Tear Area Research Articles

Study on the cutting performance in machining assembled hardened steel workpiece with torus cutter

Torus cutters are increasingly used in machining high-hardness materials because of high processing efficiency. However, due to the large hardness variation in assembled hardened steel workpiece, the tool wear occurs easily in machining process. This severely affects the machined surface quality. Here, we conduct a research on the tool wear and the machined surface quality in milling assembled hardened steel mold with a torus cutter. The experimental results show the abrasive wear mechanism dominates the initial tool wear stage of the torus cutter. As the tool wear intensifies, the adhesive wear gradually occurs due to the effect of alternating stress and impact load. Thus, the mixing effect of the abrasive and adhesive wears further accelerates tool wear, resulting in occurrence of obvious crater wear band on the rake face and coating tearing area on the flank face. Finally, the cutter is damaged by the fatigue wear mechanism, reducing seriously the cutting performance. With increase of flank wear, moreover, there are increasingly obvious differences in both the surface morphology and the cutting force at the two sides of the joint seam of the assembled hardened steel parts, including larger height difference at the two sides of the joint seam and sudden change of cutting force, as a result, leading to decreasing cutting stability and deteriorating seriously machined surface quality.

Standardizing the classification of skin tears: validity and reliability testing of the International Skin Tear Advisory PanelClassification System in 44 countries.

SummaryBackgroundSkin tears are acute wounds that are frequently misdiagnosed and under‐reported. A standardized and globally adopted skin tear classification system with supporting evidence for diagnostic validity and reliability is required to allow assessment and reporting in a consistent way.ObjectivesTo measure the validity and reliability of the International Skin Tear Advisory Panel (ISTAP) Classification System internationally.MethodsA multicountry study was set up to validate the content of the ISTAP Classification System through expert consultation in a two‐round Delphi procedure involving 17 experts from 11 countries. An online survey including 24 skin tear photographs was conducted in a convenience sample of 1601 healthcare professionals from 44 countries to measure diagnostic accuracy, agreement, inter‐rater reliability and intrarater reliability of the instrument.ResultsA definition for the concept of a ‘skin flap’ in the area of skin tears was developed and added to the initial ISTAP Classification System consisting of three skin tear types. The overall agreement with the reference standard was 0·79 [95% confidence interval (CI) 0·79–0·80] and sensitivity ranged from 0·74 (95% CI 0·73–0·75) to 0·88 (95% CI 0·87–0·88). The inter‐rater reliability was 0·57 (95% CI 0·57–0·57). The Cohen's Kappa measuring intrarater reliability was 0·74 (95% CI 0·73–0·75).ConclusionsThe ISTAP Classification System is supported by evidence for validity and reliability. The ISTAP Classification System should be used for systematic assessment and reporting of skin tears in clinical practice and research globally. What's already known about this topic? Skin tears are common acute wounds that are misdiagnosed and under‐reported too often.A skin tear classification system is needed to standardize documentation and description for clinical practice, audit and research. What does this study add? The International Skin Tear Advisory Panel Classification System was psychometrically tested in 1601 healthcare professionals from 44 countries.Diagnostic accuracy was high when differentiating between type 1, 2 and 3 skin tears using a set of validated photographs.

2029 Perforated IVC Filter Leading to Duodenocaval Fistula and Massive Gastrointestinal Bleeding

INTRODUCTION: Inferior Vena Cava (IVC) filters are primarily indicated for patients with a history of deep venous thrombosis (DVT) or pulmonary embolism (PE) who have contraindications to anticoagulation. In most patients, the indication for placement of a filter is temporary. Although filter penetration of the IVC wall has been reported to range from 9% to 24% for all IVC filters, symptomatic perforation is rare and is reported to occur in about 0.4%-0.8% of cases. We are presenting a rare case of duodenocaval fistula presenting as massive gastrointestinal bleeding. CASE DESCRIPTION/METHODS: A 39-year-old male with a history of motor vehicle accident 10 years ago resulting in paraplegia and multiple lower extremity DVTs which required the placement of an IVC filter at that time was admitted to the hospital with one day of nausea, vomiting and hematochezia. History was very concerning for high volume bright red bleeding per rectum with associated non-bilious vomiting and dizziness. On arrival, he was hypotensive with a blood pressure of 60/40 mmHg, physical examination significant for actively oozing bright red blood per rectum. Labwork was remarkable for a Hemoglobin of 7.0 mg/dL and a BUN of 35 mg/dL. A CT scan of abdomen/pelvis with contrast revealed an IVC filter strut travelling through the IVC wall and perforating to the adjacent small bowel with active extravasation of the IV contrast to the small bowel, suggestive of a fistulous communication between IVC and a perforated loop of bowel. The patient was emergently taken to the operating room for exploratory laparotomy. IVC filter strut was found to be eroding through the IVC and into the duodenum confirming the CT findings. Transverse venotomy was performed and the filter was removed. An area of small bowel serosal tear was incorporated into the enterectomy segment, and end to end small bowel anastomosis was performed. IVC was repaired, and hemostasis was secured. Post-operatively, patient stayed stable clinically and hemodynamically with cessation of hematochezia. DISCUSSION: Duodenocaval fistula is a very rare complication of IVC filter placement, with around 10 reported cases in the literature. Even though it is rare, our case highlights the importance of a thorough and timely sensitive workup for an unstable patient with gastrointestinal bleeding and history of an IVC filter placement to rule out IVC penetration into surrounding viscera, since this can lead to significant morbidity and mortality if not recognized early during the clinical course.

Second-look arthroscopic findings of cartilage and meniscus repair after injection of adipose-derived regenerative cells in knee osteoarthrits: Report of two cases.

BackgroundThe purpose of this study was to use second-look arthroscopic findings and clinical assessment to determine outcome in two cases of knee osteoarthritis treated by intra-articular knee injection of adipose-derived regenerative cells (ADRCs).Case presentationThis study involved two patients who received ADRC therapy for knee osteoarthritis and completed the six-month post-treatment follow-up period. For each treatment, 130 mL of subcutaneous adipose tissue was harvested using tumescent liposuction technique and manual aspiration of tissue from the thigh using a suction cannula under local anesthesia in the operating room. The adipose tissue harvested was processed using the Celution® Centrifuge in a dedicated cell processing room. The ADRCs were injected into the articular cavity of both knees for one patient and into a single affected knee in the second patient (three joints). Pain and knee function were assessed using a Visual Analogue Scale (VAS) and the Knee Outcome in Osteoarthritis Score (KOOS) respectively. The cartilage defect was assessed by direct visualization (arthroscopy). No serious adverse events were reported throughout follow-up. Pain and knee function were significantly improved from baseline in all treated knees at one, three and six months after ADRCs. At six-months after ADRCs treatment, the second-look arthroscopy showed that almost all the cartilage defect areas were covered by regenerated cartilage, some cartilage fibrillation area was reduced, and meniscus tear areas were repaired.ConclusionsCartilage and meniscus repair were observed six-months after ADRCs therapy under second-look arthroscopy. It was shown that a single administration of ADRCs might be effective as a treatment for knee osteoarthritis.

The Effect of Time Interval from MRI to Rotator Cuff Repair on Tear Size: Imaged vs. Actual Tear Size

