A Literature Review of the Results of Traditional versus Accelerated Anterior Cruciate Ligament (ACL) Rehabilitation in Treatment following ACL Reconstruction

In recent years, the rehabilitation of the anterior cruciate ligament (ACL) has undergone changes in its protocol. The changes in ACL rehabilitation protocol are due to clinical observations and trends in ACL rehabilitation across the country. The traditional and presently used accelerated ACL rehabilitation programs are not much different in the activities performed as in the time frames when each activity is permitted. The main purpose of this literature review is to provide material for clinicians to have accurate and recent knowledge of ACL rehabilitation. This knowledge will allow the clinician to provide the best and most beneficial treatment to the patient. The traditional and accelerated ACL rehabilitation programs will be viewed separately and versus one another. Determinants of which ACL rehabilitation program to choose are stated to increase the clinicians\u27 awareness of the proper treatment to choose for a patient. Clinicians must continue to have present knowledge of sound basic science and recent research when treating a patient with a reconstructed ACL. ACL rehabilitation protocols are guidelines only, and a clinician must be aware of all of the factors present with a patient before slowing or speeding the rehabilitation process

scRNA Transcription Profile of Adult Zebrafish Podocytes Using a Novel Reporter Strain

Background/Aims: The role of podocytes is well conserved across species from drosophila to teleosts, and mammals. Identifying the molecular markers that actively maintain the integrity of the podocyte will enable a greater understanding of the changes that lead to damage. Methods: We generated transgenic zebrafish, expressing fluorescent reporters driven by the podocin promoter, for the visualization and isolation of podocytes. We have conducted single cell RNA sequencing (scRNA-seq) on isolated podocytes from a zebrafish reporter line. Results: We demonstrated that the LifeAct-TagRFP-T fluorescent reporter faithfully replicated podocin expression in vivo. We were also able to show spontaneous GCaMP6s fluorescence using light sheet (single plane illumination) microscopy. We identified many podocyte transcripts, encoding proteins related to calcium-binding and actin filament assembly, in common with those expressed in human and mouse mature podocytes. Conclusion: We describe the establishment of novel transgenic zebrafish and their use to identify and isolate podocyte cells for the preparation of a scRNA-seq library from normal podocytes. The scRNA-seq data identifies distinct populations of cells and potential gene switching between clusters. These data provide a foundation for future comparative studies and for exploiting the zebrafish as a model for kidney development, disease, injury and repair

Percutaneous revascularization for ischemic left ventricular dysfunction: Cost-effectiveness analysis of the REVIVED-BCIS2 trial

BACKGROUND: Percutaneous coronary intervention (PCI) is frequently undertaken in patients with ischemic left ventricular systolic dysfunction. The REVIVED (Revascularization for Ischemic Ventricular Dysfunction)-BCIS2 (British Cardiovascular Society-2) trial concluded that PCI did not reduce the incidence of all-cause death or heart failure hospitalization; however, patients assigned to PCI reported better initial health-related quality of life than those assigned to optimal medical therapy (OMT) alone. The aim of this study was to assess the cost-effectiveness of PCI+OMT compared with OMT alone. METHODS: REVIVED-BCIS2 was a prospective, multicenter UK trial, which randomized patients with severe ischemic left ventricular systolic dysfunction to either PCI+OMT or OMT alone. Health care resource use (including planned and unplanned revascularizations, medication, device implantation, and heart failure hospitalizations) and health outcomes data (EuroQol 5-dimension 5-level questionnaire) on each patient were collected at baseline and up to 8 years post-randomization. Resource use was costed using publicly available national unit costs. Within the trial, mean total costs and quality-adjusted life-years (QALYs) were estimated from the perspective of the UK health system. Cost-effectiveness was evaluated using estimated mean costs and QALYs in both groups. Regression analysis was used to adjust for clinically relevant predictors. RESULTS: Between 2013 and 2020, 700 patients were recruited (mean age: PCI+OMT=70 years, OMT=68 years; male (%): PCI+OMT=87, OMT=88); median follow-up was 3.4 years. Over all follow-ups, patients undergoing PCI yielded similar health benefits at higher costs compared with OMT alone (PCI+OMT: 4.14 QALYs, £22 352; OMT alone: 4.16 QALYs, £15 569; difference: −0.015, £6782). For both groups, most health resource consumption occurred in the first 2 years post-randomization. Probabilistic results showed that the probability of PCI being cost-effective was 0. CONCLUSIONS: A minimal difference in total QALYs was identified between arms, and PCI+OMT was not cost-effective compared with OMT, given its additional cost. A strategy of routine PCI to treat ischemic left ventricular systolic dysfunction does not seem to be a justifiable use of health care resources in the United Kingdom

Arrhythmia and death following percutaneous revascularization in ischemic left ventricular dysfunction: Prespecified analyses from the REVIVED-BCIS2 trial

BACKGROUND: Ventricular arrhythmia is an important cause of mortality in patients with ischemic left ventricular dysfunction. Revascularization with coronary artery bypass graft or percutaneous coronary intervention is often recommended for these patients before implantation of a cardiac defibrillator because it is assumed that this may reduce the incidence of fatal and potentially fatal ventricular arrhythmias, although this premise has not been evaluated in a randomized trial to date. METHODS: Patients with severe left ventricular dysfunction, extensive coronary disease, and viable myocardium were randomly assigned to receive either percutaneous coronary intervention (PCI) plus optimal medical and device therapy (OMT) or OMT alone. The composite primary outcome was all-cause death or aborted sudden death (defined as an appropriate implantable cardioverter defibrillator therapy or a resuscitated cardiac arrest) at a minimum of 24 months, analyzed as time to first event on an intention-to-treat basis. Secondary outcomes included cardiovascular death or aborted sudden death, appropriate implantable cardioverter defibrillator (ICD) therapy or sustained ventricular arrhythmia, and number of appropriate ICD therapies. RESULTS: Between August 28, 2013, and March 19, 2020, 700 patients were enrolled across 40 centers in the United Kingdom. A total of 347 patients were assigned to the PCI+OMT group and 353 to the OMT alone group. The mean age of participants was 69 years; 88% were male; 56% had hypertension; 41% had diabetes; and 53% had a clinical history of myocardial infarction. The median left ventricular ejection fraction was 28%; 53.1% had an implantable defibrillator inserted before randomization or during follow-up. All-cause death or aborted sudden death occurred in 144 patients (41.6%) in the PCI group and 142 patients (40.2%) in the OMT group (hazard ratio, 1.03 [95% CI, 0.82–1.30]; P =0.80). There was no between-group difference in the occurrence of any of the secondary outcomes. CONCLUSIONS: PCI was not associated with a reduction in all-cause mortality or aborted sudden death. In patients with ischemic cardiomyopathy, PCI is not beneficial solely for the purpose of reducing potentially fatal ventricular arrhythmias. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01920048

Geometries for the group PSL(3,4)

We classify all firm, residually connected coset geometries, on which the group PSL(3,4) acts as a flag-transitive automorphism group fulfilling the residually weakly primitive condition: the stabilizer of any flag F acts primitively on the elements of some type in the residue ΓF. We demand also that every residue of rank two satisfies the intersection property. We give geometric constructions for all geometries obtained. © 2003 Elsevier Science Ltd. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Family Health History Reporting is Sensitive to Small Changes in Wording

Purpose Family health history is often collected through single-item queries that ask patients whether or not their family members are affected by certain conditions. The specific wording of these queries may affect what individuals report. Methods: Parents of Boston Children’s Hospital patients were invited to participate in a web-based survey about the return of individual genomic research results about their children. Participants reported whether 11 types of medical conditions affected them or their family. Randomization determined whether or not participants were specifically instructed to consider their extended family. Results: 2,901 participants reported family health history. Those asked to consider their extended family were more likely to report a positive family history for 8 of 11 medical conditions. The largest differences were observed for cancer (65.1% vs 45.7%, p<0.001), cardiovascular conditions (72.5% vs 56.0%, p<0.001), and endocrine/hormonal conditions (50.9% vs 36.7%, p<0.001). Conclusions: Small alterations to the way family health history queries are worded can substantially change patient responses. Clinicians and researchers need to be sensitive about patients’ tendencies to omit extended family from health history reporting unless specifically asked to consider them

The X-ray emission mechanism of large scale powerful quasar jets: Fermi rules out IC/CMB for 3C 273.

The process responsible for the Chandra-detected X-ray emission from the large-scale jets of powerful quasars is not clear yet. The two main models are inverse Compton scattering off the cosmic microwave background photons (IC/CMB) and synchrotron emission from a population of electrons separate from those producing the radio-IR emission. These two models imply radically different conditions in the large scale jet in terms of jet speed, kinetic power, and maximum energy of the particle acceleration mechanism, with important implications for the impact of the jet on the larger-scale environment. Georganopoulos et al. (2006) proposed a diagnostic based on a fundamental difference between these two models: the production of synchrotron X-rays requires multi-TeV electrons, while the EC/CMB model requires a cutoff in the electron energy distribution below TeV energies. This has significant implications for the γ-ray emission predicted by these two models. Here we present new Fermi observations that put an upper limit on the gamma-ray flux from the large-scale jet of 3C 273 that clearly violates the flux expected from the IC/CMB X-ray interpretation found by extrapolation of the UV to X-ray spectrum of knot A, thus ruling out the IC/CMB interpretation entirely for this source. Further, the upper limit from Fermi puts a limit on the Doppler beaming factor of at least δ <9, assuming equipartition fields, and possibly as low as δ <5 assuming no major deceleration of the jet from knots A through D1