Increased Construct Stiffness With Meniscal Repair Sutures and Devices Increases the Risk of Cheese-Wiring During Biomechanical Load-to-Failure Testing

Background: Cheese-wiring, the suture that cuts through the meniscus, is a well-known issue in meniscal repair. So far, contributing factors are neither fully understood nor sufficiently studied. Hypothesis/Purpose: To investigate whether the construct stiffness of repair sutures and devices correlates with suture cut-through (cheese-wiring) during load-to-failure testing. Study Design: Controlled laboratory study. Methods: In 131 porcine menisci, longitudinal bucket-handle tears were repaired using either inside-out sutures (n = 66; No. 0 Ultrabraid, 2-0 Orthocord, 2-0 FiberWire, and 2-0 Ethibond) or all-inside devices (n = 65; FastFix360, Omnispan, and Meniscal Cinch). After cyclic loading, load-to-failure testing was performed. The mode of failure and construct stiffness were recorded. A receiver operating characteristic curve analysis was performed to define the optimal stiffness threshold for predicting meniscal repair failure by cheese-wiring. The 2-tailed t test and analysis of variance were used to test significance. Results: Loss of suture fixation was the most common mode of failure in all specimens (58%), except for the Omnispan, which failed most commonly because of anchor pull-through. The Omnispan demonstrated the highest construct stiffness (30.8 ± 3.5 N/mm), whereas the Meniscal Cinch (18.0 ± 8.8 N/mm) and Ethibond (19.4 ± 7.8 N/mm) demonstrated the lowest construct stiffness. The Omnispan showed significantly higher stiffness compared with the Meniscal Cinch ( P < .001) and Ethibond ( P = .02), whereas the stiffness of the Meniscal Cinch was significantly lower compared with that of the FiberWire ( P = .01), Ultrabraid ( P = .04), and FastFix360 ( P = .03). While meniscal repair with a high construct stiffness more often failed by cheese-wiring, meniscal repair with a lower stiffness failed by loss of suture fixation, knot slippage, or anchor pull-through. Meniscal repair with a stiffness >26.5 N/mm had a 3.6 times higher risk of failure due to cheese-wiring during load-to-failure testing (95% CI, 1.4-8.2; P < .0001). Conclusion: Meniscal repair using inside-out sutures and all-inside devices with a higher construct stiffness (>26.5 N/mm) was more likely to fail through suture cut-through (cheese-wiring) than that with a lower stiffness (≤26.5 N/mm). Clinical Relevance: This is the first study investigating the impact of construct stiffness on meniscal repair failure by suture cut-through (cheese-wiring).

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Comparison of All-Inside Meniscal Repair Devices With Matched Inside-Out Suture Repair

The American Journal of Sports Medicine ◽

10.1177/0363546511424723 ◽

2011 ◽

Vol 39 (12) ◽

pp. 2634-2639 ◽

Cited By ~ 27

Author(s):

Claudio Rosso ◽

Konstantin Kovtun ◽

William Dow ◽

Brett McKenzie ◽

Ara Nazarian ◽

...

Keyword(s):

