Research Spotlight

Page, B. J. and M. Lee Brennan (2020). “Total Elbow Arthroplasty for Distal Humerus Fractures.” J Orthop Trauma 34 Suppl 2: S7-s8.

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Distal humerus fractures in elderly patients are challenging due to poor bone quality and may threaten the independence of elderly patients due to loss of functional range of motion. Total elbow arthroplasty has gained popularity in the treatment of these injuries. This video demonstrates total elbow arthroplasty in an elderly patient with a comminuted distal humerus fracture.

Hu, R., S. Quan, Y. Wang, Y. Zhou, Y. Zhang, L. Liu, X. J. Zhou and G. Xing (2020). “Spectrum of biopsy proven renal diseases in Central China: a 10-year retrospective study based on 34,630 cases.” Sci Rep 10(1): 10994

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Chronic kidney diseases have become a major issue worldwide. The spectrum of biopsy proven renal diseases differs between locations and changes over time. It is therefore essential to describe the local epidemiological trends and the prevalence of renal biopsy in various regions to shine new light on the pathogenesis of various renal diseases and provide a basis for further hypothesis-driven research. We retrospectively analyzed 34,630 hospitalized patients undergoing native renal biopsy between January 1, 2009 and December 31, 2018. Indications for renal biopsy and histological diagnosis were analyzed to describe the prevalence of renal biopsy, and changing prevalence between period 1 (2009-2013) and period 2 (2014-2018) were further analyzed. Nephrotic syndrome (NS) was the most common indication for biopsy. Membranous nephropathy (MN, 24.96%) and IgA nephropathy (IgAN, 24.09%) were the most common primary glomerulonephritis (PGN). MN was most common in adults, with IgAN more prevalent in children. Lupus nephritis (LN) was the most common secondary glomerulonephritis (SGN) in adults, while Henöch-Schönlein purpura nephritis (HSPN) in children. The prevalence of MN increased significantly and nearly doubled from period 1 (15.98%) to period 2 (30.81%) (P = 0.0004). The same trend appeared with membranoproliferative glomerulonephritis (MPGN), diabetic nephropathy (DN) and obesity-related glomerulopathy (ORG), while the frequencies of minimal change disease (MCD), focal segmental glomerulosclerosis (FSGS), LN and hepatitis B associated glomerulonephritis (HBV-GN) significantly decreased between the two intervals. NS was the most common indication for biopsy across all age groups and genders. MN has overtaken IgAN to become the most common PGN in adults, while IgAN was the most common PGN in children. LN was the most common SGN in adults, and HSPN the most common in children.

Ding, X., L. Zhou, X. Jiang, H. Liu, J. Yao, R. Zhang, D. Liang, F. Wang, M. Ma, B. Tang, E. Wu, J. Teng and X. Wang (2020). “Propagation of Pathological α-Synuclein from the Urogenital Tract to the Brain Initiates MSA-like Syndrome.” iScience 23(6): 101166.

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The neuropathological feature of multiple system atrophy (MSA), a fatal adult-onset disorder without effective therapy, is the accumulation of pathological α-synuclein (α-Syn) in the central nervous system (CNS). Here we show that pathological α-Syn exists in nerve terminals in detrusor and external urethral sphincter (EUS) of patients with MSA. Furthermore, α-Syn-preformed fibrils (PFFs) injected in the EUS or detrusor in TgM83(+/-) mice initiated the transmission of pathological α-Syn from the urogenital tract to brain via micturition reflex pathways, and these mice developed widespread phosphorylated α-Syn inclusion pathology together with phenotypes. In addition, urinary dysfunction and denervation-reinnervation of external anal sphincter were detected earlier in the mouse models with α-Syn PFFs inoculation before the behavioral manifestations. These results suggest that pathological α-Syn spreading through the micturition reflex pathways retrogradely from the urogenital tract to CNS may lead to urinary dysfunction in patients with MSA, which is different from the etiology of idiopathic Parkinson disease.

Stock, P. G., A. Wall, J. Gardner, B. Domínguez-Gil, S. Chadban, E. Muller, I. Dittmer and S. G. Tullius (2020). “Ethical Issues in the COVID Era: Doing the Right Thing Depends on Location, Resources, and Disease Burden.” Transplantation 104(7): 1316-1320.

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The same ethical principles that have always been used to guide transplant practices continue to apply during the COVID-19 era, but the balance between autonomy, beneficence, nonmaleficence, and justice will be inherently fluid, dependent on baseline resources, local practices, and where a given region resides—and is headed—on the COVID-19 incidence curve (Figure 1).4 Programmatic decisions about transplantation will weigh more heavily on distributive justice, beneficence and nonmaleficence than respect for autonomy. The overriding material principle of distributive justice will change, and be weighted more or less heavily, throughout the stages of the incidence curve based on available resources. Beneficence and nonmaleficence calculations must be continually reassessed as more data become available regarding the risk of COVID-19 infections in transplant patients, the availability and accuracy of testing, and the efficacy of new therapeutic modalities. While the complexity, threats, and consequences of COVID-19 are immense, it is reassuring to see the transplant and medical communities rallying together in such a time, and to see, as a result, such thoughtful and consistent responses to dealing with this situation around the globe. Putting aside the jargon of classical medical ethics, these global responses reflect the straightforward principles of doing the right thing for our patients, at the right time, for the right reasons. [No abstract; excerpt from article.].

Testa, G., L. Johannesson and A. E. Wall (2020). “Considering Uterus Transplantation for a Same-Sex Couple: A Case Study.” J Clin Ethics 31(2): 154-157.

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A woman with congenital absence of a uterus applied for participation in a clinical trial for uterus transplantation. She was married to a woman who had the potential to carry a child without the need for aggressive medical intervention. Thus, the question arose regarding whether the infertile partner should be considered for uterus transplantation. In this article we discuss the ethical issues with uterus transplantation for a member of a same-sex couple, whose partner could carry a pregnancy. We review the medical criteria for uterus transplantation, discuss the additional options for parenthood in same-sex couples, examine how to determine if this meets the criteria of just distribution of uterus grafts, and ultimately argue that the value of gestation is at the level of the individual rather than the couple.