Aerosol-boundary layer dynamics and its effect on aerosol radiative forcing and atmospheric heating rate in the Indian Ocean sector of Southern Ocean.

The study examines the thermodynamic structure of the marine atmospheric boundary layer (MABL) and its effect on the aerosol dynamics in the Indian Ocean sector of Southern Ocean (ISSO) between 30°S-67°S and 57°E-77°E. It includes observations of aerosols and meteorology collected during the Xth Southern Ocean Expedition conducted in December 2017. The results revealed the effect of frontal-region-specific air-sea coupling on the thermodynamic structure of MABL and its role in regulating aerosols in ISSO. The MABL over the subtropical front was unstable and formed a well-evolved mixed layer (≈2400 m) capped by low-level inversions (≈660 m). Convective activities in the Sub-Antarctic Frontal region were associated with the Agulhas Retroflection Current, which supported the formation of a well-developed mixed layer (≈1860 m). The mean estimates of aerosol optical depth (AOD) and black carbon (BC) mass concentrations were 0.095 ± 0.006 and 50 ± 14 ng m-3, respectively, and the resultant clear sky direct shortwave radiative forcing (DARF) and atmospheric heating rate (HR) were 1.32 ± 0.11 W m-2 and 0.022 ± 0.002 K day-1, respectively. In the polar front (PF) region, frequent mid-latitude cyclones led to highly stabilized MABL, supported low-level multi-layered clouds (>3-layers) and multiple high-level inversions (strength > 0.5 K m-1 > 3000 m). The clouds were mixed-phased with temperatures less than -12 °C at 3000 m altitude. Interestingly, there was higher loading of dust and BC aerosols (276 ± 24 ng m-3), maximum AOD (0.109 ± 0.009), clear sky DARF (1.73 ± 0.02 W m-2), and HR (0.029 ± 0.005 K day-1). This showed an accumulation of long-range advected anthropogenic aerosols within baroclinic-boundaries formed over the PF region. Specifically, in the region south of PF, weak convection caused weakly-unstable MABL with a single low-level inversion followed by no clouds/single-layer clouds. Predominant clean maritime air holding a small fraction of dust and BC accounted for lower estimates of AOD (0.071 ± 0.004), BC concentrations (90 ± 55 ng m-3) and associated clear sky DARF and HR were 1.16 ± 0.06 W m-2 and 0.019 ± 0.001 K day-1, respectively.

Plasma Levels of a Product of Free Radical Injury and Antioxidant Status of Patients with Different Grades of Plasmodium Falciparum Infection.

BACKGROUND: Plasmodium falciparum infection, like any other clinical condition, is prone to generating free radicals. This can worsen patients' clinical presentations. Antioxidants do help in ameliorating these free radical effects. These antioxidants, especially vitamins, are sometimes given routinely to patients with Plasmodium falciparum infection of which it can be given according to the severity of this free radical injury. METHODOLOGY: A total number of qualified 245 patients that came for malaria parasite test between March and October, 2020 were recruited into the study. Patients on arrival at the laboratory had their samples collected for malaria parasite test and for the proposed biochemical parameters (MDA, GPx, SOD and TAS). Malaria parasite test was used to categorize the severity of Plasmodium falciparum infection. RESULTS: There were statistically significant differences (p<0.0001) in MDA, GPx, SOD and TAS among patients with negative MP, 1+ and >2+ on blood film for malaria parasite. Patients with >2+ MP had highest levels (2.21±0.40) while patients with negative blood film had lowest levels(0.8194±0.33) of MDA. Patients with >2+ had lowest levels of GPx (2406.41±1272.10), SOD (104.54±30.62) and TAS (1.18±.35) as against patients with negative MP that had highest levels (5229.85±.2957.95)( 206.41±36.70)( 2.40±.53), respectively. CONCLUSION: There was evidence of free radical generation as evidenced with raised plasma malondialdehyde in patients with Plasmodium falciparum infection. This was associated with severity of this infection. There was also corresponding decrease in measured antioxidants (GPx, SOD and TAS).

CONTEXTE: L'infection à Plasmodium falciparum, comme toute autre affection clinique, est susceptible de générer des radicaux libres. Cela peut aggraver les présentations cliniques des patients. Les antioxydants aident à améliorer ces effets des radicaux libres. Ces antioxydants, notamment des vitamines, sont parfois administrés en routine aux patients infectés par Plasmodium falciparum dont il peut être administré en fonction de la gravité de cette lésion radicalaire. MÉTHODOLOGIE: Un nombre total de 245 patients qualifiés qui sont venus pour un test de dépistage du paludisme entre mars et octobre 2020 ont été recrutés dans l'étude. Les patients à leur arrivée au laboratoire ont eu leurs échantillons collectés pour le test du parasite du paludisme et pour les paramètres biochimiques proposés (MDA, GPx, SOD et TAS). Le test du parasite du paludisme a été utilisé pour catégoriser la gravité de l'infection à Plasmodium falciparum. RÉSULTATS: Il y avait des différences statistiquement significatives (p<0,0001) dans le MDA, GPx, SOD et TAS parmi les patients avec MP négatif, 1+ et >2+ sur frottis sanguin pour le parasite du paludisme. Les patients avec >2+ MP avaient les niveaux les plus élevés (2,21 ± 0,40) tandis que les patients avec un frottis sanguin négatif avaient les niveaux les plus bas (0,8194 ± 0,33) de MDA. Les patients avec >2+ avaient les niveaux les plus bas de GPx (2406,41 ± 1272,10), SOD (104,54 ± 30,62) et TAS (1,18 ± 0,35) par rapport aux patients avec MP négatif qui avaient les niveaux les plus bas (5229,85 ± 0,2957,95) (206,41 ± 36,70 )( 2,40 ± 0,53), respectivement. CONCLUSION: Il y avait des preuves de génération de radicaux libres comme en témoigne l'augmentation du malondialdéhyde plasmatique chez les patients infectés par Plasmodium falciparum. Ceci était associé à la gravité de cette infection. Il y avait également une diminution correspondante des antioxydants mesurés (GPx, SOD et TAS). Mots-clés: Radicaux libres, stress oxydatif, antioxydants, Plasmodium falciparum, paludisme.

Menstrual Characteristics of sub-Sahara Black African Women with and without Endometriosis.

BACKGROUND: One gynecological disorder which is often a mystery to premenopausal women who are affected is endometriosis, a benign condition characterized by ectopic endometrium growing outside the uterus but behaving as if it is still within the uterus. MATERIALS AND METHODS: Hospital records of 226 women who consulted for fertility management at Nordica Fertility Center were surveyed retrospectively. These women were stratified by age into <35 years and >35 years and by BMI into <18.5 (underweight), 18.5-24.9 (normal), 25.0-29.9 (overweight) and >30 (obese). There were 113 who had laparoscopic diagnosis of endometriosis and 113 without endometriosis but just infertility. STATA 13 statistical software was used for analysis of data. RESULTS: The mean (±sd) age of the women in the study was 34.3 (4.9) with no significant difference among those with (33.9 (4.3)) and without (34.6 (5.4)) endometriosis. There was a significant difference (t=-3.36, P-value=0.0005) in the mean BMI (Kg/m2) of women with endometriosis (25.8±4.9) compared to that of women without endometriosis (27.9±4.5). The probability of endometriosis among normal weight women was higher at age <35 years (OR=2.76, 95% Confidence Interval 1.33,5.73) than at age >35 years (OR=1.59, 95% Confidence Interval 0.62, 4.10). The mean (±SD) parity among those with endometriosis (0.13±0.34) was significantly lower (t-test=2.31; P-value=0.01) than that among women without endometriosis (0.28 ± 0.60). Primary infertility was more prevalent (62.0%) than secondary infertility (38.0%) among those with endometriosis while secondary infertility was more prevalent (55.8%) than primary infertility (44.3%) among those without endometriosis. The mean age (years) at menarche of women without endometriosis (13.3±1.6) was significantly higher (t-test=1.88, P-value=0.03) than that among those with endometriosis (12.9±1). Those with endometriosis were most likely to have dysmenorrhea alone, menorrhagia alone and both dysmenorrhea and menorrhagia concurrently than those without the disease. CONCLUSION: Anthropometric and abnormal menstrual profile of patients presenting with pelvic pain, co-morbidity of dysmenorrhea and menorrhagia, infertility and low parity can guide clinicians and gynecologist to make early and proper diagnosis of endometriosis for better treatment outcomes.

