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PURPOSE: To quantify cumulative radiation exposure in patients undergoing arthroscopic hip preservation surgery and occupational exposure to operating room (OR) personnel during such surgery; a secondary objective of this study was to identify factors affecting radiation exposure in patients undergoing hip arthroscopy. METHODS: Radiation exposure from all preoperative and intraoperative imaging studies was determined for 52 patients undergoing hip arthroscopy. Cumulative and effective radiation doses were calculated and correlated with pathology and body mass index (BMI). Badge dosimeters were worn by OR personnel to measure cumulative occupational exposure. A highly sensitive portable ion chamber was used to evaluate the radiation scatter during surgery performed on a high-BMI patient and a low-BMI patient to reflect a "worst-case scenario" and "best-case scenario," respectively. RESULTS: Forty-three patients underwent procedures for femoroacetabular impingement (FAI) and 9 underwent procedures for soft-tissue pathologies (ST). The median cumulative exposure was 8.6 mGy and 5.0 mGy for FAI patients and ST patients, respectively (P = .01). The cumulative effective radiation dose was 490 mrem and 350 mrem for FAI patients and ST patients, respectively (P = .47). BMI significantly correlated with cumulative exposure (P = .0004) and trended toward significance with cumulative effective dose (P = .073). OR staff cumulative occupational exposure was low (9 mrem for the surgeon). Ion chamber data showed that increasing patient BMI resulted in increased occupational exposure. CONCLUSIONS: The median cumulative effective radiation dose to patients undergoing arthroscopic hip preservation surgery is 490 mrem and results in an excess lifetime risk of death from cancer of 0.025%. Greater BMI correlates with increased cumulative radiation exposure and may increase risk to OR personnel. Occupational exposure to the surgical team from hip arthroscopy ranges from 7 to 9 mrem per 50 hip arthroscopies (+0.0005% excess lifetime risk of death from cancer). LEVEL OF EVIDENCE: Level IV, diagnostic.

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BACKGROUND: Distal biceps brachii tendon repairs performed with a tension slide technique using a cortical button (CB) and interference screw are stronger than those based on suture fixation through bone tunnels (BTs) in biomechanical studies. However, clinical comparison of these 2 techniques is lacking in the literature. PURPOSE: To perform a clinical comparison of the single-incision CB and double-incision BT techniques. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: Distal biceps tendon ruptures repaired through either the single-incision CB or double-incision BT technique were retrospectively identified at a single institution. Patients>1 year out from surgery were assessed for range of motion, strength, and complications, and they completed a DASH questionnaire (Disabilities of the Arm, Shoulder, and Hand). RESULTS: Patients in the CB group (n=20) were older (52±9.5 vs 43.7±8.7 years; P=.008), had a shorter interval from surgery to evaluation (17.7±5 vs 30.8±16.5 months; P=.001), and were less likely to smoke (0% vs 28.5%; P=.02) compared with the BT patients (n=21). DASH scores were similar between groups (4.46±4.4 [CB] vs 5.7±7.5 [BT]; P=.65). Multivariate analysis revealed no differences in range of motion or strength between groups. More CB patients (30%; n=6) experienced a complication compared with those in the BT group (4.8%; n=1) (P=.04), and these complications were predominantly paresthesias of the superficial radial nerve that did not resolve. There were no reoperations or repair failures in either group. CONCLUSION: Both the single-incision CB and double-incision BT techniques provided excellent clinical results. Complications were more common in the single-incision CB group and most commonly involved paresthesias of the superficial radial nerve.

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BACKGROUND: Distal biceps brachii tendon repairs performed by a "tension slide technique" with a cortical button and interference screw (CB) are stronger than repairs by suture anchor (SA) techniques in biomechanical studies. However, clinical comparison of the 2 techniques is lacking in the literature. METHODS: Distal biceps tendon ruptures repaired with either a CB or SA technique through a single incision were identified from 2008 to 2013 at a single institution. Patients more than a year out from surgery completed a Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire. In addition, patients were assessed for range of motion, strength, and complications. All assessments were performed by individuals blinded to the surgical technique. Strength and motion values from the operative extremity minus the nonoperative arm values yielded differential values that were averaged and used to compare treatment groups. RESULTS: The CB (n = 20) and SA (n = 17) groups had similar demographics, except for the time from the surgery to evaluation (18 ± 5 vs 32 ± 15 months, respectively; P = .007). Range of motion differed slightly between the groups. The CB group demonstrated better pronation (0° ± 5° vs -4° ± 10°; P < .05), and the SA group demonstrated better flexion (2° ± 0° vs -3° ± 5°; P < .05) and supination (-2° ± 5° vs -7° ± 12°; P < .05). Strength did not differ significantly between the groups. DASH scores did not significantly differ between the groups with univariate analysis, but multivariate analysis demonstrated slightly better DASH scores with the CB technique (4.5 ± 4.4 vs 10.3 ± 14.9; P < .0009). Complication rates were similar between groups (CB 30%, SA 35%; P > .05). CONCLUSION: CB and SA techniques provide good clinical results with similar complication rates.

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Ranolazine is a novel anti-anginal agent acting through pharmacologic mechanism of inhibition of the late phase of the inward sodium current. In addition, it is a potent inhibitor of rapid delayed rectifier potassium currents, leading to prolongation of the QT interval. However, ranolazine has not yet described to be associated with Torsade de Pointes despite its QT-prolonging effect. In this case report, we describe a patient on ranolazine who developed Torsade de Pointes and discuss about the potential contribution of ranolazine to the development of Torsade de Pointes.

