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Ipsilateral femur and tibia fractures in pediatric patients:A systematic review

World Journal of Orthopedics 2017年第8期8卷 638-643页

作者： Jason B Anari Alexander L Neuwirth B david Horn keith d baldwin department of Orthopaedic Surgery University of Pennsylvania Children’s Hospital of Philadelphia

AIM To better understand how pediatric floating knee injuries are managed after the wide spread use of new orthopaedic *** We searched EMBASE, COCHRANE and MEdLINE computerized literature databases from the earliest date available in the databases to February 2017 using the following search term including variants and pleural counterparts: Pediatric floating knee. All studies were thoroughly reviewed by multiple authors. Reference lists from all articles were scrutinized to identify any additional studies of interest. A final database of individual patients was assembled from the literature. Univariate and multivariate statistical tests were applied to the assembled database to assess differences in *** The English language literature contains series with a total of 97 pediatric patients who sustained floating knee injuries. Patients averaged 9.3 years of age and were mostly male(73). Approximately 25% of the fractures were open injuries, more tibia(27) than femur(10). Over 75% of the fractures of both the tibia and the femur involved the diaphysis. More than half(52) of the patients were treated non-operatively for both fractures. As a sequela of the injury 32(33%) patients were left with a limb length discrepancy, 24(25%) patients had lengthening of the injured limb at follow up, while 8(8%) had shortening of the affected limb. Infection developed in 9 patients and 3 had premature physeal closure. Younger patients were more likely to be treated non-operatively(P d patients treated with operative intervention had statistically significant shorter hospital length of stays(P = 0.001).CONCLUSION Given the predominance of non-operative managementin published studies, the available literature is not clinically relevant since the popularization of internal fixation for pediatric long-bone

关键词： Pediatrics Femur Tibia Fracture Floating knee

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Rigid locked nail fixation for pediatric tibia fractures-Where are the data?

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World Journal of Orthopedics 2019年第8期10卷 299-303页

作者： daniel Weltsch keith d baldwin division of Orthopaedic Surgery The Children’s Hospital of PhiladelphiaPhiladelphiaPA 19104United States department of Orthopaedic Surgery The Chaim Sheba Medical Center at Tel HashomerAffiliated to the Sackler Faculty of MedicineTel Aviv UniversityRamat Gan 52620Israel department of Orthopaedic Surgery University of PennsylvaniaPhiladelphiaPA 19104United States

Tibial shaft fractures are common injuries among the pediatric and adolescent population. Conservative treatment remains the preferred treatment. However, over the last two decades, there has been an increasing trend of operative fixation in pediatric tibia fractures, commonly with intramedullary nail fixation (IMN). Elastic stable intramedullary nails (ESIN) are heavily used especially in skeletally immature patients as they are physeal respecting and the technique for insertion is familiar. Alternatively, reamed locked intramedullary nails (RIMN) have gained traction in adolescents and skeletally immature pre-adolescents. When identifying publications germane to intramedullary fixation of pediatric tibia fractures, the majority investigated clinical and radiographic outcomes associated with ESIN. We were able to identify only one study specifically examining RIMN in this population, albeit other studies included patients treated with RIMN. In parallel, there has been considerable progress in the field of skeletal maturity estimation with criteria based on different anatomic regions. However, little data exists for trauma purposes as no gold standard system had been accepted and proven to be precise for determination of potential growth remaining around the knee or for quantifying the risk of damage to the proximal tibial physis. Systems devised have been either unvalidated or unnecessarily complex or both. In order to achieve more informed treatment choices and optimal patient outcomes when using IMN fixation in pediatrics, simple to use, validated plain film-based methodology is needed to define skeletal maturity for the proximal tibia. Additionally, further examination of outcomes and the role of RIMN in this population are warranted.

