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High-grade patellofemoral dysplasia is often associated with concomitant axial and frontal leg malalignment. However, curvature of the femur and sagittal flexion of the trochlea has not yet been studied in patellofemoral dysplastic knees. The aim of the study was to quantify the femoral curvature and sagittal flexion of the trochlea in both high-grade patellofemoral dysplastic and healthy knees.A retrospective case-control study matched 19 high-grade patellofemoral dysplastic knees (Dejour types C and D) with 19 healthy knees according to sex and body mass index. Three-dimensional (3D) femoral curvature and sagittal trochlea flexion were analysed. To analyse femoral curvature, the specific 3D radius of curvature (ROC) was calculated. Trochlear flexion was quantified through the development of the trochlea flexion angle (TFA), which is a novel 3D measurement in relation to the anatomical and mechanical femur axis and is referred to as 3D TFAOverall ROC was significantly smaller in dysplastic knees, compared with the control group [898.4 ± 210.8 mm (range 452.9-1275.1 mm) vs 1308.4 ± 380.5 mm (range 878.3-2315.8 mm), p 0.001]. TFA was significantly higher in dysplastic knees, compared with the control group, for 3D TFAHigh-grade patellofemoral dysplastic knees demonstrated increased femoral curvature and sagittal flexion of the trochlea, compared with healthy knees. The ROC and newly described TFA allowed the quantification of the sagittal femoral deformity. TFA and ROC should be incorporated in future deformity analysis to investigate their potential as a target for surgical correction.Level III.

BackgroundThe small number of organ donors forces transplant centres to consider potentially suboptimal kidneys for transplantation. Eurotransplant established an algorithm for rescue allocation (RA) of kidneys repeatedly declined or not allocated within 5 h after procurement. Data on the outcomes and benefits of RA are scarce to date.MethodsWe conducted a retrospective 8-year analysis of transplant outcomes of RA offers based on our in-house criteria catalogue for acceptance and decline of organs and potential recipients.ResultsRA donors and recipients were both older compared with standard allocation (SA). RA donors more frequently had a history of hypertension, diabetes or fulfilled expanded criteria donor key parameters. RA recipients had poorer human leucocyte antigen (HLA) matches and longer cold ischaemia times (CITs). However, waiting time was shorter and delayed graft function, primary non-function and biopsy-proven rejections were comparable to SA. Five-year graft and patient survival after RA were similar to SA. In multivariate models accounting for confounding factors, graft survival and mortality after RA and SA were comparable as well.ConclusionsFacing relevant comorbidities and rapid deterioration with the risk of being removed from the waiting list, kidney transplantation after RA was identified to allow for earlier transplantation with excellent outcome. Data from this survey propose not to reject categorically organs from multimorbid donors with older age and a history of hypertension or diabetes to aim for the best possible HLA matching and to carefully calculate overall expected CIT.

BackgroundThe increasing organ shortage in kidney transplantation leads to the necessity to use kidneys previously considered unsuitable for transplantation. Numerous studies illustrate the need for a better decision guidance rather than only the classification into kidneys from standard or expanded criteria donors referred to as SCD/ECD-classification. The kidney donor profile index (KDPI) exhibits a score utilizing a much higher number of donor characteristics. Moreover, graft biopsies provide an opportunity to assess organ quality.MethodsIn a single center analysis 383 kidney transplantations (277 after deceased and 106 after living donation) performed between January 1st, 2006, and December 31st, 2016, retrospectively underwent SCD/ECD and KDPI scoring. Thereby, the quality of deceased donor kidneys was assessed by using the KDPI and the living donor kidneys by using the living KDPI, in the further analysis merged as (L)KDPI. Baseline biopsies taken 10 min after the onset of reperfusion were reviewed for chronic and acute lesions. Survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards analysis within a 5-year follow-up.ResultsThe (L)KDPI correlated with glomerulosclerosis (r = 0.30, p < 0.001), arteriosclerosis (r = 0.33, p < 0.001), interstitial fibrosis, and tubular atrophy (r = 0.28, p < 0.001) as well as the extent of acute tubular injury (r = 0.20, p < 0.001). The C-statistic of the (L)KDPI concerning 5-year death censored graft survival was 0.692. Around 48% of ECD-kidneys were classified as (L)KDPIp = 0.025). Survival analysis revealed decreased death censored (p < 0.001) and non-death censored (p < 0.001) graft survival in kidneys with an increasing (L)KDPI divided into groups of 85%, respectively.ConclusionWith a higher granularity compared to the SCD/ECD-classification the (L)KDPI is a promising tool to judge graft quality. The correlation with chronic and acute histological lesions in post-reperfusion kidney biopsies underlines the descriptive value of the (L)KDPI. However, its prognostic value is limited and underlines the urgent need for a more precise prognostic tool adopted to European kidney transplant conditions.

