Supporting Spartina Bortolus, Alejandro; Adam, Paul; Adams, Janine B. ...
Ecology,
November 2019, Volume:
100, Issue:
11
Journal Article
Peer reviewed
Open access
In 2014, a DNA-based phylogenetic study confirming the paraphyly of the grass subtribe Sporobolinae proposed the creation of a large monophyletic genus Sporobolus, including (among others) species ...previously included in the genera Spartina, Calamovilfa, and Sporobolus. Spartina species have contributed substantially (and continue contributing) to our knowledge in multiple disciplines, including ecology, evolutionary biology, molecular biology, biogeography, experimental ecology, biological invasions, environmental management, restoration ecology, history, economics, and sociology. There is no rationale so compelling to subsume the name Spartina as a subgenus that could rival the striking, global iconic history and use of the name Spartina for over 200 yr. We do not agree with the subjective arguments underlying the proposal to change Spartina to Sporobolus. We understand the importance of both the objective phylogenetic insights and of the subjective formalized nomenclature and hope that by opening this debate we will encourage positive feedback that will strengthen taxonomic decisions with an interdisciplinary perspective. We consider that the strongly distinct, monophyletic clade Spartina should simply and efficiently be treated as the genus Spartina.
In countries with the best cancer outcomes, approximately 60% of patients receive radiotherapy as part of their treatment, which is one of the most cost-effective cancer treatments. Notably, around ...40% of cancer cures include the use of radiotherapy, either as a single modality or combined with other treatments. Radiotherapy can provide enormous benefit to patients with cancer. In the past decade, significant technical advances, such as image-guided radiotherapy, intensity-modulated radiotherapy, stereotactic radiotherapy, and proton therapy enable higher doses of radiotherapy to be delivered to the tumour with significantly lower doses to normal surrounding tissues. However, apart from the combination of traditional cytotoxic chemotherapy with radiotherapy, little progress has been made in identifying and defining optimal targeted therapy and radiotherapy combinations to improve the efficacy of cancer treatment. The National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad) formed a Joint Working Group with representatives from academia, industry, patient groups and regulatory bodies to address this lack of progress and to publish recommendations for future clinical research. Herein, we highlight the Working Group's consensus recommendations to increase the number of novel drugs being successfully registered in combination with radiotherapy to improve clinical outcomes for patients with cancer.
Background:
Tobacco use is a known risk factor for increased perioperative complications and having worse functional outcomes in many orthopedic procedures. To date, no study has elucidated the ...effect of cigarette smoking on complications or functional outcome scores after total ankle replacement (TAR).
Methods:
We retrospectively reviewed the records of 642 patients who had TAR between June 2007 and February 2014 with a known smoking status. These patients were separated into 3 groups based on their smoking status: 34 current smokers, 249 former smokers, and 359 nonsmokers. Outcome scores and perioperative complications, which included infection, wound complications, revision surgeries, and nonrevision surgeries were compared between the groups.
Results:
When comparing perioperative complications in the active smokers to the nonsmokers, we found a statistically significant increased risk of wound breakdown (hazard ratio HR 3.08, P = .047). Although the active smokers had an increased rate of infection (HR 2.61, P = .392), revision surgery (HR 1.75, P = .470), and nonrevision surgery (HR 1.69, P = .172), these findings were not statistically significant. With regard to outcome scores, all groups demonstrated improvement at 1- and 2-year follow-up compared with their preoperative outcome scores. However, the active smokers had less improvement in their outcome scores than the nonsmokers at 1- and 2-year follow-up. Furthermore, there was no significant difference in the outcome scores when comparing the nonsmokers to the former smokers.
Conclusion:
Active cigarette smokers undergoing TAR had a significantly higher risk of wound complications and worse outcome scores compared with nonsmokers and former smokers. Furthermore, tobacco cessation appeared to reverse the effects of smoking, which allowed TAR to be an effective and safe procedure for providing pain relief and improving function in former smokers as they had perioperative complication rates and outcomes similar to nonsmokers.
Level of Evidence:
Level III, retrospective comparative series.
BACKGROUND:Total ankle arthroplasty has shown durable improvements in patient-reported outcomes. However, the impact of common comorbidities and patient factors has not been fully characterized. The ...purpose of this study was to identify patient comorbidities and characteristics that impact outcomes after total ankle arthroplasty.
METHODS:Patients who underwent a total ankle arthroplasty between January 2007 and December 2016 were enrolled into a prospective study at a single academic center. Patients completed outcome measures before the surgical procedure and at the time of follow-upa visual analog scale (VAS) for pain, the 36-item Short Form Survey (SF-36), and the Short Musculoskeletal Function Assessment (SMFA). Patient and operative factors, along with prevalent preoperative comorbidities, were analyzed for association with preoperative to postoperative changes in 1 to 2-year and minimum 5-year outcomes. Comorbidities that met a significance threshold of p < 0.05 in adjusted analyses were incorporated into multivariable outcome models.
