Early Outcomes of Lisfranc Injuries Treated with Arthrex InternalBrace: A Case Series.

Introduction: The treatment of Lisfranc injuries continues to evolve with time. The purpose of this study was to report early outcomes of patients with Lisfranc ligamentous injuries treated with the Arthrex InternalBrace, which has benefits to other previously described techniques. Materials and methods: We retrospectively identified 15 adult patients with Lisfranc injuries that were treated via open reduction internal fixation with the Arthrex InternalBrace (Naples, Fl). These patients were identified at two separate United States institutions between 2019 and 2022. Demographic data, mechanism of injury, and concomitant foot injuries were recorded. Outcomes were assessed by return-to-work or sport and time to weight-bearing. Secondary complications or revision surgeries were noted. Results: The mean patient age was 35 years. Eight patients had isolated Lisfranc ligamentous injuries and seven had additional intercuneiform instability, which required a supplemental limb of the fixation device. The most common mechanism of injury was a cutting/pivoting maneuver (n = 5) followed by fall (n = 4). The mean radiographic follow-up time was 7.3 months. The average time to weight-bearing as tolerated was 6.6 weeks (± 2.2). The average time to return-to-work/sport as tolerated was 14.1 weeks (± 3.6). Only two minor complications were noted at follow-up but no major complications or revision surgeries occurred. Conclusions: The outcomes of this case series suggest that the Arthrex InternalBrace is a viable option when performing open reduction and internal fixation of Lisfranc ligamentous injuries. Future prospective studies are needed to directly compare this device with alternative fixation methods.

Preclinical models of orthopaedic trauma: Orthopaedic Research Society (ORS) and Orthopaedic Trauma Association (OTA) symposium 2022.

Orthopaedic trauma remains a leading cause of patient morbidity, mortality, and global health care burden. Although significant advances have been made in the diagnosis, treatment, and rehabilitation of these injuries, complications such as malunion, nonunion, infection, disuse muscle atrophy and osteopenia, and incomplete return to baseline function still occur. The significant inherent clinical variability in fracture care such as differing patient demographics, injury patterns, and treatment protocols make standardized and replicable study, especially of cellular and molecular based mechanisms, nearly impossible. Hence, the scientists dedicated to improving therapy and treatments for patients with orthopaedic trauma rely on preclinical models. Preclinical models have proven to be invaluable in understanding the timing between implant insertion and bacterial inoculation on the bioburden of infection. Posttraumatic arthritis (PTOA) can take years to develop clinically, but with a porcine pilon fracture model, posttraumatic arthritis can be reliably induced, so different surgical and therapeutic strategies can be tested in prevention. Conversely, the racehorse presents a well-accepted model of naturally occurring PTOA. With preclinical polytrauma models focusing on chest injury, abdominal injury, multiple fractures, and/or head injury, one can study how various injury patterns affect fracture healing can be systemically studied. Finally, these preclinical models serve as a translational bridge to for clinical application in human patients. With selection of the right preclinical model, studies can build a platform to decrease the risk of emerging technologies and provide foundational support for therapeutic clinical trials. In summary, orthopaedic trauma preclinical models allow scientists to simplify a complex clinical challenge, to understand the basic pathways starting with lower vertebrate models. Then, R&D efforts progress to higher vertebrate models to build in more complexity for translation of findings to the clinical practice.

Ion-Size Dependent Adsorption Crossover on the Surface of a Water Droplet.

The adsorption of ionic and neutral spherical solutes on the surface of a liquid water droplet are investigated using molecular dynamics simulations and theoretical analyses. The results reveal a crossover in the sign of the adsorption free energy as a function of ion size, with ions larger than iodide predicted to be increasingly surface active. Adsorption free energies are decomposed into competing energetic and entropic contributions arising from direct solute-water interaction energy and its fluctuations. The entropically driven surface activity of large ions is predicted to increase with ion size, while small ions are typically driven away from the interface by a more delicate balance of energetic and entropic contributions, with a nonmonotonic ion size dependence linked to the ion's hydration-shell structure and stability. The physical interpretation of the results is illuminated by comparisons with dielectric linear response and cavity formation predictions and implications to interfacial acidity and enhanced chemical reactivity are discussed.

Pectoralis Major Ruptures in the National Football League: Incidence, RTP, and Performance Analysis.

