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This work introduces the Queen's University Agent-Based Outbreak Outcome Model (QUABOOM). This tool is an agent-based Monte Carlo simulation for modelling epidemics and informing public health policy. We illustrate the use of the model by examining capacity restrictions during a lockdown. We find that public health measures should focus on the few locations where many people interact, such as grocery stores, rather than the many locations where few people interact, such as small businesses. We also discuss a case where the results of the simulation can be scaled to larger population sizes, thereby improving computational efficiency.

Nonlinear optical microscopic imaging techniques have advanced for chemically sensitive imaging of solid and liquid samples but lack advancements for gaseous samples. In this work, wide-field three-color ultrafast coherent anti-Stokes Raman scattering microscopy is implemented for selectively imaging the ambient nitrogen gas. Our technique operates by capturing a series of spectrally selected images with a rate of 5–10 frames per second. The recorded data are analyzed both qualitatively and quantitatively. This technique has been demonstrated to be sensitive to a variation of approximately 1011 nitrogen molecules in ambient air confined within a microscopic volume of 10 μm by 50 μm by 50 μm. We believe that our approach can potentially be extended toward real-time, in situ chemical imaging of the microscopic dynamics of gases, for example, in ammonia for nitrogen cycle, greenhouse gases for environmental pollution, plant fertilization regulation for precision agriculture, or byproducts produced from lower-temperature plasmas.

The connection between open government policy and popular voting is understudied, yet it can reveal interesting patterns of policymaking that blend agenda setting, policy formulation, and decision-making in semiformalized fluid forms. This inquiry investigates the link between policy voting and open government by comparing the case studies of cocreating open government partnership national action plans in Canada and New Zealand. It examines the role of voting within the policy cycle of open government as a system of governance comprised of transparency, participation, accountability, and civic education. It further employs an exploratory mixed-methods approach of analyzing applied reports, official documents, social media campaigns, and expert interviews. It was found that not the voting format but the government’s approach to interaction with stakeholders is associated with the diverging patterns of open government in the two countries.

As artforms, film and street art seem incompatible. Contra this incompatibility, I investigate their combination: cinematic street art. Two promising cases are the artworks MUTO and Repopulate, but I argue neither is suitable. MUTO only counts if I accept the transparency thesis, the claim that photographs allow us to literally see their depicta. Repopulate only counts if we reject Noel Carroll’s requirement that a cinematic performance token isn’t itself an artwork. However, these imperfect cases demonstrate what is required in order to have cinematic street art: the artwork is a 1) aconsensual artwork that 2) does not merely use street art as imagery or 3) merely use the street as a performance space. I introduce two hypothetical artworks inspired by this approach and discuss their merits, as well as their pitfalls relevant to my own desiderata. As such, this article serves as the foment for broader discussion within the philosophy of street art.

Summary:. Harlequin ichthyosis (HI) is a rare congenital skin disorder caused by irregular epidermal differentiation. Syndactyly in HI is associated with thick hyperkeratotic skin flexion and angulation deformity of the hand and fingers resulting in limited function of the upper extremity. Traditional syndactyly release is limited as full-thickness skin grafts typically used in reconstruction are composed of diseased skin and require donor sites in a patient predisposed for adverse wound healing. This case report is a follow-up to a previous viewpoint written about digital escharotomies in a newborn with HI and outlines a second and fourth webspace syndactyly release with a dermal substitute. Despite early evidence of adequate release and improved hand function, recurrence of syndactyly was observed within 4 months of surgical release. Our experience described within this case report may suggest the limitations and possible alternatives of surgical release of syndactyly in the HI population.

This study evaluates the use of high amounts of recycled asphalt pavement (RAP) and recycled asphalt shingle (RAS) in asphalt mixes for sustainable construction. While past research has focused on asphalt binders and laboratory performance testing, this study assesses the effect of high recycle content on constructability and long-term field performance. A total of 72 mix designs placed from 2016 to 2020 were evaluated for compaction characteristics, while the rutting, cracking, and roughness of 16 projects placed from 2011 to 2015 were assessed based on recycled asphalt levels and mix components. Results showed that high recycled mix projects had equivalent compaction characteristics to low RAP mix projects, except that high RAP mixes had lower variability. High RAP/RAS mixes with rejuvenators had a higher density than those without, and high recycled mix projects had comparable field performance to that of low RAP mix projects, except for lower longitudinal cracking in high RAP projects.

The purpose of this study was to compare the propulsion phase characteristics of the jump squat (JS), hexagonal barbell jump (HEXJ), and jump shrug (JShrug) performed across a spectrum of relative loads. Thirteen resistance-trained women (18–23 years old) performed JS, HEXJ, and JShrug repetitions at body mass (BM) or with 20, 40, 60, 80, or 100% BM during three separate testing sessions. Propulsion mean force (MF), duration (Dur), peak power output (PP), force at PP (FPP), and velocity at PP (VPP) were compared between exercises and loads using a series of 3 × 6 repeated measures ANOVA and Hedge’s g effect sizes. There were no significant differences in MF or Dur between exercises. While load-averaged HEXJ and JShrug PP were significantly greater than the JS, there were no significant differences between exercises at any individual load. The JShrug produced significantly greater FPP than the JS and HEXJ at loads ranging from BM–60% BM, but not at 80 or 100% BM. Load-averaged VPP produced during the JS and HEXJ was significantly greater than the JShrug; however, there were no significant differences between exercises at any individual load. Practically meaningful differences between exercises indicated that the JShrug produced greater magnitudes of force during shorter durations compared to the JS and HEXJ at light loads (BM–40%). The JS and HEXJ may be classified as more velocity-dominant exercises while the JShrug may be more force-dominant. Thus, it is important to consider the context in which each exercise is prescribed for resistance-trained women to provide an effective training stimulus.

The need for increased maritime security has prompted research focus on intent recognition solutions for the naval domain. We consider the problem of early classification of the hostile behavior of agents in a dynamic maritime domain and propose our solution using multinomial hidden Markov models (HMMs). Our contribution stems from a novel encoding of observable symbols as the rate of change (instead of static values) for parameters relevant to the task, which enables the early classification of hostile behaviors, well before the behavior has been finalized. We discuss our implementation of a one-versus-all intent classifier using multinomial HMMs and present the performance of our system for three types of hostile behaviors (ram, herd, block) and a benign behavior.

The aim of this study was to investigate the effects of two process-directing agents (polyaspartic acid and osteopontin) used in a polymer-induced liquid-precursor (PILP) process on the remineralization of bacteria-induced enamel demineralization. Enamel demineralization lesions (depths of about 180–200 µm) were created and exposed to Streptococcus mutans, cultured with a 10% sucrose solution for 21 days, and remineralized using a PILP process (pH = 7.4, 14 days) with a calcium phosphate solution containing either polyaspartic acid or osteopontin in the presence or absence of fluoride (0.5 ppm). The specimens were examined under scanning electron microscopy. The fluoride was successfully incorporated into the PILP remineralization process for both polyaspartic acid and osteopontin. When the fluoride was added to the PILP remineralization solution, there was more uniform remineralization throughout the lesion than with either polyaspartic acid or osteopontin alone. However, in the absence of these process-directing agents, fluoride alone showed less remineralization with the formation of a predominantly surface-only layer. The PILP remineralization process relies on the ability of process-directing agents to stabilize calcium phosphate ions and holds promise for enamel lesion remineralization, and these agents, in the presence of fluoride, seem to play an important role as a booster or supplement in the continuation of remineralization by reducing the mineral gains at the surface layer.

