An Uncommon Presentation of Coxa Saltans: A Case Report

Coxa saltans, or “snapping hip,” refers to various conditions that produce a palpable or audible snapping of the hip after movement. We present an uncommon case of coxa saltans in a patient with a snapping proximal hamstring tendon. Findings of dynamic ultrasound evaluation were used to confirm the source of snapping, characterized by a lateral subluxation of the conjoint tendon over the ischial tuberosity. Our patient was treated nonoperatively, and we observed mild improvement of her symptoms. Few cases of similar pathological findings have been described, with varying causes of tendon instability. The results of the current case may help physicians in diagnosing and treating this condition

Simultaneous Avulsion Fractures of the Tibial Tuberosity of Both Knees in a 14-Year-Old Boy: A Case Report

Fractures of the tibial tuberosity are uncommon injuries in adolescents, representing an estimated 0.4% to 2.7% of all pediatric fractures. Most of these injuries occur in young, active males commonly between the ages of 12 to 17 years. Sports, particularly those involving jumping or sudden starts and stops, are most often implicated. Injuries of the tibial tuberosity of both knees are especially rare, with little more than 30 cases reported in the past 60 years. We present a 14-year-old male football player with simultaneous avulsion fractures of the tibial tuberosity of both knees. We reviewed the anatomy, mechanisms of injury, classification systems, treatment strategies, and complications regarding this rare injury

Capitate Stress Injuries of Both Wrists in an Adolescent Female Gymnast: A Case Report

Gymnastic activities expose the wrist to a wide variety of overuse and acute stresses. Injuries to the distal radius are the most commonly reported gymnastic wrist condition; however, many other structures are at risk of injury from the sport’s high acute and overuse demands, including the carpal bones, most commonly the scaphoid. We describe a 17-year-old female, high-level gymnast in whom stress injuries to both capitate bones were ultimately diagnosed after initial symptoms of pain. This case demonstrated the need for prompt recognition, without which much chronic and debilitating injury would develop. For successful diagnosis, healthcare providers should carefully examine and evaluate reported wrist pain in high-level, adolescent gymnasts

Idiopathic Thrombocytopenic Purpura in a 21-Year-Old Collegiate Football Player: A Case Report

Muscle cramps are commonly observed in collegiate athlete-patients; however, the condition may be a symptom of severe disorders. In particular, idiopathic thrombocytopenic purpura (ITP) may be a possible diagnosis and involves a decreased number of platelets in the bloodstream. We describe a 21-year-old collegiate player of American football with initially presented with cramping of the neck, abdomen, and forearms. Although findings of physical examination were normal, results of laboratory tests indicated ITP, and the patient was hospitalized for 3 days until the platelet count increased. Because the levels continued to decrease at 6-month followup, splenectomy and use of rituximab agents have been discussed with the patient for treatment after the end of the football season, before which dexamethasone will be administered to maintain a minimum platelet count of 50. Physicians should consider coordinating traditional care and specialist consultation to help treat severe conditions such as thrombocytopenia in athlete-patients

Brachial Artery Vasculitis and Associated Stenosis Presenting as Elbow Pain in a 16-Year-Old Soccer Player: A Case Report

Chronic vascular occlusion in the upper extremity can result from repetitive trauma, atherosclerosis, proximal embolic events, hypercoagulable states, and systemic diseases such as collagen vascular disease and vasculitis. Considerable functional impairment can result from these maladies; however, sometimes the condition develops slowly with minimal effect on the patient. We describe a 16-year-old soccer player with slow-progressing elbow pain and loss of range in motion caused by brachial artery vasculitis and resultant brachial arterial stenosis. Although vascular insults and lesions rarely cause chronic vascular occlusion, physicians should consider this possibility in patients with localized pain or atrophy, especially if the condition develops slowly

A conceptual framework for implementation fidelity

<p>Abstract</p> <p>Background</p> <p>Implementation fidelity refers to the degree to which an intervention or programme is delivered as intended. Only by understanding and measuring whether an intervention has been implemented with fidelity can researchers and practitioners gain a better understanding of how and why an intervention works, and the extent to which outcomes can be improved.</p> <p>Discussion</p> <p>The authors undertook a critical review of existing conceptualisations of implementation fidelity and developed a new conceptual framework for understanding and measuring the process. The resulting theoretical framework requires testing by empirical research.</p> <p>Summary</p> <p>Implementation fidelity is an important source of variation affecting the credibility and utility of research. The conceptual framework presented here offers a means for measuring this variable and understanding its place in the process of intervention implementation.</p