CONTEXTE: Un mal gynécologique qui est souvent un mystère pour les femmes préménopausées qui sont touchées est l'endométriose, une affection bénigne caractérisée par un endomètre ectopique poussant à l'extérieur de l'utérus mais se comportant comme s'il était toujours dans l'utérus. MATÉRIEL ET MÉTHODES: Les dossiers hospitaliers de 226 femmes ayant consulté pour la gestion de la fertilité au Nordica Fertility Center ont été étudiés rétrospectivement. Ces femmes ont été stratifiées par âge en <35 ans et> 35 ans et par IMC en <18,5 (poids insuffisant), 18,5 à 24,9 (normal), 25,0 à 29,9 (surpoids) et> 30 (obèse). Il y avait 113 qui avaient un diagnostic laparoscopique d'endométriose et 113 sans endométriose, mais juste l'infertilité. Le logiciel statistique STATA 13 a été utilisé pour l'analyse des données. RÉSULTATS: L'âge moyen (± sd) des femmes de l'étude était de 34,3 (4,9) sans différence significative entre celles avec (33,9 (4,3)) et sans (34,6 (5,4)) endométriose. Il y avait une différence significative (t = -3,36, valeur p = 0,0005) dans l'IMC moyen (Kg / m2) des femmes atteintes d'endométriose (25,8 ± 4,9) par rapport à celle des femmes sans endométriose (27,9 ± 4,5). La probabilité d'endométriose chez les femmes de poids normal était plus élevée à l'âge <35 ans (OR = 2,76, intervalle de confiance à 95% 1,33,5,73) qu'à l'âge> 35 ans (OR = 1,59, intervalle de confiance à 95% 0,62, 4,10). La parité moyenne (± ET) parmi les personnes atteintes d'endométriose (0,13 ± 0,34) était significativement plus faible (test t = 2,31; valeur p = 0,01) que chez les femmes sans endométriose (0,28 ± 0,60). L'infertilité primaire était plus fréquente (62,0%) que l'infertilité secondaire (38,0%) chez les personnes atteintes d'endométriose, tandis que l'infertilité secondaire était plus fréquente (55,8%) que infertilité primaire (44,3%) chez les personnes sans endométriose. L'âge moyen (années) à la ménarche des femmes sans endométriose (13,3 ± 1,6) était significativement plus élevé (test t = 1,88, valeur p = 0,03) que celui des femmes atteintes d'endométriose (12,9 ± 1). Les personnes atteintes d'endométriose étaient plus susceptibles de souffrir de dysménorrhée seule, de ménorragie seule et à la fois de dysménorrhée et de ménorragie en même temps que celles sans maladie. CONCLUSION: Le profil anthropométrique et menstruel anormal des patientes présentant des douleurs pelviennes, une comorbidité de dysménorrhée et de ménorragie, l'infertilité et une faible parité peuvent guider les cliniciens et le gynécologue pour faire un diagnostic précoce et approprié de l'endométriose pour de meilleurs résultats de traitement. Mots clés: femmes noires africaines, dysménorrhée, endométriose, infertilité, ménorragie, parité, profil menstruel, sub-saharienne.

Plasma Lipids and CD4 Count of Newly Diagnosed HIV Sero-Positive Patients at Ekiti State University Teaching Hospital, Ado Ekiti, Nigeria.

INTRODUCTION: The pathogenesis of HIV has been linked to the affectation of a number of CD4 positive T cells upon which the severity of the disease is graded. Patients who present with complications such as disorders of lipid metabolism may be missed if appropriate laboratory investigations are not done. Dyslipidemia is a common phenomenon in patients with HIV infection. Early consideration of this may prevent further associated complications. OBJECTIVES: To determine the baseline parameters in plasma lipid profile in HIV positive patients and how they are affected by the severity of infection as measured by CD4 count. METHODS: This is a retrospective study of which records of patients that attended Anti-Retroviral Therapy (ART) clinic of Ekiti State University Teaching Hospital (EKSUTH), Ado Ekiti, Ekiti State Nigeria were looked into. All patients who attended our treatment sites for HIV/AIDS Counselling and Testing Program from June 2008 and October 2013 for the first time were reviewed. Records of four hundred and sixty-one (461) patients were found suitable and used for the study. Information about the age. RESULTS: There are statistical significant differences among categories of patients in plasma Triglyceride (TG) mmol/L (p<0.001) and TC/HDL-Chol (p<0.001). The plasma TG (mmol/L) and TC/HDL-Chol are highest in patients with CD4 count <200 cells/µl. All compared categories in plasma TG (mmol/L) are statistically significant (p<0.001) except when CD4 count between 300 and 399 cells/µl and >400 cells/µl (p=1.000) categories were compared. Comparisons of TC/HDL-Chol in different study classifications show significant differences when CD4 count of <200 cells/µl category was compared with CD4 count of 300-399 cells/µl (p=0.021) and >400 cells/µl categories (p<0.001). CONCLUSION: Plasma TG and TC/HDL-Chol were observed to have an association with severity of HIV infection as measured by a corresponding reduction in CD4 count.

