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Article ; Online: Relationship between shoulder abduction strength and rotator cuff tear in elderly women: a general population study.

Hinsley, Hannah / Ganderton, Charlotte / Arden, Nigel K / Carr, Andrew J

2023 Volume 13, Issue 7, Page(s) e071908

Abstract: Objectives: To investigate the effect of age-related rotator cuff tears on shoulder strength in a general population cohort.: Design: Cross sectional observational study.: Setting: This study was set in an outpatient clinic setting in Chingford, ... ...

Abstract	Objectives: To investigate the effect of age-related rotator cuff tears on shoulder strength in a general population cohort. Design: Cross sectional observational study. Setting: This study was set in an outpatient clinic setting in Chingford, North East London, and was a component of the 20 year visit of the Chingford 1000 women cohort. Participants: Individuals were part of the Chingford 1000 women cohort, a 20-year-old longitudinal population study. This cohort has been extensively characterised as representative of the population of the UK. At the 20 year visit, 446 attended for shoulder assessment and were aged between 64 and 87. Primary and secondary outcome measures: Isometric shoulder abduction strength measured using a Nottingham Mecmesin Myometer and the presence of rotator cuff pathology, determined via ultrasound examination (GE voluson i portable ultrasound machine with a 10-16MHz linear probe). Shoulders were classified into normal, abnormal tendon/partial tear, full-thickness tears (>0 and ≤2.5 cm) and full-thickness tears (>2.5 cm). Symptoms were defined using the Oxford Shoulder Score, where an abnormal score was defined as symptomatic. Results: 446 women (891 shoulders) aged 71 (range 65-84) were included in the study. Age, the presence of pain and the non-dominant arm were demonstrated to reduce strength. Rotator cuff tears and pathology had no isolated effect on shoulder strength in those aged under 70. However, in the over 70s full-thickness tears>0 and ≤2.5 cm, and >2.5 cm had mean reductions of 6.3 and 12.7 N, respectively (p<0.001). Conclusion: Rotator cuff tears of all sizes in those aged under 70 were not associated with a loss of shoulder strength. In those aged over 70, strength was reduced by 30% with small and 40% with large full thickness tears. Loss in strength was associated a loss of ability to perform activities of daily living but only for large tears.
MeSH term(s)	Aged ; Humans ; Female ; Aged, 80 and over ; Middle Aged ; Young Adult ; Adult ; Shoulder/diagnostic imaging ; Rotator Cuff Injuries/diagnostic imaging ; Cross-Sectional Studies ; Activities of Daily Living ; Rotator Cuff/diagnostic imaging
Language	English
Publishing date	2023-07-17
Publishing country	England
Document type	Observational Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-071908
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Article ; Online: Prevalence of rotator cuff tendon tears and symptoms in a Chingford general population cohort, and the resultant impact on UK health services: a cross-sectional observational study.

Hinsley, Hannah / Ganderton, Charlotte / Arden, Nigel K / Carr, Andrew J

BMJ open

2022 Volume 12, Issue 9, Page(s) e059175

Abstract: Objectives: To define the population prevalence of rotator cuff tears and test their association with pain and function loss; determine if severity symptom correlates with tear stage severity, and quantify the impact of symptomatic rotator cuff tears on ...

Abstract	Objectives: To define the population prevalence of rotator cuff tears and test their association with pain and function loss; determine if severity symptom correlates with tear stage severity, and quantify the impact of symptomatic rotator cuff tears on primary healthcare services in a general population cohort of women. Design: Cross-sectional observational study. Participants: Individuals were part of the Chingford 1000 Women cohort, a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and representative of the population of the UK. Main outcome measures: Rotator cuff pathology prevalence on ultrasound, shoulder symptoms using the Oxford Shoulder Score and resultant number of general practitioner (GP) consultations. Results: The population prevalence of full-thickness tears was 22.2%, which increased with age (p=0.004) and whether it was the dominant arm (Relative Risk 1.64, OR 1.58, 95% CI 1.07 to 2.33, p=0.021).Although 48.4% of full-thickness tears were asymptomatic, there was an association between rotator cuff tears and patient-reported symptoms. Individuals with at least one full-thickness tear were 1.97 times more likely than those with bilateral normal tendons (OR 3.53, 95% CI 2.00 to 5.61, p<0.001) to have symptoms. Severity of symptoms was not related to the severity of the pathology until tears are >2.5 cm (p=0.009).In the cohort, 8.9% had seen their GP with shoulder pain and a full-thickness rotator cuff tear, 18.8% with shoulder pain and an abnormality and 29.3% with shoulder pain. Conclusion: Rotator cuff tears are common, and primary care services are heavily impacted. As 50% of tears remain asymptomatic, future research may investigate the cause of pain and whether different treatment modalities, aside from addressing the pathology, need further investigation.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Cross-Sectional Studies ; Female ; Health Services ; Humans ; Lacerations ; Middle Aged ; Prevalence ; Rotator Cuff/diagnostic imaging ; Rotator Cuff Injuries/complications ; Rotator Cuff Injuries/epidemiology ; Rupture ; Shoulder Pain/epidemiology ; Shoulder Pain/etiology ; United Kingdom/epidemiology ; Young Adult
Language	English
Publishing date	2022-09-13
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2021-059175
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Article ; Online: A Hybrid Electrospun-Extruded Polydioxanone Suture for Tendon Tissue Regeneration.