BACKGROUND: While pectoralis major (PM) tears are rare injuries in National Football League (NFL) athletes (previous study reported only 10 PM ruptures between 2000 and 2010), the incidence of these injuries has increased over the past decade. The impact these injuries have on a player's performance after return has not been measured. PURPOSE/HYPOTHESIS: To identify player characteristics that may predispose to PM tears and to determine the impact of this injury on return to play and performance. We hypothesized that there would be no difference in performance between the year before and after their injury. STUDY DESIGN: Descriptive epidemiology study. METHODS: NFL players who experienced PM tears between the years 2010 and 2018 were identified using publicly available reports. Several individual player characteristics were identified and recorded, and the return-to-play rates after injury were determined for each position. The pre- and postinjury Pro Football Focus grades of players who met inclusion criteria were compared. A paired t test analysis of the change in player performance was used for analysis. RESULTS: In this study, 63 ruptures were identified between 2010 and 2018. Linebackers had the highest incidence of PM tear compared with any other position. Of all injuries, 79.3% were sustained by defensive players. The majority of PM tears occurred during games. Only 6.9% of players who sustained the injury were suspended for performance-enhancing drug use during their professional career. A total of 85.7% of players returned to play in the NFL after injury. Among those who returned to play there were no significant changes in player performance from pre- to post-injury. CONCLUSION: NFL players demonstrated 85.7% return-to-play rates and no significant drop-off in performance after PM ruptures. During the time period studied, there was an increase in incidence of PM ruptures compared with the previous decade. Further investigation is needed to determine potential causes for the increased incidence of PM ruptures in NFL players.

Combined effects of arsenic and Magnaporthe oryzae on rice and alleviation by silicon.

While the impacts of arsenic (As) and Magnaporthe oryzae on rice have been well-studied, a dearth of knowledge exists on how rice responds to their combined stress. Moreover, increasing exogenous silicon (Si) can alleviate M. oryzae infection and As uptake, but how increasing exogenous Si affects the combined stress of M. oryzae and As is unknown. We grew three cultivars of rice that varied in their susceptibility to As and M. oryzae under low (50 µM, SiL) and high (1500 µM, SiH) Si with and without As (4 µM, 80/20 As (III)/As(V)) and with or without M. oryzae infection and examined the impacts of treatments on plant As and Si concentrations, severity of disease by M. oryzae, and stress via targeted gene expression. SiH treatments generally decreased shoot As concentrations by 20-70% compared to SiL treatments depending on cultivar and M. oryzae exposure. There was no effect of Si or As treatments on percent of leaf diseased in the As-tolerant cultivar M206, but in the As-sensitive cultivar IR66, SiH treatment decreased percent of leaf diseased in the absence of As and had no impact when As was present. In the M. oryzae-susceptible Sariceltik, plants receiving SiH had significantly fewer lesions than those receiving SiL and plants with the fewest lesions were in the SiH + As treatments. Plants that were exposed to As + M. oryzae were the most stressed when grown under SiL, but this stress response was lowered by SiH treatments. A separate pathogenicity assay with Sariceltik showed that in contrast to our hypothesis, As exposure decreased lesion growth, particularly under SiH treatments, and lessened the impact of M. oryzae on rice. These results suggest that rice grown under replete Si will be able to withstand combined stressors of M. oryzae and As, but will be highly stressed under Si deficient scenarios.

A Case of Persistent Muscle Cramps in an American Football Player With Cystic Fibrosis.

Exercised-associated muscle cramp (EAMC) is a common occurrence in sports medicine. We highlight a 17-year-old male high-school football player with a history of cystic fibrosis and hyponatremic seizure, who presented for recurrent EAMC. After establishing an appropriate electrolyte replacement and hydration plan, he was able to complete his season with minimal symptoms. This case highlights the importance of hydration and nutrition planning when managing athletes with cystic fibrosis.

Outcomes of NCAA Defensive Football Players Following Achilles Tendon Repair.

BACKGROUND: The incidence of Achilles ruptures has been on the rise in National Collegiate Athletic Association (NCAA) football players, but the career impact of this injury is not fully understood. In this study, we analyzed a large series of Achilles tendon injuries in NCAA Football Bowl Subdivision (FBS) defensive football players who required repair in order to determine their return to play, performance, and career outcomes afterward. METHODS: FBS defensive football players who required Achilles repair from 2010 to 2016 were identified. The return to play of the eligible underclassmen athletes was then determined and the preinjury and postoperative performances of players who met criteria were compared with matched controls. The number of underclassmen who went on to participate in the National Football League (NFL) Combine or play in at least 1 NFL game was also determined and compared with controls. RESULTS: Fifty-seven total Achilles ruptures were identified, 40 of which occurred in underclassmen, who returned at a rate of 92.5%. Of the players who met performance criteria, only defensive backs differed from matched controls in terms of solo tackling (P = .025) and total tackling (P = .038), while still increasing compared with preoperative performance. Only 5.0% of underclassmen performed at NFL Combine and only 7.5% competed in at least 1 NFL game (20.0% and 21.3%, respectively, for matched controls). CONCLUSION: Defensive FBS players returned at a high rate following Achilles rupture and did not seem to experience a significant drop-off in performance upon return. An Achilles rupture did appear to impact their chances of playing professionally in the future, however. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Hiding in the Crowd: Spectral Signatures of Overcoordinated Hydrogen-Bond Environments.

Molecules with an excess number of hydrogen-bonding partners play a crucial role in fundamental chemical processes, ranging from anomalous diffusion in supercooled water to transport of aqueous proton defects and ordering of water around hydrophobic solutes. Here we show that overcoordinated hydrogen-bond environments can be identified in both the ambient and supercooled regimes of liquid water by combining experimental Raman multivariate curve resolution measurements and machine learning accelerated quantum simulations. In particular, we find that OH groups appearing in spectral regions usually associated with non-hydrogen-bonded species actually correspond to hydrogen bonds formed in overcoordinated environments. We further show that only these species exhibit a turnover in population as a function of temperature, which is robust and persists under both constant pressure and density conditions. This work thus provides a new tool to identify, interpret, and elucidate the spectral signatures of crowded hydrogen-bond networks.

Impact of Anterior Cruciate Ligament Reconstruction on NCAA FBS Football Players: Return to Play and Performance Vary by Position.

BACKGROUND: Anterior cruciate ligament (ACL) injuries are devastating for college football players. Although the change in functional performance of National Collegiate Athletic Association (NCAA) football players after reconstruction has been shown to be negligible, studies have failed to analyze the statistical performance of these players upon their return. PURPOSE/HYPOTHESIS: The purpose of this study was to quantify the impact of ACL reconstruction on the statistical performance of collegiate football players. We hypothesized that statistical performance would vary by position and that running backs, wide receivers, and defensive backs, compared with preinjury and controls, would experience the largest decline in performance after returning from ACL reconstruction. STUDY DESIGN: Descriptive epidemiology study. METHODS: NCAA Football Bowl Subdivision (FBS) football players who experienced ACL tears between the years 2010 and 2015 were identified. The rates of return to play after surgery were determined for each position. Preinjury and postoperative performance statistics of each running back, receiver, defensive lineman, linebacker, and defensive back who met inclusion criteria were compared. A t-test analysis was used to compare the performance changes experienced by these players versus the performance changes of matched controls. RESULTS: A total of 349 players were identified. Only 63.64% of eligible offensive linemen returned to play. Upon return, running backs experienced significant performance decreases compared with controls in carries (mean ± SD, -2.4 ± 2.7 vs 2.8 ± 1.6; P = .003), yards (-12.3 ± 15.5 vs 13.8 ± 7.8; P = .006), and receptions (-0.22 ± 0.32 vs 0.32 ± 0.23; P = .011) per game. Receivers displayed significant performance decreases compared with controls in number of touchdowns (-0.019 ± 0.110 vs 0.18 ± 0.06; P = .004), receptions (-0.11 ± 0.79 vs 1.2 ± 0.4; P = .004), and yards (-3.2 ± 10.6 vs 18.6 ± 5.4; P = .0009) per game. Linebackers demonstrated less improvement than controls in tackles for loss (0.007 ± 0.115 vs 0.31 ± 0.11; P = .0003) and sacks (0.001 ± 0.061 vs 0.10 ± 0.06; P = .026). CONCLUSION: Although offensive linemen were the least likely to return to play, running backs and receivers returned to play at a lower level of performance. The performance of defensive players was less affected by ACL reconstruction.

Silicon Decreases Dimethylarsinic Acid Concentration in Rice Grain and Mitigates Straighthead Disorder.

