Presurgical tear characteristics and estimated shear modulus as predictors of repair integrity and shoulder function one year after rotator cuff repair

Background: Rotator cuff repair provides pain relief for many patients; however, retears are relatively common and affect approximately 20%-70% of patients after repair. Although magnetic resonance imaging (MRI) offers the ability to assess tissue characteristics such as tear size, retraction, and fatty infiltration, it provides little insight into the quality of the musculotendinous tissues the surgeon will encounter during surgery. However, shear wave elastography (SWE) could provide an indirect assessment of quality (ie, stiffness) by measuring the speed of shear waves propagating through tissue. The objective of this study was to determine the extent to which estimated shear modulus predicts repair integrity and functional outcomes 1 year after rotator cuff repair. Methods: Thirty-three individuals scheduled to undergo arthroscopic rotator cuff repair were enrolled in this study. Before surgery, shear modulus of the supraspinatus tendon and muscle was estimated using ultrasound SWE. MRIs were obtained before and 1 year after surgery to assess tear characteristics and repair integrity, respectively. Shoulder strength, range of motion, and patient-reported pain and function were assessed before and after surgery. Functional outcomes were compared between groups and across time using a two-factor mixed model analysis of variance. Stepwise regression with model comparison was used to investigate the extent to which MRI and shear modulus predicted repair integrity and function at 1 year after surgery. Results: At 1 year after surgery, 56.5% of patients had an intact repair. No significant differences were found in any demographic variable, presurgical tear characteristic, or shear modulus between patients with an intact repair and those with a recurrent tear. Compared with presurgical measures, patients in both groups demonstrated significant improvements at 1 year after surgery in pain (P \u3c .01), self-reported function (P \u3c .01), range of motion (P \u3c .01), and shoulder strength (P \u3c .01). In addition, neither presurgical MRI variables (P \u3e .16) nor shear modulus (P \u3e .52) was significantly different between groups at 1 year after surgery. Finally, presurgical shear modulus generally did not improve the prediction of functional outcomes above and beyond that provided by MRI variables alone (P \u3e .22). Conclusion: Although SWE remains a promising modality for many clinical applications, this study found that SWE-estimated shear modulus did not predict repair integrity or functional outcomes at 1 year after surgery, nor did it add to the prediction of outcomes above and beyond that provided by traditional presurgical MRI measures of tear characteristics. Therefore, it appears that further research is needed to fully understand the clinical utility of SWE for musculoskeletal tissue and its potential use for predicting outcomes after surgical rotator cuff repair

Ultrasound shear wave elastography and its association with rotator cuff tear characteristics

Background: Approximately 20-60% of rotator cuff repairs fail with higher failure rates in patients with larger or more chronic tears. Although MRI provides an objective estimate of tear size, it can only provide qualitative descriptions of tear chronicity. By contrast, ultrasound shear wave elastography (SWE) may assess tear chronicity by estimating tissue mechanical properties (ie, shear modulus). Furthermore, SWE imaging does not share many of the challenges associated with MRI (eg, high cost, risk of claustrophobia). Therefore, the objective of this study was to determine the extent to which estimated supraspinatus shear modulus is associated with conventional MRI-based measures of rotator cuff tear size and chronicity. Methods: Shear modulus was estimated using ultrasound SWE in two regions of the supraspinatus (intramuscular tendon, muscle belly) under two contractile conditions (passive, active) in 22 participants with full-thickness rotator cuff tears. The extent to which estimated supraspinatus shear modulus is associated with conventional MRI measures of tear size and chronicity was assessed using correlation coefficients and Kruskal-Wallis tests, as appropriate. Results: Estimated shear modulus was not significantly associated with anterior/posterior tear size (P \u3e .09), tear retraction (P \u3e .20), occupation ratio (P \u3e .11), or fatty infiltration (P \u3e .30) under any testing condition. Discussion: Although ultrasound SWE measurements have been shown to be altered in the presence of various tendinopathies, the findings of this study suggest the utility of ultrasound SWE in this population (ie, patients with a small to medium supraspinatus rotator cuff tear) before surgical rotator cuff repair remains unclear

In Vivo Static Retraction and Dynamic Elongation of Rotator Cuff Repair Tissue After Surgical Repair: A Preliminary Analysis at 3 Months

