The Incidence and Risk Factors of Third- and Fourth-Degree Perineal Tears in Ministry of Health in Bahrain over 5 Years

Background: Perineal trauma and vaginal laceration are considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg persistent occipital posterior position, null parity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature, but data are conflicting, such as prolonged second stage of labor, episiotomy and obesity. Objective: To evaluate third- and fourth-degree perineal rears rates and the impact of related risk factors on perineal tears in Ministry of health in Bahrain over 5 years (which includes Salmanyia Medical complex (SMC) and Jidhafs maternity hospital (JMH)). Methods: This retrospective descriptive cross-sectional study analyzed all vaginal deliveries from January 2015 to December 2019 in Obstetrics and Gynecology department in Salmanyia Medical Complex (the main hospital in Kingdom of Bahrain which received all kinds of cases including low and high risks) and Jidhafs Maternity Hospital (tertiary hospital which received only low risk cases), Kingdom of Bahrain. During the period of interest 33,694 records were identified. Data were extracted from observational recording from SMC and JMH labour registry books. Results: There was no statistically significant difference between groups according to age (p = 0.199). On the other hand, there was statistically significant higher cases of >40 weeks at gestational age, obesity > 35 kg/mr, vacuum delivery, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm, episiotomy and lower cases of nulliparity in study group compared to control group 16 (66.7%) vs. 13,805 (41.0%), 3 (12.5%) vs. 1448 (4.3%), 3 (12.5%) vs. 1414 (4.2%), 4 (16.7%) vs. 1751 (5.2%), 3 (12.5%) vs. 1751 (5.2%), 12 (50.0%) vs. 15,926 (47.3%), 15 (62.5%) vs. 20,135 (59.8%) and 17 (70.8%) vs. 29,024 (86.2%);(p = 0.027, 0.009, Conclusion: Gestational age > 40 weeks, obesity > 35 kg/mr, pushing stage > 90 min, birth weight > 4 kg, head circumference > 34 cm, fetal length at birth > 50 cm and using of vacuum increase incidence of 3rd and 4th degree perineal tears with vaginal delivery however maternal age and nulliparity have no significant role. Finally, episiotomy did not represent as protective factor for perineal damage. .

Long head of biceps tendon transposition for massive and irreparable rotator cuff tears:A systematic review and meta-analysis

BACKGROUND Superior capsular reconstruction(SCR)with long head of biceps tendon(LHBT)transposition was developed to massive and irreparable rotator cuff tears(MIRCTs);however,the outcomes of this technique remain unclear.AIM To perform a systematic review of biomechanical outcomes and a meta-analysis of clinical outcomes after LHBT transposition for MIRCTs.METHODS We performed a systematic electronic database search on PubMed,EMBASE,and Cochrane Library.Studies of SCR with LHBT transposition were included according to the inclusion and exclusion criteria.Biomechanical studies were assessed for main results and conclusions.Included clinical studies were evaluated for quality of methodology.Data including study characteristics,cohort demographics,and outcomes were extracted.A meta-analysis was conducted of the clinical outcomes.RESULTS According to our inclusion and exclusion criteria,a total of six biomechanical studies were identified and reported an overall improvement in subacromial contact pressures and prevention of superior humeral migration without limiting range of motion(ROM)after LHBT transposition for MIRCTs.A total of five clinical studies were included in the meta-analysis of LHBT transposition outcomes,consisting of 253 patients.The results indicated that compared to other surgical methods for MIRCTs,LHBT transposition had advantages of more significant improvement in ROM(forward flexion mean difference[MD]=6.54,95%confidence interval[CI]:3.07-10.01;external rotation[MD=5.15,95%CI:1.59-8.17];the acromiohumeral distance[AHD][MD=0.90,95%CI:0.21-1.59])and reducing retear rate(odds ratio=0.27,95%CI:0.15-0.48).No significant difference in American Shoulder and Elbow Surgeons score,visual analogue scale score,and University of California at Los Angles score was demonstrated between these two groups for MIRCTs.CONCLUSION In general,SCR with LHBT transposition was a reliable and economical technique for treating MIRCTs,both in terms of biomechanical and clinical outcomes,with comparable clinical outcomes,improved ROM,AHD,and reduced the retear rates compared to conventional SCR and other established techniques.More high-quality randomized controlled studies on the long-term outcomes of SCR with LHBT transposition are required to further assess.

