Hypermobility, ACL reconstruction & shoulder instability: a clinical, mechanical and histological analysis

Joint movements are essential for the function of human body during the activities of daily living and sports. The movement of human joints varies from normal to those which have an increased range of joint movement (gymnasts) to those with extreme disabling laxity in patients with a connective tissue disorder (Ehlers Danlos Syndrome). “Hypermobility" is most commonly used to describe excessive movement. Hypermobility was assessed by using the current criteria of the Beighton score for signs and the Brighton criteria for symptoms of hypermobility in a group of orthopaedic patients attending the specialist knee and shoulder injury clinics. The Beighton score was found to be higher in patients attending for primary ACL reconstruction (mean 2.9, p = 0.002) and revision ACL reconstruction (mean 4, p < 0.001) when compared with the control group. Hypermobility was a risk factor for the failure of ACL reconstruction (30% vs 0%). The mean Beighton score was higher in both the primary shoulder dislocation group (mean difference 1.8, p=0.001) and the recurrent shoulder dislocation group (mean difference 1.4, p=0.004). Bone defects were studied on the CT scan following shoulder dislocations. There was no correlation between hypermobility and the bone defects. The bone defect was a risk factor for recurrent shoulder instability (48% vs 16%). A material testing system was used to assess the tissue laxity of discarded hamstring tendon and shoulder capsule obtained during stabilisation procedures. The mean gradient of slope for both tendon and capsule graphs was 23.8 (range 3.08-52.63). The tissue laxity was compared to the Beighton score, however no correlation was detected between the Beighton score and the gradient of the tissue laxity. An electronic goniometer was used to measure the angle of the MCP joint of the little finger, whilst a force plate system simultaneously measured the force required to hyperextend the MCP joint. The little finger MCP joints of each hand were assessed in this manner in a group of patients undergoing primary ACL reconstruction or open shoulder stabilization. The mean force required to produce the 40 degrees angle at the little finger MCP joint was 0.04 kg with a range from 0-0.11 kg. There was a positive correlation between the gradient of tissue laxity and the force required to produce 40 degrees angle at the little finger of the dominant hand. The expression of Collagen V and Small leucine rich proteoglycans (Decorin and Biglycan) was studied in the skin, hamstring tendon and shoulder capsule of the patients described above attending with shoulder or knee instability. These patients had different levels of hypermobility (as assessed by the Beighton score) and symptoms of hypermobility (as assessed by the Brighton criteria to diagnose Benign Joint Hypermobility Syndrome). The weaker tendon group was found to have a lower mean Beighton score, while the weaker skin group had a higher mean Beighton score. Collagen V expression was higher in the skin dermal papillae of the weaker group. The Beighton Scores were higher in patients with ACL and shoulder injuries. Hypermobility was a risk factor for the failure of ACL reconstruction. There was no correlation between hypermobility and the bone defects on the CT scan following shoulder dislocation. Bone defects were a risk factor for recurrence. There was no correlation between the Beighton Score and the tissue laxity. There was a correlation between the tissue laxity and the clinical assessment of laxity at the little finger MCPJ by using a force- goniometer system. There was a correlation between the collagen V expression in the dermal papillae of the skin and the Beighton score

Impact of Corporate Reputation on Firm Risk: An Analysis of Pakistan Stock Exchange Listed and PACRA Rated Firms

This study has examined the impact of corporate reputation on risk exposure of the firms listed at Pakistan Stock Exchange (PSX) and rated by Pakistan Credit Rating Agency (PACRA). It has employed firm’s credit ratings as a proxy for corporate reputation. It has covered the time period from 2007-2016 and unbalanced and undated panel regression analysis has been carried out to observe the significance of the relationship among corporate reputation and the firm risk i.e. total risk and its parts (systematic and unsystematic risk). It has been found that corporate reputation has a significant negative relationship with total risk and systematic risk of the firm. It is however found that corporate reputation is insignificant in explaining the unsystematic risk of the firms. Leverage and profitability (the control variables) are also found significant in explaining the risk exposures of the firms

