An Uncommon Presentation of Coxa Saltans: A Case Report

Coxa saltans, or “snapping hip,” refers to various conditions that produce a palpable or audible snapping of the hip after movement. We present an uncommon case of coxa saltans in a patient with a snapping proximal hamstring tendon. Findings of dynamic ultrasound evaluation were used to confirm the source of snapping, characterized by a lateral subluxation of the conjoint tendon over the ischial tuberosity. Our patient was treated nonoperatively, and we observed mild improvement of her symptoms. Few cases of similar pathological findings have been described, with varying causes of tendon instability. The results of the current case may help physicians in diagnosing and treating this condition

Design for Transtibial Modifiable Socket for Immediate Postoperative Prosthesis

Amputations are long-standing surgical procedures that have been performed for centuries; however, very little attention and urgency have been given to immediate restoration of movement and return to a normal lifestyle. In many cases, the time between amputation and prosthetic fitting can pause recovery and development of new routines. To increase recovery, immediate postoperative prostheses (IPOPs) have been developed yet these are under-utilized because of concerns for wound healing and complications with vascular diseases. Subsequently, we designed a transtibial IPOP that utilizes an ergonomic modifiable socket that allows for examination, wound care, and in situ edema control. Additionally, the IPOP facilitates early weight bearing and protects the amputated limb from external trauma postoperatively. Our purpose is to introduce this technology and describe how its unique design will serve to provide potential benefits and positive effects on patients who have undergone amputations

Effectiveness of conservative treatment for patellofemoral pain syndrome: A systematic review and meta-analysis

Objective: To evaluate the evidence regarding the effectiveness of conservative treatment in reducing patellofemoral pain.Data sources: CENTRAL, MEDLINE, CINAHL, and PE-Dro databases.Study selection: Adults with patellofemoral pain, randomized controlled trials only, any conservative treatment compared with placebo, sham, other conservative treatment, or no treatment. Two independent reviewers.Data extraction: Data were extracted from the full-text of the articles, based on Cochrane Collaboration recommendations. The outcome of interest was the difference between groups regarding change in pain severity.Data synthesis: The majority of studies were underpowered. More than 80% of the 37 trials did not show a clinically significant benefit. Clinically significant effects of different sizes were found for 7 trials (6 studies out of 7 had short follow-ups). These effects were found for: (i) pulsed electromagnetic fields combined with home exercise -33.0 (95% CI -45.2 to -20.8); (ii) hip muscle strengthening -65.0 (95% CI -87.7 to -48.3) and -32.0 (-37.0 to -27.0); (iii) weight-bearing exercise -40.0 (95% CI -49.4 to -30.6); (iv) neuromuscular facilitation combined with aerobic exercise and stretching -60.1 (95% CI -66.9 to -54.5); (v) postural stabilization -24.4 (95% CI -33.5 to -15.3); and (vi) patellar bracing -31.6 (95% CI -35.2 to -28.0).Conclusion: There is no evidence that a single treatment modality works for all patients with patellofemoral pain. There is limited evidence that some treatment modalities may be beneficial for some subgroups of patients with patellofemoral pain

Quantum critical points in ferroelectric relaxors : stuffed tungsten bronze K3Li2Ta5O15 and lead pyrochlore (Pb2Nb2O7)

We have synthesized ceramic specimens of the tetragonal tungsten bronze K3Li2Ta5O15 (KLT) and characterized its phase transition via X-ray diffraction, dielectric permittivity, resonant ultrasonic spectroscopy, and heat capacity measurements. The space group of KLT is reported as both P4/mbm and Cmmm with the orthorhombic distortion occurring when there are higher partial pressures of volatile K and Li used inside the closed crucibles for the solid state synthesis. The data show strong relaxor behavior, with the temperature at which the two dielectric relative permittivity peaks decreasing, with 104 ≥ Tm1 ≥ 69 K and 69 ≥ Tm2 ≥ 46 K as probe frequency f is reduced from 1 MHz to 316 Hz. F tests show that the data satisfies a Vogel-Fulcher model better than Arrhenius with an extrapolated freezing temperature for ε’ and ε” of Tf1 = +15.8 and –11.8 K and Tf2 = –5.0 and –15.0 K for f -> 0 (tending to dc). This difference between Tf from real and imaginary values, albeit counterintuitive, is mandatory, according to the theory of Tagantsev. Therefore, by tuning frequency, the transition could be shifted to absolute zero, suggesting KLT has a relaxor-type quantum critical point. In addition, we have reanalyzed the conflicting literature for Pb2Nb2O7 pyrochlore which suggests that this also has a relaxor-type quantum critical point since the freezing temperature from the Vogel-Fulcher fitting is below absolute zero. Since the transition temperature evidenced in the dielectric data at approximately 100 kHz shifts below 0 K for very low frequencies, this transition would not be seen with heat capacity data collected in the zero-frequency (dc) limit. Both of these materials show promise for possible new relaxor-type quantum critical points with non-perovskite based structures.Publisher PDFPeer reviewe

Quantum critical points in ferroelectric relaxors: Stuffed tungsten bronze K3Li2Ta5O15 and lead pyrochlore ( Pb2Nb2O7 )