BACKGROUND: As costs continue to outpace reimbursements, hospital administrators and clinicians face increasing pressure to justify new capital purchases. Massachusetts Health Care Reform has added further economic challenges for Disproportionate Share Hospitals (DSH), as resources formerly available to treat the uninsured have been redirected. In this challenging climate, many hospitals still lack a standardized process for technology planning and/or vendor negotiation. PURPOSE:: The purpose of this study was to determine whether a simple, coordinated clinical and financial analysis of a technology, Endoscopic Carpal Tunnel Release (ECTR), is sufficient to impact vendor pricing at Cambridge Health Alliance (CHA), a disproportionate share hospital (DSH) in Cambridge, Massachusetts. METHODOLOGY: This case study addressed the topic of technology adoption, a complex decision-making process every hospital administration faces. Taking note of other hospitals approaches to instill a strategic management culture, CHA combined a literature review on clinical outcomes and financial analysis on profitability. Clinical effectiveness was evaluated through a literature review. The financial analysis was based on a retrospective inquiry of fixed and variable costs, reimbursement rates, actual payer mix, and profitability of adopting ECTR over open carpal tunnel release at CHA. This clinical and financial analysis was then shared with the vendor. FINDINGS: A literature review revealed that although there are short-term benefits to ECTR, there is little to no difference in long-term outcomes to justify a calculated incremental loss of $91.49 in revenue per case. Sharing this analysis with the vendor resulted in a 30% price reduction. A revised cost analysis demonstrated a $53.51 incremental gain in revenue per case. CHA has since elected to offer ECTR to its patients. PRACTICE IMPLICATIONS: Smaller hospital systems often have modest leverage in vendor negotiations. Our results suggest that the development of adoption criteria and an evidence-based managerial approach can create dialogue with vendors and directly impact pricing. Coordinated clinical and financial analysis is a powerful tool, enabling administrators, clinicians, and medical device suppliers to work constructively to provide patients access to innovative technology, even in the face of a challenging payer mix. Ongoing assessment of clinical outcomes and financial data must be performed to reflect the most up-to-date scientific and economic climate. [ABSTRACT FROM AUTHOR]

A multitude of responsibilities, environmental and social influences, and stressors place farm women at high risk for depressive symptoms. This cross sectional survey design study examines demographic, health status, and farm lifestyle characteristics, behaviors and beliefs as risk factors contributing to depressive symptoms among farm women in southeast Louisiana. The study was conducted in a stratified, random sample of 657 women 18 years and older. Factors predictive of depressive symptoms in adjusted logistic regression included those who experience poor health, perceive hazards associated with farming, experience recent farm-related injuries and engage in farming over longer periods of time. These findings help target interventions toward women at risk for depressive symptoms. [ABSTRACT FROM AUTHOR]

In the thermal design of low sloped roofing assemblies, two parameters are overlooked, one is the surface temperature of the roof assemblies which provides the required temperature gradient for heat flow, and the other is the mean operating temperature of the roof assembly, which has direct implications on the thermal performance of the insulation. An in situ field study was conducted in collaboration with Alberta Roofing Contractors Association (ARCA) on their headquarters building located in Calgary, to generate data on the mean operating temperature of the roof assemblies and to determine whether the thermal design of roofing assemblies using conventional methods is an accurate portrayal of in-service thermal performance. For the present study, two roof assemblies insulated with polyisocyanurate insulation, one with a white reflective roof membrane and the other with the black membrane were selected and instrumented. During the monitoring period, the mean operating temperature (MOT) of the roof assembly whether it is calculated as the average of interior and exterior ambient (MOTAIR,) or the average of surface temperatures (MOTSurface), was found to be below 24 °C (75 °F), which opposes the current roof thermal designs that are being designed using label R-value (thermal resistance) of the insulation reported at the mean temperature of 24 °C (75 °F) rather than temperature-dependent thermal resistance. The comparison of two energy transfer theoretical models, QConvention and QMOT, with the measured data indicated that the conventional approach of roof thermal design underestimates the energy performance of the roof assembly on average by 30%. The use of roof surface temperatures and the corresponding temperature-dependent thermal resistance of the insulation as in QMOT has been demonstrated to improve predictions of the energy performance. In addition the loss in thermal resistance due to blowing agent diffusion in polyisocyanurate was evaluated after two years of in situ installation.

Robotic surgery has been eagerly adopted by patients and surgeons alike in the field of urology, over the last decade. However, there is a lack of standardization in training curricula and accreditation guidelines to ensure surgeon competence and patient safety. Accordingly, in this review, we aim to highlight ′who′ needs to learn ′what′ and ′how′, to become competent in robotic surgery. We demonstrate that both novice and experienced open surgeons require supervision and mentoring during the initial phases of robotic surgery skill acquisition. The experienced open surgeons possess domain knowledge, however, need to acquire technical knowledge under supervision (either in simulated or clinical environment) to successfully transition to robotic surgery, whereas, novice surgeons need to acquire both domain as well as technical knowledge to become competent in robotic surgery. With regard to training curricula, a variety of training programs such as academic fellowships, mini-fellowships, and mentored skill courses exist, and cater to the needs and expectations of postgraduate surgeons adequately. Fellowships provide the most comprehensive training, however, may not be suitable to all surgeon-learners secondary to the long-term time commitment. For these surgeon-learners short-term courses such as the mini-fellowships or mentored skill courses might be more apt. Lastly, with regards to credentialing uniformity in criteria regarding accreditation is lacking but earnest efforts are underway. Currently, accreditation for competence in robotic surgery is institutional specific.

IgE antibodies and mast cells play critical roles in the establishment of allergic responses to food antigens. Curcumin, the active ingredient of the curry spice turmeric, has anti-inflammatory properties, and thus may have the capacity to regulate Th2 cells and mucosal mast cell function during allergic responses. We assessed whether curcumin ingestion during oral allergen exposure can modulate the development of food allergy using a murine model of ovalbumin (OVA)-induced intestinal anaphylaxis. Herein, we demonstrate that frequent ingestion of curcumin during oral OVA exposure inhibits the development of mastocytosis and intestinal anaphylaxis in OVA-challenged allergic mice. Intragastric (i.g.) exposure to OVA in sensitized BALB/c mice induced a robust IgE-mediated response accompanied by enhanced OVA-IgE levels, intestinal mastocytosis, elevated serum mMCP-1, and acute diarrhea. In contrast, mice exposed to oral curcumin throughout the experimental regimen appeared to be normal and did not exhibit intense allergic diarrhea or a significant enhancement of OVA-IgE and intestinal mast cell expansion and activation. Furthermore, allergic diarrhea, mast cell activation and expansion, and Th2 responses were also suppressed in mice exposed to curcumin during the OVA-challenge phase alone, despite the presence of elevated levels of OVA-IgE, suggesting that curcumin may have a direct suppressive effect on intestinal mast cell activation and reverse food allergy symptoms in allergen-sensitized individuals. This was confirmed by observations that curcumin attenuated the expansion of both adoptively transferred bone marrow-derived mast cells (BMMCs), and inhibited their survival and activation during cell culture. Finally, the suppression of intestinal anaphylaxis by curcumin was directly linked with the inhibition of NF-κB activation in curcumin-treated allergic mice, and curcumin inhibited the phosphorylation of the p65 subunit of NF-κB in BMMCs. In summary, our data demonstrates a protective role for curcumin during allergic responses to food antigens, suggesting that frequent ingestion of this spice may modulate the outcome of disease in susceptible individuals.