Objectives: Magnetic resonance imaging (MRI) is the advanced imaging modality of choice for the evaluation and diagnosis of full thickness rotator cuff tears (RCT). Tear size progression has been correlated with increasing pain. However, there is little data on tear size progression in symptomatic RCT with regard to time from MRI to actual rotator cuff repair (RCR). The purpose of the study was to evaluate the effect of time (from date of MRI measured tear dimensions to date of RCR measured intraoperative tear dimensions) on tear size progression. Methods: In the course of a study on physical examination manual muscle tests in patients with known full thickness RCT requiring repair, MRI was obtained for each patient undergoing RCR. Tears were measured intraoperatively in the Anterior-Posterior (A-P) and Medial-Lateral (M-L) dimensions with a graduated probe. Location (anterior, central, posterior in the supraspinatus tendon), area of the tear, and anterior band of supraspinatus status (intact/ not intact) were recorded.The preoperative MRI was evaluated by the same examiner blinded to the operative results at least 4 weeks after the RCR and the same parameters measured.There were 64 consecutive shoulders with 40 male, 24 female at an average age of 58 yrs (40-76) that had MRI and underwent RCR. The mean MRI dimensions were: A-P tear:16.53 mm (SD 9.70); M-L tear: 17.3 mm (SD 9.75); Tear area: 366.7 square mm. The average time from preoperative MRI to RCR was 107.3 days (range 12-399 days). Operative mean RCT dimensions were: A-P tear: 18.38 mm (SD 10.0); M-L tear: 14.06 mm (SD 8.15); Tear area: 307.7 square mm.Descriptive statistical analysis with two-sample T-test was performed to determine the temporal effect on tear size from date of MRI to the date of surgery, and whether there was a change.Patients were grouped in the following time cohorts based on the length of time elapsed between the preoperative MRI and date of RCR: ≤1 month, 1 month to 2 months, 2 months to 3 months, 3 months to 9 months, and ≥9 months. The delta, or difference between intraoperative measurements and preoperative MRI measurements, was calculated for each cohort. Results: The t-test revealed a significant time effect with regard to tear size between the MRI and the intraoperative measured tear requiring repair. This was significant for the A-P dimension (p<0.001), the Medial-Lateral dimension (p<0.001), and the total area of the tear (p=0.009). In an attempt to determine a “watershed” or critical time interval where MRI and RCT size correlated, an additional analysis was performed. The change in A-P tear dimension between MRI and RCR findings showed increasing delta with increasing time. Positive mean delta in A-P dimension was seen in the 2-3 month group (2.64), with larger differences seen in the 3 month to 9 month (5.89) and ≥9 month (7.3) groups. A similar trend was seen for mean delta values in the M-L dimension among the cohorts. Conclusion: In a consecutive series of RCTs undergoing repair, the measured MRI dimensions and the intraoperative dimensions were recorded and analyzed. A surgeon can have a level of confidence that the RCT size will correlate with MRI tear size within a certain time frame. There is a significant effect of time on tear size progression from MRI dimensions to actual RCT dimensions at time of repair.

Dissimilar Resistance Spot Welding of DP 600/A5052/DP 600 Triple Sheets

Triple sheets of DP 600/A5052 aluminum alloy/DP 600 steel were joined by means of resistance spot welding in this study. The experimental results showed that the microstructure of fusion zone was lath martensite for DP 600 and column crystals for A5052. Their grains coarsened with increasing distance away from the base metals. The interface zone between DP 600 and A5052 was composed of continuous Fe2Al5 intermetallic compound (IMC) layer and needle-like Fe4Al13 IMC. When welding time prolonged from 8 cycles to 17 cycles, the average length of Fe4Al13 phase adjacent to A5052 shortened from 2.3 μm to 0.89 μm, whereas the thickness of Fe2Al5 IMC layer near DP 600 widened from 1.59 μm to 2.59 μm. The tensile-shear load of DP 600/A5052/DP 600 joints reached a maximum value of 10.796 kN with 14 cycles welding time. Failure during tensile-shear testing occurred along DP 600/A5052 interfaces because Fe2Al5 and Fe4Al13 were brittle phases, but an amount of tearing area was found on the fracture surface.

Arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint

To explore clinical effect of arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint. From July 2014 to December 2017, 33 patients with lateral meniscal cyst of knee joint were treated by arthroscopic cysts removal and wire-guided suture, including 13 males and 20 females, aged from 20 to 55 years old with an average age of(36.23 ±2.30) years old, the courses of disease ranged from 3 to 14 months with an average of(4.60±0.83) months; Preoperative MRI examination was clear diagnosed. There were 14 cysts on anterior horn, 18 cysts on meniscal body and 1 cyst on posterior horn;all cysts were solitary, and 3 of them were multilocular. Lysholm score and GLASOW score of knee joint function and clinical efficacy were observed before and after operation at 6 months. All patients were followed up form 6 to 24 months with an average of (7.5±1.2) months. Preoperative symptoms disappeared or significantly alleviated, and all incisions were healed by intention without complication and neurovascular injury. MRI showed meniscal tear areas and cystic defective areas healed, cyst was not recurrenced, healing time ranged form 8 to 12 weeks with an average of (9.6±1.6) weeks, and patients recovered their daily life and exercise. There was significant difference in Lysholm score before operation (61.12±4.35) and after operation at 6 momths(91.32±3.36)(t=46.11, P<0.01);according to GLASOW assessment, 31 patients with excellent recovery, and 2 good. Arthroscopic cyst removal and wire-guided suture for the treatment of lateral meniscal cyst of knee joint could reserve meniscus, repair injury of meniscus, recover knee joint function after operation, and is worth popularizing.