Policy on SMEs in Pakistan:: Relationship between Entrepreneurial Orientation, Firm Performance and Ownership Structure

To strengthen growth of SMEs in Pakistan, it is important for the policy makers to understand some significant related variables. For instance, Entrepreneurial Orientation (EO) is one such variable which can affect the performance of any business substantially; however, it is debatable if some of its dimensions do not affect the firm performance. This research investigates the relationship among the EO dimensions, firms’ performance and ownership structure. In this study, the collection of data was done by using a self-administered questionnaire survey using a 5-point Likert scale and Statistical Package for social sciences (SPSS) version 24. The findings revealed that EO has a statistically significant effect on firms’ performance and when checked individually for each dimension of the EO, it was clear that results for innovation were statistically insignificant, because innovation needs certain time and specific environmental conditions to yield significant results, whereas results for risk-seeking, proactive approach, autonomy, aggressive attitude, and competitive spirit were statistically significant and positively linked with the firms’ performance. The findings of this research reveal that ownership structure does play a significant moderating role on the relationship between performance of the firm and EO dimensions (Innovativeness, Proactiveness and competitive Energy) while Ownership structure doesn't play any significant moderating role between firm performance and few other EO dimensions (risk-attitude, autonomy and aggressiveness). Keywords: &nbsp;&nbsp;&nbsp; Public Policy, Entrepreneurial Orientation, Firm Performance, Ownership Structure, Small &amp; Medium Enterprises (SMEs), Pakista

Risk factors for femoral stem fracture following total hip arthroplasty : a systematic review and meta analysis

Background Femoral stem fracture following total hip arthroplasty (THA) is an infrequent but nevertheless devastating complication, with an increasing worldwide prevalence as demand for primary THA continues to increase. The aim of this study was to perform a systematic review and meta-analysis of risk factors for femoral stem fracture to help identify at risk patients. Methods A systematic search was conducted on EMBASE, MEDLINE and AMED to identify relevant studies. Data regard- ing study design, source, population, intervention, and outcomes was collated. Data extraction was performed on a custom form generated using Cochrane recommended methodology and analysis of risk factors performed including odds ratios (ORs) with 95% confidence intervals (CIs). Results A total of 15 studies reporting a total of 402 stem fractures in 49 723 THAs were identified. The median time from index procedure to stem fracture was 68 months (IQR 42.5–118) whilst mean age at index surgery was 61.8 years (SD 6.9). Male gender (OR = 3.27, 95% CI = 2.59–4.13, p < 0.001), patient weight above 80 kg (OR = 3.55, 95% CI = 2.88–4.37, p < 0.001), age under 63 years (OR = 1.22, 95% CI = 1.01–1.49, p < 0.001), varus stem alignment (OR = 5.77, 95% CI = 3.83– 8.7, p < 0.001), use of modular implants (OR = 1.95, 95% CI = 1.56–2.44, p < 0.01) and undergoing revision arthroplasty (OR = 3.33, 95% CI = 2.70–4.1, p < 0.001) were significant risk factors for prosthetic stem fracture. A risk window of 15 years post-surgery was identified. Conclusions This review concludes that patient weight, younger age, male sex, varus stem alignment, revision arthroplasty and use of modular stems are significant risk factors for femoral stem fracture. Modifying these risk factors where possible may help reduce incidence of femoral stem fracture in at risk patients.Peer reviewe

Adult laryngeal haemangioma; a rare entity

Laryngeal haemangioma is commonly seen in children. Adult laryngeal haemangiomas are rare and usually involve the supraglottic region. Most common symptom includes dysphagia, dysphonia and shortness of breath. Detailed history, fiberoptic laryngoscopy and computerized scanning may suggest benign nature of the lesion but diagnosis is only confirmed by a biopsy. In comparison to infantile haemangiomas which usually respond to propronolol, the treatment of adult laryngeal haemangiomas is always surgical removal. We present a case report of a supraglottic haemangioma in an adult male, who was treated surgically without any complications

Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up

Introduction Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre. Patients and methods Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture. Results Mean patient age at surgery was 65.8 years (SD 12.5, 34–88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0–99.3%) at 10 years and 96.7% (94.5–98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%). Conclusions The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.Peer reviewe

