The representation of aerosol processes and the skill in simulating the Asian summer monsoon vary widely across climate models. Yet, for the second half of the twentieth century, the models from the ...Coupled Model Intercomparison Project Phase 5 (CMIP5) show a robust decrease of average precipitation in the South and Southeast Asian (SSEA) continental region due to the increase of anthropogenic aerosols. When taking into account anthropogenic aerosols as well as greenhouse gases (GHGs), the 15 CMIP5 models considered in this study yield an average June–September precipitation least squares linear trend of −0.20 ± 0.20 mmd−1 (50 years)−1, or −2.9%, for all land points in the SSEA region (taken from 75 to 120°E and 5 to 30°N) in the years from 1950 to 1999 (multimodel average ± one standard deviation) in spite of an increase in the water vapor path of +0.99 ± 0.65 kgm−2 (50 years)−1 (+2.5%). This negative precipitation trend differs markedly from the positive precipitation trend of +0.29 ± 0.14 mmd−1 (50 years)−1, or +4.1%, which is computed for GHG forcing only. Taking into account aerosols both decreases the water vapor path and slows down the monsoon circulation as suggested by several previous studies. At smaller scales, however, internal variability makes attributing observed precipitation changes to anthropogenic aerosols more difficult. Over Northern Central India (NCI), the spread between precipitation trends from individual model realizations is generally comparable in magnitude to simulated changes due to aerosols, and the model results suggest that the observed drying in NCI might in part be explained by internal variability.
Key Points
CMIP5 models simulate robust response of Asian monsoon to anthropogenic aerosolsAnthropogenic aerosols have influenced monsoon circulation more than GHG warmingAt smaller scales internal variability is potentially as important
Background: To achieve reduction of an acute acromioclavicular (AC) joint separation, novel procedures aim to provide stability and function by restoring the coracoclavicular anatomy.
Hypothesis: ...Anatomical reconstruction for acute AC joint disruption using 2 flip-button devices results in satisfactory clinical function and provides a stable fixation.
Study Design: Case series; Level of evidence, 4.
Methods: The outcome of 23 consecutive patients (21 men, 2 women; mean age, 37.5 ± 10.2 years; range, 21-59 years) who underwent anatomical reduction for an acute AC joint dislocation using 2 flip-button devices, each separately replacing 1 coracoclavicular ligament, was evaluated clinically and radiographically preoperatively and 6, 12, and 24 months postoperatively. The evaluation included a visual analog scale for pain, the Constant score, the simple shoulder test, and the Short Form-36. An additional 7 patients had similar surgery during the same period, but 4 were lost to follow-up, 2 required surgical revision, and 1 developed postoperative infection.
Results: There were 3 Rockwood type III, 3 type IV, and 17 type V separations. Mean follow-up was 30.6 ± 5.4 months (range, 24-40 months). The visual analog scale and Constant score showed significant improvements from preoperative 4.5 ± 1.9 (range, 1-7) and 34.3 ± 6.9 (range, 22-44) to postoperative 0.25 ± 0.5 (range, 0-1) and 94.3 ± 3.2 (range, 88-98) at 24 months, respectively. Postoperative radiographic AC joint alignment was unsatisfactory in 8 cases, either in the coronal, axillary, or both planes, with no different clinical outcome when compared with the remaining patients.
Conclusion: Immediate anatomical reduction of an acute AC separation with flip-button devices provides satisfactory clinical results at intermediate-term follow-up. This technique should be performed by an experienced arthroscopist; tunnel and button placement are of utmost importance to avoid postoperative failure or loss of reduction.