Background Assessment of combined anterolateral ligament (ALL) and anterior cruciate ligament (ACL) injury remains challenging but of high importance as the ALL is a contributing stabilizer of tibial internal rotation. The effect of preoperative static tibial internal rotation on ACL -length remains unknown. The aim of the study was analyze the effect of tibial internal rotation on ACL length in single-bundle ACL reconstructions and to quantify tibial internal rotation in combined ACL and ALL injuries. Methods The effect of tibial internal rotation on ACL length was computed in a three-dimensional (3D) model of 10 healthy knees with 5° increments of tibial internal rotation from 0 to 30° resulting in 70 simulations. For each step ACL length was measured. ALL injury severity was graded by a blinded musculoskeletal radiologist in a retrospective analysis of 61 patients who underwent single-bundle ACL reconstruction. Preoperative tibial internal rotation was measured in magnetic resonance imaging (MRI) and its diagnostic performance was analyzed. Results ACL length linearly increased 0.7 ± 0.1 mm (2.1 ± 0.5% of initial length) per 5° of tibial internal rotation from 0 to 30° in each patient. Seventeen patients (27.9%) had an intact ALL (grade 0), 10 (16.4%) a grade 1, 21 (34.4%) a grade 2 and 13 (21.3%) a grade 3 injury of the ALL. Patients with a combined ACL and ALL injury grade 3 had a median static tibial internal rotation of 8.8° (interquartile range (IQR): 8.3) compared to 5.6° (IQR: 6.6) in patients with an ALL injury (grade 0–2) (p = 0.03). A cut-off > 13.3° of tibial internal rotation predicted a high-grade ALL injury with a specificity of 92%, a sensitivity of 30%; area under the curve (AUC) 0.70 (95% CI: 0.54–0.85) (p = 0.03) and an accuracy of 79%. Conclusion ACL length linearly increases with tibial internal rotation from 0 to 30°. A combined ACL and high-grade ALL injury was associated with greater preoperative tibial internal rotation. This potentially contributes to unintentional graft laxity in ACL reconstructed patients, in particular with concomitant high-grade ALL tears. Study design Cohort study; Level of evidence, 3.

Delayed graft function (DGF) following kidney transplantation is associated with increased risk of graft failure, but biomarkers to predict DGF are scarce. We evaluated serum uromodulin (sUMOD), a potential marker for tubular integrity with immunomodulatory capacities, in kidney transplant recipients and its association with DGF. We included 239 kidney transplant recipients and measured sUMOD pretransplant and on postoperative Day 1 (POD1) as independent variables. The primary outcome was DGF, defined as need for dialysis within one week after transplantation. In total, 64 patients (27%) experienced DGF. In multivariable logistic regression analysis adjusting for recipient, donor and transplant associated risk factors each 10 ng/mL higher pretransplant sUMOD was associated with 47% lower odds for DGF (odds ratio (OR) 0.53, 95% confidence interval (95%-CI) 0.30–0.82). When categorizing pretransplant sUMOD into quartiles, the quartile with the lowest values had 4.4-fold higher odds for DGF compared to the highest quartile (OR 4.41, 95%-CI 1.54–13.93). Adding pretransplant sUMOD to a model containing established risk factors for DGF in multivariable receiver-operating-characteristics (ROC) curve analysis, the area-under-the-curve improved from 0.786 [95%-CI 0.723–0.848] to 0.813 [95%-CI 0.755–0.871, p = 0.05]. SUMOD on POD1 was not associated with DGF. In conclusion, higher pretransplant sUMOD was independently associated with lower odds for DGF, potentially serving as a non-invasive marker to stratify patients according to their risk for developing DGF early in the setting of kidney transplantation.

