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Sample records for quadruple cruciate sign

  1. Prediction of quadruple hamstring graft diameter for anterior cruciate ligament reconstruction by anthropometric measurements

    PubMed Central

    Asif, Naiyer; Ranjan, Rahul; Ahmed, Sohail; Sabir, Aamir B; Jilani, Latif Z; Qureshi, Owais A

    2016-01-01

    Background: The literature is scanty regarding the anthropometric predictors on the diameter of quadruple hamstring graft obtained in anterior cruciate ligament (ACL) reconstruction in Indian population. Minimum diameter of the graft for ACL reconstruction should be >7 mm to preclude failure. The objective of this study was to assess the prediction of the hamstring graft diameter by several anthropometric parameters including age, thigh circumference, weight, height and body mass index (BMI). Materials and Methods: 46 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadruple hamstring grafts were evaluated. The age, thigh circumference of the normal side, height, weight and BMI were recorded preoperatively and Pearson correlation was done using these parameters with graft diameter measured intraoperatively. Regression analysis in a stepwise manner was undertaken to assess the influence of individual anthropometric parameters on the graft diameter. Results: There were 44 males and 2 females. Mean age was 29.4 years, mean height was 172.6 cm, mean weight was 70.9 kg, mean BMI was 23.8 kg/m2, mean thigh circumference was 47.1 cm and mean graft diameter was 7.9 mm. There was a positive correlation individually between the thigh circumference and graft diameter obtained (r = 0.8, P < 0.01, n = 46), and between the height and graft diameter (r = 0.8, P < 0.01, n = 46). On the regression analysis thigh circumference and height were found to be significant predictors of graft diameter giving the following equation: Graft diameter (mm) = 0. 079 height (cm) +0.068 thigh circumference (cm) −9.031. Conclusion: Preoperatively using the above equation if graft diameter came out to be <7 mm then alternate options of graft material must be kept in mind in order to prevent failure. PMID:26955176

  2. Two Helpful MRI Signs for Evaluation of Posterolateral Bundle Tears of the Anterior Cruciate Ligament

    PubMed Central

    Volokhina, Yulia V.; Syed, Hasan M.; Pham, Peter H.; Blackburn, Allie K.

    2015-01-01

    Background: Diagnosis of partial anterior cruciate ligament (ACL) tears is difficult on magnetic resonance imaging (MRI), particularly the isolated tears of the posterolateral bundle. Purpose: To describe 2 MRI signs of partial ACL tear involving the posterolateral bundle on conventional knee MRI sequences, specifically, the “gap” and “footprint” signs. Study Design: Case-control study. Methods: We retrospectively reviewed the MRI appearance of the ACL in 11 patients with arthroscopically proven partial ACL tears isolated to the posterolateral bundle, as well as in 10 patients with arthroscopically proven intact ACLs, and evaluated for the presence of gap and/or footprint signs. Results: There was high degree of sensitivity and specificity associated with the MRI findings of “gap” and “footprint” signs with arthroscopically proven isolated posterolateral bundle tears. Conclusion: Gap and footprint signs are suggestive of posterolateral bundle tear of the ACL, and the presence of 1 or both of these imaging findings should alert the radiologist to the possibility of a posterolateral bundle tear. PMID:26535387

  3. Secondary signs on static stress MRI in anterior cruciate ligament rupture.

    PubMed

    Al-Dadah, O; Shepstone, L; Marshall, T J; Donell, S T

    2011-08-01

    The MRI diagnosis of ACL rupture based on primary signs has variable rates of diagnostic accuracy. These signs observed on direct visualisation of the ACL include discontinuity of fibres, abnormal ligament contour and increased intrasubstance signal intensity. Secondary radiological signs of ACL rupture are increasingly being used. These indirect ancillary signs include PCL angle, translocation of the tibia relative to the femur and displacement of the posterior horns of the menisci. The aim of this study was to investigate if the application of static stress force to the knee will accentuate the secondary signs of ACL rupture on MRI. One hundred and forty-eight subjects (50 subjects with arthroscopically confirmed ACL rupture, 48 subjects with arthroscopically confirmed intact ACL and 50 subjects with clinically confirmed normal knees) underwent MRI of their knee with the application of specially designed fibreglass leg splints which exert a translational force on the knee joint. Five secondary radiological signs were evaluated and all were found to be significantly accentuated following the application of the splints (p<0.001). The MRI diagnosis of ACL rupture demonstrated a sensitivity of 95.9%, specificity of 91.7% and accuracy of 93.8%. The static stress technique improved the accuracy of diagnosing ACL ruptures on MRI and illustrated the abnormal tibiofemoral kinematics. PMID:20822911

  4. Comparison of short-term results of bone tunnel enlargement between EndoButton CL and cross-pin fixation systems after chronic anterior cruciate ligament reconstruction with autologous quadrupled hamstring tendons.

    PubMed

    Kuskucu, S M

    2008-01-01

    We performed arthroscopic anterior cruciate ligament (ACL) reconstructions of chronic ACL rupture with autologous hamstring tendon grafts in males (mean age 23.9 years). Thirty-two cross-pin fixations and 24 EndoButton CL fixations were performed on the femoral side. Distal fixations on the tibial side were maintained with interference screws plus a staple. Tunnel enlargement was evaluated using X-rays. Femoral and tibial tunnels were measured at three levels 5 mm apart, and average enlargement was calculated after correction for magnification. Tunnel enlargement 12 months after surgery was greater for the EndoButton CL system (femoral side 43.71%, tibial side 51.11%) than for the cross-pin system (femoral side 32.61%, tibial side 25.62%); the difference was significant only on the tibial side. Both proximal fixation techniques were judged clinically successful (follow-up 16 - 36 months). The far fixation point in the EndoButton CL group may be related to mechanical loosening. PMID:18230264

  5. Case report ganglion cysts of the bilateral cruciate ligaments.

    PubMed

    Noda, M; Kurosaka, M; Maeno, K; Mizuno, K

    1999-01-01

    Ganglion cysts originating from the cruciate ligaments have been reported rarely. A 38-year-old woman developed symptoms of knee pain with 10 degrees loss of knee extension. Preoperative magnetic resonance imaging showed a well-demarcated cystic mass surrounding the posterior cruciate ligament so clearly that further examination was not recommended. Because examination under anesthesia confirmed full extension of the knee, we presumed that pain produced by compression caused the diminished extension, and that mechanical block was not the reason. During arthroscopic examination, a mass was impinged between the anterior cruciate ligament and the intercondylar notch when extension of the knee was attempted. The mass was resected and immediate improvement was noted. The patient had experienced the same episode in the contralateral knee and removal of a ganglion cyst on the cruciate ligament 10 years ago. At the latest follow-up she was completely symptom free in both knees without any sign of recurrence. PMID:10564867

  6. Quadruple Lap Shear Processing Evaluation

    NASA Technical Reports Server (NTRS)

    Thornton, Tony N.; McCool, A. (Technical Monitor)

    2000-01-01

    The Thiokol, Science and Engineering Huntsville Operations (SEHO) Laboratory has previously experienced significant levels of variation in testing Quadruple Lap Shear (QLS) specimens. The QLS test is used at Thiokol / Utah for the qualification of Reusable Solid Rocket Motor (RSRM) nozzle flex bearing materials. A test was conducted to verify that process changes instituted by SEHO personnel effectively reduced variability, even with normal processing variables introduced. A test matrix was designed to progress in a series of steps; the first establishing a baseline, then introducing additional solvents or other variables. Variables included normal test plan delay times, pre-bond solvent hand-wipes and contaminants. Each condition tested utilized standard QLS hardware bonded with natural rubber, two separate technicians and three replicates. This paper will report the results and conclusions of this investigation.

  7. CCD correlated quadruple sampling processor

    NASA Technical Reports Server (NTRS)

    Gaalema, S. D. (Inventor)

    1981-01-01

    A correlated quadruple sampling processor for improved signal-to-noise ratio in the output of a charge-coupled device (CCD) is comprised of: switching means for momentarily clamping a CCD signal line at a first reference level A before a CCD data pulse and then obtaining a first data sample B with respect to the reference A during a CCD data pulse, and storing the positive sample B-A; switching means for momentarily clamping the CCD signal line a second time at the level C during the presence of the CCD data pulse and then obtaining a second data sample D with respect to the reference level C after the CCD data pulse, and storing the negative sample D-C; and means for obtaining the difference between the stored samples +(B-A) and -(D-C), thus increasing the net signal amplitude by a factor of about 2 while the noise would be increased by only a factor of square root of 2 since there will be no correlation in the noise between the double samples +(B-A) and -(D-C) effectively added.

  8. Bone tunnel enlargement on anterior cruciate ligament reconstruction

    PubMed Central

    Leonardi, Adriano Barros de Aguiar; Duarte, Aires; Severino, Nilson Roberto

    2014-01-01

    Objective: To assess the presence of tibial bone tunnel enlargement after surgical reconstruction of the anterior cruciate ligament using quadruple graft of the flexor tendons and correlate the functional results in their presence. Methods: The studied lasted six months and included 25 patients, with ages ranging from 18 to 43 years old. Assessment was based on radiographs taken immediately postoperatively and at the third and sixth month of follow up in the anterior cruciate ligament reconstruction. Reconstruction of ligaments was performed with tendon grafts of the semitendinosus and gracilis muscle fixated in the femur with transverse metal screw and in the tibia with interference screws. Patients were evaluated objectively by tests ligament, graded from zero to four crosses and subjectively by the Lysholm method preoperative and after sixth month follow up. Results: Significant increase in the tunnels diameters were observed, 20.56% for radiographs in the anteroposterior view, 26.48% in profile view and 23.22% in computed tomography. Descriptive statistics showed significant improvement in subjective and objective clinical parameters. Conclusions: The bone tunnel enlargement is a phenomenon found in the first months after surgical reconstruction of the anterior cruciate ligament and it has no implications on clinical outcomes in the short term. Level of Evidence II, Prospective Study. PMID:25328430

  9. MR imaging of cruciate ligaments.

    PubMed

    Naraghi, Ali; White, Lawrence M

    2014-11-01

    Cruciate ligament injuries, and in particular injuries of the anterior cruciate ligament (ACL), are the most commonly reconstructed ligamentous injuries of the knee. As such, accurate preoperative diagnosis is essential in optimal management of patients with cruciate ligament injuries. This article reviews the anatomy and biomechanics of the ACL and posterior cruciate ligament (PCL) and describes the magnetic resonance (MR) imaging appearances of complete and partial tears. Normal postoperative appearances of ACL and PCL reconstructions as well as MR imaging features of postoperative complications will also be reviewed. PMID:25442023

  10. Quadruple test parameters in art pregnancies

    PubMed Central

    Güdücü, Nilgün; Görmüş, Uzay; Güner, Ebru İlhan; Güzel, Ömer; Kavak, Zehra Neşe

    2014-01-01

    Aim: Quadruple test is used for Down’s syndrome screening in the second trimester of pregnancy. The aim of this study was to investigate differences in quadruple test parameters between pregnancies achieved by assisted reproductive treatments (ART) and spontaneous conception. Materials and methods: We retrospectively compared levels of alfa-fetoprotein (AFP), unconjugated Estriol (uE3), inhibin-A and hCG and also screen positive test results. Results: Levels of all quadruple test parameters were statistically significantly increased in ART pregnancies when compared to spontaneous pregnancies, AFP was 1.4±0.74 and 1.16±0.53, (p=0.001), uE3 was 1.10±0.37 and 1.00±0.28, (p=0.004), hCG was 1.56±1.04 and 1.26±0.76, (p=0.001), inhibin A was 1.38±0.76 and 1.08±0.57, (p=0.001), screen positive tests were nearly doubled (4.8% and 8.4%). Conclusions: Increased screen positive test results and quadruple test parameters in ART pregnancies may lead to unnecessary amniocentesis. PMID:25232428

  11. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique

    PubMed Central

    Prince, Matthew R.; Stuart, Michael J.; King, Alexander H.; Sousa, Paul L.; Levy, Bruce A.

    2015-01-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  12. All-Inside Posterior Cruciate Ligament Reconstruction: GraftLink Technique.

    PubMed

    Prince, Matthew R; Stuart, Michael J; King, Alexander H; Sousa, Paul L; Levy, Bruce A

    2015-10-01

    Posterior cruciate ligament (PCL) injuries account for nearly 20% of knee ligament injuries. PCL injuries can occur in isolation or, more commonly, in the setting of multiligamentous knee injuries. Isolated PCL disruptions are commonly treated nonoperatively; however, symptomatic grade III injuries, as well as PCL injuries found in multiligamentous injuries, are frequently treated surgically. Several reconstructive techniques exist for the treatment of PCL deficiency without a clear optimal approach. We describe our preferred operative technique to reconstruct the PCL using an all-inside arthroscopic approach with a quadrupled tibialis anterior or peroneus longus allograft with both tibial and femoral suspensory fixation. PMID:26900564

  13. Bioengineered anterior cruciate ligament

    NASA Technical Reports Server (NTRS)

    Altman, Gregory (Inventor); Kaplan, David (Inventor); Vunjak-Novakovic, Gordana (Inventor); Martin, Ivan (Inventor)

    2001-01-01

    The present invention provides a method for producing an anterior cruciate ligament ex vivo. The method comprises seeding pluripotent stem cells in a three dimensional matrix, anchoring the seeded matrix by attachment to two anchors, and culturing the cells within the matrix under conditions appropriate for cell growth and regeneration, while subjecting the matrix to one or more mechanical forces via movement of one or both of the attached anchors. Bone marrow stromal cells are preferably used as the pluripotent cells in the method. Suitable matrix materials are materials to which cells can adhere, such as a gel made from collagen type I. Suitable anchor materials are materials to which the matrix can attach, such as Goinopra coral and also demineralized bone. Optimally, the mechanical forces to which the matrix is subjected mimic mechanical stimuli experienced by an anterior cruciate ligament in vivo. This is accomplished by delivering the appropriate combination of tension, compression, torsion, and shear, to the matrix. The bioengineered ligament which is produced by this method is characterized by a cellular orientation and/or matrix crimp pattern in the direction of the applied mechanical forces, and also by the production of collagen type I, collagen type III, and fibronectin proteins along the axis of mechanical load produced by the mechanical forces. Optimally, the ligament produced has fiber bundles which are arranged into a helical organization. The method for producing an anterior cruciate ligament can be adapted to produce a wide range of tissue types ex vivo by adapting the anchor size and attachment sites to reflect the size of the specific type of tissue to be produced, and also adapting the specific combination of forces applied, to mimic the mechanical stimuli experienced in vivo by the specific type of tissue to be produced. The methods of the present invention can be further modified to incorporate other stimuli experienced in vivo by the

  14. Incidental Anterior Cruciate Ligament Calcification: Case Report

    PubMed Central

    Hayashi, Hisami; Fischer, Hans

    2016-01-01

    The calcification of knee ligaments is a finding noted only in a handful of case reports. The finding of an anterior cruciate ligament calcification has been reported once in the literature. Comparable studies involving the posterior cruciate ligament, medial collateral ligament and an ossicle within the anterior cruciate ligament are likewise discussed in reports of symptomatic patients. We report a case of incidentally discovered anterior cruciate ligament calcification. We discuss the likely etiology and clinical implications of this finding. PMID:27200163

  15. Single to quadruple quantum dots with tunable tunnel couplings

    SciTech Connect

    Takakura, T.; Noiri, A.; Obata, T.; Yoneda, J.; Yoshida, K.; Otsuka, T.; Tarucha, S.

    2014-03-17

    We prepare a gate-defined quadruple quantum dot to study the gate-tunability of single to quadruple quantum dots with finite inter-dot tunnel couplings. The measured charging energies of various double dots suggest that the dot size is governed by the gate geometry. For the triple and quadruple dots, we study the gate-tunable inter-dot tunnel couplings. For the triple dot, we find that the effective tunnel coupling between side dots significantly depends on the alignment of the center dot potential. These results imply that the present quadruple dot has a gate performance relevant for implementing spin-based four-qubits with controllable exchange couplings.

  16. Reconfigurable quadruple quantum dots in a silicon nanowire transistor

    NASA Astrophysics Data System (ADS)

    Betz, A. C.; Tagliaferri, M. L. V.; Vinet, M.; Broström, M.; Sanquer, M.; Ferguson, A. J.; Gonzalez-Zalba, M. F.

    2016-05-01

    We present a reconfigurable metal-oxide-semiconductor multi-gate transistor that can host a quadruple quantum dot in silicon. The device consists of an industrial quadruple-gate silicon nanowire field-effect transistor. Exploiting the corner effect, we study the versatility of the structure in the single quantum dot and the serial double quantum dot regimes and extract the relevant capacitance parameters. We address the fabrication variability of the quadruple-gate approach which, paired with improved silicon fabrication techniques, makes the corner state quantum dot approach a promising candidate for a scalable quantum information architecture.

  17. Purulent Pericarditis with Quadruple Valve Endocarditis

    PubMed Central

    Setty Natrajsetty, Huliyurdurga S.; Vijayalakshmi, Ishwarappa B.; Narasimhan, Chitra; Manjunath, Cholenahalli N.

    2015-01-01

    Patient: Male, 7 Final Diagnosis: Purulent pericarditis with quadruple valve endocarditis Symptoms: — Medication: (4S,4aS,5aR,12aS)-9-[2-(tert-butylamino)acetamido]-4,7 bis(dimethylamino)-1,4,4a,5,5a,6,11,12aoctahydro-3,10,12,12a-tetrahydroxy-1,11-dioxo-2 naphthacenecarboxamide Clinical Procedure: Pericardiocentisis Specialty: Cardiology Objective: Rare disease Background: Infective endocarditis (IE) is a disease with a highly varied clinical picture. Spread of the infection to the pericardium from the infective endocardium is uncommon and IE involving all 4 cardiac valves is also a very rare occurrence, being more common in intravenous drug users (IVDU). Case Report: A 7-year-old boy had purulent pericarditis with infective endocarditis (IE) on all 4 cardiac valves and vegetation in the left ventricular and right atrial cavity. Culture of the pericardial fluid grew methicillin-resistant staphylococcus aureus (MRSA) sensitive to tigecycline. The child made a dramatic improvement with tigecycline treatment. Conclusions: Aggressive management with pericardiocentesis and appropriate antibiotics can show remarkable clinical improvement. Tigecycline can be used safely and effectively as a life-saving drug in children. PMID:25904083

  18. Anterior Cruciate Ligament Reconstruction With Autologous Hamstring

    PubMed Central

    Grawe, Brian M.; Williams, Phillip N.; Burge, Alissa; Voigt, Marcia; Altchek, David W.; Hannafin, Jo A.; Allen, Answorth A.

    2016-01-01

    Background: Recent clinical investigations have identified inadequate autograft hamstring graft diameter (<8 mm) to be predictive of failure after reconstruction of the anterior cruciate ligament (ACL). Purpose/Hypothesis: The objective of this study was to determine the utility of preoperative magnetic resonance imaging (MRI) variables of the hamstring tendons for the prediction of graft diameter at the time of surgery. The hypothesis was that cross-sectional area (CSA) of the hamstring tendon measured on MRI could accurately predict graft diameter, and threshold measurements could be established to predict graft diameter at the time of surgery. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: A total of 84 consecutive skeletally mature patients prospectively enrolled in our ACL reconstruction patient registry were identified for study purposes. Patients were included if they underwent an MRI of the affected knee at our institution prior to ACL reconstruction with hamstring (HT) autograft. Graft preparation was performed via a standard quadrupled hamstring technique after harvesting both the gracilis and semitendinosus (4-GST). The smallest diameter end of the HT autograft was then utilized for measurement analysis. Total CSA was calculated for both hamstring tendons using the “region of interest tool” on the corresponding proton density–weighted axial image of the knee at the widest condylar dimension. Three independent reviewers measured the MRI scans so that intra- and interrater reliability of the measurements could be determined. A trend analysis was then undertaken to establish correlations between the MRI CSA and graft diameter. Predictive analysis was then performed to establish threshold MRI measurement values for specific graft diameters and determine whether any patient-specific factors would affect graft diameter (age, sex, and body mass index). Results: Mean patient age at the time of surgery was 36 years (range, 11

  19. Clinics in diagnostic imaging. 141. Complete anterior cruciate ligament tear.

    PubMed

    Lim, Hollie M Y; Peh, Wilfred C G

    2012-09-01

    A 38-year-old man presented with right knee pain and swelling following a football injury. Magnetic resonance (MR) imaging showed a complete anterior cruciate ligament (ACL) tear and lateral meniscal tears. The torn ACL was repaired with a graft obtained from the semitendinosus muscle, and the menisci were debrided. The mechanisms of injury to the ACL are varied and may be due to direct or indirect contact with the knee as well as with twisting injuries. Knowledge of the ACL's normal anatomy, together with MR imaging technique and understanding of the appearance of the lesion on MR examination, is crucial to aid in the identification of an ACL tear. Diagnosis of an ACL tear should be based on direct MR imaging signs, although indirect signs may be helpful, particularly in chronic tears. Other associated injuries to be aware of include meniscal and other ligamentous injuries. Normal ACL graft and post-ACL graft reconstruction complications are also briefly discussed. PMID:23023908

  20. Simultaneous bicompartmental bucket-handle meniscal tears with intact anterior cruciate ligament: a case report

    PubMed Central

    2010-01-01

    Introduction Bucket handle tear of the menisci is a common type of lesion resulting from injury to the knee joint. Bucket handle injury of both menisci in almost all cases is associated with a lesion to either the anterior or the posterior cruciate ligament of the knee joint. We describe a case of acute bucket-handle tear of the medial and lateral menisci with intact anterior and posterior cruciate ligaments in a dancer. To the best of our knowledge, there are no previous reports of this type of injury in the literature. Case presentation A 28-year-old Caucasian Greek woman presented to the emergency department after sustaining an injury to her right knee during dancing. An MRI evaluation demonstrated tears in both menisci of the right knee, while the anterior and posterior cruciate ligaments were found to be intact. A partial medial and lateral meniscectomy was then performed. At a follow-up examination six months after her injury, clinical tests demonstrated that our patient's right knee was stable, had a full range of motion and had no tenderness. She was satisfied with the outcome of the operation and returned to her pre-injury activities. Conclusion We present the first case in the literature that describes a combined bucket-handle injury of both the medial and lateral menisci with an intact anterior cruciate ligament. The clinical examination of the anterior cruciate ligament was unremarkable, with no signs of deficiency or rupture. The posterior cruciate ligament was also intact. On magnetic resonance imaging, the ligaments were visualised as intact in all their length. These findings were confirmed by arthroscopic evaluation. PMID:20181059

  1. Isolated posterior cruciate ligament calcification.

    PubMed

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  2. Isolated posterior cruciate ligament calcification

    PubMed Central

    Koukoulias, Nikolaos E; Papastergiou, Stergios G

    2011-01-01

    The authors present a case of calcified posterior cruciate ligament (PCL). A 61-year-old female presented in our department reporting 12 months history of knee pain that was getting worse during the night. The patient was under medication for epileptic seizure, osteoporosis and hyperthyroidism. X-rays demonstrated calcification of the PCL. CT and MRI excluded any other intra-articular and extra-articular pathology. Arthroscopic debridement of the calcium deposits was performed and the symptoms resolved immediately, while the postoperative x-rays were normal. Histological examination confirmed the calcium nature of the lesion. Two years postoperatively the patient remains asymptomatic. PMID:22669889

  3. HOW CAN BONE TUNNEL ENLARGEMENT IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION SURGERY BE MEASURED? DESCRIPTION OF A TECHNIQUE

    PubMed Central

    Aguiar Leonardi, Adriano Barros de; Severino, Nilson Roberto; Junior, Aires Duarte

    2015-01-01

    To assess the presence of tibial bone tunnel enlargement after surgery to reconstruct the anterior cruciate ligament using quadruple flexor tendon grafts, and to propose a new technique for its measurement. Methods: The study involved 25 patients aged 18-43 years over a six-month period. The assessment was based on radiographs taken immediately postoperatively and in the third and sixth months of evolution after operations to reconstruct the anterior cruciate ligament using grafts from the tendons of the semitendinosus and gracilis muscles, fixed in the femur with a transverse metal screw and in the tibia with an interference screw. The radiographs were evaluated in terms of the relative value between the diameter of the tunnel and the bone, both at 2 cm below the medial tibial condyle. Results: There were significant increases in tunnel diameters: 20.56% for radiographs in anteroposterior view and 26.48% in lateral view. Enlargement was present in 48% of anteroposterior and lateral radiographs, but was present in both views in only 16% of the cases. Conclusions: Bone tunnel enlargement is a phenomenon found in the first months after surgery to reconstruct the anterior cruciate ligament. The measurement technique proposed in this study was sufficient to detect it. PMID:27027030

  4. Cruciate retaining and cruciate substituting ultra-congruent insert

    PubMed Central

    Deledda, Davide; Rosso, Federica; Ratto, Nicola; Bruzzone, Matteo; Bonasia, Davide Edoardo; Rossi, Roberto

    2016-01-01

    The posterior cruciate ligament (PCL) conservation and the polyethylene insert constraint in total knee arthroplasty (TKA) are still debated. The PCL is one of the primary stabilizers of the joint, but cruciate retaining (CR) implants have the disadvantage of a difficult balancing of the PCL. Postero-stabilized (PS) implants were introduced to reduce this problem. However, also the PS implants have some disadvantages, due to the cam-mechanism, such as high risk of cam-mechanism polyethylene wear. To minimize the polyethylene wear of the cam-mechanism and the bone sacrifice due to the intercondylar box, different types of inserts were developed, trying to increase the implant conformity and to reduce stresses on the bone-implant interface. In this scenario ultra-congruent (UC) inserts were developed. Those inserts are characterized by a high anterior wall and a deep-dished plate. This conformation should guarantee a good stability without the posterior cam. Few studies on both kinematic and clinical outcomes of UC inserts are available. Clinical and radiological outcomes, as well as kinematic data are similar between UC mobile bearing (MB) and standard PS MB inserts at short to mid-term follow-up. In this manuscript biomechanics and clinical outcomes of UC inserts will be described, and they will be compared to standard PS or CR inserts. PMID:26855938

  5. Anterior Cruciate Ligament Reconstruction Using Hamstring Tendon Autograft With Preserved Insertions.

    PubMed

    Gupta, Ravi; Bahadur, Raj; Malhotra, Anubhav; Masih, Gladson David; Gupta, Parmanand

    2016-04-01

    We present a technique for anterior cruciate ligament (ACL) reconstruction using hamstring tendon autograft with preserved tibial insertions. The tendons, harvested with an open-ended tendon stripper while their tibial insertions are preserved, are looped around to prepare a quadrupled graft. The femoral tunnel is drilled independently through a transportal technique, whereas the tibial tunnel is drilled in a standard manner. The length of the quadrupled graft and loop of the RetroButton is adjusted so that it matches the calculated length of both tunnels and the intra-articular part of the proposed ACL graft. After the RetroButton is flipped, the graft is manually tensioned with maximal stretch on the free end, which is then sutured to the other end with preserved insertions. We propose that preserving the insertions is more biological and may provide better proprioception. The technique eliminates the need for a tibial-side fixation device, thus reducing the cost of surgery. Furthermore, tibial-side fixation of the free graft is the weakest link in the overall stiffness of the reconstructed ACL, and this technique circumvents this problem. Postoperative mechanical stability and functional outcome with this technique need to be explored and compared with those of ACL reconstruction using free hamstring autograft. PMID:27354946

  6. Posterior cruciate ligament (PCL) injury - aftercare

    MedlinePlus

    ... posterior cruciate ligament (PCL) is located inside your knee joint and connects the bones of your upper and ... such as a knee dislocation , you will need knee surgery to repair the joint. For milder injuries, you may not need surgery. ...

  7. Posterior cruciate ligament of the knee (image)

    MedlinePlus

    The posterior cruciate ligament (PCL) is a powerful ligament extending from the top-rear surface of the tibia to the bottom-front surface of the femur. The ligament prevents the knee joint from posterior instability.

  8. Vital Signs

    MedlinePlus

    Your vital signs show how well your body is functioning. They are usually measured at doctor's offices, often as part ... be a sign of a serious breathing problem. Temperature, which measures how hot your body is. A ...

  9. Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Murawski, Christopher D.; Wolf, Megan R.; Araki, Daisuke; Muller, Bart; Tashman, Scott

    2013-01-01

    Anatomic anterior cruciate ligament (ACL) reconstruction is common procedure performed by orthopedic surgeons, particularly in association with sports-related injuries. Whereas traditional reconstruction techniques used a single bundle graft that was typically placed in a non-anatomic position, a renewed interest in anatomy has facilitated the popularization of anatomic reconstruction techniques. Recently, a focus has been placed on individualizing ACL surgery based on each patient’s native anatomical characteristics (e.g., insertion site size, notch size, and shape), thereby dictating the ultimate procedure of choice. As subjective outcome measurements have demonstrated varying outcomes with respect to single- versus double-bundle ACL reconstruction, investigators have turned to more objective techniques, such as in vivo kinematics, as a means of evaluating joint motion and cartilage contact mechanics. Further investigation in this area may yield important information with regard to the potential progression to osteoarthritis after ACL reconstruction, including factors affecting or preventing it. PMID:26069663

  10. Warning Signs.

    ERIC Educational Resources Information Center

    Our Children, 1999

    1999-01-01

    Presents various signs that may indicate emotional problems in children or teens, noting that if children exhibit any of the warning signs, it is important to talk to a doctor, counselor, or mental-health professional. The warning signs are categorized as things that trouble the child, things that limit the child, behavior problems, and sudden…

  11. Single-electron Spin Resonance in a Quadruple Quantum Dot

    PubMed Central

    Otsuka, Tomohiro; Nakajima, Takashi; Delbecq, Matthieu R.; Amaha, Shinichi; Yoneda, Jun; Takeda, Kenta; Allison, Giles; Ito, Takumi; Sugawara, Retsu; Noiri, Akito; Ludwig, Arne; Wieck, Andreas D.; Tarucha, Seigo

    2016-01-01

    Electron spins in semiconductor quantum dots are good candidates of quantum bits for quantum information processing. Basic operations of the qubit have been realized in recent years: initialization, manipulation of single spins, two qubit entanglement operations, and readout. Now it becomes crucial to demonstrate scalability of this architecture by conducting spin operations on a scaled up system. Here, we demonstrate single-electron spin resonance in a quadruple quantum dot. A few-electron quadruple quantum dot is formed within a magnetic field gradient created by a micro-magnet. We oscillate the wave functions of the electrons in the quantum dots by applying microwave voltages and this induces electron spin resonance. The resonance energies of the four quantum dots are slightly different because of the stray field created by the micro-magnet and therefore frequency-resolved addressable control of each electron spin resonance is possible. PMID:27550534

  12. Single-electron Spin Resonance in a Quadruple Quantum Dot.

    PubMed

    Otsuka, Tomohiro; Nakajima, Takashi; Delbecq, Matthieu R; Amaha, Shinichi; Yoneda, Jun; Takeda, Kenta; Allison, Giles; Ito, Takumi; Sugawara, Retsu; Noiri, Akito; Ludwig, Arne; Wieck, Andreas D; Tarucha, Seigo

    2016-01-01

    Electron spins in semiconductor quantum dots are good candidates of quantum bits for quantum information processing. Basic operations of the qubit have been realized in recent years: initialization, manipulation of single spins, two qubit entanglement operations, and readout. Now it becomes crucial to demonstrate scalability of this architecture by conducting spin operations on a scaled up system. Here, we demonstrate single-electron spin resonance in a quadruple quantum dot. A few-electron quadruple quantum dot is formed within a magnetic field gradient created by a micro-magnet. We oscillate the wave functions of the electrons in the quantum dots by applying microwave voltages and this induces electron spin resonance. The resonance energies of the four quantum dots are slightly different because of the stray field created by the micro-magnet and therefore frequency-resolved addressable control of each electron spin resonance is possible. PMID:27550534

  13. On the theory of frequency-quadrupling gyroklystrons

    NASA Astrophysics Data System (ADS)

    Savilov, A. V.; Nusinovich, G. S.

    2007-05-01

    In this paper, frequency-quadrupling three-cavity gyroklystrons with successive frequency-doubling in each stage are considered. First, it is shown that such device operating in the TE4,2-mode can deliver up to 30kW output power in the regime of stable amplification with the density of Ohmic losses acceptable for continuous-wave (cw) operation. The corresponding efficiency is in the range of 17%-20%. Then, the device is scaled to 0.5THz frequency and optimized for operation at the TE4,5-mode. At this frequency, the frequency-quadrupling gyroklystron driven by the 60kV electron beam with the beam current less than 1 A can deliver up to 1kW power with acceptable Ohmic losses. The corresponding efficiency is in the range of 1%-2%.

  14. Injuries to the posterior cruciate ligament of the knee.

    PubMed

    Kannus, P; Bergfeld, J; Järvinen, M; Johnson, R J; Pope, M; Renström, P; Yasuda, K

    1991-08-01

    The posterior cruciate ligament (PCL) is the strongest ligament about the knee and is approximately twice as strong as the anterior cruciate ligament. Its main function is to prevent the posterior dislocation of the tibia in relation to the femur, providing 95% of the strength to resist the tibial posterior displacement. Along with the anterior cruciate ligament (ACL) the PCL controls the passive 'screw home' mechanism of the knee in terminal knee extension. It also provides mechanical support for the collateral ligaments during valgus or varus stress of the knee. PCL ruptures are uncommon apparently due to its strong fibre structure. The most frequent injury mechanism in isolated PCL tears is a direct blow on the anterior tibia with the knee flexed thus driving the tibia posteriorly. Automobile accidents (in which the knee hits the dashboard) and soccer injuries (in which an athlete receives a blow to the anterior surface of the tibia during knee flexion) characteristically produce this type of injury. In other PCL injury mechanisms (hyperextension, hyperflexion or rotational injuries with associated valgum/varum stress), other knee structures are also often damaged. The most characteristic diagnostic finding in a knee with a PCL rupture is the 'posterior sag sign' meaning the apparent disappearance of the tibial tubercle in lateral inspection when the knee is flexed 90 degrees. This is due to gravity-assisted posterior displacement of the tibia in relation to the femur. A positive posterior drawer test performed at 90 degrees of flexion and a knee hyperextension sign are sensitive but nonspecific tests. False negative findings are frequent, especially in acute cases. If necessary, the clinical diagnosis of the PCL tear can be verified by magnetic resonance imaging, examination under anaesthesia, arthroscopy, or a combination of these modalities. If a PCL avulsion fragment has been dislocated, surgical treatment is recommended. In isolated, complete midsubstance

  15. The Cruciate Ligaments in Total Knee Arthroplasty.

    PubMed

    Parcells, Bertrand W; Tria, Alfred J

    2016-01-01

    The early knee replacements were hinge designs that ignored the ligaments of the knee and resurfaced the joint, allowing freedom of motion in a single plane. Advances in implant fixation paved the way for modern designs, including the posterior-stabilized (PS) total knee arthroplasty (TKA) that sacrifices both cruciate ligaments while substituting for the posterior cruciate ligament (PCL), and the cruciate-retaining (CR) TKA designs that sacrifice the anterior cruciate ligament but retain the PCL. The early bicruciate retaining (BCR) TKA designs suffered from loosening and early failures. Townley and Cartier designed BCR knees that had better clinical results but the surgical techniques were challenging.Kinematic studies suggest that normal motion relies on preservation of both cruciate ligaments. Unicompartmental knee arthroplasty retains all knee ligaments and closely matches normal motion, while PS and CR TKA deviate further from normal. The 15% to 20% dissatisfaction rate with current TKA has renewed interest in the BCR design. Replication of normal knee kinematics and proprioception may address some of the dissatisfaction. PMID:27327919

  16. Anterior Cruciate Ligament Reconstruction Rehabilitation

    PubMed Central

    Wright, Rick W.; Haas, Amanda K.; Anderson, Joy; Calabrese, Gary; Cavanaugh, John; Hewett, Timothy E.; Lorring, Dawn; McKenzie, Christopher; Preston, Emily; Williams, Glenn; Amendola, Annunziato

    2015-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction rehabilitation has evolved over the past 20 years. This evolution has been driven by a variety of level 1 and level 2 studies. Evidence Acquisition: The MOON Group is a collection of orthopaedic surgeons who have developed a prospective longitudinal cohort of the ACL reconstruction patients. To standardize the management of these patients, we developed, in conjunction with our physical therapy committee, an evidence-based rehabilitation guideline. Study Design: Clinical review. Level of Evidence: Level 2. Results: This review was based on 2 systematic reviews of level 1 and level 2 studies. Recently, the guideline was updated by a new review. Continuous passive motion did not improve ultimate motion. Early weightbearing decreases patellofemoral pain. Postoperative rehabilitative bracing did not improve swelling, pain range of motion, or safety. Open chain quadriceps activity can begin at 6 weeks. Conclusion: High-level evidence exists to determine appropriate ACL rehabilitation guidelines. Utilizing this protocol follows the best available evidence. PMID:26131301

  17. Cruciate ligament loading during common knee rehabilitation exercises.

    PubMed

    Escamilla, Rafael F; Macleod, Toran D; Wilk, Kevin E; Paulos, Lonnie; Andrews, James R

    2012-09-01

    Cruciate ligament injuries are common and may lead to dysfunction if not rehabilitated. Understanding how to progress anterior cruciate ligament and posterior cruciate ligament loading, early after injury or reconstruction, helps clinicians prescribe rehabilitation exercises in a safe manner to enhance recovery. Commonly prescribed therapeutic exercises include both weight-bearing exercise and non-weight-bearing exercise. This review was written to summarize and provide an update on the available literature on cruciate ligament loading during commonly used therapeutic exercises. In general, weight-bearing exercise produces smaller loads on the anterior cruciate ligament and posterior cruciate ligament compared with non-weight-bearing exercise. The anterior cruciate ligament is loaded less at higher knee angles (i.e. 50-100 degrees). Squatting and lunging with a more forward trunk tilt and moving the resistance pad proximally on the leg during the seated knee extension unloads the anterior cruciate ligament. The posterior cruciate ligament is less loaded at lower knee angles (i.e. 0-50 degrees), and may be progressed from level ground walking to a one-leg squat, lunges, wall squat, leg press, and the two-leg squat (from smallest to greatest). Exercise type and technique variation affect cruciate ligament loading, such that the clinician may prescribe therapeutic exercises to progress ligament loading safely, while ensuring optimal recovery of the musculoskeletal system. PMID:23025167

  18. Near infrared quadruple wavelength spectrophotometry of the rat head.

    PubMed

    Hazeki, O; Tamura, M

    1989-01-01

    A quadruple wavelength method to monitor the changes in concentration of oxygenated and deoxygenated hemoglobin and the redox state of cytochrome oxidase within a living tissue is presented. The expected advantages of this technique over the triple wavelength method are (i) that it can compensate for the light scattering change of tissue itself or for instabilities of light source and photomultiplier, (ii) that it can treat the optical properties of the red blood cell in a tissue in the same way as in an in vitro model system, and (iii) that it requires no estimation of the absorption coefficient of cytochrome oxidase in situ. PMID:2551140

  19. Vital Signs

    MedlinePlus

    Your vital signs show how well your body is functioning. They are usually measured at doctor's offices, often as part ... standing, which medicines you take, and your weight. Respiratory rate, which measures your breathing. Mild breathing changes can ...

  20. Revision Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Wilde, Jeffrey; Bedi, Asheesh; Altchek, David W.

    2014-01-01

    Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B. PMID:25364483

  1. The formation of a quadruple star system with wide separation.

    PubMed

    Pineda, Jaime E; Offner, Stella S R; Parker, Richard J; Arce, Héctor G; Goodman, Alyssa A; Caselli, Paola; Fuller, Gary A; Bourke, Tyler L; Corder, Stuartt A

    2015-02-12

    The initial multiplicity of stellar systems is highly uncertain. A number of mechanisms have been proposed to explain the origin of binary and multiple star systems, including core fragmentation, disk fragmentation and stellar capture. Observations show that protostellar and pre-main-sequence multiplicity is higher than the multiplicity found in field stars, which suggests that dynamical interactions occur early, splitting up multiple systems and modifying the initial stellar separations. Without direct, high-resolution observations of forming systems, however, it is difficult to determine the true initial multiplicity and the dominant binary formation mechanism. Here we report observations of a wide-separation (greater than 1,000 astronomical units) quadruple system composed of a young protostar and three gravitationally bound dense gas condensations. These condensations are the result of fragmentation of dense gas filaments, and each condensation is expected to form a star on a timescale of 40,000 years. We determine that the closest pair will form a bound binary, while the quadruple stellar system itself is bound but unstable on timescales of 500,000 years (comparable to the lifetime of the embedded protostellar phase). These observations suggest that filament fragmentation on length scales of about 5,000 astronomical units offers a viable pathway to the formation of multiple systems. PMID:25673415

  2. MRI imaging of displaced meniscal tears: Report of a case highlighting new potential pitfalls of the MRI signs

    PubMed Central

    Prasad, Abhishek; Brar, Rahat; Rana, Shaleen

    2014-01-01

    Magnetic resonance imaging (MRI) has been found to be an excellent imaging tool for meniscal injuries. Various MRI signs have been described to detect displaced meniscal injuries, specifically the bucket-handle tears. Although these signs are quite helpful in diagnosing meniscal tears, various pitfalls have also been reported for these signs. Double anterior cruciate ligament (ACL) sign refers to presence of a linear hypointense soft tissue anterior to the ACL, which represented the flipped bucket-handle tear of the meniscus. Disproportional posterior horn and flipped meniscus signs represent asymmetrically thickened horns of the menisci due to overlying displaced meniscal fragments. We report a case wherein MRI of the knee showed tear and displacement of the medial patellofemoral ligament (MPFL) and vastus medialis complex, medial collateral ligament (MCL), and posterior cruciate ligament (PCL) mimicking these signs. To our knowledge, internally displaced MPFL and MCLs have not been described as mimics for displaced meniscal fragments. PMID:25114394

  3. Mucoid Degeneration of Posterior Cruciate Ligament with Secondary Impingement of Anterior Cruciate Ligament: A Rare Case Report

    PubMed Central

    Wang, Joon Ho; Jangir, Rajat R

    2015-01-01

    Introduction: Mucoid degeneration of cruciate ligament is well known entity, but symptomatic lesions are rare. It is even rarer to find a symptomatic posterior cruciate ligament mucoid degeneration than anterior cruciate ligament. Case Report: A 65-years-old female presented to our hospital complaining of pain in right knee joint on terminal extension since 6 months. On clinical examination, there was a flexion deformity of 5 degree and a further flexion of 150 degree with mild pain exacerbated by extension. MRI of the right knee joint showed a diffusely thickened posterior cruciate ligament (PCL) with increased intra ligamentous signal intensity on T2-weighted images. The arthroscopic findings of grossly thickened PCL with a yellowish hue are characteristic and the PCL was filled with a yellowish substance. We excised the yellowish substance from the PCL as precisely as possible not to damage the remaining PCL fiber (Limited Debulking). We did notchplasty of lateral wall and roof to accommodate the Anterior Cruciate Ligament and avoid impingement. Conclusion: Posterior cruciate ligament may enlarge significantly and may push the Anterior Cruciate Ligament in the notch and may lead to the anterior cruciate ligament (ACL) impingement symptoms. Partial Debulking of Posterior Cruciate Ligament and notchplasty is effective treatment with immediate postoperative pain relief and good functional results. PMID:27299097

  4. Vital Signs.

    ERIC Educational Resources Information Center

    Brown, Lester R.

    1993-01-01

    Presents an excerpt from the first edition of Vital Signs, a Worldwide Institute publication that provides an annual update on global environmental trends. Includes discussion of the dismantling of nuclear arms, reduction in chlorofluorocarbon production, growth in bicycle production, the decline in cigarette smoking, and decline in military…

  5. Self-aligned quadruple patterning-compliant placement

    NASA Astrophysics Data System (ADS)

    Nakajima, Fumiharu; Kodama, Chikaaki; Nakayama, Koichi; Nojima, Shigeki; Kotani, Toshiya

    2015-03-01

    Self-Aligned Quadruple Patterning (SAQP) will be one of the leading candidates for sub-14nm node and beyond. However, compared with triple patterning, making a feasible standard cell placement has following problems. (1) When coloring conflicts occur between two adjoining cells, they may not be solved easily since SAQP layout has stronger coloring constraints. (2) SAQP layout cannot use stitch to solve coloring conflict. In this paper, we present a framework of SAQP-aware standard cell placement considering the above problems. When standard cell is placed, the proposed method tries to solve coloring conflicts between two cells by exchanging two of three colors. If some conflicts remain between adjoining cells, dummy space will be inserted to keep coloring constraints of SAQP. We show some examples to confirm effectiveness of the proposed framework. To our best knowledge, this is the first framework of SAQP-aware standard cell placement.

  6. [Arthroscopic tightening of the anterior cruciate ligament].

    PubMed

    Charrois, O; Cheyrou, E; Remi, J; Panarella, L; Jouve, F; Beaufils, P

    2008-02-01

    We present here the preliminary results obtained with arthroscopic tightening of the anterior cruciate ligament. Six patients underwent the technique. Four had had prior ligamentoplasty, two had sequelae of tibial spine fractures. Laxity persisted in all cases. The transplant or the ligament were continuous and insertion points were well-positioned. The procedure consisted in using a trephine to bore the tibial bone at the "foot" of the ligament or transplant in order to tighten the ligament. There was no evidence of instability after the arthroscopic tightening procedure. Mean pre- and postoperative differential anterior drawer values were successively 9.2 and 3.9 mm. For native or reconstructed anterior cruciate ligaments, which are continuous and well-positioned but not loose, arthroscopic tightening spares the need for ligament transplant and appears to be free of specific morbidity. PMID:18342033

  7. Furazolidone-based triple and quadruple eradication therapy for Helicobacter pylori infection

    PubMed Central

    Xie, Yong; Zhu, Yin; Zhou, Hong; Lu, Zhi-Fa; Yang, Zhen; Shu, Xu; Guo, Xiao-Bai; Fan, Hui-Zhen; Tang, Jian-Hua; Zeng, Xue-Ping; Wen, Jian-Bo; Li, Xiao-Qing; He, Xing-Xing; Ma, Jiu-Hong; Liu, Dong-Sheng; Huang, Cai-Bin; Xu, Ning-Jian; Wang, Nong-Rong; Lu, Nong-Hua

    2014-01-01

    AIM: To evaluate the efficacy of furazolidone-based triple and quadruple therapy in eradicating Helicobacter pylori (H. pylori) in a multi-center randomized controlled trial. METHODS: A total of 720 H. pylori positive patients with duodenal ulcer disease were enrolled at 10 different hospitals in Jiangxi province in China. The patients were randomly assigned to four treatment groups as follows: patients in Groups 1 and 3 received rabeprazole (10 mg), amoxicillin (1000 mg) and furazolidone (100 mg) twice daily for 7 and 10 d, respectively; patients in Groups 2 and 4 received rabeprazole (10 mg), bismuth (220 mg), amoxicillin (1000 mg) and furazolidone (100 mg) twice daily for 7 and 10 d, respectively. The primary outcome measure was H. pylori eradication rate 4 wk after treatment by intention-to-treat and per protocol analysis, while the secondary outcome measures were symptom and sign changes at the end of treatment and 4 wk after the end of treatment, as well as the proportion of patients who developed adverse events. RESULTS: The demographic data of the four groups were not significantly different. Overall, 666 patients completed the scheme and were re-assessed with the 13C-urea breath test. The intention-to-treat analysis of the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 74.44%, 82.78%, 78.89% and 86.11%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. According to the per protocol analysis, the H. pylori eradication rates in Groups 1, 2, 3 and 4 were 81.21%, 89.22%, 85.54% and 92.26%, respectively. The H. pylori eradication rate in Group 4 was significantly higher than that in Group 1. The number of adverse events was 15 (8.3%), 16 (8.9%), 15 (8.3%) and 17 (9.4%) in Groups 1, 2, 3 and 4, respectively, including dizziness, vomiting, diarrhea, nausea, skin rash, itchy skin, and malaise. The symptoms were relieved without special treatment in all of the patients. CONCLUSION: Both 7- and 10-d

  8. Return to Play Following Anterior Cruciate Ligament Reconstruction.

    PubMed

    Morris, Ryan C; Hulstyn, Michael J; Fleming, Braden C; Owens, Brett D; Fadale, Paul D

    2016-10-01

    Anterior cruciate ligament reconstructions are commonly performed in an attempt to return an athlete to sports activities. Accelerated rehabilitation has made recovery for surgery more predictable and shortened the timeline for return to play. Despite success with and advancements in anterior cruciate ligament reconstructions, some athletes still fail to return to play. PMID:27543405

  9. [Infection after anterior cruciate ligament reconstruction: grave error in treatment?].

    PubMed

    Regauer, M; Neu, J

    2012-09-01

    A 28-year-old patient showed clear signs of knee joint infection 8 days after arthroscopic reconstruction of the anterior cruciate ligament. The treating physicians recommended further observation although they stated that a knee joint infection could not be reliably excluded. One week later arthroscopic revision was performed and intraoperative smear tests showed infection by Pseudomonas aeruginosa. Therefore, another 6 days later the obviously infected transplant had to be removed. In the long run painful and limited range of motion of the affected knee joint persisted. The patient complained about medical malpractice concerning management of the complication. The expert opinion stated that due to the fateful course of infection the tendon graft could not be retrieved after the eighth day post surgery anyway. Thus, only flawed delay of treatment was criticized. The arbitration board argued, however, that scientific data concerning the fate of infected tendon grafts do not support the expert opinion and that immediate arthroscopy and antibiotic treatment at least had the potential to influence the course of infection in a positive manner. Evidence clearly shows that survival of an infected tendon graft depends on early diagnosis and emergency treatment rather than just on fate. Due to the fact that, although having in mind the possibility of a knee joint infection, the necessary therapy was delayed for 8 days, the arbitration board considered the described medical malpractice a severe treatment error, leading to reversal of evidence in favour of the patient. PMID:22706649

  10. Photometric Study of the Possible Cool Quadruple System PY Virginis

    NASA Astrophysics Data System (ADS)

    Zhu, L. Y.; Qian, S. B.; Liu, N. P.; Liu, L.; Jiang, L. Q.

    2013-02-01

    Complete CCD photometric light curves in BV(RI)c bands obtained in 2012 for the short-period close binary system PY Virginis are presented. A new photometric analysis with the Wilson—Van Hamme code shows that PY Vir is an A-type marginal contact binary system. The absolute parameters of PY Vir are derived using spectroscopic and photometric solutions. Combining new determined times of minimum light with others published in the literature, the O - C diagram of the binary star is investigated. A periodic variation, with a period of 5.22(±0.05) years and an amplitude of 0.0075(±0.0004) days, was discovered. Since the spectrum of a third component has been detected by Rucinski et al., we consider this cyclic period oscillation to be the result of the light-time effect due to the presence of a third body. This third component may also be a binary itself. Therefore, PY Vir should be a quadruple system composed of two cool-type binary systems. This system is a good astrophysical laboratory to study the formation and evolution of close binaries and multiple systems.

  11. PHOTOMETRIC STUDY OF THE POSSIBLE COOL QUADRUPLE SYSTEM PY VIRGINIS

    SciTech Connect

    Zhu, L. Y.; Qian, S. B.; Liu, N. P.; Liu, L.; Jiang, L. Q.

    2013-02-01

    Complete CCD photometric light curves in BV(RI){sub c} bands obtained in 2012 for the short-period close binary system PY Virginis are presented. A new photometric analysis with the Wilson-Van Hamme code shows that PY Vir is an A-type marginal contact binary system. The absolute parameters of PY Vir are derived using spectroscopic and photometric solutions. Combining new determined times of minimum light with others published in the literature, the O - C diagram of the binary star is investigated. A periodic variation, with a period of 5.22({+-}0.05) years and an amplitude of 0.0075({+-}0.0004) days, was discovered. Since the spectrum of a third component has been detected by Rucinski et al., we consider this cyclic period oscillation to be the result of the light-time effect due to the presence of a third body. This third component may also be a binary itself. Therefore, PY Vir should be a quadruple system composed of two cool-type binary systems. This system is a good astrophysical laboratory to study the formation and evolution of close binaries and multiple systems.

  12. Update on quadruple suspension design for Advanced LIGO

    NASA Astrophysics Data System (ADS)

    Aston, S. M.; Barton, M. A.; Bell, A. S.; Beveridge, N.; Bland, B.; Brummitt, A. J.; Cagnoli, G.; Cantley, C. A.; Carbone, L.; Cumming, A. V.; Cunningham, L.; Cutler, R. M.; Greenhalgh, R. J. S.; Hammond, G. D.; Haughian, K.; Hayler, T. M.; Heptonstall, A.; Heefner, J.; Hoyland, D.; Hough, J.; Jones, R.; Kissel, J. S.; Kumar, R.; Lockerbie, N. A.; Lodhia, D.; Martin, I. W.; Murray, P. G.; O'Dell, J.; Plissi, M. V.; Reid, S.; Romie, J.; Robertson, N. A.; Rowan, S.; Shapiro, B.; Speake, C. C.; Strain, K. A.; Tokmakov, K. V.; Torrie, C.; van Veggel, A. A.; Vecchio, A.; Wilmut, I.

    2012-12-01

    We describe the design of the suspension systems for the major optics for Advanced LIGO, the upgrade to LIGO—the Laser Interferometric Gravitational-Wave Observatory. The design is based on that used in GEO600—the German/UK interferometric gravitational wave detector, with further development to meet the more stringent noise requirements for Advanced LIGO. The test mass suspensions consist of a four-stage or quadruple pendulum for enhanced seismic isolation. To minimize suspension thermal noise, the final stage consists of a silica mirror, 40 kg in mass, suspended from another silica mass by four silica fibres welded to silica ears attached to the sides of the masses using hydroxide-catalysis bonding. The design is chosen to achieve a displacement noise level for each of the seismic and thermal noise contributions of 10-19 m/√Hz at 10 Hz, for each test mass. We discuss features of the design which has been developed as a result of experience with prototypes and associated investigations.

  13. A Single Circumbinary Disk in the HD 98800 Quadruple System

    NASA Astrophysics Data System (ADS)

    Koerner, D. W.; Jensen, E. L. N.; Cruz, K.; Guild, T. B.; Gultekin, K.

    1999-12-01

    We present sub-arcsecond thermal infrared imaging of HD 98800, a young quadruple system composed of a pair of low-mass spectroscopic binaries separated by 0.8'', each with a K-dwarf primary. Images at wavelengths ranging from 5 to 24.5 microns show unequivocally that the optical secondary, HD 98800B, is the sole source of a comparatively large infrared excess upon which a silicate emission feature is superposed. The excess is detected only at wavelengths of 7.9 microns and longer, peaks at 25 microns, and has a best-fit black-body temperature of 146 K. With the assumption that the dust is in radiative equilibrium with the central stars, these characteristics require its location to be in a configuration that is circumbinary to the spectroscopic pair. A simple black-body fit underpredicts emission in the region of the broad silicate feature, however, and the feature itself requires a dust component with temperatures higher than 146 K by at least a factor of two. Further, the spectral slope at sub-millimeter wavelengths is flatter than expected for a collision-induced size-distribution of grains, suggesting a range of temperatures present at longer wavelengths. These facts suggest that the circumbinary dust is not confined to a narrow ring but is wide enough to exhibit a range of temperatures.

  14. Is There a Quadruple Bond in C2?

    PubMed

    de Sousa, David Wilian Oliveira; Nascimento, Marco Antonio Chaer

    2016-05-10

    The chemical structure of the ground state of C2 has been the subject of intense debate after the suggestion that the molecule could exhibit a "fourth" covalent bond. In this paper, we investigate this problem explicitly avoiding all the points of conflict from the previous papers to show that there is no quadruple bond in C2. The generalized product function energy partitioning (GPF-EP) method has been applied to calculate the interference energy (IE) that accounts for the formation of covalent bonds for each bond of the molecule. The IE analysis shows that for the standard σ and π bonds interference exhibits the expected behavior, while for the "fourth" bond interference is a destabilizing factor. To make sure this could not be attributed to a new kind of bond, we performed an equivalent analysis for the (3)Σ(-) excited state of C3 molecule in which similar "bonding" occurs between the two ending carbon atoms. We also show that the difference in force constants of C2 and acetylene can be rationalized in terms of the amount of charge density in the internuclear region by looking at the changes in the overlaps between orbitals along the bond axis. PMID:27045682

  15. A Child with Acute Encephalopathy Associated with Quadruple Viral Infection

    PubMed Central

    Nakata, Keiko; Kashiwagi, Mitsuru; Masuda, Midori; Shigehara, Seiji; Oba, Chizu; Murata, Shinya; Kase, Tetsuo; Komano, Jun A.

    2015-01-01

    Pediatric acute encephalopathy (AE) was sometimes attributed to virus infection. However, viral infection does not always result in AE. The risk factors for developing infantile AE upon virus infection remain to be determined. Here, we report an infant with AE co-infected with human herpesvirus-6 (HHV-6) and three picornaviruses, including coxsackievirus A6 (CVA6), Enterovirus D68 (EV-D68), and human parechovirus (HPeV). EV-D68 was vertically transmitted to the infant from his mother. CVA6 and HPeV were likely transmitted to the infant at the nursery school. HHV-6 might be re-activated in the patient. It remained undetermined, which pathogen played the central role in the AE pathogenesis. However, active, simultaneous infection of four viruses should have evoked the cytokine storm, leading to the pathogenesis of AE. Conclusion: an infant case with active quadruple infection of potentially AE-causing viruses was seldom reported partly because systematic nucleic acid-based laboratory tests on picornaviruses were not common. We propose that simultaneous viral infection may serve as a risk factor for the development of AE. PMID:25883930

  16. Ways of improving environmental quality while quadrupling output

    SciTech Connect

    Not Available

    1983-06-01

    This article reports on a symposium held in China which proposed strategic thinking on improving environmental quality in keeping with economic development. The gross industrial and agricultural output value in China is expected to quadruple by the year 2000. Although the water quality of the big rivers in China is still good, the medium and small streams in the cities have become polluted by industrial waste and domestic sewage. China devotes only 0.3% of her gross industrial and agricultural output value to environmental protection, while the Western countries allocate about 1% or even as much as 2-2.5% of their GNP for the environment. The conferees at the symposium agreed that environmental protection should work for economic development and for raising social and economic results. It is proposed that environmental protection should be carried out by enforcing discharge and drainage limits, and by encouraging enterprises to reduce the discharge of pollutants. In a survey of more than 100 enterprises engaged in papermaking, tanning, the manufacture of synthetic fatty acids, synthetic detergents and sugar, the departments of light industry found that 70-90% of the discharged pollutants are resources which can still be used. The question of focusing on planned environmental management is examined. Includes a table.

  17. WDM up-conversion employing frequency quadrupling in optical modulator.

    PubMed

    Shih, Po-Tsung; Lin, Chun-Ting; Jiang, Wen-Jr; Chen, Jason Jyehong; Huang, Han-Sheng; Chen, Yu-Hung; Peng, Peng-Chun; Chi, Sien

    2009-02-01

    This work presents an optical up-conversion system with frequency quadrupling for wavelength-division-multiplexing (WDM) communication systems using a dual-parallel Mach-Zehnder modulator without optical filtering. Four-channel 1.25-Gb/s wired fiber-to-the-x (FTTx) and wireless radio-over-fiber (RoF) signals are generated and transmitted simultaneously. Moreover, the decline in receiver sensitivities due to Mach-Zehnder modulator bias drifts is also investigated. Receiver power penalties of the 20-GHz up-converted WDM signals and baseband (BB) FTTx signals are less than 1 dB when bias deviation voltage is less the 20% of the half-wave voltage. After transmission over a 50-km SSMF, the receiver power penalties of both the BB and 20-GHz RF OOK signals are less than 1 dB. Notably, 60-GHz optical up-conversion can be achieved using 15-GHz radio frequency (RF) components and equipment. PMID:19189002

  18. Optimal Design of a Center Support Quadruple Mass Gyroscope (CSQMG).

    PubMed

    Zhang, Tian; Zhou, Bin; Yin, Peng; Chen, Zhiyong; Zhang, Rong

    2016-01-01

    This paper reports a more complete description of the design process of the Center Support Quadruple Mass Gyroscope (CSQMG), a gyro expected to provide breakthrough performance for flat structures. The operation of the CSQMG is based on four lumped masses in a circumferential symmetric distribution, oscillating in anti-phase motion, and providing differential signal extraction. With its 4-fold symmetrical axes pattern, the CSQMG achieves a similar operation mode to Hemispherical Resonant Gyroscopes (HRGs). Compared to the conventional flat design, four Y-shaped coupling beams are used in this new pattern in order to adjust mode distribution and enhance the synchronization mechanism of operation modes. For the purpose of obtaining the optimal design of the CSQMG, a kind of applicative optimization flow is developed with a comprehensive derivation of the operation mode coordination, the pseudo mode inhibition, and the lumped mass twisting motion elimination. The experimental characterization of the CSQMG was performed at room temperature, and the center operation frequency is 6.8 kHz after tuning. Experiments show an Allan variance stability 0.12°/h (@100 s) and a white noise level about 0.72°/h/√Hz, which means that the CSQMG possesses great potential to achieve navigation grade performance. PMID:27136557

  19. Self-aligned double and quadruple patterning layout principle

    NASA Astrophysics Data System (ADS)

    Nakayama, Koichi; Kodama, Chikaaki; Kotani, Toshiya; Nojima, Shigeki; Mimotogi, Shoji; Miyamoto, Shinji

    2012-03-01

    Self-Aligned Double Patterning (SADP) has become one of the most promising processes for 20nm node technology and beyond. Despite its robustness against overlay, it is a challenging process for designers since predicting the wafer image instantly is almost impossible. Self-Aligned Quadruple Patterning (SAQP) is also critical technology for sub-10nm process but more complex than SADP, so it is too difficult to design a layout intuitively. Needless to say designing layout by applying N times sidewalls intuitively is impossible for almost everyone. In this paper, we clarify a new intuitive principle for SADP layout. The principle uses "Base patterns" painted in different two colors interchangeably. The proposed method enables us to design SADP layout simply by connecting and cutting fundamental pattern arbitrarily with a few restrictions. Another benefit is that either of two colors in the pattern can be used as mandrel. We can apply the principle to not only SAQP but also N times sidewall processes. Considering these advantages, layout formed by sidewall process becomes designer-friendly.

  20. The closest M-dwarf quadruple system to the Sun

    SciTech Connect

    Davison, Cassy L.; White, R. J.; Jao, W.-C.; Henry, T. J.; Quinn, S. N.; Cantrell, J. R.; Winters, J. G.; Bailey, J. I. III; Riedel, A. R.; Subasavage, J. P.; Crockett, C. J.

    2014-02-01

    We report new infrared radial velocity measurements obtained with CSHELL at NASA's Infrared Telescope Facility that reveal the M3.5 dwarf GJ 867B to be a single-lined spectroscopic binary with a period of 1.795 ± 0.017 days. Its velocity semi-amplitude of 21.4 ± 0.5 km s{sup –1} corresponds to a minimum mass of 61 ± 7 M {sub JUP}; the new companion, which we call GJ 867D, could be a brown dwarf. Stable astrometric measurements of GJ 867BD obtained with CTIO's 0.9 m telescope over the last decade exclude the presence of any massive planetary companions (7-18 M {sub JUP}) with longer orbital periods (2-10 yr) for the majority of orientations. These complementary observations are also used to determine the trigonometric distance and proper motion of GJ 867BD; the measurements are consistent with the HIPPARCOS measured values of the M2 dwarf GJ 867AC, which is itself a 4.1 day double-lined spectroscopic binary at a projected separation of 24.''5 (216 AU) from GJ 867BD. These new measurements strengthen the case that GJ 867AC and GJ 867BD are physically associated, making the GJ 867 system one of only four quadruple systems within 10 pc of the Sun (d = 8.82 ± 0.08 pc) and the only among these with all M-dwarf (or cooler) components.

  1. Communication: The performance of non-iterative coupled cluster quadruples models.

    PubMed

    Eriksen, Janus J; Matthews, Devin A; Jørgensen, Poul; Gauss, Jürgen

    2015-07-28

    We compare the numerical performance of various non-iterative coupled cluster (CC) quadruples models. The results collectively show how approaches that attempt to correct the CC singles and doubles energy for the combined effect of triple and quadruple excitations all fail at recovering the correlation energy of the full CC singles, doubles, triples, and quadruples (CCSDTQ) model to within sufficient accuracy. Such a level of accuracy is only achieved by models that make corrections to the full CC singles, doubles, and triples (CCSDT) energy for the isolated effect of quadruple excitations of which the CCSDT(Q-3) and CCSDT(Q-4) models of the Lagrangian-based CCSDT(Q-n) perturbation series are found to outperform alternative models that add either of the established [Q] and (Q) corrections to the CCSDT energy. PMID:26233096

  2. A proteome map of a quadruple photoreceptor mutant sustains its severe photosynthetic deficient phenotype.

    PubMed

    Fox, Ana Romina; Barberini, Maria Laura; Ploschuk, Edmundo Leonardo; Muschietti, Jorge Prometeo; Mazzella, Maria Agustina

    2015-08-01

    Light is the environmental factor that most affects plant growth and development through its impact on photomorphogenesis and photosynthesis. A quadruple photoreceptor mutant lacking four of the most important photoreceptors in plants, phytochromes A and B (phyA, phyB) and cryptochromes 1 and 2 (cry1, cry2), is severely affected in terms of growth and development. Previous studies have suggested that in addition to a photomorphogenic disorder, the phyA phyB cry1 cry2 quadruple mutant might have severe alterations in photosynthetic ability. Here, we investigated the photosynthetic processes altered in the quadruple mutant and performed a proteomic profiling approach to identify some of the proteins involved. The phyA phyB cry1 cry2 quadruple mutant showed reduced leaf area and total chlorophyll content. Photosynthetic rates at high irradiances were reduced approximately 65% compared to the wild type (WT). Light-saturated photosynthesis and the response of net CO2 exchange to low and high internal CO2 concentrations suggest that the levels or activity of the components of the Calvin cycle and electron transport might be reduced in the quadruple mutant. Most of the under-expressed proteins in the phyA phyB cry1 cry2 quadruple mutant consistently showed a chloroplastic localization, whereas components of the Calvin cycle and light reaction centers were overrepresented. Additionally, Rubisco expression was reduced threefold in the phyA phyB cry1 cry2 quadruple mutant. Together, these results highlight the importance of the phytochrome and cryptochrome families in proper autotrophy establishment in plants. They also suggest that an overall limitation in the chlorophyll levels, expression of Rubisco, and enzymes of the Calvin Cycle and electron transport that affect ribulose-1,5-biphosphate (RuBP) regeneration reduced photosynthetic capacity in the phyA phyB cry1 cry2 quadruple mutant. PMID:26264966

  3. Knee imaging after anterior cruciate ligament reconstruction.

    PubMed

    Rodrigues, M B; Silva, J J; Homsi, C; Stump, X M; Lecouvet, F E

    2001-01-01

    An increasing number of reconstructions of the anterior cruciate ligament (ACL) are performed every year, due to both the increasing occurrence of sport related injuries and the development of diagnostic and surgical techniques. The most used surgical procedure for the torn ACL reconstruction is the use of autogenous material, most often the patellar and semitendinosus tendons. Magnetic resonance (MR) imaging and spiral-CT performed after arthrography with multiplanar reconstructions are the imaging methods of choice for post-operative evaluation of ACL ligamentoplasty. This paper provides a brief bibliographic and more extensive pictorial review of the normal evolution and possible complications after ACL repair. PMID:11817479

  4. PROPERTIES OF THE CLOSE-IN TERTIARY IN THE QUADRUPLE SYSTEM V401 CYG

    SciTech Connect

    Zhu, L.-Y.; Qian, S.-B.; Zhou, X.; Li, L.-J.; Zhao, E.-G.; Liu, L.; Liu, N.-P.

    2013-08-01

    V401 Cyg is a quadruple system in which the spectroscopic signature of a close-in tertiary and a distant visual companion star were reported. Orbital properties of the close-in companion should provide valuable information on the formation of close binaries and stellar dynamical interaction. By analyzing new times of minimum light together with those collected from the literature, we discovered that the observed-calculated (O - C) curve of V401 Cyg shows a cyclic change with a short period of 3.5 yr and a semi-amplitude of 0.00436 days while it undergoes an upward parabolic variation. Those photoelectric and CCD data covered more than two cycles and were analyzed for the light-travel time effect via the presence of the tertiary companion. The mass of the third body was determined to be M{sub 3}sin i' = 0.65({+-} 0.08) M{sub Sun }, which is close to the value estimated from the spectroscopic data (M{sub 3} {approx} 0.64 M{sub Sun }). This reveals that the orbital inclination of the tertiary was about i' {approx} 90 Degree-Sign , indicating that the contact components of V401 Cyg have the possibility of being eclipsed by the tertiary at an orbital distance of about 3.0 AU, and it may be a triply eclipsing hierarchical triple system. The upward parabolic change indicates a period increase at a rate of (P-dot{sub 2} = 1.5 x 10{sup -7} revealing a mass transfer from the secondary to the primary (M-dot{sub 2} = 5.9 x 10{sup -8} M{sub Sun} yr{sup -1}). This is consistent with the predictions of the theory of thermal relaxation oscillation (TRO) suggesting that V401 Cyg is undergoing an expanding-orbit stage in the TRO cycles.

  5. Treatment of Anterior Cruciate Ligament Injuries.

    PubMed

    Sanders, James O; Brown, Gregory A; Murray, Jayson; Pezold, Ryan; Sevarino, Kaitlyn S

    2016-08-01

    The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Treatment of Anterior Cruciate Ligament Injuries. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany an anterior cruciate ligament injury, as well as from current evidence-based clinical practice guidelines and supporting literature. The 56 patient scenarios and 8 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Lastly, a separate, multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3). PMID:27355285

  6. Stroke Warning Signs

    MedlinePlus

    ... News Advocate Stroke Warning Signs Quiz Stroke Warning Signs and Symptoms THINK YOU ARE HAVING A STROKE? ... Learn more stroke signs and symptoms >>>> Stroke Warning Signs Hip-Hop F.A.S.T. Video Updated Guidelines ...

  7. Headaches - danger signs

    MedlinePlus

    Migraine headache - danger signs; Tension headache - danger signs; Cluster headache - danger signs; Vascular headache - danger signs ... and bleeding in the brain can cause a headache. These problems include: Abnormal connection between the arteries ...

  8. Signing off

    NASA Astrophysics Data System (ADS)

    2001-05-01

    sharp that they cause paper cuts. Stains. If you accidentally spill some food or drink on your clothes, make sure you attempt to remove it as soon as possible and preferably within the same lunar cycle. Some teachers seem to think they should be worn with pride like the stains on a chemistry teacher's white coat. This is a myth. Materials. For scientists continually teaching about the wonder of smart materials, physics teachers are remarkably conservative in their choice of materials for their clothes. Try to break out from the traditional corduroy and tweed and practise what you teach. It is not acceptable to wear the actual tie you wore at school, as this will be at least 20 years old, be rather frayed and will have your name sewn in the back by your mum. Steven Chapman Science Year Manager, British Association for the Advancement of Science Signing Off takes a humorous and irreverent look at physics education. The views expressed here are those of the author and are not endorsed by the Editorial Board for Physics Education. Can you contribute a zany attitude or humorous anecdote? Please send your offering to ped@iop.org marked Signing Off.

  9. Cullen Sign and Grey Turner Sign Revisited.

    PubMed

    Wright, William F

    2016-06-01

    Cullen sign and Grey Turner sign, named after Thomas Stephen Cullen, MB, and George Grey Turner, MBBS, respectively, are signs of abdominal wall hemorrhage and are generally associated with acute pancreatitis. However, the research from which these signs arose was documented long before Cullen and Grey Turner made their contributions. The present article examines the history, pathologic mechanisms, and clinical application of these signs in relation to acute pancreatitis and ectopic pregnancy. PMID:27214777

  10. Signing off

    NASA Astrophysics Data System (ADS)

    2001-09-01

    Physics Related Aptitude Test As the teacher shortage bites anyone with a degree in science expects to walk into a school and be received, with open arms, as a physics teacher. Are they really suitable? To help you decide Signing Off provides the following invaluable psychometric test. Extensively researched and, for single users only, it comes completely free to Physics Education subscribers! (Copies of this Physics Related Aptitude Test are available to credit-card customers from prat@realripoff.com priced #35 per client, 125 dollars to US customers.) This invaluable psychometric test has been extensively researched. Your first lesson of the new school year introduces the study of electricity. Do you: A Use the notes prepared by your predecessor. B Find a video on electricity and play it to the class. C Arrange a series of exciting practical demonstrations to stimulate the young inquiring mind. D Let the children design and make their own circuits to light flashlight bulbs. Your 14-year-olds have completed a written test on heat and energy. Do you: A Mark correct only the work of students who have written their names neatly at the top LEFT HAND corner, as required. B Only set multiple choice tests, so that the computer can mark them for you. C Mark carefully by hand, explaining in detail to each student exactly how and why they have made errors and adding encouraging comments with lots of praise. D Give out correct sets of answers and allow students to mark their own work. There is a staff social. Do you: A Ask for a definition of the term 'social'. B Ask for a web-based version. C Determine to go, so that you can discuss setting up cross-curricular links with colleagues. D Join the organizing committee. Who do you admire most? A Sir Isaac Newton. B Bill Gates. C Leonardo da Vinci. D Leonardo di Caprio. You are required to teach biology class. Your response is: A Denial. B To ask for an appropriate computer simulation. C To attend a specialized course for biology

  11. Anterior cruciate ligament rupture and osteoarthritis progression.

    PubMed

    Wong, James Min-Leong; Khan, Tanvir; Jayadev, Chethan S; Khan, Wasim; Johnstone, David

    2012-01-01

    Anterior Cruciate Ligament (ACL) rupture is a common sporting injury that frequently affects young, athletic patients. Apart from the functional problems of instability, patients with ACL deficient knees also develop osteoarthritis. Although this is frequently cited as an indication for ACL reconstruction, the relationship between ACL rupture, reconstruction and the instigation and progression of articular cartilage degenerative change is controversial.The purpose of this paper is to review the published literature with regards ACL rupture and the multifactorial causes for osteoarthritis progression, and whether or not this is slowed or stopped by ACL reconstruction.There is no evidence in the published literature to support the view that ACL reconstruction prevents osteoarthritis, although it may prevent further meniscal damage. It must be recognised that this conclusion is based on the current literature which has substantial methodological limitations. PMID:22896777

  12. Infections in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Stucken, Charlton; Garras, David N.; Shaner, Julie L.; Cohen, Steven B.

    2013-01-01

    Context: Anterior cruciate ligament (ACL) reconstruction is a safe, common, and effective method of restoring stability to the knee after injury, but evolving techniques of reconstruction carry inherent risk. Infection after ACL reconstruction, while rare, carries a high morbidity, potentially resulting in a poor clinical outcome. Evidence Acquisition: Data were obtained from previously published peer-reviewed literature through a search of the entire PubMed database (up to December 2012) as well as from textbook chapters. Results: Treatment with culture-specific antibiotics and debridement with graft retention is recommended as initial treatment, but with persistent infection, consideration should be given to graft removal. Graft type likely has no effect on infection rates. Conclusion: The early diagnosis of infection and appropriate treatment are necessary to avoid the complications of articular cartilage damage and arthrofibrosis. PMID:24427432

  13. Posterior Cruciate Ligament: Focus on Conflicting Issues

    PubMed Central

    Lee, Yong Seuk

    2013-01-01

    There is little consensus on how to optimally reconstruct the posterior cruciate ligament (PCL) and the natural history of injured PCL is also unclear. The graft material (autograft vs. allograft), the type of tibial fixation (tibial inlay vs. transtibial tunnel), the femoral tunnel position within the femoral footprint (isometric, central, or eccentric), and the number of bundles in the reconstruction (1 bundle vs. 2 bundles) are among the many decisions that a surgeon must make in a PCL reconstruction. In addition, there is a paucity of information on rehabilitation after reconstruction of the PCL and posterolateral structures. This article focused on the conflicting issues regarding the PCL, and the scientific rationales behind some critical points are discussed. PMID:24340144

  14. Tibial Tuberosity-Posterior Cruciate Ligament Distance.

    PubMed

    Daynes, Jake; Hinckel, Betina Bremer; Farr, Jack

    2016-08-01

    When trochlear dysplasia is present, it is difficult to measure the tibial tuberosity to trochlear groove (TT-TG) distance. A new measurement to assess tuberosity position was recently described by Seitlinger et al, which avoids the difficulty of identifying the TG as it references the posterior cruciate ligament (PCL). To evaluate the reproducibility of the Seitlinger et al findings, 42 knees in 41 patients with a documented history of recurrent patellar instability and 84 knees in patients with no history of patellar instability or patellofemoral symptoms were evaluated with magnetic resonance imaging. The TT-PCL distance was increased in the instability group (mean, 21.6 mm) compared with the control group (mean, 19.0 mm). The TT-PCL distance is an independent risk factor for patients with recurrent patellar instability. Its role in surgical planning remains to be determined. PMID:26509659

  15. Patellotibial contusions in anterior cruciate ligament tears.

    PubMed

    Wissman, Robert D; England, Eric; Mehta, Kaushal; Nepute, Joshua; Von Fischer, Nathaniel; Apgar, Josh; Javadi, Ariyan

    2014-02-01

    Bone contusions are an important ancillary finding of many knee injuries. Not only are they a source of pain, they may suggest a mechanism of injury or a specific derangement of the knee joint. We have encountered a small number of patients being evaluated for anterior cruciate ligament (ACL) tears with unexplained patellar and tibial edema at magnetic resonance (MR) imaging. We present three individuals with contusions of the inferior patella with a corresponding contusion of the anteromedial tibial plateau. Internal derangements in these patients were similar to other individuals with acute ACL tears, however osseous contusions were more widespread. In conclusion, patellotibial contusions are rare and may indicate an injury with forces greater than usually encountered in most ACL tears. A careful search for uncommon associated injuries is prudent in these high-energy knee injuries. PMID:24037484

  16. [Ultrasound imaging of the anterior cruciate ligament. Possibilities and limits].

    PubMed

    Kelsch, G; Ulrich, C; Bickelhaupt, A

    1996-02-01

    We carried out sonography of the femoral origin of the anterior cruciate ligament in the dorsal cross section with a 7.5-MHz linear scanner in 25 test subjects with healthy knee joints. A physiological difference between the sides in the size of the hypoechoic region of the origin could be defined on the basis of the measurements obtained in both knee joints. Values outside a reference range which could be evaluated from this difference were rated as pathological in terms of an anterior cruciate ligament rupture. The reliability of this method in definitively diagnosing an anterior cruciate ligament rupture was analysed statistically as compared to the golden standard of arthroscopy on 65 patients by means of the two-by-two frequency table test. The femoral origin of the cruciate ligament in 25 test subjects had a median width of 3.1 mm (range 1.7-5.8 mm) on the right and 3.4 mm (range 1.7-4.4 mm) on the left. The median difference between the sides is 0.4 mm (range 0-1.8 mm). If the 3rd to the 97th percentile is selected as the reference range, our data show a physiological difference between the sides of 0-1.5 mm. The median age of the 65 patients was 31 years (range 14-74 years). Two thirds of all patients were men. A rupture of the anterior cruciate ligament was diagnosed sonographically in 19 patients. The result was confirmed arthroscopically in 15 patients. In 4 patients, there was a false positive sonographic finding. Forty-six patients did not fulfil the sonographic criteria of a rupture of the anterior cruciate ligament. Of these, 38 showed an intact anterior cruciate ligament on arthroscopy. Eight patients had a false-negative sonographic finding. The corresponding statistical analysis showed sensitivity of 65%, specificity of 90% and precision of 79%. Accordingly, the diagnostic reliability of knee joint sonography in diagnosing a rupture of the anterior cruciate ligament appears to be unsatisfactory, since old ruptures, above all, cannot be imaged with

  17. Assessment of the menisci and cruciate ligaments: an audit of clinical practice.

    PubMed

    Boeree, N R; Ackroyd, C E

    1991-07-01

    The reliability of clinical assessment of the knee was evaluated in 203 patients using magnetic resonance imaging (MRI). Neither the mechanism of injury nor clinical symptoms were useful indicators of the type of pathology. Physical signs proved insufficiently sensitive in detecting abnormalities. Overall, the accuracy of clinical diagnosis was 80.8 per cent for the anterior cruciate ligament, 62.9 per cent for the medial meniscus and 74.9 per cent for the lateral meniscus. Accurate investigations allow arthroscopy to be targeted to those likely to obtain therapeutic benefit. Reliance upon clinical judgement alone would have resulted in an 89 per cent increase in arthroscopic procedures. Investigations such as MRI or arthrography are concluded to be cost-effective methods of avoiding unnecessary hospitalization, morbidity and waste of limited resources. PMID:1937725

  18. The double flipped meniscus sign: unusual MRI findings in bucket-handle tear of the lateral meniscus.

    PubMed

    Ahn, Jin Hwan; Yim, Soo Jae; Seo, Yu Seok; Ko, Taeg Su; Lee, Joon Hee

    2014-01-01

    Bucket-handle meniscal tears are either longitudinal, vertical, or oblique in direction with an attached tear fragment displaced from the meniscus. Magnetic resonance imaging (MRI) signs are widely used in the diagnosis of these tears, including the 'fragment within the intercondylar notch sign', 'flipped meniscus sign', 'double anterior horn sign', 'absence of the bow tie sign', 'double posterior cruciate ligament (PCL) sign', 'posterior double PCL sign', and 'triple PCL sign'. We report an unusual case, not yet described in previous studies, of a bucket-handle tear presenting as a double longitudinal tear of the lateral meniscus (LM). Two longitudinal tears were observed in the white-white zone and the red-white zone of the LM, where both fragments were shown to be displaced and locked within the intercondylar notch. Partial menisectomy was performed for the central fragment and a repair with modified all-inside sutures was performed for the peripheral fragment. PMID:24156924

  19. Acute three-vessel cervical arterial occlusion due to spontaneous quadruple cervical artery dissection

    PubMed Central

    Aronov, Moisey; Shevchenko, Natalia S; Amosova, Natalia A; Kotenko, Konstantin V

    2014-01-01

    Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. Arnold et al described 11 cases (1.5%) with triple CAD of a reported 740 patients and just a single (0.1%) quadruple case in the same population. Simultaneous dissection of the four principal vessels is extremely rare. According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1–3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD. PMID:24957585

  20. EVALUATION OF THE RESULTS OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING FLEXOR TENDONS AND RIGID GUIDE TRANSVERSE SCREW

    PubMed Central

    de Castro, Renato Luiz Bevilacqua; Acras, Sandor Dosa

    2015-01-01

    Objective: The aim of this study was to analyze the results of ACL (anterior cruciate ligament) reconstruction using quadruple flexor tendons as grafts, with ligament fixation in the femur using a rigid guide transverse screw and in the tibia, using a cancellous screw with a fixing washer. Methods: 173 knees (166 from males and seven from females) that had undergone surgery with ACL reconstruction using this technique between December 2002 and February 2007 were evaluated. The mean age was 30 years (from 13 to 56 years), and the mean follow-up time was 30 months (6-55 months). We divided the knees into three groups, which were assessed using the Lysholm scale: Group A with six months of follow-up; Group B with 12 months of follow-up; and Group C with 24 months of follow-up. Results: We evaluated the results, and groups A, B and C received 94, 95 and 95 points respectively on the Lysholm scale. Conclusions: The surgical technique proved to be safe and easy to perform, with good results and a low complication rate. Also, its results were maintained throughout the study period of 24 months. PMID:27027002

  1. Warning Signs After Birth

    MedlinePlus

    ... Pregnancy > Postpartum care > Warning signs after birth Warning signs after birth E-mail to a friend Please ... infection Postpartum bleeding Postpartum depression (PPD) What warning signs should you look for? Call your provider if ...

  2. Nonbismuth concomitant quadruple therapy for Helicobacter pylori eradication in Chinese regions: A meta-analysis of randomized controlled trials

    PubMed Central

    Lin, Lien-Chieh; Hsu, Tzu-Herng; Huang, Kuang-Wei; Tam, Ka-Wai

    2016-01-01

    AIM: To evaluate the applicability of nonbismuth concomitant quadruple therapy for Helicobacter pylori (H. pylori) eradication in Chinese regions. METHODS: A systematic review and meta-analysis of randomized controlled trials was performed to evaluate the efficacy of nonbismuth concomitant quadruple therapy between sequential therapy or triple therapy for H. pylori eradication in Chinese regions. The defined Chinese regions include China, Hong Kong, Taiwan, and Singapore. The primary outcome was the H. pylori eradication rate; the secondary outcome was the compliance with therapy. The PubMed, Embase, Scopus, and Cochrane databases were searched for studies published in the period up to March 2016 with no language restriction. RESULTS: We reviewed six randomized controlled trials and 1616 patients. In 3 trials comparing concomitant quadruple therapy with triple therapy, the H. pylori eradication rate was significantly higher for 7-d nonbismuth concomitant quadruple therapy than for 7-d triple therapy (91.2% vs 77.9%, risk ratio = 1.17, 95%CI: 1.09-1.25). In 3 trials comparing quadruple therapy with sequential therapy, the eradication rate was not significant between groups (86.9% vs 86.0%). However, higher compliance was achieved with concomitant therapy than with sequential therapy. CONCLUSION: The H. pylori eradication rate was higher for nonbismuth concomitant quadruple therapy than for triple therapy. Moreover, higher compliance was achieved with nonbismuth concomitant quadruple therapy than with sequential therapy. Thus, nonbismuth concomitant quadruple therapy should be the first-line treatment in Chinese regions. PMID:27340362

  3. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    PubMed Central

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  4. Quadruple parallel mass Spectrometry for analysis of vitamin D and triacylglycerols in a dietary supplement

    Technology Transfer Automated Retrieval System (TEKTRAN)

    A ‘dilute-and-shoot’ method for vitamin D and triacylglycerols is demonstrated that employed four mass spectrometers, operating in different ionization modes, for a ‘quadruple parallel mass spectrometry’ analysis, plus three other detectors, for seven detectors overall. Sets of five samples of diet...

  5. Active knee motion after cruciate ligament rupture. Stereoradiography.

    PubMed

    Kärrholm, J; Selvik, G; Elmqvist, L G; Hansson, L I

    1988-04-01

    In 10 patients with an old injury of the anterior cruciate ligament, the three-dimensional movements of the knee joint were studied when the patients flexed their knees. Tibial motions were recorded using roentgen stereophotogrammetric analysis. Internal rotation and adduction of the tibia were reduced in the injured knees when compared with the intact knees; during flexion of the knee joint, the tibial intercondylar eminence occupied a more lateral and posterior position on the injured side. Our results may indicate that the knee joint is continuously exposed to abnormal stresses when the anterior cruciate ligament is torn. PMID:3364185

  6. Failure of Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Samitier, Gonzalo; Marcano, Alejandro I.; Alentorn-Geli, Eduard; Cugat, Ramon; Farmer, Kevin W; Moser, Michael W

    2015-01-01

    The present review classifies and describes the multifactorial causes of anterior cruciate ligament (ACL) surgery failure, concentrating on preventing and resolving such situations. The article particularly focuses on those causes that require ACL revision due to recurrent instability, without neglecting those that affect function or produce persistent pain. Although primary ACL reconstruction has satisfactory outcome rates as high as 97%, it is important to identify the causes of failure, because satisfactory outcomes in revision surgery can drop to as much as 76%. It is often possible to identify a primary or secondary cause of ACL surgery failure; even the most meticulous planning can give rise to unexpected findings during the intervention. The adopted protocol should therefore be sufficiently flexible to adapt to the course of surgery. Preoperative patient counseling is essential. The surgeon should limit the patient’s expectations for the outcome by explaining the complexity of this kind of procedure. With adequate preoperative planning, close attention to details and realistic patient expectations, ACL revision surgery may offer beneficial and satisfactory results for the patient. PMID:26550585

  7. Guideline on anterior cruciate ligament injury

    PubMed Central

    2012-01-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the “Appraisal of Guidelines for Research and Evaluation” instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  8. Guideline on anterior cruciate ligament injury.

    PubMed

    Meuffels, Duncan E; Poldervaart, Michelle T; Diercks, Ron L; Fievez, Alex W F M; Patt, Thomas W; Hart, Cor P van der; Hammacher, Eric R; Meer, Fred van der; Goedhart, Edwin A; Lenssen, Anton F; Muller-Ploeger, Sabrina B; Pols, Margreet A; Saris, Daniel B F

    2012-08-01

    The Dutch Orthopaedic Association has a long tradition of development of practical clinical guidelines. Here we present the recommendations from the multidisciplinary clinical guideline working group for anterior cruciate ligament injury. The following 8 clinical questions were formulated by a steering group of the Dutch Orthopaedic Association. What is the role of physical examination and additional diagnostic tools? Which patient-related outcome measures should be used? What are the relevant parameters that influence the indication for an ACL reconstruction? Which findings or complaints are predictive of a bad result of an ACL injury treatment? What is the optimal timing for surgery for an ACL injury? What is the outcome of different conservative treatment modalities? Which kind of graft gives the best result in an ACL reconstruction? What is the optimal postoperative treatment concerning rehabilitation, resumption of sports, and physiotherapy? These 8 questions were answered and recommendations were made, using the "Appraisal of Guidelines for Research and Evaluation" instrument. This instrument seeks to improve the quality and effectiveness of clinical practical guidelines by establishing a shared framework to develop, report, and assess. The steering group has also developed 7 internal indicators to aid in measuring and enhancing the quality of the treatment of patients with an ACL injury, for use in a hospital or practice. PMID:22900914

  9. Approaching the ruptured anterior cruciate ligament.

    PubMed

    Sarraf, Khaled M; Sadri, Amir; Thevendran, Gowreeson; Vedi, Vikas

    2011-08-01

    Anterior cruciate ligament (ACL) disruptions are common injuries that currently hold a fearsome reputation among athletes of all abilities and disciplines. Indeed, if the diagnosis is missed at first presentation, it is difficult to attribute ongoing instability and recurrent injury to an ACL tear. Classically, patients then often improve shortly before repeatedly reinjuring their knee. At some point, the knee may lock, necessitating an arthroscopic meniscectomy. Tragically, this then hastens the progression of joint arthrosis and the decline of the joint function. While the burden of responsibility does not lie solely with the junior doctor or the general practitioner, it is often at the first consultation that the natural history of this devastating injury is decided. The ability to recognise, institute early management and reassure patients with ACL tears about the future is an invaluable asset to the non-specialist junior doctor. Once diagnosed, the responsibility of advising and further counselling of patients with ACL injuries is best left to the orthopaedic knee specialist. Family practitioners and emergency room doctors should not feel pressured to offer advice on specialist areas such as return to sports without reconstruction or indeed the need for reconstruction. Indeed, decisions to return to sports with ACL-deficient knees have all too often led to disastrous reinjury events to the articular cartilage and/or the menisci. PMID:21097944

  10. Principles of postoperative anterior cruciate ligament rehabilitation

    PubMed Central

    Saka, Tolga

    2014-01-01

    It is known that anterior cruciate ligament (ACL) reconstruction needs to be combined with detailed postoperative rehabilitation in order for patients to return to their pre-injury activity levels, and that the rehabilitation process is as important as the reconstruction surgery. Literature studies focus on how early in the postoperative ACL rehabilitation period rehabilitation modalities can be initiated. Despite the sheer number of studies on this topic, postoperative ACL rehabilitation protocols have not been standardized yet. Could common, “ossified” knowledge or modalities really prove themselves in the literature? Could questions such as “is postoperative brace use really necessary?”, “what are the benefits of early restoration of the range of motion (ROM)?”, “to what extent is neuromuscular electrical stimulation (NMES) effective in the protection from muscular atrophy?”, “how early can proprioception training and open chain exercises begin?”, “should strengthening training start in the immediate postoperative period?” be answered for sure? My aim is to review postoperative brace use, early ROM restoration, NMES, proprioception, open/closed chain exercises and early strengthening, which are common modalities in the very comprehensive theme of postoperative ACL rehabilitation, on the basis of several studies (Level of Evidence 1 and 2) and to present the commonly accepted ways they are presently used. Moreover, I have presented the objectives of postoperative ACL rehabilitation in tables and recent miscellaneous studies in the last chapter of the paper. PMID:25232521

  11. Reconstruction of the anterior cruciate ligament.

    PubMed

    Seedhom, B B

    1992-01-01

    Ligaments are strong collagenous structures that act as constraints on joint motion, thus confining the articular surfaces to more or less the same paths. In so doing they prevent arbitrary apposition of these surfaces from occurring and resulting in abnormal stresses which may damage the joint surfaces. Ligaments rupture due to excessive loads, particularly those resulting from trauma occurring during sporting events or motor vehicle accidents. Knee and ankle joints have the highest frequency of ligamentous injuries. This paper is a brief review of the current approaches to the reconstruction of the knee ligaments with specific reference to the anterior cruciate ligament (ACL) being the most frequently reconstructed. This is not only because it is frequently injured but also because of the debilitating consequences of such an injury. Approaches ranging from the conservative to those that advocate the use of frank prosthetic replacement have been adopted by surgeons at both ends of the spectrum. Following a discussion of the rationale for reconstruction of the ACL, the mechanical and biological considerations of the reconstructive procedure are discussed. The different methods of ACL reconstruction are reviewed. These include: (a) primary repair, (b) reconstruction with different tissues, including autogenous allografts and xenografts, (c) reconstruction employing different synthetic devices. A brief discussion of the procedures used for reconstruction with different types of tissue and of the surviving examples of the synthetic devices will follow. PMID:1418190

  12. Anterior cruciate ligament surgery in the rabbit

    PubMed Central

    2013-01-01

    Background Various methods regarding allograft knee replacements have been described. The animal models, which are generally used for this purpose include sheep, dogs, goats, and pigs, and accrue significant costs for study protocols. The authors herein describe an efficient and cost-effective model to study either native or tissue-engineered allografts for anterior cruciate ligament (ACL) replacement in a New Zealand rabbit model with the potential for transgenic and cell migration studies. Methods ACL reconstructions were performed in rabbits under general anesthesia. For fresh allograft implantations, two animals were operated in parallel. Each right extensor digitorum longus tendon was harvested and prepared for implantation. After excision of the ACL, tibial and femoral bone tunnels were created to implant each graft in the native ACL position. Results During a 2-year period, the authors have successfully undertaken this surgery in 61 rabbits and have not noticed any major complications attributed to this surgical technique. In addition, the authors have observed fast recovery in the animals postoperatively. Conclusion The authors recommend this surgical procedure as an excellent model for the study of knee surgery. PMID:23957941

  13. Knee Bracing After Anterior Cruciate Ligament Reconstruction.

    PubMed

    Rodríguez-Merchán, E Carlos

    2016-07-01

    Although some articles in the literature are in favor of the use of a postoperative brace after anterior cruciate ligament (ACL) reconstruction, this review found that several systematic reviews and other reports on the topic do not support the use of a postoperative brace after ACL reconstruction. There is no scientific evidence so far to support the routine use of a functional knee brace following a successful ACL reconstruction in the postoperative course. Most authors believe that bracing is not necessary. There is insufficient evidence to inform current practice. Good-quality randomized trials are required to remedy this situation. Future studies should better define the role of a brace following ACL surgery. A search of MEDLINE for articles published between January 1, 1995, and September 30, 2013, was performed. Key search terms used were ACL reconstruction and knee brace. Ninety-one articles were found, but only 28 focused on the subject of bracing after ACL reconstruction and were selected for this review. Several systematic reviews and randomized, controlled trials on the topic do not recommend the use of postoperative brace after ACL reconstruction. Postoperative bracing after ACL reconstruction does not seem to help with pain, function, rehabilitation, and stability. The literature does not support the use of a postoperative brace following ACL reconstruction. [Orthopedics. 2016; 39(4):e602-e609.]. PMID:27203412

  14. MRI of anterior cruciate ligament healing

    SciTech Connect

    Ihara, Hidetoshi; Miwa, Megumi; Deya, Keizo; Torisu, Kenji

    1996-03-01

    The purpose of this study was to evaluate using MRI the natural healing of the anterior cruciate ligament (ACL) when treated conservatively by early protective motion. Consecutive acute complete intraligamentous ruptures of the ACL in 50 cases that were allowed to heal without surgery were evaluated before and after 3 month treatment by MRI, arthroscopy, and stress radiographs. Twenty-nine of the 50 patients were also reevaluated 11 months from the initial injury, of which 7 were reevaluated again 24 months from the initial injury by MRI. The MR appearance of the treated ACL was categorized into four grades depending on homogeneity, straight band, and size. MR assessment of the ACL after 3 month treatment demonstrated a well defined normal-sized straight band in 37 cases (74%). There was a significant relationship between the 3 and 11 month MR evaluations (r. = 0.801, p < 0.0001). There were also significant relationships between the MR and arthroscopic evaluations (r, = 0.455, p < 0.005) and between the MR and stress radiographic evaluations (r, = 0.348, p < 0.025) after the 3 month treatment. MRI can demonstrate ACL healing when treated conservatively with early protective mobilization. 40 refs., 3 figs., 2 tabs.

