Biomechanical evaluation of the lower limbs in patients surgically treated for tibial plateau fractures: what is the involvement of the fascia?

openStudy Design: Retrospective, single-center follow-up study. Background: There is limited data on surgical and post-operative rehabilitation, functional outcomes and there are no studies investigating the long-term asymmetry between the lower limbs in patients surgically treated for TPF. The possibility of using equipment such as force plates and dynamometers (VALD, Brisbane, Australia), has raised research questions about the potential presence of asymmetry in the two lower limbs in patients treated for TPF. Objective: The study investigates: subjective perception, quality of life, possible presence of asymmetry in: AROM, maximal strength, power, static and dynamic stability and the RFD between the limb operated and the non-operated limb. The data given us by the technology allows us to explore the possible involvement of fascial structures in the execution of functional movements that require the use of the upper limbs, in contrast to those that primarily involve the lower limbs. The data also enable us to investigate the potential impact of fascial tissue functions on the operated limb compared to the contralateral limb. Methods: The study included patients who underwent surgery between 2009 and 2016 at the orthopedic-traumatological clinic of the university-hospital in Padua. 28 patients were recruited and underwent subjective evaluation (Tegner, Lyhsolm, NPRS, AKSS, KOOS-I, IKDC, and SF-36), clinical evaluation (Lachman, Pivot Shift, Jerk, anterior drawer, posterior drawer, varus-valgus stress test, Apley test, McMurray test, meniscal palpation, alignement and PVND), strength, joint range of motion, and RFD evaluation using a dynamometer and functional assessment of SLS, SJ, CMJ and CMJL on force plates and a p-value to 5% was considered significant. Results: At an average follow-up time of 9,10 ± 2,33 years, follow-up visits were conducted on 28 individuals. They took an average of 9,71 ± 8,12 months to return to pre-injury activity levels. Subjective assessments yielded average scores of: 3,43% ± 1,17 for the Tegner Score, 83,25% ± 23,61 for the Lysholm Score, 0,68 ± 1,52 for the NPRS, 85,53% ± 23,78 for the AKSS, 77,62% ± 23,80 for the KOOS-I, 74,10% ± 18,00 for the IKDC, and 80,94% ± 17,44 for the SF-36. At the clinical examination no patients tested positive for Valgus Stress Test and Posterior Drawer Test; only one patient reported PVND following the surgery; the Apley and McMurray were the tests with the highest positivity rates, but only the Valgus Test showed significant positivity. The dynamometer evaluations showed a significant difference in terms of knee flexion strength, knee extension strength, flexion AROM, and extension AROM. From the statistical analysis conducted for the tests performed on force platforms, patients did not present statistically significant during the SLS. The average height achieved in the SJ was 10,30 ± 4,63, in the CMJ was 11,54 ± 5,14, and in the CMJL was 14,47 ± 6,17. The comparison between these showed a difference only between SJ and CMJL. Furthermore, a significant increase in concentric force impulse was observed between SJ and CMJ and SJ and CMJL. However, no differences were found when comparing concentric and eccentric force between SJ and CMJ and CMJL. The SJ is the functional movement that allowed the identification of highly significant lower limb asymmetries: concentric force, concentric RFD, landing force, and RFD during the landing phase indicating that the injured limb is weaker. In the execution of CMJ and CMJL, no marked asymmetry between the lower limbs was identified except for concentric force expression in CMJL, where a greater weakness of the operated limb was noted. Conclusion: The patients in this study demonstrated significant asymmetries in terms of joint strength and joint AROM between the two limbs. Ultimately, it cannot be excluded that fascial tissue is directly involved in the operated limb compared to the contralateral limb.Study Design: Retrospective, single-center follow-up study. Background: There is limited data on surgical and post-operative rehabilitation, functional outcomes and there are no studies investigating the long-term asymmetry between the lower limbs in patients surgically treated for TPF. The possibility of using equipment such as force plates and dynamometers (VALD, Brisbane, Australia), has raised research questions about the potential presence of asymmetry in the two lower limbs in patients treated for TPF. Objective: The study investigates: subjective perception, quality of life, possible presence of asymmetry in: AROM, maximal strength, power, static and dynamic stability and the RFD between the limb operated and the non-operated limb. The data given us by the technology allows us to explore the possible involvement of fascial structures in the execution of functional movements that require the use of the upper limbs, in contrast to those that primarily involve the lower limbs. The data also enable us to investigate the potential impact of fascial tissue functions on the operated limb compared to the contralateral limb. Methods: The study included patients who underwent surgery between 2009 and 2016 at the orthopedic-traumatological clinic of the university-hospital in Padua. 28 patients were recruited and underwent subjective evaluation (Tegner, Lyhsolm, NPRS, AKSS, KOOS-I, IKDC, and SF-36), clinical evaluation (Lachman, Pivot Shift, Jerk, anterior drawer, posterior drawer, varus-valgus stress test, Apley test, McMurray test, meniscal palpation, alignement and PVND), strength, joint range of motion, and RFD evaluation using a dynamometer and functional assessment of SLS, SJ, CMJ and CMJL on force plates and a p-value to 5% was considered significant. Results: At an average follow-up time of 9,10 ± 2,33 years, follow-up visits were conducted on 28 individuals. They took an average of 9,71 ± 8,12 months to return to pre-injury activity levels. Subjective assessments yielded average scores of: 3,43% ± 1,17 for the Tegner Score, 83,25% ± 23,61 for the Lysholm Score, 0,68 ± 1,52 for the NPRS, 85,53% ± 23,78 for the AKSS, 77,62% ± 23,80 for the KOOS-I, 74,10% ± 18,00 for the IKDC, and 80,94% ± 17,44 for the SF-36. At the clinical examination no patients tested positive for Valgus Stress Test and Posterior Drawer Test; only one patient reported PVND following the surgery; the Apley and McMurray were the tests with the highest positivity rates, but only the Valgus Test showed significant positivity. The dynamometer evaluations showed a significant difference in terms of knee flexion strength, knee extension strength, flexion AROM, and extension AROM. From the statistical analysis conducted for the tests performed on force platforms, patients did not present statistically significant during the SLS. The average height achieved in the SJ was 10,30 ± 4,63, in the CMJ was 11,54 ± 5,14, and in the CMJL was 14,47 ± 6,17. The comparison between these showed a difference only between SJ and CMJL. Furthermore, a significant increase in concentric force impulse was observed between SJ and CMJ and SJ and CMJL. However, no differences were found when comparing concentric and eccentric force between SJ and CMJ and CMJL. The SJ is the functional movement that allowed the identification of highly significant lower limb asymmetries: concentric force, concentric RFD, landing force, and RFD during the landing phase indicating that the injured limb is weaker. In the execution of CMJ and CMJL, no marked asymmetry between the lower limbs was identified except for concentric force expression in CMJL, where a greater weakness of the operated limb was noted. Conclusion: The patients in this study demonstrated significant asymmetries in terms of joint strength and joint AROM between the two limbs. Ultimately, it cannot be excluded that fascial tissue is directly involved in the operated limb compared to the contralateral limb

Dual effects of leptin in perioperative gas exchange of morbidly obese patients

Leptin has shown positive effects on respiratory function in experimental settings. The role of leptin on perioperative respiratory function in morbidly obese patients has not been established. We performed a retrospective analysis of morbidly obese patients undergoing laparoscopic sleeve gastrectomy. Fasting serum leptin and interleukin (IL)-6 were measured preoperatively, and arterial blood gases were obtained pre- and postoperatively. Outcome variables were arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and differences in PaO2 and PaCO2 between pre- and postoperative values (\u394PaO2, \u394PaCO2; postoperative minus preoperative). Patients with lower (<40 \u3bcg/L) and higher ( 6540 \u3bcg/L) leptin levels were compared. Bravais-Pearson's correlation, multiple linear regression, and logistic regression analysis were performed. A total of 112 morbidly obese patients were included. Serum leptin was significantly higher in females than in males (42.86\ub112.89 vs. 30.67\ub113.39 \u3bcg/L, p<0.0001). Leptin was positively correlated with body mass index (r = 0.238; p = 0.011), IL-6 (r = 0.473; p<0.0001), and \u394PaO2 (r = 0.312; p = 0.0008). Leptin was negatively correlated with preoperative PaO2 (r = -0.199; p = 0.035). Preoperative PaO2 was lower, \u394PaCO2 was smaller, and \u394PaO2 was greater in the high leptin group than in the low leptin group. In multiple regression analysis, leptin was negatively associated with preoperative PaO2 (estimate coefficient = -0.147; p = 0.023). In logistic regression analysis, leptin was associated with improved \u394PaO2 (odds ratio [OR] = 1.104; p = 0.0138) and \u394PaCO2 (OR = 0.968; p = 0.0334). Leptin appears to have dual effects related to perioperative gas exchange in obese patients undergoing bariatric surgery. It is associated with worse preoperative oxygenation but improved respiratory function after surgery

