Ultrasound-Guided Electroacupuncture Treatment for Rotator Cuff Tendinopathy: Proposing an Effective Alternative to Nonoperative Medical Treatments.

Background: Rotator cuff (RTC) tendinopathy is a common painful condition of the shoulder that impairs function and quality of life. Nonoperative treatments when physical therapy and oral medications have not resolved the issue often consist of different strategies to improve blood flow and promote growth factors, thereby creating regeneration and healing of injured tissue in the RTC tendons. Acupuncture could serve in a similar role when needles are strategically targeted into injured tissue utilizing ultrasound visualization. Case: A 58-year-old male presented with over 1 year of symptomatic RTC tendinopathy involving the supraspinatus and infraspinatus tendons. He had not gotten sustained pain relief with physical therapy or a corticosteroid injection to the subacromial bursa and was not a surgical candidate for RTC repair due to only having small partial tearing of the tendons. He wanted to consider alternative treatment options and it was decided that he could pursue ultrasound-guided electroacupuncture. Results: Treatment was successful and completed within 4 weekly sessions. He reported 85% improvement in symptoms two months after starting treatment and is now over 1 year out from treatment, with what the patient states as "minimal" residual discomfort with one stretching movement. Conclusions: Ultrasound guidance of acupuncture needles into areas of RTC tendon injury simulates many of the current nonoperative treatment modalities sports medicine has to offer for RTC tendinopathy. This short- and long-term successful case report provides a steppingstone for future research into this area.

The impact of a vaccine mandate and the COVID-19 pandemic on influenza vaccination uptake in Western Australian health care students.

Annual influenza vaccination of health care students and workers helps protect themselves and patients from influenza, which has a high disease burden during seasonal peaks in Australia. Health care students are an important cohort whose early attitudes and habits towards influenza vaccination may influence future behaviours. We explored the knowledge, attitudes, and behaviours towards influenza vaccination of health care students in two universities from 2018 to 2020 using convergent mixed methodology. We also assessed the impact of two external events - the introduction of mandatory influenza vaccination for select students in 2019, and the COVID-19 pandemic in 2020. We found a significant increase in self-reported vaccination uptake between 2018 (73.5%) and 2020 (89.6%), with the mandate and COVID-19 pandemic being likely drivers of increased uptake. Vaccine mandates are effective but must be supported by easy accessibility, adequately addressing concerns around effectiveness and safety, and promotion of voluntary acceptance and trust.

Stability of adsorption of Mg and Na on sulfur-functionalized MXenes.

Two-dimensional materials composed of transition metal carbides and nitrides (MXenes) are poised to revolutionize energy conversion and storage. In this work, we used density functional theory (DFT) to investigate the adsorption of Mg and Na adatoms on five M2CS2 monolayers (where M = Mo, Nb, Ti, V, and Zr) for battery applications. We assessed the stability of the adatom (i.e. Na and Mg)-monolayer systems by calculating adsorption and formation energies, as well as voltages as a function of surface coverage. For instance, we found that Mo2CS2 cannot support a full layer of Na nor even a single Mg atom. Na and Mg exhibit the strongest binding on Zr2CS2, followed by Ti2CS2, Nb2CS2 and V2CS2. Using the nudged elastic band method (NEB), we computed promising diffusion barriers for both dilute and nearly full ion surface coverage cases. In the dilute ion adsorption case, a single Mg and Na atom on Ti2CS2 experience ∼0.47 eV and ∼0.10 eV diffusion barriers between the lowest energy sites, respectively. For a nearly full surface coverage, a Na ion moving on Ti2CS2 experiences a ∼0.33 eV energy barrier, implying a concentration-dependent diffusion barrier. Our molecular dynamics results indicate that the three (one) layers (layer) of the Mg (Na) ion on both surfaces of Ti2CS2 remain stable at T = 300 K. While, according to voltage calculations, Zr2CS2 can store Na up to three atomic layers, our MD simulations predict that the outermost layers detach from the Zr2CS2 monolayer due to the weak interaction between Na ions and the monolayer. This suggests that MD simulations are essential to confirm the stability of an ion-electrode system - an insight that is mostly absent in previous studies.

Attention Deficit Hyperactivity Disorder: Unique Considerations in Athletes.

