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Presents information about the people, geography, culture, history, government, and economy of Mexico.

Each person should be able to control his own body by deciding if and when he will take medication. No one should be forced by the government to ingest a drug each time he takes a drink of water or uses water in his cooking.

Vaccination against 5 prominent meningococcal serogroups (A/B/C/W/Y) is necessary for broad disease protection. We report immunopersistence through 4 years after a 2-dose (6-month interval) pentavalent MenABCWY primary vaccine series and safety and immunogenicity of a booster administered 4 years after primary vaccination. This randomized, active-controlled, observer-blinded study was conducted in the United States and Europe. In stage 1, healthy MenACWY vaccine-naive or -experienced 10- to 25-year-olds were randomized 1:2 to receive MenABCWY and placebo or MenB-fHbp and MenACWY-CRM. Eligible participants were randomly selected to participate in stage 2, which was an open-label immunopersistence and booster extension. Immunogenicity was assessed through serum bactericidal antibody using human complement (hSBA) assays with serogroups A/C/W/Y (MenA/C/W/Y) and 4 primary serogroup B (MenB) test strains. Immunogenicity endpoints included hSBA seroprotection rates through 48 months after primary vaccination and 1 month after the booster. Safety endpoints included booster reactogenicity events and adverse events (AEs). Of 1379 eligible participants, 353 entered stage 2; 242 completed the 48-month blood draw after primary vaccination and 240 completed the booster vaccination phase. MenA/C/W/Y seroprotection rates remained high for 4 years following a 2-dose MenABCWY primary series (MenACWY-naive, 62.0 %–100.0 %; MenACWY-experienced, 98.7 %–100.0 %) and trended higher than those after a single MenACWY-CRM dose (MenACWY-naive, 38.1 %–95.2 %; MenACWY-experienced, 89.7 %–100.0 %). Corresponding seroprotection rates against MenB remained stable and generally higher than baseline (MenABCWY, 18.2 %–36.6 %; MenB-fHbp, 16.2 %–31.9 % across strains). Following a booster, seroprotection rates against all 5 serogroups were ≥ 93.8 % across groups. Most booster dose reactogenicity events were mild or moderate in severity, and AEs were infrequent. Immune responses remained high for MenA/C/W/Y and above baseline for MenB through 4 years after the MenABCWY primary series, with robust responses for all 5 serogroups observed following a booster. The MenABCWY booster had an acceptable safety and tolerability profile consistent with the primary series. NCT03135834. •Broad protection against meningococcal disease requires serogroup ABCWY vaccination•Immunopersistence up to 4y post MenABCWY primary and booster responses are reported•Seroprotection stayed high (ACWY) and largely >baseline (B) for 4y postvaccination•A MenABCWY booster at 4y induced anamnestic immune responses for all 5 serogroups•The booster had acceptable safety and tolerability, similar to the primary series

