Anthony El Alam, M.D., Tracy El Khoury, M.D., Joe Ghanimeh, M.D.
et al.
Purpose: To evaluate the impact of the tibial slope on the severity and location of meniscal tears in patients presenting with anterior cruciate ligament (ACL) rupture. Methods: We conducted a single-center retrospective observational study. We analyzed charts and records of patients who underwent ACL tear surgery between 2018 and 2021, excluding those with multiligamentous knee injuries or osteoarthritis. Posterior tibial slope was measured from lateral radiographs, and data on meniscal tears characteristics were collected, including laterality, anatomical location, blood supply zone, tear type, and treatment modality. Results: We included 749 patients (127 female, 622 male) who underwent ACL reconstruction (hamstring tendons, n = 59; bone−patellar tendon−bone, n = 659; quadriceps tendon, n = 31). Concomitant meniscal tears occurred in 361 patients (medial meniscus, 50.7%; lateral meniscus, 31.9%; both menisci, 17.4%). No correlation was found between posterior tibial slope and meniscal injury overall (P = .8). However, a significant correlation was noted between tibial slope and lateral meniscal body tear (P = .023). Conclusions: Our findings suggest that an increased tibial slope, as measured on lateral radiographs, is not indicative of concomitant meniscal tears. However, in cases in which meniscal tears did occur in patients with a high posterior tibial slope, they predominantly affected the lateral meniscal body. Level of Evidence: Level IV, prognostic, case series.
Abstract The maximal lactate steady state, abbreviated as MLSS, is the maximal exercise intensity where the concentration of earlobe capillary or arterial blood lactate remains constant over time. In the late 1970s and early 1980s, we (i.e. Hermann Heck and co-workers) developed a direct test to determine the MLSS to investigate whether it occurred at a lactate concentration of 4 mmol.L− 1, as earlier predicted by Alois Mader and colleagues. The test consisted of each participant performing several constant-intensity running bouts of ≈ 30 min at intensities close to the estimated MLSS. During each run, we measured lactate every 5 min. Based on the results, we defined the MLSS as the “workload where the concentration of blood lactate does not increase more than 1 mmo.L − 1 during the last 20 min of a constant load exercise”. This MLSS protocol is impractical for performance testing as it requires too many exercise bouts, but it is a gold standard to determine the real MLSS. It is especially useful to validate indirect tests that seek to estimate the MLSS.
Efferocytosis of apoptotic neutrophils (PMNs) by macrophages is helpful for inflammation resolution and injury repair, but the role of efferocytosis in intrinsic nature of macrophages during septic acute kidney injury (AKI) remains unknown. Here we report that CD47 and signal regulatory protein alpha (SIRPα)—the anti-efferocytotic ‘don't eat me’ signals—are highly expressed in peripheral blood mononuclear cells (PBMCs) from patients with septic AKI and kidney samples from mice with polymicrobial sepsis and endotoxin shock. Conditional knockout (CKO) of SIRPA in macrophages ameliorates AKI and systemic inflammation response in septic mice, accompanied by an escalation in mitophagy inhibition of macrophages. Ablation of SIRPA transcriptionally downregulates solute carrier family 22 member 5 (SLC22A5) in the lipopolysaccharide (LPS)-stimulated macrophages that efferocytose apoptotic neutrophils (PMNs). Targeting SLC22A5 renders mitophagy inhibition of macrophages in response to LPS stimuli, improves survival and deters development of septic AKI. Our study supports further clinical investigation of CD47-SIRPα signalling in sepsis and proposes that SLC22A5 might be a promising immunotherapeutic target for septic AKI.
