The recognition of carbohydrate moieties by cells of the innate immune system is emerging as an essential element in antifungal immunity, but despite the number and diversity of lectins expressed by ...innate immune cells, few carbohydrate receptors have been characterized. Mincle, a C-type lectin, is expressed predominantly on macrophages, and is here shown to play a role in macrophage responses to the yeast Candida albicans. After exposure to the yeast in vitro, Mincle localized to the phagocytic cup, but it was not essential for phagocytosis. In the absence of Mincle, production of TNF-alpha by macrophages was reduced, both in vivo and in vitro. In addition, mice lacking Mincle showed a significantly increased susceptibility to systemic candidiasis. Thus, Mincle plays a novel and nonredundant role in the induction of inflammatory signaling in response to C. albicans infection.
To relate changes in body mass, total body water (TBW), extracellular fluid (ECF), and serum sodium concentration (Na) from a 161-km ultramarathon to finish time and incidence of hyponatremia.
...Observational.
: The 2008 Rio Del Lago 100-Mile (161-km) Endurance Run in Granite Bay, California.
Forty-five runners.
Pre-race and post-race body mass, TBW, ECF, and serum Na.
Body mass and serum Na significantly decreased 2% to 3% (P < 0.001) from pre-race to post-race, but TBW and ECF were unchanged. Significant relationships were observed between finish time and percentage change in body mass (r = 0.36; P = 0.01), TBW (r = 0.50; P = 0.007), and ECF (r = 0.61; P = 0.003). No associations were found between post-race serum Na and percentage change in body mass (r = -0.04; P = 0.94) or finish time (r = 0.5; P = 0.77). Hyponatremia (serum Na < 135 mmol/L) was present among 51.2% of finishers. Logistic regression prediction equation including pre-race TBW and percentage changes in TBW and ECF had an 87.5% concordance with the classification of hyponatremia.
Hyponatremia occurred in over half of the 161-km ultramarathon finishers but was not predicted by change in body mass. The combination of pre-race TBW and percentage changes in TBW and ECF explained 87.5% of the variation in the incidence of hyponatremia.
Exercise-associated hyponatremia can occur simultaneously with dehydration and cannot be predicted by weight checks at races.
The C-type lectin dendritic cell-specific intercellular adhesion molecule-3 grabbing nonintegrin (DC-SIGN) mediates the innate immune recognition of microbial carbohydrates. We investigated the ...function of this molecule in the host response to pathogens in vivo, by generating mouse lines lacking the DC-SIGN homologues SIGNR1, SIGNR3, and SIGNR5. Resistance to Mycobacterium tuberculosis was impaired only in SIGNR3-deficient animals. SIGNR3 was expressed in lung phagocytes during infection, and interacted with M. tuberculosis bacilli and mycobacterial surface glycoconjugates to induce secretion of critical host defense inflammatory cytokines, including tumor necrosis factor (TNF). SIGNR3 signaling was dependent on an intracellular tyrosine-based motif and the tyrosine kinase Syk. Thus, the mouse DC-SIGN homologue SIGNR3 makes a unique contribution to protection of the host against a pulmonary bacterial pathogen.
Introduction. Endurance exercise poses many challenges to an athlete, with one of the most important being maintenance of proper hydration. Inadequate fluid intake may result in dehydration, whereas ...overconsumption can cause hyponatremia, a condition of plasma electrolyte dilution that may lead to impaired physiological function. Change in body mass is frequently used to assess an athlete's hydration status during race events, though few studies have examined change in body mass relative to body water and electrolyte levels. Furthermore, a lack of data exists in regard to these variables for ultra-endurance races lasting longer than ∼12.5 hours. Such is the reasoning for conducting the following study. Purpose. To examine the relationships among electrolyte concentrations, changes in body mass and changes in total body water (TBW) during a 161-km ultramarathon run, and relate these to finish time and incidence of hyponatremia. Methods. Subjects were recruited from the 161-km 2008 Rio Del Lago Endurance Race. Body mass, TBW, and serum electrolyte concentrations were measured approximately 12 hours pre-race and immediately post-race. Results. Body mass (p < 0.0001) and serum sodium concentration (Na+) (p < 0.001) decreased significantly from pre- to post-race, but TBW was unchanged. A significant relationship was observed between finish time and percent change in body mass (r=0.36; p=0.01), as well as between finish time and change in TBW (r=0.51; p=0.0003). Change in body mass was strongly related to percent change in TBW (r=0.79; p=0.0001). No association was found between post-race serum Na+ and change in body mass (r=0.03, p=0.83), nor between post-race serum Nat + and finish time (r=0.03, p=0.72). Based on post-race serum Na + < 134.9 mmol/l, ∼50% of finishers were classified as having either biochemical or clinical hyponatremia. Conclusions. Post-race serum Na + was not a good predictor of race performance, though faster runners tended to lose more body water and body mass than slower runners. TBW did not change, but serum Na+ decreased by 2.9% (p < 0.001); inadequate sodium intake was thus probably the largest contributor of the reduction in serum Na+.
