Clinical Comparison of Medial Patellofemoral Ligament Reconstruction With or Without Tibial Tuberosity Transfer for Recurrent Patellar Instability

Background: No clear guidelines or widespread consensus has defined a threshold value of tibial tuberosity–trochlear groove (TT-TG) distance for choosing the appropriate surgical procedures when additional tibial tuberosity osteotomy (TTO) should be added to augment medial patellofemoral ligament (MPFL) reconstruction for recurrent patellar instability. Purpose: To compare the clinical outcomes between MPFL reconstruction and MPFL reconstruction with TTO for patients who have patellar instability with a TT-TG distance of 15 to 25 mm. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed 81 patients who underwent surgical treatment using either MPFL reconstruction or MPFL reconstruction with TTO for recurrent patellar instability with a TT-TG distance of 15 to 25 mm; the mean follow-up was 25.2 months (range, 12.0-53.0 months). The patients were divided into 2 groups: isolated MPFL reconstruction (iMPFL group; n = 36) performed by 2 surgeons and MPFL reconstruction with TTO (TTO group; n = 45) performed by another 2 surgeons. Clinical outcomes were assessed using the Kujala score, Knee injury and Osteoarthritis Outcome Score, and Tegner activity score. Radiological parameters, including patellar height, TT-TG distance, patellar tilt, and congruence angle were compared between the 2 groups. Functional failure based on clinical apprehension sign, repeat subluxation or dislocation, and subjective instability and complications was assessed at the final follow-up. We also compared clinical outcomes based on subgroups of preoperative TT-TG distance (15 mm ≤ TT-TG ≤ 20 mm vs 20 mm < TT-TG ≤ 25 mm). Results: All of the clinical outcome parameters significantly improved in both groups at the final follow-up ( P < .001), with no significant differences between groups. The radiological parameters also showed no significant differences between the 2 groups. The incidence of functional failure was similar between the 2 groups (3 failures in the TTO group and 2 failures in the iMPFL group; P = .42). In the TTO group, 1 patient experienced a repeat dislocation postoperatively and 2 patients had subjective instability; in the iMPFL group, 2 patients had subjective instability. The prevalence of complications did not differ between the 2 groups ( P = .410). In the subgroup analysis based on TT-TG distance, we did not note any differences in clinical outcomes between iMPFL and TTO groups in subgroups of 15 mm ≤ TT-TG ≤ 20 mm and 20 mm < TT-TG ≤ 25 mm. Conclusion: MPFL reconstruction with and without TTO provided similar, satisfactory clinical outcomes and low redislocation rates for patients who had patellar instability with a TT-TG distance of 15 to 25 mm, without statistical difference. Thus, our findings suggest that iMPFL reconstruction is a safe and reliable treatment for patients with recurrent patellar dislocation with a TT-TG distance of 15 to 25 mm, without the disadvantages derived from TTO.

The Human Error and Functional Failure Reasoning Framework: How Does It Scale?

The goal of this research is to demonstrate the applicability of the Human Error and Functional Failure Reasoning (HEFFR) framework to complex engineered systems. Human errors are cited as a root cause of a majority of accidents and performance losses in complex engineered systems. However, a closer look would reveal that such mishaps are often caused by complex interactions between human fallibilities, component vulnerabilities, and poor design. Hence, there is a growing call for risk assessments to analyze human errors and component failures in combination. The HEFFR framework was developed to enable such combined risk assessments. Until now, this framework has only been applied to simple problems, and it is prone to be computationally heavy as complexity increases. In this research, we introduce a modular HEFFR assessment approach as means of managing the complexity and computational costs of the HEFFR simulations of complex engineered systems. Then, we validate the proposed approach by testing the consistency of the HEFFR results between modular and integral assessments and between different module partitioning assessments. Next, we perform a risk assessment of a train locomotive using the modular approach to demonstrate the applicability of the HEFFR framework to complex engineered systems. The results show that the proposed modular approach can produce consistent results while reducing complexity and computational costs. Also, the results from the train locomotive HEFFR analysis show that the modular assessments can be used to produce risk insights similar to integral assessments but with a modular context.

Oncofertility

Advances in cancer treatment, particularly chemotherapeutics, are expected to lead to significant improvements in survival rates. While cancer incidence and death rates are decreasing, quality of life after cancer may be reduced due to early functional failure of the gonads and, consequently, infertility, resulting from either the disease itself or its treatment. This chapter introduces clinicians to the new field of oncofertility and the ethical issues it raises. It will consider the situation of young cancer patients facing reproductive consequences globally, the retrieval of gametes or gonadal tissue from minors, and the use of these tissues long term. The field of oncofertility is new, but ethical considerations regarding reproductive interventions are old. Understanding how we approach these issues on a personal level and from the public’s perspective will be assessed in this chapter.

An Improved FFIP Method Based on Mathematical Logic and SysML

In recent years, the model-based safety analysis (MBSA) has been developing continuously. The Functional Failure Identification and Propagation (FFIP) method is a graphics processing technology which supports the analysis of fault propagation paths before making costly design commitments. However, the traditional FFIP has some deficiencies. In this paper, we extend the functional failure logic (FFL) in the FFIP and introduce the concept of deviation. So, FFIP can be used to analyze the failure process of the systems and make the logical analysis of functional failure easier. Based on the extended FFL, we present a new overview of the FFIP. The FFIP is improved by using mathematical logic and Systems Modeling Language (SysML). The standard expression of FFL is realized, which is conducive to the subsequent modeling and modification. Additionally, we use the failure logic analysis in the FFIP to improve the state machine diagram (SMD) in SysML. Finally, the improved FFIP method is used to analyze the fault propagation paths of the system and Simulink is used for simulation. The fault tree is generated according to the simulation results, the minimum cut set is calculated, and the key failure parts of the system are obtained.

IL-10 Deficiency Aggravates Renal Inflammation, Fibrosis and Functional Failure in High-Fat Dieted Obese Mice

BACKGROUND: High-fat diet-induced obesity is one of the major cause of chronic renal failure. This obesity-related renal failure is mainly caused by inflammatory processes. However, the role of the major anti-inflammatory cytokine interleukin (IL)-10 has not been researched intensively. METHODS: To evaluate the effect of IL-10 deficiency on obesity-related renal failure, the in vivo study was carried with four animal groups; (1) Low-fat dieted C57BL/6 mice, (2) Low-fat dieted IL-10 knockout (KO) mice, (3) High‐fat dieted C57BL/6 mice and (4) High‐fat dieted IL-10 KO mice group. The analysis was carried with blood/urine chemistry, H&E, Oil-Red-O, periodic acid-Schiff and Masson’s trichrome staining immunohistochemistry and real-time PCR methods. RESULTS: At week 12, high‐fat dieted IL-10 KO mice showed 1) severe lipid accumulation in kidneys, cholesterol elevation (in total, serum kidney) and low-density lipoprotein increasion through the SCAP-SREBP2-LDLr pathway; (2) serious histopathologic alterations showing glomerulosclerosis, tubulointerstitial fibrosis and immune cell infiltration; (3) increased pro‐inflammatory cytokines and chemokines expression; (4) enhanced renal fibrosis; and (5) serious functional failure with high serum creatinine and BUN and proteinuria excretion compared to other groups. CONCLUSION: IL-10 deficiency aggravates renal inflammation, fibrosis and functional failure in high-fat dieted obese mice, thus IL-10 therapy could be applied to obesity-related chronic renal failure.