Impact of Service Orientation on Financial Performance of Banking Sector of Pakistan: Examining the Mediating Role of Job Satisfaction

The services sector of an economy plays major role in financial and social development. Services sector is dominant in the developed economies as it contributes upto 70% of total GDP. Even in the case of manufacturers it is difficult to survive without providing quality services. To shed light on the subject, this study aims to find the impact of service orientation on financial performance through mediating role of employees’ job satisfaction in banking sector of Pakistan. For this purpose, data were collected from staff working in the banking sector of district Vehari, Pakistan.Questionnaire was used as a tool for data collection from a sample of 196 employees working in banks of district Vehari.SPSS 17 was used as a tool for data analysis.Findings of factor analysis are used to test the validity of the measured constructs.Cronbach’s alpha confirmed the reliability of the measured constructs. Likewise, correlation and regression analysis show that all the study variables are positively related to each other.More specifically, Service orientation has affirmative and significant impact on the financial performance and employees’ job satisfaction.Furthermore, it is also confirmed that employees’ job satisfaction mediates the relationship between service orientation and financial performance in banking sector of Pakistan. These findings are helpful for the HR policy makers for improvement in the HR policies and resultantly improvement in the financial performance of banks

A Systematic Synthesis of Evidence Regarding Relationship of Physical Activity and Sports Participation With Trait Self-control

Background: Individuals with low level of trait self-control exhibit several negative behaviors such as violence, addictive behaviors (drug addiction, technological addictions), suicide, unhealthy eating, and criminal behaviors. In contrast, high level of self-control thought to be associated with positive psychosocial and physical health related outcomes. Interventions contribute to boost self-control seems essential for individual with risk of low trait self-control. Objectives: The purpose of this study is to systematically evaluate the relationship between physical activity and trait self-control. Methods: For this purpose, full-text articles were searched in research databases including Psych INFO, PubMed, Medline, The Cochrane Library, Wiley Library, Taylor &amp; Francis, Science Direct, Springer, ERIC, JSTOR, Google scholar, and Sage Journals. &nbsp;Following screening for the study selection criteria and assessment of risk of bias, twenty one studies (13cross-sectional, 5 longitudinal and 3 interventions) with low or moderate risks of bias were finally selected for qualitative synthesis. Results: Findings from all of the included studies consistently showed that there was a significantly positive relationship between physical activity and trait self-control.It is suggested that increasing self-efficacy, decreasing aggression, and improvement in positive and negative emotional states might be underlying mechanisms working for beneficial effects of physical activity on trait self-control. Conclusion: These suggest that physical activity and exercise may serve as a potential means to enhance trait self-control. Practical implementation and recommendations for policy makers are put forward in this connection

Frequency and predisposing factors of pharyngocutaneous fistula after total laryngectomy

Objective The objective of our study was to determine the frequency and predisposing factors of pharyngocutaneous fistula in postlaryngectomy patients. Materials and methods Charts of those patients who were treated with total laryngectomy for laryngeal carcinoma in our department from 2000 to 2008 were reviewed. Total 77 patients were included in the study. The variables studied for the development of pharyngocutaneous fistula (PCF) after total laryngectomy were: age and gender, diabetes mellitus, post-operative hemoglobin, ischemic heart disease, chronic obstructive pulmonary disease, tumor characteristics including tumor site, stage, differentiation and extension into pyriform sinus, pre-operative radiotherapy, pre-operative chemotherapy, pre-operative tracheostomy and positive surgical margins. Results Univariate analysis showed diabetes, pre-operative radiotherapy, pre-operative chemotherapy and pre-operative tracheostomy to be significantly associated with the formation of PCF. However, multivariate regression revealed that the only pre-operative radiotherapy was highly associated with the formation of PCF (OR = 132.923, P = 0.001). Conclusions We found 28.6% incidence of pharyngocutaneous fistula mainly because of the number of patients undergoing radiotherapy and chemotherapy as primary treatment for laryngeal cancers is increasing with current approach of organ preservation protocol