LESS THAN HALF OF ACL‐RECONSTRUCTED ATHLETES ARE CLEARED FOR RETURN TO PLAY BASED ON PRACTICE GUIDELINE CRITERIA: RESULTS FROM A PROSPECTIVE COHORT STUDY

Background:A recently published Dutch practice guideline emphasizes criterion-based rehabilitation after anterior cruciate ligament reconstruction (ACLR) instead of time-based. As a consequence of this criterion-based rehabilitation, return to play is only suggested when athletes meet specific return to play (RTP) criteria.Purpose:The goal of this prospective observational study was to analyze if physical therapists adhere to ACLR practice guideline RTP criteria for testing and return to sport decisions, and to explore whether there is a difference in adherence between physical therapists specialized in sports versus those who are not.Methods:When the treating physical therapist cleared an athlete for RTP after ACLR, the primary researcher performed RTP measurements according to the ACLR practice guideline to investigate if all nine quantitative and qualitative RTP criteria were met.Results:Of the 158 athletes (54 females and 104 males, mean age 24 ± 6 years, 12 ± 3 months after surgery), 69 (44%) had performed the RTP measurements with their primary physical therapist. Of the athletes tested by their primary physical therapist 23% met all RTP criteria compared to 10% of the athletes who were not tested at all by their primary physical therapist (p = 0.026). Of the athletes rehabilitating with a sports physical therapist, 52% had been tested by their primary physical therapist compared to 34% of the athletes rehabilitating with a non-sports physical therapist (p = 0.024).Conclusion:Only 44% of the athletes were tested according to the guideline RTP criteria and only 23% of them were given an RTP advice consistent with the ACLR guideline. Although sports physical therapists adhered to the guideline more often than non-sports physical therapists, the adherence is still alarmingly low. More attention for the implementation of ACLR guidelines and RTP criteria is needed.Level of evidence:Therapy, level 2b.     

非肥胖和肥胖男女腹部容积比较（英文）

目的本文以回顾性研究方式比较肥胖与非肥胖男女腹部容积是否呈同等增加。方法比较了11名非肥胖女性、9名非肥胖男性及10名肥胖女性、10名男性的腹部容积。腹部容积用其核磁共振图像资料进行计算,并以独立的t检验进行分析。结果非肥胖女性和男性平均皮下腹部容积分别占平均总腹部容积的22.6±3.5%（均值±标准差）和19.9±4.5%（P〈0.05）;而肥胖女性和男性的该数值则分别为53.3±4.3%和37.3±7.7%（P〈0.0001）。女性的平均前皮下腹部容积与平均后皮下腹部容积与男性的相比差异显著（P〈0.0002）。非肥胖女性的平均总腹部容积和平均腹部内脏容积与非肥胖男性的相比明显小（P〈0.001）。仅肥胖女性的平均内脏容积比男性的要小得多（P〈0.0001）。除了平均内脏容积（P〈0.0125）外,肥胖女性的总腹部容积要大于非肥胖女性（P〈0.0001）;而肥胖男性的总腹部容积明显大于非肥胖男性（P〈0.0001）。结论非肥胖女性和男性的平均前皮下腹部容积与平均后皮下腹部容积相对较小且相等。肥胖女性总腹部容积的增加大都缘于皮下容积的增大,而肥胖男性总腹部容积的增加则因皮下和内脏容积两者的同时增大。     

Effects of serial plasmapheresis on serum IgA levels in IgA-deficient blood donors with IgA-suppressor T cells

