Prevalence of Cardiac Amyloidosis in Patients with Carpal Tunnel Syndrome.

Carpal tunnel syndrome (CTS) is a common finding among patients with cardiac amyloidosis. We sought to determine the prevalence of cardiac amyloidosis in patients who had undergone CTS surgery. From 2005 to 2014, 308 patients ≥ 60 years underwent CTS surgery. Of these, 233 (76%) agreed to participate in the study and 101 (73 ± 8 years; 68% females) showed left ventricular hypertrophy (LVH) ≥ 12 mm and underwent additional studies to diagnose AL and ATTR amyloidosis. Based on complementary studies, three patients were diagnosed with cardiac amyloidosis (two wild-type ATTR and one AL). The three patients showed bilateral CTS with no occupational risk factors. Prevalence of cardiac amyloidosis in the overall cohort was only 1.2% (3/233), but among patients with LVH and bilateral CTS, the prevalence was 5.5% (3/55) and 13.6% (3/22) if cases with an occupational risk factor were excluded. Cardiac amyloidosis should be excluded in the presence of bilateral CTS and particularly if an occupational risk factor is absent.

A Multicentric, Open-Label, Randomized, Comparative Clinical Trial of Two Different Doses of Expanded hBM-MSCs Plus Biomaterial versus Iliac Crest Autograft, for Bone Healing in Nonunions after Long Bone Fractures: Study Protocol.

ORTHOUNION is a multicentre, open, comparative, three-arm, randomized clinical trial (EudraCT number 2015-000431-32) to compare the efficacy, at one and two years, of autologous human bone marrow-derived expanded mesenchymal stromal cell (hBM-MSC) treatments versus iliac crest autograft (ICA) to enhance bone healing in patients with diaphyseal and/or metaphysodiaphyseal fracture (femur, tibia, and humerus) status of atrophic or oligotrophic nonunion (more than 9 months after the acute fracture, including recalcitrant cases after failed treatments). The primary objective is to determine if the treatment with hBM-MSCs combined with biomaterial is superior to ICA in obtaining bone healing. If confirmed, a secondary objective is set to determine if the dose of 100 × 106 hBM-MSCs is noninferior to that of 200 × 106 hBM-MSCs. The participants (n = 108) will be randomly assigned to either the experimental low dose (n = 36), the experimental high dose (n = 36), or the comparator arm (n = 36) using a central randomization service. The trial will be conducted in 20 clinical centres in Spain, France, Germany, and Italy under the same clinical protocol. The confirmation of superiority for the proposed ATMP in nonunions may foster the future of bone regenerative medicine in this indication. On the contrary, absence of superiority may underline its limitations in clinical use.

The influence of maxillary incisor torque on the esthetic perception of the smile.

PURPOSE: An esthetically pleasing smile is one of our patients' main goals. However, it is not always clear that the esthetic perceptions of patients and clinicians are the same. The purpose of this study was to evaluate and quantify the discrepancies in the esthetic perception of maxillary incisor torque among professionals, and between professionals and the general public. MATERIALS AND METHODS: A photograph of a 30-year-old woman was digitally manipulated to obtain nine smile images and nine full-profile images with various maxillary incisor torques, while maintaining the overjet. The images were evaluated in an online survey by three different groups: laypersons (LP, n = 21), orthodontists (OR, n = 20), and specialists in dental esthetics (SDE, n = 19). RESULTS: From among the smile images, the LP group preferred the 80-degree option (the angle that forms the tangent between the crown of the maxillary incisor and the functional occlusal plane), the SDE group preferred the 75-degree option, and the OR group preferred the 70-degree option. From among the full-profile images, both the LP and the SDE groups preferred the 80-degree option, while the OR group preferred the 75-degree option. To analyze the data and verify or reject the hypotheses of normality and homoscedasticity, ANOVA and Kruskal-Wallis tests were used. CONCLUSIONS: The LP and SDE groups coincided, in contrast to the OR group, which preferred more protrusive torques and was less tolerant of retroclined maxillary incisors.

Extra-articular lateral tenodesis for anterior cruciate ligament deficient knee: a case report.

We present the case of an extra-articular lateral tenodesis for an anterior cruciate ligament (ACL) deficient knee. A 46-year-old male patient sustained an ACL graft rupture after a motorcycle accident. He complained of rotational instability and giving-way episodes. His previous graft was fixed by an intra-articular femoral staple that was not possible to remove at the time of the ACL revision. A modified Lemaire procedure was then performed. He gained rotational stability and was able to resume his sporting activities. We believe that isolated extra-articular reconstructions may still have a role in selected indications including moderate-demand patients complaining of rotational instability after ACL graft failure.