The COVID-19 pandemic brought the global world of sports to a staggering halt. In unprecedented fashion and with few exceptions, professional leagues, mass participation endurance events, and youth sport around the globe went silent. In the face of a rapidly evolving health crisis, the decision to cancel or postpone sporting events was a logical and necessary step. COVID-19 is a highly contagious, potentially fatal virus that is transmitted primarily through contact with aerosolised or surface-dwelling respiratory secretions, a process that requires close human contact.1 Competitive sport as we know it, from athletes ‘elbowing’ one another for position on the pitch to arenas packed with fans, may be the quintessential antithesis of social distancing. There is concern that the Champions League match between Atalanta and Valencia in Milan may have influenced the trajectory of COVID-19 cases in Europe.2 In the absence of a vaccination or curative intervention, physical distancing emerged as the key step to slow or stop the spread of COVID-19. Thus, the decision to turn off the lights and to silence competitive athletics represented a logical, essential and highly visible component in the global fight against COVID-19. This has been an unusually quiet time for the sports medicine community. Athletic training rooms have gone dark, and many clinicians have been repurposed to meet the needs of patients with COVID-19. Fortunately, this will not last forever. The great American …
Background: Anterolateral ligament reconstruction (ALLR) and lateral extra-articular tenodesis (LET) show promise in lowering the risk of rerupture after anterior cruciate ligament reconstruction (ACLR), but there are little data on surgeon practices and preferences in children and adolescents. Purpose: To quantify surgeon practices regarding ALLR and LET in the pediatric population. Study Design: Cross-sectional study. Methods: An electronic survey was administered to 87 surgeons in the Pediatric Research in Sports Medicine society. The questionnaire asked several questions about surgeon and practice characteristics as well as indications, preferences, and techniques for ALLR or LET in the context of primary and revision pediatric ACLR. Chi-square and Fisher exact tests were used to evaluate factors that affect surgical preferences. Results: A total of 63 surgeons completed the survey, of whom 62% performed ≥50 pediatric ACLRs annually; 56% sometimes performed anterolateral augmentation with primary ACLR, and 79% with revision ACLR. The most common indications for ALLR or LET in the primary setting were high-grade pivot shift, knee hyperextension, generalized laxity, and type of sports participation. Surgeons whose practice was >75% sports medicine were more likely to perform ALLR or LET with both primary and revision ACLR (P = .005 and P < .001, respectively). Those who had completed a sports medicine fellowship were more likely to perform these procedures than those with only pediatric orthopaedic training, in both primary (68% vs 36%; P = .01) and revision scenarios (92% vs 60%; P = .002). Of the 28 respondents who did not perform ALLR or LET with primary ACLR, 75% cited insufficient evidence as the reason. However, 96% of surgeons who did perform these procedures expressed interest in studying them prospectively, and 87% were willing to randomize patients. Conclusion: Findings indicated that 56% of pediatric sports surgeons sometimes perform anterolateral augmentation with primary ACLR and 79% with revision ACLR. Surgeons with sports medicine fellowship training or a mostly sports practice were more likely to perform these procedures. Insufficient evidence was the most common reason given by surgeons who did not perform anterolateral augmentation. However, there was substantial willingness to prospectively study and even randomize pediatric patients to assess the impact of ALLR or LET in this population.
In recent editorials of the British Journal of Sports Medicine (Burns & Tam, 2020) and Footwear Science (Frederick, 2020; Hoogkamer, 2020), the effect of midsole construction on running performance...
Whey Proteins: From Milk to Medicine addresses the basic properties of whey proteins including chemistry, analysis, heat sensitivity, interactions with other proteins and carbohydrates, modifications (hydrolysis, aggregation, conjugation), their industrial preparation, processing and applications, quality aspects including flavour and effects of storage, as well as their role in nutrition, sports and exercise, and health and wellness. Readers of Whey Proteins will gain a better understanding of the chemical nature of the various whey proteins in cow’s milk and the milk of other species. This includes their unique physical and functional properties; the industrial processes used to extract them from milk, to process them into various forms, and to modify them to enhance their functionality; and their nutritive value and application in the fields of sports and exercise science, infant nutrition and medicine. This book is an essential resource for food and nutrition researchers, dairy and food companies, pharmaceutical organizations, and graduate students.
Abstract Background The aim of this study is to evaluate both the utility of MRI scans and reports used in the current practice routine of shoulder surgeons and their surgical decision-making process. Methods Ninety-three shoulder-specialised orthopaedic surgeons of the Canadian Shoulder and Elbow Society (CSES) Orthopaedic Association were surveyed in 2020 anonymously online to help identify the use of MR-imaging and reports in managing shoulder disorders and surgical decision process. Results Thirty out of 93 (32.25%) CSES fellowship-trained orthopaedic surgeons participated. Respondents request MRI scans in about 55% of rotator cuff (RC) pathology and 48% of shoulder instability cases. Fifty percent of patients with potential RC pathology arrive with a completed MRI scan prior first orthopaedic consult. Their surgical decision is primarily based on patient history (45–55%) and physical examination (23–42%) followed by MRI scan review (2.6–18%), reading MRI reports (0–1.6%) or viewing other imaging (3–23%) depending on the shoulder disease. Ninety percent of surgeons would not decide on surgery in ambiguous cases unless the MR-images were personally reviewed. Respondents stated that shoulder MRI scans are ordered too frequently prior specialist visit as identified in more than 50% of cases depending on pathology. Conclusions The decision-making process for shoulder surgery depends on the underlying pathology and patient history. The results demonstrate that orthopaedic surgeons are comfortable reviewing shoulder MRI scans without necessarily reading the MRI report prior to a surgical decision. MRI scans are becoming an increasingly important part of surgical management in shoulder pathologies but should not be used without assessment of patient history and or physical examination.
Osteoporosis is a disease that impacts the elderly. Low estrogen is related to changes in DNA methylation and consequent alterations in gene expression, leading to a new direction in research related to the pathophysiology of osteoporosis. We constructed an Ovariectomized (OVX) mouse model in our study, and the mouse models had osteoporosis based on the phenotype and methylation levels in the mouse’s bone. Furthermore, the methylation level of the OVX mice was significantly changed compared to that of SHAM mice. Therefore, we performed genome-level analysis on the mouse model using transcriptome and Whole Genome Bisulfite Sequencing (WGBS) by combining the data of two omics and discovered that the changes in gene expression level caused by osteoporosis primarily focused on the decrease of bone and muscle development and the activation of the immune system. According to intersection analysis of methylation and transcriptome data, the differentially expressed genes and pathways are consistent with the differentially expressed methylation locations and regions. Further, the differentially expressed methylation sites were mainly concentrated in promoters, exons, and other critical functional regions of essential differentially expressed genes. This is also the primary cause of gene differential expression variations, indicating that estrogen deficiency might regulate gene expression by altering methylation modification, leading to osteoporosis. We demonstrated the clinical value of methylation modification research, and these findings would improve the current understanding of underlying molecular mechanisms of osteoporosis incidence and development and provide new ideas for early detection and treatment of osteoporosis.
Marianna Bellafiore, Anna Maria Pintaudi, Ewan Thomas
et al.
Background The aim of this study was to investigate if the supplementation with Opuntia ficus-indica (OFI) juice may affect plasma redox balance and heart rate variability (HRV) parameters following a maximal effort test, in young physically active women. Methods A randomized, double blind, placebo controlled and crossover study comprising eight women (23.25 ± 2.95 years, 54.13 ± 9.05 kg, 157.75 ± 0.66 cm and BMI of 21.69 ± 0.66 kg/m2) was carried out. A juice containing OFI diluted in water and a Placebo solution were supplied (170 ml; OFI = 50 ml of OFI juice + 120 ml of water; Placebo = 170 ml beverage without Vitamin C and indicaxanthin). Participants consumed the OFI juice or Placebo beverage every day for 3 days, before performing a maximal cycle ergometer test, and for 2 consecutive days after the test. Plasma hydroperoxides and total antioxidant capacity (PAT), Skin Carotenoid Score (SCS) and HRV variables (LF, HF, LF/HF and rMSSD) were recorded at different time points. Results The OFI group showed significantly lower levels of hydroperoxides compared to the Placebo group in pre-test, post-test and 48-h post-test. PAT values of the OFI group significantly increased compared to those of the Placebo group in pre-test and 48-h post-test. SCS did not differ between groups. LF was significantly lower in the OFI group 24-h after the end of the test, whereas rMSSD was significantly higher in the OFI group 48-h post-test. Conclusion OFI supplementation decreased the oxidative stress induced by intense exercise and improved autonomic balance in physically active women.
Zygmunt Siedlecki, Agnieszka Gutkowska, Karol Nowak
et al.
<p>We present the current state of affairs regarding the legal claims of patients after cranioplasty operations who are dissatisfied with the treatment effect and have claims that the perioperative course is unfavorable. In the period of 11 years (2010-2020), 2 legal claims were submitted in our neurosurgical center after cranioplasty. Both are civil claims. One of them about purulent infection of the bone prosthesis was found by the judgment to be unfounded. The second one concerning the alleged general condition deterioration as a consequence of cranioplasty has been declared obsolete. A cranioplasty is a surgical procedure used to correct a defect in a bone of the skull. It is not urgent sugery and is performed in patients who had been previously in serious condition. The same medical staff who previously saved the live of patients by performing brain decompression may be subject of legal claims in the case of cranioplasty. Thus, according to authors, claims of patients regarding the alleged negative effects of cranioplasty is an interesting psychological phenomenon. Authors epmhasized that cranioplasty should be considered as a procedure of increased risk of potential legal claims for medical staff.</p>
Objective: subcutaneous rupture of the distal biceps tendon is the most common tendon injury of the elbow. Recently with the best understanding of the anatomy and the advent of new fixations many surgeons took up the use of single incision surgery, as an alternative to replace the tendon. Materials and methods: 40 male patients (average age 45,2) operated from 2006 to 2016. Results: only 3 cases had post-surgery complications: 1. a transient neurapraxia of the posterior interosseous nerve, 2. a radio-ulnar synostosis with stiffness in pronation and supination, and 3. a stiffness of the elbow in extension of approximately 5° degrees. Conclusions: the reinsertion of the distal biceps tendon with bone tunnel in anatomical site is a safe, reproducible technique that offers excellent clinical results. Patients achieve a complete recovery of the elbow range of motion, strength and endurance, with minimal risk of complications