Search

Posterior shoulder instability is increasingly recognized and represents a complex continuum of pathology that can be challenging to diagnose and treat. Current surgical options involve posterior labral repair with or without capsular plication, as well as bony procedures, including glenoid bone grafting and glenoid osteotomy when indicated, often in the setting of revision. There is presently a dearth of surgical options to directly address the root cause of soft tissue failure, including a diminutive posterior labrum, chondrolabral retroversion, and thin or hyperelastic posterior capsule. This article presents a technique for arthroscopically augmenting the posterior capsulolabral complex in the setting of soft tissue insufficiency, laxity, or poor prognostic factors for failure. Secondarily, this technique provides a lower risk revision option for reconstruction in failed posterior instability without glenoid bone defect., (© 2022 The Authors.)

There are many techniques described for biceps tenodesis that vary by fixation type, location, and open or arthroscopic method. Clinical outcomes are similar regardless of repair technique; therefore, the cost and time of procedures are increasingly points of improvement to practice value-based medicine and deliver cost-effective care. The technique described in this article builds on previous arthroscopic transosseous technical knowledge to yield a cost-effective and efficient clinical method to perform biceps tenodesis in the suprapectoral location without the cost and complications of an implant. In addition, this technique provides 4 methods of tenodesis in series, which serves to decrease the risk of mechanical failure and leverages the robust method of suture cerclage for capture of the biceps., (© 2022 The Authors.)

Biceps tenodesis is a well-accepted surgical treatment to relieve pain and dysfunction about the shoulder. Multiple locations and methods of tenodesis have been described, with similar outcomes. Transosseous cuff repairs and tendon repairs have been used for decades as a tried and true fixation method. This technique describes an arthroscopic transosseous technique for biceps tenodesis in the suprapectoral location that is technically simple, fast, eliminates the cost of implants, avoids an incision in the axillae which may be prone to dehiscence or infection, and releases the biceps sheath, which may be related to pain generation. Moreover, the biceps length tension relationship is easily recapitulated using anatomical landmarks., (© 2020 by the Arthroscopy Association of North America. Published by Elsevier.)

Competing Interests: Declaration of Competing Interest Nil to declare.

Transosseous repair has been used safely and effectively for primary and revision rotator cuff repair for decades; as a result, it is considered by many the historical gold standard of open repair techniques. Transosseous repair offers the advantage of excellent biology, double-row anatomic footprint reconstruction, and the ability to create multiple low-cost fixation points per surface area of tendon with high-strength suture, while avoiding anchor pullout, cyst formation, and imaging artifact. More recently, in arthroscopic applications, transosseous-equivalent anchor-based repairs have been introduced that have shown satisfactory clinical and biomechanical results; however, these attributes have been coupled with increased cost, nonbiologic burden to the healing interface of the tendon, and new catastrophic failure modes including tendon transection, anchor pullout, and bone voids. This article delineates a technique for arthroscopic true transosseous hybrid cuff repair that combines the use of anchors and transosseous techniques to maximize the benefits and minimize the detriments of both techniques. Level 1 (shoulder); level 2 (rotator cuff)., (© 2019 by the Arthroscopy Association of North America. Published by Elsevier.)

