, times and durations of treatments, therapeutic response, airway complications, and conduction of tracheotomy were performed., Results: LM lesions in the head and neck were located in the floor of the mouth, tongue, and neck. An overall average of 5 treatments was required; a lesion volume decrease of more than 50% was achieved in all patients. For efficacy, morphologic resolution was achieved in 3 of 15 cases (20%), and there was a substantial response in 12 of 15 cases (80%). Eight of 15 patients (53.3%) with microcystic LMs exhibited immediate swelling and had more serious upper airway symptoms than preoperatively, and 2 of 15 patients (13.3%) had feeding difficulty. No upper airway obstruction occurred and no tracheotomy was performed in the patients in this study., Conclusions: Multistage sclerotherapy with bleomycin A5 is a safe and effective treatment for extensive head and neck LMs in infants with airway involvement. A routine perioperative protocol is essential for decreasing airway complications., (Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

This study addresses the electrostatic and van der Waals interactions at the aqueous interface of large area CVD graphene, 1-3 layers thick on a silica support and assessed by Raman spectroscopy to have exclusive sp2 character. Ionic strength was found to substantially alter the interactions of silica microspheres with silica-supported graphene. Particles were nonadhesive at large Debye lengths but became irreversibly adherent at reduced Debye lengths about 2nm or less. This was demonstrated to be qualitatively parallel to the influence of ionic strength on silica-silica interactions. The observed ionic strength effects are best explained by negative charges in the vicinity, within a few nanometers, of the supported graphene. DLVO-based modeling of the silica-water-supported graphene interaction suggests that van der Waals interactions drive particle capture and that the surface potential at the supported graphene surface is at least -10 to -15mV (corresponding to a charge density of 0.02-0.06/nm 2 ). This charge could result from ion adsorption or from charges on silica beneath the graphene. The conclusions are not substantially affected by inclusion of nanometer-scale interfacial roughness in the modeling., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Patients who have lateral hip pain historically have been diagnosed with trochanteric bursitis and treated with nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy. Although this strategy is effective for most patients, a substantial number of patients continue to have pain and functional limitations. Over the past decade, our understanding of disorders occurring in the peritrochanteric space has increased dramatically. Greater trochanteric pain syndrome encompasses trochanteric bursitis, external coxa saltans (ie, snapping hip), and abductor tendinopathy. A thorough understanding of the anatomy, examination findings, and imaging characteristics aids the clinician in treating these patients. Open and endoscopic treatment options are available for use when nonsurgical treatment is unsuccessful.

This study aimed to develop a modified Tessari method for producing more sclerosing foam in treatment of extensive venous malformations. Sclerosing foam was produced by using Tessari method and the modified Tessari method. The procedure of the later was as follows: prepared foam in a sclerosant-air ratio of 1:4; connected three disposable 10 ml syringes to two medical three-way taps; drawn 4 ml of liquid sclerosant into one syringe and 16 ml averagely of air into the other two; then moved the plungers of all syringes back and forth for 20 times to produce sclerosing foam. The volume and foam half time (FHT) of foam produced by the two methods were compared. The average volume of sclerosing foam produced by Tessari method and the modified Tessari method were 9.8 and 19.7 ml, and assessed to have statistical difference. The FHT of foam produced by the two methods were 120 and 150 s, and assessed to have statistical difference. In conclusion, the modified Tessari method could produce more fresh and stable sclerosing foam.

Purpose: To categorize and summarize up-to-date anterior cruciate ligament (ACL) research published in Arthroscopy and The American Journal of Sports Medicine and systematically review each subcategory, beginning with ACL anatomy., Methods: After searching for "anterior cruciate ligament" OR "ACL" in Arthroscopy and The American Journal of Sports Medicine from January 2012 through December 2014, we excluded articles more pertinent to ACL augmentation; open growth plates; and meniscal, chondral, or multiligamentous pathology. Studies were subcategorized for data extraction., Results: We included 212 studies that were classified into 8 categories: anatomy; basic science and biomechanics; tunnel position; graft selection; graft fixation; injury risk and rehabilitation; practice patterns and outcomes; and complications. Anatomic risk factors for ACL injury and post-reconstruction graft failure include a narrow intercondylar notch, low native ACL volume, and increased posterior slope. Regarding anatomic footprints, the femoral attachment is 43% of the proximal-to-distal lateral femoral condylar length whereas the posterior border of the tendon is 2.5 mm from the articular margin. The tibial attachment of the ACL is two-fifths of the medial-to-lateral interspinous distance and 15 mm anterior to the posterior cruciate ligament. Anatomic research using radiology and computed tomography to evaluate ACL graft placement shows poor interobserver and intraobserver reliability., Conclusions: With a mind to improving outcomes, surgeons should be aware of anatomic risk factors (stenotic femoral notch, low ligament volume, and increased posterior slope) for ACL graft failure, have a precise understanding of arthroscopic landmarks identifying femoral and tibial footprint locations, and understand that imaging to evaluate graft placement is unreliable., Level of Evidence: Level III, systematic review of Level III evidence., (Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Foam sclerotherapy is an effective treatment strategy for varicose veins and venous malformations. Foam stability varies according to foam composition, volume, and injection technique., Objective: To evaluate the stability of polidocanol (POL) foam with the addition of hyaluronic acid (HA)., Materials and Methods: Group A: 2 mL of 1% POL + 0 mL of 1% HA + 8 mL of air; Group B: 2 mL of 1% POL + 0.05 mL of 1% HA + 8 mL of air; Group C: 2 mL of 1% POL + 0.1 mL of 1% HA + 8 mL of air. Tessari's method was used for foam generation. The half-life, or the time for a volume of foam to be reduced to half of its original volume, was used to evaluate foam stability. Five recordings were made for each group., Results: The half-life was 142.8 (±4.32) seconds for 1% POL without the addition of HA, 310.6 (±7.53) seconds with the addition of 0.05 mL of 1% HA, and 390.4 (±13.06) seconds with the addition of 0.1 mL of 1% HA., Conclusion: The stability of POL foam was highly increased by the addition of small amounts of HA.

Our aim was to evaluate the efficacy of sclerotherapy using radio-opaque foam and guided by digital subtraction angiography (DSA) for complex venous malformations in the head and neck in 11 selected patients between 2011 and 2013. The sclerosing foam was manufactured by the classic Tessari method and consisted of air, 1% polidocanol, and radio-opaque media iopromide (Ultravist(®)300) in a ratio of 7:2:1. We recorded the site and size of the lesion, time and duration of treatment, and therapeutic response. The lesions were on the face, cheek, temporal region, parotid region, neck, tongue, floor of the mouth, parapharyngeal space, and soft palate. The sclerosing foam was radio-opaque under DSA, and the mean (range) dose was 21 (3-65) ml. A mean (range) of 4 (2-7) treatments was required, and 10 of the 11 patients responded well. In 4 of the 11 cases the lesion resolved completely and in 6 there was a good response. Only one lesion recurred. Early complications included immediate swelling in injected areas, snoring, and pain on swallowing, but there were no air emboli or signs of cutaneous necrosis, and the complications were self-limiting. DSA-guided sclerotherapy with radio-opaque foam was safe and effective for the treatment of complex vascular malformations of the head and neck., (Copyright © 2015 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Sclerosing foam is recommended to treat venous malformations (VMs). However, determining the precise dosage for satisfactory efficacy and few side effects are still challenging., Objective: To develop a new method of preparing sclerosing foam by adding contrast agent to treat patients with VMs visibly and precisely under radiologic guidance., Materials and Methods: Sclerosant (polidocanol) and contrast agent (iopromide) were mixed to prepare a new sclerosing foam according to Tessari method, and different ratios of the 2 materials were used to study the stability (half-life) of the produced foams. X-ray absorption of the radiopaque foams was observed during patient treatment with digital subtraction angiography (DSA)., Results: The foams generated with the new method demonstrated a high x-ray absorption under DSA. The foam half-life among groups varied. The ratio of iopromide/polidocanol at 1:2 had a significantly longer half-life than the 1:1 or polidocanol-only group. The 1:2 group had a relative high x-ray absorption and was radiopaque to allow visualization of the sclerosing foam and lesion with DSA., Conclusion: Mixing contrast agent with sclerosant to prepare radiopaque foams is a new method for treating complex VMs with DSA, and a ratio of 1:2 is recommend for polidocanol and iopromide.

The present work evaluated the effects of six inorganic electrolyte anions on Cu(II) removal using aminated Fe3O4/graphene oxide (AMGO) in single- and multi-ion systems. A 2(6-2) fractional factorial design (FFD) was employed for assessing the effects of multiple anions on the adsorption process. The results indicated that the Cu(II) adsorption was strongly dependent on pH and could be significantly affected by inorganic electrolyte anions due to the changes in Cu(II) speciation and surface charge of AMGO. In the single-ion systems, the presence of monovalent anions (Cl(-), ClO4(-), and NO3(-)) slightly increased the Cu(II) adsorption onto AMGO at low pH, while the Cu(II) adsorption was largely enhanced by the presence of SO4(2-), CO3(2-), and HPO4(2-). Based on the estimates of major effects and interactions from FFD, the factorial effects of the six selected species on Cu(II) adsorption in multi-ion system were in the following sequence: HPO4(2-)>CO3(2-)>Cl(-)>SO4(2-)>NO3(-)=ClO4(-), and the combined factors of AD (Cl(-)×SO4(2-)) and EF (Cl(-)×SO4(2-)) had significant effects on Cu(II) removal., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Cd(II) has posed severe health risks worldwide. To remove this contaminant from aqueous solution, the sulfanilic acid-grafted magnetic graphene oxide sheets (MGOs/SA) were prepared and characterized. The mutual effects of Cd(II) and aniline adsorption on MGOs/SA were studied. The effects of operating parameters such as pH, ionic strength, contact time and temperature on the Cd(II) enrichment, as well as the adsorption kinetics and isotherm were also investigated. The results demonstrated that MGOs/SA could effectively remove Cd(II) and aniline from the aqueous solution and the two adsorption processes were strongly dependent on solution pH. The Cd(II) adsorption was reduced by the presence of aniline at pH<5.4 but was improved at pH>5.4. The presence of Cd(II) diminished the adsorption capacity for aniline at pH<7.8 but enhanced the aniline adsorption at pH>7.8. The decontamination of Cd(II) by MGOs/SA was influenced by ionic strength. Besides, the adsorption process could be well described by pseudo-second-order kinetic model. The intraparticle diffusion study revealed that the intraparticle diffusion was not the only rate-limiting step for the adsorption process. Moreover, the experimental data of isotherm followed the Freundlich isotherm model., (Copyright © 2014 Elsevier Inc. All rights reserved.)

