Multiple Indolent Asymptomatic Yellow-Orange Patches and Plaques.

An 83-year-old Caucasian male presented with a history of asymptomatic yellow-orange macules and plaques concentrated on his trunk and proximal extremities that have been slowly progressing for the past three years. A punch biopsy revealed the presence of eosinophilic amorphous and fissured material within the superficial and interstitial dermis consistent with nodular amyloidosis. With the lack of concurrent systemic symptoms and negative systemic laboratory workup, the patient was diagnosed with disseminated primary localized cutaneous nodular amyloidosis (PLCNA). Due to the possibility of developing systemic progression, serial monitoring was recommended. This case highlights an under-reported and unusual presentation of a widely distributed form of PLCNA compared to the more common localized nodular and plaque variants.

Transparent and Reproducible Research Practices in the Surgical Literature.

INTRODUCTION: Previous studies have established a baseline of minimal reproducibility in the social science and biomedical literature. Clinical research is especially deficient in factors of reproducibility. Surgical journals contain fewer clinical trials than non-surgical areas of medicine, suggesting that it should be easier to reproduce the outcomes of surgical literature. METHODS: In this study, we evaluated a broad range of indicators related to transparency and reproducibility in a random sample of 387 articles published in Surgery journals between 2014 and 2018. RESULTS: A small minority of our sample made available their materials (5.3%, 95% C.I. 2.4%-8.2%), protocols (1.2%, 0-2.5%), data (2.5%, 0.7%-4.2%), or analysis scripts (0.04%). Four studies were adequately pre-registered. No studies were explicit replications of previous literature. Most studies (58%), declined to provide a funding statement, while conflicts of interest were declared in a small fraction (9.3%). Most have not been cited by systematic reviews (83%) or meta-analyses (87%), and most were only accessible to paying subscribers (59%). CONCLUSIONS: The transparency of the surgical literature could improve with adherence to baseline standards of reproducibility.

Effects of Agitation and Storage Temperature on Measurements of Hydration Status.

BACKGROUND: Hypohydration can have significant implications on normal physiological functions of the body. OBJECTIVES: This study aimed to determine the impact of agitation, storage temperature, and storage time on urine osmolality compared to the criterion control. PATIENTS AND METHODS: We used a descriptive diagnostic validity test design. To investigate agitation, we recruited 75 healthy individuals (males = 41, females = 34; mean age = 22 ± 5 years; mean self-reported height = 172 ± 23 cm and mass = 77 ± 17 kg) who provided one or more samples (total = 81). The independent variables were agitation (vortex, hand shaken, no agitation) and temperature (room temperature, freezer, and refrigerator) type. Participants completed informed consent, a health questionnaire and were asked to provide a urine sample, which was split and labeled according to agitation type or storage temperature. Urine osmolality was used to determine hydration status at two time points (within 2 hours [control], 48 hours). We used t-tests to determine the difference between each condition and the control and calculated percent error for each condition. RESULTS: No significant differences for no agitation (t79 = -0.079, P = 0.937), hand shaken (t79 = 1.395, P = 0.167) or vortex mixed (t79 = -0.753, P = 0.453) were identified when compared to the criterion control. No significant differences for room temperature (t82 = -0.720, P = 0.474), refrigerator (t82 = -2.697, P = 0.008) or freezer (t82 = 2.576, P = 0.012) were identified when compared to the criterion control. CONCLUSIONS: Our findings suggest agitation of urine specimen is not necessary and samples do not require refrigeration or freezing if assessed within 48 hours. Analysis within two hours of collection is not necessary and samples can be stored for up to 48 hours without impacting the hydration status of the sample.

Ad libitum fluid consumption via self- or external administration.

CONTEXT: During team athletic events, athletic trainers commonly provide fluids with water bottles. When a limited number of water bottles exist, various techniques are used to deliver fluids. OBJECTIVE: To determine whether fluid delivered via water-bottle administration influenced fluid consumption and hydration status. DESIGN: Crossover study. SETTING: Outdoor field (22.2°C ± 3.5°C). PATIENTS OR OTHER PARTICIPANTS: Nineteen participants (14 men, 5 women, age = 30 ± 10 years, height = 176 ± 8 cm, mass = 72.5 ± 10 kg) were recruited from the university and local running clubs. INTERVENTION(S): The independent variable was fluid delivery with 3 levels: self-administration with mouth-to-bottle direct contact (SA-DC), self-administration with no contact between mouth and bottle (SA-NC), and external administration with no contact between the mouth and the bottle (EA-NC). Participants warmed up for 10 minutes before completing 5 exercise stations, after which an ad libitum fluid break was given, for a total of 6 breaks. MAIN OUTCOME MEASURE(S): We measured the fluid variables of total volume consumed, total number of squirts, and average volume per squirt. Hydration status via urine osmolality and body-mass loss, and perceptual variables for thirst and fullness were recorded. We calculated repeated-measures analyses of variance to assess hydration status, fluid variables, and perceptual measures to analyze conditions across time. RESULTS: The total volume consumed for EA-NC was lower than for SA-DC (P = .001) and SA-NC (P = .001). The total number of squirts for SA-DC was lower than for SA-NC (P = .009). The average volume per squirt for EA-NC was lower than for SA-DC (P = .020) and SA-NC (P = .009). Participants arrived (601.0 ± 21.3 mOsm/L) and remained (622.3 ± 38.3 mOsm/L) hydrated, with no difference between conditions (P = .544); however, the EA-NC condition lost more body mass than did the SA-DC condition (P = .001). There was no main effect for condition on thirst (P = .147) or fullness (P = .475). CONCLUSIONS: External administration of fluid decreased total volume consumed via a decreased average volume per squirt. The SA-DC method requires fewer squirts within a specific time frame. Fluid breaks every 15 minutes resulted in maintenance of euhydration; however, loss of body mass was influenced by fluid administration. Athletic trainers should avoid external administration to promote positive hydration behaviors. When fluid is self-administered, individual bottles may be the best clinical practice because more volume can be consumed per squirt.

Suprascapular neuropathy in collegiate baseball player.

BACKGROUND: Suprascapular neuropathy (SSN) is generally thought of as a diagnosis of exclusion. However, increasing attention is being paid to the diagnosis, treatment and rehabilitation of this pathology to prevent chronic supraspinatus and infraspinatus atrophy in patients. To date, literature has only articulated variable or customized treatment and rehabilitation plans without clear standardized care. This case study provides a detailed description of the diagnosis, treatment, and rehabilitation of a collegiate baseball player's recovery from suprascapular nerve release. CASE PRESENTATION: A 20 year-old male baseball pitcher with right shoulder pain reported for athletic training evaluation, was treated conservatively, and due to lack of resolution was referred for further imaging and evaluation by an orthopedist. Following inconclusive magnetic resonance imaging findings the patient underwent electrodiagnostic testing which showed decreased nerve conduction velocity of the right suprascapular nerve. The patient elected for surgical intervention. Post-operative rehabilitation followed and the patient was able to pitch in 22 weeks. The patient provided positive subjective feedback and was able to return to unrestricted pitching without pain, loss of velocity, or loss in pitch control. CONCLUSION: This study demonstrates a need for further investigation into the most appropriate treatment and rehabilitation of suprascapular nerve injury.