Platelet-Rich Plasma Injection With Percutaneous Needling for Recalcitrant Lateral Epicondylitis: Comparison of Tenotomy and Fenestration Techniques.

Background: Recalcitrant lateral epicondylitis (LE) is a common debilitating condition, with numerous treatment options of varying success. An injection of platelet-rich plasma (PRP) has been shown to improve LE, although it is unclear whether the method of needling used in conjunction with a PRP injection is of clinical importance. Purpose: To determine whether percutaneous needle tenotomy is superior to percutaneous needle fenestration when each is combined with a PRP injection for the treatment of recalcitrant LE. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 93 patients with recalcitrant LE were treated with a PRP injection and percutaneous needle fenestration (n = 45) or percutaneous needle tenotomy (n = 48) over a 5-year study interval. Preoperative patient data, including visual analog scale for pain (VAS-P), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE) scores and grip strength, were obtained from a chart review and compared with postoperative values obtained prospectively. Secondary outcomes included the incidence of complications, need for additional interventions, return to work, and patient satisfaction. Results: At a mean follow-up of 40 months, significant improvements in VAS-P (mean, -6.1; 95% CI, -6.8 to -5.5; P \u3c .0001), QuickDASH (mean, -46; 95% CI, -52 to -40; P \u3c .0001), and PRTEE (mean, -57; 95% CI, -64 to -50; P \u3c .0001) scores and grip strength (mean, +6.1 kg; 95% CI, 4.9 to 7.3; P \u3c .0001) were observed across the entire study cohort, with no significant differences noted between the fenestration and tenotomy groups. Nine of 45 patients (22%) underwent additional procedures to treat recurrent symptoms in the fenestration group compared with 5 of 48 patients (10%) in the tenotomy group (P = .05). No complications occurred in any patients, and no patients expressed dissatisfaction with their treatment course. Conclusion: A PRP injection with concomitant percutaneous needling is an effective treatment for recalcitrant LE, with sustained improvements in pain, strength, and function demonstrated at a mean follow-up of longer than 3 years. Although the method of concomitant needling does not appear to have a significant effect on treatment outcomes, more aggressive needle tenotomy is less likely to require conversion to open tenotomy than needle fenestration in the short term to midterm

Detection of bone defects using CBCT exam in an Italian population

Background. The aim of this study was to evaluate the in vivo incidence and the location of fenestrations in a young Italian population by using CBCT. Materials and Methods. Fifty patients who had previously performed CBCT for planning third molar extraction or orthodontic therapy were selected for the study. No previous dental treatment had been performed on these patients. Overall, 1,395 teeth were evaluated. Root fenestrations were identified according to the definition of Davies and the American Association of Endodontists. Data was collected and statistically analyzed. Results. Fenestrations were observed in 159 teeth out of 1,395 (11% of teeth). In the lower jaw, we found 68 fenestrations (5%) and 91 in the maxilla (6,5%). Incisors were the teeth with the highest incidence of fenestrations. Conclusion.The relative common finding (11%)of fenestration supports the need for CBCT exams before any surgical/implant treatment to avoid complications related to the initial presence of fenestrations. CBCT was found to be an effective and convenient tool for diagnosing fenestration

High-Performance Integrated Window and Façade Solutions for California

The researchers developed a new generation of high-performance façade systems and supporting design and management tools to support industry in meeting California’s greenhouse gas reduction targets, reduce energy consumption, and enable an adaptable response to minimize real-time demands on the electricity grid. The project resulted in five outcomes: (1) The research team developed an R-5, 1-inch thick, triplepane, insulating glass unit with a novel low-conductance aluminum frame. This technology can help significantly reduce residential cooling and heating loads, particularly during the evening. (2) The team developed a prototype of a windowintegrated local ventilation and energy recovery device that provides clean, dry fresh air through the façade with minimal energy requirements. (3) A daylight-redirecting louver system was prototyped to redirect sunlight 15–40 feet from the window. Simulations estimated that lighting energy use could be reduced by 35–54 percent without glare. (4) A control system incorporating physics-based equations and a mathematical solver was prototyped and field tested to demonstrate feasibility. Simulations estimated that total electricity costs could be reduced by 9-28 percent on sunny summer days through adaptive control of operable shading and daylighting components and the thermostat compared to state-of-the-art automatic façade controls in commercial building perimeter zones. (5) Supporting models and tools needed by industry for technology R&D and market transformation activities were validated. Attaining California’s clean energy goals require making a fundamental shift from today’s ad-hoc assemblages of static components to turnkey, intelligent, responsive, integrated building façade systems. These systems offered significant reductions in energy use, peak demand, and operating cost in California

An investigation into the effectiveness of collagenase for the percutaneous discolysis of thoracolumbar intervertebral discs in the dog : a thesis presented in partial fulfilment of the requirements for the degree of Master of Veterinary Science at Massey University

