Superior Capsule Reconstruction Is a Viable Option for Patients with Symptomatic, Isolated, and Irreparable Supraspinatus Tears.

PURPOSE: To evaluate the outcome of superior capsular reconstruction for isolated subscapularis tears using a decellularized porcine allograft as a superior capsular reconstruction. METHODS: Patients who had symptomatic tears of supraspinatus who had failed to improve a conservative rehabilitation program were included. Previous surgery to the shoulder was not a bar to inclusion. Patients were assessed preoperatively and postoperatively with the Oxford Shoulder Score (OSS), the single assessment numeric evaluation (SANE) score, as well as clinically assessed for their shoulder range of motion (ROM). Patients were followed up with in-person clinic appointments for the first year, followed by a postal questionnaire and telephone consultation at a minimum of 2 years following surgery. RESULTS: Twenty patients (11 males and 9 females) with a mean age of 67.5 years were included (range: 54-72 years). The average follow-up period was 31 months (24-50). The mean improvement in OSS was 14 points (P < .001), SANE score was 27 points (P < .01). Significant improvements in mean ROM were recorded (flexion 80.7°; P < .001; abduction: 81°; P < .001; external rotation: 31°; P < .001). Six patients suffered SCR failures diagnosed by magnetic resonance imaging, despite this they still recorded improvements in recorded OSS, SANE and ROM (excluding external rotation). Patient demographics for failed superior capsule reconstruction (SCR) highlighted smoking and revision surgery as risk factors. CONCLUSIONS: SCR appears to be a viable option for patients with symptomatic, isolated, and irreparable tears of the supraspinatus. Our results demonstrate that there are significant improvements in outcome scores and active range of motion, even in the subgroup in whom postoperative structural failure of the SCR was identified. We recommend caution in patients who have previously failed rotator cuff repair and in heavy smokers. LEVEL OF EVIDENCE: Level IV, therapeutic case series

Syntactic Control of Interference Revisited

In Syntactic Control of Interference (POPL, 1978), J. C. Reynolds proposes three design principles intended to constrain the scope of imperative state effects in Algol-like languages. The resulting linguistic framework seems to be a very satisfactory way of combining functional and imperative concepts, having the desirable attributes of both purely functional languages (such as pcf) and simple imperative languages (such as the language of while programs). However, Reynolds points out that the obvious syntax for interference control has the unfortunate property that fi-reductions do not always preserve typings. Reynolds has subsequently presented a solution to this problem (ICALP, 1989), but it is fairly complicated and requires intersection types in the type system. Here, we present a much simpler solution which does not require intersection types. We first describe a new type system inspired in part by linear logic and verify that reductions preserve typings. We then define a class of bireflective models, which provide a categorical analysis of structure underlying the new typing rules; a companion paper Bireflectivity, in this volume, exposes wider ramifications of this structure. Finally, we describe a concrete model for an illustrative programming language based on the new type system; this improves on earlier such efforts in that states are not assumed to be structured using locations

CT estimation of glenoid bone loss in anterior glenohumeral instability : a systematic review of existing techniques.

AIMS: Recurrent dislocation is both a cause and consequence of glenoid bone loss, and the extent of the bony defect is an indicator guiding operative intervention. Literature suggests that loss greater than 25% requires glenoid reconstruction. Measuring bone loss is controversial; studies use different methods to determine this, with no clear evidence of reproducibility. A systematic review was performed to identify existing CT-based methods of quantifying glenoid bone loss and establish their reliability and reproducibility. METHODS: A Preferred Reporting Items for Systematic reviews and Meta-Analyses-compliant systematic review of conventional and grey literature was performed. RESULTS: A total of 25 studies were initially eligible. Following screening, nine papers were included for review. Main themes identified compared 2D and 3D imaging, as well as linear- compared with area-based techniques. Heterogenous data were acquired, and therefore no meta-analysis was performed. CONCLUSION: No ideal CT-based method is demonstrated in the current literature, however evidence suggests that surface area methods are more reproducible and lead to fewer over-estimations of bone loss, provided the views used are standardized. A prospective imaging trial is required to provide a more definitive answer to this research question. Cite this article: Bone Jt Open 2022;3(2):114-122

CT methods for measuring glenoid bone loss are inaccurate, and not reproducible or interchangeable.

AIMS: Glenoid bone loss is a significant problem in the management of shoulder instability. The threshold at which the bone loss is considered "critical" requiring bony reconstruction has steadily dropped and is now approximately 15%. This necessitates accurate measurement in order that the correct operation is performed. CT scanning is the most commonly used modality and there are a number of techniques described to measure the bone loss however few have been validated. The aim of this study was to assess the accuracy of the most commonly used techniques for measuring glenoid bone loss on CT. METHODS: Anatomically accurate models with known glenoid diameter and degree of bone loss were used to determine the mathematical and statistical accuracy of six of the most commonly described techniques (relative diameter, linear ipsilateral circle of best fit (COBF), linear contralateral COBF, Pico, Sugaya, and circle line methods). The models were prepared at 13.8%, 17.6%, and 22.9% bone loss. Sequential CT scans were taken and randomized. Blinded reviewers made repeated measurements using the different techniques with a threshold for theoretical bone grafting set at 15%. RESULTS: At 13.8%, only the Pico technique measured under the threshold. At 17.6% and 22.9% bone loss all techniques measured above the threshold. The Pico technique was 97.1% accurate, but had a high false-negative rate and poor sensitivity underestimating the need for grafting. The Sugaya technique had 100% specificity but 25% of the measurements were incorrectly above the threshold. A contralateral COBF underestimates the area by 16% and the diameter by 5 to 7%. CONCLUSION: No one method stands out as being truly accurate and clinicians need to be aware of the limitations of their chosen technique. They are not interchangeable, and caution must be used when reading the literature as comparisons are not reliable

Constraints on the Ultra High Energy Photon flux using inclined showers from the Haverah Park array

We describe a method to analyse inclined air showers produced by ultra high energy cosmic rays using an analytical description of the muon densities. We report the results obtained using data from inclined events (60^{\circ}<\theta<80^{\circ}) recorded by the Haverah Park shower detector for energies above 10^19 eV. Using mass independent knowledge of the UHECR spectrum obtained from vertical air shower measurements and comparing the expected horizontal shower rate to the reported measurements we show that above 10^19 eV less than 48 % of the primary cosmic rays can be photons at the 95 % confidence level and above 4 X 10^19 eV less than 50 % of the cosmic rays can be photonic at the same confidence level. These limits place important constraints on some models of the origin of ultra high-energy cosmic rays.Comment: 45 pages, 25 figure

Universal neural field computation

Turing machines and G\"odel numbers are important pillars of the theory of computation. Thus, any computational architecture needs to show how it could relate to Turing machines and how stable implementations of Turing computation are possible. In this chapter, we implement universal Turing computation in a neural field environment. To this end, we employ the canonical symbologram representation of a Turing machine obtained from a G\"odel encoding of its symbolic repertoire and generalized shifts. The resulting nonlinear dynamical automaton (NDA) is a piecewise affine-linear map acting on the unit square that is partitioned into rectangular domains. Instead of looking at point dynamics in phase space, we then consider functional dynamics of probability distributions functions (p.d.f.s) over phase space. This is generally described by a Frobenius-Perron integral transformation that can be regarded as a neural field equation over the unit square as feature space of a dynamic field theory (DFT). Solving the Frobenius-Perron equation yields that uniform p.d.f.s with rectangular support are mapped onto uniform p.d.f.s with rectangular support, again. We call the resulting representation \emph{dynamic field automaton}.Comment: 21 pages; 6 figures. arXiv admin note: text overlap with arXiv:1204.546

Unraveling the directional link between adiposity and inflammation: a bidirectional mendelian randomization approach

&lt;b&gt;Context&lt;/b&gt;: Associations between adiposity and circulating inflammation markers are assumed to be causal, although the direction of the relationship has not been proven. &lt;b&gt;Objective&lt;/b&gt;: The aim of the study was to explore the causal direction of the relationship between adiposity and inflammation using a bidirectional Mendelian randomization approach. &lt;b&gt;Methods&lt;/b&gt;: In the PROSPER study of 5804 elderly patients, we related C-reactive protein (CRP) single nucleotide polymorphisms (SNPs) (rs1800947 and rs1205) and adiposity SNPs (FTO and MC4R) to body mass index (BMI) as well as circulating levels of CRP and leptin. We gave each individual two allele scores ranging from zero to 4, counting each pair of alleles related to CRP levels or BMI. &lt;b&gt;Results&lt;/b&gt;: With increasing CRP allele score, there was a stepwise decrease in CRP levels (P for trend &#60; 0.0001) and a 1.98 mg/liter difference between extremes of the allele score distribution, but there was no associated change in BMI or leptin levels (P ≥ 0.89). By contrast, adiposity allele score was associated with 1) an increase in BMI (1.2 kg/m2 difference between extremes; P for trend 0.002); 2) an increase in circulating leptin (5.77 ng/ml difference between extremes; P for trend 0.0027); and 3) increased CRP levels (1.24 mg/liter difference between extremes; P for trend 0.002). &lt;b&gt;Conclusions&lt;/b&gt;: Greater adiposity conferred by FTO and MC4R SNPs led to higher CRP levels, with no evidence for any reverse pathway. Future studies should extend our findings to other circulating inflammatory parameters. This study illustrates the potential power of Mendelian randomization to dissect directions of causality between intercorrelated metabolic factors

C-reactive protein is essential for innate resistance to pneumococcal infection

Summary: No deficiency of human C-reactive protein (CRP), or even structural polymorphism of the protein, has yet been reported so its physiological role is not known. Here we show for the first time that CRP-deficient mice are remarkably susceptible to Streptococcus pneumoniae infection and are protected by reconstitution with isolated pure human CRP, or by anti-pneumococcal antibodies. Autologous mouse CRP is evidently essential for innate resistance to pneumococcal infection before antibodies are produced. Our findings are consistent with the significant association between clinical pneumococcal infection and non-coding human CRP gene polymorphisms which affect CRP expression. Deficiency or loss of function variation in CRP may therefore be lethal at the first early-life encounter with this ubiquitous virulent pathogen, explaining the invariant presence and structure of CRP in human adults

Neutrino Detection with Inclined Air Showers

The possibilities of detecting high energy neutrinos through inclined showers produced in the atmosphere are addressed with an emphasis on the detection of air showers by arrays of particle detectors. Rates of inclined showers produced by both down-going neutrino interactions and by up-coming $\tau$ decays from earth-skimming neutrinos as a function of shower energy are calculated with analytical methods using two sample neutrino fluxes with different spectral indices. The relative contributions from different flavors and charged, neutral current and resonant interactions are compared for down-going neutrinos interacting in the atmosphere. No detailed description of detectors is attempted but rough energy thresholds are implemented to establish the ranges of energies which are more suitable for neutrino detection through inclined showers. Down-going and up-coming rates are compared.Comment: Submitted to New Journal of Physic