The Association of α Angle on Disease Severity in Adolescent Femoroacetabular Impingement.

BACKGROUND: Femoroacetabular Impingement (FAI) is a common cause of hip pain in adolescent patients. Clinical exam and radiographic markers, such as α angle and lateral center edge angle (LCEA), are commonly used to aid in the diagnosis of this condition. The purpose of this study was to correlate preoperative α angle and LCEA with preoperative symptoms, intraoperative findings, and preoperative and postoperative patient reported outcomes (PROs) in the adolescent patient. METHODS: A retrospective analysis of prospectively collected data was conducted for all patients who underwent operative intervention for FAI at an academic institution over an 11-year period. Preoperative imaging was obtained and measured for LCEA and α angle. PROs (modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA score) were collected preoperatively, as well as 1, 2, and 5 years postoperatively. Operative intervention was either open surgical hip dislocation or arthroscopic, and intraoperative disease was graded using the Beck Classification system. Patients with minimum 1-year follow-up were included in statistical analysis. RESULTS: There were 86 hips (64 female hips) included with an average age of 16.3 years (range, 10.4 to 20.5 y), with an average of 37 months of follow-up. There was no correlation between severity of preoperative symptoms or difference between pre and postoperative PROs for both α angle and LCEA. Overall, significant improvement was noted in modified Harris Hip Score, Hip Disability and Osteoarthritis Outcome Score, and UCLA Score (P<0.001 for each). Independent of preoperative symptoms, increased α angle correlated with more severe intraoperative labral disease (P<0.001), and longer length of labral tear (Corr 0.295, P<0.01). Femoral head and acetabular articular cartilage damage did not correlate with α angle or LCEA, nor did overall severity of disease. CONCLUSIONS: In adolescent patients with FAI, increased α angle was found to significantly correlate with labral pathology, including increased length of tear and severity of disease, irrespective of preoperative symptoms or postoperative patient reported outcomes. LEVEL OF EVIDENCE: Level III-retrospective.

Partial differential equation models for invasive species spread in the presence of spatial heterogeneity.

Models of invasive species spread often assume that landscapes are spatially homogeneous; thus simplifying analysis but potentially reducing accuracy. We extend a recently developed partial differential equation model for invasive conifer spread to account for spatial heterogeneity in parameter values and introduce a method to obtain key outputs (e.g. spread rates) from computational simulations. Simulations produce patterns of spatial spread which appear qualitatively similar to observed patterns in grassland ecosystems invaded by exotic conifers, validating our spatially explicit strategy. We find that incorporating spatial variation in different parameters does not significantly affect the evolution of invasions (which are characterised by a long quiescent period followed by rapid evolution towards to a constant rate of invasion) but that distributional assumptions can have a significant impact on the spread rate of invasions. Our work demonstrates that spatial variation in site-suitability or other parameters can have a significant impact on invasions and must be considered when designing models of invasive species spread.

A mathematical model of the metabolic and perfusion effects on cortical spreading depression.

Cortical spreading depression (CSD) is a slow-moving ionic and metabolic disturbance that propagates in cortical brain tissue. In addition to massive cellular depolarizations, CSD also involves significant changes in perfusion and metabolism-aspects of CSD that had not been modeled and are important to traumatic brain injury, subarachnoid hemorrhage, stroke, and migraine. In this study, we develop a mathematical model for CSD where we focus on modeling the features essential to understanding the implications of neurovascular coupling during CSD. In our model, the sodium-potassium-ATPase, mainly responsible for ionic homeostasis and active during CSD, operates at a rate that is dependent on the supply of oxygen. The supply of oxygen is determined by modeling blood flow through a lumped vascular tree with an effective local vessel radius that is controlled by the extracellular potassium concentration. We show that during CSD, the metabolic demands of the cortex exceed the physiological limits placed on oxygen delivery, regardless of vascular constriction or dilation. However, vasoconstriction and vasodilation play important roles in the propagation of CSD and its recovery. Our model replicates the qualitative and quantitative behavior of CSD--vasoconstriction, oxygen depletion, extracellular potassium elevation, prolonged depolarization--found in experimental studies. We predict faster, longer duration CSD in vivo than in vitro due to the contribution of the vasculature. Our results also help explain some of the variability of CSD between species and even within the same animal. These results have clinical and translational implications, as they allow for more precise in vitro, in vivo, and in silico exploration of a phenomenon broadly relevant to neurological disease.

Fluid-body interactions: clashing, skimming, bouncing.

Solid-solid and solid-fluid impacts and bouncing are the concern here. A theoretical study is presented on fluid-body interaction in which the motion of the body and the fluid influence each other nonlinearly. There could also be many bodies involved. The clashing refers to solid-solid impacts arising from fluid-body interaction in a channel, while the skimming refers to another area where a thin body impacts obliquely upon a fluid surface. Bouncing usually then follows in both areas. The main new contribution concerns the influences of thickness and camber which lead to a different and more general form of clashing and hence bouncing.