Some small businesses and entrepreneurs find it challenging to interact with the U.S. National Aeronautics and Space Agency (NASA). In 2016, the Small Business Innovation Research and Smal...

RESUMEN: El plexo braquial se forma a partir de cinco raíces espinales: C5, C6, C7, C8 y T1, proporcionando inervación al miembro superior. Se ha demostrado que el análisis morfométrico de las fibras nerviosas es de gran valor para detectar anormalidades, como el tamaño de los haces nerviosos, el número o tamaño de los axones y el área de mielina. El presente estudio fue realizado en muestras de 10 plexos braquiales (5 derechos, 5 izquierdos), obtenidos de 5 cadáveres frescos, de sexo masculino, con un promedio de edad entre 24 ± 3,14 (rango, 20-30 años), y 73 ± 5,52 años (rango, 60-90 años), sin antecedentes de neoplasia maligna y patología neuropsiquiátrica. Las muestras fueron fijadas en formalina 10 % y teñidas con hematoxilina-eosina. Los datos obtenidos de los 10 plexos braquiales se agruparon en dos rangos de edades, siendo estos jóvenes y adultos. En el grupo de jóvenes el número de fascículos en C5, 4,00 ± 1,22; C6, 9,25 ± 3,83; C7, 15,20 ±7,57;C8, 8,60 ± 5,39; T1, 4,80 ± 3,19 en adultos el diámetro de la raíz fue C5, 4,77 ± 1,31; C6, 5,39 ± 0,76; C7, 5,91 ± 1,63; C8, 5,19 ± 0,94; T1, 4,86 ± 1,40. Existen diferencias entre las raíces nerviosas del plexo braquial humano, de individuos jóvenes y adultos chilenos, así el área de la raíz de individuos jóvenes es menor, el número de fascículos decrece en los individuos adultos y sus diámetros siempre son mayores en estos últimos.

Dentro de la Linea Medular la investigacion de la contaminacion del medio ambiente ocasionada por el uso indiscriminado de sustancias quimicas en actividades agricolas, industriales y extractivas, resulta interesante ya que es una problematica latente pero deficientemente divulgada, la cual enfrentan los consumidores finales de alimentos expuestos a sustancias toxicas que se encuentran disponibles en los compartimientos agua, aire y suelo de los ecosistemas.

Los músculos supernumerarios intrínsecos del pie, no son frecuentemente nombrados en los textos de anatomía a pesar que ellos pueden eventualmente producir alteraciones en la mecánica articular. Describimos la presencia de dos músculos supernumerarios encontrados en un pie de un cadáver formolizado, de sexo masculino, adulto, disecado en el Curso de Anatomía Funcional del Pie, perteneciente al Programa de Magíster en Ciencias, Mención Morfología de la Universidad de La Frontera, Chile. Los músculos supernumerarios destinados al IV y V dedo: inferomedial y superolateral, respectivamente, presentaban vientres musculares cortos y tendones de inserción largos, relacionándose ambos en su origen con el nervio plantar medial. Parte de su vientre y de sus tendones se ubicaban entre los músculos cuadrado plantar y flexor corto de los dedos. Estos músculos son similares a algunos relatos de la literatura, sin embargo creemos que su incidencia es relativamente baja en individuos chilenos. The supernumerary intrinsic muscles of the toe are not frequently mentioned in anatomy texts, although they may eventually produce alterations in the articulated mechanics. We described the presence of two supernumeraries found in a formolized adult dissected male corpse in the Toe Functional Anatomy Course, belonging to the Ms. Sc. in Morphology of the Universidad de La Frontera, Chile. The supernumerary muscle for the 4th and 5th fingers: inferomedial and superolateral, respectively, presented short muscular belly and tendons of long insertion, relating both in their origin eith the medial plantar nerve. Part of their belly and tendons were located between the flexor digiti minimi muscle and the quadratus plantae muscle. These muscles are similar to some reports of the literature; however, we think their incidence is relatively low in Chilean individuals.