Abstract Objective To investigate the effect of commercial weight loss programmes on macronutrient composition and micronutrient adequacy over a 2 month period. Design Adults were randomly allocated to follow the Slim Fast Plan, Weight Watchers Pure Points Programme, Dr Atkins' New Diet Revolution, or Rosemary Conley's "Eat Yourself Slim" Diet & Fitness Plan. Setting A multi-centre randomised controlled trial. Subjects 293 adults, mean age 40.3 years and a mean BMI 31.7 (range 27–38) were allocated to follow one of the four diets or control group. Subjects completed a 7-day food and activity diary at baseline (prior to randomisation) and after 2 months. Diet records were analysed for nutrient composition using WinDiets (research version). Results A significant shift in the macronutrient composition of the diet with concurrent alteration of the micronutrient profile was apparent with all diets. There was no evidence to suggest micronutrient deficiency in subjects on any of the dietary regimens. However, those sub-groups with higher needs for specific micronutrients, such as folate, iron or calcium may benefit from tailored dietary advice. Conclusion The diets tested all resulted in considerable macronutrient change and resulted in an energy deficit indicating dietary compliance. Health professionals and those working in community and public health should be reassured of the nutritional adequacy of the diets tested. Trial Registration Number NCT00327821

Competing Interests: CR is CEO and founder of Scottish Brain Sciences and has been a paid consultant on advisory boards for Actinogen, Biogen, CogState, Eisai, Eli Lilly, Janssen Cilag, Merck, Novo Nordisk, Roche Diagnostics, and Signant Health. KB has served as a consultant at advisory boards or data monitoring committees for Acumen, Alzpath, BioArctic, Biogen, Eisai, Julius Clinical, Lilly, Novartis, Ono Pharma, Prothena, Roche Diagnostics, and Siemens Healthineers, and is a co-founder of Brain Biomarker Solutions (BBS) in Gothenburg AB, which is part of the GU Ventures Incubator Program, outside of the present work. JDG has received research support from GE Healthcare, F. Hoffmann-La Roche, and Roche Diagnostics, and speaker or consultant fees from Biogen, Philips Nederlands, and Roche Diagnostics. SJ has served as a consultant for Alzpath, Merck, and Roche Diagnostics, and has also received equipment grants from Roche Diagnostics. IvM has served as a consultant for Roche Diagnostics, received grants from ZonMW, and received PPP allowance from Health~Holland (Top Sector Life Sciences & Health). LV has served as a consultant for Roche Diagnostics and has received research support from Alzheimer Nederland, OLINK, and ZonMw; all payments were made to her institution. MS-C has served as a consultant and attended advisory boards for, and received project grants from, Roche Diagnostics, and has given lectures in symposia sponsored by Roche Diagnostics, S.L.U., Roche Farma, S.A., and Roche Sistemas de Diagnósticos, Sociedade Unipessoal, Lda; all payments for consultancy, advisory boards, and project grants were made to his institution; payments for giving lectures in symposia were made to MS-C directly and his institution. CPM and MHSC are employees of Gates Ventures LLC and volunteer for the Alzheimer's Disease Data Initiative. CAL is an employee and shareholder of Roche Diagnostics GmbH. F-CQ is a former employee and shareholder (during employment) of Roche Diagnostics International Ltd, and Altoida Inc. MCD and MC are employees and shareholders of Roche Diagnostics International Ltd. AA, ER, and OC are employees of Nagarro. The authors declare that this work received funding from Roche Diagnostics International Ltd. The funder had the following involvement: provided support and resources for the Hackathon event; and funded medical writing support for publication of this article.

Identifying locations of refugia from the thermal stresses of climate change for coral reefs and better managing them is one of the key recommendations for climate change adaptation. We review and summarize approximately 30 years of applied research focused on identifying climate refugia to prioritize the conservation actions for coral reefs under rapid climate change. We found that currently proposed climate refugia and the locations predicted to avoid future coral losses are highly reliant on  excess heat metrics, such as degree heating weeks. However, many existing alternative environmental, ecological, and life-history variables could be used to identify other types of refugia that lead to the desired diversified portfolio for coral reef conservation. To improve conservation priorities for coral reefs, there is a need to evaluate and validate the predictions of climate refugia with long-term field data on coral abundance, diversity, and functioning. There is also the need to identify and safeguard locations displaying resistance toprolonged exposure to heat waves and the ability to recover quickly after thermal exposure. We recommend using more metrics to identify a portfolio of potential refugia sites for coral reefs that can avoid, resist, and recover from exposure to high ocean temperatures and the consequences of climate change, thereby shifting past efforts focused on avoidance to a diversified risk-spreading portfolio that can be used to improve strategic coral reef conservation in a rapidly warming climate., (© 2023 The Authors. Conservation Biology published by Wiley Periodicals LLC on behalf of Society for Conservation Biology.)

Aims: The aim of this study was to establish consensus statements on medial patellofemoral ligament (MPFL) reconstruction, anteromedialization tibial tubercle osteotomy, trochleoplasty, and rehabilitation and return to sporting activity in patients with patellar instability, using the modified Delphi process., Methods: This was the second part of a study dealing with these aspects of management in these patients. As in part I, a total of 60 surgeons from 11 countries contributed to the development of consensus statements based on their expertise in this area. They were assigned to one of seven working groups defined by subtopics of interest. Consensus was defined as achieving between 80% and 89% agreement, strong consensus was defined as between 90% and 99% agreement, and 100% agreement was considered unanimous., Results: Of 41 questions and statements on patellar instability, none achieved unanimous consensus, 19 achieved strong consensus, 15 achieved consensus, and seven did not achieve consensus., Conclusion: Most statements reached some degree of consensus, without any achieving unanimous consensus. There was no consensus on the use of anchors in MPFL reconstruction, and the order of fixation of the graft (patella first versus femur first). There was also no consensus on the indications for trochleoplasty or its effect on the viability of the cartilage after elevation of the osteochondral flap. There was also no consensus on postoperative immobilization or weightbearing, or whether paediatric patients should avoid an early return to sport., Competing Interests: S. L. Sherman reports royalties or licenses from CONMED Linvatec, consulting fees from Arthrex, BioVentus, JRF Ortho, Kinamed, Smith & Nephew, Vericel, CONMED Linvatec, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthex, Joint Restoration Foundation, Kinamed, Smith & Nephew, and Vericel, and stock or stock options from Epic Bio, Reparel, Sarcio, and Vivorte, all of which are unrelated to this study. J. Chahla reports consulting fees from Arthrex, CONMED Linvatec, Ossur, and Smith & Nephew, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Smith & Nephew, all of which are unrelated to this study. M. J. Alaia reports consulting fees from BodyCad, JRF Ortho, and Mitek, institutional grants from Orcosa, and royalties from Springer, all of which are unrelated to this study. M. J. Tanaka reports grants or contracts from FujiFilm, royalties or licenses from Verywell, and consulting fees from Depuy Synthes, all of which are unrelated to this study. J. L. Pace reports consulting fees from Arthrex and JRF Ortho, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Arthrex, and stock or stock options from OutcomeMD, all of which are unrelated to this study. L. M. Jazwari reports grants or contracts from Arthrex, Mitek, Smith & Nephew, and Wolters Kluwer Health, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Wolters Kluwer Health, and stock or stock options from Lazurite, all of which are unrelated to this study., (© 2023 The British Editorial Society of Bone & Joint Surgery.)

