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Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The oxidation of polyunsaturated fatty acids during oxidative stress gives rise to a series of toxic alpha,beta-unsaturated aldehydes, including the electrophile 4-hydroxy-2-nonenal (4-HNE) and the related aldehydes, 4-hydroperoxy-2-nonenal (4-HPNE) and 4-oxo-2-nonenal (4-ONE). We synthesized these compounds, as well as the resolved enantiomers of 4-HNE, and compared their toxicities and apoptotic responses in the human colorectal cancer cell line RKO. All of these molecules execute similar death responses at comparable doses over almost identical time frames in RKO cells. The apoptotic response induced by 4-HPNE, 4-ONE, and 4-HNE enantiomers involves activation of caspases, proteolysis of downstream caspase targets, and nucleosomal DNA fragmentation. The results presented herein suggest that these molecules commonly activate certain signaling pathways that control cell death irrespective of their reactive properties.

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Background: Posterior hip precautions have been routinely prescribed to decrease dislocation rates. The purpose of this study was to determine if the absence of hip precautions improved early recovery after total hip arthroplasty via the posterolateral approach. METHODS:Patients undergoing total hip arthroplasty via the posterolateral approach at three centers were enrolled. Patients meeting the selection criteria were randomized to Standard Hip Precautions (SHP) or No Hip Precautions (NHP) for six weeks following surgery. HOOS Jr., health state visual analog score, and rate of pain scores were recorded preoperatively and in subsequent postoperative visits; dislocation episodes were also noted. Standard statistical analysis was performed. RESULTS:From 2016-2017, 159 patients were randomized to SHP and 154 patients were randomized to NHP. Controlling for the center at which the surgery was performed, the only difference in outcome scores between the two groups was at two weeks; the NHP group had a lower HOOS Jr. score when compared to the SHP group (p=0.03). There was no difference in outcome scores at any other time points when compared to preoperative assessments. In the SHP group, there were two recorded dislocations (1.3%) and one in the NHP group 0.7% (p=0.62). CONCLUSION:In this multicenter, randomized, controlled study, the absence of hip precautions in the postoperative period did not improve subjective outcomes which may be explained by the

Background The goal of periacetabular osteotomy (PAO) is to improve the insufficient coverage of the femoral head and achieve joint stability without creating secondary femoroacetabular impingement. However, the complex tridimensional morphology of the dysplastic acetabulum presents a challenge to restoration of normal radiographic parameters. Accurate acetabular correction is important to achieve long-term function and pain improvement. There are limited data about the proportion of patients who have normal radiographic parameters restored after PAO and the factors associated with under-and overcorrection. Questions/purposes (1) What is the proportion of patients undergoing PAO in which the acetabular correction as assessed by the lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), acetabular inclination (AI), and extrusion index (EI) is within defined target ranges? (2) What patient and preoperative factors are associated with undercorrection of the acetabulum as defined by a LCEA\ 22°, a factor that has been reported to be associated with PAO failure at 10-year followup? Methods Between January 2007 and December 2011 we performed 132 PAOs in 116 patients for treatment of symptomatic acetabular dysplasia. One patient with LeggCalvé-Perthes disease, one with multiple osteochondromatosis, and two with concomitant femoral osteotomy were excluded. A total of 128 hips (112 patients) were included. The hip cohort was 76% (97 of 128) female and the mean age at surgery was 28.5 years (SD 8.7 years). Correction of LCEA between 25°and 40°, ACEA between 18°and 38°, Tönnis angle between 0°and 10°, and EI B 20% were defined as adequate based on normative values. Values lower than the established parameters were o has been previously associated with PAO failure at a minimum of 10-year followup, in this study we sought to measure whether demographic factors including age, gender, body mass index, and severity of acetabular dysplasia assessed by preoperative LCEA, ACEA, AI, and EI were associated with undercorrection. Postoperative radiographs were obtained at minimum of 1 month after surgery (mean, 7 months; range, 1-44 months) and were measured by a professional research assistant and a hip reconstruction fellow not involved in the clinical care of the patients. No patient was lost to followup. Results Of the 128 hips, the proportion of hips with radiographic parameters within the established range was 78% (100 hips) for the LCEA, 86% (110 hips) for the ACEA, 89% (114 hips) for the AI, and 80% (102 hips) for the EI. For hips with an inadequate correction, the LCEA was more often undercorrected than overcorrected (20% versus 2%; 95% confidence interval [CI], 11%-27%; p\0.001), whereas the ACEA was more often overcorrected than undercorrected (11% versus 3%; 95% CI, 1%-15%; p = 0.03) After adjusting for age, sex, body mass index, and preoperative radiographic parameters including ACEA, AI, and EI, we found that the preoperative LCEA was the only independent factor associated with a postoperative LCEA\...

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The AFFIRM Study enrolled 4060 predominantly elderly patients with atrial fibrillation to compare ventricular rate control with rhythm control. The patients in the AFFIRM Study were representative of patients at high risk for complications from atrial fibrillation, which indicates that the results of this large clinical trial will be relevant to patient care.