Knee joint osteoarthritis is a complex immunological and degenerative disease. Current treatment strategies fail to alter its progression. Mesenchymal stromal cell (MSC) therapy for osteoarthritis ...has been object of research for more than 30 years. The aim of MSC therapy is intended to be holistic, with regeneration of all affected knee joint structures. The paracrine effect of the MSC secretome has been shown to be central for the regenerative capacity of MSCs. Activation of local knee-joint-specific MSCs leads to an immunomodulatory, anti-catabolic, anti-apoptotic and chondrogenic stimulus. Preclinical models have demonstrated the symptom- and disease-modifying effects of MSC therapy. At the bedside, there is evidence that autologous and allogeneic MSC therapy shows significant improvement in symptom-modifying and functional outcome. Despite this, a variety of contradictory clinical outcomes are available in the literature. The effectiveness of MSC therapy is still unclear, although there have been promising results. Regarding the diversity of cell sources, isolation, culture protocols and other factors, a comparison of different studies is difficult. Clinical translation of disease-modifying effects has not yet been shown. This narrative review presents a controversial overview of the current preclinical and clinical studies on MSC therapy in knee joint osteoarthritis.
Abstract
Background
There is no universally accepted treatment standard for idiopathic toe walking patients (ITW) in the current literature. None of the established methods provide homogenous ...satisfying results. In our department we treat ITW patients with lower leg orthoses with a circular foot unit for a total of 16 weeks. In this study we reviewed our database to evaluate the success of our treatment protocol for a 24 months follow up period.
Results
Twenty-two patients were included in this study. Age at the beginning of treatment was 7.0 years +/− 2.9 (range 2.5-13.1). Percentage of ITW at the beginning of treatment according to the perception of the parents was 89% +/− 22.2 (range 50-100). Immediately after the treatment with our device, percentage of ITW dropped to 11% +/− 13.2 (range 0-50). After 12 months, 73% of the patients (16/22) walked completely normal or showed ITW less than 10% of the day. After 24 months, 64% of the patients kept a normal gait (14/22).
Conclusion
This study provides evidence that the treatment of idiopathic toe walking with lower leg orthoses with a circular foot unit results in satisfying long-term results in two thirds of the patients.
Posterior root tears of the lateral meniscus Feucht, Matthias J.; Salzmann, Gian M.; Bode, Gerrit ...
Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA,
01/2015, Letnik:
23, Številka:
1
Journal Article
Recenzirano
Purpose
To summarize and discuss the current knowledge on posterior lateral meniscus root tears.
Methods
A comprehensive review of the MEDLINE database was carried out to identify relevant articles ...using different keywords (e.g. “meniscus root”, “root tear”, “meniscus avulsion”, “radial tear” and “lateral meniscus”). The reference lists of the reviewed articles were searched for additional relevant articles.
Results
Posterior lateral meniscus root tears are found in 7–12 % of patients with a tear of the anterior cruciate ligament (ACL). Biomechanical studies have found an increase in lateral compartment contact pressure of approximately 50 % after creation of a posterior lateral meniscus root tear. There is some evidence that the biomechanical consequences of these injuries are significantly influenced by the presence and integrity of the meniscofemoral ligaments. Clinical studies have found encouraging results after repair of posterior lateral meniscus root tears. Whether root repair can prevent the development of osteoarthritis is currently unknown.
Conclusion
A posterior lateral meniscus root tear is a clinical relevant but most likely underrecognized concomitant injury in patients with a tear of the ACL. This article may support clinicians in diagnosing and treating this unique type of meniscus tear.
Level of evidence
V.
Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer with precursor B-cell ALL (pB-ALL) accounting for ~ 85% of the cases. Childhood pB-ALL development is influenced by genetic ...susceptibility and host immune responses. The role of the intestinal microbiome in leukemogenesis is gaining increasing attention since Vicente-Dueñas’ seminal work demonstrated that the gut microbiome is distinct in mice genetically predisposed to ALL and that the alteration of this microbiome by antibiotics is able to trigger pB-ALL in
Pax5
heterozygous mice in the absence of infectious stimuli. In this review we provide an overview on novel insights on the role of the microbiome in normal and preleukemic hematopoiesis, inflammation, the effect of dysbiosis on hematopoietic stem cells and the emerging importance of the innate immune responses in the conversion from preleukemic to leukemic state in childhood ALL. Since antibiotics, which represent one of the most widely used medical interventions, alter the gut microbial composition and can cause a state of dysbiosis, this raises exciting epidemiological questions regarding the implications for antibiotic use in early life, especially in infants with a a preleukemic “first hit”. Sheading light through a rigorous study on this piece of the puzzle may have broad implications for clinical practice.
