Increasing culturally relevant science media coverage: exploring the outcomes of a collaboration in Puerto Rico.

CienciaPR, a nonprofit that brings together the largest network of Puerto Rican scientists and one of the largest networks of Hispanic/Latine scientists in the world, has collaborated with El Nuevo Día (END), Puerto Rico's newspaper of record, to increase culturally relevant stories in their science section. This Practice Insight quantifies and compares the presence of culturally relevant elements (e.g., referring to Puerto Rico, local landmarks, historic figures, slang) and other content information (e.g., topics, location, focus, protagonist) in articles authored by CienciaPR members versus articles by END, news agencies, and other organizations. Results demonstrate that CienciaPR-authored articles published in END featured culturally relevant elements more often (e.g., mentioned Puerto Rico, used Puerto Rican slang, stories located in Puerto Rico) than those by other sources.

Management of pediatric posterior cruciate ligament avulsion fractures: a systematic review.

PURPOSE: Both open and arthroscopic surgical techniques have been used for PCL avulsion fractures. The goal of this study is to evaluate the effectiveness and safety of the different management strategies proposed for PCL avulsion fractures in children. METHODS: A systematic literature review was performed utilizing Medline, Scopus, and EMBASE databases from 1977 to the present. PRISMA guidelines were followed. Data were selected and extracted by two independent reviewers. Inclusion criteria were clinical studies reporting injuries in pediatric patients with PCL avulsion injuries. Exclusion criteria were combined PCL and ACL injuries and ligamentous injuries requiring reconstruction. A subgroup analysis was performed between open reduction and arthroscopic surgeries. FINDINGS/RESULTS: Twenty-six studies were included in this systematic review. Patient sex was reported in 39 patients with a higher number of males (32/39). The age range was 7-18 years old. In the open group, 30/31 patients had clinical improvement or returned to pre-injury activity level with two complications. Lysholm scores ranged from 66 to 99. In the arthroscopic group, 11/12 patients experienced clinical improvement or returned to normal activity levels with only one complication. Lysholm scores ranged from 90 to 100 with a mean of 95. In the non-operative group, 3/3 recovered with evidence of fracture healing, full or near full knee range of motion. One Lysholm score was reported 14 months after injury and was 100/100. CONCLUSIONS: Open reduction and arthroscopic surgeries are effective and safe treatment options for pediatric PCL avulsion fractures-97% of open reduction and 92% of arthroscopic patients significantly improved symptoms. The complication rates for the open and arthroscopic groups were 11 and 9%, respectively. All three non-operative made full or near full recovery of pre-injury knee status. LEVEL OF EVIDENCE IV: Systematic review of Level-II-IV studies. Prospero Registration No CRD42021290899.

Cross-sectional areas of rotator cuff muscles in males without tears on shoulder MRI.

OBJECTIVE: To establish reference values of rotator cuff (RC) cross sectional area (CSA) in males. MATERIALS AND METHODS: We retrospectively analyzed shoulder MRIs from 500 patients aged 13-78 years, grouped as follows (N=100 in each): <20, 20-30, 30-40, 40-50, >50 years. All examinations were reviewed to exclude prior surgery, tears, or significant RC pathology. We segmented a standardized T1 sagittal MR image in each case to obtain CSA of supraspinatus (SUP), infraspinatus/teres minor (INF), and subscapularis (SUB) muscles. Across age groups, we recorded individual and total muscle CSA. We also performed ratios between individual muscle CSA and total CSA to examine total muscle mass contribution over age groups. We tested for differences between age groups controlled for BMI. RESULTS: CSAs for SUP, INF, SUB, and total RC CSA were lower in subjects >50 years compared to all other groups (P<0.003 for all comparisons), persisting after controlling for BMI (P<0.03). Relative contribution of SUP CSA to total RC CSA was stable across age groups (P>0.32). INF CSA relative to total RC CSA increased with age, whereas SUB decreased (P<0.005). Subjects >50 years showed lower SUP (-15%), INF (-6%), and SUB (-21%) CSA, when compared to mean CSAs of all subjects <50 years. Total RC CSA significantly correlated with age (r=-0.34, P<0.001), persisting after controlling for BMI (r=-0.42, P<0.001). CONCLUSION: RC muscles in male subjects with no tears on MRI show decreasing CSA with age, independent of BMI.

Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review.

BACKGROUND: Conservative management has emerged as an attractive option for partial thickness rotator cuff tears (PT-RCTs). A single algorithmic treatment strategy for patients with symptomatic PT-RCT has not yet been developed. This systematic review aims to ascertain whether a conservative approach to PT-RCTs yields positive results in terms of clinical outcomes and functional recovery. METHODS: This is a systematic review of the literature on patients with PT-RCTs receiving conservative treatment with physiotherapy, platelet-rich plasma (PRP) injections, collagen injections, hyaluronic acid (HA) injections, or corticosteroids injections coupled with polydeoxyribonucleotide (PDRN). Outcomes such as the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons and Constant-Murley Score evaluations, as well as the Shoulder Pain and Disability Index and Euro Quality of Life-5D questionnaires were reported following a conservative approach. RESULTS: Eleven studies were included. Six articles explored the outcomes of patients with PT-RCT treated with PRP injections. Significant improvements in VAS for pain were observed. Two studies examined collagen injections and reported variations in VAS for pain and Constant-Murley Score. Sodium hyaluronate and HA injections were studied in two other articles, showing notable improvements in American Shoulder and Elbow Surgeons scores. Corticosteroid and PDRN injections also displayed favorable outcomes. In addition, physical therapy protocols demonstrated improvements in VAS for pain and strength, particularly with eccentric rehabilitation. CONCLUSIONS: Conservative management of PT-RCTs, involving physical therapy, PRP injections, collagen injections, corticosteroid injections, HA injections, and PDRN in jections, demonstrates favorable clinical outcomes. In addition, favorable results are observed in terms of decreased tear width and improved strength recovery, at least during a short-term follow-up. Unfortunately, long-term insight into the structural integrity of conservatively treated rotator cuff tendons following a partial injury has not been thoroughly evaluated yet. STUDY DESIGN LEVELS OF EVIDENCE: Level IV-systematic review.

Pediatric Maisonneuve and Tillaux Fractures with Lateral Ankle Dislocation: A Pediatric "Logsplitter" Injury: A Case Report.

CASE: A 12-year-old adolescent boy presented with a proximal fibula fracture and lateral ankle dislocation consistent with a Maisonneuve fracture (MF) associated with a transsyndesmotic ankle dislocation. The dislocation was reduced under conscious sedation in the emergency department. Postreduction imaging studies demonstrated a Tillaux fracture. The patient underwent surgical stabilization of the Tillaux fragment and of the distal tibiofibular syndesmosis. At the 26-month follow-up, the patient remained active without restrictions. CONCLUSION: Operative treatment of a concurrent MF, Tillaux fracture with lateral ankle dislocation, or a pediatric "logsplitter" injury resulted in satisfactory alignment and function of the ankle joint.

Seeds of Success: Empowering Latina STEM Girl Ambassadors Through Role Models, Leadership, and STEM-Related Experiences.

Gender stereotypes and lack of access to relatable role models, mentors, and STEM opportunities have been suggested to deter middle school girls and students from underrepresented backgrounds away from STEM. Seeds of Success, an out-of-school program, is designed to inspire girls to consider STEM careers by countering gender stereotypes through relatable role models, promoting STEM confidence through STEM workshops and hands-on activities, and encouraging alignment between cultural and STEM identities through community-based STEM projects that develop leadership skills. Since 2015, the program has impacted 453 students who in turn have reached more than 42,777 people in Puerto Rico through their STEM Ambassadors projects. A robust mix-method evaluation of the 2020 and 2021 cohorts demonstrates significant improvements in participants' STEM attitudes and science identity, as well as in their self-perception as a leader, confidence in their ability to succeed in science, knowledge about STEM careers and opportunities, and access to STEM role models. Moreover, 95% of participants intend to continue participating in STEM activities after the program and overall scores for the entire survey were significantly higher after the program than before. We discuss lessons learned for other programs seeking to empower girls from historically underserved backgrounds in STEM.

