Poor cervical proprioception as a risk factor for concussion in professional male rugby union players.

BACKGROUND: Concussion is one of the most common injuries in male professional Rugby Union ('rugby') and accounts for significant time loss from training and competition. Despite the most recent Concussion in Sport Group consensus statement recommending a focus on the identification of modifiable risk factors, limited evidence for their existence is available. OBJECTIVE: To investigate the association between cervical proprioception and concussion incidence in a group of professional male rugby players over the course of a full season. METHODS: 165 players were assessed at pre-, mid- and end of season time points using the Cervical Joint Position Error Test (CJPET). Associations with diagnosed concussion injuries are presented as incidence rate ratios with 95% confidence intervals. We present the Incidence Rate Ratios (IRR) for a 10% increase in each variable and compared results against concussion using match minutes to account for risk exposure. RESULTS: During the study period, 45 concussions were incurred by 44 players [or 19.7 concussions per 1000 player-match hours]. There was a significant association between right rotation repositioning error and concussion, with a 5% increase in concussion rate for each 10% increase in gross right rotation error (P = 0.021). CONCLUSION: Poor gross right rotation repositioning error is a modifiable intrinsic risk factor for concussion in professional male rugby players. Interventions to improve proprioceptive function may act as an effective method for reducing concussion incidence in this population.

Tantalum in type IV and V Paprosky periprosthetic acetabular fractures surgery in Paprosky type IV and V periprosthetic acetabular fractures surgery.

PURPOSE: Periprosthetic acetabular fractures represent a growing and serious complication of total hip arthroplasty (THA). The purpose of the study is to report our experience in the use of tantalum for the treatment of Paprosky type IV and V periprosthetic acetabular fractures. METHOD: We analyzed 24 patients with type IV and V periprosthetic acetabular fractures. Patients were treated with a revision surgery using tantalum components, in some cases in association with posterior plating. Outcomes were evaluated using VAS, Harris hip score and considering the average time of integration of the acetabulum and the number of complications. The endpoint evaluation was established at 24 months. RESULT: Results show that the average time of integration of the neoacetabulum in tantalum was 12.3 months (range 6-18 months). The average VAS pain is 8.7/10 cm at time 0 and gradually returns to basic pre-injury values in the following months. The average value of HHS at time 0 is 13.5 points. This value tends to increase progressively until reaching a mean score of 89.3 points at 24 months, higher than the average pre-trauma value of 84.3 points. CONCLUSION: Periprosthetic fractures of the acetabulum with bone loss are a rare but potentially disastrous complication of total hip prostheses. Their management and therapeutic choice will test the ability of the orthopedic surgeon. It is important to determine the type of fracture and characteristics in order to pursue an adequate therapeutic strategy. The modern biomaterials, such as porous tantalum, offer a greater potential in replacing bone loss, promoting bone regrowth and obtaining a stable implant.

The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut.

PURPOSE: Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. MATERIALS AND METHODS: We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. RESULTS: The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. CONCLUSION: We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

Development of Aedes albopictus (Diptera: Culicidae) Larvae Under Different Laboratory Conditions.

Critical to successful application of the sterile insect technique against Aedes albopictus (Skuse) is the development of an efficient and standardized rearing protocol to be employed in the mass production system. In this study, several life history traits of Ae. albopictus were analyzed to identify upper and lower thresholds of larval density and diet concentration. Survival to pupation, time to pupation, and sex ratio were evaluated under a range of larval densities (0.5-5 larvae/ml) and food levels (0.05-1.6 mg/larva/d) using two larval diets (one locally developed; one developed by the FAO/IAEA). The larvae reared at 28 °C, at a density of 2 larvae/ml and receiving a food dose equal to 0.6 mg/larva/d of a diet consisting of 50% tuna meal, 50% bovine liver powder (the FAO/IAEA diet), and, as an additive, 0.2 g of Vitamin Mix per 100 ml of diet solution, developed in 5 d and had 90% survival to the pupal stage. With this rearing regime male pupae production 24 h after the onset of pupation was the highest; these pupae were ∼94% male.

National survey to evaluate musuloskeletal health in retired professional ballet dancers in the United Kingdom.

