Search

Lateral patellar dislocations often occur in a young, athletic population of recurrent dislocators with generalized laxity and an interest in returning to an active lifestyle. A recent appreciation for the distal patellotibial complex has directed surgeons toward attempting to re-create the native anatomy and knee biomechanics during medial patellar reconstructive procedures. By reconstructing the medial patellotibial ligament (MPTL) in addition to the medial patella-femoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL), the current article describes a potentially more stable construct that can be utilized in patients with subluxation with the knee in full extension, patellar instability with the knee in deep flexion, genu recurvatum, and generalized hyperlaxity. Additionally, the current technique utilizes a tibialis anterior allograft. The purpose of this Technical Note is to describe, in detail, the current authors' technique for a combined MPFL, MQTFL, and MPTL reconstruction.

Objectives The importance of the effects of stress on cats is well recognised, with visits to the veterinary clinic a common cause of stress. The aim of this study was to explore owners’ experiences of stress, both for themselves and their cat, during veterinary visits, and to gather data on owners’ perception of resources within the clinic to reduce stress in their cats. Methods A questionnaire aimed at cat owners with recent experience of an outpatient visit to the veterinary clinic was developed and distributed. Questions covered demographics; their most recent veterinary visit; their general experience of visits over the past 3 years; measures taken by the clinic to reduce stress; and awareness of the Cat Friendly Clinic programme. There were various question types, with owners often asked to rate stress from 1 (least stressful) to 10 (most stressful). Results A total of 277 respondents gave details about their experience of consultations over the past 3 years. Owners rated the stress of travelling to the clinic, other animals in the waiting room and the consultation itself (all median 6, interquartile range 4–8) as the most stressful elements. Most owners reported gentle methods of removing the cat from their carrier; however, almost a third (n = 81/263; 30.8%) had seen their cat scruffed during a consultation. Cat-only waiting rooms were viewed as the most effective measure to reduce stress in the clinic. Conclusions and relevance Veterinary clinics are already taking steps to address stress in cats, and owners have a good awareness of stress in their cats. Future work should focus on trialling specific interventions to determine their effectiveness in reducing stress in feline patients, and measures currently perceived by owners to be highly effective, such as cat-only waiting rooms, should be used where feasible.

Since its founding in 1990, the profession of oncology navigation has grown and evolved. Although core concepts serve as a unifying thread throughout the profession, there has not been formal agreement on standardization of definitions, scopes, and roles for the various types of navigators. This has created challenges for sustainability, including reimbursement for navigation services. Emerging from the Biden Cancer Initiative's patient navigation working group, the Professional Oncology Navigation Task Force was created to serve as the voice of professional oncology organizations with an ultimate goal of solidifying definitions, scopes, and roles of navigators across the care continuum. Task group members are committed to cross-disciplinary partnership (including nursing, social work, and nonclinically licensed navigation). As the Task Force worked to define, refine, and disseminate professional standards (with input from the navigation community), the work done by the National Navigation Roundtable was vital to our evolving understanding of the profession. This article outlines the importance of that partnership and highlights the relevant findings of each article in this supplement of Cancer to the standardization work. LAY SUMMARY: Within the profession of oncology navigation, definitions, scopes, and roles of navigators have not been solidified. Standardization of the profession is critical to allow for continued growth and evolution as well as policy direction. This article introduces the work of the Professional Oncology Navigation Task Force, which created the Oncology Navigation Standards of Professional Practice with input from professional leaders and community stakeholders. The article also links the work of the National Navigation Roundtable and the critical need to coordinate and amplify efforts across groups.

Acetylacetone (AcAc) has proven to be a fruitful but highly challenging model system for the experimental and computational interrogation of strong intramolecular hydrogen bonds. Key questions remain, however, regarding the identity of the minimum-energy structure of AcAc and the dynamics of intramolecular proton transfer. Here, we investigate the OH/OD stretch and bend regions of the enol tautomer of AcAc and its deuterated isotopologue with transient absorption and 2D IR spectroscopy. The OH bend region reveals a single dominant diagonal transition near 1625 cm

Flavin containing monooxygenases (FMOs) are promiscuous enzymes known for metabolizing a wide range of exogenous compounds. In C. elegans, fmo-2 expression increases lifespan and healthspan downstream of multiple longevity-promoting pathways through an unknown mechanism. Here, we report that, beyond its classification as a xenobiotic enzyme, fmo-2 expression leads to rewiring of endogenous metabolism principally through changes in one carbon metabolism (OCM). These changes are likely relevant, as we find that genetically modifying OCM enzyme expression leads to alterations in longevity that interact with fmo-2 expression. Using computer modeling, we identify decreased methylation as the major OCM flux modified by FMO-2 that is sufficient to recapitulate its longevity benefits. We further find that tryptophan is decreased in multiple mammalian FMO overexpression models and is a validated substrate for FMO-2. Our resulting model connects a single enzyme to two previously unconnected key metabolic pathways and provides a framework for the metabolic interconnectivity of longevity-promoting pathways such as dietary restriction. FMOs are well-conserved enzymes that are also induced by lifespan-extending interventions in mice, supporting a conserved and important role in promoting health and longevity through metabolic remodeling.

Direct link between FLASH sintering, structure, microstructure and higher residual compressive internal stress state compared to conventional sintering.

Herein, we present the initial steps toward developing a framework that will enable the characterization of photoinitiated dynamics within large molecular ions in the gas phase with temporal and energy resolution. We combine the established techniques of tag-loss action spectroscopy on cryogenically trapped molecular ions with ultrafast vibrational spectroscopy by measuring the linear action spectrum of N2-tagged protonated diglycine (GlyGlyH+·N2) with an ultrafast infrared (IR) pulse pair. The presented time-domain data demonstrate that the excited-state vibrational populations in the tagged parent ions are modulated by the ultrafast IR pulse pair and encoded through the messenger tag-loss action response. The Fourier transform of the time-domain action interferograms yields the linear frequency-domain vibrational spectrum of the ion ensemble, and we show that this spectrum matches the linear spectrum collected in a traditional manner using a frequency-resolved IR laser. Time- and frequency-domain interpretations of the data are considered and discussed. Finally, we demonstrate the acquisition of nonlinear signals through cross-polarization pump-probe experiments. These results validate the prerequisite first steps of combining tag-loss action spectroscopy with two-dimensional IR spectroscopy for probing dynamics in gas-phase molecular ions.

BackgroundMonocytes and macrophages play a pivotal role in inflammation during acute SARS-CoV-2 infection. However, their contribution to the development of post-acute sequelae of SARS-CoV-2 infection (PASC) are not fully elucidated.MethodsA cross sectional study was conducted comparing plasma cytokine and monocyte levels among three groups: participants with pulmonary PASC (PPASC) with a reduced predicted diffusing capacity for carbon monoxide [DLCOc, ResultsPlasma IL-1Ra levels were elevated but FGF levels were reduced in PG compared to NG. Circulating monocytes and three subsets were significantly higher in PG and RG compared to NG. PG and RG exhibited higher levels of CD169+monocyte counts and higher CD169 expression was detected in intermediate and non-classical monocytes from RG and PG than that found in NG. Further correlation analysis with CD169+monocyte subsets revealed that CD169+intermediate monocytes negatively correlated with DLCOc%, and CD169+non-classical monocytes positively correlated with IL-1α, IL-1β, MIP-1α, Eotaxin, and IFNγ.ConclusionThis study present evidence that COVID convalescents exhibit monocyte alteration beyond the acute COVID-19 infection period even in convalescents with no residual symptoms. These data provide further rational for determining the role of monocyte subsets in PPASC pathogenesis.

Objectives The COVID-19 pandemic saw major changes to small animal veterinary practice, many of which may have had an impact on stress in cats presented to the clinic. The aim of this study was to examine the nature of feline outpatient visits before and during the pandemic, and examine signs of stress noted in cats before, during and after these visits. Methods A questionnaire was used to gather data on cat owner experiences of visits to the veterinary clinic. Data were gathered on the owner’s most recent experience of a consultation, with consultations occurring in February 2020 or earlier coded as a standard consultation, and consultations occurring in March 2020 or later coded as COVID-19 consultations. Results A total of 371 responses were received, with 210 coded as standard consultations and 161 coded as COVID-19 consultations. Consultation type varied significantly between standard and COVID-19 consultations ( P Conclusions and relevance The findings suggest that outpatient visits to the veterinary clinic were stressful for cats both prior to and during the COVID-19 pandemic, but some measures taken during the pandemic, for example less use of waiting rooms, could be used alongside existing cat friendly measures to help to reduce stress in feline patients.

Highly effective combination antiretroviral therapy has reduced HIV infection to a manageable chronic disease, shifting the clinical landscape toward management of noninfectious comorbidities in people living with HIV (PLWH). These comorbidities are diverse, generally associated with accelerated aging, and present within multiple organ systems. Mechanistically, immune dysregulation and chronic inflammation, both of which persist in PLWH with well-controlled virally suppressive HIV infection, are suggested to create and exacerbate noninfectious comorbidity development. Persistent inflammation often leads to fibrosis, which is the common end point pathologic feature associated with most comorbidities. Fibrocytes are bone marrow–derived fibroblast-like cells, which emerged as key effector cells in tissue repair and pathologic fibrotic diseases. Despite their relevance to fibrosis, the circulating fibrocyte concentration in PLWH remains poorly characterized, and an understanding of their functional role in chronic HIV is limited. In this study, utilizing PBMCs from a cross-sectional adult HIV cohort study with matched uninfected controls (HIV−), we aimed to identify and compare circulating fibrocytes in blood. Both the percentage and number of fibrocytes and α-smooth muscle actin+ fibrocytes in circulation did not differ between the HIV+ and HIV− groups. However, circulating fibrocyte levels were significantly associated with increasing age in both the HIV+ and HIV− groups (the percentage and number; r = 0.575, p ≤ 0.0001 and r = 0.558, p ≤ 0.0001, respectively). Our study demonstrates that circulating fibrocyte levels and their fibroblast-like phenotype defined as collagen I and α-smooth muscle actin+ expression are comparable between, and strongly associated with, age irrespective of HIV status.

Objectives To evaluate the self-reported incidence of sleep disturbances, defined as ≤7 hours of sleep per 24-hour period, in patients undergoing arthroscopic-assisted knee surgery. Methods Patients who underwent arthroscopic knee surgery over the course of a 4-month period were prospectively included. Patients were excluded if a history of insomnia or other sleep altering medical history was reported. Self-reported sleep metrics included average number of hours of sleep per night, average number of awakenings during sleep per night, perceived quality of sleep, average pain level during sleep and number of hours of physical activity/therapy per week. Data were collected at weeks 1, 3, and 6 postoperatively. Joint circumference was measured on postoperative day 1 and served as an indicator of a knee effusion. Paired t-tests were used to compare preoperative to postoperative hours of sleep. Simple and multiple linear regression were used to evaluate relationships between surgical variables and postoperative sleep metrics. Results There were 123 patients who underwent arthroscopic knee surgery during the prospective enrolment period; 83 patients were included in the final analysis. The overall incidence of preoperative sleep disturbances was 20% (n=17). The overall incidence of self-reported postoperative sleep disturbances was 99%, 96% and 90% at weeks 1, 3 and 6, respectively. The average number of hours slept was significantly reduced at 1, 3 and 6 weeks postoperatively compared with the preinjury state (p 0.05). Conclusion Sleep disturbances were commonly reported in patients following arthroscopic knee surgery without correction of sleep metrics by 6 weeks postoperatively. The majority of sleep disturbances in this cohort correlated with an increased knee effusion. A multidisciplinary team approach is recommended to counsel patients regarding the potential for and problems with acute sleep disturbances following arthroscopic knee surgery. Level of evidence: 3.

