Application of a Quick Response Code as an Alternative Method to Provide Pediatric Cast Care Instructions.

BACKGROUND: There is a growing need to improve patient education for nonsurgical fracture care in children. A Quick Response (QR) code was used as an alternative method to provide cast care instructions in our outpatient fracture clinic. We evaluated satisfaction and examined the convenience and impact this might have on the child's casting experience. METHODS: A prospective study was conducted in which QR codes were embedded in the casting of nonsurgical pediatric fractures in 88 children. The number of times the QR code was scanned, who scanned the code, treatment satisfaction, cast-related issues, and whether scan helped prevent a call to the treating physician were recorded. RESULTS: Google Analytics showed the QR code was scanned an average of 1.6 times by 60 participants with most scans done by a parent (65%). Seventy-nine participants (89.9%) found it useful to have the QR code on their cast, and 65 (73.9%) were "very satisfied" with the convenience of the QR code and 37 stated that the information they found kept them from contacting the physician. DISCUSSION: We demonstrated that the use of QR codes for nonsurgical pediatric fracture care has a high level of satisfaction and may reduce calls to the treating physician.

Meniscal Repairs in the Adolescent Knee: Can the Number of Fixation Sites Improve Outcomes?

BACKGROUND: Meniscal pathology in children and adolescents is now a common occurrence because of their ever-increasing participation in youth sports. PURPOSE: To investigate the outcomes of arthroscopic meniscal repair in an adolescent cohort and analyze the variables that may affect outcomes, specifically the number of fixation sites utilized during repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of all children and adolescents younger than 18 years who underwent arthroscopic meniscal repair at a single institution was performed. Patient characteristics, operative details (eg, tear pattern, tear location, method of repair, and number of fixation sites [determined based on the number of sutures used for repair]), and concomitant procedures were recorded. RESULTS: A total of 175 primary meniscal repairs met inclusion criteria and were analyzed. Of this cohort, 115 were able to be contacted and were included in the final study cohort. The mean follow-up was 41 months. The mean age of the children was 14.9 years, and 91 (79%) had concomitant anterior cruciate ligament reconstructions with their meniscal repair. The mean Pediatric International Knee Documentation Committee functional outcome score was 91 (range, 43-100), and the mean Lysholm functional outcome score was 91 (range, 47-100). Of the 115 meniscal repairs, there were a total of 19 reoperations (17%); 15 (13%) were because of meniscal repair failures. The only variable that statistically increased the risk of meniscal repair failure was low number of fixation sites, with the failure group having a mean of 1.79 sutures and the nonfailure group having a mean of 2.97 sutures (P = .03). CONCLUSION: Successful meniscal repairs and a lower failure rate may be achieved with a greater number of fixation sites with promising results at a minimum 2-year follow-up. Validated functional outcome scores were good, with a 13% failure rate. Larger cohort, longer term, multicenter multisurgeon data are still needed to further elucidate the number of fixation sites needed when performing a meniscal repair in the pediatric and adolescent knee.

Utility of Bioabsorbable Fixation of Osteochondral Lesions in the Adolescent Knee: Outcomes Analysis With Minimum 2-Year Follow-up.

BACKGROUND: Osteochondral lesions (OCLs) of the knee, whether occurring secondary to osteochondritis dissecans or a traumatic osteochondral fracture, are commonly encountered in the pediatric and adolescent population. Given the potential for healing in this population, coupled with adequate surgical reduction and stability of OCL fixation, an opportunity exists to avoid a major restorative procedure and the associated substantial costs and potential morbidity. PURPOSE: To analyze the outcomes of bioabsorbable fixation of OCLs in the adolescent knee at a minimum of 2 years. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: An institutional review board-approved retrospective review was performed of patients younger than 18 years who underwent bioabsorbable fixation of an OCL of the knee with a minimum 2-year follow-up. Patient demographics, operative details, and postoperative clinical findings were detailed and recorded. All cases were performed by a single surgeon. RESULTS: There were 38 patients treated surgically for an OCL between 2009 and 2016. Of these, 38 patients (mean age, 14.7 years) were evaluated at a mean of 59 months. OCL fixation consisted of a mean of 1.4 bioabsorbable screws and 1.5 darts. At final follow-up, mean pre- and postoperative Tegner scores were 6.6 and 6.4, respectively, while Lysholm and Pediatric International Knee Documentation Committee scores were 89.8 and 88.1, respectively. A total of 6 patients underwent secondary procedures postoperatively. One patient required a secondary procedure related to OCL fixation, which was secondary to a proud implant. The other secondary procedures included second-look arthroscopic surgery for pain after an injury postoperatively, planned anterior cruciate ligament reconstruction, staged medial patellofemoral ligament reconstruction, and manipulation under anesthesia for arthrofibrosis (n = 2). None of the 32 patients required a revision cartilage procedure at the time of final follow-up. CONCLUSION: The use of bioabsorbable implants in the adolescent knee appears to be a safe and efficacious treatment with good functional outcomes at long-term follow-up and a low revision rate. Additional long-term multisurgeon and multicenter trials with a larger cohort are needed to further elucidate the role of bioabsorbable fixation of an OCL in the adolescent knee.

Fat Quantity and Quality, as Part of a Low-Fat, Vegan Diet, Are Associated with Changes in Body Composition, Insulin Resistance, and Insulin Secretion. A 16-Week Randomized Controlled Trial.

