Tripod Technique to Augment Transosseous Equivalent Rotator Cuff Repair.

The transosseous-equivalent Speedbridge™ technique is commonly used during rotator cuff repair; however, the soft bone of the lateral humerus may result in toggling of the lateral row anchors with subsequent de-tensioning of the repair. The technique presented here uses an additional third-row anchor, in a tripod fashion, that reduces the forces on the lateral humerus anchors and protects the repair.

Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up.

PURPOSE: To determine the prevalence and change in neuropathic pain or pain catastrophizing before and 12 months following patellar stabilisation surgery for patellofemoral instability. METHODS: We conducted a prospective clinical audit within a UK NHS orthopaedic surgical centre. Data from 84 patients with patellofemoral instability requiring stabilisation were analysed. Fifty percent (42/84) underwent MPFL reconstruction alone, and 16% (13/84) had both trochleoplasty and MPFL reconstruction. Neuropathic pain was assessed using painDETECT score. Pain catastrophizing was assessed using the Pain Catastrophizing Score. The Norwich Patellar Instability (NPI) Score and Kujala Patellofemoral Disorder Score were also routinely collected pre-operatively and one year post-operatively. RESULTS: At 12 months post-operatively there was a statistically significant reduction in mean Pain Catastrophizing Scores (18.9-15.7; p < 0.02), but no change in mean painDETECT scores (7.3-7.8; p = 0.72). There was a statistically significant improvement in NPI scores (90.2-61.9; p < 0.01) and Kujala Patellofemoral Disorder Scores (48.7-58.1; p = 0.01). The prevalence of pain catastrophizing decreased from 31% pre-operatively to 24% post-operatively, whereas the prevalence of neuropathic pain remained consisted (10-11%). CONCLUSIONS: Neuropathic pain and catastrophizing symptoms are not commonly reported and did not significantly change following patellofemoral stabilisation surgery. Whilst low, for those affected, there remains a need to intervene to improve outcomes following PFI surgery.

Effect of mental rehearsal on team performance and non-technical skills in surgical teams: systematic review.

BACKGROUND: Simulation-based training in medical education has become a common method to develop both technical and non-technical skills in teams. Mental rehearsal (MR) is the cognitive act of simulating a task in our heads to pre-experience tasks imaginatively. It has been used widely to improve individual and collective performance in fields outside healthcare, and offers potential for more efficient training in time-pressured surgical and medical team contexts. This study aimed to review the available literature to determine the impact of MR on team performance and non-technical skills in healthcare. METHODS: MEDLINE, Embase, British Educational Index, CINAHL, Web of Science, PsycInfo and Cochrane databases were searched for the period 1994-2018. The primary outcome measure was improvement in team performance and non-technical skills. Study quality of RCTs was assessed using the Medical Education Research Quality Instrument. The reported impacts of MR in all included studies were mapped on to the Kirkpatrick framework for evaluation of educational interventions. RESULTS: Eight studies with 268 participants were identified that met the inclusion criteria, of which there were six randomized trials, one prospective pragmatic trial and one qualitative study. Three studies found MR to be effective in improving team non-technical skills. MR practices were varied and often poorly defined. MR benefited team non-technical skills when it was specifically designed to do so, but was not an automatic consequence of technical MR alone. The majority of studies demonstrated benefits of MR for technical performance, but only three showed positive impacts on teamwork. Overall the studies were of low quality and lacked sufficient discriminatory focus to examine impacts on teamwork dynamics. CONCLUSION: MR can improve technical performance, but the benefits on non-technical skills are less clear. Future research should look at longitudinal mixed-method evaluation designs and focus on real clinical teams.

Symptomatic malunion after midshaft clavicle fracture in an adolescent patient: a case report of surgical deformity correction using a 3D printed model.

A 14-year-old boy underwent surgery for symptomatic malunion of the clavicle. This complication, which is uncommon in adults and adolescents, occurred after a displaced midshaft clavicle fracture that had been treated conservatively. Surgery may be considered if functional impairment, pain, weakness, fatigability and neurological symptoms persist in the presence of significant clavicular deformity. Our case was unusual because the patient had a symptomatic malunion and lost range of movement of his shoulder despite a minor degree of clavicular shortening. We adopted an approach used in lower limb deformity correction but not described for the clavicle in which corrective osteotomy was planned and practised using a three-dimensional printed model of the malunited clavicle. A three-dimensional printed model of the mirror image of the opposite clavicle served as a template of normal. Three-dimensional models were printed from the computed tomography data. The patient's symptoms resolved and he recovered full range of movement and shoulder function following the corrective osteotomy.

Is psychopathic disorder a treatable condition?

This article extends upon material presented in a previous issue of this journal (Med. Sci. Law, 1990, 30, 39-44). Three groups of respondents were asked to comment upon the degree to which they considered psychopathic disorder to be a treatable condition. The modest findings suggest that although few clear cut views exist as to the best treatment modality there are firmer indications as to those thought to be unhelpful.

Psychopathic disorder--a useful clinical concept?

The study reported upon here set out to investigate the degree to which the clinical concept of psychopathic disorder was shared between psychiatrists, psychologists and probation officers. Despite the small sample of respondents, it seems not unreasonable to conclude from the results reported below that the diagnosis of psychopathic disorder is still considered to be a useful one.

Kinetics of copper(II) uptake by apoazurin in complexing media.

We have studied the kinetics of copper uptake by apoazurin in imidazole and 1-methylimidazole buffers in the pH range of 7-9 with mu = 0.5 M and copper(II) in large excess. The reaction has been monitored by measuring the visible absorbance and circular dichroism as a function of time. The uptake occurs in a stepwise fashion, and at least two intermediates are implicated. Overall, the rate of uptake varies inversely with the concentration of the proton and the (complexing) buffer, but depends directly on the copper concentration. A model involving a weakly absorbing intermediate is proposed to rationalize the data taken at the lower end of the pH range. According to the model the intermediate forms with a second order rate constant of about 30 M-1 S-1 and is probably described as a ternary complex of copper, buffer, and one or more of the histidine ligands of the binding site. This then decays by a pH-dependent process to give product. At higher pH values there is evidence that relaxation to product occurs via a second intermediate form in which the cysteine ligand is bound to copper. The relevance of these results to the question of how copper is selectively incorporated into the protein is considered. Finally, a milder, more reliable route to the preparation of apoazurin is described.

Stoichiometry and spectral properties of the MoFe cofactor and noncofactor redox centers in the MoFe protein of nitrogenase from Azotobacter vinelandii.

Reductive EPR and optical titrations of oxidized MoFe protein using reduced methyl viologen as reductant were used to quantitate the stoichiometry of the various spectroscopically and electrochemically distinct redox centers in the oxidized MoFe protein. Three centers were found to correlate with the EPR signal development (MoFe cofactor centers), and three centers were found to be independent of the EPR signal (P clusters) but to demonstrate distinct optical and kinetic properties. Oxidative EPR and optical titrations of reduced MoFe protein are reported which support the presence of three P-cluster centers. The optical titrations show a distinct change in kinetic behavior between the MoFe cofactor and P-cluster centers. Controlled potential coulometry demonstrates that incremental oxidation of reduced protein by methylene blue, thionine, or indigodisulfonate occurs specifically at three P-cluster sites. Subsequent oxidation by methylene blue and thionine (but not indigodisulfonate) causes the EPR signal to disappear. Three P-cluster sites, two EPR sites, and one presently uncharacterized site are suggested by the results of this study.

Redox and spectroscopic properties of oxidized MoFe protein from Azotobacter vinelandii.

The MoFe protein from Azotobacter vinelandii undergoes a six-electron oxidation by various organic dye oxidants with full retention of initial activity. Reduction of the oxidized protein by S2O42- and by controlled potential electrolysis indicates the presence of two reduction regions at -290 and -480 mV, each requiring three electrons for complete reaction. Control of the oxidation conditions provides a means for preparing two distinct MoFe protein species selectively oxidized by three electrons. Selective reduction of the redox region at -290 mV causes development of the EPR signal associated with fully reduced MoFe protein while reduction at -480 mV produces a change in the visible spectrum but has no effect on the EPR signal intensity. Kinetic differences for reduction of the two redox regions indicate that the cofactor region undergoes a more rapid reaction with reductant than the other metal redox sites.

Impurities in labeled diethylstilbestrol: identification of pseudodiethylstilbestrol.

Radioactive impurities known to exist in labeled diethylstilbestrol used in tissue residue studies in cattle include at least five different compounds, one of which is identified as pseudodiethylstilbestrol.