BACKGROUND: Rotator cuff repair is a common orthopedic procedure that provides pain relief for many patients, but unfortunately, an estimated 20% to 70% of repair procedures will fail. Previous research has shown that elongation (ie, retraction) of a repaired tendon is common even in patients with a repair construct that appears intact on magnetic resonance imaging. However, it is unknown how this repair tissue functions under dynamic conditions. PURPOSE: To quantify static retraction and maximum dynamic elongation of repair tissue after rotator cuff repair. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Data from 9 patients were analyzed for this study. During surgery, a 3.1-mm tantalum bead was sutured to the supraspinatus tendon, medial to the repair site. Glenohumeral kinematics were assessed at 1 week (static) and 3 months (static and during scapular-plane abduction) after surgery using a biplanar videoradiographic system. The 3-dimensional position of the bead was calculated relative to the tendon’s insertion on the humerus (ie, bead-to-insertion distance). Static retraction was calculated as the change in the bead-to-insertion distance under static conditions between 1 week and 3 months after surgery, and maximum dynamic elongation was calculated as the maximal positive change in the bead-to-insertion distance during dynamic motion relative to the start of motion. The magnitudes of static retraction and maximum dynamic elongation were assessed with 1-sample t tests. RESULTS: At 3 months after surgery, static retraction occurred in all patients by a mean of 10.0 ± 9.1 mm (P = .01 compared with no elongation). During scapular-plane abduction, maximum dynamic elongation averaged 1.4 ± 1.0 mm (P \u3c .01 compared with no elongation). Descriptively, dynamic elongation consistently took 1 of 2 forms: an initial increase in the bead-to-insertion distance (mean, 2.0 ± 0.6 mm) before decreasing until the end of motion or an immediate and substantial decrease in the bead-to-insertion distance at the onset of motion. CONCLUSION: Repair tissue elongation (static retraction and maximum dynamic elongation) appeared to be a common and significant finding at 3 months after arthroscopic rotator cuff repair. Dynamic elongation of repair tissue during scapular-plane abduction exhibited 1 of 2 distinct patterns, which may suggest different patterns of supraspinatus mechanical and neuromuscular function

Spectrum of Neutral Helium in Strong Magnetic Fields

We present extensive and accurate calculations for the excited state spectrum of spin-polarized neutral helium in a range of magnetic field strengths up to $10^{12}$ G. Of considerable interest to models of magnetic white dwarf stellar atmospheres, we also present results for the dipole strengths of the low lying transitions among these states. Our methods rely on a systematically saturated basis set approach to solving the Hartree--Fock self-consistent field equations, combined with an ``exact'' stochastic method to estimate the residual basis set truncation error and electron correlation effects. We also discuss the applicability of the adiabatic approximation to strongly magnetized multi-electron atoms.Comment: 19 pages, 7 figures, 10 table

Mapping the Environmental Fitness Landscape of a Synthetic Gene Circuit

Gene expression actualizes the organismal phenotypes encoded within the genome in an environment-dependent manner. Among all encoded phenotypes, cell population growth rate (fitness) is perhaps the most important, since it determines how well-adapted a genotype is in various environments. Traditional biological measurement techniques have revealed the connection between the environment and fitness based on the gene expression mean. Yet, recently it became clear that cells with identical genomes exposed to the same environment can differ dramatically from the population average in their gene expression and division rate (individual fitness). For cell populations with bimodal gene expression, this difference is particularly pronounced, and may involve stochastic transitions between two cellular states that form distinct sub-populations. Currently it remains unclear how a cell population's growth rate and its subpopulation fractions emerge from the molecular-level kinetics of gene networks and the division rates of single cells. To address this question we developed and quantitatively characterized an inducible, bistable synthetic gene circuit controlling the expression of a bifunctional antibiotic resistance gene in Saccharomyces cerevisiae. Following fitness and fluorescence measurements in two distinct environments (inducer alone and antibiotic alone), we applied a computational approach to predict cell population fitness and subpopulation fractions in the combination of these environments based on stochastic cellular movement in gene expression space and fitness space. We found that knowing the fitness and nongenetic (cellular) memory associated with specific gene expression states were necessary for predicting the overall fitness of cell populations in combined environments. We validated these predictions experimentally and identified environmental conditions that defined a “sweet spot” of drug resistance. These findings may provide a roadmap for connecting the molecular-level kinetics of gene networks to cell population fitness in well-defined environments, and may have important implications for phenotypic variability of drug resistance in natural settings

Quantifying shoulder activity after rotator cuff repair: Technique and preliminary results

