The two commonly performed surgical techniques used to repair displaced midshaft clavicle fractures are plate fixation or intramedullary nailing; however, despite recent evidence, the optimal method to treat such fractures remains a continued topic of debate. A meta-analysis of randomized controlled trials (RCTs) was conducted to evaluate long term function, complications, and operative duration in adult patients receiving intramedullary nailing in comparison to plating. Seven RCTs and three quasi-randomized trials were included. No significant difference was found in long-term function between the two groups (MD: −0.66, 95% CI: −2.03 to 0.71, I2 = 62%, p = 0.34). Patients who received plating had a 2.19 times increased risk of treatment failure, but this failed to reach significance (95% CI: 0.93 to 5.15, I2 = 0%, p = 0.07). The risk of non-operative complications was 2.11 times higher in patients who received plating and this reached statistical significance (95% CI: 1.38 to 3.23, I2 = 53%, p = 0.0006). Finally, plating significantly prolonged operative duration by 20.16 minutes (95% CI: 16.87 to 23.44, I2 = 56%, p < 0.00001). Our results suggest that intramedullary nailing and plating provide equivalent long-term functional outcomes; however, plating may lead to a higher risk of treatment failure and non-operative complications.

D ue to the invasiveness of total knee arthroplasty (TKA), the procedure is often associated with extreme postoperative pain. In fact, 23% of patients cite at home pain as "severe/ extreme" after surgery, whereas 54% of the patients indicate "severe pain at least some of the time." 1 Moreover, it has been suggested that postoperative pain can also interfere with the recovery process, 2 which can put patients at an increased risk for postoperative complications including infections, loosening of the joint, and reflex sympathetic dystrophy. 3 Different techniques can be used preoperatively to complement the effects of general anesthesia, including femoral nerve block (FNB) and adductor canal block (ACB)/saphenous nerve block.Femoral nerve block has traditionally been an efficient method to reduce postoperative pain after TKA. For instance, Chan et al 4 found that FNB decreased pain scores at 24 hours as compared with a sham procedure. Moreover, Jadon et al 5 observed that FNB is a more efficient method of analgesia as compared with IV fentanyl. However, FNB has been found to have postsurgical complications, including severe quadriceps muscle weakness. 6 Certainly, surgical causes such as tourniquet-related weakness or surgical quadriceps dysfunction must also be considered, but femoral nerve blockaderelated weakness can be explained by the anatomy of the nerve targeted in the FNB. The femoral nerve not only comprises sensory branches, but also contains motor branches that innervate muscles of the upper and lower leg. The motor nerve involvement of the FNB is what leads to muscle weakness, which can alter the ability of the patient to ambulate properly and can increase the risk of postoperative falls. As such, ACB is a method of analgesia that has recently sparked tremendous interest in the scientific community due to its potential benefits over FNB; however, this approach itself does not come without controversy.Adductor canal block is thought to be as effective as FNB in reducing postoperative pain. 7 In addition to having similar pain scores reported by patients, ACB has been thought to be associated with better quadriceps strength postoperatively in comparison to FNB. Theoretically, this is intuitive because the saphenous nerve, a component of the adductor canal and the nerve targeted in ACB, is a purely sensory branch of the femoral nerve. Due to the lack of motor impairment with ACB, quadriceps muscle function is preserved. This may ultimately lead to better ambulation after TKA.

Pressure overload induces stress-induced signaling pathways and a coordinated transcriptional response that begets concentric cardiac hypertrophy. Although concentric hypertrophy initially attenuates wall stress and maintains cardiac function, continued stress can result in maladaptive cardiac remodeling. Cardiac remodeling is orchestrated by transcription factors that act within the context of an epigenetic landscape. Since the epigenetic landscape serves as a molecular link between environmental factors (stress) and cellular phenotype (disease), defining the role of the epigenome in the development and progression of cardiac remodeling could lead to new therapeutic approaches. In this study, we hypothesized that the epigenetic landscape is important in the development of cardiac hypertrophy and the progression to maladaptive remodeling. To demonstrate the importance of the epigenome in HF, we targeted the PTIP-associated histone methyltransferase complex in adult cardiac myocytes. This complex imparts histone H3 lysine 4 (H3K4) methylation marks at actively expressed genes. We subjected PTIP null (PTIP-) mice to 2 weeks of transverse aortic constriction, a stress that induces concentric hypertrophy in control mice (PTIP+). PTIP- mice have a maladaptive response to 2wk of transverse aortic constriction (TAC)-induced pressure overload characterized by cardiac dilatation, decreased LV function, cardiac fibrosis, and increased cell death. PTIP deletion resulted in altered stress-induced gene expression profiles including blunted expression of ADRA1A, ADRA1B, JUN, ATP2A2, ATP1A2, SCN4B, and CACNA1G. These results suggest that H3K4 methylation patterns and the complexes that regulate them, specifically the PTIP-associated HMT, are necessary for the adaptive response to TAC.

No abstract