C60 fullerene is a promising material due to its unique physiochemical properties. However, previous studies have reported that colloidal aggregates of C60 (nC60) produce toxicity in fish and human cell cultures. The preparation method of the nC60 raises questions as to whether the observed effects stem from the fullerenes themselves or from the organic solvents used during the preparation of the suspensions. In this paper we set out to elucidate the mechanism by which tetrahydrofuran (THF) treatment to enhance the preparation of nC60 leads to cytotoxicity in a mouse macrophage cell line. Our results demonstrate that THF/nC60 but not fullerol or aqueous nC60 generates cellular toxicity through a pathway that involves increased intracellular flux and mitochondrial perturbation in RAW 264.7 cells. Interestingly, the supernatant of the THF/nC60 suspension rather than the colloidal fullerene aggregates mimics the cytotoxic effects due to the presence of γ-butyrolactone and formic acid. Thus, the role of nC60 in the cellular responses is likely not due to the direct effect of the nC60 material surface on the cells but related to the conversion of THF into a toxic by-product during the preparation of the suspension.

Children with neurofibromatosis type 1 exhibit a variety of developmental delays. However, there is little information about the progression of these deficits over the course of development. Using the Parents' Evaluation of Developmental Status measurement tool, we assessed 124 infants (0-2 years of age), preschool-age children (3-5 years of age), and school-age children (6-8 years of age) with neurofibromatosis type 1 to define the natural history of delays. School-age children exhibited significantly more areas of delay than infants or preschool-age children. Delays in math, reading, gross motor, fine motor, and self-help development were observed more frequently in older than younger children. Finally, analysis of 43 subjects for whom longitudinal assessments were available revealed that children often migrated between delayed and nondelayed groups in all areas except gross motor development. Based on these findings, we advocate early developmental screening and intervention for this at-risk pediatric population, especially in the area of gross motor function.

Objective: To determine the association between fracture collapse with altered gait after intertrochanteric (IT) fracture using the trochanteric fixation nail (TFN) and helical blade. Design: Prospective cohort study. Setting: Academic Level I trauma center. Patients: Seventy-two patients with IT hip fractures (OTA/AO 31) treated between 2012 and 2016. The average age was 79.7 years (range, 51–94 years); there were 59 women and 13 men. Intervention: All patients were treated with cephalomedullary nailing using the TFN (DePuy-Synthes, West Chester, PA) with a helical blade. Main Outcome Measures: At follow-up appointments, temporospatial gait parameters were measured and recorded. Radiographs were analyzed at the time of surgery and at each follow-up visit. Amount of radiographic femoral neck shortening was measured radiographically. Patients completed the Harris Hip Score, visual analog scale for pain, Short Form-36 Physical Component Score, and Short Form-36 Mental Component Score. Results: The mean length of follow-up between the surgery and the gait analysis was 8.6 months (±0.7 months). The mean amount of shortening was 4.7 mm (±0.6 mm). Out of the 72 patients analyzed, there were 15 patients (20.8%) who shortened more than 8 mm, 7 patients (9.7%) who shortened 10 mm or more, and 2 patients (2.8%) who shortened more than 20 mm. Mean shortening was 3.0 mm for stable OTA/AO 31-A1 fractures, whereas the unstable patterns (OTA/AO 31-A2, 31-A3) demonstrated a mean shortening of 5.9 mm (P = 0.02). There was significant correlation between increased shortening and decreased cadence (P = 0.008), increased double support time (P < 0.001), decreased step length (P = 0.001), and increased single support asymmetry (P = 0.04) during gait analysis. The threshold of 8 mm of shortening predicted decreased cadence (P = 0.008), increased double support time (P < 0.001), and decreased step length (P = 0.006). Analysis of patient-reported outcome scores, including the Harris Hip Score, visual analog scale, SF-36 Physical Component Score, and SF-36 Mental Component Score, revealed no significant association with shortening. Conclusions: Results from this study indicate that shortening after cephallomedullary nailing of IT hip fractures using the TFN with a helical blade is associated with altered gait, specifically decreased cadence, increased double support time, decreased step length, and increased single support time asymmetry.

No abstract

Background: Despite the growing hand surgery literature on postoperative opioid use, there is little research focused on patient-centered interventions. The purpose of this randomized controlled trial was to create a standardized patient education program regarding postoperative pain management after hand surgery and to determine whether that education program would decrease postoperative opioid use. Methods: Patients scheduled to undergo ambulatory hand surgery were recruited and randomized to standardized pain management education or standard of care. All patients received a webinar with instructions for study participation, whereas the education group received an additional 10 minutes of education on postoperative pain management. All patients completed a postoperative daily log documenting opioid consumption. The total number of opioid pills consumed was compared between groups. The authors constructed a linear regression model to determine risk factors for postoperative opioid use after surgery. Results: A total of 267 patients were enrolled in the study. One hundred ninety-one patients completed the study (standardized education, n = 93; control group, n = 97). Patients in the standardized education group were more likely to take no opioid medication (42 percent versus 25 percent; p = 0.01) and took significantly fewer opioid pills (median, two) than those in the control group (median, five) (p < 0.001). Standardized education predicted decreased postoperative opioid pill consumption, whereas higher number of pills prescribed and a history of psychiatric illness were risk factors for increasing opioid use. Conclusion: Perioperative patient education and limitation of postoperative opioid prescription sizes reduced postoperative opioid use following ambulatory hand surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

No abstract

No abstract

Therapeutic, III.