Spinal Injuries in the Overhead Athlete Watkins, Robert G.; Chang, David; Watkins, Robert G.
Current reviews in musculoskeletal medicine,
12/2022, Letnik:
15, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Purpose of Review
Treatment of overhead athletes requires a systematic approach that will make an accurate diagnosis, deliver effective treatment, and make timely and safe return to sport.
Recent ...Findings
New data has shown success rates and return to play effectiveness after different types of cervical and lumbar surgery. Cervical foraminotomy has been shown to have the highest rate and fastest return to play, but with the highest incidence of need for revision surgery. Cervical artificial disc replacement has shown promising results in the general population and is being done more commonly in elite athletes, but has an unknown risk for failure. Cervical fusion is a well-established and effective treatment, but has the longest healing time and risk for adjacent level pathology. In the lumbar spine, discectomy has a long and proven track record, fusion is rarely performed but can be effective, and artificial disc replacement is extremely rare in an elite athlete.
Summary
An effective and comprehensive approach can diagnose, treat, and return overhead athletes to competitive play.
Full duplex (FD) could potentially double wireless communications capacity by allowing simultaneous transmission and reception on the same frequency channel. A single antenna architecture is proposed ...here based on a modified rat-race coupler to couple the transmit and receive paths to the antenna while providing a degree of isolation. To allow the self-interference cancellation (SiC) to be maximized, the rat-race coupler was made tuneable. This compensated for both the limited isolation of the rat race and self-interference caused by antenna mismatch. Tuneable operation was achieved by removing the fourth port of the rat race and inserting a variable attenuator and variable phase shifter into the loop. In simulation with a 50 Ω load on the antenna port, better than −65 dB narrowband SiC was achieved over the whole 2.45 GHz industrial, scientific and medical (ISM) band. Inserting the S-parameters of a commercially available sleeve dipole antenna into the simulation, better than −57 dB narrowband SiC could be tuned over the whole band. Practically, better than −58 dB narrowband tuneable SiC was achieved with a practical antenna. When excited with a 20 MHz Wi-Fi signal, −42 dB average SiC could be achieved with the antenna.
Divertor detachment offers a promising solution to the challenge of plasma-wall interactions for steady-state operation of fusion reactors. Here, we demonstrate the excellent compatibility of ...actively controlled full divertor detachment with a high-performance (β
~ 3, H
~ 1.5) core plasma, using high-β
(poloidal beta, β
> 2) scenario characterized by a sustained core internal transport barrier (ITB) and a modest edge transport barrier (ETB) in DIII-D tokamak. The high-β
high-confinement scenario facilitates divertor detachment which, in turn, promotes the development of an even stronger ITB at large radius with a weaker ETB. This self-organized synergy between ITB and ETB, leads to a net gain in energy confinement, in contrast to the net confinement loss caused by divertor detachment in standard H-modes. These results show the potential of integrating excellent core plasma performance with an efficient divertor solution, an essential step towards steady-state operation of reactor-grade plasmas.
Written by an acknowledged expert on the ISO/IEC 27001
Standard , ISO 27001:2022 - An Introduction to information
security and the ISMS standard is an ideal primer for anyone
implementing an ...information security management system aligned to
ISO 27001:2022.
The guide is a must-have resource giving a clear, concise and
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effective, reliable and auditable.
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information secure About the author:
Steve is a Director of Kinsnall Consulting Ltd, providing
board-level advice on cyber security and related standards.
Steve is an active member of SC 27, the international committee
responsible for cyber security, information security and privacy
protection standards, including the ISO 27001 family. He Chairs the
UK national committee (IST 33) that mirrors SC 27 and is the Chair
of the UK ISO/IEC 27001 User Group.
He is also a contracted ISMS and ITSMS Technical Assessor for
UKAS, supporting the assessment of certification bodies offering
accredited certification to ISO/IEC 27001 and ISO/IEC 20000-1.
TOC:
Introduction
Chapter 1: Information security - What's
that?
Chapter 2: It's not IT
Chapter 3: ISO 27001 and the management system
requirements
Chapter 4: Legal, regulatory and contractual
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Chapter 5: Information security controls
Chapter 6: Certification
Chapter 7: Signposting
Further reading
The human papillomavirus (HPV) replication cycle is tightly linked to epithelial cell differentiation. To examine HPV-associated changes in the keratinocyte transcriptome, RNAs isolated from ...undifferentiated and differentiated cell populations of normal, spontaneously immortalized keratinocytes (NIKS) and NIKS stably transfected with HPV16 episomal genomes (NIKS16) were compared using next-generation sequencing (RNA-Seq). HPV16 infection altered expression of 2,862 cellular genes. Next, to elucidate the role of keratinocyte gene expression in late events during the viral life cycle, RNA-Seq was carried out on triplicate differentiated populations of NIKS (uninfected) and NIKS16 (infected). Of the top 966 genes altered (>log
= 1.8, 3.5-fold change), 670 genes were downregulated and 296 genes were upregulated. HPV downregulated many genes involved in epithelial barrier function, which involves structural resistance to the environment and immunity to infectious agents. For example, HPV infection repressed expression of the differentiated keratinocyte-specific pattern recognition receptor TLR7, the Langerhans cell chemoattractant CCL20, and proinflammatory cytokines interleukin 1α (IL-1α) and IL-1β. However, the type I interferon regulator IRF1, kappa interferon (IFN-κ), and viral restriction factors (IFIT1, -2, -3, and -5, OASL, CD74, and RTP4) were upregulated. HPV infection abrogated gene expression associated with the physical epithelial barrier, including keratinocyte cytoskeleton, intercellular junctions, and cell adhesion. Quantitative PCR (qRT-PCR) and Western blotting confirmed changes in expression of seven of the most significantly altered mRNAs. Expression of three genes showed statistically significant changes during cervical disease progression in clinical samples. Taken together, the data indicate that HPV infection manipulates the differentiating keratinocyte transcriptome to create an environment conducive to productive viral replication and egress.
HPV genome amplification and capsid formation take place in differentiated keratinocytes. The viral life cycle is intimately associated with host cell differentiation. Deep sequencing (RNA-Seq) of RNA from undifferentiated and differentiated uninfected and HPV16-positive keratinocytes showed that almost 3,000 genes were differentially expressed in keratinocytes due to HPV16 infection. Strikingly, the epithelial barrier function of differentiated keratinocytes, comprising keratinocyte immune function and cellular structure, was found to be disrupted. These data provide new insights into the virus-host interaction that is crucial for the production of infectious virus and reveal that HPV infection remodels keratinocytes for completion of the virus replication cycle.
The importance of energy to the functioning of any economy has meant that energy industries are amongst the most regulated of industries. What might appear to be purely private decisions are made ...within a complex and evolving web of government regulations. Petropolitics: Petroleum Development, Markets and Regulations, Alberta as an Illustrative History provides an economic history of the petroleum industry in Alberta as well as a detailed analysis of the operation of the markets for Alberta oil and natural gas, and the main governmental regulations (apart from environmental regulations) faced by the industry. The tools used within this study are applicable to oil and gas industries throughout the world. Winner, 2014 Book of the Year, Petroleum History Society
Background:
It has been shown a microscopic lumbar diskectomy (MLD) is effective in getting professional athletes back to their sport after a herniated nucleus pulposus (HNP). There is a need for ...more information on the time it takes professional athletes to return after surgery.
Purpose:
To determine average time for return to play and success in returning to play for professional athletes undergoing MLD.
Study Design:
Case series; Level of evidence, 4.
Methods:
Between 1996 and 2010, the senior authors treated 171 professional athletes for lumbar HNP. A retrospective review was performed using patient charts, operative reports, team medical records, and internet search. Eighty-five patients were treated with MLD, and 86 patients were treated nonoperatively. This study focused on the return to play of the operatively treated patients. Primary outcome measures were return rate and average return time, considering only patients whose sport is in season at specific postoperative time points.
Results:
Of surgically treated patients, 89.3% returned to sport. The average time it took operative patients to return to their sport (return time) was 5.8 months. Progressive return data for surgically treated patients showed the percentage of athletes who returned increased from 50% at 3 months to 72% at 6 months to 77% at 9 months and 84% at 12 months.
Conclusion:
The chance a player returns to play after MLD is 50% at 3 months, 72% at 6 months, 77% at 9 months, and 84% at 12 months. The overall chance of returning to play at any point is 89%.
A prospective, nonblinded, multicenter study of outcomes in patients undergoing single-level anterior lumbar discectomy and interbody fusion with InFUSE Bone Graft.
To determine the safety and ...effectiveness of InFUSE Bone Graft applied to an absorbable collagen sponge in anterior lumbar interbody fusion with threaded cortical allografts.
In primates, InFUSE Bone Graft used with allograft dowels was shown to increase rates of interbody fusion by promoting osteoinduction and enhancing incorporation of the allograft. Recently, in a small series of human patients undergoing anterior lumbar interbody fusion with a tapered cylindrical metal fusion cage, InFUSE Bone Graft has been shown to promote osteoinduction and fusion.
Forty-six patients underwent a single-level anterior lumbar discectomy and interbody fusion at five investigational sites. They were randomly assigned to one of two groups, and the results in the investigational patients who received threaded cortical allograft dowels with InFUSE Bone Graft were compared with those in the control patients who received threaded allograft dowels with autogenous iliac crest bone graft. Patients' clinical outcomes were assessed using neurologic status, work status, and Oswestry Low Back Pain Disability, Short Form-36, and back and leg pain questionnaires. Anteroposterior, lateral, flexion-extension radiographs, and computed tomography scans were used to evaluate the progression of fusion at 6, 12, and 24 months after surgery.
All patients who received InFUSE Bone Graft showed radiographic evidence of bony induction and early incorporation of the cortical allografts. All patients in this group had fusions at 12 months that remained fused at 24 months. At 12 and 24 months, the investigational group showed higher rates of fusion and improved neurologic status and back and leg pain when compared with the control group. There were no unanticipated adverse events related to the use of InFUSE Bone Graft.
The use of InFUSE Bone Graft is a promising method of facilitating anterior intervertebral spinal fusion, decreasing pain, and improving clinical outcomes in patients who have undergone anterior lumbar fusion surgery with structural threaded cortical allograft bone dowels.
A stochastic magnetic boundary, produced by an applied edge resonant magnetic perturbation, is used to suppress most large edge-localized modes (ELMs) in high confinement (H-mode) plasmas. The ...resulting H mode displays rapid, small oscillations with a bursty character modulated by a coherent 130 Hz envelope. The H mode transport barrier and core confinement are unaffected by the stochastic boundary, despite a threefold drop in the toroidal rotation. These results demonstrate that stochastic boundaries are compatible with H modes and may be attractive for ELM control in next-step fusion tokamaks.
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