The loss of extension test (LOE test): A new clinical sign for the anterior cruciate ligament insufficient knee

Background: This prospective study was created to evaluate the reliability of a new clinical test, which we termed the ''loss of extension test'' (LOE test). The LOE test investigates the loss of normal maximum passive extension (MPE) of the knee due to an anterior cruciate ligament tear in comparison to the normal MPE of the healthy knee. Materials and methods: The study was divided into two consecutive parts. Part 1 was designed to assess the side-toside difference in normal MPE in a healthy population. In part 1, 100 healthy adults were enrolled. Part 2 was designed to evaluate the LOE test reliability in injured knees. In part 2, we included 196 selected patients. Results: In part 1, the average side-to-side difference in MPE in the healthy population was not statistically significant. In part 2, the overall average side-to-side difference in MPE of the injured group was 10.1 mm ± 14.1 (min -20; max 60), which was not statistically significant (p = 0.52). An anterior cruciate ligament (ACL) tear was found in 121 knees among 196 patients. The average sideto- side difference in MPE in the ACL-insufficient group was 16.9 mm ± 13.4 (min -20; max 60), which was statistically significant (p<0.0001). The accuracy of the loss of extension test was 83.7 %, its specificity was 93.3 %, its sensitivity was 77.7 %, its positive predictive value was 95 %, and its negative predictive value was 72.2 %. Conclusions: The reliability of the LOE test is comparable to those reported in the literature for the Lachman test and dynamic tests, so the LOE test could represent a useful tool for the diagnosis of the anterior cruciate ligament insufficient knee

La figura del tutor online nel supported online learning: funzioni, skills e identità

Dottorato di ricerca in Modelli di formazione, analisi teorica e comparazione, Ciclo XXIV, a.a. 2010-2011Università della Calabri

Surgical approaches in total knee arthroplasty

Total knee replacement surgery begins with correct planning of both the incision and the exposure of the joint. Indeed, these are factors that are just as crucial to an optimal outcome as choosing the right implant, positioning the components, and balancing the ligaments. While it is true that the standard incision and arthrotomy (with which we are most familiar) will, in most primary implant cases, provide adequate joint exposure, it is also true that cases characterized by certain conditions, such as previous cutaneous incisions, a stiff knee or patella baja, present specific skin and exposure problems that need to be recognized, planned for and overcome

Predictors of long-term recovery in complex activities of daily living before discharge from the stroke unit

BACKGROUND AND PURPOSE: There is a need for individuating those post-stroke patients who may benefit from an optimal and customised rehabilitation plan aiming at early reintegration in community life participation. This study investigated whether the gain of independence in complex Activities of Daily Living (ADL) may be predicted before the discharge from the stroke unit using simple bedside determinants. METHODS: In 104 first-ever stroke patients with no previous disability, ten determinants at 10 days after stroke were selected. Multivariable logistic regression analysis was applied to identify the prognostic determinants able to predict independence in complex ADL, as measured by modified Rankin Scale grade ≤2. RESULTS: The model shows that having a Barthel Index ≥9, a Motricity Index- Upper Limb ≥75, an age ≤70 and being a male resulted in 100% probability of achieving independence in complex ADL. If three of the four determinants were present, the probability was more than 90%. With the presence of two of the four determinants, the probability ranged from 87% to 28%. With the presence of only one determinant, the probability was 13%. CONCLUSIONS: Accurate prediction of independence in complex ADL can be made before the discharge from the stroke unit. The strength of the paretic upper limb, age, gender, and the ability of performing basic ADL are the significant variables. The probability of favorable prognosis depends on the presence and on the robustness of each single determinant

Polycyclic aromatic hydrocarbons assessment in the sediments of the Porto Torres Harbor (Northern Sardinia, Italy)

The distribution of polycyclic aromatic hydrocarbons (PAHs) in the sediments of Porto Torres Harbor (north Sardinia, Italy) was investigated by gas chromatography/mass spectrometry (GCMS). PAHs concentrations in the sediment (∑PAHs) ranged from 0.07 to 1.21 μg g−1, indicating low to moderate PAHs pollution. Principal component analysis (PCA), the comparative evaluation of PAHs low/high molecular weight and isomeric ratios, suggests that the pollution source is petrogenic (probably due to oil spills from ship and tanker, and to petrochemical plants near the shoreline). A significant contribution from pyrolytic PAHs is found only in the most polluted sediments. Terrigenous flows (e.g., municipal or river waters) do not affect the PAHs balance of the harbor at all. The good linear correlation between chrysene concentration and the total amount of the other 15 US EPA concerning PAHs suggests the use of chrysene as a possible marker of PAHs pollution