Background: Particulated juvenile articular cartilage (PJAC) implantation has demonstrated promising early results in the treatment of symptomatic articular cartilage defects of the patella. However, some uncertainty exists regarding the stability of this cell-based technique in lesions that are not well contained or shouldered. Purpose: To compare clinical and magnetic resonance imaging (MRI) outcomes of PJAC treatment in shouldered versus unshouldered full-thickness cartilage defects of the patella. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review of prospectively collected data from an institutional knee registry was conducted to identify patients treated with PJAC for full-thickness symptomatic patellar cartilage lesion between January 2009 and August 2017. Cartilage defects were graded arthroscopically according to the Outerbridge classification and characterized as shouldered or unshouldered. For the primary outcome, postoperative MRI studies were read by a musculoskeletal fellowship-trained radiologist who characterized the percentage of fill based on both coronal and sagittal images. Patient-reported outcome measures (PROMs) were obtained at baseline and 2-year follow-up. MRI and PROM results were compared between the shouldered and unshouldered cohorts. Results: A total of 64 knees in 60 patients (mean age, 26.3 ± 7.6 years) were identified, of which 62 (97%) knees underwent a concomitant patellar stabilization or offloading procedure. There were 32 (50%) shouldered and 32 (50%) unshouldered defects. On postoperative MRI, 68.8% of shouldered lesions demonstrated 67% to 100% fill, compared with 59.4% of unshouldered lesions; 12.5% of shouldered lesions and 15.6% of unshouldered lesions demonstrated 34% to 66% fill; and 18.8% of shouldered lesions and 25.0% of unshouldered lesions demonstrated 0% to 33% fill (P = .604). At 2 years, significant improvements were observed in Knee Injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QOL) (23.1 to 65.3; P < .001), International Knee Documentation Committee (IKDC) (41.2 to 76.0; P < .001), KOOS Physical Function Shortform (PS) (34.8 to 13.9; P < .001), Kujala (52.0 to 87.5; P < .001), 12-Item Short Form Survey (SF-12) Physical Health (39.5 to 51.5; P < .001), Veterans Rand 12 Item Health Survey (VR-12) Physical Health (40.7 to 52.8; P < .001), Veterans Rand 6D (0.66 to 0.79; P < .001), SF-12 Mental Health (48.9 to 53.4; P = .015), and VR-12 Mental Health (49.4 to 54.0; P = .019) values. No significant change was observed in Pediatric Functional Activity Brief Scale score (9.1 to 10.3; P = .384). All PROMs were equivalent between shouldered and unshouldered defects at the 2-year follow-up (P = .318-.980). There was a greater improvement in both KOOS PS (27.2 vs 10.7; P = .015) and Kujala (44.3 vs 26.9; P = .039) values from baseline to the 2-year follow-up in the shouldered group. Conclusion: PJAC implantation with concomitant patellar stabilization led to significantly improved PROMs for both shouldered and unshouldered patellar cartilage lesions over time. Additionally, minimal differences were observed between shouldered and unshouldered defects treated with PJAC at the 2-year follow-up.

Lynch syndrome (LS) is a hereditary cancer syndrome that conveys a high risk of colorectal cancer (CRC). Guidelines recommend colonoscopy every 1 to 2 years. There is limited information about screening compliance in this high-risk group. Data about cancer screening behaviors were obtained from subjects recruited through four US cancer genetics clinics. The main outcome was prevalence of appropriate CRC surveillance for LS. A total of 181 individuals had a family history that met the Amsterdam criteria for LS (n=154) and/or had an identified mutation in a mismatch repair (MMR) gene (n=105). Of these 181 individuals, 131 (73%) had appropriate LS surveillance with colonoscopies at least every 2 years for their age >25 years. Of those with inadequate surveillance, 26/49 (53%) had colonoscopies at 3- to 5-year intervals. There were no significant differences in health-care setting, perceived risk of CRC, or compliance with screening for other cancers. Rates of appropriate surveillance were higher among individuals who had been referred for genetic evaluation for LS compared with those who had not (109/136 (80%) vs. 23/45 (51%), respectively, P=0.0004). In multivariate analysis, personal history of CRC (odds ratio (OR) 2.81), having a first-degree relative with CRC at age <50 years (OR 2.61), and having undergone a genetic evaluation (OR 4.62) were associated with appropriate CRC surveillance for LS. The time between colonoscopic exams in patients with LS is often longer than recommended by current guidelines and may place them at risk for interval cancers. Recognizing clinical features of LS and providing genetic counseling, evaluation, and intensive surveillance may improve cancer prevention for those at the highest risk for CRC.