Macronutrient composition of the diet influences the development of obesity and insulin resistance. The aim of this study was to assess the role of dietary fat quantity and fatty acid composition in body composition, insulin resistance, and insulin secretion. An open parallel randomized trial design was used. Overweight participants (n = 75) were randomized to follow a low-fat vegan (n = 38) or control diet (n = 37) for 16 weeks. Dual X-ray absorptiometry was used to measure body composition. Insulin resistance was assessed with the Homeostasis Model Assessment (HOMA-IR) index. Insulin secretion was assessed after stimulation with a liquid breakfast (Boost Plus, Nestle, Vevey, Switzerland). Self-reported 3-day diet records were used to assess dietary intake. A linear regression model was used to test the relationship between fat intake and body composition, insulin resistance, and insulin secretion. Changes in fat intake expressed as percent of total energy consumed correlated positively with changes in fat mass (r = 0.52; p < 0.001; and 0.347; p = 0.006, respectively), even after adjustment for changes in body-mass index (BMI) and energy intake (0.33; p = 0.01). Decreased intakes of C18:0 (r = 0.37, p = 0.004) and CLA-trans-10-cis12 (r = 0.40, p = 0.002), but increased intake of C18:2 (r = -0.40, p = 0.002) and C18:3 (p = -0.36, p = 0.006), were associated with a decrease in HOMA-IR, independent on changes in BMI and energy intake. The main fatty acids associated with changes in fasting insulin secretion were C12:0 (r = -0.31, p = 0.03), and TRANS 16:1 (r = -0.33, p = 0.02), both independent on changes in BMI and energy intake. Our findings demonstrate that, in the context of a low-fat vegan diet, decreased intake of saturated and trans fats and increased relative content of polyunsaturated fatty acids, particularly linoleic and α-linolenic acids, are associated with decreased fat mass and insulin resistance, and enhanced insulin secretion.

A declining CD4 count and diagnosis of HIV-associated Hodgkin lymphoma: do prior clinical symptoms and laboratory abnormalities aid diagnosis?

BACKGROUND: The incidence of Hodgkin lymphoma (HL) among HIV-infected individuals remains unchanged since the introduction of combination antiretroviral therapy (cART). Recent epidemiological data suggest that CD4 count decline over a year is associated with subsequent diagnosis of HL. In an era of economic austerity monitoring the efficacy of cART by CD4 counts may no longer be required where CD4 count>350 cells/µl and viral load is suppressed (<50 copies/ml). METHODS: We sought to establish among our HIV outpatient cohort whether a CD4 count decline prior to diagnosis of HL, whether any decline was greater than in patients without the diagnosis, and also whether other clinical or biochemical indices were reliably associated with the diagnosis. RESULTS: Twenty-nine patients with a diagnosis of HL were identified. Among 15 individuals on cART with viral load <50 copies/ml the change in CD4 over 12 months preceding diagnosis of HL was -82 cells/µl (95% CI -163 to -3; p = 0.04). Among 18 matched controls the mean change was +5 cells/µl, 95% CI -70 to 80, p = 0.89). The decline in CD4 over the previous 6-12 months was somewhat greater in cases than controls (mean difference in change -55 cells/µl, 95% CI -151 to 39; p = 0.25). In 26 (90%) patients B symptoms had been present for a median of three months (range one-12) before diagnosis of HL. CONCLUSIONS: The CD4 count decline in the 12 months prior to diagnosis of Hodgkin lymphoma among HIV-infected individuals with VL<50 copies/ml on cART was not significantly different from that seen in other fully virologically suppressed individuals in receipt of cART and who did not develop HL. All those who developed HL had B symptoms and/or new palpable lymphadenopathy, suggesting that CD4 count monitoring if performed less frequently, or not at all, among those virologically suppressed individuals with CD4 counts >350 may not have delayed diagnosis.

Measuring DNA repair incision activity of mouse tissue extracts towards singlet oxygen-induced DNA damage: a comet-based in vitro repair assay.

During the past two decades, the comet-based in vitro DNA repair assay has been used regularly to measure base excision repair (BER)-related DNA incision activity. Most studies focus on the assessment of BER in human lymphocytes or cultured cells by estimating the activity of a cell extract on substrate DNA containing specific lesions such as 8-oxoguanine. However, for many 'real-life' studies, it would be preferable to measure BER in the tissues of interest instead of using in vitro models or surrogate 'tissues' such as lymphocytes. Various attempts have been made to use the comet-based repair assay for BER with extracts from rodent tissues, but high non-specific nuclease activity in such tissues were a significant impediment to robust estimates of BER. Our aim in this study was to optimise the in vitro repair assay for BER for use with rodent tissues using extracts from liver and brain from C57/BL mice. Because the DNA incision activity of an extract is dependent on its protein concentration, the first optimisation step in preventing interference by non-specific nuclease activity was to determine the protein concentration at which there is a maximal difference between the total and non-specific damage recognition. This protein concentration was 5 mg/ml for mouse liver extracts and 1 mg/ml for brain extracts. Next, we tested addition of proteinase inhibitors during the preparation of the tissue extracts, but this did not improve the sensitivity of the assay. However, addition of 1.5 µM aphidicolin to the tissue extracts improved the detection of DNA repair incision activity by reducing non-specific nuclease activity and possibly by blocking residual DNA polymerase activity. Finally, the assay was tested on tissue samples from an ageing mouse colony and in mice undergoing dietary restriction and proved capable of detecting significant inter-animal differences and nutritional effects on BER-related DNA incision activity.