Management of anterior cruciate ligament rupture in patients aged 40 years and older

The aim of anterior cruciate ligament (ACL) reconstruction is essentially to restore functional stability of the knee and to allow patients to return to their desired work and activities. While in the young and active population, surgery is often the best therapeutic option after an ACL tear, ACL reconstruction in middle-aged people is rather more controversial due to concerns about a higher complication rate. The purpose of our article is to establish, through a systematic review of the literature, useful decision-making criteria for the management of anterior cruciate ligament rupture in patients aged 40 years and older, guiding surgeons to the most appropriate therapeutic approach. Various reports have shown excellent results of ACL reconstruction in patients over the age of 40 in terms of subjective satisfaction, return to previous activity level, and reduced complication and failure rates. Some even document excellent outcomes in subjects of 50 years and older. Although there are limited high-level studies, data reported in the literature suggest that ACL reconstruction can be successful in appropriately selected, motivated older patients with symptomatic knee instability who want to return to participating in highly demanding sport and recreational activities. Deciding factors are based on occupation, sex, activity level of the subject, amount of time spent performing such highly demanding activities, and presence of associated knee lesions. Physiological age and activity level are more important than chronological age as deciding factors when considering ACL reconstruction

Розрахунок та проектування окремого фундаменту будівлі на природній ґрунтовій основі. Методичні рекомендації до виконання практичних завдань та курсового проекту з дисципліни «Механіка ґрунтів, основи і фундаменти» сту- дентами напрямів підготовки 6.060101 Будівництво та 6.050301 Гірництво

Подано методичні рекомендації до виконання практичних завдань та кур- сового проекту з дисципліни «Механіка ґрунтів, основи і фундаменти» для сту- дентів напрямів підготовки 6.060101 Будівництво та 6.050301 Гірництво. Розглянуто порядок проектування фундаменту будівлі мілкого закладан- ня на природній ґрунтовій основі. Методичні рекомендації передбачають виконання курсового проекту «Розрахунок та проектування окремого фундаменту будівлі на природній ґрун- товій основі» як із викладачем, так і під час самостійної роботи. Можна використовувати також у підготовці курсового та дипломного про- ектування

The Evolution of a Female Genital Trait Widely Distributed in the Lepidoptera: Comparative Evidence for an Effect of Sexual Coevolution

Sexual coevolution is considered responsible for the evolution of many male genital traits, but its effect on female genital morphology is poorly understood. In many lepidopterans, females become temporarily unreceptive after mating and the length of this refractory period is inversely related to the amount of spermatophore remaining in their genital tracts. Sperm competition can select for males that delay female remating by transferring spermatophores with thick spermatophore envelopes that take more time to be broken. These envelopes could select for signa, sclerotized sharp structures located within the female genital tract, that are used for breaking spermatophores. Thus, this hypothesis predicts that thick spermatophore envelopes and signa evolve in polyandrous species, and that these adaptations are lost when monandry evolves subsequently. Here we test the expected associations between female mating pattern and presence/absence of signa, and review the scant information available on the thickness of spermatophore envelopes.We made a literature review and found information on female mating pattern (monandry/polyandry), presence/absence of signa and phylogenetic position for 37 taxa. We built a phylogenetic supertree for these taxa, mapped both traits on it, and tested for the predicted association by using Pagel's test for correlated evolution. We found that, as predicted by our hypothesis, monandry evolved eight times and in five of them signa were lost; preliminary evidence suggests that at least in two of the three exceptions males imposed monandry on females by means of specially thick spermatophore envelopes. Previously published data on six genera of Papilionidae is in agreement with the predicted associations between mating pattern and the characteristics of spermatophore envelopes and signa.Our results support the hypothesis that signa are a product of sexually antagonistic coevolution with spermatophore envelopes

Phenotypic plasticity in sperm production rate : there's more to it than testis size

Evolutionary theory predicts that males should produce more sperm when sperm competition is high. Because sperm production rate is difficult to measure in most organisms, comparative and experimental studies have typically used testis size instead, while assuming a good correspondence between testis size and sperm production rate. Here we evaluate this common assumption using the marine flatworm Macrostomum lignano, in which we can estimate sperm production rate because the accumulation of produced sperm can be observed in vivo. In earlier studies we have shown that testis size is phenotypically plastic in M. lignano: worms can be induced to make larger testes by raising them in groups instead of pairs, and these larger testes have a higher cell proliferation activity (i.e. they are more energetically costly). Here we demonstrate that worms with such experimentally enlarged testes have a higher sperm production rate. Moreover, although testis size and sperm production rate were related linearly, worms with experimentally enlarged testes had a higher sperm production rate per unit testis size (i.e. a higher spermatogenic efficiency). We thus show that phenotypically plastic adjustment of sperm production rate includes a component that is independent of testis size. We discuss possible reasons for this novel finding, and suggest that the relationship between testis size and sperm production needs to be evaluated in other species as well

Avaliação de parâmetros morfométricos calculados a partir do contorno de lesões de mama em ultrassonografias na distinção das categorias do sistema BI-RADS

OBJETIVO: Avaliar o desempenho de parâmetros morfométricos, calculados a partir do contorno de lesões de mama em ultrassonografias, na quantificação de suas características morfológicas e na distinção das categorias 2, 3, 4 e 5 do sistema de classificação ecográfica BI-RADS. MATERIAIS E MÉTODOS: A casuística é composta por 40 casos com registro ortogonal de pacientes submetidas à cirurgia. A partir das lesões segmentadas, foram calculados cinco parâmetros morfométricos para quantificar o contorno e a forma das lesões: razão de área, razão de superposição, valor residual normalizado, circularidade e razão entre largura e profundidade. A análise discriminante linear foi usada para selecionar os parâmetros mais significativos na distinção das características morfológicas das lesões, usando como figura de mérito a curva ROC. RESULTADOS: A razão de superposição foi capaz de diferenciar estatisticamente as lesões classificadas como BI-RADS 3 daquelas classificadas como BI-RADS 4 (a = 5%; p = 0,015), sendo, também, o parâmetro morfométrico que apresentou melhor desempenho na diferenciação entre lesões malignas e benignas. CONCLUSÃO: Este resultado indica que a análise morfométrica de lesões de mama em ultrassonografias tem potencial para auxiliar na distinção de pacientes que deveriam ser submetidas à biópsia, daquelas que poderiam manter controle por métodos de imagem