Medial plica irritation: diagnosis and treatment

Medial plica irritation of the knee is a very common source of anterior knee pain. Patients can complain of pain over the anteromedial aspect of their knees and describe episodes of crepitation, catching, and pseudo-locking events with activities. Patients commonly have pain on physical examination upon rolling the plica fold of tissue over the anteromedial aspect of their knees and often have tight hamstrings. The majority of the patients will respond well to a non-operative treatment program consisting of quadriceps strengthening along with concurrent hamstring stretching. In cases which do not respond initially to an exercise program, an intraarticular steroid injection may be indicated. In those few patients who do not respond to a non-operative treatment program, an arthroscopic resection of their medial plica may be indicated, especially in those cases where a shelf-like plica has been found to be causing damage to the articular cartilage of the medial femoral condyle

Activation of an ATP-dependent K+ conductance in Xenopus oocytes by expression of adenylate kinase cloned from renal proximal tubules

AbstractIn rabbit proximal convoluted tubules, an ATP-sensitive K+ (KATP) channel has been shown to be involved in membrane cross-talk, i.e. the coupling (most likely mediated through intracellular ATP) between transepithelial Na+ transport and basolateral K+ conductance. This K+ conductance is inhibited by taurine. We sought to isolate this K+ channel by expression cloning in Xenopus oocytes. Injection of renal cortex mRNA into oocytes induced a K+ conductance, largely inhibited by extracellular Ba2+ and intracellular taurine. Using this functional test, we isolated from our proximal tubule cDNA library a unique clone, which induced a large K+ current which was Ba2+-, taurine- and glibenclamide-sensitive. Surprisingly, this clone is not a K+ channel but an adenylate kinase protein (AK3), known to convert NTP+AMP into NDP+ADP (N could be G, I or A). AK3 expression resulted in a large ATP decrease and activation of the whole-cell currents including a previously unknown, endogenous K+ current. To verify whether ATP decrease was responsible for the current activation, we demonstrated that inhibition of glycolysis greatly reduces oocyte ATP levels and increases an inwardly rectifying K+ current. The possible involvement of AK in the KATP channel’s regulation provides a means of explaining their observed activity in cytosolic environments characterized by high ATP concentrations

Pulsatory andesite lava flow at Bagana Volcano

Using a time series of TerraSAR-X spaceborne radar images we have measured the pulsatory motion of an andesite lava flow over a 14-month period at Bagana volcano, Papua New Guinea. Between October 2010 and December 2011, lava flowed continuously down the western flank of the volcano forming a 3 km-long blocky lava flow with a channel, levees, overflows and branches. We captured four successive pulses of lava advancing down the channel system, the first such behaviour of an andesite flow to be recorded using radar. Each pulse had a volume of the order of 107 m3 emplaced over many weeks. The average extrusion rate estimated from the radar data was 0.92 ± 0.35 m3 s-1 , and varied between 0.3 and 1.8 m3 s-1, with higher rates occurring earlier in each pulse. This, together with observations of sulphur dioxide emissions, explosions and incandescence suggest a variable supply rate of magma through Bagana’s conduit as the most likely source of the pulsatory behaviour

The Human Cytomegalovirus Chemokine vCXCL-1 Modulates Normal Dissemination Kinetics of Murine Cytomegalovirus In Vivo

Human cytomegalovirus (HCMV) is a betaherpesvirus that is a significant pathogen within newborn and immunocompromised populations. Morbidity associated with HCMV infection is the consequence of viral dissemination. HCMV has evolved to manipulate the host immune system to enhance viral dissemination and ensure long-term survival within the host. The immunomodulatory protein vCXCL-1, a viral chemokine functioning primarily through the CXCR2 chemokine receptor, is hypothesized to attract CXCR2+ neutrophils to infection sites, aiding viral dissemination. Neutrophils harbor HCMV in vivo; however, the interaction between vCXCL-1 and the neutrophil has not been evaluated in vivo. Using the mouse model and mouse cytomegalovirus (MCMV) infection, we show that murine neutrophils harbor and transfer infectious MCMV and that virus replication initiates within this cell type. Utilizing recombinant MCMVs expressing vCXCL-1 from the HCMV strain (Toledo), we demonstrated that vCXCL-1 significantly enhances MCMV dissemination kinetics. Through cellular depletion experiments, we observe that neutrophils impact dissemination but that overall dissemination is largely neutrophil independent. This work adds neutrophils to the list of innate cells (i.e., dendritic and macrophages/monocytes) that contribute to MCMV dissemination but refutes the hypothesis that neutrophils are the primary cell responding to vCXCL-1

Transport spin polarization of Ni_xFe_{1-x}: electronic kinematics and band structure