Multiple Recurrent De Novo CNVs, Including Duplications of the 7q11.23 Williams Syndrome Region, Are Strongly Associated with Autism

SummaryWe have undertaken a genome-wide analysis of rare copy-number variation (CNV) in 1124 autism spectrum disorder (ASD) families, each comprised of a single proband, unaffected parents, and, in most kindreds, an unaffected sibling. We find significant association of ASD with de novo duplications of 7q11.23, where the reciprocal deletion causes Williams-Beuren syndrome, characterized by a highly social personality. We identify rare recurrent de novo CNVs at five additional regions, including 16p13.2 (encompassing genes USP7 and C16orf72) and Cadherin 13, and implement a rigorous approach to evaluating the statistical significance of these observations. Overall, large de novo CNVs, particularly those encompassing multiple genes, confer substantial risks (OR = 5.6; CI = 2.6–12.0, p = 2.4 × 10-7). We estimate there are 130–234 ASD-related CNV regions in the human genome and present compelling evidence, based on cumulative data, for association of rare de novo events at 7q11.23, 15q11.2-13.1, 16p11.2, and Neurexin 1

Cause of Death and Predictors of All-Cause Mortality in Anticoagulated Patients With Nonvalvular Atrial Fibrillation : Data From ROCKET AF

M. Kaste on työryhmän ROCKET AF Steering Comm jäsen.Background-Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all-cause mortality may guide interventions. Methods and Results-In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all-cause mortality in the 14 171 participants in the intention-to-treat population. The median age was 73 years, and the mean CHADS(2) score was 3.5. Over 1.9 years of median follow-up, 1214 (8.6%) patients died. Kaplan-Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all-cause mortality was observed between the rivaroxaban and warfarin arms (P=0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33-1.70, P= 75 years (hazard ratio 1.69, 95% CI 1.51-1.90, P Conclusions-In a large population of patients anticoagulated for nonvalvular atrial fibrillation, approximate to 7 in 10 deaths were cardiovascular, whereasPeer reviewe

Baseline characteristics of patients in the reduction of events with darbepoetin alfa in heart failure trial (RED-HF)

&lt;p&gt;Aims: This report describes the baseline characteristics of patients in the Reduction of Events with Darbepoetin alfa in Heart Failure trial (RED-HF) which is testing the hypothesis that anaemia correction with darbepoetin alfa will reduce the composite endpoint of death from any cause or hospital admission for worsening heart failure, and improve other outcomes.&lt;/p&gt; &lt;p&gt;Methods and results: Key demographic, clinical, and laboratory findings, along with baseline treatment, are reported and compared with those of patients in other recent clinical trials in heart failure. Compared with other recent trials, RED-HF enrolled more elderly [mean age 70 (SD 11.4) years], female (41%), and black (9%) patients. RED-HF patients more often had diabetes (46%) and renal impairment (72% had an estimated glomerular filtration rate &#60;60 mL/min/1.73 m2). Patients in RED-HF had heart failure of longer duration [5.3 (5.4) years], worse NYHA class (35% II, 63% III, and 2% IV), and more signs of congestion. Mean EF was 30% (6.8%). RED-HF patients were well treated at randomization, and pharmacological therapy at baseline was broadly similar to that of other recent trials, taking account of study-specific inclusion/exclusion criteria. Median (interquartile range) haemoglobin at baseline was 112 (106–117) g/L.&lt;/p&gt; &lt;p&gt;Conclusion: The anaemic patients enrolled in RED-HF were older, moderately to markedly symptomatic, and had extensive co-morbidity.&lt;/p&gt

Livestock 2.0 – genome editing for fitter, healthier, and more productive farmed animals

Abstract The human population is growing, and as a result we need to produce more food whilst reducing the impact of farming on the environment. Selective breeding and genomic selection have had a transformational impact on livestock productivity, and now transgenic and genome-editing technologies offer exciting opportunities for the production of fitter, healthier and more-productive livestock. Here, we review recent progress in the application of genome editing to farmed animal species and discuss the potential impact on our ability to produce food