CONTEXT: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition in the general population, with evidence suggesting that it may be more common among athletes. EVIDENCE ACQUISITION: Literature searches were performed on PubMed, MEDLINE, and Cochrane databases for the years 2000 to 2016 utilizing the following key search terms: ADHD, ADD, guidelines, diagnosis, athlete, sports, treatment, pharmacotherapy, stimulants, risk, cardiovascular effects, concussion, and traumatic brain injury (TBI). STUDY DESIGN: Clinical review. LEVEL OF EVIDENCE: Level 4. RESULTS: ADHD exists among athletes at all levels of play, and symptomatology overlaps significantly with that of concussion. Treatment with stimulants has cardiovascular effects and may not be permitted by the athlete's governing body. An athlete's level of competition and individual cardiovascular risk factors may therefore affect medication choices. CONCLUSION: ADHD diagnosis and treatment are paramount to optimal quality of life and functioning in affected individuals. Pharmacologic treatment options should not specifically be avoided in athletes; however, stimulant use is an independent risk factor for heat illness. Concussion, a common athletic injury, may have an altered course in those affected by ADHD, specifically with regard to neurocognitive testing and recovery.

[Diabetic mastopathy: a recurrent benign breast disease]. / La mastopathie diabétique : une lésion mammaire bénigne sujette à récidive.

Diabetic mastopathy is an uncommon benign entity occurring in young women with type 1 diabetes. Its clinical and radiological signs are not specific and often mimic a breast carcinoma. However, the benign nature of this lesion is easily recognized on histological examination, visualizing dense keloid-like fibrosis, lymphocytic lobulitis and ductitis with lymphocytic perivascular inflammation, with or without epithelioid-like fibroblasts. Surgery can generally be avoided. The evolution of this entity is characterized by the risk of local growth, bilateralisation or recurrence after surgical treatment. We present a case in which the core biopsy allowed the diagnosis of a diabetic mastopathy and we discuss its clinical, diagnostic, pathological and therapeutic particularities.

Home oxygen for children with acute bronchiolitis.

A prospective randomised controlled pilot study was performed comparing home oxygen therapy with traditional inpatient hospitalisation for children with acute bronchiolitis. Children aged 3-24 months with acute bronchiolitis, still requiring oxygen supplementation 24 h after admission to hospital, were randomly assigned to receive oxygen supplementation at home with support from "hospital in the home" (HiTH) or to continue oxygen supplementation in hospital. 44 children (26 male, mean age 9.2 months) were recruited (HiTH n = 22) between 1 August and 30 November 2007. Only one child from each group was readmitted to hospital and there were no serious complications. Children in the HiTH group spent almost 2 days less in a hospital bed than those managed as traditional inpatients: HiTH 55.2 h (interquartile range (IQR) 40.3-88.9) versus in hospital 96.9 h (IQR 71.2-147.2) p = 0.001. Home oxygen therapy appears to be a feasible alternative to traditional hospital oxygen therapy in selected children with acute bronchiolitis.

Comprehensive health assessment for newly arrived refugee children in Australia.

Providing appropriate and responsive care to refugees from diverse backgrounds and with unique health needs is challenging. Refugee children may present with a wide range of conditions, which may be unfamiliar to health professionals in developed countries. Additionally, refugees may experience unfamiliarity with the Australian health system and distrust of authority figures and/or medical practitioners. This article provides an overview of the priority areas in health and health management for paediatric refugee patients for paediatricians as well as other relevant health care providers caring for this group. Specific issues covered include general health assessment, infectious diseases, immunization, growth and nutrition, oral health, development and disability, mental health and child protection. Comprehensive health assessment can assist in identifying children at risk of poor health and to provide them with timely and effective care, advocacy and appropriate referral.

Funhaler spacer: improving adherence without compromising delivery.

A novel asthma spacer device, the "Funhaler", incorporates incentive toys which are isolated from the main inspiratory circuit by a valve. Here we show that its use does not compromise drug delivery. Improved adherence combined with satisfactory delivery characteristics suggest that the Funhaler may be useful for management of young asthmatics.

Evaluation of reduced solvent volume solid-phase extraction cartridges with analysis by gas chromatography-mass spectrometry for determination of 11-nor-9-carboxy-delta 9-THC in urine.

A sensitive and reliable method was developed for the identification and quantitation of 11-nor-9-carboxy-delta 9-tetrahydrocannabinol (THCCOOH) in urine using a microbed solid-phase extraction (SPE) column. Extensive method validation is presented that evaluates the recovery, linearity, precision, limit of quantitation, limit of detection, and capacity of THCCOOH in urine extracts using CLEAN SCREEN reduced solvent volume (RSV) SPE columns followed by gas chromatographic-mass spectrometric analysis. The mean recovery of THCCOOH at concentrations of 2, 3, 5, 15, 50, and 150 ng/mL was found to be 91% with coefficients of variation of 7.3% or less. Linearity of the method ranged from 1.95 to 1000 ng/mL with sensitivity at 1 ng/mL for THCCOOH. The sorbent was found to retain at least 1000 ng/mL of THCCOOH with no analyte breakthrough using the described method. Reduction in both processing times and total solvent volume is shown. The RSV SPE columns showed excellent efficiency and performance while demonstrating recoveries, cleanliness, and dynamic ranges comparable with standard SPE products.