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Objectives: This study aims to investigate the effect of colloidal platinum nanoparticles (CPN) on the durability of resin-dentin bonding performance with contemporary adhesives., Methods: Sixty non-carious human maxillary premolars were subjected to microtensile bond strength (µTBS) testing and divided into two main groups: CPN-treated and untreated. Within each group, specimens were randomly allocated to Clearfil Megabond 2 (MB2), Scotchbond Universal Plus Adhesive with self-etch mode (SE-SUP), and etch-and-rinse mode (ER-SUP) subgroups (n = 10/group). CPN was applied to dentin in the MB2 and SE-SUP groups for 20 s, followed by rinsing before adhesive application. In the ER-SUP group, CPN was applied after etch-and-rinse. The µTBS was tested after 24 h, 6 months, and 1 year, and the fracture modes were observed using SEM. The µTBS data were analyzed using a two-way ANOVA and post-hoc Tukey HSD test (α = 0.05). An additional twelve premolars underwent TEM/STEM/EDX for ultra-morphological observations., Results: The application of CPN significantly prevented a decline in the µTBS of both the MB2 and SE-SUP groups. No significant decrease was observed in the ER-SUP group, either with aging or CPN application. Ultra-morphological images revealed platinum nanoparticles attaching to the collagen fibrils of the hybrid layer regardless of aging. It was highlighted that the nanoparticles attached to the banded collagen in the aging groups were observed., Significance: CPN exhibits the potential in enhancing the longevity of resin-dentin bonding in SE mode., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Adding synthetic nucleotides to DNA increases the linear information density of DNA molecules. Here we report that it also can increase the diversity of their three-dimensional folds. Specifically, an additional nucleotide (dZ, with a 5-nitro-6-aminopyridone nucleobase), placed at twelve sites in a 23-nucleotides-long DNA strand, creates a fairly stable unimolecular structure (that is, the folded Z-motif, or fZ-motif) that melts at 66.5 °C at pH 8.5. Spectroscopic, gel and two-dimensional NMR analyses show that the folded Z-motif is held together by six reverse skinny dZ - :dZ base pairs, analogous to the crystal structure of the free heterocycle. Fluorescence tagging shows that the dZ - :dZ pairs join parallel strands in a four-stranded compact down-up-down-up fold. These have two possible structures: one with intercalated dZ - :dZ base pairs, the second without intercalation. The intercalated structure would resemble the i-motif formed by dC:dC + -reversed pairing at pH ≤ 6.5. This fZ-motif may therefore help DNA form compact structures needed for binding and catalysis., (© 2024. The Author(s).)

Nanopores are increasingly powerful tools for single molecule sensing, in particular, for sequencing DNA, RNA and peptides. This success has spurred efforts to sequence non-canonical nucleic acid bases and amino acids. While canonical DNA and RNA bases have pKas far from neutral, certain non-canonical bases, natural RNA modifications, and amino acids are known to have pKas near neutral pHs at which nanopore sequencing is typically performed. Previous reports have suggested that the nanopore signal may be sensitive to the protonation state of an individual moiety. We sequenced ion currents with the MspA nanopore using a single stranded DNA containing a single non-canonical DNA base (Z) at various pH conditions. The Z-base has a near-neutral pKa ∼ 7.8. We find that the measured ion current is remarkably sensitive to the protonation state of the Z-base. We demonstrate how nanopores can be used to localize and determine the pKa of individual moieties along a polymer. More broadly, these experiments provide a path to mapping different protonation sites along polymers and give insight in how to optimize sequencing of polymers that contain moieties with near-neutral pKas., (© The Author(s) 2024. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Background: The relationship between abnormalities of the ulnar collateral ligament (UCL) on magnetic resonance imaging (MRI) and elbow symptoms in baseball players remains unclear., Purpose/hypothesis: This study aimed to compare findings of the UCL on microscopic MRI between asymptomatic and symptomatic elbows in baseball players. We hypothesized that the MRI grade of UCL injuries would exhibit no correlation with medial elbow symptoms in baseball players., Study Design: Cross-sectional study; Level of evidence, 3., Methods: The study participants were skeletally mature baseball players who underwent high-resolution microscopic MRI of the medial elbow including for medical checkups. Elbows with previous surgical treatment or traumatic UCL injuries were excluded. The patients were divided into symptomatic and asymptomatic groups. The UCL appearance on microscopic MRI was categorized into 4 grades and compared between the groups. Abnormal findings in the medial elbow including bony fragments at the medial epicondyle, osteophytes or bony fragments in the sublime tubercle, and bone marrow edema (BME) in the sublime tubercle were also evaluated., Results: A total of 426 baseball players (426 elbows) with a mean age of 20 years (range, 14-41 years) were included. The asymptomatic and symptomatic groups included 158 and 268 elbows, respectively. In the asymptomatic group, based on MRI grading of the UCL, 46 (29%) elbows were rated as grade I, 64 (41%) as grade II, 40 (25%) as grade III, and 8 (5%) as grade IV. In the symptomatic group, 75 (28%) elbows were rated as grade I, 118 (44%) as grade II, 61 (23%) as grade III, and 14 (5%) as grade IV. There was no significant difference in the MRI grades between the groups ( P = .9). BME in the sublime tubercle was more frequently seen in the symptomatic group than in the asymptomatic group ( P < .001)., Conclusion: There was no difference in MRI grades of the UCL between symptomatic and asymptomatic elbows in baseball players; approximately 30% of elbows demonstrated high-grade UCL injuries in both groups. BME in the sublime tubercle was more frequently seen in symptomatic elbows than in asymptomatic elbows. BME in the sublime tubercle was a better indicator of symptoms than was MRI grading of the UCL., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: K.M. has received research support from Arthrex and Exactech. H.S. is a paid speaker for DePuy Synthes, Smith & Nephew, Zimmer Biomet, and Wright Medical. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Purpose: To investigate and compare the pathologies and clinical outcomes of patients with traumatic anterior shoulder instability who underwent arthroscopic stabilization at 40 years or older between shoulders with initial dislocation before age 40 years and at 40 years or after., Methods: Shoulders that underwent arthroscopic stabilization for recurrent traumatic anterior shoulder instability at 40 years or older with a minimum of 2-year follow-up were included. The subjects were divided into 2 groups according to age at initial dislocation after propensity score matching to reduce potential bias: younger than 40 years (group 1) and 40 years or older (group 2). Radiographic findings, pathologies, clinical outcomes, and complications were compared between the groups., Results: Group 1 included 56 shoulders in 56 patients (26 men and 30 women) with a mean age of 51 years (range, 40-77 years). Group 2 included 28 shoulders in 28 patients (13 men and 15 women) with a mean age of 51 years (range, 40-77 years). Glenoid bone loss was greater in group 1 than in group 2 (P = .004). Rotator cuff tears were more frequently observed in group 2 than in group 1 (P < .001). Both groups showed significant improvement in the West Ontario Shoulder Instability Index score (P < .001 for each) and flexion (P < .001 for each). The recurrence rate was 4% in group 1 and 7% in group 2., Conclusions: Rotator cuff tears are significantly more frequent in recurrent shoulder instability patients with initial dislocation at age 40 or older. Arthroscopic stabilization yielded a low recurrence rate and favorable outcomes with a good return-to-sport rate in patients 40 years or older., Level of Evidence: Level III, retrospective comparative prognostic trial., Competing Interests: Disclosures The authors report the following potential conflicts of interest or sources of funding: H.S. is on the speakers bureau of DePuy Synthes, Smith & Nephew, Zimmer Biomet, and Wright Medical, outside the submitted work. K.M. receives grant support from Exactech and Arthrex, outside the submitted work. All other authors (Y.U., N.T., M.T., S.H., K.U., I.K.) declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Full ICMJE author disclosure forms are available for this article online, as supplementary material., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: The management of ulnar collateral ligament (UCL) injuries widely varies among surgeons. Although various treatment options have been proposed including surgical and conservative treatments, no golden standard treatment strategy has been established of yet. The American survey reported an overall experienced and well-trained cohort of surgeons often reached consensus opinions on how to approach UCL injury. However, the consensus among Japanese surgeons on the treatment of UCL injuries remains unclear. The purpose of this study was to survey current trends among Japanese orthopaedic surgeons in the treatment of UCL injuries in baseball players., Methods: An online survey was distributed to the active members of the Japanese doctor's network for baseball injury prevention, which was formed by partial members of the medical committee in the Japan Baseball Council. The survey was composed of three sections: demographics of the surveyees, preferred operative and nonoperative management of UCL injuries, and five fictional clinical case scenarios of baseball players with a UCL injury., Results: The 131 e-mailed invitations to society members yielded 78 completed online surveys with a participation rate of 60%. Sixty-four respondents (82%) reported >15 years of clinical experience. Sixty-five respondents (83%) performed ≤5 UCL reconstructions per year. As nonsurgical management of UCL injuries, seventy-four surgeons (95%) preferred physiotherapy followed by intraarticular injection (46%). For surgical management, seventy-three surgeons (93%) preferred UCL reconstruction. Of the five case scenarios, a consensus was reached in three cases: to perform surgery on the patient with full-thickness UCL tear. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction., Conclusion: Japanese doctors involved in the treatment of baseball injuries reached a consensus to indicate high-level athletes with a full-thickness UCL tear for surgery. When operative management was the preferred option, a consensus was reached to perform UCL reconstruction. These results may contribute to the decision-making for managing UCL injuries., Competing Interests: Declaration of competing interest The authors declare there are no conflicts of interest., (Copyright © 2024 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.)