关键词： Pediatric Trauma Skeletal maturity Reamed nail Intramedullary Fixation

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Intra-operative computed tomography guided navigation for pediatric pelvic instrumentation: A technique guide

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World Journal of Orthopedics 2018年第10期9卷 185-189页

作者： Jason B Anari Patrick J Cahill John M Flynn david A Spiegel keith d baldwin department of Orthopaedic Surgery Children's Hospital of Philadelphia

Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod(Medtronic Sofamor-danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alariliac technique(S2 AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2 AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.

关键词： Posterior instrumentation Pediatric Spinal deformity Image guidance Technique

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Neuromuscular scoliosis and pelvic fixation in 2015: Where do we stand?

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世界骨科杂志：英文版 2015年第8期6卷 564-566页

作者： Jason B Anari david A Spiegel keith d baldwin department of Orthopaedic Surgery University of Pennsylvania Children’s Hospital of Philadelphia

Neuromuscular scoliosis is a challenging problem to treat in a heterogeneous patient population. When thedecision is made for surgery the surgeon must select a technique employed to correct the curve and achieve the goals of surgery, namely a straight spine over a level pelvis. Pre-operatively the surgeon must ask if pelvic fixation is worth the extra complications and infection risk it introduces to an already compromised host. Since the advent of posterior spinal fusion the technology used for instrumentation has changed drastically. However, many of the common problems seen with the unit rod decades ago we are still dealing with today with pedicle screw technology. Screw cut out, pseudoarthrosis, non-union, prominent hardware, wound complications, and infection are all possible complications when extending a spinal fusion construct to the pelvis in a neuromuscular scoliosis patient. Additionally, placing pelvic fixation in a neuromuscular patient results in extra blood loss, greater surgical time, more extensive dissection with creation of a deep dead space, and an incision that extends close to the rectum in patients who are commonly incontinent. Balancing the risk of placing pelvic fixation when the benefit, some may argue, is limited in non-ambulating patients is difficult when the literature is so mottled. despite frequent advancements in technology issues with neuromuscular scoliosis remain the same and in the next 10 years we must do what we can to make safe neuromuscular spine surgery a reality.

关键词： Spine Fixation Neuromuscular Scoliosis Pelvic pediatrics

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direct Synthesis of Layer-Tunable and Transfer-Free Graphene on device-Compatible Substrates Using Ion Implantation Toward Versatile Applications

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Energy & Environmental Materials 2024年第5期7卷 412-422页

作者： Bingkun Wang Jun Jiang Kevin baldwin Huijuan Wu Li Zheng Mingming Gong Xuehai Ju Gang Wang Caichao Ye Yongqiang Wang department of Microelectronic Science and Engineering School of Physical Science and Technology Ningbo University Key Laboratory of Soft Chemistry and Functional Materials of MOE School of Chemistry and Chemical Engineering Nanjing University of Science and Technology Center for Integrated Nanotechnologies Los Alamos National Laboratory National Key Laboratory of Materials for Integrated Circuits Shanghai Institute of Microsystem and Information Technology Chinese Academy of Sciences Academy for Advanced Interdisciplinary Studies & department of Materials Science and Engineering Southern University of Science and Technology Guangdong Provincial Key Laboratory of Computational Science and Material design Southern University of Science and Technology Materials Science and Technology division Los Alamos National Laboratory

direct synthesis of layer-tunable and transfer-free graphene on technologically important substrates is highly valued for various electronics and device *** of the art in the field is currently a two-step process:a high-quality graphene layer synthesis on metal substrate through chemical vapor deposition (CVd)followed by delicate layer transfer onto device-relevant ***,we report a novel synthesis approach combining ion implantation for a precise graphene layer control and dual-metal smart Janus substrate for a diffusion-limiting graphene formation to directly synthesize large area,high quality,and layer-tunable graphene films on arbitrary substrates without the post-synthesis layer transfer process.