Articular cartilage lesions are identified with increasing frequency. Several cartilage repair techniques are available to treat symptomatic cartilage defects. The ultimate goal of any cartilage ...repair procedure is the prevention of premature osteoarthritis. Autologous chondrocyte implantation provides the best tissue quality. However, 2 operations and a resource-intense culturing process with high regulatory demands are disadvantages of this cartilage repair procedure. Furthermore, cellular dedifferentiation and senescence display further cell culture-associated drawbacks that hamper the procedure. Minced cartilage implantation is a relatively simple and cost-effective one-step procedure with promising biologic potential and satisfying clinical results. We present an arthroscopic surgical technique where the surgeon can apply autologous chondrocytes in a one-step procedure to treat articular cartilage defects at the knee joint.
Introduction
The purpose of this study is to identify patient, meniscus rupture and surgical characteristics that influence the outcome and clinical healing following operative repair of bucket ...handle tears.
Methods
Between 02/2006 and 10/2012, a total of 38 patients (14 women, 24 men) with bucket handle tears underwent surgical meniscus repair. There were 27 isolated repairs and 11 with concomitant anterior cruciate ligament (ACL) replacement. Patients were analyzed on an average of 44.4 months (range 15–96 months) after surgery by the use of standardized subjective scoring instruments Lysholm, International Knee Documentation Committee (IKDC), Knee Injury and Osteoarthritis Outcome Score (KOOS) and Tegner Activity Scale (TAS). To identify factors affecting the outcome and suture survival, patient-specific, trauma-specific as well as meniscus- and surgery-specific factors were collected. Patients were divided in two groups with healed menisci (group 1) and re-rupture subjects (group 2). Meniscus re-rupture was defined as a clinical failure.
Results
There were 25 patients with healed menisci and 13 (34.2%) that sustained re-rupture and underwent either partial meniscectomy (
n
= 8) or re-suture (
n
= 5). Group 1 achieved slightly higher outcome compared to group 2 Lysholm: 87.8 vs. 84.3 (
p
= 0.35), IKDC: 86.9 vs. 85.7 (
p
= 0.67), KOOS: 91.3 vs. 90.5 (
p
= 0.74). TAS was better for group 2 5.9 vs. 6.8 (
p
= 0.36). Strong impact to result in a significantly increased outcome was identified for higher age, subjective knee joint stability, high preoperative Lysholm Score, short trauma-to-repair time, previous ACL reconstruction and a smaller number of sutures to fulfill meniscus repair. Lower patient age, male gender and higher activity level had the strongest impact to provoke re-rupture.
Conclusion
Clinical outcome after meniscus bucket handle suture is satisfying. Re-rupture rate among this collective was 34.2%. Clear risk factors were identified for diminished clinical healing and outcome.
Abstract Articular cartilage defects at the knee joint are identified and treated with increasing frequency. Autologous chondrocytes may have the strongest potential to generate high-quality repair ...tissue within the defective region. Autologous chondrocyte implantation is not available in every country. We present a surgical technique where the surgeon can apply autologous chondrocytes in a one-step procedure to treat articular cartilage defects at the knee joint.
Three-dimensional detection and shape recovery of a nonrigid surface from video sequences require deformation models to effectively take advantage of potentially noisy image data. Here, we introduce ...an approach to creating such models for deformable 3D surfaces. We exploit the fact that the shape of an inextensible triangulated mesh can be parameterized in terms of a small subset of the angles between its facets. We use this set of angles to create a representative set of potential shapes, which we feed to a simple dimensionality reduction technique to produce low-dimensional 3D deformation models. We show that these models can be used to accurately model a wide range of deforming 3D surfaces from video sequences acquired under realistic conditions.
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