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Because surgeons are electing to perform simultaneous bilateral total knee arthroplasty (TKA), it is important to identify which patients are at increased risk. We performed a retrospective cohort analysis of 150 patients with unilateral TKA vs 150 patients with simultaneous bilateral TKA. The bilateral group demonstrated a 2.1 times greater mean overall complication rate as well as increased transfusion rates. Patients older than 70 years exhibited significantly higher complication rates. Having a preexisting pulmonary disorder in the bilateral cohort carried nearly a 3-fold risk of complications. Patients with body mass indices greater than 30 displayed a complication rate of 0.97 in the bilateral group as opposed to 0.44 in the control group. Our study demonstrated that age, body mass index, and a preexisting pulmonary disorder resulted in increased complications. [ABSTRACT FROM AUTHOR]

We describe 3 patients who presented with radiographic signs and clinical symptoms of adjacent segment disease several years after undergoing L4-S1 posterior pedicle screw fusion. All patients underwent successful lateral lumbar interbody fusion (LLIF) at 1-2 levels above their previous constructs, using stand-alone cages, with complete resolution of radiculopathy and a significant improvement in low-back pain. In addition to a thorough analysis of these cases, we review the pertinent literature regarding treatment options for adjacent segment disease and the applications of the lateral lumbar interbody technique., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Importance: The use of social media by dermatology journals and professional and patient-centered dermatology organizations remains largely unknown and, to our knowledge, has yet to be fully evaluated., Objective: To evaluate and quantify the extent of involvement of dermatology journals, professional dermatology organizations, and dermatology-related patient advocate groups on social networking sites., Design, Setting, and Participants: We obtained an archived list of 102 current dermatology journals from SCImago on the World Wide Web and used the list to investigate Facebook, Twitter, and individual journal websites for the presence of social media accounts. We identified professional and patient-centered dermatology organization activity on social networks through queries of predetermined search terms on Google, Facebook, Twitter, and LinkedIn. The activity of each entity was documented by recording the following metrics of popularity: the numbers of Facebook "likes," Twitter "followers," and LinkedIn "members.", Main Outcomes and Measures: The numbers of Facebook likes, Twitter followers, and LinkedIn members corresponding to each dermatology journal and each professional and patient-related dermatology organization., Results: On July 17, 2012, of the 102 dermatology journals ranked by SCImago, 12.7% were present on Facebook and 13.7% on Twitter. We identified popular dermatology journals based on Facebook likes and Twitter followers, led by the Journal of the American Academy of Dermatology and Dermatology Times, respectively. Popular professional dermatology organizations included dermRounds Dermatology Network (11 251 likes on Facebook and 2900 followers on Twitter). The most popular dermatology patient-centered organizations were the Skin Cancer Foundation (20 119 likes on Facebook), DermaTalk (21 542 followers on Twitter), and the National Psoriasis Foundation (200 members on LinkedIn)., Conclusions and Relevance: Patient-centered and professional dermatology organizations use social networking sites; however, academic journals tend to lag behind significantly. Although some journals are active in social media, most have yet to recognize the potential benefits of fully embracing popular social networks.

The Physician Quality Reporting System (PQRS) was established in 2006 by the Centers for Medicare and Medicaid Services (CMS) as part of an incentive process to improve healthcare preventive practices. As of 2011, there were 235 PQRS measures but only three specific to skin diseases, specifically melanoma. To measure current usage of the PQRS among dermatologists in Colorado, a survey was distributed at the 2011 Colorado Dermatological Society Meeting. Of the 120 physician attendees, 60 responded, yielding a response rate of 50%. Compared with responses from a similar 2010 survey, a significantly higher number of physicians are using PQRS, as well as E-prescribing and EHR systems. This is likely owing to the fact that CMS will require mandatory reporting of these measures in 2015. Respondents from the current survey commented that a major hurdle to PQRS reporting is the inability to submit data through existing EHR or billing systems. Currently, CMS requires PQRS reporting through a designated registry such as that provided by the AAD. Some practices have opted to report metrics such as tobacco and alcohol screening, since these can be reported through their billing systems. The results suggest structural improvements in the PQRS reporting system could improve compliance.

The link between psychological stress and aging is intuitive although the underlying mechanisms are not well defined. Evidence suggests that chronic psychological stress stimulates the autonomic nervous system, renin-angiotensin system, and the hypothalamic-pituitary-adrenal axis when the body attempts to resolve perceived threats to homeostasis. Prolonged activation of these pathways can result in chronic immune dysfunction, increased production of reactive oxygen species, and DNA damage, which are known to contribute to the again of skin and other tissues. Despite the lack of conclusive evidence directly linking psychological stress to skin aging, mechanisms by which stress leads to immune dysfunction, oxidative radicals, and ultimately DNA damage via neuronal, endocrine, and immune modulation may present a possible intervention for skin aging. In addition to the wide array of anti-oxidant therapies being developed to combat aging, the topical use of beta-blockers such as timolol, angiotensin receptor blockers such as valsartan, glucocorticoid blockers such as mifepristone, and cholinergic modulators including botulinum toxin, might be potential therapeutic strategies to prevent skin aging. Given the current understanding of these pathways, it would be premature to utilize such modalities for prevention of skin aging at this time, but future research into this type of topical pharmacologic anti-aging intervention may be promising.

Apoptosis-associated Speck-like protein containing a CARD (caspase recruitment domain) (ASC) was originally named because it triggered apoptosis in certain tumors. More recently, however, ASC was found to be a central adaptor protein of inflammasome, which mediates the secretion of protumorigenic inflammation. Here we examined the role of ASC in tumorigenesis of human melanoma. Compared with primary melanoma, ASC protein expression was generally downregulated in metastatic melanoma. Although overexpressing ASC in metastatic melanoma showed no effects on cell viability, silencing ASC with short hairpin RNA induced G1 cell cycle arrest, reduced cell viability, and suppressed tumorigenesis in metastatic melanoma. On the other hand, silencing ASC in primary melanoma reduced cell death, increased cell viability, and enhanced tumorigenesis. In primary and metastatic melanoma cells, ASC knockdown inhibited inflammasome-mediated caspase-1 activity and IL-1β secretion. However, phosphorylated IκB kinase (IKK)α/β expression and NF-κB activity were suppressed in metastatic melanoma and enhanced in primary melanoma after ASC knockdown. These findings suggest stage-dependent dual roles of ASC in tumorigenesis. ASC expression in primary melanoma inhibits tumorigenesis by reducing IKKα/β phosphorylation and inhibiting NF-κB activity. In metastatic melanoma, on the other hand, this inhibitory effect is diminished, and ASC induces tumorigenic pathways through enhanced NF-κB activity and inflammasome-mediated IL-1β secretion.

The inflammasome is a multi-protein complex that mediates immune responses to microbial, host, and environmental signals. When active, inflammasomes regulate caspase-1 activation and IL-1β secretion. There is a strong link between inflammation and cancer, and IL-1β is one of the major molecules involved in both of these disease processes. Here we review the role of inflammasomes in regulating IL-1β secretion, and the impact of this pathway on cancer pathogenesis, with a focus on melanoma. This represents an exciting new area of research, and could potentially result in new targets for melanoma therapeutics in the future., (Published by Elsevier Ireland Ltd.)

Ellagic is a polyphenolic compound with anti-fibrotic and antioxidant properties, and exhibits antitumor properties against various cancer cells in vitro. There are few studies, however, which examine the effects of ellagic acid on melanoma. In the present study, we observe effects of ellagic acid on melanoma cells in vitro. Three metastatic melanoma cell lines (1205Lu, WM852c and A375) were examined to determine the effects of ellagic acid on melanoma cell viability, cell-cycle, apoptosis, NF-κβ activity, and IL-1β & IL-8 secretion. Cell viability assays demonstrated that ellagic acid possesses an inhibitory effect on cell proliferation at concentrations between 25 and 100 µM. In addition, ellagic acid promoted G1 cell cycle arrest, increased levels of apoptosis and decreased synthesis of IL-1β and IL-8 in melanoma cells. Ellagic acid also decreased NF-κβ activity, suggesting at least one potential mechanism by which ellagic acid may exert its effects in melanoma cells. Our findings support further investigation into prospective roles for ellagic acid as a therapeutic, adjuvant, or preventive agent for melanoma.

