Rare first rib pseudoarthrosis with thoracic outlet syndrome in pediatric gymnast: A case report

Background: This case study evaluates the diagnosis and treatment of a 12 year old Caucasian male gymnast who had several diagnoses including an isolated first rib fracture, resultant pseudoarthrosis of the first rib, and the development of symptomatic thoracic outlet syndrome. We discuss the causes, prevalence, and suggestions for prompt diagnosis and treatment of these conditions in pediatric patients. Although all three conditions are rare in a child, this case highlights the importance of having a high clinical index of suspicion in recurrent pain in pre-pubertal athletes. Case presentation: A 10 year old Caucasian male presented with a two to three month history of worsening left shoulder pain. He was a competitive gymnast who practiced approximately ten hours per week. His shoulder pain was accompanied by a tic type movement consisting of hyperextension of the left shoulder multiple times per day. The patient was seen by a pediatric orthopedic surgeon who diagnosed the patient with overuse syndrome and prescribed physical therapy. Within one to two months, the patient\u27s shoulder pain and tightness returned. For two years, the patient continued the cycle multiple times of two to three months of physical therapy two to three times a week, relative rest, then returned to activity. He continued to be diagnosed with “overuse syndrome”. At the age of 12, the patient\u27s mother noticed atrophy to the left upper scapula region and vague weakness of the left upper extremity. Cervical MRI showed “unusual nodular mass at the apex of the left hemithorax involving the antero-lateral aspect of the left first rib.” 3D reconstructed CT images were done showing first rib pseudoarthrosis as well as demonstrating a non-displaced fracture through the left second rib. The patient underwent a left first rib resection without complication. He recovered well post operatively; the pain, “tic”, and atrophy drastically improved, and he returned to his baseline activity level. Conclusions: Children involved in high impact sports are subject to fractures due to the muscles pulling on the bone. Our patient not only had a first rib fracture, but also had incorrect healing of the fracture leading to pseudoarthrosis and eventual thoracic outlet syndrome. With the continued failure of conservative treatment for pain, more imaging studies should be ordered to evaluate for any missed pathologies. Removal of the first rib is a definitive treatment and should be considered if the patient’s thoracic outlet syndrome symptoms do not improve with conservative measures such as lifestyle modifications or physical therapy

Adopting Immunization Recommendations: A New Dissemination Model

Objective: This paper presents a new approach for understanding factors related to physician adoption of clinical guidelines, using children's vaccine recommendations as a case study. Methods: The model traces sequential steps, from awareness to agreement to adoption and, finally, adherence to the guideline. Movement through these stages can be catalyzed or retarded by many influences, grouped into two major categories: environmental characteristics of the physician's practice, and information characteristics of the guideline. Environmental characteristics include sociocultural factors, professional characteristics, and practice organization factors. Information characteristics include the guideline's relative advantage, complexity, and compatibility with existing guidelines and protocols, as well as mechanisms of guideline dissemination. Implications: This model can be used to identify characteristics that will likely impede or facilitate guideline adoption, and to focus dissemination efforts on key issues.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45322/1/10995_2004_Article_412802.pd

Co-infections of Adenovirus Species in Previously Vaccinated Patients

Adenoviral infections associated with respiratory illness in military trainees involve multiple co-infecting species and serotypes

Dynamic Behavior of Spicules Inferred from Perpendicular Velocity Components

Understanding the dynamic behavior of spicules, e.g., in terms of magnetohydrodynamic (MHD) wave mode(s), is key to unveiling their role in energy and mass transfer from the photosphere to corona. The transverse, torsional, and field-aligned motions of spicules have previously been observed in imaging spectroscopy and analyzed separately for embedded wave-mode identification. Similarities in the Doppler signatures of spicular structures for both kink and torsional Alfvén wave modes have led to the misinterpretation of the dominant wave mode in these structures and is a subject of debate. Here, we aim to combine line- of-sight (LOS) and plane-of-sky (POS) velocity components using the high spatial/temporal resolution Hα imaging-spectroscopy data from the CRisp Imaging SpectroPolarimeter based at the Swedish Solar Telescope to achieve better insight into the underlying nature of these motions as a whole. The resultant three-dimensional velocity vectors and the other derived quantities (e.g., magnetic pressure perturbations) are used to identify the MHD wave mode(s) responsible for the observed spicule motion. We find a number of independent examples where the bulk transverse motion of the spicule is dominant either in the POS or along the LOS. It is shown that the counterstreaming action of the displaced external plasma due to spicular bulk transverse motion has a similar Doppler profile to that of the m = 0 torsional Alfvén wave when this motion is predominantly perpendicular to the LOS. Furthermore, the inferred magnetic pressure perturbations support the kink wave interpretation of observed spicular bulk transverse motion rather than any purely incompressible MHD wave mode, e.g., the m = 0 torsional Alfvén wav

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum