Associations between cartilage proteoglycan density and patient outcomes 12months following anterior cruciate ligament reconstruction.

BACKGROUND: Lower proteoglycan density (PGD) of the articular cartilage may be an early marker of osteoarthritis following anterior cruciate ligament (ACL) reconstruction (ACL-R). The purpose this study was to determine associations between the Knee Injury and Osteoarthritis Outcomes Score (KOOS) and PGD of the articular cartilage in the femur and tibia 12-months following ACL-R. METHODS: We evaluated KOOS pain, symptoms, function in activities of daily living (ADL), function in sport and recreation (Sport), and quality of life (QOL), as well as PGD using T1rho magnetic resonance imaging in 18 individuals 12.50±0.70months (these are all mean±standard deviation) following unilateral ACL-R (10 females, eight males; 22.39±4.19years; Marx Score=10.93±3.33). Medial and lateral load-bearing portions of the femoral and tibial condyles were sectioned into three (anterior, central and posterior) regions of interest (ROIs). T1rho relaxation times in the ACL-R knee were normalized to the same regions of interest in the non-surgical knees. Alpha levels were set at P≤0.05. RESULTS: Worse KOOS outcomes were significantly associated with greater T1rho relaxation time ratios in the posterior-lateral femoral condyle [pain (r=-0.54), ADL (r=-0.56), Sport (r=-0.62) and QOL (r=-0.59)] central-lateral femoral condyle [Sport (r=-0.48) and QOL (r=-0.42)], and the anterior-medial femoral condyle [Sport (r=-0.46) and QOL (r=-0.40)]. There were no significant associations between the KOOS and T1rho outcomes for tibial ROI. CONCLUSIONS: Lower PGD of the femoral cartilage in the ACL-R knees was associated with worse patient-reported outcomes.

Late-Onset Alzheimer's Disease Polygenic Risk Profile Score Predicts Hippocampal Function.

BACKGROUND: We explored the cumulative effect of several late-onset Alzheimer's disease (LOAD) risk loci using a polygenic risk profile score (RPS) approach on measures of hippocampal function, cognition, and brain morphometry. METHODS: In a sample of 231 healthy control subjects (19-55 years of age), we used an RPS to study the effect of several LOAD risk loci reported in a recent meta-analysis on hippocampal function (determined by its engagement with blood oxygen level-dependent functional magnetic resonance imaging during episodic memory) and several cognitive metrics. We also studied effects on brain morphometry in an overlapping sample of 280 subjects. RESULTS: There was almost no significant association of LOAD-RPS with cognitive or morphometric measures. However, there was a significant negative relationship between LOAD-RPS and hippocampal function (familywise error [small volume correction-hippocampal region of interest] p < .05). There were also similar associations for risk score based on APOE haplotype, and for a combined LOAD-RPS + APOE haplotype risk profile score (p < .05 familywise error [small volume correction-hippocampal region of interest]). Of the 29 individual single nucleotide polymorphisms used in calculating LOAD-RPS, variants in CLU, PICALM, BCL3, PVRL2, and RELB showed strong effects (p < .05 familywise error [small volume correction-hippocampal region of interest]) on hippocampal function, though none survived further correction for the number of single nucleotide polymorphisms tested. CONCLUSIONS: There is a cumulative deleterious effect of LOAD risk genes on hippocampal function even in healthy volunteers. The effect of LOAD-RPS on hippocampal function in the relative absence of any effect on cognitive and morphometric measures is consistent with the reported temporal characteristics of LOAD biomarkers with the earlier manifestation of synaptic dysfunction before morphometric and cognitive changes.

Does Screw Configuration or Fibular Osteotomy Decrease Healing Time in Exchange Tibial Nailing?

OBJECTIVES: This multicenter study was designed to evaluate whether tibia fracture nonunions treated with exchange nailing proceed to union faster with dynamically- versus statically-locked nails, or with fibular osteotomy versus no fibular osteotomy. DESIGN: Retrospective, chart-review, multicenter study. SETTING: Multicenter review of 6 level 1 trauma centers. PATIENTS/PARTICIPANTS: Patients who had a tibia fracture treated with an intramedullary nail that progressed to nonunion, and were subsequently treated with exchange nailing, were identified. All patients that met inclusion criteria and subsequently progressed to union were included in the study. INTERVENTION: Patients underwent tibial exchange nailing to repair nonunions, with screws in either a dynamically- or statically-locked configuration with or without fibular osteotomy. MAIN OUTCOME MEASURES: The primary outcome measure was a comparison of time to healing of tibial nonunion comparing different screw configurations and fibular osteotomy. RESULTS: Fifty-two patients underwent an exchange nail procedure and their outcomes were used for the primary analysis. Patients with dynamically-locked nails proceeded to union 7.9 months after revision surgery compared with 7.3 months for those with statically-locked nails, but this was not statistically significant (P = 0.68). Patients with fibular osteotomy proceeded to union 2.9 months faster than those without fibular osteotomy, and this trended toward significance (P = 0.067). Obese patients healed on average 8.8 months after surgery compared with 6.8 months for nonobese patients (P = 0.27). Closed fractures healed after 6.4 months compared with 7.7 months for open fractures (P = 0.40). CONCLUSIONS: There was no significant difference in time to union between patients who had a dynamic screw configuration compared with a static screw configuration for their exchange nail. Patients who underwent fibular osteotomy proceeded to union faster than those without an osteotomy. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Complementary and alternative medicine use among cancer survivors: a population-based study.

INTRODUCTION: The use of complementary and alternative medicine (CAM) among cancer survivors is high, yet less is known about reasons behind such use or the communication of CAM with conventional medical providers. METHODS: Cross-sectional, multivariate logistic regression models were developed to evaluate the similarities and differences between cancer survivors and non-cancer controls in the 2007 National Health Interview Survey with 23,393 participants, including 1,471 cancer survivors. RESULTS: Among cancer survivors, 66.5% reported ever using CAM and 43.3% having used CAM in the past year. When compared with the general population, cancer survivors used CAM more often for general disease prevention, immune enhancement, and for pain (Adjusted Odds Ratio [AOR] 1.27, 95% Confidence Interval [CI] 1.10-1.48; AOR 1.32, 95% CI 1.05-1.62; AOR 1.42, 95% CI 1.05-1.92, respectively). Cancer survivors were more likely to use CAM because of recommendations from their provider (AOR 1.54, 95% CI 1.26-1.88) and were more likely to disclose their CAM use to their provider (AOR 1.45, 95% CI 1.22-1.72). DISCUSSIONS/CONCLUSIONS: When compared to the general population, cancer survivors were more likely to use CAM and communicate this use with providers, indicating a growing integration of CAM in conventional medical care. IMPLICATIONS FOR CANCER SURVIVORS: Cancer survivors are more likely than the general population to communicate CAM use with providers, suggesting greater integration of CAM use in conventional care. However, the majority of CAM use is still not being communicated to providers, indicating an important area for improvement in patient-centered care.