Data on in vitro engineered "off the shelf" matrices support the concept of endogenous cellular repopulation driving the graft's remodeling via immune-mediated response. This seems important to further accelerate the cell reconstitution and may play a crucial role when mononuclear cells are used. Nevertheless, studies on decellularized xenogeneic grafts showed only limited host cell repopulation post-implantation. This study aims at a systematic comparison of reseeding methods (dripping, injection, bathing in a cell suspension and combined puncturing-dripping method) to define the most efficient technique enhancing recellularization of tissue engineered vascular matrices (patches, vessels, small diameter and standard size valves) prior implantation. The constructs were analyzed histologically, biochemically and biomechanically. Various preconditioning treatments (wet, lyophilized and air-dried) combined with reseeding methods demonstrated the highest cell loading efficiency, despite applied crimping and flow stress, of lyophilization followed by puncturing-dripping technique. This novel seeding method allows for an efficient, time-saving graft reseeding that can be used within a one-step cardiovascular clinical intervention., Statement of Significance: The concept of living tissue engineered, self-repairing, autologous cardiovascular replacements, was proposed alternatively to existing synthetic/xenogeneic prostheses. Recent studies in animal models demonstrate faster in vivo recellularization after grafts pre-seeding with cells prior implantation. Pre-seeded cells hold either, the ability to differentiate directionally or attract host cells, crucial for graft integration and remodeling. It is unclear, however, how efficient the pre-loading is and how well cells withstand the flow. The study presents a systematic overview of cell loading techniques of different cardiovascular constructs, tested under static and dynamic conditions. Comparison illustrates a significantly higher efficiency of cells loading in lyophilized tissues punctured before their standard seeding. This technique may beneficially accelerate remodeling of cardiovascular grafts in further in vivo studies., (Copyright © 2018. Published by Elsevier Ltd.)

Marine debris remains a global challenge, with significant impacts on wildlife. Despite this, there is a paucity of research examining public understanding about marine wildlife entanglement [MWE], particularly within an Australian context. The present study surveyed two hundred and thirteen participants across three coastal sites to assess familiarity with MWE and the effectiveness of a new community education initiative 'Seal the Loop' [STL]. Results revealed attitudes toward marine wildlife were very positive (M 40.5, SD 4.12); however 32% of participants were unable to correctly explain what MWE is and risks to wildlife were under-estimated. STL may be one method to enhance public understanding and engagement-if community familiarity with the program can be increased. For those aware of STL (<13% of the sample at the time of the study), findings revealed this was having a positive impact (e.g. learning something new, changed waste disposal behaviours)., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

The present review aims to illustrate the strategies that are being implemented in regenerative medicine to treat diseases that affect the digestive tract. Possible avenues are twofold: organ bioengineering, where cells are seeded on biological or synthetic scaffolding materials ex vivo and allowed to either mature in bioreactors or be implanted without undergoing any maturation; and regeneration per se, where the diseased tissue or organ is regenerated by recapitulation of its multi-step ontogenesis. This latter avenue may be induced either in vivo or ex vivo. While bioengineering technology has already manufactured segments of the digestive tract and sphincters, pure regeneration of any segment of the digestive tract has not yet been described. However, models of regeneration extrapolated from simple organisms are elucidating the complex yet fascinating mechanisms that regulate the ontogenesis of the digestive tract and are paving the way for the development of new regenerative technologies and methods., (Copyright © 2012 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Research on pregnancy and sexual health among homeless youth is limited. In this study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices, housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk population seldom seen in a clinical setting.

Ketamine, a dissociative anesthetic, has emerged as an increasingly common drug among subgroups of young injection drug users (IDUs) in cities across the United States. In-depth qualitative interviews were conducted with 213 young IDUs aged 16-28 years recruited in New York, New Orleans, and Los Angeles between 2004 and 2006. While some initiated injection drug use with ketamine, the drug was more frequently injected by IDUs with extensive polydrug using histories. IDUs initiating with ketamine commonly self-injected via an intramuscular mode of administration. The injection group provided crucial knowledge and material resources that enabled the injection event to occur, including ketamine, syringes, and injection skills. Injection paraphernalia was commonly shared during the first injection of ketamine, particularly vials of pharmaceutically-packaged liquid ketamine. Injection events infrequently occurred in a rave or club and more typically in a private home, which challenges ketamine's designation as a 'club' drug. The first injection of ketamine was a noteworthy event since it introduced a novel drug or new mode of administration to be further explored by some, or exposed others to a drug to be avoided in the future. Risk reduction messages directed towards young IDUs should be expanded to include ketamine.

Munchausen syndrome is a rare psychiatric disorder. Patients with Munchausen syndrome insist on and repeatedly undergo unnecessary investigations and operative treatments. No organic pathosis is demonstrated, and treatment consistently fails to alleviate the symptoms. This article presents a case report and a brief discussion to facilitate recognition and management techniques.

