Neuromuscular electrical stimulation is effective in strengthening the quadriceps muscle after anterior cruciate ligament surgery.

PURPOSE: Reduced ability to contract the quadriceps muscles is often found immediately following anterior cruciate ligament (ACL) surgery. This can lead to muscle atrophy and decreased function. Application of neuromuscular electrical stimulation (NMES) may be a useful adjunct intervention to ameliorate these deficits following ACL surgery. The purpose of this review was to determine whether NMES in addition to standard physical therapy is superior to standard physical therapy alone in improving quadriceps strength or physical function following ACL surgery. METHODS: A computer-assisted literature search was conducted utilizing PubMed, CINAHL, PEDro and Cochrane Library databases for randomized clinical trials where patients after ACL surgery received NMES with the outcome of muscle strength and/or physical function. Random effect models were used to pool summary estimates using standardized mean differences (SMD) for strength outcomes. Physical function outcomes were assessed qualitatively. Methodological quality was assessed from the Physiotherapy Evidence Database (PEDro)-score. RESULTS: Eleven studies met our inclusion criteria; results from six of these were pooled in the meta-analysis showing a statistically significant short-term effect of NMES (4-12 weeks) after surgery compared to standard physical therapy [SMD = 0.73 (95% CI 0.29, 1.16)]. Physical function also improved significantly more in the NMES groups. PEDro scores ranged from 3/10 to 7/10 points. CONCLUSION: NMES in addition to standard physical therapy appears to significantly improve quadriceps strength and physical function in the early post-operative period compared to standard physical therapy alone. LEVEL OF EVIDENCE: I.

Important clinical descriptors to include in the examination and assessment of patients with femoroacetabular impingement syndrome: an international and multi-disciplinary Delphi survey.

PURPOSE: Determine which examination findings are key clinical descriptors of femoroacetabular impingement syndrome (FAIS) through use of an international, multi-disciplinary expert panel. METHODS: A three-round Delphi survey utilizing an international, multi-disciplinary expert panel operationally defined from international publications and presentations was utilized. RESULTS: All six domains (subjective examination, patient-reported outcome measures, physical examination, special tests, physical performance measures, and diagnostic imaging) had at least one descriptor with 75% consensus agreement for diagnosis and assessment of FAIS. Diagnostic imaging was the domain with the highest level of agreement. Domains such as patient-reported outcome measures (PRO's) and physical examination were identified as non-diagnostic measures (rather as assessments of disease impact). CONCLUSION: Although it also had the greatest level of variability in description of examination domains, diagnostic imaging continues to be the preeminent diagnostic measure for FAIS. No single domain should be utilized as the sole diagnostic or assessment parameter for FAIS. While not all investigated domains provide diagnostic capability for FAIS, those that do not are able to serve purpose as a measure of disease impact (e.g., impairments and activity limitations). The clinical relevance of this Delphi survey is the understanding that a comprehensive assessment measuring both diagnostic capability and disease impact most accurately reflects the patient with FAIS. LEVEL OF EVIDENCE: V.

The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).

Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis.

BACKGROUND: Surgery for hip femoroacetabular impingement/acetabular labral tear (FAI/ALT) is exponentially increasing despite lacking investigation of the accuracy of various diagnostic measures. Useful clinical utility of these measures is necessary to support diagnostic imaging and subsequent surgical decision-making. OBJECTIVE: Summarise/evaluate the current diagnostic accuracy of various clinical tests germane to hip FAI/ALT pathology. METHODS: A computer-assisted literature search of MEDLINE, CINAHL and EMBASE databases using keywords related to diagnostic accuracy of the hip joint, as well as the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used for the search and reporting phases of the study. Quality assessment of bias and applicability was conducted using the Quality of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects models were used to summarise sensitivities (SN), specificities (SP), diagnostic odds ratio (DOR) and respective confidence intervals (CI). RESULTS: The employed search strategy revealed 21 potential articles, with one demonstrating high quality. Nine articles qualified for meta-analysis. The meta-analysis demonstrated that flexion-adduction-internal rotation (pooled SN ranging from 0.94 (95% CI 0.90 to 0.97) to 0.99 (95% CI 0.98 to 1.00); DOR 5.71 (95% CI 0.84 to 38.86) to 7.82 (95% CI 1.06 to 57.84)) and flexion-internal rotation (pooled SN 0.96 (95% CI 0.81 to 0.99); DOR 8.36 (95% CI 0.41 to 171.3) tests possess only screening accuracy. CONCLUSIONS: Few hip physical examination tests for diagnosing FAI/ALT have been investigated in enough studies of substantial quality to direct clinical decision-making. Further high-quality studies across a wider spectrum of hip pathology patients are recommended to discern the confirmed clinical utility of these tests. TRIALS REGISTRATION NUMBER: PROSPERO Registration # CRD42014010144.

