A comparison of anterior cruciate ligament - Return to sports after injury (ACL-RSI) scores of male athletes nine-months Post-ACL reconstruction with matched uninjured controls.

OBJECTIVES: To report ACL-RSI scores in healthy athletes with no history of ACL injury. To measure ACL-RSI scores at nine-months post-ACL reconstruction and to assess the difference between healthy athlete and patient responses. DESIGN: Cross-sectional study. SETTING: Private sports clinic. PARTICIPANTS: 499 ACL reconstruction athletes completed the scale as they returned for their nine-month post-operative review appointment. A matched control group of 103 healthy athletes were selected for comparison. MAIN OUTCOME MEASURES: ACL-RSI for participants with controls completing a study-specific modified scale. RESULTS: The median response to the ACL-RSI for the control group was higher (80.0) (Interquartile Range (IRQ) 66.7-88.3) than that of the ACL reconstruction group (74.17) (IRQ 59.2-86.0), however the effect size was small (0.1). CONCLUSION: This study reports normative values for uninjured athletes using the ACL-RSI questionnaire giving a benchmark for recovery after ACLR but also reflecting awareness of injury risk in uninjured athletes. ACL-RSI scores nine-months post-operatively had not yet returned to levels seen in matched uninjured controls.

Temperature- and field-driven spin reorientations in triple-layer ruthenate Sr4Ru3O10.

Sr4Ru3O10, the n = 3 member of the Ruddlesden-Popper type ruthenate Srn+1Ru n O3n+1, is known to exhibit a peculiar metamagnetic transition in an in-plane magnetic field. However, the nature of both the temperature- and field-dependent phase transitions remains as a topic of debate. Here, we have investigated the magnetic transitions of Sr4Ru3O10 via single-crystal neutron diffraction measurements. At zero field, we find that the system undergoes a ferromagnetic transition with both in-plane and out-of-plane magnetic components at Tc ≈ 100 K. Below T * = 50 K, the magnetic moments incline continuously toward the out-of-plane direction. At T = 1.5 K, where the spins are nearly aligned along the c axis, a spin reorientation occurs above a critical field Bc, giving rise to a spin component perpendicular to the plane defined by the field direction and the c axis. We suggest that both the temperature- and field-driven spin reorientations are associated with a change in the magnetocrystalline anisotropy, which is strongly coupled to the lattice degrees of freedom. This study elucidates the long-standing puzzles on the zero-field magnetic orders of Sr4Ru3O10 and provides new insights into the nature of the field-induced metamagnetic transition.

Size-related shifts in the habitat associations of young-of-the-year winter flounder (Pseudopleuronectes americanus): field observations and laboratory experiments with sediments and prey.

Field surveys and laboratory studies were used to determine the role of substrata in habitat selection by young-of-the year winter flounder. A synoptic field survey of winter flounder and sediments in the Navesink River-Sandy Hook Bay estuarine system in New Jersey demonstrated that winter flounder distribution was related to sediment grain size. Analysis using a generalized additive model indicated that the probability of capturing 10-49 mm SL winter flounder was high on sediments with a mean grain diameter of /=40 mm SL) preferred coarse-grained sediments. Burying ability increased with size and all flounders avoided sediments that prevented burial. Subsequent laboratory experiments revealed that the presence of live prey (Mya arenaria) can over-ride sediment choice by winter flounder (50-68 mm SL) indicating the complexity of interrelated factors in habitat choice.

Central venous catheter infections: concepts and controversies.

Central venous catheters (CVCs) are widely used in critically ill patients in intensive care units. However, infectious complications are common and may limit their utility. We critically review the literature to determine the impact of CVC design and composition, insertion site selection, insertion procedures, care and removal of temporary CVCs on infectious complications. Relevant articles were identified and selected for review using a database search (Medline and manual of the English language literature) based upon study design and sample size with an emphasis on prospective randomized trials. To minimize infectious complications and maintain a reasonable cost-benefit ratio, we recommend: i) use a single lumen catheter unless clear indications for a multi-lumen catheter exist; ii) insert the catheter via the subclavian vein if no relative contraindication exists (bleeding diathesis, positive pressure ventilation); iii) disinfect the insertion site employing sterile technique; iv) apply a dry, sterile dressing and change the dressing every other day; v) inspect the insertion site for signs of infection and remove the catheter if pus is present; vi) if a catheter-related infection is suspected, change the catheter over a guidewire and culture the distal segment. The replacement catheter should be removed if an original catheter segment culture is positive.

Intrinsic left ventricular contractility in normal subjects.

The influence of autonomic tone on left ventricular (LV) contractility, along with the range of normal values and the effects of exercise on contractile state, were studied in 12 normal volunteers. Serial reproducibility was examined in a subgroup of 6. LV contractility was estimated by the LV peak-systolic pressure to end-systolic volume relation (pressure-volume relation), and the ratio of peak-systolic pressure to end-systolic volume (pressure/volume ratio). The cuff blood pressure and radionuclide ventriculogram were recorded at rest, during exercise and during pharmacologic pressure-afterloading with phenylephrine, before and after vagal and beta-adrenergic "blockade." Both the pressure/volume ratio and ejection fraction increased during the stimulus of exercise (both p less than or equal to 0.008). After blockade, the pressure-volume relations were highly linear (r = 0.95 +/- 0.05 [standard deviation], n = 12), and there was no systematic difference in their slopes induced by blockade. The serial studies of pressure-volume relations showed no significant differences. The results demonstrated that vagal and sympathetic tone were not important in the support of LV contractility in normal subjects at rest, and that the pressure-volume relation and pressure/volume ratio are reproducible between studies. Also, the findings confirmed that both the pressure/volume ratio and the ejection fraction were sensitive to exercise-induced changes in contractility. This demonstration of intrinsic LV contractility in normal subjects, plus the reproducibility of the measurements, supports the feasibility of serial study of LV contractility.

Correlation of two-dimensional echocardiography and pathologic findings in porcine valve dysfunction.

Two-dimensional echocardiographic findings in porcine valve dysfunction were compared with pathologic findings in 10 patients (12 valves). Three specific echocardiographic findings were identified in patients with regurgitant lesions: prolapse, fracture and flail leaflets. Prolapse was associated pathologically with thinning of the leaflets, longitudinal tears close to the ring margin and acid mucopolysaccharide accumulation. Valve fracture was seen with and without prolapse and was accompanied pathologically by small pinpoint perforations or tears of the leaflet. A flail leaflet was seen with a linear tear of the free margin and was associated with calcific deposits. Mild degrees of fracture seen pathologically were missed on the echocardiographic study in five patients. Thickening or calcification, when present in moderate or severe amounts, was correctly identified by echocardiography. When all abnormal features were considered collectively, two-dimensional echocardiography correctly identified at least one of them in all patients. Therefore, two-dimensional echocardiography may prove useful in assessing the source of valvular regurgitation in patients with bioprosthetic valves.

Electrocardiographic changes associated with isolated right ventricular infarction.

Isolated infarction of the right ventricle is an extremely rare entity. A patient is described with diffuse interstitial lung disease who developed ST segment elevation in inferior and anterior leads on a routine electrocardiogram and at autopsy was found to have an isolated right ventricular infarct involving approximately 70% of the right ventricular circumference without involvement of the left ventricle and septum. This case illustrates that isolated right ventricular infarction in the presence of cor pulmonale and right ventricular hypertrophy can produce an injury current in the limb and precordial leads of the electrocardiogram which mimics that seen in typical transmural infarction of the left ventricle.

New Campaign in Thailand.

PIP: A program run by Community-Based Family Planning Services in rural Banglamoong, Thailand, is completing its first year of family planning efforts with considerable success. Under the program, district leaders such as the police chief, doctor, school prinicipal and pharmacist, are approached and asked to recommend village inhabitants to serve as distributors of birth control pills and condoms and as referral agents for people desiring IUD insertion and sterilization. These people, who receive 5 cents for every pill or condom sale, act as salemen with a simple message, "Too many children make you poor." The fact that they are members of the community and convenient to the inhabitants has made the program more successful than some programs at the district and national level. In addition, the volunteers have formed the nucleus of a broad-based paramedical corps trained to recognize signs of certain deseases.^ieng