Study of the short-term release of the ionic fraction of heavy metals from dental amalgam into synthetic saliva, using anodic stripping voltammetry with microelectrodes

The present paper describes a fast and reproducible procedure, employing differential pulse stripping analysis technique with graphite microelectrodes, for the quantitative evaluation of the ionic fraction of heavy metals (namely Hg, Cu, and Zn) released from dental amalgams into synthetic saliva during 6&#95;h contact between amalgam and saliva, after completion of the dental restoration (short-term release ). The Zn2&#43; concentration was evaluated by linear calibration, whereas Cu2&#43; and Hg2&#43; contents were estimated by the standard additions method. While the concentration of Zn2&#43; ion does not increase significantly anymore after a 6&#45; h contact (values from 288&#177;12 to 346&#177;12 &#181;g dm&#45;3 at time of contact from 6 to 90 h, respectively), in the same time interval the concentration of both Cu2&#43; and Hg2&#43; ions progressively increases (from 38&#177;6 to 197&#177;4 12 &#181;g dm&#45;3 and from 15&#177;3 to 101&#177;2 12 &#181;g dm&#45;3, respectively). The results of the release tests reveal that Hg concentration is at the highest level of risk (HBM III), as identified by the three human biomonitoring categories suggested by the Institut f&#252;r Wasser&#45;, Boden&#45; und Lufthygiene des Umweltbundesamtes (Germany) for the estimation of potential harmful effects on health due to exposure to heavy metals

Nature, distribution and origin of polycyclic aromatic hydrocarbons (PAHs) in the sediments of Olbia harbor (Northern Sardinia, Italy)

The nature, origin and distribution of US EPA polycyclic aromatic hydrocarbons (PAHs) in the sediments of Olbia harbor (North Sardinia, Italy) were investigated by gas-chromatography/mass spectrometry (GCMS). PAH concentrations in the sediments (∑PAHs) ranged from 0.16 to 0.77 μg g−1, indicating a homogeneously low level of pollution. A rather exceptional prevalence of low molecular weight PAHs was substantiated: nearly 80% of ∑PAHs include naphthalene (15.19%) and phenanthrene (64.47%). Carcinogenic compounds were present in very low (BaP, BkF, BaA and DBA) or negligible (BbF and Inp) concentrations. As indicated by the Phen/Ant molar ratio, the main source of PAHs is petrogenic, probably due to oil spills from shipping. The low/high molecular weight ratio (ranging between 1.2 and 26) distinguishes the sediments of the tourist harbor from those of the commercial/industrial harbor. Moreover, a slight but meaningful pyrolytic contribution to pollution was found in the tourist harbor, which has the most polluted sediments in the whole harbor. Finally, good linear correlations were found between a selected PAH (Phen and Naph) and selected sums of PAHs (i.e. the total amount of the other 15 US EPA and the sum of low molecular weight PAHs)

Dependence of kinetic variables in the short-term release of Hg²⁺, Cu²⁺ and Zn²⁺ ions into synthetic saliva from an high-copper dental amalgam

The short term (up to 14 days after restoration) release of selected ions (i.e., Hg2+, Cu2+ and Zn2+) from Dispersalloy® into artificial saliva has been evaluated in regards to the nature of the saliva (Fusayama and McCarty and Shklar’s solutions), the amount of amalgam, the time of contact and the periodical renewal (every 48 h interval) of artificial saliva. The evaluation of the ionic fraction of such metals has been accomplished by using anodic stripping methods (i.e., Differential Pulse Anodic Stripping Voltammetry, DPASV) with a 7 μm graphite disk microelectrode as a working electrode. Data obtained in this work are almost unprecedented in the literature due the fact that such analytical method exclude metals in non-ionic forms (e.g., metals or organometallic compounds). The high concentrations measured in every experimental condition confirm the concern for the short-term release of metals from amalgam into saliva

Intra-arterial chemotherapy with melphalan for intraocular retinoblastoma

Recently, this journal published a paper from Marr et al 1 concerning multi-drug intra-arterial chemotherapy (IAC) for intraocular retinoblastoma. In many centres IAC has quickly garnered exciting interest, emerging as a promising, highly effective alternative for globe conserving treatment.2–4 In our institution, IAC with melphalan (IACM) has been performed since June 2008, and topotecan was added in June 2011. Fifty-nine patients have at least 1 year follow-up. Here we report our results obtained with IACM