When Surgeons Create Their Own Tools!

In their paper, El Batti et al. proposed an experimental evaluation of endovascular fenestration scissors in an ovine model of aortic dissection.1El Batti S. Ben Abdallah I. Dufetelle E. Julia P. Menasche P. Alsac J.M. Experimental evaluation of endovascular fenestration scissors in an ovine model of aortic dissection.Eur J Vasc Endovasc Surg. 2018; 56: 373-380Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar This is a really interesting study that opens the doors to a new technique for treating patients and also for involving surgeons in creating the tools they actually need. The authors proposed a new device that may allow easier and safer endovascular fenestration than the usual technique that uses a sheath over two stiff wires to create a “scissor/fork” effect.2Alomran F. Alsac J.M. Distal endovascular fenestration inside thoracic exclusion: the DEFINITE technique for complicated acute type B dissections.Eur J Vasc Endovasc Surg. 2017; 53: 103Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Contrary to this “sheath over two wires,” they proposed a new innovative device consisting of “endo-scissors” comparable with those used in open surgery. Theoretically, endo-scissors should provide sharp cuts and avoid folding and tearing of the flap. It appears logical to compare both methods and prove the efficiency of the new device. More in depth preliminary in vitro tests could have been performed to evaluate the capabilities of the new device to cut materials of different thicknesses or densities and focus in vivo on the optimal device prototype. Moreover, it would have been very interesting to know the differences the authors may have noticed concerning ease of cutting, quality of cutting such as torn area or regular cut, as well as the ability to control the quality of the procedure under X-ray. The authors included in their study a haemodynamic evaluation of flap resection in the ovine dissection model they developed. Several models of aortic dissection have already been developed, but haemodynamic evaluation has been doubtful: dissection flaps were often unpredictable and inconsistent, either being very short in length or with undefined propagation and low reproducibility, in subsequent experiments.3Qing K.X. Chang Y.C. Lau S.F. Yiu W.K. Ting A.C. Cheng S.W. Ex-vivo haemodynamic models for the study of Stanford type B aortic dissection in isolated porcine aorta.Eur J Vasc Endovasc Surg. 2012; 44: 399-405Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar In their paper, El Batti et al. assessed the validity of the model using haemodynamic criteria, giving pressure values in both lumens and their change after fenestration. It may be criticised that the relatively short and small channel of dissection did not include visceral artery ostia, however, the model appeared to allow testing of endovascular fenestration scissors, even if it is unlike human pathology and does not allow valid conclusions concerning haemodynamic evaluation. In conclusion, this study is the perfect example of what should be a surgeon driven device to answer a clinical issue. The paper demonstrates how translational research and surgeon's involvement can lead to advances in our daily practice.4Vega de Ceniga M. Chakfé N. Back to the future.Eur J Vasc Endovasc Surg. 2018; 55: 453-454Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar Experimental Evaluation of Endovascular Fenestration Scissors in an Ovine Model of Aortic DissectionEuropean Journal of Vascular and Endovascular SurgeryVol. 56Issue 3PreviewTo evaluate the experimental feasibility of endovascular fenestration using specific endovascular scissor prototypes in an ovine model of acute aortic dissection (AD). Full-Text PDF Open Archive

LONGITUDINAL CHANGE OF OUTER NUCLEAR LAYER AFTER RETINAL PIGMENT EPITHELIAL TEAR SECONDARY TO AGE-RELATED MACULAR DEGENERATION.

