Femur Stress Fracture - Marathon

HISTORY: During a race, a 35-year-old marathon runner complained of experiencing dull, achy pain in the right groin. After the race, he occasionally experienced radiating pain in the right thigh. The athlete was examined by a general practitioner (GP). During the clinical evaluation, the athlete had no signs of tenderness or swelling. The GP suggested rest and prescribed anti-inflammatory medication. PHYSICAL EXAMINATION: Ten days later, during training, the athlete felt the same discomfort after a challenging training session. He, then, decided to see an orthopedic physician. At the clinical examination, there was no localized pain. Focal pain was present during weight bearing activities only. Initial x-rays showed no significant abnormality or fracture. However, due to the complaints of the athlete, the doctor suggested additional x-rays and an MRI. DIFFERENTIAL DIAGNOSIS: Lumbar radiculopathy Rectus femoris strain Abductor strain Trochanteric bursitis TEST AND RESULTS: - X-ray showed a fracture of the middle shaft of the femur - MRI showed a medial periosteal reaction in the femoral shaft (high fluid signal) - Pain, especially during internal rotation - Pain on the affected side with a single-leg stance - Pain during activity, reproducible on passive range of motion FINAL / WORKING DIAGNOSIS: Stress fracture of the middle shaft of the right femur TREATMENT AND OUTCOMES: Tolerate weight bearing if no displacement occurs (four months max.) Treatment by a metabolic physician (Vitamin D deficiency or other) Continuing follow-up with repeated imaging: Verify resolution and minimize the progression to displacement Surgery if conservative management fails (see #1-3) Intramedullary rodding (surgical procedure

Shoulder Arthroscopy After a Proximal Humeral Fracture Malunion: Athlete Care and Clinical Medicine in Middle-Aged Athletes

Malunion of the proximal humerus is operationally defined as healing of the fractured bone in a non-anatomical position, resulting in a painful and disabling deformity (e.g., a bone being shorter than normal, twisted or rotated in a bad position, or bent), which affects the range of motion (ROM) and functional movement. A correction and functional restoration are often needed in athletes, since their profession requires superior physical functioning. Shoulder arthroscopy has evolved dramatically over the past 15 years and has been used in cases of malunion of the humerus in athletes. However, there is a scarcity of evidence concerning middle-aged athletes. PURPOSE: To examine the benefits of shoulder arthroscopy after a proximal humeral fracture unified in malposition in middle-aged athletes. METHODS: Physical examination and imaging evaluation using 3D Computed Tomography(3D-CT), Magnetic Resonance Imaging (MRI), and shoulder radiographs (anteroposterior, internal rotation, and lateral scapular view) were used to evaluate shoulder dysfunction after proximal humeral fracture in malposition. Fourteen athletes (9 males, 5 females; Mage = 43.1, SD = 3.5) were included in this research. According to Neer classification before surgery, 11 (78%) had one part displaced and the rest three (22%) had two parts displaced. Post-operative clinical results were evaluated with self-reported pain score (1-10), UCLA scores, and shoulder abduction ROM measured with a goniometer. RESULTS: There was significant difference in pain scores (Mbefore = 8, Range: 6-9; Mafter = 4, Range: 2-6; p \u3c .001), in UCLA scores (Mbefore = 12, Range: 9-16; Mafter = 28, Range: 20-31; p \u3c .01), and in shoulder abduction ROM (Mbefore = 80, Range: 70-100; Mafter = 135, Range: 120-150; p \u3c .05). CONCLUSION: Our research provides evidence for clinical translation in improving health outcomes in middle-aged athletes with a history of proximal humeral fracture union in malposition: shoulder arthroscopy can be simultaneously beneficial in terms of decreasing pain level, increasing ROM, and restoring limb function

Inhibition of TGF-β Signaling and Decreased Apoptosis in IUGR-Associated Lung Disease in Rats

