Who should receive vertebroplasty?

Percutaneous vertebroplasty has been used to treat aggressive vertebral hemangiomas, osteoporotic vertebral compression fractures, and vertebral lesions from metastatic disease or myeloma. Consider it for patients with severe acute or chronic pain related to one of these lesions who have failed a reasonable course of medical therapy (strength of recommendation [SOR]: B, based on structured reviews of observational studies). Contraindications include an uncorrectable coagulation disorder, infection in the area, spinal cord compression, destruction of the posterior wall of the vertebral body, and severe degrees of vertebral body collapse (SOR: B, based on structured reviews of observational studies). Pain relief from vertebroplasty for osteoporotic vertebral fractures may be less for older fractures (SOR: C)

Gait, function and quadriceps strength after intraarticular hyaluronan injections in patients with symptomatic knee osteoarthritis

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIntroduction: Knee OA is a common cause of decline in function and is generally associated with joint malalignment and laxity, joint space narrowing, quadriceps weakness, as well as sclerosis and attrition of subchondral bone. Intraarticular (IA) injections of Hyaluronic Acid (HA) are indicated to palliate symptoms and improve function in patients with knee OA. Primary outcome measures in studies on the efficacy of this treatment are largely self reports of pain and function. The purpose of the study was to investigate the effects of HA injections on knee function and sagittal plane kinematics in patients with knee OA. Materials and Methods: Thirteen subjects with symptomatic knee OA and scheduled for 5, weekly, IA injections of HA were recruited. Each subject was tested for baseline data. Posttreatment testing sessions were conducted within 3 weeks of finishing the series of HA and again five months after treatment. Kinematic data were collected at 120 Hz using an eight camera motion analysis system (VICON, Oxford Metrics). Subjects walked along a 10 m walkway at self-selected pace. Ten walking trials were collected and averaged. Knee function was assessed with a knee specific questionnaire (Knee Outcome Survey (KOS)), goniometric range of motion (ROM) measures, a six minute walk (6MW) and a timed stair climbing task. Quadriceps strength was evaluated isometrically at 90° with a KinCom dynamometer (Chattanooga Group, Inc., Chattanooga, TN) and expressed as a ratio of the force output of the involved vs. uninvolved side (Quadriceps Index (QI)). Repeated measures analysis of variance (ANOVA) with pairwise comparisons, multivariate analysis, linear regression analysis and paired t-tests were used to analyze the data. Alpha was set at 0.05. Results: Multivariate analysis of knee flexion angles was used at two stages of weight acceptance; initial contact (IC) and peak knee flexion (PKF) between involved (INV) and uninvolved (UNINV) knees across the three testing times. The analysis showed an interaction between stage of weight acceptance and side (F=18.716; p=0.001). There were significant interlimb differences in knee excursion during weight acceptance (flexion angle from IC to PKF) for the first (5.3°; p=0.005), second (5.2°; p=0.001) and third (5.2°; p=0.001) testing times; the affected knee demonstrating less movement. Excursions of the INV and the UNINV knees did not change across testing times. Multivariate analysis of goniometric total knee ROM between the INV and UNINV knee across testing times showed an interaction by side (F=29.996; p<0.001) but not for testing time. The INV knee’s ROM was on average 8° less than that of the UNINV at the first testing session (p=0.003), 5.2° less at the second (p<0.001) and 7.2° less at the third testing session (p=0.001). Knee ROM of either knee did not change across testing times. Larger knee flexion ROM at baseline predicted greater improvement on KOS scores on the first post-treatment testing session (r2=.540; p=0.004). Larger knee flexion ROM at the first post-treatment predicted greater improvements on KOS scores at the later testing session (r2=.398; p=0.021). Significant within-subjects effects of testing times on KOS scores were found(F=4.65; p=0.02),on 6MW distance (F=12.010; p<0.001) and QI (F=5.903; p=0.013). Discussion: Subjects demonstrated significantly improved function after a series of intra-articular hyaluronan injections as evaluated with the KOS and functional testing. Kinematic interlimb differences were unchanged across testing times despite these improvements. Goniometric measures of total knee range of motion confirmed interlimb differences in available joint ROM. Although subjects demonstrated ample functional ROM, this was not utilized during weight acceptance. The truncated knee flexion may impede the shock absorbing mechanism of the knee and impact the progression of knee OA. While improvements in self reported scores were not maintained at the 5 month evaluation, walking distance continued to improve over time. This indicates that functional improvements persisted despite concurrently increasing symptoms

Total Knee Arthroplasty Assessments Should Include Strength and Performance-Based Functional Tests to Complement Range-of-Motion and Patient-Reported Outcome Measures

Range of motion (ROM) and pain often define successful recovery after total knee arthroplasty (TKA), but these routine clinical outcomes correlate poorly or not at all to functional capacity after TKA. The purpose of this Perspective is to underscore the importance of muscle strength and performance-based functional tests in addition to knee ROM and patient-reported outcome (PRO) measures to evaluate outcomes after TKA. Specifically: (1) muscle strength is the rate-limiting step for recovery of function after TKA; (2) progressive rehabilitation targeting early quadriceps muscle strengthening improves outcomes and does not compromise ROM after TKA; (3) ROM and PROs fail to fully capture functional limitations after TKA; and (4) performance-based functional tests are critical to evaluate function objectively after TKA. This Perspective also addresses studies that question the need for or benefit of physical therapy after TKA because their conclusions focus only on ROM and PRO measures. Future research is needed to determine the optimal timing, delivery, intensity, and content of physical therapy