关键词： device applications dual-metal smart Janus substrate growth mechanism Ion implantation layer-tunable and transfer-free graphene

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Symptom presentation and evolution in the first 48 hours after injury are associated with return to play after concussion in elite Rugby Union

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Journal of Sport and Health Science 2024年第3期13卷 387-397页

作者： Ross Tucker Matt Cross keith Stokes Lindsay Starling Rosy Hyman Simon Kemp Stephen West Martin Raftery Eanna Falvey James Brown Institute of Sport and Exercise Medicine(ISEM) Department of ExerciseUniversity of StellenboschTygerberg 7505South Africa World Rugby Ltd. Dublin D02 AE93Ireland Premiership Rugby London SW1V 1PXUK Centre for Health and Injury and Illness Prevention in SportUniversity of BathClaverton Down BA27AYUK UK Collaborating Centre on Injury and Illness Prevention in Sport(UKCCIIS) University of BathClaverton Down BA27AYUK Rugby Football Union London TW27BAUK London School of Tropical Medicine London WC1E 7HTUK Sport Injury Prevention Research Centre Faculty of KinesiologyUniversity of CalgaryCalgary T2N 1N4Canada department of Medicine School of Medicine and HealthUniversity College CorkCork T12 EC8PIreland Carnegie Applied Rugby Research(CARR)centre Carnegie School of SportLeeds Beckett UniversityLeeds LS63QSUK

Background:Return to play(RTP)in elite rugby is managed using a 6-stage graduated RTP protocol,which can result in clearance to play within 1 week of *** aimed to explore how symptom,cognitive,and balance presentation and evolution during concussion screens 2 h(head injury assessment(HIA2)and 48 h(HIA3)after injury were associated with time to RTP)to identify whether a more conservative graduated RTP may be ***:A retrospective cohort study was conducted in 380 concussed rugby players from elite men’s rugby over 3 consecutive *** were classified as shorter or longer returns,depending on whether RTP occurred within 7 days(allowing them to be considered to play the match 1 week after injury)or longer than 8 days,***,cognitive,and balance performance during screens was assessed relative to baseline(normal or abnormal)and to the preceding screen(improving or worsening).Associations between sub-test abnormalities and RTP time were explored using odds ratios(OR,longer ***).Median day absence was compared between players with abnormal or worsening results and those whose results were normal or ***:Abnormal symptom results during screens 2 h and 48 h after concussion were associated with longer return time(HIA2:OR=2.21,95%confidence interval(95%CI):1.39-3.50;HIA3:OR=3.30,95%CI:1.89-5.75).Worsening symptom number or severity from the time of injury to 2 h and 48 h post-injury was associated with longer return(HIA2:OR=2.49,95%CI:1.36-4.58;HIA3:OR=3.34,95%CI:1.10-10.15).Median days absence was greater in players with abnormal symptom results at both HIA2 and *** and balance performance were not associated with longer return and did not affect median days ***:Symptom presentation and evolution within 48 h of concussion were associated with longer RTP *** may guide a more conservative approach to RTP,while still adhering to individualized concussion management principles.

关键词： Brain injury Concussion management General return to play Medical management

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EZH2 inhibitors promote β-like cell regeneration in young and adult type 1 diabetes donors

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Signal Transduction and Targeted Therapy 2024年第2期9卷 679-692页

作者： keith Al-Hasani Safiya Naina Marikar Harikrishnan Kaipananickal Scott Maxwell Jun Okabe Ishant Khurana Thomas Karagiannis Julia J.Liang Lina Mariana Thomas Loudovaris Thomas Kay Assam El-Osta Epigenetics in Human Health and disease Program Baker Heart and Diabetes Institute75 Commercial RoadMelbourne 3004 VICAustralia department of diabetes Central Clinical SchoolMonash UniversityMelbourne 3004 VICAustralia Epigenetics in Human Health and disease Laboratory Central Clinical SchoolMonash UniversityMelbourne 3004 VICAustralia School of Science STEM CollegeRMIT UniversityMelbourne 3001 VICAustralia Immunology and diabetes Unit St Vincent’s Institute of Medical ResearchFitzroy 3065 VICAustralia department of Medicine and Therapeutics The Chinese University of Hong KongSha TinHong Kong SAR Hong Kong Institute of diabetes and Obesity Prince of Wales HospitalThe Chinese University of Hong Kong3/F Lui Che Woo Clinical Sciences Building30-32-Ngan Shing StreetSha TinHong Kong SAR Li Ka Shing Institute of Health Sciences The Chinese University of Hong KongSha TinHong Kong SAR Biomedical Laboratory Science Department of TechnologyFaculty of HealthUniversity College CopenhagenCopenhagenDenmark

β-cells are a type of endocrine cell found in pancreatic islets that synthesize,store and release *** type 1 diabetes(T1d),T-cells of the immune system selectively destroy the insulin-producingβ-*** of these cells leads to a lifelong dependence on exogenous insulin administration for ***,there is an urgent need to identify novel therapies that stimulateβ-cell growth and induceβ-cell *** and others have shown that pancreatic ductal progenitor cells are a promising source for regeneratingβ-cells for T1d owing to their inherent differentiation *** transcriptional suppression is refractory to exocrine reaction and tightly controls the regenerative potential by the EZH2 *** the present study,we show that transient stimulation of exocrine cells,derived from juvenile and adult T1d donors to the FdAapproved EZH2 inhibitors GSK126 and Tazemetostat(Taz)influence a phenotypic shift towards aβ-like cell *** transition from repressed to permissive chromatin states are dependent on bivalent H3K27me3 and H3K4me3 chromatin *** EZH2 is fundamental toβ-cell regenerative *** pancreatic ductal cells exhibit insulin production and secretion in response to a physiological glucose challenge ex *** pre-clinical studies underscore the potential of small molecule inhibitors as novel modulators of ductal progenitor differentiation and a promising new approach for the restoration ofβ-like cell function.

关键词： EZH2 struction inhibitors

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Tree structure and diversity shape the biomass of primary temperate mountain forests

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Forest Ecosystems 2024年第4期11卷 568-579页

作者： dheeraj Ralhan Ruffy Rodrigo Heather keith Annemiek Irene Stegehuis Jakob Pavlin Yumei Jiang Milos Rydval Juliana Nogueira Alexandre Fruleux Marek Svitok Martin Mikolas daniel Kozak Martin dusatko Pavel Janda Oleh Chaskovsky Catalin-Constantin Roibu Miroslav Svoboda Czech University of Life Sciences Prague Faculty of Forestry and Wood SciencesKamycka 129Suchdol16521 Praha 6Czech Republic department of Forest Science Biliran Province State UniversityBiliran6549Philippines Griffith Climate Action Beacon Griffith UniversityParklands DriveSouthportGold CoastQueensland4222Australia Laboratoire de Geologie IPSLCNRSUMR 8538Ecole Normale SuperieurePSL UniversityParisFrance Univ.Lille Institut Mines-TelecomUniv.ArtoisJuniaULR 4515LGCgELaboratoire de Genie Civil et Geo-EnvironnementF-59000LilleFrance department of Biology and General Ecology Faculty of Ecology and Environmental SciencesTechnical University in ZvolenMasaryka 2496001ZvolenSlovakia Institute of Forest Management Ukrainian National Forestry UniversityLvivUkraine Forest Biometrics Laboratory–Faculty of Forestry Stefan Cel Mare University of SuceavaUniversitații Street Number.13Suceava720229Romania