Preface

Leibniz’s investigations into the structures of both natural and artificial languages, and into the impact of language use on human cognition, are widely acknowledged to have achieved real breakthroughs with respect to the standard early modern assumptions about these topics. Leibniz linked his linguistic interests with his views on mental activity by expounding the idea that language plays a fundamental role not only in communication but also in human cognition, insofar as words and signs in general serve as the indispensable thread for human thought. He used this insight into the linguistic component of thought to approach semantic phenomena such as metaphorical speech and ‘empty’ words or phrases, as well as psychological phenomena such as cognitive errors and the weakness of the will. Furthermore, his views on psycho-physical parallelism led him to explore the hypothesis that even abstract, conceptual representations have a physical counterpart in the human brain insofar as they are necessarily verbalized in a language or expressed in any other system of perceptible symbols

Eudicella trimeni Janson, 1884 (Coleoptera: Scarabaeidae: Cetoniinae: Goliathini): Description of larva with notes on conservation status, biology and taxonomy

Eudicella trimeni is reportedly one of the most endangered species of the genus, having been declared vir­tually extinct until recently. Present research has shown that the species occurs in an area wider than previously known. However, its habitat is disappearing at a fast rate and the Eastern Cape and KwaZulu-Natal populations appear to be sufficiently different from each other to warrant at least subspecies status and further investigation. Third instar larvae of the northern population were collected recently in the Karkloof Nature Reserve, KwaZulu-Natal. They were reared to adulthood under environmentally controlled conditions and are here described

Diversity and distribution of polyphagan water beetles (Coleoptera) in the Lake St Lucia system, South Africa

Water beetles belonging to the suborder Polyphaga vary greatly in larval and adult ecologies, and fulfil important functional roles in shallow-water ecosystems by processing plant material, scavenging and through predation. This study investigates the species richness and composition of aquatic polyphagan assemblages in and around the St Lucia estuarine lake (South Africa), within the iSimangaliso Wetland Park, a UNESCO World Heritage Site. A total of 32 sites were sampled over three consecutive collection trips between 2013 and 2015. The sites encompassed a broad range of aquatic habitats, being representative of the variety of freshwater and estuarine environments present on the St Lucia coastal plain. Thirty-seven polyphagan taxa were recorded during the dedicated surveys of this study, in addition to seven species-level records from historical collections. Most beetles recorded are relatively widespread Afrotropical species and only three are endemic to South Africa. Samples were dominated by members of the Hydrophilidae (27 taxa), one of which was new to science (Hydrobiomorpha perissinottoi Bilton, 2016). Despite the fauna being dominated by relatively widespread taxa, five represent new records for South Africa, highlighting the poor state of knowledge on water beetle distribution patterns in the region. Wetlands within the dense woodland characterising the False Bay region of St Lucia supported a distinct assemblage of polyphagan beetles, whilst sites occurring on the Eastern and Western Shores of Lake St Lucia were very similar in their beetle composition. In line with the Afrotropical region as a whole, the aquatic Polyphaga of St Lucia appear to be less diverse than the Hydradephaga, for which 68 species were recorded during the same period. However, the results of the present study, in conjunction with those for Hydradephaga, show that the iSimangaliso Wetland Park contains a high beetle diversity. The ongoing and future ecological protection of not only the estuarine lake itself, but also surrounding freshwater wetlands, is imperative and should be taken into consideration during future management planning for the park

Predaceous water beetles (Coleoptera, Hydradephaga) of the Lake St Lucia system, South Africa: biodiversity, community ecology and conservation implications