Projecting the effects of climate change on net reef calcium carbonate production is critical to understanding the future impacts on ecosystem function, but prior estimates have not included corals' natural adaptive capacity to such change. Here we estimate how the ability of symbionts to evolve tolerance to heat stress, or for coral hosts to shuffle to favourable symbionts, and their combination, may influence responses to the combined impacts of ocean warming and acidification under three representative concentration pathway (RCP) emissions scenarios (RCP2.6, RCP4.5 and RCP8.5). We show that symbiont evolution and shuffling, both individually and when combined, favours persistent positive net reef calcium carbonate production. However, our projections of future net calcium carbonate production (NCCP) under climate change vary both spatially and by RCP. For example, 19%-35% of modelled coral reefs are still projected to have net positive NCCP by 2050 if symbionts can evolve increased thermal tolerance, depending on the RCP. Without symbiont adaptive capacity, the number of coral reefs with positive NCCP drops to 9%-13% by 2050. Accounting for both symbiont evolution and shuffling, we project median positive NCPP of coral reefs will still occur under low greenhouse emissions (RCP2.6) in the Indian Ocean, and even under moderate emissions (RCP4.5) in the Pacific Ocean. However, adaptive capacity will be insufficient to halt the transition of coral reefs globally into erosion by 2050 under severe emissions scenarios (RCP8.5)., (© 2023 The Authors. Global Change Biology published by John Wiley & Sons Ltd.)

Landscape transcriptomics is an emerging field studying how genome-wide expression patterns reflect dynamic landscape-scale environmental drivers, including habitat, weather, climate, and contaminants, and the subsequent effects on organismal function. This field is benefitting from advancing and increasingly accessible molecular technologies, which in turn are allowing the necessary characterization of transcriptomes from wild individuals distributed across natural landscapes. This research is especially important given the rapid pace of anthropogenic environmental change and potential impacts that span levels of biological organization. We discuss three major themes in landscape transcriptomic research: connecting transcriptome variation across landscapes to environmental variation, generating and testing hypotheses about the mechanisms and evolution of transcriptomic responses to the environment, and applying this knowledge to species conservation and management. We discuss challenges associated with this approach and suggest potential solutions. We conclude that landscape transcriptomics has great promise for addressing fundamental questions in organismal biology, ecology, and evolution, while providing tools needed for conservation and management of species., (© 2023 The Authors. Molecular Ecology Resources published by John Wiley & Sons Ltd.)

Background: Differentiating dementia due to small vessel disease (SVD) from dementia due to Alzheimer's disease (AD) with concomitant SVD is challenging in clinical practice. Accurate and early diagnosis of AD is critical to delivering stratified patient care., Objective: We characterized the results of Elecsys® cerebrospinal fluid (CSF) immunoassays (Roche Diagnostics International Ltd) in patients with early AD, diagnosed using core clinical criteria, with varying extent of SVD., Methods: Frozen CSF samples (n = 84) were measured using Elecsys β-Amyloid(1-42) (Aβ42), Phospho-Tau (181P) (pTau181), and Total-Tau (tTau) CSF immunoassays, adapted for use on the cobas® e 411 analyzer (Roche Diagnostics International Ltd), and a robust prototype β-Amyloid(1-40) (Aβ40) CSF immunoassay. SVD was assessed by extent of white matter hyperintensities (WMH) using the lesion segmentation tool. Interrelations between WMH, biomarkers, fluorodeoxyglucose F18-positron emission tomography (FDG-PET), and other parameters (including age and Mini-Mental State examinations [MMSE]) were assessed using Spearman's correlation, sensitivity/specificity, and logistic/linear regression analyses., Results: The extent of WMH showed significant correlation with Aβ42/Aβ40 ratio (Rho=-0.250; p = 0.040), tTau (Rho = 0.292; p = 0.016), tTau/Aβ42 ratio (Rho = 0.247; p = 0.042), age (Rho = 0.373; p = 0.002), and MMSE (Rho=-0.410; p = 0.001). Sensitivity/specificity point estimates for Elecsys CSF immunoassays versus FDG-PET positivity for underlying AD pathophysiology were mostly comparable or greater in patients with high versus low WMH. WMH were not a significant predictor and did not interact with CSF biomarker positivity but modified the association between pTau181 and tTau., Conclusion: Elecsys CSF immunoassays detect AD pathophysiology regardless of concomitant SVD and may help to identify patients with early dementia with underlying AD pathophysiology.

Acidification-induced changes in neurological function have been documented in several tropical marine fishes. Here, we investigate whether similar patterns of neurological impacts are observed in a temperate Pacific fish that naturally experiences regular and often large shifts in environmental pH/pCO 2 . In two laboratory experiments, we tested the effect of acidification, as well as pH/pCO 2 variability, on gene expression in the brain tissue of a common temperate kelp forest/estuarine fish, Embiotoca jacksoni. Experiment 1 employed static pH treatments (target pH = 7.85/7.30), while Experiment 2 incorporated two variable treatments that oscillated around corresponding static treatments with the same mean (target pH = 7.85/7.70) in an eight-day cycle (amplitude ± 0.15). We found that patterns of global gene expression differed across pH level treatments. Additionally, we identified differential expression of specific genes and enrichment of specific gene sets (GSEA) in comparisons of static pH treatments and in comparisons of static and variable pH treatments of the same mean pH. Importantly, we found that pH/pCO 2 variability decreased the number of differentially expressed genes detected between high and low pH treatments, and that interindividual variability in gene expression was greater in variable treatments than static treatments. These results provide important confirmation of neurological impacts of acidification in a temperate fish species and, critically, that natural environmental variability may mediate the impacts of ocean acidification., (© 2022 The Authors. Molecular Ecology published by John Wiley & Sons Ltd.)