Study Objective: To determine the rapidity and extent of core temperature decrease following release of a lower extremity pneumatic tourniquet., Design: Prospective study., Setting: Inpatient surgery in a university trauma center., Patients: 11 ASA status I and II adults undergoing unilateral lower extremity fracture fixation in which a tourniquet was used, with general anesthesia., Interventions: Temperature was measured in the esophagus before and after lower extremity tourniquet release., Measurements and Main Results: Tourniquet times ranged from 41 to 129 minutes (mean 98.5 +/- 9.1 minutes). Following tourniquet deflation core temperature decreased in all patients, with a maximal decline at 10 minutes, the termination of measurements, although trending downward. Esophageal temperature decreased an average of 0.46 degree C +/- 0.2 degree C at 5 minutes, and 0.67 degree C +/- 0.2 degree C at 10 minutes following tourniquet release, respectively. Temperature changes were significant (p = 0.0001) at both time intervals., Conclusion: Core temperature drops significantly immediately following release of the tourniquet at the esophageal temperature monitoring site. This decrease is the result of cooling of systemic blood reperfusing the hypothermic limb, and mixing of cool, "washed out" blood with the systemic circulation. As the consequences of hypothermia are well-known, we recommend core temperature monitoring in all patients having lower extremity tourniquet placed during general anesthesia, as well as vigilant monitoring for prolonged effects of anesthetics in the postoperative period.

Some dental professionals may have concerns about treating patients who have seizure disorders. The authors contend that increased knowledge about seizures and how to manage them may make dental professionals more comfortable. This article reviews the various seizure types, discusses commonly used anticonvulsants and their side effects and outlines some special concerns dentists may have in providing care to these patients.

Stress proteins have been shown to provide information on the biological impact of toxic chemicals to organisms and to predict adverse consequences of that exposure. In this study we have examined the accumulation to two major stress proteins, hsp60 and hsp70, in banked samples to determine if they accumulate at high levels in organisms exposed to contaminants in their environment. We found that relative to laboratory controls, stress proteins concentrations were elevated in mussels and fish tissue collected as part of the NOAA National Status and Trends Program. Sediment and water chemistry from the stations where these organisms were collected and data on contaminant body burdens of these same organisms indicated that they had been exposed to contaminants for long durations in their environment. This study suggests that stress protein accumulation may provide a method for quantifying adverse biological impacts of exposure to chemicals in the environment when examined in wild populations from contaminated sites. This approach may also prove valuable in retrospective studies when used in banked specimens which have been collected as part of a large scale surveillance monitoring programs.

Asthmatic patients hyperventilate during acute attacks, but controversy persists as to whether they breathe rapidly, deeply or both. We monitored respiratory rate under the three following conditions: (1) asthma treated in the emergency room; (2) airways obstruction provoked by methacholine inhalation; and (3) airways obstruction provoked by exercise. In 47 acutely ill asthmatic patients, respiratory rate was higher than in 42 nonasthmatic control patients in the emergency room. Pretreatment respiratory rate correlated with peak expiratory flow rate and forced expired volume in one second. In 17 asthmatic patients and 16 healthy volunteers, breathing pattern was monitored by respiratory inductance plethysmography. Methacholine inhalation and exercise provoked significant airways obstruction in asthmatic patients but not in control subjects. In asthmatic patients, minute ventilation and tidal volume increased above that of control subjects following methacholine and exercise, but the rate was no higher than in control subjects. We conclude that the respiratory rate is increased in naturally occurring asthma, but not when acute airways obstruction is induced transiently in the laboratory. In the former setting, the respiratory rate is correlated with spirometric measures of airflow obstruction, but the weakness of the correlation does not allow the respiratory rate to be used as a substitute for spirometry.

