Adhesive capsulitis of the shoulder: pain intensity and distribution

Purpose Papers regarding adhesive capsulitis (AC) of the shoulder focused on etiology, epidemiology, diagnosis, and treatment; until now, information on shoulder pain characteristics is still scarce. Our aim was to analyze pain intensity and distribution in patients with AC. Methods The study group was composed of 278 (133M–145F) consecutive patients with AC. After diagnosis, shoulder pain distribution was assessed through an upper limb pain map and pain intensity through a visual analog scale. Patients were distinguished on the basis of gender, age, time elapsed from onset of symptoms, and severity of functional limitation. Data were submitted to statistical analysis. Results Intensity of shoulder pain caused by AC was higher in females (p 0.05). Conclusion Shoulder pain due to AC may be influenced by gender and severity of functional limitation. AC pain distribution principally involves anterior aspect of the shoulder with downward extension of the arm until its distal third

Methodology for the Industry Estimates in the 2007 R&D Satellite Account

This paper is part of a series that provides the details behind the Bureau of Economic Analysis's (BEA) satellite account on research and development (R&D) activity. It describes the data and experimental methodology used to create the GDP-by-Industry component of the satellite account for thirteen R&D-intensive industries and an aggregation of all other for-profit industries.

Impact of the COVID-19 pandemic on the Internet latency: A large-scale study

The COVID-19 pandemic dramatically changed the way of living of billions of people in a very short time frame. In this paper, we evaluate the impact on the Internet latency caused by the increased amount of human activities that are carried out on-line. The study focuses on Italy, which experienced significant restrictions imposed by local authorities, but results about Spain, France, Germany, Sweden, and the whole of Europe are also included. The analysis of a large set of measurements shows that the impact on the network can be significant, especially in terms of increased variability of latency. In Italy we observed that the standard deviation of the average additional delay – the additional time with respect to the minimum delay of the paths in the region – during lockdown is ∼3−4 times as much as the value before the pandemic. Similarly, in Italy, packet loss is ∼2−3 times as much as before the pandemic. The impact is not negligible also for the other countries and for the whole of Europe, but with different levels and distinct patterns

The 2-scope technique for rotator cuff surgery: are 2 scopes better than 1?

The arthroscopic treatment of rotator cuff tear involves 2 distinct phases: intra-articular and subacromial. We present the 2-scope technique with the aim to simultaneously perform these phases, entrusting them to 2 experienced surgeons, and to obtain possible benefits compared with the classic 1-scope technique. Better nosology of the lesion and a more accurate evaluation of suture passer action (equidistance of the sutures and avoidance of degenerated articular-side tendon areas) represent benefits of this technique. In contrast, the 2-scope technique needs an additional lateral portal and could give rise to an erroneous distribution of costs and surgeons

High rate of return to crossfit training after arthroscopic management of rotator cuff tear

Background: CrossFit is a conditioning program involving high-intensity exercises performed in rapid, successive repetitions with limited or no recovery time. The shoulder girdle is highly involved in most basic CrossFit training programs. Hypothesis: CrossFit athletes affected by rotator cuff tear may be successfully treated with arthroscopic surgery with a high rate of early return to CrossFit activities. Study Design: Case series; Level of evidence, 4. Methods: Included in this study were athletes participating regularly in CrossFit training who had undergone arthroscopic rotator cuff repair. At a minimum follow-up of 24 months, we compared pre- and postoperative clinical outcome scores, including the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and a visual analog scale (VAS) for pain, as well as imaging results. Participants completed a return-to-CrossFit questionnaire at the final follow-up, and changes in laboratory blood test results from preoperative to final follow-up were evaluated for association with outcomes and questionnaire responses. Results: A total of 22 CrossFit athletes (23 shoulders) completed the 24-month follow-up evaluation. Each athlete had undergone single-row rotator cuff tendon repair with additional procedures such as biceps tenodesis. All (100%) athletes returned to intensive CrossFit training at a mean 8.7 ± 3.4 months after surgery (range, 6-15 months). CS and ASES scores improved between preoperative and final follow-up from 73 to 92 (P =.037) and from 71 to 95 (P =.035), respectively; VAS pain score improved from 7.2 preoperatively to 0.8 at final follow-up (P <.001). Imaging evaluation of the repaired rotator cuff tendon showed complete healing in 18 cases (78%) and incomplete healing in 5 (22%). Of the 5 patients with incomplete healing, 2 had lower clinical scores at follow-up. In their questionnaire responses, 13 (59%) participants indicated return to a higher level of fitness, 7 (32%) returned to the same level, and 2 (9%) returned to a lower level. We found a significant association between patients who indicated return to a higher level of CrossFit fitness and higher levels of creatine phosphokinase and testosterone from preoperative to final follow-up (P =.029 and.023). Conclusion: Arthroscopic repair of rotator cuff tendons led to 100% return to CrossFit participation at approximately 9 months of follow-up. All athletes had returned to sport by the final follow-up. Nevertheless, 2 patients reported a lower level of performance and showed scapular dyskinesis

