Tight Rope Research Articles

The Assessment of Reduction Status Using Radiographic Parameters and Ideal Trans-Fixation Technique for Unstable Syndesmotic Injury with Ankle Fracture

Category:Ankle, TraumaIntroduction/Purpose:Anatomical restoration of distal tibiofibular syndesmosis is essential in ankle fractures with syndesmotic injury. However, intraoperative reference line of penetrating angle and evaluation of reduction status remains without consensus. The purpose of this study is to analyze the reduction status of syndesmotic injury using radiographic parameters and to find ideal fixation angle treated with trans-fixation in unstable syndesmotic injury.Methods:Twenty-six patients with ankle fractures with syndesmotic injury that underwent preoperative and postoperative bilateral computed tomography (CT) scans were enrolled. A multi-center study was performed in two tertiary medical centers. All patients were treated with tibiofibular trans-fixation screw or tight rope® fixation. The axial sections of bilateral CT scans were reviewed to measure Fibular Diastasis (FD) and Surface Area of Syndesmosis (SAS) at the level of 1.0 cm above ankle joint.Reduction status was measured by calculating the ratio of postoperative and intact side using radiologic parameters.The trans-fixation angles between the perpendicular line of incisura and distal trans-fixation material was measured. Patients were classified by trans-fixation angle into three groups, as showing 0 -1 degree (A), 1-5 degree (B), 5 or more degree (C) in absolute value.Results:The mean value of reduction status ratio was 1.13 in FD and 1.27 in SAS. The absolute mean value of trans-fixation angle was 4.11°. Trans-fixation angle and reduction status had positive correlation in FD (R = 0.522, p = 0.006) and SAS ratio (R = 0.695, p = 0.000). The absolute mean value of trans-fixation angle in group A, B, C was 0.56° (7 cases), 3.01° (12 cases), and 8.90° (7 cases). The mean value of FD ratio in group A, B, C was 1.01, 1.03 and 1.41. FD and SAS ratio had no difference between group A and B but had significant difference between group A, B and C (p < 0.05).Conclusion:Inappropriate trans-fixation technique had correlated with the loss of reduction after treatment of unstable ankle fracture associated with syndesmotic injury. An angle of 5° from the perpendicular line of the incisura is considered as the ideal trans-fixation angle to maintain the reduction status.

Short-Term Results of Lisfranc Injuries Treated with the Suture Button Technique

Category:Midfoot/Forefoot, Sports, TraumaIntroduction/Purpose:Primary fixation with screws or plates or primary arthrodesis are considered the gold-standard surgical treatment options for Lisfranc injuries. However, drawbacks of these procedures include loss of joint motion, need for later hardware removal, injury of the articular surface by screws and nonunion. Interosseous suture buttons can be used as an alternative technique for fixation of Lisfranc lesions. Theoretically, it may overcome the disadvantages of the rigid construct provided by plates and screws and minimize the harm to the joint cartilage. The aim of the present study was to provide the short-term results of Lisfranc injuries treated with the suture button technique.Methods:Sixteen consecutive patients with Lisfranc injuries requiring an operation were treated with the use of the Mini Tight Rope (Arthrex, Naples, FL) between April 2014 and November 2017. Medical records and radiographic images were retrospectively analyzed by independent observers with respect to functional outcomes, complications, need for reoperation and radiographic outcomes. The mean follow-up was 32 (range, 6-49) months. Functional outcomes were measured by the AOFAS midfoot score and the Visual Analogue Scale (VAS) at the latest follow-up.Results:At a mean follow-up of 32 months, the average AOFAS score was 95.8 (range, 82-100) and the mean VAS was 0.6 (range, 0-2). All patients but one were able to return to their previous activities. Twelve patients were very satisfied with the outcomes and four were satisfied or partially satisfied. A total of 9 complications were observed in 6 patients, with discomfort on the button insertion site being the most common (4 cases). Other complications included evidence of radiographic arthritis (3 cases), loss of reduction (1 case) and extensor hallucis longus tendinopathy (1 case). Only 1 patient required a reoperation for removal of the suture button.Conclusion:The use of the suture button for fixation of Lisfranc injuries showed excellent results in the short-term. This technique is potentially less harmful to the articular cartilage and generally does not require hardware removal. However, arthritis and/or loss of reduction were noted in 3 patients during follow-up, which could have been caused by the severity of the primary injury itself or by a lack of stability provided by the construct. Further studies are required to evaluate whether the suture button technique provides enough fixation to maintain reduction and prevent the development of arthritis in the long-term.

