Complications of calcific tendinitis of the shoulder: a concise review

Abstract: Calcific tendinitis (CT) of the rotator cuff (RC) muscles in the shoulder is a disorder which remains asymptomatic in a majority of patients. Once manifested, it can present in different ways which can have negative effects both socially and professionally for the patient. The treatment modalities can be either conservative or surgical. There is poor literature evidence on the complications of this condition with little consensus on the treatment of choice. In this review, the literature was extensively searched in order to study and compile together the complications of CT of the shoulder and present it in a clear form to ease the understanding for all the professionals involved in the management of this disorder. Essentially there are five major complications of CT: pain, adhesive capsulitis, RC tears, greater tuberosity osteolysis and ossifying tendinitis. All the above complications have been explained right from their origin to the control measures required for the relief of the patient. Level of evidence: 5

Functional outcomes and clinical strength assessment after infraspinatus-sparing surgical approach to scapular fracture: Does it really make a difference?

Background: Surgical treatment of scapular fractures with posterior approach is frequently associated with postoperative infraspinatus hypotrophy and weakness. The aim of this retrospective study is to compare infraspinatus strength and functional outcomes in patients treated with the classic Judet versus modified Judet approach for scapular fracture. Patients and methods: 20 cases with scapular neck and body fracture treated with posterior approach for lateral border plate fixation were reviewed. In 11 of 20 cases, we used the modified Judet approach (MJ group), and in 9 cases we used the classic Judet approach (CJ group). All fractures were classified according to the AO classification system. At follow-up examinations, patients had X-ray assessment with acromiohumeral distance (AHD) measurement, clinical evaluation, active range of motion (ROM) examination, Constant Shoulder Score, and Disability of the Arm, Shoulder and Hand (DASH) Score. Infraspinatus strength assessment was measured using a dynamometer during infraspinatus strength test (IST) and infraspinatus scapular retraction test (ISRT). Results: Demographic data did not significantly differ between the CJ group and MJ group, except for mean follow-up, which was 4.15\ua0years in the CJ group and 2.33 in the MJ group (p\ua0<\ua00.001). All X-ray examinations showed fracture healing. AHD was significantly decreased in the CJ group (p\ua0=\ua00.006). We did not find significant differences in active ROM between the MJ and CJ groups in the injured arm (p\ua0<\ua00.05). The Constant Score was 75.83 (\ub114.03) in the CJ group and 82.75 (\ub110.72) in the MJ group (p\ua0=\ua00.31); DASH Score was 10.16 in the CJ group and 6.25 in the MJ group (p\ua0=\ua00.49). IST showed mean strength of 8.38\ua0kg (\ub11.75) in the MJ group and 4.61\ua0kg (\ub11.98) in the CJ group (p\ua0=\ua00.002), ISRT test was 8.7 (\ub11.64) in the MJ group and 4.95 (\ub12.1) in the CJ group (p\ua0=\ua00.002). Infraspinatus hypotrophy was detected during inspection in six patients (five in the CJ group and one in the MJ group); it was related to infraspinatus strength weakness in IST and ISRT (p\ua0<\ua00.001). Conclusions: Infraspinatus-sparing surgical approach for scapular fracture avoids infraspinatus hypotrophy and external-rotation strength weakness. We suggest use of the modified Judet approach for scapular fracture and to restrict the classic Judet approach to only when the surgeon believes that the fracture is not easily reducible with a narrower exposure. Level of evidence: Level\ua0IV

The Porcellini test: a novel test for accurate diagnosis of posterior labral tears of the shoulder: comparative analysis with the established tests

Questions/purposes: Although the posterior labral tears of the shoulder are known for their disabling clinical course, especially in overhead athletes, no clinical test used in isolation can diagnose it accurately in the preoperative period. We wanted to: (1) introduce “Porcellini test” with its radiological verification furnishing the anatomical basis of its mechanism; (2) determine its accuracy; and (3) compare its accuracy with that of the other established tests for diagnosing posterior labral tears of the shoulder. Methods: To determine the anatomical basis, we initially performed radiological verification of our test. Then, we evaluated its accuracy in a retrospective case-controlled study on 310 consecutive patients who underwent shoulder arthroscopic procedures at our hospital between January 2013 and December 2013. All patients were examined preoperatively for Porcellini test, and the presence of posterior labral tear was confirmed on arthroscopy. Later, in a cohort study on 91 consecutive patients who underwent shoulder arthroscopic procedures, we compared its accuracy with O’Brien’s test, the Kim test, the Jerk test, and the Load and Shift test. The accuracy was interpreted in terms of sensitivity, specificity, and predictive values. Results: The radiological verification conferred the anatomical basis for the mechanism of the Porcellini test. This new test showed high accuracy for posterior labral tears with sensitivity of 100 %, specificity of 99.3 %, the positive and negative predictive values of 92.6 and 100 %, respectively. Also, it had superior accuracy results than every other test. The interexaminer reliability for all test results was found to be >0.80. Conclusions: We propose “Porcellini test” as a simple, accurate, reproducible, and reliable test for the preoperative diagnosis of posterior labral tears of shoulder