RESULTS:A total of 668 patients with a mean 1 to 2-year follow-up (and standard deviation) of 1.6 ± 0.5 years (range, 10 months to 2 years and 2 months) were included. Patients’ pain and function significantly improved across all outcomes (p < 0.05). However, depression, staged bilateral ankle arthroplasty, increased length of stay, a prior surgical procedure, increased American Society of Anesthesiologists (ASA) score, and particular implant types were associated with significantly smaller improvements in at least 1 patient-reported outcome after total ankle arthroplasty in the 1 to 2-year follow-up, although the effects were relatively small. At a minimum 5-year follow-up, smoking, depression, implant type, and staged bilateral ankle arthroplasty were associated with worse outcomes, and a prior surgical procedure, a simultaneous bilateral surgical procedure, and obesity were associated with improved outcomes.
CONCLUSIONS:Patients who underwent total ankle arthroplasty had significant improvement in patient-reported outcomes, although several factors were associated with a small, but significant, negative impact on improvement, including depression, increased ASA score, current smoking, increased length of stay, a prior surgical procedure, and staged bilateral total ankle arthroplasty. Current smoking, obesity, and depression are potentially modifiable risk factors that could be improved prior to total ankle arthroplasty. Patients with these characteristics should be counseled on their risk of limited improvement in ankle pain and disability after total ankle arthroplasty.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background:
Little is known about the efficacy and durability of total ankle arthroplasty (TAA) in younger patients. The purpose of this study was to determine the effect of age on the clinical, ...radiographic, and patient-reported outcomes of patients with end-stage ankle arthritis treated with TAA using modern prostheses.
Methods:
Patients who underwent primary TAA from June 2007 to July 2011 were prospectively enrolled in the study. Three hundred and ninety-five consecutive patients were reviewed with a mean follow-up of 3.5 years (range, 2-5.4 years). Patients were divided into 3 groups based on age at the time of surgery (<55, 55-70, and >70 years). Patient-reported outcome scores, physical performance scores, and weight-bearing radiographs were used to assess patients preoperatively and at yearly postoperative office visits. Revision was defined as failure of either the tibial or talar components requiring removal of the metallic implants. A repeated-measures analysis of variance with post hoc testing and the Pearson chi-square test were used to assess differences between the 3 groups. Statistical significance was set at an alpha level of .05.
Results:
Patients under the age of 55 had a greater improvement in Short-Form 36 (SF-36) Vitality (P = .026) and American Orthopaedic Foot & Ankle Society (AOFAS) Function scores (P < .001) compared with patients over the age of 70 at most recent follow-up. There were no differences in the Visual Analog Scale (VAS) pain score or the physical performance outcomes between the age groups. The incidence of wound complications, need for reoperation, and revision were not different between groups.
Conclusions:
Outcomes of TAA in younger patients were similar to outcomes in older patients at early follow-up. This study establishes a cohort of patients that will be followed to determine the effect of age on the long-term outcomes of TAA with an emphasis on the need for reoperation and revision.
Level of Evidence:
Level II, prospective comparative study.
BACKGROUND:Excessive tibiotalar malalignment in the coronal plane has been considered by some to be a contraindication to total ankle replacement. The purpose of the present study was to compare ...clinical outcomes and physical performance measures according to preoperative tibiotalar alignment.
METHODS:One hundred and three patients undergoing total ankle replacement were grouped according to coronal plane tibiotalar alignment. Seventeen patients had an excessive deformity (>15° of varus or valgus), twenty-one had moderate valgus alignment (5° to 15° of valgus), twenty-seven had moderate varus alignment (5° to 15° of varus), and thirty-eight had neutral alignment (<5° of varus or valgus). Outcome measures, including the American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score, the Foot and Ankle Disability Index (FADI), the Short Form-36 (SF-36), the timed up and go test (TUG), the four square step test (4SST), and walking speed, were assessed preoperatively and at one and two years after total ankle replacement.
RESULTS:Coronal plane alignment improved following the procedure, with 36.9% of patients having neutral alignment preoperatively as compared with 95% postoperatively. To achieve this alignment, adjunctive procedures, including deltoid ligament release, lateral ligament reconstruction, and posterior soft-tissue releases, were necessary. Significant improvements were seen for the Page3 AOFAS pain, function, alignment, and hindfoot scores (p < 0.001) and the SF-36 subscales of body pain, physical function, and role physical (p < 0.001) following total ankle replacement. Walking speed and the FADI, TUG, and 4SST scores also improved significantly (p < 0.001). Subgroup analysis demonstrated no significant differences in clinical outcomes and physical performance measures based on preoperative coronal plane alignment.
CONCLUSIONS:Total ankle replacement improves clinical and functional outcomes independent of preoperative tibiotalar alignment when postoperative alignment is restored to neutral at the time of arthroplasty.
LEVEL OF EVIDENCE:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background:
A variety of operative approaches and fixation techniques have been described for tibiotalocalcaneal (TTC) arthrodesis. The intramedullary (IM) nail and lateral, fixed-angle plating are ...commonly used because of ease of use and favorable biomechanical properties. A lateral, transfibular (LTF) approach allows for direct access to the tibiotalar and subtalar joints, but the posterior, Achilles tendon–splitting (PATS) approach offers a robust soft tissue envelope. The purpose of this study was to compare the results of TTC arthrodesis with either a PATS approach with IM nailing or LTF approach with fixed-angle plating.
Methods:
A retrospective review was performed on all patients who underwent simultaneous TTC arthrodesis with minimum 1 year clinical and radiographic follow up. Patients were excluded if they underwent TTC arthrodesis through an approach other than PATS or LTF, and received fixation without an IM nail or fixed-angle plate. Primary outcomes examined were union rate, revisions, and complications. Thirty-eight patients underwent TTC arthrodesis with a PATS approach and IM nailing, and 28 with a LTF approach and lateral plating.
Results:
The overall union rate was 71%; 76% (29 of 38 patients) for the PATS/IM nail group, and 64% (18 of 28) for LTF/plating group (P = .41). Symptomatic nonunion requiring revision arthrodesis occurred in 16% (6 of 38) of the PATS/IM nail group versus 7% (2 of 28) in the LTF/lateral plating group (P = .45). There were no significant differences in individual tibiotalar or subtalar union rates, superficial wound problems, infection, symptomatic hardware, stress fractures, or nerve irritations.
Conclusion:
Union, revision, and complication rates were similar for TTC arthrodesis performed with a PATS approach and IM nail compared with an LTF approach and fixed-angle plate in a complex patient population. Both techniques were adequate, especially when prior incisions, preexisting hardware, or deformity preclude options.
Level of Evidence:
Level III, retrospective comparative study.
We report an early onset spastic ataxia-neuropathy syndrome in two brothers of a consanguineous family characterized clinically by lower extremity spasticity, peripheral neuropathy, ptosis, ...oculomotor apraxia, dystonia, cerebellar atrophy, and progressive myoclonic epilepsy. Whole-exome sequencing identified a homozygous missense mutation (c.1847G>A; p.Y616C) in AFG3L2, encoding a subunit of an m-AAA protease. m-AAA proteases reside in the mitochondrial inner membrane and are responsible for removal of damaged or misfolded proteins and proteolytic activation of essential mitochondrial proteins. AFG3L2 forms either a homo-oligomeric isoenzyme or a hetero-oligomeric complex with paraplegin, a homologous protein mutated in hereditary spastic paraplegia type 7 (SPG7). Heterozygous loss-of-function mutations in AFG3L2 cause autosomal-dominant spinocerebellar ataxia type 28 (SCA28), a disorder whose phenotype is strikingly different from that of our patients. As defined in yeast complementation assays, the AFG3L2(Y616C) gene product is a hypomorphic variant that exhibited oligomerization defects in yeast as well as in patient fibroblasts. Specifically, the formation of AFG3L2(Y616C) complexes was impaired, both with itself and to a greater extent with paraplegin. This produced an early-onset clinical syndrome that combines the severe phenotypes of SPG7 and SCA28, in additional to other "mitochondrial" features such as oculomotor apraxia, extrapyramidal dysfunction, and myoclonic epilepsy. These findings expand the phenotype associated with AFG3L2 mutations and suggest that AFG3L2-related disease should be considered in the differential diagnosis of spastic ataxias.
Background:
Despite substantial increase in total ankle arthroplasty (TAA) nationwide, there are few studies comparing flat-cut vs chamfer-cut talar systems in TAA with regard to radiographic aseptic ...loosening rates of the implant.
Methods:
This retrospective study included 189 Salto-Talaris TAA and 132 INBONE II primary TAA with a minimum 1-year follow-up. Patient characteristics were obtained including gender, age at surgery, body mass index (BMI), smoking status, primary diagnosis, surgical time, and the presence of diabetes. Radiographic evidence for aseptic loosening was assessed. Statistical analysis was performed for comparison in outcomes between Salto-Talaris and INBONE II.
Results:
The mean age of the study population was 63.5 ± 9.8 years at surgery. Mean follow-up was 4.9 ± 3.0 years. Radiographic aseptic loosening of the tibial implant showed no significant difference between the 2 groups: Salto-Talaris, 18%, and INBONE II, 18.9% (P = .829). Aseptic loosening of the talar implant also showed no significant difference between the 2 groups: Salto-Talaris, 1.6%, and INBONE II, 1.5% (P = .959). No variables, including the implant type, were found to contribute to the aseptic loosening rate of either the tibia or talus.
Conclusion:
In our cohort, we observed no difference in radiographic implant aseptic loosening between Salto-Talaris and INBONE II systems.
Level of Evidence:
Level IV, retrospective case series study.
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