Health-related quality of life, adiposity, and sedentary behavior in patients with early schizophrenia: Preliminary study

Objective: To examine adiposity and sedentary behavior in relation to health-related quality of life (QoL) in patients with early schizophrenia. Methods: A cross-sectional study was used to assess adiposity by dual-energy X-ray absorptiometry scans, habitual physical activity and idle sitting time by the Short Form International Physical Activity Questionnaire, and health-related QoL by the RAND Medical Outcomes Study SF-36. QoL scores were compared with age-adjusted Canadian normative population data. Results: There were 36 participants with early schizophrenia, average age 25.1 (±3.6). Twenty-nine (72.5%) were males. Mean illness duration was 30 (±18) months, and mean body mass index was 28.3 (±5). Females had higher body fat content than males (30.8±6.9 vs 24.7±10.6; t=-2.6, df=34; P=0.015). Total body fat (F=14; P=0.001), lean body mass (F=10.2; P=0.001), and sedentary behavior (F=5; P=0.013) significantly increased across body mass index categories. Total body fat was correlated with sedentary behavior (r=0.62; P=0.001), and total lean body mass was negatively correlated with sedentary behavior (r=0.39; P=0.03). Based on SF-36scores, participants had significantly lower physical functioning (P=0.0034), role physical (P=0.0003), general health (P,0.0001), vitality (P=0.03), and physical component scores (P=0.003) than Canadian population comparisons. Habitual sedentary behavior, more than activity or adiposity levels, was associated with health-related QoL in early schizophrenia. Conclusion: Health-related QoL is lower in early schizophrenia and is predominantly experienced in the physical domain. QoL in early schizophrenia relates to sedentary behavior more than to activity and adiposity levels. © 2012 Strassnig etal, publisher and licensee Dove Medical Press Ltd

A multimedia package for patient understanding and rehabilitation of non-contact anterior cruciate ligament injuries

Non-contact anterior cruciate ligament (ACL) injury is one of the most common ligament injuries in the body. Many patients’ receive graft surgery to repair the damage, but have to undertake an extensive period of rehabilitation. However, non-compliance and lack of understanding of the injury, healing process and rehabilitation means patient’s return to activities before effective structural integrity of the graft has been reached. When clinicians educate the patient, to encourage compliance with treatment and rehabilitation, the only tools that are currently widely in use are static plastic models, line diagrams and pamphlets. As modern technology grows in use in anatomical education, we have developed a unique educational and training package for patient’s to use in gaining a better understanding of their injury and treatment plan. We have combined cadaveric dissections of the knee (and captured with high resolution digital images) with reconstructed 3D modules from the Visible Human dataset, computer generated animations, and images to produce a multimedia package, which can be used to educate the patient in their knee anatomy, the injury, the healing process and their rehabilitation, and how this links into key stages of improving graft integrity. It is hoped that this will improve patient compliance with their rehabilitation programme, and better long-term prognosis in returning to normal or near-normal activities. Feedback from healthcare professionals about this package has been positive and encouraging for its long-term use

Popliteus impingement after TKA may occur with well-sized prostheses

To determine the mechanisms and extents of popliteus impingements before and after TKA and to investigate the influence of implant sizing. The hypotheses were that (1) popliteus impingements after TKA may occur at both the tibia and the femur, and (2) even with an apparently well-sized prosthesis, popliteal tracking during knee flexion is modified compared to the preoperative situation. The location of the popliteus in three cadaver knees was measured using computed tomography, before and after implantation of plastic TKA replicas, by injecting the tendon with radiopaque liquid. The pre- and post-operative positions of the popliteus were compared from full extension to deep flexion using normosized, oversized, and undersized implants (one size increments). At the tibia, TKA caused the popliteus to translate posteriorly, mostly in full extension: 4.1 +/- 2 mm for normosized implants, and 15.8 +/- 3 mm with oversized implants, but no translations were observed when using undersized implants. At the femur, TKA caused the popliteus to translate laterally at deeper flexion angles, peaking between 80A degrees and 120A degrees: 2 +/- 0.4 mm for normosized implants and 2.6 +/- 0.5 mm with oversized implants. Three-dimensional analysis revealed prosthetic overhang at the posterosuperior corner of normosized and oversized femoral components (respectively, up to 2.9 mm and 6.6 mm). A well-sized tibial component modifies popliteal tracking, while an undersized tibial component maintains more physiologic patterns. Oversizing shifts the popliteus considerably throughout the full arc of motion. This study suggests that both femoro- and tibio-popliteus impingements could play a role in residual pain and stiffness after TKA