Abhari, Roxanna E / Snelling, Sarah J B / Augustynak, Edyta / Davis, Simon / Fischer, Roman / Carr, Andrew J / Mouthuy, Pierre-Alexis

Tissue engineering. Part A

2024 Volume 30, Issue 5-6, Page(s) 214–224

Abstract: Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon's poor intrinsic healing capacity and the repurposing of sutures from other clinical applications. ... ...

Abstract	Many surgical tendon repairs fail despite advances in surgical materials and techniques. Tendon repair failure can be partially attributed to the tendon's poor intrinsic healing capacity and the repurposing of sutures from other clinical applications. Electrospun materials show promise as a biological scaffold to support endogenous tendon repair, but their relatively low tensile strength has limited their clinical translation. It is hypothesized that combining electrospun fibers with a material with increased tensile strength may improve the suture's mechanical properties while retaining biophysical cues necessary to encourage cell-mediated repair. This article describes the production of a hybrid electrospun-extruded suture with a sheath of submicron electrospun fibers and a core of melt-extruded fibers. The porosity and tensile strength of this hybrid suture is compared with an electrospun-only braided suture and clinically used sutures Vicryl and polydioxanone (PDS). Bioactivity is assessed by measuring the adsorbed serum proteins on electrospun and melt-extruded filaments using mass spectrometry. Human hamstring tendon fibroblast attachment and proliferation were quantified and compared between the hybrid and control sutures. Combining an electrospun sheath with melt-extruded cores created a hybrid braid with increased tensile strength (70.1 ± 0.3N) compared with an electrospun only suture (12.9 ± 1 N,
MeSH term(s)	Humans ; Polydioxanone ; Polyglactin 910 ; Suture Techniques ; Tendons/surgery ; Sutures ; Tensile Strength ; Blood Proteins
Chemical Substances	Polydioxanone (31621-87-1) ; Polyglactin 910 (34346-01-5) ; Blood Proteins
Language	English
Publishing date	2024-01-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2420582-5
ISSN	1937-335X ; 1937-3341
ISSN (online)	1937-335X
ISSN	1937-3341
DOI	10.1089/ten.TEA.2023.0273
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Article: The case for an academic discipline of medical device science.

Lübbeke, Anne / Smith, James A / Prieto-Alhambra, Daniel / Carr, Andrew J

EFORT open reviews

2021 Volume 6, Issue 3, Page(s) 160–163

Abstract: Medical devices are a very important but largely under-recognized and fragmented component of healthcare.The limited regulation of the past and the lack of systematic rigorous evaluation of devices leading to numerous high-profile failures will now be ... ...

Abstract	Medical devices are a very important but largely under-recognized and fragmented component of healthcare.The limited regulation of the past and the lack of systematic rigorous evaluation of devices leading to numerous high-profile failures will now be replaced by stricter legal requirements and more transparent evaluation processes.This constitutes an unprecedented opportunity, but it also uncovers urgent needs in landscaping, methodology development, and independent comprehensive assessment of device risks and benefits for individual patients and society, especially in the context of increasingly complex devices.We argue that an academic discipline of 'medical device science' is well placed to lead and coordinate the efforts necessary to achieve much needed improvement in the medical device sector.Orthopaedics and traumatology could contribute and benefit considerably as one of the medical specialties with the highest use of medical devices. Cite this article:
Language	English
Publishing date	2021-03-01
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1302/2058-5241.6.200094
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Article ; Online: Advanced Robotics to Address the Translational Gap in Tendon Engineering.

Sander, Iain L / Dvorak, Nicole / Stebbins, Julie A / Carr, Andrew J / Mouthuy, Pierre-Alexis

Cyborg and bionic systems (Washington, D.C.)

2022 Volume 2022, Page(s) 9842169

Abstract: Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical ...

Abstract	Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical environment of native tissue as closely as possible. We review recent tendon tissue engineering studies in this article and highlight limitations of conventional uniaxial tensile bioreactors used in current literature. Advanced robotic platforms such as musculoskeletal humanoid robots and soft robotic actuators are promising technologies which may help address translational gaps in tendon tissue engineering. We suggest the proposed benefits of these technologies and identify recent studies which have worked to implement these technologies in tissue engineering. Lastly, key challenges to address in adapting these robotic technologies and proposed future research directions for tendon tissue engineering are discussed.
Language	English
Publishing date	2022-09-15
Publishing country	United States
Document type	Journal Article ; Review
ISSN	2692-7632
ISSN (online)	2692-7632
DOI	10.34133/2022/9842169
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Article: Registry stakeholders.

Lübbeke, Anne / Carr, Andrew J / Hoffmeyer, Pierre

EFORT open reviews

2019 Volume 4, Issue 6, Page(s) 330–336

Abstract: Clinical registries are health information systems, which have the mission to collect multidimensional real-world data over the long term, and to generate relevant information and actionable knowledge to address current serious healthcare problems.This ... ...

Abstract	Clinical registries are health information systems, which have the mission to collect multidimensional real-world data over the long term, and to generate relevant information and actionable knowledge to address current serious healthcare problems.This article provides an overview of clinical registries and their relevant stakeholders, focussing on registry structure and functioning, each stakeholder's specific interests, and on their involvement in the registry's information input and output.Stakeholders of clinical registries include the patients, healthcare providers (professionals and facilities), financiers (government, insurance companies), public health and regulatory agencies, industry, the research community and the media.The article discusses (1) challenges in stakeholder interaction and how to strengthen the central role of the patient, (2) the importance of adding cost reporting to enable informed value choices, and (3) the need for proof of clinical and public health utility of registries.In its best form, a registry is a mission-driven, independent stakeholder-registry team collaboration that enables rapid, transparent and open-access knowledge generation and dissemination. Cite this article:
Language	English
Publishing date	2019-06-03
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2844421-8
ISSN	2058-5241 ; 2058-5241 ; 2396-7544
ISSN (online)	2058-5241
ISSN	2058-5241 ; 2396-7544
DOI	10.1302/2058-5241.4.180077
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Article: Interleukin-17 Cytokines and Receptors: Potential Amplifiers of Tendon Inflammation.

Mimpen, Jolet Y / Snelling, Sarah J B / Carr, Andrew J / Dakin, Stephanie G

Frontiers in bioengineering and biotechnology

2021 Volume 9, Page(s) 795830

Abstract: Interleukin (IL)-17A, a pro-inflammatory cytokine that is linked to the pathology of several inflammatory diseases, has been shown to be upregulated in early human tendinopathy and to mediate inflammatory and tissue remodelling events. However, it ... ...

Abstract	Interleukin (IL)-17A, a pro-inflammatory cytokine that is linked to the pathology of several inflammatory diseases, has been shown to be upregulated in early human tendinopathy and to mediate inflammatory and tissue remodelling events. However, it remains unclear which cells in tendons can respond to IL-17A, and how IL-17A, and its family members IL-17F and IL-17AF, can affect intracellular signalling activation and mRNA expression in healthy and diseased tendon-derived fibroblasts. Using well-phenotyped human tendon samples, we show that IL-17A and its receptors IL-17RA and IL-17RC are present in healthy hamstring, and tendinopathic and torn supraspinatus tendon tissue. Next, we investigated the effects of IL-17A, IL-17F, or IL-17AF on cultured patient-derived healthy and diseased tendon-derived fibroblasts. In these experiments, IL-17A treatment significantly upregulated
Language	English
Publishing date	2021-12-23
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2719493-0
ISSN	2296-4185
ISSN	2296-4185
DOI	10.3389/fbioe.2021.795830
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Article ; Online: Can Shoulder Arthroscopy Work? (CSAW) trial - Authors' reply.

Beard, David J / Carr, Andrew J / Cook, Jonathan A

Lancet (London, England)

2018 Volume 392, Issue 10144, Page(s) 281–282

MeSH term(s)	Arthroscopy ; Shoulder
Language	English
Publishing date	2018-07-31
Publishing country	England
Document type	Letter ; Comment
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(18)30773-6
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Article: Electrospun Scaffold Micro-Architecture Induces an Activated Transcriptional Phenotype within Tendon Fibroblasts.

Baldwin, Mathew J / Mimpen, Jolet Y / Cribbs, Adam P / Stace, Edward / Philpott, Martin / Dakin, Stephanie G / Carr, Andrew J / Snelling, Sarah Jb

Frontiers in bioengineering and biotechnology

2022 Volume 9, Page(s) 795748

Abstract: Biomaterial augmentation of surgically repaired rotator cuff tendon tears aims to improve the high failure rates (∼40%) of traditional repairs. Biomaterials that can alter cellular phenotypes through the provision of microscale topographical cues are now ...

Abstract	Biomaterial augmentation of surgically repaired rotator cuff tendon tears aims to improve the high failure rates (∼40%) of traditional repairs. Biomaterials that can alter cellular phenotypes through the provision of microscale topographical cues are now under development. We aimed to systematically evaluate the effect of topographic architecture on the cellular phenotype of fibroblasts from healthy and diseased tendons. Electrospun polydioxanone scaffolds with fiber diameters ranging from 300 to 4000 nm, in either a highly aligned or random configuration, were produced. Healthy tendon fibroblasts cultured for 7 days on scaffolds with highly aligned fibers demonstrated a distinctive elongated morphology, whilst those cultured on randomly configured fibers demonstrated a flattened and spread morphology. The effect of scaffold micro-architecture on the transcriptome of both healthy and diseased tendon fibroblasts was assessed with bulk RNA-seq. Both healthy (
Language	English
Publishing date	2022-01-12
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2719493-0
ISSN	2296-4185
ISSN	2296-4185
DOI	10.3389/fbioe.2021.795748
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Article ; Online: Industry ties and evidence in public comments on the FDA framework for modifications to artificial intelligence/machine learning-based medical devices: a cross sectional study.

Smith, James Andrew / Abhari, Roxanna E / Hussain, Zain / Heneghan, Carl / Collins, Gary S / Carr, Andrew J

BMJ open

2020 Volume 10, Issue 10, Page(s) e039969

Abstract: Objectives: To determine the extent and disclosure of financial ties to industry and use of scientific evidence in comments on a US Food and Drug Administration (FDA) regulatory framework for modifications to artificial intelligence/machine learning (AI/ ...

Abstract	Objectives: To determine the extent and disclosure of financial ties to industry and use of scientific evidence in comments on a US Food and Drug Administration (FDA) regulatory framework for modifications to artificial intelligence/machine learning (AI/ML)-based software as a medical device (SaMD). Design: Cross-sectional study. Setting: We searched all publicly available comments on the FDA 'Proposed Regulatory Framework for Modifications to Artificial Intelligence/Machine Learning (AI/ML)-Based Software as a Medical Device (SaMD)-Discussion Paper and Request for Feedback' from 2 April 2019 to 8 August 2019. Main outcome measures: The proportion of articles submitted by parties with financial ties to industry, disclosing those ties, citing scientific articles, citing systematic reviews and meta-analyses, and using a systematic process to identify relevant literature. Results: We analysed 125 comments submitted on the proposed framework. 79 (63%) comments came from parties with financial ties; for 36 (29%) comments, it was not clear and the absence of financial ties could only be confirmed for 10 (8%) comments. No financial ties were disclosed in any of the comments that were not from industry submitters. The vast majority of submitted comments (86%) did not cite any scientific literature, just 4% cited a systematic review or meta-analysis and no comments indicated that a systematic process was used to identify relevant literature. Conclusions: Financial ties to industry were common and undisclosed, and scientific evidence, including systematic reviews and meta-analyses, were rarely cited. To ensure regulatory frameworks best serve patient interests, the FDA should mandate disclosure of potential conflicts of interest (including financial ties) in comments, encourage the use of scientific evidence, and encourage engagement from non-conflicted parties.
MeSH term(s)	Artificial Intelligence ; Conflict of Interest ; Cross-Sectional Studies ; Disclosure ; Drug Industry ; Humans ; Machine Learning ; United States ; United States Food and Drug Administration
Language	English
Publishing date	2020-10-14
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2020-039969
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