Implicating factors in the increase in cases of central precocious puberty (CPP) during the COVID-19 pandemic: Experience of a tertiary centre of pediatric endocrinology and review of the literature

Sexual development is a complex mechanism activated by the hypothalamic-pituitary-gonadal axis. Over the last one hundred years there has been a decline in the age at puberty onset in industrialised countries. Some Italian studies showed an increase in diagnoses of Central Precocious Puberty (CPP) during the COVID-19 pandemic. It is thus supposed that in this period there was an increased impact of factors that can influence pubertal development. Our retrospective monocentric study aimed to confirm the existence of this phenomenon and analysed possible related factors. We retrospectively evaluated clinical, laboratory, radiological and ultrasound (US) data of 154 girls referred to our Tertiary Centre of Paediatric Endocrinology from January 2019 to April 2021 for different forms of Precocious Puberty. We subdivided the cases into subgroups according to the final diagnosis: CPP, Early Puberty (EP), isolated thelarche and isolated pubarche. The observation period was subdivided into: Period 1, before lockdown (1 January 2019 - 8 March 2020) and Period 2, lockdown and the following months (9 March 2020 - 30 April 2021). Period 2 was further divided into "restrictive lockdown period" (Period 2.1) (March 2020 - 14 June 2020, in which the schools were closed) and "less restrictive lockdown period" (Period 2.2) (15 June 2020 - 30 April 2021). We analysed data regarding the use of electronic devices before and during lockdown in a group of girls with CPP diagnosed in Period 2 and we compared the data with that of a control group. Our data show an increase in the number of new diagnoses of CPP during lockdown and in the following months, compared with the previous period. We also detected a higher use of PCs and smartphones in girls with CPP diagnosed in Period 2, compared with the control group. The percentage of the presence of endometrial rhyme detected during the pelvic ultrasound was higher in girls with CPP in Period 2, compared with the previous period. Based on our data we assume there was an environmental effect on pubertal timing that calls our attention to factors such as food, use of electronic devices and stress. We will need further studies to better understand this data

The impact of COVID-19 on shoulder and elbow trauma: an Italian survey

Background: Because of the rapid spread of COVID-19, on March 8, 2020 Italy became a “protected area”: people were told not to leave their homes unless it was essential. The aim of this study was to evaluate the activity of our trauma center, relative to shoulder and elbow, in the 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019 to weigh the impact of COVID-19 on shoulder and elbow trauma. Materials and methods: Patients managed in our trauma center between March 8, 2020, and April 8, 2020 (COVID period), for shoulder and elbow trauma were retrospectively included and compared to patients admitted in the same period of 2019 (no-COVID period). Clinical records of all participants were examined to obtain information regarding age, sex, mechanism of injury, and diagnosis. Results: During the no-COVID period, 133 patients were admitted for a shoulder or elbow trauma; in the COVID period, there were 47 patients (65% less first aid). In the no-COVID and COVID period, patients with shoulder contusion totaled 60 (14.78% of all; male [M]: 34; female [F]: 26; mean age 51.8 years, range 18-88) and 11 (12.09% of all contusions; M: 7, F: 4; mean age 43 years, range 24-60), respectively. In the no-COVID period, 27 fractures (9.34% of all fractures) involved the shoulder, whereas 18 fractures (8.69%) were registered in the COVID period. In the no-COVID period, 14 elbow fractures were treated (4.8% of all fractures), compared with 4 in the COVID period. In the no-COVID and COVID periods, 6 patients (M: 5, F: 1; mean age 42 years, range 21-64) and 2 patients (M: 1, F: 1; mean age 29.5 years, range 24-35) reported having a feeling of momentary post-traumatic shoulder instability, and 0 and 1 patients (M: 1, F: 0; age 56 years), respectively, reported similar symptoms at the elbow. Finally, first or recurrent dislocations in the no-COVID period were 10, and in the COVID period, 7; elbow dislocations in the no-COVID period were 2, and in the COVID period, there were 3. Conclusions: During the COVID period, we provided a reduced number of health services, especially for patients with low-energy trauma and for those who underwent sports and traffic accidents. However, during the COVID period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making it more difficult to manage the hospital wards that are partly occupied by COVID-19 patients

AC joint osteoarthritis: the role of genetics. An MRI evaluation of asymptomatic elderly twins

Purpose: The anatomy of the articular surfaces has historically identified as major responsible for acromioclavicular joint osteoarthritis (ACJO). On the other side, the almost 100% prevalence of ACJO in subjects over 50 years old seems to suggest a multifactorial etiology. We compared ACJO between asymptomatic elderly monozygotic (MZ) and dizygotic (DZ) twins to investigate the influence of genetics and environmental factors. Materials and Methods: Thirty pairs of twins [15MZ-15DZ; mean age (SD): 63.70 (3.31); range: 53–72] were retrospectively enrolled. ACJO was evaluated on MRI through a 4-grade severity scale and ACJ configuration was assessed. Information regarding work activity were obtained. Heritability index was calculated. Results: The intraclass correlation coefficient (ICC) value of 0.868 (95% CI; 0.798 to 0.917). An ICC values of 0.889 (95% CI; 0.798 to 0.944) and 0.843 (95% CI, 0.712 to 0.920) were found in the MZ and DZ groups, respectively. The polychoric correlation was 0.857 in the MZ twins and 0.757 in the DZ twins. The calculated heritability index was 0.20 (20%), and the contribution of the shared environment (c2) and unique environment (e2) was 0.66 (66%) and 0.14 (14%), respectively. No relationship between job types and ACJO in both the total cohort (r = 0.089; p = 0.499) and in the monozygotic (r = 0.247; p = 0.187) and the dizygotic twin groups (r = −0.084; p = 0.658) was found. Conclusions: The role of genetics on ACJO accounts for only 20%; a specific anatomical configuration of the articular surfaces only partially acts on the development of joint osteoarthritis. Environmental factors have the greatest impact. Level of Evidence: IV

Earliest South American paucituberculatans and their significance in the understanding of 'pseudodiprotodont' marsupial radiations

We describe the oldest Paucituberculata marsupials, from the La Barda and Las Flores localities (Argentina; Late Palaeocene, and Early-Middle Eocene), as well as from the Itaboraí Basin (Brazil; Late Palaeocene). The new taxa are represented by very scarce, although well-preserved, dental remains. A parsimony analysis was performed in order to evaluate the phylogenetic affinities of these taxa. Representatives of both Riolestes capricornicus gen. et sp. nov. and Bardalestes hunco gen. et sp. nov. appear to be basal paucituberculatans, and their molar features give clues on the early evolution of the representatives of this order. Within the Paucituberculata we recognize two major clades: Caenolestoidea and Palaeothentoidea. We conclude that 'pseudodiprotodont' marsupials of the traditional literature (i.e. Polydolopimorphia + Paucituberculata) do not form a natural group.Facultad de Ciencias Naturales y Muse