Carbohydrate Taste Is Associated with Food Intake and Body Mass in Healthy Australian Adults

Background: The taste of carbohydrates may drive their intake. Sensitivity to carbohydrate taste varies among individuals, thus, it is important to understand how differences in sensitivity influence eating behaviour and body mass. Objective: The aims of this study were to assess associations among carbohydrate taste sensitivity, habitual and acute food intake, and body mass; as well as assess the reliability of the carbohydrate detection threshold (DT) test within and across days. Methods: Carbohydrate DT was assessed six times across three sessions in 36 healthy adult participants (22 female) using a three-alternate forced choice methodology. Moreover, 24 h diet records were completed on the days prior to testing sessions, and food intake at a buffet lunch was collected following each session. Anthropometry was also measured. Linear mixed regression models were fitted. Results: The DT test required at least three measures within a given day for good reliability (ICC = 0.76), but a single measure had good reliability when compared at the same time across days (ICC = 0.54–0.86). Carbohydrate DT was associated with BMI (kg/m²: β = −0.38, p = 0.014), habitual carbohydrate intake (g: β = −41.8, p = 0.003) and energy intake (kJ: β = −1068, p = 0.019) from the 24-h diet records, as well as acute intake of a buffet lunch (food weight (g): β = −76.1, p = 0.008). Conclusions: This suggests that individuals who are more sensitive to carbohydrate are more likely to consume greater quantities of carbohydrates and energy, resulting in a greater body mass.     

Vascular implications of minimally invasive plating of proximal humerus fractures

OBJECTIVES: Open reduction and internal fixation of proximal humerus fractures through the anterolateral acromial approach, which uses the anterior deltoid raphe and axillary nerve protection, has recently been advocated as a minimally invasive technique. Several recent reports have indicated variable and unpredictable vascular injuries to the humeral-head blood supply after a proximal humerus fracture, and thus a direct approach that minimizes further vascular compromise may be preferable. The purpose of this study was to define the relationship of this surgical interval to the lateral plating zone of the proximal humerus and to the penetrating vascular supply of the humeral head. DESIGN: Cadaveric vascular injection study. SETTING: Cadaveric dissection laboratory. PATIENTS: Six cadaveric specimens. INTERVENTION: The anterolateral acromial approach was performed on six cadaveric upper-extremity specimens. A locking proximal humerus plate was applied to the lateral proximal humerus, and the axillary artery was cannulated proximal to the circumflex humeral arteries. Dyed latex polymer was injected and allowed to harden, and dissection was performed to visualize the vasculature of the proximal humerus. Plates were then removed and the specimens were further inspected to examine the blood supply. MAIN OUTCOME MEASUREMENTS: The relationship of the anterolateral acromial approach to the lateral plating zone of the proximal humerus and the vascular supply of the humeral head. RESULTS: In all specimens, the filling of the anterior and posterior vessels that supplied the humeral head were undisturbed after use of the anterolateral acromial approach and locked plating. The blood vessels to the head-penetrating vascular branches were not in the surgical field. A bare spot on the lateral proximal humerus existed in the region of the greater tuberosity, which was 30 mm wide and between two penetrating humeral-head epiphyseal vessels. The nearest penetrating vessels were close to the plate, 4 mm anterior and 7 mm posterior. The anterior humeral circumflex vessel and its ascending branch, which provides critical blood supply to the humeral head, coursed directly in the region of the deltopectoral approach. CONCLUSIONS: Minimally invasive techniques have many potential benefits for fracture healing, but new surgical approaches often must be used to take full advantage of these newer methods. Splitting the anterior deltoid raphe from the acromion distally allowed direct access to the lateral plating zone of the proximal humerus. The bare spot in this region may be a safe area for plate application, if the plate is placed appropriately with thorough knowledge of the vascular anatomy. These findings may be of particular importance if the vascular supply to the humeral head has already been partially compromised by preceding trauma. This direct approach to the lateral bare spot on the proximal humerus may minimize iatrogenic vascular injury when treating these fractures.     

Developing a cultural model for long-term female urinary incontinence

The purpose of this study is to examine the subjective experience of long-term urinary incontinence and to show how a cultural model helps define that experience. Using a narrative approach within a cultural models framework, the specific aims are to describe and analyze: (1) what urinary incontinence means; and (2) how that meaning is constructed and negotiated by women living with urinary incontinence. 17 community-dwelling women (from Philadelphia, USA, and its immediate suburbs) participated in semi-structured interviews. Plot types and shared themes were compared with themes that emerged from media representations of female incontinence, and a cultural model was developed. Findings suggest: (1) the meaning of long-term female urinary incontinence is constructed and negotiated as a result of individual and shared experiences; (2) the cultural model constructed by women differs significantly from the professional, primarily biomedical model; and (3) women's narratives provide a method for accommodating similarities and differences between lay and professional models.     

‘Batter’s Shoulder’: Can Athletes Return to Play at the Same Level After Operative Treatment?

Background  

Batter’s shoulder has been defined as posterior subluxation of the lead shoulder during the baseball swing. However, it is unclear whether or how frequently patients may return to play after treatment of this uncommon condition.     

