Extra-articular tenodesis combined with an anterior cruciate ligament reconstruction in acute anterior cruciate ligament tear in elite female football players

PURPOSE: The growing popularity of elite soccer among female participants has led to increased incidents of anterior cruciate ligament (ACL) ruptures. Many authors underline a positive glide after ACL reconstruction (ACLR), especially in women. In fact, an isolated intra-articular ACLR may be inadequate to control rotational instability after a combined injury of the ACL and the peripheral structures of the knee. Extra-articular procedures are sometimes used in primary cases displaying excessive antero-lateral rotatory instability. The purpose of this case series was to report subjective and objective outcomes after combined ACL and lateral extra-articular tenodesis (LET) with a minimum 4-year follow-up in a selected high-risk population of elite female football players. METHODS: Between January 2007 and December 2010, 16 elite Italian female football players were included in the study. All patients underwent the same surgical technique: anatomical ACLR with autogenous semitendinosus and gracilis tendons. After the intra-articular reconstruction was performed, an additional extra-articular MacIntosh modified Coker-Arnold procedure was carried out. Patients were assessed pre- and post-operatively with the subjective and objective International Knee Documentation Committee (IKDC) evaluation form, Tegner activity scale (TAS) and Lysholm score. Joint laxity was assessed with KT-1000 by measuring the side-to-side (S/S) differences in displacement at manual maximum (mm) testing. RESULTS: At a mean follow-up of 72.6 ± 8.1 months, two independent examiners reviewed all players. All of the patients had a fully recovered range of motion. Lachman test was negative in all patients (100 %). The evaluation of joint laxity and clinical evaluation showed a statistically significant improvement. No patients experienced complication or a re-rupture. DISCUSSION: The rationale of combining extra-articular procedures with ACLR is to restrict the internal rotation of the reconstructed knee, taking advantage of its long lever arm and thus providing more stability in the rotational axis and preventing the ACL graft from undergoing further excessive strain. CONCLUSIONS: The combination of an LET with ACLR in elite female football players demonstrated excellent results in terms of subjective scales, post-operative residual laxity and re-rupture rate with no complication, and a complete return to sport activity

Using Graph Transformation Systems to Specify and Verify Data Abstractions

This paper proposes an approach for the specification of the behavior of software components that implement data abstractions. By generalizing the approach of behavior models using graph transformation, we provide a concise specification for data abstractions that describes the relationship between the internal state, represented in a canonical form, and the observers of the component. Graph transformation also supports the generation of behavior models that are amenable to verification. To this end, we provide a translation approach into an LTL model on which we can express useful properties that can be model-checked with a SAT solver

Chest pain caused by multiple exostoses of the ribs: A case report and a review of literature

Abstract The aim of this paper is to report an exceptional case of multiple internal exostoses of the ribs in a young patient affected by multiple hereditary exostoses (MHE) coming to our observation for chest pain as the only symptom of an intra-thoracic localization. A 16 years old patient with familiar history of MHE came to our observation complaining a left-sided chest pain. This pain had increased in the last months with no correlation to a traumatic event. The computed tomography (CT) scan revealed the presence of three exostoses located on the left third, fourth and sixth ribs, all protruding into the thoracic cavity, directly in contact with visceral pleura. Moreover, the apex of the one located on the sixth rib revealed to be only 12 mm away from pericardium. Patient underwent video-assisted thoracoscopy with an additional 4-cm mini toracotomy approach. At the last 1-year followup, patient was very satisfied and no signs of recurrence or major complication had occured. In conclusion, chest pain could be the only symptom of an intra-thoracic exostoses localization, possibly leading to serious complications. Thoracic localization in MHE must be suspected when patients complain chest pain. A chest CT scan is indicated to confirm exostoses and to clarify relationship with surrounding structures. Video-assisted thoracoscopic surgery can be considered a valuable option for exostoses removal, alone or in addiction to a mini-thoracotomy approach, in order to reduce thoracotomy morbidity

Dynamical Renormalization Group for Mode-Coupling Field Theories with Solenoidal Constraint

The recent inflow of empirical data about the collective behaviour of strongly correlated biological systems has brought field theory and the renormalization group into the biophysical arena. Experiments on bird flocks and insect swarms show that social forces act on the particles’ velocity through the generator of its rotations, namely the spin, indicating that mode-coupling field theories are necessary to reproduce the correct dynamical behaviour. Unfortunately, a theory for three coupled fields—density, velocity and spin—has a prohibitive degree of intricacy. A simplifying path consists in getting rid of density fluctuations by studying incompressible systems. This requires imposing a solenoidal constraint on the primary field, an unsolved problem even for equilibrium mode-coupling theories. Here, we perform an equilibrium dynamic renormalization group analysis of a mode-coupling field theory subject to a solenoidal constraint; using the classification of Halperin and Hohenberg, we can dub this case as a solenoidal Model G. We demonstrate that the constraint produces a new vertex that mixes static and dynamical coupling constants, and that this vertex is essential to grant the closure of the renormalization group structure and the consistency of dynamics with statics. Interestingly, although the solenoidal constraint leads to a modification of the static universality class, we find that it does not change the dynamical universality class, a result that seems to represent an exception to the general rule that dynamical universality classes are narrower than static ones. Our results constitute a solid stepping stone in the admittedly large chasm towards developing an off-equilibrium mode-coupling theory of biological groups.Fil: Cavagna, Andrea. Università degli Studi di Roma "La Sapienza"; Italia. Consiglio Nazionale delle Ricerche; ItaliaFil: Di Carlo, Luca. Università degli Studi di Roma "La Sapienza"; Italia. Consiglio Nazionale delle Ricerche; ItaliaFil: Giardina, Irene. Consiglio Nazionale delle Ricerche; Italia. Università degli Studi di Roma "La Sapienza"; ItaliaFil: Grigera, Tomas Sebastian. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Física de Líquidos y Sistemas Biológicos. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Física de Líquidos y Sistemas Biológicos; Argentina. Consiglio Nazionale delle Ricerche; ItaliaFil: Pisegna, Giulia. Università degli Studi di Roma "La Sapienza"; Italia. Consiglio Nazionale delle Ricerche; ItaliaFil: Scandolo, Mattia. Università degli Studi di Roma "La Sapienza"; Italia. Consiglio Nazionale delle Ricerche; Itali