An electron transport particle from yeast: purification and properties

This article does not have an abstract

Identifying wildlife reservoirs of neglected taeniid tapeworms : non-invasive diagnosis of endemic Taenia serialis infection in a wild primate population

Despite the global distribution and public health consequences of Taenia tapeworms, the life cycles of taeniids infecting wildlife hosts remain largely undescribed. The larval stage of Taenia serialis commonly parasitizes rodents and lagomorphs, but has been reported in a wide range of hosts that includes geladas (Theropithecus gelada), primates endemic to Ethiopia. Geladas exhibit protuberant larval cysts indicative of advanced T. serialis infection that are associated with high mortality. However, non-protuberant larvae can develop in deep tissue or the abdominal cavity, leading to underestimates of prevalence based solely on observable cysts. We adapted a non-invasive monoclonal antibody-based enzyme-linked immunosorbent assay (ELISA) to detect circulating Taenia spp. antigen in dried gelada urine. Analysis revealed that this assay was highly accurate in detecting Taenia antigen, with 98.4% specificity, 98.5% sensitivity, and an area under the curve of 0.99. We used this assay to investigate the prevalence of T. serialis infection in a wild gelada population, finding that infection is substantially more widespread than the occurrence of visible T. serialis cysts (16.4% tested positive at least once, while only 6% of the same population exhibited cysts). We examined whether age or sex predicted T. serialis infection as indicated by external cysts and antigen presence. Contrary to the female-bias observed in many Taenia-host systems, we found no significant sex bias in either cyst presence or antigen presence. Age, on the other hand, predicted cyst presence (older individuals were more likely to show cysts) but not antigen presence. We interpret this finding to indicate that T. serialis may infect individuals early in life but only result in visible disease later in life. This is the first application of an antigen ELISA to the study of larval Taenia infection in wildlife, opening the doors to the identification and description of infection dynamics in reservoir populations

Ecology eclipses phylogeny as a major driver of nematode parasite community structure in a graminivorous primate

Understanding how ecology and phylogeny shape parasite communities can inform parasite control and wildlife conservation initiatives while contributing to the study of host species evolution.We tested the relative strengths of phylogeny and ecology in driving parasite community structure in a host whose ecology diverges significantly from that of its closest phylogenetic relatives.We characterized the gastrointestinal (GI) parasite community of wild geladas Theropithecus gelada, primates that are closely related to baboons but specialized to graminovory in the Ethiopian Highlands.Geladas exhibited very constrained GI parasite communities: only two genera (Oesophagostomum and Trichostrongylus) were identified across 305 samples. This is far below the diversity reported for baboons (Papio spp.) and at the low end of the range of domestic grazers (e.g. Bos taurus, Ovis aries) inhabiting the same region and ecological niche.Using deep amplicon sequencing, we identified 15 amplicon sequence variants (ASVs) within the two genera, seven of which matched to Oesophagostomum sp., seven to Trichostrongylus sp., and one to T. vitrinus.Population was an important predictor of ASV richness. Geladas in the most ecologically disturbed area of the national park exhibited approximately four times higher ASV richness than geladas at a less disturbed location within the park.In this system, ecology was a stronger predictor of parasite community structure than was phylogeny, with geladas sharing more elements of their parasite communities with other grazers in the same area than with closely related sister taxa.A free Plain Language Summary can be found within the Supporting Information of this article.A free Plain Language Summary can be found within the Supporting Information of this article.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162742/3/fec13603_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162742/2/fec13603.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162742/1/fec13603-sup-0001-Summary.pd

Extending the Dynamic Range of Microchannel Plate Detectors Using Charge-Integration-Based Counting

Microchannel plate (MCP) detectors provide a mechanism to produce a measureable current pulse (~0.1mA over several nanoseconds) when stimulated by a single incident particle or photon. Reductions of the device's amplification factor (i.e., gain) due to high incident particle flux can lead to significant degradation of detection system performance. Here we develop a parameterized model for the variation of MCP gain with incident flux. This model provides a framework with which to quantify the limits of high-flux MCP operation. We then compare the predictions of this model to laboratory measurements of an MCP's response to a pulsed charged particle beam. Finally, we demonstrate that through integration of the MCP output current in pulsed operation, effective count rates up to ~ 1 GHz can be achieved, more than an order of magnitude increase over conventional counting techniques used for spaceflight applications

Specificity of muscle action after anterior cruciate ligament injury

Abstract Neuromuscular control is believed to be a critical factor in dynamic knee stability. The purpose of this study was to evaluate voluntary muscle control in anterior cruciate ligament deficient (ACL-D) and uninjured people. Twenty athletes of similar age participated in this study. Subjects performed a target-matching protocol that required them to produce isometric moments about the knee with fine control in flexion, extension, varus, and valgus (i.e., loads were generated in the plane perpendicular to the long axis of the shank). Electromyographic data were collected from 10 muscles that span the knee. A specificity index was calculated for each muscle to describe how fine-tuned (specific) its muscle activity pattern was with respect to its principal direction of action in the load plane. Diminished specificity of muscle action was observed in 8 of 10 muscles in the ACL-D subjectsÕ involved knees when compared with the activity patterns from their uninvolved knees and those from the uninjured subjectsÕ knees. The vastus lateralis muscle was especially affected. Increased and more global co-contraction was also observed in the ACL-D limbs. The alterations in muscle firing patterns observed in this study are consistent with diminished neuromuscular control

The effect of periodontal therapy on lymphocyte blastogenesis to plaque associated microorganisms

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66105/1/j.1600-0765.1983.tb00340.x.pd