Background: Because of the proximity of several ligaments, aponeuroses, and capsule in the limited area of the elbow joint, the precise anatomy is difficult to understand. In the current narrative review, we focused on two anatomical perspectives: the capsular attachment and structures consisting of ligaments., Methods: Based on the previously performed studies regarding the elbow anatomy, a narrative review was prepared in terms of the capsular attachment and structures consisting of ligaments., Results: At the tip of the coronoid process, the joint capsule attaches roughly 6 mm distal to its tip with 6-12 mm length. On the lateral epicondyle of the humerus, the capsular attachment at the anterior part of the extensor carpi radialis brevis origin is narrower than the one distal to it. A single interpretation of the lateral collateral ligament is the capsulo-aponeurotic membrane, which is composed of the joint capsule intermingling with the supinator aponeurosis. The anterior bundle of the ulnar collateral ligament could be interpreted as the grossly separated collagenous structure from the tendinous complex, which is composed of the tendinous septum between the flexor digitorum superficialis and pronator teres muscle, the medial part of the brachialis muscle, and deep aponeurosis of the flexor digitorum superficialis muscle., Discussion: Based on these perspectives, ligaments could function as a "static-dynamic" stabilizer rather than a simple static one., (© 2024 The Author(s).)

Background: The flexor pronator muscles (FPMs) have been thought as a dynamic stabilizer to protect the ulnar collateral ligament (UCL) from valgus stress during throwing motion. Thus, evaluation of the FPMs is important for preventing UCL injuries. Shear wave ultrasound elastography (SWE) is an imaging modality that quantifies tissue elasticity. The purpose of this study was to measure the tissue elasticities of healthy FPMs using SWE., Methods: We investigated 22 healthy men (mean age, 29 ± 6 years). The elasticities of the FPMs, including the pronator teres (PT), flexor digitorum superficialis (FDS), and flexor carpi ulnaris (FCU), were measured using SWE for each arm under two conditions: at rest (unloaded) and under valgus stress (loaded). The values obtained under different loading conditions were compared between both elbows., Results: The mean SWE values of the PT, FDS, and FCU for the dominant elbows were 22.4 ± 3.6, 22.8 ± 2.9, and 22.3 ± 3.4 kPa, respectively. The corresponding mean SWE values for the nondominant elbows were 24.2 ± 4.6, 23.1 ± 3.5, and 23.4 ± 3.5 kPa, respectively. The mean SWE values of the PT, FDS, and FCU at rest (unloaded) were 23.3 ± 4.2, 22.9 ± 3.2, and 22.9 ± 3.5 kPa, respectively. The corresponding mean SWE values under valgus stress (loaded) were 35.0 ± 6.2, 34.7 ± 5.3, and 31.9 ± 4.8 kPa, respectively., Conclusion: This noninvasive evaluation of the stiffness of the FPMs may provide clinically relevant data for the prevention of UCL injuries., (© 2024 The Author(s).)

Background: There remain arguments regarding whether fatty degeneration of the rotator cuff muscles improves following rotator cuff repair. The purpose of this study was to prospectively investigate changes in fatty degeneration of the rotator cuff muscles, quantitatively measured on magnetic resonance imaging (MRI) with use of transverse relaxation time (T2) mapping techniques, and to assess the relationship between these changes and clinical outcomes., Methods: Patients were included if they were scheduled for arthroscopic rotator cuff repair using the suture-bridge technique between June 2014 and December 2015, underwent preoperative MRI including the T2 mapping sequence, and consented to participate in the study. Exclusion criteria consisted of trauma within 2 months before preoperative MRI, isolated subscapularis tears, patch augmentation, neuromuscular disease, and a follow-up duration of <2 years. MRI scans were acquired preoperatively and at 2 years postoperatively, and T2 values of the supraspinatus and infraspinatus muscles were measured, with smaller T2 values indicating less fat content. Shoulders were evaluated on the basis of active range of motion (ROM), Constant and University of California Los Angeles Shoulder Rating Scale scores, shoulder external rotation strength with the arm at the side, and rotator cuff integrity on postoperative MRI., Results: A total of 103 patients (103 shoulders) with a mean age of 65 ± 9 years (range, 42 to 83 years) were included, of whom 52 were male and 51 were female. There were 13 partial, 18 small, 35 medium, 33 large, and 4 massive tears. Concomitant subscapularis tears were observed in 35 shoulders. Overall, ROM, clinical scores, and external rotation strength significantly improved postoperatively. Retears were found in 27 shoulders (26%). External rotation strength significantly improved postoperatively only in shoulders without a retear. Among shoulders without a retear, the postoperative T2 values of the supraspinatus and infraspinatus were significantly smaller than the preoperative values (p < 0.001 for both); however, no improvement was seen in shoulders with a retear., Conclusions: Shoulders with successful repair demonstrated significantly smaller T2 values postoperatively as well as significantly improved external rotation strength. Fatty degeneration of the cuff muscles can be reversed, at least in part, and muscle strength improves in shoulders with successful repair., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence., Competing Interests: Disclosure: No external funding was received for this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSOA/A586)., (Copyright © 2024 The Authors. Published by The Journal of Bone and Joint Surgery, Incorporated. All rights reserved.)

Structural biology efforts using cryogenic electron microscopy are frequently stifled by specimens adopting "preferred orientations" on grids, leading to anisotropic map resolution and impeding structure determination. Tilting the specimen stage during data collection is a generalizable solution but has historically led to substantial resolution attenuation. Here, we develop updated data collection and image processing workflows and demonstrate, using multiple specimens, that resolution attenuation is negligible or significantly reduced across tilt angles. Reconstructions with and without the stage tilted as high as 60° are virtually indistinguishable. These strategies allowed the reconstruction to 3 Å resolution of a bacterial RNA polymerase with preferred orientation, containing an unnatural nucleotide for studying novel base pair recognition. Furthermore, we present a quantitative framework that allows cryo-EM practitioners to define an optimal tilt angle during data acquisition. These results reinforce the utility of employing stage tilt for data collection and provide quantitative metrics to obtain isotropic maps., (© 2024. The Author(s).)

Artificially Expanded Genetic Information Systems (AEGIS) add independently replicable unnatural nucleotide pairs to the natural G:C and A:T/U pairs found in native DNA, joining the unnatural pairs through alternative modes of hydrogen bonding. Whether and how AEGIS pairs are recognized and processed by multi-subunit cellular RNA polymerases (RNAPs) remains unknown. Here, we show that E. coli RNAP selectively recognizes unnatural nucleobases in a six-letter expanded genetic system. High-resolution cryo-EM structures of three RNAP elongation complexes containing template-substrate UBPs reveal the shared principles behind the recognition of AEGIS and natural base pairs. In these structures, RNAPs are captured in an active state, poised to perform the chemistry step. At this point, the unnatural base pair adopts a Watson-Crick geometry, and the trigger loop is folded into an active conformation, indicating that the mechanistic principles underlying recognition and incorporation of natural base pairs also apply to AEGIS unnatural base pairs. These data validate the design philosophy of AEGIS unnatural basepairs. Further, we provide structural evidence supporting a long-standing hypothesis that pair mismatch during transcription occurs via tautomerization. Together, our work highlights the importance of Watson-Crick complementarity underlying the design principles of AEGIS base pair recognition., (© 2023. The Author(s).)

The 4-letter DNA alphabet (A, T, G, C) as found in Nature is an elegant, yet non-exhaustive solution to the problem of storage, transfer, and evolution of biological information. Here, we report on strategies for both writing and reading DNA with expanded alphabets composed of up to 12 letters (A, T, G, C, B, S, P, Z, X, K, J, V). For writing, we devise an enzymatic strategy for inserting a singular, orthogonal xenonucleic acid (XNA) base pair into standard DNA sequences using 2'-deoxy-xenonucleoside triphosphates as substrates. Integrating this strategy with combinatorial oligos generated on a chip, we construct libraries containing single XNA bases for parameterizing kmer basecalling models for commercially available nanopore sequencing. These elementary steps are combined to synthesize and sequence DNA containing 12 letters - the upper limit of what is accessible within the electroneutral, canonical base pairing framework. By introducing low-barrier synthesis and sequencing strategies, this work overcomes previous obstacles paving the way for making expanded alphabets widely accessible., (© 2023. The Author(s).)

We show that in silico design of DNA secondary structures is improved by extending the base pairing alphabet beyond A-T and G-C to include the pair between 2-amino-8-(1'-β-d-2'-deoxyribofuranosyl)-imidazo-[1,2- a ]-1,3,5-triazin-(8 H )-4-one and 6-amino-3-(1'-β-d-2'-deoxyribofuranosyl)-5-nitro-(1 H )-pyridin-2-one, abbreviated as P and Z . To obtain the thermodynamic parameters needed to include P-Z pairs in the designs, we performed 47 optical melting experiments and combined the results with previous work to fit free energy and enthalpy nearest neighbor folding parameters for P-Z pairs and G-Z wobble pairs. We find G-Z pairs have stability comparable to that of A-T pairs and should therefore be included as base pairs in structure prediction and design algorithms. Additionally, we extrapolated the set of loop, terminal mismatch, and dangling end parameters to include the P and Z nucleotides. These parameters were incorporated into the RNAstructure software package for secondary structure prediction and analysis. Using the RNAstructure Design program, we solved 99 of the 100 design problems posed by Eterna using the ACGT alphabet or supplementing it with P-Z pairs. Extending the alphabet reduced the propensity of sequences to fold into off-target structures, as evaluated by the normalized ensemble defect (NED). The NED values were improved relative to those from the Eterna example solutions in 91 of 99 cases in which Eterna-player solutions were provided. P-Z-containing designs had average NED values of 0.040, significantly below the 0.074 of standard-DNA-only designs, and inclusion of the P-Z pairs decreased the time needed to converge on a design. This work provides a sample pipeline for inclusion of any expanded alphabet nucleotides into prediction and design workflows.

Objectives: To determine the effect of an extra hydrophobic resin layer (EHL) on the bond strength and durability of three different pH one-step universal adhesives (UAs) utilized in self-etch (SE) mode, and to explore whether UAs can be used as a primer in two-step bonding system., Methods: Three different pH UAs were utilized: G-Premio Bond (GPB), Scotchbond Universal (SBU), All-Bond Universal (ABU), while the bonding agent of Clearfil SE Bond 2 (SE2) was selected as the EHL. For the EHL groups, EHL was applied after the air blow of each UA and before light curing. The microtensile bond strength (μTBS), fracture modes, interfacial structures and nanoleakage (NL) were evaluated after 24 h water storage and after 15,000 thermal cycling (TC). Elastic modulus (EM) and hardness (H) was tested by a nanoindenter after 24 h., Results: Significantly higher μTBS was achieved in the GPB+EHL group compared with GPB both at 24 h and after 15,000 TC, while the additional use of EHL did not improve the μTBS of SBU and ABU significantly both at 24 h and after 15,000 TC. GPB+EHL demonstrated lower NL than GPB. The mean EM and H of the adhesive layer in GPB+EHL was significantly decreased compared with GPB., Conclusions: The results indicated that the bond strength and durability of low pH one-step UA (GPB) were significantly improved by additional application of EHL both at 24 h and after 15,000 TC, while no significant improvement was observed for ultra-mild one-step UAs (SBU and ABU)., Clinical Significance: This study indicates that GPB can be used as a primer in a two-step bonding system, while SBU and ABU may not be as effective. These findings may help guide clinicians in selecting the appropriate UAs and bonding techniques for different clinical scenarios., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Abstract Background/purpose: The most widely utilized irrigation solution in endodontic therapy is sodium hypochlorite (NaOCl). The purpose of this study was to assess the effects of NaOCl on the bond strength of four universal adhesives and one two-step self-etch adhesive to pulp chamber dentin., Materials and Methods: One hundred sixteen extracted sound human third molars were used in this study. All the teeth were divided into two groups: (1) with NaOCl treatment and (2) without NaOCl treatment. These two groups were subdivided into five bonding groups: G-Premio Bond (GP), Beautibond Xtreme (BBX), Scotchbond Universal (SBU), Clearfil Universal Bond Quick (UBQ), and Clearfil Megabond 2 (MB2). The microtensile bond strength (μTBS), the fracture mode analysis, resin-dentin interface and dentin surface were observed by SEM. Two-way ANOVA was performed to analyze the μTBS (α = 0.05)., Results: The μTBS of the NaOCl group significantly decreased for GP and MB2 ( P  < 0.05). Significant effects of adhesive (F = 12.182, P  < 0.001), and irrigation (F = 27.224, P  < 0.001) on the μTBS were observed, whereas interaction between adhesive and irrigation was not significant (F = 1.761, P  = 0.144). The adhesive layer with variable thickness was observed in all groups with different morphological structures., Conclusion: The effect of NaOCl treatment on the μTBS differs depending on the type of adhesives., Competing Interests: The authors have no conflicts of interest relevant to this article., (© 2022 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.)

Chemists have now synthesized new kinds of DNA that add nucleotides to the four standard nucleotides (guanine, adenine, cytosine, and thymine) found in standard Terran DNA. Such "artificially expanded genetic information systems" are today used in molecular diagnostics; to support directed evolution to create medically useful receptors, ligands, and catalysts; and to explore issues related to the early evolution of life. Further applications are limited by the inability to directly sequence DNA containing nonstandard nucleotides. Nanopore sequencing is well-suited for this purpose, as it does not require enzymatic synthesis, amplification, or nucleotide modification. Here, we take the first steps to realize nanopore sequencing of an 8-letter " hachimoji " expanded DNA alphabet by assessing its nanopore signal range using the MspA ( Mycobacterium smegmatis porin A) nanopore. We find that hachimoji DNA exhibits a broader signal range in nanopore sequencing than standard DNA alone and that hachimoji single-base substitutions are distinguishable with high confidence. Because nanopore sequencing relies on a molecular motor to control the motion of DNA, we then assessed the compatibility of the Hel308 motor enzyme with nonstandard nucleotides by tracking the translocation of single Hel308 molecules along hachimoji DNA, monitoring the enzyme kinetics and premature enzyme dissociation from the DNA. We find that Hel308 is compatible with hachimoji DNA but dissociates more frequently when walking over C-glycoside nucleosides, compared to N-glycosides. C-glycocide nucleosides passing a particular site within Hel308 induce a higher likelihood of dissociation. This highlights the need to optimize nanopore sequencing motors to handle different glycosidic bonds. It may also inform designs of future alternative DNA systems that can be sequenced with existing motors and pores.

The first structural model of duplex DNA reported in 1953 by Watson & Crick presented the double helix in B-form, the form that genomic DNA exists in much of the time. Thus, artificial DNA seeking to mimic the properties of natural DNA should also be able to adopt B-form. Using a host-guest system in which Moloney murine leukemia virus reverse transcriptase serves as the host and DNA as the guests, we determined high-resolution crystal structures of three complexes including 5'-CTT BPPBBSSZZS AAG, 5'-CTT SSPBZPSZBB AAG and 5'-CTT ZZPBSBSZPP AAG with 10 consecutive unnatural nucleobase pairs in B-form within self-complementary 16 bp duplex oligonucleotides. We refer to this ALternative Isoinformational ENgineered (ALIEN) genetic system containing two nucleobase pairs ( P:Z , pairing 2-amino-imidazo-[1,2- a ]-1,3,5-triazin-(8 H )-4-one with 6-amino-5-nitro-(1 H )-pyridin-2-one, and B:S , 6-amino-4-hydroxy-5-(1 H )-purin-2-one with 3-methyl-6-amino-pyrimidin-2-one) as ALIEN DNA. We characterized both position- and sequence-specific helical, nucleobase pair and dinucleotide step parameters of P:Z and B:S pairs in the context of B-form DNA. We conclude that ALIEN DNA exhibits structural features that vary with sequence. Further, Z can participate in alternative stacking modes within a similar sequence context as captured in two different structures. This finding suggests that ALIEN DNA may have a larger repertoire of B-form structures than natural DNA. This article is part of the theme issue 'Reactivity and mechanism in chemical and synthetic biology'.

The ability of nucleic acids to catalyze reactions (as well as store and transmit information) is important for both basic and applied science, the first in the context of molecular evolution and the origin of life and the second for biomedical applications. However, the catalytic power of standard nucleic acids (NAs) assembled from just four nucleotide building blocks is limited when compared with that of proteins. Here, we assess the evolutionary potential of libraries of nucleic acids with six nucleotide building blocks as reservoirs for catalysis. We compare the outcomes of in vitro selection experiments toward RNA-cleavage activity of two nucleic acid libraries: one built from the standard four independently replicable nucleotides and the other from six, with the two added nucleotides coming from an artificially expanded genetic information system (AEGIS). Results from comparative experiments suggest that DNA libraries with increased chemical diversity, higher information density, and larger searchable sequence spaces are one order of magnitude richer reservoirs of molecules that catalyze the cleavage of a phosphodiester bond in RNA than DNA libraries built from a standard four-nucleotide alphabet. Evolved AEGISzymes with nitro-carrying nucleobase Z appear to exploit a general acid-base catalytic mechanism to cleave that bond, analogous to the mechanism of the ribonuclease A family of protein enzymes and heavily modified DNAzymes. The AEGISzyme described here represents a new type of catalysts evolved from libraries built from expanded genetic alphabets.