Manure placement depth impacts on crop yields and N retained in soil.

The objective of this study was to determine the impact of manure placement depth on crop yield and N retention in soil. Experimental treatments were deep manure injection (45 cm), shallow manure injection (15 cm), and conventional fertilizer-based management with at least three replications per site. Water infiltration, and changes in soil N and P amounts were measured for up to 30 months and crop yield monitored for three seasons following initial treatment. Deep and shallow manure injections differed in soil inorganic N distributions. For example, in the manure slot the spring following application, NO(3)-N in the surface 60 cm was higher (p < .01) when injected 15 cm (21.4 micro g/g) into the soil than 45 cm (11.7 micro g/g), whereas NH(4)-N had opposite results with shallow injection having less (p = 0.045) NH(4)-N (102 micro g/g) than deep (133 micro g/g) injection. In the fall one year after the manure was applied, NO(3)-N and NH(4)-N were lower (p = 0.001) in the shallow injection than the deep injection. The net impact of manure placement on total N was that deep injection had 31, 59, and 44 more kg N ha(- 1) than the shallow injection treatment 12, 18, and 30 months after application, respectively. Deep manure injection did not impact soybean (Glycine max L.) yield, however corn (Zea mays L.) yield increased if N was limiting. The higher corn yield in the deep injected treatment was attributed to increased N use efficiency. Higher inorganic N amounts in the deep injection treatment were attributed to reduced N losses through ammonia volatilization, leaching, or denitrification. Results suggest that deep manure placement in glacial till soil may be considered a technique to increase energy, N use efficiency, and maintain surface and ground water quality. However, this technique may not work in glacial outwash soils due to the inability to inject into a rocky subsurface.

Immunoglobulin G antibodies to moulds in school-children from moisture problem schools.

BACKGROUND: The purpose of the present study was to evaluate mould-specific immunoglobulin G (IgG) antibodies in children exposed to moisture and mould problems in their school, and the association between IgG antibodies and mould allergy, active or passive smoking and respiratory symptoms. METHODS: IgG antibodies were studied to 24 moulds in 93 children from three moisture problem schools and in 33 children from a reference school. The antibodies were measured by enzyme-linked immunosorbent assay and compared to positive adult sera. RESULTS: There were no significant differences in mould-specific IgG concentrations between exposed and non-exposed school-children. Antibodies to moulds common in moisture damaged buildings were associated with allergic diseases, as well as with mould-specific immunoglobulin E (IgE) or skin prick test (SPT) findings. Aspergillus fumigatus and A. versicolor were the moulds with the most consistent findings. Active and passive smoking were associated with low levels of antibodies to many moulds. Though the association between asthma, wheezing or cough symptoms, and IgG to moulds was not significant, 7 (39%) of the 18 children with multiple (> 7) elevated IgG findings suffered from asthma or wheezing. CONCLUSIONS: Allergy was, but asthma was not, associated with IgG antibodies to the moulds that can be found in moisture damaged buildings. However, no association was found between IgG antibodies to moulds and exposure to moisture and moulds in school.

An outbreak of respiratory diseases among workers at a water-damaged building--a case report.

We describe a military hospital building with severe, repeated and enduring water and mold damage, and the symptoms and diseases found among 14 persons who were employed at the building. The exposure of the employees was evaluated by measuring the serum immunoglobulin G (IgG)-antibodies against eight spieces of mold and yeast common in Finnish water and mold damaged buildings and by sampling airborne viable microbes within the hospital. The most abundant spieces was Sporobolomyces salmonicolor. All but one of the employees reported some building-related symptoms, the most common being a cough which was reported by nine subjects. Four new cases of asthma, confirmed by S. salmonicolor inhalation provocation tests, one of whom was also found to have alveolitis, were found among the hospital personnel. In addition, seven other workers with newly diagnosed rhinitis reacted positively in nasal S. salmonicolor provocation tests. Skin prick tests by Sporobolomyces were negative among all 14 workers. Exposure of the workers to mold and yeast in the indoor air caused an outbreak of occupational diseases, including asthma, rhinitis and alveolitis. The diseases were not immunoglobulin E (IgE)-mediated but might have been borne by some other, as yet unexplained, mechanism.

Exposure to microbes, endotoxins and total dust in cigarette and cigar manufacturing: an evaluation of health hazards.

The concentrations of airborne microbes, endotoxins and total dust were measured in one cigar and two cigarette factories in order to evaluate the risk of respiratory symptoms. The role of humidifiers as a source of microbes was investigated. Air samples for the analyses were collected near workers' breathing zones during different phases of production. Gram-negative bacteria, mesophilic fungi, thermotolerant fungi and thermophilic actinomycetes, but not Aspergillus glaucus fungi, were found in higher concentrations in the cigar factory than in the cigarette factories. High microbe concentrations (10(4)-10(5)cfu m(-3)) occurred throughout the production line in the cigar factory. The highest dust and endotoxin concentrations were found in the wick-making department in the cigar factory (3.3mg dust per m(3) and 38ng endotoxin per m(3)) and during the weighing or handling of raw tobacco in the cigarette factories (4.5 mg dust per m(3) and 106ng endotoxin per m(3)). The spray humidifiers in the cigar factory were a more important source of microbes than was raw tobacco. In the cigarette factories, steam humidifiers were used; the humidified air was free of microbes. The microbe concentrations in the tobacco factories were lower than in environments known to have caused allergic alveolitis.

IgG antibodies, chronic bronchitis, and pulmonary function values in farmer's lung patients and matched controls.

We measured IgG antibody levels against eight different microbes in farmer's lung (FL) patients an average of 14 years after the first diagnosed episode of FL and in matched controls. The study population consisted of 87 FL patients and 81 control farmers, matched by age, sex, and smoking habits. Clinical studies included the measurement of IgG antibody levels against Absidia corymbifera, Aspergillus umbrosus, A. fumigatus, Humicola grisea, Saccharopolyspora rectivirgula, Penicillium brevicompactum, Rhodotorula glutinis, and Thermoactinomyces vulgaris, in addition to spirometry, pulmonary diffusing capacity (DL(CO)), and the evaluation of chronic bronchitis. Median IgG antibody levels were two or more times higher in FL patients than control farmers against Ab. corymbifera, S. rectivirgula, and T. vulgaris (P<0.001). Against A. fumigatus, H. grisea, and R. glutinis, FL patients also had significantly higher antibody levels. FL patients often had positive antibody titers against several microbes, whereas control farmers usually had a positive titer against one or two microbes. A positive association between IgG antibody levels and chronic bronchitis and DL(CO) was observed in FL patients, but not in control farmers. It is suggested that the high antibody levels noted in FL patients were due not only to high exposure but also to individual sensitivity to environmental microbes.

Endotoxins and IgG antibodies as indicators of occupational exposure to the microbial contaminants of metal-working fluids.