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Ulnar impaction is a common condition encountered by hand surgeons. Historically, treatment of this condition has been with wafer resection of the distal ulna, by either open or arthroscopic means, or diaphyseal ulnar shortening osteotomy; however, both of these have the potential for prolonged recovery or a need for additional procedures. Wafer procedures, whether done by open or arthroscopic techniques, can result in hemarthrosis, and diaphyseal osteotomies can require hardware removal. Recently, Slade and Gillon described a technique of ulnar shortening in the osteochondral region of the ulnar head, which offers advantages over previously used techniques. The purpose of this manuscript is to describe this technique, as well as pearls and pitfalls associated with the procedure. To more accurately describe the location of the osteotomy, we have changed the name of the procedure from Dr. Slade's original description to distal metaphyseal ulnar-shortening osteotomy.

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Complete colonoscopy for cancer screening requires cecal intubation. Failure to reach and examine the cecum may result in missed right colon pathology. We developed and validated a novel classification scheme for the endoscopic appearance of the normal appendiceal orifice (AO). We analyzed 1,456 AO images and grouped them into four categories based on distinguishing features: "diverticuloid," "umbilicoid," "crescent," and "linear." An expert panel classified the images and modified these categories, combining crescent and linear categories into "curvilinear." A 100-image subset was classified twice by a validation cohort consisting of gastroenterology faculty and fellows. Inter-observer agreement among the expert panel, and intra- and inter-observer agreement among the validation cohort were analyzed using Fleiss' kappa statistic. The distribution of AO images was 67% curvilinear, 19% umbilicoid, and 10% diverticuloid; 85 images (4%) were not classifiable. There was substantial inter-observer agreement among the expert panel (κ, 0.72). Inter-observer agreement among the validation cohort was moderate (κ, 0.53 and 0.55 for the first and second viewing, respectively). Intra-observer κ values among the validation cohort were 0.69 for the overall classification, 0.65 for diverticuloid, 0.70 for umbilicoid, and 0.70 for curvilinear, indicating substantial agreement. This simple, validated classification scheme for the endoscopic appearance of the normal AO can be used both as a research and clinical tool to measure endoscopic quality, improve cecal examination, and document successful cecal intubation.

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We present what is to our knowledge the first demonstration of a potentially low-cost refractive-index sensor based on UV processing. A channel waveguide and a Bragg grating are defined in a single UV processing step, resulting in a buried structure with a well-defined grating period. A subsequent wet etch process located over the Bragg grating opens a sensing window in the device and reveals the grating structure. Sensitivity of as much as 5 x 10(-6) was inferred from our device.

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The purpose of this study was to determine the effects of carbohydrate refeeding on intermittent sprint exercise, blood lactate response, and mood following a typical weight-reduction program practiced by college wrestlers. Fifteen collegiate wrestlers from the University of Northern Iowa completed 3 trials of intermittent arm cranking and a mood inventory prior to weigh-ins (baseline), after weigh-ins, and 1 hour postconsumption of either 1.5 g carbohydrate (CHO)/kg body mass carbohydrate beverage (25% solution) or placebo taken within 1 hour after weigh-ins. Blood lactate responses were determined with each trial. Repeated measures analysis of variance indicated no significant interaction between group and trial for total work (p = 0.08), blood lactate (p = 0.29), positive mood (p = 0.49), or negative mood (p = 0.78). Simple effects analysis indicated a significant difference in lactate response between trials (p = 0.002); however, no difference for work (p = 0.75), positive mood (p = 0.13), or negative mood (p = 0.08). The results of this study suggest that intermittent sprint exercise, blood lactate response, and mood were not positively affected by ingestion of CHOs following an acute weight-reduction period.

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The purpose of this study was twofold: (1) to identify attributes of athletic training programs that have been accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) as they relate to outcomes of their students on the National Athletic Training Association Board of Certification (NATABOC) examination and (2) to determine the most effective curriculum in preparing candidates for the examination. For all subjects, the following survey information was assessed: the seven domains (competencies), number of clinical rotation sites, grade point average requirement, faculty responsibilities, faculty terminal degrees, faculty K-12 experience, association with allied health schools, capstone course availability, and course examination similarities. Fifty-four subjects, representing 60% of all of the program directors of CAAHEP accredited athletic training programs, responded in this study. Data were analyzed using a general linear model procedure and regression analyses. Even domains of athletic training, variety of rotation sites, clinical responsibility of faculty, faculty terminal degrees, and faculty K-12 school experience significantly affected the passing rate of first time certification examinees. Grade point average requirement, allied health school association, course examination format, and capstone course were not related significantly to the passing rate of first-time certification examinees. The most effective curricular model included the seven domains of athletic training, faculty clinical responsibilities, and faculty K-12 work experience as related to the passing rate. Emphasizing the domains of athletic training (competencies), having a variety of rotation sites, separating clinical and academic responsibilities for faculty, and having faculty with terminal degrees and less public school experience increase the passing rate of first-time NATABOC examinees. The most effective curricular model in affecting passing rate, according to this study, includes emphasizing the seven domains of athletic training (competencies), separating clinical and academic responsibilities of faculty, and not focusing on hiring faculty with K-12 work experience. Although this article focuses primarily on athletic training education, we believe that this study can be used as a model to evaluate educational programs in other allied health, competency-based educational programs.

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