Clinical instability of the sternoclavicular (SC) joint is a challenging problem. Recurrent subluxation and pain can lead to significant functional limitations. Although many patients respond ...positively to conservative treatment, chronic dislocations often require operative intervention. The complex anatomy of the diarthrodial SC joint and the existence of concomitant SC joint degenerative changes compounded with close-by neurovascular structures present a surgical challenge. The purpose of this Technical Note is to describe a technique for the open management of symptomatic sternoclavicular joint instability using a figure-of-8 reconstruction with a gracilis autograft. The present authors believe this technique provides a technically safe and reproducible method for reconstructing the SC joint without compromising biomechanical strength.
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Video depicting the surgical technique for the open management of symptomatic sternoclavicular joint instability using a figure-of-8 reconstruction with a gracilis autograft.
While functional reconstruction of massive irreparable rotator cuff tears remains a challenge, current techniques aimed at recentering and preventing superior migration of the humeral head allow for ...clinical and biomechanical improvements in shoulder pain and function. Recentering of the glenohumeral joint reduces the moment arm and helps the deltoid to recruit more fibers, which compensates for insufficient rotator cuff function and reduces joint pressure. In the past, the concept of a superior capsular reconstruction with a patch secured by suture anchors has been used. However, several innovative arthroscopic treatment options have also been developed. The purpose of this article is to present an overview of new strategies and surgical techniques and if existing present initial clinical results. Techniques that will be covered include rerouting the long head of the biceps tendon, utilization of the biceps tendon as an autograft to reconstruct the superior capsule, utilization of a semitendinosus tendon allograft to reconstruct the superior capsule, superior capsular reconstruction with dermal allografts, and subacromial spacers.
Poly(vinylphosphonic acid-co-acrylic acid) (PVPA-co-AA) has recently been identified as a possible candidate for use in bone tissue engineering. It is hypothesized that the strong binding of ...PVPA-co-AA to calcium in natural bone inhibits osteoclast activity. The free radical polymerization of acrylic acid (AA) with vinylphosphonic acid (VPA) has been investigated with varying experimental conditions. A range of copolymers were successfully produced and their compositions were determined quantitatively using 31P NMR spectroscopy. Monomer conversions were calculated using 1H NMR spectroscopy and a general decrease was found with increasing VPA content. Titration studies demonstrated an increase in the degree of dissociation as a function of VPA in the copolymer. However, a VPA content ca. 30 mol % was found to be the optimum for calcium chelation, suggesting that this composition is the most promising for biomaterials applications. Assessment of cell metabolic activity showed that PVPA-co-AA has no detrimental effect on cells, regardless of copolymer composition.
Posterior shoulder instability (PSI) is a relatively less common form of instability that frequently affects young overhead or contact athletes. The etiology of PSI may be traumatic or atraumatic, ...with establishment of the diagnosis being more difficult in cases of atraumatic instability. Surgical management of PSI has evolved from open techniques to arthroscopic techniques. Posterior stabilization has commonly been performed with 2 posterior working portals with the patient in the lateral decubitus position. The objective of this Technical Note is to describe a technique for posterior labral repair using all-suture anchors with the patient in the beach-chair position via 1 working portal with capsular closure.
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Snapping scapula syndrome (SSS) is a painful and debilitating condition that occurs as a result of disruption of normal scapulothoracic articulation and inflammation of numerous soft tissue and ...bursal structures that function to facilitate scapulothoracic motion. Historically, when nonoperative management of SSS failed, patients progressed to open surgical management. However, as arthroscopic techniques have evolved, the condition has been increasingly treated arthroscopically because of the minimally invasive nature, periscapular muscle-preserving approach with decreased risk to surrounding neurovascular structures, better intraoperative visualization, and quicker patient recovery and rehabilitation. The objective of this Technical Note is to describe our arthroscopic approach for the management of SSS using two portals to complete a scapulothoracic bursectomy and partial scapulectomy of the superomedial scapula. Level of Evidence: Level I: shoulder
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Step-by-step video illustration of an arthroscopic scapulothoracic bursectomy and partial scapulectomy for the treatment of snapping scapula syndrome. Careful arthroscopic approach and advanced knowledge of anatomy are used to minimize risk to surrounding neurovascular structures while addressing the snapping scapula syndrome pathology.
