Indian Ocean glacial deoxygenation and respired carbon accumulation during mid-late Quaternary ice ages.

Reconstructions of ocean oxygenation are critical for understanding the role of respired carbon storage in regulating atmospheric CO2. Independent sediment redox proxies are essential to assess such reconstructions. Here, we present a long magnetofossil record from the eastern Indian Ocean in which we observe coeval magnetic hardening and enrichment of larger, more elongated, and less oxidized magnetofossils during glacials compared to interglacials over the last ~900 ka. Our multi-proxy records of redox-sensitive magnetofossils, trace element concentrations, and benthic foraminiferal Δδ13C consistently suggest a recurrence of lower O2 in the glacial Indian Ocean over the last 21 marine isotope stages, as has been reported for the Atlantic and Pacific across the last glaciation. Consistent multi-proxy documentation of this repeated oxygen decline strongly supports the hypothesis that increased Indian Ocean glacial carbon storage played a significant role in atmospheric CO2 cycling and climate change over recent glacial/interglacial timescales.

Convalescence after arthroscopic capsular release in frozen shoulder.

INTRODUCTION: To determine if arthroscopic capsular release (ACR) shortens duration of illness in frozen shoulder (FS) in comparison to the depicted natural course of 30.1 months and to identify risk factors for persisting complaints. MATERIALS AND METHODS: A consecutive group of 71 shoulders in 70 patients with mean age of 54 (37-74) years with FS were treated by ACR and enrolled in our study with follow-up investigation at 1, 3, 6 and finally 32 (19-49) months postoperatively. RESULTS: Patients had complaints for 8 (3-60) months preoperatively. 8 shoulders (11%) were classified as primary and 63 (89%) shoulders as secondary type FS. 6 patients were lost to follow-up. Relative Constant score increased significantly from 31% before surgery to 103% at last follow-up. 55 patients (85%) achieved subjective remission after 7 (1.5-18) months, postoperatively. Overall duration of illness was 16 (5-72) months. All patients with primary FS achieved remission and all patients with persisting symptoms had secondary FS. CONCLUSION: Duration of illness was shortened by more than 12 months compared with the natural time course defined by Reeves. Secondary FS, especially ac-joint pathologies, previous surgery, diabetes and more than 12 months preoperative illness duration were identified as risk factors for persisting complaints. Hypothesis of worse outcome in secondary FS was confirmed.

Calcifying tendinitis and outlet impingement - Evaluation of the prevalence analyzing radiological and intraoperative criteria.

INTRODUCTION: The question of our study was to evaluate the incidence of coexisting outlet impingement among patients with calcifying tendinitis and a failure of the conservative treatment using intraoperative in addition to radiological criteria.This question is of clinical relevance as there is still a discussion about whether an additional arthroscopic subacromial decompression (ASD) should be performed when arthroscopic removal of the calcific deposits is needed. MATERIALS AND METHODS: From February 2017 to 02/2018, we prospectively enrolled 50 patients who needed shoulder arthroscopy for calcifying tendinitis. We evaluated the x-rays for outlet impingement, measuring the lateral acromial angle (LAA), acromion slope, acromion index (AI) and Bigliani-type of the acromion. During shoulder arthroscopy, we evaluated the acromial undersurface for a bony impingement using a standardized view. If impingement was present, we performed an additional ASD. Before surgery, three months later and at final follow-up 20 months after surgery, we determined the relative Constant Score (rCS). RESULTS: 92.5% of the patients had an intraoperatively confirmed outlet impingement, whereas 82.5% of the patients had a radiological outlet impingement. The sensitivity of the radiographs was 83.8%, the specificity 33.3% when combining all parameters. The mean rCS improved significantly from 45% to 100% at final follow-up. CONCLUSION: Our results show that coexisting outlet impingement is very common in patients with calcifying tendinitis and failure of the conservative treatment. As the radiological diagnosis is uncertain, an intraoperative assessment for impingement is rational and justifies an additional ASD.

[Isolated fracture of the coracoid process in a 14-year-old national water polo player : Case example]. / Isolierte Fraktur des Processus coracoideus bei einem 14-jährigen Wasserballnationalspieler : Fallbeispiel.

BACKGROUND: Isolated fractures of the coracoid process during sporting activities are very rare. There are a few case studies and retrospective studies with low numbers of cases. OBJECTIVE: Presentation of an initially neglected fracture and conservative treatment. METHODS: Case study of a 14-year-old national water polo player with a non-dislocated fracture of the coracoid process and conservative therapy using focused shockwave therapy. RESULT: Return to sports after conservative therapy was after 13 weeks and return to competitive sport after 14 weeks. CONCLUSION: In cases with therapy refractory shoulder pain after trauma and unremarkable native X­ray, extended 3D imaging by magnetic resonance imaging (MRI) or computed tomography (CT) should be done early. Conservative therapy of a non-dislocated fracture in this case showed a good outcome.

Coupled microbial bloom and oxygenation decline recorded by magnetofossils during the Palaeocene-Eocene Thermal Maximum.

Understanding marine environmental change and associated biological turnover across the Palaeocene-Eocene Thermal Maximum (PETM; ~56 Ma)-the most pronounced Cenozoic short-term global warming event-is important because of the potential role of the ocean in atmospheric CO2 drawdown, yet proxies for tracing marine productivity and oxygenation across the PETM are limited and results remain controversial. Here we show that a high-resolution record of South Atlantic Ocean bottom water oxygenation can be extracted from exceptionally preserved magnetofossils-the bioinorganic magnetite nanocrystals produced by magnetotactic bacteria (MTB) using a new multiscale environmental magnetic approach. Our results suggest that a transient MTB bloom occurred due to increased nutrient supply. Bottom water oxygenation decreased gradually from the onset to the peak PETM. These observations provide a record of microbial response to the PETM and establish the value of magnetofossils as palaeoenvironmental indicators.

Ultrasound is as reliable as plain radiographs in the diagnosis of cam-type femoroacetabular impingement.

INTRODUCTION: In the diagnosis of femoroacetabular impingement (FAI), plain radiographs are accepted as the initial imaging method. However, there is no consensus regarding the optimal lateral view, and radiographs can underestimate the asphericity of the head-neck junction. Our research question was if ultrasound has at least the same reliability as X-ray and can be used as an alternative or additional method in the initial imaging of FAI. MATERIALS AND METHODS: Forty patients with a median age of 39 years were consecutively included after diagnosis of cam-type FAI on magnetic resonance imaging (MRI). All patients underwent radiography involving a plain anteroposterior-view, frog-leg lateral view, and ultrasound of the hip joint in the ventral longitudinal section at 20° internal rotation. Parameters measured by MRI, radiographs, and ultrasound were the alpha angle, anterior offset, offset ratio, and anterior femoral distance. RESULTS: No significant difference between the alpha angle on MRI (64.8°), the frog-leg view (66.3°), or ultrasound (65.6°) could be detected. Comparable correlation was found between the alpha angle on MRI and the frog-leg lateral view (r = 0.73; p < 0.0001) and between the alpha angle on MRI and sonograms (r = 0.77; p < 0.0001). The intra-class correlation coefficient for measurements using ultrasound was 0.81-0.98, and using radiographs was 0.83-0.99, with the exception of measurements involving the anterior offset on the frog-leg lateral view (0.61 and 0.64). CONCLUSIONS: Ultrasound is as reliable as plain radiographs in the diagnosis of cam-type FAI and can serve as an alternative or additional method in initial imaging.

Patients With Impingement Syndrome With and Without Rotator Cuff Tears Do Well 20 Years After Arthroscopic Subacromial Decompression.

PURPOSE: To present the long-term outcome of arthroscopic subacromial decompression (ASD) for patients with impingement syndrome with or without rotator cuff tears as well as with or without calcific tendinitis in a follow-up of 20 years. METHODS: We included 95 patients after a mean follow-up of 19.9 (19.5 to 20.5) years. All patients underwent ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning without cuff repair. The Constant score was used to assess the functioning of the shoulder. In addition, we defined a combined failure end point of a poor Constant score and revision surgery. RESULTS: Revision surgery was performed in14.7% of the patients. The combined end point showed successful results in 78.8% of all cases. All patients with isolated impingement syndrome achieved successful results. Those with partial-thickness tears had successful outcomes in 90.9% of all cases, and patients with full-thickness tears had successful outcomes in 70.6% of all cases. The tendinitis calcarea group showed the poorest results, with a 65.2% success rate. CONCLUSIONS: Our long-term results show that patients with impingement syndrome who received ASD, including acromioplasty, resection of the coracoacromial ligament, and coplaning do well 20 years after the index surgery. ASD without cuff repair even appears to be a safe, efficacious, and sustainable procedure for patients with partial rotator cuff tears. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Ultrasonography can quantify the extent of osteochondroplasty after treatment of Cam-type femoroacetabular impingement.

PURPOSE: Surgical resection of femoroacetabular Cam impingement (cam-FAI) is now a generally accepted treatment, producing adequate hip score increases. Insufficient resection at the head-neck junction is the main reason for revision. The anterolateral region of the head-neck junction is visualized only suboptimally by radiography, which can be inadequate for monitoring resection results postoperatively. Our aim was to investigate the extent of Cam resection by ultrasonography (US) and determine if there is any correlation with clinical outcome. METHODS: Altogether, 40 consecutive patients (mean age 39 years) were enrolled in this prospective study following arthroscopic Cam resection. All patients underwent standardized US examination in the ventral longitudinal section at 20° external rotation, neutral position, and 20° internal rotation the day before arthroscopy and two days afterward. Alpha angle, anterior offset, offset ratio, and anterior femoral distance were measured on sonograms. Hip Disability and Osteoarthritis Outcome Score (HOOS) and Western Ontario and McMaster University Index of Osteoarthritis (WOMAC) were conducted the day before surgery and 6 weeks postoperatively (at the earliest). RESULTS: Alpha angle was significantly smaller on postoperative US in all hip joint positions. At 20° internal rotation, the alpha angle decreased from 65.6 to 36.9° (p < 0.0001). All but two (5%) patients had alpha angles <50°. Anterior offset increased significantly on US in neutral position and at 20° internal rotation. HOOS and WOMAC increased significantly. No correlation was found between measurements for Cam-FAI and the scores. CONCLUSIONS: US may be a useful tool for monitoring Cam-FAI resection results postoperatively.

Biomechanical analysis for primary stability of shoulder arthrodesis in different resection situations.

BACKGROUND: Only very few publications dealing with shoulder arthrodesis after bone resection procedures and no biomechanical studies are available. The presented biomechanical analysis should ascertain the type of arthrodesis with the highest primary stability in different bone loss situations. METHODS: On 24 fresh cadaveric shoulder specimens three different bone loss situations were investigated under the stress of abduction, adduction, anteversion and retroversion without destruction by the use of a material testing machine. In each of the testings a 16-hole reconstruction plate was used and compared to arthrodesis with an additional dorsal 6-hole plate. FINDINGS: The primary stability of shoulder arthrodesis with a 16-hole reconstruction plate after humeral head resection could be increased significantly if an additional dorsal plate was used. However, no significant improvement with the additional plate was detected after resection of the acromion. Of all investigated forms, arthrodesis after humeral head resection with additional plate showed the highest and arthrodesis after humeral head resection without additional plate showed the lowest force values. The mean values for forces achieved in abduction and adduction were considerably higher than those in anteversion and retroversion. INTERPRETATION: There are no consistent specifications of arthrodesis techniques after resection situation available, thus the presented biomechanical testings give important information about the most stable form of arthrodesis in different types of bone loss. These findings provide an opportunity to minimize complications such as pseudarthrosis for a satisfying clinical outcome.

Evaluation of Cam-type femoroacetabular impingement by ultrasound.

PURPOSE: In the diagnosis of femoroacetabular impingement (FAI), magnetic resonance imaging (MRI) and X-ray are widely accepted methods for detection. When evaluating the hip head-neck junction using MRI, oblique axial sequences are required. However, the construction and analysis of these images are restricted to specialist radiologists and surgeons in the field of hip joint MRI. This study sought to investigate whether ultrasound, a simple and inexpensive method, can be used as a reliable tool for diagnosing Cam-type FAI. METHODS: Forty patients, with a mean age of 39 years (range, 18-61 years), were consecutively included in this prospective study, following a diagnosis of Cam-type FAI on an oblique axial MRI. All patients underwent ultrasound examination in the ventral longitudinal section at 20° external rotation, neutral position and 20° internal rotation. The alpha angle, anterior offset, offset-ratio, and anterior femoral distance (AFD) were measured using MRI and ultrasound. RESULTS: No significant differences were detected between the alpha angle on MRI and that using ultrasound in the neutral position or in 20° internal rotation, with strong correlations observed between these parameters (r = 0.67 for neutral position, r = 0.77 for 20° internal rotation). The Pearson's correlation coefficient for the alpha angle on MRI and the ratio of AFD/anterior offset on ultrasound in internal rotation was 0.76 (p < 0.0001). CONCLUSIONS: The results show strong correlations between MRI and ultrasound measurements in patients with Cam-type FAI. Consequently, ultrasound may provide a useful tool for the early diagnosis of Cam-type FAI in daily practice.

[Replacement of the Glenoid Using a Reconstruction Socket (EPOCA RECO]. / Endoprothetischer Glenoidersatz mit Rekonstruktionsschale (EPOCA RECO).

OBJECTIVE: Alleviation of pain, restoration of function and active range of motion in the shoulder in case of cuff tear arthropathy. INDICATIONS: Cuff tear arthropathy with an insufficient coracoacromial arch and salvage operation of failed hemiprosthesis or reverse shoulder prosthesis. CONTRAINDICATIONS: Active or chronic infections. Lesions of the plexus. Insufficiency of deltoid muscle or subscapularis muscle. Neurologic diseases. Young active patients. SURGICAL TECHNIQUE: Deltopectoral approach. Resection of the humeral head and removal of the failed implant, respectively. Periarticular arthrolysis with preservation of neurovascular structures. Exposure of the glenoid and three-point fixation of the reconstruction socket (EPOCA RECO) at the glenoid, the acromion and the coracoid process. Cemented fixation of the polyethylene inlay. Cemented or cementless implantation of the humeral stem in 25 degrees retroversion related to the long axis of the forearm. Reconstruction of the subscapularis muscle. POSTOPERATIVE MANAGEMENT: Bedding of the arm in a Gilchrist brace. Passive and active- assisted exercises including continuous passive motion. RESULTS: From 2002 to 2007, a total of 35 reconstruction sockets (EPOCA RECO) were implanted in 34 patients (six men, 28 women - one bilateral implantation was performed at an interval of 8 months in a female patient). Five EPOCA RECO implants had to be removed due to major complications. Three patients died, another three patients refused the follow-up examination. The remaining 23 patients (three men, 20 women, average age at the time of surgery 76 years [64-88 years]) were examined 2 years (4-60 months) postoperatively. The preoperative gender-related Constant Score was 21 and improved significantly (p < 0.001) to 58 postoperatively. The pain was significantly reduced. Range of motion for active elevation, internal and external rotation was improved (preoperatively/ postoperatively): elevation 37.2 degrees/65 degrees; internal rotation 14.8%/50%; external rotation 11.3%/47.5%. All patients would undergo the operation again. Overall, there were five major and two minor complications (complication rate 20%).