CASQ2 (cardiac calsequestrin) is commonly believed to serve as the SR (sarcoplasmic reticulum) luminal Ca2+ sensor. Ablation of CASQ2 promotes SCWs (spontaneous Ca2+ waves) and CPVT (catecholaminergic polymorphic ventricular tachycardia) upon stress but not at rest. How SCWs and CPVT are triggered by stress in the absence of the CASQ2-based luminal Ca2+ sensor is an important unresolved question. In the present study, we assessed the role of the newly identified RyR2 (ryanodine receptor 2)-resident luminal Ca2+ sensor in determining SCW propensity, CPVT susceptibility and cardiac hypertrophy in Casq2-KO (knockout) mice. We crossbred Casq2-KO mice with RyR2 mutant (E4872Q+/-) mice, which lack RyR2-resident SR luminal Ca2+ sensing, to generate animals with both deficiencies. Casq2+/- and Casq2-/- mice showed stress-induced VTs (ventricular tachyarrhythmias), whereas Casq2+/-/E4872Q+/- and Casq2-/-/E4872Q+/- mice displayed little or no stress-induced VTs. Confocal Ca2+ imaging revealed that Casq2-/- hearts frequently exhibited SCWs after extracellular Ca2+ elevation or adrenergic stimulation, whereas Casq2-/-/E4872Q+/- hearts had few or no SCWs under the same conditions. Cardiac hypertrophy developed and CPVT susceptibility increased with age in Casq2-/- mice, but not in Casq2-/-/E4872Q+/- mice. However, the amplitudes and dynamics of voltage-induced Ca2+ transients in Casq2-/- and Casq2-/-/E4872Q+/- hearts were not significantly different. Our results indicate that SCWs, CPVT and hypertrophy in Casq2-null cardiac muscle are governed by the RyR2-resident luminal Ca2+ sensor. This implies that defects in CASQ2-based lumi-nal Ca2+ sensing can be overridden by the RyR2-resident luminal Ca2+ sensor. This makes this RyR2-resident sensor a promising molecular target for the treatment of Ca2+-mediated arrhythmias.

Introduction: This study aimed to examine the attendance rates of post-discharge supervised rehabilitation as recommended by the multidisciplinary team at discharge among subacutely disabled adults and the barriers preventing adherence., Materials and Methods: Patients were from a community hospital, aged 40 years or older. They had been assessed by a multidisciplinary team to benefit from rehabilitation after discharge, were mentally competent and communicative. We used a sequential qualitative-quantitative mixed methods study design. In the initial qualitative phase, we studied the patient-perceived barriers to adherence to rehabilitation using semi-structured interviews. Emerging themes were then analysed and used to develop a questionnaire to measure the extent of these barriers. In the subsequent quantitative phase, the questionnaire was used with telephone follow-up at 3, 6, 9 and 12 months after discharge., Results: Qualitative phase interviews (n = 41) revealed specific perceived financial, social, physical and health barriers. At the start of the quantitative phase (n = 70), 87.1% of the patients viewed rehabilitation as beneficial, but overall longitudinal attendance rate fell from 100% as inpatient to 20.3% at 3 months, 9.8% at 6 months, 6.3% at 9 months and 4.3% at 12 months. The prevalence of physical and social barriers were high initially but decreased with time. In contrast, the prevalence of financial and perceptual barriers increased with time., Conclusion: Attendance of post-hospitalisation rehabilitation in Singapore is low. Self-perceived barriers to post-discharge rehabilitation attendance were functional, social, financial and perceptual, and their prevalence varied with time.

This research was conducted to search and identify spontaneously growing heavy metal-tolerant plant species that are potentially useful for phytoremediation in contaminated sediment. Five sites were selected for collection of plants growing on polluted shore (river bank) sediment of the Xiang River, China. The concentrations of Zn, Pb, Cu and Cd in plants, sediments, and grasshoppers were determined using flame atomic absorption spectrophotometer (AAS700, Perkin-Elmer, USA). Considering translocation factor and bioaccumulation factor, Rumex crispus (Polygonaceae), Rumex dentatus (Polygonaceae), and Lagopsis supina (Labiatae) could be potentially useful for phytostabilization of metals. R. crispus can be considered potentially useful for phytoextraction of Cd. In light of the biomagnification factors, grasshoppers are deconcentrators for Pb and Cd, microconcentrators for Zn and macroconcentrators for Cu to the plants, respectively. To the best of our knowledge, the present study is the first report on Zn, Pb, Cu and Cd accumulation in R. crispus and L. supina, providing a pioneer contribution to the very small volume of data available on the potential use of native plant species from contaminated sediments in phytostabilization and phytoremediation technologies.