In-out versus out-in technique for ACL reconstruction. a prospective clinical and radiological comparison

Background: Several studies have recently shown better restoration of normal knee kinematics and improvement of rotator knee stability after reconstruction with higher femoral tunnel obliquity. The aim of this study is to evaluate tunnel obliquity, length, and posterior wall blowout in single-bundle anterior cruciate ligament (ACL) reconstruction, comparing the transtibial (TT) technique and the out–in (OI) technique. Materials and methods: Forty consecutive patients operated on for ACL reconstruction with hamstrings were randomly divided into two groups: group A underwent a TT technique, while group B underwent an OI technique. At mean follow-up of 10 months, clinical results and obliquity, length, and posterior wall blowout of femoral tunnels in sagittal and coronal planes using computed tomography (CT) scan were assessed. Results: In sagittal plane, femoral tunnel obliquity was 38.6 ± 10.2° in group A and 36.6 ± 11.8° in group B (p = 0.63). In coronal plane, femoral tunnel obliquity was 57.8 ± 5.8° in group A and 35.8 ± 8.2° in group B (p = 0.009). Mean tunnel length was 40.3 ± 1.2 mm in group A and 32.9 ± 2.3 mm in group B (p = 0.01). No cases of posterior wall compromise were observed in any patient of either group. Clinical results were not significantly different between the two groups. Conclusions: The OI technique provides greater obliquity of the femoral tunnel in coronal plane, along with satisfactory length of the tunnel and lack of posterior wall compromise. Level of evidence: II, prospective study

Non uniformity: structural strategy for optimizing functionality in skeletal ligaments

Ligaments serve as compliant connectors between hard tissues. In that role, they function under various load regimes and directions. However, the 3D structure of ligaments is still considered uniform. The periodontal ligament connects the tooth to the bone and like other ligaments, it sustains different types of loads in various directions. Using the PDL as a model, and employing a fabricated motorized set-up in a microCT instrument, morphological automated segmentation methods and 2nd harmonic generation imaging, we demonstrate that the fibrous network structure within the PDL is not uniform, even before the tooth becomes functional. We find that areas sustaining compression loads are pre-structured with sparse collagenous networks and large blood vessels, whereas other areas contain dense collagen networks with few blood vessels. Therefore, the PDL develops as a non-uniform structure, with an architecture designed to sustain specific types of load in different areas. Based on these findings, we propose that ligaments in general should be regarded as non-uniform entities structured for optimal functioning under variable load regimes.2019-09-26T00:00:00

Three dimensional anatomy of the anterior cruciate ligament: a new approach in anatomical orthopedic studies and a literature review

Background: The anterior cruciate ligament (ACL) is an important structure in the knee. The ACL does not heal following lesions, and surgical reconstruction is the standard treatment among athletes. Some steps of ACL reconstruction remain controversial. It is important to fully understand the anatomy of the ACL to accurately reproduce its anatomy during surgical reconstructions. The purpose of this study was to evaluate the use of anaglyphic images that produce 3D images to better visualize the anatomy of the ACL, and to highlight the anatomical features of this ligament as reported in the literature.Methods: We included ten knees in this study. After dissection of the knee structures, pictures were acquired using a camera with Nikon D40, AF-S Nikkor 18-55 mm (1:3.5-5.6 G2 ED), and Micro Nikkor 105 mm (1:2.8) lenses. The pair of images was processed using Callipyan 3D Anabuilder software, which transforms the two images into one anaglyphic image.Results: During the dissection of the knees, nine pictures were acquired and transformed into anaglyphic images.Conclusion: This study, demonstrated that the use of 3D images is a useful tool that can improve the knowledge of the anatomy of the knee, while also facilitating knee reconstruction surgery

Visualization of postoperative anterior cruciate ligament reconstruction bone tunnels: Reliability of standard radiographs, CT scans, and 3D virtual reality images