This paper sheds light on the design and field results of a strategic Long-Term Polymer Injectivity Test (LTPIT) to de-risk phased commercial polymer-flooding in the largest sandstone field worldwide in pursuit of production acceleration, reserves growth and cost optimization. Effluent water with up to 170,000ppm TDS was used in conjunction with a pre-selected sulfonated polymer to evaluate injectivity at multiple rates and polymer concentrations under sub-fracturing conditions. Reservoir parting pressure was judiciously estimated to be around 2,500 psi. Polymer and water injected below parting pressure flowed into and through the Wara reservoir matrix as evidenced by the increase in downhole pressure with increasing injection rate in line with Darcy’s law. Polymer solutions expressed in-situ viscosities of up to 2.75 cP when injected below fracture parting pressure while displaying pseudoplastic flow characteristics. Water on the other hand displayed Newtonian behavior. Polymer adsorption onto the Wara formation developed a residual resistance factor of 1.17 for an effective water permeability reduction of approximately 20%. Polymer injection evidently improved reservoir conformance and resulted in more uniform zonal intake. Injected fluid distribution between 4,693 to 4,706 ft decreased from 85% to 71% and injection out of this depth range increased from 3% to 15.5%. Step rate testing with varying polymer concentrations evinced that increasing polymer concentration will decrease injection rate and, therefore, the duration of any mobility control polymer flood in the Wara reservoir will be affected by polymer concentration. A dynamic model was developed using CMG STARS and calibrated to wellbore petrophysics, polymer concentrations, downhole pressures, injection rates and pertinent surveillance/monitoring data. Numerical simulation sensitivity analysis indicates that 1800 ppm of the pre-selected sulfonated polymer (ZLPAM 40520), dissolved in effluent water, is the optimal concentration with 0.8 PV of injection being the optimal injected volume in terms of oil recovery and project economics. The benefits associated with polymer injection in terms of production acceleration, incremental recovery and cost optimization can be significantly increased by fast-tracking polymer injection using optimal well configuration. Performance forecasts using field data demonstrated that polymer injection has the potential to considerably reduce water-handling requirements, thus resulting in major cost savings. Furthermore, assuming an oil price of $80/bbl, drilling additional wells to establish 40-acre spacing for polymer injection can result in 9.4% incremental recovery at a Unit Technical Cost (UTC) of 19.3 $/bbl inclusive of the cost associated with polymer, additional wells, surface facilities, operations and maintenance. The results of this strategic field trial establish the techno-economic feasibility of phased commercial polymer-flooding in the Wara reservoir of the Greater Burgan field in Kuwait.

BackgroundLow-density granulocytes (LDGs) are a distinct subset of neutrophils whose increased abundance is associated with the severity of COVID-19. However, the long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on LDG levels and phenotypic alteration remain unexplored.MethodsUsing participants naïve to SARS-CoV-2 (NP), infected with SARS-CoV-2 with no residual symptoms (NRS), and infected with SARS-CoV-2 with chronic pulmonary symptoms (PPASC), we compared LDG levels and their phenotype by measuring the expression of markers for activation, maturation, and neutrophil extracellular trap (NET) formation using flow cytometry.ResultsThe number of LDGs was elevated in PPASC compared to NP. Individuals infected with SARS-CoV-2 (NRS and PPASC) demonstrated increased CD10+ and CD16hi subset counts of LDGs compared to NP group. Further characterization of LDGs demonstrated that LDGs from COVID-19 convalescents (PPASC and NRS) displayed increased markers of NET forming ability and aggregation with platelets compared to LDGs from NP, but no differences were observed between PPASC and NRS.ConclusionsOur data from a small cohort study demonstrates that mature neutrophils with a heightened activation phenotype remain in circulation long after initial SARS-CoV-2 infection. Persistent elevation of markers for neutrophil activation and NET formation on LDGs, as well as an enhanced proclivity for platelet-neutrophil aggregation (PNA) formation in COVID-19 convalescent individuals may be associated with PPASC prognosis and development.

Background Antenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME. Methods The primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally. Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only. All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter. Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol. Discussion Trial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere. Trial registration https://doi.org/10.1186/ISRCTN10833250. Registered 09/03/2020

An organism’s ability to perceive and respond to changes in its environment is crucial for its health and survival. Here we reveal how the most well-studied longevity intervention, dietary restriction, acts in-part through a cell non-autonomous signaling pathway that is inhibited by the presence of attractive smells. Using an intestinal reporter for a key gene induced by dietary restriction but suppressed by attractive smells, we identify three compounds that block food odor effects in C. elegans, thereby increasing longevity as dietary restriction mimetics. These compounds clearly implicate serotonin and dopamine in limiting lifespan in response to food odor. We further identify a chemosensory neuron that likely perceives food odor, an enteric neuron that signals through the serotonin receptor 5-HT1A/SER-4, and a dopaminergic neuron that signals through the dopamine receptor DRD2/DOP-3. Aspects of this pathway are conserved in D. melanogaster. Thus, blocking food odor signaling through antagonism of serotonin or dopamine receptors is a plausible approach to mimic the benefits of dietary restriction.

