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Lippincott, Williams and Wilkins; Philadelphia, 2002 256 pages - $39.95 Reviewed by Sidney Weissman, M.D. As the authors note, "Test taking is never a pleasant experience unless you are prepared [...]

Objective: To investigate the effects of the attachment site of grafts and the tunnel angle on the function of knee joint after anterior cruciate ligament reconstruction., Methods: From January 2006 to May 2009, 47 patients(32 males and 15 females, ranging in age from 19 to 51 years old, with an average of 35.3 years old) were treated with single-bundle reconstruction of anterior cruciate ligament. Several indexes were measured at the latest follow-up as follow: attachment sites of graft on the femoral condyle were recorded, the femoral tunnel angles on coronal and sagittal planes were measured on postoperative X-ray films. According to the IKDC score, these patients were divided into two groups. In the first group, 38 patients were found the IKDC score more than 90 at the latest follow-up, and in the second group 9 patients were found IKDC score less than 90. By comparing the two groups, the relation of the indexes and postoperative function of knee was analyzed., Results: The IKDC which was more than 90 at the latest follow-up was found in 38 patients, whose femoral attachments site of ACL was positioned at (29.73 +/- 4.31)% (ranged from 16.21% to 53.82%) from the posterior end of Blumensaat's line. IKDC which was less than 90 was found in 9 patients, whose femoral attachments site of ACL was positioned at (46.61 +/- 3.43)% (ranged from 27.18% to 72.34%). There was significant difference between the two groups (P = -0.000 7). The IKDC more than 90 at the latest follow-up was found in 38 patients,whose femoral tunnel angle on coronal plane was (49.5 +/- 4.72) degrees (ranged from 33 degrees to 67 degrees) and on sagittal plane was (31.3 +/- 5.12) degrees (ranged from 11 degrees to 45 degrees) were significantly less than those whose IKDC less than 90 at the latest follow-up on coronal plane was (67.6 +/- 3.09) degrees (ranged from 41 degrees to 81 degrees) and on sagittal plane was (41.2 +/- 5.69) degrees (ranged from 23 degrees to 56 degrees) (P = 0.000 7, P = -0.000 8)., Conclusion: There is close relation between the attachment site of grafts and the tunnel angle with the function of knee, so in anterior cruciate ligament should be anatomic reconstructed with the anterior medial approach.

Pavlovian fear conditioning provides one of the best rodent models of acquired anxiety disorders, including posttraumatic stress disorder. Injection of a variety of drugs after training in fear-conditioning paradigms can impair consolidation of fear memories. Indeed, early clinical trials suggest that immediate administration of such drugs after a traumatic event may decrease the risk of developing posttraumatic stress disorder in humans (Pitman et al., 2002; Vaiva et al., 2003). The use of such a treatment is limited by the difficulty of treating every patient at risk and by the difficulty in predicting which patients will experience chronic adverse consequences. Recent clinical trials suggest that administration of glucocorticoids may have a beneficial effect on established posttraumatic stress disorder (Aerni et al., 2004) and specific phobia (Soravia et al., 2006). Conversely, glucocorticoid administration after training is known to enhance memory consolidation (McGaugh and Roozendaal, 2002; Roozendaal, 2002). From a clinical perspective, enhancement of a fear memory or a reactivated fear memory would not be desirable. We report here that when glucocorticoids are administered immediately after reactivation of a contextual fear memory, subsequent recall is significantly diminished. Additional experiments support the interpretation that glucocorticoids not only decrease fear memory retrieval but, in addition, augment consolidation of fear memory extinction rather than decreasing reconsolidation. These findings provide a rodent model for a potential treatment of established acquired anxiety disorders in humans, as suggested by others (Aerni et al., 2004; Schelling et al., 2004), based on a mechanism of enhanced extinction.