Is the pull-out force of the Meniscus Arrow in bone affected by the inward curling of the barbs during biodegradation? An in vitro study

Background: Inward curling of the barbs of Meniscus Arrows during degradation was observed in a previous study, in which swelling, distention, and water uptake by Meniscus Arrows was evaluated. This change of configuration could have consequences with respect to anchorage capacity in bone. Material/Methods: Eight non-degraded Meniscus Arrows in the original configuration were pulled out of thawed, fresh-frozen human femoral condyle, and pull-out force was measured and compared with that of 6 Meniscus Arrows after 31 days of degradation under controlled conditions. Results: No significant difference was found between the 2 groups with respect to the required pull-out force (t test), the distribution of the data, or the interaction between degradation and location, as evaluated by mann-Whitney test, and no significant difference was found between the 2 groups with respect to the degradation state or position in the coudyles, as evaluated by 2-way analysis of variance. Conclusions: Our results indicate that the decrease in barb-barb diameter during the first month of degradation of the Meniscus Arrows has no significant effect on the tensile pull-out force required for removal from human femur condyle. Further research should be undertaken to examine whether the same is true for other biodegradable devices with barbs

Models to predict positive and negative effects of cochlear implantation on tinnitus

Objectives: The effect of cochlear implantation on tinnitus is heterogeneous: implantation does not always reduce tinnitus and may even worsen tinnitus. Therefore, it is important to know which factors influence the consequences of cochlear implantation for tinnitus. To date, no consensus has been reached regarding the factors that influence tinnitus. This study aimed to create prognostic models, using binary logistic regression analyses to predict positive or negative changes in tinnitus after cochlear implantation. Methods: For this study we retrospectively sent two questionnaire packages to 117 cochlear implant patients. Results: In the binary logistic regression analyses of the responses to the questionnaires, it was not possible to create a significant model to predict a positive effect of cochlear implantation on tinnitus. However, a negative effect of cochlear implantation on tinnitus was predictable, using a backward stepwise selection method in a model including the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Tinnitus Handicap Questionnaire (THQ) (P < .001, Nagelkerke R2 = 0.529). Conclusions: Our results suggest that the lower the preoperative tinnitus handicap and the preoperative hearing handicap, the higher the chance that cochlear implantation will worsen tinnitus. More research needs to be done, preferable in a big prospective study, to make this model instrumental for clinical decision making and preoperative patient counselling. However, our results might suggest that preoperative THQ and APHAB screening could be meaningful. Especially in patients who are afraid to develop tinnitus or tinnitus worsening as complication of cochlear implantation. Level of Evidence: 4

A trap motion in validating muscle activity prediction from musculoskeletal model using EMG

Musculoskeletal modeling nowadays is becoming the most common tool for studying and analyzing human motion. Besides its potential in predicting muscle activity and muscle force during active motion, musculoskeletal modeling can also calculate many important kinetic data that are difficult to measure in vivo, such as joint force or ligament force. This paper will validate muscle activity predicted by the model during a static motion like knee flexion motion (squat motion). In this experiment, knee flexion motion was performed by 5 healthy subjects and modeled by using Gait Lower Extremity model from AnyBody Modeling System (AMS). Eight lower limb muscle activity prediction from the model will be validated by 8 EMG electrodes that measured the same muscles during squat motion. Muscle activity pattern and the position of onset would be used as a key factor in this validation study. Pearson correlation coefficient will be used to compare the pattern of both graphs. Knee joint force prediction from the model will also be compared with the literature studies. The result showed that 3 muscles showed high correlation coefficient, while the other 4 muscles showed slightly medium and one showed low correlation. Time delay of muscle activation between the model and EMG was recorded from Vastus Medialis muscle (18.38 ms) and Vastus Lateralis (22.8 ms), with muscle activation from the model was late compared to EMG. In conclusion, this statistical study has shown some detail differences between EMG and muscle activity prediction from the model. Knee flexion motion can be used as a trap motion when validating muscle activity of a musculoskeletal model, because the model will activate muscle activity based on motion data of markers, while in knee-flexed position, there was no marker’s movement, but the EMG was highly active due to the posture of the subjects in maintaining the knee-flexed position. However, the knee compressive force prediction from the model has showed positive confirmation from the literatures

Malnutrition is associated with worse health-related quality of life in children with cancer

Purpose:\ud Malnutrition in childhood cancer patients has been associated with lower health-related quality of life (HRQOL). However, this association has never actually been tested. Therefore, we aimed to determine the association between nutritional status and HRQOL in children with cancer.\ud \ud Methods:\ud In 104 children, aged 2–18 years and diagnosed with hematological, solid, or brain malignancies, nutritional status and HRQOL were assessed at diagnosis and at 3, 6, and 12 months using the child- and parent-report versions of the PedsQL 4.0 Generic scale and the PedsQL 3.0 Cancer Module. Scores on both scales range from 0 to 100.\ud \ud Results:\ud Undernourished children (body mass index (BMI) or fat-free mass < −2 standard deviation score (SDS)) reported significantly lower PedsQL scores compared with well-nourished children on the domains physical functioning (−13.3), social functioning (−7.0), cancer summary scale (−5.9), and nausea (−14.7). Overnourished children (BMI or fat mass >2 SDS) reported lower scores on emotional (−8.0) and cognitive functioning (−9.2) and on the cancer summary scale (−6.6), whereas parent-report scores were lower on social functioning (−7.5). Weight loss (>0.5 SDS) was associated with lower scores on physical functioning (−13.9 child-report and −10.7 parent-report), emotional (−7.4) and social functioning (−6.0) (child-report), pain (−11.6), and nausea (−7.8) (parent-report). Parents reported worse social functioning and more pain in children with weight gain (>0.5 SDS) compared with children with stable weight status.\ud \ud Conclusions:\ud Undernutrition and weight loss were associated with worse physical and social functioning, whereas overnutrition and weight gain affected the emotional and social domains of HRQL. Interventions that improve nutritional status may contribute to enhanced health outcomes in children with cancer