Epigallocatechin-3-gallate (EGCG), the major polyphenolic component of green tea, has been demonstrated to possess anti-inflammatory, antioxidant, anti-mutagenic and anti-carcinogenic properties. The anti-melanoma effect of EGCG has been previously suggested, but no clear mechanism of action has been established. In this study, we demonstrated that EGCG inhibits melanoma cell growth at physiological doses (0.1-1 μM). In the search for mechanisms of EGCG-mediated melanoma cell suppression, we found that NF-κB was inhibited, and that reduced NF-κB activity was associated with decreased IL-1β secretion from melanoma cells. Since inflammasomes are involved in IL-1β secretion, we investigated whether IL-1β suppression was mediated by inflammasomes, and found that EGCG treatment led to downregulation of the inflammasome component, NLRP1, and reduced caspase-1 activation. Furthermore, silencing the expression of NLRP1 abolished EGCG-induced inhibition of tumor cell proliferation both in vitro and in vivo, suggesting a key role of inflammasomes in EGCG efficacy. This paper provides a novel mechanism for EGCG-induced melanoma inhibition: inflammasome downregulation→decreased IL-1β secretion→decreased NF-κB activities→decreased cell growth. In addition, it suggests inflammasomes and IL-1β could be potential targets for future melanoma therapeutics., (Published by Elsevier Inc.)

Physicians wearing white coats are perceived as having more authority, being more friendly and being more attractive than those not wearing white coats, and patients report that they prefer their dermatologist to wear a white coat. The aim of the study was to determine the prevalence of dermatologists wearing white coats on practice websites. We searched Google for dermatology practice websites in six states representing distinct geographic regions in the United States. The first one hundred search results were evaluated, and photographs of dermatologists on these websites were examined for the presence or absence of white coats. Most (77%) of dermatologists did not wear white coats. The highest prevalence was in the eastern states of Massachusetts and South Carolina, with 29% and 39%, respectively. Colorado had the lowest rate at 13%. Rates were essentially equal when segmented by gender. Although patients report that they prefer their dermatologist to wear a white coat, dermatologists often do not wear a white coat on their practice websites.

Background: Combined lateral elbow tendinosis (tennis elbow) and medial elbow tendinosis (golfer's elbow) can be a disabling condition that, if unresponsive to nonoperative treatments, may be effectively treated surgically. The authors are not aware of any study that reports the outcome of a combined operation for lateral and medial elbow tendinosis (country club elbow) performed in the same operative setting., Hypothesis: Combined surgical treatment of country club elbow in the same operative setting has similar outcomes to those seen in the literature for single operative procedures., Study Design: Case series; Level of evidence 4., Methods: Outcome measurements included the Numeric Pain Intensity Scale, the Nirschl tennis elbow scoring system, and the American Shoulder and Elbow Surgeons elbow form. Forty-eight patients (53 clinical elbows) were available by telephone, with a minimum time to follow-up of 5 years (range, 5-19 years; mean, 11.7 years)., Results: The average Nirschl tennis elbow score improved from 16.7 preoperatively to 70.8 postoperatively (P < .01). The average American Shoulder and Elbow Surgeons elbow score improved from 45.2 to 90.4 (P < .01). The Numeric Pain Intensity Scale score improved from 8.8 to 1.7 (P < .01). By the criteria of the Nirschl tennis elbow score, results were rated excellent in 38 elbows, good in 7 elbows, fair in 5 elbows, and poor in 3 elbows, with 85% (45 of 53) good to excellent results. Patient satisfaction with the surgery averaged 8.7 out of 10. Of the 46 patients who played sports, 44 (96%) reported returning to their sports., Conclusion: When nonoperative treatment of lateral and medial elbow tendinosis fails, combined surgical intervention via the Nirschl operative techniques for country club elbow is highly effective, with results similar to those of single-sided intervention.

Transfer of the latissimus dorsi to the greater tuberosity has been used successfully in the treatment of massive rotator-cuff deficiency. For safe release and transfer of the tendon, the variations in the tendinous insertions of the latissimus dorsi and teres major onto the humerus need to be understood. In anatomical dissection of 12 cadavers, mean width of the latissimus tendon was 3.3 cm at its insertion, and mean length was 7.3 cm. In all specimens, there were fascial connections between the latissimus and teres major and between the latissimus and the long head of the triceps. There were 3 insertion patterns of the latissimus dorsi tendon onto the humerus with respect to the tendon of the teres major: completely separate (8 cadavers), loosely bound (3 cadavers), and completely joined (1 cadaver). If the latissimus dorsi were being transferred in the last type, the teres major would need to be transferred with the latissimus dorsi as a common musculotendinous unit.