BACKGROUND Few existing studies have examined the relationship between lower extremity bone length and quadriceps strength. PURPOSE/HYPOTHESIS To evaluate the relationship between lower extremity, tibia and femur lengths, and isometric quadriceps strength in patients undergoing knee surgery. The null hypothesis was that there would be no correlation between lower extremity length and isometric quadriceps strength. STUDY DESIGN Cross-sectional study METHODS Patients with full-length weightbearing radiographs that underwent isometric quadriceps strength testing after knee surgery were included. Using full-length weightbearing radiographs, limb length was measured from the ASIS to the medial malleolus; femur length was measured from the center of the femoral head to the joint line; tibia length was measured from the center of the plateau to the center of the plafond. Isometric quadriceps strength was measured using an isokinetic dynamometer. Pearson’s correlation coefficient was used to report the correlation between radiographic limb length measurements. A Bonferroni correction was utilized to reduce the probability of a Type 1 error. RESULTS Forty patients (26 males, 14 females) with an average age of 25.8 years were included. The average limb, femur, and tibia lengths were not significantly different between operative and non-operative limbs (p>0.05). At an average of 5.8±2.5 months postoperatively, the peak torque (156.6 vs. 225.1 Nm), average peak torque (151.6 vs. 216.7 Nm), and peak torque to bodyweight (2.01 vs 2.89 Nm/Kg) were significantly greater in the non-surgical limb (pp = 0.048). CONCLUSION Femur length was significantly correlated with the isometric quadriceps peak torque for non-surgical limbs. Additionally, femur length and limb length were found to be negatively correlated with quadriceps strength deficit among ligament reconstruction patients. A combination of morphological features and objective performance metrics should be considered when developing individualized rehabilitation and strength programs.

Background A national drug resistance survey (DRS) was implemented for the first time in Timor-Leste (TL) in 2019. The primary objective of the survey was to assess the prevalence of drug resistance among new and previously treated pulmonary TB patients in the country. Methods This nation-wide cross-sectional survey was conducted in 2019 targeting all new and previously treated sputum smear-positive pulmonary TB patients. Sputum samples were submitted to the National TB Reference Laboratory for confirmation of TB and to determine resistance to rifampicin by Xpert MTB/RIF. Culture was performed on solid media, and culture isolates of confirmed TB cases were shipped to the WHO Supranational TB Reference Laboratory in Chennai, India for whole genome sequencing (WGS). Survey summary statistics, data cross-tabulations and analysis of potential risk factors of rifampicin-resistant TB (RR-TB) were conducted using R statistical software (version 3.5.2). Results A total of 953 sputum-smear positive patients were enrolled, of which 917 were confirmed as positive for TB by either Xpert MTB/RIF or culture. An electronic web-based system was used for entry and storage of the data. Rifampicin resistance was detected among 0.6% (95% CI 0.2–1.3) of new cases and 2.7% (95% CI 0.5- 8.2) of previously treated cases. WGS was conducted for validation purposes on 65 randomly selected isolates (29% of RR-TB (2/7) and 7% of RS-TB (63/910) by Xpert MTB/RIF or pDST). The original test results agreed with the WGS validation results for 62/64 isolates (97%). Conclusion The prevalence of RR-TB in Timor-Leste is relatively low compared to the estimated proportions of RR-TB in the WHO South-East Asia Region (2.5% [95% CI 1.9–3.3] among new cases and 14% [95% CI 7.7–21] among previously treated cases). The rapid sputum collection and transportation mechanism implemented in the survey demonstrates its feasibility in low resource settings and should be replicated for routinely transporting TB specimens from microscopy labs to GeneXpert sites. Establishment of in-country capacity for rapid molecular diagnostics for both first- and second-line DST is an immediate need for achieving universal drug susceptibility testing (DST) to guide appropriate patient management.

In 1954, archaeologists James Allen Lancaster and Don Watson and dendrochronologist Edmund Schulman asserted that a small grove of Douglas-fir (Pseudotsuga menziesii [Mirbel] Franco var. glauca [Beissener] Franco) trees in Navajo Canyon on the west side of Chapin Mesa in Mesa Verde National Park contained evidence of stone-axe-cut tree limbs. In 1965, archaeologists Robert Nichols and David Smith published an article entitled “Evidence of Prehistoric Cultivation of Douglas-Fir Trees at Mesa Verde,” in which they supported the Lancaster/Watson/Schulman assertion with tree-ring dates from suspected stone-axe-cut limbs. If correct, Nichols and Smith (1965) document the only trees in the entire U.S. Southwest that contain ancient stone-axe-cut stubs and evidence of precolumbian forest management. Rather than accept their interpretations at face value, we attempt to replicate their dates through the (re)analysis of archived and recently collected tree-ring samples, and through a controlled analysis and comparison of archived and published records. We could not confirm their results, and we have no option but to reject their claim that Schulman Grove contains evidence of precolumbian tree manipulation by Ancestral Puebloan inhabitants of Mesa Verde.

