Lack of Consensus on the Management of Medial Collateral Ligament Tears in the Setting of Concomitant Anterior Cruciate Ligament Injury: A Critical Analysis.

¼ There is no clear agreement on the optimal timing or superior type of fixation for medial collateral ligament (MCL) tears in the setting of anterior cruciate ligament (ACL) injury.¼ Anatomic healing of medial knee structures is critical to maintain native knee kinematics, supported by biomechanical studies that demonstrate increased graft laxity and residual valgus rotational instability after ACL reconstruction (ACLR) alone in the setting of concomitant ACL/MCL injury.¼ Historically, most surgeons have favored treating acute combined ACL/MCL tears conservatively with MCL rehabilitation, followed by stress radiographs at 6 weeks after injury to assess for persistent valgus laxity before performing delayed ACLR to allow for full knee range of motion, and reduce the risk of postoperative stiffness and arthrofibrosis.¼ However, with the advancement of early mobilization and aggressive physical therapy protocols, acute surgical management of MCL tears in the setting of ACL injury can have benefits of avoiding residual laxity and further intra-articular damage, as well as earlier return to sport.¼ Residual valgus laxity from incomplete MCL healing at the time of ACLR should be addressed surgically, as this can lead to an increased risk of ACLR graft failure.¼ The treatment of combined ACL/MCL injuries requires an individualized approach, including athlete-specific factors such as level and position of play, timing of injury related to in-season play, contact vs. noncontact sport, and anticipated longevity, as well as consideration of the tear pattern, acuity of injury, tissue quality, and surgeon familiarity with the available techniques.

Anterior Cruciate Ligament Reconstruction: Fixation Techniques.

Anterior cruciate ligament reconstruction (ACLR) is among the most common procedures performed by orthopaedic sports medicine surgeons and has inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Awareness of the anatomic and biomechanical factors, including graft selection and tunnel placement, along with graft tensioning and fixation techniques, is vital in achieving a successful clinical outcome. Common techniques for ACLR graft fixation include intratunnel fixation with interference screws, suspensory fixation, or hybrid fixation strategies, along with several supplemental fixation techniques. Interference screw fixation may decrease graft-tunnel motion, tunnel widening, and graft creep and may be performed with metallic, PEEK (polyether ether ketone), or bioabsorbable screws. Suspensory fixation techniques primarily include suture-buttons, anchors, staples, and screws/washers. Suspensory fixation allows adequate biomechanical strength, although some techniques have been linked to increased graft-tunnel motion and potential tunnel widening. Supplemental fixation techniques may be performed in the setting of concerns for adequacy of primary fixation and includes the use of suture anchors, staples, and screw/washer devices. Regardless of the implant chosen for fixation, secure fixation is paramount to avoid displacement of the graft and allow for integration into the bone tunnel and facilitates early postoperative rehabilitation. It is important for orthopaedic sports medicine surgeons performing primary and revision ACLR to be familiar with multiple fixation techniques.

Acute Anterior Cruciate Ligament Reconstruction Performed Within 10 Days of Injury Does Not Increase Risk of Postoperative Arthrofibrosis: A Systematic Review and Meta-analysis.

