Search

ABSTRACTBackground: Military personnel and veterans are at heightened risk for exposure to traumatic events and posttraumatic stress disorder (PTSD), as well as intimate relationship problems associated with PTSD.Objective: The purpose of this study was to evaluate the relative efficacy of CBCT and PE in improving intimate relationship functioning in active duty military personnel or veterans and their intimate partners; both conditions were hypothesized to significantly improve PTSD. Method: In this study, 32 military service members or veterans with PTSD and their intimate partners were randomized to receive either Cognitive–Behavioral Conjoint Therapy for PTSD (n = 15; CBCT; [Monson, C. M., & Fredman, S. J. (2012). Cognitive-behavioral conjoint therapy for posttraumatic stress disorder: Harnessing the healing power of relationships. Guilford]), a trauma-focused couple therapy, or Prolonged Exposure (n = 17; PE; [Foa, E. B., Hembree, E. A., Dancu, C. V., Peterson, A. L., Cigrang, J. A., & Riggs, D. S. (2008). Prolonged exposure treatment for combat-related stress disorders – provider’s treatment manual [unpublished]. Department of Psychiatry, University of Pennsylvania]), a front-line evidence-based individual treatment for PTSD.Results: There were significant challenges with recruitment and a significant difference in dropout from treatment for the two therapies (65% for PE; 27% for CBCT). Treatment dropout was differentially related to pre-treatment relationship functioning; those with below average relationship functioning had higher dropout in PE compared with CBCT, whereas those with above average relationship functioning did not show differential dropout. In general, CBCT led to relational improvements, but this was not consistently found in PE. Clinician- and self-reported PTSD symptoms improved with both treatments.Conclusions: This study is the first to test a couple or family therapy against a well-established, front-line recommended treatment for PTSD, with expected superiority of CBCT over PE on relationship outcomes. Lessons learned in trial design, including considerations of equipoise, and the effects of differential dropout on trial analyses are discussed. This trial provides further support for the efficacy of CBCT in the treatment of PTSD and enhancement of intimate relationships.

For many faculty, Padlet has become an important Web 2.0 tool in face-to-face and online instruction. In this paper, faculty in the College of Business at a large private university located in the Southwestern United States examined best practices in the use of Padlet in the online classroom and explored other ways this Web tool can be used. While integrating this resource to augment classroom instruction is its primary application, we identified additional ways to engage and collaborate with Padlet and recommend using it for student resources, instructor collaboration, student collaboration, practitioner starter kits, faculty starter kits, and conference resources. We also provide applications and suggestions for each.

Purpose: To evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. To qualify for study inclusion, articles were required to be published in English, use a laboratory design using either human or animal tissue, and directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique with percutaneous repair using either a locking or nonlocking suture construct. The biomechanical outcomes evaluated were displacement (millimeters) and load to failure (Newtons). Results: Twelve studies met inclusion criteria, including 234 specimens (open: 97, percutaneous locking: 73; percutaneous nonlocking: 64) that underwent primary midsubstance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (P = .240) or load to failure (P = .912) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (P = .109) between the locking and nonlocking tendon repair systems. Conclusions: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary midsubstance Achilles tendon repair. Clinical Relevance: In clinical studies, similar rerupture rates have been observed after open or percutaneous Achilles tendon repair. It may be beneficial for surgeons to understand whether biomechanical differences exist between these repair techniques.