O uso da SIS-C no aprimoramento da relação família-escola / The use of SIS-C to improve the family-school relationship

A família e a escola são sistemas fundamentais para desencadear processos evolutivos, e o sucesso desta relação é um dos principais fatores do desenvolvimento e ensino-aprendizagem de alunos com deficiência intelectual. Dessa forma, o presente estudo busca compreender se o uso de um instrumento de avaliação da intensidade de apoio para alunos, público-alvo da Educação Especial, pode contribuir para a relação entre a família-escola do indivíduo avaliado. Foram selecionados nove estudantes, com idade de 5 a 16 anos, matriculados em escola especializada, e familiares (n=9) e profissionais (n=11) que convivem com esses alunos. Foi aplicado um instrumento que avalia a intensidade de apoio do aluno com deficiência intelectual junto aos familiares e profissionais e perguntas para investigar a percepção dos participantes após a avaliação. Os resultados apontam que a experiência para os participantes foi positiva e útil, assim como contribuiu para aproximação da relação família-escola. Ao possibilitar um espaço para a participação da família, a Escala de Intensidade de Apoio para Crianças (SIS-C) reforça a nova conceituação da deficiência intelectual sob a perspectiva funcional do comportamento, reposicionando e incluindo a família para a construção de currículos funcionais, como defende a nova conceituação paradigmática.

The family and the school are fundamental systems to trigger evolutionary processes, and the success of this relationship is one of the main factors in the development and teaching-learning of students with intellectual disabilities. Thus, the present study seeks to understand whether the use of an instrument to assess the intensity of support for students, the target audience of Special Education, can contribute to the relationship between the family-school of the individual being evaluated. Nine students were selected, aged between 5 and 16 years old, enrolled in a specialized school, and family members (n=9) and professionals (n=11) who live with these students. An instrument was applied to assess the support intensity of students with intellectual disabilities with family members and professionals, and questions were asked to investigate the participants' perception after the evaluation. The results indicate that the experience for the participants was positive and useful, as well as contributing to the approximation of the family-school relationship. By providing a space for family participation, the Escala de Intensidade de Apoio para Crianças (SIS-C) (Support Intensity Scale for Children, in English) reinforces the new conceptualization of intellectual disability from the functional perspective of behavior, repositioning and including the family for the construction of functional curricula, as advocated by the new paradigmatic conceptualization.

The Thrower's Shoulder.

¼: The thrower's shoulder has been a subject of great interest for many decades. Different theories have been proposed to clarify the pathophysiology, clinical presentation, and treatment options for this condition. In this review article, we summarize the relevant anatomy and pathophysiology and how these translate into signs, symptoms, and imaging findings. Also, a historical review of the treatment methodologies in the setting of an evolving concept is presented. ¼: The initial event in the cascade is thickening and contracture of the posteroinferior capsule resulting from repetitive tensile forces during the deceleration phase of throwing. This is known as "the essential lesion" and is clinically perceived as glenohumeral internal rotation deficit (GIRD), and a Bennett lesion may be found on radiographs. ¼: Change in the glenohumeral contact point leads to a series of adaptations that are beneficial for the mechanics of throwing, specifically in achieving the so-called "slot," which will maximize throwing performance. ¼: The complexity of the throwing shoulder is the result of an interplay of the different elements described in the cascade, as well as other factors such as pectoralis minor tightness and scapular dyskinesis. However, it is still unclear which event is the tipping point that breaks the balance between these adaptations and triggers the shift from an asymptomatic shoulder to a painful disabled joint that can jeopardize the career of a throwing athlete. Consequences are rotator cuff impingement and tear, labral injury, and scapular dyskinesis, which are seen both clinically and radiographically. ¼: A thorough understanding of the pathologic cascade is paramount for professionals who care for throwing athletes. The successful treatment of this condition depends on correct identification of the point in the cascade that is disturbed. The typical injuries described in the throwing shoulder rarely occur in isolation; thus, an overlap of symptoms and clinical findings is common. ¼: The rationale for treatment is based on the pathophysiologic biomechanics and should involve stretching, scapular stabilization, and core and lower-body strengthening, as well as correction of throwing mechanics, integrating the entire kinetic chain. When nonoperative treatment is unsuccessful, surgical options should be tailored for the specific changes within the pathologic cascade that are causing a dysfunctional throwing shoulder.