The white-rot fungus Phanerochaete chrysosporium has been widely used for the treatment of waste streams containing heavy metals and toxic organic pollutants. The development of fungal-based treatment technologies requires detailed knowledge of the relationship between bulk water quality and the physiological responses of fungi. A noninvasive microtest technique was used to quantify real-time changes in proton, oxygen, and cadmium ion fluxes following the exposure of P. chrysosporium to environmental toxic (2,4-dichlorophenol and cadmium). Significant changes in H(+) and O(2) flux occurred after exposure to 10 mg/L 2,4-dichlorophenol and 0.1 mM cadmium. Cd(2+) flux decreased with time. Reactive oxygen species formation and antioxidant levels increased after cadmium treatment. Superoxide dismutase activity correlated well with malondialdehyde levels (r(2) = 0.964) at low cadmium concentrations. However, this correlation diminished and malondialdehyde levels significantly increased at the highest cadmium concentration tested. Real-time microscale signatures of H(+), O(2), and Cd(2+) fluxes coupled with oxidative stress analysis can improve our understanding of the physiological responses of P. chrysosporium to toxic pollutants and provide useful information for the development of fungal-based technologies to improve the treatment of wastes cocontaminated with heavy metals and organic pollutants.

Proteins requiring post-translational modifications such as N-linked glycosylation are processed in the endoplasmic reticulum (ER). A diverse array of cellular stresses can lead to dysfunction of the ER and ultimately to an imbalance between protein-folding capacity and protein-folding load. Cells monitor protein folding by an inbuilt quality control system involving both the ER and the Golgi apparatus. Unfolded or misfolded proteins are tagged for degradation via ER-associated degradation (ERAD) or sent back through the folding cycle. Continued accumulation of incorrectly folded proteins can also trigger the unfolded protein response (UPR). In mammalian cells, UPR is a complex signaling program mediated by three ER transmembrane receptors: activating transcription factor 6 (ATF6), inositol requiring kinase 1 (IRE1) and double-stranded RNA-activated protein kinase (PKR)-like endoplasmic reticulum kinase (PERK). UPR performs three functions, adaptation, alarm, and apoptosis. During adaptation, the UPR tries to reestablish folding homeostasis by inducing the expression of chaperones that enhance protein folding. Simultaneously, global translation is attenuated to reduce the ER folding load while the degradation rate of unfolded proteins is increased. If these steps fail, the UPR induces a cellular alarm and mitochondrial mediated apoptosis program. UPR malfunctions have been associated with a wide range of disease states including tumor progression, diabetes, as well as immune and inflammatory disorders. This review describes recent advances in understanding the molecular structure of UPR in mammalian cells, its functional role in cellular stress, and its pathophysiology., (Copyright © 2011 Wiley Periodicals, Inc.)

A novel coarsening route for extracellularly biosynthesized cadmium nanocrystals was investigated for the first time. In this process, the white rot fungus Coriolus versicolor was employed to take up cadmium ions and synthesize extracellular cadmium crystal particles. The coarsening of the particles was induced by thioacetamide under certain conditions. Scanning electron microscopy showed that the formed cadmium crystal particles were coarsened from about 100nm to 2-3μm. The corresponding energy-dispersive X-ray spectra confirmed the presence of proteins in the particles. The maximum removal efficiency of Cd(II) increased from 17% to 87%, and the corresponding sorption capacity of biomass increased from 4 to 24mgg(-1) with the completion of the coarsening process. The properties of the coarsened particles were also examined using X-ray diffraction (XRD) and transmission electron microscopy (TEM). XRD analysis of fungal mycelial pellets embedded with the coarsened particles confirmed the formation of cubic crystalline cadmium sulfide particles. The TEM results suggest that the coarsened particles were composed of clusters of several smaller particles. The changes in the functional groups on the biomass surface were studied through Fourier transform infrared spectroscopy. Based on the results above, a possible mechanism for the formation and coarsening of cadmium crystal particle is also discussed., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The well-known Crab Nebula is at the center of the SN1054 supernova remnant. It consists of a rotationally powered pulsar interacting with a surrounding nebula through a relativistic particle wind. The emissions originating from the pulsar and nebula have been considered to be essentially stable. Here, we report the detection of strong gamma-ray (100 mega-electron volts to 10 giga-electron volts) flares observed by the AGILE satellite in September 2010 and October 2007. In both cases, the total gamma-ray flux increased by a factor of three compared with the non-flaring flux. The flare luminosity and short time scale favor an origin near the pulsar, and we discuss Chandra Observatory x-ray and Hubble Space Telescope optical follow-up observations of the nebula. Our observations challenge standard models of nebular emission and require power-law acceleration by shock-driven plasma wave turbulence within an approximately 1-day time scale.

