Diagnosis of Waldenstrom Macroglobulinemia Using Postoperative Histopathology During Routine Total Knee Arthroplasty: A Case Report.

CASE: We present a 63-year-old patient diagnosed with Waldenstrom macroglobulinemia (WM) through histopathology of bone tissue after total knee arthroplasty for routine osteoarthritis. The patient, surgical team, and the pathologist were unaware of this diagnosis before the surgery. CONCLUSION: The cost-effectiveness of routine histopathologic examination of bone cuts and synovial samples after total joint arthroplasty continues to be a source of debate. Our case highlights an example of the utility of histopathology because it led to the early detection of WM, resulting in prompt treatment to improve quality of life.

Dissociation of a Medial Pivot Polyethylene in a Kinematically Aligned Total Knee Arthroplasty.

An 81-year-old male patient who underwent a Medacta GMK sphere kinematically aligned (KA) total knee arthroplasty (TKA) for end-stage knee osteoarthritis presented with a dislocated medial pivot (MP) tibia polyethylene (PE) insert on routine six-week postoperative x-rays. The patient presented asymptomatic with a normal range of motion. Dissociation of a fixed-bearing (FB) PE implant is an uncommon complication after TKA. There are only a few cases reported in the literature. We report for the first time a case of non-traumatic dissociation of MP PE from the tibial baseplate in a KA TKA in an asymptomatic patient but identified on routine postoperative radiographs.

Efficacious, effective, and embedded interventions: implementation research in infectious disease control.

BACKGROUND: Research in infectious disease control is heavily skewed towards high end technology; development of new drugs, vaccines and clinical interventions. Oft ignored, is the evidence to inform the best strategies that ensure the embedding of interventions into health systems and amongst populations. In this paper we undertake an analysis of the challenge in the development of research for the sustainable implementation of disease control interventions. RESULTS: We highlight the fundamental differences between the research paradigms associated with the development of technologies and interventions for disease control on the one hand and the research paradigms required for enhancing the sustainable uptake of those very same interventions within the communities on the other. We provide a definition for implementation research in an attempt to underscore its critical role and explore the multidisciplinary science needed to address the challenges in disease control. CONCLUSION: The greatest value for money in health research lies in the sustainable and effective implementation of already proven, efficacious solutions. The development of implementation research that can help provide some solutions on how this can be achieved is sorely needed.

Downhill ski injuries in children and adolescents.

Downhill skiing is considered to be an enjoyable activity for children and adolescents, but it is not without its risks and injuries. Injury rates now range between 3.9 and 9.1 injuries per 1000 skier days, and there has been a well documented increase in the number of trauma cases and fatalities associated with this sport. Head and neck injuries are considered the primary cause of fatal injuries and constitute 11-20% of total injuries among children and adolescents. Cranial trauma is responsible for up to 54% of total hospital injuries and 67% of all fatalities, whereas thoracoabdominal and spine injuries comprise 4-10% of fatalities. Furthermore, there has been an increase in the proportion of upper extremity trauma with acromioclavicular dislocations, and clavicle and humeral fractures accounting for the majority (22-79%) of the injuries. However, the most common and potentially serious injuries in children and adolescents are those to the lower extremity, with knee sprains and anterior cruciate ligament tears accounting for up to 47.7% of total injuries. Knee sprains and grade III ligament trauma associated with lower leg fractures account for 39-77% of ski injuries in this young population. Approximately 15% of downhill skiing injuries among children and adolescents are caused by musculoskeletal immaturity. Other factors include excessive fatigue, age, level of experience, and inappropriate or improperly adjusted equipment. Collisions and falls constitute a significant portion (up to 76%) of trauma, and are commonly associated with excessive speed, adverse slope conditions, overconfidence leading to carelessness, and behavioural patterns within and among gender. The type and severity of injuries are typically functions of biomechanical efficiency, skiing velocity or slope conditions; however, a multiplicative array of intrinsic and extrinsic factors may simultaneously be involved. Despite extensive efforts to provide a comprehensive picture of the aetiology of injury, limitations have hampered reporting. These limitations include age and injury awareness, data collection challenges, lack of uniformity in the definition or delineation of age classification and lack of knowledge of predisposing factors prior to injury. Since skill level is the primary impetus in minimising ski injuries, formal instruction focusing on strategies such as collision avoidance and helmet use, fall training minimising lower extremity trauma, altering ski technique and avoiding behaviours that lead to excessive risk are, therefore, highly recommended. Skiing equipment should be outfitted to match the young skier's height, weight, level of experience, boot size and slope conditions. Additionally, particular attention should be paid to slope management (i.e. overcrowding, trail and obstacle marker upkeep) and minimising any opportunity for excessive speed where children are present. Whether increases in knowledge, education and technology will reduce predisposition to injury among this population remains to be seen. As with all high-risk sports, the answer may lie in increased wisdom and responsibility of both the skier and the parent to ensure an adequate level of ability, self-control and simply common sense as they venture out on the slopes.

Comparison of muscle force production using the Smith machine and free weights for bench press and squat exercises.

The Smith machine (SM) (vertical motion of bar on fixed path; fixed-form exercise) and free weights (FWs) (free-form path) are commonly used strength training modes. Exercisers may need to alternate between types of equipment, depending on testing, training, rehabilitation, and/or the exercisers' goals. The purposes of this study were to compare muscle force production for SM and FWs using a 1 repetition maximum (1RM) for the parallel back squat and supine bench press exercises and to predict the 1RM for one mode from 1RM on the other mode. Men (n = 16) and women (n = 16) alternately completed 1RM testing for squat and bench press using SM and FWs. Analyses of variance (type of equipment x sex) and linear regression models were calculated. A significant difference was found between bench press and squat 1RMs for each mode of equipment for all participants. The squat 1RM was greater for the SM than the FWs; conversely, the bench 1RM was greater for FWs than the SM. When sex was considered, bench 1RM for FWs was greater than SM for men and women. The squat 1RM was greater for SM than FWs for women only. The 1RM on one mode of equipment was the best predictor of 1RM for the other mode. For both sexes, the equation SM bench 1RM (in kilograms) = -6.76 + 0.95 (FW bench 1RM) can be used. For women only, SM squat 1RM (in kilograms) = 28.3 + 0.73 (FW squat 1RM). These findings provide equations for converting between SM and FW equipment for training.

Physiological and sport-specific skill response of olympic youth soccer athletes.

Although many studies have been focused on soccer athletes, no comprehensive studies have been conducted on adolescent soccer athletes in the United States. Therefore, the purpose of this study was to quantify the physiological and sport-specific skill characteristics of Olympic Developmental Program (ODP) soccer athletes by age group and game experience. Following written, informed consent, 59 male athletes (age = 14.6 +/- 2.0 years; wt = 60.5 +/- 1.4 kg; ht = 172.4 +/- 1.2 cm) completed a battery of tests to determine aerobic power (VO(2)max), heart rate (HR(max)), ventilation (VE(max)), respiratory exchange ratio (RER), anaerobic threshold (AT), blood pressure (BP(rest/max)), anaerobic power/capacity [peak power (PP), mean power (MP), total work output (TWO), fatigue index (FI)], leg power [vertical squat jump (VJS), countermovement jump (VJC)], body composition [percent body fat (%BF), lean body mass (LBM)], joint range of motion (trunk, back, hip, knee, and ankle), and agility/sport-specific skills (T-test, line drill test, juggling test, Johnson wall volley, and modified-Zelenka circuit). Factor analyses with subsequent multivariate analyses of variance (MANOVAs) indicated significant main effects across age (p = 0.0001) but not by game experience (p = 0.82). Older athletes exhibited greater height, weight, LBM, VE(max), Time(max), PP, TWO, and VSJ values than younger athletes. Although not significant, there were differences with increasing age in the agility tests (T-test, wall volley, and juggling test). In conclusion, improvements in anaerobic power, agility, and sport-specific skill should be addressed at this developmental level of competition.