RESUMEN
Few studies have compared outcomes between autografts versus hybrid grafts (combination of autograft and allograft) for anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare revision rate and patient-reported outcomes following primary ACLR with a hamstring autograft versus a preoperatively planned hybrid autograft-allograft. At a minimum 2-year follow-up, patients who had undergone primary ACLR with a double-stranded semitendinosus and gracilis hamstring autograft (A) or a planned hybrid (H) graft (single-strand semitendinosus with nonirradiated peroneus longus or tibialis posterior allograft) were contacted to fill out a survey containing the Knee Injury and Osteoarthritis Outcome Score (KOOS), Subjective International Knee Documentation Committee (IKDC) score, Single Assessment Numeric Evaluation (SANE), 12-Item Short-Form Health Survey (SF-12), and visual analog scale (VAS) for activity level prior to injury and at follow-up. From this collection of patients, a matched-pair comparison was made between groups, with patients matched by gender, age at the time of surgery, and follow-up time. Revision rate at follow-up was 8.4 and 2.4% in the A and H groups, respectively (p = 0.073). A total of 148 surveys were completed (83 A, 65 H), from which 36 matched pairs were formed. Within the matched pairs, average age at surgery did not differ significantly between groups (A: 35.7 years, H: 36.0 years, p = 0.23). Time to follow-up was 4.3 and 3.7 years in the A and H groups, respectively. Patients with a hybrid graft had significantly higher KOOS Quality of Life subscores (A 69.6, H 79.2, p = 0.028), subjective IKDC scores (A 72.6, H 79.7, p = 0.031), and SANE scores (A 83.2, H 91.4, p = 0.015) at follow-up. Otherwise, no significant differences were found in patient-reported outcome scores between groups. A preoperatively planned hybrid graft, with use of a fresh-frozen, nonirradiated allograft, should be considered as a viable alternative for primary ACLR in older patients.
Asunto(s)
Lesiones del Ligamento Cruzado Anterior/cirugía , Reconstrucción del Ligamento Cruzado Anterior/métodos , Tendones Isquiotibiales/trasplante , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Calidad de Vida , Estudios Retrospectivos , Encuestas y Cuestionarios , Trasplante Autólogo , Trasplante Homólogo , Resultado del Tratamiento , Adulto JovenRESUMEN
In the ongoing effort to unlock the chemical potential of marine bacteria, genetic engineering of biosynthetic gene clusters (BGCs) is increasingly used to awake or improve expression of biosynthetic genes that may lead to discovery of novel bioactive natural products. Previously, we reported the successful capture, engineering and heterologous expression of an orphan BGC from the marine actinomycete Saccharomonospora sp. CNQ-490, which resulted in the isolation of the novel lipopeptide antibiotic taromycin A. Herein we report the isolation and structure elucidation of taromycin B, the second most abundant product of the taromycin biosynthetic series, and show that taromycins A and B exhibit complex chromatographic properties indicative of interconverting conformations. Taromycins A and B display potent activity against methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus faecium clinical isolates, suggestive that the taromycin molecular scaffold is a promising starting point for further derivatization to produce compounds with promising antibiotic characteristics.