BACKGROUND: The optimal timing of anterior cruciate ligament (ACL) reconstruction (ACLR) remains a controversial topic. Previous reviews have demonstrated that there are no differences between early and delayed ACLR; however, these studies have been limited by heterogeneous definitions of acute ACL injury. PURPOSE: To evaluate postoperative patient functional outcomes and risk for arthrofibrosis after acute arthroscopic ACLR performed ≤10 days after injury. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using multiple medical databases. Inclusion criteria were studies that evaluated postoperative range of motion outcomes for patients undergoing ACLR ≤10 days after initial ACL injury. For included comparative studies comparing patient groups undergoing ACLR ≤10 days and patients undergoing "delayed" ACLR after ≥3 weeks of initial injury, quantitative analysis was performed to assess for differences in postoperative arthrofibrosis, reoperation rates, and patient-reported outcomes between groups. DerSimonian-Laird binary random-effects models were constructed to quantitatively describe the association between the ACLR time period and patient outcomes by generating effect estimates in the form of odds ratios with 95% CIs. Qualitative analysis was performed to describe variably reported patient outcomes and the risk of arthrofibrosis after ACLR for noncomparative studies. RESULTS: Screening yielded 6 full-text articles with 448 patients who underwent ACLR (296 ACLR <10 days, 152 ACLR >3 weeks), with a pooled mean age of 28.1 years. For studies amenable to quantitative analysis, there were no significant differences between ACLR performed ≤10 days and ACLR performed at the 3-week point or after in terms of postoperative stiffness (3 studies; odds ratio, 1.27; P = .508), Tegner scores (2 studies; mean difference, -0.056; P = .155), or reoperation for stiffness (3 studies; odds ratio, 0.869; P = .462). The overall incidence of postoperative arthrofibrosis after 12 months of follow-up was 11 of 296 (3.7%) for ACLRs performed ≤10 days versus 6 of 152 (3.9%) for those performed at the 3-week point or after. CONCLUSION: ACLR performed ≤10 days after the inciting injury does not increase the risk of postoperative arthrofibrosis and demonstrates similar patient-reported outcomes compared with ACLR performed at the 3-week point or after.

From forests to fields: investigating Culicoides (Diptera: Ceratopogonidae) abundance and diversity in cattle pastures and adjacent woodlands.

Culicoides Latreille (Diptera: Ceratopogonidae) biting midges are hematophagous flies that feed on wild and domestic ruminants. They can transmit arboviruses, such as bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV), which circulate in the United States. Larvae occupy a range of aquatic and semiaquatic habitats, and disperse short distances from their development sites. In the southeastern United States, there are limited studies on the abundance and diversity of Culicoides in wooded and adjacent livestock pasture habitats. In this study, we characterized Culicoides diversity and abundance within these distinct habitat types. BG-Sentinel and CDC miniature suction traps baited with CO2 or UV-light were placed in wooded and pasture habitats at 2 locations on a university beef farm in Savoy, Arkansas. Traps were set once per week for 9 wk during August-October of 2021 and 2022. Fifteen species were collected during this study, and the 2 most abundant species were Culicoides haematopotus Malloch and Culicoides stellifer Coquillett. There was a significant effect of site and location on C. haematopotus collections, and a significant effect and interaction of site and trap on C. stellifer collections. In the woods, significantly more C. stellifer were collected from CDC-UV traps, while in the pasture significantly more were collected in CDC-CO2 traps. These data suggest that C. stellifer, a putative vector of BTV and EHDV in the southeast, may be traveling into the pasture to host-seek, while C. haematopotus remains primarily in wooded areas. This study reveals community differences between these habitat types and implications for Culicoides control.

No Difference in Recurrent Instability Between Knotted and Knotless Repair Techniques in Arthroscopic Treatment of Isolated Posterior Labral Tears: A Systematic Review.

Purpose: To compare clinical failure, recurrent instability, patient-reported outcome measures (PROMs), and return to sport (RTS) between knotted and knotless fixation methods in arthroscopic posterior labral repair for isolated posterior shoulder instability (PSI). Methods: Multiple databases were queried according to Preferred Reported Items for Systematic Reviews and Meta-Analyses guidelines for clinical studies with Level I to IV evidence, including knotted and knotless suture anchors for arthroscopic posterior labral repair. Combined anterior and posterior instability, multidirectional instability, SLAP injuries, unspecified repair techniques, majority open procedures, and revision surgery were excluded. Results: Screening yielded 17 full-text articles reporting on 852 shoulders undergoing posterior labral repair. Recurrent instability ranged from 0% to 21%, and the rate of revision surgery ranged from 0% to 11% in knotted only, 0% in knotless only, and 2.0% to 8.1% in knotted and knotless studies. Six studies with both pre- and postoperative visual analog scale scores and 7 studies with both pre- and postoperative American Shoulder and Elbow Score scores all showed improvement in scores after intervention regardless of repair technique. Thirteen studies reported RTS or duty rates with a minimum of 79%. Conclusions: Overall recurrent instability after posterior labral repair for isolated PSI was low with improvement in PROMs and favorable RTS rates regardless of fixation method. There was no clear difference in recurrent instability or revision surgery between knotted and knotless fixation methods for isolated posterior labral repair. However, the current literature is predominantly limited by Level III and IV evidence. The quality of literature and lack of standardization on the definition of clinical failure and recurrent instability among surgeons preclude any definitive conclusion regarding one clinically superior fixation method. Level of Evidence: Level IV, systematic review of Level III and IV studies.

In Situ Hybridization (RNAscope) Detection of Bluetongue Virus Serotypes 10 and 17 in Experimentally Co-Infected Culicoides sonorensis.

Bluetongue virus (BTV) is a segmented, double-stranded RNA virus transmitted by Culicoides biting midges. Infection of domestic and wild ruminants with BTV can result in a devastating disease and significant economic losses. As a virus with a segmented genome, reassortment among the BTV serotypes that have co-infected a host may increase genetic diversity, which can alter BTV transmission dynamics and generate epizootic events. The objective of this study was to determine the extent of dissemination and characterize the tropism of BTV serotypes 10 and 17 in co-infected Culicoides sonorensis. Midges were exposed to both BTV serotypes via blood meal and processed for histologic slides 10 days after infection. An in situ hybridization approach was employed using the RNAscope platform to detect the nucleic acid segment 2 of both serotypes. Observations of the mosaic patterns in which serotypes did not often overlap suggest that co-infection at the cellular level may not be abundant with these two serotypes in C. sonorensis. This could be a consequence of superinfection exclusion. Understanding BTV co-infection and its biological consequences will add an important dimension to the modeling of viral evolution and emergence.

PREVALENCE OF EHRLICHIA AND ANAPLASMA SPP. IN TICKS COLLECTED FROM CATTLE AND DEER IN ARKANSAS, USA.

Bovine anaplasmosis, caused by Anaplasma marginale, is widespread in cattle in the southeast United States. The pathogen is biologically transmitted by Dermacentor spp. ticks, and mechanically transmitted by biting flies and via fomites. Despite high reported regional seroprevalence, Dermacentor spp. are rare on cattle in the southeast. To identify other putative An. marginale vectors, and to characterize cattle exposure to other tick-borne pathogens, we collected ticks from Arkansas cattle herds in 2020-2022. Recognizing that deer are important hosts for some of the same tick species that parasitize cattle, we also collected ticks from hunter-killed deer in the fall and winter of 2021. Ticks were screened for bacteria in the family Anaplasmataceae using qPCR. Positive samples were further amplified using a PCR assay targeting the groEL gene, and the resulting amplicons were sequenced for identification. A total of 3,794 ticks were collected, the majority of which were Amblyomma americanum. Amblyomma americanum was the most common species on cattle, and Ixodes scapularis was most common on deer. No ticks were positive for An. marginale, though Anaplasma phagocytophilum was detected in deer-collected I. scapularis, as well as in a single engorged Am. americanum from cattle. Amblyomma americanum from cattle were infected with Ehrlichia ewingii, Ehrilichia chaffeensis, and Panola Mountain Ehrlichia. Cattle in Arkansas are exposed to several ehrlichial pathogens and may also be exposed to An. phagocytophilum. The importance of these pathogens, particularly Panola Mountain Ehrlichia, in causing cattle disease in Arkansas deserves further study, as does the importance of mechanical transmission of An. marginale in bovine anaplasmosis epidemiology.

Topical, contact, and oral susceptibility of adult Culicoides biting midges (Diptera: Ceratopogonidae) to fluralaner.