Background: Overcompression of the distal tibiofibular syndesmosis during open reduction and internal fixation of ankle fracture may affect multidirectional flexibility of the ankle bones. Methods: Ten cadaveric lower limbs (78.3±13.0 years, 4 female, 6 male) underwent biomechanical testing in sagittal, coronal, and axial rotation with degrees of motion quantified. The intact force (100%) was the force needed to compress the syndesmosis just beyond the intact position, and overcompression was defined as 150% of the intact force. After intact testing, the anterior inferior tibiofibular ligament (AITFL), interosseus membrane (IOM), and posterior inferior tibiofibular ligament (PITFL) were sectioned and testing was repeated. The IOM and AITFL were reconstructed in sequence and tested at 100% and 150% compression. Results: Overcompression of the syndesmosis did not significantly reduce ROM of the ankle bones for any loading modality ( P > .05). IOM+AITFL reconstruction restored distal tibiofibular axial rotation to the intact condition. Axial rotation motion was significantly lower with AITFL fixation compared with IOM fixation alone ( P

BACKGROUND: Distinguishing men with aggressive from indolent prostate cancer is critical to decisions in the management of clinically localized prostate cancer. Molecular signatures of aggressive disease could help men overcome this major clinical challenge by reducing unnecessary treatment and allowing more appropriate treatment of aggressive disease. METHODS: We performed a mass spectrometry-based proteomic analysis of normal and malignant prostate tissues from 22 men who underwent surgery for prostate cancer. Prostate cancer samples included Grade Groups (3-5), with 8 patients experiencing recurrence and 14 without evidence of recurrence with a mean of 6.8 years of follow-up. To better understand the biological pathways underlying prostate cancer aggressiveness, we performed a systems biology analysis and gene enrichment analysis. Proteins that distinguished recurrent from nonrecurrent cancer were chosen for validation by immunohistochemical analysis on tissue microarrays containing samples from a larger cohort of patients with recurrent and nonrecurrent prostate cancer. RESULTS: In all, 24,037 unique peptides (false discovery rate

Objectives: Tricuspid valve surgery is associated with high rates of shock and in-hospital mortality. Early initiation of venoarterial extracorporeal membrane oxygenation after surgery may provide right ventricular support and improve survival. We evaluated mortality in patients undergoing tricuspid valve surgery based on the timing of venoarterial extracorporeal membrane oxygenation. Methods: All consecutive adult patients undergoing isolated or combined surgical tricuspid valve repair or replacement from 2010 to 2022 requiring venoarterial extracorporeal membrane oxygenation use were stratified by initiation in the operating room (Early) versus outside of the operating room (Late). Variables associated with in-hospital mortality were explored using logistic regression. Results: There were 47 patients who required venoarterial extracorporeal membrane oxygenation: 31 Early and 16 Late. Mean age was 55.6 years (standard deviation, 16.8), 25 (54.3%) were in New York Heart Association class III/IV, 30 (60.8%) had left-sided valve disease, and 11 (23.4%) had undergone prior cardiac surgery. Median left ventricular ejection fraction was 60.0% (interquartile range, 45-65), right ventricular size was moderately to severely increased in 26 patients (60.5%), and right ventricular function was moderately to severely reduced in 24 patients (51.1%). Concomitant left-sided valve surgery was performed in 25 patients (53.2%). There were no differences in baseline characteristics or invasive measurements immediately before surgery between the Early and Late groups. Venoarterial extracorporeal membrane oxygenation was initiated 194 (23.0-840.0) minutes after cardiopulmonary bypass in the Late venoarterial extracorporeal membrane oxygenation group. In-hospital mortality was 35.5% (n = 11) in the Early group versus 68.8% (n = 11) in the Late group (P = .037). Late venoarterial extracorporeal membrane oxygenation was associated with in-hospital mortality (odds ratio, 4.00; 1.10-14.50; P = .035). Conclusions: Early postoperative initiation of venoarterial extracorporeal membrane oxygenation after tricuspid valve surgery in high-risk patients may be associated with improvement in postoperative hemodynamics and in-hospital mortality.