Biological augmentation of meniscal repair: a systematic review.

PURPOSE: Orthopedic literature remains divided on the utility of biologic augmentation to optimize outcomes after isolated meniscal repair. The aim of this systematic review is to analyze the clinical outcomes and re-operation rates of biologically augmented meniscal repairs. METHODS: PubMed, CINAHL, Cochrane, and EMBASE databases were queried in October 2020 for published literature on isolated meniscal repair with biological augmentation. Studies were assessed for quality and risk of bias by two appraisal tools. Patient demographics, meniscal tear characteristics, surgical procedure, augmentation type, post-operative rehabilitation, patient reported outcome measures, and length of follow-up were recorded, reviewed, and analyzed by two independent reviewers. RESULTS: Of 3794 articles, 18 met inclusion criteria and yielded 537 patients who underwent biologic augmentation of meniscal repair. The biologically augmented repair rates were 5.8-27.0% with PRP augmentation, 0.0-28.5% with fibrin clot augmentation, 0.0-12.9% with marrow stimulation, and 0.0% with stem cell augmentation. One of seven studies showed lower revision rates with augmented meniscal repair compared to standard repair techniques, whereas five of seven found no benefit. Three of ten studies found significant functional improvement of biologically augmented repair versus standard repair techniques and six of ten studies found no difference. There was significant heterogeneity in methods for biologic preparation, delivery, and post-operative rehabilitation protocols. CONCLUSION: Patients reported significant improvements in functional outcomes scores after repair with biological augmentation, though the benefit over standard repair controls is questionable. Revision rates after biologically augmented meniscal repair also appear similar to standard repair techniques. Clinicians should bear this in mind when considering biologic augmentation in the setting of meniscal repair. LEVEL OF EVIDENCE: IV.

Simultaneous bilateral shoulder arthroplasty: a case series.

BACKGROUND: Staged bilateral shoulder arthroplasty procedures have been shown to have good functional outcomes. The next step is to explore the option of simultaneous bilateral shoulder arthroplasty (SBSA). We report on the first case series of SBSA in the United States. The purpose of this study was to examine the safety and postoperative complication profile of SBSA and provide a technique reference for surgeons considering performing or investigating this procedure. METHODS: We conducted a retrospective record review of all the SBSA procedures performed by the senior author between 2007 and 2020. Patient demographic characteristics, surgical information, and postoperative data were collected. Data were compiled, and means, standard deviations, and ranges were calculated. Any readmissions or postoperative complications requiring revision were noted. A cohort of patients matched for age, sex, and body mass index with staged (sequential) bilateral total shoulder arthroplasty was analyzed for comparison. RESULTS: Thirteen patients were identified in the simultaneous group (SBSA). The mean age was 64 ± 15 years, with 9 women (69%) and 4 men (31%); the mean body mass index was 29.1 ± 7.5. The mean American Society of Anesthesiologists score was 2.55 ± 0.7, average blood loss was 364 ± 170 mL (range, 50-600 mL), 5 of 13 patients (38%) underwent blood transfusions, and the mean surgical time was 183 ± 42 minutes. Postoperatively, the mean visual analog scale pain score on postoperative day 1 was 4 ± 2 (range, 0-7), and the mean length of stay was 3.3 days. Postoperative complications included urinary tract infections in 2 patients, urinary retention in 2 patients, and recurrence of paroxysmal atrial fibrillation in 1 patient. No patient was readmitted within 90 days of surgery. One patient underwent a reoperation 2 years postoperatively for symptomatic hardware removal (cerclage cables around the tuberosities). A matched cohort of staged bilateral total shoulder arthroplasty patients was analyzed for comparison. Postoperative complications in the staged group included 1 reverse total shoulder arthroplasty patient with subjective instability that was managed with additional physical therapy. There were no documented readmissions within 90 days or revision arthroplasty procedures in either cohort. CONCLUSIONS: SBSA is a reasonable procedure that can be useful in select patients, with promising short-term safety noted in this series. Prospective randomized studies are needed to assess the long-term safety and efficacy of the procedure.

