Is Nonoperative Treatment Appropriate for All Patients With Type 1 Tibial Spine Fractures? A Multicenter Study of the Tibial Spine Research Interest Group

BACKGROUND: Type 1 tibial spine fractures are nondisplaced or ≤2 mm-displaced fractures of the tibial eminence and anterior cruciate ligament (ACL) insertion that are traditionally managed nonoperatively with immobilization. HYPOTHESIS: Type 1 fractures do not carry a significant risk of associated injuries and therefore do not require advanced imaging or additional interventions aside from immobilization. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We reviewed 52 patients who were classified by their treating institution with type 1 tibial spine fractures. Patients aged ≤18 years with pretreatment plain radiographs and ≤ 1 year of follow-up were included. Pretreatment imaging was reviewed by 4 authors to assess classification agreement among the treating institutions. Patients were categorized into 2 groups to ensure that outcomes represented classic type 1 fracture patterns. Any patient with universal agreement among the 4 authors that the fracture did not appear consistent with a type 1 classification were assigned to the type 1+ (T1+) group; all other patients were assigned to the true type 1 (TT1) group. We evaluated the rates of pretreatment imaging, concomitant injuries, and need for operative interventions as well as treatment outcomes overall and for each group independently. RESULTS: A total of 48 patients met inclusion criteria; 40 were in the TT1 group, while 8 were in the T1+ group, indicating less than universal agreement in the classification of these fractures. Overall, 12 (25%) underwent surgical treatment, and 12 (25%) had concomitant injuries. Also, 8 patients required additional surgical management including ACL reconstruction (n = 4), lateral meniscal repair (n = 2), lateral meniscectomy (n = 1), freeing an incarcerated medial meniscus (n = 1), and medial meniscectomy (n = 1). CONCLUSION: The classification of type 1 fractures can be challenging. Contrary to prior thought, a substantial number of patients with these fractures (\u3e20%) were found to have concomitant injuries. Overall, surgical management was performed in 25% of patients in our cohort

LICENSING, MIGRATION, AND EARNINGS: SOME EMPIRICAL INSIGHTS -super-1

The authors estimate the impact of occupational licensing on interstate migration and earnings. Interstate misallocation of labor resources and a redistribution of income in favor of the most highly regulated occupations is seen as a consequence of licensure barriers. The article presents descriptive information about the barriers to mobility posed by licensure; it compares interstate migration rates; and it develops an econometric model of licensing, migration, and earnings for those in universally licensed occupations. Copyright 1982 by The Policy Studies Organization.

Direct zinc finger protein persulfidation by H(2)S is facilitated by Zn(2+)

H(2)S is a gaseous signaling molecule that modifies cysteine residues in proteins to form persulfides (P-SSH). One family of proteins modified by H(2)S are zinc finger (ZF) proteins, which contain multiple zinc coordinating cysteine residues. Herein, we report the reactivity of H(2)S with a ZF protein called Tristetraprolin (TTP). Rapid persulfidation leading to complete thiol oxidation of TTP mediated by H(2)S was observed by low temperature ESI-MS and fluorescence spectroscopy. Persulfidation of TTP required O(2), which reacts with H2S to form superoxide, as detected by ESI-MS, a hydroethidine fluorescence assay and EPR spin trap. H(2)S was observed to inhibit TTP function (binding to TNFα mRNA) via an in vitro fluorescence anisotropy assay and to modulate TNFα in vivo. H(2)S was unreactive towards TTP when the protein was bound to RNA, suggesting a protective effect of RNA

A manual of individual mental tests and testing,

Bibliography: p. [255]-279.Mode of access: Internet