Complete Detachment Research Articles

Excisional Debridement for Chronic Achilles Insertional Tendinosis: A Novel Technique and Case Review.

Operative treatment of chronic Achilles insertional tendinosis (AIT) involves tendon debridement, removal of the retrocalcaneal bursitis, and excision of the calcaneal exostosis, often followed by repair of the Achilles tendon and deep tendon transfer. The literature describes a variety of techniques without a single standard of care. This is a retrospective review of 57 patients treated with an excisional debridement of the central portion of the Achilles tendon. The novelty of this technique is that instead of complete detachment of the tendon from its insertion, only the central portion is debrided and excised. This allows for enhanced visibility of the calcaneal exostosis and increased healing with apposition of viable tendon during side-to-side repair. Patient-reported outcome scores and pain significantly improved from preoperatively to a minimum of 2 years postoperatively. Complications were similar to those previously reported, with superficial wound breakdown being the most common. In conclusion, the use of this reliable, reproducible, and effective technique for the treatment of patients with chronic AIT is encouraged because it provides both enhanced visibility and allows complete resection of all pathological tissue. Level IV: Retrospective case series.

Temperature controlled decohesion regimes of an elastic chain adhering to a fixed substrate by softening and breakable bonds

We study the rate-independent decohesion process for a chain linked to a substrate through a series of breakable elements with a softening mechanism. Such an assumption describes the realistic case when connecting links can undergo softening transitions before breaking. For instance, this is a diffuse mechanism observed both in fracture of soft materials and biological adhesion. The analysis of this model is developed in the framework of equilibrium statistical mechanics. In order to describe mechanically induced detachment of the chain from the substrate both in the cases of hard devices (prescribed extension) or soft devices (applied force), we consider both Helmholtz and Gibbs ensembles. In any case, the model can be exactly solved and is characterized by a phase transition at a given critical temperature, corresponding to the complete detachment of the chain even without mechanical actions. Interestingly, according to the ‘size’ of the softened region, we observe two different regimes. In one case (fragile regime) during the decohesion the measure of the softened region is negligible, whereas in the other case (ductile regime) we obtain a finite measure of the softened region that is constant, giving a temperature dependent analytic measure of the process zone.

Failure Rates in Contact versus Non-Contact Athletes Following Arthroscopic Inferior Capsular Shift at 10-Year Follow-Up (237)

Objectives:Arthroscopic Bankart repair has become the surgical procedure of choice for many in the United States, over the Latarjet in Europe, for first time anterior shoulder instability with minimal bone loss, less than 20%. However, high recurrence rates in contact athletes have led many to proceed with open type procedures. Our purpose was to compare failure rates and functional outcomes of the arthroscopic inferior capsular shift in contact and non-contact athletes. We hypothesized that contact and non-contact athletes would exhibit excellent functional outcomes and return to sport with low recurrence rates.Methods:A consecutive series of 69 shoulders in 61 contact and non-contact athletes underwent an arthroscopic inferior capsular shift with ≥3 suture anchors by a single surgeon (1999-2018). Thirty shoulders in 26 contact athletes (6 women; 25.3±8.1 years) and 39 shoulders in 35 non-contact athletes (7 women; 34.8±10.0 years) were included. Inclusion criteria were complete anterior inferior labral detachment (6 unit hours) and ≥2-year follow-up. Exclusion criteria included multidirectional instability, engaging Hill Sachs lesion or glenoid bone loss >30%. A modified 3-portal technique utilizing the outside-in method was employed. A conservative rehabilitation program was followed with return to sport no sooner than 3 months in non-contact, 4-5 months in contact, and 9 months in throwing athletes. Functional outcomes were measured using Constant Scores, American Shoulder and Elbow Surgeons (ASES) Score, Western Ontario Shoulder Instability Index (WOSI), Melbourne Instability Shoulder Scale (MISS), and Rowe. Forward elevation, external rotation at side and 90° abduction and internal rotation range of motion (ROM) were measured. Independent samples t-tests were used to assess differences in outcomes between contact and non-contact athletes (Bonferroni correction: p<0.006).Results:Follow-up was 11.0±3.5 years (range 2-16 years) in contact athletes and 12.2±4.3 years (range 2-21 years) in non-contact athletes (p=0.264). Contact athletes were significantly younger than non-contact athletes (p<0.0001). An average of 3.9±1.7 and 3.1±1.0 suture anchors were used in contact and non-contact groups, respectively (p=0.348). There were no significant differences in post-operative functional scores (all p>0.053) or shoulder ROM (all p>0.034) between groups. Forward flexion was 163.75±16.8° pre-operatively and 168.89±13.0° post-operatively in contact athletes (p=0.212) and 162.5±13.7° preoperatively and 170±7.7° post-operatively in non-contact athletes (p=0.005). External rotation at the side was 59.04±19.4° pre-operatively and 67.9±18.6° value post-operatively in contact athletes (p=0.094) and 52.94±25.1° pre-operatively and 62.83±14.3° post-operatively in non-contact athletes (p=0.062). External rotation at 90° abduction was 92.61±20.1° pre-operatively and 93.39±12.9° post-operatively in contact athletes (p=0.867) and 88.33±21.1° pre-operatively and 87.5±8.1° post-operatively in non-contact athletes (p=0.842).Internal rotation behind the back was to an average of T11 pre-operatively and T9 post-operatively in contact athletes (p=0.004) and L1 pre-operatively and T9 post-operatively in non-contact athletes (p=0.001).In contact and non-contact athletes, respectively, Rowe scores were 65.35±17.6 and 51.25±13.2 preoperatively and 89.22±17.6 and 96.25±12.4 post-operatively (p=0.002 and p<0.001); Constant Scores were 75.69±12.6 and 61.67±11.3 pre-operatively 85.79±19.6 and 89.71±13.6 post-operatively; ASES scores were 80.40±15.3 and 62.14±22.2 pre-operatively and 93.91±9.9 and 86.06±20.7 post-operatively (p<0.001 and p<0.001); MISS scores were 59.36±12.4 and 48.39±15.5 preoperatively and 88.20±13.5 and 75.75±19.7 post-operatively (p<0.001 and p<0.001); WOSI was 3.50±1.3 and 4.55±1.4 pre-operatively and 1.70±3.0 and 2.94±2.7 post-operatively (p=0.101 and p=0.066). Overall recurrence rate was 4.3% (3/69). Two contact athletes (2/30; 6.7%) and one non-contact athlete (1/39; 2.6%) experienced a traumatic recurrent instability event requiring revision surgery (p=0.439). These three patients underwent a revision arthroscopic inferior capsular shift with an additional 3-4 plication sutures and returned to pre-injury sports including hockey, football, skiing, and tennis without recurrence of instability at greater than 7 years following the revision surgery.Conclusions:Modified arthroscopic inferior capsular shift utilizing ≥3 suture anchors with plication sutures returns contact and non-contact athletes to sports with excellent functional outcomes, low recurrence rates (3/69), and full unrestricted ROM. While loss of ROM is a concern, particularly in overhead athletes, ROM was successfully restored in all patients, most notably in external rotation at 90° abduction. We recommend a modified arthroscopic inferior capsular shift with plication sutures as the primary procedure in all athletes with anterior instability with less than 30% bone loss excluding those with high Beighton scores rather than a Latarjet.

Utility of ECG-Gated CTA for Detecting and Classifying Coronary Artery Involvement in Patients With Type A Aortic Dissection and Sinus of Valsalva Involvement.

BACKGROUND. Extension of type A aortic dissection (TAAD) from the sinus of Valsalva (SV) into the coronary arteries is associated with a poor prognosis and requires direct coronary repair or coronary artery bypass grafting (CABG) depending on the extent of involvement. OBJECTIVE. The purpose of this study was to assess the diagnostic performance of ECG-gated aortic CTA with surgical findings as the reference for detection and classification of coronary artery involvement in patients with TAAD involving the SV. METHODS. This retrospective study included 112 patients who underwent preoperative ECG-gated aortic CTA that showed TAAD with SV involvement. Two radiologists independently reviewed CTA images for right coronary artery (RCA) and left coronary artery (LCA) involvement. Involvement was classified according to a previously described system as type A (coronary ostial dissection), B (dissection with coronary false channel), or C (complete detachment from aortic root with dissection encircling the coronary artery). The diagnostic performance of CTA was calculated with surgical findings as the reference; interreader agreement was assessed; and surgical interventions were summarized. RESULTS. At surgery, the RCA was uninvolved in 33 patients and had type A involvement in 45, type B involvement in 19, and type C involvement in 15 patients. The LCA was uninvolved in 70 patients and had type A involvement in 34 patients, type B involvement in eight patients, and type C involvement in no patient. For the two readers, sensitivity in making the diagnosis in the RCA was 86.7% and 91.1% for type A, 79.0% and 89.5% for type B, 86.7% and 93.3% for type C, and 97.5% and 98.7% for any involvement. Sensitivity for the LCA was 85.3% and 91.2% for type A, 87.5% and 100% for type B, and 100% for any involvement. Specificity for the RCA was 94.0% and 97.0% for type A, 95.7% and 96.7% for type B, 96.9% and 96.9% for type C, and 93.9% and 97.0% for any involvement. Specificity for the LCA was 96.2% and 98.7% for type A, 96.2% and 97.1% for type B, and 97.1% and 98.6% for any involvement. Interreader agreement for types of involvement ranged from a kappa value of 0.85 to 0.96. The most common interventions were aortic repair for SV involvement alone (55.7-63.6%), coronary artery repair for types A and B involvement (53.3-87.5%), and CABG for type C involvement (86.7%). CONCLUSION. ECG-gated CTA has high diagnostic performance in the detection and classification of coronary involvement in TAAD with SV involvement. CLINICAL IMPACT. CTA findings may help guide presurgical planning for patients with TAAD.

Indications and outcomes for intravitreal injection of C3F8 gas for symptomatic vitreomacular traction

To evaluate the indications and outcomes of perfluoropropane (C3F8) gas injection for symptomatic vitreomacular traction (VMT). A retrospective analysis of eyes with VMT treated with 0.3 mL of C3F8 gas was performed. Patients were not asked to posture after gas injection. In phakic patients, cataract surgery was performed simultaneously. Patients were examined after one week and one month postoperatively. Twenty-nine consecutive eyes of 26 patients with symptomatic VMT who underwent pneumatic vitreolysis were included. A complete posterior vitreous detachment was achieved in 18 eyes (62.1%) after a single gas injection at the final visit. The rate of posterior vitreous detachment was reduced significantly with the presence of epiretinal membrane (ERM) (p = 0.003). Three eyes formed a macular hole (MH) postoperatively and another eye developed a retinal detachment. Mean visual acuity increased significantly after one month (p < 0.008). Pneumatic vitreolysis is a viable option for treating VMT with few adverse events. Patient with concomitant ERM had a significantly lower success rate.

SOLPS-ITER modeling of ASDEX Upgrade L-mode detachment states

SOLPS-ITER is used to model ASDEX Upgrade L-mode detachment states including the onset of detachment, the fluctuating detachment, and the complete detachment states, considering drifts and mimicking filamentary convective transport with a radial outward velocity in the low field side. The effect of drifts, perpendicular outward convection and core boundary conditions on the numerical solution is presented. The modeling results are validated against experimental data. We find a good agreement of particle flux at the inner target between modeling results and experimental data. On the opposite, at the outer target computations underestimate measured particle flux by a factor of about 2 ∼ 3 in the onset of detachment and the fluctuating detachment states.

Cemental tear: Literature review, proposed classification and recommendations for treatment.

Cemental tears are an important condition of relevance to Endodontics but are often overlooked. A cemental tear is the partial or complete detachment of the cementum from the cemento-dentinal junction or along the incremental line within the body of cementum. The limited attention received is most likely due to the limited awareness amongst dental professionals and challenges in accurately diagnosing them, resulting in misdiagnosis and erroneous treatment. The aim of this review is to describe the: (i) epidemiology and predisposing factors; (ii) clinical, radiographic and histological features and (iii) the clinical management and treatment outcomes of cemental tear. The review included 37 articles published in English that comprised eight observational studies and 29 case reports. The prevalence of cemental tears was reported to be lower than 2%; whilst the incidence remains unknown. Internal factors due to the inherent structural weakness of cementum and its interface with the dentine, and external factors that are associated with stress have been proposed as the two mechanisms responsible for the development and propagation of cemental tears. Predisposing factors that have been implicated were tooth type, gender, age, previous root canal treatment, history of dental trauma, occlusal trauma and excessive occlusal force; however, evidence is limited. Common clinical and radiographic manifestations of cemental tears resemble the presentations of primary endodontic diseases, primary periodontal diseases and combined endodontic-periodontal lesions. Clinical management tended to focus on complete removal of the torn fragments and periodontal treatment, often combined with regenerative treatment. In this article, a new classification for cemental tears is developed that consists of classes 0 to 6 and stages A, B, C and D based on the: (i) location and accessibility of the torn cemental fragment; (ii) the pattern and extension of the associated bony defect in relation to the root length and (iii) the number of root surface/s affected by the cemental tear/s and the associated bony defect. Recommendations for treatment strategies are also provided and linked to the classification to aid in streamlining the process of treatment decision making.

Seismic Vulnerability Assessment of a Stone Arch Using Discrete Elements

ABSTRACT Conservation of the European-built heritage is nowadays closely related to interventions in masonry construction. Since a significant part of these structures are located in earthquake prone zones, designing protective measures that ensure their preservation requires the assessment of the associated seismic vulnerability and the understanding of their degradation mechanisms. However, due to the presence of discontinuities between its constituent elements, the numerical simulation of the non-linear response of masonry structures subjected to strong earthquakes is a cumbersome task, especially when performed using the traditional finite element method. As an alternative, the discrete element method is particularly suitable for the numerical analysis of such structures under large, damaging loads. By allowing discrete displacements/rotations of individual bodies, and by automatically recognising new contacts between bodies, while eliminating obsolete ones, this numerical approach can simulate the complete detachment of discrete bodies initially in contact. The present paper illustrates the use of the discrete element method to assess the seismic vulnerability of stone arches. A probabilistic approach allows to consider the variability of the seismic action and the uncertainties in the definition of the material properties. First, an un-reinforced masonry arch is considered. Based on non-linear multi-directional incremental dynamic analyses, five damage states are proposed and the respective fragility curves are elaborated. To improve the arch’s seismic performance, two reinforcing solutions using steel elements are considered and analysed comparatively.

Incidence and Risk Factors of Epiretinal Membrane after Cataract Surgery

Purpose: To investigate the incidence and risk factors of epiretinal membrane (ERM) after cataract surgery.Methods: We reviewed the medical records of patients who underwent cataract surgery between January 2016 and December 2018. Eyes with ERM, as observed by optical coherence tomography performed 1-2 months after surgery, were excluded from the study. ERM was diagnosed by fundus photography. The incidence rate was determined 2-6, 6-12, and 12-24 months after surgery. The cumulative incidence rate of ERM was calculated by Kaplan-Meier analysis. Data were analyzed using logistic regression to determine the associations between ERM development and various factors.Results: The study included 218 eyes of 161 patients with a mean age of 66.6 ± 9.7 years at the time of surgery. ERM was observed in 3 of 218 eyes (1.4%) between 2 and 6 months, 15 of 176 eyes (8.3%) between 6 and 12 months, and 14 of 150 eyes (10.3%) between 12 and 24 months after surgery. The cumulative incidence rate of ERM was 11.7% over the 24-month period after surgery. In multivariate logistic regression analysis, older age (≥65 years; odds ratio [OR], 8.59, 95% confidence interval [CI], 1.43-51.49), fellow eye with ERM (OR, 3.63; 95% CI, 1.04-12.73), longer axial length (≥26 mm; OR, 8.02; 95% CI, 1.08-59.66), and complete posterior vitreous detachment development (OR, 7.48; 95% CI, 1.64-34.14) were significantly associated with ERM development.Conclusions: ERM is not rare after cataract surgery. Long-term retinal examination should be required after cataract surgery.

A Randomized, Crossover, Adhesion Performance and Pharmacokinetic Study of a Lidocaine Topical System Under Conditions of Water Exposure in Healthy Subjects.

PurposeThis study compares the adhesion performance, pharmacokinetic profile, and safety of lidocaine topical system 1.8%, which is approved to treat postherpetic neuralgia, under conditions of swimming and showering versus normal conditions.Patients and MethodsThis open-label, 3-period, 3-treatment crossover study randomized 24 healthy adults to receive one lidocaine topical system during each of three treatment periods; subjects either swam in a heated swimming pool for 15 minutes 4.0 hours post-product application (swimming), showered for 10 minutes 8.0 hours after product application (showering), or the product remained dry throughout the treatment period (normal conditions). The product was applied to the mid-upper back and was removed after 12 hours. The pharmacokinetic profile of each subject under water exposure conditions was compared to subjects under normal conditions. Skin irritation, adhesion, and adverse events were assessed.ResultsTwenty-four (24) subjects enrolled and 23 completed the study. Exposure to water resulted in lifting of the topical systems. There were two complete detachments, as well as seven occurrences of major lifting (more than 50% detached) after water exposure. The topical systems were immediately pressed down and/or reapplied after observing lifting and remained adhered to for the rest of the 12-hour application period. No clinically relevant differences in systemic absorption were observed under either showering or swimming conditions. The topical systems were well tolerated, with only mild adverse events, none leading to discontinuation.ConclusionThese data show that while water exposure can cause the topical system to lift or detach, the lidocaine topical system 1.8% is capable of being reapplied and maintains adhesion for up to 12 hours of wear with no clinically significant changes in drug delivery.Clinicaltrials.govNCT04784728.

Translating the diatom-grazer defense mechanism to antiparasitic treatment for monogenean infection in guppies

Monogenean parasites impose a major constraint on sustainable aquacultural production and trade due to fish morbidity and mortality. Traditional chemical treatments carry environmental and human health risks and are frequently banned in aquaculture; associated development of pathogen resistance is also common. These highlight the need for alternative. The pennate diatom Phaeodactylum tricornutum is a potent source for food additives and pharmaceuticals due to its robustness and content of high-value compounds. Its extracts also have antibacterial properties. The use of P. tricornutum to develop a treatment against the monogenean parasite Gyrodactylus turnbulli affecting Poecilia reticulate (guppies) was investigated. Ethanolic extracts of freshly broken P. tricornutum biomass were effective against the parasite in vitro and in vivo. Sonication and Kolliphor EL (food-grade nonionic solubilizer and emulsifier) increased the efficacy of the ethanolic extract in vitro; complete detachment and 97% mortality of the parasite were achieved within 240 min at a concentration of 5 μL mL−1. Complete infection clearance from fish was achieved following a bath treatment with 2.5 μL mL−1 ethanolic extract for 24 h. The diatom extract's antibacterial properties, tested against the Gram-positive Streptococcus iniae and Gram-negative Vibrio harveyi, were used to calibrate P. tricornutum culture conditions and extract preparation. Maximal antibacterial effect was obtained with a two-week-old culture, following cell breakage of the wet biomass and extraction in 100% ethanol. Fatty acid composition analysis of thin-layer chromatography fractions of the ethanolic extracts revealed that the free fatty acids liberated during cell breakage, enriched in 16:0, 16:1n7, and eicosapentaenoic acid (20:5n3), are the major active compounds. In-vitro antiparasitic assays and gas chromatography–mass spectrometry analysis confirmed that free 16:1n7 and 20:5n3 are responsible for most of the antiparasitic activity. Results support the use of broken P. tricornutum ethanolic extracts as a potential treatment against monogenean infection in cultured fish.

Некоторые аспекты движения жидкости внутри глазного яблока при математическом моделировании интравитреальной инъекции

Background. The avalanche-like growth of intravitreal injections in the world has significantly increased interest in the hemodynamics of the processes that occur in the eye when a drug is injected into the vitreous cavity. Every year, the number of intravitreally used drugs and promising areas in which they can be used is growing. This also applies to the creation of new combined medicines and the development of drugs with a long-term therapeutic effect. Aims. Create mathematical model of eyeball to evaluate the movement of the drug substance in it; to estimate the time of the drug's presence in the eye cavity before its complete removal, to characterize the ways of its removal from the eye cavity; to assess the significance of posterior vitreous detachment during the time when the drug is present in the eye cavity; to evaluate the effect on the hydrodynamics of the depth of drug administration. Results. When the drug is administered closer to the center of the eyeball, its residence time increases in comparison with the parietal administration. With a complete posterior detachment of the vitreous body, the time of finding the drug in the eye is prolonged compared to its absence. The obtained results of mathematical modeling of the movement of the drug administered intravitreally cannot be mechanically transferred to the human eye, due to the more complex structure of the latter. Key words: intravitreal injections, vitreous body, mathematic computing.