  15. Spatial Change of Cruciate Ligaments in Rat Embryo Knee Joint by Three-Dimensional Reconstruction

    PubMed Central

    Zhang, Xiangkai; Aoyama, Tomoki; Takaishi, Ryota; Higuchi, Shinya; Yamada, Shigehito; Kuroki, Hiroshi; Takakuwa, Tetsuya

    2015-01-01

    This study aimed to analyze the spatial developmental changes of rat cruciate ligaments by three-dimensional (3D) reconstruction using episcopic fluorescence image capture (EFIC). Cruciate ligaments of Wister rat embryos between embryonic day (E) 16 and E20 were analyzed. Samples were sectioned and visualized using EFIC. 3D reconstructions were generated using Amira software. The length of the cruciate ligaments, distances between attachment points to femur and tibia, angles of the cruciate ligaments and the cross angle of the cruciate ligaments were measured. The shape of cruciate ligaments was clearly visible at E17. The lengths of the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) increased gradually from E17 to E19 and drastically at E20. Distances between attachment points to the femur and tibia gradually increased. The ACL angle and PCL angle gradually decreased. The cross angle of the cruciate ligaments changed in three planes. The primordium of the 3D structure of rat cruciate ligaments was constructed from the early stage, with the completion of the development of the structures occurring just before birth. PMID:26098761

  16. Cruciate Retaining Versus Cruciate Stabilising Total Knee Arthroplasty – A Prospective Randomised Kinematic Study

    PubMed Central

    Godwin, T L; Bayan, A

    2016-01-01

    Objective: While there is a large body of research in regards to cruciate retaining(CR) and cruciate sacrificing total condylar knee replacement, the literature is spars in regards to highly conforming polyetheylene such as the triatholon cruciate stabilising tibial insert (CS).The aim was to determine whether there is a difference in the range of motion, kinematics as well as the functional outcome for Triathlon CS and CR TKJR. Methods: A single hospital consecutive series of one surgeon between 2011 and 2013 were enrolled. Kinematic data recorded prospectively at the time of surgery utilizing imageless navigation included preoperative and post-replacement extension, gravity flexion, passive flexion and rotation. Intraoperative femoral and tibial cuts and definitive implants were also recorded. Statistically analysis performed to compare CS and CR TKJR range of motion, deformity correction, and rotation pre and post-operatively. Oxford functional scores were obtained at the final follow up. 124 patients were randomised to 71 CS and 53 CR TKJR. The demographics were comparable between the two groups. Results: No significant difference was found between the groups’ preoperative range of motion. The net gain in extension for the CS group was 5.65 degrees (4.14-7.17) and for CR 5.64 degrees (4.24-7.04, p=0.99) with no significant difference shown. Post-operative gravity flexion significantly increased in CS TKJR with 129.01 degrees (127.37130.66) compared with 126.35 degrees (124.39-128.30, p =0.04) for CR. A weak positive correlation was shown between the size of distal femoral cut and post-operative extension for both CS and CR TKJR. A weak positive correlation was also shown for the difference between the intraoperative cuts (tibial and femoral) and the size of the implants used, in relation to post-operative extension. Post-operative oxford scores at average of 3.4 year follow up comparable between groups. Conclusion: The kinematics of CS and CR TKJR are

  17. Radiographic Risk Factors for Contralateral Rupture in Dogs with Unilateral Cranial Cruciate Ligament Rupture

    PubMed Central

    Chuang, Connie; Ramaker, Megan A.; Kaur, Sirjaut; Csomos, Rebecca A.; Kroner, Kevin T.; Bleedorn, Jason A.; Schaefer, Susan L.; Muir, Peter

    2014-01-01

    Background Complete cranial cruciate ligament rupture (CR) is a common cause of pelvic limb lameness in dogs. Dogs with unilateral CR often develop contralateral CR over time. Although radiographic signs of contralateral stifle joint osteoarthritis (OA) influence risk of subsequent contralateral CR, this risk has not been studied in detail. Methodology/Principal Findings We conducted a retrospective longitudinal cohort study of client-owned dogs with unilateral CR to determine how severity of radiographic stifle synovial effusion and osteophytosis influence risk of contralateral CR over time. Detailed survival analysis was performed for a cohort of 85 dogs after case filtering of an initial sample population of 513 dogs. This population was stratified based on radiographic severity of synovial effusion (graded on a scale of 0, 1, and 2) and severity of osteophytosis (graded on a scale of 0, 1, 2, and 3) of both index and contralateral stifle joints using a reproducible scoring method. Severity of osteophytosis in the index and contralateral stifles was significantly correlated. Rupture of the contralateral cranial cruciate ligament was significantly influenced by radiographic OA in both the index and contralateral stifles at diagnosis. Odds ratio for development of contralateral CR in dogs with severe contralateral radiographic stifle effusion was 13.4 at one year after diagnosis and 11.4 at two years. Odds ratio for development of contralateral CR in dogs with severe contralateral osteophytosis was 9.9 at one year after diagnosis. These odds ratios were associated with decreased time to contralateral CR. Breed, age, body weight, gender, and tibial plateau angle did not significantly influence time to contralateral CR. Conclusion Subsequent contralateral CR is significantly influenced by severity of radiographic stifle effusion and osteophytosis in the contralateral stifle, suggesting that synovitis and arthritic joint degeneration are significant factors in the

  18. Cranial cruciate ligament repair in dogs with and without meniscal lesions treated by different minimally invasive methods.

    PubMed

    Ertelt, J; Fehr, M

    2009-01-01

    The goal of this study was to evaluate different minimally invasive surgical options as therapy for cranial cruciate ligament rupture and resulting meniscal injuries. In this study, 81 stifle joints of dogs with complete or partial rupture of the cranial cruciate ligament were treated with minimally invasive surgery at the Small Animal Clinic of the University of Veterinary Medicine in Hannover. The patients were divided into three groups depending on intraoperative diagnosis and the surgical technique applied. The dogs in group I (n = 26) had an isolated rupture of the cranial cruciate ligament (CCLR), while those in groups II (n = 26) and III (n = 29) also had an injury of the medial meniscus. Resection of the damaged meniscal part was performed by arthroscopically guided partial meniscectomy (AGPM) on the dogs in group II, while minimally invasive medial arthrotomy (MIMA) was used on the dogs of group III. All of the stifles were stabilized with a modified lateral imbrication technique using a braided, synthetic, absorbable suture material (Panacryl). Six months after surgery 76.5% of all patients were examined clinically and 74.1% radiographically for evaluation of the success of the different treatment techniques. At this examination, there were no signs of lameness in 42.1% of group I (CCLR), 65.0% of group II (AGPM) and 87.0% of group III (MIMA). Upon palpation, 75.8% of these stifle joints were found to be stable. Radiographic evaluations did not show any indication of progression of gonarthrosis in 73.3% of all stifle joints examined here. PMID:19151866

  19. Posterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Chang, Ji-Hoon

    2008-01-01

    Generalized joint laxity has been considered a risk factor causing late failure of reconstructed anterior cruciate ligaments, although it is unknown whether that is the case for reconstructed posterior cruciate ligaments. We hypothesized patients with generalized joint laxity, compared with those without laxity, would have similar postoperative knee stability, range of motion, and functional scores after posterior cruciate ligament reconstruction. The Beighton and Horan criteria were used to determine generalized joint laxity. We enrolled 24 patients with generalized joint laxity (Group L) and 29 patients without any positive findings of joint laxity (Group N) matched by gender and age. The average side-by-side differences of posterior tibial translation were 4.72 mm in Group L and 3.63 mm in Group N. We observed no differences in posterior tibial translation with differing graft materials or combined procedures. In Group L the International Knee Documentation Committee score was normal in 12.5% and nearly normal in 45.8% whereas in Group N, 24.1% were normal and 55.2% nearly normal. Patients with generalized joint laxity showed more posterior laxity than patients without joint laxity. Generalized joint laxity therefore appears to be a risk factor associated with posterior laxity after posterior cruciate ligament reconstruction. Level of Evidence: Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18843524

  20. Anterior Cruciate Ligament Reconstruction in Patients with Generalized Joint Laxity

    PubMed Central

    Kim, Sung-Jae; Kumar, Praveen

    2010-01-01

    Generalized joint laxity is a genetically determined component of overall joint flexibility. The incidence of joint laxity in the overall population is approximately 5% to 20%, and its prevalence is higher in females. Recently it was noticed that individuals with generalized joint laxity are not only prone to anterior cruciate ligament injuries but also have inferior results after a reconstruction. Therefore, an anterior cruciate ligament reconstruction in patients with generalized laxity should be undertaken with caution due to the higher expected failure rate from the complexity of problems associated with this condition. It is also necessary to identify the risk factors for the injury as well as for the post operative outcome in this population. A criterion that includes all the associated components is necessary for the proper screening of individuals for generalized joint laxity. Graft selection for an anterior cruciate reconstruction in patients with ligament laxity is a challenge. According to the senior author, a hamstring autograft is an inferior choice and a double bundle reconstruction with a quadriceps tendon-bone autograft yields better results than a single bundle bone-patella tendon-bone autograft. Future studies comparing the different grafts available might be needed to determine the preferred graft for this subset of patients. Improved results after an anterior cruciate ligament reconstruction can be achieved by proper planning and careful attention to each step beginning from the clinical examination to the postoperative rehabilitation. PMID:20808583

  1. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair.

    PubMed

    Yong, Elaine X L; Cheong, Elaine Y L; Boutlis, Craig S; Chen, Darren B; Liu, Eunice Y-T; McKew, Genevieve L

    2015-08-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. PMID:26041900

  2. Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair

    PubMed Central

    Cheong, Elaine Y. L.; Boutlis, Craig S.; Chen, Darren B.; Liu, Eunice Y.-T.

    2015-01-01

    Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis. PMID:26041900

  3. Anterior Cruciate Ligament Reconstruction and Osteoarthritis

    PubMed Central

    Duthon, Victoria; Servien, Elvire; Neyret, Philippe

    2013-01-01

    Objective: The goals of this study are to address several questions, the answers to which are key to the understanding and eventually to the prevention of this frequent source of morbidity. These questions include the following: (1) What is the natural history of anterior cruciate ligament (ACL) deficiency? (2) How important is the status of the meniscus at the time of reconstruction? (3) Does ACL reconstruction prevent the development of osteoarthritis in the long term? (4) Can we predict which patients will develop osteoarthritis? (5) What can be done? Design: This study addresses the key questions above through the long-term follow-up of a cohort of patients treated with ACL reconstruction by Professor Henri Dejour in Lyon, France, supplemented with a review of the relevant literature. Results: The prevalence of osteoarthritis in ACL-deficient knees is about 40% after 15 years and close to 90% after 25 to 35 years. It remains unclear whether reconstruction of the ACL significantly reduces this risk. The status of the meniscus at the time of ACL reconstruction is a strong predictor of the risk of osteoarthritis: Patients who undergo total meniscectomy are at 2- to 10-fold increased risk of developing osteoarthritis relative to those with intact menisci. Patients showing early evidence of arthritis at short- to medium-term follow-up are at high risk for progression over subsequent years. Numerous emerging techniques may provide tools to more effectively prevent and treat osteoarthritis following ACL injury in the future. Conclusion: Osteoarthritis following ACL injury continues to be a major problem requiring further research. PMID:26069662

  4. Anterior Cruciate Ligament Injuries in Wakeboarding

    PubMed Central

    Starr, Harlan M.; Sanders, Brett

    2012-01-01

    Background: Wakeboarding is an increasingly popular sport that involves aggressive stunts with high risk for lower extremity injury, including anterior cruciate ligament (ACL) rupture. Little has been reported on prevalence or mechanism of ACL injury while wakeboarding. Hypothesis: The prevalence of ACL injury in wakeboarding approaches that of other high-risk sports. Analyzing the mechanism of ACL injury may aid in future efforts of prevention. Study Design: Descriptive epidemiology study. Methods: In sum, 1580 surveys were sent internationally to professional and amateur wakeboarders. The survey questioned the participants on their history of an ACL tear while wakeboarding and asked them to describe the mechanism of injury and treatment. Results: A total of 123 surveys were returned. Of this group, 52 (42.3%) acknowledged having had an ACL tear while wakeboarding. The majority described feeling a pop or buckle after attempting to land a high jump. Only 5 participants (13.5%) described a rotational mechanism created by catching the board edge in the water. Thirty-seven participants (71.15%) said that the injury ruined their ability to wakeboard before reconstruction, and 41 (78.85%) had the injury repaired surgically. Conclusion: The prevalence of ACL tears in this data set, 42.3%, is the highest reported in the literature for wakeboarding and one of the highest for any sport. The main mechanism of injury appears to involve axial compression while one lands in a provocative position; it is not related to a rotational force created by fixed bindings. The injury should be surgically repaired to effectively continue the sport. Further study is needed to determine if wakeboarding represents a high-risk sport for ACL injury. Clinical Significance: Wakeboarding may be a high-risk sport for ACL injury. Noncontact axial compression appears to be the main mechanism of injury. PMID:23016104

  5. Photonic generation of frequency-quadrupling millimeter-wave signals using polarization property

    NASA Astrophysics Data System (ADS)

    Zhu, Min; Tang, Xianfeng; Xi, Lixia; Zhang, Wenbo; Zhang, Xiaoguang

    2016-03-01

    We propose and analyze a photonic method of generating frequency-quadrupling millimeter-wave signal. This scheme is realized by using a single LiNbO3 intensity modulator (IM) and a Faraday mirror based transverse-electrical and transverse-magnetic mode converter in a Sagnac loop without using an optical filter or an electrical microwave phase shifter. Making use of the intrinsic polarization dependence and the velocity phenomenon of the IM, a special double sideband modulation is implemented, which ensures that the optical carrier can be effectively cancelled employing polarization manipulation. A linear polarizer is used as the polarization selection element to choose the second-order sidebands from the modulated light. After beating at the photodiode, a frequency-quadrupled millimeter-wave signal with >30 dB radio frequency spurious suppression ratio is generated. The imperfection of the devices is considered when estimating the system performance.

  6. Strain-dependence of the electronic properties in periodic quadruple helical G4-wires.

    PubMed

    Di Felice, Rosa; Calzolari, Arrigo; Garbesi, Anna; Alexandre, Simone S; Soler, José M

    2005-12-01

    The electronic structure of periodic quadruple helix guanine wires, which mimic G4-DNA molecules, was studied as a function of the stacking distance between consecutive planes, by means of first principles density functional theory calculations. We show that, whereas for the native DNA interplane separation of 3.4 A the HOMO- and LUMO-derived bands are poorly dispersive, the bandwidths can be significantly increased when compressive strain is applied along the helical axis. Our findings indicate that efficient band conduction for both holes and electrons can be supported by such wires for stacking distances below 2.6 A, which imply a huge axial deformation with respect to double and quadruple helices in solutions and in crystals. PMID:16853904

  7. Simultaneous quadruple modal nonlinear optical imaging for gastric diseases diagnosis and characterization

    NASA Astrophysics Data System (ADS)

    Wang, Zi; Zheng, Wei; Lin, Jian; Huang, Zhiwei

    2015-03-01

    We report the development of a unique simultaneous quadruple-modal nonlinear optical microscopy (i.e., stimulated Raman scattering (SRS), second-harmonic generation (SHG), two-photon excitation fluorescence (TPEF), and third-harmonic generation (THG)) platform for characterization of the gastric diseases (i.e., gastritis, intestinal metaplasia (IM), intestinal type adenocarcinoma). SRS highlights the goblet cells found in IM. SHG images the distribution of collagen in lamina propria. Collagen is found to aggregate for intestinal type adenocarcinoma. TPEF reveals the cell morphology and can reflect the damage inside glands caused by the diseases. THG visualizes the nuclei with high spatial resolution, which facilitates the identification of neutrophils that are usually used as a feature of inflammation. This work shows that the co-registration of quadruple-modal images can be an effective means for diagnosis and characterization of gastric diseases at the cellular and molecular levels.

  8. Signs and Symptoms

    MedlinePlus

    ... print email share facebook twitter google plus linkedin Signs and Symptoms Partly because there are different types ... This section presents a general picture of CMT signs and symptoms. Contractures and bone deformities Many people ...

  9. Dermatomyositis: Signs and Symptoms

    MedlinePlus

    ... print email share facebook twitter google plus linkedin Signs and Symptoms What happens to someone with dermatomyositis? ... be damaged as a result. About Dermatomyositis (DM) Signs and Symptoms Diagnosis Causes/Inheritance Medical Management Research ...

  10. Moxifloxacin-containing triple therapy after non-bismuth quadruple therapy failure for Helicobacter pylori infection

    PubMed Central

    Lim, Ji Hyun; Lee, Dong Ho; Lee, Seong Tae; Kim, Nayoung; Park, Young Soo; Shin, Cheol Min; Song, In Sung

    2015-01-01

    AIM: To assess the efficacy of moxifloxacin-containing triple therapy after non-bismuth quadruple therapy failure for Helicobacter pylori (H. pylori) eradication. METHODS: Between January 2010 and December 2012, we screened individuals who were prescribed non-bismuth quadruple therapy for H. pylori eradication. Among them, a total of 98 patients who failed non-bismuth quadruple therapy received 1-wk or 2-wk moxifloxacin-containing triple therapy (400 mg moxifloxacin once daily, and 20 mg of rabeprazole and 1 g of amoxicillin twice daily). H. pylori status was evaluated using the 13C-urea breath test 4 wk later, after treatment completion. The eradication rates were determined by intention-to-treat and per-protocol analyses. RESULTS: In total, 60 and 38 patients received 1-wk and 2-wk moxifloxacin-containing triple therapy, respectively. The intention-to-treat and per-protocol eradication rates were 56.7% (95%CI: 45.0-70.0) and 59.6% (95%CI: 46.6-71.7) in the 1-wk group and 76.3% (95%CI: 63.2-89.5) and 80.6% (95%CI: 66.7-91.9) in the 2-wk group (P = 0.048 and 0.036, respectively). All groups had good compliance (95% vs 94.9%). Neither group showed serious adverse events, and the proportions of patients experiencing mild side effects were not significantly different (21.1% vs 13.9%). Clinical factors such as age, sex, alcohol and smoking habits, comorbidities, and presence of gastric or duodenal ulcer did not influence the eradication therapy efficacy. The efficacy of second-line eradication therapy did not differ significantly according to the first-line regimen. CONCLUSION: Two-week moxifloxacin-containing triple therapy showed better efficacy than a 1-wk regimen after non-bismuth quadruple therapy failure. PMID:26673999

  11. Sign, Symbol and Form.

    ERIC Educational Resources Information Center

    Ballinger, Louise Bowen; Ballinger, Raymond A.

    Signs are such a commonplace sight in our everyday lives, that we can easily miss the artistic beauty and graphic harmony of the symbols used. Thoughtfully well designed and planned signs communicate with a simplicity and directness that signmakers and designers have adhered to for ages. Even contemporary signs still reflect their timelessness…

  12. British Sign Name Customs

    ERIC Educational Resources Information Center

    Day, Linda; Sutton-Spence, Rachel

    2010-01-01

    Research presented here describes the sign names and the customs of name allocation within the British Deaf community. While some aspects of British Sign Language sign names and British Deaf naming customs differ from those in most Western societies, there are many similarities. There are also similarities with other societies outside the more…

  13. On the System of Person-Denoting Signs in Estonian Sign Language: Estonian Name Signs

    ERIC Educational Resources Information Center

    Paales, Liina

    2010-01-01

    This article discusses Estonian personal name signs. According to study there are four personal name sign categories in Estonian Sign Language: (1) arbitrary name signs; (2) descriptive name signs; (3) initialized-descriptive name signs; (4) loan/borrowed name signs. Mostly there are represented descriptive and borrowed personal name signs among…

  14. Quadruple-junction lattice coherency and phase separation in a binary-phase system

    NASA Astrophysics Data System (ADS)

    Chung, Sung-Yoon; Choi, Si-Young; Kim, Jin-Gyu; Kim, Young-Min

    2015-09-01

    If each phase has an identical crystal structure and small misfit in the lattice parameters in a binary-phase crystalline system, coherent phase boundaries usually form during separation. Although there have been numerous studies on the effect of coherency elastic energy, no attempt has been made to demonstrate how the phase-separation behaviour varies when multiple interfaces meet at a junction. Here we show that a comprehensively different phase-separation morphology is induced, to release the high coherency strain confined to quadruple junctions. High-temperature in-situ transmission electron microscopy reveals that phase boundaries with a new crystallographic orientation emerge over twinned crystals to provide strain relaxation at quadruple junctions. The high coherency strain and the formation of different phase boundaries can be understood in terms of the force equilibrium between interface tensions at a junction point. Visualizing the quadruple points at atomic resolution, our observations emphasize the impact of multiple junctions on the morphology evolution during phase separation.

  15. Quadruple-junction lattice coherency and phase separation in a binary-phase system

    PubMed Central

    Chung, Sung-Yoon; Choi, Si-Young; Kim, Jin-Gyu; Kim, Young-Min

    2015-01-01

    If each phase has an identical crystal structure and small misfit in the lattice parameters in a binary-phase crystalline system, coherent phase boundaries usually form during separation. Although there have been numerous studies on the effect of coherency elastic energy, no attempt has been made to demonstrate how the phase-separation behaviour varies when multiple interfaces meet at a junction. Here we show that a comprehensively different phase-separation morphology is induced, to release the high coherency strain confined to quadruple junctions. High-temperature in-situ transmission electron microscopy reveals that phase boundaries with a new crystallographic orientation emerge over twinned crystals to provide strain relaxation at quadruple junctions. The high coherency strain and the formation of different phase boundaries can be understood in terms of the force equilibrium between interface tensions at a junction point. Visualizing the quadruple points at atomic resolution, our observations emphasize the impact of multiple junctions on the morphology evolution during phase separation. PMID:26346223

  16. Dual-source multi-energy CT with triple or quadruple x-ray beams

    NASA Astrophysics Data System (ADS)

    Yu, Lifeng; Li, Zhoubo; Leng, Shuai; McCollough, Cynthia H.

    2016-03-01

    Energy-resolved photon-counting CT (PCCT) is promising for material decomposition with multi-contrast agents. However, corrections for non-idealities of PCCT detectors are required, which are still active research areas. In addition, PCCT is associated with very high cost due to lack of mass production. In this work, we proposed an alternative approach to performing multi-energy CT, which was achieved by acquiring triple or quadruple x-ray beam measurements on a dual-source CT scanner. This strategy was based on a "Twin Beam" design on a single-source scanner for dual-energy CT. Examples of beam filters and spectra for triple and quadruple x-ray beam were provided. Computer simulation studies were performed to evaluate the accuracy of material decomposition for multi-contrast mixtures using both tri-beam and quadruple-beam configurations. The proposed strategy can be readily implemented on a dual-source scanner, which may allow material decomposition of multi-contrast agents to be performed on clinical CT scanners with energy-integrating detector.

  17. Near-infrared Spectroscopy of 2M0441+2301 AabBab: A Quadruple System Spanning the Stellar to Planetary Mass Regimes

    NASA Astrophysics Data System (ADS)

    Bowler, Brendan P.; Hillenbrand, Lynne A.

    2015-10-01

    We present Keck/NIRC2 and OSIRIS near-infrared imaging and spectroscopy of 2M0441+2301 AabBab, a young (1–3 Myr) hierarchical quadruple system comprising a low-mass star, two brown dwarfs, and a planetary-mass companion in Taurus. All four components show spectroscopic signs of low surface gravity, and both 2M0441+2301 Aa and Ab possess Paβ emission indicating they each harbor accretion subdisks. Astrometry spanning 2008–2014 reveals orbital motion in both the Aab (0.″23 separation) and Bab (0.″095 separation) pairs, although the implied orbital periods of >300 years mean dynamical masses will not be possible in the near future. The faintest component (2M0441+2301 Bb) has an angular H-band shape, strong molecular absorption (VO, CO, H2O, and FeH), and shallow alkali lines, confirming its young age, late spectral type (L1 ± 1), and low temperature (≈1800 K). With individual masses of {200}-50+100 MJup, 35 ± 5 MJup, 19 ± 3 MJup, and 9.8 ± 1.8 MJup, 2M0441+2301 AabBab is the lowest-mass quadruple system known. Its hierarchical orbital architecture and mass ratios imply that it formed from the collapse and fragmentation of a molecular cloud core, demonstrating that planetary-mass companions can originate from a stellar-like pathway analogous to higher-mass quadruple star systems as first speculated by Todorov et al. More generally, cloud fragmentation may be an important formation pathway for the massive exoplanets that are now regularly being imaged on wide orbits. The data presented herein were obtained at the W. M. Keck Observatory, which is operated as a scientific partnership among the California Institute of Technology, the University of California and the National Aeronautics and Space Administration. The Observatory was made possible by the generous financial support of the W. M. Keck Foundation.

  18. Clinical Outcomes After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Tibor, Lisa M.; Long, Joy L.; Schilling, Peter L.; Lilly, Ryan J.; Carpenter, James E.; Miller, Bruce S.

    2010-01-01

    Background: Clinical outcomes of autograft and allograft anterior cruciate ligament (ACL) reconstructions are mixed, with some reports of excellent to good outcomes and other reports of early graft failure or significant donor site morbidity. Objective: To determine if there is a difference in functional outcomes, failure rates, and stability between autograft and allograft ACL reconstructions. Data Sources: Medline, Cochrane Central Register of Controlled Trials (Evidence Based Medicine Reviews Collection), Cochrane Database of Systematic Reviews, Web of Science, CINAHL, and SPORTDiscus were searched for articles on ACL reconstruction. Abstracts from annual meetings of the American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America were searched for relevant studies. Study Selection: Inclusion criteria for studies were as follows: primary unilateral ACL injuries, mean patient age less than 41 years, and follow-up for at least 24 months postreconstruction. Exclusion criteria for studies included the following: skeletally immature patients, multiligament injuries, and publication dates before 1990. Data Extraction: Joint stability measures included Lachman test, pivot-shift test, KT-1000 arthrometer assessment, and frequency of graft failures. Functional outcome measures included Tegner activity scores, Cincinnati knee scores, Lysholm scores, and IKDC (International Knee Documentation Committee) total scores. Results: More than 5000 studies were identified. After full text review of 576 studies, 56 were included, of which only 1 directly compared autograft and allograft reconstruction. Allograft ACL reconstructions were more lax when assessed by the KT-1000 arthrometer. For all other outcome measures, there was no statistically significant difference between autograft and allograft ACL reconstruction. For all outcome measures, there was strong evidence of statistical heterogeneity between

  19. Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

    PubMed Central

    Galdi, Balazs; Reyes, Allan; Brabston, Eugene W.; Levine, William N.

    2015-01-01

    Background: The anteromedial portal technique for drilling of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction has been advocated by many surgeons as allowing improved access to the anatomical footprint. Furthermore, suspensory fixation of soft tissue grafts has become popularized because of complications associated with cross-pin fixation. Concerns regarding the use of both have recently arisen. Purpose: To raise awareness of the increased risk of graft failure when using the anteromedial portal technique with suspensory femoral fixation during ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: From November 1998 to August 2012, a total of 465 primary ACL reconstructions were performed using quadrupled hamstring autograft tendons, with drilling of the femoral tunnel performed via the transtibial portal. Graft fixation on the femur was achieved with cross-pin fixation, while interference screw fixation was used on the tibia. From September 2012 to October 2013, there were 69 reconstructions performed through an anteromedial portal. While there was no change in graft choice, a change was made to using suspensory femoral fixation. No other surgical or postoperative rehabilitation changes were made. Results: During the 14-year period in which ACL reconstructions were performed via the transtibial portal and with cross-pin fixation, 2 graft failures (0.4% failure rate) were reported. After switching to the anteromedial portal with suspensory fixation, 7 graft failures (10.1% failure rate) were reported over a 13-month period. These were 5 male and 2 female patients, with a mean age of 18.8 years—all elite athletes. The same surgical technique was used in all patients, and all patients had at least an 8 mm–diameter graft. Patients were cleared to return to sport at an average of 8.4 months postoperatively, after completing functional performance tests. Of the 7 patients, 6 sustained a rerupture of the graft within

  20. Biomechanical Measures During Landing and Postural Stability Predict Second Anterior Cruciate Ligament Injury After Anterior Cruciate Ligament Reconstruction and Return to Sport

    PubMed Central

    Paterno, Mark V.; Schmitt, Laura C.; Ford, Kevin R.; Rauh, Mitchell J.; Myer, Gregory D.; Huang, Bin; Hewett, Timothy E.