OBJECTIVES: The aim of this study was to evaluate workers' exposure to microbes and bacterial endotoxins during the use of metal-working fluids (MWF). METHODS: Air and bulk sampling with biomonitoring of workers' serum IgG antibodies were used to estimate the exposure to biological agents at 18 workplaces. The types of emulsified MWF used were synthetic fluid, mineral oil or rape seed oil, in grinding, turning and drilling work. RESULTS: The endotoxin concentrations in the air ranged from 0.04 to 600 ng/m(3) when the endotoxin levels in MWF were 0.03-25,000 ng/ml. A high correlation was found between the endotoxin levels and the bacterial counts from MWF, as well as between the total culturable bacteria and the gram-negative bacteria concentrations in the air. Comamonas testosteroni and C. acidovorans were the most common strains in the samples but also colonies of Ochrobactrum anthropi, Pantoea agglomerans and Stenotrophomonas maltophilia were isolated from the workplaces. Fungi like Aspergillus, Cladosporium and Penicillium species were identified in the air but only rarely in the MWF. Positive IgG antibodies were found in the sera of 22 of the 25 MWF workers examined. Antibodies against S. maltophilia, P. agglomerans and C. acidovorans were the most common, appearing in 72%, 64% and 64%, respectively, of the cases. The MWF workers showed significantly higher IgG antibody responses to bacterial antigens than did the controls. CONCLUSIONS: The results clearly proved that in occupational hygiene measurements, endotoxins serve as excellent indicators of exposure to the microbial contaminants of MWF. IgG antibodies against antigens identified from workplace samples could be a practical tool for occupational health physicians.

Exposure to airborne microorganisms and volatile organic compounds in different types of waste handling.

Occupational exposure of workers to airborne microorganisms and volatile organic compounds (VOC) in different types of waste treatment situations was examined during summer time. Microorganisms were collected as stationary samples using a six-stage Andersen impactor, while for VOCs both personal and stationary sampling was conducted. The exposure at the waste handling facility was considerably greater than at landfill sites or in waste collection. The concentrations of viable fungi were maximally 10(5) cfu/m3, and the concentrations of both total culturable bacteria and Gram-negative bacteria exceeded the proposed occupational exposure limit values (OELV), being 10(4) and 10(3) cfu/m3, respectively. Exposure to VOCs in the waste handling facility was three times higher than at the landfill sites, being at highest 3000 microg/m3, considered to be the limit for discomfort. The use of personal protective equipment at work, thorough hand washing and changing clothes after the work shift are strongly recommended in the waste handling facility and the landfill sites.

Cat, dog, and house-dust-mite allergen levels of house dust in Finnish apartments.

The presence of indoor allergens in Finnish homes was studied for the first time. Dust samples (n = 30) were collected by vacuuming a 1 m2 area from a living-room carpet in 30 apartments divided into three groups: homes with cats (n = 10), homes with dogs (n = 10), and homes without pets (n = 10). The levels of major cat (Fel d 1), dog (Can f 1), and house-dust-mite (Der p 1) allergens were analyzed by two-site ELISA methods. Der p 1 levels were below the detection limit in all dust samples. In the homes with cats or dogs, Fel 1 d and Can f 1 levels ranged from 147 to 2800 micrograms/g (geometric mean 296 micrograms/g), respectively, 567 micrograms/g), and from 86 to 1400 micrograms/g (geometric mean 296 micrograms/g), respectively, being slightly higher than those reported elsewhere. Low allergen levels, mainly below 3 micrograms/g were also detected in the homes without pets, indicating the transfer of allergens from place to place. However, in 25% of these samples, allergen levels exceeded the proposed threshold levels for cat or dog sensitization. The presence of pets was the most significant factor affecting cat and dog allergen levels in the house dust, and other factors, such as the amount of dust collected, residential time, and cleaning habits, had no or only a weak effect on allergen levels.

Serum IgG antibodies against Wallemia sebi and Fusarium species in Finnish farmers.