We have synthesized ceramic specimens of the tetragonal tungsten bronze K3Li2Ta5O15 (KLT) and characterized its phase transition via x-ray diffraction, dielectric permittivity, resonant ultrasonic spectroscopy, and heat capacity measurements. The space group of KLT is reported as both P4/mbm and Cmmm with the orthorhombic distortion occurring when there are higher partial pressures of volatile K and Li used inside the closed crucibles for the solid state synthesis. The data show strong relaxor behavior, with the temperature at which the two dielectric relative permittivity peaks decreasing, with 104≥Tm1≥69K and 69≥Tm2≥46K as probe frequency f is reduced from 1 MHz to 316 Hz. F tests show that the data satisfies a Vogel-Fulcher model better than Arrhenius with an extrapolated freezing temperature for ɛ′ and ɛ′′ of Tf1=+15.8 and −11.8K and Tf2=−5.0 and −15.0K for f→0 (tending to dc). This difference between Tf from real and imaginary values, albeit counterintuitive, is mandatory, according to the theory of Tagantsev. Therefore, by tuning frequency, the transition could be shifted to absolute zero, suggesting KLT has a relaxor-type quantum critical point. In addition, we have reanalyzed the conflicting literature for Pb2Nb2O7 pyrochlore which suggests that this also has a relaxor-type quantum critical point since the freezing temperature from the Vogel-Fulcher fitting is below absolute zero. Since the transition temperature evidenced in the dielectric data at approximately 100 kHz shifts below 0 K for very low frequencies, this transition would not be seen with heat capacity data collected in the zero-frequency (dc) limit. Both of these materials show promise for possible new relaxor-type quantum critical points with nonperovskite based structures

Predictors of Poor Perinatal Outcome following Maternal Perception of Reduced Fetal Movements: A Prospective Cohort Study

Background Maternal perception of reduced fetal movement (RFM) is associated with increased risk of stillbirth and fetal growth restriction (FGR). RFM is thought to represent fetal compensation to conserve energy due to insufficient oxygen and nutrient transfer resulting from placental insufficiency. Objective To identify predictors of poor perinatal outcome after maternal perception of reduced fetal movements (RFM). Design Prospective cohort study. Methods 305 women presenting with RFM after 28 weeks of gestation were recruited. Demographic factors and clinical history were recorded and ultrasound performed to assess fetal biometry, liquor volume and umbilical artery Doppler. A maternal serum sample was obtained for measurement of placentally-derived or modified proteins including: alpha fetoprotein (AFP), human chorionic gonadotrophin (hCG), human placental lactogen (hPL), ischaemia-modified albumin (IMA), pregnancy associated plasma protein A (PAPP-A) and progesterone. Factors related to poor perinatal outcome were determined by logistic regression. Results 22.1% of pregnancies ended in a poor perinatal outcome after RFM. The most common complication was small-for-gestational age infants. Pregnancy outcome after maternal perception of RFM was related to amount of fetal activity while being monitored, abnormal fetal heart rate trace, diastolic blood pressure, estimated fetal weight, liquor volume, serum hCG and hPL. Following multiple logistic regression abnormal fetal heart rate trace (Odds ratio 7.08, 95% Confidence Interval 1.31–38.18), (OR) diastolic blood pressure (OR 1.04 (95% CI 1.01–1.09), estimated fetal weight centile (OR 0.95, 95% CI 0.94–0.97) and log maternal serum hPL (OR 0.13, 95% CI 0.02–0.99) were independently related to pregnancy outcome. hPL was related to placental mass. Conclusion Poor perinatal outcome after maternal perception of RFM is closely related to factors which are connected to placental dysfunction. Novel tests of placental function and associated fetal response may provide improved means to detect fetuses at greatest risk of poor perinatal outcome after RFM

Abstracts from the NIHR INVOLVE Conference 2017

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Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Whole-genome landscapes of major melanoma subtypes

Melanoma of the skin is a common cancer only in Europeans, whereas it arises in internal body surfaces (mucosal sites) and on the hands and feet (acral sites) in people throughout the world. Here we report analysis of whole-genome sequences from cutaneous, acral and mucosal subtypes of melanoma. The heavily mutated landscape of coding and non-coding mutations in cutaneous melanoma resolved novel signatures of mutagenesis attributable to ultraviolet radiation. However, acral and mucosal melanomas were dominated by structural changes and mutation signatures of unknown aetiology, not previously identified in melanoma. The number of genes affected by recurrent mutations disrupting non-coding sequences was similar to that affected by recurrent mutations to coding sequences. Significantly mutated genes included BRAF, CDKN2A, NRAS and TP53 in cutaneous melanoma, BRAF, NRAS and NF1 in acral melanoma and SF3B1 in mucosal melanoma. Mutations affecting the TERT promoter were the most frequent of all; however, neither they nor ATRX mutations, which correlate with alternative telomere lengthening, were associated with greater telomere length. Most melanomas had potentially actionable mutations, most in components of the mitogen-activated protein kinase and phosphoinositol kinase pathways. The whole-genome mutation landscape of melanoma reveals diverse carcinogenic processes across its subtypes, some unrelated to sun exposure, and extends potential involvement of the non-coding genome in its pathogenesis