Lateral Compartment Contact Pressures Do Not Increase After Lateral Extra-articular Tenodesis and Subsequent Subtotal Meniscectomy

© The Author(s) 2019. Background: Modified Lemaire lateral extra-articular tenodesis (LET) has been proposed as a method of addressing persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR). However, concerns remain regarding the potential for increasing lateral compartment contact pressures. Purpose: To investigate changes in tibiofemoral joint contact pressures after isolated ACLR and combined ACLR plus LET with varying states of a lateral meniscal injury. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knee specimens (mean age, 60.0 ± 3.4 years) were utilized for this study, with specimens potted and loaded on a materials testing machine. A pressure sensor was inserted into the lateral compartment of the tibiofemoral joint, and specimens were loaded at 0°, 30°, 60°, and 90° of flexion in the following states: (1) baseline (ACL- and anterolateral ligament–deficient), (2) ACLR, (3) ACLR with LET, (4) partial meniscectomy (removal of 50% of the posterior third of the lateral meniscus), (5) subtotal meniscectomy (removal of 100% of the posterior third of the lateral meniscus), and (6) LET release (LETR). Mean contact pressure, peak pressure, and center of pressure were analyzed using 1-way repeated-measures analysis of variance. Results: Across all flexion angles, there was no statistically significant increase in the mean contact pressure or peak pressure after ACLR plus LET with and without lateral meniscectomy compared with isolated ACLR. There was a significant reduction in the mean contact pressure, from baseline, after subtotal meniscectomy (69.72% ± 19.27% baseline; P =.04) and LETR (65.81% ± 13.40% baseline; P =.003) at 0° and after the addition of LET to ACLR at 30° (61.20% ± 23.08% baseline; P =.031). The center of pressure was observed to be more anterior after partial (0°, 30°) and subtotal (0°, 60°) meniscectomy and LETR (0°, 30°, 60°). Conclusion: Under the loading conditions of this study, LET did not significantly alter lateral compartment contact pressures when performed in conjunction with ACLR in the setting of an intact or posterior horn–deficient lateral meniscus. Clinical Relevance: This study should provide surgeons with the confidence that it is safe to perform LET in this manner in conjunction with ACLR without altering lateral compartment pressures, regardless of the status of the lateral meniscus

Christianity as Public Religion::A Justification for using a Christian Sociological Approach for Studying the Social Scientific Aspects of Sport

The vast majority of social scientific studies of sport have been secular in nature and/or have tended to ignore the importance of studying the religious aspects of sport. In light of this, Shilling and Mellor (2014) have sought to encourage sociologists of sport not to divorce the ‘religious’ and the ‘sacred’ from their studies. In response to this call, the goal of the current essay is to explore how the conception of Christianity as ‘public religion’ can be utilised to help justify the use of a Christian sociological approach for studying the social scientific aspects of sport. After making a case for Christianity as public religion, we conclude that many of the sociological issues inherent in modern sport are an indirect result of its increasing secularisation and argue that this justifies the need for a Christian sociological approach. We encourage researchers to use the Bible, the tools of Christian theology and sociological concepts together, so to inform analyses of modern sport from a Christian perspective

Effect of clinical signs, endocrinopathies, timing of surgery, hyperlipidemia, and hyperbilirubinemia on outcome in dogs with gallbladder mucocele

Gallbladder mucocele (GBM) is a common extra-hepatic biliary syndrome in dogs with death rates ranging from 7 to 45%. Therefore, the aim of this study was to identify the association of survival with variables that could be utilized to improve clinical decisions. A total of 1194 dogs with a gross and histopathological diagnosis of GBM were included from 41 veterinary referral hospitals in this retrospective study. Dogs with GBM that demonstrated abnormal clinical signs had significantly greater odds of death than subclinical dogs in a univariable analysis (OR, 4.2; 95% CI, 2.14–8.23; P < 0.001). The multivariable model indicated that categorical variables including owner recognition of jaundice (OR, 2.12; 95% CI, 1.19–3.77; P = 0.011), concurrent hyperadrenocorticism (OR 1.94; 95% CI, 1.08–3.47; P = 0.026), and Pomeranian breed (OR, 2.46; 95% CI 1.10–5.50; P = 0.029) were associated with increased odds of death, and vomiting was associated with decreased odds of death (OR, 0.48; 95% CI, 0.30–0.72; P = 0.001). Continuous variables in the multivariable model, total serum/plasma bilirubin concentration (OR, 1.03; 95% CI, 1.01–1.04; P < 0.001) and age (OR, 1.17; 95% CI, 1.08–1.26; P < 0.001), were associated with increased odds of death. The clinical utility of total serum/plasma bilirubin concentration as a biomarker to predict death was poor with a sensitivity of 0.61 (95% CI, 0.54–0.69) and a specificity of 0.63 (95% CI, 0.59–0.66). This study identified several prognostic variables in dogs with GBM including total serum/plasma bilirubin concentration, age, clinical signs, concurrent hyperadrenocorticism, and the Pomeranian breed. The presence of hypothyroidism or diabetes mellitus did not impact outcome in this study.Supplemental Table S1. Number of dogs included from each institution and years reviewed.Supplemental Table S2. Included breeds.Supplemental Table S3. Distribution of various reasons given for performing cholecystectomy in the 179 subclinical dogs with gallbladder mucocele (GBM).Supplemental Table S4. Distribution of clinical signs associated with systemic illness in 982 dogs with gallbladder mucocele.Supplemental Table S5. Distribution of reasons for death in-hospital (i.e. euthanized and died) in 179 dogs with gallbladder mucocele that underwent cholecystectomy.http://www.elsevier.com/locate/tvjlhj2020Companion Animal Clinical Studie

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent

Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p = 0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (p \u3c 0.01). There were no changes in the knee moments on the non-surgical limb. Medial opening wedge high tibial osteotomy is associated with sustained (12 months) changes in knee moments in all three planes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation

Predicting Distal Radius Bone Strains and Injury in Response to Impacts Using Multi-Axial Accelerometers

Measuring a bone&apos;s response to impact has traditionally been done using strain gauges that are attached directly to the bone. Accelerometers have also been used for this purpose because they are reusable, inexpensive and can be attached easily. However, little data are available relating measured accelerations to bone injury, or to judge if accelerometers are reasonable surrogates for strain gauges in terms of their capacity to predict bone injuries. Impacts were applied with a custom designed pneumatic impact system to eight fresh-frozen human cadaveric radius specimens. Impacts were repeatedly applied with increasing energy until ultimate failure occurred. Three multiaxial strain gauge rosettes were glued to the bone (two distally and one proximally). Two multiaxial accelerometers were attached to the distal dorsal and proximal volar aspects of the radius. Overall, peak minimum and maximum principal strains were calculated from the straintime curves from each gauge. Peak accelerations and acceleration rates were measured parallel (axial) and perpendicular (off-axis) to the long axis of the radius. Logistic generalized estimating equations were used to create strain and acceleration-based injury prediction models. To develop strain prediction models based on the acceleration variables, Linear generalized estimating equations were employed. The logistic models were assessed according to the quasi-likelihood under independence model criterion (QIC), while the linear models were assessed by the QIC and the marginal R 2 . Peak axial and off-axis accelerations increased significantly (with increasing impact energy) across all impact trials. The best injury prediction model (QIC ¼ 9.42) included distal resultant acceleration (p &lt; 0.001) and donor body mass index (BMI) (p &lt; 0.001). Compressive and tensile strains were best predicted by separate uni-variate models, including peak distal axial acceleration (R 2 ¼ 0.79) and peak off-axis acceleration (R 2 ¼ 0.79), respectively. Accelerometers appear to be a valid surrogate to strain gauges for measuring the general response of the bone to impact and predicting the probability of bone injury

Fracture resistance of commonly used self-drilling orthodontic mini-implants

© 2015 by The EH Angle Education and Research Foundation, Inc. Objective: To investigate the fracture resistance of six commonly used self-drilling orthodontic mini-implants by comparing their respective fracture torques during insertion. Materials and Methods: Ninety self-drilling mini-implants from six manufacturers (Aarhus, Dual Top, OrthoEasy, Tomas-pin, Unitek, and VectorTAS), with diameters ranging from 1.4 to 1.8 mm, were inserted into acrylic blocks using a custom-made insertion device. Insertion torques were measured using a 6-degree-of-freedom load cell fixed to the base of the acrylic blocks, and peak torques experienced at the time of fracture for each of the mini-implants were recorded. One-way analysis of variance (a 5 .05) was used to compare the fracture torques among the six different groups. Results: Statistical analysis revealed significant differences (P \u3c .05) in the peak fracture torques among mini-implant groups. Mean fracture torques ranked as follows: Unitek (72 Ncm) . Tomaspin (36 Ncm) . Dual-Top (32 Ncm) \u3c VectorTAS (31 Ncm) . OrthoEasy (28 Ncm) . Aarhus (25 Ncm), with significant differences found between all manufacturers, except for Dual-Top and VectorTAS. Conclusions: Mini-implants tested showed a wide range of torque at fracture depending on the manufacturer, with only a weak correlation between mini-implant diameter and fracture resistance. This torque should be considered at the time of mini-implant insertion to minimize the risk of implant fracture, especially in areas of high-density bone without predrilling