A reader-friendly overview of the fundamentals in hip pathology and treatment presented by esteemed experts! Synopsis of Hip Surgery by renowned hip specialists Shane Nho, Joshua Harris, Brett ...Levine, and an impressive group of contributors provides a well-rounded perspective on the surgical and nonsurgical management of common to rare hip conditions. The generously illustrated clinical reference is both concise and comprehensive, not only encompassing the full age continuum but also a wide array of hip disorders such as congenital and degenerative issues and problems associated with sports injuries. The first seven chapters lay a solid foundation, covering hip anatomy, patient history, physical examination, radiographic imaging, diagnostic tests, biomechanics, pathomechanics, and implant biology. Subsequent chapters detail prevalent conditions such as femoroacetabular impingement syndrome, hip dysplasia, soft-tissue injuries, and osteoarthritis. The text also covers less common diseases including synovial proliferative disorders, primary and metastatic tumors, and osteonecrosis. Procedure-specific chapters focus on primary and revision total hip arthroplasty and hip replacement surgery. Key Features * An outline format and bulleted text provide a quick, easy reference for trainees and practitioners to consult prior to conferences, at the office, and in the operating room * Over 200 color illustrations enhance understanding of impacted anatomy and procedures * Fractures of the pelvis and hip including intracapsular, extracapsular, and acetabulum * Discussion of pediatric conditions including Legg-Calve-Perthes disease, slipped capital femoral epiphysis, and hip fractures This concise resource is essential reading for orthopaedic surgery residents, orthopaedic sports medicine and adult reconstruction fellows, general orthopaedic surgeons, and hip specialists.
Cardiogenic shock (CS) during elective percutaneous coronary intervention (PCI) is a rare but potentially lethal clinical condition. Pharmacological inotropic support and mechanical circulatory ...assistance with intra-aortic balloon pump (IABP) counterpulsation remains the gold-standard treatment. We report the case of a patient who developed refractory CS during elective PCI and was successfully managed with concomitant use of IABP and the Impella 2.5 L support device.
Following gyro failures in April 2001 and April 2003, HST Pointing Control System engineers designed reduced-gyro control laws to extend the spacecraft science mission. The Two-Gyro Science (TGS) and ...One-Gyro Science (OGS) control laws were designed and implemented using magnetometers, star trackers, and Fine Guidance Sensors in succession to control vehicle rate about the missing gyro axes. Both TGS and OGS have demonstrated on-orbit pointing stability less than 7 milli-arcseconds, which depends upon the guide star magnitude used by the Fine Guidance Sensor. This paper describes the design, implementation, and on-orbit performance of the HST reduced-gyro control system.
Vessel perforation is an undesirable and life-threatening complication during vein graft angioplasty. We report on a case of vein graft rupture during angioplasty, which was successfully managed with ...deployment of a polytetrafluoroethylene-covered stent.
The upper respiratory tract is continually assaulted with harmful dusts and xenobiotics carried on the incoming airstream. Detection of such irritants by the trigeminal nerve evokes protective ...reflexes, including sneezing, apnea, and local neurogenic inflammation of the mucosa. Although free intra-epithelial nerve endings can detect certain lipophilic irritants (e. g., mints, ammonia), the epithelium also houses a population of trigeminally innervated solitary chemosensory cells (SCCs) that express T2R bitter taste receptors along with their downstream signaling components. These SCCs have been postulated to enhance the chemoresponsive capabilities of the trigeminal irritant-detection system. Here we show that transduction by the intranasal solitary chemosensory cells is necessary to evoke trigeminally mediated reflex reactions to some irritants including acyl-homoserine lactone bacterial quorum-sensing molecules, which activate the downstream signaling effectors associated with bitter taste transduction. Isolated nasal chemosensory cells respond to the classic bitter ligand denatonium as well as to the bacterial signals by increasing intracellular Ca₂₊. Furthermore, these same substances evoke changes in respiration indicative of trigeminal activation. Genetic ablation of either Ga-gustducin or TrpM5, essential elements of the T2R transduction cascade, eliminates the trigeminal response. Because acyl-homoserine lactones serve as quorum-sensing molecules for Gram-negative pathogenic bacteria, detection of these substances by airway chemoreceptors offers a means by which the airway epithelium may trigger an epithelial inflammatory response before the bacteria reach population densities capable of forming destructive biofilms.