Serum Uric Acid Predicts Antihypertensive Medication Adherence in Nigeria: A Hospital Based Study.

BACKGROUND: Hypertension is a major risk factor for cardiovascular morbidity and mortality. Optimum adherence to medication is still a perplexing matter for hypertensive patients in Nigeria and serum markers use as predictor for medication adherence has not been conclusive. AIM: To define the level of antihypertensive medication adherence, its possible correlation with serum uric acid (SUA) levels and other predictors of antihypertensive medication adherence among Nigerian patients. METHODS: Patients were recruited from the University Teaching Hospital Cardiology Clinic. Blood was drawn for SUA levels. Validated 8-item MMAS-8 was administered to hypertensives to measure adherence, and correlations analysed between SUA levels and the MMAS-8 score, with SPSS-23. SUA is defined as elevated in men with concentrations of =430µmols/l, normal range 200-430µmols/l, and =360µmol/l in women, normal range140-360µmol/l. Linear regression analysis of the predictors of antihypertensive medication adherence was done. A statistical p value of <0.05 was considered significant. RESULTS: The total number and mean age of the cases were 271 and 60.8±12.3years respectively. MMAS-8 revealed that about half of the hypertensives (131 cases, 48.3%) had low adherence (MMAS-8 score 4), 81 cases (29.5%) had medium adherence (MMAS-8 score 2) while 59 cases (22.1%) showed high adherence (MMAS-8 score 0). Bivariate Correlation between SUA levels in hypertensives and antihypertensive medication adherence was of moderate degree and significant (r=0.396, p<0.001) suggesting that SUA levels increased with increasing non-adherence to antihypertensive medications. This correlation remained significant after adjusting for singular confounding variables like age (r=0.371 fair relationship, p=<0.001), DM (r=0.382 fair relationship, p<0.001); blood pressure (BP) duration and class r=0.356, 0.306, fair relationship p<0.001 respectively). The correlation between SUA levels and adherence to antihypertensive medications was weakened (r=0.209, p<0.001) after adjusting for combined confounding variables. Linear regression revealed that SUA levels is a predictor of antihypertensive medication adherence. CONCLUSION: Antihypertensive medication adherence was unsatisfactory, elevated SUA levels correlated with low antihypertensive adherence, and this correlation was influenced by several singular and combined confounding variables in our patient population. Hence SUA levels can be a predictor and a marker of antihypertensive medication adherence.

Evaluating the efficacy of surgical excision and topical dimethyl sulphoxide (DMSO) in the treatment of equine cutaneous pythiosis.

BACKGROUND: Cutaneous pythiosis in horses is a chronic ulcerative granulomatous disease caused by the oomycete Pythium insidiosum. AIMS: The objective of the present study was to evaluate the response of cutaneous pythiosis in horses to surgical excision and topical dimethyl sulphoxide (DMSO). METHODS: Thirty horses were presented clinically with pruritus, fistulae discharging serosanguineous fluid, and output kunkers in different body areas (limb, abdomen, neck, and face). The clinical diagnosis was confirmed by isolation of the causative agent and histopathology. All animals were treated by surgical excision alone, or surgical excision followed by topical DMSO. The healing process was monitored every week macroscopically to evaluate the response to treatment until complete recovery. RESULTS: The existence of Pythium insidiosum was confirmed in all cases. Histologically, affected horses were characterized by granulation tissue with abundant eosinophils. The size of wounds and the clinical features of pythiosis lesions decreased more after surgical debridement with DMSO application than surgical excision alone. The cutaneous pythiosis lesions were completely recovered at 35 ± 7 and 60 ± 5 days after the surgical excision with topical DMSO and surgical excision alone, respectively. CONCLUSION: The combination of surgical excision and topical DMSO is found an effective treatment for cutaneous pythiosis in horses.

Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment.

PURPOSE: The purpose of this study was to determine the clinical success rate of nonoperative treatment of partial-thickness rotator cuff tears (PT-RCTs), to determine baseline clinical factors predictive of outcome of nonoperative treatment of PT-RCTs, and to determine the imaging outcome of nonoperative treatment of PT-RCTs. PATIENTS AND METHODS: All patients with a primary diagnosis of a PT-RCT were eligible for inclusion. Seventy-six patients (48 males, 28 females) with an average age of 52±10 years were included in the study. Patients were evaluated using a standardized format including clinical, imaging, and shoulder specific quality-of-life outcomes. Patients were assessed and treated either successfully nonoperatively or consented to undergo surgical intervention of their PT-RCT. Patients treated nonoperatively underwent follow-up by MRI arthrogram. RESULTS: Thirty-seven patients (49%) underwent nonoperative treatment. Logistic regression analysis indicated that the baseline variables of side (dominant or nondominant side involved), onset (traumatic or atraumatic), and thickness of tendon tear (<50% or >50%) were significant predictors of outcome. At a mean 46±7 months of follow-up, nonoperatively treated patients demonstrated a mean American Shoulder and Elbow Surgeons score of 85.1±16.0, and a Simple Shoulder Test score of 10.0±2.5. Overall, 76% of tears treated nonoperatively did not show a tear progression on anatomic imaging. Nine patients (24%) demonstrated tear progression, of which three patients (8%) demonstrated full-thickness tearing. CONCLUSION: Nonoperative treatment was utilized in ~50% of the patients and resulted in improved clinical outcomes. Onset, shoulder involved, and thickness of the tear were predictive of the success of nonoperative treatment.

Long-term outcomes of the Bankart and Latarjet repairs: a systematic review.

The most common surgical techniques for the treatment of recurrent anterior shoulder instability include the arthroscopic Bankart repair, the open Bankart repair and the open Latarjet procedure. The purpose of this study was to evaluate and compare the long-term outcomes following these procedures. A systematic review of modern procedures with a minimum follow-up of 5 years was completed. The objective outcome measures evaluated were post-operative dislocation and instability rate, the Rowe score, radiographic arthritis and complications. Twenty-eight studies with a total of 1652 repairs were analyzed. The estimated re-dislocation rate was 15.1% following arthroscopic Bankart repair, 7.7% following open Bankart repair and 2.7% following Latarjet repair, with the comparison between arthroscopic Bankart and open Latarjet reaching statistical significance (p<0.001). The rates of subjective instability and radiographic arthritis were consistently high across groups, with no statistical difference between groups. Estimated complication rates were statistically higher in the open Latarjet repair (9.4%) than in the arthroscopic Bankart (0%; p=0.002). The open Latarjet procedure yields the most reliable method of stabilization but the highest complication rate. There are uniformly high rates of post-operative subjective instability symptoms and radiographic arthritis at 5 years regardless of procedure choice.

Magnetic resonance imaging arthrography following type II superior labrum from anterior to posterior repair: interobserver and intraobserver reliability.

BACKGROUND: Arthroscopic repair of type II superior labrum from anterior to posterior (SLAP) lesions is a common surgical procedure. However, anatomic healing following repair has rarely been investigated. The intraobserver and interobserver reliability of magnetic resonance imaging arthrography (MRA) following type II SLAP repair has not previously been investigated. This is of particular interest due to recent reports of poor clinical results following type II SLAP lesion repair. PURPOSE: To evaluate the MRA findings following arthroscopic type II SLAP lesion repair and determine its intraobserver and interobserver reliability. STUDY DESIGN: Cohort study (diagnosis), Level of Evidence, 2. METHODS: Twenty-five patients with an isolated type II SLAP lesion (confirmed via diagnostic arthroscopy) underwent standard suture anchor-based repair. At a mean of 25.2 months post-operatively, patients underwent a standardized MRA protocol to investigate the integrity of the repair. MRAs were independently reviewed by two radiologists and a fellowship trained shoulder surgeon. The outcomes were classified as healed SLAP repair or re-torn SLAP repair. RESULTS: On average, 54% of MRAs were interpreted as healed SLAP repairs while 46% of MRAs were interpreted as having a re-torn SLAP repair. Overall, only 43% of the studies had 100% agreement across all interpretations. The intraobserver reliability ranged from 0.71 to 0.81 while the interobserver reliability between readers ranged from 0.13 to 0.44 (Table 1). CONCLUSION: The intraobserver agreement of MRA in the evaluation of type II SLAP repair was substantial to excellent. However, the interobserver agreement of MRA was poor to fair. As a result, the routine use of MRA in the evaluation of type II SLAP lesion repair should be utilized with caution. A global evaluation of the patient, including detailed history and physical examination, is paramount in determining the cause of failure and one should not rely on MRA alone.