Context: Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes. Evidence Acquisition: Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020). Study Design: Clinical review. Level of Evidence: Level 3. Results: Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended. Conclusion: We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.

To examine clinical gait parameters, hip muscle strength, pelvic functional outcomes, and psychological outcomes after surgical fixation of OTA/AO 61-B and 61-C pelvic ring injuries.Retrospective review identified 10 OTA/AO 61-B patients and 9 OTA/AO 61-C patients for recruitment who were between 1 and 5 years after pelvic fixation. Gait and strength assessments, and patient-reported outcome scores were performed/collected and analyzed.Outpatient clinical motion performance laboratory.Patients with OTA/AO 61-B and OTA/AO 61-C fractures who were between 1 and 5 years after pelvic fixation.Hip strength, kinetics, and spatial-temporal outcomes; Majeed Pelvic Outcome Score; Short Form 36; Hamilton Anxiety/Depression Rating Scales.There were no differences in age, body mass index, or time since definitive fixation between OTA/AO 61-B and 61-C groups. The OTA/AO 61-C group had higher median injury severity scores, longer length of stay, and greater postoperative pelvic fracture displacement. There was no difference in bilateral hip strength, bilateral peak hip moments, peak hip power, and walking speed between groups. Patients with OTA/AO 61-C fractures had lower scores on Short Form 36 General Health and Majeed Work, with a trend toward a lower Total Majeed score. There were no differences in self-reported total anxiety and depression symptoms.This study did not identify any gait, strength, or psychological differences between OTA/AO 61-B and 61-C injuries at 1-5 years of follow-up. However, increased injury severity in OTA/AO 61-C patients may have residual consequences on perceived general health and ability to work. This pilot study establishes a template for future research into functional recovery of patients with severe pelvic ring trauma.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Background: Short- and midterm follow-up studies suggest that arthroscopic labral refixation/preservation leads to superior outcomes compared with labral excision/debridement. Purpose: To update the previous early (16 months) and midterm (mean, 42 months) follow-up of this cohort, which reported better patient-reported outcome measures and lower failure rates in the repair/refixation group. Study Design: Cohort study; Level of evidence, 3. Methods: The authors identified patients who underwent labral debridement/focal labral excision during a period before the development of labral repair techniques. A consecutive group of patients within the labral debridement group thought to be repairable with the authors’ current arthroscopic techniques were compared with a group of consecutive patients who underwent labral repair/refixation. In 46 hips, the labrum was focally excised/debrided consistent with pincer- or combined pincer- and cam-type impingement; in 54 hips, the labrum was repaired/refixed. Subjective outcomes were measured with the modified Harris Hip Score (mHHS), 12-Item Short Form Health Survey (SF-12), and visual analog scale (VAS) for pain preoperatively and postoperatively. Results: The mean age was 34.0 years in the debridement group and 28.3 years in the repair/refixation group, with a mean follow-up of 7.3 years (range, 2-13.6 years). At the mean follow-up of 7.3 years, subjective outcomes were significantly improved ( P < .01) for both groups compared with preoperative scores. The mHHS ( P = .008), SF-12 score ( P = .012), and VAS pain score ( P = .002) were all significantly better for the repair/refixation group compared with the debridement group. Although most recent outcomes for both groups fell slightly at the mean follow-up of 7.3 years in comparison with the 16-month and 3.5-year follow-ups, these differences were not significant. However, the failure rate in the debridement group did get significantly worse ( P = .014). Good to excellent results were 47.7% in the debridement group and 86.3% in the refixation group ( P < .001), and failure rates were 30.4% (debridement) and 13% (refixation) ( P = .033). There were 4 revisions in the debridement group and 3 revisions in the refixation group. Conclusion: Longer term, >7-year follow-up comparing focal labral excision/debridement with repair/refixation revealed better patient-reported outcomes and lower failure rates in the labral repair/refixation cohort. Additionally, despite an absolute decrease in patient-related outcome scoring and number of good/excellent results in both groups compared with the 3.5-year report, there was a significantly greater increase in failure rates over time for the excision/debridement group with better maintenance of good to excellent results in the repair/refixation group.