Preliminary proteomic analysis of human tears in lacrimal adenoid cystic carcinoma and pleomorphic adenoma

·AIM: To detect proteomic differences in tears between adenoid cystic carcinoma(ACC) and pleomorphic adenoma(PA).·METHODS: Tear samples were collected from 4 patients with ACC, 5 with PA, and 4 control cases. Label-free analysis and parallel reaction monitoring(PRM) were used to screen and validate the tear proteome. Gene Ontology(GO) annotation and Kyoto Encyclopedia of Genes and Genomes(KEGG) were conducted for bioinformatics analysis.·RESULTS: In total, 1059 proteins in tear samples were identified by label-free analysis. Between ACC and PA, 415 differentially expressed proteins were detected. Based on the GO annotation, enzyme regulator activity and serinetype endopeptidase inhibitor activity in the molecular function category, blood microparticle and extracellular matrix in the cellular component category, and response to nutrient levels in the biological process category were most predominant. By KEGG pathway annotation, the different proteins between ACC and PA mainly par ticipated in complement and coagulation cascades, amoebiasis, African trypanosomiasis and cholesterol metabolism. Eight proteins with mostly significant differences were verified by PRM, and five proteins with more than 10-fold increases in ACC compared with PA, including integrin β, α-2-macroglobulin, epididymal secretory sperm binding protein Li 78p, RAB5C, and complement C5, were identified.·CONCLUSION: The combined tools of label-free analysis and PRM are very effective and efficient, especially for samples such as tears. Some proteomic dif ferences in tears between ACC and PA are identified and these protein candidates may be specific biomarkers for future exploration.

Meniscus tears treatment:The good,the bad and the ugly-patterns classification and practical guide

Over the years,several studies demonstrated the crucial role of knee menisci in joint biomechanics.As a result,save the meniscus has become the new imperative nowadays,and more and more studies addressed this topic.The huge amount of data on this topic may create confusion in those who want to approach this surgery.The aim of this review is to provide a practical guide for treatment of meniscus tears,including an overview of technical aspects,outcomes in the literature and personal tips.Taking inspiration from a famous movie directed by Sergio Leone in 1966,the authors classified meniscus tears in three categories:The good,the bad and the ugly lesions.The inclusion in each group was determined by the lesion pattern,its biomechanical effects on knee joint,the technical challenge,and prognosis.This classification is not intended to substitute the currently proposed classifications on meniscus tears but aims at offering a readerfriendly narrative review of an otherwise difficult topic.Furthermore,the authors provide a concise premise to deal with some aspects of menisci phylogeny,anatomy and biomechanics.

Late presentation of dural tears:Two case reports and review of literature

BACKGROUND The late presentation of dural tears(LPDT)has a low incidence rate and hidden symptoms and is easily ignored in clinical practice.If the disease is not treated in time,a series of complications may occur,including low intracranial pressure headache,infection,pseudodural cyst formation,and sinus formation.Here,we describe two cases of LPDT.CASE SUMMARY Two patients had sudden fever 1 wk after lumbar surgery.Physical examination showed obvious tenderness in the operation area.The patients were confirmed as having LPDT by lumbar magnetic resonance imaging and surgical exploration.One case was caused by continuous negative pressure suction and malnutrition,and the other was caused by decreased dural ductility and low postoperative nutritional status.The first symptom of both patients was fever,with occasional headache.Both patients underwent secondary surgery to treat the LPDT.Dural defects were observed and dural sealants were used to seal the dural defects,then drainage tubes were retained for drainage.After the operation,the patients were treated with antibiotics and the patients’surgical incisions healed well,without fever or incision tenderness.Both recovered and were discharged 1 wk after the operation.CONCLUSION LPDT is a rare complication of spinal surgery or neurosurgery that has hidden symptoms and can easily be overlooked.Since it may cause a series of complic-ations,LPDT needs to be actively addressed in clinical practice.

