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Purpose: The tibial insertion of the posterior cruciate ligament (PCL) frequently becomes damaged when performing a tibial cut in a PCL-retaining total knee replacement (TKA). The aim of this study was to quantify the functional effect of this structural damage on the tensile strength and failure load.Methods: Six paired knees from fresh-frozen cadaver specimens were used. All soft tissues but the PCL were removed. In the left-sided specimens, a classic tibial cut at a depth of 9 mm with 3° of posterior slope was made, while in the right-sided specimens, a bone block was left in front of the tibial PCL insertion. After cementing a tibial tray, the specimens were mounted in a loading frame in 60° of flexion. The femur was translated anteriorly at a constant velocity rate of 0.5 mm/s. Tensions in the PCL were measured continuously until failure occurred.Results: In one specimen, the tibial PCL insertion was completely removed by the tibial cut. In the other five paired specimens, the mean tensile strength of the PCL was 380.6 ± 154.7 N in the left-sided knees. In the right-sided knees, the mean tensile strength was 738.4 ± 166.7. The average right-to-left ratio was 2.2 ± 0.7 (p = 0.006).Conclusion: The results of this study indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in a significant decrease in tensile strength of the PCL, rendering it susceptible to failure and subsequent midflexion instability. Therefore, we recommend leaving the posterior tibial cortex anterior to the PCL insertion intact when performing a cruciate-retaining TKA. [ABSTRACT FROM AUTHOR]

In forest ecosystems, organic solutes play prominent roles in pollutant and nutrient transport. This study, conducted in subalpine forested Humaquepts in Switzerland, investigated the influence of redox conditions and flow processes on dissolved organic carbon (DOC) and dissolved organic nitrogen (DON). In the mineral soil, concentrations of DOC were higher under reduced than under oxidized conditions. They averaged 1.2 mmol DOC L-1 in the reduced mineral soil at a 100-cm depth. A close correlation between DOC and dissolved Fe concentrations (r2 = 0.83; p < 0.001) suggests that reductive dissolution of Fe-oxides was the major reason for the low retention. However, during aerobic sampling of soil solution from the reduced mineral soil, DOC coprecipitated with Fe. This suggests that the DOC inputfrom reduced mineral soils to aerobic stream water is lower than expected from the high DOC concentrations in the soil. Organic N was themajor form of total dissolved N at all soil depths. In the reduced subsoil, dissolved N was completely organically bound. This was probably due to both an immobilization of inorganic N and a low retention of DON. During storms, DOC concentrations increased rapidly with increasing discharge in the subsurface flow. At peak flow, DOC concentrations were doubled, compared with base flow. The molar UV absorptivity of DOC in the subsurface flow corresponded closely to that of the topsoil. These findings suggest that DOC concentrations and properties are sensitive to flow velocities, and that DOC is preferentially transported to the subsoil at high discharge. [ABSTRACT FROM AUTHOR]

Two small experimental headwater catchments (approx. 1500 m2) were set up in an alpine spruce forest in the Alptal valley (central Switzerland). They are located at an altitude of 1200 rn and receive an average of 2300 mm precipitation a year. The site is moderately impacted by atmospheric nitrogen deposition (12 kg N ha-1 yr-1 bulk deposition of inorganic N). Two different gley soils occur as patches atop a Flysch substratum. The spatial heterogeneity of the soil is related with both the microtopography of the site and the vegetation. The catchments were made by digging 80-cm deep trenches into the shallow gleyic soils. Because of the low permeability of the clay-rich subsoil, these trenches collect the lateral water flow generated in the plots. The catchments were equipped with gauging stations (V-notch weirs) and automatic runoff-proportional watersamplers. Meteorological parameters, deposition, water and solute discharge were monitored during one year. A correct water balance was obtained from the experimental catchments. The leaching of inorganic nitrogen was estimated to be 4 kg N ha-1 yr-1, mainly as nitrate. It is, however, not clear if this nitrate is leached because the ecosystem is nitrogen saturated (N in surplus of the maximal ecosystem retention). Quick preferential water flow occurs through the soil, and this may prevent nitrate from rain or snowmelt to be removed by the soil matrix before entering the water runoff pathways. Both mini-catchments showed similar biogeochemical cycles, especially for nitrogen. The time series obtained will be used as reference period for a paired-catchment experiment simulating an increased nitrogen (ammonium nitrate) deposition. [ABSTRACT FROM AUTHOR]