BACKGROUND: Culicoides biting midges (Diptera: Ceratopogonidae) are economically important blood-feeding pests closely associated with livestock production. They are the principal vectors of two hemorrhagic disease viruses affecting both wild and domestic ruminants within the US: bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV). BTV impacts the US agriculture sector through direct commodity loss and strict international livestock trade restrictions. Yet, despite posing a considerable threat to US livestock, Culicoides are understudied, and management strategies are lacking. Current control tools for Culicoides are limited to synthetic chemicals, predominantly pyrethroids. With limited products available for livestock producers, proper pesticide rotation is difficult. The present study investigates the efficacy of fluralaner, an isoxazoline insecticide, beyond its current labeled use as an ectoparasiticide in anticipation of adding a new class of pesticides into rotation for use against biting midges. METHODS: The efficacy of fluralaner was evaluated by conducting contact, topical, and oral toxicity bioassays on adult female Culicoides sonorensis. Contact toxicity was assessed by using a modified WHO cone assay, which simulates exposure through landing on an insecticide-treated surface. A modified WHO topical toxicity assay, in which fluralaner dilutions were administered to the lateral thorax, was used to assess topical toxicity. For evaluation of oral toxicity, females were offered a blood meal spiked with fluralaner in an artificial membrane feeding system to simulate a systemic insecticide. RESULTS: Contact exposure of fluralaner did not cause extensive or consistent mortality. Even the highest concentration tested (100 mg/ml) resulted in an average of only 24.3% mortality at 24 h, and mortality did not significantly differ between exposed and control midges at any concentration. One hundred percent mortality was consistently achieved at concentrations of 1 mg/ml when fluralaner was applied topically. The LC50 for topical exposure to fluralaner at 24 h was estimated to be 0.011 mg/ml. Oral exposure to fluralaner through ingestion of a spiked blood meal proved to be the most effective exposure method, significantly increasing mortality in a dose-dependent manner at 1 h post-exposure. The LC50 at 24 h following ingestion was 14.42 ng/ml. CONCLUSION: Our results suggest that fluralaner is a viable candidate for use as an insecticide against adult biting midges if exposed orally, such as in a systemic given to livestock. As withdrawal period requirements for meat animals present unique yet definitive challenges, pharmacokinetic studies of isoxazoline drugs need to be pursued and finalized for livestock before fluralaner may be used as a management strategy in this manner. Alternatively, livestock not raised for consumption, such as hair sheep, would directly benefit from administering oral fluralaner as a component of a BTV disease management program.

Minimally Invasive Distal Biceps Tendon Reconstruction With Semitendinosus Allograft and Dual Unicortical Button Fixation.

Complete rupture of the distal biceps tendon is routinely treated with direct repair; however, chronic, mid-substance, or musculotendinous tears are challenging clinical scenarios for surgeons. Although attempts at direct repair should be considered, in cases of severe retraction or tendon deficiency, a reconstruction may be warranted. Herein the authors describe a technique for distal biceps reconstruction using allograft with a Pulvertaft weave via a standard anterior incision, similar to primary repair, with a small catchment incision more proximally for tendon retrieval. Use of this technique with dual unicortical buttons allows for early range of motion, restoration of the distal footprint, and improved biomechanical construct strength, which has proven invaluable in a population of elite and highly active military servicemembers.

Co-occurrence of Culicoides guttipennis (Coquillett) with tree hole mosquito species, including Aedes albopictus Skuse, in container habitats in northwest Arkansas, U.S.A.

Natural and artificial water-filled containers serve as development sites for several larval Dipterans, including medically important mosquito species and Culicoides biting midges. Containers are discrete habitats with limited carrying capacity and high levels of both intra- and interspecific competition. While the outcomes of the interactions between mosquito species, particularly native and introduced Aedes, have been well described, competition between mosquitoes and other taxa, including Culicoides, is largely unstudied. To determine the extent of shared resource use between container-inhabiting mosquito and biting midge species, we surveyed water-filled natural and artificial container habitats in Washington County, AR. Larvae were collected from containers in the field and reared in the laboratory until the adult stage, where they were identified to species. Culicoides guttipennis, the only Culicoides species identified, co-occurred with four mosquito species, including the invasive Aedes albopictus. Culicoides larvae were more common in natural than artificial containers. Natural container samples from which Ae. albopictus emerged were significantly less likely to harbor Culicoides larvae than samples where that mosquito species was absent, suggesting the possibility that Ae. albopictus competes either directly or indirectly with other native taxa beyond congeners. Further research is needed on the nature of the interactions between Ae. albopictus and native Culicoides spp.

