Clinical Outcomes of Superior Capsular Reconstruction for Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft and Autograft Fascia Lata.

PURPOSE: To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. RESULTS: A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted mean follow-up of 36.9 months (range 12 to 60). Visual analogue scale (VAS) pain scores decreased from 4.0 to 6.9 mm preoperatively to 0 to 2.5 mm postoperatively. American Shoulder & Elbow Surgeons score increased from 20.3 to 54.5 preoperatively to 73.7 to 97.0 postoperatively. Forward flexion increased from 27.0° to 142.7° preoperatively to 134.5° to 167.0° postoperatively. External rotation increased from 13.2° to 41.0° preoperatively to 30.0° to 59.0° postoperatively. Acromiohumeral distance increased from 3.4 to 7.1 mm preoperatively to 6.0 to 9.7 mm postoperatively. The total rates of complications, graft failure, and revision surgery were 5.6%, 13.9%, and 6.9%, respectively. CONCLUSIONS: Irrespective of tissue source, SCR serves as a reasonable joint-preserving option for massive, irreparable rotator cuff tears, with favorable short- to midterm improvements in patient-reported outcomes and range of motion. LEVEL OF EVIDENCE: IV, systematic review of level III and IV studies.

The Development and Implementation of a Multi-Couple Therapy Model with Torture Survivors in the Democratic Republic of the Congo.

In this article, we present development and feasibility of implementation of a multi-couple group for use with torture-surviving couples. The model was developed in the Democratic Republic of the Congo in a community that experienced widespread torture during the wars from 1998 to 2004. The Torture-Surviving Couple Group model is a short-term intervention designed to use few human resources to address relational difficulties resulting from exposure to traumatic stressors. The model was guided by critical and feminist epistemologies and employed an ecological lens to incorporate neurobiology and attachment processes along with narrative therapy techniques. An existing multi-couple group model for addressing violence (Stith, Rosen, McCollum, & Thomsen, ), and a stage model for healing trauma (Herman, ) also informed the structural development of the Torture-Surviving Couple Group model. Couple groups were conducted using a 10-session program with 13 couples who met weekly. Session themes were incorporated into four phases emphasizing: (a) preparation; (b) safety and stabilization; (c) processing the relationship effects of trauma and grief; and (d) reintegration and rebuilding couple and family life. Couples reported and showed remarkable progress in their relationships after participating in the groups. Clinical and research implications and discussed along with the feasibility of developing and testing the model in a post-conflict low income setting.

Cannabinoids: Medical implications.

Herbal cannabis has been used for thousands of years for medical purposes. With elucidation of the chemical structures of tetrahydrocannabinol (THC) and cannabidiol (CBD) and with discovery of the human endocannabinoid system, the medical usefulness of cannabinoids has been more intensively explored. While more randomized clinical trials are needed for some medical conditions, other medical disorders, like chronic cancer and neuropathic pain and certain symptoms of multiple sclerosis, have substantial evidence supporting cannabinoid efficacy. While herbal cannabis has not met rigorous FDA standards for medical approval, specific well-characterized cannabinoids have met those standards. Where medical cannabis is legal, patients typically see a physician who "certifies" that a benefit may result. Physicians must consider important patient selection criteria such as failure of standard medical treatment for a debilitating medical disorder. Medical cannabis patients must be informed about potential adverse effects, such as acute impairment of memory, coordination and judgment, and possible chronic effects, such as cannabis use disorder, cognitive impairment, and chronic bronchitis. In addition, social dysfunction may result at work/school, and there is increased possibility of motor vehicle accidents. Novel ways to manipulate the endocannbinoid system are being explored to maximize benefits of cannabinoid therapy and lessen possible harmful effects.

A better understanding of lymphatic drainage of the prostate with modern imaging and surgical techniques.