Terrible triad of the elbow and associated variants: a systematic review.

Background: The terrible triad of the elbow (TTE) is a complex injury consisting of simultaneous elbow dislocation or subluxation, radial head fracture, and coronoid fracture. During the initial assessment of a TTE, the typical severity of presenting pain, swelling, and limited range of motion may limit the ability to perform a thorough physical examination and thus divert a clinician's attention away from additional injuries to the ipsilateral upper extremity. Therefore, the purpose of this study was to review the literature for reported cases of concomitant ipsilateral upper extremity injuries associated with a TTE and discuss various strategies to increase clinician awareness to avoid underdiagnosis and missed diagnoses. Methods: A systematic review of five databases in four languages (English, Spanish, French, and Portuguese), from inception to May 2021, was conducted. Articles describing a TTE with a concomitant osseous, chondral, ligamentous, or musculotendinous injury occurring on the ipsilateral upper extremity were included. The patients were divided into two groups, those presenting with a classic TTE and concomitant ipsilateral upper extremity injury (group 1) and those in whom a TTE variant was described (group 2). A TTE variant was defined as a combination of osseous and/or chondral injuries to the elbow other than the classic description of TTE, in which at least two of the three classical elements of a TTE (elbow dislocation, coronoid fracture, and radial head fracture) were present in addition to other unique elbow osteoarticular injury. Results: Nineteen articles met inclusion criteria and were further analyzed. A total of 27 patients were analyzed, 23 from group 1 and 4 from group 2. Overall, 33 concomitant injuries were documented in group 1, the most common being an olecranon fracture (27.3%), followed by Essex-Lopresti injury, triceps tendon avulsion, and carpal fracture-dislocation with 4 (12.1%) cases each. Group 2 had four patients, all of whom presented with a unique variant of the classically described TTE. Conclusion: Despite a characteristic radiographic appearance of the classic TTE, additional injuries of the ipsilateral extremity or variants of the classic TTE may be easily missed, especially in cases resulting from high-energy mechanisms of injury. By analyzing the available data on associated injuries and variants that may occur with a TTE, we hope to increase awareness so that clinicians may recognize these less common but more complex injury patterns.

Acute injuries in American collegiate taekwondo competitions: a prospective study spanning four competitive seasons.

BACKGROUND: Injury patterns are well-documented for taekwondo competitions prior to the use of an electronic chest protector for scoring tabulation. To see if injury rates and types changed following this rule change that transformed the fighting style in taekwondo, we investigated injuries in collegiate taekwondo competitions in the USA. METHODS: Data were collected at eight collegiate taekwondo tournaments from April 2018 to December 2019. All injured athletes seen at the first-aid station were invited to complete a survey that included injury location, type, and mechanism of injury. Injury rates were calculated per 1000 athlete-exposures (A-Es) and minute-exposures (M-Es). Risk factors were modeled using logistic regression and χ2 analysis. RESULTS: Out of 1096 athletes, 194 athletes reported 275 acute injuries. We found an injury risk of 17.7/100 athletes (95% CI: 15.4, 20.0) and injury rate of 68.9/1000 A-E (95% CI: 60.7, 77.0) which was comparable to previous studies. The most common injuries were contusions to the lower limbs. In contrast to prior reports, men were injured more frequently from delivering a kick and women from receiving a kick. Populations at higher risk for injury included those with low belt rank and middle weight class for women. CONCLUSIONS: It appears that the new fighting style did not affect injury rates. Injury locations and types remain similar, but the mechanisms of injury have reversed as men are more injured from attacking and women from defending. There remains a strong need for research to improve protective equipment and safety rules in taekwondo.

