What is the Efficacy of Intra-Articular Platelet-Rich Plasma Injections for Knee Osteoarthritis in Clinical Practice? A "Real-Life" Prospective Cohort.

INTRODUCTION: Platelet-rich plasma (PRP) injections may improve symptoms in patients suffering from knee osteoarthritis. However, there is a lack of data on its effectiveness in a "real-life" cohort. This multi-site institutional registry study aimed to assess patients' longitudinal progress after PRP injection for knee osteoarthritis. MATERIALS AND METHODS: All patients receiving PRP injections for knee osteoarthritis at a large, integrated tertiary academic center (December 18, 2017 to March 1, 2021) were eligible. A prospective data collection instrument was used to collect patient demographics, procedural information, and patient-reported outcome measures. Overall, 97 patients met the inclusion criteria, and 53 were included in the analysis. RESULTS: One in four patients (26%) improved on all three Knee Injury and Osteoarthritis Outcome Score subscales: 17% in two subscales and 20% in one subscale, respectively. Overall, 64% of patients improved in at least one patient-reported outcomes measure. At six months post injection, 49% of patients were satisfied. CONCLUSION: PRP injection provides positive changes in two out of three patients in different magnitudes and characteristics with careful attention to clinically meaningful differences.

From Invisible to Visible: Impacts of Metadata in Communicative Data Visualization.

Leaving the context of visualizations invisible can have negative impacts on understanding and transparency. While common wisdom suggests that recontextualizing visualizations with metadata (e.g., disclosing the data source or instructions for decoding the visualizations' encoding) may counter these effects, the impact remains largely unknown. To fill this gap, we conducted two experiments. In Experiment 1, we explored how chart type, topic, and user goal impacted which categories of metadata participants deemed most relevant. We presented 64 participants with four real-world visualizations. For each visualization, participants were given four goals and selected the type of metadata they most wanted from a set of 18 types. Our results indicated that participants were most interested in metadata which explained the visualization's encoding for goals related to understanding and metadata about the source of the data for assessing trustworthiness. In Experiment 2, we explored how these two types of metadata impact transparency, trustworthiness and persuasiveness, information relevance, and understanding. We asked 144 participants to explain the main message of two pairs of visualizations (one with metadata and one without); rate them on scales of transparency and relevance; and then predict the likelihood that they were selected for a presentation to policymakers. Our results suggested that visualizations with metadata were perceived as more thorough than those without metadata, but similarly relevant, accurate, clear, and complete. Additionally, we found that metadata did not impact the accuracy of the information extracted from visualizations, but may have influenced which information participants remembered as important or interesting.

Influence of Sex and Previous Concussion History on Postconcussive Recovery in Young Athletes.

OBJECTIVE: To determine whether concussed female athletes with a previous history of concussion have longer postconcussive recovery than that of male counterparts. DESIGN: Retrospective cohort study. SETTING: Outpatient sports medicine clinic in an academic practice. PARTICIPANTS: Male and female youth, high school, and collegiate athletes (n = 431; ages = 10-21 years) who sustained a sport-related concussion (SRC). INTERVENTIONS: The clinical courses of young athletes treated for concussion by 1 provider at an outpatient sports medicine clinic were retrospectively reviewed. MAIN OUTCOME MEASURES: Recovery time was compared after an SRC with relationship to sex and previous concussion history. RESULTS: When comparing male and female athletes with a previous history of concussion, there were no differences found (P = 0.820) in SRC recovery time. Regardless of previous concussion history, males recovered faster from an SRC compared with their female counterparts (P = 0.0002). Without regard to sex, those with no previous history of concussion recovered faster than those with a previous concussion history, although the difference was not statistically significant (P = 0.668). Athletes with a previous history of concussion were more likely to require neuropsychology referral than those with no previous concussion history (P = 0.021), and females, without regard to concussion history, were more likely to require neuropsychology referral than males (P = 0.001). CONCLUSIONS: A previous concussion history does not appear to significantly influence postconcussive recovery time in young athletes, although it does increase the probability of neuropsychological referral. Without regard to a previous concussion history, young female athletes recover slower than males from concussion and are also more likely to require neuropsychological referral.

Patterns and Pace: Quantifying Diverse Exploration Behavior with Visualizations on the Web.

The diverse and vibrant ecosystem of interactive visualizations on the web presents an opportunity for researchers and practitioners to observe and analyze how everyday people interact with data visualizations. However, existing metrics of visualization interaction behavior used in research do not fully reveal the breadth of peoples' open-ended explorations with visualizations. One possible way to address this challenge is to determine high-level goals for visualization interaction metrics, and infer corresponding features from user interaction data that characterize different aspects of peoples' explorations of visualizations. In this paper, we identify needs for visualization behavior measurement, and develop corresponding candidate features that can be inferred from users' interaction data. We then propose metrics that capture novel aspects of peoples' open-ended explorations, including exploration uniqueness and exploration pacing. We evaluate these metrics along with four other metrics recently proposed in visualization literature by applying them to interaction data from prior visualization studies. The results of these evaluations suggest that these new metrics 1) reveal new characteristics of peoples' use of visualizations, 2) can be used to evaluate statistical differences between visualization designs, and 3) are statistically independent of prior metrics used in visualization research. We discuss implications of these results for future studies, including the potential for applying these metrics in visualization interaction analysis, as well as emerging challenges in developing and selecting metrics depicting visualization explorations.

Mild Traumatic Brain Injury in a High School Football Player With Familial Hemiplegic Migraine: A Case Report.

Mild traumatic brain injury is a major concern in young athletes, with an estimated 1.6-3.8 million reported concussions in the United States annually. Familial hemiplegic migraine is a rare autosomal-dominant condition characterized by sporadic episodes of transient unilateral motor weakness that may begin at any age. We present a case of a 17-year-old boy with a history of familial hemiplegic migraine who suffered prolonged symptoms after a mild traumatic brain injury during sports participation. LEVEL OF EVIDENCE: V.

Selective photothermal inactivation of cells labeled with near-infrared croconaine dye.

Photothermal inactivation of cells caused by laser heating of a near-infrared croconaine dye is more effective when the dye is located inside the cell. The cell inactivation is spatially confined - laser irradiation of a mixed population of two different cell lines produces selective inactivation of the cells labeled with croconaine dye and does not harm adjacent unlabeled cells.

Preassembled Fluorescent Multivalent Probes for the Imaging of Anionic Membranes.

A new self-assembly process known as Synthavidin (synthetic avidin) technology was used to prepare targeted probes for near-infrared fluorescence imaging of anionic membranes and cell surfaces, a hallmark of many different types of disease. The probes were preassembled by threading a tetralactam macrocycle with six appended zinc-dipicolylamine (ZnDPA) targeting units onto a linear scaffold with one or two squaraine docking stations to produce hexavalent or dodecavalent fluorescent probes. A series of liposome titration experiments showed that multivalency promoted stronger membrane binding by the dodecavalent probe. In addition, the dodecavalent probe exhibited turn-on fluorescence due to probe unfolding during fluorescence microscopy at the membrane surface. However, the dodecavalent probe also had a higher tendency to self-aggregate after membrane binding, leading to probe self-quenching under certain conditions. This self-quenching effect was apparent during fluorescence microscopy experiments that recorded low fluorescence intensity from anionic dead and dying mammalian cells that were saturated with the dodecavalent probe. Conversely, probe self-quenching was not a factor with anionic microbial surfaces, where there was intense fluorescence staining by the dodecavalent probe. A successful set of rat tumor imaging experiments confirmed that the preassembled probes have sufficient mechanical stability for effective in vivo imaging. The results demonstrate the feasibility of this general class of preassembled fluorescent probes for multivalent targeting, but fluorescence imaging performance depends on the specific physical attributes of the biomarker target, such as the spatial distance between different copies of the biomarker and the propensity of the probe-biomarker complex to self-aggregate.

HindSight: Encouraging Exploration through Direct Encoding of Personal Interaction History.

Physical and digital objects often leave markers of our use. Website links turn purple after we visit them, for example, showing us information we have yet to explore. These "footprints" of interaction offer substantial benefits in information saturated environments - they enable us to easily revisit old information, systematically explore new information, and quickly resume tasks after interruption. While applying these design principles have been successful in HCI contexts, direct encodings of personal interaction history have received scarce attention in data visualization. One reason is that there is little guidance for integrating history into visualizations where many visual channels are already occupied by data. More importantly, there is not firm evidence that making users aware of their interaction history results in benefits with regards to exploration or insights. Following these observations, we propose HindSight - an umbrella term for the design space of representing interaction history directly in existing data visualizations. In this paper, we examine the value of HindSight principles by augmenting existing visualizations with visual indicators of user interaction history (e.g. How the Recession Shaped the Economy in 255 Charts, NYTimes). In controlled experiments of over 400 participants, we found that HindSight designs generally encouraged people to visit more data and recall different insights after interaction. The results of our experiments suggest that simple additions to visualizations can make users aware of their interaction history, and that these additions significantly impact users' exploration and insights.

Advanced Ultrasound-Guided Interventions for Tendinopathy.