Assessment of tear film parameters post-treatment with commercial eyelid cleaning wipes:a pilot study

AIM:To investigate the short-term effects of commercially available eyelid-cleaning wipes on film parameters.METHODS:This study enrolled 48 healthy participants aged 20-35y(both males and females).Clinical assessment included the Ocular Surface Disease Index(OSDI)questionnaire,non-invasive tear break-up time(NITBUT),tear meniscus height(TMH),and lipid layer pattern(LLP).Based on these initial results,participants were categorized as either non-dry eye or dry eye.Participants in each group were randomly allocated to either Blephaclean■or Systane■treatments.Changes in NITBUT,TMH,and LLP levels before and after lid wipe treatment were assessed.RESULTS:The dry eye group exhibited significantly higher OSDI scores and lower NITBUT and TMH levels than in the non-dry eye group(P<0.001).Following the application of eyelid wipes(Systane■wipes),dry eye subjects experienced a significant improvement in NITBUT levels(P=0.0014)compared to the non-dry eye individuals.Although the remaining participants showed a marginal increase in TMH and NITBUT levels,these changes did not achieve statistical significance(P>0.05).Similarly,the LLP levels were significantly improved with Systane■(P<0.001)post-treatment compared to individuals in the non-dry eye group.However,the dry eye subjects showed higher posttreatment LLP levels than the untreated group(P<0.02).CONCLUSION:The short-term effects of Systane®eyelid wipes on tear film parameters suggest their effectiveness in dry eye disease.Nonetheless,further exploration of their long-term impact is essential to justify their cost effectiveness and efficacy in treating both aqueous deficiency and evaporative dryness.

Suppression of the m/n=2/1 tearing mode by electron cyclotron resonance heating on J-TEXT

Stabilization of tearing modes and neoclassical tearing modes is of great importance for tokamak operation.Electron cyclotron waves(ECWs)have been extensively used to stabilize the tearing modes with the virtue of highly localized power deposition.Complete suppression of the m/n=2/1 tearing mode(TM)by electron cyclotron resonance heating(ECRH)has been achieved successfully on the J-TEXT tokamak.The effects of ECW deposition location and power amplitude on the 2/1 TM suppression have been investigated.It is found that the suppression is more effective when the ECW power is deposited closer to the rational surface.As the ECW power increases to approximately 230 k W,the 2/1 TM can be completely suppressed.The island rotation frequency is increased when the island width is reduced.The experimental results show that the local heating inside the magnetic island and the resulting temperature perturbation increase at the O-point of the island play dominant roles in TM suppression.As the ECW power increases,the 2/1 island is suppressed to smaller island width,and the flow shear also plays a stabilizing effect on small magnetic islands.With the stabilizing contribution of heating and flow shear,the 2/1 TM can be completely suppressed.

Pro-inflammatory cytokines levels in tears and dry eye disease in Parkinson’s disease

Background:Neuroinflammation is an essential event in Parkinson’s disease(PD).Identifying affordable and less invasive biomarkers to make an early diagnosis and monitor therapeutic strategies should be a priority among researchers.The study’s objective was to measure tear levels of cytokines in subjects with PD and their association with motor features and the presence of dry eye symptoms.Methods:A total of 16 subjects with PD and 16 age-and sex-matched controls were included.Movement Disorders Society-Unified Parkinson’s Disease Rating Scale(MDS-UPDRS),Hoehn and Yahr(HY)stage scale,Montreal Cognitive Assessment(MoCA),tear break-up time(TBUT),blink rate(BR),Dry Eye Questionnaire 5(DEQ-5)were examined,and pro-inflammatory cytokines[interleukin(IL)-1β,IL-6,IL-8,IL-10,IL-12p70 and tumor necrosis factor-alpha(TNF-α)]were quantified in tears using the BD Cytometric Bead Array Human Inflammatory Cytokine Kit.Results:Higher tear TNF-αwere quantified in PD compared to controls(2.94±3.95 vs.0.33±0.49 pg/mL,P=0.008).According to DEQ-5,50.0%(n=8)of PD subjects and 12.5%(n=2)controls had dry eye disease(DED).No differences were found in cytokines concentrations between PD patients with DED compared to those without DED.IL-8 was associated with the HY stage,TBUT,DEQ-5,and a better MoCA score.A higher BR correlated moderately with a lower HY stage(r=−0.645,P=0.007),and DED patients have lower BR in PD(12.14±2.54 vs.9.0±2.06 blinks/minute,P=0.031).Conclusions:PD patients have higher levels of TNF-αin tears than age-and sex-matched HC.IL-8 in tears may be both involved in the severity of the disease and in the development of DED in PD.In addition,our findings suggest that as HY stage increases,indicating a more advanced stage,BR decreases,indicating greater motor impairment.Conversely,the presence of DED is associated with higher levels of bradykinesia in PD patients,suggesting a potential relationship between DED and motor impairment severity.

Effects of diamagnetic drift on nonlinear interaction between multi-helicity neoclassical tearing modes

A numerical study of the diamagnetic drift effect on the nonlinear interaction between multi-helicity neoclassical tearing modes(NTMs) is carried out using a set of four-field equations including two-fluid effects.The results show that,in contrast to the single-fluid case,5/3 NTM cannot be completely suppressed by 3/2 NTM with diamagnetic drift flow.Both modes exhibit oscillation and coexist in the saturated phase.To better understand the effect of the diamagnetic drift flow on multiple-helicity NTMs,the influence of typical relevant parameters is investigated.It is found that the average saturated magnetic island width increases with increasing bootstrap current fraction f_(b) but decreases with the ion skin depth δ.In addition,as the ratio of parallel to perpendicular transport coefficients χ_(‖)/χ_(⊥) increases,the average saturated magnetic island widths of the 3/2 and 5/3 NTMs increase.The underlying mechanisms behind these observations are discussed in detail.

Microstructure and Hot Tearing Sensitivity Simulation and Parameters Optimization for the Centrifugal Casting of Al-Cu Alloy

Four typical theories on the formation of thermal tears:strength,liquid film,intergranular bridging,and solidifica-tion shrinkage compensation theories.From these theories,a number of criteria have been derived for predicting the formation of thermal cracks,such as the stress-based Niyama,Clyne,and RDG(Rapaz-Dreiser-Grimaud)criteria.In this paper,a mathematical model of horizontal centrifugal casting was established,and numerical simulation analysis was conducted for the centrifugal casting process of cylindrical Al-Cu alloy castings to investigate the effect of the centrifugal casting process conditions on the microstructure and hot tearing sensitivity of alloy castings by using the modified RDG hot tearing criterion.Results show that increasing the centrifugal rotation and pouring speeds can refine the microstructure of the alloy but increasing the pouring and mold preheating temperatures can lead to an increase in grain size.The grain size gradually transitions from fine grain on the outer layer to coarse grain on the inner layer.Meanwhile,combined with the modified RDG hot tearing criterion,the overall distribution of the castings’hot tearing sensitivity was analyzed.The analysis results indicate that the porosity in the middle region of the casting was large,and hot tearing defects were prone to occur.The hot tearing tendency on the inner side of the casting was greater than that on the outer side.The effects of centrifugal rotation speed,pouring temperature,and preheating temperature on the thermal sensitivity of Al-Cu alloy castings are summarized in this paper.This study revealed that the tendency of alloy hot cracking decreases with the increase of the centrifugal speed,and the maximum porosity of castings decreases first and then increases with the pouring temperature.As the preheating temperature increases,the overall maximum porosity of castings shows a decreasing trend.

Effects of counter-current driven by electron cyclotron waves on neoclassical tearing mode suppression

Through theoretical analysis,we construct a physical model that includes the influence of counter-external driven current opposite to the plasma current direction in the neoclassical tearing mode(NTM).The equation is used with this model to obtain the modified Rutherford equation with co-current and counter-current contributions.Consistent with the reported experimental results,numerical simulations have shown that the localized counter external current can only partially suppress NTM when it is far from the resonant magnetic surface.Under some circumstances,the Ohkawa mechanism dominated current drive(OKCD)by electron cyclotron waves can concurrently create both co-current and counter-current.In this instance,the minimal electron cyclotron wave power that suppresses a particular NTM was calculated by the Rutherford equation.The result is marginally less than when taking co-current alone into consideration.As a result,to suppress NTM using OKCD,one only needs to align the co-current with a greater OKCD peak well with the resonant magnetic surface.The effect of its lower counter-current does not need to be considered because the location of the counter-current deviates greatly from the resonant magnetic surface.

