Rehabilitation versus surgical reconstruction for non-acute anterior cruciate ligament injury (ACL SNNAP): a pragmatic randomised controlled trial

BackgroundAnterior cruciate ligament (ACL) rupture is a common debilitating injury that can cause instability of the knee. We aimed to investigate the best management strategy between reconstructive surgery and non-surgical treatment for patients with a non-acute ACL injury and persistent symptoms of instability.MethodsWe did a pragmatic, multicentre, superiority, randomised controlled trial in 29 secondary care National Health Service orthopaedic units in the UK. Patients with symptomatic knee problems (instability) consistent with an ACL injury were eligible. We excluded patients with meniscal pathology with characteristics that indicate immediate surgery. Patients were randomly assigned (1:1) by computer to either surgery (reconstruction) or rehabilitation (physiotherapy but with subsequent reconstruction permitted if instability persisted after treatment), stratified by site and baseline Knee Injury and Osteoarthritis Outcome Score—4 domain version (KOOS4). This management design represented normal practice. The primary outcome was KOOS4 at 18 months after randomisation. The principal analyses were intention-to-treat based, with KOOS4 results analysed using linear regression. This trial is registered with ISRCTN, ISRCTN10110685, and ClinicalTrials.gov, NCT02980367.FindingsBetween Feb 1, 2017, and April 12, 2020, we recruited 316 patients. 156 (49%) participants were randomly assigned to the surgical reconstruction group and 160 (51%) to the rehabilitation group. Mean KOOS4 at 18 months was 73·0 (SD 18·3) in the surgical group and 64·6 (21·6) in the rehabilitation group. The adjusted mean difference was 7·9 (95% CI 2·5–13·2; p=0·0053) in favour of surgical management. 65 (41%) of 160 patients allocated to rehabilitation underwent subsequent surgery according to protocol within 18 months. 43 (28%) of 156 patients allocated to surgery did not receive their allocated treatment. We found no differences between groups in the proportion of intervention-related complications.InterpretationSurgical reconstruction as a management strategy for patients with non-acute ACL injury with persistent symptoms of instability was clinically superior and more cost-effective in comparison with rehabilitation management

Organizing pneumonia: a kaleidoscope of concepts and morphologies

Abstract The basic histopathological pattern of organizing pneumonia (OP) is well recognized, but the contexts in which it is encountered continue to increase. In parallel with an appreciation of new causes and associations of OP, an understanding of OP in the spectrum of lung injury and repair has evolved. There is an increasing array of HRCT manifestations of OP, some of which have only recently been described. This article concentrates on new concepts surrounding OP and highlights newly described imaging patterns

Agroforestry Systems for Ammonia Abatement. AC0201 Final Report

Ammonia (NH3) emissions to the atmosphere increased significantly during the 20th century, largely due to the intensification of agricultural production. Ammonia is a soluble and reactive gas that is emitted by volatilization from various agricultural nitrogen forms including urea, uric acid and mineral fertilizers. Emissions are dependent on various meteorological inputs like temperature and wind speed, and are higher in warmer drying conditions, with smaller emissions occurring under cooler wetter conditions. Impacts of excess nitrogen can include eutrophication and acidification effects on semi-natural ecosystems that can lead to species composition changes. Agroforestry Ammonia Abatement (AAA) is a practical concept which uses both the dispersive effect of a barrier and the uptake of NH3 into the tree canopy to mitigate NH3 emissions. This work built upon the research carried out in Defra project AC0201, bringing together measurements, modelling and agroeconomic analyses to build an assessment of the potential benefits and drawbacks of applying AAA strategies both on a local and national scale. The project objectives were to assess the efficacy of farm woodland features for the recapture of agricultural NH3 emissions. The potential of farm woodlands for NH3 mitigation at a local and the UK scale were assessed. The combined modelling and measurement results from this project show that AAA carefully planned and implemented can lead to a significant decrease in NH3 concentrations downwind from sources and a moderate, up to 20% net decrease in emissions to the atmosphere. AAA systems could be used as a protective measure of downwind sensitive ecosystems where local concentration reductions can be higher. Use of existing woodland plantations and panting new forestry can both be used to mitigate emissions, though scrubbing of NH3 at source and reuse would also be a solution. UK scale modelling shows that targeted application of tree planting around agricultural installations would have a modest effect by modifying ‘on-farm’ emission factors, however when the approach is targeted in regions hot-spot emissions, significant effects on NH3 and N-deposition can be achieved.In many agricultural businesses there are no current economic advantages for converting valuable arable land to woodland without specific opportunity benefits (e.g. woodland egg price margins due to animal welfare considerations, carbon or nitrogen credits). However as the woodland egg example shows, when other considerations become relevant, AAA can be a useful approach. It is noted that mitigating ammonia with trees only addresses one nitrogen flow in the farming systems and the net effect on both the reactive and GHG N budgets over the landscape scale should be considered

Evaluation of sulfatase-directed quinone methide traps for proteomics

Lenger J, Schröder M, Ennemann E, et al. Evaluation of sulfatase-directed quinone methide traps for proteomics. Bioorganic & Medicinal Chemistry. 2012;20(2):622-627.Sulfatases hydrolytically cleave sulfate esters through a unique catalytic aldehyde, which is introduced by a posttranslational oxidation. To profile active sulfatases in health and disease, activity-based proteomic tools are needed. Herein, quinone methide (QM) traps directed against sulfatases are evaluated as activity-based proteomic probes (ABPPs). Starting from a p-fluoromethylphenyl sulfate scaffold, enzymatically generated QM-traps can inactivate bacterial aryl sulfatases from Pseudomonas aeruginosa and Klebsiella pneumoniae, and human steroid sulfatase. However, multiple enzyme-generated QMs form, diffuse, and non-specifically label purified enzyme. In complex proteomes, QM labeling is sulfatase-dependent but also non-specific. Thus, fluoromethylphenyl sulfates are poor ABPPs for sulfatases