The diagnostic accuracy of a shock advisory algorithm in automated external defibrillators in the presence of real-world artifacts.

BACKGROUND: The current standards for shock advisory algorithms in AEDs require performance testing on artifact-free ECGs. However, AED analysis in the real world is more challenging due to potential artifacts from various sources (e.g., patient handling, and electromagnetic interference). This retrospective data analysis reports the real-world performance and behavior of a shock advisory algorithm used in three AED models with the presence of artifacts. METHODS: ECG rhythm analyses recorded during the use of three AED models (HS1, FRx and FR3) were reviewed. The shock recommendations made in the AEDs were compared to the expert annotations of reviewers. The effects of real-world artifacts and the handling by the algorithm were analyzed. RESULTS: Among the 3,941 analyses, 619 were annotated as shockable rhythms, and 2,912 were non-shockable. The overall sensitivity and specificity were 97.1% (601/619), and 99.9% (2,908/2,912), respectively. Artifacts were detected by the algorithm in 23.3% (918/3,941) of the analysis periods. The algorithm performance for the analysis periods with artifacts detected was 95.2% (80/84) for sensitivity and 100.0% (687/687) for specificity. In the remaining analysis periods with no artifacts detected, the sensitivity was 97.4% (521/535), and specificity was 99.8% (2,221/2,225). CONCLUSIONS: The performance of this shock advisory algorithm during real-world resuscitations with or without artifacts, exceeded AHA recommendations and the requirements in international standards. The high sensitivity and specificity demonstrate the effectiveness and safety of this algorithm in all three AED models.

Factors influencing the implementation of anterior cruciate ligament injury prevention strategies by girls soccer coaches.

Women are 3 times more likely to injure their anterior cruciate ligament (ACL) while playing soccer than men. ACL injury prevention programs (IPPs) involving stretching and strengthening drills can reduce the incidence of ACL injury when incorporated into routine training. The rate of implementation among coaches is largely unknown. The purpose of this study was to determine the rate of implementation of ACL IPP, to identify factors that influence implementation, and to acquire information to assist in design dissemination and implementation strategies. Study subjects were coaches of woman soccer players aged 11-22 years in Utah (n = 756). Data were gathered using a Web-based survey followed by a qualitative study in which "best practice coaches"-coaches who met criteria for successful implementation of ACL IPP-were interviewed via telephone. A minority of survey respondents, 19.8% (27/136), have implemented ACL IPP. Factors associated with successful implementation include length of coaching experience and presence of additional support staff such as a strength and conditioning coach or athletic trainer. Best practice coaches (14/136) unanimously agreed on the following: (a) there are performance-enhancing benefits of ACL IPP, (b) education on ACL injury prevention should be required for licensure, and (c) dissemination and implementation will require soccer associations to enact policies that require IPPs. In conclusion, a minority of girls soccer coaches have implemented ACL IPP and those that have do so because they believe that prevention improves performance and that soccer organizations should enact policies requiring ACL injury prevention education and implementation. Efforts to implement ACL IPP should be driven by soccer organizations, emphasize performance-enhancing benefits, and engage additional coaching staff.

In situ assay of fatty acid ß-oxidation by metabolite profiling following permeabilization of cell membranes.

Quantitative analysis of mitochondrial FA ß-oxidation (FAO) has drawn increasing interest for defining lipid-induced metabolic dysfunctions, such as in obesity-induced insulin resistance, and evaluating pharmacologic strategies to improve ß-oxidation function. The aim was to develop a new assay to quantify ß-oxidation function in intact mitochondria and with a low amount of cell material. Cell membranes of primary human fibroblasts were permeabilized with digitonin prior to a load with FFA substrate. Following 120 min of incubation, the various generated acylcarnitines were extracted from both cells and incubation medium by protein precipitation/desalting and subjected to solid-phase extraction. A panel of 30 acylcarnitines per well was quantified by MS/MS and normalized to citrate synthase activity to analyze mitochondrial metabolite flux. Pretreatment with bezafibrate and etomoxir revealed stimulating and inhibiting regulatory effects on ß-oxidation function, respectively. In addition to the advantage of a much shorter assay time due to in situ permeabilization compared with whole-cell incubation systems, the method allows the detection of multiple acylcarnitines from an only limited amount of intact cells, particularly relevant to the use of primary cells. This novel approach facilitates highly sensitive, simple, and fast monitoring of pharmacological effects on FAO.

Substrate promiscuity of a rosmarinic acid synthase from lavender (Lavandula angustifolia L.).

One of the most common types of modification of secondary metabolites is the acylation of oxygen- and nitrogen-containing substrates to produce esters and amides, respectively. Among the known acyltransferases, the members of the plant BAHD family are capable of acylating a wide variety of substrates. Two full-length acyltransferase cDNAs (LaAT1 and 2) were isolated from lavender flowers (Lavandula angustifolia L.) by reverse transcriptase-PCR using degenerate primers based on BAHD sequences. Recombinant LaAT1 exhibited a broad substrate tolerance accepting (hydroxy)cinnamoyl-CoAs as acyl donors and not only tyramine, tryptamine, phenylethylamine and anthranilic acid but also shikimic acid and 4-hydroxyphenyllactic acid as acceptors. Thus, LaLT1 forms esters and amides like its phylogenetic neighbors. In planta LaAT1 might be involved in the biosynthesis of rosmarinic acid, the ester of caffeic acid and 3,4-dihydroxyphenyllactic acid, a major constituent of lavender flowers. LaAT2 is one of three members of clade VI with unknown function.

Multi-substrate flavonol O-glucosyltransferases from strawberry (Fragaria x ananassa) achene and receptacle.

In an effort to characterize fruit ripening-related genes functionally, two glucosyltransferases, FaGT6 and FaGT7, were cloned from a strawberry (Fragaria x ananassa) cDNA library and the full-length open reading frames were amplified by rapid amplification of cDNA ends. FaGT6 and FaGT7 were expressed heterologously as fusion proteins in Escherichia coli and target protein was purified using affinity chromatography. Both recombinant enzymes exhibited a broad substrate tolerance in vitro, accepting numerous flavonoids, hydroxycoumarins, and naphthols. FaGT6 formed 3-O-glucosides and minor amounts of 7-O-, 4'-O-, and 3'-O-monoglucosides and one diglucoside from flavonols such as quercetin. FaGT7 converted quercetin to the 3-O-glucoside and 4'-O-glucoside and minor levels of the 7- and 3'-isomers but formed no diglucoside. Gene expression studies showed that both genes are strongly expressed in achenes of small-sized green fruits, while the expression levels were generally lower in the receptacle. Significant levels of quercetin 3-O-, 7-O-, and 4'-O-glucosides, kaempferol 3-O- and 7-O-glucosides, as well as isorhamnetin 7-O-glucoside, were identified in achenes and the receptacle. In the receptacle, the expression of both genes is negatively controlled by auxin which correlates with the ripening-related gene expression in this tissue. Salicylic acid, a known signal molecule in plant defence, induces the expression of both genes. Thus, it appears that FaGT6 and FaGT7 are involved in the glucosylation of flavonols and may also participate in xenobiotic metabolism. The latter function is supported by the proven ability of strawberries to glucosylate selected unnatural substrates injected in ripe fruits. This report presents the first biochemical characterization of enzymes mainly expressed in strawberry achenes and provides the foundation of flavonoid metabolism in the seeds.

Patients' and psychiatrists' perceptions of clinical decisions during schizophrenia treatment.

Shared decision making is advocated for patients with schizophrenia. However, there is limited knowledge as to which events are actually considered to be decisions by psychiatrists and patients. Semistructured interviews with regard to clinical decisions of the preceding week were performed with psychiatrists and inpatients with schizophrenia. There was good correspondence between patients and psychiatrists regarding decisional topics but poor correspondence regarding individual decisions. Medication issues were the most prominent, but other topics were also frequently cited. Not being included in decisions was associated with patients' desire to make the decisions differently. Patients treated involuntarily felt more often that they were not included in decisions and wanted to make different decisions. Thus, many patients do not feel involved in treatment decisions and are at the risk of noncompliance since they state that they would have made decisions differently from their psychiatrists. This is especially true of those being treated involuntarily.

Fluorescein pattern interpretation in keratoconus.

PURPOSE: The purpose of this study is to assess the effect of disease severity on how accurately contact lens fluorescein patterns can be interpreted in keratoconus by clinician assessment. METHODS: Two clinicians evaluated fluorescein patterns on 111 eyes of 60 patients with mild (<45 D, 14 eyes), moderate (45 D to 52 D, 61 eyes,) and severe (>52 D, 36 eyes) keratoconus. The masked clinicians were given six contact lenses in random order, the lens that just cleared the corneal apex (the first definite apical clearance lens), three lenses flatter (in 0.1 mm increments), and two lenses steeper (in 0.1 mm increments) than the first definite apical clearance lens. They ranked the lenses from flattest to steepest, based on the fluorescein patterns. The percentage of lenses correctly ranked was determined using (1) exact match with actual; (2) within 0.1 mm of actual; and (3) within 0.2 mm of actual. Accuracy was assessed as the sum of the squared differences between the actual base curve value and each clinician's ranking. Comparison of the mean percentage correctly ranked and accuracy for each keratoconus severity groups was performed using a mixed linear model. RESULTS: Neither percentage correctly ranked (using any of the three protocols) nor accuracy was found to be related to severity of keratoconus (p > 0.15 for all comparisons). CONCLUSIONS: Accuracy of ranking contact lenses in order of base curve radius based on fluorescein pattern assessment by clinicians does not seem to be related to severity of keratoconus. Many factors influence interpretation of fluorescein patterns including all components of the system, fluorescein, tears, cornea, contact lens, external forces, and technique.

Corneal oxygen uptake associated with piggyback contact lens systems.

PURPOSE: The purpose of this study was to determine the effects of static (without blinking) and dynamic (with blinking once every 5 seconds) wear of piggyback contact lens systems on corneal oxygen uptake. METHODS: Corneal oxygen uptake rates were measured on the right eyes of 11 human subjects by using a polarographic electrode. Measurements were made for the normal open eye and after 5 minutes of wear of 4 rigid lens materials (Dk/t 0-82.5), 4 soft lens materials (Dk/t 13-122), and 16 combinations of rigid and soft lens materials. The piggyback systems were worn under both static and dynamic conditions. Repeated-measures analysis of variance was used to compare oxygen uptake rates associated with the wear of the rigid lens components, soft lens components, piggyback systems, and static versus dynamic wearing conditions. Spearman correlation coefficients and regression analyses were used to examine relationships between corneal oxygen uptake rates. RESULTS: Measurable differences were found among oxygen uptake rates associated with the rigid lens components, soft lens components, and piggyback systems. Blinking resulted in no reduction in corneal oxygen uptake with the piggyback systems. Corneal oxygen uptake associated with the wear of the piggyback systems could not be predicted from those associated with the rigid and soft lens components of the systems. CONCLUSIONS: Piggyback combinations of rigid and soft lens components with the highest transmissibilities resulted in the least increase in corneal oxygen uptake beyond that of the normal open eye.

Functional characterization of enone oxidoreductases from strawberry and tomato fruit.

Fragaria x ananassa enone oxidoreductase (FaEO), earlier putatively assigned as quinone oxidoreductase, is a ripening-induced, negatively auxin-regulated enzyme that catalyzes the formation of 4-hydroxy-2,5-dimethyl-3(2H)-furanone (HDMF), the key flavor compound in strawberry fruit by the reduction of the alpha,beta-unsaturated bond of the highly reactive precursor 4-hydroxy-5-methyl-2-methylene-3(2H)-furanone (HMMF). Here we show that recombinant FaEO does not reduce the double bond of straight-chain 2-alkenals or 2-alkenones but rather hydrogenates previously unknown HMMF derivatives substituted at the methylene functional group. The furanones were prepared from 4-hydroxy-5-methyl-3(2H)-furanone with a number of aldehydes and a ketone. The kinetic data for the newly synthesized aroma-active substrates and products are similar to the values obtained for an enone oxidoreductase from Arabidopsis thaliana catalyzing the alpha,beta-hydrogenation of 2-alkenals. HMMF, the substrate of FaEO that is formed during strawberry fruit ripening, was also detected in tomato and pineapple fruit by HPLC-ESI-MSn and became 13C-labeled when d-[6-13C]-glucose was applied to the fruits, which suggested that a similar HDMF biosynthetic pathway occurs in the different plant species. With a database search (http://ted.bti.cornell.edu/ and http://genet.imb.uq.edu.au/Pineapple/), we identified a tomato and pineapple expressed sequence tag that shows significant homology to FaEO. Solanum lycopersicon EO (SlEO) was cloned from cDNA, and the protein was expressed in Escherichia coli and purified. Biochemical studies confirmed the involvement of SlEO in the biosynthesis of HDMF in tomato fruit.

Factors influencing the measurement of oxygen shortfall of the human cornea: sequencing of test conditions.

PURPOSE: The effects of sequencing of test conditions, in this case contact lens thicknesses, on the measurement of the oxygen shortfall of human corneas were studied. METHODS: Corneal oxygen uptake rates were measured with a Clark-type polarographic electrode on the central, unanesthetized right corneas of 14 human subjects. Measurements were made under the following conditions: (1) the normal open eye; (2) after 5 min of static (without blinking) wear of each of seven rigid gas permeable lenses of seven center thicknesses (0.18, 0.12, 0.16, 0.20, 0.24, 0.28, and 0.32 mm); (3) after 5 min of static wear of a polymethylmethacrylate (PMMA) contact lens. Lens thicknesses were randomly assigned numbers, which were sequenced in seven cycles. Two subjects were assigned to each sequencing cycle, and each subject participated in two identical sessions. RESULTS: The interaction of order x thickness was determined to be insignificant (F=0.99; p=0.5101). The effect of lens order was also insignificant (F=0.76; p=0.6239), indicating that the order of lens placement did not affect the measured corneal oxygen shortfall. Not surprisingly, the analysis indicated a significant effect of lens thickness on corneal oxygen shortfall (F=3.94; p=0.0032). CONCLUSIONS: The sequencing of lenses of various thicknesses on the cornea does not affect the measurement of corneal oxygen shortfall.

Baseline factors predictive of incident penetrating keratoplasty in keratoconus.

PURPOSE: To identify baseline demographic and clinical factors associated with undergoing penetrating keratoplasty (PK) in a prospective cohort of 1,065 keratoconus patients followed for eight years in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. DESIGN: Multicenter, prospective, observational cohort study. METHODS: We report the rate of PK over eight years and baseline factors predictive of PK in 1,065 patients who, at the time of study enrollment, had not undergone PK in either eye. RESULTS: Eighty-two percent of patients completed the eight-year close-out visit. Twelve percent (126 of 1,065) had PK in one (9.3%) or both eyes (2.5%). Baseline factors associated with increased likelihood of PK included younger age, steeper keratometric values, worse visual acuity, corneal scarring, poorer contact lens comfort, and poorer vision-related quality of life. The percent of eyes undergoing PK was 15% for patients 40 years old and younger, 28% for eyes with a steep keratometric value greater than 52 diopters, 33% for visual acuity less than 20/40, and 24% for eyes with corneal scarring. CONCLUSIONS: The CLEK Study confirmed previous reports of the increased likelihood of PK associated with corneal scarring, steeper keratometry values, poorer visual acuity, and poorer contact lens comfort. The CLEK Study is among the first to report an increased risk of PK associated with younger age, worse vision-related quality of life, and flatter contact lens fits. Knowledge of these factors is beneficial to clinicians in patient education and may be useful in disease management.

A theophylline responsive riboswitch based on helix slipping controls gene expression in vivo.

Riboswitches are newly discovered regulatory elements which control a wide set of basic metabolic pathways. They consist solely of RNA, sense their ligand in a preformed binding pocket and perform a conformational switch in response to ligand binding resulting in altered gene expression. We have utilized the enormous potential of RNA for molecular sensing and conformational changes to develop novel molecular switches with predetermined structural transitions in response to the binding of a small molecule. To validate these in vivo, we exploit the distance-dependent inhibitory potential of secondary structure elements placed close to the bacterial ribosome binding site. We created a translational control element by combining the theophylline aptamer with a helical communication module for which a ligand-dependent one-nucleotide slipping mechanism had been proposed. This structural element was inserted at a position just interfering with translation in the non ligand-bound form. Addition of the ligand then shifts the inhibitory element to a distance which permits efficient translation. We present here a novel regulatory mechanism in the first rationally designed, in vivo active RNA switch. Its use of a slippage mechanism to control gene expression makes it different from natural riboswitches which are based on sequestration or antitermination.

Conditional gene expression by controlling translation with tetracycline-binding aptamers.

We present a conditional gene expression system in Saccharomyces cerevisiae which exploits direct RNA-metabolite interactions as a mechanism of genetic control. We inserted preselected tetracycline (tc) binding aptamers into the 5'-UTR of a GFP encoding mRNA. While aptamer insertion generally reduces GFP expression, one group of aptamers displayed an additional, up to 6-fold, decrease in fluorescence upon tc addition. Regulation is observed for aptamers inserted cap-proximal or near the start codon, but is more pronounced from the latter position. Increasing the thermodynamic stability of the aptamer augments regulation but reduces expression of GFP. Decreasing the stability leads to the opposite effect. We defined nucleotides which influence the regulatory properties of the aptamer. Exchanging a nucleotide probably involved in tc binding only influences regulation, while mutations at another position alter expression in the absence of tc, without affecting regulation. Thus, we have developed and characterized a regulatory system which is easy to establish and controlled by a non-toxic, small ligand with good cell permeability.

Clinical outcomes following osteochondral autologous transplantation (OATS).

This study evaluated the clinical outcome in 21 patients (22 knees) undergoing osteochondral autologous transplantation (OATS) in the knee over a 5-year period. Sixteen knees in 15 patients were available for follow-up at an average of 40 months after the procedure. The clinical outcome was analyzed using the IKDC and Knee and Osteoarthritis Outcome Score (KOOS) evaluation forms, a subjective questionnaire, and a clinical examination. At final follow-up, the average KOOS result for pain was 80.6 (range: 56-94), symptoms 53.6 (range: 25-71), function of activities of daily living 93.4 (range: 79-100), function of sports and recreational activities 65.3 (range: 20-100), and quality of life 51.0 (range: 6-88). The average IKDC score was 68.2. On our subjective questionnaire, the average preoperative grade given was 3.1 (range: 1-7) with an improvement at the most recent follow-up to a grade of 8.0 (range: 5-10) (P < .00001). Thirteen (86%) patients reported that they would have the surgery again if they had to make the decision a second time. Age did not correlate with subjective results on the IKDC evaluation (P = .7048) or score difference on our questionnaire (P = .9175). This procedure provides an option for articular resurfacing of the femoral condyles for focal areas of chondral defects with promising results regarding subjective improvement.

Corneal oxygen uptake: A review of polarographic techniques, applications, and variables.

Factors that influence the polarographic measurement of the oxygen uptake of the cornea are reviewed. These factors include the technique, electrode assembly, oxygen reservoir, membrane material and thickness, oxygen tension of the corneal environment, duration of exposure to environmental conditions and time to application of the probe all influencing measured oxygen uptake rates. Subject factors include lid position, palpebral aperture size, blinking, corneal thickness, and corneal integrity. Contact lens wear influences corneal oxygen uptake, with lens material and design parameters influencing rates obtained both under static (without blinking) and dynamic (with blinking) conditions. Measurement of corneal oxygen uptake rates remains an excellent method to quantify the oxygen supply in contact lens systems that include the contact lens, the tears, and the cornea, in which oxygen flux is influenced by the thickness and diffusion characteristics of each component.

Differences in keratoconus as a function of gender.

PURPOSE: To characterize gender differences in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study. DESIGN: Observational, longitudinal study. METHODS: A total of 1209 subjects at 16 clinics. For eye-specific categorical variables, the number of eyes per subject with the characteristic was counted. For eye-specific continuous variables, the mean of both eyes was calculated. Multivariate linear (for continuous outcomes) and logistic (for categorical outcomes) regression models were created for each baseline characteristic with statistically significant (P < or = .05) differences between men and women. Age, race, education, and corneal curvature were covariates. RESULTS: The women were older, more likely to report a family history of keratoconus, more likely to be nonwhite, and less likely to complete college than men. Vogt's striae and monocular and binocular high-contrast entrance acuity were the only visual characteristics that varied between men and women in the multivariate model. Women were more likely than men to report ocular symptoms of dryness and complaints based upon a composite score of ocular symptoms. Women reported more hours per day of near work and were less likely to report the ability to wear contact lenses for enough hours to permit reading at home in the evening. Women reported more visits to their eye care practitioner during the previous 12 months. NEI-VFQ results revealed differences in self-reported difficulty with distance activities and driving. CONCLUSIONS: Gender differences exist in patient history, vision, and ocular symptoms in keratoconus patients.

The effects of semitendinosus and gracilis harvest in anterior cruciate ligament reconstruction.

PURPOSE: There is significant debate concerning the morbidity of hamstring harvest for use during anterior cruciate ligament (ACL) reconstruction. We hypothesized that harvest of the semitendinosus and gracilis tendons for ACL reconstruction would result in no measurable hamstring weakness, but that abnormalities of the semitendinosus and gracilis muscle would be observed on magnetic resonance imaging (MRI) scans. TYPE OF STUDY: Case series. METHODS: Nine patients undergoing ACL reconstruction with doubled semitendinosus and gracilis tendons had MRI cross-sectional area measurements of both limbs made from axial images and muscle contour was studied on coronal images at 3 and 12 months. The semitendinosus, semimembranosus, gracilis, sartorius, and biceps muscles were evaluated. Isokinetic testing was performed on the operative and nonoperative legs at 60 degrees and 180 degrees per second at 6 and 12 months postoperatively. RESULTS: The gracilis cross-sectional area at 1 year averaged 2 cm2 on the operative side and 3.7 cm2 on the contralateral side. The semitendinosus averaged 2.1 cm2 on the operative side and 6.6 cm2 on the contralateral side at 1 year. Both of these differences were statistically significant (P < .05). In most cases, the semitendinosus muscle was retracted. Distally, the gracilis and occasionally the semitendinosus were blending with the gastrocnemius or sartorial fascia. The gracilis and semitendinosus in 1 case extended to near the original attachment site. Hamstring strength testing revealed a 26% deficit on the operative side at 60 degrees/second at 6 months and 16% at 180 degrees/second. At 12 months the mean 60 degrees/second deficit was 21% and the deficit at 180 degrees/second was 13%. CONCLUSIONS: At 1 year, the semitendinosus and gracilis muscles showed significant and persistent atrophy on the operative side and frequent retraction of the semitendinosus muscle belly. There were also hamstring strength deficits persisting at 1 year after the use of the tendons for ACL reconstruction. LEVEL OF EVIDENCE: Level IV.

Between-eye asymmetry in keratoconus.

PURPOSE: To report baseline differences between eyes on key variables in the Collaborative Longitudinal Evaluation of Keratoconus (CLEK) Study cohort compared with a retrospectively assembled group of myopic contact lens wearers without ocular disease. METHODS: A total of 1,079 keratoconus patients who had not undergone a penetrating keratoplasty in either eye before their baseline visit were enrolled and examined at baseline. Records from 330 contact lens-wearing myopes were reviewed. Corneal curvature (keratometry), visual acuity, refractive error (manifest refraction), and corneal scarring were measured. RESULTS: The mean differences between keratoconic eyes are as follows (better eye-worse eye for each variable, separately). Flat keratometry: -3.59 +/-4.46 D and steep keratometry: -4.35 +/-4.41 D; high-contrast best-corrected visual acuity: 7.30 +/-6.83 letters; low-contrast best-corrected visual acuity: 8.53 +/-7.51 letters; high-contrast entrance visual acuity: 9.03 +/-8.40 letters; low-contrast entrance visual acuity: 9.43 +/-7.88 letters; spherical equivalent refractive error: 3.15 +/-3.84 D; and refractive cylinder power 1.55 +/-1.42 D. Twenty-one percent of the keratoconus patients had corneal scarring in only one eye. There is an association between patient-reported unilateral eye rubbing and greater asymmetry in corneal curvature, and between a history of unilateral eye trauma and greater asymmetry in corneal curvature and refractive error, with the rubbed/traumatized eye being the steeper eye most of the time. CONCLUSIONS: Keratoconus is asymmetric in the CLEK Study sample.

Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation.

BACKGROUND: Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is rare, and the most appropriate treatment is unclear. Current recommendations are that, if the graft is removed, reimplantation should be delayed for 6 to 9 months. HYPOTHESIS: Early removal of the graft with appropriate infection management followed by early reimplantation can lead to good results. STUDY DESIGN: Uncontrolled retrospective review. METHODS: Records of all patients who developed postoperative infection after anterior cruciate ligament reconstruction were reviewed. Four patients had early graft removal and appropriate infection management including 6 weeks of intravenous antibiotics followed by anterior cruciate ligament graft reimplantation within 6 weeks of completion of antibiotic therapy. RESULTS: Follow-up at an average of 21 months (range, 14 to 31) showed that the patients treated with early reimplantation had full symmetric knee range of motion and no effusion. The average modified Lysholm score was 92.5. Radiographs demonstrated no joint-space narrowing or osteophyte formation. The 30-pound KT-1000 arthrometer side-to-side difference averaged 3 mm. CONCLUSION: Graft removal after confirmed anterior cruciate ligament graft infection and intravenous antibiotic administration followed by early graft reimplantation can give excellent results.

The thickness of the tear film.

Measurements of the thickness of the pre-corneal tear film, pre-lens tear film, post-lens tear film, and the lipid layer on the surface of the tear film are summarized. Spatial and temporal variations in tear film thickness are described. Theoretical predictions of tear film thickness are discussed. Mechanisms involved in the upward drift of the tear film after a blink, and in the formation of dry spots, are considered.