Arthroscopic Reverse Remplissage in a Bilateral Seizure-related Posterior Shoulder Dislocation: Technique Description and 3-Year Follow-up Case Report.

The treatment options for posterior instability associated with epilepsy includes grafts, osteotomies, arthrodesis and arthroplasty. The technique of reverse arthroscopic remplissage was described in 2006 as a method of filling the anterior humeral bone defect, associated with tenodesis of the subscapularis tendon. This case report presents the results of the reverse remplissage technique in relation to a patient who suffered a bilateral posterior glenohumeral dislocation with a reverse Hill-Sachs lesion.

Rehabilitation variability after rotator cuff repair.

BACKGROUND: There has been increasing recognition of the importance for standardized postoperative rehabilitation protocols. Despite published guidelines in 2016 by the American Society of Shoulder and Elbow Therapists (ASSET), optimal postoperative rehabilitation after rotator cuff repair (RCR) remains an area of active academic debate. The goals of this study were (1) to assess the variability of RCR rehabilitation protocols published online, (2) to study the congruence between online RCR rehabilitation protocols and the ASSET consensus statement, and (3) to identify differences in online RCR rehabilitation protocols from before and after 2016. METHODS: A web-based search was conducted for publicly available RCR rehabilitation protocols from websites of all Accreditation Council for Graduate Medical Education (ACGME) academic orthopedic institutions. A supplemental 10-page Google search was also performed with the search terms "rotator cuff repair rehabilitation protocol." Collected protocols were grouped by tear size (small/medium or large/massive) and examined for information relating to the following categories: protocol demographics, adjunctive therapy use, immobilization/range of motion, and strengthening. Findings were compared to the ASSET statement's recommendations. Protocols published before and after ASSET's 2016 publication were compared for differences. RESULTS: A total of 66 online RCR rehabilitation protocols were collected. Only 16 of 187 (8.5%) ACGME institutions provided online RCR rehabilitation protocols. The collected protocols recommend more aggressive rehabilitation in comparison to ASSET, specifically regarding immobilization time, passive range of motion initiation, active assisted range of motion initiation, and strengthening initiation (P < .001). Protocols published after 2016 trended toward more conservative recommendations in comparison to protocols published before 2016. Regardless of this trend, the majority of these recommendations were still largely more aggressive than ASSET's recommendations. CONCLUSION: Despite an attempt by ASSET to provide standardization, this study highlights the marked variations that still exist regarding RCR rehabilitation. Additionally, online RCR rehabilitation protocols tend to make more aggressive recommendations than the ASSET consensus statement. Further research is needed to address these variations and to either validate, alter, or reject the ASSET recommendations.

Detection of mycobacteria in paraffin-embedded Ziehl-Neelsen-Stained tissues using digital pathology.

INTRODUCTION: Early diagnosis of paucibacillary tuberculosis represents a challenge, even with direct tissue examination. Digital pathology allows the digital analysis of tissues to identify microorganisms. We aim to develop a program to detect and quantify typical and atypical mycobacteria in paraffin-embedded Ziehl-Neelsen-stained tissues. MATERIAL AND METHODS: Program development: The building of the program, named Pat-Scan, included pathology, systems engineering, and scientific applications. The iScan Coreo Au scanner® was used, and 9 variables were adjusted. Ten Ziehl-Neelsen-stained samples were fragmented into 2000 images and analyzed to validate the reproducibility of the bacilli images in the tissue, as detected by the software. RESULTS: Pat-Scan included software and a scanner that were used to detect and quantify bacilli in paraffin-embedded Ziehl-Neelsen-stained tissues. All samples containing mycobacteria were successfully analyzed by the scanner, and the bacilli could be detected; these results were validated by expert pathologists by microscopy examination, and the presence of bacilli was confirmed in all cases. CONCLUSIONS: Pat-Scan allowed the identification and quantification of mycobacteria in paraffin-embedded Ziehl-Neelsen-stained tissues, offering a reproducible diagnostic method that reduces the time for diagnosis and does not affect precision. Further validation is needed for application in the clinical setting.