This investigation compared the effectiveness of chemonucleolysis with 500 units of collagenase, to lateral fenestration of the thoracolumbar intervertebral discs of the non-chondrodystrophoid dog. Effectiveness was based on the amount of nuclear material removed from the disc and the associated modifications to intervertebral disc structure, as determined by histological examination. The object was to determine whether the percutaneous injection of collagenase enzyme could be an alternative to fenestration as a prophylaxis against herniation of a degenerate intervertebral disc. Eight one year old, non-chondrodystrophoid mongrel dogs were used in the experiment. Apart from two dogs which remained untreated, the remaining six dogs were from two litters which had been sired by the same animal. Two of these dogs had six intervertebral discs (T10/11 to L2/3) injected with 500 units of collagnease VIIs delivered percutaneously. Another two dogs had their equivalent discs surgically fenestrated by the lateral approach as described by Flo and Brinker. The remaining two dogs were subjected to a placebo injection of physiological saline. The animals were examined clinically, neurologically and radiologically before treatment and at regular intervals following treatment. Six months following treatment, the dogs were euthanased. The results showed that collagenase caused almost complete removal of normal nuclear material from within the disc. The centre of the disc was replaced by a variable combination of fibrocartilage and hyaline cartilage, which appeared to develop from the collapsed inner lamellae of the annulus fibrosus. Complications were recorded in only one dog, who suffered a transient hind limb paralysis in the two days immediately following injection. A massive dorsal extrusion of nuclear material was observed in one disc at post-mortem in this dog and was believed to be the cause of the paralysis. The dog recovered without treatment and remained normal on clinical, neurological and radiological examination six months after injection. The annulus fibrosus, dorsal and ventral longitudinal ligaments remained intact in all other dogs. Fenestration was found to cause a variable disruption to the normal architecture of the nucleus pulposus. In most discs, cellular aggregations from the normal nucleus pulposus were undergoing a transformation to fibrocartilage. These cell groups were separated by an increased amount of amorphous matrix material which stained moderately with alcian blue. In the remaining discs (3/12), an increased fibrosus of the nucleus pulposus was seen, but no other disruption to the normal architecture was recorded. No complications occurred in these dogs. The injection of the discs with physiological saline caused remarkably similar histological effects to the disc as did fenestration. The investigators concluded that collagenase appeared to be an attractive alternative to fenestration for the prophylaxis of intervertebral disc herniation, on the basis of its completeness of removal of nuclear tissue, and its simplicity, cheapness, non-invasiveness and the lack of medium and short term complications. Since intervertebral disc protrusions occur more commonly in chondrodystrophoid breeds of dog, the effect of collagenase should be studied in degenerate disc of these breeds before it can be recommended for clinical use

Passive Design of Buildings for Extreme Weather Environment

Buildings account for nearly 40% of the end-use energy consumption and carbon emissions globally. Buildings, once built, are used at least for several decades. The building sector therefore holds a significant responsibility for implementing strategies to increase energy efficiency and reduce carbon emissions and thus contribute to global efforts directed toward mitigating the adverse effects of climate change. The work presented in this paper is a part of continuing efforts to identify, analyze and promote the design of low energy, sustainable buildings with special reference to the Kazakhstan locality. Demonstration of improved environmental conditions and impact on energy savings will be outlined through a case study incorporating a passive design approach and detailed computational fluid dynamics analysis for an existing building complex. The influence of orientation and configuration is discussed with reference to energy efficiency and associated wind comfort and safety. The effect of these aspects on energy consumption and comfortable wind environment has been assessed using CFD analysis and proved to be affective. Single building and multiple building configurations have been analyzed and compared. According to the findings, multiple building configurations have better wind conditions when compared with a single standing building. With respect to orientation the former one should be modeled with the fully surrounded side of a “box” opposite to the predominant wind direction whereas the latter one should be located with the rear side opposite to the wind direction. Thus, results indicated that there is a considerable influence of passive design and orientation on energy efficiency, wind comfort and safety. Careful consideration and application of the findings can potentially lead to considerable decrease of energy consumption and, therefore, allow saving money and the environment at the same time