The Prevalence Type of the Meniscus Tear in Patients with Anterior Cruciate Ligament (ACL) Injury, in Abu Arish General Hospital, Jazan, KSA

Background: The anterior cruciate ligament (ACL) is the main structure that prevents the forward movement of the tibia about the femur Meniscus tear which is a common finding in patients with anterior cruciate ligament (ACL) injury. Aim: To investigate the prevalence of types of meniscus tears in patients with Anterior Cruciate Ligament (ACL) Injury. Methods: A retrospective study was conducted among inpatients. Clinical evaluation included side-to-side difference in anterior tibial translation (ATT) as measured by a KT-1000 arthrometer (MEDmetric Corp) and a grade of pivot-shift test at final follow-up in all patients. Subsequent meniscal tear was defined by symptoms of joint line pain and/or locking or joint effusion requiring surgical treatment. Results: Most of patients were males (92.6%). The patients were categorized into 5 groups according to age with a mean of age 32.8 ± 10.6. The most common causes of ACL injury were falling down (43.2%), trauma (38.1%) or knee torsion (18.8%). Medial meniscal tear was found in 92 knees (55.7%), while lateral meniscal tear was found in 19 knees (10.8%) and the most common type was the longitudinal tear that was found in 31 knees (17.6%). Similarly, 66.7% of the meniscal flap tears and half of the meniscal bucket-handle tears were significantly associated with loose body (P Conclusion: The present study demonstrated that meniscus tears are more common in individuals with chronic ACL rupture. The main factors contributing to ACL injury were classified as falls, trauma, and knee torsion. Gender was identified as a critical determinant in the etiology of ACL injury. The occurrence of a ramp lesion was associated longitudinal meniscal tears, whereas chodoral injury was associated with the majority of meniscal flap tears and meniscal bucket-handle tears.

Rotator cuff tears: An evidence based approach

Lesions of the rotator cuff(RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an agedependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears(PTT) can be bursalsided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears(FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations- cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, antiinflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being costeffective, this helps in providing a functional shoulder witha stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, costeffective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

Treatment of meniscal tears: An evidence based approach

Treatment options for meniscal tears fall into three broad categories;non-operative,meniscectomy or meniscal repair.Selecting the most appropriate treatment for a given patient involves both patient factors(e.g.,age,co-morbidities and compliance)and tear characteristics(e.g.,location of tear/age/reducibility of tear).There is evidence suggesting that degenerative tears in older patients without mechanical symptoms can be effectively treated non-operatively with a structured physical therapy programme as a first line.Even if these patients later require meniscectomy they will still achieve similar functional outcomes than if they had initially been treated surgically.Partial meniscectomy is suitable for symptomatic tears not amenable to repair,and can still preserve meniscal function especially when the peripheral meniscal rim is intact.Meniscal repair shows 80%success at 2 years and is more suitable in younger patients with reducible tears that are peripheral(e.g.,nearer the capsular attachment)and horizontal or longitudinal in nature.However,careful patient selection and repair technique is required with good compliance to post-operative rehabilitation,which often consists of bracing and non-weight bearing for 4-6 wk.

A Comparative Assessment of the Efficacy of Carbomer Gel and Carboxymethyl Cellulose Containing Artificial Tears in Dry Eyes

The present study aimed to compare the clinical efficacy of a 0.4% carbomer gel and 1% carboxymethyl cellulose （CMC） containing artificial tears in treatment of dry eye patients. Sixty subjects with mean age of 45.89 years who had symptoms and signs of dry eye were enrolled in this prospective, investigator-masked and stratified random sampling study. The subjects were divided into two parallel groups with 30 subjects （60 eyes） in each group. One group received carbomer gel, and the other group received 1% CMC containing artificial tears. Subjects received the drops 3 to 4 times or more per day for 3 months. At the first visit time, the precorneal residence time of these two drops was measured. The efficacy was assessed by comparing the subjective symptoms （ocular dry- ness, foreign body sensation, burning sensation and pain）, and the objective test results of tears breakup time, Schirmer＇s test and corneal fluorescein staining prior to the study and after the treat- ment. As a result, the ocular residence time of carbomer gel was significantly longer than that of 1% CMC （P〈0.001）. Most of the primary subjective symptoms and objective test results were improved after treatment in both carbomer gel group and 1% CMC group. As to the improvement of each symptom and objective test result, carbomer gel was more effective than 1% CMC group （P〈0.01）. In conclusion, carbomer gel had longer precorneal residence time and was more effective than 1% CMC in the treatment of patients with dry eyes.

