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

Surface pretreatments for medical application of adhesion

Medical implants and prostheses (artificial hips, tendono- and ligament plasties) usually are multi-component systems that may be machined from one of three material classes: metals, plastics and ceramics. Typically, the body-sided bonding element is bone. The purpose of this contribution is to describe developments carried out to optimize the techniques , connecting prosthesis to bone, to be joined by an adhesive bone cement at their interface. Although bonding of organic polymers to inorganic or organic surfaces and to bone has a long history, there remains a serious obstacle in realizing long-term high-bonding strengths in the in vivo body environment of ever present high humidity. Therefore, different pretreatments, individually adapted to the actual combination of materials, are needed to assure long term adhesive strength and stability against hydrolysis. This pretreatment for metal alloys may be silica layering; for PE-plastics, a specific plasma activation; and for bone, amphiphilic layering systems such that the hydrophilic properties of bone become better adapted to the hydrophobic properties of the bone cement. Amphiphilic layering systems are related to those developed in dentistry for dentine bonding. Specific pretreatment can significantly increase bond strengths, particularly after long term immersion in water under conditions similar to those in the human body. The bond strength between bone and plastic for example can be increased by a factor approaching 50 (pealing work increasing from 30 N/m to 1500 N/m). This review article summarizes the multi-disciplined subject of adhesion and adhesives, considering the technology involved in the formation and mechanical performance of adhesives joints inside the human body

Active ageing, pensions and retirement in the UK

The ageing population has led to increasing concerns about pensions and their future sustainability. Much of the dominant policy discourse around ageing and pension provision over the last decade has focussed on postponing retirement and prolonging employment. These measures are central to productive notions of ‘active ageing’. Initially the paper briefly sets out the pension developments in the UK. Then it introduces active ageing and active ageing policy, exploring its implications for UK pension provision. It demonstrates that a more comprehensive active ageing framework, which incorporates a life-course perspective, has the potential to assist the UK to respond to the challenges of an ageing population. In doing so it needs to highlight older people as an economic and social resource, and reduce barriers to older people’s participation in society

Multifaceted roles of GSK-3 and Wnt/β-catenin in hematopoiesis and leukemogenesis: opportunities for therapeutic intervention

Glycogen synthase kinase-3 (GSK-3) is well documented to participate in a complex array of critical cellular processes. It was initially identified in rat skeletal muscle as a serine/threonine kinase that phosphorylated and inactivated glycogen synthase. This versatile protein is involved in numerous signaling pathways that influence metabolism, embryogenesis, differentiation, migration, cell cycle progression and survival. Recently, GSK-3 has been implicated in leukemia stem cell pathophysiology and may be an appropriate target for its eradication. In this review, we will discuss the roles that GSK-3 plays in hematopoiesis and leukemogenesis as how this pivotal kinase can interact with multiple signaling pathways such as: Wnt/β-catenin, phosphoinositide 3-kinase (PI3K)/phosphatase and tensin homolog (PTEN)/Akt/mammalian target of rapamycin (mTOR), Ras/Raf/MEK/extracellular signal-regulated kinase (ERK), Notch and others. Moreover, we will discuss how targeting GSK-3 and these other pathways can improve leukemia therapy and may overcome therapeutic resistance. In summary, GSK-3 is a crucial regulatory kinase interacting with multiple pathways to control various physiological processes, as well as leukemia stem cells, leukemia progression and therapeutic resistance. GSK-3 and Wnt are clearly intriguing therapeutic targets