Diagnostic SARS-CoV-2 Cycle Threshold Value Predicts Disease Severity, Survival, and Six-Month Sequelae in COVID-19 Symptomatic Patients

To date, there is no severe acute respiratory syndrome coronavirus 2-(SARS-CoV-2)-specific prognostic biomarker available. We assessed whether SARS-CoV-2 cycle threshold (Ct) value at diagnosis could predict novel CoronaVirus Disease 2019 (COVID-19) severity, clinical manifestations, and six-month sequelae. Hospitalized and outpatient cases were randomly sampled from the diagnoses of March 2020 and data collected at 6 months by interview and from the regional database for COVID-19 emergency. Patients were stratified according to their RNA-dependent-RNA-polymerase Ct in the nasopharyngeal swab at diagnosis as follows: Group A ≤ 20.0, 20.0 < group B ≤ 28.0, and Group C > 28.0. Disease severity was classified according to a composite scale evaluating hospital admission, worst oxygen support required, and survival. Two hundred patients were included, 27.5% in Groups A and B both, 45.0% in Group C; 90% of patients were symptomatic and 63.7% were hospitalized. The median time from COVID-19 onset to swab collection was five days. Lethality, disease severity, type, and number of signs and symptoms, as well as six-month sequelae distributed inversely among the groups with respect to SARS-CoV-2 Ct. After controlling for confounding, SARS-CoV-2 Ct at diagnosis was still associated with COVID-19-related death (p = 0.023), disease severity (p = 0.023), number of signs and symptoms (p < 0.01), and presence of six-month sequelae (p < 0.01). Early quantification of SARS-CoV-2 may be a useful predictive marker to inform differential strategies of clinical management and resource allocation

First records of Anagraphis ochracea (Araneae: Gnaphosidae) for continental Italy and Sicily with new observations on its myrmecophilous lifestyle

In the present study we describe and discuss for the first time the peculiar myrmecophilous habits of Anagraphis ochracea (L. Koch, 1867) and its strong association with the ant species Messor ibericus Santschi, 1931. The study is based on behavioural observations carried out both in the field and in captivity, and sheds light on the lifestyle of this poorly studied and rarely observed species. We also recorded the presence of A. ochracea on continental Italy and Sicily for the first time; provide a brief overview of its taxonomical history and present photographs of adult and juvenile specimens, the egg sac and the copulatory organs of both sexes. Finally, we provide a DNA-barcode (COI) for A. ochracea, which is the first for the genus Anagraphis as well

Age above 70 years and Charlson Comorbidity Index higher than 3 are associated with reduced survival probabilities after radical cystectomy for bladder cancer. Data from a contemporary series of 334 consecutive patients.

Objective: To assess the joint effect of age and comorbidities on clinical outcomes of radical cystectomy (RC).Methods: 334 consecutive patients undergoing open RC for bladder cancer (BC) during the years 2005-2015 were analyzed. Pre-, peri- and post-operative parameters, including age at RC (ARC) and Charlson Comorbidity Index (CCI), were evaluated. Overall and cancer-specific survivals (OS, CSS) were assessed by univariate and multivariate modelling. Furthermore, a three-knot restricted cubic spline (RCS) was fitted to survival data to detect dependency between death-rate ratio (HR) and ARC. Results: Median follow-up time was 3.8 years (IQR = 1.3-7.5) while median OS was 5.9 years (95%CL = 3.8-9.1). Globally, 180 patients died in our cohort (53.8%), 112 of which (62.2%) from BC and 68 patients (37.8%) for unrelated causes. After adjusting for preoperative, pathological and perioperative parameters, patients with CCI > 3 showed significantly higher death rates (HR = 1.61; p = 0.022). The highest death rate was recorded in ARC = 71-76 years (HR = 2.25; p = 0.034). After fitting an RCS to both OS and CSS rates, two overlapping nonlinear trends, with common highest risk values included in ARC = 70-75 years, were observed. Conclusions: Age over 70 years and CCI > 3 were significant factors limiting the survival of RC and should both be considered when comparing current RC outcomes