Purpose
The importance of meniscus integrity in the prevention of early osteoarthritis is well known, and preservation is accepted as the primary goal. The purpose of the ESSKA (European Society for ...Sports Traumatology, Knee Surgery and Arthroscopy) European consensus on traumatic meniscus tears was to provide recommendations for the treatment of meniscus tears based on both scientific evidence and the clinical experience of knee experts.
Methods
Three groups of surgeons and scientists elaborated and ratified the so-called formal consensus process to define the recommendations for the management of traumatic meniscus tears. A traumatic meniscus tear was defined as a tear with an acute onset of symptoms caused by a sufficient trauma. The expert groups included a steering group of eight European surgeons and scientists, a rating group of another nineteen European surgeons, and a peer review group. The steering group prepared twenty-seven question and answer sets based on the scientific literature. The quality of the answers received grades of A (a high level of scientific support), B (scientific presumption), C (a low level of scientific support) or D (expert opinion). These question and answer sets were then submitted to and evaluated by the rating group. All answers were scored from 1 (= totally inappropriate) to 9 (= totally appropriate) points. Thereafter, the comments of the members of the rating group were incorporated by the steering group and the consensus was submitted to the rating group a second time. Once a general consensus was reached between the steering and rating groups, the finalized question and answer sets were submitted for final review by the peer review group composed of representatives of the ESSKA-affiliated national societies. Eighteen representatives replied.
Results
The review of the literature revealed a rather low scientific quality of studies examining the treatment of traumatic meniscus tears. Of the 27 questions, only one question received a grade of A (a high level of scientific support), and another received a grade of B (scientific presumption). The remaining questions received grades of C and D. The mean rating of all questions by the rating group was 8.2 (95% confidence interval 8.1–8.4). A general agreement that MRI should be performed on a systematic basis was not achieved. However, MRI was recommended when arthroscopy would be considered to identify concomitant pathologies. In this case, the indication for MRI should be determined by a musculoskeletal specialist. Based on our data, stable left in situ lateral meniscus tears appear to show a better prognosis than medial tears. When repair is required, surgery should be performed as early as possible. Evidence that biological enhancement such as needling or the application of platelet-rich plasma would improve healing was not identified. Preservation of the meniscus should be considered as the first line of treatment because of an inferior clinical and radiological long-term outcome after partial meniscectomy compared to meniscus repair.
Discussion
The consensus was generated to present the best possible recommendations for the treatment of traumatic meniscus tears and provides some groundwork for a clinical decision-making process regarding the treatment of meniscus tears. Preservation of the meniscus should be the first line of treatment when possible, because the clinical and radiological long-term outcomes are worse after partial meniscectomy than after meniscus preservation. The consensus clearly states that numerous meniscus tears that were considered irreparable should be repaired, e.g., older tears, tears in obese patients, long tears, etc.
Level of evidence
II
The present work studies the improvement of Methylene Blue (MB) from aqueous solutions by an electrocoagulation (EC)/banana peel (BP) adsorption coupling process. The kinetics of this coupling ...process was studied using different amounts of adsorbent material in order to identify the most appropriate dosage, for enhancing wastewater treatment. The influence of current density on the removal efficiency and energy consumption of the EC/BP coupling process was also determined.
The coupling between electrocoagulation and BP showed that the addition of an appropriate BP dosage resulted in the enhancement of the removal rate of dyes especially at lower current densities, and in a considerable reduction in the contact time compared to the conventional simple EC process and simple adsorption process, having achieved efficiency removal of approximately 99%.
Based on the high removal efficiency, short contact time and low energy consumption, the EC/BP coupling method could be recommended instead of the conventional simple EC.
Purpose
The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions.
Methods
A questionnaire was sent ...to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects.
Results
Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3–6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered.
Conclusions
Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI.
Level of evidence
V.
Background:
Acute inversion ankle sprains are among the most common musculoskeletal injuries. Higher grade sprains, including anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) ...injury, can be particularly challenging. The precise effect of CFL injury on ankle instability is unclear.
Hypothesis:
CFL injury will result in decreased stiffness, decreased peak torque, and increased talar and calcaneal motion and will alter ankle contact mechanics when compared with the uninjured ankle and the ATFL-only injured ankle in a cadaveric model.