The adsorption of chromium (VI) ions from aqueous solution by ethylenediamine-modified cross-linked magnetic chitosan resin (EMCMCR) was studied in a batch adsorption system. Chromium (VI) removal is pH dependent and the optimum adsorption was observed at pH 2.0. The adsorption rate was extremely fast and the equilibrium was established within 6-10min. The adsorption data could be well interpreted by the Langmuir and Temkin model. The maximum adsorption capacities obtained from the Langmuir model are 51.813mgg(-1), 48.780mgg(-1) and 45.872mgg(-1) at 293, 303 and 313K, respectively. The adsorption process could be described by pseudo-second-order kinetic model. The intraparticle diffusion study revealed that film diffusion might be involved in the present case. Thermodynamic parameters revealed the feasibility, spontaneity and exothermic nature of adsorption. The sorbents were successfully regenerated using 0.1N NaOH solutions., (Copyright © 2010 Elsevier B.V. All rights reserved.)

Pulsars are known to power winds of relativistic particles that can produce bright nebulae by interacting with the surrounding medium. These pulsar wind nebulae are observed by their radio, optical, and x-ray emissions, and in some cases also at TeV (teraelectron volt) energies, but the lack of information in the gamma-ray band precludes drawing a comprehensive multiwavelength picture of their phenomenology and emission mechanisms. Using data from the AGILE satellite, we detected the Vela pulsar wind nebula in the energy range from 100 MeV to 3 GeV. This result constrains the particle population responsible for the GeV emission and establishes a class of gamma-ray emitters that could account for a fraction of the unidentified galactic gamma-ray sources.

Objective: To investigate whether recent Chinese immigrants in British Columbia diagnosed with severe and persistent mental illness used mental health services at a lower rate than a similar group of nonimmigrants and longer-term immigrants., Method: Subjects were selected from linked immigration and health administrative databases. Their health service use records for the years 1992 to 2001 were extracted. Rates and rate ratios of use for severe psychiatric disorders for Chinese immigrants and the comparison group were calculated for 4 types of health services: mental health visits to general practitioners (GPs), visits to psychiatrists, psychiatric hospitalizations, and use of psychiatric medications. Rates and rate ratios of use for any mental health condition were calculated for the above 4 types of services, plus community mental health service and nonmental health visits to GPs., Results: The Chinese immigrants (n = 786) and comparison subjects (n = 3962) having severe and persistent mental illness were identified. For serious mental disorders, Chinese immigrants were more likely to visit psychiatrists (RR = 1.36) but less likely to use the other types of services, with rate ratios ranging from 0.51 to 0.81. Including all mental health conditions, Chinese immigrants were less likely to use all 6 types of services, with rate ratios ranging from 0.41 to 0.90., Conclusions: Except for psychiatric visits for serious disorders, recent Chinese immigrants diagnosed with severe and persistent mental illness used fewer mental health services than subjects from the comparison group. Seriously ill Chinese immigrants may experience problems with access to mental health services.