Improving visualization in shoulder arthroscopy.

Arthroscopic shoulder procedures are one of the most common procedures used to restore function through minimally invasive techniques. With the demand for shoulder arthroscopic procedures comes the need for safe, effective, and efficient surgery that maximizes patient outcomes while minimizing complications. Many variables contribute to visualization in shoulder arthroscopy including vascular anatomy, blood pressure control, arthroscopic pump systems, turbulence control, epinephrine, and tranexamic acid. Furthermore, patient positioning can have a dramatic effect on visualization with both the beach chair position and lateral decubitus positioning having various strengths and weaknesses depending on the intended procedure being performed. The purpose of this review is to examine the benefits and complications reported in the literature for improving visualization in shoulder arthroscopy.

Biomechanical comparison of anterior cruciate ligament reconstruction fixation methods and implications on clinical outcomes.

Anterior cruciate ligament reconstruction (ACLR) is one of the more common surgeries encountered by orthopaedic surgeons, which has its inherent challenges due to the complex anatomy and biomechanical properties required to reproduce the function and stability of the native ACL. Multiple biomechanical factors from graft choice and tunnel placement to graft tensioning and fixation methods are vital in achieving a successful clinical outcome. Common methods of ACLR graft fixation in both the primary and revision setting are classified into compression/interference, suspensory, or hybrid fixation strategies with multiple adjunct methods of fixation. The individual biomechanical properties of these implants are crucial in facilitating early post-operative rehabilitation, while also withstanding the shear and tensile forces to avoid displacement and early graft failure during graft osseointegration. Implants within these categories include the use of interference screws (IFSs), as well as suspensory fixation with a button, posts, surgical staples, or suture anchors. Outcomes of comparative studies across the various fixation types demonstrate that compression fixation can decrease graft-tunnel motion, tunnel widening, and graft creep, at the risk of damage to the graft by IFSs and graft slippage. Suspensory fixation allows for a minimally invasive approach while allowing similar cortical apposition and biomechanical strength when compared to compression fixation. However, suspensory fixation is criticized for the risk of tunnel widening and increased graft-tunnel motion. Several adjunct fixation methods, including the use of posts, suture-anchors, and staples, offer biomechanical advantages over compression or suspensory fixation methods alone, through a second form of fixation in a second plane of motion. Regardless of the method or implant chosen for fixation, technically secure fixation is paramount to avoid displacement of the graft and allow for appropriate integration of the graft into the bone tunnel. While no single fixation technique has been established as the gold standard, a thorough understanding of the biomechanical advantages and disadvantages of each fixation method can be used to determine the optimal ACLR fixation method through an individualized patient approach.

A Review of the Vector Status of North American Culicoides (Diptera: Ceratopogonidae) for Bluetongue Virus, Epizootic Hemorrhagic Disease Virus, and Other Arboviruses of Concern.

Purpose of Review: Culicoides biting midges transmit several pathogens of veterinary importance in North America, but the vector status of many midge species is unresolved. Additionally, the available evidence of vector competence in these species is scattered and variable. The purpose of this review is to summarize current knowledge on confirmed and putative North American Culicoides arbovirus vectors. Recent Findings: While the vector status of Culicoides sonorensis (EHDV, BTV, VSV) and Culicoides insignis (BTV) are well established, several other potential vector species have been recently identified. Frequently, these species are implicated based primarily on host-feeding, abundance, and/or detection of arboviruses from field-collected insects, and often lack laboratory infection and transmission data necessary to fully confirm their vector status. Recent genetic studies have also indicated that some wide-ranging species likely represent several cryptic species, further complicating our understanding of their vector status. Summary: In most cases, laboratory evidence needed to fully understand the vector status of the putative Culicoides vectors is absent; however, it appears that several species are likely contributing to the transmission of arboviruses in North America.

Improving Care by Decreasing Wait Times: A Military Health System Quality Improvement Project.

