Predicted and measured responses achieved by index selection on a positive and a negative selection line of pigs

International audienc

Neurological Complications of Elbow Arthroscopy

Elbow arthroscopy is an increasingly common procedure performed in orthopedic surgery. However, due to the presence of several major neurovascular structures in close proximity to the operative portals, it can have potentially devastating complications. The largest series of elbow arthroscopies to date described a 2.5% rate of post-operative neurological injury. All of these injuries were transient nerve injuries resolved without intervention. A recent report of major nerve injuries after elbow arthroscopy demonstrated that these injuries are likely under-reported in literature. A review of our records from 1998 to 2014 revealed six patients who had undergone elbow arthroscopy and developed neurological injury post-operatively. While complications after elbow arthroscopy are rare, the most common permanent nerve palsy post-operatively is the posterior interosseous nerve (PIN) followed by the ulnar nerve. Because of the surrounding neurovascular structures, familiarity with the normal elbow anatomy and portals will decrease the risk of damage to important structures. The purpose of this chapter is to review important steps in performing elbow arthroscopy with an emphasis on avoiding neurovascular injury. With a sound understanding of the important bony anatomic landmarks, sensory nerves, and neurovascular structures, elbow arthroscopy can provide both diagnostic and therapeutic intervention with little morbidity

The Structure of Mouse Cytomegalovirus m04 Protein Obtained from Sparse NMR Data Reveals a Conserved Fold of the m02-m06 Viral Immune Modulator Family

SummaryImmunoevasins are key proteins used by viruses to subvert host immune responses. Determining their high-resolution structures is key to understanding virus-host interactions toward the design of vaccines and other antiviral therapies. Mouse cytomegalovirus encodes a unique set of immunoevasins, the m02-m06 family, that modulates major histocompatibility complex class I (MHC-I) antigen presentation to CD8+ T cells and natural killer cells. Notwithstanding the large number of genetic and functional studies, the structural biology of immunoevasins remains incompletely understood, largely because of crystallization bottlenecks. Here we implement a technology using sparse nuclear magnetic resonance data and integrative Rosetta modeling to determine the structure of the m04/gp34 immunoevasin extracellular domain. The structure reveals a β fold that is representative of the m02-m06 family of viral proteins, several of which are known to bind MHC-I molecules and interfere with antigen presentation, suggesting its role as a diversified immune regulation module

Effects of graft pretensioning in anterior cruciate ligament reconstruction

Purpose Graft pretensioning is used in anterior cruciate ligament (ACL) reconstruction to prevent secondary slackening. Its effects on collagen fibrillar ultrastructure are not known. In this study, we hypothesized that graft pretensioning in ACL reconstruction creates ultrastructural changes detectable in scanning electron microscopy (SEM). Methods A prospective comparative study was carried out on 38 ACL reconstructions using a 4-strand semitendinosus graft. Samples were harvested intra-operatively before and after pretensioning for 30 s, 2 or 5 min. The images produced in SEM were analyzed using an original semi-quantitative «CIP» score taking into account collagen cohesion, integrity, and parallelism. Intra- and inter-tester reliability for the CIP score were tested. Results The CIP scores decreased by 3.5 (1.6) points after pretensioning (P < 0.05). Significant differences were found in the 5, 2 min and 30 s subgroups for the global CIP score. Relative decrease (Delta CIP) was significantly higher in the 2 and 5 min subgroups after pretensioning in comparison with the 30 s subgroups. Intra- and inter-tester reliability for the CIP score were 0.85 and 0.92 (P < 0.05). Conclusion Pretensioning ACL grafts resulted in alteration of the collagen fibrillar ultrastructure, detectable using SEM. These results confirm the existence of collagen ultrastructural changes after pretensioning that may be related to its duration. Level of evidence Prospective comparative study, Level II

Information use in chronic illness care: The role of the electronic health record in bridging patient experience and healthcare contexts