We present measurements of the transport spin polarization of Ni_xFe_{1-x} (0<x<1) using the recently-developed Point Contact Andreev Reflection technique, and compare them with our first principles calculations of the spin polarization for this system. Surpisingly, the measured spin polarization is almost composition-independent. The results clearly demonstrate that the sign of the transport spin polarization does not coincide with that of the difference of the densities of states at the Fermi level. Calculations indicate that the independence of the spin polarization of the composition is due to compensation of density of states and Fermi velocity in the s- and d- bands

Systematic review and meta-analysis of clinical outcomes after management of posterior cruciate ligament tibial avulsion fractures

BACKGROUND: There is no consensus regarding the management of posterior cruciate ligament (PCL) avulsion fractures and the expected outcomes after treatment. PURPOSE: To systematically review clinical outcomes and complications after management of tibial-sided avulsion fractures of the PCL. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A literature search of Scopus, PubMed, Medline, and the Cochrane Central Register for Controlled Trials was performed in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included were studies with evidence levels 1 to 4 that reported clinical outcomes after treatment of PCL tibial-sided avulsion fractures in humans. The quality of the included studies was performed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. A meta-analysis was performed for patient-reported outcome measures using random-effects modeling with 95% CIs. RESULTS: A total of 58 studies published between 1999 and 2022 were identified. The mean MINORS score was 9.90 ± 4.12, indicating overall low-quality evidence with high risk of bias. The studies comprised 1440 patients (mean age, 32.59 ± 5.69 years; 75.2% males) with a mean follow-up of 26.9 ± 19.6 months (range, 5.3-126 months). Most patients were treated with open surgery (63.6%), followed by arthroscopic surgery (29.7%) and nonoperative treatment (6.7%). All patients reported significant posttreatment improvement in both subjective and objective outcomes ( CONCLUSION: Although nonoperative and surgical management of PCL tibial avulsion fractures resulted in high rates of fracture union and improvement in functional outcome scores and a low incidence of complications, nonoperative treatment yielded a high side-to-side posterior displacement (\u3e4 mm) with a lower rate of fracture union compared to surgical treatment

Treatment of a hip capsular injury in a professional soccer player with platelet-rich plasma and bone marrow aspirate concentrate therapy

Abstract This report presents a 27-year-old male professional soccer player who developed heterotopic ossification of his hip capsule and gluteus minimus tendon after an arthroscopic hip procedure. After removal of the heterotopic bone, the patient had a symptomatic deficiency of his hip capsule and gluteus minimus tendon. A series of orthobiologic treatments with platelet-rich plasma and bone marrow aspirate concentrate improved the patient&apos;s pain and strength as well as the morphologic appearance of the hip capsule and gluteus minimus tendon on magnetic resonance imaging. A series of motion analyses demonstrated significant improvement in his stance-leg ground reaction force and hip abduction, as well as linear foot velocity at ball strike and maximum hip flexion following ball strike in his kicking leg. Level of evidence IV

Impact of a centralized osteoporosis coordinator on post-fracture osteoporosis management: a cluster randomized trial

SUMMARY: We conducted a cluster randomized trial evaluating the effect of a centralized coordinator who identifies and follows up with fracture patients and their primary care physicians about osteoporosis. Compared with controls, intervention patients were five times more likely to receive BMD testing and two times more likely to receive appropriate management. INTRODUCTION: To determine if a centralized coordinator who follows up with fracture patients and their primary care physicians by telephone and mail (intervention) will increase the proportion of patients who receive appropriate post-fracture osteoporosis management, compared to simple fall prevention advice (attention control). METHODS: A cluster randomized controlled trial was conducted in small community hospitals in the province of Ontario, Canada. Hospitals that treated between 60 and 340 fracture patients per year were eligible. Patients 40 years and older presenting with a low trauma fracture were identified from Emergency Department records and enrolled in the trial. The primary outcome was ‘appropriate’ management, defined as a normal bone mineral density (BMD) test or taking osteoporosis medications. RESULTS: Thirty-six hospitals were randomized to either intervention or control and 130 intervention and 137 control subjects completed the study. The mean age of participants was 65 ± 12 years and 69% were female. The intervention increased the proportion of patients who received appropriate management within 6 months of fracture; 45% in the intervention group compared with 26% in the control group (absolute difference of 19%; adjusted OR, 2.3; 95% CI, 1.3–4.1). The proportion who had a BMD test scheduled or performed was much higher with 57% of intervention patients compared with 21% of controls (absolute difference of 36%; adjusted OR, 4.8; 95% CI, 3.0–7.0). CONCLUSIONS: A centralized osteoporosis coordinator is effective in improving the quality of osteoporosis care in smaller communities that do not have on-site coordinators or direct access to osteoporosis specialists