Category: Hindfoot; Basic Sciences/Biologics Introduction/Purpose: Primary repair of mid-substance Achilles tendon rupture may be performed using an open or a percutaneous technique. Previous meta-analyses of clinical data comparing the two techniques have demonstrated mostly equivalent functional outcomes and re-rupture rates. Individual cadaveric studies have also compared the biomechanical properties of the two approaches. However, the results of these studies have been heterogeneous, and there is currently no consensus as to whether one technique may be biomechanically superior. The purpose of this meta-analysis was to evaluate the biomechanical properties of open versus percutaneous Achilles tendon repair. Methods: A systematic review of original research articles was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. To qualify for study inclusion, articles were required to be published in English, utilized a cadaveric laboratory design, and had to directly compare the biomechanical properties of open Achilles repair using a Krackow or Kessler technique versus percutaneous repair using either the PARS (Arthrex) or Achillon (Integra) tendon repair systems. Evaluated outcomes included displacement (mm), load to failure (N), and stiffness (N/m). Results: Nine studies met inclusion criteria, including 190 cadaveric specimens (open: 83, PARS: 56; Achillon: 51) that underwent primary mid-substance Achilles tendon repair. Pooled analysis demonstrated no statistically significant difference in displacement (p = 0.418; Figure 1), load to failure (p = 0.923; Figure 2), or stiffness (p = 0.195; Figure 3) between the open and percutaneous techniques. Among the percutaneous approaches, there was no difference in displacement (p = 0.109; Figure 4) between the PARS and Achillon tendon repair systems. Conclusion: The results of this study suggest that both open and percutaneous techniques are biomechanically viable approaches for primary mid-substance Achilles tendon repair. These biomechanical findings must be interpreted in the context of clinical outcomes data as well as the differing complication profiles of the two techniques to best inform the surgical decision-making process for primary mid-substance Achilles tendon repair.

Category: Trauma; Ankle Introduction/Purpose: Overtightening of the distal tibiofibular syndesmosis during open reduction and internal fixation (ORIF) of ankle fractures remains a clinical concern, and there are limited data delineating the effect of syndesmosis overcompression on subsequent range of motion of the ankle joint bones. The primary objective of the current study was to determine the effect of syndesmotic overcompression on the relative range of motion (ROM) of the tibia, fibula, and talus, and to determine the syndesmotic fixation construct that most accurately restores native motion. Methods: Ten cadaveric lower limbs were utilized (78.3±13.0 yrs, 4F; 6M). A musculoskeletal simulator at ±7.5 Nm was used to test flexibility in dorsiflexion-plantarflexion, inversion-eversion, and internal-external rotation. After intact testing, syndesmotic probes were used to arthroscopically measure the intact position of the distal tibiofibular syndesmosis. The force needed to compress the syndesmosis just beyond the intact position represented the intact force (100%), and overcompression was defined as 150% of the intact force. The anterior inferior tibiofibular ligament (AITFL), interosseus membrane (IOM), and posterior inferior tibiofibular ligament (PITFL) were then sectioned. Testing was repeated for destabilized, IOM reconstruction at 100% compression and 150% overcompression, IOM reconstruction plus AITFL fixation at 100% compression and 150% overcompression, and AITFL fixation alone. ROM data was reported as a percentage of the intact condition. Repeated measures ANOVA and Bonferroni post hoc test were performed to assess differences between conditions with p< 0.05. Results: Average force needed to compress the syndesmosis was 71.0 ± 22.2 N. There was a significant increase in distal tibiofibular ROM in internal and external rotation for all conditions compared to intact (Figure 1) (p < 0.05). In the axial plane, reconstruction of the IOM membrane did not restore the intact condition and was similar to the destabilized treatment, regardless of compression force. The addition of AITFL fixation significantly reduced distal tibiofibular motion compared to IOM reconstructions alone, but still did not approach the intact condition. Overcompression of the syndesmosis did not significantly affect relative ROM of the ankle bones in any plane (p>0.05). Changes in the proximal tibiofibular ROM were similar in magnitude and direction as the distal tibiofibular ROM for all conditions. Conclusion: In the current study, overcompression of the distal tibiofibular syndesmosis did not restrict relative ROM of the tibia, fibula, or talus. Reconstructing the AITFL in addition to the IOM decreased tibiofibular ROM, particularly in the axial plane. In the clinical setting, surgical reconstruction with dynamic fixation of the distal tibiofibular syndesmosis may result in increased ROM and mechanical stress at the proximal tibiofibular articulation.

Category: Ankle; Other Introduction/Purpose: Peroneus brevis (PB) tendon tears are an important cause of lateral ankle pain. When PB tears are irreparable, allograft reconstruction maintains native anatomy and avoids the morbidity of tenodesis and tendon transfer procedures. Current data on allograft PB reconstruction is limited to small case series. We sought to retrospectively determine the clinical outcomes and complications in a large series of patients who underwent PB tendon reconstruction with semitendinosus allograft. Methods: After institutional review board approval, patients with PB tears who underwent tendon reconstruction with semitendinosus allograft at a single tertiary center between March 2010 and January 2020 were retrospectively reviewed. Hospital records, preoperative and postoperative visual analog pain scale (VAS), and complications were evaluated. A phone survey was conducted to assess postoperative work status, use of assistive devices, satisfaction, and patient-reported outcomes (PROMIS scores). Results: Sixty-eight patients (69 feet) (24 men,44 women) were identified. Mean age at surgery was 51.7 years (range, 23.0-74.0) and mean follow-up was 20.4 months (range, 3.4-71.4). VAS pain scale improved postoperatively (4.0±2.7 vs 2.4±2.8, p=0.0012). Most common complication was sural neuralgia in 18 (26.1%) feet, but only 2 (11%) required surgery. The allograft failed in 7 (10.1%) feet (Table 1).Of 29 (42.6%) patients available for survey, 25 (86.2%) were employed preoperatively, of whom 23 (92.0%) returned to work. Of the 29 survey patients, 25 (86.2%) did not use an assistive device, 20 (69.0%) reported being satisfied, and average T-scores for physical function and pain interference were 49.5±9.7 and 50.8±9.7, respectively. Revision PB surgery (30 [43%] feet) was not associated with sural neuralgia or patient satisfaction. Conclusion: This study demonstrated a relatively high rate of postoperative transient sural neuralgia after PB reconstruction with semitendinosus allograft, but the rate of reoperation for this complication was low. Among the subgroup of patients who completed a phone survey, there was a high rate of return to work, low rate of assistive device use, and good patient satisfaction after the procedure. These findings suggest that allograft reconstruction is a clinically effective treatment for irreparable PB tendon tears when few other options exist.

A study of faculty views about General Education requirements, paired with a review of faculty syllabi, revealed concerns about communication of General Education goals to students. Syllabi reviewed were those for courses meeting the Natural Sciences General Education requirement. At our institution, students demonstrate Natural Science competency with work from various science courses that is deposited in an electronic portfolio. Electronic portfolios are evaluated systematically as part of the university General Education assessment plan. We explore possible reasons for gaps in faculty communication about the Natural Science competency requirement, including issues such as institution type and faculty desire for autonomy. Factors that contribute to the creation of successful syllabi are also reviewed, and we discuss how these factors could be employed to better communicate General Education requirements to students.

Alkaliweed (Cressa truxillensis) is a native perennial plant of the western USA and in California, they are found primarily in saline and alkaline soils. Lately, it has been observed in Central Valley pistachio, olive, and almond orchards as a problematic species. Very little information is available on the effect of environmental factors on germination, shade tolerance, and the response of this species to herbicides. Therefore, studies were conducted to assess the effect of environmental factors (water potential, salinity, and pH) on seed germination, the influence of shade (30% shade 70% shade, and no shade) on aboveground growth, and the response of alkaliweed to common registered post-emergent herbicides. Results showed that the seeds were moderately tolerant to drought but highly adapted to salinity and pH as germination occurred up to an electrical conductivity level of 20 dS m−1 and pH range of 5 to 9. Both shade levels reduced aboveground growth and formation of reproductive structures. None of the postemergence herbicides provided adequate control of the plants. Therefore, an integrated management plan needs to be developed for alkaliweed control in Central Valley orchards.