Neer Award 2007: Reversion of structural muscle changes caused by chronic rotator cuff tears using continuous musculotendinous traction. An experimental study in sheep

HYPOTHESIS: Chronic rotator cuff tears are associated with irreversible architectural muscle changes and a high rate of repair failure. The changes observed in man and their irreversibility with a single stage repair can be reproduced in sheep. It was the purpose of this experiment to test the hypothesis that slow, continuous elongation of a retracted musculotendinous unit allows reversal of the currently irreversible structural muscle changes. MATERIALS AND METHODS: The infraspinatus tendon of 12 sheep was released using a greater tuberosity osteotomy and allowed to retract for 4 months. Then, a new device was mounted on the scapular spine and used to extend the infraspinatus muscuculotendinous unit transcutaneously by 1 mm per day. Thereafter, the tendon was repaired back to the greater tuberosity. We assessed the muscular architecture using magnetic resonance imaging, macroscopic dissection, histology, and electron microscopy. Fatty infiltration (in Hounsfield units 1/4 HU) and muscular cross-sectional area (in % of the control side) were monitored with computed tomography at tendon release, initiation of elongation, repair, and at sacrifice. RESULTS: Sixteen weeks after tendon release, the mean tendon retraction was 29 +/- 6 mm (14% of original length, P = .008). In 8 sheep, elongation was achieved as planned (group I), but in 4, the elongation failed technically (group II). The mean traction time was 24 +/- 6 days with a mean traction distance of 19 +/- 4 mm. At sacrifice, the mean pennation angle in the infraspinatus of group I was not different from the control side (29.8 degrees +/-7.5 degrees vs. 30 degrees +/-6 degrees , P = .575). In group II, the pennation angle had increased from 30 degrees +/-6 degrees to 55 degrees +/-14 degrees (P = .035). There was no fatty infiltration at the time of tendon release. After retraction, there was a significant increase in fatty infiltration of the infraspinatus muscle and a decrease of its cross-sectional area to 57% of the contralateral side (P = .0001). During traction, the degree of fatty infiltration remained unchanged (36 HU to 38 HU, P = .381), and atrophy improved to a muscle square area of 78% of the contralateral side (P = .0001) in group I. In group II, an increase of fatty infiltration was measured from 36 HU to 28 HU; however, this increase was not significant (P = .144). Atrophy did not change in group II (57-55%, P = .946). At sacrifice, the remaining muscle mass was 64% in group I and 46% in group II (P = .019). DISCUSSION: Our preliminary results document, that continuous elongation of a retracted, fatty infiltrated and atrophied musculotendinous unit is technically feasible. CONCLUSION: In the sheep, continuous elongation can lead to restoration of normal muscle architecture, to partial reversal of muscle atrophy, and to arrest of the progression of fatty infiltration. LEVEL OF EVIDENCE: Basic science level 2; Prospective comparative therapeutic study.

Single crowns versus conventional fillings for the restoration of root-filled teeth.

BACKGROUND Endodontic treatment involves removal of the dental pulp and its replacement by a root canal filling. Restoration of root filled teeth can be challenging due to structural differences between vital and non-vital root-filled teeth. Direct restoration involves placement of a restorative material e.g. amalgam or composite, directly into the tooth. Indirect restorations consist of cast metal or ceramic (porcelain) crowns. The choice of restoration depends on the amount of remaining tooth, and may influence durability and cost. The decision to use a post and core in addition to the crown is clinician driven. The comparative clinical performance of crowns or conventional fillings used to restore root-filled teeth is unknown. This review updates the original, which was published in 2012. OBJECTIVES To assess the effects of restoration of endodontically treated teeth (with or without post and core) by crowns versus conventional filling materials. SEARCH METHODS We searched the following databases: the Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE via OVID, EMBASE via OVID, CINAHL via EBSCO, LILACS via BIREME. We also searched the reference lists of articles and ongoing trials registries.There were no restrictions regarding language or date of publication. The search is up-to-date as of 26 March 2015. SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-randomised controlled trials in participants with permanent teeth that have undergone endodontic treatment. Single full coverage crowns compared with any type of filling materials for direct restoration or indirect partial restorations (e.g. inlays and onlays). Comparisons considered the type of post and core used (cast or prefabricated post), if any. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included trial and assessed its risk of bias. We carried out data analysis using the 'treatment as allocated' patient population, expressing estimates of intervention effect for dichotomous data as risk ratios, with 95% confidence intervals (CI). MAIN RESULTS We included one trial, which was judged to be at high risk of performance, detection and attrition bias. The 117 participants with a root-filled, premolar tooth restored with a carbon fibre post, were randomised to either a full coverage metal-ceramic crown or direct adhesive composite restoration. None experienced a catastrophic failure (i.e. when the restoration cannot be repaired), although only 104 teeth were included in the final, three-year assessment. There was no clear difference between the crown and composite group and the composite only group for non-catastrophic failures of the restoration (1/54 versus 3/53; RR 0.33; 95% CI 0.04 to 3.05) or failures of the post (2/54 versus 1/53; RR 1.96; 95% CI 0.18 to 21.01) at three years. The quality of the evidence for these outcomes is very low. There was no evidence available for any of our secondary outcomes: patient satisfaction and quality of life, incidence or recurrence of caries, periodontal health status, and costs. AUTHORS' CONCLUSIONS There is insufficient evidence to assess the effects of crowns compared to conventional fillings for the restoration of root-filled teeth. Until more evidence becomes available, clinicians should continue to base decisions about how to restore root-filled teeth on their own clinical experience, whilst taking into consideration the individual circumstances and preferences of their patients.

Structural Analysis of Thin Tile Vaults and Domes: The Inner Oval Dome of the Basilica de los Desamparados in Valencia

The inner oval dome of the Basílica de la Virgen los Desamparados, built in 1701, is one of the most slender masonry vaults ever built. It is a tile dome with a total thickness of 80 mm and a main span of 18.50 m. It was built without centering with great ingenuity and economy of means, thirty three years after the termination of the building in 1667. The dome is in contact with the external dome only in the inferior part with the projecting ribs of the intrados, the lunettes of the windows, and, in the upper part, through 126 inclined iron bars. This unique construction was revealed in the 1990's in the studies previous to the restoration of the Basílica, and has given rise to different theories about the mode of construction and the structural behaviour and safety of the dome. The present contribution aims to provide a plausible hypothesis about the mode of construction and to explain the safety of the inner dome which has stood, without need of repairs or reinforcement, for 300 hundred years.

Towards the formation of a sustainable South Florida: An analysis of conflict resolution and consensus building in the South Florida Everglades Ecosystem Restoration Initiative

This dissertation examines the sociological process of conflict resolution and consensus building in South Florida Everglades Ecosystem Restoration through what I define as a Network Management Coordinative Interstitial Group (NetMIG). The process of conflict resolution can be summarized as the participation of interested and affected parties (stakeholders) in a forum of negotiation. I study the case of the Governor's Commission for a Sustainable South Florida (GCSSF) that was established to reduce social conflict. Such conflict originated from environmental disputes about the Everglades and was manifested in the form of gridlock among regulatory (government) agencies, Indian tribes, as well as agricultural, environmental conservationist and urban development interests. The purpose of the participatory forum is to reduce conflicts of interest and to achieve consensus, with the ultimate goal of restoration of the original Everglades ecosystem, while cultivating the economic and cultural bases of the communities in the area. Further, the forum aim to formulate consensus through envisioning a common sustainable community by providing means to achieve a balance between human and natural systems. ^ Data were gathered using participant observation and document analysis techniques to conduct a theoretically based analysis of the role of the Network Management Coordinative Interstitial Group (NetMIG). I use conflict resolution theory, environmental conflict theory, stakeholder analysis, systems theory, differentiation and social change theory, and strategic management and planning theory. ^ The purpose of this study is to substantiate the role of the Governor's Commission for a Sustainable South Florida (GCSSF) as a consortium of organizations in an effort to resolve conflict rather than an ethnographic study of this organization. Environmental restoration of the Everglades is a vehicle for recognizing the significance of a Network Management Coordinative Interstitial Group (NetMIG), namely the Governor's Commission for a Sustainable South Florida (GCSSF), as a structural mechanism for stakeholder participation in the process of social conflict resolution through the creation of new cultural paradigms for a sustainable community. ^

Using Florida Keys Reference Sites As a Standard for Restoration of Forest Structure in Everglades Tree Islands

In south Florida, tropical hardwood forests (hammocks) occur in Everglades tree islands and as more extensive forests in coastal settings in the nearby Florida Keys. Keys hammocks have been less disturbed by humans, and many qualify as “old-growth,” while Everglades hammocks have received much heavier use. With improvement of tree island condition an important element in Everglades restoration efforts, we examined stand structure in 23 Keys hammocks and 69 Everglades tree islands. Based on Stand Density Index and tree diameter distributions, many Everglades hammocks were characterized by low stocking and under-representation in the smaller size classes. In contrast, most Keys forests had the dense canopies and open understories usually associated with old-growth hardwood hammocks. Subject to the same caveats that apply to off-site references elsewhere, structural information from mature Keys hammocks can be helpful in planning and implementing forest restoration in Everglades tree islands. In many of these islands, such restoration might involve supplementing tree stocking by planting native trees to produce more complete site utilization and a more open understory.

Eastern oysters (Crassostrea virginica) as an indicator for restoration of Everglades Ecosystems

The Comprehensive Everglades Restoration Plan (CERP) attempts to restore hydrology in the Northern and Southern Estuaries of Florida. Reefs of the Eastern oyster Crassostrea virginica are a dominant feature of the estuaries along the Southwest Florida coast. Oysters are benthic, sessile, filter-feeding organisms that provide ecosystem services by filtering the water column and providing food, shelter and habitat for associated organisms. As such, the species is an excellent sentinel organism for examining the impacts of restoration on estuarine ecosystems. The implementation of CERP attempts to improve: the hydrology and spatial and structural characteristics of oyster reefs, the recruitment and survivorship of C. virginica, and the reef-associated communities of organisms. This project links biological responses and environmental conditions relative to hydrological changes as a means of assessing positive or negative trends in oyster responses and population trends. Using oyster responses, we have developed a communication tool (i.e., Stoplight Report Card) based on CERP performance measures that can distinguish between responses to restoration and natural patterns. The Stoplight Report Card system is a communication tool that uses Monitoring and Assessment Program (MAP) performance measures to grade an estuary's response to changes brought about by anthropogenic input or restoration activities. The Stoplight Report Card consists of both a suitability index score for each organism metric as well as a trend score (− decreasing trend, +/− no change in trend, and + increasing trend). Based on these two measures, a component score (e.g., living density) is calculated by averaging the suitability index score and the trend score. The final index score is obtained by taking the geometric score of each component, which is then translated into a stoplight color for success (green), caution (yellow), or failure (red). Based on the data available for oyster populations and the responses of oysters in the Caloosahatchee Estuary, the system is currently at stage “caution.” This communication tool instantly conveys the status of the indicator and the suitability, while trend curves provide information on progress towards reaching a target. Furthermore, the tool has the advantage of being able to be applied regionally, by species, and collectively, in concert with other species, system-wide.

