Comparing Sex-Specific Outcomes After Medial Patellofemoral Ligament Reconstruction for Patellar Instability: A Systematic Review.

BACKGROUND: The impact of patient sex on outcomes after medial patellofemoral ligament ligament reconstruction (MPFLR) has not been well studied. PURPOSE: To conduct a systematic review to determine sex-based differences in outcomes after MPFLR for patellar instability and the proportion of studies examining this as a primary or secondary purpose. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was performed using the PubMed, Cochrane Library, PubMed Central, Ovid, and Embase databases according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they were written in English, were performed on humans, consisted of patients who underwent MPFLR with allograft or autograft, evaluated at least 1 of the selected outcomes comparing male and female patients, and had statistical analysis available for relevant findings. Excluded were case reports, review studies or systematic reviews, studies that did not evaluate at least 1 sex-specific outcome, studies that included other injuries associated with patellofemoral instability injury, cadaveric studies, and those in which patients underwent concomitant procedures. RESULTS: The initial search yielded 3470 studies; 2647 studies remained after removing duplicates. Of the 401 studies that underwent full-text review, 10 met all inclusion criteria and were included for quantitative analysis. A meta-analysis could not be performed given the heterogeneity within the data set. Of the 2647 studies evaluated in this study, only 2 (0.08%) studies examined the impact of patient sex on MPFLR outcomes as a primary purpose and only 8 (0.30%) studies explored it as a secondary purpose. CONCLUSION: Only 0.38% of the articles compared outcomes between male and female patients after MPFLR. The limited data available were too heterogenous to draw any concrete conclusions about the impact of patient sex on outcomes after MPFLR. Further research in this area is warranted, as findings may influence treatment plans and improve patient outcomes.

Symptoms of posttraumatic stress in young adult survivors of childhood cancer.

PURPOSE: This study assessed the prevalence of posttraumatic stress symptoms in young adult survivors of childhood cancer and the association of posttraumatic stress with anxiety, adjustment, perceptions of illness and treatment, and medical data extracted from oncology records. PATIENTS AND METHODS: Seventy-eight young adults (ages 18 to 40 years) who had been treated for childhood cancer completed questionnaires and psychiatric interviews assessing posttraumatic stress, anxiety, perceptions of their illness and treatment, and symptoms of psychologic distress. Data on treatment intensity and severity of medical late effects were collected via chart review. RESULTS: Of the patient sample, 20.5% met American Psychiatric Association Diagnostic and Statistical Manual criteria for posttraumatic stress disorder (PTSD) at some point since the end of their treatment. Clinically significant levels of intrusive (9%) and avoidant (16.7%) symptoms were reported. Participants also reported elevated state and trait anxiety. Participants with PTSD reported higher perceived current life threat, more intense treatment histories, and higher (and clinically significant) levels of psychologic distress than those who did not have PTSD. CONCLUSION: One-fifth of this sample of young adult survivors of childhood cancer met criteria for a diagnosis of PTSD, with clinically significant symptoms of intrusion and avoidance reported. As in other samples, PTSD in young adult survivors was associated with anxiety and other psychologic distress. Survivors' perceptions of treatment and its effects were more highly associated with posttraumatic stress than were more objective medical data. The data suggest that cancer-related posttraumatic stress may emerge in young adulthood and may affect the achievement of developmental milestones and orientation toward health care.

Subclinical thyroid disease after radiation therapy detected by radionuclide scanning.

PURPOSE: The actuarial risk for developing benign or malignant thyroid disease following radiation therapy (RT) is controversial, but may be as high as 50% at 20 years. An effective screening modality should be specific but not overly sensitive, a limitation of ultrasound. We questioned whether Technetium-99 m pertechnetate ((99m)Tc TcO(4)(-)) scanning could detect clinically significant disease in ostensibly disease-free cancer survivors. METHODS AND MATERIALS: Eligibility criteria included an interval of at least 5 years after RT to the cervical region, a thyroid gland that was normal to palpation, euthyroid status determined by clinical examination, free T4 and TSH. The 34 patients scanned included 16 children (<18 years old) and 18 adults at the time of RT, 16 females and 18 males. The mean age at RT was 20 years (range, 2.1-50.3 years), and the mean age at (99m)Tc TcO(4)-scanning was 33 years (range, 13.6-58 years), providing a mean interval of 13 years (range, 5.3-26.6 years). The mean RT dose to the thyroid was 36.4 Gy (range, 19.5-52.5). Thyroid scanning was performed with a 5 mCi dose of (99m)Tc TcO(4)(-) obtaining flow, immediate and delayed static, and pinhole collimator images. RESULTS: Seven patients (21.6%) had abnormal scans, and the percentage was higher among children (25%) and females (25%) compared to adults (16.7%) and males (16.7%), respectively. Two of 34 patients (5.9%) were discovered to have a thyroid cancer; histopathologies were papillary and follicular carcinoma. CONCLUSION: In this population of clinically normal cancer survivors who had been irradiated to the cervical region, subclinical thyroid disease, of potential clinical significance, was detected by (99m)Tc TcO(4)(-) in about 20%. Children may be more commonly affected. Although the cost effectiveness of screening will require a larger sample number, we propose a surveillance schema for this patient population.