Efficacy of anti-vascular endothelial growth factor agents for treating neovascular age-related macular degeneration in vitrectomized eyes.

To evaluate the efficacy of intravitreal anti-vascular endothelial growth factor (anti-VEGF) agents for treatment of neovascular age-related macular degeneration (nAMD) in vitrectomized eyes. The medical records were reviewed of nAMD patients treated with anti-VEGF agents who previously underwent pars plana vitrectomy (PPV). PPV was performed with complete posterior vitreous detachment induction. A total of 44 eyes from 44 patients were included. The mean central foveal thickness (CFT) was 478.50 ± 156.93 μm at baseline, 414.25 ± 143.55 μm (86.6% of baseline) at 1 month after first injection (P < 0.001), and 386.75 ± 141.45 μm (80.8% of baseline) after monthly multiple injections (2.30 ± 1.07; range, 1-5) (P < 0.001). The mean logarithm of the minimum angle of resolution best-corrected visual acuity visual acuity (BCVA) was 0.85 ± 0.57 at baseline, 0.86 ± 0.63 after the first injection, and 0.84 ± 0.64 after monthly multiple injections. BCVA improved in 39.5% at 1 month after first injection and 45.2% at 1 month after monthly multiple injections. In the subgroup analysis, CFT of eyes with the posterior capsule decreased significantly to 85.8% and 79.8% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively. CFT of eyes without the posterior capsule decreased to 91.6% and 87.4% of baseline values at 1 month after the first injection and after monthly multiple injections, respectively, without statistical significance. Monthly injections of Intravitreal anti-VEGF agents induced favorable anatomical improvement and vision maintenance in vitrectomized eyes with nAMD.

Outcomes and Material Cost Comparison of Transosseous Versus Suture Anchor Fixation of the Achilles Tendon: A Retrospective Study

Insertional Achilles tendinopathy is a common pathology that may be resistant to conservative treatment requiring surgical intervention. Treatment often involves partial to complete detachment of the Achilles tendon, debridement, and reattachment. Although 50% of the tendon may be safely resected without significantly compromising strength, the addition of a lengthening procedure requires further reinforcement. We conducted a retrospective review of 43 procedures comparing outcomes of 16 single suture anchor procedures with 27 transosseous fixation procedures for reattachment of the Achilles. The suture anchor group utilized one of 2 different industry anchors while the transosseous group utilized sutures ranging in size from 2-0 to #2. Female patients contributed 67% of the procedures with 53% occurring on the left side. For each group the median preoperative pain score (scale 0-10) was 8 and the median of the lowest reported postoperative pain score was 0. The typical time to lowest postoperative pain was 10 weeks for the suture anchor group and 4 weeks for the transosseous group. Tourniquet time averaged 59.3 (12.9) minutes for the suture anchor group and 65.1 (16.4) for the transosseous group. There was a large difference in material costs between the suture anchor and transosseous groups which ranged from $364.51 to $448.51 and $99.80 to $104.00 respectively. With similar results on postoperative pain and adverse event rate to suture anchor fixation and lower material costs than anchor fixation, transosseous fixation remains a viable option for fixating the Achilles tendon to bone in treatment of insertional Achilles tendinopathy.

Identification of a variant in NDP associated with X-linked retinal dysplasia in the English cocker spaniel dog.

PurposeThree related male English Cocker Spaniels (ECS) were reported to be congenitally blind. Examination of one of these revealed complete retinal detachment. A presumptive diagnosis of retinal dysplasia (RD) was provided and pedigree analysis was suggestive of an X-linked mode of inheritance. We sought to investigate the genetic basis of RD in this family of ECS.MethodsFollowing whole genome sequencing (WGS) of the one remaining male RD-affected ECS, two distinct investigative approaches were employed: a candidate gene approach and a whole genome approach. In the candidate gene approach, COL9A2, COL9A3, NHEJ1, RS1 and NDP genes were investigated based on their known associations with RD and retinal detachment in dogs and humans. In the whole genome approach, affected WGS was compared with 814 unaffected canids to identify candidate variants, which were filtered based on appropriate segregation and predicted pathogenic effects followed by subsequent investigation of gene function. Candidate variants were tested for appropriate segregation in the ECS family and association with disease was assessed using samples from a total of 180 ECS.ResultsThe same variant in NDP (c.653_654insC, p.Met114Hisfs*16) that was predicted to result in 15 aberrant amino acids before a premature stop in norrin protein, was identified independently by both approaches and was shown to segregate appropriately within the ECS family. Association of this variant with X-linked RD was significant (P = 0.0056).ConclusionsFor the first time, we report a variant associated with canine X-linked RD. NDP variants are already known to cause X-linked RD, along with other abnormalities, in human Norrie disease. Thus, the dog may serve as a useful large animal model for research.