Background and purpose: Non-anatomic bone tunnel placement is the most common cause of a failed ACL reconstruction. Accurate and reproducible methods to visualize and document bone tunnel placement are therefore important. We evaluated the reliability of standard radiographs, CT scans, and a 3-dimensional (3D) virtual reality (VR) approach in visualizing and measuring ACL reconstruction bone tunnel placement. Methods: 50 consecutive patients who underwent single-bundle ACL reconstructions were evaluated postoperatively by standard radiographs, CT scans, and 3D VR images. Tibial and femoral tunnel positions were measured by 2 observers using the traditional methods of Amis, Aglietti, Hoser, Stubli, and the method of Benereau for the VR approach. Results: The tunnel was visualized in 50-82% of the standard radiographs and in 100% of the CT scans and 3D VR images. Using the intraclass correlation coefficient (ICC), the inter- and intraobserver agreement was between 0.39 and 0.83 for the standard femoral and tibial radiographs. CT scans showed an ICC range of 0.49-0.76 for the inter- and intraobserver agreement. The agreement in 3D VR was almost perfect, with an ICC of 0.83 for the femur and 0.95 for the tibia. Interpretation: CT scans and 3D VR images are more reliable in assessing postoperative bone tunnel placement following ACL reconstruction than standard radiographs. Copyright

Limitations of widely used high-risk human papillomavirus laboratory-developed testing in cervical cancer screening.

OBJECTIVE: To increase awareness of the limitations of high-risk human papillomavirus (hrHPV) laboratory-developed testing (LDT) widely used in US cervical cancer screening. METHODS AND RESULTS: A young woman in her 30s was diagnosed and treated for stage 1B1 cervical squamous cell carcinoma in which HPV 16 DNA was detected using polymerase chain reaction testing. Both 1 month before and 42 months before cervical cancer diagnosis, the patient had highly abnormal cytology findings; however, residual SurePath™ (Becton, Dickson and Company, Franklin Lakes, NJ) vial fluid yielded negative Hybrid Capture 2 (HC2; Qiagen NV, Hilden, Germany) hrHPV LDT results from each of the two specimens. This prompted questions to be asked concerning the performance characteristics of hrHPV LDT. A review of the available data indicates that (1) purification of DNA from SurePath specimens requires complex sample preparation due to formaldehyde crosslinking of proteins and nucleic acids, (2) HC2-SurePath hrHPV testing had not been Food and Drug Administration-approved after multiple premarket approval submissions, (3) detectible hrHPV DNA in the SurePath vial decreases over time, and (4) US laboratories performing HC2-SurePath hrHPV LDT testing are not using a standardized manufacturer-endorsed procedure. CONCLUSION: Recently updated cervical screening guidelines in the US recommend against the use of hrHPV LDT in cervical screening, including widely used HC2 testing from the SurePath vial. The manufacturer recently issued a technical bulletin specifically warning that use of SurePath samples with the HC2 hrHPV test may provide false negative results and potentially compromise patient safety. Co-collection using a Food and Drug Administration-approved hrHPV test medium is recommended for HPV testing of patients undergoing cervical screening using SurePath samples

Double bundle arthroscopic Anterior Cruciate Ligament reconstruction with remnant preserving technique using a hamstring autograft

<p>Abstract</p> <p>Background</p> <p>Preservation of the Anterior Cruciate Ligament (ACL) remnant is important from the biological point of view as it enhances revascularization, and preserves the proprioceptive function of the graft construct. Additionally, it may have a useful biomechanical function. Double bundle ACL reconstruction has been shown to better replicate the native ACL anatomy and results in better restoration of the rotational stability than single bundle reconstruction.</p> <p>Methods</p> <p>We used the far anteromedial (FAM) portal for creation of the femoral tunnels, with a special technique for its preoperative localization using three dimensional (3D) CT. The central anteromedial (AM) portal was used to make a longitudinal slit in the ACL remnant to allow visualization of the tips of the guide pins during anatomical creation of the tibial tunnels within the native ACL tibial foot print. The use of curved hemostat allow retrieval of the wire loop from the apertures of the femoral tunnels through the longitudinal slit in the ACL remnant thereby, guarding against impingement of the reconstruction graft against the ACL remnant as well as the roof of the intercondylar notch.</p> <p>Conclusion</p> <p>Our technique allows for anatomical double bundle reconstruction of the ACL while maximally preserving the ACL remnant without the use of intra-operative image intensifier.</p

MRI laxity assessment

Knee laxity, by definition, is a dynamic and multifactorial condition. MRI evaluation, due to its known capacity in achieving high soft tissue contrast (e.g., meniscus, synovia, ligaments, cartilage) and multiplanar joint assessment without ionizing radiation, has contributed to its popularity in the last decades. However, “traditional�? MRI studies provide static evaluation, thus requiring careful correlation to clinical findings, particularly when dealing with functional ligament stability. This work aims to describe the most important features of current MRI studies when dealing with anterior cruciate ligaments injuries, while also presenting the evolving possibilities of dynamic and objective MRI assessment of knee instability.(undefined