Deactivation of ATP-Binding Cassette Transporters ABCB1 and ABCC1 Does Not Influence Post-ischemic Neurological Deficits, Secondary Neurodegeneration and Neurogenesis, but Induces Subtle Microglial Morphological Changes.

ATP-binding cassette (ABC) transporters prevent the access of pharmacological compounds to the ischemic brain, thereby impeding the efficacy of stroke therapies. ABC transporters can be deactivated by selective inhibitors, which potently increase the brain accumulation of drugs. Concerns have been raised that long-term ABC transporter deactivation may promote neuronal degeneration and, under conditions of ischemic stroke, compromise neurological recovery. To elucidate this issue, we exposed male C57BL/6 mice to transient intraluminal middle cerebral artery occlusion (MCAO) and examined the effects of the selective ABCB1 inhibitor tariquidar (8 mg/kg/day) or ABCC1 inhibitor MK-571 (10 mg/kg/day), which were administered alone or in combination with each other over up to 28 days, on neurological recovery and brain injury. Mice were sacrificed after 14, 28, or 56 days. The Clark score, RotaRod, tight rope, and open field tests revealed reproducible motor-coordination deficits in mice exposed to intraluminal MCAO, which were not influenced by ABCB1, ABCC1, or combined ABCB1 and ABCC1 deactivation. Brain volume, striatum volume, and corpus callosum thickness were not altered by ABCB1, ABCC1 or ABCB1, and ABCC1 inhibitors. Similarly, neuronal survival and reactive astrogliosis, evaluated by NeuN and GFAP immunohistochemistry in the ischemic striatum, were unchanged. Iba1 immunohistochemistry revealed no changes of the overall density of activated microglia in the ischemic striatum of ABC transporter inhibitor treated mice, but subtle changes of microglial morphology, that is, reduced microglial cell volume by ABCB1 deactivation after 14 and 28 days and reduced microglial ramification by ABCB1, ABCC1 and combined ABCB1 and ABCC1 deactivation after 56 days. Endogenous neurogenesis, assessed by BrdU incorporation analysis, was not influenced by ABCB1, ABCC1 or combined ABCB1 and ABCC1 deactivation. Taken together, this study could not detect any exacerbation of neurological deficits or brain injury after long-term ABC transporter deactivation in this preclinical stroke model.

Open versus modified arthroscopic treatment of acute acromioclavicular dislocation using a single tight rope: randomized comparative study of clinical outcome and cost-effectiveness

The purpose of this study was to compare clinical outcome and cost-effectiveness between arthroscopic and open repair using TightRope in acromioclavicular joint dislocation III and IV. Fifty-two patients with acute acromioclavicular joint dislocation type III and IV were included. Patients were randomly allocated to either of 2 groups: Arthroscopic Repair Group (ARG) and Open Repair Group (ORG). Constant-Murley Score (CMS), visual analog scale (VAS) score, and coracoclavicular (CC) distance were measured preoperatively and 3 months, 6 months, 1 year, and 2 years postoperatively. CMS increased from 40.68 for the ARG and 40.70 for the ORG preoperatively to 84.18 and 84.45 after 2 years from operation. VAS score decreased from 60.59 for the ARG and 64.50 for the ORG 1 day after surgery to 18.04 and 17.87 respectively after 6 months. CC distance decreased from 29.27 mm in the ARG and 28.16 mm in the ORGpreoperativelyto 9.86 mm in the ARG and 10.54 mm in the ORGon postoperative day 1. Rewidening of the CC distance occurred after 6 months (13.27 mm for the ARG and 13.62 mm for the ORG) and 1 year postoperatively (15.77 for the ARG and 15.41 for the ORG) but remained stable at final follow-up. There was a significant difference in surgical time (80.00 minutes in the ARG compared to 52.79 minutes in the ORG) and cost of consumables (US$1729.95 in the ARG compared to US$851.87in the ORG). Open and arthroscopic repair of acute acromioclavicular joint dislocation yielded good clinical results, yet the arthroscopic technique is more expensive and has a longer surgical time.

Moses Maimonides and Judah Halevi on order and law in the world of nature, and beyond

The concept of order, expressed by a number of forms of the Arabic root n.z.m., was of paramount importance in the natural philosophy of medieval Jewish thinkers, far more important than the related concept of law. Moses Maimonides walked a very tight rope between the order that is present in the cosmos, and which testifies to its intelligent Creator, and some minor streaks of apparent disorder, which indicate that the universe is not an eternally self-maintaining entity ruled only by necessity. Judah Halevi was mostly concerned with hierarchical levels of increasing order: a basic orderliness, which describes the cosmos, and a higher level of order, which applies to the Jewish people.

A Survey on optimized implementation of deep learning models on the NVIDIA Jetson platform

Abstract Design of hardware accelerators for neural network (NN) applications involves walking a tight rope amidst the constraints of low-power, high accuracy and throughput. NVIDIA’s Jetson is a promising platform for embedded machine learning which seeks to achieve a balance between the above objectives. In this paper, we provide a survey of works that evaluate and optimize neural network applications on Jetson platform. We review both hardware and algorithmic optimizations performed for running NN algorithms on Jetson and show the real-life applications where these algorithms have been applied. We also review the works that compare Jetson with similar platforms. While the survey focuses on Jetson as an exemplar embedded system, many of the ideas and optimizations will apply just as well to existing and future embedded systems. It is widely believed that the ability to run AI algorithms on low-cost, low-power platforms will be crucial for achieving the “AI for all” vision. This survey seeks to provide a glimpse of the recent progress towards that goal.

Optimizing Different Conditions to Develop a Single Stranded Phage-Lambda DNA (λDNA) Tightrope

λDNA tightrope can be referred to as λDNA is suspended between two beads above the surface of the flow cell which allows the λDNA to be viewed extended rather than in collapse form. It is use for DNA studies such DNA repairs, but when using the normal protocol (at a velocity of 300 µl/minutes, beads size of 5 µm and concentration of 500.0 µg/ml of 1.0 λDNA) it results to multiple tightropes forming on the beads which interference with a many studies. In this study, different conditions were optimized to develop a single stranded λDNA tight rope by taking into consideration the following conditions, velocity (100 to 600), beads size (3 µm and 5µm), concentration (500.0 µg/ml, 375.0 µg/ml and 250.0 µg/ml) and time. To form the tightrope, beads were added into water in an eppendorf tube, centrifuged and sonicated before putting into the flow cell. The flow cell, syringe pump and perfusion tube were all fixed together, where ABC buffer and λDNA were put into the perfusion tube and set according to protocol to make the tightropes. YOYO-1 dye was used to stain the λDNA before using atomic force microscopy to image the tightropes, the same procedure was repeated for the different conditions and all dispense readings of the flow rate were taken at not less than 3.0 µl/minutes. λDNA on the surface of the flow cell was observed at the velocity of 100 and 200 µl/minutes for all the conditions. The optimized result was at velocity of 300µl/ml, concentration 375.0 µg/ml of 1.0 μλDNA and beads size of 3 µl which lasted for 15 minutes which gave the best result of single stranded λDNA tightrope compared to all the conditions and the normal protocol.

Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope (Mohandas Jagsun technique)

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Avulsion fractures of tibial insertion of the posterior cruciate ligament are rare among the knee injuries. Purpose of this study is to determine the functional outcome of arthroscopic reattachment of tibial avulsion of the Posterior cruciate ligament by ABS button (Arthrex) and tight rope.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 15 Patients with PCL avulsion fracture were included. The Inclusion criteria were: 1) Displaced avulsion fractures (type-2 and type-3). They were followed at regular intervals using IKDC score, Lysholm score and subjective questionnaire.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All cases showed complete osseous union during follow up. All knees are stable on examination by posterior sag sign and posterior drawer test. Two patients had loss of about 10&lt;sup&gt;0 &lt;/sup&gt;flexion. According to the IKDC form assessment 13 patients classified as normal and 2 were classified as near normal.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Arthroscopic reattachment of tibial avulsion fractures of the posterior cruciate ligament using ABS button and tightrope&lt;strong&gt; &lt;/strong&gt;gives fairly good clinical outcomes. &lt;/p&gt;

What is the Effective Technique for Syndesmotic Stabilization Tight Rope or Screw?

What is the Effective Technique for Syndesmotic Stabilization Tight Rope or Screw?

Posttraumatic trapeziometacarpal joint instability in a child — A case report

Good hand function requires pain-free stability of the thumb. The thumb determines prehension in the hand. Opposition, the most important type of prehension, occurs at the trapeziometacarpal (TMC) joint. Instability of the TMC joint is mostly caused by osteoarthritis or rheumatoid arthritis. The clinical management of TMC joint traumatic injuries with instability requires a clear understanding of the anatomy and function of the TMC joint. Surgical intervention is typically used when conservative therapy is unable to retard the progression of instability. Surgery is especially considered when the instability is associated with uncontrollable pain and a loss of function. The authors report a case of a 12-year-old female patient presented with trauma who developed a posttraumatic TMC joint instability. We report the case of a 12-year-old girl who sustained a left thumb injury. On examination, left thumb showed instability on TMC joint. The contralateral TMC joint was stable. General examination showed some joint laxity. The patient was treated with a thumb spica cast but the application of a thumb spica was unsuccessful in the resolution of pain and instability of the TMC joint. The Mini-Tightrope™ (Arthrex, Naples, FL) for suspension of the thumb metacarpal was used as an adjunct and stabilizer of the TMC joint. Surgery was done under fluoroscopy to verify the construct and check the position of suspension of the thumb metacarpal. Post-operatively, wear a thumb spica cast for 3 weeks, where gentle grip strengthening exercises was commenced. At 6 weeks, she was encouraged to progress to medium activities and at 9 weeks to all activities without restriction, including sports. This procedure resulted in very good outcomes, with no instability, no pain and almost no scars. Posttraumatic instability of the TMC joint are rarely reported, especially in children. Surgical treatment is used to restore stability and prevent subluxation dislocation of the TMC joint while preserving mobility. New technology (as the Mini-Tightrope™) has the potential to greatly impact the medical field because it may lead to a greater quality of life, decreased pain, or increased function for our patients. This was of special importance in this case because it allows us to stabilize the TMC joint without harming the growth physis. The Mini Tight Rope technique for the TMC joint relieves pain, restores stability while preserves physis and preserves functional range of motion in children.

Preliminary finite element analysis of anterior inferior tibiofibular syndesmosis injuries treated with screw and tight-rope fixation

To establish finite element models of anterior inferior tibiofibular syndesmosis injuries (AITSI), screw fixation and Tight-rope(TR) fixation, and to compare its force and displacement, so as provide evidence for clinical diagnosis and treatment. A three-dimensional model of a healthy ankle complex was developed by computed tomography (CT) images, and anterior inferior tibiofibular syndesmosis injuries(AITSI) model also established, then a screw was inserted into AITSI model to obtain a screw fixation model, and a Tight-rope system was put into AITSI model to obtain a TR model. Simulated loads were applied under three conditions:neutral position with single-foot standing, internal and external rotation of the ankle. The focus was on the stress of distal tibia, distal fibula and talus articular surface, and displacement of distal tibia and fibula. AITSI increased the stress of distal tibia, distal fibula and talus articular surface, which also increased the displacement of distal tibia and fibula. when AITSI existing, either a screw or TR could restrict excessive displacement of distal tibia and fibula. However, screw fixation severely limited normal physiological activity of ankle, and increased the force of distal tibia, distal fibula and articular surface of talus. The forces were concentrated on the screw. In the screw fixation model, the maximum force of tibia and fibula was more than 1.3 times that of TR model, and the contact force of talus articular surface was about 1.8 times. In the screw fixation model, the displacement of tibial attachment point of anterior tibiofibular ligaments was approximately 0.6 times that of the normal model. While the data in the TR model is about 1.1 times, but TR has poor control of the displacement of fibula. Severe anterior inferior tibiofibular syndesmosis injuries could cause stress and displacement distribution of ankle joint to change ankle instability and should be treated with internal fixation. Both of the screw and TR could be effective for AITSI. Tight-rope has advantages over screw fixation in terms of skeletal force, activity of ankle joint, and internal fixation fracture, but Tight-rope has disadvantage in fibular rotation. Patients with Weber type C ankle fractures and obesity are more suitable for screw fixation.

TRIPLE THERAPY - WALKING ON A TIGHT ROPE!

Managing patients with atrial fibrillation (AF) requiring percutaneous interventionor those on anticoagulant therapy needing an intervention is an act of greatbalancing like walking on a tight rope. The premise revolves around three basicconsiderations - the risk of embolism and stroke due to AF, the possibility ofthrombosis due to underlying coronary obstructive disease and interventionsand more importantly the hazard of bleeding in combining different therapeuticagents. Risk of thromboembolic stroke is determined by a host of factors. CHA DS VASC score is well-validated risk score based onage, gender and comorbidities. It identifies patients at higher risk of thromboembolism who require anticoagulants to preventstroke. HASBLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile internationalnormalized ratio [INR], elderly [>65 years], drugs/alcohol concomitantly) has been recommended as a bleeding risk score forpatients with AF, with scores Ý3 considered high risk. Both scores have to be used with a grain of common sense andconsidering patient as a whole, though the HAS-BLED score has been credited to predict bleeding significantly; thediscriminating value is overall limited and similar to CHA DS VASC score. A brief period of washout from the anticoagulant effect of OAC is preferable whenever possible in elective and non-emergentprocedures. In patients on Vit K antagonists, those being subjected to radial approach, INR should be preferably U2.0 and iffemoral approach is used INR has to be U 1.5. In patients on NOAC, irrespective of vascular access site, treatment may bewithheld for 24 hours (or 48 hours for patients with impaired renal function with dabigatran). Although in stable CAD patientsbridging with parenteral anticoagulation can be omitted yet this should be considered for patients presenting with an ACS. To conclude, treating patients with triple therapy in the setting of AF and PCI is like walking on a tight rope. Three importantconsiderations for all decisions making are risk of thrombo-embolism and stroke, risk for thrombotic complications and risk ofbleeding. Meticulous management is recommended pre, intra and post procedure. This entails selecting patients usingappropriate criteria, employing radial approach, using latest generation DES, starting triple therapy and then changing over toSAPT earlier or later balancing thrombotic versus bleeding risks.

Biomechanical properties of adjustable extracortical graft fixations in ACL reconstruction

BackgroundReliable biomechanical data about the strength of different tibial extracortical graft fixation devices is sparse. This biomechanical study compares the properties of tibial graft fixation in ACL reconstruction with either the ACL Tight Rope™ or the Rigid Loop Adjustable™ device. The hypothesis was that both fixation devices would provide comparable results concerning gap formation during cyclic loading and ultimate failure load.MethodsSixteen sawbone tibiae (Sawbones™) underwent extracortical fixation of porcine flexor digitorum profundus grafts for ACL reconstruction. Either the ACL Tight Rope™ (Arthrex) or the Rigid Loop Adjustable™ (DePuy Mitek) fixation device were used, resulting in 2 groups with 8 specimens per group. Biomechanical analysis included pretensioning the constructs 10 times with 0.75 Hz, then cyclic loading of 1,000 position-controlled cycles and 1,000 force-controlled cycles applied with a servohydraulic testing machine. Elongation during cyclic loading was recorded. After this, ultimate failure load and failure mode analysis were performed.ResultsNo statistically significant difference could be noted between the groups regarding gap formation during cyclic loading (4.6 ± 2.6 mm for the Rigid Loop Adjustable™ vs. 6.6 ± 1.5 mm for the ACL Tight Rope™ (p > 0.05)), and ultimate failure loads (980 ± 101.9 N for the Rigid Loop Adjustable™ vs. 861 ± 115 N ACL Tight Rope™ (p > 0.05)).ConclusionACL Tight Rope™ and the Rigid Loop Adjustable™ fixation devices yield comparable biomechanical results for tibial extracortical graft fixation in ACL reconstruction. These findings may be of relevance for the future surgical decision-making in ACL reconstruction. Randomized controlled clinical trials comparing both fixation devices are desirable for the future.

Creating the Dance and Dancing Creatively: Exploring the Liminal Space of Choreography for Emergence

In this paper, three dance scholars explore the tensions and bliss inherent in curriculum delivery through dance integration. It meets the call for a curriculum attuned to provoking encounters (Pinar &amp; Grumet, 2015) through philosophical narration that interweaves experiences as dancers, dance educators, dance scholars and dance integrators. Personal vignettes unveil the sense-making of creative artists tasked with the duty to “deliver” curriculum, and as arts integration specialists tasked with the duty to share knowledge, with teachers, for designing learning through dance. The authors liken the inherent tensions to those of a tight rope walker balancing between forces pulled in opposite directions. They share their own encounters of pedagogical balance and counterbalance, of choreography and emergence, and of leading and following, as each relates to learning design. They also explore the duality of meeting curricular ends and unfolding endless possibilities (Aoki, 2005; Roth, 2014). Together, the authors find that their collective experience leads to three charges for curricular reform: 1) embed dance integration in teacher preparation; 2) infuse dance integration in K-12 curriculum; and 3) provide time for pedagogical experimentation through dance-based inquiry.

Extending Horizons of Extracorporeal Membrane Oxygenation: Can the Tight Rope of Anticoagulation Help Further?

Extending Horizons of Extracorporeal Membrane Oxygenation: Can the Tight Rope of Anticoagulation Help Further?

Fixation method for treatment of unstable distal clavicle fracture: systematic review and network meta-analysis.

Surgical management is recommended for unstable distal clavicle fractures. A variety of methods have been previously reported, but there is no current consensus regarding which method is most suitable. Therefore, we have conducted a systematic review and network meta-analysis to compare postoperative shoulder function and complications between different fixation methods to identify which class of fixation is best for unstable distal clavicle fractures. We searched the literature systematically using eligibility criteria of all comparative studies that compared postoperative outcomes of coracoclavicular fixation (tight rope, screw or endobutton), hook plating, plate and screws, tension band wiring and transacromial pinning fixation for unstable distal clavicle fractures from PubMed, EMBASE, and Scopus databases up to February 10, 2018. Two reviewers independently extracted data. A network meta-analysis was applied to combine direct and indirect evidence and to estimate the relative effects of the treatment options. The probability of being the best treatment was estimated using surface under the cumulative ranking curves (SUCRA). Ten comparative studies (n = 505 patients) with one RCT study (n = 42) met the inclusion criteria. Intervention included coracoclavicular fixation (n = 111 patients), hook plating (n = 300 patients), plate and screws (n = 41 patients), tension band wiring (n = 81 patients) and transacromial pinning (n = 14 patients). A network meta-analysis showed that CM scores of coracoclavicular fixation were significantly higher when compared to hook plate and tension band wiring, with pooled mean of 2.98 (95% CI 0.05-5.91) and 7.11 (95% CI 3.04-11.18). For UCLA, CC fixation and plate and screw fixation had significantly higher scores compared to hook plating fixation with a mean score 2.22 (95% CI 0.44-3.99) and 3.20 (95% CI 0.28-6.12), respectively. In terms of complications, plate and screw fixation had lower risk with RRs of 0.63 (95% CI 0.20-1.98), 0.37 (95% CI 0.19-0.72), 0.11 (95% CI 0.04-0.30) and 0.02 (95% CI 0.002-0.16) when compared to coracoclavicular fixation, hook plating, tension band wiring and transacromial pinning. The SUCRA probabilities of CC fixation were in the first rank with 96.8% for CMS, while plate and screw fixation were in the first rank with 67.7 and 93.8% for UCLA score and complications. We recommend using plate and screw and CC fixation as the first- and second-line treatment of unstable distal clavicle fractures. As the quality of studies for this meta-analysis was not high, larger and higher-quality randomized controlled trials are required to confirm these conclusions for informed clinical decision making.

Behavioral effects of the combined use of alcohol and energy drinks on alcohol hangover in an experimental mice model

In last few years it has been a significant increase in the consumption of alcohol combined with energy drink. The aim of this work was to study the effect of this mixture in motor and affective behaviors during an alcohol hangover episode. Male Swiss mice received one of the following treatments: saline + sucrose; saline + energy drink; ethanol + sucrose; ethanol + energy drink. Ethanol dose was 3.8 g/kg BW (i.p.) and energy drink dose was 18 ml/kg BW (gavage) at ZT1 (8 am) (ZT: Zeitgeber time; ZT0: 7 am; lights on). The behavioral tests used were tight rope test to determine motor coordination; hanging wire test to study muscular strength; elevated plus maze and open field tests to evaluate anxiety like-behavior and locomotor activity. Tests were carried out at basal point that matched with lights onset and every 6 h up to 18 h after treatments. Hangover onset was established at ZT7 when blood alcohol concentration (BAC) was almost zero. Our results showed that the mixture of alcohol and energy drink altered significantly motor skills. Specifically, a significant decrease was observed in the performance of the animals in the tightrope and hanging wire tests in groups treated with the mixture of alcohol and energy drink. A significant impairment in the anxiety-like behavior was observed mainly at the beginning of alcohol hangover. These findings suggest that energy drink added to alcohol extends motor disabilities observed during an alcohol hangover episode in comparison with animals that received alcohol alone.

A Perioperative Medicine Model for Population Health: An Integrated Approach for an Evolving Clinical Science.

Health care delivery in the United States continues to balance on the tight rope that connects its transition from volume to value. Value in economic terms can be defined as the amount something exceeds its commodity price and is determined by extraordinary reputation, quality, and/or service, whereas its destruction can be a consequence of poor management, unfavorable policy, decreased demand, and/or increased competition. Going forward, payment for health care delivery will increasingly be based on services that contribute to improvements in individual and/or population health value, and funds to pay for health care delivery will become increasingly vulnerable to competitive market forces. Therefore, a sustainable population health strategy needs to be comprehensive and thus include perioperative medicine as an essential component of the complete cycle of patient-centered care. We describe a multidisciplinary integrated program to support perioperative medicine services that are integral to a comprehensive population health strategy.

Acromioclavicular joint disruptions: A comparison of two surgical approaches 'hook' and 'rope'.

Acromioclavicular joint injuries are common shoulder girdle injuries most commonly resulting from a direct blow to the acromion with the arm adducted. Type-I or type-II acromioclavicular joint injuries can be managed with sling immobilization, early shoulder motion, and physiotherapy. The management of type-III injuries remains controversial and is individualized. Type IV and V injuries should be treated surgically. A myriad of surgical techniques for the management of acromioclavicular joint injuries have been reported. We present a comparative study of 76 patients treated with two most common modalities of treatment for AC joint disruption and that is Hook plate stabilisation (n=52) or arthroscopically assisted tight rope stabilisation (n=24). The primary objective was to establish whether hook plate stabilization was superior compared to arthroscopic tight rope fixation in reducing pain and increasing function in the short-term and long-term for patients with AC joint disruptions III-IV. We also wanted to assess how quickly patients returned to their work/job. It was a prospective study, we included all the patients operated between 2008 and 2015 for AC joint disruption by the two shoulder surgeons of our department. All patients followed a strict physiotherapy protocol and were assessed at 6 weeks, 3 months and 12 months. We used the Harm and cost criteria of assessment and the patient specific functional outcome scores. Both modalities of treatment have high patient satisfaction rate, return to work is faster in tight rope group but after a year both group of patients returned to their premorbid state. Removal of hook plate is not mandatory and lysis of acromion is rare (1% in our series). Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.

Anticoagulation during ECMO: Will the Tight Rope be Tighter in 2018?

Anticoagulation during ECMO: Will the Tight Rope be Tighter in 2018?