Roles for the troponin tail domain in thin filament assembly and regulation. A deletional study of cardiac troponin T.

Striated muscle contraction is regulated by Ca2+ binding to troponin, which has a globular domain and an elongated tail attributable to the NH2-terminal portion of the bovine cardiac troponin T (TnT) subunit. Truncation of the bovine cardiac troponin tail was investigated using recombinant TnT fragments and subunits TnI and TnC. Progressive truncation of the troponin tail caused progressively weaker binding of troponin-tropomyosin to actin and of troponin to actin-tropomyosin. A sharp drop-off in affinity occurred with NH2-terminal deletion of 119 rather than 94 residues. Deletion of 94 residues had no effect on Ca2+-activation of the myosin subfragment 1-thin filament MgATPase rate and did not eliminate cooperative effects of Ca2+ binding. Troponin tail peptide TnT1-153 strongly promoted tropomyosin binding to actin in the absence of TnI or TnC. The results show that the anchoring function of the troponin tail involves interactions with actin as well as with tropomyosin and has comparable importance in the presence or absence of Ca2+. Residues 95-153 are particularly important for anchoring, and residues 95-119 are crucial for function or local folding. Because striated muscle regulation involves switching among the conformational states of the thin filament, regulatory significance for the troponin tail may arise from its prominent contribution to the protein-protein interactions within these conformations.

Parental presence plus oral midazolam decreases frequency of 5% halothane inductions in children.

STUDY OBJECTIVE: To determine the frequency of 5% halothane induction and behavioral distress during inhalation induction with both oral midazolam and parental presence compared with parental presence alone. DESIGN: Randomized, controlled, double blind study. SETTING: Same day anesthesia at a university department of anesthesiology. PATIENTS: 72 ASA status I and II children, 3 to 10 years of age, scheduled for first time anesthesia. INTERVENTIONS: Children were assigned to one of two groups to receive midazolam 0.5 mg/kg orally or placebo. A parent was present during induction. Children were videotaped at baseline, after treatment, and during induction. Tapes were scored for behavioral distress using the revised Observational Scale of Behavioral Distress. MEASUREMENTS AND MAIN RESULTS: Children who received midazolam in the setting of parental presence had significantly fewer 5% halothane inductions than those who received placebo (p < 0.02). They also had less behavioral distress (p < 0.01). CONCLUSIONS: The combination of parental presence plus oral midazolam reduces the likelihood of needing a 5% rapid halothane induction when compared with parental presence without premedication.

Relapse of acute lymphoblastic leukemia in the inferior rectus muscle of the eye.

BACKGROUND: Extramedullary involvement of acute lymphoblastic leukemia (ALL) in sites outside the central nervous system (CNS) or testes is rare and may signal a refractory form of leukemia. METHODS: The authors describe a child with ALL who experienced a relapse involving the inferior rectus muscle of the eye. This patient had been treated with a bone marrow transplant for previous bone marrow and ovarian relapse. RESULTS: The patients had a pre-B ALL with a t(1;19) chromosomal translocation and previously had experienced relapse during therapy. At the time of the muscle relapse, she had pancreatomegaly consistent with leukemic infiltration but no CNS or bone marrow disease. CONCLUSIONS: Relapse of ALL in unusual sites may indicate disease that is particularly difficult to eradicate. Factors in addition to age and leukocyte count at diagnosis determined risk. Additional research is needed to define these factors and develop more effective therapy.

The effects of 10% methohexital on the rectal mucosa in mice.

The effects of 10% methohexital (pH 10 and osmolarity 820) on the mucosal lining of the mouse rectum was examined after transrectal instillation and application to a rectal mucosal pouch. In addition to 10% methohexital, control solutions of pH 4, 7, 12, and osmolarities of 823 mOsm/1, 1027 mOsm/1, and 1372 mOsm/1 were also applied to the rectal pouch. Using a lesion index scoring system for grading macroscopic and microscopic changes in the rectal pouch 10% methohexital produced a superficial mucosal lesion of significantly higher severity score than that produced by control and solutions of varying pH or osmolarities. The methohexital-induced rectal mucosal lesion had its onset within minutes of drug application to the mucosal lining, appeared to mature by 60 min and left minimal effects 24 h after mucosal contact. The lesion appeared to be due to the methohexital itself and not secondary to the alkalinity or hyperosmolarity. In summary, the authors' data in mice supports an extensive 20-yr clinical experience that 10% rectal methohexital, despite inducing a transient mucosal lesion, is free of long-term serious complication related to this lesion.