Outcomes Following Anterior Cruciate Ligament Reconstruction with Patellar Tendon vs Hamstring Autografts: A Systematic Review of Randomized Controlled Trials with a Mean Follow-up of 15 Years

BACKGROUND: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction (ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review is to evaluate randomized controlled trials (RCTs) with a minimum 10-year follow-up data to compare the long-term outcomes of ACL reconstructions performed using PT and HS autografts. METHODS: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs with a minimum of 10-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts. RESULTS: Four RCTs with a total of 299 patients were included in the study. The mean follow-up ranged from 10.2 to 17 years (mean, 14.79 years). No significant differences in knee laxity or clinical outcome scores were demonstrated in any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates. CONCLUSION: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience greater kneeling pain and osteoarthritis. Therefore, orthopedic surgeons should consider patient-centric factors when discussing graft options with patients

New anti-perovskite-type Superconductor ZnNyNi3

We have synthesized a new superconductor ZnNyNi3 with Tc ~3 K. The crystal structure has the same anti-perovskite-type such as MgCNi3 and CdCNi3. As far as we know, this is the third superconducting material in Ni-based anti-perovskite series. For this material, superconducting parameters, lower-critical field Hc1(0), upper-critical field Hc2(0), coherence length x(0), penetration depth l(0), and Gintzburg -Landau parameter k(0) have been experimentally determined.Comment: 13 pages, 3 figures, 1 tabl

Volunteer trials of a novel improvised dry decontamination protocol for use during mass casualty incidents as part of the UK’S Initial Operational Response (IOR)

Copyright: © 2017 Amloˆt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Previous studies have demonstrated that rapid evacuation, disrobing and emergency decontamination can enhance the ability of emergency services and acute hospitals to effectively manage chemically-contaminated casualties. The purpose of this human volunteer study was to further optimise such an “Initial Operational Response” by (1) identifying an appropriate method for performing improvised skin decontamination and (2) providing guidance for use by first responders and casualties. The study was performed using two readily available, absorbent materials (paper towels and incontinence pads). The decontamination effectiveness of the test materials was measured by quantifying the amount of a chemical warfare agent simulant (methyl salicylate) removed from each volunteer’s forearm skin. Results from the first study demonstrated that simulant recovery was lower in all of the dry decontamination conditions when compared to matched controls, suggesting that dry decontamination serves to reduce chemical exposure. Blotting in combination with rubbing was the most effective form of decontamination. There was no difference in effectiveness between the two absorbent materials. In the following study, volunteers performed improvised dry decontamination, either with or without draft guidelines. Volunteers who received the guidance were able to carry out improvised dry decontamination more effectively, using more of the absorbent product (blue roll) to ensure that all areas of the body were decontaminated and avoiding cross-contamination of other body areas by working systematically from the head downwards. Collectively, these two studies suggest that absorbent products that are available on ambulances and in acute healthcare settings may have generic applicability for improvised dry decontamination. Wherever possible, emergency responders and healthcare workers should guide casualties through decontamination steps; in the absence of explicit guidance and instructions, improvised dry decontamination may not be performed correctly or safely.Peer reviewedFinal Published versio

Vacuum ultraviolet photoabsorption spectroscopy of space-related ices: 1 keV electron irradiation of nitrogen- and oxygen-rich ices

Context. Molecular oxygen, nitrogen, and ozone have been detected on some satellites of Saturn and Jupiter, as well as on comets. They are also expected to be present in ice-grain mantles within star-forming regions. The continuous energetic processing of icy objects in the Solar System induces physical and chemical changes within the ice. Laboratory experiments that simulate energetic processing (ions, photons, and electrons) of ices are therefore essential for interpreting and directing future astronomical observations. Aims. We provide vacuum ultraviolet (VUV) photoabsorption spectroscopic data of energetically processed nitrogen- and oxygen-rich ices that will help to identify absorption bands and/or spectral slopes observed on icy objects in the Solar System and on ice-grain mantles of the interstellar medium. Methods. We present VUV photoabsorption spectra of frozen O2 and N2, a 1:1 mixture of both, and a new systematic set of pure and mixed nitrogen oxide ices. Spectra were obtained at 22 K before and after 1 keV electron bombardment of the ice sample. Ices were then annealed to higher temperatures to study their thermal evolution. In addition, Fourier-transform infrared spectroscopy was used as a secondary probe of molecular synthesis to better identify the physical and chemical processes at play. Results. Our VUV data show that ozone and the azide radical (N3) are observed in our experiments after electron irradiation of pure O2 and N2 ices, respectively. Energetic processing of an O2:N2 = 1:1 ice mixture leads to the formation of ozone along with a series of nitrogen oxides. The electron irradiation of solid nitrogen oxides, pure and in mixtures, induces the formation of new species such as O2, N2, and other nitrogen oxides not present in the initial ice. Results are discussed here in light of their relevance to various astrophysical environments. Finally, we show that VUV spectra of solid NO2 and water can reproduce the observational VUV profile of the cold surface of Enceladus, Dione, and Rhea, strongly suggesting the presence of nitrogen oxides on the surface of the icy Saturn moons

A Multimodal Protocol to Diminish Pain Following Common Orthopedic Sports Procedures: Can We Eliminate Postoperative Opioids?