OBJECTIVES: To explore the musculoskeletal health of retired professional ballet dancers in the United Kingdom (UK). DESIGN: Online national survey. PARTICIPANTS: Retired professional ballet dancers living in the UK. METHODS: The survey explored: what musculoskeletal injuries or diseases are experienced by retired professional ballet dancers; which anatomical regions were affected by musculoskeletal injuries or diseases in retired professional ballet dancers; whether ballet dancers were forced to retire from professional ballet due to musculoskeletal injuries or disease. RESULTS: Forty-six retired ballet dancers responded. Thirty-six percent (n = 17) of respondents reported retiring from ballet due to musculoskeletal injury. The median age when respondents retired from professional ballet was 29 years. The most common issues that caused people to retire were hip and back pain (25%; n = 9 respectively), followed by hamstring injuries, ankle injuries, cervical spine injuries, and anterior knee pain (13% respectively; n = 5). Ninety-one percent (n = 42) reported experiencing muscle and joint pain post-retirement. CONCLUSIONS: Musculoskeletal pain and disease was a problem for respondents in this study. Further investigation is needed to define the problem, so management can be examined. Comparing performance and training regimes to injury rates in professional dancers, and then following these cohorts into retirement, would increase knowledge on this population.

Consensus statement: Oral health and elite sport performance.

While the research base is limited, studies have consistently reported poor oral health in elite athletes since the first report from the 1968 Olympic Games. The finding is consistent both across selected samples attending dental clinics at major competitions and more representative sampling of teams and has led to calls from the International Olympic Committee for more accurate data on oral health. Poor oral health is an important issue directly as it can cause pain, negative effects on appearance and psychosocial effects on confidence and quality of life and may have long-term consequences for treatment burden. Self-reported evidence also suggests an impact on training and performance of athletes. There are many potential challenges to the oral health of athletes including nutritional, oral dehydration, exercise-induced immune suppression, lack of awareness, negative health behaviours and lack of prioritisation. However, in theory, oral diseases are preventable by simple interventions with good evidence of efficacy. The consensus statement aims to raise awareness of the issues of oral health in elite sport and recommends strategies for prevention and health promotion in addition to future research strategies.

Pilot field trials with Aedes albopictus irradiated sterile males in Italian urban areas.

The pilot field studies here presented are part of a long-term research program aimed to develop a cost-effective sterile insect technique (SIT) methodology to suppress Aedes albopictus (Skuse) populations. Aedes albopictus is a mosquito species mainly developing in man-made containers and with an island-like urban and suburban distribution. These two features make the application of the sterile insect technique a possible control strategy. Five trials have been performed in three small towns from 2005 to 2009 (Emilia-Romagna region, northern Italy). Reared male pupae, sexed by a sieving technique allowing the recovery of approximately 26-29% of males, were exposed to gamma rays and immediately released in the field. Adult population density was estimated based on a weekly monitoring of egg density in the ovitraps, whereas induced sterility was estimated by measuring the hatching percentage of weekly collected eggs in SIT and control areas. Results showed that sterile males released at the rate of 896-1,590 males/ha/wk induced a significant sterility level in the local population. In addition, when the sterility level achieved values in the range of 70-80%, a similar reduction also was found for the egg density in the ovitraps. We could estimate that the minimum egg sterility value of 81% should be maintained to obtain suppression of the local population. Immigration of mated females was not a main issue in the small villages where trials have been run.

Mating competitiveness of Aedes albopictus radio-sterilized males in large enclosures exposed to natural conditions.

Mating competitiveness trials have been conducted in large net-screened enclosures (8 by 5 by 2.8 m) built in a natural shaded environment, in the summers of 2006, 2007, 2008, and 2009 in northern Italy. Aedes albopictus (Skuse) males were radio-sterilized by applying gamma radiations at doses in the range 30-60 Gy. Gamma radiation was administered to aged pupae at the rate of 2.3 Gy/min. Reared radiated males (originally collected in Rimini, Forli, Bologna, Matera, Pinerolo) and hybrid radiated males were tested against wild fertile males (originated from eggs collected in Rimini and Cesena) and reared fertile males, in multiple comparisons for mating competitiveness with reared or wild females. The ratio was kept constant at 100-100_100 (fertile males-radiated males_virgin females). Mating competitiveness was estimated through the calculation of the hatching rate of the eggs laid in oviposition traps positioned inside enclosures. No clear effect of the strains tested (reared, wild, or hybrid) was found. Results demonstrated that reducing the radiation dose from 60 to 30 Gy increases males' competitiveness. Laboratory investigations conducted after controversial results in the 2006 preliminary trials, showed that radiation induces precociousness in adult male emergence.

Gamma ray dosimetry and mating capacity studies in the laboratory on Aedes albopictus males.