Deep learning method for segmentation of rotator cuff muscles on MR images.

OBJECTIVE: To develop and validate a deep convolutional neural network (CNN) method capable of (1) selecting a specific shoulder sagittal MR image (Y-view) and (2) automatically segmenting rotator cuff (RC) muscles on a Y-view. We hypothesized a CNN approach can accurately perform both tasks compared with manual reference standards. MATERIAL AND METHODS: We created 2 models: model A for Y-view selection and model B for muscle segmentation. For model A, we manually selected shoulder sagittal T1 Y-views from 258 cases as ground truth to train a classification CNN (Keras/Tensorflow, Inception v3, 16 batch, 100 epochs, dropout 0.2, learning rate 0.001, RMSprop). A top-3 success rate evaluated model A on 100 internal and 50 external test cases. For model B, we manually segmented subscapularis, supraspinatus, and infraspinatus/teres minor on 1048 sagittal T1 Y-views. After histogram equalization and data augmentation, the model was trained from scratch (U-Net, 8 batch, 50 epochs, dropout 0.25, learning rate 0.0001, softmax). Dice (F1) score determined segmentation accuracy on 105 internal and 50 external test images. RESULTS: Model A showed top-3 accuracy > 98% to select an appropriate Y-view. Model B produced accurate RC muscle segmentations with mean Dice scores > 0.93. Individual muscle Dice scores on internal/external datasets were as follows: subscapularis 0.96/0.93, supraspinatus 0.97/0.96, and infraspinatus/teres minor 0.97/0.95. CONCLUSIONS: Our results show overall accurate Y-view selection and automated RC muscle segmentation using a combination of deep CNN algorithms.

Reading in developmental dyslexia: the role of phonemic awareness and executive functions / Leitura na dislexia do desenvolvimento: o papel da consciência fonêmica e das funções executivas

This study investigated the correlations and the possible deficits in reading, phonemic awareness, and executive functions among students with developmental dyslexia. A total of 28 students participated in the study, between 9 and 11 years old, 14 with developmental dyslexia and 14 without reading difficulties. Specific instruments were used to assess reading, phonemic awareness, and executive functions. The Spearman test indicated moderate and very significant correlations between performance in tasks of phonemic awareness and reading (recognition and comprehension) and tasks that assessed cognitive functioning involving the following executive functions: cognitive flexibility, working memory, inhibitory control, and orthographic verbal fluency. No correlation was found between the reading and phonemic awareness assessments and the results of the planning done with the Tower of London instrument. The results allowed the researchers to hypothesize that an intervention planned for the development of phonemic awareness and executive functions may have an effect in improving the reading performance of dyslexics.

Este estudo investigou as correlações e os possíveis déficits em leitura, consciência fonêmica e funções executivas entre estudantes com dislexia do desenvolvimento. Participaram do estudo 28 estudantes, com idade entre 9 e 11 anos, sendo 14 com dislexia do desenvolvimento e 14 sem dificuldade de leitura. Foram utilizados instrumentos específicos para avaliação da leitura, consciência fonêmica e funções executivas. O teste Spearman indicou correlações moderadas e muito significativas entre o desempenho nas tarefas de consciência fonêmica e leitura (reconhecimento e compreensão) e as tarefas que avaliaram o funcionamento cognitivo envolvendo as seguintes funções executivas: flexibilidade cognitiva, memória de trabalho, controle inibitório e fluência verbal ortográfica. Não foi encontrada correlação entre as avaliações de leitura e consciência fonêmica e planejamento com o instrumento Torre de Londres. Os resultados possibilitam hipotetizar que uma intervenção para o desenvolvimento da consciência fonêmica e das funções executivas pode melhorar o desempenho em leitura dos disléxicos.

Paget-Schroetter syndrome in athletes: a comprehensive and systematic review.

BACKGROUND: Paget-Schroetter syndrome (PSS) is a rare condition of axillosubclavian vein thrombosis often seen in athletes with a history of repetitive external rotation and abduction of the shoulder. The purpose of this review was to analyze the literature and characterize PSS in the athletic population, including risk of PSS by sport. We also provide a comprehensive review of PSS to inform clinicians on the pathophysiology, detection, and management of the condition. METHODS: Four databases were reviewed to identify cases of PSS occurring in athletes. Data on patient demographics, reported sport, diagnosis, treatment, management, return to sport, and complications were extracted and analyzed by 2 independent reviewers. RESULTS: Of the 123 cases of PSS identified, baseball and weight lifting had the highest incidence (26.8% and 19%, respectively), followed by swimming, football, and basketball. The average return to sport was 4.7 months, and 26.7% of subjects reported complications, most commonly pulmonary embolism. CONCLUSION: In athletes presenting with upper extremity pain and swelling with a history of playing baseball or weight lifting, PSS should be higher on a clinicians differential diagnosis list. Swimmers, football, and basketball players are less likely to present with PSS but are still more likely than other types of athletes to develop the condition. Clinician awareness of PSS in athletes is critical to avoid delays in treatment and misdiagnosis, and to allow for a timely return to sport with minimal complications.

Injured vs. uninjured elbow opening on clinical stress radiographs and its relationship to ulnar collateral ligament injury severity in throwers.

BACKGROUND: Stress radiography measures medial joint space opening of the elbow, but its value in the management of throwing athletes is unclear. The purpose of this study was to analyze the relationship between medial joint opening (gapping and excess opening) and ulnar collateral ligament (UCL) injury severity on magnetic resonance imaging, as well as to explore factors related to the unexpected finding of a greater opening of the uninjured elbow compared with the injured elbow (negative excess opening) with valgus stress radiography. METHODS: Medial joint space measurements were independently performed by 2 raters in a clinical series of 74 patients evaluated with standardized valgus stress radiography as part of their clinical workup for throwing-related medial elbow pain. Demographic data were collected by chart review, and UCL injury severity was classified based on available imaging into intact UCLs, partial-thickness tears of the anterior bundle, or full-thickness tears of the anterior bundle. RESULTS: Joint gapping was related to UCL injury severity (P = .003), and group-level comparison showed a difference among tear severity groups (P = .050). Excess opening was not significantly related to UCL injury severity (P = .109). A negative excess opening was observed in 22% of patients, but no factors corroborating guarding or a mechanical explanation were significant for a decreased medial joint opening of the injured elbow compared with the uninjured elbow. CONCLUSIONS: Medial joint gapping was correlated to UCL injury severity in throwing athletes with medial elbow pain and a clinical suggestion of UCL injury, but no association between injury severity and excess opening was observed in this clinical series, which may limit the usefulness of stress radiography in the clinical workup of throwing athletes.

Arthroscopic Latarjet: Technique Description and Preliminary Results. Study of the First 30 Cases.

Objective Arthroscopic Latarjet has been performed with the aim to be an accurate technique with a low incidence of complications. The aim of the present study was to briefly describe the technique and to evaluate the shot-term complications following arthroscopic Latarjet procedure to correct anterior shoulder dislocation with glenoid bone loss. Methods Retrospective study with 30 subjects with anterior shoulder instability, submitted to arthroscopic Latarjet. Intraoperative and short-term postoperative complications were recorded, as well as the rate of revision surgery. Results Five cases had complication (16.7%), and in the last 10 cases no complication occurred. In 1 case (3.3%), it was required to reverse for open surgery due to a fracture of the coracoid process during fixation in the glenoid. No other intraoperative complication occurred. No infection was observed. Two cases (6.7%) evolved with temporary neuropraxia of the musculocutaneous nerve, totally reversed with physiotherapy. With a follow-up from 6 to 26 months, 2 patients (6.7%) required a new intervention for graft/screws removal and release of the joint due to excessive limitation in external rotation. There was no case of recurrence. Conclusion Even in an initial learning curve, arthroscopic Latarjet demonstrated a low rate of short-tem complications and was a safe procedure for treating anterior dislocation of the shoulder with glenoid bone loss.