Repair tissue healing after rotator cuff repair remains a significant clinical problem, and excessive shoulder activity after surgical repair is believed to contribute to re-tears. In contrast, small animal studies have demonstrated that complete removal of activity impairs tendon healing and have advocated for an appropriate level of activity, but in humans the appropriate amount of shoulder activity to enhance healing is not known. As an initial step toward understanding the relationship between postoperative shoulder activity and repair tissue healing, the objectives of this study were to assess the precision, accuracy, and feasibility of a wrist-worn triaxial accelerometer for measuring shoulder activity. Following assessments of precision (±0.002 g) and accuracy (±0.006 g), feasibility was assessed by measuring 1 week of shoulder activity in 14 rotator cuff repair patients and 8 control subjects. Shoulder activity was reported in terms of volume (mean acceleration, activity count, mean activity index, active time) and intensity (intensity gradient). Patients had significantly less volume (p ≤ .03) and intensity (p = .01) than controls. Time post-surgery was significantly associated with the volume (p ≤ .05 for mean acceleration, activity count, and mean activity index) and intensity (p = .03) of shoulder activity, but not active time (p = .08). These findings indicate this approach has the accuracy and precision necessary to continuously monitor shoulder activity with a wrist-worn sensor. The preliminary data demonstrate the ability to discriminate between healthy control subjects and patients recovering from rotator cuff repair and provide support for using a wearable sensor to monitor changes over time in shoulder activity

Cyclic Avian Mass Mortality in the Northeastern United States Is Associated with a Novel Orthomyxovirus

UnlabelledSince 1998, cyclic mortality events in common eiders (Somateria mollissima), numbering in the hundreds to thousands of dead birds, have been documented along the coast of Cape Cod, MA, USA. Although longitudinal disease investigations have uncovered potential contributing factors responsible for these outbreaks, detecting a primary etiological agent has proven enigmatic. Here, we identify a novel orthomyxovirus, tentatively named Wellfleet Bay virus (WFBV), as a potential causative agent of these outbreaks. Genomic analysis of WFBV revealed that it is most closely related to members of the Quaranjavirus genus within the family Orthomyxoviridae. Similar to other members of the genus, WFBV contains an alphabaculovirus gp64-like glycoprotein that was demonstrated to have fusion activity; this also tentatively suggests that ticks (and/or insects) may vector the virus in nature. However, in addition to the six RNA segments encoding the prototypical structural proteins identified in other quaranjaviruses, a previously unknown RNA segment (segment 7) encoding a novel protein designated VP7 was discovered in WFBV. Although WFBV shows low to moderate levels of sequence similarity to Quaranfil virus and Johnston Atoll virus, the original members of the Quaranjavirus genus, additional antigenic and genetic analyses demonstrated that it is closely related to the recently identified Cygnet River virus (CyRV) from South Australia, suggesting that WFBV and CyRV may be geographic variants of the same virus. Although the identification of WFBV in part may resolve the enigma of these mass mortality events, the details of the ecology and epidemiology of the virus remain to be determined.ImportanceThe emergence or reemergence of viral pathogens resulting in large-scale outbreaks of disease in humans and/or animals is one of the most important challenges facing biomedicine. For example, understanding how orthomyxoviruses such as novel influenza A virus reassortants and/or mutants emerge to cause epidemic or pandemic disease is at the forefront of current global health concerns. Here, we describe the emergence of a novel orthomyxovirus, Wellfleet Bay virus (WFBV), which has been associated with cyclic large-scale bird die-offs in the northeastern United States. This initial characterization study provides a foundation for further research into the evolution, epidemiology, and ecology of newly emerging orthomyxoviruses, such as WFBV, and their potential impacts on animal and/or human health

The effect of mesomorphology upon the performance of nanoparticulate organic photovoltaic devices

Scanning transmission X-ray microscopy (STXM) compositional mapping has been used to probe the mesomorphology of nanoparticles (NPs) synthesized from two very different polymer:fullerene blends: poly(3-hexylthiophene) (P3HT): phenyl-C61-butyric acid methyl ester (PCBM) and poly[4,8-bis(2-ethylhexyloxy)benzo(1,2-b:4,5-b')dithiophene-alt-5, 6-bis(octyloxy)-4,7-di(thiophen-2-yl)(2,1,3-benzothiadiazole)-5,5'-diyl] (PSBTBT): PCBM. The STXM data shows that both blends form core-shell NP structures with similar shell compositions, but with different polymer:fullerene ratios in the core regions. P3HT:PCBM and PSBTBT:PCBM NP organic photovoltaic (OPV) devices have been fabricated and exhibit similar device efficiencies, despite the PSBTBT being a much higher performing low band gap material. By comparing the measured NP shell and core compositions with the optimized bulk hetero-junction (BHJ) compositions, we show that the relatively higher performance of the P3HT:PCBM NP device arises from the fact that its shell composition is much closer to the optimal BHJ value than that of the PSBTBT:PCBM NP device