[Translated article] 4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis.

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4 DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4 DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

Age influences the efficacy of osteochondral autograft transfer: Promising results for patients under 40. / [Artículo traducido] La edad influye en la eficacia de la transferencia autóloga osteocondral: resultados prometedores para pacientes menores de 40 años.

BACKGROUND: Previous research using osteochondral autograft transfer (OAT) has shown poorer outcomes with increasing patient age. The aim of this article is to evaluate a cohort of patients that received an OAT and to correlate their clinical results with their age at procedure. METHODS: Patients that underwent an OAT to treat an osteochondral (OC) lesion with a minimum 24-month follow-up were included. Patients were categorized into two groups based on their age at procedure (<40 years and ≥40 years). Postoperatively, each patient completed the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Lysholm scales. RESULTS: 51 patients were included (35<40 years, 16≥40 years). Mean follow-up was 4.2 years (2-7). For patients<40 years, IKDC averaged 80.8 (SD 15.9) versus 71.2 (SD 19.4) in ≥40 years (p=0.03). For patients <40 years, Lysholm averaged 85.9 (SD 10.8) versus 77.0 (SD 21.6) in ≥40 years (p=0.02). For patients<40 years, KOOS averaged 78.3 (SD 11.8) versus 68.9 (SD 18.5) in ≥40 years (p=0.01). There was a 100% sensibility in identifying all the patients with a poor IKDC and Lysholm from 34 years old (AUC 0.76 and 0.8). CONCLUSIONS: OAT has better outcomes in patients younger than 40 years compared to patients older than 40 years. Based on the prognostic capacity of age, the ideal candidate for an OAT is a patient younger than 34 years old.

4 Domain Sports PROM in Spanish: Cross-cultural adaptation in the Chilean population and reliability analysis. / 4 Domain Sports PROM en español: adaptación transcultural en la población chilena y análisis de confiabilidad.

BACKGROUND: Patient-Reported Outcome Measures (PROMs) are tools of increasing interest in the sports population. The purpose of this study was to perform the cross-cultural adaptation and reliability analysis of the 4 Domain Sports Patient-Reported Outcome Measure (4DSP) into Spanish. METHODS: A six-stage cross-cultural adaptation protocol was executed to obtain the Spanish version of the 4DSP (S-4DSP). Subsequently, the questionnaire was administered to a population of 108 postoperative athletes with ACL (Anterior Cruciate Ligament) injuries. The questionnaire was administered again after 30 days. Acceptability, floor and ceiling effects, internal consistency (Cronbach's alpha), and reproducibility (Intraclass Correlation) were evaluated. RESULTS: The S-4DSP was fully completed by 108 participants (mean age 34±10.75, 26% women), achieving 100% acceptability. No floor effect was detected. The statistical analysis yielded a global Cronbach's alpha for the questionnaire of 0.65, and domain-specific alphas of 0.88, 0.72, 0.27, and 0.68 for the first, second, third, and fourth domains, respectively. The Intraclass Correlation test reached a maximum of 0.94 and a minimum of 0.48 for the first and fifth questions, respectively. CONCLUSIONS: The S-4DSP is a reliable and useful tool for evaluating Spanish-speaking athletes after ACL reconstruction.

Age influences the efficacy of osteochondral autograft transfer: Promising results for patients under 40.

BACKGROUND: Previous research using osteochondral autograft transfer (OAT) has shown poorer outcomes with increasing patient age. The aim of this article is to evaluate a cohort of patients that received an OAT and to correlate their clinical results with their age at procedure. METHODS: Patients that underwent an OAT to treat an osteochondral (OC) lesion with a minimum 24-month follow-up were included. Patients were categorized into two groups based on their age at procedure (<40 years and ≥40 years). Postoperatively, each patient completed the Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC), and Lysholm scales. RESULTS: 51 patients were included (35<40 years, 16≥40 years). Mean follow-up was 4.2 years (2-7). For patients<40 years, IKDC averaged 80.8 (SD 15.9) versus 71.2 (SD 19.4) in ≥40 years (p=0.03). For patients <40 years, Lysholm averaged 85.9 (SD 10.8) versus 77.0 (SD 21.6) in ≥40 years (p=0.02). For patients<40 years, KOOS averaged 78.3 (SD 11.8) versus 68.9 (SD 18.5) in ≥40 years (p=0.01). There was a 100% sensibility in identifying all the patients with a poor IKDC and Lysholm from 34 years old (AUC 0.76 and 0.8). CONCLUSIONS: OAT has better outcomes in patients younger than 40 years compared to patients older than 40 years. Based on the prognostic capacity of age, the ideal candidate for an OAT is a patient younger than 34 years old.

Minimally Invasive Diagnosis of Secondary Intracranial Lymphoma.

Diffuse large B cell lymphomas (DLBCL) are an aggressive group of non-Hodgkin lymphoid malignancies which have diverse presentation and can have high mortality. Central nervous system relapse is rare but has poor survival. We present the diagnosis of primary mandibular DLBCL and a unique minimally invasive diagnosis of secondary intracranial recurrence. This case highlights the manifold radiological contributions to the diagnosis and management of lymphoma.

Nestin-specific green fluorescent protein expression in embryonic stem cell-derived neural precursor cells used for transplantation.

Expression of the enhanced green fluorescent protein (EGFP) under control of a thymidine kinase promoter/nestin second intron was specifically detected in nestin immunoreactive neural precursor cells after selection of murine embryonic stem (ES) cells in chemically defined medium. Allowing differentiation in vitro, the capacity of these cells to give rise to astroglia, oligodendroglia, and neurones was investigated. After intracerebral transplantation, long-lasting integration of precursor cells into the host tissue was observed, serving as a pool for successive neuronal and glial differentiation. EGFP expression by ES cell-derived neural precursor cells may be a valuable tool to optimize protocols for maintenance and expansion of these cells in vitro as well as in vivo after intracerebral transplantation. In addition, preparative fluorescence-activated cell sorting of EGFP-labeled neural precursor cells should be useful for standardization of a donor cell population for cell replacement therapies.

Somatic and prejunctional nicotinic receptors in cultured rat sympathetic neurones show different agonist profiles.

1. The release of [3H]-noradrenaline ([3H]-NA) in response to nicotinic acetylcholine receptor (nAChR) agonists was compared with agonist-induced currents in cultured rat superior cervical ganglion (SCG) neurones. 2. [3H]-NA release in response to high concentrations of nicotinic agonists was reduced, but not fully inhibited, by the presence of either tetrodotoxin (TTX) or Cd2+ to block voltage-gated Na+ or Ca2+ channels, respectively. We used the component of transmitter release that remained in the presence of these substances (named TTX- or Cd2+-insensitive release) to pharmacologically characterize nAChRs in proximity to the sites of vesicular exocytosis (prejunctional receptors). Prejunctional nAChRs were activated by nicotinic agonists with a rank order of potency of dimethylphenylpiperazinium iodide (DMPP) > nicotine > cytisine > ACh, and with EC50 values ranging from 22 microM (DMPP) to 110 microM (ACh). 3. [3H]-NA release in response to low concentrations of nAChR agonists was fully inhibited by the presence of either TTX or Cd2+ (named TTX- or Cd2+-sensitive release). TTX-sensitive release was triggered by nicotinic agonists with a rank order of potency of DMPP > cytisine approximately nicotine approximately ACh, which due to its similarity to TTX-insensitive release indicates that it might also be triggered by prejunctional-type nAChRs. The EC50 values for TTX (Cd2+)-sensitive release were less than 10 microM for all four agonists. 4. By contrast to transmitter release, somatic nAChRs as seen by patch clamp recordings were most potently activated by cytisine, with a rank order of potency of cytisine > nicotine approximately DMPP > ACh. EC50 values for the induction of currents exceeded 20 microM for all four agonists. 5. The nicotinic antagonist mecamylamine potently inhibited all transmitter release in response to nicotine. alpha-Bungarotoxin (alpha-BuTX) was, on the other hand, without significant effect on nicotine-induced TTX-insensitive release. The competitive antagonist dihydro-beta-erythroidine (DHbetaE) caused rightward shifts of the dose-response curves for both TTX-sensitive and TTX-insensitive transmitter release as well as for currents in response to nicotine, with pA2 values ranging from 4.03 to 4.58. 6. Due to clear differences in the pharmacology of agonists we propose that nAChRs of distinct subunit composition are differentially targeted to somatic or axonal domains.

Morphology and blood supply of the iliac crest applied to jaw reconstruction.

The aim of this study was to improve vessel and nerve security and the harvesting procedure of the iliac crest in the microvascular reconstruction of the upper and lower jaw by iliac crest flap in cases of tumour invasion or trauma. The critical points for the surgeon in harvesting the iliac crest are the course of the deep circumflex iliac artery and lateral cutaneous nerve of the thigh in relation to the iliac crest and the position of their subsequent ramifications. Bilateral anatomical preparations of the iliac bone (total 90 dissections) were examined in 45 formalin preserved cadavers (21 male, 24 female) with the course of the vessel and nerve supply being mapped. Topographic variations of muscles, bones, vessels and nerves were documented by measurement by photographic documentation and diagrams. In 78% (70 cases) a standard-type arrangement with a single main vessel coming from the external iliac artery above the inguinal ligament and crossing the upper part of the iliac crest with second ramifications was observed. In 12% (11 cases) the main vessel was observed to be 2-3 cm below the iliac crest, in 7% (6 cases) a second main branch of the deep circumflex iliac artery was found to run parallel to the iliac crest. In other cases the following variations were observed: one main vessel without ramification, separate branching of the main vessel and ramifications or common trunks of the deep and superficial circumflex iliac arteries. Because of these results it might be possible to perform window resection of the iliac crest in some cases rather than bloc resection: this may have postoperative advantages for the patient.

A pig collagen peptide fraction. A unique material for maintaining biological activity during lyophilization and during storage in the liquid state.

There is frequent use of human and animal proteins as stabilizers during lyophilization of a variety of biological substances with a view to long term stable storage. This report describes the comparative excellent stabilizing effect of a porcine collagen peptide fraction (CPF) during the lyophilization and subsequent storage of three commonly used biological substances, alkaline phosphatase, tissue plasminogen activator and thrombin. The CPF was heated to 150 degrees C for one hour before use. The CPF was shown to have some advantage during lyophilized storage over human serum albumin. Solutions of thrombin stored in CPF at room temperature and at 37 degrees C for one week retained nearly all activity, while storage of thrombin in human serum albumin solution at 37 degrees C lost nearly all biological activity. These preliminary data suggest that porcine CPF is a safe and advantageous stabilizer for addition to biological products with a view to long-term lyophilized storage and short-term liquid storage.

Streptococcus milleri as a cause of antecubital abscess and bacteremia in intravenous drug abusers.

S milleri should be added to the list of organisms producing wound infections in parenteral drug addicts. Recovery of "viridans streptococci" from an antecubital aspirate should prompt the clinician to request speciation, examine closely for abscess formation, and anticipate prolonged antibiotic therapy.

[Educational-vocational development of young aphasic patients: results of a catamnestic study]. / Zur schulisch-beruflichen Entwicklung jugendlicher Aphasiker: Ergebnisse einer katamnestischen Studie.

60 adolescents whose course of recovery from their aphasic disorders had already been studied during the postacute treatment phase in a rehabilitation clinic were catamnestically assessed by a questionnaire. The aim of the study was to gain information about their further linguistic, educational, vocational and social development, and to evaluate the validity of the recommendations made at discharge from the rehabilitation clinic. The results show that inspite of the generally good improvement of aphasic disorders in adolescents, there hardly ever is complete recovery; and they mainly make clear the severe consequences on the further educational and vocational development, which seem to be underestimated as far as institutional help is concerned. Moreover the consequences of the language disturbances on social relations seem to be felt as even harder to cope with. The educational and vocational recommendations at the end of the postacute rehabilitation phase turned out to be valid to a surprisingly high degree. Concluding, some possible consequences the results could have on improving the rehabilitation process are discussed.

Simple technique for shaping hydrophilically coated guide wires: usefulness in selective angiography.

A method is described to shape hydrophilically coated guide wires with specially prepared electronic round-nose pliers. These shaped wires can be engaged with 4-F catheters in the performance of selective angiography. Now even demanding selective catheterizations may be accomplished more easily and safely with small catheters.

Clinical management of keratoconus. A multicenter analysis.

The clinical management of 746 eyes in 417 patients referred for keratoconus from January 1984 through January 1988 was retrospectively analyzed. In 357 patients, 554 eyes (74%) did not require surgery and were managed with contact lenses or spectacles, 156 eyes (21%) in 137 patients either underwent penetrating keratoplasty (PK) (140 eyes) or surgery was recommended (16 eyes), and 36 eyes (4%) in 34 patients underwent epikeratoplasty. Comparing baseline and final examination findings, the nonsurgical group showed a significant improvement in average best-corrected visual acuity from 20/30 to 20/25, the PK group from 20/70 to 20/25, and the epikeratoplasty group from 20/40 to 20/30. Average keratometry was unchanged in the nonsurgical group, but decreased by 10.7 diopters (D) for the PK group and 6.5 D for the epikeratoplasty group. Corneal cylinder was unchanged in the nonsurgical group, whereas there was a reduction of the percentage of eyes with indeterminant cylinder from 55 to 2% in the PK group and from 36 to 0% in the epikeratoplasty group. Previous contact lens history, best-corrected visual acuity of 20/50 or worse, and average keratometry of 55 D or greater at baseline were associated with a significant risk for PK. No baseline variables were associated with significant risk for epikeratoplasty, suggesting that this group was similar to the nonsurgical group, except for contact lens intolerance. The nonsurgical management of keratoconus continues to play a predominant role in the management of this disorder in a referral population.

A morphologic and fluorophotometric analysis of the corneal endothelium in long-term extended wear soft contact lens wearers.

Eleven extended wear soft contact lens wearers with an average of 4 years of wear underwent corneal fluorophotometry and quantitative specular microscopy. Compared to age-matched controls, a significant increase in mean endothelial permeability was found in the contact lens group, indicating a defect in their endothelial barrier function. A significant increase in the mean endothelial pump rate was also noted in the contact lens group. In addition, mean corneal thickness was significantly greater in the contact lens group. No significant difference was noted between the two groups in mean cell area and figure coefficient; however, the coefficient of variation was significantly higher in the contact lens group. Duration of contact lens wear correlated positively with coefficient of variation. An inverse correlation was noted between contact lens oxygen transmissibility and cell area, as well as corneal thickness. These data suggest both a morphologic and functional defect in the corneal endothelium of long-term extended wear soft contact lens wearers.

The use of contact lenses after keratoconic epikeratoplasty.

Thirty-three epikeratoplasties were performed on 31 keratoconic contact lens intolerant patients. Thirty-two of these procedures were anatomically successful with clear lenticules and flattening of the postoperative keratometric measurements in all but one eye. One patient's lenticule developed a persistent epithelial defect that eventually required its removal at 42 days. This patient subsequently underwent a successful penetrating keratoplasty. Of the 32 eyes that were anatomically successful, 20 eyes in 19 patients were able to achieve satisfactory visual improvement requiring either no correction or spectacle lenses. Twelve eyes in 11 patients were successfully refit with contact lenses for anisometropic refractive errors (11 eyes) and residual irregular astigmatism (one eye). Three patients (two in the non-contact lens group and one in the contact lens group) have subsequently undergone penetrating keratoplasty for further visual improvement. Our data suggest that the majority of keratoconic epikeratoplasties achieve a satisfactory visual result either unaided or with spectacles; however, those patients who wish to resume contact lens wear may do so successfully.

Epikeratoplasty. The surgical correction of aphakia, myopia, and keratoconus.

Thirty-five patients have had 39 consecutive epikeratoplasty procedures (12 adult aphakic, 9 pediatric aphakic, 12 myopic, and 6 keratoconic eyes) by the same surgeon, using commercially prepared lenticules. The lenticule remained totally clear in 85% of eyes. Two lenticules were removed due to infection and scarring; four lenticules had minimal scarring and did not require removal. Spectacle-corrected acuity was worse than one line from the preoperative spectacle-corrected acuity in 58% of the adult aphakic eyes; however, 75% were 20/50 or better postoperatively. Fifty percent were within 2 diopters (D) of emmetropia and 92% within 3 D. All pediatric aphakic patients showed an improvement in best-corrected acuity, and 83% of eyes at 6 months were within 2 D of emmetropia; by 1 year a 3.4-D average myopic shift had occurred. Two of the six eyes (33%) using the original myopia technique were within 2 D of emmetropia, whereas five of the six eyes (83%) with the current technique are within this range. Spectacle-corrected acuity in the entire current myopia group has either improved by one or more lines or has remained unchanged. Five of the six keratoconic eyes had 20/40 or better spectacle-corrected and 20/25 contact lens-corrected acuity postoperatively; average corneal flattening was 6 D. Persistent epithelial defect and irregular astigmatism were the principal factors in delay in visual recovery.

Corneal endothelial polymegathism induced by PMMA contact lens wear.

Central corneal endothelial photographs were taken for 15 persons who had worn polymethylmethacrylate (PMMA) contact lenses for 7-15 yr and for a nonwearing control group matched for age and sex. An individual cell area analysis was made from the cell tracings. Significant endothelial polymegathism was noted for each member of the contact lens wearing group. PMMA wearers showed an average coefficient of variation of 0.445 for central corneal endothelial cell area compared to 0.245 for nonwearers (81.6% increase in polymegathism). The average maximum/minimum cell size ratio was 8.06 for the PMMA wearers vs 3.42 for the nonwearing control group. The frequency distributions for the cell areas reveal that the contact lens wearer develops cells that are much smaller and larger than normal.

Surrogate color vision by luster discrimination.

A selective filter, such as the X-chrom lens, which is placed before one eye, serves to create a luminance difference between the two eyes. The amount of the luminance difference is dependent upon the wavelength distribution of the stimulus and could therefore serve as a clue to assist color discrimination. The ability to detect and discriminate levels of luster is investigated. One of three subjects shows a crude ability to discriminate levels of luster. The performance level is such that a filter may aid dichromacy but not anomalous trichromacy.