It’s time to change perspective! New diagnostic tools for lateral elbow pain

Purpose: The presence of intra-articular findings that may complement the extra-articular pathology in lateral epicondilytis has been suggested, and a role for minor instability of the elbow as part of the causative process of this disease has been postulated. This study was designed to describe two new clinical tests, aimed at detecting intra-articular pathology in patients affected by recalcitrant lateral epicondylitis and investigate their diagnostic performance. Methods: Ten patients suffering of atraumatic lateral elbow pain unresponsive to conservative treatment were considered in this study. Two clinical tests were developed and administrated prior to arthroscopy: Supination and Antero-Lateral pain Test (SALT); Posterior Elbow Pain by Palpation-Extension\uc2\ua0of the Radiocapitellar joint (PEPPER). Sensitivity, specificity, predictive values and accuracy of SALT and PEPPER as diagnostic tests for seven intra-articular findings were calculated. Results: In 90% of the patients, at least one test was positive. All patients with signs of lateral ligamentous patholaxity or intra-articular abnormal findings had a positive response to at least one of the two tests. SALT proved to have a high sensitivity but a low specificity and is accurate in detecting the presence of intra-articular abnormal findings, especially synovitis. PEPPER test was sensible, specific and accurate in the detection of radial head chondropathy. Conclusions: Two new diagnostic tests (SALT and PEPPER) were specifically designed to evoke pain from intra-articular structures. These tests could be a valid support in the diagnostic algorithm of recalcitrant lateral elbow pain. Positive findings may be indicative of a minor instability of the lateral elbow condition. Level of evidence: Diagnostic study, development of diagnostic criteria on basis of consecutive patients, level II

Deformazioni indotte da flussi idrici sotterranei nel Carso Triestino

Il Carso Classico \ue8 un vasto areale a carso maturo sviluppato in una potente idrostruttura, caratterizzata da intensa e diffusa carsifi cazione anche ben al di sotto del livello del mare. La zona satura \ue8 potente ed estesa con una zona di oscillazione che verso monte raggiunge il centinaio di metri di spessore durante le piene importanti, come risulta dagli strumenti posizionati nell\u2019Abisso di Trebiciano, circa 20 km in linea d\u2019aria dalle sorgenti. Fra l\u2019Abisso di Trebiciano e le foci, a circa 12 km da queste ultime, si apre la Grotta Gigante, all\u2019interno della quale, dal 1960, \ue8 presente una stazione geodetica per la registrazione delle deformazioni crostali. Si analizzano le deformazioni indotte dalle variazioni di livello delle acque di fondo del Carso confrontando i dati geodetici della Grotta Gigante con quelli idrologici dell\u2019Abisso di Trebiciano. Analizzando i dati con campionamento giornaliero, si riconosce una correlazione fra il segnale clinometrico e le piene; i due segnali hanno sfasamento temporale massimo di un giorno. Il segnale clinometrico \ue8 un transiente, per cui il clinometro torna alla posizione iniziale successivamente al passaggio della piena ed ha un\u2019orientazione caratteristica lungo la direttrice N150W-N30E. Il segnale clinometrico \ue8 proporzionale al livello raggiunto nell\u2019Abisso di Trebiciano (100 nrad di inclinazione corrispondono a 9.7 m di incremento di livello). Le piene nell\u2019Abisso di Trebiciano devono superare 23.2 m, per provocare il segnale clinometrico a Grotta Gigante

Droughts Prediction: a Methodology Based on Climate Seasonal Forecasts

This study proposes a methodology for the drought assessment based on the seasonal forecasts. These are climate predictions of atmospheric variables, such as precipitation, temperature, wind speed, for upcoming season, up to 7\ua0months. In regions particularly vulnerable to droughts and to changes in climate, such as the Mediterranean areas, predictions of precipitation with months in advance are crucial for understanding the possible shifts, for example, in water resource availability. Over Europe, practical applications of seasonal forecasts are still rare, because of the uncertainties of their skills; however, the predictability varies depending on the season and area of application. In this study, we describe a methodology which integrates, through a statistical approach, seasonal forecast and reanalysis data to assess the climate state, i.e. drought or not, of a region for predefined periods in the next future, at monthly scale. Additionally, the skill of the forecasts and the reliability of the released climate state assessment are estimated in terms of the false rate, i.e. the probability of missing alerts or false alarms. The methodology has been first built for a case study in Zakynthos (Greece) and then validated for a case study in Sicily (Italy). The selected locations represent two areas of the Mediterranean region often suffering from drought and water shortage situations. Results showed promising findings, with satisfying matching between predictions and observations, and false rates ranging from 1 to 50%, depending on the selected forecast period

