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Tennis elbow or lateral epicondylosis (LE) is a frequent cause of elbow pain affecting patients between 30 and 55 years of age. Although symptoms in most cases are self-limited, pain may persist and be refractory to conservative management. This review article will present evidence-based recommendations about conservative and interventional management options available for LE. Conservative management aimed at reducing pain with a short course of topical or oral anti-inflammatory medications, activity modification, correction of kinetic chain dysfunction, and the use of an exercise progression from isometric to eccentric exercise can be performed in the acute stage of the disease. If patients persist with pain and disability, nonsurgical interventional techniques such as corticosteroid injections, platelet-rich plasma injections, or other regenerative techniques such as extracorporeal shock wave therapy have shown evidence in improving patients’ pain in the subacute and chronic phases of the disease. LE is the most common disorder of the arm causing disability. Treatment options range from conservative to surgical interventions. Continued research on nonsurgical interventional techniques that effectively treat pain and improve function in patients with LE is required to guide treatment.

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

Mutations in the human LMNA gene cause a collection of diseases called laminopathies, which includes muscular dystrophy and dilated cardiomyopathy. The LMNA gene encodes lamins, filamentous proteins that form a meshwork on the inner side of the nuclear envelope. How mutant lamins cause muscle disease is not well understood, and treatment options are currently limited. To understand the pathological functions of mutant lamins so that therapies can be developed, we generated new Drosophila models and human iPS cell-derived cardiomyocytes. In the Drosophila models, muscle-specific expression of the mutant lamins caused nuclear envelope defects, cytoplasmic protein aggregation, activation of the Nrf2/Keap1 redox pathway, and reductive stress. These defects reduced larval motility and caused death at the pupal stage. Patient-derived cardiomyocytes expressing mutant lamins showed nuclear envelope deformations. The Drosophila models allowed for genetic and pharmacological manipulations at the organismal level. Genetic interventions to increase autophagy, decrease Nrf2/Keap1 signaling, or lower reducing equivalents partially suppressed the lethality caused by mutant lamins. Moreover, treatment of flies with pamoic acid, a compound that inhibits the NADPH-producing malic enzyme, partially suppressed lethality. Taken together, these studies have identified multiple new factors as potential therapeutic targets for LMNA-associated muscular dystrophy., Highlights • Drosophila models of LMNA muscular dystrophy exhibited redox imbalance. • Amino acid substitutions in all three domains of lamins caused reductive stress. • iPS cell-derived cardiomyocytes showed an altered response to NAC treatment. • Genetic manipulation of autophagy regulators suppressed lethality caused by mutant lamins. • Pamoic acid, a malic enzyme inhibitor, suppressed lethality caused by mutant lamins.

Brain G-protein coupled receptors have been hypothesized to be potential targets for maintaining or restoring cognitive function in normal aged individuals or in patients with neurodegenerative disease. A number of recent reports suggest that activation of melanocortin receptors (MCRs) in the brain can significantly improve cognitive functions of normal rodents and of different rodent models of the Alzheimer’s disease. However, the potential impact of normative aging on the expression of MCRs and their potential roles for modulating cognitive function remains to be elucidated. In the present study, we first investigated the expression of these receptors in six different brain regions of young (6 months) and aged (23 months) rats following assessment of their cognitive status. Correlation analysis was further performed to reveal potential contributions of MCR subtypes to spatial learning and memory. Our results revealed statistically significant correlations between the expression of several MCR subtypes in the frontal cortex/hypothalamus and the hippocampus regions and the rats’ performance in spatial learning and memory only in the aged rats. These findings support the hypothesis that aging has a direct impact on the expression and function of MCRs, establishing MCRs as potential drug targets to alleviate aging-induced decline of cognitive function.