Chronic health conditions typically manifest as pervasive and ongoing in daily life, in contrast to their curative and episodic mode of treatment in most healthcare settings. A growing sense of provider‐patient disconnect and calls for healthcare reform have emerged new chronic care models that advocate for a team approach to care that is heavily supported through the use of an electronic health record (EHR). This interdisciplinary research examines the use of the EHR in chronic illness care within a best‐practice environment to understand how provider practices frame patient experience. Drawing on data from 144 hours of observation and 49 interviews with healthcare providers at three VA primary care clinics, we examined information use in provider work and patient care. Findings indicate the EHR as a de facto representation of the patient and a ubiquitous force in shaping provider work and patient care. The organizational context and provider work practices as reified in the EHR privileged and elevated objective indicators of the patient's level of “control” while obscuring subjective information and patient narrative that could be useful in problem‐solving disease management. The pervasive use of objective information in patient care and communication framed patient experience in the healthcare context in ways that seemed abstracted from their lived experience with illness, contributing to providerpatient disconnects. Providers were stymied by not having enough information to support effective self‐management or a more complete picture of patients' everyday life experiences, but there was no clear pathway for capturing, retrieving, and using such information in patient care. We suggest that EHR design for chronic illness care should make patients' experiential information more readily available and enable patient input and patient‐provider co‐construction of information. More work is needed to further understand how everyday life experience is presented and received in patient encounters.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90165/1/14504801192_ftp.pd

Mortality Rate in Veterans with Multiple Chronic Conditions

Background: Among patients with multiple chronic conditions, there is increasing appreciation of the complex interrelatedness of diseases. Previous studies have focused on the prevalence and economic burden associated with multiple chronic conditions, much less is known about the mortality rate associated with specific combinations of multiple diseases. Objective: Measure the mortality rate in combinations of 11 chronic conditions. Design: Cohort study of veteran health care users. Participants Veterans between 55 and 64 years that used Veterans Health Administration health care services between October 1999 and September 2000. Measurements: Patients were identified as having one or more of the following: COPD, diabetes, hypertension, rheumatoid arthritis, osteoarthritis, asthma, depression, ischemic heart disease, dementia, stroke, and cancer. Mutually exclusive combinations of disease based on these conditions were created, and 5-year mortality rates were determined. Results: There were 741,847 persons included. The number in each group by a count of conditions was: none = 217,944 (29.34%); 1 = 221,111 (29.8%); 2 = 175,228 (23.6%); 3 = 86,447 (11.7%); and 4+ = 41,117 (5.5%). The 5-year mortality rate by the number of conditions was: none = 4.1%; 1 = 6.0%; 2 = 7.8%; 3 = 11.2%; 4+ = 16.7%. Among combinations with the same number of conditions, there was significant variability in mortality rates. Conclusions: Patients with multiple chronic conditions have higher mortality rates. Because there was significant variation in mortality across clusters with the same number of conditions, when studying patients with multiple coexisting illnesses, it is important to understand not only that several conditions may be present but that specific conditions can differentially impact the risk of mortality

Response of Vicia faba L. to metal toxicity on mine tailing substrate:Geochemical and morphological changes in leaf and root

Vicia faba L. seeds were grown in a pot experiment on soil, mine tailings, and a mixture of both to mimic field situations in cultivated contaminated areas near mining sites. Metals in the substrates and their translocation in root, stem and leaf tissues were investigated, including morphological responses of plants growing on mine tailings. Metal concentration � and generally bioaccumulation � was in the order: roots > leaves > stems, except Pb and Cd. Translocation was most significant for Zn and Cd, but limited for Pb. Metal concentration in root and leaf was not proportional to that in the substrates, unexpectedly the minimum being observed in the mixed substrate whilst plant growth was retarded by 20% (38% on tailings). Calcium, pH, organic matter and phosphorus were the main influencing factors for metal translocation. The ultrastructure of V. faba L. cells changed a lot in the mine tailings group: root cell walls were thickened with electron dense Pb, Zn and C particles; in chloroplasts, the number of plastoglobuli increased, whereas the thylakoids were swollen and their number decreased in grana. Finally, needle-shaped crystalline concretions made of Ca and P, with Zn content, were formed in the apoplast of the plants. The stratagems of V. faba L. undergoing high concentrations of toxic metals in carbonate substrate, suggest root cell wall thickening to decrease uptake of toxic metals, a possible control of metal transport from roots to leaves by synthesizing phytochelators�toxic metal complexes, and finally a control of exceeded Ca and metal concentration in leaves by crystal P formation as ultimate response to stress defense. The geochemical factors influencing metal availability, guaranty a reduction of metal content in plant growing on mixed tailing/soil substrate as far as carbonate are not completely dissolved