The purpose of this study was to evaluate the microtensile bond strength (µTBS) and Knoop hardness number (KHN) of a novel experimental light-cured resin cement (HL). Eighteen flat dentin surfaces of human molars were polished using #600 SiC paper and bonded to CAD/CAM resin blocks with the respective resin cements and composites: HL, Panavia V5 (PV), and Clearfil AP-X (AP). All specimens were stored in distilled water at 37 °C for 24 h and 7 days. Scanning electron microscope (SEM) and energy dispersive X-ray (EDX) observations were performed to evaluate filler morphology and to detect the elements. The resin cements had a significant effect on the immediate µTBS (F = 22.59, p < 0.05) and after water storage µTBS (F = 22.83, p < 0.05). Significant differences (p < 0.05) in the KHN between the tested materials were observed, and HL indicated the highest KHN when compared with PV. HL showed a combination of the regular-shaped filler and spherical-shaped filler within the matrix. Silicon was detected in HL from the EDX evaluation. HL exhibited better bonding performance and polymerization, which may have contributed to the improvement of the adhesive strength.

A fundamental property of DNA built from four informational nucleotide units (GCAT) is its ability to adopt different helical forms within the context of the Watson-Crick pair. Well-characterized examples include A-, B-, and Z-DNA. For this study, we created an isoinformational biomimetic polymer, built (like standard DNA) from four informational "letters", but with the building blocks being artificial. This ALternative Isoinformational ENgineered (ALIEN) DNA was hypothesized to support two nucleobase pairs, the P : Z pair matching 2-amino-imidazo-[1,2 a ]-1,3,5-triazin-[8 H ]-4-one with 6-amino-3-5-nitro-1 H -pyridin-2-one and the B : S pair matching 6-amino-4-hydroxy-5-1 H -purin-2-one with 3-methyl-6-amino-pyrimidin-2-one. We report two structures of ALIEN DNA duplexes at 1.2 Å resolution and a third at 1.65 Å. All of these are built from a single self-complementary sequence (5'-CT SZZPBSBSZPPB AG) that includes 12 consecutive ALIEN nucleotides. We characterized the helical, nucleobase pair, and dinucleotide step parameters of ALIEN DNA in these structures. In addition to showing that ALIEN pairs retain basic Watson-Crick pairing geometry, two of the ALIEN DNA structures are characterized as A-form DNA and one as B-form DNA. We identified parameters that map differences effecting the transition between the two helical forms; these same parameters distinguish helical forms of isoinformational natural DNA. Collectively, our analyses suggest that ALIEN DNA retains essential structural features of natural DNA, not only its information density and Watson-Crick pairing but also its ability to adopt two canonical forms.

Purpose: To evaluate whether varying thicknesses of universal adhesives utilizing the additional coating strategy would affect their microtensile bond strength (µTBS) to dentin, hardness, and elastic modulus (mechanical properties)., Materials and Methods: Ninety-nine human maxillary premolars were cut to expose coronal dentin, ground with regular-grit diamond burs, and randomly distributed into 9 groups based on 1. adhesive: Scotchbond Universal Adhesive (SB; universal), G Premio Bond (GP; universal) and Clearfil Megabond 2 (MB; two-step self-etch; control); and 2. application strategy (one, two or three coats; each coat light cured). After adhesive application and resin composite buildup, the bonded teeth were stored in distilled water (37°C; 24 h). Resin-dentin sticks from eight premolars per group (each premolar yielded 3 sticks; n = 24 sticks altogether) were prepared for the µTBS test, followed by measurement of the adhesive thicknesses at their fractured ends using SEM. The mechanical properties of the adhesive layers produced by different coats were evaluated on separate resin-dentin slices (n = 3 teeth per group)., Results: Two coats significantly increased the µTBS (p < 0.001) of all the adhesives. The correlation between adhesive thickness and bond strength was positive for GP but negative for SB. MB did not show any correlation. Additional coating significantly increased the mechanical properties of GP (p < 0.05) but did not affect SB and MB (p < 0.05)., Conclusion: An additional adhesive coating over the manufacturers' recommendations improved the bond strength of all the adhesives tested. However, the increased mechanical properties of the adhesives with additional curing was material dependent.

This study evaluated the antibacterial activity of colloidal platinum nanoparticles (CPNs) toward Streptococcus mutans (S. mutans) viability. S. mutans 109c was treated with water and three CPN solutions at 37°C for 24 h (i.e., control, PAA-Pt, C-Pt, C-CyD-Pt). Dilution series (10 -1 -10 -5 ) were prepared using brain heart infusion (BHI) broth for all samples, and a 100 µL suspension of each dilution was spread onto a BHI agar plate. Colony-forming units (CFU/mL) were determined after 24 h. The effects of CPNs on S. mutans survival and biofilm formation were investigated using fluorescence and scanning electron microscopies. The antibacterial rate of S. mutans increased with increasing concentrations of all three CPNs, with PAA-Pt nanoparticles exhibiting the highest antibacterial efficacy. CPNs were found to reduce S. mutans growth and inhibit biofilm formation remarkably.

Purpose: To retrospectively investigate the mid-term outcomes after arthroscopic repair of isolated subscapularis tears with a relatively large number of patients and to compare them by tear size., Methods: Medical records were reviewed for patients who underwent arthroscopic rotator cuff repair between 2010 and 2017 at our institute. The inclusion criterion was isolated subscapularis tears that underwent arthroscopic rotator cuff repair. The exclusion criteria were (1) previous rotator cuff surgery, (2) lack of imaging studies or clinical evaluation data, (3) neuromuscular diseases, and (4) <2-year follow-up. Range of motion, American Shoulder and Elbow Society score, and bear-hug or belly-press test were assessed pre- and postoperatively. Repair integrity was evaluated with magnetic resonance imaging at postoperative1 year. The clinical and imaging study outcomes were compared between smaller (Lafosse types 1-3) and larger (types 4 and 5) tears., Results: The subjects included 38 males and 8 females with a mean age of 59 years (range, 25-77 years). The mean follow-up was 36 months (range, 24-96 months). There were 13 type 1, 10 type 2, 12 type 3, 6 type 4, and 5 type 5 shoulders. Postoperative American Shoulder and Elbow Society scores were significantly better in smaller tears than larger tears: 93 ± 8 and 75 ± 14, respectively ( P  = .003). Smaller tears showed better postoperative internal rotation than larger tears ( P  = .004). Significant decrease of positive bear-hug or belly-press test was observed in smaller tears (preoperative, 25; postoperative, 11; P < .001), but there was no significant improvement in larger tears (preoperative, 11; postoperative, 9). The retear rate was significantly greater in larger tears (64%) than smaller tears (6%, P < .001)., Conclusions: The clinical and structural outcomes after arthroscopic repair of isolated subscapularis tears were better in smaller tears than larger tears with a mid-term follow-up. Larger tears showed high retear rates with poorer improvement in active range of internal rotation and subscapularis strength., Level of Evidence: Level III, retrospective, comparative study., (© 2022 The Authors.)