Arthroscopic repair of type II SLAP lesions: Clinical and anatomic follow-up.

AIMS: The aim was to evaluate the clinical and anatomic outcome of arthroscopic repair of type II SLAP lesions. MATERIALS AND METHODS: The senior author performed isolated repairs of 25 type II SLAP lesions in 25 patients with a mean age of 40.0 ± 12 years. All tears were repaired using standard arthroscopic suture anchor repair to bone. All patients were reviewed using a standardized clinical examination by a blinded, independent observer, and using several shoulder outcome measures. Patients were evaluated by magnetic resonance imaging arthrogram at a minimum of 1-year postoperatively. STATISTICAL ANALYSIS USED: Two-tailed paired t-test were used to determine significant differences in preoperative and postoperative clinical outcomes scores. In addition, a Fisher's exact test was used. RESULTS: At a mean follow-up of 54-month, the mean American Shoulder and Elbow Surgeons Shoulder Index (ASES) scores improved from 52.1 preoperatively to 86.1 postoperatively (P < 0.0001) and the Simple Shoulder Test (SST) scores from 7.7 to 10.6 (P < 0.0002). Twenty-two out of the 25 patients (88%) stated that they would have surgery again. Of the 21 patients who had postoperative magnetic resonance imaging arthrographys (MRAs), 9 patients (43%) demonstrated dye tracking between the labrum bone interface suggestive of a recurrent tear and 12 patients (57%) had a completely intact repair. There was no significant difference in ASES, SST, and patient satisfaction scores in patients with recurrent or intact repairs. CONCLUSIONS: Arthroscopic repair of type II SLAP lesions demonstrated improvements in clinical outcomes. However, MRA imaging demonstrated 43% of patients with recurrent tears. MRA results do not necessarily correlate with clinical outcome.

Partial Thickness Rotator Cuff Tears: Current Concepts.

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized.

Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature.

PURPOSE: Over the past decade, a number of arthroscopic or arthroscopically assisted reconstruction techniques have emerged for the management of acromioclavicular (AC) separations. These techniques provide the advantage of superior visualization of the base of the coracoid, less soft tissue dissection, and smaller incisions. While these techniques have been reported to provide excellent functional results with minimal complications, discrepancies exist within the literature. This systematic review aims to assess the rate of complications following these procedures. METHODS: Two independent reviewers completed a search of Medline, Embase, PubMed, and the Cochrane Library entries up to December 2013. The terms "Acromioclavicular Joint (MeSH)" OR "acromioclavicular* (text)" OR "coracoclavicular* (text)" AND "Arthroscopy (MeSH)" OR "Arthroscop* (text)" were used. Pooled estimates and 95% confidence intervals were calculated assuming a random-effects model. Statistical heterogeneity was quantified using the I(2) statistic. LEVEL OF EVIDENCE: IV. RESULTS: A total of 972 abstracts met the search criteria. After removal of duplicates and assessment of inclusion/exclusion criteria, 12 articles were selected for data extraction. The rate of superficial infection was 3.8% and residual shoulder/AC pain or hardware irritation occurred at a rate of 26.7%. The rate of coracoid/clavicle fracture was 5.3% and occurred most commonly with techniques utilizing bony tunnels. Loss of AC joint reduction occurred in 26.8% of patients. CONCLUSION: Arthroscopic AC reconstruction techniques carry a distinct complication profile. The TightRope/Endobutton techniques, when performed acutely, provide good radiographic outcomes at the expense of hardware irritation. In contrast, graft reconstructions in patients with chronic AC separations demonstrated a high risk for loss of reduction. Fractures of the coracoid/clavicle remain a significant complication occurring predominately with techniques utilizing bony tunnels.

