[Treatment of triangular fibrocartilage complex tear under wrist arthroscopy].

PubMed

Mi, Kun; Liu, Wu; Liu, Pengfei; Feng, Zhibin; Li, Yuwen; Hui, Guisheng

2011-01-01

To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12 cases, and by falling in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main clinical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and lifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 +/- 5.18) degrees at volar flexion, (41.22 +/- 3.83) degrees at dorsal extension, (17.82 +/- 2.48) degrees at radial deviation, (21.35 +/- 4.61) degrees at ulnar deviation, (69.85 +/- 8.36) degrees at pronation, and (70.13 +/- 6.34) degrees at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridement on triangular fibrocartilage disc, ulnolunate ligament, and ulnotriguetrum ligament; and 1 case of ID with trimming plastic operation. All incisions healed by first intention, and no complications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal life and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 +/- 6.21) degrees at volar flexion, (45.37 +/- 4.65) degrees at dorsal extension, (18.95 +/- 3.56) degrees at radial deviation, (26.28 +/- 5.09) degrees at ulnar deviation, (78.87 +/- 7.69) degrees at pronation, and (76.46 +/- 8.31) degrees at supination; showing significant differences when compared with preoperative values (P < 0.05). According to Green-O'Brien standard, the results were excellent in 9 cases, good in 6 cases, fair in 1 case, and the excellent and good rate was 93.75%. The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. In addition, the incision is small and the function is easy to recover, and the occurrence of chronic ulnar-sided wrist pain can be effectively avoided.

MR Morphology of Triangular Fibrocartilage Complex: Correlation with Quantitative MR and Biomechanical Properties

PubMed Central

Bae, Won C.; Ruangchaijatuporn, Thumanoon; Chang, Eric Y; Biswas, Reni; Du, Jiang; Statum, Sheronda

2016-01-01

Objective To evaluate pathology of the triangular fibrocartilage complex (TFCC) using high resolution morphologic magnetic resonance (MR) imaging, and compare with quantitative MR and biomechanical properties. Materials and Methods Five cadaveric wrists (22 to 70 yrs) were imaged at 3T using morphologic (proton density weighted spin echo, PD FS, and 3D spoiled gradient echo, 3D SPGR) and quantitative MR sequences to determine T2 and T1rho properties. In eight geographic regions, morphology of TFC disc and laminae were evaluated for pathology and quantitative MR values. Samples were disarticulated and biomechanical indentation testing was performed on the distal surface of the TFC disc. Results On morphologic PD SE images, TFC disc pathology included degeneration and tears, while that of the laminae included degeneration, degeneration with superimposed tear, mucinous transformation, and globular calcification. Punctate calcifications were highly visible on 3D SPGR images and found only in pathologic regions. Disc pathology occurred more frequently in proximal regions of the disc than distal regions. Quantitative MR values were lowest in normal samples, and generally higher in pathologic regions. Biomechanical testing demonstrated an inverse relationship, with indentation modulus being high in normal regions with low MR values. The laminae studied were mostly pathologic, and additional normal samples are needed to discern quantitative changes. Conclusion These results show technical feasibility of morphologic MR, quantitative MR, and biomechanical techniques to characterize pathology of the TFCC. Quantitative MRI may be a suitable surrogate marker of soft tissue mechanical properties, and a useful adjunct to conventional morphologic MR techniques. PMID:26691643

MR Imaging of the Triangular Fibrocartilage Complex.

PubMed

Cody, Michael E; Nakamura, David T; Small, Kirstin M; Yoshioka, Hiroshi

2015-08-01

MR imaging has emerged as the mainstay in imaging internal derangement of the soft tissues of the musculoskeletal system largely because of superior contrast resolution. The complex geometry and diminutive size of the triangular fibrocartilage complex (TFCC) and its constituent structures can make optimal imaging of the TFCC challenging; therefore, production of clinically useful images requires careful optimization of image acquisition parameters. This article provides a foundation for advanced TFCC imaging including factors to optimize magnetic resonance images, arthrography, detailed anatomy, and classification of injury. In addition, clinical presentations and treatments for TFCC injury are briefly considered. Copyright © 2015 Elsevier Inc. All rights reserved.

Arthroscopic Management of Triangular Fibrocartilage Complex Foveal Injury.

PubMed

Fujio, Keiji

2017-11-01

The deep component of triangular fibrocartilage complex (TFCC) inserts onto the fovea of the ulnar head. This component is critical to provide distal radioulnar joint stability. The surgical techniques and results of transosseous inside-out TFCC foveal repair are discussed. The rewarding results encouraged the repair of TFCC to the fovea arthroscopically. Although the results are good, the factors of age (traumatic or degenerative) and quality of stump and TFCC proper, which relate to the results should be considered in the future. Copyright © 2017 Elsevier Inc. All rights reserved.

Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation.

PubMed

Hammer, Niels; Hirschfeld, Ulrich; Strunz, Hendrik; Werner, Michael; Wolfskämpf, Thomas; Löffler, Sabine

2017-01-01

Introduction . The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods . Microcomputed tomography ( μ -CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results . TFCC reconstruction was impossible using μ -CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion . This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ -CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool.

Can the Diagnostics of Triangular Fibrocartilage Complex Lesions Be Improved by MRI-Based Soft-Tissue Reconstruction? An Imaging-Based Workup and Case Presentation

PubMed Central

Hirschfeld, Ulrich; Strunz, Hendrik; Werner, Michael; Wolfskämpf, Thomas; Löffler, Sabine

2017-01-01

Introduction. The triangular fibrocartilage complex (TFCC) provides both mobility and stability of the radiocarpal joint. TFCC lesions are difficult to diagnose due to the complex anatomy. The standard treatment for TFCC lesions is arthroscopy, posing surgery-related risks onto the patients. This feasibility study aimed at developing a workup for soft-tissue reconstruction using clinical imaging, to verify these results in retrospective patient data. Methods. Microcomputed tomography (μ-CT), 3 T magnetic resonance imaging (MRI), and plastination were used to visualize the TFCC in cadaveric specimens applying segmentation-based 3D reconstruction. This approach further trialed the MRI dataset of a patient with minor radiological TFCC alterations but persistent pain. Results. TFCC reconstruction was impossible using μ-CT only but feasible using MRI, resulting in an appreciation of its substructures, as seen in the plastinates. Applying this approach allowed for visualizing a Palmer 2C lesion in a patient, confirming ex postum the arthroscopy findings, being markedly different from MRI (Palmer 1B). Discussion. This preliminary study showed that image-based TFCC reconstruction may help to identify pathologies invisible in standard MRI. The combined approach of μ-CT, MRI, and plastination allowed for a three-dimensional appreciation of the TFCC. Image quality and time expenditure limit the approach's usefulness as a diagnostic tool. PMID:28246600

[Kinematics of the triangular fibrocartilage complex during forearm rotation in vivo].

PubMed

Xu, Jing; Tang, Jin-bo; Jia, Zhong-zheng; Xie, Ren-guo

2009-11-01

To investigate three-dimensional kinematics of the superficial and deep portion of triangular fibrocartilage complex (TFCC) in different parts of the forearm rotation. Six wrists of 6 volunteers were used to obtain CT scans at different positions of the wrist. The wrists were scanned from 90 degrees of pronation to 90 degrees of supination at an interval of 30 degrees. The 3-dimensional radius and ulna were reconstructed with customized software and changes in length of the superficial and deep portion of TFCC during forearm rotation. In forearm pronation, the superficial dorsal portion and the deep palmar portion of the TFCC were tight. While the superficial palmar portion and the deep dorsal potion of the TFCC were lax. In supination, the changes in length of all these fibers were reverse. In forearm rotation one portion fibers of dorsal TFCC and one portion fibers of palmar TFCC are tight, and this mechanism controls stability during DRUJ rotation.

High-Resolution 3T MR Imaging of the Triangular Fibrocartilage Complex

PubMed Central

von Borstel, Donald; Wang, Michael; Small, Kirstin; Nozaki, Taiki; Yoshioka, Hiroshi

2017-01-01

This study is intended as a review of 3Tesla (T) magnetic resonance (MR) imaging of the triangular fibrocartilage complex (TFCC). The recent advances in MR imaging, which includes high field strength magnets, multi-channel coils, and isotropic 3-dimensional (3D) sequences have enabled the visualization of precise TFCC anatomy with high spatial and contrast resolution. In addition to the routine wrist protocol, there are specific techniques used to optimize 3T imaging of the wrist; including driven equilibrium sequence (DRIVE), parallel imaging, and 3D imaging. The coil choice for 3T imaging of the wrist depends on a number of variables, and the proper coil design selection is critical for high-resolution wrist imaging with high signal and contrast-to-noise ratio. The TFCC is a complex structure and is composed of the articular disc (disc proper), the triangular ligament, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament (UCL), the extensor carpi ulnaris (ECU) tendon sheath, and the ulnolunate and ulnotriquetral ligaments. The Palmer classification categorizes TFCC lesions as traumatic (type 1) or degenerative (type 2). In this review article, we present clinical high-resolution MR images of normal TFCC anatomy and TFCC injuries with this classification system. PMID:27535592

High-Resolution 3T MR Imaging of the Triangular Fibrocartilage Complex.

PubMed

von Borstel, Donald; Wang, Michael; Small, Kirstin; Nozaki, Taiki; Yoshioka, Hiroshi

2017-01-10

This study is intended as a review of 3Tesla (T) magnetic resonance (MR) imaging of the triangular fibrocartilage complex (TFCC). The recent advances in MR imaging, which includes high field strength magnets, multi-channel coils, and isotropic 3-dimensional (3D) sequences have enabled the visualization of precise TFCC anatomy with high spatial and contrast resolution. In addition to the routine wrist protocol, there are specific techniques used to optimize 3T imaging of the wrist; including driven equilibrium sequence (DRIVE), parallel imaging, and 3D imaging. The coil choice for 3T imaging of the wrist depends on a number of variables, and the proper coil design selection is critical for high-resolution wrist imaging with high signal and contrast-to-noise ratio. The TFCC is a complex structure and is composed of the articular disc (disc proper), the triangular ligament, the dorsal and volar radioulnar ligaments, the meniscus homologue, the ulnar collateral ligament (UCL), the extensor carpi ulnaris (ECU) tendon sheath, and the ulnolunate and ulnotriquetral ligaments. The Palmer classification categorizes TFCC lesions as traumatic (type 1) or degenerative (type 2). In this review article, we present clinical high-resolution MR images of normal TFCC anatomy and TFCC injuries with this classification system.

An immunohistochemical study of the triangular fibrocartilage complex of the wrist: regional variations in cartilage phenotype

PubMed Central

Milz, S; Sicking, B; Sprecher, C M; Putz, R; Benjamin, M

2007-01-01

The triangular fibrocartilage complex (TFCC) transmits load from the wrist to the ulna and stabilizes the distal radioulnar joint. Damage to it is a major cause of wrist pain. Although its basic structure is well established, little is known of its molecular composition. We have analysed the immunohistochemical labelling pattern of the extracellular matrix of the articular disc and the meniscal homologue of the TFCC in nine elderly individuals (age range 69–96 years), using a panel of monoclonal antibodies directed against collagens, glycosaminoglycans, proteoglycans and cartilage oligomeric matrix protein (COMP). Although many of the molecules (types I, III and VI collagen, chondroitin 4 sulphate, dermatan sulphate and keratan sulphate, the oversulphated epitope of chondroitin 6 sulphate, versican and COMP) were found in all parts of the TFCC, aggrecan, link protein and type II collagen were restricted to the articular disc and to entheses. They were thus not a feature of the meniscal homologue. The shift in tissue phenotype within the TFCC, from a fibrocartilaginous articular disc to a more fibrous meniscal homologue, correlates with biomechanical data suggesting that the radial region is stiff and subject to considerable stress concentration. The presence of aggrecan, link protein and type II collagen in the articular disc could explain why the TFCC is destroyed in rheumatoid arthritis, given that it has been suggested that autoimmunity to these antigens results in the destruction of articular cartilage. The differential distribution of aggrecan within the TFCC is likely to be reflected by regional differences in water content and mobility on the radial and ulnar side. This needs to be taken into account in the design of improved MRI protocols for visualizing this ulnocarpal complex of the wrist. PMID:17532798

High-resolution 3 T MRI of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities using Palmer and Outerbridge classifications.

PubMed

Nozaki, T; Rafijah, G; Yang, L; Ueno, T; Horiuchi, S; Hitt, D; Yoshioka, H

2017-10-01

To investigate the usefulness of high-resolution 3 T magnetic resonance imaging (MRI) for the evaluation of traumatic and degenerative triangular fibrocartilage complex (TFCC) abnormalities among three groups: patients presenting with wrist pain who were (a) younger than age 50 years or (b) age 50 or older (PT<50 and PT≥50, respectively), and (c) asymptomatic controls who were younger than age 50 years (AC). High-resolution 3 T MRI was evaluated retrospectively in 96 patients, including 47 PT<50, 38 PT≥50, and 11 AC. Two board-certified radiologists reviewed the MRI images independently. MRI features of TFCC injury were analysed according to the Palmer classification, and cartilage degeneration around the TFCC was evaluated using the Outerbridge classification. Differences in MRI findings among these groups were detected using chi-square test. Cohen's kappa was calculated to assess interobserver and intra-observer reliability. The incidence of Palmer class 1A, 1C and 1D traumatic TFCC injury was significantly (p<0.05) higher in PT≥50 than in PT<50 (class 1A: 47.4% versus 27.7%, class 1C: 31.6% versus 12.8%, and class 1D: 21.1% versus 2.1%). Likewise, MRI findings of TFCC degeneration were observed more frequently in PT≥50 than in PT<50 (p<0.01). Outerbridge grade 2 or higher cartilage degeneration was significantly (p<0.01) more frequently seen in PT≥50 than in PT<50 (55.3% versus 17% in the lunate, 28.9% versus 4.3% in the triquetrum, 73.7% versus 12.8% in the ulna). High-resolution wrist MRI at 3 T enables detailed evaluation of TFCC traumatic injury and degenerative changes using the Palmer and Outerbridge classifications, with good or excellent interobserver and intra-observer reliability. Copyright © 2017 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture: six cases related to triangular fibrocartilage complex injury.

PubMed

Lee, Seoung-joon; Rathod, Chasanal Mohan; Park, Kwang-Won; Hwang, Jin-Ho

2012-05-01

Persistent ulnar-sided wrist pain after treatment of triquetral dorsal chip fracture even after union is a matter of concern. There could be various reasons for this persistent pain like arthritis, instability, fractures and non-union. We correlate our findings of physical examination and wrist arthroscopy as triangular fibrocartilage complex injury to be one of the causes of this persistent pain. Six subjects who had persistent ulnocarpal joint pain and tenderness after triquetral dorsal chip fracture, despite 2 months of conservative treatment, were subjected to physical tests. If the physical examination yields positive results, then magnetic resonance imaging followed by arthroscopic treatment was performed. The six patients were then evaluated using the visual analogue scale, the Mayo modified wrist score, and the grip strength test. Triangular fibrocartilage complex (TFCC) injury was observed in all six cases and partial TFCC resection and synovectomy were performed. Analysis of the visual analogue scale, Mayo modified wrist score, and grip strength test data revealed statistically significant improvements (P < 0.05). In addition to several causes reported in the published literature, TFCC injury can be a cause of persistent ulnar pain after treatment of triquetral dorsal chip fracture. Arthroscopic partial TFCC resection can be considered to be a suitable treatment for such cases.

Patterns of triangular fibrocartilage complex (TFCC) injury associated with severely dorsally displaced extra-articular distal radius fractures.

PubMed

Scheer, Johan H; Adolfsson, Lars E

2012-06-01

The aim of the study was to examine triangular fibrocartilage (TFCC) injury patterns associated with unstable, extra-articular dorsally displaced distal radius fractures. Twenty adult patients with an Arbeitsgemeinschaft für Osteosynthesefragen (AO), type A2 or A3, distal radius fracture with an initial dorsal angulation greater than 20° were included. Nine had a tip fracture (distal to the base) of the ulnar styloid and 11 had no such fracture. They were all openly explored from an ulnopalmar approach and TFCC injuries were documented. Eleven patients also underwent arthroscopy and intra-articular pathology was recorded. All patients had TFCC lesions of varying severity, having an extensor carpi ulnaris subsheath avulsion in common. Eighteen out of 20 also displayed deep foveal radioulnar ligament lesions, with decreasingly dorsal fibres remaining. The extent of this foveal injury could not be appreciated by radiocarpal arthroscopy. Severe displacement of an extra-articular radius fracture suggests an ulnar-sided ligament injury to the TFCC. The observed lesions concur with findings in a previous cadaver study. The lesions follow a distinct pattern affecting both radioulnar as well as ulnocarpal stabilisers. Copyright © 2012 Elsevier Ltd. All rights reserved.

High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy.

PubMed

Zhan, Hui-Li; Li, Wen-Ting; Bai, Rong-Jie; Wang, Nai-Li; Qian, Zhan-Hua; Ye, Wei; Yin, Yu-Ming

2017-04-05

The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese.

High-resolution 3T Magnetic Resonance Imaging of the Triangular Fibrocartilage Complex in Chinese Wrists: Correlation with Cross-sectional Anatomy

PubMed Central

Zhan, Hui-Li; Li, Wen-Ting; Bai, Rong-Jie; Wang, Nai-Li; Qian, Zhan-Hua; Ye, Wei; Yin, Yu-Ming

2017-01-01

Background: The injury of the triangular fibrocartilage complex (TFCC) is a common cause of ulnar-sided wrist pain. The aim of this study was to investigate if the high-resolution 3T magnetic resonance imaging (MRI) could demonstrate the detailed complex anatomy of TFCC in Chinese. Methods: Fourteen Chinese cadaveric wrists (from four men and three women; age range at death from 30 to 60 years; mean age at 46 years) and forty healthy Chinese wrists (from 20 healthy volunteers, male/female: 10/10; age range from 21 to 53 years with a mean age of 32 years) in Beijing Jishuitan Hospital from March 2014 to March 2016 were included in this study. All cadavers and volunteers had magnetic resonance (MR) examination of the wrist with coronal T1-weighted and proton density-weighted imaging with fat suppression in three planes, respectively. MR arthrography (MRAr) was performed on one of the cadaveric wrists. Subsequently, all 14 cadaveric wrists were sliced into 2 mm thick slab with band saw (six in coronal plane, four in sagittal plane, and four in axial plane). The MRI features of normal TFCC were analyzed in these specimens and forty healthy wrists. Results: Triangular fibrocartilage, the ulnar collateral ligament, and the meniscal homolog could be best observed on images in coronal plane. The palmar and dorsal radioulnar ligaments were best evaluated in transverse plane. The ulnotriquetral and ulnolunate ligaments were best visualized in sagittal plane. The latter two structures and the volar and dorsal capsules were better demonstrated on MRAr. Conclusion: High-resolution 3T MRI is capable to show the detailed complex anatomy of the TFCC and can provide valuable information for the clinical diagnosis in Chinese. PMID:28345546

How does ulnar shortening osteotomy influence morphologic changes in the triangular fibrocartilage complex?

PubMed

Yamanaka, Yoshiaki; Nakamura, Toshiyasu; Sato, Kazuki; Toyama, Yoshiaki

2014-11-01

Ulnar shortening osteotomy often is indicated for treatment of injuries to the triangular fibrocartilage complex (TFCC). However, the effect of ulnar shortening osteotomy on the changes in shape of the TFCC is unclear. In our study, quantitative evaluations were performed using MRI to clarify the effect of ulnar shortening on triangular fibrocartilage (TFC) thickness attributable to disc regeneration of the TFC and TFC angle attributable to the suspension effect of ulnar shortening on the TFC. The purposes of this study were (1) to compare preoperative and postoperative TFC thickness and TFC angle on MR images to quantitatively evaluate the effect of ulnar shortening osteotomy on disc regeneration and the suspension effect on the TFC; and (2) to assess whether changes in TFC thickness and TFC angle correlated with the Mayo wrist score. Between 1995 and 2008, 256 patients underwent ulnar shortening osteotomy for TFCC injuries. The minimum followup was 24 months (mean, 51 months; range, 24-210 months). A total of 79 patients (31%) with complete followup including preoperative and postoperative MR images and the Mayo wrist score was included in this retrospective study. Evaluation of the postoperative MR images and the Mayo wrist score were performed at the final followup. The remaining 177 patients did not undergo postoperative MRI, or they had a previous fracture, large tears of the disc proper, or were lost to followup. Two orthopaedists, one of whom performed the surgeries, measured the TFC thickness and the TFC angle on coronal MR images before and after surgery for each patient. Correlations of the percent change in the TFC thickness and the magnitude of TFC angle change with age, sex, postoperative MR images, extent of ulnar shortening, preoperative ulnar variance, and postoperative Mayo wrist score were assessed. Stepwise regression analysis showed a correlation between the percent change in TFC thickness and preoperative ulnar variance (R2=0.21; β=-0.33; 95% CI, -0.11 to 0.01; p=0.01) and between the magnitude of change in the TFC angle and the extent of ulnar shortening (R2=0.18; β=-0.29; 95% CI, -5.8 to 0.29; p=0.03). The Mayo wrist score was not correlated with the percent change in TFC thickness or the magnitude of change in the TFC angle. These results suggest that, in patients with TFCC injury with a smaller preoperative ulnar variance, a high residual potential for regeneration in the disc proper was seen after ulnar shortening osteotomy, and correlated with the extent of ulnar shortening and the suspension effect on TFC. However, there was no correlation between disc regeneration or the suspension effect on TFC and the Mayo wrist score. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Arthroscopically assisted reconstruction of triangular fibrocartilage complex foveal avulsion in the ulnar variance-positive patient.

PubMed

Kim, ByungSung; Yoon, Hong-Kee; Nho, Jae-Hwi; Park, Kang Hee; Park, Sung-Yong; Yoon, Jun-Hee; Song, Hyun Seok

2013-11-01

Our aim was to evaluate the clinical results of patients treated by arthroscopically assisted reconstruction of foveal avulsion injury of the triangular fibrocartilage complex (TFCC) using a suture anchor. We retrospectively reviewed the results of 15 patients (11 men and 4 women; mean age, 30.5 years) who underwent surgical procedures for the treatment of TFCC foveal avulsion at our hospital. The patients were followed up for a mean of 29 months. The patients had TFCC foveal avulsion caused by sprains (n = 8), falls (n = 4), playing baseball (n = 2), and a motor vehicle accident (n = 1). All the patients underwent magnetic resonance imaging. Radiographs obtained to assess ulnar variance (UV), ulnar-dorsal subluxation, and function of the wrist based on grip power; Disabilities of the Arm, Shoulder and Hand score; and Mayo wrist score were examined for all patients both preoperatively and postoperatively. On preoperative magnetic resonance imaging, TFCC foveal avulsion was observed in 13 of 15 cases. The mean UV value based on preoperative simple radiographic findings was 1.7 ± 1.0 mm, and dorsal subluxation at the distal ulna improved from 2.9 ± 3.0 mm to 0.2 ± 0.9 mm (P = .017). In all cases the distal radioulnar joint instability disappeared postoperatively. Grip power (compared with the uninvolved limb) was 79.3% preoperatively and 82.9% postoperatively (P = .086). The Disabilities of the Arm, Shoulder and Hand scores were 28.4 points preoperatively and 16.6 points postoperatively (P = .061). The Mayo wrist scores were excellent in 10 cases, good in 2, and fair in 3, and the mean score improved significantly from 64 points preoperatively to 84 points postoperatively (P = .007). Arthroscopic-assisted suture anchor reattachment of the TFCC in patients with traumatic TFCC foveal avulsion can prevent or reduce distal radioulnar joint instability and reduce pain even in chronic cases with positive UV. Level IV, therapeutic case series. Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

[Classification and MR imaging of triangular fibrocartilage complex lesions].

PubMed

Zhan, H L; Liu, Y; Bai, R J; Qian, Z H; Ye, W; Li, Y X; Wu, B D

2016-06-07

To explore the MRI characteristics of injuries of triangular fibrocartilage complex (TFCC), and provide imaging basis for the early diagnosis and treatment of the injuries. A total of 10 healthy volunteers without wrist injuries and 200 patients from Beijing Jishuitan Hospital who complained ulnar-sided wrist pain and were highly suspected as the injury of TFCC underwent the wrist magnetic resonance examination. All subjects were in a prone position and underwent examination on coronal T1WI scan and PD-FS on 3 planes respectively. Then the MRI characteristics of 3 healthy volunteers and 67 patients with TFCC injuries that confirmed by operation were analyzed. According to the comparative analysis of normal anatomy and Palmer classification, the injuries were classified and MRI features of different types of injuries were analyzed. At last, imaging findings were compared with surgical results. Three healthy volunteers without injuries showed mainly in low signal intensity on T1WI and PD-FS images. According to Palmer classification, there were 52 traumatic injuries (ⅠA 9, ⅠB 25, ⅠC 3, ⅠD 13, In addition, 1 has central perforation and ulnar avulsion and 1 has ulnar and radial injuries simultaneously) and 15 degenerative injuries (ⅡA 5, ⅡB 1, ⅡC 2 , ⅡD 1 , ⅡE 6) among 67 patients. The central perforation mainly demonstrated as linear high signal perpendicular to the disk, and run in a sagittal line. The ulnar, distal, and radial avulsion mainly showed the injuries were irregular, the structures were ambiguous, and there was high signal intensity in the injured structures on PD-FS. Degenerative injuries demonstrated the irregularity of TFC and heterogeneous signals on PD-FS. There were mixed intermediate-high signals and changes in the articular cartilage of lunate and ulna, high signal in the lunotriquetral ligament and ulnocarpal or radioulnar arthritis. MRI can demonstrate the anatomy of TFCC accurately, evaluate and make the general classification of injuries. It is of significance for the early diagnosis and treatment protocols of the TFCC injuries.

U.S. Navy Task Force Climate Change

NASA Astrophysics Data System (ADS)

Miller, T.; McBride, B.; St. John, C.

2011-12-01

In May 2009, the Chief of Naval Operations established Task Force Climate Change (TFCC) to develop Navy policy, plans, and recommendations regarding future investments to adapt to the world's changing climate. With a near-term focus on the changing Arctic ocean and consequent increase in access to the region, TFCC has adopted a science-based approach in collaboration with other U.S. government agencies, international partners, industry, and academia. TFCC has developed two roadmaps that provide 5-year action plans for the Navy to address the Arctic and global climate change. Critical elements of both roadmaps are assessments of: (1) current and projected climate change, (2) resulting impacts to Naval missions and infrastructure, and (3) associated risks of not taking adaptation actions that are operationally, environmentally, and ecologically sustainable. Through TFCC, the Navy acknowledges the link between climate change and national security, and engages in extensive outreach and strategic communication to remain informed on the best climate science and promote public understanding and support regarding the Navy's climate change efforts.

A Comparison of Ulnar Shortening Osteotomy Alone Versus Combined Arthroscopic Triangular Fibrocartilage Complex Debridement and Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome

PubMed Central

Song, Hyun Seok

2011-01-01

Background This study compared the results of patients treated for ulnar impaction syndrome using an ulnar shortening osteotomy (USO) alone with those treated with combined arthroscopic debridement and USO. Methods The results of 27 wrists were reviewed retrospectively. They were divided into three groups: group A (USO alone, 10 cases), group B (combined arthroscopic debridement and USO, 9 cases), and group C (arthroscopic triangular fibrocartilage complex [TFCC] debridement alone, 8 cases). The wrist function was evaluated using the modified Mayo wrist score, disabilities of the arm, shoulder and hand (DASH) score and Chun and Palmer grading system. Results The modified Mayo wrist score in groups A, B, and C was 74.5 ± 8.9, 73.9 ± 11.6, and 61.3 ± 10.2, respectively (p < 0.05). The DASH score in groups A, B, and C was 15.6 ± 11.8, 19.3 ± 11.9, and 33.2 ± 8.5, respectively (p < 0.05). The average Chun and Palmer grading score in groups A and B was 85.7 ± 8.9 and 84.7 ± 6.7, respectively. The difference in the Mayo wrist score, DASH score and Chun and Palmer grading score between group A and B was not significant (p > 0.05). Conclusions Both USO alone and combined arthroscopic TFCC debridement with USO improved the wrist function and reduced the level of pain in the patients treated for ulnar impaction syndrome. USO alone may be the preferred method of treatment in patients if the torn flap of TFCC is not unstable. PMID:21909465

Arthroscopic Management of Triangular Fibrocartilage Complex Peripheral Injury.

PubMed

Haugstvedt, Jan Ragnar; Søreide, Endre

2017-11-01

Patients suffering from ulnar-sided wrist pain after trauma may develop tenderness, clicking, a positive fovea sign, or instability of the distal radioulnar joint. If the pain is persistent, conservative treatment does not help, and the patient agrees to surgery, arthroscopy may reveal a triangular fibrocartilage complex (TFCC) injury with capsular detachment, foveal avulsion, or a combination thereof. Capsular reattachment is possible using an arthroscopic assisted technique. The reattachment can be performed with an inside-out, outside-in, or all-inside technique, providing good to excellent results, which tend to persist over time, in 60% to 90% of cases. Copyright © 2017 Elsevier Inc. All rights reserved.

Classification of ulnar triangular fibrocartilage complex tears. A treatment algorithm for Palmer type IB tears.

PubMed

Atzei, A; Luchetti, R; Garagnani, L

2017-05-01

The classical definition of 'Palmer Type IB' triangular fibrocartilage complex tear, includes a spectrum of clinical conditions. This review highlights the clinical and arthroscopic criteria that enable us to categorize five classes on a treatment-oriented classification system of triangular fibrocartilage complex peripheral tears. Class 1 lesions represent isolated tears of the distal triangular fibrocartilage complex without distal radio-ulnar joint instability and are amenable to arthroscopic suture. Class 2 tears include rupture of both the distal triangular fibrocartilage complex and proximal attachments of the triangular fibrocartilage complex to the fovea. Class 3 tears constitute isolated ruptures of the proximal attachment of the triangular fibrocartilage complex to the fovea; they are not visible at radio-carpal arthroscopy. Both Class 2 and Class 3 tears are diagnosed with a positive hook test and are typically associated with distal radio-ulnar joint instability. If required, treatment is through reattachment of the distal radio-ulnar ligament insertions to the fovea. Class 4 lesions are irreparable tears due to the size of the defect or to poor tissue quality and, if required, treatment is through distal radio-ulnar ligament reconstruction with tendon graft. Class 5 tears are associated with distal radio-ulnar joint arthritis and can only be treated with salvage procedures. This subdivision of type IB triangular fibrocartilage complex tear provides more insights in the pathomechanics and treatment strategies. II.

Intraoperative Physical Examination for Diagnosis of Interosseous Ligament Rupture-Cadaveric Study.

PubMed

Kachooei, Amir Reza; Rivlin, Michael; Wu, Fei; Faghfouri, Aram; Eberlin, Kyle R; Ring, David

2015-09-01

To study the intraobserver and interobserver reliability of the diagnosis of interosseous ligament (IOL) rupture in a cadaver model. On 12 fresh frozen cadavers, radial heads were cut using an identical incision and osteotomy. After randomization, the soft tissues of the limbs were divided into 4 groups: both IOL and triangular fibrocartilage (TFCC) intact; IOL disruption but TFCC intact; both IOL and TFCC divided; and IOL intact but TFCC divided. All incisions had identical suturing. After standard instruction and demonstration of radius pull-push and radius lateral pull tests, 10 physician evaluators with different levels of experience examined the cadaver limbs in a standardized way (elbow at 90° with the forearm held in both supination and pronation) and were asked to classify them into one of the 4 groups. Next, the same examiners were asked to re-examine the limbs after randomly changing the order of examination. The interobserver reliability of agreement for the diagnosis of IOL injury (groups 2 and 3) was fair in both rounds of examination and the intraobserver reliability was moderate. The intra- and interobserver reliabilities of agreement for the 4 groups of injuries among the examiners were fair in both rounds of examination. The sensitivity, specificity, accuracy, positive, and negative predictive values were all around 70%. The likelihood of a positive test corresponding with the presence of IOL rupture (positive likelihood ratio) was 2.2. The likelihood of a negative test correctly diagnosing an intact IOL was 0.40. In cadavers, intraoperative tests had fair reliability and 70% accuracy for the diagnosis of IOL rupture using the push-pull and lateral pull maneuvers. The level of experience did not have any effect on the correct diagnosis of intact versus disrupted IOL. Although not common, some failure of surgeries for traumatic elbow fracture-dislocations is because of failure in timely diagnosis of IOL disruption. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Tear Film Dynamics: the roles of complex structure and rheology

NASA Astrophysics Data System (ADS)

Dey, Mohar; Feng, James; Vivek, Atul S.; Dixit, Harish N.; Richhariya, Ashutosh

2016-11-01

Ocular surface infections such as microbial and fungal keratitis are among leading causes of blindness in the world. A thorough understanding of the pre-corneal tear film dynamics is essential to comprehend the role of various tear layer components in the escalation of such ocular infections. The pre-corneal tear film comprises of three layers of complex fluids, viz. the innermost mucin layer, a hydrophilic protective cover over the sensitive corneal epithelium, the intermediate aqueous layer that forms the bulk of the tear film and is often embedded with large number of bio-polymers either in the form of soluble mucins or pathogens, and finally the outermost lipid layer that stabilizes the film by decreasing the air/tear film interfacial tension. We have developed a comprehensive mathematical model to describe such a film by incorporating the effects of the non-uniform mucin distribution along with the complex rheology of the aqueous layer with/without pathogens, Marangoni effects from the lipid layer and the slip effects at the base of the tear film. A detailed linear stability analysis and a fully non-linear solution determine the break up time (BUT) of such a tear film. We also probe the role of the various components of the pre-corneal tear film in the dynamics of rupture.

Role of MRI in the diagnosis and management of patients with clinical scaphoid fracture.

PubMed

Tibrewal, Saket; Jayakumar, Prakash; Vaidya, Sujit; Ang, Swee Chai

2012-01-01

The American College of Radiologists (ACR) recognises the value of magnetic resonance imaging (MRI) as the investigation of choice in patients with a clinically suspected scaphoid fracture but normal plain radiographs. The Royal College of Radiologists (RCR) in the UK produces no similar guidelines, as evidenced by the inconsistent management of such cases in hospitals around the UK. In discussion with our musculoskeletal radiologists, we implemented new guidelines to standardise management of our patients and now report our findings. A consecutive series of 137 patients referred to the orthopaedic department with clinically suspected scaphoid fracture but normal series of plain radiographs were prospectively followed up over a two-year period. We implemented the use of early MRI for these patients and determined its incidence of detected scaphoid injury in addition to other occult injuries. We then prospectively examined results of these findings on patient management. Thirty-seven (27%) MRI examinations were normal with no evidence of a bony or soft-tissue injury. Soft-tissue injury was diagnosed in 59 patients (43.4%). Of those, 46 were triangular fibrocartilage complex (TFCC) tears (33.8%) and 18 were intercarpal ligament injuries (13.2 %). Bone marrow oedema with no distinct fracture was discovered in 55 cases (40.4%). In 17 (12.5%) cases, this involved only the scaphoid. In the remainder, it also involved the other carpal bones or distal radius. Fracture(s) were diagnosed on 30 examinations (22.0%). MRI should be regarded as the gold standard investigation for patients in whom a scaphoid fracture is suspected clinically. It allows the diagnosis of occult bony and soft-tissue injuries that can present clinically as a scaphoid fracture; it also helps exclude patients with no fracture. We believe that there is a need to implement national guidelines for managing occult scaphoid fractures.

Ulnar Impaction Syndrome: A case series investigating the appropriate diagnosis, management, and post-operative considerations.

PubMed

Woitzik, Erin; deGraauw, Chris; Easter, Brock

2014-12-01

Ulnar sided wrist pain is a common site for upper extremity disability. Ulnar impaction syndrome results in a spectrum of triangular fibrocartilage complex (TFCC) injuries and associated lunate, triquetrum, and ligamentous damage. Patients commonly present with insidious ulnar sided wrist pain and clicking, and a history of trauma or repetitive axial loading and rotation. In this case series, three patients presented to a sports chiropractor for evaluation and were subsequently diagnosed with ulnar impaction syndrome. Treatment strategies consist of conservative management, arthroscopic debridement or repair, arthroscopic wafer procedure, or ulnar shortening osteotomy. For the athlete, intervention should be individualized and sport-specific, considering athletic priorities, healing potential, return to play, and long-term health concerns.

[Effect of total flavones from Cuscuta chinensis on expression of Fas/FasL, PCNA and HB-EGF in SD rats model with bromocriptine-induced abortion].

PubMed

Ma, Hong-Xia; You, Zhao-Ling; Wang, Xiao-Yun

2008-11-01

To explore the effect of total flavones from cuscuta chinensis (TFCC) on expression of Fas, PCNA and HB-EGF in SD rats model with bromocriptine-induced abortion. The model rats of bromocriptine during 6-8 d of pregnancy induced early abortion was established, adopting respectively herbs in high and low dosage and progesterone affect model rat and after 12 d, Immunohistochemical was applied to determine Fas, HB-EGF and PCNA in deciduas and placenta. Expression of PCNA on trophoblast and deciduas, HB-EGF on trophoblast, PR on deciduas in the model used Semen cuscutae flavonoid, proesterone and normal pregnacy, were significantlly higher than those of the pure model. Expression of Fas on trophoblast and deciduas in above four groups, were significantlly lower than those of the pure model. There were no expression of HB-EGF on deciduas. TFCC regulates the proliferation and apoptosis of the deciduas and cytotrophoblasts and prevents spontaneous abortions.

Detection of sialomucin complex (MUC4) in human ocular surface epithelium and tear fluid.

PubMed

Pflugfelder, S C; Liu, Z; Monroy, D; Li, D Q; Carvajal, M E; Price-Schiavi, S A; Idris, N; Solomon, A; Perez, A; Carraway, K L

2000-05-01

To evaluate human ocular surface epithelium and tear fluid for the presence of sialomucin complex (MUC4), a high-molecular-weight heterodimeric glycoprotein composed of mucin (ASGP-1) and transmembrane (ASGP-2) subunits. Reverse transcription-polymerase chain reaction (RT-PCR) and Northern blot analysis assays were used to identify sialomucin complex RNA in ocular surface epithelia. Immunoprecipitation and immunoblot analysis were used to identify immunoreactive species in human tears and in the corneal and conjunctival epithelia using antibodies specific for carbohydrate and peptide epitopes on the sialomucin complex subunits. Immunofluorescence staining was used to detect sialomucin complex in frozen sections and impression cytology specimens of human cornea and conjunctival epithelia. ASGP-1- and ASGP-2-specific sequences were amplified from RNA extracted from both conjunctival and corneal epithelial biopsies by RT-PCR. Sialomucin complex transcripts were also detected in these tissues by Northern blot analysis, with a greater level of RNA detected in the peripheral than the central corneal epithelium. Sialomucin complex was immunoprecipitated from tear fluid samples and both corneal and conjunctival epithelia and detected by immunoblot analysis with specific anti-ASGP-1 and anti-ASGP-2 antibodies. The ASGP-1 peptide antibody HA-1 stained the full thickness of the corneal and conjunctival epithelia. In contrast, antibody 15H10, which reacts against a carbohydrate epitope on ASGP-1, stained only the superficial epithelial layers of these tissues. No staining was observed in the conjunctival goblet cells. Sialomucin complex was originally identified in rat mammary adenocarcinoma cells and has recently been shown to be produced by the ocular surface epithelia of rats. Furthermore, it has been identified as the rat homologue of human MUC4 mucin. The present studies show that it is expressed in the stratified epithelium covering the surface of the human eye and is present in human tear fluid. Expression of a carbohydrate-dependent epitope on the mucin subunit (ASGP-1) of sialomucin complex occurs in a differentiation-dependent fashion. Sialomucin complex joins MUC1 as another membrane mucin produced by the human ocular surface epithelia but is also found in the tear fluid, presumably in a soluble form, as found on the rat ocular surface.

Evaluation of antioxidant-associated efficacy of flavonoid extracts from a traditional Chinese medicine Hua Ju Hong (peels of Citrus grandis (L.) Osbeck).

PubMed

Jiang, Jianping; Shan, Letian; Chen, Zhiyun; Xu, Haishun; Wang, Jianping; Liu, Yuwen; Xiong, Yaokang

2014-12-02

Hua Ju Hong (HJH, peels of Citrus grandis (L.) Osbeck) is a popularly used traditional Chinese medicine recorded by "Compendium of Materia Medica" (Ben Cao Gang Mu) in Ming Dynasty of China (1578 A.D.). With flavonoid components, HJH possesses hypolipidemic effect associated with antioxidation action. However, no report was found regarding the flavonoid profile and antioxidant activity of HJH. Five purified flavonoid extracts (TFCA, TFCB, TFCC, TFCD and TFCE.) were obtained from HJH using Ca(OH)2 and HPD-300 macroporous resins, and their total flavonoids and representative flavonoid components were analyzed. In vitro tests of DPPH free radical scavenging activity, reducing power, and total antioxidant activity of each extract were evaluated. The most effective extract was selected for in vivo antioxidative evaluation using a rat hyperlipemia model. The total flavonoid content was varying among each HJH extract and decreased in an order of TFCB>TFCD>TFCC>TFCE>TFCA. TFCB, TFCD, and TFCC contained more than 50% of total flavonoids, the highest content of which was found in TFCB (80.7%). HPLC analysis showed that the contents of three flavonoid components, narirutin, naringin and neohesperidin, displayed a similar trend as that of total flavonoids. In vitro antioxidative tests determined that TFCB at 0.24 to 1.2mg/ml possessed the most significant antioxidant effects among other extracts and was also superior to BHT. In vivo experiment also revealed the significant antioxidant and antihyperlipidemic activities of TFCB started from 50 to 200mg/kg after oral administration to hyperlipemia rats. These results indicate that TFCB with the highest flavonoid contents has the strongest antioxidant-associated activities. This is the first report regarding antioxidant-associated activities and relevant flavonoid components of HJH extracts, providing a promising candidate of traditional Chinese medicine for antioxidative treatment. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

MR arthrography of the posterior labrocapsular complex: relationship with glenohumeral joint alignment and clinical posterior instability.

PubMed

Tung, Glenn A; Hou, David D

2003-02-01

The purpose of our study was to investigate the relationship between tears of the posterior labrocapsular complex and glenohumeral alignment on MR arthrography and the presence and extent of posterior labrocapsular tears in patients with posterior instability. Posterior labrocapsular tears identified on 24 MR arthrograms and surgically confirmed were evaluated for length of tear and labrocapsular avulsion. These examinations and a comparison cohort of 70 normal MR arthrograms with normal findings were also evaluated for humeral head position relative to the glenoid fossa. Medical records were reviewed for clinical diagnosis of posterior instability and history of shoulder trauma. The position of the humeral head relative to the glenoid was significantly more posterior in patients with posterior labral tear than in patients with a normal posterior labrum (4.9 mm versus 0.7 mm; p < 0.0001). The mean length (+/- SD) of posterior labral tear was 15.9 +/- 1.7 mm, and a direct correlation was found between tear length and posterior humeral translation (r = -0.65; p = 0.002). Posterior labral tears were significantly longer (18.6 vs 13.1 mm; p = 0.04), and posterior humeral translation was greater (6.4 vs 3.4 mm; p = 0.006) in patients with labrocapsular avulsion than in those without avulsion. Twelve (50%) of the patients with posterior labrocapsular tear had posterior instability, and 10 (83%) had a history of macrotrauma. On MR arthrography, the mean posterior humeral translation was greater (6.2 mm +/- 0.08; p = 0.019), posterior labral tears were longer (19.4 mm +/- 1.7; p = 0.0008), and labrocapsular avulsion was more common (83%; p = 0.0001) in patients with posterior instability than in patients who had a posterior labral tear but a clinically stable shoulder. Clinical posterior instability is associated with excessive posterior humeral translation, long posterior labral tears, and posterior labrocapsular avulsion.

Rotator cuff repair

MedlinePlus

... techniques are used to repair a rotator cuff tear: During open repair, a surgical incision is made ... repair is done for large or more complex tears. During arthroscopy, the arthroscope is inserted through small ...

Pulley lesions in rotator cuff tears: prevalence, etiology, and concomitant pathologies.

PubMed

Hawi, Nael; Liodakis, Emmanouil; Garving, Christina; Habermeyer, Peter; Tauber, Mark

2017-08-01

This study aimed to demonstrate the prevalence of lesions in the biceps pulley complex in a representative, consecutive series of rotator cuff tears and rotator cuff interval treatments. We also analyzed associated tear pattern of rotator cuff injuries and superior labrum anterior-posterior (SLAP) lesions. We evaluated the relationships of these lesions to traumatic genesis and the prevalence of pulley lesions in revision cases. This retrospective study analyzed all pre- and intra-operative documentation on arthroscopic rotator cuff reconstructions and isolated pulley lesion treatments performed by a single surgeon over 2 consecutive years. According to Habermeyer et al., we classified cases into four groups, based on the presence of additional or related complete or partial rotator cuff tears, SLAP lesions, trauma, and primary or revision surgery. Among 382 patients with rotator cuff tears, 345 (90.3%) had an injured pulley system; 151 (43.8%) had partial tears of the rotator cuff; out of these, 106 (30.6%) were articular-sided. All of these articular-sided partial tears showed extension into the pulley complex. In 154 cases (44.6%), history of shoulder trauma was associated with the beginning of symptoms. In addition, concomitant SLAP lesions occurred in 25-62% of pulley lesions, correlating with the severity of pulley lesions. Among the 345 cases, there have been 32 (9.3%) revision cases where a pulley lesion was intra-operatively identified and addressed. Pulley complex lesions are present in 90.3% of surgically treated rotator cuff lesions, particularly in articular-sided injuries. In addition, we found a significant relationship between the incidence of SLAP lesions and the severity of pulley lesions. It seems reasonable to assume an important role of pulley system injuries in the pathogenesis of rotator cuff lesions.

Diagnosis of dry eye disease and emerging technologies

PubMed Central

Zeev, Maya Salomon-Ben; Miller, Darby Douglas; Latkany, Robert

2014-01-01

Dry eye is one of the most commonly encountered problems in ophthalmology. Signs can include punctate epithelial erosions, hyperemia, low tear lakes, rapid tear break-up time, and meibomian gland disease. Current methods of diagnosis include a slit-lamp examination with and without different stains, including fluorescein, rose bengal, and lissamine green. Other methods are the Schirmer test, tear function index, tear break-up time, and functional visual acuity. Emerging technologies include meniscometry, optical coherence tomography, tear film stability analysis, interferometry, tear osmolarity, the tear film normalization test, ocular surface thermography, and tear biomarkers. Patient-specific considerations involve relevant history of autoimmune disease, refractive surgery or use of oral medications, and allergies or rosacea. Other patient considerations include clinical examination for lid margin disease and presence of lagophthalmos or blink abnormalities. Given a complex presentation and a variety of signs and symptoms, it would be beneficial if there was an inexpensive, readily available, and reproducible diagnostic test for dry eye. PMID:24672224

Relationship between subscapularis tears and injuries to the biceps pulley.

PubMed

Godenèche, Arnaud; Nové-Josserand, Laurent; Audebert, Stéphane; Toussaint, Bruno; Denard, Patrick J; Lädermann, Alexandre

2017-07-01

The purpose of this study was to analyse the relationship between long head of the biceps brachii (LHBT) lesions and subscapularis tears. The hypothesis was that a bicipital pulley might remain intact, even in the case of a subscapularis tear. Between 2010 and 2011, all patients who had a primary arthroscopic repair of a subscapularis tear were potentially included in this prospective study. The outcome of interest was the prevalence and type of arthroscopic lesions of the LHBT and bicipital pulley. Furthermore, the supposed pathomechanics of injury and the treatment proposed (conservative, pulley repair, tenodesis, tenotomy, etc.) was recorded. The following baseline characteristics were assessed: age, sex, shoulder side, and limb dominance. Of the 218 patients, the superior glenohumeral ligament/coracohumeral ligament (SGHL/CHL) complex was normal in 54 patients (25%), stretched in 84 patients (39%), and absent in 77 patients (35%). Below the SGHL/CHL complex in the bicipital groove, the medial wall of the LHBT sheath was normal in 25%, partially torn in 39%, and completely torn in 35%. In 25 of the 218 patients (11%), a pathologic LHBT with an intact SGHL/CHL complex was observed. In these cases, the medial wall of the bicipital sheath was torn in 92%. The biceps pulley system, including the SGHL/CHL complex and subscapularis tendon, merits recognition as an important anatomical structure, and its lesions contribute to shoulder pathology. The subscapularis tendon is very important for the stability of the LHBT and should be included in the pulley system. In cases of a tear associated with a lesion of the SGHL/CHL complex, the LHBT is nearly always unstable and pathologic. II.

A Systematic Review of Outcomes after Arthroscopic Débridement for Triangular Fibrocartilage Complex Tear.

PubMed

Saito, Taichi; Malay, Sunitha; Chung, Kevin C

2017-11-01

Evidence regarding the effectiveness of arthroscopic débridement for a triangular fibrocartilage complex tear is uncertain. The purpose of this study was to conduct a systematic review of outcomes to evaluate the effectiveness of débridement for triangular fibrocartilage complex tears. The authors searched all available literature in the PubMed, Embase, and MEDLINE (Ovid) databases for articles reporting on triangular fibrocartilage complex tear débridement. Data collection included arc of motion, grip strength, patient-reported outcomes, and complications. A total of 1723 unique studies were identified, of which 18 studies met the authors' criteria. The mean before and after arc of wrist extension/flexion motion values were 120 and 146 degrees (six studies). The mean before and after grip strength values were 65 percent and 91 percent of the contralateral side (10 studies). Disabilities of the Arm, Shoulder, and Hand scores (six studies) and pain visual analogue scale scores (seven studies) improved from 39 to 18, and from 7 to 3, respectively. The mean pain visual analogue scale score after débridement was 1.9 in the ulnar-positive group and 2.4 in the ulnar-neutral and ulnar-negative groups. Eighty-seven percent of patients returned to their original work. Patients reported reduced pain and improved functional and patient-reported outcomes after débridement of triangular fibrocartilage complex tears. Most patients after débridement returned to previous work, with few complications. Although some of these cases may require secondary procedures, simple débridement can be performed with suitable satisfactory outcomes for cases with any type of ulnar variance.

Complex Medial Meniscus Tears Are Associated With a Biconcave Medial Tibial Plateau.

PubMed

Barber, F Alan; Getelman, Mark H; Berry, Kathy L

2017-04-01

To determine whether an association exists between a biconcave medial tibial plateau and complex medial meniscus tears. A consecutive series of stable knees undergoing arthroscopy were evaluated retrospectively with the use of preoperative magnetic resonance imaging (MRI), radiographs, and arthroscopy documented by intraoperative videos. Investigators independently performed blinded reviews of the MRI or videos. Based on the arthroscopy findings, medial tibial plateaus were classified as either biconcave or not biconcave. A transverse coronal plane ridge, separating the front of the tibial plateau from the back near the inner margin of the posterior body of the medial meniscus, was defined as biconcave. The medial plateau slope was calculated with MRI sagittal views. General demographic information, body mass index, and arthroscopically confirmed knee pathology were recorded. A total of 179 consecutive knees were studied from July 2014 through August 2015; 49 (27.2%) biconcave medial tibial plateaus and 130 (72.8%) controls were identified at arthroscopy. Complex medial meniscus tears were found in 103. Patients with a biconcave medial tibial plateau were found to have more complex medial meniscus tears (69.4%) than those without a biconcavity (53.1%) (P = .049) despite having lower body mass index (P = .020). No difference in medial tibial plateau slope was observed for biconcavities involving both cartilage and bone, bone only, or an indeterminate group (P = .47). Biconcave medial tibial plateaus were present in 27.4% of a consecutive series of patients undergoing knee arthroscopy. A biconcave medial tibial plateau was more frequently associated with a complex medial meniscus tear. Level III, case-control study. Copyright © 2016 Arthroscopy Association of North America. All rights reserved.

Biological and Clinical Implications of Lysozyme Deposition on Soft Contact Lenses

PubMed Central

Omali, Negar Babaei; Subbaraman, Lakshman N.; Coles-Brennan, Chantal; Fadli, Zohra; Jones, Lyndon W.

2015-01-01

ABSTRACT Within a few minutes of wear, contact lenses become rapidly coated with a variety of tear film components, including proteins, lipids, and mucins. Tears have a rich and complex composition, allowing a wide range of interactions and competitive processes, with the first event observed at the interface between a contact lens and tear fluid being protein adsorption. Protein adsorption on hydrogel contact lenses is a complex process involving a variety of factors relating to both the protein in question and the lens material. Among tear proteins, lysozyme is a major protein that has both antibacterial and anti-inflammatory functions. Contact lens materials that have high ionicity and high water content have an increased affinity to accumulate lysozyme during wear, when compared with other soft lens materials, notably silicone hydrogel lenses. This review provides an overview of tear film proteins, with a specific focus on lysozyme, and examines various factors that influence protein deposition on contact lenses. In addition, the impact of lysozyme deposition on various ocular physiological responses and bacterial adhesion to lenses and the interaction of lysozyme with other tear proteins are reviewed. This comprehensive review suggests that deposition of lysozyme on contact lens materials may provide a number of beneficial effects during contact lens wear. PMID:26002002

Assessment, prevention and management of skin tears.

PubMed

Benbow, Maureen

2017-04-28

Skin tears are common in older people. They are acute wounds that are at high risk of becoming complex, chronic wounds due to the interplay between the physiological changes in the skin and trauma from the external environment. Skin tears have been reported to have prevalence rates equal to, or greater than, those for pressure ulcers. A comprehensive risk assessment should include assessment of the individual's general health (chronic/critical disease, polypharmacy and cognitive, sensory and nutritional status); mobility (history of falls, impaired mobility, dependent activities of daily living, and mechanical trauma); and skin (extremes of age, fragile skin and previous skin tears). A recognised classification system should be used to identify and document skin tears and guide treatment decisions in line with local wound management protocols. Nurses and carers are in a prime position to prevent, assess and manage skin tears.

Injury patterns of the acromioclavicular ligament complex in acute acromioclavicular joint dislocations: a cross-sectional, fundamental study.

PubMed

Maier, Dirk; Jaeger, Martin; Reising, Kilian; Feucht, Matthias J; Südkamp, Norbert P; Izadpanah, Kaywan

2016-09-06

Horizontal instability impairs clinical outcome following acute acromioclavicular joint (ACJ) reconstruction and may be caused by insufficient healing of the superior acromioclavicular ligament complex (ACLC). However, characteristics of acute ACLC injuries are poorly understood so far. Purposes of this study were to identify different ACLC tear types, assess type-specific prevalence and determine influencing cofactors. This prospective, cross-sectional study comprised 65 patients with acute-traumatic Rockwood-5 (n = 57) and Rockwood-4 (n = 8) injuries treated operatively by means of mini-open ACJ reduction and hook plate stabilization. Mean age at surgery was 38.2 years (range, 19-57 years). Standardized pre- and intraoperative evaluation included assessment of ACLC tear patterns and cofactors related to the articular disc, the deltoid-trapezoidal (DT) fascia and bony ACJ morphology. Articular disc size was quantified as 0 = absent, 1 = remnant, 2 = meniscoid and 3 = complete. All patients showed complete ruptures of the superior ACLC, which could be assigned to four different tear patterns. Clavicular-sided (AC-1) tears were observed in 46/65 (70.8 %), oblique (AC-2) tears in 12/65 (18.5 %), midportion (AC-3) tears in 3/65 (4.6 %) and acromial-sided (AC-4) tears in 4/65 (6.1 %) of cases. Articular disc size manifestation was significantly (P < .001) more pronounced in patients with AC-1 tears (1.89 ± 0.57) compared to patients with AC-2 tears (0.67 ± 0.89). Other cofactors did not influence ACLC tear patterns. ACLC dislocation with incarceration caused mechanical impediment to anatomical ACJ reduction in 14/65 (21.5 %) of cases including all Rockwood-4 dislocations. Avulsion "in continuity" was a consistent mode of failure of the DT fascia. Type-specific operative strategies enabled anatomical ACLC repair of all observed tear types. Acute ACLC injuries follow distinct tear patterns. There exist clavicular-sided (AC-1), oblique (AC-2), midportion (AC-3) and acromial-sided (AC-4) tears. Articular disc size was a determinant factor of ACLC tear morphology. Mini-open surgery was required in Rockwood-4 and a relevant proportion of Rockwood-5 dislocations to achieve both anatomical ACLC and ACJ reduction. Type-specific operative repair of acute ACLC tears might promote biological healing and lower rates of horizontal ACJ instability following acute ACJ reconstruction.

Superior labrum anterior to posterior tears and glenohumeral instability.

PubMed

Virk, Mandeep S; Arciero, Robert A

2013-01-01

Cadaver experiments and clinical studies suggest that the superior labrum-biceps complex plays a role in glenohumeral stability. Superior labrum anterior to posterior (SLAP) tears can be present in acute and recurrent glenohumeral dislocations and contribute to glenohumeral instability. Isolated SLAP tears can cause instability, especially in throwing athletes. Diagnosing a SLAP tear on the basis of the clinical examination alone is difficult because of nonspecific history and physical examination findings and the presence of coexisting intra-articular lesions. Magnetic resonance arthrography is the imaging study of choice for diagnosing SLAP tears; however, arthroscopy remains the gold standard for diagnosis. Arthroscopy is the preferred technique for the repair of a type II SLAP tear and its variant types (V through X) in acute glenohumeral dislocations and instability in younger populations. Clinical outcome studies report a low recurrence of glenohumeral instability after the arthroscopic repair of a SLAP tear in addition to a Bankart repair. Long-term follow-up studies and further advances in arthroscopic fixation techniques will allow a better understanding and improvement in outcomes in patients with SLAP tears associated with glenohumeral instability.

Interaction of lysozyme with a tear film lipid layer model: A molecular dynamics simulation study.

PubMed

Wizert, Alicja; Iskander, D Robert; Cwiklik, Lukasz

2017-12-01

The tear film is a thin multilayered structure covering the cornea. Its outermost layer is a lipid film underneath of which resides on an aqueous layer. This tear film lipid layer (TFLL) is itself a complex structure, formed by both polar and nonpolar lipids. It was recently suggested that due to tear film dynamics, TFLL contains inhomogeneities in the form of polar lipid aggregates. The aqueous phase of tear film contains lachrymal-origin proteins, whereby lysozyme is the most abundant. These proteins can alter TFLL properties, mainly by reducing its surface tension. However, a detailed nature of protein-lipid interactions in tear film is not known. We investigate the interactions of lysozyme with TFLL in molecular details by employing coarse-grained molecular dynamics simulations. We demonstrate that lysozyme, due to lateral restructuring of TFLL, is able to penetrate the tear lipid film embedded in inverse micellar aggregates. Copyright © 2017 Elsevier B.V. All rights reserved.

Forced tearing of ductile and brittle thin sheets.

PubMed

Tallinen, T; Mahadevan, L

2011-12-09

Tearing a thin sheet by forcing a rigid object through it leads to complex crack morphologies; a single oscillatory crack arises when a tool is driven laterally through a brittle sheet, while two diverging cracks and a series of concertinalike folds forms when a tool is forced laterally through a ductile sheet. On the other hand, forcing an object perpendicularly through the sheet leads to radial petallike tears in both ductile and brittle materials. To understand these different regimes we use a combination of experiments, simulations, and simple theories. In particular, we describe the transition from brittle oscillatory tearing via a single crack to ductile concertina tearing with two tears by deriving laws that describe the crack paths and wavelength of the concertina folds and provide a simple phase diagram for the morphologies in terms of the material properties of the sheet and the relative size of the tool.

Antibody Protein Array Analysis of the Tear Film Cytokines

PubMed Central

Li, Shimin; Sack, Robert; Vijmasi, Trinka; Sathe, Sonal; Beaton, Ann; Quigley, David; Gallup, Marianne; McNamara, Nancy A.

2013-01-01

Purpose Many bioactive proteins including cytokines are reported to increase in dry eye disease although the specific profile and concentration of inflammatory mediators varies considerably from study to study. In part this variability results from inherent difficulties in quantifying low abundance proteins in a limited sample volume using relatively low sensitivity dot ELISA methods. Additional complexity comes with the use of pooled samples collected using a variety of techniques and intrinsic variation in the diurnal pattern of individual tear proteins. The current study describes a recent advance in the area of proteomics that has allowed the identification of dozens of low abundance proteins in human tear samples. Methods Commercially available stationary phase antibody protein arrays were adapted to improve suitability for use in small volume biological fluid analysis with particular emphasis on tear film proteomics. Arrays were adapted to allow simultaneous screening for a panel of inflammatory cytokines in low volume tear samples collected from individual eyes. Results A preliminary study comparing tear array results in a small population of Sjögren’s syndrome patients was conducted. The multiplex microplate array assays of cytokines in tear fluid present an unanticipated challenge due to the unique nature of tear fluid. The presence of factors that exhibit an affinity for plastic, capture antibodies and IgG and create a complex series of matrix effects profoundly impacting the reliability of dot ELISA, including with elevated levels of background reactivity and reduction in capacity to bind targeted protein. Conclusions Preliminary results using tears collected from patients with Sjögren’s syndrome reveal methodological advantages of protein array technology and support the concept that autoimmune-mediated dry eye disease has an inflammatory component. They also emphasize the inherent difficulties one can face when interpreting the results of micro-well arrays that result from blooming effects, matrix effects, image saturation and cross-talk between capture and probe antibodies that can greatly reduce signal-to-noise and limit the ability to obtain meaningful results. PMID:18677223

Contact lens physical properties and lipid deposition in a novel characterized artificial tear solution

PubMed Central

Heynen, Miriam; Kay, Lise M.M.; Dominici, Claudia Yvette; Khan, Warda; Ng, Wendy W.S.; Jones, Lyndon

2011-01-01

Purpose To characterize various properties of a physiologically-relevant artificial tear solution (ATS) containing a range of tear film components within a complex salt solution, and to measure contact lens parameters and lipid deposition of a variety of contact lens materials after incubation in this ATS. Methods A complex ATS was developed that contains a range of salts, proteins, lipids, mucin, and other tear film constituents in tear-film relevant concentrations. This ATS was tested to confirm that its pH, osmolality, surface tension, and homogeneity are similar to human tears and remain so throughout the material incubation process, for up to 4 weeks. To confirm that silicone hydrogel and conventional hydrogel contact lens materials do not alter in physical characteristics beyond what is allowed by the International Organization for Standardization (ISO) 18369–2. The diameter, center thickness, and calculated base curve were measured for five different lens materials directly out of the blister pack, after a rinse in saline and then following a two week incubation in the modified ATS. To test the ATS and the effect of its composition on lipid deposition, two lens materials were incubated in the ATS and a modified version for several time points. Both ATS solutions contained trace amounts of carbon-14 cholesterol and phosphatidylcholine, such that deposition of these specific lipids could be quantified using standard methods. Results This ATS is a complex mixture that remains stable at physiologically relevant pH (7.3–7.6), osmolality (304–306 mmol/kg), surface tension (40–46 dynes/cm) and homogeneity over an incubation period of three weeks or more. The physical parameters of the lenses tested showed no changes beyond that allowed by the ISO guidelines. Incubations with the ATS found that balafilcon A lenses deposit significantly more cholesterol and phosphatidylcholine than omafilcon A lenses (p<0.05) and that removing lactoferrin and immunoglobulin G from the ATS can significantly decrease the mass of lipid deposited. Conclusions This paper describes a novel complex artificial tear solution specially designed for in-vial incubation of contact lens materials. This solution was stable and did not adversely affect the physical parameters of the soft contact lenses incubated within it and showed that lipid deposition was responsive to changes in ATS composition. PMID:22219635

Partial Thickness Rotator Cuff Tears: Current Concepts

PubMed Central

Matthewson, Graeme; Beach, Cara J.; Nelson, Atiba A.; Woodmass, Jarret M.; Ono, Yohei; Boorman, Richard S.; Lo, Ian K. Y.; Thornton, Gail M.

2015-01-01

Partial thickness rotator cuff tears are a common cause of pain in the adult shoulder. Despite their high prevalence, the diagnosis and treatment of partial thickness rotator cuff tears remains controversial. While recent studies have helped to elucidate the anatomy and natural history of disease progression, the optimal treatment, both nonoperative and operative, is unclear. Although the advent of arthroscopy has improved the accuracy of the diagnosis of partial thickness rotator cuff tears, the number of surgical techniques used to repair these tears has also increased. While multiple repair techniques have been described, there is currently no significant clinical evidence supporting more complex surgical techniques over standard rotator cuff repair. Further research is required to determine the clinical indications for surgical and nonsurgical management, when formal rotator cuff repair is specifically indicated and when biologic adjunctive therapy may be utilized. PMID:26171251

Time-dependent Fracture Behaviour of Polyampholyte Hydrogels

NASA Astrophysics Data System (ADS)

Sun, Tao Lin; Luo, Feng; Nakajima, Tasuku; Kurokawa, Takayuki; Gong, Jian Ping

Recently, we report that polyampholytes, polymers bearing randomly dispersed cationic and anionic repeat groups, form tough and self-healing hydrogels with excellent multiple mechanical functions. The randomness makes ionic bonds with a wide distribution of strength, via inter and intra chain complexation. As the breaking and reforming of ionic bonds are time dependent, the hydrogels exhibit rate dependent mechanical behaviour. We systematically studied the tearing energy by tearing test with various tearing velocity under different temperature, and the linear viscoelastic behaviour over a wide range of frequency and temperature. Results have shown that the tearing energy markedly increase with the crack velocity and decrease with the measured temperature. In accordance with the prediction of Williams, Landel, and Ferry (WLF) rate-temperature equivalence, a master curve of tearing energy dependence of crack velocity can be well constructed using the same shift factor from the linear viscoelastic data. The scaling relation of tearing energy as a function of crack velocity can be predicted well by the rheological data according to the developed linear fracture mechanics.

Quantitative analysis of tear film fluorescence and discomfort during tear film instability and thinning.

PubMed

Begley, Carolyn; Simpson, Trefford; Liu, Haixia; Salvo, Eliza; Wu, Ziwei; Bradley, Arthur; Situ, Ping

2013-04-12

The purpose of this study was to test the association between tear film fluorescence changes during tear break-up (TBU) or thinning and the concurrent ocular sensory response. Sixteen subjects kept one eye open as long as possible (MBI), indicated their discomfort level continuously, and rated ocular sensations of irritation, stinging, burning, pricking, and cooling using visual analog scales (VAS). Fluorescence of the tear film was quantified by a pixel-based analysis of the median pixel intensity (PI), TBU, and percentage of dark pixels (DarkPix) over time. A cutoff of 5% TBU was used to divide subjects into either break-up (BU) or minimal break-up (BUmin) groups. Tear film fluorescence decreased (median PI) and the percentage of TBU and DarkPix increased in all trials, with the rate significantly greater in the BU than the BUmin group (Mann-Whitney U test, P < 0.05). The rate of increasing discomfort during trials was highly correlated with the rate of decrease in median PI and developing TBU (Spearman's, r ≥ 0.70). Significant correlations were found between corneal fluorescence, MBI, and sensory measures. Concentration quenching of fluorescein dye with tear film thinning best explains decreasing tear film fluorescence during trials. This was highly correlated with increasing ocular discomfort, suggesting that both tear film thinning and TBU stimulate underlying corneal nerves, although TBU produced more rapid stimulation. Slow increases in tear film hyperosmolarity may cause the gradual increase in discomfort during slow tear film thinning, whereas the sharp increases in discomfort during TBU suggest a more complex stimulus.

Posterior Root Meniscal Tears: Preoperative, Intraoperative, and Postoperative Imaging for Transtibial Pullout Repair.

PubMed

Palisch, Andrew R; Winters, Ronald R; Willis, Marc H; Bray, Collin D; Shybut, Theodore B

2016-10-01

The menisci play an important biomechanical role in axial load distribution of the knees by means of hoop strength, which is contingent on intact circumferentially oriented collagen fibers and meniscal root attachments. Disruption of the meniscal root attachments leads to altered biomechanics, resulting in progressive cartilage loss, osteoarthritis, and subchondral edema, with the potential for development of a subchondral insufficiency fracture. Identification of meniscal root tears at magnetic resonance (MR) imaging is crucial because new arthroscopic surgical techniques (transtibial pullout repair) have been developed to repair meniscal root tears and preserve the tibiofemoral cartilage of the knee. An MR imaging classification of posterior medial meniscal root ligament lesions has been recently described that is dedicated to the posterior root of the medial meniscus. An arthroscopic classification of meniscal root tears has been described that can be applied to the anterior and posterior roots of both the medial meniscus and the lateral meniscus. This arthroscopic classification includes type 1, partial stable root tears; type 2, complete radial root tears; type 3, vertical longitudinal bucket-handle tears; type 4, complex oblique tears; and type 5, bone avulsion fractures of the root attachments. Knowledge of these classifications and the potential contraindications to meniscal root repair can aid the radiologist in the preoperative reporting of meniscal root tear types and the evaluation of the tibiofemoral cartilage. As more patients undergo arthroscopic repair of meniscal root tears, familiarity with the surgical technique and the postoperative radiographic and MR imaging appearance is important to adequately report the imaging findings. © RSNA, 2016.

Tearfulness: a psychoanalytic interpretation.

PubMed

Wood, E C; Wood, C D

1984-01-01

In our view, the tearful feeling state is occasioned by the ego temporarily threatened with being inundated by complex memories and affects. For the moment, the ego cannot provide appropriate satisfying and integrated verbal expression. Words and verbal thinking are delayed. In this brief period, a controlled regression occurs during which the ego relates the current "precipitating experience" to temporally older conflictual experiences in the presence of the current object as a transference object and with a series of relationships so closely connected to that experience that they are interchanged in whole or part by the less selective, regressed, ego operations. The conscious experience may be sadness, gratitude, love, pride, or joy. But beneath these, there is the controlled regression, which interrupts verbal expression while the ego works through the earlier related conflicts,now remembered. The tearful feeling, a step in the direction of overt weeping, primitively expresses the frustration of an early wish for relief from pain, the pain of the imbalance of a complex conflict. The tearful feeling both expresses the wish for relief of pain and, at the same time, interrupts current verbal expression until the needed defense operations reduce the threat of ego disruption by working through old conflicts once again. Our thesis, then, is that within the analytic or psychotherapeutic hour the patient's feeling of tearfulness is a "too much" ego phenomenon that leads to a psychophysiological outlet.

Randomized Controlled Study to Investigate the Effect of Topical Diquafosol Tetrasodium on Corneal Sensitivity in Short Tear Break-Up Time Dry Eye.

PubMed

Kaido, Minako; Kawashima, Motoko; Shigeno, Yuta; Yamada, Yoshiaki; Tsubota, Kazuo

2018-05-01

Complex mechanisms underlie dry eye (DE) symptom provocation. In particular, corneal hypersensitivity may provoke symptoms in short tear break-up time (BUT) DE characterized by tear film instability. We hypothesized that improved tear film stability may alleviate corneal sensitivity in patients with short tear BUT DE. Therefore, we investigated the effect of topical diquafosol tetrasodium (DQS) on corneal sensitivity in unstable tear film DE. This prospective, randomized study included 27 subjects (age: 39.1 ± 8.4 years; range: 25-59 years) with short tear BUT DE, defined based on the presence of DE symptoms and tear film instability. Subjects were randomly divided into DQS (3% DQS, 12 subjects) and artificial tear (AT; preservative-free AT, 15 subjects) groups. Subjects applied the medication 6 times a day for 5 weeks. The perception of touch (S-touch) and pain (S-pain) sensitivity was measured using a Cochet-Bonnet esthesiometer. Tear evaluation, corneal sensitivity, and DE symptoms were compared before and after DQS or AT administration. The correlation between the improvement degrees of corneal sensitivity and DE symptoms following medication was analyzed. DQS significantly improved tear BUT and tear meniscus height (TMH) scores (p < 0.05), while AT significantly improved tear BUT (p < 0.05) but not TMH score. Mean S-pain and DE symptom scores were lower after medication use in the DQS (S-pain and DE symptoms: p  < 0.05) and AT groups (S-pain: p  = 0.05; DE symptoms: p  < 0.05). However, S-touch did not change significantly in either group. A positive correlation was observed between the improvement degrees of S-pain and DE symptoms in the overall subjects studied. Both DQS and AT alleviate corneal hypersensitivity and DE symptoms in eyes with short tear BUT DE. However, DQS seems to be more effective to adjust tear environment, leading to the normalization of corneal sensitivity and DE symptoms. UMIN Clinical Trials Registry Identifier, UMIN000014536.

[Effects of creating a tunnel through intercondylar fossa under arthroscopy for the treatment of complex tears at the medial meniscus posterior horn].

PubMed

Dong, Ling-Dai; Bing, Chang-Jian; Li, Jian-Lin; Cai, Yue

2017-04-25

To discuss the advantages of the arthroscopic treatment for complex tears of the medial meniscus posterior horn by creating a tunnel passageway through the intercondylar fossa. All 127 patients including 24 males and 103 females with complex tears at the medial meniscus posterior horn were reviewed. The age of all patients ranged from 45 to 78 years old, with an average of 67 years old. All 127 patients were treated with partial meniscectomy, in which 112 patients were treated with partial meniscectomy smoothly with three incisions (anterior medial incision, anterior lateral incision, high anterior lateral incision), and 15 patients were treated with four incisions (anterior medial incision, anterior lateral incision, high anterior lateral incision, posterior medial incision). Four aspects were estimated:whether the meniscus posterior horns could be observed totally and conveniently, whether tools could be pushed to target area conveniently, the damage of adjacent cartilages, operation time(the operation time of partial meniscectomy). Posterior horns of all patients were totally and conveniently observed, tools were conveniently pushed to the target area in all cases, and all the cases had no iatrogenic injuries at adjacent cartilages. The operation time of partial meniscectomy at posterior horns with three incisions ranged from 5 to 10 minutes, and it ranged from 10 to 30 minutes with four incisions. It is very convenient and fast of the arthroscopy to treat complex tears of the medial meniscus posterior horn by creating a tunnel through the intercondylor fossa. Iatrogenic injuries of the adjacent cartilages were prevented to the greatest extent.

Behavior of sphingomyelin and ceramide in a tear film lipid layer model.

PubMed

Olżyńska, Agnieszka; Cwiklik, Lukasz

2017-03-01

Tear film lipid layer is a complex lipid mixture forming the outermost interface between eye and environment. Its key characteristics, such as surface tension and structural stability, are governed by the presence of polar lipids. The origin of these lipids and exact composition of the mixture are still elusive. We focus on two minor polar lipid components of the tear film lipid later: sphingomyelin and ceramide. By employing coarse grain molecular dynamics in silico simulations accompanied by Langmuir balance experiments we provide molecular-level insight into behavior of these two lipids in a tear film lipid layer model. Sphingomyelin headgroups are significantly exposed at the water-lipids boundary while ceramide molecules are incorporated between other lipids frequently interacting with nonpolar lipids. Even though these two lipids increase surface tension of the film, their molecular-level behavior suggests that they have a stabilizing effect on the tear film lipid layer. Copyright © 2016 Elsevier GmbH. All rights reserved.

The Implications of Strike-Slip Earthquake Source Properties on the Transform Boundary Development Process

NASA Astrophysics Data System (ADS)

Neely, J. S.; Huang, Y.; Furlong, K.

2017-12-01

Subduction-Transform Edge Propagator (STEP) faults, produced by the tearing of a subducting plate, allow us to study the development of a transform plate boundary and improve our understanding of both long-term geologic processes and short-term seismic hazards. The 280 km long San Cristobal Trough (SCT), formed by the tearing of the Australia plate as it subducts under the Pacific plate near the Solomon and Vanuatu subduction zones, shows along-strike variations in earthquake behaviors. The segment of the SCT closest to the tear rarely hosts earthquakes > Mw 6, whereas the SCT sections more than 80 - 100 km from the tear experience Mw7 earthquakes with repeated rupture along the same segments. To understand the effect of cumulative displacement on SCT seismicity, we analyze b-values, centroid-time delays and corner frequencies of the SCT earthquakes. We use the spectral ratio method based on Empirical Green's Functions (eGfs) to isolate source effects from propagation and site effects. We find high b-values along the SCT closest to the tear with values decreasing with distance before finally increasing again towards the far end of the SCT. Centroid time-delays for the Mw 7 strike-slip earthquakes increase with distance from the tear, but corner frequency estimates for a recent sequence of Mw 7 earthquakes are approximately equal, indicating a growing complexity in earthquake behavior with distance from the tear due to a displacement-driven transform boundary development process (see figure). The increasing complexity possibly stems from the earthquakes along the eastern SCT rupturing through multiple asperities resulting in multiple moment pulses. If not for the bounding Vanuatu subduction zone at the far end of the SCT, the eastern SCT section, which has experienced the most displacement, might be capable of hosting larger earthquakes. When assessing the seismic hazard of other STEP faults, cumulative fault displacement should be considered a key input in determining potential earthquake size.

The effect of Meibomian lipids and tear proteins on evaporation rate under controlled in vitro conditions.

PubMed

Herok, George Henryk; Mudgil, Poonam; Millar, Thomas James

2009-07-01

The lipid layer of the tear film is associated with preventing evaporative loss. The ability of human Meibomian lipids to reduce evaporation in vitro was tested. Films of human or animal Meibomian lipids or mixtures of cholesterol and phosphatidylcholine were spread on the surface of either artificial buffer or on whole tears and placed on a mass balance that was enclosed in a sealed chamber. The temperature was adjusted to 37 degrees C and gas flow was controlled. Increasing the amounts of Meibomian lipids gave a very small reduction in evaporation. It was concluded from these in vitro experiments that prevention of evaporation from the tear film is not due to the Meibomian lipids alone, but is more likely to be due to a complex interaction between components of the aqueous and the Meibomian lipids.

A novel capsulorhexis technique using shearing forces with cystotome.

PubMed

Karim, Shah M R; Ong, Chin T; Sleep, Tamsin J

2010-05-15

To demonstrate a capsulorhexis technique using predominantly shearing forces with a cystotome on a virtual reality simulator and on a human eye. Our technique involves creating the initial anterior capsular tear with a cystotome to raise a flap. The flap left unfolded on the lens surface. The cystotome tip is tilted horizontally and is engaged on the flap near the leading edge of the tear. The cystotome is moved in a circular fashion to direct the vector forces. The loose flap is constantly swept towards the centre so that it does not obscure the view on the tearing edge. Our technique has the advantage of reducing corneal wound distortion and subsequent anterior chamber collapse. The capsulorhexis flap is moved away from the tear leading edge allowing better visualisation of the direction of tear. This technique offers superior control of the capsulorhexis by allowing the surgeon to change the direction of the tear to achieve the desired capsulorhexis size. The EYESI Surgical Simulator is a realistic training platform for surgeons to practice complex capsulorhexis techniques. The shearing forces technique is a suitable alternative and in some cases a far better technique in achieving the desired capsulorhexis.

Realistic facial expression of virtual human based on color, sweat, and tears effects.

PubMed

Alkawaz, Mohammed Hazim; Basori, Ahmad Hoirul; Mohamad, Dzulkifli; Mohamed, Farhan

2014-01-01

Generating extreme appearances such as scared awaiting sweating while happy fit for tears (cry) and blushing (anger and happiness) is the key issue in achieving the high quality facial animation. The effects of sweat, tears, and colors are integrated into a single animation model to create realistic facial expressions of 3D avatar. The physical properties of muscles, emotions, or the fluid properties with sweating and tears initiators are incorporated. The action units (AUs) of facial action coding system are merged with autonomous AUs to create expressions including sadness, anger with blushing, happiness with blushing, and fear. Fluid effects such as sweat and tears are simulated using the particle system and smoothed-particle hydrodynamics (SPH) methods which are combined with facial animation technique to produce complex facial expressions. The effects of oxygenation of the facial skin color appearance are measured using the pulse oximeter system and the 3D skin analyzer. The result shows that virtual human facial expression is enhanced by mimicking actual sweating and tears simulations for all extreme expressions. The proposed method has contribution towards the development of facial animation industry and game as well as computer graphics.

Realistic Facial Expression of Virtual Human Based on Color, Sweat, and Tears Effects

PubMed Central

Alkawaz, Mohammed Hazim; Basori, Ahmad Hoirul; Mohamad, Dzulkifli; Mohamed, Farhan

2014-01-01

Generating extreme appearances such as scared awaiting sweating while happy fit for tears (cry) and blushing (anger and happiness) is the key issue in achieving the high quality facial animation. The effects of sweat, tears, and colors are integrated into a single animation model to create realistic facial expressions of 3D avatar. The physical properties of muscles, emotions, or the fluid properties with sweating and tears initiators are incorporated. The action units (AUs) of facial action coding system are merged with autonomous AUs to create expressions including sadness, anger with blushing, happiness with blushing, and fear. Fluid effects such as sweat and tears are simulated using the particle system and smoothed-particle hydrodynamics (SPH) methods which are combined with facial animation technique to produce complex facial expressions. The effects of oxygenation of the facial skin color appearance are measured using the pulse oximeter system and the 3D skin analyzer. The result shows that virtual human facial expression is enhanced by mimicking actual sweating and tears simulations for all extreme expressions. The proposed method has contribution towards the development of facial animation industry and game as well as computer graphics. PMID:25136663

Arthroscopic and magnetic resonance imaging evaluation of meniscus lesions in the chronic anterior cruciate ligament-deficient knee.

PubMed

Naranje, Sameer; Mittal, Ravi; Nag, Hiralal; Sharma, Raju

2008-09-01

We performed this prospective study to evaluate the incidence of meniscus tears arthroscopically and the effectiveness of magnetic resonance imaging (MRI) in detecting these lesions in patients with chronic anterior cruciate ligament (ACL)-deficient knees. We reviewed 50 patients (46 male and 4 female) with a mean age of 27 years (range, 18 to 48 years) who underwent ACL reconstruction for chronic ACL tears. Injuries were classified as chronic because arthroscopy was performed after more than 6 weeks of injury. All 50 patients had clinical and MRI evaluation followed by knee arthroscopy. The MRI and arthroscopic findings were then analyzed by a single independent reviewer. The presence of meniscus tears and their morphologic types and locations were analyzed. The sensitivity, specificity, positive predictive value, and negative predictive value of MRI were calculated. On arthroscopy, a medial meniscus tear was found in 18 patients (36%), a lateral meniscus tear was found in 11 patients (22%), both menisci were torn in 8 patients (16%), and no meniscus lesion was found in 13 patients (26%). The most common morphologic type of tear seen in the medial meniscus was "complex" (n = 11 [42%]), and that in the lateral meniscus was "longitudinal" (n = 10 [53%]). The posterior horn of the meniscus was the most common tear site. The overall sensitivity, specificity, positive predictive value, and negative predictive value for detecting meniscus tears in chronic ACL-deficient knees on MRI were 90%, 89%, 87%, 93%, respectively. We conclude from our study that in chronic ACL-deficient patients, the prevalence of posterior horn medial meniscus tears seems to be high. Anterior horn tears and radial and horizontal patterns of meniscus tears seem to be rare in chronic ACL deficiency. MRI correlates well with arthroscopy and has high negative predictive values. Level I, prognostic prospective study.

Tear glucose detection combining microfluidic thread based device, amperometric biosensor and microflow injection analysis.

PubMed

Agustini, Deonir; Bergamini, Márcio F; Marcolino-Junior, Luiz Humberto

2017-12-15

The tear glucose analysis is an important alternative for the indirect, simple and less invasive monitoring of blood glucose levels. However, the high cost and complex manufacturing process of tear glucose analyzers combined with the need to exchange the sensor after each analysis in the disposable tests prevent widespread application of the tear in glucose monitoring. Here, we present the integration of a biosensor made by the electropolymerization of poly(toluidine blue O) (PTB) and glucose oxidase (GOx) with an electroanalytical microfluidic device of easy assembly based on cotton threads, low cost materials and measurements by microflow injection analysis (µFIA) through passive pumping for performing tear glucose analyses in a simple, rapid and inexpensive way. A high stability between the analyses (RSD = 2.54%) and among the different systems (RSD = 3.13%) was obtained for the determination of glucose, in addition to a wide linear range between 0.075 and 7.5mmolL -1 and a limit of detection of 22.2µmolL -1 . The proposed method was efficiently employed in the determination of tear glucose in non-diabetic volunteers, obtaining a close correlation with their blood glucose levels, simplifying and reducing the costs of the analyses, making the tear glucose monitoring more accessible for the population. Copyright © 2017 Elsevier B.V. All rights reserved.

Evaluation of commercial glucometer test strips for potential measurement of glucose in tears.

PubMed

Cha, Kyoung Ha; Jensen, Gary C; Balijepalli, Anant S; Cohan, Bruce E; Meyerhoff, Mark E

2014-02-04

Tear glucose measurements have been suggested as a potential alternative to blood glucose monitoring for diabetic patients. While previous work has reported that there is a correlation between blood and tear glucose levels in humans, this link has not been thoroughly established and additional clinical studies are needed. Herein, we evaluate the potential of using commercial blood glucose test strips to measure glucose in tears. Of several blood glucose strips evaluated, only one brand exhibits the low detection limit required for quantitating glucose in tears. Calibration of these strips in the range of 0-100 μM glucose with an applied potential of 150 mV to the working electrode yields a sensitivity of 0.127 nA/μM and a limit of quantitation (LOQ) of 9 μM. The strips also exhibit ≤13% error (n = 3) for 25, 50, and 75 μM glucose in the presence of 10 μM acetaminophen, 100 μM ascorbic acid, and 100 μM uric acid. Measurements of glucose in tears from nine normal (nondiabetic) fasting human subjects using strips yielded glucose values within the range of 5-148 μM (mean = 47 μM, median = 43 μM), similar to those for human tears reported by others with more complex LC-MS methods. The glucometer strip method could facilitate more clinical studies to determine whether tear glucose and blood glucose levels sufficiently correlate for application to routine measurements in tears to supplement blood glucose testing. This would be especially helpful for children, adolescents, other Type 1 diabetics, and also for Type 2 diabetics who require treatment with insulin and cannot tolerate multiple finger sticks per day.

Computational Failure Modeling of Lower Extremities

DTIC Science & Technology

2012-01-01

bone fracture, ligament tear, and muscle rupture . While these injuries may seem well-defined through medical imaging, the process of injury and the...to vehicles from improvised explosives cause severe injuries to the lower extremities, in- cluding bone fracture, ligament tear, and muscle rupture ...modeling offers a powerful tool to explore the insult-to-injury process with high-resolution. When studying a complex dynamic process such as this, it is

The performance of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury: a meta-analysis.

PubMed

Wang, Z X; Chen, S L; Wang, Q Q; Liu, B; Zhu, J; Shen, J

2015-06-01

The aim of this study was to evaluate the accuracy of magnetic resonance imaging in the detection of triangular fibrocartilage complex injury through a meta-analysis. A comprehensive literature search was conducted before 1 April 2014. All studies comparing magnetic resonance imaging results with arthroscopy or open surgery findings were reviewed, and 25 studies that satisfied the eligibility criteria were included. Data were pooled to yield pooled sensitivity and specificity, which were respectively 0.83 and 0.82. In detection of central and peripheral tears, magnetic resonance imaging had respectively a pooled sensitivity of 0.90 and 0.88 and a pooled specificity of 0.97 and 0.97. Six high-quality studies using Ringler's recommended magnetic resonance imaging parameters were selected for analysis to determine whether optimal imaging protocols yielded better results. The pooled sensitivity and specificity of these six studies were 0.92 and 0.82, respectively. The overall accuracy of magnetic resonance imaging was acceptable. For peripheral tears, the pooled data showed a relatively high accuracy. Magnetic resonance imaging with appropriate parameters are an ideal method for diagnosing different types of triangular fibrocartilage complex tears. © The Author(s) 2015.

Glenohumeral instability: evaluation with MR arthrography.

PubMed

Beltran, J; Rosenberg, Z S; Chandnani, V P; Cuomo, F; Beltran, S; Rokito, A

1997-01-01

Magnetic resonance arthrography is superior to other imaging techniques in evaluation of the glenohumeral joint. Normal variants that can be diagnostic pitfalls include the anterosuperior sublabral foramen, the Buford complex, and hyaline cartilage under the labrum. Anteroinferior dislocation is the most frequent cause of anterior glenohumeral instability and produces a constellation of lesions (anteroinferior labral tear, classic and osseous Bankart lesions, Hill-Sachs lesion). Variants of anteroinferior labral tears include anterior labroligamentous periosteal sleeve avulsion and glenoid labral articular disruption. Anterior glenohumeral instability can also involve tears of the anterior or anterosuperior labrum or the glenohumeral ligaments. Posterior glenohumeral instability can involve a posterior labral tear, posterior capsular stripping or laxity; fracture, erosion, or sclerosis and ectopic ossification of the posterior glenoid fossa; reverse Hill-Sachs lesion; McLaughlin fracture; or posterosuperior glenoid impingement. Superior labral anterior and posterior lesions involve the superior labrum with varying degrees of biceps tendon involvement.

Treatment of Refractory Filamentary Keratitis With Autologous Serum Tears.

PubMed

Read, Sarah P; Rodriguez, Marianeli; Dubovy, Sander; Karp, Carol L; Galor, Anat

2017-09-01

To report a case of filamentary keratitis (FK) successfully treated with autologous serum tears and to review the pathogenesis and management of FK. Case report including high-resolution anterior segment optical coherence tomography and filament histopathology. A 61-year-old Hispanic man presented with pain and photophobia of the right eye. He was found to have a corneal epithelial defect and a small peripheral infiltrate 4 months after Laser Assisted in situ Keratomileusis. After resolution of the epithelial defect, he developed FK. Over a 4-month period, conservative management with aggressive lubrication, lid hygiene, topical corticosteroids, topical cyclosporine, bandage contact lenses, and oral doxycycline failed to resolve the corneal filaments. Notably, treatment with 20% autologous serum tears, four times daily, led to a sustained resolution of the FK within 1 week. This case demonstrates the complexity of FK management and introduces autologous serum tears as a viable management option when conservative approaches to this condition fail.

A two-fluid study of oblique tearing modes in a force-free current sheet

DOE Office of Scientific and Technical Information (OSTI.GOV)

Akçay, Cihan, E-mail: akcay@lanl.gov; Daughton, William; Lukin, Vyacheslav S.

2016-01-15

Kinetic simulations have demonstrated that three-dimensional reconnection in collisionless regimes proceeds through the formation and interaction of magnetic flux ropes, which are generated due to the growth of tearing instabilities at multiple resonance surfaces. Since kinetic simulations are intrinsically expensive, it is desirable to explore the feasibility of reduced two-fluid models to capture this complex evolution, particularly, in the strong guide field regime, where two-fluid models are better justified. With this goal in mind, this paper compares the evolution of the collisionless tearing instability in a force-free current sheet with a two-fluid model and fully kinetic simulations. Our results indicatemore » that the most unstable modes are oblique for guide fields larger than the reconnecting field, in agreement with the kinetic results. The standard two-fluid tearing theory is extended to address the tearing instability at oblique angles. The resulting theory yields a flat oblique spectrum and underestimates the growth of oblique modes in a similar manner to kinetic theory relative to kinetic simulations.« less

The presence and significance of polar meibum and tear lipids.

PubMed

Pucker, Andrew D; Haworth, Kristina M

2015-01-01

The ocular tear film is a complex structure composed of a number of elements. While all of these components serve valuable functional and structural roles, the external lipid layer has been a focus because it is known to play a critical role in dry eye. Traditionally, meibomian gland phospholipids have been considered to be the vital amphiphilic molecules needed to create an interphase between the outer nonpolar lipid layer and inner aqueous layers, yet recent work has called this theory into question. The purpose of this review is to clarify the current understanding of the origins, identity, and significance of polar tear lipids. Studies indicate that both phospholipids and ω-hydroxy fatty acids likely play a critical role in tear film stability. Studies also indicate that polar lipids likely originate from multiple sources and that they are integrally involved in ocular surface disease. Additional studies are needed to fully understand the origins and significance of polar tear lipids, because to date only correlational evidence has described their hypothesized origins and functions. Copyright © 2015 Elsevier Inc. All rights reserved.

A two-fluid study of oblique tearing modes in a force-free current sheet

DOE PAGES

Akçay, Cihan; Daughton, William; Lukin, Vyacheslav S.; ...

2016-01-01

Kinetic simulations have demonstrated that three-dimensional reconnection in collisionless regimes proceeds through the formation and interaction of magnetic flux ropes, which are generated due to the growth of tearing instabilities at multiple resonance surfaces. Because kinetic simulations are intrinsically expensive, it is desirable to explore the feasibility of reduced two-fluid models to capture this complex evolution, particularly, in the strong guide field regime, where two-fluid models are better justified. With this goal in mind, this paper compares the evolution of the collisionless tearing instability in a force-free current sheet with a two-fluid model and fully kinetic simulations. Our results indicatemore » that the most unstable modes are oblique for guide fields larger than the reconnecting field, in agreement with the kinetic results. The standard two-fluid tearing theory is extended to address the tearing instability at oblique angles. As a results this theory yields a flat oblique spectrum and underestimates the growth of oblique modes in a similar manner to kinetic theory relative to kinetic simulations.« less

Complex Meniscus Tears Treated with Collagen Matrix Wrapping and Bone Marrow Blood Injection

PubMed Central

Piontek, Tomasz; Ciemniewska-Gorzela, Kinga; Naczk, Jakub; Jakob, Roland; Szulc, Andrzej; Grygorowicz, Monika; Slomczykowski, Michal

2015-01-01

Objective To collect and analyze the 2-year follow-up clinical and MRI results of patients treated with an arthroscopic technique of collagen membrane-based meniscus repair. Design 53 consecutive patients with combined (horizontal and radial or longitudinal component) and complex meniscal tears (tear extended through avascular zones or/and composed with two or more morphological tear pattern) were treated with an “all-inside” arthroscopic suture of meniscus and wrapping with a collagen membrane (Chondro-Gide) technique with bone marrow blood injection. The IKDC 2000 subjective score, IKDC 2000 clinical evaluation score, Lysholm score and Barret clinical criteria of meniscal healing were recorded. All patients were examinated by MRI 2 years postoperatively, using modified WORMS criteria for meniscal integrity. Results The 2 year follow-up was achieved in 50 cases. Of these, 2 patients were excluded from the evaluation due to incomplete data and 2 patients underwent partial meniscectomy and were classified as failures. In 46 patients (86.8% of the intended to treat cases), a statistically significant improvement in IKDC 2000 subjective, Lysholm scores and IKDC 2000 clinical assessment between preoperative and the 2-year follow-up time points were obsereved. Barret criteria demonstrated an improved clinical outcome between pre- and post-operative values. MRI revealed a non-homogeneous signal without meniscal tear (WORMS grade 1) in 76% of the operated menisci (13% WORMS grade 2). Conclusions The 2-year follow-up data demonstrate that this technique is safe and can offer an additional tool to save the meniscus in the patients otherwise scheduled for meniscal removal. Level of evidence IV PMID:27047635

Tearing modes induced by perpendicular electron cyclotron resonance heating in the KSTAR tokamak

NASA Astrophysics Data System (ADS)

Lee, H. H.; Lee, S. G.; Seol, J.; Aydemir, A. Y.; Bae, C.; Yoo, J. W.; Na, Y. S.; Kim, H. S.; Woo, M. H.; Kim, J.; Joung, M.; You, K. I.; Park, B. H.

2014-10-01

This paper reports on experimental evidence that shows perpendicular electron cyclotron resonance heating (ECRH) can trigger classical tearing modes when deposited near a rational flux surface. The complex evolution of an m = 2 island is followed during current ramp-up in KSTAR plasmas, from its initial onset as the rational surface enters the ECRH resonance layer to its eventual lock on the wall after the rational surface leaves the layer. Stability analysis coupled to a transport calculation of the current profile with ECRH shows that the perpendicular ECRH may play a significant role in triggering and destabilizing classical m = 2 tearing modes, in agreement with our experimental observation.

Coupled thermal stress simulations of ductile tearing

DOE PAGES

Neilsen, Michael K.; Dion, Kristin

2016-03-01

Predictions for ductile tearing of a geometrically complex Ti-6Al-4V plate were generated using a Unified Creep Plasticity Damage model in fully coupled thermal stress simulations. Uniaxial tension and butterfly shear tests performed at displacement rates of 0.0254 and 25.4 mm/s were also simulated. Results from these simulations revealed that the material temperature increase due to plastic work can have a dramatic effect on material ductility predictions in materials that exhibit little strain hardening. Furthermore, this occurs because the temperature increase causes the apparent hardening of the material to decrease which leads to the initiation of deformation localization and subsequent ductilemore » tearing earlier in the loading process.« less

4A syndrome: ocular surface investigation in an Italian young patient.

PubMed

Aragona, Pasquale; Rania, Laura; Roszkowska, Anna Maria; Puzzolo, Domenico; Micali, Antonio; Pisani, Antonina; Salzano, Giuseppina; Messina, Maria Francesca

2014-12-08

Allgrove's 4A syndrome determines ocular surface changes. This is the first report providing an up-to-dated analysis of the ocular surface in an affected patient. An 18-years-old male Caucasian patient, with a complex progressive gait disorder and adrenal insufficiency, was referred for ophthalmic evaluation, as part of the clinical assessment. He underwent the following tests: best corrected visual acuity, tear osmolarity, tear film break-up time (BUT), corneal fluorescein staining, Schirmer's I test, lid margin assessment, corneal sensitivity, in vivo corneal confocal microscopy, conjunctival impression cytology, tonometry and fundus exam. A dry eye condition was documented by the Schirmer's I test of 0 mm/5' in both eyes, accompanied by tear hyperosmolarity, mild meibomian gland dysfunction, reduced BUT, mucus filaments in the tear film and conjunctival epithelium metaplasic changes. The corneal confocal microscopy showed the presence of activated keratocytes, while the nerve pattern was normal. The dry eye in this patient appears to be due to tear aqueous deficiency and can be considered as part of the 4A syndrome. The decreased tear production, resulting from a deterioration of the autonomic innervation of the lacrimal glands rather than an impaired corneal innervation, can be considered as part of the systemic autonomic dysfunction present in this disease.

The prevalence of proximal hamstring pathology on MRI in the asymptomatic population.

PubMed

Thompson, S M; Fung, S; Wood, D G

2017-01-01

Injury to the proximal hamstring complex (PHC) is becoming more frequently diagnosed. Patients attending our tertiary referral centre demonstrated 'pathological changes' in the unaffected normal contralateral PHC on MRI. The prevalence of PHC pathology, however, has not been previously documented in the literature in asymptomatic subjects. It is the hypothesis of this study that the natural history of asymptomatic pathological change on MRI in the PHC is not clear. The aim is to quantify the natural history of PHC degeneration. Two hundred and fifty-three consecutive patients with an asymptomatic PHC were reviewed retrospectively between 2009 and 2010. The PHC was assessed in multiple MRI planes by a specialist musculoskeletal consultant radiologist. Five hundred and six proximal hamstrings complexes were reviewed. Eighty-nine patients (35 %) were radiological normal both sides, median age 51 years (range 13-88). Thirty-four patients (13 %) had unilateral pathology, median age 55 years (range 25-89). Of these, 3 patients (1 %) had presence of a complete tear, median age 81 years (range 72-87). Sixteen patients (7 %) had tendinosis, median age 60 years (range 37-78). Fifteen patients (6 %) had a unilateral partial tear, median age 57 years (range 35-78). One hundred and thirty patients (52 %) had bilateral pathology, median age 65 years (range 25-89). Fifty-three patients (21 %) had the presence of bilateral tendinopathy alone, median age 56 years (range 25-89). Twenty-seven patients (11 %) had a partial tear on one side and tendinosis on the other, median age 68 years (range 38-89). Thirty-nine patients (15 %) had evidence of bilateral partial tears, median age 63 years (range 36-89), with 52 % demonstrating a torn conjoined and semi-membranosus tendon. The remaining 48 % had either an isolated tear of the conjoined or the semi-membranosus (the more commonly injured tendon 74 % of the time). Four patients (2 %) had bilateral complete ruptures with a median age of 68 years (range 59-78). Six patients (2 %) had a complete tear on one side and a partial tear on the other, median age 68 years (range 34-83). One patient had a complete tear on one side and tendinosis on the other, age 81 years. There is a higher prevalence of pathology in the asymptomatic population, 15 % have bilateral partial tears, and 2 % have bilateral complete tears. The semi-membranosus being the most affected, this may help clinically stratify the need for surgical intervention. I.

Glycomic characterization of basal tears and changes with diabetes and diabetic retinopathy.

PubMed

Nguyen-Khuong, Terry; Everest-Dass, Arun V; Kautto, Liisa; Zhao, Zhenjun; Willcox, Mark D P; Packer, Nicolle H

2015-03-01

As a secreted fluid, the state of tear glycosylation is particularly important in the role of immunity of the ocular surface. Tears are a valuable source of non-invasive biomarkers for disease and there are continued efforts to characterize their components thoroughly. In this study, a small volume of basal tears (5 μL) was collected from healthy controls, patients with diabetes without retinopathy and patients with diabetes and retinopathy. The detailed N- and O-linked tear protein glycome was characterized and the relative abundance of each structure determined. Of the 50 N-linked glycans found, 89% were complex with 50% containing a bisecting N-acetylglucosamine, 65% containing a core fucose whilst 33% were sialylated. Of the 8 O-linked glycans detected, 3 were of cores 1 and 5 of core 2 type, with a majority of them being sialylated (90%). Additionally, these glycan structures were profiled across the three diabetic disease groups. Whilst the higher abundant structures did not alter across the three groups, only five low abundance N-linked glycans and 1 O-linked glycan did alter with the onset of diabetes mellitus and diabetic retinopathy (DR). These results suggest the conservation of glycan types on basal tear proteins between individuals and point to only small changes in glycan expression on the proteins in tears with the development of diabetes and DR. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Identification of fatty acids and fatty acid amides in human meibomian gland secretions.

PubMed

Nichols, Kelly K; Ham, Bryan M; Nichols, Jason J; Ziegler, Corrie; Green-Church, Kari B

2007-01-01

The complex superficial lipid layer of the tear film functions to prevent evaporation and maintain tear stability. Although classes of lipids found in the tear film have been reported, individual lipid species are currently being studied with more sophisticated. The purpose of this work was to show the identification of fatty acids and the fatty acid amides in human meibomian gland secretions by using electrospray mass spectrometry. methods. Human meibomian gland secretions (meibum) were analyzed by electrospray quadrupole time-of-flight mass spectrometry (positive- and negative-ion mode). Accurate mass determination and collision-induced dissociation of meibum, and lipid standards were used to identify lipid species. Mass analysis of meibum in an acidic chloroform-methanol solution in positive-ion mode revealed a mass peak of m/z 282.3, which was identified as the protonated molecule of oleamide [C(18)H(35)NO+H](+). The high-resolution mass analysis of the m/z 282.2788 peak (oleamide) demonstrated a mass accuracy of 3.2 parts per million (ppm). Collision-induced dissociation of this species from meibum, compared with an oleamide standard, confirmed its identification. Myristic, palmitic, stearic, and oleic free fatty acids were identified in a similar manner, as were the other fatty acid amides (myristamide, palmitamide, stearamide, and erucamide). The findings indicate that oleamide (cis-9-octadecenamide), an endogenous fatty acid primary amide, is a predominant component of meibum when examined by electrospray mass spectrometry. The novel finding of oleamide and other members of the fatty acid amide family in the tear film could lead to additional insights into the role of fatty acid amide activity in human biological systems and may indicate a new function for this lipid class of molecules in ocular surface signaling and/or in the maintenance of the complex tear film.

Medial joint line bone bruising at MRI complicating acute ankle inversion injury: what is its clinical significance?

PubMed

Chan, V O; Moran, D E; Shine, S; Eustace, S J

2013-10-01

To assess the incidence and clinical significance of medial joint line bone bruising following acute ankle inversion injury. Forty-five patients who underwent ankle magnetic resonance imaging (MRI) within 2 weeks of acute ankle inversion injury were included in this prospective study. Integrity of the lateral collateral ligament complex, presence of medial joint line bone bruising, tibio-talar joint effusion, and soft-tissue swelling were documented. Clinical follow-up at 6 months was carried out to determine the impact of injury on length of time out of work, delay in return to normal walking, delay in return to sports activity, and persistence of medial joint line pain. Thirty-seven patients had tears of the anterior talofibular ligament (ATFL). Twenty-six patients had medial joint line bone bruising with altered marrow signal at the medial aspect of the talus and congruent surface of the medial malleolus. A complete ATFL tear was seen in 92% of the patients with medial joint line bone bruising (p = 0.05). Patients with an ATFL tear and medial joint line bone bruising had a longer delay in return to normal walking (p = 0.0002), longer delay in return to sports activity (p = 0.0001), and persistent medial joint line pain (p = 0.0003). There was no statistically significant difference in outcome for the eight patients without ATFL tears. Medial joint line bone bruising following an acute ankle inversion injury was significantly associated with a complete ATFL tear, longer delay in the return to normal walking and sports activity, as well as persistent medial joint line pain. Its presence should prompt detailed assessment of the lateral collateral ligament complex, particularly the ATFL. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Combined Palmer Type 1A and 1B Traumatic Lesions of the Triangular Fibrocartilage Complex A New Category.

PubMed

Nance, Erin; Ayalon, Omri; Yang, Steven

2016-06-01

We present a series of eight patients who underwent wrist arthroscopy for presumed solitary tears of the triangular fibrocartilage (TFC) and were, instead, found to have combined 1A (central tear) and 1B (ulnar avulsion) tears. The Palmer Classification does not currently categorize this combined pattern. All but one patient had a traumatic injury. Each subject had preoperative radiographs and MRI scans. TFC tears were evident on all MRI scans, though only one was suggestive of a combined tear pat - tern. Surgical management included arthroscopic central tear debridement and ulnar peripheral repair. Average follow-up was 22 months. Grip strength in the affected hand improved from 16% deficit as compared to the unaffected side, to 3.5% deficit postoperatively (p = 0.003), and visual analog scores (VAS) decreased from an average of 7.1/10 preoperatively to 2.3/10 postoperatively (p < 0.001). There was no statistically significant change in wrist range of motion (ROM), however. Arthroscopic debridement of the central perforation (1A lesion) with concomitant repair of the ulnar detachment (1B lesion) resulted in functional and symptomatic improvement. This combined 1A/1B TFC injury is not reliably diagnosed preoperatively and should be considered a new subset in the Palmer classification, as this will raise awareness of its presence and assist in preoperative planning of such lesions.

Computational study of haemodynamic effects of entry- and exit-tear coverage in a DeBakey type III aortic dissection: technical report.

PubMed

Karmonik, C; Bismuth, J; Shah, D J; Davies, M G; Purdy, D; Lumsden, A B

2011-08-01

Outcome prediction in DeBakey Type III aortic dissections (ADs) remains challenging. Large variations in AD morphology, physiology and treatment exist. Here, we investigate if computational fluid dynamics (CFD) can provide an initial understanding of pressure changes in an AD computational model when covering entry and exit tears and removing the intra-arterial septum (IS). A computational mesh was constructed from magnetic resonance images from one patient (one entrance and one exit tear) and CFD simulations performed (scenario #1). Additional meshes were derived by virtually (1) covering the exit tear (false lumen (FL) thrombus progression) (scenario #2), (2) covering the entrance tear (thoracic endovascular treatment, TEVAR) (scenario #3) and (3) completely removing the IS (fenestration) (scenario #4). Changes in flow patterns and pressures were quantified relative to the initial mesh. Systolic pressures increased for #2 (300 Pa increase) with largest inter-luminal differences distally (2500 Pa). In #3, false lumen pressure decreased essentially to zero. In #4, systolic pressure in combined lumen reduced from 2400 to 800 Pa. CFD results from computational models of a DeBakey type III AD representing separate coverage of entrance and exit tears correlated with clinical experience. The reported results present a preliminary look at a complex clinical problem. Copyright © 2011 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

Examination of acetabular labral tear: a continued diagnostic challenge.

PubMed

Reiman, Michael P; Mather, Richard C; Hash, Thomas W; Cook, Chad E

2014-02-01

Acetabular labrum tears (ALT) are present in 22-55% of individuals with hip or groin pain. Tears can occur as a result of trauma or degeneration and are markedly associated with femoral acetabular morphological variations. An ALT can lead to biomechanical deficiencies and a loss of stability to the coxafemoral joint due to the labrum serving as a stabilising structure of this joint. The diagnosis of ALT is complex and multidimensional. Although tremendous improvements in diagnostic utility for ALT have occurred in the past 25 years, there are few patient history, clinical examination and special test findings that are unique to the condition. Imaging methods such as MRI, CT and ultrasonography have demonstrated reasonable accuracy, but not at a level that allows use as a stand-alone measure. Outcomes measures that focus on functional limitation or that are used to measure recovery should envelop the complexities of the condition and be captured using both self-report and physical performance measures. Only when patient history, objective testing, clinical examination special testing and imaging are combined can a clinician fully elucidate the multidimensional diagnosis of ALT.

Dynamic interfacial properties of human tear-lipid films and their interactions with model-tear proteins in vitro.

PubMed

Svitova, Tatyana F; Lin, Meng C

2016-07-01

This review summarizes the current state of knowledge regarding interfacial properties of very complex biological colloids, specifically, human meibum and tear lipids, and their interactions with proteins similar to the proteins found in aqueous part of human tears. Tear lipids spread as thin films over the surface of tear-film aqueous and play crucial roles in tear-film stability and overall ocular-surface health. The vast majority of papers published to date report interfacial properties of meibum-lipid monolayers spread on various aqueous sub-phases, often containing model proteins, in Langmuir trough. However, it is well established that natural human ocular tear lipids exist as multilayered films with a thickness between 30 and 100nm, that is very much disparate from 1 to 2nm thick meibum monolayers. We employed sessile-bubble tensiometry to study the dynamic interfacial and rheological properties of reconstituted multilayered human tear-lipid films. Small amounts (0.5-1μg) of human tear lipids were deposited on an air-bubble surface to produce tear-lipid films in thickness range 30-100nm corresponding to ocular lipid films. Thus, we were able to overcome major Langmuir-trough method limitations because ocular tear lipids can be safely harvested only in minute, sub-milligram quantities, insufficient for Langmuir through studies. Sessile-bubble method is demonstrated to be a versatile tool for assessing conventional synthetic surfactants adsorption/desorption dynamics at an air-aqueous solution interface. (Svitova T., Weatherbee M., Radke C.J. Dynamics of surfactant sorption at the air/water interface: continuous-flow tensiometry. J. Colloid Interf. Sci. 2003;261:1170-179). The augmented flow-sessile-bubble setup, with step-strain relaxation module for dynamic interfacial rheological properties and high-precision syringe pump to generate larger and slow interfacial area expansions-contractions, was developed and employed in our studies. We established that this method is uniquely suitable for examination of multilayered lipid-film interfacial properties. Recently it was compellingly proven that chemical composition of human tear lipids extracted from whole tears is substantially different from that of meibum lipids. To be exact, healthy human tear lipids contain 8-16% of polar lipids, similar to lung lipids, and they are mostly double-tailed phospholipids, with C16 and longer alkyl chains. Rationally, one would assume that the results obtained for meibum lipids, devoid of surface-active components such as phospholipids, and, above all, in a form of monolayers, are not pertinent or useful for elucidating behavior and stability of an averaged 60-nm thick ocular tear-lipid films in vivo. The advantage of sessile-bubble technique, specifically, using a small amount of lipids required to attain multilayered films, unlocks the prospect of evaluating and comparing the interfacial properties of human tear lipids collected from a single individual, typically 100-150μg. This is in sharp contrast with several milligrams of lipids that would be required to build equally thick films for Langmuir-trough experiments. The results of our studies provided in-depth understanding of the mechanisms responsible for properties and stability of human tear-lipid films in vivo. Here we summarize recent publications and our latest findings regarding human tear-lipid interfacial properties, their chemical composition, and their interaction with model proteins mimicking the proteins found in human tear-aqueous phase. Published by Elsevier B.V.

Reliability of magnetic resonance imaging in evaluating meniscal and cartilage injuries in anterior cruciate ligament-deficient knees.

PubMed

Wong, Kenneth Pak Leung; Han, Audrey XinYun; Wong, Jeannie Leh Ying; Lee, Dave Yee Han

2017-02-01

The accuracy of magnetic resonance (MR) imaging in assessing meniscal and cartilage injuries in anterior cruciate ligament (ACL)-deficient knees as compared to arthroscopy was evaluated in the present study. The results of all preoperative MR imaging performed within 3 months prior to the ACL reconstruction were compared against intraoperative arthroscopic findings. A total of 206 patients were identified. The location and type of meniscal injuries as well as the location and grade of the cartilage injuries were studied. The negative predictive value, positive predictive value, sensitivity, specificity and accuracy of MR imaging for these 206 cases were calculated and analysed. In patients with an ACL injury, the highest incidence of concomitant injury was that of medial meniscus tears, 124 (60.2 %), followed by lateral meniscus tears, 105 (51.0 %), and cartilage injuries, 66 (32.0 %). Twenty-three (11.2 %) patients sustained injuries to all of the previously named structures. MR imaging was most accurate in detecting medial meniscus tears (85.9 %). MR imaging for medial meniscus tears also had the highest sensitivity (88.0 %) and positive predictive value (88.7 %), while MR imaging for cartilage injuries had the largest specificity (84.1 %) and negative predictive value (87.1 %). It was least accurate in evaluating lateral meniscus tears (74.3 %). The diagnostic accuracy of medial meniscus imaging is significantly influenced by age and the presence of lateral meniscus tears, while the duration between MR imaging and surgery has greater impact on the likelihood of lateral meniscus and cartilage injuries actually being present during surgery. The majority of meniscus tears missed by MR imaging affected the posterior horn and were complex in nature. Cartilage injuries affecting the medial femoral condyle or medial patella facet were also often missed by MR imaging. MR imaging remains a reliable tool for assessing meniscus tears and cartilage defects preoperatively. It is most accurate when evaluating medial meniscus tears. However, MR imaging should be used with discretion especially if there is a high index of suspicion of lateral meniscus tears. IV.

Arthroscopic assisted tendon reconstruction for triangular fibrocartilage complex irreparable tears.

PubMed

Luchetti, R; Atzei, A

2017-05-01

We report our 11-year experience of performing arthroscopically assisted triangular fibrocartilage complex reconstruction in the treatment of chronic distal radio-ulnar joint instability resulting from irreparable triangular fibrocartilage complex injuries. Eleven patients were treated. Three skin incisions were made in order to create radial and ulna tunnels for passage of the tendon graft, which is used to reconstruct the dorsal and palmar radio-ulnar ligaments, under fluoroscopic and arthroscopic guidance. At a mean follow-up of 68 months all but one had a stable distal radio-ulnar joint. Pain and grip strength, Mayo wrist score, Disability of the Arm Hand and Shoulder and patient-rated wrist and hand evaluation scores improved. The ranges of forearm rotation remained largely unchanged. Complications included an early tendon graft tear, two late-onset graft ruptures, one ulna styloid fracture during surgery and persistent wrist discomfort during forearm rotation requiring tendon graft revision in one case. An arthroscopic assisted approach for triangular fibrocartilage complex reconstruction appears safe and produces comparable results with the open technique. IV.

Determination of water-soluble and fat-soluble vitamins in tears and blood serum of infants and parents by liquid chromatography/mass spectrometry.

PubMed

Khaksari, Maryam; Mazzoleni, Lynn R; Ruan, Chunhai; Kennedy, Robert T; Minerick, Adrienne R

2017-02-01

Tears serve as a viable diagnostic fluid with advantages including less invasive sample to collect and less complex to prepare for analysis. Several water-soluble and fat-soluble vitamins were detected and quantified in human tears and compared with blood serum levels. Samples from 15 family pairs, each pair consisting of a four-month-old infant and one parent were analyzed; vitamin concentrations were compared between tears and blood serum for individual subjects, between infants and parents, and against self-reported dietary intakes. Water-soluble vitamins B 1 , B 2 , B 3 (nicotinamide), B 5 , B 9 and fat-soluble vitamin E (α-tocopherol) were routinely detected in tears and blood serum while fat-soluble vitamin A (retinol) was detected only in blood serum. Water-soluble vitamin concentrations measured in tears and blood serum of single subjects were comparable, while higher concentrations were measured in infants compared to their parents. Fat-soluble vitamin E concentrations were lower in tears than blood serum with no significant difference between infants and parents. Serum vitamin A concentrations were higher in parents than infants. Population trends were compiled and quantified using a cross correlation factor. Strong positive correlations were found between tear and blood serum concentrations of vitamin E from infants and parents and vitamin B 3 concentrations from parents, while slight positive correlations were detected for infants B 3 and parents B 1 and B 2 concentrations. Correlations between infants and parents were found for the concentrations of B 1 , B 2 , B 3 , and E in tears, and the concentrations of B 2, A, and E in blood serum. Stronger vitamin concentration correlations were found between infants and parents for the breast-fed infants, while no significant difference was observed between breast-fed and bottle-fed infants. This work is the first to demonstrate simultaneous vitamin A, B, and E detection and to quantify correlations between vitamin concentrations in tears and blood serum. Our results suggest that tears are a viable biofluid to monitor nutritional health because they sufficiently mirror blood serum data and may enhance the speed of deficiency diagnoses. Copyright © 2016 Elsevier Ltd. All rights reserved.

Rapamycin Eye Drops Suppress Lacrimal Gland Inflammation In a Murine Model of Sjögren's Syndrome

PubMed Central

Shah, Mihir; Edman, Maria C.; Reddy Janga, Srikanth; Yarber, Frances; Meng, Zhen; Klinngam, Wannita; Bushman, Jonathan; Ma, Tao; Liu, Siyu; Louie, Stan; Mehta, Arjun; Ding, Chuanqing; MacKay, J. Andrew; Hamm-Alvarez, Sarah F.

2017-01-01

Purpose To evaluate the efficacy of topical rapamycin in treating autoimmune dacryoadenitis in a mouse model of Sjögren's syndrome. Methods We developed rapamycin in a poly(ethylene glycol)-distearoyl phosphatidylethanolamine (PEG-DSPE) micelle formulation to maintain solubility. Rapamycin or PEG-DSPE eye drops (vehicle) were administered in a well-established Sjögren's syndrome disease model, the male nonobese diabetic (NOD) mice, twice daily for 12 weeks starting at 8 weeks of age. Mouse tear fluid was collected and tear Cathepsin S, a putative tear biomarker for Sjögren's syndrome, was measured. Lacrimal glands were retrieved for histological evaluation, and quantitative real-time PCR of genes associated with Sjögren's syndrome pathogenesis. Tear secretion was measured using phenol red threads, and corneal fluorescein staining was used to assess corneal integrity. Results Lymphocytic infiltration of lacrimal glands from rapamycin-treated mice was significantly (P = 0.0001) reduced by 3.8-fold relative to vehicle-treated mice after 12 weeks of treatment. Rapamycin, but not vehicle, treatment increased tear secretion and decreased corneal fluorescein staining after 12 weeks. In rapamycin-treated mice, Cathepsin S activity was significantly reduced by 3.75-fold in tears (P < 0.0001) and 1.68-fold in lacrimal gland lysates (P = 0.003) relative to vehicle-treated mice. Rapamycin significantly altered the expression of several genes linked to Sjögren's syndrome pathogenesis, including major histocompatibility complex II, TNF-α, IFN-γ, and IL-12a, as well as Akt3, an effector of autophagy. Conclusions Our findings suggest that topical rapamycin reduces autoimmune-mediated lacrimal gland inflammation while improving ocular surface integrity and tear secretion, and thus has potential for treating Sjögren's syndrome–associated dry eye. PMID:28122086

Arthroscopy in the early diagnosis of injuries to the knee joint.

PubMed

Lysholm, J; Gillquist, J; Liljedahl, S O

1981-02-01

In a series of 192 patients with acute knee injuries the diagnosis at arthroscopy was compared with the clinical diagnosis with or without confirmation at arthrotomy. Arthroscopy was used in 117 cases, clinical examination in 72 cases, and arthrography in 3 cases. All patients presented for diagnosis and treatment within 4 weeks of injury, and most within 1 week. The anterior cruciate ligament (ACL) was torn in 100 cases, and in 92 this was the main injury. The incidence of complete, isolated ACL tear was 1.5 per cent. ACL tear occurred in a higher proportion of cases in the arthroscopy group compared with diagnosis by other methods. An ACL tear was usually combined with injury to the medial ligament complex. Twenty-five patients showed tear of the posterior cruciate ligament (PCL), and in one-third of these there was also injury to the ACL. The medial ligaments were injured in 77 per cent of the whole series and this was the predominant lesion in 57 cases. Tear of the postero-medial capsular ligament (PMCL) was found in more than half of our patients. The ratio lateral/medial meniscus tear was 1:1.6 in the arthroscopy group and 1:27 in the group where arthroscopy was not undertaken. Arthroscopy resulted in an increase in the number of components of injury identified owing to improved diagnosis of tears of the ACL, the PMCL, the lateral meniscus, and possibly also of the PCL. There were no complication or side-effects of arthroscopy. In 93 per cent of cases primary suture was done. Reconstruction was rarely necessary if operation was undertaken within 2 weeks of injury.

MR arthrography in glenohumeral instability.

PubMed

Van der Woude, H J; Vanhoenacker, F M

2007-01-01

The impact of accurate imaging in the work-up of patients with glenohumeral instability is high. Results of imaging may directly influence the surgeon's strategy to perform an arthroscopic or open treatment for (recurrent) instability. Magnetic resonance (MR) imaging, and MR arthrography in particular, is the optimal technique to detect, localize and characterize injuries of the capsular-labrum complex. Besides TI-weighted sequences with fat suppression in axial, oblique sagital and coronal directions, an additional series in abduction and exoroation position is highly advocated. This ABER series optimally depicts abnormalities of the inferior capsular-labrum complex and partial undersurface tears of the spinatus tendons. Knowledge of different anatomical variants that may mimic labral tears and of variants of the classic Bankart lesion are useful in the analysis of shoulder MR arthrograms in patients with glenohumeral instability.

On the Lipid Composition of Human Meibum and Tears: Comparative Analysis of Nonpolar Lipids

PubMed Central

Butovich, Igor A.

2009-01-01

PURPOSE To qualitatively compare the nonpolar lipids present in meibomian gland (MG) secretions (samples T1) with aqueous tears (AT) collected from the lower tear menisci of healthy, non-dry eye volunteers using either glass microcapillaries (samples T2) or Schirmer test strips (samples T3). METHODS Samples T1 to T3 were analyzed with the use of high-pressure liquid chromatography/positive ion mode atmospheric pressure chemical ionization mass spectrometry. Where possible, the unknown lipids were compared with known standards. RESULTS Samples T1 had the simplest lipid composition among all the tested specimens. Samples T2 and T3 were similar to each other but were noticeably different from samples T1. In addition to all the compounds detected in samples T1, lower molecular weight wax esters and other compounds were found in samples T2 and T3. No appreciable amounts of fatty acid amides (e.g., oleamide), ceramides, or monoacyl glycerols were routinely detected. The occasionally observed minor signals of oleamide (m/z 282) in samples T3 were attributed to the contamination of the samples with common plasticizers routinely found in plastic ware extractives and organic solvents. CONCLUSIONS The MG is a prominent source of lipids for the tear film. However, it would have been a mistake to exclude from consideration other likely sources of lipids such as conjunctiva, cornea, and tears produced by the lacrimal glands. These data showed that lipids in AT are more complex than MG secretions, which necessitates more cautious interpretation of the functions of the latter in the tear film. PMID:18487374

On the lipid composition of human meibum and tears: comparative analysis of nonpolar lipids.

PubMed

Butovich, Igor A

2008-09-01

To qualitatively compare the nonpolar lipids present in meibomian gland (MG) secretions (samples T1) with aqueous tears (AT) collected from the lower tear menisci of healthy, non-dry eye volunteers using either glass microcapillaries (samples T2) or Schirmer test strips (samples T3). Samples T1 to T3 were analyzed with the use of high-pressure liquid chromatography/positive ion mode atmospheric pressure chemical ionization mass spectrometry. Where possible, the unknown lipids were compared with known standards. Samples T1 had the simplest lipid composition among all the tested specimens. Samples T2 and T3 were similar to each other but were noticeably different from samples T1. In addition to all the compounds detected in samples T1, lower molecular weight wax esters and other compounds were found in samples T2 and T3. No appreciable amounts of fatty acid amides (e.g., oleamide), ceramides, or monoacyl glycerols were routinely detected. The occasionally observed minor signals of oleamide (m/z 282) in samples T3 were attributed to the contamination of the samples with common plasticizers routinely found in plastic ware extractives and organic solvents. The MG is a prominent source of lipids for the tear film. However, it would have been a mistake to exclude from consideration other likely sources of lipids such as conjunctiva, cornea, and tears produced by the lacrimal glands. These data showed that lipids in AT are more complex than MG secretions, which necessitates more cautious interpretation of the functions of the latter in the tear film.

Peroneus longus tears associated with pathology of the os peroneum.

PubMed

Stockton, Kristopher G; Brodsky, James W

2014-04-01

There is a range of different types of tears and pathology of the peroneal tendons. One of the least common types is the tear of the peroneus longus associated with fracture, enlargement, or entrapment at the cuboid tunnel of the os peroneum. The purpose of this study was to evaluate the pathologic patterns of these uncommon peroneal tendon tears, to review the treatment, and to report the patient outcomes following treatment with excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. A 5-year retrospective review of all patients with peroneal tendon tears identified 12 patients operatively treated for peroneus longus tendon tears with associated pathology of the os peroneum, and in whom there was a viable peroneus brevis. All patients were treated with an operative procedure consisting of excision of the os peroneum, debridement, and tenodesis of the peroneus longus to the peroneus brevis. Mean age was 51.5 (range, 33 to 73) years, including 7 males and 5 females. Operative and radiographic records were reviewed to characterize the nature of the peroneus longus tears and associated pathology. Preoperative and postoperative AOFAS hindfoot, SF-36 questionnaires, and Visual Analog Scale (VAS) pain scores were compiled and patient records were reviewed for complications. Mean follow-up after surgery was 63.3 (range, 12 to 114) months. All of the patients had an os peroneum associated with a complex, irreparable tear of the peroneus longus tendon. The peroneus longus was typically enlarged, fibrotic, and adhered to the surrounding tissues. In 8 patients, the peroneus longus tendon tear was associated with a fracture of the os peroneum, and in 4 patients with an enlarged and entrapped os peroneum which prevented movement at the cuboid tunnel. Of the 12 patients, 9 had partial tears of the peroneus brevis, which were treated with debridement and suture repair. AOFAS hindfoot scores increased from a preoperative mean of 61 (range, 46 to 75) to a postoperative mean of 91.7 (range, 60 to 100). Mean preoperative SF-36 Physical Component Scores (PCS) increased from 36 to 52 postoperatively. Mean VAS pain scores decreased from a preoperative mean of 6.3 (range, 4 to 8) to a postoperative mean of 1.0 (range, 0 to 4). Complications included 2 patients with sural neuritis and 3 with superficial delayed wound healing successfully treated nonoperatively. Tears of the distal peroneus longus tendon, which are much less commonly reported than tears of the peroneus brevis, can be associated with pathology of the os peroneum. Excision of the os peroneum, tendon debridement, and tenodesis of the longus to brevis was an effective surgical technique. Level IV, case series.

Surface imprint of toroidal flow at retreating slab edges: The first geodetic evidence in the Calabrian subduction system

NASA Astrophysics Data System (ADS)

Palano, M.; Piromallo, C.; Chiarabba, C.

2017-01-01

Dense GPS observations can help Earth scientists to capture the surface imprint of mantle toroidal flow at slab edges. We document this process in the Calabrian subduction system, where the Ionian slab rollback took place during the past 30 Ma, following a stepwise process driven by migration of lithospheric tearing. We found rotation rates of 1.29°/Ma (counterclockwise) and 1.74°/Ma (clockwise), for poles located close to the northern and southern slab edges, respectively. These small-scale, opposite rotations occur along complex sets of active faults representing the present-day lithospheric expression of the tearing processes affecting the southeastward retreating Ionian slab at both edges. The observed rotations are likely still young and the process more immature at the northern tear, where it is unable to reorient mantle fabric and therefore is unseen by SKS splitting.

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders - new strategies for diagnosis and treatment.

PubMed

Milner, Mark S; Beckman, Kenneth A; Luchs, Jodi I; Allen, Quentin B; Awdeh, Richard M; Berdahl, John; Boland, Thomas S; Buznego, Carlos; Gira, Joseph P; Goldberg, Damien F; Goldman, David; Goyal, Raj K; Jackson, Mitchell A; Katz, James; Kim, Terry; Majmudar, Parag A; Malhotra, Ranjan P; McDonald, Marguerite B; Rajpal, Rajesh K; Raviv, Tal; Rowen, Sheri; Shamie, Neda; Solomon, Jonathan D; Stonecipher, Karl; Tauber, Shachar; Trattler, William; Walter, Keith A; Waring, George O; Weinstock, Robert J; Wiley, William F; Yeu, Elizabeth

2017-01-01

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition.

Dysfunctional tear syndrome: dry eye disease and associated tear film disorders – new strategies for diagnosis and treatment

PubMed Central

Milner, Mark S.; Beckman, Kenneth A.; Luchs, Jodi I.; Allen, Quentin B.; Awdeh, Richard M.; Berdahl, John; Boland, Thomas S.; Buznego, Carlos; Gira, Joseph P.; Goldberg, Damien F.; Goldman, David; Goyal, Raj K.; Jackson, Mitchell A.; Katz, James; Kim, Terry; Majmudar, Parag A.; Malhotra, Ranjan P.; McDonald, Marguerite B.; Rajpal, Rajesh K.; Raviv, Tal; Rowen, Sheri; Shamie, Neda; Solomon, Jonathan D.; Stonecipher, Karl; Tauber, Shachar; Trattler, William; Walter, Keith A.; Waring, George O.; Weinstock, Robert J.; Wiley, William F.; Yeu, Elizabeth

2017-01-01

Dysfunctional tear syndrome (DTS) is a common and complex condition affecting the ocular surface. The health and normal functioning of the ocular surface is dependent on a stable and sufficient tear film. Clinician awareness of conditions affecting the ocular surface has increased in recent years because of expanded research and the publication of diagnosis and treatment guidelines pertaining to disorders resulting in DTS, including the Delphi panel treatment recommendations for DTS (2006), the International Dry Eye Workshop (DEWS) (2007), the Meibomian Gland Dysfunction (MGD) Workshop (2011), and the updated Preferred Practice Pattern guidelines from the American Academy of Ophthalmology pertaining to dry eye and blepharitis (2013). Since the publication of the existing guidelines, new diagnostic techniques and treatment options that provide an opportunity for better management of patients have become available. Clinicians are now able to access a wealth of information that can help them obtain a differential diagnosis and treatment approach for patients presenting with DTS. This review provides a practical and directed approach to the diagnosis and treatment of patients with DTS, emphasizing treatment that is tailored to the specific disease subtype as well as the severity of the condition. PMID:28099212

Self-folding mechanics of graphene tearing and peeling from a substrate

NASA Astrophysics Data System (ADS)

He, Ze-Zhou; Zhu, Yin-Bo; Wu, Heng-An

2018-06-01

Understanding the underlying mechanism in the tearing and peeling processes of graphene is crucial for the further hierarchical design of origami-like folding and kirigami-like cutting of graphene. However, the complex effects among bending moduli, adhesion, interlayer interaction, and local crystal structure during origami-like folding and kirigami-like cutting remain unclear, resulting in challenges to the practical applications of existing theoretical and experimental findings as well as to potential manipulations of graphene in metamaterials and nanodevices. Toward this end, classical molecular dynamics (MD) simulations are performed with synergetic theoretical analysis to explore the tearing and peeling of self-folded graphene from a substrate driven by external force and by thermal activation. It is found that the elastic energy localized at the small folding ridge plays a significant role in the crack trajectory. Due to the extremely small bending modulus of monolayer graphene, its taper angle when pulled by an external force follows a scaling law distinct from that in case of bilayer graphene. With the increase in the initial width of the folding ridge, the self-folded graphene, motivated by thermal fluctuations, can be self-assembled by spontaneous self-tearing and peeling from a substrate. Simultaneously, the scaling law between the taper angle and adhesive energy is independent of the motivations for thermal activation-induced self-assembly and external force tearing, providing effective insights into the underlying physics for graphene-based origami-like folding and kirigami-like cutting.

Distance-Based Tear Lactoferrin Assay on Microfluidic Paper Device Using Interfacial Interactions on Surface-Modified Cellulose.

PubMed

Yamada, Kentaro; Henares, Terence G; Suzuki, Koji; Citterio, Daniel

2015-11-11

"Distance-based" detection motifs on microfluidic paper-based analytical devices (μPADs) allow quantitative analysis without using signal readout instruments in a similar manner to classical analogue thermometers. To realize a cost-effective and calibration-free distance-based assay of lactoferrin in human tear fluid on a μPAD not relying on antibodies or enzymes, we investigated the fluidic mobilities of the target protein and Tb(3+) cations used as the fluorescent detection reagent on surface-modified cellulosic filter papers. Chromatographic elution experiments in a tear-like sample matrix containing electrolytes and proteins revealed a collapse of attractive electrostatic interactions between lactoferrin or Tb(3+) and the cellulosic substrate, which was overcome by the modification of the paper surface with the sulfated polysaccharide ι-carrageenan. The resulting μPAD based on the fluorescence emission distance successfully analyzed 0-4 mg mL(-1) of lactoferrin in complex human tear matrix with a lower limit of detection of 0.1 mg mL(-1) by simple visual inspection. Assay results of 18 human tear samples including ocular disease patients and healthy volunteers showed good correlation to the reference ELISA method with a slope of 0.997 and a regression coefficient of 0.948. The distance-based quantitative signal and the good batch-to-batch fabrication reproducibility relying on printing methods enable quantitative analysis by simply reading out "concentration scale marks" printed on the μPAD without performing any calibration and using any signal readout instrument.

Extreme Facial Expressions Classification Based on Reality Parameters

NASA Astrophysics Data System (ADS)

Rahim, Mohd Shafry Mohd; Rad, Abdolvahab Ehsani; Rehman, Amjad; Altameem, Ayman

2014-09-01

Extreme expressions are really type of emotional expressions that are basically stimulated through the strong emotion. An example of those extreme expression is satisfied through tears. So to be able to provide these types of features; additional elements like fluid mechanism (particle system) plus some of physics techniques like (SPH) are introduced. The fusion of facile animation with SPH exhibits promising results. Accordingly, proposed fluid technique using facial animation is the real tenor for this research to get the complex expression, like laugh, smile, cry (tears emergence) or the sadness until cry strongly, as an extreme expression classification that's happens on the human face in some cases.

Tear Film Lipids

PubMed Central

Butovich, Igor A.

2013-01-01

Human meibomian gland secretions (MGS, or meibum) are formed from a complex mixture of lipids of different classes such as wax esters, cholesteryl esters, (O-acyl)-ω-hydroxy fatty acids (OAHFA) and their esters, acylglycerols, diacylated diols, free fatty acids, cholesterol, and a smaller amount of other polar and nonpolar lipids, whose chemical nature and the very presence in MGS have been a matter of intense debates. The purpose of this review is to discuss recent results that were obtained using different experimental techniques, estimate limitations of their usability, and discuss their biochemical, biophysical, and physiological implications. To create a lipid map of MGS and tears, the results obtained in the author’s laboratory were integrated with available information on chemical composition of MGS and tears. The most informative approaches that are available today to researchers, such as HPLC-MS, GC-MS, and proton NMR, are discussed in details. A map of the meibomian lipidome (as it is seen in reverse phase liquid chromatography/mass spectrometry experiments) is presented. Directions of future efforts in the area are outlined. PMID:23769846

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears

PubMed Central

Anastasopoulos, Panagiotis P.; Alexiadis, George; Spyridonos, Sarantis; Fandridis, Emmanouil

2017-01-01

Background: Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. Methods: Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. Results: Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. Conclusion: Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component. PMID:28400877

Latissimus Dorsi Transfer in Posterior Irreparable Rotator Cuff Tears.

PubMed

Anastasopoulos, Panagiotis P; Alexiadis, George; Spyridonos, Sarantis; Fandridis, Emmanouil

2017-01-01

Massive rotator cuff tears pose a difficult and complex challenge even for the experienced surgeon; inability to repair these tears by conventional means designates them as irreparable, while management becomes quite taxing. Several operative options have been suggested for the management of such lesions with varying degrees of success, while it is imperative to match patient demands and expectations to the predicted outcome. Research articles are examined and key concepts are discussed, in order to provide an evidence based review of the available literature. The anatomy and pathomechanics along with the indications, contraindications and surgical techniques are reported. Transfer of the Latissimus dorsi has been used with success to restore shoulder function in deficits of the posterior rotator cuff. Although it can be used in a variety of settings, the ideal patient for a Latissimus dorsi tendon transfer is a young and active individual, with no glenohumeral osteoarthritis that has a severe disability and weakness related to an irreparable posterior cuff tear. Tendon transfers have proved to be a successful treatment option in salvaging this difficult problem, providing pain relief and restoring shoulder function. Despite the excellent functional outcomes and pain suppression following operation, a variety of factors may affect the outcome; thus making indications and preoperative assessment a valuable component.

A comparison of basal and eye-flush tears for the analysis of cat tear proteins.

PubMed

Petznick, Andrea; Evans, Margaret D M; Madigan, Michele C; Markoulli, Maria; Garrett, Qian; Sweeney, Deborah F

2011-02-01

To identify a rapid and effective tear collection method providing sufficient tear volume and total protein content (TPC) for analysis of individual proteins in cats. Domestic adult short-haired cats (12-37 months; 2.7-6.6 kg) were used in the study. Basal tears without stimulation and eye-flush tears after instillation of saline (10 μl) were collected using microcapillary tubes from animal eyes either unwounded control or wounded with 9-mm central epithelial debridement giving four groups with n = 3. Tear comparisons were based on total time and rate for tear collection, TPC using micro bicinchoninic acid (BCA), tear immunoglobulin A (IgA), total matrix-metalloproteinase (MMP)-9 concentration using sandwich enzyme-linked immunosorbent assay (ELISA) and MMP-9 activity. Eye-flush tears were collected significantly faster than basal tears in wounded eyes with higher rates for tear collection in unwounded control and wounded eyes. TPC was significantly lower in eye-flush tears compared to basal tears. The relative proportion of tear IgA normalized to TPC (% IgA of TPC) was not significantly different between basal and eye-flush tears. In unwounded control eyes, MMP-9 was slightly higher in eye-flush than in basal tears; activity of MMP-9 in both tear types was similar. In wounded eyes, eye-flush tears showed highest MMP-9 levels and activity on Day 1, which subsequently decreased to Day 7. MMP-9 activity in basal tears from wounded eyes did not display changes in expression. Eye-flush tears can be collected rapidly providing sufficient tear volume and TPC. This study also indicates that eye-flush tears may be more suitable than basal tears for the analysis of MMPs following corneal wounding. © 2011 The Authors. Acta Ophthalmologica © 2011 Acta Ophthalmologica Scandinavica Foundation.

Tear oxygen under hydrogel and silicone hydrogel contact lenses in humans.

PubMed

Bonanno, Joseph A; Clark, Christopher; Pruitt, John; Alvord, Larry

2009-08-01

To determine the tear oxygen tension under a variety of conventional and silicone hydrogel contact lenses in human subjects. Three hydrogel and five silicone hydrogel lenses (Dk/t = 17 to 329) were coated on the back surface with an oxygen sensitive, bovine serum albumin-Pd meso-tetra (4-carboxyphenyl) porphine complex (BSA-porphine). Each lens type was placed on the right eye of 15 non-contact lens wearers to obtain a steady-state open eye tear oxygen tension using oxygen sensitive phosphorescence decay of BSA-porphine. A closed-eye oxygen tension estimate was obtained by measuring the change in tear oxygen tension after 5 min of eye closure. In separate experiments, a goggle was placed over the lens wearing eye and a gas mixture (PO2 = 51 torr) flowed over the lens to simulate anterior lens oxygen tension during eye closure. Mean open eye oxygen tension ranged from 58 to 133 torr. Closed eye estimates ranged from 11 to 42 torr. Oxygen tension under the goggle ranged from 8 to 48 torr and was higher than the closed eye estimate for six out of the eight lenses, suggesting that the average closed eye anterior lens surface oxygen tension is <51 torr. For Dk/t >30, the measured tear oxygen tension is significantly lower than that predicted from previous studies. The phosphorescence decay methodology is capable of directly measuring the in vivo post lens PO2 of high Dk/t lenses without disturbing the contact lens or cornea. Our data indicate that increasing Dk/t up to and beyond 140 continues to yield increased flux into the central cornea.

Arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears.

PubMed

Jung, Sung-Weon; Kim, Dong-Hee; Kang, Seung-Hoon; Lee, Ji-Heon

2017-07-01

While a conventional single- or double-row repair technique could be applied for repair of C-shaped tears, a different surgical strategy should be considered for repair of U- or L-shaped tears because they typically have complex patterns with anterior, posterior, or both mobile leaves. This study was performed to examine the outcomes of the modified Mason-Allen technique for footprint restoration in the treatment of large U- or L-shaped rotator cuff tears. Thirty-two patients who underwent an arthroscopic modified Mason-Allen technique for large U- or L-shaped rotator cuff tears between January 2012 and December 2013 were included in this study. Margin convergence was first performed to reduce the tear gap and tension, and then, an arthroscopic Mason-Allen technique was performed to restore the rotator cuff footprint in a side-to-end repair fashion. All patients were evaluated preoperatively and for a minimum of 2 years of follow-up with a visual analog scale (VAS) for pain, Constant score, and ultrasonography. There was significant improvement in all VAS and Constant scores compared with the preoperative values (P < 0.001). Functional results by Constant scores included 9 cases that were classified as excellent, 11 cases as good, 8 cases as fair, and 2 cases as poor. Binary logistic regression analysis revealed that heavy work, pseudoparalysis, joint space narrowing, fatty degeneration of the SST and IST, and a positive tangent sign were found to significantly correlate with functional outcomes. Multivariable logistic regression analysis revealed that only fatty degeneration of the SST was a risk factor for fair/poor clinical outcomes. Complications occurred in 5 of the 32 patients (15.6 %), and the reoperation rate due to complications was 6.3 % (2 of 32 patients). An arthroscopic modified Mason-Allen technique was sufficient to restore the footprint of the rotator cuff in our data. Overall satisfactory results were achieved in most patients, with the exception of those with severe fatty degeneration. An arthroscopic modified Mason-Allen technique could be an effective and reliable alternative for patients with large U- or L-shaped rotator cuff tears. Case Series, Therapeutic Level IV.

Readability of the Most Commonly Accessed Arthroscopy-Related Online Patient Education Materials.

PubMed

Akinleye, Sheriff D; Krochak, Ryan; Richardson, Nicholas; Garofolo, Garret; Culbertson, Maya Deza; Erez, Orry

2018-04-01

To assess the readability and comprehension of written text by the most commonly visited websites containing patient education materials on common conditions that can be treated arthroscopically. We examined 50 websites, assessed independently by 2 orthopaedic surgery residents (S.A. and G.G.), with educational materials on 5 common conditions treated by arthroscopic surgeons: anterior cruciate ligament (ACL) tear, meniscus tear, hip labral tear, shoulder labral tear, and rotator cuff tear. Following a Google search for each condition, we analyzed the 10 most visited websites for each disorder using a widely used and validated tool for assessing the reading levels of written materials (Flesch-Kincaid formula). The average grade reading level of the 50 websites studied was 9.90 with a reading ease of 52.14 ("fairly difficult, high school"). Only 26% of the websites were at or below the national average of an eighth-grade reading level. Of the 5 conditions treated by arthroscopic surgery, ACL tear had the highest average grade reading level at 10.73 ± 1.54, whereas meniscus tear had the lowest at 9.31 ± 1.81. Every condition in this study had an average readability at or above the ninth-grade reading level. The most frequently accessed materials for patients with injuries requiring arthroscopic surgery exceeds the readability recommendations of the American Medical Association and National Institutes of Health, as well as the average reading ability of US adults. Given the fact that these are the most commonly visited websites by the lay public, there needs to be a greater emphasis on tailoring written information to the literacy levels of the patient population. This study emphasizes the discrepancy between the recommended versus the measured reading levels of online patient education materials related to conditions treated by arthroscopic surgeons. The subject matter of these conditions is inherently complex; thus, relying solely on text to inform patients increases the likelihood that the reading level of the material exceeds that of the majority of the lay public. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Meniscal tears missed on MR imaging: relationship to meniscal tear patterns and anterior cruciate ligament tears.

PubMed

De Smet, A A; Graf, B K

1994-04-01

MR imaging of the knee is a valuable technique for diagnosing meniscal tears, but some tears found at arthroscopy are not shown on MR imaging. The purpose of this study was to determine whether or not tears were more frequently missed in the presence of an anterior cruciate ligament tear or when tears had certain locations or configurations. We reviewed the original MR reports and surgical records of 400 patients who had both an MR examination and arthroscopy of the knee. Using chi 2 analysis, we examined how the sensitivity for detecting meniscal tears varied with the presence of a tear of the anterior cruciate ligament, with the location of the tear within the meniscus, and among six configurations of meniscal tears. We also studied whether sensitivity decreased with an increasing delay between MR examination and arthroscopy. In the presence of a tear of the anterior cruciate ligament, the sensitivity decreased from 0.97 to 0.88 (p = .016) for medial meniscal tears and from 0.94 to 0.69 (p = .0005) for lateral tears. The overall sensitivity for lateral meniscal tears was significantly less for posterior (p = .001) and peripheral (p = .005) tears than for other tear locations or configurations. The sensitivities did not significantly differ between tear locations and configurations in the medial meniscus or with an increasing delay until arthroscopy. Patients with a torn anterior cruciate ligament were more likely to have peripheral tears of the medial meniscus (p = .00004) and posterior (p = .0004) and peripheral (p = .04) tears of the lateral meniscus. Because of their location and configuration, meniscal tears associated with an anterior cruciate ligament injury are more difficult to detect on MR images than are tears in knees with an intact ligament. If a tear of the anterior cruciate ligament is detected, special attention should be given to the subtle peripheral tears that may be present in either meniscus, but most commonly in the posterior horn of the lateral meniscus. These tears are especially difficult to detect on MR images.

Tear dynamics in healthy and dry eyes.

PubMed

Cerretani, Colin F; Radke, C J

2014-06-01

Dry-eye disease, an increasingly prevalent ocular-surface disorder, significantly alters tear physiology. Understanding the basic physics of tear dynamics in healthy and dry eyes benefits both diagnosis and treatment of dry eye. We present a physiological-based model to describe tear dynamics during blinking. Tears are compartmentalized over the ocular surface; the blink cycle is divided into three repeating phases. Conservation laws quantify the tear volume and tear osmolarity of each compartment during each blink phase. Lacrimal-supply and tear-evaporation rates are varied to reveal the dependence of tear dynamics on dry-eye conditions, specifically tear osmolarity, tear volume, tear-turnover rate (TTR), and osmotic water flow. Predicted periodic-steady tear-meniscus osmolarity is 309 and 321 mOsM in normal and dry eyes, respectively. Tear osmolarity, volume, and TTR all match available clinical measurements. Osmotic water flow through the cornea and conjunctiva contribute 10 and 50% to the total tear supply in healthy and dry-eye conditions, respectively. TTR in aqueous-deficient dry eye (ADDE) is only half that in evaporative dry eye (EDE). The compartmental periodic-steady tear-dynamics model accurately predicts tear behavior in normal and dry eyes. Inclusion of osmotic water flow is crucial to match measured tear osmolarity. Tear-dynamics predictions corroborate the use of TTR as a clinical discriminator between ADDE and EDE. The proposed model is readily extended to predict the dynamics of aqueous solutes such as drugs or fluorescent tags.

The tear turnover and tear clearance tests - a review.

PubMed

Garaszczuk, Izabela K; Montes Mico, Robert; Iskander, D Robert; Expósito, Alejandro Cerviño

2018-03-01

The aim is to provide a summary of methods available for the assessment of tear turnover and tear clearance rates. The review defines tear clearance and tear turnover and describes their implication for ocular surface health. Additionally, it describes main types of techniques for measuring tear turnover, including fluorescein tear clearance tests, techniques utilizing electromagnetic spectrum and tracer molecule and novel experimental techniques utilizing optical coherence tomography and fluorescein profilometry. Areas covered: Internet databases (PubMed, Science Direct, Google Scholar) and most frequently cited references were used as a principal resource of information on tear turnover rate and tear clearance rate, presenting methodologies and equipment, as well as their definition and implications for the anterior eye surface health and function. Keywords used for data-search were as follows: tear turnover, tear clearance, fluorescein clearance, scintigraphy, fluorophotometry, tear flow, drainage, tear meniscus dynamics, Krehbiel flow and lacrimal functional unit. Expert commentary: After decades, the topic of tear turnover assessment has been reintroduced. Recently, new techniques have been developed to propose less invasive, less time consuming and simpler methodologies for the assessment of tear dynamics that have the potential to be utilized in clinical practice.

Dry Eye as a Mucosal Autoimmune Disease

PubMed Central

Stern, Michael E.; Schaumburg, Chris S.; Pflugfelder, Stephen C.

2013-01-01

Dry eye is a common ocular surface inflammatory disease that significantly affects quality of life. Dysfunction of the lacrimal function unit (LFU) alters tear composition and breaks ocular surface homeostasis, facilitating chronic inflammation and tissue damage. Accordingly, the most effective treatments to date are geared towards reducing inflammation and restoring normal tear film. The pathogenic role of CD4+ T cells is well known, and the field is rapidly realizing the complexity of other innate and adaptive immune factors involved in the development and progression of disease. The data support the hypothesis that dry eye is a localized autoimmune disease originating from an imbalance in the protective immunoregulatory and proinflammatory pathways of the ocular surface. PMID:23360156

Tear progression of symptomatic full-thickness and partial-thickness rotator cuff tears as measured by repeated MRI.

PubMed

Kim, Yang-Soo; Kim, Sung-Eun; Bae, Sung-Ho; Lee, Hyo-Jin; Jee, Won-Hee; Park, Chang Kyun

2017-07-01

The purpose of this study was to analyse the natural course of symptomatic full-thickness and partial-thickness rotator cuff tears treated non-operatively and to identify risk factors affecting tear enlargement. One hundred and twenty-two patients who received non-surgical treatment for a partial- or full-thickness supraspinatus tear were included in this study. All rotator cuff tears were diagnosed with magnetic resonance imaging (MRI), and the same modality was used for follow-up studies. Follow-up MRI was performed after at least a 6-month interval. We evaluated the correlation between tear enlargement and follow-up duration. Eleven risk factors were analysed by both univariate and multivariate analyses to identify factors that affect enlargement of rotator cuff tears. The mean follow-up period was 24.4 ± 19.5 months. Out of 122 patients, 34 (27.9%) patients had an initial full-thickness tear and 88 (72.1%) patients had a partial-thickness tear. Considering all patients together, tear size increased in 51/122 (41.8%) patients, was unchanged in 65/122 (53.3%) patients, and decreased in 6/122 (4.9%) patients. Tear size increased for 28/34 (82.4%) patients with full-thickness tears and 23/88 (26.1%) patients with partial-thickness tears. From the two groups which were followed over 12 months, a higher rate of enlargement was observed in full-thickness tears than in partial-thickness tears (6-12 months, n.s.; 12-24 months, P = 0.002; over 24 months, P < 0.001). Logistic regression revealed that having a full-thickness tear was the most reliable risk factor for tear progression (P < 0.001). This study found that 28/34 (82.4%) of symptomatic full-thickness rotator cuff tears and 23/88 (26.1%) of symptomatic partial-thickness tears increased in size over a follow-up period of 6-100 months. Full-thickness tears showed a higher rate of enlargement than partial-thickness tears regardless of the follow-up duration. Univariate and multivariate analyses suggested that full-thickness tear was the most reliable risk factor for tear enlargement. The clinical relevance of these observations is that full-thickness rotator cuff tears treated conservatively should be monitored more carefully for progression than partial-thickness tears. IV.

Risk Factors for Tear Progression in Symptomatic Rotator Cuff Tears: A Prospective Study of 174 Shoulders.

PubMed

Yamamoto, Nobuyuki; Mineta, Mitsuyoshi; Kawakami, Jun; Sano, Hirotaka; Itoi, Eiji

2017-09-01

The risk factors for tear progression in symptomatic rotator cuff tears have not been clarified yet. It is important for orthopaedic surgeons to know the natural course of tear progression when nonoperative management is to be chosen. Tears in younger patients, high-activity patients, or heavy laborers would progress in size more than those in older patients, low-activity patients, or light laborers. Case-control study; Level of evidence, 3. Two hundred twenty-five consecutive patients with symptomatic rotator cuff tears visited our institute between 2009 and 2015. Of these, 174 shoulders of 171 patients (mean age, 66.9 years) who underwent at least 2 magnetic resonance imaging (MRI) examinations were prospectively enrolled. The mean follow-up was 19 months. Tear progression was defined as positive when the tear size increased by ≥2 mm. The demographic factors that were analyzed by multivariate analysis included age, sex, hand dominance, smoking, alcohol drinking, hypercholesterolemia, sports participation, job type, tear size, and tear type (full or partial thickness). Of the 174 shoulders, 82 shoulders (47%) showed tear progression. The mean (±SD) tear length and width in the progression group on final MRI were 23.1 ± 12.5 mm and 17.3 ± 9.6 mm, respectively; the tear size progressed by a mean 5.8 ± 5.6 mm in length and 3.1 ± 5.2 mm in width. The mean propagation speed was 3.8 mm/y in length and 2.0 mm/y in width. The size of full-thickness tears significantly increased compared with that of articular-sided partial-thickness tears ( P = .0215). The size of medium tears significantly increased compared with that of other tears ( P < .0001). According to the logistic regression analysis, smoking was significantly correlated with tear progression ( P = .026). Subgroup analyses showed that male sex, hand dominance, and trauma were correlated with tear progression. Age, alcohol drinking, hypercholesterolemia, sports participation, and job type did not show any correlation with tear progression. The tear size of symptomatic rotator cuff tears progressed in 47% of the shoulders during a mean of 19 months, and the speed of progression was 3.8 mm/y in length and 2.0 mm/y in width. The risk factors for tear progression were (1) a medium-sized tear, (2) a full-thickness tear, and (3) smoking.

Structure and microanalysis of tear film ferning of camel tears, human tears, and Refresh Plus.

PubMed

Am, Masmali; Ra, Fagehi; El-Naggar, Ahmad H; Tm, Almubrad

2018-01-01

This study aimed to investigate the tear ferning pattern and chemical elements of the tear film of camel tears compared with human tears and Refresh Plus eye lubricant. Refresh Plus was used as a control because it provides a healthy ferning pattern, due to the presence of an optimum ratio of carboxymethylcellulose (CMC) sodium and electrolytes. The main research focus is elucidating the viability of camel tear film in the dry, harsh environment of the desert. The tears were collected from five camels, five male desert workers (20-25 years old) at a small village located 100 km from Riyadh, Saudi Arabia, and five male subjects (20-25 years old) from Riyadh. A small drop (1 μl) of tears was dried on a glass slide and observed under a light (Olympus BX1) and scanning electron microscope (Inspect S50, Field Electron and Ion Company [FEI]). Energy-dispersive X-ray spectroscopy (EDS) of the tear film and Refresh Plus were investigated with a JEOL 1400 scanning transmission electron microscope. The camel tear film pattern was surrounded by thick, peripheral, homogenous layers containing small oily droplets, particles, and tiny branches in the tear ferning. The tear ferning of the camel was grade 0-1, whereas the tear ferning of human tears and Refresh Plus was grade 1-2. The mass percentage of chloride was highest in the camel tears. The mass percentage of potassium in the camel tears was greater than that in the human tears, but it was less than that in the Refresh Plus lubricant. Camel tears exhibit a better quality than human tears and Refresh Plus lubricant do. The presence of oily droplet-like structures at the periphery of tear ferning suggests that camel tear film may have a higher quality and quantity of minerals and lubricants, which may help the animal to avoid eye dryness. Future work is required to investigate the identification of the elements present in the peripheral and central part of the tear ferning.

Effects of Menthol-Containing Artificial Tears on Tear Stimulation and Ocular Surface Integrity in Normal and Dry Eye Rat Models.

PubMed

Ahn, Somin; Eom, Youngsub; Kang, Boram; Park, Jungboung; Lee, Hyung Keun; Kim, Hyo Myung; Song, Jong Suk

2018-05-01

To evaluate the effects of menthol-containing artificial tears on tear stimulation and ocular surface integrity in normal and dry eye rat models. A total of 54 male Lewis rats were used. The levels of tear secretion and tear MUC5AC concentrations were compared between the menthol-containing artificial tear-treated group (menthol group) and the vehicle-treated group (vehicle group). The groups were compared after a single instillation to evaluate the immediate effects, and after repeated instillation (five times a day for 5 days) to evaluate the longer-term effects. Tear lactate dehydrogenase (LDH) activity was measured to evaluate eye drop instillation-induced ocular surface damage. The effects of menthol-containing artificial tears were also evaluated in a dry eye rat model. After a single instillation of menthol-containing artificial tears, tear secretion increased from 4.37 (±0.75) mm at baseline to 7.37 (±1.60) mm. However, after repeated instillations, the effects of tear stimulation decreased. The tear MUC5AC concentration was significantly lower in the menthol group than in the vehicle group after a single instillation, but not after repeated instillation. However, the tear LDH concentration was significantly increased in the menthol group after repeated instillation. In the dry eye rat model, the extent of menthol-induced tear stimulation was reduced. Menthol-containing artificial tears increased tear secretion, but lowered the tear MUC5AC concentration. Menthol-induced tear stimulation was reduced after repeated instillation for 5 days and in the dry eye rat model. Conversely, repeated instillation of menthol-induced ocular surface damage, resulting in increased tear LDH activity.

Plasminogen activator activity in tears of pregnant women.

PubMed

Csutak, Adrienne; Steiber, Zita; Tőzsér, József; Jakab, Attila; Berta, András; Silver, David M

2017-01-01

Plasminogen activator activity (PAA) in tears of pregnant women was investigated at various gestation times to assess the availability of plasminogen activator for aiding potential corneal wound healing processes during pregnancy. PAA was measured by a spectrophotometric method. The analysis used 91 tear samples from pregnant and non-pregnant women, supplemented with 10 additional tear PAA measurements from non-pregnant women obtained in a previous study. Tear levels of PAA in pregnant women formed a bimodal distribution. Either the tear PAA level was zero or non-zero during pregnancy. When non-zero, the tear PAA level was dissociated from gestation time and not different than non-pregnant and post-pregnant levels. The frequency of occurrence of zero level tear PAA increased with gestation: 16%, 17% and 46% had zero tear PAA in samples taken from women in the first, second and third trimester, respectively. Overall, of the tear samples taken from women during pregnancy, a total of 26% were at zero tear PAA. The remaining tear samples had non-zero tear PAA values throughout gestation equivalent to non-pregnant tear PAA values, suggesting local control of the source of PAA in tears. Given the importance of the plasminogen activator system in tears to wound healing in the cornea, and the high occurrence of zero tear PAA in our sample of pregnant women, elective corneal surgery would be contraindicated. If corneal surgery is nevertheless necessary, the tear PAA level would be worth checking and patients with low level should be closely observed during the postoperative period.

Arthroscopic meniscal repair with use of the outside-in technique.

PubMed

Rodeo, S A

2000-01-01

The outside-in technique of arthroscopic repair is effective for repair of most meniscal tears. The overall indications for the use of this technique are similar to those for the commonly used inside-out technique. The outside-in technique is especially useful for suturing the anterior horn of the meniscus as well as for suturing meniscal replacement devices such as a collagen meniscal implant or a meniscal allograft. Other specific advantages of this technique include the ability to predictably avoid neurovascular injury without the need for a large posterior incision. A particular disadvantage is the difficulty of achieving perpendicular orientation of sutures when a tear is adjacent to the site of attachment of the posterior horn. Use of the inside-out technique or an all-inside implant is suggested for these tears. The use of this suturing technique is facilitated by attention to several technical points. The knee should be maintained in flexion for repair of tears of the lateral meniscus (to avoid injury to the peroneal nerve) and in nearly full extension for repair of the posterior aspect of the medial meniscus (to avoid injury to the saphenous nerve and its branches). Care must be taken to avoid tying the sutures around a branch of the saphenous nerve during repair of the medial meniscus. The sutures should be retrieved through a cannula in the anterior portal to avoid the entrapment of the sutures in soft tissue. A probe can be used to prevent displacement of the inner fragment of a bucket handle tear when the needles are placed across the tear, as the entering needles may push the torn fragment into the knee. A vertical suture orientation is preferred in order to evenly co-apt the meniscus to the capsule. If knot-end sutures (so-called Mulberry knots) are used, 2 sutures can be vertically stacked, with 1 on each surface of the meniscus. If a mattress suture is used, a vertical orientation is easily achieved with the outside-in technique. Use of an exogenous fibrin clot is suggested for isolated tears. The clot can be secured to the site of repair by a suture that has been placed through a spinal needle with the outside-in method. Delayed weightbearing should be considered as postoperative management for patients who have had repair of a tear with a radial component or repair of a complex tear in which a fibrin clot was used. Previous studies have demonstrated that the location of the tear and the condition of the anterior cruciate ligament are important factors in determining the success of meniscal repair. The overall results with use of the outside-in technique are comparable with those reported with use of the inside-out method. Patients with concomitant tears of the medial meniscus and the anterior cruciate ligament should have combined meniscal repair and reconstruction of the anterior cruciate ligament. As healing was demonstrated in 8 of 13 patients with an unrepaired tear of the anterior cruciate ligament, consideration should still be given to meniscal repair in patients who refuse reconstruction of the anterior cruciate ligament. In this setting, it may be advisable to use multiple permanent sutures, and the patient must be counseled regarding the higher rate of failure with this approach. Repairs of the lateral meniscus have a higher rate of success, and repair of the lateral meniscus should be considered even in the presence of injury of the anterior cruciate ligament.

How often do surgeons intervene on shoulder labral lesions detected at MR examination? A retrospective review of MR examinations correlated with arthroscopy

PubMed Central

2014-01-01

Objective: We report the prevalence of surgical intervention on shoulder labral lesions detected at MR examinations and how surgeons describe labral tears seen at MR examinations in their arthroscopy reports. Methods: A retrospective review of 100 consecutive patients aged 50 years or younger who had shoulder labral tears on MR and went on to have surgery performed. It was determined whether surgical intervention was performed on the MR lesions. Results: Of these 100 patients, 72 had superior labral anterior to posterior (SLAP) tears, 38 had posterior labral tears and 28 had anterior labral tears on MR examination. All 100 patients went on to arthroscopy. All lesions described on MRI were described on arthroscopy. Of the 72 SLAP tears, 64 were described as fraying on arthroscopy with 51 debrided. The remaining eight SLAP tears were tacked surgically. Of the 38 posterior labral tears, 36 were described as fraying on arthroscopy with 29 debrided and 2 had surgical tacking performed. Of the 28 anterior labral tears described on MR examination, 26 had surgical tacking performed and 2 were debrided. There were four SLAP tears, two anterior labral tears and three posterior labral tears seen on arthroscopy but not seen on MR examination. Conclusion: In this series, a high percentage of SLAP tears and posterior labral tears described on MR examination did not have surgical tacking. Most anterior labral tears had surgical tacking. Based on the above, our surgeons request we describe superior and posterior labral lesions as fraying and/or tearing, unless we can see a displaced tear. Most anterior labral lesions are treated with surgical tacking. Advances in knowledge: MRI allows for sensitive detection of labral tears. The tears often are not clinically significant. PMID:24712320

[Rotator cuff repair: single- vs double-row. Clinical and biomechanical results].

PubMed

Baums, M H; Kostuj, T; Klinger, H-M; Papalia, R

2016-02-01

The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique. The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques. The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair. In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques. Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.

Rotator cuff tears in children and adolescents: experience at a large pediatric hospital.

PubMed

Zbojniewicz, Andrew M; Maeder, Matthew E; Emery, Kathleen H; Salisbury, Shelia R

2014-06-01

Prior literature, limited to small case series and case reports, suggests that rotator cuff tears are rare in adolescents. However, we have identified rotator cuff tears in numerous children and adolescents who have undergone shoulder MRI evaluation. The purpose of this study is to describe the prevalence and characteristics of rotator cuff tears in children and adolescents referred for MRI evaluation of the shoulder at a large pediatric hospital and to correlate the presence of rotator cuff tears with concurrent labral pathology, skeletal maturity and patient activity and outcomes. We reviewed reports from 455 consecutive non-contrast MRI and magnetic resonance arthrogram examinations of the shoulder performed during a 2-year period, and following exclusions we yielded 205 examinations in 201 patients (ages 8-18 years; 75 girls, 126 boys). Rotator cuff tears were classified by tendon involved, tear thickness (partial or full), surface and location of tear (when partial) and presence of delamination. We recorded concurrent labral pathology when present. Physeal patency of the proximal humerus was considered open, closing or closed. Statistical analysis was performed to evaluate for a relationship between rotator cuff tears and degree of physeal patency. We obtained patient activity at the time of injury, surgical reports and outcomes from clinical records when available. Twenty-five (12.2%) rotator cuff tears were identified in 17 boys and 7 girls (ages 10-18 years; one patient had bilateral tears). The supraspinatus tendon was most frequently involved (56%). There were 2 full-thickness and 23 partial-thickness tears with articular-side partial-thickness tears most frequent (78%). Insertional partial-thickness tears were more common (78%) than critical zone tears (22%) and 10 (43%) partial-thickness tears were delamination tears. Nine (36%) patients with rotator cuff tears had concurrent labral pathology. There was no statistically significant relationship between rotator cuff tears and physeal patency (P > 0.05). Most patients were athletes (76%). Five tears were confirmed at surgery. Poor clinical follow-up limited evaluation of patient outcomes. Rotator cuff tears can be identified during MRI examination of symptomatic child and adolescent shoulders and often consist of tear patterns associated with repetitive microtrauma in overhead athletic activities or with single traumatic events. Rotator cuff tears are seen throughout the range of skeletal maturity, often coexist with labral tears and typically are found in athletes.

Tear Oxygen Under Hydrogel and Silicone Hydrogel Contact Lenses in Humans

PubMed Central

Bonanno, Joseph A.; Clark, Christopher; Pruitt, John; Alvord, Larry

2011-01-01

Purpose To determine the tear oxygen tension under a variety of conventional and silicone hydrogel contact lenses in human subjects. Methods Three hydrogel and five silicone hydrogel lenses (Dk/t = 17 to 329) were coated on the back surface with an oxygen sensitive, bovine serum albumin-Pd meso-tetra (4-carboxyphenyl) porphine complex (BSA-porphine). Each lens type was placed on the right eye of 15 non-contact lens wearers to obtain a steady-state open eye tear oxygen tension using oxygen sensitive phosphorescence decay of BSA-porphine. A closed-eye oxygen tension estimate was obtained by measuring the change in tear oxygen tension after 5 min of eye closure. In separate experiments, a goggle was placed over the lens wearing eye and a gas mixture (PO2 = 51 torr) flowed over the lens to simulate anterior lens oxygen tension during eye closure. Results Mean open eye oxygen tension ranged from 58 to 133 torr. Closed eye estimates ranged from 11 to 42 torr. Oxygen tension under the goggle ranged from 8 to 48 torr and was higher than the closed eye estimate for six out of the eight lenses, suggesting that the average closed eye anterior lens surface oxygen tension is <51 torr. For Dk/t >30, the measured tear oxygen tension is significantly lower than that predicted from previous studies. Conclusions The phosphorescence decay methodology is capable of directly measuring the in vivo post lens PO2 of high Dk/t lenses without disturbing the contact lens or cornea. Our data indicate that increasing Dk/t up to and beyond 140 continues to yield increased flux into the central cornea. PMID:19609230

Adsorption of human tear lipocalin to human meibomian lipid films.

PubMed

Millar, Thomas J; Mudgil, Poonam; Butovich, Igor A; Palaniappan, Chendur K

2009-01-01

Tear lipocalin (Tlc) is a major lipid binding protein in tears and is thought to have an important role in stabilizing the Meibomian lipid layer by transferring lipids to it from the aqueous layer or ocular surface, or by adsorbing to it directly. These possible roles have been investigated in vitro using human Tlc. Tlc was purified from human tears by size exclusion chromatography followed by ion exchange chromatography. Three additional samples of the Tlc were prepared by lipidation, delipidation, and relipidation. The lipids extracted from the purified Tlc were analyzed by HPLC-MS followed by fragmentation. Adsorption of these different forms of Tlc to a human Meibomian lipid film spread on the surface of an artificial tear buffer in a Langmuir trough were observed by recording changes in the pressure with time (Pi-T profile) and monitoring the appearance of the film microscopically. These results were compared with similar experiments using a bovine Meibomian lipid film. The results indicated that Tlc binds slowly to a human Meibomian lipid film compared with lysozyme or lactoferrin, even at 37 degrees C. The adsorption of Tlc to a human Meibomian lipid film was very different from its adsorption to a bovine Meibomian lipid film, indicating the nature of the lipids in the film is critical to the adsorption process. Similarly, the different forms of Tlc had quite distinct adsorption patterns, as indicated both by changes in Pi-T profiles and the microscopic appearance of the films. It was concluded that human Tlc was capable of adsorbing to and penetrating into a Meibomian lipid layer, but this process is very complex and depends on both the types of lipids bound to Tlc and the lipid complement comprising the Meibomian lipid film.

Adsorption of Human Tear Lipocalin to Human Meibomian Lipid Films

PubMed Central

Millar, Thomas J.; Mudgil, Poonam; Butovich, Igor A.; Palaniappan, Chendur K.

2009-01-01

Purpose Tear lipocalin (Tlc) is a major lipid binding protein in tears and is thought to have an important role in stabilizing the Meibomian lipid layer by transferring lipids to it from the aqueous layer or ocular surface, or by adsorbing to it directly. These possible roles have been investigated in vitro using human Tlc. Methods Tlc was purified from human tears by size exclusion chromatography followed by ion exchange chromatography. Three additional samples of the Tlc were prepared by lipidation, delipidation, and relipidation. The lipids extracted from the purified Tlc were analyzed by HPLC-MS followed by fragmentation. Adsorption of these different forms of Tlc to a human Meibomian lipid film spread on the surface of an artificial tear buffer in a Langmuir trough were observed by recording changes in the pressure with time (∏-T profile) and monitoring the appearance of the film microscopically. These results were compared with similar experiments using a bovine Meibomian lipid film. Results The results indicated that Tlc binds slowly to a human Meibomian lipid film compared with lysozyme or lactoferrin, even at 37°C. The adsorption of Tlc to a human Meibomian lipid film was very different from its adsorption to a bovine Meibomian lipid film, indicating the nature of the lipids in the film is critical to the adsorption process. Similarly, the different forms of Tlc had quite distinct adsorption patterns, as indicated both by changes in ∏-T profiles and the microscopic appearance of the films. Conclusions It was concluded that human Tlc was capable of adsorbing to and penetrating into a Meibomian lipid layer, but this process is very complex and depends on both the types of lipids bound to Tlc and the lipid complement comprising the Meibomian lipid film. PMID:18757516

Incidence and patterns of meniscal tears accompanying the anterior cruciate ligament injury: possible local and generalized risk factors.

PubMed

Mansori, Ashraf El; Lording, Timothy; Schneider, Antoine; Dumas, Raphael; Servien, Elvire; Lustig, Sebastien

2018-05-26

Injury to the anterior cruciate ligament (ACL) is frequently accompanied by tears of the menisci. Some of these tears occur at the time of injury, but others develop over time in the ACL-deficient knee. The aim of this study was to evaluate the effects of the patient characteristics, time from injury (TFI), and posterior tibial slope (PTS) on meniscal tear patterns. Our hypothesis was that meniscal tears would occur more frequently in ACL-deficient knees with increasing age, weight, TFI, PTS, and in male patients. Of the ACL-injured patients, 362 were analyzed, and details of meniscal lesions were collected. The medial and lateral tibial slopes (MTS, LTS) were measured via computed tomography. Patient demographics, TFI, MTS, and LTS were correlated with the diagnosed meniscal tears. Of the patients, 113 had a medial meniscus (MM) tear, 54 patients had a lateral meniscus (LM) tear, 34 patients had tears of both menisci, and 161 patients had no meniscal tear. The most common tear location was the posterior horn (PH) of the MM, followed by tear involving the whole MM. Patient age, BMI, and TFI were significantly associated with the incidence of MM tear. Female patients had a higher incidence of injury than males in all tear sites except in the body and PH. Male patients had more vertical and peripheral tears. The median MTS and LTS for patients with MM tears were 7.0°and 8.7°, respectively, while those of patients with LM tears were 6.9° and 8.1°. Steeper LTS was significantly associated with tears of LM and of both menisci. Older age, male sex, increased BMI, and prolonged TFI were significant factors for the development of MM tears. An increase in the tibial slope, especially of the lateral plateau, seems to increase the risk of tear of the LM and of both menisci. Level III.

Magnetic Resonance Imaging Currently Fails to Fully Evaluate the Biceps-Labrum Complex and Bicipital Tunnel.

PubMed

Taylor, Samuel A; Newman, Ashley M; Nguyen, Joseph; Fabricant, Peter D; Baret, Nikolas J; Shorey, Mary; Ramkumar, Prem; O'Brien, Stephen J

2016-02-01

To determine the diagnostic accuracy of magnetic resonance imaging (MRI) for biceps-labrum complex (BLC) lesions, including the extra-articular bicipital tunnel. A retrospective review of 277 shoulders with chronic refractory BLC symptoms that underwent arthroscopic subdeltoid transfer of the long head of the biceps tendon (LHBT) to the conjoint tendon was conducted. Intraoperative lesions were categorized as "inside" (labral tears and dynamic LHBT incarceration), "junctional" (LHBT partial tears, LHBT subluxation, and biceps chondromalacia), or "bicipital tunnel" (extra-articular bicipital tunnel scar/stenosis, loose bodies, LHBT instability, and LHBT partial tears) based on anatomic location. Attending radiologist-generated MRI reports were graded dichotomously as positive or negative for biceps and labral damage and then compared with intraoperative findings. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for MRI with respect to intraoperative findings. With regard to inside lesions, MRI had an overall sensitivity, specificity, PPV, and NPV for labrum lesions of 77.3%, 68.2%, 57.3%, and 84.5% respectively. The sensitivity, specificity, PPV, and NPV of MRI for junctional lesions were 43.3%, 55.6%, 73.1%, and 26.0%, respectively. For the bicipital tunnel, MRI had a sensitivity, specificity, PPV, and NPV of 50.4%, 61.4%, 48.7%, and 63.0%, respectively. MRI was unreliable for ruling out BLC lesions among chronically symptomatic patients, including when the bicipital tunnel was affected. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Arthroscopic repair of a chondrolabral lesion associated with anterior glenohumeral dislocation.

PubMed

Page, Richard; Bhatia, Deepak N

2010-12-01

Chondrolabral lesions are uncommon after anteroinferior glenohumeral dislocations. This report describes a new dual-lesion complex that involved an avulsion of the anteroinferior glenoid labrum and a flap tear of the adjacent articular cartilage [glenoid labral tear and articular cartilage flap (GLAF) lesion]. The chondral component involved a large undermined region of the anterior half of the lower glenoid articular cartilage, and the labral component involved an avulsion from the 2.30-6 o'clock position on the glenoid. The labral tear was reconstructed with 3 suture anchors to form a neo-labrum in an attempt to overlap and stabilize the periphery of the chondral flap. A meniscal repair device was used to place a mattress stitch in the cartilage periphery to further stabilize the flap. This technique resulted in a secure repair without any chondral damage, and this remained intact on an MRI performed at a 3-month follow-up. A final 12-month follow-up showed complete recovery, as assessed by the Oxford shoulder instability score and Rowe score, and by a return to the pre-injury sporting level.

Symptomatic rotator cuff tears show higher radioisotope uptake on bone scintigraphy compared with asymptomatic tears.

PubMed

Koike, Yoichi; Sano, Hirotaka; Kita, Atushi; Itoi, Eiji

2013-09-01

Some patients with rotator cuff tears complain of pain, whereas others are asymptomatic. Previous studies have pointed out the presence of active bone metabolism in the painful shoulder, identified with increased radioisotope uptake during bone scintigraphy. Shoulders with symptomatic rotator cuff tears will demonstrate higher radioisotope uptake than shoulders with asymptomatic tears with bone scintigraphy, reflecting active bone metabolism in symptomatic tears. Cross-sectional study; Level of evidence, 3. The study consisted of 3 groups: patients with symptomatic tears (symptomatic group), patients with asymptomatic tears (asymptomatic group), and controls (no tear group). The symptomatic group consisted of 28 shoulders from 28 patients with symptomatic rotator cuff tears (pain score ≤4 on the University of California, Los Angeles [UCLA] shoulder evaluation form) who underwent bone scintigraphy followed by rotator cuff repair. Of 70 volunteers who had previously undergone bone scintigraphy for diseases unrelated to their shoulder, 34 were selected for the asymptomatic group (pain score ≥8 on the UCLA shoulder form), and 32 were selected for the no tear group. The mean radioisotope uptake in the symptomatic group was significantly higher than that in the asymptomatic group (P = .02) and the no tear group (P = .02). Ten of 28 shoulders (36%) in the symptomatic group showed increased radioisotope uptake exceeding 2 standard deviations from the mean of the no tear group. This percentage was significantly higher when compared with the asymptomatic group (0%) (P < .01). Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. The radioisotope uptake in shoulders with an asymptomatic tear was comparable with that in shoulders without a tear. Positive radioisotope uptake may be associated with pain in a subgroup of patients with rotator cuff tears.

Divalent cations in tears, and their influence on tear film stability in humans and rabbits.

PubMed

Wei, Xiaojia Eric; Markoulli, Maria; Millar, Thomas J; Willcox, Mark D P; Zhao, Zhenjun

2012-06-05

Reduced tear film stability is reported to contribute to dry eye. Rabbits are known to have a more stable tear film than humans. Thus, we sought to examine the tears of rabbits and humans for metal cations, and to test how they influence tear film stability. Tears were collected from 10 healthy humans and 6 rabbits. Tear osmolality was measured by vapor pressure osmometer, and metals analyzed using inductively coupled plasma (ICP) mass spectrometry or ICP atomic emission spectroscopy. The influence of divalent cations on tears was analyzed by measuring surface tension using the Langmuir trough in vitro, using different concentrations of cations in the subphase, and grading the tear break-up in rabbits in vivo after instillation of chelating agents. Rabbit tears had a higher osmolality compared to humans. Major metals did not differ between species; however, rabbits had higher levels of Mg(2+) (1.13 vs. 0.39 mM) and Ca(2+) (0.75 vs. 0.36 mM). In rabbit tears in vitro, diminishing divalent cations resulted in a decrease in the maximum surface pressure from 37 to 30 mN/m. In vivo, an increase in the amount of tear film that was broken-up was found. In contrast, when changing divalent cation concentrations in human tears, the maximum surface pressure remained at 26 mN/m. The normal osmolality of rabbit tears is significantly higher than that in humans. While divalent cations had little influence on human tears, they appear to have an important role in maintaining tear film stability in rabbits.

Increasing age and tear size reduce rotator cuff repair healing rate at 1 year.

PubMed

Rashid, Mustafa S; Cooper, Cushla; Cook, Jonathan; Cooper, David; Dakin, Stephanie G; Snelling, Sarah; Carr, Andrew J

2017-12-01

Background and purpose - There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair. Patients and methods - Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for. Results - The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age. Interpretation - Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor.

A Controlled Study on the Correlation between Tear Film Volume and Tear Film Stability in Diabetic Patients.

PubMed

Eissa, Iman M; Khalil, Noha M; El-Gendy, Heba A

2016-01-01

Purpose. To assess the tear film quantity and correlate it with the quality and stability of the tear film in diabetics and compare them to age matched controls. Introduction. Diabetes affects tear film parameters in multiple ways. Poor metabolic control and neuropathy are postulated factors. To further understand how diabetes affects tear film parameters this study was conducted. Subjects and Methods. Tear meniscus height was measured by anterior segment OCT, along with tear thinning time, a subtype of noninvasive tear break-up time, and blinking rate per minute which were all recorded for 22 diabetic patients. Correlations between these tear film parameters were studied and then compared to 16 age matched controls. Results. A statistically significant difference was found in blinking rate between the diabetic and the control group (P = 0.002), with higher blinking rate among diabetics. All tear film parameters were negatively correlated with duration of diabetes. A positive correlation was found between tear film volume and stability. Conclusion. Diabetes affects the tear film in various ways. Diabetics should be examined for dry eye signs even in absence of symptoms which may be masked by associated neuropathy. Duration of diabetes has an impact on tear film status.

Goldmann tonometry tear film error and partial correction with a shaped applanation surface.

PubMed

McCafferty, Sean J; Enikov, Eniko T; Schwiegerling, Jim; Ashley, Sean M

2018-01-01

The aim of the study was to quantify the isolated tear film adhesion error in a Goldmann applanation tonometer (GAT) prism and in a correcting applanation tonometry surface (CATS) prism. The separation force of a tonometer prism adhered by a tear film to a simulated cornea was measured to quantify an isolated tear film adhesion force. Acrylic hemispheres (7.8 mm radius) used as corneas were lathed over the apical 3.06 mm diameter to simulate full applanation contact with the prism surface for both GAT and CATS prisms. Tear film separation measurements were completed with both an artificial tear and fluorescein solutions as a fluid bridge. The applanation mire thicknesses were measured and correlated with the tear film separation measurements. Human cadaver eyes were used to validate simulated cornea tear film separation measurement differences between the GAT and CATS prisms. The CATS prism tear film adhesion error (2.74±0.21 mmHg) was significantly less than the GAT prism (4.57±0.18 mmHg, p <0.001). Tear film adhesion error was independent of applanation mire thickness ( R 2 =0.09, p =0.04). Fluorescein produces more tear film error than artificial tears (+0.51±0.04 mmHg; p <0.001). Cadaver eye validation indicated the CATS prism's tear film adhesion error (1.40±0.51 mmHg) was significantly less than that of the GAT prism (3.30±0.38 mmHg; p =0.002). Measured GAT tear film adhesion error is more than previously predicted. A CATS prism significantly reduced tear film adhesion error bŷ41%. Fluorescein solution increases the tear film adhesion compared to artificial tears, while mire thickness has a negligible effect.

Hypertrophy of the extra-articular tendon of the long head of biceps correlates with the location and size of a rotator cuff tear.

PubMed

Takahashi, N; Sugaya, H; Matsuki, K; Miyauchi, H; Matsumoto, M; Tokai, M; Onishi, K; Hoshika, S; Ueda, Y

2017-06-01

The aim of this study was to assess hypertrophy of the extra-articular tendon of the long head of biceps (LHB) in patients with a rotator cuff tear. The study involved 638 shoulders in 334 patients (175 men, 159 women, mean age 62.6 years; 25 to 81) with unilateral symptomatic rotator cuff tears. The cross-sectional area (CSA) of the LHB tendon in the bicipital groove was measured pre-operatively in both shoulders using ultrasound. There were 154 asymptomatic rotator cuff tears in the contralateral shoulder. Comparisons were made between those with a symptomatic tear, an asymptomatic tear and those with no rotator cuff tear. In the affected shoulders, the CSAs were compared in relation to the location and size of the rotator cuff tear. The mean CSA was 21.0 mm 2 (4 to 71) in those with a symptomatic rotator cuff tear, 19.9 mm 2 (4 to 75) in those with an asymptomatic rotator cuff tear and 14.1 mm 2 (5 to 43) in those with no rotator cuff tear. The mean CSA in patients with both symptomatic and asymptomatic rotator cuff tears was significantly larger than in those with no rotator cuff tear (p < 0.001). In the affected shoulders, there were significant differences between patients with more than a medium sized posterosuperior cuff tear and those with an antero-superior cuff tear. Regardless of the symptoms, there was significant hypertrophy of the extra-articular LHB tendon in patients with a rotator cuff tear. The values were significantly related to the size of the tear. Cite this article: Bone Joint J 2017;99-B:806-11. ©2017 The British Editorial Society of Bone & Joint Surgery.

Increasing age and tear size reduce rotator cuff repair healing rate at 1 year

PubMed Central

Rashid, Mustafa S; Cooper, Cushla; Cook, Jonathan; Cooper, David; Dakin, Stephanie G; Snelling, Sarah; Carr, Andrew J

2017-01-01

Background and purpose — There is a need to understand the reasons why a high proportion of rotator cuff repairs fail to heal. Using data from a large randomized clinical trial, we evaluated age and tear size as risk factors for failure of rotator cuff repair. Patients and methods — Between 2007 and 2014, 65 surgeons from 47 hospitals in the National Health Service (NHS) recruited 447 patients with atraumatic rotator cuff tendon tears to the United Kingdom Rotator Cuff Trial (UKUFF) and 256 underwent rotator cuff repair. Cuff integrity was assessed by imaging in 217 patients, at 12 months post-operation. Logistic regression analysis was used to determine the influence of age and intra-operative tear size on healing. Hand dominance, sex, and previous steroid injections were controlled for. Results — The overall healing rate was 122/217 (56%) at 12 months. Healing rate decreased with increasing tear size (small tears 66%, medium tears 68%, large tears 47%, and massive tears 27% healed). The mean age of patients with a healed repair was 61 years compared with 64 years for those with a non-healed repair. Mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years). Increasing age was an independent factor that negatively influenced healing, even after controlling for tear size. Only massive tears were an independent predictor of non-healing, after controlling for age. Interpretation — Although increasing age and larger tear size are both risks for failure of rotator cuff repair healing, age is the dominant risk factor. PMID:28880113

Statistics without Tears: Complex Statistics with Simple Arithmetic

ERIC Educational Resources Information Center

Smith, Brian

2011-01-01

One of the often overlooked aspects of modern statistics is the analysis of time series data. Modern introductory statistics courses tend to rush to probabilistic applications involving risk and confidence. Rarely does the first level course linger on such useful and fascinating topics as time series decomposition, with its practical applications…

Ocular manifestations of xeroderma pigmentosum: long term follow-up highlights the role of DNA repair in protection from sun damage

PubMed Central

Brooks, Brian P; Thompson, Amy H; Bishop, Rachel J; Clayton, Janine A; Chan, Chi-Chao; Tsilou, Ekaterini T; Zein, Wadih M; Tamura, Deborah; Khan, Sikandar G.; Ueda, Takahiro; Boyle, Jennifer; Oh, Kyu-Seon; Imoto, Kyoko; Inui, Hiroki; Moriwaki, Shin-Ichi; Emmert, Steffen; Iliff, Nicholas T.; Bradford, Porcia; DiGiovanna, John J.; Kraemer, Kenneth H

2013-01-01

Objective Xeroderma pigmentosum (XP) is a rare autosomal recessive disease caused by mutations in DNA repair genes. Clinical manifestations of XP include mild to extreme sensitivity to ultraviolet radiation resulting in inflammation and neoplasia in sun-exposed areas of the skin, mucous membranes, and ocular surfaces. This report describes the ocular manifestations of XP in patients systematically evaluated in the Clinical Center at the National Institutes of Health. Design Retrospective Observational Case Series Participants Eighty-seven participants, aged 1.3 to 63.4 years, referred to the National Eye Institute for examination from 1964 to 2011. Eighty-three had XP, 3 had XP/Cockayne Syndrome complex, and 1 had XP/trichothiodystrophy complex. Methods Complete, age- and developmental stage-appropriate ophthalmic examination. Main Outcome Measures Visual acuity; eyelid, ocular surface and lens pathology; tear film and tear production measures; and cytological analysis of conjunctival surface swabs. Results Of the 87 patients, 91% had at least one ocular abnormality. The most common abnormalities were conjunctivitis (51%), corneal neovascularization (44%), dry eye (38%), corneal scarring (26%), ectropion (25%), blepharitis (23%), conjunctival melanosis (20%), and cataracts (14%). Thirteen percent of patients had some degree of visual axis impingement and 5% had no light perception in one or both eyes. Ocular surface cancer or a history of ocular surface cancer was present in 10% of patients. Patients with an acute sunburning skin phenotype were less likely to develop conjunctival melanosis and ectropion but more likely to develop neoplastic ocular surface lesions than non-burning patients. Some patients also showed signs of limbal stem cell deficiency. Conclusions Our longitudinal study reports the ocular status of the largest group of XP patients systematically examined at one facility over an extended period of time. Structural eyelid abnormalities, neoplasms of the ocular surface and eyelids, tear film and tear production abnormalities, ocular surface disease and inflammation, as well as corneal abnormalities were present in this population. Burning and non-burning XP patients exhibit different rates of important ophthalmologic findings, including neoplasia. Additionally, ophthalmic characteristics can help refine diagnoses in the case of XP complex phenotypes. DNA repair plays major role in protection of the eye from sunlight induced damage. PMID:23601806

Potential Market for New Meniscus Repair Strategies: Evaluation of the MOON Cohort

PubMed Central

Fetzer, Gary B.; Spindler, Kurt P.; Amendola, Annunziato; Andrish, Jack T.; Bergfeld, John A.; Dunn, Warren R.; Flanigan, David C.; Jones, Morgan; Kaeding, Christopher C.; Marx, Robert G.; Matava, Matthew J.; McCarty, Eric C.; Parker, Richard D.; Wolcott, Michelle; Vidal, Armando; Wolf, Brian R.; Wright, Rick W.

2013-01-01

Background An estimated 200,000 ACL reconstructions are performed each year in the United States. The presence of concomitant meniscus tears and subsequent treatment at the time of ACL reconstruction may determine long-term outcomes of these knees. The authors contend that a substantial number of these meniscal tears are treated in a fashion that reduces meniscal function and that new technologies are needed to treat meniscal tears in a fashion that preserves function. A large cohort of patients with meniscal tears is needed to demonstrate this need. The purpose of this study is to determine the incidence of meniscal tears, describe tear morphology, and selected treatment in the MOON prospective longitudinal cohort of ACL reconstruction. We also will demonstrate based on national statistics the large potential market that exists for future tissue engineering aimed at preserving meniscal function. Methods A multicenter cohort of 1014 patients undergoing ACL reconstruction between January 2002 and December 2003 were evaluated. All procedures were performed by nine fellowship trained sports medicine orthopaedic surgeons. Data on patient demographics, presence of a meniscus tear at time of ACL reconstruction, tear morphology, and meniscal treatment were collected prospectively. Meniscal tears were categorized into three potential tissue engineering treatment strategies: all-biologic repair, advanced repair, and scaffold replacement. Results 1014 ACL reconstructions were performed over the two year period. The median age at the time of surgery was 24 years. Thirty-six percent of the knees had medial meniscal tears and 44% of the knees had lateral meniscal tears. Longitudinal tears were the most common tear morphology. The most frequent treatment modality was partial meniscectomy (60%). Thirty percent of medial meniscal tears and 10% of lateral meniscal tears could be treated with all-biologic repair, 32% of medial meniscal tears and 28% of lateral meniscal tears could be treated with an advanced repair technique, and 35% of medial meniscal tears and 62% of lateral meniscal tears could be treated with scaffold replacement. Conclusions Although meniscal preservation is a generally accepted concept in the treatment of meniscal tears, the majority of tears in this young cohort undergoing ACL reconstruction were either not repairable types (radial) and/or in the avascular zone. Even with contemporary approaches to meniscal tear repair, we found significant limitations faced by the treating surgeon. The majority of tears in this population are currently treated by partial meniscectomy. The results of this cohort will hopefully, stimulate and focus future research and development of new tissue engineering strategies for a large potential market for meniscal function in an ACL reconstructed cohort. PMID:19634719

Comparison of Clinical and Radiological Results in the Arthroscopic Repair of Full-Thickness Rotator Cuff Tears With and Without the Anterior Attachment of the Rotator Cable.

PubMed

Cho, Nam Su; Moon, Seong Cheol; Hong, Se Jung; Bae, Seong Hae; Rhee, Yong Girl

2017-09-01

The anterior rotator cable is critical in force transmission of the rotator cuff. However, few clinical studies have examined the correlation between the integrity of the anterior supraspinatus tendon and surgical outcomes in patients with rotator cuff tears. To compare the clinical and structural outcomes of the arthroscopic repair of full-thickness rotator cuff tears with and without anterior disruption of the supraspinatus tendon. Cohort study; Level of evidence, 3. One hundred eighty-one shoulders available for magnetic resonance imaging (MRI) at least 6 months after arthroscopic rotator cuff repair, with a minimum 1-year follow-up, were enrolled. The anterior attachment of the rotator cable was disrupted in 113 shoulders (group A) and intact in 68 shoulders (group B). The mean age at the time of surgery in groups A and B was 59.6 and 59.2 years, respectively, and the mean follow-up period was 24.2 and 25.1 months, respectively. There were statistically significant differences in the preoperative tear size and pattern and muscle fatty degeneration between the 2 groups ( P = .004, P = .008, and P < .001, respectively). At final follow-up, the mean visual analog scale (VAS) for pain score during motion was 1.31 ± 0.98 and 1.24 ± 0.90 in groups A and B, respectively ( P = .587). The mean Constant score was 77.5 ± 11.2 and 78.0 ± 11.9 points in groups A and B, respectively ( P = .875). The mean University of California, Los Angeles score was 30.5 ± 4.1 and 31.0 ± 3.0 points in groups A and B, respectively ( P = .652). In assessing the repair integrity on postoperative MRI, the retear rate was 23.9% and 14.7% in groups A and B, respectively ( P = .029). Irrespective of involvement in the anterior attachment of the rotator cable, the mean 24-month follow-up demonstrated excellent pain relief and improvement in the ability to perform activities of daily living after arthroscopic rotator cuff repair. However, tears with anterior disruption of the rotator cable showed a significantly larger and more complex tear pattern and more advanced fatty degeneration. Additionally, the retear rate was significantly higher in patients with a tear involving the anterior attachment of the rotator cable.

The prevalence of rotator cuff tears: is the contralateral shoulder at risk?

PubMed

Liem, Dennis; Buschmann, Vera Elisa; Schmidt, Carolin; Gosheger, Georg; Vogler, Tim; Schulte, Tobias L; Balke, Maurice

2014-04-01

Rotator cuff tears are a common cause of pain and disability of the shoulder. Information on the prevalence and identification of potential risk factors could help in early detection of rotator cuff tears and improve treatment outcome. Patients treated for a symptomatic rotator cuff tear on one side have a higher prevalence of rotator cuff tears and decreased shoulder function on the contralateral side compared with an age- and sex-matched group of healthy individuals. Case control study; Level of evidence, 3. One group consisted of 55 patients who had been arthroscopically treated on one shoulder for rotator cuff tear (tear group). In this group, the nonoperated contralateral shoulder was examined. For comparison, the matching shoulder in a control group consisting of 55 subjectively healthy individuals matched by age (±1 year) and sex to the tear group was included. Diagnosis of a rotator cuff tear was made by ultrasound. Outcomes were measured using the Constant score. The prevalence of supraspinatus tears was significantly higher (P < .0001) in the tear group (67.3%) compared with the control group (11.0%). The Constant score for the activities of daily living subscale, however, was significantly lower (18.4) in the tear group compared with the control group (19.9; P = .012). No other subcategory score nor the overall score showed a significant difference. There was a significantly higher tear prevalence in the tear group of patients aged between 50 and 59 years (P < .001) and 60 and 69 years (P = .004). No tear was diagnosed in the control group in individuals younger than 60 years. Patients treated for partial and full-thickness rotator cuff tears have a significantly higher risk of having a tear on the contralateral side and have noticeable deficits in their shoulder function regarding activities of daily living even if the tear is otherwise asymptomatic.

The Degeneration of Meniscus Roots Is Accompanied by Fibrocartilage Formation, Which May Precede Meniscus Root Tears in Osteoarthritic Knees.

PubMed

Park, Do Young; Min, Byoung-Hyun; Choi, Byung Hyune; Kim, Young Jick; Kim, Mijin; Suh-Kim, Haeyoung; Kim, Joon Ho

2015-12-01

Fibrocartilage metaplasia in tendons and ligaments is an adaptation to compression as well as a pathological feature during degeneration. Medial meniscus posterior roots are unique ligaments that resist multidirectional forces, including compression. To characterize the degeneration of medial meniscus posterior root tears in osteoarthritic knees, with an emphasis on fibrocartilage and calcification. Cross-sectional study; Level of evidence, 3. Samples of medial meniscus posterior roots were harvested from cadaveric specimens and patients during knee replacement surgery and grouped as follows: normal reference, no tear, partial tear, and complete tear. Degeneration was analyzed with histology, immunohistochemistry, and real-time polymerase chain reaction. Uniaxial tensile tests were performed on specimens with and without fibrocartilage. Quantifiable data were statistically analyzed by the Kruskal-Wallis test with the Dunn comparison test. Thirty, 28, and 42 samples harvested from 99 patients were allocated into the no tear, partial tear, and complete tear groups, respectively. Mean modified Bonar tendinopathy scores for each group were 3.97, 9.31, and 14.15, respectively, showing a higher degree of degeneration associated with the extent of the tear (P < .05 for all groups). The characterization of root matrices revealed an increase in fibrocartilage according to the extent of the tear. Tear margins revealed fibrocartilage in 59.3% of partial tear samples and 76.2% of complete tear samples, with a distinctive cleavage-like shape. Root tears with a similar shape were induced within fibrocartilaginous areas during uniaxial tensile testing. Even in the no tear group, 56.7% of samples showed fibrocartilage in the anterior margin of the root, adjacent to the meniscus. An increased stained area of calcification and expression of the ectonucleotide pyrophosphatase/phosphodiesterase 1 gene were observed in the complete tear group compared with the no tear group (P < .0001 and P = .24, respectively). Fibrocartilage and calcification increased in medial meniscus posterior roots, associated with the degree of the tear. Both findings, which impair the ligament's resistance to tension, may play a pivotal role during the pathogenesis of degenerative meniscus root tears in osteoarthritic knees. Fibrocartilage and calcification may be useful as diagnostic markers as well as markers of degeneration, which may aid in determining the treatment modality in meniscus root tears. The presence of fibrocartilage in intact roots may suggest an impending tear in osteoarthritic knees. © 2015 The Author(s).

Anterior Segment Optical Coherence Tomography for Tear Meniscus Evaluation and its Correlation with other Tear Variables in Healthy Individuals

PubMed Central

Dhasmana, Renu; Nagpal, Ramesh Chander

2016-01-01

Introduction Dry eye is one of the most common ocular diseases in this cyber era. Despite availability of multiple tests, no single test is accurate for the diagnosis of dry eye. Anterior segment optical coherence tomography is the recent tool which can be added in the armentarium of dry eye tests. Aim To evaluate tear meniscus with anterior segment optical coherence tomography and its correlation with other tear variables in normal healthy individuals. Materials and Methods In this prospective cross-sectional observational study, right eye of 203 consecutive patients were studied. All the patients were divided into three groups Group 1, 2 and 3 according to their age ≤20 years, 21-40 years and >40 years respectively. All patients underwent routine ophthalmologic examinations along with slit-lamp bio-microscopy for tear meniscus height measurement, tear film break up time, Schirmer’s I test (with anaesthesia) and optical coherence tomography imaging of inferior tear meniscus height. After focusing of the instrument with a Cross Line (CL) centered on lower tear meniscus at 6’0 clock of cornea, a 6 mm long scan was obtained. The tear meniscus height (μm) and tear meniscus area (mm2) were measured manually with help of callipers by joining upper corneo-meniscus junction to the lower lid-meniscus junction and tear meniscus height and area within the plotted line respectively and calculated by using the integrated analysis available in the custom software. Results There was significant decrease in the all tear variables with the increase in the age. According to age groups in group 1, the mean Schirmer’s (24.0±4.9)mm, tear film break up time (11.1±1.9) sec, tear meniscus height on slit lamp (600.2±167.3)mm were higher but decreased in group 2 (21.5±5.4,10.8±1.4, 597.5±186.3) and group 3 (19.8 ± 5.1, 10.2 ± 1.6, 485.6 ± 157.7) respectively. Schirmer’s test values and tear film break up time were similar in both sexes (p=0.1 and p= 0.9). Tear meniscus height on slit lamp and Optical coherence based tear meniscus area were similar in both sexes (p=0.5 and p=0.1). However, tear meniscus height on optical coherence tomography was significantly higher in females (p=0.04). Value of Schirmer’s and tear film break up time (r =0.2; p= 0.001) and Schirmer’s and tear meniscus height on slit lamp (r=0.6; p<0.001) had positive correlation. Tear meniscus height and tear meniscus area on optical coherence tomography had positive correlation (r =.9; p<0.001). Conclusion On optical coherence tomography tear meniscus height and area significantly correlated. Despite higher values of Schirmer’s, tear film break up time, Slit lamp based tear meniscus height in younger age group the tear meniscus height and tear meniscus area with optical coherence tomography were lower. PMID:27437253

TFOS DEWS II Tear Film Report.

PubMed

Willcox, Mark D P; Argüeso, Pablo; Georgiev, Georgi A; Holopainen, Juha M; Laurie, Gordon W; Millar, Tom J; Papas, Eric B; Rolland, Jannick P; Schmidt, Tannin A; Stahl, Ulrike; Suarez, Tatiana; Subbaraman, Lakshman N; Uçakhan, Omür Ö; Jones, Lyndon

2017-07-01

The members of the Tear Film Subcommittee reviewed the role of the tear film in dry eye disease (DED). The Subcommittee reviewed biophysical and biochemical aspects of tears and how these change in DED. Clinically, DED is characterized by loss of tear volume, more rapid breakup of the tear film and increased evaporation of tears from the ocular surface. The tear film is composed of many substances including lipids, proteins, mucins and electrolytes. All of these contribute to the integrity of the tear film but exactly how they interact is still an area of active research. Tear film osmolarity increases in DED. Changes to other components such as proteins and mucins can be used as biomarkers for DED. The Subcommittee recommended areas for future research to advance our understanding of the tear film and how this changes with DED. The final report was written after review by all Subcommittee members and the entire TFOS DEWS II membership. Copyright © 2017 Elsevier Inc. All rights reserved.

The brilliant beauty of the eye: light reflex from the cornea and tear film.

PubMed

Goto, Eiki

2006-12-01

Light reflex from the cornea and tear film as contributors to beautiful eyes ("eye sparkling") are reviewed. A systematic literature review was conducted using "Purkinje-Sanson image," "corneal light reflex," "corneal topography," "corneal wavefront aberration," and "tear interference image" as search terms. Articles on corneal surface regularity and stability and tear interferometry of the precorneal tear lipid layer were reviewed. PS-1 image, that is light reflex from the cornea and tear film, is widely used in practical ophthalmic examination. To achieve a brilliant beauty of the eye ("eye sparkling"), it is important that the tear film (aqueous layer) surface is smooth and stable with adequate tear volume and that the tear lipid layer is present in adequate thickness.

Shifting the IGF-axis: An age-related decline in human tear IGF-1 correlates with clinical signs of dry eye.

PubMed

Patel, Roshni; Zhu, Meifang; Robertson, Danielle M

2018-06-01

The human corneal epithelium expresses both the insulin-like growth factor type 1 receptor (IGF-1R) and the IGF-1R/insulin receptor (INSR) hybrid. Despite the previous identification of IGF-1 in human tear fluid, little is known regarding the regulation of IGF-1 in tear fluid and its role in corneal epithelial homeostasis. In the present study, we investigated the impact of biological parameters on the concentration of human tear levels of IGF-1. Tear levels of IGF-1 were measured in 41 healthy, human volunteers without any reported symptoms of dry eye. All volunteers underwent standard biomicroscopic examination of the cornea and tear film. In a subgroup of volunteers, corneal staining with sodium fluorescein, tear film break up time and tear production using a Schirmer's test strip were measured to assess clinical signs of dry eye. Tears were collected from the inferior tear meniscus using glass microcapillary tubes and IGF-1 levels were measured using a solid phase sandwich ELISA. Tear levels of IGF-1 were highest in young adults and significantly decreased in older adults (P = 0.003). There were no differences in tear IGF-1 between males and females (P = 0.628). Tear IGF-1 levels were correlated with tear film break up time (R = 0.738) and tear production (R = 0.826). These data indicate that there is a progressive decline in tear IGF-1 due to aging that is associated with clinical signs of dry eye. This effect is likely due to age-related changes in the lacrimal gland. Copyright © 2018 Elsevier Ltd. All rights reserved.

Detection of endogenous cortisol in equine tears and blood at rest and after simulated stress.

PubMed

Monk, Caroline S; Hart, Kelsey A; Berghaus, Roy D; Norton, Natalie A; Moore, Phillip A; Myrna, Kathern E

2014-07-01

To determine whether cortisol is present in equine tears at rest and during simulated stress and compare tear cortisol to serum free and total cortisol. Fourteen healthy adult horses were included. Paired tear total cortisol and serum total and free cortisol concentrations were measured with ELISA, chemiluminescent immunoassay, and ultrafiltration methodology, respectively, in 10 horses at rest once daily for five consecutive days. In an additional four horses, paired tear and serum samples were collected for cortisol measurement before and after adrenocorticotropic hormone (ACTH) stimulation (cosyntropin, 1 μg/kg IV). Cortisol was detectable in equine tears at rest. Following ACTH stimulation, tear cortisol increased significantly from baseline at 60-120 min (P ≤ 0.001). Serum total and free cortisol also increased significantly at 30-180 min after ACTH stimulation (P ≤ 0.001). Both serum and tear cortisol returned to baseline concentrations by 360 min. Changes in tear cortisol were similarly associated with changes in serum total and free cortisol, although high tear cortisol concentrations suggest a portion of tear cortisol may be protein-bound. Cortisol is present in equine tears and increases in concert with serum cortisol following ACTH stimulation. Further study is needed to determine whether endogenous cortisol in tears contributes to ocular pathology. © 2013 American College of Veterinary Ophthalmologists.

A comparison of MRI findings in patients with acute and chronic ACL tears.

PubMed

Dimond, P M; Fadale, P D; Hulstyn, M J; Tung, G A; Greisberg, J

1998-01-01

This retrospective study compared the magnetic resonance imaging (MRI) findings in 87 patients with acute and chronic anterior cruciate ligament (ACL) tears. Sixty patients had acute tears and 27 had chronic tears. The appearance of the torn ligament was examined on MRI, and associated meniscal and osteochondral injuries were described. All findings were verified at arthroscopy. Acute ACL tears (MRI examination was performed within 6 weeks of injury) were typified by the presence of diffuse (58%) or focal (42%) increased signal within the ligament, whereas chronic ACL tears (MRI examination was performed more than 6 months after injury) usually appeared as either a fragmented ligament (44%) or an intact band of low signal with abnormal orientation (30%). Patients with chronic ACL tears had a higher prevalence of medial meniscal tears (78% versus 40%), articular chondromalacia, and an increased posterior cruciate bow ratio (0.47 versus 0.37) in association with chronic ACL tears. A bone bruise was seen in 68% of acute ACL tears but in no case of chronic ACL tear. On MRI, there are salient differences between acute and chronic ACL tears. Chronic ACL tears are associated with a greater prevalence of meniscal and osteochondral injuries. These findings may have implications for future treatment recommendations.

[Environmental pollution by products of wear and tear automobile-road complex].

PubMed

Levanchuk, A V

2014-01-01

North-West State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation, 191015. There is supposed the method for the assessment of amounts of pollutants released into the environment during the operational wear of tyre treads, brake system of cars and the road pavement. There are presented results of chemical analysis of residues of combustion. The necessity of control of products of work wear of automobile-road complex has been substantiated.

Simultaneous measurement of tear film dynamics using wavefront sensor and optical coherence tomography.

PubMed

Koh, Shizuka; Tung, Cynthia; Aquavella, James; Yadav, Rahul; Zavislan, James; Yoon, Geunyoung

2010-07-01

PURPOSE. To investigate tear film dynamics using simultaneous measurements of ocular aberrations and lower tear meniscus. METHODS. Simultaneous measurements of wavefront aberration and lower tear meniscus were performed for 11 normal eyes and 7 eyes with short tear film break-up time (SBUT) dry eye, with a tear film break-up time shorter than 5 seconds, using a wavefront sensor and an anterior segment optical coherence tomography (OCT). During the measurement, the subjects were instructed to blink every 6 seconds for a total of 30 seconds. From the measured aberration, root mean square (RMS) wavefront error and volume modulation transfer function (vMTF) induced by changes in tear film dynamics were calculated for a 5-mm pupil. Lower tear meniscus height (TMH) and area (TMA) were estimated from the cross-sectional OCT images of lower tear meniscus. RESULTS. There was a positive correlation between RMS and tear meniscus dimensions and a negative correlation between vMTF and tear meniscus in both groups. There were moderate negative correlations between the postblink initial RMS change and baseline TMH (R = -0.61) and TMA (R = -0.54) in SBUT dry eyes that were stronger than in normal eyes (R = -0.37, R = -0.38). CONCLUSIONS. Tear meniscus dimensions increase with RMS over time, and tear quantity before blink has a significant role in maintaining initial optical integrity, especially in SBUT dry eye. Simultaneous measurement of optical quality and tear meniscus has the potential to improve understanding of tear stability in normal eyes and dry eyes.

Mass Spectrometric Identification of Phospholipids in Human Tears and Tear Lipocalin

PubMed Central

Dean, Austin W.; Glasgow, Ben J.

2012-01-01

Purpose. The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Methods. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Results. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490–540) accounted for about 80% of the total integrated ion count. The [M+H]+ compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin–bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Conclusions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin. PMID:22395887

Mass spectrometric identification of phospholipids in human tears and tear lipocalin.

PubMed

Dean, Austin W; Glasgow, Ben J

2012-04-02

The purpose of this article was to identify by mass spectrometry phosphocholine lipids in stimulated human tears and determine the molecules bound to tear lipocalin or other proteins. Tear proteins were separated isocratically from pooled stimulated human tears by gel filtration fast performance liquid chromatography. Separation of tear lipocalin was confirmed by SDS tricine gradient PAGE. Protein fractions were extracted with chloroform/methanol and analyzed with electrospray ionization MS/MS triple quadrupole mass spectrometry in precursor ion scan mode for select leaving groups. For quantification, integrated ion counts were derived from standard curves of authentic compounds of phosphatidylcholine (PC) and phosphatidylserine. Linear approximation was possible from integration of the mass spectrometrically obtained ion peaks at 760 Da for the PC standard. Tears contained 194 ng/mL of the major intact PC (34:2), m/z 758.6. Ten other monoisotopic phosphocholines were found in tears. A peak at 703.3 Da was assigned as a sphingomyelin. Four lysophosphatidylcholines (m/z 490-540) accounted for about 80% of the total integrated ion count. The [M+H](+) compound, m/z 496.3, accounted for 60% of the signal intensity. Only the tear lipocalin-bearing fractions showed phosphocholines (104 ng/mL). Although the intact phospholipids bound to tear lipocalin corresponded precisely in mass and relative signal intensity to that found in tears, we did not identify phosphocholines between m/z 490 and 540 in any of the gel-filtration fractions. Phospholipids, predominantly lysophospholipids, are present in tears. The higher mass intact PCs in tears are native ligands of tear lipocalin.

Comparison of low-abundance biomarker levels in capillary-collected nonstimulated tears and washout tears of aqueous-deficient and normal patients.

PubMed

Guyette, Nicole; Williams, Larezia; Tran, My-Tho; Than, Tammy; Bradley, John; Kehinde, Lucy; Edwards, Clara; Beasley, Mark; Fullard, Roderick

2013-05-01

Low tear volume limits the use of nonstimulated (NS) microcapillary tear collection in aqueous-deficient (AD) patients. Adding a small amount of "washout" fluid to the eye prior to tear collection is a potentially viable alternative method for abundant proteins, but is relatively untested for low-abundance biomarkers. This study determined the feasibility of the washout (WO) method as an NS alternative for low-abundance biomarkers. NS and WO biomarker profiles were compared between AD patients and non-AD controls to determine if the two methods identify the same intergroup differences. Matching NS and WO tears were collected from 48 patients by micropipette, the WO sample after instillation of 10 μL saline. Tear cytokine levels were measured by 27-Plex Bio-Rad assay. Bland-Altman analyses for each biomarker determined the agreement between tear sample types. Patients were grouped as AD or non-AD based on Schirmer score to determine if NS profile between-group differences were preserved in WO tears. Bland-Altman plots showed good biomarker level agreement between NS and WO tears for most cytokines. Five biomarkers, among those most often cited as differing in AD dry eye, differed significantly between non-AD and AD groups in both tear types. Additional biomarker differences were seen in NS tears only. The WO tear collection method is a viable alternative to NS tears for many low-abundance biomarkers and is able to replicate major NS tear differences between dry eye groups. More subtle intergroup differences are lost in WO samples because of reduced statistical power.

Non-contrast magnetic resonance imaging for diagnosing shoulder injuries.

PubMed

Arnold, Heino

2012-12-01

To compare preoperative non-contrast magnetic resonance imaging (MRI) with arthroscopy findings in diagnosing labral and rotator cuff tears. 86 men and 60 women aged 21 to 70 (mean, 52) years underwent non-contrast MRI before arthroscopic operations on the glenohumeral joint. Slices were made in a transverse, parasagittal, and paracoronar orientation. The sequences used were T2- and proton-weighted for paracoronar imaging, T1- and T2-weighted for transverse and parasagittal imaging, and T2-weigthed sequences with fat suppression and short tau inversion recovery sequences. MRI was evaluated with the surgeon to eliminate interobserver bias. Arthroscopic surgery was performed by a single surgeon. If a labral or rotator cuff tear was found, surgery was performed using corkscrew anchors. For full thickness rotator cuff tears, MRI and arthroscopy detected them in 76 and 82 patients, respectively. One such tear found by MRI could not be confirmed by arthroscopy. MRI missed 4 subscapularis and 3 supraspinatus tears. The sensitivity and specificity of MRI in diagnosing full thickness rotator cuff tears were 0.90 and 0.91, respectively. For labral tears, MRI and arthroscopy detected them in 16 and 31 patients, respectively. One anterior labral tear detected by MRI could not be verified by arthroscopy. All 16 labral tears detected by MRI were Bankart type-I tears (of the anterior glenoid) except for one superior labral tear from anterior to posterior (SLAP tear). All 13 SLAP tears (10 type 2 and 3 type 3) except for one could be found by arthroscopy only. The sensitivity and specificity of MRI in diagnosing labral tears were 0.52 and 0.89, respectively. Non-contrast MRI is reliable only for diagnosing full thickness rotator cuff tears and anterior labral tears. Direct or indirect contrast enhancement is recommended for more differentiation. Special scan orientation is necessary for SLAP tears.

Tear-Film Evaporation Rate from Simultaneous Ocular-Surface Temperature and Tear-Breakup Area.

PubMed

Dursch, Thomas J; Li, Wing; Taraz, Baseem; Lin, Meng C; Radke, Clayton J

2018-01-01

A corneal heat-transfer model is presented to quantify simultaneous measurements of fluorescein tear-breakup area (TBA) and ocular-surface temperature (OST). By accounting for disruption of the tear-film lipid layer (TFLL), we report evaporation rates through lipid-covered tear. The modified heat-transfer model provides new insights into evaporative dry eye. A quantitative analysis is presented to assess human aqueous tear evaporation rate (TER) through intact TFLLs from simultaneous in vivo measurement of time-dependent infrared OST and fluorescein TBA. We interpret simultaneous OST and TBA measurements using an extended heat-transfer model. We hypothesize that TBAs are ineffectively insulated by the TFLL and therefore exhibit higher TER than does that for a well-insulting TFLL-covered tear. As time proceeds, TBAs increase in number and size, thereby increasing the cornea area-averaged TER and decreasing OST. Tear-breakup areas were assessed from image analysis of fluorescein tear-film-breakup video recordings and are included in the heat-transfer description of OST. Model-predicted OSTs agree well with clinical experiments. Percent reductions in TER of lipid-covered tear range from 50 to 95% of that for pure water, in good agreement with literature. The physical picture of noninsulating or ruptured TFLL spots followed by enhanced evaporation from underlying cooler tear-film ruptures is consistent with the evaporative-driven mechanism for local tear rupture. A quantitative analysis is presented of in vivo TER from simultaneous clinical measurement of transient OST and TBA. The new heat-transfer model accounts for increased TER through expanding TBAs. Tear evaporation rate varies strongly across the cornea because lipid is effectively missing over tear-rupture troughs. The result is local faster evaporation compared with nonruptured, thick lipid-covered tear. Evaporative-driven tear-film ruptures deepen to a thickness where fluorescein quenching commences and local salinity rises to uncomfortable levels. Mitigation of tear-film rupture may therefore reduce dry eye-related symptoms.

The Fate of Meniscus Tears Left in situ at the time of Anterior Cruciate Ligament Reconstruction: A 6-year Follow-up Study from the MOON Cohort

PubMed Central

Duchman, Kyle R.; Westermann, Robert W.; Spindler, Kurt P.; Reinke, Emily K.; Huston, Laura J.; Amendola, Annunziato; Wolf, Brian R.

2016-01-01

Background The management of meniscus tears identified at the time of primary ACL reconstruction is highly variable and includes repair, meniscectomy, and non-treatment. Hypothesis/Purpose The purpose of this study is to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with minimum follow-up of 6 years. We hypothesize that small, peripheral tears identified at the time of ACL reconstruction managed with “no treatment” will have successful clinical outcomes. Study Design Retrospective study of a prospective cohort; Level of Evidence, 3 Methods Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. Need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. Results There were 194 patients with 208 meniscus tears (71 medial; 137 lateral) left in situ without treatment with complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction and 7 tears (3.4%) underwent reoperation for isolated meniscus pathology. Patient age was significantly lower in patients requiring reoperation, while tears measuring ≥ 10 mm more frequently required reoperation. Conclusions Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings reemphasize the low reoperation rate following non-treatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment. PMID:26430058

Posterior meniscus root tears: associated pathologies to assist as diagnostic tools.

PubMed

Matheny, Lauren M; Ockuly, Andrew C; Steadman, J Richard; LaPrade, Robert F

2015-10-01

The purpose of this study was to investigate associated pathologies identified at arthroscopy in patients with meniscus root tears. This study was Institutional Review Board approved. All patients who underwent arthroscopic knee surgery where a complete meniscus root tear was identified were included in this study. Concurrent ligament tears and articular cartilage changes ≥Outerbridge grade 2 were recorded and stored in a data registry. Fifty patients (28 males, 22 females) [mean age = 36.5 years (range 17.1-68.1 years)] who were diagnosed with a medial or lateral meniscus root tear at arthroscopy were included in this study out of 673 arthroscopic surgeries (prevalence 7.4 %). Twenty-three (46 %) patients had a medial meniscus root tear, 26 (52 %) patients had a lateral meniscus root tear and one (2 %) patient had both. Thirty-four per cent of patients (n = 17) underwent partial meniscectomy, while 60 % (n = 31) underwent suture repair. During arthroscopy, 60 % (n = 30) of patients were diagnosed with an anterior cruciate ligament (ACL) tear. Patients with lateral meniscus root tears were 10.3 times (95 % CI 2.6-42.5) more likely to have ACL tears than patients with medial meniscus root tears (p = 0.012). Patients who had medial meniscus root tears were 5.8 times (95 % CI 1.6-20.5) more likely to have chondral defects than patients who had lateral meniscus root tears (p = 0.044). In this study, patients' preoperative functional scores and activity levels were low. Patients with lateral meniscal root tears were more likely to have an ACL tear. Patients with medial meniscal root tears were more likely to have an knee articular cartilage defect with an Outerbridge grade 2 or higher chondral defect. This study confirms the importance of comprehensive assessment of concurrent injuries to properly diagnose meniscus root tears. IV.

The Fate of Meniscus Tears Left In Situ at the Time of Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study From the MOON Cohort.

PubMed

Duchman, Kyle R; Westermann, Robert W; Spindler, Kurt P; Reinke, Emily K; Huston, Laura J; Amendola, Annunziato; Wolf, Brian R

2015-11-01

The management of meniscus tears identified at the time of primary anterior cruciate ligament (ACL) reconstruction is highly variable and includes repair, meniscectomy, and nontreatment. The purpose of this study was to determine the reoperation rate for meniscus tears left untreated at the time of ACL reconstruction with a minimum follow-up of 6 years. The hypothesis was that small peripheral tears identified at the time of ACL reconstruction managed with "no treatment" would have successful clinical outcomes. Cohort study; Level of evidence, 3. Patients with meniscus tears left untreated at the time of primary ACL reconstruction were identified from a multicenter study group with a minimum 6-year follow-up. Patient, tear, and reoperation data were obtained for analysis. The need for reoperation was used as the primary endpoint, with analysis performed to determine patient and tear characteristics associated with reoperation. There were 194 patients with 208 meniscus tears (71 medial, 137 lateral) left in situ without treatment with a complete follow-up for analysis. Of these, 97.8% of lateral and 94.4% of medial untreated tears required no reoperation. Sixteen tears (7.7%) left in situ without treatment underwent subsequent reoperation: 9 tears (4.3%) underwent reoperation in the setting of revision ACL reconstruction, and 7 tears (3.4%) underwent reoperation for an isolated meniscus injury. The patient age was significantly lower in patients requiring reoperation, while tears measuring ≥10 mm more frequently required reoperation. Lateral and medial meniscus tears left in situ at the time of ACL reconstruction did not require reoperation at a minimum 6-year follow-up for 97.8% and 94.4% of tears, respectively. These findings re-emphasize the low reoperation rate after the nontreatment of small, peripheral lateral meniscus tears while noting less predictable results for medial meniscus tears left without treatment. © 2015 The Author(s).

Visualisation of the temporary cavity by computed tomography using contrast material.

PubMed

Schyma, Christian; Hagemeier, Lars; Greschus, Susanne; Schild, Hans; Madea, Burkhard

2012-01-01

The temporary cavity of a missile produces radial tears in ordnance gelatine, which correlate to the energy transfer. Computed tomography is a useful and non-destructive method to examine gelatine blocks. However, the tears give only few radiocontrast by air filling, which decreases with the time past shooting. Therefore, systematically, a radiocontrast material was searched to enhance the contrast. Different contrast materials were amalgamated to acryl paint, and about 7 g was sealed in a foil bag, which was integrated in the front of a standard 10% gelatine cylinder. Shots with Action-5 expanding bullets were performed from a 5-m distance. Gelatine was scanned by multi-slice computed tomography. The multiplanar reconstructed images were compared to mechanically cut slices of 1 cm thickness. It was shown experimentally that iodine containing water-soluble contrast material did not give sufficient contrast and caused diffusion artefacts. Best results were obtained by barium sulphate emulsion. The amount of acryl paint was sufficient to colour the tears for optical scanning. The radiocontrast of barium leads to satisfying imaging of tears and allowed the creation of a three-dimensional reconstruction of the temporary cavity. Comparison of optical and radiological results showed an excellent correlation, but absolute measures in computed tomographic (CT) images remained lower compared with optically gathered values in the gelatine slices. Combination of paint and contrast material for CT examination will facilitate the evaluation of complex ballistic models and increase accuracy.

Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis

PubMed Central

NITODA, EIRINI; LAVARIS, ANASTASIOS; LAIOS, KONSTANTINOS; ANDROUDI, SOPHIA; KALOGEROPOULOS, CHRIS D; TSATSOS, MICHAEL; DAMASKOS, CHRISTOS; GARMPIS, NIKOLAOS; MOSCHOS, MARILITA M

2018-01-01

Background/Aim: Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Patients and Methods: Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. Results: The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Conclusion: Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. PMID:29475928

Effect of controlled adverse chamber environment exposure on tear functions in silicon hydrogel and hydrogel soft contact lens wearers.

PubMed

Kojima, Takashi; Matsumoto, Yukihiro; Ibrahim, Osama M A; Wakamatsu, Tais Hitomi; Uchino, Miki; Fukagawa, Kazumi; Ogawa, Junko; Dogru, Murat; Negishi, Kazuno; Tsubota, Kazuo

2011-11-11

To prospectively evaluate the effect of controlled adverse chamber environment (CACE) exposure on tear function, including tear osmolarity, in subjects wearing narafilcon A versus those wearing etafilcon A soft contact lens (SCL). Thirty-one healthy subjects with no history of contact lens wear (13 women, 18 men; average age, 30.5 ± 6.5 years) were randomly divided into age- and sex-matched groups (15 subjects wearing narafilcon A SCL; 16 subjects wearing etafilcon A SCL) and entered a CACE for 20 minutes. All subjects underwent tear osmolarity, tear evaporation rate, strip meniscometry, tear film breakup time, fluorescein vital staining, and functional visual acuity measurement before and after exposure to the controlled adverse chamber. The mean blink rate increased with significant deteriorations in the mean symptom VAS scores, mean tear osmolarity, tear evaporation rate, strip meniscometry score, and tear stability with CACE exposure along with a decrease in visual maintenance ratio in functional visual acuity testing in etafilcon A wearers. The mean symptom VAS scores, mean tear evaporation rate, tear stability, blink rates, and visual maintenance ratios did not change significantly in narafilcon A wearers after CACE exposure. This study suggested marked tear instability, higher tear osmolarity, and increased tear evaporation with marked dry eye and visual symptomatology in nonadapted hydrogel SCL wearers, suggesting that silicone hydrogel SCLs may be suitable for persons who live and work in cool, low-humidity, and windy environments, as tested in this study.

Tear analysis in contact lens wearers.

PubMed Central

Farris, R L

1985-01-01

Tear analysis in contact lens wearers was compared with tear analysis in aphakics without contact lens wear and normal phakic patients. Subjects were divided into five groups: group 1, aphakic without contact lens; group 2, phakic with daily-wear hard contact lens; group 3, phakic with daily-wear soft contact lens; group 4, phakic with extended-wear soft contact lens; and group 5, aphakic with extended-wear soft contact lens. The experimental groups were compared with age- and sex-matched control groups for statistical analysis of tear variables by means of the Student's t-test. The variables measured were tear osmolarity, tear albumin, and lysozyme and lactoferrin concentrations in basal and reflex tears. Highly significant elevations of tear osmolarity were found in aphakic subjects without contact lenses. Less significant differences in tear osmolarity were found in phakic subjects with hard daily-wear lenses or with extended-wear soft lenses. Tear albumin, lysozyme, and lactoferrin in basal and reflex tears were not significantly different in the different groups of contact lens wearers or in the group of aphakic subjects without contact lenses compared with their control groups. Individual variations in tear albumin, lysozyme, and lactoferrin appeared to be responsible for the inability to demonstrate significant differences in tear composition in association with the wearing of different types of contact lenses. Older and aphakic patients demonstrated a tendency to have increased concentrations of proteins in the tears compared with younger, phakic contact lens wearers and normal controls without contact lenses. PMID:3914131

Behavioral and neural responses to infant and adult tears: The impact of maternal love withdrawal.

PubMed

Riem, Madelon M E; van IJzendoorn, Marinus H; De Carli, Pietro; Vingerhoets, Ad J J M; Bakermans-Kranenburg, Marian J

2017-09-01

The current study examined behavioral and neural responses to infant and adult tears, taking into account childhood experiences with parental love-withdrawal. With functional MRI (fMRI), we measured neural reactivity to pictures of infants and adults with and without tears on their faces in nulliparous women with varying childhood experiences of maternal use of love withdrawal. Behavioral responses to infant and adult tears were measured with an approach-avoidance task. We found that individuals with experiences of love withdrawal showed less amygdala and insula reactivity to adult tears, but love withdrawal did not affect amygdala and insula reactivity to infant tears. During the approach-avoidance task, individuals responded faster to adult tears in the approach condition compared with the avoidance condition, indicating that adult tears facilitate approach behavior. Individuals responded faster to infant tears than to adult tears, regardless of approach or avoidance condition. Our findings suggest that infant tears are highly salient and may, therefore, overrule the effects of contextual and personal characteristics that influence the perception of adult crying. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

[Rotator cuff tear athropathy prevalence].

PubMed

Guerra-Soriano, F; Encalada-Díaz, M I; Ruiz-Suárez, M; Valero-González, F S

2017-01-01

Glenohumeral arthritis secondary to massive rotator cuff tear presents with a superior displacement and femoralization of the humeral head with coracoacromial arch acetabularization. The purpose of this study was to establish prevalence of rotator cuff tear artropathy (CTA) at our institution. Four hundred electronic records were reviewed from which we identified 136 patients with rotator cuff tears. A second group was composed with patients with massive cuff tears that were analized and staged by the Seebauer cuff tear arthropathy classification. Thirty four patients with massive rotator cuff tears were identified, 8 male and 26 female (age 60.1 ± 10.26 years). Massive rotator cuff tear prevalence was 25%. CTA prevalence found in the rotator cuff group was 19 and 76% in the massive cuff tears group. Patients were staged according to the classification with 32% in stage 1a, 11% 1b, 32% 2a and 0% 2b. CTA prevalence in patients with rotator cuff tears and massive cuff tears is higher than the one reported in American population. We consider that a revision of the Seebauer classification to be appropriate to determine its reliability.

Characteristics of radial tears in the posterior horn of the medial meniscus compared to horizontal tears.

PubMed

Choi, Chul-Jun; Choi, Yun-Jin; Song, In-Bum; Choi, Chong-Hyuk

2011-06-01

The clinical and radiologic features of radial tears of the medial meniscus posterior horn were compared with those of horizontal tears. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Among these, 91 were radial tears in the medial meniscus posterior horn, and 95 were horizontal tears in the posterior segment of the medial meniscus. The patients' data (age, gender, duration of symptom, body mass index, and injury history), radiographic findings (Kellgren and Lawrence score, posterior tibial slope, and femorotibial angle), and chondral lesions were recorded. The patient factors of age, gender, and body mass index were related to radial tears of the medial meniscus posterior horn. Radial tears were significantly correlated with Kellgren and Lawrence score, varus alignment, posterior tibial slope, and severity of the chondral lesion. Radial tears of the medial meniscus posterior horn are a unique clinical entity that are associated with older age, females and obesity, and are strongly associated with an increased incidence and severity of cartilage degeneration compared to horizontal tears.

The Coracohumeral Distance in Shoulders With Traumatic and Degenerative Subscapularis Tendon Tears.

PubMed

Balke, Maurice; Banerjee, Marc; Greshake, Oliver; Hoeher, Juergen; Bouillon, Bertil; Liem, Dennis

2016-01-01

A reduced coracohumeral distance (CHD) is thought to be responsible for subcoracoid impingement. This only accounts for degenerative tendon tears. In traumatic tears, the subcoracoid space should be normal. The CHD in patients with traumatic subscapularis tendon tears is larger than that in patients with degenerative tears and does not differ from patients with an intact subscapularis tendon. Cohort study; Level of evidence, 3. A total of 83 patients with arthroscopically certified subscapularis tendon tears were included in the study. Forty-four patients had degenerative causes (group 1), and 39 had traumatic causes (group 2). The control group consisted of 20 patients with traumatic supraspinatus tendon tears and arthroscopically proven, intact subscapularis tendons (group 3). On preoperative axial magnetic resonance imaging, the distance between the CHD was measured, and the values of the 3 groups were compared using the t test. The mean (±SD) CHD in patients with degenerative subscapularis tendon tears was 8.6 ± 2.0 mm (range, 4.0-13.2 mm) and was significantly (P = .0003) smaller than that in patients with traumatic tears (10.2 ± 2.0 mm; range, 6.6-16.2 mm) or controls (10.4 ± 1.8 mm; range, 6.8-14.0 mm). The CHD of controls and patients with traumatic tears did not differ significantly (P = .7875). A CHD of less than 6 mm only occurred in patients with degenerative subscapularis tendon tears. The hypothesis that the CHD in patients with degenerative subscapularis tendon tears is significantly smaller than that in patients with traumatic tears or intact subscapularis tendons was confirmed. The CHD in patients with traumatic tears does not differ from that in controls. A CHD of less than 6 mm only occurs in patients with degenerative subscapularis tendon tears. © 2015 The Author(s).

Incidence of skin tears in the extremities among elderly patients at a long-term medical facility in Japan: A prospective cohort study.

PubMed

Sanada, Hiromi; Nakagami, Gojiro; Koyano, Yuiko; Iizaka, Shinji; Sugama, Junko

2015-08-01

There is a lack of data from cohort studies for the incidence of skin tears among an elderly population in an Asian country. We estimated the cumulative incidence of skin tear, and identify its risk factor. The present prospective cohort study was carried out at a long-term medical facility in Japan. Participants included patients (n = 368) aged 65 years or older receiving hospital care. The 3-month cumulative incidence of skin tears was estimated by identifying them using direct inspection of the extremities. In order to find the risk factors for the skin tear incidence, odds ratios and their 95% confidence intervals of skin tear development in association with the factors were estimated using logistic regression analyses. A total of 14 patients developed skin tears, and their cumulative incidence was 3.8%. No patients with skin tears developed multiple wounds on their extremities. Half of the skin tears occurred on the outside of the right forearm, and just three skin tears were found in the lower legs. Multiple logistic analyses showed that pre-existing skin tears (odds ratio 15.42, 95% confidence interval 3.53-67.43, P < 0.001) and a 6-point decrease in the total score of the Braden Scale (odds ratio 0.10, 95% confidence interval 0.01-0.83, P < 0.033) were significantly associated with skin tear development. Patients with pre-existing skin tears and a low score of the Braden Scale have a higher risk of skin tear development during 3 months. These factors could be used to identify patients requiring prevention care for skin tears. © 2014 Japan Geriatrics Society.

From Crisis to Empowerment: African American Women in Community Colleges

ERIC Educational Resources Information Center

Bates, Marcie Ann

2012-01-01

Social challenges tear at the fabric of the African American family, revealing complexities that identify a de facto leader, the African American woman. She exists in a chasm of overt circumstances which heavily influences her successes. The purpose of this study is to identify factors that motivated seven female African American community college…

Effect of the transverse ligament rupture on the biomechanics of the cervical spine under a compressive loading.

PubMed

Mesfar, Wissal; Moglo, Kodjo

2013-10-01

In order to diagnosis a transverse ligament rupture in the cervical spine, clinicians normally measure the atlas-dens interval by using CT scan images. However, the impact of this tear on the head and neck complex biomechanics is not widely studied. The transverse ligament plays a very important role in stabilizing the joint and its alteration may have a substantial effect on the whole head and neck complex. A finite element model consisting of bony structures along with cartilage, intervertebral discs and all ligaments was developed based on CT and MRI images. The effect of head weights (compressive load) of 30 N to 57 N was investigated in the cases of intact and ruptured transverse ligament joints. The model was validated based on experimental studies investigating the response of the cervical spine under the extension-flexion moment. The predictions indicate a significant alteration of the kinematics and load distribution at the facet joints of the cervical spine with a transverse ligament tear. The vertebrae flexion, the contact force at the facets joints and the atlas-dens interval increase with the rupture of the transverse ligament and are dependent to the head weight. A transverse ligament tear increases the flexion angle of the head and the vertebrae as well as the atlas-dens interval. The atlas-dens interval reaches a critical value when the compressive loading exceeds 40 N. Supporting the head after an injury should be considered to avoid compression of the spinal cord and permanent neurologic damage. © 2013.

The Relationship Between Intraoperative Tear Dimensions and Postoperative Pain in 1624 Consecutive Arthroscopic Rotator Cuff Repairs.

PubMed

Yeo, Daniel Y T; Walton, Judie R; Lam, Patrick; Murrell, George A C

2017-03-01

Rotator cuff repair often results in significant pain postoperatively, the cause of which is undetermined. Purpose/Hypothesis: The aim of this study was to evaluate the relationship between rotator cuff tear area and postoperative pain in patients who had undergone arthroscopic rotator cuff repair. We hypothesized that larger tears would be more painful because of elevated repair tension at 1 week postoperatively but that smaller tears would be more painful because of a greater healing response, especially from 6 weeks postoperatively. Cohort study; Level of evidence, 3. A total of 1624 patients who underwent arthroscopic rotator cuff repair were included in this study. Exclusion criteria were moderate to severe osteoarthritis, isolated subscapularis repair, calcific tendinitis, synthetic patch repair, revision surgery, and retears on ultrasound at 6 months after surgery. Rotator cuff tears were subdivided into groups based on the tear size and retear rate found for each group. A modified L'Insalata questionnaire was given before surgery and at 1 week, 6 weeks, 3 months, and 6 months after surgery. Pearson and Spearman correlation coefficient tests were performed between rotator cuff tear areas and pain scores. Intraoperative rotator cuff tear areas did not correlate with pain scores preoperatively or at 1 week after surgery. A smaller tear area was associated with more frequent and severe pain with overhead activities, at rest, and during sleep as well as a poorer perceived overall shoulder condition at 6 weeks, 3 months, and 6 months after repair ( r = 0.11-0.23, P < .0001). Patients who were younger, had partial-thickness tears, and had occupational injuries experienced more pain postoperatively ( r = 0.10-0.28, P < .0001). Larger tears did not have more pain at 1 week after surgery. The retear rate was 7% in tears <2 cm 2 but reached 44% in tears >8 cm 2 . There were fewer retears with smaller tears, but they were more painful than large tears postoperatively from 6 weeks to 6 months after surgery. Smaller tears may heal more vigorously, causing more pain. Patients with smaller tears experienced more pain after rotator cuff repair compared with patients with larger tears. These findings are contrary to previous ideas about tear size and postoperative pain. Healing is likely a determinant of postoperative pain.

Biomechanical comparison of single-row arthroscopic rotator cuff repair technique versus transosseous repair technique.

PubMed

Tocci, Stephen L; Tashjian, Robert Z; Leventhal, Evan; Spenciner, David B; Green, Andrew; Fleming, Braden C

2008-01-01

This study determined the effect of tear size on gap formation of single-row simple-suture arthroscopic rotator cuff repair (ARCR) vs transosseous Mason-Allen suture open RCR (ORCR) in 13 pairs of human cadaveric shoulders. A massive tear was created in 6 pairs and a large tear in 7. Repairs were cyclically tested in low-load and high-load conditions, with no significant difference in gap formation. Under low-load, gapping was greater in massive tears. Under high-load, there was a trend toward increased gap with ARCR for large tears. All repairs of massive tears failed in high-load. Gapping was greater posteriorly in massive tears for both techniques. Gap formation of a modeled RCR depends upon the tear size. ARCR of larger tears may have higher failure rates than ORCR, and the posterior aspect appears to be the site of maximum gapping. Specific attention should be directed toward maximizing initial fixation of larger rotator cuff tears, especially at the posterior aspect.

Ultrasound determination of rotator cuff tear repairability

PubMed Central

Tse, Andrew K; Lam, Patrick H; Walton, Judie R; Hackett, Lisa

2015-01-01

Background Rotator cuff repair aims to reattach the torn tendon to the greater tuberosity footprint with suture anchors. The present study aimed to assess the diagnostic accuracy of ultrasound in predicting rotator cuff tear repairability and to assess which sonographic and pre-operative features are strongest in predicting repairability. Methods The study was a retrospective analysis of measurements made prospectively in a cohort of 373 patients who had ultrasounds of their shoulder and underwent rotator cuff repair. Measurements of rotator cuff tear size and muscle atrophy were made pre-operatively by ultrasound to enable prediction of rotator cuff repairability. Tears were classified following ultrasound as repairable or irreparable, and were correlated with intra-operative repairability. Results Ultrasound assessment of rotator cuff tear repairability has a sensitivity of 86% (p < 0.0001) and a specificity of 67% (p < 0.0001). The strongest predictors of rotator cuff repairability were tear size (p < 0.001) and age (p = 0.004). Sonographic assessments of tear size ≥4 cm2 or anteroposterior tear length ≥25 mm indicated an irreparable rotator cuff tear. Conclusions Ultrasound assessment is accurate in predicting rotator cuff tear repairability. Tear size or anteroposterior tear length and age were the best predictors of repairability. PMID:27582996

Bilateral Patellar Tendon Rupture.

PubMed

Kamienski, Mary

The knee is the most complex and largest joint in the body. Injuries to any part of this joint affect the entire body. There are multiple injuries that can occur to the knee, with the most common being ligament and meniscus tears. A not-so-common injury to the knee is a patellar tendon rupture. A bilateral patellar tendon rupture is extremely rare. A case study of a 43-year-old man who sustained a bilateral patellar tendon rupture while playing softball is used to present this devastating injury. This discussion includes the incidence and diagnosis of the tear, surgical repair, as well as a description of the comprehensive rehabilitation process necessary to allow the patient to return to normal physical activity. Risks and complications of this surgery and the expected outcomes are also presented.

Glenohumeral instability and rotator cuff tear.

PubMed

Porcellini, Giuseppe; Caranzano, Francesco; Campi, Fabrizio; Pellegrini, Andrea; Paladini, Paolo

2011-12-01

The prevalence of rotator cuff tears after traumatic dislocation increases with advancing age, a likely consequence of the age-associated deterioration of the structure and mechanical properties of the tendons of the rotator cuff. These are the effective stabilizers of the glenohumeral joint, compressing the humeral head in the 3-dimensional concavity of the glenohumeral joint. It is impossible to establish whether a lesion of the capsular-labrum complex or of the rotator cuff causes or follows a dislocation, regardless of whether it is anterior or posterior. A peripheral nerve or a brachial plexus injury can be associated with tendon lesion and instability, developing the "terrible triad" of the shoulder. Both conservative and surgical management are possible, and surgeons must choose the most appropriate management modality according to the biologic age, functional demands, and type of lesion.

Tear Film Osmolarity in Subjects with Acute Allergic Rhinoconjunctivitis.

PubMed

Nitoda, Eirini; Lavaris, Anastasios; Laios, Konstantinos; Androudi, Sophia; Kalogeropoulos, Chris D; Tsatsos, Michael; Damaskos, Christos; Garmpis, Nikolaos; Moschos, Marilita M

2018-01-01

Acute allergic rhinoconjuctivitis is the most common form of ocular allergies. The pathogenetic mechanisms are based on an immunoglobulin E (IgE)-mediated hypersensitivity reaction. On the other hand, tear osmolarity has been suggested to be an index of ocular surface damage and inflammation. These data were the motive to investigate the levels of tear osmolarity in subjects with acute allergic rhinoconjuctivitis, before and after administration of artificial tears. Forty-five subjects with acute allergic rhinoconjuctivitis were randomly divided into three groups, based on the type of artificial tears that they received: Group A (Thera tears), Group B (Wet therapy) and Group C (Tears Naturale free). The eye drops were administered six times a day for 60 days and all subjects underwent grading of subjective symptoms and clinical examination at baseline and at the end of the treatment. The diagnosis of severe eye disease, which was based on ocular surface disease index (OSDI; Allergan, Inc, Irvine, CA, USA) and tear osmolarity values, concerned all patients at baseline. Although the administration of artificial tears significantly ameliorated the symptoms and the ocular variables in all groups, the results were better in the first group. Tear osmolarity was strongly and negatively correlated with tear film breakup time (BUT) and Schirmer I test at 2 months. Contrariwise, symptoms were eliminated, when tear osmolarity was decreased. Acute allergic rhinoconjuctivitis is characterized by tear hyperosmolarity, which can be rehabilitated with the administration of hypotonic artificial tears. Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

Evaporation-driven instability of the precorneal tear film.

PubMed

Peng, Cheng-Chun; Cerretani, Colin; Braun, Richard J; Radke, C J

2014-04-01

Tear-film instability is widely believed to be a signature of eye health. When an interblink is prolonged, randomly distributed ruptures occur in the tear film. "Black spots" and/or "black streaks" appear in 15 to 40 s for normal individuals. For people who suffer from dry eye, tear-film breakup time (BUT) is typically less than a few seconds. To date, however, there is no satisfactory quantitative explanation for the origin of tear rupture. Recently, it was proposed that tear-film breakup is related to locally high evaporative thinning. A spatial variation in the thickness of the tear-film lipid layer (TFLL) may lead to locally elevated evaporation and subsequent tear-film breakup. We examine the local-evaporation-driven tear-film-rupture hypothesis in a one-dimensional (1-D) model for the evolution of a thin aqueous tear film overriding the cornea subject to locally elevated evaporation at its anterior surface and osmotic water influx at its posterior surface. Evaporation rate depends on mass transfer both through the coating lipid layer and through ambient air. We establish that evaporation-driven tear-film breakup can occur under normal conditions but only for higher aqueous evaporation rates. Predicted roles of environmental conditions, such as wind speed and relative humidity, on tear-film stability agree with clinical observations. More importantly, locally elevated evaporation leads to hyperosmolar spots in the tear film and, hence, vulnerability to epithelial irritation. In addition to evaporation rate, tear-film instability depends on the strength of healing flow from the neighboring region outside the breakup region, which is determined by the surface tension at the tear-film surface and by the repulsive thin-film disjoining pressure. This study provides a physically consistent and quantitative explanation for the formation of black streaks and spots in the human tear film during an interblink. Copyright © 2013 Elsevier B.V. All rights reserved.

49 CFR 178.1070 - Tear test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.1070 Section 178.1070... Containers § 178.1070 Tear test. (a) General. The tear test must be conducted for the qualification of all of Flexible Bulk Containers design types. (b) Special preparation for the tear test. Flexible Bulk Container...

Human tears contain a chemosignal.

PubMed

Gelstein, Shani; Yeshurun, Yaara; Rozenkrantz, Liron; Shushan, Sagit; Frumin, Idan; Roth, Yehudah; Sobel, Noam

2011-01-14

Emotional tearing is a poorly understood behavior that is considered uniquely human. In mice, tears serve as a chemosignal. We therefore hypothesized that human tears may similarly serve a chemosignaling function. We found that merely sniffing negative-emotion-related odorless tears obtained from women donors induced reductions in sexual appeal attributed by men to pictures of women's faces. Moreover, after sniffing such tears, men experienced reduced self-rated sexual arousal, reduced physiological measures of arousal, and reduced levels of testosterone. Finally, functional magnetic resonance imaging revealed that sniffing women's tears selectively reduced activity in brain substrates of sexual arousal in men.

Tear thinning time and topical anesthesia as assessed using the HIRCAL grid and the NCCA.

PubMed

Blades, K J; Murphy, P J; Patel, S

1999-03-01

The literature contains conflicting reports of the effects of topical anesthetics on tear film stability, with some consensus that unpreserved topical anesthetics are less likely to reduce tear film stability than preserved preparations. This experiment investigated the effect of unpreserved 0.4% benoxinate hydrochloride on tear thinning time (TTT), in parallel with "real time" corneal sensitivity assessment. Tear film stability was assessed (HIRCAL grid) in parallel with real time assessment of the pharmacological activity (NCCA) of unpreserved 0.4% benoxinate hydrochloride in normal eyes. The anesthetic used did not significantly affect tear film stability. This finding is in agreement with previous investigators. Unpreserved 0.4% benoxinate hydrochloride could be used to facilitate tear film stability assessment. The experimental protocol used could also be applied to investigate the temporal relationship between anesthesia and tear film stability with preserved topical anesthetics that have been found to decrease tear film stability.

Tear exchange and contact lenses: A review

PubMed Central

Muntz, Alex; Subbaraman, Lakshman N.; Sorbara, Luigina; Jones, Lyndon

2015-01-01

Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. PMID:25575892

Tear dysfunction and the cornea: LXVIII Edward Jackson Memorial Lecture.

PubMed

Pflugfelder, Stephen C

2011-12-01

To describe the cause and consequence of tear dysfunction-related corneal disease. Perspective on effects of tear dysfunction on the cornea. Evidence is presented on the effects of tear dysfunction on corneal morphology, function, and health, as well as efficacy of therapies for tear dysfunction-related corneal disease. Tear dysfunction is a prevalent eye disease and the most frequent cause for superficial corneal epithelial disease that results in corneal barrier disruption, an irregular optical surface, light scattering, optical aberrations, and exposure and sensitization of pain-sensing nerve endings (nociceptors). Tear dysfunction-related corneal disease causes irritation and visual symptoms such as photophobia and blurred and fluctuating vision that may decrease quality of life. Dysfunction of 1 or more components of the lacrimal functional unit results in changes in tear composition, including elevated osmolarity and increased concentrations of matrix metalloproteinases, inflammatory cytokines, and chemokines. These tear compositional changes promote disruption of tight junctions, alter differentiation, and accelerate death of corneal epithelial cells. Corneal epithelial disease resulting from tear dysfunction causes eye irritation and decreases visual function. Clinical and basic research has improved understanding of the pathogenesis of tear dysfunction-related corneal epithelial disease, as well as treatment outcomes. Copyright © 2011 Elsevier Inc. All rights reserved.

Increased Tear Film Osmolarity in Systemic Lupus Erythematosus.

PubMed

Duru, Necati; Altinkaynak, Hasan; Uysal, Betul Seher; Duru, Zeynep; Can, Mehmet Erol; Erten, Sukran; Yuksel, Nilay; Kalkan Akcay, Emine

2017-01-01

To evaluate tear film osmolarity in patients with systemic lupus erythematosus (SLE). A total of 55 eyes from 55 patients with SLE and 47 eyes from 47 age- and gender-matched healthy individuals were included in this study. Tear film osmolarity was evaluated with a lab-on-a-chip technique (TearLab; TearLab Corporation, San Diego, CA) in SLE patients in comparison with healthy individuals, and results were correlated to clinically available diagnostic tests for dry eye, such as tear film break-up time (BUT), Schirmer's test, and Ocular Surface Disease Index (OSDI). The mean tear film osmolarity in the SLE patients and healthy individuals was 306.02 ± 13.27 mOsm/L and 300.74 ± 9.11 mOsm/L, respectively, which made for a statistically significant difference (p = 0.020). In the SLE group, tear film osmolarity was negatively correlated with the Schirmer's test score and the BUT value (r = -0.295 p = 0.029 and r = 0.347 p = 0.009, respectively), whereas tear film osmolarity was not correlated with OSDI score (r = -0.182 p = 0.183). This study revealed that tear film hyperosmolarity and abnormal tear film function are associated with SLE.

Emotional tears facilitate the recognition of sadness and the perceived need for social support.

PubMed

Balsters, Martijn J H; Krahmer, Emiel J; Swerts, Marc G J; Vingerhoets, Ad J J M

2013-02-12

The tearing effect refers to the relevance of tears as an important visual cue adding meaning to human facial expression. However, little is known about how people process these visual cues and their mediating role in terms of emotion perception and person judgment. We therefore conducted two experiments in which we measured the influence of tears on the identification of sadness and the perceived need for social support at an early perceptional level. In two experiments (1 and 2), participants were exposed to sad and neutral faces. In both experiments, the face stimuli were presented for 50 milliseconds. In experiment 1, tears were digitally added to sad faces in one condition. Participants demonstrated a significant faster recognition of sad faces with tears compared to those without tears. In experiment 2, tears were added to neutral faces as well. Participants had to indicate to what extent the displayed individuals were in need of social support. Study participants reported a greater perceived need for social support to both sad and neutral faces with tears than to those without tears. This study thus demonstrated that emotional tears serve as important visual cues at an early (pre-attentive) level.

Anatomical significance of a posterior horn of medial meniscus: the relationship between its radial tear and cartilage degradation of joint surface.

PubMed

Kan, Akinori; Oshida, Midori; Oshida, Shigemi; Imada, Masato; Nakagawa, Takumi; Okinaga, Shuji

2010-01-12

Traumatic injury and surgical meniscectomy of a medial meniscus are known to cause subsequent knee osteoarthritis. However, the difference in the prevalence of osteoarthritis caused by the individual type of the medial meniscal tear has not been elucidated. The aim of this study was to investigate what type of tear is predominantly responsible for the degradation of articular cartilage in the medial compartment of knee joints. Five hundred and forty eight cadaveric knees (290 male and 258 female) were registered in this study. The average age of cadavers at death was 78.8 years old (range: 52-103 years). The knees were macroscopically examined and their medial menisci were classified into four groups according to types of tears: "no tear", "radial tear of posterior horn", "other types of tear" and "worn-out meniscus" groups. The severity of cartilage degradation in their medial compartment of knee joints was evaluated using the international cartilage repair society (ICRS) grading system. We statistically compared the ICRS grades among the groups using Mann-Whitney U test. The knees were assigned into the four groups: 416 "no tear" knees, 51 "radial tear of posterior horn" knees, 71 "other types of tear" knees, and 10 "worn-out meniscus" knees. The knees with substantial meniscal tears showed the severer ICRS grades of cartilage degradation than those without meniscal tears. In addition, the ICRS grades were significantly severer in the "radial tear of posterior horn" group than in the "other types of tear" group, suggesting that the radial tear of posterior horn in the medial meniscus is one of the risk factors for cartilage degradation of joint surface. We have clarified the relationship between the radial tear of posterior horn in the medial meniscus and the severer grade of cartilage degradation. This study indicates that the efforts should be made to restore the anatomical role of the posterior horn in keeping the hoop strain, when patients' physical activity levels are high and the tear pattern is simple enough to be securely sutured.

Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

PubMed

Davis, Bryan A; Hiller, Lucas P; Imbesi, Steven G; Chang, Eric Y

2015-08-01

We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

IETI – Isogeometric Tearing and Interconnecting

PubMed Central

Kleiss, Stefan K.; Pechstein, Clemens; Jüttler, Bert; Tomar, Satyendra

2012-01-01

Finite Element Tearing and Interconnecting (FETI) methods are a powerful approach to designing solvers for large-scale problems in computational mechanics. The numerical simulation problem is subdivided into a number of independent sub-problems, which are then coupled in appropriate ways. NURBS- (Non-Uniform Rational B-spline) based isogeometric analysis (IGA) applied to complex geometries requires to represent the computational domain as a collection of several NURBS geometries. Since there is a natural decomposition of the computational domain into several subdomains, NURBS-based IGA is particularly well suited for using FETI methods. This paper proposes the new IsogEometric Tearing and Interconnecting (IETI) method, which combines the advanced solver design of FETI with the exact geometry representation of IGA. We describe the IETI framework for two classes of simple model problems (Poisson and linearized elasticity) and discuss the coupling of the subdomains along interfaces (both for matching interfaces and for interfaces with T-joints, i.e. hanging nodes). Special attention is paid to the construction of a suitable preconditioner for the iterative linear solver used for the interface problem. We report several computational experiments to demonstrate the performance of the proposed IETI method. PMID:24511167

The Location of Anterior Cruciate Ligament Tears: A Prevalence Study Using Magnetic Resonance Imaging

PubMed Central

van der List, Jelle P.; Mintz, Douglas N.; DiFelice, Gregory S.

2017-01-01

Background: Over the past decade, there has been a resurgence of interest in anterior cruciate ligament (ACL) preservation. Proximal and distal avulsion tears have been treated with arthroscopic primary repair, while augmented repair, remnant tensioning, primary repair with biological scaffold, and remnant preservation have been proposed for different types of midsubstance tears. Currently, the incidence of these different tear types is unknown. Purpose: To propose a magnetic resonance imaging (MRI) classification system for different tear types based on clinical relevance and to assess the distribution of these different ACL tear types. Study Design: Case series; Level of evidence, 4. Methods: A retrospective search in an institutional radiographic database was performed for patients who underwent knee MRI at our institution between June 2014 and June 2016. Patients younger than 18 years and those with reports of chronic tears, partial tears, multiligamentous injuries, were excluded. Tear types were graded as proximal avulsion (distal remnant length >90% of total ligament length, type I), proximal (75%-90%, type II), midsubstance (25%-75%, type III), distal (10%-25%, type IV), and distal avulsion (<10%, type V). An orthopaedic surgeon, a radiologist, and a research fellow graded the tear type on 30 MRIs to determine reliability, and the research fellow graded all MRIs. Inter- and intraobserver reliability were measured using kappa statistics. Results: A total of 353 patients (57% male; mean age, 37.1 years; range, 18.1-81.2 years) were included. Interobserver reliability was 0.670 (95% confidence interval, 0.505-0.836), and intraobserver reliability ranged from 0.741 to 0.934. Incidence of type I tears was 16%, type II tears 27%, type III tears 52%, type IV tears 1%, and type V tears 3% (2.5% with bony avulsion). Type I tears were more common in patients older than 35 years compared with those younger than 35 years (23% vs 8%; P < .001). Conclusion: This classification system was reliable in assessing tear location in acute ACL injuries. Type I tears were seen in 16%, type II in 27%, and type III in 52% of patients in our cohort. These data suggest that there may be greater potential application for ACL preservation techniques. PMID:28680889

Can the optimum artificial tear treatment for dry eye disease be predicted from presenting signs and symptoms?

PubMed

Essa, Laika; Laughton, Deborah; Wolffsohn, James S

2018-02-01

To assess dry eye treatment with four preservative-free dry eye artificial tear treatments to facilitate evidence-based prescribing. A randomised, single masked crossover trial of Clinitas Soothe, Hyabak, Tears Again and TheraTears artificial tears was conducted on 50 symptomatic dry eye patients, aged 60.8±14.2years. At baseline and after trialling each treatment for 4 weeks, signs and symptoms were assessed using the Ocular Surface Disease Index (OSDI), non-invasive tear break-up time, fluorescein tear break-up time, tear meniscus height (TMH), Phenol Red test, lid-parallel conjunctival folds (LIPCOF), ocular surface staining, and lipid layer grading and osmolarity (baseline visit only). OSDI (p=0.002), LIPCOF (p=0.014) and conjunctival staining (p<0.001) significantly improved from baseline, however, the impact of each dry eye treatment on ocular symptoms and signs was similar. Clinitas Soothe and Hyabak were preferred by 34%/30% of participants, but only subjective comparison with the other drops influenced this choice. TheraTears was preferred (by 24%) by those with a lower baseline tear volume (p=0.01) and Tears Again (by 12%) by those with a thinner baseline lipid layer (p=0.04). The treatment that afforded the greatest improvement in clinical signs did not consistently match each individual's preferred treatment. If prescribed to a general dry eye population, the artificial tears performed similarly, improving symptoms and conjunctival signs. However, osmolarity balanced artificial tears were the preferred treatment in individuals with low baseline tear volume and lipisomal spray for individuals with a baseline lipid layer deficiency. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Does partial tear repair of adjacent tendons improve the outcome of supraspinatus tendonfull-thickness tear reinsertion?

PubMed

Nich, C; Dhiaf, N; Di Schino, M; Augereau, B

2014-11-01

Partial tearing of the infraspinatus and/or subscapularis tendon(s) is frequently associated with supraspinatus full-thickness tears. However, limited data regarding its influence on supraspinatus surgical repair is available. Our aim was to assess the functional and anatomical outcomes of open repair of supraspinatus full-thickness tears combined with adjacent partial tearing, comparatively to a control. We retrospectively identified 22 patients (22 shoulders) with a partial tear, most of them being a delamination tear, of the infraspinatus and/or subscapularis tendons associated with a complete detachment of the supraspinatus tendon. Twenty-seven patients (27 shoulders) treated for an isolated complete detachment of the supraspinatus tendon by open repair served as controls. The mean age was 58 years. A proximalized trans-osseous reinsertion of the supraspinatus tendon was combined with a curettage-closure of the delamination tear. Patients were evaluated with standardized MRI at last follow-up. At a mean of 75-month follow-up, the presence of a partial tear of either infraspinatus or subscapularis, or both, did not influence function and healing rates of supraspinatus tendon repair. Conversely to the control, when a retear occurred, the functional score tended to worsen. Preoperatively, fatty muscular degeneration was more pronounced when a partial tear was present. Fatty degeneration worsened regardless of repair healing. Open reinsertion of a supraspinatus full-thickness tear associated with a thorough treatment of partial tear of adjacent tendons led to optimal functional and anatomical mid term outcomes. Our results suggest the presence of a partial tear of adjacent tendons could be associated with poorer function in case of supraspinatus tendon re-rupture. Level III case-control study. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

49 CFR 178.818 - Tear test.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 49 Transportation 3 2013-10-01 2013-10-01 false Tear test. 178.818 Section 178.818 Transportation... Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not less than...

49 CFR 178.818 - Tear test.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Tear test. 178.818 Section 178.818 Transportation... § 178.818 Tear test. (a) General. The tear test must be conducted for the qualification of all flexible IBC design types. (b) Special preparation for the tear test. The flexible IBC must be filled to not...

Extensive characterization of human tear fluid collected using different techniques unravels the presence of novel lipid amphiphiles1[S

PubMed Central

Lam, Sin Man; Tong, Louis; Duan, Xinrui; Petznick, Andrea; Wenk, Markus R.; Shui, Guanghou

2014-01-01

The tear film covers the anterior eye and the precise balance of its various constituting components is critical for maintaining ocular health. The composition of the tear film amphiphilic lipid sublayer, in particular, has largely remained a matter of contention due to the limiting concentrations of these lipid amphiphiles in tears that render their detection and accurate quantitation tedious. Using systematic and sensitive lipidomic approaches, we validated different tear collection techniques and report the most comprehensive human tear lipidome to date; comprising more than 600 lipid species from 17 major lipid classes. Our study confers novel insights to the compositional details of the existent tear film model, in particular the disputable amphiphilic lipid sublayer constituents, by demonstrating the presence of cholesteryl sulfate, O-acyl-ω-hydroxyfatty acids, and various sphingolipids and phospholipids in tears. The discovery and quantitation of the relative abundance of various tear lipid amphiphiles reported herein are expected to have a profound impact on the current understanding of the existent human tear film model. PMID:24287120

Artificial tears potpourri: a literature review

PubMed Central

Moshirfar, Majid; Pierson, Kasey; Hanamaikai, Kamalani; Santiago-Caban, Luis; Muthappan, Valliammai; Passi, Samuel F

2014-01-01

Numerous brands and types of artificial tears are available on the market for the treatment of dysfunctional tear syndrome. Past literature has focused on comparing the components of these products on patient’s clinical improvement. The wide array of products on the market presents challenges to both clinicians and patients when trying to choose between available tear replacement therapies. Different formulations affect patients based on etiology and severity of disease. In order to provide an unbiased comparison between available tear replacement therapies, we conducted a literature review of existing studies and National Institutes of Health clinical trials on commercially available, brand name artificial tears. Outcomes evaluated in each study, as well as the percent of patients showing clinical and symptomatic improvement, were analyzed. Fifty-one studies evaluating different brands of artificial tears, and their efficacy were identified. Out of the 51 studies, 18 were comparison studies testing brand name artificial tears directly against each other. Nearly all formulations of artificial tears provided significant benefit to patients with dysfunctional tear syndrome, but some proved superior to others. From the study data, a recommended treatment flowchart was derived. PMID:25114502

Numerical MHD study for plasmoid instability in uniform resistivity

NASA Astrophysics Data System (ADS)

Shimizu, Tohru; Kondoh, Koji; Zenitani, Seiji

2017-11-01

The plasmoid instability (PI) caused in uniform resistivity is numerically studied with a MHD numerical code of HLLD scheme. It is shown that the PI observed in numerical studies may often include numerical (non-physical) tearing instability caused by the numerical dissipations. By increasing the numerical resolutions, the numerical tearing instability gradually disappears and the physical tearing instability remains. Hence, the convergence of the numerical results is observed. Note that the reconnection rate observed in the numerical tearing instability can be higher than that of the physical tearing instability. On the other hand, regardless of the numerical and physical tearing instabilities, the tearing instability can be classified into symmetric and asymmetric tearing instability. The symmetric tearing instability tends to occur when the thinning of current sheet is stopped by the physical or numerical dissipations, often resulting in the drastic changes in plasmoid chain's structure and its activity. In this paper, by eliminating the numerical tearing instability, we could not specify the critical Lundquist number Sc beyond which PI is fully developed. It suggests that Sc does not exist, at least around S = 105.

[Abnormal of tear lipid layer and recent advances in clinical study of dry eye].

PubMed

Xiao, Xin-Ye; Liu, Zu-Guo

2012-03-01

Dry eye is a common disease in the ophthalmological clinic, which is related to the dysfunction of tear film. The tear film is composed of lipid layer, aqueous layer and mucin layer (or lipid layer, aqueous/mucin layer). The lipid of the outmost layer derived from Meibomian gland and distributed on the tear film after blinking can decrease the evaporation and stabilize the tear film. The thickness, quality, and distribution of lipid layer are impaired in many dry eye patients, hence restoring the physiological function of lipid layer may be crucial for the treatment of this kind of dry eye. The lipid artificial tears manifest great effects on increasing lipid layer thickness, stabilizing tear film, improving Meibomian gland dysfunction, and promoting tear film distribution.

Phospholipid transfer protein is present in human tear fluid.

PubMed

Jauhiainen, Matti; Setälä, Niko L; Ehnholm, Christian; Metso, Jari; Tervo, Timo M T; Eriksson, Ove; Holopainen, Juha M

2005-06-07

The human tear fluid film consists of a superficial lipid layer, an aqueous middle layer, and a hydrated mucin layer located next to the corneal epithelium. The superficial lipid layer protects the eye from drying and is composed of polar and neutral lipids provided by the meibomian glands. Excess accumulation of lipids in the tear film may lead to drying of the corneal epithelium. In the circulation, phospholipid transfer protein (PLTP) and cholesteryl ester transfer protein (CETP) mediate lipid transfers. To gain insight into the formation of tear film, we investigated whether PLTP and CETP are present in human tear fluid. Tear fluid samples were collected with microcapillaries. The presence of PLTP and CETP was studied in tear fluid by Western blotting, and the PLTP concentration was determined by ELISA. The activities of the enzymes were determined by specific lipid transfer assays. Size-exclusion and heparin-affinity chromatography assessed the molecular form of PLTP. PLTP is present in tear fluid, whereas CETP is not. Quantitative assessment of PLTP by ELISA indicated that the PLTP concentration in tear fluid, 10.9 +/- 2.4 microg/mL, is about 2-fold higher than that in human plasma. PLTP-facilitated phospholipid transfer activity in tears, 15.1 +/- 1.8 micromol mL(-)(1) h(-)(1), was also significantly higher than that measured in plasma. Inactivation of PLTP by heat treatment (+58 degrees C, 60 min) or immunoinhibition abolished the phospholipid transfer activity in tear fluid. Size-exclusion chromatography of tear fluid indicated that PLTP eluted in a position corresponding to a size of 160-170 kDa. Tear fluid PLTP was quantitatively bound to Heparin-Sepharose and could be eluted as a single peak by 0.5 M NaCl. These data indicate that human tear fluid contains catalytically active PLTP protein, which resembles the active form of PLTP present in plasma. The results suggest that PLTP may play a role in the formation of the tear film by supporting phospholipid transfer.

Antioxidant content and ultraviolet absorption characteristics of human tears.

PubMed

Choy, Camus Kar Man; Cho, Pauline; Benzie, Iris F F

2011-04-01

Dry eye syndrome is a common age-related disorder, and decreased antioxidant/ultraviolet (UV) radiation protection in tears may be part of the cause. This study aimed to compare the tear antioxidant content and flow rate in young and older adults. The total antioxidant content and UV absorbing properties of various commercially available ophthalmic solutions used to alleviate dry eye symptoms were also examined. Minimally stimulated tears were collected from 120 healthy Chinese adults with no ocular pathology. Two age groups were studied: 19 to 29 years (n = 58) and 50 to 75 years (n = 62). Tear samples from each subject and 13 ophthalmic solutions were analyzed for total antioxidant content (as the Ferric Reducing/Antioxidant Power value). Tear flow rates were estimated from time taken to collect a fixed volume of tear fluid. UV absorbance spectra of pooled fresh reflex tear fluid and the ophthalmic solutions were determined. Results showed that the antioxidant content of minimally stimulated tears from older subjects (398 ± 160 μmol/l) was not significantly lower than that of younger subjects (348 ± 159 μmol/l; p = 0.0915). However, there was a significant difference in the tear flow rates between the two groups (p < 0.0001), with the younger group having three to four fold higher flow rate. None of the commercial preparations tested had detectable antioxidant content, and none showed the UV absorption characteristics of natural reflex tears. The effect of low flow rate on the dynamic antioxidant supply to the corneal surface indicates that older subjects have poorer overall defense against photooxidative and other oxidative processes. This could predispose older persons to corneal stress and development of dry eye syndrome. The commercially available artificial tears tested lack both the antioxidant content and UV absorbing characteristics of natural tears. Artificial tears formulations that help restore natural antioxidant and UV absorbing properties to the tear film of the aging eye may help prevent or improve dry eye symptoms and promote ocular health.

A novel remaining tendon preserving repair technique leads to improved outcomes in special rotator cuff tear patterns.

PubMed

Jeon, Yoon Sang; Kim, Rag Gyu; Shin, Sang-Jin

2018-05-16

The purpose of this study was to identify the tear pattern that could be anatomically repaired by preserving the remaining tendon on footprint and evaluate clinical outcomes of patients who underwent remaining tendon preserving cuff repair. Of 523 patients with full-thickness rotator cuff tears who underwent arthroscopic repair, 41 (7.8%) patients had repairable rotator cuff tear while preserving the remaining tendon. Among them, 31 patients were followed-up for more than 2 years, including 26 patients with posterior L-shaped tear and 5 patients with transtendinous tear patterns. Clinical outcomes were evaluated using ASES and Constant score, SANE score for patient satisfaction, and VAS for pain. MRI was taken for tendon integrity 6 months postoperatively. Of the 31 patients, 11 (35.5%) had previous injury history before rotator cuff tear, including 7 (26.9%) of the 26 patients with posterior L-shaped tear and 4 (80%) of the 5 patients with transtendinous tear. The average size of preoperative cuff tear was 17.8 ± 6.8 mm in anterior-to-posterior direction and 15.2 ± 5.1 mm in medial-to-lateral direction. ASES and Constant score, SANE score, and VAS for pain were significantly (p < 0.001) improved after remaining tendon preserving rotator cuff repair. Rotator cuff tendons of 22(84.6%) patients with posterior L-shaped tear and 4(80%) patients with transtendinous tear patterns were healed. Patients who underwent rotator cuff repair with preservation of the remaining tendon on the footprint obtained satisfactory functional outcomes. Rotator cuff tears in patients who had posterior L-shaped tear extending between supraspinatus and infraspinatus tendons or transtendinous tear pattern with substantial remaining tendon could be repaired using remaining tendon preserving repair technique. Anatomic reduction of torn cuff tendon without undue tension could be achieved using the remaining tendon preserving repair technique.

[Diagnostic value of MRI for posterior root tear of medial and lateral meniscus].

PubMed

Qian, Yue-Nan; Liu, Fang; Dong, Yi-Long; Cai, Chun-Yuan

2018-03-25

To explore diagnostic value of MRI on posterior root tear of medial and lateral meniscus. From January 2012 to January 2016, clinical data of 43 patients with meniscal posterior root tear confirmed by arthroscopy were retrospective analyzed, including 25 males and 18 females, aged from 27 to 69 years old with an average age of(42.5±8.3)years old;27 cases on the right side and 16 cases on the left side. MRI examinations of 43 patients with tear of posterior meniscus root confirmed by knee arthroscopies were retrospectively reviewed. MRI images were double-blinded, independently, retrospectively scored by two imaging physicians. Sensitivity, specificity and accuracy of MRI diagnosis of lateral and medial meniscus posterior root tear were calculated, and knee ligament injury and meniscal dislocation were calculated. Forty-three of 143 patients were diagnosed with meniscus posterior root tears by arthroscopy, including 19 patients with lateral tears and 24 patients with medial tears. The sensitivity, specificity and accuracy in diagnosis of posterior medial meniscus root tears for doctor A were 91.67%, 86.6% and 83.9% respectively, and for doctor B were 87.5%, 87.4% and 87.4%, 19 patients with medial meniscal protrusion and 2 patients with anterior cruciate ligament tear. The sensitivity, specificity and accuracy in diagnosis of posterior lateral meniscus root tears for doctor A were 73.7%, 79.9% and 79% respectively, and for doctor B were 78.9%, 82.3% and 82.5%, 4 patients with lateral meniscus herniation and 16 patients with cruciate ligament tear. Kappa statistics for posterior medial meniscus root tears and posterior lateral meniscus root tears were 0.84 and 0.72. MRI could effectively demonstrate imaging features of medial and lateral meniscal root tear and its accompanying signs. It could provide the basis for preoperative diagnosis of clinicians, and be worthy to be popularized. Copyright© 2018 by the China Journal of Orthopaedics and Traumatology Press.

Associations of anatomical measures from MRI with radiographically defined knee osteoarthritis score, pain, and physical functioning.

PubMed

Sowers, Maryfran; Karvonen-Gutierrez, Carrie A; Jacobson, Jon A; Jiang, Yebin; Yosef, Matheos

2011-02-02

The prevalence of knee osteoarthritis is traditionally based on radiographic findings, but magnetic resonance imaging is now being used to provide better visualization of bone, cartilage, and soft tissues as well as the patellar compartment. The goal of this study was to estimate the prevalences of knee features defined on magnetic resonance imaging in a population and to relate these abnormalities to knee osteoarthritis severity scores based on radiographic findings, physical functioning, and reported knee pain in middle-aged women. Magnetic resonance images of the knee were evaluated for the location and severity of cartilage defects, bone marrow lesions, osteophytes, subchondral cysts, meniscal and/or ligamentous tears, effusion, and synovitis among 363 middle-aged women (724 knees) from the Michigan Study of Women's Health Across the Nation. These findings were related to Kellgren-Lawrence osteoarthritis severity scores from radiographs, self-reported knee pain, self-reported knee injury, perception of physical functioning, and physical performance measures to assess mobility. Radiographs, physical performance assessment, and interviews were undertaken at the 1996 study baseline and again (with the addition of magnetic resonance imaging assessment) at the follow-up visit during 2007 to 2008. The prevalence of moderate-to-severe knee osteoarthritis changed from 3.7% at the baseline assessment to 26.7% at the follow-up visit eleven years later. Full-thickness cartilage defects of the medial, lateral, and patellofemoral compartments were present in 14.5% (105 knees), 4.6% (thirty-three knees), and 26.2% (190 knees), respectively. Synovitis was identified in 24.7% (179) of the knees, and joint effusions were observed in 70% (507 knees); 21.7% (157) of the knees had complex or macerated meniscal tears. Large osteophytes, marked synovitis, macerated meniscal tears, and full-thickness tibial cartilage defects were associated with increased odds of knee pain and with 30% to 40% slower walking and stair-climbing times. Middle-aged women have a high prevalence of moderate-to-severe knee osteoarthritis corroborated by strong associations with cartilage defects, complex and macerated meniscal tears, osteophytes and synovitis, knee pain, and lower mobility levels.

Blepharitis

MedlinePlus

... tear film can result in excess tearing or dry eye. Because tears are necessary to keep the cornea ... redness of the eye, blurred vision, frothy tears, dry eye, or crusting of the eyelashes on awakening. Treatment ...

Rotator cuff problems

MedlinePlus

... smooth layer) lining these tendons. A rotator cuff tear occurs when one of the tendons is torn ... Poor posture over many years Aging Rotator cuff tears TEARS Rotator cuff tears may occur in two ...

Tearing relaxation and the globalization of transport in field-reversed configurations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Steinhauer, Loren; Barnes, D. C.

2009-09-15

Tearing instability of field-reversed configurations (FRC) is investigated using the method of neighboring equilibria. It is shown that the conducting wall position in experiment lies very close to the location needed for tearing stability. This strongly suggests that vigorous but benign tearing modes, acting globally, are the engine of continual self-organization in FRCs, i.e., tearing relaxation. It also explains the ''profile consistency'' and anomalous loss rate of magnetic flux. In effect, tearing globalizes the effect of edge-driven transport.

Constraint on the magma sources in Luzon Island Philippines by using P and S wave local seismic tomography

NASA Astrophysics Data System (ADS)

Nghia, N. C.; Huang, B. S.; Chen, P. F.

2017-12-01

The subduction of South China Sea beneath the Luzon Island has caused a complex setting of seismicity and magmatism because of the proposed ridge subduction and slab tearing. To constrain the validity of slab tearing induced by ridge subduction and their effect, we performed a P and S wave seismic tomography travel time inversion using LOTOS code. The dataset has been retrieved from International Seismological Centre from 1960 to 2008. A 1D velocity inverted by using VELEST with a Vp/Vs ratio of 1.74 is used as the starting input velocity for tomographic inversion. Total of 20905 P readings and 8126 S readings from 2355 earthquakes events were used to invert for velocity structure beneath Luzon Island. The horizontal tomographic results show low-velocity, high Vp/Vs regions at the shallow depth less than 50 km which are interpreted as the magmatic chambers of the volcanic system in Luzon. At the suspected region of slab tearing at 16oN to 18oN, two sources of magma have been indentified: slab window magma at shallow depth (< 50 km) and magma induced by mantle wedge partial melting from higher depth. This slab melting may have changed the composition of magmatic to become more silicic with high viscosity, which explains the volcanic gap in this region. At the region of 14oN to 15oN, large magma chambers under active volcanos are identified which explain the active volcanism in this region. Contrast to the region of slab tearing, in this region, the magma chambers are fed by only magma from partial melting of mantle wedge from the depth higher than 100 km. These observations are consistent with previous work on the slab tearing of South China Sea and the activities of volcanism in the Luzon Island.

Slab rupture and delamination under the Betics and Rif constrained from receiver functions

NASA Astrophysics Data System (ADS)

Mancilla, Flor de Lis; Booth-Rea, Guillermo; Stich, Daniel; Pérez-Peña, José Vicente; Morales, José; Azañón, José Miguel; Martin, Rosa; Giaconia, Flavio

2015-11-01

We map the lithospheric structure under the westernmost Mediterranean convergent setting interpreting P-receiver functions obtained from a dense seismic network. No orogenic root occurs under the eastern and great part of the central Betics. However, the subducted South Iberian continental lithosphere is found beneath the western Betics where the Iberian Moho reaches depths of approximately 65 km, dipping gently towards the SE. Meanwhile, at the Rif, strong crustal and lithospheric thickness contrasts occur across the Nekor NW-SE sinistral fault that overlies the region of present slab tearing. East of the Nekor fault there is no orogenic root and the crust has been thinned to approximately 22 km, whilst to the west the crust reaches 55 km thickness and the Maghrebian continental lithosphere is attached to the lithospheric slab imaged by tomography under the Alboran basin. These data suggest that subduction rollback under the Alboran and Algerian basins, together with continental slab tearing or detachment producing edge delamination under the Betics and Rif have been the main tectonic mechanisms driving extension, magmatism and regional uplift in the westernmost Mediterranean since the Late Miocene until present. The surface expression of edge-delamination and slab tearing is marked by regional uplift, denudation of HP rocks in elongated core-complex type domes, late Miocene volcanism in the Eastern Betics and Rif, and by large NE-SW strike-slip transfer faults like the Alpujarras, Crevillente, Torcal or Nekor faults that accommodate strong gradients in crustal displacements. The Iberian slab is still attached to the oceanic slab imaged under the Alboran basin at the western Betics where intermediate depth seismicity, recent dextral strike-slip faulting and folding, could reflect slab tearing. Meanwhile, active faulting and differential GPS-measured displacements would mark slab tearing beneath the Rif coinciding with the trace of the sinistral Nekor fault.

Observations of Displacement-driven Maturation along a Subduction-Transform Edge Propagator Fault

NASA Astrophysics Data System (ADS)

Neely, J. S.; Furlong, K. P.

2016-12-01

The Solomon Islands-Vanuatu composite subduction zone represents a tectonically complex region along the Pacific-Australia plate boundary in the southwest Pacific Ocean. Here the Australia plate subducts under the Pacific plate in two parts - the Solomon Trench and the Vanuatu Trench - with the two segments separated by a transform fault produced by a tear in the approaching Australia plate. As a result of the Australia plate tearing, the two subducting sections are offset by the 280 km long San Cristobal Trough (SCT) transform fault, which acts as a Subduction-Transform Edge Propagator (STEP) fault. The formation of this transform fault provides an opportunity to study the evolution of a newly created transform plate boundary. As distance from the tear increases, both the magnitude and frequency of earthquakes along the transform increase reflecting the coalescence of fault segments into a through-going structure. Over the past few decades, there have been several instances of larger magnitude earthquakes migrating westward along the STEP through a rapid succession of events. A recent May 2015 sequence of MW 6.8, MW 6.9, and MW 6.8 earthquakes followed this pattern, with an east to west migration over three days. However, neither this 2015 sequence, nor a previous 1993 progression, ruptured into or nucleated a large earthquake within the region near the tear. SCT sequence termination outside the region of the newly formed fault occurs even though Coulomb Failure Stress analyses reveal that the tear end of the SCT is positively loaded for failure by the earthquake sequence. Changing seismicity patterns along the SCT are also mapped by b-value variations that correspond to the rupture patterns of these propagating sequences. These seismicity pattern changes along the SCT reveal a fault maturation process with strain localization driven by cumulative slip corresponding to approximately 80-100 km of displacement.

Cemental tear: To know what we have neglected in dental practice.

PubMed

Jeng, Po-Yuan; Luzi, Arlinda Luzi; Pitarch, Rocio Marco; Chang, Mei-Chi; Wu, Yu-Hsueh; Jeng, Jiiang-Huei

2018-04-01

Cemental tear is a special kind of root surface fracture, contributing to periodontal and periapical breakdown. However, it is a challenge for doctors to diagnose, resulting in delayed or improper treatment. We reviewed the predisposing factors, location, radiographic/clinical characteristics, diagnosis and treatments of cemental tears. From the literature, patients with cemental tear were mainly males, over 60 year-old. Possible predisposing factors include gender, age, tooth type, traumatic occlusal force and vital teeth. Cemental tears were common in upper and lower anterior teeth, single or multiple, and can be present in cervical, middle and apical third of roots. Morphology of cemental tears can be either piece-shaped or U-shaped. Clinically, cemental tear shows a unitary periodontal pocket and signs/symptoms mimicking localized periodontitis, apical periodontitis and vertical root fractures. Treatment of cemental tears include scaling, root planning, root canal treatment, periodontal/periapical surgery, guided tissue regeneration, bone grafting, and intentional replantation. Recurrence of cemental tear is possible especially when the fracture involves root apex. Extraction is recommended for teeth with poor prognosis. In conclusion, cemental tears can involve both periodontal and periapical area. Dentists should understand the predisposing factors and clinical features of cemental tears for early diagnosis/treatment to prevent bone loss/tooth extraction. Copyright © 2017. Published by Elsevier B.V.

Two types of peak emotional responses to music: The psychophysiology of chills and tears

PubMed Central

Mori, Kazuma; Iwanaga, Makoto

2017-01-01

People sometimes experience a strong emotional response to artworks. Previous studies have demonstrated that the peak emotional experience of chills (goose bumps or shivers) when listening to music involves psychophysiological arousal and a rewarding effect. However, many aspects of peak emotion are still not understood. The current research takes a new perspective of peak emotional response of tears (weeping, lump in the throat). A psychophysiological experiment showed that self-reported chills increased electrodermal activity and subjective arousal whereas tears produced slow respiration during heartbeat acceleration, although both chills and tears induced pleasure and deep breathing. A song that induced chills was perceived as being both happy and sad whereas a song that induced tears was perceived as sad. A tear-eliciting song was perceived as calmer than a chill-eliciting song. These results show that tears involve pleasure from sadness and that they are psychophysiologically calming; thus, psychophysiological responses permit the distinction between chills and tears. Because tears may have a cathartic effect, the functional significance of chills and tears seems to be different. We believe that the distinction of two types of peak emotions is theoretically relevant and further study of tears would contribute to more understanding of human peak emotional response. PMID:28387335

Factors predicting rotator cuff retears: an analysis of 1000 consecutive rotator cuff repairs.

PubMed

Le, Brian T N; Wu, Xiao L; Lam, Patrick H; Murrell, George A C

2014-05-01

The rate of retears after rotator cuff repair varies from 11% to 94%. A retear is associated with poorer subjective and objective clinical outcomes than intact repair. This study was designed to determine which preoperative and/or intraoperative factors held the greatest association with retears after arthroscopic rotator cuff repair. Cohort study; Level of evidence, 3. This study retrospectively evaluated 1000 consecutive patients who had undergone a primary rotator cuff repair by a single surgeon using an arthroscopic inverted-mattress knotless technique and who had undergone an ultrasound evaluation 6 months after surgery to assess repair integrity. Exclusion criteria included previous rotator cuff repair on the same shoulder, incomplete repair, and repair using a synthetic polytetrafluoroethylene patch. All patients had completed the modified L'Insalata Questionnaire and underwent a clinical examination before surgery. Measurements of tear size, tear thickness, associated shoulder injury, tissue quality, and tendon mobility were recorded intraoperatively. The overall retear rate at 6 months after surgery was 17%. Retears occurred in 27% of full-thickness tears and 5% of partial-thickness tears (P < .0001). The best independent predictors of retears were anteroposterior tear length (correlation coefficient r = 0.41, P < .0001), tear size area (r = 0.40, P < .0001), mediolateral tear length (r = 0.34, P < .0001), tear thickness (r = 0.29, P < .0001), age at surgery (r = 0.27, P < .0001), and operative time (r = 0.18, P < .0001). These factors produced a predictive model for retears: logit P = (0.039 × age at surgery in years) + (0.027 × tear thickness in %) + (1 × anteroposterior tear length in cm) + (0.76 × mediolateral tear length in cm) - (0.17 × tear size area in cm(2)) + (0.018 × operative time in minutes) -9.7. Logit P can be transformed into P, which is the chance of retears at 6 months after surgery. A rotator cuff retear is a multifactorial process with no single preoperative or intraoperative factor being overwhelmingly predictive of it. Nevertheless, rotator cuff tear size (tear dimensions, tear size area, and tear thickness) showed stronger associations with retears at 6 months after surgery than did measures of tissue quality and concomitant shoulder injuries.

Prevalence of Skin Tears in Elderly Patients: A Retrospective Chart Review of Incidence Reports in 6 Long-term Care Facilities.

PubMed

Hawk, Joyce; Shannon, Mary

2018-04-01

The incidence and prevalence of skin tears in long-term care (LTC) facilities has not been well established. To ascertain the point prevalence of reported skin tears, a retrospective review of incident reports was performed in 6 LTC facilities in western Pennsylvania from November 1, 2016 through December 31, 2016. Report data, including resident age; gender; mobility limitations; skin tear location, number, and cause (if known); occurrence time (7 am to 3 pm, 3 pm to 11 pm, or 11 pm to 7 am nursing shift); and history of previous skin tears, were abstracted. All data were entered into a statistical analysis program and analyzed using descriptive statistics. Period prevalence was used to determine prevalence rate; an independent t test was used to compare the presence of skin tears between genders. Differences between location and cause of skin tears were evaluated using a multinomial test of related proportions. A test of proportions was used to evaluate skin tear occurrence time (nursing shift) differences. The overall point prevalence rate was 9% (N = 1253 residents) ranging from 6 to 28 skin tears per facility. The average age of residents with a skin tear (n = 119) was 83.5 years. The majority (111, 93%) had mobility limitations. Falls accounted for 38 skin tears (31.9%), followed by propelling in a wheelchair (18, 15.1%; X2 =7.14; P = .008). Forearm skin tears (37, 31.1%) occurred significantly more frequently than lower leg skin tears (19, 16%; P = .016). Significantly more skin tears occurred during the 7 am to 3 pm shift (47, 39.5%) and 3 pm to 11 pm shift (49, 41.2%) than during the 11 pm to 7 am shift (23, 19.3%; X2 = 5.78; P <.01). The results of this study confirm skin tears are a significant problem among elderly residents in LTC, especially because the reported rate is likely lower than the actual rate. Research to further elucidate the incidence and prevalence of skin tears and associated risk factors is needed to help develop evidence-based risk assessment, classification systems, treatment guidelines, and preventive measures.

Aspergillus flavus induced alterations in tear protein profile reveal pathogen-induced host response to fungal infection.

PubMed

Kandhavelu, Jeyalakshmi; Demonte, Naveen Luke; Namperumalsamy, Venkatesh Prajna; Prajna, Lalitha; Thangavel, Chitra; Jayapal, Jeya Maheshwari; Kuppamuthu, Dharmalingam

2017-01-30

Aspergillus flavus and Fusarium sp. are primary causative agents of keratitis that results in corneal tissue damage leading to vision loss particularly in individuals from the tropical parts of the world. Proteins in the tear film collected from control and keratitis patients was profiled and compared. A total of 1873 proteins from control and 1400 proteins from patient tear were identified by mass spectrometry. While 847 proteins were found to be glycosylated in the patient tear, only 726 were glycosylated in control tear. And, some of the tear proteins showed alterations in their glycosylation pattern after infection. Complement system proteins, proteins specific for neutrophil extracellular traps and proteins involved in would healing were found only in the patient tear. The presence of these innate immune system proteins in the tear film of patients supports the previous data indicating the involvement of neutrophil and complement pathways in antifungal defense. High levels of wound healing proteins in keratitis patient tear implied activation of tissue repair during infection. The early appearance of the host defense proteins and wound healing response indicates that tear proteins could be used as an early marker system for monitoring the progression of pathogenesis. Identification of negative regulators of the above defense pathways in keratitis tear indicates an intricate balance of pro and anti-defense mechanisms operating in fungal infection of the eye. Tear proteins from control and mycotic keratitis patients were separated into glycoproteins and non-glycosylated proteins and then identified by mass spectrometry. Tear proteins from keratitis patients showed alteration in the glycosylation pattern indicating the alteration of glycosylation machinery due to infection. Neutrophil extracellular traps specific proteins, complement pathway proteins, as well as wound healing proteins, were found only in patient tear showing the activation of antifungal defense in the patient tear. Negative regulators of these defense pathways were also found in patient tear indicating a fine balance between pathogen clearance and host tissue destruction during fungal infection depending upon the individual specific host - pathogen interaction. This understanding could be used to predict the progression and outcome of infection. Copyright © 2016 Elsevier B.V. All rights reserved.

Concentrations of MUC16 and MUC5AC using three tear collection methods

PubMed Central

Nichols, Jason J.

2017-01-01

Purpose To determine the optimal tear collection method for analysis of ocular surface mucins MUC5AC and MUC16. Methods Fifteen subjects without ocular surface disease were recruited. Subjects presented for tear collection on three separate days for three different tear collection methods with the order of method randomized. Methods used to collect tears from right and left eyes included Schirmer’s strip, basal tear collection, and flush tear collection. All samples from the right eyes were individually analyzed for MUC5AC whereas the left eye samples were individually analyzed for MUC16. For each individual sample, 10 μg of protein were loaded per lane into a 1% (w/v) agarose gel and run in electrophoresis buffer for 2 h. After overnight capillary transfer, membranes were incubated with either MUC5AC antibody CLH2 or MUC16 antibody OC125 for western blot analysis. Blots were developed with enhanced chemiluminescence (ECL) and signals captured with the Odyssey Fc (LI-COR). The relative amounts of MUC5AC and MUC16 were quantified with densitometry using software and compared for statistically significant differences between tear collection methods using the Kruskal–Wallis test in SPSS 22 and GraphPad Prism 7.02. Dunn’s multiple comparisons test was used for pairwise post-hoc comparisons. Results Samples containing less than 10 μg of total protein were not used for analysis which left eight samples (out of 45) unusable. The calculated MUC5AC median signal intensities from Schirmer’s strip, basal tears, and flush tears were 2.86 (n = 15, the interquartile range [IQR] = 2.54–3.21), 1.65 (n = 14, IQR = 1.34–3.1), and 1.67 (n = 9, IQR = 1.42–1.72), respectively (H = 9.5, p = 0.009). Post-hoc pairwise comparisons showed a statistically significant difference between Schirmer’s strip and flush tears (p = 0.01). The calculated MUC16 median signal intensities from Schirmer’s strip, basal tears, and flush tears were 1.88 (n = 14, IQR = 1.43–2.61), 5.24 (n = 15, IQR = 4.16–6.21), and 2.45 (n = 7, IQR = 1.85–2.48), respectively (H = 18.1, p = 0.001). Post-hoc pairwise comparison showed statistically significant differences between basal tears and Schirmer’s strip (p = 0.0003) and between basal tears and flush tears (p = 0.006). Conclusions MUC5AC and MUC16 are present in human tear fluid and can be captured using various tear collection methods. Although basal tear collection yielded the highest relative concentration of MUC16, Schirmer’s strip tear collection yielded the highest MUC5AC concentration. Therefore, the tear collection method chosen depends on the mucin of interest. PMID:28761326

Arthroscopic repair of partial-thickness and small full-thickness rotator cuff tears: tendon quality as a prognostic factor for repair integrity.

PubMed

Chung, Seok Won; Kim, Jae Yoon; Yoon, Jong Pil; Lyu, Seong Hwa; Rhee, Sung Min; Oh, Se Bong

2015-03-01

The healing failure rate is high for partial-thickness or small full-thickness rotator cuff tears. To retrospectively evaluate and compare outcomes after arthroscopic repair of high-grade partial-thickness and small full-thickness rotator cuff tears and factors affecting rotator cuff healing. Cohort study; Level of evidence, 3. Included in the study were 55 consecutive patients (mean age, 57.9 ± 7.2 years) who underwent arthroscopic repair for high-grade partial-thickness (n = 34) and small full-thickness (n = 21) rotator cuff tears. The study patients also underwent magnetic resonance imaging (MRI) preoperatively and computed tomography arthrography (CTA) at least 6 months postoperatively, and their functional outcomes were evaluated preoperatively and at the last follow-up (>24 months). All partial-thickness tears were repaired after being converted to full-thickness tears; thus, the repair process was almost the same as for small full-thickness tears. The tendinosis of the torn tendon was graded from the MRI images using a 4-point scale, and the reliabilities were assessed. The outcomes between high-grade partial-thickness tears that were converted to small full-thickness tears and initially small full-thickness tears were compared, and factors affecting outcomes were evaluated. The inter- and intraobserver reliabilities of the tendinosis grade were good (intraclass correlation coefficient, 0.706 and 0.777, respectively). Failure to heal as determined by CTA was observed in 12 patients with a high-grade partial-thickness tear (35.3%; complete failure in 4 and partial failure in 8) and in 3 patients with a small full-thickness tear (14.3%; complete failure in 1 and partial failure in 2). The patients with high-grade partial-thickness rotator cuff tears showed a higher tendinosis grade than did those with small full-thickness tears (P = .014), and the severity of the tendinosis was related to the failure to heal (P = .037). Tears with a higher tendinosis grade showed a 7.64-times higher failure rate (95% CI, 1.43-36.04) than did those with a lower tendinosis grade (P = .013). All functional outcome scores improved after surgery (all P < .001); however, there was no difference between groups. The high-grade partial-thickness rotator cuff tears showed more severe tendinosis compared with the small full-thickness tears in this study. Contrary to previous impressions that tear size or fatty infiltration is the factor that most influences healing, tendinosis severity assessed by preoperative MRI was the only factor associated with failure to heal, given the numbers available for analysis, in patients with partial-thickness and small full-thickness rotator cuff tears. Surgeons should pay more attention to tendon quality during repair surgery or rehabilitation in smaller rotator cuff tears, especially in high-grade partial-thickness tears with severe tendinosis. © 2014 The Author(s).

Tear exchange and contact lenses: a review.

PubMed

Muntz, Alex; Subbaraman, Lakshman N; Sorbara, Luigina; Jones, Lyndon

2015-01-01

Tear exchange beneath a contact lens facilitates ongoing fluid replenishment between the ocular surface and the lens. This exchange is considerably lower during the wear of soft lenses compared with rigid lenses. As a result, the accumulation of tear film debris and metabolic by-products between the cornea and a soft contact lens increases, potentially leading to complications. Lens design innovations have been proposed, but no substantial improvement in soft lens tear exchange has been reported. Researchers have determined post-lens tear exchange using several methods, notably fluorophotometry. However, due to technological limitations, little remains known about tear hydrodynamics around the lens and, to-date, true tear exchange with contact lenses has not been shown. Further knowledge regarding tear exchange could be vital in aiding better contact lens design, with the prospect of alleviating certain adverse ocular responses. This article reviews the literature to-date on the significance, implications and measurement of tear exchange with contact lenses. Copyright © 2014 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.

Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation.

PubMed

Koplas, Monica C; Schneider, Erika; Sundaram, Murali

2011-05-01

Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.

The Changes of Tear Status after Conventional and Wavefront-Guided IntraLASIK

PubMed Central

Foo, Say Kiang; Kaur, Sharanjeet; Abd Manan, Faudziah; Low, Aloysius Joseph

2011-01-01

Background: IntraLASIK is a LASIK surgery that involved IntraLase femtosecond laser for the corneal flap creating. The objective of this research was to investigate and compare the changes in tear status at 1 and 3 months after undergoing conventional IntraLASIK with Bausch & Lomb PlanoScan (PS) algorithm, Bausch & Lomb Zyoptix Tissue Saving (ZTS) algorithm, and wavefront-guided (WG) IntraLASIK with VISX CustomVue. Methods: Tear status of 36 patients who were divided into 3 groups depending on the type of IntraLASIK they underwent (PS, n = 13; ZTS, n = 9; WG, n = 14) was evaluated. Tear status was determined by classifying the category of the thickness of pre-corneal tear lipid layer, non-invasive tear break-up time, and tear meniscus height. Repeated measures analysis of variance (ANOVA) and one way ANOVA were used for the statistical analyses. Results: The category of the thickness of tear lipid layer, non-invasive tear break up time and tear meniscus height were neither significantly changed after IntraLASIK for all groups nor showed significant difference among groups at 1 and 3 months post-IntraLASIK (P > 0.05). Blinking rate and palpebral aperture also had no significant changed after IntraLASIK. Conclusion: Both conventional (PS and ZTS) and WG IntraLASIK did not affect tear status up to 3 months post-IntraLASIK. WG IntraLASIK did not show superiority in preserving tear status 1 and 3 months post-surgery compared with conventional IntraLASIK. PMID:22135584

Malnutrition is independently associated with skin tears in hospital inpatient setting-Findings of a 6-year point prevalence audit.

PubMed

Munro, Emma L; Hickling, Donna F; Williams, Damian M; Bell, Jack J

2018-05-24

Skin tears cause pain, increased length of stay, increased costs, and reduced quality of life. Minimal research reports the association between skin tears, and malnutrition using robust measures of nutritional status. This study aimed to articulate the association between malnutrition and skin tears in hospital inpatients using a yearly point prevalence of inpatients included in the Queensland Patient Safety Bedside Audit, malnutrition audits and skin tear audits conducted at a metropolitan tertiary hospital between 2010 and 2015. Patients were excluded if admitted to mental health wards or were <18 years. A total of 2197 inpatients were included, with a median age of 71 years. The overall prevalence of skin tears was 8.1%. Malnutrition prevalence was 33.5%. Univariate analysis demonstrated associations between age (P ˂ .001), body mass index (BMI) (P < .001) and malnutrition (P ˂ .001) but not gender (P = .319). Binomial logistic regression analysis modelling demonstrated that malnutrition diagnosed using the Subjective Global Assessment was independently associated with skin tear incidence (odds ratio, OR: 1.63; 95% confidence interval, CI: 1.13-2.36) and multiple skin tears (OR 2.48 [95% CI 1.37-4.50]). BMI was not independently associated with skin tears or multiple skin tears. This study demonstrated independent associations between malnutrition and skin tear prevalence and multiple skin tears. It also demonstrated the limitations of BMI as a nutritional assessment measure. © 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

Evaluation of inter-day and inter-individual variability of tear peptide/protein profiles by MALDI-TOF MS analyses

PubMed Central

González, Nerea; Iloro, Ibon; Durán, Juan A.; Elortza, Félix

2012-01-01

Purpose To characterize the tear film peptidome and low molecular weight protein profiles of healthy control individuals, and to evaluate changes due to day-to-day and individual variation and tear collection methods, by using solid phase extraction coupled to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) profiling. Methods The tear protein profiles of six healthy volunteers were analyzed over seven days and inter-day and inter-individual variability was evaluated. The bilaterality of tear film and the effect of tear collection methods on protein profiles were also analyzed in some of these patients. MALDI-TOF MS analyses were performed on tear samples purified by using a solid phase extraction (SPE) method based on C18 functionalized magnetic beads for peptide and low molecular weight protein enrichment, focusing spectra acquisition on the 1 to 20 kDa range. Spectra were analyzed using principal component analysis (PCA) with MultiExperiment Viewer (TMeV) software. Volunteers were examined in terms of tear production status (Schirmer I test), clinical assessment of palpebral lids and meibomian glands, and a subjective OSD questionnaire before tear collection by a glass micro-capillary. Results Analysis of peptides and proteins in the 1–20 kDa range showed no significant inter-day differences in tear samples collected from six healthy individuals during seven days of monitoring, but revealed subtle intrinsic inter-individual differences. Profile analyses of tears collected from the right and left eyes confirmed tear bilaterality in four healthy patients. The addition of physiologic serum for tear sample collection did not affect the peptide and small protein profiles with respect to the number of resolved peaks, but it did reduce the signal intensity of the peaks, and increased variability. Magnetic beads were found to be a suitable method for tear film purification for the profiling study. Conclusions No significant variability in tear peptide and protein profiles below 20 kDa was found in healthy controls over a seven day period, nor in right versus left eye profiles from the same individual. Subtle inter-individual differences can be observed upon tear profiling analysis and confirm intrinsic variability between control subjects. Addition of physiologic serum for tear collection affects the proteome and peptidome in terms of peak intensities, but not in the composition of the profiles themselves. This work shows that MALDI-TOF MS coupled with C18 magnetic beads is an effective and reproducible methodology for tear profiling studies in the clinical monitoring of patients. PMID:22736947

Warm and touching tears: tearful individuals are perceived as warmer because we assume they feel moved and touched.

PubMed

Zickfeld, Janis H; Schubert, Thomas W

2018-01-31

Recent work investigated the inter-individual functions of emotional tears in depth. In one study (Van de Ven, N., Meijs, M. H. J., & Vingerhoets, A. (2017). What emotional tears convey: Tearful individuals are seen as warmer, but also as less competent. British Journal of Social Psychology, 56(1), 146-160. Https://doi.org/10.1111/bjso.12162) tearful individuals were rated as warmer, and participants expressed more intentions to approach and help such individuals. Simultaneously, tearful individuals were rated as less competent, and participants expressed less intention to work with the depicted targets. While tearful individuals were perceived as sadder, perceived sadness mediated only the effect on competence, but not on warmth. We argue that tearful individuals might be perceived as warm because they are perceived as feeling moved and touched. We ran a pre-registered extended replication of Van de Ven et al. Results replicate the warmth and helping findings, but not the competence and work effects. The increase in warmth ratings was completely mediated by perceiving feeling moved and touched. Possible functions of feeling moved and touched with regard to emotional tears are discussed.

Evaluating tear clearance rate with optical coherence tomography.

PubMed

Garaszczuk, Izabela K; Mousavi, Maryam; Cervino Exposito, Alejandro; Bartuzel, Maciej M; Montes-Micó, Robert; Iskander, D Robert

2018-02-01

To assess the early-phase of tear clearance rate (TCR) with anterior segment optical coherence tomography (OCT) and to determine the association between TCR and other clinical measures of the tear film in a group of young subjects with different levels of tear film quality. TCR was classified as the percentage decrease of subject's inferior tear meniscus height 30s after instillation of 5μl 0.9% saline solution. Fifty subjects (32F and 18M) aged (mean±standard deviation) 25.5±4.3 years volunteered for the study. It consisted of a review of medical history, Ocular Surface Disease Index (OSDI) questionnaire, tear film osmolarity measurements, slit lamp examination and TCR estimation based on dynamic measurements of the lower tear meniscus with OCT. Estimates of TCR were contrasted against subject age and tear film measures commonly used for dry eye diagnosis, which includes OSDI score, fluorescein tear film break-up time (FBUT), tear meniscus height (TMH), blinking frequency, tear film osmolarity and corneal staining. The group mean TCR was 29±13% and 36±19% respectively after 30 and 60s margin after saline solution instillation. Statistically significant correlations were found between TCR and FBUT (r 2 =0.319, p<0.001), blinking frequency (r 2 =0.138, p<0.01), tear film osmolarity (r 2 =0.133, p<0.01) and subject's age (r 2 =0.095, p<0.05). Anterior segment optical coherence tomography allows following changes of tear meniscus morphology post saline solution instillation and evaluating the TCR. OCT based TCR might be used as additional measure of the lacrimal functional unit. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Predicting Rotator Cuff Tears Using Data Mining and Bayesian Likelihood Ratios

PubMed Central

Lu, Hsueh-Yi; Huang, Chen-Yuan; Su, Chwen-Tzeng; Lin, Chen-Chiang

2014-01-01

Objectives Rotator cuff tear is a common cause of shoulder diseases. Correct diagnosis of rotator cuff tears can save patients from further invasive, costly and painful tests. This study used predictive data mining and Bayesian theory to improve the accuracy of diagnosing rotator cuff tears by clinical examination alone. Methods In this retrospective study, 169 patients who had a preliminary diagnosis of rotator cuff tear on the basis of clinical evaluation followed by confirmatory MRI between 2007 and 2011 were identified. MRI was used as a reference standard to classify rotator cuff tears. The predictor variable was the clinical assessment results, which consisted of 16 attributes. This study employed 2 data mining methods (ANN and the decision tree) and a statistical method (logistic regression) to classify the rotator cuff diagnosis into “tear” and “no tear” groups. Likelihood ratio and Bayesian theory were applied to estimate the probability of rotator cuff tears based on the results of the prediction models. Results Our proposed data mining procedures outperformed the classic statistical method. The correction rate, sensitivity, specificity and area under the ROC curve of predicting a rotator cuff tear were statistical better in the ANN and decision tree models compared to logistic regression. Based on likelihood ratios derived from our prediction models, Fagan's nomogram could be constructed to assess the probability of a patient who has a rotator cuff tear using a pretest probability and a prediction result (tear or no tear). Conclusions Our predictive data mining models, combined with likelihood ratios and Bayesian theory, appear to be good tools to classify rotator cuff tears as well as determine the probability of the presence of the disease to enhance diagnostic decision making for rotator cuff tears. PMID:24733553

Effect of lipid-based dry eye supplements on the tear film in wearers of eye cosmetics.

PubMed

Wang, Michael T M; Cho, Irene Sung Hee; Jung, Soo Hee; Craig, Jennifer P

2017-08-01

To compare the effects on tear film parameters and contamination in cosmetic eyeliner wearers, after single application of two lipid-based dry eye treatments: a lipid-containing lubricant eye drop and a phospholipid liposomal spray. Fifty participants were enrolled in a prospective, randomised, paired-eye, investigator-masked trial. Pencil eyeliner (Body Shop ® Crayon Eye Definer) was applied to the upper eyelid periocular skin of both eyes, anterior to the lash line. Baseline tear film quality was assessed fifteen minutes after eyeliner application. A lubricant drop (Systane ® Balance) was then applied to one eye (randomised), and liposomal spray (Tears Again ® ) to the contralateral eye. Tear film contamination, lipid layer grade, non-invasive tear film break-up time and tear evaporation rate were evaluated fifteen minutes post-treatment and compared to pre-treatment values. Pre-treatment measurements did not differ between eyes assigned to lubricant drop and liposomal spray. Tear film contamination was observed in a greater proportion of eyes following both treatments (both p<0.05), with no significant difference between treatments (p=0.41). Both treatments improved lipid layer thickness (both p≤0.01), but effected no significant change in non-invasive tear film break-up time or tear evaporation rate (all p>0.05). Changes in tear film parameters did not differ between treatments (all p>0.05). Both the lipid-containing lubricant eye drop and phospholipid liposomal spray result in clinically apparent tear film contamination in eyeliner cosmetic wearers. Although both treatments effected an increase in lipid layer thickness, neither displayed clinical efficacy in improving tear film stability. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

The evaluation of central corneal thickness and intraocular pressure in conjunction with tear IGF-1 levels in patients with acromegaly.

PubMed

Kan, Emrah; Kan, Elif K; Okuyucu, Ali

2017-08-30

To compare the central corneal thickness (CCT), intraocular pressure (IOP), and tear insulin-like growth factor 1 (IGF-1) levels between patients with acromegaly and a control group and to evaluate the possible effect of tear IGF-1 and duration of the disease on CCT and IOP. We included 31 patients with acromegaly (study group) and 40 age- and sex-matched controls in the study. Patients with acromegaly were divided into 2 subgroups based on disease status (active/inactive). All participants underwent complete ophthalmologic evaluation including CCT and IOP values. Basal tear samples were collected from both groups and tear IGF-1 levels were measured. The CCT, IOP, and tear IGF-1 levels were compared between groups and subgroups and the association between tear IGF-I levels and ocular parameters (CCT, IOP) and disease duration were also evaluated. Central corneal thickness, IOP, and tear IGF-1 levels did not show a significant difference between study and control groups. We also did not find a significant difference in terms of CCT, IOP, or tear IGF-1 levels between subgroups of patients. Correlation analysis did not show an association between the duration of disease and tear IGF-1 levels with CCT or IOP. There was no significant difference in tear IGF-1 levels between patients with acromegaly and controls. Additionally, there was no correlation between disease duration and tear IGF-1 levels with CCT or IOP levels. This lack of association may suggest that tear IGF-1 levels might not have an effect on CCT or IOP findings in patients with acromegaly.

Full-thickness tears of the supraspinatus tendon: A three-dimensional finite element analysis.

PubMed

Quental, C; Folgado, J; Monteiro, J; Sarmento, M

2016-12-08

Knowledge regarding the likelihood of propagation of supraspinatus tears is important to allow an early identification of patients for whom a conservative treatment is more likely to fail, and consequently, to improve their clinical outcome. The aim of this study was to investigate the potential for propagation of posterior, central, and anterior full-thickness tears of different sizes using the finite element method. A three-dimensional finite element model of the supraspinatus tendon was generated from the Visible Human Project data. The mechanical behaviour of the tendon was fitted from experimental data using a transversely isotropic hyperelastic constitutive model. The full-thickness tears were simulated at the supraspinatus tendon insertion by decreasing the interface area. Tear sizes from 10% to 90%, in 10% increments, of the anteroposterior length of the supraspinatus footprint were considered in the posterior, central, and anterior regions of the tendon. For each tear, three finite element analyses were performed for a supraspinatus force of 100N, 200N, and 400N. Considering a correlation between tendon strain and the risk of tear propagation, the simulated tears were compared qualitatively and quantitatively by evaluating the volume of tendon for which a maximum strain criterion was not satisfied. The finite element analyses showed a significant impact of tear size and location not only on the magnitude, but also on the patterns of the maximum principal strains. The mechanical outcome of the anterior full-thickness tears was consistently, and significantly, more severe than that of the central or posterior full-thickness tears, which suggests that the anterior tears are at greater risk of propagating than the central or posterior tears. Copyright © 2016 Elsevier Ltd. All rights reserved.

Rotator cuff muscle degeneration and tear severity related to myogenic, adipogenic, and atrophy genes in human muscle.

PubMed

Shah, Shivam A; Kormpakis, Ioannis; Cavinatto, Leonardo; Killian, Megan L; Thomopoulos, Stavros; Galatz, Leesa M

2017-12-01

Large rotator cuff tear size and advanced muscle degeneration can affect reparability of tears and compromise tendon healing. Clinicians often rely on direct measures of rotator cuff tear size and muscle degeneration from magnetic resonance imaging (MRI) to determine whether the rotator cuff tear is repairable. The objective of this study was to identify the relationship between gene expression changes in rotator cuff muscle degeneration to standard data available to clinicians. Radiographic assessment of preoperative rotator cuff tear severity was completed for 25 patients with varying magnitudes of rotator cuff tears. Tear width and retraction were measured using MRI, and Goutallier grade, tangent (tan) sign, and Thomazeau grade were determined. Expression of myogenic-, adipogenic-, atrophy-, and metabolism-related genes in biopsied muscles were correlated with tear width, tear retraction, Goutallier grade, tan sign, and Thomazeau grade. Tear width positively correlated with Goutallier grade in both the supraspinatus (r = 0.73) and infraspinatus (r = 0.77), along with tan sign (r = 0.71) and Thomazeau grade (r = 0.68). Decreased myogenesis (Myf5), increased adipogenesis (CEBPα, Lep, Wnt10b), and decreased metabolism (PPARα) correlated with radiographic assessments. Gene expression changes suggest that rotator cuff tears lead to a dramatic molecular response in an attempt to maintain normal muscle tissue, increase adipogenesis, and decrease metabolism. Fat accumulation and muscle atrophy appear to stem from endogenous changes rather than from changes mediated by infiltrating cells. Results suggest that chronic unloading of muscle, induced by rotator cuff tear, disrupts muscle homeostasis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2808-2814, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Diagnostic accuracy of 3T conventional shoulder MRI in the detection of the long head of the biceps tendon tears associated with rotator cuff tendon tears.

PubMed

Lee, Ro Woon; Choi, Soo-Jung; Lee, Man Ho; Ahn, Jae Hong; Shin, Dong Rock; Kang, Chae Hoon; Lee, Ki Won

2016-12-01

To evaluate the diagnostic performance (DP) of 3T (3 Tesla field strength) conventional shoulder magnetic resonance imaging (MRI) in detecting the long head of the biceps tendon (LHBT) tears in association with rotator cuff tendon tears. This study included 80 consecutive patients who underwent arthroscopic surgery for rotator cuff tendon tears. Two radiologists independently evaluated the preoperative 3T shoulder MRI for the presence of LHBT tears. The DP of MRI was evaluated using the results of arthroscopy as the reference standard. We also evaluated the DP of several MR signs of LHBT in detection of partial LHBT tears. Arthroscopic examination revealed 35 partial and 5 complete tears. According to the results of evaluation by reviewers 1 and 2, shoulder MRI exhibited sensitivities of 77.14 and 80 % and specificities of 71.11 and 73.33 % in detection of partial LHBT tears and sensitivities of 80 and 100 % and a specificity of 100% (both) in detection of complete LHBT tears. In detecting partial LHBT tears, increased T2 signal intensity of the LHBT exhibited high sensitivities (reviewers 1 and 2; 82.85 and 80 %, respectively) and the presence of intratendinous defects or C-signs exhibited the highest specificities (reviewers 1 and 2; 95.55 and 93.33 %, respectively), followed by abnormalities in shape and outer margins of the LHBT (reviewers 1 and 2; 91.11 and 82 %; 91.11 and 86.66 %, respectively). Non-contrast-enhanced 3T shoulder MRI is potentially highly accurate in detection of complete LHBT tears, but moderately accurate in detection of partial LHBT tears.

Atraumatic tears of the ligamentum teres are more frequent in professional ballet dancers than a sporting population.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2016-07-01

To compare the frequency of atraumatic ligamentum teres (LT) tear in professional ballet dancers with that of athletes, and to determine the relationship with clinical and imaging findings. Forty-nine male and female professional ballet dancers (98 hips) and 49 age and sex-matched non-dancing athletes (98 hips) completed questionnaires on hip symptoms and physical activity levels, underwent hip rotation range of movement (ROM) and hypermobility testing, and 3.0-Tesla magnetic resonance imaging (3 T MRI) on both hips to detect LT tears, acetabular labral tears, and articular cartilage defects, and to measure the lateral centre edge angles (LCE). A higher frequency of LT tear was found in dancers (55 %) compared with athletes (22 %, P = 0.001). The frequency and severity of LT tears in dancers increased with older age (P = 0.004, P = 0.006, respectively). The Hip and Groin Outcome Score (HAGOS) pain scores or hip rotation ROM did not differ significantly among participants with normal, partial, or complete tears of LT (P > 0.01 for all). Neither the frequency of generalised joint hypermobility (P = 0.09) nor the LCE angles (P = 0.32, P = 0.16, left and right hips respectively) differed between those with and those without LT tear. In most hips, LT tear co-existed with either a labral tear or a cartilage defect, or both. The higher frequency of atraumatic LT tears in professional ballet dancers suggests that the LT might be abnormally loaded in ballet, and caution is required when evaluating MRI, as LT tears may be asymptomatic. A longitudinal study of this cohort is required to determine if LT tear predisposes the hip joint to osteoarthritis.

Patient acceptability of tear collection in the primary healthcare setting.

PubMed

Quah, Joanne Hui Min; Tong, Louis; Barbier, Sylvaine

2014-04-01

The primary healthcare setting is well placed for health screening. Tear fluid composition gives valuable information about the eye and systemic health, and there is now significant interest in the potential application of tears as a tool for health screening; however, the acceptability of tear collection in the primary healthcare setting as compared with other methods of human sample collection has not been previously addressed. The objective of this study was to evaluate the patient acceptability of tear collection in a primary healthcare setting. This was a cross-sectional study on 383 adult patients seeking primary healthcare, who were not diabetic and were not attending for an eye-related complaint. Tear collection was done using Schirmer strips, and an interviewer-administered questionnaire was conducted to collate information on the pain score (0-10) of the Schirmer tear collection, as well as to score the pain associated with their previous experience of antecubital venous puncture and finger prick test. The pain score for Schirmer tear collection was significantly lower (p < 0.001) than antecubital venous puncture but higher (p < 0.001) than finger prick. The pain scores for all three procedures were significantly higher in participants of younger age, female gender, and higher education level. Among the participants, 70% did not mind their tears being collected to screen for eye problems, whereas only 38% did not mind this procedure being performed for general health screening. Nevertheless, 69% of the participants preferred tear to urine collection, and 74% of participants preferred tear to blood collection. Tear collection using Schirmer strips is a highly acceptable form of investigation that has the potential for use in health screening in the primary healthcare setting. This study has implications on using tear collection as a method of ocular and systemic health screening in the primary healthcare setting.

Punctal plugs versus artificial tears for treating dry eye: a comparative observation of their effects on contrast sensitivity.

PubMed

Qiu, Weiqiang; Liu, Ziyuan; Zhang, Zhihong; Ao, Mingxin; Li, Xuemin; Wang, Wei

2012-01-01

This study aimed to compare the effects of treatment with punctal plugs versus artificial tears on visual function and tear film stability for dry eye. A total of 56 consecutive eyes of 28 dry eye patients observed at our clinic from May to October in 2009 were divided into two groups. One group (32 eyes of 16 patients) was treated with artificial tears, and punctal plugs were used in the other group (24 eyes of 12 patients). A questionnaire was used in these patients before treatment and was repeated 2 weeks after treatment. Fluorescent staining for tear film break-up time (BUT), the Schirmer test I (STI), and contrast sensitivity was performed at the same time. The questionnaire indicated that all patients complained about the uncomfortable symptoms associated with dry eye. These symptoms were relieved after the application of artificial tears or punctal plugs, and there was no significant difference between these two groups. We found that the corneal fluorescent staining disappeared after treatment. The BUT was improved significantly after treatment in both groups, but the improvement was greater in patients who received punctal plugs than those that received artificial tears. There was no remarkable change in the STI in the artificial tears group, but a significant change was observed in the punctal plugs group. The contrast sensitivities were greatly improved in simulated daylight, night, and glare disability conditions after treatment with artificial tears and punctal plugs. However, the changes in contrast sensitivity did not significantly differ between groups. Both artificial tears and punctal plugs relieved dry eye symptoms, repaired corneal lesions, enhanced tear film stability, and improved contrast sensitivity. Punctal plugs could improve tear film stability and elongate the BUT better than artificial tears.

Tear-Duct Obstruction and Surgery

MedlinePlus

... Staying Safe Videos for Educators Search English Español Tear-Duct Obstruction and Surgery KidsHealth / For Parents / Tear- ... year old with little or no treatment. About Tear Ducts Our eyes are continually exposed to dust, ...

Watery eyes

MedlinePlus

... JavaScript. Watery eyes means you have too many tears draining from the eyes. Tears help keep the surface of the eye moist. ... the eye. Causes Your eyes are always making tears. These tears leave the eye through a small ...

Conjunctival Tear Layer Temperature, Evaporation, Hyperosmolarity, Inflammation, Hyperemia, Tissue Damage, and Symptoms: A Review of an Amplifying Cascade.

PubMed

McMonnies, Charles W

2017-12-01

This review examines the evidence for and significance of pre-conjunctival tear temperature being higher than central pre-corneal temperature with associated more rapid evaporation of warmer pre-conjunctival tears in normal eyes but especially in hyperemic dry eye disease. PubMed searches using the terms "evaporative dry eye," "conjunctival tear evaporation," "tear evaporation," and "dry eye conjunctival hyperemia" indicated 157, 49, 309, and 96 potentially relevant papers, respectively. Selections from these lists were the basis for examining the significance of the evidence relevant to pre-conjunctival tear layer temperature and evaporation. There is evidence supporting an amplifying inflammatory and para-inflammatory hyperemia dry eye cascade, which increases pre-conjunctival tear temperature and the risk of accelerated pre-conjunctival tear evaporation with exacerbated osmolarity elevation and inflammation. Dry eye cascade amplification is consistent with increases in symptoms and inflammatory as well as para-inflammatory hyperemia toward the end of the waking day. Apart from age-related conjunctivochalasis, dry eye-related conjunctival epithelial cell pathology including reduced goblet cell numbers and associated mucin deficiency, squamous metaplasia, and increased separation of cell layers could help to destabilize tears and facilitate evaporation as part of an amplifying cascade. Greater difficulty in assessing conjunctival tear break up may contribute to an underestimation of a role for faster evaporation of pre-conjunctival tears in dry eye disease and help explain any non-correspondence between symptoms and corneal signs of dry eye disease. Success with anti-inflammatory therapies for dry eye disease may be at least partly due to reductions in conjunctival hyperemia and deamplification of evaporative cascades. Conjunctival inflammatory hyperemia in other diseases may contribute to accelerated pre-conjunctival tear evaporation and the risk of tear-deficiency- associated exacerbation of those diseases including impaired responses to therapeutic approaches to them. Similarly, postsurgical conjunctival inflammation and associated acceleration of tear evaporation could contribute to delayed wound healing.

Total IgE and eotaxin (CCL11) contents in tears of patients suffering from seasonal allergic conjunctivitis.

PubMed

Eperon, Simone; Berguiga, Marouen; Ballabeni, Pierluigi; Guex-Crosier, Catherine; Guex-Crosier, Yan

2014-09-01

To prospectively investigate patients with seasonal allergic conjunctivitis (SAC) during the pollen season and test associations between tears total IgE, eotaxin concentrations, and SAC severity. Enrolled patients presented ocular symptoms and clinical signs of SAC at the time of presentation. Ocular itching, hyperaemia, chemosis, eyelid swelling, and tearing were scored, and the sum of these scores was defined as the clinical score. Conjunctival papillae were separately graded. We measured eotaxin concentration in tears by an enzyme-linked immunosorbent assay (ELISA) and total tear IgE by Lacrytest strip. Among thirty patients (30 eyes), 11 showed neither tear IgE nor tear eotaxin, while 15 out of 19 patients with positive IgE values presented a positive amount of eotaxin in their tears (Fisher's test: p < 0.001). The mean eotaxin concentration was 641 ± 154 (SEM) pg/ml. In patients with no amount of tear IgE, we observed a lower conjunctival papilla grade than in patients whose tears contained some amount of IgE (trend test: p = 0.032). In the 15 patients whose tear eotaxin concentration was null, tear IgE concentration was 5.3 ± 3.5 arbitrary units; in the other 15 patients whose eotaxin was positive, IgE reached 21 ± 4.3 arbitrary U (Mann-Whitney: p < 0.001). We measured 127 ± 47 pg/ml eotaxin in patients with no history of SAC but newly diagnosed as suffering from SAC, and 852 ± 218 pg/ml eotaxin in patients with a known SAC (p = 0.008). In contrast, tear IgE concentrations of both groups did not differ statistically significantly (p = 0.947). If IgE and eotaxin secreted in tears are major contributors in SAC pathogenesis, they however act at different steps of the process.

Interferometric measurements of the tear film irregularities on the human cornea

NASA Astrophysics Data System (ADS)

Szczesna, Dorota H.; Jaronski, Jaroslaw; Kasprzak, Henryk T.; Stenevi, Ulf

2005-09-01

The pre-ocular tear film is the most anterior refractive surface of the eye. Its stability plays an important role in the condition of vision from the optical and physiological point of view. If the eye is opened for a significantly long time or suffers from an anormalities in tear production, there appear isolated dry islands - break-ups - with a random distribution in the continuous lacrimal film. We applied an interferometric method - Lateral Shearing Technique for investigating the tear film stability and the smoothness of the tear film surface. This method is non-invasive and it is characterised by the high accuracy and sensitivity. Interferometry allows dynamic measurements of the tear film stability in real time by observation of interference fringes. The evaporation of tears and appearance of the breakups causes changes in the fringe geometry. Fast Fourier Transform has been used for quantitative assessment of the fringe smoothness and as a consequence of the tear film surface geometry. This paper presents the method used for quantitative evaluation of the tear film distribution on the cornea. Examples of interferograms recorded on eyes of patients with healthy eyes, suffering from dry eye syndrome and wearing contact lenses are also given. With our technique we were able to observe distinct differences in stability of the tear film between healthy and dry eyes, and the tear film on contact lenses.

Bone mineralization changes of the glenoid in shoulders with symptomatic rotator cuff tear.

PubMed

Harada, Yohei; Yokoya, Shin; Akiyama, Yuji; Mochizuki, Yu; Ochi, Mitsuo; Adachi, Nobuo

2018-06-06

Computed tomography osteoabsorptiometry (CTO) is a method to analyze the stress distribution in joints by measuring the subchondral bone density. The purpose of this study was to evaluate the bone mineralization changes of the glenoid in shoulders with rotator cuff tears by CTO and to evaluate whether rotator cuff tears are associated with stress changes in the glenoid. In total, 32 patients, who were diagnosed with unilateral rotator cuff tears and underwent arthroscopic rotator cuff repair, were enrolled in this study. They underwent CT scanning of both shoulders pre-operatively and the glenoid was evaluated using CTO. Hounsfield units (HU) in seven areas of the glenoid were compared between the affected and unaffected sides. The central area of the glenoid on the affected side had significantly lower HU than on the unaffected side among all patients. Focusing on the rotator cuff tear size and the subscapularis tendon, only patients with larger cuff tears or with subscapularis tendon tears showed significantly lower HU in the central area of the affected side. This study showed a decrease in bone mineralization density in the central glenoid in shoulders with rotator cuff tear. This change was observed in the case of larger cuff tears and subscapularis tendon tears. Our results help clarify the changes in stress distribution in the shoulder joint caused by symptomatic rotator cuff tears.

New testing options for diagnosing and grading dry eye disease.

PubMed

Foulks, Gary N; Pflugfelder, Stephen C

2014-06-01

To describe new options for diagnosis and severity grading of dry eye disease. Perspective on technological advancements to identify tear dysfunction and their value in diagnosing and grading dry eye disease. Evidence is presented on new and evolving technologies to measure tear stability, composition, and meniscus height and their role in dry eye diagnosis and therapeutic efficacy grading is assessed. Evolving concepts regarding pathogenesis and new technologies to evaluate the tears and ocular surface have improved the ability to diagnose, classify, and grade the severity of dry eye disease. New technologies include noninvasive imaging of tear stability and tear meniscus height as a measure of tear volume and tear composition (osmolarity, lacrimal factors, inflammatory mediators, growth and differentiation factors). Approved tests, such as tear osmolarity and tear imaging, are being integrated into clinical practice and may eventually supplant certain traditional tests that have greater variability and less sensitivity. Other tests, such as molecular assays of tears and conjunctival cells, are currently being used in studies investigating pathogenesis and therapeutic mechanism of action. They may eventually translate to routine clinical practice. New technologies have emerged that can noninvasively evaluate the tears and measure disease-associated compositional changes. These tests are being integrated into clinical practice and therapeutic trials for diagnosis, classification, and severity grading of dry eye disease. Copyright © 2014 Elsevier Inc. All rights reserved.

Partial articular-sided rotator cuff tears: in situ repair versus tear completion prior to repair.

PubMed

Sethi, Paul M; Rajaram, Arun; Obopilwe, Elifho; Mazzocca, Augustus D

2013-06-01

Uncertainty exists over the ideal surgical treatment method for partial articular-sided rotator cuff tears, with options ranging from debridement to in situ repair to tear completion prior to repair. The purpose of this study was to determine whether in situ repair was a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. Fourteen fresh-frozen cadaveric shoulders were dissected. Partial articular-sided tears were created and repaired using in situ repair or tear completion prior to the repair. Strain and displacement were measured at 45°, 60°, and 90° of glenohumeral abduction. Testing was performed with a load of 100 N applied for 30 cycles. Data from the biomechanical testing displayed 4 conditions that showed improved characteristics of in situ repair over completion and repair: bursal-sided strain anteriorly at 45°, bursal-sided strain anteriorly at 90°, bursal-sided displacement anteriorly at 45°, and bursal-sided displacement anteriorly at 90°. The data indicate that in situ repair is a viable biomechanical treatment option compared with tear completion prior to repair of partial articular-sided rotator cuff tears. When clinically appropriate, the in situ repair may offer some biomechanical advantages, with lower strain and displacement observed on the bursal side compared with tear completion prior to repair. Copyright 2013, SLACK Incorporated.

Blocked Tear Duct

MedlinePlus

... of the nose (lacrimal sac). From there tears travel down a duct (the nasolacrimal duct) draining into your nose. Once in the nose, tears are reabsorbed. A blockage can occur at any point in the tear drainage system, from the puncta ...

Metabolomics and Trace Element Analysis of Camel Tear by GC-MS and ICP-MS.

PubMed

Ahamad, Syed Rizwan; Raish, Mohammad; Yaqoob, Syed Hilal; Khan, Altaf; Shakeel, Faiyaz

2017-06-01

Camel tear metabolomics and elemental analysis are useful in getting the information regarding the components responsible for maintaining the protective system that allows living in the desert and dry regions. The aim of this study was to correlate that the camel tears can be used as artificial tears for the evaluation of dryness in the eye. Eye biomarkers of camel tears were analyzed by gas chromatography-mass spectroscopy (GC-MS) and inductively coupled plasma mass spectroscopy (ICP-MS). The major compounds detected in camel tears by GC-MS were alanine, valine, leucine, norvaline, glycine, cadaverine, urea, ribitol, sugars, and higher fatty acids like octadecanoic acid and hexadecanoic acid. GC-MS analysis of camel tears also finds several products of metabolites and its associated metabolic participants. ICP-MS analysis showed the presence of different concentration of elemental composition in the camel tears.

Hot-tearing of multicomponent Al-Cu alloys based on casting load measurements in a constrained permanent mold

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sabau, Adrian S; Mirmiran, Seyed; Glaspie, Christopher

Hot-tearing is a major casting defect that is often difficult to characterize, especially for multicomponent Al alloys used for cylinder head castings. The susceptibility of multicomponent Al-Cu alloys to hot-tearing during permanent mold casting was investigated using a constrained permanent mold in which the load and displacement was measured. The experimental results for hot tearing susceptibility are compared with those obtained from a hot-tearing criterion based temperature range evaluated at fraction solids of 0.87 and 0.94. The Cu composition was varied from approximately 5 to 8 pct. (weight). Casting experiments were conducted without grain refining. The measured load during castingmore » can be used to indicate the severity of hot tearing. However, when small hot-tears are present, the load variation cannot be used to detect and assess hot-tearing susceptibility.« less

Sphincter tears in primiparous women: Is age a factor?

PubMed Central

BOWLING, C. Bryce; WHEELER, Thomas L.; GERTEN, Kimberly A.; CHAPMAN, Victoria R.; BURGIO, Kathryn L.; RICHTER, Holly E.

2011-01-01

Introduction and Hypothesis Anal sphincter tears during vaginal delivery may result in serious sequelae. We examined whether younger primiparous patients were at increased risk for sphincter tears during vaginal delivery. Methods Data from an obstetric automated record were analyzed. Primiparous women delivering term infants (n = 5,937) were included to test for an association between age and sphincter tear rates. Three age groups were considered: young adolescents (≤16 years), older adolescents (17-20 years) and adults (≥21 years). Results No significant difference was found in tear rates among age cohorts (9.2%, 8.0%, and 9.6% respectively; p = 0.12). Logistic regression modeling revealed that young adolescents were not more likely to have sphincter tears compared to older cohorts. Conclusions Younger adolescents may not be at increased risk of anal sphincter tears. Decisions regarding interventions to decrease sphincter tears during vaginal delivery should not be made on the basis of maternal age alone. PMID:18985267

Meniscus root repair.

PubMed

Vyas, Dharmesh; Harner, Christopher D

2012-06-01

Root tears are a subset of meniscal injuries that result in significant knee joint pathology. Occurring on either the medial or lateral side, root tears are defined as radial tears or avulsions of the posterior horn attachment to bone. After a root tear, there is a significant increase in tibio-femoral contact pressure concomitant with altered knee joint kinematics. Previous cadaver studies from our institution have shown that root repair of the medial meniscus is successful in restoring joint biomechanics to within normal limits. Indications for operative management of meniscal root tears include (1) a symptomatic medial meniscus root tear with minimal arthritis and having failed non-operative treatment, and (2) a lateral root tear in associated with an ACL tear. In this review, we describe diagnosis, imaging, patient selection, and arthroscopic surgical technique of medial and lateral meniscus root injuries. In addition we highlight the pearls of repair technique, associated complications, post-operative rehabilitation regimen, and expected outcomes.

Hot tearing studies in AA5182

NASA Astrophysics Data System (ADS)

van Haaften, W. M.; Kool, W. H.; Katgerman, L.

2002-10-01

One of the major problems during direct chill (DC) casting is hot tearing. These tears initiate during solidification of the alloy and may run through the entire ingot. To study the hot tearing mechanism, tensile tests were carried out in semisolid state and at low strain rates, and crack propagation was studied in situ by scanning electron microscopy (SEM). These experimentally induced cracks were compared with hot tears developed in an AA5182 ingot during a casting trial in an industrial research facility. Similarities in the microstructure of the tensile test specimens and the hot tears indicate that hot tearing can be simulated by performing tensile tests at semisolid temperatures. The experimental data were compared with existing hot tearing models and it was concluded that the latter are restricted to relatively high liquid fractions because they do not take into account the existence of solid bridges in the crack.

A mass and solute balance model for tear volume and osmolarity in the normal and the dry eye.

PubMed

Gaffney, E A; Tiffany, J M; Yokoi, N; Bron, A J

2010-01-01

Tear hyperosmolarity is thought to play a key role in the mechanism of dry eye, a common symptomatic condition accompanied by visual disturbance, tear film instability, inflammation and damage to the ocular surface. We have constructed a model for the mass and solute balance of the tears, with parameter estimation based on extensive data from the literature which permits the influence of tear evaporation, lacrimal flux and blink rate on tear osmolarity to be explored. In particular the nature of compensatory events has been estimated in aqueous-deficient (ADDE) and evaporative (EDE) dry eye. The model reproduces observed osmolarities of the tear meniscus for the healthy eye and predicts a higher concentration in the tear film than meniscus in normal and dry eye states. The differential is small in the normal eye, but is significantly increased in dry eye, especially for the simultaneous presence of high meniscus concentration and low meniscus radius. This may influence the interpretation of osmolarity values obtained from meniscus samples since they need not fully reflect potential damage to the ocular surface caused by tear film hyperosmolarity. Interrogation of the model suggests that increases in blink rate may play a limited role in compensating for a rise in tear osmolarity in ADDE but that an increase in lacrimal flux, together with an increase in blink rate, may delay the development of hyperosmolarity in EDE. Nonetheless, it is predicted that tear osmolarity may rise to much higher levels in EDE than ADDE before the onset of tear film breakup, in the absence of events at the ocular surface which would independently compromise tear film stability. Differences in the predicted responses of the pre-ocular tears in ADDE compared to EDE or hybrid disease to defined conditions suggest that no single, empirically-accessible variable can act as a surrogate for tear film concentration and the potential for ocular surface damage. This emphasises the need to measure and integrate multiple diagnostic indicators to determine outcomes and prognosis. Modelling predictions in addition show that further studies concerning the possibility of a high lacrimal flux phenotype in EDE are likely to be profitable.

The risk of stanford type-A aortic dissection with different tear size and location: a numerical study.

PubMed

Shi, Yue; Zhu, Minjia; Chang, Yu; Qiao, Huanyu; Liu, Yongmin

2016-12-28

This study is to investigate the influence of hemodynamics on Stanford type-A aortic dissection with different tear size and location, to provide some support for the relationships between the risks (rupture, reverse tearing and further tearing) and tear size and location for clinical treatment. Four numerical models of Stanford type-A aortic dissection were established, with different size and location of the tears. The ratio of the area between the entry and re-entry tears(RA) is various within the model; while, the size and the location of the re-entry in the distal descending aorta are fixed. In model A11 and A21, the entry tears are located near the ascending aorta. The RA in these models are 1 and 2, respectively; In the model B11 and B21, the entry tears are located near the proximal descending aorta and the RA in these models are again assigned to 1 and 2, respectively. Then hemodynamics in these models was solved with numerically and the flow patterns and loading distributions were investigated. The flow velocity of the true lumen in model A21, B21 is lower than that in A11, B11, respectively; the time-averaged wall shear stress (TAWSS) of the false lumen in model A21 and B21 is higher, and for ascending aorta false lumen, A11, A21 are higher than B11, B21, respectively. False lumen intimal wall pressure of A11, A21 are always higher than the true lumen ones. The variation of the RA can significantly affect the dynamics of blood within the aortic dissection. When the entry tear size is larger than the re-entry tear ones, the false lumen, proximal descending aorta and the wall near re-entry tear are prone to cracking. Entry tear location can significantly alter the hemodynamics of aortic dissection as well. When entry tear location is closer to proximal ascending aorta, false lumen continues to expand and compress the true lumen resulting in the true lumen reduction. For proximal ascending aorta, high pressure in false lumen predicts a higher risk of reverse tear.

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon.

PubMed

Tosounidis, Theodoros; Hadjileontis, Constantine; Triantafyllou, Christos; Sidiropoulou, Varvara; Kafanas, Antonios; Kontakis, George

2013-03-01

The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology. We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells. A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions. Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.

Tear cytokine profile as a noninvasive biomarker of inflammation for ocular surface diseases: standard operating procedures.

PubMed

Wei, Yi; Gadaria-Rathod, Neha; Epstein, Seth; Asbell, Penny

2013-12-23

To provide standard operating procedures (SOPs) for measuring tear inflammatory cytokine concentrations and to validate the resulting profile as a minimally invasive objective metric and biomarker of ocular surface inflammation for use in multicenter clinical trials on dry eye disease (DED). Standard operating procedures were established and then validated with cytokine standards, quality controls, and masked tear samples collected from local and distant clinical sites. The concentrations of the inflammatory cytokines in tears were quantified using a high-sensitivity human cytokine multiplex kit. A panel of inflammatory cytokines was initially investigated, from which four key inflammatory cytokines (IL-1β, IL-6, INF-γ, and TNF-α) were chosen. Results with cytokine standards statistically satisfied the manufacturer's quality control criteria. Results with pooled tear samples were highly reproducible and reliable with tear volumes ranging from 4 to 10 μL. Incorporation of the SOPs into clinical trials was subsequently validated. Tear samples were collected at a distant clinical site, stored, and shipped to our Biomarker Laboratory, where a masked analysis of the four tear cytokines was successfully performed. Tear samples were also collected from a feasibility study on DED. Inflammatory cytokine concentrations were decreased in tears of subjects who received anti-inflammatory treatment. Standard operating procedures for human tear cytokine assessment suitable for multicenter clinical trials were established. Tear cytokine profiling using these SOPs may provide objective metrics useful for diagnosing, classifying, and analyzing treatment efficacy in inflammatory conditions of the ocular surface, which may further elucidate the mechanisms involved in the pathogenesis of ocular surface disease.

The Relationship between Metabolic Syndrome, Its Components, and Dry Eye: A Cross-Sectional Study.

PubMed

Erdur, Sevil Karaman; Aydin, Rukiye; Ozsutcu, Mustafa; Olmuscelik, Oktay; Eliacik, Mustafa; Demirci, Goktug; Kocabora, Mehmet Selim

2017-08-01

The aim of this study was to evaluate tear osmolarity and tear film function and ocular surface changes in patients with metabolic syndrome. 108 eyes of 64 patients with metabolic syndrome (group 1) and 110 eyes of 55 healthy individuals (group 2) were included in this cross-sectional study. All participants were evaluated using the Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), and tear osmolarity. Main outcome measures were Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, tear film break-up time (TBUT), and tear osmolarity values. Tear osmolarity values and OSDI scores were significantly higher in group 1 (314.4 ± 19.1 mOsm and 38.9 ± 1.1, respectively) compared with group 2 (295 ± 14.3 mOsm and 18.69 ± 17.2, respectively) (p = 0.01 for both). The Schirmer test values and TBUT in group 1 (10 ± 3.7 mm and 14.8 ± 3.6 sec, respectively) were significantly lower compared with group 2 (16.8 ± 2.6 mm and 18.1 ± 0.5 sec, respectively) (p < 0.001 for both). There was significant correlation between tear osmolarity versus waist circumference and fasting blood glucose in the study group (r = 0.364, p = 0.04; and r = 0.542, p ≤ 0.001, respectively). This study showed that metabolic syndrome can influence tear osmolarity and tear film function. Patients with metabolic syndrome showed tear hyperosmolarity and tear film dysfunction.

Subregional effects of meniscal tears on cartilage loss over 2 years in knee osteoarthritis.

PubMed

Chang, Alison; Moisio, Kirsten; Chmiel, Joan S; Eckstein, Felix; Guermazi, Ali; Almagor, Orit; Cahue, September; Wirth, Wolfgang; Prasad, Pottumarthi; Sharma, Leena

2011-01-01

Meniscal tears have been linked to knee osteoarthritis progression, presumably by impaired load attenuation. How meniscal tears affect osteoarthritis is unclear; subregional examination may help to elucidate whether the impact is local. This study examined the association between a tear within a specific meniscal segment and subsequent 2-year cartilage loss in subregions that the torn segment overlies. Participants with knee osteoarthritis underwent bilateral knee MRI at baseline and 2 years. Mean cartilage thickness within each subregion was quantified. Logistic regression with generalised estimating equations were used to analyse the relationship between baseline meniscal tear in each segment and baseline to 2-year cartilage loss in each subregion, adjusting for age, gender, body mass index, tear in the other two segments and extrusion. 261 knees were studied in 159 individuals. Medial meniscal body tear was associated with cartilage loss in external subregions and in central and anterior tibial subregions, and posterior horn tear specifically with posterior tibial subregion loss; these relationships were independent of tears in the other segments and persisted in tibial subregions after adjustment for extrusion. Lateral meniscal body and posterior horn tear were also associated with cartilage loss in underlying subregions but not after adjustment for extrusion. Cartilage loss in the internal subregions, not covered by the menisci, was not associated with meniscal tear in any segment. These results suggest that the detrimental effect of meniscal tears is not spatially uniform across the tibial and femoral cartilage surfaces and that some of the effect is experienced locally.

Complete vs partial-thickness tears of the posterior cruciate ligament: MR findings.

PubMed

Patten, R M; Richardson, M L; Zink-Brody, G; Rolfe, B A

1994-01-01

We sought to define the MRI appearance of both complete and partial-thickness tears of the posterior cruciate ligament (PCL) and to describe patterns of injury and associated MRI findings. Three radiologists retrospectively reviewed MR images and medical records on 32 patients with PCL tears (15 complete, 17 partial) and correlated MRI findings to results of clinical testing and surgery. The PCL had indistinct margins in 27 (84%) of 32 patients and was abnormally thick in 25 (78%) patients. In 31 (97%) patients, the torn PCL showed increased signal intensity on both T1- and T2-weighted pulse sequences. Although there was no statistically significant difference between patients with complete tears and those with partial tears with regard to thickness, margination, and signal intensity of the PCL, MR images in patients with complete tears were more likely to show focal areas of ligamentous discontinuity (10 of 15 cases) (p = 0.01). Associated knee injuries were seen in 21 (66%) patients and were seen more frequently in patients with complete PCL tears (p = 0.015). Bony injury (n = 11, 34%) and tears of the medial collateral ligament (n = 13, 41%) and menisci (n = 10, 31%) were common. No specific pattern of bony injury was found. Posterior cruciate ligament tears can be diagnosed readily by multiplanar MRI using both morphological and signal intensity characteristics. Although differentiation between complete and partial-thickness PCL tears by MRI criteria alone is more problematic, complete tears are more likely to show focal areas of discontinuity and partial tears are more likely to show at least some intact fibers.

Age-related changes in the signal value of tears.

PubMed

Zeifman, Debra M; Brown, Sarah A

2011-08-12

Emotional tears may be uniquely human and are an effective signal of distress in adults. The present study explored whether tears signal distress in younger criers and whether the effect of tears on observers is similar in magnitude across the life span. Participants rated photographs of crying infants, young children, and adults, with tears digitally removed or added. The effectiveness of tears in conveying sadness and eliciting sympathy was greatest for images of adults, intermediate for images of children, and least potent for images of infants. These findings suggest that the signal value of tears varies with the age of the crier. The results may shed light on the functional significance of crying at different stages of human development.

Relationship of Tear Size and Location to Fatty Degeneration of the Rotator Cuff

PubMed Central

Kim, H. Mike; Dahiya, Nirvikar; Teefey, Sharlene A.; Keener, Jay D.; Galatz, Leesa M.; Yamaguchi, Ken

2010-01-01

Background: Fatty degeneration of the rotator cuff muscles may have detrimental effects on both anatomical and functional outcomes following shoulder surgery. The purpose of this study was to investigate the relationship between tear geometry and muscle fatty degeneration in shoulders with a deficient rotator cuff. Methods: Ultrasonograms of both shoulders of 262 patients were reviewed to assess the type of rotator cuff tear and fatty degeneration in the supraspinatus and infraspinatus muscles. The 251 shoulders with a full-thickness tear underwent further evaluation for tear size and location. The relationship of tear size and location to fatty degeneration of the supraspinatus and infraspinatus muscles was investigated with use of statistical comparisons and regression models. Results: Fatty degeneration was found almost exclusively in shoulders with a full-thickness rotator cuff tear. Of the 251 shoulders with a full-thickness tear, eighty-seven (34.7%) had fatty degeneration in either the supraspinatus or infraspinatus, or both. Eighty-two (32.7%) of the 251 full-thickness tears had a distance of 0 mm between the biceps tendon and anterior margin of the tear. Ninety percent of the full-thickness tears with fatty degeneration in both muscles had a distance of 0 mm posterior from the biceps, whereas only 9% of those without fatty degeneration had a distance of 0 mm. Tears with fatty degeneration had significantly greater width and length than those without fatty degeneration (p < 0.0001). Tears with fatty degeneration had a significantly shorter distance posterior from the biceps than those without fatty degeneration (p < 0.0001). The distance posterior from the biceps was found to be the most important predictor for supraspinatus fatty degeneration, whereas tear width and length were found to be the most important predictors for infraspinatus fatty degeneration. Conclusions: Fatty degeneration of the rotator cuff muscles is closely associated with tear size and location. The finding of this study suggests that the integrity of the anterior supraspinatus tendon is important to the development of fatty degeneration. Patients with full-thickness tears that extend through this area may benefit from earlier surgical intervention if fatty degeneration has not already occurred. Additionally, the findings suggest the importance of secure fixation and healing of the anterior aspect of the supraspinatus with surgical repair. PMID:20360505

Radial tears associated with cleavage tears of the medial meniscus in athletes.

PubMed

Kidron, Amos; Thein, Rafael

2002-03-01

To evaluate the significance of a small radial tear in the root of the posterior horn of the medial meniscus in an otherwise normal-looking meniscus in individuals who play vigorous sports. Retrospective review. Arthroscopy was performed in 1,270 patients; 11 patients (0.86%) had a small radial tear in the root of the medial meniscus. Trimming of the tear revealed a large horizontal cleavage tear of the posterior horn and body of the meniscus. The average age of the affected patients was 29.6 years (range, 21 to 45 years), and all were active in sports. Magnetic resonance imaging was of dubious diagnostic value. Three patients had undergone previous arthroscopy at which time the small radial root tear had been noted but was not thought to warrant treatment. All 11 patients returned to their former levels of activity after adequate surgery. When a radial root tear in the medial meniscus is found in an athletic patient, the edges of the tear should be trimmed, the root of the medial meniscus examined, and any additional torn cartilage resected.

Patterns of meniscal tears associated with anterior cruciate ligament lesions in athletes.

PubMed

Binfield, P M; Maffulli, N; King, J B

1993-09-01

In this study, 400 clinically anterior cruciate ligament (ACL) deficient knees were arthroscoped and studied prospectively in the period January 1986 to April 1992. An ACL tear was always confirmed, and 41 per cent of these patients did not have an associated meniscal tear. In 30.25 per cent the lateral meniscus was torn; in 21.25 per cent the ACL tear was associated with a medial meniscus tear, and in the remaining 7 per cent both menisci were torn. The most frequently associated meniscal injury was the bucket handle tear of the medial meniscus (9 per cent), followed by the posterior horn tear of the lateral meniscus, which showed the same frequency as the ragged (or degenerated) tear of the lateral meniscus (6 per cent). The horizontal tear of the posterior part of the lateral meniscus showed a prevalence of 4.3 per cent. This picture is probably dependent on a secondary referral nature of the centre surveyed, in which the average time between injury and arthroscopy was 23.3 months.

Ocular Pharmacology of Tear Film, Dry Eye, and Allergic Conjunctivitis.

PubMed

Gulati, Shilpa; Jain, Sandeep

2017-01-01

Dry Eye Disease (DED) is "a multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear-film instability with potential damage to the ocular surface." DED comprises two etiologic categories: aqueous-deficient dry eye (ADDE) and evaporative dry eye (EDE). Diagnostic workup of DED should include clinical history, symptom questionnaire, fluorescein TBUT, ocular surface staining grading, Schirmer I/II, lid and meibomian pathology, meibomian expression, followed by other available tests. New diagnostic tests employ the Oculus Keratograph, which performs non-invasive tear-film analysis and a bulbar redness (BR). The TearLab Osmolarity Test enables rapid clinical evaluation of tear osmolarity. Lipiview is a recently developed diagnostic tool that uses interferometry to quantitatively evaluate tear-film thickness. In DED, epithelial and inflammatory cells produce a variety of inflammatory mediators. A stagnant tear film and decreased concentration of mucin result in the accumulation of inflammatory factors that can penetrate tight junctions and cause epithelial cell death. DED treatment algorithms are based on severity of clinical signs and symptoms, and disease etiology. Therapeutic approaches include lubricating artificial tears and immunomodulatory agents.

[The correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK].

PubMed

Zhang, Luyan; Sun, Xiyu; Yu, Ye; Xiong, Yan; Cui, Yuxin; Wang, Qinmei; Hu, Liang

2016-01-01

To investigate the correlations between corneal sensation, tear meniscus volume, and tear film osmolarity after femtosecond laser-assisted LASIK (FS-LASIK) surgery. In this prospective clinical study, 31 patients undergoing FS-LASIK for myopia were recruited. The upper and lower tear meniscus volumes (UTMV and LTMV) were measured by customized anterior segment optical coherence tomography, tear film osmolarity was measured by a TearLab Osmolarity test device, central corneal sensation was measured by a Cochet-Bonner esthesiometer preoperatively, at 1 week, 1 and 3 months postoperatively. Repeated measures analysis of variance was used to evaluate whether the tear film osmolarity, tear meniscus volume, and corneal sensation were changed after surgery. The correlations between these variables were analyzed by the Pearson correlation analysis. The tear film osmolarity was (310.03 ± 16.48) mOsms/L preoperatively, (323.51 ± 15.92) mOsms/L at 1 week, (319.93 ± 14.27) mOsms/L at 1 month, and (314.97±12.91) mOsms/L at 3 months. The UTMV was (0.42±0.15), (0.25± 0.09), (0.30±0.11), and (0.35±0.09) μL, respectively; the LTMV was (0.60±0.21),(0.37±0.08), (0.44± 0.14), and (0.52±0.17) μL, respectively. The tear film osmolarity was significantly higher at 1 week and 1 month postoperatively compared with the baseline (P=0.001, 0.004), and reduced to the preoperative level at 3 months (P=0.573). The UTMV, LTMV, and corneal sensation values presented significant decreases at all postoperative time points (all P<0.05). The Pearson correlation analysis showed the postoperative UTMV had a weak relationship with corneal sensation at 1 week after surgery (r=0.356,P=0.005). There were significant correlations between the preoperative LTMV and corneal sensation at 1 week, 1 and 3 months (respectively, r=0.422, 0.366, 0.352;P=0.001, 0.004, 0.006). No significant correlations were found between the tear film osmolarity, tear meniscus volume, and corneal sensation after surgery (all P>0.05). The tear film osmolarity, tear meniscus volume, and corneal sensation became aggravated due to the FS-LASIK surgery procedures. There were significant correlations between the preoperative tear meniscus volume and recovery of corneal sensation early after surgery. A higher tear meniscus volume before surgery may contribute to a faster corneal sensation recovery.

Status of the contralateral rotator cuff in patients undergoing rotator cuff repair.

PubMed

Ro, Kyung-Han; Park, Jong-Hoon; Lee, Soon-Hyuck; Song, Dong-Ik; Jeong, Ha-Joon; Jeong, Woong-Kyo

2015-05-01

Although the prevalence of rotator cuff tear (RCT) in the general population has been analyzed, little information is available on the status of the opposite-side rotator cuff in patients who have undergone arthroscopic rotator cuff repair. To identify the characteristics of the contralateral shoulder and to identify factors associated with RCT of the contralateral shoulder in patients who underwent surgery for symptomatic RCT. The hypothesis was that the prevalence of RCT in the contralateral shoulder would be higher in patients with increasingly larger cuff tears requiring surgical intervention. Case series; Level of evidence, 4. The study cohort consisted of 140 patients with RCT who underwent arthroscopic rotator cuff repair. Opposite-shoulder rotator cuff tendons of all patients were evaluated by ultrasonography. Demographic information and factors related to contralateral RCT were investigated, and risk factors associated with contralateral RCT were assessed. Of the 140 patients who underwent arthroscopic rotator cuff repair, 54 (38.6%) had an RCT of the contralateral shoulder. Of 51 patients with partial-thickness and small-sized full-thickness tears of the operated shoulder, 35 (68.6%) had no tears; 14 (27.5%) had partial-thickness tears; and 2 (3.9%) had small-sized full-thickness tears of the contralateral shoulder. Of 75 patients with medium-sized full-thickness tears, 43 (57.3%) had no tears; 12 (16%) had partial-thickness tears; and 20 (26.7%) had full-thickness tears of the contralateral shoulder. Of 14 patients with large to massive full-thickness tears, 8 (57.1%) had no tears; 1 (7.1%) had a partial-thickness tear; and 5 (35.7%) had full-thickness tears of the contralateral shoulder. The prevalence of RCT of the contralateral shoulder differed significantly among groups classified by tear size (P=.007). The mean American Shoulder and Elbow Surgeons score was significantly lower in the RCT than in the nontear group (55.8±16.9 vs 61.6±13.3; P=.03). Of 29 subjects with symptomatic tears involving the nondominant arm, 17 (58.6%) had contralateral asymptomatic RCT, compared with 37 of 111 (33.3%) subjects with symptomatic tears involving the dominant arm (P=.007). The prevalence of RCT of the contralateral asymptomatic shoulder tends to be higher in patients with more symptomatic RCT on one side, in patients with medium-sized or larger RCT in the operated shoulder, and in patients with symptomatic RCT in the nondominant arm. © 2015 The Author(s).

Response of Metals and Metallic Structures to Dynamic Loading

DTIC Science & Technology

1978-05-01

materials for service by testing under high rates of loading. Impact tests such as the Charpy test, the drop-weight tear test, and the dynamic tear...have clearly shown this for precracked charpy specimens and for the drop-weight tear test. Hence, there is a strong need for additional dynamic...dynamic fracture resistance ( Charpy , dynamic-tear, drop-weight tear test, etc.), normally assures that fracture in dynamically loaded structures is

Interferometer for measuring the dynamic surface topography of a human tear film

NASA Astrophysics Data System (ADS)

Primeau, Brian C.; Greivenkamp, John E.

2012-03-01

The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. Following a blink, the tear film quickly smoothes and starts to become irregular after 10 seconds. This irregularity can affect comfort and vision quality. An in vivo method of characterizing dynamic tear films has been designed based upon a near-infrared phase-shifting interferometer. This interferometer continuously measures light reflected from the tear film, allowing sub-micron analysis of the dynamic surface topography. Movies showing the tear film behavior can be generated along with quantitative metrics describing changes in the tear film surface. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or corneal topography and provides better sensitivity and resolution than shearing interferometry methods. The interferometer design is capable of identifying features in the tear film much less than a micron in height with a spatial resolution of about ten microns over a 6 mm diameter. This paper presents the design of the tear film interferometer along with the considerations that must be taken when designing an interferometer for on-eye diagnostics. Discussions include eye movement, design of null optics for a range of ocular geometries, and laser emission limits for on-eye interferometry.

Ocular surface inflammation, and nerve growth factor level in tears in active thyroid-associated ophthalmopathy.

PubMed

Yoon, Jin Sook; Choi, Soo Hyun; Lee, Joon H; Lee, Sung Jun; Lee, Sang Yeul

2010-02-01

To measure tear nerve growth factor (NGF) concentrations in cases of active thyroid-associated ophthalmopathy (TAO) before and after glucocorticoid treatment, and to correlate NGF levels with disease inflammatory activity and thyroid autoantibody concentration. The study involved 20 patients with active TAO and 20 age- and gender-matched controls. Tear break-up time (BUT) was obtained, the Schirmer test was performed, and tear NGF/total protein ratio was measured in control subjects and patients with active TAO before, and 2 and 4 weeks after, steroid treatment. Tear BUT and Schirmer values significantly increased after 2 and 4 weeks of steroid treatment (p < 0.001 and p = 0.004 respectively). Baseline tear NGF/total protein ratio was higher in patients with active TAO than in control subjects, and the ratio significantly decreased after 2 and 4 weeks of steroid treatment (p < 0.001). Tear NGF/total protein ratio did not correlate with inflammatory activity score, exophthalmos value and thyroid binding inhibiting immunoglobulin (TBII) level (p > 0.05). Tear NGF may have a specific role in ocular surface inflammation, which protects against ocular surface damage in patients with active TAO. Anti-inflammatory treatment significantly reduced the level of NGF in tears, increased tear film stability and production, and decreased congestive symptoms.

Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis.

PubMed

Choi, Eui-Sung; Park, Sang-Jun

2015-06-01

To investigate the incidence of root tears of the posterior horn of the medial meniscus in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears. There were 197 knees of 140 enrolled patients who had undergone total knee replacement arthroplasty between September 2010 and May 2014. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, severity of symptoms (visual analogue scale [VAS] score and medial joint line tenderness), grade of osteoarthritis (Kellgren-Lawrence grading scale), body mass index (BMI), varus deformity, and mechanical axis deviation. Meniscal tears were observed in 154 knees (78.17%). The root tear had correlation with the severity of osteoarthritis (p<0.05), varus deformity (p<0.05), mechanical axis deviation (p<0.05), and BMI (p<0.05). Factors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn. Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn.

Reduced tear production in three canine endocrinopathies.

PubMed

Williams, D L; Pierce, V; Mellor, P; Heath, M F

2007-05-01

Previous reports have suggested that hypothyroid and diabetic patients can be predisposed to keratoconjunctivitis sicca. This study aimed to measure tear production in dogs with diabetes, hypothyroidism and hyperadrenocorticism using the Schirmer tear test and to compare these results with Schirmer tear test values for a group of normal dogs. Schirmer tear tests were performed on 16 dogs with hyperadrenocorticism, 18 with diabetes and 12 with hypothyroidism together with 100 control dogs. Corneal sensitivity was also measured in 12 of the 18 diabetic dogs with a Cochet Bonnet aesthesiometer and compared with age- and breed-matched normal dogs. Schirmer tear test values in dogs with hypothyroidism, hyperadrenocorticism and diabetes were 12.3+/-3.2, 14.0+/-4.0 and 12.3+/-5.3 mm/minutes, respectively. Schirmer tear test values were significantly lower than that for the control group (19.6+/-4.2 mm/minutes) in all dogs with an endocrinopathy. Only in two hypothyroid dogs and three diabetics, this was manifested as profound keratoconjunctivitis sicca with Schirmer tear test value lower than 5 mm/minutes. Diabetic dogs had significantly reduced corneal sensitivity compared with a matched set of control dogs. This study shows a significant reduction in tear production in animals with diabetes mellitus, hypothyroidism and hyperadrenocorticism. Further research is needed to elucidate the mechanisms by which this reduction in tear production occurs. Assessment of tear production should be undertaken in animals diagnosed with these endocrinopathies, as these animals may progress to clinical keratoconjunctivitis sicca.

Dry eye symptoms are increased in mice deficient in phospholipid transfer protein (PLTP).

PubMed

Setälä, Niko L; Metso, Jari; Jauhiainen, Matti; Sajantila, Antti; Holopainen, Juha M

2011-05-01

In the tear fluid the outermost part facing the tear-air interface is composed of lipids preventing evaporation of the tears. Phospholipid transfer protein (PLTP) mediates phospholipid transfer processes between serum lipoproteins and is also a normal component of human tears. To study whether PLTP plays any functional role in tear fluid we investigated PLTP-deficient mice, applying functional and morphologic analyses under normal housing and experimentally induced dry eye conditions. Aqueous tear fluid production, corneal epithelial morphology, barrier function, and occludin expression were assessed. In mice with a full deficiency of functional PLTP enhanced corneal epithelial damage, increased corneal permeability to carboxyfluorescein, and decreased corneal epithelial occludin expression were shown. These pathologic signs were worsened by experimentally induced dry eye both in wild-type and PLTP knock-out mice. Deficiency in the production of tear PLTP in mice is accompanied by corneal epithelial damage, a feature that is typical in human dry eye syndrome (DES). To complement animal experiments we collected tear fluid from human dry eye patients as well as healthy control subjects. Increased tear fluid PLTP activity was observed among DES patients. In conclusion, the presence of PLTP in tear fluid appears to be essential for maintaining a healthy and functional ocular surface. Increased PLTP activity in human tear fluid in DES patients suggests an ocular surface protective role for this lipid transfer protein. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Diadenosine tetraphosphate contributes to carbachol-induced tear secretion.

PubMed

Fonseca, Begoña; Martínez-Águila, Alejandro; Díaz-Hernández, Miguel; Pintor, Jesús

2015-03-01

The purpose of this study is to investigate if the cholinergic stimulation by carbachol on tear secretion is a direct process or if it is also mediated by purinergic mechanisms. Experiments were performed in New Zealand male rabbits. The amount of tear secretion was measured with Schirmer's test and then analyzed by a HPLC protocol in order to study the nucleotide levels. Animal eyes were instilled with carbachol (a cholinergic agonist), pirenzepine, gallamine and 4-DAMP (muscarinic antagonists), PPADS, suramin and reactive blue 2 (purinergic antagonists), and a P2Y2 receptor small interfering RNA (siRNA). Tear secretion increased with the instillation of carbachol, approximately 84 % over control values 20 min after the instillation and so did Ap4A and ATP release. When we applied carbachol in the presence of muscarinic antagonists, tear volume only increased to 4 % with atropine, 12 % in the case of pirenzepine, 3 % with gallamine, and 8 % with 4-DAMP. In the presence of carbachol and purinergic antagonists, tear secretion was increased to 12 % (all values compared to basal tear secretion). By analyzing tear secretion induced with carbachol in presence of a P2Y2 receptor siRNA, we found that tear secretion was diminished to 60 %. The inhibition of tear secretion in the presence of carbachol and purinergic antagonists or P2Y2 siRNA occurred with no apparent change in the tear amount of Ap4A. These experiments demonstrated the participation of Ap4A in lacrimal secretion process.

Evaluation of cartilage degeneration in a rat model of rotator cuff tear arthropathy

PubMed Central

Kramer, Erik J.; Bodendorfer, Blake M.; Laron, Dominique; Wong, Jason; Kim, Hubert T.; Liu, Xuhui; Feeley, Brian T.

2013-01-01

Introduction Rotator cuff tears are the most common injury seen by shoulder surgeons. Many late stage rotator cuff tear patients develop glenohumeral osteoarthritis as a result of torn cuff tendons, termed cuff tear arthropathy. However, the mechanisms of cuff tear arthropathy have not been fully established. It has been hypothesized that a combination of synovial and mechanical factors contribute equally to the development of cuff tear arthropathy. The goal of this study was to assess the utility of this model in investigating cuff-tear arthropathy. Methods We utilized a rat model which accurately reflects rotator cuff muscle degradation after massive rotator cuff tears through either infraspinatus and supraspinatus tenotomy or suprascapular nerve transection. Using a Modified-Mankin Scoring System (MMS), we found significant glenohumeral cartilage damage following both rotator cuff tenotomy and suprascapular nerve transection after only 12 weeks. Results Cartilage degeneration was similar between groups, and was present on both the humeral head and the glenoid. Denervation of the supraspinatus and infraspinatus muscles without opening the joint capsule caused cartilage degeneration similar to that found in the tendon transection group. Conclusions These results suggest that altered mechanical loading after rotator cuff tears is the primary factor in cartilage degeneration after rotator cuff tears. Clinically, understanding the process of cartilage degeneration after rotator cuff injury will help guide treatment decisions in the setting of rotator cuff tears. Level of evidence Basic Science Study, Animal Model PMID:23664745

A review of patient and skin characteristics associated with skin tears.

PubMed

Rayner, R; Carville, K; Leslie, G; Roberts, P

2015-09-01

Skin tears are the most common wound among the elderly and have the potential to cause infection, form chronic wounds, reduce quality of life and increase health-care costs. Our aim was to identify studies that reviewed patient and skin characteristics associated with skin tears. A review of skin tear studies reported in the English literature between 1980 and 2013 was undertaken using the following electronic databases: PubMed, Medline, CINAHL, Embase, Scopus, Evidence Based and Medicine Reviews (EBM). Search terms included aged, skin, tears or lacerations, skin tearing, geri tear, epidermal tear and prevalence. There were 343 articles found with using the search terms. After abstract review nine were found to be relevant to the search. The principle findings from these eight published articles and one unpublished study revealed that the most common patient characteristics were a history of skin tears, impaired mobility and impaired cognition. Skin characteristics associated with skin tears included senile purpura, ecchymosis and oedema. This review provides an overview of identified patient and skin characteristics that predispose the elderly to skin tears and exposes the lack of research within this domain. R. Rayner is a recipient of a 2013 Australian Postgraduate Award, Curtin University Postgraduate Scholarship and a Wound Management Cooperative Research Centre (CRC) PhD stipend. The School of Nursing, Midwifery and Paramedicine, Curtin University and the Silver Chain Group, Western Australia are participants in the Wound Management Innovation CRC. No conflict of interest exists among the authors.

Neurostimulation of the Lacrimal Nerve for Enhanced Tear Production

PubMed Central

Kossler, Andrea L.; Wang, Jianhua; Feuer, William; Tse, David T.

2014-01-01

Purpose To design a proof-of-concept study to assess the effect of lacrimal nerve stimulation (LNS) with an implantable pulse generator (IPG) to increase aqueous tear production. Methods Experimental animal study design of six Dutch Belted rabbits. Ultra high-resolution optical coherence tomography (UHR-OCT) quantified tear production by measuring the baseline tear volume of each rabbit’s right and left eye. A neurostimulator was implanted adjacent to the right lacrimal nerve. After two minutes of LNS (100 μs, 1.6 mAmp, 20 Hz, 5–8 volts), the tear volumes were measured with UHR-OCT. The change in tear volume was quantified and compared to the non-stimulated left eye. Three rabbits underwent chronic LNS (100 μS, 1.6 mAmp, 10 Hz, 2 volts) and their lacrimal glands were harvested for histopathologic analysis. Results UHR-OCT imaging of the right eyes tear volume showed a 441% average increase in tear production after LNS as a percent of baseline. After stimulation, right eyes had statistically significant greater increase in tear volumes than left eyes (p=0.028, Wilcoxon test). Post-stimulation right eye tear volumes were significantly greater compared to baseline (p=0.028, Wilcoxon test). Histopathologic examination of the lacrimal glands showed no discernible tissue damage from chronic neurostimulation. Additionally, there were no gross adverse effects on the general well-beings of the animals due to chronic stimulation. Conclusions Lacrimal nerve stimulation with an implantable pulse generator appears to increase aqueous tear production. Chronic LNS showed no histopathologic lacrimal gland damage. This study suggests LNS is a promising new treatment strategy to increase aqueous tear production. PMID:25126767

Identification and Comparison of the Polar Phospholipids in Normal and Dry Eye Rabbit Tears by MALDI-TOF Mass Spectrometry

PubMed Central

Ham, Bryan M.; Cole, Richard B.; Jacob, Jean T.

2008-01-01

Purpose To identify and compare the phosphorylated lipids in normal and dry eye rabbit tears using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Methods MALDI-TOF MS studies were performed on tear samples from normal and dry eyes of female New Zealand White rabbits. Experimental dry eye was induced by complete removal of the main and accessory lacrimal glands and nictitating membranes. A solid ionic crystal MALDI matrix of paranitroaniline and butyric acid was used to enhance the mass spectral responses of the phospholipids. In addition, a novel lipid isolation, preconcentration, and clean-up method using pipettes containing immobilized metal ion affinity chromatography (IMAC) medium was used. Results The polar phospholipids present in the normal and dry eye rabbit tears showed both similarities and differences. Species related to platelet-activating factor (PAF) and/or lysophosphatidylcholine (lyso-PC), phosphatidylcholine (PC), and sphingomyelin (SM) were found in both the normal and dry eye rabbit tears. However, the number of types and the concentrations of SM molecules were markedly greater in the dry eye tears than in the normal tears. In addition, phosphatidylserine (PS) species that were readily detectable in dry eye tears were not found in normal tears. Conclusions The combination of immobilized metal ion affinity chromatography and the solid ionic crystal matrix for MALDI enabled the detection and study of phosphorylated lipids in the tears. Specific differences between phospholipid levels in normal and dry eye tears were observable with this methodology. The appearance of various SM species only in the dry eye tears may provide markers for this disease state in the future. PMID:16877399

Fluorophotometric measurement of the buffering action of human tears in vivo.

PubMed

Yamada, M; Kawai, M; Mochizuki, H; Hata, Y; Mashima, Y

1998-10-01

The buffering action of human tears is thought to be important to keep its pH constant. We measured the change in pH in the precorneal tear film in vivo when the acidic solution is challenged, using a fluorophotometric technique. Twelve eyes from 6 healthy subjects were entered in this study. Each subject was pretreated with either one drop of 0.4% oxybuprocaine for once (light anesthesia), three times (deep anesthesia), or none (controls). The measurement was initiated by instilling 20 microl of 0.067 M phosphate buffer at pH 5.5 containing 2 mM bis-carboxyethyl-carboxyfluorescein free acid, a pH sensitive dye, into the subject's eye. The pH was determined by the ratio of fluorescent intensities at two excitation wavelengths (490 and 430 nm). pH recovery time (PHRT) as defined by the time required for pH to reach 95% of pH at equilibrium was used for the marker of tear buffering action. Tear turnover rate was also determined using the fluorescent decay curve at 430 nm, which was independent of pH, but dependent on dye concentration. Immediately after the instillation, the pH value in the tear film was around 6.0-6.5 in all cases. The tear film rapidly became more alkaline, reaching its normal value in 2.3 +/- 0.5 min in untreated eyes. The pretreatment with 0.4% oxybuprocaine retarded the neutralization process. A single regression analysis revealed that the PHRT had a significant negative correlation with the tear turnover rate (r = -0.78). Our results suggest that the neutralization process of tears largely depends on the tear turnover rate. The buffering action of tears in vivo consists of the tear turnover as well as its chemical buffering capacity.

Different patterns of lateral meniscus root tears in ACL injuries: application of a differentiated classification system.

PubMed

Forkel, Philipp; Reuter, Sven; Sprenker, Frederike; Achtnich, Andrea; Herbst, Elmar; Imhoff, Andreas; Petersen, Wolf

2015-01-01

Posterior lateral meniscus root tears (PLMRTs) affect the intra-articular pressure distribution in the lateral compartment of the knee. The biomechanical consequences of these injuries are significantly influenced by the integrity of the meniscofemoral ligaments (MFLs). A newly introduced arthroscopic classification system for PLMRTs that takes MFL integrity into account has not yet been clinically applied but may be useful in selecting the optimal method of PLMRT repair. Prospective ACL reconstruction data were collected. Concomitant injuries of the lateral meniscus posterior horn were classified according to their shape and MFL status. The classifications were: type 1, avulsion of the root; type 2, radial tear of the lateral meniscus posterior horn close to the root with an intact MFL; and type 3, complete detachment of the posterior meniscus horn. Between January 2011 and May 2012, 228 consecutive ACL reconstructions were included. Lateral and medial meniscus tears were identified in 38.2% (n = 87) and 44.7% (n = 102), respectively. Of the 87 lateral meniscus tears, 32 cases had PLMRTs; the overall prevalence of PLMRTs was 14% (n = 32). Two medial meniscus root tears were detected. All PLMRTs were classified according to the classification system described above, and the fixation procedure was adapted to the type of meniscus tear. The PLMRT tear is a common injury among patients undergoing ACL repair and can be arthroscopically classified into three different types. Medial meniscus root tears are rare in association with ACL tears. The PLMRT classification presented here may help to estimate the injury's impact on the lateral compartment and to identify the optimal treatment. These tears should not be overlooked, and the treatment strategy should be chosen with respect to the type of root tear. IV.

The effect of a rotator cuff tear and its size on three-dimensional shoulder motion.

PubMed

Kolk, Arjen; Henseler, Jan Ferdinand; de Witte, Pieter Bas; van Zwet, Erik W; van der Zwaal, Peer; Visser, Cornelis P J; Nagels, Jochem; Nelissen, Rob G H H; de Groot, Jurriaan H

2017-06-01

Rotator cuff-disease is associated with changes in kinematics, but the effect of a rotator cuff-tear and its size on shoulder kinematics is still unknown in-vivo. In this cross-sectional study, glenohumeral and scapulothoracic kinematics of the affected shoulder were evaluated using electromagnetic motion analysis in 109 patients with 1) subacromial pain syndrome (n=34), 2) an isolated supraspinatus tear (n=21), and 3) a massive rotator cuff tear involving the supraspinatus and infraspinatus (n=54). Mixed models were applied for the comparisons of shoulder kinematics between the three groups during abduction and forward flexion. In the massive rotator cuff-tear group, we found reduced glenohumeral elevation compared to the subacromial pain syndrome (16°, 95% CI [10.5, 21.2], p<0.001) and the isolated supraspinatus tear group (10°, 95% CI [4.0, 16.7], p=0.002) at 110° abduction. Reduced glenohumeral elevation in massive rotator cuff tears coincides with an increase in scapulothoracic lateral rotation compared to subacromial pain syndrome (11°, 95% CI [6.5, 15.2], p<0.001) and supraspinatus tears (7°, 95% CI [1.8, 12.1], p=0.012). Comparable differences were observed for forward flexion. No differences in glenohumeral elevation were found between the subacromial pain syndrome and isolated supraspinatus tear group during arm elevation. The massive posterosuperior rotator cuff-tear group had substantially less glenohumeral elevation and more scapulothoracic lateral rotation compared to the other groups. These observations suggest that the infraspinatus is essential to preserve glenohumeral elevation in the presence of a supraspinatus tear. Shoulder kinematics are associated with rotator cuff-tear size and may have diagnostic potential. Copyright © 2017 Elsevier Ltd. All rights reserved.

Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears.

PubMed

Chalmers, Peter N; Salazar, Dane H; Steger-May, Karen; Chamberlain, Aaron M; Stobbs-Cucchi, Georgia; Yamaguchi, Ken; Keener, Jay D

2016-11-01

Very little longitudinal information has been available regarding the relationship of cuff tears and arthritis. The purpose of this study was to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear. Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI). Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI. Glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Role of tear location on outcomes of open primary repair of the anterior cruciate ligament: A systematic review of historical studies.

PubMed

van der List, Jelle P; DiFelice, Gregory S

2017-10-01

The general opinion is that outcomes of open primary repair of the anterior cruciate ligament (ACL) in the historical literature were disappointing. Since good outcomes of primary repair of proximal tears have recently been reported, we aimed to assess the role of tear location on open primary repair outcomes in the historical literature. All studies reporting outcomes of open primary ACL repair published between the inception of PubMed, Embase and Cochrane and 2000 were identified. Studies were included if tear location was reported. Outcome scores, return to sports, stability examinations, failures and patient satisfaction were collected and reviewed in the total study cohort and in a subgroup of studies treating only proximal tears. Spearman correlation analysis was performed between the percentage of proximal tears in the studies and all outcomes. Twenty-nine studies were included reporting outcomes of open primary in 1457 patients of which 72% had proximal and 23% midsubstance tears. Mean age was 30years, 65% were males, and mean follow-up was 3.6years. Good outcomes were noted in the total cohort, and excellent outcomes were noted following repair of proximal tears. Positive correlation was found between the percentage proximal tears in the studies and percentage satisfied patients (p=0.010). Tear location seems to have played a role on the outcomes of open primary ACL repair. Outcomes of open primary repair in patients with proximal tears were excellent, which confirms there may be a potential role for primary repair as treatment for proximal ACL tears. Copyright © 2017 Elsevier B.V. All rights reserved.

Learning curve of office-based ultrasonography for rotator cuff tendons tears.

PubMed

Ok, Ji-Hoon; Kim, Yang-Soo; Kim, Jung-Man; Yoo, Tae-Wook

2013-07-01

To compare the accuracy of ultrasonography and MR arthrography (MRA) imaging in detecting of rotator cuff tears with arthroscopic finding used as the reference standard. The ultrasonography and MRA findings of 51 shoulders that underwent the arthroscopic surgery were prospectively analysed. Two orthopaedic doctors independently performed ultrasonography and interpreted the findings at the office. The tear size measured at ultrasonography and MRA was compared with the size measured at surgery using Pearson correlation coefficients (r). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value and false-positive rate were calculated for a diagnosis of partial-and full-thickness rotator cuff tears. The kappa coefficient was calculated to verify the inter-observer agreement. The sensitivity of ultrasonography and MRA for detecting partial-thickness tears was 45.5 and 72.7 %, and that for full-thickness tears was 80.0 and 100 %, respectively. The accuracy of ultrasonograpy and MRA for detecting partial-thickness tears was 45.1 and 88.2 %, and that for full-thickness tears was 82.4 and 98 %, respectively. Tear size measured based on ultrasonography examination showed a poor correlation with the size measured at arthroscopic surgery (r = 0.21; p < 0.05). However, tear size estimated by MRA showed a strong correlation (r = 0.75; p < 0.05). The kappa coefficient was 0.47 between the two independent examiners. The accuracy of office-based ultrasonography for beginner orthopaedic surgeons to detect full-thickness rotator cuff tears was comparable to that of MRA but was less accurate for detecting partial-thickness tears and torn size measurement. Inter-observer agreement on the interpretation was fair. These results highlight the importance of the correct technique and experience in operation of ultrasonography in shoulder joint. Diagnostic study, Level II.

Effects of DA-6034 on aqueous tear fluid secretion and conjunctival goblet cell proliferation.

PubMed

Choi, Seul Min; Lee, Yeong Geon; Seo, Mi Jung; Kang, Kyung Koo; Ahn, Byoung Ok; Yoo, Moohi

2009-06-01

This study was conducted to evaluate the effect of DA-6034, a potent secretagogue, on aqueous tear fluid secretion and its quality in normal rabbit. We also evaluated, in animal models of experimentally induced dry eye disease, its effectiveness over time to stimulate aqueous tear production by ocular ferning test and goblet cell proliferation. Aqueous tear production, total protein levels, and glycoprotein levels in normal rabbits were evaluated after topical application of DA-6034 (0.3, 1, and 3%). Moreover, time course aqueous tear volume measurement and ocular ferning test in tear fluid were performed in dry eyes of rabbits that had been given 1% atropine sulfate, topically. Altogether, tear fluid production and conjunctival goblet cell numbers were measured in dry eyes of mice that had been given topical scopolamine. Topical application of DA-6034 (0.3, 1, and 3%) significantly increased (P < 0.05) aqueous tear production in a concentration-dependent manner in normal rabbits. There was no change in total protein levels while glycoprotein levels were significantly increased (P < 0.05) at 3% DA-6034. The increase in aqueous tear fluid was significant (P < 0.05) and lasted for 2 h post-instillation in dry eyes of rabbits that had been given 1% atropine sulfate; 10-day repeated instillation of the drug in this model resulted in large and homogeneous fern-like tear patterns. In a mouse model, DA-6034 given as a 3% eyedrop solution significantly increased (P < 0.05) tear fluid production and conjunctival goblet cell number. These results suggest that DA-6034 accelerates not only tear secretion but also mucin production and may be a potential therapeutic agent for the treatment of dry eye disease.

Regeneration of Full-Thickness Rotator Cuff Tendon Tear After Ultrasound-Guided Injection With Umbilical Cord Blood-Derived Mesenchymal Stem Cells in a Rabbit Model.

PubMed

Park, Gi-Young; Kwon, Dong Rak; Lee, Sang Chul

2015-11-01

Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit's activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears. The tendon tear size and walking capacity at 4 weeks after UCB-derived MSC injection under ultrasound guidance were significantly improved compared with the same parameters immediately after tendon tear. UCB-derived MSC injection under ultrasound guidance without surgical repair or bioscaffold resulted in the partial healing of full-thickness rotator cuff tendon tears in a rabbit model. Histology revealed that UCB-derived MSCs induced regeneration of rotator cuff tendon tear and that the regenerated tissue was predominantly composed of type I collagens. In this study, ultrasound-guided injection of human UCB-derived MSCs contributed to regeneration of the full-thickness rotator cuff tendon tear without surgical repair. The results demonstrate the effectiveness of local injection of MSCs into the rotator cuff tendon. The results of this study suggest that ultrasound-guided umbilical cord blood-derived mesenchymal stem cell injection may be a useful conservative treatment for full-thickness rotator cuff tendon tear repair. ©AlphaMed Press.

Regeneration of Full-Thickness Rotator Cuff Tendon Tear After Ultrasound-Guided Injection With Umbilical Cord Blood-Derived Mesenchymal Stem Cells in a Rabbit Model

PubMed Central

Park, Gi-Young; Lee, Sang Chul

2015-01-01

Rotator cuff tendon tear is one of the most common causes of chronic shoulder pain and disability. In this study, we investigated the therapeutic effects of ultrasound-guided human umbilical cord blood (UCB)-derived mesenchymal stem cell (MSC) injection to regenerate a full-thickness subscapularis tendon tear in a rabbit model by evaluating the gross morphology and histology of the injected tendon and motion analysis of the rabbit’s activity. At 4 weeks after ultrasound-guided UCB-derived MSC injection, 7 of the 10 full-thickness subscapularis tendon tears were only partial-thickness tears, and 3 remained full-thickness tendon tears. The tendon tear size and walking capacity at 4 weeks after UCB-derived MSC injection under ultrasound guidance were significantly improved compared with the same parameters immediately after tendon tear. UCB-derived MSC injection under ultrasound guidance without surgical repair or bioscaffold resulted in the partial healing of full-thickness rotator cuff tendon tears in a rabbit model. Histology revealed that UCB-derived MSCs induced regeneration of rotator cuff tendon tear and that the regenerated tissue was predominantly composed of type I collagens. In this study, ultrasound-guided injection of human UCB-derived MSCs contributed to regeneration of the full-thickness rotator cuff tendon tear without surgical repair. The results demonstrate the effectiveness of local injection of MSCs into the rotator cuff tendon. Significance The results of this study suggest that ultrasound-guided umbilical cord blood-derived mesenchymal stem cell injection may be a useful conservative treatment for full-thickness rotator cuff tendon tear repair. PMID:26371340

Assessment of tear film osmolarity using the TearLab™ osmometer in normal dogs and dogs with keratoconjunctivitis sicca.

PubMed

Sebbag, Lionel; Park, Shin Ae; Kass, Philip H; Maggs, David J; Attar, Mayssa; Murphy, Christopher J

2017-07-01

To evaluate repeatability and reproducibility of tear osmolarity measured using the TearLab ™ osmometer in normal dogs and to assess its diagnostic potential in dogs with keratoconjunctivitis sicca (KCS). Beagle dogs; six normal and five with KCS. Tear osmolarity and Schirmer tear test-1 (STT-1) values were obtained at various times. Normal dogs were assessed for diurnal variation and repeatability and reproducibility of measurements. Dogs with KCS were evaluated before and after 5 months' topical twice-daily therapy with 2% cyclosporine. Mean ± SD tear osmolarity (mOsm/L) was significantly higher in normal dogs (337.4 ± 16.2) than in dogs with KCS before therapy (306.2 ± 18.0; P < 0.0001), but not following therapy with 2% cyclosporine (330.5 ± 13.7; P = 1.00). Osmolarity readings lower than 325.5 mOsm/L were suggestive of KCS (84.8% sensitivity and 87.1% specificity). In normal dogs, tear osmolarity readings were stable during the daytime (P = 0.99). Repeated measurements revealed high variability and typically poor-to-moderate repeatability and reproducibility, although this was improved by taking three successive measurements at each session. Considering combined data from all dogs, a positive correlation existed between STT-1 and tear osmolarity measurements (Pearson's correlation test, P = 0.04, r = 0.62). Canine tear osmolarity as determined by TearLab ™ osmometer was variable, required multiple readings to be informative, and differed from values reported for humans. Dogs with KCS had a lower tear osmolarity than did normal dogs, and this increased following cyclosporine therapy. © 2016 American College of Veterinary Ophthalmologists.

The use of intrathecal analgesia and contrast radiography as preoperative diagnostic methods for digital flexor tendon sheath pathology.

PubMed

Fiske-Jackson, A R; Barker, W H J; Eliashar, E; Foy, K; Smith, R K W

2013-01-01

The sensitivity of ultrasonography for the diagnosis of manica flexoria (MF) tears within the digital flexor tendon sheath (DFTS) is lower than for diagnosis of marginal tears of the deep digital flexor tendon (DDFT). Additional diagnostic tools would assist in appropriate decision making for either conservative or surgical management. To evaluate the improvement in lameness of horses with MF or DDFT tears following intrathecal analgesia and to assess the sensitivity and specificity of contrast radiography for the diagnosis of these tears. The case records of horses presented to a referral clinic over a 7-year period that underwent intrathecal diagnostic analgesia, or intrathecal analgesia and contrast radiography, of the DFTS with subsequent tenoscopy were examined. Fifty-three limbs had intrathecal diagnostic analgesia performed and 23 contrast tenograms were assessed in horses undergoing DFTS tenoscopy. Horses with DDFT tears were significantly more likely to respond positively to intrathecal diagnostic analgesia than those with MF tears (P = 0.02). Using contrast radiography, tears of the MF were predicted with an overall sensitivity of 96% and specificity of 80%; marginal tears of the DDFT were predicted with an overall sensitivity of 57% and specificity of 84%. The results of intrathecal analgesia of the DFTS in combination with contrast radiography have a high sensitivity for predicting MF tears. The sensitivity of contrast radiography for predicting tears of the DDFT is lower but the specificity remains high. Contrast radiography performed at the same time as intrathecal analgesia provides useful information regarding the presence of MF tears and DDFT tears, which can assist in the decision of whether to manage the lameness conservatively or with tenoscopic evaluation. © 2012 EVJ Ltd.

Sympathy Crying: Insights from Infrared Thermal Imaging on a Female Sample

PubMed Central

Morris, Paul; Terry, Samantha; Baker, Marc; Gallese, Vittorio; Reddy, Vasudevi

2016-01-01

Sympathy crying is an odd and complex mixture of physiological and emotional phenomena. Standard psychophysiological theories of emotion cannot attribute crying to a single subdivision of the autonomic nervous system (ANS) and disagreement exists regarding the emotional origin of sympathy crying. The current experiment examines sympathy crying using functional thermal infrared imaging (FTII), a novel contactless measure of ANS activity. To induce crying female participants were given the choice to decide which film they wanted to cry to. Compared to baseline, temperature started increasing on the forehead, the peri-orbital region, the cheeks and the chin before crying and reached even higher temperatures during crying. The maxillary area showed the opposite pattern and a gradual temperature decrease was observed compared to baseline as a result of emotional sweating. The results suggest that tears of sympathy are part of a complex autonomic interaction between the sympathetic and the parasympathetic nervous systems, with the latter preceding the former. The emotional origin of the phenomenon seems to derive from subjective internal factors that relate to one’s personal experiences and attributes with tears arising in the form of catharses or as part of shared sadness. PMID:27716801

Structural analysis using thrust-fault hanging-wall sequence diagrams: Ogden duplex, Wasatch Range, Utah

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schirmer, T.W.

1988-05-01

Detailed mapping and cross-section traverses provide the control for structural analysis and geometric modeling of the Ogden duplex, a complex thrust system exposed in the Wasatch Mountains, east of Ogden, Utah. The structures consist of east-dipping folded thrust faults, basement-cored horses, lateral ramps and folds, and tear faults. The sequence of thrusting determined by means of lateral overlap of horses, thrust-splay relationships, and a top-to-bottom piggyback development is Willard thrust, Ogden thrust, Weber thrust, and Taylor thrust. Major decollement zones occur in the Cambrian shales and limestones. The Tintic Quartzite is the marker for determining gross geometries of horses. Thismore » exposed duplex serves as a good model to illustrate the method of constructing a hanging-wall sequence diagram - a series of longitudinal cross sections that move forward in time and space, and show how a thrust system formed as it moved updip over various footwall ramps. A hanging wall sequence diagram also shows the complex lateral variations in a thrust system and helps to locate lateral ramps, lateral folds, tear faults, and other features not shown on dip-oriented cross sections. 8 figures.« less

Gene expression profiles of changes underlying different-sized human rotator cuff tendon tears.

PubMed

Chaudhury, Salma; Xia, Zhidao; Thakkar, Dipti; Hakimi, Osnat; Carr, Andrew J

2016-10-01

Progressive cellular and extracellular matrix (ECM) changes related to age and disease severity have been demonstrated in rotator cuff tendon tears. Larger rotator cuff tears demonstrate structural abnormalities that potentially adversely influence healing potential. This study aimed to gain greater insight into the relationship of pathologic changes to tear size by analyzing gene expression profiles from normal rotator cuff tendons, small rotator cuff tears, and large rotator cuff tears. We analyzed gene expression profiles of 28 human rotator cuff tendons using microarrays representing the entire genome; 11 large and 5 small torn rotator cuff tendon specimens were obtained intraoperatively from tear edges, which we compared with 12 age-matched normal controls. We performed real-time polymerase chain reaction and immunohistochemistry for validation. Torn rotator cuff tendons demonstrated upregulation of a number of key genes, such as matrix metalloproteinase 3, 10, 12, 13, 15, 21, and 25; a disintegrin and metalloproteinase (ADAM) 12, 15, and 22; and aggrecan. Amyloid was downregulated in all tears. Small tears displayed upregulation of bone morphogenetic protein 5. Chemokines and cytokines that may play a role in chemotaxis were altered; interleukins 3, 10, 13, and 15 were upregulated in tears, whereas interleukins 1, 8, 11, 18, and 27 were downregulated. The gene expression profiles of normal controls and small and large rotator cuff tear groups differ significantly. Extracellular matrix remodeling genes were found to contribute to rotator cuff tear pathogenesis. Rotator cuff tears displayed upregulation of a number of matrix metalloproteinase (3, 10, 12, 13, 15, 21, and 25), a disintegrin and metalloproteinase (ADAM 12, 15, and 22) genes, and downregulation of some interleukins (1, 8, and 27), which play important roles in chemotaxis. These gene products may potentially have a role as biomarkers of failure of healing or therapeutic targets to improve tendon healing. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Posterior Displacement of Supraspinatus Central Tendon Observed on Magnetic Resonance Imaging: A Useful Preoperative Indicator of Rotator Cuff Tear Characteristics.

PubMed

Updegrove, Gary F; Armstrong, April D; Mosher, Timothy J; Kim, H Mike

2015-11-01

To characterize the orientation of the normal supraspinatus central tendon and describe the displacement patterns of the central tendon in rotator cuff tears using a magnetic resonance imaging (MRI)-based method. We performed a retrospective MRI and chart review of 183 patients with a rotator cuff tear (cuff tear group), 52 with a labral tear but no rotator cuff tear (labral tear group), and 74 with a normal shoulder (normal group). The orientation of the supraspinatus central tendon relative to the bicipital groove was evaluated based on axial MRI and was numerically represented by the shortest distance from the lateral extension line of the central tendon to the bicipital groove. Tear size, fatty degeneration, and involvement of the anterior supraspinatus were evaluated to identify the factors associated with orientation changes. The mean distance from the bicipital groove to the central tendon line was 0.7 mm and 1.3 mm in the normal group and labral tear group, respectively. Full-thickness cuff tears involving the anterior supraspinatus showed a significantly greater distance (17.7 mm) than those sparing the anterior supraspinatus (4.9 mm, P = .001). Fatty degeneration of the supraspinatus was significantly correlated with the distance (P = .006). Disruption of the anterior supraspinatus and fatty degeneration of the supraspinatus were independent predictors of posterior displacement. The supraspinatus central tendon has a constant orientation toward the bicipital groove in normal shoulders, and the central tendon is frequently displaced posteriorly in full-thickness rotator cuff tears involving the anterior leading edge of the supraspinatus. The degree of posterior displacement is proportional to tear size and severity of fatty degeneration of the supraspinatus muscle. A simple and quick assessment of the central tendon orientation on preoperative MRI can be a useful indicator of tear characteristics, potentially providing insight into the intraoperative repair strategy. Level IV, diagnostic case-control study. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Comparison of the accuracy rates of 3-T and 1.5-T MRI of the knee in the diagnosis of meniscal tear.

PubMed

Grossman, Jeffrey W; De Smet, Arthur A; Shinki, Kazuhiko

2009-08-01

The purpose of this study was to compare the accuracy of 3-T MRI with that of 1.5-T MRI of the knee in the diagnosis of meniscal tear and to analyze the causes of diagnostic error. We reviewed the medical records and original MRI interpretations of 100 consecutive patients who underwent 3-T MRI of the knee and of 100 consecutive patients who underwent 1.5-T MRI of the knee to determine the accuracy of diagnoses of meniscal tear. Knee arthroscopy was the reference standard. We retrospectively reviewed all MRI diagnostic errors to determine the cause of the errors. At arthroscopy, 109 medial and 77 lateral meniscal tears were identified in the 200 patients. With two abnormal MR images indicating a meniscal tear, the sensitivity and specificity for medial tear were 92.7% and 82.2% at 1.5-T MRI and 92.6% and 76.1% at 3-T MRI (p = 1.0, p = 0.61). The sensitivity and specificity for lateral tears were 68.4% and 95.2% at 1.5-T MRI and 69.2% and 91.8% at 3-T MRI (p = 1.0, p = 0.49). Of the false-positive diagnoses of medial meniscal tear, five of eight at 1.5 T and seven of 11 at 3 T were apparent peripheral longitudinal tears of the posterior horn. Fifteen of the 26 missed medial and lateral meniscal tears were not seen in retrospect even with knowledge of the tear type and location. Allowing for sample size limitations, we found comparable accuracy of 3-T and 1.5-T MRI of the knee in the diagnosis of meniscal tear. The causes of false-positive and false-negative MRI diagnoses of meniscal tear are similar for 3-T and 1.5-T MRI.

Assay of mucins in human tear fluid.

PubMed

Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

2007-05-01

Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 > 0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention.

Assay of Mucins in Human Tear Fluid

PubMed Central

Spurr-Michaud, Sandra; Argüeso, Pablo; Gipson, Ilene

2007-01-01

Mucin genes, both secreted (MUC2, MUC5AC, MUC5B, MUC7) and membrane associated (MUC1, MUC4, MUC16), have been reported to be expressed by ocular surface epithelia. The purpose of this study was to comprehensively assay the mucin content of human tear fluid using multiple antibodies for each mucin and to develop a sensitive, semi-quantitative method for the assay of mucins in tears. Tear washes were obtained by instillation of saline onto the ocular surface, followed by collection from the inferior fornix. Tear proteins were separated in 1% agarose gels, transferred to nitrocellulose membrane by vacuum blotting and probed with multiple antibodies recognizing MUC1, MUC2, MUC4, MUC5AC, MUC5B, MUC7 and MUC16. Binding was detected using chemiluminescence, and quantity was determined by densitometry. Serial dilutions of pooled tears from normal individuals were assayed to determine the linear range of detectability. MUC1, MUC4, MUC16, MUC5AC and low levels of MUC2 were consistently detected in human tear fluid, while MUC5B and MUC7 were not. Use of several antibodies recognizing different epitopes on the same mucin confirmed these findings. The antibodies to mucins bound to serial dilutions of tears in a linear fashion (r2 >0.9), indicating the feasibility of semi-quantitation. MUC5AC in tear fluid had an increased electrophoretic mobility compared to MUC5AC isolated from conjunctival tissue. This study provides clear evidence that the mucin component of tears is a mixture of secreted and shed membrane-associated mucins, and for the first time demonstrates MUC16 in tear fluid. Immunoblots of tears using agarose gel electrophoresis and chemiluminescence detection provide a semi-quantitative assay for mucin protein that will be useful for comparisons with tears from diseased eyes or after pharmacological intervention. PMID:17399701

Evaluation of the Effects of Conjunctivochalasis Excision on Tear Stability and Contrast Sensitivity

PubMed Central

Qiu, Weiqiang; Zhang, Mingzhou; Xu, Ting; Liu, Ziyuan; Lv, Huibin; Wang, Wei; Li, Xuemin

2016-01-01

Conjunctivochalasis (CCh) disrupts tear flow and damages tear film stability. This study sought to evaluate the tear stability and contrast sensitivity of patients with CCh on whom CCh excision was performed. The study included 39 eyes from 39 patients; all patients had eyes with grade 2 or 3 CCh, underwent CCh excision, and were evaluated before and three months after the surgery. The evaluated variables included the ocular surface disease index (OSDI), the tear break-up time (TBUT), corneal fluorescein staining, corneal surface irregularity, Schirmer’s I test, the tear meniscus area (TMA), and contrast sensitivity. A follow-up of three months was achieved in 36 eyes for 36 patients. All parameters improved significantly after surgery (p < 0.05), except Schirmer’s I test, thus suggesting that CCh excision is an effective method for reconstructing the lower tear meniscus and improving both tear film stability and corneal surface irregularity. The results further demonstrated a simultaneous increase in contrast sensitivity after surgery. PMID:27892479

Oxidative Stress Induced Inflammation Initiates Functional Decline of Tear Production

PubMed Central

Uchino, Yuichi; Kawakita, Tetsuya; Miyazawa, Masaki; Ishii, Takamasa; Onouchi, Hiromi; Yasuda, Kayo; Ogawa, Yoko; Shimmura, Shigeto; Ishii, Naoaki; Tsubota, Kazuo

2012-01-01

Oxidative damage and inflammation are proposed to be involved in an age-related functional decline of exocrine glands. However, the molecular mechanism of how oxidative stress affects the secretory function of exocrine glands is unclear. We developed a novel mev-1 conditional transgenic mouse model (Tet-mev-1) using a modified tetracycline system (Tet-On/Off system). This mouse model demonstrated decreased tear production with morphological changes including leukocytic infiltration and fibrosis. We found that the mev-1 gene encodes Cyt-1, which is the cytochrome b560 large subunit of succinate-ubiquinone oxidoreductase in complex II of mitochondria (homologous to succinate dehydrogenase C subunit (SDHC) in humans). The mev-1 gene induced excessive oxidative stress associated with ocular surface epithelial damage and a decrease in protein and aqueous secretory function. This new model provides evidence that mitochondrial oxidative damage in the lacrimal gland induces lacrimal dysfunction resulting in dry eye disease. Tear volume in Tet-mev-1 mice was lower than in wild type mice and histopathological analyses showed the hallmarks of lacrimal gland inflammation by intense mononuclear leukocytic infiltration and fibrosis in the lacrimal gland of Tet-mev-1 mice. These findings strongly suggest that oxidative stress can be a causative factor for the development of dry eye disease. PMID:23071526

Influence of interfacial rheology on stabilization of the tear film

NASA Astrophysics Data System (ADS)

Bhamla, M. Saad; Fuller, Gerald G.

2014-11-01

The tear film that protecting the ocular surface is a complex, thin film comprised of a collection of proteins and lipids that come together to provide a number of important functions. Of particular interest in this presentation is meibum, an insoluble layer that is spread from glands lining our eyelids. Past work has focussed on the role of this layer in reducing evaporation, although conflicting evidence on its ability to reduce evaporative loss has been published. We present here the beneficial effects that are derived through the interfacial viscoelasticity of the meibomian lipid film. This is a duplex film is comprised of a rich mixture of phospholipids, long chain fatty esters, and cholesterol esters. Using interfacial rheology measurements, meibum has been shown to be highly viscoelastic. By measuring the drainage and dewetting dynamics of thin aqueous films from hemispherical surfaces where those films are laden with insoluble layers of lipids at controlled surface pressure, we offer evidence that these layers strongly stabilize the films because of their ability to support surface shearing stresses. This alternative view of the role of meibum can help explain the origin of meibomian gland dysfunction, or dry eye disease, where improper compositions of this lipid mixture do not offer the proper mechanical resistance to breakage and dewetting of the tear film.

Dynamic topology and flux rope evolution during non-linear tearing of 3D null point current sheets

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wyper, P. F., E-mail: peterw@maths.dundee.ac.uk; Pontin, D. I., E-mail: dpontin@maths.dundee.ac.uk

2014-10-15

In this work, the dynamic magnetic field within a tearing-unstable three-dimensional current sheet about a magnetic null point is described in detail. We focus on the evolution of the magnetic null points and flux ropes that are formed during the tearing process. Generally, we find that both magnetic structures are created prolifically within the layer and are non-trivially related. We examine how nulls are created and annihilated during bifurcation processes, and describe how they evolve within the current layer. The type of null bifurcation first observed is associated with the formation of pairs of flux ropes within the current layer.more » We also find that new nulls form within these flux ropes, both following internal reconnection and as adjacent flux ropes interact. The flux ropes exhibit a complex evolution, driven by a combination of ideal kinking and their interaction with the outflow jets from the main layer. The finite size of the unstable layer also allows us to consider the wider effects of flux rope generation. We find that the unstable current layer acts as a source of torsional magnetohydrodynamic waves and dynamic braiding of magnetic fields. The implications of these results to several areas of heliophysics are discussed.« less

High prevalence of all complex Segond avulsion using ultrasound imaging.

PubMed

Klos, Burt; Scholtes, Marlon; Konijnenberg, Stephan

2017-04-01

The aim of this study was to determine the prevalence of a Segond avulsion fractures in acute ACL tears with ultrasound and to investigate whether other injuries can predict the avulsion. One hundred thirty-eight ultrasound analyses of acute knee trauma were collected and scored for diagnosed injuries. The reports of patients with an ACL tear (N = 87) were evaluated to determine possible increased prevalence of Segond avulsion fracture with ultrasound. The associations between the diagnosed injuries and presence of a Segond avulsion were scored. The sports carried out at the time of injury were evaluated as possible prognostic factor. In 25/87 (29%) of the patients with an ACL tear, a Segond avulsion was observed in ultrasound. Lateral femoral condyle (LFC) impaction showed the strongest individual association with a Segond avulsion and was the best predicting variable. LFC impaction, sustained during low-risk pivoting sport, shows a stronger association with a Segond avulsion, as compared to LFC impaction sustained during high-risk pivoting sports. Ultrasound shows a higher prevalence of Segond avulsions as literature shows with MRI or radiography. LFC impaction is the best variable in predicting this type of avulsion. Ultrasound examination should be considered, if this fracture was not diagnosed with MRI or radiographic analysis. IV.

A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status.

PubMed

Harryman, Douglas T; Hettrich, Carolyn M; Smith, Kevin L; Campbell, Barry; Sidles, John A; Matsen, Frederick A

2003-04-01

Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function. As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function. Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.

Measurement of Tear Production in English Angora and Dutch Rabbits

PubMed Central

Rajaei, Seyed Mehdi; Rafiee, Siamak Mashhady; Ghaffari, Masoud Selk; Masouleh, Mohammad N; Jamshidian, Mahmoud

2016-01-01

The purpose of this study was to establish normal values for tear production tests in different breeds of domestic rabbits. Healthy adult rabbits (n = 60; 120 eyes) of 2 different breeds (English angora and Dutch; n = 15 of each sex and breed) were used in this study. Tear production was measured by using the 1-min Schirmer tear test (STT), phenol red thread test (PRTT), and endodontic absorbent paper point tear test (EAPTT). In addition, horizontal palpebral fissure length was evaluated as a measure of ocular adnexal dimensions. Tear production (mean ± 1 SD) in English angora rabbits was 5.4 ± 1.6 mm/min according to the STT, 25.0 ± 2.7 mm in 15 s for the PRTT, and 18.8 ± 2.1 mm/min by the EAPTT; in Dutch rabbits, these values were 4.6 ± 1.2 mm/min, 23.6 ± 2.3 mm in 15 s, and 16.9 ± 1.7 mm/min, respectively. Only the EAPTT revealed a significant difference in tear production between English Angora and Dutch rabbits. These results provide reference values for tear production in English Angora and Dutch rabbits according to 3 different quantitative tear film assessment methods. PMID:27025815

Effect of topical ophthalmic epinastine and olopatadine on tear volume in mice.

PubMed

Villareal, Arturo L; Farley, William; Pflugfelder, Stephen C

2006-12-01

To investigate the effects of topical epinastine and olopatadine on tear volume by using a mouse model. Eighty-five C57BL6 mice (170 eyes) were treated twice daily with topical ophthalmic epinastine 0.05%, olopatadine 0.1%, or atropine 1% or served as untreated controls. A thread-wetting assay was used to measure tear volume at baseline and 15, 45, 90, 120, and 240 minutes after the last instillation of the drug on days 2 and 4 of treatment. After 2 days of treatment, epinastine-treated mice showed greater mean tear volumes than olopatadine-treated mice did at 15, 45, 90, and 240 minutes, with statistical significance at 15 and 45 minutes (P<0.001). Olopatadine significantly reduced tear volume versus untreated controls at 15 and 45 minutes (P<0.001). After 4 days, tear volumes with epinastine treatment exceeded those with olopatadine treatment at all time points, with statistical significance at 45 minutes (P<0.05). Atropine rendered tears undetectable at 15, 45, and 90 minutes; tear volume returned to baseline levels at 240 minutes. Topical epinastine did not inhibit tear secretion, whereas olopatadine caused a significant decrease in tear volume. Because of its neutral impact on the lacrimal functional unit, epinastine may be an especially good choice for the treatment of allergic conjunctivitis in patients with dry eye disease or in those who are at risk for developing dry eye.

Effects of tear film dynamics on quality of vision.

PubMed

Koh, Shizuka; Tung, Cynthia I; Inoue, Yasushi; Jhanji, Vishal

2018-06-15

The precorneal tear film is maintained by blinking and exhibits different phases in the tear cycle. The tear film serves as the most anterior surface of the eye and plays an important role as a first refractive component of the eye. Alterations in tear film dynamics may cause both vision-related and ocular surface-related symptoms. Although the optical quality associated with the tear film dynamics previously received little attention, objective measurements of optical quality using wavefront sensors have enabled us to quantify optical aberrations induced by the tear film. This has provided an objective method for assessing reduced optical quality in dry eye; thus, visual disturbances were included in the definition of dry eye disease in the 2007 Dry Eye Workshop report. In addition, sequential measurements of wavefront aberrations have provided us with valuable insights into the dynamic optical changes associated with tear film dynamics. This review will focus on the current knowledge of the mechanisms of wavefront variations that are caused by different aspects of tear film dynamics: specifically, quality, quantity and properties of the tear film, demonstrating the respective effects of dry eye, epiphora and instillation of eye drops on the quality of vision. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Lipid peroxidation is increased in tears from the elderly.

PubMed

Benlloch-Navarro, Soledad; Franco, Ilenia; Sánchez-Vallejo, Violeta; Silvestre, Dolores; Romero, Francisco Javier; Miranda, María

2013-10-01

We describe a procedure in which tears, obtained from Schirmer strips, are used to measure a marker of lipid peroxidation, malondialdehyde (MDA). We also compared the levels of proteins and MDA in tears from two groups of people: young adults (18-30 years old) and elderly adults (65-85 years old), because the data related to total protein concentration of human tears vary widely and because the majority of people over the age of 65 experience some symptoms of dry eyes and this condition has been recognized as an oxidative stress-induced disease. Our results show a significant difference in the protein concentration of the tears taken from the two age categories, younger adults (18-30 years old) and older adults (65-85 years old). Herein, we report for the first time an increase in MDA concentrations determined by HPLC in human tears based on age. It is possible that alterations in the tear lipid layer may lead to an increase in lipid peroxidation. Further studies are needed to understand the nature and function of tear film and stability in order to obtain new methods to analyze tears in patients with different diseases. In this sense, it would be interesting to compare MDA concentration in tears from control subjects and from people with meibomian gland dysfunction. Copyright © 2013 Elsevier Ltd. All rights reserved.

Electrophoresis of tear proteins as a new diagnostic tool for two high risk groups for dry eye: computer users and contact lens wearers.

PubMed

Chiva, Andreea

2011-08-15

Dry eye is the most prevalent condition seen by the ophthalmologist, in particular in elderly. The identification of new common risk factors (computer use and contact lens wear) extends the disease among the young people. The early diagnosis of dry eye is essential, but difficult, because the biochemical changes in tear film usually occur before any detectable signs. Due its advantages, electrophoresis of tear proteins could be an important tool for diagnosis of tear film impairment in high risk groups for dry eye. The role of tear proteins electrophoresis in early diagnosis of dry eye related to computer use and contact lens wear, as well as the biochemical changes in these high risk groups are presented. This review will summarize the actual data concerning the electrophoretic changes of tear proteins in computer users and contact lens wearers, two common high risk groups for dry eye. Electrophoresis of tear proteins using automated system Hyrys-Hydrasys SEBIA France is an important tool for early diagnosis of tear film alterations and monitoring of therapy. The quantification of many proteins in a single analysis using a small quantity of unconcentrated reflex tears is the main advantage of this technique. Electrophoresis of tear proteins should became a prerequisite, in particular for computer users less than 3 h/day, as well as at prescribing contact lenses.

Clinical Evaluation of the Root Tear of the Posterior Horn of the Medial Meniscus in Total Knee Arthroplasty for Osteoarthritis

PubMed Central

Park, Sang-Jun

2015-01-01

Purpose To investigate the incidence of root tears of the posterior horn of the medial meniscus in total knee replacement arthroplasty for knee osteoarthritis and retrospectively analyze clinical results and factors associated with root tears. Materials and Methods There were 197 knees of 140 enrolled patients who had undergone total knee replacement arthroplasty between September 2010 and May 2014. The presence of a root tear of the posterior horn of the medial meniscus was confirmed in all patients. Statistical analysis was performed to investigate the correlation between root tears and the possible factors of meniscal tears including gender, age, severity of symptoms (visual analogue scale [VAS] score and medial joint line tenderness), grade of osteoarthritis (Kellgren-Lawrence grading scale), body mass index (BMI), varus deformity, and mechanical axis deviation. Results Meniscal tears were observed in 154 knees (78.17%). The root tear had correlation with the severity of osteoarthritis (p<0.05), varus deformity (p<0.05), mechanical axis deviation (p<0.05), and BMI (p<0.05). Conclusions Factors considered to represent the severity of osteoarthritis were found to be associated with root tears of the medial meniscus posterior horn. Increased BMI seemed to be associated with the increased incidence of root tears of the medial meniscus posterior horn. PMID:26060607

Preexisting Rotator Cuff Tears as a Predictor of Outcomes in National Football League Athletes.

PubMed

Gibbs, Daniel B; Lynch, T Sean; Gombera, M Mustafa; Saltzman, Matthew D; Nuber, Gordon W; Schroeder, Gregory D; Labelle, Mark; Hollett, Brian P

A preexisting rotator cuff tear may affect the draft status and career performance of National Football League (NFL) players. Preexisting rotator cuff tears decrease a player's draft status, performance, and longevity in the NFL. Retrospective cohort study. Level 3. Medical reports of prospective NFL players during the NFL Scouting Combine from 2003 to 2011 were evaluated to identify players with a previous rotator cuff tear. Athletes were matched to control draftees without documented shoulder pathology by age, position, year drafted, and round drafted. Career statistics and performance scores were calculated. Between 2003 and 2011, 2965 consecutive athletes were evaluated. Forty-nine athletes had preexisting rotator cuff tears: 22 athletes underwent surgical intervention for their tear and 27 were treated nonoperatively. Those with a rotator cuff tear were significantly less likely to be drafted than those without a previous injury (55.1% vs 77.5%, P = 0.002). The 27 drafted athletes with preexisting rotator cuff tears started significantly fewer games (23.7 vs 43.0, P = 0.02) and played significantly fewer years (4.3 vs 5.7, P = 0.04) and significantly fewer games (47.1 vs 68.4, P = 0.04) than matched control athletes without rotator cuff tears. Athletes with a preexisting rotator cuff tear were less likely to be drafted and had decreased career longevity.

Corneal Sensitivity in Tear Dysfunction and its Correlation with Clinical Parameters and Blink Rate

PubMed Central

Rahman, Effie Z.; Lam, Peter K.; Chu, Chia-Kai; Moore, Quianta; Pflugfelder, Stephen C.

2015-01-01

Purpose To compare corneal sensitivity in tear dysfunction due to a variety of causes using contact and non-contact esthesiometers and to evaluate correlations between corneal sensitivity, blink rate and clinical parameters. Design Comparative observational case series. Methods Ten normal and 33 subjects with tear dysfunction [meibomian gland disease (n = 11), aqueous tear deficiency (n = 10) - without (n = 7) and with (n = 3) Sjögren syndrome (SS) and conjunctivochalasis (n = 12)] were evaluated. Corneal sensitivity was measured with Cochet-Bonnet and air jet esthesiometers and blink rate by electromyelography. Eye irritation symptoms, tear meniscus height, tear break-up time (TBUT), and corneal and conjunctival dye staining were measured. Between group means were compared and correlations calculated. Results Compared with control (Cochet-Bonnet 5.45 mm, air esthesiometer 3.62 mg), mean sensory thresholds were significantly higher in aqueous tear deficiency using either Cochet-Bonnet (3.6 mm; P = 0.003) or air (11.7 mg; P = 0.046) esthesiometers, but were not significantly different in the other groups. Reduced corneal sensitivity significantly correlated with more rapid TBUT and blink rate, and greater irritation and ocular surface dye staining with one or both esthesiometers. Mean blink rates were significantly higher in both aqueous tear deficiency and conjunctivochalasis compared with control. Among all subjects, blink rate positively correlated with ocular surface staining and irritation and inversely correlated with TBUT. Conclusion Amongst conditions causing tear dysfunction, reduced corneal sensitivity is associated with greater irritation, tear instability, ocular surface disease and blink rate. Rapid blinking is associated with worse ocular surface disease and tear stability. PMID:26255576

Diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears at 3.0 T.

PubMed

Lee, Ji Hyun; Yoon, Young Cheol; Jee, Sukkyung

2015-06-01

Indirect magnetic resonance (MR) arthrography is a non-invasive method for shoulder imaging. However, there are no studies that have examined the diagnostic performance of indirect MR arthrography for the diagnosis of rotator cuff tears in a large patient population. To assess the diagnostic performance of indirect fast spin-echo (FSE) MR arthrography for the diagnosis of rotator cuff tears at 3.0 T. A total of 149 patients who had undergone indirect shoulder MR arthrography followed by arthroscopic surgery were enrolled in this retrospective study. Two musculoskeletal radiologists evaluated images from each patient for the presence of supraspinatus-infraspinatus (SSP-ISP) or subscapularis (SSC) tendon tears. Using the arthroscopic findings as the reference standard, the overall diagnostic performance and detection rates for SSP-ISP and SSC tendon tears were calculated. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSP-ISP tendon tears were 94% and 95%, 89% and 85%, and 93% and 93%, respectively. The sensitivity of imaging for detection of SSP-ISP tendon tears by readers I and II were 100% and 100% for full-thickness tears and 84% and 86% for partial-thickness tears, respectively. The sensitivity, specificity, and accuracy of readers I and II for the diagnosis of SSC tendon tears were 80% and 76%, 89% and 93%, and 85% and 85%, respectively. Indirect MR arthrography is useful for the detection of SSP-ISP and SSC tendon tears. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Hot-Tearing Assessment of Multicomponent Nongrain-Refined Al-Cu Alloys for Permanent Mold Castings Based on Load Measurements in a Constrained Mold

NASA Astrophysics Data System (ADS)

Sabau, Adrian S.; Mirmiran, Seyed; Glaspie, Christopher; Li, Shimin; Apelian, Diran; Shyam, Amit; Allen Haynes, J.; Rodriguez, Andres F.

2018-06-01

The hot-tearing resistance of multicomponent Al-Cu alloys during permanent mold casting was investigated using a constrained permanent mold in which the load and temperature were measured. The nominal Cu composition was varied from 5 to 8 wt pct. Casting experiments were conducted without adding any grain-refining inoculants. The following variables, which were obtained from the measured load data during casting, were considered to assess the hot-tearing resistance of the Al-Cu multicomponent alloys: "V"-like signature in the load rate variation, load at solidus point, and load rate average over the freezing range. In addition, a hot-tearing criterion based on the variation of the fraction of solid in the late stages of solidification was used. It was found that all criteria considered can accurately predict the alloys with the lowest and highest hot-tear resistance, respectively. It was found that the rate of measured load during casting could be used to indicate substantial hot tearing. However, the load rate variation could not be used to detect when small hot tears were present. Among all the criteria considered, the load at the solidus point shows an excellent agreement with experimentally observed hot-tearing resistance for all but one alloy. The poorly resistant hot-tearing alloys exhibited mainly coarse columnar grains while the most hot-tearing resistant alloys exhibited a much more refined grain microstructure. This is the first study in which good hot-tear resistance is demonstrated for multicomponent Al-Cu alloys with nominal Cu content greater than 7 wt pct.

Dynamics and function of the tear film in relation to the blink cycle.

PubMed

Braun, R J; King-Smith, P E; Begley, C G; Li, Longfei; Gewecke, N R

2015-03-01

Great strides have recently been made in quantitative measurements of tear film thickness and thinning, mathematical modeling thereof and linking these to sensory perception. This paper summarizes recent progress in these areas and reports on new results. The complete blink cycle is used as a framework that attempts to unify the results that are currently available. Understanding of tear film dynamics is aided by combining information from different imaging methods, including fluorescence, retroillumination and a new high-speed stroboscopic imaging system developed for studying the tear film during the blink cycle. During the downstroke of the blink, lipid is compressed as a thick layer just under the upper lid which is often released as a narrow thick band of lipid at the beginning of the upstroke. "Rippling" of the tear film/air interface due to motion of the tear film over the corneal surface, somewhat like the flow of water in a shallow stream over a rocky streambed, was observed during lid motion and treated theoretically here. New mathematical predictions of tear film osmolarity over the exposed ocular surface and in tear breakup are presented; the latter is closely linked to new in vivo observations. Models include the effects of evaporation, osmotic flow through the cornea and conjunctiva, quenching of fluorescence, tangential flow of aqueous tears and diffusion of tear solutes and fluorescein. These and other combinations of experiment and theory increase our understanding of the fluid dynamics of the tear film and its potential impact on the ocular surface. Copyright © 2014 Elsevier Ltd. All rights reserved.

Impact of environmental adaptation on tear film assessments.

PubMed

Fagehi, R

2018-03-01

The purpose of this study was to investigate the effect of ocular environmental adaptation on clinical tear film assessment. Thirty subjects (male, mean age 23±2.5) participated in this study. A number of clinical tear film tests were applied, including: fluorescein tear break-up time (FTBUT), Schirmer test and tear prism height test (TPH). The tear physiology of each subject was evaluated twice, once immediately when they arrived from the external environment, and then after 30minutes adaptation in the exam room environment. The mean values were: Schirmer test A (22.1±2.99), Schirmer test B (24.2±2.63), FTBUT A (8.00±1.94), FTBUT B (9.13±2.04), TPH A (0.179±0.026) and TPH B* (0.187±0.023). Statistical testing using Wilcoxon-signed rank test showed a significant difference between the Schirmer test results measured at the different times (P=0.008). Also, the FTBUT and tear prism height test results showed significant differences between the two evaluation times, (P=0.001, 0.011, respectively) (A: tear assessed when the subject comes from the outside environment, B: tear film assessed after 30min adaptation in the clinical environment). This study showed a significant difference between the tear film test results evaluated when the subjects were assessed immediately from the outside environment and after an adaptation time in the clinic environment. Practitioners must consider the effect of differences between external and clinical environment adaptation on clinical tear film physiology. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Dynamics and function of the tear film in relation to the blink cycle

PubMed Central

Braun, R.J.; King-Smith, P.E.; Begley, C.G.; Li, Longfei; Gewecke, N.R.

2014-01-01

Great strides have recently been made in quantitative measurements of tear film thickness and thinning, mathematical modeling thereof and linking these to sensory perception. This paper summarizes recent progress in these areas and reports on new results. The complete blink cycle is used as a framework that attempts to unify the results that are currently available. Understanding of tear film dynamics is aided by combining information from different imaging methods, including fluorescence, retroillumination and a new high-speed stroboscopic imaging system developed for studying the tear film during the blink cycle. During the downstroke of the blink, lipid is compressed as a thick layer just under the upper lid which is often released as a narrow thick band of lipid at the beginning of the upstroke. “Rippling” of the tear film/air interface due to motion of the tear film over the corneal surface, somewhat like the flow of water in a shallow stream over a rocky streambed, was observed during lid motion and treated theoretically here. New mathematical predictions of tear film osmolarity over the exposed ocular surface and in tear breakup are presented; the latter is closely linked to new in vivo observations. Models include the effects of evaporation, osmotic flow through the cornea and conjunctiva, quenching of fluorescence, tangential flow of aqueous tears and diffusion of tear solutes and fluorescein. These and other combinations of experiment and theory increase our understanding of the fluid dynamics of the tear film and its potential impact on the ocular surface. PMID:25479602

Oxidative Stress Measures of Lipid and DNA Damage in Human Tears.

PubMed

Haworth, Kristina M; Chandler, Heather L

2017-05-01

We evaluate feasibility and repeatability of measures for lipid peroxidation and DNA oxidation in human tears, as well as relationships between outcome variables, and compared our findings to previously reported methods of evaluation for ocular sun exposure. A total of 50 volunteers were seen for 2 visits 14 ± 2 days apart. Tear samples were collected from the inferior tear meniscus using a glass microcapillary tube. Oxidative stress biomarkers were quantified using enzyme-linked immunosorbent assay (ELISA): lipid peroxidation by measurement of hexanoyl-lysine (HEL) expression; DNA oxidation by measurement of 8-oxo-2'-deoxyguinosone (8OHdG) expression. Descriptive statistics were generated. Repeatability estimates were made using Bland-Altman plots with mean differences and 95% limits of agreement were calculated. Linear regression was conducted to evaluate relationships between measures. Mean (±SD) values for tear HEL and 8OHdG expression were 17368.02 (±9878.42) nmol/L and 66.13 (±19.99) ng/mL, respectively. Repeatability was found to be acceptable for both HEL and 8OHdG expression. Univariate linear regression supported tear 8OHdG expression and spring season of collection to be predictors of higher tear HEL expression; tear HEL expression was confirmed as a predictor of higher tear 8OHdG expression. We demonstrate feasibility and repeatability of estimating previously unreported tear 8OHdG expression. Seasonal temperature variation and other factors may influence tear lipid peroxidation. Support is demonstrated to suggest lipid damage and DNA damage occur concurrently on the human ocular surface.

Association of anti-herpes simplex virus IgG in tears and serum with clinical presentation in patients with presumed herpetic simplex keratitis.

PubMed

Borderie, Vincent M; Gineys, Raquel; Goldschmidt, Pablo; Batellier, Laurence; Laroche, Laurent; Chaumeil, Christine

2012-11-01

To assess the clinical relevance of tear anti-herpes simplex virus (HSV) antibody measurement for the diagnosis of herpes simplex keratitis. Records of 364 patients clinically suspect of HSV-related keratitis who had tear anti-HSV IgG assessment (tear-quantified anti-HSV IgG/filtrated IgG ratio) in our institution between January 2000 and August 2008 were retrospectively analyzed. Patients were classified into 4 groups as follows: group 1, anti-HSV IgG negative in serum and tears; group 2, anti-HSV IgG negative in tears and positive in serum; group 3, anti-HSV IgG nonsignificantly positive in tears and positive in serum; and group 4, anti-HSV IgG significantly positive in serum and tears. Randomly selected patient charts from each group were reviewed for clinical data. The prevalence of anti-HSV IgG in blood increased with age from >70% before 20 years to 95% after 70 years. The prevalence of anti-HSV IgG in tears increased with age from 20% before 20 years to >50% after 70 years. The presence (either significant or not) of anti-HSV IgG in tears was significantly associated with decreased corneal sensation, presence of stromal opacities, and with neurotrophic keratitis. Logistic regression showed no significant association between age and clinical signs except for herpetic ulcers and herpetic necrotizing keratitis. Tear production of anti-HSV IgG increases with age, and it is associated with sequelae of herpes simplex keratitis. Conversely, it is poorly associated with clinical signs of acute herpes simplex keratitis.

Antimicrobial Compounds in Tears

PubMed Central

McDermott, Alison M.

2013-01-01

The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. PMID:23880529

Critical shoulder angle in an East Asian population: correlation to the incidence of rotator cuff tear and glenohumeral osteoarthritis.

PubMed

Shinagawa, Kiyotsugu; Hatta, Taku; Yamamoto, Nobuyuki; Kawakami, Jun; Shiota, Yuki; Mineta, Mitsuyoshi; Itoi, Eiji

2018-05-03

Focus has recently been on the critical shoulder angle (CSA) as a factor related to rotator cuff tear and osteoarthritis (OA) in the European population. However, whether this relationship is observed in the Asian population is unclear. The correlation between the CSAs measured on anteroposterior radiographs and the presence or absence of rotator cuff tears or OA changes was assessed in 295 patients. Rotator cuff tears were diagnosed with magnetic resonance imaging or ultrasonography. OA findings were classified using the Samilson-Prieto classification. The CSAs among the patients with rotator cuff tears, OA changes, and those without pathologies were compared. Multivariable analyses were used to clarify the potential risks for these pathologies. The mean CSA with rotator cuff tear (33.9° ± 4.1°) was significantly greater than that without a rotator cuff tear (32.3° ± 4.5°; P = .002). Multivariable analysis also showed that a greater CSA had a significantly increased risk of rotator cuff tears, with the odds ratio of 1.08 per degree. OA findings showed no significant correlation to the CSAs. Our study demonstrates that the CSA is greater in those with a rotator cuff tear than in those without a tear or OA changes, which may be an independent risk factor for the incidence of rotator cuff tears in the Japanese population. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Asymptomatic rotator cuff tears: Patient demographics and baseline shoulder function

PubMed Central

Keener, Jay D.; Steger-May, Karen; Stobbs, Georgia; Yamaguchi, Ken

2010-01-01

Background The purpose of this study is to characterize the demographic features and physical function of subjects with asymptomatic rotator cuff tears and to compare their shoulder function to controls with an intact rotator cuff. Materials and Methods 196 subjects with an asymptomatic rotator cuff tear and 54 subjects with an intact rotator cuff presenting with a painful rotator cuff tear in the contralateral shoulder were enrolled. Various demographic features, shoulder function (ASES score and SST score), range of motion and strength were compared. Results The demographic features of the study and control groups were similar. Hand dominance was associated with the presence of shoulder pain (p < .05). Subjects with an intact rotator cuff had greater but clinically insignificant ASES (p < .05) and SST scores (p < .05) than those with an asymptomatic tear. No differences in functional scores, range of motion or strength were seen between partial (n=61) and full-thickness tears (n=135). Of the full-thickness tears, 36 (27%) were classified as small, 85 (63%) as medium and 14 (10%) as large tears. No differences were seen in functional scores between full-thickness tears of various sizes. Conclusions When asymptomatic, a rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared to those with an intact rotator cuff. Therefore, a clinically detectable decline in shoulder function may indicate an “at-risk” asymptomatic tear. The presence of pain is important in cuff deficient shoulders for creating a measurable loss of shoulder function. Hand dominance appears to be an important risk factor for pain. PMID:21030274

Relationship of ABO Blood Type on Rotator Cuff Tears.

PubMed

Lee, Doo-Hyung; Lee, Han-Dong; Yoon, Seung-Hyun

2015-11-01

ABO blood groups are associated with various diseases. A relationship between Achilles tendon ruptures and blood type O has been reported, although its pathogenesis was not clear. To the best of our knowledge, there is no published study describing the relationship between blood type and rotator cuff tendon tears. To determine whether patients with rotator cuff tear had a greater prevalence of blood type O than those without rotator cuff tear. A cross-sectional study. Research hospital outpatient evaluation. A total of 316 subjects with shoulder pain were included and divided into "tear" and "no-tear" groups according to ultrasonographic examination. ABO blood group, gender, dominant arm, smoking history, trauma history, and age were compared between the 2 groups and the odds ratios of these factors were evaluated by logistic regression. The tear group (38.6%) had more instances of blood type O than the healthy population (27.2%; P = .002). The adjusted odds ratio for rotator cuff tear for blood type O to non-O was 2.38 (95% confidence interval 1.28-4.42). The odds ratios for rotator cuff tears for smoking, major trauma history, minor trauma history, and age were 2.08, 3.11, 2.29, and 1.06, respectively. Patients with rotator cuff tears were more likely to have blood type O. The odds ratios of factors for rotator cuff tears were high in the following order: major trauma history, blood type O, minor trauma history, and age. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

49 CFR 173.340 - Tear gas devices.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 49 Transportation 2 2010-10-01 2010-10-01 false Tear gas devices. 173.340 Section 173.340... SHIPMENTS AND PACKAGINGS Gases; Preparation and Packaging § 173.340 Tear gas devices. (a) Packagings for tear gas devices must be approved prior to initial transportation by the Associate Administrator. (b...

Surface interactions on hydrogel contact lenses: scanning electron microscopy (SEM).

PubMed

Hart, D E

1987-12-01

SEM was used to visualize tear-film/hydrogel polymer surface interactions. Lenses were preserved by fixation including a quaternary ammonium complex to aid in mucin preservation. In less than 2 weeks of continuous wear the anterior surface was completely coated, yet the coating was absent from the posterior lens surface. Tear-film break-up over the deposited lens surface, combined with degradation and deformation at the polymer surface boundary, as well as entrapment of moieties within the polymer matrix, all occurred. These are the likely culprits which can contribute to adverse reactions as well as cause light scatter and diminished vision. Lenses removed directly from the eyes of patients suffering with different forms of conjunctivitis were obtained. Bacterial and viral conjunctivitis can induce a microbially contaminated as well as a heavily deformed and deposited lens. Viable and intact microbes were not typically observed in the mucoprotein layer of hydrogel contact lenses.

Morphological and functional changes in TRPM8-expressing corneal cold thermoreceptor neurons during aging and their impact on tearing in mice.

PubMed

Alcalde, Ignacio; Íñigo-Portugués, Almudena; González-González, Omar; Almaraz, Laura; Artime, Enol; Morenilla-Palao, Cruz; Gallar, Juana; Viana, Félix; Merayo-Lloves, Jesús; Belmonte, Carlos

2018-08-01

Morphological and functional alterations of peripheral somatosensory neurons during the aging process lead to a decline of somatosensory perception. Here, we analyze the changes occurring with aging in trigeminal ganglion (TG), TRPM8-expressing cold thermoreceptor neurons innervating the mouse cornea, which participate in the regulation of basal tearing and blinking and have been implicated in the pathogenesis of dry eye disease (DED). TG cell bodies and axonal branches were examined in a mouse line (TRPM8 BAC -EYFP) expressing a fluorescent reporter. In 3 months old animals, about 50% of TG cold thermoreceptor neurons were intensely fluorescent, likely providing strongly fluorescent axons and complex corneal nerve terminals with ongoing activity at 34°C and low-threshold, robust responses to cooling. The remaining TRPM8 + corneal axons were weakly fluorescent with nonbeaded axons, sparsely ramified nerve terminals, and exhibited a low-firing rate at 34°C, responding moderately to cooling pulses as do weakly fluorescent TG neurons. In aged (24 months) mice, the number of weakly fluorescent TG neurons was strikingly high while the morphology of TRPM8 + corneal axons changed drastically; 89% were weakly fluorescent, unbranched, and often ending in the basal epithelium. Functionally, 72.5% of aged cold terminals responded as those of young animals, but 27.5% exhibited very low-background activity and abnormal responsiveness to cooling pulses. These morpho-functional changes develop in parallel with an enhancement of tear's basal flow and osmolarity, suggesting that the aberrant sensory inflow to the brain from impaired peripheral cold thermoreceptors contributes to age-induced abnormal tearing and to the high incidence of DED in elderly people. © 2018 Wiley Periodicals, Inc.

Myofascial treatment for patients with acetabular labral tears: a single-subject research design study.

PubMed

Cashman, Glenn E; Mortenson, W Ben; Gilbart, Michael K

2014-08-01

Single-subject research design using 4 consecutive patients. To assess whether treatment using soft tissue therapy (ART or Active Release Technique), stretching, and strengthening of the hip abductors, hip external rotators, and tensor fascia latae muscles reduces pain and improves self-reported hip function in patients with acetabular labral tears who also have posterolateral hip pain of suspected myofascial origin. Acetabular labral tears cause pain in some but not all patients. Pain commonly presents anteriorly but may also present posteriorly and laterally. The standard of care is arthroscopic repair, which helps many but not all patients. It is possible that these patients may present with extra-articular contributions to their pain, such as myofascial pain, making their clinical presentation more complex. No previous study has assessed soft tissue therapy as a treatment option for this subset of patients. This A-B-A design used repeated measures of the Hip Outcome Score and visual analog scale for pain. Four patients were treated for 6 to 8 weeks, using a combination of soft tissue therapy, stretching, and strengthening for the hip abductors, external rotators, and tensor fascia latae. Data were assessed visually, statistically, and by comparing mean differences before and after intervention. All 4 patients experienced both statistically significant and clinically meaningful improvement in posterolateral hip pain and hip-related function. Three patients also experienced reduction in anteromedial hip pain. Myofascial hip pain may contribute to hip-related symptoms and disability in patients with acetabular labral tears and posterolateral hip pain. These patients may benefit from soft tissue therapy combined with stretching and strengthening exercises targeting the hip abductors, tensor fascia latae, and hip external rotator muscles. Level of Evidence Therapy, level 4.

Tear clearance implications for ocular surface health.

PubMed

de Paiva, Cintia Sade; Pflugfelder, Stephen C

2004-03-01

Tear clearance/turnover provides a global assessment of the function of the lacrimal functional unit and of tear exchange on the ocular surface. It is an indirect measure of dry eye induced inflammation on the ocular surface. It shows better correlation with the severity of ocular irritation symptoms and corneal epithelial disease in dry eye than the Schirmer 1 test. Delayed tear clearance may prove to be the best measure for identifying patients with tear film disorders who may respond to anti-inflammatory therapy.

Mechanical function near defects in an aligned nanofiber composite is preserved by inclusion of disorganized layers: Insight into meniscus structure and function.

PubMed

Bansal, Sonia; Mandalapu, Sai; Aeppli, Céline; Qu, Feini; Szczesny, Spencer E; Mauck, Robert L; Zgonis, Miltiadis H

2017-07-01

The meniscus is comprised of circumferentially aligned fibers that resist the tensile forces within the meniscus (i.e., hoop stress) that develop during loading of the knee. Although these circumferential fibers are severed by radial meniscal tears, tibial contact stresses do not increase until the tear reaches ∼90% of the meniscus width, suggesting that the severed circumferential fibers still bear load and maintain the mechanical functionality of the meniscus. Recent data demonstrates that the interfibrillar matrix can transfer strain energy to disconnected fibrils in tendon fascicles. In the meniscus, interdigitating radial tie fibers, which function to stabilize and bind the circumferential fibers together, are hypothesized to function in a similar manner by transmitting load to severed circumferential fibers near a radial tear. To test this hypothesis, we developed an engineered fibrous analog of the knee meniscus using poly(ε-caprolactone) to create aligned scaffolds with variable amounts of non-aligned elements embedded within the scaffold. We show that the tensile properties of these scaffolds are a function of the ratio of aligned to non-aligned elements, and change in a predictable fashion following a simple mixture model. When measuring the loss of mechanical function in scaffolds with a radial tear, compared to intact scaffolds, the decrease in apparent linear modulus was reduced in scaffolds containing non-aligned layers compared to purely aligned scaffolds. Increased strains in areas adjacent to the defect were also noted in composite scaffolds. These findings indicate that non-aligned (disorganized) elements interspersed within an aligned network can improve overall mechanical function by promoting strain transfer to nearby disconnected fibers. This finding supports the notion that radial tie fibers may similarly promote tear tolerance in the knee meniscus, and will direct changes in clinical practice and provide guidance for tissue engineering strategies. The meniscus is a complex fibrous tissue, whose architecture includes radial tie fibers that run perpendicular to and interdigitate with the predominant circumferential fibers. We hypothesized that these radial elements function to preserve mechanical function in the context of interruption of circumferential bundles, as would be the case in a meniscal tear. To test this hypothesis, we developed a biomaterial analog containing disorganized layers enmeshed regularly throughout an otherwise aligned network. Using this material formulation, we showed that strain transmission is improved in the vicinity of defects when disorganized fiber layers were present. This supports the idea that radial elements within the meniscus improve function near a tear, and will guide future clinical interventions and the development of engineered replacements. Copyright © 2017 Acta Materialia Inc. All rights reserved.

Hot Tearing in Aluminium — Copper Alloys

NASA Astrophysics Data System (ADS)

Viano, David; StJohn, David; Grandfield, John; Cáceres, Carlos

For many aluminium alloys, hot tearing susceptibility follows a lambda curve relationship when hot tearing severity is plotted as a function of solute content. In the past, there has been some difficulty quantifying hot tearing. Traditional methods rely upon measuring electrical resistivity or the number and/or length of cracks in tests such as the ring test. In this experimental program, a hot tear test rig was used to investigate a series of binary Al-Cu alloys. This device measures the load imposed on the mushy zone during solidification. Hot tearing susceptibility was quantified in two ways. The first method involved measuring the load at the solidus temperature (548°C). The second method was to radiograph the hot spot and measure the image density of the cracks. Both methods had advantages and disadvantages. It was found that the results from the hot tear rig correlates with other published data using different experimental methods.

Evaluation of Lacrimation Characteristics in Clinically Normal New Zealand White Rabbits by Using the Schirmer Tear Test I

PubMed Central

Whittaker, Alexandra L; Williams, David L

2015-01-01

Rabbits are a common animal model in eye research and in safety testing of novel chemical agents. In addition, ocular disease is a routine presentation in clinical practice. However, few studies have quantitatively examined lacrimation kinetics in this species. This study used a noninvasive method of tear measurement (the Schirmer tear test, STT) to quantify values for basal and reflex tearing and to determine the kinetic nature of tear production in 76 New Zealand white rabbits. We obtained a value of 7.58 ± 2.3 mm/min for the standard 1-min STT. Calculated values for mean residual tear volume and reflex tear flow were 1.95 µL and 0.035 µL/s, respectively. In addition, this study provides preliminary evidence for an interaction effect between eyes given that higher STT values were obtained from the second eye tested. PMID:26632789

Tear and decohesion of bovine pericardial tissue.

PubMed

Tobaruela, Almudena; Elices, Manuel; Bourges, Jean Yves; Rojo, Francisco Javier; Atienza, José Miguel; Guinea, Gustavo

2016-10-01

The aim of this study was to evaluate quantitatively the fracture-by tear and delamination-of bovine pericardium tissues which are usually employed for the manufacture of bioprosthetic valves. A large number of samples (77) were tested in root-to-apex and circumferential directions, according to a standardised tear test (ASTM D 1938). Before performing the tear test, some samples were subjected to 1000 cycles of fatigue to a maximum stress of 3MPa. Fracture toughness of tearing and delamination were computed by following a simple fracture model. The study showed significantly lower values of delamination toughness compared with tear delamination. Moreover, tear forces were different in each test direction, revealing a clear orthotropic behaviour. All these results, as well as the testing procedure, could be of value for future research in the physiological function of pericardium tissues and clinical applications. Copyright © 2016 Elsevier Ltd. All rights reserved.

Topical anaesthetic and tear film stability.

PubMed

Mengher, L S; Pandher, K S; Bron, A J

1986-02-01

The effect of unpreserved topical anaesthetic on tear film stability (0.4% oxybuprocaine hydrochloride) was investigated in a double masked randomised study in 12 healthy volunteers, using a noninvasive tear film break up technique (NIBUT). It was found that the topical anaesthetic did not reduce the pre-corneal tear film stability, contrary to the electron microscopic evidence.

78 FR 27020 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-09

... circumferential tear strap, the ``Z'' stiffeners at the dome cap, and existing repairs [retained actions from AD... Inspection Under the Tear Strap This paragraph restates the one-time inspection under the tear strap required... under the outer circumferential tear strap, or do a one-time HFEC inspection for cracks from the forward...

26 CFR 1.1016-3 - Exhaustion, wear and tear, obsolescence, amortization, and depletion for periods since February...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Exhaustion, wear and tear, obsolescence... Rules of General Application § 1.1016-3 Exhaustion, wear and tear, obsolescence, amortization, and... be decreased for exhaustion, wear and tear, obsolescence, amortization, and depletion by the greater...

26 CFR 1.1016-4 - Exhaustion, wear and tear, obsolescence, amortization, and depletion; periods during which income...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 11 2010-04-01 2010-04-01 true Exhaustion, wear and tear, obsolescence...) INCOME TAXES Basis Rules of General Application § 1.1016-4 Exhaustion, wear and tear, obsolescence... be made for exhaustion, wear and tear, obsolescence, amortization, and depletion to the extent...

Chemosignalling effects of human tears revisited: Does exposure to female tears decrease males' perception of female sexual attractiveness?

PubMed

Gračanin, Asmir; van Assen, Marcel A L M; Omrčen, Višnja; Koraj, Ivana; Vingerhoets, Ad J J M

2017-01-01

Gelstein et al. reported the results of three experiments suggesting a dampening influence of inhalation of female emotional tears on males' arousal and perception of female sexual attractiveness, specifically in non-sexual situations. This prompted the hypothesis that crying exerts its influence on others not only via the auditory and visual mode but also via chemosignals. In three studies, we attempted to replicate and extend Gelstein et al.'s findings by including an additional condition with irritant tears, by using pictures of sexually attractive women, and by testing related hypotheses on the pro-social effects of exposure to tears. All three studies, separately or combined in a meta-analysis, failed to replicate the original inhibitory effects of tears. In addition, sniffing tears did not affect measures of connectedness, aggression and pro-social behaviour. It is concluded that the effects of female tears on male arousal and perception of female sexual attractiveness, if any, are very weak at best. Rather, it seems that crying exerts its strong inter-personal effects through the visual and auditory sensory channels.

Stable Meniscal Tears Left In Situ at the Time of Arthroscopic Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PubMed

Rothermich, Marcus A; Cohen, Jared A; Wright, Rick

2016-04-01

Meniscal tears can be incidentally encountered at the time of anterior cruciate ligament (ACL) reconstruction. In these cases, the surgeon has several treatment options that include benign neglect, debridement, trephination, and repair. The authors performed a systematic review of the literature studying the various treatment options for meniscal tears discovered at the time of ACL reconstruction. This systematic review included eight articles that had relevant data regarding benign neglect compared with debridement, trephination, or repair of incidentally encountered meniscal tears. Combined data from these studies resulted in a total of 646 meniscal tears treated with benign neglect with follow-up information available. Importantly, there were differences in reoperation rates between medial and lateral meniscal tears left in situ. However, stable medial and lateral meniscal tears treated with benign neglect did not have different subjective or objective outcomes than those treated with surgical intervention. This systematic review concludes that when stable meniscal tears are encountered at the time of arthroscopic ACL reconstruction, benign neglect can be used for a successful outcome. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Tear gas: an epidemiological and mechanistic reassessment

PubMed Central

Rothenberg, Craig; Achanta, Satyanarayana; Svendsen, Erik R.

2016-01-01

Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved—with aerial drone systems tested and requested by law enforcement—epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain‐sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed. PMID:27391380

Examination of in vivo tear film stability after eye blink and eye drying

NASA Astrophysics Data System (ADS)

Szczesna, Dorota H.; Kulas, Zbigniew; Kasprzak, Henryk T.; Stenevi, Ulf

2007-07-01

The purpose of this study is to investigate the kinetics of precorneal tear film stabilization process after eye blink and the process of creating the break-up of the tear film layer. The tear film of patients were examined in vivo by used the lateral shearing interferometer. The information about the distribution and stability of the tear film over the cornea is carried by the wave front reflected from the surface of tears and coded in interference fringes. Smooth and regular fringes indicate the smooth surface of tears over the cornea. Immediately after eye blink the interference fringes are observed on background of bright and dark areas. The contrast of this structure fades with time slowly and after 1-3 sec the background of interference fringes becomes uniform. The vertical orientation and instability of this structure suggests connection with eyelid movement and the spread of tears. If the eye is kept open for a long time, bright lines appear in the background of fringes after a dozen seconds. The slowly appearing structure might signify the tear film break-up. In case of eyes after a LASIK surgery the shape of the background structure has different nature and might be stable in time suggesting the stability of the corneal surface irregularities.

Symptoms, visual function, and mucin expression of eyes with tear film instability.

PubMed

Shimazaki-Den, Seika; Dogru, Murat; Higa, Kazunari; Shimazaki, Jun

2013-09-01

We examined symptoms, tear stability, visual function, and conjunctival cytology in eyes with an unstable tear film (UTF), expressed as a short tear film breakup time without epithelial damage or low tear secretion, and compared the results with those from eyes with aqueous deficiency (AD) associated with epithelial damage, and healthy eyes. We divided the patients with ocular discomfort into 2 groups according to the breakup time, Schirmer value, and epithelial staining score: UTF group (≤5 seconds, >5 mm, and <3 points; 21 eyes of 21 patients) and AD group (≤5 seconds, ≤5 mm, and ≥3 points; 21 eyes of 21 patients). We examined all patients and 17 healthy subjects for symptoms, tear functions, tear film stability by tear film lipid layer interferometry and tear film analysis system, and functional visual acuity. Conjunctival impression cytology was performed to investigate changes in goblet cell density, squamous metaplasia, and messenger RNA expression of MUC5AC and MUC16. The symptom scores, tear film analysis system index, and functional visual acuity testing were significantly worse in the UTF and AD groups compared with those in the control group (P < 0.05). The messenger RNA expression levels of MUC5AC and MUC16 were significantly lower in UTF and AD eyes compared with those in the control eyes (P < 0.0001). An UTF itself can cause dry eye symptoms and visual disturbance comparable with those of AD dry eyes.

The efficacy, sensitivity, and specificity of strip meniscometry in conjunction with tear function tests in the assessment of tear meniscus.

PubMed

Ibrahim, Osama M A; Dogru, Murat; Ward, Samantha K; Matsumoto, Yukihiro; Wakamatsu, Tais Hitomi; Ishida, Katsushi; Tsuyama, Atsushi; Kojima, Takashi; Shimazaki, Jun; Tsubota, Kazuo

2011-04-06

To evaluate the specificity and sensitivity of strip meniscometry (SM) testing in conjunction with tear function tests in the diagnosis of dry eye (DE) disease and to investigate the effect of SM on reflex tearing. One hundred seven left eyes of 107 patients with definite DE disease according to the Japanese DE diagnostic criteria and 68 left eyes of 68 age- and sex-matched control subjects were studied. Tear meniscus height (TMH) measurements, fluorescein tear film break-up time (FTBUT), fluorescein (F) and rose bengal (RB) staining, and Schirmer's test-1 (ST) were also performed. The assessment of reflex tearing before and after SM application was assessed with a graticule scale at the slit lamp and by optical coherence tomography. The sensitivity and specificity of SM alone and in combination with tear function tests were also sought. The SM scores, TMH measurements, FTBUTs, and STs were significantly lower in dry eye patients than in the controls (P < 0.001). The RB and F staining scores were significantly higher in the dry eye group than in the control group (P < 0.001). The meniscometry strips did not induce significant changes in relation to reflex tearing. SM had an acceptable sensitivity and specificity. SM is a swift, noninvasive, promising method of assessing tear meniscus volume. The combined SM and FTBUT examination appears to be a sensitive approach to the assessment of dry eye disease.

Quantitation of 47 human tear proteins using high resolution multiple reaction monitoring (HR-MRM) based-mass spectrometry.

PubMed

Tong, Louis; Zhou, Xi Yuan; Jylha, Antti; Aapola, Ulla; Liu, Dan Ning; Koh, Siew Kwan; Tian, Dechao; Quah, Joanne; Uusitalo, Hannu; Beuerman, Roger W; Zhou, Lei

2015-02-06

Tear proteins are intimately related to the pathophysiology of the ocular surface. Many recent studies have demonstrated that the tear is an accessible fluid for studying eye diseases and biomarker discovery. This study describes a high resolution multiple reaction monitoring (HR-MRM) approach for developing assays for quantification of biologically important tear proteins. Human tear samples were collected from 1000 subjects with no eye complaints (411 male, 589 female, average age: 55.5±14.5years) after obtaining informed consent. Tear samples were collected using Schirmer's strips and pooled into a single global control sample. Quantification of proteins was carried out by selecting "signature" peptides derived by trypsin digestion. A 1-h nanoLC-MS/MS run was used to quantify the tear proteins in HR-MRM mode. Good reproducibility of signal intensity (using peak areas) was demonstrated for all 47 HR-MRM assays with an average coefficient of variation (CV%) of 4.82% (range: 1.52-10.30%). All assays showed consistent retention time with a CV of less than 0.80% (average: 0.57%). HR-MRM absolute quantitation of eight tear proteins was demonstrated using stable isotope-labeled peptides. In this study, we demonstrated for the first time the technique to quantify 47 human tear proteins in HR-MRM mode using approximately 1μl of human tear sample. These multiplexed HR-MRM-based assays show great promise of further development for biomarker validation in human tear samples. Both discovery-based and targeted quantitative proteomics can be achieved in a single quadrupole time-of-flight mass spectrometer platform (TripleTOF 5600 system). Copyright © 2015 Elsevier B.V. All rights reserved.

Pharmacological inhibition of myostatin protects against skeletal muscle atrophy and weakness after anterior cruciate ligament tear.

PubMed

Wurtzel, Caroline Nw; Gumucio, Jonathan P; Grekin, Jeremy A; Khouri, Roger K; Russell, Alan J; Bedi, Asheesh; Mendias, Christopher L

2017-11-01

Anterior cruciate ligament (ACL) tears are among the most frequent knee injuries in sports medicine, with tear rates in the US up to 250,000 per year. Many patients who suffer from ACL tears have persistent atrophy and weakness even after considerable rehabilitation. Myostatin is a cytokine that directly induces muscle atrophy, and previous studies rodent models and patients have demonstrated an upregulation of myostatin after ACL tear. Using a preclinical rat model, our objective was to determine if the use of a bioneutralizing antibody against myostatin could prevent muscle atrophy and weakness after ACL tear. Rats underwent a surgically induced ACL tear and were treated with either a bioneutralizing antibody against myostatin (10B3, GlaxoSmithKline) or a sham antibody (E1-82.15, GlaxoSmithKline). Muscles were harvested at either 7 or 21 days after induction of a tear to measure changes in contractile function, fiber size, and genes involved in muscle atrophy and hypertrophy. These time points were selected to evaluate early and later changes in muscle structure and function. Compared to the sham antibody group, 7 days after ACL tear, myostatin inhibition reduced the expression of proteolytic genes and induced the expression of hypertrophy genes. These early changes in gene expression lead to a 22% increase in muscle fiber cross-sectional area and a 10% improvement in maximum isometric force production that were observed 21 days after ACL tear. Overall, myostatin inhibition lead to several favorable, although modest, changes in molecular biomarkers of muscle regeneration and reduced muscle atrophy and weakness following ACL tear. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2499-2505, 2017. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

MRI of lesser metatarsophalangeal joint plantar plate tears and associated adjacent interspace lesions.

PubMed

Umans, Hilary; Srinivasan, Ramya; Elsinger, Elisabeth; Wilde, Gregory E

2014-10-01

To identify the variety of second and third intermetatarsal space (IS) lesions that may coexist with and without adjacent metatarsophalangeal joint (MTP) plantar plate (PP) tears. One hundred forefoot MRIs in 96 patients with metatarsalgia obtained between 30 September 2011 and 21 July 2012 using 1.5- or 3-T MRI were retrospectively reviewed in consensus by two MSK radiologists and one podiatrist (DPM). MRI was evaluated for second and third MTP PP tear and the presence/nature of second and third IS lesions. Second and third IS neuromas were measured in transverse (trans) dimension. A total of 40 PP tears were identified: 36 at the second and 4 at the third MTP. Second MTP PP tear was identified in 33% of females and 40.5% of males. In the 63 female feet there were 21 second MTP PP tears, all of which also had second IS lesions: pericapsular fibrosis (16), bursitis (4), and ganglion (1). In the 37 male feet there were 15 second MTP PP tears, 14 of which had second IS lesions: pericapsular fibrosis (8), bursitis (5), and ganglion (1). There was no definite second IS neuroma adjacent to any second MTP PP tear. In females without PP tear, there were 24 second (3 mm trans average) and 43 third IS neuromas (4.1 mm trans average). In males without PP tear, there were 9 second (3.4 mm trans average) and 16 third IS neuromas (4.1 mm trans average). MTP PP tears occurred in 40% of our cases, 90% of which occurred at the second MTP. Almost all coexisted with non-neuromatous second IS lesions.

Hot-Tearing Assessment of Multicomponent Nongrain-Refined Al-Cu Alloys for Permanent Mold Castings Based on Load Measurements in a Constrained Mold

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sabau, Adrian S.; Mirmiran, Seyed; Glaspie, Christopher

Here, the hot-tearing resistance of multicomponent Al-Cu alloys during permanent mold casting was investigated using a constrained permanent mold in which the load and temperature were measured. The nominal Cu composition was varied from 5 to 8 wt pct. Casting experiments were conducted without adding any grain-refining inoculants. The following variables, which were obtained from the measured load data during casting, were considered to assess the hot-tearing resistance of the Al-Cu multicomponent alloys: “V”-like signature in the load rate variation, load at solidus point, and load rate average over the freezing range. In addition, a hot-tearing criterion based on themore » variation of the fraction of solid in the late stages of solidification was used. It was found that all criteria considered can accurately predict the alloys with the lowest and highest hot-tear resistance, respectively. It was found that the rate of measured load during casting could be used to indicate substantial hot tearing. However, the load rate variation could not be used to detect when small hot tears were present. Among all the criteria considered, the load at the solidus point shows an excellent agreement with experimentally observed hot-tearing resistance for all but one alloy. The poorly resistant hot-tearing alloys exhibited mainly coarse columnar grains while the most hot-tearing resistant alloys exhibited a much more refined grain microstructure. This is the first study in which good hot-tear resistance is demonstrated for multicomponent Al-Cu alloys with nominal Cu content greater than 7 wt pct.« less

The effects of 2 week senofilcon-A silicone hydrogel contact lens daily wear on tear functions and ocular surface health status.

PubMed

Dogru, Murat; Ward, Samantha K; Wakamatsu, Tais; Ibrahim, Osama; Schnider, Cristina; Kojima, Takashi; Matsumoto, Yukihiro; Ogawa, Junko; Shimazaki, Jun; Tsubota, Kazuo

2011-04-01

To prospectively investigate the effects of 2 week senofilcon A contact lens (CL) daily wear on the functional visual acuity (VA), ocular surface and tear film. Seventeen right eyes of 17 senofilcon A CL wearers without any ocular or systemic diseases were examined before and 2 weeks after lens wear. Visual acuity measurements, tear evaporation rate, ELISA for tear cytokines, strip meniscometry, tear lipid layer interferometry, tear film break-up time (BUT), in vivo confocal microscopy, corneal sensitivity, ocular surface vital staining, Schirmer I test and brush cytology for MUC5AC mRNA expression were performed before and after CL wear. The best corrected Landolt VA, functional VA parameters, the mean lipid layer interferometry grades, tear evaporation rates, Schirmer test values, vital staining scores and in vivo confocal microscopy parameters did not show any significant differences after 2 weeks of CL wear. The tear film BUT showed a significant decrease together with a significant down regulation of MUC5 AC mRNA expression after CL wear. A statistically significant elevation in the mean tear interleukin (IL)-6 concentration was also observed after 2 weeks of CL wear. Two week senofilcon A daily CL wear seems to be associated with tear instability, a decrease in MUC5AC expression, and elevation of IL-6 in tears without significant alterations in epithelial damage scores or in the morphology or density of in vivo keratoconjunctival cells and nerves. Alterations associated with long term wear and patients with dry eye disease need to be studied in future trials. Copyright © 2010 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Formation of Hot Tear Under Controlled Solidification Conditions

NASA Astrophysics Data System (ADS)

Subroto, Tungky; Miroux, Alexis; Bouffier, Lionel; Josserond, Charles; Salvo, Luc; Suéry, Michel; Eskin, Dmitry G.; Katgerman, Laurens

2014-06-01

Aluminum alloy 7050 is known for its superior mechanical properties, and thus finds its application in aerospace industry. Vertical direct-chill (DC) casting process is typically employed for producing such an alloy. Despite its advantages, AA7050 is considered as a "hard-to-cast" alloy because of its propensity to cold cracking. This type of cracks occurs catastrophically and is difficult to predict. Previous research suggested that such a crack could be initiated by undeveloped hot tears (microscopic hot tear) formed during the DC casting process if they reach a certain critical size. However, validation of such a hypothesis has not been done yet. Therefore, a method to produce a hot tear with a controlled size is needed as part of the verification studies. In the current study, we demonstrate a method that has a potential to control the size of the created hot tear in a small-scale solidification process. We found that by changing two variables, cooling rate and displacement compensation rate, the size of the hot tear during solidification can be modified in a controlled way. An X-ray microtomography characterization technique is utilized to quantify the created hot tear. We suggest that feeding and strain rate during DC casting are more important compared with the exerted force on the sample for the formation of a hot tear. In addition, we show that there are four different domains of hot-tear development in the explored experimental window—compression, microscopic hot tear, macroscopic hot tear, and failure. The samples produced in the current study will be used for subsequent experiments that simulate cold-cracking conditions to confirm the earlier proposed model.

Changes in Tear Volume after 3% Diquafosol Treatment in Patients with Dry Eye Syndrome: An Anterior Segment Spectral-domain Optical Coherence Tomography Study.

PubMed

Lee, Kwan Bok; Koh, Kyung Min; Kwon, Young A; Song, Sang Wroul; Kim, Byoung Yeop; Chung, Jae Lim

2017-08-01

To evaluate changes in the tear meniscus area and tear meniscus height over time in patients with dry eye syndrome, using anterior segment spectral-domain optical coherence tomography after the instillation of 3% diquafosol ophthalmic solution. Sixty eyes from 30 patients with mild to moderate dry eye syndrome were included. Tear meniscus images acquired by anterior segment spectral-domain optical coherence tomography were analyzed using National Institutes of Health's image-analysis software (ImageJ 1.44p). Tear meniscus area and tear meniscus height were measured at baseline, 5 minutes, 10 minutes, and 30 minutes after instillation of a drop of diquafosol in one eye and normal saline in the other eye. Changes in ocular surface disease index score, tear film break-up time, corneal staining score by Oxford schema, and meibomian expressibility were also evaluated at baseline, and after 1 week and 1 month of a diquafosol daily regimen. Sixty eyes from 30 subjects (mean age, 29.3 years; 8 men and 22 women) were included. In eyes receiving diquafosol, tear volume was increased at 5 and 10 minutes compared with baseline. It was also higher than saline instilled eyes at 5, 10, and 30 minutes. Changes in tear volume with respect to baseline were not statistically different after the use of diquafosol for 1 month. Ocular surface disease index score, tear film break-up time, and Oxford cornea stain score were significantly improved after 1 week and 1 month of daily diquafosol instillation, but meibomian expressibility did not change. Topical diquafosol ophthalmic solution effectively increased tear volume for up to 30 minutes, compared to normal saline in patients with dry eye syndrome. © 2017 The Korean Ophthalmological Society

Non-invasive pre-lens tear film assessment with high-speed videokeratoscopy.

PubMed

Llorens-Quintana, Clara; Mousavi, Maryam; Szczesna-Iskander, Dorota; Iskander, D Robert

2018-02-01

To evaluate the effect of two types of daily contact lenses (delefilcon A and omafilcon A) on the tear film and establish whether it is dependent on pre-corneal tear film characteristics using a new method to analyse high-speed videokeratoscopy recordings, as well as to determine the sensitivity of the method in differentiating between contact lens materials on eye. High-speed videokeratoscopy recordings were analysed using a custom made automated algorithm based on a fractal dimension approach that provides a set of parameters directly related to tear film stability. Fifty-four subjects participated in the study. Baseline measurements, in suppressed and natural blinking conditions, were taken before subjects were fitted with two different daily contact lenses and after four hours of contact lens wear. The method for analysing the stability of the tear film provides alternative parameters to the non-invasive break up time to assess the quality of the pre-corneal and pre-lens tear film. Both contact lenses significantly decreased the quality of the tear film in suppressed and natural blinking conditions (p<0.001). The utilised method was able to distinguish between contact lens materials on eye in suppressed blinking conditions. The pre-corneal tear film characteristics were not correlated with the decrease in pre-lens tear film quality. High-speed videokeratoscopy equipped with an automated method to analyse the dynamics of the tear film is able to distinguish between contact lens materials in vivo. Incorporating the assessment of pre-lens tear film to the clinical practice could aid improving contact lens fitting and understand contact lens comfort. Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

Antimicrobial compounds in tears.

PubMed

McDermott, Alison M

2013-12-01

The tear film coats the cornea and conjunctiva and serves several important functions. It provides lubrication, prevents drying of the ocular surface epithelia, helps provide a smooth surface for refracting light, supplies oxygen and is an important component of the innate defense system of the eye providing protection against a range of potential pathogens. This review describes both classic antimicrobial compounds found in tears such as lysozyme and some more recently identified such as members of the cationic antimicrobial peptide family and surfactant protein-D as well as potential new candidate molecules that may contribute to antimicrobial protection. As is readily evident from the literature review herein, tears, like all mucosal fluids, contain a plethora of molecules with known antimicrobial effects. That all of these are active in vivo is debatable as many are present in low concentrations, may be influenced by other tear components such as the ionic environment, and antimicrobial action may be only one of several activities ascribed to the molecule. However, there are many studies showing synergistic/additive interactions between several of the tear antimicrobials and it is highly likely that cooperativity between molecules is the primary way tears are able to afford significant antimicrobial protection to the ocular surface in vivo. In addition to effects on pathogen growth and survival some tear components prevent epithelial cell invasion and promote the epithelial expression of innate defense molecules. Given the protective role of tears a number of scenarios can be envisaged that may affect the amount and/or activity of tear antimicrobials and hence compromise tear immunity. Two such situations, dry eye disease and contact lens wear, are discussed here. Copyright © 2013 Elsevier Ltd. All rights reserved.

Incomplete response to artificial tears is associated with features of neuropathic ocular pain.

PubMed

Galor, Anat; Batawi, Hatim; Felix, Elizabeth R; Margolis, Todd P; Sarantopoulos, Konstantinos D; Martin, Eden R; Levitt, Roy C

2016-06-01

Artificial tears are first-line therapy for patients with dry eye symptoms. It is not known, however, which patient factors associate with a positive response to therapy. The purpose of this study was to evaluate whether certain ocular and systemic findings are associated with a differential subjective response to artificial tears. Cross-sectional study of 118 individuals reporting artificial tears use (hypromellose 0.4%) to treat dry eye-associated ocular pain. An evaluation was performed to assess dry eye symptoms (via the dry eye questionnaire 5 and ocular surface disease index), ocular and systemic (non-ocular) pain complaints and ocular signs (tear osmolarity, tear breakup time, corneal staining, Schirmer testing with anaesthesia, and eyelid and meibomian gland assessment). The main outcome measures were factors associated with differential subjective response to artificial tears. By self-report, 23 patients reported no improvement, 73 partial improvement and 22 complete improvement in ocular pain with artificial tears. Patients who reported no or partial improvement in pain with artificial tears reported higher levels of hot-burning ocular pain and sensitivity to wind compared with those with complete improvement. Patients were also asked to rate the intensity of systemic pain elsewhere in the body (other than the eye). Patients who reported no or incomplete improvement with artificial tears had higher systemic pain scores compared with those with complete improvement. Both ocular and systemic (non-ocular) pain complaints are associated with a differential subjective response to artificial tears. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair

PubMed Central

Abechain, José Jorge Kitagaki; Godinho, Glaydson Gomes; Matsunaga, Fabio Teruo; Netto, Nicola Archetti; Daou, Julia Pozzetti; Tamaoki, Marcel Jun Sugawara

2017-01-01

AIM To compare the functional outcomes of traumatic and non-traumatic rotator cuff tears after arthroscopic repair. METHODS Eighty-seven patients with rotator cuff tears following arthroscopic treatment were divided into traumatic and non-traumatic tear groups. Postoperative muscle strength and outcomes using the modified University of California, Los Angeles score were evaluated. Sex, age, affected limb and dominant limb were correlated between groups. Muscle strength of the repaired and unaffected shoulders was compared. Rotator cuff injury size was measured. RESULTS Of the 87 patients who underwent rotator cuff repairs, 35 had traumatic tears and 52 had non-traumatic tears. In patients with non-traumatic tears, the average age was 59 years, 74.5% were female, 96.1% were right-hand dominant and 92.3% had their dominant shoulder affected. Patients with traumatic tears were 59.5 years old on average, 51.4% were female, 91.4% were right-hand dominant and 88.5% had their dominant shoulder affected. No difference existed in the mean modified University of California, Los Angeles score between patients with traumatic tears (33.7) compared with those with non-traumatic tears (32.8). No strength differences were observed between groups: The strength difference between the non-affected and affected sides was 1.21 kg in the non-traumatic group and 1.39 kg in the traumatic group (P = 0.576), while the strength ratio between the non-affected/affected sides was 0.805 in the non-traumatic group and 0.729 in the traumatic group (P = 0.224). CONCLUSION The functional results of traumatic rotator cuff repairs are similar to non-traumatic tears. Both outcomes are satisfactory. PMID:28875129

Hot-Tearing Assessment of Multicomponent Nongrain-Refined Al-Cu Alloys for Permanent Mold Castings Based on Load Measurements in a Constrained Mold

DOE PAGES

Sabau, Adrian S.; Mirmiran, Seyed; Glaspie, Christopher; ...

2018-02-16

Here, the hot-tearing resistance of multicomponent Al-Cu alloys during permanent mold casting was investigated using a constrained permanent mold in which the load and temperature were measured. The nominal Cu composition was varied from 5 to 8 wt pct. Casting experiments were conducted without adding any grain-refining inoculants. The following variables, which were obtained from the measured load data during casting, were considered to assess the hot-tearing resistance of the Al-Cu multicomponent alloys: “V”-like signature in the load rate variation, load at solidus point, and load rate average over the freezing range. In addition, a hot-tearing criterion based on themore » variation of the fraction of solid in the late stages of solidification was used. It was found that all criteria considered can accurately predict the alloys with the lowest and highest hot-tear resistance, respectively. It was found that the rate of measured load during casting could be used to indicate substantial hot tearing. However, the load rate variation could not be used to detect when small hot tears were present. Among all the criteria considered, the load at the solidus point shows an excellent agreement with experimentally observed hot-tearing resistance for all but one alloy. The poorly resistant hot-tearing alloys exhibited mainly coarse columnar grains while the most hot-tearing resistant alloys exhibited a much more refined grain microstructure. This is the first study in which good hot-tear resistance is demonstrated for multicomponent Al-Cu alloys with nominal Cu content greater than 7 wt pct.« less

Rotator cuff tear and sarcopenia: are these related?

PubMed

Chung, Seok Won; Yoon, Jong Pil; Oh, Kyung-Soo; Kim, Hyung Sup; Kim, Young Gun; Lee, Hyun-Joo; Jeong, Won-Ju; Kim, Dong-Hyun; Lee, Jong Soo; Yoon, Jee Wook

2016-09-01

Sarcopenia is the loss of muscle mass and consequent loss of muscle function with aging. Its prevalence among the general population is 12% to 30% in those aged >60 years. We evaluated (1) the difference in the prevalence of sarcopenia between patients with rotator cuff tear and controls and (2) the sarcopenia severity according to the size of the rotator cuff tear. Group 1 included 48 consecutive patients with chronic symptomatic full-thickness rotator cuff tears (mean age, 60.1 ± 6.5 years; range, 46-76 years), and group 2 included 48 age- and sex-matched patients. The sarcopenic index was evaluated by using the grip strength of the asymptomatic contralateral side and the skeletal muscle mass. No significant differences were found in the baseline data and demographic factors between the groups. The sarcopenic index was significantly inferior in the rotator cuff tear group than in the age- and sex-matched control groups (P = .041, .007, and .05, respectively). Patients with large to massive tears had a significantly inferior sarcopenic index than those with small and medium tears. The results showed that sarcopenia was more severe in patients with a chronic symptomatic full-thickness rotator cuff tear than in the age- and sex-matched control population and was correlated with the size of the tear, with the numbers available. Despite the individual variance in the underlying medical condition and physical activities, this study suggests that clinicians should consider the sarcopenic condition of patients with a rotator cuff tear, especially in elderly patients with large to massive tears. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Delaminated rotator cuff tear: extension of delamination and cuff integrity after arthroscopic rotator cuff repair.

PubMed

Gwak, Heui-Chul; Kim, Chang-Wan; Kim, Jung-Han; Choo, Hye-Jeung; Sagong, Seung-Yeob; Shin, John

2015-05-01

The purpose of this study was to evaluate the extension of delamination and the cuff integrity after arthroscopic repair of delaminated rotator cuff tears. Sixty-five patients with delaminated rotator cuff tears were retrospectively reviewed. The delaminated tears were divided into full-thickness delaminated tears and partial-thickness delaminated tears. To evaluate the medial extension, we calculated the coronal size of the delaminated portion. To evaluate the posterior extension, we checked the tendon involved. Cuff integrity was evaluated by computed tomography arthrography. The mean medial extension in the full-thickness and partial-thickness delaminated tears was 18.1 ± 6.0 mm and 22.7 ± 6.3 mm, respectively (P = .0084). The posterior extension into the supraspinatus and the infraspinatus was 36.9% and 32.3%, respectively, in the full-thickness delaminated tears, and it was 27.7% and 3.1%, respectively, in the partial-thickness delaminated tears (P = .0043). With regard to cuff integrity, 35 cases of anatomic healing, 10 cases of partial healing defects, and 17 cases of retear were detected. Among the patients with retear and partial healing of the defect, all the partially healed defects showed delamination. Three retear patients showed delamination, and 14 retear patients did not show delamination; the difference was statistically significant (P = .0001). The full-thickness delaminated tears showed less medial extension and more posterior extension than the partial-thickness delaminated tears. Delamination did not develop in retear patients, but delamination was common in the patients with partially healed defects. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Impact of Flow Rate, Collection Devices, and Extraction Methods on Tear Concentrations Following Oral Administration of Doxycycline in Dogs and Cats.

PubMed

Sebbag, Lionel; Showman, Lucas; McDowell, Emily M; Perera, Ann; Mochel, Jonathan P

2018-04-30

Compare the precision of doxycycline quantification in tear fluid collected with either Schirmer strips or polyvinyl acetal (PVA) sponges following oral drug administration. Three dogs and 3 cats were administered doxycycline orally at a dose of 4.2-5 mg/kg every 12 h for 6 consecutive days. At day 5 and 6, blood and tear fluid were sampled to capture doxycycline trough and maximal concentrations. Tear fluid was collected 3 times (spaced 10 min apart) at each session with the absorbent material placed in the lower conjunctival fornix until the 20-mm mark was reached (Schirmer strip, one eye) or for 1 min (PVA sponge, other eye). Tear extraction was performed with either centrifugation or elution in methanol. Doxycycline concentrations were measured with liquid chromatography-mass spectrometry. Low (100 ng/mL) and high (1,000 ng/mL) tear concentrations measured in vivo were spiked into each absorbent material in vitro to evaluate percentage drug recovery. After oral administration of doxycycline, the drug reached the tear compartment at concentrations of 45.1-900.7 ng/mL in cats and 45.4-632.0 ng/mL in dogs, representing a tear-to-serum ratio of 12% and 16%, respectively. Doxycycline tear concentrations were significantly more precise when tear collection was performed with Schirmer strips rather than PVA sponges (P = 0.007), but were not correlated with tear flow rate. In vitro doxycycline recovery was poor to moderate (<75%). Schirmer strips represent a good option for lacrimal doxycycline quantification, although the collection and subsequent extraction have to be optimized to improve drug recovery.

Photon correlation spectroscopy applied to tear analysis.

PubMed

Picarazzi, S; Lecchi, M; Pastori, V; D'Arienzo, M; Scotti, R; Tavazzi, S

2017-09-01

This study aims to deepen the knowledge on tear film properties by the development of a protocol for analyses of Photon Correlation Spectroscopy (PCS) on human tears and by the comparison between PCS results obtained on tears of contact lens wearers and non-wearers. Tears (5μL) were collected by a glass capillary. The analyses provide the hydrodynamic diameter of tear components by analyzing intensity fluctuations in time of scattered light. PCS appears a promising technique for studying tear features and for shedding light on specific eye conditions, such as on the clinical effects of CL wear. In fact, statistical difference (p<0.001) was found between the measured mean hydrodynamic diameter of tear components of wearers and non-wearers, the resulting value significantly higher for CL wearers. The scenario does not substantially change after (25±5)min from the CL removal. The difference is attributed to changes in the interactions between tear constituents due to CL wear. In order to get deeper insights on the influence of CL wear on aggregation and structure of tear components, a preliminary Electron Spin Resonance (ESR) investigation was performed, monitoring Fe 3+ species. ESR spectra on tears of both CL wearers and non-wearers showed the presence of intense signals, probably associated to iron (III) centers in proteins such as lactoferrin, and a weaker resonance attributable to Fe 3+ species interacting with S-S bridges of lysozyme. Differences in ESR spectra between CL wearers and non-wearers were detected and tentatively ascribed to changes in coordination or in local environment of Fe 3+ centers connected to aggregation phenomena induced by CL wear, which promote their interaction with other neighboring iron species. Copyright © 2017. Published by Elsevier B.V.

Effect of Ambient Temperature on the Human Tear Film.

PubMed

Abusharha, Ali A; Pearce, E Ian; Fagehi, Raied

2016-09-01

During everyday life, the tear film is exposed to a wide range of ambient temperatures. This study aims to investigate the effect of ambient temperature on tear film physiology. A controlled environment chamber was used to create different ambient temperatures (5, 10, 15, 20, and 25°C) at a constant relative humidity of 40%. Subjects attended for two separate visits and were exposed to 25, 20, and 15°C at one visit and to 10 and 5°C at the other visit. The subjects were exposed to each room temperature for 10 min before investigating tear film parameters. The order of the visits was random. Tear physiology parameters assessed were tear evaporation rate, noninvasive tear break-up time (NITBUT), lipid layer thickness (LLT), and ocular surface temperature (OST). Each parameter was assessed under each condition. A threefold increase in tear evaporation rate was observed as ambient temperature increased to 25°C (P=0.00). The mean evaporation rate increased from 0.056 μL/min at 5°C to 0.17 μL/min at 25°C. The mean NITBUT increased from 7.31 sec at 5°C to 12.35 sec at 25°C (P=0.01). A significant change in LLT was also observed (P=0.00), LLT median ranged between 20 and 40 nm at 5 and 10°C and increased to 40 and 90 nm at 15, 20, and 25°C. Mean reduction of 4°C OST was observed as ambient temperature decreased from 25 to 5°C. Ambient temperature has a considerable effect on human tear film characteristics. Tear evaporation rate, tear LLT, tear stability, and OST were considerably affected by ambient temperature. Chronic exposure to low ambient temperature would likely result in symptoms of dry eye and ultimately ocular surface disorders.

Association Between Contact Lens Discomfort and Pre-lens Tear Film Kinetics.

PubMed

Guillon, Michel; Dumbleton, Kathryn A; Theodoratos, Panagiotis; Wong, Stephanie; Patel, Kishan; Banks, Gaidig; Patel, Trisha

2016-08-01

The relationship between contact lens wettability and comfort has been extensively evaluated; however, a direct correlation between the characteristics of the pre-lens tear film and the symptoms associated with contact lens discomfort has yet to be established. In addition, there is relatively limited knowledge relating to the entire tear film kinetics during the inter-blink period in contact lens wearers. The purpose of this analysis was to identify the characteristics of the pre-lens tear film kinetics that may be associated with the symptoms of contact lens discomfort. The study population comprised 202 soft (hydrogel and silicone hydrogel) contact lens wearers attending pre-screening visits at the OTG-i research clinic. All participants completed the Ocular Surface Disease Index (OSDI) questionnaire and the tear film was quantified via post hoc, masked analysis of high definition digital Tearscope videos recorded at the visit. The tear film kinetics of the least symptomatic wearers (OSDI lowest quintile scores, n = 45) were compared to the tear film kinetics of the most symptomatic wearers (OSDI highest quintile scores, n = 43). The hypothesis tested was that the tear film kinetics of asymptomatic wearers were better than tear film kinetics of symptomatic wearers. The distribution of lens types worn was as follows: Daily Disposable 46.5%, 1-Month Replacement 39.6%, and 2-Week Replacement 13.6%. 48.2% of lenses were silicone hydrogel and 51.8% hydrogel. Symptomatic wearers had a shorter break-up time (4.7 s vs. 6.0 s; p = 0.003), lesser surface coverage by the tear film during the interblink period (95.1% vs. 98.5%; p < 0.001) and greater surface exposure at the time of the blink (9.4% vs. 3.9%; p = 0.001). The current study demonstrated that the tear film kinetics of asymptomatic and symptomatic contact lens wearers were different, the findings supporting the hypothesis of poorer tear film kinetics for symptomatic than asymptomatic wearers in a general contact lens wearing population.

[Effects of acupuncture on lactoferrin content in tears and tear secretion in patients suffering from dry eyes: a randomized controlled trial].

PubMed

Shi, Jing-lin; Miao, Wan-hong

2012-09-01

With the understanding of the immune inflammatory response in the pathogenesis of dry eyes, and the limitations of widely used artificial tears and numerous pharmaceuticals and methods to promote tear secretion, clinicians pay more attention to the therapies that can promote tear secretion actively. Acupuncture treatment for dry eye may meet this requirement. To observe the clinical efficacy of acupuncture treatment on dry eye and the effects on duration, and to examine the mechanisms of acupuncture in treating patients with dye eyes. The study was performed at Department of Ophthalmology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine from August 2010 to May 2011. Patients with the primary diagnosis of dry eye were enrolled. Sixty-five patients were randomly divided into treatment group and control group, and were given 3 weeks of acupuncture treatment or artificial tear therapy respectively. The enzyme-linked immunosorbent assay was used to detect the lactoferrin content of the tears before and after treatment. In order to evaluate the efficacy of the treatment methods, the Schirmer I test and break-up time were also measured. Compared with before treatment, the lactoferrin content in the tears of patients in the treatment group increased, break-up time was prolonged and the result of the Schirmer I test showed improvement after 3 weeks of treatment. The indexes mentioned above did not change in the control group after treatment. There were no significant differences in tear lactoferrin and Schirmer I test between one week after treatment and after 3-week treatment in the treatment group, but break-up time was significantly shortened. The result of Schirmer I test in the treatment group was significantly higher than that in the control group one week after treatment. Acupuncture can increase tear lactoferrin level, extend tear film break-up time and promote tear secretion in patients with dry eye in a time-limited trial. With the end of treatment, the effect decreased.

[Alterations in tears aqueous layer during cytostatics treatment].

PubMed

Wojciechowska, Katarzyna; Wieckowska-Szakiel, Marzena; Rózalska, Barbara; Jurowski, Piotr

2013-01-01

The aim of the study was to evaluate tears secretion, pH and lysozyme activity in tears aqueous layer during chemotherapy in lung, breast and bowel cancer. 36 patients were enrolled to the study. Depending on the type of cancer and type of chemotherapy patients were divided into three groups. Group I (12 patients) diagnosed with non-small-cell lung cancer treated with PE schema (cisplatin, etoposide), Group II (12 patients) with breast cancer treated with FAC schema (fluorouracil, doxorubicin, cyclophosphamide), Group III (12 patients) with bowel cancer treated with FU/LV schema (fluorouracil, leucovorin). In all the patients: Schirmer's I test, pH measurements and lysozyme test were performed. Patients were examined before chemotherapy, after 2nd, 4th, 6th cycle. In group I and II lowering of tears secretion (p < 0.001) was revealed. In group III there was higher tears secretion (p < 0.001). PH was lowered after 2nd chemotherapy course in group I and II. In further treatment pH value were in the same lower level as after the second course. In group III there was higher pH--more alkaline (p < 0.001) after 2nd cycle of treatment and it was on the same level to the end of the examination process. Lowering of lysozyme activity in the tears film in all groups (p < 0.001) was established. The higher alterations of the lysozyme activity were observed in group treated with FAC schema. Cytostatic treatment has major influence on tears aqueous layer causing alterations of tears secretions. PH alterations depending on type of chemotherapy was observed. Lowering of lysozyme activity in tears was observed. All the deteriorations aggravate with duration of chemotherapy. Alterations of tears film parameters during chemotherapy may influence upon eye surface homeostasis and infectious complication. tears aqueous layer, Schirmer's test, lysozyme activity, tears pH.

Predictors of degenerative medial meniscus extrusion: radial component and knee osteoarthritis.

PubMed

Lee, Dae-Hee; Lee, Bum-Sik; Kim, Jong-Min; Yang, Kyung-Sook; Cha, Eun-Jong; Park, Ji-Hun; Bin, Seong-Il

2011-02-01

the purpose of this study was to determine the effect of a radial tear on degenerative medial meniscus posterior horn tear extrusion and to identify predictors of medial meniscus extrusion. we reviewed the records of 102 knees with medial meniscus posterior horn tears and degeneration that underwent a partial meniscectomy. Tears were classified as root (n = 17) and non-root (n = 85) tears, or as radial (n = 46) and non-radial (n = 56) tears. Groups were compared in terms of absolute and relative meniscal extrusion, and the proportion of knees with major (> 3 mm) extrusion. Multiple regression analysis was used to identify predictors of extrusion. the radial group had greater mean absolute (4 ± 1 vs. 3 ± 1 mm, P = 0.001) and relative (31 ± 11 vs. 23 ± 12%, P = 0.031) extrusion than the non-radial group. The radial group also had a greater proportion of major extrusions than the non-radial group (74% vs. 26%; P = 0.016). In contrast, the root tear and non-root tear groups were similar in terms of mean absolute (3 ± 1 vs. 3 ± 1 mm, P = n.s.) and relative (30 ± 7 vs. 26 ± 13%; P = n.s.) extrusion and in terms of proportion with major extrusions (59 vs. 55%; P = n.s.). Extrusion was found to be associated with a similar strength with both the presence of a radial component and the preoperative Kellgren-Lawrence grade. meniscal extrusion was greater and more severe in knees with a radial tear component than in knees without a radial component. The incidence and degree of major extrusion was similar in knees with root tears and non-root tears. A radial component and knee osteoarthritis severity were similarly predictive of absolute and relative extrusion. Meniscal extrusion in osteoarthritic knees was associated not only with degenerative meniscal tear but also with osteoarthritis severity. Therefore, arthroscopic meniscal procedures, especially meniscal repair, should be cautiously considered in patients with meniscal extrusion.

Should massive rotator cuff tears be reconstructed even when only partially repairable?

PubMed

Godenèche, Arnaud; Freychet, Benjamin; Lanzetti, Riccardo Maria; Clechet, Julien; Carrillon, Yannick; Saffarini, Mo

2017-07-01

(1) To evaluate midterm functional outcomes of arthroscopic repair of massive rotator cuff tears and (2) to determine the prognostic factors that could influence outcome. The hypothesis was that both partial and complete repairs would result in equivalent improvement of clinical score. From a prospective series of 525 rotator cuff repairs, we analysed records of the 73 patients who were treated for massive tears. The median follow-up was 41 months (range 29-55), and functional outcome was evaluated using the Constant score, shoulder strength, and subjective shoulder value. The median CS improved from 34 points to 81 points (p < 0.001). The scores were better for both types of two-tendon tears, posterosuperior (83, n = 33) and anterosuperior (85, n = 13) (n.s.), than for three-tendon tears (74, n = 27) (p < 0.001). The scores were also better when fatty infiltration was of stage I (84, n = 28) than of stage II (78, n = 34) (p < 0.001) or stage III (74, n = 11) (p = 0.04). The scores were only slightly higher for completely reparable tears (81.5, n = 50) than for partially reparable tears (79, n = 23) (n.s.). Ultrasonic examination revealed incomplete healing, in 10 of the 50 completely repaired tears, and in 11 of the 23 partially repaired tears. The results of the present study compare favourably with those in recent literature and confirm the hypothesis that both partial and complete repairs of massive rotator cuff tears produce equivalent improvements of Constant scores. The clinical relevance of these observations is that even if repairs of two-tendon tears result in superior functional outcomes, repairs of three-tendon tears produce equivalent 'relative' improvement that grants sufficient patient satisfaction and autonomy. Comparative case series, Level IV.

Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.

PubMed

Choi, Chul-Jun; Choi, Yun-Jin; Lee, Jae-Jeong; Choi, Chong-Hyuk

2010-12-01

The purpose of this study was to evaluate the relation between meniscal extrusion on magnetic resonance imaging (MRI) and tearing of the posterior root of the medial meniscus, as well as to understand the relation between meniscal extrusion and chondral lesions. From January 2007 to December 2008, 387 consecutive cases of medial meniscal tears were treated arthroscopically. Of these cases, 248 (64.1%) with MRI were reviewed. Arthroscopic findings were reviewed for the type of tear and medial compartment cartilage lesion. Root tear was defined as a radial tear in the posterior horn of the medial meniscus near the tibial spine (i.e., within 5 mm of the root attachment). An MRI scan of the knee was used to evaluate the presence and extent of meniscal extrusion. Meniscal extrusion of 3 mm or greater was considered pathologic. Arthroscopic findings were compared with respect to the extent of meniscal extrusion. There were 98 male patients and 150 female patients. The mean age was 53.5 years (range, 15 to 81 years). The results showed 127 cases (51.2%) in which the medial meniscus had meniscal extrusion of 3 mm or greater. Posterior root tears were found in 66 (26.6%) of the 248 knees. The mean meniscal extrusion in patients with root tear was 3.8 ± 1.4 mm, whereas the mean extrusion of those who had no root tear was 2.7 ± 1.3 mm. We found an association between pathologic meniscal extrusion and root tear (P < .001). Meniscal extrusion showed a low positive predictive value (39%) and specificity (58%) with regard to the meniscal root tear. Meniscal extrusion was also significantly correlated with severity of chondral lesions (P < .001). Considerable extrusion (≥3 mm) can be associated with tearing of the medial meniscus root and chondral lesion of the medial femoral condyle. Level IV, therapeutic case series. Copyright © 2010 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Clinical and surgical correlation of hip MR arthrographic findings in adolescents.

PubMed

Jawahar, Anugayathri; Vade, Aruna; Lomasney, Laurie; Okur, Gokcan; Evans, Douglas; Subbaiah, Perla

2016-06-01

The purpose of this study was to analyze the utility of MRA-H in adolescents by comparing the results of imaging with surgical findings and/or clinical outcome. After obtaining appropriate IRB approval, the Radiologic Information System database was queried for all patients 13-18 years of age who underwent MRA-H from 2004 through 2013. The electronic medical record was reviewed for clinical history, clinical examination findings, and operative notes. MRA-H images were reviewed for soft tissue abnormalities (labral tear, paralabral ganglion, articular cartilage loss, synovitis, ligament tears) and bony abnormalities (cam-type femoroacetabular impingement (FAI), pincer-type FAI, hip dysplasia). MRA-H findings were correlated with surgical findings and with clinical outcomes. Twenty-six patients with labral tears by MRA-H were included in study and grouped as follows: Group I) patients who underwent surgical management (n=10); group II) patients managed non-surgically (medication, intra-articular injection, physical therapy) (n=9); group III) patients lost to follow up after being advised to have surgery (n=7). With regard to presenting symptomatology, 87.5% of patients with labral tear had groin pain. Of those patients who were diagnosed with a labral tear, 52% were categorized as idiopathic labral tears, 26% as secondary tears (secondary to abnormal bony morphology), and 22% as traumatic labral tears. The labral tears were found to be anterior in 61% and posterior in 22%. Associated articular cartilage lesions were found in 29% of patients. In group I (surgical patients), MRA-H labral findings were confirmed at surgery in 9/10. Seventy percent of labral tears in our study had some form of abnormal bony morphology. Nine of the 12 patients with bone abnormalities were derived from group I patients. Six out of 7 patients with cam-type FAI had a labral tear. Labral tears diagnosed by MRA-H in the adolescent population correlated well with clinical examination and surgical findings. Also, MRA-H contributed by defining bony morphology that was directly applied to surgical management. Non-surgical management of labral tears diagnosed on MRA-H had a generally favorable outcome. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Altered tibiofemoral contact mechanics due to lateral meniscus posterior horn root avulsions and radial tears can be restored with in situ pull-out suture repairs.

PubMed

LaPrade, Christopher M; Jansson, Kyle S; Dornan, Grant; Smith, Sean D; Wijdicks, Coen A; LaPrade, Robert F

2014-03-19

An avulsion of the posterior root attachment of the lateral meniscus or a radial tear close to the root attachment can lead to degenerative knee arthritis. Although the biomechanical effects of comparable injuries involving the medial meniscus have been studied, we are aware of no such study involving the lateral meniscus. We hypothesized that in situ pull-out suture repair of lateral meniscus root avulsions and of complete radial tears 3 and 6 mm from the root attachment would increase the contact area and decrease mean and peak tibiofemoral contact pressures, at all knee flexion angles, relative to the corresponding avulsion or tear condition. Eight human cadaveric knees underwent biomechanical testing. Eight lateral meniscus conditions (intact, footprint tear, root avulsion, root avulsion repair, radial tears at 3 and 6 mm from the posterior root, and repairs of the 3 and 6-mm tears) were tested at five different flexion angles (0°, 30°, 45°, 60°, and 90°) under a compressive 1000-N load. Avulsion of the posterior root of the lateral meniscus or an adjacent radial tear resulted in significantly decreased contact area and increased mean and peak contact pressures in the lateral compartment, relative to the intact condition, in all cases except the root avulsion condition at 0° of flexion. In situ pull-out suture repair of the root avulsion or radial tear significantly reduced mean contact pressures, relative to the corresponding avulsion or tear condition, when the results for each condition were pooled across all flexion angles. Posterior horn root avulsions and radial tears adjacent to the root attachment of the lateral meniscus significantly increased contact pressures in the lateral compartment. In situ pull-out suture repairs of these tears significantly improved lateral compartment joint contact pressures. In situ repair may be an effective treatment to improve tibiofemoral contact profiles after an avulsion of the posterior root of the lateral meniscus or a complete radial tear adjacent to the root. In situ repairs should be further investigated clinically as an alternative to partial lateral meniscectomy.

Proteases, proteolysis and inflammatory molecules in the tears of people with keratoconus.

PubMed

Balasubramanian, Sivaraman Arumugam; Mohan, Sujatha; Pye, David Cecil; Willcox, Mark Duncan Perry

2012-06-01

To investigate the expression of proteases, proteolytic activity and cytokines in the tear film of people with keratoconus. Basal tears from people with keratoconus, from individuals who had undergone corneal collagen cross-linking for the treatment of keratoconus, and from normal controls were collected using a capillary tube. Corneal curvature of each subject was mapped. The total protein in tears was estimated. Levels and activity of proteases in the tears were analysed using specific antibody arrays and activity assays. The total tear protein level was significantly reduced in keratoconus (4.1 ± 0.9 mg/ml) compared with normals (6.7 ± 1.4 mg/ml) (p < 0.0001) or subjects who had undergone corneal collagen cross-linking (5.7 ± 2.3 mg/ml) (p < 0.005). Significantly (p < 0.05) increased tear expression of matrix metalloproteinases (MMP) -1, -3, -7, -13, interleukins (IL) -4, -5, -6, -8 and tumour necrosis factor (TNF) -α, -β were evident in keratoconus. Tear IL-6 was the only cytokine significantly (p < 0.05) increased in tears of keratoconus subjects compared with the collagen cross-linked group. No significant difference in tear proteases were observed between the normal and the cross-linked groups, although the expression of TNF-α was significantly (p < 0.05) increased in the cross-linked group compared with the controls. Elevated gelatinolytic (87.5 ± 33.6 versus 45.8 ± 24.6 FIU, p < 0.0001) and collagenolytic (6.1 ± 3.2 versus 3.6 ± 2.0 FIU, p < 0.05) activities were observed in tears from keratoconus compared with normal subjects. The activity of tear gelatinases (69.6 ± 22.2 FIU) and collagenases (5.7 ± 3.3 FIU) in the collagen cross-linked group was not significantly different compared with either keratoconus or normals. Tears of people with keratoconus had 1.9 times higher levels of proteolytic activity and over expression of several MMPs and cytokines compared with tears from controls. Further investigations are required to study the possible implications of these changes and whether they can be used to monitor disease progression or determine the success of corneal collagen cross-linking. © 2012 The Authors. Acta Ophthalmologica © 2012 Acta Ophthalmologica Scandinavica Foundation.

Moved to Tears: Technical Considerations and Dilemmas Encountered in Working with a 13-Year-Old Boy with Acquired Quadriplegia

ERIC Educational Resources Information Center

Owens, Caroline

2005-01-01

This paper is about therapeutic work with David, a 13-year-old boy who, at the age of 5, was the victim of a hit-and-run road traffic accident resulting in quadriplegia. The circumstances leading to the accident and its sequelae reveal a particularly complex picture, which combines early emotional deprivation and trauma. Although cognitively…

Do Ligamentum Teres Tears Portend Inferior Outcomes in Patients With Borderline Dysplasia Undergoing Hip Arthroscopic Surgery? A Match-Controlled Study With a Minimum 2-Year Follow-up.

PubMed

Chaharbakhshi, Edwin O; Perets, Itay; Ashberg, Lyall; Mu, Brian; Lenkeit, Christopher; Domb, Benjamin G

2017-09-01

Arthroscopic surgery in borderline dysplastic hips remains controversial, but the role of the ligamentum teres (LT) has not been studied in this setting. Borderline dysplastic patients with LT tears have worse short-term outcomes than those without LT tears. Cohort study; Level of evidence, 3. Data were prospectively collected on patients who underwent arthroscopic surgery between February 2008 and April 2014. The inclusion criteria were borderline dysplasia (lateral center-edge angle [LCEA], 18°-25°) and labral tears; arthroscopic treatments including labral preservation and capsular plication; and preoperative patient-reported outcome scores including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport-Specific Subscale, and visual analog scale for pain. Patients were excluded for preoperative Tönnis osteoarthritis grade >0, workers' compensation claims, previous ipsilateral hip surgery and conditions, or frank dysplasia (LCEA <18°). Patients with LT tears were pair-matched to patients without tears for sex, age at surgery ±10 years, body mass index (<30 kg/m 2 vs ≥30 kg/m 2 ), labral treatment type, and microfracture. Of 68 eligible patients, 63 (93%) had a minimum 2-year follow-up, and 30 (48%) had LT tears. Twenty patients in each group were pair-matched. The mean follow-up time was 54.3 months (range, 24.2-83.8 months) for the LT tear group and 38.6 months (range, 24.6-70.6 months) for the control group ( P = .002). Ninety percent were female. There were no significant differences regarding demographics or intra-operative procedures. The LT tear group trended toward lower postoperative mHHS ( P = .09) and NAHS ( P = .09) values. Mean satisfaction was 8.1 for the LT tear group and 7.9 for the control group. Preoperative and follow-up scores were not significantly different between the groups. The LT tear group had 5 revisions, with 1 revision in the control group. Three patients (15%) in the LT tear group underwent total hip arthroplasty (THA); no patients in the control group required THA. In borderline dysplastic patients undergoing hip arthroscopic surgery with labral treatment and capsular plication, LT tears may indicate advanced instability and portend slightly inferior outcomes when compared with a match-controlled group. Borderline dysplastic patients with LT tears may have increased propensities toward revision arthroscopic surgery and conversion to THA. LT tears in these patients may warrant consideration for additional procedures including periacetabular osteotomy and LT reconstruction.

77 FR 66757 - Airworthiness Directives; The Boeing Company Airplanes

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-07

... tear straps and in the skin locations common to the tear straps. Additionally, we received a report of... cracking in the lap joint fastener row between tear straps of the crown lap and do a detailed inspection of...-53A1255, Revision 2, dated August 7, 2012. (j) Optional Inspections for Tear Strap Locations Only As an...

A very rare case of bloody tears with enigmatic epistaxis and haematuria.

PubMed

Ho, Jason Z S; de Silva, Julian; Olver, Jane

2011-03-01

Bloody tears are a rare symptom that can be caused by local or systemic pathology. We describe a very rare case of bloody tears that resulted from hyperthyroidism. A 15-year-old female patient presented with a 6-month history of bloody tears and epistaxis. Examination excluded local ocular and nasal pathology, including neoplasm and coagulopathy. Systemic investigations identified elevated thyroid function and following treatment her symptoms resolved. We discuss the mechanism by which hyperthyroidism may induce haemostatic dysfunction. We present the first case of bloody tears secondary to thyroid dysfunction.

The Art of Dressing Selection: A Consensus Statement on Skin Tears and Best Practice.

PubMed

LeBlanc, Kimberly; Baranoski, Sharon; Christensen, Dawn; Langemo, Diane; Edwards, Karen; Holloway, Samantha; Gloeckner, Mary; Williams, Ann; Campbell, Karen; Alam, Tarik; Woo, Kevin Y

2016-01-01

To provide information about product selection for the management of skin tears. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Explain skin tear (ST) risk factors and assessment guidelines.2. Identify best practice treatments for STs, including the appropriate dressings for each ST type. To aid healthcare professionals in product selection specific for skin tears, the International Skin Tear Advisory Panel conducted a systematic literature review and 3-phase Delphi consensus with a panel of international reviewers to provide the best available evidence for product selection related to the treatment of skin tears.

Interactions of toroidally coupled tearing modes in the KSTAR tokamak

NASA Astrophysics Data System (ADS)

Kim, Gnan; Yun, Gunsu S.; Woo, Minho; Park, Hyeon K.; KSTAR Team2, the

2018-03-01

The evolutions of toroidally coupled radially-distant and radially-adjacent tearing modes are visualized in 2D in detail on the Korea superconducting tokamak for advanced research. The coupled tearing modes are in-phase on the out-board mid-plane and become destabilized or compete with each other depending on their spatial separation. When two coupled tearing modes are far apart, both are increasingly destabilized. On the other hand, when they become close to each other, one becomes stabilized while the other becomes destabilized. In such cases, an additional tearing mode is often formed on outer rational flux surface and the three tearing modes compete. The competitions suggest that spatial overlap (merging) of coupled magnetic islands is difficult.

Investigation of Tear Biomarkers as an Indicator of Human Health

NASA Technical Reports Server (NTRS)

Morton, Stephen; Tucker, Bethany; Crucian, Brian; Steinberg, Susan; Hagan, Suzanne

2017-01-01

Scientific literature suggests that tear biomarkers can be used as a guide towards clinical diagnosis of human health (Hagan et al., 2016). This study will investigate whether tear biomarkers represents a research and clinical opportunity to assess human health prior to, during, and after exposure to the spaceflight environment. The focus of this study is to compare biomarkers previously identified as potentially relevant to both ocular and brain health against unique physiological outcomes of exposure to the space flight environment. Study subjects suffering from terrestrial conditions thought to be similar to Spaceflight Associated Neuro-ocular Syndrome (SANS: formerly VIIP), e.g. patients with idiopathic intracranial hypertension (IIH) and optic neuritis may be relevant to conditions associated with spaceflight. This study will review methodologies, tear biomarkers related to state of ocular and brain health, the strengths and weakness of using tear fluid biomarkers versus other body fluid samples, and will survey current tear fluid biomarker knowledge in research and clinical practice. A strength of using tear biomarkers is that sampling is non-invasive and used as a guide in understanding pathologies, including ocular and systemic inflammatory conditions (Cocho et al., 2016)., Salvisberg et al., 2014). Moreover, tear biomarkers may reflect diseases affecting the central nervous system (CNS) (Salvisberg et al., 2014). For example, in multiple sclerosis (MS), the concordance rate between tear biomarkers versus cerebrospinal fluid (CSF) is approximately 83%, indicating that, in the majority of cases, tears are at least as effective as CSF in potentially identifying novel MS biomarkers (Devos et al., 2001).

Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI.

PubMed

Ringler, Michael D; Shotts, Ezekiel E; Collins, Mark S; Howe, B Matthew

2016-12-01

Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee.

Hyperosmolar Tears Induce Functional and Structural Alterations of Corneal Nerves: Electrophysiological and Anatomical Evidence Toward Neurotoxicity

PubMed Central

Hirata, Harumitsu; Mizerska, Kamila; Marfurt, Carl F.; Rosenblatt, Mark I.

2015-01-01

Purpose In an effort to elucidate possible neural mechanisms underlying diminished tearing in dry eye disease, this study sought to determine if hyperosmolar tears, a ubiquitous sign of dry eye disease, produce functional changes in corneal nerve responses to drying of the cornea and if these changes correlate with alterations in corneal nerve morphology. Methods In vivo extracellular electrophysiological recordings were performed in rat trigeminal ganglion neurons that innervated the cornea before, and up to 3 hours after, the ocular application of continuous hyperosmolar tears or artificial tears. In corollary experiments, immunohistochemical staining was performed to compare corneal nerve morphology in control and in eyes treated with hyperosmolar solutions. Results Our previous studies identified a population of corneal afferents, dry-sensitive neurons that are strongly excited by corneal dessication (“dry response”), a response thought to trigger the lacrimation reflex. In the present study, we found that the dry responses of corneal dry-sensitive neurons were depressed or even completely abolished by hyperosmolar tears in a time- (30 minutes to 3 hours) and dose (450- to 1000-mOsm solutions)-dependent manner. Furthermore, eyes treated with hyperosmolar tears for 3 hours contained large numbers of morphologically abnormal (granular, fragmented, or prominently beaded) subbasal nerves that appeared to be undergoing degeneration. Conclusions These results demonstrate that tear hyperosmolarity, considered to be a “core” mechanism of dry eye disease, significantly decreases physiological sensitivity and morphologic integrity of the corneal nerves important in tear production. These alterations might contribute to the diminished tearing seen clinically in dry eye patients. PMID:26720465

Advanced glycation end product (AGE) modified proteins in tears of diabetic patients.

PubMed

Zhao, Zhenjun; Liu, Jingfang; Shi, Bingyin; He, Shuixiang; Yao, Xiaoli; Willcox, Mark D P

2010-08-11

High glucose level in diabetic patients may lead to advanced glycation end product (AGE) modified proteins. This study investigated AGE modified proteins in tears and compared their levels in diabetic patients (DM) with non-diabetic controls (CTL). Basal tears were collected from DM with (DR) or without (DNR) retinopathy and CTL. Total AGE modified proteins were detected quantitatively by a dot immunobinding assay. The AGE modified proteins were separated in 1D- and 2D-SDS gels and detected by western-blotting. The individual AGE modified proteins were also compared between groups using densitometry. Compared with the CTL group, tear concentrations of AGE modified proteins were significantly elevated in DR and DNR groups. The concentration of AGE modified proteins in diabetic tears were positively correlated with AGE modified hemoglobin (HbA1c) and postprandial blood glucose level (PBG). Western blotting of AGE modified proteins from 1D-SDS gels showed several bands, the major one at around 60 kDa. The intensities of AGE modified protein bands were higher in DM tears than in CTL tears. Western blotting from 2D-SDS gels showed a strongly stained horizontal strip, which corresponded to the major band in 1D-SDS gels. Most of the other AGE modified protein species were within molecular weight of 30-60 kDa, PI 5.2-7.0. Densitometry analysis demonstrated several AGE modified proteins were elevated in DR or DNR tears. Total and some individual AGE modified proteins were elevated in DM tears. AGE modified proteins in tears may be used as biomarkers to diagnose diabetes and/or diabetic retinopathy.

Detection of prosecretory mitogen lacritin in nonprimate tears primarily as a C-terminal-like fragment.

PubMed

Laurie, Diane E; Splan, Rebecca K; Green, Kari; Still, Katherine M; McKown, Robert L; Laurie, Gordon W

2012-09-12

Lacritin is a human tear glycoprotein that promotes basal tear protein secretion in cultured rat lacrimal acinar cells and proliferation of subconfluent human corneal epithelial cells. When topically added to rabbit eyes, lacritin promotes basal tearing. Despite these activities on several species, lacritin's presence in nonprimate tears or other tissues has not been explored. Here we probed for lacritin in normal horse tears. Sequences were collected from the Ensembl genomic alignment of human LACRT gene with high-quality draft horse genome (EquCab2.0) and analyzed. Normal horse tears were collected and assayed by Western blotting, ELISA, and mass spectrometry. Newly generated rabbit antibodies, respectively, against N- and C-terminal regions of human lacritin were employed. Identity was 75% and 45%, respectively, at nucleotide and protein levels. Structural features were conserved, including a C-terminal amphipathic α-helix. Anti-C-terminal antibodies strongly detected a ∼13 kDa band in horse tears that was validated by mass spectrometry. In human tears, the same antibody detected uncleaved lacritin (∼24 kDa) strongly and C-terminal fragments of ∼13 and ∼11 kDa weakly. Anti-N-terminal antibodies were slightly reactive with a ∼24 kDa horse antigen and showed no reaction with the anti-C-terminal-reactive ∼13 kDa species. Similar respective levels of horse C-terminal versus N-terminal immunoreactivity were apparent by ELISA. Lacritin is present in horse tears, largely as a C-terminal fragment homologous to the mitogenic and bactericidal region in human lacritin, suggesting potential benefit in corneal wound repair.

Hyperosmolar Tears Induce Functional and Structural Alterations of Corneal Nerves: Electrophysiological and Anatomical Evidence Toward Neurotoxicity.

PubMed

Hirata, Harumitsu; Mizerska, Kamila; Marfurt, Carl F; Rosenblatt, Mark I

2015-12-01

In an effort to elucidate possible neural mechanisms underlying diminished tearing in dry eye disease, this study sought to determine if hyperosmolar tears, a ubiquitous sign of dry eye disease, produce functional changes in corneal nerve responses to drying of the cornea and if these changes correlate with alterations in corneal nerve morphology. In vivo extracellular electrophysiological recordings were performed in rat trigeminal ganglion neurons that innervated the cornea before, and up to 3 hours after, the ocular application of continuous hyperosmolar tears or artificial tears. In corollary experiments, immunohistochemical staining was performed to compare corneal nerve morphology in control and in eyes treated with hyperosmolar solutions. Our previous studies identified a population of corneal afferents, dry-sensitive neurons that are strongly excited by corneal dessication ("dry response"), a response thought to trigger the lacrimation reflex. In the present study, we found that the dry responses of corneal dry-sensitive neurons were depressed or even completely abolished by hyperosmolar tears in a time- (30 minutes to 3 hours) and dose (450- to 1000-mOsm solutions)-dependent manner. Furthermore, eyes treated with hyperosmolar tears for 3 hours contained large numbers of morphologically abnormal (granular, fragmented, or prominently beaded) subbasal nerves that appeared to be undergoing degeneration. These results demonstrate that tear hyperosmolarity, considered to be a "core" mechanism of dry eye disease, significantly decreases physiological sensitivity and morphologic integrity of the corneal nerves important in tear production. These alterations might contribute to the diminished tearing seen clinically in dry eye patients.

Do Magnetic Resonance Imaging Characteristics of Full-Thickness Rotator Cuff Tears Correlate With Sleep Disturbance?

PubMed

Reyes, Bryan A; Hull, Brandon R; Kurth, Alexander B; Kukowski, Nathan R; Mulligan, Edward P; Khazzam, Michael S

2017-11-01

Many patients with rotator cuff tears suffer from nocturnal shoulder pain, resulting in sleep disturbance. To determine whether rotator cuff tear size correlated with sleep disturbance in patients with full-thickness rotator cuff tears. Cross-sectional study; Level of evidence, 3. Patients with a diagnosis of unilateral full-thickness rotator cuff tears (diagnosed via magnetic resonance imaging [MRI]) completed the Pittsburgh Sleep Quality Index (PSQI), a visual analog scale (VAS) quantifying their shoulder pain, and the American Shoulder and Elbow Surgeons (ASES) questionnaire. Shoulder MRI scans were analyzed for anterior-posterior tear size (mm), tendon retraction (mm), Goutallier grade (0-4), number of tendons involved (1-4), muscle atrophy (none, mild, moderate, or severe), and humeral head rise (present or absent). Bivariate correlations were calculated between the MRI characteristics and baseline survey results. A total of 209 patients with unilateral full-thickness rotator cuff tears were included in this study: 112 (54%) female and 97 (46%) male (mean age, 64.1 years). On average, shoulder pain had been present for 24 months. The mean PSQI score was 9.8, and the mean VAS score was 5.0. No significant correlations were found between any of the rotator cuff tear characteristics and sleep quality. Only tendon retraction had a significant correlation with pain. Although rotator cuff tears are frequently associated with nocturnal pain and sleep disruption, this study demonstrated that morphological characteristics of full-thickness rotator cuff tears, such as size and tendon retraction, do not correlate with sleep disturbance and have little to no correlation with pain levels.

A Multicenter Study of the Presentation, Treatment, and Outcomes of Cervical Dural Tears.

PubMed

O'Neill, Kevin R; Fehlings, Michael G; Mroz, Thomas E; Smith, Zachary A; Hsu, Wellington K; Kanter, Adam S; Steinmetz, Michael P; Arnold, Paul M; Mummaneni, Praveen V; Chou, Dean; Nassr, Ahmad; Qureshi, Sheeraz A; Cho, Samuel K; Baird, Evan O; Smith, Justin S; Shaffrey, Christopher; Tannoury, Chadi A; Tannoury, Tony; Gokaslan, Ziya L; Gum, Jeffrey L; Hart, Robert A; Isaacs, Robert E; Sasso, Rick C; Bumpass, David B; Bydon, Mohamad; Corriveau, Mark; De Giacomo, Anthony F; Derakhshan, Adeeb; Jobse, Bruce C; Lubelski, Daniel; Lee, Sungho; Massicotte, Eric M; Pace, Jonathan R; Smith, Gabriel A; Than, Khoi D; Riew, K Daniel

2017-04-01

Retrospective multicenter case series study. Because cervical dural tears are rare, most surgeons have limited experience with this complication. A multicenter study was performed to better understand the presentation, treatment, and outcomes following cervical dural tears. Multiple surgeons from 23 institutions retrospectively identified 21 rare complications that occurred between 2005 and 2011, including unintentional cervical dural tears. Demographic data and surgical history were obtained. Clinical outcomes following surgery were assessed, and any reoperations were recorded. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), Nurick classification (NuC), and Short-Form 36 (SF36) scores were recorded at baseline and final follow-up at certain centers. All data were collected, collated, and analyzed by a private research organization. There were 109 cases of cervical dural tears among 18 463 surgeries performed. In 101 cases (93%) there was no clinical sequelae following successful dural tear repair. There were statistical improvements ( P < .05) in mJOA and NuC scores, but not NDI or SF36 scores. No specific baseline or operative factors were found to be associated with the occurrence of dural tears. In most cases, no further postoperative treatments of the dural tear were required, while there were 13 patients (12%) that required subsequent treatment of cerebrospinal fluid drainage. Analysis of those requiring further treatments did not identify an optimum treatment strategy for cervical dural tears. In this multicenter study, we report our findings on the largest reported series (n = 109) of cervical dural tears. In a vast majority of cases, no subsequent interventions were required and no clinical sequelae were observed.

The triple PCL sign: bucket handle tears of both medial and lateral menisci in a chronically ACL-deficient knee.

PubMed

Kakel, Rafid; Russell, Robert; VanHeerden, Pieter

2010-10-11

Bucket handle tears of both menisci in the setting of acute or chronic anterior cruciate ligament (ACL) tears of the same knee have rarely been reported in the literature. This article presents a case of a bucket handle tear affecting both the medial and lateral menisci in a patient with chronic ACL rupture. Both bucket handle tears were displaced and locked in the intercondylar notch. A new magnetic resonance image (MRI) sign suggested on sagittal view is called the triple PCL sign, comprising the intact posterior cruciate ligament (PCL) and the 2 displaced fragments in the intercondylar notch from the two bucket handle tears. The precise diagnosis of this condition is of obvious importance for optimal operative planning. While finding the displaced fragment from the medial meniscus is expected to cause the double PCL sign, the torn ACL may have made it easier to visualize the bucket handle tear of the lateral meniscus in the same sagittal plane as the PCL. Only 5 other reports mention bimeniscal bucket handle tears of both the medial and lateral menisci in association with an ACL tear. None have shown the suggested triple PCL sign because of lack of overlap between the 2 bucket handle tears in the coronal plane while lying in the intercondylar notch causing them not to fall in the same sagittal plane. Our patient showed some overlap between the 2 meniscal fragments while lying in the notch to create the triple PCL sign on sagittal MRI. Copyright 2010, SLACK Incorporated.

Association of parameniscal cysts with underlying meniscal tears as identified on MRI and arthroscopy.

PubMed

De Smet, Arthur A; Graf, Ben K; del Rio, Alejandro Munoz

2011-02-01

Although patients with parameniscal cysts usually have underlying meniscal tears, we noted that this association was less common with anterior lateral cysts. We wished to determine whether the frequency of a meniscal tear underlying a parameniscal cyst varied with cyst location. We reviewed a database of 7,771 knee MR examinations and identified 134 patients with an MR diagnosis of 138 parameniscal cysts and correlative arthroscopy in 78 patients. We reviewed their medical records and MR studies to determine the location of the cysts and presence of an underlying meniscal tear as determined by MRI or arthroscopy. There were 50 lateral and 88 medial parameniscal cysts. Medial meniscal tears were found underlying a cyst in 96% of arthroscopy patients and 86% of patients who had only MR examinations without a location difference in tears (p = 0.68). Meniscal tears were found on MRI or arthroscopy in all 28 patients with a lateral cyst overlying the body or posterior horn of the lateral meniscus, whereas a tear was found on MRI or arthroscopy in only 14 (64%) of 22 patients with cysts adjacent to or extending to the lateral meniscus anterior horn (p = 0.006). Anterior lateral cysts extended medially either into the root or into Hoffa fat-pad, but the type of extension did not correlate with the presence of an underlying meniscal tear. In contrast to medial parameniscal cysts or cysts at other locations adjacent to the lateral meniscus, anteriorly located lateral parameniscal cysts are less likely to have underlying meniscal tears.

From platelet-rich plasma to the reverse prosthesis: controversies in treating rotator cuff pathology.

PubMed

Craig, Edward V; Galatz, Leesa M; Sperling, John W

2014-01-01

Rotator cuff pathology and tearing remains a common cause of shoulder pain and disability. Although little controversy and disagreement exists regarding the treatment of small to moderate size tears in good quality tissue without retraction, there is difficulty in agreeing on the ideal treatment of the largest tears, particularly because those tears may be accompanied by widely variable levels of pain and function. Clinical decision making is made more difficult because of the variable presentations observed in patients with a documented full-thickness rotator cuff tear: some have good function and no pain, some have good function and pain, some have poor function and no pain, and some have both poor function and pain. The role of biologics as an adjunct in treating most rotator cuff tears remains unclear, with ongoing exploration of the roles of stem cells, growth factors, and platelet-rich plasma. In patients with unreconstructable tears with marked weakness in external rotation but good elevation, a latissimus transfer may restore rotation. Patches may play a role in partial repairs while serving as both a lattice for healing and a biomechanical anchoring point for sutures. In patients with massive tears and arthritis and in many who have rotator cuff insufficiency, pseudoparalysis, or anterosuperior escape without arthritis, reverse shoulder arthroplasty has led to improvements in pain and strength and revolutionized the treatment of rotator cuff tears.

Influence of topical anesthesia on tear dynamics and ocular drug bioavailability in albino rabbits.

PubMed

Patton, T F; Robinson, J R

1975-02-01

The bioavailability of topically applied ocular drugs is very poor, due largely to drug loss through drainage and tear turnover. The use of high viscosity solutions or solid matrixes to delay or eliminate drainage is the usual approach for decreasing drug loss but the alternative approach of chemically reducing tear turnover and/or solution drainage has not been investigated. By means of a simple isotopic dilution technique, using radioactive technetium sulfur colloid, the quantitative influence of topical anesthetics on tear production and instilled solution drainage was determined. The reduction in the rate of tear turnover and solution drainage varies for different anesthetics and is dose dependent. The implication of these results for some long accepted clinical procedures is discussed, and questions are raised regarding the present understanding of the mechanisms of tear production. Quantitation of precorneal drug loss through instilled solution drainage and tear turnover permits the establishment of a baseline for ocular drug bioavailability. Aqueous humor drug concentration versus time profiles of radioactive pilocarpine nitrate were obtained, both in the presence and absence of topical anesthesia. The results verify the importance of tear turnover and instilled solution drainage as a major route of drug loss in the eye. Moreover, the success of the present study in improving ocular drug bioavailability by the chemical approach of repressing solution drainage and tear turnover suggests that this approach is viable for improving drug bioavailability.

Evaluation of aqueous tear production in dogs after general anaesthesia with medetomidine-propofol-carprofen-halothane.

PubMed

Komnenou, A T H; Kazakos, G M; Savvas, I; Thomas, A L N

2013-08-10

The influence of an anaesthetic protocol, which included medetomidine, propofol, carprofen and halothane on tear production in the dog. There are no previous studies on the effects of this combination on tear production in dogs or in any other species. The present study included 39 dogs, which underwent non-ophthalmic surgery in our clinic. Preanaesthetically, all dogs had normal tear production (18.62±3.65 mm/minute) as this was recorded with Schirmer tear test I (STT I) and the ophthalmologic examination did not reveal anything abnormal. Tear production readings were recorded before the administration of premedication, at the end of anaesthesia, one hour and two hours postanaesthesia. No reverse agent was administrated. At the end of anaesthesia (right eye (oculus dexter, OD) P<0.0005, left eye (oculus sinister, OS) P<0.0005), as well as one hour postanaesthesia (OD P=0.020, OS P=0.001) there was a statistically significant reduction in tear production, which returned to normal values two hours postanaesthesia, regardless of the duration of the operation. This anaesthetic combination resulted in a decrease in tear production and, therefore, the use of tear substitute treatment in dogs undergoing anaesthesia with this protocol (combination) from the time the sedative is given until at least two hours after the end of anaesthesia is highly recommended.

Role of hyperosmolarity in the pathogenesis and management of dry eye disease: proceedings of the OCEAN group meeting.

PubMed

Baudouin, Christophe; Aragona, Pasquale; Messmer, Elisabeth M; Tomlinson, Alan; Calonge, Margarita; Boboridis, Kostas G; Akova, Yonca A; Geerling, Gerd; Labetoulle, Marc; Rolando, Maurizio

2013-10-01

Dry eye disease (DED), a multifactorial disease of the tears and ocular surface, is common and has a significant impact on quality of life. Reduced aqueous tear flow and/or increased evaporation of the aqueous tear phase leads to tear hyperosmolarity, a key step in the vicious circle of DED pathology. Tear hyperosmolarity gives rise to morphological changes such as apoptosis of cells of the conjunctiva and cornea, and triggers inflammatory cascades that contribute to further cell death, including loss of mucin-producing goblet cells. This exacerbates tear film instability and drives the cycle of events that perpetuate the condition. Traditional approaches to counteracting tear hyperosmolarity in DED include use of hypotonic tear substitutes, which have relatively short persistence in the eye. More recent attempts to counteract tear hyperosmolarity in DED have included osmoprotectants, small organic molecules that are used in many cell types throughout the natural world to restore cell volume and stabilize protein function, allowing adaptation to hyperosmolarity. There is now an expanding pool of clinical data on the efficacy of DED therapies that include osmoprotectants such as erythritol, taurine, trehalose and L-carnitine. Osmoprotectants in DED may directly protect cells against hyperosmolarity and thereby promote exit from the vicious circle of DED physiopathology. Copyright © 2013 The Authors. Published by Elsevier Inc. All rights reserved.

Dynamic measurement of the corneal tear film with a Twyman-Green interferometer

NASA Astrophysics Data System (ADS)

Micali, Jason D.; Greivenkamp, John E.; Primeau, Brian C.

2014-07-01

An interferometer for measuring dynamic properties of the in vivo tear film on the human cornea has been developed. The system is a near-infrared instantaneous phase-shifting Twyman-Green interferometer. The laser source is a 785 nm solidstate laser; the system has been carefully designed and calibrated to ensure that the system operates at eye safe levels. Measurements are made over a 6 mm diameter on the cornea. Successive frames of interferometric height measurements are combined to produce movies showing both the quantitative and qualitative changes in the topography of the tear film surface and structure. To date, measurement periods of up to 120 seconds at 28.6 frames per second have been obtained. Several human subjects have been examined using this system, demonstrating a surface height resolution of 25 nm and spatial resolution of 6 μm. Examples of features that have been observed in these in preliminary studies of the tear film include: post-blink disruption, evolution, and stabilization of the tear film; tear film artifacts generated by blinking; tear film evaporation and break-up; and the propagation of foreign objects in the tear film. This paper discusses the interferometer design and presents results from in vivo measurements.

Dynamic measurement of the corneal tear film with a Twyman-Green interferometer

NASA Astrophysics Data System (ADS)

Micali, Jason D.; Greivenkamp, John E.; Primeau, Brian C.

2015-05-01

An interferometer for measuring dynamic properties of the in vivo tear film on the human cornea has been developed. The system is a near-infrared instantaneous phase-shifting Twyman-Green interferometer. The laser source is a 785 nm solid-state laser, and the system has been carefully designed and calibrated to ensure that the system operates at eye-safe levels. Measurements are made over a 6 mm diameter on the cornea. Successive frames of interferometric height measurements are combined to produce movies showing both the quantitative and qualitative changes in the topography of the tear film surface and structure. To date, measurement periods of up to 120 s at 28.6 frames per second have been obtained. Several human subjects have been examined using this system, demonstrating a surface height resolution of 25 nm and spatial resolution of 6 μm. Examples of features that have been observed in these preliminary studies of the tear film include postblink disruption, evolution, and stabilization of the tear film; tear film artifacts generated by blinking; tear film evaporation and breakup; and the propagation of foreign objects in the tear film. This paper discusses the interferometer design and presents results from in vivo measurements.

Relevance of Lipid-Based Products in the Management of Dry Eye Disease.

PubMed

Garrigue, Jean-Sébastien; Amrane, Mourad; Faure, Marie-Odile; Holopainen, Juha M; Tong, Louis

2017-11-01

Components of the ocular surface synergistically contribute to maintaining and protecting a smooth refractive layer to facilitate the optimal transmission of light. At the air-water interface, the tear film lipid layer (TFLL), a mixture of lipids and proteins, plays a key role in tear surface tension and is important for the physiological hydration of the ocular surface and for ocular homeostasis. Alterations in tear fluid rheology, differences in lipid composition, or downregulation of specific tear proteins are found in most types of ocular surface disease, including dry eye disease (DED). Artificial tears have long been a first line of treatment in DED and aim to replace or supplement tears. More recently, lipid-containing eye drops have been developed to more closely mimic the combination of aqueous and lipid layers of the TFLL. Over the last 2 decades, our understanding of the nature and importance of lipids in the tear film in health and disease has increased substantially. The aim of this article is to provide a brief overview of our current understanding of tear film properties and review the effectiveness of lipid-based products in the treatment of DED. Liposome lid sprays, emulsion eye drops, and other lipid-containing formulations are discussed.

Examination of tear film smoothness on corneae after refractive surgeries using a noninvasive interferometric method

NASA Astrophysics Data System (ADS)

Szczesna, Dorota H.; Kulas, Zbigniew; Kasprzak, Henryk T.; Stenevi, Ulf

2009-11-01

A lateral shearing interferometer was used to examine the smoothness of the tear film. The information about the distribution and stability of the precorneal tear film is carried out by the wavefront reflected from the surface of tears and coded in interference fringes. Smooth and regular fringes indicate a smooth tear film surface. On corneae after laser in situ keratomileusis (LASIK) or radial keratotomy (RK) surgery, the interference fringes are seldom regular. The fringes are bent on bright lines, which are interpreted as tear film breakups. The high-intensity pattern seems to appear in similar location on the corneal surface after refractive surgery. Our purpose was to extract information about the pattern existing under the interference fringes and calculate its shape reproducibility over time and following eye blinks. A low-pass filter was applied and correlation coefficient was calculated to compare a selected fragment of the template image to each of the following frames in the recorded sequence. High values of the correlation coefficient suggest that irregularities of the corneal epithelium might influence tear film instability and that tear film breakup may be associated with local irregularities of the corneal topography created after the LASIK and RK surgeries.

An Overview on Dry Eye Treatment: Approaches for Cyclosporin A Delivery

PubMed Central

Yavuz, Burçin; Bozdağ Pehlivan, Sibel; Ünlü, Nurşen

2012-01-01

Dry eye syndrome (DES, Keratoconjunctivitis sicca) is a common disorder of the tear film caused by decreased tear production or increased evaporation. Changes in tear composition also promote inflammation on the ocular surface by various mechanisms. Artificial tear drops, tear retention treatment, stimulation of tear secretion, or anti-inflammatory drugs may be used for dry eye treatment according to the severity of the disease. For untreated patients, the risk of ocular infection increases at considerable level and clinical course of the disease may proceed up to infection, corneal ulcer, and blindness. Artificial tears and/or punctual occlusions are used for tear replacement or preservation. New treatment approaches are designed to modify the underlying disease process. For the treatment of severe dry eye disease, cyclosporin A (CsA), the first one of the new generation immunomodulatory drugs, which has an anti-inflammatory effect, is frequently used. CsA has immunosuppressive effects following systemic application. Following local administration of CsA, it is expected to obtain effective drug concentration at the target area and to avoid the various side effects associated with systemic delivery. Microspheres, implants, and liposomes have been developed for administration of CsA subconjunctivally in order to enhance its efficiency. PMID:22619624

Oral administration of royal jelly restores tear secretion capacity in rat blink-suppressed dry eye model by modulating lacrimal gland function.

PubMed

Imada, Toshihiro; Nakamura, Shigeru; Kitamura, Naoki; Shibuya, Izumi; Tsubota, Kazuo

2014-01-01

Tears are secreted from the lacrimal gland (LG), a dysfunction in which induces dry eye, resulting in ocular discomfort and visual impairment. Honey bee products are used as a nutritional source in daily life and medicine; however, little is known about their effects on dry eye. The aim of the present study was to investigate the effects of honey bee products on tear secretion capacity in dry eye. We selected raw honey, propolis, royal jelly (RJ), pollen, or larva from commercially available honey bee products. Tear secretion capacity was evaluated following the oral administration of each honey bee product in a rat blink-suppressed dry eye model. Changes in tear secretion, LG ATP content, and LG mitochondrial levels were measured. RJ restored the tear secretion capacity and decrease in LG ATP content and mitochondrial levels to the largest extent. Royal jelly can be used as a preventative intervention for dry eye by managing tear secretion capacity in the LG.

The effect of benoxinate on the tear stability of Hong Kong-Chinese.

PubMed

Cho, P; Brown, B

1995-07-01

We conducted a series of experiments to examine the effect of local anaesthetic instillation on tear stability measurements. All experiments were conducted with the examiner masked with respect to treatments. We measured tear break-up time (TDUT) and non-invasive tear break-up time (NITBUT) 30s after instillation of benoxinate (0.4%) in a single masked experiment and found that NITBUT was significantly increased while TBUT was unaffected. In separate experiments tear stability was assessed 5 min after instillation of benoxinate and there was no significant effect on either TBUT or NITBUT measurements. In a control experiment to examine the effect of instilling a drop of liquid into the eye, neither TBUT nor NITBUT were affected 30s after the instillation of saline. No corneal staining was observed in any of the subjects after instillation of benoxinate. The results suggest that benoxinate does not affect the stability of the precorneal tear film, and that tear stability can be assessed after the instillation of unpreserved benoxinate.

[Shoulder instability and rotator cuff tear].

PubMed

Voigt, C; Lill, H

2009-01-01

A rotator cuff tear as a complication of anterior shoulder dislocation is well known in patients over 40 years old. The incidence of this accompanying injury correlates with the patient's age and the number of redislocations. The tear localization and dimension depend on the patient's age. To what extent these tears are a complication of shoulder dislocation is often unclear, as rotator cuff tears and glenohumeral instability interact. Reports on this combined injury pattern are rare, but based on the patient's age, activity level, and functional demand, therapeutic concepts have been devised. In active patients younger than 60 years and in cases of redislocation, both the rotator cuff tear and the capsule-labrum-ligament lesion should be reconstructed arthroscopically. In lesser active patients age 60 years or older, an isolated rotator cuff reconstruction is often sufficient to stabilize the glenohumeral joint. This treatment concept shows a predominantly good outcome.As a special form of anterior shoulder dislocation, a rotator cuff tear and a plexus brachialis lesion--the"terrible triad of the shoulder"--is described here.

Freezing Range, Melt Quality, and Hot Tearing in Al-Si Alloys

NASA Astrophysics Data System (ADS)

Uludağ, Muhammet; Çetin, Remzi; Dispinar, Derya

2018-02-01

In this study, three different aluminum-silicon alloys (A356, A413, and A380) that have different solidification morphology and solidification ranges were examined with an aim to evaluate the hot tearing susceptibility. T-shape mold and Constrained Rod Casting (CRC) mold were used for the characterization. Reduced Pressure Test (RPT) was used to quantify the casting quality by measuring bifilm index. It was found that bifilm index and solidification range have an important role on the hot tearing formation. As it is known, bifilms can cause porosity and in this case, it was shown that porosity formed by bifilms decreased hot tearing tendency. As the freezing range of alloy increases, bifilms find the time to unravel that reduces hot tearing. However, for eutectic alloy (A413), due to zero freezing range, regardless of bifilm content, hot tearing was never observed. A380.1 alloy had the highest tendency for hot tearing due to having the highest freezing range among the alloys investigated in this work.

Comparison of ophthalmic sponges and extraction buffers for quantifying cytokine profiles in tears using Luminex technology

PubMed Central

Inic-Kanada, Aleksandra; Nussbaumer, Andrea; Montanaro, Jacqueline; Belij, Sandra; Schlacher, Simone; Stein, Elisabeth; Bintner, Nora; Merio, Margarethe; Zlabinger, Gerhard J.

2012-01-01

Purpose Evaluating cytokine profiles in tears could shed light on the pathogenesis of various ocular surface diseases. When collecting tears with the methods currently available, it is often not possible to avoid the tear reflex, which may give a different cytokine profile compared to basal tears. More importantly, tear collection with glass capillaries, the most widely used method for taking samples and the best method for avoiding tear reflex, is impractical for remote area field studies because it is tedious and time-consuming for health workers, who cannot collect tears from a large number of patients with this method in one day. Furthermore, this method is uncomfortable for anxious patients and children. Thus, tears are frequently collected using ophthalmic sponges. These sponges have the advantage that they are well tolerated by the patient, especially children, and enable standardization of the tear collection volume. The aim of this study was to compare various ophthalmic sponges and extraction buffers to optimize the tear collection method for field studies for subsequent quantification of cytokines in tears using the Luminex technology. Methods Three ophthalmic sponges, Merocel, Pro-ophta, and Weck-Cel, were tested. Sponges were presoaked with 25 cytokines/chemokines of known concentrations and eluted with seven different extraction buffers (EX1–EX7). To assess possible interference in the assay from the sponges, two standard curves were prepared in parallel: 1) cytokines of known concentrations with the extraction buffers and 2) cytokines of known concentrations loaded onto the sponges with the extraction buffers. Subsequently, a clinical assessment of the chosen sponge-buffer combination was performed with tears collected from four healthy subjects using 1) aspiration and 2) sponges. To quantify cytokine/chemokine recovery and the concentration in the tears, a 25-plex Cytokine Panel and the Luminex xMap were used. This platform enables simultaneous measurement of proinflammatory cytokines, Th1/Th2 distinguishing cytokines, nonspecific acting cytokines, and chemokines. Results We demonstrated the following: (i) 25 cytokines/chemokines expressed highly variable interactions with buffers and matrices. Several buffers enabled recovery of similar cytokine values (regulated and normal T cell expressed and secreted [RANTES], interleukin [IL]-13, IL-6, IL-8, IL-2R, and granulocyte-macrophage colony-stimulating factor [GM-CSF]); others were highly variable (monocyte chemotactic protein-1 [MCP-1], monokine induced by interferon-gamma [MIG], IL-1β, IL-4, IL-7, and eotaxin). (ii) Various extraction buffers displayed significantly different recovery rates on the same sponge for the same cytokine/chemokine. (iii) The highest recovery rates were obtained with the Merocel ophthalmic sponge except for tumor necrosis factor-α: the Weck-Cel ophthalmic sponge showed the best results, either with cytokine standards loaded onto sponges or with tears collected from the inner canthus of the eye, using the sponge. (iv) IL-5, IL-10, and interferon-α were not detected in any tear sample from four normal human subjects. Twenty-two cytokines/chemokines that we detected were extracted from the Merocel sponge to a satisfactory recovery percentage. The recovery of IL-7 was significantly lower in the extracted Merocel sponge compared to the diluted tear samples. The cytokine/chemokine extraction from tears showed the same pattern of extraction that we observed for extracting the standards. Conclusions Simultaneous measurement of various cytokines using ophthalmic sponges yielded diverse results for various cytokines as the level of extraction differs noticeably for certain cytokines. A second set of controls (standard curves “with sponges”) should be used to delineate the extent of extraction for each cytokine to be analyzed. Many cytokines/chemokines were detected in tear samples collected with the Merocel sponge, including many that have been implicated in ocular surface disease. Luminex detection of cytokine/chemokine profiles of tears collected with Merocel sponges and extracted with buffer EX1 may be useful in clinical studies, for example, to assess cytokine profiles evaluation in ocular surface diseases. PMID:23233782

Comparison of ophthalmic sponges and extraction buffers for quantifying cytokine profiles in tears using Luminex technology.

PubMed

Inic-Kanada, Aleksandra; Nussbaumer, Andrea; Montanaro, Jacqueline; Belij, Sandra; Schlacher, Simone; Stein, Elisabeth; Bintner, Nora; Merio, Margarethe; Zlabinger, Gerhard J; Barisani-Asenbauer, Talin

2012-01-01

Evaluating cytokine profiles in tears could shed light on the pathogenesis of various ocular surface diseases. When collecting tears with the methods currently available, it is often not possible to avoid the tear reflex, which may give a different cytokine profile compared to basal tears. More importantly, tear collection with glass capillaries, the most widely used method for taking samples and the best method for avoiding tear reflex, is impractical for remote area field studies because it is tedious and time-consuming for health workers, who cannot collect tears from a large number of patients with this method in one day. Furthermore, this method is uncomfortable for anxious patients and children. Thus, tears are frequently collected using ophthalmic sponges. These sponges have the advantage that they are well tolerated by the patient, especially children, and enable standardization of the tear collection volume. The aim of this study was to compare various ophthalmic sponges and extraction buffers to optimize the tear collection method for field studies for subsequent quantification of cytokines in tears using the Luminex technology. Three ophthalmic sponges, Merocel, Pro-ophta, and Weck-Cel, were tested. Sponges were presoaked with 25 cytokines/chemokines of known concentrations and eluted with seven different extraction buffers (EX1-EX7). To assess possible interference in the assay from the sponges, two standard curves were prepared in parallel: 1) cytokines of known concentrations with the extraction buffers and 2) cytokines of known concentrations loaded onto the sponges with the extraction buffers. Subsequently, a clinical assessment of the chosen sponge-buffer combination was performed with tears collected from four healthy subjects using 1) aspiration and 2) sponges. To quantify cytokine/chemokine recovery and the concentration in the tears, a 25-plex Cytokine Panel and the Luminex xMap were used. This platform enables simultaneous measurement of proinflammatory cytokines, Th1/Th2 distinguishing cytokines, nonspecific acting cytokines, and chemokines. WE DEMONSTRATED THE FOLLOWING: (i) 25 cytokines/chemokines expressed highly variable interactions with buffers and matrices. Several buffers enabled recovery of similar cytokine values (regulated and normal T cell expressed and secreted [RANTES], interleukin [IL]-13, IL-6, IL-8, IL-2R, and granulocyte-macrophage colony-stimulating factor [GM-CSF]); others were highly variable (monocyte chemotactic protein-1 [MCP-1], monokine induced by interferon-gamma [MIG], IL-1β, IL-4, IL-7, and eotaxin). (ii) Various extraction buffers displayed significantly different recovery rates on the same sponge for the same cytokine/chemokine. (iii) The highest recovery rates were obtained with the Merocel ophthalmic sponge except for tumor necrosis factor-α: the Weck-Cel ophthalmic sponge showed the best results, either with cytokine standards loaded onto sponges or with tears collected from the inner canthus of the eye, using the sponge. (iv) IL-5, IL-10, and interferon-α were not detected in any tear sample from four normal human subjects. Twenty-two cytokines/chemokines that we detected were extracted from the Merocel sponge to a satisfactory recovery percentage. The recovery of IL-7 was significantly lower in the extracted Merocel sponge compared to the diluted tear samples. The cytokine/chemokine extraction from tears showed the same pattern of extraction that we observed for extracting the standards. Simultaneous measurement of various cytokines using ophthalmic sponges yielded diverse results for various cytokines as the level of extraction differs noticeably for certain cytokines. A second set of controls (standard curves "with sponges") should be used to delineate the extent of extraction for each cytokine to be analyzed. Many cytokines/chemokines were detected in tear samples collected with the Merocel sponge, including many that have been implicated in ocular surface disease. Luminex detection of cytokine/chemokine profiles of tears collected with Merocel sponges and extracted with buffer EX1 may be useful in clinical studies, for example, to assess cytokine profiles evaluation in ocular surface diseases.

Recent developments on dry eye disease treatment compounds.

PubMed

Colligris, Basilio; Alkozi, Hanan Awad; Pintor, Jesus

2014-01-01

Dry eye syndrome is a common tears and ocular surface multifactorial disease, described by changes in the ocular surface epithelia related to reduced tears quantity and ocular surface sensitivity, leading to inflammatory reaction. Managing the eye inflammation proved helpful to patients with dry eye disease and current treatment is based on the use of topically applied artificial tear products/lubricants, tear retention management, stimulation of tear secretion and using anti-inflammatory drugs. In this article we revise the corresponding literature and patents assembling the new treatment approaches of novel and future pharmaceutical compounds destined for the dry eye disease treatment. The most frequent categories of compounds presented are secretagogues and anti-inflammatory drugs. These compounds are the research outcome of novel therapeutic strategies designed to reduce key inflammatory pathways and restore healthy tear film.

Biomechanics of Reverse Shoulder Arthroplasty: 
Current Concepts.

PubMed

Lorenzetti, Adam J; Stone, Geoffrey P; Simon, Peter; Frankle, Mark A

2016-01-01

The evolution of reverse shoulder arthroplasty has provided surgeons with new solutions for many complex shoulder problems. A primary goal of orthopaedics is the restoration or re-creation of functional anatomy to reduce pain and improve function, which can be accomplished by either repairing injured structures or replacing them as anatomically as possible. If reconstructible tissue is lacking or not available, which is seen in patients who have complex shoulder conditions such as an irreparable rotator cuff-deficient shoulder, cuff tear arthropathy, or severe glenoid bone loss, substantial problems may arise. Historically, hemiarthroplasty or glenoid grafting with total shoulder arthroplasty yielded inconsistent and unsatisfactory results. Underlying pathologies in patients who have an irreparable rotator cuff-deficient shoulder, cuff tear arthropathy, or severe glenoid bone loss can considerably alter the mechanical function of the shoulder and create treatment dilemmas that are difficult to overcome. A better biomechanical understanding of these pathologic adaptations has improved treatment options. In the past three decades, reverse total shoulder arthroplasty was developed to treat these complex shoulder conditions not by specifically re-creating the anatomy but by using the remaining functional tissue to improve shoulder balance. Reverse total shoulder arthroplasty has achieved reliable improvements in both pain and function. Initial implant designs lacked scientific evidence to support the design rationale, and many implants failed because surgeons did not completely understand the forces involved or the pathology being treated. Implant function and clinical results will continue to improve as surgeons' biomechanical understanding of shoulder disease and reverse shoulder arthroplasty implants increases.

Lactoferrin Levels in Tears are Increased by the Topical Application of Diadenosine Tetraphosphate.

PubMed

Loma, Patricia; Guzman-Aranguez, Ana; Perez de Lara, Maria J; Pintor, Jesus

2016-09-01

This study was undertaken to determine the effect of the topical application of diadenosine tetraphosphate on lactoferrin levels in rabbit tears. Diadenosine tetraphosphate was topically instilled in a single-dose, tear samples were collected by micropipette and lactoferrin was measured by Enzyme-Linked ImmunoSorbent Assay (ELISA). The concentration of lactoferrin in rabbit tears was significantly increased 1 h after diadenosine tetraphosphate application, remaining elevated for 3 h more. This effect was blocked by P2 receptors antagonists. Topical application of diadenosine tetraphosphate stimulates the secretion of lactoferrin in rabbit tears through P2 receptor activation.

Facile Determination of Sodium Ion and Osmolarity in Artificial Tears by Sequential DNAzymes.

PubMed

Kim, Eun Hye; Lee, Eun-Song; Lee, Dong Yun; Kim, Young-Pil

2017-12-07

Despite high relevance of tear osmolarity and eye abnormality, numerous methods for detecting tear osmolarity rely upon expensive osmometers. We report a reliable method for simply determining sodium ion-based osmolarity in artificial tears using sequential DNAzymes. When sodium ion-specific DNAzyme and peroxidase-like DNAzyme were used as a sensing and detecting probe, respectively, the concentration of Na⁺ in artificial tears could be measured by absorbance or fluorescence intensity, which was highly correlated with osmolarity over the diagnostic range ( R ² > 0.98). Our approach is useful for studying eye diseases in relation to osmolarity.

Rotator Cuff Injuries

MedlinePlus

... They include tendinitis, bursitis, and injuries such as tears. Rotator cuff tendons can become inflamed from frequent ... to wear down, which can lead to a tear. Some tears are not painful, but others can ...

Sonography on injury of the medial patellofemoral ligament after acute traumatic lateral patellar dislocation: Injury patterns and correlation analysis with injury of articular cartilage of the inferomedial patella.

PubMed

Zhang, Guang-Ying; Zheng, Lei; Shi, Hao; Qu, Su-Hui; Ding, Hong-Yu

2013-12-01

The purpose of this study was to investigate the accuracy of high-frequency ultrasonography in the diagnosis of injuries of medial patellofemoral ligaments (MPFLs), analyse the characteristics of MPFL injury and correlations between injury of the MPFL and articular cartilage of the inferomedial patella in patients with acute traumatic lateral patellar dislocation. High-frequency sonographic images of 49 patients with acute traumatic lateral patellar dislocations treated surgically were reviewed. The χ(2) tests were performed for statistical analysis. Twenty-eight cases of complete MPFL tear and 21 cases of partial MPFL tear were identified in operation, with 27 cases of MPFL tear located at their femoral attachment, 21 cases of tear at the patellar attachment and one case of midsubstance tear. The diagnostic accuracy of sonography regarding partial MPFL tear and complete MPFL tear was 89.8% and 89.8%. Among the patients with MPFL tear at the patellar attachment, eight and six cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, in contrast to nine and six cases in patients with MPFL tear at the femoral attachment, respectively. There was no significant difference between the two locations described above regarding the prevalence rates of chondral or osteochondral lesions of the inferomedial patella (P=0.732, P=0.614). Among the patients with complete MPFL tear, 12 and 10 cases were concomitant with chondral and osteochondral lesions in the inferomedial patella, respectively, while six and two cases were concomitant with partial MPFL tear. There was no significant difference between the two types of injuries discussed above on the prevalence rates of chondral lesions of the inferomedial patella (P=0.305), but the prevalence rate of osteochondral lesions between the two types of injuries discussed above was statistically different (P=0.035). The MPFL is most easily injured at the femoral attachment, secondly at the patellar attachment. High-frequency ultrasonography is an accurate method in the diagnosis of an MPFL tear. There are neither significant differences on the prevalence rates of chondral or osteochondral lesions of the inferomedial patella between locations of MPFL injuries, nor significant difference on the prevalence rates of chondral lesions between MPFL injury types; but the complete MPFL tear is more often concomitant with inferomedial patellar osteochondral lesions than the partial MPFL tear. Copyright © 2013 Elsevier Ltd. All rights reserved.

The importance of the posterior oblique ligament in repairs of acute tears of the medial ligaments in knees with and without an associated rupture of the anterior cruciate ligament. Results of long-term follow-up.

PubMed

Hughston, J C

1994-09-01

Forty-one of fifty patients (fifty knees) who had had a repair of an acute tear of the medial ligaments, a procedure in which repair of the posterior oblique ligament and the semimembranosus complex was emphasized, were re-evaluated after an average duration of follow-up of twenty-two years (range, eighteen to thirty years). The ages of the patients at the time of the injury had ranged from fifteen to twenty-one years. In twenty-four of the forty-one knees, the anterior cruciate ligament had been torn. In seventeen of these knees, the torn ligament had been debrided; in six others, which had had avulsion of a bone fragment or a terminal tear, the ligament had been repaired with absorbable sutures; and in the remaining knee, the repaired anterior cruciate ligament had been augmented. Four patients had had a pes anserinus transfer to supplement the medial repair. The medial meniscus had been intact or repaired in twenty-five of the forty-one knees and had been removed from the remaining sixteen. The lateral meniscus had been retained in thirty-nine knees and removed from two. Postoperatively, all knees had been immobilized for six weeks in 60 degrees of flexion by means of a plaster cast. This had not caused lasting loss of motion, persistent muscle atrophy, or clinically demonstrable deterioration of the articular cartilage. In the twenty-four knees that had had a tear of the anterior cruciate ligament, the rates of instability, meniscal injury, and deterioration of the joint had not increased since the time of treatment, compared with those in the knees with an intact ligament, even though repair and augmentation of this ligament had not been performed (except in one patient, in whom it was unsuccessful). Thirty-eight patients had good stability and a normal range of motion, as well as little or no muscle atrophy. Radiographic changes were slight or absent in all but four knees. Most patients had maintained a high level of physical fitness and recreational athletic activity. There were three failures of treatment (7 per cent). This previously described treatment of acute tears of the medial ligaments, with or without an associated tear of the anterior cruciate ligament, provides good long-term results and is still recommended.

Comparison of Clinical and Structural Outcomes by Subscapularis Tendon Status in Massive Rotator Cuff Tear.

PubMed

Lee, Sung Hyun; Nam, Dae Jin; Kim, Se Jin; Kim, Jeong Woo

2017-09-01

The subscapularis tendon is essential in maintaining normal glenohumeral biomechanics. However, few studies have addressed the outcomes of tears extending to the subscapularis tendon in massive rotator cuff tears. To assess the clinical and structural outcomes of arthroscopic repair of massive rotator cuff tears involving the subscapularis. Cohort study; Level of evidence, 3. Between January 2010 and January 2014, 122 consecutive patients with massive rotator cuff tear underwent arthroscopic rotator cuff repair. Overall, 122 patients were enrolled (mean age, 66 years; mean follow-up period, 39.5 months). Patients were categorized into 3 groups based on subscapularis tendon status: intact subscapularis tendon (I group; n = 45), tear involving less than the superior one-third (P group; n = 35), and tear involving more than one-third of the subscapularis tendon (C group; n = 42). All rotator cuff tears were repaired; however, subscapularis tendon tears involving less than the superior one-third in P group were only debrided. Pain visual analog scale, Constant, and American Shoulder and Elbow Surgeons scores and passive range of motion were measured preoperatively and at the final follow-up. Rotator cuff integrity, global fatty degeneration index, and occupation ratio were determined via magnetic resonance imaging preoperatively and 6 months postoperatively. We identified 37 retears (31.1%) based on postoperative magnetic resonance imaging evaluation. Retear rate in patients in the C group (47.6%) was higher than that in the I group (22.9%) or P group (20.0%) ( P = .011). Retear subclassification based on the involved tendons showed that subsequent subscapularis tendon retears were noted in only the C group. The improvement in clinical scores after repair was statistically significant in all groups but not different among the groups. Between-group comparison showed significant differences in preoperative external rotation ( P = .021). However, no statistically significant difference was found in any shoulder range of motion measurements after surgery. Arthroscopic repair of massive tears results in substantial improvements in shoulder function, despite the presence of combined subscapularis tears. However, this study showed a high failure rate of massive posterosuperior rotator cuff tear repair extending more than one-third of the subscapularis tendon. When combined subscapularis tendon tear was less than the superior one-third of the subscapularis tendon, arthroscopic debridement was a reasonable treatment method where comparable clinical and anatomic outcomes could be expected.

76 FR 74704 - Folded Self-Mailers and Unenveloped Mailpieces

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-01

....14.8 or 3.14.9b through 3.14.9f. 3.15.2 Letter-Size Mailpieces With Tear-Off Strips When letter-size mailpieces have tear-off strips on the leading and/or trailing edge, any unfolded edges must be sealed with.... b. Tear-off strips may be up to \\9/16\\ inch (0.5625) wide. c. Tear lines (single lines of...

Identification of Suitable Reference Genes for Investigating Gene Expression in Anterior Cruciate Ligament Injury by Using Reverse Transcription-Quantitative PCR.

PubMed

Leal, Mariana Ferreira; Astur, Diego Costa; Debieux, Pedro; Arliani, Gustavo Gonçalves; Silveira Franciozi, Carlos Eduardo; Loyola, Leonor Casilla; Andreoli, Carlos Vicente; Smith, Marília Cardoso; Pochini, Alberto de Castro; Ejnisman, Benno; Cohen, Moises

2015-01-01

The anterior cruciate ligament (ACL) is one of the most frequently injured structures during high-impact sporting activities. Gene expression analysis may be a useful tool for understanding ACL tears and healing failure. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) has emerged as an effective method for such studies. However, this technique requires the use of suitable reference genes for data normalization. Here, we evaluated the suitability of six reference genes (18S, ACTB, B2M, GAPDH, HPRT1, and TBP) by using ACL samples of 39 individuals with ACL tears (20 with isolated ACL tears and 19 with ACL tear and combined meniscal injury) and of 13 controls. The stability of the candidate reference genes was determined by using the NormFinder, geNorm, BestKeeper DataAssist, and RefFinder software packages and the comparative ΔCt method. ACTB was the best single reference gene and ACTB+TBP was the best gene pair. The GenEx software showed that the accumulated standard deviation is reduced when a larger number of reference genes is used for gene expression normalization. However, the use of a single reference gene may not be suitable. To identify the optimal combination of reference genes, we evaluated the expression of FN1 and PLOD1. We observed that at least 3 reference genes should be used. ACTB+HPRT1+18S is the best trio for the analyses involving isolated ACL tears and controls. Conversely, ACTB+TBP+18S is the best trio for the analyses involving (1) injured ACL tears and controls, and (2) ACL tears of patients with meniscal tears and controls. Therefore, if the gene expression study aims to compare non-injured ACL, isolated ACL tears and ACL tears from patients with meniscal tear as three independent groups ACTB+TBP+18S+HPRT1 should be used. In conclusion, 3 or more genes should be used as reference genes for analysis of ACL samples of individuals with and without ACL tears.

Human tear serotonin levels correlate with symptoms and signs of dry eye

PubMed Central

Chhadva, Priyanka; Lee, Tinthu; Sarantopoulos, Constantine D.; Hackam, Abigail S.; McClellan, Allison L.; Felix, Elizabeth R.; Levitt, Roy C.; Galor, Anat

2015-01-01

Purpose Serotonin, a neurotransmitter known to be involved in nociceptor sensitization, is present in human tears. The purpose of this study was to correlate tear serotonin levels, as a marker of nociceptor sensitization, to facets of dry eye (DE) including symptoms and signs. Design Cross-sectional study Participants Sixty-two patients with normal eyelid and corneal anatomy were prospectively recruited from a Veterans Administration Ophthalmology Clinic over 11 months. Methods DE symptoms (Ocular Surface Disease Index [OSDI]), signs (tear break-up time [TBUT], corneal staining, and Schirmer’s score), and clinical descriptors of neuropathic ocular pain (NOP) (sensitivity to light and/or sensitivity to wind) were assessed. For tear analysis, each patient’s tears were collected after instilling 50µl of sterile saline to the lower cul-de-sac of each eye and using capillary action microcaps to collect the ocular wash. Tear serotonin levels were measured using enzyme-linked immunosorbent assay. Main Outcomes Measured Correlations between tear serotonin concentrations and DE symptoms and signs. Results The mean age of the population was 61±14 years and 84% (n=52) of the patients were male. Serotonin concentrations negatively correlated with Schirmer’s scores (r=−0.28; p=0.02), but did not correlate with other DE parameters, such as OSDI scores, sensitivity to light or wind, TBUT, or staining. According to our hypothesis, we divided patients into groups based on both DE symptoms and aqueous tear production; serotonin concentrations were found to be significantly higher in DE group 1 (OSDI≥6 and Schirmer’s<8) compared to both DE group 2 (OSDI≥6 and Schirmer’s≥8) and controls (OSDI<6 and Schirmer’s≥8). Patients in the DE group 2 more frequently complained of sensitivity to light (64%) and wind (67%) compared to the DE group 1 (40% and 60%, respectively) and controls (8% and 17%, respectively). Conclusion Patients with DE symptoms and aqueous tear deficiency had higher tear serotonin levels compared to those with DE symptoms but normal tear production and those without DE symptoms. PMID:25983214

THE CLINICAL, FUNCTIONAL AND BIOMECHANICAL PRESENTATION OF PATIENTS WITH SYMPTOMATIC HIP ABDUCTOR TENDON TEARS.

PubMed

Ebert, Jay R; Retheesh, Theertha; Mutreja, Rinky; Janes, Gregory C

2016-10-01

Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome (GTPS), though limited information exists on the disability associated with this condition and specific presentation of these patients. To describe the clinical, functional and biomechanical presentation of patients with symptomatic HAT tears. Secondary purposes were to investigate the association between these clinical and functional measures, and to compare the pain and disability reported by HAT tear patients to those with end-stage hip osteoarthritis (OA). Prospective case series. One hundred forty-nine consecutive patients with symptomatic HAT tears were evaluated using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, an additional series of 10 questions more pertinent to those with lateral hip pain, active hip range of motion (ROM), maximal isometric hip abduction strength, six-minute walk capacity and 30-second single limb stance (SLS) test. The presence of a Trendelenburg sign and pelvis-on-femur (POF) angle were determined via 2D video analysis. An age matched comparative sample of patients with end-stage hip OA was recruited for comparison of all patient-reported outcome scores. Independent t-tests investigated group and limb differences, while analysis of variance evaluated pain changes during the functional tests. Pearson's correlation coefficients investigated the correlation between clinical measures in the HAT tear group. No differences existed in patient demographics and patient-reported outcome scores between HAT tear and hip OA cohorts, apart from significantly worse SF-12 mental subscale scores (p = 0.032) in the HAT tear group. Patients with HAT tears demonstrated significantly lower (p < 0.05) hip abduction strength and active ROM in all planes of motion on their affected limb. Pain significantly increased throughout the 30-second SLS test for the HAT tear group, with 57% of HAT tear patients demonstrating a positive Trendelenburg sign. POF angle during the test was not significantly associated with pain. Patients with symptomatic HAT tears demonstrate poor function, and report pain and disability similar to or worse than those with end-stage hip OA. This information better defines and differentiates the presentation of these patients. Level 3 case-controlled study, with matched comparison.

Comparison of Medial and Lateral Meniscus Root Tears

PubMed Central

Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

2015-01-01

The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients’ ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29–71 years) and 30 years (range: 14–62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in patients with MMRTs. However, it is rare in patients with LMRTs, which are more commonly associated with a history of trauma and ACL tears. PMID:26488288

Comparison of Medial and Lateral Meniscus Root Tears.

PubMed

Koo, Ji Hyun; Choi, Sang-Hee; Lee, Seung Ah; Wang, Joon Ho

2015-01-01

The meniscus root plays an essential role in maintaining the circumferential hoop tension and preventing meniscal displacement. Studies on meniscus root tears have investigated the relationship of osteoarthritis and an anterior cruciate ligament tear. However, few studies have directly compared the medial and lateral root tears. To assess the prevalence of meniscal extrusion and its relationship with clinical features in medial and lateral meniscus root tears, we performed a retrospective review of the magnetic resonance imaging (MRI) results of 42 knee patients who had meniscus posterior horn root tears and who had undergone arthroscopic operations. The presence of meniscal extrusion was evaluated and the exact extent was measured from the tibial margin. The results were correlated with arthroscopic findings. Clinical features including patients' ages, joint abnormalities, and previous trauma histories were evaluated. Twenty-two patients had medial meniscus root tears (MMRTs) and twenty patients had lateral meniscus root tears (LMRTs). Meniscal extrusion was present in 18 MMRT patients and one LMRT patient. The mean extent of extrusion was 4.2mm (range, 0.6 to 7.8) in the MMRT group and 0.9mm (range, -1.9 to 3.4) in the LMRT group. Five patients with MMRT had a history of trauma, while 19 patients with LMRT had a history of trauma. Three patients with MMRT had anterior cruciate ligament (ACL) tears, while 19 patients with LMRT had ACL tears. The mean age of the patients was 52 years (range: 29-71 years) and 30 years (range: 14-62 years) in the MMRT and LMRT group, respectively. There was a significant correlation between a MMRT and meniscal extrusion (p<0.0001), and between an ACL tear and LMRT (p<0.0001). A history of trauma was significantly common in LMRT (p<0.0001). LMRT patients were significantly younger than MMRT patients (p<0.0001). Kellgren-Lawrence (K-L) grade differed significantly between MMRT and LMRT group (p<0.0001). Meniscal extrusion is common in patients with MMRTs. However, it is rare in patients with LMRTs, which are more commonly associated with a history of trauma and ACL tears.

Location of Rotator Cuff Tear Initiation: A Magnetic Resonance Imaging Study of 191 Shoulders.

PubMed

Jeong, Jeung Yeol; Min, Seul Ki; Park, Keun Min; Park, Yong Bok; Han, Kwang Joon; Yoo, Jae Chul

2018-03-01

Degenerative rotator cuff tears (RCTs) are generally thought to originate at the anterior margin of the supraspinatus tendon. However, a recent ultrasonography study suggested that they might originate more posteriorly than originally thought, perhaps even from the isolated infraspinatus (ISP) tendon, and propagate toward the anterior supraspinatus. Hypothesis/Purpose: It was hypothesized that this finding could be reproduced with magnetic resonance imaging (MRI). The purpose was to determine the most common location of degenerative RCTs by using 3-dimensional multiplanar MRI reconstruction. It was assumed that the location of the partial-thickness tears would identify the area of the initiation of full-thickness tears. Cross-sectional study; Level of evidence, 3. A retrospective analysis was conducted including 245 patients who had RCTs (nearly full- or partial-thickness tears) at the outpatient department between January 2011 and December 2013. RCTs were measured on 3-dimensional multiplanar reconstruction MRI with OsiriX software. The width and distance from the biceps tendon to the anterior margin of the tear were measured on T2-weighted sagittal images. In a spreadsheet, columns of consecutive numbers represented the size of each tear (anteroposterior width) and their locations with respect to the biceps brachii tendon. Data were pooled to graphically represent the width and location of all tears. Frequency histograms of the columns were made to visualize the distribution of tears. The tears were divided into 2 groups based on width (group A, <10 mm; group B, <20 and ≥10 mm) and analyzed for any differences in location related to size. The mean width of all RCTs was 11.9 ± 4.1 mm, and the mean length was 11.1 ± 5.0 mm. Histograms showed the most common location of origin to be 9 to 10 mm posterior to the biceps tendon. The histograms of groups A and B showed similar tear location distributions, indicating that the region approximately 10 mm posterior to the biceps tendon is the most common site of tear initiation. These results demonstrate that degenerative RCTs most commonly originate from approximately 9 to 10 mm posterior to the biceps tendon.

The effects of 2% rebamipide ophthalmic solution on the tear functions and ocular surface of the superoxide dismutase-1 (sod1) knockout mice.

PubMed

Ohguchi, Takeshi; Kojima, Takashi; Ibrahim, Osama M; Nagata, Taeko; Shimizu, Takahiko; Shirasawa, Takuji; Kawakita, Tetsuya; Satake, Yoshiyuki; Tsubota, Kazuo; Shimazaki, Jun; Ishida, Susumu

2013-11-21

To investigate the efficacy of 2% rebamipide ophthalmic solution on the tear functions and ocular surface status of the superoxide dismutase-1(Sod1(-/-)) mice. Two percent Rebamipide ophthalmic solution was applied to 40-week-old male Sod1(-/-) and wild-type (WT) mice four times a day for 2 weeks. We examined the cytokine concentrations in the tear fluid (by CytoBead assay), tear film break-up time, amount of tear production, and expressions of mucins 1, 4, and 5AC, by RT-PCR. We also performed vital staining of the ocular surface, PAS staining for muc5AC, and immunohistochemical stainings for 4-hydroxy-2-nonenal (4-HNE), 8-hydroxy-2'-deoxyguanosine (8-OHdG), in the conjunctiva to compare the results before and after rebamipide instillations. The tear functions and ocular surface epithelial damage scores were significantly worse in the Sod1(-/-) than in the WT mice. Application of 2% rebamipide for 2 weeks significantly improved the tear film break-up time, the amount of tear production, and the corneal epithelial damage scores, which also significantly increased the conjunctival goblet cell density and muc5 mRNA expression, in the Sod1(-/-) mice. The mean IL-6, IL-17, TNF-α, and IFN-γ levels in the tear fluid were reduced significantly along with a significant decrease in the density of cells positive for 4-HNE and 8-OHdG in the conjunctiva. Two percent Rebamipide ophthalmic solution significantly improved the tear stability and corneal epithelial damage, and enhanced the expression of muc5 mRNA on the ocular surface. We also observed anti-inflammatory effects in the tear film together with antioxidative effects in the conjunctiva, suggesting the efficacy of rebamipide in age-related dry eye disease attributable to SOD1 knockout.

Comparison of camel tear proteins between summer and winter

PubMed Central

Chen, Ziyan; Shamsi, Farrukh A.; Li, Kaijun; Huang, Qiang; Al-Rajhi, Ali A.; Chaudhry, Imtiaz A.

2011-01-01

Purpose Proteins in the tear fluid have positive effects on maintaining the integrity and stabilization of the tear film, which is affected by several environmental factors. The aim of this study is to investigate seasonal variation of protein patterns in camel tears collected during the summer and winter season. Methods Tears from both eyes of 50 clinically normal camels (Camelus dromedarius) were collected in the summer (June – July) and in the winter (December – January) respectively. Pooled tear protein samples from two seasons were separated by SDS–PAGE and two-dimensional electrophoresis (2-DE). Protein spots of differential expression in two season gels were excised and subjected to in-gel digestion and identification by matrix assisted laser desorption/ionization-time of flight/time of flight-mass spectrum (MALDI-TOF/TOF-MS) analysis. Two differentially expressed proteins, lactoferrin (LF) and vitelline membrane outer layer protein 1 homolog (VMO1 homolog), were validated by western blotting. Results Thirteen well resolved bands were detected in SDS–PAGE gels of both summer and winter camel tears. By band densitometry, significantly higher intensities of band 6, 7, 11, and lower intensity of band 13 were observed in the summer group compared to the winter group. In 2-DE profiles of camel tears, four protein spots were found expressed differentially in two seasons. Further protein identification by MALDI-TOF/TOF-MS and confirmation by western blotting indicated that there was a significant decrease in LF (p=0.002) and an increase in VMO1 homolog (p=0.042) in tears in the summer compared to the winter. Conclusions The seasonal variation of camel tear fluids has been found in the composition of proteins, including LF and VMO1 homolog. This result will expand our knowledge of physiologic characteristics of tear fluids and establish a foundation for the mechanistic studies and clinical practices on ocular surface disorders. PMID:21293736

Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

PubMed Central

Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J.; Miller, Bruce

2018-01-01

Background: Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. Purpose: To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. Results: A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC (P = .96), ASES (P = .71), or VAS (P = .86). Conclusion: Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair. PMID:29623283

Expression of Lipid Peroxidation Markers in the Tear Film and Ocular Surface of Patients with Non-Sjogren Syndrome: Potential Biomarkers for Dry Eye Disease.

PubMed

Choi, Won; Lian, Cui; Ying, Li; Kim, Ga Eon; You, In Cheon; Park, Soo Hyun; Yoon, Kyung Chul

2016-09-01

To investigate the expression of lipid peroxidation markers in the tear film and ocular surface and their correlation with disease severity in patients with dry eye disease. The concentrations of hexanoyl-lysine (HEL), 4-hydroxy-2-nonenal (HNE), and malondialdehyde (MDA) were measured with enzyme-linked immunosorbent assays in tears obtained from 44 patients with non-Sjogren syndrome dry eye and 33 control subjects. The correlations between the marker levels and the tear film and ocular surface parameters, including tear film break-up time (BUT), Schirmer tear value, tear clearance rate, keratoepitheliopathy scores, corneal sensitivity, conjunctival goblet cell density, and symptom score, were analyzed. The expression of the lipid peroxidation markers HEL, 4-HNE, and MDA in the conjunctiva was evaluated using immunohistochemistry. The concentrations of HEL, 4-HNE, and MDA were 279.84 ± 69.98 nmol/L, 0.02 ± 0.01 μg/mL, and 3.80 ± 1.05 pmol/mg in control subjects and 283.21 ± 89.67 nmol/L (p = 0.97), 0.20 ± 0.03 μg/mL (p < 0.01), and 13.32 ± 4.03 pmol/mg (p < 0.01) in dry eye patients. 4-HNE and MDA levels significantly correlated with BUT, Schirmer tear value, tear clearance rate, keratoepitheliopathy scores, conjunctival goblet cell density, and symptom score (p < 0.05), whereas HEL levels did not correlate with these parameters. Staining intensities for 4-HNE and MDA increased in dry eye patients. The expression of late lipid peroxidation markers, 4-HNE and MDA, increases in the tear film and ocular surface of patients with dry eye. The levels correlate with various tear film and ocular surface parameters and may reflect the severity of dry eye disease.

Does the Rotator Cuff Tear Pattern Influence Clinical Outcomes After Surgical Repair?

PubMed

Watson, Scott; Allen, Benjamin; Robbins, Chris; Bedi, Asheesh; Gagnier, Joel J; Miller, Bruce

2018-03-01

Limited literature exists regarding the influence of rotator cuff tear morphology on patient outcomes. To determine the effect of rotator cuff tear pattern (crescent, U-shape, L-shape) on patient-reported outcomes after rotator cuff repair. Cohort study; Level of evidence, 3. Patients undergoing arthroscopic repair of known full-thickness rotator cuff tears were observed prospectively at regular intervals from baseline to 1 year. The tear pattern was classified at the time of surgery as crescent, U-shaped, or L-shaped. Primary outcome measures were the Western Ontario Rotator Cuff Index (WORC), the American Shoulder and Elbow Surgeons (ASES), and a visual analog scale (VAS) for pain. The tear pattern was evaluated as the primary predictor while controlling for variables known to affect rotator cuff outcomes. Mixed-methods regression and analysis of variance (ANOVA) were used to examine the effects of tear morphology on patient-reported outcomes after surgical repair from baseline to 1 year. A total of 82 patients were included in the study (53 male, 29 female; mean age, 58 years [range, 41-75 years]). A crescent shape was the most common tear pattern (54%), followed by U-shaped (25%) and L-shaped tears (21%). There were no significant differences in outcome scores between the 3 groups at baseline. All 3 groups showed statistically significant improvement from baseline to 1 year, but analysis failed to show any predictive effect in the change in outcome scores from baseline to 1 year for the WORC, ASES, or VAS when tear pattern was the primary predictor. Further ANOVA also failed to show any significant difference in the change in outcome scores from baseline to 1 year for the WORC ( P = .96), ASES ( P = .71), or VAS ( P = .86). Rotator cuff tear pattern is not a predictor of functional outcomes after arthroscopic rotator cuff repair.

Rotator cuff tear shape characterization: a comparison of two-dimensional imaging and three-dimensional magnetic resonance reconstructions.

PubMed

Gyftopoulos, Soterios; Beltran, Luis S; Gibbs, Kevin; Jazrawi, Laith; Berman, Phillip; Babb, James; Meislin, Robert

2016-01-01

The purpose of this study was to see if 3-dimensional (3D) magnetic resonance imaging (MRI) could improve our understanding of rotator cuff tendon tear shapes. We believed that 3D MRI would be more accurate than two-dimensional (2D) MRI for classifying tear shapes. We performed a retrospective review of MRI studies of patients with arthroscopically proven full-thickness rotator cuff tears. Two orthopedic surgeons reviewed the information for each case, including scope images, and characterized the shape of the cuff tear into crescent, longitudinal, U- or L-shaped longitudinal, and massive type. Two musculoskeletal radiologists reviewed the corresponding MRI studies independently and blind to the arthroscopic findings and characterized the shape on the basis of the tear's retraction and size using 2D MRI. The 3D reconstructions of each cuff tear were reviewed by each radiologist to characterize the shape. Statistical analysis included 95% confidence intervals and intraclass correlation coefficients. The study reviewed 34 patients. The accuracy for differentiating between crescent-shaped, longitudinal, and massive tears using measurements on 2D MRI was 70.6% for reader 1 and 67.6% for reader 2. The accuracy for tear shape characterization into crescent and longitudinal U- or L-shaped using 3D MRI was 97.1% for reader 1 and 82.4% for reader 2. When further characterizing the longitudinal tears as massive or not using 3D MRI, both readers had an accuracy of 76.9% (10 of 13). The overall accuracy of 3D MRI was 82.4% (56 of 68), significantly different (P = .021) from 2D MRI accuracy (64.7%). Our study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing rotator cuff tear shapes compared with current 2D MRI-based techniques. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Dynamic changes in ocular Zernike aberrations and tear menisci measured with a wavefront sensor and an anterior segment OCT.

PubMed

Xu, Jingjing; Bao, Jinhua; Deng, Jun; Lu, Fan; He, Ji C

2011-07-29

To measure dynamic change characteristics of spatial and temporal variations in the post-blink tear film of normal eyes. A wavefront sensor was used to measure dynamic changes in wavefront aberrations, up to the seventh order, for 10 seconds in a group of 33 normal young adults. Tear menisci were imaged with an anterior segment optical coherence tomography (AS-OCT) system and tear film break-up times (TFBUTs) were determined. Systematic changes in main axis astigmatism (R(2) = 0.933, P < 0.0001), vertical coma (R(2) = 0.935, P < 0.0001) and spherical aberrations (R(2) = 0.879, P = 0.0002) occurred during the 10-second post-blink period. Both lower tear meniscus height and area increased by 10 seconds compared with the initial levels (P < 0.0001 for each). The change of vertical coma had significant correlation with the increase of lower tear meniscus areas during the 10-second post-blink period (R(2) = 0.181, P = 0.014). Subjects with TFBUTs < 15 seconds had significantly increased main axis astigmatism, vertical coma, and spherical aberrations by 10 seconds. Subjects with longer TFBUTs did not have any significant wavefront aberrations during that period. Systematic changes in some Zernike aberrations after blinking are associated with the changes in tear menisci and TFBUT. There was a substantial individual variation in dynamic changes of Zernike aberrations, suggesting the necessity to explore individual differences in tear quality and tear performance. Dynamic wavefront measurement combined with anterior segment optical coherence tomography could provide a useful tool to understand spatial and temporal processes of the tear film in clinical practice.

Immunoglobulin Concentration in Tears of Contact Lens Wearers

PubMed Central

Maurya, Rajendra P.; Bhushan, Prashant; Singh, Virendra P.; Singh, Mahendra K.; Kumar, Prakash; Bhatia, Ravindra P.S.; Singh, Usha

2014-01-01

Purpose: To evaluate changes in the concentration of tear immunoglobulins in contact lens wearers. Methods: A total of 45 cases including 23 contact lens wearers (43 eyes) and 22 age and sex matched healthy controls having no ocular pathology were studied for immunoglobulins (IgA, IgG, IgM) in their tears by single radial immunodiffusion method. Results: Most of the cases used soft (56.6%) and semi-soft gas permeable (30.4%) contact lenses. Tear IgM was detected in only 17.4% and tear IgG in 43.6% of contact lens wearers, while in controls IgG was detected in 9.1% but none of the controls had IgM. There was a significant rise in total tear IgA (13.17 ± 4.44 mg/dl) in contact lens wearer as compared to controls (8.93 ± 3.79 mg/dl). Rise of tear IgA was more in symptomatic patients (15.38 ± 5.28 mg/dl) and in those wearing hard (19.73 ± 5.43 mg/dl) and semi-soft contact lenses (13.31 ± 5.43 mg/dl). A significant increase in tear IgA was noticed in subjects wearing lenses for >3 years (15.69 ± 5.39 mg/dl). About 43.4% of lens wearers were symptomatic and 80% of their lenses showed deposits and/or haziness. All cases with IgM in tear were symptomatic. Conclusion: The relation of immunoglobulin concentration with increasing duration of wear and material of contact lens shows that tear immunoglobulin rise accrues due to mechanical stimulation, hence contact lenses should not be used for a long period and lenses of hard nature should be discouraged. The maintenance, cleaning and deproteinization of the lenses are of high importance to avoid immunostimulation. PMID:25667732

Assessment of tear osmolarity and other dry eye parameters in post-LASIK eyes.

PubMed

Hassan, Ziad; Szalai, Eszter; Berta, Andras; Modis, Laszlo; Nemeth, Gabor

2013-07-01

To assess the tear osmolarity using the TearLab device after laser in situ keratomileusis (LASIK) and to compare the values with those obtained by traditional tear film tests before and after the procedure. Thirty eyes of 15 refractive surgery candidates (5 men and 10 women of mean age: 30.55 ± 11.79 years) were examined. Using a special questionnaire (Ocular Surface Disease Index), subjective dry eye complaints were evaluated, and then, the tear osmolarity was measured with the TearLab system (TearLab Corporation) and conventional dry eye tests were carried out. Examinations were performed preoperatively and at 1, 30, and 60 days after the surgery. The mean value of tear osmolarity was 303.62 ± 12.29 mOsm/L before the surgery and 303.58 ± 20.14 mOsm/L at 60 days after the treatment (P = 0.69). Mean lid parallel conjunctival folds value was 0.68 ± 0.68 before the procedure and 0.58 ± 0.65 subsequent to surgery (P = 0.25). Meibomian gland dysfunction was not detected. No significant deviation was observed in the values of Schirmer test, corneal staining, tear break-up time, and lid parallel conjunctival folds when compared with postoperatively obtained values during the follow-up period (P > 0.05). During LASIK flap creation, intact corneal innervation is damaged, and the ocular surface lacrimal functional unit can be impaired. In our study, no abnormal dry eye test results were observed before or after the procedure. Based on our results, LASIK treatment is safe for dry eye involving the administration of adequate artificial tears for a minimum of 3 months.

Post-blink tear film dynamics in healthy and dry eyes during spontaneous blinking.

PubMed

Szczesna-Iskander, Dorota H

2018-01-01

The aim was to investigate the dynamics of post-blink tear film leveling in natural blinking conditions (NBC) for healthy subjects and those diagnosed with dry eye syndrome (DES) and to relate this phase to the tear film surface quality (TFSQ) before the following blink. The study included 19 healthy persons and 10 with dry eye, grouped according to symptoms and signs observed during examination. Lateral shearing interferometry was used to examine TFSQ. Post-blink tear film dynamics was modeled by an exponential function, characterized by the decay parameter b, and a constant, describing the level of the stabilized TFSQ. Pre-next-natural-blink TFSQ dynamics was modeled with a linear trend, described by a parameter A. The post-blink tear film dynamics reached its plateau at a significantly (P = 0.006) lower level in the normal tear film group than in the dry eye group. The median exponential decay parameter b was statistically significantly higher for the control group than for the DES group, P = 0.026. The parameter b calculated for each interblink interval was significantly correlated with the corresponding parameter A (Spearman's R = 0.35; P < 0.001). Correlation between the median b and tear film fluorescein break-up time for each subject was also found (R = 0.41, P = 0.029). Significantly faster leveling of post-natural-blink tear film was observed in the group with DES than in healthy eyes. This dynamic was correlated with the pre-next-natural-blink TFSQ and tear film stability. The results of this pilot study support previous works that advocate the importance of polar lipids in the mechanism of tear film lipid spreading. Copyright © 2017 Elsevier Inc. All rights reserved.

Effects of topical cyclosporine a plus artificial tears versus artificial tears treatment on conjunctival goblet cell density in dysfunctional tear syndrome.

PubMed

Demiryay, Elvan; Yaylali, Volkan; Cetin, Ebru Nevin; Yildirim, Cem

2011-09-01

The aim was to compare the effects of topical cyclosporine A and artificial tears combination with artificial tears alone in patients with dysfunctional tear syndrome (DTS). Forty-two eyes of 42 patients with DTS were enrolled in the study. The inclusion criteria for the study were Schirmer I (without anesthesia) scores below 10 mm/5 min and tear film break-up time (BUT) below 10 sec. The patients were randomly divided into two groups. The study group (22 patients) underwent 0.05% cyclosporine A treatment twice a day and preservative-free artificial tears for four times a day for 4 months. The control group (20 patients) was administered only preservative-free artificial tears four times a day for 4 months. The BUT, Schirmer test scores, corneal fluorescein staining, conjunctival lissamine green staining, and goblet cell density derived by impression cytology were recorded before and after treatment in each group. In the study group, all parameters improved statistically significantly after treatment at the 4-month follow-up compared with the pretreatment values (P<0.001 for all). In the control group, corneal fluorescein staining (P<0.001) and conjunctival lissamine green staining (P=0.014) improved, but BUT and Schirmer scores did not change significantly after treatment. At the end of the 4-month follow-up, the study group demonstrated statistically significantly better BUT (P=0.020), Schirmer scores (P=0.002), goblet cell density (P=0.006), corneal fluorescein staining (P=0.003), and conjunctival lissamine green staining (P=0.017) scores than did the control group. Topical cyclosporine A and artificial tears treatment significantly increases goblet cell density, decreases the signs of DTS, and improves ocular surface health.

Detection of Prosecretory Mitogen Lacritin in Nonprimate Tears Primarily as a C-Terminal-Like Fragment

PubMed Central

Laurie, Diane E.; Splan, Rebecca K.; Green, Kari; Still, Katherine M.; McKown, Robert L.; Laurie, Gordon W.

2012-01-01

Purpose. Lacritin is a human tear glycoprotein that promotes basal tear protein secretion in cultured rat lacrimal acinar cells and proliferation of subconfluent human corneal epithelial cells. When topically added to rabbit eyes, lacritin promotes basal tearing. Despite these activities on several species, lacritin's presence in nonprimate tears or other tissues has not been explored. Here we probed for lacritin in normal horse tears. Methods. Sequences were collected from the Ensembl genomic alignment of human LACRT gene with high-quality draft horse genome (EquCab2.0) and analyzed. Normal horse tears were collected and assayed by Western blotting, ELISA, and mass spectrometry. Newly generated rabbit antibodies, respectively, against N- and C-terminal regions of human lacritin were employed. Results. Identity was 75% and 45%, respectively, at nucleotide and protein levels. Structural features were conserved, including a C-terminal amphipathic α-helix. Anti-C-terminal antibodies strongly detected a ∼13 kDa band in horse tears that was validated by mass spectrometry. In human tears, the same antibody detected uncleaved lacritin (∼24 kDa) strongly and C-terminal fragments of ∼13 and ∼11 kDa weakly. Anti-N-terminal antibodies were slightly reactive with a ∼24 kDa horse antigen and showed no reaction with the anti-C-terminal–reactive ∼13 kDa species. Similar respective levels of horse C-terminal versus N-terminal immunoreactivity were apparent by ELISA. Conclusions. Lacritin is present in horse tears, largely as a C-terminal fragment homologous to the mitogenic and bactericidal region in human lacritin, suggesting potential benefit in corneal wound repair. PMID:22871838

Microarray-based IgE detection in tears of patients with vernal keratoconjunctivitis.

PubMed

Leonardi, Andrea; Borghesan, Franco; Faggian, Diego; Plebani, Mario

2015-11-01

A specific allergen sensitization can be demonstrated in approximately half of the vernal keratoconjunctivitis (VKC) patients by conventional allergic tests. The measurement of specific IgE in tears using a multiplex allergen microarray may offer advantages to identify local sensitization to a specific allergen. In spring-summer 2011, serum and tears samples were collected from 10 active VKC patients (three females, seven males) and 10 age-matched normal subjects. Skin prick test, symptoms score and full ophthalmological examination were performed. Specific serum and tear IgE were assayed using ImmunoCAP ISAC, a microarray containing 103 components derived from 47 allergens. Normal subjects resulted negative for the presence of specific IgE both in serum and in tears. Of the 10 VKC patients, six resulted positive to specific IgE in serum and/or tears. In three of these six patients, specific IgE was found positive only in tears. Cross-reactivity between specific markers was found in three patients. Grass, tree, mites, animal but also food allergen-specific IgE were found in tears. Conjunctival provocation test performed out of season confirmed the specific local conjunctival reactivity. Multiple specific IgE measurements with single protein allergens using a microarray technique in tear samples are a useful, simple and non-invasive diagnostic tool. ImmunoCAP ISAC detects allergen sensitization at component level and adds important information by defining both cross- and co-sensitization to a large variety of allergen molecules. The presence of specific IgE only in tears of VKC patients reinforces the concept of possible local sensitization. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Posterior root tear of the medial and lateral meniscus.

PubMed

Petersen, Wolf; Forkel, Philipp; Feucht, Matthias J; Zantop, Thore; Imhoff, Andreas B; Brucker, Peter U

2014-02-01

An avulsion of the tibial insertion of the meniscus or a radial tear close to the meniscal insertion is defined as a root tear. In clinical practice, the incidence of these lesions is often underestimated. However, several biomechanical studies have shown that the effect of a root tear is comparable to a total meniscectomy. Clinical studies documented progredient arthritic changes following root tears, thereby supporting basic science studies. The clinical diagnosis is limited by unspecific symptoms. In addition to the diagnostic arthroscopy, MRI is considered to be the gold standard of diagnosis of a meniscal root tear. Three different direct MRI signs for the diagnosis of a meniscus root tear have been described: Radial linear defect in the axial plane, vertical linear defect (truncation sign) in the coronal plane, and the so-called ghost meniscus sign in the sagittal plane. Meniscal extrusion is also considered to be an indirect sign of a root tear, but is less common in lateral root tears. During arthroscopy, the function of the meniscus root must be assessed by probing. However, visualization of the meniscal insertions is challenging. Refixation of the meniscal root can be performed using a transtibial pull-out suture, suture anchors, or side-to-side repair. Several short-term studies reported good clinical results after medial or lateral root repair. Nevertheless, MRI and second-look arthroscopy revealed high rates of incomplete or absent healing, especially for medial root tears. To date, most studies are case series with short-term follow-up and level IV evidence. Outerbridge grade 3 or 4 chondral lesions and varus malalignment of >5° were found to predict an inferior clinical outcome after medial meniscus root repair. Further research is needed to evaluate long-term results and to define evident criteria for meniscal root repair.

The adhesion of Pseudomonas aeruginosa to high molecular weight human tear film species corresponds to glycoproteins reactive with Sambucus nigra lectin.

PubMed

Aristoteli, Lina Panayiota; Willcox, Mark D P

2006-11-01

Pseudomonas aeruginosa is a pathogen gaining prevalence in contact lens-related corneal ulcers. Tear outflow protects the ocular surface, where high molecular weight tear glycoproteins bind bacteria for removal from the eye. The purpose of the present study was to identify glycoproteins in human tears involved in the adhesion of ocular P. aeruginosa isolates. Basal human tears were applied to a bacterial adhesion assay involving electrophoretic separation of tear components, transfer to nitrocellulose and incubation with biotin-labelled bacteria. Glycoproteins were further characterised using lectin profiling. The results showed large-dimension agarose gels were imperative for the detection of at least four glycoproteins with a migration >200 kDa, including species not previously identified. P. aeruginosa 6294 preferentially bound to a well-defined glycoprotein near the origin of the gel that, unlike other glycoproteins >200 kDa, reacted with Sambucus nigra lectin (sialic acid alpha2-6) but not WGA lectin (N-acetylglucosamine, sialic acid alpha2-3). Adhesion did not involve free biotin label or hydrophobic interactions. Also, the pre-incubation of separated tear glycoproteins with S. nigra lectin increased subsequent adhesion of 6294 to this tear glycoprotein. The less virulent Paer1 strain showed diffuse adhesion in the S. nigra-reactive region at the gel origin. In conclusion, an overlay adhesion assay was developed that identified slow-migrating sialylated glycoprotein species in human tears preferentially bound by P. aeruginosa ocular strains, and S. nigra lectin seemed to enhance the interaction. The study provides a basis for direct investigation of bacterial adhesion to glycoproteins with an apparent migration >200 kDa in tear fluid.

Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care

PubMed Central

Cadogan, Angela; McNair, Peter; Laslett, Mark; Hing, Wayne; Taylor, Stephen

2013-01-01

Objectives: Rotator cuff tears are a common and disabling complaint. The early diagnosis of medium and large size rotator cuff tears can enhance the prognosis of the patient. The aim of this study was to identify clinical features with the strongest ability to accurately predict the presence of a medium, large or multitendon (MLM) rotator cuff tear in a primary care cohort. Methods: Participants were consecutively recruited from primary health care practices (n = 203). All participants underwent a standardized history and physical examination, followed by a standardized X-ray series and diagnostic ultrasound scan. Clinical features associated with the presence of a MLM rotator cuff tear were identified (P<0.200), a logistic multiple regression model was derived for identifying a MLM rotator cuff tear and thereafter diagnostic accuracy was calculated. Results: A MLM rotator cuff tear was identified in 24 participants (11.8%). Constant pain and a painful arc in abduction were the strongest predictors of a MLM tear (adjusted odds ratio 3.04 and 13.97 respectively). Combinations of ten history and physical examination variables demonstrated highest levels of sensitivity when five or fewer were positive [100%, 95% confidence interval (CI): 0.86–1.00; negative likelihood ratio: 0.00, 95% CI: 0.00–0.28], and highest specificity when eight or more were positive (0.91, 95% CI: 0.86–0.95; positive likelihood ratio 4.66, 95% CI: 2.34–8.74). Discussion: Combinations of patient history and physical examination findings were able to accurately detect the presence of a MLM rotator cuff tear. These findings may aid the primary care clinician in more efficient and accurate identification of rotator cuff tears that may require further investigation or orthopedic consultation. PMID:24421626

Acute non-contact anterior cruciate ligament tears are associated with relatively increased vastus medialis to semimembranosus cross-sectional area ratio: a case-control retrospective MR study.

PubMed

Wieschhoff, Ged G; Mandell, Jacob C; Czuczman, Gregory J; Nikac, Violeta; Shah, Nehal; Smith, Stacy E

2017-11-01

Hamstring muscle deficiency is increasingly recognized as a risk factor for anterior cruciate ligament (ACL) tears. The purpose of this study is to evaluate the vastus medialis to semimembranosus cross-sectional area (VM:SM CSA) ratio on magnetic resonance imaging (MRI) in patients with ACL tears compared to controls. One hundred knee MRIs of acute ACL tear patients and 100 age-, sex-, and side-matched controls were included. Mechanism of injury, contact versus non-contact, was determined for each ACL tear subject. The VM:SM CSA was measured on individual axial slices with a novel method using image-processing software. One reader measured all 200 knees and the second reader measured 50 knees at random to assess inter-reader variability. The intraclass correlation coefficient (ICC) was calculated to evaluate for correlation between readers. T-tests were performed to evaluate for differences in VM:SM CSA ratios between the ACL tear group and control group. The ICC for agreement between the two readers was 0.991 (95% confidence interval 0.984-0.995). Acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.44 vs. 1.28; p = 0.005). Non-contact acute ACL tear patients have an increased VM:SM CSA ratio compared to controls (1.48 vs. 1.20; p = 0.003), whereas contact acute ACL tear patients do not (1.23 vs. 1.26; p = 0.762). Acute non-contact ACL tears are associated with increased VM:SM CSA ratios, which may imply a relative deficiency in hamstring strength. This study also demonstrates a novel method of measuring the relative CSA of muscles on MRI.

The potential of optical coherence tomography in meniscal tear characterization

NASA Astrophysics Data System (ADS)

Ling, Hang-yin; Guo, Shuguang; Thieman, Kelley M.; Wise, Brent T.; Pozzi, Antonio; Xie, Huikai; Horodyski, MaryBeth

2009-02-01

Meniscal tear is one of the most common knee injuries leading to pain and discomfort. Partial and total meniscectomies have been widely used to treat the avascular meniscal injuries in which tears do not heal spontaneously. However, the meniscectomies would cause an alteration of the tibiofemoral contact mechanics resulting in progressive osteoarthritis (OA). To mitigate the progression of OA, maximal preservation of meniscal tissue is recommended. The clinical challenge is deciding which meniscal tears are amenable to repair and which part of damaged tissues should be removed. Current diagnosis techniques such as arthroscopy and magnetic resonance imaging can provide macrostructural information of menisci, but the microstructural changes that occur prior to the observable meniscal tears cannot be identified by these techniques. Serving as a nondestructive optical biopsy, optical coherence tomography (OCT), a newly developed imaging modality, can provide high resolution, cross-sectional images of tissues and has been shown its capabilty in arthroscopic evaulation of articular cartilage. Our research was to demonstrate the potential of using OCT for nondestructive characterization of the histopathology of different types of meniscal tears from clinical cases in dogs, providing a fundamental understanding of the failure mechanism of meniscal tears. First, cross-sectional images of torn canine menisci obtained from the OCT and scanning electronic microscopy (SEM) were be compared. By studying the organization of collegan fibrils in torn menisci from the SEM images, the feasibility of using OCT to characterize the organization of collegan fibrils was elucidated. Moreover, the crack size of meniscal tears was quantatitively measured from the OCT images. Changes in the crack size of the tear may be useful for understanding the failure mechanism of meniscal tears.

Similar Prevalence of Acetabular Labral Tear in Professional Ballet Dancers and Sporting Participants.

PubMed

Mayes, Susan; Ferris, April-Rose; Smith, Peter; Garnham, Andrew; Cook, Jill

2016-07-01

To compare the prevalence of acetabular labral tear in male and female professional ballet dancers with age-matched and sex-matched sporting participants and to determine the relationship to clinical findings and cartilage defects. Case-control study. Clinical and radiology practices. Forty-nine (98 hips) male and female professional ballet dancers (current and retired) with median age 30 years (range: 19-64 years) and 49 (98 hips) age-matched and sex-matched sporting participants. Group (ballet or sports), sex, age, hip cartilage defects, history of hip pain, Hip and Groin Outcome Score, passive hip internal rotation (IR), and external rotation range of movement (ROM). Labral tear identified with 3T magnetic resonance imaging (MRI). Labral tears were identified in 51% of all 196 hips. The prevalence did not differ significantly between the ballet and sporting participants (P = 0.41) or between sexes (P = 0.34). Labral tear was not significantly associated with clinical measures, such as pain and function scores or rotation ROM (P > 0.01 for all). Pain provocation test using IR at 90° of hip flexion had excellent specificity [96%, 95% confidence intervals (CIs), 0.77%-0.998%] but poor sensitivity (50%, 95% CI, 0.26%-0.74%) for identifying labral tear in participants reporting hip pain. Older age and cartilage defect presence were independently associated with an increased risk of labral tear (both P < 0.001). The prevalence of labral tear in male and female professional ballet dancers was similar to a sporting population. Labral tears were not associated with clinical findings but were related to cartilage defects, independent of aging. Caution is required when interpreting MRI findings as labral tear may not be the source of the ballet dancer's symptoms.

78 FR 22213 - Airworthiness Directives; Eurocopter France Helicopters

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-15

... float assemblies for any cuts, tears, punctures, or abrasion. Replace the cover if the internal... cuts, tears, punctures, or abrasion. If there is a cut, tear, puncture, or any abrasion, repair the...

Recent developments on dry eye disease treatment compounds

PubMed Central

Colligris, Basilio; Alkozi, Hanan Awad; Pintor, Jesus

2013-01-01

Dry eye syndrome is a common tears and ocular surface multifactorial disease, described by changes in the ocular surface epithelia related to reduced tears quantity and ocular surface sensitivity, leading to inflammatory reaction. Managing the eye inflammation proved helpful to patients with dry eye disease and current treatment is based on the use of topically applied artificial tear products/lubricants, tear retention management, stimulation of tear secretion and using anti-inflammatory drugs. In this article we revise the corresponding literature and patents assembling the new treatment approaches of novel and future pharmaceutical compounds destined for the dry eye disease treatment. The most frequent categories of compounds presented are secretagogues and anti-inflammatory drugs. These compounds are the research outcome of novel therapeutic strategies designed to reduce key inflammatory pathways and restore healthy tear film. PMID:24526854

Advances in thickness measurements and dynamic visualization of the tear film using non-invasive optical approaches.

PubMed

Bai, Yuqiang; Nichols, Jason J

2017-05-01

The thickness of tear film has been investigated under both invasive and non-invasive methods. While invasive methods are largely historical, more recent noninvasive methods are generally based on optical approaches that provide accurate, precise, and rapid measures. Optical microscopy, interferometry, and optical coherence tomography (OCT) have been developed to characterize the thickness of tear film or certain aspects of the tear film (e.g., the lipid layer). This review provides an in-depth overview on contemporary optical techniques used in studying the tear film, including both advantages and limitations of these approaches. It is anticipated that further developments of high-resolution OCT and other interferometric methods will enable a more accurate and precise measurement of the thickness of the tear film and its related dynamic properties. Copyright © 2017 Elsevier Ltd. All rights reserved.

Interferometric characterization of tear film dynamics

NASA Astrophysics Data System (ADS)

Primeau, Brian Christopher

The anterior refracting surface of the eye is the thin tear film that forms on the surface of the cornea. When a contact lens is on worn, the tear film covers the contact lens as it would a bare cornea, and is affected by the contact lens material properties. Tear film irregularity can cause both discomfort and vision quality degradation. Under normal conditions, the tear film is less than 10 microns thick and the thickness and topography change in the time between blinks. In order to both better understand the tear film, and to characterize how contact lenses affect tear film behavior, two interferometers were designed and built to separately measure tear film behavior in vitro and in vivo. An in vitro method of characterizing dynamic fluid layers applied to contact lenses mounted on mechanical substrates has been developed using a phase-shifting Twyman-Green interferometer. This interferometer continuously measures light reflected from the surface of the fluid layer, allowing precision analysis of the dynamic fluid layer. Movies showing this fluid layer behavior can be generated. The fluid behavior on the contact lens surface is measured, allowing quantitative analysis beyond what typical contact angle or visual inspection methods provide. The in vivo interferometer is a similar system, with additional modules included to provide capability for human testing. This tear film measurement allows analysis beyond capabilities of typical fluorescein visual inspection or videokeratometry and provides better sensitivity and resolution than shearing interferometry methods.

The Arabidopsis RING-Type E3 Ligase TEAR1 Controls Leaf Development by Targeting the TIE1 Transcriptional Repressor for Degradation[OPEN

PubMed Central

Zhang, Jinzhe; Wei, Baoye; Yuan, Rongrong; Yu, Hao

2017-01-01

The developmental plasticity of leaf size and shape is important for leaf function and plant survival. However, the mechanisms by which plants form diverse leaves in response to environmental conditions are not well understood. Here, we identified TIE1-ASSOCIATED RING-TYPE E3 LIGASE1 (TEAR1) and found that it regulates leaf development by promoting the degradation of TCP INTERACTOR-CONTAINING EAR MOTIF PROTEIN1 (TIE1), an important repressor of CINCINNATA (CIN)-like TEOSINTE BRANCHED1/CYCLOIDEA/PCF (TCP) transcription factors, which are key for leaf development. TEAR1 contains a typical C3H2C3-type RING domain and has E3 ligase activity. We show that TEAR1 interacts with the TCP repressor TIE1, which is ubiquitinated in vivo and degraded by the 26S proteasome system. We demonstrate that TEAR1 is colocalized with TIE1 in nuclei and negatively regulates TIE1 protein levels. Overexpression of TEAR1 rescued leaf defects caused by TIE1 overexpression, whereas disruption of TEAR1 resulted in leaf phenotypes resembling those caused by TIE1 overexpression or TCP dysfunction. Deficiency in TEAR partially rescued the leaf defects of TCP4 overexpression line and enhanced the wavy leaf phenotypes of jaw-5D. We propose that TEAR1 positively regulates CIN-like TCP activity to promote leaf development by mediating the degradation of the TCP repressor TIE1. PMID:28100709

In vivo tear film thickness measurement and tear film dynamics visualization using spectral domain OCT and an efficient delay estimator

NASA Astrophysics Data System (ADS)

Aranha dos Santos, Valentin; Schmetterer, Leopold; Gröschl, Martin; Garhofer, Gerhard; Werkmeister, René M.

2016-03-01

Dry eye syndrome is a highly prevalent disease of the ocular surface characterized by an instability of the tear film. Traditional methods used for the evaluation of tear film stability are invasive or show limited repeatability. Here we propose a new noninvasive approach to measure tear film thickness using an efficient delay estimator and ultrahigh resolution spectral domain OCT. Silicon wafer phantoms with layers of known thickness and group index were used to validate the estimator-based thickness measurement. A theoretical analysis of the fundamental limit of the precision of the estimator is presented and the analytical expression of the Cramér-Rao lower bound (CRLB), which is the minimum variance that may be achieved by any unbiased estimator, is derived. The performance of the estimator against noise was investigated using simulations. We found that the proposed estimator reaches the CRLB associated with the OCT amplitude signal. The technique was applied in vivo in healthy subjects and dry eye patients. Series of tear film thickness maps were generated, allowing for the visualization of tear film dynamics. Our results show that the central tear film thickness precisely measured in vivo with a coefficient of variation of about 0.65% and that repeatable tear film dynamics can be observed. The presented method has the potential of being an alternative to breakup time measurements (BUT) and could be used in clinical setting to study patients with dry eye disease and monitor their treatments.

Biceps-Related Physical Findings Are Useful to Prevent Misdiagnosis of Cervical Spondylotic Amyotrophy as a Rotator Cuff Tear.

PubMed

Iwata, Eiichiro; Shigematsu, Hideki; Inoue, Kazuya; Egawa, Takuya; Tanaka, Masato; Okuda, Akinori; Morimoto, Yasuhiko; Masuda, Keisuke; Yamamoto, Yusuke; Sakamoto, Yoshihiro; Koizumi, Munehisa; Tanaka, Yasuhito

2018-02-01

Case-control study. The aim of the present study was to identify physical findings useful for differentiating between cervical spondylotic amyotrophy (CSA) and rotator cuff tears to prevent the misdiagnosis of CSA as a rotator cuff tear. CSA and rotator cuff tears are often confused among patients presenting with difficulty in shoulder elevation. Twenty-five patients with CSA and 27 with rotator cuff tears were enrolled. We included five physical findings specific to CSA that were observed in both CSA and rotator cuff tear patients. The findings were as follows: (1) weakness of the deltoid muscle, (2) weakness of the biceps muscle, (3) atrophy of the deltoid muscle, (4) atrophy of the biceps muscle, and (5) swallow-tail sign (assessment of the posterior fibers of the deltoid). Among 25 CSA patients, 10 (40.0%) were misdiagnosed with a rotator cuff tear on initial diagnosis. The sensitivity and specificity of each physical finding were as follows: (1) deltoid weakness (sensitivity, 92.0%; specificity, 55.6%), (2) biceps weakness (sensitivity, 80.0%; specificity, 100%), (3) deltoid atrophy (sensitivity, 96.0%; specificity, 77.8%), (4) biceps atrophy (sensitivity, 88.8%; specificity, 92.6%), and (5) swallow-tail sign (sensitivity, 56.0%; specificity, 74.1%). There were statistically significant differences in each physical finding. CSA is likely to be misdiagnosed as a rotator cuff tear; however, weakness and atrophy of the biceps are useful findings for differentiating between CSA and rotator cuff tears to prevent misdiagnosis.

Pit above the lesser tuberosity in axial view radiography.

PubMed

Cho, Jae-Ho; Han, Kyeong-Jin; Lee, Doo-Hyung; Chung, Nam-Su; Park, Do Young

2015-02-01

This study examined the relationship between the presence of a pit above the lesser tuberosity on axial view radiographs and rotator cuff tears and compared the demographic data between groups according to the presence of a pit above the lesser tuberosity. The hypothesis of this study was that the radiographic finding of a pit above the lesser tuberosity is related to rotator cuff tears. For 112 patients with a symptomatic rotator cuff tear, plain radiographs of the symptomatic shoulder (tear side radiographs) and plain radiographs of the asymptomatic contralateral shoulder (no-tear side radiographs) were assessed. Seventeen radiological findings, including a pit above the lesser tuberosity, osteophytes, subchondral cysts, and sclerosis, were recorded by one blinded observer. Demographic data such as age, duration of symptoms, sex, arm dominance, smoking history, trauma history, American Shoulder and Elbow Surgeons score, Constant score, and involved tendon were collected. A pit above the lesser tuberosity was noted on tear side radiographs of 40 patients (35.7 %) and on the no-tear side radiographs of 27 patients (24.1 %), representing a significant difference (P = 0.040). A pit associated with a rotator cuff tear was observed more often in the dominant arm (P = 0.040) and more often in patients with less previous trauma (P = 0.024). A pit above the lesser tuberosity on axial view radiography was associated with a rotator cuff tear and occurred more often in the dominant arm of patients who had no trauma history. Prognostic study, Level III.

Tears from children with chronic hepatitis B virus (HBV) infection are infectious vehicles of HBV transmission: experimental transmission of HBV by tears, using mice with chimeric human livers.

PubMed

Komatsu, Haruki; Inui, Ayano; Sogo, Tsuyoshi; Tateno, Akihiko; Shimokawa, Reiko; Fujisawa, Tomoo

2012-08-15

Body fluids such as saliva, urine, sweat, and tears from hepatitis B virus (HBV) carriers are potential sources of HBV transmission. Thirty-nine children and 8 adults who were chronically infected with HBV were enrolled. Real-time polymerase chain reaction was used for the quantification of HBV DNA. HBV DNA was detected in 73.7% of urine samples (14 of 19), 86.8% of saliva samples (33 of 38), 100% of tear samples (11 of 11), and 100% of sweat samples (9 of 9). Mean HBV DNA levels (±SD) in urine, saliva, tears, and sweat were 4.3 ± 1.1 log copies/mL, 5.9 ± 1.2 log copies/mL, 6.2 ± 0.7 log copies/mL, and 5.2 ± 0.6 log copies/mL, respectively. A statistically significant correlation was observed between the HBV DNA level in serum specimens and HBV DNA levels in saliva and tear specimens (r = 0.88; P < .001). Tear specimens from a child were injected intravenously into 2 human hepatocyte-transplanted chimeric mice. One week after inoculation, both chimeric mice had serum positive for HBV DNA. The levels of HBV DNA in tear specimens from young children were high. Tears were confirmed to be infectious, using chimeric mice. Strict precautions should be taken against direct contact with body fluids from HBV carriers with high-level viremia.

Influence of Ophthalmic Solutions on Tear Components.

PubMed

Shigeyasu, Chika; Yamada, Masakazu; Akune, Yoko

2016-11-01

Tear fluids are a mixture of secretions derived from lacrimal glands, accessory lacrimal glands, conjunctiva, and meibomian glands. Compositional changes to tears occur in the normal state and during ocular surface disease, such as dry eye conditions. We have investigated compositional changes to tears after topical application of ophthalmic solutions, with regard to tear-specific proteins (secretory immunoglobulin A, lactoferrin, lipocalin-1, and lysozyme) and ocular surface mucin in normal and dry eye conditions using high-performance liquid chromatography. After application of saline solution (0.9% sodium chloride) in normal subjects, transient but significant decreases in all tear components were observed. The recovery of protein concentrations took up to 30 minutes and lasted longer when the saline solution was applied more frequently. When applying ophthalmic solutions, a balance between washout and dilutional effects should be considered in addition to the therapeutic effect. Investigation of the effect of diquafosol solution (3%) in normal subjects revealed a significant increase in sialic acid concentration, a marker of ocular mucin, at 5 minutes after application, whereas a significant decrease was observed with saline. This result indicates the accelerated secretion of mucin from ocular tissues induced by diquafosol. A clinical study to determine the efficacy of diquafosol in patients with dry eye revealed improvements in tear breakup time, keratoconjunctival staining scores, and Schirmer test score, accompanied by an increase in sialic acid concentration in tears. Investigating normal and dry eye conditions through tear analysis may clarify the pathophysiology of dry eye conditions and support the efficacy of treatments.

Diquafosol sodium ophthalmic solution for the treatment of dry eye: clinical evaluation and biochemical analysis of tear composition.

PubMed

Shigeyasu, Chika; Yamada, Masakazu; Akune, Yoko; Tsubota, Kazuo

2015-11-01

To evaluate the clinical efficacy of 3% diquafosol sodium ophthalmic solution for dry eye, and to analyze the concentration of tear proteins and mucin-like substances after the treatment. Fifty eyes of 25 patients with dry eye syndrome were prospectively enrolled. The patients were treated with diquafosol solution at a dose of 1 drop in each eye 6 times daily for 4 weeks. The parameters of clinical efficacy were tear osmolarity, tear breakup time (BUT), fluorescein staining scores for the cornea and conjunctiva, Schirmer test values, and subjective symptoms evaluated using the ocular surface disease index (OSDI). Tears collected with Schirmer test strips were analyzed by high-performance liquid chromatography, and the concentrations of the total protein and the 4 major tear proteins, namely, secretory IgA, lactoferrin, lipocalin-1, lysozyme, and N-acetyl-neuraminic acid (Neu5Ac), were measured. Neu5Ac is a major sialic acid, a marker of secretory mucins. The BUT, keratoconjunctival staining scores, and Schirmer test values were improved with statistical significance after the treatment with diquafosol solution, while changes in the other parameters, including tear osmolarity, corneal staining scores, and OSDI scores were not significant. The Neu5Ac concentration was significantly increased, which was not accompanied by changes in tear proteins. Topical application of diquafosol significantly improved the clinical parameters of the BUT, keratoconjunctival staining scores, and Schirmer test values and was accompanied by increased sialic acid content in the tears of patients with dry eye.

Relevance of Lipid-Based Products in the Management of Dry Eye Disease

PubMed Central

Amrane, Mourad; Faure, Marie-Odile; Holopainen, Juha M.; Tong, Louis

2017-01-01

Abstract Components of the ocular surface synergistically contribute to maintaining and protecting a smooth refractive layer to facilitate the optimal transmission of light. At the air–water interface, the tear film lipid layer (TFLL), a mixture of lipids and proteins, plays a key role in tear surface tension and is important for the physiological hydration of the ocular surface and for ocular homeostasis. Alterations in tear fluid rheology, differences in lipid composition, or downregulation of specific tear proteins are found in most types of ocular surface disease, including dry eye disease (DED). Artificial tears have long been a first line of treatment in DED and aim to replace or supplement tears. More recently, lipid-containing eye drops have been developed to more closely mimic the combination of aqueous and lipid layers of the TFLL. Over the last 2 decades, our understanding of the nature and importance of lipids in the tear film in health and disease has increased substantially. The aim of this article is to provide a brief overview of our current understanding of tear film properties and review the effectiveness of lipid-based products in the treatment of DED. Liposome lid sprays, emulsion eye drops, and other lipid-containing formulations are discussed. PMID:28956698

Tearing Instability of a Current Sheet Forming by Sheared Incompressible Flow

NASA Astrophysics Data System (ADS)

Tolman, Elizabeth; Loureiro, Nuno; Uzdensky, Dmitri

2017-10-01

Sweet-Parker current sheets are unstable to the tearing mode, suggesting they will not form in physical systems. Understanding magnetic reconnection thus requires study of the stability of a current sheet as it forms. Such formation can occur as a result of sheared, sub-Alfvénic incompressible flows into and along the sheet. This work presents an analysis of how tearing perturbations behave in a current sheet forming under the influence of such flows, beginning with a phase when the growth rate of the tearing mode is small and the behavior of perturbations is primarily governed by ideal MHD. Later, after the tearing growth rate becomes significant relative to the time scale of the driving flows, the flows cause a slight reduction in the tearing growth rate and wave vector of the dominant mode. Once the tearing mode enters the nonlinear regime, the flows accelerate the tearing growth slightly; during X-point collapse, the flows have negligible effect on the system behavior. This analysis allows greater understanding of reconnection in evolving systems and increases confidence in the application of tools developed in time-independent current sheets to changing current sheets. This material is based upon work supported by the National Science Foundation Graduate Research Fellowship.

Effect of Leukocyte-Rich and Platelet-Rich Plasma on Healing of a Horizontal Medial Meniscus Tear in a Rabbit Model

PubMed Central

Shin, Kyun Ho; Lee, Haseok; Kang, Seonghyun; Ko, You-Jin; Lee, Seung-Yup; Park, Jung-Ho; Bae, Ji-Hoon

2015-01-01

There are limited reports on the effect of platelet-rich plasma (PRP) on meniscus healing. The purpose of this study was to investigate the effect of leukocyte-rich PRP (L-PRP) on potential healing of the horizontal medial meniscus tears in a rabbit model. A horizontal medial meniscus tear was created in both knees of nine skeletally mature adult rabbits. Left or right knees were randomly assigned to a L-PRP group, or a control group. 0.5 mL of L-PRP from 10 mL of each rabbit's whole blood was prepared and injected into the horizontal tears in a L-PRP group. None was applied to the horizontal tears in a control group. The histological assessment of meniscus healing was performed at two, four, and six weeks after surgery. We found that there were no significant differences of quantitative histologic scoring between two groups at 2, 4, and 6 weeks after surgery (p > 0.05). This study failed to show the positive effect of single injection of L-PRP on enhancing healing of the horizontal medial meniscus tears in a rabbit model. Single injection of L-PRP into horizontal meniscus tears may not effectively enhance healing of horizontal medial meniscus tears. PMID:26180783

Assessment and treatment strategies for rotator cuff tears

PubMed Central

Al-Hakim, Wisam; Noorani, Ali

2014-01-01

Tears of the rotator cuff are common and becoming an increasingly frequent problem. There is a vast amount of literature on the merits and limitations of the various methods of clinical and radiological assessment of rotator cuff tears. This is also the case with regard to treatment strategies. Certain popular beliefs and principles practiced widely and the basis upon which they are derived may be prone to inaccuracy. We provide an overview of the historical management of rotator cuff tears, as well as an explanation for how and why rotator cuff tears should be managed, and propose a structured methodology for their assessment and treatment. PMID:27582960

Towards Multiscale Interactions Between Tearing Modes and Microturbulence

NASA Astrophysics Data System (ADS)

Williams, Z. R.; Pueschel, M. J.; Terry, P. W.

2017-10-01

Work on the Madison Symmetric Torus Reversed-Field Pinch (RFP) has shown that large-scale tearing modes present in standard operation are highly detrimental to confinement. These tearing modes, even when reduced in improved confinement regimes of operation, significantly affect zonal flow activity and play a large role in setting microturbulent-induced transport levels. Previous gyrokinetic work has shown that a small but finite tearing fluctuation amplitude is necessary to produce transport values in agreement with experimental observation. This has previously been implemented via an ad-hoc, constant-in-time A∥ perturbation. This work details self-consistent modeling of tearing fluctuations in the RFP using the Gene code via the inclusion of a current gradient drive incorporated into the background distribution function. Tearing mode growth rates calculated from gyrokinetic simulations are benchmarked with results from fluid theory. Additionally, first results from multiscale Gene simulations describing tearing mode interactions with RFP microturbulence are presented. This work is supported by the U.S. Department of Energy, Grant No. DE-FG02-85ER-53121.

Retinal tear: an unusual complication of ocular toxoplasmosis.

PubMed

Celebi, Ali Riza Cenk; Kilavuzoglu, Ayse Ebru; Altiparmak, Ugur Emrah; Cosar, Cemile Banu; Ozkiris, Abdullah

2015-01-01

It is aimed to report on a 16-year-old patient with acquired ocular toxoplasmosis complicated by a retinal tear. Retrospective medical chart review. A 16-year-old Caucasian female presented with vision loss in her right eye. In addition to a white active lesion between the fovea and the optic nerve head, marked vitreous opacification was noted. She was diagnosed with ocular toxoplasmosis. The patient was treated with oral azithromycin, clindamycin, and trimethoprimsulfamethoxazole. One month later, retinochoroiditis resolved and vitreous cleared. Three months after onset, patient presented with floaters in the right eye and a retinal tear was located at the temporal region of the retina. Prophylactic argon laser treatment that encircled the retinal tear was performed. No other abnormalities were noted during 6 months of follow-up. Retinal tear associated with ocular toxoplasmosis is rare; however, a retinal tear can occur due to vitreoretinal traction following post-inflammatory structural alteration of the vitreous. Retinal tears may be seen during the healing phase, when the inflammation turns into tightening of vitreous substance. Careful retinal examination in cases of ocular toxoplasmosis is warranted, especially in patients with severe vitreous inflammation.

Composition of incubation solution impacts in vitro protein uptake to silicone hydrogel contact lenses

PubMed Central

Heynen, Miriam; Luensmann, Doerte; Jones, Lyndon

2012-01-01

Purpose To determine the impact of incubation solution composition on protein deposition to silicone hydrogel (SH) contact lenses using a simplistic and a complex model of the tear film. Methods Three SH materials – senofilcon A (SA), lotrafilcon B (LB), and balafilcon A (BA) – were incubated in two different solutions; Solution A was a simplistic augmented buffered saline solution containing a single protein, whereas Solution B was a complex artificial tear solution (ATS), containing the augmented buffered saline solution in addition to proteins, lipids, and mucins (pH=7.4). The proteins of interest (lysozyme, lactoferrin, albumin) were radiolabeled with Iodine-125 (2% protein of interest) and the accumulation of the conjugated protein to the lens materials was determined after 1, 7, 14, and 28 days of incubation. Protein deposition was measured using a gamma counter and the raw data were translated into absolute amounts (µg/lens) via extrapolation from standards. Results After 28 days, lysozyme uptake was significantly lower on BA lenses when incubated in Solution A (33.7 μg) compared to Solution B (56.2 μg), p<0.001. SA lenses deposited similar amounts of lysozyme when incubated in either Solution A (2.6 μg) or Solution B (4.1 μg), p>0.05. LB lenses also deposited similar amounts of lysozyme for both solutions (Solution A: 5.0 μg, Solution B: 4.7 μg, p>0.05). After 28 days, BA lenses accumulated approximately twice the amount of lactoferrin than the other lens materials, with 30.3 μg depositing when exposed to Solution A and 22.0 μg with Solution B. The difference between the two solutions was statistically significant (p<0.001). LB materials deposited significantly greater amounts of lactoferrin when incubated in Solution A (16.6 μg) compared to Solution B (10.3 μg), p<0.001. Similar amounts of lactoferrin were accumulated onto SA lenses regardless of incubation solution composition (Solution A: 8.2 μg, Solution B: 11.2 μg, p>0.05). After 28 days, albumin deposition onto BA lenses was significantly greater when lenses were incubated in Solution B (1.7 μg) compared to Solution A (0.9 μg), p<0.001. Similar amounts of albumin were deposited on SA lenses when incubated in either solution (0.6 μg versus 0.7 μg, p>0.05). LB lenses incubated in Solution A deposited more albumin compared to Solution B (0.9 μg versus 0.6 μg), p=0.003. Discussion Protein deposition onto SH materials varied when contact lenses were incubated in either a complex ATS compared to a single protein solution. More lysozyme accumulated onto BA lenses incubated in a complex analog of the human tear film, whereas lactoferrin deposited onto SA lenses independent of incubation solution composition. To better mimic the ex vivo environment, future studies should use more appropriate analogs of the tear film. PMID:22355245

Emotion with tears decreases allergic responses to latex in atopic eczema patients with latex allergy.

PubMed

Kimata, Hajime

2006-07-01

Allergic responses are enhanced by stress, whereas they are reduced by laughter in atopic eczema patients. Emotion with tears decreases plasma IL-6 levels in patients with rheumatoid arthritis. Thus, the effect of emotion with tears on allergic responses in patients with atopic eczema was studied. Sixty patients with atopic eczema having latex allergy viewed both the weather information video and the heart-warming movie, Kramer vs. Kramer. Just before and immediately after viewing each video, allergic responses to latex were measured. Viewing the weather information video did not cause emotion with tears in any patients, and it failed to modulate allergic responses. In contrast, viewing Kramer vs. Kramer caused emotion with tears in 44 of 60 patients, and it reduced allergic skin wheal responses to latex and latex-specific IgE production in them. Emotion with tears reduced allergic responses, and it may be useful in the treatment of allergic diseases.

Pharmacokinetic analysis of topical tobramycin in equine tears by automated immunoassay.

PubMed

Czerwinski, Sarah L; Lyon, Andrew W; Skorobohach, Brian; Léguillette, Renaud

2012-08-21

Ophthalmic antibiotic therapy in large animals is often used empirically because of the lack of pharmacokinetics studies. The purpose of the study was to determine the pharmacokinetics of topical tobramycin 0.3% ophthalmic solution in the tears of normal horses using an automated immunoassay analysis. The mean tobramycin concentrations in the tears at 5, 10, 15, 30 minutes and 1, 2, 4, 6 hours after administration were 759 (±414), 489 (±237), 346 (±227), 147 (±264), 27.6 (±28.4), 14.8 (±66.6), 6.7 (±18.6), and 23.4 (±73.4) mg/L. Mean tobramycin concentration was maintained above the MIC90 for commonly isolated bacteria for 68.5 min. A single dose of topical tobramycin resulted in therapeutic concentrations of tobramycin in the tears for 1 h after administration. Therapeutic levels of tobramycin remained in equine tears 6 times longer than was reported in rabbit tears.

Touching the base: heart-warming ads from the 2016 U.S. election moved viewers to partisan tears.

PubMed

Seibt, Beate; Schubert, Thomas W; Zickfeld, Janis H; Fiske, Alan P

2018-03-07

Some political ads used in the 2016 U.S. election evoked feelings colloquially known as being moved to tears. We conceptualise this phenomenon as a positive social emotion that appraises and motivates communal relations, is accompanied by physical sensations (including lachrymation, piloerection, chest warmth), and often labelled metaphorically. We surveyed U.S. voters in the fortnight before the 2016 U.S. election. Selected ads evoked the emotion completely and reliably, but in a partisan fashion: Clinton voters were moved to tears by three selected Clinton ads, and Trump voters were moved to tears by two Trump ads. Viewers were much less moved by ads of the candidate they did not support. Being moved to tears predicted intention to vote for the candidate depicted. We conclude that some contemporary political advertising is able to move its audience to tears, and thereby motivates support.

A review of surgical repair methods and patient outcomes for gluteal tendon tears.

PubMed

Ebert, Jay R; Bucher, Thomas A; Ball, Simon V; Janes, Gregory C

2015-01-01

Advanced hip imaging and surgical findings have demonstrated that a common cause of greater trochanteric pain syndrome (GTPS) is gluteal tendon tears. Conservative measures are initially employed to treat GTPS and manage gluteal tears, though patients frequently undergo multiple courses of non-operative treatment with only temporary pain relief. Therefore, a number of surgical treatment options for recalcitrant GTPS associated with gluteal tears have been reported. These have included open trans-osseous or bone anchored suture techniques, endoscopic methods and the use of tendon augmentation for repair reinforcement. This review describes the anatomy, pathophysiology and clinical presentation of gluteal tendon tears. Surgical techniques and patient reported outcomes are presented. This review demonstrates that surgical repair can result in improved patient outcomes, irrespective of tear aetiology, and suggests that the patient with "trochanteric bursitis" should be carefully assessed as newer surgical techniques show promise for a condition that historically has been managed conservatively.

Rare and Severe Maxillofacial Injury Due to Tear Gas Capsules: Report of Three Cases.

PubMed

Çorbacɩoğlu, Şeref Kerem; Güler, Sertaç; Er, Erhan; Seviner, Meltem; Aslan, Şahin; Aksel, Gökhan

2016-03-01

Tear gases are used by police or armed forces for control of riots or social events or by the general population for private self-defense. These agents are used widely throughout the world, but some harmful effects have reported. In addition, despite well-defined chemical side effects documented in the literature, data are insufficient regarding mechanical injury due to tear gas capsules. We report three cases of severe maxillofacial injury in patients who had these capsules fired from tear gas guns directly to their faces. The capsules penetrated the patients' faces, causing potentially fatal injuries. To our knowledge, reports of this kind of injury related to tear gas capsules are very rare in the literature. In conclusion, tear gas guns may be very dangerous in terms of human health and they may cause severe injuries, especially when they are not used according to strict guidelines. © 2015 American Academy of Forensic Sciences.

Unstable domains of tearing and Kelvin-Helmholtz instabilities in a rotating cylindrical plasma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fan, D. M.; Wei, L.; Wang, Z. X., E-mail: zxwang@dlut.edu.cn

2014-09-15

Effects of poloidal rotation profile on tearing and Kelvin-Helmholtz (KH) instabilities in a cylindrical plasma are investigated by using a reduced magnetohydrodynamic model. Since the poloidal rotation has different effects on the tearing and KH modes in different rotation regimes, four unstable domains are numerically identified, i.e., the destabilized tearing mode domain, stabilized tearing mode domain, stable-window domain, and unstable KH mode domain. It is also found that when the rotation layer is in the outer region of the rational surface, the stabilizing role of the rotation can be enhanced so significantly that the stable window domain is enlarged. Moreover,more » Alfvén resonances can be induced by the tearing and KH modes in such rotating plasmas. Radially wide profiles of current and vorticity perturbations can be formed when multiple current sheets on different resonance positions are coupled together.« less

Predicting Dural Tear in Compound Depressed Skull Fractures: A Prospective Multicenter Correlational Study.

PubMed

Salia, Shemsedin Musefa; Mersha, Hagos Biluts; Aklilu, Abenezer Tirsit; Baleh, Abat Sahlu; Lund-Johansen, Morten

2018-06-01

Compound depressed skull fracture (DSF) is a neurosurgical emergency. Preoperative knowledge of dural status is indispensable for treatment decision making. This study aimed to determine predictors of dural tear from clinical and imaging characteristics in patients with compound DSF. This prospective, multicenter correlational study in neurosurgical hospitals in Addis Ababa, Ethiopia, included 128 patients operated on from January 1, 2016, to October 31, 2016. Clinical, imaging, and intraoperative findings were evaluated. Univariate and multivariate analyses were used to establish predictors of dural tear. A logistic regression model was developed to predict probability of dural tear. Model validation was done using the receiver operating characteristic curve. Dural tear was seen in 55.5% of 128 patients. Demographics, injury mechanism, clinical presentation, and site of DSF had no significant correlation with dural tear. In univariate and multivariate analyses, depth of fracture depression (odds ratio 1.3, P < 0.001), pneumocephalus (odds ratio 2.8, P = 0.005), and brain contusions/intracerebral hematoma (odds ratio 5.5, P < 0.001) were significantly correlated with dural tear. We developed a logistic regression model (diagnostic test) to calculate probability of dural tear. Using the receiver operating characteristic curve, we determined the cutoff value for a positive test giving the highest accuracy to be 30% with a corresponding sensitivity of 93.0% and specificity of 43.9%. Dural tear in compound DSF can be predicted with 93.0% sensitivity using preoperative findings and may guide treatment decision making in resource-limited settings where risk of extensive cranial surgery outweighs the benefit. Copyright © 2018 Elsevier Inc. All rights reserved.

Tear Osmolarity and Correlation With Ocular Surface Parameters in Patients With Dry Eye.

PubMed

Mathews, Priya M; Karakus, Sezen; Agrawal, Devika; Hindman, Holly B; Ramulu, Pradeep Y; Akpek, Esen K

2017-11-01

To analyze the distribution of tear film osmolarity in patients with dry eye and its association with other ocular surface parameters. Tear osmolarity and other quantitative dry eye parameters were obtained from patients with 1) clinically significant dry eye (significant symptoms and ocular surface staining, n = 131), 2) symptoms-only dry eye (significant symptoms but no significant ocular surface staining, n = 52), and 3) controls (no significant symptoms or staining, n = 42). Tear osmolarity varied significantly across groups (P = 0.01), with patients with clinically significant dry eye having the highest tear osmolarity (312.0 ± 16.9 mOsm/L), control patients having the lowest tear osmolarity (305.6 ± 9.7 mOsm/L), and patients with symptoms-only dry eye falling in between (307.4 ± 5.6 mOsm/L). Patients with clinically significant dry eye also tended to have a greater intereye difference in osmolarity (12.0 ± 13.4) than did the individuals with symptoms-only dry eye (9.1 ± 12.4) and controls (9.0 ± 7.4) (P = 0.06). In multivariable regression models, higher tear osmolarity was associated with higher Ocular Surface Disease Index, discomfort subscore (P = 0.02), and higher corneal and conjunctival staining scores (P < 0.01 for both). Worse eye tear osmolarity was not correlated with the corresponding tear film breakup time or Schirmer test (P > 0.05 for both). Individuals with symptomatic dry eye that is not yet clinically significant seem to have higher and more variable osmolarity measurements than controls, potentially indicating that changes in osmolarity precede clinical findings.

The Potential of Computational Fluid Dynamics Simulation on Serial Monitoring of Hemodynamic Change in Type B Aortic Dissection

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yu, Simon C. H., E-mail: simonyu@cuhk.edu.hk; Liu, Wen; Wong, Randolph H. L.

PurposeWe aimed to assess the potential of computational fluid dynamics simulation (CFD) in detecting changes in pressure and flow velocity in response to morphological changes in type B aortic dissection.Materials and MethodsPressure and velocity in four morphological models of type B aortic dissection before and after closure of the entry tear were calculated with CFD and analyzed for changes among the different scenarios. The control model (Model 1) was patient specific and built from the DICOM data of CTA, which bore one entry tear and three re-entry tears. Models 2–4 were modifications of Model 1, with two re-entry tears lessmore » in Model 2, one re-entry tear more in Model 3, and a larger entry tear in Model 4.ResultsThe pressure and velocity pertaining to each of the morphological models were unique. Changes in pressure and velocity findings were accountable by the changes in morphological features of the different models. There was no blood flow in the false lumen across the entry tear after its closure, the blood flow direction across the re-entry tears was reversed after closure of the entry tear.ConclusionCFD simulation is probably useful to detect hemodynamic changes in the true and false lumens of type B aortic dissection in response to morphological changes, it may potentially be developed into a non-invasive and patient-specific tool for serial monitoring of hemodynamic changes of type B aortic dissection before and after treatment.« less

A Disposable Tear Glucose Biosensor—Part 1: Design and Concept Testing

PubMed Central

Bishop, Daniel K.; La Belle, Jeffrey T.; Vossler, Stephen R.; Patel, Dharmendra R.; Cook, Curtiss B.

2010-01-01

Background Tear glucose has been suggested previously as a potential approach for the noninvasive estimation of blood glucose. While the topic remains unresolved, an overview of previous studies suggests the importance of a tear sampling approach and warrants new technology development. A concept device is presented that meets the needs of a tear glucose biosensor. Methods Three approaches to chronoamperometric glucose sensing were evaluated, including glucose oxidase mediated by potassium ferricyanide or oxygen with a hydrogen peroxide catalyst, Prussian blue, and potassium ferricyanide-mediated glucose dehydrogenase. For tear sampling, calcium alginate, poly(2-hydroxyethyl methacrylate), and polyurethane foam were screened as an absorbent tear sampling material. A quantitative model based on the proposed function of concept device was created. Results For glucose sensing, it was found that potassium ferricyanide with glucose dehydrogenase was ideal, featuring oxygen insensitivity, long-term stability, and a lower limit of detection of 2 μM glucose. Polyurethane foam possessed all of the required characteristics for tear sampling, including reproducible sampling from a hydrogel-simulated, eye surface (4.2 ± 0.5 μl; n = 8). It is estimated that 100 μM of glucose tear fluid would yield 135 nA (14.9% relative standard deviation). Conclusion A novel concept device for tear glucose sampling was presented, and the key functions of this device were tested and used to model the performance of the final device. Based on these promising initial results, the device is achievable and within reach of current technical capabilities, setting the stage for prototype development. PMID:20307389

Predictive MRI correlates of lesser metatarsophalangeal joint plantar plate tear.

PubMed

Umans, Rachel L; Umans, Benjamin D; Umans, Hilary; Elsinger, Elisabeth

2016-07-01

To identify correlated signs on non-enhanced MRI that might improve diagnostic detection of plantar plate (PP) tear. We performed an IRB-approved, HIPAA-compliant retrospective analysis of 100 non-contrast MRI (50 PP tear, 50 controls). All were anonymized, randomized, and reviewed; 20 were duplicated to assess consistency. One musculoskeletal radiologist evaluated qualitative variables. A trained non-physician performed measurements. Consistency and concordance were assessed. Pearson's Chi-square test was used to test the correlation between qualitative findings and PP tear status. Correlation between measurements and PP status was assessed using t tests and Wilcoxon's rank-sum test (p values < 0.05 considered significant). Classification and regression trees were utilized to identify attributes that, taken together, would consistently distinguish PP tear from controls. Quantitative measurements were highly reproducible (concordance 0.88-0.99). Elevated 2nd MT protrusion, lesser MT supination and rotational divergence of >45° between the 1st-2nd MT axis correlated with PP tear. Pericapsular soft tissue thickening correlated most strongly with PP tear, correctly classifying 95 % of cases and controls. Excluding pericapsular soft tissue thickening, sequential assessment of 2nd toe enthesitis, 2nd flexor tendon subluxation, and splaying of the second and third toes accurately classified PP status in 92 %. Pericapsular soft tissue thickening most strongly correlated with PP tear. For cases in which it might be difficult to distinguish pericapsular fibrosis from neuroma, sequential assessment of 2nd toe enthesitis, flexor tendon subluxation and splaying of the 2nd and 3rd toe is most helpful for optimizing accurate diagnosis of PP tear.

Biophysical characterization of monofilm model systems composed of selected tear film phospholipids.

PubMed

Patterson, Matthew; Vogel, Hans J; Prenner, Elmar J

2016-02-01

The tear film protects the eye from foreign particles and pathogens, prevents excess evaporation, provides lubrication, and maintains a high quality optical surface necessary for vision. The anterior layer of tear film consists of polar and non-polar lipid layers. The polar lipids form a monolayer on the aqueous subphase, acting as surfactants for the non-polar lipid multilayer. A tear film polar lipid biomimetic consisting of dipalmitoyl phosphatidylcholine (DPPC), dipalmitoyl phosphatidylethanolamine (DPPE), palmitoyl glucosylceramide (PGC), and palmitoyl sphingomyelin (PSM) was characterized using Langmuir monolayers and Brewster angle microscopy (BAM). Lipid combinations formed very stable monolayers, especially those containing DPPC or PSM. Surface experiments and elasticity analyses revealed that PGC resulted in more condensed and rigid mixed monolayers. DPPE provided resistance to large changes in lipid ordering over a wide surface pressure range. Ternary mixtures containing DPPE and PGC with either DPPC or PSM experienced the greatest lipid ordering within the natural tear film surface pressure range suggesting that these lipids are important to maintain tear film integrity during the inter-blink period. Finally, BAM images revealed unique structures within monolayers of DPPC, DPPE, and PGC at the natural tear film surface pressure. 3D analysis of these domains suggested either the formation of multilayers or outward protrusions at surface pressures far below the point of irreversible collapse as seen on the isotherm. This entails that the polar lipids of tear film may be capable of multilayer formation or outward folding as a mechanism to prevent rupture of the tear film during a blink. Copyright © 2015 Elsevier B.V. All rights reserved.

Human tears reveal insights into corneal neovascularization.

PubMed

Zakaria, Nadia; Van Grasdorff, Sigi; Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

2012-01-01

Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization.

Human Tears Reveal Insights into Corneal Neovascularization

PubMed Central

Wouters, Kristien; Rozema, Jos; Koppen, Carina; Lion, Eva; Cools, Nathalie; Berneman, Zwi; Tassignon, Marie-José

2012-01-01

Corneal neovascularization results from the encroachment of blood vessels from the surrounding conjunctiva onto the normally avascular cornea. The aim of this study is to identify factors in human tears that are involved in development and/or maintenance of corneal neovascularization in humans. This could allow development of diagnostic tools for monitoring corneal neovascularization and combination monoclonal antibody therapies for its treatment. In an observational case-control study we enrolled a total of 12 patients with corneal neovascularization and 10 healthy volunteers. Basal tears along with reflex tears from the inferior fornix, superior fornix and using a corneal bath were collected along with blood serum samples. From all patients, ocular surface photographs were taken. Concentrations of the pro-angiogenic cytokines interleukin (IL)-6, IL-8, Vascular Endothelial Growth Factor (VEGF), Monocyte Chemoattractant Protein 1 (MCP-1) and Fas Ligand (FasL) were determined in blood and tear samples using a flow cytometric multiplex assay. Our results show that the concentration of pro-angiogenic cytokines in human tears are significantly higher compared to their concentrations in serum, with highest levels found in basal tears. Interestingly, we could detect a significantly higher concentration of IL- 6, IL-8 and VEGF in localized corneal tears of patients with neovascularized corneas when compared to the control group. This is the first study of its kind demonstrating a significant difference of defined factors in tears from patients with neovascularized corneas as compared to healthy controls. These results provide the basis for future research using animal models to further substantiate the role of these cytokines in the establishment and maintenance of corneal neovascularization. PMID:22590547

The knee meniscus: management of traumatic tears and degenerative lesions

PubMed Central

Beaufils, Philippe; Becker, Roland; Kopf, Sebastian; Matthieu, Ollivier; Pujol, Nicolas

2017-01-01

Meniscectomy is one of the most popular orthopaedic procedures, but long-term results are not entirely satisfactory and the concept of meniscal preservation has therefore progressed over the years. However, the meniscectomy rate remains too high even though robust scientific publications indicate the value of meniscal repair or non-removal in traumatic tears and non-operative treatment rather than meniscectomy in degenerative meniscal lesions In traumatic tears, the first-line choice is repair or non-removal. Longitudinal vertical tears are a proper indication for repair, especially in the red-white or red-red zones. Success rate is high and cartilage preservation has been proven. Non-removal can be discussed for stable asymptomatic lateral meniscal tears in conjunction with anterior cruciate ligament (ACL) reconstruction. Extended indications are now recommended for some specific conditions: horizontal cleavage tears in young athletes, hidden posterior capsulo-meniscal tears in ACL injuries, radial tears and root tears. Degenerative meniscal lesions are very common findings which can be considered as an early stage of osteoarthritis in middle-aged patients. Recent randomised studies found that arthroscopic partial meniscectomy (APM) has no superiority over non-operative treatment. Thus, non-operative treatment should be the first-line choice and APM should be considered in case of failure: three months has been accepted as a threshold in the ESSKA Meniscus Consensus Project presented in 2016. Earlier indications may be proposed in cases with considerable mechanical symptoms. The main message remains: save the meniscus! Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160056. Originally published online at www.efortopenreviews.org PMID:28698804

[Functional tear production indices in thyroid eye disease].

PubMed

Safonova, T N; Likhvantseva, V G; Gontiurova, O A; Rudenko, E I; Vygodin, V A

2013-01-01

Analysis of functional tear production indices in patients with Grave's disease and thyroid eye disease confirmed lacrimal gland involvement in inflammatory autoimmune process. Close direct correlation was found between tear production and main disease characteristics - severity and activity.

Questions and Answers About Shoulder Problems

MedlinePlus

... months your shoulder is not better. Rotator Cuff Tear Treatment for a rotator cuff tear may also include: Heat or cold to the ... into your shoulder joint. Surgery to repair the tear if you don’t see improvement with other ...

THE CLINICAL, FUNCTIONAL AND BIOMECHANICAL PRESENTATION OF PATIENTS WITH SYMPTOMATIC HIP ABDUCTOR TENDON TEARS

PubMed Central

Retheesh, Theertha; Mutreja, Rinky; Janes, Gregory C.

2016-01-01

Background Hip abductor tendon (HAT) tearing is commonly implicated in greater trochanteric pain syndrome (GTPS), though limited information exists on the disability associated with this condition and specific presentation of these patients. Purpose To describe the clinical, functional and biomechanical presentation of patients with symptomatic HAT tears. Secondary purposes were to investigate the association between these clinical and functional measures, and to compare the pain and disability reported by HAT tear patients to those with end-stage hip osteoarthritis (OA). Study Design Prospective case series. Methods One hundred forty-nine consecutive patients with symptomatic HAT tears were evaluated using the Harris (HHS) and Oxford (OHS) Hip Scores, SF-12, an additional series of 10 questions more pertinent to those with lateral hip pain, active hip range of motion (ROM), maximal isometric hip abduction strength, six-minute walk capacity and 30-second single limb stance (SLS) test. The presence of a Trendelenburg sign and pelvis-on-femur (POF) angle were determined via 2D video analysis. An age matched comparative sample of patients with end-stage hip OA was recruited for comparison of all patient-reported outcome scores. Independent t-tests investigated group and limb differences, while analysis of variance evaluated pain changes during the functional tests. Pearson's correlation coefficients investigated the correlation between clinical measures in the HAT tear group. Results No differences existed in patient demographics and patient-reported outcome scores between HAT tear and hip OA cohorts, apart from significantly worse SF-12 mental subscale scores (p = 0.032) in the HAT tear group. Patients with HAT tears demonstrated significantly lower (p < 0.05) hip abduction strength and active ROM in all planes of motion on their affected limb. Pain significantly increased throughout the 30-second SLS test for the HAT tear group, with 57% of HAT tear patients demonstrating a positive Trendelenburg sign. POF angle during the test was not significantly associated with pain. Conclusion Patients with symptomatic HAT tears demonstrate poor function, and report pain and disability similar to or worse than those with end-stage hip OA. This information better defines and differentiates the presentation of these patients. Level of Evidence Level 3 case-controlled study, with matched comparison PMID:27757285

Diagnostic accuracy of 3.0 T magnetic resonance imaging for the detection of meniscus posterior root pathology.

PubMed

LaPrade, Robert F; Ho, Charles P; James, Evan; Crespo, Bernardo; LaPrade, Christopher M; Matheny, Lauren M

2015-01-01

The purpose of this study was to determine the diagnostic accuracy of 3 T MRI, including sensitivity, specificity, negative and positive predictive values, for detection of posterior medial and lateral meniscus root tears and avulsions. All patients who had a 3 T MRI of the knee, followed by arthroscopic surgery, were included in this study. Arthroscopy was considered the gold standard. Meniscus root tears diagnosed at arthroscopy and on MRI were defined as a complete meniscus root detachment within 9 mm of the root. All surgical data were collected prospectively and stored in a data registry. MRI exams were reported prospectively by a musculoskeletal radiologist and reviewed retrospectively. There were 287 consecutive patients (156 males, 131 females; mean age 41.7 years) in this study. Prevalence of meniscus posterior root tears identified at arthroscopy was 9.1, 5.9% for medial and 3.5% for lateral root tears (one patient had both). Sensitivity was 0.770 (95% CI 0.570, 0.901), specificity was 0.729 (95% CI 0.708, 0.741), positive predictive value was 0.220 (95% CI 0.163, 0.257) and negative predictive value was 0.970 (95% CI 0.943, 0.987). For medial root tears, sensitivity was 0.824 (95% CI 0.569, 0.953), specificity was 0.800 (95% CI 0.784, 0.808), positive predictive value was 0.206 (95% CI 0.142, 0.238) and negative predictive value was 0.986 (95% CI 0.967, 0.996). For lateral meniscus posterior root tears, sensitivity was 0.600 (95% CI 0.281, 0.860), specificity was 0.903 (95% CI 0.891, 0.912), positive predictive value was 0.181 (95% CI 0.085, 0.261) and negative predictive value was 0.984 (95% CI 0.972, 0.994). This study demonstrated moderate sensitivity and specificity of 3 T MRI to detect posterior meniscus root tears. The negative predictive value of 3 T MRI to detect posterior meniscus root tears was high; however, the positive predictive value was low. Sensitivity was higher for medial root tears, indicating a higher risk of missing lateral root tears on MRI. Imaging has an important role in identifying meniscus posterior horn root tears; however, some root tears may not be identified until arthroscopy. Prognostic study (diagnostic), Level II.

Treatment of cerebrospinal fluid leak after spine surgery.

PubMed

Fang, Zhao; Tian, Rong; Jia, Yu-Tao; Xu, Tian-Tong; Liu, Yang

2017-04-01

Owing to the complexity of spinal surgery, there is a great prevalence of dural tear causing cerebrospinal fluid (CSF) leakage. Many studies focused on suture repair for dural tear to stop CSF leak. Now some new treatment strategies have shown a promising effect that is listed as follows: 1) creating watertight dural closure to stop CSF leak with the help of dural substitute material; and 2) retarding CSF leak by changing pressure difference, including reducing the subarachnoid fluid pressure, increasing the epidural space pressure and both. In fact several methods mentioned above are usually combined to treat CSF leak. However, no update review summarized the relevant studies implemented in recent years. In this review, the authors would compare the effects of different dural closure techniques, and introduce the latest treatment methods and mechanisms. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

Change in the Pathologic Supraspinatus: A Three-Dimensional Model of Fiber Bundle Architecture within Anterior and Posterior Regions

PubMed Central

Kim, Soo Y.; Sachdeva, Rohit; Li, Zi; Rosser, Benjamin W. C.

2015-01-01

Supraspinatus tendon tears are common and lead to changes in the muscle architecture. To date, these changes have not been investigated for the distinct regions and parts of the pathologic supraspinatus. The purpose of this study was to create a novel three-dimensional (3D) model of the muscle architecture throughout the supraspinatus and to compare the architecture between muscle regions and parts in relation to tear severity. Twelve cadaveric specimens with varying degrees of tendon tears were used. Three-dimensional coordinates of fiber bundles were collected in situ using serial dissection and digitization. Data were reconstructed and modeled in 3D using Maya. Fiber bundle length (FBL) and pennation angle (PA) were computed and analyzed. FBL was significantly shorter in specimens with large retracted tears compared to smaller tears, with the deeper fibers being significantly shorter than other parts in the anterior region. PA was significantly greater in specimens with large retracted tears, with the superficial fibers often demonstrating the largest PA. The posterior region was absent in two specimens with extensive tears. Architectural changes associated with tendon tears affect the regions and varying depths of supraspinatus differently. The results provide important insights on residual function of the pathologic muscle, and the 3D model includes detailed data that can be used in future modeling studies. PMID:26413533

Effects of a warm compress containing menthol on the tear film in healthy subjects and dry eye patients

NASA Astrophysics Data System (ADS)

Arita, Reiko; Morishige, Naoyuki; Sakamoto, Ichiro; Imai, Natsuko; Shimada, Yuko; Igaki, Michihito; Suzuki, Atsushi; Itoh, Kouzo; Tsubota, Kazuo

2017-04-01

Menthol is thought to stimulate lacrimation via activation of cold-sensitive primary afferent neurons in the cornea. We evaluated a warm compress containing menthol as a potential treatment for dry eye by examining its effects on the tear film in healthy subjects (n = 20) and dry eye patients (n = 35). Disposable eyelid-warming steamers that either did (MH) or did not (HO) contain menthol were applied to one eye of each subject either once only for 10 min or repeatedly over 2 weeks. Single application of MH significantly increased tear meniscus volume (P = 8.6 × 10-5, P = 1.3 × 10-5) and tear film breakup time (P = 0.006, P = 0.002) as well as improved meibum condition in healthy subjects and dry eye patients, respectively. Repeated application of MH significantly increased tear meniscus volume (P = 0.004, P = 1.7 × 10-4) and tear film breakup time (P = 0.037, P = 0.010) in healthy subjects and dry eye patients, respectively. Repeated application of MH thus induced persistent increases in tear fluid volume and tear film stability in dry eye patients, suggesting that repeated use of a warm compress containing menthol is a potential novel treatment for dry eye disease.

Summary of Meta-Analyses Dealing with Single-Row versus Double-Row Repair Techniques for Rotator Cuff Tears

PubMed Central

Spiegl, U.J.; Euler, S.A.; Millett, P.J.; Hepp, P.

2016-01-01

Background: Several meta-analyses of randomized clinical trials have been performed to analyze whether double-row (DR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing compared to single-row (SR) repair. The purpose of this study was to sum up the results of meta-analysis comparing SR and DR repair with respect on clinical outcomes and re-tear rates. Methods: A literature search was undertaken to identify all meta-analyses dealing with randomized controlled trials comparing clinical und structural outcomes after SR versus DR RCR. Results: Eight meta-analyses met the eligibility criteria: two including Level I studies only, five including both Level I and Level II studies, and one including additional Level III studies. Four meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas four favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas six found DR repair to be superior for tears greater than 3 cm tears. Conclusion: No clinical differences are seen between single-row and double-row repair for small and medium rotator cuff tears after a short-term follow-up period with a higher re-tear rate following single-row repairs. There seems to be a trend to superior results with double-row repair in large to massive tear sizes. PMID:27708735

Not all ultrasounds are created equal: general sonography versus musculoskeletal sonography in the detection of rotator cuff tears

PubMed Central

Cole, Brandi; Twibill, Kristen; Lam, Patrick; Hackett, Lisa

2016-01-01

Background This cross-sectional analytic diagnostic accuracy study was designed to compare the accuracy of ultrasound performed by general sonographers in local radiology practices with ultrasound performed by an experienced musculoskeletal sonographer for the detection of rotator cuff tears. Methods In total, 238 patients undergoing arthroscopy who had previously had an ultrasound performed by both a general sonographer and a specialist musculoskeletal sonographer made up the study cohort. Accuracy of diagnosis was compared with the findings at arthroscopy. Results When analyzed as all tears versus no tears, musculoskeletal sonography had an accuracy of 97%, a sensitivity of 97% and a specificity of 95%, whereas general sonography had an accuracy of 91%, a sensitivity of 91% and a specificity of 86%. When the partial tears were split with those ≥ 50% thickness in the tear group and those < 50% thickness in the no-tear group, musculoskeletal sonography had an accuracy of 97%, a sensitivity of 97% and a specificity of 100% and general sonography had an accuracy of 85%, a sensitivity of 84% and a specificity of 87%. Conclusions Ultrasound in the hands of an experienced musculoskeletal sonographer is highly accurate for the diagnosis of rotator cuff tears. General sonography has improved subsequent to earlier studies but remains inferior to an ultrasound performed by a musculoskeletal sonographer. PMID:27660657

The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study

PubMed Central

Jain, Nitin B.; Luz, Jennifer; Higgins, Laurence D.; Dong, Yan; Warner, Jon J.P.; Matzkin, Elizabeth; Katz, Jeffrey N.

2016-01-01

Objective The aim was to assess diagnostic accuracy of 15 shoulder special tests for rotator cuff tears. Design From 02/2011 to 12/2012, 208 participants with shoulder pain were recruited in a cohort study. Results Among tests for supraspinatus tears, Jobe’s test had a sensitivity of 88% (95% CI=80% to 96%), specificity of 62% (95% CI=53% to 71%), and likelihood ratio of 2.30 (95% CI=1.79 to 2.95). The full can test had a sensitivity of 70% (95% CI=59% to 82%) and a specificity of 81% (95% CI=74% to 88%). Among tests for infraspinatus tears, external rotation lag signs at 0° had a specificity of 98% (95% CI=96% to 100%) and a likelihood ratio of 6.06 (95% CI=1.30 to 28.33), and the Hornblower’s sign had a specificity of 96% (95% CI=93% to 100%) and likelihood ratio of 4.81 (95% CI=1.60 to 14.49). Conclusions Jobe’s test and full can test had high sensitivity and specificity for supraspinatus tears and Hornblower’s sign performed well for infraspinatus tears. In general, special tests described for subscapularis tears have high specificity but low sensitivity. These data can be used in clinical practice to diagnose rotator cuff tears and may reduce the reliance on expensive imaging. PMID:27386812

Contributions of ocular surface components to matrix-metalloproteinases (MMP)-2 and MMP-9 in feline tears following corneal epithelial wounding.

PubMed

Petznick, Andrea; Madigan, Michele C; Garrett, Qian; Sweeney, Deborah F; Evans, Margaret D M

2013-01-01

This study investigated ocular surface components that contribute to matrix-metalloproteinase (MMP)-2 and MMP-9 found in tears following corneal epithelial wounding. Laboratory short-haired cats underwent corneal epithelial debridement in one randomly chosen eye (n = 18). Eye-flush tears were collected at baseline and during various healing stages. Procedural control eyes (identical experimental protocol as wounded eyes except for wounding, n = 5) served as controls for tear analysis. MMP activity was analyzed in tears using gelatin zymography. MMP staining patterns were evaluated in ocular tissues using immunohistochemistry and used to determine MMP expression sites responsible for tear-derived MMPs. The proMMP-2 and proMMP-9 activity in tears was highest in wounded and procedural control eyes during epithelial migration (8 to 36 hours post-wounding). Wounded eyes showed significantly higher proMMP-9 in tears only during and after epithelial restratification (day 3 to 4 and day 7 to 28 post-wounding, respectively) as compared to procedural controls (p<0.05). Tears from wounded and procedural control eyes showed no statistical differences for pro-MMP-2 and MMP-9 (p>0.05). Immunohistochemistry showed increased MMP-2 and MMP-9 expression in the cornea during epithelial migration and wound closure. The conjunctival epithelium exhibited highest levels of both MMPs during wound closure, while MMP-9 expression was reduced in conjunctival goblet cells during corneal epithelial migration followed by complete absence of the cells during wound closure. The immunostaining for both MMPs was elevated in the lacrimal gland during corneal healing, with little/no change in the meibomian glands. Conjunctival-associated lymphoid tissue (CALT) showed weak MMP-2 and intense MMP-9 staining. Following wounding, migrating corneal epithelium contributed little to the observed MMP levels in tears. The major sources assessed in the present study for tear-derived MMP-2 and MMP-9 following corneal wounding are the lacrimal gland and CALT. Other sources included stromal keratocytes and conjunctiva with goblet cells.

Potential of FTIR spectroscopy for analysis of tears for diagnosis purposes.

PubMed

Travo, Adrian; Paya, Clément; Déléris, Gérard; Colin, Joseph; Mortemousque, Bruno; Forfar, Isabelle

2014-04-01

It has been widely reported that the tear film, which is crucially important as a protective barrier of the eye, undergoes biochemical changes as a result of a wide range of ocular pathology. This tends to suggest the possibility of early detection of ocular diseases on the basis of biochemical analysis of tears. However, studies of tears by conventional methods of biomolecular and biochemical analysis are often limited by methodological difficulties. Moreover, such analysis could not be applied in the clinic, where structural and morphological analyses by, mainly, slit-lamp biomicroscopy remains the recommended method. In this study, we assessed, for the first time, the potential of FTIR spectroscopy combined with advanced chemometric processing of spectral data for analysis of raw tears for diagnosis purposes. We first optimized sampling and spectral acquisition (tears collection method, tear sample volume, and preservation of the samples) for accurate spectral measurement. On the basis of the results, we focused our study on the possibility of discriminating tears from normal individuals from those of patients with different ocular pathologies, and showed that the most discriminating spectral range is that corresponding to variations of CH2 and CH3 of lipid aliphatic chains. We also report more subtle discrimination of tears from patients with keratoconus and those from patients with non-specific inflammatory ocular diseases, on the basis of variations in spectral ranges attributed notably to lipid and carbohydrate vibrations. Finally, we also succeeded in distinguishing tears from patients with early-stage and late-stage keratoconus on the basis of spectral features attributed to protein structure. Therefore, this study strongly suggests that FTIR spectral analysis of tears could be developed as a valuable and cost-saving tool for biochemical-based detection of ocular diseases, potentially before the appearance of the first morphological signs of diseases. Combined with supervised modelling methods and with use of a spectral data base acquired for representative patients, such a spectral approach could be a useful addition to current methods of clinical analysis for improvement of patient care.

Meniscal pathology associated with acute anterior cruciate ligament tears in patients with open physes.

PubMed

Samora, Walter P; Palmer, Ryan; Klingele, Kevin E

2011-01-01

The purpose of this study is to characterize meniscal pathology associated with anterior cruciate ligament (ACL) rupture in skeletally immature patients. We also evaluate the accuracy of preoperative magnetic resonance imaging (MRI) in predicting ACL and meniscus pathology. A retrospective chart review was performed on 124 skeletally immature patients who underwent arthroscopically assisted ACL reconstruction within 3 months of injury. Operative reports and arthroscopic images were reviewed to determine patterns of meniscal injury. The accuracy of preoperative MRI in predicting ACL rupture and meniscus pathology was also compared. One hundred twenty-four patients, including 80 males with an average age of 14.3 years, and 44 females with an average age of 14.1 years were included. The lateral meniscus was torn in 51 patients, the medial meniscus in 17 patients, and both menisci in 19. The prevalence of meniscus tear was 69.3%. Location of the tear occurred in the posterior horn in 69 tears (65.0%), the middle and posterior horn in 31 tears (29.2%), the middle horn in 4 tears (3.7%), and the anterior horn and posterior horn in 2 tears (1.8%). MRI showed 95.6% sensitivity in detecting complete ACL rupture. Further, MRI had a sensitivity of 58.6% and a specificity of 91.3% in characterizing meniscus tears. There are many studies that evaluate ACL rupture in the skeletally immature population, but few studies focus on the meniscus pathology that is associated with these injuries. We reinforce the fact that meniscal injury is commonly associated with ACL rupture in patients with open physes (prevalence of 69.3%). We were able to conclude that lateral meniscus tears are more common than medial meniscus tears, which were equally as common as combined tears in our patient population. The posterior horn is injured in most of patients, and is usually in a repairable configuration and vascular zone. These findings will help to guide surgeons in their clinical evaluation and treatment of skeletally immature patients with ACL rupture. Level IV, retrospective case series.

Accuracy of MRI findings in chronic lateral ankle ligament injury: comparison with surgical findings.

PubMed

Park, H-J; Cha, S-D; Kim, S S; Rho, M-H; Kwag, H-J; Park, N-H; Lee, S-Y

2012-04-01

To evaluate the accuracy of magnetic resonance imaging (MRI) findings in chronic lateral ankle ligament injury in comparison with that of surgical findings. Forty-eight cases (25 men, 23 women, mean age 36 years) of clinically suspected chronic ankle ligament injury underwent MRI studies and surgery. Sagittal, coronal, and axial, T1-weighted, spin-echo, proton density and T2-weighted, fast spin-echo images with fat saturation were obtained in all patients. MRI examinations were read in consensus by two fellowship-trained academic musculoskeletal radiologists who evaluated the lateral ankle ligaments, including the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) without clinical information. The results of the MRI studies were then compared with the surgical findings. The MRI findings of ATFL injury showed a sensitivity of detection of complete tears of 75% and specificity of 86%. The sensitivity of detection of partial tears was 75% and the specificity was 78%. The sensitivity of detection of sprains was 44% and the specificity was 88%. Regarding the MRI findings of CFL injury, the sensitivity of detection of complete tears was 50% and the specificity was 98%. The sensitivity of detection of partial tear was 83% and the specificity was 93%. The sensitivity of detection of sprains was 100% and the specificity was 90%. Regarding the ATFL, the accuracies of detection were 88, 58, 77, and 85% for no injury, sprain, partial tear, and complete tear, respectively, and for the CFL the accuracies of detection were 90, 90, 92, and 96% for no injury, sprain, partial tear, and complete tear, respectively. The diagnosis of a complete tear of the ATFL on MRI is more sensitive than the diagnosis of a complete tear of the CFL. MRI findings of CFL injury are diagnostically specific but are not sensitive. However, only normal findings and complete tears were statistically significant between ATFL and CFL (p < 0.001). Copyright © 2011 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Use of tear ring permits repair of sealed module circuitry

NASA Technical Reports Server (NTRS)

1965-01-01

Improved packaging technique for modular electronic circuitry utilizes a tear ring which may be removed for repair and resealed. The tear ring is put over the container and header to which the electronic circuit assembly has been attached.

[The role of arthroscopy in subacromial pathology. Retrospective study of a series of arthroscopic acromioplasties].

PubMed

Schiepers, P; Pauwels, P; Penders, W; Brandelet, B; Putz, P

2000-12-01

The authors report the results of a retrospective study of 59 arthroscopic acromioplasties. Objective shoulder assessment was made following the relative Constant score and UCLA rating scale. Subjective satisfaction of the patient was assessed on an analogic scale. The patients were divided into 3 groups, according to the subacromial pathology treated. The first group (27 shoulders in 23 patients) included patients with subacromial impingement without a complete rotator cuff tear. The objective result, between 80 and 90%, was close to results in others series reported. Distinction between patients with no tear or partial tear of the cuff showed better results for patients with partial tears. This surprising finding may be at least partially explained by the fact that these patients were older than those without a cuff tear. The results of this study, and the review of the literature, confirmed the value of subacromial decompression as a treatment for impingement without complete cuff tear resistant to at least 6 months of conservative treatment; comparison between surgical and arthroscopic series showed similar results. The second group (19 shoulders in 19 patients) included patients with impingement and complete cuff tear. The objective results and the literature review led us to specify indications. Subacromial decompression with debridment of the tear has given excellent results in older patients--over 60 for most authors--when the tear was limited. In our study, the function of the shoulder at revision was good when the tear was limited to the supraspinatus and part of the infraspinatus. The third group (13 shoulders in 10 patients) included patients with calcifying tendinitis. Arthroscopic acromioplasty was performed in every case; excision of the calcification was performed in less than half of the cases and did not influence the final result. The calcifications had disappeared at revision in all cases. This may suggest that the treatment of the associated impingement was the most important procedure in these cases.

[Immunoassay for matrix metalloproteinase-9 in the tear film of patients with pseudoexfoliation syndrome - a pilot study].

PubMed

Zimmermann, N; Erb, C

2013-08-01

Matrix-metalloproteinases (MMPs) are proteolytic enzymes released by irritated epithelial cells of the ocular surface. It has been established that the subtype MMP-9 can serve as an inflammatory marker within the tear film. MMP-9 is also attributed to have an effect on the PEX-glaucoma development. Recently, a rapid immunoassay for detection of MMP-9 in the tear film was developed to estimate inflammatory extent during dry eye disease. The aim of this study was to analyse the MMP-9 concentration in tear film in PEX-syndrome. In addition, an assessment of the feasibility, reliability and readability of the test was done. We randomly selected 10 patients with PEX-syndrome and 10 healthy control patients and measured tear film MMP-9 of one eye with the RPS InflammaDry Detector™ (Rapid Pathogen Screening Inc., USA). We detected increased levels of MMP-9 in tear film in PEX-syndrome. 80 % of the PEX-patients and 20 % of the controls showed a positive test result (>or= 40 ng/mL MMP-9) indicating a test specificity and sensitivity of 80 %. This corresponds approximately to the published values for the dry eye (sensitivity 87 %, specificity: 92 %). The performance of the test is simple. The patients tolerated the inclusion of the test strips well. However, it is difficult to estimate whether enough tear film was used and in many cases, the intensity of the "indicator line" was weak. The rapid MMP-9-immunoassay is a novel, meaningful approach for the detection of inflammatory activity of the ocular surface. We have shown an up-regulation of the non-specific inflammatory marker MMP-9 in tear film in PEX-syndrome and suggest an association with a tear film disorder. However, an improvement in the estimation of the amount of collected tears and readability is desirable. Georg Thieme Verlag KG Stuttgart · New York.

Electronic enhancement of tear secretion

NASA Astrophysics Data System (ADS)

Brinton, Mark; Lim Chung, Jae; Kossler, Andrea; Kook, Koung Hoon; Loudin, Jim; Franke, Manfred; Palanker, Daniel

2016-02-01

Objective. To study electrical stimulation of the lacrimal gland and afferent nerves for enhanced tear secretion, as a potential treatment for dry eye disease. We investigate the response pathways and electrical parameters to safely maximize tear secretion. Approach. We evaluated the tear response to electrical stimulation of the lacrimal gland and afferent nerves in isofluorane-anesthetized rabbits. In acute studies, electrical stimulation was performed using bipolar platinum foil electrodes, implanted beneath the inferior lacrimal gland, and a monopolar electrode placed near the afferent ethmoid nerve. Wireless microstimulators with bipolar electrodes were implanted beneath the lacrimal gland for chronic studies. To identify the response pathways, we applied various pharmacological inhibitors. To optimize the stimulus, we measured tear secretion rate (Schirmer test) as a function of pulse amplitude (1.5-12 mA), duration (0.1-1 ms) and repetition rate (10-100 Hz). Main results. Stimulation of the lacrimal gland increased tear secretion by engaging efferent parasympathetic nerves. Tearing increased with stimulation amplitude, pulse duration and repetition rate, up to 70 Hz. Stimulation with 3 mA, 500 μs pulses at 70 Hz provided a 4.5 mm (125%) increase in Schirmer score. Modulating duty cycle further increased tearing up to 57%, compared to continuous stimulation in chronically implanted animals (36%). Ethmoid (afferent) nerve stimulation increased tearing similar to gland stimulation (3.6 mm) via a reflex pathway. In animals with chronically implanted stimulators, a nearly 6 mm increase (57%) was achieved with 12-fold less charge density per pulse (0.06-0.3 μC mm-2 with 170-680 μs pulses) than the damage threshold (3.5 μC mm-2 with 1 ms pulses). Significance. Electrical stimulation of the lacrimal gland or afferent nerves may be used as a treatment for dry eye disease. Clinical trials should validate this approach in patients with aqueous tear deficiency, and further optimize electrical parameters for maximum clinical efficacy.

Significance of perianular enhancement associated with anular tears on magnetic resonance imagings in diagnosis of radiculopathy.

PubMed

Byun, Woo Mok; Ahn, Sang Ho; Ahn, Myun-Whan

2008-10-15

Retrospective analysis of magnetic resonance imaging (MRI) and clinical findings about chemical radiculitis-associated anular tear in patients with radiculopathy. To investigate MRI findings of the chemical radiculitis caused by anular tears and to determine whether chemical radiculitis detected by MRI is the cause of radiculopathy. Many studies document that irritation of adjacent nerve roots by a chemical mediator of inflammation from the nucleus pulposus may result in radiculopathy. Computed tomography (CT) discography may be the best examination for diagnosing discogenic chemical radiculitis but is too invasive. A reliable imaging method for replacing invasive provocative CT discography and diagnosing chemical radiculitis is required. The study population consisted of 12 patients with pain referred to leg(s) with or without low back pain who underwent lumbar spine MRI. All cases of our study demonstrated perianular enhancement caused by chemical radiculitis associated with anular tears. Patterns and locations of perianular enhancement adjacent to anular tears on MRI were assessed. MRI findings were compared with clinical symptoms and/or provocative transforaminal epidural injection (n = 6). For documentation of the relationship between perianular enhancement and radiculopathy, provocative CT discography was performed in 2 cases. Perianular enhancement associated with anular tears revealed thick linear patterns (2.5-7 mm thickness) along margins of anular tears on contrast enhanced axial T1-weighted images with fat suppression. Locations of perianular enhancement adjacent to anular tears were at foraminal (n = 6) and extraforaminal portions (n = 6). CT discography showed a leak of contrast from anular tear to the perianular regions. Pain reproduction at contrast leak level during discography showed concordant pain. There was an apparent correlation between perianular enhancement on MRI and clinical symptoms or provocative epidural nerve root injection in all cases. The perianular enhancement adjacent to anular tears on MRI may be relevant in the diagnosis of symptomatic chemical radiculitis.

[Risk factors for the development of rotator cuff tears in individuals with paraplegia : A cross-sectional study].

PubMed

Pepke, W; Brunner, M; Abel, R; Almansour, H; Gerner, H J; Hug, A; Zeifang, F; Kentar, Y; Bruckner, T; Akbar, M

2018-02-27

Shoulder pain and rotator cuff tears are highly prevalent among wheelchair dependent individuals with paraplegia. The purpose of this study was to identify potential risk factors associated with the development of rotator cuff tears in this population. A total of 217 wheelchair dependent individuals with paraplegia were included in this cross-sectional study (level of evidence III). The mean age of this population was 47.9 years and the mean duration of wheelchair dependence was 24.1 years. Each individual was asked to complete a questionnaire designed to identify risk factors for rotator cuff tears and underwent a standardized clinical examination with the documentation of the Constant-Murley shoulder outcome score and magnetic resonance imaging (MRI) of both shoulder joints. MRI analysis revealed at least one rotator cuff tear in 93 patients (43%). Multiple logistic regression analysis identified the following factors to be associated with the presence of rotator cuff tear: patient age, duration of spinal cord injury/wheelchair dependence, gender, and wheelchair athletic activity. Neither BMI nor the level of spinal cord injury was found to pose a risk factor in the population studied. With respect to patient age, the risk of developing a rotator cuff tear increased by 11% per annum. In terms of duration of spinal cord injury, the analysis revealed a 6% increased risk per year of wheelchair dependence (OR = 1.06). Females had a 2.6-fold higher risk of developing rotator cuff tears than males and wheelchair sport activity increased the risk 2.3-fold. There is a high prevalence of rotator cuff tears in wheel-chair dependent persons with paraplegia. Risk factors such as age, gender, duration of paraplegia, and wheel chair sport activity seem to play an important role in the development of rotator cuff tears.

Physicians’ accuracy and interrator reliability for the diagnosis of unstable meniscal tears in patients having osteoarthritis of the knee

PubMed Central

Dervin, Geoffrey F.; Stiell, Ian G.; Wells, George A.; Rody, Kelly; Grabowski, Jenny

2001-01-01

Objective To determine clinicians’ accuracy and reliability for the clinical diagnosis of unstable meniscus tears in patients with symptomatic osteoarthritis of the knee. Design A prospective cohort study. Setting A single tertiary care centre. Patients One hundred and fifty-two patients with symptomatic osteoarthritis of the knee refractory to conservative medical treatment were selected for prospective evaluation of arthroscopic débridement. Intervention Arthroscopic débridement of the knee, including meniscal tear and chondral flap resection, without abrasion arthroplasty. Outcome measures A standardized assessment protocol was administered to each patient by 2 independent observers. Arthroscopic determination of unstable meniscal tears was recorded by 1 observer who reviewed a video recording and was blinded to preoperative data. Those variables that had the highest interobserver agreement and the strongest association with meniscal tear by univariate methods were entered into logistic regression to model the best prediction of resectable tears. Results There were 92 meniscal tears (77 medial, 15 lateral). Interobserver agreement between clinical fellows and treating surgeons was poor to fair (κ < 0.4) for all clinical variables except radiographic measures, which were good. Fellows and surgeons predicted unstable meniscal tear preoperatively with equivalent accuracy of 60%. Logistic regression modelling revealed that a history of swelling and a ballottable effusion were negative predictors. A positive McMurray test was the only positive predictor of unstable meniscal tear. “Mechanical” symptoms were not reliable predictors in this prospective study. The model was 69% accurate for all patients and 76% for those with advanced medial compartment osteoarthritis defined by a joint space height of 2 mm or less. Conclusions This study underscored the difficulty in using clinical variables to predict unstable medial meniscal tears in patients with pre-existing osteoarthritis of the knee. The lack of interobserver agreement must be overcome to ensure that the findings can be generalized to other physician observers. PMID:11504260

Biomechanical consequences of a posterior root tear of the lateral meniscus: stabilizing effect of the meniscofemoral ligament.

PubMed

Forkel, Philipp; Herbort, Mirco; Schulze, Martin; Rosenbaum, Dieter; Kirstein, Lars; Raschke, Michael; Petersen, Wolf

2013-05-01

The purpose of this study was to evaluate the effects of different types of lateral meniscus root tears in terms of tibiofemoral contact stress. Ten porcine knees each underwent five different testing conditions with the menisci intact, a simulated lateral posterior root tear with and without cutting the meniscofemoral ligament and with an artificial tear of the posterior root of the medial meniscus. Biomechanical testing was performed at 30° of flexion with an axial load of 100 N. A pressure sensor (st Sensor Type S2042, Novel, Munich) was used to measure the tibiofemoral contact area and the tibiofemoral contact pressure. Data were analyzed to assess the differences in contact area and tibiofemoral peak contact pressure among the five meniscal conditions. There was no significant difference in mean contact pressure between the state with the menisci intact and an isolated posterior root tear of the lateral meniscus. In case of a root tear and a tear of the meniscofemoral ligament, the contact area decreased in comparison with the intact state of the menisci. After additional cutting of the meniscofemoral ligament, the tibiofemoral contact pressure was significantly higher in comparison with the intact state and the avulsion injury. In the medial compartment, joint compression forces were significantly increased in comparison with the intact state after cutting the posterior root of the medial meniscus (P < 0.05). The consequence of a medial meniscus root tear is well known and was verified by this analysis. The results of the present study show that the biomechanical consequences of a lateral meniscus root tear depend on the state of the meniscofemoral ligament. An increase in tibiofemoral contact pressure is only to be expected in combined injuries of the meniscus root and the meniscofemoral ligaments. Posterior lateral meniscus root tear might have a better prognosis in terms of the development of osteoarthritis when the meniscofemoral ligament is intact.

Does a critical rotator cuff tear stage exist?: a biomechanical study of rotator cuff tear progression in human cadaver shoulders.

PubMed

Oh, Joo Han; Jun, Bong Jae; McGarry, Michelle H; Lee, Thay Q

2011-11-16

It is unknown at which stage of rotator cuff tear the biomechanical environment is altered. The purpose of this study was to determine if a critical rotator cuff tear stage exists that alters glenohumeral joint biomechanics throughout the rotational range of shoulder motion, and to evaluate the biomechanical effect of parascapular muscle-loading. Eight cadaver shoulders were used with a custom testing system. Four progressive rotator cuff tear stages were investigated on the basis of footprint anatomy. Three muscle-loading conditions were examined: rotator cuff only; rotator cuff with deltoid muscle; and rotator cuff, deltoid, pectoralis major, and latissimus dorsi muscles. Testing was performed in the scapular plane with 0°, 30°, and 60° of shoulder abduction. The maximum internal and external rotations were measured with 3.4 Nm of torque. The position of the humeral head apex with respect to the glenoid was calculated with use of a MicroScribe 3DLX digitizing system throughout the rotational range of motion. The abduction capability was determined as the abduction angle achieved with increasing deltoid load. Tear of the entire supraspinatus tendon significantly increased maximum external rotation and significantly decreased abduction capability with higher deltoid loads (p < 0.05). Tear of the entire supraspinatus tendon and half of the infraspinatus tendon significantly shifted the humeral head apex posteriorly at the midrange of rotation and superiorly at maximum internal rotation (p < 0.05). Loading the pectoralis major and latissimus dorsi muscles decreased the amount of humeral head elevation due to deltoid loading. Tear of the entire supraspinatus tendon was the critical stage for increasing rotational range of shoulder motion and for decreased abduction capability. Further tear progression to the infraspinatus muscle was the critical stage for significant changes in humeral head kinematics. The pectoralis major and latissimus dorsi muscles played an important role in stabilizing the humeral head as the rotator cuff tear progressed.

Magnetic resonance imaging assessment of the rotator cuff: is it really accurate?

PubMed

Wnorowski, D C; Levinsohn, E M; Chamberlain, B C; McAndrew, D L

1997-12-01

Magnetic resonance imaging (MRI) is used increasingly for evaluating the rotator cuff. This study of 39 shoulders (38 patients) compared the accuracy of MRI interpretation of rotator cuff integrity by a group of community hospital radiologists (clinical community scenario, CCS) with that of a musculoskeletal radiologist (experienced specialist scenario, ESS), relative to arthroscopy. For the CCS subgroup, the sensitivity, specificity, positive predictive value (PV), negative PV, and accuracy for partial tears were: 0%, 68%, 0%, 82%, and 59%, respectively; for complete tears: 56%, 73%, 36%, 86%, and 69%, respectively; and for all tears combined: 85%, 52%, 50%, 87%, and 64%, respectively. For the ESS subgroup, the respective values for partial tears were: 20%, 88%, 20%, 88%, and 79%, respectively; for complete tears: 78%, 83%, 58%, 92%, and 82%, respectively; and for all tears: 71%, 71%, 59%, 81%, and 71%, respectively. We concluded that MRI assessment of the rotator cuff was not accurate relative to arthroscopy. MRI was most helpful if the result was negative, and MRI diagnosis of partial tear was of little value. Considering the high cost of shoulder MRI, this study has significant implications for the evaluation of patients with possible rotator cuff pathology.

Shoulder disorders in an outpatient clinic: an epidemiological study.

PubMed

Malavolta, Eduardo Angeli; Gracitelli, Mauro Emilio Conforto; Assunção, Jorge Henrique; Pinto, Gustavo de Mello Ribeiro; da Silveira, Arthur Zorzi Freire; Ferreira, Arnaldo Amado

2017-01-01

To describe shoulder disorders in patients evaluated by two shoulder and elbow surgeons. This cross-sectional study analyzed patients evaluated by two authors, excluding acute fractures and dislocations and patients with symptoms not involving the shoulder. Age and sex distribution was determined for the different diagnoses. We evaluated 1001 patients. Mean age was 51.43±15.15 years and 51.0% were female. Disorders of the rotator cuff occurred in 64.3% (41.2% tendinopathy, 11.0% partial tears and 12.2% full-thickness tears). Adhesive capsulitis occurred in 13.5% of cases and glenohumeral instability in 8.1%. Rotator cuff disorders were more common in women, with a peak between 50 and 59 years for tendinopathy and partial tears and between 60 and 69 years for full-thickness tears. Glenohumeral instability was more frequent in men, with a peak between 30 and 39 years. The most frequent diagnosis was rotator cuff tendinopathy, followed by adhesive capsulitis, full-thickness rotator cuff tears, partial rotator cuff tears and glenohumeral instability. Rotator cuff lesions were more common in women, with a peak between 60 and 69 years for full-thickness tears. Level of Evidence IV, Case Series.

Characteristics and Clinical Outcomes in Overhead Sports Athletes after Rotator Cuff Repair

PubMed Central

Inui, Hiroaki; Ninomiya, Hiroki; Tanaka, Hiroshi; Nobuhara, Katsuya

2017-01-01

Rotator cuff tears in young overhead sports athletes are rare. The pathomechanism causing rotator cuff tears in young overhead athletes is different from that in aged patients. The purpose of this study was to investigate rotator cuff tear characteristics in young overhead sports athletes to reveal the pathomechanism causing these injuries. This study included 25 overhead sports athletes less than 30 years old with atraumatic rotator cuff tears necessitating repair. Rotator cuff tear characteristics were evaluated intraoperatively, including rotator cuff tear shape and injured rotator cuff tendon. Clinical outcome measures were assessed before surgery and at the final follow-up. In this study, 22 patients reported minimal to no shoulder pain and returned to sports without significant complaints at last follow-up. The isolated infraspinatus tendon was most often injured; the incidence rate of the tear at this site was 32% (8 cases). In the deceleration phase of overhead motion, the eccentric contraction force of the ISP (infraspinatus) tendon peaks and the increased load leads to injury at the ISP tendon. The pathomechanism of rotator cuff injuries in young overhead athletes might be not only internal or subacromial impingement, but also these mechanisms. PMID:28702502

Unraveling the molecular repertoire of tears as a source of biomarkers: beyond ocular diseases.

PubMed

Pieragostino, Damiana; D'Alessandro, Michele; di Ioia, Maria; Di Ilio, Carmine; Sacchetta, Paolo; Del Boccio, Piero

2015-02-01

Proteomics and metabolomics investigations of body fluids present several challenges for biomarker discovery of several diseases. The search for biomarkers is actually conducted in different body fluids, even if the ideal biomarker can be found in an easily accessible biological fluid, because, if validated, the biomarker could be sought in the healthy population. In this regard, tears could be considered an optimum material obtained by noninvasive procedures. In the past years, the scientific community has become more interested in the study of tears for the research of new biomarkers not only for ocular diseases. In this review, we provide a discussion on the current state of biomarkers research in tears and their relevance for clinical practice, and report the main results of clinical proteomics studies on systemic and eye diseases. We summarize the main methods for tear samples analyses and report recent advances in "omics" platforms for tears investigations. Moreover, we want to take stock of the emerging field of metabolomics and lipidomics as a new and integrated approach to study protein-metabolites interplay for biomarkers research, where tears represent a still unexplored and attractive field. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Acromion Index in Korean Population and Its Relationship with Rotator Cuff Tears.

PubMed

Kum, Dong Ho; Kim, Jun Ho; Park, Keun Min; Lee, Eun Su; Park, Yong Bok; Yoo, Jae Chul

2017-06-01

Among the many causes of rotator cuff tears, scapular morphology is associated with the accelerating degenerative process of the rotator cuff. Acromion index (AI) was previously introduced and compared in two populations. We enrolled 100 Korean patients diagnosed with full-thickness rotator cuff tears by magnetic resonance imaging and intraoperative arthroscopic findings between January and December 2013. Another 100 Korean patients with an intact rotator cuff tendon identified on magnetic resonance imaging and other shoulder diseases, such as frozen shoulder and instability, were enrolled as controls. We retrospectively compared these 100 rotator cuff tear patients (mean age, 63 years) and 100 controls (mean age, 51 years) in this study. Two independent orthopedic surgeons assessed the AI on radiographs. We performed an interobserver reliability test of the AI assessment, and then compared the AI between two groups. The measurement of the AI showed excellent reliability (intraclass correlation coefficient, 0.82). The mean AI in the rotator cuff tear group was 0.68 and it was significantly different between groups ( p <0.001, 95% confidence interval). The AI was not related to tear size. Our study showed that the AI was an effective predictive factor for rotator cuff tears in a Korean population.

Changes in the tear film and ocular surface from dry eye syndrome.

PubMed

Johnson, Michael E; Murphy, Paul J

2004-07-01

Dry eye syndrome (DES) refers to a spectrum of ocular surface diseases with diverse and frequently multiple aetiologies. The common feature of the various manifestations of DES is an abnormal tear film. Tear film abnormalities associated with DES are tear deficiency, owing to insufficient supply or excessive loss, and anomalous tear composition. These categorizations are artificial, as in reality both often coexist. DES disrupts the homeostasis of the tear film with its adjacent structures, and adversely affects its ability to perform essential functions such as supporting the ocular surface epithelium and preventing microbial invasion. In addition, whatever the initial trigger, moderate and severe DES is characterized by ocular surface inflammation, which in turn becomes the cause and consequence of cell damage, creating a self-perpetuating cycle of deterioration. Progress has been made in our understanding of the aetiology and pathogenesis of DES, and these advances have encouraged a proliferation of therapeutic options. This article aims to amalgamate prevailing ideas of DES development, and to assist in that, relevant aspects of the structure, function, and production of the tear film are reviewed. Additionally, a synopsis of therapeutic strategies for DES is presented, detailing treatments currently available, and those in development.

Evaluation of meniscus tears of the knee by radionuclide imaging

DOE Office of Scientific and Technical Information (OSTI.GOV)

Marymont, J.V.; Lynch, M.A.; Henning, C.E.

We compare the accuracy of radionuclide imaging of the knee with Tc99m-pyrophosphate with arthrography for the evaluation of meniscus tears in young athletes with clinically suspected knee injury. All patients had arthroscopy which was used as the standard against which the other two diagnostic procedures were compared. Radionuclide scintigraphy and arthrography were comparable in their ability to detect tears of the medial meniscus. Scintigraphy was superior for the detection of tears of the lateral meniscus and of both menisci.

A New Criterion for Prediction of Hot Tearing Susceptibility of Cast Alloys

NASA Astrophysics Data System (ADS)

Nasresfahani, Mohamad Reza; Niroumand, Behzad

2014-08-01

A new criterion for prediction of hot tearing susceptibility of cast alloys is suggested which takes into account the effects of both important mechanical and metallurgical factors and is believed to be less sensitive to the presence of volume defects such as bifilms and inclusions. The criterion was validated by studying the hot tearing tendency of Al-Cu alloy. In conformity with the experimental results, the new criterion predicted reduction of hot tearing tendency with increasing the copper content.

Polyimide Film of Increased Tear Strength

NASA Technical Reports Server (NTRS)

St. Clair, A. K.; Hinkley, J. A.; Ezzell, S. A.

1986-01-01

High-temperature linear aromatic polyimide with improved resistance to tearing made by new process that incorporates elastomer into polyimide. Linear aromatic condensation polyimides are materials of prime choice for use as films and coatings on advanced spacecraft and aircraft where durability at temperatures in range of 200 to 300 degree C required. Elastomer-containing polyimide film with improved toughness proves useful for applications where resistance to tearing and long-term thermal stability necessary. Desired resistance to tearing achieved by careful control of amount and chemical composition of added elastomer.

Seismic anisotropy in the Hellenic subduction zone: Effects of slab segmentation and subslab mantle flow

NASA Astrophysics Data System (ADS)

Evangelidis, C. P.

2017-12-01

The segmentation and differentiation of subducting slabs have considerable effects on mantle convection and tectonics. The Hellenic subduction zone is a complex convergent margin with strong curvature and fast slab rollback. The upper mantle seismic anisotropy in the region is studied focusing at its western and eastern edges in order to explore the effects of possible slab segmentation on mantle flow and fabrics. Complementary to new SKS shear-wave splitting measurements in regions not adequately sampled so far, the source-side splitting technique is applied to constrain the depth of anisotropy and to densify measurements. In the western Hellenic arc, a trench-normal subslab anisotropy is observed near the trench. In the forearc domain, source-side and SKS measurements reveal a trench-parallel pattern. This indicates subslab trench-parallel mantle flow, associated with return flow due to the fast slab rollback. The passage from continental to oceanic subduction in the western Hellenic zone is illustrated by a forearc transitional anisotropy pattern. This indicates subslab mantle flow parallel to a NE-SW smooth ramp that possibly connects the two subducted slabs. A young tear fault initiated at the Kefalonia Transform Fault is likely not entirely developed, as this trench-parallel anisotropy pattern is observed along the entire western Hellenic subduction system, even following this horizontal offset between the two slabs. At the eastern side of the Hellenic subduction zone, subslab source-side anisotropy measurements show a general trench-normal pattern. These are associated with mantle flow through a possible ongoing tearing of the oceanic lithosphere in the area. Although the exact geometry of this slab tear is relatively unknown, SKS trench-parallel measurements imply that the tear has not reached the surface yet. Further exploration of the Hellenic subduction system is necessary; denser seismic networks should be deployed at both its edges in order to achieve a more definite image of the structure and geodynamics of this area.

Oxygen diffusion and edema with modern scleral rigid gas permeable contact lenses.

PubMed

Compañ, Vicente; Oliveira, Cristina; Aguilella-Arzo, Marcel; Mollá, Sergio; Peixoto-de-Matos, Sofia C; González-Méijome, José M

2014-09-04

We defined the theoretical oxygen tension behind modern scleral contact lenses (CLs) made of different rigid gas permeable (RGP) materials, assuming different thickness of the tear layer behind the lens. A second goal was to show clinically the effect of the postlens tear film on corneal swelling. We simulated the partial pressure of oxygen across the cornea behind scleral CLs made of different lens materials (oxygen permeability Dk, 75-200 barrer) and different thickness (Tav, 100-300 μm). Postlens tear film thicknesses (Tpost-tear) ranging from 150 to 350 μm were considered. Eight healthy subjects were fitted randomly with a scleral lens with a thin and a thick postlens tear layer in two different sessions for a period of 3 hours under open-eye conditions. The CLs with less than 125 barrer of Dk and a thickness over 200 μm depleted the oxygen availability at the lens-cornea interface below 55 mm Hg for a postlens tear film of 150 μm. For a postlens tear film thickness of 350 μm, no combination of material or lens thickness will meet the criteria of 55 mm Hg. Our clinical measures of corneal edema showed that this was significantly higher (P < 0.001, Wilcoxon signed ranks test) with the thicker compared to the thinner Tpost-tear (mean ± SD, 1.66 ± 1.12 vs. 4.27 ± 1.19%). Scleral RGP CLs must be comprised of at least 125 barrer of oxygen permeability and up to 200 μm thick to avoid hypoxic effects even under open eye conditions. Postlens tear film layer should be below 150 μm to avoid clinically significant edema. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

Phospholipids and their degrading enzyme in the tears of soft contact lens wearers.

PubMed

Yamada, Masakazu; Mochizuki, Hiroshi; Kawashima, Motoko; Hata, Seiichiro

2006-12-01

Low tear phospholipids levels are associated with tear film instability in soft contact lens wearers. We assayed levels of phospholipids and their degrading enzyme secretory phospholipase A2 (sPLA2) both in tears and deposited on contact lenses composed of 2 hydrophilic materials after 1 day of routine use. Polymacon (Medalist; FDA group 1, low water/nonionic) and Etafilcon A (One Day Acuvue; group 4, high water/ionic) contact lenses were worn for 12 hours by 16 experienced contact lens wearers. Phospholipids in tear fluids and deposited on contact lenses were estimated by phosphorus determination with ammonium molybdate through enzymatic digestion. Double-antibody sandwich ELISA was used to determine group IIa sPLA2 concentrations, and sPLA2 activity was assayed using 1,2-diheptanoyl thio-phosphatidylcholine as substrate. Phospholipids concentrations in tears with Polymacon and Etafilcon A were 186 +/- 39 and 162 +/- 33 microg/mL, respectively. The latter concentration was significantly lower than that observed in the same subjects when not wearing contact lenses (P = 0.0023). In tears, both group IIa sPLA2 concentrations and enzymatic activity remained unchanged, regardless of lens wearing. However, Etafilcon A (0.57 +/- 0.09 microg/lens) showed more group IIa sPLA2 deposition than Polymacon (0.01 +/- 0.01 microg/lens; P < 0.001). Furthermore, group IIa sPLA2 deposited on Etafilcon A but not on Polymacon lenses retained its enzymatic activity. Significant differences of group IIa sPLA2 deposition were found in the 2 lenses tested. Such deposition might induce phospholipid hydrolysis in tears and thereby promote tear film instability in hydrophilic contact lens wearers.