Asunto(s)
Antibacterianos/aislamiento & purificación , Antibacterianos/farmacología , Lipopéptidos/aislamiento & purificación , Actinobacteria/enzimología , Actinobacteria/genética , Actinobacteria/metabolismo , Enterococcus faecium/efectos de los fármacos , Ingeniería Genética , Lipopéptidos/farmacología , Staphylococcus aureus Resistente a Meticilina/efectos de los fármacos , Familia de Multigenes , Streptomyces coelicolor/química , Streptomyces coelicolor/metabolismo , Resistencia a la Vancomicina/efectos de los fármacosRESUMEN
BACKGROUND: To further reduce the invasiveness of arthroscopic rotator cuff repair surgery the all-suture anchor has been developed. The all-suture anchor requires less bone removal and reduces the potential of loose body complications. The all-suture anchor must also have adequate biomechanical strength for the repair to heal. The hypothesis is there is no significant difference in the biomechanical performance of supraspinatus repairs using an all-suture anchor when compared to traditional solid-body suture anchors. METHODS: Using nine shoulders per group, the supraspinatus tendon was dissected from the greater tuberosity. The four different double row repairs tested were (medial row/lateral row): A: ICONIX2/ICONIX2; B: ICONIX2/Stryker ReelX 3.9mm; C: ICONIX2/Stryker ReelX 4.5mm; D: Arthrex BioComposite CorkScrew FT 4.5mm/Arthrex BioComposite SwiveLock 4.75mm. The ICONIX2 was the only all-suture anchor tested. Tendons underwent cyclic loading from 10 to 100N for 500 cycles, followed by load-to-failure. Data was collected at cycles 5, 100, 200, 300, 400, and 500. One-way ANOVA analysis was used to assess significance (P≤0.05). FINDINGS: The anchor combinations tested did not differ significantly in anterior (P>0.4) or posterior (P>0.3) gap formation, construct stiffness (P>0.7), ultimate load (P=0.06), or load to 5mm gap formation (P=0.84). INTERPRETATION: The all-suture anchor demonstrated comparable biomechanical performance in multiple double-row anchor combinations to a combination of traditional solid-body anchors. Thus it may be an attractive option to further reduce the invasiveness of rotator cuff repairs.
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Manguito de los Rotadores/cirugía , Anclas para Sutura , Técnicas de Sutura , Traumatismos de los Tendones/cirugía , Tendones/cirugía , Anciano , Artroplastia , Artroscopía/métodos , Fenómenos Biomecánicos , Cadáver , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estrés Mecánico , Cicatrización de HeridasRESUMEN
BACKGROUND: The purpose of this study was to compare the effect of compressive cryotherapy (CC) vs. ice on postoperative pain in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. A commercial device was used for postoperative CC. A standard ice wrap (IW) was used for postoperative cryotherapy alone. METHODS: Patients scheduled for rotator cuff repair or subacromial decompression were consented and randomized to 1 of 2 groups; patients were randomized to use either CC or a standard IW for the first postoperative week. All patients were asked to complete a "diary" each day, which included visual analog scale scores based on average daily pain and worst daily pain as well as total pain medication usage. Pain medications were then converted to a morphine equivalent dosage. RESULTS: Forty-six patients completed the study and were available for analysis; 25 patients were randomized to CC and 21 patients were randomized to standard IW. No significant differences were found in average pain, worst pain, or morphine equivalent dosage on any day. CONCLUSION: There does not appear to be a significant benefit to use of CC over standard IW in patients undergoing shoulder arthroscopy for rotator cuff repair or subacromial decompression. Further study is needed to determine if CC devices are a cost-effective option for postoperative pain management in this population of patients.
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Artroscopía/efectos adversos , Crioterapia/métodos , Descompresión Quirúrgica/efectos adversos , Aparatos de Compresión Neumática Intermitente , Dolor Postoperatorio/terapia , Manguito de los Rotadores/cirugía , Adulto , Anciano , Femenino , Humanos , Hielo , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Estudios ProspectivosRESUMEN
Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article.
Asunto(s)
Algoritmos , Articulación del Codo , Artropatías/diagnóstico , Imagen por Resonancia Magnética , Examen Físico , Articulación del Hombro , Articulación de la Muñeca , Artralgia/etiología , Diagnóstico por Imagen , HumanosRESUMEN
The lower-extremity anatomy is complex and normal function is dependent on intact osteochondral, musculotendinous, and ligamentous structures. Injury may result in pain and functional limitation. Specific clinical tests are used to help isolate and define the pathoanatomy; however, their terminology may be confusing to the radiologist and the diagnostic value of these tests may not be well understood. This article presents an algorithmic approach to evaluation of the hip, knee, and ankle to improve the radiologist's understanding of lower-extremity physical examination. Knowledge of test terminology, clinical utility, and diagnostic accuracy will improve clinical and radiologic correlation. The article reviews the common clinical tests used to evaluate the lower extremity and provides an algorithm to establish a clinical examination road map and rapidly review the clinical utility and study hierarchy of a particular test. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. The structured algorithmic approach to lower-extremity examination described here, knowledge of test jargon, and familiarity with the diagnostic accuracy of the clinical and MR imaging examinations may help the radiologist focus image search patterns and provide detailed and clinically relevant reports. Online supplemental material is available for this article.