Arthroscopic repair of massive, contracted, immobile tears using interval slides: clinical and MRI structural follow-up.

PURPOSE: The purpose of this study was to determine clinical and structural outcomes of arthroscopic repair of massive, contracted, immobile rotator cuff tears using interval slides. METHODS: Eleven patients who had rotator cuff tears that were irreparable using standard mobilization techniques, but were repaired using interval slides were reviewed. Patients were evaluated at mean 25.2 months (±10.3) post-operatively utilizing a standardized clinical examination and by magnetic resonance imaging (MRI). RESULTS: American Shoulder and Elbow Surgeons (ASES) and Simple Shoulder Test (SST) scores improved significantly (ASES p = 0.0001; SST p = 0.0001) from pre- to post-operative. Range of motion in forward elevation and external rotation increased from pre- to post-operative, though not significantly. Strength via manual muscle testing improved on forward elevation (p = 0.001) and external rotation (p = 0.007) from pre- to post-operative. Post-operative MRI demonstrated massive re-tearing to the original size in 6 patients (55 %) and intact rotator cuffs with tissue spanning the defects in 5 (45 %) patients. CONCLUSIONS: In patients with massive, contracted, immobile tears, an interval slide technique may be utilized as a salvage procedure. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using interval slide techniques can lead to good clinical and satisfactory structural outcomes. LEVEL OF EVIDENCE: IV.

The rotator cuff quality-of-life index predicts the outcome of nonoperative treatment of patients with a chronic rotator cuff tear.

BACKGROUND: Chronic rotator cuff tears are prevalent and can be disabling. The existing literature is unclear regarding the effectiveness of nonoperative treatment. The purposes of this study were to determine whether the outcome of nonoperative treatment can be predicted on the basis of the presenting clinical characteristics and whether the outcome achieved at three months after treatment can be maintained at two years. METHODS: The prospective cohort included ninety-three patients with a documented chronic full-thickness rotator cuff tear. Patients underwent a three-month supervised program of nonoperative treatment and were then evaluated by an orthopaedic surgeon. The treatment outcome was defined as a success if surgical treatment was no longer deemed appropriate by both patient and surgeon because the patient had improved considerably and was predominantly asymptomatic. The outcome was defined as a failure if the patient elected to have surgery after failing to improve and remaining symptomatic. The presenting clinical characteristics that were analyzed included age, sex, smoking status, hand dominance, duration of symptoms, onset (traumatic etiology or insidious onset), shoulder motion, external rotation strength, tear size as documented by ultrasonography or magnetic resonance imaging, and the Rotator Cuff Quality-of-Life Index (RC-QOL). RESULTS: Seventy (75%) of the patients were successfully treated. Logistic regression analysis showed that the baseline RC-QOL score was a significant predictor of outcome (p = 0.017). Eighty-nine percent of patients maintained their three-month outcome at two years of follow-up. CONCLUSIONS: The RC-QOL was predictive of the outcome of nonoperative treatment of patients with a chronic full-thickness rotator cuff tear. Patients in whom the nonoperative treatment was deemed successful at the conclusion of three months of treatment had a very high chance of ongoing success at two years after the initiation of treatment.

Transtendon rotator-cuff repair of partial-thickness articular surface tears can lead to medial rotator-cuff failure.

PURPOSE: The purpose of this study was to evaluate clinical and anatomic outcomes of patients following transtendon rotator-cuff repair of partial articular supraspinatus tendon avulsion (PASTA) lesions. PATIENTS AND METHODS: Patients in the senior author's practice who had isolated PASTA lesions treated by transtendon rotator-cuff repair were included (n=8) and retrospectively reviewed. All patients were evaluated preoperatively and at a mean of 21.2 months (±9.7 months) postoperatively using standardized clinical evaluation (physical exam, American Shoulder and Elbow Surgeons, and Simple Shoulder Test). All patients underwent postoperative imaging with a magnetic resonance imaging arthrogram. RESULTS: There was a significant improvement in American Shoulder and Elbow Surgeons (42.7±17.5 to 86.9±25.2) and Simple Shoulder Test (4.6±3.2 to 10.1±3.8) scores from pre- to postoperative, respectively. Postoperative imaging demonstrated full-thickness medial cuff tearing in seven patients, and one patient with a persistent partial articular surface defect. CONCLUSION: Transtendon repair of PASTA lesions may lead to improvements in clinical outcome. However, postoperative imaging demonstrated a high incidence of full-thickness rotator-cuff defects following repair.

