Intrinsic graft laxity variation with open kinetic chain exercise after anterior cruciate ligament reconstruction: A non-randomized controlled study.

OBJECTIVES: To determine whether quadriceps and hamstring strengthening in a rehabilitation program involving early open kinetic chain (OKC) and/or closed kinetic chain (CKC) knee joint exercises had an influence on graft laxity at 1, 3, and 6 months after anterior cruciate ligament reconstruction (ACLR). DESIGN: Retrospective study. METHODS: Two groups (n = 53) of ACLR patients (combination of OKC and CKC exercises group compared to a CKC exercise group) were recruited. OKC protocol was introduced at 2 weeks post-operatively without external resistance and progressed at 4 weeks with load. Comparative ACL graft laxity measurement and isokinetic strength testing were prospectively performed up to 6 months in both groups. RESULTS: No significant differences were observed in the knee laxity at 1 (p = 0.263), 3 (p = 0.263), and 6 months (p = 0.256) follow up between the groups. Similarly, no significant results were observed in within-group knee laxity between 1 and 6 months after ACLR in the intervention (p = 0.155) and control group (p = 0.690). CONCLUSION: The early initiation of OKC along with CKC exercises doesn't seem to increase the ACLR graft laxity as compared to a rehabilitation program with only CKC exercises.

Evaluation of Muscle Strength and Graft Laxity With Early Open Kinetic Chain Exercise After ACL Reconstruction: A Cohort Study.

Background: Open kinetic chain (OKC) exercise is an effective method to improve muscle function during rehabilitation after anterior cruciate ligament reconstruction (ACLR); however, there is controversy about its use in the early phase of rehabilitation. Purpose: To determine (1) whether the use of OKC and closed kinetic chain (CKC) exercises improves quadriceps and hamstring strength in the early phase of rehabilitation after ACLR and (2) whether the early use of OKC exercise affects graft laxity at 3 and 6 months postoperatively in patients with a hamstring tendon graft. Study Design: Cohort study; Level of evidence, 3. Methods: This study included an intervention group that underwent OKC + CKC exercises (n = 51) and a control group that underwent CKC exercise only (n = 52). In the intervention group, OKC exercise for the quadriceps and hamstring was started at 4 weeks after ACLR. At 3 and 6 months postoperatively, isokinetic testing was performed to calculate the limb symmetry index (LSI) and the peak torque to body weight ratio (PT/BW) for the quadriceps and hamstring. Anterior knee laxity was measured by an arthrometer. Results: At 3 and 6 months postoperatively, quadriceps strength was higher in the intervention group than in the control group for the LSI (3 months: 76.14% ± 0.22% vs 46.91% ± 0.21%, respectively; 6 months: 91.05% ± 0.18% vs 61.80% ± 0.26%, respectively; P < .001 for both) and PT/BW (3 months: 1.81 ± 0.75 vs 0.85 ± 0.50 N·m/kg, respectively; 6 months: 2.40 ± 0.73 vs 1.39 ± 0.70 N·m/kg, respectively; P < .001 for both). There were similar findings regarding hamstring strength for the LSI (3 months: 86.13% ± 0.22% vs 64.26% ± 0.26%, respectively; 6 months: 91.90% ± 0.17% vs 82.42% ± 0.24%, respectively; P < .001 at three months, P = .024 at 6 months) and PT/BW (3 months: 1.09 ± 0.36 vs 0.67 ± 0.39 N·m/kg, respectively; 6 months: 1.42 ± 0.41 vs 1.07 ± 0.39 N·m/kg, respectively; P < .001 for both). No significant difference in laxity was observed between the intervention and control groups at 3 or 6 months. Conclusion: Early use of OKC exercise for both the quadriceps and the hamstring, in addition to conventional CKC exercise, resulted in better correction of quadriceps and hamstring strength deficits without increasing graft laxity.

Description of Cumbeba (Tacinga inamoena) Waste Drying at Different Temperatures Using Diffusion Models.

One approach to improve sustainable agro-industrial fruit production is to add value to the waste generated in pulp extraction. The processing of cumbeba (Tacinga inamoena) fruits generates a significant amount of waste, which is discarded without further application but can be a source of bioactive compounds, among other nutrients. Among the simplest and most inexpensive forms of processing, convective drying appears as the first option for the commercial utilization of fruit derivatives, but it is essential to understand the properties of mass transfer for the appropriate choice of drying conditions. In this study, cumbeba waste was dried at four temperatures (50, 60, 70 and 80 °C). Three diffusion models were fitted to the experimental data of the different drying conditions. Two boundary conditions on the sample surface were considered: equilibrium condition and convective condition. The simulations were performed simultaneously with the estimation of effective mass diffusivity coefficients (Def) and convective mass transfer coefficients (h). The validation of the models was verified by the agreement between the theoretical prediction (simulation) and the experimental results. The results showed that, for the best model, the effective mass diffusivities were 2.9285 × 10-9, 4.1695 × 10-9, 8.1395 × 10-9 and 1.2754 × 10-8 m2/s, while the convective mass transfer coefficients were 6.4362 × 10-7, 8.7273 × 10-7, 8.9445 × 10-7 and 1.0912 × 10-6 m/s. The coefficients of determination were greater than 0.995 and the chi-squares were lower than 2.2826 × 10-2 for all simulations of the experiments.

Evolution of Functional Recovery using Hop Test Assessment after ACL Reconstruction.

The purpose of this study was to evaluate improvements in functional performance through the use of the Limb Symmetry Index of Single and Triple Hop tests between 12 and 52 weeks after anterior cruciate ligament reconstruction, and to compare these values with usual time-based and performance-based criteria used during the return to sport continuum. Repeated functional assessments using Single and Triple Hop Tests at 12, 16, 22, 26, 39 and 52 postoperative weeks were evaluated. At each session, the median and interquartile range of Limb Symmetry Index of tests were calculated and compared with the usual criteria: return to participation:≥85%, between 12-16 w; return to play:≥90%, between 26-39 w. The results indicate that the median increased over time to 39 postoperative weeks and then stabilized. For Single Hop Test, wide variability was seen at 12 and 16 weeks (interquartile range=20%); this was lower from 22 to 52 weeks (interquartile range=8-6%). At 12 weeks for Single Hop Test, the median was 83.6% and did not meet>85% criteria for return to participation. Hop tests could be interesting functional tests to follow the functional recovery and help decision-making regarding return to participation and return to play.

Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review.

OBJECTIVE: To describe the criteria used to guide clinical decision-making regarding when a patient is ready to return to running (RTR) after ACL reconstruction. DESIGN: Scoping review. DATA SOURCES: The MEDLINE (PubMed), EMBASE, Web of Science, PEDro, SPORTDiscus and Cochrane Library electronic databases. We also screened the reference lists of included studies and conducted forward citation tracking. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Reported at least one criterion for permitting adult patients with primary ACL reconstruction to commence running postoperatively. RESULTS: 201 studies fulfilled the inclusion criteria and reported 205 time-based criteria for RTR. The median time from when RTR was permitted was 12 postoperative weeks (IQR=3.3, range 5-39 weeks). Fewer than one in five studies used additional clinical, strength or performance-based criteria for decision-making regarding RTR. Aside from time, the most frequently reported criteria for RTR were: full knee range of motion or >95% of the non-injured knee plus no pain or pain <2 on visual analogue scale; isometric extensor limb symmetry index (LSI)>70% plus extensor and flexor LSI>70%; and hop test LSI>70%. CONCLUSIONS: Fewer than one in five studies reported clinical, strength or performance-based criteria for RTR even though best evidence recommends performance-based criteria combined with time-based criteria to commence running activities following ACL reconstruction.

Criteria for Return to Sport after Anterior Cruciate Ligament reconstruction with lower reinjury risk (CR'STAL study): protocol for a prospective observational study in France.