Water beetles are one of the dominant macroinvertebrate groups in inland waters and are excellent ecological indicators, reflecting both the diversity and composition of the wider aquatic community. The predaceous water beetles (Hydradephaga) make up around one-third of known aquatic Coleoptera and, as predators, are a key group in the functioning of many aquatic habitats. Despite being relatively well-known taxonomically, ecological studies of these insects in tropical and subtropical systems remain rare. A dedicated survey of the hydradephagan beetles of the Lake St Lucia wetlands (South Africa) was undertaken between 2013 and 2015, providing the first biodiversity census for this important aquatic group in the iSimangaliso Wetland Park, a UNESCO World Heritage Site within the Maputaland biodiversity hotspot. A total of 32 sites covering the entire spectrum of waterbody types were sampled over the course of three collecting trips. The Lake St Lucia wetlands support at least 68 species of Hydradephaga, a very high level of diversity comparing favourably with other hotspots on the African continent and elsewhere in the world and a number of taxa are reported for South Africa for the first time. This beetle assemblage is dominated by relatively widespread Afrotropical taxa, with few locally endemic species, supporting earlier observations that hotspots of species richness and centres of endemism are not always coincident. Although there was no significant difference in the number of species supported by the various waterbody types sampled, sites with the highest species richness were mostly temporary depression wetlands. This contrasts markedly with the distribution of other taxa in the same system, such as molluscs and dragonflies, which are most diverse in permanent waters. Our study is the first to highlight the importance of temporary depression wetlands and emphasises the need to maintain a variety of wetland habitats for aquatic conservation in this biodiverse region

The Motion of Grains of a Bed-Load Layer under a Turbulent Liquid Flow

Sediment Transport and Morphodynamic

Efecto de la hipersalinidad sobre el crecimiento y anomalías esqueléticas en juveniles de sargo del Cabo, Rhabdosargus holubi (Sparidae)

Estuarine organisms are exposed to hypersaline conditions for prolonged periods during drought conditions and under severely restricted river flow resulting from freshwater abstraction and impoundments. Consequently, marine estuarine-dependent fish such as Rhabdosargus holubi may be subjected to extreme conditions, such as hypersalinity prevailing for long periods ( > 2 months). Hypersalinity may impact the energetic demands of fish due to osmoregulation leading to compromised growth. This study assessed the impact of high salinity on the growth and skeletal development of R. holubi juveniles. Skeletons of juveniles grown at different salinities in the wild and in aquaria were analysed for anomalies. The impact of hypersaline conditions on juvenile R. holubi growth was also determined in aquaria. Aquarium experiments indicated that hypersalinity of 50 did not significantly impact growth rates over two months. Overall, anomalies were rare and vertebral-related anomalies specifically did not differ significantly between salinities. However, fin rays were significantly impacted in fish growing at higher salinities in the wild. It was concluded that the strong osmoregulatory ability of R. holubi offers protection against hypersalinity affecting internal structures, but external structures may remain vulnerable. As such, from a locomotory standpoint, R. holubi may be vulnerable to long periods of exposure to hypersaline conditions.Los organismos que habitan en estuarios están expuestos a condiciones de hipersalinidad durante períodos de sequía y en momentos en los que el aporte de agua fluvial se reduce de forma importante por substracción de aguas o presencia de embalses. Así, los peces marinos que dependen de los estuarios, como Rhabdosargus holubi, pueden estar expuestos a condiciones extremas, tales como una hipersalinidad de larga duración ( > 2 meses). La hipersalinidad puede afectar los requerimientos energéticos de los peces debido al proceso de osmoregulación y comprometer el correcto crecimiento del individuo. Este estudio investigó el impacto de altas salinidades sobre el crecimiento y el desarrollo esquelético en juveniles de Rhabdosargus holubi. Se analizó el esqueleto de juveniles crecidos en diferentes salinidades, tanto en el medio natural como en acuarios, para detectar la presencia de anomalías esqueléticas. Además, se estudió el impacto de condiciones de hipersalinidad en acuarios, sobre el crecimiento de juveniles de Rhabdosargus holubi. Los experimentos en acuario indicaron que una exposición de 2 meses a hipersalinidad de 50 no afectaron significativamente las tasas de crecimiento. La presencia de anomalías esqueléticas fue escasa y en concreto, las relativas a las vértebras fueron similares entre los grupos expuestos a las diferentes salinidades. Sin embargo, si se detectó un impacto significativo sobre el desarrollo de los radios de las aletas en los peces expuestos a altas salinidades en el medio natural. En conclusión, los resultados del estudio sugieren que la fuerte capacidad osmoreguladora de R. holubi le protege contra los efectos de la hipersalinidad sobre las estructuras internas, pero no sobre las estructuras externas, que permanecerían vulnerables a estas condiciones. Así, desde el punto de vista de la locomoción, R. holubi sería vulnerable a una exposición prolongada a condiciones de hipersalinidad