Ulnar-sided wrist injuries are common in sports that require repeated pronosupination, wrist radial/ulnar deviation, axial loading, and gripping equipment. Common anatomic structures affected include the triangular fibrocartilage complex, extensor carpi ulnaris tendon, distal radioulnar and ulnocarpal joints, and hamate bone. Presenting symptoms include pain with activity, swelling, possible snapping or clicking, and reproduction of symptoms with provocative maneuvers. Imaging may confirm or rule out pathologies, but abnormal findings also may present in asymptomatic athletes. Initial treatment is usually nonoperative with splinting, load management, activity modification, strengthening the components of the kinetic chain of the particular sport, and pain management. Surgery is usually indicated in ulnar-wrist pain pathology such as hook of hamate fractures and required in associated instability. Future research should address specific treatment and rehabilitation protocols, emphasizing the complete kinetic chain along with the injured wrist.

The influenza A virus undergoes genetic drift and shift, leaving the general population susceptible to emerging pandemic strains, despite seasonal flu vaccination. Here we describe a single dose influenza vaccine derived from recombinant outer membrane vesicles (rOMVs) that display an antigen-mapped heterospecies tandem sequence of the M2 protein from the influenza A virus, released over 30days from poly(lactic-co-glycolide) (PLGA) microparticles. Four weeks post vaccination, BALB/c mice developed high anti-M2e IgG titers that were equivalent to those generated at 8weeks in a typical prime/boost vaccine regimen. Challenge of mice with a lethal dose of mouse adapted influenza virus PR8 (H1N1) 10weeks post vaccination resulted in 100% survival for both rOMV single-dose microparticle and prime/boost vaccinated mice. Anti-M2e IgG1 and IgG2a antibody titers were weighted toward IgG1, but splenocytes isolated from rOMV single-dose microparticle vaccinated mice produced high levels of IFNγ relative to IL-4 in response to stimulation with M2e peptides, supporting a more Th1 biased immune response. The protective immune response was long lasting, eliciting sustained antibody titers and 100% survival of mice challenged with a lethal dose of PR8 six months post initial vaccination. Together, these data support the potential of controlled release rOMVs as an effective single dose, long lasting and rapidly effective vaccine to protect against influenza.

Therapeutic proteins have become an integral part of health care. However, their controlled delivery remains a challenge. Protein function depends on a delicate three dimensional structure, which can be damaged during the fabrication of controlled release systems. This study presents a microgel-based controlled release system capable of high loading efficiencies, prolonged release and retention of protein function. A new DMSO/Pluronic microemulsion served as a reaction template for the crosslinking of poly(acrylic acid) and oligo (ethylene glycol) to form microgels. Poly(acylic acid) molecular weights and microgel crosslinking densities were altered to make a series of microgels. Microgel capacity to capture and retain proteins of different sizes and isoelectric points, to control their release rate (over ~30 days) and to maintain the biofunctionality of the released proteins were evaluated. Microgels of different sizes and morphologies were synthesized. Loading efficiencies of 100% were achieved with lysozyme in all formulations. The loading efficiency of all other proteins was formulation dependent. Release of lysozyme was achieved for up to 30 days and the released lysozyme retained over 90% of its activity. High loading efficiencies and prolonged release of different proteins was achieved. Furthermore, lysozyme’s functionality remained uncompromised after encapsulation and release. This work begins to lay the foundation for a broad platform for the delivery of therapeutic proteins.

BACKGROUND Capsular contracture remains one of the most commonly reported complications in aesthetic and reconstructive breast patients. Previous in vitro studies from the authors' laboratory have recommended a new triple antibiotic povidone-iodine irrigation (2000) and subsequently a triple antibiotic non-povidone-iodine-containing irrigant (2001) to optimize broad-spectrum coverage of various bacteria implicated in capsular contracture; however, the clinical efficacy of these in vitro studies remains unproven. The purpose of this study was to determine the clinical efficacy for the previously reported triple antibiotic breast irrigation. The cost-effectiveness of universal application of irrigation solutions in breast prosthesis surgery was analyzed as well. METHODS Patients undergoing aesthetic and reconstructive breast implant procedures were treated with a standardized operative technique, including the use of triple antibiotic breast irrigation by a single surgeon. Capsular contracture was assessed using a simplified Baker scale and graded by two independent caregivers to maximize objectivity and consistency. Additional complications were also recorded, including reoperation. Patient charges for antibiotic irrigation and reoperation for contracture were determined and compared. RESULTS A total of 335 patients operated on since 1997 were evaluated prospectively. They ranged in age from 18 to 86 years, and the mean follow-up was 14 months (range, 6 to 75 months). The rate of grade III/IV capsular contracture in the study groups was 1.8 percent for patients undergoing primary breast augmentation. Patients undergoing augmentation-mastopexy had a grade III/IV contracture rate of 0 percent. Breast reconstruction patients had a 9.5 percent rate of grade III/IV contracture. CONCLUSIONS Triple antibiotic breast irrigation is clinically associated with a low incidence of capsular contracture compared with other published reports, and its clinical efficacy supports previously published in vitro studies. Application of triple antibiotic irrigation is recommended for all aesthetic and reconstructive breast procedures and is cost effective.