To evaluate whether augmenting traditional fixation with a femoral neck buttress plate (FNBP) improves clinical outcomes in young adults with high-energy displaced femoral neck fractures.
Multicenter ...retrospective matched cohort comparative clinical study.
Twenty-seven North American Level 1 trauma centers.
Adult patients younger than 55 years who sustained a high-energy (nonpathologic) displaced femoral neck fracture.
Operative reduction and stabilization of a displaced femoral neck fracture with (group 1) and without (group 2) an FNBP.
Complications including failed fixation, nonunion, osteonecrosis, malunion, and need for subsequent major reconstructive surgery (early revision of reduction and/or fixation), proximal femoral osteotomy, or arthroplasty.
Of 478 patients younger than 55 years treated operatively for a displaced femoral neck fracture, 11% (n = 51) had the definitive fixation augmented with an FNBP. One or more forms of treatment failure occurred in 29% (n = 15/51) for group 1 and 49% (209/427) for group 2 ( P < 0.01). When FNBP fixation was used, mini-fragment (2.4/2.7 mm) fixation failed significantly more often than small-fragment (3.5 mm) fixation (42% vs. 5%, P < 0.01). Irrespective of plate size, anterior and anteromedial plates failed significantly more often than direct medial plates (75% and 33% vs. 9%, P < 0.001).
The use of a femoral neck buttress plate to augment traditional fixation in displaced femoral neck fractures is associated with improved clinical outcomes, including lower rates of failed fixation, nonunion, osteonecrosis, and need for secondary reconstructive surgery. The benefits of this technique are optimized when a small-fragment (3.5 mm) plate is applied directly to the medial aspect of the femoral neck, avoiding more anterior positioning .
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
To perform a quantitative anatomic evaluation of the (1) coracoid process, specifically the attachment sites of the conjoint tendon, the pectoralis minor, the coracoacromial ligament (CAL), and the ...coracoclavicular (CC) ligaments in relation to pertinent osseous and soft tissue landmarks; (2) CC ligaments' attachments on the clavicle; and (3) CAL attachment on the acromion in relation to surgically relevant anatomic landmarks to assist in planning of the Latarjet procedure, acromioclavicular (AC) joint reconstructions, and CAL resection distances avoiding iatrogenic injury to surrounding structures.
Ten nonpaired fresh-frozen human cadaveric shoulders (mean age 52 years, range 33-64 years) were included in this study. A 3-dimensional coordinate measuring device was used to quantify the location of pertinent bony landmarks and soft tissue attachment areas. The ligament and tendon attachment perimeters and center points on the coracoid, clavicle, and acromion were identified and subsequently dissected off the bone. Coordinates of points along the perimeters of attachment sites were used to calculate areas, whereas coordinates of center points were used to determine distances between surgically relevant attachment sites and pertinent bony landmarks.
The CAL had a single consistent acromial attachment (mean area 77 mm 51.9, 102.2) and then bifurcated into 2 bundles, anterior and posterior, that separately inserted on the lateral aspect of the coracoid. The footprint areas were 54.4 mm2 31.7, 77.2 and 30.6 mm2 23.4, 37.7 for the anterior and posterior CAL bundles, respectively. These anterior and posterior bundles attached 10.6 mm 8.4, 12.9 and 24.8 mm 12.3, 27.4 medial and proximal to the apex of the coracoid process, respectively. The minimum distance between the coracoid apex and the trapezoid ligament was 25.1 mm 22.1, 28.1 and was noted to be different in males (28.1 mm 25.1; 31.2) and females (22.0 mm 18.2, 25.9). The most lateral insertion of the CC ligaments on the clavicle the AC joint was 15.7 mm 13.1, 18.3. The distance between the most medial to the most lateral point of the CC ligaments on the clavicle was 25.6 mm 22.3, 28.9, which accounted for 18.2% 15.8, 20.6 of the clavicle length.
In contrast to previous findings, 2 different coracoid attachments (anterior and posterior bundles) of the CAL were consistently identified in all specimens. Moreover, a coracoid osteotomy for a bone graft for the Latarjet procedure should be performed at less than 28.1/22 mm from the apex of the coracoid in male/female patients, respectively. The CC ligaments' attachments on the clavicle were located 15.7 mm from the AC joint, which should be considered for reconstruction.