Posterior oblique ligament of the knee: state of the art.

The posterior oblique ligament (POL) is the predominant ligamentous structure on the posterior medial corner of the knee joint. A thorough understanding of the anatomy, biomechanics, diagnosis, treatment and rehabilitation of POL injuries will aid orthopaedic surgeons in the management of these injuries.The resulting rotational instability, in addition to valgus laxity, may not be tolerated by athletes participating in pivoting sports. The most common mechanism of injury – accounting for 72% of cases – is related to sports activity, particularly football, basketball and skiing. Moreover, three different injury patterns have been reported: those associated with injury to the capsular arm of the semimembranosus (SM), those involving a complete peripheral meniscal detachment and those involving disruption of the SM and peripheral meniscal detachment.The hallmark of an injury related to POL lesions is the presence of anteromedial rotatory instability (AMRI), which is defined as ‘external rotation with anterior subluxation of the medial tibial plateau relative to the distal femur’.In acute settings, POL lesions can be easily identified using coronal and axial magnetic resonance imaging (MRI) where the medial collateral ligament (MCL) and POL appear as separate structures. However, MRI is not sensitive in chronic cases.Surgical treatment of the medial side leads to satisfactory clinical results in a multi-ligamentous reconstruction scenario, but it is known to be associated with secondary stiffness.In young patients with high functional demands, return to sports is allowed no earlier than 9–12 months after they have undergone a thorough rehabilitation programme.Cite this article: EFORT Open Rev 2021;6:364-371. DOI: 10.1302/2058-5241.6.200127

Muller Cell Role in Foveolar Schisis, Comparative Review of Three Cases

Three cases of non-high myopic foveolar schisis and discuss factors that affect Muller cell integrity and foveolar schisis development are documented. Case 1: A 67-year-old Asian female with best corrected visual acuities (BVA) of 20/20 right eye (OD), left eye (OS) and an epiretinal membrane with an underlying foveolar schisis OD. Case 2: A 60-year-old Hispanic female with sudden decreased vision OD and BVA of 20/30 OD, 20/20 OS. A macular hole, complete posterior vitreous detachment and surrounding foveolar schisis was present OD. Following surgical repair, BVA OD improved to 20/20 with the macula re-attached. Case 3: An otherwise healthy and generally asymptomatic 52-year-old Hispanic female with BVA of 20/20/OD and OS, presented with a foveolar schisis OD. In all cases, the parafoveal Z- shaped Muller cells demonstrated a reduction of the subtended angle θ towards the center of the fovea (or increases farther from the center of the fovea). We conclude that a greater subtended angle by the parafoveal Z-shaped Muller cells in all th ree cases of foveolar schisis may help explain the good and stable visual acuity. CE Notification: This article is available as a COPE accredited CE course. You may take this course for 1-hour credit. Read the article and take the qualifying test to earn your credit. [Click here to Enroll]https://www.crojournal.com/muller-cell-role-in-foveolar-schisis-comparative-review-of-three-cases) Please check COPE course expiry date prior to enrollment. The COPE course test must be taken before the course expiry date.

Open-Label Adhesion Performance Studies of a New Lidocaine Topical System 1.8% versus Lidocaine Patches 5% and Lidocaine Medicated Plaster 5% in Healthy Subjects.

