Notes

Deterioration regarding bioplastics in organic and natural waste through mesophilic anaerobic digestion, recycling as well as earth incubation.
Although spreader graft technique is a very effective method in midvalve management, we believe that T-splay graft technique may also produce effective outcomes. In addition, the midvalve functions could be better simulated anatomically and functionally with T-splay graft technique. Therefore, we believe that T-splay graft technique is an alternative method that can be safely used in selected cases.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Because of its superficial location in the dorsal regions of the scalp, the greater occipital nerve (GON) can be injured during neurosurgical procedures, resulting in post-operative pain and postural disturbances. The aim of this work is to specify the course of the GON and how its injuries can be avoided while performing posterior fossa approaches.

This study was carried out at the department of anatomy at Bordeaux University. 4 specimens were dissected to study the GON course. Posterior fossa approaches (midline suboccipital, paramedian suboccipital, retrosigmoid and petrosal) were performed on 4 other specimens to assess potential risks of GON injuries.

The GON runs around the obliquus capitis inferior (100%), crosses the semispinalis capitis (100%) and the trapezius (75%) or its aponeurosis (25%). Direct GON injuries can be seen in paramedian suboccipital approaches. Stretching of the GON can occur in midline suboccipital and paramedian suboccipital approaches. We found no evidence of direct or indiital approaches. Furthermore, the incision for retrosigmoid approaches should be as lateral as possible and not too caudal. Finally, avoiding extreme patient positioning reduces the risk of GON stretching in all approaches.
Tendinopathy is a major complication of diet-induced obesity. However, the effects of a high-fat diet (HFD) on tendon have not been well characterised. We aimed to determine [1] the impact of a HFD on tendon properties and gene expression; and [2] whether dietary transition to a control diet (CD) could restore normal tendon health.

Sprague-Dawley rats were randomised into three groups from weaning and fed either a CD, HFD or HFD for 12weeks and then CD thereafter (HF-CD). Biomechanical, histological and structural evaluation of the Achilles tendon was performed at 17 and 27weeks of age. Tail tenocytes were isolated with growth rate and collagen production determined. Tenocytes and activated THP-1 cells were exposed to conditioned media (CM) of visceral adipose tissue explants, and gene expression was analysed.

There were no differences in the biomechanical, histological or structural tendon properties between groups. However, tenocyte growth and collagen production were increased in the HFD group at 27weeks. There was lower SOX-9 expression in the HFD and HF-CD groups at 17weeks and higher expression of collagen-Iα1 and matrix metalloproteinase-13 in the HFD group at 27weeks. THP-1 cells exposed to adipose tissue CM from animals fed a HFD or HF-CD had lower expression of Il-10 and higher expression of Il-1β.

In this rodent model, a HFD negatively altered tendon cell characteristics. Dietary intervention restored some gene expression changes; however, adipose tissue secretions from the HF-CD group promoted an increased inflammatory state in macrophages. These changes may predispose tendon to injury and adverse events later in life.
In this rodent model, a HFD negatively altered tendon cell characteristics. Dietary intervention restored some gene expression changes; however, adipose tissue secretions from the HF-CD group promoted an increased inflammatory state in macrophages. These changes may predispose tendon to injury and adverse events later in life.
The purpose of this study was to investigate the correlation between femoral intercondylar notch volume and the characteristics of femoral tunnels in anatomical single bundle anterior cruciate ligament (ACL) reconstruction.

Fifty-one subjects (24 male and 27 female median age 27 range 15-49), were included in this study. Anatomical single bundle ACL reconstruction was performed in all subjects using a trans-portal technique. Femoral tunnel length was measured intra-operatively. Three-dimensional computed tomography (3D-CT) was taken at pre and post-surgery. The intercondylar notch volume was calculated with a truncated-pyramid shape simulation using the pre-operative 3D-CT image. In the post-operative 3D-CT, the modified quadrant method was used to measure femoral ACL tunnel placement.

Femoral tunnel placement was 47.6 ± 10.5% in the high-low (proximal-distal) direction, and 22.6 ± 5.4% in the shallow-deep (anterior-posterior) direction. Femoral tunnel length was 35.3 ± 4.4cm. Femoral intercondylar notch volume was 8.6 ± 2.1cm
. A significant correlation was found between femoral intercondylar notch volume and high-low (proximal-distal) femoral tunnel placement (Pearson's coefficient correlation 0.469, p = 0.003).

Femoral ACL tunnel placement at a significantly lower level was found in knees with large femoral intercondylar notch volume in the trans-portal technique. For the clinical relevance, although the sample size of this study was limited, surgeons can create femoral ACL tunnel low (distal) in the notch where close to the anatomical ACL footprint in the knees with large femoral intercondylar notch volume.

III.
III.
(1) Report concomitant cartilage and meniscal injury at the time of anterior cruciate ligament reconstruction (ACLR), (2) evaluate the risk of aseptic revision ACLR during follow-up, and (3) evaluate the risk of aseptic ipsilateral reoperation during follow-up.

