A complication following ACL reconstruction using bioabsorbable cross-pins

This is a case of a proximal pin migration after ACL reconstruction in medial soft tissue with pain, inflammatory reaction and functional reduction. 33-year-old male presented at our clinic with a complete ACL rupture. Reconstruction with autogenous gracilis and semitendinosus hamstring tendons was performed and graft fixed in the femoral canal with two PLLA bioabsorbable pins (RIGIDFIX\uae Cross Pin System). Two months postoperatively the patient presented swelling and pain on the medial side of the knee, full range of motion and negative results at the Lachman and Pivot shift tests. MRI examination showed the superior femoral tunnel crossing both the lateral and medial cortex lodging the pin in the knee\u2019s medial soft tissue corresponding to the swelling area reported by the patient. The tendon graft was properly positioned. After surgical removal of the pin through a small skin incision, the pain and swelling promptly subsided allowing the patient return to normal activities in few weeks without any pain. In our opinion the painful swelling of the knee was due to a displacement of the pin that had been accidentally lodged in the soft tissues instead of the bone causing a foreign-body reaction resulting in granuloma formation with local inflammation. This dislodgement could have been due to an inappropriately long femoral tunnel

Reconstructing Native American Population History

The peopling of the Americas has been the subject of extensive genetic, archaeological and linguistic research; however, central questions remain unresolved1–5. One contentious issue is whether the settlement occurred via a single6–8 or multiple streams of migration from Siberia9–15. The pattern of dispersals within the Americas is also poorly understood. To address these questions at higher resolution than was previously possible, we assembled data from 52 Native American and 17 Siberian groups genotyped at 364,470 single nucleotide polymorphisms. We show that Native Americans descend from at least three streams of Asian gene flow. Most descend entirely from a single ancestral population that we call “First American”. However, speakers of Eskimo-Aleut languages from the Arctic inherit almost half their ancestry from a second stream of Asian gene flow, and the Na-Dene-speaking Chipewyan from Canada inherit roughly one-tenth of their ancestry from a third stream. We show that the initial peopling followed a southward expansion facilitated by the coast, with sequential population splits and little gene flow after divergence, especially in South America. A major exception is in Chibchan-speakers on both sides of the Panama Isthmus, who have ancestry from both North and South America

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

[Alegoría del Antiguo y Nuevo Testamento] [Material gráfico] / Jo. Baptista Tiepolo delin. ; Franc. Bortolozzi sculp

Estampa separada de: Biblia Sacra Vulgatæ editionis : Sixti V. & Clementis VIII. Pont. Max. auctoritate recognita, versiculis distincta: una cum selectis annotationibus ... / auctore Jo. Baptista Du Hamel ..., ; accedunt libelli duo ab eruditissimo vivo Francisco Luca Brugensi exarati ... -- Editio novissima ad ultimam Parisiensem exacta & summa diligentia a mendis omnibus repurgata. -- Bassani ; sed prostant Venetiis : apud Remondini ..., 177

[Alegoría del Antiguo y Nuevo Testamento] [Material gráfico] / Jo. Baptista Tiepolo delin. ; Franc. Bortolozzi sculp

Estampa separada de: Biblia Sacra Vulgatæ editionis : Sixti V. & Clementis VIII. Pont. Max. auctoritate recognita, versiculis distincta: una cum selectis annotationibus ... / auctore Jo. Baptista Du Hamel ..., ; accedunt libelli duo ab eruditissimo vivo Francisco Luca Brugensi exarati ... -- Editio novissima ad ultimam Parisiensem exacta & summa diligentia a mendis omnibus repurgata. -- Bassani ; sed prostant Venetiis : apud Remondini ..., 177

Below- vs above-elbow cast for distal radius fractures: is elbow immobilization\ua0really effective for reduction maintenance?

Purpose: The choice of the cast length in conservative management of distal radius fractures still represents a debated controversy. Historically, the elbow is immobilized to reduce the risk of secondary displacement; however, short-arm casts are currently felt to be equally effective with less complications and better patient comfort. This paper investigates whether immobilization of the elbow is actually effective in reducing the risk of loss of reduction in conservatively manipulated distal radius fractures. Methods: We retrospectively studied 297 consecutive patients with distal radius fractures requiring manipulation and subsequently immobilized with above-elbow cast or below-elbow cast. Maintenance of reduction, radial height, radial inclination, and volar tilt were assessed after the reduction and at 35\ua0days. Appropriate statistical analysis was performed to correct data selection bias and to assess any difference in the effectiveness among the two treatments. Results: The mean difference of loss of radial height, inclination, and volar tilt between the two groups was 0.8\ua0mm, 0.4\ub0, and 0.9\ub0 respectively, being not statistically significant. Average difference in reduction maintenance probability between the two groups stratified with a statistical propensity score was 1.2%. Conclusions: Above- and below-elbow casts had comparable performance in maintaining reduction of manipulated distal radius fractures

Short arm cast is as effective as long arm cast in maintaining distal radius fracture reduction: Results of the SLA-VER noninferiority trial

BACKGROUND Distal radius fractures (DRFs) are a common challenge in orthopaedic trauma care, yet for those fractures that are treated nonoperatively, strong evidence to guide cast treatment is still lacking. AIM To compare the efficacy of below elbow cast (BEC) and above elbow cast (AEC) in maintaining reduction of manipulated DRFs. METHODS We conducted a prospective, monocentric, randomized, parallel-group, open label, blinded, noninferiority trial comparing the efficacy of BEC and AEC in the nonoperative treatment of DRFs. Two hundred and eighty patients > 18 years of age diagnosed with DRFs were successfully randomized and included for analysis over a 3-year period. Noninferiority thresholds were defined as a 2 mm difference for radial length (RL), a 3 & DEG; difference for radial inclination (RI), and volar tilt (VT). The trial is registered at Clinicaltrials.gov (NCT03468023). RESULTS One hundred and forty-three patients were treated with BEC, and 137 were treated with AEC. The mean time of immobilization was 33 d. The mean loss of RL, RI, and VT was 1.59 mm, 2.83 & DEG;, and 4.11 & DEG; for BEC and 1.63 mm, 2.54 & DEG;, and 3.52 & DEG; for AEC, respectively. The end treatment differences between BEC and AEC in RL, RI, and VT loss were respectively 0.04 mm (95%CI: -0.36-0.44), -0.29 & DEG; (95%CI: -1.03-0.45), and 0.59 & DEG; (95%CI: -1.39-2.57), and they were all below the prefixed noninferiority thresholds. The rate of loss of reduction was similar. CONCLUSION BEC performs as well as AEC in maintaining the reduction of a manipulated DRF. Being more comfortable to patients, BEC may be preferable for nonoperative treatment of DRFs