PurposeThe primary objective was to evaluate adhesion performance of the lidocaine topical system 1.8% for 12 hours in healthy human subjects in three studies: as a single product (Study 1) and versus other lidocaine topical products (lidocaine patch 5% and lidocaine medicated plaster 5% [Study 2] and generic lidocaine patch 5% [Study 3]). Safety of the lidocaine topical system 1.8%, with a skin irritation focus, was a secondary objective.Patients and MethodsAll three studies were open-label, randomized, Phase 1 adhesion performance studies in healthy adult volunteers (N=125). Lidocaine topical products were applied for 12 hours per test, per study arm. Adhesion of all test products was scored at 0, 3, 6, 9, and 12 hours post-application. Skin irritation was scored after product removal or when a product detached.ResultsOverall, the majority (≥75%) of subjects treated with the lidocaine topical system 1.8% demonstrated ≥90% adhesion (FDA adhesion score 0) throughout the 12-hour administration period versus 13.6% of subjects treated with lidocaine patch 5%, 15.9% of subjects treated with lidocaine medicated plaster 5%, and 0% of subjects treated with the generic lidocaine patch 5%. There were no complete detachments with the lidocaine topical system 1.8%, whereas 4.5% of lidocaine patch 5% and lidocaine medicated plaster 5% detached, and 29% of generic lidocaine patch 5% detached. Minimal skin irritation was observed with each lidocaine topical product.ConclusionAcross three studies, lidocaine topical system 1.8% demonstrated superior adhesion performance versus the three other products tested. Skin irritation was minimal across products and studies.Clinicaltrials.govNCT04312750, NCT04320173, NCT04319926.

IMPACT OF DEFORMABLE STAMP WITH A MULTILAYERED WALL

In this paper, was performed by numerical work according to the difference scheme. Analysis of the numerical results showed: one of the important issues of contact interaction is to determine the duration of the impact of the colliding bodies. Obviously, under the condition of a hard clutch, sticking of the striker from the barrier will not occur. To study the process of complete breakage of mechanical contact (appearance of separation zones), we will use boundary conditions that simulate a perfectly smooth impact. Analysis of the dynamics of contact resistance has shown that its magnitude and features of evolution over time substantially depend on the geometric and physicomechanical parameters of the deformable system, as well as on the type of boundary conditions. An increase in the acoustic rigidity of the impactor leads to an increase in the amplitude and duration of the impact. The impact of a less rigid punch or the presence in the barrier of a shielding layer of a polymeric material reduces the contact resistance of the plate, but the force interaction between the impacted bodies is longer. As the analysis of the results shows, the evolution of contact stresses is characterized by a number of specific features. For example, there is a direct correlation between the height of the cylinder and the time of its complete detachment from the obstacle, which corresponds to the vanishing of the function   tk  . An increase in the acoustic rigidity of the impactor leads to a sharp increase in the amplitude of the total resistance and an increase in the duration of the contact interaction. Thus, the contours of the isolines provide a visual representation of the configuration of the areas at which points the stresses develop, immediately preceding the appearance of elastoplastic deformations for spall fractures (for brittle materials).

Retention strength of ball-attachment titanium post for removable partial denture or overdenture

Aim: To evaluate the retention of an endodontic titanium postwith a spherical head for removable partial denture or overdentureattachment according to surface treatment type. Methods: Sixtyhealthy single-rooted teeth, sectioned at the enamel/cementumjunction, were treated endodontically and steadily fixed in theembedding acrylic resin. The titanium posts were subdivided intofour groups: control, no surface treatment (Ctrl); posts with macroretentivegrooves (MR); air abrasion of the post surface (AB); andposts with macro-retentive grooves and air abrasion of the postsurface (MR+AB). The posts were luted in the root canal usingself-adhesive dual resin cement. Pull-out testing was performedusing a universal testing machine until complete detachment wasachieved. After pull-out testing, the metallic posts were examinedunder an optical microscope and the failures were classifiedbased on the cement distribution pattern on the extracted posts:0, no cement left on the post (cement/post failure); 1, postsurface partially covered by adhered cement (post/cement anddentin/cement mixed failure); 2, post surface completely coveredby cement (dentin/cement failure). The retention data wereanalyzed by one-way ANOVA, Bonferroni–Dunn test (p&lt;0.05)and Weibull analysis. Results: AB showed the highest retentionvalue (485.37±68.36), followed by MR+AB (355.80±118.47), MR(224.63±42.54) and Ctrl (113.12 ± 51.32). AB and MR showedthe highest Weibull moduli. Conclusions: The data indicatedthat air abrasion alone could significantly increase the retentionof titanium posts/attachments for use with overdentures orremovable partial denture.