Protein therapeutics are playing an ever increasing role in disease treatment; however, their controlled release remains challenging. In this study a series of microgels with varying crosslinking densities was synthesized, characterized and evaluated for their potential as controlled release protein delivery devices.

Deep vein thrombosis is a known serious complication of surgical procedures and a significant cause of morbidity and mortality. Plastic surgeons' management of the risk of deep vein thrombosis and current information regarding deep vein thrombosis incidence rates are limited. A survey was designed and mailed to plastic surgeons to collect data on the patterns of practice with regard to deep vein thrombosis in patients undergoing plastic surgery procedures.A comprehensive self-administered, anonymous survey was mailed to 1557 plastic surgeons in March of 2003.A total of 334 completed responses were available for analysis. Subsets of surgeons do not use any deep vein thrombosis prophylaxis: 16.4 percent who perform face lifts; 21.3 percent who perform liposuction; and 8.7 percent who perform a combined abdominoplasty-liposuction procedure. Only 48.7 percent of surgeons performing face lifts, 43.7 percent of surgeons performing liposuction, and 60.8 percent performing a combined procedure use deep vein thrombosis prophylaxis all the time.These results demonstrate a need for educational efforts and guidelines to direct clinical practice in line with evidence-based data concerning plastic surgery procedures and deep vein thrombosis. Plastic surgeons should be aware of the potential and real risks of deep vein thrombosis and procedures for prevention and treatment to reduce morbidity and mortality associated with deep vein thrombosis in all plastic surgery patients.

Restoration of the aesthetic neck contour is an integral component of facial rejuvenation. Multiple deformities of the neck and chin complex can make treatment of the cervical region daunting. An algorithmic approach to neck rejuvenation based on individual anatomic and clinical analysis is prudent. The authors created a simplified anatomic approach to the most common cervical deformities encountered in the patient seeking facial rejuvenation.Retrospective analysis of the senior author's (R.J.R.) technique evolution over the last 15 years was performed. The operative techniques used in neck rejuvenation were evaluated and the long-term postoperative results were reviewed.Recurrent patterns of cervical deformity are present in patients presenting for facial rejuvenation. These patterns can be classified into categories based on specific anatomic deformities.Facial rejuvenation requires appropriate identification of deformity to effect the desired changes. Cervical deformities are classified into clinically useful categories based on careful preoperative analysis. A thorough understanding of the anatomic bases for the deformities allows the surgeon to choose the appropriate treatments to achieve consistent and reliable results.

The latissimus dorsi muscle flap is a versatile flap used in a variety of reconstructive procedures. The major complication reported with its use is donor-site seroma, reported to occur in 20 to 79 percent of cases. A retrospective review of 47 patients undergoing latissimus dorsi muscle harvest from April of 1998 through May of 2002 was performed. Progressive tension sutures were used during donor-site closure in 22 patients from March of 2000 through May of 2002. This group was compared with historical controls from April of 1998 through March of 2000 (n = 23) who underwent latissimus dorsi harvest without use of the technique. Seven of 23 controls (30 percent) developed seromas at the donor site, compared with 0 of 22 (Fisher's exact text, p = 0.0092). The authors conclude that use of progressive tension sutures placed at the time of donor-site closure is an effective method to reduce or eliminate the most common complication associated with latissimus dorsi harvest. Technique recommendations are reviewed.