During the Latarjet technique, to maintain the integrity of the CC ligaments, precise knowledge of differences between male and female anatomy is necessary during a coracoid osteotomy. Furthermore, when reconstructing the AC joint, the distance from the lateral aspect of the clavicle and the size of the attachments areas should be considered to better replicate the native anatomy.
To evaluate the effect of technical errors (TEs) on the outcomes after repair of femoral neck fractures in young adults.
Multicenter retrospective clinical study.
26 North American Level 1 Trauma ...Centers.
Skeletally mature patients younger than 50 years of age with 492 femoral neck fractures treated between 2005 and 2017.
Operative repair of femoral neck fracture.
The association between TE (malreduction and deviation from optimal technique) and treatment failure (fixation failure, nonunion, malunion, osteonecrosis, malunion, and revision surgery) were examined using logistic regression analysis.
Overall, a TE was observed in 50% (n = 245/492) of operatively managed femoral neck fractures in young patients. Two or more TEs were observed in 10% of displaced fractures. Treatment failure in displaced fractures occurred in 27% of cases without a TE, 56% of cases with 1 TE, and 86% of cases with 2 or more TEs. TEs were encountered less frequently in treatment of nondisplaced fractures compared with displaced fractures (39% vs. 53%, P < 0.001). Although TE(s) in nondisplaced fractures increased the risk of treatment failure and/or major reconstructive surgery (22% vs. 9%, P < 0.001), they were less frequently associated with treatment failure when compared with displaced fractures with a TE (22% vs. 69% P < 0.001).
TEs were found in half of all femoral neck fractures in young adults undergoing operative repair. Both the occurrence and number of TEs were associated with an increased risk for failure of treatment. Preoperative planning for thoughtful and well-executed reduction and fixation techniques should lead to improved outcomes for young patients with femoral neck fractures. This study should also highlight the need for educational forums to address this subject.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
To provide a quantitative and qualitative anatomic analysis of the pectoralis major, teres major, and latissimus dorsi on the humerus, as well as the deltoid tendinous attachments on the proximal ...humerus and acromion, and to quantitatively characterize the humeral course of the axillary nerve.
Ten nonpaired, fresh-frozen human cadaveric shoulders were analyzed. A portable coordinate-measuring device quantified the location of bony landmarks and tendon attachment areas. The tendon footprints were recorded by tracing their outlines and center points. The footprint areas of the tendons, the distances between the footprint areas and pertinent osseous and soft-tissue landmarks, and the distance between where the axillary nerve courses across the humerus relative to the acromion and greater tuberosity were measured.
Of the 10 specimens, 9 (90%) had 5 distinct tendinous bands attaching the deltoid to the acromion; 1 specimen had 4 bands. The distances between the center of the deltoid footprint on the humerus and the centers of the pectoralis major, latissimus dorsi, and teres major tendon footprints on the humerus were 43.5 mm, 58.5 mm, and 49.4 mm, respectively. The shortest distances from the perimeter of the pectoralis major to the latissimus dorsi and teres major tendon footprints were 3.9 mm and 9.5 mm, respectively. The distance from the superior aspect of the greater tuberosity to the axillary nerve on the humeral shaft was 50.3 mm (95% confidence interval, 47.0-53.5 mm). The distance from the lateral acromion to the axillary nerve was 69.3 mm (95% confidence interval, 64.1-74.5 mm).
The deltoid muscle had 4 to 5 tendinous insertions on the acromion, and the axillary nerve was 50.3 mm from the tip of the greater tuberosity. The distance between the lower border of the pectoralis major and the axillary nerve was 9.4 mm.
Knowledge of the quantitative anatomy of the tendons of the proximal humerus and axillary nerve can aid in identifying structures of interest during open shoulder surgery and in avoiding iatrogenic axillary nerve injury. Furthermore, this study provides direction to avoid injury to the deltoid tendons during open surgery.
Hunting stand-related injuries in orthopedics Lebus, George F; Krueger, Chad A; Stinner, Daniel J ...
Southern medical journal (Birmingham, Ala.),
2014-September, Letnik:
107, Številka:
9
Journal Article
Recenzirano
Hunting remains an extremely popular recreational activity, with nearly 15 million Americans receiving a hunting license annually. Precautions have helped decrease accidents, but hunting-related ...injuries remain relatively common. The majority of severe, hunting-related accidents involve either a fall from a hunting platform or an accidental shooting. Both of these mechanisms frequently result in orthopedic injuries, many of which require operative care. Although firearms-associated injury has seemingly decreased, hunting platform falls and their sequelae are increasing. Understanding the mechanisms of these injuries and increasing awareness of them may minimize their morbidity and mortality or help prevent them altogether.
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