PURPOSE: In prostate cancer, the spread of cancer to the lymph nodes is often determined by sampling lymph nodes from the obturator region. Historical findings from this area are often used as the basis for calculating the risk of lymph node metastasis in patients with prostate cancer. Therefore, it is of utmost importance to determine whether this sampling is a realistic representation of actual risk of lymphatic spread. This is important for risk assessment as well as for targeting lymphatics in treatment. MATERIALS AND METHODS: We attempted to reconcile historical anatomic descriptions with contemporary imaging and surgical experience to try to obtain an accurate description of the lymphatic drainage of the prostate. RESULTS AND CONCLUSIONS: Although obturator lymph nodes are clearly one of the possible sites of spread of prostate cancer, their sampling was never intended to be a definitive description of the routes of lymphatic cancer or the absolute incidence of lymph node metastasis. There are multiple other lymphatic areas at risk, with drainage primarily from the periprostatic area to the deep branches of the internal iliac lymphatics. The subsequent spread is to the perirectal and lower sacral vessel lymphatics, the proximal external iliac, the obturator, the upper sacral, common iliacs, and, ultimately, the para-aortic lymphatics. Describing the risk of lymphatic spread of prostate cancer based on obturator lymph node dissection alone is not totally accurate and probably underestimates the actual risk by 50% or more. A better understanding of the routes of drainage should make therapy that targets the lymphatics more effective.

Factors controlling the stability of a kinetically hindered lamellar-lamellar transition.

We show that we can manipulate the stability of a metastable gel phase, either to enhance its transitory nature or to "lock" it in. Using simple additives such as salt and fatty alcohol we were able to examine both the long-range effect, acting between charged bilayers, and short-range effects on the metastability. We found that the addition of salt to the cationic surfactant diethanolamine ester dimethyl ammonium chloride destabilized the gel phase, and at high concentrations it was able to decrease the length of time taken for the gel phase to revert to a hydrated solid "coagel" phase by an order of magnitude. The growth of the coagel phase was also found to be affected by increasing salt concentration, changing from needle-like (1D) to spherical growth. In contrast to the marked destabilization of the gel phase by salt, the addition of 1-octadecanol was found to prolong the lifetime of the gel phase almost indefinitely by disrupting the short-range packing between the surfactant molecules. This suggests that counterion binding plays a major role in the stability of metastable lamellar gel phases.

The lyotropic phase behaviour of ester quaternary surfactants.

The lyotropic phase behaviour of two analogues of dioctadecyl dimethylammonium chloride was investigated. Both the inclusion of ester groups and subsequent minor structural rearrangement of the interfacial region of the surfactant were found to increase the chain melting temperature, although the overall phase behaviour remained similar for both compounds. Both of the two analogues were found to underswell, due to the formation of multi-lamellar vesicles. We also found that the inclusion of these ester linkages substantially reduced the metastability of the 'gel phase' in which the surfactants usually reside, accelerating the rate of collapse to a coagel state. This occurred via a nucleation-growth mechanism, where the growth was found to be one-dimensional, i.e. needle-like.

Polyethylene wear and osteolysis with a new modular titanium acetabular component: results at 7 to 13 years.

The first-generation and second-generation modular titanium fiber-metal acetabular components were notable for high rates of pelvic osteolysis and liner dislodgment. This is a prospective, consecutive study of 111 new modular titanium-fiber metal acetabular components with a novel polyethylene locking mechanism at a mean follow-up of 9.5 years (range, 7-13 years). The polyethylene was gamma-irradiated in air in 58 hips and gamma-irradiated in nitrogen in 54 hips. No acetabular component migrated, none were revised, and there was no liner dislodgment. Pelvic osteolysis was seen in only 2 hips. The mean linear wear rate was 0.085 mm/y (range, 0.001-0.3 mm/y). There was a significantly lower rate of wear with polyethylene liners sterilized by gamma-irradiation in nitrogen (P = .0001). The high rate of success and low rate of polyethylene wear and pelvic osteolysis at this length of follow-up may be related to the new design features of this modular acetabular component.

Delayed presentation of ipsilateral femoral neck fractures in diaphyseal femur fractures.

Femoral neck fractures with delayed presentation following ipsilateral femoral diaphyseal fracture stabilization have been described as clandestine, attributed to missed diagnosis, or related to surgical technique. Clandestine fractures are present from time of injury but not detectable. The authors hypothesize that femoral neck fractures with delayed presentation can be clandestine, missed, or caused by surgical technique. A retrospective study and a comprehensive literature review are presented to determine the true incidence and etiology of these fractures.

The role of metabolites in bioequivalence.