Background: Good to excellent short-term results have been reported for the surgical treatment of lateral epicondylitis using various surgical techniques., Hypothesis: Surgical treatment for lateral epicondylitis using the mini-open Nirschl surgical technique will lead to durable results at long-term follow-up., Study Design: Case series; Level of evidence, 4., Methods: Records from 139 consecutive surgical procedures (130 patients) for lateral epicondylitis performed by 1 surgeon between 1991 and 1994 were retrospectively reviewed. Eighty-three patients (92 elbows) were available by telephone for a mean follow-up of 12.6 years (range, 10-14 years). Outcome measures included the Numeric Pain Intensity Scale, Nirschl and Verhaar tennis elbow-specific scoring systems, and American Shoulder and Elbow Surgeons elbow form. Preoperative data were collected retrospectively., Results: The mean age of the study group was 46 years (range, 23-70 years) with 45 men and 38 women. Eighty-seven of the procedures were primary, and 5 were revision tennis elbow surgeries. Concomitant procedures were performed in 30 patients including ulnar nerve release in 24 patients, medial tennis elbow procedures in 23 patients, shoulder arthroscopy in 2 patients, carpal tunnel release in 1 patient, and triceps debridement and osteophyte excision in 1 patient. The mean duration of preoperative symptoms was 2.2 years (range, 2 months to 10 years). The mean Nirschl tennis elbow score improved from 23.0 to 71.0, and the mean American Shoulder and Elbow Surgeons score improved from 34.3 to 87.7 at a minimum of 10-year follow-up (P < .05). The Numeric Pain Intensity Scale pain score improved from 8.4 preoperatively to 2.1 (P < .05). Results were rated as excellent in 71 elbows, good in 6 elbows, fair in 9 elbows, and poor in 6 elbows by the Nirschl tennis elbow score. By the criteria of Verhaar et al, the results were excellent in 45 elbows, good in 32 elbows, fair in 8 elbows, and poor in 7 elbows. Eighty-four percent good to excellent results were achieved using both scoring systems. Ninety-two percent of the patients reported normal elbow range of motion. The overall improvement rate was 97%. Patient satisfaction averaged 8.9 of 10. Ninety-three percent of those available at a minimum of 10-year follow-up reported returning to their sports., Conclusion: The mini-open Nirschl surgical technique with accurate resection of the tendinosis tissue remains highly successful in the long term.

The spin and orbital moments of Au/Co/Au trilayers grown on a W(110) single crystal substrate have been investigated by means of x-ray magnetic circular dichroism. Our findings suggest that the orbital moment of Co does not obtain a maximum value along the easy axis, in contrast with previous experience. This is attributed to the large spin-orbit interaction within the Au caps. Both second order perturbation theory and first principles calculations show how the magnetocrystalline anisotropy (MCA) is dramatically influenced by this effect, and how this leads to the fact that the orbital moment anisotropy is not proportional to the MCA.

The aim of this study was to compare the somersaulting techniques used in the 16 highest-scoring and 16 lowest-scoring Roche vaults. Our hypothesis was that the gymnasts performing the highest-scoring Roche vaults would demonstrate a better technique than those performing the lowest-scoring Roche vaults while on the horse (pushing off the horse more effectively), somersaulting (executing most of the required somersaults higher in flight), and landing (showing a greater control). A 16-mm motion picture camera, operating at 100 Hz, recorded the vaults during the official competition. The two-dimensional direct linear transformation was used for spatial reconstruction. The results of t-tests (P < 0.05) indicated that, compared with the low-scoring gymnasts, the high-scoring gymnasts had: (1) greater height of body centre of mass and a more fully extended body position at the horse take-off; (2) greater height of body centre of mass at the peak of post-flight, knee release, and touchdown on the mat; (3) greater horizontal and vertical displacements of body centre of mass, greater somersaulting rotation, and longer time from the knee release to mat touchdown; and (d) markedly smaller landing point deductions. In conclusion, a successful Roche vault is likely when the focus is on: (a) leaving the horse with a large vertical velocity in an extended body position to achieve a high trajectory of centre of mass by first extending the legs, then immediately pushing off the horse vigorously, using the muscles of the upper extremity; (b) grasping the knees immediately after the take-off from the horse, achieving the tightly tucked body position early during the ascent to the peak, and completing two-thirds of the required somersaults at a great height; (c) releasing the knees and extending the body above the top level of the horse; and (d) contacting the mat with a high body centre of mass position.

We have used element-specific hysteresis measurements, based on the x-ray magnetic circular dichroism technique, to investigate magnetic trilayer structures composed of Fe and Ni layers. Within a critical regime we have discovered a class of structures in which the exchange interaction, the mechanism responsible for the macroscopic magnetism, can become vanishingly small. The experimental observations are supported by first principles theory and are explained as arising from a cancellation of several competing magnetic interactions. Hence, we have discovered a system with a novel exchange interaction between magnetic layers in direct contact that replaces the conventional exchange interaction in ferromagnets.

Using coherent x-ray speckle metrology, we have measured the influence of disorder on major loop return point memory (RPM) and complementary point memory (CPM) for a series of perpendicular anisotropy Co/Pt multilayer films. In the low disorder limit, the domain structures show no memory with field cycling--no RPM and no CPM. With increasing disorder, we observe the onset and the saturation of both the RPM and the CPM. These results provide the first direct ensemble-sensitive experimental study of the effects of varying disorder on microscopic magnetic memory and are compared against the predictions of existing theories.

The 16 highest-scored Roche vaults (G1) performed during the 2000 Olympic Games were compared with those receiving the 16 lowest-scores (G2). A 16-mm motion picture camera operating at 100 Hz recorded the vaults during the competition. The results of t tests (p < .05) indicated G1, compared to G2, had (a) shorter time of board support, greater normalised average upward vertical force and backward horizontal force exerted by the board, greater change in the vertical velocity while on the board, and greater vertical velocity at board take-off, (b) comparable linear and angular motions in pre-flight, (c) smaller backward horizontal impulse exerted by the horse, smaller loss of the horizontal velocity while on the horse, and greater horizontal and vertical velocities at horse take-off, (d) greater height and larger horizontal distance of post-flight, (e) higher body mass centre at knee release, and (f) higher mass centre, greater normalised moment of inertia, and smaller vertical velocity at mat touchdown. Therefore, gymnasts and coaches should focus on sprinting the approach; blocking and pushing-off the take-off board rapidly and vigorously; departing the board with a large vertical velocity; exerting large downward vertical force and small forward horizontal force from the hand-stand position while on the horse; departing the horse with large horizontal and vertical velocities; and completing the majority of the double salto forward near the peak of trajectory and releasing the knees above the top of the horse to prepare for a controlled landing.

We have performed x-ray absorption spectroscopy at the Fe, Ni, and Co L2,3 edges of in situ grown thin magnetic films. We compare electron yield measurements performed at SSRL and BESSY-I. Differences in the L2,3 white line intensities are found for all three elements, comparing data from the two facilities. We propose a correlation between spectral intensities and the degree of spatial coherence of the exciting radiation. The electron yield saturation effects are stronger for light with a higher degree of spatial coherence. Therefore the observed, coherence related, intensity variations are due to an increase in the absorption coefficient, and not to secondary channel related effects.

Ultra thin films of Fe deposited on the (100) surface of a Cu single crystal exhibit a net perpendicular magnetic anisotropy. The addition of very low coverages of Co results in the easy magnetic direction reorienting into the film plane. This behavior is in contrast to the addition of similar amounts of Fe, whereupon the ferromagnetic response vanishes. This result is discussed in terms of the anisotropy energies derived from the spectroscopic data.

Epitaxic thin and ultrathin films on surfaces allow crystallographic phases that do not occur naturally in the bulk to be stabilized. They also offer new possibilities for an improved understanding of soft X-ray photoabsorption in magnetic systems. Data collected using the Elliptically Polarizing Undulator at BL 5.2 of the Stanford Synchrotron Radiation Laboratory are presented herein. Fe, Co and Ni films were prepared on Cu(100) surfaces. L2,3-edge spectra were recorded with circular and linear light. Fresnel diffractometry was used to quantify the degree of transverse beam coherence. A quantitative analysis of the spectral features indicates a correlation of the spectral intensities and the transverse beam coherence. Resonant reflectivity spectra for Co ultrathin films that exhibit strong dichroism are presented. The reflectivity data indicate that interference effects of the reflected beams at the two interfaces are of importance, even for ultrathin films.

Core-level x-ray absorption spectroscopy measurements have been performed at the L3,2 edges of Fe and Co thin films. The degree of source coherence was varied using soft x rays from five different beam lines. We observe an increase of the L edge resonance intensities relative to the continuum states which we propose is due to the presence of transverse coherence in the exciting radiation.