Seventeen IgA-deficient blood donors, without antibodies to IgA, underwent plasmapheresis four to eight consecutive times at intervals of 8 weeks or less to provide fresh-frozen plasma for patients with anti-IgA. Blood samples, drawn for analysis no more than 1 hour before plasmapheresis and again at the conclusion of each procedure, were analyzed for lymphocyte subpopulations and serum IgA levels. Five lymphocyte subpopulations, including natural killer cells, the suppressor-inducer CD4 subset, the suppressor-precursor CD8 subset, non-major histocompatibility complex (MHC)-restricted cytotoxic T cells, and CD5+ B cells, were all decreased significantly after plasmapheresis (p less than 0.05). In a subgroup of IgA-deficient donors with excessive IgA-suppressor T-cell activity, serum IgA increased to levels exceeding 0.05 g per L following the fourth consecutive plasmapheresis procedure. Serum IgA levels did not similarly increase in IgA-deficient donors without excessive IgA-suppressor T-cell activity or in controls without IgA deficiency. Our study shows the potential, in a subpopulation of IgA-deficient donors who undergo frequent plasmapheresis, for a transient increase in serum IgA to a level no longer considered IgA deficient.     

蝙蝠葛碱和粉防己碱对[~3H]WEB 2086与体外牛脑前动脉平滑肌细胞结合的影响(英文)

用标记的血小板活化因子拮抗剂[~3H]WEB 2086,在培养的牛脑前动脉平滑肌细胞上鉴定了血小板活化因子受体。结果表明在25℃时该细胞上存在两种与配基具有不同亲和力的受体结合位点,其中K_(d-1)=22.8±5.0 nmol·L~(-1),K_(d-2)=186+20.5 nmol·L~(-1);B_(max-1)=2.1±0.3 pmol/10~4细胞,B_(max-2)=12.1±1-5 pmol/10~6细胞。蝙蝠葛碱和粉防己碱均能抑制[~3H]WEB2086与上述细胞的结合。     

Invasive line placement in critically ill patients: do hemostatic defects matter?

BACKGROUND: Blood components are often given prophylactically before the placement of invasive lines in patients with coagulation defects. Little, however, is known about the epidemiology of defects in these patients. The purpose of this study is to ascertain what proportion of intensive care patients who receive invasive lines have hemostatic defects, what actions are taken by physicians to correct these abnormalities before invasive line insertion, and what the incidence is of bleeding complications after invasive line placement. STUDY DESIGN AND METHODS: Charts were retrospectively reviewed for 490 intensive care patients in whom 938 arterial, pulmonary artery, and central venous lines were placed. RESULTS: At least one defect in hemostasis was documented for 388 patients (41%) before line placement, with 253 (27%) of these patients evidencing severe abnormalities. Seventeen percent of patients had no preprocedure laboratory evaluation. Trauma patients showed the highest numbers of abnormalities in hemostatic testing, but medical patients had more-severe defects. The occurrence of isolated abnormal laboratory values did not predict bleeding, but a score derived from a consideration of multiple defects did. Correction of the abnormalities was attempted in 37 percent of patients with hemostatic defects. Sixteen patients had bleeding complications, but only two had complications that were life-threatening. None of the complications were fatal. CONCLUSION: Invasive lines are used frequently in patients with hemostatic defects, often without any attempt to correct the abnormalities. Nevertheless, rates of hemorrhage are low and appear to be closely related to the level of experience of the physician rather than to defects in hemostasis. These findings suggest that the use of blood components for preprocedure correction of hemostatic defects is not necessary, except in those patients who have the most severe hemostatic abnormalities.     

Nonbronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis

Twenty patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolotherapy between 1979 and 1986 for the following diseases: cavitary aspergillosis (n = 4); cystic fibrosis (n = 4); tuberculosis (n = 3); bronchogenic carcinoma (n = 3); bronchiectasis (n = 3); small cell lung carcinoma 6 years after irradiation (n = 1); congenital heart disease, after Glenn and Blalock anastomoses (n = 1); and unknown interstitial disease (n = 1). Bronchial arteries were embolized in all but one patient. In nine patients (45%) nonbronchial systemic collateral arteries contributed significantly to areas of pathologic pulmonary tissue and frequently were the major arterial supply. These nonbronchial systemic collaterals included branches of the subclavian and axillary arteries (n = 7), intercostal arteries (n = 5), and phrenic arteries (n = 3) and accounted for 59.5% of the total number of arteries embolized. Recognition and occlusion of nonbronchial systemic collaterals providing blood to hypervascular pulmonary lesions is essential for successful percutaneous embolotherapy of hemoptysis.