Not all spondylolisthesis grading instruments are reliable

Spondylolisthesis is the slippage of one vertebral body on an adjacent level, and occurs commonly at the lumbosacral junction in children. Many radiographic measurement instruments have been described to predict progression and need for intervention. We evaluated the reliability of eight common grading instruments. Four raters reviewed 30 lateral radiographs of the lumbar spine in patients with spondylolisthesis. Each rater measured each film twice, and had mean individual correlation coefficients of at least 0.76 (range, 0.76-0.91). Only three measurements had interobserver correlations greater than 0.75 (slip percentage, Meyerding's grade, and sacral inclination), which corresponded to excellent reliability. For intraobserver reliability, six measurements had correlations greater than 0.75 (all except kyphosis angle and lumbar index), indicating excellent agreement. Slip percent, Meyerding's grade, and sacral inclination had excellent interobserver agreement and intraobserver agreement.     

Cycling injuries of the lower extremity

Cycling is an increasingly popular recreational and competitive activity, and cycling-related injuries are becoming more common. Many common cycling injuries of the lower extremity are preventable. These include knee pain, patellar quadriceps tendinitis, iliotibial band syndrome, hip pain, medial tibial stress syndrome, stress fracture, compartment syndrome, numbness of the foot, and metatarsalgia. Injury is caused by a combination of inadequate preparation, inappropriate equipment, poor technique, and overuse. Nonsurgical management may include rest, nonsteroidal anti-inflammatory drugs, corticosteroid injection, ice, a reduction in training intensity, orthotics, night splints, and physical therapy. Injury prevention should be the focus, with particular attention to bicycle fit and alignment, appropriate equipment, proper rider position and pedaling mechanics, and appropriate training.     

J-integral fracture toughness and tearing modulus measurement of radiation cross-linked UHMWPE.

Radiation and chemical cross-linking of medical grade ultrahigh molecular weight polyethylene (UHMWPE) has recently been utilized in an effort to improve wear performance of total joint replacement components. However, reductions in mechanical properties with cross-linking are cause for concern regarding the use of cross-linked UHMWPE for high-stress applications such as in total knee replacement prostheses. In this study, the fracture behavior of radiation cross-linked UHMWPE was compared to that of uncross-linked UHMWPE. The Rice and Sorensen model that utilizes mechanical parameters obtained from uniaxial tensile and compact tension tests was used to calculate the steady state J-integral fracture toughness, Jss, for radiation cross-linked UHMWPE. Jss decreased monotonically with increase in radiation dose. UHMWPE exhibited tough, ductile tearing behavior with stable crack growth when it was cross-linked using a gamma radiation dose of 0-50 kGy. However, in cross-linked UHMWPE irradiated to a dose of 100 and 200 kGy, unstable fracture occurred spontaneously upon attaining the initial crack driving force, J1c. This indicates that a high degree of cross-linking is less desirable for high-stress applications in orthopaedic implants. However, a substantial increase in J1c, even at a low degree of cross-linking, suggests that a low degree of cross-linking may be beneficial for resistance to delamination and catastrophic failure, both of which require an initiation step for the fracture to propagate in the material. This mechanical test should, however, be considered along with fatigue tests and joint simulator testing before determination of an appropriate amount of cross-linking for total joint replacement prostheses that experience high stresses.     

Prenatal versus neonatal long-term effect of phenobarbital on mouse microsomal drug-oxidizing system

Mice were exposed to phenobarbital (PhB) prenatally or neonatally. Prenatal treatment (PreB) was accomplished by feeding the mother PhB, 3 g/kg milled food on gestation days 9-18. Neonates (NeoB mice) were injected daily with 50 mg/kg PhB. The activity of the hepatic microsomal drug-oxidizing system was assayed in the PreB mice (at ages 28 and 50 days), NeoB mice (22, 28 and 50 days) and controls. PreB had at day 28 only small increases in enzyme activity. However, on day 50 there was a 3-fold increase in PhB level compared to control. Among NeoB mice the enzyme activity was 3 times above control on day 22 but the increase was abolished on days 28 and 50. Thus, the long-term increase in the microsomal drug-oxidizing system takes place only after prenatal (and not neonatal) PhB exposure, and the increased enzyme activity occurs around maturity.     

Glenohumeral Chondrolysis After Shoulder Arthroscopy With Thermal Capsulorrhaphy

Glenohumeral chondrolysis is a rare but devastating complication that can occur after shoulder arthroscopy and thermal capsulorrhaphy. We retrospectively reviewed the medical records and imaging studies of 8 patients in whom glenohumeral chondrolysis developed after shoulder arthroscopy in which thermal energy was used. Of the 8 patients, 5 had previous thermal capsulorrhaphy for the diagnosis of instability. Two patients were diagnosed with instability with associated labral tears and underwent labral repair with thermal capsular shrinkage. One patient was diagnosed with a labral tear and underwent labral debridement with an extensive glenohumeral synovectomy via a thermal probe. No patients had evidence of chondral damage at their index arthroscopy, and none received postoperative pain pumps. In all patients, radiographic evidence of chondrolysis developed and repeat arthroscopy was performed to confirm the diagnosis. Open surgical stabilization has not been known to have this complication, and it is speculated that heating of the joint fluid at the time of arthroscopy from any source plays a role in cartilage death. Further studies are warranted to determine whether adequate outflow during shoulder arthroscopy where the fluid volume is relatively small will aid in avoiding complications associated with the use of heat sources.