In Italy, Aedes albopictus Skuse is currently recognized as the most dangerous mosquito, and as currently applied conventional control methods gave unsatisfactory results, we are developing alternative strategies such as the sterile insect technique. To find the optimal sterilizing dose, male pupae were exposed to different doses of gamma rays in the range 20-80 Gy, generated by a Cesium-137 source. The effects of male pupal age at irradiation and gamma ray dose on adult male emergence, sterility level, longevity, and mating capacity were evaluated, and dose-response curves of residual fertility were calculated. Radiation tests were also performed on female pupae to observe their reproductive capacity in case of accidental release. Results confirmed that the age at which the male pupa is irradiated is an important factor that affects the longevity of the adult, whereas the effect of age on the induced sterility level is less pronounced. When male pupae older than 30 h were irradiated, the longevity of the adults was not affected by doses up to 40 Gy. The 40-Gy dose appeared sufficient to induce high level of sterility (>99%) at any male pupal age for all the strains tested. The duration of coupling and the number of mated females per male appeared to be affected by the radiation received by male pupae only at doses higher than 40 Gy. The female pupae were more sensitive to radiation than male pupae, with strong reduction in fecundity and fertility at 20 Gy and complete suppression of oviposition at higher doses.

Defence mechanisms against insecticides temephos and diflubenzuron in the mosquito Aedes caspius: the P-glycoprotein efflux pumps.

P-glycoproteins (P-gps) are efflux transporters found in cells of a broad range of both procaryotic and eukaryotic taxa, whose action is to relieve the cells of multiple, structurally dissimilar, toxic compounds. The possible role of P-gps in defence against the insecticides temephos and diflubenzuron was investigated in the mosquito Aedes caspius (Pallas), also known as Ochlerotatus (Aedes) caspius (Diptera: Culicidae), and the genomic DNA sequences encoding for P-gp transporters were isolated to provide molecular instruments for future research into the expression and characterization of genes codifying for P-gps in this mosquito species. Mosquito larvae were treated with insecticides alone and in conjunction with a sublethal dose of the P-gp inhibitor verapamil. The inhibition of P-gps reduced the LD(50) values of temephos and diflubenzuron by factors of 3.5 and 16.4, respectively, suggesting the potential involvement of P-gps in insecticide defence. Using a polymerase chain reaction (PCR)-based approach, a 481-bp sequence was isolated. The inferred nucleotide sequence shows high homology with the C-terminal sequence of known P-gps. The isolation and characterization of a putative P-gp sequence from Ae. caspius is the first step towards a better molecular understanding of the role played by multidrug transporters in the defence against insecticides in this species. This knowledge may open the way to a novel control strategy based on the inhibition of pest defences. The beneficial consequences of the inhibition of efflux pumps in improving insecticide performance are discussed.

Evaluation of the mutagenic, antimutagenic and antiproliferative potential of Croton lechleri (Muell. Arg.) latex.

Sangre de Drago is a red viscous latex extracted from Croton lechleri (Euphorbiaceae) cortex, renowned in South American popular medicine for its wound-healing properties. The in vitro antiproliferative effects were determined on the human myelogenous leukemia K562 cells line (IC50 = 2.5 +/- 0.3 microg ml(-1)). The mutagenic and antimutagenic activity of C. lechleri sap was examined by means of the Ames/Salmonella test. No mutagenic activity was found on the Salmonella typhimurium strains T98 and T100, either with or without S9 activation. On the other hand, the sap showed an inhibitory effect against the mutagenic activity of the indirectly acting mutagen 2-Aminoanthracene in presence of S9 and a moderate protective activity against directly acting mutagens Sodium Azide and 2-Nitrofluorene. Therefore we suggest that C. lechleri sap interacts with the enzymes of the S9 mix, thereby inhibiting the transformation of 2-Aminoantracene into its active forms.

Incidence of childhood type 1 diabetes mellitus in Gomel, Belarus.

BACKGROUND: The importance of genetic and environmental factors in causing type 1 diabetes mellitus (DM1) in many European countries is unknown. We studied this question by assessing the incidence of the disease in children in Gomel, Belarus, in the years subsequent to the Chernobyl disaster, comparing it to the antecedent period. METHODS: We identified all new patients with DM1 under 15 years at onset who presented between 1976 and 1999; we used as denominator the number of children aged 0-14 born in Gomel, to calculate the incidence. All data were validated by using the capture-recapture method. We compared the incidence rate between the periods before and after 1986; we also calculated the average increment of incidence in the latter period (1987-1999). RESULTS: In the whole period, 438 new patients presented, with an average crude rate of incidence of 4.6/100,000 but with a net difference between the former (before 1986) and latter (after 1986) periods. The average standard incidence in the latter period was 5.7 (C.I. 4.5-7.0), with a significant increase in the 10-14 year age group. The average yearly increase of incidence in the same period was 8.9%, highly significant (p < 0.001). CONCLUSIONS: The results seem to confirm the hypothesis of the influence of environmental pollution subsequent to the Chernobyl accident.

Wild Amaranthus caudatus seed oil, a nutraceutical resource from Ecuadorian flora.

Seed oil of wild Amaranthus caudatus from Ecuador was analyzed for determining the tocopherol, fatty acid, and sterol contents. The data obtained were compared with the analogous chemical profile of seed oil of Italian A. caudatus with the objective of evaluating the nutraceutical and alimentary potential of the Ecuadorian matrix. Supercritical fluid and ultrasound-enhanced extractions were performed on both matrices. Qualitative and quantitative determinations of tocopherols were performed by HPLC, whereas GC and GC-MS were used to determine the fatty acid composition and sterols, respectively. Supercritical fluid extraction at 400 atm was the most efficient extraction method in terms of both total yield extract and tocopherol yield. Seeds of Ecuadorian of A. caudatus contained higher levels of tocopherols than Italian samples, whereas the fatty acid composition and sterol content were similar. From the obtained results it can be suggested that seed oil of wild Ecuadorian A. caudatus can prove to be an effective nutraceutical and alimentary resource and a valid alternative to the European varieties.

[University hospitals: past, present and future]. / Hospitais universitários: passado, presente e futuro.

PURPOSE: This article discusses the evolution of university hospitals, their characteristics, functioning and financing and their role in medical education and research. METHODS: Data come from a workshop organized by the World Health Organization on university hospitals in 22 countries. RESULTS: The main finding is that these institutions are increasingly inadequate to the reality of the health sector in which they operate and to the challenges posed by the profound changes currently taking place in the health system of most countries. CONCLUSION: A reform is needed, and the article presents a few possible strategies for reforming these hospitals.

[Cystic tumours of the pancreas]. / Tumori cistici del pancreas.

The authors illustrate 2 cases of cystic pancreatic neoplasms recently observed at the 2nd Surgical Clinic of IRCCS Policlinico San Matteo in Pavia. Having emphasised the rarity of this pathology, they describe the specific nature of the clinical condition and symptoms which may remain unchanged for a long period. They then highlight the most significant radiological aspects, paying special attention to differential diagnosis. Surgery is indicated as the treatment of election, correlated to the topography of the lesion, the anatomic and histological nature of the disease, especially mucinous, and the patient s general conditions.

Hospitais universitários: passado, presente e futuro / University hospitals: past, present and future

OBJETIVO: O presente artigo discute a evoluçäo dos hospitais universitários, suas características, funcionamento e financiamento, e seu papel no ensino e pesquisa médicos. MÉTODOS: Baseia-se nas informaçöes e conclusöes de um seminário organizado pela Organizaçäo Mundial da Saúde sobre os hospitais universitários de 22 países. RESULTADOS: O artigo avalia que essas instituiçöes estäo crescentemente inadaptadas à realidade do setor saúde em que se inserem e aos desafios impostos pelas mudanças profundas atualmente em curso no sistema de saúde da maioria dos países. CONCLUSÄO: Conclui-se pela necessidade de reforma dos hospitais universitários, e algumas estratégias para essas reformas säo apresentadas e discutidas

Anodic electrochemical oxidation of cholic acid.

Regioselectivity in the anodic electrochemical oxidation of cholic acid with different anodes is described. The oxidation with PbO(2) anode affords the dehydrocholic acid in quantitative yield after 22 h. 3alpha,12alpha-Dihydroxy-7-oxo-5beta-cholan-24-oic acid (59%) and 3alpha-hydroxy-7,12-dioxo-5beta-cholan-24-oic acid (51%) are obtained stopping the reaction at lower time. The rate of the OH-oxidation is C7 > C12 > C3. The electro-oxidation with platinum foil anode gives selectively the 7-ketocholic acid in 40% yield. On the other hand, the graphite plate anode, varying the reaction conditions, produces selectively the dehydrocholic acid in quantitative yield or the 3alpha,12alpha-dihydroxy-7-oxo-5beta-cholan-24-oic acid (96%) while the 3alpha,7alpha-dihydroxy-12-oxo-5beta-cholan-24-oic acid (34%) is obtained together with the other oxo acids.

Myoepithelioma of the palate: a case report.

Myoepithelioma is a rare malignant neoplasm, representing about the 1% of all the salivary gland's tumors. It mainly affects women, particularly in the 7th and 8th decade of life. A case of myoepithelioma of the palate in a 70-year-old woman is described. The tumor was completely excised two years ago. Nowadays, there are no signs of local recurrence and/or distant metastasis. The discrepancy between the histological diagnosis of low-grade malignancy and the clinical aggressive behavior of the tumor is discussed.

Ectopic third molar in the condylar process: case report.

We describe an ectopic inferior third molar which is positioned in the condylar process and associated with an odontogenic cyst. The ectopic third molar is a quite frequent condition but it become unusual when the tooth is placed in the condylar region. In the reported case the removal of both the tooth and the cyst was recommended to solve the infective and articular symptoms and to prevent worse complications like pathologic fractures due to bone's absorption.