Dual-Camera Technique for Arthroscopic Rotator Cuff Repair

An all-arthroscopic rotator cuff repair demands a high level of technical skill and is associated with a steep learning curve. It is well accepted that small rotator cuff tears or partial tears can be more difficult than large or even massive tears to repair. Part of the reason is the difficulty in visualizing the tear, as well as important surrounding structures, during repair. To improve visibility during the repair process, we have introduced a second arthroscopic camera. Two cameras allow the surgeon to observe the rotator cuff from both the articular and bursal sides. We find this technique has merit in small or partial-thickness rotator cuff tears; however, there may be other applications

Stenting and Medical Therapy for Atherosclerotic Renal-Artery Stenosis

BACKGROUND Atherosclerotic renal-artery stenosis is a common problem in the elderly. Despite two randomized trials that did not show a benefit of renal-artery stenting with respect to kidney function, the usefulness of stenting for the prevention of major adverse renal and cardiovascular events is uncertain. METHODS We randomly assigned 947 participants who had atherosclerotic renal-artery stenosis and either systolic hypertension while taking two or more antihypertensive drugs or chronic kidney disease to medical therapy plus renal-artery stenting or medical therapy alone. Participants were followed for the occurrence of adverse cardiovascular and renal events (a composite end point of death from cardiovascular or renal causes, myocardial infarction, stroke, hospitalization for congestive heart failure, progressive renal insufficiency, or the need for renal-replacement therapy). RESULTS Over a median follow-up period of 43 months (interquartile range, 31 to 55), the rate of the primary composite end point did not differ significantly between participants who underwent stenting in addition to receiving medical therapy and those who received medical therapy alone (35.1% and 35.8%, respectively; hazard ratio with stenting, 0.94; 95% confidence interval [CI], 0.76 to 1.17; P = 0.58). There were also no significant differences between the treatment groups in the rates of the individual components of the primary end point or in all-cause mortality. During follow-up, there was a consistent modest difference in systolic blood pressure favoring the stent group (−2.3 mm Hg; 95% CI, −4.4 to −0.2; P = 0.03). CONCLUSIONS Renal-artery stenting did not confer a significant benefit with respect to the prevention of clinical events when added to comprehensive, multifactorial medical therapy in people with atherosclerotic renal-artery stenosis and hypertension or chronic kidney disease. (Funded by the National Heart, Lung and Blood Institute and others; ClinicalTrials.gov number, NCT00081731.

Holocene and Late Pleistocene Bat Fossils (Mammalia: Chiroptera) from Hamilton County, TN, and their Ecological Implications

Chiropteran mandibles from late Pleistocene/Holocene fossil cave localities in Hamilton County were identified in order to examine changes in bat species diversity and population trends over extended periods of time, providing insight into how bats in Southeast Tennessee have responded to major environmental changes over the past 10,000–20,000 years. Generic and species identifications were based on an unpublished key developed by the authors. Measurements of alveolar length (c1–m3) and total length measurements from the symphysis to the condyle were taken for all specimens identified as members of the genus Myotis in an attempt to identify species in this genus. The results of this study failed to confirm those of previous univariate morphological studies, suggesting that multivariate morphometric analyses may be needed to establish a means to differentiate among the species in this genus. Diversity data indicated two patterns of species abundance, with Eptesicus fuscus (Big Brown Bat) dominating some sites and Myotis sp. dominating others. The data suggest, but do not conclusively demonstrate, that a temporal replacement of older Eptesicus faunas by younger, Myotis-dominated faunas has occurred, connected with post-Pleistocene global warming. In addition, a correspondence between human disturbance and bat populations levels was observed. It is very likely that human disturbance has caused bat populations to become extinct in the caves under study, reinforcing the claim of previous researchers that bat population decline is a recent phenomenon that is tightly linksed to human disturbance

Observation of Three-Neutron Sequential Emission from ²⁵O

Background: Measurements of neutron-unbound states can test nuclear models in very neutron-rich nuclei that in some cases cannot be probed with other methods. Purpose: Search for highly excited neutron-unbound states of 25O above the three neutron separation energy. Method: The decay energy of 25O was reconstructed using the invariant mass spectroscopy method. A 101.3 MeV/u 27Ne beam collided with a liquid deuterium target. Two-proton removal reactions populated excited 25O that decayed into three neutrons and an 22O fragment. The neutrons were detected by arrays of plastic scintillator bars, while a 4 Tm dipole magnet placed directly after the target redirected charged fragments to a series of charged-particle detectors. The data were compared with detailed Monte Carlo simulations of the reaction process and subsequent decay. Results: The data show evidence of neutron-unbound level(s) in 25O at an excitation energy of about 9 MeV which decay sequentially by the emission of three neutrons to 22O. Conclusion: The observation of resonance strength in 25O at about 9 MeV is consistent with shell-model/eikonal calculations for the two-proton removal reaction from 27Ne.</p