Study Design:
Descriptive laboratory study.
Methods:
Ten matched pairs of cadaver specimens with a pressure sensor in the ankle joint and motion trackers on the fibula, talus, and calcaneus were mounted on a material testing system with 20° of ankle plantarflexion and 15° of internal rotation. Intact specimens were axially loaded to body weight and then underwent inversion along the anatomic axis of the ankle from 0° to 20°. The ATFL and CFL were sequentially sectioned and underwent inversion testing for each condition. Linear mixed models were used to determine significance for stiffness, peak torque, peak pressure, contact area, and inversion angles of the talus and calcaneus relative to the fibula across the 3 conditions.
Results:
Stiffness and peak torque did not significantly decrease after sectioning of the ATFL but decreased significantly after sectioning of the CFL. Peak pressures in the tibiotalar joint decreased and mean contact area increased significantly after CFL release. Significantly more inversion of the talus and calcaneus as well as calcaneal medial displacement was seen with weightbearing inversion after sectioning of the CFL.
Conclusion:
The CFL contributes considerably to lateral ankle instability. Higher grade sprains that include CFL injury result in significant decreases in rotation stiffness and peak torque, substantial alteration of contact mechanics at the ankle joint, increased inversion of the talus and calcaneus, and increased medial displacement of the calcaneus.
Clinical Relevance:
Repair of an injured CFL should be considered during lateral ligament reconstruction, and there may be a role for early repair in high-grade injuries to avoid intermediate and long-term consequences of a loose or incompetent CFL.
Emergence Delirium (ED) is an essential condition in the immediate postoperative period. Systematic review and meta-analysis of randomized controlled trials have concluded that the effect of ketamine ...on postoperative delirium remains unclear. The present study sought to evaluate if the intraoperative use of ketamine for postoperative analgesia is associated with postoperative ED in laparoscopic surgeries.
A prospective observational study was performed in the PostAnesthetic Care Unit (PACU) to evaluate patients who had undergone laparoscopic surgery under a rigid intraoperative anesthesia protocol from July 2018 to January 2019. Patients submitted to laparoscopic surgery for cholecystectomy, oophorectomy, or salpingectomy with a score ≥1 on the Richmond Assessment Sedation Scale (RASS) or ≥2 on the Nursing Delirium Screening Scale (Nu-DESC) were considered to have ED. t-test, Chi-Square test or Fisher's exact tests were used for comparison.
One hundred and fifteen patients were studied after laparoscopic surgery. Seventeen patients (14.8%) developed ED, and the incidence of ED in patients who received ketamine was not different from that of other patients (18.3% vs. 10.6%, p = 0.262). Patients with ED had more postoperative pain and morphine requirement at the PACU (p = 0.005 and p = 0.025, respectively). Type of surgery (general surgery, OR = 6.4, 95% CI 1.2‒35.2) and postoperative pain (OR = 3.7, 95% CI 1.2‒11.4) were risk factors for ED.
In this study, no association was found between ED and intraoperative administration of ketamine in laparoscopic surgeries. Type of surgery and postoperative pain were risk factors for ED.
In this paper, we propose an evolutionary multiobjective regenerator placement strategy for elastic optical networks (eMORP). The proposed optimization strategy uses the genetic algorithm NSGA-II to ...determine non-dominated solutions when the call request blocking probability and the total amount of regenerators used in the network are taken into account. In our simulations, we considered the amplified spontaneous emission noise generated by optical amplifiers (in-line, booster, and pre-amplifier) as physical impairment. Two recently proposed heuristics for regenerator assignment have been used, together with the regenerator placement strategies proposed and analyzed in this paper, for comparison purpose. The results obtained for two different network physical topologies state the efficiency of eMORP. Our regenerator placement strategy reduced considerably the call request blocking probability for the same number of regenerators in the network, as well as it acquired efficient solutions with just a fraction of the nodes with regeneration capability in comparison to other heuristics presented in the literature.