Cyclic Loading ◽

Meniscal Repair ◽

Suture Repair ◽

Initial Displacement ◽

Displacement Response ◽

Significant Difference ◽

Mode Of Failure ◽

Load To Failure ◽

Suture Failure ◽

Inside Out

Background: All-inside meniscal repairs are performed with increasing frequency because of the availability of newly developed devices. A comparison of their biomechanical characteristics may aid physicians in selecting a method of meniscal repair. Hypothesis: All-inside meniscal repairs will be superior to their inside-out controls in response to cyclic loading and load-to-failure testing. Study Design: Controlled laboratory study. Methods: Sixty-six bucket-handle tears in matched porcine menisci were repaired using the Ultra FasT-Fix, Meniscal Cinch, Ultrabraid No. 0, and FiberWire 2-0 sutures. Initial displacement, cyclic loading (100, 300, and 500 cycles), and load-to-failure testing were performed. The displacement, response to cyclic loading, and mode of failure were recorded. The stiffness was calculated. Results: The Meniscal Cinch demonstrated a significantly higher initial displacement than the other methods tested ( P = .04). No significant difference was found among the methods in response to cyclic loading. The inside-out FiberWire repair demonstrated the highest load to failure (120.8 ± 23.5 N) and was significantly higher than both the Meniscal Cinch (64.8 ± 24.1 N, P < .001) and the Ultra FasT-Fix (88.3 ± 14.3 N, P = .002). It was not significantly higher than the inside-out Ultrabraid suture repair (98.8 ± 29.2 N). The inside-out FiberWire repair had the highest stiffness (28.7 ± 7.8 N/mm). It was significantly higher than the Meniscal Cinch (18.0 ± 8.8 N/mm, P = .01). The most common mode of failure in all methods was suture failure. Conclusion: An inside-out suture repair affords surgeons the best overall biomechanical characteristics of the devices tested (initial displacement, response to cyclic loading, and load to failure). For an all-inside repair, the Ultra FasT-Fix reproduces the characteristics of its matched inside-out suture repair more closely than the Meniscal Cinch. Clinical Relevance: Inside-out sutures and all-inside devices have similar responses to cyclic loading.

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Efficacy of Crisis Intervention

Crisis ◽

10.1027//0227-5910.20.2.78 ◽

1999 ◽

Vol 20 (2) ◽

pp. 78-85 ◽

Cited By ~ 6

Author(s):

Thomas Reisch ◽

Petra Schlatter ◽

Wolfgang Tschacher

Keyword(s):

Crisis Intervention ◽

Intervention Program ◽

Suicide Ideation ◽

Indirect Evidence ◽

Well Being ◽

Term Therapy ◽

Contributing Factors ◽

Step Therapy ◽

Long Term Therapy ◽

The Impact

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

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Relative contributions of family history and a polygenic risk score on COPD and related outcomes: COPDGene and ECLIPSE studies

BMJ Open Respiratory Research ◽

10.1136/bmjresp-2020-000755 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000755

Author(s):

Matthew Moll ◽

Sharon M. Lutz ◽

Auyon J. Ghosh ◽

Phuwanat Sakornsakolpat ◽

Craig P. Hersh ◽

...

Keyword(s):

Family History ◽

Risk Score ◽

Characteristic Curve ◽

Significant Proportion ◽

Chronic Obstructive ◽

Polygenic Risk Score ◽

Positive Interaction ◽

Polygenic Risk ◽

Mediation Analyses ◽

The Impact

IntroductionFamily history is a risk factor for chronic obstructive pulmonary disease (COPD). We previously developed a COPD risk score from genome-wide genetic markers (Polygenic Risk Score, PRS). Whether the PRS and family history provide complementary or redundant information for predicting COPD and related outcomes is unknown.MethodsWe assessed the predictive capacity of family history and PRS on COPD and COPD-related outcomes in non-Hispanic white (NHW) and African American (AA) subjects from COPDGene and ECLIPSE studies. We also performed interaction and mediation analyses.ResultsIn COPDGene, family history and PRS were significantly associated with COPD in a single model (PFamHx <0.0001; PPRS<0.0001). Similar trends were seen in ECLIPSE. The area under the receiver operator characteristic curve for a model containing family history and PRS was significantly higher than a model with PRS (p=0.00035) in NHWs and a model with family history (p<0.0001) alone in NHWs and AAs. Both family history and PRS were significantly associated with measures of quantitative emphysema and airway thickness. There was a weakly positive interaction between family history and the PRS under the additive, but not multiplicative scale in NHWs (relative excess risk due to interaction=0.48, p=0.04). Mediation analyses found that a significant proportion of the effect of family history on COPD was mediated through PRS in NHWs (16.5%, 95% CI 9.4% to 24.3%), but not AAs.ConclusionFamily history and the PRS provide complementary information for predicting COPD and related outcomes. Future studies can address the impact of obtaining both measures in clinical practice.