من ضفاف نهر دجلة إلى مدينة أور السومرية بحث علماء الآثار فى العراق لسنين طويلة عن أدلة لتاريخ شعب العراق اقرأ عن المئذنة الحلزونية فى سامراء انظر إلى الطرز المعمارية الرائعة والتقويم المكتوب بالخط المسمارى التي ابتكرها الفنانون الأشوريون فى كاليخو \"نيمرود\" تعرف كيف ساعدت الكنوز القديمة علماء الآثار اليوم فى جمع تاريخ ماضي العراق كل قطعة فنية اكتشفت قدمت إلينا فهما جديدا للعراق القديم أنها مهمة ناشيونال جيوجرافيك لاستكشاف العالم وكل ما فيه لتقديم آخر الاكتشافات وأحدث المعلومات إلى أكبر عدد من الشباب فى جميع أنحاء العالم فهذه السلسلة تقدم لقرائها الشباب أحدث أساليب البحث والتنقيب والاكتشافات الحالية والطريقة التي بها تلقي تلك الاكتشافات مزيدا من الضوء على واحدة من أعرق حضارات العالم.

Objectives: It is not currently understood which subset of patients with recurrent patellofemoral instability require concomitant bony realignment procedures in addition to a soft tissue stabilization. Additionally, the optimal timing of surgical intervention is not well defined by current literature and can be dictated by the skeletal maturity of a patient. If the patient’s complete pathology is not addressed at their primary procedure, there can be a high risk of recurrent instability necessitating revision surgery. It is not known if the outcomes of medial patellofemoral reconstruction with concomitant tibial tubercle osteotomy (MPFL+TTO) performed as a revision procedure equate the outcomes of MPFL+TTO performed in the primary setting. This study compares patients who underwent primary MPFL+TTO versus those who underwent the same procedure in the revision setting. Methods: Patients who underwent a MPFL+TTO from March 2014 to December 2018 were identified from an institutional patellofemoral registry. Patients were separated into two groups, those undergoing a primary MPFL+TTO and those undergoing a MPFL+TTO after a previously failed surgical attempt for patellar stabilization. Baseline demographic, radiographic, and knee-specific patient reported outcome measures (PROMs) including KOOS QOL, Pedi-Fabs, IKDC, KOOS-PS, and Kujala were collected prior to surgery and at 1- and 2-years following surgical intervention. Return to sport (RTS) rates and recurrent instability events were also collected. Results: 92 knees (84 patients) were included; 59 in the primary group and 33 in the revision group. No differences were identified between the groups with respect to sex (85% vs. 82%, p=0.715), age (23.7 vs. 22.5, p=0.468), BMI (26.3 vs 24.5, p=0.144), TT-TG (20.3 vs 19.3, p=0.238), or patella alta (33% vs 19%, p=0.354). Previous procedures in the revision cohort included 12 MPFL reconstructions, 3 tibial tubercle transfers, 16 lateral releases, 9 imbrications/reefings/plications, 7 loose body removals and 9 chondroplasties. 53 (90%) patients in the primary group and 29 (88%) patients in the revision group had a minimum of 2-year follow-up. There was no difference between the groups for recurrent dislocation (4% vs 0%, p=0.547), recurrent subluxation (9% vs 0%, p=0.162) and RTS (88% vs 83%, p=0.713). In regard to RTS, 79% of the primary surgery group and 71% of the revision group returned at an equal or higher level (p=0.461). At baseline, the primary group had a higher IKDC (42.0 vs 34.7, p=0.049). At 2-year follow-up both groups had significant improvements from baseline in all PROMs, except Pedi-FABS which had no change. There was no difference between groups at 2-year follow-up in KOOS-QoL (60.8 vs 51.1, p=0.186), Pedi-FABS (8.0 vs 7.3, p=0.796), IKDC (75.2 vs 67.7, p=0.206), KOOS-PS (15.8 vs 20.9, p=0.379), and Kujala (86.5 vs 77.9, p=0.143). Conclusions: Management of patellofemoral instability is complex. The optimal timing of surgical intervention and whether a concomitant bony realignment procedure is indicated has yet to be elucidated. This study demonstrates that primary MPFL+TTO versus revision MPFL+TTO have comparable objective and subjective outcomes at short term follow-up. Ongoing data collection for this patient cohort will determine whether these results are sustained at long term follow-up.