Purpose: To morphologically evaluate the interface between a conventional glass-ionomer cement (GIC) and dentin one day after placement, as well as the changes at the interface after one year of aging/functioning in monkey teeth., Materials and Methods: On the buccal surfaces of seven intact teeth in each of two monkeys, shallow class V cavities were prepared, which were then filled with Fuji IX GP (GC) to provide 1-year in vivo data. A year later, two more teeth in each monkey were similarly prepared and restored for the 1-day in vivo group. The following day, the restored teeth were extracted and the restoration interfaces observed using transmission electron microscopy (TEM). In addition, restorations were similarly placed in two extracted human teeth (control, 1-day in vitro group) and observed a day after placement using TEM., Results: The 1-day in vivo and in vitro results showed that the GIC appeared to bond to dentin through a demineralized zone similar to the hybrid layer produced by resinous adhesives. However, the interface between GIC and dentin after 1 year in vivo appeared to change over time: many needle-like crystals were detected within the remineralized layer and along the collagen fibrils. Slow diffusion of ions resulted in pores, which filled with mineral crystals and made the pores smaller., Conclusion: The interface between GIC and dentin morphologically changes over time, and recrystallization or remineralization at the interface may occur (1 year in vivo).

Background: Boileau et al have reported on the unstable, painful shoulder (UPS), which was defined as painful shoulders without any recognized anteroinferior subluxations or dislocations that were associated with roll-over lesions (ie, instability lesions) on imaging or at arthroscopy. However, they included various pathologies, probably due to the ambiguity in their definitions of UPS. We redefined UPS as follows: (1) shoulder pain during daily or sports activities, (2) traumatic onset, (3) no complaint of shoulder instability, and (4) soft-tissue or bony lesions, such as Bankart or humeral avulsion of glenohumeral ligament lesion, confirmed by arthroscopy. The purpose of this study was to retrospectively investigate pathologies of UPS based on our definitions. We also aimed to assess the outcomes after arthroscopic soft-tissue stabilization for UPS., Methods: We reviewed patients who were retrospectively diagnosed as UPS based on our definition and underwent arthroscopic stabilization between January 2007 and September 2018. Patients' demographics, physical and radiographic findings, intraoperative findings, clinical outcomes (Rowe scores, Subjective Shoulder Value [SSV], and the visual analog scale [VAS] for pain), and return to play sport (RTPS) were investigated., Results: This study included 91 shoulders in 91 patients with a mean age of 23 years (range, 15-51). The mean follow-up was 37 months (range, 24-156). Eighty-seven patients were involved in sports activities: collision/contact, 55 patients (60%); overhead, 26 patients (29%). The pain was reproduced during the anterior apprehension test in 86 shoulders (95%). Normal type (49%) predominated in glenoid morphology followed by fragment (bony Bankart) type (37%). Most fragment-type lesions were seen in collision/contact athletes. Intraoperative findings demonstrated that Bankart lesions were found in all patients and Hill-Sachs lesions only in 42%. Magnetic resonance arthrography in the abducted and externally rotated positions showed a Bankart lesion in 76 shoulders (84%). Rowe score, SSV, and pain VAS significantly improved postoperatively ( P  < .001 for each). Forty-two of 70 athletes (60 %) with > 2-year follow-up returned to the sport at a complete or near-preinjury level. Six (9%) athletes experienced reinjury., Conclusion: All shoulders that were diagnosed as UPS with our definition had a Bankart lesion. There seemed to be two different types of pathologies: Bankart lesions in lax shoulders and bony Bankart lesions in collision/contact athletes. The pain experienced during the anterior apprehension test may be useful for the diagnosis of UPS. Arthroscopic soft-tissue stabilization yielded good clinical outcomes with a high RTPS rate, but the reinjury rate was relatively high., (© 2022 The Authors.)

Background: Teres minor atrophy can be seen in shoulders both with and without a rotator cuff tear, even among the young population. The purpose of this study was to retrospectively investigate the incidence of teres minor atrophy in young and middle-aged patients with or without a rotator cuff tear., Methods: Patient records were reviewed to identify 10-39-year-old patients (Group Y) and 60-69-year-old patients (Group O) who underwent MRI because of shoulder disorders. The exclusion criteria were as follows: (1) prior surgeries, (2) neurological disorders in the cervical spines or shoulder girdle, (3) global atrophy of all four cuff muscles without a rotator cuff tear, (4) acute trauma, and (5) poor image quality due to artifacts. An experienced shoulder surgeon evaluated teres minor atrophy on T1-weighted oblique sagittal images. Statistical analysis was performed using the chi-square test for comparison of Groups Y and O., Results: Group Y consisted of 528 shoulders in 520 patients, including 406 males and 114 females with a mean age of 26 years. Group O consisted of 884 shoulders in 837 patients, including 394 males and 443 females with a mean age of 65 years. Rotator cuff tears were seen in 33 shoulders (6.3 %) in Group Y, and 411 shoulders (46.5%) in Group O. Teres minor atrophy was more present in Group O (59 shoulders [6.7%]) than Group Y (11 shoulders [2.1%], P  < .001). Among shoulders with teres minor atrophy, the incidence of intact cuff tended to be higher in Group Y than O (7 shoulders [64%] and 21 shoulders [36%], P  = .08). However, the ratio of the intact cuff to the number of patients in each group was not significantly different (Group Y, 7 of 528 [1.3%]; Group O, 21 of 884 [2.3%]). Teres minor muscle atrophy tended to be more common in athletes than nonathletes in Group Y, although the difference was not significant ( P  = .057)., Conclusion: The incidence of teres minor atrophy was significantly higher in middle-aged patients than young patients. Middle-aged patients with teres minor atrophy were more associated with rotator cuff tears. The common cause of teres minor atrophy may be rotator cuff tears. Teres minor atrophy in young patients might be associated with sports-related factors such as infraspinatus hypertrophy or axillary nerve injury., (© 2022 The Author(s).)

This study aimed to evaluate the pulpal responses of monkey's pulp after direct pulp capping (DPC) with the novel mineral trioxide aggregate containing phosphorylated pullulan-based material (MTAPPL). Seventy-two teeth were randomly divided into four groups: MTAPPL; Nex-Cem MTA (NX); TheraCal LC (TH); and Dycal (DY). Histopathological changes in the pulps were observed at days 3, 7 and 70. On day 3, mild inflammatory responses were observed in the MTAPPL, no to moderate inflammatory responses in the TH, whereas moderate inflammatory responses in the NX and DY. No mineralized tissue formation (MTF) was observed in all groups. On day 7, no or mild inflammatory responses were observed in all groups. Initial MTF was observed except for DY. No inflammation with complete MTF including presence of odontoblast-like cells was observed in the MTAPPL, NX and TH groups at day 70. These findings indicate that MTAPPL could be an efficient DPC material.

Introduction: There is no consensus regarding the range of immobilization in the conservative treatment of distal radius fractures (DRFs). Therefore, this systematic review and meta-analysis aimed to compare the clinical outcome of patients with DRFs treated conservatively with below- or above-elbow immobilization., Materials and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, two independent reviewers searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov and World Health Organization International Clinical Trials Registry Platform in April 2020; a subsequent update search was conducted in April 2021. We identified all randomised controlled trials comparing two immobilization methods in DRFs. The primary outcome measures were the Disabilities of the Arm, Shoulder and Hand (DASH) or QuickDASH questionnaire scores in the short- and long-term (≤ and >six weeks, respectively) follow-up as well as the treatment failure rate. The secondary outcome measures were radiographic outcome, patient-rated wrist evaluation (PRWE) score, pain score and adverse events. Risk of bias was evaluated using the Cochrane Risk of Bias tool version 2. We used the Grading of Recommendations Assessment, Development and Evaluation approach to evaluate the quality of evidence., Results: The initial search revealed 1,775 records, and ten studies with 909 participants in total were included. There was no significant difference in DASH score in the short-term follow-up (4.99 lower, 95% confidence interval (CI): 10.45 lower to 0.46 higher; very low certainty) and treatment failure (risk ratio: 0.91, 95% CI: 0.59 to 1.40; low certainty). A clinically irrelevant but significant mean difference (0.83 lower, 95%CI: 1.64 lower to 0.03 lower; low certainty) was found in the DASH score in favour of below-elbow immobilization in the long-term follow-up. The overall risk of bias in DASH scores was high based on the measurement bias. Furthermore, there was no significant difference in secondary outcome measures., Conclusion: This meta-analysis did not demonstrate clinically meaningful difference between below- and above-elbow immobilization in terms of DASH score both in the short- and long-term follow-ups. However, overall certainty of evidence was considered very low, based on the very serious risk of bias, inconsistency and imprecision. Hence, there is a need for further higher quality research., Trial Registration Number: UMIN000040134 (4/14/2020)., Competing Interests: Declarations of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to investigate the clinical and radiographic outcomes of arthroscopic iliac bone grafting with capsulolabral reconstruction for severe glenoid bone loss with a minimum of 5 years' follow-up., Methods: The inclusion criterion was shoulders that underwent arthroscopic iliac bone grafting for >20%-25% glenoid defect between January 2007 and April 2014, and the exclusion criterion was <5 years' follow-up. Iliac crest bone grafts of approximately 2.0 cm length and 0.8 cm height were arthroscopically fixed to the anterior glenoid using 2 cannulated screws followed by capsulolabral repair. Rowe score, Western Ontario Shoulder Instability Index (WOSI), and passive range of motion were evaluated. Radiographic findings including the Kellgren and Lawrence osteoarthritis grade and graft integration on 3-dimensional computed tomography at the final follow-up were also evaluated., Results: Forty-eight shoulders met the inclusion criteria, and 24 shoulders with ≥5 years' follow-up were included (1 died; 23 were lost follow-up): 22 males, 2 females; a mean age at surgery, 30 years (range, 18-52 years); a mean follow-up of 8 years (range, 5-11 years). The mean preoperative glenoid bone defect was 22% (range, 20%-28%). All shoulders had a Hill-Sachs lesion including 4 on-track lesions. One shoulder experienced traumatic redislocation at 5 years after surgery. The scores significantly improved: Rowe score, 19 ± 8 to 94 ± 8 (P < .001); WOSI, 1547 ± 241 to 439 ± 318 (P < .001). Postoperative flexion showed significant improvement from 158 ± 18 to 169 ± 11 (P = .008), whereas internal rotation deteriorated from T8 ± 3 to T10 ± 3 (P = .005). Graft integration showed remodeling in 54% and excessive absorption in 13%. Osteoarthritis grades progressed significantly (P < .001), but only grade 1 osteoarthritic changes were seen, except for 4 shoulders with grade 2 osteoarthritis., Conclusions: Arthroscopic iliac bone grafting for traumatic anterior shoulder instability with severe glenoid bone loss yielded satisfactory outcomes with mid-term follow-up. Arthritic changes progressed in half of the shoulders; however, most shoulders only demonstrated grade 1 osteoarthritis., Level of Evidence: Level IV, therapeutic case series., (Copyright © 2021 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Recently, magnetic resonance imaging (MRI) classification of medial ulnar collateral ligament (UCL) tears has been introduced, but little is known about the relationship between MRI grading and medial joint laxity. It has been reported that microscopy coils could make it possible to achieve high-resolution images of upper extremities with a superior diagnostic ability to conventional MRI. However, there is no report that has compared the diagnostic reliability between microscopic and conventional MRI. The purpose of this study was to assess the relationship between MRI findings and medial joint laxity evaluated with stress ultrasound (US). Secondary objective was to compare the reliabilities of UCL evaluation between microscopic and conventional MRI., Methods: One-hundred thirty baseball players who underwent MRI of the elbow for the diagnosis of UCL injury using both conventional and microscopy MRI were included in this study. They also underwent stress US for assessment of medial joint laxity against valgus stress. Our MRI grading system for UCL injuries was compared to medial joint laxity evaluated with stress US. The intrarater and interrater reliabilities of our grading system were assessed with both microscopic and conventional MRI., Results: Our grading system was related to valgus stability, especially with microscopic MRI. The reliabilities were fair when combined with microscopic MRI, which exhibited better intrarater and interrater reliabilities than conventional MRI., Conclusion: High-resolution microscopic MRI may contribute to the accurate diagnosis of UCL injuries., (© 2021 The Authors.)

Background: Many surgeons prefer bony stabilization including Bristow or Latarjet procedures for shoulder instability in collision athletes, even though several potential complications have been reported. There has been a limited number of studies on the midterm outcomes of arthroscopic soft tissue stabilization for anterior shoulder instability in competitive collision athletes., Purpose: To assess the outcomes of arthroscopic soft tissue stabilization in combination with selective augmentation procedures for collision athletes with traumatic anterior shoulder instability., Study Design: Case series; Level of evidence, 4., Methods: We retrospectively assessed rugby or American football players (<40 years old) who underwent arthroscopic Bankart or bony Bankart repair with selective augmentations (rotator interval closure and/or Hill-Sachs remplissage) for traumatic anterior shoulder instability between January 2012 and March 2017. Shoulders that required other bony procedures were excluded. Recurrence, complications, return to sport, and functional scores (Rowe score and Subjective Shoulder Value sports score) were investigated., Results: This study included 113 shoulders in 100 patients with a mean age of 20 years (range, 15-36 years) at surgery. Rotator interval closure was performed on 36 shoulders in addition to Bankart repair, and rotator interval closure and Hill-Sachs remplissage were performed on 77 shoulders. The mean follow-up period was 44 months (range, 24-72 months). Of the 113 shoulders, 4 (3.5%) experienced postoperative dislocation, but there were no complications. A total of 93 athletes (93%) attained complete or near complete preinjury sports activity levels. The mean Rowe score significantly improved from 36 (range, 10-75) at presurgery to 96 (range, 35-100; P = .003) at postsurgery. The mean Subjective Shoulder Value sports score significantly improved after surgery, from a mean preoperative score of 22 (range, 0-50) to a postoperative score of 92 (range, 64-100; P = .002)., Conclusion: Our treatment strategy, where arthroscopic soft tissue stabilization was combined with selected augmentations, provided good clinical outcomes for competitive collision athletes in terms of low rates of recurrence and complication, a high rate of return to sports, and good shoulder function.

Background: Scapular notching is a frequently observed complication after reverse shoulder arthroplasty. Impingement of the humeral plastic insert against the scapular neck is believed to be the cause of notching. There have been no in vivo studies that analyzed the positional relationship between the scapular neck and humeral insert. The purpose of this study was to measure the distance between the scapular neck and insert in shoulders with Grammont-type prostheses during active external rotation at the side., Methods: Eighteen shoulders with Grammont-type prostheses were enrolled in this study. There were 13 males and 5 females, and the mean age at surgery was 74 years (range, 63-91). Fluoroscopic images were recorded during active external rotation at the side from maximum internal to external rotation at an average of 14 months (range, 7-24) after surgery. Implant kinematics were determined with three-dimensional models of the implants and fluoroscopic images using model-image registration techniques. Based on the implant kinematics, the closest distance between the scapular neck and insert was computed at each 5° increment of glenohumeral internal/external rotation., Results: Mean glenohumeral abduction during rotation was 17°-22°. The mean distance between the neck and insert was approximately 1 mm throughout the activity. The separation distance tended to narrow with arm external rotation, but the change was not significant., Interpretation: The small distance between the scapular neck and insert in early post-operative reverse shoulder arthroplasty patients may be associated with the high incidence of scapular notching in Grammont-type prostheses., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The choice of surgical option for unstable large capitellar osteochondritis dissecans (OCD) lesions in skeletally immature athletes remains controversial., Purpose/hypothesis: The purpose was to investigate functional and radiographic outcomes after arthroscopic fragment resection and osteochondral autograft transplantation (OAT) for unstable large capitellar OCD lesions in skeletally immature athletes with a minimum 5 years' follow-up. We hypothesized that the outcomes after OAT for large capitellar OCD lesions would be superior to those after arthroscopic fragment resection., Study Design: Cohort study; Level of evidence, 3., Methods: A total of 19 elbows in 19 patients (17 male and 2 females) who underwent arthroscopic resection were assigned to group 1 (mean age, 14 years [range, 13-15 years]), whereas 29 elbows in 29 patients (29 male) who underwent OAT were assigned to group 2 (mean age, 14 years [range, 13-15 years]), with the mean follow-up of 8 (range, 5-11 years) and 7 (range, 5-13 years) years, respectively. All OCD lesions were larger than one-half of the radial head diameter. Functional scores, patient satisfaction, and range of motion were compared between the groups. Radiographic changes, including superior migration, radial head enlargement, and osteoarthritis (OA) grade, were examined., Results: All patients returned to sports activity. Functional scores, patient satisfaction, and flexion at the final follow-up were significantly improved in both groups compared with preoperative values, and differences were not significant between groups at the final follow-up. Extension showed a significant improvement in both groups (group 1: -17° to 0°; group 2: -18° to -6°; P < .001). Extension in group 1 was significantly better than that in group 2 at the final follow-up ( P = .045). No elbows developed postoperative severe OA in group 1, whereas 3 elbows in group 2 had grade 3 OA; these 3 elbows had preoperative superior migration and radial head enlargement., Conclusion: No differences were observed in clinical and radiographic outcomes between patients undergoing arthroscopic fragment resection and OAT, except for elbow extension, at a minimum 5 years' follow-up. We believe that for adolescents with large capitellar OCD lesion, OAT is a good option for skeletally immature elbows and that arthroscopic fragment resection is a reliable and less invasive surgical option for relatively mature elbows.

Background: Various factors may be related to outcomes of reverse shoulder arthroplasty (RSA) including patient and surgical factors. Differences in shoulder kinematics might be associated with poor function after RSA; however, kinematic differences between shoulders with good or poor elevation have not been elucidated. The purpose of this study was to compare RSA kinematics between shoulders with good or poor elevation., Methods: The study included 28 shoulders with a minimum 6-month follow-up after RSA using Grammont-type prostheses. Subjects comprised 17 men and 11 women with the mean age of 75 years (range, 63-91). Subjects underwent fluoroscopy during active scapular plane abduction. Computed tomography of their shoulders was performed to create 3-dimensional scapular implant models. Using model-image registration techniques, poses of 3-dimensional implant models were iteratively adjusted to match their silhouettes with the silhouettes in the fluoroscopic images, and 3-dimensional kinematics of implants were computed. Kinematics and glenosphere orientation were compared between shoulders with good (>90 degree) or poor (<90 degree) scapular plane abduction., Results: Nineteen and 9 shoulders were assigned to the good- and poor-elevation groups, respectively. There were no significant differences between the groups in age, sex, height, weight, preoperative range of motion, or Constant score, but body mass index in the poor elevation shoulders was significantly larger than that in the good elevation shoulders. There were no significant differences in glenosphere (upward/downward rotation, anterior/posterior tilt, internal/external rotation) or glenohumeral (internal/external rotation, abduction/adduction) kinematics between the good and poor elevation shoulders. Scapulohumeral rhythm was significantly higher in the good elevation shoulders than the poor elevation shoulders ( P  = .04). Glenosphere superior tilt was 2.3° ± 4.2° in the good-elevation group and 8.1° ± 8.9° in the poor-elevation group, and the difference was statistically significant ( P  = .03)., Discussion: Shoulders with good elevation after RSA demonstrated better scapulohumeral rhythm than those with poor elevation, though there were no significant differences in glenosphere and glenohumeral kinematics. It may be important for better elevation to achieve good glenohumeral motion in shoulders with RSA. Glenosphere orientations may affect postoperative shoulder function., (© 2021 The Author(s).)

Objective: The purpose of this study was to determine the bond stability and the change in interfacial ultra-structure of a conventional glass-ionomer cement bonded to dentin, with and without pre-treatment using a polyalkenoic acid conditioner., Methods: The occlusal dentin surfaces of six teeth were ground flat. Glass-ionomer cement was bonded to the surfaces either with or without polyalkenoic acid conditioning. The teeth were sectioned into 1-mm 2 stick-shaped specimens. The specimens obtained were randomly assigned to two groups with different periods of storage in water: 1 week and 1 year. The micro-tensile bond strength (μTBS) was determined for each storage time. Additional specimens were prepared for Transmission Electron Microscopy (TEM); they were produced with or without prior polyalkenoic acid conditioning in the same way as in the μTBS test., Results: There was no significant difference in μTBS to conditioned dentin and non-conditioned dentin (p > 0.05). The failures appeared to be of a mixed nature, although aging caused more areas of cohesive than adhesive failure in both groups. The TEM observation showed an intermediate layer, a matrix-rich layer and a partially demineralized layer in the polyalkenoic acid conditioned group., Significance: Aging did not reduce the bond strength of the conventional glass-ionomer cement to dentin with or without the use of a polyalkenoic acid conditioner., (Copyright © 2020 The Academy of Dental Materials. Published by Elsevier Inc. All rights reserved.)