While root Si transporters play a role in the uptake of arsenite and organic As species dimethylarsinic acid (DMA) and monomethylarsonic acid (MMA) in rice ( Oryza sativa L.), the impact of Si addition on the accumulation of DMA and MMA in reproductive tissues has not been directly evaluated, particularly in isolation from inorganic As species. Furthermore, DMA and MMA are suspected causal agents of straighthead disorder. We performed a hydroponic study to disentangle the impact of Si on accumulation of DMA and MMA in rice grain. At 5 µM, MMA was toxic to rice, regardless of Si addition, although Si significantly decreased root MMA concentrations. Plants dosed with 5 µM DMA grew well vegetatively but exhibited straighthead disorder at the lowest Si dose, and this DMA-induced yield loss reversed with increasing solution Si. Increasing Si also significantly decreased DMA concentrations in roots, straw, husk, and grain, particularly in mature plants. Si restricted grain DMA through competition for root uptake and downregulation of root Si transporters particularly at later stages of growth when Si uptake was greatest. Our finding that DMA causes straighthead disorder under low Si availability but not under high Si availability suggests Si as a straighthead management strategy.

Interfacial Adsorption of Neutral and Ionic Solutes in a Water Droplet.

Direct (solute-water) and indirect (water-water) contributions to adsorption at an air-water interface are identified using the Widom potential distribution theorem and quantified using molecular dynamics simulations of a liquid water droplet containing either neopentane or iodide-like solutes with charges of 0 or ±1. The results are used to quantitatively compare direct and indirect energetic and entropic contributions to adsorption, as well as to critically test surface capillary wave, linear response (LR), and mean field (MF) predictions. The negative signs of the total adsorption energies and entropies of both the anionic and cationic solutes are found to result from indirect adsorption induced changes in water-water interactions, rather than from surface capillary wave perturbations, which are found to be asymmetric with respect to solute charge. The LR and MF approximations both accurately describe the adsorption of neutral (hydrophobic) solutes, while for ionic solutes the MF approximation is entirely inappropriate and LR predictions are qualitatively (but not quantitatively) accurate.

Development of the dorsal circumorbital bones in the leopard gecko (Eublepharis macularius) and its bearing on the homology of these elements in the gekkota.

Five nominal elements comprise the circumorbital series of bones in gekkotans: prefrontal, postfrontal, postorbital, jugal, and lacrimal. Determination of the homology of two of these, the postfrontal and postorbital, has been particularly problematic. Two conflicting hypothesis exist relating to these: either the postorbital is lost and the postfrontal remains or they fuse during development to form a combined element, the postorbitofrontal. Such a combined element apparently occurs in at least some members of all lizard clades. There is, however, no direct developmental evidence that supports either theory. To overcome that, we investigate the sequence and pattern of ossification in the circumorbital region in a developmental series of the Leopard gecko. We posit that both the postfrontal and postorbital appear during development. Contrary to previous predictions they neither fuses to each other, nor do either degenerate. Instead, the postfrontal shifts anteriorly and fuses with the frontal to become indistinguishable from it by the time of hatching, and the postorbital persists as a robust independent element bounding the frontoparietal suture. These observations accord, in part, with both hypotheses of homology of these elements and result in the recognition of a new pattern, placing in doubt the existence of the composite postorbitofrontal. The phylogenetic implications of these findings may prove to be far reaching if similar and conserved patterns of development are encountered in other clades.

An embryonic staging table for in ovo development of Eublepharis macularius, the leopard gecko.

Squamates constitute a major vertebrate radiation, representing almost one-third of all known amniotes. Although speciose and morphologically diverse, they remain poorly represented in developmental studies. Here, we present an embryonic staging table of in ovo development for the basal gekkotan Eublepharis macularius (the leopard gecko) and advocate this species as a laboratory-appropriate developmental model. E. macularius, is a hardy and tractable species of relatively large body size (with concomitantly relatively large eggs and embryos), that is widely available and easy to maintain and propagate. Additionally, E. macularius displays a body plan appropriate to the study of the plesiomorphic quadrupedal condition of early pentadactylous terrestrial amniotes. Although not unexpected, it is worth noting that the morphological events characterizing limb development in E. macularius are comparable with those described for the avian Gallus gallus. Therefore, E. macularius holds great promise as a model for developmental studies focusing on pentadactyly and the formation of digits. Furthermore, it is also attractive as a developmental model because it demonstrates temperature-dependent sex determination. The staging table presented herein is based on an all-female series and represents the entire 52 day in ovo period. Overall, embryogenesis of E. macularius is similar to that of other squamates in terms of developmental stage attained at the time of oviposition, patterns of limb and pharyngeal arch development, and features of the appearance of scalation and pigmentation, indicative of a conserved developmental program.