Effect of Hydrologic Restoration on the Habitat of The Cape Sable Seaside Sparrow, Annual Report of 2002-2003

After developing field sampling protocols and making a series of consultations with investigators involved in research in CSSS habitat, we determined that vegetationhydrology interactions within this landscape are best sampled at a combination of scales. At the finer scale, we decided to sample at 100 m intervals along transects that cross the range of habitats present, and at the coarser scale, to conduct an extensive survey of vegetation at sites of known sparrow density dispersed throughout the range of the CSSS. We initiated sampling in the first week of January 2003 and continued it through the last week of May. During this period, we established 6 transects, one in each CSSS subpopulation, completed topographic survey along the Transects A, C, D, and F, and sampled herb and shrub stratum vegetation, soil depth and periphyton along Transects A, and at 179 census points. We also conducted topographic surveys and completed vegetation and soil depth sampling along two of five transects used by ENP researchers for monitoring long-term vegetation change in Taylor Slough. We analyzed the data by summarizing the compositional and structural measures and by using cluster analysis, ordination, weighted averaging regression, and weighted averaging calibration. The mean elevation of transects decreased from north to south, and Transect F had greater variation than other transects. We identified eight vegetation assemblages that can be grouped into two broad categories, ‘wet prairie’ and ‘marsh’. In the 2003 survey, wet prairies were most dominant in the northeastern sub-populations, and had shorter inferred-hydroperiod, higher species richness and shallower soils than marshes, which were common in Subpopulations A, D, and the southernmost regions of Sub-population B. Most of the sites at which birds were observed during 2001 or 2002 had an inferred-hydroperiod of 120-150 days, while no birds were observed at sites with an inferred-hydroperiod less than 120 days or more than 300 days. Management-induced water level changes in Taylor Slought during the 1980’s and 1990’s appeared to elicit parallel changes in vegetation. The results described in detail in the following pages serve as a basis for evaluating and modifying, if necessary, the sampling design and analytical techniques to be used in the next three years of the project.

Effect of Hydrologic Restoration on the Habitat of The Cape Sable Seaside Sparrow, Annual Report of 2003-2004

Following on our previous year’s work on ‘Effect of hydrologic restoration on the habitat of the Cape Sable seaside sparrow (CSSS)’, we presented first year results at the Cape Sable seaside sparrow – fire planning workshop at Everglades National Park in December 2003. Later, with almost the same set of crews as in the previous year, we started field work in the first week of January and continued till May 26, 2004. Protocols for sampling topography and vegetation in 2004 were identical to the previous year. In the early season, we completed topographic surveys along two remaining transects, B and E (~16.5 km), and vegetation surveys along three transects, D, E and F (~10.8 km), leaving only the vegetation sampling on transects B and C to be completed in 2005. During April and May, vegetation sampling was completed at 230 census sites, making the total of 409 CSSS census sites for which we have complete vegetation data. We updated data sets from both 2003 and 2004, and analyzed them together using cluster analysis, ordination, weighted-averaging regression and analysis of variance, as we had in 2003. Additionally, we used logistic regression to examine the effect of vegetation structural parameters on the recent occurrence of CSSS. We also analyzed vegetation observations recorded by the sparrow census team in 1981 and annually between 1992 and 2004 to assess historical patterns of vegetation change in CSSS habitat.

Solutions for the conservation and restoration of cement-based materials in XX Century architectural heritage

Among the most representative materials of XX Century architectural heritage, this dissertation focuses on the cement-based ones, investigating some different fields where they were exploited. Primarily, concerning the surface preservation of cement-based materials used with aesthetic intent, new self-cleaning treatments based on titania nanoparticles embedded in inorganic matrices were tested. In order to consider the role of porosity, the treatments were applied to different kinds of materials (cement-based mortar, marble and concrete) and several analyses were conducted to investigate the morphology of the coatings, their photocatalytic effectiveness, their durability and the interaction between the coating and the substrate material. The outcomes showed that several parameters influence the treatment’s performances, in particular, the presence and nature of the matrix, the concentration and dispersion of nanoparticles and, in some cases, the amount of substrate material which interacts with the coatings. Secondly, this dissertation deals with the historic “Terranova” render, a colored dry-mix mortar largely widespread in Europe in the first half of XX Century, whose formulation is still basically unknown. Some original samples of supposedly Terranova renders were subjected to several characterization analyses and the results were compared to those of the original “Terranova” render of the Engineering Faculty in Bologna. Despite the recurrence of some features, defining a common formulation seemed to be challenging. Finally, the repair and conservation of structural reinforced concrete in heritage buildings were investigated, adopting the former “Casa del Fascio” in Predappio (FC, Italy) as case study. Three different materials and solutions were tested on a slab of the building, making its repair only from the intrados. Then several analyses were conducted both on site and in laboratory. Aside from the specific features characterizing every product, the results highlighted that the application method played a fundamental role in the effectiveness of the retrofit strategies.