Association between the levels of prostaglandin E2 in tears and severity of dry eye

AIM: To investigate the relationship between the levels of prostaglandin E2(PGE2) in tears and dry eye disease severity based on both clinical symptoms and signs.METHODS: Tear samples were collected from 36 non-Sj?gren syndrome dry eye patients(10 males and 26 females, mean age 50.11±11.17 y). All participants completed the Ocular Surface Disease Index(OSDI) questionnaire and underwent a detailed ophthalmic examination including, tear film breakup time(TBUT), ocular surface fluorescein staining, Schirmer I test, and meibomian gland assessment. The level of PGE2 in tears was measured using enzyme-linked immunosorbent assay(ELISA). The independent associations between tear PGE2 levels and other variables including demographics, OSDI scores, TBUT, Schirmer scores, ocular surface staining scores, and stage of meibomian gland dysfunction(MGD) were evaluated using linear regression analysis. RESULTS: The mean PGE2 level in tears of dry eye patients was 537.85±234.02 pg/mL. The tear PGE2 levels significantly positively correlated with OSDI scores(R=0.608, P<0.001), however, they did not significantly associate with TBUT(R=0.153, P=0.373), Schirmer scores(R=-0.098, P=0.570), ocular surface staining scores(R=0.282, P=0.095), and stage of MGD(R=-0.107, P=0.535).Male sex was significantly negatively correlated with tear PGE2 levels.CONCLUSION: The levels of PGE2 in tears are positively correlated with dry eye symptoms. However, no significant association was found between tear PGE2 levels and the results of other common dry eye diagnostic tests.

Reporting rotator cuff tears on magnetic resonance arthrography using the Snyder's arthroscopic classification

AIM To determine diagnostic performance of magnetic resonance arthrography(MRA) in evaluating rotator cuff tears(RCTs) using Snyder's classification for reporting.METHODS One hundred and twenty-six patients(64 males, 62 females; median age 55 years) underwent shoulder MRA and arthroscopy, which represented our reference standard. Surgical arthroscopic reports were reviewed and the reported Snyder's classification was recorded. MRA examinations were evaluated by two independent radiologists(14 and 5 years' experience) using Snyder's classification system, blinded to arthroscopy. Agreement between arthroscopy and MRA on partial-and fullthickness tears was calculated, first regardless of their extent. Then, analysis took into account also the extent of the tear. Interobserver agreement was also calculated the quadratically-weighted Cohen kappa statistics.RESULTS On arthroscopy, 71/126 patients(56%) had a fullthickness RCT. The remaining 55/126 patients(44%) had a partial-thickness RCT. Regardless of tear extent, out of 71 patients with arthroscopically-confirmed fullthickness RCTs, 66(93%) were correctly scored by both readers. All 55 patients with arthroscopic diagnosis of partial-thickness RCT were correctly assigned as having a partial-thickness RCT at MRA by both readers. Interobserver reproducibility analysis showed total agreement between the two readers in distinguishing partial-thickness from full-thickness RCTs, regardless of tear extent(k = 1.000). With regard to tear extent, in patients in whom a complete tear was correctly diagnosed, correct tear extent was detected in 61/66 cases(92%); in the remaining 5/66 cases(8%), tear extent was underestimated. Agreement was k = 0.955. Interobserver agreement was total(k = 1.000).CONCLUSION MRA shows high diagnostic accuracy and reproducibility in evaluating RCTs using the Snyder's classification for reporting. Snyder's classification may be adopted for routine reporting of MRA.

