Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics

"Published online: 24 October 2017"PURPOSE: Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD). METHODS: Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD = 1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task. RESULTS: The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P = 0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P = 0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P < 0.001). CONCLUSIONS: Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively. LEVEL OF EVIDENCE: Level II, prospective cohort study.The authors gratefully acknowledge the funding support from the Hellenic Association of Orthopaedic Surgery and Traumatology (HAOST-EEXOT)info:eu-repo/semantics/publishedVersio

Favorable results from the use of herbal and plant products in inflammatory bowel disease: Evidence from experimental animal studies

The use of herbal therapy for inflammatory bowel disease is increasing worldwide. The aim of this study was to review the available literature on the efficacy of herbal therapy in experimental colitis. All relevant studies published in Medline and Embase up to June 2015 have been reviewed. The results of bowel histology and serum parameters have been recorded. A satisfactory number of published experimental studies, and a quite large one of both herbal and plant products tested in different studies have been reported. The results showed that in the majority of the studies, herbal therapy reduced the inflammatory activity of experimental colitis and diminished the levels of many inflammatory indices, including serum cytokines and indices of oxidative stress. The most promising plant and herbal products were tormentil extracts, wormwood herb, Aloe vera, germinated barley foodstuff, curcumin, Boswellia serrata, Panax notoginseng, Ixeris dentata, green tea, Cordia dichotoma, Plantago lanceolata, Iridoid glycosides, and mastic gum. Herbal therapies exert their therapeutic benefit via various mechanisms, including immune regulation, anti-oxidant activity, inhibition of leukotriene B4 and nuclear factor-κB, and antiplatelet activity. Large, double-blind clinical studies assessing these natural substances should be urgently conducted. © 2016 Hellenic Society of Gastroenterology

Poor sleep and high anxiety levels in women with functional hypothalamic amenorrhoea: A wake-up call for physicians?

Objective: To assess sleep disorders (SleD)in women with functional hypothalamic amenorrhoea (FHA)and to identify possible associations with known FHA predisposing factors. Study design: We conducted a prospective case-control study spanning the period January 2016 to April 2018. We recruited forty-one FHA women and 86 healthy controls. We assessed SleD and other FHA predisposing factors via self-reported questionnaires. The Spearman&apos;s correlation coefficient (rho)was used to examine possible correlations among the different variables. Multivariate logistic regression analysis was conducted to identify independent factors associated with SleD. Results: Women with FHA reported having higher SleD (p = 0.004), abnormal eating attitudes (p &lt; 0.0001), higher anxiety levels (AL)(p &lt; 0.0001), overweight preoccupation (P &lt; 0.0001)and increased weekly physical activity (p = 0.004). There was a significant positive correlation between SleD and AL (rho = 0.88, p &lt; 0.0001). Significant correlation was also found between AL and several Athens insomnia scale constituents, including sleep induction (rho = 0.53, p = 0.0004), awakenings during the night (rho = 0.6, p &lt; 0.0001), final awakening (rho = 0.42, p = 0.006), total sleep duration (rho = 0.64, p &lt; 0.0001), quality of sleep (rho = 0.63, p &lt; 0.0001), well-being during the day (rho = 0.34, p = 0.03)and sleepiness during the day (rho = 0.51, p = 0.007). High AL were correlated with 2.83-fold increased SleD risk (p = 0.04). Conclusion: FHA women are seemingly more prone to SleD and those with SleD suffer from higher AL. In view of this evidence, the potential rationale of adding psychological and SleD evaluation to their clinical care is highlighted. © 201

Severity of Alopecia Predicts Coronary Changes and Arterial Stiffness in Untreated Hypertensive Men

An association between androgenic alopecia (AGA), coronary artery disease, and hypertension has been reported in previous epidemiological studies. The authors evaluated the relationship of target organ damage caused by hypertension with AGA in 101 newly diagnosed and untreated hypertension men with mild to moderate AGA (AGAm), severe AGA (AGAs), and non-AGA. Pulse wave velocity (PWV), office and 24-hour pulse pressure (PP), carotid intima-media thickness (IMT), left ventricular hypertrophy (LVH), coronary flow reserve (CFRd), and AGA severity by Hamilton-Norwood scale were estimated. CFRd was significantly impaired in AGAs patients compared with AGAm (P=.007) and non-AGA patients (P=.02). No differences were found within groups regarding PWV, PP, IMT, and LVH. AGA severity was related to CFRd (independently) and PP while AGA duration and age of onset were related to CFRd and PP, respectively. The authors conclude that impaired coronary microcirculation and aortic stiffness might precede the appearance of significant stenotic coronary lesions in hypertensive patients with severe AGA. In addition, hypertensive patients with severe and early AGA onset seem to be exposed to an augmented cardiovascular risk. ©2016 Wiley Periodicals, Inc