Asunto(s)
Algoritmos , Articulación del Tobillo , Articulación de la Cadera , Artropatías/diagnóstico , Articulación de la Rodilla , Imagen por Resonancia Magnética , Examen Físico , Artralgia/etiología , Diagnóstico por Imagen , HumanosRESUMEN
Recent developments in next-generation sequencing technologies have brought recognition of microbial genomes as a rich resource for novel natural product discovery. However, owing to the scarcity of efficient procedures to connect genes to molecules, only a small fraction of secondary metabolomes have been investigated to date. Transformation-associated recombination (TAR) cloning takes advantage of the natural in vivo homologous recombination of Saccharomyces cerevisiae to directly capture large genomic loci. Here we report a TAR-based genetic platform that allows us to directly clone, refactor, and heterologously express a silent biosynthetic pathway to yield a new antibiotic. With this method, which involves regulatory gene remodeling, we successfully expressed a 67-kb nonribosomal peptide synthetase biosynthetic gene cluster from the marine actinomycete Saccharomonospora sp. CNQ-490 and produced the dichlorinated lipopeptide antibiotic taromycin A in the model expression host Streptomyces coelicolor. The taromycin gene cluster (tar) is highly similar to the clinically approved antibiotic daptomycin from Streptomyces roseosporus, but has notable structural differences in three amino acid residues and the lipid side chain. With the activation of the tar gene cluster and production of taromycin A, this study highlights a unique "plug-and-play" approach to efficiently gaining access to orphan pathways that may open avenues for novel natural product discoveries and drug development.
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Vías Biosintéticas/genética , Daptomicina/análogos & derivados , Lipopéptidos/biosíntesis , Familia de Multigenes/genética , Cromatografía Líquida de Alta Presión , Clonación Molecular , Daptomicina/biosíntesis , Daptomicina/química , Regulación Bacteriana de la Expresión Génica , Genes Bacterianos/genética , Genes Reguladores/genética , Prueba de Complementación Genética , Vectores Genéticos/genética , Lipopéptidos/química , Datos de Secuencia Molecular , Mapeo Físico de Cromosoma , Recombinación Genética/genética , Reproducibilidad de los Resultados , Streptomyces/genéticaRESUMEN
The absolute stereostructures of the components of symplocin A (3), a new N,N-dimethyl-terminated peptide from the Bahamian cyanobacterium Symploca sp., were assigned from spectroscopic analysis, including MS, 2D NMR, and Marfey's analysis. The complete absolute configuration of symplocin A, including the unexpected D-configurations of the terminal N,N-dimethylisoleucine and valic acid residues, was assigned by chiral-phase HPLC of the corresponding 2-naphthacyl esters, a highly sensitive, complementary strategy for assignment of N-blocked peptide residues where Marfey's method is ineffectual or other methods fall short. Symplocin A exhibited potent activity as an inhibitor of cathepsin E (IC(50) 300 pM).
Asunto(s)
Catepsina E/antagonistas & inhibidores , Cianobacterias/química , Naftalenos/química , Péptidos/aislamiento & purificación , Bahamas , Cromatografía Líquida de Alta Presión , Ésteres , Concentración 50 Inhibidora , Estructura Molecular , Resonancia Magnética Nuclear Biomolecular , Péptidos/química , Péptidos/farmacologíaRESUMEN
The complete NMR assignments of N,N'-methyleno-didemnin A from Trididemnum solidum Van Name 1902 are reported along with a strategic analysis of (1)J(CH) coupling constants that confirm the presence of the imidazolidinone ring.