Lung Age Is Related To Carotid Structural Alterations In Hypertensive Subjects.

Hypertensive patients exhibit higher cardiovascular risk and reduced lung function compared with the general population. Whether this association stems from the coexistence of two highly prevalent diseases or from direct or indirect links of pathophysiological mechanisms is presently unclear. This study investigated the association between lung function and carotid features in non-smoking hypertensive subjects with supposed normal lung function. Hypertensive patients (n = 67) were cross-sectionally evaluated by clinical, hemodynamic, laboratory, and carotid ultrasound analysis. Forced vital capacity, forced expired volume in 1 second and in 6 seconds, and lung age were estimated by spirometry. Subjects with ventilatory abnormalities according to current guidelines were excluded. Regression analysis adjusted for age and prior smoking history showed that lung age and the percentage of predicted spirometric parameters associated with common carotid intima-media thickness, diameter, and stiffness. Further analyses, adjusted for additional potential confounders, revealed that lung age was the spirometric parameter exhibiting the most significant regression coefficients with carotid features. Conversely, plasma C-reactive protein and matrix-metalloproteinases-2/9 levels did not influence this relationship. The present findings point toward lung age as a potential marker of vascular remodeling and indicate that lung and vascular remodeling might share common pathophysiological mechanisms in hypertensive subjects.

Structural Connectivity Of The Default Mode Network And Cognition In Alzheimer׳s Disease.

Disconnectivity between the Default Mode Network (DMN) nodes can cause clinical symptoms and cognitive deficits in Alzheimer׳s disease (AD). We aimed to examine the structural connectivity between DMN nodes, to verify the extent in which white matter disconnection affects cognitive performance. MRI data of 76 subjects (25 mild AD, 21 amnestic Mild Cognitive Impairment subjects and 30 controls) were acquired on a 3.0T scanner. ExploreDTI software (fractional Anisotropy threshold=0.25 and the angular threshold=60°) calculated axial, radial, and mean diffusivities, fractional anisotropy and streamline count. AD patients showed lower fractional anisotropy (P=0.01) and streamline count (P=0.029), and higher radial diffusivity (P=0.014) than controls in the cingulum. After correction for white matter atrophy, only fractional anisotropy and radial diffusivity remained significantly lower in AD compared to controls (P=0.003 and P=0.05). In the parahippocampal bundle, AD patients had lower mean and radial diffusivities (P=0.048 and P=0.013) compared to controls, from which only radial diffusivity survived for white matter adjustment (P=0.05). Regression models revealed that cognitive performance is also accounted for by white matter microstructural values. Structural connectivity within the DMN is important to the execution of high-complexity tasks, probably due to its relevant role in the integration of the network.

Electronic And Structural Study Of Pt-modified Au Vicinal Surfaces: A Model System For Pt-au Catalysts.

Two single crystalline surfaces of Au vicinal to the (111) plane were modified with Pt and studied using scanning tunneling microscopy (STM) and X-ray photoemission spectroscopy (XPS) in ultra-high vacuum environment. The vicinal surfaces studied are Au(332) and Au(887) and different Pt coverage (θPt) were deposited on each surface. From STM images we determine that Pt deposits on both surfaces as nanoislands with heights ranging from 1 ML to 3 ML depending on θPt. On both surfaces the early growth of Pt ad-islands occurs at the lower part of the step edge, with Pt ad-atoms being incorporated into the steps in some cases. XPS results indicate that partial alloying of Pt occurs at the interface at room temperature and at all coverage, as suggested by the negative chemical shift of Pt 4f core line, indicating an upward shift of the d-band center of the alloyed Pt. Also, the existence of a segregated Pt phase especially at higher coverage is detected by XPS. Sample annealing indicates that the temperature rise promotes a further incorporation of Pt atoms into the Au substrate as supported by STM and XPS results. Additionally, the catalytic activity of different PtAu systems reported in the literature for some electrochemical reactions is discussed considering our findings.

