Patients with Small Acetabular Cartilage Defects Caused by Femoroacetabular Impingement Do Not Benefit from Microfracture

Objective: According to current recommendations, large cartilage defects of the hip over 2 cm2 are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm2 ) actually benefit from microfracture. Design: In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm2 and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain. Results: The untreated group showed a statistically significant improvement of the iHOT33 after 12 (p = 0.005), 24 (p = 0.019), and 36 months (p = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS. Conclusion: The subjective outcome of patients with small cartilage defects of the hip (≤100 mm2 ) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed

Risk-shifting Through Issuer Liability and Corporate Monitoring

This article explores how issuer liability re-allocates fraud risk and how risk allocation may reduce the incidence of fraud. In the US, the apparent absence of individual liability of officeholders and insufficient monitoring by insurers under-mine the potential deterrent effect of securities litigation. The underlying reasons why both mechanisms remain ineffective are collective action problems under the prevailing dispersed ownership structure, which eliminates the incentives to moni-tor set by issuer liability. This article suggests that issuer liability could potentially have a stronger deterrent effect when it shifts risk to individuals or entities holding a larger financial stake. Thus, it would enlist large shareholders in monitoring in much of Europe. The same risk-shifting effect also has implications for the debate about the relationship between securities litigation and creditor interests. Credi-tors’ claims should not be given precedence over claims of defrauded investors (e.g., because of the capital maintenance principle), since bearing some of the fraud risk will more strongly incentivise large creditors, such as banks, to monitor the firm in jurisdictions where corporate debt is relatively concentrated

Patients with Small Acetabular Cartilage Defects Caused by Femoroacetabular Impingement Do Not Benefit from Microfracture

Objective: According to current recommendations, large cartilage defects of the hip over 2 cm2 are suggested to undergo autologous chondrocyte transplantation (ACT), while small defects should be treated with microfracture. We investigated if patients with small chondral defects of the hip joint (≤100 mm2) actually benefit from microfracture. Design: In this retrospective multicenter cohort study 40 patients with focal acetabular cartilage defects smaller than 100 mm2 and of ICRS grade ≥2 caused by femoroacetabular impingement were included. Twenty-six unrandomized patients underwent microfracture besides treatment of the underlying pathology; in 14 patients cartilage lesions were left untreated during arthroscopy. Over a mean follow-up of 28.8 months patient-reported outcome was determined using the iHOT33 (international hip outcome tool) and the VAS (visual analog scale) for pain. Results: The untreated group showed a statistically significant improvement of the iHOT33 after 12 (p = 0.005), 24 (p = 0.019), and 36 months (p = 0.002) compared to the preoperative score, whereas iHOT33 in the microfracture group did not reveal statistically significant changes over time. There was no significant difference between both groups on any time point. Regarding pain both groups did not show a significant improvement over time in the VAS. Conclusion: The subjective outcome of patients with small cartilage defects of the hip (≤100 mm2) improves 12 months after arthroscopic FAIS surgery without any cartilage treatment. However, no improvement could be seen after microfracture. Therefore, a reserved surgical treatment for small cartilage defects of the hip under preservation of the subchondral bone is recommended especially if a simultaneous impingement correction is performed

Baclofen for alcohol use disorder-a systematic meta-analysis

ObjectiveTo evaluate the efficacy and tolerability of baclofen vs. placebo for long-term treatment of alcohol use disorder. MethodSystematic review and meta-analysis following methods of the Cochrane Collaboration Handbook (PROSPERO registration: CRD42017073663). Primary outcome was the random-effects summary estimate of all standardized mean differences (SMDs), as calculated from the primary outcomes of each study. ResultsFourteen double-blind RCTs (1522 patients) were included. Heterogeneity was substantial for most analyses (I-2 about 75%). Baclofen showed a small, but not statistically significant superiority over placebo: SMD=0.22 ([95% CI: -0.03; 0.47], P=0.09). This result was supported by a leave-one-out-analysis, and Orwin's fail-safe N, by predefined secondary analyses (on abstinence rates and amount of drinking), and by a post hoc-analysis of high-dose studies (>80mg/day). An analysis of low risk of bias studies (SMD=0.10 [-0.20; 0.41], P=0.51, I-2=43.3%) found no effect. Exclusion of four studies focusing on patients with comorbidity yielded a small positive effect. Drop-out rates were similar. ConclusionOur results question baclofen's utility in the long-term treatment of alcohol use disorder at both normal and high doses. While the confidence intervals indicate that marginally harmful or moderately beneficial effects of baclofen remain a possibility, the most likely effect size is slightly above placebo effects

Regiochemical Effects of Furan Substitution on the Electronic Properties and Solid-State Structure of Partial Fused-Ring Oligothiophenes

Oligomers containing the new fused-ring heterocyclic conjugated building block thieno­[3,2-<i>b</i>]­furan were synthesized, and the effects associated with furan ring substitution into fused-ring oligothiophenes on the electronic properties and solid-state structure were assessed. A series of four-ring oligomers which vary in the degree of furan ring substitution and the regiochemistry of placement were synthesized via Stille cross-coupling and oxidative homocoupling strategies. The electronic properties of these oligomers were studied by UV–vis absorption and fluorescence spectroscopies. Substitution of furan rings at the terminal positions yields oligomers with a narrower HOMO–LUMO gap relative to the all-thiophene analogue 2,2′-bithieno­[3,2-<i>b</i>]­thiophene, and incorporation of furan rings at the interior positions results in oligomers with an increase in rigidity and a higher fluorescence quantum yield. Packing motifs of the oligomers were determined using single crystal X-ray diffraction. In contrast to the herringbone crystal packing observed for nonfused oligothiophenes, oligofurans, thiophene–furan hybrid oligomers, and the all-thiophene analogue 2,2′-bithieno­[3,2-<i>b</i>]­thiophene, all three regioisomers derived from the dimerization of thieno­[3,2-<i>b</i>]­furan arrange in a π-stacked packing motif in the solid state