Spontaneous or secondary to intravitreal injections of anti-angiogenic agents retinal pigment epithelial tears in age-related macular degeneration

·AIM:Toevaluatethevisualfunctionevolutionofretinal pigment epithelial(RPE) tears in patients with age-related macular degeneration(AMD) according to type of occurrence [spontaneous or secondary to anti-vascular endothelial growth factor(anti-VEGF) injection] and the topographic location of the tear after a two-year followup period.·METHODS: A total of 15 eyes of 14 patients with RPE tears in exudative AMD were analyzed retrospectively at the University Eye Clinic of Trieste. Inclusion criteria were: patient age of 50 or older with AMD and RPE tears both spontaneous occurring or post anti-VEGF treatment. Screening included: careful medical history,complete ophthalmological examination, fluorescein angiography(FA), indocyanine green angiography(ICG),autofluorescence and infrared imaging and optical coherence tomography(OCT). Patients were evaluated every month for visual acuity(VA), fundus examination and OCT. Other data reported were: presence of PED,number of injections before the tear, location of the lesion.·RESULTS:Meanfollow-up was24wk(SD±4wk). Atotal of 15 eyes were studied for RPE tear. In 6 cases(40%),the RPE tears occurred within two years of anti-VEGF injections the others occurred spontaneously. In 13cases(86.6%), the RPE tear was associated with pigment epithelial detachment(PED). In 7 cases(46.6%), the RPE tear occurred in the central area of the retina and involved the fovea. Two lesions were found in the parafoveal region, six in the extra-macular area. In all cases visual acuity decreased at the end of the follow-up period(P <0.01) independently of the type or the topographical location of the lesion.·CONCLUSION: RPE tear occurs in exudative AMD as a spontaneous complication or in relation to anti-VEGF injections. Visual acuity decreased significantly and gradually in the follow-up period in all cases. No correlation was found between visual loss and the type of onset or the topographic location of the tears.

Effects of Drought Stress Simulated by Polyethylene Glycol on Seed Germination, Root and Seedling Growth, and Seedling Antioxidant Characteristics in Job’s Tears

Two Job’s tears cultivars, yy18-1 (high resistance to drought stress) and yy12-7 (susceptible to drought stress) were used to investigate the responses of seed germination, root and seedling growth, and seedling antioxidant characteristics to drought stress simulated by polyethylene glycol (PEG) 6000 solutions with 0, -0.05, -0.1, -0.15, and -0.2 MPa osmotic potentials. The results showed that the germination energy, germination rate, germination index, root and seedling lengths, root and seedling diameters, root and seedling fresh masses, root and seedling dry masses, and seedling relative water content (RWC) decreased with the decrease of the osmotic potential of PEG 6000 solution. The contents of hydrogen peroxide (H2O2), malondialdehyde (MDA), and proline in seedling increased with the decrease of the osmotic potential of PEG 6000 solution. The activities of peroxidase (POD), catalase (CAT), ascorbate peroxidase (APX), and glutathione reductase (GR) in seedling increased and then decreased with the decrease of osmotic potential of PEG 6000 solution. -0.1 MPa was the optimal osmotic potential of PEG 6000 solution simulated drought stress at germination stage for Job’s tears. The proline content and activities of POD and CAT were important mechanisms for the maintenance of drought resistance in Job’s tears seedling.

Partial anterior cruciate ligament tears treated with intraligamentary plasma rich in growth factors

AIM:To evaluate the effect of the application of plasma rich in growth factors(PRGF)-Endoret to the remaining intact bundle in partial anterior cruciate ligament(ACL)tears.METHODS:A retrospective review of the rate of return to play in football players treated with the application of PRGF-Endoret in the remaining intact bundle in partial ACL injuries that underwent surgery for knee instability.Patients with knee instability requiring revision surgery for remnant ACL were selected.PRGF was applied in the wider part of posterolateral bundle and the time it took patients to return to their full sporting activities at the same level before the injury was evaluated.RESULTS:A total of 19 patients were reviewed.Three had a Tegner activity level of 10 and the remaining 16level 9.The time between the injury and the time of surgery was 5.78 wk(SD 1.57).In total,81.75%(16/19)returned to the same pre-injury level of sport activity(Tegner 9-10).17 males and 2 females were treated.The rate of associated injury was 68.42%meniscal lesions and 26.31%cartilage lesions.The KT-1000 values were normalized in all operated cases.One patient was not able to return to sport due to the extent of their cartilage lesions.The 15 patients with Tegner activity level 9 returned to play at an average of 16.20 wk(SD1.44)while the 3 patients with Tegner activity level 10did so in 12.33 wk(SD 1.11).CONCLUSION:With one remaining intact bundle the application of PRGF-Endoret in instability cases due to partial ACL tear showed high return to sport rates at pre-injury level in professional football players.