Background: Despite the presence of multiple classification systems for discoid meniscus, no system has yet to demonstrate utility in predicting the need for meniscal repair. The purpose of this study was to correlate characteristics associated with meniscal repair and propose a model that can inform preoperative planning and initial counseling of surgical plans and expectations., Methods: Medical and operative records of 434 knees with lateral discoid meniscus in children and adolescents treated between 1991 and 2016 were reviewed retrospectively to determine the surgical procedure performed (saucerization with or without meniscal repair), discoid meniscal morphology and stability, and location and type of any associated tear. Univariate associations between discoid meniscal characteristics and surgery type were calculated and a logistic regression model of surgery type was generated., Results: In univariate models, unstable menisci (93%, or 179/204, P<0.001) and menisci with tears extending peripherally (75%, or 85/204, P<0.001) were more likely to receive surgery with repair. In isolation, instability demonstrated 89% sensitivity and 94% specificity in predicting surgery with repair. A logistic regression model including stability, tear, and their interaction (stability×tear) showed that that the odds of unstable lateral discoid menisci receiving surgery with repair was 114 times higher than stable menisci (P<0.001) while lateral discoid menisci with peripherally extending tears had 6.4 times higher odds of receiving repair than those that had an isolated central tear (P<0.001)., Conclusion: Stability and tear location of lateral discoid menisci were associated with surgical treatment in univariate and logistic regression models. The proposed classification system, in which menisci are classified by stability [Stable (S0), Unstable (S1), morphology (Incomplete (M0), Complete (M1))], and tear [No tear (T0), Central tear, isolated (T1), or Central tear, peripheral extension (T2)], is easily remembered and predicts surgical repair for discoid menisci. This scheme can serve to inform preoperative planning and initial counseling of primary surgical management and postoperative expectations. Subsequent research should develop a system that predicts meniscal survival and patient outcomes following the index operation., Level of Evidence: Level III., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Discoid meniscus is a congenital variant, typically involving the lateral meniscus, that comprises a spectrum of meniscal shapes and degrees of instability in an estimated 1% to 15% of the population. The purpose of this study was to describe the clinical and operative course of a large cohort of children and adolescents patients with symptomatic lateral discoid meniscus., Methods: Medical records of 470 knees with symptomatic lateral discoid meniscus in 401 patients ages 18 years or younger diagnosed at a single institution between 1991 and 2016 were reviewed retrospectively for patient characteristics, treatment course (nonoperative and/or operative), and complications. Surgical reports were reviewed in the operative group., Results: The series included 401 patients of mean age 11.6 years (range: 1 mo-18.9 y), of which 222 (55%) were female, and 69 (17%) had bilateral involvement. Of 470 knees, 83 (18%) were initially managed nonoperatively. Of these, 32 knees (39%) failed nonoperative management and were converted to surgical treatment at a median of 7.9 months (interquartile range: 4.0-15.1). In total, 419 knees were managed surgically with saucerization (partial meniscectomy) with or without meniscal repair/stabilization; 84 knees (20%) required at least one concurrent nonmeniscal procedure. Discoid meniscus tears were reported in 264/419 knees (63%) intraoperatively; horizontal cleavage tears were most common. Reoperation was required for 66/379 cases (17%) with clinical follow-up, at a median of 19.6 months (range: 9.2-34.9) after index saucerization; 60/379 cases (16%) had ongoing pain and/or mechanical symptoms at final follow-up., Conclusion: With a failure rate of 39% (32/83 knees), nonoperative management for discoid lateral meniscus frequently convert to surgical treatment. During surgery, meniscus tearing and instability are common and should be anticipated. Postoperatively, 33% (126/379) of knees with clinical follow-up underwent either reoperation, or had ongoing symptoms of the knee at final follow-up. Discoid mensical retear is the most common complication (94%, 62/66) prompting repeat surgery, and should be discussed with families before the index operation., Level of Evidence: Level IV-descriptive case series., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: A previous publication demonstrated that the oral intake of losartan promoted microfracture-mediated hyaline-like cartilage repair in osteochondral defects of a rabbit knee model. However, an intra-articular (IA) injection of losartan may have direct beneficial effects on cartilage repair and has not been studied., Purpose: To determine the dosage and beneficial effects of an IA injection of losartan on microfracture-mediated cartilage repair and normal cartilage homeostasis., Study Design: Controlled laboratory study., Methods: Rabbits were divided into 5 groups (n = 6 each): a microfracture group (MFX group) and 4 different losartan treatment groups that received varying doses of IA losartan (0.1, 1, 10, and 100 mg per knee). An osteochondral defect (5 mm) was created in the trochlear groove cartilage of 1 limb in each rabbit, and 5 microfracture perforations were made in the osteochondral defect. Both the injured and the contralateral knee joints were injected with IA losartan immediately after microfracture and at 2 and 4 weeks after surgery. Rabbits were sacrificed at 6 weeks after surgery for analysis including gross observation, micro-computed tomography, histology, and reverse transcription quantitative polymerase chain reaction., Results: Micro-computed tomography and gross observation demonstrated comparable subchondral bone healing and hyaline-like cartilage morphology in the 0.1-, 1-, and 10-mg losartan groups relative to the MFX group. Conversely, the 100-mg losartan group showed neither bony defect healing nor cartilage repair. Histology revealed higher O'Driscoll scores and hyaline-like cartilage regeneration in the 1-mg losartan group compared with the MFX group. In contrast, the 100-mg losartan group showed the lowest histology score and no cartilage repair. An IA injection of losartan at the doses of 0.1, 1, and 10 mg did not cause adverse effects on uninjured cartilage, while the 100-mg dose induced cartilage damage. Quantitative polymerase chain reaction results showed downregulation of the transforming growth factor β (TGF-β) signaling pathway after IA losartan injection., Conclusion: An IA injection of losartan at the dose of 1 mg was most effective for the enhancement of microfracture-mediated cartilage repair without adversely affecting uninjured cartilage. Conversely, a high dose (100 mg) IA injection of losartan inhibited cartilage repair in the osteochondral defect and was chondrotoxic to normal articular cartilage., Clinical Relevance: An IA injection of losartan at an optimal dosage represents a novel microfracture enhancement therapy and warrants a clinical trial for future clinical applications.

Forecasts from climate models and oceanographic observations indicate increasing deoxygenation in the global oceans and an elevated frequency and intensity of hypoxic events in the coastal zone, which have the potential to affect marine biodiversity and fisheries. Exposure to low dissolved oxygen (DO) conditions may have deleterious effects on early life stages in fishes. This study aims to identify thresholds to hypoxia while testing behavioral and physiological responses of two congeneric species of kelp forest fish to four DO levels, ranging from normoxic to hypoxic (8.7, 6.0, 4.1, and 2.2 mg O 2 /L). Behavioral tests identified changes in exploratory behavior and turning bias (lateralization), whereas physiological tests focused on determining changes in hypoxia tolerance (pCrit), ventilation rates, and metabolic rates, with impacts on the resulting capacity for aerobic activity. Our findings indicated that copper rockfish (Sebastes caurinus) and blue rockfish (Sebastes mystinus) express sensitivity to hypoxia; however, the strength of the response differed between species. Copper rockfish exhibited reduced absolute lateralization and increased escape time at the lowest DO levels, whereas behavioral metrics for blue rockfish did not vary with oxygen level. Both species exhibited decreases in aerobic scope (as a function of reduced maximum metabolic rate) and increases in ventilation rates to compensate for decreasing oxygen levels. Blue rockfish had a lower pCrit and stronger acclimation response compared to copper rockfish. The differences expressed by each species suggest that acclimatization to changing ocean conditions may vary, even among related species that recruit to the same kelp forest habitat, leading to winners and losers under future ocean conditions. Exposure to hypoxia can decrease individual physiological fitness through metabolic and aerobic depression and changes to anti-predator behavior, with implications for the outcome of ecological interactions and the management of fish stocks in the face of climate change., (© 2020 John Wiley & Sons Ltd.)