Abstract Background Severe aortic stenosis (AS) can manifest as exertional angina even in the presence of unobstructed coronary arteries. Objectives The authors describe coronary physiological ...changes during exercise and hyperemia in the healthy heart and in patients with severe AS. Methods Simultaneous intracoronary pressure and flow velocity recordings were made in unobstructed coronary arteries of 22 patients with severe AS (mean effective orifice area 0.7 cm2 ) and 38 controls, at rest, during supine bicycle exercise, and during hyperemia. Stress echocardiography was performed to estimate myocardial work. Wave intensity analysis was used to quantify waves that accelerate and decelerate coronary blood flow (CBF). Results Despite a greater myocardial workload in AS patients compared with controls at rest (12,721 vs. 9,707 mm Hg/min−1 ; p = 0.003) and during exercise (27,467 vs. 20,841 mm Hg/min−1 ; p = 0.02), CBF was similar in both groups. Hyperemic CBF was less in AS compared with controls (2,170 vs. 2,716 cm/min−1 ; p = 0.05). Diastolic time fraction was greater in AS compared with controls, but minimum microvascular resistance was similar. With exercise and hyperemia, efficiency of perfusion improved in the healthy heart, demonstrated by an increase in the relative contribution of accelerating waves. By contrast, in AS, perfusion efficiency decreased due to augmentation of early systolic deceleration and an attenuated rise in systolic acceleration waves. Conclusions Invasive coronary physiological evaluation can be safely performed during exercise and hyperemia in patients with severe aortic stenosis. Ischemia in AS is not related to microvascular disease; rather, it is driven by abnormal cardiac-coronary coupling.
Nasal trigeminal chemosensitivity in mice and rats is mediated in part by epithelial solitary chemoreceptor (chemosensory) cells (SCCs), but the exact role of these cells in chemoreception is ...unclear. Histological evidence suggests that SCCs express elements of the bitter taste transduction pathway including T2R (bitter taste) receptors, the G protein alpha-gustducin, PLCbeta2, and TRPM5, leading to speculation that SCCs are the receptor cells that mediate trigeminal nerve responses to bitter taste receptor ligands. To test this hypothesis, we used calcium imaging to determine whether SCCs respond to classic bitter-tasting or trigeminal stimulants. SCCs from the anterior nasal cavity were isolated from transgenic mice in which green fluorescent protein (GFP) expression was driven by either TRPM5 or gustducin. Isolated cells were exposed to a variety of test stimuli to determine which substances caused an increase in intracellular Ca2+ (Ca2+i). GFP-positive cells respond with increased Ca2+i to the bitter receptor ligand denatonium and this response is blocked by the PLC inhibitor U73122. In addition, GFP+ cells respond to the neuromodulators adenosine 5'-triphosphate and acetylcholine but only very rarely to other bitter-tasting or trigeminal stimuli. Our results demonstrate that TRPM5- and gustducin-expressing nasal SCCs respond to the T2R agonist denatonium via a PLC-coupled transduction cascade typical of T2Rs in the taste system.
To determine whether subgroups of patients exist based on the rate-of-recovery pattern of International Knee Documentation Committee (IKDC) scores after anterior cruciate ligament reconstruction ...(ACLR) and to determine clinical predictors for these subgroups.
Patients who underwent primary or revision ACLR at a single institution from January 2014 to January 2019 were identified. Latent class growth analyses and growth mixture models (GMMs) with 1 to 6 classes were used to identify subgroups of patients based on functional rate-of-recovery patterns by use of preoperative, 1-year postoperative, and 2-year postoperative IKDC scores.
A total of 245 patients who underwent ACLR were included in the analysis. A 3-class GMM was chosen as the final model after 6 different models were run. Class 1, showing improvement from preoperatively to 1-year follow-up, with sustained improvement from 1 to 2 years postoperatively, constituted 77.1% of the study population (n = 189), whereas class 2, showing functional improvement between 1- and 2-year follow-up, was the smallest class, constituting 10.2% of the study population (n = 25), and class 3, showing slight improvement at 1-year follow-up, with a subsequent decline in IKDC scores between 1- and 2-year follow-up, constituted 12.7% of the study population (n = 31). Revision surgery (P = .005), a psychiatric history (P = .025), preoperative chronic knee pain (P = .024), and a subsequent knee injury within the follow-up period (P = .011) were the predictors of class 2 and class 3 rate-of-recovery patterns. Patient demographic characteristics, graft type, and concomitant ligament, meniscus, or cartilage injury at the time of surgery were not associated with the different recovery patterns described in this study.
Patients may follow different rate-of-recovery patterns after ACLR. By use of the GMMs, 3 different rate-of-recovery patterns based on IKDC scores were identified. Although most patients follow a more ideal rate-of-recovery pattern, fewer patients may follow less favorable patterns. Revision surgery, a history of psychiatric illness, preoperative chronic knee pain, and a subsequent knee injury within the follow-up period were predictive of less favorable rate-of-recovery patterns.
Level III, retrospective cohort study.
The Core Optical Networks (CORONET) program addresses the development of architectures, protocols, and network control and management to support the future advanced requirements of both commercial ...and government networks, with a focus on highly dynamic and highly resilient multi-terabit core networks. CORONET encompasses a global network supporting a combination of IP and wavelength services. Satisfying the aggressive requirements of the program required a comprehensive approach addressing connection setup, restoration, quality of service, network design, and nodal architecture. This paper addresses the major innovations developed in Phase 1 of the program by the team led by Telcordia and AT&T. The ultimate goal is to transfer the technology to commercial and government networks for deployment in the next few years.
PDF