To investigate longitudinal changes of outer nuclear layer (ONL) thickness in patients with retinal pigment epithelium tears secondary to neovascular age-related macular degeneration. This is an institutional retrospective interventional case series. Twenty-six eyes of 22 patients with retinal pigment epithelium tears identified between April 2009 and March 2015. The patients underwent intravitreal injection of anti-vascular endothelial growth factor agents as needed. Volume scans of optical coherence tomography at first diagnosis of tear (baseline) and after 12 months were analyzed. Outer nuclear layer was segmented, and average ONL thickness inside the tear area, at the border of the tear, and in areas outside the tear was measured. Change of ONL thickness. We also explored several factors for their association with ONL thinning including tear area, number of treatments, and the duration with persistent subretinal fluid. Thinning of ONL was found in all the investigated areas (P < 0.01, respectively). Among the investigated factors, larger tear area was associated with greater ONL thinning outside the tear area (standardized β = -0.37, P = 0.030), and younger age was associated with greater ONL thinning inside the tear area (standardized β = 0.37, P = 0.041). After an retinal pigment epithelium tear, thinning of ONL occurs in the area devoid of retinal pigment epithelium and also in adjacent areas. Few factors were predictive for the degree of ONL thinning. These results provide new insight in disease progression of this particular neovascular age-related macular degeneration subphenotype.

Polydeoxyribonucleotide injection in the patients with partial-thickness tear of supraspinatus tendon: a prospective and pilot study using ultrasound

ABSTRACTObjective: Polydeoxyribonucleotide as adenosine receptor (A2A) agonist has been used in plastic surgery and dermatology related to its regenerative property. The aim of this pilot study is to evaluate the safety and efficacy of polydeoxynucleotide injection in patients with rotator cuff tears by a variety of outcomes including pain, disability, physical performance test, and ultrasonography (US).Methods: Seventeen patients (9 men, 8 women, age: 57.9 ± 9.1) with partial-thickness tear of supraspinatus tendon were evaluated in a prospective, open-label, and pre-and-post study. Seventeen patients underwent 3 times intra-lesional polydeoxynucleotide injection under ultrasound (US) guidance on weeks 0, 2 and 4. The safety and efficacy were assessed on weeks 0, 6 and 12. Main outcome measures included shoulder pain on Visual Analogue Scale (VAS) and DASH (disabilities of arm, hand, shoulder) score, range of motion in shoulder, shoulder strength and tear volume (cm3) by US. Adverse events were monitored. (CRIS: https://www.cris.nih.go.kr, KCT0000767).Results: Active shoulder pain on VAS reduced from 5.53 to 3.53 (P = 0.016), and acting pain, one of DASH questionnaires, reduced from 3.35 to 2.00 (P < 0.001). However, resting shoulder pain on VAS and total DASH scores were not significantly different. Forward flexion and internal rotation in range of motion improved significantly (from 169.41 to 178.13 degrees [P = 0.004] and from 83.53 to 88.75 degrees [P = 0.014], respectively). The volume of torn lesion decreased during the study period, however it was not significant. There were no significant adverse events leading to hospitalization.Conclusions: Minimally invasive procedure through polydeoxynucleotide injection into torn area of supraspinatus tendon on US could be candidate for the safe and effective treatment on shoulder pain and limited range of motion in patients with rotator cuff tear.

Study of hot cracking potential in a 6-ton steel ingot casting

A new hot cracking potential (HCP) criterion, for the appearance of hot tearing in steel ingot castings, is proposed. The maximum value of the first principal stress, divided by the dynamic yield strength in the brittle temperature range (BTR), was used to identify the HCP. Experiments were carried out on a 6-ton P91 steel ingot in which severe hot tearing was detected in the upper centerline. Another ingot, with a better heat preservation riser, and without hot tearing, was used for comparison. Samples were obtained from the area of the ingot body with hot tearing, and their morphologies were inspected by a X-ray high energy industrial computed tomography. The carbon and sulfur distributions around the hot tearing were characterized by an infrared spectrometry carbon and sulfur analyzer. High temperature mechanical properties were obtained by a Gleeble thermal simulation machine, under different strain rates. Then, thermo-mechanical simulations using an elasto-viscoplastic finite-element model were conducted to analyze the stress and strain evolution during ingot solidification. The results showed that the hot tearing area, which was rich in both carbon and sulfur, was under excessive tensile stress in the BTR, bearing the highest HCP.

Cluster analysis of acute ascending aortic dissection provides novel insight into mechanisms of distal progression.