During recent years, researchers have been focusing on the concept of an infectious etiology of autoimmune diseases. The
most discussed theory is molecular mimicry, i.e. the emergence of autoreactive ...clones of T- and B-lymphocytes as a result
of cross-immune response to homologous bacterial or viral antigen. Information on the role of probiotic microorganisms
(PM) in the molecular mechanisms of autoimmune thyroid diseases (ATD) is limited. Using proteins and immunogenic
peptides databanks and relevant computer programs, the homology between the amino acid sequences of thyroid
peroxidase (TPO) and thyroglobulin (Tg), which are potential B- and T-cell epitopes of these antigens, and proteins of
bifidobacteria and lactobacilli was established. Moreover, we have found components of cells of Bifidobacterium bifidum
791, Bifidobacterium adolescentis 94 BIM, Bifidobacterium longum B379M and Lactobacillus plantarum B-01 that
selectively bind human antibodies to TPO (anti-TPO) and antibodies to Tg (anti-Tg) and compete with natural antigens for
the binding of anti-TPO and anti-Tg in ELISA. Additionally, a three-fold difference was observed between the probability
of detecting antibodies (Abs) to the antigens of L. plantarum B-01 and B. bifidum 791 in serum samples containing and
those not containing anti-TPO. On the whole, our data are arguments in favour of the assumption of the possible role
of PM of the genera Bifidobacterium and Lactobacillus in triggering ATD by the mechanism of molecular mimicry. The
data obtained in silico and in vitro should be proven by use of animal models and clinical studies for extrapolations to the
whole body. Possible antigenic properties of components/proteins of bifidobacteria and lactobacilli, selectively binding
anti-TPO and anti-Tg should be taken into consideration. Natural human Abs to these bacterial components are probably
able to cross-react with the TPO and Tg in the ELISA for detection of anti-TPO and anti-Tg, which are serologic markers
of ATD. It can lead to unspecific false positive results and, hence, to an incorrect diagnosis.
The study describes extraction of extracellular polymeric substances (EPS) from sewage sludge by applying enzymes and enzymes combined with sodium tripolyphosphate (STPP). Additionally, a systematic ...study of two non-enzymatic extraction agents is described. The assessment of the released products is made by colorimetrical methods and polysaccharides/glycoconjugates identification by the interaction with four immobilized lectins. Bio-sludge from Helsingborg (Sweden) and Damhusåen (Denmark) were used as two case studies for testing enzymatic extractability and thereby to make useful prediction of sludge bio-digestibility. From Helsingborg sludge the enzymes extracted about 40% more of EPS than from Damhusåen. The polysaccharides/glycoconjugates in both sludges maintained the same level, and showed substantial different interaction motifs with lectins panel. Damhusåen enzymatic extracted EPS had an enhanced amount of suspended material that was post-hydrolysed by the use of polygalacturonase and lysozyme resulting in pectin like polymers and petiptidoglycans. Petiptidoglycan is a marker from bacterial cell debris. STPP and cation exchange resin (CER) released different quantities of EPS. The CER released polysaccharides/glycoconjugates had higher molecular weight and stronger affinity towards Concanavalin A than the one released by the action of STPP. Independent of the extraction conditions, STPP released elevated amounts of polyvalent cations and humic substances in contrast to the very low amounts of released by CER.
Mathematical models have been developed to explore the population dynamics of viral diseases among wildlife. However, assessing the predictions stemming from these models with wildlife databases ...adequate in size and temporal duration is uncommon. An epizootic of raccoon rabies that began in the mid-Atlantic region of the United States in the late 1970s has developed into one of the largest and most extensive in the history of wildlife rabies. We analyzed the dynamics of local epizootics at the county level by examining a database spanning more than 20 years and including 35,387 rabid raccoons. The size, number, and periodicity of rabies epizootics among raccoons were compared with predictions derived from a susceptible, exposed, infectious, and recovered model of raccoon rabies Coyne, J., Smith, G. & McAllister, F. E. (1989) Am. J. Vet. Res. 50, 2148-2154. After our methods for defining epizootics were applied to solutions of the model, the time series revealed recurrent epizootics in some counties, with a median first epizootic period of 48 months. Successive epizootics declined in size and the epizootic period progressively decreased. Our reanalysis of the model predicted the initial-epizootic period of 4-5 years, with a progressive dampening of epizootic size and progressive decrease in epizootic period. The best quantitative agreement between data and model assumed low levels of immunity (1-5%) within raccoon populations, suggesting that raccoons develop little or no rabies immune class. These results encourage the use of data obtained through wildlife surveillance in assessing and refining epidemic models for wildlife diseases.
Eight decades after Blundell Bankart first described the characteristic anteroinferior labral lesion following an anterior shoulder dislocation, there are still various recommendations regarding the ...timelines for returning to sport and work after nonsurgical and surgical treatments. The differences stem from diverse patient collectives and the vast evolution in evidence-based nonoperative and operative therapeutic strategies. Most studies initially addressed topics such as nonoperative versus operative techniques, implant material, and clinical and radiographic outcomes. However, to give patients a realistic outlook on performance capability and evidence-based timeframes, the focus has shifted toward more patient-centered metrics such as return to play, to sport, and to work. This review highlights return-to-sport and return-to-work rates after nonoperative and operative management of traumatic unidirectional anterior shoulder instability and functions in order to give physicians practical, up-to-date guidance on therapy-dependent timeframes for these metrics.
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