Westover Heights Clinic

Rehabilitation details after open, comminuted patellar fractures in older adults are seldom published; this case maps a full 20-week recovery using a structured, criteria-based program. A healthy 56-year-old woman was unable to bear weight after a fall, with anterior knee wounds and imaging that showed an open, comminuted left-patella fracture. Six weeks postoperatively, she reported resting pain of 4/5 on the Verbal Rating Scale (VRS) and demonstrated only 40° active range of motion (AROM). The injury was classified as a Type I/II open patellar fracture. It was stabilized with open reduction and internal fixation (ORIF) with tension-band wiring plus screws. Beginning at postoperative Week 6, the patient followed a five-phase outpatient protocol progressing from immobilized isometrics to closed kinetic chain (CKC) functional drills over ≈42 visits. By Week 20, active flexion increased to 129°, quadriceps strength to 4+/5, and the Lower Extremity Functional Scale (LEFS) score to 50/80. Mid-patella circumference fell 1.8 cm, serial radiographs confirmed union, and resting pain fell to 2/5, although intermittent stiffness and mild activity-related aching persisted. A staged, adaptable rehabilitation plan can yield substantial gains in mobility, strength, and function within five months of an ORIF procedure for complex patellar fractures. Daily low-load motion and progressive closed-chain loading appear key, and patients should be advised that modest pain and strength asymmetry may linger beyond 20 weeks, warranting continued follow-up.

Coal mining disrupts the stress equilibrium of the surrounding rock mass, and the rock mass cracks as a result of the changes in the stress field, releasing strain energy and causing microseismic events. Monitoring seismicitiy during coal mining is critical for ensuring safe production and preventing geological disasters. In this study, we deployed 29 surface seismic nodes above an underground coal mine in the Yulin region of Shaanxi Province, China, to monitor the mining operation for 665 hours. A large number of microseismic events have been detected from continuous monitoring data, and analyzed using event clustering, source location, and mechanism estimate. The results show that (1) the frequency and intensity of microseismic events are related to underground mining working conditions; (2) the temporal and spatial locations of the microseismic sources may be utilized for real-time tracking the location of the underground coal mining face; and (3) three rupture mechanisms of tension rupture, implosion rupture, and shear rupture reflect the triggering mechanisms of the coal pillar failure, roof breakage and movement and fault slip. 

Introduction Focus HerpeSelect type specific ELISA is the most commonly used commercial assay for detection of HSV-1 and HSV-2 serostatus. We evaluated the accuracy of the HerpeSelect ELISA in patients who were seeking to confirm their serostatus with the University of Washington Western blot (UW WB). Methods We reviewed charts of all persons who were tested for HSV antibody at the Westover Heights Clinic in Portland, OR between July 2010 and April 2014, and who were tested with both HerpeSelect ELISA and UW WB. Results We evaluated test results on 442 persons, of whom 49% were women, with a median age of 36 (range 18–68). Overall, by UW WB, 61 persons tested HSV-2 seropositive only, 81 tested HSV-1 and HSV-2 seropositive, 170 were HSV-1 seropositive only, and 130 were seronegative for an overall HSV-2 prevalence of 32% and HSV-1 prevalence of 57%. Among 199 persons who tested HSV-2 positive on HerpeSelect ELISA according to manufacturer’s cutoff of index value ³1.1, 58% confirmed by the UW WB. Among 131 persons with an index value 1.1–2.9, 50% confirmed; among 37 persons with an index value ≥3, 81% confirmed with the UW WB (c 2 test, p = 0.0007). The risk of false positive HSV-2 results was similar among persons with and without HSV-1 antibody (44% vs 39%, c 2 test, p = 0.41). Among 156 persons who tested HSV-2 negative by ELISA, 2% were found UW WB positive. Among 143 persons who tested HSV-1 positive by ELISA, 133 (92%) confirmed by the UW WB. However, an additional 49 persons were HSV-1 seropositive by UW WB but negative by the ELISA, for a negative predictive value of 72%. Conclusion HerpeSelect ELISA has poor positive predictive value for HSV-2 and poor negative predictive value for HSV-1 in clinical practice. More accurate commercially available tests are needed for HSV antibody diagnostics. Disclosure of interest statement No pharmaceutical grants were received for this study.

To evaluate the efficacy of a 1-day course of valacyclovir in reducing the duration and severity of genital herpes recurrences and to measure the frequency of viral shedding episodes subsequent to antiviral therapy. In an open-label pilot study, patients with recurrent genital herpes simplex virus 2 (HSV-2) infection were given a 1-day course of valacyclovir (2000 mg given by mouth twice daily) to be taken at the first sign of recurrence or prodrome. Participants maintained diaries of signs and symptoms and collected genital swabs for viral culture while lesions persisted and HSV DNA PCR for 14 days after initiating treatment. Ninety (78%; 41 men, 49 women) of the 115 enrolled persons experienced either a lesional recurrence or prodrome. Seventy-seven (86%) participants developed lesions; 4 (5%) participants experienced a second lesional recurrence during the 14-day study period. The median lesion duration was 5 days, episode duration was 5 days, and pain duration was 3 days. Viral shedding was detected in 60 persons by PCR and 31 persons by culture. Shedding detected by culture lasted for a median of 2 days, and shedding detected by PCR lasted for a median of 3 days. Of 60 participants with viral shedding, 14 (23%) had an additional shedding episode after their initial lesion healed, lasting for a median of 2 days. A 1-day course of valacyclovir may be a convenient treatment for recurrent genital herpes and comparative trials are warranted.

The clinical spectrum of herpes simplex virus (HSV) infections, ranging from asymptomatic to frequently distressing outbreaks, suggests that there may be immunologic determinants of disease severity that are associated with human leukocyte antigen (HLA) expression. A controlled, prospective study identified several major histocompatibility complex (MHC) class I and II antigens whose frequencies are associated with HSV-2 infection or with frequent symptomatic genital recurrences. Previous studies were hampered by the inability to serologically identify patients with asymptomatic HSV-2 infection. Clinical evaluation and Western blot assay were used to identify 3 subject cohorts: 1 with no prior HSV infections, 1 with HSV-2 antibodies but no recognized symptoms, and 1 with HSV-2 antibodies and frequent genital recurrences. Statistical comparisons of HLA frequencies among these cohorts showed associations of HLA-B27 and -Cw2 with symptomatic disease. Also, HLA-Cw4 was significantly associated with HSV-2 infection. These associations indicate that immunologic factors linked to the MHC influence the risk of HSV-2 infection and disease expression.