Psychosocial stress is thought to influence gestational weight gain (GWG), but results are inconsistent. We investigated the relationship of questionnaire-based maternal stress and related constructs assessed at childbirth with maternal weight measured throughout pregnancy. Data were derived from the Ulm SPATZ Health Study, a birth cohort recruited from the general population (04/2012-05/2013, Ulm, Germany). Adjusted generalized estimating equations were performed. Regression coefficients (b) and 95% confidence intervals, each highest versus lowest tertile of stress or related constructs, are presented. In 748 women, we observed positive associations for maternal chronic stress (b = 4.36 kg (1.77; 6.95)), depressive symptoms (b = 2.50 kg (0.14; 4.86)), anxiety symptoms (b = 3.26 kg (0.62, 5.89)), and hair cortisol (b = 3.35 kg (0.86; 5.83)) with maternal weight at the first gestational month. GWG was considerably lower in mothers with higher chronic stress. Pregnancy-related anxiety was positively related to weight at first month (b = 4.16 kg (1.74; 6.58)) and overall GWG. In contrast, no association was observed between anxiety symptoms and GWG. Odds ratios for association with inadequate weight gain according to Institute of Medicine recommended cutoffs differed from the results presented obove. There is evidence of an association between stress and weight gain lying beyond the recommended cut-offs, which however needs further corroboration.

Global climate change is predicted to increase the co-occurrence of high pCO 2 and hypoxia in coastal upwelling zones worldwide. Yet, few studies have examined the effects of these stressors on economically and ecologically important fishes. Here, we investigated short-term responses of juvenile blue rockfish (Sebastes mystinus) to independent and combined high pCO 2 and hypoxia at the molecular level, using changes in gene expression and metabolic enzymatic activity to investigate potential shifts in energy metabolism. Fish were experimentally exposed to conditions associated with intensified upwelling under climate change: high pCO 2 (1200 μatm, pH~7.6), hypoxia (4.0 mg O 2 /L), and a combined high pCO 2 /hypoxia treatment for 12 h, 24 h, or two weeks. Muscle transcriptome profiles varied significantly among the three treatments, with limited overlap among genes responsive to the single and combined stressors. Under elevated pCO 2 , blue rockfish increased expression of genes encoding proteins involved in the electron transport chain and muscle contraction. Under hypoxia, blue rockfish up-regulated genes involved in oxygen and ion transport and down-regulated transcriptional machinery. Under combined stressors, blue rockfish induced a unique set of ionoregulatory and hypoxia-responsive genes not expressed under the single stressors. Thus, high pCO 2 and hypoxia exposure appears to induce a non-additive transcriptomic response that cannot be predicted from single stressor exposures alone, further highlighting the need for multiple stressor studies at the molecular level. Overall, lack of a shift towards anaerobic metabolism or induction of a cellular stress response under multiple stressors suggests that blue rockfish may be relatively resistant to intensified upwelling conditions in the short term., (Copyright © 2019. Published by Elsevier Inc.)

The objective of the study was to investigate the potential association of human milk leptin concentrations with child body mass index (BMI) and BMI trajectory patterns up to two years of age among children in the Ulm SPATZ Health Study. Leptin concentration was measured in skimmed human milk by ELISA (R&D System). Child BMI was determined at two to three days, three to four weeks, four to five months, one year, and two years of age. In SPATZ, leptin concentration at six weeks was inversely associated with child BMI at four to five weeks [beta -0.13, 95%CI -0.21;-0.05)] and at three to four months -0.12 -0.21;-0.03)]. Among infants of average BMI shortly after delivery, six week leptin was positively associated with greater increase in BMI from four to five weeks up to two years of age [0.16 (0.04;0.27)]. No associations were observed for six month leptin. Direction of association was the same in the Ulm Birth Cohort Study (UBCS), but statistically insignificant as the point estimate included the null effect value. Our results from SPATZ suggest human milk leptin may play a role in early infant growth. However, it is plausible that the lack of associations in UBCS suggest that these differences of human milk leptin composition between populations could have an impact in infant growth and development in a given population.

Purpose: To compare the impact of an inside-out repair versus meniscectomy of a medial meniscus bucket-handle tear in restoring native contact areas and pressures across the tibial plateaus in the setting of an anterior cruciate ligament (ACL) reconstruction (ACLR)., Methods: Ten fresh-frozen cadaveric knees were tested in 6 knee conditions (1: intact; 2: ACL torn and bucket-handle tear of medial meniscus, flipped; 3: bucket-handle tear of medial meniscus, reduced; 4: bucket-handle tear of medial meniscus, repaired via inside-out vertical mattress suture technique; 5: ACLR with bone patella tendon bone autograft and bucket-handle repair; 6: ACLR and medial meniscus bucket-handle tear debridement) at 4 flexion angles (0°, 30°, 45°, and 60°), under a 1,000-N axial load. Contact area and pressure were measured with Tekscan sensors., Results: ACLR with a concurrent medial meniscectomy for a medial meniscus bucket-handle tear resulted in significantly decreased contact area (P < .05) and increased mean and peak pressure in both the medial and lateral compartments across all tested flexion angles (P < .05). The ACLR with medial meniscectomy state also demonstrated significantly lower contact area than the bucket-handle repair state between 30° and 60° of flexion (all P < .05)., Conclusions: Resection of a bucket-handle medial meniscus tear concurrent with an ACLR resulted in significant increases in mean and peak contact pressures in not only the medial but also the lateral compartment. Preservation of the medial meniscus in the face of a bucket-handle tear is essential to more closely restore native tibiofemoral biomechanics., Clinical Relevance: The increased mean and peak tibiofemoral contact pressure seen with excision of a bucket-handle medial meniscus tear would over time result in increased cartilaginous degradation and resultant osteoarthritis. Decreasing both of these factors through concomitant ACLR and inside-out bucket-handle meniscal repairs should improve patient outcomes by restoring knee biomechanics and kinematics closer to that of the native state., (Copyright © 2019 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Articular cartilage injuries of the knee are common among young, active patients presenting with knee pain, swelling, and/or mechanical symptoms. These injuries have limited healing potential due to the avascular nature of hyaline cartilage. While several treatment options exist, osteochondral allograft (OCA) transplantation for the knee has been used successfully in primary management of large chondral or osteochondral defects and salvage of previously failed cartilage repair. OCA transplantation potentially yields a natural, matching contour of the native recipient surface anatomy and transplants mature, viable hyaline cartilage to the affected defect. Following OCA transplantation, strict compliance with a rehabilitation protocol is essential to enable optimal recovery. The outlined rehabilitation protocol is informed by the existing literature and incorporates current rehabilitation principles, the science of osteochondral incorporation, and adaptations based on an individual's readiness to progress through subsequent phases. The purpose of this clinical commentary is to discuss the diagnosis, surgical management, and post-operative rehabilitation following OCA transplantation and to assist the physical therapist in returning athletes to full sports participation., (© 2019 by the Sports Physical Therapy Section.)