In the past decade, the global distribution of energy resources has expanded significantly. The increasing number of prosumers creates the prospect for a more decentralized and accessible energy ...market, where the peer-to-peer energy trading paradigm emerges. This paper proposes a methodology to optimize the participation in peer-to-peer markets based on the double-auction trading mechanism. This novel methodology is based on two reinforcement learning algorithms, used separately, to optimize the amount of energy to be transacted and the price to pay/charge for the purchase/sale of energy. The proposed methodology uses a competitive approach, and that is why all agents seek the best result for themselves, which in this case means reducing as much as possible the costs related to the purchase of energy, or if we are talking about sellers, maximizing profits. The proposed methodology was integrated into an agent-based ecosystem where there is a direct connection with agents, thus allowing application to real contexts in a more efficient way. To test the methodology, a case study was carried out in an energy community of 50 players, where each of the proposed models were used in 20 different players, and 10 were left without training. The players with training managed, over the course of a week, to save 44.65 EUR when compared to a week of peer-to-peer without training, a positive result, while the players who were left without training increased costs by 17.07 EUR.
Introduction
Peroneal tendon injuries are a significant cause of lateral ankle symptoms in the active population. Accurate diagnosis and prompt treatment is important for minimizing the risk of ...long-term sequelae associated with chronic peroneal tendinopathy. Although several studies have been published on diagnostic strategies and treatment outcomes, there is no consensus on the optimal management of peroneal tendon pathologies.
Purpose
The purpose of this ESSKA-AFAS consensus statement was to conduct an international and multidisciplinary agreed guideline on management of patients with peroneal tendon pathologies.
Methods
Using the Nominal Group Technique, a panel comprised of sixteen specialists spanning nine countries was convened by the ESSKA-AFAS board. In preparation for the meeting, relevant questions were identified and supported by a systematic literature search. During the meeting, the panel members gave presentations on each question, and the evidence supporting each subject was then vetted by open discussion. Statements were thereafter adjusted on the basis of the discussion and voted upon to determine consensus using a 0–10 range Likert scale. Agreement was confirmed when a mean score of at least 7.5 was reached.
Conclusion
This ESSKA-AFAS consensus statement on the optimal management of peroneal tendon pathologies is the result of international and multidisciplinary agreement combined with a systematic review of the literature.
Level of evidence
V.
Onset of Mediterranean outflow into the North Atlantic Hernández-Molina, F. Javier; Stow, Dorrik A. V.; Alvarez-Zarikian, Carlos A. ...
Science (American Association for the Advancement of Science),
06/2014, Letnik:
344, Številka:
6189
Journal Article
Recenzirano
Odprti dostop
Sediments cored along the southwestern Iberian margin during Integrated Ocean Drilling Program Expedition 339 provide constraints on Mediterranean Outflow Water (MOW) circulation patterns from the ...Pliocene epoch to the present day. After the Strait of Gibraltar opened (5.33 million years ago), a limited volume of MOW entered the Atlantic. Depositional hiatuses indicate erosion by bottom currents related to higher volumes of MOW circulating into the North Atlantic, beginning in the late Pliocene. The hiatuses coincide with regional tectonic events and changes in global thermohaline circulation (THC). This suggests that MOW influenced Atlantic Meridional Overturning Circulation (AMOC), THC, and climatic shifts by contributing a component of warm, saline water to northern latitudes while in turn being influenced by plate tectonics.
Este artigo apresenta os resultados da pesquisa que objetivou analisar comparativamente eco vilas implantadas no eixo Uruçuca-Itacaré, localizado no Litoral Sul da Bahia, e seus inerentes processos ...ecossistêmicos. A metodologia contemplou as seguintes etapas: 1 articulação conceitual entre o que se entende por ocupações eco urbanas, eco edificações e interação ecossistêmica; 2 análise de dados secundários para compreender a dinâmica ocupacional urbana local e 3 trabalho de Campo – identificação, escolha e visita às eco vilas para: a) fotografia, croquis (desenhos à mão livre) in loco e b) aplicação de roteiro de observação elaborado para análise do desenho urbano e das tipologias arquitetônicas sob o viés do Ecossistema Urbano. A análise dos dados permitiu compreender como tais ocupações interagem com os meios sistêmicos preexistentes (habitats aquático e verde) e o grau de impacto ambiental considerando os meios sistêmicos concomitantes (habitats construído e de resíduos).
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