INTRODUCTION: Maximizing patient satisfaction is now a significant focus in many outpatient orthopedic clinics as it has been shown to affect many facets of healthcare. With this quality improvement study, we sought to determine the areas of the longest patient wait time during their clinical encounter and evaluate the effect of an identification card system on those times. We hypothesized that utilizing an identification card system would expedite the time patients spend in the clinic and decrease wait times. METHODS: This quality improvement study was conducted in an orthopedic hand surgery clinic within a military treatment facility. Pre-intervention and intervention data collection consisted of a time sheet that was filled out by surgeons and clinic staff as the patient progressed through their appointment. The intervention consisted of a card system to track the patient throughout their encounter and mark their order in the queue. RESULTS: There were a total of 130 patients in the pre-intervention group and 113 in the intervention group. Compared with the pre-intervention group, the intervention group patients had significantly less time from check-in to being roomed by the clinic staff with a mean of 13 ± 13 vs. 21 ± 19 minutes in the pre-intervention group (P < .001). In the pre-intervention cohort, the average clinic encounter was 66 ± 38 minutes compared to 57 ± 35 minutes in the intervention cohort, which was not statistically significant (P = .112). The time spent with the orthopedic surgeon and occupational therapists increased in the intervention group. CONCLUSION: We provided a simple way to decrease patient wait times and increase time with the healthcare team, utilizing our existing clinic space. Time with the orthopedic surgeon significantly increased because of our intervention, while the overall clinic time trended down.

Aedes aegypti (L.) and Anopheles stephensi Liston (Diptera: Culicidae) Susceptibility and Response to Different Experimental Formulations of a Sodium Ascorbate Toxic Sugar Bait.

Attractive toxic sugar baits (ATSBs) require target insects to locate, orient toward, and feed on an insecticidal sugar solution to control populations. Formulating these baits with different attractants and phagostimulants can increase their efficacy by causing insects to choose the ATSB over competing natural sugar sources, and to ingest more of the bait solution. We tested formulations of a 20% sodium ascorbate (SA) ATSB solution using different sugars, adenosine triphosphate (ATP), gallic acid, and six plant volatile compounds to determine their effect on adult Aedes aegypti (L.) and Anopheles stephensi Liston mortality. Baits formulated with fructose or sucrose had no effect on either species, neither did the addition of ATP. Gallic acid increased the survival of Ae. aegypti. Four of the six volatile compounds increased mortality in at least one species. We also examined An. stephensi response to baits formulated with each of the six volatile compounds. Anisaldehyde significantly increased the number of mosquitoes responding toward the SA-ATSB, but increasing the amount had no effect. Addition of anisaldehyde also significantly increased An. stephensi feeding rates on the SA-ATSB, though mosquitoes will avoid the toxic bait if a nontoxic sugar source is available. Formulation of SA-ATSBs with synthetic blends of attractive compounds can increase bait efficacy and consistency, though further research is needed to assess their performance in the field in the presence of natural sugar sources.

Bluetongue Research at a Crossroads: Modern Genomics Tools Can Pave the Way to New Insights.

Bluetongue virus (BTV) is an arthropod-borne, segmented double-stranded RNA virus that can cause severe disease in both wild and domestic ruminants. BTV evolves via several key mechanisms, including the accumulation of mutations over time and the reassortment of genome segments.Additionally, BTV must maintain fitness in two disparate hosts, the insect vector and the ruminant. The specific features of viral adaptation in each host that permit host-switching are poorly characterized. Limited field studies and experimental work have alluded to the presence of these phenomena at work, but our understanding of the factors that drive or constrain BTV's genetic diversification remains incomplete. Current research leveraging novel approaches and whole genome sequencing applications promises to improve our understanding of BTV's evolution, ultimately contributing to the development of better predictive models and management strategies to reduce future impacts of bluetongue epizootics.

Structural and Morphological Properties of Wool Keratin and Cellulose Biocomposites Fabricated Using Ionic Liquids.

In this study, the structural, thermal, and morphological properties of biocomposite films composed of wool keratin mixed with cellulose and regenerated with ionic liquids and various coagulation agents were characterized and explored. These blended films exhibit different physical and thermal properties based on the polymer ratio and coagulation agent type in the fabrication process. Thus, understanding their structure and molecular interaction will enable an understanding of how the crystallinity of cellulose can be modified in order to understand the formation of protein secondary structures. The thermal, morphological, and physiochemical properties of the biocomposites were investigated by Fourier transform infrared (FTIR) spectroscopy, scanning electron microscopy (SEM), thermal gravimetric analysis (TGA), differential scanning calorimetry (DSC), and X-ray scattering. Analysis of the results suggests that both the wool keratin and the cellulose structures can be manipulated during dissolution and regeneration. Specifically, the ß-sheet content in wool keratin increases with the increase of the ethanol solution concentration during the coagulation process; likewise, the cellulose crystallinity increases with the increase of the hydrogen peroxide concentration via coagulation. These findings suggest that the different molecular interactions in a biocomposite can be tuned systematically. This can lead to developments in biomaterial research including advances in natural based electrolyte batteries, as well as implantable bionics for medical research.

The Application of Hyaluronic Acid/Alginate Sheet to Flexor Pollicis Longus Tendon Repair to Prevent Adhesion Formation: A Second Look.

Soft tissue traumas with tendon lacerations are challenging injuries to manage. Repair of these tendon injuries can be complicated by adhesions postoperatively, limiting patient function and satisfaction. Biologic agents have been developed to optimize tendon gliding after repair and can be used as adjuncts. When used in conjunction with a postoperative rehabilitation protocol, they can help restore function and range of motion (ROM). It is rare that the orthopedic surgeon can visualize a healed tendon repair as the results are often followed clinically. We present the case of a patient who underwent flexor tendon repair with the addition of hyaluronic acid (HA) and alginate tendon wrap. This same patient sustained a distal radius fracture one year later, allowing for a second look at the flexor tendon repair site during the operative fixation of his fracture.

On-field Emergencies and Emergency Action Plans.

Sideline coverage can be an enjoyable experience and provide the opportunity to witness and evaluate an athlete's pathology at the time of injury. While the majority of on-field injury will likely be of low acuity, it is essential to develop an Emergency Action Plan (EAP) to deliver excellent medical care efficiently. The EAP should provide a written, standardized multidisciplinary approach involving key personnel. The EAP should be rehearsed on at least an annual basis and should highlight the initial assessment of the patient while also accounting for the various types of trauma that may occur on the field and appropriate field extrication procedures. As most players who have a true on-field emergency will not return to same-day play, a thorough understanding of how to deliver emergency care and transfer the player to a higher level of care is essential.

A comparison of BG Sentinel and CDC trap attractants for mosquito surveillance in urban and suburban areas of Montgomery and Prince George's Counties, Maryland, U.S.A.

Monitoring mosquito populations is crucial for vector-borne disease surveillance. Routine mosquito surveillance in many regions of the United States is performed either by vector abatement districts or public health departments. These surveillance programs often use multiple trap types and attractants to target key mosquito species, however setting different traps with varying attractants can be expensive and labor intensive. Because funding for mosquito control is highly variable throughout the U.S., some programs may be limited in their surveillance capabilities. To determine whether a single trap-attractant combination could provide specificity for key vector and nuisance species, as well as sensitivity for rare species, we compared the BG-Sentinel 2 and CDC miniature light traps paired with CO2, UV-LED, BG Lure, BG Sweetscent, octenol, or chicken feathers. Trapping was conducted biweekly from June/July-October 2019 and 2020 in Montgomery and Prince George's County, MD. BG traps collected significantly more Aedes albopictus than CDC traps when paired with BG Lure, Sweetscent, or octenol. BG/CO2 traps collected both the greatest number of total mosquitoes and Culex pipiens. BG/CO2, CDC/CO2, and CDC/UV traps provided the most diverse collections. Trapping with the CO2-baited BG-Sentinel is recommended as an effective strategy for general mosquito surveillance when resources are limited.