Using a United States integrated healthcare system's ACLR registry, patients who underwent primary isolated ACLR were identified (2010-2018). Multivariable Cox proportional-hazards regression was used to evaluate the risk of aseptic revision, with a secondary outcome evaluating ipsilateral aseptic reoperation. Outcomes were evaluated by time from injury to ACLR acute (< 3weeks), subacute (3weeks-3months), delayed (3-9months), and chronic (≥ 9months).

The final sample included 270 acute (< 3weeks), 5971 subacute (3weeks-3months), 5959 delayed (3-9months), and 3595 chronic (≥ 9months) ACLR. Medial meniscus [55.4% (1990/3595 chronic) vs 38.9% (105/270 acute)] and chondral injuries [40.0% (1437/3595 chronic) vs 24.8% (67/270 acute)] at the timeported for ACLR performed ≥ 9 months after the date of injury, a lower risk of revision and reoperation was observed following chronic ACLR relative to patients undergoing surgery in acute or subacute fashions. Level of evidence III.
The increasing number of implant-associated infections during trauma and orthopedic surgery caused by biofilm-forming Staphylococcus aureus in combination with an increasing resistance of conventional antibiotics requires new therapeutic strategies. One possibility could be testing for different therapeutic strategies with differently coated plates. Therefore, a clinically realistic model is required. The pig offers the best comparability to the human situation, thus it was chosen for this model. The present study characterizes a novel model of a standardized low-grade acute osteitis with bone defect in the femur in mini-pigs, which is stabilized by a titanium locking plate to enable further studies with various coatings.

A bone defect was performed on the femur of 7 Aachen mini-pigs and infected with Methicillin-resistant S. aureus (MRSA ATCC 33592). The defect zone was stabilized with a titanium plate. After 14days, a plate change, wound debridement and lavage were performed. Finally, after 42days, the el can be used in further clinical studies, to investigate various coated implants, bone healing, biofilm formation and immune response in implant-associated osteitis.
Various positions for pelvic floor muscle (PFM) relaxation are recommended during PFM training in physiotherapy clinics. To our knowledge, there is no study addressing the most effective position for PFM and abdominal muscle relaxation. Therefore, the current study aimed to investigate the effect of different relaxation positions on PFM and abdominal muscle functions in women with urinary incontinence (UI).

Sixty-seven women diagnosed with UI were enrolled in the study. The type, frequency, and amount of UI were assessed with the International Incontinence Questionnaire-Short Form and bladder diary. DNA Damage inhibitor Superficial electromyography was used to assess PFM and abdominal muscle functions during three relaxation positions modified butterfly pose (P1), modified child pose (P2), and modified deep squat with block (P3). Friedman variance analyses and Wilcoxon signed rank test with Bonferroni corrections were used to evaluate the difference between positions.

The most efficient position for PFM relaxation was P1 and followed by P3 and P2, respectively. The order was also the same for abdominal muscles (p < 0.001), P1 > P3 > P2. The rectus abdominis (RA) was the most affected muscle during PFM relaxation. The extent of relaxation of RA muscle increased as the extent of PFM relaxation increased (r = 0.298, p = 0.016). No difference was found between different types of UI during the same position in terms of PFM relaxation extents (p > 0.05).

Efficient PFM relaxation is maintained during positions recommended in physiotherapy clinics. The extent of PFM and abdominal muscle relaxation varies according to the positions.
Efficient PFM relaxation is maintained during positions recommended in physiotherapy clinics. The extent of PFM and abdominal muscle relaxation varies according to the positions.
Women with a symptomatic rectocele may undergo different trajectories depending on the specialty consulted. This survey aims to evaluate potential differences between colorectal surgeons and gynecologists concerning the management of a rectocele.

A web-based survey was sent to abdominal surgeons (CS group) and gynecologists (G group) asking about their perceived definition, diagnostic workup, multidisciplinary discussion (MDT) and surgical treatment of rectoceles. The answers of both groups were analyzed with the chi-square test or Fisher's exact test at p < 0.050.

A rectocele was defined as a prolapse of the posterior vaginal wall by 78% of the G and 41% of the CS group. All gynecologists and 49% of the CS group evaluated a rectocele clinically in dorsal decubitus, with 91% of gynecologists using a speculum and 65% using the Pelvic Organ Prolapse-Quantification (POP-Q) scoring system, compared to < 1/3 of colorectal surgeons. A digital rectal examination was performed by 90% of the CS group and 57% of the G group. A transvaginal ultrasound was only used by the G group, while anal manometry was opted for by the CS group (65%) and minimally by the G group (14%). In the G group, a posterior repair was the preferred surgical technique (78%), whereas 63% of the CS group preferred a rectopexy. Multidisciplinary discussions (MDT) were mostly organized ad hoc.

An availability bias is seen in different aspects of rectocele evaluation and treatment. Colorectal surgeons and gynecologists are acting based on their training and experience. Motivation for pelvic floor MDT starts with creating awareness of the availability bias.
An availability bias is seen in different aspects of rectocele evaluation and treatment. Colorectal surgeons and gynecologists are acting based on their training and experience. Motivation for pelvic floor MDT starts with creating awareness of the availability bias.
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