Background: Leptin in human breast milk has been implicated as a potential regulator of early-life metabolic programming. We comprehensively investigated the influence of maternal body mass index (BMI) and non-adiposity associated determinants on breast milk leptin concentration at 6 weeks, 6 months, and 1 year postpartum., Methods: The Ulm SPATZ Health Study consists of 1006 newborns and their mothers recruited from the general population in the University Medical Center Ulm, Southern Germany, in 2012/2013. Leptin concentration was measured in skimmed breast milk using commercially available ELISA (R&D System). Generalized estimating equations (GEE) accounting for repeated measures were used to calculate beta coefficients and 95% confidence intervals for association of potential demographic and lifestyle related determinants of hormone concentration with BMI-standardized leptin z-scores., Results: Leptin concentration was measured in breast milk samples obtained from 694 mothers at approximately 6 weeks (n = 668), 6 months (n = 445), and 1 year (n = 69) postpartum. Differences in crude leptin concentrations between collection times were mostly explained by changes in BMI, breastfeeding frequency, and breast milk fat concentration. Positive associations between BMI and leptin were nonlinear and stronger among lower BMI subjects. Upon standardization, residual leptin concentrations were associated with maternal birth country, parity, age, and smoking history., Conclusions: Breast milk leptin concentration is primarily determined by adiposity-related factors. Studies using BMI as a proxy measure for adiposity should account for an observed nonlinear association with leptin, which may be especially important in determining causal associations with health outcomes from this and other adiposity-related hormones in breast milk.

Background and Purpose: Distal biceps rupture is less common than injury to the proximal biceps; however, injury distally has profound functional implications on activities which rely on power during elbow flexion and forearm supination. The majority of distal biceps ruptures can be treated with surgical repair of the distal biceps utilizing either a single or two-incision technique; both of which achieve comparable improved outcomes and reported minimal pain and disability at two years. Safe and effective rehabilitation following distal biceps repair is accomplished through a phased progression, with avoidance of premature stress to the healing soft tissue repair.The purpose of this clinical commentary is to provide a concise review of distal biceps tendon injury, including relevant anatomy, etiology, diagnosis, and operative intervention as well as post-operative factors influencing the pursuit of a criterion based, progressive rehabilitation program after distal biceps tendon repair. This commentary seeks to provide an update on current treatment strategies used in distal biceps rehabilitation with accompanying scientific rationale., Level of Evidence: 5.

Background: Soluble CD14 (sCD14) is one of many factors in human breast milk which may influence programming of the immune response in the breastfed child. Although previous studies have mostly found little association between sCD14 concentration in breast milk and atopic outcomes, recent evidence continues to support a role of sCD14 in immune-related disease., Objective: We aimed to clarify whether an association exists between sCD14 concentration in human breast milk (m-sCD14) and child atopic dermatitis (AD) diagnosis by age 3 years within the context of two large birth cohorts., Methods: Data were obtained from the Ulm Birth Cohort Study (UBCS) and the Ulm SPATZ Health Study, methodologically similar birth cohort studies, each consisting of approximately 1000 newborns and their mothers recruited from the general population shortly after delivery in Ulm, Southern Germany, respectively, from 11/2000 to 11/2001 and 04/2012 to 05/2013. sCD14 concentrations were measured by different ELISAs (UBCS: IBL, SPATZ: R&D) in breast milk samples collected at 6 weeks post-delivery in both studies and additionally at 6 months and 1 year in SPATZ. Children's AD diagnosis was assessed using parent and paediatrician reports at 1, 2 and 3 years of age., Results: Complete exposure and outcome data were available for 659 UBCS and 489 SPATZ children. In both cohorts, sCD14 concentration was significantly associated with breastfeeding frequency (P < 0.01). We observed no association between m-sCD14 concentration and child AD diagnosis in either study., Conclusions: Our results do not support an association between sCD14 concentration in mature breast milk and AD among breastfed children., (© 2018 John Wiley & Sons Ltd.)

Fibular collateral ligament (FCL) injuries can present as lateral-sided knee pain with feelings of side-to-side instability during activity. Patients with FCL injuries can have accompanying symptoms related to irritation of the common peroneal nerve. Preoperative diagnosis is imperative and should include a thorough physical examination complemented with varus stress radiographs before surgical reconstruction is indicated. In the adolescent cohort, surgical planning can be complicated by the presence of open physes, and caution must be taken to avoid drilling through or placing screw fixation across the physes. Potential complications include growth arrest and limb length discrepancy. Therefore, the purpose of this Technical Note is to describe an anatomic FCL reconstruction technique in the skeletally immature adolescent patient.

Rodents as standardized test animals were developed for commercial distribution in the USA between 1910 and the 1930s. The selective breeding of rats (Rattus norvegicus) and pure-bred mice (Mus musculus) at the Wistar Institute and the Jackson Memorial Laboratories eventually led to a decline in the diversity of species used in American medical and life sciences. The early driving figures, science administrator Milton Greenman and the scientists Henry Donaldson and Clarence Little, sought to standardize animals to render science and its application to humanity more precise. But their efforts were exaggerated in the USA through an expanding industrial and engineering ideal, culminating in a preference for Big Science. I explore the nineteenth century origins of this ideal in Emil Du Bois-Reymond's neurophysiology. This foundation later merged with increasing standardization, American commercialism, and the success of Big Science to transform animal laboratory "standards" into "model animals." Recent accounts of research with commercially bred mice reveal how findings can be co-constructed using human clinical data, as animal research is applied to humans. The neglect of evolutionary perspectives and the dominance of "models" may even have begun with the government's post-war emphasis on funding greater species access for large-scale biomedical research., (© 2019 S. Karger AG, Basel.)