Whether primary tear size impacts extent of type A dissection is unclear. Using statistical groupings based on dissection morphology, we examined its relationship to primary tear area. We retrospectively reviewed 108 patients who underwent acute ascending dissection repair from 2000-2016. Dissection morphology was characterized using 3-dimensional (3D) reconstructions of computed tomography (CT) scan images. Two-step cluster analysis was performed to group the dissections by examining the true lumen area as a fraction of the total aortic area at various levels. Cluster analysis defined two distinct categories. This first grouping corresponds to DeBakey type I (n=71, 65.7%) with a dissection extending from the ascending aorta to the aortic bifurcation. The second grouping conforms more closely to DeBakey type II dissection (n=37, 34.3%). It differs however from the classic type II definition as the dissection may extend up to the distal arch from the ascending aorta. Compared to type I, this "extended" DeBakey type II had no malperfusion (P<0.05), a larger primary tear area (6.6 vs. 3.7 cm2, P=0.009), and a greater burden of atherosclerotic coronary artery disease (P<0.05). A smaller aortic valve annulus (P=0.025) and a smaller root false lumen area (P=0.017) may explain less aortic valve insufficiency (P<0.05) in extended type II dissections. No differences in complications or survival were seen. In this series, limited distal extension of DeBakey type II dissections appears to be related to a larger primary tear area and greater atherosclerotic disease burden. It is also associated with less malperfusion and aortic valve insufficiency.

Ultrasound-guided percutaneous bone drilling for the treatment of lateral epicondylitis.

To determine the clinical efficacy of sonographically-guided percutaneous bone drilling of the lateral epicondyle (LE) for the treatment of patients with LE. We included 24 patients with LE who reported pain in this study. All patients underwent sonographically-guided percutaneous bone drilling of the lateral epicondyle. Follow-up sonography and physical examinations were performed 1, 3 and 6months after the procedure. The outcome measures included sonographic findings, visual analogue scale (VAS) score, maximum voluntary grip strength (MVGS) and patient-related tennis elbow evaluation (PRTEE) score. None of the patients had immediate complications during the procedure. The area of the extensor carpi radialis brevis (ECRB) tears decreased significantly at 1month and declined gradually over the remaining 5months of the study (p < 0.001). The mean pain VAS score was significantly lower at 6months than preoperatively (respectively; p < 0.001). The mean MVGS increased significantly between pretreatment and 6months post-treatment (p < 0.001), whereas the PRTEE score decreased significantly during the same period (p < 0.001). Sonographically-guided percutaneous drilling is a quick and safe treatment option for LE that can be performed in an outpatient setting. • Percutaneous drilling of the lateral condyle is effective for the treatment of LE. • The area of ECRB tears can be measured by US-guided saline injection. • US-guided percutaneous drilling is a quick and safe treatment option for LE.

Primary care in the Calais Jungle.

Last summer our small medical team visited the Calais ‘Jungle’. Since that time much has changed and the camp is being demolished and by the time this article is read, it will probably be long gone. Some youngsters are finally being brought to the UK under the ‘Dubs’ amendment. However, once this camp is cleared it will not solve the ongoing flight of refugees from war torn areas: other camps are already appearing. A young Afghan man caught his finger on a sharp point while trying to cross a barbed wire fence. The finger was partially degloved. He attended the local hospital, where they placed a few sutures, but now, 2 weeks later, the skin is necrotic and the underlying tissue looks infected. He is in danger of losing his finger. A middle-aged Sudanese man has been having rigors and is generally unwell. He says it is similar to when he last had malaria. A young Ukrainian woman complains of lower back pain and urinary frequency. The paths of these three people may never have crossed; yet here they are, denizens of the Calais Jungle. They turn up to a makeshift primary care ‘clinic’ that we set up in the heart of the unofficial refugee camp one weekend in July 2016. With only basic medical supplies, we are immediately challenged by what we see. How can we arrange secondary care for the young Afghan in danger of losing his finger? We try to persuade him to return to the original local hospital, but he is reluctant. It was not a good experience for …

The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs

Background: Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L’Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Results: Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair (r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively (r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm2 but reached 44% in tears >8 cm2. Conclusion: There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.

Role of Pulse Pressure and Geometry of Primary Entry Tear in Acute Type B Dissection Propagation

The hemodynamic and geometric factors leading to propagation of acute Type B dissections are poorly understood. The objective is to elucidate whether geometric and hemodynamic parameters increase the predilection for aortic dissection propagation. A pulse duplicator set-up was used on porcine aorta with a single entry tear. Mean pressures of 100 and 180 mmHg were used, with pulse pressures ranging from 40 to 200 mmHg. The propagation for varying geometric conditions (%circumference of the entry tear: 15–65%, axial length: 0.5–3.2 cm) were tested for two flap thicknesses (1/3rd and 2/3rd of the thickness of vessel wall, respectively). To assess the effect of pulse and mean pressure on flap dynamics, the %true lumen (TL) cross-sectional area of the entry tear were compared. The % circumference for propagation of thin flap (47 ± 1%) was not significantly different (p = 0.14) from thick flap (44 ± 2%). On the contrary, the axial length of propagation for thin flap (2.57 ± 0.15 cm) was significantly different (p < 0.05) from the thick flap (1.56 ± 0.10 cm). TL compression was observed during systolic phase. For a fixed geometry of entry tear (%circumference = 39 ± 2%; axial length = 1.43 ± 0.13 cm), mean pressure did not have significant (p = 0.84) effect on flap movement. Increase in pulse pressure resulted in a significant change (p = 0.02) in %TL area (52 ± 4%). The energy acting on the false lumen immediately before propagation was calculated as 75 ± 9 J/m2 and was fairly uniform across different specimens. Pulse pressure had a significant effect on the flap movement in contrast to mean pressure. Hence, mitigation of pulse pressure and restriction of flap movement may be beneficial in patients with type B acute dissections.

RETINAL PIGMENT EPITHELIAL TEAR AND ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR THERAPY IN EXUDATIVE AGE-RELATED MACULAR DEGENERATION: Clinical Course and Long-Term Prognosis.

To document the long-term outcome in cases of retinal pigment epithelial (RPE) tears after treatment of vascularized pigment epithelial detachments with anti-vascular endothelial growth factor therapy. A retrospective analysis of the long-term outcome of a consecutive series of eyes with RPE tear developed during anti-vascular endothelial growth factor therapy for pigment epithelial detachment associated with choroidal neovascularization or retinal angiomatous proliferation (vascularized pigment epithelial detachment) was performed. Best-corrected visual acuity (BCVA), spectral domain optical coherence tomography, and autofluorescence images and also fluorescein angiograms were analyzed to determine the functional and morphologic development over time. The long-term outcome of 22 eyes (21 patients, 13 women and 8 men; 65-85 years; mean: 76 years) with RPE tear was performed with minimal follow-up of 3 years (range: 3-5 years, mean: 44 months) and re-treatment with different therapeutic strategies. The eyes were differentiated in 2 groups according to the course of BCVA after the first 2 years of follow-up: Group 1 (11 eyes) demonstrated a stabilized or improved BCVA after 2 years and Group 2 (11 eyes) demonstrated a decrease in BCVA after 2 years. The initial BCVA between both groups was comparable. Also the mean initial size of the RPE tear was the same between the 2 groups, the area of the RPE tear decreased continuously during follow-up in Group 1, whereas this was the case in Group 2 only at the beginning of treatment with a further increase of the size of the RPE tear with longer follow-up. This corresponded with a different morphologic development between the two groups. In Group 1, increasing recovery of autofluorescence at the RPE-free area was visible beginning from the outer border, whereas in Group 2, further growth of the neovascular complex in the area of the RPE tear was observed resulting in larger fibrovascular scars. In addition, in both groups, the development of hyperreflective tissue was seen on spectral domain optical coherence tomography in the RPE-free area. The major therapeutic difference between the 2 groups was a significantly larger number of injections especially during the first year in Group 1. The development of RPE tear after anti-vascular endothelial growth factor therapy for vascularized pigment epithelial detachment in exudative age-related macular degeneration does not necessarily result in large disciform scars and functional loss, but multiple injections seem to be beneficial especially in the first year. With this strategy, RPE tears seem to be covered by autofluorescent and hyperreflective tissue and a regrowth of the neovascular complex can be prohibited. As a result, photoreceptor cells regain their metabolic support with functional recovery.

Effects of Long-term Soft Contact Lenses on Tear Menisci and Corneal Nerve Density.