Real-time measurements of dissipative solitons in a mode-locked fiber laser

Dissipative solitons are remarkable localized states of a physical system that arise from the dynamical balance between nonlinearity, dispersion and environmental energy exchange. They are the most universal form of soliton that can exist in nature, and are seen in far-from-equilibrium systems in many fields including chemistry, biology, and physics. There has been particular interest in studying their properties in mode-locked lasers producing ultrashort light pulses, but experiments have been limited by the lack of convenient measurement techniques able to track the soliton evolution in real-time. Here, we use dispersive Fourier transform and time lens measurements to simultaneously measure real-time spectral and temporal evolution of dissipative solitons in a fiber laser as the turn-on dynamics pass through a transient unstable regime with complex break-up and collision dynamics before stabilizing to a regular mode-locked pulse train. Our measurements enable reconstruction of the soliton amplitude and phase and calculation of the corresponding complex-valued eigenvalue spectrum to provide further physical insight. These findings are significant in showing how real-time measurements can provide new perspectives into the ultrafast transient dynamics of complex systems.Comment: See also M. Narhi, P. Ryczkowski, C. Billet, G. Genty, J. M. Dudley, Ultrafast Simultaneous Real Time Spectral and Temporal Measurements of Fibre Laser Modelocking Dynamics, 2017 Conference on Lasers and Electro-Optics Europe & European Quantum Electronics Conference, paper EE-3.5 (2017

Impact of the 2014 American Academy of Pediatrics recommendation and of the resulting limited financial coverage by the Italian Medicines Agency for palivizumab prophylaxis on the RSV-associated hospitalizations in preterm infants during the 2016-2017 epidemic season: a systematic review of seven Italian reports

Background: The only pharmacologic prophylaxis against respiratory syncytial virus (RSV) infection in preterm infants is the humanized monoclonal antibody palivizumab. After the 2014 modification of the American Academy of Pediatrics (AAP) recommendations, the Italian Medicines Agency (AIFA) limited the financial coverage for palivizumab prescriptions to otherwise healthy preterm infants with &lt; 29 weeks of gestational age (wGA) aged &lt; 12 months at the beginning of the 2016-2017 RSV season. However, due to the effect on disease severity and hospitalizations following this limitation, shown by several Italian clinical studies, in November 2017 AIFA reinstated the financial coverage for these infants. In this systematic review, we critically summarize the data that show the importance of palivizumab prophylaxis. Methods: Data from six Italian pediatric institutes and the Italian Network of Pediatric Intensive Care Units (TIPNet) were retrieved from the literature and considered. The epidemiologic information for infants 29-36 wGA, aged &lt; 12 months and admitted for viral-induced acute lower respiratory tract infection were retrospectively reviewed. RSV-associated hospitalizations were compared between the season with running limitation, i.e. 2016-2017, versus 2 seasons before (2014-2015 and 2015-2016) and one season after (2017-2018) the AIFA limitation. Results: During the 2016-2017 RSV epidemic season, when the AIFA limited the financial coverage of palivizumab prophylaxis based on the 2014 AAP recommendation, the study reports on a higher incidences of RSV bronchiolitis and greater respiratory function impairment. During this season, we also found an increase in hospitalizations and admissions to the Pediatric Intensive Care Units and longer hospital stays, incurring higher healthcare costs. During the 2016-2017 epidemic season, an overall increase in the number of RSV bronchiolitis cases was also observed in infants born full term, suggesting that the decreased prophylaxis in preterm infants may have caused a wider infection diffusion in groups of infants not considered to be at risk. Conclusions: The Italian results support the use of palivizumab prophylaxis for otherwise healthy preterm (29-36 wGA) infants aged &lt; 6 months at the beginning of the RSV season

Deep learning-based pixel-wise lesion segmentation on oral squamous cell carcinoma images

Oral squamous cell carcinoma is the most common oral cancer. In this paper, we present a performance analysis of four different deep learning-based pixel-wise methods for lesion segmentation on oral carcinoma images. Two diverse image datasets, one for training and another one for testing, are used to generate and evaluate the models used for segmenting the images, thus allowing to assess the generalization capability of the considered deep network architectures. An important contribution of this work is the creation of the Oral Cancer Annotated (ORCA) dataset, containing ground-truth data derived from the well-known Cancer Genome Atlas (TCGA) dataset

Physical activity, ketogenic diet, and epilepsy: A mini-review

One-third of patients with epilepsy do not respond to antiepileptic drugs and may seek complementary and alternative treatment modalities. Dietary therapies, such as the ketogenic diet (KD), the modified Atkins diet, as well as the medium-chain triglyceride and the low glycaemic index diets, have been successfully implemented with some forms of epilepsy and are growing in utilization. The KD is a high-fat, low-protein, low-carbohydrate diet that has been used for various conditions for over a century. Insights into the mechanism of action of these diets may provide more targeted interventions for patients with epilepsy. Knowledge of these mechanisms is growing and includes neuroprotective effects on oxidative stress, neuroinflammation, potassium channels in the brain, and mitochondrial function. In this review, we explain the role of physical exercise and the ketogenic diet on epilepsy

Real-time full bandwidth measurement of spectral noise in supercontinuum generation

The ability to measure real-time fluctuations of ultrashort pulses propagating in optical fiber has provided significant insights into fundamental dynamical effects such as modulation instability and the formation of frequency-shifting rogue wave solitons. We report here a detailed study of real-time fluctuations across the full bandwidth of a fiber supercontinuum which directly reveals the significant variation in measured noise statistics across the spectrum, and which allows us to study correlations between widely separated spectral components. For two different propagation distances corresponding to the onset phase of spectral broadening and the fully-developed supercontinuum, we measure real time noise across the supercontinuum bandwidth, and we quantify the supercontinuum noise using statistical higher-order moments and a frequency-dependent intensity correlation map. We identify correlated spectral regions within the supercontinuum associated with simultaneous sideband generation, as well as signatures of pump depletion and soliton-like pump dynamics. Experimental results are in excellent agreement with simulations

Nocturnal obstructive respiratory events severity is associated with low parental quality

Objective: Despite of the large prevalence of obstructive sleep apnea syndrome (OSAS) in pediatric age, numerous aspects of its impact on day life and on parental quality are still poor studied and considered in the clinical management. The study evaluated the stress levels and copying styles in a large sample of mother of children with OSAS. Method: 374 mothers of children affected by OSAS (mOSAS) were compared with a group of mothers of 421 neurotypical healthy children (mTDC) for stress perceived stress levels and for coping strategies. Subjects were recruited from Italian Regions in Sicily, Campania, Calabria and Umbria. Results: Among both groups mOSAS and mTDC no differences were reported for children age (p=0.340), children gender (p=0.956), similarly for age of mothers (p=0.188). Discussion: The perceived stress assessment in mOSAS showed higher rate of all parental stress scores of PSI-SF: Parental Distress domain (p&lt;0.001), Difficult Child subscale (p&lt;0.001), Parent-Child Dysfunctional Interaction domain (p&lt;0.001) and Total Stress subscale score (p &lt;0.001) than mTDC. Regarding the CISS evaluation, mOSAS reported higher scores in emotion-oriented (p&lt;0.001) and avoidance-oriented (p &lt;0.001) scales, while low task-oriented coping style scale score was reported (p&lt;0.001) than mTDC. Pearson’s correlation analysis showed significant values for AHI, ODI and mdes SpO2 for each scale of PSI-SF questionnaire, particularly relevant for P-CDI (p&lt;0.001), DC (p&lt;0.001) and Stress Tot (p&lt;0.001). Conclusion: Pediatric OSAS tends to cause maternal high stress levels than controls, with a significant correlation between respiratory parameters and all PSI-SF scores. Moreover, mothers of affected children showed significantly differences in emotion-oriented and avoidance-oriented coping tasks. The present study suggested the importance of evaluation for caregivers of children affected by OSAS

LiNbO3 acousto-optical and electro-optical micromodulators

We report on acousto-optical (AO) and electro-optical (EO) LiNbO3 modulators with an active length of only 11 µm. The miniature devices are based on photonic crystal (PhC) structures that are controlled by an external effect (DC electric field or Surface Acoustic Waves). Two processes are presented for realizing the PhCs despite the resistance of the material to etching. The first method is based on direct FIB writing and can yield the fabrication of holes with depth of 32 m and diameter of 12 m or less. The second method consists in FIB patterning of a mask which is deposited on the substrate. This process is followed by proton exchange (PE) and reactive ion etching (RIE). Thus, structures with a diameter of 400 nm and an aspect ratio of 3:1 have been fabricated. The methods have been applied to the fabrication of EO and AO micromodulators showing a driving voltage of 13,5 V and a driving electric power of 20 mW respectively. These developments open the way to dense integration of dynamic optical functionalities