The Diagnosis of Knee Pain

The knee is open to injury because it is designed for rapid action, not simply during its large excursion from extension to full flexion, but also lesser accommodative movements of rotation, tilt and glide. As if that were not enough, that highly developed but sometimes temperamental sesamoid, the patella, adds its own unique problems. The complexities of these movements are reflected in the subtleties of the structure of the knee. Regrettably they have also led to a proliferation of clinical tests and surgical repairs whose sophistication confuses rather than enlightens.Before enquiring about the characteristics of the painful knee the general characteristics of the patient should be assessed quickly. In children problems usually relate to patellar malalignment syndromes, possibly a discoid meniscus, and the aching discomfort produced by traction apophysitis such as Osgood-Schlatter's disease of the tibial tuberosity. After puberty girls are particularly likely to develop patellar pain, which may be associated with lateral subluxation of that bone. In the young woman the sources of such pain may be so prolix that the surgeon may do more harm than good if he operates. During adolescence and early adult life males are most likely to suffer from meniscal and ligamentous tears, often brought on by exertion or accidents during sport. A patient with an endomorphic physique usually has associated genu valgum and may present with medial ligament sprains and patello-femoral pain. Those with ligamentous laxity are also prone to sprains and patellar subluxation. The mesomorphic athlete is likely to injure the menisci, or may come in with significant tears of the ligaments and synovium

A Library Sets Sail

Hurry down New Bond Street too fast and miss the main entrance of the Sotheby salerooms.  It is a small fronting done out in fading cream paint with the apologetic air of a second rate bookie’s office.  But inside the building expands into a veritable Ali Baba’s cave for there is no denying the pivotal position of Sotheby & Co. in the world of fine art, of books, of the rare and the beautiful.  The front entrance is, by some quirk, no more than a curious self-effacement in the centre of exhibitionist London, and the eighteenth Egyptian dynasty animal statue (circa 1320 BC) perched above the twin doorways and entitled SEKHMET appears to be having the last laugh

The Diagnosis of Knee Pain

The knee is open to injury because it is designed for rapid action, not simply during its large excursion from extension to full flexion, but also lesser accommodative movements of rotation, tilt and glide. As if that were not enough, that highly developed but sometimes temperamental sesamoid, the patella, adds its own unique problems. The complexities of these movements are reflected in the subtleties of the structure of the knee. Regrettably they have also led to a proliferation of clinical tests and surgical repairs whose sophistication confuses rather than enlightens.Before enquiring about the characteristics of the painful knee the general characteristics of the patient should be assessed quickly. In children problems usually relate to patellar malalignment syndromes, possibly a discoid meniscus, and the aching discomfort produced by traction apophysitis such as Osgood-Schlatter's disease of the tibial tuberosity. After puberty girls are particularly likely to develop patellar pain, which may be associated with lateral subluxation of that bone. In the young woman the sources of such pain may be so prolix that the surgeon may do more harm than good if he operates. During adolescence and early adult life males are most likely to suffer from meniscal and ligamentous tears, often brought on by exertion or accidents during sport. A patient with an endomorphic physique usually has associated genu valgum and may present with medial ligament sprains and patello-femoral pain. Those with ligamentous laxity are also prone to sprains and patellar subluxation. The mesomorphic athlete is likely to injure the menisci, or may come in with significant tears of the ligaments and synovium

Leptin: A Metabolic Signal for the Differentiation of Pituitary Cells

Pituitary cell function is impacted by metabolic states and therefore must receive signals that inform them about nutritional status or adiposity. A primary signal from adipocytes is leptin, which recent studies have shown regulates most pituitary cell types. Subsets of all pituitary cell types express leptin receptors and leptin has been shown to exert transcriptional control through classical JAK/STAT pathways. Recent studies show that leptin also signals through post-transcriptional pathways that involve the translational regulatory protein Musashi. Mechanistically, post-transcriptional control would permit rapid cellular regulation of critical pre-existing pituitary transcripts as energy states change. The chapter will review evidence for transcriptional and/or post-transcriptional regulation of leptin targets (including Gnrhr, activin, Fshb, Gh, Ghrhr, and Pou11f1) and the consequences of the loss of leptin signaling to gonadotrope and somatotrope functions

Navigating the stigmatised identities of poverty in austere times: Resisting and responding to narratives of personal failure

© 2015, © The Author(s) 2015. Behavioural explanations of poverty and disadvantage have figured heavily in political rhetoric in the era of austerity, as a means to understand trajectories into poverty and subsequent relationships between benefit claimants and the state. These discourses are not restricted to political debate, as previous studies demonstrate they impact upon public consciousness and structure the ways that the general public think about poverty, as well as shaping the ways in which people living on low incomes are treated. Drawing upon the testimonies of 62 people in England and Scotland experiencing poverty, this article seeks to understand our participants’ responses to these discourses, in particular: how these behavioural explanations impact upon their understanding of their own situations, as well as their self perceptions; how these discourses shape their relationships with others, in terms of their experience of disrespect; and how participants seek to dissociate themselves from their stigmatising implications

Arsenic in Soils and Forages from Poultry Litter-Amended Pastures

In regions of concentrated poultry production, poultry litter (PL) that contains significant quantities of trace elements is commonly surface-applied to pastures at high levels over multiple years. This study examined the effect of long-term applications of PL on soil concentrations of arsenic (As), copper (Cu), Zinc (Zn), and the uptake of these elements by bermuda grass grown on Cecil (well-drained) and Sedgefield (somewhat poorly-drained) soils. The results showed that concentrations of As, Cu, and Zn in soils that had received surface-applied PL over a 14-year period were significantly greater than untreated soil at 0–2.5 and 2.5–7.5 cm depths. However, the levels were well below the USEPA loading limits established for municipal biosolids. Arsenic fractionation showed that concentrations of all As fractions were significantly greater in PL-amended soils compared to untreated soils at 0–2.5 and 2.5–7.5 cm depths. The residual fraction was the predominant form of As in all soils. The water-soluble and NaHCO3-associated As were only 2% of the total As. Significant differences were found in concentrations of these trace elements and phosphorus (P) in forage from PL-amended soils compared to that in untreated plots. The concentrations of Cu, Zn, As, and P were significantly greater in forage from Sedgefield amended soil compared to Cecil soil, but were in all cases below levels of environmental concern