    2016-01-01

    Background Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non–anterior cruciate ligament–injured athletes. Hypotheses Prospective measures of neuromuscular control and postural stability after ACLR will predict relative increased risk for a second anterior cruciate ligament injury. Study Design Cohort study (prognosis); Level of evidence, 2. Methods Fifty-six athletes underwent a prospective biomechanical screening after ACLR using 3-dimensional motion analysis during a drop vertical jump maneuver and postural stability assessment before return to pivoting and cutting sports. After the initial test session, each subject was followed for 12 months for occurrence of a second anterior cruciate ligament injury. Lower extremity joint kinematics, kinetics, and postural stability were assessed and analyzed. Analysis of variance and logistic regression were used to identify predictors of a second anterior cruciate ligament injury. Results Thirteen athletes suffered a subsequent second anterior cruciate ligament injury. Transverse plane hip kinetics and frontal plane knee kinematics during landing, sagittal plane knee moments at landing, and deficits in postural stability predicted a second injury in this population (C statistic = 0.94) with excellent sensitivity (0.92) and specificity (0.88). Specific predictive parameters included an increase in total frontal plane (valgus) movement, greater asymmetry in internal knee extensor moment at initial contact, and a deficit in single-leg postural stability of the involved limb, as measured by the Biodex stability system. Hip rotation moment independently predicted second anterior cruciate ligament injury (C = 0.81) with high sensitivity (0.77) and specificity (0.81). Conclusion Altered neuromuscular control of the hip and knee during a dynamic landing task

  1. Locked bucket-handle tears of both medial and lateral menisci with simultaneous anterior cruciate and medial collateral ligaments injury.

    PubMed

    Koukoulias, Nikolaos E; Kyparlis, Dimitris; Koumis, Panagiotis; Lola, Despoina; Papastergiou, Stergios G

    2011-01-01

    The authors report the case of a 38-year-old male who presented to the accident and emergency department with a locked knee after falling from a height. The knee was locked at 35° of flexion without any signs of instability in clinical examination. The patient was operated within 6 h from injury. During arthroscopy bucket-handle tears of both medial and lateral menisci were found. The bucket-handle fragments were displaced into the intercondylar notch causing the knee to lock. Additionally, tears of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) were also found. The patient underwent ACL reconstruction with hamstrings autograft, medial subtotal meniscectomy and lateral meniscus repair. The MCL was treated conservatively. The postoperative period was uneventful and the patient returned to the preinjury level of activity within 8 months. The patient remains asymptomatic 2 years postoperatively. PMID:22691631

  2. Locked bucket-handle tears of both medial and lateral menisci with simultaneous anterior cruciate and medial collateral ligaments injury

    PubMed Central

    Koukoulias, Nikolaos E; Kyparlis, Dimitris; Koumis, Panagiotis; Lola, Despoina; Papastergiou, Stergios G

    2011-01-01

    The authors report the case of a 38-year-old male who presented to the accident and emergency department with a locked knee after falling from a height. The knee was locked at 35° of flexion without any signs of instability in clinical examination. The patient was operated within 6 h from injury. During arthroscopy bucket-handle tears of both medial and lateral menisci were found. The bucket-handle fragments were displaced into the intercondylar notch causing the knee to lock. Additionally, tears of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) were also found. The patient underwent ACL reconstruction with hamstrings autograft, medial subtotal meniscectomy and lateral meniscus repair. The MCL was treated conservatively. The postoperative period was uneventful and the patient returned to the preinjury level of activity within 8 months. The patient remains asymptomatic 2 years postoperatively. PMID:22691631

  3. Functional results from reconstruction of the anterior cruciate ligament using the central third of the patellar ligament and flexor tendons☆

    PubMed Central

    de Souza Leao, Marcos George; Pampolha, Abelardo Gautama Moreira; Orlando Junior, Nilton

    2015-01-01

    Objectives To evaluate knee function in patients undergoing reconstruction of the anterior cruciate ligament (ACL) using the central third of the patellar ligament or the medial flexor tendons of the knee, i.e. quadruple ligaments from the semitendinosus and gracilis (ST-G), by means of the Knee Society Score (KSS) and the Lysholm scale. Methods This was a randomized prospective longitudinal study on 40 patients who underwent arthroscopic ACL reconstruction between September 2013 and August 2014. They comprised 37 males and three females, with ages ranging from 16 to 52 years. The patients were numbered randomly from 1 to 40: the even numbers underwent surgical correction using the ST-G tendons and the odd numbers, using the patellar tendon. Functional evaluations were made using the KSS and Lysholm scale, applied in the evening before the surgical procedure and six months after the operation. Results From the statistical analysis, it could be seen that the patients’ functional capacity was significantly greater after the operation than before the operation. There was strong evidence that the two forms of therapy had similar results (p = >0.05), in all the comparisons. Conclusions The results from the ACL reconstructions were similar with regard to functional recovery of the knee and improvement of quality of life, independent of the type of graft. It was not possible to identify the best method of surgical treatment. The surgeon's clinical and technical experience and the patient are the factors that determine the choice of graft type for use in ACL surgery. PMID:27218084

  4. Anterior Cruciate Ligament Injury in Female Athletes: Epidemiology

    PubMed Central

    Ireland, Mary Lloyd

    1999-01-01

    Objective: To present epidemiologic studies on anterior cruciate ligament (ACL) injuries in female athletes. Data Sources: MEDLINE was searched from 1978 to 1998 with the terms “anterior cruciate ligament” and “female athlete” among others. Additional sources were knowledge base and oral, didactic, and video presentations. Data Synthesis: Epidemiologic studies have focused on level of participation, specific sports, sex differences and contributing factors, injury mechanism, prevention programs, and outcomes studies. Female athletes have a significantly increased risk of noncontact ACL injuries over male athletes in soccer and basketball. Conclusions/Recommendations: I believe that appropriate intervention programs can reduce these alarming rates of ACL injuries. ImagesFigure 2.Figure 3. PMID:16558558

  5. Ganglion cyst of the posterior cruciate ligament in a child.

    PubMed

    Hameed, Shamsi Abdul; Sujir, Premjit; Naik, Monappa A; Rao, Sharath K

    2012-04-01

    Ganglion cysts are more commonly associated with the anterior cruciate ligament than the posterior cruciate ligament (PCL). A literature review showed that all reported cases of ganglion cysts to date involved adults. We report a rare case of ganglion cyst in the PCL of a four-year-old boy, and discuss its aetiology, clinical presentation, imaging features and management. Ganglion cysts of the PCL may be confused with meniscal cysts arising from tears of the posterior horn of the medial meniscus on magnetic resonance (MR) imaging. Hence, the posterior horn of the medial meniscus has to be carefully evaluated to rule out a tear. MR imaging is the method of choice to confirm diagnosis, and arthroscopic resection is a safe treatment modality even in children. PMID:22511069

  6. Controversies in Knee Rehabilitation: Anterior Cruciate Ligament Injury

    PubMed Central

    Failla, Mathew J.; Arundale, Amelia J.H.; Logerstedt, David S.; Snyder-Mackler, Lynn

    2014-01-01

    Controversy in management of athletes exists after anterior cruciate ligament injury and reconstruction. Consensus criteria for evaluating successful outcomes following ACL injury include no re-injury or recurrent giving way, no joint effusion, quadriceps strength symmetry, restored activity level and function, and returning to pre-injury sports. Using these criterions, we will review the success rates of current management strategies after ACL injury and provide recommendations for the counseling of athletes after ACL injury. PMID:25818715

  7. Fast presurgical magnetic resonance imaging of meniscal tears and concurrent subchondral bone marrow lesions. Study of dogs with naturally occurring cranial cruciate ligament rupture.

    PubMed

    Olive, J; d'Anjou, M-A; Cabassu, J; Chailleux, N; Blond, L

    2014-01-01

    Meniscal tears and subchondral bone marrow lesions have both been described in dogs with cranial cruciate ligament rupture, but their possible concurrence has not been evaluated. In a population of 14 dogs exhibiting signs of stifle pain with surgically confirmed cranial cruciate ligament rupture, a short presurgical 1.5T magnetic resonance (MR) imaging protocol including dorsal proton density, dorsal T1-weighted gradient recalled echo, and sagittal fat-saturated dual echo sequences was tested to further investigate these features and illustrate meniscal tears. Interobserver agreement for detection of medial meniscal tears (k=0.83) and bone marrow lesions (k=0.87) was excellent. Consensus MR reading allowed detection of nine out of 12 surgically confirmed medial meniscal tears and there was no false positive. All dogs had cruciate ligament enthesis-related bone marrow lesions in the tibia, femur or both bones. Additionally, among the 12 dogs with confirmed medial meniscal tears, subchondral bone marrow lesions were present in the caudomedial (9 dogs) and caudoaxial (11 dogs) regions of the tibial plateau, resulting in odds ratios (13.6, p=0.12, and 38.3, p=0.04, respectively) that had large confidence intervals due to the small group size of this study. The other two dogs had neither tibial bone marrow lesions in these locations nor medial meniscal tears. These encouraging preliminary results warrant further investigation using this clinically realistic preoperative MR protocol. As direct diagnosis of meniscal tears remained challenging in dogs even with high-field MR, identification of associated signs such as subchondral bone marrow lesions might indirectly allow suspicion of an otherwise unrecognized meniscal tear. PMID:24226972

  8. A Comparison of Anterior and Posterior Cruciate Ligament Laxity Between Female and Male Basketball Players.

    ERIC Educational Resources Information Center

    Weesner, Carol L.; And Others

    1986-01-01

    The anterior cruciate ligament and posterior cruciate ligament laxity of 90 uninjured male and female high school players were measured. No significant differences were found, indicating that the greater female injury rate may be due to inadequate conditioning, not greater knee ligament laxity. (Author/MT)

  9. VW LMi: tightest quadruple system known. Light-time effect and possible secular changes of orbits

    NASA Astrophysics Data System (ADS)

    Pribulla, T.; Baluďanský, D.; Dubovský, P.; Kudzej, I.; Parimucha, Š.; Siwak, M.; Vaňko, M.

    2008-10-01

    Tightest known quadruple system VW LMi consists of contact eclipsing binary with P12 = 0.477551 d and detached binary with P34 = 7.93063 d revolving in rather tight, 355.0-d orbit. This paper presents new photometric and spectroscopic observations yielding 69 times of minima and 36 disentangled radial velocities for the component stars. All available radial velocities and minima times are combined to better characterize the orbits and to derive absolute parameters of components. The total mass of the quadruple system was estimated at 4.56Msolar. The detached, non-eclipsing binary with orbital period P = 7.93 d is found to show apsidal motion with U ~ 80 yr. Precession period in this binary, caused by the gravitational perturbation of the contact binary, is estimated to be about 120 yr. The wide mutual orbit and orbit of the non-eclipsing pair are found to be close to coplanarity, preventing any changes of the inclination angle of the non-eclipsing orbit and excluding occurrence of the second system of eclipses in future. Possibilities of astrometric solution and direct resolving of the wide, mutual orbit are discussed. Nearby star, HD95606, was found to form loose binary with quadruple system VW LMi. Based on the data obtained at the David Dunlap Observatory, University of Toronto. E-mail: pribulla@ta3.sk (TP); bdaniel@pobox.sk (DB); var@kozmos.sk (PD); vihorlatobs1@stonline.sk (IK); stefan.parimucha@upjs.sk (SP); siwak@oa.uj.edu.pl (MS); vanko@ta3.sk (MV)

  10. Adequacy of Semitendinosus Tendon Alone for Anterior Cruciate Ligament Reconstruction Graft and Prediction of Hamstring Graft Size by Evaluating Simple Anthropometric Parameters

    PubMed Central

    Stergios, Papastergiou G.; Georgios, Konstantinidis A.; Konstantinos, Natsis; Efthymia, Papathanasiou; Nikolaos, Koukoulias; Alexandros, Papadopoulos G.

    2012-01-01

    Introduction. Preoperative identification of patients with inadequate hamstring grafts for anterior cruciate ligament reconstruction is still a subject of interest. Purpose. The purpose of this study was to determine whether the semitendinosus tendon length is adequate for four-strand graft harvested by common technique (without bone plug) and whether there is correlation of gracilis and semitendinosus tendon grafts length and diameter of quadrupled graft with anthropometric parameters. Materials and Methods. In this retrospective study, 61 patients (45 males, 16 females) undergoing ACL reconstruction using four-strand hamstring autograft tendons were included. Results. The length of semitendinosus tendon, harvested by the common technique, was in 21% of our cases inadequate in order to be used alone as a four-strand graft especially in females (43%). There was moderate correlation between semitendinosus and gracilis graft diameter and patient's height and weight and fair correlation to BMI. We found no statistically important predictor for graft diameter in female patients. Conclusions. The length of semitendinosus tendon, harvested by common technique, is usually inadequate to be used alone as a four-strand graft especially in females. The most reliable predictor seems to be patient's height in males. In female patients, there is no statistically important predictor. PMID:22900187

  11. Quadruple Cancers of Non-producing Multiple Myeloma, Cholangiocellular Carcinoma, and Two Different Thyroid Cancers.

    PubMed

    Mizutani, Shinsuke; Kuroda, Junya; Sasaki, Nana; Kiyota, Miki; Tatekawa, Shotaro; Tsukamoto, Taku; Maegawa, Saori; Chinen, Yoshiaki; Shimura, Yuji; Nagoshi, Hisao; Kobayashi, Tsutomu; Horiike, Shigeo; Tando, So; Fushiki, Shinji; Taniwaki, Masafumi

    2016-01-01

    We report the case of a 72-year-old man who presented with non-producing multiple myeloma (MM) with three additional concomitant solid tumors that were identified by postmortem autopsy. The disease was refractory to anti-MM therapy including bortezomib and lenalidomide, and he finally died of bacterial pneumonia with diffuse alveolar damage 8 months after the diagnosis. An autopsy revealed that he was also affected by three other solid cancers, cholangiocellular carcinoma, medullary thyroid cancer and papillary thyroid cancer that were clinically asymptomatic and remained undiagnosed before death. A review of the literature suggests that primary quadruple cancers including MM are extremely rare. PMID:27150876

  12. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

    PubMed Central

    Bodenheimer, Thomas; Sinsky, Christine

    2014-01-01

    The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff. PMID:25384822

  13. Triple and quadruple excitation contributions to the binding in Be clusters - Calibration calculations on Be3

    NASA Technical Reports Server (NTRS)

    Watts, John D.; Cernusak, Ivan; Noga, Jozef; Bartlett, Rodney J.; Bauschlicher, Charles W., Jr.; Lee, Timothy J.; Rendell, Alistair P.

    1990-01-01

    The contribution of connected triple and quadruple excitations to the binding in Be3 is investigated by comparing various coupled-cluster (CC) and truncated configuration-interaction (CI) treatments with multireference CI (MRCI) and full CI (FCI) calculations. The CC method with single and double excitations (CCSD) produces results that differ substantially from more elaborate treatments, but most extensions to CCSD that account approximately for connected triple excitations perform very well. In contrast, good agreement with CFI for Be2 can be achieved only with the highest level CC and MRCI methods.

  14. Triple and quadruple excitation contributions to the binding in Be clusters: Calibration calculations on Be3

    NASA Technical Reports Server (NTRS)

    Watts, John D.; Cernusak, Ivan; Noga, Jozef; Bartlett, Rodney J.; Bauschlicher, Charles W., Jr.; Lee, Timothy J.; Rendell, Alistair P.; Taylor, Peter R.

    1991-01-01

    The contribution of connected triple and quadruple excitations to the binding in Be3 is investigated by comparing various coupled-cluster (CC) and truncated configuration interaction (CI) treatments with multireference CI (MRCI) and full CI(FCI) calculations. The CC method with single and double excitations (CCSD) produces results that differ substantially from more elaborate treatments, but most extensions to CCSD that account approximately for connected triple excitations perform very well. In constrast, good agreement with FCI for Be2 can be achieved only with the highest level CC and MRCI methods.

  15. Standardization of Sign Languages

    ERIC Educational Resources Information Center

    Adam, Robert

    2015-01-01

    Over the years attempts have been made to standardize sign languages. This form of language planning has been tackled by a variety of agents, most notably teachers of Deaf students, social workers, government agencies, and occasionally groups of Deaf people themselves. Their efforts have most often involved the development of sign language books…

  16. Sign-a-Palooza

    ERIC Educational Resources Information Center

    McMorran, Charles; Reynolds, Veronica

    2010-01-01

    A halo of signs, some stuffed into thick plastic sheaths while others curled under yellow tape, cluttered the service desks of the New City Library. They bleated out messages of closings, procedures, and warnings. Their number undermined their cause. All too often a customer would ask a question that was answered by the very sign they had pushed…

  17. Quadruple primary malignancy patient with survival time more than 20 years

    PubMed Central

    Jiao, Feng; Hu, Hai; Wang, Li-Wei

    2013-01-01

    Multiple primary carcinoma (MPC) is defined as two or more carcinomas without subordinate relationship detected in the same or other organs of an individual patient. The diagnosis of MPC must comply with the following standards: each of the tumors must present a definite picture of malignancy, each tumor must be histologically distinct, and the probability of one being a metastasis of the other must be excluded. MPC often occurs in the digestive system, but its pathogenesis remains unclear involving genetic susceptibility, tumor immunity and iatrogenic factors, including radiotherapy and chemotherapy. Most MPC patients are double primary malignancy; the occurrence of quadruple primary malignancy is below 0.1%. Here we present a rare case of quadruple primary malignancy involving the small intestine, descending colon, renal pelvis and pancreas. Due to its rarity, the relevant literature is also reviewed. In general, the incidence of MPC is rising, so prevention, early diagnosis and treatment will become necessary and important. Therefore, further research should focus on the etiology and mechanism of MPC. PMID:23538731

  18. Quadruple zebrafish mutant reveals different roles of Mesp genes in somite segmentation between mouse and zebrafish.

    PubMed

    Yabe, Taijiro; Hoshijima, Kazuyuki; Yamamoto, Takashi; Takada, Shinji

    2016-08-01

    The segmental pattern of somites is generated by sequential conversion of the temporal periodicity provided by the molecular clock. Whereas the basic structure of this clock is conserved among different species, diversity also exists, especially in terms of the molecular network. The temporal periodicity is subsequently converted into the spatial pattern of somites, and Mesp2 plays crucial roles in this conversion in the mouse. However, it remains unclear whether Mesp genes play similar roles in other vertebrates. In this study, we generated zebrafish mutants lacking all four zebrafish Mesp genes by using TALEN-mediated genome editing. Contrary to the situation in the mouse Mesp2 mutant, in the zebrafish Mesp quadruple mutant embryos the positions of somite boundaries were clearly determined and morphological boundaries were formed, although their formation was not completely normal. However, each somite was caudalized in a similar manner to the mouse Mesp2 mutant, and the superficial horizontal myoseptum and lateral line primordia were not properly formed in the quadruple mutants. These results clarify the conserved and species-specific roles of Mesp in the link between the molecular clock and somite morphogenesis. PMID:27385009

  19. Complex Genomic Rearrangements at the PLP1 Locus Include Triplication and Quadruplication

    PubMed Central

    Beck, Christine R.; Carvalho, Claudia M. B.; Banser, Linda; Gambin, Tomasz; Stubbolo, Danielle; Yuan, Bo; Sperle, Karen; McCahan, Suzanne M.; Henneke, Marco; Seeman, Pavel; Hobson, Grace M.; Lupski, James R.

    2015-01-01

    Inverted repeats (IRs) can facilitate structural variation as crucibles of genomic rearrangement. Complex duplication—inverted triplication—duplication (DUP-TRP/INV-DUP) rearrangements that contain breakpoint junctions within IRs have been recently associated with both MECP2 duplication syndrome (MIM#300260) and Pelizaeus-Merzbacher disease (PMD, MIM#312080). We investigated 17 unrelated PMD subjects with copy number gains at the PLP1 locus including triplication and quadruplication of specific genomic intervals—16/17 were found to have a DUP-TRP/INV-DUP rearrangement product. An IR distal to PLP1 facilitates DUP-TRP/INV-DUP formation as well as an inversion structural variation found frequently amongst normal individuals. We show that a homology—or homeology—driven replicative mechanism of DNA repair can apparently mediate template switches within stretches of microhomology. Moreover, we provide evidence that quadruplication and potentially higher order amplification of a genomic interval can occur in a manner consistent with rolling circle amplification as predicted by the microhomology-mediated break induced replication (MMBIR) model. PMID:25749076

  20. Correlation of pregnancy outcome with quadruple screening test at second trimester

    PubMed Central

    Yazdani, Shahla; Rouholahnejad, Rahele; Asnafi, Nesa; Sharbatdaran, Majid; Zakershob, Marziihe; Bouzari, Zinatossadat

    2015-01-01

    Background: Abnormal levels of the markers AFP, hCG, and uE3 could be useful in predicting adverse pregnancy outcomes. This study was designed to determine the correlation between second trimester maternal serum markers and adverse pregnancy outcome (APO). Methods: In this historical cohort study, we randomly followed 231 obstetric patients with quadruple screening test in 14-18 weeks of gestation from March 2012 to March 2013 in a medical laboratory in Babol, Iran. We measured maternal serum levels of alphafetoprotein (AFP), human chorionic gonadotropin (hCG), unconjugated estriol (uE3), and inhibin-A. The risk of adverse pregnancy outcomes (APOs) were then compared between patients with negative and positive test results. We used Chi-square and Fisher-exact tests for qualitative variables and t-test for quantitative variables. Demographic differences between the two groups were minimized by applying logistic regression. Results: The risk of having an APO such as pre-eclampsia (p=0.008), fetal growth restriction (p=0.028) and premature rupture of membrane (p=0.040) increased significantly in patients with abnormal markers. Conclusion: Abnormal results of quadruple screening test could be associated with APO in women with normal appearing fetus. PMID:26913244

  1. High energy quadruple pass amplifier for high power laser preamplifier module

    NASA Astrophysics Data System (ADS)

    Peng, Yujie; Wang, Jiangfeng; Pan, Xue; Lu, Xinghua; Li, Xuechun

    2013-09-01

    Pre-amplifier between the frontend and main power amplifier is the key unit of high power laser divers. The recent progresses on the off-axis quadruple pass amplifier are presented, which include the beam path design, parasitic oscillation research and experimental results. A single longitudinal mode, temporally shaped laser pulse with 5ns pulse duration at 1053nm is injected into a Nd: Glass regenerative amplifier, which can provide a 12mJ energy output with 0.5% long term energy stability. The quadruple pass amplifier is designed as an off-axis pattern. With 1.3mJ energy injection, amplified pulse with 16.5J can be achieved, and the measured output energy stability of the amplifier is 7.3% (PV) at this output energy level, corresponding to a 21 shot result. The total gain of the amplifier is more than 10,000. The parasitic oscillation was analyzed and discussed, and the parasitic mode and pencil beam are neither observed in the experiment.

  2. Stratospheric ozone response to a solar irradiance reduction in a quadrupled CO2 environment

    NASA Astrophysics Data System (ADS)

    Jackman, Charles H.; Fleming, Eric L.

    2014-07-01

    We used the Goddard Space Flight Center (GSFC) global two-dimensional (2D) atmospheric model to investigate the stratospheric ozone response to a proposed geoengineering activity wherein a reduced top-of-atmosphere (TOA) solar irradiance is imposed to help counteract a quadrupled CO2 atmosphere. This study is similar to the Geoengineering Model Intercomparison Project (GeoMIP) Experiment G1. Three primary simulations were completed with the GSFC 2D model to examine this possibility: (A) a pre-industrial atmosphere with a boundary condition of 285 ppmv CO2 (piControl); (B) a base future atmosphere with 1140 ppmv CO2 (abrupt4xCO2); and (C) a perturbed future atmosphere with 1140 ppmv CO2 and a 4% reduction in the TOA total solar irradiance (G1). We found huge ozone enhancements throughout most of the stratosphere (up to 40%) as a result of a large computed temperature decrease (up to 18 K) when CO2 was quadrupled (compare simulation abrupt4xCO2 to piControl). Further, we found that ozone will additionally increase (up to 5%) throughout most of the stratosphere with total ozone increases of 1-2.5% as a result of a reduction in TOA total solar irradiance (compare simulation G1 to abrupt4xCO2). Decreases of atomic oxygen and temperature are the main drivers of this computed ozone enhancement from a reduction in TOA total solar irradiance.

  3. The Quadruple Bonding in C2 Reproduces the Properties of the Molecule.

    PubMed

    Shaik, Sason; Danovich, David; Braida, Benoit; Hiberty, Philippe C

    2016-03-14

    Ever since Lewis depicted the triple bond for acetylene, triple bonding has been considered as the highest limit of multiple bonding for main elements. Here we show that C2 is bonded by a quadruple bond that can be distinctly characterized by valence-bond (VB) calculations. We demonstrate that the quadruply-bonded structure determines the key observables of the molecule, and accounts by itself for about 90% of the molecule's bond dissociation energy, and for its bond lengths and its force constant. The quadruply-bonded structure is made of two strong π bonds, one strong σ bond and a weaker fourth σ-type bond, the bond strength of which is estimated as 17-21 kcal mol(-1). Alternative VB structures with double bonds; either two π bonds or one π bond and one σ bond lie at 129.5 and 106.1 kcal mol(-1), respectively, above the quadruply-bonded structure, and they collapse to the latter structure given freedom to improve their double bonding by dative σ bonding. The usefulness of the quadruply-bonded model is underscored by "predicting" the properties of the (3)Σ+u state. C2's very high reactivity is rooted in its fourth weak bond. Thus, carbon and first-row main elements are open to quadruple bonding! PMID:26880488

  4. Complex genomic rearrangements at the PLP1 locus include triplication and quadruplication.

    PubMed

    Beck, Christine R; Carvalho, Claudia M B; Banser, Linda; Gambin, Tomasz; Stubbolo, Danielle; Yuan, Bo; Sperle, Karen; McCahan, Suzanne M; Henneke, Marco; Seeman, Pavel; Garbern, James Y; Hobson, Grace M; Lupski, James R

    2015-03-01

    Inverted repeats (IRs) can facilitate structural variation as crucibles of genomic rearrangement. Complex duplication-inverted triplication-duplication (DUP-TRP/INV-DUP) rearrangements that contain breakpoint junctions within IRs have been recently associated with both MECP2 duplication syndrome (MIM#300260) and Pelizaeus-Merzbacher disease (PMD, MIM#312080). We investigated 17 unrelated PMD subjects with copy number gains at the PLP1 locus including triplication and quadruplication of specific genomic intervals-16/17 were found to have a DUP-TRP/INV-DUP rearrangement product. An IR distal to PLP1 facilitates DUP-TRP/INV-DUP formation as well as an inversion structural variation found frequently amongst normal individuals. We show that a homology-or homeology-driven replicative mechanism of DNA repair can apparently mediate template switches within stretches of microhomology. Moreover, we provide evidence that quadruplication and potentially higher order amplification of a genomic interval can occur in a manner consistent with rolling circle amplification as predicted by the microhomology-mediated break induced replication (MMBIR) model. PMID:25749076

  5. Dual-Source Multi-Energy CT with Triple or Quadruple X-ray Beams

    PubMed Central

    Yu, Lifeng; Leng, Shuai; McCollough, Cynthia H.

    2016-01-01

    Energy-resolved photon-counting CT (PCCT) is promising for material decomposition with multi-contrast agents. However, corrections for non-idealities of PCCT detectors are required, which are still active research areas. In addition, PCCT is associated with very high cost due to lack of mass production. In this work, we proposed an alternative approach to performing multi-energy CT, which was achieved by acquiring triple or quadruple x-ray beam measurements on a dual-source CT scanner. This strategy was based on a “Twin Beam” design on a single-source scanner for dual-energy CT. Examples of beam filters and spectra for triple and quadruple x-ray beam were provided. Computer simulation studies were performed to evaluate the accuracy of material decomposition for multi-contrast mixtures using a tri-beam configuration. The proposed strategy can be readily implemented on a dual-source scanner, which may allow material decomposition of multi-contrast agents to be performed on clinical CT scanners with energy-integrating detector. PMID:27330237

  6. Frequency quadrupling optoelectronic oscillator using a single polarization modulator in a Sagnac loop

    NASA Astrophysics Data System (ADS)

    Wang, Wen Ting; Li, Wei; Zhu, Ning Hua

    2014-05-01

    We propose and demonstrate a novel and cost efficient method to generating a frequency quadrupling optoelectronic oscillator (OEO) using a single polarization modulator (PolM) in a Sagnac loop. The OEO loop and the Sagnac loop share the same PolM. In the OEO loop, the PolM is used to generate the fundamental microwave signal. In the Sagnac loop, the joint use of the PolM, a polarization controller (PC), and a polarization beam splitter (PBS) is equivalent to an intensity modulator. The odd order sidebands of the modulated signal are suppressed by biasing the equivalent intensity modulator at the maximum transmission point. Moreover, the undesired optical carrier is also eliminated by bidirectional use of the PolM. As a result, only the two second order sidebands are left. The beating between the two second order sidebands in a photodetector (PD) generates a microwave signal at the frequency corresponding to four times of the fundamental tone. A frequency quadrupling microwave signal at the frequency of 39.74 GHz with a phase noise of -100.14 dBc/Hz at 10 kHz frequency offset was experimentally generated.

  7. Degenerative changes of the cranial cruciate ligament harvested from dogs with cranial cruciate ligament rupture

    PubMed Central

    ICHINOHE, Tom; KANNO, Nobuo; HARADA, Yasuji; YOGO, Takuya; TAGAWA, Masahiro; SOETA, Satoshi; AMASAKI, Hajime; HARA, Yasushi

    2015-01-01

    Degenerative cranial cruciate ligament (CCL) rupture is characterized histologically by degenerating extracellular matrix (ECM) and chondroid metaplasia. Here, we describe the progression of chondroid metaplasia and the changes in the expression of ECM components in canine CCL rupture (CCLR). CCLs from 26 stifle joints with CCLR (CCLR group) and normal CCLs from 12 young beagles (control group) were examined histologically and immunohistochemically for expression of type I (COLI), type II (COLII), type III collagen (COLIII) and Sry-type HMG box 9 (SOX9). Cell density and morphology of CCLs were quantified using hematoxylin–eosin staining. The percentage of round cells was higher in the CCLR group than in controls. COLI-positive areas were seen extensively in the connecting fibers, but weakly represented in the cytoplasm of normal CCLs. In the CCLR group, there were fewer COLI-positive areas, but many COLI-positive cells. The percentages of COLII-, COLIII- and SOX9-positive cells were higher in the CCLR group than in controls. The number of spindle cells with perinuclear halo was high in the CCLR group, and most of these cells were SOX9-positive. Deposition of COLI, the main ECM component of ligaments, decreased with increased COLIII expression in degenerated CCL tissue, which shows that the deposition of the ECM is changed in CCLR. On the contrary, expression of SOX9 increased, which may contribute to the synthesis of cartilage matrix. The expression of COLII and SOX9 in ligamentocytes showed that these cells tend to differentiate into chondrocytes. PMID:25716871

  8. Switchable quadruple-wavelength Erbium-doped fiber laser based on a chirped fiber grating and polarization-maintaining fiber

    NASA Astrophysics Data System (ADS)

    Cheng, Jianqun; Chen, Weicheng; Chen, Guojie

    2016-04-01

    A switchable quadruple-wavelength Erbium-doped fiber laser based on two Sagnac loops with a chirped fiber grating and polarization-maintaining fiber is proposed and demonstrated experimentally at room temperature. The two loops act as comb filters to excite multi-wavelength output. On the basis of the polarization hole burning effect, the laser can switch flexibly to output ten different modes from single-wavelength to quadruple-wavelength. All of the lasing lines with narrow linewidth have the optical signal-to-noise ratio of more than 35 dB. The laser with good power uniformity shows better stability with respect to the wavelength and peak power.