Tendinopathy is increasingly recognized as an important cause of musculoskeletal pain and disability. Tendinopathy is thought to be principally a degenerative process, rather than inflammatory as was traditionally believed. Consequently, traditional tendinopathy treatments focused solely on decreasing inflammation have often been ineffective or even harmful. The advancement of ultrasonography as for guidance of outpatient musculoskeletal procedures has facilitated the development of novel percutaneous procedures for the treatment of tendinopathy, mostly by using mechanical intervention to stimulate regeneration. Several of these techniques, including percutaneous needle tenotomy, percutaneous ultrasonic tenotomy, high-volume injection, and percutaneous needle scraping, are reviewed in this article.

Pre-Assembly of Near-Infrared Fluorescent Multivalent Molecular Probes for Biological Imaging.

A programmable pre-assembly method is described and shown to produce near-infrared fluorescent molecular probes with tunable multivalent binding properties. The modular assembly process threads one or two copies of a tetralactam macrocycle onto a fluorescent PEGylated squaraine scaffold containing a complementary number of docking stations. Appended to the macrocycle periphery are multiple copies of a ligand that is known to target a biomarker. The structure and high purity of each threaded complex was determined by independent spectrometric methods and also by gel electrophoresis. Especially helpful were diagnostic red-shift and energy transfer features in the absorption and fluorescence spectra. The threaded complexes were found to be effective multivalent molecular probes for fluorescence microscopy and in vivo fluorescence imaging of living subjects. Two multivalent probes were prepared and tested for targeting of bone in mice. A pre-assembled probe with 12 bone-targeting iminodiacetate ligands produced more bone accumulation than an analogous pre-assembled probe with six iminodiacetate ligands. Notably, there was no loss in probe fluorescence at the bone target site after 24 h in the living animal, indicating that the pre-assembled fluorescent probe maintained very high mechanical and chemical stability on the skeletal surface. The study shows how this versatile pre-assembly method can be used in a parallel combinatorial manner to produce libraries of near-infrared fluorescent multivalent molecular probes for different types of imaging and diagnostic applications, with incremental structural changes in the number of targeting groups, linker lengths, linker flexibility, and degree of PEGylation.

High Affinity Macrocycle Threading by a Near-Infrared Croconaine Dye with Flanking Polymer Chains.

Croconaine dyes have narrow and intense absorption bands at ∼800 nm, very weak fluorescence, and high photostabilities, which combine to make them very attractive chromophores for absorption-based imaging or laser heating technologies. The physical supramolecular properties of croconaine dyes have rarely been investigated, especially in water. This study focuses on a molecular threading process that encapsulates a croconaine dye inside a tetralactam macrocycle in organic or aqueous solvent. Macrocycle association and rate constant data are reported for a series of croconaine structures with different substituents attached to the ends of the dye. The association constants were highest in water (Ka ∼ 10(9) M(-1)), and the threading rate constants (kon) increased in the solvent order H2O > MeOH > CHCl3. Systematic variation of croconaine substituents located just outside the croconaine/macrocycle complexation interface hardly changed Ka but had a strong influence on kon. A croconaine dye with N-propyl groups at each end of the structure exhibited a desirable mixture of macrocycle threading properties; that is, there was rapid and quantitative croconaine/macrocycle complexation at relatively high concentrations in water, and no dissociation of the preassembled complex when it was diluted into a solution of fetal bovine serum, even after laser-induced photothermal heating of the solution. The combination of favorable near-infrared absorption properties and tunable mechanical stability makes threaded croconaine/macrocycle complexes very attractive as molecular probes or as supramolecular composites for various applications in absorption-based imaging or photothermal therapy.

Improving Bayesian Reasoning: The Effects of Phrasing, Visualization, and Spatial Ability.

Decades of research have repeatedly shown that people perform poorly at estimating and understanding conditional probabilities that are inherent in Bayesian reasoning problems. Yet in the medical domain, both physicians and patients make daily, life-critical judgments based on conditional probability. Although there have been a number of attempts to develop more effective ways to facilitate Bayesian reasoning, reports of these findings tend to be inconsistent and sometimes even contradictory. For instance, the reported accuracies for individuals being able to correctly estimate conditional probability range from 6% to 62%. In this work, we show that problem representation can significantly affect accuracies. By controlling the amount of information presented to the user, we demonstrate how text and visualization designs can increase overall accuracies to as high as 77%. Additionally, we found that for users with high spatial ability, our designs can further improve their accuracies to as high as 100%. By and large, our findings provide explanations for the inconsistent reports on accuracy in Bayesian reasoning tasks and show a significant improvement over existing methods. We believe that these findings can have immediate impact on risk communication in health-related fields.

Sensitive Structural Control of Macrocycle Threading by a Fluorescent Squaraine Dye Flanked by Polymer Chains.

A macrocyclic tetralactam is threaded by a complementary squaraine dye that is flanked by two polyethylene glycol chains to produce a pseudorotaxane complex with favorable near-infrared fluorescence properties. The association thermodynamics and kinetics were measured for a homologous series of squaraines with different N-alkyl substituents at both ends of the dye. The results show that subtle changes in substituent steric size have profound effects on threading kinetics without greatly altering the very high association constant.

Rapid Macrocycle Threading by a Fluorescent Dye-Polymer Conjugate in Water with Nanomolar Affinity.

A macrocyclic tetralactam host is threaded by a highly fluorescent squaraine dye that is flanked by two polyethylene glycol (PEG) chains with nanomolar dissociation constants in water. Furthermore, the rates of bimolecular association are very fast with k(on) ≈ 10(6)-10(7) M(-1) s(-1). The association is effective under cell culture conditions and produces large changes in dye optical properties including turn-on near-infrared fluorescence that can be imaged using cell microscopy. Association constants in water are ∼1000 times higher than those in organic solvents and strongly enthalpically favored at 27 °C. The threading rate is hardly affected by the length of the PEG chains that flank the squaraine dye. For example, macrocycle threading by a dye conjugate with two appended PEG2000 chains is only three times slower than threading by a conjugate with triethylene glycol chains that are 20 times shorter. The results are a promising advance toward synthetic mimics of streptavidin/biotin.

Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study.

PURPOSE: To compare the results of arthroscopic repair of large to massive rotator cuff tears (RCTs) with or without augmentation using an extracellular matrix (ECM) graft and to present ECM graft augmentation as a valuable surgical alternative used for biomechanical reinforcement in any RCT repair. METHODS: We performed a prospective, blinded, single-center, comparative study of patients who underwent arthroscopic repair of a large to massive RCT with or without augmentation with ECM graft. The primary outcome was assessed by the presence or absence of a retear of the previously repaired rotator cuff, as noted on ultrasound examination. The secondary outcomes were patient satisfaction evaluated preoperatively and postoperatively using the 12-item Short Form Health Survey, the American Shoulder and Elbow Surgeons shoulder outcome score, a visual analog scale score, the Western Ontario Rotator Cuff index, and a shoulder activity level survey. RESULTS: We enrolled 35 patients in the study: 20 in the ECM-augmented rotator cuff repair group and 15 in the control group. The follow-up period ranged from 22 to 26 months, with a mean of 24.9 months. There was a significant difference between the groups in terms of the incidence of retears: 26% (4 retears) in the control group and 10% (2 retears) in the ECM graft group (P = .0483). The mean pain level decreased from 6.9 to 4.1 in the control group and from 6.8 to 0.9 in the ECM graft group (P = .024). The American Shoulder and Elbow Surgeons score improved from 62.1 to 72.6 points in the control group and from 63.8 to 88.9 points (P = .02) in the treatment group. The mean Short Form 12 scores improved in the 2 groups, with a statistically significant difference favoring graft augmentation (P = .031), and correspondingly, the Western Ontario Rotator Cuff index scores improved in both arms, favoring the treatment group (P = .0412). CONCLUSIONS: The use of ECM for augmentation of arthroscopic repairs of large to massive RCTs reduces the incidence of retears, improves patient outcome scores, and is a viable option during complicated cases in which a significant failure rate is anticipated. LEVEL OF EVIDENCE: Level III, prospective, blinded, nonrandomized, comparative study.

Ultrasound evaluation of focal neuropathies in athletes: a clinically-focused review.

Focal neuropathies represent a rare but clinically important and potentially challenging aetiology of pain in athletes. Diagnostic ultrasound is commonly used in the evaluation of nerve entrapments, and has several advantages over other imaging modalities, including high resolution, portability, lack of ionising radiation, low cost, point-of-care access, ease of contralateral comparison and capability of Doppler and dynamic imaging techniques. In this review, we discuss the use of ultrasound for the evaluation of injuries to the brachial plexus including 'stingers,' suprascapular nerve, ulnar nerve, radial nerve, common fibular nerve, tibial nerve and interdigital nerves of the foot at selected common sites of entrapment.

Percutaneous ultrasound-guided aspiration of an anterior cruciate ligament ganglion cyst: description of technique and case presentation.

An anterior cruciate ligament ganglion cyst is an infrequent but potentially clinically significant cause of knee pain. Although the cyst may be removed surgically, percutaneous ultrasound-guided anterior cruciate ligament ganglion cyst aspiration and injection is feasible. To our knowledge, we present the first reported case description of the utilization of ultrasound guidance to perform this procedure with a successful clinical outcome.