Background: Sesamoid injuries can have a significant effect on the ability of athletes to return to play. The literature shows mixed results with sesamoid excisions and the ability to return to sports. Hypothesis/Purpose: The purpose was to describe patient-reported outcomes and return to sports in athletes after sesamoidectomy with a proper surgical technique and a well-structured rehabilitation protocol. It was hypothesized that sesamoid excision would demonstrate reproducible and encouraging long-term patient outcomes. Study design: Case series; Level of evidence, 4. Methods: All patients from a single surgeon’s practice who underwent sesamoidectomy between January 2006 and September 2015 were identified. Medial sesamoids were excised through a medial approach, and lateral sesamoids were excised through a plantar approach. The plantar structures were adequately repaired after excision. The Foot Function Index–Revised (FFI-R), 12-Item Short Form Health Survey (SF-12), and visual analog scale (VAS) were collected preoperatively and at subsequent follow-up appointments. A patient satisfaction survey and Single Assessment Numeric Evaluation (SANE) questionnaire were also collected. Athletes were defined as those who participated in sports at a high school level or higher. Results: Of the 108 feet that met the inclusion criteria, 26 werelost to follow-up, leaving 82 feet for analysis at a mean 31.3 ± 26.0 months. There were 72 female patients and 10 male patients included in the final analysis, with a mean age of 44.9 ± 20.2 years. There were 54 medial, 18 lateral, and 10 medial and lateral sesamoid excisions. There were 26 competitive athletes with follow-up appointments (dancer, n = 12; pivot sport athlete, n = 8; runner, n = 6). Both the entire study population and the athletes demonstrated a significant improvement in SF-12, SANE, VAS, and FFI-R cumulative at the latest available follow-up ( P < .05). Among the athletes, 80% were able to return to competitive sports at a mean 4.62 ± 1.01 months after surgery. The median satisfaction score among all patients was 97.5%. There was no difference in the success rate between the different etiologies at any of the follow-up intervals. Conclusion: Chronic sesamoid pain is difficult to treat, but this study confirms that with a meticulous surgical technique and a dedicated postoperative rehabilitation program, encouraging patient-reported outcomes can be expected with a minimal risk of complications. Moreover, in the current study, 80% of competitive athletes were able to return to sports at a mean of 4.62 months after surgery.

Matrix metalloproteinases (MMPs) are enzymes that are elevated during states of inflammation and have specifically been linked to cartilage, tendon and bone pathologies. Concentrations of these enzymes fluctuate naturally with various injury states, and these enzymes have been shown to be directly inhibited by doxycycline. Historically, doxycycline has been used exclusively for its antimicrobial properties, but recent studies have investigated the anti-inflammatory properties of doxycycline and its effects on musculoskeletal pathologies. This study sought to describe the current use of doxycycline for its MMP inhibitory properties in the setting of musculoskeletal pathologies. During preclinical studies, improved healing properties were noted acutely in tendon injuries following surgical repair and chronically in cartilage injuries, demonstrating decreased rates of joint space narrowing and improved cartilage quality. There is only one known clinical trial that has examined doxycycline use, and it reported that doxycycline can decrease the rate of joint space narrowing in patients with osteoarthritis. Furthermore, doxycycline was well tolerated with minimal side effects reported in both animal and human studies. While it can be reasonably inferred that the positive effects of doxycycline are related to its ability to inhibit MMP activity, further clinical research is warranted to investigate the use of doxycycline in orthopaedic and musculoskeletal pathologies. Level of Evidence: Current Concepts, Level IV.

