The Management of large and massive rotator cuff tears- Current trends amongst UK shoulder surgeons

Background: Management of large and massive rotator cuff tears remains controversial. Such tears are often irreparable, and results of treatment are unpredictable. This study documents the current practice of orthopaedic surgeons in the British Elbow and Shoulder Society. Methods: A questionnaire was prepared pertaining to the management of large and massive rotator cuff tears with minimal degenerative changes in three age groups: Patients of 50 years (young), 65 years (still active), aged 75 years (elderly) were considered. Various risk factors for failure of repair were considered. Results: Physiotherapy and arthroscopic debridement were the most commonly selected management options in young and middle groups in cases of a large/massive rotator cuff tear. Patch repairs were offered by 30% of respondents overall. Latissimus dorsi transfer was utilised by 30%, 8% and 2% respectively in each age group. Reverse shoulder replacement was indicated by 8%, 36% and 76% respectively. Discussion: There was a marked inconsistency in the pre-op planning and number and choice of options between respondents. Most surgeons offered non-augmented repairs in a scenario where they admitted failure was likely. The need for a multicenter trial is widely recognised and 87% of respondents were willing to participate in such a trial

Fluvial sediment supply to a mega-delta reduced by shifting tropical-cyclone activity

© 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved. The world's rivers deliver 19 billion tonnes of sediment to the coastal zone annually, with a considerable fraction being sequestered in large deltas, home to over 500 million people. Most (more than 70 per cent) large deltas are under threat from a combination of rising sea levels, ground surface subsidence and anthropogenic sediment trapping, and a sustainable supply of fluvial sediment is therefore critical to prevent deltas being 'drowned' by rising relative sea levels. Here we combine suspended sediment load data from the Mekong River with hydrological model simulations to isolate the role of tropical cyclones in transmitting suspended sediment to one of the world's great deltas. We demonstrate that spatial variations in the Mekong's suspended sediment load are correlated (r = 0.765, P < 0.1) with observed variations in tropical-cyclone climatology, and that a substantial portion (32 per cent) of the suspended sediment load reaching the delta is delivered by runoff generated by rainfall associated with tropical cyclones. Furthermore, we estimate that the suspended load to the delta has declined by 52.6 ± 10.2 megatonnes over recent years (1981-2005), of which 33.0 ± 7.1 megatonnes is due to a shift in tropical-cyclone climatology. Consequently, tropical cyclones have a key role in controlling the magnitude of, and variability in, transmission of suspended sediment to the coast. It is likely that anthropogenic sediment trapping in upstream reservoirs is a dominant factor in explaining past, and anticipating future, declines in suspended sediment loads reaching the world's major deltas. However, our study shows that changes in tropical-cyclone climatology affect trends in fluvial suspended sediment loads and thus are also key to fully assessing the risk posed to vulnerable coastal systems

Fluxes of water, sediments, and biogeochemical compounds in salt marshes

Tidal oscillations systematically flood salt marshes, transporting water, sediments, organic matter, and biogeochemical elements such as silica. Here we present a review of recent studies on these fluxes and their effects on both ecosystem functioning and morphological evolution of salt marshes. We reexamine a simplified model for the computation of water fluxes in salt marshes that captures the asymmetry in discharge between flood and ebb. We discuss the role of storm conditions on sediment fluxes both in tidal channels and on the marsh platform. We present recent methods and field instruments for the measurement of fluxes of organic matter. These methods will provide long-term data sets with fine temporal resolution that will help scientists to close the carbon budget in salt marshes. Finally, the main processes controlling fluxes of biogenic and dissolved silica in salt marshes are explained, with particular emphasis on the uptake by marsh macrophytes and diatoms

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified