Return to sports after bucket handle medial meniscus tear repair using inside out technique in recreational sports players.

The main purpose of our study is to determine the outcomes of bucket handle medial meniscus tears repaired with the inside out technique in recreational sports players, and the return of these to pre-injury sports levels. 41 athletes with medial meniscus bucket handle tear were included in the study. 28 cases were associated with ACL tear while rest were isolated tears. Medial meniscus repair was done exclusively with arthroscopy assisted inside out technique. Lysholm score, IKDC score and Tegner staging were used to evaluate functional status of patients with minimum 1-year follow-up. Data was analyzed using Wilcoxon Matched pairs test, and Friedman test. All patients were examined clinically at regular intervals. Lysholm score and IKDC score showed significant increase in their values. Tegner staging showed no significant change compared to their preinjury game level. On VAS pain scale, there was significant decrease in their pain at regular follow up intervals. 2 patients had re-tears of the repaired medial meniscus. Repairing bucket handle tears of the medial meniscus in recreational sports players with the inside out technique yields good results in terms of clinical and functional outcomes. It successfully allows them to return to sports at 1 year.

Development and validation of an interpretable deep learning framework for Alzheimer's disease classification.

Alzheimer's disease is the primary cause of dementia worldwide, with an increasing morbidity burden that may outstrip diagnosis and management capacity as the population ages. Current methods integrate patient history, neuropsychological testing and MRI to identify likely cases, yet effective practices remain variably applied and lacking in sensitivity and specificity. Here we report an interpretable deep learning strategy that delineates unique Alzheimer's disease signatures from multimodal inputs of MRI, age, gender, and Mini-Mental State Examination score. Our framework linked a fully convolutional network, which constructs high resolution maps of disease probability from local brain structure to a multilayer perceptron and generates precise, intuitive visualization of individual Alzheimer's disease risk en route to accurate diagnosis. The model was trained using clinically diagnosed Alzheimer's disease and cognitively normal subjects from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset (n = 417) and validated on three independent cohorts: the Australian Imaging, Biomarker and Lifestyle Flagship Study of Ageing (AIBL) (n = 382), the Framingham Heart Study (n = 102), and the National Alzheimer's Coordinating Center (NACC) (n = 582). Performance of the model that used the multimodal inputs was consistent across datasets, with mean area under curve values of 0.996, 0.974, 0.876 and 0.954 for the ADNI study, AIBL, Framingham Heart Study and NACC datasets, respectively. Moreover, our approach exceeded the diagnostic performance of a multi-institutional team of practicing neurologists (n = 11), and high-risk cerebral regions predicted by the model closely tracked post-mortem histopathological findings. This framework provides a clinically adaptable strategy for using routinely available imaging techniques such as MRI to generate nuanced neuroimaging signatures for Alzheimer's disease diagnosis, as well as a generalizable approach for linking deep learning to pathophysiological processes in human disease.

Repairing Posteromedial Meniscocapsular Separation: A Technique Using Inside-Out Meniscal Repair Needles.

Posteromedial meniscocapsular separation of the knee has received renewed interest, with many articles describing a high incidence in association with anterior cruciate ligament injury. Various techniques have been described to address these lesions using all-inside meniscal repair sutures or using rotator cuff repair instruments through the posteromedial portal. Most orthopaedic surgeons are accustomed to using the "inside-out" meniscal repair technique with a double-armed suture. This technique is cost-effective and, in our opinion, more efficient in repairing such tears. We present our technique of repairing peripheral meniscocapsular lesions using an inside-out meniscal repair system. We believe that this technique is easily reproducible, is less time-consuming, and ensures a good "bite" of the capsular tissue, producing a robust repair.

Factors influencing adherence to ART: new insights from a center providing free ART under the national program in Delhi, India.

BACKGROUND: Adherence to therapy is central to the success of antiretroviral treatment (ART). With the availability of free ART under the national program in India, cost of ART is no longer the primary determinant of adherence. This study evaluated the adherence and factors influencing it among patients receiving free ART in a public health ART center in India. METHODS: The adherence and its influences among 250 HIV-positive patients on first line ART for at least 3 months from the ART Center of Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India were analyzed. The adherence was assessed by patients' self report using the adult AIDS Clinical Trial Group (ACTG) questionnaire and counter checked with pharmacy records. The association of various parameters affecting adherence levels was analyzed by using SPSS package and Epiinfo software. RESULTS: Of the 250 patients, 242 (96.8%) had optimum adherence (>95%) and 8 (3.2%) were "non-adherent." CD4 counts (P = 0.05), high level of belief among patients, patients' knowledge about importance of adherence (P = 0.04), and sound mental health were positively influencing adherence. The main barriers to adherence were poor mental health and negative psychological states in the patients (0.001). The presence of adverse reactions to ART also resulted in poorer adherence. CONCLUSIONS: The modifiable factors most strongly associated with good adherence rates were higher current CD4 counts, patients' beliefs in ART, and positive mental health. These factors can be targeted by simple, practical interventions to improve and maintain high adherence levels.