Extra-articular arthroscopic release of lateral epicondylitis: a prospective study

Background: Operative management of lateral epicondylitis can be managed with percutaneous, arthroscopic, or open surgical release. Extraarticular arthroscopic release is a new technique, and no study has compared its outcomes and risk profile. Methods: A 26-patient cohort was reviewed before and after extraarticular arthroscopic release, which was performed by the senior author. The Mayo Elbow Performance Scores were used as a functional outcome score and obtained via a phone interview. Results were analyzed using a paired t-test with a statistical significance set at P \u3c .05. Results: Of the 26 patients, 10 were being treated under workers compensation. Preoperative Mayo Elbow Performance Score was 47.5, and the postoperative score was 90.2 with a significant difference of 42.7 (P value 1⁄4 .05). The workers compensation group scored 13.3 points lower postoperatively than the remainder of patients, which was shown to also be significant with a P value of .002. Discussion and Conclusion: The advantage of extraarticular arthroscopic release was better visualiza- tion of affected structures, which improved accuracy of debridement, and a small capsulotomy, which decreased the risk of a transient radial nerve palsy. Overall, extraarticular arthroscopic results were found to be good and comparable to the results of other operative techniques with the added advantage of a lower risk profile

Why Wait?: Early Enteral Feeding After Pediatric Gastrostomy Tube Placement

Purpose Early initiation of feedings after gastrostomy tube (GT) placement may reduce associated hospital costs, but many surgeons fear complications could result from earlier feeds. We hypothesized that, irrespective of placement method, starting feedings within the first 6 h following GT placement would not result in a greater number of post-operative complications. Methods An IRB-approved retrospective review of all GTs placed between January 2012 and December 2014 at three academic institutions was undertaken. Data was stratified by placement method and whether the patient was initiated on feeds at less than 6 h or after. Baseline demographics, operative variables, post-operative management and complications were analyzed. Descriptive statistics were used and P-values < 0.05 were considered significant. Results One thousand and forty-eight patients met inclusion criteria. GTs were inserted endoscopically (48.9%), laparoscopically (44.9%), or via an open approach (6.2%). Demographics were similar in early and late fed groups. When controlling for method of placement, those patients who were fed within the first 6 h after gastrostomy placement had shorter lengths of stay compared to those fed greater than 6 h after placement (P < 0.05). Total post-operative outcomes were equivalent between feeding groups for all methods of placement (laparoscopic (P = 0.87), PEG (P = 0.94), open (P = 0.81)). Conclusions Early initiation of feedings following GT placement was not associated with an increase in complications. Feeds initiated earlier may shorten hospital stays and decrease overall hospital costs

A mouse model of heart failure with preserved ejection fraction due to chronic infusion of a low subpressor dose of angiotensin II

Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome of HF symptoms associated with impaired diastolic function. Although it represents ∼50% of patients with HF, the mechanisms of disease are poorly understood, and therapies are generally ineffective in reducing HF progression. Animal models of HFpEF not due to pressure or volume overload are lacking, therefore limiting in-depth understanding of the pathophysiological mechanisms and the development of novel therapies. We hypothesize that a continuous infusion of low-dose angiotensin II (AT(II)) is sufficient to induce left ventricular (LV) diastolic dysfunction and HFpEF, without increasing blood pressure or inducing LV hypertrophy or dilatation. Osmotic pumps were implanted subcutaneously in 8-wk-old male mice assigned to the AT(II) (0.2 mg·kg(−1)·day(−1)) or volume-matched vehicle (N = 8/group) for 4 wk. We measured systolic and diastolic arterial blood pressures through a tail-cuff transducer, LV dimensions and ejection fraction through echocardiography, and LV relaxation through pulsed-wave Doppler and LV catheterization. Myocardial fibrosis and cardiomyocyte cross-sectional area were measured. AT(II) infusion had no effects on systemic arterial blood pressure. AT(II) induced significant impairment in LV diastolic function, as measured by an increase (worsening) in LV isovolumetric relaxation time, myocardial performance index, isovolumetric relaxation time constant, and LV end-diastolic pressure without altering LV dimensions, mass, or ejection fraction. Chronic infusion of low-dose AT(II) recapitulates the HFpEF phenotype in the mouse, without increasing systemic arterial blood pressure. This mouse model may provide insight into the mechanisms of HFpEF

Overexpression of the astrocyte glutamate transporter GLT1 exacerbates phrenic motor neuron degeneration, diaphragm compromise, and forelimb motor dysfunction following cervical contusion spinal cord injury.

A major portion of spinal cord injury (SCI) cases affect midcervical levels, the location of the phrenic motor neuron (PhMN) pool that innervates the diaphragm. While initial trauma is uncontrollable, a valuable opportunity exists in the hours to days following SCI for preventing PhMN loss and consequent respiratory dysfunction that occurs during secondary degeneration. One of the primary causes of secondary injury is excitotoxic cell death due to dysregulation of extracellular glutamate homeostasis. GLT1, mainly expressed by astrocytes, is responsible for the vast majority of functional uptake of extracellular glutamate in the CNS, particularly in spinal cord. We found that, in bacterial artificial chromosome-GLT1-enhanced green fluorescent protein reporter mice following unilateral midcervical (C4) contusion SCI, numbers of GLT1-expressing astrocytes in ventral horn and total intraspinal GLT1 protein expression were reduced soon after injury and the decrease persisted for ≥6 weeks. We used intraspinal delivery of adeno-associated virus type 8 (AAV8)-Gfa2 vector to rat cervical spinal cord ventral horn for targeting focal astrocyte GLT1 overexpression in areas of PhMN loss. Intraspinal delivery of AAV8-Gfa2-GLT1 resulted in transduction primarily of GFAP(+) astrocytes that persisted for ≥6 weeks postinjury, as well as increased intraspinal GLT1 protein expression. Surprisingly, we found that astrocyte-targeted GLT1 overexpression increased lesion size, PhMN loss, phrenic nerve axonal degeneration, and diaphragm neuromuscular junction denervation, and resulted in reduced functional diaphragm innervation as assessed by phrenic nerve-diaphragm compound muscle action potential recordings. These results demonstrate that GLT1 overexpression via intraspinal AAV-Gfa2-GLT1 delivery exacerbates neuronal damage and increases respiratory impairment following cervical SCI

Assessments of residential and global positioning system activity space for food environments, body mass index and blood pressure among low-income housing residents in New York City

Research has examined how the food environment affects the risk of cardiovascular disease (CVD). Many studies have focused on residential neighbourhoods, neglecting the activity spaces of individuals. The objective of this study was to investigate whether food environments in both residential and global positioning system (GPS)-defined activity space buffers are associated with body mass index (BMI) and blood pressure (BP) among low-income adults. Data came from the New York City Low Income Housing, Neighborhoods and Health Study, including BMI and BP data (n=102, age=39.3±14.1 years), and one week of GPS data. Five food environment variables around residential and GPS buffers included: fast-food restaurants, wait-service restaurants, corner stores, grocery stores, and supermarkets. We examined associations between food environments and BMI, systolic and diastolic BP, controlling for individual- and neighbourhood-level sociodemographics and population density. Within residential buffers, a higher grocery store density was associated with lower BMI (β=- 0.20 kg/m2, P<0.05), and systolic and diastolic BP (β =-1.16 mm Hg; and β=-1.02 mm Hg, P<0.01, respectively). In contrast, a higher supermarket density was associated with higher systolic and diastolic BP (β=1.74 mm Hg, P<0.05; and β=1.68, P<0.01, respectively) within residential buffers. In GPS neighbourhoods, no associations were documented. Examining how food environments are associated with CVD risk and how differences in relationships vary by buffer types have the potential to shed light on determinants of CVD risk. Further research is needed to investigate these relationships, including refined measures of spatial accessibility/exposure, considering individual’s mobility

A practical approach to continuous glucose monitoring (rtCGM) and FreeStyle Libre systems (isCGM) in children and young people with Type 1 diabetes

Real-time continuous glucose monitoring (rtCGM) and FreeStyle Libre glucose monitoring systems (isCGM) are new evolving technologies used in the management of Type 1 diabetes. They offer potential to improve diabetes control and reduce hypoglycaemia. rtCGM can be linked to insulin pump providing hybrid closed loop therapy. Families of children and young people are keen to have the benefit from these technologies. These are relatively expensive so it is important that health care professionals, families of children and young people (CYP) with diabetes are adequately trained in the use of these devices. Health care professionals need to be able to make patient selection based on individual needs and preferences to achieve maximum benefit. Association of Children’s Diabetes Clinicians (ACDC) developed a comprehensive guideline in 2017 to help identify which patients may be most likely to benefit and how these technologies may be practically implemented. Since then new technologies have been introduced and the use of GCM has expanded in routine clinical practice. This article, aims to provide a practical approach and help identify which patients may be most likely to benefit and how the technology may be implemented in order to maximise the clinical benefits

Individual common variants exert weak effects on the risk for autism spectrum disorders.

While it is apparent that rare variation can play an important role in the genetic architecture of autism spectrum disorders (ASDs), the contribution of common variation to the risk of developing ASD is less clear. To produce a more comprehensive picture, we report Stage 2 of the Autism Genome Project genome-wide association study, adding 1301 ASD families and bringing the total to 2705 families analysed (Stages 1 and 2). In addition to evaluating the association of individual single nucleotide polymorphisms (SNPs), we also sought evidence that common variants, en masse, might affect the risk. Despite genotyping over a million SNPs covering the genome, no single SNP shows significant association with ASD or selected phenotypes at a genome-wide level. The SNP that achieves the smallest P-value from secondary analyses is rs1718101. It falls in CNTNAP2, a gene previously implicated in susceptibility for ASD. This SNP also shows modest association with age of word/phrase acquisition in ASD subjects, of interest because features of language development are also associated with other variation in CNTNAP2. In contrast, allele scores derived from the transmission of common alleles to Stage 1 cases significantly predict case status in the independent Stage 2 sample. Despite being significant, the variance explained by these allele scores was small (Vm&lt; 1%). Based on results from individual SNPs and their en masse effect on risk, as inferred from the allele score results, it is reasonable to conclude that common variants affect the risk for ASD but their individual effects are modest