Carbon-fiber-reinforced polyetheretherketone (CFR) composite plates have a more favorable stress modulus than stainless steel (SS) plates that may confer an advantage to bridge plating. The purpose of this study was to compare callus formation after CFR and SS plating of distal femur fractures. A retrospective review identified distal femoral fractures treated with CFR (n = 10) and SS (n = 21) plate fixation. Callus formation was measured using the modified Radiographic Union Score for Tibia (mRUST) at 3- and 6-month follow-up by three orthopedic trauma surgeons. Loss of alignment, implant failure, and revision surgeries were reviewed. At 3 months, the mRUST in the CFR and SS groups was 9.0 (range, 6.3–12.3) and 6.9 (range, 4.3–11.7), respectively (p = 0.01). At 6 months, the mRUST in the CFR and SS groups was 11.4 (range, 7.7–16.0) and 10.5 (range, 6.0–15.7), respectively (p = 0.3). CFR and SS groups had a loss of fracture alignment in 1 (10%) and 1 (5%) patient, respectively (p = 0.5), and an unplanned revision surgery in 0 (0%) and 3 (15%) patients, respectively (p = 0.2). All three revisions surgeries in the SS group were for nonunion repair. Treatment of distal femur fractures with CFR versus SS plating resulted in greater callus formation at 3 months. At 6 months, there was no difference in callus formation between groups. A larger series of patients is necessary to determine if the observed early increased callus formation confers a benefit to clinical outcomes. Therapeutic level III.

FLASH sintering is a field-assisted technique that allows the densification of ceramics in a few seconds at temperatures significantly lower than those of conventional cycles. There is still discussion among the scientific community about the mechanism behind this sintering process, that has been typically attributed to Joule heating, defect creation and movement or liquid phase assisted sintering. Computational modelling can be a powerful tool in helping to explain and predict this process. Using potassium sodium niobate (KNN) as a case study, a lead-free piezoelectric, this work explores Finite Element Modelling to evaluate the dependence of Joule heating generation and temperature distribution as a function of the cubic particle orientation.

The iconic Plaza Tree of Pueblo Bonito is widely believed to have been a majestic pine standing in the west courtyard of the monumental great house during the peak of the Chaco Phenomenon (AD 850–1140). The ponderosa pine (Pinus ponderosa) log was discovered in 1924, and since then, it has been included in “birth” and “life” narratives of Pueblo Bonito, although these ideas have not been rigorously tested. We evaluate three potential growth origins of the tree (JPB-99): Pueblo Bonito, Chaco Canyon, or a distant mountain range. Based on converging lines of evidence—documentary records, strontium isotopes (87Sr/86Sr), and tree-ring provenance testing—we present a new origin for the Plaza Tree. It did not grow in Pueblo Bonito or even nearby in Chaco Canyon. Rather, JPB-99 originated from the Chuska Mountains, over 50 km west of Chaco Canyon. The tree was likely carried to Pueblo Bonito sometime between AD 1100 and 1130, although why it was left in the west courtyard, what it meant, and how it might have been used remain mysteries. The origin of the Plaza Tree of Pueblo Bonito underscores deep cultural and material ties between the Chaco Canyon great houses and the Chuska landscape.

Micro‐contact impedance spectroscopy (MCIS) is potentially a powerful tool for the exploration of resistive surface layers on top of a conductive bulk or substrate material. MCIS employs micro‐contacts in contrast to conventional IS where macroscopic electrodes are used. To extract the conductivity of each region accurately using MCIS requires the data to be corrected for geometry. Using finite element modeling on a system where the resistivity of the surface layer is at least a factor of ten greater than the bulk/substrate, we show how current flows through the two layers using two typical micro‐contact configurations. This allows us to establish if and what is the most accurate and reliable method for extracting conductivity values for both regions. For a top circular micro‐contact and a full bottom counter electrode, the surface layer conductivity (σs) can be accurately extracted using a spreading resistance equation if the thickness is ~10 times the micro‐contact radius; however, bulk conductivity (σb) values can not be accurately determined. If the contact radius is 10 times the thickness of the resistive surface, a geometrical factor using the micro‐contact area provides accurate σs values. In this case, a spreading resistance equation also provides a good approximation for σb. For two top circular micro‐contacts on thin resistive surface layers, the MCIS response from the surface layer is independent of the contact separation; however, the bulk response is dependent on the contact separation and at small separations contact interference occurs. As a consequence, there is not a single ideal experimental setup that works; to obtain accurate σs and σb values the micro‐contact radius, surface layer thickness and the contact separation must all be considered together. Here we provide scenarios where accurate σs and σb values can be obtained that highlight the importance of experimental design and where appropriate equations can be employed for thin and thick resistive surface layers.