Intracranial artery dissection in an adolescent with Marfan syndrome

Marfan syndrome is an autosomal dominant connective tissue disorder commonly due to mutation of the fibrillin-1 (FBN-1) gene that causes disruption of elastic fibers in large- and medium-size arteries and predisposes to aneurysm formation and arterial dissection. Cardiovascular complications occur in most patients with Marfan syndrome, but interestingly, neurovascular complications of Marfan syndrome are rare. We present a novel case of an adolescent with Marfan syndrome with spontaneous intracranial cerebral artery dissection and ischemic stroke with hemorrhagic transformation. This case is novel in that it reports spontaneous intracranial dissection in a young patient with Marfan syndrome and highlights the rare intrinsic neurovascular complications that can occur in these patients.     

Granular cell myoblastoma of the tongue in a 2-year-old girl: a case report

Granular cell tumours are uncommon lesions, although the head and neck region accounts for approximately 50% of all lesions. It is not clear whether or not granular cell tumour is a true neoplasm, a developmental anomaly, or a trauma-induced proliferation. The basic cell of origin is now thought to be neural, although past reports frequently indicated an origin from striated muscle, or less frequently an origin from histiocytes, fibroblasts or pericytes. The tongue and the buccal mucosa are common intraoral sites. The other head and neck site likely to be involved is the larynx. The tumour generally occurs in middle or older aged adults. More than a third of all granular cell tumours occur on the lingual dorsum, usually as a sessile, painless, somewhat firm, immoveable nodule less than 1.5 cm in greatest diameter. Lesions often demonstrate a pallor or a yellowish discolouration and typically have a smooth surface. Histochemical and ultrastructural studies propose the origin of the lesion from Schwann cells, striated muscle, mesenchymal cells, histiocytes and epithelial cells. As most of the granular cell tumours are benign, surgical excision of the lesion is the treatment of choice.     

Reported willingness and associated factors related to utilization of voluntary counseling and testing services by female sex workers in Shandong Province, China

Objective To explore reported willingness and factors associated with utilization of voluntary counseling and testing services by female sex workers （FSWs） in China and to offer recommendations to optimize use of such services. Methods A questionnaire to explore willingness to use VCT was designed based on social ecological theory and formative qualitative research. A cross-sectional survey was conducted among FSWs from entertainment venues. Single and multiple logistic regression analyses were employed to examine factors associated with reported willingness to utilize VCT. Results A total of 970 FSWs provided valid questionnaires, with 69% （669） expressing willingness to utilize VCT. Factors at the interpersonal level associated with reported willingness included knowledge about VCT, desire to get help if diagnosed as HIV positive, ability to imagine life after an HIV positive diagnosis, and perceived support for VCT from peers, managers, and family members. Availability of free antiretroviral （ARV） treatment represented a factor at policy level. Other factors included intention to leave sex work in the near future, having had a previous HIV test, and lack of a suspected STD history. Conclusions The rate of reported willingness to use VCT among FSWs was substantially higher than that of actual VCT utilization （11%）. The next step is to explore the connection between reported willingness and actual use. Based on these findings, peer education, VCT knowledge dissemination, and free ARV treatment should be emphasized to increase FSWs＇ willingness to use VCT.     

Anatomical exposure of ventricular septal defect

The ventricular septal defect approached through the right atrium is associated with inadequate exposure and thus difficulty in its closure. The retraction, to expose the defect, leads to distortion of anatomy and a limitation of space to operate. We propose a simple procedure of retracting sutures to expose the defect without this limitation.     

A biomechanical evaluation of three surgical techniques for subscapularis repair

This study was designed to determine which subscapularis repair method performs best under fatigue loading. Fresh-frozen human cadaveric shoulders were used. A standard circumferential release was performed, including a rotator interval release and separation of the subscapularis from the anterior and inferior capsules. One of 3 methods was used to repair the subscapularis tendon: tendon-to-tendon, tendon-to-bone, or bone-to-bone using a buttress plate. The shoulder was mounted on a fatigue-testing machine, and the medial end of the subscapularis tendon was attached to a soft-tissue clamp. We initially tested each specimen for fatigue at 150 N for 500 cycles, then at 300 N for 2500 cycles. The failure rate of bone-to-bone and tendon-to-tendon repairs was significantly better than that of the tendon-to-bone repair. The bone-to-bone repair exhibited the best combination of repair strength and restoration of subscapularis length.     

The Mark Coventry Award: In Vivo Knee Forces During Recreation and Exercise After Knee Arthroplasty

Knee forces directly affect arthroplasty component survivorship, wear of articular bearing surfaces, and integrity of the bone-implant interface. It is not known which activities generate forces within a range that is physiologically desirable but not high enough to jeopardize the survivorship of the prosthetic components. We implanted three patients with an instrumented tibial prosthesis and measured knee forces and moments in vivo during exercise and recreational activities. As expected, stationary bicycling generated low tibial forces, whereas jogging and tennis generated high peak forces. On the other hand, the golf swing generated unexpectedly high forces, especially in the leading knee. Exercise on the elliptical trainer generated lower forces than jogging but not lower than treadmill walking. These novel data allow for a more scientific approach to recommending activities after TKA. In addition, these data can be used to develop clinically relevant structural and tribologic testing, which may result in activity-specific knee designs such as a knee design more tolerant of golfing by optimizing the conflicting needs of increased rotational laxity and conformity.