The role of metabolites in bioequivalence studies has been a contentious issue for many years. Many papers have published recommendations for the use of metabolite data based on anecdotal evidence from the results of bioequivalence studies. Such anecdotal evidence has validity, but the arguments lack weight because the "correct" answers are always unknown. A more promising area of exploration is recommendations based on simulated bioequivalence studies for which the "correct" answers are known, given the assumptions. A review of the literature, however, reveals scant evidence of attempts to apply to real data the pharmacokinetic principles on which the recommendations from simulated studies relied. We therefore applied those principles (based on estimates of intrinsic clearance after oral administration of the parent drug) to four bioequivalence studies from our archives, in which the parent drug and at least one metabolite were monitored. In each case, the outcome is discussed in the context of the complexity of the metabolic processes that impact on the parent drug and the metabolite(s) during the first passage from the intestinal lumen to the systemic circulation. Our observation is that no simple generalization can be made such that each drug/metabolite combination must be examined individually. Our recommendation, however, is that in the interests of safety, bioequivalence decision-making should be based on the parent drug whenever possible.

Anesthesia during and after exposure to microgravity.

Human spaceflight has evolved over the past 40 yr in pursuit of larger, more complex, and more distant missions. As this evolution continues, inevitably a spaceflight crewmember will require medical treatment involving anesthesia, either during flight or immediately upon return. If the need occurs during a deep space mission, onboard medical staff will need to be capable of surgery and anesthesia because evacuation and telemedicine will be impractical. In addition, current anesthesia techniques and procedures will have to be adapted to meet the special problems and risks that arise in administering anesthesia in space or to microgravity-exposed patients. However, very little is known about what those adaptations will entail. While there has been some presentient research regarding airway management in microgravity suggesting the laryngeal mask airway (LMA) be used, only four articles have directly treated the topic of anesthesia care in microgravity. Many others, though, have extrapolated applications and considerations for microgravity-exposed patients from patients and conditions that offer useful adaptation parallels. Researchers have explored parallels to orthostatic intolerance adaptations and related neurological, cardiovascular, and multifactorial causes. Investigators have also focused on skeletal muscle adaptations, especially acetylcholine receptor functional changes and redistribution with disuse. These changes may influence the use of depolarizing and non-depolarizing neuromuscular blockers in microgravity-exposed patients, suggesting they be used with caution. This review surveys, assesses, and compiles the existing literature to provide a foundation of consolidated reference for future investigations.

Double C-H activation during functionalization of phenyl(methyl)ketene on iridium(I) using alkynes. synthesis of 1,4-dien-3-ones.

Under the influence of an Ir(I) metal fragment, the methyl group of phenyl(methyl)ketene undergoes two C-H activations in reacting with internal alkynes, giving metallacycles 3 in 86-94% yield. Treatment of 3 with CO liberates 1,4-dien-3-ones 5 in 81-93% yield, along with CO complex 4. A possible mechanism for the very selective double C-H activation-alkyne coupling is discussed.

Determination of clozapine, and its metabolites, N-desmethylclozapine and clozapine N-oxide in dog plasma using high-performance liquid chromatography.

Clozapine and its two major metabolites, N-desmethylclozapine and clozapine N-oxide were quantified using a high-performance liquid chromatographic method with UV detection in dog plasma following a single dose of clozapine. The analysis was performed on a 5-micrometer Hypersil CN (CPS-1; 250x4.6 mm) column. The mobile phase consisted of acetonitrile-water-1 M ammonium acetate (50:49:1, v/v/v), which was adjusted to pH 5.0 with acetic acid. The detection wavelength was 254 nm. A liquid-liquid extraction technique was used to extract clozapine and its metabolites from dog plasma. The recovery rates for clozapine, N-desmethylclozapine, and the internal standard (I.S.) were close to 100% using this method. The recovery rate for clozapine N-oxide (62-66%) was lower as expected because it is more polar. The quantitation limits for clozapine, clozapine N-oxide, and N-desmethylclozapine were 0.11, 0.05 and 0.05 microM, respectively. Intra-day reproducibility for concentrations of 0.1, 1.0 and 5.0 microM were 10.0, 4.4 and 4.2%, respectively, for N-oxide; 11.2, 4.3 and 4.9%, respectively, for N-desmethylclozapine; and 10.8, 2.2 and 4.9%, respectively, for clozapine. Inter-day reproducibility was <15% for clozapine N-oxide, <8% for N-desmethylclozapine and <19% for clozapine. This simple method was applied to determine the plasma concentration profiles of clozapine, N-desmethylclozapine and clozapine N-oxide in dog following administration of a 10 mg/kg oral dose of clozapine.

