The potential impact from glenohumeral internal rotation deficit to the knee kinematics in baseball pitchers: A case-control study.

ABSTRACT: A recent study suggested that baseball pitchers with glenohumeral internal rotation deficit (GIRD) may tend to use trunk rotation as compensation to adjust ball placement, which may lead to subsequent counter movement at the knee of the leading leg.This study aims to investigate the kinematic characteristics of the counter movements between the femur and the tibia (knee torsion), from the landing of the leading leg until the follow-through phase, during throwing between pitchers with and without GIRD at the dominant arm.This is a case-control study. Twenty-one senior high school baseball pitchers were recruited in this study. The glenohumeral internal and external rotation, hip internal and external rotation of all participants were measured. Eight pitchers without GIRD and 13 pitchers with GIRD were enrolled into the control group and experiment group, respectively. The maximal angular movement between the femur and the tibia (knee torsion) of the leading leg was measured, using The Zebris 3D (Zebris Medizintechnik GmbH, Isny, Germany) motion analysis system, in the interval from the landing until the follow-through phase during pitching a fastball to the bottom-outside corner with their dominant arm.The results showed that the maximal knee torsion of the leading leg in the experimental group (13.67 ±â€Š0.9 degrees) was significantly greater than the control group (4.25 ±â€Š1.369 degrees) (P < .05).Pitchers with GIRD had greater counter movement in the knee joint than pitchers without GIRD.

Pulmonary hemorrhage in very low-birthweight infants: risk factors and management.

BACKGROUND: Beginning 2007, the intratracheal route of epinephrine to end massive pulmonary hemorrhage (MPH) in very low-birthweight (VLBW) infants was modified at Kaohsiung Veterans General Hospital. The aim of the present study was to assess the change in outcomes for these infants, and to evaluate the risk factors of MPH. METHODS: Using the database of the Premature Baby Foundation of Taiwan, the mortality, risk factors and characteristics of VLBW infants with or without MPH were compared between 2000-2006 and 2007-2010. RESULTS: Between January 2000 and December 2010, 399 VLBW infants were admitted to Kaohsiung Veterans General Hospital. Mean birthweight (BW) was 1099.6 ± 272.7 g, and mean gestational age (GA) was 28.7 ± 2.9 weeks. The overall survival rate was 84.2%. Sixteen (4%) had MPH: 11 in the first group (2000-2006; 18.2% survival rate), and five in the second group (2007-2010; 80% survival rate; P= 0.0000002). Infants with MPH had lower mean BW (864.9 ± 301.4 g, P= 0.0004), smaller mean GA (26.1 ± 2.0 weeks, P= 0.0002), significantly lower Apgar scores at 1 and 5 min, higher severity of respiratory distress syndrome (RDS; grades 3 or 4), and greater use of surfactant than infants without MPH. They also had more intraventricular hemorrhage and higher mortality. CONCLUSIONS: Smaller GA, lower BW, lower Apgar scores at 1 and 5 min, severe RDS (grades 3 or 4), and use of surfactant place VLBW infants at greater risk of MPH. Proper prenatal care and preventing premature labor and delivery were the most important preventative factors. A quick, deep thrust of intratracheal epinephrine with a catheter may improve survival.

Negative associations between PBDE levels and thyroid hormones in cord blood.

Polybrominated diphenyl ethers (PBDEs) causing thyroidal effects have been demonstrated in in vivo and in vitro studies. PBDEs with structural similarities to thyroid hormones have increased recently, but the health effects for thyroid hormones have not been well studied. The study aimed to determine PBDE levels in cord blood and further to explore associations between prenatal PBDE exposures and thyroid hormones in cord blood. Fifty-four cord blood samples were collected after delivery. Cord-blood levels of BDE-15, 28, 47, 99, 100, 153, 154, and 183 were analyzed using a high resolution gas chromatograph with a high resolution mass spectrometer. Thyroid hormones were determined by an automated chemiluminescence analyzer. The mean, median, and standard deviation of ΣPBDEs were 4.72, 3.49, and 6.36 ng/g lipid, respectively. To adjust for confounding by maternal age, pre-pregnant BMI and gestational age, stepwise multiple linear regression was used after log(2) transformation of the exposure variables. A doubling of BDE-154 was associated with 0.043 ng/mL lower triiodothyronine (T3) values (adjusted r=-0.245, p=0.043). Likewise a doubling of BDE-153 was associated with 0.143 ng/mL lower free T3 (FT3) values and a doubling of BDE-183 with 0.084 ng/mL lower FT3 values (adjusted r=-0.487, p=0.023). In contrast, the T4 (thyroxine)/T3 ratio increased by 4.93 (adjusted r=0.277, p=0.017) when doubling BDE-100 exposure. No significant associations with BDE-47 or any other of the PBDEs was found. Our findings of an inverse relationship between BDE-153, BDE-154 or BDE-184 and thyroid hormones confirm the results of animal experiments but are in contrast to most epidemiological studies.

An early diagnosis leads to a good prognosis: a patient with maple syrup urine disease--screened by tandem mass spectrometry.

Maple syrup urine disease (MSUD), or branched-chain ketoaciduria, is an autosomal recessive disorder of branched-chain amino acid metabolism. The classic MSUD is the most severe form. The prognosis is usually guarded. The acute metabolic decompensation and neurological deterioration attribute to severe sequelae. The age of diagnosis and subsequent metabolic control are the most important determinants of long-term prognosis. We report one classic MSUD case with good outcome. The early diagnosis was achieved by tandem mass spectrometry screening. Since most MSUD patients in Taiwan are native Taiwanese, we strongly suggest routine tandem mass screening of MSUD is necessary, especially in the high-risk groups, to minimize morbidity and mortality.

Subclavian central venous catheterization in infants with body weight less than 10 kg.

Central venous access is an important aspect of medical treatment in intensive care units. We frequently require central venous catheterization (CVC) for total parenteral nutrition (TPN), intravenous antibiotics, multiple transfusions, and chemotherapy. The primary aim of this study is to demonstrate that percutaneous central venous catheterization in patients with body weight (BW) less than 10 kg can be conducted by the subclavian vein rather than the traditional femoral vein. Between January 1998 and December 2003, we performed 70 subclavian vein catheterizations (SVCs) in 46 patients with BW less than 10 kg in the pediatric intensive care unit (PICU) of a tertiary medical center. We divided patients according to their body weight into two groups, BW less than 5 kg and BW between 5 and 10 kg. We found SVC had a high total success rate, 92.9% (65/70), for the whole group. Success rate was 83.3% (15/18) for the BW less than 5 kg group and 96.2% (50/52) for the BW 5-10 kg group. In this study we found percutaneous subclavian venous catheterization in children with BW below 10 kg to be a relatively safe procedure with low risk of complication and no risk of mortality.

Isolated complete agenesis of corpus callosum.

Agenesis of corpus callosum (ACC) often accompanies other neural migration disorders and its prognosis must take these disorders and other associated abnormalities into account. Isolated complete ACC, i.e., agenesis of corpus callosum without other central nervous system anomaly, is rare. A total of six patients, aged nine months to 15 years, with isolated complete ACC diagnosed by brain image study in the past eight years of our hospital were evaluated for associated defects and prognosis. Isolated complete ACC without associated congenital heart disease (CHD) was found in four of the six patients (4/6), of whom three had normal development so far. The other two patients (2/6) were found to have associated CHD and both had poor prognosis. This result suggests that checking for any associated CHD may play an important prognostic role for isolated complete ACC patients. Therefore, it is recommendable that prenatal brain MRI and fetal echocardiography should be performed for evaluation and for genetic consultation whenever ACC is suspected.