  9. Signs of Overload

    MedlinePlus

    ... Listen Text Size Email Print Share Signs of Overload Page Content Article Body Although stress is a ... 12 (Copyright © 2004 American Academy of Pediatrics) The information contained on this Web site should not be ...

  10. Warning Signs of Bullying

    MedlinePlus

    ... to talk to kids about bullying. Respond to Bullying Learn how to respond to bullying . From stopping ... away . Back to top Signs a Child is Bullying Others Kids may be bullying others if they: ...

  11. Symptoms and Warning Signs

    MedlinePlus

    ... Signs Past Issues / Spring 2008 Table of Contents Anorexia Nervosa emaciation (extremely thin from lack of nutrition) relentless ... from diuretic abuse severe dehydration from purging Binge Eating Disorder frequently eating large amounts of food (binge-eating) ...

  12. The du Bois sign.

    PubMed

    Voelpel, James H; Muehlberger, Thomas

    2011-03-01

    According to the current literature, the term "du Bois sign" characterizes the condition of a shortened fifth finger as a symptom of congenital syphilis, Down syndrome, dyscrania, and encephalic malformation. Modern medical dictionaries and text books attribute the eponym to the French gynecologist Paul Dubois (1795-1871). Yet, a literature analysis revealed incorrect references to the person and unclear definitions of the term. Our findings showed that the origin of the term is based on observations made by the Swiss dermatologist Charles du Bois (1874-1947) in connection with congenital syphilis. In addition, a further eponymical fifth finger sign is closely associated with the du Bois sign. In conclusion, the du Bois sign has only limited diagnostic value and is frequently occurring in the normal healthy population. PMID:21263293

  13. Response to the Comment by J. Grunenberg on "The Nature of the Fourth Bond in the Ground State of C2: The Quadruple Bond Conundrum''.

    PubMed

    Shaik, Sason; Danovich, David; Hiberty, Philippe C

    2015-11-16

    The quadruple bond structure in C2 emerges from solid quantum-chemical calculations and won't go away! There is no mystery in the rather small bond dissociation energy, and this cannot constitute the reason to reconsider the whole concept of quadruple bonding. PMID:26482677

  14. Anatomic Double-Bundle Posterior Cruciate Ligament Reconstruction.

    PubMed

    Chahla, Jorge; Nitri, Marco; Civitarese, David; Dean, Chase S; Moulton, Samuel G; LaPrade, Robert F

    2016-02-01

    The posterior cruciate ligament (PCL) is known to be the main posterior stabilizer of the knee. Anatomic single-bundle PCL reconstruction, focusing on reconstruction of the larger anterolateral bundle, is the most commonly performed procedure. Because of the residual posterior and rotational tibial instability after the single-bundle procedure and the inability to restore the normal knee kinematics, an anatomic double-bundle PCL reconstruction has been proposed in an effort to re-create the native PCL footprint more closely and to restore normal knee kinematics. We detail our technique for an anatomic double-bundle PCL reconstruction using Achilles and anterior tibialis tendon allografts. PMID:27284530

  15. Anterior Cruciate Ligament: Structure, Injuries and Regenerative Treatments.

    PubMed

    Negahi Shirazi, Ali; Chrzanowski, Wojciech; Khademhosseini, Ali; Dehghani, Fariba

    2015-01-01

    Anterior cruciate ligament (ACL) is one of the most vulnerable ligaments of the knee. ACL impairment results in episodic instability, chondral and meniscal injury and early osteoarthritis. The poor self-healing capacity of ACL makes surgical treatment inevitable. Current ACL reconstructions include a substitution of torn ACL via biological grafts such as autograft, allograft. This review provides an insight of ACL structure, orientation and properties followed by comparing the performance of various constructs that have been used for ACL replacement. New approaches, undertaken to induce ACL regeneration and fabricate biomimetic scaffolds, are also discussed. PMID:26545750

  16. Anterior Cruciate Ligament Reconstruction in Ehlers-Danlos Syndrome.

    PubMed

    Williams, John; Hutt, Jonathan; Rickman, Mark

    2015-01-01

    This report details the reconstruction of the anterior cruciate ligament in an 18-year-old man with Ehlers-Danlos syndrome (EDS). The reduced mechanical properties of the tissue in EDS can pose a challenge to the orthopaedic surgeon. In this case, we describe the use of a hamstring autograft combined with a Ligament Advanced Reinforcement System (LARS). There was a good radiographical, clinical, and functional outcome after two years. This technique gave a successful outcome in the reconstruction of the ACL in a patient with EDS and therefore may help surgeons faced with the same clinical scenario. PMID:26221555

  17. Ossicle in Anterior Cruciate Ligament: A Rare Occurrence

    PubMed Central

    Singh, Amanpreet; Gogna, Paritosh

    2014-01-01

    The occurrence of an intra-articular ossicle is not rare in the knee, with reports suggesting the existence of meniscal osscile. There are also reports describing the attachment of the posterolateral bundle of the anterior cruciate ligament (ACL) to an accessory ossicle. However, despite an extensive search of the English literature we did not find much written about an intrasubstance ossicle in the ACL. We present the case of a 13-year-old male with an intrasubstance ossicle in the anteromedial bundle of the ACL of his right knee. PMID:24822144

  18. An audit of tunnel position in anterior cruciate ligament reconstruction.

    PubMed

    Topliss, C; Webb, J

    2001-03-01

    We audited 114 primary anterior cruciate ligament (ACL) reconstructions. Notes were reviewed and tunnel positions assessed on lateral and AP radiographs. A literature review established optimal tunnel position. Sixteen surgeons performed 57 arthroscopic and 57 open reconstructions, using 24 hamstring and 90 bone-tendon-bone autografts. Eighty-five sets of radiographs were available for review. Sixty-five percent of femoral tunnels and 59% of the tibial tunnels were malpositioned in the sagittal plane. Guidelines for best practice are required for key procedures in each speciality. Tunnel position in ACL reconstruction can be easily measured and should be correct in at least 90% of cases. PMID:11248570

  19. Anatomical reconstruction of the anterior cruciate ligament: a logical approach

    PubMed Central

    Gali, Julio Cesar

    2015-01-01

    We describe the surgical approach that we have used over the last years for anterior cruciate ligament (ACL) reconstruction, highlighting the importance of arthroscopic viewing through the anteromedial portal (AMP) and femoral tunnel drilling through an accessory anteromedial portal (AMP). The AMP allows direct view of the ACL femoral insertion site on the medial aspect of the lateral femoral condyle, does not require guides for anatomic femoral tunnel reaming, prevents an additional lateral incision in the distal third of the thigh (as would be unavoidable when the outside-in technique is used) and also can be used for double-bundle ACL reconstruction. PMID:26417571

  20. The Evolution of Anatomic Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Getgood, Alan; Spalding, Tim

    2012-01-01

    Anterior cruciate ligament reconstruction has evolved significantly since the early 1900’s, back when an emphasis was placed on repair and not reconstruction. Over the past century, the technique has evolved from intra-articular non anatomic reconstruction, to extra articular reconstruction, back to intra articular (performed arthroscopically), to now, the advent of anatomic insertion site restoration. This review will aim to illustrate the changes that have occurred, describing the rational for this process, based upon anatomical, radiological, biomechanical and clinical studies, all of which have aimed to improve patient function following ACL injury. PMID:22905073

  1. Posterior Wall Blowout in Anterior Cruciate Ligament Reconstruction

    PubMed Central

    Mitchell, Justin J.; Dean, Chase S.; Chahla, Jorge; Menge, Travis J.; Cram, Tyler R.; LaPrade, Robert F.

    2016-01-01

    Violation of the posterior femoral cortex, commonly referred to as posterior wall blowout, can be a devastating intraoperative complication in anterior cruciate ligament (ACL) reconstruction and lead to loss of graft fixation or early graft failure. If cortical blowout occurs despite careful planning and adherence to proper surgical technique, a thorough knowledge of the anatomy and alternative fixation techniques is imperative to ensure optimal patient outcomes. This article highlights anatomic considerations for femoral tunnel placement in ACL reconstruction and techniques for avoidance and salvage of a posterior wall blowout. PMID:27335885

  2. Anterior cruciate ligament injury in indoor ball games.

    PubMed

    Ebstrup, J F; Bojsen-Møller, F

    2000-04-01

    Three videorecorded incidents of knee injuries inflicted during indoor ball games are reported. Injuries and especially anterior cruciate ligament ruptures seemed to be triggered in varus loaded knees by femural external rotation, or in valgus loaded knees by femural internal rotation with the pivot shifted to the lateral femurotibial compartment. The observations suggest that it may be to the players' advantage to be trained in not letting their knees sag medially or laterally during side-stepping or sudden changes in speed. PMID:10755283

  3. A Smile Face Monopole Antenna with Quadruple Band-Notched Characteristics

    NASA Astrophysics Data System (ADS)

    Yang, Xiao-Lin; Kong, Fang-Ling; Wang, Yan

    2015-05-01

    A compact planar ultra-wideband (UWB) monopole antenna with quadruple band-notched characteristics is presented. The notched band at 3.3-4.2 GHz (C-band) is obtained by embedding a pair of Z-shaped slots on the elliptical radiation patch. Meanwhile, a modified U-shaped slot is etched in the radiation patch to create the notched band at 4.9-5.4 GHz for WLAN. In addition, by introducing E-shaped stubs on the back layer, the notched bands at 5.5-6.1 GHz for WLAN and 7-8.15 GHz for downlink of X-band satellite communication system are obtained. The antenna is fabricated and measured, showing broadband matched impedance and good Omni-directional patterns with high fidelity and phase linearity (outside the notched bands).

  4. Application of a quadruple probe technique to MPD thruster plume measurements

    NASA Astrophysics Data System (ADS)

    Burton, Rodney L.; Delmedico, Susan G.; Andrews, J. C.

    1993-10-01

    A new quadruple Langmuir probe diagnostic technique is applied to the plume of a pulsed magnetoplasmadynamic (MPD) thruster with argon propellant. The probe permits simultaneous measurement of electron temperature T(e), density n(e), and ion flow velocity u in the exhaust stream. For distances of 3-25 cm from the thruster face, T(e) is 8-1.5 eV, n(e) is 4.8-1.2 x 10 exp 19/cu m, and u is 0.7-1.8 x 10 exp 4 m/s. The measurements suggest that the plume is well-collimated, and that the ion temperature is significantly higher than the electron temperature, consistent with an ion-conduction model of the thruster.

  5. Modulated spin helicity stabilized by incommensurate orbital density waves in a quadruple perovskite manganite

    NASA Astrophysics Data System (ADS)

    Johnson, R. D.; Khalyavin, D. D.; Manuel, P.; Bombardi, A.; Martin, C.; Chapon, L. C.; Radaelli, P. G.

    2016-05-01

    Through a combination of neutron diffraction and Landau theory we describe the spin ordering in the ground state of the quadruple perovskite manganite CaMn7O12 —a magnetic multiferroic supporting an incommensurate orbital density wave that onsets above the magnetic ordering temperature, TN 1=90 K. The multi-k magnetic structure in the ground state was found to be a nearly-constant-moment helix with modulated spin helicity, which oscillates in phase with the orbital occupancies on the Mn3 + sites via trilinear magneto-orbital coupling. Our phenomenological model also shows that, above TN 2=48 K, the primary magnetic order parameter is locked into the orbital wave by an admixture of helical and collinear spin density wave structures. Furthermore, our model naturally explains the lack of a sharp dielectric anomaly at TN 1 and the unusual temperature dependence of the electrical polarization.

  6. Improved stability and stabilization design for networked control systems using new quadruple-integral functionals.

    PubMed

    Li, Zhichen; Bai, Yan; Li, Tianqi

    2016-07-01

    This paper investigates stability analysis and stabilization for networked control systems. By a refined delay decomposition approach, slightly different Lyapunov-Krasovskii functionals (LKFs) with quadruple-integral terms and augmented vectors containing triple-integral forms of state are constructed. New integral inequalities are proposed to estimate the cross terms from derivatives of the LKFs, which can be proved to offer tighter bounds than what the Jensen one produces theoretically. Moreover, the non-strictly proper rational functions in deriving process are fully handled via reciprocally convex approach. A state feedback controller design approach is also developed. Numerical examples and applications to practical power and oscillator systems demonstrate the superiority of the proposed criteria in conservatism reduction compared to some existing ones. PMID:27087136

  7. Research of photonic-assisted triangular-shaped pulses generation based on quadrupling RF modulation

    NASA Astrophysics Data System (ADS)

    Yuan, Jin; Ning, Ti-gang; Li, Jing; Li, Yue-qin; Chen, Hong-yao; Zhang, Chan

    2015-05-01

    We propose an approach to generate optical triangular-shaped pulse train with tunable repetition rate using quadrupling radio frequency (RF) modulation and optical grating dispersion-induced power fading. In this work, a piece of chirped fiber Bragg grating (FBG) is employed as the dispersive media to remove the undesired 8th harmonic in optical intensity. Thus, the generated harmonics of optical intensity can be corresponding to the first two Fourier components of typical periodic triangular pulses. This work also analyzes the impacts of the extinction ratio and the bias voltage drift on the harmonic distortion suppression ratio. After that, the value of the extinction ratio and the range of the bias voltage drift can be obtained. The advantage of this proposal is that it can generate high order frequency-multiplexed optical pulses train which can be applied in all optical signal processing and other fields.

  8. Si/SiGe quadruple quantum dots with direct barrier gates

    NASA Astrophysics Data System (ADS)

    Ward, Daniel; Gamble, John; Foote, Ryan; Savage, Donald; Lagally, Max; Coppersmith, Susan; Eriksson, Mark

    2014-03-01

    We have fabricated a quadruple quantum dot in a Si/SiGe heterostructure with the aim of demonstrating a two-qubit quantum gate. This device makes use of direct barrier gates, in which individual gates are placed directly over the quantum dots and tunnel barriers. This design enables rational control of both energies and tunnel rates in coupled quantum dots. In this talk we discuss the design, fabrication, and initial characterization of the device. This work was supported in part by ARO (W911NF-12-0607), NSF (DMR-1206915), and the United States Department of Defense. The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressly or implied, of the US Government.

  9. Full control of quadruple quantum dot circuit charge states in the single electron regime

    SciTech Connect

    Delbecq, M. R. Nakajima, T.; Otsuka, T.; Amaha, S.; Watson, J. D.; Manfra, M. J.; Tarucha, S.

    2014-05-05

    We report the realization of an array of four tunnel coupled quantum dots in the single electron regime, which is the first required step toward a scalable solid state spin qubit architecture. We achieve an efficient tunability of the system but also find out that the conditions to realize spin blockade readout are not as straightforwardly obtained as for double and triple quantum dot circuits. We use a simple capacitive model of the series quadruple quantum dots circuit to investigate its complex charge state diagrams and are able to find the most suitable configurations for future Pauli spin blockade measurements. We then experimentally realize the corresponding charge states with a good agreement to our model.

  10. Full control of quadruple quantum dot circuit charge states in the single electron regime

    NASA Astrophysics Data System (ADS)

    Delbecq, M. R.; Nakajima, T.; Otsuka, T.; Amaha, S.; Watson, J. D.; Manfra, M. J.; Tarucha, S.

    2014-05-01

    We report the realization of an array of four tunnel coupled quantum dots in the single electron regime, which is the first required step toward a scalable solid state spin qubit architecture. We achieve an efficient tunability of the system but also find out that the conditions to realize spin blockade readout are not as straightforwardly obtained as for double and triple quantum dot circuits. We use a simple capacitive model of the series quadruple quantum dots circuit to investigate its complex charge state diagrams and are able to find the most suitable configurations for future Pauli spin blockade measurements. We then experimentally realize the corresponding charge states with a good agreement to our model.

  11. Development of a narrow-band, tunable, frequency-quadrupled diode laser for UV absorption spectroscopy.

    PubMed

    Koplow, J P; Kliner, D A; Goldberg, L

    1998-06-20

    A compact, lightweight, low-power-consumption source of tunable, narrow-bandwidth blue and UV radiation is described. In this source, a single-longitudinal-mode diode laser seeds a pulsed, GaAlAs tapered amplifier whose ~860-nm output is frequency quadrupled by two stages of single-pass frequency doubling. Performance of the laser system is characterized over a wide range of amplifier duty cycles (0.1-1.0), pulse durations (50 ns-1.0 mus), peak currents (

  12. Computational triadic algebras of signs

    SciTech Connect

    Zadrozny, W.

    1996-12-31

    We present a finite model of Peirce`s ten classes of signs. We briefly describe Peirce`s taxonomy of signs; we prove that any finite collection of signs can be extended to a finite algebra of signs in which all interpretants are themselves being interpreted; and we argue that Peirce`s ten classes of signs can be defined using constraints on algebras of signs. The paper opens the possibility of defining multimodal cognitive agents using Peirce`s classes of signs, and is a first step towards building a computational logic of signs based on Peirce`s taxonomies.

  13. Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy

    PubMed Central

    Zhang, F.; Bao, Z.J.; Shi, D.M.; Xiang, P.; Xiao, L.; Huang, Y.Q.; Zhang, G.S.; Yin, S.M.

    2016-01-01

    We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients. PMID:26871968

  14. Is V899 Herculis an unsolved quadruple system containing double close binary stars?

    NASA Astrophysics Data System (ADS)

    Qian, S.-B.; Liao, W.-P.; He, J.-J.; Yuan, J.-Z.; Zhu, L.-Y.

    2006-10-01

    Orbital period variation of the W UMa-type eclipsing binary, V899 Herculis, discovered by the Hipparcos satellite was investigated based on all available photoelectric and CCD times of light minimum. It is discovered that the orbital period of the binary shows a cyclic change with an amplitude of 0.0117 days. The cyclic period change can be explained as the light-travel time orbit of a tertiary component in the system, which is in agreement with the spectroscopic result obtained by Lu et al. [Lu, W., Rucinski, S.M., Ogloza, W., 2001. AJ 122, 402] who found that the system, of which V899 Herculis is a fainter component (B), is a triple, even quadruple and with the photometric result obtained by Özdemir et al. [Özdemir, S., Demircan, O., Erdem, A., Cicek, C., Bulut, I., Soydugan, E., Soydugan, F., 2002. A&A 387, 240] who reported a large amount of third light ( L3 ˜ 0.68) of the system. The third body (A) rotates around the eclipsing pair in a period of 3.7 years. Lu et al. [Lu, W., Rucinski, S.M., Ogloza, W., 2001. AJ 122, 402] reported that the tertiary component is F5-type main-sequence star. However, the present analysis shows that the mass of the third component is no less than 2.8 M⊙, which is larger than the mass of an F5-type main-sequence star suggesting that the tertiary component may be a non-eclipsing close binary. Therefore, the system may be a possible unsolved quadruple system containing double close binary stars. It is a good astrophysical laboratory to study the formation and evolution of binary and multiple system. The timescale for the formation of the G-type overcontact binary (V899 Herculis) via AML should be shorter than the main-sequence time of an F5-type star.

  15. THE QUADRUPLE PRE-MAIN-SEQUENCE SYSTEM LkCa 3: IMPLICATIONS FOR STELLAR EVOLUTION MODELS

    SciTech Connect

    Torres, Guillermo; Latham, David W.; Ruiz-Rodriguez, Dary; Prato, L.; Wasserman, Lawrence H.; Badenas, Mariona; Schaefer, G. H.; Mathieu, Robert D.

    2013-08-10

    We report the discovery that the pre-main-sequence (PMS) object LkCa 3 in the Taurus-Auriga star-forming region is a hierarchical quadruple system of M stars. It was previously known to be a close ({approx}0.''5) visual pair, with one component being a moderately eccentric 12.94 day single-lined spectroscopic binary. A re-analysis of archival optical spectra complemented by new near-infrared (NIR) spectroscopy shows both visual components to be double lined; the second one has a period of 4.06 days and a circular orbit. In addition to the orbital elements, we determine optical and NIR flux ratios, effective temperatures, and projected rotational velocities for all four stars. Using existing photometric monitoring observations of the system that had previously revealed the rotational period of the primary in the longer-period binary, we also detect the rotational signal of the primary in the 4.06 day binary, which is synchronized with the orbital motion. With only the assumption of coevality, a comparison of all of these constraints with current stellar evolution models from the Dartmouth series points to an age of 1.4 Myr and a distance of 133 pc, consistent with previous estimates for the region and suggesting that the system is on the near side of the Taurus complex. Similar comparisons of the properties of LkCa 3 and the well-known quadruple PMS system GG Tau with the widely used models from the Lyon series for a mixing length parameter of {alpha}{sub ML} = 1.0 strongly favor the Dartmouth models.

  16. On the origin of the flux ratio anomaly in quadruple lens systems

    NASA Astrophysics Data System (ADS)

    Inoue, Kaiki Taro

    2016-09-01

    We explore the origin of the flux ratio anomaly in quadruple lens systems. Using a semi-analytic method based on N-body simulations, we estimate the effect of a possible magnification perturbation caused by subhaloes with a mass scale of ≲109 h-1 M⊙ in lensing galaxy haloes. Taking into account astrometric shifts and assuming that the primary lens is described by a singular isothermal ellipsoid, the expected change to the flux ratios for a multiply lensed image is just a few per cent and the mean of the expected convergence perturbation at the effective Einstein radius of the lensing galaxy halo is <δκsub> = 0.003, corresponding to the mean of the ratio of a projected dark matter mass fraction in subhaloes at the effective Einstein radius = 0.006. In contrast, the expected change to the flux ratio caused by line-of-sight structures is typically ˜10 per cent and the mean of the convergence perturbation is <|δκlos|> = 0.008, corresponding to = 0.017. The contribution of the magnification perturbation caused by subhaloes is ˜40 per cent of the total at a source redshift zS = 0.7 and decreases monotonically in zS to ˜20 per cent at zS = 3.6. Assuming statistical isotropy, the convergence perturbation estimated from 11 observed quadruple lens systems has a positive correlation with the source redshift zS, which is much stronger than that with the lens redshift zL. This feature also supports that the flux ratio anomaly is caused mainly by line-of-sight structures rather than subhaloes. We also discuss a possible imprint of line-of-sight structures in the demagnification of minimum images due to locally underdense structures in the line of sight.

  17. Functional outcome of quadruple amputees with end-stage renal disease.

    PubMed

    Garrison, S J; Merritt, B S

    1997-01-01

    A rare but catastrophic complication in end-stage renal disease (ESRD) patients with peripheral vascular disease is amputation of all four limbs secondary to gangrene. We present three patients with ESRD who underwent quadruple amputation. The purpose of this case study is to investigate the functional benefit of inpatient rehabilitation for such amputees. Our large, tertiary acute care hospital admitted 1,469 patients with ESRD during a continuous 63-month period. There were 72 amputation procedures: 57 involving lower limbs, and 15 involving upper limbs. Three patients had all four limbs amputated; these three were subsequently admitted to our acute inpatient rehabilitation center. Their median Functional Independence Measurement (FIM) score on admission was 52 and on discharge was 75. Their median length of stay was 24.5 days, which may be attributed to early postoperative therapy and de-emphasis on prosthetic replacement. At discharge, all three patients were able to perform sliding board transfers and self-propel wheelchairs modified with quad knobs and brake extenders. Each continued hemodialysis three times per week. Two patients were independent with feeding using adaptive equipment, and one required verbal cues. Two patients were able to write using dorsal wrist splints and pencil holders. One patient was able to use a speaker phone and lift lightweight objects with a left below-the-elbow hook-type prosthesis. Our review of these three cases demonstrates that inpatient rehabilitation can improve functional scores in quadruple amputee patients with ESRD. A large multicenter study is warranted to obtain adequate sample size to demonstrate statistical significance. PMID:9207709

  18. On the Origin of Flux Ratio Anomaly in Quadruple Lens Systems

    NASA Astrophysics Data System (ADS)

    Inoue, Kaiki Taro

    2016-05-01

    We explore the origin of flux ratio anomaly in quadruple lens systems. Using a semi-analytic method based on N-body simulations, we estimate the effect of possible magnification perturbation caused by subhaloes with a mass scale of ≲ 109 h-1M⊙ in lensing galaxy haloes. Taking into account astrometric shifts, assuming that the primary lens is described by a singular isothermal ellipsoid, the expected change to the flux ratios per a multiply lensed image is just a few percent and the mean of the expected convergence perturbation at the effective Einstein radius of the lensing galaxy halo is <δκsub> = 0.003, corresponding to the mean of the ratio of a projected dark matter mass fraction in subhaloes at the effective Einstein radius = 0.006. In contrast, the expected change to the flux ratio caused by line-of-sight structures is typically ˜10 percent and the mean of the convergence perturbation is <|δκlos|> = 0.008, corresponding to = 0.017. The contribution of magnification perturbation caused by subhaloes is ˜40 percent of the total at a source redshift zS = 0.7 and decreases monotonically in zS to ˜20 percent at zS = 3.6. Assuming statistical isotropy, the convergence perturbation estimated from observed 11 quadruple lens systems has a positive correlation with the source redshift zS, which is much stronger than that with the lens redshift zL. This feature also supports an idea that the flux ratio anomaly is caused mainly by line-of-sight structures rather than subhaloes. We also discuss about a possible imprint of line-of-sight structures in demagnification of minimum images due to locally underdense structures in the line of sight.

  19. Efficacy of a quadruple therapy regimen for Helicobacter pylori eradication after partial gastrectomy.

    PubMed

    Zhang, F; Bao, Z J; Shi, D M; Xiang, P; Xiao, L; Huang, Y Q; Zhang, G S; Yin, S M

    2016-02-01

    We aimed to evaluate the effectiveness and safety of bismuth-containing quadruple therapy plus postural change after dosing for Helicobacter pylori eradication in gastrectomized patients. We compared 76 gastric stump patients with H. pylori infection (GS group) with 50 non-gastrectomized H. pylori-positive patients who met the treatment indication (controls). The GS group was divided into GS group 1 and GS group 2. All groups were administered bismuth potassium citrate (220 mg), esomeprazole (20 mg), amoxicillin (1.0 g), and furazolidone (100 mg) twice daily for 14 days. GS group 1 maintained a left lateral horizontal position for 30 min after dosing. H. pylori was detected using rapid urease testing and histologic examination of gastric mucosa before and 3 months after therapy. Mucosal histologic manifestations were evaluated using visual analog scales of the updated Sydney System. GS group 1 had a higher prevalence of eradication than the GS group 2 (intention-to-treat [ITT]: P=0.025; per-protocol [PP]: P=0.030), and the control group had a similar prevalence. GS group 2 had a lower prevalence of eradication than controls (ITT: P=0.006; PP: P=0.626). Scores for chronic inflammation and activity declined significantly (P<0.001) 3 months after treatment, whereas those for atrophy and intestinal metaplasia showed no significant change. Prevalence of adverse reactions was similar among groups during therapy (P=0.939). A bismuth-containing quadruple therapy regimen plus postural change after dosing appears to be a relatively safe, effective, economical, and practical method for H. pylori eradication in gastrectomized patients. PMID:26871968

  20. The Meaning of Signs:

    PubMed Central

    Stein, Claudia

    2006-01-01

    This article reconstructs the diagnostic act of the French pox in the French-disease hospital of sixteenth-century Augsburg. It focuses on how the participants in the clinical encounter imagined the configuration of the pox and its localization in the human body. Of central importance for answering this question is the early modern conception of physical signs. It has been argued that it was due to a specific understanding of bodily signs and their relationship to a disease and its causes, that disease definition and classification in the early modern period showed a high degree of flexibility and fluidity. This paper looks at how the sixteenth-century theoretical conception of physical signs not only shaped the diagnosis and treatment of the pox but also reflected the overall organization of institutions. PMID:17242549

  1. Eponymous signs in dermatology

    PubMed Central

    Madke, Bhushan; Nayak, Chitra

    2012-01-01

    Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these “signs” and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. “Signs” commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper. PMID:23189246

  2. Variations in cell morphology in the canine cruciate ligament complex.

    PubMed

    Smith, K D; Vaughan-Thomas, A; Spiller, D G; Clegg, P D; Innes, J F; Comerford, E J

    2012-08-01

    Cell morphology may reflect the mechanical environment of tissues and influence tissue physiology and response to injury. Normal cruciate ligaments (CLs) from disease-free stifle joints were harvested from dog breeds with a high (Labrador retriever) and low (Greyhound) risk of cranial cruciate ligament (CCL) rupture. Antibodies against the cytoskeletal components vimentin and alpha tubulin were used to analyse cell morphology; nuclei were stained with 4',6-diamidino-2-phenylindole, and images were collected using conventional and confocal microscopy. Both cranial and caudal CLs contained cells of heterogenous morphologies. Cells were arranged between collagen bundles and frequently had cytoplasmic processes. Some of these processes were long (type A cells), others were shorter, thicker and more branched (type B cells), and some had no processes (type C cells). Processes were frequently shown to contact other cells, extending longitudinally and transversely through the CLs. Cells with longer processes had fusiform nuclei, and those with no processes had rounded nuclei and were more frequent in the mid-substance of both CLs. Cells with long processes were more commonly noted in the CLs of the Greyhound. As contact between cells may facilitate direct communication, variances in cell morphology between breeds at a differing risk of CCL rupture may reflect differences in CL physiology. PMID:22465617

  3. The effect of immediate weightbearing after anterior cruciate ligament reconstruction.

    PubMed

    Tyler, T F; McHugh, M P; Gleim, G W; Nicholas, S J

    1998-12-01

    Immediate weightbearing has been advocated after anterior cruciate ligament reconstruction and is thought to enhance the return of quadriceps muscle activity and knee extension range of motion without jeopardizing graft integrity. This study examined the effect of immediate weightbearing after anterior cruciate ligament reconstruction on the return of vastus medialis oblique electromyography activity, knee extension range of motion, knee stability, physical examination, Lysholm score, and anterior knee pain. Forty-nine patients (24 men and 25 women) undergoing endoscopic central third patella tendon autograft reconstruction were randomized prospectively into two groups. Group 1 patients underwent immediate weightbearing as tolerated. Group 2 patients were kept nonweightbearing for 2 weeks. All measurements were taken before surgery, 2 weeks after surgery, and between 6 and 14 months (average, 7.3 months) followup. There was no effect of weightbearing on knee extension range of motion or vastus medialis oblique function at followup. In addition, knee stability was not compromised after surgery. Seven of 20 (35%) nonweightbearing patients and only two of 25 (8%) immediate weightbearing patients reported anterior knee pain at followup. Overall, immediate weightbearing did not compromise knee joint stability and resulted in a better outcome with a decreased incidence of anterior knee pain. PMID:9917711

  4. Genetic basis of cranial cruciate ligament rupture (CCLR) in dogs.

    PubMed

    Baird, Arabella Elizabeth Gardiner; Carter, Stuart D; Innes, John F; Ollier, William E; Short, Andrea D

    2014-08-01

    Cranial Cruciate Ligament rupture (CCLR) is one of the most common forms of lameness in dogs and is analogous to rupture of the anterior cruciate ligament in humans, for which it can serve as a model. As there is a strong breed-related predisposition to CCLR in dogs, a study was undertaken to consider putative genetic components in susceptible dog breeds. A candidate gene, single nucleotide polymorphism (SNP) genotyping approach using MALDI-TOF mass spectrometry (Sequenom Ltd) was designed to investigate several CCLR-susceptible dog breeds and identify CCLR-associated genes/gene regions that may confer susceptibility or resistance. A meta-analysis was performed using the breed case/control candidate gene data to identify SNP associations that were common to the whole cohort of susceptible dogs. We identified SNPs in key genes involved in ligament strength, stability and extracellular matrix formation (COL5A1, COL5A2, COL1A1, COL3A1, COL11A1, COL24A1, FBN1, LOX, LTBP2) which were significantly associated with CCLR susceptibility across the dog breeds used in this study. These SNPs could have an involvement in CCLR due to a detrimental effect on ligament structure and strength. This is the first published candidate gene study that has revealed significant genetic associations with canine CCLR. PMID:24684544

  5. REHABILITATION PROTOCOL AFTER ISOLATED POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    de Paula Leite Cury, Ricardo; Kiyomoto, Henry Dan; Rosal, Gustavo Fogolin; Bryk, Flávio Fernandes; de Oliveira, Victor Marques; de Camargo, Osmar Pedro Arbix

    2015-01-01

    To create a rehabilitation protocol following reconstruction of the posterior cruciate ligament (PCL), through a literature review. The literature review was conducted in the Medline and Embase databases, to search for data on biomechanical concepts and analyses relating to the posterior cruciate ligament of the knee. The search strategy was set up using the following rules: problem or injury in association with anatomical location terms; or surgical intervention procedure in association with rehabilitation terms. We began the process in this manner and subsequently introduced restrictions on certain terms to improve the search specificity. To design the protocol, a table was created for better data assessment, based on the time that elapsed between surgery and the start of physiotherapy. A rehabilitation protocol was created to improve weight-bearing control in the initial weeks after surgery, with the aid of a knee brace. Our aim was to achieve gains in total range of motion of the knee, which should be attained by the third month, thereby avoiding contractures resulting from the tissue healing process. Strengthening exercises and sensory-motor training were guided accordingly, thus avoiding overload on the graft and respecting the healing phases. The protocol proposed through this review was based on the current evidence relating to this subject. PMID:27047844

  6. Evaluation of pain after arthroscopically assisted anterior cruciate ligament reconstruction.

    PubMed

    Brown, D W; Curry, C M; Ruterbories, L M; Avery, F L; Anson, P S

    1997-01-01

    Pain after arthroscopically assisted anterior cruciate reconstruction was examined during the first 5 postoperative days to evaluate its intensity and duration. One hundred consecutive patients who underwent arthroscopically assisted anterior cruciate ligament reconstruction using a bone-patellar tendon-bone autograft were examined. During surgery, ketorolac (60 mg) was given intravenously and 0.25% bupivicaine (1 ml/kg total) was injected into the joint space and the graft donor site. After surgery, all patients received scheduled doses of oral acetaminophen (650 mg) and ketorolac (10 mg) four times a day, and they were allowed to take oral oxycodone (5 to 10 mg) every 2 hours as needed. Pain scores at rest and with activity reached a maximum on the 2nd postoperative morning. Oxycodone consumption also peaked on the 2nd postoperative day. Eighty-nine (89%) patients reported overall pain as mild or moderate, and 95 patients (95%) reported either excellent or good overall relief of pain. The 5-day cumulative mean of visual analog scale pain scores for attempting straight leg raises was significantly higher for patients unable to successfully perform that activity than for patients who were able to perform it. The association between elevated pain scores and diminished ability to perform straight leg raises suggests that pain may inhibit function and therefore early rehabilitation. PMID:9079170

  7. Signs in Speare's "The Sign of the Beaver."

    ERIC Educational Resources Information Center

    Moseley, Ann

    1995-01-01

    Describes the use of signs in Elizabeth George Speare's "The Sign of the Beaver," in which a settler youth and a young Indian learn to communicate by signs, and how the signs reveal much about each character's culture. Summarizes the plot elements of the book, including characters who are not as sympathetic to the Indian point of view. (PA)

  8. Synthesis and properties of a new quadruple perovskite: A-site ordered PbMn{sub 3}Mn{sub 4}O{sub 12}

    SciTech Connect

    Locherer, T.; Dinnebier, R.; Kremer, R.K.; Greenblatt, M.; Jansen, M.

    2012-06-15

    PbMn{sub 3}Mn{sub 4}O{sub 12} a quadruple perovskite was prepared by high pressure and high temperature synthesis. Powder X-ray diffraction (PXD) and differential scanning calorimetry reveal a structural phase transition at {approx}380 K. Rietveld refinement of the synchrotron room temperature data indicate rhombohedral symmetry (R-3) with a=6.43675(4) A and {alpha}=109.556(2) Degree-Sign . Similar 423 K PXD data refined in a body centered cubic cell (Im-3) with a=7.4283(9) A. The temperature variation of magnetization, shows a magnetic field dependent antiferromagnetic-like transition at 68 K, and dynamic fluctuations indicative of magnetic frustration. The semiconducting electrical behavior indicates a large decrease in the conductivity near 68 K. The temperature dependence of the real part of the dielectric constant, {epsilon}{sub real} increases dramatically at {approx}68 K, and shows relaxor-type ferroelectric behavior as a function of frequency. The intimate coupling of magnetic, electrical and dielectric properties at 68 K in PbMn{sub 3}Mn{sub 4}O{sub 12} suggests possible multiferroic behavior. - Graphical abstract: Resistance vs. temperature plot showing drastically increasing resistances at temperatures below 68 K (a). Formation of a frequency dependency of the dielectric constant between 68 K and ambient temperature (b). Sharp cusp in the magnetic susceptibility observed at 68 K which is suppressed with increasing magnetic field (c) indicates coupling of magnetic, electric and dielectric effects. Highlights: Black-Right-Pointing-Pointer PbMn{sub 3}Mn{sub 4}O{sub 12} a quadruple perovskite was prepared at high pressure. Black-Right-Pointing-Pointer A structural transition is seen at 380 K from space group R-3-to-Im-3. Black-Right-Pointing-Pointer An antiferromagnetic transition is observed at 68 K. Black-Right-Pointing-Pointer It is semiconducting with a large decrease in the conductivity near 68 K. Black-Right-Pointing-Pointer The temperature dependence

  9. An unusual epidemic of Staphylococcus-negative infections involving anterior cruciate ligament reconstruction with salvage of the graft and function.

    PubMed

    Viola, R; Marzano, N; Vianello, R

    2000-03-01

    We performed a retrospective study of 13 patients who had postoperative clinical and laboratory signs of infection after autogenous bone-patellar tendon-bone (BPTB) anterior cruciate ligament (ACL) reconstructions. From January 1991 to November 1996 we experienced only 2 infected knees in 1,300 reconstructions, but between December 1996 and February 1997 10 patients in 70 ACL reconstructions developed a postoperative suspected infection. We found the origin of contamination (coagulase-negative Staphylococcus) in the supposedly sterile inflow cannula. When we changed this device, we had only 1 infection in the next 400 reconstructions. The diagnosis in these cases was derived from clinical signs and laboratory results, but only 2 of 11 samples of aspirated synovial fluid tested positive for Staphylococcus. The mean interval between the surgery and the onset of signs of infection and the start of antibiotic therapy was 7.7 days. All the patients had antibiotic association at the highest level. Six knees underwent arthroscopic debridement when the clinical signs indicated resistence to antibiotics. The normal postoperative rehabilitation program was modified but was not discontinued. Although recovery time was longer, overall results were similar to uncomplicated reconstructions. On the basis of our experience, we believe that when there is a notable increase in infection rates, a thorough search for contamination is indicated. Our source of infection was material that was thought to be sterile. Ultimately, early diagnosis and treatment is of critical importance to obtain good results. Even suspicion of infective postoperative complication should be sufficient cause to search for responsible microorganisms and begin antibiotic therapy. Arthroscopic debridement should be proposed to patients with resistence to antibiotics. PMID:10705329

  10. Surgical Treatment of a Rare Isolated Bilateral Agenesis of Anterior and Posterior Cruciate Ligaments

    PubMed Central

    2014-01-01

    The isolated bilateral agenesis of both cruciate ligaments is a rare congenital disorder. A 17-year-old male came to our attention due to an alteration in gait pattern, pain, and tendency to walk on the forefoot with his knee flexed. The patient did not recall previous injuries. Upon physical examination anterior and posterior chronic instability were observed. Radiographic examination of both knees showed hypoplasia of the tibial eminence, a hypoplastic lateral femoral condyle, and a narrow intercondylar notch. MRI brought to light a bilateral agenesis of both posterior cruciate ligaments. Arthroscopic evaluation confirmed bilateral isolated agenesis of both cruciate ligaments. We recommended a rehabilitation program to prepare the patient for the arthroscopic construction of both cruciate ligaments. PMID:25197599

  11. LEG'S COMPARTMENT SYNDROME AFTER RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT: CASE REPORT

    PubMed Central

    Filho, Jorge Sayum; Ramos, Leonardo Adeo; Sayum, Jorge; de Carvalho, Rogério Teixeira; Ejnisman, Benno; Matsuda, Marcelo Mitsuro; Nicolini, Alexandre; Cohen, Moisés

    2015-01-01

    The authors report a case of a patient that was submitted to a surgery of reconstruction of anterior cruciate ligament and collateral medial ligament repair of the left knee that complicated to a compartment syndrome. PMID:27047834

  12. Suicide Warning Signs

    MedlinePlus

    ... health professional or by call- ing the National Suicide Prevention Lifeline at 1-800-273-TALK if you or someone you know exhibits any of the following signs: n Threatening to ... or writing about death, dying, or suicide when these actions are out of the ordinary ...

  13. Sign Language Web Pages

    ERIC Educational Resources Information Center

    Fels, Deborah I.; Richards, Jan; Hardman, Jim; Lee, Daniel G.

    2006-01-01

    The World Wide Web has changed the way people interact. It has also become an important equalizer of information access for many social sectors. However, for many people, including some sign language users, Web accessing can be difficult. For some, it not only presents another barrier to overcome but has left them without cultural equality. The…

  14. Signing in Science

    ERIC Educational Resources Information Center

    Ashby, Rachael

    2013-01-01

    This article describes British Sign Language (BSL) as a viable option for teaching science. BSL is used by a vast number of people in Britain but is seldom taught in schools or included informally alongside lessons. With its new addition of a large scientific glossary, invented to modernise the way science is taught to deaf children, BSL breaks…

  15. Derivative Sign Patterns

    ERIC Educational Resources Information Center

    Clark, Jeffrey

    2011-01-01

    Analysis of the patterns of signs of infinitely differentiable real functions shows that only four patterns are possible if the function is required to exhibit the pattern at all points in its domain and that domain is the set of all real numbers. On the other hand all patterns are possible if the domain is a bounded open interval.

  16. Sign-away Pressures

    ERIC Educational Resources Information Center

    Rosen, Catherine E.

    1976-01-01

    Why would mental health clients sign release-of-information forms unless they thought a refusal to do so would jeopardize their access to service? The author believes that the practice of not advising clients of their rights to privacy has ethical implications that can compromise the value of the treatment. (Author)

  17. Signs of Success.

    ERIC Educational Resources Information Center

    Styles-Lopez, Robin

    1998-01-01

    Explains how to make a well-designed signage package that is effective and enhances visitor first impressions of an institution. Examines questions to ask when planning traffic-pattern signage and the significance of the different hierarchy of signs; concludes with advice on signage design. (GR)

  18. Isokinetic and anterior cruciate ligament reconstruction with hamstrings or patella tendon graft: analysis of literature.

    PubMed

    Dauty, M; Tortellier, L; Rochcongar, P

    2005-09-01

    We report isokinetic results of anterior cruciate ligament reconstruction with patellar tendon or hamstring graft from the literature analysis. The literature was defined from two search "textwords": Isokinetic and Anterior cruciate ligament reconstruction, and from three databases: Medline, Pascal, and Herasmus. Two independent physicians (Physical Medicine and Rehabilitation) carried out an analysis according to the French National Accreditation and Health Evaluation Agency recommendations. Fifty-three studies were selected: 29 reported isokinetic results after anterior cruciate ligament reconstruction with patellar tendon graft, 15 reported isokinetic results after anterior cruciate ligament reconstruction with hamstring graft, and 9 studies compared the two surgical procedures. After discussing different bias and in reference to prospective randomised and comparative studies, the anterior cruciate ligament reconstruction with patellar tendon graft involves a knee extensors deficit during several months. The hamstring surgical procedure involves a less important knee extensor deficit (from 6 to 19 % against 8 to 21 %). Knee sprain and intra-articular surgery involve a long-lasting knee extensors deficit. Anterior cruciate ligament reconstruction with hamstrings graft involves a knee flexors deficit over several months. The patellar tendon surgical procedure involves a less important knee flexors deficit (from 1 to 15 % against 5 to 17 %). In reference to isokinetic parameters, no difference between the two surgical procedures (patellar tendon graft or hamstring graft) is shown after more than twenty-four post-surgical months. PMID:16195995

  19. Wrong Signs in Regression Coefficients

    NASA Technical Reports Server (NTRS)

    McGee, Holly

    1999-01-01

    When using parametric cost estimation, it is important to note the possibility of the regression coefficients having the wrong sign. A wrong sign is defined as a sign on the regression coefficient opposite to the researcher's intuition and experience. Some possible causes for the wrong sign discussed in this paper are a small range of x's, leverage points, missing variables, multicollinearity, and computational error. Additionally, techniques for determining the cause of the wrong sign are given.

  20. Manual Signing in Adults with Intellectual Disability: Influence of Sign Characteristics on Functional Sign Vocabulary

    ERIC Educational Resources Information Center

    Meuris, Kristien; Maes, Bea; De Meyer, Anne-Marie; Zink, Inge

    2014-01-01

    Purpose: The purpose of this study was to investigate the influence of sign characteristics in a key word signing (KWS) system on the functional use of those signs by adults with intellectual disability (ID). Method: All 507 signs from a Flemish KWS system were characterized in terms of phonological, iconic, and referential characteristics.…

  1. Democracy and environment as references for quadruple and quintuple helix innovation systems

    NASA Astrophysics Data System (ADS)

    Carayannis, Elias G.; Campbell, David F. J.; Orr, Barron J.

    2015-04-01

    The perspective of democracy and the ecological context define key references for knowledge production and innovation in innovation systems. Particularly under conditions of environmental change where enhancing the potential for adaptation is critical, this requires a closer look at ecological responsibility and sensitivity in the different innovation models and governance regimes. The "Quintuple Helix" innovation model is an approach that stresses the necessary socio-ecological transition of society and economy by adding an environment helix to an innovation system already made up of three (university-industry-government) or four (civil society relations) helices in a way that supports adaptation by incorporating global warming as both a challenge to and a driver of innovation. There is the proposition that knowledge production and innovation co-evolve with democracy (Carayannis and Campbell, 2014). In the Triple Helix model (Etzkowitz and Leydesdorff, 2000) the existence of a democracy does not appear to be necessary for knowledge production and innovation. However, the Quadruple Helix (Carayannis and Campbell, 2009, 2010 and 2014) is defined and represented by additional key attributes and components: "media-based and culture-based public", "civil society" and "arts, artistic research and arts-based innovation" (Bast, Carayannis and Campbell, 2015). Implications of this are that the fourth helix in the Quadruple Helix innovation systems brings in and represents the perspective of "dimension of democracy" or the "context of democracy" for knowledge in general and knowledge production and innovation in more particular. Within theories of democracy there is a competition between narrow and broader concepts of democracy (Campbell, 2013). This is particularly true when democracy is to be understood to transcend more substantially the narrow understanding of being primarily based on or being primarily rooted in government institutions (within a Triple Helix

  2. Vital signs monitoring system

    NASA Technical Reports Server (NTRS)

    Steffen, Dale A. (Inventor); Sturm, Ronald E. (Inventor); Rinard, George A. (Inventor)

    1981-01-01

    A system is disclosed for monitoring vital physiological signs. Each of the system components utilizes a single hybrid circuit with each component having high accuracy without the necessity of repeated calibration. The system also has low power requirements, provides a digital display, and is of sufficiently small size to be incorporated into a hand-carried case for portable use. Components of the system may also provide independent outputs making the component useful, of itself, for monitoring one or more vital signs. The overall system preferably includes an ECG amplifier and cardiotachometer signal conditioner unit, an impedance pneumograph and respiration rate signal conditioner unit, a heart/breath rate processor unit, a temperature monitoring unit, a selector switch, a clock unit, and an LCD driver unit and associated LCDs, with the system being capable of being expanded as needed or desired, such as, for example, by addition of a systolic/diastolic blood pressure unit.

  3. Planetary Vital Signs

    NASA Astrophysics Data System (ADS)

    Kennel, Charles; Briggs, Stephen; Victor, David

    2016-07-01

    The climate is beginning to behave in unusual ways. The global temperature reached unprecedented highs in 2015 and 2016, which led climatologists to predict an enormous El Nino that would cure California's record drought. It did not happen the way they expected. That tells us just how unreliable temperature has become as an indicator of important aspects of climate change. The world needs to go beyond global temperature to a set of planetary vital signs. Politicians should not over focus policy on one indicator. They need to look at the balance of evidence. A coalition of scientists and policy makers should start to develop vital signs at once, since they should be ready at the entry into force of the Paris Agreement in 2020. But vital signs are only the beginning. The world needs to learn how to use the vast knowledge we will be acquiring about climate change and its impacts. Is it not time to use all the tools at hand- observations from space and ground networks; demographic, economic and societal measures; big data statistical techniques; and numerical models-to inform politicians, managers, and the public of the evolving risks of climate change at global, regional, and local scales? Should we not think in advance of an always-on social and information network that provides decision-ready knowledge to those who hold the responsibility to act, wherever they are, at times of their choosing?

  4. BD -22 5866: A Low-Mass, Quadruple-lined Spectroscopic and Eclipsing Binary

    NASA Astrophysics Data System (ADS)

    Shkolnik, Evgenya; Liu, Michael C.; Reid, I. Neill; Hebb, Leslie; Cameron, Andrew C.; Torres, Carlos A.; Wilson, David M.

    2008-08-01

    We report our discovery of an extremely rare, low-mass, quadruple-lined spectroscopic binary BD -22 5866 (=NLTT 53279, integrated spectral type = M0 V), found during an ongoing search for the youngest M dwarfs in the solar neighborhood. From the cross-correlation function, we are able to measure relative flux levels, estimate the spectral types of the components, and set upper limits on the orbital periods and separations. The resulting system is hierarchical, composed of a K7 + K7 binary and an M1 + M2 binary with semimajor axes of aAsin iA <= 0.06 and aBsin iB <= 0.30 AU. A subsequent search of the SuperWASP photometric database revealed that the K7 + K7 binary is eclipsing with a period of 2.21 days and at an inclination angle of 85°. Within uncertainties of 5%, the masses and radii of both components appear to be equal (0.59 M⊙, 0.61 R⊙). These two tightly orbiting stars (a = 0.035 AU) are in synchronous rotation, causing the observed excess Ca II, Hα, X-ray, and UV emission. The fact that the system was unresolved with published adaptive optics imaging, limits the projected physical separation of the two binaries at the time of the observation to dABlesssim 4.1 AU at the photometric distance of 51 pc. The maximum observed radial velocity difference between the A and B binaries limits the orbit to aABsin iAB <= 6.1 AU. As this tight configuration is difficult to reproduce with current formation models of multiple systems, we speculate that an early dynamical process reduced the size of the system, such as the interaction of the two binaries with a circumquadruple disk. Intensive photometric, spectroscopic, and interferometric monitoring, as well as a parallax measurement of this rare quadruple system, is certainly warranted. Based on observations collected at the W. M. Keck Observatory and the Canada-France-Hawaii Telescope (CFHT). The Keck Observatory is operated as a scientific partnership between the California Institute of Technology, the University

  5. Modified sequential therapy vs quadruple therapy as initial therapy in patients with Helicobacter infection

    PubMed Central

    Liao, Xiao-Min; Nong, Gao-Hui; Chen, Mei-Zu; Huang, Xue-Ping; Cong, Yun-Yan; Huang, Yi-Ying; Wu, Bai-He; Wei, Jin-Qi

    2015-01-01

    AIM: To evaluate the efficacy and safety of modified sequential therapy and to compare modified sequential therapy with standard quadruple therapy for Helicobacter pylori (H. pylori) eradication. METHODS: In total, 200 consecutive patients who were diagnosed with H. pylori-infected chronic gastritis by electronic endoscopy and rapid urease testing from December 2012 to October 2013 were enrolled in this study. The patients had not previously received H. pylori eradication treatment, and were randomized into two groups. The patients in Group A (n = 101) were treated with ilaprazole + bismuth potassium citrate + amoxicillin and clavulanate potassium + levofloxacin, and the patients in Group B (n = 99) were administered a modified sequential therapy composed of ilaprazole at 5 mg bid and amoxicillin and clavulanate potassium at 914 mg for the first five days followed by ilaprazole at 5 mg bid, furazolidone at 100 mg bid and levofloxacin at 500 mg qid for the next five days. Four to six weeks after the end of treatment, a 14C-urea breath test was performed for all the subjects to confirm the eradication of H. pylori. The intention-to-treat and per-protocol eradication rates were determined. RESULTS: A total of 190 of the 200 patients completed the study. All 200 patients were included in the intention-to-treat analysis, whereas 190 patients were included in the per-protocol analysis. In the intention-to-treat analysis, the rates of H. pylori eradication in Groups A and B were 85.15% (86/101) and 81.82% (81/99), respectively. In the per-protocol analysis, the H. pylori eradication rates in Groups A and B were 88.66% (86/97) and 87.09% (81/93), respectively. No significant difference was observed (χ2 = 0.109, P = 0.741) in the eradication rate between Groups A and B. The rates of adverse effects observed in the groups were similar at 6.19% (6/97) for Group A and 7.53% (7/93) for Group B (P > 0.05). No mortality or major morbidities were observed in any of the patients

  6. [Increase in surgical treatment of anterior cruciate ligament injury].

    PubMed

    Meuffels, D E

    2009-01-01

    An anterior cruciate ligament (ACL) rupture is a very common musculoskeletal injury. The number of ACL reconstructions is increasing, both in the Netherlands and worldwide. Substantial progress has been made in surgical technique: from open to arthroscopic procedures. An ACL reconstruction will not diminish the chance of osteoarthritis, and the biomechanical properties of the knee will never be the same as before the trauma. An ACL reconstruction does, however, reduce the chance of instability, or 'giving way', which is the most important indication for surgical intervention. There are insufficient long-term results described in the literature to indicate either surgery or conservative measures as the treatment of choice. Treatment should be individually determined, taking into consideration factors such as: pattern of symptoms, degree of instability, desire to practise sport, age and willingness to commit to a 9-month rehabilitation programme. PMID:21401972

  7. Simultaneous bilateral ganglion cysts of the anterior cruciate ligaments

    PubMed Central

    Demircay, Emre; Ofluoglu, Demet; Ozel, Omer; Oztop, Pinar

    2015-01-01

    Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL. PMID:25917477

  8. Anterior cruciate ligament assessment using arthrometry and stress imaging.

    PubMed

    Rohman, Eric M; Macalena, Jeffrey A

    2016-06-01

    Arthrometry and stress imaging are useful clinical tools for the objective assessment of anterior cruciate ligament (ACL) integrity. They are most frequently used for the diagnosis of a complete ACL tear when other workup is equivocal, in conjunction with history and clinical exam findings. Other applications include the diagnosis of partial ACL tears, injury prognosis, and post-operative monitoring. However, further studies are needed to validate these uses. Many different devices and techniques exist for objective examination, which have been compared in recent literature. Reliability and validity measures of these methods vary, and often depend upon examiner familiarity and skill. The KT series of devices is the current gold standard for arthrometry, although the newer robotic GNRB device shows promising early results. Newer methods of data interpretation have been developed for stress imaging, and portable technology may impact this field further. PMID:26984335

  9. Transient Superficial Peroneal Nerve Palsy After Anterior Cruciate Ligament Reconstruction

    PubMed Central

    2016-01-01

    A 19-year-old male subject was diagnosed with medial meniscal, lateral meniscal and anterior cruciate ligament (ACL) tear. The symptoms did not subside after 4 months of physical therapy, and he underwent arthroscopic partial medial and lateral meniscectomy and ACL reconstruction. Immediately after the patient woke up from general anesthesia, he started experience loss of sensation in the area of superficial peroneal nerve with inverted dorsiflexion of foot and ankle. Instantly, the bandage and knee brace was removed and a diagnosis of compartment syndrome was ruled out. After eight hours, post-operatively, the patient started receiving physiotherapy. He complained of numbness and tingling in the same area. After 24 h, post-operatively, the patient started to regain dorsiflexion and eversion gradually. Two days after the surgery, the patient exhibited complete recovery of neurological status. PMID:27478579

  10. Popliteal pseudoaneurysm after arthroscopic posterior cruciate ligament reconstruction.

    PubMed

    van Dorp, Karin B; Breugem, Stefan J M; Driessen, Marcel J M

    2014-09-01

    This report presents the case of a 30-year-old motocross (BMX) cyclist with a third-degree posterior cruciate ligament rupture. The technique used for reconstruction was the transtibial single-bundle autologous hamstring technique. Unfortunately, the procedure was complicated by a popliteal pseudoaneurysm, which was located in line with the tibial canal. The pseudoaneurysm was treated with an end-to-end anastomosis and the patient recovered without further complaints. In this case, the popliteal artery was damaged most probably by the edge of the reamer or the guide wire during removal. Vascular complications can be limb- and life-threatening. This case report aims to increase the awareness of this serious complication with a review of the literature. PMID:25229050

  11. Simultaneous bilateral ganglion cysts of the anterior cruciate ligaments.

    PubMed

    Demircay, Emre; Ofluoglu, Demet; Ozel, Omer; Oztop, Pinar

    2015-04-01

    Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL. PMID:25917477

  12. Radiological evidence for the triple bundle anterior cruciate ligament.

    PubMed

    MacKay, James W; Whitehead, Harry; Toms, Andoni P

    2014-10-01

    The anterior cruciate ligament (ACL) has traditionally been described as having two bundles--one anteromedial and one posterolateral. This has been challenged by studies proposing the existence of a third, intermediate, bundle with distinct functional significance, an arrangement that has been described in a number of domesticated animal species. No radiological evidence for the triple bundle ACL has previously been described. A prevalence study was carried out on 73 consecutive human knee magnetic resonance (MR) studies to determine the number of visible bundles, excluding individuals with a history of ACL injury or mucoid degeneration. A triple bundle ACL was demonstrated in 15 out of 73 human knees (20.5%, 95% confidence interval 12.9-31.2%). This is the first radiological description of the human triple bundle ACL. There was MR imaging evidence of a triple bundle ACL in approximately one fifth of human knees in this study. PMID:24890455

  13. Anterior cruciate ligament reconstruction graft harvesting: pitfalls and tips.

    PubMed

    McGuire, David A; Hendricks, Stephen D

    2007-12-01

    Surgical treatment for anterior cruciate ligament deficiency has relied predominantly on reconstruction with autografts. Grafts taken from patients' own central third of their patellar tendon, bone-patellar tendon bone, or one or more of the hamstring tendons, semitendinosus, and gracilis, constitute the majority of grafts used for these purposes. Although there is no single graft option that clearly outperforms another, an abundance of articles replete with complications associated with harvest and use are available from peer-reviewed journals. It is these complications and their prevention that will be addressed in the following chapter. The idea in mind is that the reader might adopt these techniques to improve their patient outcomes by minimizing, or eliminating, the ongoing problems that such complications produce. PMID:18004217

  14. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review.

    PubMed

    Vaishya, Raju; Agarwal, Amit Kumar; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  15. Current Trends in Anterior Cruciate Ligament Reconstruction: A Review

    PubMed Central

    Vaishya, Raju; Ingole, Sachin; Vijay, Vipul

    2015-01-01

    Anterior cruciate ligament reconstruction (ACLR) is an accepted and established surgical technique for anterior cruciate ligament (ACL) injuries and is now being practiced across the globe in increasing numbers. Although most patients get good to excellent results in the short-term after ACLR, its consequences in the long-term in prevention or acceleration of knee osteoarthritis (OA) are not yet well-defined. Still, there are many debatable issues related to ACLR, such as the appropriate timing of surgery, graft selection, fixation methods of the graft, operative techniques, rehabilitation after surgery, and healing augmentation techniques. Most surgeons prefer not to wait long after an ACL injury to do an ACLR, as delayed reconstruction is associated with secondary damages to the intra- and periarticular structures of the knee. Autografts are the preferred choice of graft in primary ACLR, and hamstring tendons are the most popular amongst surgeons. Single bundle ACLR is being practiced by the majority, but double bundle ACLR is getting popular due to its theoretical advantage of providing more anatomical reconstruction. A preferred construct is the interference fixation (Bio-screw) at the tibial site and the suspensory method of fixation at the femoral site. In a single bundle hamstring graft, a transportal approach for creating a femoral tunnel has recently become more popular than the trans-tibial technique. Various healing augmentation techniques, including the platelet rich plasma (PRP), have been tried after ACLR, but there is still no conclusive proof of their efficacy. Accelerated rehabilitation is seemingly more accepted immediately after ACLR. PMID:26697280

  16. Intermediate outcome of a cruciate-retaining tibia.

    PubMed

    Mesko, J Wesley; Heath, Sara; Shen, Jianhua

    2013-07-01

    The use of an all-polyethylene tibia in total knee arthroplasty is being revisited as a means to decrease backside polyethylene wear and lessen cost. The Depuy Sigma all-polyethylene tibia (Depuy Orthopedics, Warsaw, Indiana) has been reported with good outcomes at a greater than 10-year interval, whereas the Biomet AGC I beam design (Biomet, Warsaw, Indiana) has had a high failure rate at an early interval. This is a retrospective review of another design. One hundred seventy patients (190 cruciate-retaining total knee replacements) with a Scorpio (Stryker, Mahwah, New Jersey) all-polyethylene implant and tibia were identified in the authors' registry. This implant was chosen for all octogenarians deemed fit for a cruciate-retaining knee and a few septuagenarians who were deemed likely to remain inactive postoperatively for reasons other than knee arthritis. Mean follow-up was 38 months (range, 24-83 months). Mean patient age was 83.1 years (range, 72.7-93.8 years). Twenty-seven patients (29 knees) were lost to follow-up. Nineteen patients (24 knees) died before 24-month follow-up; all implants were in place, and no deaths were associated with the index procedure. Fifty-one patients (55 knees) were followed by telephone interview only and 75 patients (81 knees) by an office visit with radiograph analysis. One tibia revision was performed 2 months postoperatively for an implant placed in extension and varus. No infections, component wear, radiolucent lines, or impending revisions of the remaining cohort occurred. Lower Extremity Activity Scale scores ranged from 2 to 10 (mean score, 6.8), which demonstrated success even in patients with an active lifestyle. This previously unreported design is a promising all-polyethylene tibia alternative for total knee arthroplasty in older patients. PMID:23823045

  17. Anterior cruciate ligament injury and reconstruction among university students.

    PubMed

    Freedman, K B; Glasgow, M T; Glasgow, S G; Bernstein, J

    1998-11-01

    The consequences of athletic injuries extend beyond the musculoskeletal system. Depression, anger, and tension have been observed in athletes with athletic injuries. It was hypothesized that among student athletes, the psychologic impact of injury may be seen as a drop in academic performance. Thirty-eight students who had an anterior cruciate ligament injury and subsequent reconstruction were evaluated retrospectively by academic transcript and questionnaire to measure their academic performance before their injury, in the semester of their injury, and in the semester after their surgery. The patients were compared with randomly selected undergraduate control subjects. To evaluate any effect of the timing of the surgery on academic performance, the patients were separated into two groups, according to the timing of their reconstruction: those who had surgery during the academic semester, and those who elected to wait for a school break. There was a significant drop in grade point average of 0.3 grade points during the semester of injury among all injured students. Compared with those who had surgery during a break, the students who had surgery during the semester received more frequently the grade of failure (6% versus 0%) or incomplete (33% versus 9%). These students also missed more school days (10.5 days versus 1.5 days) and examinations (2.2 examinations versus 0.1 examinations). Only 47% of students who had surgery during the semester were satisfied with their decision for surgical timing, compared with 96% satisfied with the timing during an academic break. Acute anterior cruciate ligament rupture, and surgical reconstruction during an academic semester, have a significant academic effect in university students. PMID:9917686

  18. Broad-search algorithms for finding triple-and quadruple-satellite-aided captures at Jupiter from 2020 to 2080

    NASA Astrophysics Data System (ADS)

    Lynam, Alfred E.