Comorbid Psychiatric Disorders and Predictors of Pain Management Program Success in Patients With Chronic Pain.

BACKGROUND: This prospective investigation assessed success rates of a pain management program for patients with and without DSM-III-R Axis I and II psychiatric disorders. METHOD: Subjects included 40 consecutive patients with chronic pain who were referred to a physical therapy-oriented, "standard" pain management program. Serial ratings of pain levels were measured via a visual analogue scale (VAS) at baseline, weekly throughout a 12-week program, and during a follow-up interval 1 month after completion of the program. Weekly reports of hours of gainful employment were recorded. VAS scores and number of hours worked per week were combined into a measure of pain improvement. This dependent variable was used to compare groups of patients across psychiatric disorders diagnosed via the Diagnostic Interview Schedule (DIS). Percentages of patients in each diagnostic group who met minimal criteria for improvement were computed and compared. A chi-square analysis was conducted on success rates between patients with and without any Axis I disorder, any Axis II disorder, and any substance abuse/dependence disorder. RESULTS: Overall, 70% of patients (N = 28) were found to have a DIS psychiatric disorder. There were differences in improvement between patients with and without Axis I disorders and between those with and without Axis II disorders. The presence of a diagnosis was associated with significantly lower improvement rates (p <.05). CONCLUSION: Patients with chronic pain enrolled in this clinic had a high prevalence of comorbid psychiatric disorders, and these comorbid patients were less likely to improve with standard chronic pain treatment. In a population of patients seeking treatment for chronic pain, these results suggest a need for detection and diagnosis of psychiatric disorders and further research on the efficacy of psychiatric treatment interventions in chronic pain management.

H(2)GaN(3) and Derivatives: A Facile Method to Gallium Nitride.

We describe the formation and properties of H(2)GaN(3) (1), which is a very simple and stable molecular source for chemical vapor deposition (CVD) of GaN heterostructures. Compound 1 and the perdeuterated analogue D(2)GaN(3) (2) are prepared by the LiGaH(4) and LiGaD(4) reduction of Br(2)GaN(3) (3), respectively. Compound 3 is obtained from the thermal decomposition of the crystalline adduct SiMe(3)N(3).GaBr(3) (4) via loss of SiMe(3)Br. A single-crystal X-ray structure of 4 reveals that the molecule is essentially a Lewis acid-base complex between SiMe(3)N(3) and GaBr(3) and crystallizes in the orthorhombic space group Pna2(1), with a = 14.907(5) Å, b = 7.759(3) Å, c = 10.789(5) Å, V = 1248(1) Å,(3) and Z = 4. The new azidobromogallane HBrGaN(3) (5) is also prepared by reaction of appropriate amounts of 3 and LiGaH(4). Both H(2)GaN(3) (1) and D(2)GaN(3) (2) are volatile species at room temperature and can be readily distilled at 40 degrees C (0.20 Torr) without decomposition. Normal-mode analysis and ab initio theoretical calculations suggest that the vapor phase IR spectra of 1 and 2 are consistent with a trimeric (H(2)GaN(3))(3) and (D(2)GaN(3))(3) molecular structure of C(3)(v)() symmetry. On the basis of the mass spectrum, 1 is a trimer in the vapor phase and decomposes readily at low temperatures by elimination of only H(2) and N(2) to yield pure and highly stoichiometric GaN thin films. Crucial advantages of this new and potentially practical CVD method are the significant vapor pressure of the precursor that permits rapid mass transport at 22 degrees C and the facile decomposition pathway that allows film growth at temperatures as low as 200 degrees C with considerable growth rates up to 800 Å/min.

Synthesis and Structure of a Novel Lewis Acid-Base Adduct, (H(3)C)(3)SiN(3).GaCl(3), en Route to Cl(2)GaN(3) and Its Derivatives: Inorganic Precursors to Heteroepitaxial GaN.