CFA is a complex onco-developmental membrane marker system that is being investigated at the cellular, molecular, genetic and functional levels. CFA appears to be a family of genetically-determined carbohydrate side chains attached to a membrane-bound polypeptide chain. Unique combinations of the thirteen serologically detectable CFA determinants are expressed on erythroid and lymphoid cells of all avian species tested. Whether or not CFA determinants are hematopoietic specific markers remains to be established. The CFA determinants are proving to be useful membrane markers for the study of normal as well as neoplastic hematopoietic cellular differentiation. The probability that CFA determinants are differentiation-stage-specific markers for cells of both the erythroid and lymphoid series coupled with the observation that one of the CFA determinants acts as a cell membrane binding site for an arbovirus makes this antigen system a valuable tool for studying the cellular differentiation blockage hypothesis of neoplasia.

Arthrography of the temporomandibular joint is used principally in cases of pain and dysfunction, specifically clicking, popping, or locking joints. The procedure is effective and safe but technically difficult to perform.

A review was made of 136 cases of carcinoma in situ of the vagina seen over a 30-year period, 1953 to 1982. The patients ranged in age from 17 to 77 years, with a mean age of 55 years. One hundred sixteen patients (85%) presented with an abnormal Papanicolaou smear. Colposcopically directed biopsies were used for diagnosis in 62% of the patients. The upper one third of the vagina was the most common site of disease, with 54% of patients having unifocal lesions. A previous hysterectomy had been performed in 71% of patients, 35% of whom had undergone operation for benign disease. A concomitant, subsequent, or prior neoplasm of the lower genital tract or pelvis was noted in 109 patients. Surgical intervention in the form of either wide local excision or partial or total vaginectomy was the most frequently used method of treatment. Radiotherapy, usually in the form of a vaginal mold, was the second most commonly used method of treatment, and it was used in 27 patients. Radiotherapy and more extensive surgical treatment methods gave the best results. Four patients subsequently developed invasive carcinoma of the vagina.

Immune cytolysis and immunofluorescence were used to examine chicken fetal antigen CFA) and chicken adult antigen (CAA) expression on the differentiation/maturation series of definitive erythroid cells obtained from the bone marrow of different aged chickens. We found that erythroid cells undergo changes in CFA/CAA antigenic expression dependent on their differentiation/maturation stages as well as the developmental age of the chicken. All differentiation/maturation stages of erythroid cells in the bone marrow of 12 and 18-day-old embryos express CFA only. Erythroblasts obtained from 7-day post-hatched chickens express either CFA or CAA. All three CFA/CAA phenotypes (i.e., CFA, CAA, and CFA + CAA) are observed in subsequent maturation stages, but only the CFA + CAA phenotype is observed in mature erythroid cells in the bone marrow of 7-day post-hatched chickens. Erythroblasts from 62 day post-hatched chickens exhibit all three CFA/CAA phenotypes. Cells in the subsequent maturation stages express various CFA, CAA, or CFA + CAA phenotypes resulting in a majority of the mature erythrocytes expressing both CFA and CAA, and a small population of mature erythrocytes expressing CAA only. Erythroblasts from adult chickens express both CFA and CAA; however, CFA is lost during erythroid maturation resulting in mature erythrocytes which express CAA only. These studies indicate that both the erythroid differentiation/ maturation stage and the developmental age of the chicken influence CFA and CAA antigenic expression on erythroid cells undergoing cellular differentiation/maturation in the bone marrow.

Osteochondromatous exostosis of the condyle is rare. When these exotoses become large, they can cause temporomandibular pain and clicking with mandibular movements. Treatment consists of surgical removal of the mass. Adjunctive care may include use of intermaxillary fixation, training elastics, and jaw exercises.

These experiments investigated the effects of pargyline, N-[2-(o-Chlorophenoxy)-ethyl]-cyclopropylamine (Lilly 51641), and nialamide on voluntary ethanol consumption of C57BL/6J mice. Both pargyline and Lilly 51641 reduced ethanol preference; in contrast, nialamide did not affect preference, despite the fact that it inhibited MAO activity by more than 90%. A subsequent experiment determined that both pargyline and Lilly 51641 produced substantially greater elevations in acetaldehyde levels than did nialamide. It is suggested that increased acetaldehyde is the mechanism responsible for the reduction in ethanol preference observed with pargyline and Lilly 51641.