PURPOSE: To determine if postsurgical pain, measured by visual analogue scale (VAS), following common orthopedic sports procedures could be managed effectively with a nonopioid multimodal analgesic protocol. METHODS: This prospective study evaluated a custom multimodal non-opioid pain protocol in patients undergoing common orthopedic sports procedures by a single fellowship trained Orthopaedic Sports surgeon from May 2018 to December 2018. Procedures included anterior cruciate ligament reconstruction, rotator cuff repair, arthroscopic partial meniscectomy, and labrum repair. The non-opioid pain protocol consisted of preoperative analgesics, intraoperative local infiltration analgesia, and a postoperative pain regimen. Patient pain was immediately reported after surgery and 1 week postoperatively using the VAS, while rescue opioids (oxycodone 5 mg) used were recorded using a prescription opioid journal. Statistical analysis of patient VAS scores, demographic correlations, and comparison between opioid rescue users vs. nonusers was performed. RESULTS: A total of 141 patients were included. One week following surgery patients reported a mean VAS level of 3.2±2.3 and required on average 2.6±3.6 breakthrough oxycodone pills (8.6±12.0 morphine equivalents). Forty-five percent of patients did not require any breakthrough prescription opioids and reported satisfaction with pain management. Patients who required opioids were more likely to have a history of anxiety/depression (44.2% vs. 23.8%,P=.012) and reported higher pain scores as compared to non-users (3.94±2.5 vs. 2.41±1.75,P=.016). The most common side effect of the pain protocol was feeling drowsy (23.5%). All patients were satisfied with their pain management postoperatively. CONCLUSIONS: A multimodal, non-opioid pain protocol was found to be effective in managing postoperative pain following common orthopedic sports procedures. Patients were found to have low levels of pain, require minimal rescue opioids and had no severe side effects related to the protocol. These results suggest a non-opioid alternative to pain management following common orthopedic sports procedures

Risk Factors for Postoperative Opioid Use in Arthroscopic Meniscal Surgery.

PURPOSE: (1) To evaluate the influence of preoperative opioid use on postoperative consumption after arthroscopic meniscal surgery and (2) to determine preoperative patient factors associated with increased opioid use after meniscal surgery. METHODS: We performed a retrospective review of all patients with a primary diagnosis of a meniscal tear at a single institution between August 2013 and February 2017. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before meniscal surgery, as acute users if they received at least 1 opioid prescription within 1 month preceding meniscal surgery, or as chronic users if they received at least 1 opioid prescription within 3 months preceding meniscal surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery. We also recorded patient demographic characteristics and the degree of knee osteoarthritis at the time of surgery using the Outerbridge classification. RESULTS: A total of 735 patients were included. The average age was 46.7 years (range, 12-79 years), and the average body mass index was 30.2 ± 6.2 (range, 13.3-55.4). Patients who were acute or chronic opioid users preoperatively were more likely to continue to use opioids beyond 1 month postoperatively (P \u3c .001). A higher percentage of patients with advanced osteoarthritis (Outerbridge grade 3 or 4) were found to continue to use opioids at all time points beyond the first postoperative month (P \u3c .05). Pair-wise comparisons showed that the number of total opioid prescriptions filled was significantly higher in the group with Outerbridge grade 1 or 2 and the group with Outerbridge grade 3 or 4 than the group with Outerbridge grade 0 (P = .023 and P = .014, respectively). No significant difference in postoperative opioid use was noted when we compared meniscal repair versus resection, primary procedure versus revision, different tear types, or concomitant procedures. CONCLUSIONS: In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use. LEVEL OF STUDY: Level III, retrospective comparative study

Do anatomic changes found in the throwing arm after a season of pitching resolve with off-season rest? A dynamic ultrasound study

Hypothesis: Our hypothesis was that seasonal adaptive changes in the ulnar collateral ligament (UCL), ulnohumeral joint space (UHJS), and glenohumeral internal rotation deficit (GIRD) of the pitching extremity would subsequently resolve with off-season rest. Methods: Eleven collegiate pitchers underwent preseason, postseason, and off-season evaluations including physical examination; dynamic ultrasound imaging of the UCL and UHJS; and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire. Ultrasound images were evaluated by 2 fellowship-trained musculoskeletal radiologists. Results: All 11 pitchers were included in the final analysis, with an average age of 20.1 years and with 14.1 years of playing experience. After a season of pitching, we found significant increases in GIRD (P= .004) and UCL thickness (P = .033) and nonsignificant increases in both unloaded (P = .069) and loaded (P = .122) UHJS. Preseason GIRD correlated with this increase in loaded UHJS (r = 0.80, P = .003). The increase in UCL thickness was significantly greater in pitchers with GIRD greater than 10° (P\u3c .05). After the off-season, UCL thickness returned to baseline and significant decreases were noted in both unloaded (P = .004) and loaded (P = .041) UHJS, but a progression in GIRD was found (P = .021). Pitchers with GIRD of 10° or less showed greater improvement in UHJS after the off-season (P \u3c .05). Conclusions: The pitching season produced adaptive changes in the throwing elbow that subsequently resolved after off-season rest. However, shoulder range-of-motion deficits were progressive and did not resolve. Ultrasound adaptations of the pitching elbow were significantly related to GIRD