The formation of a novel Lewis acid-base complex between the silyl azide Si(CH(3))(3)N(3) and GaCl(3) having the formula (H(3)C)(3)SiN(3).GaCl(3)()()(1) is demonstrated. The X-ray crystal structure of 1 shows that the electron-donating site is the nitrogen atom directly bonded to the organometallic group. Compound 1 crystallizes in the orthorhombic space group Pnma, with cell dimensions a = 15.823(10) Å, b = 10.010(5) Å, c = 7.403(3) Å, and Z = 4. Low-temperature decomposition of 1 via loss of (H(3)C)(3)SiCl yields Cl(2)GaN(3) (2), which serves as the first totally inorganic (C,H-free) precursor to heteroepitaxial GaN by ultrahigh-vacuum chemical vapor deposition. A volatile monomeric Lewis acid-base adduct of 2 with trimethylamine, Cl(2)GaN(3).N(CH(3))(3) (3), has also been prepared and utilized to grow high-quality GaN on Si and basal plane sapphire substrates. The valence bond model is used to analyze bond lengths in organometallic azides and related adducts.

Synthesis and Structure of the Ruthenium(II) Complexes [(eta-C(5)Me(5))Ru(NO)(bipy)](2+) and [(eta-C(5)Me(5))Ru(NO)(dppz)](2+). DNA Cleavage by an Organometallic dppz Complex (bipy = 2,2'-Bipyridine; dppz = Dipyrido[3,2-a:2',3'-c]phenazine).

The salts [(eta-C(5)Me(5))Ru(NO)(bipy)][OTf](2) (1[OTf](2)) and [(eta-C(5)Me(5))Ru(NO)(dppz)][OTf](2) (2[OTf](2)) are obtained from the treatment of (eta-C(5)Me(5))Ru(NO)(OTf)(2) with 2,2'-bipyridine (bipy) or dipyrido[3,2-a:2',3'-c]phenazine (dppz) (OTf = OSO(2)CF(3)). X-ray data for 1[OTf](2): monoclinic space group P2(1)/c, a = 11.553 (4) Å, b = 16.517 (5) Å, c = 14.719 (4) Å, beta = 94.01 (2) degrees, V = 2802 (2) Å(3), Z = 4, R1 = 0.0698. X-ray data for 2[OTf](2): monoclinic space group P2(1)/c, a = 8.911 (2) Å, b = 30.516 (5) Å, c = 24.622 (4) Å, beta = 99.02 (1) degrees, V = 6613 (2) Å(3), Z = 8, R1 = 0.0789. Both 1[OTf](2) and 2[OTf](2) are soluble in water where they exhibit irreversible electrochemical oxidation and reduction. A fluorescence-monitored titration of a DNA solution containing 2[OTf](2) with ethidium bromide provides evidence that 2(2+) intercalates into DNA with a binding constant greater than 10(6) M(-)(1). DNA cleavage occurs when the DNA solutions containing 2[OTf](2) are photolyzed or treated with H(2)O(2) or K(2)S(2)O(8).

A comparison of realised niche relations of species in New Zealand and Britain.

Many plant species prominent in the native vegetation of the dry shingle banks at Dungeness (Britain) are also prominent as exotics in the dry Upper Clutha catchment (New Zealand). To examine the realised niche relations of these species, vegetation was sampled in the two areas. Inverse classification and ordination were used to determine the relative beta niches of the species in the two areas. There was little agreement; it seems that the exotic species in the Upper Clutha were pre-adapted to different niches from those in their native range.

Alteration of Cartilage Lysosomal Enzyme Activities during Development: (acid hydrolases/cartilage development/cartilage growth/hypophysectomy).

Cartilage cathepsin D, cathepsin B and acid phosphatase activities decreased with maturation of Sprague-Dawley rats. Although this phenomenon may largely be due to an age-dependent decrease in cell concentration at young ages (1-8 weeks), in older (8-25 weeks) rats there appeared to be a decrease in enzyme activity per cell. The dimunition in cartilage cathepsin D activity coincided with an apparent decrease in its concentration. In addition, the inverse correlation between rat age and cartilage lysosomal enzyme activities was, at least in part, tissue specific as the pattern of liver lysosomal enzyme activities was quite different from that noted with cartilage. Interestingly, hypophysectomy greatly diminished age-related modulations in lysosomal enzyme activities suggesting that one or more pituitary hormones may be involved in the mechanism of this age-dependent phenomenon. In addition, cartilage growth rate appeared to be correlated with the level of cartilage lysosomal enzyme activities, indicating that these enzymes may be related to the biochemical mechanism of cartilage growth and development.