Liver Abscesses: a 10-year Vinnytsya University Study

According to MEDLINE database there were about 1278 papers on liver abscess published in a period from 2001 to 2015.The aim of the study is to improve liver abscess treatment results comparing minimally invasive and traditional operative techniques.Materials and methods. 137 patients were included in the study and divided on two comparison groups. Traditional methods were used for the treatment of 66 participants of the control group (48.2 %). For 71 patients (51.8 %) of the general group the mini-invasive drainages were predominating.Results. Cholangiogenic causes of liver abscesses were found in 41 patients (29.93±3.91 %), cryptogenic ones – in 37 (27.01±3.79 %), haematogenous causes – in 29 (21.17±3.49 %), contact ones – in 16 (11.68±2.75 %), posttraumatic ones – in 11 (8.03±2.32 %) and purulent destruction of metastases – in 3 (2.19±1.25 %).Single abscesses occurred more often – in 117 (85.40±3.02 %), multiple once – in 20 (14.60±3.02 %). Mostly 3, 6 and 7 liver segments were damaged – 19 (13.88±2.95 %), 35 (25.55±3.73 %), 44 (32.12±3.99 %).In control group, the abscess drainage via laparotomy was performed on 58 patients (87.88±4.02 % of 66 ones) versus 21 (29.58±5.42 % of 71 ones) in general group. Percutaneous drainage was used in 8 (12.12±4.02 %) and in 44 (61.97±5.76 %) cases respectively. 6 or 8.45±3.30 % laparoscopic interventions were used only in the general group. Finally, mini-invasive drainages were applied in the greater part of general group - 50 (70.42±5.42 %) versus 8 ones (12.12±4.02 %) in control group.Conclusions. Minimally invasive liver abscess drainages showed a significant reduction of postoperative complications from 24.24±5.27 % in the control group to 12.66±3.95 % in the general group, shortening of hospital terms from 14.6±1 in control to 5.2±0.8 days and decreasing of mortality from 7.58±3.26 % to 2.82±1.96 %

Endoscopic stapedectomy our experience

Stapedecomy traditionally is performed using operating microscope. Eventhough it is a time tested procedure, it had its own draw backs. In patients with excessive bony overhang it would bedifficult to access the middle ear cavity using operating microscope. Using Endoscope authors were able to circumvent these difficulties. Endoscopic examination of middle ear cavity was invogue since 1992. 10 Advantages of using endoscope include: Excellent exposure, visualization of entire middle ear cavity with ease, excellent crystal clear images. All the steps of stapedectomycould easily be performed using endoscope. Only flip side being the use of only one hand for the entire procedure as the non dominant hand will be holding the endoscope.

Twisted atrioventricular connections in double inlet right ventricle: evaluation by magnetic resonance imaging

Twisted atrioventricular connections occur almost exclusively in the hearts with biventricular atrioventricular connections. Only one example of double inlet left ventricle has been illustrated in which the axes of the two atrioventricular valves crossed each other. We describe herein three patients, and one autopsied specimen, with double inlet right ventricle in which magnetic resonance imaging clearly demonstrated twisted atrioventricular connections

Managing change in North Shore’s Residential 3 Built Heritage zone: An evaluation of resource consent outcomes

The goal of the study presented in this report has been to determine the extent to which resource consent outcomes in North Shore City’s Residential 3 Built Heritage zone comply with the District Plan. To this end, a sample of 250 properties was selected representing a sample size of 6.5%. The records for each of these properties was checked to identify those that have had a consent granted for additions and alterations to buildings, new and relocated buildings, and the demolition or removal of houses in the Residential 3 zone. This revealed that 100 properties in the sample (or 40%) have been granted a total of 126 resource consents for one or more of these activities. Each of the 100 properties was visited and the outcomes of the consents were compared against the District Plan assessment criteria

Characterization of early disease status in treatment-naive male paediatric patients with Fabry disease enrolled in a randomized clinical trial.

Trial designThis analysis characterizes the degree of early organ involvement in a cohort of oligo-symptomatic untreated young patients with Fabry disease enrolled in an ongoing randomized, open-label, parallel-group, phase 3B clinical trial.MethodsMales aged 5-18 years with complete α-galactosidase A deficiency, without symptoms of major organ damage, were enrolled in a phase 3B trial evaluating two doses of agalsidase beta. Baseline disease characteristics of 31 eligible patients (median age 12 years) were studied, including cellular globotriaosylceramide (GL-3) accumulation in skin (n = 31) and kidney biopsy (n = 6; median age 15 years; range 13-17 years), renal function, and glycolipid levels (plasma, urine).ResultsPlasma and urinary GL-3 levels were abnormal in 25 of 30 and 31 of 31 patients, respectively. Plasma lyso-GL-3 was elevated in all patients. GL-3 accumulation was documented in superficial skin capillary endothelial cells (23/31 patients) and deep vessel endothelial cells (23/29 patients). The mean glomerular filtration rate (GFR), measured by plasma disappearance of iohexol, was 118.1 mL/min/1.73 m(2) (range 90.4-161.0 mL/min/1.73 m(2)) and the median urinary albumin/creatinine ratio was 10 mg/g (range 4.0-27.0 mg/g). On electron microscopy, renal biopsy revealed GL-3 accumulation in all glomerular cell types (podocytes and parietal, endothelial, and mesangial cells), as well as in peritubular capillary and non-capillary endothelial, interstitial, vascular smooth muscle, and distal tubules/collecting duct cells. Lesions indicative of early Fabry arteriopathy and segmental effacement of podocyte foot processes were found in all 6 patients.ConclusionsThese data reveal that in this small cohort of children with Fabry disease, histological evidence of GL-3 accumulation, and cellular and vascular injury are present in renal tissues at very early stages of the disease, and are noted before onset of microalbuminuria and development of clinically significant renal events (e.g. reduced GFR). These data give additional support to the consideration of early initiation of enzyme replacement therapy, potentially improving long-term outcome.Trial registrationClinicalTrials.gov NCT00701415