Intrauterine growth restriction is associated with impaired lung function in adulthood. It is unknown whether such impairment of lung function is linked to the transforming growth factor (TGF)-β system in the lung. Therefore, we investigated the effects of IUGR on lung function, expression of extracellular matrix (ECM) components and TGF-β signaling in rats. IUGR was induced in rats by isocaloric protein restriction during gestation. Lung function was assessed with direct plethysmography at postnatal day (P) 70. Pulmonary activity of the TGF-β system was determined at P1 and P70. TGF-β signaling was blocked in vitro using adenovirus-delivered Smad7. At P70, respiratory airway compliance was significantly impaired after IUGR. These changes were accompanied by decreased expression of TGF-β1 at P1 and P70 and a consistently dampened phosphorylation of Smad2 and Smad3. Furthermore, the mRNA expression levels of inhibitors of TGF-β signaling (Smad7 and Smurf2) were reduced, and the expression of TGF-β-regulated ECM components (e.g. collagen I) was decreased in the lungs of IUGR animals at P1; whereas elastin and tenascin N expression was significantly upregulated. In vitro inhibition of TGF-β signaling in NIH/3T3, MLE 12 and endothelial cells by adenovirus-delivered Smad7 demonstrated a direct effect on the expression of ECM components. Taken together, these data demonstrate a significant impact of IUGR on lung development and function and suggest that attenuated TGF-β signaling may contribute to the pathological processes of IUGR-associated lung disease

Measurement of electrons from semileptonic heavy-flavour hadron decays at midrapidity in pp and Pb-Pb collisions at √ s(NN)=5.02 TeV

The differential invariant yield as a function of transverse momentum (pT) of electrons from semileptonic heavy-flavour hadron decays was measured at midrapidity in central (0\u201310%), semi-central (30\u201350%) and peripheral (60\u201380%) lead\u2013lead (Pb\u2013Pb) collisions at sNN=5.02 TeV in the pT intervals 0.5\u201326 GeV/c (0\u201310% and 30\u201350%) and 0.5\u201310 GeV/c (60\u201380%). The production cross section in proton\u2013proton (pp) collisions at s=5.02 TeV was measured as well in 0.5<10 GeV/c and it lies close to the upper band of perturbative QCD calculation uncertainties up to pT=5 GeV/c and close to the mean value for larger pT. The modification of the electron yield with respect to what is expected for an incoherent superposition of nucleon\u2013nucleon collisions is evaluated by measuring the nuclear modification factor RAA. The measurement of the RAA in different centrality classes allows in-medium energy loss of charm and beauty quarks to be investigated. The RAA shows a suppression with respect to unity at intermediate pT, which increases while moving towards more central collisions. Moreover, the measured RAA is sensitive to the modification of the parton distribution functions (PDF) in nuclei, like nuclear shadowing, which causes a suppression of the heavy-quark production at low pT in heavy-ion collisions at LHC

Longitudinal and azimuthal evolution of two-particle transverse momentum correlations in Pb-Pb collisions at root √sNN=2.76 TeV

This paper presents the first measurements of the charge independent (CI) and charge dependent (CD) two-particle transverse momentum correlators G2CI and G2CD in Pb–Pb collisions at sNN=2.76TeV by the ALICE collaboration. The two-particle transverse momentum correlator G2 was introduced as a measure of the momentum current transfer between neighboring system cells. The correlators are measured as a function of pair separation in pseudorapidity (Δη) and azimuth (Δφ) and as a function of collision centrality. From peripheral to central collisions, the correlator G2CI exhibits a longitudinal broadening while undergoing a monotonic azimuthal narrowing. By contrast, G2CD exhibits a narrowing along both dimensions. These features are not reproduced by models such as HIJING and AMPT. However, the observed narrowing of the correlators from peripheral to central collisions is expected to result from the stronger transverse flow profiles produced in more central collisions and the longitudinal broadening is predicted to be sensitive to momentum currents and the shear viscosity per unit of entropy density η/s of the matter produced in the collisions. The observed broadening is found to be consistent with the hypothesized lower bound of η/s and is in qualitative agreement with values obtained from anisotropic flow measurements

Achilles Tendon Rupture – Young Adult Female Volleyball Player

CASE HISTORY: A 25-year-old professional volleyball player, who was playing in a game in Iceland, was transitioning off the net back-pedaling and pivoting as she felt something pop in her right calf. Initially, the athlete denied having any pain but was unable to plantarflex her foot or weight bear. At the time of injury, she was taking Sertraline (HCL 50 mg), Trazodone (50 mg), Wellbutrin XL (Bupropion HCL) 150 mg, Adderall (5mg) and birth control. PHYSICAL EXAM: The athlete was evaluated at an emergency room, where a Thompson squeeze test was performed and determined positive for an acute Achilles tendon rupture. The athlete was placed in a soft cast and was scheduled to be treated nonoperatively. DIFFERENTIAL DIAGNOSES: Acute Achilles tendon peritendinitis, medial gastrocnemius tear, calf muscle strain or rupture, posterior tibialis stress syndrome, posterior tibialis tendon injury, and peroneal injury. TESTS & RESULTS: Approximately one week after her initial diagnosis, she made arrangements to return to the US and to be re-evaluated by an Orthopedic surgeon. During the evaluation, the athlete reported pain over the Achilles tendon. Objectively, another positive Thompson squeeze test was performed. There was swelling over the Achilles tendon and a definite defect on the distal ⅓ of the tendon. There was no pain over the insertion point at the calcaneus or calf pain. An Ultrasound Duplex Doppler scan was performed to confirm the initial diagnosis and assess for deep vein thrombosis (DVT). Gray scale, color and imaging of the deep venous system of the right leg was performed from the level of the common femoral vein down to the level of the popliteal vein. There was no echogenic clot seen within the venous lumen. The veins tested exhibited normal compression and augmentation properties with color flow demonstrated within the tested veins. There was no evidence of DVT in the right leg. Evaluation before surgery showed obvious edema over her Achilles and a definite defect on the distal third of her Achilles. Non-operative and operative options were discussed. Surgery was elected due to nature of her sport. The athlete was made aware of the complications of surgery for this injury and the procedure was scheduled for the next day. FINAL DIAGNOSIS: Right Achilles tendon rupture. DISCUSSION: The most common mechanism of this injury is a forceful contraction of the calf and when the foot is placed into overpronation. The nature of the athlete\u27s sport made her more susceptible to this type of injury. However, it is relatively unusual for an athlete of her age/sex without previous medical history. Causes of Achilles rupture include tendinopathy, which is associated with overactivity of the sympathetic nervous system (SNS). The combination of those medications could lead to serotonin syndrome, which indicates an overactive SNS. It is possible that the duration and the interaction between this medley of medications may have increased her susceptibility to injury. OUTCOME OF THE CASE: Open repair of right Achilles tendon rupture. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Based on physical therapy notes, there was swelling but the incision was well healed with little tenderness. Slowly, she regained ROM and her strength. The right Achilles was noted to be thicker than the contralateral side. She voluntarily discontinued all medications shortly after the surgery. After several months of extensive rehabilitation and strengthening, she was able to return to the same level of performance