    2015-04-01

    Multiple-satellite-aided capture is a -efficient technique for capturing a spacecraft into orbit at Jupiter. However, finding the times when the Galilean moons of Jupiter align such that three or four of them can be encountered in a single pass is difficult using standard astrodynamics algorithms such as Lambert's problem. In this paper, we present simple but powerful techniques that simplify the dynamics and geometry of the Galilean satellites so that many of these triple- and quadruple-satellite-aided capture sequences can be found quickly over an extended 60-year time period from 2020 to 2080. The techniques find many low-fidelity trajectories that could be used as initial guesses for future high-fidelity optimization. Results indicate the existence of approximately 3,100 unique triple-satellite-aided capture trajectories and 6 unique quadruple-satellite-aided capture trajectories during the 60-year time period. The entire search takes less than one minute of computational time.

  19. Wrestling model of the repertoire of activity propagation modes in quadruple neural networks.

    PubMed

    Shteingart, Hanan; Raichman, Nadav; Baruchi, Itay; Ben-Jacob, Eshel

    2010-01-01

    The spontaneous activity of engineered quadruple cultured neural networks (of four-coupled sub-networks) exhibits a repertoire of different types of mutual synchronization events. Each event corresponds to a specific activity propagation mode (APM) defined by the order of activity propagation between the sub-networks. We statistically characterized the frequency of spontaneous appearance of the different types of APMs. The relative frequencies of the APMs were then examined for their power-law properties. We found that the frequencies of appearance of the leading (most frequent) APMs have close to constant algebraic ratio reminiscent of Zipf's scaling of words. We show that the observations are consistent with a simplified "wrestling" model. This model represents an extension of the "boxing arena" model which was previously proposed to describe the ratio between the two activity modes in two coupled sub-networks. The additional new element in the "wrestling" model presented here is that the firing within each network is modeled by a time interval generator with similar intra-network Lévy distribution. We modeled the different burst-initiation zones' interaction by competition between the stochastic generators with Gaussian inter-network variability. Estimation of the model parameters revealed similarity across different cultures while the inter-burst-interval of the cultures was similar across different APMs as numerical simulation of the model predicts. PMID:20890451

  20. Lable-free quadruple signal amplification strategy for sensitive electrochemical p53 gene biosensing.

    PubMed

    Wang, Zonghua; Xia, Jianfei; Song, Daimin; Zhang, Feifei; Yang, Min; Gui, Rijun; Xia, Lin; Bi, Sai; Xia, Yanzhi

    2016-03-15

    A versatile label-free quadruple signal amplification biosensing platform for p53 gene (target DNA) detection was proposed. The chitosan-graphene (CS-GR) modified electrode with excellent electron transfer ability could provide a large specific surface for high levels of AuNPs-DNA attachment. The large amount of AuNPs could immobilize more capture probes and enhance the electrochemical signal with the excellent electrocatalytic activity. Furthermore, with the assist of N.BstNB I (the nicking endonuclease), target DNA could be reused and more G-quadruplex-hemin DNAzyme could be formed, allowing significant signal amplification in the presence of H2O2. Such strategy can enhance the oxidation-reduction reaction of adsorbed methylene blue (MB) and efficiently improve the sensitivity of the proposed biosensor. The morphologies of materials and the stepwise biosensor were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM) and cyclic voltammetry (CV). Differential pulse voltammetry (DPV) signals of MB provided quantitative measures of the concentrations of target DNA, with a linear calibration range of 1.0 × 10(-15)-1.0 × 10(-9)M and a detection limit of 3.0 × 10(-16)M. Moreover, the resulting biosensor also exhibited good specificity, acceptable reproducibility and stability, indicating that the present strategy was promising for broad potential application in clinic assay. PMID:26406456

  1. The Quadruple Process model approach to examining the neural underpinnings of prejudice.

    PubMed

    Beer, Jennifer S; Stallen, Mirre; Lombardo, Michael V; Gonsalkorale, Karen; Cunningham, William A; Sherman, Jeffrey W

    2008-12-01

    In order to investigate the systems underlying the automatic and controlled processes that support social attitudes, we conducted an fMRI study that combined an implicit measure of race attitudes with the Quadruple Process model (Quad model). A number of previous neural investigations have adopted the Implicit Association Test (IAT) to examine the automatic processes that contribute to social attitudes. Application of the Quad model builds on this previous research by permitting measures of distinct automatic and controlled processes that contribute to performance on the IAT. The present research found that prejudiced attitudes of ingroup favoritism were associated with amygdala, medial and right lateral orbitofrontal cortex. In contrast, prejudiced attitudes of outgroup negativity were associated with caudate and left lateral orbitofrontal cortex. Frontal regions found in previous neural research on the IAT, such as anterior cingulate, dorsolateral prefrontal cortex and operculum were associated with detecting appropriate responses in situations in which they conflict with automatic associations. Insula activity was associated with attitudes towards ingroup and outgroup members, as well as detecting appropriate behavior. PMID:18809502

  2. VZ Librae: A truly unsolved quadruple system containing double close binaries

    NASA Astrophysics Data System (ADS)

    Qian, S.-B.; Liao, W.-P.; Liu, L.; Yuan, J.-Z.; He, J.-J.; Zhu, L.-Y.; Dai, Z.-B.; Zhang, J.

    2008-02-01

    New orbital period and period variation of the W UMa-type eclipsing binary, VZ Librae, are presented. It is discovered that the orbital period of VZ Librae shows a periodic change with an amplitude of 0.0200 d and a period of 17.1 year. The cyclic period change can be explained as the light travel-time orbit of a tertiary component in the system. This is consistent with the spectroscopic results by Lu et al. [Lu, W.-X., Rucinski, S.M., Ogloza, W., 2001. AJ 122, 402] who found a faint spectroscopic companion in the system (VZ Librae B) that may be a close binary. Based on the light travel-time analysis, it is shown that the mass of the tertiary component is no less than 1.07 M⊙, which is much larger than that ( M3 ˜ 0.67 M⊙) estimated by D'Angelo et al. [D'Angelo, C., van Kerkwijk, M.H., Rucinski, S.M., 2006. AJ 132, 650]. This finding, in combination with its low luminosity, indicates that the spectroscopic companion is a close binary star suggesting that VZ Librae is an unsolved quadruple system containing double close binary stars in a separation less than 7.2 AU. As in the case of V899 Herculis, it is a good astrophysical laboratory to study the formation and evolution of overcontact binaries and multiple systems.

  3. Three unsuccessful treatments of Helicobacter pylori infection by a highly virulent strain with quadruple antibiotic resistance.

    PubMed

    Boyanova, Lyudmila; Evstatiev, Ivailo; Yordanov, Daniel; Markovska, Rumyana; Mitov, Ivan

    2016-07-01

    We report a case of an adult patient undergoing three unsuccessful Helicobacter pylori treatments, including proton pump inhibitor (PPI), bismuth subcitrate, metronidazole and tetracycline in 2012, PPI, amoxicillin and clarithromycin in 2013, and PPI, amoxicillin and rifampin in 2014. Following the first treatment, the isolate was metronidazole and ciprofloxacin/levofloxacin resistant. After the second treatment, the isolate was resistant to metronidazole, ciprofloxacin/levofloxacin and rifampin, developing secondary clarithromycin resistance by A2143G mutation and was susceptible only to tetracycline. After the third treatment, the patient still remained H. pylori positive. Patient's strain was highly virulent (cagA (+) , cagE (+) and vacA s1a/m1/i1). The evolution of the patient's disease was from gastroesophageal reflux disease in 2012 to two duodenal ulcers in 2015. Briefly, the infecting strain showed quadruple antibiotic resistance and a transient amoxicillin resistance. Triple clarithromycin-based treatment induced secondary clarithromycin resistance by A2143G mutation, while rifampin resistance caused the third treatment failure. Several options for the next treatment regimens are discussed. PMID:26634607

  4. Preventing cerebral oedema in acute liver failure: the case for quadruple-H therapy.

    PubMed

    Warrillow, S J; Bellomo, R

    2014-01-01

    Severe cerebral oedema is a life-threatening complication of acute liver failure. Hyperammonaemia and cerebral hyperaemia are major contributing factors. A multimodal approach, which incorporates hyperventilation, haemodiafiltration, hypernatraemia and hypothermia (quadruple-H therapy), may prevent or attenuate severe cerebral oedema. This approach is readily administered by critical care clinicians and is likely to be more effective than the use of single therapies. Targeting of PaCO2 in the mild hyperventilation range, as seen in acute liver failure patients before intubation, aims to minimise hyperaemic cerebral oedema. Haemodiafiltration aims to achieve the rapid control of elevated blood ammonia concentrations by its removal and to reduce production via the lowering of core temperature. The administration of concentrated saline increases serum tonicity and further reduces cerebral swelling. In addition, the pathologically increased cerebral blood-flow is further attenuated by therapeutic hypothermia. The combination of all four treatments in a multimodal approach may be a safe and effective means of attenuating or treating the cerebral oedema of acute liver failure and preventing death from neurological complications. PMID:24471667

  5. Forcing and feedback in the MPI-ESM-LR coupled model under abruptly quadrupled CO2

    NASA Astrophysics Data System (ADS)

    Block, K.; Mauritsen, T.

    2013-12-01

    Radiative feedback mechanisms associated with temperature, water vapor, cloud, and surface albedo change determine climate sensitivity to radiative forcing. Here we use the linearized radiative kernel-technique in combination with a Gregory analysis to determine the strength and structure of feedbacks, as well as direct and adjusted CO2 forcings in the coupled Max Planck Institute Earth System Model at base resolution (MPI-ESM-LR). We show that the combined Kernel-Gregory approach yields an elegant separation of surface temperature-dependent feedbacks from contributions to radiative forcing by fast adjustments. MPI-ESM-LR exhibits a relatively large cloud adjustment of nearly 2 W m-2 in direct response to quadrupled CO2, with positive cloud adjustment evident throughout the tropics, subtropics and over most landmasses whereas midlatitude storm tracks contribute negatively. The model features a nonlinear regression of radiation imbalance to global mean surface temperature change, resulting in a significantly increasing effective climate sensitivity after about 20 years which is approximately at temperatures 4-5 K above preindustrial. This feature is not uncommon among climate models and is relevant for future climate projections. We analyze the contribution of the individual feedback processes to this behavior and discuss possible origins such as differential ocean warming patterns associated with deep-ocean heat uptake or state dependencies of the feedback processes.

  6. Inverse Charge Transfer in the Quadruple Perovskite CaCu3Fe4O12.

    PubMed

    Yamada, Ikuya; Murakami, Makoto; Hayashi, Naoaki; Mori, Shigeo

    2016-02-15

    Structural and spectroscopic analyses revealed that the quadruple perovskite CaCu3Fe4O12 undergoes an "inverse" electron charge transfer in which valence electrons move from B-site Fe to A'-site Cu ions (∼3Cu(∼2.4+) + 4Fe(∼3.65+) → ∼3Cu(∼2.2+) + 4Fe(∼3.8+)) simultaneously with a charge disproportionation transition (4Fe(∼3.8+) → ∼2.4Fe(3+) + ∼1.6Fe(5+)), on cooling below 210 K. The direction of the charge transfer for CaCu3Fe4O12 is opposite to those reported for other perovskite oxides such as BiNiO3 and ACu3Fe4O12 (A = Sr(2+) or the large trivalent rare-earth metal ions), in which the electrons move from A/A'-site to B-site ions. This finding sheds a light on a new aspect in intermetallic phenomena for complex transition metal compounds. PMID:26815133

  7. Triple/quadruple patterning layout decomposition via novel linear programming and iterative rounding

    NASA Astrophysics Data System (ADS)

    Lin, Yibo; Xu, Xiaoqing; Yu, Bei; Baldick, Ross; Pan, David Z.

    2016-03-01

    As feature size of the semiconductor technology scales down to 10nm and beyond, multiple patterning lithography (MPL) has become one of the most practical candidates for lithography, along with other emerging technologies such as extreme ultraviolet lithography (EUVL), e-beam lithography (EBL) and directed self assembly (DSA). Due to the delay of EUVL and EBL, triple and even quadruple patterning are considered to be used for lower metal and contact layers with tight pitches. In the process of MPL, layout decomposition is the key design stage, where a layout is split into various parts and each part is manufactured through a separate mask. For metal layers, stitching may be allowed to resolve conflicts, while it is forbidden for contact and via layers. In this paper, we focus on the application of layout decomposition where stitching is not allowed such as for contact and via layers. We propose a linear programming and iterative rounding (LPIR) solving technique to reduce the number of non-integers in the LP relaxation problem. Experimental results show that the proposed algorithms can provide high quality decomposition solutions efficiently while introducing as few conflicts as possible.

  8. Infrared/ultraviolet quadruple resonance spectroscopy to investigate structures of electronically excited states

    SciTech Connect

    Weiler, M.; Bartl, K.; Gerhards, M.

    2012-03-21

    Molecular beam investigations in combination with IR/UV spectroscopy offer the possibility to obtain structural information on isolated molecules and clusters. One of the demanding tasks is the discrimination of different isomers, e.g., by the use of isomer specific UV excitations. If this discrimination fails due to overlaying UV spectra of different isomers, IR/IR methods offer another possibility. Here, we present a new IR/UV/IR/UV quadruple resonance technique to distinguish between different isomers especially in the electronically excited state. Due to the IR spectra, structural changes and photochemical pathways in excited states can be assigned and identified. The method is applied to the dihydrated cluster of 3-hydroxyflavone which has been investigated as photochemically relevant system and proton wire model in the S{sub 1} state. By applying the new IR/UV/IR/UV technique, we are able to show experimentally that both in the electronic ground (S{sub 0}) and the electronically excited state (S{sub 1}) two isomers have to be assigned.

  9. Optimal Design of a Center Support Quadruple Mass Gyroscope (CSQMG) †

    PubMed Central

    Zhang, Tian; Zhou, Bin; Yin, Peng; Chen, Zhiyong; Zhang, Rong

    2016-01-01

    This paper reports a more complete description of the design process of the Center Support Quadruple Mass Gyroscope (CSQMG), a gyro expected to provide breakthrough performance for flat structures. The operation of the CSQMG is based on four lumped masses in a circumferential symmetric distribution, oscillating in anti-phase motion, and providing differential signal extraction. With its 4-fold symmetrical axes pattern, the CSQMG achieves a similar operation mode to Hemispherical Resonant Gyroscopes (HRGs). Compared to the conventional flat design, four Y-shaped coupling beams are used in this new pattern in order to adjust mode distribution and enhance the synchronization mechanism of operation modes. For the purpose of obtaining the optimal design of the CSQMG, a kind of applicative optimization flow is developed with a comprehensive derivation of the operation mode coordination, the pseudo mode inhibition, and the lumped mass twisting motion elimination. The experimental characterization of the CSQMG was performed at room temperature, and the center operation frequency is 6.8 kHz after tuning. Experiments show an Allan variance stability 0.12°/h (@100 s) and a white noise level about 0.72°/h/√Hz, which means that the CSQMG possesses great potential to achieve navigation grade performance. PMID:27136557

  10. Integral-field spectrophotometry of the quadruple QSO HE 0435-1223: Evidence for microlensing

    NASA Astrophysics Data System (ADS)

    Wisotzki, L.; Becker, T.; Christensen, L.; Helms, A.; Jahnke, K.; Kelz, A.; Roth, M. M.; Sanchez, S. F.

    2003-09-01

    We present the first spatially resolved spectroscopic observations of the recently discovered quadruple QSO and gravitational lens HE 0435-1223. Using the Potsdam Multi-Aperture Spectrophotometer (PMAS), we show that all four QSO components have very similar but not identical spectra. In particular, the spectral slopes of components A, B, and D are indistinguishable, implying that extinction due to dust plays no major role in the lensing galaxy. While also the emission line profiles are identical within the error bars, as expected from lensing, the equivalent widths show significant differences between components. Most likely, microlensing is responsible for this phenomenon. This is also consistent with the fact that component D, which shows the highest relative continuum level, has brightened by 0.07 mag since Dec. 2001. We find that the emission line flux ratios between the components are in better agreement with simple lens models than broad band or continuum measurements, but that the discrepancies between model and data are still unacceptably large. Finally, we present a detection of the lensing galaxy, although this is close to the limits of the data. Comparing with a model galaxy spectrum, we obtain a redshift estimate of zlens=0.44+/- 0.02.

  11. Temperature and baric dependence of nuclear quadruple resonance spectra in indium and gallium monoselenides

    NASA Astrophysics Data System (ADS)

    Khandozhko, Victor; Raranskii, Nikolai; Balazjuk, Vitaly; Samila, Andriy; Kovalyuk, Zahar

    2013-12-01

    Pulsed radiospectroscopy method has been used to study nuclear quadruple resonance (NQR) spectra of 69Ga and 115In isotopes in the layered semiconductors GaSe and InSe. It has been found that in GaSe and InSe there is a considerable temperature dependence of NQR frequency which in the temperature range of 250 to 390 K is practically linear with conversion slope 1.54 kHz/degree for 69Ga and 2.35 kHz/degree for 115In. In the same crystals the effect of uniaxial pressure on NQR spectra applied along the optical axis с up to the values of 500 kg/сm2 has been studied. A strong attenuation of NQR spectra intensity with increase in pressure on layered crystal package has been established. The unvaried multiplicity of resonance spectra indicates the absence of structural transformations in these layered crystals over the investigated range of temperatures and pressures.

  12. A quadruple cascade protocol for the one-pot synthesis of fully-substituted hexahydroisoindolinones from simple substrates.

    PubMed

    Zhang, Hong-Bo; Luo, Yong-Chun; Hu, Xiu-Qin; Liang, Yong-Min; Xu, Peng-Fei

    2016-01-01

    A new and efficient synthetic method to obtain fully-substituted hexahydroisoindolinones was developed by using bifunctional tertiary amine-thioureas as powerful catalysts. As far as we know, there is no efficient synthetic method developed toward fully-substituted hexahydroisoindolinones. The products were obtained in good yield and diastereoselectivity. The one-pot cascade quadruple protocol features readily available starting materials, simple manipulation, mild conditions and good atom economy. PMID:26977184

  13. A quadruple cascade protocol for the one-pot synthesis of fully-substituted hexahydroisoindolinones from simple substrates

    PubMed Central

    Zhang, Hong-Bo; Luo, Yong-Chun; Hu, Xiu-Qin; Liang, Yong-Min

    2016-01-01

    Summary A new and efficient synthetic method to obtain fully-substituted hexahydroisoindolinones was developed by using bifunctional tertiary amine-thioureas as powerful catalysts. As far as we know, there is no efficient synthetic method developed toward fully-substituted hexahydroisoindolinones. The products were obtained in good yield and diastereoselectivity. The one-pot cascade quadruple protocol features readily available starting materials, simple manipulation, mild conditions and good atom economy. PMID:26977184

  14. Assessment of the accuracy of coupled cluster perturbation theory for open-shell systems. II. Quadruples expansions

    NASA Astrophysics Data System (ADS)

    Eriksen, Janus J.; Matthews, Devin A.; Jørgensen, Poul; Gauss, Jürgen

    2016-05-01

    We extend our assessment of the potential of perturbative coupled cluster (CC) expansions for a test set of open-shell atoms and organic radicals to the description of quadruple excitations. Namely, the second- through sixth-order models of the recently proposed CCSDT(Q-n) quadruples series [J. J. Eriksen et al., J. Chem. Phys. 140, 064108 (2014)] are compared to the prominent CCSDT(Q) and ΛCCSDT(Q) models. From a comparison of the models in terms of their recovery of total CC singles, doubles, triples, and quadruples (CCSDTQ) energies, we find that the performance of the CCSDT(Q-n) models is independent of the reference used (unrestricted or restricted (open-shell) Hartree-Fock), in contrast to the CCSDT(Q) and ΛCCSDT(Q) models, for which the accuracy is strongly dependent on the spin of the molecular ground state. By further comparing the ability of the models to recover relative CCSDTQ total atomization energies, the discrepancy between them is found to be even more pronounced, stressing how a balanced description of both closed- and open-shell species—as found in the CCSDT(Q-n) models—is indeed of paramount importance if any perturbative CC model is to be of chemical relevance for high-accuracy applications. In particular, the third-order CCSDT(Q-3) model is found to offer an encouraging alternative to the existing choices of quadruples models used in modern computational thermochemistry, since the model is still only of moderate cost, albeit markedly more costly than, e.g., the CCSDT(Q) and ΛCCSDT(Q) models.

  15. Assessment of the accuracy of coupled cluster perturbation theory for open-shell systems. II. Quadruples expansions.

    PubMed

    Eriksen, Janus J; Matthews, Devin A; Jørgensen, Poul; Gauss, Jürgen

    2016-05-21

    We extend our assessment of the potential of perturbative coupled cluster (CC) expansions for a test set of open-shell atoms and organic radicals to the description of quadruple excitations. Namely, the second- through sixth-order models of the recently proposed CCSDT(Q-n) quadruples series [J. J. Eriksen et al., J. Chem. Phys. 140, 064108 (2014)] are compared to the prominent CCSDT(Q) and ΛCCSDT(Q) models. From a comparison of the models in terms of their recovery of total CC singles, doubles, triples, and quadruples (CCSDTQ) energies, we find that the performance of the CCSDT(Q-n) models is independent of the reference used (unrestricted or restricted (open-shell) Hartree-Fock), in contrast to the CCSDT(Q) and ΛCCSDT(Q) models, for which the accuracy is strongly dependent on the spin of the molecular ground state. By further comparing the ability of the models to recover relative CCSDTQ total atomization energies, the discrepancy between them is found to be even more pronounced, stressing how a balanced description of both closed- and open-shell species-as found in the CCSDT(Q-n) models-is indeed of paramount importance if any perturbative CC model is to be of chemical relevance for high-accuracy applications. In particular, the third-order CCSDT(Q-3) model is found to offer an encouraging alternative to the existing choices of quadruples models used in modern computational thermochemistry, since the model is still only of moderate cost, albeit markedly more costly than, e.g., the CCSDT(Q) and ΛCCSDT(Q) models. PMID:27208932

  16. Measurement and analysis of quadruple ({alpha}{gamma}{gamma}) angular correlations for high spin states of {sup 24}Mg.

    SciTech Connect

    Wiedenhover, I.; Wuosmaa, A. H.; Lister, C. J.; Carpenter, M. P.; Janssens, R. V. F.; Amro, H.; Caggiano, J.; Heinz, A.; Kondev, F. G.; Lauritsen, T.; Siem, S.; Sonzogni, A.; Bhattacharyya, P.; Devlin, M.; Sarantites, D. G.; Sobotka, L. G.

    2000-10-30

    The high-lying, {alpha}-decaying states in {sup 24}Mg have been studied by measuring the complete decay path of {alpha} and {gamma} emissions using five segmented Silicon detectors in conjunction with GAMMASPHERE. The authors analyzed the ({alpha}{gamma}) triple angular correlations and, for the first time, ({alpha}{gamma}{gamma}) quadruple correlations. The data analysis is based on a new Fourier transformation technique. The power of the technique is demonstrated.

  17. Deep-UV generation by frequency quadrupling of a high-power GaAlAs semiconductor laser.

    PubMed

    Goldberg, L; Kliner, D A

    1995-05-15

    Tunable UV radiation near 215 nm was produced by frequency quadrupling the 860-nm emission of a mode-locked external-cavity compound semiconductor laser containing a tapered GaAlAs amplifier. A KNbO(3) crystal generated the 430-nm second harmonic, which was doubled by a beta-BaB(2)O(4) crystal, producing tunable UV radiation with as much as 15 microW of average power. PMID:19859453

  18. Deep-UV generation by frequency quadrupling of a high-power GaAlAs semiconductor laser

    SciTech Connect

    Goldberg, L.; Kliner, D.A.V.

    1995-05-15

    Tunable UV radiation near 215 nm was produced by frequency quadrupling the 860-nm emission of a mode-locked external-cavity compound semiconductor laser containing a tapered GaAlAs amplifier. A KNbO{sub 3} crystal generated the 430-nm second harmonic, which was doubled by a {beta}-BaB{sub 2}O{sub 4} crystal, producing tunable UV radiation with as much as 15 {mu}W of average power.

  19. Sign Lowering and Phonetic Reduction in American Sign Language

    PubMed Central

    Tyrone, Martha E.; Mauk, Claude E.

    2010-01-01

    This study examines sign lowering as a form of phonetic reduction in American Sign Language. Phonetic reduction occurs in the course of normal language production, when instead of producing a carefully articulated form of a word, the language user produces a less clearly articulated form. When signs are produced in context by native signers, they often differ from the citation forms of signs. In some cases, phonetic reduction is manifested as a sign being produced at a lower location than in the citation form. Sign lowering has been documented previously, but this is the first study to examine it in phonetic detail. The data presented here are tokens of the sign WONDER, as produced by six native signers, in two phonetic contexts and at three signing rates, which were captured by optoelectronic motion capture. The results indicate that sign lowering occurred for all signers, according to the factors we manipulated. Sign production was affected by several phonetic factors that also influence speech production, namely, production rate, phonetic context, and position within an utterance. In addition, we have discovered interesting variations in sign production, which could underlie distinctions in signing style, analogous to accent or voice quality in speech. PMID:20607146

  20. Planning Sign Languages: Promoting Hearing Hegemony? Conceptualizing Sign Language Standardization

    ERIC Educational Resources Information Center

    Eichmann, Hanna

    2009-01-01

    In light of the absence of a codified standard variety in British Sign Language and German Sign Language ("Deutsche Gebardensprache") there have been repeated calls for the standardization of both languages primarily from outside the Deaf community. The paper is based on a recent grounded theory study which explored perspectives on sign language…

  1. Sign Language Comprehension: The Case of Spanish Sign Language

    ERIC Educational Resources Information Center

    Rodriguez Ortiz, I. R.

    2008-01-01

    This study aims to answer the question, how much of Spanish Sign Language interpreting deaf individuals really understand. Study sampling included 36 deaf people (deafness ranging from severe to profound; variety depending on the age at which they learned sign language) and 36 hearing people who had good knowledge of sign language (most were…

  2. Quadruple wild-type (WT) GIST: defining the subset of GIST that lacks abnormalities of KIT, PDGFRA, SDH, or RAS signaling pathways

    PubMed Central

    Pantaleo, Maria A; Nannini, Margherita; Corless, Christopher L; Heinrich, Michael C

    2015-01-01

    A subset of GISTs lack mutations in the KIT/PDGFRA or RAS pathways and yet retain an intact succinate dehydrogensase (SDH) complex. We propose that these KIT/PDGFRA/SDH/RAS-P WT GIST tumors be designated as quadruple wild-type (WT) GIST. Further molecular and clinicophatological characterization of quadruple WT GIST will help to determine their prognosis as well as assist in the optimization of medical management, including clinical test of novel therapies. PMID:25165019

  3. Quadruple wild-type (WT) GIST: defining the subset of GIST that lacks abnormalities of KIT, PDGFRA, SDH, or RAS signaling pathways.

    PubMed

    Pantaleo, Maria A; Nannini, Margherita; Corless, Christopher L; Heinrich, Michael C

    2015-01-01

    A subset of GISTs lack mutations in the KIT/PDGFRA or RAS pathways and yet retain an intact succinate dehydrogensase (SDH) complex. We propose that these KIT/PDGFRA/SDH/RAS-P WT GIST tumors be designated as quadruple wild-type (WT) GIST. Further molecular and clinicophatological characterization of quadruple WT GIST will help to determine their prognosis as well as assist in the optimization of medical management, including clinical test of novel therapies. PMID:25165019

  4. Measles (Rubeola): Signs and Symptoms

    MedlinePlus

    ... Initiative World Health Organization Pan American Health Organization Signs and Symptoms Language: English Español (Spanish) Recommend on ... of a patient with Koplik spots, an early sign of measles infection. Three to five days after ...

  5. CDC Vital Signs: Hispanic Health

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Vital Signs Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Vital Signs Current issue Infographic Topics Covered Alcohol Cancer Cardiovascular ...

  6. CDC Vital Signs: Legionnaires' Disease

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Vital Signs Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Vital Signs Current issue Infographic Topics Covered Alcohol Cancer Cardiovascular ...

  7. Aging changes in vital signs

    MedlinePlus

    ... Vital signs include body temperature, heart rate (pulse), breathing rate, and blood pressure. As you age, your vital ... symptoms and signs of infection. HEART RATE AND BREATHING RATE As you grow older, your pulse rate is ...

  8. CDC Vital Signs: Preventing Melanoma

    MedlinePlus

    ... Search The CDC Cancel Submit Search The CDC Vital Signs Note: Javascript is disabled or is not supported ... message, please visit this page: About CDC.gov . Vital Signs Current issue Infographic Topics Covered Alcohol Cancer Cardiovascular ...

  9. Signs of a Heart Attack

    MedlinePlus

    ... attack Heart Health and Stroke Signs of a heart attack Related information Make the Call. Don't Miss ... to top More information on Signs of a heart attack Read more from womenshealth.gov Make the Call, ...

  10. Avulsion fracture of the posterior cruciate ligament in an uncommon location associated with distal injury to the patellar ligament☆

    PubMed Central

    e Albuquerque, Rodrigo Pires; da Palma, Idemar Monteiro; Cobra, Hugo; de Paula Mozella, Alan; Vaques, Victor

    2015-01-01

    Avulsion fractures of the posterior cruciate ligament in unusual locations are rare injuries. We report the first case in the literature of an avulsion fracture of the posterior cruciate ligament associated with distal injury to the patellar ligament. The aim of this study was to present a novel case, the therapy used and the clinical follow-up. PMID:27218089