BACKGROUND: Wallemia sebi and Fusarium species are common fungi in agricultural environments. Because Fusarium species are difficult to culture, and W. sebi has only recently been found in an agricultural environment with the use of a new culture medium, immunochemical methods may be important for evaluating exposure to these fungi. OBJECTIVE: Immunoglobulin (Ig) G antibodies against W. sebi and two Fusarium species were measured in the sera of Finnish farmers to estimate exposure to fungi. METHODS: Serum-specific IgG antibody levels against the fungi were determined in farmers with farmer's lung disease and asthma, as well as in asymptomatic farmers with low and high IgG antibody levels against other agricultural microorganisms, and in control persons (printing and office workers). Both enzyme-linked immunosorbent assay (ELISA) and enzyme-linked immunofiltration assay (ELIFA) techniques were used. RESULTS: Significantly higher IgG antibody levels against the fungi studied were observed in farmer's lung patients and asymptomatic farmers with high IgG levels against other agricultural fungi, than in the control group. On the other hand, the development of IgG antibodies to the fungi in asthmatic farmers remained unclear because of a discrepancy between the ELISA and ELIFA results. Cross-reactivity between Fusarium species was detected. CONCLUSIONS: The results indicate that Finnish farmers are exposed to W. sebi and Fusarium species in their work environment to a greater extent than has earlier been evaluated with air sampling and microbiologic methods.

Qualitative identification of volatile metabolites from two fungi and three bacteria species cultivated on two media.

Two fungal species, Aspergillus fumigatus and Penicillium brevicompactum and three bacteria, Klebsiella pneumoniae, Enterobacter agglomerans and Streptomyces albus were cultivated on two media, malt extract agar and dichloran glycerol agar. The volatile metabolite samples from the cultures were adsorbed on Tenax TA and analyzed qualitatively by thermal desorption gas chromatography and with a mass selective detector. Various hydrocarbons, alcohols, ketones, esters and terpenes were identified. The production was highly dependent on both the medium and the microbial species. 2-Methyl-1-propanol, 2-methyl-1-butanol and 3-methyl-1-butanol were the most commonly produced substances. The bacterial species did not produce any hydrocarbons that were characteristic to the fungi (e.g. methyl-1,3-pentadiene, 1-octene and 1,3-octadiene or 8-carbon alcohols 1-octen-3-ol and 3-octanol). Instead, K. pneumoniae and E. agglomerans produced 3-hydroxy-2-butanone and 1-hydroxy-2-propanone, which were not produced by the fungi. Geosmin and a large number of sesquiterpenes were produced by S. albus.

Respiratory health of cigar factory workers.

OBJECTIVES: To determine whether occupational exposure to raw tobacco causes respiratory or allergic diseases, an excess of respiratory symptoms, a decrease in lung function, or parenchymal changes in chest radiography among Finnish cigar workers. METHODS: This cross sectional study included all Finnish cigar workers (n = 106) exposed to raw tobacco and also a group of unexposed matched referents. Data were collected with a self administered questionnaire, flow volume spirometry, measurements of diffusing capacity of the lung for carbon monoxide, chest radiography and skin prick tests. A questionnaire was also sent to former workers of the factory. RESULTS: There were no significant differences between the groups in the prevalence of respiratory symptoms and chest radiography findings. Nine of 102 tobacco workers had pulmonary fibrosis of at least 1/0 (according to the International Labour Organisation (ILO) 1980 classification) and the corresponding figure was five for the referents. The tobacco workers tended to have a low forced vital capacity (FVC), and they had impaired forced expiratory volume in 1 second and lower means of the maximal expiratory flow at 25% of the FVC significantly more often than the referents. Diffusing capacity tended to be lower among the referents. The referents more often had atopy and earlier atopic diseases than the exposed workers. These results indicate the possibility of selection among the exposed workers. CONCLUSIONS: No excess of prevalence of respiratory symptoms in the tobacco workers was found. According to the questionnaire episodes of allergic alveolitis may have occurred in the cigar factory workers. However, in the absence of impairments in lung function and radiological changes it was not possible to distinguish humidifier fever and allergic alveolitis. In exposure conditions that include humidification of the air humidifier, fever and allergic alveolitis constitute a risk for tobacco workers. No effects were shown of exposure to tobacco dust on lung function.

Exposure of subgingival margins by nonsurgical gingival displacement.

A procedure has been outlined in which (1) gingival displacement is accomplished prior to subgingival tooth preparation and (2) the margins thus created can be very readily registered with commonly used elastic impression materials. Although the technique involves the placement of three cords, the benefits of better visibility and not having to cope with bleeding tissues result in a saving of time during the preparation appointment. The predictability of tissue contours results in fewer remakes and more esthetic and biologically acceptable restorations.