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Parkinson’s Disease and the COVID-19 Pandemic

Journal of Parkinson s Disease ◽

10.3233/jpd-202320 ◽

2021 ◽

pp. 1-14

Author(s):

Conor Fearon ◽

Alfonso Fasano

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Indirect Effects ◽

Mortality Data ◽

Contributing Factors ◽

Scientific Rigor ◽

The Impact ◽

The Relationship ◽

Non Motor Symptoms ◽

Convincing Data

Studies focusing on the relationship between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), coronavirus disease 2019 (COVID-19), and Parkinson’s disease (PD) have provided conflicting results. We review the literature to investigate: 1) Are PD patients at higher risk for contracting COVID-19 and are there specific contributing factors to that risk? 2) How does COVID-19 affect PD symptoms? 3) How does COVID-19 present in PD patients? 4) What are the outcomes in PD patients who contract COVID-19? 5) What is the impact of COVID-19 on PD care? 6) Does COVID-19 increase the risk of developing PD? A literature search was performed from 1979 to 2020 using the terms: ‘Parkinson’s disease’ and ‘parkinsonism’ combined with: ‘COVID-19’; ‘SARS-CoV-2’ and ‘coronavirus’. It does not appear that PD is a specific risk factor for COVID-19. There is evidence for direct/indirect effects of SARS-CoV-2 on motor/non-motor symptoms of PD. Although many PD patients present with typical COVID-19 symptoms, some present atypically with isolated worsening of parkinsonian symptoms, requiring increased anti-PD therapy and having worse outcomes. Mortality data on PD patients with COVID-19 is inconclusive (ranging from 5.2%to 100%). Patients with advanced PD appear to be particularly vulnerable. Single cases of acute hypokinetic-rigid syndrome have been described but no other convincing data has been reported. The rapidity with which COVID-19 has swept across the globe has favored the proliferation of studies which lack scientific rigor and the PD literature has not been immune. A coordinated effort is required to assimilate data and answer these questions in larger PD cohorts.

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Contributing Factors to Perinatal Outcome in Pregnancies with Gestational Diabetes—What Matters Most? A Retrospective Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10020348 ◽

2021 ◽

Vol 10 (2) ◽

pp. 348

Author(s):

Friederike Weschenfelder ◽

Friederike Hein ◽

Thomas Lehmann ◽

Ekkehard Schleußner ◽

Tanja Groten

Keyword(s):

Weight Gain ◽

Gestational Diabetes ◽

Perinatal Outcome ◽

Perinatal Outcomes ◽

Large For Gestational Age ◽

Obese Women ◽

Patient Counseling ◽

Contributing Factors ◽

Prepregnancy Bmi ◽

The Impact

The aim of diabetes care of pregnant women with gestational diabetes mellitus (GDM) is to attain pregnancy outcomes including rates of large-for-gestational-age (LGA) newborns, pre-eclampsia, C-sections (CS) and other neonatal outcomes similar to those of the non-GDM pregnant population. Obesity and excessive weight gain during pregnancy have been shown to also impact perinatal outcome. Since GDM is frequently associated with elevated body mass index (BMI), we evaluated the impact of maternal prepregnancy BMI, development of GDM and gestational weight gain (GWG) during pregnancy on perinatal outcome. We compared 614 GDM patients with 5175 non-diabetic term deliveries who gave birth between 2012 and 2016. Multivariate regression analysis was used to evaluate the independent contribution of each factor on selected perinatal outcome variables. Additionally, subgroup analysis for obese (BMI ≥ 30 kg/m2) and non-obese women (BMI < 30 kg/m2) was performed. LGA was significantly influenced by BMI, GWG and GDM, while Neonatal Intensive Care Unit (NICU) admission was solely impacted by GDM. Maternal outcomes were not dependent on GDM but on GWG and prepregnancy BMI. These results remained significant in the non-obese subgroup only. Thus, GDM still affects perinatal outcomes and requires further improvement in diabetic care and patient counseling.