A New Platinum Complex With Tryptophan: Synthesis, Structural Characterization, Dft Studies And Biological Assays In Vitro Over Human Tumorigenic Cells.

A new platinum(II) complex with the amino acid L-tryptophan (trp), named Pt-trp, was synthesized and characterized. Elemental, thermogravimetric and ESI-QTOF mass spectrometric analyses led to the composition [Pt(C11H11N2O2)2]⋅6H2O. Infrared spectroscopic data indicate the coordination of trp to Pt(II) through the oxygen of the carboxylate group and also through the nitrogen atom of the amino group. The (13)C CP/MAS NMR spectroscopic data confirm coordination through the oxygen atom of the carboxylate group, while the (15)N CP/MAS NMR data confirm coordination of the nitrogen of the NH2 group to the metal. Density functional theory (DFT) studies were applied to evaluate the cis and trans coordination modes of trp to platinum(II). The trans isomer was shown to be energetically more stable than the cis one. The Pt-trp complex was evaluated as a cytotoxic agent against SK-Mel 103 (human melanoma) and Panc-1 (human pancreatic carcinoma) cell lines. The complex was shown to be cytotoxic over the considered cells.

Structural And Biomechanical Changes In The Achilles Tendon After Chronic Treatment With Statins.

Cases of tendinopathy and tendon ruptures have been reported as side effects associated with statin therapy. This work assessed possible changes in the structural and biomechanical properties of the tendons after chronic treatment with statins. Wistar rats were divided into the following groups: treated with atorvastatin (A-20 and A-80), simvastatin (S-20 and S-80) and the group that received no treatment (C). The doses of statins were calculated using allometric scaling, based on the doses of 80 mg/day and 20 mg/day recommended for humans. The morphological aspect of the tendons in A-20, S-20 and S-80 presented signals consistent with degeneration. Both the groups A-80 and S-80 showed a less pronounced metachromasia in the compression region of the tendons. Measurements of birefringence showed that A-20, A-80 and S-80 groups had a lower degree of organization of the collagen fibers. In all of the groups treated with statins, the thickness of the epitenon was thinner when compared to the C group. In the biomechanical tests the tendons of the groups A-20, A-80 and S-20 were less resistant to rupture. Therefore, statins affected the organization of the collagen fibers and decreased the biomechanical strength of the tendons, making them more predisposed to ruptures.

Kinase Inhibitor Profile For Human Nek1, Nek6, And Nek7 And Analysis Of The Structural Basis For Inhibitor Specificity.

Human Neks are a conserved protein kinase family related to cell cycle progression and cell division and are considered potential drug targets for the treatment of cancer and other pathologies. We screened the activation loop mutant kinases hNek1 and hNek2, wild-type hNek7, and five hNek6 variants in different activation/phosphorylation statesand compared them against 85 compounds using thermal shift denaturation. We identified three compounds with significant Tm shifts: JNK Inhibitor II for hNek1(Δ262-1258)-(T162A), Isogranulatimide for hNek6(S206A), andGSK-3 Inhibitor XIII for hNek7wt. Each one of these compounds was also validated by reducing the kinases activity by at least 25%. The binding sites for these compounds were identified by in silico docking at the ATP-binding site of the respective hNeks. Potential inhibitors were first screened by thermal shift assays, had their efficiency tested by a kinase assay, and were finally analyzed by molecular docking. Our findings corroborate the idea of ATP-competitive inhibition for hNek1 and hNek6 and suggest a novel non-competitive inhibition for hNek7 in regard to GSK-3 Inhibitor XIII. Our results demonstrate that our approach is useful for finding promising general and specific hNekscandidate inhibitors, which may also function as scaffolds to design more potent and selective inhibitors.