Rationale and design of the OPTIMIZE trial: OPen label multicenter randomized trial comparing standard IMmunosuppression with tacrolimus and mycophenolate mofetil with a low exposure tacrolimus regimen In combination with everolimus in de novo renal transplantation in Elderly patients

BackgroundIn 2019, more than 30% of all newly transplanted kidney transplant recipients in The Netherlands were above 65 years of age. Elderly patients are less prone to rejection, and death censored graft loss is less frequent compared to younger recipients. Elderly recipients do have increased rates of malignancy and infection-related mortality. Poor kidney transplant function in elderly recipients may be related to both pre-existing (i.e. donor-derived) kidney damage and increased susceptibility to nephrotoxicity of calcineurin inhibitors (CNIs) in kidneys from older donors. Hence, it is pivotal to shift the focus from prevention of rejection to preservation of graft function and prevention of over-immunosuppression in the elderly. The OPTIMIZE study will test the hypothesis that reduced CNI exposure in combination with everolimus will lead to better kidney transplant function, a reduced incidence of complications and improved health-related quality of life for kidney transplant recipients aged 65 years and older, compared to standard immunosuppression.MethodsThis open label, randomized, multicenter clinical trial will include 374 elderly kidney transplant recipients (>= 65 years) and consists of two strata. Stratum A includes elderly recipients of a kidney from an elderly deceased donor and stratum B includes elderly recipients of a kidney from a living donor or from a deceased donor= 45 ml/min per 1.73 m(2) in stratum B, after 2 years, respectively.ConclusionsThe OPTIMIZE study will help to determine the optimal immunosuppressive regimen after kidney transplantation for elderly patients and the cost-effectiveness of this regimen. It will also provide deeper insight into immunosenescence and both subjective and objective outcomes after kidney transplantation in elderly recipients.Trial registrationClinicalTrials.gov: NCT03797196, registered January 9th, 2019. EudraCT: 2018-003194-10, registered March 19th, 2019.Nephrolog

Long-term quality of life in adult survivors of pediatric differentiated thyroid carcinoma

Context: Little is known about long-term quality of life (QoL) of survivors of pediatric differentiated thyroid carcinoma. Therefore, this study aimed to evaluate generic health-related QoL (HRQoL), fatigue, anxiety, and depression in these survivors compared with matched controls, and to evaluate thyroid cancer–specific HRQoL in survivors only. Design: Survivors diagnosed between 1970 and 2013 at age #18 years, were included. Exclusion criteria were a follow-up ,5 years, attained age ,18 years, or diagnosis of DTC as a second malignant neoplasm (SMN). Controls were matched by age, sex, and socioeconomic status. Survivors and controls were asked to complete 3 questionnaires [Short-Form 36 (HRQoL), Multidimensional Fatigue Inventory 20 (fatigue), and Hospital Anxiety and Depression Scale (anxiety/depression)]. Survivors completed a thyroid cancer–specific HRQoL questionnaire. Results: Sixty-seven survivors and 56 controls. Median age of survivors at evaluation was 34.2 years (range, 18.8 to 61.7). Median follow-up was 17.8 years (range, 5.0 to 44.7). On most QoL subscales, scores of survivors and controls did not differ significantly. However, survivors had more physical problems (P = 0.031), role limitations due to physical problems (P = 0.021), and mental fatigue (P = 0.016) than controls. Some thyroid cancer–specific complaints (e.g., sensory complaints and chilliness) were present in survivors. Unemployment and more extensive disease or treatment characteristics were most frequently associated with worse QoL. Conclusions: Overall, long-term QoL in survivors of pediatric DTC was normal. Survivors experienced mild impairment of QoL in some domains (physical problems, mental fatigue, and various thyroid cancer–specific complaints). Factors possibly affecting QoL need further exploration

Psychosocial development in survivors of childhood differentiated thyroid carcinoma: A cross-sectional study

Objective: The impact of childhood differentiated thyroid carcinoma (DTC) on psychosocial development has not yet been studied. The aim of this study was to evaluate the achievement of psychosocial developmental milestones in long-term survivors of childhood DTC. Design and methods: Survivors of childhood DTC diagnosed between 1970 and 2013 were included. Reasons for exclusion were age 35 years at follow-up, a follow-up period <5 years or diagnosis with DTC as a second malignant neoplasm. Survivors gathered peer controls of similar age and sex (n=30