We investigated the relationship between tear menisci and corneal subbasal nerve density (SND) in long-term soft contact lens (CL) wearers. Three groups were enrolled for this study: asymptomatic non-CL controls (N-CL group), asymptomatic soft CL wearers (A-CL group), and symptomatic soft CL wearers with self-reported moderate to severe dryness (S-CL group). Upper and lower tear menisci height (UTMH, LTMH) and area (UTMA, LTMA) were measured by optical coherence tomography. This was followed by measurements of fluorescein tear breakup time, fluorescein staining, and the Schirmer I test. In vivo confocal microscopy measured the SND in the nasal, central, and temporal regions of the cornea. The UTMH, UTMA, LTMH, and LTMA were significantly lower in the S-CL group compared with the N-CL group (P<0.05). The combined corneal SND of the temporal and nasal regions of the S-CL group was lower than for the N-CL group (P<0.05). The LTMH was correlated with the SND of the temporal (r=0.410), nasal (r=0.423), combined temporal and nasal (r=0.516), and combined temporal, nasal, and central regions (r=0.430, all P<0.01). The LTMA was also correlated with the SND of the temporal (r=0.379), nasal (r=0.292), combined temporal and nasal (r=0.422), and combined temporal, nasal, and central regions (r=0.367, all P<0.05). The temporal and nasal corneal SNDs were more strongly correlated with the LTMH and LTMA than with the UTMH and UTMA. Soft CL wearers with dry eye symptoms have reduced tear menisci. The alteration of midperipheral corneal SND may contribute to dry eye symptoms.

Once Again, the Status of the Rotator Cuff Does Not Correlate with Patient Symptoms: Commentary on an article by James D. Wylie, MD, MHS, et al.: "Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears".

Decision-making strategies for the appropriate treatment of patients with symptomatic, atraumatic, full-thickness rotator cuff tears are becoming increasingly difficult. It is becoming clear that symptoms of rotator cuff tears do not correlate with disease severity. There have been several recent studies attempting to define a relationship of rotator cuff tears with symptoms such as pain and patient-reported outcome measures1-3. In this Level-II prospective cohort study, Wylie et al. evaluated 169 patients and examined the relationship between rotator cuff tear severity on magnetic resonance imaging (MRI) (number of tendons torn, tear size, tear retraction, and tear area) and patient-reported outcomes, pain, and mental health as measured by the Short Form-36 Mental Component Summary (SF-36 MCS) score. The authors pose two important questions regarding the association of rotator cuff tear morphology and patient-reported outcome measures: How does mental health as …

Грибковый каналикулит: диагностика, лечение, профилактика рецидивов заболевания

Up to 2.4 % of primary patients seeking ophthalmological care are cases of canaliculitis. Purpose: to systematize the methods of diagnosing, treatment and relapse prevention of fungal canaliculitis on the basis of the authors’ experience. Material and methods. The results of diagnosing, treatment and relapse prevention are systematized based on the analysis of examination of 57 patients aged 46 to 89 with tear duct disorders of micotic origin. Results. Canaliculitises of fungal etiology are characterized by chronic course of the disease and complications caused by late diagnosis and prolonged inadequate treatment. Practical ophthalmologists should be aware of the fact that this pathology develops primarily in senior females suffering from chronic conjunctivitis and inflammatory disorders of ocular adnexa within the tear duct area that are resistant to antibiotics. A plan of diagnostic examination is recommended based on the analysis of the clinical picture, determination of patency of lacrimal passages during washing and probing, and canalicular and nasolacrimal assays. We also used bacteriological methods of study and X-ray contrasting of tear ducts. The main technique of treatment of fungal canaliculitis is surgical dissection of lacrimal canaliculi, removal of their content with subsequent instillations and washing of tear ducts with antiseptics and antifugal preparations. In the follow-up period spanning 2 months to 5 years no relapses of the process were observed. Conclusion. The use of special diagnostic methods based on the analysis of clinical picture and surgical treatment combined with antimicotic preparations is necessary for relapse prevention and rehabilitation of patients with fungal diseases of lacrimal canaliculi // Russian Ophthalmological Journal, 2016; 4: 74-9. doi: 10.21516/2072-0076-2016-9-4-74-79.