Intermediates of Metabolism: From Bystanders to Signalling Molecules

British Heart Foundation Fellowship FS/12/38/2964

Detection of fiber-digesting bacteria in the forestomach contents of llamas (Lama glama) by PCR

AbstractThe high fibrolytic activity and large biomass of strictly-anaerobic bacteria that inhabit the rumen makes them primarily responsible for the degradation of the forage consumed by ruminants. Llamas feed mainly on low quality fibrous roughages that are digested by an active and diverse microflora. The products of this fermentation are volatile fatty acids and microbial biomass, which will be used by the animals. The aim of this study was to detect the three major fiber-digesting anaerobic bacteria in the forestomach contents of llamas by PCR. In this study, we detected Ruminococcus albus, Ruminococcus flavefaciens and Fibrobacter succinogenes in the forestomach contents of eight native llamas from Argentina

The centrosomal Deubiquitylase USP21 regulates Gli1 transcriptional activity and stability

USP21 is a centrosome-associated deubiquitylase (DUB) that has been implicated in the formation of primary cilia – crucial organelles for the regulation of the Hedgehog (Hh) signaling pathway in vertebrates. Here, we identify KCTD6 – a cullin-3 E3-ligase substrate adapter that has been previously linked to Hh signaling – as well as Gli1, the key transcription factor responsible for Hh signal amplification, as new interacting partners of USP21. We identify a cryptic structured protein interaction domain in KCTD6, which is predicted to have a similar fold to Smr domains. Importantly, we show that both depletion and overexpression of catalytically active USP21 suppress Gli1-dependent transcription. Gli proteins are negatively regulated through protein kinase A (PKA)-dependent phosphorylation. We provide evidence that USP21 recruits and stabilises Gli1 at the centrosome where it promotes its phosphorylation by PKA. By revealing an intriguing functional pairing between a spatially restricted deubiquitylase and a kinase, our study highlights the centrosome as an important hub for signal coordination

A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears

BACKGROUND: The purpose of this prospective study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears. METHODS: Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospective longitudinal study. Two hundred and twenty-four subjects (118 initial full-thickness tears, fifty-six initial partial-thickness tears, and fifty controls) were followed for a median of 5.1 years. Validated functional shoulder scores were calculated (visual analog pain scale, American Shoulder and Elbow Surgeons [ASES], and simple shoulder test [SST] scores). Subjects were followed annually with shoulder ultrasonography and clinical evaluations. RESULTS: Tear enlargement was seen in 49% of the shoulders, and the median time to enlargement was 2.8 years. The occurrence of tear-enlargement events was influenced by the severity of the final tear type, with enlargement of 61% of the full-thickness tears, 44% of the partial-thickness tears, and 14% of the controls (p < 0.05). Subject age and sex were not related to tear enlargement. One hundred subjects (46%) developed new pain. The final tear type was associated with a greater risk of pain development, with the new pain developing in 28% of the controls, 46% of the shoulders with a partial-thickness tear, and 50% of those with a full-thickness tear (p < 0.05). The presence of tear enlargement was associated with the onset of new pain (p < 0.05). Progressive degenerative changes of the supraspinatus muscle were associated with tear enlargement, with supraspinatus muscle degeneration increasing in 4% of the shoulders with a stable tear compared with 30% of the shoulders with tear enlargement (p < 0.05). Nine percent of the shoulders with a stable tear showed increased infraspinatus muscle degeneration compared with 28% of those in which the tear had enlarged (p = 0.07). CONCLUSIONS: This study demonstrates the progressive nature of degenerative rotator cuff disease. The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear, and tear enlargement is associated with a greater risk of pain development across all tear types. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence