Rotator cuff outcomes and mental health indices: Correlation or causation?

Background: Psychological factors such as catastrophizing, anxiety, and depression influence clinical outcomes in many conditions. Our purpose was to examine trends and associations between these and outcomes of rotator cuff surgery. Methods: 148 patients (76 W:72 M, 55.1 ± 8.2 years) with unilateral symptomatic rotator cuff syndrome were followed for 1 year after surgery. The Western Ontario Rotator Cuff Score (WORC), the Pain Catastrophizing Score (PCS), and the Hospital Anxiety and Depression Score (HADS) were administered. Evolution and associations of WORC, HADS and PCS scores were examined using uni- and multivariate analyzes. Results: At 1 year, PCS, HADS-A, and HADS-D scores negatively correlated with WORC score (R = -0.6, -0.61, -0.69). The strength of correlation was lower between baseline PCS, HADS-A, and HADS-D scores and 1-year WORC score (R = -0.38, -0.43, -0.42). Prior anxiety diagnosis was associated with higher HADS-A scores at 2- and 6- weeks post-op (p = 0.013, 0.011). 106 participants experienced an improving HADS-D over the year of follow-up. Worse pre-op pain, WORC, PCS, HADS-A, HADS-D, cardiovascular disease and current smoking were associated with non-improving HADS-D. Discussion: Patient-reported outcomes of rotator cuff surgery are associated with patient-reported anxiety, depression, and pain catastrophizing. In many, all outcome scores improved over time suggesting a two-way association between shoulder condition and psychological parameters. Level of evidence: II.

Dual infection in pregnancy: Disseminated Mycoplasma hominis and necrotizing herpes simplex 2 hepatitis.

Mycoplasma hominis is part of the genitourinary flora in sexually active people and can cause disseminated infection in immunocompromised patients. We describe a rare case of an immunocompetent pregnant woman with simultaneous necrotizing HSV hepatitis and disseminated M. hominis infection. Detection of M. hominis and antimicrobial susceptibility testing of this fastidious organism in the clinical laboratory is discussed.

Laser desorption with corona discharge ion mobility spectrometry for direct surface detection of explosives.

We present a new highly sensitive technique for the detection of explosives directly from the surface using laser desorption-corona discharge-ion mobility spectrometry (LD-CD-IMS). We have developed LD based on laser diode modules (LDM) and the technique was tested using three different LDM (445, 532 and 665 nm). The explosives were detected directly from the surface without any further preparation. We discuss the mechanism of the LD and the limitations of this technique such as desorption time, transport time and desorption area. After the evaluation of experimental data, we estimated the potential limits of detection of this method to be 0.6 pg for TNT, 2.8 pg for RDX and 8.4 pg for PETN.

Elbow kinematics after radiocapitellar arthroplasty.

PURPOSE: Radiocapitellar arthroplasty has been proposed as a reconstructive option for combined radial head and capitellar deficiency. The purpose of this study was to assess the impact of radiocapitellar replacement on elbow kinematics. We hypothesized that with the medial collateral ligament (MCL) intact, radiocapitellar arthroplasty would replicate normal kinematics, and that a radiocapitellar arthroplasty would more closely approximate normal kinematics than an elbow with a deficient lateral column or with a deficient MCL. METHODS: We tested 7 cadaveric arms in an upper extremity joint simulator. Each arm underwent computed tomographic scanning to aid implant size selection and computer-assisted implant insertion. We obtained kinematic data using an electromagnetic tracking system during elbow flexion. The capitellar and radial head implants were placed through an extended lateral epicondylar osteotomy. We sectioned the anterior bundle of the MCL, leaving the flexor-pronator mass intact. Outcomes of interest were varus-valgus and rotational kinematics of the ulnohumeral joint. RESULTS: The radiocapitellar arthroplasty showed no difference in kinematics compared with the postosteotomy control. The MCL-deficient elbow showed more valgus angulation and more external ulnar rotation than the control or radiocapitellar arthroplasty in the pronated, valgus loaded position. The deficient lateral column demonstrated increased external ulnar rotation kinematics during active elbow flexion. CONCLUSIONS: Radiocapitellar arthroplasty can restore normal elbow kinematics with the MCL intact. If the MCL is deficient, radiocapitellar arthroplasty does not restore normal kinematics. CLINICAL RELEVANCE: Radiocapitellar arthroplasty should be considered in cases of lateral column deficiency because it maintains normal elbow kinematics during active motion. Whereas radiocapitellar arthroplasty improves the stability of the MCL-deficient elbow with deficiency of the lateral column, reconstruction of the MCL may further improve normal kinematics.

The impact of capitellar arthroplasty on elbow contact mechanics: Implications for implant design.

BACKGROUND: Radiocapitellar arthroplasty is indicated for capitellar deficiency. Although current implants employ a spherical capitellar surface, the capitellum is elliptical. This has implications for congruency and wear in capitellar arthroplasty. Our objective was to evaluate the contact mechanics of radiocapitellar arthroplasty. We hypothesized that capitellar replacement would decrease joint contact area relative to the native articulation; and an anatomical implant design would replicate more normal contact morphology than a spherical implant. METHODS: Eight paired humeri and radii were potted in a custom jig. A compressive load of 85N was applied with the articulation flexed at 45° in neutral forearm rotation. Joint casts were made and the articular contact area and shape were quantified. Anatomical and spherical capitellar implants were tested against the native radial head (hemiarthroplasty). FINDINGS: The contact areas for the anatomical and spherical hemiarthroplasties were 59 and 51% of the native articulation (P<0.005), while the unicompartmental arthroplasties' contact areas were 84 and 89% (anatomical, spherical) of the native articulation (P<0.01). No implant was superior in recreating the native contact shape. INTERPRETATION: Placement of any capitellar implant resulted in a large decrease in contact area when articulating with a native radial head. This suggests that the radial head cartilage would see a marked increase in contact pressure relative to the native articulation. The unicompartmental arthroplasties demonstrated an even larger reduction in contact area, raising concern about accelerated surface wear. Further investigation needs to correlate these contact mechanics to cartilage wear and implant longevity.

Use of co-registered high-resolution computed tomography scans before and after screw insertion as a novel technique for bone mineral density determination along screw trajectory.

INTRODUCTION: Bone mineral density (BMD) is an important factor in the examination of the performance of bone instrumentation both in and ex vivo, and until now, there has not existed a reliable technique for determining BMD at the precise location of such hardware. This paper describes such a technique, using cadaveric human sacra as a model. METHODS: Nine fresh-frozen sacra had solid and hollow titanium screws placed into the S1 pedicles from a posterior approach. High-resolution micro-computed tomography (CT) was performed on each specimen before and after screw placement. All images were reconstructed with an isotropic spatial resolution of 308 mum, reoriented, and the pre-screw and post-screw scans were registered and transformed using a six-degree rigid-body transformation matrix. Once registered, two points, corresponding to the center of the screw at the cortex and at the screw tip, were determined in each scan. These points were used to generate cylindrical regions of interest (ROI) with the same trajectory and dimensions as the screw. BMD measurements were obtained within each of the ROI in the pre-screw scan. To examine the effect of artefact on BMD measurements around the titanium screws, annular ROI of 1 mm thickness were created expanding from the surface of the screws, and BMD was measured within each in both the pre- and post-screw scans. RESULTS: The registration process was accurate to 190 mum, with a precision of 189 mum and error in BMD measurement of +/-2% in repeated scans. BMD values in the cylindrical ROI corresponding to screw trajectories were not statistically different from side to side of each specimen (p=0.23). Metal artefact created significant differences in BMD values (p=0.001) and followed an exponential decay curve as distance from the screws increased, approaching a low value of approximately 20 mg HA cm(-3), but not disappearing completely. SUMMARY: CT in the presence of metal creates artefact, making measured BMD values near implants unreliable. This technique is accurate for determination of BMD, non-destructive, and eliminates the problem of this metal artefact through the use of co-registered scans. This technique has applications both in vitro and in vivo.

Evaluation of free-stall mattress bedding treatments to reduce mastitis bacterial growth.

Bacterial counts were compared in free-stall mattresses and teat ends exposed to 5 treatments in a factorial study design on 1 dairy farm. Mattresses in five 30-cow groups were subjected to 1 of 5 bedding treatments every other day: 0.5 kg of hydrated limestone, 120 mL of commercial acidic conditioner, 1 kg of coal fly ash, 1 kg of kiln-dried wood shavings, and control (no bedding). Counts of coliforms, Klebsiella spp., Escherichia coli, and Streptococcus spp. were lowest on mattresses bedded with lime. Mattresses bedded with the commercial acidic conditioner had the next lowest counts for coliforms, Klebsiella spp., and Streptococcus spp. Wood shavings and the no-bedding control had the highest counts for coliform and Klebsiella spp. Compared with wood shavings or control, fly ash reduced the counts of coliforms, whereas for the other 3 bacterial groups, the reduction was not always significant. Streptococcus spp. counts were greatest in the control group and did not differ among the shavings and fly ash groups. Teat swab results indicated that hydrated lime was the only bedding treatment that significantly decreased the counts of both coliforms and Klebsiella spp. There were no differences in Streptococcus spp. numbers on the teats between any of the bedding treatments. Bacterial populations grew steadily on mattresses and were generally higher at 36 to 48 h than at 12 to 24 h, whereas bacterial populations on teats grew rapidly by 12 h and then remained constant. Hydrated lime was the only treatment that significantly reduced bacterial counts on both mattresses and teat ends, but it caused some skin irritation.

Thyroid hormone: the modulator of erectile function in the rabbit.

The possible role of thyroid hormones in the Nitric Oxide (NO)-mediated response to sexual stimulation, and on prostaglandin E1 (PGE1) and Sildenafil in the treatment of erectile dysfunction was investigated using the corpus cavernosum of the New Zealand rabbit animal model. The parameters studied were penile erection monitored as contractile force of the erectile tissue, sperm count and motility; in parallel with the haematocrit, red cell count or rheology, Heart Rate (HR), Mean Arterial Pressure (MAP), Thyroid Stimulating Hormones (TSH) and Thyroxine levels. Hypothyroidism or thyroidectomy was found to cause depletion of Endothelium Derived Relaxant Factor (EDRF) thereby causing very feeble contraction of the cavernosum muscle, in both prostaglandin E1 (PGE1) and sildenafil, oligospermia and less than 45 % motile sperms. Thyroxine treatment produced contraction proportionate to the concentrations of PGE1 and Sildenafil; providing evidence that the erectogenic actions of both PGE1 and Sildenafil are possible only in the presence of adequate thyroid hormone level.

Dependence of calcium on thyroid hormone for the regulation of cellular functions.

Recently, the thyroid hormone has been shown to cause increase in Ca2+ concentration by mobilizing intracellular Ca2+. The mobilization of intracellular Ca2+ in the absence of transmembrane Ca2+ influx has been accepted as evidence for a cell-surface Ca2+- receptor. The possible role of thyroid hormone in the regulation of cellular functions by Ca2+-channel was investigated using parameters proven to indispensably involve Ca2+: Bleeding and clotting times and rat uterine muscle activity in Ca2+-free Tyrode's solution. Adult female Wistar rats divided into four groups, namely; (i) Control, (ii) Thyroidectomized, (iii) Throidectomized-treated with thyroxine and (iv) Thyroxine-treated; were fed on rat chow. While groups i and ii were allowed access to tap water ad libitum for 60 days, groups iii and iv received tyroxine (10mg/kg body weight) every alternate day and tap water ad libitum for 60 days. All groups were kept in an air-conditioned room till they were euthanized. The results showed that thyroxine elicited biphasic contraction in Ca2+ - depletion and potentiated uterine contraction during Ca2+- loading (P<0.001). Inhibition of contractions in thyroidectomy, showed dependency of Ca2+ on thyroid hormones for the regulation of cellular functions.

Comparison of bacteria populations in clean and recycled sand used for bedding in dairy facilities.

Bedding samples were collected twice from commercial dairy free-stall facilities that used recycled sand and clean sand in both the summer and winter. Collection began on the day sand was taken from the pile (d 0) and placed in the free stalls, and continued for 5 to 7 additional days. The number of colonies per gram of bedding of gram-negative bacteria, coliforms, Streptococcus spp., and Klebsiella spp. were estimated for each sand sample as well as amounts of dry and organic matter. Clean sand (CS) and recycled sand (RS) had the same bacterial counts when compared at any sampling time. The mean counts of bacterial populations did vary over the course of the study in both CS and RS. There was a significant increase in bacterial counts from d 0 to d 1 for gram-negative bacteria, coliforms, and Streptococcus spp. in both winter and summer. Counts of gram-negative bacteria, coliforms, Klebsiella spp., and Streptococcus spp. did not differ from d 1 to 7 in the winter. Total counts of gram-negative bacteria did not differ from d 1 to 7 in the summer. On d 1 in the summer, coliform counts were lower than at d 5 to 7, and Klebsiella spp. counts were lower than on d 3 to 7. Streptococcus spp. counts were high on d 1 and were constant through d 7 in both winter and summer trials. The number of coliform and Klebsiella spp. in both CS and RS was below the threshold thought to cause mastitis during the sampling times. The number of Streptococcus spp. was high in both CS and RS during the sampling periods. Other management factors need to be identified to decrease the number of Streptococcus spp. in bedding. Recycled sand had a higher organic matter and lower dry matter compared with CS in winter and summer. The results for this study were obtained from multiple herd comparisons, and herd was a significant effect suggesting that different management systems influence the number and types of bacteria in both CS and RS.

Dependence of calcium on thyroid hormone for the regulation of cellular functions.

Recently, the thyroid hormone has been shown to cause increase in calcium ion (Ca(2+)) concentration by mobilizing intracellular calcium((2+)). The mobilization of intracellular calcium((2+)) in the absence of transmembrane calcium((2+)) influx has been accepted as evidence for a cell-surface Ca((2+))-receptor. The possible role of thyroid hormone in the regulation of cellular functions by ca((2+)-channel was investigated using parameters proven to indispensably involve Ca(2+). Bleeding and clotting times and rat uterine muscle activity in Ca(2+)-free Tyrode's solution. Adult female Wistar rats divided into four groups, namely; (i) Control, (ii) Thyroidectomized, (iii) Throidectomized-treated with thyroxine and (iv) Thyroxine-treated; were fed on rat chow. While groups i and ii were allowed access to tap water ad libitum for 60 days, groups iii and iv received tyroxine (10 mg/kg body weight) every alternate day and tap water ad libitum for 60 days. All groups were kept in an air-conditioned room till they were euthanized. The results showed that thyroxine elicited biphasic contraction in Ca (2+)-depletion and potentiated uterine contraction during Ca(2+)-loading (P < 0.001). Inhibition of contractions in thyroidectomy, showed dependency of Ca (2+) on thyroid hormones for the regulation of cellular functions.

Terbinafine-associated taste disturbance with normal taste threshold scores.

The medical literature reveals numerous reports of transient taste disturbance associated with the use of oral terbinafine. A review of these reports, however, fails to confirm taste disturbances by formal taste testing. In this article, a case of long-standing taste dysfunction in a patient who exhibited normal formal taste thresholds is described.

Isolated gouty tophus of a tibial sesamoid of the foot.

A case of tophaceous gout involving a foot sesamoid is described in a middle-aged man with a history of chronic gout. Microscopic findings consisting of tophaceous foci located beneath an intact hyaline articulating surface are correlated with associated radiographs.

Comparison of pure tone and transient otoacoustic emissions screening in a grade school population.

HYPOTHESIS: Otoacoustic emissions provide an alternative to traditional pure tone hearing screening in a diverse grade school population. BACKGROUND: Mandated pure tone hearing screening programs for grade school children have several significant limitations. Otoacoustic emissions have been shown to be a reliable screening test in newborns, but there are no data on screening a diverse grade school population. METHODS: Five hundred eighty-three grade school children in four separate school populations were screened for hearing loss using the standard pure tone four-frequency protocol and transient evoked otoacoustic emissions. Students failing either test received a comprehensive audiogram by an audiologist that served as the "gold standard." Sensitivity and specificity of both tests were compared. RESULTS: The sensitivity and specificity of pure tone screening was 87% and 80%, respectively, compared with 65% and 91% for transient evoked otoacoustic emissions. CONCLUSION: Pure tone screening was a statistically significant better screening test for detecting hearing loss in this population of grade school children.

A benchmark project to improve cost and quality outcomes for CABG patients.

Today's health care environment is forcing health care providers to find ways to provide more effective and efficient care. This article describes a collaborative benchmark project that examined acute care for coronary artery bypass graft surgery patients and reduced costs and improved patient outcomes.