Primary forests are spatially diverse terrestrial ecosystems with unique characteristics,being naturally regenerative and heterogeneous,which supports the stability of their carbon storage through the accumulation of live and dead ***,little is known about the interactions between biomass stocks,tree genus diversity and structure across a temperate montane primary ***,we investigated the relationship between tree structure(variability in basal area and tree size),genus-level diversity(abundance,tree diversity)and biomass stocks in temperate primary mountain forests across Central and Eastern *** used inventory data from726 permanent sample plots from mixed beech and spruce across the Carpathian *** used nonlinear regression to analyse the spatial variability in forest biomass,structure,and genus-level diversity and how they interact with plot-level tree age,disturbances,temperature and *** found that the combined effects of genus and structural indices were important for addressing the variability in biomass across different spatial *** processes in disturbance regimes and uneven tree age support forest hete rogeneity and the accumulation of live and dead biomass through the natural regeneration,growth and decay of the forest *** complexities in basal area index,supporte d by genus-level abundance,positively influence total biomass stocks,which was modulated by tree age and *** forests showed higher tree density and basal area than mixed beech forests,though mixed beech still contributes significantly to biomass across *** heterogeneity was strongly influenced by complexities in forest composition(tree genus diversity,structure).We addressed the importance of primary forests as stable carbon stores,achieved through structure and *** such ecosystems is critical for ensuring the stability of the primary forest,carbon store and biodiversity into the future.

关键词： Biodiversity indicators Biomass carbon stock Ecosystem functioning Forest composition Primary forest structure Tree size distribution

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Clinical features and management of primary sclerosing cholangitis

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World Journal of Gastroenterology 2008年第21期14卷 3338-3349页

作者： Marina G Silveira keith d Lindor division of Gastro-enterology and Hepatology Miles and Shirley Fiterman Center for Digestive DiseasesMayo Clinic and FoundationRochesterMinnesotaUnited States

Primary sclerosing cholangitis is a chronic cholestatic liver disease characterized by inflammation and fibrosis of the bile ducts,resulting in cirrhosis and need for liver transplantation and reduced life *** majority of cases occur in young and middle-aged men,often in association with inflammatory bowel *** etiology of primary sclerosing cholangitis includes immune-mediated components and elements of undefined *** effective medical therapy has been *** multiple complications of primary sclerosing cholangitis include metabolic bone disease,dominant strictures,bacterial cholangitis,and malignancy,particularly cholangiocarcinoma,which is the most lethal complication of primary sclerosing *** transplantation is currently the only life-extending therapeutic alternative for patients with end-stage disease,although recurrence in the allografted liver has been described.A PSC-like variant attracting attention is cholangitis marked by raised levels of the immunoglobulin G4 subclass,prominence of plasma cells within the lesions,and steroid responsiveness.

关键词： Sclerosing cholangitis diagnosis Therapy Cholestasis Cholangiocarcinoma Liver transplantation

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Attribution of Fano resonant features to plasmonic particle size, lattice constant, and dielectric wavenumber in square nanoparticle lattices

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Photonics Research 2014年第1期2卷 15-23页

作者： drew deJarnette Justin Norman d.keith Roper Microelectronics and Photonics Graduate Program University of ArkansasFayettevilleArkansas 72701USA department of Chemical Engineering University of ArkansasFayettevilleArkansas 72701USA

Fano resonances between plasmons and diffracted light offer tunable energies and locales,but attribution of Fano resonance features to geometry and physicochemistry of metal nanostructures and adjacent dielectrics has been confounded by complexity and computational *** work shows predictable modal shifts of Fano resonance in square lattices of plasmonic nanostructures can be attributed directly to changes in medium wavenumber,particle size,and lattice constant that alter plasmon polarizability and diffractive *** 45 to 80 nm radius particles,a window of lattice constants that support Fano resonances is identified in a range from 500 to 900 *** constants that support high intensity resonances are determined by individual particle polarizability and medium *** resonance wavelengths redshift from diffracted photon energies as local refractive index(RI)changes due to coupling with particle polarizability in the *** sensitivities for quadrupole,dipole,and Fano resonances are 150,348,and 541 nm,respectively,per RI *** resonance intensity may be enhanced more than tenfold by selecting nanoparticle sizes and lattice *** quantitative effects of such parametric changes are rapidly and intuitively distinguished using a semi-analytic approach,consisting of an exact expression for particle polarizability,a trigonometric description of diffraction,and a semianalytical coupled dipole approximation.

关键词： lattice particle wave

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