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When Triple Helix Unravels

Industry and Higher Education ◽

10.5367/ihe.2011.0057 ◽

2011 ◽

Vol 25 (5) ◽

pp. 333-345 ◽

Cited By ~ 10

Author(s):

Denis Gray ◽

Eric Sundstrom ◽

Louis G. Tornatzky ◽

Lindsey McGowen

Keyword(s):

Social Science ◽

Triple Helix ◽

Science Literature ◽

Contributing Factors ◽

Cooperative Research ◽

Success Stories ◽

The Impact ◽

Cooperative Research Centres ◽

Research Centres ◽

Learning Points

Cooperative research centres (CRCs) increasingly foster Triple Helix (industry–university–government) collaboration and represent significant vehicles for cooperation across sectors, the promotion of knowledge and technology transfer and ultimately the acceleration of innovation. A growing social science literature on CRCs focuses on their management and best practices, mainly through success stories and rarely by describing and analysing CRC failures. The literature on CRCs can benefit by learning from failures, as has been seen in other areas of social science. Here the authors present four mini-cases of CRC failures – centres that were successfully launched but later declined and closed – and, in contrast, one mini-case of a success story. The analysis identifies: (a) likely contributing factors in the failures, mainly environmental influences and mismanagement of centre transitions; (b) themes in the failures, notably a tendency for problems in one area to magnify the impact of problems in other areas; and (c) learning points for CRCs concerning leadership and succession. The implications for Triple Helix organizations are discussed.

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The Experiment on Soil Water Characteristic Curve Considering the Effect of Urea Concentration

Advanced Materials Research ◽

10.4028/www.scientific.net/amr.919-921.795 ◽

2014 ◽

Vol 919-921 ◽

pp. 795-799

Author(s):

Gai Qing Dai ◽

Dong Fang Tian ◽

Yao Ruan ◽

Lang Tian ◽

You Le Wang

Keyword(s):

Water Content ◽

Soil Water ◽

Characteristic Curve ◽

Urea Concentration ◽

Test Method ◽

Materials Selection ◽

Valuable Data ◽

Soil Water Characteristic Curve ◽

Concentration Test ◽

The Impact

A new soil water characteristic curve (SWCC) experiment contemplating urea concentration is presented in the paper. We focus on the impact of the SWCC considering urea concentration test method for materials selection and introduction, experimental results, and finally, we have conducted some experiments of SWCC and obtained some valuable data which could affect urea concentration. By using linear fitting, an exponential function between water content and suction and urea concentration is established.

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Outcomes of Inside-out Meniscal Repair in the Setting of Multiligament Reconstruction in the Knee

The American Journal of Sports Medicine ◽

10.1177/0363546517698944 ◽

2017 ◽

Vol 45 (9) ◽

pp. 2098-2104 ◽

Cited By ~ 5

Author(s):

Jorge Chahla ◽

Chase S. Dean ◽

Lauren M. Matheny ◽

Justin J. Mitchell ◽

Mark E. Cinque ◽

...

Keyword(s):

Failure Rate ◽

Meniscal Repair ◽

Postoperative Outcome ◽

Control Group ◽

Failure Rates ◽

Significant Difference ◽

Outcome Scores ◽

Inside Out ◽

Repair Group

Background: Limited evidence exists for meniscal repair outcomes in a multiligament reconstruction setting. Purpose/Hypothesis: The purpose of this study was to assess outcomes and failure rates of meniscal repair in patients who underwent multiligament reconstruction compared with patients who underwent multiligament reconstruction but lacked meniscal tears. The authors hypothesized that the outcomes of meniscal repair associated with concomitant multiligament reconstruction would significantly improve from preoperatively to postoperatively at a minimum of 2 years after the index surgery. Secondarily, they hypothesized that this cohort would demonstrate similar outcomes and failure rates compared with the cohort that did not have meniscal lesions at the time of multiligament reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Inclusion criteria for the study included radiographically confirmed skeletally mature patients of at least 16 years of age who underwent multiligamentous reconstruction of the knee without previous ipsilateral osteotomy, intra-articular infections, or intra-articular fractures. Patients were included in the experimental group if they underwent inside-out meniscal suture repair with concurrent multiligament reconstruction. Those included in the control group (multiligament reconstruction without a meniscal tear) underwent multiligament reconstruction but did not undergo any type of meniscal surgery. Lysholm, Western Ontario and McMaster Universities Osteoarthritis Index, Short Form–12 physical component summary and mental component summary, Tegner activity scale, and patient satisfaction scores were recorded preoperatively and postoperatively. The failure of meniscal repair was defined as a retear of the meniscus that was confirmed arthroscopically. Results: There were 43 patients (16 female, 27 male) in the meniscal repair group and 62 patients (25 female, 37 male) in the control group. Follow-up was obtained in 93% of patients with a mean of 3.0 years (range, 2.0-4.7 years). There was a significant improvement between all preoperative and postoperative outcome scores ( P < .05) for both groups. The meniscal repair group had significantly lower preoperative Lysholm and Tegner scores ( P = .009 and P = .02, respectively). There were no significant differences between any other outcome scores preoperatively. The failure rate of the meniscal repair group was 2.7%, consisting of 1 symptomatic meniscal retear. There was no significant difference in any postoperative outcome score at a minimum 2-year follow-up between the 2 groups. Conclusion: Good to excellent patient-reported outcomes were reported for both groups with no significant differences in outcomes between the cohorts. Additionally, the failure rate for inside-out meniscal repair with concomitant multiligament reconstruction was low, regardless of meniscus laterality and tear characteristics. The use of multiple vertical mattress sutures and the biological augmentation resulting from intra-articular cruciate ligament reconstruction tunnel reaming may be partially responsible for the stability of the meniscal repair construct and thereby contribute to the overall improved outcomes and the low failure rate of meniscal repair, despite lower preoperative Lysholm and Tegner scores in the meniscal repair group.

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Modeling Consumer Decisions on Returning End-of-Use Products Considering Design Features and Consumer Interactions: An Agent Based Simulation Approach

Volume 2A: 41st Design Automation Conference ◽

10.1115/detc2015-46864 ◽

2015 ◽

Cited By ~ 1

Author(s):

Ardeshir Raihanian Mashhadi ◽

Behzad Esmaeilian ◽

Sara Behdad

Keyword(s):

Electronic Waste ◽

Peer Pressure ◽

Waste Stream ◽

Contributing Factors ◽

Agent Based Simulation ◽

Design Features ◽

Agent Based ◽

Consumer Decisions ◽

Take Back ◽

The Impact

As electronic waste (e-waste) becomes one of the fastest growing environmental concerns, remanufacturing is considered as a promising solution. However, the profitability of take back systems is hampered by several factors including the lack of information on the quantity and timing of to-be-returned used products to a remanufacturing facility. Product design features, consumers’ awareness of recycling opportunities, socio-demographic information, peer pressure, and the tendency of customer to keep used items in storage are among contributing factors in increasing uncertainties in the waste stream. Predicting customer choice decisions on returning back used products, including both the time in which the customer will stop using the product and the end-of-use decisions (e.g. storage, resell, through away, and return to the waste stream) could help manufacturers have a better estimation of the return trend. The objective of this paper is to develop an Agent Based Simulation (ABS) model integrated with Discrete Choice Analysis (DCA) technique to predict consumer decisions on the End-of-Use (EOU) products. The proposed simulation tool aims at investigating the impact of design features, interaction among individual consumers and socio-demographic characteristics of end users on the number of returns. A numerical example of cellphone take-back system has been provided to show the application of the model.

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