Background: The medial collateral ligament (MCL) is one of the most commonly injured structures in the knee, especially in young athletes. The impact of MCL injury on National Football League (NFL) performance in elite collegiate athletes has not yet been described in the literature., Purpose: We aim to (1) describe the prevalence and severity of MCL injuries in NFL Combine participants, (2) detail injury management, and (3) analyze the impact of MCL injury on NFL performance in terms of draft position, games played, games started, and snap percentage., Study Design: Cohort study; Level of evidence, 3., Methods: A retrospective review of all NFL Combine participants from 2009 to 2015 was performed by reviewing medical records and imaging reports from the combine to identify all players with MCL injuries. A control group was developed from the players evaluated at the combine without MCL injury. For each affected knee, the MCL injury was classified by location and severity based on results of magnetic resonance imaging (MRI). Each player's respective NFL draft position, number of NFL games played, number of NFL games started, and NFL snap percentage for the first 2 seasons in the league were collected through the use of NFL.com and Pro-Football-Focus, which are web-based, publicly accessible, comprehensive sports statistics databases., Results: A total of 2285 players participated in the NFL Combine between 2009 and 2015. Three hundred one athletes (13.2%) were identified as having MCL injuries; 36 (12%) of the athletes with MCL injury presented with bilateral injuries, for a total of 337 MCL injuries. Additional soft tissue injury was identified on 187 of 337 (55%) MRIs. Players with a history of MCL injury were more likely to play at least 2 years in the NFL compared with those in the control group ( P = .003). Players who had isolated MCL injury performed significantly better compared with athletes who had combined injuries with regard to draft position ( P = .034), proportion playing at least 2 seasons in the NFL ( P = .022), games played ( P = .014), and games started ( P = .020) in the first 2 years. No significant difference was found between players who underwent operative versus nonoperative management of their MCL injury., Conclusion: A relatively high percentage of players at the NFL Combine had evidence of MCL injury (13%). A prior history of MCL tear had no negative impact on an athlete's NFL performance. Players who had isolated MCL injury performed significantly better compared with athletes who had combined injuries with regard to draft position, proportion playing 2 seasons or more in the NFL, and games played and started in the first 2 years., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: C.A.L. receives research support from Novartis Pharmaceuticals and Smith & Nephew. M.D.P. is a consultant for Arthrex, Kairos Surgical, DePuy, and Arthrosurface. J.P.B. receives royalties from Arthrex. R.F.L. receives royalties from Arthrex, Ossur, and Smith & Nephew; is a consultant for Arthrex, Ossur, and Smith & Nephew; and receives research support from Arthrex, Linvatec, Ossur, and Smith & Nephew. M.T.P. receives royalties from Arthrex and SLACK Inc and is a consultant for Arthrex and the Joint Restoration Foundation (Allosource).

Purpose: In utero exposure to cardiometabolic risk factors may determine health related outcomes at birth and in later life. The aim of this analysis was to describe the relationship of maternal serum uric acid (SUA) and cystatin C with maternal and neonatal cardiometabolic risk markers and with birth weight and risk of small-for-gestational age (SGA) as well as large-for gestational age (LGA)., Material and Methods: In the Ulm SPATZ Health Study, 934 singleton newborns and their mothers were recruited during their hospital stay in the University Medical Center Ulm between 04/2012 and 05/2013 (overall response 49%). The association between SUA and cystatin C (both in quartiles and as continuous measures) with risk for SGA as well as with LGA was quantified by means of multivariable logistic regression., Results: Overall, n = 885 mother-newborn pairs were included in the final analysis. Most of the mothers were of German nationality (85%) and were between 26 and 35 years of age at delivery (69%). Maternal SUA was associated with maternal age, body mass index, alcohol consumption and history of hypertension as well as with many other maternal and neonate cardiovascular risk markers. Cystatin C was associated with parity. No clear association of SUA with SGA and LGA was observed in fully adjusted models. However, cystatin C was negatively associated with SGA with an odds ratio (OR) of 0.35 (95% CI: 0.16-0.77; p for trend 0.04) comparing the top quartile vs. the bottom quartile and was positively associated with LGA with an OR of 5.92 (95% CI: 2.27-15.44; p for trend <0.0001) after adjustment for covariates., Conclusions: We found a positive association of cystatin C with birth weight and a clearly increased risk for LGA with maternal increased cystatin C values in a population with fairly normal renal function., Competing Interests: The authors have declared that no competing interest exist.

Fetal growth may be a precursory factor in observed association between birthweight and atopic dermatitis (AD), however, recent studies utilizing fetal ultrasound-based data have reported contradictory results. This study aims to clarify previous findings through comprehensive investigation of association between several trimester-specific ultrasound-based anthropometric measures with AD diagnosis by age 3 years. Measurements of 386 newborns in the Ulm SPATZ Health Study were converted into adjusted z-scores categorized as "low" (≤1 SD below mean), "normal," or "high" (≥1 SD above mean). AD cases were defined using parent- or pediatrician-report of physician-diagnosis or clinical diagnosis. Adjusted risk ratios (RR) with 95% confidence intervals (95% CI) were calculated using modified Poisson regression. Compared to normal, both low and high 2 nd trimester abdominal circumference [RR 1.51, (95% CI 1.01; 2.24) and 1.83 (1.21; 2.76)], high 2 nd trimester head- abdominal circumference ratio [1.69 (1.16; 2.48)], and faltering 2 nd to 3 rd trimester [1.59 (1.04; 2.43)] head circumference were associated with greater AD risk. High 3 rd trimester femur length [0.54 (0.31; 0.94)] was associated with lower risk. Using more inclusive exposure cut-points (0.8 SD), lower 1 st trimester crown-rump length was also associated with greater AD risk. Our data suggest several different patterns of fetal growth may be differentially associated with AD.

Purpose: To determine the epidemiology by player position, examination, imaging findings, and associated injuries of posterior cruciate ligament (PCL) injuries in players participating in the National Football League (NFL) Combine., Methods: All PCL injuries identified at the NFL Combine (2009-2015) were reviewed. Data were obtained from the database organized by the NFL medical personnel for the compilation of the medical and physical performance examination results of NFL Draftees participating in the NFL Combine from 2009 to 2015. Inclusion criteria were any player with clinical findings or a previous surgery consistent with a PCL injury who participated in the NFL Combine., Results: Of the 2,285 players who participated in the NFL Combine between 2009 and 2015, 69 (3%) had evidence of a PCL injury, of which 11 players (15.9%) were managed surgically. On physical examination, 35 players (52%) had a grade II or III posterior drawer. Concomitant injuries were present frequently and included medial collateral ligament (MCL; 42%), anterior cruciate ligament (ACL; 11.6%), and chondral injuries (31.8%), especially in the lateral tibiofemoral compartment., Conclusions: Three percent of the players at the NFL Combine presented with a PCL injury, with a significant amount being either running backs (14/69, 20.2%) or offensive linemen (14/69, 20.2%). Approximately half of the players with a PCL tear had a residual grade II or III posterior drawer after sustaining a PCL injury. Concomitant injuries were present frequently and included MCL (42%), ACL (11.6%), and chondral injuries (31.8%), especially in the lateral tibiofemoral compartment. For those players with clinical concern for PCL ligamentous laxity, there should be a complete comprehensive workup that includes plain and PCL stress view radiographs, and magnetic resonance imaging., Level of Evidence: Level IV, case series., (Copyright © 2017. Published by Elsevier Inc.)

Discoid meniscus is a congenital variant of the knee joint that typically involves abnormal morphology and potential instability of the lateral meniscus. Some discoid menisci have abnormal peripheral attachments and are unstable. Discoid menisci are prone to tearing secondary to increased thickness, poor tissue quality, and instability. Patients may or may not be symptomatic. Torn or unstable discoid menisci cause mechanical symptoms, pain, and swelling. Symptomatic patients in whom nonsurgical management fails most frequently are treated with arthroscopic surgery. Historically, complete meniscectomy has successfully alleviated symptoms but has resulted in poor midterm results, with degenerative changes to the knee joint. Current treatment emphasizes the saucerization of the meniscus, with removal of the central disk and retention of the peripheral crescent. Peripheral meniscal repair is performed when instability is present. Short-term results are good; however, degenerative changes have been reported at intermediate follow-up.