Introduction: People-centered care (PCC) strategies are believed to improve overall health outcomes. Medicines use is essential for the treatment of many patients with chronic conditions. Non-adherence rates are high and result in poor health outcomes, and increased healthcare utilization and costs. This study aimed to explore the relationship between PCC and adherence to medicines for persons with chronic medicines use, as well as the extent to which patients' beliefs about medicines are influenced by their level of perceived PCC., Methods: A cross-sectional survey design was performed with adults using at least 3 chronic medicines per day. To measure the degree of medicines adherence, patients' ideas about medication, and PCC, four validated questionnaires were used: The Medication Adherence Report Scale (MARS-5), Beliefs about medicines questionnaire (BMQ), Client-Centered Care Questionnaire (CCCQ) and the Shared Decision Making Questionnaire (SDM-Q-9). Socio-demographics, health status, and drug-related burden were questioned as potential factors to impact the relationship between PCC and adherence., Results: A sample of 459 persons participated. The mean score on the CCCQ (adjusted to pharmacotherapy) was 52.7 on 75 (sd = 8.83, range [18-70]). The top 20% scored 60 or more, the 20% lowest scores were 46 or less. Adherence levels were high, with a mean score of 22.6 on 25 on the MARS-5, and 88% scoring 20 or more. An increase in PCC corresponded to a higher chance of medicines adherence (OR 1.07, 95%CI [1.02-1.12]), corrected for age, the burden due to chronic diseases, the impact of side effects on daily life, and participants' beliefs about medicines. PCC showed positive correlations with the necessity of medicines use (r = 0.1, p = 0.016) and the balance between necessity and concerns (r = 0.3, p < 0.001); and negative correlations with levels of concerns (r = -0.3, p < 0.001) and scores on harmfulness (r = -0.3, p < 0.001) and overuse of medicines (r = -0.4, p < 0.001)., Conclusion: Patients with chronic medicine use perceived an average high level of people-centeredness in the pharmaceutical care they received. This PCC was weakly positively associated with adherence to their medicines. The higher PCC was evaluated, the more patients believed in the necessity of the medicines use and the better the balance between necessity and concerns. The people-centeredness of pharmaceutical care showed several shortcomings and can still be improved. As such, healthcare providers are advised to actively engage in PCC, and not to wait passively for information provided by the patient., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper, (© 2023 The Authors.)

Aim: To provide an overview of responsibilities and tasks of nurses in pharmaceutical care., Design: Scoping review., Methods: Two databases were systematically searched (MEDLINE and Scopus) for recent original research papers concerning nurses' responsibilities and tasks in pharmaceutical care. The definition of responsibility was based on literature, moral and ethical discussions. Existing responsibilities and tasks beyond preparation and administration of medication were collected and synthesized. This main study outcome was extracted from titles and abstracts only. Results were reported in accordance with PRISMA-ScR guidelines., Results: Of the 3,805 titles and abstracts reviewed, 453 abstracts were included. A total of seven responsibilities were identified: (a) management of therapeutic and adverse effects of medication, (b) management of medication adherence, (c) management of patient medication self-management, (d) management of patient education and information about medication, (e) prescription management, (f) medication safety management and (g) (transition of) care coordination. Within these responsibilities, all tasks performed by nurses were described., (© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

We present a case of a 59-year-old woman with a history of a right-sided patellectomy. She presented with right-sided anteromedial osteoarthritis. A unicondylar knee arthroplasty was performed. In the literature, we found only a few similar cases, with varying results. The woman in this case showed excellent postoperative clinical results. We concluded that a patellectomy may not be a contraindication for unicondylar knee arthroplasty in patients with isolated medial compartment osteoarthritis., (© 2019 The Authors.)

Purpose: Based on the anatomy of the tibial PCL insertion site, we hypothesized that at least part of it is damaged while performing a standard tibial cut in a PCL-retaining total knee replacement. The purpose of this study was to determine and quantify the amount of resection of the tibial PCL attachment with a 9 mm tibial cut with 3 degrees of posterior slope., Methods: Twenty cadaver tibias were used. The borders of the PCL footprint were demarcated, and calibrated digital pictures were taken in order to determine the surface area. A standard tibial intramedullary guide was used to prepare and perform a tibial cut at a depth of 9 mm with 3 degrees posterior slope. After the tibial cut was made, a second digital picture was taken using the same methodology to measure the surface area of the remaining PCL insertion., Results: The mean surface area of the intact tibial PCL footprint before the cut was 148.9 ± 25.8 mm(2) and after the tibial cut 47.1 ± 28.0 mm(2). On average, 68.8 ± 15.3 % of the surface area of the PCL insertion was removed., Conclusion: The results of this study, therefore, indicate that the conventional technique for tibial preparation in cruciate-retaining total knee arthroplasty can result in damage or removal of a significant part of the tibial PCL insertion.

Bone marrow oedema is a common finding on MRI. Differential diagnosis includes many different clinical entities. We hereby present a case of migrating symptomatic bone marrow oedema from the medial to the lateral femoral condyle after which spontaneous resolution of both clinical and radiographic findings occurred. The role of altered weight-bearing due to therapeutic use of an unloading brace as a potential causative factor in the pathogenesis of migrating bone marrow oedema remains unclear. The literature on the topic is reviewed.

The influence of pentosanepolysulfate (SP 54) and a combination of pentosanepolysulfate, metamizol and paracetamol (Probaphen) on the course of an experimentally induced erythema caused by intracutaneous injection of a lipopolysaccharide from Pseudomonas has been studied in man. The intramuscular injection of Probaphen as well as SP 54, separately given, showed a significant antiinflammatory effect. A similar effect was also achieved after administration of Probaphen suppositories. Probaphen shortened the inflammatory reaction more effectively than did SP 54 alone. The oral application of Probaphen, however, did not influence the course of inflammation.

The influence of creatinine, urea and guanidine injection on the course of an artifically induced inflammatory reaction has been studied in rats. The formalin and bolus alba edema served as inflammatory models. It was shown that the inflammatory reaction was not significantly altered by urea. By creatinine, however, the inflammation was diminished. If urea and creatinine were given together the course of the inflammatory reaction was not altered significantly, suggesting an inhibitory interrelation between these two substances. Guanidines showed the strongest inhibiting effect on inflammation. It is discussed that guanidines influence energy availability by inhibition of oxydative phosphorylation.