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
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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.
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.
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.
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 critical issue for fusion-plasma research is the erosion of the first wall of the experimental device due to impulsive heating from repetitive edge magneto-hydrodynamic instabilities known as ...'edge-localized modes' (ELMs). Here, we show that the addition of small resonant magnetic field perturbations completely eliminates ELMs while maintaining a steady-state high-confinement (H-mode) plasma. These perturbations induce a chaotic behaviour in the magnetic field lines, which reduces the edge pressure gradient below the ELM instability threshold. The pressure gradient reduction results from a reduction in the particle content of the plasma, rather than an increase in the electron thermal transport. This is inconsistent with the predictions of stochastic electron heat transport theory. These results provide a first experimental test of stochastic transport theory in a highly rotating, hot, collisionless plasma and demonstrate a promising solution to the critical issue of controlling edge instabilities in fusion-plasma devices. PUBLICATION ABSTRACT
30 years of [11C]methyl triflate Jewett, Ethan M.; Någren, Kjell; Mock, Bruce H. ...
Applied radiation and isotopes,
July 2023, 2023-Jul, 2023-07-00, 20230701, Letnik:
197
Journal Article
Recenzirano
Some scientific discoveries are well known only to a core group of researchers working on technical subjects. Nevertheless, they open new research directions, allow existing knowledge to be viewed in ...entirely new and useful ways, or provide a way to make something that was hard or impossible to make before. Carbon-11 methyl triflate (11CMeOTf) is one such advance, facilitating the synthesis of many carbon-11 radio tracers and broadening the range of applications of carbon-11 radiochemistry. The year 2022 marked the 30th anniversary of the original paper in Applied Radiation and Isotopes introducing a simple synthesis of 11CMeOTf from carbon-11 methyl iodide (11CMeI) and it also marked the end of the fruitful career and life of the researcher who developed it, Douglas Jewett. It seems fitting to say a few words on how it came to be and how it has helped advance carbon-11 radiochemistry.
•Carbon-11 methyl triflate has been used extensively to improve carbon-11 radiosyntheses.•It has been 30 years since the original paper on carbon-11 methyl triflate appeared in Applied Radiation and Isotopes.•We review the impact of carbon-11 methyl triflate on carbon-11 radiochemistry and the resulting discoveries.
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