Type IV, Salter Harris Fracture - Adolescent Male Soccer Player

CASE HISTORY: An amateur, 14-year-old soccer player celebrated his goal by attempting a backflip. He ended up landing abnormally on his left foot. He complained about pain and swelling in the lateral aspect of the left ankle. PHYSICAL EXAM: The athlete was admitted to Children’s Hospital. The diagnosis based on the first X-Ray was Type II, Salter Harris fracture. The patient was treated conservatively. A short, leg cast was placed and per os analgesics were given. He was hospitalized for two days. Before getting discharged, a second X-Ray showed a well-aligned fracture. Two days later, the patient was still in pain. He decided to visit a private orthopedic doctor who made the plaster rounded and placed the foot in tip-toe gait. Two days after that, the athlete decided to visit a different private doctor since the pain was not subsiding. That doctor suspected that the fracture may continue into the posterior malleolus with the fracture line going through the growth plate inside the joint of the ankle. Therefore, he ordered a MRI and spiral CT for the left ankle. DIFFERENTIAL DIAGNOSES: Salter Harris II, Salter Harris III, Salter Harris IV, Salter Harris V, or additional fractures. TESTS & RESULTS: A) Radiological evaluation: a) Posterior and anterior view: Fracture passes through most of the growth plate and up through the metaphysis. Orthopedic Classification: Salter Harris Type II and b) Lateral view: Fracture passes along the growth plate and down through the epiphysis. Orthopedic Classification: Salter Harris Type III. B) CT SCAN: The fracture line goes through the metaphysis, growth plate and down through the epiphysis. Orthopedic Classification: Salter Harris Type IV. FINAL DIAGNOSIS: Fracture across the metaphysis, physis and epiphysis: Salter Harris Type IV. DISCUSSION: Type IV Salter Harris fracture involves all three elements of the bone and is an intra-articular fracture. Chronic disability is a potential outcome as these fractures can cause premature focal fusion. Therefore, these injuries can result in growth retardation, altered joint mechanics, and functional impairment. Urgent orthopedic evaluation and surgical restoration are crucial, especially in children and adolescents. OUTCOME OF THE CASE: Due to delayed treatment, doctors had the following surgical options: 1. Close reduction and osteosynthesis with k-wires; 2. Open reduction and internal fixation with cannulated screws; and 3. Ankle joint arthroscopy in case of non-satisfactory alignment of the fracture. The final treatment decision included closed reduction with one k-wire and circular cast. RETURN TO ACTIVITY AND FURTHER FOLLOW-UP: Post operation X-Rays showed success. A month later and after additional X-Rays, the circular cast and the k-wire were removed. The athlete gradually proceeded to muscle-strengthening exercises and reached full active ROM

Mitochondria as sensors and regulators of calcium signalling.

During the past two decades calcium (Ca(2+)) accumulation in energized mitochondria has emerged as a biological process of utmost physiological relevance. Mitochondrial Ca(2+) uptake was shown to control intracellular Ca(2+) signalling, cell metabolism, cell survival and other cell-type specific functions by buffering cytosolic Ca(2+) levels and regulating mitochondrial effectors. Recently, the identity of mitochondrial Ca(2+) transporters has been revealed, opening new perspectives for investigation and molecular intervention

Measurement of Upsilon(1S) Elliptic Flow at Forward Rapidity in Pb-Pb Collisions at root s(NN)=5.02 TeV

The first measurement of the Upsilon(1S) elliptic flow coefficient (v(2)) is performed at forward rapidity (2.5 < y < 4) in Pb-Pb collisions at root s(NN) = 5.02 TeV with the ALICE detector at the LHC. The results are obtained with the scalar product method and are reported as a function of transverse momentum (pT) up to 15 GeV/c in the 5%-60% centrality interval. The measured Upsilon(1S)v(2) is consistent with 0 and with the small positive values predicted by transport models within uncertainties. The v(2) coefficient in 2 < p(T) < 15 GeV=c is lower than that of inclusive J/psi mesons in the same p(T) interval by 2.6 standard deviations. These results, combined with earlier suppression measurements, are in agreement with a scenario in which the Upsilon(1S) production in Pb-Pb collisions at LHC energies is dominated by dissociation limited to the early stage of the collision, whereas in the J/psi case there is substantial experimental evidence of an additional regeneration component

K*(892)(0) and phi(1020) production at midrapidity in pp collisions at root s=8 TeV

The production of K∗(892)0 and φ(1020) in pp collisions at s=8 TeV was measured by using Run 1 data collected by the ALICE collaboration at the CERN Large Hadron Collider (LHC). The pT-differential yields d2N/dydpT in the range 0<20 GeV/c for K∗0 and 0.4<16 GeV/c for φ have been measured at midrapidity, |y|<0.5. Moreover, improved measurements of the K∗0(892) and φ(1020) at s=7 TeV are presented. The collision energy dependence of pT distributions, pT-integrated yields, and particle ratios in inelastic pp collisions are examined. The results are also compared with different collision systems. The values of the particle ratios are found to be similar to those measured at other LHC energies. In pp collisions a hardening of the particle spectra is observed with increasing energy, but at the same time it is also observed that the relative particle abundances are independent of the collision energy. The pT-differential yields of K∗0 and φ in pp collisions at s=8 TeV are compared with the expectations of different Monte Carlo event generators