Malondialdehyde and antioxidant enzymes in second and third trimesters of pre-eclamptic Nigerian women.

AIM AND OBJECTIVE: To determine changes in malondialdehyde (product of lipid peroxidation) and antioxidant enzymes (Superoxide Dismutase, Glutathione Per-oxidase) levels in pre-eclamptic Nigerian women PATIENTS AND METHODS: A Total of 100 subjects each for pre-eclamptic,apparently normal and non pregnant women were recruited into the study.Venous blood samples were taken from the participants during second and third trimesters of pregnancy and at the point of contact for non pregnant women. Malondialdehyde, glutathione peroxidase and superoxide dismutase were measured accordingly from plasma and haemolysate prepared from whole blood.Variables were analysed using SPSS version 16, taking level of significance to be 0.05 RESULTS: Plasma malondialdehyde in the third trimester (3.13±0.61umol/l) of pre-eclamptic subjects was higher than in the second trimester (3.00±1.21umol/l).Plasma malondialdehyde in the third trimester of normal pregnancy (2.03±0.71umol/l) was also found to be significantly higher than in the second trimester (1.65±0.62umol/ l)(p<0.0001). Glutathione peroxidase in pre-eclamptic subjects was significantly higher in the third trimester (2804.11±1573.00U/L) as compared to the second trimester (2655.00±1751.30U/L), p= 0.0001.Glutathione peroxidase activity in the third trimester of normal pregnancy(3339.50±1733.80U/L) was also found to be higher than in the second trimester(3023.50±1115.90U/L)(p=0.131). Superoxide dismutase activity was significantly lower in the third trimester of pre-eclamptic pregnancy when compared to second trimester (110.40±59.47 Vs 118.01±64.41 U/ ml)(p<0.039) .Similarly,superoxide dismutase activity was significantly lower in the third trimester of normal pregnancy (110.40±59.47U/ml) than in the second trimester(153.01±71.85U/ml)(p<0.0001). CONCLUSION: There was an increased level of lipid peroxidation products,malondialdehyde in subjects with pre-eclampsia. This was more in the third trimester. There was an increased oxidative stress in pre-eclampsia as evidenced also by low serum level of superoxide dismutase in the third trimester.Diet rich in antioxidant enzyme might be beneficial.

The use of an intra-articular depth guide in the measurement of partial thickness rotator cuff tears.

Purpose. The purpose of this study was to compare the accuracy of the conventional method for determining the percentage of partial thickness rotator cuff tears to a method using an intra-articular depth guide. The clinical utility of the intra-articular depth guide was also examined. Methods. Partial rotator cuff tears were created in cadaveric shoulders. Exposed footprint, total tendon thickness, and percentage of tendon thickness torn were determined using both techniques. The results from the conventional and intra-articular depth guide methods were correlated with the true anatomic measurements. Thirty-two patients were evaluated in the clinical study. Results. Estimates of total tendon thickness (r = 0.41, P = 0.31) or percentage of thickness tears (r = 0.67, P = 0.07) using the conventional method did not correlate well with true tendon thickness. Using the intra-articular depth guide, estimates of exposed footprint (r = 0.92, P = 0.001), total tendon thickness (r = 0.96, P = 0.0001), and percentage of tendon thickness torn (r = 0.88, P = 0.004) correlated with true anatomic measurements. Seven of 32 patients had their treatment plan altered based on the measurements made by the intra-articular depth guide. Conclusions. The intra-articular depth guide appeared to better correlate with true anatomic measurements. It may be useful during the evaluation and development of treatment plans for partial thickness articular surface rotator cuff tears.

Lateral releases of the subscapularis tendon.

The technique of arthroscopic subscapularis repair continues to evolve. A three-sided subscapularis release (e.g. anterior, posterior, superior) is commonly advocated for improving tendon excursion to bone. However, a lateral release is commonly required as well, particularly for full thickness, upper subscapularis tears and full thickness, complete subscapularis tears. We describe the techniques to identify and release the lateral subscapularis border, which aids in the completion of other releases.