INTRODUCTION: The decision regarding when to return to sport after an anterior cruciate ligament reconstruction (ACLR) is an important one. Using a variety of subjective and objective parameters, various attempts have been made to determine an optimal timeline for a return to sport after ACLR, but none have been validated.The aim of the present study is therefore to determine which criteria or combination of criteria could allow to return to sport with the lowest possible risk of reinjury. METHODS AND ANALYSIS: This study is a prospective cohort, single-centre study, with repeated assessments at 6, 9 and 12 months post-ACL surgical reconstruction and including a 3-year follow-up of patients' sporting activity and reinjuries. 275 patients will be included to test explanatory variables. Postural control analysis, knee laxity, questionnaires (International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia-11 (TSK-11), Anterior Cruciate Ligament-Return to Sport After Reinjury (ACL-RSI) and Single Assessment Numeric Evaluation (SANE)), modified Star Excursion Balance Test, running and sprinting biomechanics, Hop Tests and Isokinetic Tests will all be used. The primary outcome will be any reinjury during the follow-up period, defined as a graft rupture, a contralateral ACL rupture or any injury necessitating an interruption of training and requiring a medical consultation. Two groups will be constituted during the follow-up, separating reinjured from non-reinjured patients. In addition, classic analysis and data mining approaches will be used to build predictive models. ETHICS AND DISSEMINATION: The results of this study will be disseminated through peer-reviewed publications and scientific presentations. Ethical approval was obtained through the ethics committee of the University Hospital of Saint-Etienne (reference number IRBN522015/CHUSTE).

[Similarities and differences between pathological gambling and substance dependance: A clarification]. / Similitudes et différences entre le jeu pathologique et la dépendance aux substances : qu'en est-il ?

UNLABELLED: Similarities and differences between pathological gambling and substance dependence: a clarification. A critical analysis of a French review of the international literature on gambling. INTRODUCTION: The integration of pathological gambling in the spectrum of addictive disorders modeled by substance dependence is currently discussed. OBJECTIVE: To perform a systematic review of the similarities and differences between pathological gambling and substance dependence, and to classify and analyze them, based on the data collected by a previously published French systematic analysis of the international literature on pathological gambling. METHOD: We established a checklist of each comparison of pathological gambling with substance dependence within the report. Then, every entry was classified as similarity or difference, analyzed and discussed. RESULTS: Similarities retrieved were epidemiological characteristics (gender, age, socio-demographic characteristics of subjects), diagnostic criteria from DSM-IV (five criteria in common), frequent co-occurrence of pathological gambling and substance dependence, neurobiological and genetic characteristics, cases of spontaneous recovery, and similarities of therapeutic care. Differences retrieved were a more elevated prevalence of mood disorders and suicide among pathological gamblers, intrinsic risk factors related to gambling activity (delay between bid and result, gambling device, big win), cognitive distortion of pathological gamblers (notably chasing), specificities of cognitive behavioral therapies focused on these cognitive distortions, and specificities of social care of pathological gamblers. DISCUSSION: Pathological gambling shared many similarities with substance dependence, but also some differences. However, our critical analysis of these elements, reported to be specific to pathological gambling, showed significant commonalities with substance dependence. Also, the existence of key symptoms of substance dependence such as craving and loss of control in pathological gambling was not discussed in the review, although other data suggest a common ground. These could be key elements to group together pathological gambling and substance dependence within the addictive disorders.

A dynamic tactile map as a tool for space organization perception: application to the design of an electronic travel aid for visually impaired and blind people.

This paper addresses a new concept of visuotactile human-machine interface for a certain representation of the peripersonnal space, especially useful for visually impaired and blind people navigation. The proposed space representation have been successfully implemented on a tactile device and validated via series of experiments involving naive blindfolded sighted people. Results show that is possible to interact with the space via the proposed tactile representation.

Study design in osteoporosis: a European perspective.

The advent of effective agents for the treatment of osteoporosis has led to the view that placebo-controlled trials to test new agents for efficacy are no longer appropriate. Rather, studies of superiority, equivalence, or non-inferiority have been recommended. Such studies require very large sample sizes, and the burden of osteoporotic fracture in a trial setting is substantially increased. Studies of equivalence cannot be unambiguously interpreted because the variance in effect of active comparator agents is too large in osteoporosis. If fracture studies are required by regulatory agencies, there is still a requirement for placebo-controlled studies, although perhaps of shorter duration than demanded at present.

Uncertain future of trials in osteoporosis.

The advent of effective agents for the treatment of osteoporosis has led to the view that placebo-controlled trials to test new agents for efficacy are no longer appropriate since proven treatments are available. In this review we argue that, if new agents are to be developed, there is still a place for the placebo-controlled trial. A move to studies of equivalence or non-inferiority raises more problems than it resolves.

[French system of drug surveillance]. / Le système francais de pharmacovigilance.

The French drug surveillance system is characterized by: a network of thirty one regional drug surveillance centres, located to provide convenient proximity to health care professionals; a causality assessment method, compulsory for all persons involved in drug surveillance, to assess the causal relationship between an adverse effect and one or more drugs; if necessary, an additional evaluation of the causal relationship will be performed using pharmaco-epidemiology methods; a Technical committee and a National Commission of Drug Surveillance which centralize and assess all the data in order to provide a consensual advice to the relevant authorities on necessary measures, to prevent, or reduce a drug related adverse effect; in the case of an inquiry, the drug surveillance department of the pharmaceutical company and the network of regional drug surveillance centers will pool their data with the aim to exchange information and ideas.

[Clinical evaluation of drug interactions of cyclosporin]. / Evaluation clinique des interactions médicamenteuses de la ciclosporine.

Cyclosporin is a nephrotoxic immunosuppressant metabolized in the liver and requiring drug monitoring. Numerous pharmacokinetic and pharmacodynamic drug interactions have occurred with this compound. Some of them are well substantiated while others are merely suspected. The major interactions must definitely be prevented of corrected, whereas the others need no more than careful drug monitoring.

Rationale for ACE inhibition in the elderly: treatment of arterial hypertension with enalapril.

A randomized, double-blind, placebo-controlled trial was conducted with 32 elderly patients (aged 75-97 years) with uncomplicated essential hypertension, to evaluate the efficacy and tolerance of enalapril, an angiotensin-converting enzyme inhibitor. It was given over an 8-week period in doses from 20 to 40 mg/day and was compared with an identical placebo. Enalapril caused a significant reduction in systolic blood pressure (SBP) and diastolic blood pressure (DBP) by the 2nd week, an effect that persisted through to the 8th week (190 +/- 16/102 +/- 7 to 151 +/- 19/85 +/- 11 mm Hg); 67% of patients had their pressures normalized (less than 160/95 mm Hg). BP was also significantly decreased by the 8th week under placebo (183 +/- 16/101 +/- 9 to 165 +/-21/91 +/- 13 mm Hg), but only 35% of patients attained a normal pressure. Heart rate did not change with treatment. Enalapril caused an increase in plasma renin activity (1.22 +/- 0.08 to 3.66 +/- 2.50 ng/ml/h), whereas aldosterone levels remained unchanged. There was a mild, significant elevation of creatinine level with enalapril but other laboratory parameters, including serum potassium, were unaltered. Two deaths occurred in the enalapril group, but were not considered to be treatment-related. The drug was otherwise well tolerated. Serum enalapril concentration was assessed in 10 patients taking 20 mg/day over an 8-day period. At equilibrium, the level was 22.3 +/- 5.0 ng/l and it correlated both with converting enzyme inhibition and with renal function. Enalapril is shown to be an effective and well-tolerated antihypertensive medication in elderly patients.

[Quality assurance of clinical trials]. / Pour une assurance de qualité des essais cliniques.

A quality assurance system for clinical trials entails the definition, prior to the trial, of a number of procedures (the "good clinical practices") ensuring that it will be correctly conducted and the verification that these procedures have been respected. Setting up a clinical trial quality assurance system involving the manufacturer, university staff and public authorities should result in trials that are better performed. The role and responsibilities of each party are discussed, together with the consequences to be expected from the introduction of good clinical practices in France.

Reversible renal failure after combined treatment with enalapril and frusemide in a patient with congestive heart failure.

A patient with congestive heart failure and moderate renal insufficiency developed severe reversible non-oliguric renal failure while on frusemide and enalapril. Renal failure developed when enalapril was given in the presence of pronounced sodium depletion. When positive sodium balance was restored the plasma creatinine concentration began to fall while angiotensin converting enzyme inhibition remained effective and blood pressure was stable. These observations suggest that the degree of sodium depletion plays an important role in the tendency for angiotensin converting enzyme inhibitors to induce renal failure in patients with congestive heart failure and moderate renal insufficiency. Restoration of a positive sodium balance promotes the recovery of renal function after the combined administration of angiotensin converting enzyme inhibitors and diuretics.